Bed side management for unconscious patients.pptx

care for bed ridden patient

1. Bed side management Used of bedpan and urinal Observation of stools, urine and sputum

2. BEDPANS AND URINALS bedpans serves as a receptacle for urine and feces for clients who are restricted to bed.

3. Urinal Urinals is cylinder container for collection of urine Types Male female

4. PURPOSES: To provide a receptacle for elimination of waste materials for patients who are confined to bed. To obtain a urine or stool specimen for laboratory examination. To obtain an accurate measurement/assessment of the client's urine output or stool.

5. EQUIPMENT: Clean bedpan/ urinal. Bedpan cover. Toilet tissue. Basin of water, soap, wash cloth & towel for client's use in washing hands after. Plastic bag or waste receptacle.

6. PROCEDURE: Check the client's physical status to determine whether a bedpan or urinal is necessary. Wash hands and put on clean gloves. Explain procedure to the client. Close the door or bed curtain to provide privacy. Raise the bed to 45 to 90 degrees Place the client in a recumbent position with your hand under the lumbosacral area of the back of the patient, ask the client to raise the buttocks as you push the pan into position.

7. For urinals, place it between slightly spread legs with the bottom of the urinal resting on the bed. Leave the client for a time, to provide privacy during elimination, or if not possible, just step outside within calling distance if client suddenly needs assistance. When the client signals, return promptly. Put on clean gloves and if necessary wipe the genital area with tissue (anteroposterior). Remove the bedpan carefully to prevent contents from spilling. Cover & carry the bedpan or urinal to the bathroom, and if ordered, measure the urine output.

8. Collect a specimen of urine or feces, if ordered. Empty contents into the toilet and flush. Thoroughly clean the pan and wash with disinfectant solution and handled brush. Dry pan and return to storage unit. Remove and dispose gloves. Give the client a basin of water and soap, and a towel so the client can wash hands and perineal area if desired. Place the bed back in low position to provide comfort. Document.

9. Stool specimens Characteristics of normal stool Colour Normally the colour of the stool is light to dark brown due to the presence of bile pigments. Odour Normal stool has a pungent smell . It is normally affected by the type of bacterial flora, by the food and medications ingested. Frequency One to two per day and it is painless.

10. Consistency and Form In adult, the stool is well formed and the consistency is semisolid. Quantity Quantity depends upon the type and the amount of food taken. When the roughage in the diet is increased the amount is also increased. Quantity varies from four to five ounces per day Composition The faeces contain 30% water. The remaining portion consists of shed epithelium from the intestine, bacteria a small quantity of nitrogenous matter mainly mucin, salts, calcium, phosphates, little iron and cellulose if present in the diet.

11. Stool of infants At birth the stool of infants is dark green and it is called "Meconium". At the end of the first week, it becomes yellow and soft due to intake of milk diet.

12. CHARACTERISTICS OF ABNORMAL STOOL Colour Tarry black stools indicate bleeding in the upper gastrointestinal tract, the blood having been altered by the intestinal juices. The occult blood test will be positive (occult-hidden). When the stool appears black, it is termed as "melaena". Black stools may also result from the administration of iron or charcoal. White stools may to the flow of bile. The bile pigment colors appear due to the presence of barium salts after barium tests.

13. Odour In melaena and dysentery, there will be foul smell. A strong smell results from meat diet. Frequency decreased in constipation and in patient with low residual. Frequency is increased in diarrhea.

14. Consistency and form In constipation, the stools are very hard. Flattened and ribbon like stools indicate some obstruction in the lumen of the bowel. Watery stools are found in diarrhea, digestive upsets, due to bacterial invasions and after taking purgatives. "Rice water stools" are typical of cholera. "Pea soup stools" are typical of typhoid fever. Pale, bulky, semisolid and frothy stools are characteristic of sprue.

15. Appearance Fresh blood in large amounts is suggestive of bleeding piles, mixing the stool with menstrual blood, bleeding from the large colon (the digestive juices will not alter this blood), malignant growths, scurvy, leukaemia or purpura. The commonest cause of blood and mucus found in the stool is due to dysentery which may be amoebic or bacillary. Stool may contain worms or segments of worms e.g., round worm, threadworm, hookworm and tapeworm. On microscopic examination, the stool is found to contain various amoebae, E. coli, vibrio cholera, A.F.B., and salmonella group of organisms.

16. Method of collecting stool specimen Waterproof disposable containers or wide- mouthed containers are provided with necessary instructions. The client passes stool in a clean bedpan. A small amount of stool is removed with a stick and is placed in the container. Discard the stick in the waste bin

17. SPUTUM SPECIMENS Normally no sputum is expectorated. The amount of sputum coughed up in 24 hours varies with the diseases. Consistency The sputum may be classified into various types according to its consistency and appearance, e.g., serous, frothy, mucoid, purulent, seropurulent and haemorrhagic . Odour Normally the sputum is odourless . In acute diseases the sputum is odourless . In chronic infection, when the sputum is retained inside the lung and has undergone some decomposition, the odour becomes foul. In case of lung abscess, carcinoma and bronchiectasis etc., the sputum will be foul smelling.

18. Colour When sputum consists largely of mucus it may be colorless and translucent. Presence of pus may give rise to yellowish colour . A blackish sputum contains a lot of carbon pigments as seen in excessive smoking. Presence of blood in the sputum is called as "Hemoptysis" and may appear as bright red or dark red. Bright red and frothy sputum indicates fresh bleeding from the lungs. Dark red shows that it was in the lungs for sometime. Rusty colour of the sputum is due to the altered hemoglobin as seen in pneumonia. Greenish colour is seen in bronchiectasis. Brown colour is seen in gangrenous condition of the lungs.

19. Appearance If sputum is examined microscopically, a few W.B.C. and epithelial cells may be seen. Eosinophils are found in such conditions as asthma. R.B.C. is found only when there is hemoptysis. The main organisms that are looked for in a stained sputum are tubercle bacilli (AFB). Others are streptococci, pneumococci and diphtheria bacilli.

20. Method of collecting sputum specimen Waterproof disposable sputum cups or wide-mouthed containers are used to collect sputum specimen. A large container is required if the physician desires to have the total sputum expectorated in 24 hours. If sterile specimens are desired, a wide-mouthed sterile glass bottle with a screw cap or a sterile petri dish can be used. The client should be given the container on the previous evening and is instructed to raise the material from the lungs by coughing and not simply expectorating the saliva or discharges from the nose or throat.

21. The sputum should be collected in the morning before brushing the teeth and taking the food. Mouth can be rinsed with plain water and not with any antiseptic mouth washes. To collect the sputum from a young child, use a cotton applicator and a test tube. When the sputum is coughed up, wipe off the sputum with cotton applicator and is dropped into the clean test tube. Close the test tube with a cotton plug.

22. Observation of urine Method of urine collection Midstream urine 24 hours urine specimen Urine collection from children

23. Method of collecting midstream urine Ask the client to clean the genital area with soap and water, then rinse with water alone. In female clients, the labia are separated for cleaning and kept apart until the urine had been collected. Is male clients, the foreskin should be retracted and the glans penis is cleaned before the collection the urine. The client begins to void into the toilet, commode or bedpan then stops the stream of urine, the sterile container is position and continues to void into the container. When enough urine has been voided, for specimen, the client stops the stream again, the container is removed and then finishes voiding in the original receptacle. By this method, the first stream of urine flushes out the organisms and mucus usually present at the meatus, so that accurate result can be obtained For unconscious clients catherization is done

24. Method of collecting 24 hours urine specimen Twenty-four hours urine specimen means to collect all the urine voided in 24 hours. The collection of urine begins at 6 A.M. Ask the client to void at 6 A.M. and discard the whole urine. All the subsequent voiding should be measured and collected in the bottle which is labelled. Continue to collect till next morning. Ask the client to void at 6 A.M. on the next day and add it to the urine previously collected. It is necessary to add preservatives to the urine to prevent decomposition and multiplication of bacteria. A variety of preservatives are available such as toluene, boric acid, concentrated hydro chloric acid, formalin, chloroform etc.

25. Method of collecting urine specimen children To collect urine from male babies or unconscious male clients, take a test tube, a barrel of a syringe or nirodh /condom with rubber tubing and is attached to the penis. It is kept in place by adhesive tape in place. The rubber tubing is connected to a bottle and the urine is collected in the bottle. To collect the urine from the female babies, attach a wide mouthed container or a funnel with a rubber tubing to the vulva by means of a "T" binder. The rubber tubing is connected to a bottle and the urine is collected in the bottle.

26. Examination of t he urine Characteristics of normal urine Volume An amount of 1000 to 2000 ml of urine is excreted in 24 hours. The urine output depends upon the water intake. In cold weather it is increased and in hot weather it is decreased. Colour The normal urine is pale yellowish or amber in colour. When the quantity of urine is increased, the colour becomes pale yellow and when the quantity of urine is decreased, the colour becomes deep yellow. Appearance The normal urine is clear with no deposit.

27. Odour The normal urine has an aromatic odour. When the urine is collected and kept for sometime, strong ammoniac smell comes due to the decomposition of the urea. Reaction Reaction of the normal urine is slightly acidic. Specific gravity The specific gravity of urine varies from 1.016 to 1.025, with a normal fluid intake.

28. Urine pH The pH of urine — its alkalinity or acidity reflects the kidney's ability to maintain a normal hydrogen ion concentration in plasma and extracellular fluids. t he normal pH of urine varies from 4.6 to 8.0 Constituents of urine 96% is constitutes of water urea 2% and the remaining 2% consists of uric acid, urates, creatinine, chlorides, phosphates, sulphates and oxalates.

29. CHARACTERISTICS OF ABNORMAL URINE Volume Abnormal increase in the volume is known as "polyuria", and is found in "diabetes mellitus" and "diabetes insipidus". Decreased quantity of urine is called "oliguria" and is found in heart diseases, kidney diseases and in shock conditions. Total absence or marked decrease of urine is known as "anuria Colour Green or brownish - Bile salts and bile yellow pigments. Reddish brown - Urobilinogen. Bright red -A large amount of fresh blood.

30. Odour Sweetish or fruity odour is due to the presence of ketone bodies. Appearance Cloudy appearance is due to the presence of amorphous phosphates. This disappears dilution of acetic acid. Turbidity of urine is due to the presence of pus which clears on filtering. Deposits are due to presence of various substances Mucus - appear as a flocculent cloud. Pus - settles at the bottom as a heavy cloud. Stones - as fine sand. Uric acid- as grains of pepper.

31. Reaction Where there is cystitis, the reaction of the urine may be alkaline Urine should be collected freshly Specific gravity In disease the specific gravity may range from 1.001 to 1.060. It may be high in DM and low in renal disease

32. Constituents of urine Albumin is present when there is kidney damage. Presence of albumen in the urine termed as "albuminuria". Sugar in the indicates diabetes mellitus. In pregnancy, when the renal threshold is lowered, sugar is found in the urine. Acetone is found in the urine due to incomplete metabolism of fat usually seen in diabetic clients

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