2. Subacute Care Chapter 25

3. Subacute Care Care for Residents With Specific Needs Formerly cared for in Hospital Rehabilitation Complicated Respiratory Care Special Equipment

4. Rehabilitation

5. Overcoming effects of stroke or disease Traumatic Injury May be younger than general population Stay for shorter period of time

6. Mechanical Ventilator

7. Artificial Respiration May prevent immediate death and prolong life Not your responsibility – do not adjust dials or controls Meeting the residents needs

9. Important Tips Ventilator panel turned away from resident Remember even unconscious residents can hear Be sure call signal within reach Answer call signal immediately Two people frequently needed for care Weaning will require additional support Will require a tracheostomy

11. Tracheostomy

14. Surgical opening to create an artificial airway Tube inserted into the trachea Resident breathes through tube rather than nose or mouth Secured by tapes, ties or Velcro

15. CNA Responsibilities Mouth care q 2 hours Avoid getting dressings wet during care Report anything unusual Assist with tracheostomy care or suctioning Report to nurse any symptoms that indicate resident needs to be suctioned Remember Standard Precautions

17. IV

18. Needle or special catheter placed in vein Provides fluids, nutrients, or medications Tubing connected to bag which hangs from an IV poleconnected

19. CNA Responsibilities Keep IV bag above insertion site Tubing should not be kinked, tangled, or under the resident’s body Call nurse if tubing becomes disconnected Report leaking around site, swelling, redness, bleeding, pain, or burning Do not use IV arm for BP’s Record shift total on I&O Store pump properly

21. Feeding Tubes

22. Gastrostomy Tubes

23. Nasogastric (NG) Tubes Gastrostomy (G) Tubes May be connected all the time or only during feedings Resident is usually NPO Resident should not lie flat – at least 30 0 Check nose or abdominal site for irritation and report redness, rash, bleeding, or drainage Report to nurse if pump alarms or tube becomes plugged Report any nausea, fullness, diarrhea

24. Gastrointestinal Suctioning

25. Suctioning Portable or wall suction May be low to suction continuously May be high intermittently

26. CNA Responsibility Keep containers at appropriate levels Empty containers each shift or as instructed Report change in drainage – color or amount Report nausea or abdominal pain

27. Chest Tubes Hollow drainage tube inserted into chest Drains air, blood, or fluid from pleural cavity Also allows for full expansion of the lung

28. Pleural Cavity Space between the layers of the pleura Pleura is the thin membrane that covers and protects the lungs

29. Conditions requiring chest tube insertion Pneumothorax – air or gas in the pleural space Hemothorax – blood in the pleural space Left Hemothorax

30. Conditions requiring chest tube insertion Empyema – pus in the pleural space Certain types of surgery Chest trauma or injuries Right Empyema

31. A chest tube is used to remove fluid from the space between the lungs and the wall of the chest. The tube is placed between the ribs and into the space between the inner lining and the outer lining of the lung (pleural space).

34. Chest tube connected to a bottle of sterile water. Suction is sometimes attached to the system to encourage drainage. The system must be sealed so that air cannot enter the pleural cavity.