4.3 Specialized Care & Comfort
Key Takeaways
- Measure and record all intake and output in milliliters (mL); fluid intake includes beverages AND foods liquid at room temperature such as ice cream, gelatin, and popsicles.
- Empty a catheter drainage bag wearing gloves into a graduate, keep the drain spout from touching the container, keep the bag below bladder level, and never let tubing kink.
- SRNAs never adjust oxygen flow rate; oxygen safety includes no smoking or open flame, an 'Oxygen in Use' sign, and checking the skin behind the ears and around the cannula.
- Heat and cold applications are done ONLY with a nurse's order/delegation, for limited time (about 15-20 minutes), checking skin frequently for burns or frostbite.
- A healthy stoma is pink-to-red and moist; the SRNA may empty an ostomy pouch and reports any dark, dusky, or bleeding stoma to the nurse.
Intake & Output (I&O)
Accurate intake and output (I&O) monitoring detects dehydration and fluid overload (important for residents with heart failure, kidney disease, or on fluid restriction). All amounts are recorded in milliliters (mL), using the facility's standard container volumes. A key exam point: fluid intake includes all beverages AND any food that is liquid at room temperature — ice cream, gelatin (Jell-O), sherbet, popsicles, and broth all count. Output includes urine, emesis (vomit), liquid stool, and wound or ostomy drainage.
When documenting meal intake, a percentage such as "50%" means the resident ate approximately half of the total food on the tray, not half of each item or 50 calories. Intake below about 75% should be reported; a pattern of very low intake (under 25%) with lethargy signals a possible medical problem, depression, or swallowing difficulty and must be reported to the nurse.
Specimen Collection Basics
SRNAs collect routine urine and stool specimens but never perform sterile procedures beyond their scope. General rules: wear gloves, use the correct labeled container, avoid contaminating the inside of the container or lid, collect at the specified time, and transport promptly. Label with the resident's name and the date/time.
- Routine urine: the resident voids into a clean specimen "hat" or bedpan; pour into the container without touching the inside.
- Clean-catch (midstream) urine: clean the perineum front-to-back, have the resident start voiding, then catch the middle of the stream — this reduces surface bacteria for an accurate culture.
- Stool specimen: collect from a clean bedpan with a tongue blade, avoiding contamination with urine or toilet water.
Remember infection control: if the resident has active tuberculosis (TB), you must wear a fitted, seal-checked N95 respirator to enter the room even for a urine specimen, because TB is airborne.
Catheter & Drainage-Bag Care
An indwelling (Foley) urinary catheter is a major infection risk — catheter-associated urinary tract infection (CAUTI). SRNA responsibilities and rules:
| Task | Correct Practice |
|---|---|
| Perineal/catheter cleaning | Clean from the meatus outward (away from the body), fresh wipe per stroke |
| Bag position | Keep the drainage bag below bladder level at all times; never place on the floor |
| Tubing | Keep free of kinks and dependent loops; secure to leg |
| Emptying | Wear gloves, drain into a graduate, keep the spout from touching the container, measure and record |
| No output | Check for kinks and bag height, then report to the nurse |
Catheter irrigation and inserting/removing the catheter are outside the SRNA scope in Kentucky. If a catheter has drained no urine for several hours, check the tubing for kinks and confirm the bag is below the bladder, then report to the nurse immediately — never irrigate.
Ostomy Care Awareness
An ostomy is a surgical opening (stoma) that diverts stool (colostomy/ileostomy) or urine (urostomy) into a pouch (appliance). Within SRNA awareness scope: you may empty the pouch, observe and report, and provide gentle skin care around the appliance. A healthy stoma is pink-to-red, moist, and slightly raised — report any stoma that is pale, dark, dusky, purple, bleeding, or pulled inward, and report skin breakdown or leaking around the seal. Changing the appliance is usually the nurse's role or requires specific delegation and training.
Pain & Comfort Measures
Pain is a resident-rights and quality-of-care issue. When a resident reports pain — for example, 6 out of 10 at bedtime — the SRNA does NOT give medication (that is outside scope) but reports the pain level to the nurse so ordered treatment can be given. Meanwhile the SRNA offers non-pharmacological comfort within scope: repositioning, pillow support, a back rub, warm blankets, a quiet dim environment, and emotional reassurance. Always report unrelieved pain.
Heat & Cold Applications
Heat and cold have therapeutic uses (heat relaxes muscles and increases circulation; cold reduces swelling and pain), but they can cause burns or frostbite, especially in residents with impaired sensation or circulation. In Kentucky, SRNAs apply heat or cold only with a nurse's order/delegation, following these safety rules:
- Limit application to about 15-20 minutes (or the ordered time).
- Check the skin frequently — remove immediately for pallor, blistering, redness, numbness, or complaints.
- Wrap cold packs in a cloth barrier; never apply ice directly to skin.
- Confirm safe temperature; residents with diabetes, neuropathy, or dementia are high-risk.
Never apply a warm compress on your own initiative (for example, to a swollen, red, warm surgical joint — that could be a blood clot and must be reported, not heated).
Special Equipment & Oxygen Safety
SRNAs care for residents with special equipment but stay within scope. For oxygen, the SRNA never adjusts the flow rate or liter setting — only the nurse or respiratory therapist changes the prescription. Oxygen supports combustion, so safety is critical:
- No smoking, open flames, or sparks in the room; post an "Oxygen in Use" sign.
- Ensure tubing is not kinked and the cannula prongs sit correctly in the nares.
- Check the skin behind the ears and around the nostrils for pressure from tubing.
- Report low tank levels, empty humidifier water, or a resident's shortness of breath.
For intravenous (IV) lines, never disconnect, adjust, or remove them; when changing a gown, thread the sleeve over the IV bag without disconnecting the line, keeping the bag elevated. Report any IV alarm, leaking, or site redness to the nurse.
When emptying a resident's Foley catheter drainage bag, the SRNA should:
Which item counts toward a resident's fluid INTAKE for I&O documentation?
A resident receiving oxygen by nasal cannula complains of shortness of breath. The SRNA should: