Policy Manual sample

MDT Home Health Care Agency, Inc. 85 NOSTRIL CARE PURPOSE: Nostril care is provided to preserve integrity of nasal mucosa by lubricating mucosa and removing debris, prevent mucosal bleeding and breakdown, promote patient comfort and improve airway patency. RESPONSIBLE PERSONNEL: RN, LPN, RT, CRTT EQUIPMENT: • Soap and water • Tape • Wash cloth • Gloves • Tissues • Optional equipment: • Cotton swabs * Half-strength peroxide • Flashlight * Adhesive remover • Water soluble lubricant GENERAL CONSIDERATIONS: 1. Particular attention to nasal mucosa is due when: • Nasoenteric tubes are in place • Nasal breathing is the primary route of respiration (patient keeps mouth tightly closed) • Decannulation of tracheostomy has occurred, rerouting intake of air; or • Secretions are obvious and audible and patient cannot clear them on command 2. Nostril care is performed as often as indicated. 3. Schedule the procedure when the patient is relaxed and in an upright position and before feeding. PROCEDURE: 1. Wash hands. Gather equipment. 2. Explain procedure to patient and elicit cooperation. Minimize procedure if patient is uncooperative or cannot be controlled. Include caregiver as indicated. 3. If nasogastric tube is in place, remove tape and temporarily anchor it close to nose. 4. Cleanse external nares of tape, debris, oil and perspiration. 5. Examine internal nares with flashlight for signs of trauma. 6. Lubricate several swabs, and wipe nostrils clear from back to front while visualizing with light. Use half strength peroxide sparingly for crusted, adherent secretions. Avoid probing beyond length of nostril. Rinse peroxide with water. 7. Clean and dry nasogastric tube. 8. Reposition nasogastric tube to avoid contact with nasal mucosa. 9. Apply tape securely to tube and apply it to new site on nose. DOCUMENTATION: Document nasal care, observations and patient/caregiver education on the Clinical Visit Note.