pcc cna-2011 unit 11, cna

EliminationUnit 11

Giving the BedpanGiving Catheter CareMeasuring Intake and Output

Importance of accurate measuring and recording of intake and output

• Information helps to monitor the medical treatment of a resident’s disease (effects of a diuretic medication or progression of a condition with fluid retention)

• Intake and output measurements are used by the physician to make a diagnosis or to decide the kind and amount of medication to prescribe. Accurate measurement and recording is vital.

Methods to measure and record fluid intake• Liquids and foods that are

liquid at body temperature are included for intake measurement.• Nurse will measure other fluid

intake from sources such as IV, tube feeding.

Method’s to measure and record fluid intake

• Unit of measurement is the milliliter.(ml)• Facility will usually have a listing of the

volume of its standard mealtime food containers.

• Using this list for reference, CNA can estimate the volume of liquid consumed. Accuracy is the result of paying attention.

• CNA may need to convert measurement in ounces(oz) to milliliters(ml)

Method’s to measure and record fluid intake

• CNA may ask for assistance if unsure of how to estimate measurement or convert systems of measurement.

• Record the intake consumed at end of each meal or snack, and when bedside water glass is refilled.

• Total the amounts of fluid at the end of each shift and at the end of the 24-hour period.

Variations form the Usual Amount of Fluid Intake• Encourage fluids: goal is to

increase oral fluid intake.• Restrict fluids: 24 hour intake

is limited to a prescribed amount.

• NPO: Nothing by Mouth. Resident has no oral intake of food or fluids.

Methods to measure and record fluid output

• Fluids measured and recorded• Usually include urine and emesis• When resident is incontinent, record the

number of times incontinent

Collecting urine to measureFemale resident will void into bedpan or specipan placed under seat of toilet or commode. Measure after each voiding or urination with a graduate (measuring cup). Record measurement with each voiding or urination. Toilet tissue is not to be placed in bedpan or specipan.

Methods to measure and record fluid intake

• Male resident will urinate into urinal. Measured after each voiding or urination with a graduate (measuring cup). Record measurement with each voiding or urination.

• If resident has urinary catheter, urine will collect in a drainage bag. It is measured in graduate at the end of each shift. Special care required to prevent introducing microorganisms into drainage system.

Assisting resident with elimination

• Actions by the CNA• Understand resident’s regular toileting

habits.• Provide for privacy by closing door

and/or curtains and by covering resident.

• Use good body mechanics and lifting devices as appropriate.

• Use standard precautions while assisting the resident with urination or voiding and defection.

Assisting resident with elimination

• Make sure resident can reach toilet paper.• Provide access to call signal if CNA is not at

resident’s side. Answer call signal quickly

• Assist resident in providing for good skin care/perineal care following voiding or defecation.

• Assist resident with hand washing after voiding or defecation.

• Do not empty urinal, bedpan or flush toilet if urine or feces look unusual . Notify nurse.

Bedside Commode or toilet• Resident position

• Upright position is more familiar, usually easier for resident.

• Comfortably seated. Males often prefer to stand to urinate or void.

• A riser may be placed on the toilet seat to assist the resident to sit and rise up from the toilet.

Bedside Commode or toilet• Stay with resident as necessary

for safety. Do not restrain resident on commode or toilet.

• Time to allow resident to remain on commode or toilet-follow facility policy. Check resident in at least 10 minutes, assisting from toilet after 20 minutes unless otherwise directed by nurse.

Bedside commode or toilet

• Cover commode bucket while carrying to toilet to dispose of contents. Clean bucket before replacing.

Bedpan• Use appropriate type of bedpan

(regular or fracture pan).• Resident may use assistive devices

to move onto bedpan, otherwise follow standard procedure steps to position resident.

• Cover bedpan while carrying to toilet to dispose of contents, Clean bedpan before storing.

Urinal

• Male uses urinal if unable to leave bed to urinate.

• Follow standard procedure steps for placement.

• Clean urinal before storing or returning to resident.

Incontinence

• Consequences of incontinence• Discomfort and embarrassment

for resident.• Potential skin breakdown if

urine or feces remain in contact with skin.

Incontinence

• Resident care• Understand resident’s regular

toileting habits. Check care plan for restorative goals and activities or toileting program.

• Answer call signal promptly. Resident may be unable to wait.

• Provide for privacy

Incontinence• If resident has history of inability to

control urine or feces, check regularly for incontinence. This practice is called “check and change”

• Respect resident’s dignity by retaining positive attitude while changing clothing and/or bed linen.

• Clean skin and provide perineal care, using mild soap and water or skin-cleaning spray/wipes according to facility policy. Leave skin clean and dry.

Incontinence

• Observe for signs of skin redness or irritation. Report to nurse.

• Adult briefs or clothing protectors may be used.

• Clothing protectors or incontinence products are to be changed when wet or soiled.