Lesson 12 Objectives- - PowerPoint Presentation

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Lesson 12 Objectives- ADL’s: Dressing and Toileting

Demonstrate how to dress a dependent resident

Demonstrate competence in assisting a resident with toileting needs.Slide2

Clothing

An expression of each resident’s personality and individuality

Each has their own style and preferences

(accessories as requested)

Makes them feel good inside when they look good on the outside= improves self-esteemSlide3

Clothing

Each piece of residents clothing should be:

~inventoried according to policy

~labeled with resident's name in an inconspicuous place

~neatly folded in drawers or hung in closet

~kept clean and in good repair

~Placed in appropriate dirty linen hamper per facility procedureSlide4

Assisting with dressing

Dress affected limb FIRST and undress it last

Avoid pullover garments if the resident has an affected side or difficulty with the neck and shoulders, unless requested

Understand their perception of room temp may differ from yours

Simplify dressing for residents with dementia (discussed next slide)

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Dressing a Confused Resident

~one-piece dresses for females

~limit outfits to 2 options

~Velcro instead of buttons

~stretch/elastic pants

~keep commands short

~give only one direction at a time

~ lay out in order they are to be put on by the residentSlide6

Change Gown

Top bed linen can be used as the drape

Remove soiled gown by rolling it down under linens

Place clean gown on top of linens After soiled gown is removed

Roll linens down under the clean gown and back over resident

Watch RCP #44Slide7

Dressing a Dependent Resident

Start with Pants-then-Shirt

Dress lower and upper body of one side together to eliminate the number of times the resident is turned from side to side

Maintain Privacy, keep covered/draped

Watch RCP #45Slide8

Elimination

Process of ridding the body of waste through urination and defecation

Urine

-a liquid waste secreted by the kidneys every 2-8hours (AKA void)

*pale yellow, clear and free of particles, blood and pus

Feces (stool, bowel movement)-

semisolid waste from the digestive tract passed through the anus 2-3xday to 2xweek

*medium brown and free of blood or mucous, soft to formed consistencySlide9

Elimination

Provide and properly use equipment

Urinal, bedpan, fracture pan, bedside commode, or toilet

Assist resident to comfortable/natural position for elimination (HOB to sitting position)

*Men stand to urinate if possible

(often to difficult for elderly)

Check frequently for need to eliminate

Provide privacy and enough time

Report complaints or observations of diarrhea or constipation

Encourage good nutrition, fluid intake, and exercise

Wipe from cleanest to dirtiest (front to back)

Promote independence

Assist resident with hand washingSlide10

Incontinence

Inability to control bowel and/or bladder function

~causes: injury, disease, infection, medications, lack of access to toilet facilities

CNA must:

Respond to call light immediately

Check resident often for wetness/soiling

Provide peri care

Use incontinence briefs and check for proper fit with plastic side away from skinSlide11

Application of Incontinent Brief RCP #53

Ensure appropriate size brief (S, M, L, XL)

Apply, preventing skin abrasions

Remove soiled brief, change gloves, provide peri care, change gloves, then apply clean brief

Bag soiled brief and dispose of in soiled utility room, do not leave soiled briefs or linens in resident roomsSlide12

Bowel & Bladder Training Program

Ordered to help improve control of elimination & improve self-esteem and quality of life

CNA must:

-Follow elimination schedules exactly as the nurse instructs

-Document success or lack of success accurately

-Work cooperatively with team members “Continuity” is the key!

-Be supportive and sensitive

-Adequate fluid intake

-Muscle strengthening exercises

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Bowel & Bladder Training ProgramContinued

CNA must:

Explain program to resident

Offer toileting before beginning long procedures, before and after meals, and at bedtime

30 minutes following fluid intake, offer trip to bathroom

Praise success and attemptsSlide14

Perineal care after toileting

Ensure resident is safe to stand holding onto walker, grab bar, or with assistance from a second caregiver

Resident stands with wide stance, NA wipes from front to back, using a different part of washcloth for each stroke and changing washcloth as necessary

Rinse & pat dry prior to raising undergarments

*If peri care is not needed, this same technique can be used to wipe with just plain toilet paper or a wet wipeSlide15

Urinary Catheter:

Tube inserted by the nurse through the urethra into the bladder to drain urine

*

indwelling catheter-

left in the bladder continually

*

in & out catheterization-

done to empty bladder, but then taken out immediately after (AKA straight cath)

*

Texas catheter-

placed on males externally “condom catheter”

Texas Catheter

Leg BagSlide16

Urinary Catheters

CNA should:

a. Keep drainage bag below level of bladder

b. Check tubing for kinks,

l

eakage,

s

ecretions, &

i

rritation

c. Place tubing over leg to prevent pressure sores

d. Attach bag to bed frame, not to guard rail

e. Keep bag and tubing off floor

f. Urinary drainage bag system when moving or transferring

g. Clean catheter from meatus out, 4 inches down tubing

h. Empty drainage bag and measure urine at least once per shift and document

i. Use leg straps according to manufacturer’s instructionsSlide17

Empty Urinary Drainage Bag RCP #50

Standard Precautions

Be sure to place paper towel on floor beneath bag and place urinal or graduated cylinder on paper towel

Detach spout and point into center of container without touching sides, unclamp to drain urine, then clamp and replace spout

Empty at least Once per shift

Check urine for COCA=

C

olor,

O

dor,

C

haracter,

A

mount

Document & Report unusual findings

Rinse/Sanitize container per facility policySlide18
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Urine Specimen Collection RCP #51

Routine Specimen- prepare label, need a clean bedpan, urinal, bedside commode or plastic hat. Resident should not put toilet paper into specimen

Clean Catch/Midsteam Specimen- prepare label, need towelettes to clean around meatus, do not collect first and last part of urination for sample

*Fill specimen cup at least half fullSlide20

Urine Specimen

Some specimens may be tested immediately using a dip strip to test for various issues (ie. pH level helps determine risk of infection)Slide21

Stool Specimen RCP # 52

Have resident inform NA when needing to have a BM

Label Specimen cup appropriately

Instruct not to urinate at same time otherwise specimen is contaminated

2

pairs of gloves,

2

tongue blades, collecting

2

tablespoons, from

2

different areas of the stool

Give to nurse promptly so lab can be notified of specimen collectionSlide22

CNA’s Role:

Provide for privacy during elimination

Respect resident’s right to confidentiality when incontinent

Clean incontinent resident immediately to prevent skin breakdown

Follow Standard Precautions

Assist residents to wash their hands after elimination

Be aware of indewelling caths when moving residents

Never embarrass the resident if he/she is incontinent

Observe COLOR, ODOR, CHARACTER, and AMOUNT of urine or feces. Report unusual findings before discarding/flushingSlide23

Lesson 12: Dressing & ToiletingReview Questions

True or False? Affected limbs should be dressed first and undressed last.

True or False? Use a bath blanket to drape the resident when changing a gown.

What observations should the NA make about urine or feces before discarding it?

How often should a urinary drainage bag be emptied?

When assisting a resident to use a bedpan, urinal, or commode what 2 things should the NA give him or her before leaving the room?