mod 9

Question 1

basic principles of collecting urine

Answer 1

• always wear PPE
• verify w nurse the correct storages and mL
• Verify specific timing reequipments

Question 2

What is needed for collecting a urine sample

Answer 2

have the required container and biohazard bag
label the container or outside of biohazard bag
label the container with
- date, time, resident name, and date of birth
after the sample is collected and placed in biohazard bin removed gloves & wash hands
take to designated area
if taken to storage area report to nurse and tell exact time which it was taken

Question 3

Urinary analysis (UA)

Answer 3

test that looks for bateria in the urine
- could mean there is a uti
other reasons:
- determining kidney function
- measuring electrolytes
- checkign drug levels
resident must be able to sit on toilet or commode to provide sample
if not nurse most perform straight catheterization

Question 4

Why should you never obtain a sample via bedpan or urinal

Answer 4

They harbor bacteria which can containment
obtain sample only by collecting urine as it directly exists by the body

Question 5

Steps for collecting UA

Answer 5

perform peri-care
can use towelettes if given in cup
- wipe 3 times (urethra to anus)
- ask resident to start then stop voiding
- when the cup is under them without touching them ask them to void again
- fill the cup as indicated by nrs (usually 50mL)
- if they are unable to start and stop, place cup under the stream of pee
- after place the lid on the container without touching the lids inside
- place in biohazard bag

Question 6

Straining for kidney stones

Answer 6

after the urine is strained then it may be left in the strainer
collect all urine, place commode under pt and remind them not to throw tp in there
after voiding and tending to needs then empty the contents of the commode hat through the strainer an into the toilet
- see if stone is passed then put into labeled container, then into biohazard bag

Question 7

fecal specimes

Answer 7

collect samples via commode hats and bedpans
try to keep from becoming contaminated w urine
male: ask to void in urinal first
place the commode under the seat back half
obtain sample through a wooden toung blade or plastic spoon
take a sample from three different areas (each end/middle)

Question 8

Special fecal specimens collection

Answer 8

for infectious diherrial illbess
special container
- unscrew the top
use the small spoon to collect stool
shake w special liquid
line outside should tell you amount of liquid needed
attach and place in biohazard
give to nurse or place in designated storage area

Question 9

occult blood “hidden” test
“stool guaiac, fecal occult blood test, hemosure, and hemoccult”

Answer 9

after resident has bowel movement obtain a small sample with small wooden stick provided with test
if none use Tounge blade
wipe the stool on one area of the hemoccult card under window A and close the flap
window turns blue it is positive for occult blood
place card in biohazard then give to nrs

Question 10

sputum specimes

Answer 10

respiratory illness a sputum specimen is required
sputum is mucous expelled from the lungs during illness
colored/thick
expel sputum into sterile container
if cannot, should tell resident to expel in container and notify cna when done

Question 11

care of paitents with tubing

Answer 11

avoid any tugging or tension on the tubing
have a slack in the tubing at all times
always check for skin irritation and if it is working properly
if it is not working properly or skin integrity changes notify the nrs

Question 12

Types of Catheters

Answer 12

straight or immediate cath
will have a opening which the urine will be dumped few hours/reg basis
straight catheters to obtain urine sampled
indwelling catheters (foley)
ballon is inflated to keep cathered from moving
inserted via urethra or lower abdomen

Question 13

what is a suprapubic catheter

Answer 13

A catheter that is inserted through an opening in the abdomen into the bladder

Question 14

CNA role in care of resident with a catheter

Answer 14

monitor for signs/symptoms of urinary tract infection
report any signs to nrs

Question 15

Cath securment

Answer 15

always have it secure to prevent pulling and tugging which is painful
cath holder is attached to residents thigh/abdomen
enough slack to ensure there is not tugging to pulling

Question 16

cleaning the cath

Answer 16

pt has a suprapubic cath, clean the tubing prior to peri-care
hold the cath w nondominant hand close to pt body
w dominant hand clean the cath w soapy washcloth in downward motion for 4 inches away from body
rineless product
if pt is not circumcised then retract the skin after
after cleaning rinsing and drying replace the foreskin
cath should be cleaned 2x daily

Question 17

Chaning the collection bag to a leg bah

Answer 17

better alternative for ambulatory residents
requires cath system to be open
greater risk for UTI
empty and record urine (write down amount in notebook)
clamp the cath just below the junction of two ports, where cath meets tubing collection bag
clean the cath and leg bag port with alcohol wipes, after join the two
offer dry washcloth under
fasten leg straps
leg bag only used when in upright positon
always change resident back to collection bag when ready to lay down

Question 18

protecting privacy of resident who use cath

Answer 18

the collection bag must be covered at all times
hung at foot of bed or under the wheelchair
place the collection bag into another bag to conceal it

Question 18

Where should the collection bag be?

Answer 18

collection bag hung on bed frame toward foot of the bed
prior to reposition removed bag from bed frame
move bag to side of bed the resident will be facing

Question 19

Collecting urine from collection bag or leg bag

Answer 19

place paper towel on floor
place container over
wipe drainage port with alcohol wipe
open and empty
once again clean drainage pot with alcohol wipe
place paper towels to place container
measure to closest 25mL, rounding up or down as needed

Question 20

When cleaning collection/leg bags, what are the solutions?

Answer 20

sometimes equal parts water/vinegar
sometimes 1 part bleach to 10 parts water
empty and clean it
supplies typically found in 2/3 drawer

Question 20

Intravenous therpay

Answer 20

continous IV therapy, always connected
before transfer iv must be next to pt
when pt has their own clothes, remove iv from pole
bag goes through first and followed by arm
place iv back on pole when done

Question 21

chronic condition- supplemental o2

Answer 21

chronic conditions: disease, inj, illness lasts for long period of time
less concentrated
used for those with chronic obstructive pulmonary disease (COPD) and emphysema
lung removed/lung cancer
1 to 6 liters per min

Question 22

Acute O2

Answer 22

short-lived new illness or injury may be unsolved
require supplemental oxygen can include:
asthma attack, allergic reactions, tramua w large blood loss
oxygen for those often highly concentrated

Question 23

CNA role in oxygen therpay

Answer 23

change over portable cylinder or concertation vice versa must verify it is working and running correct flow rate role to verify correct flow rate if not tell nrs

Question 24

Delivery routes- nasal and face mask

Answer 24

nasal cannula: deliver up to 6 liters place upward in nose and goes behind ears/head face mask: higher amounts of concentrated oxygen or meds with it metal clip on top of mask, after on resident face slightly pinch the metal nose can often be very drying, causing nosebleeds. o2 can be humified. distilled or sterile water accomplished this. if resident complains then K-Y jelly can be used

Question 25

oxygen cylinders

Answer 25

small: attached to wheelchair, can move freely 4 t 6 hrs. running at 2L/ min large: in room regulators can be conserving these deliver one puff of oxygen with every breath conventional reg: delivers a constant stream of oxygen- last longer important to check tank life.

Question 26

oxygen concentrator

Answer 26

more economical way to deliver oxygen, never needs refilling removed o2 from air then puts back in plugs into sockets 1 to 6 liters per min reg is on the front of machine tubing connected directly to machine or humidification bottle switch to portable oxygen

Question 27

Interventions to help breathing and ease anxiety

Answer 27

relaxation exercises answer call light promptly reassure you are there to help her positioning, assist to comfortable position tripod or fowlers position

Question 28

coughing and deep breathing execrises

Answer 28

help maintain lung function by expanding lung tissues and clearing it of mucus help with those of respiratory illness taught by nr, reinforced by cna remind to take several deep breaths and cough deep breaths by nose and hold 5 sec and exhale after ask to cough let them take breaks offer tissues for ay phlegma

Question 29

incentive spirometry

Answer 29

medical exercise used to maintain lung function or to increase lung function during respiratory illness asked to exhale all air from his lungs when mouthpiece is in mouth slowly breaths in, once inhaled or has reached target volume mouthpiece is removed and pt exhales take breaks, normally this is repeated 5-10 times per sitting incentive spirometry required care plan should say how many

Question 30

input and outake

Answer 30

record output: urine feces vomit notebook only use room numbers or initial for HIPPA urine: commode in front Feeces: commode in back both: front and back

Question 31

linens

Answer 31

linens: bedding that covers the matters clean linen: promote healthy skin, prevent germs, and promote comfort incontinent: 1-2 incontinent pad used incontinent pad: used to protect bed from getting soiled alternating pressure mattress or alternating pressure bad: a disposable pad mattress pads: never used on any hospital mattress changed: 1 to 2 times a week acute care: daily should be changed: soiled, wrinkled, sweating excessively

Question 32

What is the collection order of linens

Answer 32

1) bath blanket, if used by facility 2) fitted sheet 3) draw sheet- lift sheet 4) reusable incontinence pad 5) top sheet 6) blanket 7) bedspread 8) pillowcase

Question 33

Infection control- linens

Answer 33

keep linens away from body place linens on clean surface before putting linen down, flip them over do no shake out linens pillow becomes soiled/ wet should be turn out linens not used: dirty linens never go on floor, if fall: dirty linens gloves before removing linens

Question 34

body mechincas

Answer 34

release breaks and move away from wall raise bed to good working height (waist) lower rails occupied bed: only lower rail of side working on once down place to original position (low and call light, brakes)

Question 35

closed bed

Answer 35

made with all linens in place over mattress prior to admission LTC: made once the resident gets up for day mitered corners , wrinkle free, tidy bed

Question 36

open bed

Answer 36

invites resident to go lay down fanfold to side of bed when transferring from stretcher cover resident with linens pul upward on linens to make a toe peat pleat reduces risk of pressure injuries

Question 37

uncopied bed

Answer 37

pt gets out of bed may sit in wheelchair while perform the task bed must be completely changed every bath day heavily soiled/wrinkled, resident discharge

Question 38

occupied bed

Answer 38

unable to get out of bed (bed bound) asked to roll over to opposite side of process never lie on bare mattress soiled linened rolled inward clean tucked under soiled linens always have side roll up to side pt is o some facilities do not have side rails, so roll pt toward you

Question 39

what to do if a over the counter enema does not work?

Answer 39

high-volume enema are used prior to surgies/procedures bucket filled with water and castile soap contains 1,000 mL fluid inserted into rectum via a tube connected to bucket hold fluid in until a bowel movement no bowel movement may be obwel obstruction which require further treatment report to nrs: complains of pain any changes in vital or bleeding always lie on left side

Question 40

admin, transfer, discharge

Answer 40

admission: vitals, height, weight settle into room transfer; communication discharge: helping the resident pack up personal belonging and communicate

Question 41

transfer/discharge

Answer 41

pt has right to stay at their chosen facilities cannot be honored when: - facility cannot meet residents need - resident no longer needs skilled nrs services - threatening safety - cannot pay for services can be discharged for nonpayment after 30 day notice discharge must include: - why and date of discharge - where they are going - contact info for states ombudsman - info on bed hold and readmission policies copy sent to pt or power of attorney to pt

Question 42

hospital and nursing facility transfers

Answer 42

3 night qualifying and needs care continued (Medicare pays) special needs prior to going to hospital for things like pneumonia

Question 43

the medical resident

Answer 43

chronic/acute medical illness which needs to be closely monitored issues include: bowel obstruction pneumonia uncontrolled diabetes heart attack, stroke congestive hr fail chronic obstructive pulmonary disease (COPD) vital signs every 4 hr ambulation every shift - 2 hr

Question 44

postsurgical resident- inpatients

Answer 44

inpatients (stay overnight) joint replacements heart procedures bowel surgeries amputations higher risk for complications, need to be monitored surgical resident make up a large % of residents in hospitals

Question 45

what is ambulatory surgery

Answer 45

does not require overnight stay, performed on same day that they are admitted and discharged outpatients or same day surgery

Question 46

diets for post surgery

Answer 46

NPO- nothing by mouth bowel movements, pass faults, or gas before anything by mouth after directive is given clear liquid diet then onto full liquids, then soft diet, then reg diet not tolerating update the nrs

Question 47

activity for postsurgical pt

Answer 47

activity helps w strengthen her and preventing comp common comp: pneumonia, atelectasis, constipation, bowl obstruction level of activity limited: repositions every 2 hr if can: walk 1 per shift talk to nr if refuse to walk

Question 48

what is atelectasis?

Answer 48

it is a resp disorder in which gas Exhange is limited due to either alveoli collapse or fluid build up

Question 49

weight bearing stat

Answer 49

orthopedic surgery may be assigned weight- Bering stat % is given for affected leg or foot 50% weight bearing on left- only allowed to place half weight on left leg toe touch ( toes can touch floor but no weight on them) weight bearing as tolerated (WBAT)

Question 50

respiratory complications

Answer 50

immobility after surgery or caused by medical illness most often atelectasis or pneumonia complete depth breathing/ cough exercises and incentive spirometer abdominal pain, chest or bowel surgery- to lessen discomfort encourage resident to splint

Question 51

what is spilting

Answer 51

it is a process that supports the chest and abdomen during coughing and deep breathing to decrease pain. places a pillow lengthwise across the abdomen arms are place on top of pillow remind pt to bear down then do execrises

Question 52

cardaic complications

Answer 52

immobility or medical illness most common: blood clot form in legs symptoms of blood clot: pain, heat, redness in lower legs if blood clot breaks free it can travel to heart or lungs which can cause death best preventions: anticoagulant meds or ted hose

Question 53

how to prevent blood clot from immboile or bed bound pt

Answer 53

sequential stocking sleeves w blood clot backing attached connected to air pump air is pumped moving from bottom to top in sequence actions moved blood worn entire time in bed

Question 54

bandages and Non legend topical ointments

Answer 54

keep wound dry and clean some are to absorb and protect the skin allows follow nrs directive

Question 55

to change non sterile bandages

Answer 55

wash hands have supplies ready on clean surface remove old bandage, throw away open other only touching edges can apply no med ointments if skin is open do not apply any creams or ointments

Question 56

non adherent pads

Answer 56

absorbent dressing for wounds that have some drainage can absurd more than gauze surface ensure they will not stick to wound bed

Question 57

foam dressing

Answer 57

used for woumds wiht moedrate/ heavy drainage used to pressure inj

Question 58

calcium alginates

Answer 58

used for moderate/significant drainage great for venous or arterial ulcers mold to skin

Question 59

hydrogel dressings

Answer 59

wounds with limited/minimal drainage used for wounds w dead tissue offers protections ad padding for wound can be used for pressure inj

Question 60

transparent dressings

Answer 60

used for wounds with limited drainage offers flexible protection to wounds can act as second skin for skin tears and blisters