CNA 1 ch 1-55

Common incontinence products book

1) Complete incontinence brief 2) Pad and undergarment - looks like normal underwear, pad entered into pouch 3) Pull on underwear 4) Belted undergarment - pad attached to reusable belt

Paying for healthcare

1) Private insurance - bought by individuals/families 2) Group insurance - bought by groups/organizations for indivduals. employee benefit 3) MEdicare - federal program for persons 65+ - Some younger people with certain disabilities qualify - indivdiuals pay a premium 4) Medicaid - jointly funded by gov and states. For people and family with low incomes - both children and older, blind, and disabled persons Obamacare was made with goal of insurance for everyone and requires people to have it

Altered respiratory function - 3 parts of respiratory function - hypoxia (S&S) slides

3 processes: - air moves in/out of lungs - o2 and co2 are exchanged at alveoli - blood carries o2 to cells and removes co2 from them *If even one process is affected, respiratory function altered* *Hypoxia* - cells do not have enough oxygen - Restlessness, dizziness, and disorientation are early signs Signs and symptoms of Hypoxia • Restlessness • Dizziness • Disorientation and confusion • Fatigue • Agitation • Respirations increasing rate and depth • Cyanosis - bluish skin color 644 (signs to report at once)

Preschool: 5 yr

5 yr old - Coordination increases - Jump rope, skate, tie shoelaces, dress and bath - Can use a pencil well - Communication increases - Full sentences, meaningful questions - Take part in conversations - More responsible and truthful - More aware of rules and manners - Enjoy doing thing with primary caregiver of same sex - Tolerate brothers and sisters

Wills

A legal document of how a person wants property distributed after death - you can ethically and legally witness a will signing or refuse without repercussion You cannot prepare a will Do not witnes a will signing if you are named in it, otherwise you won't get anything Witnesses testify: 1) That person was of sound mind 2) PErson stated that document was his or her last will

Straining urine: calculi slides

A stone (calculus) can develop in a kidney, ureter, or the bladder. - Stones (calculi) vary in size. Some stones are removed by medical or surgical procedures. - Others pass through urine—therefore all urine is strained when a doctor suspects a kidney stone All passed stones are sent to the laboratory - The person will need to drink 8 to 12 glasses of water a day to help pass the stone

A healthy plate (myplate symbol):

(Some fatphobia here) Helps make wise food choices by: - balancing calories > eating less, avoiding over-sized portions - Increasing certain foods > Making half of plate fruits and veg > Making at least half grains whole grains > Drinking fat-free/low-fat milk - Reducing certain foods > Choosing low-sodium foods > Drinking water instead of sugary drinks ---------- Recommends - 2 hrs and 30 min a week of moderate activity - 1 hr and 15 min a week of vigorous activity - at least 3 days a week for at least 10 min at a time

factors affecting urine production: + normal amt per day

*A normal healthy adult produces 1500ml (milliliters) or 3 pints of urine EVERY day.* Factors - Age - Amount/type of fluids ingested - Amount of Salt in diet (more water retention) - Body Temperature - Perspiration (sweating) - Disease process - Some medications

Admission slides

*Admission* - is the official entry of a person into a health care setting. - starts in admitting office or ER. Info obtained for admission record, given ID number and bracelet. Consent obtained. - Introduce self by name and title

Infancy - Developmental tasks

*Infancy* - the first year of life - Rapid growth and dev Tasks 1) Learn to walk 2) Learn to eat solid foods 3) Begin to talk and communicate with others 4) Learn to trust 5) Begin to have emotional relationships w/ family 6) Develop stable sleep and feeding patterns

Active listening - guidelines

*Listening = focusing on verbal/nonverbal communication* - Requires *care and interest*. Can diffuse anger ----------------------- 1) Listening guidelines a) face person b) have good eye contact c) Lean toward the person d) respond to person e) avoid comm barriers

Signs and symptoms of infection

- Chills - Pulse rate increased - Pain or tenderness - Respiratory rate increased - Fatigue and loss of energy - Appetite loss - Nausea/vomiting - Diarrhea - Rash - Redness/swelling - Fever - Headache - Muscle aches

C&S

- When the lab gets your specimen they put in in a culture dish and put several different antibiotics on it to see what it is sensitive to. - That helps determine what antibiotic the patient will receive.

Logrolling

- is turning the person as a unit, in alignment, with 1 motion Requires 2 people: one at the shoulder and hip, one at the hip and thighs. Keep the spine and neck straight, Turn the person in alignment Turning person on their side helps prevent complications from bedrest. Move the person in segments: *head, then torso, then legs.*

Expressive aphasia symptoms book

- omit small words (is, and, of, the) - speak in single words/short sentences - put words in wrong order - think one thing but say another - call people by wrong names - make up words - produce sounds and no words - cry or swear for no apparent reason

Venous ulcer prevention book

- prevent skin breakdown - prevent injury (do not bump legs/feet) - move person carefully/gently Persons at risk need professional footcare DO NOT cut toenails of persons with diseases affecting circulation Doctor may order: 1) Drugs for infection/to decrease swelling 2) Medicated bandages adn other wound care products 3) Devices used for pressure ulcers 4) Elastic stockings/bandages

What to report and record: haircare

- scalp sores - flaking - itching - rash - patches of hair loss - hair falling out in patches - very dry or very oily hair - matted or tangled hair - presence of nits or lice > nits oval and yellow > Lice - about size of sesame seed and grayish white > Itching > Complaints of tickling feeling/something moving in hair > Irritability > Sores caused by scratching > rash

Food labels delete book

- serving size + number of servings in package - calories - nutrients Daily values (DV) - percent of 2000 calories daily

Wound care - trauma - unrelieved pressure/friction - care includes slides

wound - a break in the skin or mucous membrane. *Trauma* -an accident or violent act that injuries the skin, mucous membranes, bones and organs. - Ex: Falls, vehicle accidents, gunshots, stabbings *Unrelieved pressure or friction* - Decreases blood flow through the arteries or veins, can cause nerve damage Wounds are portals of entry for microbes, Infection is a major threat Wound care includes: - preventing infection and further injury to the wound and nearby tissues - Blood loss and pain are also prevented by good wound care

factors that affect wound healing slides

◦Type of wound ◦Age ◦Health ◦Nutrition ◦Life style ◦Smoker ◦Circulatory disease/diabetic ***good nutrition is needed for wound healing especially protein*

Nursing assistant duties

*1) Activities of daily living (ADLs)* - Assist/provide daily personal care activities like bathing, dressing, eating, and grooming *2) Measurement and client observation* - Assess person's vital signs, intake/output - assist w/ meals - recognize, report, and document changes in resident's condition - Collect lab specimens *3) Infection control* - Prevent/isolate client infection through: > handwashing > Proper care and handling of contaminated objects > isolation procedures > Observing/reporting environments/situations that could spread infection *4) Assist with ambulation, movement, and exercise* - lifting, moving, and transporting residents from one position to another *5) Environmental care/safety* - Making resident's living conditions comfortable and as safe as possible *6) Communication* - Verbal/written with residents, visitors, healthcare team members - Observing and recording resident care and information

Dying: - mental and emotional needs - the family slides

*Mental and emotional needs* - are very personal. Some persons are calm and at peace. Others are anxious or depressed and have specific fears and concerns. - Simple measures may be soothing - touch, hold hands, back massage, soft lighting, music at a low volume. Be available if they wish to talk. *The family* - this may be a hard time for the family. Allow them to stay as long as needed. - Show you care by being available, courteous, and considerate. - Respect the right to privacy.

Discharge and transfer - what are they - who orders - reasons slides

*Transfer* - is moving the person to another health care setting. In some agencies it means moving the person to a new room within the agency. *Discharge* - is the official departure of a person from a health care setting. Nurse tells you to start discharge/transfer. Doctor gives order before person can leave - CNA helps with moving person and helping them move belongings Sometimes people change rooms or transfer, this could be due to: - Change in condition - the person requests a room change - because Roommates do not get along - have changes in care needs

Poisoning - intentional vs unitnentional - Preventing poisoning

*poison* = any substance harmful to body when ingested, inhaled, injected, or absorbed via skin Intentional or unintentional - Intentional = give/take poison intending to cause harm - Unintentional = give/take substance w/o intending to cause harm *Mr. Yuk is recognized warning label of harmful substances* If poisoning is suspected, call poison control center for directions - 1-800-222-1222 --------------------- preventing poisoning (160) - keep child resistant caps on all harmful products - keep harmful products in high, locked areas - store personal care items according to agency policy (soap, mouthwash, etc) - Provide good lighting and read labels carefully - Do not store harmful products near food

Urine specimens: - random urine specimen - midstream urine specimen slides

*random urine specimen* - used for a routine urinalysis (UA). - No special measures needed. *midstream urine specimen* ( "clean-voided specimen" or "clean-catch specimen") - The perineal area is cleaned first to reduce the microbes in the urethral area. - The person starts to void, then stops in the middle of the stream - a sterile specimen container is positioned, and the person then re-starts to void - specimen collected in the middle of the urine stream.

pre op care book

- Bowel prep (cleansing) and urine elimination before getting pre-op drugs - Light meal allowed, then person NPO for 6-8 hrs pre op > reduce risk of vomiting/aspiration Personal care 1) Complete baath/shower with shampoo - reduce # microbes present = reduce risk of wound infection. Pt wears gown 2) Make up, nail products removal - color/circulation observed 3) Hair care - Oral hygiene - needs to be frequent during NPO, but water can't be swallowed 4) Dentures - allow them to wear as long as possible (according to care plan) 5) Prostheses - eyeglasses, contacts, hearing aids, and other prostheses removed. Hearing aids may be left in if person needs to hear surgen 6) Other - elastic stockings and sequential compression devices put on before transport to OR Jewelry - easily lost in OR and PACU + can cause pressure injuries - All jewelry removed and stored > weddign rings/religious medals can be kept (secure item in place with gauze/tape > some surgeries of arm/hand may require removal due to possible swelling

Preventing equipment accidents: - Chemicals > health problems (book only)... delete

- Health hazards can cause acute/chronic health problems > Cancer > Affect blood cell formation/function > Damage kidneys, nervous system, lungs, skin, eyes, or mucous membranes > Cause birth defects, miscarriages, and fertility problems

*Pediculosis (lice)* - capitis - pubis - coporis

- Infestation (in or on host) with wingless insects Pediculosis capitis - is the infestation of the scalp Pediculosis pubis - is the infestation of the pubic hair with lice Pediculosis corporis - is the infestation of the body If someone is admitted with lice they are bathed in a special medicated soap to kill the lice and their eggs called nits.

Stroke care measures book

- Position in side-lying to prevent aspiration - keep bed semifowlers - do things (approach, call light, etc) on strong side - incentive spirometry and deep breathing - have person do as much as possible - person may need dysphagia diet - elastic stockings to prevent thrmobi in legs - do not rush person. movements slowed - ROM and repositioning every 2 hrs normal nursing care (repositioning, ROM, etc)

Pressure ulcer: risk factors slides

- Pressure, - Friction - Shearing - Breaks in the skin - Poor circulation - Moisture - Dry skin - Skin irritation by urine and feces

aspiration signs slides

- Wet, gurgle sound to voice or respirations - Weak or absent cough - Frequent coughing, choking or throat clearing during meals - Excessive secretions from oral cavity - Horse vocal quality or no voice - Regurgitation - Refusal to accept food or liquid orally - High temperature of unknown origin - Reduced alertness/responsiveness - Increased heart rate - Decreased oxygen saturations - Increased work of breathing - Sweating Report signs at once!

Preschool: 4 yr

------------------------ 4 yr - CAn hop, skip, and throw and catch a ball - CAn tie shoes, draw faces, copy squares - CAn bathe/toilet with help - Know more words - ASk many questions - can sing simple songs, repeat numbers - Tend to tease, tattle, and tell fibs - Showing off - Enjoy playing dress up and other imagination games. Imitate adults. - prefer primary caregiver of other sex

droplet (Transmission based) precautions - examples slide

------------------------ Droplet 1} Contact precautions PLUS mask > Mask protects you from known/suspected pathogens transmitted by respiratory droplets generated by cough or sneeze. > Mask's protect your mucous membranes. - Infectious respiratory droplets can travel short distances and infect a host if it finds an open mucous membrane (mouth/nose). - Example of respiratory pathogens: influenza, RSV, meningitis, MRSA infection of lungs

You are dressing an older resident with thin, fragile skin. You notice a new skin tear on the person's arm. What do you do? How can you prevent skin tears?

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Bowel training - goals - timing

1) To gain control of BMs 2) To develop regular pattern of elimination. Prevent problems - meals (especially breakfast) stimulate BMs - usual BM time noted on care plan

CAtheter use reasons book

1) To keep bladder empty before, during, and after surgery - reduces risk of bladder injury + monitors urine amount 2) To promote comfort - prevent incontinence for people who can't urinate/move to do so 3) To protect wounds/pressure ulcers from contact with urine 4) For hourly urine output measurements 5) To collect sterile urine specimins 6) To measure amount of urine in bladder after person voids (residual urine) They do not treat cause of incontinence. Are last resort for incontinence

Toddler - Developmental skills

1-3 years - SLower growth rate Developmental skills 1) Tolerate separation from primary caregiver 2) Gain control of bowel/bladder funct 3) Use words to communicate 4) Become less dependent on primary caregiver --------------------------- - Learn to walk well - Curious and explore everything within reach - Climb onto high places - By 3, they can run, jump, climb, ride a tricycle, and walk stairs - Hand coordination increases - CAn feed themselves > Develop fine motor skills and hand-eye coordination - Toilet training (related to CNS development) > Bowel control, then bladder day, then bladder night - Imitate others to learn words - Understand more words than they say. Me and mine used often - Play skills increase - Child plays alongside other children but not together - Do not share - Posessive - Temper tantrums and saying no are common - Learn to tolerate separation - Learn to feel secure and tolerate it

- common MDROs + symptoms + how they're acquired + protection

2 common MDROs 1) *Methicillin-resistant STaphylococcus aureus (MRSA)* - Resistant to penicillin derivatives - Found in nose and skin. CAn cause serious wound/bloodstream infections + pneumonia Acquired: - through direct contact with infected wound + sharing personal items that touch skin Protect by: 1) wear ppe 2) Keep cuts/scrapes clean and covered 3) Good hand hygiene and body hygiene 4) clean and/body frequently - Symptoms: > Red/tender skin around a wound > Swollen, painful, oozing boils > Fever, chills, difficulty breathing, chest pain > Illness not responding to antibiotics Treatment - drain infection and prescribe antibiotic that infection doesn't resist (as determined by lab cultures) --------------------- 2) *Vancomycin-resistant Enterococci (VRE)* - Found in intestines + feces - Transmitted via contaminated hands and items (toilets, care equipment, etc) - If outside intestines, can cause UTIs, wound, pelvic, and other infections

Vital signs - essential body processes - vital signs + TPR, BP (normal values) slides

3 body processes essential for life: 1) Regulation of body temp 2) Heart function 3) Breathing Vital signs (normal values): 1) Temperature - (oral - 98.6 F) 2) Pulse - (60-100 beats/min) 3) Respirations - (12-20 breaths/min) 4) Blood pressure - (btwn 90/60 mm Hg and 120/80 mm Hg) 5) Pain (sometimes) *TPR* = temperature pulse respiration *BP* = blood pressure For children measure in this order: R-P-BP-T

Delegation - who

3) Delegate - To authorize another person to perform nursing task (CNAs don't do this) Delegation requires a nurse's knowledge + judgement RNs delegate to LPNs/LVNs + CNAs v LPNs/LVNs can delegate to CNAs v *CNAs CANNOT delegate to anyone* - can ask for *help*, but cannot tell people to do/document your work - can refuse a task if you are not trained for that skill, or if isn't in your scope of practice / job description Delegating nurse is legally *accountable* - Being responsible for one's actions and actions of others who performed the delgated tasks; answering Qs about and explaining one's actions and actions of others Tasks should be within nurse's scope of tasks, listed in your job description, and w/i CNA range of functions - refuse if not

Preschool: 3 yr

3-6 years Developmental tasks 1) Increase ability to communicate with/understand others 2) Perform self-care 3) Learn gender differences and develop sexual modesty 4) Learn to play with others 5) Learn right from wrong and good from bad 6) Develop family relationships ---------------------- 3 yr old - Can walk on tiptoe and balance on 1 foot for a bit - Run, jump, kick a ball, climb with ease - Personal care skills increase (put on clothes, manage buttons, wash hands, brush teeth, feed self) - Language skills increase > Can talk and ask questions Play together and can share - Learn simple rules - Imaginary friends/imitating adults common - Know there are sexes. And their own sex, wonder about others - Concept of time - Nightmares common - Less fearful of strangers, can be away from primary caregivers

Fruit group book

Avoid fruits canned in syrup Health benefits - reduce risk for stroke, heart disease, high BP, cardiovascular disease, obesity, and type 2 diabetes - May protect against certain cancers (same as veg) - reduce risk of kidney stones - reduce bone loss - help lower calorie intake (low in fat/calories) - contain no *cholesterol* - may prevent certain birth defects - low in sodium - contain: > K, fiber, vit C, and folate

Urinary disorders UTIs Urostomy slides

Disorders can occur in the urinary system structures including the KUB (kidneys, ureter, bladder) and urethra *Urinary Tract Infections (UTI)* - common. the infection can spread through the urinary system. > People with urinary catheters and women are at higher risk. - Urinary tract infections can lead to sepsis if not detected and treated. > Elderly patients are at high risk and the infection can spread very quickly. Cancer or bladder injury may necessitate the removal of the bladder and creation of a *urostomy* - a surgically created opening (stomy) that connects to the urinary tract.

The patient care partnership: Understanding expectations, rights and responsibilities is concerned with:

Document that explains person's right and expectations during hospital stays. Stresses relationship between doctor, health dteam, and patient

Anxiety disorders - generalized anxiety disorder book

Has extreme worry for little or no reason prevents functioning

Mr. Lazar has right-sided weakness. You need to help him sit up at the side of the bed (dangle). Which side of the bed should he sit on - right, left, or either? Why? As he dangles, his face turns pale and he says he is dizzy. What will you do? • ^ slide

Sit him on the left side of the bed, so he leads with his strong side - he can give more help and it's safer that way ... Put him back down in laying position (?)

KorotKoff sounds - phases - rate of deflation

Sounds you hear when deflating BP cuff 1) Tapping - systolic 2) Swishing - sort of breathy 3) Knocking 4) Muffling - softer knocking 5) Diastolic - diastolic Rate of deflation

TPN - reasons

Total parenteral nutrition (TPN) or hyperalimentation = Giving nutrients through a catheter inserted into a vein. - nutrients directly into blood stream Used when they can't receive oral feedings. Nurse handles all aspects of TPN - CNA observe person + help with ADLs -------------- Common reasons - disease, injury, surgery to GI tract -severe trauma, infection, or burns - being NPO for more than 5-7 days - GI side effects from cancer treatments - Prolonged coma - Prolonged anorexia (Appetite loss)

Types of communication, barriers to communication, therapeutic communication

Types 1) Verbal 2) Nonverbal 3) Direct questions (Y/N Qs) 4) Indirect questions (open ended) 5) Paraphrasing ------------------ Barriers: 1) Communicating with angry/depressed patients 2) Communicating with blind/vision/hearing impaired patients ---------------- Therapeutic 1) Use a calm voice 2) Eye contact 3) Give your full attention

Vegetable group book

Types: - dark green - red and orang - beans and peas - starchy veg - other veg (artichoke, beets, cabbage, etc) health benefits - reduce risk for stroke, high BP, heart/cardiovascular disease, type 2 diabetes - protect against certain cancers (mouth, stomach, colon) - reduce risk of kidney stones - reduce bone loss - help lower calorie intake (low in fat/calories) - contain no *cholesterol* (soft, waxy substance found in bloodstream and body cells), which is found in animal foods (same with fruits) - may prevent certain birth defects - contain: > K, dietary fiber, folate, vit A and C

Umbilical cord care book

Umbilical cord - Stump left on baby dries and falls off within 2 weeks - cord care done at each diaper change > continued 1-2 days after diaper falls off - do not wet stump - keep diaper below cord - give sponge baths until cord falls off. then tub baths - do not pull cord off - report swelling, redness, odor, or bleeding from stump/navel area. Also fever + crying when areas near cord are touched

Workplace violence

Violent acts (assault, threats, weapons, murders, etc) directed towards persons at work or while on duty Reporting incidents - incident = any event that has harm/could harm a patient/resident, visitor, or staff - Report accidents and errors STAT Make sure to follow agency training/guidelines *Agitated persons* - Do not touch, maintain distance, be nonthreatening, leave asap, ID possible weapons - do not let agitated person get between you and door - stay close to door - Be aware of body language, do not point or glare Avoid being in low traffic, low light areas alone

Moving fallen person from floor: basic course of action

Wait for nurse before moving person - Nurse will assess for injuries - Assist as nurse directs For no to minor injuries - OSHA recommends minimal manual lifting (so often mechanical lift is used) If person can stand alone staff standby or a gait belt is used to assist

Feeding the person

Weakness, paralysis, casts, confusion and other limits can make self-feeding difficult or impossible - Some residents/patients need to be fed Fluids help the person chew and swallow The spoon should be one-third (1/3) full. This portion is chewed and swallowed. Visually impaired persons need to be oriented to their plate using numbers on the clock for the location of food (12 o clock, etc)

Clostridium Difficile Infection

AKA *C-diff* A spore forming bacteria which is shed in the feces (bowel movements) Symptoms include: - Watery diarrhea - Fever - Loss of appetite - Nausea - Abdominal pain/tenderness - Dehydration *HAND ALCOHOL-BASED RUBS DO NOT KILL SPORES, USE SOAP AND WATER.* WASH HANDS FOR - C diff - Norovirus

Wound causes: - abrasion - Excoriation - Contusion - Incision slides 606 (pics)

Abrasion -partial-thickness wound caused by scraping away or rubbing of the skin Excoriation -loss of the top skin layer (epidermis) caused by scratching or when skin rubs against skin, clothing, or other material, or prolonged contact with urine Contusion -a closed wound caused by a blow to the body (a bruise). - blood vessel damage Incision - a cut produced surgically by a sharp instrument. It creates an opening into an organ or body space.

what admissions/transfers/discharges involve slides

Admissions/transfers/discharges events involve: 1) Privacy and Confidentiality 2) Reporting and recording 3) Understanding and communicating with the person 4) Communicating with the health care team 5) Respect for the person and their property 6) Being kind, courteous, and respectful

Enemas - use - who orders - Process

An Enema is the introduction of fluid into the rectum and lower colon. - used to remove feces or constipation, fecal impaction, and flatulence or to clean out the bowel area before surgery The DOCTOR orders the enema solution - you DO NOT give enemas containing drugs. The doctors do Process - Have person void first, lubricate the tubing, - Give enema slowly, can take 10 to 15 minutes. The liquid is usually at body temperature. - Sims position preferred - Keep the enema bag about 12 inches above buttocks. Insert 2-4 inches - If the person complains of cramping, clamp the tubing until the cramping subsides, then restart slowly.

Measuring and reporting vital signs - purpose of measurement slides

An essential part of the assessment step in the nursing process ◦ Normal vital signs vary (within certain limits) throughout the day. Vital signs are measured to: - detect changes in your normal body function. - Demonstrate your bodies response to treatment - see Changes in health or life threatening events *Report vital signs changed from previous measurements or abnormal vital signs at once* - If you are unsure abt measurement, ask nurse Each individual has their own glass/digital thermometer (prevent spread of infection). Use glove for rectal

Anxiety disorders slides

Anxiety Disorders: - Anxiety is a vague, uneasy feeling in response to stress. - Often anxiety occurs when needs are not met. - Anxiety level depends on the stressor (the event or factor that causes stress). ---------- book Some anxiety is normal Coping and other defense mechanisms help relieve anxiety - defense mechanisms are unconscious reactions that block unpleasant or threatening feelings - some use of defense mechanisms are normal

Severe infection can be deadly for:

Any patient who is immunocomprimised 1) Burn patients - Destroyed skin is a good portal of entry for microbes - Burns also affect immune system ability to fight infection 2) Transplant patients - New organ/tissue is foreign object, and immune system may attack (reject) - Drugs supress immune system antibody creation to prevent rejection 3) Chemotherapy patients - Some drugs affect ability to produce WBCs.

Binders and compression garments book

Applied to abdomen, chest, or perenial area Support wounds and hold dressings in place - prevent/reduce swelling, promote comfort, prevent injury 1) abdominal binder - top part at waist, lower part on hips. SEcured with velcro or hook loop 2) Breast binder - support breasts after surgery. SEcured with velcro or padded zippers --------------- Compression garments help: - reduce swelling - prevent fluid buildup at plastic surgery site - hold skin against body - achieve desired shape Report at once if breathing changes, if there is redness, irritation, or other signs of a skin problem

Oil book

Are fats at room temp - come from plants and fish (*are NOT a food group*) - high in calories - best oils come from fish, nuts, and veg - some foods like mayo and dressing are mainly oil - oil from plant doesn't have cholesterol - solid fats = butter, milk, animal (not fish) fat have ~ 120 cal per tbsp

Ocular prostheses book

Artificial eye - for looks - some permenant, some removable process: 1) Hand hygiene 2) Collect kidney basin, denture cup, or other container - line with soft cloth/4x4 gauze 3) Have person put eye in container 4) Line sink w/ towl 5) Wash with mild soap/warm water. Rinse well. Do NOT use cloth to wash/dry eye 6) Line a container with new soft cloth/gauze 7) Fill with sterile water/saline soln 8) Place eye in container 9) Label container with name and room + bed number 10) Place labeled container in top drawer of bedside stand 11) Wash the eye socket with warm water/saline. Use washcloth/square gauze 12) Wash eyelid adn eyelashes with warm water (inner to outer aspect). Dry eyelid 13) Rinse prosthesis with sterile water before insertion

Amyotropic lateral sclerosis (lou gehrig's disease) - what it is - progress - care book

Attacks CNS nerve cells controlling voluntary muscles - muscles atrophy and twitch. No control over muscles (all voluntary functions, then respiratory and swallowing) - rapid progress and fatal - usually between 40-60 yrs. death in 2-5 yrs after onset - doesn't usually affect cognitive function or senses, though dementia can happen. Bowel and bladder also unaffected No cure. Some drugs slow progress/improve symptoms Care: - therapies for lost functions - mobilitiy aids, ROM exercises - comfort/pain relief - dysphagia diet/feeding tube - communication methods - respiratory support - fall prevention hospice

Autism slides

Autism is a brain disorder with no cure. It affects social skills and communication. Signs of delayed development are seen at about 18 months of age. Autism is more common in boys than girls. The cause is unknown. Social and work skills are needed. As adults some can work and live independently. Others need family and community support 789

Bariatric care (bathing)

Bariatric patients/residents may need help with hygiene They may not be able to reach body parts and skin folds require extra attention to prevent fungal infections (pillow cases between folds can help) Plan for extra time for hygiene. Avoid seeming rushed. Ask other staff who have cared for person for more accurate timeframe

Bathing

Bathing cleans the skin and is refreshing and relaxing - prevents odors and discomfort. - Circulation is stimulated and body parts exercised - Observations on the condition of residents/patients skin is made and documented - Person's choice of bath time is respected when possible. Always offer bedpan, urinal or bathroom break *before the bath begins.* - otherwise they will pee - can set basin on bedside table The first thing the CNA should always do is check the water temperature for the resident and allow the resident to check the water being used on them. Water usually between 110-115 F. Lower for older adults

Bedmaking. - Clean beds do what - to keep beds neat

Beds are made or straightened throughout the day and night. Hem-stitching faces away from person. Upper hem of bedspread is even with top of mattress Bed linen should be clean, dry and wrinkle-free: • Promotes comfort • Prevents skin breakdown To keep beds neat: • Change linens when they are wet, soiled, or damp • Straighten linens whenever loose or wrinkled and before bedtime • Check for and remove food/crumbs • Check linens for dentures, eyeglasses, hearing aids, sharp objects, and other items

Behavior issues

Behavior issues 1) Anger - is a common emotion/violent behaviors can occur 2) Demanding behavior - nothing seems to please the person 3) Self-centered behavior -person only cares about his/her needs 4) Aggressive behavior - person may swear, bite, hit, pinch, scratch, or kick 5) Withdrawal - person has little to no contact with family, friends and staff 6) Inappropriate sexual behavior - some people make inappropriate sexual remarks or touch others in the wrong way

Newborn (neonatal period) - Abilities

Birth - 1 mo Head larger than chest (until 1 yr) CNS not fully developed - See ~8-12 inches > can follow large objects > like faces and bright colors - Good hearing - Know mother's voice, startled by loud sounds - REact to touch/pain. Can smell and taste - Cannot hold heads up. Turn heads from side to side - Sleep 16-18 hrs a day. Feed every 2-3 hrs (bottle fed feed less often) > Sleep lessens and time between feedings increases as they develop Reflexes present

Body mechanics Body alignment Base of support

Body mechanics - using body in an efficient and careful way - Involves good posture, balance, and using largest muscles for work *Body alignment (aka posture)* - the way the head, trunk, arms, and legs are aligned with one another. Helps body function more efficiently *Base of support* - area on which an object rests *Good base of support needed for balance* a) Feet are your base of support when standing b) Bend knees and squat to lift a heavy object c) Hold items close to body and base of support to be able to lift with your legs

GI system review: bowel elimination - peristalsis - defecation - feces

Bowel elimination is the excretion of wastes through the GI tract Feces move through the intestines by *peristalsis* Feces move through the large intestine to the rectum then stored in the rectum for excretion from the body *Defecation* (bowel movement) - the process of excreting feces from the rectum through the anus. *Feces* - Waste products in colon that is expelled via anus

Braille Mobility Eyeglasses book

Braille is a touch reading and writing system that uses raised dots for each letter of the alphabet. This is how blind people can read. - first 10 letters also represent 0-9 Special devices allow for keyboard access ------------- Mobility cane (white/silver) with red tip > announce presence first, ask if you can assist. Don't interfere with arm holding cane. Person stores cane (if you do tell them where) guide dog - moves in response to master's commands, disobeyed to avoid danger - do not pet, feed, or distract guide dog ---------- glasses - cleaned daily and as needed - wash with warm water - dry with lens/cotton cloth - use special cleaning soln - clean in circular motion, lift frames from ears

Causes of aspiration during tube feeding book

CAn occur: 1) During insertion - slips into the airway during NG and naso-enteral tubes. Use x-ray to check placement 2) From tube moving out of place - coughing, sneezing, vomiting, suctioning, and poor positioning cause this - Can move out of stomach/intestines into esopahgus and then airway. - RN checks placement before every scheduled feeding (or every 4 hrs for continuous). CNA doesn't check this. > measure pH of fluids tube connects to 3) From regurgitation - backward flow of stomach contents into mouth - commonly caused by delayed stomach emptying nd over-feeding Check tube placement and residual stomach contents before tube feeding

Fluid imbalance: Edema

CAuses - high sodium intake, infections, injuries, burns, certain kidney, liver/cardiac diseases, sitting too long in one position Problems - swelling - weight gain - SOB - reduced circulation - increased risk of skin ulcers

Cerebrovascular accident (Stroke) - what it is slides

CVA - Occurs when either a blood vessel in the brain bursts and bleeds into the brain (cerebral hemorrhage) OR a blood clot blocks a blood vessel in the brain (ischemic stroke). - Blood flow stops. Brain cells are affected in the area that do not get enough oxygen and nutrients. Brain damage then occurs. A leading cause of death and disability in the US The person needs emergency care - Blood flow to the brain must be restored as soon as possible

Poison book

Call poison control In eyes: rinse with running water On skin: remove any clothing in contact. Rinse skin with water Inhaled: Leave area, get person to fresh air Swallowed: Do not have person vomit. Activate EMS if person stops breathing, collapses, or has a seizure

Fluid imbalance: dehydration

Causes: - diarrhea, vomiting, bleeding, excessive perspiration (diaphoresis), and poor fluid intake Problems - decreased or concentrated urine, weight loss, mebranes dry, makes it hard to swallow, skin becomes dry and craks, confusion, decreased LOC, death

Abnormal respirations Cheyne-stokes respirations Biot's respirations Kussmaul respirations book

Cheyne-stokes respirations - respirations gradually increase in rate/depth, then become shallow and slow. Apnea may occur for 10-20 sec - caused by drug over dose, heart or renal failure, and brain disorder - common when death is near Biot's respirations - rapid and deep respirations followed by 10-30 sec of apnea - nervous system disorders Kussmaul respirations - very deep and rapid respirations - signal diabetic coma

Circumcision care book

Circumcision - when baby's foreskin is removed - prevents UTIS, allows for easier hygiene, lowers risk of penis cancer, prevent problem with retraction, decrease STIs - done within 1-10 days after birth. - tip should be swollen but not the rest. Doesn't interfere with voiding normally - should heal in 7-10 days - clean penis at each diaper change, especially after BM - use mild soap/water, just water, or wipes - apply petrolatum gauze ressing/jelly as nurse directs. prevents sticking and protects penis - apply diaper loosely.

Types of wounds: clean and dirty - Clean wound - Clean - contaminated wound - Contaminated wound - Infected wound - dirty wound - Chronic wound

Clean wound - is not infected. Microbes have not entered the wound. Sterile - Reprotductive, urinary, respiratory, GI systms are not entered Clean - contaminated wound - occurs from the surgical entry of the reproductive, urinary, respiratory or GI system. - Some or all parts contain normal flora Contaminated wound - has a high risk of infection. - Unintentional wounds usually contaminated Infected wound - dirty wound - contains large amounts of microbes and shows signs of infection. Chronic wound - does not heal easily. Pressure ulcers and circulatory ulcers are examples.

UTI symptoms Cystitis Pyelonephritis book

Common S&S - Urianry frequency - oliguria - urgency - dysuria - hematuria - pyuria (pus in urine) - cloudy urine - urine odor - pelvic pain (women) - rectal pain (men) Cystitis - bladder infection caused by bacteria - additional symptoms: pelvic pressure, lower abdominal discomfort Pyelonephritis - Inflammation of the kidney pelvis - additional symptoms: back/side pain, hgih fever, nausea and vomiting, shaking and chills Fluids encouraged (usually 2000 ml a day)

The healthcare team

Comprised of varied healthcare workers whose skills go towards providing quality care of the person Include: - doctors - nurses -CNAs - PTs - recreational therapists - occupational therapists - social workers - discharge planners - dieticians - housekeeping - more Led by RN

Common problems BMs - constipation, fecal impaction, fecal incontinence, diarrhea slides

Constipation - is the passage of a hard, dry stool. - This may result when residents ignore or delay the urge to defecate Fecal Impaction - is the prolonged retention and buildup of feces in the rectum Fecal incontinence - is the inability to control the passage of feces and gas through the anus Diarrhea - is the frequent passage of liquid stools. Fluids are lost and can cause dehydration. - Dehydration is the excessive loss of water from the tissues. Diarrhea can also cause skin breakdown

Contact (Transmission based) precautions - examples slide

Contact: 1} Gown and gloves > Gown protects your clothing and skin from exposure to known/suspected pathogens spread via contact with body fluids. - Examples of pathogens: MRSA on skin or wound, VRE, ESBL, C-DIFF, lice and scabies, Norovirus, other surface MDRO's.

Other walking aids: crutches - gaits (527) book

Crutches - used when person cannot use 1 leg or when 1-2 legs need to gain strength - check that crutches are in good condition, avoid loose fitting clothes. - Know gait: 4-point gait 3-point gait 2-point gait swing-to gait swing-through gait

Dairy and protein book

Dairy - low fat or fat-free choices best - helps build/maintain bone mass (reduce osteoporosis) - Reduce risk of cardiovascular diesases, type 2 diabetes, and high BP - contain > Ca, K, and vit D ------------------------- Protein - includes all meat + beans, peas, and soy - Choose lean/low-fat meat - fish are rich in substances that reduce risk of heart disease - organ meats are high in cholesterol (egg yolks too) - processed meats have added Na+ Provides: - B vitamins, Fe, Zn, and Mg

Spina bifda book

Defect of spinal column - occurs in first month of pregnancy - comorbid with Hydrocephalus Vertebrae don't close properly, nere damage occurs. Paralysis, bowel bladder problems. Lower back is a common site Types: 1) Occulta - vertebrae are closed, but there is a defect in closure. spinal cord and nerves not damaaged. Dimple or tuft of hair present on back. No symptoms, though foot weakness adn bowel/bladder problems can occur 2) Meningocele - Meninges swell and protrude through opening in back. Doesn't contian nerve tissue, and nerves aren't usually damaged 3) Myelomeningocele - sac of fluid containing nervees + part of spinal cord comes through opening in back. Nerve damage occurs, loss of function below lvl of damage. Lack of sensation and bladder and bowel control occur. Paralysis.

Types of wounds - Partial thickness wound - Full thickness wound slides

Describe depth Partial thickness wound - the dermis and epidermis of the skin are broken. Full thickness wound - the dermis, epidermis and subcutaneous tissue are penetrated. Muscle and bone may be involved.

Diabetic diet

Diabetic diet - consistency is key > food preferences. Food amounts/prep methods may be restricted > same amt of carbs, proteins, and fats eaten at same time each day > Eating meals/snacks at regular times to maintain blod sugar lvl

Physical changes of aging - Digestive - reproductive slide

Digestive system ◦Decreased in saliva production/*dysphagia* ◦Decrease in secretion of digestive juices > more indigestion > avoid dry, fried, hard to chew, and fatty foods - peristalsis decreases whole grain cereals and cooked fruits/vegetables provide soft bulk Need fewer calories but more fluids for chewin, swallowing, digestion, and kidney function --------------- Reproductive system - Hormones decrease slowing/decreasing force of reproductive systems (erection, etc)

Dysphagia diet

Dysphagia = difficulty swallowing -- *slow swallow* = person has difficulty getting enough food/fluids for nutrition - *unsafe swallow* = food enters airway (aspiration) due to weak throat muscles Feed person according to care plan, following aspiration precautions - position person upright, maintain this position for at least 1 hr after eating - support upper back,s houlders, and neck with a pillow - chcek person's mouth for pocketing (under tongue, in cheeks, on roof of mouth)

Urinary elimination problems: Dysuria Hematuria Nocturia Oliguria Polyuria Urinary frequency Urinary incontinence Urinary retention Urinary urgency

Dysuria - painful or difficult urination Hematuria -blood in the urine Nocturia - frequent urination at night --------------- Oliguria - scant amount of urine less than 500 ml in 24 hours Polyuria - abnormally large amounts of urine Urinary frequency - voiding at frequent intervals --------------- Urinary incontinence - involuntary loss or leakage of urine Urinary retention - inability to void Urinary urgency - the need to void at once

Eating disorders Anorexia Bulimia Binge eating slides

Eating Disorders involve extremes in eating patterns. - person may have other mental health disorders. *Anorexia nervosa* - the person eats in small amounts and only certain foods. - The person has an intense fear of gaining weight. *Bulimia nervosa* - binge eating occurs. The person eats large amounts of food - then the person purges the food to prevent weight gain. *Binge eating disorder* - the person eats large amounts of food - eating is out of control. - Binge eating is not followed by purging. Often the person is over-weight/obese.

Endocrine system: Pituitary gland

Endocrine glands secrete hormones into blood stream, which *regulate activities of other organs in body* Pituitary gland (master gland) located at base of brain. Divided into anterior and posterior lobes Anterior secretes: 1) Growth hormone (GH) - needed for growth of muscles, bones, and other organs 2) Thyroid-stimulating hormone (TSH) 3) Adrenocorticotropic hormone (ACTH) - stimulines adrenal glands Posterior secretes hormones that regulate growth, development, and function of male/female reproductive systems 1) Antidiuretic hormone (ADH( - water retention by kidneys 2) Oxytocin - causes uterine contraction during childbirth

Physical comfort: dying - pain - breathing problems slides

Every effort is made to promote physical and psychological comfort. *Allow the person to die in peace with dignity.* *Pain* - can range from none to severe, report and observe for signs of pain. *Breathing problems* - shortness of breath and difficulty breathing (dyspnea), are common end of life problems. - Semi-Fowler's position and oxygen (if ordered) are helpful. --------------- book Death rattle breathing common - due to mucus collecting in airway. May be helped by: > side lying > suctioning > drugs to reduce mucus

Foodborne illness: - danger zone - safety tips

Food isn't sterile. Easily contaminated via other food and handlers Pathogens grow rapidly between 40 F and 140 F - "danger zone" - keep food out of this range Safety tips - Clean (wash surfaces/hands/utensils often) > sanitize surfaces w/ hot, soapy water (1 tbsp chlorine bleach to 1 gal water) > discard cooked leftovers after 4 days - Separate (Avoid cross contamination) - Cook (cook food to safe temp. Reheat to 165 F) - Chill (refrigerate/freeze food within 2 hrs. If air is 90 F+, chill within 1 hr)

CPR for - children - infants book

For children: - same except for > 2 rescuers ratio of 15:2 > 2 inch depth > two hands or 1 hand on lower half of sternum > witnessed collapse, activate emergency response system. > Unwitnessed, give 2 min. of CPR, then activate emergency response system For infants: - same except for > 2 rescuers ratio of 15:2 > compression depth 1.5 inches > 2 fingers or 2 thumbs in center of chest > witnessed collapse, activate emergency response system. > Unwitnessed, give 2 min. of CPR, then activate emergency response system

wound Dressings - functions - types book

Functions: - protect wounds from injury/microbes - absorb drainage - remove dead tissue - promote comfort - cover unsightly wounds - provide a moist environment for wound healing - apply pressure to help control bleeding ----------- Types 1) Gauze - absorbs drainage/moisture 2) Non adherent gauze - removes easily without injuring tissue 3) Transparent adhesive film - air can reach wound but fluid/microbes can't. Wound kept moist, drainage not absorbed - allows for observation ----- Dry dressing - gauze placed over wound. Absorbed draiange removed with dressing. - can stick to wound Wet dressing - wound filled with gauze saturated wtih a soln - moist gauze covered with dry dressing - absorves drainage and provides moist environment for wound change

Flautulence - causes

Gas/air passed through anus = flatus - Flatulence is excessive formation of gas/air in stomach/intestines Causes - swallowing air while eating/drinking (chewing gum, eating fast, drinking through straw, carbonated beverages, anxiety) - bacteria in intestines - gas-forming foods (onion, beans, cabbage, cauliflower, radishes, cucumbers) - constipation - bowel and abdominal surgeries - drugs that decrease peristalsis If not expelled, intestines swell/distend from pressure - abdominal cramping/pain, SoB, and swollen abdomen Exercise, walking, moving in bed, left side-lying position often expel it. Drugs or enemas also

Preop drugs: surgery book

Given to: 1) Help person relax/feel drowsy 2) Reduce respiratory secretions to prevent aspiration (causes ddry mouth) 3) Prevent nausea/vomiting Person feels sleep/light-headed. Not allowed out of bed. To preven falls/accidents: 1) Have person void before drugs are given 2) Raise bed rails 3) Move furniture to make room for stretcher 4) Clean off over-bed table and bedside stand

Managing incontinence

Goals: 1) Prevents urinary tract infections (UTIs) 2) Offer use of bathroom or commode often to attempt to restore as much normal bladder function as possible - Incontinence is embarrassing - Garments get wet and odors develop - Skin irritation, infection, and pressure ulcers can develop from incontinence *Incontinence Products are called "Briefs" or "Depends" NEVER DIAPERS!*

Sputum specimen - what to have person do slides

Have the person rinse the mouth with water > decreases saliva + food particles - Mouth wash is NOT used - Have the person take a deep breath and cough, expectorating their sputum into a labeled sterile container. Can use postural drainage (positioning so sputum flows via gravity) for older persons

Circulatory system

Heart, blood, and blood vessels Heart pumps blood. - 3 layers (pericardium, muscular myocardium, endocardium) - vena cava > right atrium > tricuspid valve > right ventricle > pulmonary artery > left atrium > bicuspid (mitral valve) > left ventricle > aorta Systole (pumping) / diastole (rest fill) - *Arteries* take blood *away* from heart. - *Veins* and smaller venules return blood to heart - Capillaries exchange nutrients with tissues Blood functions 1) Carries food, hormones, and other substances to cells 2) Transports (carries) gases of respiration 3) Remove waste products from cells 4) Maintain body fluid balance 5) Regulate body temp 6) Produce/carry cells that defend body from microbes that cause disease --------------------- Blood - contains blood cells and plasma (containing proteins, fats, carbs, hormones, and chemicals) - RBC = erythrocyte *Hemoblogin* - Substance in RBCs that carries O2 and gives blood its red color - oxygen saturated Hb = brighter blood *White blood cells* fight infection Platelets (thrombocytes) help blood clot

Applying incontinence products

Help keep person dry. - position penis downward - check for proper placement (creases between thighs and perineal area) - do not let plastic backing touch skin - provide perineal care after each incontinent episode - do not use product as turning/lift sheet - attach lower tape first. Stretch and apply at slightly upward angle - attach upper tape after, attach in horizontal manner

Hydrocephalus slides

Hydrocephalus - when cerebrospinal fluid collects in and around the brain. Head enlarges Intellectual disabilities and neurological damage occurs. Vision problems , seizures and learning disabilities can occur. -------- shunt (long flexible tube) placed in brain, allows CSF to drain can occur at any age

Norovirus

Illness characterized by nausea, acute-onset vomiting and watery diarrhea with abdominal cramps Dehydration is most common complication and may require Intravenous fluids replacement of fluids (IV) Symptoms usually last 24 to 60 hours Highly contagious Seen in all age groups—severe outcomes and longer duration is seen among the elderly *Must wash hands with soap and water Using friction - hand sanitizers do not kill Norovirus*

Pressure ulcer complications slides

Infection is the most common complication - all stage 2-4 ulcers colonized iwth bacteria > *colonized* = presence of bacteria on/in wound. Person doesn't have S&S of infection > infected if bacteria invade tissues around/in pressure ulcer. Has signs of infection *Osteomyelitis* - inflammation of the bone and bone marrow (myel = bone marrow) - a risk if pressure ulcer is over bony prominence. Great risk if ulcer isn't healing - severe pain. treated with bedrest and antibiotics. Surgery possible Pain management important - pain affects movement and activity. Immobility a risk + may delay healing of ulcer Bed sores tend to heal very slowly

Illnesses and effect on sexual function slides

Injury, illness, and surgery can affect sexual function. Sometimes the nervous, circulatory, and reproductive systems are involved. Sexual ability may change. Most chronic illnesses affect sexual function. Heart disease, stroke, diabetes, and chronic obstructive pulmonary disease are examples. Reproductive system surgeries have physical and mental effects. Removal of the uterus, ovaries, or one or both breasts affects women. Emotional changes are common. The person may feel unclean, unwhole, unattractive, or mutilated. - There is often a period of grieving for the lost body part. The person may feel unfit for closeness and love.

Intake and output calculations slides

Intake and output are measured and recorded in milliliters (ml) or cubic centimeters (cc) A Graduate - is a measuring container for fluid. Hold at eye lvl to read To change ounces to ml's or cc's multiply by 30. - Example: a 10 ounce glass 10oz. x 30 = 300ml's

Types of wounds - Intentional - Unintentional - Open wound - Closed wound

Intentional wound - is created for therapy. Surgical incisions are examples. Unintentional wound - results from trauma. Open wound - the skin or mucous membrane is broken. Closed wound - tissues are injured but the skin is not broken. Bruises, and sprains are examples

Urinary incontinence -causes

Involuntary loss/leakage of urine. - not a normal part of aging, but older persons are at risk Causes: 1) Mental/cognitive changes-alterations 2) Prostrate disease 3) Spinal cord injury 4) Urinary track infections 5) Immobility-loss of mobility 6) Constipation 7) Diet 8) Gastrointestinal diseases 9) Weakness or loss of pelvic muscle function

Bone joints

Joints - A point where bones meet. allow for movement - Cartilage is a CT found at end of long bones - Synovial membrane lines joints and secretes synovial fluid - Ligaments secure bone to bone 3 types (movement definition): 1) Synarthroses (no movement) - *suture of skull* 2) Amphiarthroses (slight movement) - Vertebral discs 4) Diarthroses (freely moveable) a) *Ball and socket* - movement in all directions b) Pivot - Rotation around one point (neck) c) *Hinge* - movement in one direction (elbow) d) Saddle - Allow flexion/extension and abduction adduction (thumb only) e) Condyloid - Allow up-down and side to side moments (fingers, carpals, etc) f) Gliding - ankle, forearm to wrist (allow free sliding/movement)

Artificial airways: cont book

Keep airway *patent* (open and unblocked) Needed: 1) When disease, injury, secretions, or aspiration obstructs airway 2) For mechanical ventilation 3) By some persons who are semi-conscious/unconscious 4) During recovery from anesthesia ----------- *Intubation* - inserting an artificial airway 1) Oro-pharyngeal airway - inserted through mouth and into pharynx by a nurse/respiratory therapist 2) Endotracheal (ET) tube - inserted through mouth/nose into a trachea - doctor inserts using a lighted scope. some RNs and RTs can too 3) Tracheostomy tube - inserted through surgically created opening into trachea. - cuffed tubes common. doctor performs VS and pulse o2 measured often - observed for S&S of respiratory distress - frequent oral hygiene needed - if airway comes out, tell nurse at once

Chronic kidney disease - causes slides

Kidney function is *gradually* lost. Nephrons are destroyed over many years. High blood pressure, and diabetes are the most common causes. - Infections, urinary tract obstructions, and cancer are other causes. Treatment includes fluid restriction, diet therapy, drugs and dialysis. *Dialysis* - process of removing waste products from the blood. ------------ book hemodialysis removes waste by filtering blood peritoneal dialysis uses the lining of the abdominal cavity to remove waste/fluid in blood

Wound causes: - laceration - penetrating wound - puncture wound - ulcer slides 606 (pics)

Laceration - an open wound with torn tissues and jagged edges. Penetrating wound - an open wound that breaks the skin and enters a body area, organ, or cavity. Puncture wound - an open wound made by a sharp object. Such as stepping on a nail. Ulcer -a shallow or deep crater-like sore of the skin or mucous membrane.

Burn severity

Leading cause of death among children and older persons - can be from smoking, spilled liquids, hot baths/showers Classified by severity: 1) superficial (1st degree) - epidermis. skin is red/painful to touch. some swelling 2) Partia-thickness (2nd degree) - epidermis and dermis. SKin is deep red. Pain and blisters present. Skin may look glossy from fluid leakage 3) Full-thickness (3rd degree) - epidermis, dermis, fat, muscle, and bone - Burn isn't painful bc nerve endings are destroyed - Skin charred, or has white/brown/black patches

Endocrine system: adrenal glands + gonads

Located on top of kidneys. Two parts: 1) Adrenal cortex secretes: a) Glucocorticoids - REgulate metabolism of carbohydrates. Control body's response to stress and inflammation b) Mineralocorticoids - Regulate amount of salt and water absorbed/lost by kidneys c) Small amounts of male and female sex hormones 2) Adrenal medulla - secretes epinephrine and norepinephrine - stimulate body to quickly produce energy during emergenceis (HR, BP, muscle strength, energy up) -------------------- Gonads - testes and ovaries secrete testosterone and estrogen/progesterone

MSD risk factors

MSD Risk Factors include: 1) Force - the amount of physical effort needed to perform a task. Lifting and transferring heavy persons, preventing falls and unexpected or sudden motions are examples 2) Repeating action - doing the same motion or series of motion continually or frequently. Re-positioning persons/transfers for examples. 3) Awkward postures - assuming positions that place stress on the body. Examples are reaching above shoulder height, kneeling, leaning over a bed/twisting the torso while lifting. 4) Heavy lifting - manually lifting people who cannot move themselves.

Meniere's disease slides

Meniere's Disease involves the inner ear. Usually 1 ear is affected. ◦ With Meniere's disease fluid builds up in the inner ear. The increased fluid causes swelling and pressure ◦ Symptoms are sudden - and can last 20 minutes or 2 - 24 hours. Symptoms include: ◦Vertigo (dizziness) ◦Tinnitus ◦Hearing loss ◦Feeling of fullness or pressure in the ear Drugs and low salt diets decrease fluid in inner ear. Avoid smoking, caffeine, and alcohol During vertigo lie person down, prevent falls, have person keep head still. Talk to person by standing in front of him or her - avoid sudden movements or bright lights

Shampoo - method

Method 1) SHampoo during shower/tub bath - use hand held nozzle 2) Shampoo at sink - person lies/sits facing away from sink. Folded towel placed over sink edge to protect neck - use water pitcher or hand held nozzle to we/rinse 3) Shampoo in bed - head and shoulders are at edge of bed if possible. Shampoo tray under head to protect linens and mattress from water. Use water pitcher to wet/rinse hair - used for persons > needing complete bed baths > Who cannot use a chair/w/c, or stretcher 4) Shampoo caps - has cleaning agent and doesn't ned rinsing - warm package following instructions - check temp - apply cap - massage gently (follow instructions on how long) - remove cap - dry hair with towel if needed - comb Shampooing usually done weekly on person's bath or shower day Water temp usually 105 F

Fragile x syndrome book

Most common inherited intellectual developmental disability Body makes little to none of a protein needed for brain development girls have milder symptoms. no cure - treated with educational, behavior, physical, and drug therapies Problems: 1) learning 2) Physical (long/large face, loose/fexible joints, poor muscle tone, flat feet, large body size) 3) social and emotional (attention problems, aggression, shyness) 4) boys have more severe delays in speech/language

Exercise and activity slides

Most people move about and function without help. Illness, surgery, injury, pain and aging cause weakness and some activity limits. Inactivity, mild or severe, affect every body system and mental well-being.

Multiple sclerosis - what it is - ways it presents slides

Multiple Sclerosis - a CNS disease - Symptoms start between 20 and 40 years of age - The myelin (which covers nerve fibers) in the brain and spinal cord is destroyed. - Nerve impulses are not sent to and from the brain normally - Functions are impaired or lost --------- - women and whites at greater risk. family history too - No cure. drugs can slow. try to stay as active/independent as possible Presents in many ways: - symptoms appear then seem to go away (Remission). Then symptoms flare up (relapse) - more symptoms appear and condition worsens - remissions + relapses at first. eventually symptoms become worse. More symptoms occur wiht each flare-up - person's condition declines

Physical changes of aging - nervous slide

Nervous system ◦Reflexes slow ◦Reduced blood flow to brain ◦Shorter memory/forget-fullness ◦Sleep pattern changes ◦Poor vision/changes in acoustic nerve Nerve cells are lost, slowing transmission and increasing risk of falls - Lower blood flow to brain also contributes to falls

Pre-op teaching book

Nurse explains what to expect before, during, and after surgery. includes: 1) Pre-op care - tests + purpose, skin prep, personal care, purpose/effects of pre op drugs 2) Deep breathing, coughing, incentive spirometry - practice. These are done post op every 1-2 hrs awake 3) PACU (post anesthesia care unity - aka recovery room) - Where person wakes up. Care explained 4) Vital signs - taken until stable 5) Food and fluids - post op person is NPO and has IV 6) Turning and repositioning - done every 1-2 hrs post op 7) Early ambulation - done ASAP post op 8) Pain - what to expect + drugs given 9) Treatments/equipment - urine catheter, NG tube, oxygen, wound suction, cast, or traction 10) Position restrictions

*Professional boundaries* defintion

OSBN division 63 (definition 20): - Relationship limitations that promote professional and therapeutic interactions. - Professional boundaries allow for safe/therapeutic interactions between NA and person, NA and colleagues, NA and society *Professionalism* - Following laws, being ethical, having good work ethic, having the skill to do your work - Ethics deal with right/wrong conduct that requires judgements about what to do/not do

Hearing, Speech, and Vision Problems: hearing - otitis media - tinnitus slides

Occur in all age groups Common causes are birth defects, injuries, infections, diseases and aging *Otitis Media* -is an infection of the middle ear. - can be acute or chronic, and can damage the structures needed for hearing. - Fluids build up in the ear and pain (earache), hearing loss, fever and tinnitus occur. - persons with dementia or children can't communicate pain with words. Look for behavior changes (tugging, fluid drainage, irritability, etc) *Tinnitus* is a ringing, roaring, hissing, or buzzing sound in the ears or head.

Osteoporosis slides

Osteoporosis - the bone becomes porous and brittle ◦ fragile and break easily (even from slight activity) ◦Spine, hip and wrist fractures are common ◦ Older people are at risk ◦ Women at risk more after menopause ◦ Low levels of calcium and vitamin D cause bone changes

Oxygen Needs - CPAP slides

Oxygen therapy is commonly used if the patient/resident does not have enough oxygen in the blood/cells (hypoxemia) - this can be caused by illness *Non-invasive respiratory support - CPAP (continuous positive airway pressure)*machines keep airways open allowing the patient/resident to take more oxygen into their blood. Many patients/residents have apnea (especially at night) called *sleep apnea*, and will need to use a CPAP machine to keep their oxygen levels within normal limits

Parkinson's disease slides

Parkinson's Disease - A progressive disorder affecting movement (mild > severe progression) S&S: - 50+ yrs at risk - One or both sides of the body are affected - Tremors / trembling in hands, arms, legs - Rigid / stiff muscles - Stooped posture and impaired balance > hard to walk/falls a big risk (shuffling gait) - Mask-like expression > person cannot blink or smile/fixed stare - swallowing, chewing issues, constipation, sleep issues, depression, fear and insecurity (emotion), memory loss, and slow thinking develop over time - slow monotone speech ----------- controlled with drugs (no cure) - PT/exercise help - speech adn swallowing therapy needed

Casts - care Book

Part protected with stockinette and cotton padding. - plastic and fiberglass casts dry quickly - paris cast dries in 24-48 hours Care: Cast: - do not cover with blankets, plastic, or other material (cast creates heat, covering it can cause burns) - promote drying (reposition every 2 hrs, expose all surfaces to air) - maintain shape of cast > don't place wet cast on hard surface > use pillows to support entire length > support wet cast with palms (not fingertips) to turn/reposition person (waterproof material may be applied if near perineal area) - do not remove stockinette/padding Positioning: - elevate casted extremities to reduce swelling - Have enough help to re-position person. Casts heavy Safety - Do not let person insert anything into cast (they want to scratch, but infection and skin breakdown is risk) - Don't put powder under cast - no rings

PArts of the CNS

Parts of the brain 1) Cerebellum - REgulates/coordinates body movements - Balance, smoothing of movements 2) Cerebrum - higher function, contralateral control - Outer cerebral cortex 3) Brain stem - Connects cerebrum to spinal cord. 3 sections a) Medulla (controls HR, breathing, blood vessel size, swallowing, coughing, vomiting) b) Midbrain c) Pons - Relay messages between medulla and cerebrum

Sitting on the side of bed (dangle)

Patients/residents sit on side of bed and dangle for many reasons. They may become dizzy/faint when changing positions or getting out of bed too fast. Have them sit on side of bed for 1 to 5 minutes before getting up. Have them cough and deep breath and move legs to stimulate circulation

IV sites book

Peripheral IV sites (away from center of body) - back of hand + inner forearm Central venous sites - used for: > Parenteral nutrition > to give large amts of fluid > For long term IV therapy > Give drugs that irritate peripheral veins - subclavian vein - internal jugular vein (central venous sites) - Superior vena cava, rigth atrium (central venous catheter/central line) Peripherally inserted central catheters (PICCs) - cephalic and basilic vein in arms

Informed consent

Person has right to decide what will be done to them/who can touch them. Doctors must inform person about all aspects of treatment including: - reason for it - what will be done - how it will be done - who will do it - expected outcomes (risks, etc) - other options - effects of not doing it Persons who are under 18, mentally impaired (sedated, etc) cannot give consent. Consent is needed when person enters agency for care - in form of written, verbal, implied, etc *CNAs are never responsible for obtaining written consent.*Sometimes you can be a witness.

Chest tubes - Pneumothorax - Hemothorax - Pleural effusion book

Pneumothorax - air in pleural space Hemothorax - Blood in pleural space Pleural effusion - escape and collection of fluid in pleural space Collection of these substances causes pressure - air exchange doesn't occur and heart works harder to try and compensate Doctor inserts tubes between costae to remove trapped substance (sterile). Chest tubes attach to drainage system - air tight system (no air entry into pleural space - Chest tube attaches to connecting tubing - connecting tubing attaches to tube in drainage container - tube in drainage container extends under water. water prevents air from entering chest/pleural sapce

Application of lotions and creams slide

Products like cream, ointments, lotions and gels are all effective at treating skin problems. Ointments, creams, and lotions are different in ways that they are formulated. - An ointment is 80% oil and 20% water. - A cream is 50% oil and 50% water. - Lotion is similar to a cream, but it is an even light or less thick formulation. When applying topical creams and ointments they should be rubbed into the skin until there is no residue.

Prostate enlargement book

Prostate grows large as men age (benign prostatic hyperplasia) Common in older men. Enlarged prostate presses against urethra, obstructing flow. Bladder funct gradually lost. Problems common: - trouble starting urine stream - weak urine stream - frequent voidings of small amts of urine - urgency and leaking or dribbling of urine - nocturia -urinary retention (cannot void) - incontinence - pain during urination Drugs can shrink prostate/stop growth. Microwave and laser treatments destroy excess TURP for more severe cases

Immune system

Protects body from disease and infection Immunity = person has protection against disease/condition - will not get/be affected by disease - Acquired through immunizations 1) Specific immunity (reaction to a certain threat) 2) Nonspecific immunity (body's reaction to anything not recognized as normal) 1) Antibodies - recognize specific antigens and attack 2) Phagocytes - WBCS that digest and destroy foreign substances + dead cells 3) Lymphocytes - WBCs that produce antibodies. Production increases in response to infection a) B lymphocytes (B cells) - cause production of antibodies which circulate in plasma. Specific b) T lymphocytes (T cells) - Destroy invading cells. Some attract other cells - Killer T cells poison near invading cells.

Special diets General/Regular Cardiac diet Nutritional supplements Dysphagia Puree Thickened

Regular, general, and house diet - mean no dietary limits/restrictions Cardiac diet Nutritional supplements... --------- Dysphagia Puree - No lumps, mounds on a plate. Mashed potato like Thickened - no lumps. thickness of baby food, doesn't mound on plate. sauce like > medium thick = v8 juice > extra thick = honey-like. mounds a bit, can be drunk > yogurt-like = holds shape

What to report: nail care

Report - dry, reddened, irritated, or callused areas - breaks in skin - corns on top of/between toes - blisters - very thick nails - loose nails check between toes

Risk management: reporting incidents - Definition - Incident types - Reporting slide

Reporting *Incident = any event that has harmed/could harm a patient, resident, visitor, or staff member Incidents include: - accidents - errors in care (wrong care, wrong person, etc) - broken/lost items, money, or clothing - HAzardous chemical incidents - Workplace violence incidents Reporting: - Report accidents and errors stat via an *incident report* - These are reviewed by risk managment + health care committee. Look for patterns and trends and implement new procedures as needed. Incident reports are used to improve systems and promote safety, not for punishment. Processes may be changed to make mistakes more difficult. Or make it easier to do the right thing.

Risk factors for venous ulcers + Phlebitis slides

Risk Factors for Venous Ulcers ◦ History of blood clots ◦ History of varicose veins ◦ Decreased mobility ◦ Obesity ◦ Surgery: leg, foot, bones, joints ◦ Advanced age ◦ *Phlebitis* - is an inflammation of a vein.

S&S of illness in infants book

S&S may be sudden. Report at once - use apical pulse - jaundice - redness/drainage around cord stump/circumcision - limp and slow to respond - hard to wake up - less activity than normal - cries all the time/doesn't stop crying - red/irritated eyes - turns head to 1 side or puts hand up to 1 ear (earache) - prolonged screaming - poor feeding/skips meals - vomiting most of feeding/between feedings - fewer wet diapers -rash also other normal signs (perspiration, fever, abnormal stools, etc)

Types of assistance to provide with ADLs

Setup -gather basins, hair brush / combs, toothbrush, toothpaste, a towel. - All the things they will need for the morning routine. Place on a table or other location (over bed table) where resident can reach them. Positioning - assist the resident to get in a position which will make their morning routine easier to complete. - They may choose to sit or stand at the edge of the bed or sink. This can include you transferring them to a wheelchair. Physical assist - help the resident begin the task and complete the procedure if/when the resident is unable to do so. - Use discretion in providing assistance - avoid doing things that the resident is able to perform independently.

Preventing falls: bed rails

Seves as a guard/barrier along side of bed - ARe half, 3/4, or full length of bed - If a person needs rails, keep up except when giving care - They can be hazards, such as when person tries to climb over them or cannot get out to toilet > also entrapment (getting caught, trapped, tangled, or strangled) CMS (Centers for medicare and medicaid services) considers bed rails restraints if: 1) PErson cannot get out of bed 2) Person can't lower them w/o help

Sodium controlled diet

Sodium controlled diet - certain amount of sodium allowed - for heart disease, fluid retention, liver diseases, and some kidney diseases - adding salt, highly salted foods, not allowed. limit salt in cooking - less than 1500 mg daily for > age 51 and older > african americans of any age > People who have hypertension, diabetes, or chronic kidney diseases - for people needing to lower BP: - consume no more than 2400 mg daily - lower to 1500 mg to lower BP - lower sodium intake by at least 1000 mg daily even if above goal cannot be met - sodium increases water retention, increases strain on heart

CAncer in children vs adults book

Some cancers more common in children - leukemia - brain tumors - lymphomas (lymph vessels) - bone cancers - soft tissue cancers - eye - kidney - nerve cells Often occur suddenly. Have a high cure rate

Circulatory ulcers slides

Some diseases affect blood flow to the legs and feet. - Poor circulation can cause pain, open wounds and *edema*. - Open wounds and poor circulation can lead to infection and *gangrene*. > gangrene = tissue death *Circulatory Ulcers (vascular ulcers)* —are open sores on the lower legs or feet. They are caused by decreased blood flow through the arteries and veins. - persons with diseases affecting blood vessels are at risk

Stages of pressure ulcers book

Stage 1: Intact skin w/ redness over bony prominence Stage 2: Partial-thickness skin loss STage 3: Full-thickness tissue loss Stage 4: Full thickness tissue loss w/ muscle, tnedon, and bone exposure Unstageable: Full thickness tissue loss with ulcer covered by slough and/or eschar Suspected deep tissue injury: A purple/maroon area of intact skin or a blood filled blister

Pressure ulcer: stage 3 slides

Stage 3 - full thickness tissue loss. The skin is gone. Subcutaneous fat may be exposed. *Slough* (dead tissue that is shed from the skin) may be present. - light colored, soft and moist. stringy The ulcer becomes a crater and that goes below the skin surface.

Pressure ulcer: stage 4 slides

Stage 4 - Full thickness tissue loss with muscle, tendon, and bone exposure. Slough and eschar may be present. (*Eschar* is thick, leathery dead tissue that may be loose or adhered to the skin. It is often black or brown)

nervous system

System controls and coordinates body functions - Reflex = body's response to a stimulus (involuntary) divisions 1) Central nervous system - brain/spinal cord 2) PEripheral nervous system - All other nerves. 12 pairs of cranial nerves, 31 pairs of spinal nerves > Autonomic vs somatic > Parasympathetic (rest and digest) vs sympathetic (fight or flight) Meninges protect the brain and spinal cord Outside to inside Dura mater > arachnoid mater > pia mater

Securing dressing book

Tape - Adhesive, paper, plastic, cloth, and elastic tapes common. - Adhesive tape sticks well. Problems with it: > Hard to remove > Can irritate > Skin tears/abrasions occur if skin is removed with tape > Many people are allergic to adhesive - Apply to top, middle, and bottom of dressing, extending several inches beyond each side fo dressing - DO NOT apply tape to circle body part. Could cut off circulation Montgomery ties - Used for large dressings and frequent dressing changes - Adhesive strip with cloth ties, which are secured towrad the middle of the dressing - Adhesive strips stay in place and ties are undone fro dressing changes. Not removed unless soiled. - reduce irritation from frequent removal

Mrs. Riley has a urinary catheter. She tells you: "I feel like I have to pee, and I feel pressure down there." She points to her lower abdomen. There is no urine in her drainage bag.Is this normal? What do you do

That's not normal. Indicates catheter blockage, very dangerous! Tell nurse

The person's unit - definition - how to document valuables slide^ - comfort points

The *person's unit* is the personal space, furniture, and equipment provided for the person. Considered private *Document their personal valuables* - do not specify Gemstones and expensive metals instead you could say - one ring with a clear stone and yellow band

Nurse practice act

The Nurse Practice Act is a legal instrument that *defines* what functions of nursing shall be and *sets standards* for licensure. It *grants a nurse* the authority to carry out those functions Each *state* has *its own* Nurse Practice Act, but all must be consistent with provisions or statutes established at the federal level.

Wound healing - phases slides

The healing process has 3 phases. Inflammatory phase - 3 days - blood vessel injury + coagulation (clotting) - cell recruitment - release of cytokines and growth factors - blood flow promotess healing - inflammation: redness, swelling, warmth, pain • Bleeding stops. A scab forms, preventing microbes from entering the wound. An increased blood supply to the wound brings nutrients and healing substances. Loss of function may occur. Proliferative phase - 3-21 days - cell recruitment, migration, and proliferation. work to repair wound - formualtion of granulation tissue - Induction of angiogenesis and ECM secretion Maturation phase - 2 wk-2 yrs - Reepithelialization - wound contraction - scar tissue formation (red at first, then thin and pale) - scar gains strength

Oxygen needs - equipment - cna responsibilities (can/cannot) slides

The initial set up is usually done by a *Respiratory Therapist* Equipment can include: - Oxygen tank, tubing, mask, non-rebreather mask, nasal cannula, simple face mask CNA responsibility: - observing flow rates for patients/residents - ensure oxygen is flowing at the correct rate - can change oxygen tanks and set liters for patients/residents *You cannot decide to change amount of oxygen delivered ( flow rate)* - measured in L/min - doctor orders 1-15 liters

Psychological care: surgery slides

The person needs to be prepared for what happens before, during, and after surgery. Surgery causes many fears and concerns. Nursing assistants role: - listen and allow the person to talk about fears and concerns. - explain care you will give + need (and provide good care) - report requests to see clergy - *Refer questions to the nurse* > DO NOT tell about results/diagnoses - *Report signs of fear and anxiety*

Anxiety disorders - OCD slides

The person with OCD has obsessions and compulsions. *Obsession* - a recurrent unwanted thought, idea, or image. - Obsessions can be related to microbes, dirt, violent thoughts, the order of things, and more *Compulsion* - irepeating the act over and over again. (a ritual - copes with anxiety caused by obsession) - *may not make sense* - *Anxiety is great if the act is not done* Common rituals include hand-washing, cleaning, counting things to a certain number, or touching things in a certain order.

Reasons for surgery - in-patient vs. out-patient

There are many reasons for surgery 1) Remove, repair, or replace a diseased or injured body part 2) Remove a tumor 3) Make a diagnosis 4) Relieve symptoms 5) Restore or improve function or appearance Surgeries can be done: - *in-patient* -where the person stays in the hospital. admitted morning of or 1-2 days before. - *out-patient* - person goes home the same day of the surgery

FAll prevention programs - definition - Safety measures slides

These measures are part of care plan/program (+lists risk factors). Also apply to home settings. * Common sense and simple safety measures can prevent MANY falls.* --------------------- Basic needs ◦ Making sure basic needs are met ◦ Person properly positioned in bed/wheelchair/chair ◦ Exercise programs to help improve balance, strength Bathrooms ◦ Shower chairs are used ◦ Safety measures are followed in baths and showers Floors ◦ Floor are free of clutter and other items that can cause tripping/falling Furniture ◦ Furniture is kept in place or able to move freely Beds/equipment ◦ Bed is at the correct height ◦ Rooms, hallways have good lighting ◦ Non-skid footwear is worn ◦ Clothing and shoes fit properly ◦ Belts are secured in place Call lights/alarms ◦ Person is taught/reminded how to use call light Other ◦ Call for assistance ◦ Frequent checks are made on persons with poor judgement/memory ◦ Safety checks are made frequently on all patients/residents - Pull, do not push, wheelchairs, stretches, carts, and other wheeled equipment through doors > Allows you to lead and see where you are going

Endocrine system: - thyroid - Parathyroid - thymus - pancreas

Thyroid gland - Located in neck. Secretes: 1) Thyroid hormone - regulates metabolism (burning of food/heat/energy by cells) - lack = slowed body processes/movements, weight gain - too much TH causes excess energy, weight loss ------------------ Parathyroid glands - located on thyroid glands (2 on each side) 1) Parathormone regulates calcium use - lack of calcium causes tetany (severe muscle contraction/spasm) ------------------ Thymus 1) Thymosin hormone - important for development/function of immune system --------------- Pancreas 1) Insulin - Regulates amount of sugar in blood. Needed for sugar to enter cells - If insulin is lacking, sugar stays in blood (diabetes)

Understanding the person

To effectively treat persons, we must treat them as a whole and individual. Holistic approach *Holism* - Whole. A concept that considers the whole person, including their physical, social, psychological, and spiritual parts - These parts are inseparable

Wheelchair etiquette - to go down a curb - to go out a door or onto an elevator slide

To go down a curb - Lower the back wheels first, use the tip bar to gently lower the front wheels To go out a door or onto an elevator - Go through the door backwards so you can maneuver freely. - Guide the person in backwards, so they are facing the front of the elevator

Wheelchair etiquette - bed <> w/c - down a ramp - climb a curb slide

Transfer from bed to wheelchair/wheelchair to bed - Move person to a standing position then pivot to the new position by taking small steps Moving down a ramp - The person in the wheelchair faces uphill and you are positioned behind the wheelchair. You move downhill first, keeping your legs bent as you maneuver downhill To climb a curb - Push the front wheels up to the curb. Tip the wheelchair back and put the front wheels up on the curb. Push the wheelchair forward until the back wheels contact the curb. - Use your hip to push the wheelchair forward . To reposition person in wheelchair - put feet flat on floor

Transurethral resection of prostate (TURP) book

Transurethral resection of prostate (TURP) - common surgery. Lighted scope with wire loop is inserted through penis is used to cut tissue and seal blood vessels. Removed tissue is flused out via catheter fluid - bleeding and blood clots normal for benign prostatic hyperplasia Care plan for turp: - no straining/sudden movemnts - at least 8 cups water daily - no straining for BM - balanced diet to prevent constipation - no heavy lifting

Types of seizures book

Types 1) Partial - 1 part of brain involved. Body part may jerk, person has sensory problem or stomach discomfort. No loss of consciousness 2) Generalized tonic-clonic (grand mal) seizure - 2 phases: > Tonic (person loses consciousness, body rigid due to all muscles contracting) > Clonic (Muscle groups contract adn relax, causing jerking/twitching movements. Incontinence may occur). Deep sleep common afterwards. Confusion and headache upon awakening 3) Generalized absence (petit mal) - lasts a few seconds. Loss of consciousness, twitching of eyelids, and staring. Guide person away from dangers

Bathing safety

Use grab bars, NOT towel bars for support Dry floor of shower/tub before person gets in Check that safety aids (bars, etc) are in good condition Cover person for warmth and privacy Turn cold wate on, then hot. Hot off, then cold Fill tub before person gets into it Avoid using bath oils, make ground slippery

Mechanical lifts -use - common types

Used for persons who cannot assist with transfers + persons who are too heavy for staff to move TWo types common: 1) Stand assist lift - for persons who require some help w/ transfers adn can > Bear some weight > Follow directions > Sit up at side of bed with/without assistance > Bend hips, knees, and ankles 2) Full-sling mechanical lifts used for persons who: - cannot assist with transfers - are partially able/unable to bear weight - are too heavy to move safely - have physical limits preventing other types of transfers

Techniques for residents who are confused, have dementia/are disoriented slides

Various techniques are used with confused/disoriented/dementia residents 1) Cueing -techniques to simplify instructions (get the comb) 2) Visual -pointing to objects or gesturing 3) Verbal -short, simple, or one-step instruction 4) Tactile -holding someone's hand to have them walk with you 5) Mirroring -standing directly in front of a person to show them Sometimes 2 or 3 cueing techniques are used simultaneously

CPR defibrillation book

Ventricular fibrillation is an abnormal heart rhythm - heart shakes and quivers.. Not coordinated Defibrillator delivers a shock to heart - resets heart and allows return of regular rhythm Adult: - use AED asap - minimize interruptions in chest compressiosn before and after shock. CPR given while pads applied until AED is ready to check rhythm - give 1 shock, resume CPR - check for heart rhythm again after about 2 min of CPR (when prompted by AED)

Communication techniques with AD patients - techniques - things to avoid slides

Video: abcnews.go.com/Nightline/video/virtual-dementia-tour-families-understanding-alzheimers-disease-11226182 Communication techniques with Alzheimer's Disease patients: 1) Approach from the front in a calm, quiet manner 2) Treat the person with respect and dignity 3) Make eye contact to get his/her attention, and call person by name 4) Be aware of your tone of voice, volume, and body language 5) Encourage a two-way conversation 6) Use multiple methods to increase understanding - such as a gentle touch to guide them 7) Try distracting the person if communication creates problems (offer a snack or a walk) 8) Hold the person's hand while you talk 9) Be patient with angry outbursts - remember it is the illness 'talking' 10) Play soft music Avoid: - giving orders (alt. let me help you...) - wanting them mto remember the truth. just give info - correcting errors, just give info - pointing out errors - giving many choices - asking open ended questions (use Y/N)

Enterovirus D68 book

Virus found in saliva, mucus, and sputum - coughing,s neezing, touching contaminated surface then mucus membrane spreads S&S - fever - runny nose, sneezing, cough - skin rash and mouth blisters - body and muscle aches Infants, children, and teens at highest risk No vaccine - symptoms relieved by drugs

Vomitus book

Vomit that looks like coffee grounds contains undigested blood (signals bleeding) turn person's head to one side if they are supine Oral hygiene (741)

Cerebrovascular accident (Stroke): - TIA - warning signs slides

Warning Signs of a STROKE - may last a few minutes then goes away. known as *Transient ischemic attack (TIA)* > Blood supply interrupted to brain for short time (*Needs emergency care*) ◦ numbness or weakness of the face, arm, or leg especially on 1 side of the body ◦ confusion, trouble speaking, or understanding speech ◦ trouble seeing in 1 or both eyes ◦ trouble walking, dizziness, loss of balance or coordination ◦ Sudden, severe headache with no known cause

Weight and height book

Weight daily, weekly, or monthly Standing scale used for ambulatory patients Chair, wheelchair, bed, and lift scales used for people who can't stand To measure: - person wears only gown or PJs. No footwear. - person voids - Dry incontinence product worn - Weigh person at same time of day (before breakfast ideal, as food adds weight) - Use the same scale > balance scale - arms at sides, not holding anything ^ these add weight/height

Oral hygiene (mouth care) -what to report

What to report: - dry, cracked, swollen, or blistered lips - Mouth or breath odor - Redness, swelling, irritation, sores, or white patches in mouth/tongue - bleeding, swelling, or redness of gums - loose teeth - rough, sharp, or chipped areas in dentures

Assisting with the exam + after exam Book

You can stay in room for legal protection if you are same gender, or if female examiner wants a male present when examining a male After exam - Person dresses and returns to bed - Vagina/rectum cleaned if lubricant used. - discard disposable items - Clean reusable items (speculum needs to be sterilized) - Label specimens - straighten room

Sputum specimen slides

You may see your order as a " *Sputum C&S" (culture and sensitivity)* Respiratory disorders cause the lungs, bronchi, and trachea to secrete mucus. Mucus from the respiratory system is call sputum when *expectorated* (expelled) through the mouth - from bronchi/trachea *Sputum is NOT saliva* Sputum specimens are tested for blood, microbes and abnormal cells - *It is easiest to collect sputum first thing in the morning* *Hemoptysis* (bloody sputum)

Transfer to and from toilet slide

You may use a stand and pivot transfer or Sometimes mechanical lifts or a sit to stand lift are used for toilet transfers

CNA role in delegation

You must protect person from harm 1) Accept - You are responsible for your actions and must complete the task safely - Ask help if needed and report back 2) Refuse - Sometimes your right and duty Reasons to refuse 1) When it is beyond legal limits/range of functions of your role 2) Task is not in job description 3) You were not trained to perform task 4) Task could harm person 5) PErson's condition has changed 6) You do not know how to use the supplies or equipment 7) Directions are not ethical/legal 8) Directions are against agency policies 9) Directions are not clear/complete 10) No nurse is available for supervision NEVER ignore an order. Tell nurse you can't, otherwise they assume it will be done "I know this task is in my job description, but I did not learn it in training. Can you show me what to do, then observe me doing it? That would really help me." "I'm sorry, but I cannot do that task. I was not trained to give drugs and that task is not in my job description."

Types of nursing (book only) a) team nursing b) functional nursing c) patient-focused care d) primary nursing e) CAse managment f) Patient-focused care

a) team nursing - a team of nursing staff led by an RN - RN decides amount and kind of care person needs. delegates tasks b) functional nursing - focuses on tasks and jobs. each nursing team member has certain tasks/jobs c) patient-focused care - when services are moved from departments to the bedside. Nursing team performs basic skills usually done by other team members. reduces amount of staff d) primary nursing - Primary nurse (an RN) is responsible for person's total care. Nursing team assists as needed e) CAse management - A nursing case manager coordinates the care of specific groups or patients from admission through discharge and into the home or long term setting

Rehabilitation and disability - rehabilitation goals - disability acute vs. chronic slides

ableism *Rehabilitation* - the process of restoring the person to their highest possible level of physical, psychological, social and economic function. 0 takes longer in older persons - Goals: > Prevent/reduce degree of disability > Improve abilities. Maintain highest lvl of function/reduce loss of function > Help person adjust - can continue in home OBRA requires nursing centers to provide rehab services/obtain them from another source ---------------- *Disability* - any loss, absent, or impaired physical or mental function. - Acute = short course with complete recovery - Chronic = long course, problem controlled not cured *REHABILITATION IS WORKING WITH THE WHOLE PERSON*

breastfeeding book

breast feeding Either direct feeding or pumping milk from breasts into bottle - breast milk used Usually done every 2-3 hrs during first month (8-12/day). Fed on demand, not schedule - breast milk digested quickly Short nursing times at first, then gets up to 10-20 min at each breast Feeding ends when: - sucking slows - baby pulls off - baby isn't interested Baby weighted before and after breast feeding (calcualtes amount of milk taken in) - also weighed during assessment - baby weighed without diaper or anything

Constipation causes + prevention/relieving

causes: - low fiber diet, ignoring urge to have BM, decreased fluid intake, inactivity, drugs, aging, certain diseases Preventative/relief - stool softeners - laxatives (promotes bowel elimination by increasing bulk, softening, and lubricating intestineal wall) - suppositories - enemas

Assisting with o2 therapy - who orders, gives o2 - o2 sources book

doctor orders - you DO NOT give oxygen - nurse or respiratory therapist start/maintain o2 therapy Oxygen sources 1) Wall outlet 2) Oxygen tank 3) Oxygen concentrator - takes o2 from air. needs power 4) Liquid oxygen system - portable has enough for 8 hrs. 651

Autonomic hyperreflexia book

occurs with injuries above mid-thoracic level - autonomic system over-reacts to stimulus (full bladder, constipation, fecal impaction, skin disorders) > make sure these needs are met/avoided. Do not perform rectal procedures that could stimulate it - causes onset of excessively high BP, stroke, seizures, HR, death things to report at once on pg 712 Treatment HOB raised/person sits upright, tight clothing removed, cause treated

Speech rehab book

slides Some persons need speech rehabilitation. - A speech-language pathologist assists the person --------------- Speech-langauge pathologist helps the person - use remaining abilities - restore/improve language abilities to the extent possible - learn other communication methods - Strengthen speech muscles

CNAs must observe restraints for:

§Observe for increased confusion/agitation §Protection of the person's quality of life §Observe the person every 15 minutes §Remove - release - reposition the person and meet basic needs at least every 2 hours

Preparing for meals slides

• Assist with elimination needs • Provide oral hygiene, a clean mouth helps food taste better • Make sure dentures are in place • Make sure eye glasses are clean and on • Make sure hearing aides are on • Assist the person with hand washing • Position the person in a comfortable position • Open containers for the person if they are unable

Collecting specimens slides

• Follow Standard Precautions and Blood-borne Pathogen Standard • Use a clean container for each specimen • Use the correct container • Do not touch the inside of the container or inside of the lid • Identify the person's name, date of birth/and time specimen collected on container • Secure the lid on the specimen container tightly • Place the specimen container in a labeled biohazard plastic bag - ask females if they are having period. May cause blood in urine - ask person not to BM during urine specimen (Bowel and urine specimens can't be cross contaminated) place specimen in biohazard bag and seal

Diabetic care measures

4 essentials of preventing DFU (diabetic foot ulcers) 1) Patient education 2) Foot skin + toenail care 3) PRotective footwear 4) Protective surgeries ------------ Check feet daily for: - cuts - sores -blisters -redness - calluses - infected toenails - pus - warm skin Wash feet every day in warm water (90-95 F) with mild soap - do not use hot water - Do not let feet soak in water (Dries skin) - dry feet and between toes well Apply talcum powder or cornstarch between toes Apply layer of lotion, cream, or petroleum jelly on tops/bottoms of feet (not between toes Have person wear closed toed shoes and clean socks. Prevents blisters and sores - lightly padded socks best - tight socks and knee high stockings avoided - athletic and walking shoes best - open toed shoes, pointy shoes, and high heels not worn - shoes made of canvas, leather, or suede. Not vinyl and plastic. These don't stretch and don't allow air movement Make sure shoes and socks are in good condition No walking barefoot Socks at night Promote blood flow to feet - elevate feet while sitting - wiggle toes for 5 min 2-3 times a day -move angkles up and down and in and out - avoid crossing legs Do not trim/cut toenails or corns/calluses. Requires professional footcare

Middle adulthood

40-65 yrs A more comfortable and stable stage - CHildren grown and moved away - Less worries about children/money Developmental tasks 1) Adjust to physical changes 2) Adjust to having grown children 3) Develop leisure-time activities 4) Adjust to aging parents ------------------- - Physical changes occur gradually or early > grey hair > energy and endurance begin to slow > decline in some physical functions > *menstruation stops and menstrual cycles end (menopause)* between ages of 45-55 - Many diseases and disorders develop - Spare time increases, more time for hobbies. Important after retirement - Have to deal with death of parents

Types of incontinence - functional - reflex - transient book

5) Functional incontinence - has bladder control but can't use toilet in time 6) Reflex incontinence - urine lost at predictable intervals when bladder is full - person doesn't feel need to void. commonly caused by nervous system disorders and injuries 7)Transient incontinence - Temporary/occasional incontinence that is reversed when cause is treated

Patient unit: Temperature and ventilation book

68-74 F usually comfortable, but not for everyone. 71-81 F is temperature range required by OBRA and CMS Older people, less active persons, and people who don't move well prefer warm temperatures Ventilation provides fresh air and reduces odors. However, it causes drafts Protecting patients from drafts: - have them wear correct + enough clothing - Offer lap robes to those in chairs/wheelchairs (covering legs) - provide enough blankets for warmth - cover with bath blankets when giving care - move them from drafty areas

Infant skills > 9 > 10 > 11 > 12

9 mos - Can pull up to standing when holding onto something - CAn hold bottle, play pat a cake, and drink from cup or glass - point/use gestures to communicate 10 - *Can stand alone* - WAlk with help - crawl up stairs 11 - walk alone 12 - Walking skills increase - CAn climb onto furniture - Turn book pages and put objects into a container - Weaning (stopping bottle/breast feeding) begins - ATtempt word imitation (by this time) - Know words for common items - Understands simple instructions - Turns and looks towrads sounds - Responds to no Trust develops with consistent care - Physical needs met

Late childhood - dev tasks, skills

9/10-12 yrs Developmental tasks 1) Become independent of adults/learn to depend on oneself 2) Develop and keep friendships 3) Understand physical, psychological, and social changes 4) DEvelop moral and ethical behavior 5) Develop greater muscular strength + physical skill + balance 6) Learn to study ------------------- - Many permanent teeth emerge - Girls have growth spurt earlier. Heavier and taller than boys around 12 yrs - Grace/coordination increases - Math and language skills increase - Read stories, news, etc Onset of *puberty* nears - PErsiod when reproductive organs begin to function and secondary sex characteristics appear - need good, factual info - Peer groups are center of activity - affects attitudes and behavior - same sex friends preferred - attraction begins - Aware of mistakes/faults of adults > rebellion

Incontinence products: OBservations ot report nd record

= complaints of pain, burning, irritation, or need to void - signs and symptoms of skin breakdown > redness, irritation, blisters > Complaints of pain, burning, tingling, or itching - amnt of urine - urine color - blood in urine - leakage - poor product fit

Mechanical ventilation book

= using a machine to move air in/out of the lungs An ET or tracheostomy tube needed Problems that interfere with breathing/normal o2 lvls: 1) Weak muscle effort, obstructed airway, damaged lung tissue 2) Nervous system diseases and injuries affecting brain 3) Nerve damage interfering with lung-brain communications 4) Drug over dose depressing the brain 1 alarm means person is disconnected - reconnect tube and tell nurse at once - do not re-set alarms - tubes should have slack - don't change machine settings - give day, date, and time when you give care - use agreed upon signals (person can't talk) - person weaned from ventilator when possible (can take weeks, planned by RT and RN)

Catheters - definition - catheterization - types

A *catheter* is a tube used to drain or inject fluid through a body opening. A catheter inserted through the urethra (BY A NURSE) into the bladder drains urine. - *Catheterization* is the process of inserting a catheter --------- *Indwelling catheter (Foley catheter)* - is left in the bladder and urine drains constantly into the drainage bag. *Straight catheter* - drains bladder and then is removed

TB slides

A bacterial infection most often in the lungs - can occur in the kidneys, bones, joints, nervous system (including the spine), muscles, and other parts of the body If not treated, the person can die Spread by airborne droplets with coughing, sneezing, speaking, singing, or laughing Age, poor nutrition, and HIV infection are other risk factors Symptoms - tiredness - loss of appetite - weight loss -fever - chills - night sweats ----------- book - can be latent for years before becoming active, but only spreads when active drug treatment available sHouldn't be treated in long term care facilities (SNF, hospice, etc) UNLESS - administrative/environmental controls are in place - agency has respiratory protection program coughing exercises not done unless controls are in place

Safety - IDing person

A basic need. Goal is to reduce person's risk of accidents and injuries w/o limiting mobility and independence For safety: 1) Always ID person > name/DOB/picture/arm bracelet 2) Always use 2 IDs - Assignment sheet vs. ID 3) CAll person by name - *NOT room #, since those change* - *hazard* - anything in person's setting that could cause injury or illness *Always assist person on weaker side*

Circadian rhythm + sleep cycle sliddes + book

A daily rhythm based on a 24-hour cycle. Aka day-night cycle/body rhythm - Includes a sleep-wake cycle *NREM sleep* = phase of sleep with no rapid eye movements - 4 stages that go from light to deep sleep *REM* sleep - has rapid eye movements. Person is hard to wake. Mental restoration occurs and preparations for the next day occur. Usually 4-6 cycles of NREM and REM during 7-8 hrs of sleep - stage 1 NREM usually not repeated.

Standards of practice

A guide with which the State Board of Nursing evaluates safe/effective nursing care + whether care is below standard *Provides a framework for evaluation of continued competency* *The Code of Conduct for Nurses* (all nurses) - nurses who fail to conform to legal/accepted standards of nursing or who aversely affect the health, safety, and wellfare of the public may be guilty of conduct derogatory to the standards of nursing

Ostomy pouches - what - when to empty - when to change - slides

A plastic pouch with an adhesive backing which is applied to the skin. - Pouches have a drain at the bottom that closes with a clamp. - The drain is opened to empty the pouch The pouch is *emptied* when stools are present, and opened and burped to release flatus. *If allowed to over-fill they will detach from the skin, spilling their contents.* Pouches are not flushed down the toilet, but thrown away They are *changed* and replaced weekly (2-7 days), or when they begin to leak

Kennedy terminal ulcer book

A pressure ulcer that develops 2-3 days before death - most commonly in sacrum - due to skin failure. shutting down of body 10-14 days before death Sudden onset - pear, butterfly, or horseshoe shaped - Can be red, yellow, purple, or black Progresses in a matter of hours

Suspected deep tissue injury book

A purple or maroon area of intact skin or a blood-filled blister - pressure/shear has damaged underlying soft tissue - tissue may be firm, soft, warm, cool, or painful Hard to see in persons with darker skin

Pulse oximetry: taking measurement sldes

A sensor attaches to a *finger, toe, earlobe, or nose* - if poor flow in fingers/toes use other sites A good sensor site is needed. - *Avoid sites that are swollen or have skin breaks.* Bright light, cool skins, nail polish, artificial nails, and movements or shaking can affect measurements. ------ book - place towel over sensor to block light - remove nail polish/use different site - do not use finger if there are fake nails - use earlobe if person moves from shivering, seizures, or tremors (also for children that move a lot) - do not measure BP on the side of a finger site

Traction - skin - skeletal - care book

A steady pull from two directions keeps bone in place (neck, arm, or pelvis) - also used for muscle spasms and to correct deformities/contractures - uses weights, ropes, and pulleys Skin traction - applied to skin (boots, wraps, tape, splints) - weights attached Skeletal traction - wires/pins inserted through bone - for cervical traction, tongs applied to skull. Weights attached to bone. Care - keep weights off floor, or add/remove weights - ROM for uninvolved joints - report frayed ropes at once - usually only supine person around - Fracture pan - Bottom linens on bed from top down - Put botom linens on bed from top down. Person uses trapeze to raise body off bed - check pins for signs of redness, drainage, odors. report at once - report cast care observations

Bariatric beds slides

A wide frame with a weight capacity of 500 to 1000 pounds. Some bariatric beds convert into chairs *When taking care of a Bariatric resident/patient* • Think before you speak (be aware of fatphobia/bias) • Always show caring, dignity and respect Over-bed Table is for meals, writing, reading and other activities. - *Keep it clean* for the resident. - The bedside stand can be used for personal items and personal care equipment. Privacy curtains - *ALWAYS pull completely around the bed* before giving care to provide privacy

Standard (universal) precautions - Hospital infection factors + prevention - contact and droplet precautions slides

(229) Standard precautions: 1) Reduce risk of spreading pathogens 2) Reduce risk of spreading known and unknown infections *Used for all persons whenever care is given* Hospital infection is a result of several factors: *Microbial source + transmission + susceptible host = infection* - follow hand hygiene - wear gloves that fit if required task has risk of coming in contact w/ body fluids, contaminated surfaces, or mucous membranes - change gloves as needed *Contact precaution* = for surface pathogens *Droplet precautions* = for respiratory pathogens

Types of agencies - hospitals (in vs out patient) - long term care centers -skilled nursing facilities - ALR - mental health centers - home care agencies - hospice

*1) Hospitals* - Provide emergency care, surgery, nursing care, x-ray procedures/treatment, and lab testing. > Also therapies such as respiratory, physical, speech, and occupational - Two forms: > a) *In-patient care* (provided in hospital) > b) *Out-patient care* (when care is received and then patient goes home) *2) Long term care centers* - For people who cant care for themselves at home but don't need hospital care. - Services include medical, nursing, dietary, recreational and social. Needs vary in degree. - People who live in them are called *residents* *3) Skilled nursing facilities (SNFs)* - Provide more complex care than long term care facilities. - Residents may need extended rehab/recovery time *4) Assisted living residences (ALR)* - Provide housing, personal care, support services, healthcare, and social activities - Home-like setting for people who need assistance with activities of daily living (ADLs) - Residents usually ambulatory and require minimal assistance *5) Mental health centers* - For treating people with mental illnesses or who are having trouble with life events. - Some may have acute illnesses and pose a danger to self or others *6) Home care agencies* - Care taken to where people live. Range from health teaching, assistance with ADLs, PT, occupational therapy, dressing changes, and supervision to bedside nursing care. *7) Hospice* - Agency/program for people who are dying (usually <6 mos to live). - No longer respond to curative treatments, so focus is on physical, emotional, social, and spiritual needs of family.

Urine specimens: - 24 hr urine specimen slides

*24-hour urine specimen* - when for 24 hours all the urine that is voided gets collected. - To prevent the growth of microbes, the urine is chilled on ice. - The person voids to start the test with an empty bladder. - Discard the 1st void, then save *ALL* voids for the next 24 hours. The test needs to re-start if: 1) A voiding was not save 2) Toilet tissue was discarded into the specimen 3) The specimen contains bowel movements

Advance directives slides

*Advance Directives* - a document stating a person's wishes about health care when that person cannot make his or her own decisions. - the Patient Self Determination Act and the Omnibus Budget Reconciliation Act of 1987 ( *OBRA*) give persons the right to accept or refuse treatment. - They also give persons the right to make advanced directives. This is a written statement of a person's wishes regarding medical treatment, often including a living will, made to ensure those wishes are carried out should the person be unable to communicate them to a doctor. Living will and durable power of attorney are common types

Age-related macular degeneration (AMD) slides

*Age-Related Macular Degeneration (AMD)* - blurs central vision. AMD damages the macula in the center of the retina (fine detail). - blank spot in middle of vision ^slides Risk factors - risk increases after age 60 - smoking - whites -family history Treatment - Advanced AMD has no treatment - Some may stop/slow progress (ex. laser surgery) Reduce risk - eating diety high in leafy greens and fish - not smoking - regular exercise - maintaining normal BP and cholesterol

Ambulation: Canes slides

*Ambulation* - the act of walking. Some residents/patients need the assistance of a cane or a walker when ambulating. *Canes* - are used for weakness on 1 side of the body. They provide balance and support. - Ordered by dactor, nurse, or PT. For proper cane position, the cane is held to the side and in front of the *strong* foot. - The cane is moved forward about 6 to 10 inches. The leg opposite the cane, (weak leg) is brought forward with the cane. - strong leg moves ahead of both cane and weak leg. repeat

Loss of a limb - defintion - cause Gangrene - defintion - cause > = book slides

*Amputation* -is the removal of all or part of an extremity - Severe injuries, tumors, severe infection, gangrene and vascular disorders are common causes *Gangrene* -is a condition in which there is death of tissue - Infection, injuries, and vascular disorders common cause. Blood flow is affected. > Tissue becomes black, cold and shriveled. > IF untreated, it spreads Remaining limb shaped into a cone to fit prostheses Phantom pain can last for years

Angina - things that affect oxygen needs - Pain description + locations - symptoms (what + length) slides

*Angina* - is chest pain from reduced blood flow and oxygen to part of the heart muscle. - Exertion, a heavy meal, stress, excitement increase the heart's need for O2 (oxygen) - Smoking, very hot or cold temperatures increase the heart's need for O2 Symptoms - Chest pain is described as a tightness, pressure, squeezing, or burning in the chest > can occur in the shoulders, arms, neck, jaw or back - The person may be pale, feel faint, and perspire - Dyspnea is common - Nausea, fatigue, and weakness may occur - Some persons complain of "gas" or indigestion Rest often relieves symptoms in 3 to 15 minutes (reduces O2 need) ------- book - nitroglycern held under tongue - similar treatment to coronary artery disease - If pain lasts longer, may signal heart attack

Speech disorders - aphasia - expressive aphasia - receptive aphasia - global aphasia slides

*Aphasia* - the total or partial loss of the ability to use or understand language, parts of the brain responsible for language are damaged. - Caused by stroke, head injury, brain infections, dementia, and cancer ------------ book *Expressive aphasia* (motor, Broca's aphasia) - difficulty expressing/sending out thoughts through speech or writing - person knows what to say but has problems speaking, spelling, counting, gesturing, or writing *Receptive aphasia (wernicke's aphasia)* - difficulty understanding language - has trouble understanding what is said or written - may not know how to use everyday items *Global aphasia (mixed)* - difficulty expressing thoughts AND difficulty understanding language

Speech disorders - apraxia -dysarthria slides

*Apraxia* = To not act or perform (praxia) - Cannot use speech muscles for understandable speech. Motor speech area damaged - Can understand *Dysarthria* - difficult or poor speech (arthria). Nervous system damage affects mouth - Slurred speech, speaking slowly or softly, hoarseness and drooling

Arterial ulcers slides

*Arterial Ulcers* - open wounds on the lower legs or feet caused by poor arterial blood flow. Found between the toes, on top of the toes and on the outer side of the ankle - mottling/palor - dry skin - atrophy of skin, SQ muscle - edema The ulcer is very painful Ulcers are caused by decreased arterial blood flow to the legs and feet - High blood pressure, diabetes, injuries, and narrowed arteries from aging are causes. - Smoking is a risk factor.

Asepsis Medical asepsis Surgical asepsis - sterilization - sterile Contamination - cross-contamination

*Asepsis* = absence of disease-producing microbes - *microbes are everywhere* *Medical asepsis (clean technique)* are practices used to: 1) Reduce number of microbes 2) Prevent microbe spread from person to place *Surgical asepsis (sterile technique)* - Practices used to remove all microbes (*Sterile* = absence of microbes) - *Sterilization* = Process of destroying all microbes (pathogens, non-pathogens) *Contamination* - Process of becoming unclean (pathogens present) *Cross contamination* - Passing microbes from 1 person to another by contaminated hands, equipment, or supplies - Prevented by medical and surgical asepsis

Assisted living - types of ADLs slides

*Assisted living* is a housing option for older persons who need help with ADLs but do not need constant care. - mobility and stable health often a requirement They usually need some help with 1 or more ADL. • Personal care - bathing, dressing, grooming, elimination • Meal - cooking, eating, taking medications • Housekeeping and personal safety • Transportation Moving to an ALR can bring mixed emotions. - They may be happy and excited. - Fear, anxiety, and uncertainty are also common. Help the resident and family adapt to the change. Be professional and caring.

Asthma -triggers Sleep apnea slides

*Asthma* - the airway becomes inflamed and narrow - Extra mucus produced - Dyspnea results - Wheezing and coughing are common (Fear makes attack worse) Asthma usually is triggered by allergies - Air pollutants and irritants - Smoking- Secondary smoke - Respiratory infections - Cold air/Exertion *Sleep Apnea* - apnea is the lack or absence of breathing (pnea). In sleep apnea, pauses in breathing occur during sleep.

Blood Borne Pathogen standard

*BLood Borne Pathogens* - Infectious microorganisms in blood and OPIM(other pontentiall infectious material) - that can be transmitted causing disease - Include HIV and HBV (hepatitis B) *Contaminated are bagged for removal from person's room immediately.* - HAve biohazard symbol on them - if isolation patient double bagging required *Biohazardous waste* = items contaminated with blood, body fluids, secretions, or excretions

Back injuries - signs and symptoms

*Back injuries are major risks. Back injuries can occur from repeated activities or 1 event* 1) Pain when trying to assume normal posture 2) Decreased mobility 3) Pain when standing/rising from seated position 4) Reaching when lifting 5) Poor posture 6) Staying in 1 position for too long 7) Poor body mechanics 8) Repetitive motions 9) Twisting or bending when lifting 10) Shifting weight when person loses balance/strength when moving 11) Reaching over raised bed raise 12) Fatigue (254)

Skeletal system - Function

*Bear weight of body* - 206 bones - Periosteum contains blood vessels that supply bones with nutrients Bone types: -long (bear weight) -short (allow skill/ease of movement) -flat (protect organs) -irregular (allow various degrees of movement/flexibility) Function 1) Provides support/framework for body 2) Allows body to move 3) Protects internal organs 4) Creates blood (in bone marrow)

Bipolar disorder Depression slides

*Bipolar disorder* - the person with bipolar disorder has severe extremes in mood, energy, and function. - There are emotional highs or "ups" and emotional lows or "downs" (depression). Can be mild to severe. - Mood changes from mania to depression and are called "episodes". *Depression* - involves the body, mood and thoughts. - The person has prolonged sadness. With MAJOR depression severe and prolonged feelings of sadness, loss, anger, or frustration interfere with daily life. > Common in older persons

Eye disorders - blindness - cataracts > S&S > risk factors slides

*Blindness* -is the absence of sight - legally blind = 20 ft vision at what normal people see 200 ft *Cataracts* -is a clouding of the lens. - A cataract can occur in 1 or both eyes. Symptoms/signs: - Overall Cloudy, blurry, or dimmed vision - Sensitivity to light and glares - Poor vision at night - Halos around lights - Double vision in the affected eye - colors faded/brownish. Blues and purples hard to see ---------------- book Risk factors (Cataract) - caused by aging. - family history, diabetes, excessive alcohol use, smoking, and prolonged exposure to sunlight - high BP, obesity, and eye injuries/surgeries

Blood pressure (B/P) - affected by - systole vs diastole slides

*Blood Pressure (B/P)* - is the amount of force exerted against the walls of an artery by the blood. - measured in mm Hg (millimeters of mercury) Your blood pressure is controlled by - *The force of heart contractions - The amount of blood pumped with each heartbeat - the ease that the blood flows through blood vessels.* *Systole (Systolic)* - is the period of heart muscle contractions. The heart is pumping blood. *Diastole (Diastolic)* - is the period of heart muscle relaxation. The heart at rest.

Temperature - definition - febrile vs afebrile slide

*Body temperature* - is the amount of heat in the body. It is the balance between the amount of heat produced and the amount lost. Heat is produced as cells use food for energy, and lost through the skin, breathing, urine, and feces. Your body temperature should remain fairly stable --------------------- Fever means an elevated body temperature - *Febrile* is with a fever - *Afebrile* is without a fever Older folks have lower body temps, so an oral temp at baseline (98.6) might indicate fever

Required CMS restraint reporting

*CMS* (centers for medicaid and medicare services) requires reporting of any death that occurs: - while person is in a restraint - within 24 hrs after restraint was removed - within 1 week after restraint was removed if it may have contributed directly/indirectly to death

Certification (nursing assistant)

*Certification* - official recognition by a state that the standards/requirements have been met *Nursing assistants* can have their certifications denied, revoked, or suspended for reasons listed by National Council of STate Boards of Nursing (NCSBN) - You are required to maintain competence. If you haven't worked for *24 months* retraining and a new competency eval are required - RNs or LVNs oversee CNA work and delegate tasks Nursing task - Nursing care or function, procedure, activity, or work that can be delegated to CNAs (and doesn't require a nurse's professional knowledge/judgement - *OSBN division 63 outlines what you can/cannot do as a CNA*

Cold applications slides

*Check every 5 minutes, leave on no longer than 15-20 minutes.* *Cold makes blood vessels constrict (narrow), meaning less oxygen and nutrients are carried to the tissues* Cold applications are often used right after an injury • Reduces pain • Reduce swelling by decreasing circulation and bleeding • Cold has numbing effect, reducing pain - cool fever *Cold application should never be in direct contact with the skin*

Heat applications - checking/use - effects - complications slides

*Check every 5 minutes, leave on no longer than 15-20 minutes.* Can be applied to almost any body part • Relieves pain • Relaxes muscles • Promotes healing • Reduces tissue swelling • Decreases joint stiffness *When heat is applied to the skin, blood vessels in the area dilate (expand or open wider)* COMPLICATIONS OF HEAT: • if applied too long the blood vessels constrict (less nutrients, tissue damage) • If client has decreased sensation (nervous issues, consciousness) they could not feel a burn occurring • Burns, redness, blisters • Be careful with fragile delicate skin - metal implants conduct heat - not applied to pregnant abdomen

Comfort needs: dying - goals slides

*Comfort Needs* Comfort is a part of end-of-life involving physical, mental, emotional and spiritual needs *Comfort goals*: 1) Prevent or relieve suffering to the extent possible 2) Respect and follow end-of-life wishes 3) Dying person may want family/friends present 4) They may want to talk about their fears/worries/and anxieties 5) Listening - let the person talk about and share worries and concerns 6) Touching -touch shows care and concern when words cannot "Would you like to talk? I have time to listen?" "You seem sad. How can I help?" "Is it alright if I sit with you for a while?"

Comfort and pain Types of pain slides

*Comfort is the state of well-being.* - The person has no physical or emotional pain. - He/she is calm and at peace. *Pain* or discomfort means to ache, hurt, or be sore. It is unpleasant. - a warning sign --------------------- Types of Pain: *Acute pain* - is felt suddenly from injury, disease, trauma, or surgery. Lasts a short time and lessens with healing. It may signal a new injury or a life-threatening event. - Tissue damage *Chronic pain* - is persistent pain, continues for a long time (months or years) - Or occurs off and on. There is no longer tissue damage. Chronic pain remains long after healing. *Radiating pain* - is felt at the site of tissue damage and in nearby areas. - Ex. Heart pain in left chest/jaw/shoulder/arm. Gallbladder disease in right upper abdomen, back, and right shoulder *Phantom pain* - is felt in a body part that is no longer there.

commodes

*Commodes:* - a chair or a wheeled chair with an opening for a container. People unable to walk to the bathroom often use a bedside commode Lock the wheels after the commode is positioned over the toilet or by the bedside Make sure you empty, clean and disinfect after each use.

Focus on communication

*Communication* - exchange of info in which a message is sent and correctly interpreted Your speech and communication must be professional. 1) Do not use foul language 2) Speak clearly 3) Control the volume and tone of your voice 4) Do not fight or argue 5) Use words that mean the same thing to you and the person receiving the message 6) Use familiar words 7) Be brief and concise 8) Give information in a logical and orderly way 9) Organize your thoughts 10) Give facts and be specific

Confusion - causes slides

*Confusion* - a mental state of being disoriented to person, place, time, situation. - With confusion, memory and the ability to make good judgments are lost. *Confusion* might be from physical or psychological reasons : - Disease - Infections - Hearing/vision loss - Medication side affects - Brain injury/decrease blood supply to brain - Hypoxia - Reasoning problems

Preventing respiratory/circulatory complications - methods - signs/symptoms of blood clots slides

*Coughing and deep breathing* exercises and *Incentive spirometry* prevent respiratory complications including post-operative pneumonia = older persons at risk (weaker, less elastic lungs. Less strength for coughing) Circulation must be stimulated for blood flow in the legs - If blood flow is sluggish, blood clots may form - many peoplel lack symptoms Signs and Symptoms of a blood clot (report at once!): 1) Swollen area of a leg 2) Pain or tenderness in a leg. This may occur only when standing or walking. 3) Warmth in the part of the leg that is swollen or painful 4) Red or discolored skin

Understanding the person: culture and religion

*Culture* - Characteristics of a group of people, language, values, beliefs, habits, likes, dislikes, adn customs - Passed from one generation to another. Every area has its own culture *Religion* - Spiritual beliefs, needs, and practices. Very important and must be respected US has people from many different cultures and religions. Must respect client bgs

Oxygen needs: deep breathing and coughing slides

*Deep breathing and coughing* moves air into most parts of the lungs - coughing helps remove mucus and keep the airway clear. > incision splinted with hands or pillow Deep breathing and coughing are usually done every 1 to 2 hours while awake. Deep breathing and coughing help prevent pneumonia and *atelectasis*. Especially after surgery or a procedure. *Atelectasis* is the collapse of a portion of a lung. Which then cannot exchange oxygen. 649

Dehiscence and evisceration: post op complications slides

*Dehiscence* - the separation of wound layers *Evisceration* - the separation of the wound along with the protrusion of abdominal organs (surgical emergency) - organ leakage delete

Delirium - S&S slides

*Delirium* - is a state of sudden, severe confusion and rapid changes in brain function. • Usually temporary and reversible • Occurs with physical or mental illness • can signal physical illness • Often lasts for about 1 week—but may take several weeks for normal mental function to return Signs/Symptoms: • Alertness - changes in awareness • Sensation • Movement - active or very slow moving • Drowsiness/Confusion about time and place • Think and behavior, trouble concentrating • Speech/ emotional changes

Dementia - warning signs slides

*Dementia* - is the loss of cognitive function that interferes with routine personal, social and occupational activities. *It is a group of symptoms not a specific disease.* Caused by damage to brain cells. Isn't a normal part of aging. > some can be reversed, but no cure for permenant dementia Changes in personality, mood, behavior and communication are common. ----------- book warning signs: - memory loss - problems with common tasks - problems with language/communication. forgetting simple words - getting lost in familiar places - misplacing things and putting things in odd places - personality, mood, and behavior changes *pseudodementia* = person has signs/symptoms of dementia but has no changes in brain. occurs with delirium and depression

Diabetic foot ulcers slides

*Diabetic Foot Ulcers* - is an open wound on the foot caused by complications from diabetes. Often painless, diabetic foot ulcers can take several weeks or months to heal. Some never heal. ---------- Diabetes can affect the nerves and blood vessels. v *Nerve* - loss of sensation in a foot or leg. Person does not feel injury. infection and large sore can develop *Blood vessels* - blood flow decreases. Tissues and cells do not get needed oxygen and nutrients. - Sores heal poorly. Infection and tissue death (gangrene) can occur.

Diabetic retinopathy slides

*Diabetic Retinopathy* - blood vessels in the retina are damaged and vision progressively blurs - splotches that increase over time ^slides --------------------- risk factors: diabetes Treatment - control diabetes, BP, and cholesterol - laser surgery - surgery where blood is removed from center of eye - low vision services

Illness and disability

*Disability* - Lost, absent, or impaired physical/mental function. - May be temporary or permanent. Recovery can be delayed or not occur - Will affect all other aspects of life. - Fears of death, disability, chronic illness, loss of function, and *anger* are common *Rehabilitation* - Helping a person return to their optimal level of function. - *Optimal level of function* - person's highest potential for mental and physical performance - NAs can make person feel safe, secure, and cared for - Holding a hand, touch, taking time to visit with them. Listening to concerns/frustrations while maintaining professional boundaries

Disaster and RACE (fire)

*Disaster* - sudden catastrophic event. People are injured/killed, property is destroyed What to do: RACE R) Rescue persons in immediate danger. Move to safe place A) Alarm - sound the nearest fire alarm. CAll 911 C) Confine fire by closing doors/windows. Turn of O2 or electrical items in area of fire E) Extinguish small fires using fire extinguisher DO NOT use elevators in case of fire

Drawsheets

*Drawsheet* - a small sheet placed over middle of bottom sheet *Cotton drawsheet* made of cotton. Helps keep mattress and bottom linens clean. Used on its own *PAdded waterproof drawsheet* - made of an absorbent top and waterproof bottom. Protects mattress from soiling Drawsheet reduces heat retention and absorbs moisture - often used to assist with patient transfer (place sheet under head to above the knees)

Drug abuse and addiction - drug abuse - addiciton - withdrawal slides

*Drug Abuse and Addiction* - can involve illegal drugs or the mis-use of legal drugs. - Drugs affecting the nervous system affect normal brain function. Drug abuse - using a drug for non-medical or non-therapy effects Drug addiction - a strong urge or craving to use the substance and cannot stop using. Withdrawal syndrome - the physical and mental response after stopping or severely reducing the use of a substance that was used regularly. > anxiety, restlessness, insomnia, irritability, impaired attention, and physical illness

Dysrhythmias slides

*Dysrhythmias (arrhythmia)* - is an abnormal heart rhythm. - The rhythm may be too fast or too slow or irregular - Caused by changes in the heart's electrical system ------------ book Cause: Hypertension, CAD, MI, heart failure, weakening/changes to heart muscle, drug, alcohol abuse, excess caffiene, thyroid issues, drugs Symptoms - dizziness/lightheadedness - fluttering in chest - chest pain - dyspnea Treatment depends on type - defibrillation - electrical shock given to reset rhythm - ablation - areas of tissue in hart sending abnormal signals are destroyed - pacemaker (monitors and regulates heart rhythm) - Implantable cardioverter defibrillator (ICD) used for life-threatening dysrhythmias. REstores regular rhythm

Elder abuse - definition - forms - Reporting signs on pg 47-48

*Elder abuse* - any knowing, intentional, or negligent act by caregiver or any other person to an elder. Act causes harm or serious risk of harm. ------------------------- Forms: 1) Physical (threats or acts) 2) *Neglect* - failure of responsible persons to provide food, shelter, health care, or protection for a vulnerable elder 3) Verbal 4) Involuntary seclusion 5) Financial exploitation/misappropriation - to unjustly use stuff/take it away from an elder's use (money, resources, etc) 6) Emotional/mental (depravation, threats, infantilization, etc) 7) Sexual 8) Abandonment (4 points) - Accept assignment to care for a person - Accept assignment for a certain time period - Remove self from care setting - You do not report off to a staff who will assume responsibility of care ---------------- Reporting abuse - Discuss with nurse the possibility and your observations (as much as possible) - Nurse contacts community agencies that investigate

End-Of-Life Care slides

*End of life care* -describes the support and care given during the time surrounding death. Death can be sudden or an expected event Death and dying cause staff discomfort - Your feelings about death affect the care you give. How do you feel about death/dying? - I'm scared of it, and it makes me uncomfortable. Haven't had much experience with it, but I also don't think it's necessarily a bad thing. It's not the ultimate enemy of medicine

Endocrine disorders - diabetes - hyper/hypoglycemia - S&S slides

*Endocrine Disorders* - the endocrine system is made up of glands, which secrete hormones that affect other organs and glands *Diabetes* is the most common disorder. - in this, the body cannot produce or use insulin properly - Without enough insulin, sugar (glucose) builds up in the blood - Cells do not have enough sugar (glucose) for energy and cannot function - glucose monitored daily/3-4 times a day Hyperglycemia - high blood sugar Hypoglycemia - low blood sugar (746) Signs and symptoms - Fatigue, weakness, dizziness - Vision changes - Excessive Hunger - Tingling around the mouth - Headache - Cool clammy skins - Sweating - Rapid shallow respirations - Rapid pulse - Low blood pressure - Clumsy movements - Shaking or trembling - blurred vision, frequent urination *Confusion then unconsciousness and convulsions then death if untreated*

Enteral nutrition - common causes

*Enteral Nutrition* - is giving nutrients into the gastrointestinal (GI) tract through a feeding tube. Some people cannot or will not ingest, chew, or swallow food. If food cannot pass from the mouth into the esophagus to the stomach and small intestine - poor nutrition results *Aspiration is a risk!* *Doctor will order type of food/formula for tube feedings* - given at room temp to avoid cramping (from cold)/microbe growth (warm) > warmed wash basin full of water - CNAs never insert feeding tubes, check placement, or check residual stomach contents *gavage* = process of giving a tube feeding

ERgonomics Bed mobility

*Ergonomics* - science of designing a job to fit a worker - changing task, work station, equipment, and tools to reduce stress on body Bed mobility - how a person moves to and from a lying position, turns from side to side, and repositions in a bed or other furniture

Female reproductive system

*Estrogen and progesterone* - Female hormones produced in ovaries - Needed for reproductive system function + development of secondary sex characteristics > Breast size, body hair, deepening of voice, widening/rounding of hips Ovary v fallopian tube v uterus (fundus = main part, cervix = narrow section) - lined by endometrium v cervix v vagina - partly closed by hymen membrane (ruptures during first sex External genitalia = vulva - Mon pubis (fatty, rounded pad over pubic symphisis) - labia majora and minora suround vaginal opening - clitoris = composed of erectile tissue ---------------- Menstruation - processing which endometrium breaks up and is discharged from body through vagina (~ every 28 days)

Relieving choking

*FBAO* = choking and foreign body airway obstruction - ABdominal thrusts (quick, upwards thrusts to abdomen). Force air out of lungs and create artificial cough > make one hand into fist, the other wraps above it between navel and xyphoid process > Chest thrust used for obese/pregnant persons - Relief occurs when you feel air move/see chest rice (rescue breaths), or when foreign body is removed If you assist, report and record what happened (including what you did and person's response

Stages of pressure ulcers: stage 1 slides

*First sign of pressure/bed/decubitus sore* - may be only a patch of redness. Darker skinned persons have skin discoloration sometimes - *This red patch will be "non blanching" meaning it does not turn white when you press it with your finger* - area may feel warm or cool. Complaints of burning, itchiness, tingling, pain, or nothing at all If the red patch is not protected from additional or repeated pressure the redness can form blisters or an open sore (ulcer) *Stage I* - intact skin with redness over a bony prominence.

Partial bath Tub baths and showers Towel bath Bag bath

*First thing nursing assistant should do is check water temp and allow resident to check water temp* *Partial bath* - is the face, hands, underarms, back, buttocks, and perineal area are washed. - NOT feet Tub baths and Showers - Shower chairs are used for those to weak or unsteady to stand - Stay with residents when they shower and offer assistance as needed - No longer than 20 min Towel bath - big towel soaked in solution that doesn't need rinsing is put over body - water, cleaning, skin softening, and drying agents - often works well for dementia patients Bag bath - filled with washcloths soaked in soln that doesn't need rinsing - washcloths are warmed. New washcloth used for each body part. Air dry

Fracture - simple - open - closed - comminuted slide

*Fracture* - is a broken bone Simple fracture - the bone is broken in 1 place Open (compound) fracture - the broken bone has come through the skin Closed fracture - the bone is broken but the skin is intact Comminuted Fracture - the bone is broken in multiple places

GERD slides

*Gastro-Esophageal Reflux Disease (GERD)* - occurs when stomach contents flow back up into the esophagus. *Heartburn* (burning sensation in throat) is the most common symptom. Other symptoms - Pain in the chest or upper abdomen - Hoarseness or sore throat - Dysphagia - Dry cough - Bad breath - Nausea/vomiting > esophagitis ------------ book risk = overweight, alcohol use, pregnancy, smoking, hiatal hernia (upper part of stomach above diaphragm) - large meals, lying down while eating can also cause - chocolate, caffeine drinks, fried/fatty foods, garlic, onions, spicy foods, and tomato sauce ^ avoid these, wear loose clothing, and sit upright for 3 hrs after meals Drugs or surgery might be needed

Care of older person - Gerontology - Geriatrics - Retirement

*Gerontology* - study of the aging process *Geriatrics* - care of aging people Aging, and its changes, is normal. Risk for injury, death, and disabilities increase ------------- Retirement - Allows person to relax - Means reduced income, despite continued expenses - May have to limit living (food, social, housing, healthcare, etc)

Glaucoma

*Glaucoma* - fluid builds up in the eye causing pressure on the optic nerve. - Peripheral vision Is lost. Can occur in one or both eyes. Onset is sudden or gradual. - The person sees through a tunnel and sees halos around lights. Severe pain nausea and vomiting occur with sudden onset. --------- book Risk factors - leading cause of vision loss - Black people ovr 40+ years - Everyone 60+, especially mexican americans - family history Treatment - no cure, damage can't be reveresed - surgery/drugs can control glaucoma + prevent further damage to optic nerve

Reducing odors slide

*Good nursing care, ventilation, and housekeeping prevent odors* To reduce odors: 1) Empty, clean, and disinfect bedpans, urinals, bedside commodes promptly 2) Make sure toilets are flushed 3) Check incontinent residents/patients often, at least every 2 hours 4) Clean persons who are wet or soiled from urine/feces, vomitus, or wound drainage 5) Change wet or soiled linens and clothing promptly 6) Keep trash containers closed and empty as necessary 7) Dispose of incontinence and ostomy products in dirty utility room promptly 8) Provide good hygiene to prevent body and breath odor

Preventing equipment accident: - Electrical - Bariatric

*Ground* carries leaking current to earth away from item. Prevents shock - bottom prong in 3 part electric plugs - should always use 3 prong plugs - Plug bed directly into wall - only plug one item into an extension cord - Do not use damaged items. Give damaged items to nurse for discard or repair. faulty appliance Warning signs: 1) Shocks 2) Loss of power/pwoer surge 3) Dimming/flickering lights 4) Sparks 5) Sizzling/buzzing sounds 6) Burning odor 7) Loose plugs ----------------- Bariatric - Mind weight limits - Equipment labeled with EC (Extended capacity), weight limit

Growth and development - Definitions - Timeline

*Growth* - Physical changes that are measured, which occur in a stead and orderly manner *Development* - Changes in mental, emotional, and social functions These overlap, occur simultaneously, and depend on each other *Primary caregiver* - PErson mainly responsible for providing/assisting with child's basic needs --------------------- 1) Infancy (birth - 1 yr) a) Newborn (birth- 1 mo) 2) Toddlerhood (1-3) 3) Preschool (3-6) 4) School age (6- 9~) 5) Late childhood (10 - 12) 6) Adolescence (12-18) 7) Young adulthood (18-40) 8) Middle adulthood (40-65) 9) Late adulthood (65+)

Common aseptic practices - when to wash hands

*Hand hygiene is easiest and most important way to prevent spread of microbes and infection* Wash your hands: 0) When entering and leaving room 1) Before and after direct patient/resident care and contact 2) Before and after all procedures 3) AFter removing gloves (slides ^)

Preventing equipment accidents: - Chemicals >Hazard examples

*Hazardous chemical* - any chemical that is a health/physical hazard - Physical hazards can cause fire/explosions Hazards: 1) Latex gloves 2) Thermometers and BP equipment containing mercury 3) Cleaners and disinfectants ----------------- Hazard communication standard (HCS) is a policy of Occupational Safety and HEalth Administration (OSHA) > Requires container labeling, safety data sheets (SDSs), and employee training (pg 171 for pic)

Healthcare-Associated Infections - common sites - Prevention

*Healthcare-Associated infection (HAI)* (aka nosocomial infection) - Infection that develops in person cared for any setting where healthcare is given. Related to receiving healthcare - Caused by both normal flora or microbes Poor hygiene spreads. - on care equipemnt - Staff can transmit microbes from person to person Common HAI sites 1) Urinary 2) Respiratory 3) Wounds 4) Bloodstream ------------------- Prevention 1) MEdical asepsis (hand hygiene, etc) 2) Surgical asepsis 3) Standard precautions 4) Transmission based precautions 5) Bloodborne pathogen standard

Hearing loss - risk factors slides

*Hearing loss* - is common in the elderly and more so in men - Can be caused by damage to the outer, middle, inner ear, or to the acoustic nerve. *Risk factors include:* - Aging and heredity - Exposure to loud noises, music, engines, firearms, etc. - Medication - antibiotics, too much aspirin - Infections - Reduced blood flow to the ear from high blood pressure, heart and vascular diseases, diabetes - Stroke - Head injuries - Tumors - Birth defects Excessive buildup of earwax (cerumen) can cause decrease in hearing

Hearing loss and deafness slides

*Hearing loss* - not being able to hear the normal range of sounds associated with normal hearing. deafness is the most severe form. *Deafness* - hearing loss in which it is impossible for the person to understand speech through hearing alone. - use terms deaf or hard of hearing

Heart failure/congestive heart failure (CHF) - left vs right - causes - goal of treatment slides

*Heart Failure or Congestive Heart Failure (CHF)* - occurs when the weakened heart cannot pump normally. - Blood backs up and tissue congestion occurs ------------- book Left side = Blood backs up into lungs (pulmonary edema) right side = congestion in venous system (vena cava - body) Caused by damaged or weak heart. - CAD, MI, hypertension, diabetes, age, irregular heart rhythms. Damaged valves + kidney disease also cause Goals of treatment - treat cause of failure - reduce symptoms - prevent worsening heart failure - improve quality of life - prolong life > sodium controlled diet > drugs strengthen heart, decrease strain on heart, reduce fluid build up > O2 given > semi fowlers preferred > reduce CAD risk factors

Hemorrhage slides

*Hemorrhage* - is the excessive loss of blood in a short time. - can be internal or external. How to assess for internal bleeding? What do you report? - coughing up/vomiting blood, pain, shock, cold/moist skin, loss of consciousness - keep person warm, flat, and quiet until help arrives. do not give fluids What to do for external bleeding? What do you report? - Artery bleeding spurts, veinous has steady flow - do not remove objects that have pierced/stabbed person - Place sterile dressing directly over wound, apply pressure. Do not release until bleeding stops - do not remove dressing, apply more layers as needed - bind wound when bleeding stops.

Bedrest: positioning - hip abduction wedge - hand roll/grip - splints - bed cradle slides

*Hip abduction wedge* -keeps the hips abducted (apart). Placed between legs - Often used after hip replacement surgery to support the new ball and socket joint. *Hand roll or hand grip* - prevents contractures of the thumb, fingers, and wrist - Foam rubber sponges, rubber balls, and finger cushions also used *Splints* - keep elbows, wrists, thumbs, fingers, ankles, or knees in normal position *Bed cradle* - to keep weight of top linens off the feet and toes. Basically makes a tent. - The weight of top linens can cause foot drop and pressure ulcers.

Fluid balance - hydration - input - output - normal requirements

*Hydration* - having an adequate amount of water in body tissue - dehydration = too little intake, too much output *Intake (input)* - is the amount of fluid taken in. All oral fluids are measured and recorded. Any food that melts at room temperature is considered liquid. *Output* - is the amount of fluid lost - all fluids coming out example: urine, emesis, wound drainage amounts Normal Fluid Requirements - normal adults need 2000 to 2500 ml of water every day.

Normal and abnormal BP - hypertension - hypotension - orthostatic hypertension slides

*Hypertension* - hyper (high/above) tension (blood pressure) - systolic pressure = 140+ mmHg - diastolic pressure = 90+ mmHg *Hypotension* -hypo (below) tension (blood pressure) - systolic pressure = less than 90 mmHg - diastolic pressure = less than 60 mmHg. *Orthostatic hypotension* - when the blood pressure drops when the person stands up - *blood pressure is taken lying, then sitting, then standing to assess for change*

IV therapy - who manages - CNA must watch tubing when

*IV therapy* - intravenous is giving fluids, medications through a needle or a catheter inserted into a vein. - doctor orders it to provide fluids when NPO > replace minerals/vitamins lost > provide sugar > give drugs and blood *Nurses manage IV intake, and IV site/fluids !!!* Nursing assistants must watch the site and tubing when: • Dressing residents/patients • Bathing residents/patients • When moving resident/patient > Move IV bag to side of bed on which person is lying (allows for slack) -------------------------- CNAs never: - start/maintain IV therapy - regulate flow rate or change IV bags - give blood or IV drugs

Infection Infection control Antisepsis

*Infection* - is a disease state resulting from the invasion and growth of pathogens in the body. - Major safety/health hazard - Infants, older, and disabled persons at risk *Infection control* - certain practices/procedures followed by health team to prevent spread of infection *Antisepsis* - Processes, procedures, and chemical treatments that kill microbes/prevent them from causing infection

Influenza Pneumonia Slides

*Influenza (flu)* - is a respiratory infection caused by viruses. - Treatment is fluid and rest book > season = october-march > children and older persons at risk > most people recover in a weak. Spread through coughing and sneezing + contaminated surface contact with mucous membranes. Standard precautions > Has fever, headache, severe aches/pains, extreme exhaustion, bronchitis, pneumonia (unlike cold) > cold has stuffy nose, sore throat, and sneezing more commonly than flu has vaccine (recommended for all persons 6 mo and older)

Sleep Disorders - insomnia - sleep depravation - sleepwalking slides

*Insomnia* - is a chronic condition in which the person cannot sleep or stay asleep all night - 3 forms > can't fall asleep > can't stay asleep > early awakening + can't sleep - Caused by emotional problems, fear of dying during sleep/not being able to sleep, physical/emotional discomfort *Sleep deprivation* - the amount and quality of sleep are decreased over a period of time *Sleepwalking* - is when the person leaves the bed and walks about - guide back to bed and awaken gently

Intellectual and Developmental Disabilities

*Intellectual disabilities* - relate to learning, thinking, reasoning and solving problems. *Developmental disabilities* - lifelong disabilities resulting from physical or intellectual impairments or a combination of both. *Mental retardation* - term is offensive and outdated. Intellectual disabilities is preferred. Disabilities present themselves before the age of 22 and impact daily functioning. - Brain development is impaired. - Intellectual disabilities can be mild to severe. ------------ book some involve birth defects (problems that develop during pregnancy, often first 3 months)

Internal vs external hemorrhage - signs and symptoms slides

*Internal Hemorrhage* - you cannot see internal hemorrhage ◦ Bleeding occurs inside the body into tissues and body cavities ◦ Shock, vomiting blood, coughing up blood, and loss of consciousness signal internal hemorrhage - *hematoma* may form *External Hemorrhage* - you can see external hemorrhage ◦ Common signs are bloody drainage and dressings soaked with blood ------------ Signs and symptoms include: ◦ Blood pressure low ◦ Pulse rapid and weak ◦ Respirations rapid ◦ Skin cold, moist, pale ◦ Restlessness ◦ Thirst ◦ Confusion ◦ Consciousness loss of alert nurse at once

Isolation precautions - communicable disease - tiers

*Isolation precautions* - Prevent spread of *communicable disease* from one person to another. > These are diseases caused by pathogens that spread easily > via blood, body fluids, secretions, and excretions Based on clean vs dirty - clean = nno pathogens - dirty = contaminated with pathogens. Contaminates other objections depending on pathogen spread Two tiers of precautions 1) Standard precautions 2) Transmission based precautions

CNA observations during tube feeding

*Keep clients head of bed elevated at least 45 degrees at all times while tube feeding is on* Watch for and tell the nurse immediately if the person has : • Nausea • Discomfort during the feeding • Vomiting • Distended (enlarged/swollen) abdomen • Coughing • Complaints of digestion/heartburn • Fever • Increased pulse rate/signs of respiratory distress • Complaints of flatulence/diarrhea

Equipment in physical exam *Laryngeal mirror* *Nasal speculum* *Ophthalmoscope* *Otoscope* *Percussion hammer* *Tuning fork* *Vaginal speculum* book

*Laryngeal mirror* - for examining mouth, teeth, and throat *Nasal speculum* - examine nose *Ophthalmoscope* - lighted instrument used to examine internal eye *Otoscope* - lighted instrument used to examine external ear and eardrum *Percussion hammer* - Used to tap body parts to test reflexes *Tuning fork* - Vibrated to test hearing *Vaginal speculum* - Used to open vagina to examine it and cervix

Communicating with the health team: Medical record

*Medical record (chart, clinical record)* - legal account of a person's condition and response to treatment and care - Written using paper forms or electronically (EHR - electronic health record is the computer charting) - *A permanent legal document* You have an ethical/legal duty to keep info confidential - *If you are not involved with person's care, you have no right to review their chart* *All documentation done in military time by 24 hr clock* - 3:00 pm > 1500 ("fifteen hundred hours) - 1:25 am > 0125 ("Zero three twenty five hundred hours") Write: 1) What you observed 2) What you did and if you reported something. To whom you reported 3) Person's response to your treatment

Mental illness slides

*Mental illness* - a condition that impacts a person's thinking, feeling or mood and may affect his/her ability to relate to others and function on a daily basis. Not the result of one event. Research suggests multiple, interlinking causes. - Genetics, environment, and lifestyle. A mental illness is a disease that causes mild to severe disturbances in thought and/or behavior, resulting in an inability to cope with life's ordinary demands and routines.

Microbes and pathogens - definitions of the above - microbe requirements

*Microbe* (microorganism) - is a small living thing. It is seen only with a microscope. Microbes that are harmful and can cause infections are called *pathogens*. - *Non-pathogens* are microbes that do not usually cause an infection. -------------- Microbes require a *reservoir* (host). - This is the environment in which the microbe lives and grows. - Provides water, nourishment, a warm/dark environment, and O2 (if needed). > Body temp good for most. Destroyed by heat/light > Soil, food, water, living things are common reservoirs ------------ Older persons may not show signs of infection, even if it's serious, due to reduced immune system function

Work related injuries

*Musculo-Skeletal Disorders (MSDs)* - are injuries and disorders of the muscles, tendons, ligaments, joints and cartilage. They can be caused or made worse by the work setting. - can involve nervous system - often involves arms, back, hands, fingers, neck, wrists, legs, and shoulders - Early signs and symptoms include pain, limited joint movement, soft tissue swelling *OSHA* (the Occupational Health and Safety Administration) has identified MSD risk factors for the nursing team. An MSD is more likely if risk factors are combined.

Restraints - what are they - enablers vs restraints

*Must try all appropriate and less restrictive alternatives before using restraint* - generally involve meeting needs for comfort, diversions, etc - Restraints increase risk of falls Only used for *medical symptoms* (indications/characteristics of physical or psychological conditions) Restraints can be anything that impairs a person from moving freely - physical: gait belt, rails; chemicals, etc - chemical restraints are drugs/dosages that a) control behavior/restrict movement, and b) are not standard treatment for person's condition *Enablers* - device that limits freedom of movement but is used to promote independence, comfort, or safety - things that are restraints can also be enablers, depending on circumstances (ex. bed rails asked for and used to help with movement)

Myocardial infarction (MI) -cause - risk - rehab slides

*Myocardial Infarction* - Myocardial refers to the heart muscle. Infarction means tissue death. During myocardial infarction (MI) part of the heart muscle dies. It is caused by a sudden blockage of blood flow in the coronary arteries - a thrombus in an artery or plaque causing blockage The damage area may be small or large. --------- book Risk: CAD, angina, and previous MI Rehab needed - recover and resume normal activities - prevent another MI - prevent complications such as heart failure or sudden cardiac arrest

Patient needs (maslow)

*Need* = something necessary or desired for maintaining life and mental wellbeing Maslow's hierarchy of needs that lower needs must be met before higher lvl needs can be addressed (bottom to top) 1) Basic/physiological - needs necessary for maintaining life and mental well being (ex. food, water, shelter, sleep) - Without these, we can't function 2) Safety and security - To people, hospitals cause danger and fear - For each task, person should know > Why it is needed > Who will do it > How it will be done > What sensations/feelings to expect 3) Love and belonging 4) Self esteem - *Esteem* = worth, value, or opinion one has of a person - *Self esteem* refers to oneself and seeing that one has value 5) Self actualization - experiencing one's potential. Understanding, learning, and creating to extent of person's ability

Normal Flora and MDROs - MDRO causes

*Normal flora* - Microbes that live and grow in a certain area - Non pathogens when in/on a natural reservoir. BEcomes a pathogen when transferred from natural site (ex. Escherichia coli moving from colon to urinary system) *Multidrug-resistant organism* - Microbes that can resist *antibiotics* (drugs that kill certain pathogens) - Caused by: > prescribing antibiotics when not necessary (over prescribing) > Not taking antibiotics for length of time prescribed

Nutrition and nutrients - healthy plate

*Nutrition* - is the processes involved in the ingestion, digesting, absorption, and use of food and fluids by the body. *Nutrients* - are grouped into fats, proteins, carbohydrates, vitamins, minerals and water > *calorie* = fuel/energy value of food > 1 g fat (9 cal), 1 g protein (4), 1 g carb (4)

Oral hygiene (mouth care) - what it does -flossing

*Oral hygiene* - Keeps the mouth and teeth clean - Prevents mouth odors and infections - Increases comfort - Makes food taste better - Reduces the risk for cavities and periodontal disease (gum inflammation) > *Plaque* is a thin film (microbes, saliva, others) that builds up at gumline and causes tooth decay. > Hardened plaque = *tartar* Flossing - removes hidden plaque - removes food from between teeth - once a day

Other walking aids: Orthotic devices - braces - ankle-foot orthosis (AFO)

*Orthotic Devices* - used to support a muscle, promote a certain motion, or correct a deformity. Paralysis and muscle weakness are common reasons for orthotic devices. *Braces* - support weak body parts. They also prevent or correct deformities or prevent joint movement. Ankle-foot orthosis (AFO) is worn with a shoe. - brace that is common after a stroke - remove according to are plan. nurse assesses skin every shift Make sure skin/bony points under orthotic devices are clean and dry to prevent skin breakdown - report redness/signs of skin breakdown at once - also report pain or discomfort

Ostomy - STOMA - colostomy ileostomy slides

*Ostomy* - a surgically created opening that connects an internal organ to the body's surface. The surgically created opening seen on the body's surface is called a *STOMA.* *Colostomy : - is a surgically created opening between the colon and the body's surface.* - the more colon remaining to absorb water, the more solid/formed the stool is. *Ileostomy*: - is a surgically created opening between the ileum (small intestine) and the body's surface. - Entire colon removed - cocnstant liquid drain (bc no colon = no water absorption) An established ostomy should appear moist and pink. Liquid stool and flatus will be evacuated from the stoma.

POLST Livingwill Durable power of attorney for healthcare slides

*POLST (physician orders for life sustaining treatment)* - an approach to improving end-of-life care in the United States, encouraging doctors to speak with patients and create specific medical orders to be honored by healthcare workers during a medical crisis. *Living Will* - form of advance directive - a written statement detailing a person's desires regarding their medical treatment in circumstances in which they are no longer able to express informed consent, especially an advance directive. - ex. not to start measures that prolong dying, to remove measures that prolong dying *Durable Power of Attorney for Health Care* - form of advance directive - gives power to another person to make health care decisions. This must be a power of attorney for healthcare. - not related to property/financial matters *DNR* - DO NOT RESUSCITATE, NO CPR the person is allowed to die with peace and dignity

Anxiety disorders - panic disorder > panic definition > S&S slides

*Panic* is an intense and sudden feeling of fear, anxiety, terror, and dread. Onset is sudden with no obvious reason. The person cannot function. Signs and symptoms of panic: - Chest pain - Shortness of breath - Numbness and tingling in the hands - Dizziness - A smothering feeling - Feeling of impending doom or loss of control ------- book occur any time, last 10+ minutes

PAranoia (AD) - causes - behaviors slides

*Paranoia* - is a disorder of the mind. The person has false beliefs (delusions) and suspicions about people or situations. Common causes: - pain, infection, discomfort, anxiety, lack of sleep, too much stimuli, - hunger, the need to eliminate or incontinence, confusion, - Caregiver stress,nfeeling rushed to do something, feeling lost Behaviors include Aggression and Combativeness Hitting, pinching, grabbing, biting, swearing, scratching running into others with their wheelchair

Purpose of healthcare

*Person is the center of care* - holistic approach (treat both mind and body) *Goal of all healthcare systems is to meet healthcare needs of both the person and their family* ------------------ *1) Health promotion* - Reduce risk of physical/mental illness - Learn healthy living via diet, exercise, and lifestyle + how to ID warning signs/symptoms of illness (ex. self breast exam) *2) Disease prevention* - Measures taken to reduce risk factors > prevent disease *3) Detect + treat disease* - Diagnostic tests, physical exams, surgery, emergency care and medications used to treat disease - Also includes therapies such as respiratory, physical, speech, and occupational *4) Rehabilitation and restorative care* - Restoring person to higher possible lvl of physical and mental function and independence. Maintenance of function key.

Personality disorders Boderline personality disorder (BPD slides Antisocial personality disorder book

*Personality disorders* - involve rigid and maladaptive behaviors. *Borderline personality disorder (BPD)* - involves unstable moods, behaviors, and relationships. -------- book Antisocial - long-term pattern of thinking/behaving that violates rights and safety of others. No guilt. Takes advantage of others for personal gain/pleasure

AD - pillaging - hoarding - sleep disturbances - reality orientation - validating slides

*Pillaging* - taking things that belong to someone else - simply return found items to their owner *Hoarding* - collecting and putting things away in a guarded way *Sleep disturbances* very common with AD *Reality orientation* - involves use of calendars, clocks, signs and pictures *Validating* - means giving value or approval can provide comfort - Explore the resident's beliefs, NEVER argue with them or correct them, it will increase agitation REORIENT - TO TIME, PLACE AND PERSON DO NOT TAKE THINGS PERSONALLY !!!!!!!! • Alzheimer's disease is a devastating mental and physical disorder • May not recognize caregiver or family • May be agitated one minute and fine the next • May curse and call names

Pneumonia slides

*Pneumonia* - means inflammation and infection of lung tissue - Bacteria, viruses and other microbes are causes - complication of flu ------------- book children under 2 and adults 65+ at risk Smoking, age, stroke, bedrest, immobility, chronic diseases, and tube feedings increase risk Fluid intake increased bc of fever and to thin secretions - IV therapy, oxygen. Semi fowler's position + rest. - transmission adn standard precautions followed. Mouth care and frequent linen changes important

Postmortem care slides

*Post mortem care* - is care of the body after death (done to maintain good apearance). - Within 2 to 4 hours after death rigor mortis develops *Rigor Mortis* - is the stiffness or rigidity of skeletal muscles that occurs after death - position body supine, arms and legs straight. pillow under head. close eyes and mouth An autopsy, which is the examination of the body to determine cause of death may be ordered. - Check with the nurse prior to removing any lines or tubes. - Usually a bath is given. Soiled areas are bathed and the body is placed in good alignment. Application of a shroud

*Psychological Problems* - remind them slides

*Psychological Problems* - A condition affecting thought, mood and behavior which can threaten health and well-being of residents. Changes in the brain and nervous system occur with aging and certain disease processes and medications. - Cognitive function may be affected. People can become frightened and resist care, they may become suspicious, it is important to remind them: - who they are - where they are - the current date and time

Pulse rate - tachycardia vs bradycardia - rate, rhythm, quality slides

*Pulse Rate* - the number of heartbeats or pulses in 1 minute. The adult (12+) pulse rate is between *60-100 beat per minute.* *Tachycardia* - is a rapid heart rate is more than 100 beats per minute. *Bradycardia* - is a slow heart rate less than 60 beats per minute.

Pulse oximetry slides

*Pulse oximetry* measures the o2 concentration in arterial blood. *Oxygen concentration* is the amount (%) of hemoglobin containing O2. You may hear it called any of these: • Pulse oximetry or pulse ox • O2 saturation or O2 sat • SpO2 (saturation of peripheral oxygen) Measurements are used to prevent and treat hypoxia. - *normal range is 95% to 100%*. For example: if 97% of all hemoglobin (100%) carries O2, tissues get enough oxygen. if only 90% carries O2, tissues do not get enough oxygen. - 85% can be normal for some chronic diseases

Communicating with the health team: Reporting and recording

*Reporting* = oral account of care and observations *Recording* (charting, documentation) is written account of care/observations Agency policies address 1) Who records 2) When to record 3) Ink color to use (paper) - usually only black 4) Abbreviations that can be used 5) How to make/sign entries 6) How to correct errors, never use more than one line to cross out an entry (previous entry needs to be visible) ----------------- Anyone who reads your charting should know: - what you observed - what you did - the person's response (see rules on pg 75)

Respirations slides

*Respirations* - means breathing air into (inhalation) and out of (exhalation) the lungs. O2 enters the lungs during inhalation and CO2 leaves the lungs during exhalation. Count respirations right after taking the pulse. - Keep fingers on pulse site (So person thinks you're taking pulse). Don't tell person (as it affects breathing patterns) - when the person is at rest. To count respirations watch the chest rise and fall, that is ONE respiration. The state test requires that you count respirations *for a full minute.*

Rest - basic needs that need to be met slides

*Rest* - means to be calm, at ease and relaxed with no anxiety or stress. 15-20 min can refresh some people *Physical needs* - thirst, hunger, elimination and pain *Safety and security needs* - person feel safe from falling, or other injuries, maintaining their routines/rituals - Always explain procedures. Follow routines when possible *Love and belonging* - visits or calls from family/friends may relax the person *Self-esteem needs* - many people sleep better in their own sleepwear, and do not want to be exposed

Restorative nursing care Restorative aides slides

*Restorative nursing care* - care that helps persons regain health, strength, and independence. Prevents unnecessary decline in function > helps maintain highest lvl of function > prevents unnecessary decline in function - Measures promote: >Self care > Elimination > positioning > mobility > communication > cognitive function be hopeful, do not give pity. praise for even small improvements --------------- *Restorative aide* - a CNA with special training in restorative nursing and rehabilitation skills Rehabilitation aides learn how to work with individuals with prosthesis (an artificial replacement for a missing body part)

Application of lotions and creams - what to verify slide

*Right person, right cream, right area/surface, right time* Do not apply to open wounds - notify the nurse - Check expiration date before use - Do not allow products to come into contact with eyes or other mucous membranes - Use exactly as stated on label

Sedation and anesthesia - general vs regional vs local slides

*Sedation* - is a state of quiet, calmness, or sleep produced by a drug (lvls: minimal, moderate (conscious), deep) *Anesthesia* - is the loss of all sensation, especially pain *General anesthesia* - is a treatment with certain drugs that produces a deep sleep and the absence of all sensation, especially pain - IV or gas *Regional anesthesia* - is the loss of sensation, produced by a drug, in a large area, such as an arm - injected *Local anesthesia* - causes the loss of sensation produced by a drug in a small area - injected

Seizures slides

*Seizures - (convulsions)* - are violent and sudden contractions or tremors of muscle groups caused by abnormal electrical activity in the brain. Movements are uncontrolled, the person may lose consciousness. - Lack of blood flow to the brain can also cause seizures. Make sure person is breathing and can breath on their own - *If not* maintain their airway, place them in the lateral recovery position, *Remain calm,* Protect the person from injury ------------- Epilepsy - recurring seizures due to problem affecting brain. Develops more in older adultsa dn children, but any age is possible No cure. Drugs control for some but not others. Controlled doesn't usually affect learning

Shock - anaphylactic > S&S slides

*Shock* = tissues and organs not getting enough blood - rapid/weak pulse and respirations, cold/moist skin, thirst, nausea vomiting, restlessness, confusion and loss of consciousness, falling BP - if no injuries, raise legs 12 inches, maintain open airway, control bleeding book ----------------- slide *Anaphylactic Shock - (anaphylaxis)* - is a life-threatening sensitivity to an antigen. Medication, food, environmental factors, can be antigens *Signs and symptoms:* - itchy rash, hives, swelling of the tongue or throat, flushed or pale skin, feeling warm, dyspnea, fast/weak pulse, dizziness/fainting Anaphylactic shock is an emergency - needs drug treatment and EMS activation - keep eprson lying down and airway open. Epinephrine (1 dose) injected into outer thigh > person may give themself 2nd dose if 1st dose has no response or EMS arrival will take more than 5-10 min.

Signs of imminent death Signs of death slides

*Signs of imminent death* - Anxiety, Restlessness and agitation - Drowsiness and / or confusion - Constipation or incontinence - Nausea and loss of appetite - edema - Peristalsis and other GI functions slow down - Body temperature rises, but skins feel cool and possibly moist - Circulation fails - Slow or rapid, shallow respirations; Shortness of breath; pauses in breathing - Pain decreases as the person loses consciousness - Coma The signs of death include: no pulse, no respirations, and no blood pressure. - doctor pronounces person dead

sleep slides

*Sleep* - is a state of unconsciousness, reduced voluntary muscle activity, and lowered metabolism. Sleep is a basic physical need - Mind and body rest - Body saves energy - Tissue healing and repair occur - Regaining energy and mental alertness - Thinking and functioning is better after sleep

Sphygmomanometer - aneroid type - mercury type - electronic type - wrist monitor

*Sphygmomanometer* - has a cuff and a measuring device for measuring blood pressure. - Sphygmo means pulse. A device for measuring pressure is called a manometer. BP cuff placed over brachial artery -------------------- book 1) Aneroid type - round dial and needle 2) Mercury type - Column of mercury in tube ^ for these two - Tube connects cuff to a bulb. Turn valve clockwise to close valve and squeeze bulb to inflate. Turn valve counter-clockwise to release. - Blood flowing through arteries makes sounds. Listen with stethoscope ----- 3) Electronic type - shows systolic/diastolic pressures + pulse rate - Doesn't need a stethoscope. PRess button to inflate cuff, deflates automatically. 4) Wrist monitor - measures BP at wrist. USed for bariatric persons, very sensitive to body position

Stool info - normal - abnormal slides

*Stools provide information about a persons health* - Stools are normally brown, soft, formed, and moist - The have normal odor caused by bacteria in the intestines - *Bleeding in the stomach or small intestine causes black or tarry stools* > Bleeding in lower colon/rectum can cause red stool. Also foods with red coloring > Foods can alter color. Diseases too - *Diarrhea can be indicative of a number of medical problems* - Constipation or very hard stools may indicate a partial bowel obstruction

Substance abuse disorder alcoholism - involves (4) slides

*Substance Abuse Disorder* - is when a person needs alcohol or a drug (illegal or legal) to function normally. Physical and mental health are affected, so is the welfare of others. *Alcoholism* is alcohol dependence that involves: 1) Craving - a strong need or urge to drink 2) Loss of control - cannot stop drinking once started 3) Physical dependence - withdrawal symptoms (nausea, sweating, shakiness, anxiety) when drinking is stopped 4) Tolerance - greater amounts of alcohol are needed to feel the same effect Alcoholism is a chronic disease. - can be treated but not cured. The person must avoid all alcohol to prevent a relapse. Alcohol abuse = drinking leads to problems but person isn't dependent

Preventing suffocation - suffocation definition - Choking definition - common causes - mild vs severe airway restriction

*Suffocation* = when breathing stops from lack of oxygen Common causes = choking (meat), drowning, inhaling gas/smoke, strangulation, electric shock CNA Prevention: - *Choking* = airway is blocked and air cannot get into lungs/body > often occurs during eating (often large piece of meat) - Mild airway obstruction = some air passing. Person is conscious and can usually speak. Wheezing breaths > Coughing can help. > *stay with person < Encourage person to keep coughing > Do not interrupt person's efforts to clear airway. If they are breathing, heimlech is not needed* - SEvere airway obstruction has difficulty breathing. No air movement in/out of lungs. Person blue/pale in color, no sound when breathing. Clutching at throat (universal choking sign) > stay with person > abdominal thrusts > encourage coughing > call for help

Suicide - warnign signs slides

*Suicide* - means to kill oneself on purpose. Risk factors include: - depression, substance abuse, prior suicide attempt, family history of mental health disorder, substance abuse, suicide. - Family violence in the home, exposure to suicidal behaviors. Suicide most often occurs when stressors exceed current coping ability. Depression is the most common condition associated with suicide. - Conditions like depression, anxiety and substance abuse problems, especially when unaddressed, increase the risk for suicide. *Suicide Warning Signs* - Something to look out for when concerned that a person may be suicidal is a change in behavior or the presence of entirely new behaviors. - This is of sharpest concern if the new or changed behavior is related to a painful event, loss, or change. Most people who take their lives exhibit one or more warning signs, either through what they say or what they do. ---------------- *If a person mentions or talks about suicide, take them seriously. Call nurse at once. DO NOT leave person alone* - don't promise not to tell Suicide contagion - exposure to suicide/suicidal behaviors within one's family, peer group, or media reports - leads to suicides

Suppositories slides

*Suppository* - cone-shaped, solid drug inserted into body opening. Melts at body temp - BM occurs ~ 30 min later - inserted alone rectal wall, NOT into feces *Doctor* may order it for - constipation - fecal impaction - bowel training

Terminal illness palliative care hospice care slides

*Terminal Illness* - an illness or injury from which the person will not likely recover. Doctors cannot predict the time of death. Hope and the will to live strongly influence living and dying. - Terminally ill persons may choose palliative care or hospice care. They may start with palliative care then change to hospice care. *Palliative care* - involves relieving or reducing the intensity of uncomfortable symptoms without producing a cure. Focus is on relieving symptoms to improve quality of life that is left. *Hospice Care* - focuses on the physical, emotional, social, and spiritual needs of the dying person and their family

Male Reproductive system

*Testosterone* - Produced in testes - Hormone needed for reproductive function + development of secondary sex characteristics > Pubic/axillary (armpit)/other hair > Increased neck/shoulder size Testes inside scrotum v epidydimis v vas defrens v seminal vesicles (Store/produce semen) v ejaculatory duct (prostate gland around this) v urethra v penis v glans penis Erectile tissue fils with blood when arousal occurs. Cowper's glands under prostate produce fluid before ejaculation (clans urethra, protects sperm, provides lubrication)

The person's rights: OBRA - representative - ombudsman

*The omnibus budget reconciliation act of 1987 (OBRA)* - Federal law that requires nursing centers to provide care in a manner/setting that increases quality of life, health, and safety (in all 50 states) - CNA training/competency are under OBRA, and *patient rights* are a big part of it - Nursing centers must promote and protect such rights - A *representative* is a person who has legal right to act on a resident's behalf when they are unable to *OMBUDSMAN* - someone who supports or promotes needs/interests of another person - they will follow up on complaints and inquiries of any issue regarding a resident in a nursing facility. Patient advocate.

Thrombus, emoblus, and prevention slides

*Thrombus* (stationary) can break loose and travel through bloodstream. Becomes an *embolus* (moves through system and lodges elsewhere) Older persons at risk ------------ Circulation is stimulated and thrombi prevented by: 1) Leg exercises - docto orders. nurse tells you when to do (at least every 1-2 hrs, 5 times) - make circles with toes (ankle rotation) - Dorsiflex and plantar flex feet - Flex and extend 1 knee, then the other - Raise/lower leg off bed 2) Ambulation as soon as possible - person dangles and BP/pulse are measured. If stable, they can walk 3) TED hose/elastic stockings, elastic bandages - Exert pressure on veins, promoting venous blood return to heart. TED - thrombo-embolic disease. Have opening near toes to check circulation - at risk: > have heart/circulatory disorders - are on bedrest - are older - are pregnant - stocking can't be too loose, too tight, have wrinkles, etc > apply before person gets out of bed. Person lies in bed when stockings are off, otherwise legs can swell - For bandages, apply from distal to proximal. Expose fingers/toes if possible + check color/circulation every hr. Replace moist bandges. Apply w/ firm, even pressure > to reduce swelling 4) Sequential compression devices - often worn with elastic stockings - pump inflates device with air. As 1 leg side deflates, other inflates 5) No prolonged standing or sitting

Urinary elimination: - anatomy - urination

*URINATION (micturition and voiding)* -means the process of emptying urine from the bladder. - urine consists of excess fluid and waste filtered through the kidneys. Elimination of waste is a physical need The Urinary System removes waste products from the blood. - urine flows through the 2 ureters to the bladder where it is stored. - The opening at the end of the urethra is called the MEATUS (both male/female)

Venous ulcers slides

*Venous Ulcers (stasis ulcers)* - are open sores on the lower legs or feet caused by poor venous blood flow. > Stasis means stopped or slowed fluid flow. Venous ulcers can develop when valves in the leg veins do not close well. - The veins do not pump blood back to the heart in a normal way. Blood and fluid collect in the legs and feet and small skin veins rupture. - Venous ulcers are painful and walking is difficult. - Fluid may seep from the wound. - Infection is a risk. - Healing is slow. Hemoglobin seeps into skin, turning it brown - Skin is dry, leathery, hard, and itchy - common in heels and ankles

Physical comfort: dying - vision, hearing, and speech - mouth, nose, and skin slides

*Vision, hearing and speech* - in the event of failing vision, make sure you explain/identify yourself and why you are there. > Hearing is one of the last functions lost. Watch your tone/volume of voice. > Speech becomes difficult, it may be hard to understand the person, do not ask questions with long answers, only Y/N *Mouth, nose, and skin* - oral hygiene promotes comfort. Provide oral care at least every 2 hours. - Carefully clean nose. Circulation fails, and body temperature rises even though the skins feel cold and sweaty, good skin care is very important. Skin may feel cool, and look pale and mottled. (blotchy)

Ambulation: Walkers - deconditioning slides

*Walkers* - gives more support than a cane. Wheeled walkers have wheel on the front legs and rubber tips on the back legs. - Rubber tips on back prevent the walker from moving while the person is standing. - walker pushed in front Never push walker when person is seated ----------------- Regular walking helps prevent deconditioning. *Deconditioning* - a complex process of physiological change following a period of inactivity, bedrest or sedentary lifestyle. - It results in functional losses in such areas as mental status, degree of continence and ability to accomplish activities of daily living

Positioning the person

*When you enter a room, always* introduce self, check resident's ID, and explain what you are doing there* Good alignment provides comfort, well-being, and safety - maintains airway - avoids pressure/constriction of chest cavity - prevents pressure ulcers and contractures - improves circulation - prevents nerve damage

Good work ethics

*Work ethics* = relates to behavior in the workplace - Productivity - Respect - Attitude - Good Attendance - Team Work - Cooperation - Organizational Skills - Communication Skills - Appearance - Character

Communicating with patients

*You communicate w/ your patients ever time you give care or enter their room* 1) Use words that have the same meaning for you and the other person 2) Avoid medical terms/words that are not familiar to the other person 3) Give facts - be specific, Be brief and concise, keep it short 4) Understand and respect the person 5) View the person as a physical, psychological, social, and spiritual human being (holistically) 6) Respect the person's rights, religion, and culture 7) Give the person time to understand the information that you give 8) Repeat information as needed *Ask questions to make sure person understands*

Pulse - arteries - pulse points slides

*arteries* carry blood from the heart to all parts of the body. PULSE - beat of the heart felt at an artery site as a wave of blood passes through the artery. ----------------- Pulse points (close to body surface and over a bone = easier to find): - Temporal - carotid (CPR) - brachial (above elbow) - radial (wrist - commonly used) - femoral (near groin) - popliteal (behind knee) > for thigh BP, put cuff near pelvis. measure here - posterior tibial (near Achilles tendon) - dorsalis pedis (top of foot) > Used to check circulation of foot > Doppler ultrasound stethoscope used when pulse cannot be felt - apical (over heart, stethoscope) > used for children under 2 - listen for a full minute

Positioning: oxygen needs slides

*orthopneic position* - can ease breathing. - a seated position with the arms supported on pillows and the client leaning forward over a bedside table (falling asleep at desk) This position allows room for maximum vertical and lateral chest expansion and can provide comfort while resting or sleeping ---- breathing also usually easier in semi-fowlers aand fowlers, but orthopenic preferred must not lie on one side for a long time. secretions pool and lungs can't expand - change positions at least every 2 hrs

Suctioning book

*suction* = process of withdrawing or sucking up fluid secretions - tube connects suction source at 1 end and to a suction catheter at the other end. - catheter inserted into airway, secretions suctioned through catheter - done as needed - semi fowlers or lateral w/ head turned to one side - check pulse, respirations and pulse oximetry before,, after, and during procedure. lvl of consciousness too 661 for instructions Upper (nose, mouth, pharynx) and lower (trachea, and bronchi) airways are suctioned

Safely transferring a person - transfer -safety measures - stand and pivot transfers slide

*transfer* - how a person moves to and from surfaces bed, chair, wheelchair, toilet, or standing position. Safety measures include - Good body mechanics and alignment - Pivot movement, and using slide boards as needed - Always move the strong side first. Stand and Pivot Transfers Some people are only able to stand and pivot. *PIVOT* - means to turn ones body from a set standing position

Denture care:

- Dentures are generally removed at bedtime - slippery when wet, easily chip if dropped > NEVER carry in hands. Use a denture cup or kidney basin > Gauze squares can help with grip when removing - During cleaning, firmly hold them over the sink, with a washcloth in the bottom. Brush like normal + surfaces that touch gums - After cleaning they should be placed in a denture cup with cool water. > prevents warping if 2 halves, keep other half in cup while cleaning the other

Respiratory

- Provides body with oxygen and removes waste (CO2) - Gas exchange occurs at alveoli - Air ~ 21% O2. Sufficient under normal circumstances *Respiration* - PRocess of supplying cells w/ O2 and remove CO2 - inspiration and expiration Nose > pharynx > epiglottis (cartilage) > larynx > Trachea > bronchus > bronchioles > alveoli alveoli = site of exchange right lung has 3 lobes, left has 2 Pleura (2 layered sack) surrounds lungs - secretes fluid between layers, preventing friction

Healthcare providers and reporting abuse

- abuse = willful infliction of injury, unreasonable confinement, intimidation (threaten to hurt/punish) or punishment that results in physical or mental pain > depriving person of goods/services required for mental wellbeing *we are mandatory reporters of abuse* If you see abuse you must report! Federal and state laws require the reporting of Elder Abuse and Child Abuse or Neglect. *Vulnerable adults* are persons 18+ who have disabilities or conditions that make them at risk to be wounded, attacked, or damage - have trouble caring for themselves for various reasons including aging, brain damage, - all patients are vulnerable, regardless of age

Care of person with hip fracture book

- adduction, internal rotation, external rotation and severe flexion are avoided after surgery > trochanter rolls/pillow > keep leg abducted at all times (hip abduction wedge - encourage incentive spirometry and deep-breathing/coughing as directed - person usually not positioned on operative side - do not exercise affected leg - provide straight back chair with armrests. person needs high, firm seat - no standing on operative leg unless allowed by doctor - Elevate leg following care plan > internal fixation device: leg isn't elevated when person sits (strains device) - Use elastic stockings - no crossing legs

Common causes of needing enteral nutrition

- cancer (esp head, neck, esophagus) - trauma to face, mouth, head, or neck - coma - dysphagia - dementia - nervous system disorders - prolonged vomiting - major trauma/surgery - AIDs - other disorders affecting ilness/nutrition

Common rehab programs and services book

- cardiac - brain injury - spinal cord - stroke - respiratory - orthopedic (fractures, joint replacement, musculo-skeletal) - amputee - hearing, speech, vision > done in private - drug adn alcohol treatment - behavioral health - for complex medical and surgical conditions (wound care, diabetes, and burns)

Sleep apnea - S&S - Treatments book (some in slide pictures)

- commonly caused by blocked airway S&S - pauses in breathing - loud snoring - wkaing during sleep with gasp/shortness of breath - difficulty staying asleep - day time sleepiness - morning headache - dry mouth/sore throat after sleeping Treatments - lifestyle changes, weight loss, no smoking, side-lying position for sleep, and avoiding alcohol/sedatives before sleep - CPAP (consistent air pressure forced through face mask, keeping airway open) - Bilevel positive airway pressure (BiPAP) > similar to CPAP except more pressure given when breathing in. More comfy for some

CAD (coronary artery disease) - common cause - major complications - treatment goals book

- cornoary arteries supply heart with blood - some portion of arteries become hard and narrow Most common cause = atherosclerosis - plaque (fat, cholesterol, etc) collects on walls - blot clots can form Major complications: - angina, MI, irregular heartbeats, and sudden death More risk factors = greater risk Treatment goals - relieve symptoms - slow/stop atherosclerosis - lower risk of blood clots - widen/bypass clogged arteries - reduce cardiac events

Risks from restraint use

- cuts, bruises, fractures - death from strangulation - constipation - contractures - decline in physical funciton - dehydration - falls - head trauma -incontinence - infections: pneumonia and urinary tract - nerve injuries - pressure ulcers -social/mental health problems (agitaiton, loss of dignity, humiliation, withdrawal)

Risks from restraint use

- cuts, bruises, fractures - death from strangulation - constipation - contractures - decline in physical funciton - dehydration - falls - head trauma -incontinence - infections: pneumonia and urinary tract - nerve injuries - pressure ulcers -social/mental health problems (agitaiton, loss of dignity, humiliation, withdrawal) *CMS* (centers for medicaid and medicare services) requires reporting of any death that occurs: - while person is in a restraint - within 24 hrs after restraint was removed - within 1 week after restraint was removed if it may have contributed directly/indirectly to death

Kidney failure: care measures book

- diet low in protein, potassium, and Na+ - fluid restriction - measure orthostatic BP - measuring daily wgt - prevent ulcers - prevent itching (bath oils, lotions, creams)

Infant safety - general safety - sleep - environment - crib book

- do not lay infant on soft materials or toys (suffocation) - shake powder onto your hand and away from baby (NOT on) Sleep - baby sleeps on back. NEVER stomach (chest expansion and breathing interference) - can lay on stomachs/sides when awake and supervised - avoid clothing that covers infant head/cause over-heating during sleep - babies need neck support. DO NOT pick them up by arms - sleep in same room as parents, but NOT same bed. - keep cords and strings out of reach + away from playpens - outlet plugs are a choking hazard, use with caution - water below 120 F - drawstrings, ribbons, cords, loose/long clothing, and neck clothing are choking hazards crib - bumper pads not used - mattress covered with fitted, snug crib sheet (in good repair) - No soft products in crib - Plastic not used to protect mattress - firm, thin mattress (no greater than 6 in) - bars no more than 2 3/8 in apart (soda can). Crib at least 26 inch deep - No cut outs in head/foot boards

Burn emergency care book

- do not touch person if in contact with electricity. turn off power - stop burning process - apply cool water for 10-15 minutes (do not apply ice directly) - remove hot clothing that isn't sticking to skin. if can't be removed, cool clothing with water - remove any jewelry and tight clothing that isn't sticking to skin - cover burns with sterile, dry dressings/cloth - do not put oil, butter, salve, or ointments on the burn - Do not break blisters - elevate burned area above heart - cover person to prevent heat loss

Bed to chair or W/C transfer or vice versa ------ transfer to and from toilet: use of sliding boards

- help person out of bed on strong side (right strong, get out on right) > for getting into bed, w/c should start with their weak side facing out - Person should not put arms around neck (you risk injury and loss of balance) - Either lock or unlock wheels on chair as according to care plan ----------------- Use of sliding boards (toilet) - w/c armrests can be removed - person has upper body strength - person has good sitting balance - if there is enough space to position w/c near toilet

Stethoscope slides

- is an instrument used to listen to the sounds produced by the heart, lungs and other body organs. This instrument makes sounds louder for easy hearing - Wipe pieces w/ antiseptic wipes before/after use - place ear-piece tips in ears. Bend of tips comes forward. Shouldn't cause pain/discomfort - Tap diaphragm gently. Should hear tapping. If not, turn chest piece at tubing. - Make sure room is silent

Chest tube care book

- keep drainage system below chest report at once: - VS and pulse o2 measurements - S&S of hypoxia and respiratory distress - complaints of pain/difficulty breathing - changes in chest drainage (amount, bright red drainage) - if bubblign in sysem changes - if parts of drainage are loose/disconnected - Keep tubing coiled on bed, but with enough slack that person can move - Prevent tubing kinks - turn and position gently - assiste with deep breathing and coughing and incentive spirometery - keep sterile petrolatum gauze at bedside > needed if chest tube comes out - call for help at once if chest tube comes out. cover insertion site with sterile petrolatum gauze, stay with person

Collecting specimens (book only)

- label specimen container/biohazard specimen bag. Apply warning labels > Leave biohazard bags outside of room - Wear gloves, don other PPE as needed - Put speciment container and lid in person's bathroom on a paper towel - Collect speciment without contaminating outside of container - Avoid contamination when transferring specimen from collecting vessel to specimen container -use a paper towel to pick up and take container out of room

Applying dressings book

- let pain relief drugs take effect (wait 30 min) - meet fluid/elimination needs beforehand + collect supplies - Remove soiled ressings so person can't see soiled side - Do not force person to look at wound - Remove tape by pulling it toward wound - if dressing sticks, nurse may have you wet dressing with saline soln - touch only outer edges

Chronic kidney disease S&S book

- nausea and vomiting - loss of appetite - fatigue adn weakness - sleep problems - decreased urine output - decreased mental alertness - muscle cramps - foot and ankle edema - dry, itchy skin - chest pain - shortness of breath - htn

Diverticular Disease - risk - symptoms - treatment slides

- small pouches (diverticulum) develop in the colon Risk factors - 50+ years of age - Aging/obesity - Smoking/lack of exercise - Low-fiber diet/diet high in animal fat When feces enter the pouches they can become inflamed and infected - abdominal pain and tenderness in LLQ - fever, nausea, vomiting, chills, cramping, and constipation/diarrhea likely - diverticulitis = pouch inflammation ----------- book pouch can rupture (rare), but feces spill into abdomen causing life threatening infection pouch can also cause blockage in intestine diet changes, antibiotics, and probiotics may be ordered. surgical removal done for severe disease, obstruction, and ruptured.

Assisting mother to breast-feed book

- stay within hearing distance - provide good nutrition > increased calory intake, 3 servings from dairy group, high calcium diet, can eat foods she likes unless baby reacts to it (onions, garlic, spices, cabbage, brussels, asparagus, beans) > caffiene in moderation. Chocolate > no alcohol ----------------- Assisting - provide mother fluids (gets thirsty) - hand hygine for you and mother - cradle position, side-lying position, and football hold are basic positions for breast feeding - change diaper - have mom hold baby close to breast and brush nipple against cheek (rooting reflex) - make sure nose isn't blocked > can help to reposition baby's hips + move baby's head back slightly > Use thumb to keep breast tissue away from baby's nose. (breast supported w/ one hand) - encourage nursing from both breasts at each feeding. start with last breast used (end right start right) - insert finger at corner of baby's mouth to end suction (mother) - baby burped after nursing each breast - air dry nipples - use ointment/cream prescribed if nipples are cracked. Wash this off before feeding - no soap used to clean breasts. just washcloth and warm water - nursing bra can prevent leakage - change baby's diaper after feeding

Heat and cold applications - observations to report/record slides

-------------- OBSERVATIONS TO REPORT and RECORD - Complaints of pain/discomfort/numbness or burning - Excessive redness - Blisters - Pale, white/gray skin - Cyanosis - Shivering - Rapid pulse, weakness - Time, site and length of application

Restraints -types and why

----------------- Types: 1) Wrist (risk for pulling out devices, scratches/peels at skin/wound) 2) Mitt (prevent finger use, allow arm movements. same use as wrist) 3) Belt - To prevent injuries from falls or for positioning during medical treatment - person can't get out of bed or chair. roll belt may allow turning side to side 4) Vest/jacket restraints - nurse only - Same purpose as belt restraints 5) Elbow splints - used to limit elbow bending in children - prevent scratching/touching incision. Pulling out tubes 6) Anything that restricts movement - tray table, rails, etc If you don't know how to apply a certain restraint, tell the nurse so and ask them to show you + watch you do it

School age actions/skills

------------------- - Baby teeth are lost (start ~6) - Can run, jump, skip, hop, and ride a bike. Swim, dance, jump rope - Play in groups, team sports > learn teamwork - Reading, writing, grammar, and math skills develop - Learn writing. More complex sentences - AS reading skills increase and language skills. Like reading - Play activities have purpose and involve work - ~7 same sex play preferred - 8/9 some play/interest involves boys and girls. - Want to be liked

common poison

-------------------- Common poisons: - drugs and vitamins - household products - personal care products (soap, shampoo, lotion, etc) - fertilizers/insecticides - plants - mushrooms - alcohol V CO (carbon monoxide) lead

- Psychological and social changes of aging slide

-------------------- Psych and social changes 1) Parent may rely on children for care - Changed role may be difficult to navigate (tension, loss of dignity, etc. often due to loss of privacy, criticisms about housekeeping, child raising, cooking, and friends) 2) Need to find new activities after retirement 3) Adjustment to death How they cope depends on 1) Health status 2) Life experiences 3) Finances (retirement/reduced income) 4) Education 5) Social support systems (especially w/ friends/family passing away)

What to note when taking pulse:

-------------------- When taking a pulse note the *rate, rhythm, and quality (force).* *rate* - is how fast the heart is beating. *Rhythm* - can be regular or irregular (not evenly spaced, beats skipped). *Force or quality* - can be described as *strong, full, or bounding* - hard-to-feel pulses are described as *weak, thready, or feeble.* Have to feel pulse to determine force - rate, rhythm, and BP can be measured be BP equipment.

Newborn reflexes

----------------------- *Reflexes* decline/disappear as CNS develops 1) Moro/startle reflex - When baby is startled by a loud noise, sudden movement, or head falling back, the arms are thrown apart. Legs extend then flex. Brief cry. 2) Rooting reflex - When something touches baby's cheek, mouth opens and head turns toward touch 3) Sucking reflex - When baby's lips touch something, it sucks 4) Palmar grasp reflex - When palm is stroked, fingers close around object 5) Step (dance) reflex - When baby is held upright and feet touch surface, feet make stepping motions

Chemical precautionary statement - contain - use slide

----------------------- Precautionary statements (4): 1) Prevention (how to minimize exposure) 2) Response (emergency response and first aid 3) Storage 4) Disposal method Pictogram (image used to convey info about a chemical hazard) If warning label is removed/damaged, do not use. Show container to nurse. Do not leave container unattended

Preventing burns

----------------------- Preventing burns - Keep hot food/liquids away from edges - Assist with eating and drinking as needed - Do not pour hot things near children/older persons - Turn on cold water first, then hot. Hot then cold to turn off - Measure bath/shower temp before person gets in - make sure smoking is only done in smoking area > do not leave smoking materials at bedside

Disaster and fire - elopement book only

------------------------ *Elopement* - When a patient or resident leaves the agency w/o staff knowledge - CMS requires disaster plans to address this > agency must ID > Monitor/supervise at risk people > ADdress elopement in those care plans > Have a plan for finding missing residents

Physical changes of aging - musculo-skeletal slide

------------------------- Musculo-skeletal system ◦Muscle strength, tone and contractility decrease ◦Bone mass decreases/weaker/bones break easier (osteoporosis) - move them carefully ◦Joints become stiff and painful *atrophy* (shrinkage) of muscles occurs

Preventing carbon book only

----------------------------- Carbon monoxide - A colorless, odorless, tasteless gas. PRoduced via burning fuel (gas, oil, kerosene, wood, charcoal) - Can build up in closed areas. CO binds to RBCs faster than O2, so suffocation occurs Symptoms - breathing problems - cherry-pink skin - angina - confusion - dizziness - fainting - headache - nausea - sleepiness - slurred speech - vomiting - weakness Prevention: - ventilate room when using a space heater - Do not use a gas oven/stove to heat a room If you/others show signs/symptoms - open doors and windows - turn off appliances - leave home - go to an ER

Infant - Skills at different months > 2 > 3-4 > 4-5 > 4-6

1 month to a year - CAn briefly lift heads when on stomach - Can turn head and smile - 2 mo old infants can hold up head when held straight. > On stomachs can turn head from side to side. > NEed support to sit in an angled position > Smile to others 3-4 mos - Can hold heads up - startle, rooting, and grasp reflexes disappear - Reach for objects - SMiles when parent appears - MAkes cooing sounds - BEcomes quiet/smiles when spoken to - REcognizes parent's voice - Different cries for different needs 4-5 mos - CAn roll from front to back (roll back to front @ 5-6 mos) - Can sit by leaning on hands - Teething may begin - Sleep all night - Can play peekaboo 4-6 mos - Solid foods (mushy to solid) > Thin and pureed at first. Thicker and chunkier given as more teeth emerge and chewing/swallowing develops

Conversions for I&O

1 oz = 30 ml or cc 1 tsp = 5 ml 1 tbsp = 3 tsp = 15 ml 2 tbsp = 1 oz = 30 ml 1/4 cup = 2 oz 1/2 = 4 oz 1 cup = 8 oz 1 quart = 32 oz

Skin and scalp conditions - alopecia - hirsutism - dandruff - pediculosis - scabies

1) *Alopecia* - hair loss/thinning of hair - causes hereditary, from treatments (cancer), skin disease, stress, poor nutrition, pregnancy, some drugs, hormone changes > hair usually grows back except from aging 2) *Hirsutism* - excessive body hair - hereditary + abnormal amounts of male hormones 3) *Dandruff* - excessive amount of dry, white flakes on scalp. Itchy - medicated shampoos help 4) *Pediculosis (lice)* 5) *Scabies* - Transmitted via close contact - causes rash and intense itching. Commonly between fingers, wrists, underarm, thighs, and genitals. Also breast, waist, and buttocks.ƒdia

moist heat applications slides

1) *Hot compress* - is the application of a moist, heated, soft pad - sometimes has aquathermia pad applied over compress to maintain temp of compress ---------------- book Moist = water in contact with skin - water conducts heat, so moist heat has faster/greater effects than dry - penetrates deeper. Have lower temps 2) Hot soak - body part put into water. Usually used for smaller body parts (below elbow, below knee) 3) Sitz bath - perineal and rectal areas immersed in warm/hot water - common for hemorrhoids, after rectal/female pelvic surgeries, and after childbirth. used to: > clean perineal and anal wounds > promote healing > relieve pain and soreness > increase circulation > stimulate voiding 4) Hot pack - *pack* = wrapping body part with wet/dry application • Single use (disposable) and re-usable packs

Restraint safety - CNA observation (205)

1) *Observe for increased confusion and agitation* - struggling against them, asking others for help - Restrained persons need repeated explanations/reassurance 2) *Protect person's quality of life* - use restraints for as short a time as possible - needs are met with as little restraint as possible 3) Follow manufacturer's instructions - cannot be tight (snug and firm instead) - tiight affects circulation and breathing 4) Apply restraints with enough help to protect person and staff from injury 5) *Observe the person at least every 15 min* or as directed by nurse/care plan 6) *Remove or release the restraint, reposition the person, and meet basic needs at least every 2 hours* (or as noted in care plan) - remove for at least 10 min - provide food, fluid, comfort, safety, hygiene, elimination, and skincare needs - perform ROM exercise or help person walk as according to care plan

Delegation process

1) ASsessment and planning - Nurse collects info about patient needs and your knowledge, skills, and job descriptions - Nurse decides if it is safe to delegate task. 2) Communication - Nurse gives instructions on how to complete task, what observations to record, when to report, task priorities, resident concerns to report stat, and what to do if condition changes - You ask clarifying questions, ensuring that you understand the task > ask for needed training/supervision, state if you haven't done the task before, ask for needed training or supervision, and restate information given to you to communicate understanding > also know what to do in an emergency - report care given 3) Surveillance and supervision - Nurse supervises care you give, making sure task is done correctly. Monitors person's response - Nurse follows up on problems/questions 4) Evaluation and feedback - Nurse decides if delegation was successful. Correct and safe? - Makes decisions about changes in person's care -Provides feedback to you

Types of illnesses

1) Acute - Sudden onset, recovery expected 2) Chronic - On-going illness w/ slow or gradual onset - No known cure, but can be controlled/complications prevented with proper treatment 3) Terminal - Illness/injury from which recovery is unlikely

Communicating with the health team: Parts of the medical record + Kardex , assignment sheet

1) Admission record - completed when person is first admitted - Has identifying info + info of nearest relative/legal representatives - Relevant medical info such as allergies, previous doctors - PErson is given an ID number - Also has advance directives 2) Health history - Nurse interviews person about: > chief complaint (Reason for visit) > Past health issues, surgeries, injuries > Childhood illness > Allergies > Lifestyle > Need for assistive devices > Problems with ADLs > Education and occupation 3) Graphic sheet - Used to record observations made daily, every shift, or 3-4 times a day - includes vital signs (BP, T, pulse, R) - Weight, intake/output, bowel movements, and doctor's visits 4) *Progress notes* - Describes care given and person's response/progress. Nurse records > signs and symptoms > Info about treatment/drugs > Info about teaching/counseling > Procedures performed by doctor > Visits by other health team members ---------------------- *Kardex* - A type of card file that summarizes info in the medical record - drugs, treatments, diagnoses, routine care measures, equipment, and special needs - NOT part of the permanent medical record. More for quick reference -------------------- *Assignment sheets* - Tells about: > Each person's care > What measures/tasks need to be done > Which nursing tasks to do

Factors affecting sleep book

1) Age - amount needed decreases with age 2) Illness - increases need for sleep but interferres with it 3) Nutrition - sleep needs increase with weight gain and decrease w/ weight loss - Caffeine prevents sleep, tryptophan protein helps sleep (found in meat, dairy, etc) 4) Exercise - avoid 2 hrs before sleep 5) Environment 6) Drugs adn other substances - sleeping pills and alcohol decrease REM sleep 7) Life-style changes 8) Emotional problems - anxiety, etc

Factors affecting BP

1) Age - increases 2) Gender - Women usually have lower BP. Women BP rise after menopause 3) Blood volume - more blood = higher BP - Less blood = lower BP 4) Stress - Increases 5) Pain - increases except for in shock from severe pain > BP severely low in shock 6) Exercise - BP increases 7) Weight - Higher with higher weight generally 8) Race - black people generally have higher BP than white people 9) Diet - high sodium diet increases water retention and BP 10) Drugs 11) Position - higher when lying down - lower in standing 12) Smoking - Nicotine causes vesssels to narrow = higher BP 13) Alcohol (Excessive) - raise BP

stool observations to document slides

1) Amount and Color - white, clay, yellow, orange, green, bright red, dark red, brown, black 2) Presence of mucus or blood 3) Odor 4) Shape and consistency - formed with lumps, formed with cracks, smooth and soft - small hard lumps, small soft lumps - loose and unformed, watery 5) Time the person had a BM 6) Frequency of BMs 7) Complaints of pain or discomfort

Persons at risk: pressure ulcer book

1) Are bedfast/chairfast - confined to bed/chair 2) Need some or total help in moving 3) Are agitated, have muscle spasms, or involuntary muscle movements. Cause rubbing against linens and other surfaces 4) Are incontinent - urine and feces cause skin breakdown, also source of moisture 5) Are exposed to moisture - increases risk of shearing/friction 6) Have poor nutrition/fluid balance 7) Have limited awareness 8) Have problems sensing pain/pressure 9) Have ciruclatory problems 10) Have weight loss/are very thin - reduced padding 11) Are obese 12) Have medical devices

Communicating with speech impaired persons slides

1) Ask the person to repeat or rephrase statements as needed 2) Ask the person to write down key words or the message 3) Ask the person to point, gesture 4) Provide a calm, quiet setting. Have no other distractions 5) Listen and give the person your full attention 6) Use short, simple sentences 7) Repeat what you are saying as needed 8) Speak in a normal tone 9) Allow the person plenty of time to talk 10) Watch facial expressions, gestures, and body language

Nursing process

1) Assessment - collect info about person - *gathering info* (hearing, seeing , smelling, touching) - see pg 85 2) Nursing diagnosis - Describes a health problem that can be treated using nursing measures - Different from a *medical diagnosis*, which is ID of a disease/condition by a doctor 3) Planning - Setting priorities (what is most important) and goals > *Goals* = that which is desired for/by a person as a result of giving nursing care - *nursing intervention* - action/measure taken by nursing team to help person reach a goal. These don't need doctor's order, but some can come from them - *Nursing care plan* = written guide about person's care. Contains nursing diagnoses, goals, and measures for each goal. > Communicates what care to give, ensures consistency in care - Plan shared in care conference by RN 4) Implementation - Carry out nursing intervention/actions - Nurse delegates tasks as appropriate. Report after giving care 5) Evaluation - Measure if goals in planning step were met - If it didn't work, go back to assessment

*Accident risk factors* - types of paralysis

1) Awareness of surroundings - Need to know surroundings to protect them from injury. Confused/disoriented persons may not - *Coma* (state of being unaware of setting and being unable to react/respond to outside stimuli) 2) age - Children and older persons 3) agitated/aggressive behaviors - Can be caused by pain, confusion, decreased awareness of surroundings, and fear 4) vision loss - tripping, poisoning from failure to read labels 5) hearing loss - May not hear warnings or approaching objects 6) impaired smell/touch - May not detect smoke or gas. Burns more likely, unaware of injury. 7) impaired mobility - Unable to move to safety or paralysis - *paralysis* - loss of muscle function, sensation, or both > *paraplegia* (in legs and lower trunk) > *quadriplegia (tetraplegia)* - Paralysis in arms, legs, and trunk > *hemipelagia* - paralysis on 1 half 8) Drugs - side effects may increase risk (balance, drowsiness, confusion, dizziness)

Dying person's bill of rights slides

1) Be treated as a living human being until death 2) Maintain a sense of hopefulness 3) Be cared for by those who can maintain a sense of hopefulness 4) Express their feelings and emotion about approaching death in their own way 5) Participate in decisions concerning their care 6) Expect continuing medical and nursing attentions even though "cure" goals must be changed to "comfort" goals 7) Not die alone 8) Be free from pain 9) Have questions answered honestly 10) Not be deceived 11) Expect that the sanctity of the human body will be respected after death

Body: levels of organization

1) Cell - Basic unit of body structure >nucleus, cell membrane, cytoplasm, (aka protoplasm) > Chromosomes are in nucleus, contain genes > Reproduce via mitosis (46 chromosomes > 23 > 46) 2) Tissue - groups of cells with similar functions > Epithelial tissue (cover internal/external surfaces) > Connective tissue (anchors, connects, and supports other tissues) (blood, bone, fat, tendons, ligaments, cartilage) > Muscle tissue > Nerve tissue 3) Organ - groups of tissues 4) System - Organs that work together to perform special functions

Prevention/treatment of skin breakdown

1) Check the skin frequently 2) Promptly clean the skin 3) Gently wipe skin when cleaning 4) Use skin cleansing products 5) Do not rub or scrub skin 6) Observe skin in perineal area on all patients/residents 7) Report any changes to the nurse

Observations to record during bathing

1) Color of skin, lips, nail beds, and sclera 2) If skin appears pale, grayish, yellow (jaundice), blue (cyanotic) 3) Location and description of rashes 4) Skin texture (smooth, rough, scaly, flaky, dry, moist) 5) *Diaphoresis* - excessive sweating 6) Bruises/open skin 7) Pale, reddened, or discolored areas (especially over bony parts) 8) Drainage or bleeding from wounds/body coverings 9) Swelling of feet/legs 10) Corns or calluses on feet 11) Skin temp (cold, cool, warm, hot) 12) Complaints of pain/discomfort

Diabetes foot care: common problems book

1) Corns/calluses - thick skin caused by too much rubbing/pressure over bony areas 2) Blisters - due to illfitting shoes/socks 3) Ingrown toenails - occur when skin is cut when trimming toenails + from tight shoes 4) Bunions - bump on outside edge of big toe. Toe slants towards small toes - Due to heredity, poor fitting shoes, high heels, and pointy shoes 5) Plantar warts - on bottom of feet, caused by a virus. painful 6) Hammer toes - one or more toes flexed. Due to weaened foot muscles from diabetic nerve damage 7) Dry and cracked skin - nerve damage, poor blood flow 8) Athletes foot 9) Fungal infection of toenails

Ethics and Laws: 1) Criminal laws 2) Civil laws 3) Negligence 4) Malpractice 5) Standard of care. 6) Tort

1) Criminal laws - are concerned with offenses against the public and society in general. - An act that violates a criminal law is called a crime. (murder, robbery, rape, kidnapping) 2) Civil laws - are concerned with relationships between people. 3) Negligence - is an unintentional wrong - the negligent person did not act in a reasonable and careful manner—as a result a person or the person's property was harmed. 4) Malpractice - is negligence by a professional person. A person has professional status because of his or her education and service provided 5) Standard of care - refers to the skills, care, and judgments required by a health team member under similar conditions. ------------- book only 6) Tort - wrong committed against person or person's property. can be intentional or unintentional

Factors affecting eating and nutrition

1) Culture or Religion 2) Finances - limited incomes 3) Appetite - desire for food -- aromas can stimulate appetite - *anorexia* (loss of appetite) can occur 4) Personal choice - food likes and dislikes 5) Body reactions - avoid food that cause allergic reactions 6) Illness - appetite decreases during illness and recovery from injuries 7) Medications - can cause a loss of appetite 8) Chewing problems - mouth, teeth and gum problems can affect chewing 9) Swallowing problems - stroke, pain, confusion, dry mouth, diseases of mouth/throat 10) Disability - disease or injury to hands/wrists/arms 11) Impaired cognitive function - affects person's ability to use eating utensils 12) Age - can decrease appetite, lack of activity 13) Adaptive equipment in eating - Make individuals more independent in feeding - thumb handle cups, plate guard, wider grip utensils, etc

Ethics and laws 1) Defamation > 2) Libel > 3) Slander 4) False imprisonment 5) Invasion of privacy 6) Fraud 7) Assault 8) Battery

1) Defamation - is injuring a person's name and reputation by making false statements to a third person. > 2) Libel - is making false statements in print, in writing, (email/texts) through pictures/video/posted on-line sites, through video sites and social media sites. > 3) Slander - is making false statements through the spoken work, sounds, sign language or gestures. 4) False imprisonment - is the unlawful restraint or restriction of a person's freedom of movement. Includes threatening to restrain or restrict. 5) Invasion of privacy - is violating a person's right not to have his/her name, photo, or private affairs exposed or made public without giving consent. 6) Fraud - is saying or doing something to trick, fool or deceive a person. 7) Assault - is intentionally attempting or threatening to touch a person's body without the person's consent. 8) Battery - is touching a person's body without his/her consent.

Nursing measures for pain slides

1) Distraction - means to change the person's center of attention, attention is moved away from the pain 2) Relaxation -means to be free from mental and physical stress - breathing/muscle contraction exercises 3) Guided imagery - is creating and focusing on an image 4) The Back Massage (back rub) - can promote comfort and help relieve pain. It relaxes muscles and stimulates circulation. Good to do after repositioning, after baths/showers, and with evening care. - Back massages last 3 to 5 minutes - Warm lotion between hands/in warm water before applying - DO NOT massage reddened bony areas Schedule care 30 min after pain drugs are given

Positioning and draping (564) - dorsal - lithotomy - knee-chest (genupectoral) - sims book

1) Dorsal recumbent/horizontal recumbent - PErson is supine with legs together - used to examine abdomen, chest, and breasts - Perineal area = knees flexed and hips externally rotated - person draped up to shoulders 2) Lithotomy - Person lies on back. Hips at edge of exam table. Knees flexed and hips externally rotated - Feet in stirrups - Used to examine vagina and cervix - draped like for perineal care 3) Knee-chest (genupectoral) - Person kneels and rests body on knees in chest. Head turned to 1 side. ARms are above head or flexed at elbows. Back is straight, body flexed 90 degrees at hips (buttocks in air) - Used to examine rectum - Apply drape in diamond shape to cover back, buttocks, and thighs 4) sims position

Safety measures: tracheostomies book

1) Dressings don't have loose gauze or lint 2) Stoma/tube covered when outdoors. Prevents dust, insects, and other small particles from entering stoma 3) Stoma is not covered with plastic, leather, or materials that prevent air from entering 4) Tub baths taken or shower guard worn. Hand-held nozzle used to direct water away from stoma 5) The person is assisted with shampooing. Water must not enter stoma 6) Stoma is covered when shaving 7) No swimming 8) Medical-alert jewelry and ID card worn

When to do vital signs (8) slides

1) During physical Exam or assessments, 2) Admission to health care agencies, 3) If a persons condition changes (as often as condition requires) 4) Before and after surgery /complex procedures 5) After a fall or injury, 6) After certain medications are administered (ones that affect respiratory/circulatory system) 7) If a person complains of dizziness, light-headed, pain, shortness of breath. 8) As stated on care plan Can share vital signs with patient/family if it complies with agency policy

Surgeries are described as: - types (elective, urgent, emergency) - pre vs post op

1) Elective surgery - done by choice to improve life or well-being - not life saving (ex. joint replacement/cosmetic) 2) Urgent surgery - needed for the person's health. It can be delayed for a few days (ex. cancer, coronary artery bypass) 3) Emergency surgery - done at once to save life or function (ex. car crash, stabbings, bullet wounds) ------------------ *Pre-operative* - refers to before surgery - goal = prevent complications before, during, and after surgery *Post-operative* - refers to after surgery

Ethics terms 1) Ethics 2) Code of ethics 3) boundary 3.5a) Professional boundaries 3.5b) Boundary crossing 3.5c) Boundary violation 4) Professional sexual misconduct

1) Ethics - is knowledge of what is right conduct and wrong conduct. > Morals involve ideas of right and wrong > Prejudice/bias means making judgements/having views before knowing the facts 2) Code of ethics - is the rules, standards of conduct for group members to follow. 3) boundary - limits or separates something. 3.5a) Professional boundaries - separate helpful behaviors from behaviors that are not helpful. 3.5b) Boundary crossing - is a brief act or behavior of being over-involved with the person. > boundary sign = indication that you are getting too involved 3.5c) Boundary violation - is an act or behavior that meets your needs, NOT the person's. 4) Professional sexual misconduct - is an act, behavior or comment that is sexual in nature.

Sensory organs

1) Eye - sight. contains receptors for vision. easily injured, 3 layers > Sclera (eye white). Tough CT > Choroid (made up of blood vessels, the ciliary muscle, and iris + pupil) > Retina - inner layer, contains nerve receptors for optic nerve (1) Cornea > aqueous (humor) chamber > lens (lies behind pupil) > vitreous humor > retina ----------------------- 2) Ear - functions in hearing and balance - 3 parts: a) External (pinna/auricle) v auditory canal (cerumen secreted here) v tympanic membrane/eardrum b) Middle (eustachian tube + auditory ossicles) - malleus, incus, stapes c) Inner (semicircular canals + cochlea connected to auditory nerve) ------------------ 3) Tongue - Taste (taste buds = chemical receptors) 4) Nose - Smell. Olfactory receptors in nose 5) Touch - Throughout body. Varied kinds

Types of wound healing - first intention (primary closure) - second intention - third intention (delayed, tertiary) book

1) First intention (primary closure) - wound is closed. 2) Second intention - contaminated/infeced wounds cleaned and dead tissue removed - wound edges are not brought together - Healing takes longer, leaves larger scar. Great risk of infection 3) Third intention (delayed, tertiary) - wound is left open and closed later. Combines first and second intention - Infection and poor circulations are reasons for it

Bedmaking rules

1) Good body mechanics 2) MEdical asepsis 3) Standard precautions + bloodborne pathogen standard 4) Hand hygiene before handling clean linens 5) Bring only linens you will need - DO NOT use for other people if you have extra. cross-contamination 6) Never shake linens (spreads microbes 7) Hold linens away from your body/uniform. Do not let them touch 8) Do not put used linens on floor or on clean linens 9) Bag used linens in room where they are used 10) Make as much of one side of the bed as possible 11) Change soiled/damp linens right away

Resolving conflict

1) ID real problem 2) Collect info about problem 3) ID possible solutions 4) Select best solution 5) Carry out solution 6) Evaluate results Talk with person in a private setting. Ask supervisor for advice - Explain problem adn what is bothering you, give facts and specific behaviors. Focus on problem NOT person - Listen to person, do not interrupt - ID ways to solve the problem (both party's ideas) - Set a date/time to review - Express gratitude

Prevention and treatment (pressure ulcers?) slides

1) Identifying the persons at risk, Implement prevention measures - manage moisture, good nutrition and fluid balance, and relieving pressure key - ex. use Braden scale for Predicting pressure sore risk (done weekly or daily dpending on condition + risk factors) 2) *Re-position bedfast/chair-fast persons every 2 hours* - reposition chairfast every hr 3) Do not position the person on a pressure ulcer, or reddened area - no donut shaped cushions - not on pressure ulcers, reddened areas, on tubes/other devices - 30 degree lateral recommended. 4) Use pillows or foam wedges to prevent bony areas from contact with other surfaces 5) Keep heels and ankles off the bed - support feet properly with stool when off bed 6) Inspect the skin every time you give care - no hot water - use cleansing agent. soap can dry/irritate - do not apply heat/cold directly to ulcer 7) Prevent friction/shearing when moving - powder sheets lightly - do not raise HoB more than 30 degrees - avoid seams, buttons or zippers that press against skin - avoid tight clothes, and bunching/wrinkling

Interacting with Aggressive residents slides

1) If they are combative you need a calm demeanor and understanding 2) Do not argue or return their aggression 3) To diffuse the aggressive behavior, leave the situation if you can and return later 4) Sit down, keep your hands open, maintain eye contact 5) Use clear - simple language 6) Listen carefully to the person - letting them know you are paying attention 7) Ask them what they need

Zones of entrapment book (310 for picture)

1) In rail 2) Between top of mattress and bottom of rail, between supports 3) Between rail and mattress 4) Between top of matress and bottom of the rail end 5) Between split rails 6) Between end of rail and side of head/foot board 7) between head and footboard and mattress end

Maintaining the Person's Unit slide

1) Keep call light/signal light within person's reach at ALL times - meet alternatives for people who can't use it 2) Make sure the person can reach over bed table 3) Arrange personal items as the person prefers 4) Adjust lighting, temperature, ventilation for the person's comfort 5) Handle equipment carefully to prevent noise 6) Respect the person's belongings 7) Straighten bed linens often 8) Complete safety check before leaving room

Communication with confused/disoriented person slides

1) Keep your voice low 2) Do not raise your voice or shout 3) Use the person's name and speak clearly in simple short sentences 4) Use facial expressions and body language to aide in understanding 5) Reduce distractions in the area by reducing stimulation, such as turning down the TV 6) Be gentle, try to decrease their fears 7) Break up a complex task into small, simpler one-step at a time tasks 8) Uses signs, pictures, gestures or written words to help communicate 9) Repeat - using the same words and phrases, as often as needed

CNA role in prepping person's room post op + return from PACU book

1) Make a surgical bed - in highest position 2) Place equipment/supplies - thermometer - stehtoscope/sphygmomanometer - kidney basin -tissues -baxter pad - vital signs flow sheet -I&O record - IV pole - other items as directed by nurse 3) Move furniture out of way for stretcher ------------- PACU - CNA assists nurse with stretcher to bed transfer + positioning - take VS + make observations - Nurse checks for bleeding in surgical site

CPR breathing methods 1) Mouth to mouth 2) Barrier device breathing 3) Mouth to nose breathing 4) Mouth to stoma breathing book

1) Mouth to mouth - mouth over person's mouth - pinch nostrils shut 2) Barrier device breathing - Prevents contact with person's mouth and blood, body fluids, secretions, excretions - placed over nose and mouth, seal must be tight 3) Mouth to nose breathing - Used when you cannot breath through mouth, cannot open mouth, your mouth is too small to make a tight seal, mouth is severely injured, person is breathing from mouth - mouth closed 4) Mouth to stoma breathing - keep mouth closed - do not tilt head back - seal mouth around stoma - blow > may have to pinch nostrils shut

Types of feeding tubes

1) Naso-gastric (NG) tube feeding - inserted *through the nose* and into the stomach. 2) Naso enteral (book) - inserted *through the nose* and into the small bowel (intestine) ^Short term (<6 weeks) -------------------------------- v Long term (>6 weeks) 3) Gastrostomy tube - a doctor inserts a feeding tube through a surgically created opening into the *stomach.* 4) Jejunostomy tube - a feeding tube is inserted into a surgically created *opening in the jejunum* of the small intestine. 5) Percutaneous endoscopic gastrostomy (PEG) tube - a doctor inserts a feeding tube into the stomach through (per) a small incision (tomy) made through the skin (cutaneous). Doctors or RNs insert tube

Persons at risk for skin tears slides

1) Need help moving 2) Have poor nutrition 3) Have poor hydration 4) Have altered mental awareness 5) Are very thin 6) Have very thin fragile skin Older persons at risk for - decubitus ulcers, delayed skin healing, skin cancer, skin tears, cellulitis, fingernail/toenail problems

Restraint safety keypoints - for more see 205

1) Observe for increased confusion and agitation - struggling against them, asking others for help - Restrained persons need repeated explanations/reassurance 2) Protect person's quality of life - use restraints for as short a time as possible - needs are met with as little restraint as possible 3) Follow manufacturer's instructions - cannot be tight (snug and firm instead) - tiight affects circulation and breathing 4) Apply restraints with enough help to protect person and staff from injury 5) Observe the person at least every 15 min or as directed by nurse/care plan 6) Remove or release the restraint, reposition the person, and meet basic needs at least every 2 hours (or as noted in care plan) - remove for at least 10 min - provide food, fluid, comfort, safety, hygiene, elimination, and skincare needs - perform ROM exercise or help person walk as according to care plan

Types of patients NAs care for

1) Obstetrics - Mother and newborns (pregnancy, labor, post birth care) 2) Pediatrics - Children (growth, development, care) - Up to around 16 3) Bariatric -overweight - Field focused on management and control of obesity - *obesity* = having excess amount of body fat. Body weight 20% or more above "normal" for that person's height/age - *morbid obesity* - weighs 100 lbs or more over their normal weight - At risk for high BP, heart disease, stroke, cancer, diabetes, skin problems, depression 4) Adults with medical problems 5) Surgical patients - reduce pain, prevent complications, help patient adjust to body changes 6) Trauma patients 7) Patients with mental health disorders - psychiatry deals with this 8) Persons in special care units - These units treat/prevent life threatening problems - Emergency room, intensive care, coronary care, burn, kidney dialysis 9) Persons in sub-acute units - need more recovery time than hospital care allows 10) Persons in rehabilitation units 11) Geriatrics -older population - field focuses on problems/diseases of old age

Communication techniques

1) Paraphrasing - REstating person's message in own words 2) Direct questions - Focus on certain info. Y/N questions 3) Open-ended questions - Lead or invite the person to share thoughts, feelings, or ideas. Encourage conversation 4) Clarifying - Checking that person you are talking to understands the message 5) Focusing - Concentrating on a certain topic *Silence is a very powerful way to communicate* - can show you care, just by being there - gives you time to process info/make better decisions - silence can be uncomfortable, but sometimes the person needs it.

General precaution when feeding a patient

1) Patient/resident should be upright at 90 degrees (in chair when possible) 2) The chin should be tucked to help protect the airway 3) No straws unless specified, • straws tend to dump liquids in back of mouth • residents/patients may suck more at a time than they can handle 4) Mixed consistencies and liquids are most difficult to swallow 5) Patients/residents must be alert and awake 6) Allow the person to cough, don't ask questions, let them clear their airway. 7) *Stop feeding immediately if resident begins to drool or has wet / gurgling speech or respirations and notify the nurse* 8) It is best to stay upright 30-60 minutes after mealtime 9) Provide oral care, a clean mouth/teeth/dentures make food taste better

Complete change of linen when:

1) Person is returning to room from surgery (surgical bed) 2) Person arrives at agency by ambulance if: > person is a new patient/resident > Is returning to agency from hospital 3) People who use portable tubs (because of bathing, complete change is needed 4) Closed bed Not when: - person goes by stretcher to treatment or therapy area

Preventing aspiration during tube feeding

1) Position person in fowlers/semifowlers before feeding (As according to care plan) 2) Maintain fowlers/semifowlers position after feeding (1-2 hrs after or at all times) - allows formula to move through GI tract. see care plan 3) Avoid left side lying position - prevents stomach from emptying into small intestine NG and gastrostomy tubes at greater risk for regurgitation than intestinal tubes

Complications of bedrest slides

1) Pressure ulcers -localized injury to the skin and underlying tissue due to irritation and continuous pressure. 2) Constipation + fecal impaction 3) Urinary tract infections and renal calculi (kidney stones) 4) Blood Clots (Thrombi) 5) Pneumonia and fluid in the lungs 6) *Contracture* - is the lack of joint mobility caused by abnormal shortening of a muscle. - common in all joings/limbs. Also neck and spine 7) *Atrophy* - is the decrease in size or the wasting away of tissue. 8) *Orthostatic hypotension (Postural Hypotension)* - is abnormally low blood pressure when the person suddenly stands up. - lying to a standing position causes the blood pressure to drop, making the person dizzy, and weak. 9) *Syncope* (fainting) - a brief loss of consciousness.

Growth and Development principles

1) Process starts at fertilization and continues until death 2) Process proceeds from simple to complex (sit > stand > walk > run, etc) 3) Process occurs in certain directions a) head to foot b) center of body outward (medial lateral) 4) PRocess occurs in a sequence, order, and pattern - Stages can't be skipped, each stage is a basis for the next 5) Rate of process is uneven 6) Each stage has its own characteristics and tasks - *Developmental tasks* are skills that need to be completed during a stage of development.

Nutrients book (447 for vit functions)

1) Protein - most important nutrient - tissue growth/repair 2) Carbs - provide enrgy + fiber for BMs 3) Fats - provide energy and help body use certain vitamins 4) Vitamins - needed for certain body functions - body stores A, D, E, and K - Vit C and B are not stored (must ingest daily) 5) Minerals -needed for bone/tooth formation, nerve/muschle function, fluid balance, and other - calcium preents msuculo-skeletal changes 6) water - needed for everything

Bowel elimination: Safety and comfort slides

1) Provide for privacy 2) Stay nearby if the person is weak or unsteady 3) Help the person to toilet/commode or bedpan 4) Allow enough time for the bowel movement 5) Place the call light within reach 6) Provide perineal care if needed 7) Dispose of bowel movement promptly which reduces odors and prevents the spread of microbes 8) Assist the person with hand washing after elimination

Code of conduct for Nursing assistants

1) Respect each person as an individual 2) Know the limits of your role and knowledge 3) Perform only those tasks that are within the legal limits of your role 4) Perform no act that will harm the person 5) Report errors and incidents at once ------------------- 6) Follow the directions and instructions of the nurse to the best of your ability 7) Follow the agency's policies and procedures ------------------- 8) Complete each task safely 9) Be loyal to your employer and co-workers 10) Act as a responsible citizen at all times ------------------- 11) Keep the person's information confidential 12) Protect the person's privacy 13) Protect the person's property ------------------- 14) Consider the person's needs to be more important than your own 15) Take drugs only if prescribed and supervised by your doctor 16) Be accountable for your actions

Restraint laws + guidelines

1) Restraints must protect person - not for staff convenience/discipline - only used when it is the best safety measure 2) *A doctor's order is required* - in emergency nurse can decide to get restraints - doctor decides how/where restraint is applied 3) The least restrictive method is used - allows most body access/motion (ex. rails which allow movement vs. vest restraints) 4) Restraints are only used after other measures fail to protect person 5) *Unnecessary restraint is false imprisonment* - you must clearly understand reason for restraint and its risks. If not, ask. 6) Informed consent is required - must be obtained before use 7) Apply restraints with enough help to protect person and staff from injury

Restraint laws, rules, and guidelines

1) Restraints must protect person - not for staff convenience/discipline - only used when it is the best safety measure 2) A doctor's order is required - in emergency nurse can decide to get restraints - doctor decides how/where restraint is applied 3) The least restrictive method is used - allows most body access/motion (ex. rails which allow movement vs. vest restraints) 4) Restraints are only used after other measures fail to protect person 5) Unnecessary restraint is false imprisonment - you must clearly understand reason for restraint and its risks. If not, ask. 6) Informed consent is required - must be obtained before use

5 rights of delegation

1) Right task - Whether the task is appropriate to you (in job description, scope of tasks) 2) Right circumstances - Does task suit physical, mental, emotional, and spiritual needs of the person 3) Right person - Do you have sufficient training to perform task safely for this person 4) Right directions + communication - Nurse must give clear and complete directions (what, when, observations to make, when to report) - Allows questions and helps set priorities 5) Right supervision - Nurse: > guides, directs, adn evaluates care given > Demonstrates tasks as needed and is available for Qs. Some task srequire more supervision than others (complex, ones you haven't done) > ASsess task effect on person and your performance > Gives feedback and how to improve

Wound drainage 1) Serous drainage 2)Sanguineous drainage 3) Serosanguineous drainage 4) Purulent drainage book

1) Serous drainage - clear, watery fluid (serum portion of blood) > no blood cells or platelets (ex. blister fluid) 2)Sanguineous drainage - bloody. Hemorrhage suspected. Bright drainage = fresh bleeding, dark = old 3) Serosanguineous drainage - thin, watery drainage that is blood tinged 4) Purulent drainage - thick green, yellow, or brown drainage Drainage must leave wound for healing, otherwise edema occurs When large amts of drainage are expected drain is inserted

Types of incontinence - stress -urge -mixed - overflow book

1) Stress incontinence - leakage during exercise and certain movements that cause pressure on bladder (laughing, sneezing, etc) - loss is small 2) Urge incontinence (over-active bladder) - urine lost in response to a sudden, urgent need to void. Person cannot get to toilet in time - urinary frequency, urinary urgency, and night-time voiding common 3) Mixed incontinence - combination of stress and urge incontinence - many older women have 4) Over-flow incontinence - small amts of urine leak from full blader - person feels like bladder is not empty - dribbling, weak urine stream

Reasons for losing certification

1) Substance abuse or dependency 2) Abandoning, abusing or neglecting a person 3) Fraud or deceit 4) Violating professional boundaries 5) Giving unsafe care 6) Performing acts beyond the nursing assistant role 7) Misappropriation (stealing, theft) or mis-using property 8) Obtaining money or property from a patient or resident. This can be done through fraud, falsely representing oneself, or force 9) Being convicted of a crime 10) Failing to conform to the standards of nursing assistants 11) Putting patients and residents at risk for harm 12) Violating a person's privacy 13) Failing to maintain the confidentiality of patient or resident information

Enema solution types - tap - saline - SSE - small vol - oil-retention book

1) Tap water enema - obtained from faucet - may create fluid imbalance, only *1* given - More increase risk of excess fluid absorption - cleansing 2) Saline enema - solution of salt and water (1-2 tsp salt to 500-1000 mL tap water) - Body retains water from excess salt - cleansing, used fir children 3) Soapsuds enema (*SSE*) - For adults, 3-5 mL of castile soap added to 500-1000 mL tap - irritates bowel's mucous lining. Repeated enemas/ can damage bowel - cleansing 4) Small-volume enema - adult size has ~120 mL soln. Child size has ~60 mL soln - irritates/distends rectum to cause BM in about 5-10 min. retained until BM 5) Oil-retention enema - Has mineral, olive, or cottonseed oil. - adult size has ~120 mL soln. Child size has ~60 mL soln - relieve constipation and fecal impaction. Softens feces/lubricates rectum - retained for 30 min. REady to use *enemas until clear* order means enema given until return soln is clear and free of stools

How to provide assistance with ADLs

1) Verbal cues (prompt/hints) -brief, clear and concise directions that prompt the resident to do something. 2) Hand-over-hand technique -placing your hand over the resident's hand and guiding him/her to perform the desired action. 3) Coaching -gently urging or encouraging the resident to perform the task. 4) Pacing -allowing the resident to perform the task at his/her own rate of speed, without rushing. 5) Encouragement and/or support -giving emotional support. Provide positive reinforcement and praise. A positive attitude is import. Give the resident confidence that he/she can do the task.

Process of cleaning equipment

1) Wear PPE to clean items contaminated with bodily fluids, blood, secretions/excretions 2) Work from clean to dirty areas 3) Rinse in cold water to remove organic mater. Heat makes it harder to remove 4) Wash item in soap/hot water 5) Scrub thouroughly, rinse in warm water, dry 6) Disinfect item or send it to be sterilized 7) Disinfect equipment used and the sink 8) Discard PPE 9) Practice hand hygiene

Drainage measurement book

1) Weighing dressings before putting them on and after taken them out 2) Noting number and size of dressings with drainage - kind/amount of drainage - saturation - which parts of dressing - how many layers did it soak through 3) Measuring amt of drianage in collection container (for closed drainage - drain attached to suction, microbes can't enter)

Change garments:

1) When wet/soiled 2) AFter bathing 3) On admission and discharge Allow for personal choice/independence with garments Remove clothing from strong/good side first. Put clothing on weak side first

Patient rights (pg 14)

1) to be fully informed of his/her health condition. - You cannot give out info. Report request to the nurse. 2) to refuse treatment. - *treatment* = care provided to maintain/restore health and function, or to relieve symptoms 3) to personal privacy and to make their own choices. - protect them from exposure, allow private conversations/mail/phonecalls, etc - choose doctors, when to get up, how to spend time, choosing visitors, etc 4) to voice concerns, questions and complaints about treatment and care. 5) to work or perform services if he/she *wants* to do so. 6) to form and take part in resident groups. 7) to keep and use personal items. 8) to be free from verbal, sexual, physical and mental abuse. - free from *involuntary seclusion* (separation from others/confinement/ keeping them away from their room) 9) to quality of life. 10) to participate in activities that enhance each person's physical, mental and psycho-social well-being. 11) to a safe, clean, and comfortable and home-like setting 12) Right not to be restrained (physically, w/ drugs, etc)

Reporting/recording restraint info

1) type of restraint 2) Body parts restrained 3) Reason for application 4) Safety measures taken (call light, bed rails padded, etc) 5) Time you applied the restraint 6) Time you removed/released restraint + for how long 7) Person's vital signs 8) Skin color and condition 9) Care given when restraint was removed/for how long 10) Condition of limbs 11) Pulse felt in restrained part 12) Changes in patient behavior Report following complaints stat 1) Difficulty breathing 2) PAin, numbness, tingling in restrained part 3) A tight restraint

Focus your day + managing stress/burnout

1. Job safety - protect patients, residents, families, visitors, co-workers, and yourself 2. Planning your work - prioritize tasks to be done at certain times, others are done later or at the end of the shift > which person has greatest needs > Which task nurse/person needs done first > Tasks that need to be done at a certain time > Tasks that need to be done when shift starts/ends > Time to complete at ask < Help needed > Who can help and when 3. Meals and breaks - meals are 30 minutes, breaks are 15 minutes, leave and return on time 4. Managing Stress - stress is response/change in body caused by emotional, physical, social or economic factors. It's normal. Both good and bad stress - prolonged or frequent stress threatens physical and mental health. - Exercise, getting enough rest/sleep, eating healthy, and plan personal time for you will help. 5. Burnout - job stress which occurs over time. Results in > Physical/mental exhaustion > Doubting abilities > Doubting value of work - Keeping a positive attitude is important in a stressful occupation like healthcare - Focus on your patients and residents do not let anyone else pull you into their drama. Guard against burnout!

Adolescence

12-18 - Time between puberty and adulthood. There is rapid growth, physical, sexual, emotional, and social changes Developmental tasks 1) Accept changes in body/appearance 2) Develop appropriate relationships w/ others and begin to attract partners 3) Become independent from parents/adults 4) Prepare for marriage and family life 5) Prepare for a career 6) DEvelop morals, attitudes, and values needed to function in society ------------------- - Need ~9.5 hours of sleep due to rapid growth - Girls complete physical dev by 17 - Boys complete ~18-21 *Menarche* - first menstruation and start of menstrual cycles - Signals start of puberty. Pregnancy can now occur - Secondary sex characteristics appear *Ejaculation* - Marks onset of puberty in boys - Nocturnal emissions (Wet dreams) occur - Secondary sex characteristics --------------- - Seem awkward and clumsy due to uneven muscle/bone growth - Mood swings occur > Gradually manage better - Become independent of parents. - Require guidance and discipline. EMotional and financial support from parents - Confide in and seek advice from adults other than their parents - Begin to feel/show a *sexual orientation* > Sexual arousal or romantic attraction to other persons

Young adulthood dev skills

18-40 yr - little physical growth Developmental skills 1) Choosing education/career 2) Selecting a partner 3) Learning to live with a partner 4) Becoming a parent and raising children 5) Developing a satisfactory sex life - PArtners must learn to accommodate and adjust

Infant skills > 6 > 7 > 8

6 mos - Can bear weight when pulled to standing - Sit with support. Move around by rolling - Start to drink from cup - Smile at themselves in mirror - Respond to name - Make gurgling sounds - Babbles - MAkes sounds to voice pleasure/displeasure - Moves eyes towards sounds - Responds to changes in parent's voice - Pays attention to music/toy sounds 7 mos - crawling - can stand while holding onto support - Make sounds in response 8 mos - Can sit for long periods - CAn go from lying to sitting and vice versa - Pincer grasp develops (holding objects in thumb and index) - CAn pick up small foods. Drink from cup with handles

School age: developmental skills

6 to 9/10 years Developmental skills 1) Develop social/physical skill needed for play 2) Learn to get along with peers (persons of same age/bg) 3) Learn gender appropriate behaviors/attitudes 4) Learn basic reading, writing, and math 5) Develop conscience and morals 6) Develop a good feeling and attitude about oneself

Factors affecting pain: how - value/meaning of pain - Support - Culture - illness - age

6) The value or meaning of pain - to the person. some see it as weakness or serious illness. Some pain (like childbirth) brings pleasure. - Some pain seems useful (get attention/care) 7) Support from others - dealing with pain is often easier with family and friends offer comfort and support. 8) Culture - affects pain responses. In some cultures the person in pain is expected to remain stoic. 9) Illness - some diseases affect pain sensations. The person may not feel pain 10) Age - The effect of age on pain sensitivity is unclear. Some studies suggest a loss of pain perception with age, whereas other studies indicate either no change or an increase in pain sensitivity with age.

Late adulthood

65+ Developmental tasks 1) Adjust to decreased str and loss of health 2) Adjust to retirement/reduced income 3) Cope with partner's death 4) Develop new friends and relationships 5) Prepare for own death ------------------ oldest old = 85+

condom catheter

A condom catheter is a soft sheath that slides over the penis and is used to drains urine. - Condom catheters are changed daily after perineal care - *Only use elastic tape (in a spiral) to secure condom catheter. NEVER other tape. These don't expand and may cause damage to penis.* - leave about 1 inch at bottom. DO NOT let penis touch tip Must close drain

Special diets Clear liquids Full liquids Mechanical soft Bland Gluten free slides

A dietitian and speech therapist assess the resident/patient for diet and /or nutritional needs and abilities. *The doctor orders diets* Clear liquids - foods liquid at body temp and leave small amts of residue. Non irritating/gas forming - used after surgery, for acute illness, infection, nausea/vomiting, to prepare for GI exams Full liquids - Foods liquid at room temp/melt at body temp - advance from clear-liquid tiet fater surgery, for stomach irritaiotn, fever, nausea, and vomiting, persons unable to chew/swallow/digest solid foods Mechanical soft - semi-solid foods that are easily digested - advance from full liquid diet, chewing problems, GI disorders, infections - no raw fruits/veg Bland - Foods that are non-irritating and low in roughage; served at moderate temps. no strong spices/condiments - used for ulcers, gallbladder disorders, some intestinal disorders, after abdominal surgery - plain foods, veg, meat, etc - no fried/spicy foods Gluten free - Foods without gluten protein - for celiac disease - no foods containing wheat, barley, tricticale, or rye

Interacting/communicating with the blind person slides

Adjustments can be hard and long. - Identify yourself when you enter the room. - Do not touch the person until you have indicated your presence - Leave the person's belongings in the same place that you found them - Do not re-arrange furniture and equipment - Complete a safety check before leaving the room - Keep the call light within reach - Watch your terms—"Over there" verses "On your left side" - Provide a consistent meal-time setting - Guide the person to a seat by placing your guiding arm on the seat and allow the person to feel your arm down - Have the person wear comfortable shoes that fit correctly

Factors affecting Bowel movements (BMs)

Affect BM frequency, consistency, color, and odor 1) Privacy - lack of privacy can prevent a BM despite the urge. Odors and sounds are embarrassing 2) Habits - many people have a routine/habit when they have a bowel movement - easier when relaxed 3) Diet -high fiber foods - leave a residue for needed bulk to prevent constipation -other foods - milk and milk products can cause constipation in some and in others diarrhea 5) Fluids - feces contain water. Stool consistency depends on the amount of water absorbed in the colon. Not enough fluid intake can create an obstruction. 6) Activity - exercise and activity maintain muscle tone and stimulate peristalsis. Constipation is a risk from inactivity and bedrest 7) Medications - can prevent constipation and/or control diarrhea 8) Disability - some people cannot control bowel movements 9) Aging - affects bowel elimination, inactivity can slow peristalsis

Chemotherapy - effects - side effects - safety book

Affects whole body. Both cancerous and normal cells - drug stays in body for 3-7 days. Excreted effects - cure - shrinks tumor before surgery - slow growth - prevent spread - kill cells that break off of tumor - relieve symptoms side effects - alopecia - GI irritation (poor appetite, NVD, *stomatitis* = inflammation of mouth) - decreased blood cell production (bleeding, infection) - changes in thinking/memory/emotion Safety (non obvious stuff) - wash parts that come into contact with fluids/secretions/excretions (feces, etc) from person at once. soap + water - put lid down on toilet when flushing. Flush twice if children/pets are around - wash supplies (basins, bedpans, etc) at least once day with soap + water - double bag disposable products that come in contact with body fluids (pads, etc). - wash soiled linens asap/place in plastic bag - wash separately + twice

Healthcare agency standards and your role in meeting standards CErtification vs accreditation vs licensure

Agencies must meet standards set by federal/state governments and accrediting agencies. Standards relate to policies, procedures, and quality of care Your role: 1) Provide quality care 2) Protect person's rights 3) Provide for person's and your own safety 4) Help keep agency clean and safe 5) Act professionally 6) HAve good work ethics 7) Follow agency policies and procedures 8) Answer Qs honestly and completely ------------------ Licensure - agency must have state license to operate/provide care Certification - required to receive medicare and medicaid Accreditation - Voluntary. Signals quality and excellence

SUID (sudden unexpected infant death) book

Any sudden/unexpected death in infant younger than 1 year Most common causes: 1) SIDS (sudden infant death syndrome) - unexpected death between 1 month-1 yr of age (most between 1-4 mo). Usually during sleep 2) Accidental suffocation/strangulation in bed 3) Unknown Prevention - crib/sleep safety - breast feeding - offer pacifier for sleep (given after feeding well) - keep babies away from smoke (2nd hand, areas, etc) - Avoid products that claim to reduce SIDs risk - Vaccines *Prenatal care* - health care received while pregnant. Affects risk of SUID - avoid drugs, smoking, alcohol

HIV/AIDS - transmission book

Attacks immune system and destroys body's ability to fight disease - spread through body fluids (blood, semen, vaginal, rectal, breast milk). Not contact, sweat, etc - saliva may transfer if it contacts blood + through oral sex Main Transmission - sex (multiple partners, anal, vaginal) - sharing equipment used to inject drugs HIV can be transmitted at any stage and persons can be symptom free for 10+ years HIV Treated/controlled with drugs - AIDS cannot e controlled Follow standard precautions and blood borne pathogen standard Acute - "worst flu ever" for a few days to several weeks v clinical latency stage - HIV developing but mild to no symptoms v AIDs - immune system badly damaged HIV prevention - condoms - Pre/post exposure prophylaxis drugs (post w/i 3 days) - encouraging treatment, safe sex practices

Professional boundaries: List

Be: CDCC RHSP 1) caring - have concern for person 2) Dependable - keep obligations and promises 3) Considerate - respect feelings, be gentle and kind 4) Cheerful - interact with others pleasantly 5) Respectful - do not judge, condemn, or deny a patient dignity 6) Honest - accurately report errors, observations, or care 7) Self aware - know own feelings, strengths, weaknesses so you can better treat your patients 8) Patient - tolerate problems and delays w/o getting upset/annoyed. stay calm

Preventing falls: - Bed and chair alarms - Gait belts - assist the falling person (see skills quizlet for more info on use) slides

Bed and Chair Alarms - alert the staff when a person is moving from their bed or chair and staff can quickly assist patient/resident. Transfer/Gait Belts -is a device applied around the waist used to support a person who is unsteady or disabled. Assist the falling person, allow them to 'fall' down your leg safely and remain in sitting position until more help arrives. Call for help.

+ bedpans - standard - fracture > when to use

Bedpans are used by persons who can't be out of bed. - Women use bedpans for voiding and bowel movements - Men use them for bowel movements - Men void in a urinal Standard bedpan - wide rim placed under buttocks ----------------- Fracture pan - thin rim, shallow at one end (flat end placed under buttocks) - Used by: > Persons with casts > Persons in traction > Persons with limited back motion > Older persons with osteoporosis/arthritis > After spinal cord injury/surgery > After hip fracture > After hip replacement

Elderly living - board and care homes - adult care facilities - continuing care

Board and care homes - private homes adapted for group living - frat house Adult care facilities - private apartments designed for older people, with access for disabilities - medical services on call, daily check ins Continuing care retirement communities - Range from independent living units to 24 hour nursing care. Provide housing, activity, and health services

CArdiac rehabilitation book

CAD complications require rehab Two parts: 1) Exercise training (how to exercise safely, strengthn muscle and improve stamina) 2) Education counseling/training. Learns about: - heart condition - reducing risk of future problems - adjusting to new lifestyle -dealing with fears of the future

Fall risk factors slides

CAre setting 0} Restraint use 1} Bed height too low or too high 2} Floors: cluttered/wet/or uneven 3} Furniture out of place/setting unfamiliar ---------------------- PErson 4} Balance/cooridnation problems 5} Confusion/depression 6} Dizziness/on standing 7} Medication side effects > Low BP, drowsiness, fainting, unsteadiness, any risks listed here > Frequent urination, diarrhea 8} Elimination - voiding at night (nocturia) > Incontinence, frequency, urgency 9} Memory problems 10 } Weakness 11} Shoes that fit poorly 12} Vision problems 13} History of falls 14} AGe 65+ Anything physical/mental that affects space navigation (movement, memory, perception, etc)

•CPR (cardio-pulmonary-resuscitation) - chest compressions - airway book

CPR supports circulation and breathing. Involves: - chest compressions - airway - breathing - defibrilation Move person only if setting is unsafe Chest compressions (ratio 30:2) 1) Check for pulse on carotid artery near you (<10 sec) + any signs of breathing - Activate emergency response, then do CPR (adult) - or send someone 2) Use heel of hands. Remove clothing, put heel of hand in center of bare chest (between nipples on lower half of sternum) 3) Layer hands. arms straight, shoulders directly over hands, fingers interlocked. 4) Depress sternum 2 inches at a rate of 100-120/min. Allow chest to recoil - interruptions less than 10 sec Airway - place palm on forehead and tilt head back - place fingers of other hand under lower jaw and lift jaw - mouth should be slightly open Breathing - Each breath should take 1 second. 1 breath every 6 sec. You should see chest rise.

Conduct unbecoming of a nursing assistant

Can cause disciplinary action (including revoking of CNA certification) - described in OSBN division 63 Causes of disciplinary action: 1) Failure to maintain professional boundaries 2) Abusing or neglecting a person 3) Violating rights to privacy/confidentiality 4) Engaging in unacceptable behavior towards or around client. Includes: - derogatory names - derogatory/threatening gestures - profane language - offensive speech or language - showing disrespect to patients, residents, families, visitors, coworkers, or supervisors

Cardiovascular disorder risk - cannot and can change book

Cannot change - 45+ (M), 55+ (F) - men > women risk - race (black people more at risk) - family history Can change - being overweight (maybe) - stress - smoke/tobacco use - poor diet (fat, salt, sugar, cholesterol) - excessive alcohol - lack of exercise - BP - high blood cholesterol - diabetes

Cardiovascular disorder - hypertension > s&S slides

Cardiovascular (circulatory) system delivers blood to the body's cells. ◦ Problems can occur in the heart or blood vessels (arteries/veins) *Hypertension* (High BP) - the systolic pressure is 140mm Hg or higher or the diastolic pressure is 90mm Hg or higher. - Narrow blood vessels are a common cause - The heart pumps with more force to move blood through narrowed vessels - Known as the 'silent killer' hypertension can go unnoticed for many years Signs/Symptoms: ◦ Headache ◦ Blurred vision ◦ Dizziness (vertigo) ◦ Nose bleeds

Assisting with Tracheostomy care book

Care done daily or every 8-12 hrs to prevent infection, promote healing, and promote comfort Done as needed for excess secretions, soiled ties/collar, or soiled/moist dressings Care involves: 1) Cleanning inner cannula to remove mucus and keep airway patent. 2) Cleaning stoma to prevent infection and skin breakdown 3) Applying clean ties or a velcro collar. clean ties are applied before removing the used ones - hold outer cannula in place until nurse secures new collar/ties - must be secure but not tight (finger should slide under for adults, finger tip for children)

Catheter care

Catheter bags should be kept below the level of the bladder . - DO NOT hang drain bag on bedrail. When you turn or move the client the catheter must move with the person. The catheter should be emptied *at least once at the end of the shift.* Check it to be sure it does not need to be emptied more often. If the tubing becomes accidentally disconnected, apply gloves and immediately wipe the ends with alcohol, reconnect the tubing and notify the nurse. To clean a catheter , wipe from the meatus down the catheter at least 4 "

Cirrhosis book

Caused by chronic liver damage (especially due to alcohol abuse, hepatitis B/C, and extra fat). Scar tissue blocks blood flow Liver functions affecteD: - fighting infection - processing, storing,a nd delivering nutrients to body - cleaning blood of toxins, fats, cholesterol, and drugs - making proteins for blood clotting - producing bile for fat digestion S&S don't appear in early stages - weakness/fatigue - loss of appetite and weight loss - nausea - ascites (abdominal bloating from fluid build up) - edema in lower extremities - itching - spider-like blood vessels on skin - jaundice Infection, bruising, and bleeding occur. Blood vessels in esophagus and stomach burst, gallstones develop, toxins build up in brain treatment aimed at preventing scar tissue and treating complications - diuretic drugs ordered, low sodium diet needed - antibiotics for infection - alchol avoided and liver transplant needed care - use warm water with baking soda for bathing. decrease itching. lotion skin, no scratching - mouth care every 2 hrs and before meals - fluid restriction - semi fowlers/fowlers position - support arms with pillows - coughing/deep breathing exercises - obseve for decreased mental funct - measure vitals every 2-4 hrs and take weight daily

Fecal impaction

Causes abdominal discomfort, distension, nausea, cramping, and rectal pain - poor appetite and confusion in older persons Digital (finger) exam done to check for impaction in lower rectum - sometimes digital removal is done. lubricated finger hooked around stool, and finger and stool removed > check pulse before, during, and after digital removal. stop if pulse slowed/rhythm is irregular Vagus nerve can be stimulated - slows heart rate. very dangerous

Tumors - benign - malignant - metastasis slides

Cells reproduce for tissue growth and repair in an orderly way. Tumor: - a mass of abnormal cells that develops when cell division and growth are out of control *Benign tumors* - do not spread to other body parts. - They can be large but rarely threaten life - Don't usually grow back when removed *Malignant Tumors* - invade and destroy nearby issues. They can spread to other body parts. - They may be life-threatening - Can grown back after removal. *Metastasis* -is the spread of cancer to other body parts. Cancer cells break off of the tumor and travel to other body parts where a new tumor grows.

Cerebral Palsy slides

Cerebral Palsy (CP) is a group of disorders involving paralysis and injuries or abnormalities in the brain. Movement, learning, hearing, seeing, and thinking can be affected. It affects a persons ability to maintain balance and posture. CP results from brain damage or poor brain development before, during, or within 2 years after birth. There is no cure. Life long help, support, special services are needed. -------- book types 1) Spastic CP most common - spastic movements (uncontrolled contractions fo skeletal muscles) - 1 or both sides no cure - abnormal movements, unsteady gait, learning disabilities, delayed growth problems (790)

Ch 4 definitions: 2) Competent 4) Nursing task 5) Responsibility NCSBN

Ch 4 definitions: 2) Competent - Having necessary knowledge, ability, or skill to perform a task safely and sucessfully 4) Nursing task - Nursing care or function, procedure, activity, or work that can be delegated to CNAs (doesn't require RN's knowledge/judgement) 5) Responsibility - Duty or obligation to perform some act or function NCSBN (National Council of State Boards of Nursing)

Chronic obstructive pulmonary disease COPD - most important risk factor - effects slides

Chronic Obstructive Pulmonary Disease (COPD) - involves 2 disorders: Chronic Bronchitis and emphysema Theses disorders interfere with oxygen and carbon dioxide exchange - They obstruct airflow - Cigarette smoking is most important risk factor --------------- book Effects - airways/alveoli become less elastic - wals between alveoli destroyed (less surface area) - airway walls become thick, inflamed, and swollen - airway secretes more mucus, cloggin airway - frequent respiratory infections - chronic cough

COPD -chronic bronchitis - emphysema book

Chronic bronchitis - occurs after repeated episodes of bronchi inflammation - smoker's cough in morning is first symptom (dry then mucus cough. More frequent) Emphysema - alveoli enlarge, become less elastic, and don't expand normally - air gets trapped in alveoli, and air exchange can't occur - barrel chest develops over time due to air trapped inside - Shortness of breath and cough. At first only with exertion, then with rest. - Sputum may contain pus, fatigue common. - breathing easier when person sits upright and slightly forward

Physical changes of aging - circulatory - respiratory slide

Circulatory system ◦Heart pumps with less force/heart rate may slow/abnormal heart rhythms can occur > has to work harder and may be unable to meet needs ◦Number of red blood cells decrease - arteries narrow, are less elastic - poorer circulation care measures - moderate amount exercise, some avoid exertion exercise helps, but some with severe circulatory changes can't do this ------------------------- Respiratory system ◦Respiratory muscles weaken - difficult, labored, or painful breathing (dyspnea) may occur with activity breathing usually easier in semifowlers, activity helps, light linens, turned often if on bedrest

cleaning vs disinfection vs sterilization

Cleaning = reduces # microbes and removes organic matter - done in *dirty* utility room ------------------ *Disinfection* - Process of killing pathogens (but doesn't kill *spores*) > spores = bacteria w/ a hard shell. Killed by high temp only - *Disinfectant* = liquid chemical that can kill many pathogens (but not spores) > used on items such as BP cuffs, W/Cs, furniture, and commodes ------------------ Sterilization - Destroys all non pathogens, pathogens, and spores - Involves high temp (boiling water, rdiation, liquid/gas chemicals, dry heat, and *steam under pressure* (in autoclave)) > autoclave not used for plastic or rubber (destroyed This and disinfection done in clean areas

CLosed and open beds also occupied and surgical beds

Closed beds made for: 1) Nursing center residents/home care patients who are up for most or all the day - top linens folded back at bedtime - clean linens used as needed 2) New patients/residents - made after bed system is cleaned/disinfected Open bed = sheets have been fan folded for easy access. For: 1) Newly admitted persons arriving by w//c 2) Persons getting ready for bed 3) Persons who are out of bed for a short time Occupied bed - made when person is in it Surgical bed - made to transfer person from stretcher to bed. Kept in highest position

Comfortable Lighting book

Comfortable lighting: - Lessens glares -lets person control intensity, location, and direction of light - lets visually impaired persons maintain or increase independent functioning

Noise - comfortable sound lvls - decreasing noise lvls (slides)

Comfortable sound levels: 1) Do not interfere with hearing 2) Promote privacy as desired 3) Allows person to take part in social activities To decrease noise levels: 1) Control your voice 2) Handle equipment carefully 3) Keep equipment in good working order 4) Answer phones, CALL LIGHTS, and intercoms PROMPTLY

Terminally ill resident slides

Coming to grips with one's own mortality is a term describing the need to realize that everyone's life is finite, or has a timeline. End-of-life issues can become controversial, especially if family members or loved ones disagree with the resident's wishes. Terminally ill residents might receive Hospice Care while in the nursing home. They deserve the same level of care and comfort as other residents. Terminally ill residents must be treated HOLISTICALLY. Include their family in the care.

Hip fractures - risk factors - S&S - most common cause - post op complications book

Common in older persons Risk factors - 65+ years - gender (women) - osteoporosis - drugs (weaken bones/dizziness) - nutrition (calcium, vit D) - inactivity (activity needed to strengthen bone) -smoking and alcohol use (cause bone loss) Falls are the most common cause - also standing adn twisting S&S - Being unable to move after falling - severe hip/groin pain - shorter leg on injured side - turning leg outward on injured side Post op complications - pneumonia, UTI, thrombi. Pressure ulcers, constipation, confusion

Pressure ulcers - alt names - bony prominence > locations slides

Common names for an open wound on the skin caused by pressure. ◦ Pressure ulcers ◦ Decubitus ulcers ◦ Pressure sore ◦ Bed sore *bony prominence* (pressure points) - an area where the bone sticks out or projects from the flat surface of the body. Shoulder blades, elbows, back of hands, hips, spine, sacrum, knees, ankles, heels, and toes are bony prominences. - ears, thigh, elbow also at risk The *sacrum* is a major body part where pressure ulcers are likely to form *epidermal stripping* - removing epidermis as tape is removed from skin. Newborns at risk

Risk management: - Colored Wristbands

Communicate alerts/warnings. Printed text on band is useful in dim lighting + for colorblind people 1) REd - Allergy (stop) 2) Yellow - fall risk (caution) 3) Purple - Do not resuscitate (DNR) order ------------------- Agencies have others. To use properly: 1) Know colors used at agency 2) Check care plan/assignment sheet when you see a wristband 3) Do not confuse "Social cause" (ex. breast cancer awareness) w/ hospital wristbands 4) Check for wristbands on transfer patients. Other agencies may use different colors 5) Tell nurse if person needs a color coded wristband

Catheter: what to report

Complaints - report at once. Burning, pain, need to void, irritation - color, clarity, odor, and presence of particles or blood Signs of UTIs. Report the following at once: - fever - chills - flank pain/tenderness (area in back between ribs and hip - changes in urine (blood, smell, particles, cloudiness, oliguria) - change in mental or functional status (confusioin, decreased appetite, falls, decreased activity, tiredness) - urine leakage around catheter

Types of SCIs book

Complete and incomplete damage - complete = no sensor/muscle function below injury site - incomplete = some sensory and muscle function below lvl of injury Lumbar injuries - occur in lower back. Affect legs, results in *paraplegia* > Paralysis in legs, lower trunk, and pelvic organs Thoracic injuries - In middle and upper back. Function lost below chest. Paraplegia Cervical injuries - occur at neck. *tetraplegia/quadriplegia* occur > paralysis in arms, legs, trunk, and pelvic organs > reposition/turn every hours

Complications of cold applications Moist and dry cold applications slides

Complications of cold applications Cold applied for a long period of time makes the blood vessels dilate and can cause: - Pain - Burns or blisters - Reduced circulation - Damage to fragile skin ------------------ Moist and dry cold applications - Moist cold applications penetrate deeper than dry ones (must be warmer than dry) - cold compress = moist cold Dry - Ice bags - Ice collars - Ice gloves - Devices filled with crushed ice - Single use/ disposable - Re-usable

Child abuse - definition - forms signs on pg 50

Definition: Intentional harm/mistreatment of a child under 18. Involves: a) Any recent act/failure to act as parent/caregiver b) Act of failure results in death, serious harm, sexual abuse, or exploitation c) failure to act/act presents immediate or likely risk for harm ----------------------- Types 1) Physical 2) Neglect (failing to provide basic needs) a) physical (food, shelter, supervision) b) medical c) educational d) emotional (needs for affection/attention, allowing use of alcohol or drugs by child) 3) Sexual abuse a) rape/sexual assult b) molestation (sexual advances, forced sexual acts) c) incest d) child pornography e) child prostitution 4) Emotinal abuse - almost always prsent with other forms of abuse 5) Substance abuse - prenatal exposure, exposure to controlled substances, etc 6) Abandonment - parent's identity unknwon and child is left in circumstances where they experience serious harm - parent fails to maintain contact with/support child Report to nurse, give as much detail as possible.

Thermometers: electronic book

Devices used to measure temperature Electronic thermometers - battery operated, disposable covers used to prevent infection 1) Standard electronic thermometers - measure T at oral, rectal, and axillary sites in a few sec. Blue probe for oral/axillary, red for rectal 2) Tympanic membrane thermometers - measure at ear for 1-3 sec. Comfortable and noninvasive. - Fewer microbes in ear vs mouth/rectum = less chance of disease 3) Temporal arter thermometers - measure for 3-4 sec. Non invasive. Same temp as blood coming out of heart. - Use side of head that is exposed (not covered or that was on a pillow) 4) Digital thermometer - Measure at oral, rectal, and axillary sites. Temp measured in 6-60 sec 5) Pacifier thermometer - baby sucks on device for 90 sec *Use type and site as stated in care plan*

Digestive system

Digestive - *Digestion* - process through which food is broken down physically + chemically so it can be used by cells > Begins at mouth. Mechanically chew/grind and chemically use saliva to make swallowing easier > food is moved by *peristalsis* (involuntary muscle contractions in digestive system), down esophagus and through intestines alimentary canal (GI tract) extends from mouth to anus - made up of mouth, pharynx,, esophagus, stomach, small intestine (duodenum, jejunum, ileum), large intestine (ascending, transverse, descending, sigmoid), rectum, and anus - accessories are teeth, tongue, salivary glands, liver, gallbladder, pancreas - chyme is the mix of food and juices. bile produced in liver and stored in gallbladder is added to chyme at small intestine in duodenum - jejunum and ileum contain vili, which allow for absorption of digestive foods - colon absorbs most of water, the rest is known as feces

Directions for incentive spirometry slides

Directions for use. Have the person: 1. Sits on the side of the bed, in Fowler's position, or in a chair. 2. Places the spirometer upright. 3. Exhales normally. 4. Seals the lips around the mouthpiece. 5. Takes a slow, deep breath until the piston rises to the desired height. A marker on the spirometer shows the desired height. 6. Holds the breath for 3 to 5 seconds to keep the piston floating. 7. Removes the mouthpiece and exhales slowly. 8. Rests for a few seconds. 9. Repeats steps 3 through 8 at least 10 times. 10. Coughs after at least 10 breaths. 11. Repeats steps 1 through 10 at least every 1 to 2 hours while awake. You will mark the best inhalation, let the person rest if needed.

Persons with special needs - disabilities - behavior issues

Disabilities - can be acquired at any age - Head injuries that impair cognitive funct - Spinal cord injuries that impair movement - Blind patients - Comatose clients unable to respond, but can still feel/hear > use same courtesies you would for other patients (tell person time, place, your name, explain procedure, tell person when you leave, etc) Require knowledge/skill to meet the person's needs - attitude is important - treat them with respect adn dignity, like everyone else - treat them like adults --------------------

Disaster - disaster plan - bomb threats

Disaster plan accounts for > evacuation procedures if facility is damaged < discharing persons who can go home < Assigning staff/equipment to emergency area > Assigning staff to transport persons > CAlling off-duty staff to work Bomb threat - follow agency procedure

Thermometer: - disposable oral - temperature sensitive tape - glass > tip types > problems book

Disposable oral - chemical dots change color when heated (each dot has a different temp) - 45-60 sec Temperature sensitive tape - Changes color in response to body heat (15 sec). Tape applied to forehead Glass - Substance inside tube expands as it heats and rises in tube. - Long/slender tip, pear tip, and stubby tip used for oral and axillary temp. - rectal thermometers have stubby tips - Color coded at stem: Blue (oral axillary), red (rectal) - Reusable but have the following problems: > slow (3-10 min) > break easily, causing injury (rectum, bitten oral) > mercury (Hg) in oral can cause Hg poisoning

bathing an infant - nail care book

Do not need daily baths. 3 time s a week common. Pay special attention to creased areas (under arms, behind ears, around neck, genital area). Also between fingers and toes Baths are important times for stimulation, interaction, and development Two baths: 1) Sponge baths - used while umbilical stump is present. STUMP CANNOT get wet 2) Tub bath - given after site heals - 1 arm under baby shoulders. Thumb on shoulder, fingers below - support buttocks - water between 100-105 F - Room temp between 75-80 F (close doors and windows 20 min before) - Cannot leave baby alone, so gather everything before bath - keep face out of water --------- Nails kept short. - cut after bath or when baby is sleeping - toenails straight across, fingernails following natural shape of nail

TAking BP: guidelines - where not to take BP - how to slides

Do not take BP on arm: 1) With an IV infusion 2) With an arm cast 3) With a dialysis access site 4) On the side of breast surgery 5) That is injured --------------- book - Let person rest 10-20 minutes before taking BP - Measure sitting/lying - Apply cuff to bare skin, make sure it is snug - Check care plan/ask nurse for size of cuff to use - Make sure room is quiet - Place diaphragm of stethoscope firmly over brachial artery - Wait 30-60 sec before retaking a measurement - Tell nurse at once if you can't hear BP - First sound = systolic - When sound stops = diastolic

Special tests book

Doctor evaluates person's health using tests: Common: 1) Chest x ray 2) CBC 3) U/A (urinalysis) 4) Electrocardiogram (ECG/EKG) Others depend on person's condition/surgery Type and crossmatch - blood test for compatible donors + blood type

Patient info: surgery book

Doctor explains need for surgery. Shares: 1) Surgery, risks, complications 2) Risk for not having surgery 3) Who will do surgery 4) Date/time 5) Length of surgery Answers questions, gives care instructions

Skin prep: pre op book (591-592)

Doctor orders skin care + marks surgical site before pre-op drugs given: 1) Cleansing with antimicrobial soap 2) Clipping/removing hair at/around site - cream remover used or shaving (via skin prep kit) - shave in direction of hair growth Prep done in persons room or in OR

Protection devices: pressure ulcers book

Doctor orders these 1) Bed cradle - props up sheets and prevents pressure on lower extremities. Miter linens under bed 2) Heel/elbow protectors - made of cushioning materials. Fit shape of heels/elbows. Promote comfort and reduce shear/friction 3) Heel and foot elevators - raise heels/feet off bed, prevent pressure and foot drop 3) Gel/fluid-filled pads/cushions - Have pressure-relieving fluid/gel. USed for chairs and wheelchairs - device placed in fabric cover to protect sskin (2 colored sides to remind about repositioning) - treatment for pressure ulcers 4) *Special beds* - air mattress: some have air flow through mattress, distributing weight evenly. - Some allow repositioning w/o moving person (bed tilted, alignment maintained, little friction) - Some rotate constantly from side to side. Useful for persons with spinal cord injuries - egg crate - sheep skin - water mattress 5) Other - Pillows, trochanter rolls, foot-boards, other positioning devices. Maintain good alignment

Testing urine - what for book

Doctor orders type/frequency of tests - random urine specimens needed 1) Testing for pH - Normal pH = 4.6-8.0 - Changes due to illness, food, and drugs 2) Testing for blood - *Hematuria* = blood in urine - can be either seen or unseen (occult) 3) Testing for glucose and ketones - In diabetes, not enough insulin to store sugars, so sugar remains in blood. - *glucosuria/glycosuria* = sugar in urine - may also cause *ketones (ketone bodies, acetone)* in urine. Ketone = substances that appear in urine from rapid breakdown of fat for energy - Tests usually done 4 times a day (30 min before meals and at bedtime) - drugs given are based on these tests 4) Testing for infection - WBC can indicate UTI 5) testing for protein - Can signal kidney/other diseases

bottle feeding - forms - bottle prep book

Doctor prescribes formula. Three forms: 1) Ready to feed (just pour out of can. Refrigerate after opening, use in 24 hrs) 2) Powdered 3) Liquid concentrate To prep bottle: 1) Boil water 2) Follow instructions exactly 3) Gently shake/swirl to mix 4) Place bottle under cold water/ice water to cool. Do not let water touch lid 5) Check temp by placing drops on inside of wrist. Warm, not hot. When washing, make sure to squeeze warm water through nipple to remove soap Baby fed every 2-4 hrs, on demand. - stops eating when satisfied. they like warmed formula - warm in pan or on stove (low heat, turn often) - use warm running tap water alternatively. turn to warm evenly. Sprinkle a few drops in wrist. - DO NOT wait for it to warm on its own. microbes. also don't microwave (burns) - Make sure neck/nipple are always full. Prevent air getting into stomach. - do not prop bottle and lay baby on ground for feeding. - if not finished, discard remaining formula Solid foods given at 4-6 months

Bedrest - function - types slides

Doctors order bedrest to treat a health problem. It is ordered to: 1) reduce physical activity 2) reduce pain 3) encourage rest 4) regain strength 5) promote healing. Types: 1) Strict bedrest -everything is done for the person 2) Bedrest -person performs some ADL's (eating, oral hygiene, bathing, shaving, hair) 3) Bedrest with bathroom privileges (bedrest with BRP) - the person can use the bathroom for elimination - Alt: commode privileges (can use commode

Down syndrome - cause - features - intervention slides

Down Syndrome - a genetic cause of mild to moderate intellectual disabilities. Intellectual disabilities occur in childhood and are characterized by substantial limitations in cognitive functioning and adaptive skills. Normally each cell has 23 chromosomes. In DS an additional chromosome at the time of conception occurs, with a DS child having 47 chromosomes. The DS child has certain features caused by the extra chromosome. • Small head, ears, and mouth, • Eyes that slant upward, • Flat face and wide, flat nose, • Short, wide neck, • Large tongue, • Short stature, • Short, wide hands with short fingers, • Poor muscle tone Intervention includes support + specific strategies to promote the development, education, interests, and well-being of the child or adult. - Individualized supports can improve daily functioning, promote self determination, and strengthen their abilities.

dry heat applications slides

Dry heat applications - is when water is not in contact with the skin Hot packs • Single use (disposable) and re-usable packs • Aquathermia pad K-pad - Electrical device with tubes inside the pad area which are filled with distilled water. Heated water flows through pad - do not secure with pins. can puncture pad - do not place pad under a body part (heat can't escape) - temp usually 105 - do not apply over topical medicated areas ------------- - stays at desired temp longer - doesn't penetrate as deep, needs to be hotter

Heat and cold applications - info from nurse/care plan (temp ranges pg 637) slides

During ANY APPLICATION OF HOT OR COLD *Protect the skin* - cover the application with towel/pillowcase *Always check every 5 minutes - Leave on no longer than 15-20 minutes* other notes (book) - measure temp - don't apply very hot (106 F+) (nurse does this) - less extreme temps for persons at risk - don't let person change temp of application - can do work, but stay nearby to monitor -------------- slides Obtain information from nurse and care plan about • Type of application • Application site • How often to apply

Physical comfort: dying - nutrition - elimination - person's room slides

End-Of-Life Care *Nutrition* - loss of appetite is common with end of life care. Nausea and vomiting can occur. Make sure person is clean and mouth care given. *Elimination* - urinary and fecal incontinence may occur. Use incontinence products and protectors as needed. *Person's room* - provide a comfortable and pleasant room. The person and family arrange the room as they wish. The room should reflect the person's choices.

ROM exercises - How many - Active vs passive vs active-assistive slides

Exercise helps prevent complications of bedrest. They need exercise more frequently - OBRA requires an assessment/care plan regarding ROM *Range of Motion Exercises (ROM)* - the movement of a joint to the extent possible, without causing pain. - They are done *at least 3 times for each joint and usually are done at least 2 times a day.* ------------- Active ROM exercises - done by person Passive ROM exercises - you move joints through ROM Active-assistive - person does motions with some help - expose only body parts being exercised. Cover person for warmth/privacy - Move slowly, do not force joint beyond current ROM or to pain

Factors affecting pain: how - Experience - anxiety - rest/sleep - attention - personal/family duties

Factors affecting pain: - Experience - anxiety - rest/sleep - attention - personal/family duties - value/meaning of pain - Support - Culture - illness - age -------------------- 1) Past experience - how pain was handled or occurred in the past 2) Anxiety - pain can cause anxiety, anxiety is fear, worry and concern. anxiety can make pain worse. knowing what to expect can help 3) Rest and sleep - restore energy and reduce body demands. The body repairs itself, without rest/sleep pain seems worse. 4) Attention - thinking about the pain makes it worse - often seems worse at night for this reason 5) Personal and family duties - taking care of family/having other duties can cause people to deny pain

Factors affecting vital signs

Factors which can affect your vital signs include: - Activity, Age, Anger, Anxiety, - Drugs, Eating, Exercise, Fear, - Sex, Illness, Noise, Pain, - Sleep, Smoking, Stress, Weather, and Weight.

Rights and Respect: ALR slides

Federal and state laws protect the person's rights. - The person has the right to quality of life, privacy, protection against restraint and abuse, and access to information. - The person also has rights regarding the transfer, discharge, or eviction from the ALR. Take pride in protecting the person's rights.

Nail and footcare

Feet are easily injured and infected. Also collect odors/injuries. - Poor circulation in older, diabetic, and patients with vascular diseases are at risk for slower healing/infection. Soak for 5-10 min (fingers) or 15-20 (feet) - do other tasks in room during this time. - apply lotion/petroleum jelly (but put on nonskid footwear, cause feet can be slippery after) - clip straight across, then file You don't trim toenails for persons who: - have diabetes - poor circulation - take anticoagulents - hav very thick nails/ingrown nails

Disaster and fire - Fire and oxygen book only

Fire and oxygen - Needs a spark/flame, material that will burn, O2 - Some patients use O2, and precautions must be taken > No smoking signs > SMoking materials removed > Wool/synthetic fabrics that cause static electricity are removed > Cotton gown/pajamas worn by patient > easily ignited materials removed (nail polish remover, grease, oil, etc)

Basic Emergency Care - goal - sudden cardiac arrest (definition) - respiratory arrest (definition) slides

First aid is the emergency care given to an ill or injured person before medical help arrives. The goals of first aid are to: • Prevent death • Prevent injuries from becoming worse ----------------- *Sudden cardiac arrest* (cardiac arrest) - when the heart stops suddenly and without warning Signs 1) No response 2) No breathing or agonal gasps/respirations. Gasping breaths 3) No pulse Person's skin is cool, pale, and gray. Hands only CPR - for civillians not trained in CPR - just call 911 and push hard and fast in center of chest Recovery position -------------------- *Respiratory arrest* - when breathing stops but heart action continues for several minutes Adult: 1 breath / 5-6 sec Infant/children: 1 breath / 3-4 sec Breath given over 1 second. Check pulse every 2 min. If no pulse (or pulse < 60 in infant/child) begin CPR

Hearing aids - Other hearing devices book

Fit inside or behind - make sounds louder, don't cure problems - Makes sounds louder - Battery-operated If it doesn't work properly: - Check if it's on - Check battery position - Insert new battery - Clean the hearing aid - turned off when not used + battery removed - Hair spray and other hair care products avoided. Can damage the device ------------------- Other hearing devices - phone amplifying devices - Extension bells make phones ring louder - Telecommnications Relay Service (TRS) > Disabilities act requires that states provide access > TV and radio listening systems > Smoke alarms with strobe lights > Doorbells can be heard throughout house

Before using a mechanical lift ^ slide

For patients/residents too heavy for frail to stand, or for staff to move. Before using a mechanical lift: • Be trained in the use of it • Sling, straps, hooks and chains must be in good repair • Person's weight must not exceed the lift's capacity • You need enough help - at least 2 (4 for full sling) staff members are needed for most lifts • Follow agency policy and the person's care plan • Ensure the patients arms are folded across their chest *Lock the wheels, project confidence, explain the procedure to the patient*

Diarrhea - causes -CNA role

Frequent passage of liquid stools - feces move through intestines rapidly, water cannot be absorbed - treated with drugs and diet that reduce peristalsis Causes - infections, drugs, irritating foods, microbes - children and older persons at risk (report diarrhea at once) - children/infants have large amts of body water, older persons have less CNA role: - Assist with elimination needs promptly - Dispose of stools promptly (prevent odors and microbe spread) - Give good skincare (risk for pressure ulcers plus skin breakdown) - Replace fluids (dehydration common) > Lower BP, dizziness, confusion, fast pulse, respiration, dark urine, pale/flushed dry skin, coated tongue

Protecting the skin - friction, shearing - reducing both

Friction - is the rubbing of 1 surface against another Shearing - is when the skin sticks to a surface while muscles slide in the direction the body is moving To reduce friction and shearing: 1) Roll the person 2) Use friction-reducing devices - Lift sheets, baxter pads, turning pads - Slide boards

Traumatic brain injury (TBI) - causes - those at risk - S&S book

From violent injury to brain - falls - traffic accidents - violence - sports - explosive blasts/combat injuries Results in torn/bruised brain tissue - men, infants, children, YA, and older adults at risk > major cause of death in newborns Permanent brain damage likely - cognitive problems - sensory problems - communication problems - emotional problems - changes in LOC > coma > vegetative state (has sleep/wake cycles, may open eyes, make sounds, or move) > brain death (no brain funct, heart beats still. No reflex, movement, or respirations)

Functional status (slide) - transfers

Functional Status - ability to perform ADL required to meet basic needs, health, and well being - found on the patients kardex Lvl 0: Independent -person can turn, reposition, sit up, stand without help Lvl 1: Supervision -staff to observe, encourage/remind or cue the person Lvl 2: Limited assistance -person moves alone, staff supports the person - staff may put assist devices in place Lvl 3: Extensive assistance -person needs help to turn, reposition, sit up, move - person can bear some weight, but need help - two or more staff provide weight bearing help - friction reducing devices used, or lifts are used Lvl 4: Total dependence -person is unable to sit up, lie down, turn or reposition without help/assistance - cannot stand - mechanical lift or friction reducing device is used

>label requirements for chemicals book

HCS requires following on label: - name and contact info of manufacturer/responsible party - product ID (chemical name, code number, batch number)) - Signal word which communicates severity of a potential hazard > danger (severe) > Warning (less severe) - Hazard statements: describe nature of hazard (harmful if swallowed, etc)

complications of wound healing - hemorrhage and shock - infection dehiscence - evisceration slides

HEMORRHAGE AND SHOCK Hemorrhage - is the excessive loss of blood in a short time. Can be internal or external. Shock —results when tissues and organs do not get enough blood Infection - wound appears reddened and has drainAGE - FEVER. PAIN. tenderness --------- Dehiscence - separating of wound layers (sutures split) - skin or underlying tissues. Common in abdominal wounds Evisceration - Wound separates and organs protrude - cough, vomiting, and abdominal distension )swelling) put stress on wound - described as popping open - emergency, report at once

Grooming

Hair care, shaving, nail and foot care and clean garments prevent infection and promote comfort. - provide when needed and before visitors arrive Usually the hair is washed in the shower For long hair that is tangled, start at one section and work from the bottom up. Conditioners and detanglers can be helpful. *NEver cut the person's hair*

Harassment SExual harassment Bullying

Harassment - To trouble, torment, offend, or worry a person by one's behavior or comments You have the right not to be harassed as a student or employee ------------- Sexual harassment - unwanted sexual behaviors/comments ------------ Bullying - repeated attacks or threats of fear/distres/harm

Head injury slides

Head Injuries - Result from trauma to the scalp, skull, or brain > Open wound = skull broken - Injuries range from minor bump to a serious, life-threatening brain injury > onset of symptoms can be immediate or delayed - Traffic accidents, falls, assaults, and gunshots are common causes

Health, hygiene and appearance (work ethics)

Health 1) Diet 2) Sleep and rest 3) Body mechanics 4) Eyes 5) SMoking (avoid) 6) Drugs (only those ordered) 7) Alcohol (do not go to work drunk) Hygiene - bathe regularly, brush teeth, etc Appearance - appearance reflects on workplace - see pg 57

HIPAA Wrongful use of electronic communications Phone communcations

Health insurance portability and accountability act of 1996 Protects the privacy and security of a persons health information. - *Protected health information* refers to identifying information and information about the person's health care that is maintained or sent in any form, (paper, electronic or oral). *Failure to follow HIPAA rules can result in fines penalties, and criminal actions including jail time.* ---------------- 9) Wrongful use of electronic communications: - email, texts, faxes, websites, video sites, and social media sites (face-book, twitter, etc.) - can be dismissal from program, and loss of jobs, loss of your certification. - never take photo or video, broadcast, or post/share patient info - only share info with people directly involved in care --------------- Phone communication - You will answer phones at the nurses' station or person's room - write down info about caller + message (phone number, name) as well as date and time - Do not share PHI over phone

Hepatitis - types (A-E) slides

Hepatitis is the inflammation and infection of the liver caused by a virus. - some have no symptoms There are 5 types of hepatitis: *Hepatitis A* - spread by food, water or object contaminated by feces > raw shellfish from sewage water, sex/close contact > has vaccine > preschoolers and school age children at risk (especially daycare) *Hepatitis B* - spread through infected blood or body fluids > vaccine available *Hepatitis C* - spread through blood (mostly contaminated tools) > can spread with no symptoms. REsults in serious liver disease/damage > treated with drugs *Hepatitis D and E* - D occur only in people infected with Hepatitis B - E spread through food/water contaminate with feces

Other cancer therapies - hormone - biological - other book

Hormone - block/remove hormones cancers need to grow - prevent production, remove endocrine glands. can affect fertility Biological - Helps immune system fight cancer + protects body from side effects Other - stem cell transplants (recover blood cells lost form therapy) - complementary and alternative medicine (CAM) > complementary used with standard treatments > alternative used instead of standard treatments - massage therapy, herbs, vitamins, diets, spiritual healing, acupuncture

Personal hygiene and daily care - AM care - Morning care - Evening care

Hygiene promotes comfort, safety, and health. - Skin is body's 1st line of defense. Intact skin prevents microbes from entering the body and causing infection. Good hygiene is relaxing and increases circulation. ---------------------- Daily care follows residents/patients routines and habits. Hygiene measures are done before and after meals, and at bedtime. *Early Morning care (AM care)* - routine care given before breakfast *Morning care* -care given after breakfast. Hygiene measures are more thorough at this time *Evening care (PM care)* -care given in the evening at bedtime.

Intimate partner violence (IPV)

IPV = physical, sexual, or psychological harm by a current or former partner or spouse - 1 partner has power Types: 1) Physical 2) Sexual - physical, intoxicated, abusive 3) Threats of physical/sexual violence 4) Psychological and emotional - humiliation, controlling victim actions, purposefully embarrassing victim, isolating victim, denying resources, stalking, etc

Repositioning in chair/wheelchair

If a patient/resident needs to be repositioned in chair/wheelchair • Ask co-worker to help you • Lock the wheel brakes on the wheelchair • Have person stand up with gait belt • Move buttocks back to hit chair and have them sit *do not pull person from behind the chair or wheelchair. Always be in front*

You are assisting Mr. Park with feeding. He begins to cough loudly. He can speak a few words. You hear wheezing between breaths. What do you do? Mr. Park is suddenly unable to cough, speak, or breathe. What do you do?

If he can still speak, mild obstruction. Let him try and cough it out, but stay nearby. If he stops coughing/breathing, activate emergency services and begin abdominal thrusts (doing them upward below xyphoid process) until object is removed or he loses consciousness.

Moving fallen person from floor: Manual lift

If manual lift is required: 1) Use good body mechanics 2) Roll person onto side and position assistive device (drawsheet, etc). Avoid reaching across person 3) Have 2+ staff on each side of person. More needed for larger person 4) Bend knees, not back. Do not twist To manual lift: 1) Kneel on 1 knee 2) Grasp assistive device 3) Lift smoothly with legs as you stand. STand together on count of 3, do not bend back

Oxygen set up book

If not humidified, oxygen dries mucous membranes - distilled water added to humidifier, creating water vapor. bubbles to produce Flowmeter attached to humidifier. o2 device attached to humidifier - DO NOT set flowmeter or apply O2 device. call nurse to start - DO NOT adjust flow rate Low flow rates (1-2 L/min) via cannula aren't usually humidified

Viral hemorrhagic fevers - common themes - ebola book

Illnesses caused by viruses. Mild to severe, but share common points: 1) affect many organs 2) Damage blood vessels 3) Impair body's ability to regulate itself 4) May cause hemorrhage Have a natural reservoir in animals/insects. Found in same area as host. Most have no cure/drug treatment Ebola - severe and deadly. - S&S appear in 2-21 days. Last 8-10 days. Include > fever, severe headache, muscle pain > weakness, fatigue, diarrhea, vomiting - hemorrhage + bleeding rash - abdominal pain Contagious once symptoms appear - spread through blood/body fluids, contaminated objects, and infected animals - No cure/vaccine

Intellectual disabilities - adaptive behaviors - social skills -ADLs slides

Impaired in people with intellectual disabilities *Adaptive behaviors* - skills needed to function in everyday life - to live, work, and play. They include: • Communication, • Reading, • Writing, • Money concepts and managing money *Social skills* - are interpersonal skills, responsibility, not being tricked by others, following rules, obeying laws ADLs - the things we do each day - eating, dressing, mobility, elimination, preparing meals, taking drugs, using the phone, using transportation, housekeeping, job skills, and maintaining a safe setting

Diapering infant book

In first 1-2 days, newborns have *meconium* stools (dark green to black, tarry, bowel movement) By day 3-4 - stolls greenish brown to yellow brown and less sticky By day 4-5: 1) Breast fed babies have yellow/seedy looking stools. Soft or runny. BM with every feeding 2) Bottle fed babies have yellow to brown stools. Fewer stools than breastfed and firmer stools (1-2 a day) Elimination pattern develops over time. Diarrhea is a serious problem in infants Wet 6-8+ times a day - diapers changed when soiled. Cloth diapers: - rinse soiled cloth diaper (feces into toilet) - store in diaper pail. Wash daily-every 2 days - do not wash with other laundry. use baby laundry detergent - put through wash cycle again to remove all detergent Disposable - don't flush down toilet

Kidney failure Acute kidney failure - causes - progress slides

In kidney/renal failure, the kidneys don't function/ are impaired. - Waste products are not removed from the blood. - Fluid is retained. Heart failure and hypertension easily result. - The person becomes very ill and may die. *Acute Kidney Failure* - sudden. Blood flow to the kidneys is severely decreased. Causes: severe injury, bleeding, heart attack, burns, infection and severe allergic reactions. At first Oliguria occurs - this is a scant amount of urine. Output < 400mL in 24 hours - a few days to 2+ weeks Then *diuresis* occurs - process of passing large amounts of urine 1000mL-3000mL or more a day. - Kidney function improves and returns to normal during the recovery phase which can take up to 1 year. Some people develop chronic kidney failure.

Fecal incontinence - causes - person needs

Inability to control passage of feces/gas through anus Causes - intestinal diseases - nervous system diseases/injuries - fecal impaction/diarrhea - drugs - chronic illness - aging - mental health problems/dementia (may not recognize need for BM) - unanswered call lights - not able to get to bathroom in time (mobility, distance, etc) - Problems removing clothes - Not finding bathroom Person needs - Bowel training - help with elimination after meals/every 2-3 hrs - Incontinence products to stay clean - Good skincare

Incentive spirometry slides

Incentive means to encourage, and a spirometer is a machine that measures the amount (volume) of air inhaled. *This provides a measurement of lung volume.* *The goal is to improve lung function and prevent complications such as pneumonia by expanding and clearing their lungs.* In using the Incentive spirometer the client must inhale as deeply as possible and hold their breath for 3-5 seconds. Like yawning or sighing, the breathing is long, slow, and deep. This moves air deep into the lungs loosens secretions, improving O2 and CO2 exchange between the alveoli and capillaries.

The nursing team (who)

Includes several workers who focus on physical, social, emotional, and spiritual needs of the person and family *1) RN (registered nurse)* - Has completed a 2 or 4 yr program and passed a license test - DON is this. Can also be charge nurses - DON is Responsible for entire nursing staff and care. charge nurses are responsible for the care during that shift - Assess, diagnose, plan, implement, and evaluate nursing care. Delegate and provide care to the nursing team. - Teach person and family how to improve health and independence. - Cannot prescribe treatments or drugs *2) LPN (licensed practical nurse)* - Has completed a practical nursing program (~1 yr) and passed a licensing test - aka *licensed vocational nurse (LVN) in CA and TX only - Fewer responsibilities/functiosn than RNs. Need little supervision when person's condition is stable and care is simple. Assist RNs w/ acutely ill persons + complex procedures *3) Nursing assistant* - HAs completed a nursing assistant training program and passed the state certification to become a CNA - Perform delegated tasks *under the supervision of licensed nurse* All must have a license recognized by the state

Incontinence and pressure ulcers risk factors

Incontinence and pressure ulcers have a number of risk factors in common - Both conditions are most likely in patients/residents w/ poor health and problems with mobility - Residents/patients vulnerable to skin injury from pressure and shearing are also vulnerable to skin damage from moisture, friction and irritants

Physical changes of aging - integument slide

Integument ◦Skin loses elasticity, str, and fatty tissue. more fragile > Wrinkles appear > thins and sags ◦Fewer nerve endings - Greater risk for burns (do not use hot water botles/heating pads) ◦More sensitive to cold ◦Decreased sensitivity to pain - Increased risk for skin breakdown, skin tears, pressure ulcers, bruising, delayed healing > Skin blood vessels fragile - Cleaning less frequent, gentle soaps used - Creams/lotions prevent drying

Bed safety - hospital bed system - entrapment - persons at greatest risk book

Involves *hospital bed system* - the bed frame and its parts (mattress, bed rails, head and foot boards, and bed attachments) Entrapment - getting caught, trapped, or entangled in spaces created by bed rails, mattress, bed frame, head-board, or foot-board (7 zones) Persons at risk: 1) Older 2) Frail 3) Confused/disoriented 4) Restless 5) HAve uncontrolled body moveemnts 6) Have poor muscle control 7) Are small 8) Are restrained

*Perineal care*

Involves cleaning the genital and anal areas. - done daily during bath + when soiled Work from the urethral to the anal area - for uncircumcised males, be sure to retract the foreskin. - Promote safety and comfort - Check water temperature, too hot can burn perineal area - Follow Standard Precautions - Protect privacy - Allow the resident/patient to perform as much of the care as they can Scripts: "Mr. xx, I'll give you time to finish your bath. Please wash your genital and rectal areas. Signal for me when you're done or need help." "Mrs. xx, next I'll clean between your legs. I'll keep you covered with the bath blanket and tell you before I touch you. Please let me know if you feel any pain or discomfort."

Risk management - intent - safety issues

Involves controlling/IDing risks + safety hazards Intent: 1) PRotect everyone in agency 2) Protect agency property 3) Protect person's valuables 3) PRevent accidents and injuries ------------------ Deal with the following safety issues: 1) Accident adn fire prevention 2) NEgligence and malpractice 3) Abuse 4) Workplace violence 5) Federal + state requirements

Professionalism

Involves following laws, being ethical, having good work ethics, and having the skills to do your work Laws = rules Ethics = knowing right vs. wrong conduct

Integumentary system

Largest system in the body 2 layers 1) Epidermis - Contains living and dead cells. Avascular. Contains pigment, has few nerve endings. 2) Dermis - Deeper living layer made of connective tissue. Contains blood vessels, nerves, sweat glands, oil glands, and hair roots These layers are supported by subcutaneous tissue (thick layer of fat and CT) ---------------------- Appendages of skin 1) Hair - Protects organs from dust, insects, and foreign objects 2) Nails - Protect tips of finger and does 3) Sweat glands (sudoriferous glands) - Help body regulate temp 4) Oil glands (sebaceous glands) - Lie near hair shafts. Secrete oily substances, keepign hair/skin soft and shiny ---------------------- Functions: 1) Protection a) Prevents entry of microbes/substances from entry b) Abrasions, etc 2) Prevent excess water loss 3) Protects organs from injury 4) Sensory - Contains nerve endings 5) Helps regulate body temp - dilate to cool, constrict to retain 6) Store fat and water

Preventing lead and carbon book only

Lead - A strong poison that can injure brain, nervous system, RBCs, kidneys, liver, teeth, and bones - Affect mental functioning, affect learning and behavior problems Enters through 1) Inhaling dust (windowsills) 2) Ingestion - toys, lead paint chips (railings, etc), water Children between 6 mos and 6 yrs are at high risk for lead poisoning and affect growth/development Prevention: - Open windows from top - Discourage chewing on non-food items - Run cold water run for 1-2 mins before drinking water or using it for cooking. - Limit contact with hobbies related to lead (paints, pottery, welding, etc)

pulse oximetry: how it works slides

Light beams on 1 side of the sensor pass through tissues. A detector on the other side measures the amount of light passing through the tissues. With this information, the oximeter measures the O2 concentration. It tells us what percentage of the oxygen we breath in, is transported to the oximetry site. ------ oximetry alarm sounds if: - o2 concentration is low - pulse rate is too fast or slow - other problems occur ^report at once

Effects of stroke on a person slides

Loss of face, hand, arm, leg or body control May neglect one side of their body (called neglect) dysphagia Aphasia or slurred/slow speech Urinary/bowel problems Behavior changes Impaired memory, changes in thought process Depression and frustration Changing emotions, (crying easily, or mood swings sometimes no reason) rehab starts at once

Lymphatic disorders -lymphedema - lymphoma slides

Lymph is transported through the lymph system. It contains WBC's, proteins and fats. This system helps remove the extra water from cells to prevent swelling, fights infection, and absorbs fat from the digestive system to transport to the bloodstream. The spleen is the largest structure of the lymphatic system *Lymphedema* -is the buildup of lymph in the tissues causing edema (swelling) - Damage to the lymph system cannot be reversed so treatment is to reduce symptoms. > caused by cancer, infection, removal of lymph nodes, scar tissue, absent/abnormal lymph nodes *Lymphoma* - is a cancer involving cells in the immune system

Lymphatic system

Lymphatic - Complex network that transports lymph throughout body. > drains excess fluids and returns it to blood (maintain fluid balance) > Produces lymphocytes > Absorbs fats from intestines and transports them to blood - Contains proteins, fats, and WBCs - Lymphatic vessels (lymphatic capillaries > lymphatic venules > right lymphatic duct >thoracic duct > blood near neck) - Right lymphatic duct collects lymph from right arm, right head/neck/chest - Empties into vein on right side of neck - Thoraccic duct collects lymph from pelvis, abdomen, lower chest, and rest of body Lymph nodes - Found in neck, chest, abdomen, groin, pelvis - swell when producing lymphocytes to fight infection - Filter bacteria, cancer cells, and damaged cells (prevents circulation of these thru the body) Thymus - T lymphocytes develop here Tonsils - back of throat. Adenoids are behind nose - Trap microorganisms Spleen - Largest structure. Rich blood supply a) filter/remove bacteria b) destroys old RBCs c) recycles iron from Hb d) Stores blood, then returns it to circulatory system when needed

Preventing orthostatic hypotension book

Measure BP, PR with person supine When putting person in fowler's, helping person sit, helping person stand, helping person sit/walk: - ask about weakness, spots in vision, dizziness. Keep person in position for a bit, if symptoms occur return person to sitting/lower position to prevent falls

Temperature sites (488): - people not used for - baseline + ranges basic sites on slide

Mouth (P.O.) - normal range 97.6-99.6 F (baseline 98.6) > Not used for people under 4-5 yrs > not for people who are unconscious or confused, or have seizures/ are receiving oxygen Ear (Tympanic) - normal range 98.6 - used for confused persons - pull ear up and back Axillary (Armpit) - Less reliable than others. Dry before taking temp - normal range 96.6-98.6 (baseline 97.6) Temporal artery (forehead) - Normal 99.6 - used for confused persons Rectal - normal range 98.6-100.6 F (baseline 99.6) > children under 3 > Not used with heart disease (vagal nerve) or confused persons - Insert 1/2 inch - Not used if there are conditions/injuries associated with the area

Muscular system

Muscles 500+ muscles - tendons connect muscle for bone - Sphincters open/close passages > Pyloric sphincter (stomach to small intestine (duodenum)) > Anal sphincter > Urethral sphincter Types 1) Skeletal (voluntary) 2) Smooth (involuntary) 3) Cardiac (heart - involuntary) -------------- Functions 1) Move body parts 2) Maintain posture/muscle tone 3) Produce body heat

Arthritis - rheumatoid - osteoarthritis slides

Musculo-skeletal disorders Affect movement - Injury and aging are common causes - Daily living, social activities and quality of life are affected. *Arthritis* - means join inflammation - Pain, swelling, stiffness, and reduced range of motion occur in affected joints *Osteoarthritis* -cartilage covering the ends of bones wears away > often in hands, knees, hips, spine *Rheumatoid arthritis* - autoimmune disease/RA attacks the lining of the joint/wrist and finger joints commonly affected. Bilateral effect > fever, fatigue > sometimes decreases RBC, dry eyes/mouth, inflammation of blood vessels, lungs and heart

Restraints - what are they - enablers vs restraints -types and why

Must try all appropriate alternatives before using restraint - generally involve meeting needs for comfort, diversions, etc Only used for *medical symptoms* (indications/characteristics of physical or psychological conditions) Restraints can be anything that impairs a person from moving freely (physical: gait belt, rails; chemicals, etc) - chemical restraints are drugs/dosages that a) control behavior/restrict movement, and b) are not standard treatment for person's condition *Enablers* - device that limits freedom of movement but is used to promote independence, comfort, or safety - things that are restraints can also be enablers, depending on circumstances (ex. bed rails asked for and used to help with movement) ----------------- Types: 1) Wrist (risk for pulling out devices, scratches/peels at skin/wound) 2) Mitt (prevent finger use, allow arm movements. same use as wrist) 3) Belt - To prevent injuries from falls or for positioning during medical treatment - person can't get out of bed or chair. roll belt may allow turning side to side 4) Vest/jacket restraints - nurse only - Same purpose as belt restraints 5) Elbow splints - used to limit elbow bending in children - prevent scratching/touching incision. Pulling out tubes If you don't know how to apply a certain restraint, tell the nurse so and ask them to show you + watch you do it

Comfort measures: feeding tubes

NPO, so dry lips/mouth, and sore throat cause discomfort Common measures (every 2 hrs awake): - oral hygiene - lip lubricant - mouth rinsing - sometimes gum/hard candy allowed Can also irritate nose - clean nose every 4-8 hrs - secure tube to nose using tape/tube holder. do not retape (irritating) - secure tube to person's garment at shoulder area (prevents pulling/dangling > loop rubber band around tube then pin it to garment > tape to garment

Preparing person for examination book

Need informed consent for exam 1) Provide for privacy - draw curtain - have person put on gown 2) Have person void (allows for feeling organs) 3) Obtain urine specimine 4) Measure vital signs, wgt, height, O2 concentration 5) Drape person using paper drape, bath blanket, sheet, or drawsheet 6) Position person for exam

Abnormal respirations Tachypnea Bradypnea Apnea Hypoventilation Hyperventilation Dyspnea Orthopnea slides

Normal adult breathe 12 to 20 times per minute, Normal respirations are easy, full, regular, and effective Tachypnea - rapid breathing (20+/min) - caused by fever,e xercise, pain, pregnancy, airway obstruction, hypoxemia (reduced amt of o2 in blood) Bradypnea - slow breathing (less than 12/min) - Drug overdose and nervous sytem disorders cause it Apnea - lack of breathing - cardiac arrest and respiratory arrest Hypoventilation - slow, shallow, and sometimes irregular ventilation - lung disorders affecting alveoli, obesity, airway obstruction, and drug side effects cause Hyperventilation - fast breathing - asthma, emphysema, infection, fever, nervous ssytem disorders, hypoxia, anxiety, pain, and drugs cause Dyspnea - difficult, labored, or painful breathing - heart disease and anxiety cause Orthopnea - breathing deeply and comfortably only while sitting - caused by emphysema, asthma, pneumonia, angina, and other heart/respiratory disorders

Urine observations to make: + normal urine

Normal urine: - pale yellow, straw-colored or amber. - clear with no particles - A faint odor is normal *Observe urine for color, clarity, odor, amount, particles, and blood* - report complaints of urgency, burning, dysuria, etc

Special fluid orders NPO Encourage fluids Restrict fluids Thickened liquids

Nothing by mouth NPO - remove the water pitcher and cup from the room - Person can't eat or drink - Ordered before/after surgery (6-10 hrs), before some lab tests/diagnostic procedures, and to treat certain illnesses - Need frequent oral hygiene Encourage fluids - person drinks more fluid, as stated by order. Fluids kept within person's reach Restrict fluids - Fluids limited (small containers/amts). WAter removed from room and kept out of sight - need frequent oral hygiene to keep mouth moist Thickened liquids - Thickener added to all fluids

Other unit items

OVerbed table - Can be rolled and adjusted for height - Place only clean adn sterile items on table, NEVER bedpans, urinals, or soiled linen. Should always be in reach Bedside stand - Used for personal items and personal care equipment (used for hygiene/elimination) - Top drawr = money, eyeglasses, books, etc - Top or middle shelf used for personal care items (soap, powder, lotion, deodorant, towels, PJs, bath blankt, washcloth) - Kidney/emesis basin stored in top drawer, middle drawer, or on top shelf - Bedpan/cover, urinal, and TP are stored on lower shelf or in bottom drawer - Stand top often used for personal care items, cards, photos, clock, etc - place only clean, sterile items on bedside stand. Never bedpans, urinals, or soiled linens... Person must be able to reach things in closet

Autoimmune disorders - celiac disease - graves disease - lupus - MS slides

Occur when the immune system attacks the body's own healthy cells, tissues, and organs. Celiac Disease - person cannot tolerate gluten Graves' Disease - thyroid gland produces excess amounts of thyroid hormone - bulging eyes Lupus - damage the joints, skin, kidneys, heart, lungs, and other body parts - butterfly rash on face Multiple sclerosis - the covering of the nerve fibers is destroyed so nerve impulses cannot be sent to the brain in the same way

Restraint alternatives

Often there are causes and reasons for harmful behaviors. Trying to find out what the behavior means can prevent restraint use. Physical needs 1} Is the person in pain, ill, or injured? 2} Is the person short of breath? Are cells getting enough oxygen? 5} Is clothing or a wound dressing tight and causing discomfort? 6} Are body fluids, secretions, excretions causing the skin discomfort? 7} Is the person too hot/cold? Hungry or thirsty? 8} Does the person have trouble communicating? Safety/security needs 3} Is the person afraid in a new setting? 4} Does the person need to use the restroom? Belonging needs 9) Is diversion provided 10) Families/friends call --------------------- What is the nursing assistant's job to help identify and provide alternatives? - Nurse tries to find out what harmful behaviors mean

Factors that affect oxygen needs slides

Oxygen is a tasteless, odorless, and colorless gas. *It is a drug and requires a doctors order!!!!!* - you DO NOT alter amount *Factors that affect oxygen needs:* 1) Circulatory system - narrowed vessels affect blood flow 2) Red blood cell count - RBC's contain hemoglobin, hemoglobin picks up and transports oxygen through out the body - bone marrow issues or bleeding can cause low #s 3) Nervous system - diseases and injury can affect respiratory muscles - when o2 lacking or co2 in excess, breathing increases 4) Aging - respiratory muscles weaken 5) Exercise - oxygen needs increase with exercise 6) Fever - oxygen needs increase and respiratory rate and depth increase 7) Pain - oxygen needs increase 8) Medications - some depress the respiratory system, slowing respirations - *respiratory depression* = slow, weak respirations at less than 12/min - *respiratory arrest* = breathing stops 9) Smoking - affects oxygen intake and exchange 10) Allergies - mucous membranes in the upper airway swell. severe swelling can close the airway. 11) Nutrition - body needs iron and vitamins to produce RBC's --- 12) Pullutants - harmful substances that can damage lungs 13) Alcohol - depresses brain. Excess reduces cough reflex and increases risk of aspiration

Risk management: personal belongings

PAtient belongings are often sent home with family. A list of belongings is completed For valuables: - Valuables envelope used for jewelry and money (describes each item) > HAve person watch. seal and sign envelop like personal belonging's list - Count money with person - Give envelope to nurse Some items (assistive devices, electronic devices, money etc) are kept at beside - THese are listed in person's record.

Burping a baby book

Pat/rub baby's back with circular motions for 2-3 minutes Positions 1) Over the shoulder - place clean towel/diaper on shoulder (protects from spit up milk) 2) On lap - hold towel in front of baby. Support infant head/neck for 1st 3 months!!! 3) On baby's stomach - place clean diaper/towel on lap where head will be. Position baby on your lap with stomach down

Incontinence associated dermatitis slides

Patients/residents at risk for *Incontinence Associated Dermatitis* put them at risk for pressure ulcer development - inflammation of skin due to repeated exposure to urine and fecal material - manifests as redness with or w/o blistering + skin erosion

ALR services slides

People choose assisted living for many reasons. - Many need some help. - Many like the social interaction with other residents. The ALR's activities and services offer other benefits. They promote independence, and assist as needed, while allowing as much privacy and personal choice as possible. Residents are urged to take part in activity and recreational programs. - Social, physical, and community activities promote well-being and independence. Follow the resident's service plan. -------------

Measuring food intake

Percentage of food eaten-intake ranges from 0 to 100%. To measure intake, compare what was served to what is left and ESTIMATE how much is missing. Example; if they eat ½ of their meat, ½ of their vegetable and ½ of their desert - they ate ½ of their meal

Tracheostomy cont: book

Permanent when larynx is surgically removed - Cancer, airway injury, long term coma, spinal cord injuries, and diseases causing weakness or paralysis of the respiratory muscles 3 parts: 1) Obturator - has round end, used to guide outer cannula (tube) - then it's removed and taped to wall/bedside stand in case tracheostomy falls out 2) Outer cannula - secured in place with ties around neck/a Velcro collar - not removed. Keeps tracheostomy patent - call for nurse at once if it falls out 3) Inner cannula - inserted into outer cannula and locked in place. Removed for cleaning and mucus removal - keeps airway patent

Anxiety disorders - phobias slides

Phobia means an intense fear. The person has an intense fear of an object, situation, or activity that has little or no actual danger. The person avoids what is feared. When faced with the fear, the person has high anxiety and cannot function --------- book common phobias - open/crowded//public places, being in pain/seeing others in pain, aquaphobia, claustrophobia, uncleanliness, nyctophobia, pyrophobia, xenophobia (strangers)

Dating violence

Physical, sexual, psychological, emotional violence. Stalking - Often begins with teasing/name calling - Occurs frequently (10% of HS sreported being physically hurt), 25% reported experiencing a form of dating violence Consequences: - Doing poorly in school, using substances, suicide attempts, fighting, violence in future relationships Teens at risk: - Approve of using threats/violence to get their way or express anger/frustration - CAnnot manage anger/frustration - HAve violent peers - Have conflict w/ a partner - Have multiple sexual partners - Have a friend invovled in dating violence - ARe depressed or anxious - Witness violence at home/in community - History of aggressive behavior or bullying

Positioning post op slides

Positioning the person: - For easy comfortable breathing - To prevent stress on the incision - To prevent aspiration HOB raised slightly when supine reposition every 1-2 hrs to prevent respiratory/circulatory complications Nurse tells you what positions and when to reposition. Assist nurse, but tasks may be delegated if person is stable

PTSD slides

Post-Traumatic Stress Disorder - (PTSD) occurs after a terrifying event. - There was physical harm or the threat of physical harm. - can develop at any age. *flashback* = reliving the trauma in thoughts during the day and in nightmares during sleep. - Flashbacks are common. - may involve images, sounds, smells, or feelings. S&S usually develop about 3 months after the event. Some people recover within 6 months. it lasts longer in other people. The condition may become chronic. S&S on 760

Measurements and observations post op - when/what vitals are taken - voiding slides

Post-operative (after surgery) vital signs BP,TPR with o2 saturation are done (596): - Every 15 minutes until the person's condition is stable (refer to the nurse) - Every 30 minutes for 1 to 2 hours (recover from anesthesia) - Every 1 hour for 4 hours - Then every 4 hours Doctor orders pat to be moved to their room when: - VS are stable - Respiratory funct good - person can respond/call for help The patient *must* void within 8 hours after surgery - Intake and Output is monitored

Care of the mother (postpartum) - timeframe - lochia - episiostomy book

Postpartum = care after childbirth - starts with birth of baby, ends 6 weeks later as body returns to normal state Involution of uterus = uterus returning to pre-pregnant size If mother doesn't breast feed, period returns in 4-6 weeks. - Breast feeding is NOT an effective method of birth control Vaginal discharge (*lochia*) occurs - blood and other matter left in uterus. Changes in color and decreases as time goes on 1) Lochia rubra (dark/bright red blood, first 3-4 days) 2) Lochia serosa (pinkish-brown. lasts 10 days) 3) Lochia alba (continues for 10-14+ days after birth) Lochia increases with breast feeding/activity. Normal lochia smells like menstrual flow (foul smelling = infection) - perineal care important - sanitary napkins should NOT saturate within 1 hr. indicates a problem *episiostomy* - Incision into perineum that some mothers have. Increases size of vaginal opening for baby. sutured after delivery - sitz baths ordered by doctor C-section - when baby must be delivered to save its or mom's life - if baby is too large or in abnormal position - mother has transmittable vaginal infection - normal vaginal delivery difficult

Prefix vs. root vs. suffix

Prefix - root - suffix Prefixes and suffixes change meaning of word Root is the basic meaning of the word Ex. Olig - scant, small amount, Uria - urine Oliguria = small amount of urine

Preparing the room - what to do slides

Preparing the room - Admission paper work to be filled out , gather equipment for Vital Signs and weight/height > urine specimen, make list of clothing/personal belongings, etc - Lower the bed to a safe and comfortable level, and attach the call light - orient person and family to area The nursing assistant needs to: 1) Use good communication skills - Avoid 'pat' answers like "It will be okay", - Use touch to provide comfort 2) Introduce the person to the staff/roommate 3) Wish the person well as you leave 4) Make sure they know how and where their call light is located

Pressure ulcer slides

Pressure ulcer - is a localized injury to the skin and/or underlying tissue, usually over a bony prominence. - result of pressure or pressure + shearing. - develops in 2-6 hr It can be any lesion caused by unrelieved pressure that results in damage to underlying tissues. Unrelieved pressure squeezes tiny blood vessels - the squeezing or pressure prevents blood flow to the skin and underlying tissues. - Oxygen and nutrients cannot get to the cells. - Skin and tissues die as a result. - friction causes open area. Limited blood flow causes skin/tissue death

Emergency care for seizures book

Protect person from injury - activate EMS - don't leave person alone - lower person to floor - note time seizure started - pplace something soft under person's head (pillow, your lap, jacket, etc) - remove glassess and loosen tight jewelry/clothing from neck - turn person (and head) to side - do not put anything between person's teeth - do not try to stop seizure or control person's movements - Move furniture, equipment, and sharp objects away from person. - not time when it ends - make sure mouth is clear of food, fluids, and saliva after seizure - provide BLS if person isn't breathing after seizure

Safely moving the person - what to know

Provide comfort and avoid causing pain Nursing Assistants need to know: (see orders) 1) The person's functional status -ability to perform ADL's 2) The number of staff needed 3) What equipment + procedure to use -gait belt, lift

Turning persons in bed

Provides safety and comfort - Use good body mechanics to turn a person in a bed - The person must be in good alignment - this helps prevent musculo-skeletal injuries, skin breakdown, and pressure ulcers -Use pillows as directed to support the person in the side-lying position. - Make sure the person's face, nose, and mouth are not obstructed by a pillow or other device

You measure a patient's vital signs. The pulse is 110. The respiratory rate is 24. The oral temperature is 100.8°F. You think you heard the blood pressure at 86/52. You are unsure of the measurement. What will you do? Which, if any, of these vital signs are abnormal? What must you do?

Pulse is elevated (normal range 60-100) Respiratory rate elevated (normal range 12-20) Oral temp elevated (normal range 97.6-99.6 F (baseline 98.6)) Normal range BP = (120-90)/(80-60) - this range is low. Retake reading after waiting 60 seconds Report to nurse at once if these have changed from before

Flow rate book

RN figures out flow rate - doctor orders amt of fluid to infuse + amount of time to give it in *flow rate* = # drops per minute (gtt/min) or milliliters per hour (mL/hr) - count - Can change with position, kinked tubes, or lying on tube *gtt* = drops ------------ Clamp or electronic pump sets flow rate - NEVER change position of clamp or adjust any controls on IV pumps Tell RN if: - no fluid is drippping - rate is too fast/slow - bag is empty/close to empty All tubes should be labeled with purpose. View in good lighting.

Successful rehabilitation - To promote quality of life... slides

Rehabilitation is a team effort. - The person is the key team member. The team meets often to discuss the person's progress. - focus is on progress. Successful rehabilitation and restorative care improves quality of life. A hopeful - winning outlook is needed. *To promote quality of life:* 1) Protect the right of privacy 2) Encourage personal choice 3) Protect the right to be free from abuse and mistreatment 4) Learn to deal with their anger/frustration 5) Encourage activities 6) Provide a safe setting 7) Show patience, understanding and sensitivity 8) do not pity person/give sympathy

Reporting signs and symptoms of pain - what to include

Rely on what a person tells you. Promptly report any information that you collect about the pain. - use person's own words ------------------ Your assessment should include: 1) *Location* - where is the pain, have you had it before 2) *Intensity* - mild, moderate or severe (can use Wong-Baker faces or 0-10 scale) 3) *Description* (535) - burning, stabbing 4) *Onset and duration* - when did it start, how long has it lasted 5) *Factors causing the pain* - moving or turning (what makes it better/worse) 6) *Factors affecting the pain* - what makes the pain better or worse 7) *Vital signs* - measure pulse, respirations, and blood pressure - Vital signs tend to increase with pain - faster HR and breathing, higher BP 8) *Other signs and symptoms* - does the person have other symptoms, Dizziness, nausea, vomiting, weakness, numbness or tingling

What to report: personal hygiene - at once - perenial care

Report at once - bleeding - skin breakdown signs - discharge from vagina/urinary tract - unusual odors - changes from prior observations Perenial care - odors - redness, swelling, discharge, bleeding, or iritation - complaints of pain, burning, or other discomfort - signs of urinary/fecal incontinence

Cast observations to report at once book

Report at once - pain - swelling + tight cast (reduced blood flow) - pale skin - cyanosis - odor (infection) - inability to move fingers/toes (pressure on a nerve) - numbness - temp changes (cool = circulation, hot = inflammation) - drainage (infection or bleeding - Chills, fever, nausea, vomiting (infection)

Foodborne illness: signs book

Report signs at once - abdominal cramps/pain - backache - breathing problems - chills - diarrhea - droopy eyelids - fever - headache - muscle pain - nausea - speaking problems - swallowing problems - double vision - vomiting

Admission process: patient fears/concerns slides

Residents/patients have concerns and fears about: 1) Where to go, what to do and what to expect 2) Never returning home 3) Who gives care, how care is given, and if correct care is given 4) Getting meals 5) Finding the bathroom 6) How to get help 7) Being abused 8) Strange sight and sounds 9) Being apart from family and friends 10) Leaving home and possessions behind

What to note for respirations + normal respirations slides

Respirations are normally quiet, effortless and regular. - Both sides of the chest rise and fall equally. - The healthy adult has 12 to 20 respirations per minute. - if respirations are regular - if both sides of chest rise equally - depth - any pain/difficulty breathing - abnormal respiratory patterns

effects of retained secretions + routes used for suctioning book

Retained secretions: 1) Obstruct air flow into and out of the airway 2) Provide an environment for microbes 3) Interfere with o2 and co2 exchange Routes used: 1) Oro-pharyngeal - suction catheter passed through mouth to pharynx. 2) Naso pharyngeal - Suction catheter passed through nose into pharynx 3) Lower airway - catheter passed through ET or tracheostomy tube - lungs hyperventilated before suctioning using ET or tracheostomy tube (given extra breaths)

Autoimmune disorders - rheumatoid arthritis - type 1 diabetes - inflammatory bowel disease - hashimoto's disease slides

Rheumatoid arthritis - attacks the lining of joints Type 1 diabetes - occurs primarily in children . Pancreas produces little or no insulin Inflammatory bowel disease - chronic inflammation of the GI tract. --------- Hashimoto's disease - thyroid gland doesn't produce enough hormone

Arthritis - risk - treatment book

Risk - aging, overweight, gender (women), joint injury, family history Treatment - no cure. similar treatments - pain/swelling control - heat and cold - exercise (for flexibility + weight control) - Rest and joint care - Assistive devices (canes, splints) - Weight control (reduces stress on weight bearing joints) - Healthy lifestyle - Safety (fall prevention, ADL assistance) - joint replacement surgery (*arthroplasty*) > to relieve pain, restore joint function, or correct a deformed joint >Incentive spirometry and deep-breathing + coughing, elastic stockings, measures to protect hip (715), long handled devices for reaching things

osteoporosis risk prevention book

Risk - family history - being thin/small - eating disorders - tobacco use - alcoholism - lack of exercise - bedrest - immobility PRevetion - estrogen + calcium/vitamin supplements - exercising weight bearing joints - no smoking/limited alcohol - back supports or corsets for posture - safety measures to prevent falls/accidents - good body mechanics - safe moving, transfer, and positioning procedures

stroke - risk factors - S&S slides

Risk factors - high BP - smoking heart disease - diabetes - high cholesterol - TIAs - 55+ yrs - Being over-weight - lack of physical activity - family history Signs and symptoms can occur suddenly: ◦ nausea/vomiting ◦ *Hemiplegia* - paralysis on 1 side of the body ◦ Memory loss/inability to speak ◦Seizures - loss of bladder control - noisy breathing - high BP - slow pulse - redness of face

Risk factors: cancer slides

Risk factors for cancer: - Age (older) - Tobacco/smoking (2nd hand too) - Radiation - Infections - Immuno-suppressive drugs - Alcohol - Diet > fruits may protect from some, diet high in fat/protein/red meat/calories may increase risk - Hormones (estrogen + progesterone) - Obesity - Environment

TPN observations

Risk for infection, fluid and blood sugar imbalances - fever, chills, other signs of infection - signs and symptoms of sugar imbalances - chest pain - difffiuclty breathing/SoB - cough - nausea nd vomiting - diarrhea - thirst - rapit HR or irregular heartbeat - weakness/fatigue - sweating - pallor (pale skin) - trembling - confusion/behavior changes

Fall risks

Risk of falling increases with age - 65+ yr olds at risk, 1/3 of them fall each year - History of falls increase risk of falling again > Fear of falling can further loss of function, depression, feelings of helplessness, and social isolation - Falls are the most common accident in nursing centers + main cause of injury-related deaths - Hip fractures and head trauma from falls increases risk of death

Bladder training - bladder retraining - prompted voiding - habit training - catheter clamping book

Rules for normal elimination are followed, normal position for urinating assumed if possible. Plan may include: 1) Bladder retraining (blader rehab) - person needs to: > Resist/ignore strong desire to urinate > Postpone/delay voiding > Urinate following a schedule rather than urge to void 2) Prompted voiding - person voids at scheduled times. Person is taught to: > Recognize when bladder is full > Recognize need to void > ASk for help > Respond when prompted to void 3) Habit training/scheduled voiding - Voiding scheduled at regular times to match person's habits (~3-4 hours). 4) Catheter clamping - catheter clamped to prevent urine flow from bladder. Usually clamped for 1 hr, then 3-4 hrs. Urine drains when catheter is unclamped.

Multiple sclerosis - S&S book

S&S - blurred/double vision, blindness in 1 eye - muscle weakness in extremities - balance/coordination problems - tingling, pricking, or numb sensations - partial or complete paralysis - pain - speech problems - tremors -diziness -concentration, attention, emmory,a nd judgement issues - depression - bladder + sexual function problems - hearing loss fatigue

CHF - signs and symptoms - aspects of care you assist with book

S&S - dyspnea (worse with exertion/lying down) - sputum (white, pink, blood-tinged, foamy) - cough - wheezing/gurgling lung sounds - confusion -dizziness - fainting -fatigue -weakness -pallor -nocturia -nausea -appetite: decreased - swelling (feet, ankles, legs, abdomen, neck veins) - weight gain - rapid and irregular pulse Care you assist with: - promoting rest/activity - I&O recording - measure wgt dily - Pulse O2 - restrict fluids - promote low sodium, fat, and cholesterol diet - prevent skin breakdown and pressure ulcers - assisting with ROM - assist with transfers/ambulation - assist with self care - maintain good alignment - apply elastic stockings

Hepatitis - S&S - persons at risk (A-E) book

S&S - jaundice - fatigue - abdominal/joint pain - loss of appetite - NVD - light/clay colored BMs - dark urine - fever - headache - itching - weight loss - skin rash At risk: A - international travellers - persons living with/having sex with infected person - people living in areas where children aren't routinely vaccinated - day-care children and staff (during outbreaks) - MlM - drug users B - persons living with/having sex with infected person - MlM - multiple sex partners - injection drug users - immigrants/children of immigrants from areas with high rates of hepatitis B - infants born to infected mothers - hemodialysis patients - persons who received blood/blood products before 1987 - international travellers C - injection drug users - those who have sex with infected persons - mulitple sex partners - health care workers - infants of infected mothers - nonsterile tattoos/piercings - hemodialysis patients - person receiving blood/blood products before 1992 - People who received blood clotting factors made before 1987 D - people who live with/have sex with infected person - persons who received blood/blood products before 1987 E - international travelers - people living in areas where outbreaks are common - people living with/having sex with infected persons

Fracture - S&S - reduction - fixation book

S&S - pain - swelling - loss of function/movement - movement where it shouldn't happen - abnormal position of part (deformity) - bruising at fracture site -bleeding Treatment - reduction and fixation (bone ends brought into and held in normal position) Reduction = bone moved back into place. External or internal - open reduction = bone surgically exposed and moved into alignment - closed reduction = bone not exposed Fixation - Bone held in place. External or internal - External = pins, screws, or wires set into bone above and below fracture. Held in place by a ring or bar outside skin. Removed after healing. - Internal = Nails, rods, pins, screws, plates, or wires surgically placed to keep bone in place. Device is under skin.

SDS + handling a chemical spill book

Safety data sheet (SDS) - name and common names - hazards - chemical ingredients - first aid measures - fire fighting measures - accidental release measures - safe handling/storage measures - exposure controls and personal protection matters Check SDS before using substance, cleaning up a leak or spill, disposing of substance CAll for nurse about a leak or spill stat. Do not leave spill unattended

Shaving

Safety razors or electric razors can be used. - safety have blades and can cause nicks/cuts Soften the hair before shaving with a warm cloth, soap, or shaving cream. *If a resident or patient is on ANTICOAGULANTS (a medication that prevents blood clots) only an electric razor can be used.* - safety razor also not used with older persons or persons with dementia Direction - safety face + underarms: shave in direction of hair growth - safety ankles: shave up from ankles (against hair growth) - Electric shave against hair growth Report nicks, cuts, and irritation at once

You are a student in the clinical setting. You need to practice the bathing skill. A nursing assistant and an older resident are preparing for a bath. You introduce yourself and ask if you can assist. The resident says: "Cindy always gives me my bath." The nursing assistant says: "You don't have any modesty left at your age. The student can give your bath today." The resident is quiet. What will you do?

Say that the resident has a choice in the matter and ask if the nursing assistant can give them their bath

Feeding times: tube feeding

Scheduled feedings - aka intermittent. Feeding times are scheduled - at least 4/day. Usualy 8-12 oz given over 30 min (similar to normal eating pattern) - Formula inserted, then end of feeding tube clamped to prevent fluid from exiting and air from entering. Continuous feedings - usually given over 24 hours via feeding pump - keeps going

Schizophrenia slides

Schizophrenia means split mind. The person's thinking and emotions are not in balance. This is a severe, chronic, disabling brain disorder which involves: *Psychosis* - a severe mental impairment where the person can't identify reality *Hallucinations* - seeing, hearing, smelling or feeling things that are not real (voices most common) *Delusions* - false beliefs *Delusions of grandeur* - belief that they are superman , or someone famous *Delusions of persecution* - believe someone is out to get them , or others are plotting against them or spying on them *Thought disorders* - the person has trouble organizing or connecting thoughts logically. *Movement disorders* - agitated body movements, repeating motions over and over. Emotional or behavioral problems - no motivation or emotion, neglect personal hygiene, withdraw socially Cognitive problems - they may have trouble paying attention or understanding or remembering information. Symptoms make it hard for the person to perform daily tasks.

Physical changes of aging - senses slide

Senses also affected - touch/sensitivity to pain and pressure reduced. heat/cold too - Increases risk for injury > protect older persons > follow heat/cold safety measures > watch for signs of skin breakdown > give good skin care > prevent skin tears/pressure ulcers ----------- Taste adn smell dull, decreasing appetite. sweet and salty lost first Eye - Pupil less able to respond to light. Poor dark vision + adjustment - more farsighted (less close vision) > fall risk - less tear secretion Eardrums atrophy, less sensitived to high-pitched sounds - wax harder and thicker, easily impacted (wedged in ear) => hearing loss

Sexually transmitted diseases slides

Sexual activities involve the structures and functions of the reproductive system. *Sexually transmitted disease (STD)* is spread by oral, vaginal or anal sex. STD's are also spread through skin breaks, by contact with infected body fluids (blood, semen, salvia) or by contaminated blood or needles. Standard Precautions and Blood-borne Pathogen Standard are followed. (pg 755 for diseases)

SExuality slides

Sexuality Sex - is the physical activities involving the body and reproductive organs. Sexuality - is the physical, emotional, social, cultural, and spiritual factors that affect a person's feelings and attitudes about his/her sex. Sexuality involves the personality of the body - how a person behaves, thinks, dresses, and responds to others. Love, affection and intimacy are needed throughout life. - Older people love, fall in love, hold hands and embrace. Allow for privacy for residents/patients.

Communicating with the health team: Shift report

Shift report given at end of shift to oncoming shift - Report care given during shift, person's condition (including changes), and changes to nurse/doctor's orders - *Include both subjective and objective info* *Subjective info (Symptom)* - what the resident/patient states "I have a headache" - Includes symptoms you *can't see* (ex *pain or feelings*) *Objective info (Sign)* - Observable and measurable data which can be seen, heard, or felt externally - ex. high temperature, vital signs, skin temp/moisture, vomiting, blood, etc

Skin tears + causes slides

Skin Tears - is a break or tip in the outer layers of the skin. The epidermis (top skin layer) separates from the underlying tissues. - common in hands/arms/lower legs older persons Causes: ◦ Friction/shearing ◦ Falls, or bumping body part ◦ Holding arm/leg too tight ◦ Removing tape/adhesives ◦ Bathing, dressing/other tasks ◦ Pulling buttons, zippers across fragile skin ◦ Jewelry/rings/watches across fragile skin ◦ Long or jagged fingernails Skin tears are painful—portals of entry for infection. - report at once

Skin disorders - definition - shingles slides

Skin disorders vary greatly in symptoms and severity. - can be temporary or permanent, and may be painless or painful. - Some have situational causes, while others may be genetic. Some skin conditions are minor, and others can be life-threatening. *Shingles* - caused by the same virus that causes chicken pox. Hides in nerve tissue. Person who have had chicken pox at risk for shingles. Also those with weakened immune systems/stress - Most common in person over 50 years of age - Pain is mild to intense. Itching is common - infectious until it crusts over. antiviral drugs and pain relief drugs used - healing in 3-5 weeks

Slings - types - contamination

Slings come in various forms (padded, unpadded, mesh, etc) and are used depending on lift type and person Types 1) Standard full sling - normal transfers 2) Bathing sling - transfer person directly into bathtub. left in place during bath 3) Extended length sling - for people with extra large thighs 4) Toileting sling - Bottom of sling is open. Each indivdual has their own 5) Bariatric sling Contaminated if: - has any visible sign of blood, body fluids, secretions, or excretions - is used on person's bare skin - is used to bathe a person follow manufacturer's instructions + agency policy for handling contaminated slings

Soap BAth oils Creams and lotions Powders Deodorants Antiperspirants

Soap - clean - remove dirt, dead skin, skin oil, some microbes, and persperation - tends to dry skin. not needed for all baths BAth oils - keep skin soft - prevent dry skin - can be slippery Creams and lotions - protect skin from effect of air/evaporation Powders - absorb moisture - prevent friction when 2 surfaces rub together - excess can cake/crust and irritate skin - apply on your hand, then spread on person Deodorants - mask/control odors Antiperspirants - reduce amount of perspiration

Respiratory Support and Therapies slides

Some people have serious problems affecting their respiratory system. - They can require complex procedures and equipment. Artificial airways keep the airways open. *Tracheostomy* - is a surgically created opening (stoma) into the trachea. - They are often temporary, but can be permanent. Reasons for a tracheostomy include: - Cancer, airway injury, long term coma, spinal cord injuries, and diseases causing weakness or paralysis of the respiratory muscles

Chain of infection

Source > Reservoir > Portal of exit > MEthod of transmission > Portal of entry > Susceptible host 1) Source - a pathogen 2) Reservoir - Needs a place to grow and multiply - *Carrier* = creature that is a reservoir but does not develop infection. passes it to others - *Vector* = carrier that transmits disease > Dogs and rabies > Ticks and Rocky Mountain spotted fever > Mites and scabies 3) Portal of exit - A way to leave the reservoir - Include GI, respiratory, urinary, and reproductive tracts > breaks in skin, blood 4) Method of transmission - transmitted to another host - *Vehicle* = any substance that transmits microbes 5) Portal of entry - enters body. Same as portals of entry 6) Susceptible host - Transmitted microbe needs host to grow and multiply. People at risk for infection: > Very young or older > Are ill > Were exposed to pathogen > Do not follow practices for preventing infection Repeat

Spinal cord injury - S&S slides

Spinal Cord Injury ◦ Usually results from a sudden, traumatic blow to the spine ◦ Fractures or dislocation of vertebrae in the spine ◦ Spinal cord tissue is torn or bruised ◦ Spinal cord injuries can seriously damage the nervous system ◦ Problems depend on the amount of damage to the spinal cord and the level of injury. ◦ *Paralysis* —loss of muscle function, sensation or both ------------ book - Young men highest risk - traffic accidents, falls, violence, sports, alcohol abuse, cancer S&S - loss of movement - loss of sensation - incontinence - problems with balance/walking - breathing problems - odd position or twisted neck/back Cervical traction with special bed + good alignment needed at all times - bed in low position

Pressure ulcer: stage 2 slides

Stage 2 - partial-thickness skin loss. The wound may involve a blister or shallow ulcer. The ulcer may appear to be reddish-pink. A blister may be intact or open. There may be a surrounding area of red or purple discoloration, mild swelling and some oozing.

Urine drainage system

Standard drainage bag - hold at least 2000 mL Leg bags - attach to thigh or calf, hold less than 1000 mL *You may change from urine drainage bag to a leg bag* if the client is going out to lunch or to a doctors visit for example *Leg drainage bags are worn under pants/clothing* and used for a short period of time. *They do not hold as much urine so must be emptied more often.*

Removing indwelling catheters

Sterile water used to inflate ballon - Need to make sure ALL water that went into balloon is drawn out (via syringe). Otherwise urethral damage can occur (ex. 10 mL in, 10 mL out). > If there's a difference, call the nurse immediately - Tell person what they might feel and when you are going to do things

Gallstones book

Stones formed of hardened bile - gallstones can lodge in ducts as they're carried from liver to gallbladder - pancreas and liver can become inflamed + infected Risk - women (pregnant, on hormone replacement therapy, who take birth control) - 40+ yrs - native or mexican americans - over-weight, obese, or have rapid weight loss - diabetics Gallstone attack usually occurs after eating - nausea, vomiting, pain in abdomen, back, or right underarm. Surgical removal common

Stool specimens - melena - occult blood slides

Stools are studied for fat, microbes, worms, blood and other abnormal Contents. - Ulcers, colon cancer, hemorrhoids are common causes of bleeding. - *Stools will become black and tarry* from bleeding in the stomach or upper gastro-intestinal tract and it is called *Melena*. Bleeding may also be in very small amounts - The stools are tested for *OCCULT blood. Occult means hidden or not seen* > screens for colon cancer/other digestive orders - Urine must NOT contaminate the stool specimen A tongue blade is used to transfer a small amount of stool to the labeled specimen container

Fainting slides

Sudden loss of consciousness from an inadequate blood supply to brain - hunger, fatigue, fear, pain are common causes Warning signals: dizziness, perspiration, blackness before the eyes. person looks pale, pulse is weak, respirations are shallow if consciousness is lost It can also be a more significant sign of a more serious health emergency such as acute blood loss, cardiac problems, stroke or other medical emergency. - have person sit/lie - sitting person bends forward and places head between knees - raise legs of laying person - loosen tight clothing - keep person lying down if fainting has occured. raise legs 1 ft (on your shoulders) - do not let person get up quickly - help person to sitting position after recovery, observe - call for help

Bedrest: positioning - bed board -foot board - trochanter roll

Supportive devices are often used to support and maintain a certain position. *Bed Boards* - placed under the mattress to prevent it from sagging. Mostly used at home. *Foot Board* ---prevents plantar flexion that can lead to foot drop. Feet placed flush against board (like standing on floor). > Also keep top linens off of feet/toes - Foot drop is when the foot falls down at the ankle (permanent plantar flexion). *Trochanter roll* - prevents the hips and legs from turning outward. (external rotation). Cushions outside area from hip to knee. (bath blanket rolled up and tucked by body). - Most often seen after fracture of a pelvis from falling or car accidents

Concussions book

Symptoms affect - thinking - physical function - mood - sleep - long term (repeated): concentration, memory, headaches, balance problems Emergency care - activate EMS - provide BLs if person is not responding or breathing - Place hands on both sides of head to keep head aligned with spine. prevent movement - apply pressure with clean cloth to bleeding. - do not apply direct pressure if open wound (skull fractured) - do not remove objects from wound - logroll person to side if vomiting occurs - apply ice to swollen areas Children need EMS if: - will not stop crying - cannot be comforted - will nto nurse or eat

Alzheimer's disease (AD) - symptoms - later symptoms - sundowning slides

Symptoms: Difficulty remembering recent conversations, names and events, apathy and depression > classic sign is gradual loss of short-term memory Later symptoms: - Impaired communication, Poor judgement, Disorientation/Confusion > doesn't do well with excess noise, strange settings, signs, and mirrors - Behavior changes, Difficulty in speaking, Difficulty in swallowing - Difficulty in walking > severe need help with ADLs and total care *Sundowning* - in the evening hours after the sun goes down confusion, agitation, and restlessness increase. Persons with AD are not oriented to person, place, or time and therefore they may wander off and not be able to find their way back. - They experience hallucinations, delusions (false beliefs), and paranoia (type of delusion). These may worsen as memory loss gets worse. Inappropriate sexual behavior occurs with AD, use distraction to defer their behavior

Normal and abnormal BP slides

Systole/diastole - 120/80 mm Hg normal Blood pressure can change from minute to minute. Systolic - *90 - 120 mmHg* Diastolic - *60 - 80 mm Hg* Report any abnormal readings to the nurse .

Alzheimer's disease (AD) - what happens - decline in what functions slides

The most common type of permanent dementia. - Many brain cells are destroyed and die. Nerve cell death and tissue loss shrink the size of the brain. > plaques + tangles = pieces + fibers of protein that build up are thought to be cause - With AD there is a slow steady decline in mental functioning including: - Memory - Thinking - Reasoning - Judgement - Language - Behavior - Mood - personality Greatest risk factor is age (65+) - also some family history

Complete bed bath - who needs them

The person's entire body is washed in bed, keep them covered with a bath blanket to maintain warmth. Bed baths are usually needed by persons who are: - Unconscious - Paralyzed - In casts or traction - Weak from illness or surgery *Change the water whenever it becomes soapy and cool.* *Always wash from the cleanest area to the dirtiest*

MI -treatment - symptoms book

Treatment - relieve pain - restore blood flow - stabilize VS - give O2 - calm person - prevent death Symptoms - chest pain - sudden/severe on left side/center - Described as pressure, tightness, fullness, or squeezing - More severe/lasts longer than angina - not relieved by rest or nitroglycerin - pain/numbness in 1-2 arms, back, neck, jaw, or stomach - indigestion/heartburn - dyspnea -nausea, vomiting - dizziness - fainting - perspiration/ cold clammy skin - pallor or cyanosis - fast irregular pulse - fear/apprehension/feeling of doom

Cataract > treatment > post op care slides

Treatment - surgery only. lens substituted with plastic one. done when it affects daily activities Post op care: - keep eye shield in place (including sleep/naps if ordereD) - follow measures for visually impaired/blind people when eye shield is worn - remind person not to rub/press on affected eye - do not bump eye - place overbed table and bedside stand on un-operative side - place needed items in reach - remind person not to bend, stoop, cough, or lift things - report eye drainage and complaints of pain at once

Treatment: cancer - goals slide

Treatment depends on tumor type, site, and size. Treatment options can include surgery, radiation therapy, and / or chemotherapy. ------------- book Goal is: - cure. remove/kill cancer cells - control disease progress - reduce S&S from cancer + treatments

Mr. Rosin has moderate AD. While preparing him for a bath, he becomes restless and upset. He repeats: "Go away" over and over. How will you respond? How might you meet his hygiene needs?

Try again when he's calmer. Have me or another coworker distract him. ...

State certification exam

Two parts 1) Written test - multiple choice Qs 2) Skills test Submit an app to OSBN to take test w/ your certificate of completion, pay a fee, and resubmit your fingerprints. After that you can schedule your test OBRA requires CNA registry in each state - an official record or listing of people who have sucessfully completed each state's *NATCEP* (Nurse aide/assistant training and competency evaluation program) Oregon state board of nursing has and keeps this registry

Inflammatory bowel disease (IBD) - two types - S&S - risk - complications - treatment slides

Two types: *Crohn's disease* - the lining of the small and/or large intestine are inflamed *Ulcerative colitis* - the lining of the large intestine and rectum is inflamed and has ulcers ----------- book thought to be an autoimmune disorder S&S - diarrhea - abdominal pain/cramping - fever - bright red bleeding in toilet, dark blood in stools, occult blood - loss of appetite - weight loss often diagnosed before 30 yrs Risk: - family history, smoking, some drugs, diet high in fat/refined foods Can result in bowel obstruction, ulcers in GI tract, colon cancer, osteoporosis, and liver disease Treatment - diet changes and drug therapy - surgery + colostomy/ileostomy possible

- microbe types

Types: 1) Bacteria (single-celled organisms) - can infect any body system 2) Fungi - Plantlike multicellular organisms - infect mouth, vagina, skin, feet and other 3) Protozoa (single celled organisms - infect blood, brain, intestine and other 4) Rickettsiae - found in fleas, lice, ticks, and other insects, spread via bites. Cause chill, fever,, headache, rash. 5) Virus - Grows in a living cell. Cause common cold, herpes, AIDS, and hepatitis among others

Avoidable and unavoidable ulcers book

Unavoidable pressure ulcer - occurs despite efforts to prevent one through proper nursing processes Avoidable pressure ulcer - develops from improper use of nursing process - agency must evaluate person's condition and pressure ulcer risk - ID measures to meet person's needs/goals - monitor/evaluate effects of measures - Revise measures - provide necessary treatment and services to promote healing, prevent infection, and prevent new ulcers Agency must ID persons at risk for pressure ulcers

Mouth care for the Unconscious person

Unconscious people cannot eat or drink Some breath with an open mouth and may receive oxygen These factors cause mouth dryness, and cause crusting on tongue and mucous membranes. Mouth care is done with a *soft toothette at least every 2 hours*, with the patient in a side lying position to prevent *aspiration* (inhaling stuff into lungs) - dentures not used for unconscious persons - use small amount of fluid Oral hygiene keeps the mouth clean, moist, prevents infection.

Pressure ulcer: unstageable slides

Unstageable: Depth unknown, full thickness tissue loss in which the base of the ulcer is covered by slough, and/or eschar in the wound bed. Until enough slough and/or eschar is removed to expose the base of the wound, the true depth, and therefore Category/Stage, cannot be determined.

Urinary system

Urinary 1) Removes waste from blood. 2) Maintains electrolyte/water balance 3) Maintains acid-base balance (between 7.35-7.45) - Kidney > Ureter > bladder > urethra Electrolytes 1) Sodium - needed for fluid balance. Water follows it, so loss can result in dehydration 2) Potassium 3) calcium - K and Ca needed for proper muscle function Kidneys - Contains nephrons made up of 1) bowman's capsule at end of convoluted tubule. connected to arteries - Bowman's capsule surrounds glomerulus capillaries, which filters blood 2) proximal convoluted tubule 3) Ascending and descending loops of henle - reabsorb water/electrolytes 4) Distal convoluted tubule (DCT) 5) collecting duct 6) renal pelvis 7) ureters

Urinary diversion -Ileal conduity - cutaneous ureterostomy book

Urinary diversion -surgically created pathway for urine to leave body OFten involves a Urostomy Two main types: 1) Ileal conduity - small section of small intestine repositions to channel urine. Ureters connected to conduit and conduit is connected to stoma 2) Cutaneosu ureterostomy - ureters brought through abdominal wall and stoma is created Urine drains constantly into pouch applied over stoma. Empty every 3-4 hrs or when 1/3 full - changed every 5-7 days or when it leaks

Physical changes of aging - Urinary

Urinary system ◦Bladder muscles weaken - loss of control (incontinence) - kidney and bladder shrinkage > more urinary urgency/frequency - many have to urinate during the night Urinary tract infections are risks. - Adequate fluids are needed—water, juices, milk, gelatin. Follow the care plan. Remind the person to drink -kidney function decreases. kidneys shrink most fluids should be taken before 1700 (5). Reduces need to void at night

Apical-Radial pulse - apical - radial slides

Use 2-3 fingers (NOT thumb) Radial - have person sit/lie down - place on thumb side of wrist - take pulse for full minute (some agencies do 30 sec x 2) Apical - on left side of chest, slightly below nipple. Taken on persons who: > have heart disease > Have irregular heart rhythms > Take drugs that affect the heart Apical and radial pulse rates should be the same - weak heart contractions don't create strong enough pulse to reach radial. Radial rate less than apical. - 1 lub-dub = 1 beat (not separate) Apical radial pulse - Need 2 staff. One takes radial, one takes apical at the same time - *pulse deficit* = apical-radial

Blood glucose test - best sites book

Used for persons with diabetes - used to regulate drugs/diet. *report at once* Drop of capillary blood collected through skin puncture (often fingertip) - do not use swollen, bruised, cyanotic, scarred, or calloused sites (poor blood flow) > calluses often form at tips of thumbs and index fingers. Not good site - *Use side toward tip of middle/ring finger.* Do not use center, fleshy part of finger (lots of nerves) - heel used in non-walking infants - older adults have poor circulation. CAn increase blood flow by applying warm washcloth/washing hands in warm water ---------------------- Use sterile, disposable lancet to puncture skin *glucometer* - measures blood glucose - drop of blood applied to reagent strip, blood glucose displayed *hematoma* - swelling that contains blood. report if seen

Good verbal and nonverbal comunication

Verbal 1) Face person w/ good eye contact 2) Position yourself at person's eye lvl 3) Control loudness/tone of voice 4) Speak clearly, slowly, and distinctly 5) Do not use slang/vulgar words 6) Repeat info as needed 7) Ask 1 Q, wait for an answer 8) Do not shout, whisper, or mumble 9) Be kind, courteous, and friendly --------------------- Nonverbal 1) *Touch is a very important form of nonverbal comms* 2) Body language - expressions - gestures - posture - hand/body movements - gait - eye contact - appearance 3) Pictures/picture boards can be helpful for people who can't speak or read

Low vision - impaired function - risk - treatment book

Vision loss that can't be corrected with eyeglasses, contact lenses, drugs, or surgery. Interferes with everyday acctivities while using glasses/contact lenses, person has trouble: - recognizing faces of family/friends - doing tasks that require close vision (cooking, etc) - reading signs - picking out/sorting matching colors - doing things because lighting seems dimmer Risk factors - eye diseases (glaucoma, cataracts, AMD) - diabetes - eye injuries - birth defects Treatment - assistive devices - reading glasses - large print - magnifiers - telescopic aids for far vision - black felt tip marker for writing - paper with bold lines - audio tapes - electronic reading machines - computers w/ large print and speech systems - clsoed-circuit TV - phones, clocks,, and watches with large numbers and that talk - adjustable lighting - dark colored light switches/electrical outlets against light-colored walls - motion lights that turn on when person enters a room

Grains group book

Whole grains = have entire grain kernel Refined grains = processed to remove grain kernel - less fiber than whole grains Benefits - reduce risk of heart disease - prevent constipation - help with weight management - prevent birth defects - contain nutrients > Dietary fiber, several B vitamins, and minerals (Fe, Mg, selenium)

ALR CNA role: medication book

You DO NOT give drugs - person also has right to refuse to take drugs Yoru role - remind person to take drug (*medication reminder*) > reminding person to take drugs, observe them being taken as prescribed, and recording taking - read drug label - open containers - check dosage against label - provide food/fluids - record that person took/refused to take the drug (documentation). - store drugs - make person follows 6 rights of drug administration: > right drug > right dose > right route > right time > right person > right documentation

- communication barriers

avoid a) Use of complicated, unfamiliar, or technical terms b) Emotional barriers ("off limit") subjects c) Lack of attention, distraction - failure to listen - do not pretend to lsiten d) Physical difficulties - speech/hearing illness e) changing the subject f) Cultural differences g) age differences h) Giving your opinion - expresses judgement. Let others express feelings/concerns w/o adding your opinion - Do not make judgements or jump to conclusions i) talking a lot while others are silent k) Pat answers - don't worry, everything will be okay, etc - Makes person feel like you don't care about their feelings, concerns, and fears

Radiation therapy: - effects - side effects - cautions book

effects - destroys both normal and cancerous cells - destroys tumors - shrinks tumor before surgery - destroys cancer cells that remain after surgery - controls tumor growth side effects - causes skin to be dry, swell, have reddness, itchiness, or blistering. Also discomfort, NVD cautions > do not work with radiation if pregnant. Work quickly and wear protective equipment. Maintain distance as possible. > Leave trash in room. Discard protective gear before leaving room and wash hands > person has a private room, visitors may have to stand at door

Diabetes - types - treatment book

family history risk Type 1 - most often in children and teens -pancreas produces little/no insulin - rapid onset - treatment with daily insulin therapy, healthy eating, exercise Type 2 - can occur at any age - over weight/lack of exercise are risks - pancreas makes insulin normally, but body cannot use it well - onset slow, infections frequent, wounds heal slowly > natives, black people, asian americans, and hispanics at risk - treatment with healthy eating, exercise, and weight loss, drugs ^ both involve controlling BP, cholesterol, and risk factors for CAD - good foot care needed Gestational dibetes - develops during pregnancy - usually goes away after baby is born, but mother more at risk for type 2

Room guidelines (droplet and contact) Airborne precautions

for both airborne and droplet Single room preferred. Draw privacy curtain between beds if single isn't possible - change PPE between fare of persons sharing a room - limit resident transport - do not transport items between resident rooms --------------------- Airborne -person is placed in airborne infection isolation room (AIIR) AIIR practices 1) All persons entering wear a tuberculosis respirator 2) Door is kept close except when entering or leaving 3) Treatments and procedures done in room 4) Person wears mask during transport

Cooling and warming blankets slides

made to warm or cool the core body temperature, they *must* have a doctors order. *hyperthermia* blankets - warm body *hypothermia* blankets - cool body - sometimes used with ice packs applied to head, neck, underarms, and groin After applying this what would you check for with patient/resident? - check for vital signs often (prevent rapid temp changes) What observations would you make and document? -excess redness, blisters - pale, white, or gray skin - cyanosis - shivering - complaints of pain, discomfort, numbness, or burning - rapid pulse, weakness, faintness, and drowsiness (sitz bath)

Kidney stones (calculi) - symptoms and signs slides

more common in men than in women. Symptoms and signs: • Severe, cramping pain in back and side • Pain in lower abdomen, thigh and urethra • Nausea/vomiting • Fever and chills • Dysuria/hematuria • Pain on urination • Foul smelling urine • Cloudy urine Urine may need to be strained to obtain stones. -------- book bedrest, immobility, and poor intake are risk factors drugs given for pain. 2000-3000 mL a day needed to flush out kidney stones

Oxygen devices - nasal cannula - simple face mask - partial rebreather mask - non rebreather mask - venturi mask book

nasal cannula - prongs inserted into nostrils. band goes behind ears and undre chin - allows for eating and drinking, but puts pressure on ears/cheekbones. can irritate nose simple face mask - covers nose and mouth. co2 escapes through small holes partial rebreather mask - bag added to simple face mask for exhaled air. when breathing, some exhaled air as well as o2 is inhaled. bag should not totally deflate non rebreather mask - exhaled air cannot enter bag. exhaled air leaves through holes in mask. when inhaling only air from bag is inhaled - bag shouldn't totally collapse venturi mask - precise amts of o2 given. color coded adapters show the amnt of o2

Stages of dying slides

not necessarily accurate Dr. Elisabeth Kubler-Ross described 5 stages of dying - 'stages of grief' (Grief is a person's response to loss). Stage 1 Denial - the person refuses to believe that he/she is dying. Stage 2 Anger - the person has anger and rage. Dying persons envy and resent those with health and life. Stage 3 Bargaining - the person may bargain with a higher power/God for more time. Stage 4 Depression - the person mourns lost things and future loss of life. Stage 5 Acceptance - the person is calm, at peace and accepts death. Dying persons do not always pass through each stage. They may go back and forth. They may never get beyond a certain stage.

dysphagia signs slides

• Having food residue inside the mouth or cheeks during and after meals • Tires during meal • Has food spill out of mouth while eating • Coughing or choking before, during or after swallowing • Has hoarseness especially after eating • Excessive drooling • Decreased appetite • Eats slowly/avoid eating • Difficulty chewing foods • Clearing the throat frequently during and after meals

Elderly living situations

• Living with family and/or going to Adult Day Care (most common) • Elder cottage housing opportunity (ECHO) • Rental options • Senior citizen housing • Residential hotels • Home-sharing • Group settings/mobile home parks for elderly • Assisting living residences • Adult foster care • Nursing Centers

Promoting sleep

• Plan care for uninterrupted rest • Allow a flexible bedtime • Provide a comfortable room temperature • Make sure incontinent persons are clean and dry • Follow bedtime routines (allowed if safe) • Reduce noise • Darken the room • Make sure linens are wrinkle free and dry • Position the person in good alignment • Give a back massage

Heat and cold applications slides

• Promote healing • Promote comfort • Reduce tissue swelling Heat and cold have opposite effects on body functions. Before you apply heat or cold make sure that: • You have the training and know the expected result • Know how to use the equipment - have nurse available to supervise children and older persons have fragile skin. At risk for burns - older also have ciruclatory/nervous system issues. watch for behavior chagnes

Preventing MSDs

•Wear shoes with good traction •Get help from other staff members •Balance light and harder tasks •Bend your legs not your back !! •Adjust the height of the bed to a safe and comfortable level •Keep heavy loads close to your body •Lower the bed rails •Use transfer/gait belts •Avoid bending, reaching, or twisting •Use stand and pivot transfers •Push, do not pull •Pivot with your feet to turn - minimize lifting - eliminate manual lifting when possible (255)

Common causes for Skin Breakdown slides

◦ Age-related skin changes ◦ Breaks in the skin ◦ Dry skin ◦ Fragile and weak capillaries ◦ General thinning of the skin ◦ Loss of the fatty layer under the skin ◦ Decreased sensation to touch, heat, and cold ◦ Decreased mobility ◦ Sitting in a chair or lying in bed most of the day ◦ Chronic diseases (diabetes, high blood pressure) ◦ Diseases that decrease circulation; poor circulation to an area ◦ Poor nutrition; poor hydration ◦ Incontinence; urinary and fecal ◦ Moisture in dark body areas; skin folds, under breasts, perineal area ◦ Pressure on bony parts ◦ Poor fingernail and toenail care ◦ Friction and shearing ◦ Edema ◦ Length of time pressure is exerted on the skin (duration) ◦ Amount of pressure ◦ Ability of the person's tissue to tolerate the externally applied pressure

Elderly living ◦Home-sharing ◦Group settings/mobile home parts for elderly ◦Assisting living residences ◦Adult foster care

◦Home-sharing - People share house/apartment (roommates) - Provides companionship and comfort ◦Group settings/mobile home parts for elderly - Provide housing, support services, and social activities. - HElp wtih hygiene, eating, ambulation, bathrooming, phone, housework, meal prep, shopping, money management ◦Assisting living residences - Help wtih ADLs in a homelike setting ◦Adult foster care a) older person lives with a family b) signle family home serves 4-5 persons with special needs - REceives aid with indepedence + personal care

elderly Living situation ◦Living with family ◦Adult Day Care ◦Elder cottage housing opportunity (ECHO)

◦Living with family - Provide companionship - Share living expenses - Provide care during illness/disability - Adjustments may need to be made ◦Adult Day Care - Provide meals, supervision, and activities during child's working hours. May provide rides and have rehabilitation services - Varying requirements ◦Elder cottage housing opportunity (ECHO) - Small portable homes placed in yard/attached to house - Has all the necessary rooms - allows independent living but within easy access of help

Elderly living ◦Nursing Centers

◦Nursing Centers (150) - People stay here until death or when able to return home. Homelike as possible - Center is a SNF - Administrator licensed by state. BG checks conducted on staff - Training on preventing abuse/neglect - Provides lvl of care needed - Close enough for family/friends to visit - Policies to protect resident belongings - Person may suffer losses: > loss of identity as family/community > Loss of possessions > loss of independence > real world experiences > health/mobility - medicaid/medicare funded and certified. comply with OBRA

elderly Living situation ◦Rental options ◦Senior citizen housing ◦Residential hotels

◦Rental options - maintains independence, landlord maintains/repairs. CAn be costly. ◦Senior citizen housing - Apartment complexes for low-moderate income elderly. Lower rent that depends on income ◦Residential hotels - Rented rooms with access to roomservice, dining, recreational activitiies and EMS. Close to civic services, church, shopping