1. Lesson 12 Objectives- ADL’s: Dressing and Toileting Demonstrate how to dress a dependent resident Demonstrate competence in assisting a resident with toileting needs.

2. Clothing An expression of each resident’s personality and individuality Each has their own style and preferences (accessories as requested) Makes them feel good inside when they look good on the outside= improves self-esteem

3. Clothing Each piece of residents clothing should be: ~inventoried according to policy ~labeled with resident's name in an inconspicuous place ~neatly folded in drawers or hung in closet ~kept clean and in good repair ~Placed in appropriate dirty linen hamper per facility procedure

4. Assisting with dressing Dress affected limb FIRST and undress it last Avoid pullover garments if the resident has an affected side or difficulty with the neck and shoulders, unless requested Understand their perception of room temp may differ from yours Simplify dressing for residents with dementia (discussed next slide)

5. Dressing a Confused Resident ~one-piece dresses for females ~limit outfits to 2 options ~Velcro instead of buttons ~stretch/elastic pants ~keep commands short ~give only one direction at a time ~ lay out in order they are to be put on by the resident

6. Change Gown Top bed linen can be used as the drape Remove soiled gown by rolling it down under linens Place clean gown on top of linens After soiled gown is removed Roll linens down under the clean gown and back over resident Watch RCP #44

7. Dressing a Dependent Resident Start with Pants-then-Shirt Dress lower and upper body of one side together to eliminate the number of times the resident is turned from side to side Maintain Privacy, keep covered/draped Watch RCP #45

8. Elimination Process of ridding the body of waste through urination and defecation Urine-a liquid waste secreted by the kidneys every 2- 8hours (AKA void) *pale yellow, clear and free of particles, blood and pus Feces (stool, bowel movement)-semisolid waste from the digestive tract passed through the anus 2-3xday to 2xweek *medium brown and free of blood or mucous, soft to formed consistency

9. Elimination Provide and properly use equipment Urinal, bedpan, fracture pan, bedside commode, or toilet Assist resident to comfortable/natural position for elimination (HOB to sitting position) *Men stand to urinate if possible (often to difficult for elderly) Check frequently for need to eliminate Provide privacy and enough time Report complaints or observations of diarrhea or constipation Encourage good nutrition, fluid intake, and exercise Wipe from cleanest to dirtiest (front to back) Promote independence Assist resident with hand washing

10. Incontinence Inability to control bowel and/or bladder function ~causes: injury, disease, infection, medications, lack of access to toilet facilities CNA must: Respond to call light immediately Check resident often for wetness/soiling Provide peri care Use incontinence briefs and check for proper fit with plastic side away from skin

11. Application of Incontinent Brief RCP #53 Ensure appropriate size brief (S, M, L, XL) Apply, preventing skin abrasions Remove soiled brief, change gloves, provide peri care, change gloves, then apply clean brief Bag soiled brief and dispose of in soiled utility room, do not leave soiled briefs or linens in resident rooms

12. Bowel & Bladder Training Program Ordered to help improve control of elimination & improve self-esteem and quality of life CNA must: -Follow elimination schedules exactly as the nurse instructs -Document success or lack of success accurately -Work cooperatively with team members “Continuity” is the key! -Be supportive and sensitive -Adequate fluid intake -Muscle strengthening exercises

13. Bowel & Bladder Training Program Continued CNA must: Explain program to resident Offer toileting before beginning long procedures, before and after meals, and at bedtime 30 minutes following fluid intake, offer trip to bathroom Praise success and attempts

14. Perineal care after toileting Ensure resident is safe to stand holding onto walker, grab bar, or with assistance from a second caregiver Resident stands with wide stance, NA wipes from front to back, using a different part of washcloth for each stroke and changing washcloth as necessary Rinse & pat dry prior to raising undergarments *If peri care is not needed, this same technique can be used to wipe with just plain toilet paper or a wet wipe

15. Urinary Catheter: Tube inserted by the nurse through the urethra into the bladder to drain urine *indwelling catheter- left in the bladder continually *in & out catheterization- done to empty bladder, but then taken out immediately after (AKA straight cath) * Texas catheter- placed on males externally “condom catheter” Texas Catheter Leg Bag

16. Urinary Catheters CNA should: a. Keep drainage bag below level of bladder b. Check tubing for kinks, leakage, secretions, & irritation c. Place tubing over leg to prevent pressure sores d. Attach bag to bed frame, not to guard rail e. Keep bag and tubing off floor f. Urinary drainage bag system when moving or transferring g. Clean catheter from meatus out, 4 inches down tubing h. Empty drainage bag and measure urine at least once per shift and document i. Use leg straps according to manufacturer’s instructions

17. Empty Urinary Drainage Bag RCP #50 Standard Precautions Be sure to place paper towel on floor beneath bag and place urinal or graduated cylinder on paper towel Detach spout and point into center of container without touching sides, unclamp to drain urine, then clamp and replace spout Empty at least Once per shift Check urine for COCA= Color, Odor, Character, Amount Document & Report unusual findings Rinse/Sanitize container per facility policy

19. Urine Specimen Collection RCP #51 1.Routine Specimen- prepare label, need a clean bedpan, urinal, bedside commode or plastic hat. Resident should not put toilet paper into specimen 2.Clean Catch/Midsteam Specimen- prepare label, need towelettes to clean around meatus, do not collect first and last part of urination for sample *Fill specimen cup at least half full

20. Urine Specimen Some specimens may be tested immediately using a dip strip to test for various issues (ie. pH level helps determine risk of infection)

21. Stool Specimen RCP # 52 Have resident inform NA when needing to have a BM Label Specimen cup appropriately Instruct not to urinate at same time otherwise specimen is contaminated 2 pairs of gloves, 2 tongue blades, collecting 2 tablespoons, from 2 different areas of the stool Give to nurse promptly so lab can be notified of specimen collection

22. CNA’s Role: a.Provide for privacy during elimination b.Respect resident’s right to confidentiality when incontinent c.Clean incontinent resident immediately to prevent skin breakdown d.Follow Standard Precautions e.Assist residents to wash their hands after elimination f.Be aware of indewelling caths when moving residents g.Never embarrass the resident if he/she is incontinent h.Observe COLOR, ODOR, CHARACTER, and AMOUNT of urine or feces. Report unusual findings before discarding/flushing

23. Lesson 12: Dressing & Toileting Review Questions 1.True or False? Affected limbs should be dressed first and undressed last. 2.True or False? Use a bath blanket to drape the resident when changing a gown. 3.What observations should the NA make about urine or feces before discarding it? 4.How often should a urinary drainage bag be emptied? 5.When assisting a resident to use a bedpan, urinal, or commode what 2 things should the NA give him or her before leaving the room?