Nursing Aide Final Exam

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Link #4 Mode of Transportation: Indirect Contact

*Harmful germs travel by indirect contact with body fluids where germs live, such as: Germs on hands after coughing, sneezing, wiping nose, or using the restroom and then spreading the germs to someone else or to an object that someone else might touch Touching blood, infected wounds, stool, or vomit of infected person, and do not clean our hands properly before going to the next resident or before touching something that someone else might touch

Neglect

- a failure to provide goods and services necessary to avoid physical harm, mental anguish, or mental illness • Dehydration, malnutrition, untreated pressure ulcers, and poor personal hygiene • Unsanitary and unclean conditions, such as being dirty, having to lie in feces or urine, inadequate clothing • Resident's report of neglect

Tort

- a wrong committed against a person or property o Unintentional - did not mean to cause harm o Intentional - did mean to cause harm

Tort

- a wrong committed against a person or propertyo Unintentional - did not mean to cause harmo Intentional - did mean to cause harm

Ombudsman

- every resident living in a North Carolina long-term care facility has access to a person assigned to their district who supports or promotes their interests o District assignments of NC long term care ombudsman - located at

Ombudsman

Misappropriation of property

- illegal or improper use of resident's money, property, assets; by another, without consent, for personal gain • Signs and Symptoms o The sudden appearance of a staff member's name on a bank signature card o The discovery of a forged version of the resident's name o The sudden and unauthorized withdrawal of money using an ATM card or other means o Unexplained disappearance of the resident's personal property or money from the resident's room o Resident's report of missing personal property, assets, or money • Examples o Cashing a resident's checks without permission o Forging a resident's name on documents o Misusing or stealing a resident's money or personal property

Misappropriation of property -

Exploitation

- taking advantage of a resident for personal gain by manipulation, intimidation, threats, or coercion .examples • New friend or caretaker appears to have restrictive control and dominance over resident • Visitors are denied access to resident • New friend or caretakers makes all decisions for resident • Resident mistrusts family members and long-time friends • Signs and Symptoms o Emotionally upset or agitated o Extremely withdrawn, will not talk, or is nonresponsive o Deferent, passive, acting shamed o Depressed, voices feelings of helplessness and hopelessness o Trembling, clinging, cowering, minimal eye contact o Unusual behavior (sucking, biting, rocking) that may be mistakenly attributed to dementia o Resident's report of emotional or psychological abuse

Exploitation

- taking advantage of a resident for personal gain by manipulation, intimidation, threats, or coercion. examples • New friend or caretaker appears to have restrictive control and dominance over resident • Visitors are denied access to resident • New friend or caretakers makes all decisions for resident • Resident mistrusts family members and long-time friends • Signs and Symptoms o Emotionally upset or agitated o Extremely withdrawn, will not talk, or is nonresponsive o Deferent, passive, acting shamed o Depressed, voices feelings of helplessness and hopelessness o Trembling, clinging, cowering, minimal eye contact o Unusual behavior (sucking, biting, rocking) that may be mistakenly attributed to dementia o Resident's report of emotional or psychological abuse

General guidelines to obtain and keep NA certification

-A NA has a certain amount of time from the date he is employed to take the state test. -Must take the state test within 24 months of completing a NA course -Must work for pay during the 24 month certification period. If doesn't, a new training program and examination must be completed -3 chances to pass the state test -A NA must keep certification current. --File a change of address with state agency if move to ensure receival of certification renewal

What are the details of OBRA?

-Designed to improve quality of life of residents living in a nursing home environment - One component of OBRA defines requirements for nurse aide training and competency evaluation, and the nurse aide registry -Defines the minimum standard for nursing assistant training, staffing requirements, resident assessment instructions, and information on rights for residents

Before accepting a delegated task, the nurse aide must ask self:

-Do I have all the information I need to do the task and do I have questions about the task? -Do I believe I can do the task and have the necessary skills to do the task? -Do I have the equipment and supplies I need? -Do I know who my supervisor is and how I can find him/her if needed? -Have I told my supervisor if I need help to do the task?

Physical Abuse

-Hitting, beating, pushing, kicking, slapping, pinching, shaking -Burning -Handling or moving the resident roughly -Withholding personal or medical care -Inappropriate use of drugs and physical restraints -Force-feeding • Signs and symptoms o Resident inconsistent with longstanding values/beliefs o Wills, living wills, trusts, income flow altered with new caretaker or friend as beneficiary/executor o Begins using new bankers, physician, attorneys o Increasingly helpless, frightened, despondent, feeling only caretaker or friend can prevent further decline o Resident does not see true nature of the caretaker or friend

Physical Abuse

Emotional or Psychological Abuse

-Instilling fear through intimidation -Not answering call signal -Mocking or making mean remarks to resident -Sexual harassment -Demands to perform demeaning acts -Verbal threats of harm, insults -Humiliation -Harassment -Treating resident like a baby -Enforced social isolation • Signs and Symptoms o Emotionally upset or agitated o Extremely withdrawn, will not talk, or is nonresponsive o Deferent, passive, acting shamed o Depressed, voices feelings of helplessness and hopelessness o Trembling, clinging, cowering, minimal eye contact o Unusual behavior (sucking, biting, rocking) that may be mistakenly attributed to dementia o Resident's report of emotional or psychological abuse

Emotional or Psychological Abuse

What information is part of the Nurse Aide 1 Registry?

-NAs full name -Home address and other information such as DOB and SSN -The date that a nursing assistant was placed in the registry and results from the state testing -The expiration date of NA's certificate -Info about investigations and hearing regarding abuse, neglect or theft, which becomes a part of a NA's permanent record

ENDING PROCEDURES

1. Confirm Comfort 2. Safety- Call Light- 6 Bed 3. Open Curtain 4. Remove Gloves (If Worn) 5. Report and Record

What are the safety steps when transferring a patient out of bed to wheelchair?

1. Identify yourself by name and resident and greet resident 2. wash hands 3. explain procedure to resident. speak clearly, slowly. and directly. maintain face-to-face contact whenever possible 4. provide for the resident's privacy with a curtain, screen, or door 5. place the wheelchair at the head/foot of the bed (depending on which ever way the resident can easily pivot). the arm of the wheelchair should be almost touching the bed. it should be placed on resident's stronger or unaffected side 6. remove wheelchair footrests close to bed 7. lock wheelchair wheels 8. raise the head of the bed. adjust bed level to lowest position. lock bed wheels 9. assist resident to a sitting position with feet flat on the floor. let resident sit for a few minutes to adjust to change in position 10, put nonskid footwear on resident and securely fasten 11. stand in front of resident. stand with feet about shoulder width apart. bend your knees and keep your back straight 12. place the transfer belt around resident's waist over clothing (not on bare skin). tighten the buckle until it is snug. leave enough room to insert flat fingers/hand comfortably under the belt. check to make sure the skin or skin fold are not caught under the belt. Grasp the belt securely on both sides, with hands in an upward position. 13. provide instructions one at a time to allow resident to help with transfer. 14. with your legs, brace/support the resident's lower legs to prevent slipping. this can be done by placing one of your knees against the resident's knees or by placing both knees against resident's knees 15. on the count of 3, slowly help resident to stand 16. have resident to take small steps in the direction to the chair while turning their back toward the chair. if more help is needed, help resident pivot to stand in front of chair with back of resident's legs against chair. 17. ask resident to put their hands on wheelchair armrests. when the chair is touching the back of resident's legs, help him lower themself into chair. 18. reposition resident so hips touch the back of the chair 19. attach footrest and place resident's feet in them. check for proper alignment and gently remove the belt 20. make resident comfortable 21. leave bed lowered and remove privacy matters 22. leave call bell within resident's reach 23. wash hands 24. be respectful/courteous 25. report any changes in the resident to nurse.

Reservoir groups:

1st group - people not infected, are well and are not a current reservoir for germs 2nd group - people who are infected, are obviously sick, and you know these people might get you sick 3rd group - people who are carriers; have the harmful germs living on or in their body, but germs are not making them sick; because they are not sick, you do not know they have infections; are carriers of infection and do not show symptoms of infection, but can still infect others

The Resident with Cancer - Nurse Aide's Role

a. Resident's needs include: i. Pain relief or control ii. Balance of rest and exercise iii. Fluids and nutrition iv. Prevention of skin breakdown v. Prevention of bowel problems vi. Dealing with side effects of treatment vii. Psychologic and social needs viii. Spiritual needs ix. Understand that each resident is different x. Social interaction xi. Proper nutrition xii. Pain control xiii. Assist with comfort and circulation xiv. Skin care xv. Mouth care b. Observe for and report to the nurse the following: i. Increased weakness, fatigue, fainting ii. Nausea, vomiting, diarrhea iii. Change in appetite weight loss iv. Depression, confusion, change in mental state v. Blood in mouth, urine, or bowel movement vi. Changes in skin, new lumps, sores, rash vii. Increase in pain or pain that is not relieved by medication c. Self-image - may be an issue; hair loss common side effect d. Visitors and family - if visit is positive one, do not intrude; watch for and report negative interactions to the nurse during visits

How do you provide privacy?

Abide by HIPPA and always pull the curtain and or shut the door when assisting the patient Cover when you giving resident care HIPPAA-Health INsurance Portability and Accountability Act. This law set standards for protecting the privacy of patients health information. PHI protects confidentiality. It also passed to facilitate the transfer of payment and research needs

Musculoskeletal System - Normal Findings

Ability to perform routine movements and activities of daily living • Ability to perform full range of motion exercises bilaterally, without pain • Able to perform the following movements • Abduction bilaterally without pain • Adduction bilaterally without pain • Extension of arm bilaterally without pain • Flexion of arm bilaterally without pain • Flexion of leg bilaterally without pain •Pronation • Supination • Dorsiflexion • Plantar flexion • Opposition

Critical Thinking - Questions to Ask

As critical thinkers, the nurse aide should ask questions: • What problem do I need to solve? o Who should be involved in the process? • What information do I need? o How do I determine it is accurate? • How do I solve the problem? o What are the advantages and disadvantages? • What am I missing?

Orthotic Device

Definition - helps support and align a limb, and improves function • Examples include splints, braces, and shoe inserts

Dignity (1) - Nurse Aide's Role

Meet resident's physical, social, emotional, intellectual, and spiritual needs • Explain procedure to resident before beginning task • Respect resident's room and personal items • Be patient and do not rush resident • Encourage resident to make as many decisions as possible • Refrain from judging the resident • Be positive, supportive, and encouraging • Be familiar with preferences • Be empathetic • During interactions with resident, assist resident to maintain and enhance self-esteem and self-worth by o Respecting resident's social status, speaking respectfully, listening carefully, treating residents with respect o Focusing on residents as individuals when talking with them and addressing residents as individuals when providing care o Assisting residents to attend activities of own choosing o Respecting resident's private space and property - HOW? • How can a nurse aide demonstrate respectful behaviors toward a resident's private space and property? o By not changing the radio or television station without the resident's permission o By knocking on doors and requesting permission to enter o By closing doors as requested by resident o By not moving or inspecting resident's personal possessions without permission

Dignity (1) - Nurse Aide's Role

Describe the importance of delegation of tasks to nurse aides.

Nurse uses delegation of skills and legal regulations to assign duties and tasks to others on the health care team Improves efficiency and shows trust in others (but nurse is still accountable) Nurse assesses knowledge/skills of the delegate and matches tasks to skills, using the 5 Rights of Delegation

Pacing and Patience

Pacing - the awareness and adjustment of nursing care based on how slow or how fast a person is functioning • Patience - the ability to put-up with slowness, delay, or boredom without complaining or appearing rushed • Pacing and patience can be used to offset effects of a resident's slowed reaction time • When allowed to take their time and set own pace, residents o Are better able to perform tasks or learn new things o Have time to use their physical and physiological assets to respond to the best of their abilities o Feel better about themselves, feel competent, and feel more in control

5th Stage - Acceptance

Person has worked through feelings and understands that death is imminent; is calm, at peace, and accepts death; may or may not make it to this stage before death; this is the stage that the person begins to get affairs in order - financial and personal; may make plans for the care of others and pets; may plan for the funeral; reaching this stage does not mean death is imminent

Joints - Structure

Point where bones meet • Made up of connective tissue called cartilage that cushions bones; keeps them from rubbing together • Synovial membrane lines joints and secretes synovial fluid that acts as lubricant so joints move smoothly • May be movable (ankle), slightly movable (backbone), or immovable (skull) • Ligaments located here hold bones together • Types - ball-and-socket, hinge, and pivot

Cells - Normal Findings

Reproduce for tissue growth and repair in a controlled and orderly manner

Life in a Nursing Home - Residents

Residents of a nursing home represent a wide range of ages, may stay for a short time or a long time, have a variety of diagnoses, vary in their degree of functional impairment or disability, vary in their level of cognition, and are 75% female

Self-actualization in the Older Adult

Self-actualization may be difficult for older adult due to unmet: • physical needs such as lack of mobility or pain • security needs such lack of privacy or fear • love and affection needs such as social isolation or lack of family support • Self-esteem needs such as negative feelings about self or lack of confidence

OBRA Empowers Nursing Home Residents

The regulation of nursing homes focuses on quality of life for residents and emphasizes their individual rights. Because of OBRA, nursing home residents are more empowered and have a greater say in their own quality of life

Skeleton (Bones) - Function

The skeleton o Provides framework for body o Protects organs of the body • Bones o Allows body to move o Stores calcium o Make and store blood cells (in bone marrow)

Congestive Heart Failure (CHF)

When one or both sides of heart stop pumping blood effectively • All the conditions listed can cause severe damage to the heart muscle, resulting in heart not being able to pump effectively • Left side damage causes blood to back up into lungs; right side damage causes blood to back up into legs, feet, or abdomen • Signs and symptoms - tiredness, weakness, dizziness, rapid or irregular heartbeat, shortness of breath, edema (swelling of feet and ankles), increased urination at night, weight gain • Nurse aide's role - assist to bathroom; respond to call signal promptly; rest periods; intake and output; elastic stockings per order; extra pillows; HOB elevated; weigh resident; range of motion

Laws: Civil

deal with relationships between people

Assault

o Act of threatening to touch, or attempting to touch a person, without proper consent (key is consent) o Example - threatening to "tie a resident down"

Negligence

o Actions or failure to act or give proper care, resulting in injury o Examples - brakes on wheelchair not locked and resident falls, failure to provide water if permitted and resident requests

Negligence

o Actions or failure to act or give proper care, resulting in injury o Examples - brakes on wheelchair not locked and resident falls, failure to provide water if permitted and resident requests

● Define ergonomics and body alignment ?

o Alignment (posture) - how the head, trunk, arms, and legs are aligned with one another, when the back is straight ▪ Maintain correct body alignment when lifting/carrying an object ● • Keep object close to the body ● • Point feet and body in direction you are moving ● • Do not twist at waist o Ergonomics ▪ About proper use of body mechanics ▪ Center of gravity

Prosthetic Device Nurse aide's role

o Devices are usually expensive and should be handled with care o A nurse or a therapist should demonstrate application before this is attempted by the nurse aide o Expect some specific instructions for areas of prosthetic attachment o Observe skin under and near the prosthetic device frequently for signs of skin breakdown cause by pressure and abrasion o Keep any skin under the prosthetic device clean and dry o Provide good skin care to all areas at risk for rubbing by any prosthetic device o Be emphatic or able to identify with and understand how a resident feels; remember the psychological toll the need for a prosthetic device takes on the individual and always support the use of the device

Orthotic Device Nurse aide's role

o Devices are usually specific to the resident and should only be used with that resident o Always be alert for devices that might rub a bony prominence and report immediately o If trained to do so, pad between bony prominence and device

Defamation

o False statement made to a third person that causes a person shame or ridicule, or ruins the reputation o Written is libel o Verbal is slander o Example - saying or writing that a resident is insane

Defamation

o False statement made to a third person that causes a person shame or ridicule, or ruins the reputation o Written is libel o Verbal is slander o Example - saying or writing that a resident is insane

Malpractice

o Giving care for which you are not allowed legally to perform o Example - nurse aide performing treatment only allowed by nurses, such as starting a blood transfusion

Malpractice

o Giving care for which you are not allowed legally to perform o Example - nurse aide performing treatment only allowed by nurses, such as starting a blood transfusion

Vitamins

o Help the body function normally o Body gets majority of vitamins from certain foods o Examples are Vitamins A and C

Minerals

o Help the body function normally o One mineral, calcium, keeps bones and teeth strong o One mineral, iron, helps blood carry oxygen to all parts of the body

● Know correct procedure for taking BP

o Introduce self o Tell why your there o Ask if there is an arm they prefer o Check brachial pulse o Bp cuff has to go over brachial pulse o Cuff is on snog but not too tight o Proper cuff size for pt o Don't pump cuff up more than 180 ml but at least 160

Ethics

o Is knowledge of what is right conduct and wrong conduct, or knowing right from wrong o Inner knowledge that assists us in making choices or judgments

Ethics

o Is knowledge of what is right conduct and wrong conduct, or knowing right from wrong o Inner knowledge that assists us in making choices or judgments

Endocrine • Changes Due to Aging

o Levels of hormones decrease o Insulin production decreases o Body is less capable to deal with stress • Blurred vision

● How do you safely transfer a patient from bed to wheelchair and move them up in bed?

o Lock wheels of chair o Bed is low and locked o Make sure you have a gate belt o Give pt instructions o Pt has skid proof shoe/bootie o Moving pt in bed vie rolling sheet o Bring bed up to working height o Work with another person o And ask pt to work with you as much as possible o Don't drag pt o Pt needs to be off bed about 1 inch

● Recite Beginning & Ending Procedures.

o Method used by nurses to plan and deliver nursing care to the resident ▪ • Assessment ▪ • Nursing diagnosis ▪ • Planning ▪ • Implementation ▪ • Evaluation o Introduce by name a role o Engage pt by name o Explain why you are there/purpose of contact o Check bed: low and locked o Then ask permission to provide care

● What are the risk factors for hypertension?

o Obesity o Poor diet o Inactivity o Consuming a lot of salty food plus not enough water o Poor kidney function o Noncompliant with meds o Large levels of alcohol o genetics

● Know normal and abnormal ranges for all vital signs and medical terminology for abnormal ranges

o Pulse Values Normal = between 60 and 100 beats per minute; regular and strong (document) o Temperature Values (1) ▪ • Oral ● o Baseline - 98.6oF ● o Normal range - 97.6oF to 99.6oF ▪ • Rectal ● o Baseline - 99.6oF ● o Normal range - 98.6oF to 100.6oF ▪ • Axillary ● o Baseline - 97.6oF ● o Normal range - 96.6oF to 98.6oF ▪ • Tympanic membrane ● o Baseline - 98.6oF ● o Normal range - 97.6oF to 99.6oF ▪ • Temporal ● o Baseline - 98.6oF ● o Normal range - 97.6oF to 99.6oF o Respiration Values - Normal ▪ • Called eupnea ▪ • Between 12 and 20 breaths/minute ▪ • Regular ▪ • Quiet ▪ • Both sides of chest equal o Normal Blood Pressure Ranges ▪ • Systolic - 90 mm Hg to 119 mm Hg ▪ • Diastolic - 60 mm Hg to 79 mg Hg ▪ 120 over 80 o O2 ▪ Normal 92-100% ● COPD 87%-92% ▪ Abnormal o Respiration Values - Abnormal ▪ • Bradypnea - less than 12 breaths/minute ▪ • Tachypnea - more than 20 breaths/minute ▪ • Apnea - 0 ▪ • Hypoventilation ● low ▪ • Hyperventilation ● high ▪ • Dyspnea ▪ • Cheynes-Stokes o Abnormal pulse ▪ • Bradycardia - less than 60 beats/minute ▪ • Tachycardia - more than 100 beats/minutes ▪ • Irregular pulse rhythm ▪ • Weak in strength o Abnormal Blood Pressure Ranges ▪ • Elevated blood pressure ● oSystolic - 120 mm Hg to 129 mm Hg AND ● o Diastolic - below 80 mm Hg ▪ • Hypertension ● o Systolic - 130 mm Hg or higher OR ● o Diastolic - 80 mm Hg or higher ▪ • Hypotension ● o Systolic - less than 90 mm Hg ● o Diastolic - less than 60 mm Hg

● What is the definition, Rehabilitation Restorative Nursing Care, PM Care ?

o Rehabilitation - restoration of a resident's highest possible functioning following illness or injury ▪ Aiding to recover back to baseline or new baseline according to their condition or injury o Basic Restorative Care ▪ • Care provided after rehabilitation when the resident's highest possible functioning has been restored following illness or injury ▪ • Goals are to maintain function that has been restored through rehabilitation and to increase independence ▪ Helping them get back to where they used to be --o Assisting a pt to gain as much independence as possible and to provide self-care as possible ● Do as much as they can ● Work on the stuff they cant to o Pm care ▪ Partial bed bath ● Face ● Under arms ● Arms ▪ Mouth care ▪ Peri-care

Code of Ethics

o Rules of conduct for particular group o May differ from one facility to another, but revolves around idea that resident is valuable person who deserves ethical care o Helps employees deal with issues of right and wrong

Immune - Variation of Normal

o Signs of infection - fever, redness, swelling o Anxiety o Nausea and vomiting o Stiff, swollen, painful joints

● How do you prevent skin breakdown and where does it commonly occur?

o Skin breakdown is the breaking down of the bodies largest organ, the skin. It most often occurs in areas of pressure and friction. o The nurse aides role in preventing skin break down include reporting pain levels, providing proper skin hygiene. A good nutrition and food intake also help prevent skin breakdown.

Endocrine • Normal Findings

o Skin warm/dry o No variation of weight, appetite o Awake, alert, oriented

Privacy

o The personal responsibility and activities that prevent the intrusion of one person onto another o Example - pulling suspended curtains completely around a resident's bed during care provides physical barrier from others o Example - lowering one's voice when talking in the hall about a resident's condition

Privacy

Battery

o Touching a person without consent o Example - hitting a resident o Example - performing a procedure that resident refused

Battery

o Touching a person without consent o Example - hitting a resident o Example - performing a procedure that resident refused

False imprisonment

o Unlawful restraining or restricting a person's movement o Example - restraining a person, without authorization or justification o Example - not allowing a person to leave a facility

False imprisonment

o Unlawful restraining or restricting a person's movement o Example - restraining a person, without authorization or justification o Example - not allowing a person to leave a facility

● How do you look professional at work/What do you do if you have a tattoo?

o Where appropriate uniforms o Wear long sleeves or arm sleeves o Wear water proof makeup o Band aids

● What is a Prosthetic Device?

o artificial replacement device for body part that is missing or deformed; improves person's function and/or appearance o ex ▪ prosthetic leg ▪ prosthetic eye ▪ any device that is used in place of an extremity that is missing

● Know definition of diastole

o the phase of the heartbeat when the heart muscle relaxes and allows the chambers to fill with blood.

● Describe good body mechanics when performing bedside care.

o • Raise bed to about waist height when changing linen o Not bending, reaching, or stretching over pt o Use sheet to roll pt

● Identify the Points to Remember When Lifting.

o • When given a choice push or pull, rather than lift o • Use large muscles of arms and thighs o • Move in a smooth motion. Do not jerk the object. o • Face object or person o • Use both arms and hands o Engage your core o Know weight of object o Know distance you have to take that object o Is it a one person move

NA role in oxygen use:

observe skin, vital signs, ensure oxygen is on and in patient's nose properly, no smoking near patient wearing oxygen, no petroleum jelly as a moisturizer,

Link #4 Mode of Transmission: Direct contact

• *One way harmful germs travel is by direct contact with body fluids where germs live, such as o Blood o Sputum (mucous that is coughed up) o Pus or wound fluid (from a cut or sore) o Saliva (or spit) o Stool (or bowel movement) o Vomit • Examples o Needle sticks with blood on the needle o Contact with skin that has a rash, cuts or scratches o Splash or spray of body fluids to the mucus membranes of the eyes, nose and/or mouth

Conversion Problem - Grape Juice

• 120 cubic centimeters (cc) of grape juice in the glass • 1 cc = 1 milliliter (mL) • 120 mL of grape juice in the glass

Standard Precautions

• 1st level is to prevent and control infections • Basic tasks that health care workers must do when caring for EACH and EVERY RESIDENT in order to prevent and control the spread of infection • This means that ALL body fluids, non-intact skin, and mucus membranes are treated as if they were infected

Height Component - Rod

• 2 Units of measure o Inches o Centimeters • 2 sections o Movable upper section o Non-movable lower section • Movable upper section o Raised or lowered to adjust to resident's height o "Read height here" area is the location of the weight value if resident's height is located in this section o Numbers increase from top to bottom • Non-movable lower section o Height read in lower section if resident's height is located in this area o Numbers increase from bottom to top

Transmission-Based Precautions

• 2nd level to prevent and control infections • Specific tasks and measures must be taken when caring for residents who are infected or may be infected with specific types of infections • Nurse aides must follow Standard Precaution rules to protect self, co-workers, and residents from getting infections • 3 types of Transmission-Based Precautions o Contact Precautions o Droplet Precautions o Airborne Precautions

Conversion Problem - Apple Juice

• 8 fluid ounces of apple juice in the glass • 1 fluid ounce = 30 milliliters (mL) • 8 x 30 milliliters (mL) = 240 milliliters (mL) • 240 mL of apple juice in the glass

Do Not Resuscitate (DNR)

• A choice of the resident • A medical order that instructs medical professionals not to perform cardiopulmonary resuscitation (CPR) if the person no longer has a pulse and/or is breathing • Tells health care team that the resident does not wish any extraordinary measures to be used if resident suffers cardiac or respiratory arrest; extraordinary measures - interventions used to restore heart beat or respiratory effort (cardiopulmonary resuscitation or CPR) • Typically written for o A person with a terminal illness o A person who almost certainly could not be saved if CPR was initiated • Legally, the nurse aide must honor the resident's DNR order and not initiate CPR

Conscious Choking Resident

• A common sign that residents are choking is when they put their hands around their throats • Encourage resident to cough as forcefully as possible • Ask someone to get nurse • Stay with person • Follow facility's procedure for clearing an obstructed airway

Coronary Artery Disease (CAD)

• A condition in which blood vessels in the coronary arteries narrow, lowering blood supply to the heart and depriving it of oxygen • Along time, fatty deposits block arteries, which may result in a myocardial infarction (MI or heart attack) • If artery is blocked in brain, a stroke results

Medical Emergency

• A dire situation when a person's health or life is at risk

Personal Protective Equipment (PPE)

• A group of items used by a nurse aide to block harmful germs from getting on skin and clothes • This is what nurse aide puts on at work to keep blood, urine, stool, saliva, and other body liquids off skin and clothes • Type of PPE nurse aide wears depends on o What is being done o What kind of contact there will be with blood, body fluids, non-intact skin, and mucus membranes • Whether the person is on Transmission-Based Precautions (will be talking more about later)

Family

• A group of people related by blood, marriage, or a feeling of closeness

Link #1 Causative Agent

• A harmful germ that causes an infection • Examples - bacteria, a virus, a fungus, or a parasite

The Milliliter (mL)

• A unit of measure in the metric system • Fluids measured using the milliliter (mL) • Another unit of measure used in healthcare is called the cubic centimeter (cc); however nurse aides should use the abbreviation, mL instead of cc when documenting volume of fluid • 1 milliliter is equal to 1 cubic centimeter • Most people are familiar with the teaspoon; there are 5 mL in a teaspoon

Nurse Aide Definition

• A valued, unlicensed member of the health care team, responsible for providing delegated nursing tasks, within a defined range of function for residents (patients, clients) in a variety of settings and who is listed on the NC Nurse Aide I Registry

Disposal of Sharps

• ALWAYS put anything sharp that has been used on a resident in a sharps container (also called - needle disposal container or sharps box), o A special biohazard container used for disposal of sharps o Is hard and leak-proof o Labeled with warning that contents of container are harmful • SAFETY, SAFETY, SAFETY o NEVER, EVER stick your hand or fingers into a sharps container o NEVER, EVER try to cram just one more needle in the sharps container o NEVER, EVER over fill a needle disposal box - it should only be filled ¾ full, and then disposed of

Reproductive - Normal Findings

• Absence of bleeding (other than menses) and vaginal discharge/penile discharge • Absence of pain and itching • Absence of enlargement of prostate gland

Mistreatment of Vulnerable Adult - Points to Remember

• Abuse is cause for immediate dismissal of the perpetrator and posted on Nurse Aide Registry, if substantiated • Not reporting abuse is aiding and abetting

Culture and Communication - NA's Role

• Accept each resident as an individual • Follow the nursing care plan that incorporates cultural and religious beliefs • Demonstrate respect o Greet the resident using his/her title such as Mr., Mrs., Miss and their last name o Do not refer to the resident as sweetie, honey, dearie, gramps or sugar. These terms are disrespectful and degrading. o Attempt to pronounce the name correctly, speak slowly and ask for clarification. • Follow appropriate cultural preferences (eye contact, distance) • Communicate in a non-threatening, therapeutic manner

The Graduate

• Accurate measuring device for fluids when resident is on I&O • Even though graduate is marked in ounces, plus milliliters (mL) or cubic centimeters, fluid for I&O is measured and documented in mL • Measure fluid at eye-level on flat surface • If both intake and output are to be measured with the graduate, two separate graduates are used and labelled Units of Measure for the Graduate • The C.C. (cubic centimeter) side of the measurement scale is used in health care • Recall 1 C.C. on the graduate = 1 milliliter (mL) • Shortest line represents either 25 cc/mL or 75 cc/mL • Longest lines represent multiples of 50 cc/mL

Pain - How Residents Might Describe Pain

• Aching • Burning • Creaky • Dull • Exhausting • Gnawing • Hurting • Miserable • Nagging • Numb • Penetrating • Radiating • Sharp • Shooting • Sore • Squeezing • Stabbing • Stiff • Tender • Throbbing • Tiring • Unbearable

Pneumonia

• Acute infection of tissue of lung or lungs that may be caused by bacteria, virus, or fungus • Signs - high fever, chills, cough, greenish or yellow sputum, chest pains, and rapid pulse • Resident with COPD at great risk for developing pneumonia, especially if weakened; recovery longer for older residents and residents with COPD

Digestive - Normal Findings

• Adequate intake of a well-balanced diet, with fluids • Passage of a brown, soft, formed, tubular shaped stool (feces), without pain • Flat abdomen • Active bowel sounds

Moving to a Nursing Home

• Admission to a nursing home o About 1/3 of men and over 1/2 of women who turn 65 are expected to live in a nursing home before they die o The older adult may fear life in a nursing home more than his/her own death o Older adults often view admission to a nursing home as a series of losses and being forced into unpredictable surroundings in which the only certainty is further loss o Admission is often involuntary and traumatic for the older adult and initiated by a family member

Cancer Treatment - Chemotherapy (or Chemo)

• Affects whole body; cancer cells and normal cells affected • Targeted therapy may be given that can tell the difference between cancer cells and normal cells • May be given orally or intravenously, which may require a port (implanted device in a vein allowing for medications and/or IV fluids to be given and blood drawn) • Be aware of safety needs for health care providers and visitors, specifically handling body fluids; follow directives from care plan and nurse • Side effects depend on drugs used o Hair loss (alopecia) o Digestive disturbances, such as poor appetite, nausea, vomiting, diarrhea, and loss of appetite o Stomatitis - inflammation of the mouth o Decreased blood cell production, resulting in potential for bleeding and infection; weakness and tiredness o Changes in thinking and memory o Emotional changes • Targeting chemotherapy can also raise blood pressure • Nurse aide care directed at minimizing side effects and providing emotional support

Two Ways to Check for an Active Diaphragm

• After inserting ear pieces into ears, tap diaphragm lightly to determine if tap is heard; if tap not heard, rotate chest piece at tubing, and repeat the tap • If chest-piece has an indicator dot, rotate chest-piece so indicator dot is closed

Factors Affecting Temperature

• Age (older lower temperature than younger) • Illness (typically increases with infection) • Stress (causes an increase) • Environment (dependent upon humidity and temperature) • Exercise (causes an increase) • Time of day (lowest in the morning; higher in afternoon and evening)

Dementia and Alzheimer's Disease - Agitation

• Agitation occurs for a variety of reasons • Nurse aides must ensure safety and dignity of agitated resident while protecting safety and dignity of other residents • Interventions o Do not crowd the resident; allow them room to move around while still providing for safety o Ask permission to approach or touch them o Maintain a normal, calm voice • Interventions o Slow down and do not rush the resident o Limit stimulation in the resident's area o Avoid confrontations and force o Avoid sudden movements outside of the resident's field of vision

Critical Thinking - Importance

• Allows the nurse aide to put theory into practice when caring for the resident • Allows the nurse aide to administer care in a safe confident manner • Requires the use of sound judgment in a variety of situations • Helps the nurse aide identify situations that deviate from the norm o Not all nurse aide activities can be specifically directed o Not all situations can be described in a textbook o Scenarios should focus on problem solving

Medical Asepsis

• Also called clean technique • Practices used to remove or destroy microorganisms and to prevent their spread from one person or place to another person or place

Kidney Stones

• Also called renal calculi • Form when urine crystallizes in kidneys • Can block kidneys and ureters causing excruciating pain • Signs include - abdominal pain, flank or back pain, painful urination, frequent urination, blood in urine, nausea, vomiting, chills, fever • Urine straining - process of pouring urine into a fine filter strainer to catch any particles; if found, save, and report to nurse

Cardiovascular

• Also called the circulatory system • The continuous movement of blood through the body

Special Diets

• Also called therapeutic or modified diet • Ordered by the doctor and planned by dietician with input from resident • May restrict or totally eliminate certain foods or fluids, based on illness (i.e. Celiac Disease), in preparation for procedures, or to meet nutritional needs

ABC's of Correct Body Mechanics - Alignment

• Also known as posture • How the head, trunk, arms, and legs are aligned with one another, when the back is straight • Correct body alignment allows the body to move and function efficiently and with strength • When you stand up straight, a line can be drawn straight down through the center of your body and the two sides of body are mirror images of each other, with body parts lined up naturally, arms at the side, palms directed forward, and feet pointed forward and slightly apart (also called anatomic position) • Important to maintain correct body alignment when sitting and lying down • Maintain correct body alignment when lifting/carrying an object o Keep object close to the body o Point feet and body in direction you are moving o Do not twist at waist

Digestive

• Also known as the gastrointestinal (GI) system • Extends from the mouth to the anus • Has 2 functions: digestion and elimination

Balance Bar and Balance Window

• Always ensure that the balance bar is floating freely and in the center of the window when upper/lower bars are set on 0 and resident is not standing on scale • If balance bar is off-center and/or touching the window when upper and lower bars are set on 0 and resident is not standing on scale, do not weigh resident and notify the nurse

Types of Dementia

• Alzheimer's disease - most common cause of dementia. Thought to be caused by clumps of proteins (referred to as tangles) in the brain • Vascular dementia - can occur when blood circulation to the brain decreases as a result of a stroke or another problem, damaging blood vessels in the brain • Dementia with Lewy bodies - deposits of protein that develop throughout the brain. These protein deposits damage and kill nerves in the brain over time. • Mixed dementia -

Angles

• An angle is formed when 2 lines meet • Angles are measured in degrees or abbreviated, o • The bed frame and head of bed are the 2 lines used to determine the angle of the bed

Myocardial Infarction (MI, Heart Attack)

• An emergency situation when all or part of the blood flow to the heart muscle is blocked and oxygen and nutrients cannot reach cells in the area • Waste products are not removed; muscle cells in the area die • Area may be small or large, depending on which artery is involved • If resident survives, cardiac rehabilitation is ordered

Psychological Effects of Aging - Definition

• An exploration of feelings, emotional stress, physical, psychosocial and psychological adjustments that are part of the aging process

Healthcare-associated infection (HAI)

• An infection that a resident gets while staying or living in a health care setting (nosocomial infection)

Checking Respirations - Equipment

• Analog watch with a second hand • Note pad/assignment sheet and pen

Assistive (Adaptive) Devices for Eating

• Angled utensils - for limited arm or wrist movement (pictured) • Sipper cup (pictured) • Large grip handled utensils (pictured) • Plate with lip around the edge - keeps food on plate • Snap on food guard - keeps food on plate

Link #5 Portal of Entry

• Any opening on a person's body that allows harmful germs to enter • Germs can usually get in the same way they got out • Portals of entry are also portals of exit • Examples of portals of entry include: o Nose and mouth - person breathes in harmful germs o Gastrointestinal tract - when person eats food or drinks liquids that have harmful germs in them o Breaks in skin that allow harmful germs to enter, such as open sore, cut, needle stick, and cracked skin

Spills on Surfaces

• Any time blood or body fluids get on any surface, you must clean surface with whatever product is provided at the facility • You must follow facility procedures and product instructions very closely • Examples of surfaces that may need to be cleaned include over-bed tables, wheelchairs, counter tops in utility rooms, and shower chairs

Link #3 Portal of Exit

• Any way or route that harmful germs escape from the reservoir • Examples o The nose and mouth - harmful germs leave in mucous droplets and saliva (or spit) o The gastrointestinal tract - harmful germs leave in stool or vomit o Skin - harmful germs leave through direct contact or in blood, pus, or other liquids that come from inside of body

Hazard

• Anything in the resident's environment that may cause illness or injury Examples - burns, poisoning, suffocation, equipment, fire, falls

Communication - Appropriate methods

• Appropriate communication includes: o Use words that mean the same to the sender and receiver o Use words that are familiar o Be concise o State information in an organized, logical order o State facts and be specific

Microorganisms

• Are also called germs • Live almost everywhere - both inside and outside the body • Some help and others cause problems or diseases • Requirements to survive o Warmth o Moisture o Some need oxygen to live (aerobic) and others do not (anaerobic) o Tissue to feed on • Examples - bacteria, viruses, parasites, fungi • Cause infections

Cells - Structure and Function

• Are building blocks of the human body • Have same basic structure; function, size, and shape may differ • Need food, water, and oxygen to live and function • Microscopic in size • Divide, grow, and die, renewing tissues and organs • Reproduce for tissue growth and repair in an orderly manner • Combine to form tissue

Basic Human Rights

• Are protected by the Constitution of the United States • Right to be treated with respect, live in dignity, pursue a meaningful life and be free of fear • Examples of infringement of these rights - addressing residents as children, using demeaning nicknames for residents, leaving door open during bath, threatening a resident with harm

Religions

• Are recognized throughout the world o Buddhism, Christian, Hindu, Islam, Jehovah's Witness, Jewish, Mormon (these are only a few) • Play a vital role in the resident's life • Impact whether a resident accepts or rejects medical treatments and care • Are misunderstood due to lack of knowledge

Laws

• Are rules made by government to help protect public • Person liable if laws not obeyed and may be fined or jailed • Two types o Criminal - offenses against the public o Civil - deal with relationships between people

Pain - Common Causes

• Arthritis • Cancers • Headache pain • Ischemic pain • Neuropathic pain • Osteoporosis and associated fractures • Pain associated with contractures • Pain from other medical causes including ulcer disease, urinary tract infection, angina, constipation • Phantom limb pain • Physical therapy • Pressure sores • Recent surgeries • Wound dressing changes

Aspiration

• Aspiration (recall the definition) - the accidental breathing in of food, fluid, vomit, or other object into lungs • Can cause pneumonia or death • Nurse aide's role in preventing aspiration o Place resident in upright position at 90 degree angle for eating and drinking, and at least 30 minutes afterward o Feed slowly o Avoid distractions o Offer small amounts of food o Offer bite of food, then sip of liquid, repeat o If one side is paralyzed, place food in non-paralyzed side of the mouth o Make sure food is swallowed after each bite before next bite/sip o Provide mouth care after meals o Report signs of aspiration immediately - gagging, vomiting, clutching throat (classic sign of choking), cyanosis, shortness of breath or difficulty breathing; unconsciousness, complaints of chest pain or chest tightness o Provide thickened liquids, per directive from nurse

The Nursing Process - NA's Role

• Assist the nurse in collecting information through interactions with the resident. o Obtain heights and weights, vital signs, record intake and output • Encourage the resident to participate in meeting established goals • Provide care determined to positively impact the wellbeing of the resident o Turn, reposition, toilet, assist with activities of daily living (ADLs) • Report observations to help the healthcare team determine if priorities and goals are met o Document accurately to assist the nurse with evaluating interventions o Nurse relies on observations by nurse aides to assist with evaluation o Most important part during intervention stage is to accurately report reactions to interventions o If intervention does not work, nurse modifies nursing care plan

The Nursing Care Plan - NA's Role

• Assist the nurse with collection of data o Through observation and working with the resident • Report how the resident responds or reacts to interventions o If an intervention does not work, nurse modifies nursing care plan • Accurately report reactions to interventions • Nurse relies on nurse aides to assist with evaluation

Resident Sexuality - Nurse Aide's Role

• Assist to maintain sexual identity by dressing resident in clothing of choice • Assist with personal hygiene • Assist to prepare for special activities by dressing up (selecting attractive clothing, styling hair in a special way, applying cosmetics, wearing a special perfume or aftershave) • Help to develop a positive self-image • Respect resident's sexual orientation and gender identity o Use transgender resident's chosen name and pronouns such as he, she, or other pronoun of choice o Encourage resident to talk about their "family members of choice." o Avoid assuming all residents are heterosexual or straight - it deprives residents of dignity and respect • Show acceptance and understanding for resident's expression of love or sexuality (provide privacy, always knock before entering a resident's room at any time, assure privacy when requested) • Accept the resident's sexual relationships • Respect Do Not Disturb signs • Refrain from gossiping and breaking confidentiality about resident's sexuality • Avoid viewing expression of sexuality as disgusting or cute - it deprives residents of dignity and respect • Provide protection for the non-consenting resident • Be firm but gentle in your objection of a resident's sexual advances

Preventing Falls - Nurse Aide's Role

• Assist with ambulation when necessary • Provide appropriate assistance/supervision • Keep environment free of clutter • Keep all walkways free from rugs, cords, boxes, and equipment • Observe frequently • Report unsafe conditions immediately • Make sure call signal is always within resident's reach • Answer call signals promptly • Properly position residents in chairs and/or beds • Wipe up spilled liquids immediately • Pick up litter and place it in the proper container

Caring for Residents Who Are Demanding - Nurse Aide Role

• Attempt to discover factors responsible for behavior • Display a caring attitude • Listen to verbal and nonverbal messages • Give consistent care • Spend some time with the resident • Agree to return to see the resident at a specific time and keep your promise

Types of Joints - Function

• Ball-and-socket - allows movement in all directions; made up of rounded end of one bone fitted into the hollow end of another bone; examples - hips and shoulders • Hinge - allows movement in one direction; example - elbow and knee • Pivot - allows turning from side to side; example - skull connected to spine

Basic Human Needs

• Basic human needs - elements necessary for survival and physical and mental well-being • Nurse aides should be aware of ways to meet resident's basic human needs for life and mental well-being • Note that the term, "physical," is used in place of the term, "physiological," when discussing basic human needs

What are the job responsibilities of a Nurse Aide 1?

• Basic nursing skills • Personal care skills • Interpersonal skills

Cell Theory

• Basic unit of all living tissues or organisms • All living organisms made of cells • Cellular function is essential process of living things • Cells have several functioning structures called organelles, that carry on work of cell

Height Component - Head Piece

• Becomes active when extended upward in preparation for measuring the resident's height • Lowered and placed on resident's head and height measured • Becomes at rest when flat and low against height rod

The 30o Lateral Position

• Bed is not raised more than 30o • Pillows are placed under head, shoulder, and leg • Position lifts up the hip to avoid pressure on the hip at about a 30o angle • Person does not lie on hip as with the side-lying position

Pressure Injury - Residents at Risk

• Bedfast (confined to bed) residents • Requires some or total help moving (coma, paralysis, hip fracture) • Agitated or have involuntary muscle movement • Urinary or fecal incontinence • Exposed to moisture • Poor nutrition; poor fluid balance • Lowered mental awareness • Problems sensing pain or pressure • Have circulatory problems • Are older • Are obese or very thin • Refuse care • History of pressure injuries

Dementia and Alzheimer's Disease - Behavior Issues

• Behavior - an observable, recordable, and measurable physical activity o People with normal brain function have the ability to control responses o People with Alzheimer's disease and dementia have lost much of this ability • Behavior is a response to a need o The resident is frequently unable to express his or her needs because of cognitive losses o Nurse aides must be attentive to gestures and clues demonstrated by the resident o Every behavior is a response to a need or situation o Gestures, sounds, and conversation may reveal trigger to the behavior o As verbal skills diminish, behavior becomes the communication method • Before choosing a specific behavioral intervention, trigger of behavior must be identified • Triggers may be environmental, physical, or emotional o Environmental triggers - rearrangement of furniture, increased number of people in facility, change in daily schedule o Physical triggers - new medications, infections, pain o Emotional triggers - may include reactions to loss, depression, frustration, self-perception, past life events, personality • Effective behavior management o Identifying trigger o Understanding trigger o Adapting environment to resolve behavior • Changing the environment (such as reducing excessive noise and activity) or providing comfort measures (such as rest or pain medication) may reduce behavior • Intervention must meet needs of resident while maintaining respect, dignity and independence • Successful behavioral interventions o Preserve resident's dignity o Helps staff gain confidence, improve morale, and increase job satisfaction • Behavior control also assists in reducing use of restraints, decreases abuse and neglect, and increases family satisfaction • Common behaviors o Wandering o Sundowning o Depression o Disorientation to person, place, and/or time o Inappropriate sexual behavior o Emotional outbursts o Combativeness (hostility or tendency to fight) o Inappropriate toileting (use of inappropriate areas for toileting, such as a plant) o Easy frustration o Repetitive speech or actions o Swearing, insulting, or tactless speech o Shadowing (following others) o Withdrawal o Hoarding (hiding objects or food) o Sleep disturbances o Paranoia and suspiciousness o Delusions and/or hallucinations o Decreased awareness of personal safety o Catastrophic reactions (extreme emotional responses such as yelling, crying, or striking out that seem out of proportion to the actual event)

Dementia and Alzheimer's Disease - Key Words About Behavior Issues

• Behavior - how a person acts • Catastrophic reaction - an extreme response • Delusion - a false belief • Depression - a loss of interest in usual activities • Paranoia - an extreme or unusual fear • Sundowning - increased agitation, confusion and hyperactivity that begins in the late afternoon and builds throughout the evening • Trigger - an event that causes other events • Wandering - moving about the facility with no purpose and is usually unaware of safety • Alzheimer's disease progresses in stages and so does behavior

Pain - Importance

• Believing what the patient says will lead to more effective evaluation and treatment of pain

Lifting an Object off the Floor

• Bend hips/knees and get close to object before lifting • Face object • Grip object firmly with both hands • Move smoothly and not jerky • Lift by pushing up with strong leg muscles • Use wide base of support Get help when needed

Reproductive System - Variation of Normal

• Bleeding other than menses • Pain • Vaginal/penile discharge • Itching

Osteoporosis

• Bones lose density causing them to become porous and brittle; bones break easily • Caused by lack of calcium in diet, lack of regular exercise, decrease in mobility, decrease in female hormones • Signs - low back pain, stooped posture, becoming shorter, and broken bones • Nurse aide's role - to prevent or slow progress encourage walking and simple exercise per care plan or nurse's directive; move resident carefully

Weight Indicators

• Both upper and lower bars have movable weight indicators • The weight indicator for the lower bar fits into the groove as weight is obtained

Weight and Height

• Both weight and height are measured on admission to the facility • Units of measure o Weight may be measured using pounds or kilograms, per facility policy o Height may be measured using feet and inches or just inches, per facility policy; centimeters typically are not used • After admission o Height typically not measured again o Weight measured per facility policy or per doctor's order; as directed by nurse and care plan - daily, weekly, monthly

Bowel and Bladder Training - Points to Remember

• Bowel and bladder retraining can be accomplished • Staff must be consistent and follow the plan • Recording and reporting vital to success of both bowel and bladder retraining • Success can take 8 to 10 weeks

Bowel Movement

• Bowel movement is called feces or stool or simply, BM • The passage is called defecation or bowel elimination and involves the movement of the feces from the large intestines out of the body through the anus • Semi-solid material made of water, solid waste, bacteria, and mucus • Number of bowel movements a person has dependent upon age and what the person has eaten • Iron supplements can cause a dark black color; red food coloring, beets, and tomato juice can cause a red color • Descriptors o Diarrhea - liquid stool o Constipation - inability to have a stool or infrequent, difficult, and possibly painful elimination of a hard, dry stool o Flatulence - gas o Incontinence (of stool) - not able to control bowels, leading to an unintentional, spontaneous passage of stool

Respiratory Values - Abnormal

• Bradypnea - less than 12 breaths per minute • Tachypnea - more than 20 breaths per minute • Apnea - none (apnea) • Hypoventilation - slow, shallow breathing that may be irregular • Hyperventilation - rapid, deep breathing • Dyspnea - painful or difficult breathing • Cheyne-Stokes - alternating periods of slow, irregular breathing and rapid, shallow breathing, plus short periods of apnea • Document and notify nurse

Integumentary System - Variation of Normal

• Breaks in skin • Pale, white or reddened areas • Black and blue areas • Changes in scalp or hair • Rash, itching or skin discoloration • Abnormal temperature • Swelling • Ulcers, sores, or lesions • Dry or flaking skin • Fluid or bloody drainage

Fracture

• Broken bone caused by an accident or osteoporosis • Closed (does not break the skin) or open (also called compound and breaks through the skin); • Most common - fractures of arms, wrists, elbows, legs and hips • Goal is to put bone back in alignment, so it can heal; bone tissue grows and fuses area together, but must be allowed to do so by not moving area by typical use of a cast • Signs - pain, swelling, bruising, limited mobility • Nurse aide's role - prevention in falls crucial, follow fall prevention concepts; cast - elevate arm or leg slightly higher than level of heart; observe circulation of fingers or toes (warmth, color, movement of fingers or toes); report swelling, tightness of cast, sores, cool fingers or toes, drainage or bleeding; report irritation from edges of cast; keep cast dry and assist with personal care per directive of care plan or; nurse; monitor and report if resident sticks objects in the cast

Self-esteem Needs of the Resident

• Call resident by name he or she prefers • Praise accomplishments • Discuss current issues • Request resident's opinion • Show respect and approval • Assist to dress and help with grooming • Encourage independence and socialization • Share goals

Respiratory Values - Normal

• Called eupnea • Rate = between 12 and 20 breaths per minute , • Regular, quiet, with both sides of chest rising and falling equally • Document

Calories

• Calorie is energy value of a food or beverage • Shows the number of calories in one serving • Most people who are trying to lose weight are concerned with calories

Effects of a Fast Pace on an Older Resident

• Can negatively affect older resident's ability to learn something new, perform a task, or maintain motivation to complete an activity • Older residents tend to be more cautious and less willing to respond quickly in situations where they think they might fail • Some may choose not to even do task because of fear of failure

The Importance of the Nursing Process

• Care is organized, individualized and has purpose • Care is consistent • Resident feels safe and secure • Assists healthcare team members to deliver care

Role of the Nurse Aide in Regards to Prevention of the Mistreatment of Vulnerable Adult

• Care of personal property o Handle possessions carefully o Report observed theft o Add any new possessions to list of resident belongings, per facility policy o Mark items with resident's name o Do not accept tips or ask for tips • Review key terms and understand what must be reported to nurse • Recognize signs/symptoms of various types of abuse, neglect, and misappropriation of funds • If abuse is observed by another health care provider, stop abuse and report immediately to nurse • Report questionable practices by others to nurse

Role of the Nurse Aide in Regards to Prevention of the Mistreatment of Vulnerable Adult

The Nursing Process & Nursing Care Plan

• Care of the resident is a process that constantly changes. It requires teamwork, effective communication, accurate observations and detailed reporting. • The resident's health and wellbeing are dependent upon the entire team

What to Report - NA's Role

• Care or treatment given, the time, and resident's response • Observations - what is normal and what appears to be abnormal; noticeable changes • Conversations with resident during treatment/activities that cause concern or appear to be out of the ordinary • Unusual actions/behaviors that deviate from the normal or from previous actions • Observations must be reported to nurse IMMEDIATELY • Resident complains of sudden or severe pain • Change in resident's ability to respond - a responsive resident no longer responds, or a non-responsive resident who now responds • Change in resident's mobility - inability to move a body part, or improved ability to move a body part • Change in vision; pain or difficulty breathing; difficulty swallowing • Change in facial responses/appearance, drooping eyelid, crooked smile, drooling • Complaints of numbness in lips, arms, other areas • Vomiting • Bleeding • Bloody stools, change in bowels or urine • Unusual odors • Vital signs that are outside the resident's normal range or differ from normal ranges that were taught • Change in skin color, sore or reddened area

Basic Restorative Care

• Care provided after rehabilitation when the resident's highest possible functioning has been restored following illness or injury • Goals are to maintain function that has been restored through rehabilitation and to increase independence

Devices That Collect Output

• Catheter bag -Connected to indwelling (Foley) catheter which drains bladder of urine -Emptied into a measuring device at end of shift (or sooner, if full) - Measurement done using measuring device instead of catheter bag; measurement markings are not as accurate as a graduate • Urinal - A plastic, elongated device, angled at the top and used by men to urinate into, particularly when confined to bed or on output - Meant for single-resident use - As a measuring device, it is marked in ounces and cc (same as mL), with 100 cc (mL) increments marked lines and 50 cc (mL) unmarked lines between • Commode hat - A plastic collection container placed under the commode lid - Used when resident has bathroom privileges and o Is on output and/or o Has a urine or stool specimen ordered -As a measuring device, it is marked in ounces and cc (same as mL) and has a grooved edge allowing for ease of emptying into the commode - Important for resident to not put toilet paper into the hat/pan, but into the commode • Emesis basin - A plastic, shallow basin shaped like a kidney that fits against the resident's neck and collects body fluids - Used o During mouthcare o When a resident is nauseated -As a measuring device, it is marked in ounces and cc (same as mL), with 100 cc (mL) increments

Shingles (Herpes Zoster)

• Caused by a virus; same virus that causes chicken pox; virus is inactive in nerve tissue and can become active years later; most common in people over 50 • Signs - rash or blisters on one side of body, burning pain, numbness, and itching; lasts about 3 to 5 weeks; Centers for Disease Control (CDC) states that the following should avoid contact with infected resident: never had chicken pox or immunization, have a weakened immune system, is pregnant never had chicken pox or immunization • Infectious until lesions are crusty • Nurse aide's role - per directive of care plan, keep rash covered until crusty, remind resident to wash hands often and avoid scratching or touching rash; vaccine recommended for people 60 years or older who have had chicken pox

Cells - Variation of Normal

• Cell division and growth are out of control developing into a mass or clump of cells • Tumor - growth of abnormal cells; may be benign or malignant o Benign (non-cancerous) - do not spread to other body parts; may grow large, but nonlife-threatening; do not grow back when removed o Malignant (cancerous) - invade and destroy nearby tissues; can also spread to other parts of body (metastasis) by breaking off and travelling; may be life-threatening; may grow back when removed; can occur almost anywhere in or on the body, but commonly occurs on skin and in the lung, colon, breast, prostate, uterus, ovary, bladder, and kidney

Centers for Disease Control and Prevention - CDC

• Centers for Disease Control and Prevention (CDC) is an agency of the federal government in charge of the control and prevention of disease in our country • Works to protect the public by helping keep members of the public healthy and safe by education • Developed a two-tiered or two-level way to prevent and control infections in health care - Standard Precautions and Transmission-Based (Isolation) Precautions

The Brain - Cerebellum and Brain Stem

• Cerebellum o Controls balance and regulates voluntary muscles o Produces and coordinates smooth movements • Brain Stem o Regulatory center o Controls heart rate, breathing, swallowing, opening/closing blood vessels

Developmental Tasks of Aging - Skills

• Certain skills that must be mastered during a stage of development • Late adulthood tasks include o Adjustment to retirement, reduced income, death of friends, death of spouse, physical changes, loss of independence o Creating new friendships and relationships o Loss of vitality o Integrating life experiences o Preparation for death

Cancer - Seven Warning Signs

• Change in bowel or bladder habits • A sore that does not heal • Unusual bleeding or discharge from any body opening • Thickening or lump in breast or elsewhere • Indigestion or difficulty swallowing • Obvious change in a wart or mole • Nagging cough or hoarseness

Nervous - Variation of Normal

• Changes in gait or movement • Complaint of loss of feeling or inability to move one side of the body • Paralysis • Seizures • Confusion • Speech, vision, or hearing changes • Complaints of numbness, dizziness, nausea

Urinary System - Variation of Normal

• Changes in urine o Color, cloudiness, odor, amount, frequency may indicate infection o Presence of sugar, acetone, blood, sediment in urine • Weight loss or gain • Swelling in arms or legs • Dysuria - pain or burning during urination • Swelling in bladder or abdomen • Pain in kidney or back • Incontinence • Fever

Vital Signs - Importance

• Changes in vital sign measurements can indicate that resident's condition is worsening • Can reflect how body is responding to medication and/or treatment • The value of a vital sign may be the basis for a medication that the nurse gives to the resident • Accuracy when taking vital signs is crucial; never guess; if unsure ask for help • Report abnormal vital signs immediately to the nurse and per facility policy

Poor Nutrition - Characteristics

• Changes in weight • Poor skin color and appearance • Dull looking hair, eyes and skin • Irregular elimination habits • Poor sleep patterns • Abnormal conditions, such as osteoporosis or anemia • Tired

Stealth Respirations

• Check respirations right after checking pulse (without moving hand from wrist) so resident does not realize respirations are being counted; tend to change pattern if resident is aware it is being checked

Restraints - Definition and Types

• Chemical, physical or mechanical methods used to restrict freedom of movement or normal access to one's body o Chemical: drugs or drug doses used to control behavior or restrict movement (F605) o Physical: any manual method, physical or mechanical device, material or equipment attached to or near an individual that cannot be removed easily and restricts freedom of movement or normal access to one's body (F604) • Cloth or leather o Soft cloth or mesh is used most often o Leather is used for extreme agitation and combativeness and is applied to wrists and ankles

Gastroesophageal Reflux Disease (GERD)

• Chronic condition when liquid contents of stomach back up into esophagus; very inflammatory and can damage the lining of esophagus • Heartburn most common symptom caused by weakening of sphincter muscle joining esophagus to stomach; if untreated, cause ulceration • Nurse aide's role - follow care plan; evening meal eaten 3 to 4 hours before bedtime; should remain upright 2 to 3 hours after eating; provide extra pillows; dietary modifications may also help

Asthma

• Chronic inflammatory disease occurs when respiratory system is hyperreactive (reacts quickly and strongly) to irritants, such as pollen and dust • Exercise and stress can worsen • When bronchi become irritated from the irritants, they constrict, making it difficult to breathe • Responding to irritation and inflammation, mucus membranes produce thick mucus; further inhibiting breathing because air gets trapped in lungs causing coughing and wheezing • Residents with asthma should avoid triggers (irritants)

Ulcerative Colitis

• Chronic inflammatory disease of large intestine; serious condition that can result in a colostomy • Colostomy - a surgically created opening (stoma) through the abdomen into large intestine to allow stool to be expelled into a bag affixed to the abdomen

Chronic Obstructive Pulmonary Disease

• Chronic, progressive disease-causing trouble breathing, particularly getting air out of lungs; include chronic bronchitis and emphysema o Chronic bronchitis - irritation and inflammation of bronchi usually caused by smoking; signs - productive cough that brings up sputum (phlegm) and mucus, breathlessness, and wheezing o Emphysema - chronic disease of lungs usually results from chronic bronchitis and smoking; signs - problems breathing, coughing, breathlessness, and rapid heartbeat; no cure and irreversible; is usually on oxygen • When lungs do not get enough oxygen, all body systems affected; resident with chronic lung disease may live in constant fear of not being able to breathe causing them to sit upright in attempt to improve lung expansion; have poor appetites, do not sleep well, leading to further weakness and poor health; feel out of control; fear suffocation • COPD signs - chronic cough or wheeze, difficulty breathing, sob during exertion, pale cyanotic reddishpurple skin, confusion, weakness, difficulty in finishing meal because of sob, fear and anxiety

Spills on Floor

• Clean up spills based on procedures listed in facility's infection prevention policy or notify housekeeping, if necessary (and available) • In general o Put on gloves o Absorb spill o Clean area with correct product, following directions on the product label o Discard waste in appropriate container (a biohazard bag if spill involves body fluids) o Apply disinfectant to area, following directions of product o Place warning cone or sign to warn others if there is wet surface • Why are spills on the floor involving body fluids especially dangerous in a long-term care facility? • Spills that involve body fluids are a safety threat in the long-term care facility for two (2) reasons o Falls o Risk of infection

Qualities of an Effective Team

• Climate - informal, comfortable, and relaxed; members are interested and involved • Communication - open and two-way, ideas and feelings encouraged • Interactions - inclusive and trusting; people like each other and like working with each other • Goals and tasks are appropriate, understood, and modified so that work gets done • Leaders lead and members participate in a respectful and cooperative manner • Everyone pulls together - high levels of inclusion, trust, liking, and support • Problem-solving is high - when a problem arises, people consult with appropriate resources and work to resolve problem

Qualities of an Ineffective Team

• Climate - tense • Communication - closed and one-way; ideas and feelings are discouraged; members are hesitant to speak up • Interactions - Based on authority only; people with more power dominate and look down on people they feel are unequal and undeserving of their time • Goals - unclear, misunderstood, or forced; may result in not getting the job done • Decision-making - done by the highest authority with minimal group involvement • Trust - distrust among members and members forced to conform • Getting along - disagreements or conflicts are ignored, denied, suppressed • Problem-solving - low; criticism is destructive; members are attacked; job doesn't get done

Dementia and Alzheimer's Disease - Key Terms

• Cognition - ability to think quickly and logically • Confusion - inability to think clearly, causing disorientation and trouble focusing • Irreversible - disease or condition that cannot be cured • Onset - the time when signs and symptoms of a disease begins • Progressive - the way a disease advances

Life in a Nursing Home

• Cognitively impaired residents are housed with cognitively intact residents o Cognitively intact and cognitively impaired residents share the same dining hall in most nursing homes and may be a shock to the cognitively intact (such as residents drooling or spitting) o Programs and activities are often the same for cognitively intact and cognitively impaired residents, and often very simple and very basic - and not very challenging o Residents may be frightened by erratic screams, moans, or repetitive sounds from other residents

Restraints - Understanding the Need

• Communicate, explore, observe and inquire about the resident's current and past medical history to gain understanding of the need for restraints • Consider how the following may influence the decision for use of restraints: o Pain, mental/physical illness/impairments, injury, discomfort o Uncomfortable clothing, wound dressings, body positioning o Anger/Loss of control o Fear of environment, family members, caregivers, selfimage, death o Phobias, obsessions o Sleep disorders o Confusion, disorientation o Hunger, thirst, temperature changes

Dementia and Alzheimer's Disease - Communication Strategies Used by Nurse Aide

• Communication strategies to use when communicating with residents that have dementia o Listen carefully and encourage them; do not talk down to them, nor talk to others about them as if they were not present o Minimize distractions and noise o Allow enough time for resident to process and respond; if they have difficulty explaining something, ask them to explain in a different way o Monitor body language to ensure a non-threatening posture and maintain eye contact o Nonverbal communication is very important to dementia residents o Choose simple words and short sentences, and use a calm tone of voice o Call the person by name and make sure you have their attention before speaking o Keep choices to a minimum in order to reduce resident's frustration and confusion o Include residents in conversations with others o Do not make flat contradictions to statements that are not true o Change the way responses are made to avoid confusion, frustration, embarrassment, and behavioral outbursts o Use of communication devices (such as a picture board, books, or pictures) encourages resident's independence and decreases frustration

Dementia and Alzheimer's Disease - Communication Tips by Nurse Aide

• Communication tips to use when caring for resident with Alzheimer's disease o Be calm and supportive o Focus on feelings, not facts o Pay attention to tone of voice o Identify yourself and address the resident by name o Speak slowly and clearly o Use short, simple and familiar words, and short sentences o Ask one question at a time o Allow enough time for a response o Avoid the use of pronouns (e.g., he, she, they), negative statements and quizzing o Use nonverbal communication, such as pointing and touching o Offer assistance as needed o Have patience, flexibility and understanding

Incident Report - Points to Remember

• Complete the report as soon as possible • Reporting and recording events of the incident is a protective rather than punitive measure •Documentation is reviewed by management and members of the healthcare team o Becomes part of the resident's records o Is used to track how/if the resident becomes negatively impacted from the incident • New policies and procedures may be established to prevent future incidents

Chronic Pain

• Considered chronic when it is long-term, lasting for six months or more • Often comes on gradually, people may have a hard time pinpointing when it started and/or describing it to others • Chronic pain serves no purpose since it continues after the healing process is complete • Diagnosing the cause of chronic pain can be difficult and may persist despite treatment • When people are experiencing chronic pain, the source of their discomfort may not be obvious to others; they may just seem depressed. This is because chronic pain can slow down the body, causing

Contracture and Muscle Atrophy

• Contracture - the muscle or tendon shortens, freezes, becomes inflexible; causes permanent disability • Muscle atrophy - the muscle wastes away, decreases in size, and becomes weak, from disuse • Prevention of these two conditions critical; perform range of motion exercises; use positioning and supportive devices to maintain structure and function of extremities

Nervous System -

• Control and coordinate all body functions • Reflex centers for heartbeat and respiration • Senses and interprets information from outside the body and responds to needed changes both inside and outside the body Consists of two main divisions o Central nervous system (CNS) - brain and spinal cord o Peripheral nervous system - includes nerves that travel throughout the body

De-escalation of a Resident Who is Cognitively Impaired While Keeping Self and Others Safe

• Control the environment o Stand with feet 18 inches apart and to the side of the resident; keep a distance of 6 feet o Move others out of harm's way o Remove objects that could harm o Watch client without touching o Keep client safe • Look for meaning of the behavior and be a detective o Address feelings, not just words o Look at body language and facial expression o Given what is known about the resident, what might the behavior mean? • Check for underlying causes because all behavior has meaning o Physical or medical conditions (for example, pain, infection, hunger, medications) o Social or emotional triggers (for example, resident was startled, nurse aide with bad mood sensed by resident, losses, feeling threatened) o Environmental conditions (for example, loud and hectic area, too hot/cold, change in preferred schedule, around people resident doesn't like) • Respond in person's reality o Redirection - draw attention to another subject o Explore triggers of behavior o Engage in resident's story (for example, if resident is upset about husband who passed away years ago not coming to pick her up today, comment that the resident must really care about her husband and ask her to talk about husband)

* End of Life Care - Culture and Religion

• Culture and religion provide framework within which personal experiences with death take on meaning • Personal experiences, culture, religion, and age influence resident's individual set of beliefs in ways that may differ from nurse aide's personal beliefs about death • Nurse aide must not impose beliefs upon the resident who is dying, the family, or those people close to the resident who is dying • It is important for team to discover specific, cultural issues in order to provide respectful care to resident who is dying • Individuals from different cultures appreciate being asked about practices. Health care team may ask: o Who is allowed to provide personal care? (In some cultures, a member of the opposite sex cannot provide care) o Does the resident or family have any special customs? o Are there specific post mortem customs that the staff should know? • Some cultures believe dying at home is preferable while others fear death at home • Chinese culture o Traditional healing practices include using herbal preparations given only once o Autopsy and disposal of body are not permitted by religion; therefore, organ donation encouraged o Japanese culture - number four means death, so getting medication four times a day could be problematic • Vietnamese culture o Believe in reincarnation, so quality of life is more important than length of life • Hindu culture o Persons are often accepting of God's will o Desires to be clear-headed at time of death o Prayer helps deal with anxiety and conflict o Blood transfusions, organ transplants, and autopsies are allowed o Cremation is preferred o Believes in reincarnation

Cultural Food Preferences and Dietary Restrictions

• Culture influences dietary practices, food choices, and food preparation • Many Buddhists are vegetarians, but some may include fish in their diet • Some Christians, mostly Roman Catholics, do not eat meat on Fridays during Lent • Mormons may not drink alcohol, coffee, or tea. • Many Jewish people eat kosher foods, but do not eat pork, lobster, shrimp, or clams (shellfish). Kosher food is prepared according to Jewish dietary laws. Kosher and non-kosher foods cannot come into contact with the same plates. Jewish people who observe dietary laws may not eat meat at the same meal with dairy products • Muslims do not eat pork. • *When consuming fowl it must be prepared according to their religious practice. • They may not drink alcohol. • Muslims observe regular periods of fasting as part of their religious practice.

Weights of Residents in Long-term Care Facilities

• Current standards of practice in long-term care facilities recommend weighing resident on admission or readmission (to establish a baseline weight), weekly for the first 4 weeks after admission, and at least monthly thereafter to help identify and document trends such as weight loss or gain • Crucial that weight is obtained accurately and consistently so comparisons along time are more reliable o Facility-wide scales must be calibrated and functioning appropriately o A consistent process in place

Death

• Death is natural conclusion to life • Death may be sudden and unexpected or expected • Resident's response to death is based on personal, cultural and religious beliefs and experiences; affects both emotions and behavior • A nurse aide's feelings about death affect the care given • Because nurse aides are often the caregiver closest to the resident, the nurse aide must understand the dying process and know how to react and approach the resident with care, kindness, and respect

Urinary - Changes Due to Aging

• Decreased kidney size and ability to filter blood • Decreased capacity, elasticity, muscle tone of bladder • Decreased ability to concentrate urine • Difficulty or incomplete emptying of urinary bladder • Enlargement of prostate in males • Many awaken several times at night to urinate • Sense of thirst lessens, resulting in less intake, resulting in less output which may lead to dehydration

Digestive - Changes Due to Aging

• Decreased number of taste buds • Slowing of peristalsis causing constipation • Slower absorption of nutrients • Loss of bowel muscle tone • Loss of sphincter muscle tone • Digestion takes longer and less efficient • Thinning of stomach lining • Decrease in saliva causing difficulty chewing and swallowing • Decrease in amounts of digestive enzymes and saliva production • Decrease in appetite • Loss of teeth • Altered taste and smell • Proteins, vitamins, and minerals not absorbed as well

Resident's Rights

• Defined o Residents have same legal rights as all citizens of the United States plus legally protected Resident's Rights o Rights that have been written into federal law (OBRA) that identify how a resident must be treated while living in a long-term care facility o Provides a code of ethics for health care providers o Posted in long-term care facility and given to resident/legal representative on admission

Resident's Rights

Orthostatic Hypotension

• Defined - abnormal low blood pressure that occurs when the resident suddenly stands up; complaints of feeling weak, dizzy, faint and seeing spots before the eyes • May be a complication from being on bed rest - Process • Nurse aide may be asked to take an orthostatic blood pressure measurement; process includes: o BP checked while lying down, record in note pad o Have resident sit up, wait 2 minutes, check BP, record in notepad o Have resident stand up, wait 2 minutes, check BP, record in notepad o Record and report findings to nurse • Throughout process, nurse aide should check to see if resident is feeling weak, dizzy, faint, or seeing spots - Prevention • Per care plan and directive from nurse o Increase activity in stages: bed rest then sitting on side of bed (dangling) then walking o Before standing, while sitting on side of bed (dangling), have resident cough/deep breathe and move legs back-and-forth in circles, 1 to 5 minutes o Ask resident to report weakness, dizziness, faintness, or seeing spots

Body Temperature

• Defined - amount of heat created by the body; balance between the amount heat produced and the heat lost • Is typically stable • Produced - created in the body when cells use food for energy • Lost to the environment - through skin, breathing, urine, and stool - Terminology • Fever - an elevated temperature • Febrile - with a fever • Afebrile - without a fever • Thermometer - device used to measure body temperature • Fahrenheit (F) and Centigrade (C) - scales used to measure temperature; stated in degrees (o)

Nurse Aide's Role in Performing Postmortem Care

• Defined - care of the body after death and is done to maintain a good appearance of the body • Begins when resident is pronounced death • Consult with nurse to find out if o Dentures are inserted or left out and placed in denture cup o If rings are removed and secured per policy or left on o The family wants to view the body • Within 2 to 4 hours after death, rigor mortis develops; important to position in normal alignment before rigor mortis occurs • Understand that because post mortem care involves movement of the body, air may escape from the lungs and expelled from the intestines causing sounds to be heard; do not let these sounds scare you as they are normal and to be expected • Wash body and comb hair; put on gown and cover perineal area with a pad • Position body in supine position, legs straight and arms folded across abdomen with one pillow under head • Each facility has its own policy regarding post mortem care; nurse aides must follow this policy and perform only tasks delegated to them

Seizure

• Defined - involuntary contractions of muscles; small area or entire body; caused by abnormal electrical activity in the brain • Main goal - keep resident safe

End of Life Care and Key Terms

• Defined - support and care provided during the time surrounding death; may last days, weeks, or months • Terminal illness - an illness or injury from which the person will not likely recover; a terminal illness ends in death • Dying - the near end of life and near cessation of bodily functions • Death - the end of life and cessation of bodily functions • Post mortem care - care of the body after death

Elopement

• Defined - when a resident leaves a health care facility without the staff's knowledge • At risk for exposure to heat or cold, drowning, getting struck by a car, dehydration • Facility must have a plan in place in case a resident elopes

Analog Watch

• Definition - a watch that has moving hands and typically marked with from numbers 1 through 12 • Has an hour hand, minute hand, and second hand • The nurse aide uses the second hand to count respirations and pulse rate • When counting respirations for 60 seconds, while watching the second hand, start counting and stop counting on the same number o Start with second hand on 3, stop with second hand on 3

Dementia or Delirium?

• Delirium and dementia are often confused • Remember, delirium is sudden, severe, and usually reversible; dementia is progressive and irreversible • A resident who has dementia may experience delirium; immediately report any sudden change in behavior or a sudden increase in behaviors associated with dementia to the nurse - a resident with dementia may be experiencing delirium

Mood Disorders

• Depression may cause a loss of interest in activities once enjoyed, such as eating, sleeping, and work. The individual may suffer intense emotional and physical pain. If left untreated, depression may lead to suicide, especially in older adults. • Bipolar disorder is a condition in which an individual has mood swings and changes in energy levels including the ability to function. The mood swings can alternate from extreme activity (a manic episode) to periods of deep depression (a depressive episode). • Schizophrenia interferes with an individual's ability to interact with others, make decisions, think normally, and communicate clearly. Individuals who experience hallucinations may see someone or something that is not really present or hear a conversation that is not real. Individuals who experience delusions may believe that other people are controlling their thoughts

Incident Report - Guidelines

• Describe in detail what was seen or heard • Document the time the incident occurred • Describe the person's reaction to the incident • State the facts; do not include opinions • Describe the action taken to give care • Describe the outcomes noted from actions taken

Dehydration - Nurse Aide's Role

• Determine preferences of fluids and offer fluids each time nurse aide enters room • Assure water pitcher and cup are within reach • Measure and record I&O accurately, if ordered • Force fluids (encourage to drink more fluids), if ordered by the doctor • Observe for and report signs and symptoms of potential dehydration and presence of dehydration o Warning signs for dehydration - drinks less than six 8-ounce glasses of fluids per day; drinks little or no fluids during meals; needs help drinking fluids; has trouble swallowing fluids; has fever, vomiting, diarrhea; complaints of thirst, dry mouth; decrease in urinary output o Signs/symptoms of dehydration - rapid, weak pulse; irregular heartbeat; low blood pressure; dark, strong-smelling urine, in small amounts; severe thirst; dry mouth and mucous membranes; cracked lips; warm, dry, wrinkled skin; flushed face; constipation; weight loss; weakness, dizziness, confusion; headache; irritable

Determining and Documenting Food Intake - Importance

• Determining intake of meals accurately is important in identifying the resident at risk for or already experiencing impaired nutrition • Food intake is one of the factors that reflects the resident's nutritional status • Poor food intake at meals or changes in food intake that persists for multiple meals may indicate an underlying problem or illness and should be reported to the nurse • Much of a resident's daily fluid intake comes from meals; when resident has decreased appetite, can result in fluid/electrolyte imbalance. • The nurse aide compares the amount of food that was eaten with the amount of food served • To measure food intake, the nurse aide needs a basic understanding of percentages in relation to a whole, which is 100%

Communication - NA's Role

• Develop skills that enhance effective communication o Use appropriate verbal and non-verbal communication skills o Listen to what is being said o Ask questions for clarification and acknowledge understanding o Avoid interrupting o Do not express personal opinions or disapproval o Develop patience o Reduce or eliminate environmental distractions o Understand and use silence appropriately and in a supportive manner

USDA's MyPlate

• Developed by U.S. Department of Agriculture • It recommends balancing the intake of healthy food choices and physical activity • Designed to help people easily build a healthy plate during meal times • Shows the amounts of each food group that should be on a person's plate during meals • Emphasizes vegetables, fruits, grains, protein, and low-fat dairy • Think about halves - make half your plate fruits and vegetables; and make half your grains whole grains • Advocates drinking water instead of sugary drinks • Replaces the MyPyramid • Make half your plate fruits and vegetables • Vegetables - choose a variety of colored vegetables • Fruits - choose whole fruits - fresh, frozen, dried, or canned in 100% juice • *Grains - make half your grains whole grains • Dairy - choose low-fat or fat-free milk or yogurt • Protein - mix up your protein foods to include seafood, beans and peas, unsalted nuts and seeds, soy products, eggs, and lean meats and poultry

Caring for Residents with Developmental Disabilities - Nurse Aide Role

• Diagnoses may include mental retardation or cerebral palsy • Treat the individual with respect and dignity • Encourage residents to make personal choices, do as much as possible for themselves, use age appropriate personal skills, achieve their potential, interact with others • Do not act as resident's parent, create dependency, label or categorize residents • Provide privacy • Build resident's self-esteem

Digestive - Variation of Normal

• Difficulty swallowing or chewing • Poor intake of diet and fluids • Weight gain or loss • Loss of appetite • Abdominal pain and cramping • Blood, pus, mucus, or other discharge in stool • Incontinence • Nausea and vomiting • Heartburn • Liquid stool (diarrhea) or hard stool/inability to pass a stool (constipation) • Pain when having a bowel movement • Whitish, black, or red colored stool (unless food or iron supplement related)

Alzheimer's Disease - Stage 4 - Moderate Decline

• Difficulty with simple math • Poor short-term memory (may not recall what they ate for lunch) • Inability to manage finances

Types of Thermometers

• Digital - oral, rectal, axillary • Electronic - oral, rectal, axillary • Tympanic - ear • Temporal - forehead • Non-mercury, liquid-filled glass (oral - green tipped) • Non-mercury, liquid-filled glass (rectal - red tipped)

Maintenance of Respect, Dignity and Quality of Life

• Dignity - respect and honor • Independence - ability to make decisions that are consistent, reasonable and organized; having the ability to perform activities of daily living without assistance • Quality of life - overall enjoyment of life • Respect - treated with honor, show of appreciation and consideration • Every human being is unique and valuable, therefore, each person deserves understanding and respect • Dementia does not eliminate this basic human need • Person-centered care maintains and supports the person regardless of level of dementia • Residents' abilities, interests, and preferences should be considered when planning activities and care • As the disease progresses, adjustments will be required in order to maintain dignity • Important for staff to know who the resident was before the dementia started • An individual's personality is created by his/her background, including o Ethnic group membership (race, nationality, religion) o Cultural or social practices o Environmental influences, such as where and how they were raised as children o Career choices o Family life o Hobbies • Encourage residents to participate in activities and daily care, but avoid situations where resident is bound to fail • Humiliation is disrespectful, degrading, and can increase likelihood of disruptive behaviors • To promote independence, do things with resident rather than for them • Allow time for residents to express feelings and take time to understand what they are feeling • Provide emotional support • Long-term care facilities must provide care for residents in a manner and an environment that promotes maintenance or enhancement of each resident's dignity, respect, and quality of life

The Nature of Dignity

• Dignity is our inborn (inherent) value and worth as human beings; everyone is born with it. All people have the right to be recognized for their inherent humanity and treated ethically • After people learn about dignity, a remarkable thing happens. Everyone recognizes that we all have a deep, human desire to be treated as something of value • Dignity has the potential to change the world. Nurse aides have the potential to change the world where they work by treating each individual, both residents and members of the health care team, with dignity

The Nature of Dignity

Acquired Immune Deficiency Syndrome (AIDS)

• Disease caused by a virus, HIV and attacks the immune system and destroys infection-fighting and cancer fighting cells of the body • Spread through body fluids including blood, semen, vaginal secretions, and breast milk

Benign Prostatic Hypertrophy (BPH)

• Disorder common in men over age of 60 • Prostate gland enlarges and causes pressure on urethra • Signs - frequent urination, dribbling of urine and difficulty beginning to urinate • Urinary retention (when urine remains in bladder) may occur, which can cause urinary tract infection; urine can further back up into the ureters and kidneys creating damage to structures • Nurse aide's role - report signs of infection in urine and elevated temperature to nurse; provide perineal care or assist with care as needed

Caring for Residents who are Combative - Nurse Aide Role

• Display a calm manner • Avoid touching the resident • Provide privacy for out-of-control residents • Secure help if necessary • Do not ignore threats • Protect yourself from harm • Listen to verbal aggression without argument

Dementia and Alzheimer's Disease - Disruptive Verbal Outbursts

• Disruptive verbal outbursts are one of the most persistent behaviors in a long-term care facility. These outbursts may include: o Screaming o Swearing o Crying o Shouting o Loud requests for attention o Negative remarks to other residents or staff (including racial slurs) o Talking to self • Anger and aggression are often the visible symptoms of anxiety and fear. • Interventions o Reassure residents that they are safe o Redirect their attention to an activity o Assist residents with toileting, feeding or fluids o Move residents to a quiet area • Notify nurse immediately of aggressive behaviors that may threaten other residents and/or staff and stay with the resident

Brain - The Cerebrum

• Divided into right and left hemispheres o Right hemisphere controls movement and function of left side o Left hemisphere controls movement and function of right side o Any illness or injury to right hemisphere affects function of left side; any illness or injury to left hemisphere affects function of right side • Cerebral cortex - outer layer; ideas, thinking, analysis, judgment, emotions, memory occurs, guides speech, interprets messages from senses, controls voluntary muscle movement • Each side of your brain contains four lobes. o The frontal lobe is important for cognitive functions and control of voluntary movement or activity o The parietal lobe processes information about temperature, taste, touch and movement o The occipital lobe is primarily responsible for vision o The temporal lobe processes memories, integrating them with sensations of taste, sound, sight and touch

Blood Pressure - Nevers

• Do not take blood pressure on an arm with an IV, dialysis shunt, or other medical device in place • Avoid taking blood pressure on a side that has been injured or burned, is paralyzed, has a cast, or has had a mastectomy

OBRA

• Do you remember when Ms. Smith, the state surveyor, knocked on your door when you were a resident of Happy Care Nursing Home? • There actually are Ms. Smiths in our State who inspect nursing homes • Recall learning about OBRA and how OBRA was major legislation that was passed to protect residents in nursing homes and to assure that they would receive quality care and have a quality life • The law requires States to have a survey and certification process in place, whereby each nursing home is surveyed annually to determine compliance with federal regulations • The survey is unannounced and performed annually to review quality of care as indicated by an evaluation of criteria including medical, nursing, and rehabilitative care; dietary services; infection control; pharmacy services; physical environment; incidents of abuse, neglect, and exploitation; and resident-centered care planning • Variety of methods are used during survey - observations of staff providing care, resident/family interviews, evaluation of environment for safety and cleanliness, and records review • Based on findings of the state surveyors, the nursing home can get a clean bill of health and found to be in compliance; or may be subject to fines, denial of federal funds, or at the extreme - closed

Physician Orders for Life-sustaining Treatment (POLST)

• Doctor's order stating what treatments are to be used when person is very sick Includes medical measures the resident wants to receive and not those to be withheld • Based on conversations between the resident and the doctor - beliefs, goals, diagnosis, prognosis, and options (that include benefits and detriments for each option); decisions become medical orders

Electronic Recording - NA's Role

• Document as per facility policy • Use the mouse and drop-down boxes or touch-screen • Sign electronically as per facility policy • Always maintain confidentiality

Body Mechanics - Importance

• Due to nature of their duties, nurse aides are subject to back and other injuries to the body so practicing correct body mechanics is critically important • Maximizes strength, minimizes fatigue, avoids muscle strain and injury, and assures personal and resident safety • Job requirements for nurse aide include lifting, moving and carrying objects • Reduces costs to resident and facility • Reduces employee absences due to back injuries • Reduces liability for the facility due to workman's compensation • By not using proper body mechanics, even picking up piece of paper from the floor can cause back injury

Bowel and Bladder Training

• During bowel training, enemas, laxatives, suppositories, and stool softeners may be ordered • Enemas involve the introduction of fluid into the colon to eliminate stool or feces or stimulate bowel activity o Enemas will be ordered by the doctor o The order for an enema may be found on the nursing care plan o Common varieties of enemas include: tap water, saline, soapsuds o Usually contains approximately 500 ml of the ordered fluid. o Commercially prepared enemas usually have about 120 ml of fluid that contains additives designed to soften the stool so it can be more easily passed o Hiring facilities will train the nurse aide to administer an enema before the nurse aide is delegated the task

Screening of Pain: When to Ask Residents About Pain

• During personal care • During transfers and ambulation • Following activities • At appropriate times after pain management therapies • Are you in pain, uncomfortable, hurting? • Where is the pain? Ask the resident to point to area • When did the pain start? • How long does the pain last; how often does it occur? • How bad is the pain? Pain scales: use the one available at facility (examples - 0-10 Numeric Rating Scale, Wong-Baker Faces Pain Rating Scale) • Does pain come and go? • Have you had this pain before? What helped relieve it? • Do you remember what you were doing when the pain started?

Dysphagia

• Dysphagia is difficulty in swallowing • With dysphagia, there is a danger in aspiration • Causes of dysphagia o Illness, such as stroke o Some medicines o Problems with mouth and throat muscles o Weakness o Problems with teeth or dentures •Signs/symptoms of dysphagia o General - eats very slowly, frequent throat clearing - "ahem," and decrease in appetite o Avoids - eating and certain textured foods o When eating/drinking - vomits or chokes, has problems with breathing, eyes water, spits out food pieces, has difficulty with chewing, has difficulty swallowing small pieces of food (or pills), suddenly spits out food, and has to swallow several times when eating a single bite of food o During/after meals - drools or dribbles food or fluid from mouth, pockets or keeps food inside mouth or cheeks, coughs, gurgles when talking, and food/fluid comes up into or out of the nose o Complaints - heartburn, food getting stuck, and hoarseness after eating

Tympanic Thermometer

• Ear • Registers temperature in seconds • May need practice to operate accurately

Body Mechanics

• Efficient and safe use of the body by the coordination of body alignment, balance, and movement

Elderly are at Risk for Injury

• Elderly are at greater risk for injury and rely on health care team to keep them safe o Knee joint instability o Decreased strength o Slower movement o Medication side effects, such as dizziness, drowsiness, etc o Low blood pressure o Impaired coordination o Hearing impairment o Reduced sense of smell and touch o Visual impairment o Cognitive impairment causing poor judgment and misperceptions

Assistive (Adaptive) Devices for Hygiene

• Electric toothbrush (pictured) • Denture care kit (pictured) • Fingernail brush (pictured) • Extra-long sponge (pictured) • Device used by residents with diabetes o To examine heels for abrasions and sores o To wash feet

Abnormal Blood Pressure Values

• Elevated blood pressure ranges (likely to develop high blood pressure unless steps are taken to control the blood pressure) o Systolic (top number) - 120 mm Hg to 129 mm Hg AND o Diastolic (bottom number) - below 80 mm Hg • Hypertension - consistent elevated systolic or diastolic values o Systolic (top number) - 130 mm Hg or higher, OR o Diastolic (bottom number) - 80 mm Hg or higher • Hypotension - too low systolic and/or diastolic values o Systolic (top number) - less than 90 mm Hg o Diastolic (bottom number) - less than 60 mm Hg • Always document on the record and report abnormal blood pressures to nurse

Dementia and Alzheimer's Disease - Catastrophic Reaction

• Emotional, environmental, or physical triggers may result in a catastrophic reaction • Catastrophic reactions are out-of-proportion responses to activities or situations • Warning signs of a possible reaction o Sudden mood changes o Sudden, uncontrolled crying o Increased agitation o Increased restlessness • Outburst of anger (physical or verbal) Interventions include o Speak softly and gently in calm voice o Protect resident, self, and others as necessary o Remove the person from a stressful situation o Avoid arguing with the resident o Avoid the use of restraints o Redirect the resident's attention o Change activities if the activity is causing the reaction Interventions that should not be used include o Arguing with resident or other staff members o Speaking loudly to resident or other staff members o Treating resident like a child o Asking complicated questions o Using force or commanding resident to do something • Caregiver behaviors that should be encouraged and used to decrease or prevent use of restraints o Maintaining calm and non-controlling attitude o Speaking softly and calmly o Asking one question at a time and waiting patiently for the answer o Using simple, one step commands, and positive phrases o Avoiding crowding resident with more people than needed for the task o Providing a distraction, such as an activity or music

Basic Restorative Care - Importance

• Emphasis on maintaining and/or improving existing abilities • Important to prevent any further complications • Aimed at moving individual toward independence as much as possible and to encourage residents do as much as they can, as long as they can, as often as they can • Team effort to assist resident to develop a productive lifestyle • Important to assist individual to accept or adapt to limitations that cannot be overcome

Arthritis - Nurse Aide's Role

• Encourage activity, follow care plan, canes, safety rails helpful; • Encourage independence by assisting with use of devices that help with bathing, dressing, and feeding; offer clothing choices that are easy to put on and fasten; treat each resident individually; • Help maintain self-esteem by encouraging self-care as much as possible, listen • Watch for and report stomach upset and heartburn, due to medicine

Encouraging Self-actualization in the Older Adult

• Encourage resident to meet new people • Assist residents to attend presentations or activities such as guest speakers and musical performances in the facility or on a field trip • Discuss plans for trying something new • Offer praise when resident succeeds at something new • Encourage creativity in music, art, poetry, writing • Offer audiobooks and/or music playlist with playback devices if available • Spend time with resident to discover what activities are meaningful to the resident; ask resident, "What matters to you?" and/or "What matters to you today?" to start a conversation; report information gained to the supervisor to share with other members of the team • Support resident in experiencing treasured activities after resident shares what matters such as enjoying outdoor life with a walk or socializing with others

Caring for Residents Who Are Agitated - Nurse Aide Role

• Encourage to talk about fears • Remind resident of past ability to cope with change • Encourage to ask questions about concerns • Involve in activities that promote self-esteem • Observe for safety and to prevent wandering • Assign small tasks • Use reality orientation

Family Support

• Encouragement, assurance, and a sense of connection for the resident offered by blood relatives or groups of individuals close to the resident

Ethics - End of Life Care

• End of life decision making usually follow resident's individual ethical principles • Nurse aides must respect fact that resident has right to make own self-determination regarding end of life decisions and may differ from nurse aide's own personal ethics • Resident has o Right to refuse medical intervention at end of life o Right to request everything possible in order to prolong life

Ethics - End of Life Care

Providing Drinking Water - Concepts

• Ensure resident's name and room number is labeled on ice pitcher • Check for cracks and chips in water pitcher and cup when filling; also make sure they are clean; replace when needed • Never touch inside or rim of cup and pitcher • Never take resident's used water pitcher directly to ice machine; can transmit germs • Never scoop ice with resident's watcher pitcher • Always place ice into the water pitcher first, then fill with water

Systemic Infection

• Entire body part or system • Symptoms −Fever −Chills −Fatigue −Nausea, vomiting Example - respiratory infection

Interpersonal Skills

• Essential skills used by a person when working with others • Determined by standards and values, culture and environment, heredity, interests, feelings, expectations others have for us, and past experiences • In a health care setting, generally refers to a health care provider's ability to get along with others while getting the job done

Critical Thinking

• Exercising or involving careful judgment based on facts and observations • Required to provide safe, competent care to residents in a variety of situations • Developed through real-life experiences, education, communication, observation and practical application • Incorporated into thought processes and daily activities

Sexuality

• Expressed by individuals of all ages; sexual needs and desires continue throughout life • May be expressed in a variety of ways such as sexual intercourse, caressing, touching, holding hands, masturbation • Some ways to show feminine or masculine qualities is through choice of clothing styles and colors, hairstyles, hobbies and interests, sexual habits, and gestures • Illness, disability, or living environment may affect needs and desires

Facility Restraint Practices

• Facilities have practices that are considered forms of restraints • Side rails - used to keep resident from voluntarily getting out of bed • Tucking in or using Velcro to hold a sheet, fabric, or clothing tightly is used to restrict a resident's movement • Placing a resident in a chair (such as a Geri-chair/recliner) to prevent from rising • Placing a chair or bed so close to a wall that the wall prevents the resident from rising out of the chair or voluntarily getting out of bed • Placing a walker out of reach to discourage the resident independence • Be aware of ways residents may be restrained

The 5th Vital Sign - Pain

• Facilities may consider pain the 5th vital sign because it is considered as important as the other vital signs • Whereas other vital signs are objective (collected by the nurse aide's senses), pain is different because it is subjective and reported to health care provider by the resident • Pain is whatever the resident says it is and response to pain varies from resident to resident • Will learn more about pain later in the course

Facility Restraints

• Facilities may unintentionally use methods to help ensure resident safety which may be viewed as restraints • It is important to recognize items that can restrict residents and prevent them from being mobile • Communicate concerns to the nurse in a professional manner • Consider the use of: o Over-bed table - placed across a resident sitting in a chair or wheelchair o Sheets - placed around and under a resident o Geri-chair o Wheelchair locked - when the resident is unable to unlock it

Culture - Knowledge: Family

• Family o Living together in one unit o Living in separate locations (other cities, states or countries) o Being isolated • Can be supportive/destructive during illness

Alzheimer's Disease - Stage 3 - Mild Decline

• Family members and friends may begin to notice cognitive problems • Difficulty finding the right word during conversations • Difficulty organizing and planning • Difficulty remembering names of new individuals

Restraints - Federal and State Laws

• Federal and state laws are in place to protect residents • Accrediting agencies help oversee and enforce the laws o Code of Federal Regulations (CFR) o North Carolina Administrative Code o Centers for Medicare and Medicaid Services (CMS) o Food and Drug Administration (FDA) o The Joint Commission (TJA) o The Safe Medical Devices Act (SMDA) applies if a restraint causes illness, injury, or death • Remind students that while laws are meant to protect and can't be enforced unless concerns are accurately reported

Pelvic Organ Prolapse

• Female reproductive organs held in place by muscles and connective tissue; pelvic organs may drop down (prolapse) into vaginal canal o Cystocele - when bladder drops down o Rectocele - when rectum shifts downward o Uterine prolapse - when uterus shifts downward • Incontinence may occur • Conditions range from mild to severe • Women may have tried Kegel exercises to attempt to tighten pelvic muscles • Nurse aide's role - provide perineal care as needed and report abnormal observations to nurse

Reproductive - Structure and Function

• Female reproductive structures include the uterus, fallopian tubes, ovaries, and vagina • Male reproductive structures include the penis, testicles, scrotum, and urethra • Responsible for production of reproductive cells, produce hormones responsible for sex characteristics, and reproduction

Bladder Infection Symptoms

• Fever and chills • Pain during urination • Urine that has a bad or strong odor • Urine that appears to contain blood • "My urine smells bad and it hurts when I use the bathroom"

Symptoms of Respiratory Infection

• Fever and chills • Sniffling and snorting • Coughing and sneezing • Hacking up globs of green or yellow, slimy mucous

Alzheimer's Disease - Stage 7 - Very Severe Decline

• Final stage and nearing death • Lose ability to communicate or respond to their environment • May be able to utter words or phrases • No awareness regarding their condition • Need assistance with all activities of daily living • May lose their ability to swallow

Life in a Nursing Home - Routines and Schedules

• Fixed routines and schedules for personal care (baths and showers); meals, medications, wake times, and bedtimes used in most nursing homes to accommodate needs of all residents • Older adult's life is built on previously established social roles and personal routines • Personal routines and schedules may collide with institutional schedules, causing conflict • Examples - John has always been the king of his household and now has discovered that he must do what he's told; George is expected to eat breakfast at age 76 years of age for the first time in his life; Mary can no longer read her morning paper before breakfast

AIDS - Nurse Aide's Role

• Follow Standard Precautions and Blood Borne Pathogen Standard as nurse aide cares for resident • Assist with activities of daily living as needed • Provide fluids as ordered • Measure and record I&O and obtain weights • Encourage deep-breathing and coughing exercises as directed • Encourage self-care as tolerated • Observe for and report signs of infection • Provide emotional support

Endocrine Nurse Aide's Role

• Follow care plan directives closely; ensure meals are served and resident eats his diet, report to nurse if resident refuses a meal, observe intake of meal and document carefully; if meal is delayed for lab or other reason, retrieve meal as soon as resident is allowed to eat • Encourage resident to follow exercise program which assists with circulation • Observe for signs of low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia); low blood sugar may result from refusal of meal, delay of meal, increase in exercise; report immediately to nurse • Signs of hypoglycemia - hunger, vomiting, weakness, shakiness, sweating, headache, dizziness, fast pulse, low blood pressure, fast respirations, confusion, cool and clammy skin, convulsions, unconsciousness (do not let it get that far) • Signs of hyperglycemia - weakness, drowsiness, thirst, dry mouth, hunger, frequent urination, flushed face, sweet breath odor, respirations rapid and deep, blood pressure low, skin dry, headache, blurred vision, convulsions, coma (do not let it get that far • Provide for foot care as directed and observe for irritation or sores, report immediately to nurse

Body Mechanics - ABC's

• Follow the ABC's of correct body mechanics o Alignment o Base of Support o Coordination

Restraints - NA's Role

• Follow the Nursing Care Plan • Whenever possible, schedule care to align with the resident's past routines/likes/preferences • Consider the resident's needs based on Maslow's Hierarchy of Needs • Nutrition, elimination, breathing, sleep, exercise o Take time with meals, encourage fluids o Assist to the bathroom, encourage self-hygiene, place bedpan or urinal within reach o Allow time for bathing, back rubs and grooming o Make the bed comfortable, position pillows, provide warmth o Remove unwanted items from overbed/bedside table o Place items at arm's reach whenever possible o Reduce or eliminate noise, odors, other distractions • Safety and security o Observe, visit and check on the resident every 15 minutes or more often o Position bed at lowest height, lock wheels o Place floor cushions next to bed, when applicable o Remove or relocate furniture with sharp corners o Provide or eliminate lighting to promote sleep o Place call bell within reach and respond promptly o Be attentive to the resident's fears/reaction to people, places or things • Report accurately and promptly concerns seen, heard, and communicated by the resident or others Love and belonging o Spend time with the resident, encourage pleasant conversation, walk with the resident o Provide diversion - TV, literature, books, videos, games o Encourage visits from family, friends and clergy • Self-esteem and Self-actualization o Encourage, compliment and reassure the resident

Advanced Diet

• Food is gradually reintroduced to the resident • Reasons - surgery or medical condition • Resident may start out NPO (nothing by mouth) -- > ice chips -->clear liquids --> full liquids -->mechanical soft--> regular diet

ABC's of Correct Body Mechanics - Base of Support

• Foundation that supports an object • Good base of support needed for balance • Wide base of support more stable than narrow base of support • For a person, the feet are the base of support (legs shoulder-length apart is ideal)

Love and Affection Needs

• Friendship • Social Acceptance • Closeness • Meaningful relationships with others • Love • Sexuality • Belonging o Need often met by family/support system o Friends may meet this need • Nursing staff can become family o Sit and visit for a few minutes when time allows o Display human warmth with gentle touch o Show acceptance of resident for unique qualities o Promote care in kind, friendly, considerate manner

Resident Unit

• Furnished and equipped to meet basic needs of the resident • Personal space, furniture, and equipment provided for the resident by the long-term care center • Closet and/or drawer space • A bed (electric or manual), call system, over-bed table, bedside stand, chair, and privacy curtain • Personal care items (bedpan, wash basin, emesis basin, water pitcher, cups, soap, hair care supplies, deodorant) also located within the resident unit, typically in the bedside stand • May also contain resident's choice of items from home (such as recliner, pictures, bedspread, throw pillows)

Gastric Ulcer and Gastritis

• Gastric (peptic ulcer) - raw sores in stomach caused by excessive acid secretion; signs - burning pain 1 to 3 hours after eating, belching, and vomiting; can cause bleeding resulting in black, tarry stool; nurse aide's role - report abnormal stools to nurse; do not flush in case nurse would like to assess stool; encourage resident to follow prescribed diet • Gastritis - inflammation of the lining of the stomach; risk factors - use of certain pain relievers, older adults increased risk of gastritis because the stomach lining tends to thin with age, excessive alcohol use, and stress

Anxiety Disorders

• Generalized anxiety disorder is characterized by anxiety and worry, in the absence of an imminent event • Obsessive-compulsive disorder is categorized by obsessive behavior or thoughts, which may cause an individual to repeatedly perform a behavior or routine such as washing their hands over and over • Posttraumatic stress disorder is brought on by experiencing or witnessing a traumatic event, such as a violent crime or combat in the military • Phobia is an intense, irrational fear of an object, place or situation, such as flying

Family and Family Support - Importance

• Gives resident sense of connection • Helps resident make difficult decisions • Gives assurance that specific wishes will be honored • Offers personal support and encouragement • Helps meet safety and security, love and belonging needs • Decreases loneliness • Provides comfort, support, relief from loneliness, contact with familiar people and things, mental stimulation, and reasons to live

Pain - Effects

• Giving up hope • Depression • Anxiety • Withdrawal • Decrease in or loss of appetite • Decrease in activities • Inability to sleep •Restlessness/agitation • Refusal to participate in activities of daily living • Refusal to participate in treatment programs • Thoughts of suicide and/or suicide • Negative effect on immune system • May be higher risk for injuries, accidents or falls

Dementia and Alzheimer's Disease - Activities

• Goal in the care of residents with Alzheimer's disease is to give support needed so that they can participate in the world around them to the best of their ability • Nurse aide must focus on the fact that the resident is involved and satisfied, not on the task or activity • Activities fall into two categories o Doing activities - keep the person busy o Meaningful activities - have value to the resident with dementia • Activity-based care is focused on assisting resident to find meaning in his or her day, rather than doing activities just to keep the person busy • Principles of activity-based care o Focuses on giving caregivers the tools to create chances for residents with dementia to be successful in activities and their relations with other people o Uses any daily activity that can be broken down into individual, sequential steps o Works within remaining abilities or strengths of the resident with Alzheimer's disease, helping to shift emphasis away from resident's disabilities and impairments o Adjusts an activity based on resident's ability level o Depends on caregiver's interest and desire to create opportunities for successful interactions that are planned and guided to encourage resident's full involvement o Rewards the resident's attempts at participating in activities and provides them with a sense of being capable and alive • Timing of activities is important and individualized o Attention and focus activities, physical activities and sensory activities provided during each resident's prime time and on a set, routine basis may increase participation and satisfaction with that activity • Cultural environment refers to values and beliefs of people in an area o Staff, residents, families, visitors and volunteers determine culture of the facility o Promotion of positive environment begins with inclusion of the residents and making them feel important to relationships and activities

Cancer - Treatment

• Goals - cure (removal from body and kill cancer cells); control (help resident live longer); reduce signs and symptoms from disease and treatment • Key is to find cancer early • Includes - surgery, radiation, chemotherapy, others (hormone, stem cell transplants, alternative) • Dependent on type, site, size, and if it has spread • May need 1 or several types of treatment • Can damage healthy cells and tissues nearby cancer • Side effects depend on type and extent of treatment

Fats

• Good source of energy and gives flavor to food • Certain fats may increase cholesterol levels and lead to heart disease • Sources of fat - butter, oil, fatty meat, etc

Mental Health and Mental Illness - Importance

• Great day-to-day relationships are at the heart of deescalation • The nurse aide can come to know what is normal for particular resident and what signs resident may have that he or she is becoming agitated

Grief

• Grief - deep distress or sorrow over a loss; a dynamic and personal process • The dying resident and family may pass through five stages of grief, according to Dr. Elizabeth Kubler-Ross • Five stages of grief are denial, anger, bargaining, depression, and acceptance • Each person may experience stages at different rate or time; some may stay in one stage until death; others may bounce back and forth between stages • May not even be possible for person to pass through stages if death is fast or unexpected • Nurse aide's role - understand the stages; do not take anger personal; listen and be ready to assist

Remember

• HIPAA is a law that protects the resident's privacy; it is a legal document • Maintain confidentiality at all times • Report observations immediately and accurately • Report and record facts, not opinions • Relay information in specific terms not vague general terms • Document according to established facility policy using the established conventional or military time • Ensure information remains confidential • Do not use electronic devices/computers/kiosks for anything other than the intended purpose • Do no share passwords or other information • Understand the difference between objective and subjective data and use it appropriately • When in doubt, always ask for clarification

When NOT to Take a Rectal Temperature

• Has diarrhea • Has rectal problem • Has heart disease • Recent rectal surgery • Is confused or agitated

Communication - Health Care System

• Has its own culture • Beliefs - standardized definitions of health and illness, believes in the power of technology • Practices - encourages maintenance of health (annual physical examination/routine diagnostic procedures) and prevention of illness • Rituals - limiting visitors and specific visiting hours • Expectations - punctuality such as arriving for appointments on time

Extrinsic Risk Factors

• Hazards of the environment (poor lighting, clutter, wet floor) • Equipment that is unsafe (wheelchair brakes not working) • Unsafe or inaccessible personal items (shoes do not fit correctly)

Endocrine System - Variation of Normal

• Headache • Blurred vision • Dizziness • Weakness • Hunger • Irritability • Sweating • Dry skin • Confusion • Weight gain/loss • Appetite increase/decrease • Tiredness • Increase thirst • Increase urination

HIPAA

• Health Insurance Portability and Accountability Act • Law that protects the privacy and security of a person's health information o Maintains that electronic transmission of documentation, photos, videos or other identifiable means is securely protected o Protects the person's identity; his/her past, present or future health conditions/concerns; phone number; social security number; and other identifiable information • Only people involved with direct resident care or processing records are allowed access to information

Hospice Care

• Health care agency or program for people who are dying (usually less than six months to live) • Purpose is to improve the quality of life for a person who is dying • Provides comfort measures and pain management • Preserves dignity, respect and choice • Offers empathy and support for the resident and the family • Works with staff as well as resident and family

The Healthy Aging Brain

• Healthy older adults do not have notable decreases in cognitive ability and are able to learn new information o Cognitive function is related to use for healthy older adults o Important for an older person to use his/her brain or lose it o Ability to think or problem-solve remains sharp, especially for usual situations and familiar experiences o Generally remains as intelligent and creative as ever

Cardiovascular - Changes Due to Aging

• Heart muscle less efficient • Blood pumps with less force • Arteries lose elasticity and become narrow • Blood pressure increases

COPD - Nurse Aide's Role

• Help sit up or forward leaning supported with pillows • Offer fluids and small, frequent meals • Support pursed-lip breathing taught by nurse - inhaling slowly through nose and exhaling slowly through pursed lips (as if about to whistle) • Observe oxygen in use (NEVER adjust) • Be supportive of fears, carefully • Follow infection prevention principles during care • Encourage rest period COPD Resident Report to Nurse • Signs/symptoms of colds or illness (make COPD worse) • Changes in breathing and changes in lung secretions • Changes in mental state • Excessive weight gain • Increasing dependency on staff and family

Mechanical Lifts

• Helps prevent injury to staff and residents • Used to transfer residents to/from beds, chairs, wheelchairs, stretchers, tubs, shower chairs, and commodes • Use requires special training • Never use if unsure of the operation of the lift; always ask questions if further explanation is needed • Different types of lifts available o Those used to lift dependent residents o Those used with residents who have some weightbearing capability • Use may be mandatory if the facility has a "no lift" policy • Follow care plan and supervisor's directive regarding which mechanical lift to use and how many people are required • Notify supervisor if the lift is not working right or needs repair • Remember to explain the procedure to the resident and what is happening throughout the procedure • The nurse aide must be at least 18-years old to use the lift • Realize that just because the nurse aide knows how to use one type of lift does not mean the nurse aide knows how to use all types of lifts

Bloodborne Infections

• Hepatitis B (HBV) • Hepatitis C (HBC) • Human Immunodeficiency Virus (HIV) • Infection comes from bloodborne pathogens through accidental puncture wounds from needles or sharp objects and direct contact with infected blood

Musculoskeletal System - Variation of Normal

• History of falls • Difficulty with holding or lifting objects • Loss of muscle strength and tone • Generalized weakness and tiredness • Bruising • Slow and unsteady body movement • White, shiny, red, or warm areas over a joint • Complaints of pain in joints or muscles • Swelling, redness, and warmth of joints • Complaints of pain with movement • Inability to move joints

Sudden Admission to a Nursing Home

• How does the older adult feel when he/she is suddenly admitted to a nursing home? o Typically experiences a great deal of stress and feels a sense of loss, fear, isolation, confusion, and being out of control o May feel relief over the move - no more caring for the home, no more cooking, no more cleaning, and no more shopping o Event is often viewed as the ending of one phase of the older adult's life and the beginning of the final phase

Culture - Knowledge: Hygiene/Illness

• Hygiene o Bathing is not viewed the same by all cultures o Clothing styles and colors vary among cultures o Often impacts a person's feeling of self-worth • Illness o Impacts self-image and lowers self-worth o Treatments are impacted/dictated in some cultures o Acceptance/denial is a sign of strength/weakness o Becoming familiar with various illnesses helps provide improved or alternative means of care • Asking questions and researching treatment options opens doors for discussion and helps ease fear.

Personal Care Skills Examples

• Hygiene o Tasks performed to keep bodies clean and healthy o Examples include bathing and brushing teeth • Grooming o Tasks performed to maintain the person's appearance while fostering dignity and choice o Examples include caring for fingernails and hair • A.m. Care includes toileting, assisting with face/hand wash, mouth care before/after breakfast • P.m. Care includes toileting, assisting with face/hand wash, snack, mouth care, back rub

Emotional And Psychological Needs Of A Resident Who is Dying and the Family

• Identify incidents that affect resident's moods; note behavior changes and report to nurse immediately • Approach resident and dying process with dignity • Respect each resident's idea of death and spiritual beliefs • Offer support/understanding • Respect resident preference regarding solitude or interaction • Use touch where appropriate • Listen to resident and family • Communicate with resident, even if non-responsive; identify self and explain everything being done • Be aware of resident's sensitivity to what is being said/ability to hear when other senses diminish • Be guided by resident's attitude • Present a positive attitude and provide positive physical and emotional care • Give resident and family privacy, but not isolation • Spend time with the resident even when not providing care. • Do not take anger directed at you personally • Be supportive • Respect the resident's and family's spiritual beliefs • Encourage family members to participate as much as they can

Preventing Elopement

• Identify residents at risk for elopement (example - resident has history of wandering • Assign a newly admitted resident to a room away from exits and increase staff awareness for risk of elopement; half of elopements occur during the first few days of admission • Technology - locked doors with staff keypads; cameras at exits; combination resident bracelet/door alarm when resident nears the door

Prevention is Key

• Identify residents at risk • Measures directed at 1) handling, moving, and positioning of the resident and 2) providing skin care

Edema

• If fluid intake is greater than fluid output o Tissues will swell with water - called edema o May occur with kidney or heart disease • Nurse aide's role o Obtain accurate weights, per order o Increase pillows per resident's request o Restrict fluids - fluids limited per doctor's order o Observe for and report signs/symptoms of fluid overload •Signs/symptoms of fluid overload o Weight gain (of 1 to 2 pounds in a day) o Fatigue o Difficulty breathing or shortness of breath o Swelling of ankles, feet, fingers, hands o Swollen abdomen o Coughing o Decrease in urine output o Tight, smooth, shiny skin o Increased heart rate

Dehydration

• If fluid intake is less than fluid output, dehydration occurs • Resident does not take in enough fluid for the body causing tissues to lack water • When does it occur? May occur with bleeding, dementia, fever, poor fluid intake, fluid restriction, excess sweating, vomiting, increase in urination, medicines. • Nurse aide's role in preventing dehydration o Determine preferences of fluids and offer o Assure water pitcher and cup are within reach o Offer assistance and use assistive devices if needed o Measure and record I & O accurately, if ordered o Force fluids (encourage to drink more fluids), if ordered by the doctor o Observe for and report signs and symptoms of potential dehydration and presence of dehydration • Warning signs of potential for dehydration o Drinks less that six 8-ounce glasses of fluids per day o Drinks little or no fluids during meals o Needs help drinking fluids o Has trouble swallowing fluids o Has fever, vomiting, diarrhea o Confused o Complaints of thirst, dry mouth o Decrease in urinary output •Signs/symptoms of dehydration o Severe thirst o Dry mouth and mucous membranes o Cracked lips o Warm, dry, wrinkled skin o Sunken eyes o Flushed face o Dark, strong-smelling urine, in small amounts o Constipation o Weight loss o Weakness, dizziness, confusion o Headache o Irritable o Rapid, weak pulse o Irregular heartbeat o Low blood pressure

Blood Pressure

• Important indicator of health status; shows how well heart is working • Can change from minute to minute depending on: o The activity of the resident (for position, BP is higher lying in bed than seated in chair or standing; for exercising, BP increases) o Lifestyle choices (BP increases with smoking and drinking; BP higher if resident is overweight and decreases as weight is lost; BP may be high if resident eats a high salt diet) o Reaction to stressful events (BP increases with anxiety, emotional responses, and stress) o Acute injury or emergency (a blood volume decrease from injury will decrease BP; BP increases with pain) o Medications (raises or lowers BP depending on the medication) • Genetic factors affect blood pressure: o Age (BP increases with age) o Gender (women's BP usually lower) o Race (black residents BP higher than white) • The nurse aide uses three senses simultaneously when checking a resident's blood pressure: o Seeing - watches the needle's movement in relation to the numbers on the manometer o Hearing - using the stethoscope, listens for sounds indicating changes in blood flow in the brachial artery o Touching - controls the inflation and deflation of the cuff using the thumb and index finger

Understanding Reaction Time

• Important that nurse aides who work with residents be aware of changes in reaction time and pace themselves accordingly • Important that nurse aides develop understanding of ways to help resident make up for slowed reaction time

Temperature Sites

• Important to check with nurse or care plan to see what type of thermometer is used o Mouth (oral) o Rectum (rectal) - most accurate; never let go of rectal thermometer while checking temperature o Armpit (axilla) - least accurate o Ear (tympanic) o Temporal artery (forehead)

When Providing Personal Care

• Important to help residents be as independent as possible and encourage residents to do as much of care for self as possible • Residents may feel embarrassed at having to be helped with personal care needs so nurse aides should be professional and provide privacy during care • While assisting with personal care needs, nurse aide can observe resident's skin, mobility, comfort, and cognition

Mental Health and Mental Illness - Nurse Aide's Role

• Important to recognize appropriate and inappropriate behavior and function so nurse aide can o Report inappropriate or different behavior and/or function to the nurse immediately o De-escalate behaviors • Has many chances to observe and get to know resident

Palliative Care

• In hospice care, goals are the resident's comfort and dignity • Type of care given to residents who are dying that focuses on relieving pain, controlling symptoms, and minimizing side effects and complications • Nurse aide's role - be a good listener, respect privacy and independence, individualize care, be aware of own feelings and stress nurse aide may feel • Nurse aide must take care of self to provide palliative care to others

Special Fluid Ordersv

• In order to maintain fluid balance, the doctor may order amount of fluid a resident must drink a day • Encourage fluids o Resident drinks increased amount of fluids o Fluids that resident likes and are on resident's diet are left at bedside within easy reach; kept at appropriate temperature; may require being placed on ice in a pan o Nurse aide offers fluids regularly if person is dependent and cannot feed self or is confused o Nurse aide offers fluids each time he/she enters the room • Restrict fluids o Fluids are limited to certain amount o Fluids offered in small amounts o Water pitcher removed from room (or out of sight) o Resident will require frequent mouth care Nothing by mouth (NPO) o Not allowed to eat or drink anything o Typically ordered before/after surgery, before certain lab tests, before special diagnostic procedures, and for certain illnesses o Water pitcher removed from room (or out of sight) o Resident will require frequent mouth care • Thickened liquids o All fluids must be thickened, even water o Thickness depends on resident's ability to swallow • Located on the care plan • Nurse aide must measure and record intake very carefully

Urinary Incontinence

• Inability to control bladder leading to an involuntary loss of urine; not normal part of aging • Can occur in residents who are dependent, confined to bed, paralyzed, elderly, or diseases of the nervous or circulatory system o Stress incontinence - loss of urine with sneezing or coughing o Urge incontinence - involuntary loss of urine from a sudden urge to void o Functional incontinence - loss of urine caused by cognitive, physical, or environment reasons o Overflow incontinence - loss of urine to bladder overflow or distention • Nurse aide's role - answer call lights promptly, check on resident for need to void frequently; keep resident clean and dry, urine can be irritating to the skin and a risk factor for pressure injuries; change wet clothing and linen immediately; encourage residents to drink fluids; be respectful and provide reassurance to residents, never refer to adult briefs as a diaper

Time

• Include the date and exact time, each time information is recorded • Health care facilities choose to use conventional (also called civilian or standard) time or choose to use military time (also called the 24-hour clock)

Culture - Characteristics

• Includes language, values, beliefs, habits, likes, dislikes and customs • Not all individuals accept all characteristics of the group

Reaction to Relocation

• Individual people will have individual reactions to relocation from the home depending upon o Degree of choice that the older adult had o Degree of preparation that the older adult had o Degree of sameness of the new location with the previous location o Degree of predictability of the new location o Number of additional losses that occurred in older adult's life - loss of loved one, loss of health, loss of finances, loss of roles

Arthritis

• Inflammation or swelling of the joints; causes stiffness, pain, and decreased mobility; two common types: o Osteoarthritis (degenerative joint disease); affects the elderly and may occur with aging or joint injury; usually weight-bearing hips and knees involved, but may also include fingers, thumbs, and spine; pain and stiffness typically increase with damp, cold weather o Rheumatoid arthritis - affects any age; starting with smaller joints then progressing to larger ones; joints become red, swollen, and very painful, fever, tiredness, and weight loss occur; severe and painful deformities can result with eventual movement restricted; considered an autoimmune disease when normal tissue is attacked by the immune system

Recording - NA's Role

• Information must be recorded in a responsible manner • Must be based on facts, not opinions, as per facility policy • Documents often used: o Check sheets o Flow sheet o Graphs o Incident reports o Facility specific forms • Observe the resident, using senses o Sight (facial expressions, rashes, skin color, bruising, ambulation, body language) o Hearing (breathing, speaking, moaning) o Smell (odor of breath, urine, body) o Touch (lumps, skin temperature, change in pulse) • Document observations regarding: o Personal care - oral, bathing, perineal, catheter, skin, turning/positioning o Treatments - hot/cold applications, soaks or wound care (as per facility policy) o Measurements - vital signs, intake/output, elimination o Activities - eating, sitting, ambulating, talking, sleeping, socializing, participation in activities or events o Mental/emotional status - subtle or drastic changes • Document per facility procedures • Ask for assistance to understand various forms • Clarify what and where the NA is allowed to document information • Use a pen, with blue or black ink, or per facility policy • Do not use a pencil or ink that can be erased • Carry a small notebook/worksheet to make notations • Do not record protected information, in case the notebook or worksheet is misplaced/lost • Keep written information with you at all times • Write clearly - remember this is a legal document • Do not draw multiple lines through a writing error or use white out • Sign full name and title (NA), or per facility policy • Keep medical records in secure location ALWAYS, per facility policy • Always maintain confidentiality

Providing Skin Care

• Inspect skin every time care is provided • Follow care plan for bathing schedule; do not use hot water; use cleansing agent (soap can dry and irritate skin) • Prevent incontinence • Check for perspiration or wound drainage • Apply moisturizer to dry areas • Give a back rub when repositioning; do not rub over boney prominences • Keep linen clean, dry, and free of wrinkles • Avoid scrubbing vigorously when bathing or drying • Avoid skin-to-skin contact by using pillow or blanket placement • No heat directly on pressure injury

Stethoscope

• Instrument used to listen to heart and lung sounds • For blood pressure checks, used to listen to sounds in brachial artery • May be single-head (with diaphragm only) or dual-head (with diaphragm and bell) Stethoscope - Parts • Ear pieces • Binaurals • Rubber or plastic tubing • Chest-piece (with diaphragm or diaphragm/bell) Stethoscope - Ear Pieces • To prevent infection, always clean before use and after use with an alcohol wipe • Insert ear pieces into ears so that they point forward toward the nose Should fit snugly in ears to block out noise Dual-head Stethoscope - Diaphragm • Before using dual-head stethoscope to take blood pressure, determine which side of chest-piece is active • To check blood pressure, diaphragm needs to be active

Intake and Output

• Intake (also called input) - the amount of fluid taken in by the body • Output - the amount of fluid lost from the body • Intake and output are typically seen together and commonly abbreviated (I&O) • For fluid balance to occur fluid intake roughly equals fluid output

Fall Risk Factors

• Intrinsic - those risk factors that result from the resident's inner being • Extrinsic - those risk factors that result from those things outside of the resident

Peristalsis

• Involuntary contractions that move food through the digestive system

Endocrine

• Is a system of glands that secrete chemicals directly into the bloodstream to regulate body functions • Different types of glands are pictured on slide

Respiration

• Is the process that supplies oxygen to the cells and removes carbon dioxide from cells • Involves o Inspiration (inhalation) - breathing in of oxygen through nose; chest rises o Expiration (exhalation) - breathing out of carbon dioxide through nose and mouth; chest falls • Each respiration involves one inspiration and one expiration • Respiratory rate (or respirations) - is the number of inspirations (inhalations) the person takes in a minute

Reporting

• Is the verbal account of care provided and observations noted by the health care team • Is initiated immediately when there is a change in the resident's condition • Is communicated regardless of time, circumstances or schedules and prior to the end-of-shift

Recording

• Is the written/electronic documentation of care and observations by the health care team • Medical Record o Legal document o Collection of documentation regarding a resident's condition and response to treatment and care o Is used to keep all team members updated about the resident's care

When NOT to Take an Oral Temperature

• Is unconscious • Recent facial or mouth surgery • Recent injury to face • Has sores, redness, or mouth pain • Is confused or agitated • History or seizure • Is using oxygen • Is mouth-breather • Has a feeding tube

Developmental Tasks of Aging - Issues

• Issues involving care of elderly that may arise o Amount of care needed o Cost o Nutritional needs o Relationship with family/support system o Location of family/support system o Medical care needs o The elderly person may experience changes in lifestyle - living with a group of people, less independence, structured lifestyle, less privacy, difficulty adapting to change o Decision made by individual or family for long-term care may cause stress

Sharps

• Items that have corners, edges, or projections that can cut or pierce the skin, such as needles, needles with syringes, needles with attached tubing, and razor blades • SAFETY, SAFETY, SAFETY o Wear gloves and be careful when using or handling anything sharp that could have touched blood or body fluids o Be careful not to cut self or resident during shaves o Be careful not to jab yourself with a sharp • NEVER, EVER re-cap a needle or other sharp object because you may jab yourself • NEVER, EVER put anything sharp in a regular trashcan

Environmental Needs of The Resident Who is Dying

• Keeping resident's environment as normal as possible o Room - well lighted and well ventilated o Open drapes and door o Play resident's favorite music

Urinary - Structure and Function

• Kidneys o Bean-shaped paired organs o Located at the back of abdominal cavity, slightly above the waist o About four or five inches long and an inch thick o Filter waste from the blood and produces urine o Help maintain water balance and blood pressure in the body o Regulate amounts of electrolytes in the body • Ureters o Narrow tubes o Connect the kidneys to the urinary bladder o About a foot long • Urinary bladder o Muscular sac o Stores the urine until it passes from the body • Urethra o A tube o Located between the urinary bladder to the outside of the body o About seven or eight inches long in males and about one and a half inches long in females

Cancer Treatment - Radiation

• Kills cancer cells using X-ray beams aimed at tumor or radioactive material implanted at or near the tumor • Side effects o At site - sore, irritated, redness, and blistering o Head and neck - dry mouth and sore throat o Tiredness o Discomfort, nausea, vomiting, diarrhea, and loss of appetite • Be aware of safety needs for health care providers and visitors; follow directives from care plan and nurse • Nurse aide care directed at minimizing side effects and providing emotional support

* Ethics - Importance

• Knowledge of right and wrong guides sense of duty and conduct of all health care providers • Guides all health care providers in providing quality care • Governs actions of health care providers • Vital to safety and well-being of residents

* Ethics - Importance

Communication - Barriers

• Language • Using inappropriate words, clichés or slang • Giving responses that cause confusion or frustration • Talking too fast • Giving advice or offering a personal opinion or point of view • Ignoring or belittling the resident • Using non-verbal communication skills when verbal communication is more appropriate • Prejudices and attitudes • Different life experiences • Age • Cultural differences • Noise and lack of privacy • Mental or physical impairments

Chronic Kidney Disease (CKD

• Lasting damage of kidneys that worsens gradually; 5 stages; with the latter stages resulting in the need for dialysis • CKD can be prevented from advancing into further stages by controlling diabetes, maintain healthy blood pressure, exercise, and maintain a healthy weight

Importance of Laws

• Laws tell people what they can and cannot do • Laws are written to protect the public and society from harm

Importance of Laws

• Laws tell people what they can and cannot do • Laws are written to protect the public and society from harm

Communication - Importance

• Learn about the resident in order to provide care that meets individual needs • Be a source of encouragement to the resident and family members • Establish trust • Build meaningful relationships that benefit the resident • Serve as a liaison between the resident and healthcare team. • Provide information and respond to questions appropriately. • Listen, observe, report and record details accurately o Discuss the importance of being a liaison and patient advocate.

Learning and Memory

• Learning o The gaining of information, skills, and knowledge measured by an improvement in some obvious response o The ability to learn remains throughout life o Older adults learn things easier and better when they can set their own pace o Depends on the person's memory • Memory - involves the storing of information in the brain for later use and the ability to recall the information when needed

Restraints - Application

• Leave 1 to 2 inches of slack in the straps to allow some movement of the part, unless instructed otherwise • Pad bony areas as instructed by the nurse to prevent pressure and injury • Observe the resident closely - every 15 minutes or as directed by the Nursing Care Plan • Remove/release the restraint, reposition the resident and attend to their basic needs (food, water, elimination, comfort, safety, hygiene and skin care) at least every 2 hours for at least 10 minutes, or as often as stated in the Nursing Care Plan • Monitor vital signs and perform range of motion (ROM) at intervals as instructed

Restraints - Safe Application

• Leg/ankle - limits mobility of leg/ankle o Should allow 1 finger between the leg and restraint • Arm - limits mobility of arm o Should allow 1 finger between the arm and restraint • Hand mitt - limits mobility of hand, prevents finger use o Should allow 1 finger between the wrist and restraint • Wrist - limits arm movement, prevents pulling on tubes or medical devices and scratching the skin or a wound o The soft part is next to the skin o Should allow 1 finger between the wrist and restraint • Seat belt - reduces falls while sitting o Should be placed at a 45-degree angle over the thighs when sitting o Resident's hips should touch the back of the chair o Allows the resident to turn from side to side or sit up in bed • Jacket - limits mobility of upper body o Opening is in back o Should be snug but allow for movement o Should allow the resident to breathe easily o Should allow a flat hand to slide between the restraint and the resident's body Vest - limits mobility of upper body o "V" is in front o Crisscrosses in front o Should be snug but allow for movement o Should allow the resident to breathe easily o Should allow a flat hand to slide between the restraint and the resident's body • Lap tray - helps prevent the resident from leaning forward and falling out of the chair o Should be secured properly o Resident's hips should touch the back of the chair o Observe often to prevent the resident from sliding down under the tray • Side rails - use of sides rails that prohibit resident voluntarily getting out of bed is prohibited unless they are necessary to treat a resident's medical symptoms (42CFR483.10(e), 42CFR483.12(a)(2)) • Enablers - are allowed to promote independence and in place for the resident to grasp to help turn or assist with standing

Workload of the Nurse Aide

• Let's switch gears and talk about the workload of the nurse aide o Tend to have a lot to do in a short period of time o When working with residents, nurse aides may accidentally quicken pace and expectations as they get pressed for time

Positioning the Resident (Supine)

• Lies flat on back with arms and hands at the side • Use pillows for support under the head and shoulders to maintain correct body position • Use pillows, rolled towels or washcloths to support arms or hands • To create floating (or elevated) heels, place pillow under calves • Place pillows or a padded board (footboard) against the feet to keep the feet positioned correctly • Remember - facing UP (sUPine)

Urine - Normal Findings

• Light yellow to amber in color • Clear or transparent when freshly voided, with a faint smell • About 1000 to 1500 milliliters per day

Fluids Considered as Intake

• Liquids that the resident drinks • Semi-liquid foods that are eaten • Other fluids including intravenous (IV) fluids and tube feedings that nurse is responsible for maintaining and measuring

Caring for Residents who are Stressed - Nurse Aide Role

• Listen to concerns • Observe and report nonverbal messages • Treat with dignity and respect • Attempt to understand behavior • Be honest and trustworthy • Never argue with residents • Attempt to locate source of stress • Support efforts to deal with stress

Health Care Personnel Registry (HCPR)

• Lists pending allegations and substantiated findings of nurse aides and other unlicensed personnel • HCPR listings can lead to negative consequences for the nurse aide • Substantiated finding of abuse, neglect and misappropriation of resident property will cause a finding on the HCPR • Nurse aides cannot be employed in a nursing home with a substantiated finding on the HCPR

Health Care Personnel Registry (HCPR)

Fluid Balance

• Living things need water to survive • Adult needs about 1500 mL of water intake daily to survive • About 2000 to 2500 mL needed for normal fluid balance • Hydration - having the right amount of water in the body's tissues • The body takes in water by drinking fluids and eating foods • The body loses water by way of urine, feces (bowel movement), vomit, perspiration (sweat), and lungs (breathing out), plus drainage from wounds or liquids from stomach suctioning • Death can occur if the body has too much or too little water in the tissues

Advance Directives Documents

• Living will - a document that outlines the medical care a person wants or does not wants in case the person cannot make those decisions; living will must be written while resident is mentally competent or by resident's legal representative • Durable Health Care Power of Attorney - a signed, dated, and witnessed legal document that appoints someone to make healthcare decisions for the person in the event he/she cannot do so

Upper Poise Bar

• Long lines represent pounds • Short lines represent ¼ pounds each; increments include ¼, ½, ¾ • Single lines represent increments of 50 pounds • Grooves located along the top of the lower bar align with weight increments

Positioning the Resident (Lateral)

• Lying on right or left-side

System - Structure and Function

• Made of groups of several organs functioning together for a specific purpose or purposes • Combine to form an organism • Systems of the body include urinary, musculoskeletal, nervous, respiratory, cardiovascular, digestive, integumentary, endocrine, and reproductive

Organ - Structure and Function

• Made of tissue, may be several types of tissues • Carries on a special function; examples are heart, stomach, bladder • Some are paired; examples are kidneys, lungs • Combine to form a system

Organism - Structure and Function

• Made up of systems functioning together to perform activities of daily living needed for continued life

Safety in the Resident's Environment - Nurse Aide's Role

• Maintain comfortable room temperature and lighting • Be aware that residents may prefer warmer room temperature than employees • Be aware that most residents have poor vision and need bright light, if reading • Keep unit clean and dirty items disposed of properly • Identify and report any unsafe conditions or faulty equipment • Allow resident a choice, if possible, in arrangement of personal items • Check linen for personal items contained in folds prior to sending to the laundry

Alzheimer's Disease - Stage 5 - Moderately Severe Decline

• Maintain functionality • Usually able to bathe and toilet independently • Still know their family members • Difficulty dressing appropriately • Inability to recall simple details, such as their own address or telephone number • Significant confusion

Digestive System - Nurse Aide's Role

• Make sure dentures are in place and fit properly • Observe for choking if there is a history of trouble with chewing and swallowing • Provide fluids with meals • Encourage daily bowel movements • Residents with fecal incontinence must be kept clean and dry; follow infection prevention concept of wiping from front to back; assist resident with handwashing • Important for nurse aide to provide privacy when attending to elimination needs of resident; should not be rushed or interrupted • Fiber and drink plenty of fluids; should offer fluids each time nurse aide enters room (unless fluid restricted); healthy resident should drink about 64 ounces of fluid each day • Regular physical activity is very beneficial to elimination; strengthens muscles of abdomen and pelvic which help with peristalsis; immobility and lack of exercise weakens these muscles slowing down peristalsis and elimination; encourage regular activity as tolerated and assist if needed • Understand bowel habits for each resident is individual and personal; determine bowel habits of resident; preferred time or times of day; typically, though elimination usually happens after meals Ideal position for elimination is in a leaning forward, squatting position; if resident cannot get out of bed, assist with positioning so that resident is sitting up and by doing so allows for the resident to contract muscles and to work with gravity

Pain

• Margo McCaffery, a nurse and expert in the field of pain management defines pain as "anything the patient says it is, occurring whenever the patient says it does." • Health care team does not define resident's pain. • Most widely accepted symptom of pain is self-reported pain

Maslow's Hierarchy of Needs

• Maslow's Hierarchy of Needs is used to assist nurses prioritize and develop a plan of care on patient-centered outcomes • Physiological Needs: nutrition (water and food), elimination (toileting), breathing/circulation (vital signs), sleep, sex, shelter, and exercise • Safety and Security: injury prevention (call lights, hand hygiene, fall precautions, assistive devices, close observation); build trust (communication, reassurance, empathy); ensure clean, safe environment (free from harm, recognition and alleviation of fears) and resident and family education • Love and Belonging: supportive relationships free from social isolation, therapeutic communication skills, meaningful relationships • Self-Esteem: acceptance into a community or facility, personal achievement, sense of control or empowerment, accepting one's physical appearance and mental capabilities • Self-Actualization: empowering environment, spiritual growth, ability to recognize other's point of view, reaching one's maximum potential • The order of importance begins at the lowest level on the hierarchy • Lower-level needs must be met before higher-level needs are met • The NA is a vital link in assisting the resident to achieve individual levels of need • Physical needs include nutrition, elimination, breathing, sleep, sex, shelter and exercise; the absence of physical needs prevents an individual from moving to the next level • Safety and security includes an environment free from harm, danger and fear • Injuries, neglect and abuse impact this level • Self-actualization is achieved when an individual experiences his/her potential • Individuals may have difficulty achieving this level

Nursing Home as an Accidental Community

• May be perceived as an accidental community where people with different interests, tastes, cultural backgrounds, social classes, educational backgrounds, former occupations, and income live together in a blended living arrangement in an institutional setting with dozens or even hundreds of people

Social Breakdown Syndrome

• May occur if resident is rushed too much and not allowed enough time to begin to do tasks, respond to requests, or answer questions • Will likely keep quiet and not ask for slower pace and tends to blame self for not being able to keep up and then become frustrated • Gradually begins to feel incompetent and has decrease in self-esteem • May give up doing things leading to dependence and helplessness • Often labeled as slow and unable to keep up in society • Living in an advanced, high technological society, where everything and everyone is functioning at a high rate of speed, leads to lower self-esteem among older adult population • Society becomes impatient with those who cannot keep up

The Blood Pressure Value

• Measured in millimeters of mercury (mm Hg) • Recorded as a fraction, for example 120/80 o Top number is systolic o Bottom number is diastolic o Pronounced as 120 over 80 • Normal blood pressure ranges for adult o Systolic (top number) - 90 mm Hg to 119 mm Hg o Diastolic (bottom number) - 60 mm Hg to 79 mg Hg • Document on record

Temporal Thermometer

• Measures heat from skin over the forehead, specifically over temporal artery • Done by a stroke or scan over the area • Registers within 3 seconds • Noninvasive

Bowel and Bladder Training - Importance

• Measures taken to restore function of urination and defecation by resident, with ultimate goal of continence o Urination (or voiding) - process of emptying the bladder o Defecation - process of emptying the rectum of feces o Continence - ability to control urination or defecation o Incontinence - the inability to control urination or defecation • Incontinence embarrassing for resident • Resident will limit lifestyle because of incontinence • Odors can cause family and friends to shun individual • Infections can develop • Residents may find it difficult to discuss and ask for help

Mental Health and Mental Illness - Treatment

• Medication • Psychotherapy • Cognitive behavioral therapy

Mental Health and Mental Illness

• Mental health - a resident's ability to cope with and adjust to everyday stresses in ways that society accepts • Mental illness - a disturbance in the ability to cope or adjust to stress; behavior and function are impaired; mental disorder, emotional illness, psychiatric disorder • De-escalate - to (cause to) become less dangerous or difficult

Incident Report

• Method of documenting facts surrounding an unexpected event in healthcare setting • Based on factual, objective account of what occurred o Explain how to documents facts through observation • Are confidential and intended for use between the facility and facility legal team o Explain how documentation may be used if legal action is pursued by the resident, family or facility

The Nursing Process

• Method used by nurses to plan and deliver nursing care to the resident • Five steps are o Assessment - collecting information about a resident o Nursing diagnosis - describes a health problem that can be treated using nursing measures o Planning - setting priorities and goals for a resident o Implementation - performing or carrying out nursing measures that impact resident care o Evaluation - measuring to determine if priorities and goals were met that impacted resident care o Evaluation is time when nurses look at nursing care plans and see if plan worked in solving health issues and if interventions were effective • Based on the individual needs of the resident • Used to support directives given from the doctor and other members of the healthcare team

Fluids - Semi-liquid Foods

• Milkshakes • Ice cream • Sherbet • Custard • Pudding • Gelatin • Popsicles

Alzheimer's Disease - Stage 2 - Very Mild Decline

• Minor memory problems • Lose things around the house • Unlikely to be noticed by family members

Outbreaks

• More illness in more residents than what is expected or what is normal for the facility • Is a healthcare associated infection • Examples - respiratory illness, such as influenza (flu); and gastrointestinal illness, such as norovirus • Influenza and norovirus are very dangerous for people aged 65 and older

Diabetes Mellitus (Diabetes)

• Most common disorder of endocrine system • Occurs when pancreas produces too little insulin or does not use insulin properly • Insulin needed for glucose to move from blood into cells; cells need glucose for energy • Without enough insulin, sugar builds up in blood; causing blood glucose levels to rise • Three types - Type 1, Type 2, and Gestational

Water

• Most essential nutrient • Needed for every cell in body • Main part of the blood • Importance to body o Helps move oxygen and nutrients into cells and removes waste products out of cells o Helps with digestion and absorption of food o Helps maintain temperature by perspiration • Only can survive a few days without water

Home as a Castle

• Most older adults view their home as their castle and have lived in their current home for 20 years

End of Life Care - Importance

• Most people die in hospitals or long-term care facilities • A nurse aide's feelings about death affect care given • A caring, kind, and respectful approach helps the resident who is dying and family

Muscles - Structure

• Muscles o Body has over 600 muscles made up of elastic tissue o Some are connected to bones by tendons • May be involuntary (cardiac or smooth) or voluntary (skeletal) • Involuntary - work automatically; cannot control o Cardiac - in the heart; striated o Smooth - control action of organs, such as stomach, intestines, blood vessels, and others; smooth • Voluntary - can be controlled o Skeletal - attached to the skeleton; include the arm and the legs; striated

Musculoskeletal System - Changes Due to Aging

• Muscles weaken and lose tone • Bones lose density and become brittle • Slower muscle and nerve interaction • Joints stiffen, become less flexible, and become painful causing decrease in range of motion and flexibility • Height decreases from 1 to 2 inches, between age 20 and 70 • Slowed recovery from position changes and sudden movement • Pain when moving • Reaction time, movement speed, agility, and endurance decrease • Poorer response to stimuli

Alzheimer's Disease - Stage 6 - Severe Decline

• Need constant supervision, usually require professional care • Confusion or unawareness of environment and surroundings • Inability to remember most details of personal history • Loss of bladder and bowel control • Major personality changes • Possible behavior problems • Need assistance with bathing and toileting • Wandering

Age Related Changes Affecting Nutrition

• Need for fewer calories • Vitamin and mineral requirements change • Drugs may affect how nutrients absorbed and used •Teeth/dentures affect ability to chew food • Saliva and gastric juices decrease • Appetite and thirst decrease • Constipation may occur • Taste and smell diminish • May require assistance with dining

Protein

• Needed by every cell to help grow new tissue and help with tissue repair • Sources of proteins - meats, cheese, beans, etc

Fluid Balance

• Needed for good health • Amount of fluid taken in (intake) equals the amount of fluid lost (output)

Fluid Balance - Water

• Needed to survive • Death can occur if you get too little or too much • Take in water by drinking fluids and eating foods • *Lose water via urine, feces, vomit, perspiration (sweat), and lungs (breathing out), plus drainage from wounds or liquids from stomach suctioning

The Neuron (Nerve Cell)

• Neuron - basic unit of the nervous system • Carry messages or impulses through spinal cord to and from the brain o Fragile and take long time to heal if injured; o Some are covered and insulated with a protective fiber, called the myelin sheath; also allows for speed of conduction of impulses

Pulse Values

• Normal pulse for adults (document) o Rate = between 60 and 100 beats per minute o Regular, and strong • Abnormal pulse for adults (document and notify nurse) o Bradycardia - less than 60 beats per minute o Tachycardia - more than 100 beats per minute o Irregular pulse rhythm o Weak in strength

Nurse Aide's Role During a Seizure

• Note time of start and stop of seizure • Send for supervisor, but do not leave resident alone • Put on gloves • Cradle head to protect it • Loosen clothing to assist with breathing • Do not attempt to restrain resident • Do not force anything in resident's mouth between teeth • Do not give resident food or liquids • If no injuries are suspected (head, neck, spine), turn resident on side when seizure is over to prevent aspiration (choking on saliva or vomitus)

Death: Signs That the Resident has Died; Notify Nurse Immediately

• Notify the nurse immediately • No pulse/heartbeat • No respirations • No blood pressure • Pupils are fixed (do not respond to light) and dilated (big) • No response when resident is talked to or touched • Eyelids may remain opened; enlarged pupils that do not respond to changes in light • Mouth may remain open • May have bowel and bladder incontinence

End of Life Care - Nurse Aide's Feelings About Death

• Nurse aide must recognize and deal with own feelings and attitudes toward death in order to provide essential support to residents who are dying • Many factors influence attitudes, such as age, personal experiences, culture, and religion • First encounters with death and dying can be frightening • Nurse aide can use co-workers as support system for dealing with the experience

Pain - Use of Medications

• Nurse aide reports complaints of pain to nurse so nurse can assess pain and medicate if appropriate

Bowel and Bladder Training - Nurse Aide's Role

• Nurse aide valued member of health care team (that also includes resident and family) and is involved with bowel and bladder retraining plan • Support explanation by doctor or nurse of bowel training schedule to resident, so others cannot hear • Keep an accurate record of bladder/bowel pattern and amounts • Answers call lights promptly • Do not rush resident; be patient • Be positive • Don't scold if there are accidents • Assist to bathroom, if requested • Provide privacy, either in bed or in the bathroom • Provide encouragement; be supportive and sensitive • Offer fluids per the schedule; encourage plenty of fluids • Encourage fiber foods - fruits, vegetables, breads and cereals • Encourage regular exercise • Teach good pericare • Keep bedding clean and odor-free • Attempts to void are scheduled and resident is encouraged to void o When resident awakens o One hour before meals o Every two hours between meals o Before going to bed o During night as needed • Attempts to void are scheduled and resident is encouraged to void o Running water in the sink o Have resident lean forward, putting pressure on the bladder o Put resident's hands in warm water o Offer fluids to drink o Pour warm water over the resident's perineum

Dementia and Alzheimer's Disease - Communication Techniques Used by Nurse Aide

• Nurse aide's method of communicating with the resident with Alzheimer's disease is as critical as the actual communication • Utilizing the following techniques will decrease frustration for both the resident and nurse aide o Obtain resident's attention before speaking and maintain attention while speaking o Address resident by name, approach slowly from front or side and get on same level or height as resident o Set a good tone by using calm, gentle, low-pitched tone of voice o If conversation is interrupted or nurse aide or resident leaves room, start over from beginning o Slow down, do not act rushed or impatient o If information needs to be repeated, do so using same words and phrases as before o Speak clearly and distinctly using short, familiar words and short sentences, and avoiding long explanations o Emphasize key words, break tasks and instructions into clear and simple steps, offer one step at a time; and provide resident time and encouragement to process and respond to requests o Use nonverbal cues, such as touching, pointing or starting the task for resident o If the resident's speech is not understandable, encourage to point out what is wanted or needed

Basic Restorative Care - Nurse Aide's Role

• Nurse aides are often the first health care provider to recognize signs that resident is feeling a loss in independence and should be reported to supervisor o Negative self-image o Anger directed toward others o Feelings of helplessness, sadness, hopelessness o Feelings of being useless o Increased dependence o Depression • Encourage the resident and support the family when functional loss (partial or complete loss of the function of a body part) and loss of independence causes these feelings • Be sensitive to resident's needs. Some may be embarrassed, need more encouragement than others, and need to be more involved in planning for activities • Be positive and supportive • Emphasize abilities • Explain planned activities and how nurse aide will help • Treat with respect • Allow for expression of feelings • Develop empathy for situation • Praise accomplishments o Assist resident to do as much as possible o Be realistic though, and never give false hope • Review skills that will be needed to assist with restorative activities • Focus on small tasks and accomplishments • Recognize that setbacks will occur • Inform individual that setbacks occur and are to be expected • Encourage to continue with planned care in the face of setbacks • Explain that setbacks are an opportunity to improve the next attempt • Give resident control • Allow some choice on when activities are performed • Encourage selection of appropriate clothing • Show patience when preparing for activity • Provide for rest periods • Encourage as much as possible independence during activity • Encourage use of any prescribed adaptive devices • Consider involving family in activity, with resident's permission

Interpersonal Skills - Importance

• Nurse aides interact with a variety of people while on duty and it is important to understand how their own actions and attitudes impact those around them including residents, family members, and co-workers • Nurse aides are a valued member of the health care team and spend the majority of their workday with residents

Pain - Nurse Aide Role in Pain Management

• Nurse aides play an important role in pain management • Nurse aides are at the bedside and often the people most likely to notice when a resident is acting differently or showing signs of pain • Nurse aides' personal relationships with residents can be helpful in pain management • Nurse aides should take an active role in pain management • Pain should be controlled or alleviated whenever possible

Delegation - Points to Remember

• Nurse maintains accountability and responsibility for delivery of safe and competent care • Decisions regarding delegation of any nurse aide activity are made by nurse on resident-by-resident basis • Never be afraid to ask for help • Always ask if you do not understand a task, need more information, or if not sure about something • If you think you do not have the skills necessary to do the task, talk to your supervisor

* Safety in the Resident's Environment - Importance

• OBRA (1987) and regulatory agencies require that long-term care facilities follow safety policies and procedures • The facility is home to the resident and resident should be encouraged and assisted to make room as home-like and safe as possible • Safety is a basic resident need and residents are at great risk for accidents and falls • Goal is to keep resident safe, without limiting independence and mobility

Pressure Injury - Sites

• Objects can contribute to pressure injury - eye glasses, oxygen tubing, tubes, casts, braces • Obese people can have pressure areas occur where skin is in contact with skin, such as abdominal folds, legs, buttocks, thighs, and under breasts

Importance of Communication

• Observations and communication from the nurse aide are of vital importance to the health care team • Allows health members to make sound decisions about care and treatment plans • Accurate documentation from nurse aide becomes part of legal records • Must be reported and recorded accurately and in detail

Care of the Resident Who is Cognitively Impaired and Who is in Pain

• Observe for signs (listed as most frequent occurring to least frequent occurring) o Change in facial expression, especially grimacing o Restless body movement o Change in behavior based on individual o Moaning o Tense muscles o Agitation o Combative/angry (pulls away when touched) • Report what is observed to the nurse immediately • When you find something that works, let the nurse and other nurse aides know • Work as a team with other staff members

Edema - Nurse Aide's Role

• Obtain accurate weights per order • Increase pillows per resident's request • Restrict fluids per doctor's order • Measure and record I&O accurately, if ordered • Observe for and report signs/symptoms: weight gain of 1 to 2 pounds in a day; decrease in urine output; increased heart rate; difficult breathing or shortness of breath; fatigue; swelling of ankles, feet, fingers, hands; coughing; tight, smooth, shiny skin

Angina Pectoris (Angina)

• Occurs when heart muscle is not getting enough oxygen • Causes chest pain, pressure or tightness of chest, pain radiating up the jaw, and/or down the left arm, may sweat and get short of breath • Exercise, stress, excitement, or digesting a big meal require additional oxygen; with coronary artery disease, the narrowed blood vessels keep heart muscle from getting enough oxygen

Constipation

• Occurs when stool moves too slowly through the intestine; • Signs - abdominal swelling, gas, irritability, and verbalizing of resident that no recent bowel movement • Can result from decreased fluid intake, poor diet, inactivity, medications, aging, certain diseases, or not taking the time to have a bowel movement

Cerebrovascular Accident (CVA)

• Often referred to as a stroke • Occurs when blood supply to a part of the brain is blocked or blood vessel leaks/breaks in a part of the brain • A true emergency because a quick response is critical to reduce severity of the stroke • Acronym BEFAST can be used to remember sudden signs that stroke is occurring o Balance - loss of balance; dizziness o Eyes - blurred vision o Face - one side of face is drooping o Arms - arm (or leg) weakness o Speech - speech difficulty o Time - time to call 911 (or notify supervisor if the resident in a health care facility)

Temperature Values

• Oral o Baseline - 98.6oF o Normal range - 97.6oF to 99.6oF • Rectal o Baseline - 99.6oF o Normal range - 98.6oF to 100.6oF • Axillary o Baseline - 97.6oF o Normal range - 96.6oF to 98.6oF • Tympanic membrane o Baseline - 98.6oF o Normal range - 97.6oF to 99.6oF • Temporal o Baseline - 98.6oF o Normal range - 97.6oF to 99.6oF

Non-mercury, Liquid-filled Glass Thermometers

• Oral, rectal, or axillary • Color-coded o Either blue or green for oral o Red for rectal • Takes a long time to register - 3 to 10 minutes based on site • Held at the stem of the thermometer and read at eye level • The nurse aide must read the thermometer after it registers the temperature; held at stem; read at eye level • Most health care providers use the Fahrenheit scale to measure temperature, even though both Fahrenheit and Celsius values are typically seen on thermometer Reading the Non-mercury, Liquid-filled Glass Thermometer • For Fahrenheit readings: o The long line represents 1 degree o The short line represents two tenths (2/10) of a degree

Digital Thermometer

• Oral, rectal, or axillary • Displays results digitally and is quick, within 2 - 60 seconds, and beeps or flashes when done • Battery-operated • Requires a disposable sheath

Electronic Thermometer

• Oral, rectal, or axillary • Have oral (blue tipped) and rectal (red tipped) probes; for axillary temperature use oral (blue tipped) thermometer • Displays results digitally and is quick, within 2 - 60 seconds, and beeps or flashes when done • Battery-operated and stored in recharging device • Requires a probe cover

The Regular Diet

• Ordered by the doctor • A basic, well-balanced diet • Without limits or restrictions

I&O

• Ordered by the doctor; found on care plan and directive from nurse • Typically calculated at the end of each shift and totaled every 24-hours • Documented on a facility-specific form in the appropriate column • Calculations and totals based on the milliliter (mL)

Family and Family Support - Nurse Aide's Role

• Orient family to the facility and how it works • Learn family names and address by name • Get to know family - their likes and dislikes • Get familiar with family routines • Keep in mind, each culture and family tradition is unique and may be different from nurse aide's • Work to build positive and trusting relationship with family • Let family know role is supported • Keep lines of communication open • Always be respectful and kind to family • Encourage expressions of emotions • Reassure family members as they cope with resident's actions, problems and concerns • Provide explanations when asked and refer to supervisor to assist the family when necessary • Refer family concerns to supervisor • Incorporate and honor family wishes, if possible • Allow time for privacy during visits • Permit family members to assist with care if resident does not object • Encourage family to assist with feeding/dining if safe and resident agrees • Encourage family to bring special foods or beverages for resident, if allowed • Use tact in dealing with family complaints and requests that you cannot honor • Avoid involvement in family affairs • Be tactful when asking family member to leave resident's room • After family visit ends, observe effects visit had on the resident • Report negative visit effects to supervisor • Residents with no living relatives may have friends or neighbors who act as family members •Resident's family may not look like nurse aide's definition of family

Link #4 Mode of Transportation: Other ways

• Other ways harmful germs get around o Through animal and insect bites; an insect or animal bites an infected person or animal and then bites a new person or animal and shares the infection o By eating or drinking food or water that is infected with harmful germs

Intrinsic Risk Factors

• Over 65-years old; effects of aging on balance and gait • Medical conditions and diseases • Decline in function due to inactivity • Effects and side-effects of medication

Immune System

• Overview - this system defends threats both inside and outside the body • Structure - antibodies and white blood cells • Function o Protects the body from harmful infection-causing germs, such as bacteria and viruses o Provides immunity from certain diseases • Normal findings - body can fight infection • Changes due to aging o Immune system weakens and person more prone to getting infections o Person's immune system may attack itself causing disease

Physical Needs - Requirements for Sustaining Life

• Oxygen o Elevate head of bed o Up in chair o Assist with breathing exercises o Report cyanosis (or blue lip color) • Food o Assist those unable to eat without help o Make sure dentures in place o Serve food at proper temperature, in a friendly manner, in a pleasant environment, in appropriate amounts • Water o Be sure it is within reach o Provide fresh water at periodic intervals during day • Elimination o Assist with toileting as needed o Provide for privacy o Change soiled linen immediately o Follow routine for bowel and bladder training as required • Activity o Range of motion exercises as directed o Turn and reposition at least every two hours o Assist with activity as directed o Encourage movement o Encourage interesting recreational activities

Pain - Facts

• Pain may come with aging, but people do not have to live with unrelieved or unmanaged pain • Pain is significantly under-reported in nursing facilities especially among the oldest old, females, minorities and the cognitively impaired; although pain can be relieved in up to 90% of cases, a significant number of nursing home residents receive inadequate or no treatment • In nursing homes, 71-83% of residents experience pain; up to 80% experience pain that interferes with activities of daily living and quality of life • Caregivers, including nurses and nurse aides, commonly underestimate pain • Under rating and under treating pain can be neglect, negligence, or even elder abuse • Nursing homes that do not manage pain properly will be cited with a deficiency by long-term care surveyors; surveyors will interview nurse aides, the caregivers who work most closely with residents, about residents' pain and how it is treated

Serving Sizes Using the Hand

• Palm - 3 ounces (meat, poultry, fish) • Handful - 1 ounce (nuts, raisins, small candies) • Woman's fist - 1 cup (rice, fruit, veggies, cereal, pasta, baked potato) • 2 handfuls - 1 ounce (chips, popcorn, pretzels) • Deck of cards - 3 ounces (meat, poultry, fish) • Baseball - 1 cup (rice, fruit, veggies, cereal, pasta) • Tennis ball - 1 medium size fruit • Postage stamp - butter

Culture - Knowledge: People

• People react differently based on their beliefs and values • Emotions - weakness; strength o Impact others in positive and negative ways. o Can prevent emotional healing o Should be acknowledged in a positive manner • Personal space - standing close, touching, gestures, eye contact o Should allow communication to occur comfortably

Cardiovascular System - Nurse Aide's Role

• Per directive of care plan or nurse, monitor vital signs (BP and P) and report abnormal values • Assist with special diet needs (low fat, low sodium) • Measure intake and output if resident receives special medication • Provide rest periods at intervals; rest reduces need for extra oxygen • Prevent resident from tiring • Layer clothing to help with warmth • Report complaints of chest pain immediately to the nurse; stay with resident and use call signal for assistance • Avoid extremes in temperature, particularly a cold room • Reduce stressful situations; be aware of interactions between resident and visitors; notify nurse if resident becomes upset

4th Stage - Depression

• Person begins the process of mourning; cries, withdraws from others; may be becoming weaker and symptoms are worsening; may lack the strength to do simple things; will need additional assistance with physical care and emotional support; the "yes me" stage; nurse aide needs to demonstrate understanding and a willingness to listen

3rd Stage - Bargaining

• Person tries to arrange for more time to live to take care of unfinished business; bargains with the doctors or God; this stage is usually private and spiritual; the "yes me, but...." stage

Link #6 Susceptible Host

• Person who does not have an infection now, but is at risk for becoming next person to get infected from harmful germs • Susceptible host is a person whose body for some reason cannot fight off infection • Some of the reasons why a person's body cannot fight off an infection include o Age o Chronic illness o Not having proper vaccinations o Open cuts or skin breakdown o Fatigue o Poor nutrition o Stress

Stomach Infection

• Person with a stomach infection will probably have stomach pains and may vomit

Life in a Nursing Home - Limited Space

• Personal space is limited and reduced to a few square feet around the bed • Storage space is limited

Causes of Mental Illness

• Physical factors such as illness, disability, aging, substance abuse, and chemical imbalances • Environmental factors such as weak interpersonal or family relationships • Traumatic past experiences, such as abuse • Inherited traits • Ability to cope with stress

Link #2 Reservoir

• Place where harmful germs live, grow, and increase in numbers (a home for germs) • When reservoir is a person, harmful germs may live and multiply in: o Blood o The skin o The digestive tract, such as the mouth, stomach, intestines • The respiratory tract, such as the nose, throat or lungs • Examples - a person, an animal, dirt, water, or other places in the environment • Can you look at a person and ALWAYS tell if he has an infection that can be given to you, a co-worker, or another resident? • The answer is "NO, not always."

ABC's of Correct Body Mechanics - Center of Gravity

• Point where most weight is concentrated for an object or body • For a standing person, pelvis is center of gravity • A low center of gravity gives you a more stable base of support and balance is increased • By bending knees to lift an object, instead of at the waist o Center of gravity lowered o Stability increases o Less likely to strain muscles • When moving or transferring resident, center of gravity includes the resident, so resident needs to be close to your body as possible

Peripheral Vascular Disease (PVD)

• Poor circulation of legs, feet, arms, hands due to fatty deposits that harden in blood vessels • Signs - nail beds and feet pale or blue, swelling in hands and feet, ulcers of legs and feet, pain while walking • Follow care plane directive regarding elastic stockings

Physical Needs of The Resident Who is Dying

• Positioning o Place resident in most comfortable position for breathing and avoiding pain o Maintain body alignment o Change resident's position frequently to avoid pressure ulcers • Cleanliness o Providing skin care, including back rubs o Bathe and groom resident frequently to promote selfesteem • Mouth and Nose o Clean sores or bleeding in mouth following Standard Precautions o Provide oral care as needed. Cover lips with thin layer of petroleum jelly o Check for difficulty swallowing or choking o Gently clean nose o Offer drinking water as often as possible • Nutrition o Offer resident's favorite foods; include liquids or semiliquids o Offer foods frequently and in small amounts o A balanced diet is not a primary concern • Elimination o Keep the resident's skin and linen clean o Provide perineal care as often as necessary

Logrolling

• Positioning a resident on the side with problems with the neck or back, spinal cord injury, or surgery of the back or hip requires a special technique called logrolling • As the resident is being turned, the resident must be turned as a unit; the head, back, and legs must remain in a straight line • It is best to have two people perform the logroll together using a draw sheet and a count of three

Muscles - Function

• Power movement of skeleton - tendons that connect muscles to bone and move bones when muscles contract (shorten) • Give body form (or posture) • Produce most of body heat - when muscles contract, food is burned for energy producing heat; more muscle activity, greater amount of heat; when body is cold, rapid muscle contractions occur producing heat, called shivering

The Diet Card

• Prepared by dietary department based on doctor's order • Each resident's meal has its own diet card • At a minimum, lists the resident's room number, name, and type of diet • The nurse aide who delivers the meal tray must verify that the right resident is receiving the right meal tray, with the right diet on it

Pressure Injury - At Risk Factors

• Pressure is major cause of pressure injuries; shearing and friction are contributing factors; all contribute to skin breakdown • Risk factors - immobility, breaks in skin, poor circulation to area, moisture, dry skin, and urine and feces irritation • Older residents and disabled residents are at risk due to skin changes due to age, chronic disease, and frailty

Musculoskeletal - Nurse Aide's Role

• Prevention, prevention, prevention! • Most falls are preventable in the long-term care facility; answer call lights immediately, keep pathways clear, clean up spills, and do not move furniture; keep walkers and canes nearby so resident can reach them; resident should wear correctly fitted, non-skid footwear that is secured correctly to the feet • Encourage regular movement, activity, self-care with ADLs • Encourage resident to walk, do light exercise, and active range of motion

Alzheimer's Disease

• Progressive disease • Gradual decline in memory, thinking and physical ability over several years • Average life span in 8 years, but survival may be from 3 to 20 years • Progressive into 7 stages

Defense Mechanisms

• Projection - blaming others • Rationalization - false reason for situation • Denial - pretending a problem does not exist • Compensation - making up for a situation in some other way • Displacement - transferring feelings about the one person to another person • Daydreaming - escape from reality • Identification - idolizing another and trying to copy him/her • Sublimation - redirecting feelings to constructive activity

Good Nutrition - Importance

• Promotes physical and mental health • Increases resistance to illness • Produces energy and vitality • Aids in healing • Assists one to feel and sleep better • Helps avoid or manage common diseases o Certain cancers o Type 2 diabetes o Heart disease o High blood pressure o Obesity o Osteoporosis

Why is Dignity Important?

• Promotes sense of self-importance • Promotes quality of life • Promotes feelings of positive self-worth • Guides nurse aide in giving care

Why is Dignity Important?

• Promotes sense of self-importance • Promotes quality of life • Promotes feelings of positive self-worth • Guides nurse aide in giving care

Dignity - Points to Remember

• Promotion of dignity is constant and on-going • Should always be respectful - whether in communication or in performance of resident skills • Essential for every nurse aide activity • Resident's dignity is valued if nurse aide gives appropriate, compassionate and effective care

Dignity - Points to Remember

Safety in the Resident's Environment - Points to Remember

• Provide care to right resident • Keep bed in lowest position except when giving bedside care • Keep call signal within easy reach • Arrange resident's room for convenience to the resident; fosters independence • OBRA requires 71o F to 81o F for room temperature • Lock wheelchair before moving resident into or out of it • Be careful of feet when transporting residents in wheelchairs • Consider over-bed table a clean area; must be kept clean and free of clutter • Respect the resident's right to full visual privacy • Respect that residents can have and use personal items • Always check water temperature prior to bath or shower • Report if water seems too hot • Monitor wandering residents

Safety and Security Needs

• Provide for warmth • Establish familiar surroundings o Explain procedures o Talk about their room o Keep promises o Provide safe environment o Promote use of personal belongings • Maintain order and follow routines • Assist to reduce fear and anxiety, check on resident frequently • Avoid rushing and assist resident in gentle manner

Respiratory System - Nurse Aide's Role

• Provide rest periods at intervals • Encourage exercise and regular movement • Encourage and assist with deep breathing exercises • Limit exposure to smoke, polluted air, or noxious odors by residents with respiratory conditions • Position residents in a manner to maximize lung expansion

Musculoskeletal System

• Provides structure and movement for the body • Protects and gives the body shape

Dementia and Alzheimer's Disease - Nurse Aide Stress and Burnout

• Providing care on daily basis for resident with Alzheimer's or dementia extremely stressful • This population of residents may be more prone than others to becoming victims of abuse or neglect • Because of this, nurse aides that deal with Alzheimer's or dementia residents must take additional precautions to ensure they do not over-react or react negatively to resident behaviors • Regardless of the cause, nurse aides must take necessary steps to ensure that they do not react inappropriately to resident behavior • Frustration can lead to o Negative, harsh or mean-spirited statements made to staff or residents o Physical abuse of residents o Emotional abuse of residents o Verbal abuse of residents o Neglect of residents • Nurse aides must always remember that statements and behaviors of residents suffering from Alzheimer's or dementia are beyond control of the resident and not personally directed toward nurse aide • Usual profile of employee who is subject to burnout o Takes work personally and seriously o Works over at end of a shift o Works extra shifts o Takes on extra projects o Very high or unrealistic expectations o Perfectionist attitude • Signs of staff burnout include o No longer enjoying work o Irritable with residents and co-workers o Fear of failure, inadequacy, job loss and obligation to supervisor, co-workers, family o Feelings of being overwhelmed o Viewing work as a chore o Frequent complaints of illness • Strategies to use to assist in preventing burnout include o Maintain good physical and mental health o Get adequate amounts of sleep on off days and before each shift o Remain active within family and community o Maintain a separation between work and personal relationships o Maintain a sense of humor

Impending Death: Signs That the Resident is Within Hours or Days of Death and Should be Reported to Nurse

• Psychological and physical withdrawal • Decreased level of alertness, with increased periods of sleeping • Body temperature rises o Feels cool, looks pale, and perspires • Circulatory system fails o Pulse is fast or slow, weak and irregular o Blood pressure drops o Extremities become cold and pale, mottling occurs (bruise-like discoloration • Respiratory system fails with erratic breathing patterns occurring o irregular, rapid and shallow or slow and heavy o Cheyne-Stokes breathing - when resident takes several shallow breaths followed by periods of no breathing for 5, 30, or even 60 seconds; does not cause the resident discomfort o Noisy respirations o Mucus collects in airway, a rattling or gurgling sound as the resident breathes (what some people refer to as "death rattle") o Apnea - respiration stops • Digestive system - slows down o Distention of abdomen o Fecal incontinence due to relaxed muscles o Nausea and vomiting • Urinary system o Dark-colored urine in very small amounts due to decreased blood supply to the kidneys o Incontinence due to relaxed muscles • Muscle tone o Starting in the feet and legs movement and muscle tone are lost o Eventually mouth muscles relaxes and jaw sags; o Body becomes limp • Sensory - sensory perception decline o Blurred and failing vision; may stare yet not respond, lack of blinking; o Touch is diminished o Hearing is believed to be the last sense to be lost o Pain decreases with loss of consciousness

Contact Precautions

• Purpose - prevent spread of harmful germs spread by direct contact • PPE - follow Standard Precautions, plus wear gown and gloves • Examples - Methicillin-Resistant Staphylococcus Aureus (MRSA) infection (is the bacteria known for causing skin infections in addition to many other types of infections) and Norovirus (the virus that causes diarrhea and vomiting)

Droplet Precautions

• Purpose - prevent spread of harmful germs that travel by droplets in the air • Some harmful germs (like the flu) can be spread or travel by way of droplets o Droplets spread after being sprayed from nose or mouth when infected person sneezes, coughs, sings, talks, or laughs • Droplets might land on another person (direct contact), or might land on doorknob, railing, or other surface that another person might touch (indirect contact) • Droplets o Usually do not go farther than three feet, but could travel farther o Spread when an infected resident cough, sings, sneezes, or laughs • PPE - follow Standard Precautions, plus wear a mask and gloves • Examples - influenza, meningitis, and whooping cough

Airborne Precautions

• Purpose - prevent spread of harmful germs that travel in the air at a distance • Harmful germs o Float around for a while o Can be carried by moisture, air currents and dust • PPE - Standard Precautions, plus wear a respirator, depending on specific disease • Examples - tuberculosis (or TB), chicken pox, measles

Dignity - Definition

• Quality or state of being worthy of esteem or self-respect • An important component in OBRA's Residents' Rights

Dignity - Definition

• Quality or state of being worthy of esteem or self-respect • An important component in OBRA's Residents' Rights

Body Mechanics - Changing Linen

• Raise bed to about waist height when changing linen

Feelings and Responses By The Resident's Family, Friends And Other Residents During The Dying Process

• Realize that even if the dying process is prolonged, staff and the family may not be prepared for the actual moment of death • Staff may be shocked or surprised when death actually happens; these feelings are normal • Recognize variety of feelings/responses may be displayed - guilt, anger, sadness/depression, avoidance, denial, acceptance, relief • Listen empathetically • Demonstrate caring, interested attitude • Observe for changes in other residents (such as signs of depression, etc) and report/record appropriate information

Self-actualization Defined

• Realizing personal potential including creative activities • Self-fulfillment • Seeking personal growth and peak experiences • A desire to become everything one is capable of becoming

Caring for Residents who are Paranoid - Nurse Aide Role

• Reassure the resident that you will provide safety • Realize behavior is based on fear situations • Avoid agreeing or disagreeing with comments • Provide calm environment • Involve in reality activities

Urinary Tract Infection (UTI)

• Recall the differences in the female and male urethras; more common in females than males • An infection of urethra, bladder, ureter, or kidney typically caused by E. coli, a bacteria found in the digestive system • Signs include frequency, urgency, voiding in small amounts, pain, burning • Nurse aide's role - always wipe/wash from front to back (both resident and nurse aide); provide careful perineal care when changing adult briefs; encourage fluids; offer toileting opportunity at least every 2 hours; answer call lights promptly showers are preferable to baths; report abnormal urine signs to nurse

Positioning the Resident (Fowler's)

• Reclined sitting position • 45 to 60 degrees

Caring for Residents Who Are Depressed

• Recognize reasons for depression o Loss of independence o Death of spouse or friend o Loss of job or home o Decreased memory o Terminal illness • Recognize common signs and symptoms of depression o Change in sleep pattern o Loss of appetite and weight loss o Crying o Withdrawal from activities o Appearing sad • When the resident is depressed o Listen to feelings o Encourage to reminisce o Involve in activities o Encourage friends and family to visit o Report changes in eating, elimination or sleeping patterns o Avoid pitying the resident o Help to focus on reality o Monitor eating and drinking o Promote self-esteem o Report observations to supervisor • Recognize defense mechanisms - unconscious behaviors that resident may display when stressed

Handling, Moving, and Positioning of Resident

• Refer to care plan for directives • Follow repositioning schedule • Use assistive devices (pillows, foam wedges); support feet properly • Do not position on red area, pressure injury, on tubes or other medical devices • Prevent bed friction (powdered sheets are an example) • Prevent shearing (do not raise the head more than 30o) • Keep feet and heels off bed

Pain - Factors Effecting Reactions to Pain

• Religious beliefs and cultural traditions affect pain; men and women may report pain differently; staff should consider these differences; some residents, families and staff worry about drug side effects, addiction and dependency; others fear bothering the nursing staff • Staff's religious beliefs and cultural traditions affect how they view and manage residents' pain. Resident may be in pain and staff member does not recognize it or believe it should be treated

RACE

• Remove residents from danger • Activate alarm • Contain the fire by closing all doors and windows, if possible • Extinguish the fire, or fire department will extinguish

Reporting - NA's Role

• Report as per facility policy • Report accurately in a respectable manner • State facts, not opinions • Emphasize that facilities may choose to not allow students to document directly on a form or in a medical document • Explain that nurse aide students may be allowed to report observations and activities to facility employees • Remind students that they are guests in a facility and area required to adhere to facility policies • Use reminder notes from notebook or worksheet to report observations and activities • Report immediately and accurately to the designated employee • Reports facts, not opinions • Understand difference between objective and subjective data o Objective data - observations using the senses o Subjective data - information you are told that you cannot observe through your senses • Report changes as they occur • Report before end-of-shift so information can be passed to the next shift

Restraints - Observe, Report and Act

• Report observations and communication accurately • Report to the nurse every time you check the resident and release the restraint • Keep scissors with you at all times, in case the resident's safety is compromised as in choking, aspiration, strangulation, seizures or other emergencies • Place the call light within the resident's reach at all times

Incident Report - Importance

• Required by the facility based upon State and Federal guidelines • Completed by individuals involved at the scene, those on duty at the time, and those who observed incident • Detailed accurate account of who was involved, what, when and where the incident occurred, what immediate actions and additional steps were taken to prevent recurrence

Life in a Nursing Home - Lack of Privacy

• Resident may live in a shared bedroom with no choice of roommates and no control over who stays in other bed - could be someone dying, a resident who is confused, or even a series of roommates • May feel violated if confused residents invade their personal space or take personal items • At home o Older adult could lock the door and choose whether to answer a knock at that door o May also choose whether to let the individual come through the door At nursing home o Resident cannot lock door o A knock on the door signifies that entry is being announced, instead of person requesting to come into room

Positioning the Resident

• Resident must always be properly positioned and correctly aligned • Reposition in bed or chair at least every two hours (or more frequently per care plan) • Use good body mechanics • Ask a co-worker for assistance as needed • Use pillows for support and correct alignment • Understand correct placement for variety of positions while resident is in bed

Restraints - Safety Guidelines

• Resident safety is the highest priority • Restraints must be applied properly o Check size and condition of restraint (must be free from defect) o Ensure the restraint fastens correctly and securely o Secure straps out of the person's reach, under the seat or chair or wheelchair o *Secure the restraint to movable parts of the bed so it does not tighten or loosen when the head or foot is raised or lowered

Mental Health and Mental Illness - Points to Remember

• Residents are more than a diagnosis o Recognize that a person with a mental illness is an individual o Every resident diagnosed with depression, anxiety, paranoia, mania or bi-polar disorder is different from all the other residents with the same diagnoses • All behavior has meaning - looking for the meaning behind the behavior is key • In some instances, such as a resident with dementia, the resident is not responsible for his or her behavior - resident may not be doing things on purpose • Nurse aide can lay the groundwork for successfully handling situations when resident is stressed and agitated by knowing how to communicate effectively day to-day with resident When a resident's unusual or inappropriate behavior escalates, or increases quickly and becomes more serious, resident may be a danger to self and others o Nursing care plan will include specific details about resident's condition and any special approaches to use when working with resident o An important tool to calm residents who are agitated is de-escalation • This is worth repeating: great day-to-day relationships are at the heart of de-escalation

Spiritual Needs

• Residents have right to worship and express faith freely o Respect residents' beliefs and religious objects o Inform residents of the time and place for religious services important to them o Assist resident to attend religious services o Provide privacy for visits by members of the clergy

Other Forms of Nourishment

• Residents may be unable to eat due to illness, surgery, or injury • *Enteral nutrition - feeds the resident through a feeding tube into the gastrointestinal tract, through the nose and directly into the stomach (naso-gastric tube), or into the stomach through the abdomen (gastrostomy) • Nurse is responsible for care of resident's gastrostomy • Nurse aide must keep the head of bed elevated per facility policy • Nurse aide must be careful to not pull on the gastrostomy tube and to keep tube secure • Intravenous (IV) Fluids - feeds the resident through a vein o Nurse is responsible for care o Nurse aide observes for and reports redness, swelling, or pain at the site o Nurse aide reports low supply of fluid in bag • Nurse aide must be careful with tubing and connections when providing care

Dementia and Alzheimer's Disease - Communication

• Residents with Alzheimer's disease often experience problems in making wishes known and in understanding spoken words • Communication becomes more difficult as time goes by • Changes commonly seen in the resident with Alzheimer's o Inability to recognize a word, phrase o Inability to name objects o Using a general term instead of specific word o Getting stuck on ideas or words and repeating them over and over o Easily losing a train of thought o Using inappropriate, silly, rude, insulting or disrespectful language during conversation o Increasingly poor written word comprehension o Gradual loss of writing ability o Combining languages or return to native language o Decreasing level of speech and use of select words, which may also cause the use of nonsense syllables o Reliance on gestures rather than speech

Urination - Nurse Aide's Role

• Residents with incontinence must be kept clean and dry; follow infection prevention concept of wiping from front to back; assist resident with handwashing • Important for nurse aide to provide privacy when attending to elimination needs of resident; should not be rushed or interrupted • To promote normal urination, nurse aide should encourage residents to drink fluids often and should offer fluids each time nurse aide enters room (unless fluid restricted) • Ideal position for urination for men is standing; for women is a sitting position; if resident cannot get out of bed, assist with positioning so that resident is sitting up and by doing so allows for the process to work with gravity

Flu

• Respiratory infection • Risky for people 65 years and older o People 65 years and older are at greater risk of serious complications and death from the flu compared with young, healthy adults o 90 percent of flu-related deaths and more than half of flu-related hospitalizations each year occur in people 65 years and older • Yearly flu vaccination is the first and most important step in protecting against flu • Healthy adults may be able to infect others 1 day before showing flu symptoms and then 5 to 7 days after becoming sick • Employees with fever and respiratory symptoms (such as cough or sore throat) should not come to work until fever has been gone for at least 24 hours without the use of fever-reducing medicines like Tylenol or ibuprofen • Encourage EVERYONE (employees, residents, and visitors) to practice good hand hygiene and to cover mouth and nose when coughing or sneezing • Follow Standard Precautions and Transmission-Based Precautions

Respiratory System - Changes Due to Aging

• Respiratory muscles weaken • Lung tissue gradually becomes less elastic • Shortness of breath upon exertion • Lung capacity decreases • Oxygen in the blood decreases • Muscles of the diaphragm become weaker • Limited expansion of the chest due to changes in posture

The Nursing Care Plan

• Responsibility of the nurse to provide a written plan of care o Is sometimes simply called the Care Plan o Outlines the individual priorities and goals established for the care of each resident • Based on the nursing process • Used for coordination and continuity of care • May be standardized, computerized or written in Kardex o A standardized form may be completed by the resident or a family member. The form may ask for contact information, medical conditions, preferred healthcare providers, hospitals or pharmacies, general or special medical needs, disabilities and advanced care planning directives. o A kiosk may be used to electronically submit a Care Plan. Medical updates, reports and resident activities of daily living (ADL) may also be entered by all members of the healthcare team, as per established facility policies. o Kardex is a type of card file that summarizes information found in the resident's medical record to include medications, treatments, diagnoses, equipment and special needs and routine care measures

Restraint-free Care and Restraint Alternatives

• Restraint-free care - an environment in which restraints are not kept or used for any reason • Restraint alternative - measures used instead of physical or chemical restraints

Restraint Remember

• Restraints are NEVER used as a convenience for the nursing staff or as an act of discipline/punishment • Unnecessary restraint (physical, mechanical, chemical) is considered false imprisonment (unlawful restraint or restriction of resident's freedom of movement) • Restraints are used as a last resort intended to protect the welfare and safety of the resident and others • Restraints take away a resident's right to freedom and violates his/her right to be treated with respect and dignity • Restraints require a doctor's order • Always ask for clarification before applying a restraint • Practice patience, show kindness and be empathetic to residents who are restrained

Restraints - Criteria for Use

• Restraints must protect the person • A doctor's order is required • Restraints are used only in the event other measures fail to protect the resident • The least restrictive method is used • Informed consent is required from the resident or designated legal representative • Residents must be monitored for vital signs, respiratory status and dehydration

Head and Spinal Cord Injuries

• Result from diving accidents, sports injuries, motor vehicle accidents, and war injuries; injuries range from mild concussion to coma, paralysis, and death • Head injuries may cause permanent brain damage; disabilities are related to the part of brain injured and may include personality changes, seizures, memory loss, paresis (loss of use of muscle function affecting only part of body), and full-blown paralysis • Severity of spinal cord injuries depend on the level and force of injury regarding the spinal cord; the higher the injury to the spinal cord, the greater loss of function: paraplegia - complete loss of function occurs to lower body; quadriplegia - complete loss of function occurs to lower and upper body, plus trunk • Nurse aide's role - provide emotional support and realize that the resident may exhibit feelings of anger and frustration; encourage resident to participate in much of self-care as possible; crucial for position changes at a minimum of every two hours due to loss of function; range of motion per directives of care plan; immobility may lead to constipation, so encourage fluids and intake of fiber, if ordered; due to nature of disability, urinary catheter may be necessary, which increases occurrence of urinary tract infection, so provide catheter care and encourage fluids; immobility may lead to poor circulation, offer rest periods during care and apply stockings per directive; encourage deep breathing and coughing, per order, to prevent pneumonia

Cancer (CA) - Risk Factors

• Second largest cause of death; National Cancer Institute describes risk factors o Age - getting older most important risk factor o Tobacco - actual use (smoke, chew, dip) and second-hand (being around it) o Radiation - sunlight, x-rays, and radon gas o Infections - certain viruses and bacteria • Immuno-suppressive drugs - lower body's natural defense of stopping cancer from forming (organ transplant) • Alcohol • Diet - high in fat, protein, calories, and red meat (colon and rectal); fruits and vegetables are great • Hormones - female hormones • Obesity • Environment - air pollution, second-hand smoke, and asbestos

Respiratory System - Variation of Normal

• Shallow breathing or breathing through pursed lips • Coughing or wheezing • Nasal congestion or discharge, or productive cough • Noisy respirations • Gasping for breaths • Too slow or too fast respiratory rate • Cyanosis - changes in skin color, pale or bluish color of lips and extremities • Dyspnea - difficulty breathing • Changes in rate and rhythm of breathing • Need to sit after mild exertion • Pain in the chest

Assistive (Adaptive) Devices for Dressing

• Shirt and jacket pull (pictured) • Zipper pull (pictured) • Button fastener (pictured) • Socks and stocking aid (pictured) • Long-handled shoe horn (pictured)

Cardiovascular - Variation of Norma

• Shortness of breath, changes in or difficulty breathing • Change in pulse rate and rhythm • Loss of ability to perform ADLs • Chest pain

Nurse Aide's Role - Care of the Family After Death

• Show family members to a private place to sit where they can talk privately • Inquire if there is anyone that they would like called • Provide water or a beverage • If family members would like to visit with the deceased, provided privacy and close door quietly; do not rush family • Nurse aides respond differently to the death of a resident; may not know what to say; may cope with stress by talking too much; the nurse aide should offer support without talking too much; listen patiently when family members want to talk and do not interrupt • What to say? Key is to be sincere and understand that a simple, "I'm sorry" is enough; avoid the non-therapeutic response of "she is in a better place" or "it is for the best"; the nurse aide could possibly say something like "your mom will be missed here" if it is true, this response is both kind and supportive

Vital Signs

• Show how well vital organs are functioning - heart and lungs, plus the regulation of temperature • Include temperature, pulse, respiration, and blood pressure • May also be called TPR & BP

Communication - Three-way process

• Simplest form is a three-way process o Sender communicates the message o Receiver receives the message o Feedback allows sender and receiver to respond to each other in some way

A Resident is About to Fall

• Simply control direction of fall by easing resident to floor, protecting head • Keep resident still until nurse can check for injuries • DO NOT try to hold the resident up because it can hurt nurse aide and resident • DO NOT try to hold the resident up because the nurse aide may lose balance and both land on floor

Nurse Aide's Role in Preventing Choking

• Sit resident upright to eat • Provide assistance at mealtime to prevent spilling hot liquids • Encourage resident to use dentures when eating • Assist resident by cutting food in small pieces • Report any difficulty in chewing or swallowing

Positioning the Resident (High Fowler's)

• Sitting up almost straight • 60 to 90 degrees

Cognitive Changes due to Aging

• Size of neurons (brain cells) progressively decrease • Total brain mass decreases •Physiological/psychological responses slow down • Increased learning time needed for new activities • More difficulty in learning motor skills • Decrease processing, response time and reaction time, making fast-paced instruction more challenging • More deliberate, less frequent responses and less effective performance when pace is fast - particularly in stressful/unfamiliar surroundings • Slow with tasks when response speed is needed • Cannot adapt as well, especially in stressful/unfamiliar environments and with impaired senses •Easily confused when too many changes or losses happen at one time or when moved to a different environment • Mild short-term memory loss often occurs (forgetting names, misplacing items, poor recall of recent conversations) • Motivation to learn decreases • Feels threatened more when declining cognitive abilities may be publicly demonstrated • Difficulties in doing more than one task or dealing with more than one request at a time occur • Unable to ignore irrelevant stimuli • Reaction time - the time it takes for a person to begin an answer or a movement after someone asks him/her a question or makes a request o Changes in reaction time vary from person to person o Reaction time slows gradually after age 60 (it takes longer for resident to begin with an answer or to start a movement), especially when the older adult has to make a choice or change movement from one direction to another o Impaired by aging process, sensory deficits, or chronic disease

Stasis Dermatitis

• Skin condition affecting lower legs and ankles • Occurs from buildup of fluid under skin • Problems with circulation resulting in fragile skin • Can lead to open ulcers and wounds • Early signs - scaly, red, itchy areas; later signs - swelling of legs, ankles, or other areas; thin skin; darkening skin, leg pain • Nurse aide's role - report signs; note too tight stockings and shoes and report to nurse; follow directives of care plan which may include anti-embolism stockings and elevation of feet

Integumentary System - Changes Due to Aging

• Skin is thinner, drier, more fragile • Skin loses elasticity • Fatty layer decreases so person feels colder • Hair thins and may gray Folds, lines, wrinkles and brown spots may appear • Nails harden and become more brittle • Reduced circulation to skin, leading to dryness and itching • Development of skin tags, warts and moles

Pacing and Patience - Role of the nurse aide

• Slow down pace when working with residents • Let the resident set the pace • Ensure that the resident is wearing hearing aid and/or glasses before beginning a task, if applicable • Tell the resident ahead of time about the task • Allow time for resident to focus attention on the task or question • Allow time for resident to think about what has been said • Give clear, short, easy instructions that are based on what the resident already knows • Relate new information or tasks with past experiences • Use simple words that resident understands • Show the resident what is to be done • If something has just been learned, allow resident to look at equipment (if equipment is used) • Praise resident when a task is done

Alternative and Supplemental Feedings

• Sometimes given when resident needs extra protein, calories, and fluids o Ordered by physician and to serve as between-meal foods and fluids o Examples include: milk, juice, pudding, ice cream, milk shake, fruit, crackers • Nurse aide's responsibility o Assist the resident as needed Report amount resident ate or drank

Relocation from the Home

• Sometimes the older adult must relocate from the home due to: o Decrease in finances o Decline in physical or mental state resulting in the need for more assistance o Inability to manage the home o Lack of social support o Increasingly unsafe neighborhood

Basic Restorative Care - ALWAYS REMEMBER

• Sometimes you may think it is easier and quicker to do something for a resident, rather than encouraging the resident to do the task independently - important, though, to be patient and encourage resident to do as much of the task as possible, regardless of how long it takes or how poorly the resident performs the task • Independence helps with the resident's self-esteem and speeds up recovery

Assistive (Adaptive) Devices

• Special equipment that helps a disabled or ill resident perform activities of daily living (ADLs) o Promote independence o Successful use of adaptive devices depends on resident's attitude, acceptance, motivation, support from others

Supportive Device

• Special equipment that helps a disabled or ill resident with movement • Examples include canes, walkers, crutches, wheelchairs, and motorized chairs

The Enema

• Specific amount of water that may or may not have an additive and is inserted into the colon to stimulate passage of stool • Doctor will write order for type and amount of fluid; four different types - tap water, soapsuds, saline, commercially- prepared and pre-packaged • Follow facility's procedure for administering enemas

Pressure Injury Stages

• Stage 1 - intact skin; redness over bony prominence • Stage 2 - Skin loss (partial-thickness); may see a blister or shallow reddish-pink ulcer; the blister may be intact or open • Stage 3 - Skin loss (full-thickness); skin gone; may see subcutaneous fat; slough (dead soft tissue, often moist and varies in color - white, yellow, green, or tan) may be present; could be attached or stringy loose • Stage 4 - Full-thickness skin and tissue loss with muscle, tendon, and bone exposure; slough and eschar (thick, leathery dead tissue that may be loose or attached to skin); often black or brown • Unstageable - Full-thickness tissue loss with injury covered by slough and/or eschar • Deep tissue injury - purple or deep red localized area of discolored intact skin or blood-filled blister; usually due to damage of underlying soft tissue from pressure and/or shear

Delirium

• State of severe sudden confusion that is usually reversible • Triggered by acute illness or change in physical condition • Can be life threatening if not recognized and treated • Symptoms of delirium o Rapid decline in cognitive function (ability to think) o Increased confusion o Disorientation to place and time o Decreased attention span o Poor short-term memory and immediate recall o Poor judgment o Restlessness o Altered level of consciousness o Suspiciousness o Hallucinations, delusions • Notify nurse and stay with resident • Communicating with a resident who is showing signs of delirium o Stay calm o Keep voice at a normal volume; do not shout o Use resident's name o Speak clearly in simple sentences o Use facial expressions and body language to aid in understanding o Reduce distractions in the environment, such as turning down TV or closing curtains to block bright sunlight

Checking Blood Pressure - Equipment

• Stethoscope • Sphygmomanometer, also known as a blood pressure cuff (hereafter referred to as BP cuff) • Alcohol wipes • Note pad/assignment sheet and pen

The Nurse Aide as Employee - Nurse Aide's Role

• Strive to be the best nurse aide you can be because the residents of North Carolina are depending on you • Understand requirements of being a nurse aide in North Carolina and maintain current listing on Nurse Aide I Registry • Know what nurse aides are legally allowed to do • Have concern for others and help make their lives happier and easier - whether it be residents, families, or co-workers • Maintain excellent appearance, grooming, and hygiene, while at work Report to work on time and when scheduled • Use sick time for just that - sick time • Perform an honest day's work for an honest day's pay • Show respect to boss and supervisors; don't join in when others are criticizing management • Perform tasks delegated by nurse • Be gentle and kind to residents, families, and co-workers • Be able to put self in the other person's shoes and attempt to understand the person (empathy) • Be pleasant, not moody, bad-tempered, or sad, while at work • Respect others and their possessions • Always try your best • Never be afraid to ask when you do not know an answer or how to do something • Treat residents, families, and co-workers with dignity • Be a team player and help others when you are asked and when you have down-time • Be careful and alert to surroundings at work and to resident cues • Be eager and excited about going to work • Do not gossip • Do not lie, cheat, or steal (not even a note pad or ink pen) • Always seek the good in others • Remain loyal to facility and employer • Always take the opportunity to praise others when the chance arises • Do not use profanity or tell off-color jokes

Endocrine - Structure and Function

• Structure - glands located throughout the body that secrete chemicals, called hormones that regulate bodily function • Function o Maintains homeostasis (balance) o Influences growth and development o Regulates sugar in the blood and calcium in the bones o Regulates reproduction o Regulates how fast cells burn food

Communication - Definition

• Successfully sending and receiving messages using signs, symbols, words, drawings and pictures o Explore the meaning behind certain symbols o Locate drawings/pictures that convey a universal message

Carbohydrates

• Supplies energy and helps body use fats • Certain carbohydrates add fiber to diet that help with elimination • Sources of carbohydrates - breads, fruits, candy, sugary soft drinks, etc

Comfort Measures - Nurse Aide's Role

• Supportive talk • Gentle touch • Music • Soft lighting • Decreased noise • Warm or cold packs (if approved by nurse) • Massage • Re-positioning • Soothing activities • Prayer and spiritual support • Listening and conversation • Favorite foods or drinks • Help with personal cleanliness • Reminiscing • A walk

Amputation

• Surgical removal of some or all of a body part; occurs - arm, hand, leg, foot; caused - disease or accident • Phantom sensation - person feels the body part is still there; phantom pain - person experiences pain in the area that has been amputated; do not ignore either; possibly results from damaged nerve endings; report to nurse • Nurse aide's role - per care plan and nurse directive, provide assistance with activities of daily living; provide support if phantom statements are made and do not argue with resident, report to nurse; assist with position changes and range of motion exercises per directive; follow care plan regarding prosthetic care

Total Knee Replacement (TKR)

• Surgical replacement of knee with a prosthesis; prosthesis - device that replaces body part that is missing or deformed • Performed to relieve pain and restore mobility, damaged by arthritis or injury • Post-op care is similar to hip replacement; resident does have greater ability to do self-care though • Goals - prevent blood clots, special stockings and machines used; speed up recovery, decrease stiffness, increase range of motion, • Nurse aide's role - follow care plan and nurse's directive regarding mobility; encourage fluids to reduce urinary infections; report pain and redness, swelling, heat, or tenderness in calves

Cardiovascular System - Variation of Normal

• Swelling of hands and feet • Pale or bluish lips, hands, or feet • Weakness and tiredness • Weight gain

Stroke (CVA, Cerebrovascular Accident)

• Talked about or will talk about the signs of a stroke in the emergency component of the curriculum and importance of seeking emergency care immediately • Caused when (1) a blood vessel leaks or breaks in the brain; or (2) when oxygen to an area is disrupted, brain cells die • Can be mild or severe • Recall that cerebrum is divided into right and left hemispheres; right controls movement and function of left side; left controls movement and function of right side; illness or injury to right hemisphere affects function of left side; illness or injury to left hemisphere affects function of right side • Further recall that each side of your brain contains four lobes with important functions • The area of the brain and the size of the area affected by the injury will impact the severity of the stroke, signs and symptoms the resident will exhibit, extent of disability, and prognosis • After the stroke, the resident may experience: o Hemiplegia - paralysis on one side of body o Hemiparesis - weakness on one side of body o Expressive aphasia - trouble communicating thoughts by speech or writing o Receptive aphasia - difficulty understanding spoken or written words o Emotional lability - inappropriate or uncalled for laughing, crying, or expressions of anger o Loss of sensations (temperature, touch) o Loss of bowel/bladder control o Cognitive impairment (poor judgment, memory loss, inability to solve problems, confusion) o Dysphagia (difficulty swallowing)

Pulse Sites

• Temporal • Carotid - never check pulse rates on both carotid arteries at the same time • Apical - over the heart and taken with a stethoscope • Brachial - typically used during blood pressure checks • Radial - used most often, easy to reach, easy to find, used for routine vital signs • Pedal - used to check circulation of the leg

Pain - Acute Pain

• Temporary, lasts for a few hours, or, at most, up to six months • Usually comes on suddenly, as a result of disease, inflammation or injury • Goes away when the healing process is complete • Serves a purpose because it warns the body of a problem that needs attention • Identifying and treating the cause of acute pain is usually possible • When people are in acute pain, their discomfort tends to be obvious • In fact, acute pain can rev up the body and may cause pale sweaty skin and an increase in heart rate, respiratory rate and blood pressure

The Pressure Injury

• The Centers for Medicare and Medicaid Services (CMS) defines the pressure ulcer (injury) as "any lesion caused by unrelieved pressure that results in damage to underlying tissues; friction and shear are factors" • The CMS requires that long term care facilities identify residents at risk for pressure ulcers • Many pressure ulcers occur within first 4 weeks of admission to the facility • Bony prominence - an area where bone sticks out or projects from flat surface of the body; back of head, shoulder blades, elbows, hips, spine, sacrum, knees, ankles, heels, and toes • Shear - when layers of skin rub up against each other; or it could be when skin remains in place, but tissues underneath move and stretch causing damage to capillaries and blood vessels • Friction - rubbing of one surface against another; skin is dragged across a surface • CMS has defined two other terms o Unavoidable pressure injury - a pressure injury occurs despite efforts to prevent one through proper use of the nursing process o Avoidable pressure injury - one that develops from improper use of the nursing process

Blood Pressure Site

• The brachial artery and the upper arm are sites most often used by the nurse aide when checking blood pressure

Adapting to Life in a Nursing Home (

• The cognitively intact older adult adapts to life in a nursing home in one of three ways o Becomes depressed or may regress, withdraws from others and only shows interest in events that affect own personal, physical self, OR o Becomes narrow-minded, uncooperative with staff, and fights all attempts to be included into normal, standard routine of nursing home activities, does not view nursing home as home, OR o Determined to make the best of his or her stay in nursing home and claims to prefer it to life before admission • Important to realize that a normal response to sudden placement into a nursing home, such as depression, withdrawal, or moodiness, is often viewed as poor adjustment to nursing home life • Nursing home staff may unfairly and prematurely label the resident as difficult or a troublemaker

Communicating with the Health Care Team

• The exchange of information, either verbal or written, between and among members of the health care team

Urinary

• The filtering system of the body • Responsible for ridding body of waste products from blood

OBRA Dietary Requirements for Resident's in Nursing Homes

• The food is o Appetizing, smells and looks good o Varied in color and texture o Served at the correct temperature o Served promptly o Prepared to meet individual needs • Other foods are offered if food serve is refused • Each person receives at least 3 meals a day, with the offer of a bedtime snack • Assistive devices and utensils provided as needed

Cognition

• The manner in which messages from the five senses are changed, stored in memory, recovered from memory, and later used to answer questions, respond to requests, and perform tasks

Pulse - Checking Pulse and Documentation

• The nurse aide counts pulse rate for 60 seconds (1 minute) • While watching the second hand of an analog watch, the nurse aide starts counting and stops counting on the same number • Document on the resident's record if the pulse falls within the range of 60 and 100 and is regular and strong • Document on the resident's record and notify the nurse, if pulse is abnormal

Urination and Urine

• The passing of urine from the bladder through the urethra to the outside of the body is called urination or micturition or voiding • Made up of water and waste products filtered from blood by kidneys • Many factors can change color of urine, such as medications, certain food and dyes and vitamins and supplements • B vitamins can cause urine to become bright yellow; beets can cause a pink or red color

Structure and Function of the Heart

• The pump of the cardiovascular (circulatory) system • Consists of 4 chambers - right and left atria, and right and left ventricles • Has 2 phases o (1) Working phase, or systole, when the heart is pumping blood to the body, and the top number of a blood pressure reading and o (2) The resting phase, or diastole, when the heart fills with blood, and the bottom number of a blood pressure reading Blood pressure - is the amount of force exerted by the blood against the walls of the artery o Top number is the systolic pressure and the pressure when the heart contracts and pumps blood out o Bottom number is the diastolic pressure when the heart rests as the heart fills with blood

Resident's Rights

• The resident has the right to be free from any physical or chemical restraints imposed for purposes of discipline or convenience, and not required to treat the resident's medical symptoms (CMS F604; F605) (42CFR483.10(e), 42CFR483.12(a)(2)) • Unnecessary restraints are false imprisonment

Consent

• The right to decide what will be done to the body and who can touch the body • Example of written consent - signs a form (nurse aide does not obtain this) • Example of verbal consent - a verbal "yes" or "ok" (nurse aide can obtain this) • Example of implied consent - resident extends arm after nurse aide asks to check blood pressure (nurse aide can obtain this)

Skeletal (Bones) - Structure

• The skeleton o Has 206 bones o Framework • Bones o Outside is hard and rigid o Covered with periosteum, which contains blood vessels o Bone marrow, located inside, is soft and spongy o Connected to other bones by ligaments o Connected to muscles by tendons

Integumentary System

• The skin • Largest organ and system in the body • Accessory structures include hair and nails • Responsible for providing a natural protective covering of the body

Structure and Function of the Blood Vessels

• The transportation system of the cardiovascular (circulatory) system o Veins - carry blood with waste products away from the cells and to the heart o Arteries - carry blood with oxygen and nutrients away from the heart and to the cells Pulse - the beat of the heart felt at an artery, as a wave of blood passes through the artery o Pulse rate - is the number of heart beats (or pulses) per minute o Pulse rhythm - is the regularity of the heart beats (pulses) and should be the same interval between beats o Pulse force - is the strength of the pulse and should be easy to fee

Restraints - Risks

• The use of restraints sometimes results in health risks/injuries to the resident: o Cuts, bruises, skin tears, skin breakdown, pressure ulcers and fractures o Aspiration o Death from strangulation o Constipation, contractures, decreased ability to walk o Dehydration, incontinence o Infections such as pneumonia and urinary tract o Swelling (edema) in limbs, nerve damage o Mental health issues: agitation, anger, delirium, depression, reduced social contact, withdrawal o Self-esteem issues: embarrassment, humiliation, loss of dignity, confidence and self-worth

Communicating with Resident with Dementia and Alzheimer's Disease - Nurse Aide's Role

• There are several components when assisting resident with communication o Patience with resident o Show interest in the subject o Offer comfort and reassurance o Listen for a response o Avoid criticizing or correcting o Avoid arguments with resident o Offer a guess as to what resident wants o Focus on the feelings, not on the truth o Limit distractions o Encourage non-verbal communication

When to Hand Rub

• There are times when alcohol-based hand rubs are acceptable choice in hand hygiene o Before and after eating o Before and after handling food o Before and after routine resident care

When to Hand Wash

• There are times when nurse aide should use soap and water, instead of alcohol-based hand rub o If hands are visibly dirty o After using restroom o After blowing nose o After sneezing in hands

Non-mercury, Liquid-filled Glass Thermometers - Equipment

• Thermometer • Sheath • Gloves • Watch • Pen • Notepad • Alcohol wipe • Water soluble lubricant (rectal temperature only)v

Urethra - Male Versus Female

• Think about the anatomy of the female urethra and the male urethra in terms of length • Note the difference between one and a half inches versus seven/eight inches and how the male and female genitalia differ

Reproductive

• This system allows human beings to create a new human life and may be subdivided into two categories (1) the female reproductive system and (2) the male reproductive system

Respiratory System - Structure and Function

• Thorax o Closed cavity of the body that contains the structures needed for respiration o Extends from the base of the neck to the diaphragm, and surrounded by muscles and ribs • Upper Respiratory Tract o Consists of nose, mouth, sinuses, pharynx, larynx, and top of trachea • Lower Respiratory Tract o Consists of lower trachea, bronchi, and lungs • Function - involves the breathing in of oxygen (inspiration) and the breathing out of carbon dioxide (expiration)

Integumentary System - Structure

• Three layers o Epidermis - the outer layer; has living and dead cells; living cells push dead cells up as they divide and dead cells flake off; living cells contain pigment that give the skin its color; does not have blood vessels and only few nerve cells o Dermis - inner layer; made up of connective tissue; blood vessels, nerves, sweat glands, oil glands, and hair roots located there o Subcutaneous (fatty) tissue - thick layer of fat and connective tissue

An Older Adult's Home

• To an older adult, a home may represent o Independence o A link to the past o A part of his/her identity o The center for family gatherings o A connection to the neighborhood o Symbol of position in the community o A place to maintain autonomy and control

Convert Military to Conventional Time

• To convert military to conventional time, reverse the processes • For a.m. simply remove the 0 in front of the hours, add the colon and a.m. • For p.m. simply subtract 12 from the hours, add the colon and p.m.

Determining Oral Fluids as Intake

• To determine intake, nurse aide must know serving sizes of containers that fluids are served in a facility o Typically found on the I&O sheet o Nurse aide will eventually know serving sizes of containers without needing to refer to I&O sheet as resource • Two methods to measure intake of oral fluids o Measures - using a designated graduate, the nurse aide measures the amount of fluid left in the container and subtracts that amount from the total amount the container holds o Using fractions - knowing the amount in milliliters that a serving container holds, the nurse aide uses fractions to calculate how much fluid the resident drank based on the amount of fluid left in the container • Follow facility policy and/or procedure when determining intake of fluids during and between meals

Reading the Weight

• To determine weight: add the value for the lower bar to the value for the upper bar • 100 pounds + 38 pounds = 138 pounds

Psychological Effects of Aging - Importance

• To function successfully, nurse aides should be aware of basic human behavior and needs and how these behaviors and needs change with aging

Diaphragm Concepts

• To prevent infection, always clean before use, between residents, and after use with an alcohol wipe • Warm diaphragm with hand before making contact with resident • To use diaphragm, apply enough pressure to make a seal against the brachial artery at the crook of the elbow

Serving Size

• Two important pieces of information o Shows the number of servings in the package or container o Shows the amount for one serving of a food or beverage • Serving sizes given in familiar measurements, such as cups or pieces

BP Cuff

• Two types o Manual (aneroid) i. Manometer 1. Long lines mark 10 mm Hg 2. Short lines mark 2 mm Hg 3. When checking blood pressure, the needle drops from a higher number to a lower number, so nurse aide will be counting backwards ii. Tubing 1. Made of rubber 2. Two tubes connect the: a. (#1) Cuff to the manometer b. (#2) Cuff to the handheld inflation bulb iii. Air- release valve 1. To deflate cuff and open valve, turn air-release valve counterclockwise with the thumb and index finger in a slow and controlled manner; remember thumb goes down, needle goes down iv. Bulb 1. To inflate cuff, turn air-release valve clockwise to close valve; then squeeze the bulb; remember thumb goes up, needle goes up • Inflate cuff to between 160 mm Hg to 180 mm Hg • If beat is heard immediately, deflate the cuff; wait 30 - 60 seconds; inflate cuff to no more than 200 mg Hg v. Cuff 1. After wrapping the cuff around the bare upper arm a. The cuff inflates and puts pressure on the brachial artery b. As cuff deflates, BP is determined • Cuffs come in child-sized, small (circumference of arm is 7-9 inches), regular (circumference of arm is 9-13 inches), and extra-large (circumference of arm is 13-17 inches) • Important to choose correct size because a too big or too small cuff can impact accuracy of reading • Typically has 1 or 2 arrows (left arm/right arm) on cuff which align with brachial artery • Cuff positioned/wrapped at least an inch above the elbow • Cuff or stethoscope should not be placed over clothing o Electronic (digital) • No stethoscope • After BP cuff is placed on arm, button is pressed causing cuff to inflate/deflate automatically • BP reading is displayed

Diabetes - Three Types

• Type 1 - onset typically during childhood and early adult; pancreas does not produce insulin; lifelong condition; managed with daily doses on insulin, a special diet, and regular blood glucose testing • Type 2 - develops after about age 35; pancreas secretes insulin, but does not use it well; develops slowly; usually controlled by diet and oral medicine • 3rd type is gestational diabetes; occurs during pregnancy

Radial Pulse Site

• Typically used to take pulse during routine vital signs checks • Does not expose resident • Located on thumb side of wrist • First 2 or 3 fingers used; never use thumb

Legal - Nurse Aide's Role

• Understand range of function and know what he/she can legally perform, while on duty • Keep skills and knowledge current • Keep resident's safety and well-being in mind• Understand directions for use when using equipment, materials, supplies • Follow long-term care facility's policy and procedures, regarding care of resident • Do no harm to resident or belongings • Report questionable practices by others to the nurse • Review legal key terms and understand examples of each

Legal - Nurse Aide's Role

• Understand range of function and know what he/she can legally perform, while on duty • Keep skills and knowledge current • Keep resident's safety and well-being in mind • Understand directions for use when using equipment, materials, supplies • Follow long-term care facility's policy and procedures, regarding care of resident • Do no harm to resident or belongings • Report questionable practices by others to the nurse • Review legal key terms and understand examples of each

Definition of a Fall

• Unintentionally coming to rest on the ground, floor, or other lower level • Any sudden, uncontrollable descent from a higher level to a lower level which may result in injury

Digestive System - Structure and Function

• Upper GI structures include the mouth, pharynx, esophagus and stomach • Lower GI structures include the small intestines and large intestines • Accessory structures include the teeth, tongue, salivary glands, liver, gall bladder, and pancreas • GI System digests food, absorbs nutrients, and eliminates waste

Fluids Considered as Output

• Urine • Vomit • Diarrhea • Wound drainage • Gastric suction material

PASS

• Use fire extinguisher, only if trained in PASS o Pull the pin o Aim at the base of the fire when spraying o Squeeze the handle o Sweep back and forth at the base of the fire

* Ethics - Nurse Aide's Role

• Use good judgment • Keep staff and resident information confidential • Document accurately • Follow plan of care as outlined • Be honest and trustworthy at all times • Report abuse or suspected abuse • Understand and respect Resident's Rights • Report all resident observations and incidents • Show empathy for residents • Respect all residents equally • Provide high quality of resident care • Protect residents' privacy • Treat all residents professionally • Avoid stereotyping due to residents beliefs or culture • Respect values and beliefs that differ from your own • Safeguard the resident's property

* Ethics - Nurse Aide's Role

• Use good judgment• Keep staff and resident information confidential • Document accurately • Follow plan of care as outlined • Be honest and trustworthy at all times • Report abuse or suspected abuse • Understand and respect Resident's Rights • Report all resident observations and incidents • Show empathy for residents• Respect all residents equally • Provide high quality of resident care • Protect residents' privacy • Treat all residents professionally • Avoid stereotyping due to residents beliefs or culture • Respect values and beliefs that differ from your own • Safeguard the resident's property

Physician Mechanical Beam Scale

• Used for measuring weight and height • Residents who cannot stand o Weighed using chair, wheelchair, bed, or mechanical lift, as directed by the nurse or care plan o Height measured in the bed using a tape measure and ruler • Balance beam with upper and lower poise bars • Weight indicators • Balance bar and window • Height rod with upper and lower sections • Head piece - resting and active • Scale platform • Pillar and pillar head Balance Beam • Has 2 poise bars - the upper bar and the lower bar • May include pounds only or pounds on the top part of each bar and kilograms on the bottom part of each bar; may have interchangeable pound and kilogram bars

Full-sling Mechanical Lift

• Used for residents who o Cannot assist during transfers o Are heavy o Have physical limits which do not allow for other methods of transfer • Before use, nurse aide needs to know the following from the care plan or supervisor o Resident's level of function or dependency o What type and size of sling to use

Measuring I&O - Importance

• Used to evaluate fluid balance • Used to evaluate kidney function • Assists in planning and evaluating medical treatment • Assists with carrying out special fluid orders • Used to help prevent or detect complications from fluid intake • Fluid intake is one factor that reflects the resident's nutritional status

Stand-assist Lift

• Used when resident can o Bear some weight on legs, is able to stand, has some arm strength o Can bend hips, knees, and ankles o Can sit on side of bed o Can follow directions

Conventional Time

• Uses numbers 1 through 12 to show each of the 24- hours of the day • Has either 3 or 4 digits - the first one or two digits are hours and the remaining two are minutes • A colon (:) separates the hours from the minutes • a.m. is used to specify morning - beginning at 12:00 a.m. • p.m. is used to specify afternoon/evening - beginning at 12:00 p.m. (noon)

Communication - Non-Verbal

• Using body language such as movements, facial expressions, gestures, posture, gait, eye contact and appearance to send a message • Can be used to support or oppose spoken or written communication o Smiling reinforces the statement, "I am happy today!" while frowning or smirking opposes the statement. • Is often an unconscious gesture, movement or facial expression that blocks effective communication • Can be perceived in different ways by different individuals • Examples of non-verbal communication include: o Positive - face the resident while speaking, stand up straight, smile, nod with approval, place arms at sides, show relaxed movements o Negative - turn your back during communication, slouch, avoid eye contact, eye roll, frown, cross arms across chest, show tense movements

Communication - Verbal

• Using written or spoken words, pictures or symbols to send a message • Involves active listening skills and silence • Includes paraphrasing, clarifying and focusing • Asking direct, open-ended questions

Dementia

• Usually progressive condition marked by development of multiple cognitive deficits such as memory impairment, aphasia, and inability to plan and initiate complex behavior

Basic Self-esteem

• Value, worth or opinion of oneself • Seeing oneself as useful • Being well thought of by others

USDA's MyPlate Healthy Choices

• Vegetables o Eat more red, orange, and dark-green, such as tomatoes, sweet potatoes, broccoli o Add beans or peas to salads, soups, or side dishes o For canned vegetables, choose reduced sodium or no salt added • Fruits o Use fruits as snacks, salads, and desserts o At breakfast, add bananas or strawberries to oatmeal or cereal; or blueberries to pancakes o Choose fresh, frozen, canned in water or 100% juice, or dried o Select fruit juices that are 100% fruit juice • Grains o Choose whole-grain instead of refined-grain foods when selecting breads, bagels, rolls, cereals, crackers, rice, and pasta o Whole grains include the "whole grain" and refined grains have valuable parts of the grain removed o Examples of whole grain include brown rice, wild rice, oatmeal, whole wheat/oats/corn products • Dairy o Choose skim (fat free) or 1% (low-fat) milk o Include low-fat yogurt on fruit salads and baked potatoes • Protein o Eat a variety of foods each week, including seafood, beans and peas, and nuts, plus lean meats, poultry, and eggs o Choose seafood twice a week o Choose lean meats and ground beef that is at least 90% lean o Cut fat from meat and remove skin from poultry

Invasion of Privacy

• Violation of right to control personal information or the right to be left alone • Example - gossiping in the hall about a resident's medical condition and others hear the conversation • Example - picture taken of resident and put on a social network, without consent

7) Invasion of Privacy

Upper Respiratory Infection (URI, a Cold

• Viral or bacterial infection of nose, sinuses, and throat • Signs - nasal drainage, sneezing, sore throat, fever, and tiredness • Remedy - body's immune system, fluids, and rest; stay away from smoke; may be more comfortable sitting up; stay away from residents with COPD

Wandering

• Wandering is a known and persistent problem behavior that has a high risk factor for resident safety • Safety risk factors may include o Falls o Elopement o Risk of physical attack by other residents who may feel threatened or irritated by the activity • Residents wander for several reasons and may include o Trying to fulfill a past duty, such as going to work o Feeling restless o Experiencing difficulty locating their room, bathroom or dining room o Reacting to a new or changed environment • Preservation of resident safety is the main objective when caring for the wandering resident and interventions include o Establish a regular route o Provide rest areas o Accompany the resident o Provide food and fluid o Redirect attention to other activities or objects o Determine if behavior is due to environmental stress

Integumentary System - Normal Findings

• Warm, dry • Absence of breaks, rash, discoloration, swelling

Respiratory Site

• Watch the chest rise and fall • Count the chest rises (inspirations) only

Fluids - Liquids

• Water • Milk • Coffee • Tea • Juices • Soups • Soft drinks

Six Nutrients

• Water - the most essential nutrient for life • Fats - help the body store energy • Carbohydrates - supply the body with energy and extra protein • Protein - essential for tissue growth and repair and supply the body with energy • Vitamins - needed by the body to function • Minerals - help build bones, make hormones, and help in blood formation

Typical Serving Sizes of Liquids

• Water glass = 240 mL • Tea glass = 180 mL • Juice glass = 120 mL • Milk carton = 240 mL • Coffee cup = 240 mL • Soft drink can = 360 mL • Gelatin = 120 mL • Soup bowl = 180 mL • Ice chips = 1/2 amount of mL in container

Weights - Consistent Process

• Weigh the resident: o Wearing a similar type of clothing o At approximately the same time of the day (preferably before breakfast) o Using the same scale o Either consistently wearing or not wearing orthotics or prostheses

Good Nutrition - Characteristics

• Well-developed, healthy body, at the appropriate weight • Alert facial expression • Healthy, shiny hair • Clear skin and bright eyes • Healthy appetite • Regular elimination habits • Restful sleep patterns

Assistive (Adaptive) Devices - Recording and Reporting

• What activity was attempted • What assistive devices were used • How successful was the activity as this relates to the activity goal • Any increase/decrease in ability noted • Any changes in attitude or motivation, both positive and negative • Any changes in health as evidenced by skin color, respirations, energy level, etc.

Communication - Special Approaches

• When a resident speaks a different language • Use a caring tone of voice and facial/body expression • Speak slowly and distinctly, but not loudly • Keep messages simple • Repeat the message in different ways as needed • Focus on a single idea or experience • Avoid medical terms and abbreviations • Allow silence • Pay close attention to non-verbal behavior • Note and use words the resident seems to understand • Reference a language dictionary as needed

Interpersonal Skills - Nurse Aide's Role

• When caring for residents, nurse aide should o Empathize (view things or events as the resident views them) o Anticipate needs o Treat residents as unique individuals and honor requests when possible o Display patience and tolerance while attempting to understand behavior o Be sensitive to resident's moods and be mindful of your own reactions to their moods • Be respectful to family and understand concerns they may have • Maintain an open, positive, and professional relationship with each member of the health care team • Effectively communicate and work well with others

Fluid Balance Not Achieved - Edema

• When fluid intake is greater than fluid output, edema occurs • Body tissues swell with water • May occur from heart or kidney disease

Fluid Balance Not Achieved - Dehydration

• When fluid intake is less that fluid output, dehydration occurs • Body tissues are lacking in water • May occur from vomiting, diarrhea, fever, or simply refusing to drink fluids

Points to Remember When Lifting

• When given a choice, push or slide objects rather than lifting them • Use large muscles of upper arms and thighs to lift • Keep movements smooth when lifting and do not twist or make jerky movements • Face object or person when moving • Use both arms and hands when lifting, pushing or carrying objects

Measuring the Height

• When measuring in feet and inches using height rod o Long lines represent inches o Shorter lines represent ¼ inch each; increments include ¼, ½, ¾ • Read height to the nearest ¼ inch

Importance of Standard Precautions

• Why must Standard Precautions be used with every resident? o Because there are residents you provide care for who have infections that no one knows about o Yes, a resident may be infected and not show signs or symptoms of being sick o Without practicing Standard Precautions, you can get the infection and pass it along to others o Following Standard Precaution Rules prevents self, visitors, family, co-workers, residents and other members of the health team from getting infections

Stroke - Nurse Aide's Role

• Will vary depending on severity of stroke and region of the brain involved • In general, to assist team to strengthen muscles and keep joints mobile, provide range of motion; maintain correct body alignment and support extremities with pillows and other measures; maintain positive attitude, use non-verbal and verbal communication to do so, never refer to the weak side as the "bad leg or bad arm", assist with communication using techniques recommended by speech therapist or nurse; • Understand that confusion and/or memory loss can be frightening and frustrating to the resident, may cry for no reason, again maintain a positive attitude when caring for resident, smiles and simple gestures may be helpful • Encourage independence and self-esteem by letting resident do as much care whenever possible, celebrate small victories, make tasks as easy as possible • Be very observant for changes in skin condition especially those areas at risk for pressure injury development; this resident may be at increased risk for pressure injury if loss of sensation is present or resident cannot move a side of the body; report changes immediately to nurse • Be aware with bath water temperature and shaving if the resident has loss of touch or sensation • Adapt self-care activities to limitations of the resident's condition by having them use assistive devices for eating and dressing; remember to put items the resident will need - call signal, water pitcher, glasses on the resident's unaffected side

Basic Nursing Skills

•Essential skills required of nurse aides in health care setting -Privacy is key when providing basic nursing skills Examples include -Monitoring, documenting, and reporting of vital signs -Management of pain as directed by the nursing care plan -Application of warm/cold -Dressing changes

Personal Care Skills

•Tasks that deal with a person's body, appearance, and hygiene • Privacy is key when providing personal care skills • Done on a daily basis - in the a.m., p.m., and in-between • Each individual has own preferences, such as time of bath, certain soaps, or hairstyles

Hepatitis B (HBV)

−A disease of the liver −About 1/3 of people infected with HBV do not show symptoms -Can live outside body on equipment or surfaces for 7 days and infect during that time

Localized Infection

An infection found in one part of the body and symptoms are limited to that one part of the body • Symptoms −Painful −Red −Hot to touch −Puffy −Drainage Example - an infected finger (when a finger becomes infected, it may be red, painful, hot, puffy, with drainage)

Neglect

Fraud

- an intentional deception or misrepresentation made by a person with knowledge that deception could result in some unauthorized benefit to self or some other person

Resident's Rights

- are included in OBRA (1987 and 2016) and spell out how residents MUST be treated while living in a long-term care facility

Empathy

- identifying with and understanding the feelings of another without feeling sorry for the person

Confidentiality

- not disclosing or telling information that is personal or private about a resident, except to authorized people

Nutrients -

- substance found in food and fluids that are used by body for growth and maintenance of health

Diversion of drugs

- unauthorized taking or use of any drug

Obituary

A description (typically placed in a local newspaper) of a resident's life, including listing of relatives, birth information, accomplishments/activities, and death, written upon the death of the resident

2nd Stage - Anger

Expressions of rage and resentment; normal and healthy reaction; often upset by smallest things; lashes out at anyone; begins to face possibility of upcoming death; may be angry because of the healthy lifestyle maintained throughout life; the nurse aide may be the target of anger, but must not take it personal; the "why me" stage

Basic Nursing Skills Importance

Performance of basic nursing skills is important duty of nurse aide Following resident's plan of care, following directives from supervisors, and reporting important findings are all critical for well-being of residents

North Carolina Nurse Aide I Registry

a registry of all people who meet state and federal training and testing requirements to perform Nurse Aide I tasks in the State of North Carolina

Malnutrition

the lack of proper nutrition because of a lack of food intake, improper diet, or impaired use of food by the body

Delegation

delegated or delegation is the process of assigning part of one's responsibility to another qualified person in a specific situation (National Council of State Boards of Nursing) transferring responsibility for the performance of an activity or task while retaining accountability for the outcome (ANA)

Assault

o Act of threatening to touch, or attempting to touch a person, without proper consent (key is consent) o Example - threatening to "tie a resident down"

Laws: Criminal

offenses against the public

Prosthetic Device Definition

replacement for loss of body part, specifically fitted to one person Examples are implanted lens, cochlear implant, hip prosthesis, artificial body part such as a leg or hand

Mistreatment of Vulnerable Adult - Points to Remember

• Abuse is cause for immediate dismissal of the perpetrator and posted on Nurse Aide Registry, if substantiated • Not reporting abuse is aiding and abetting

Basic Human Rights

Hepatitis C (HCV)

transmitted through blood or body fluids • There is no vaccine

Chain of Infection

way to explain how infection is passed around from one host to another host by using a picture of a chain Has six (6) links -Link #1 Causative Agent -Link #2 Reservoir -Link #3 Portal of Exit -Link #4 Mode of Transportation -Link #5 Portal of Entry -Link #6 Susceptible Host

Abuse

willful infliction of injury, unreasonable confinement, intimidation or punishment with resulting physical harm, pain, or mental anguish

Abuse -

willful infliction of injury, unreasonable confinement, intimidation or punishment with resulting physical harm, pain, or mental anguish

Sexual Activity

• Inappropriate sexual activity is another behavior issue. Offensive or inappropriate language, public exposure, offensive and/or misunderstood gestures are the characteristics of this behavior • Interventions o Treat the resident with dignity and respect o Remove resident from public situation o Redirect attention to an appropriate activity o Assist the resident to bathroom

Assistive (Adaptive) Devices for Positioning

• Include regular pillows, cylindrical pillows, and/or wedge shaped foam pillows (pictured) • Bed cradles - keep bed covers off legs and feet (pictured) • Footboards - help prevent foot drop • Heel protectors - help with foot alignment

Consent

BEGINNING PROCEDURES

1. Knock-Introduce Self 2. Wash Hands 3. ID Patient 4. Gather Supplies 5. Provide Privacy 6. Explain Procedure: Clearly, Slowly, Directly; Face-to-Face 7. Safety- Raise Bed to Working Height

Incident Report - Required when

A resident falls, verbalizes or shows fear or signs of harm, develops unusual signs of pain, has a visible misalignment of an extremity or develops a noticeable change in gait o Resident may not put weight on a leg because a fracture has occurred during an unwitnessed event • A resident is reported missing from the facility • A mistake is made while providing resident care • An item or personal belonging breaks, becomes damaged or is missing • A request is made that is outside the NA's scope of practice • The NA is made to feel uncomfortable, threatened or unsafe • Inappropriate actions, sexual advances or remarks are made • An angry outburst occurs by family members or staff

Concept of ADLs

Activities of Daily Living (ADLs) is common term • Hygiene and grooming, plus dressing, eating, transferring, and toileting equal activities of daily living (ADLs) • Assisting with ADLs of assigned residents is important duty of nurse aides

Who are Vulnerable Adults?

Adults who are at risk for abuse or mistreatment because they are not able to protect selves from harm due to mental, emotional, developmental disability; or brain damage; or changes from aging

Nervous - Normal Findings

Alert and oriented, with clear short-term/long-term memory • Sensory function intact • Ability to sense heat, cold, pain • Straight gait; coordination of limbs • Reflexes present

Alzheimer's Disease - Stage 1 - No Impairment

Alzheimer's disease is not evident • No memory problems

1st Stage - Denial

Begins when people are told of impending death; may refuse to accept diagnosis or discuss situation; may believe that a mistake was made and demands that lab work be repeated; may act like it is not really happening; the "no, not me" stage

Advance Care Planning

Choices an individual makes about the medical care the individual would want to receive if he/she suddenly became incapacitated and could not speak for his/herself; choices are based on personal values, preferences and discussions with loved ones

Reproductive System - Changes Due to Aging

Decreased size and function of reproductive structures • Enlargement of prostate • Sagging breasts • Loss of hair in vulva area • Weakened muscles that hold female reproductive organs in place

Safety in the Resident's Environment

Definition - when a resident has little risk of illness or injury in the environment to which he/she lives

Ethics - Points to Remember

Ethical behavior - always being accountable for actions • When do nurse aides use ethical behavior? Always! • Ethical behavior can vary with different cultures and social backgrounds • We are all individuals who think differently

Ethics - Points to Remember

When was OBRA enacted and updated?

Federal Law, enacted by Congress, in 1987; updated in 2016

De-escalation of a Resident Who is Agitated While Keeping Self and Others Safe

First and only objective in de-escalation is to reduce level and intensity of resident behavior so that discussion becomes possible • Behavior o Appear calm, centered, and self-assured even if that is not the case o Anxiety can make resident feel anxious and unsafe which can escalate aggression • Posture o Always be at the same eye level - encourage client to be seated, but if he/she needs to stand, stand up also o Keep relaxed and alert posture o Stand up straight with feet about shoulder width apart and weight evenly balanced o Avoid aggressive stances • Position self for safety o Never turn back for any reason o Maintain distance of at least two arms' lengths between self and agitated party o Place hands in front of body in open and relaxed position because this gesture appears nonthreatening and positions hands for blocking if need arises • Body movement and language o Body movements indicate anxiety and will tend to increase agitation o Minimize body movements, such as excessive gesturing, pacing, fidgeting, or weight shifting o Avoid crossed arms, hands in pockets, or arms behind back since it can be interpreted as negative body language, as well as putting self at tactical disadvantage if attack occurs o Refrain from pointing or shaking finger o Refrain from touching even if some touching is generally culturally appropriate and usual in setting; cognitive disorders in people who are agitated allow for easy misinterpretation of physical contact as hostile and threatening • Facial expression o Maintain neutral facial expression o A calm, attentive expression reduces hostility • Eye contact o Maintain limited eye contact o Loss of eye contact may be interpreted as expression of fear, lack of interest or regard, or rejection o Excessive eye contact may be interpreted as threat or challenge, do not stare down resident • Attitude o Refrain from becoming defensive even if comments or insults are directed at nurse aide; comments are not about nurse aide; the nurse aide should not defend self or anyone else from insults, curses, or misconceptions about roles or behaviors o Be respectful even when firmly setting limits or calling for help; individual who is agitated is sensitive to feeling shamed and disrespected; resident needs to know that it is not necessary to show that they should be respected; automatically treat them and all residents with dignity and respect • Tone o Use low monotonous tone of voice (normal tendency is to have a high-pitched, tight voice when scared) o Refrain from getting loud or trying to yell over screaming person; wait until resident takes a breath, then talk o Speak calmly at an average volume • Responses o Respond selectively o Answer only informational questions no matter how rudely asked, (e.g. "Why am I in this g-d place"?) - this is real information-seeking question o Do not answer abusive questions (e.g. "Why are all nurses' a**holes"?); this sort of question should get no response whatsoever o Be honest; lying to resident to calm them down may lead to future escalation if they become aware of the dishonesty o Do not volunteer information which may further upset resident • Reasoning o If directed by nursing care plan, explain limits and rules in authoritative, firm, but respectful tone o Give choices, where possible, in which both alternatives are safe ones (for example, "Would you like to continue our walk calmly or would you prefer to stop now and come walk later today when things can be more relaxed?") - approach is most useful with residents who do not have trouble thinking and not residents with dementia o Empathize with feelings, but not with behavior (for example, "I understand that you have every right to feel angry, but it is not okay for you to threaten me or my staff.") - approach is most useful with residents who do not have trouble thinking and not residents with dementia o Suggest alternative behaviors where appropriate (for example, "Would you like to take a break and have a cup of coffee or some water?") o Do not analyze or interpret how a person is feeling o Refrain from arguing or convincing o List consequences of inappropriate behavior without threats or anger - approach is most useful with residents who do not have trouble thinking and not residents with dementia o Express limitations are because of facility rather than personal - approach is most useful with residents who do not have trouble thinking and not residents with dementia Trust instincts; if nurse aide decides or feels that deescalation is not working, the nurse aide should STOP and calmly call for help

PPE: Gloves

Gloves should be worn when there is the possibility of • Contact with blood and body fluids • Non-intact skin, such as sores, cuts • Mucus membranes such as eyes, nose, mouth, genitals, rectum Always wear gloves during mouth care, wiping a resident's nose, doing perineal care, caring for a sore, and shaving a resident

Link #4 Mode of Transportation

How harmful germs travel or get around from place to place

PPE: Gown

Gown should be worn when there is the possibility of • Contact with blood and body fluids, beyond the gloved hand Wear a gown when changing and disposing of soiled bed linen, gown, pads, or bandages that may come into contact with your skin beyond the gloved area or your clothes

Tissue - Structure and Function

Grouped together and carry out a particular function • Types o Epithelial - covers internal and external body surfaces; lines nose, mouth, respiratory tract, stomach, and intestines; skin, hair, nails, and glands o Connective - anchors, connects, and supports other tissues; located in every part of the body; bones, tendons, ligaments, and cartilage; blood is a form of connective tissue o Muscle - stretches and contracts to let body move o Nerve - receives and carries impulses to the brain • Combine to form organs

Fecal Impaction

Hard stool stuck in the rectum and cannot be expelled, resulting in ongoing constipation • Signs - no stool for several days, oozing of liquid stool, cramping, abdominal distention (swelling), and pain in rectum • Nurse aides are not allowed to remove fecal impactions

Military Time

Has 4 digits - the first two numbers are hours and the remaining two are minutes o a.m. and p.m. are not used • Examples: o 0100 hours is 1:00 a.m. (in the morning) o 0800 hours is 8:00 a.m. (in the morning) o 1200 hours is 12:00 p.m. (noon) o 1500 hours is 3:00 p.m. (in the afternoon) o 2100 hours is 9:00 p.m. (in the evening) o 2400 hours is (midnight) • Midnight may be documented as 2400 hours or 0000 hours

Breaking Chain of Infection at Each Link - Examples

If YOU can break any link in the Chain of Infection, YOU can prevent the occurrence of a new infection • Examples of a very simple way that everyone can break each link of the chain o Break 1st link, the infectious agent, by getting an immunization against flu o Break 2nd link, the reservoir, by staying home from work when you are sick o Break 3rd link, the portal of exit, by covering your mouth and nose when you sneeze o Break 4th link, the mode of transmission, by washing your hands o Break 5th link, the portal of entry, by covering an open sore with a bandage o Break 6th link, the susceptible host, by eating a proper diet

Other Common Disorders

Lupus - when immune system attacks tissues causing redness, pain, swelling, and damage o Graves disease - immune system attacks thyroid gland which causes it to secrete more thyroid hormone • Nurse aide's role o Observe for and report signs of infection o Follow standard precautions o Provide for nutrition, hydration, and rest for the resident

Positioning the Resident (Prone)

Lying on abdomen • Not a comfortable position for many people • Never leave resident in prone position very long

Hypertension (High Blood Pressure)

Major cause is atherosclerosis, or what lay people refer to as "hardening of the arteries" • Arteries harden due to plaque build-up from fatty deposits • May complain of headache, blurred vision, and dizziness

PPE: Mask

Mask should be worn when there is the possibility of • Breathing in harmful germs through the nose and mouth Wear a mask to protect self when a resident has an illness that is transmitted by droplets and when you have a cough or cold symptoms

NAT-CEP

Nurse Aide Training and Competency Evaluation Program -Must complete at least 75 hours of training that covers topics like basic nursing skills, personal care skills, restorative skills, mental health and social service needs, Resident's Rights, safety and emergency care, and cognitive impairment. -Programs may require 80 to 150 hours in theory and clinical skills -NA's must pass a competency evaluation before employed -NA's must attend regular in service education classes (min of 12 hrs per year) to keep their skills updated

Advance Directive

Patient Self-Determination Act (PSDA) and the Omnibus Budget Reconciliation Act of 1987 (OBRA) give persons the right to accept or refuse treatment; also give persons the right to make advance directives; also requires that health care facilities that receive Medicare/Medicaid funds give residents who are newly admitted information about their rights related to advance directives • Advance directive - legal documents that allow people to decide what kind of medical health care they wish to have in the event they cannot make those decisions themselves • Includes living wills and durable powers of attorney • Can be changed or cancelled at any time by the person • Legally, the nurse aide must honor advance directives

Parkinson's Disease

Progressive, incurable disease that causes a part of the brain to degenerate; causes muscles to stiffen, gait shuffling, bent posture, pin-rolling with finger and thumb, tremors, and shaking; mask-like facial expression may develop • Nurse aide's role - protect resident and keep out of unsafe areas, assist with ambulation because resident is at high risk for falls and running into things, due to changes in mobility and visual impairments; assist with activities of daily living and assist resident with self-care

Integumentary System - Function

Protects body from injury and pathogens • Regulates body temperature • Eliminates waste through perspiration • Contains nerve endings for cold, heat, pain, pressure and pleasure • Stores fat and vitamins

Link #6 Susceptible Host: Long term living

Residents living in long-term care facilities more likely to get infection than other people who live in the community because o Many have several things wrong with health, such as a resident who may have lung, heart, and kidney problems o Many are elderly More likely to come in contact with harmful germs because they live close together and because they share staff and medical equipment

When does Rehabilitation begin?

Rehabilitation is used to restore a persons function back to their highest level after an injury, illness, or accident (Page 443). This can occur after the care team develops a treatment plan based on their goals of restoring the highest level of function depending on the patient's needs. when the goals of rehabilation has been met consisting of 1. Assist the resident in maintaining and/or regaining the ability to perform activities living (ADLs) 2.Promote resident's independence and help resident adapt to the new disability 3. Prevent complications mobility as soon as you are stabilized

Definition of Pain

Relate the definition of pain back to the collages the students created and talked about. All collages will be about the student's perception of pain

5 Rights of Delegation

Right Task Right Circumstance Right Person Right Direction and Communication Right Supervision and Evaluation

Nervous - Changes Due to Aging

Some hearing loss occurs • Appetite decreases • Less tear production • Vision decreases • Problems seeing blue and green • Pupils less responsive to light • Changes in memory, most likely with short-term memory Loss of nerve/brain cells • Slowed response and reflex time • Jerking motions or tremors • Reduced sense of touch and sensitivity to pain • Reduced blood flow to the brain • Forgetfulness • Each of the senses decrease in function • Sensitivity to heat and cold decreases

Spinal Cord and Sensory Organs

Spinal cord o Located within the spine o Connected to the brain o Conducts messages between the brain and the body by pathways • Sensory Organs o Include skin, tongue, nose, eyes, and ears o Receive impulses from environment and relay impulses to brain

Sundowning

Sundowning is behavioral symptom of dementia that refers to increased agitation, confusion, and hyperactivity that begins in late afternoon and builds throughout the evening • Interventions o Encourage rest times o Plan bulk of activities for the morning hours o Perform quieter, less energetic activities during the afternoon

Accurate Weights - Importance

Weight is one of the parameters that reflects the resident's nutritional status • Fluid loss or retention can cause short term weight changes; abrupt weight changes along with change in food intake are signs of fluid and electrolyte imbalance. • Weight loss may be important indicator of a change in resident's health status or sign of malnourishment • If significant weight loss noted, health care team reviews for possible causes

● Calculate oral intake

o 1 ounce = 30 ml

Code of Ethics

Positioning the Resident (Sims)

• Left side-lying position

Life in a Nursing Home - Nurse Aide's Role

• Staff can decrease resident's doubts and fears of unknown, and increase feelings of control by providing newly admitted residents with orientation to facility o Find out how each resident wishes to be addressed (Mr., Mrs., Ms., Dr.) and preferred name (first name, middle name, last name, nickname); use with all subsequent introductions and verbal communications with resident o Provide each resident with map of facility, a personalized tour, and visual points of reference to help get used to facility o Introduce resident to staff and other residents o Provide initial explanations of routines and procedures o Always explain what is being done, reason it is being done, and where resident is being taken o Learn about resident's previous lifestyle, environment, and routines so that nurse can add to nursing care plan • Older adults must part with many important objects when relocating to a nursing home; familiar objects and keepsakes are links to resident's background and relationships o Encourage as much personalization of space as possible to provide sense of continuation of life; items may include a piece of furniture, figurines, pictures of family members, books, children's art work, etc.; be tolerant of clutter o Let resident have plenty of time to decide on placement of keepsakes; may keep resident's thoughts and attention for one or two weeks; only after resident has organized living space can he/she direct their energies to new people and new places in facility o Provide praise for personalization of resident's space • Lack of privacy and personal space, can increase stress and anxiety for resident; can be displayed in form of illness, aggression, anger, submissiveness, and withdrawal; when resident's privacy, personal space, and personal belongings are respected, can relate better to others, feels more secure, and maintains identity • Remember that each resident needs down time or time to relax and get away from people o Always knock on resident's door and wait to be invited in before entering o Approach resident slowly and maintain a degree of physical distance when possible o Ask resident for permission before touching belongings or going into closet and drawers o Never read resident's mail unless requested to do so o Keep the resident's personal belongings safe, yet available for use • Be aware of resident's reasons for admission (death of spouse, declining health) and understand these stressors directly affect behavior and reactions to nursing home life; also, remember it is difficult to change lifelong habits, schedules, and rituals o Realize major changes that resident is expected to handle in short period of time and empathize o Recognize losses - home and familiar surroundings, belongings, former neighbors, former routines and lifestyles, declining health, and possible loss of loved ones o Recognize adjustments - to a confined living space, living near others, possibly having to share a bedroom with a stranger, new routines, services, and facility staff watching his/her every move o Encourage resident to have as much control as possible; encourage to participate in planning of daily schedule o Encourage resident to set own pace and prioritize daily activities o Encourage resident to participate in facility activities when ready to do so

Nutrition

- when the body takes in and uses foods and fluids to maintain health

Milliliters and Ounces

• A common conversion in health care is changing (or converting) ounces to milliliters • 1 ounce = 30 mL • To convert ounces to milliliters, simply multiply number of ounces by 30

Pressure Injury - Pressure Points

• Occur over bony areas, called pressure points and include back of head, ears, shoulder blades, elbows, hips, spine, sacrum, knees, ankles, heels, and toes; sacrum being the most common site

Hip Fracture

A break in the hip bone, serious condition requiring months of recovery; older resident heals slowly, and complications may occur - secondary illnesses and disability • Results from falling and breaking the hip, OR a broken hip due to weakened bones that causes a fall • Most require surgery and total hip replacement; goals of care include - healing of incision, slow strengthening of muscles of the hip region, mobility, gait and endurance increase • Nurse aide's role - prevention in falls crucial, follow fall prevention concepts; after surgery and during rehabilitation, follow care plan carefully as it will provide guidance on weight bearing limitation, how much resident can do, and which assistive devices may be used; following and understanding directives about weightbearing limitations (how much weight the resident can support - non, partial, or full); do not perform range of motion until directed to do so; be very aware of limitations of leg and hip movements, use abduction pillow (special foam pillow placed in between legs that immobilizes and positions hips and legs using straps) as directed by care plan and nurse; report the following to the nurse - incision redness, drainage, bleeding; increased pain; numbness or tingling of feet and legs; tenderness or swelling in calves of legs; shortening or rotation outward of affected leg; abnormal vital signs; resident is being non-compliant with limitations; decrease in appetite; and improvements that are noted

Nurse Aide's Role when Oxygen is in Use

• Post Oxygen in Use signs • Never have open flames or smoking in area • Do not use electrical equipment in room without facility approval • No Petroleum Jelly

Positioning the Resident - Importance

• Regular position changes and correct alignment o Promote well-being and comfort o Promote easier breathing o Promote circulation o Prevent pressure ulcers and contractures

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