1. Nurse Assisting Skills
Diversified Health Occupations
Chapter 20
pg. 617-737

2. Nurse Assisting
OBJECTIVES
Upon completion of this unit, the student should be
able to…
 Admit, transfer, or discharge a patient,
demonstrating proper care of pts belongings.
 Administer personal hygiene
 Measure and record intake and output
 Assist a patient with eating, feed a patient
 Collect stool specimens
 Ostomy care
 Catheter care

3. ADMITTING, DISCHARGING, AND
TRANSFERRING A PATIENT
 This may be one of your responsibilities.
 Alleviating anxiety and fear
 Admission can cause anxiety and fear for many pts and
their families
 Even a transfer from one room to another can cause
anxiety because the individual will have to adjust to
another environment
 Essential for health care provider to create a positive first
impression
 Assistant can do much to alleviate fear by being
courteous, supportive, and kind.

4. ADMITTING, DISCHARGING, AND
TRANSFERRING A PATIENT
 Alleviating anxiety and fear
 Help patient become familiar with the unit
 Provide clear instructions on how to operate
equipment
 Explain the type of routine to expect, such as times
for meals
 Do not hurry or rush
 Allow the pt to ask questions and to express
concerns
 If you do not know the answers to specific
questions, refer to your immediate supervisor

5. ADMISSION FORMS
 Forms list the procedures that must be performed
 Will vary slightly from facility to facility
 Important for health care worker to become familiar
with required information on the form
 Much of the information on the admission form is
used as a basis for the nursing care plan
 Must be complete and accurate!
 It the pt is unable to answer the questions, a relative
or the person responsible for the pt is usually able to
provide the information

6. PROCEDURES PERFORMED
UPON ADMISSION
 Vital signs
 Height and weight measurements
 Collection of a routine urine specimen
 Protect patient’s possessions
 Make a list of clothing, valuables, and personal items
 In a hospital a family member will frequently take clothing home
 Any personal items left in a room should be noted on a list, and the list should be
signed by the pt and the assistant
 At the time of transfer or discharge, the list of items is checked to make sure all of the
belongings are returned
 If the family member does not take items home, the items should be placed in a safe
 FOLLOW CORRECT TECHNIQUE WHILE PERFORMING THESE
PROCEDURES!!

7. PROCEDURES PERFORMED
UPON ADMISSION
 Orient patient to facility
 Provide instructions on how to operate the bed, call light,
remote control for TV, etc.
 Explain visiting hours, location of lounges, smoking
regulations, availability of services, times for meals, and
other rules and regulations
 Many facilities have a pamphlet or paper listing this
information, which is given to the patient and family
members.
 FOLLOW CORRECT TECHNIQUE WHILE
PERFORMING THESE PROCEDURES!!

8. TRANSFERS
 Done for a variety of reasons
 Change in the patient’s condition
 Per patient request
 Agency policy must be followed during any transfer
 Reason for transfer should be explained to patient
and family by the appropriate personnel
 New room or unit must be ready to receive the
patient
 All personal items must be moved with patient
 Organized and efficient transfer will help prevent
fear and anxiety for the patient

9. DISCHARGE
 Doctor’s order usually required
 If an individual plans to leave a facility without
permission, report this immediately to your
supervisor
 Facilities have special policies that must be followed
when a patient leaves against medical advice (AMA)
 When an order for discharge is received, assistant
must check and pack the patient’s belongings
 Check the unit, including any drawers, closets, and
storage areas carefully to find all items

10. DISCHARGE
 Most agencies require a staff member to
accompany the individual to the car
 If a patient is transferred by ambulance, the
ambulance attendants will bring a stretcher to
the room
 Most agencies have forms or checklists that
are used during a discharge to ensure that all
procedures have been followed.

11. ADMITTING
 Obtain orders
 Prepare the room for the admission
 Greet and identify the patient
 Introduce yourself
 Ask the family to wait in the lounge or lobby
 Close the door and screen the unit
 Ask the patient to change into a gown
 Position the patient comfortably in the bed

12. ADMITTING
 Complete the admission form or checklist
 Measure and record vital signs
 Weigh and measure the patient
 Complete the clothing list and make sure patient or
family member checks the list
 Obtain a urine specimen, if ordered
 Orient the patient to the facility and explain all
routines
 Fill the water pitcher if patient is allowed to have
liquids

13. ADMITTING
 Observe all checkpoints
 Patient is comfortable and in good alignment
 S/R x 4
 bed is at lowest position
 Call light and supplies within reach
 Area is neat and clean
 When admission is complete, allow family
members to return and answer any questions
they have
 Record required information on patient’s

14. DISCHARGING
 Obtain orders
 Check with patient to determine when relatives will
arrive for discharge
 Close the door or screen the room
 Help the patient dress, if needed
 Assemble all the patient’s personal belongings
 Assemble any equipment that is given to the patient,
such as the admission kit
 Check to make sure patient has received d/c orders
and instructions from the nurse or physician

15. DISCHARGING
 Obtain the patient’s valuables if they are in a safe
 Complete a d/c checklist
 Place all patient’s belongings on a cart
 Assist the patient into a w/c
 Transport patient to exit area and help patient into
the car
 Observe all safety factors while transporting patient
 Say good-bye 

16. DISCHARGING
 Return to the unit, strip the bed, remove any
equipment and follow agency policy for
cleaning the room
 Record all required information on the
patient’s chart

17. WORDS TO THE WISE!!!
 TALK WITH YOUR PATIENTS AT ALL
TIMES
 WATCH WHAT YOU SAY!!
 UNCONSCIOUS AND SEMI-CONSCIOUS
PATIENTS MAY BE ABLE TO HEAR
YOU
 ALWAYS BE KIND!!!!!!!!!!

18. Positioning, Turning, Moving, and
Transferring Patients
 ALIGNMENT “positioning body parts in
relation to each other in order to maintain
correct body posture”
 PREVENTS
 Fatigue
 Pressure ulcers (decubitus ulcers)
 Contractures
 FOOT DROP

19. Decubitus Ulcers
STAGE I STAGE II
STAGE III STAGE IV

20. PREVENTION
 PROVIDING GOOD SKIN CARE
 PROMPT CLEANING OF URINE AND FECES FROM
SKIN
 MASSAGING IN A CIRCULAR MOTION AROUND A
REDDENED AREA
 FREQUENT TURNING
 POSITIONING TO AVOID PRESSURE ON IRRITATED
AREAS
 KEEPING LINEN CLEAN, DRY, AND WRINKLE FREE
 APPLYING PROTECTORS TO BONY PROMINENCES
(HEELS & ELBOWS)
 EGG CRATE, ALTERNATING PRESSURE
MATTRESSES OR WATER/GEL FILLED MATTRESSES

21. TURNING
 AT LEAST q 2 hr IF PERMITTED BY MD
 PROVIDES EXERCISE FOR MUSCLES
 STIMULATES CIRCULATION
 PREVENTS DECUBITUS ULCERS AND
CONTRACTURES
 PROVIDES COMFORT TO PATIENT

22. DANGLING
 FOR PATIENTS WHO HAVE BEEN
CONFINED TO THE BED FOR A PERIOD
OF TIME
 DONE PRIOR TO PATIENT BEING
TRANSFERRED FROM THE BED
 SITTING WITH THE LEGS HANGING
DOWN OVER THE SIDE OF THE BED
 PULSE CHECKED AT LEAST 3 TIMES
DURING THIS PROCEDURE!!!

23. DANGLING
 PULSE CHECKED
 BEFORE—used as control, or resting rate
 DURING—immediately after positioning the patient in the
dangling position
 AFTER—returning the patient to the supine position
 ALSO NOTE RESPIRATIONS, BALANCE, COLOR,
PERSPIRATION, COLOR, OTHER CHARACTERISTICS
 RETURN PATIENT TO SUPINE POSITION
IMMEDIATELY IF DANGLING IS NOT TOLERATED!!
 FOLLOW PROPER CHARTING AND NOTIFICATION
TO SUPERVISOR

24. TRANSFERS
 BED TO WHEELCHAIR OR CHAIR
 WHEELCHAIR OR CHAIR TO BED
 BED TO STRETCHER
 MECHANICAL LIFT
 NEVER TRANSFER WITHOUT PROPER
AUTHORIZATION
 OBSERVE PATIENT CLOSELY FOR CHANGES
IN PULSE RATE, RESPIRATIONS, AND COLOR,
DIZZINESS, INCREASED PERSPIRATION, OR
DISCOMFORT

25. ADMINISTERING PERSONAL
HYGIENE
 Usually includes the bath, back care, perineal care,
oral hygiene, hair care, nail care, and shaving when
necessary.
 Must be sensitive to the patient’s needs and respect
the patient’s right to privacy while personal care is
administered.
 Reasons for providing personal hygiene
 Promotes good habits of personal hygiene
 Provides comfort and stimulates circulation
 Provides health care worker an opportunity to develop a
good and caring relationship with the patient

26. BATHS
 Type of bath depends on the patient’s condition and
ability to help.
 Complete bed bath (CBB)
 Health assistant bathes all parts of the body; which
includes oral hygiene
 Partial bed bath (PB)
 Health assistant bathes some parts of the body and also
gathers supplies needed by the patient
 Tub bath or shower
 Assistant helps by providing towels and supplies,
preparing tub or shower area

27. ORAL HYGIENE
 Refers to the care of the mouth and teeth
 Should be done at least 3 times a day and more often
if patient’s condition requires frequent oral care
 PURPOSES
 Prevents disease, caries, and halitosis.
 Stimulates appetite and provides comfort
 ROUTINE ORAL HYGIENE
 Refers to regular tooth brushing and flossing
 Patient can often do self care, but assistant can help when
needed

28. ORAL HYGIENE
 Denture care
 Many patients sensitive about dentures
 Assistant must provide privacy and reassure the patient
 Extreme care must be taken while handling dentures
 NPO Patients
 Special oral hygiene
 Care provided to unconscious or semiconscious patient
 Care must be taken to clean all parts of the mouth
 Special supplies may be used for this procedure

29. HAIR CARE
 Important aspect of personal care that is often
neglected
 Brushing will stimulate circulation to scalp
and help prevent scalp disease
 Shampooing must be approved by the doctor
 Various types of dry or fluid shampoos are
available for pts confined to bed
 Special devices are available for use while giving
a shampoo to a pt confined to bed

30. NAIL CARE
 Should be done as part of daily hygiene and
patient care
 Often neglected area in personal care of the pt
 Nails harbor dirt and can lead to infection and
disease
 Never cut the toenails!

31. SHAVING
 Normal daily routine for most men
 Important to provide when pt unable to shave
 Both regular and electric razors may be used
 Correct technique must be used to prevent injury to
patient
 Females usually appreciate shaving of legs and
underarms
 BE SURE YOU HAVE SPECIFIC ORDERS FROM
DOCTOR OR IMMEDIATE SUPERVISOR

32. BED BATHS
 As with any procedure—obtain proper authorization,
assemble equipment, knock, introduce yourself,
identify the patient, screen the unit, eliminate drafts,
adjust the thermostat, wash hands (you will need
gloves for part of a complete bed bath), lock wheels
on bed, & elevate bed to proper level
 As you bathe patient, take special care to expose
ONLY the area of the body you are washing at the
time
 Keep patient warm and covered

33. BED BATHS
 Lower side rail on side you are working
 Replace top linen with bed blanket
 Provide oral hygiene
 Shave male patient or after face is washed
 Fill basin 2/3 full with warm, not hot water
(105°-110°)

34. BED BATHS
 Help patient move to side of bed nearest you
 Remove bedclothes keeping patient covered
with bath blanket
 Place towel over upper edge of bath blanket
 With washcloth, form mitten around hand,
tucking in edges (see figure 20-41, page 668)

35. BED BATHS
 Wet washcloth, squeezing out extra water
 Wash patient’s eyes, starting at inner area,
moving to outside
 Use different part of cloth for other eye
 Rinse cloth
 Wash face, neck, and ears, using soap on face
if patient desires
 Rinse and pat dry

36. BED BATHS
 Towel lengthwise under arm on ***far side
 Hand and nails in basin
 Wash, rinse, and pat arm dry from axilla to
hand
 Nail care

37. BED BATHS
 Bath towel over chest
 Fold bath blanket down from under towel
 Wash, rinse, and dry the chest and breasts
 Pay particular attention to area under female’s
breasts
 Dry thoroughly—apply lotion as desired

38. BED BATHS
 Turn towel lengthwise to cover chest and
abdomen
 Fold bath blanket down to pubic area
 Wash, rinse, and dry abdomen
 Replace bath blanket
 Remove towel

39. BED BATHS
 Fold bath blanket to expose patient’s far leg
 Place towel lengthwise under leg and foot
 Place foot in basin by flexing the knee
 Wash and rinse leg and foot
 Remove basin
 Dry leg and foot
 Repeat for other leg

40. BED BATHS
 Provide nail care as needed
 NEVER cut toenails
 File straight across
 Apply lotion to feet
 Observe for any color changes or irritated
areas that may signify problems

41. BED BATHS
 ELEVATE SIDERAIL
 CHANGE WATER IN BASIN
 ALWAYS CHANGE WATER AT THIS
TIME
 WATER MAY BE CHANGED AT OTHER
TIMES IF IT BECOMES TOO COOL,
DIRTY, OR SOAPY

42. BED BATHS
 Lower siderail
 Turn patient onto side or prone
 Place towel lengthwise on the bed along patient’s
back
 Wash, rinse, dry entire back thoroughly with towel
 Observe for changes that may signify problems,
especially bony areas
 Give backrub

43. BACK RUBS
 RUB SMALL AMOUNT OF LOTION INTO HANDS TO WARM
 A.—REPEAT 4 TIMES
 B.—REPEAT 4 TIMES
 C.—REPEAT 1 TIME
 D. –USE FIRST MOTION FOR 3-5 MINUTES
 E. –REPEAT FOR 1-2 MINUTES (RELAXATION AFTER STIMULATION)

44. BED BATHS
 Turn patient onto back
 Keep patient draped with bath blanket
 If patient can wash perineal area, place basin
with water, soap, washcloth, towel, and call
signal within easy reach
 Raise siderail and wait outside for patient to
complete procedure

45. BED BATHS
 STRAIGHTEN BED LINEN
 CHANGE GOWN AS NEEDED

46. BED BATHS
 If patient cannot wash perineal area:
 Put on gloves
 Drape and position the female patient in
dorsal recumbent position, male patient in
horizontal recumbent position
 Towel or disposable underpad under patient

47. PERINEAL CARE--FEMALE
 Always wash from front to back (or rectal
area)
 Separate the labia, or lips
 Cleanse area thoroughly with front to back
motion
 Use clean area of washcloth or rinse cloth
between each wipe
 Wash rectal area

48. PERINEAL CARE--MALE
 Cleanse the tip of penis using a circular motion
starting at urinary meatus working outward
 Cleanse penis from top to bottom
 If not circumcised, gently draw the foreskin back to
wash the area
 After rinsing and drying the area, gently return
foreskin to normal position
 Wash scrotum and scrotal area
 Turn male patient on his side to wash rectal area

49. BED BATHS
 When perineal area is rinsed, clean, and dry,
reposition patient on his/her back
 Remove towel or underpad
 Remove gloves
 Wash hands
 Provide clean bedclothes
 Provide hair care
 Make bed—occupied bed

50. BED BATHS
 Observe all checkpoints
 Clean and replace all equipment
 Proper charting procedures

51. TUB BATHS OR SHOWERS
 MAKE SURE THE TIME IS APPROPRIATE FOR
A SHOWER OR BATH
 TAKE SUPPLIES TO BATH OR SHOWER AREA
 TUBS SHOULD BE CLEANED BEFORE AND
AFTER USE
 NON SKID STRIPS OR RUBBER MAT IN TUB
OR SHOWER
 FILL TUB ½ FULL OF WARM WATER (105°)
OR ADJUST SHOWER TEMPERATURE

52. TUB BATHS OR SHOWERS
 ASSIST PATIENT WITH ROBE AND
SLIPPERS
 ASSIST PATIENT TO TUB/SHOWER
AREA USING WHEELCHAIR AS
NEEDED
 IF NECESSARY, OR IN ACCORDANCE
WITH FACILITY POLICY, REMAIN WITH
PATIENT OR INSTRUCT PATIENT ON
USE OF EMERGENCY CALL LIGHT

53. TUB BATHS OR SHOWERS
 CHECK ON PATIENT FREQUENTLY
 IF PATIENT SHOWS SIGNS OF WEAKNESS OR
DIZZINESS, USE CALL BUTTON TO GET HELP
 ASSIST TO WHEELCHAIR/CHAIR FROM
SHOWER
 EMPTY TUB
 KEEP PATIENT COVERED WITH TOWEL OR
BATH BLANKET TO PREVENT CHILLING

54. TUB BATHS OR SHOWERS
 HELP AS NEEDED AFTER TUB OR
SHOWER
 HELP WITH CLEAN BED CLOTHES
 ADMINISTER BACK RUB, HAIR, OR
NAIL CARE
 OBSERVE ALL CHECKPOINTS BEFORE
LEAVING PATIENT

55. TUB BATHS OR SHOWERS
 REPLACE ALL EQUIPMENT AND
SUPPLIES
 CLEAN BATH/SHOWER AREA USING
GLOVES
 WASH HANDS
 CHART ACCORDING TO POLICY

56. FEEDING A PATIENT
 Good nutrition is an important part of patient’s
treatment
 Important to make mealtimes as pleasant as possible
 Mealtimes are social times
 Most people prefer to eat with others
 People who eat alone often have poor appetites and poor
nutrition
 In LTCF, patients are encouraged to eat in the dining
room and interact socially with others
 If patient is confined to bed—important to talk while
serving or feeding

57. FEEDING A PATIENT--Preparation
 Patient should be ready to eat when tray arrives
 Offer bedpan/urinal or assist to bathroom
 Clear room of offensive odors
 Allow patient to wash hands & face
 Provide oral hygiene
 Position patient comfortably, in sitting position, if
able
 Clear overbed table & position it for meal tray
 Remove objects such as emesis basin & urinal from
patient’s view

58. FEEDING A PATIENT
 If patient’s tray is delayed due to tests, etc., explain
this to patient
 Check food tray carefully before serving
 Check patient’s name, room number, & type of diet
 Note anything that seems out of place, such as:
 Salt shaker on low salt diet
 Sugar on diabetic diet
 Inform supervisor of any problems
 Never add any food to tray without checking diet
order

59. FEEDING A PATIENT
 ALWAYS allow patient to feed him/herself if
possible
 Assist by cutting meat, opening milk cartons,
buttering bread
 If patient is blind or visually impaired;
 Tell patient what food is on plate by comparing it to clock
face
 Ex: Swiss steak at 12; peas and carrots at 4, mashed
potatoes at 9
 Make sure all utensils are conveniently placed
 Position towel or napkin under the patient’s chin

60. FEEDING A PATIENT
 Test temperature of hot foods before feeding
patient
 Place small amount on your wrist (NOT the
patient’s!!) to check temperature
 NEVER blow on hot food to cool it!!!!

61. PRINCIPLES OF FEEDING A
PATIENT
 Alternate the foods by giving sips of liquids
between solid foods, but don’t mix foods
 Use straws for liquids whenever possible
 Do not use straws if patient has dysphagia or
difficulty in swallowing
 Straws can force liquids down the throat faster
and cause choking
 “Thick-It” solidifies liquids slightly to make
easier to swallow, but must be ordered by MD or
dietician

62. FEEDING A PATIENT
 Hold spoon or fork at right angles to patient’s
mouth so you are feeding them from the tip
 Place small amounts on the spoon—1/3 to ½
full
 Tell the patient what s/he is eating
 Encourage the patient to eat as much as
possible

63. FEEDING A PATIENT
 Provide relaxed, unhurried atmosphere
 Allow patient sufficient time to chew food
 Observe how much patient eats
 Keep record of nutritional intake
 If patient does not like a certain food, check
with supervisor to see if substitutions can be
made
 Record the intake if patient is on I&O

64. FEEDING A PATIENT
 Always be alert to signs of choking while
feeding a patient
 Make every effort to prevent choking
 Feed small quantities
 Allow patient time to chew and swallow
 Provide liquids to keep the mouth moist and
make chewing and swallowing easier

65. FEEDING A PATIENT
 If patient has had a stroke, one side of mouth might
be affected
 As you feed the patient, direct the food to unaffected
side
 Watch patient’s throat to check swallowing
 Watch for food that may be lodged in the affected
side of the mouth
 If patient chokes, be prepared to proved abdominal
thrusts or Heimlich maneuver

66. FEEDING A PATIENT
 Allow patient to hold bread or help to extent the
patient is able
 Use towel or napkin to wipe mouth as necessary
 Be alert at all times to signs of dysphagia and or
choking
 When meal is complete, allow patient to wash hands
and face and provide oral hygiene
 Note amount of food eaten & record I&O

67. BEDPANS/URINALS
 ELIMINATION
 TERMINOLOGY
 URINATE, MICTURATE, VOID
 DEFECATE, BOWEL
MOVEMENTS (BM)

68. INTAKE AND OUTPUT
 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
 Fluid balance may be abnormal in certain pts
 Heart or kidney disease
 Loss of fluid through diarrhea, vomiting, diarrhea,
excessive perspiration, or bleeding
 Swelling or edema occurs when excessive fluid is
retained

69. INTAKE AND OUTPUT
 Dehydration occurs if excessive fluid is lost
 Edema or dehydration can lead to death if not
treated
 I and O record used to record all fluids taken
in and discharged from the body
 Forms vary but most contain separate sections
for intake and output

70. INTAKE
 Oral
 Tube feeding or enteral feedings
 IV
 Irrigation

71. OUTPUT
 BM
 Emesis
 Urine
 Irrigation

72. INPUT AND OUTPUT
 Records must be accurate
 Care must be taken when adding or totaling
the columns
 Totals are calculated for 8 hour and 24 hours
periods
 Careful instruction must be given to patients
AND their families on I&O’s

73. Procedure for recording I&O
 Use a blue or black pen
 Find the correct time line and column to record the
information
 Note the number of cc’s or ml’s for standard
containers such as coffee cup, glass, and other
containers at the top of the chart
 Recheck all entries for accuracy
 Enter observations about colors, types, solutions
used, and other information in the remarks column

74. Procedure for recording I&O
 After all the information for an 8-hour time period is
recorded, total each column separately to calculate
the 8-hour total
 When all 8-hour time periods have been totaled, add
the three 8-hour totals together for each separate
column
 On some charts, all 24-hour totals for intake are
added together for a 24-hour intake total, and all 24-
hour totals for output are added together for a 24-
hour output total

75. Procedure for recording I&O
 If you make an error
 Draw one line through the error
 Initial, and record the correct information
 Do a final check of the I & O
 Make sure all entries are correct
 Make sure comments are noted in comment
section
 Make sure all additions are accurate and legible

76. CATHETER CARE
 Provided to keep urinary meatus clean and
free of secretions
 Helps prevent bladder and kidney infections
 Done AT LEAST once every 8 hours
 Careful observation of urine
 Amount, color, presence of other substances
 Report unusual observations immediately

77. CATHETER CARE
 Obtain proper authorization
 Knock, pause, introduce self, identify patient,
explain procedure, provide privacy
 Safety points & standard precautions
 Female patient in dorsal recumbent position
 Male patient in horizontal recumbent position
 Drape patient to expose only perineal area
 Sterile applicator moistened with antiseptic solution
or soap and water

78. CATHETER CARE--FEMALE
 Gently separate labia or lips to expose urinary
meatus
 Wipe from front to back with sterile
applicator
 Place used applicator in plastic waste bag
 Use clean, sterile applicator each time, and
continue to wipe from front to back until area
is clean

79. CATHETER CARE--MALE
 Gently grasp penis and draw foreskin back
 Use circular motion to clean around meatus
 Use sterile applicator to wipe from meatus down the
shaft
 Place used applicator in plastic waste bag
 Use clean sterile applicator each time, and continue
to wipe from meatus down shaft until area clean
 After the area is clean, gently return the foreskin to
its normal position

80. CATHETER CARE
 Use sterile applicator to clean catheter from
meatus down about 4 inches
 Take care not to pull on catheter
 Place used applicator in plastic waste bag
 Use clean sterile applicator and repeat until
clean
 Observe area carefully for any signs of
irritation, abnormal discharges, or crusting

81. CATHETER CARE
 Reposition patient comfortably in correct
alignment
 Check all points on catheter and urinary
drainage unit
 Always check patient for safety and comfort
before leaving
 Record and/or report all required information

82. OSTOMY CARE
 OBJECTIVES
 DEFINE OSTOMY
 DIFFERENTIATE BETWEEN A
URETEROSTOMY, ILEOSTOMY, COLOSTOMY
 LIST BASIC PRINCIPLES FOR OSTOMY CARE
 IDENTIFY UNIVERSAL PRECAUTIONS
OBSERVED DURING OSTOMY CARE

83. OSTOMY CARE
 Ostomy
 Surgical procedure in which an opening, called a
stoma, is created in the abdominal wall
 Allows wastes such as urine or stool (feces) to be
expelled through the opening
 Most often done due to tumors/cancers in urinary
bladder or intestine
 Birth defects, ulcerative colitis, bowel obstruction,
injuries
 Permanent or temporary

84. TYPES OF OSTOMIES
 Ureterostomy
 Opening into one of the ureters
 Ureter is brought to the surface of abdomen to drain urine
 Ileostomy
 Opening in ileum (small intestine), with loop brought to
abdomen
 Entire large intestine is bypassed
 Stool expelled—liquid and frequent
 Contains digestive enzymes that irritate skin

85. TYPES OF OSTOMIES
 Colostomy
 Opening into large intestine or colon
 Different kinds of colostomies depending on the area of
large intestine involved
 Stool expelled through an ascending colostomy is usually
more liquid
 Transverse or descending colostomy more solid and
formed
 Sigmoid colostomy is similar to normal stool
 Digestive products have moved through most of the
intestine
 Water and other substances have been reabsorbed

86. OSTOMY CARE
 Bags or pouches to collect urine or stool
 Held in place by belt or adhesive seal
 Problems include leakage, odor, irritation of skin
surrounding stoma
 Pouch must be emptied frequently
 Good stoma and skin care essential since these areas
are irritated by the urine or stool drainage
 Skin barriers

87. OSTOMY CARE
 New colostomies are cared for by RNs
 “older” ostomies may be cared for by trained
health care assistants
 Know facility policy and legal responsibilities
 Eventual self care of ostomy

88. OSTOMY CARE-Pyschological
 Loss of self worth and dignity
 Patient feels different even though clothes cover bag
 Sometimes difficulty maintaining normal sex life
 Anger, anxiety, depression, fear, hopelessness
(especially with CA diagnosis)
 Allow expression of feelings, verbalize fears
 Understanding
 Support groups

89. OSTOMY CARE--Observations
 Stoma is mucous membrane-no nerve endings
 Bright to dark red with wet appearance
 Rubbing or pressure can cause bleeding
 Report any abnormal appearance
 Blue to black color indicates interference with
blood supply
 Pale or pink color can indicate low hemoglobin
 Dry or dull appearance signifies dehydration

90. OSTOMY CARE-Observations
 Profuse bleeding, ulceration or cuts, or
formation of crystals on the stoma indicate
problems
 Discharge in bag should be observed
 Note amount, color, type (liquid, semi-formed,
formed)
 REPORT and RECORD anything unusual

91. OSTOMY CARE
 Standard precautions
 Gloves, wash hands often, eye protection
 Discard pouch in biohazard bag
 If bedpan is used, it must be cleaned and
disinfected
 Any areas contaminated with urine or stool
must be cleaned with disinfectant

92. OSTOMY CARE
 Obtain proper authorization
 Knock, pause, introduce yourself, identify
patient, explain the procedure, provide
privacy
 Observe all safety points regarding body
mechanics, siderails, height of bed, and
patient safety
 Observe standard precautions

93. OSTOMY CARE
 Cover the patient with a bath blanket
 Place bed protector or underpad under the
patient’s hips on the side of the stoma
 Fill basin with water (105-110°F)
 Place the bedpan and plastic waste bag within
easy reach and put on gloves

94. OSTOMY CARE
 Open belt and carefully remove ostomy bag
 Be gentle when peeling bag away from stoma
 Note amount, color, and type of drainage in
the bag
 Place bag in bedpan or biohazard bag (if
ostomy bag is disposable)

95. OSTOMY CARE
 If bag is reusable
 Drain the fecal material (or urine) by placing the clamp
end of the bag over a bedpan
 Release the clamp and allow the fecal material to empty
into the bedpan
 Wash the inside of the bag with soap and water and allow
it to dry before reapplying the bag
 Most people use a second bag while the first is drying
 Use toilet tissue to gently wipe around the stoma to
remove feces or drainage

96. OSTOMY CARE
 Look at the stoma and surrounding skin carefully
 Check for irritated areas, bleeding, edema or swelling, or
discharge
 Report unusual observations
 Wash ostomy area gently with soap and water, using
a circular motion, working from the stoma outward
 Rinse entire area well to remove any soapy residue
and dry the area gently
 Use measuring chart to determine the correct size
barrier wafer

97. OSTOMY CARE
 If the wafer is not self-adhesive
 Apply adhesive stoma paste to the skin around
the stoma
 Allow paste to dry if necessary
 Peel the paper backing from the wafer
 Position the wafer, adhesive side down, over the
adhesive paste
 Position the belt around the patient

98. OSTOMY CARE
 Place a clean ostomy bag in place over the wafer and seal bag
tightly to wafer to prevent leakage
 If the pouch has a drainage area, make sure the clip or clamp
is secure
 Remove underpad
 Reposition patient comfortably in correct alignment
 Check patient for comfort and safety before leaving
 Observe standard precautions while discarding the used
ostomy bag, drainage, and other contaminated equipment
 REPORT AND RECORD

99. URINE SPECIMENS
 SPECIMEN USUALLY COLLECTED
FROM FIRST URINE VOIDED IN AM
 URINE IS MORE CONCENTRATED
 MORE SHOW MORE ABNORMALITIES
 USUALLY HAS ACID pH, WHICH HELPS
PRESERVED CELL PRESENT
 IF TEST FOR GLUCOSE AND ACETONE,
SPECIMEN MUST BE FRESH AND
COLLECTED JUST BEFORE TESTING

100. URINE SPECIMENS
 MAY BE COLLECTED IN BEDPAN/URINAL OR
SPECIAL URINE COLLECTOR AND POURED
INTO SPECIMEN CONTAINER
 MAY VOID DIRECTLY INTO CONTAINER
 USUALLY 120cc SUFFICIENT FOR TESTING
 PLACE IN BIOHAZARD BAG TO SEND TO LAB
 REFRIGERATE UNTIL TESTING

101. URINE SPECIMENS
 CLEAN CATCH OR MIDSTREAM
 SPECIAL METHOD OF OBTAINING URINE
SPECIMEN FREE FROM CONTAMINATION
 STERILE URINE SPECIMEN
 CATHETERIZATION REQUIRED

102. URINE SPECIMENS
 24 HOUR SPECIMEN
 USED FOR KIDNEY FUNCTION & FOR
COMPONENTS SUCH AS PROTEIN, CREATININE,
UROBILINOGEN, HORMONES, CALCIUM
 PT VOIDS, URINE DISCARDED-TIME NOTED
BEGINNING 24 HOUR PERIOD
 ALL URINE VOIDED IN NEXT 24 HOURS SAVED
 LAST URINE VOIDED AT END OF 24 HOUR PERIOD
SAVED FOR FINAL COLLECTION

103. STOOL SPECIMENS
 Specimen of feces or stool examined by lab
personnel
 Usually done for ova and parasites (O&P)—eggs
and worms!!
 Specimen must be kept warm at body temperature
 Should be tested within 30 minutes for accurate
results
 Can be examined for presence of fats,
microorganisms, and other abnormal substances or
OCCULT BLOOD
 Special stool specimen container

104. STOOL SPECIMENS-Hemoccult
 Blood from intestinal tract in stool—occult (hidden)
blood
 Test requires very small amount of stool
 Special card with chemical
 Uses developing solution
 Color change indicates positive results=presence of
blood
 No requirements for immediate testing or special
temperature

105. PRACTICE & CHECK OFF
 PCA REQUIREMENTS!!!