HS 2 Medical and Nursing Services Created by

HS 2 Medical and Nursing Services Created by: Dana Cashion, Spring 2016 Part 3, PP#2 Admitting, transferring, discharging patient Turning and transferring patient to wheelchair Measuring Input and Output Assisting with Urinal Catheter Care

21: 1 Admitting, Transferring, and Discharging Patients DHO pg 782 � HCW in hospital and LTC facility may have to admit, transfer, and discharge pts � Admission cause anxiety and fear for pt and family � HCW needs to be positive, courteous, and supportive to alleviate fear � Give clear instructions on what to expecthow to operate equipment and routines )

Admission � Complete required forms � Information on forms used for nursing care plans � If pt cannot answer questions, have relative or responsible person answer � Questions re: medications and allergies fall under RN scope of practice

Admission Procedures � Besides paperwork, specific procedures performed � VS � Height and weight � Routine urine specimen

Patient and Family Orientation � Instructions on how to operate call light, bed controls, television, and telephone � Visiting hours, pt lounges, religious services, mealtime, and other routines explained to pt and family � Pt and family given info pamphlet, but still verbally go over the information

Patient Transfer � Can be done for a variety of reasons-r/t change in pt condition ie. To ICU � Transfer may be at pt request, such as to a private room � Reason for transfer should be explain to pt and family (usually MD or RN) � Gather all of patient’s personal items � And consider how to transport pt to new room-pt ambulate, wheelchair, stretcher

Discharge � Physician’s order required to discharge pt � Most facilities require HCW to accompany individuals to their car, and most require individual to be in a wheelchair � Pt can leave facility against doctor’s orders. Called AMA-against medical advice

21: 2 Turning and Transferring Patients DHO pg 790 � If procedure done correctly, provides patient with optimum comfort and care � Improper moving, turning, or transferring can result in serious injury to patient � Correct body mechanics essential for either of these procedures � If you are unable to move or turn a patient by yourself, always get help � Always have proper authorization before procedure

Patient Positioning � Pt confined to bed-Pt position must be changed every 2 hours, ie 6, 8, 10, noon � Frequent turning provides exercise for muscles, stimulates circulation, prevents pressure ulcers and contractures, and provides pt comfort � You are responsible for reading DHO CH 21, procedure 21: 2 A

Transferring Pt from Bed to Wheelchair � Different ways to move a pt from bed to wheelchair � Mechanical lift transfer weak or paralyzed pt � Can also use a transfer belt to move pt � Observe proper body mechanics during transfer � Once pt moved and belt removed, observe pt for signs of distress � Read Ch 21 procedure 21: 2 F pg 803

Applying elastic stockings DHO CH 21. 13, pg 915 Ø AKA surgical hose or TED hose Ø Can be ordered to support the veins of the legs and increase circulation � Also help prevent formation of blood clots in the legs � Must be applied correctly-if too tight, they can interfere with circulation � Prevent wrinkles, smooth out sock � Top should be just below the knee � Provide toe room

Checking the elastic hose � Check hose at intervals � Look for signs of impaired circulation ◦ ◦ ◦ Abnormal skin color or temperature Swelling Report abnormalities to supervisor immediately Remove hose at least once/8 hrs Perform skin care to skin under the hose Read Procedure 21: 13 D on page 915

21: 5 Measuring and Recording Intake and Output DHO pg 849 �A large part of the body is fluid, so there must be a balance between the amount of fluid taken into the body and the amount lost from the body � Swelling or edema results from excessive fluid ie heart or kidney disease � Dehydration is excessive fluid loss ie vomiting, diarrhea, perspiration, bleeding � Either condition can result in death )

Input � Intake: fluids taken in by patient � This can be liquids such as water, tea, soups, ice cream � Can also be tube feedings, or enteral feeding for pts unable to swallow or comatose � Also can be IV fluids, such as blood or plasma � Can be irrigation fluids which are fluids placed into tubes that have been placed in the body, such as NG tube irrigation � You record only the amount of irrigation fluid that is left in the body

Output � Output: fluids eliminated by patient � Should include bowel movements (BM), both liquid and solid (feces) � Emesis=vomit � Urine-voided and drained via catheter is measured and recorded. Should be more than 30 ml/hr � Irrigation-any irrigation or suction drainage from NG tubes, hemo-vacs, chest tubes

Recording Intake and Output � Must be accurate � Measure it in graduates, container that measures in m. L/cm cubed or ounces � Recorded in 8 hr and/or 24 hr increments � Usually record in metric units � 1 m. L=1 cc=15 gtts (drops) � 5 m. L=1 tsp � 15 m. L=1 tbsp � 30 m. L=1 ounce

Basic Principles of I&Os � Various agencies can have different policies for recording I&Os � Where the I&O form is kept-BS vs chart � Who actually records the info-MA, RN, unit secretary � Patients need to understand what is intake and output-when it is considered I&O, what is considered I&O, and how to collect output=bedpan/urinal, nun’s cap

21: 7 Assisting with a Bedpan DHO 21: 7, pg 859 � Elimination of body waste is essential � Many patients sensitive about using bedpan/urinal ØProvide privacy ØMake patient comfortable ØProvide bedpan immediately when called for ØOffer bedpan frequently � Accurate observations important re: frequency, amount, and appearance of urine and stool

Terminology R/T Elimination � Urinate, micturate, or void: emptying the bladder of urine produced by the kidneys ◦ Urinal used by males ◦ Bedpan used by females (either fracture or orthopedic bedpan and standard bedpan) Defecate: discharge of waste (feces or stool) thru rectum

Standard Precautions � MUST be observed when handling urine or feces � Hands washed and gloves worn � One glove technique: used to protect the environment while assisting with bedpans ◦ Two gloves worn while handling bedpan ◦ Then remove one glove and hold in other gloved hand ◦ Ungloved hand is used to open doors, turn on faucets, raise siderails NEVER place bedpan on overbed table or bedside stand

At the end: � Rinse the bedpan thoroughly � Then disinfect bedpan � Use for only one patient � After d/c, dispose of bedpan or sterilize � Patient’s should have opportunity to wash their hands and receive perineal care afterwards � You are responsible for reading 21: 7 with procedure 21: 7 A

21: 8 Providing Catheter Care DHO pg 864 �A catheter may be inserted into the bladder if a patient cannot urinate or void � The catheter is attached to a drainage unit to collect the urine ◦ French or straight cath-inserted and removed; for sterile urine specimen ◦ Foley or indwelling or retention cath-used over an extended period of time. This catheter must be kept sterile at all times ◦ Insertion of cath is a sterile technique

Drainage Unit � Closed unit to keep microorganisms from entering catheter and prevent infection � Unit is the tubing attached to catheter and extends to the bag that collects urine � Careful observation of catheter and drainage unit is required and should be checked frequently ◦ 10 listed items to monitor on page 866

Monitoring the Catheter and Drainage Unit 1. 2. 3. 4. 5. 6. 7. Make sure the connection between catheter and drainage unit secure Tubing free from kinks and bends that stop urine flow Bag below the level of the bladder Urine is flowing freely into bag Catheter is taped, strapped, or tied to patient’s leg Bad is emptied frequently (q 8 h) Bag is not lying on the floor

Monitoring Continued 8. 9. 10. No loops of drainage tub are hanging below the bag Drainage tubing leading to the bag is above the level of the urine Pt complains of burning, pain, irritation, or tenderness in urethral area, report to supervisor immediately Careful observation of the urine drained should be made-amount, color, type, and presence of other substances should be noted

Providing Catheter Care � Urinary meatus must be kept clean and free from secretions � Catheter care provided for this purpose � Administered q 8 h � Usually provided during the bath and as a part of perineal care � Standard precautions used during procedure You are responsible for reading 21: 8 A r/t female catheter care