CNAP + HHA Exam Study Guide (NA 309)

For a confused resident - stay calm & maintain a quiet environment

- Do not leave a confused resident alone. - Stay calm. Provide a quiet environment. Speak in a lower tone of voice. Speak clearly and slowly. Introduce yourself each time you see the resident. Remind the resident of his or her location, name, and the date. Explain what you are going to do, using simple instructions. Do not rush the resident. Talk to confused residents about plans for the day. Keeping a routine may help. Encourage the use of glasses and hearing aids. Make sure they are clean and are not damaged. Promote self-care and independence. Report observations to the nurse.

Know the Rights of medication: Right Client, Right Medication, Right Time, Right Route, and Right Amount (Dose)

1. The Right Client: Always check the label on the medication container to make sure the client's name is on it. 2. The Right Medication: Check the expiration date and the name of the medication before giving the container to the client. Make sure the medication name on the container matches the name listed in the care plan. 3. The Right Time: Make sure the instructions on the container label for what time or how often to take the medication match the instructions in the care plan. 4. The Right Route: Check the label for instructions on how the medication is to be taken. Make sure the instructions on the label match those in the care plan. 5. The Right Amount: Make sure the instructions on the container label for how much medication to take match the instructions in the care plan.

Read Distinguishing between fact & fallacy concerning mental illness

Fact: Mental illness is a disease like any physical illness. People with mental illness cannot control their illness. Fallacy: People with mental illness can control their illness. They can choose to be well.

With an autoimmune illness the body/s ___________ system attacks normal tissue

Immune system

What does osteoporosis cause?

A common type of arthritis that affects the elderly. It may occur with aging or as the result of joint injury. Hips and knees, which are weight-bearing joints, are usually affected. Joints of the fingers, thumbs, and spine can also be affected. Pain and stiffness seem to increase in cold or damp weather.

What does a pulse oximeter measure?

A noninvasive device that uses a light to determine the amount of oxygen in the blood (also called oxygen saturation). A pulse oximeter also measures a person's pulse rate.

Read Guidelines: Multiple Sclerosis

A progressive disease that affects the central nervous system. Assist with ADLs as needed. Be patient with self-care and movement. Allow enough time for tasks. Offer rest periods as necessary. Give resident plenty of time to communicate. People with MS may have trouble forming their thoughts. Be patient. Do not rush him or her. Prevent falls, which may due to a lack of coordination, fatigue, or vision problems. Stress can worsen the effects of MS. Be calm. Listen to residents when they want to talk. Encourage a healthy diet with plenty of fluids. Give excellent skin care to prevent pressure sores. Assist with range of motion exercises exactly as ordered to prevent contractures and to strengthen muscles.

Read what Parkinson's disease can cause

A progressive disease. It causes a section of the brain to degenerate, and it affects the muscles, causing them to become stiff. In addition, it causes stooped posture and a shuffling walk. It can also cause pillrolling. This is a circular movement of the tips of the thumb and the index finger when brought together, which looks like rolling a pill. Tremors or shaking make it hard for a person to perform ADLs such as eating and bathing.

What is a phantom sensation?

After amputation, some people feel that the limb is still there. They may feel pain in the part that has been amputated. It may last for a short time or for several years - the pain is real from remaining nerve endings - never ignore or ridicule.

Definition of apnea

Apnea is the state of not breathing. Some babies may stop breathing for periods of time due to immaturity of the lungs or other reasons.

Purpose of umbilical cord care: prevent infection

At birth the umbilical cord that connected the baby to the placenta inside the mother's uterus is cut. The stump of the cord remains attached to a newborn's navel for up to three weeks. Proper care of the cord stump is necessary to prevent infection and allow healing. With every diaper change, moisten the cord with rubbing alcohol Never pull on or handle the cord. It will fall off by itself. The baby will feel no pain when the cord falls off. Keep diapers folded down away from the cord to allow air to circulate and prevent irritation. No tub baths until the cord has fallen off.

Postmortem care - nursing assistant's role - does not include removing tubes or equipment/eyes should be carefully closed/may need to place drainage pads where needed

Bathe the body. Be very gentle to avoid bruising. Place drainage pads where needed. This is most often under the head and/or under the perineum (the genital and anal area) Put dentures in and close eyes, position body on back with legs straight. Strip the bed after the body is removed, open windows if needed. Respect the family and be sensitive to their needs.

Misuse of prescription drugs can be fatal Prescription drugs can be abused also Many drugs should not be mixed with alcohol People should not take other people's drugs

Be alert to the signs of misuse or abuse and report them to your supervisor immediately.

How to respond to inappropriate sexual behavior

Be matter-of-fact when dealing with such behavior. Do not over-react, as this may reinforce the behavior. Be sensitive to the nature of the problem. Is the behavior actually intentional? Is it consistent? Try to distract the resident. Tell the nurse. A resident may be reacting to a need for physical stimulation or affection. Try backrubs, a soft doll or stuffed animal to cuddle, comforting blankets, pieces of cloth, or physical touch

Alzheimer's disease - read through pgs. 351-356 Strategies for better communication; General principles for personal care & Interventions for problems with ADLs (how to help with memory loss, what to do if resident is frightened & problems with bathing & eating)

Better communication: always be clear, use simple words, positive body language and voice, repeat yourself, general repetition, simple tasks, involve the resident, use nonverbal cues, use pictures, offer comfort, limit negative words, do not take personal offense to behavior or paranoia, really listen, report signs of depression, have fun activities together. Personal care: - Develop a strict routine - Promote self-care - Be the best NA by caring for yourself to improve care for the resident Interventions for problems with ADLs: - Encourage fluids and check in every 30 mins. - Observe and enact a bathroom time - Schedule bathing when resident is not agitated and make it quick. - Take all safety precautions, be relaxed and explain the purpose of bathing - Lay clothes in the order in which they are put on. - Have regular consistent meal times daily, make sure there is good lighting, the task of eating should be simple (ex: finger foods) - No very hot foods and place dishes in simple pattern. (one dish and one utensil). - Encourage exercise, observe overall health, maintain self-esteem and positivity with smiles, hugs, and warm touches.

Diabetics - need to maintain proper nutrition & exercise , & receive good foot care (feet should be checked daily)

Careful foot care, including regular, daily inspection, is vital. The goals of diabetic foot care are to check for irritation or sores, to promote blood circulation, and to prevent infection. Encourage: well-fitting leather shoes and cotton socks. Never: cut toenails or let the resident be barefoot.

Observations of mentally ill persons: report changes in personality; withdrawal & imagined physical symptoms; & report comments about suicide or hurting self or others even if indicate they were joking - Observing & Reporting: Mentally Ill Resident's

Changes in ability Positive or negative mood changes, especially withdrawal Behavior changes, including changes in personality, extreme behavior, and behavior that does not seem to fit the situation Comments, including jokes, about hurting self or others Failure to take medicine or improper use of medicine Real or imagined physical symptoms Events, situations, or people that upset or excite residents

Radiation & chemotherapy may cause nausea, vomiting, diarrhea, hair loss & decreased resistance to infection

Chemotherapy refers to medications given to fight cancer. Some drugs destroy cancer cells and limit the rate of cell growth. However, many of these drugs are toxic to the body. They kill healthy cells as well as cancer cells.

Read common signs/symptoms of clinical depression

Clinical depression is not a normal reaction to stress. Sadness is only one sign of this illness. Not all people who have depression complain of sadness or appear sad. Symptoms: Pain, including headaches, abdominal pain, and other body aches • Low energy or fatigue • Apathy, or lack of interest in activities • Irritability • Anxiety • Loss of appetite or overeating • Problems with sexual functioning and desire • Sleeplessness, difficulty sleeping, or excessive sleeping • Lack of attention to basic personal care tasks (e.g. bathing, combing hair, changing clothes) • Intense feelings of despair • Guilt • Difficulty concentrating • Withdrawal and isolation • Repeated thoughts of suicide and death

Read Guidelines: COPD - independence, positioning, infection control & being supportive

Colds or viruses can make residents very ill quickly. Always observe and report signs of symptoms getting worse. Help residents sit upright or lean forward. Plenty of fluids and small, well balanced frequent meals. Encourage as much independence with ADLs as possible. Encourage saving energy for important tasks and pursed-lip breathing.

What do deep breathing exercises do?

Deep breathing exercises help expand the lungs, clearing them of mucus and preventing infections (such as pneumonia)

Read about defense mechanisms - do they help cope with stress?

Defense mechanisms are unconscious behaviors used to release tension or cope with stress. They help to block uncomfortable or threatening feelings. Mentally ill people over use them. If a person is unable to recognize problems, he or she will not address them, and the problems may get worse.

Read & know examples of emergency surgery

Emergency surgery is unexpected and unscheduled surgery that is performed immediately to save a patient's life or a limb. A gunshot wound, car accident, or ruptured appendix are examples of situations that can require emergency surgery

Always have supplies ready when giving a baby a bath including a diaper

Equipment: disposable gloves, clean basin, blanket or towel to pad surface, washcloth and towel, baby cleanser or mild soap, baby shampoo or mild shampoo, cotton hat, lotion or oil, cotton ball or cotton tipped swabs and alcohol, diaper ointment if used, clean diaper, clean clothes or sleeper, clean receiving blanket 1. Wash your hands. 2. Put on gloves. Be careful—gloves make the baby slippery! 3. Give the bath in a warm place. Use a blanket or towel to pad the surface the baby will lie on. Have all your supplies within reach. You will need to keep one hand on the baby during the entire bath. Remove caps from shampoo and cleanser to make it easier. 4. Fill the basin with warm water. Test the temperature on the inside of your wrist. Put the bottle of lotion or oil in the warm water to warm it. 5. With the baby still dressed, hold him or her in the football hold. Wet the washcloth and gently wipe the eyes, from the inner corner to the outer. Then clean the rest of the face. Use only warm water—no soap. 6. To wash hair, hold the baby in the football hold with the head over the basin. Use the washcloth to wet the hair. Using a small amount of shampoo, lather the baby's hair. Rinse with the washcloth. Pat the head dry immediately with the towel. 7. Lay the baby down on the padded surface. Always keep at least one hand on the baby. 8. Undress the upper body. Wash the neck, chest, back, arms, and hands using the washcloth and small amounts of soap. Rinse using the washcloth and water from the basin . Pat dry. Cover the upper body with a towel. 9. Undress the lower body, removing the diaper. Wash the baby's abdomen and legs. Rinse. Pat dry. 10. Wash the perineal area last. For a girl, wipe the perineal area from front to back. For a boy who has recently been circumcised, do not wash the area of the circumcision. Follow special instructions to care for the circumcision. 11. Wash the baby's bottom thoroughly and dry the entire area completely with the towel. Moisture can contribute to diaper rash. 12. As gently and quickly as possible, rub lotion over the baby's body. Avoid the umbilical cord stump if it has not yet healed. Use lotion on the face only if skin is very dry. Be extremely careful not to get any lotion near the eyes. Keep the baby covered except for the part you are rubbing. 13. Diaper and dress the baby. Wrap baby in blanket and put him or her down safely. 14. Put used towels and washcloth in the laundry. Discard water. Clean basin and store. Store other supplies. Discard gloves. 15. Wash your hands. 16. Document the bath, including any observations.

A resident with GERD should not lie down for 2 to 3 hours after eating

GERD or gastroesophageal reflux disease, is a chronic condition in which the liquid contents of the stomach back up into the esophagus. The liquid can inflame and damage the lining of the esophagus.

Read Important observations to report & document for the baby

General: vital signs of Mom and baby The home: Is it clean, healthy, and safe? The family: Are older children maintaining their regular routines? Do the husband or partner and other family members know how they can help? The mother: Is she able to rest? Does she seem to be handling everything? Is she depressed, crying, or moody? Watch for signs of postpartum (after birth) depression, similar to signs of depression. The baby: Is the baby eating regularly, wetting and soiling diapers, and sleeping well? Does the baby have good color? The baby's room or space: Is there a safe place for the baby to sleep? Is the crib, bassinet, or bed free of pillows, toys, or excess bedding that could cause suffocation? Is the room temperature comfortably warm?

Read: Describe the grief process

Grieving is an individual process. No two people will grieve in exactly the same way: Shock Denial Anger Guilt Regret Sadness Loneliness

How is HIV transmitted?

HIV is a sexually transmitted disease. It is also spread through infected blood, infected needles, or to a fetus from an infected mother. Found in Bodily fluids: -Blood -Semen -Vaginal fluid -Breast milk

COPD - how should the resident be positioned?

Help residents sit upright or lean forward. Offer pillows for support

Home Care after childbirth - New mothers often need to rest & recover after leaving the hospital after childbirth

Home care helps ease the transition from hospital to home. It allows the mother to rest and recover. Home health aides also assist with household management when an expectant mother is put on bed rest by her doctor. Bed rest is ordered if a woman shows signs of early labor, has a history of miscarriage or premature deliveries, or is extremely ill

Hospice - focuses on pain relief & comfort

Hospice is the term for the special care that a dying person needs. It is a compassionate way to care for dying people and their families. Hospice care uses a holistic approach. It treats the person's physical, emotional, spiritual, and social needs.

How to respond to hallucinations

Ignore harmless hallucinations and delusions. • Reassure a resident who seems agitated or worried. • Do not argue with a resident who is imagining things. The feelings are real to him or her. Do not tell the resident that you can see or hear his or her hallucinations. Redirect resident to other activities or thoughts. • Be calm. Reassure resident that you are there to help.

What happens to blood pressure as death is approaching?

It decreases. Common symptoms: -Blurred and failing vision • Unfocused eyes • Impaired speech • Diminished sense of touch • Loss of movement, muscle tone, and feeling • A rising or below-normal body temperature • Decreasing blood pressure • Weak pulse that is abnormally slow or rapid • Slow, irregular respirations or rapid, shallow respirations, called Cheyne-Stokes respirations • A "rattling" or "gurgling" sound as the person breathes • Cold, pale skin • Mottling (bruised appearance), spotting, or blotching of the skin caused by poor circulation. - Perspiration • Incontinence (both urine and stool) • Disorientation or confusion

Read Guidelines for caring for resident who have had hip replacements

Keep often-used items, such as medications, telephone, tissues, call light, and water, within easy reach. Avoid placing items in high places. Dress starting with the affected side first. Never rush the resident. Use praise and encouragement often. Do this even for small tasks. Ask the nurse to give pain medication prior to moving and positioning if needed. Have the resident sit to do tasks if allowed. This saves energy. Follow the care plan exactly, even if the resident wants to do more. Follow orders for weight-bearing. An order may be written as partial weight bearing (PWB) or non-weight bearing (NWB). Partial weight bearing means the resident is able to support some weight on one or both legs. Non-weight bearing means the resident is unable to support any weight on one or both legs. Full weight bearing (FWB) means that one or both legs can bear 100 percent of the body weight on a step. Assist resident as needed with cane, walker, or crutches. Never perform range of motion exercises on a leg on the side of a hip replacement unless directed by the nurse. Caution the resident not to sit with his or her legs crossed or turn toes inward. The hip cannot be bent or flexed more than 90 degrees. It cannot be turned inward or outward When preparing to transfer the resident from the bed, a pillow should be used between the thighs to keep the legs separated. The head of the bed can be raised to allow the resident to move her legs over the side of the bed with the thighs still separated. It is better to transfer from the bed on the side where the unaffected hip is so that the strong side leads in standing, pivoting, and sitting. With chair or toilet transfers, the operative leg/knee should be straightened. The strong leg should stand first (with a walker or crutches) before bringing the foot of the affected leg back to the walking position.

Read about methods of medication storage

Keep the client's medications in one place, separate from medicine used by other members of the household. If there are young children or a disoriented elderly person in the home, recommend to the family that medications be locked away All medications should be kept in childproof containers if children are in the home. If medicine requires refrigeration, make sure the bottle is toward the back on an upper shelf, out of a child's reach. The client or a family member should discard medications that have expired, are not labeled, or are discolored. If the client or family will not dispose of expired medications, inform your supervisor. Do not dispose of them yourself.

Know the difference between prescription & over the counter drugs - read Guidelines

Know the difference between prescription drugs and over-the-counter drugs. Antibiotics (such as penicillin), heart drugs (such as nitroglycerin), and potent pain medications (such as codeine) are examples of prescription drugs. Aspirin or cold medications, such as decongestants, are over-the-counter drugs.

Common treatments for mental illness - 2 common treatments are medication & psychotherapy

Medication may allow mentally ill people to function more completely. Medication used to treat mental illness must be taken properly to promote benefits and reduce side effects. Psychotherapy is a method of treating mental illness that involves talking about one's problems with mental health professionals. Individuals, groups, couples, or families meet with trained, licensed professionals to work on their problems.

Congestive Heart Failure (CHF) : Guidelines - read about diet & fluids, medication to remove excess fluid & purpose of elastic stockings

Medications help remove excess fluids. This means more trips to the bathroom. Answer call lights promptly. Keep a portable commode nearby if the resident is weak and has trouble getting out of bed and walking to the bathroom. Assist resident as needed. A low-sodium diet or fluid restrictions may be prescribed Input and output of fluids may be measured. Elastic leg stockings may be used to reduce swelling in feet and ankles.

Definition of abduction

Moving a body part away from the midline of the body

How should a baby be placed in the crib to sleep? - Guidelines for safely handling a baby

Never put a baby down on his or her abdomen. Babies should be placed on their backs. Crib mattresses should be firm. Infants should not be placed on a blanket, comforter, pillow, or sheepskin to sleep. These items can cause suffocation and may contribute to SIDS.

Head or spinal injuries frequently cause paralysis or paresis

Paresis is paralysis, or loss of ability, that affects only part of the body. Often, paresis describes a weakness or loss of ability on one side of the body.

Diabetes can lead to impaired wound healing

Poor circulation and impaired wound healing may cause leg and foot ulcers, infected wounds, and gangrene. Gangrene can lead to amputation.

Communication with mentally ill person - involves maintaining eye contact & listen closely to what they say - fig. 20-3 & read Guidelines: Mental Illness

Practice good communication skills with mentally ill residents. Do not talk to adults as if they are children. Use simple, clear statements and a normal tone of voice. Be sure that what you say and how you say it show respect and concern. Sit or stand at a normal distance from the resident. Be aware of your body language. Be honest and direct, as you would with any resident. - Avoid arguments. - Maintain eye contact. - Listen carefully

Guidelines: Restorative Care - read about the nursing assistant's role

Rehabilitation is care that is managed by professionals to help to restore a person to the highest possible level of functioning. NA's role: - Be patient - Be positive and supportive - Focus on small tasks and accomplishments. - Recognize that setbacks occur and progress occurs at different rates. - Be sensitive to the resident's needs. - Encourage independence - Involve residents in their care.

Read Tip: Walking Aids

Residents using new ambulatory aids, such as canes, walkers, boots, crutches, etc. are likely to be off-balance. Stay close by to be sure they are using these appliances safely. Observe residents for signs of dizziness. To avoid falls, clear pathways, and wipe up spills immediately.

Resident's who have HIV and have an infection of the mouth need to eat foods that are soft or pureed and avoid spicy foods

Residents with infections of the mouth may need food that is low in acid and neither cold nor hot. Spicy seasonings should not be used. Soft or pureed foods may be easier to swallow. Liquid meals and fortified drinks may help ease the pain of chewing. Warm salt water or other rinses may ease the pain of mouth sores. Good mouth care is vital.

The BRAT diet is helpful for someone with diarrhea

Residents with mild diarrhea may need frequent small meals that are low in fat, fiber, and milk products. If diarrhea is severe, the doctor may order a "BRAT" diet (a diet of bananas, rice, apples, and toast). This diet is helpful for short-term use.

Read about seizures & what should & should not be done

Seizures are involuntary, often violent, contractions of muscles. They can involve a small area or the entire body. Seizures are caused by an abnormality in the brain. Main goal: make the resident safe Do: assist immediately, call the nurse, move furniture way to prevent injury, check breathing, report and document. Do Not: restrain, place hands near mouth of resident, give liquid or food

People in subacute settings require more treatment, monitoring, & services

Subacute care is a kind of specialized care that falls between acute care and long-term care. This type of care can take place in hospitals and in skilled nursing facilities. Subacute care may be necessary due to recent surgery, injuries, or chronic illnesses, such as AIDS.

Know what suctioning is & why it might need to be done

Suctioning removes mucus and secretions from the lungs when a person cannot do this on his own. A person who has a tracheostomy may require suctioning. Suctioning can be performed through the nose, mouth, or throat.

Surgery is the main treatment for most forms of cancer

Surgery is the first line of defense against most forms of cancer. It is the key treatment for malignant tumors of the skin, breast, bladder, colon, rectum, stomach, and muscle. Surgeons remove as much of the tumor.

Read Guidelines: Telemetry

Telemetry is used to measure the heart rhythm and rate on a continuous basis. Report to the nurse if the pads become wet or soiled. Report if pads appear loose or fall off. Report if the alarm sounds. The alarm may sound if the pads disconnect, or if the battery is low. Check the skin around the pads often. Report any of the following: - Swelling - Sores, redness, or irritation - Fluid or blood draining from skin - Broken skin Report resident complaints of chest pain or discomfort, as well as any difficulty breathing. Check vital signs as ordered. Report changes to the nurse.

Amount and know what the Right Route means

The Right Route: Check the label for instructions on how the medication is to be taken. Make sure the instructions on the label match those in the care plan.

Residents with angina pectoris should avoid cold weather

The heart muscle that is not getting enough oxygen causes chest pain, pressure, or discomfort, called angina pectoris. The heart needs more oxygen during exercise, stress, excitement, or a heavy meal

What is a contracture?

The muscle shortens, becomes inflexible, and "freezes" in position. This can cause permanent disability of the limb.

What does an anti-embolic stocking do?

They aid circulation

What does sexual contact include?

This contact includes sexual intercourse, contact of the mouth with the genitals or anus, and contact of the hands to the genitals.

If a client takes another person's medication by mistake call local poison control immediately

Treat an overdose, whether it was accidental or intentional, as a poisoning. Call the local poison control number immediately and send paramedics.

Precautions to prevent urinary tract infections - encourage fluids, showers instead of baths, proper perineal care, & cranberry juice

Urinary tract infections are common. Encourage a high intake of fluids and give extra catheter care as needed.

For a resident who has had a stroke - know what side should lead, what side to stand on, how to refer to the weaker side, and if use of a gait belt is helpful to transfer resident

Weaknesses on the right side show that the left side of the brain was affected. Weaknesses on the left side show that the right side of the brain was affected. Assist the resident on their weaker side, Never use the term 'bad' but use weaker or involved. Always use a gait belt for safety. Stand on the weaker side. Support the weaker (involved) side. Lead with the stronger (uninvolved) side

How to respond to sundowning & violent behavior

When a person gets restless and agitated in the late afternoon, evening, or night. Responses: - Remove triggers. - Avoid stressful situations and limit activity - Set a bedtime and play soft music. - Remove caffeine from diet if present. - Give back massage and distract. - Block blows and NEVER hit back - Step out of reach and call for help if needed. - Do not leave resident alone

Read Guidelines: Myocardial Infarction - re: smoking, diet, exercise, & what type of temperatures to avoid

When blood flow to the heart muscle is blocked, oxygen and nutrients fail to reach cells in that region and waste products are not removed and the muscle cells die. This is called a MI, or heart attack. Generally, residents who have had an MI will be placed on a regular exercise program. Residents may be on a diet that is low in fat and cholesterol and/or a low-sodium diet. Medications may be used to regulate heart rate and blood pressure. Quitting smoking will be encouraged. A stress management program may be started to help reduce stress levels. Residents recovering from a heart attack may need to avoid exposure to cold temperatures.

Are hearing aids, artificial eyes, glasses, & dentures examples of prosthetic devices?

Yes.

"The Dying Peron's Bill of Rights" - should a person's questions be answered honestly?

Yes. I have the right to: • Be treated as a living human being until I die. • Maintain a sense of hopefulness, however changing its focus may be. • Be cared for by those who can maintain a sense of hopefulness, however changing this might be. • Express my feelings and emotions about my approaching death in my own way. • Participate in decisions concerning my care. Expect continuing medical and nursing attentions even though "cure" goals must be changed to "comfort" goals. • Not die alone. • Be free from pain. • Have my questions answered honestly. • Not be deceived. • Have help from and for my family in accepting my death. • Die in peace and dignity. • Retain my individuality and not be judged for my decisions, which may be contrary to the beliefs of others. • Discuss and enlarge my religious and/or spiritual experiences, whatever these may mean to others. • Expect that the sanctity of the human body will be respected after death. • Be cared for by caring, sensitive, knowledgeable people who will attempt to understand my needs and will be able to gain some satisfaction in helping me face my death.