Chapter 6-11 Nursing Assistant Study Guide

Why are the elderly at an increased risk for infection?

1) They are more likely to be hospitalized 2) With hospitalization, they are exposed to hospital related infections 3) Their skin is less elastic-more likely to tear, become dry and fragile, and form pressure ulcers/ wounds from decreased mobility or repositioning and expose the underlying tissue to microorganisms 4) With age comes fragile bones that could more easily break 5) Broken bones could take a long time to heal and the decreased circulation can increase the time to heal wounds.

If a person stops breathing, it is called what? 1)Cardiac arrest 2)Respiratory arrest 3)CPR 4)Sternal Rub

2) Respiratory arrest. In a respiratory arrest, the heart may still be beating, likely not in a normal rhythm, and not for long, unless the airway is restored. Cardiac Arrest is when the heart stops beating. CPR is what you perform when you see a person that is not breathing. (Cardiopulmonary Resuscitation) A sternal rub entails rubbing back and forth quite forcefully to see if the person comes to with that stimulation, or when people "fake" being unconscious for several reasons. It is quite painful and a person that is faking being unconscious usually can't handle it and will wake up.

How long are you supposed to wash your hands? Tell me the proper way to wash them.

20 seconds. You should use a paper towel to turn on the faucet, get your hands and wrists wet, apply soap and apply friction on all surfaces of your hands, making sure to clean under each fingernail, keep hands pointing downwards, and take a new paper towel to turn off the faucet, get another new paper towel to dry hands thoroughly. (Avoid shaking hands off at the end of process).

If one of the residents that has dementia was ordered a restraint, how often do you have to check the resident? How often do you need to take the restraint off and provide care. 1) Check the resident every 15 minutes, Take off restraint and provide care every 2 hours 2) Check the resident every 45 min, Take off restraint and provide care every 6 hours 3) Check the resident every 30 min, Take off restraint and provide cares every 3 hours

A

What is Chain Link 6: A Susceptible Host?

A host is anyone that is uninfected, but could become ill.

What does it mean to be a susceptible host?

A susceptible host is a person that is at an increased risk of an infection.

If you were going to bring your loved one to live in a nursing home, what would make you feel like the nursing home if good? A) The nursing home seems home-like and comfortable, clean, and well kept. B) There are residents that are in dirty clothing clawing at the windows trying to escape. C) There are no doctors, therapists, etc to talk to when you arrive at 8 p.m.. D) You notice a French lady that speaks only French being cared for by a nurse that doesn't know what she is saying.

A)

What are the signs of stroke? A) Facial droop B) A resident insisting to lift a couch because she was a weight lifter back in her day C) A resident asking when she can go home the moment she gets to the nursing home. D)

A) Signs of a stroke: Sudden NUMBNESS or weakness of face (facial droop), arm, or leg, especially on one side of the body. Sudden CONFUSION, trouble speaking or understanding speech. Sudden TROUBLE SEEING in one or both eyes. Sudden TROUBLE WALKING, dizziness, loss of balance or coordination. Sudden SEVERE HEADACHE with no known cause.

How can you show respect to a resident in her room? A) Knock and wait for permission to enter B) Clean up any messes so that the area looks tidy for family and guests C) Make sure that the cords in front of the resident's chair are painted in orange so that the resident doesn't trip D) Keep the room the way the resident wants it, even if there is moldy food, fruit flies, or expired snacks on their tray table.

A) Always know and wait to be asked to enter. It shows respect and gives the resident privacy when needed.

You are about to take care of a resident and in the care plan is states that you need to use Standard Precautions when working with this person. What does that mean? Do you take care of that kind of resident, or do you tell the nurse?

A) I would wear gloves every time I care for the resident, like when I hand them their newspaper, help them answer their phone, assist them into their recliner. B) I would wear gloves any time I would expect to come in contact with their bodily fluids, like when I plan to brush the resident's teeth, wash their perineal area, empty a catheter, or possibly become exposed to blood, urine, or feces. C) I would look up the resident's medical history to see if the person has HIV/AIDS/ Hepatits to determine if I need to wear gloves or not. D) I would wear gloves the entire time that I am caring for a resident and then change them after doing hand hygiene between residents.

When would you expect to give abdominal thrusts to someone? A) When the person is choking B) When the person is short of breath C) When the person is unable to cough (That person cannot cough, speak, or breathe) D) When the person didn't like the dinner she was served and wants it to come back out

A) If you see someone choking you should place your thumb on your dominant hand directly under the sternal notch/breast bone and use your other hand to push up fast and quite forcibly until the object comes out and the person is breathing.

What are some ways that you would be able to prevent infection with the portal of exit mode?

A) Taking a shower B) Covering your mouth when you sneeze or cough C) Wearing gloves even with completely intact skin D) Putting in new contacts every day E) Getting every vaccination possible to prevent disease

What is hand hygiene?

A) Washing hands with soap and warm water or using an alcohol based hand sanitizer.

What type if bed would a person that is at risk for developing a pressure ulcer have? A) An alternating pressure mattress B) An electric bed C) A closed bed D) A bariatric bed

An alternating pressure mattress because the pump that is connected to the bed changes the inflation/ pressures of the mattress frequently to prevent skin breakdown in people that don't move on, or don't move often enough on their own.

What is an example of Chain Link 3: Portal of Exit?

Any open areas of the body that allows microorganisms to exit the body. Examples are the mouth, nose, eyes, cuts in the skin, or genital areas.

What is restraint?

Anything that prohibits a person from being able to move freely. Ex.-string, tape, medications, belts, trays that fit onto wheelchairs, similar to a high chair of a young child, straps that hold the person in bed or in their mobility device like a wheelchair.

When you apply a transfer belt (gait belt) on a resident, where should you put it? A) Directly on their skin B) Around the person's waist C) Around the person's chest D) Around the person's broken arm

Around the waist

What does RACE mean? A) Get out of somewhere fast. B) Rescue Residents, Activate alarm, Contain Fire, Extinguish C) Retain residents for questions, active the fire alarms, call for help, Escape D Run, Alert residents, Climb out the nearest exit, Evacuate

B

You're a CNA and it is your first day on the job. How would you leave the residents room? A) You noticed a spill earlier, but are leaving it for the next staff because you didn't have time to clean it up. B) You would leave the room neat and tidy. C) You would shut and lock the resident's door so that other people can't get in during the night D) You would reorganize the room to meet your sense of fashionable expectations.

B

What if you come upon a resident that has to go to the bathroom "right now" but you don't feel safe lifting him by yourself, would you: A) Take a chance a lift him since you think you should be able to make it that short of distance B) Ask another CNA/Nurse/etc to help you C)You know it's busy and everyone is probably assisting other residents, so you ask the resident if he can walk to the bathroom himself, even though his care plan says 2 assist with occasional mechanical lift as needed.

B) Always ask for help. It's better to have an incontinent resident that can easily be changed, than one who is lying on the floor with injuries and is incontinent, not to mention you will get in trouble for not following the care plan, which could cost you your job.

What does ambulatory mean? A) The person can speak well B) The person can walk C) The person is on precautions D) The person is the smartest of all the residents

B) Ambulatory means being able to walk

Julia has a Hepatitis C which is a blood borne illness. You are concerned that you might have been exposed to her virus. Tell me how you might have been exposed. A) When you gave her a hug and her tears got on your scrubs. B) When you applied a bandage to her draining wound and had an open scratch on your finger, because the nurse asked you to put pressure on the area until she returned with new bandages. C) When she coughed in your face accidentally when you were helping her into bed. D) When she used your pen to write something down and then gave it back to you.

B) When you applied a bandage to her draining wound and had an open scratch on your finger, because the nurse asked you to put pressure on the area until she returned with new bandages.

If a nursing assistant is checking in on a resident and he feels faint how would you help him? A) Call the nurse B) Have the resident lean forward and put their head toward /between their knees C) Leave that resident alone so that the symptoms will get better

B)If your resident states that he or she feels like they are about to faint, have the person lie down, preferably in a position where their head is low and their legs are raised. This will encourage blood flow to the brain. ... If you think someone is about to faint, you should help them lie down or sit with their head between their knees.

How would you provide oxygen safety to a resident that has oxygen? A) Offer her a cigarette as long as she go outside to the smoking area. B) Put the resident next to the fireplace in the lobby so she stays warm and can enjoy the warmth of the fire. C) Remove her from any areas with open flames. D) Apply Vaseline to be applied to the residents nose since it is irritated.

C) A resident that is using oxygen should never be around open flames. Oxygen is flammable and the person using oxygen could start on fire when exposed to an open flame because oxygen can get trapped in the fibers in clothing. Vaseline should NEVER be used on a person with oxygen because it is an oil based petroleum product and is also flammable. There is a chance that if the person is near a heat source that oxygen and vaseline could pose a fire threat.

How would you exhibit proper body mechanics when lifting someone? A) Keep your knees straight so you can lift with your back B) Keep your feet close together to get more support as you lift C) Pushing whenever possible rather than lifting D) Twisting from one side to the other to get the resident moved in the correct alignment

C) Pushing is always better than lifting. If you do have to lift, keeps those knees bent and feet shoulder width apart to put the weight on your legs, not your back.

You just learned about burns and scalds, and now you are putting your knowledge to work. In order to prevent a burn or scald, which option would be the best? A) Put the little 86 year old lady in the bathtub without checking the water temp because she is complaining of being cold. B) Leaving a heating pad on the elderly mans back for 30 minutes at a time, because he has been having severe back pain all day. C) Giving an elderly resident a cup of coffee that she requested as she is walking down the hallway. D) Checking the water temperature of the whirlpool bath an elderly resident is about to take before she gets in.

D) Checking the water temp before putting her in the tub is a great idea. Have the resident test it before she goes in, since everyone has a different temp that they think is too hot or too cold.

What type of accidents would you expect happen most in nursing homes, long term care facilities, or even an older person's own home? A) Poisoning B) Overdoses C) Burns D) Falls E) Wounds

D) Falls

When should you use a restraint? A) Anytime the resident is confused B) Whenever it is convenient for you, so that you can get your work done on time C) Only with the Nurses Order D) Only with the Dr.'s Order

D) Only with the Doctor's order

Who is the Nursing Assistant's Immediate Supervisor? A)The Doctor B) The HUC ( Health Unit Coordinator) C) The CNA that has been at the facility the longest D) The Nurse ( RN or LPN)

D) The Nurse- You are practicing under the RN or LPN's license so the Nurse should be notified before anyone else. She will make the necessary assessments and ensure that residents and staff are safe. The HUC may or may not be a Certified Nursing Assistant. They do more of the scheduling, planning for appointments, and calling to make sure residents have rides to and from appointments, have all of the information necessary for their upcoming appointment etc. The CNA that has been there the longest is at the same rank asana other CNA and cannot make any decisions that you, as a CNA, cannot make.

Which of these options are NOT considered bodily fluids? A) Tears B) Saliva C) Sputum D) Urine E) Sweat F)Semen G) Vaginal Secretions H) Pus or other wound drainage I) Vomit J) Feces

E) Sweat

Where would nursing assistants be able to work? A) Individual Homes B) Assisted Living Facilities C) Long Term Care Facilities D) Hospitals E) Travel Assignments F) None of these G) All of these

G) All of these

If you took care of a resident that was known to have AIDS, but has no open wounds and is not currently displaying any signs of illness, would you use standard precautions, double gloved precautions, contact precautions, or droplet precautions and why?

I would use standard precautions because the person doesn't have any obvious cuts/sores/illness present and we treat everyone's bodily fluids like they could be infected, so we wear gloves.

What is log rolling?

It allows for the resident to be turned in one unit without changing the alignment of the body. Very important to know in someone that may have or has a spinal cord injury. See p. 178 for more details.

What is a carrier?

It is a human or animal that is carrying a disease, but does not display symptoms. A carrier may or may not get the disease later in time.

What is Chain Link 5: Portal of Entry?

It is any area of the body opening of an uninfected person that allows pathogens to enter. These would include the nose, mouth, eyes, and other mucous membranes (genitals, cuts in the skin, placenta-from mother to baby).

Why would disposable equipment be using in healthcare facilities? A) It is less expensive because they don't have to pay someone to wash dishes B) It is safer to use than regular silverware C) It makes everyone's jobs easier D) It prevents the spread of microorganisms

It prevents the spread of microorganisms. You'll see disposable dishes, silverware, etc used if there is every an outbreak of C-diff, or other highly contagious illnesses going through the nursing home

What is the Chain Link 1: Causative Agent

It's a pathogenic microorganism that causes disease. They can be found on the skin, in food, in the air, and in water. Causative agents include: Fungi, Bacteria, Viruses, and Parasites.

What is the Chain Link 2: Reservoir?

It's a place that pathogens live and multiply. A reservoir can be human, animal, plant, soil, or any substance. Warm, dark, moist places are the perfect places for microorganisms to grow, multiply, and thrive. Some microorganisms need oxygen to survive, others do not.

What are the 6 links of infection?

Link 1: Causative Agent Link 2: Reservoir Link 3: Portal of Exit Link 4: Mode of Transmission Link 5: Portal of Entry Link 6: Susceptible Host

How many links of the chain of infection have to be broken to ward off infection?

Only 1 has to be broken.

What is the overbid table used for?

Placing meals and serving them to the resident(Main reason). Anything else that you use it for must have a barrier placed before using. Some men put urinals on it, but that is not a super sanitary act. Just think if you put your dinner right next to a urinal....doesn't sound too appetizing. If it is ok with the resident put the urinal on their bedrail so the person can reach it. Otherwise, it can be stored in their bathroom or bedside stand and they can use their call light to have someone bring it to them and provide assistance if needed.

What is a closed bed? When would you make a closed bed.

Please look up.

What is an open bed?

Please look up.

What is an unoccupied bed?

Please look up.

What is an occupied bed?

Please look up..

How would you carry out dirty linens from a resident's room?

Roll any bed linens away from you and carry them away from you, not allowing them to touch your uniform at any point. You cannot take linens from one room to another, even if you did not need them in the first resident's room. They are considered soiled the moment they enter anyone's room. You must put them in the laundry.

What is shearing?

Rubbing or friction resulting from the skin moving in one way and the bone underneath it remaining in a fixed position or moving in the opposite direction.

How does a person that is in the supine position look?

See P 172

What is the lateral position?

See P 172

What is Fowler's Position? What is semi-Fowlers? What is high Fowlers?

See P 173

What is the SIM's position?

See P. 173

What would it look like if you were in the prone position?

See p. 172

When a resident has a weak side due to having a stroke, spinal injury or other illness/injury, which side would you move first?

See page 183 (Blue Box)

What is the thing the bedside stand is used for? Serving meals Putting all supplies needed to bathe the resident Storing the basins, wash cloths, laundry etc

Storing all basins, toiletries, personal belongings etc

How would you answer a question that the resident has, but you should not answer?

Tell the resident politely that you do not know the answer, but you will have the charge nurse come and she/he can talk to you about the issue.

What areas in the body would be a great reservoirs for microorganisms to grow and multiply?

The Blood and Lungs

Who do you think would be susceptible hosts?

The elderly, people with a poor immune system, people that are stressed or fatigued (students), people that don't have good fluid intake, and people that take certain medications such as chemo, medications for autoimmune diseases, and people with HIV/AIDS, TB, etc.

What is Chain Link 4: Mode of Transmission?

The mode of transmission can occur via droplet, contact, and airborne transmission. The main mode of transmission in healthcare is where? You guessed it--Your HANDS!! That's why we wash them so often.

What is the most important thing you can do to prevent the spread of illness and infection?

Wash your hands!!

If you just put all of your dirty linens in the dirty utility room, what would be the first thing that you would do to prevent the spread of microorganisms and infection.

Wash your hands!!!