Download How to clean the skin around suprapubic

NUR 121 L
Standard Precautions For all Patient Care
Handwashing is not required in:
 Talking to patient.
 Adjusting IV fluid rate or non-invasive equipment.
Handwashing is required to the following procedures:
 Examining pt. without touching blood, body fluids, mucuous membrane.
 Examining pt. including contact with blood, body fluids, mucous membrane.
 Drawing blood.
 Inserting Venous Access.
 Suctioning.
 Inserting face or body catheters.
 Handling soiled waste, linen, other materials.
 Intubation
 Inserting arterial access.
 Endoscopy.
 Operations and other procedures which produce which produce which produce
extensive splattering of blood or body fluids.
Gloving is required to the following procedures:
 Examining pt. including contact with blood, body
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fluids, mucous membrane.
Drawing blood.
Inserting Venous Access.
Suctioning.
Inserting face or body catheters.
Handling soiled waste, linen, other materials.
Inserting arterial access.
Endoscopy.
Operative and other procedures which produce which
produce which produce extensive splattering of blood
or body fluids.
Gowning, mask, eyewear is required to the following
procedures:
 Use gown, mask, eyewear if bloody body fluid splattering is
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likely.
Use gown, mask, eyewear only if waste or linen are
extremely contaminated and splattering is likely.
Suctioning.
Inserting face or body catheters.
Handling soiled waste, linen, other materials.
Inserting arterial access.
Endoscopy.
Operative and other procedures which produce which
produce which produce extensive splattering of blood or
body fluids.
Exiting Client’s Room Utilizing Standard precautions
 Remove gown by first untying string at the waist.
 Remove first glove by pulling it off so glove turns inside
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out. Place rolled-up glove in palm of second hand and
remove second glove.
Untie gown at neck and take off gown by pulling down
from shoulders.
Turn gown inside out as it is being pulled off.
Dispose of gown in linen hamper/ for disposable gown
place dirty gown in garbage bag.
Remove protective eyewear , if worn and mask.
Wash hands in room or use antiseptic gel. After exiting
room, repeat hand hygiene.
Dispose of all soiled equipment or contaminated material
in appropriate receptacle.
Clinical Alert
Disposal precautions
Secretions
 Client should be instructed to expectorate into tissue held close
to mouth. Suction catheters and gloves should be disposed of in
impervious, sealed bags.
Excrement
 Excrement should be disposed of by flushing into sewage
system. Strict attention should be paid to careful hand hygiene;
disease can be spread by oral-fecal route.
Blood
 Needles and syringes should be disposable. Used needles should
not be recapped. They should be place in a puncture –resistant
container that is prominently labeled
 “ isolation” . Specimens should be labeled “ blood precaution”.
HIV-HBV Clinical Alert
Sample protocol for accidental contact with blood or
bloody fluids.
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Any percutaneous or mucocutaneous exposure should receive immediate
first aid.
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Apply immediate first aid to site.
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Needle stick or puncture wound: Scrub area vigorously with soap and water
for 5 minutes.
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Oral mucous membrane exposure. Rinse area several times with water.
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Ocular exposure: irrigate immediately with water or normal saline solution.
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Human Bite: Cleanse wound with povidone iodine and sterile water.
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Report unusual occurrence to the charge nurse or supervisor.
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Complete an unusual occurrence form and follow-reporting requirements
mandated by OSHA.
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Follow facility protocol for emergency care, If risk assessment indicates,
follow PEP Protocol.
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Document circumstances of exposure , post exposure management,
counseling and follow-up procedures in health care worker’s confidential
medical file.
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The CDC has now approved rapid result tests for HIV. Most people exposed
to HIV developed antibodies within 2-8 week, but two minutes will know the
results from one of thsese new diagnostics tests.
Basic and Expanded HIV Exposure Prophylaxis
Regimens
 Basic – Occupational HIV exposures for which there is a
recognized transmission risk.
Drug Regimen: 4 weeks (28 days) of both Zidovudine 600
mg every day in 2 or 3 divided doses and Lamivudine 150
mg twice a day. Now available combined as Comvibar single
tablet given 2x daily.
 Expanded – Occupational HIV exposures that pose an
increased for for transmission (e.g. larger volume of blood
and/or higher virus titer in blood.
Drug Regimen: Basic regiment plus either Indinavir 800 mg
every 8 hours on an empty stomach or Nelfinavir 750 mg
three times a day with meals or snacks.
Preparing for Isolation
Equipment
 Specific equipment depends on isolation precaution
system used.
 Soap and running water.
 Isolation cart containing mask, gowns, plastic bags,
isolation tape.
 Linen hamper and trash can, when needed.
 Paper towels
 Door card indicating precautions.
Procedure
 Check physician’s order for isolation.
 Obtain isolation cart from central supply, if needed.
 Check that all necessary equipment to carry out the
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isolation order is available.
Place isolation card/signage on the client’s door.
Ensure that linen hamper and trash cans are available,
if needed.
Explain purpose of isolation to client and family.
Instruct family in procedures required.
Wash hands with antimicrobial soap or use alcoholbased gel before and after entering isolation room.
Clinical Alert
 Respiratory N95 or HEPA (High –Efficiency particulate Air)
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masks are recommended for suspected or confirmed
multidrug-resident tuberculosis.
Masks are fitted to worker.
Wear mask until it becomes difficult to breathe. This
indicates mask is clogged.
When not in use, store mask in zip-lock bag in safe area.
Masks are expensive and can be used repeatedly until it is
difficult to breath though them.
Some isolation gowns do not tie at the neck, they slip over
the head. When removing this gown, pull shoulders
forward to loosen the Velcro at the neck area. Remove
gown in the same manner as you would tied at the neck.
Removing Items from Isolation Room
 Place lab. Specimen in biohazard plastic bag.
 Dispose of all sharps in appropriate red plastic
container in room.
 Place all linen in linen bag.
 Place re-usable equipment such as procedures trays in
plastic bags.
Equipment
• I and O bedside Form
• Client’s own graduated container
•Bedpan, urinal or underseat basin for toilet “hat”.
• Hourly inline urine measurement device for client
requiring frequent monitoring.
•Clean Gloves
Preparation
 Explain to client purpose of keeping I and O record to
client.
 Instruct client to keep record of all fluid taken
orally. Keep an I and O record at bedside for the client
to document intake
 Instruct client to void into bedpan, urinal, or
underseat basin for toilet.
 Instruct client not to place toilet tissue in bedpan or
defecate in bedpan.
Procedure
Fluid Intake
1. Measure all fluid intake (oral, IV Fluid, medications,
and TF) according to hospital values.
2. Record Time and amount of fluids in the appropriate
space in on bedside form.
3. Check bedside I and O record for approximate
amounts of fluid containers.
4. Total 8 hour fluid intake on bedside I and O record.
5. Complete a 24-hour intake record by adding together
all three 8-hour total.
6. Same goes for twelve hour shift intake. Add two 12
hour shift to get the 24 hour total.
Fluid Output
 Don gloves to measure output from all sources.
 Empty urinal, bedpan, or drainage bag into into client’s
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graduated container
To drain urine collection bag, use the client’s individual
labeled graduated receptacle. Slide port opener clockwise
to allow urine to drain and turn port opener to counterclock wise to close.
Remove gloves and perform hand hygiene.
Record time and amount of output on bedside I and O
record.
Complete 24 hour output record be adding together all
immediate output totals during that 24-hour period, and
place total on graphic sheet.
Notify physician for any significant imbalance; more
intensive monitoring maybe indicated.
Documentation for Intake and
Output
 Time and amount of all oral fluid intake.
 8 hour totals of all IV and enteral fluids.
 24 hour total of all fluid intake.
 Remove gloves and perform hand hygiene.
 Record time and amount of output on bedside I and O
record.
 Complete 24 hour urine output record by adding
together all immediate output totals during the 24 –
hour period, and place total on graphic sheet.
 Notify physician of any significant imbalance, more
intensive monitoring maybe included.
Computing for I and O
 Practice Sheet provided.
Bladder Irrigation
 Irrigating by Opening a Closed System. Smith pp. 785
– 786.
- Equipment
- Preparation
- Procedure
- Clinical Alert
Irrigating a Close System. Smith pp. 786 – 787.
Maintaining Continuous Bladder Irrigation. Smith pp.
787 – 788.
Care of Suprapubic Catheter
 What is a suprapubic catheter? A suprapubic catheter is a bendable
rubber tube that is inserted directly from the abdomen into urinary
bladder to drain urine.
 A suprapubic catheter may be used in conditions where there is a
problem passing urine. These problems may include an infection,
obstruction, or an injury caused by trauma or surgery in the bladder.
 A spinal cord injury, diabetes, and certain medicines may also cause
urinary retention.
 Males who have an enlarged prostate, and females who have a cystocele
may also have problems draining urine. Suprapubic catheters may be
used for long-term management of these conditions.
 How to clean the skin around suprapubic catheter?
 The opening created for the suprapubic catheter is called a stoma.
Clean the skin around stoma every day. The following are directions for
cleaning the skin around your stoma
Suprapubic Catheter
 Instead of being passed up through the urethra as is usual,
the supra pubic catheter is inserted through the abdominal
wall just above the pubic bone and into the bladder.
 This is a minor surgical procedure and involves giving a
local anaesthetic injected around the area before the
insertion.
 More often, this procedure is carried out as part of a larger
surgical procedure, ie. Prostatectomy, and will be inserted
in the operating room when you are asleep.
 The medical term for "above" is "supra" hence Suprapubic,
"above the pubic", in this case it is refering to where it is
positioned. This can be a long term solution.
Equipment
 Closed drainage system including a foley catheter
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tubing and bag.
Catheter clamp and plug
Dry sterile dressing and tape if ordered.
Cleansing solution
Clean gloves
Sterile gloves.
Preparation
 Gather all the items needed
Cleansing Solution.
Clean washcloth or sterile gauze bandage.
Clean towel.
New gauze bandage.
Sterile (clean) medical gloves.
Trash can.
 Remove the bandage and look at the site:
Wash hands using soap, or use a hand cleaner. Put on clean gloves.
Gently remove the bandage. Do this by supporting the skin around the stoma with one
hand. With the other hand, gently remove any adhesive tape by pulling in the direction
of hair growth. Throw the bandage away in the trash can.
Look for problems such as redness, separation of skin, red spots and swelling. Report any
skin changes to your caregiver. Throw away your used gloves. Wash your hands, and put
on clean gloves.
 Clean the area with cleanser:
Hold the end of the catheter tube in place to keep it from being pulled out while
cleaning.
Wash the catheter to remove blood or other material, moving away from the stoma.
Rinse the stoma and the skin around it in a circular manner, moving away from the
stoma.
Pat the area gently with a clean towel to dry it.
Throw away your used gloves. Wash hands, and put on clean gloves. If you use a
bandage, apply a new one.
Loop the catheter tubing and secure it well. Avoid kinking or blocking the tubing. Throw
away your used gloves. Wash hands.
Procedure
 Smith pp. 790.
 Documentation for Suprapubic cather care