CNA Context Information

Lesson #25 Content

Content - Gastrointestinal System: I. Gastrointestinal System A. Mouth - takes food in and masticates (chews) food and fluid B. Esophagus - tube that transports masticated (chewed) food from mouth to stomach C. Stomach - sac that mixes food and fluid with digestive juices D. Small Intestine - tube that absorbs water and digested food from waste E. Large Intestine - tube that absorbs water from waste F. Rectum - sac at end of large intestine which stores waste G. Anus - opening at end of rectum through which waste is expelled H. Other organs which aid in digestion include - gall bladder, liver, pancreas II. Common Conditions of the Gastrointestinal System A. Gastroesophageal Reflux Disease (GERD) B. PepticUlcer C. UlcerativeColitis D. Hemorrhoids E. Constipation 1. If a resident has not had a bowel movement within three days, most facilities have protocols for intervention to prevent impaction (hard stool in the rectal vault) F. Colostomy/Ileostomy G. Diarrhea III. Normal Changes with Age A. Taste buds loose sensitivity causing decreased appetite B. Tooth and gum problems result in inability to eat properly C. Digestion is less efficient causing constipation and food intolerance IV. Role of the Nurse Aide A. Observe and Report to the nurse 1. Difficulty chewing and/or swallowing 2. Loss of appetite 3. Abdominal pain or complaint of cramping 4. Diarrhea a) frequency, amount, consistency b) observe for blood 5. Nausea and/or vomiting a) if vomitus looks like coffee grounds, immediately report to nurse 6. Constipation a) frequency, consistency and size bowel movements b) observation of stool for blood; notify nurse Content - Endocrine System: I. Endocrine System A. Glands that produce hormones and secretions to regulate body functions II. Common Conditions that Affect the Endocrine System A. Diabetes Mellitus 1. Hypoglycemia (low blood sugar) a) sign/symptoms: cold, clammy skin, double or blurry vision, shaking/ trembling, hunger, tingling or numbness of skin; increased confusion 3. Hyperglycemia (high blood sugar) a) signs/symptoms: shortness of breath, breath smells fruity, nausea/vomiting, frequent urination, thirst G. Hyperthyroidism 1. sign/symptoms: can't tolerate being hot 2. increased heart rate, and enlarged thyroid (goiter) H. Hypothyroidism 1. sign/symptoms: confusion, tired 2. inability to tolerate the cold V. Normal Changes with Age A. Insulin production decreases possibly causing excess sugar in blood B.Adrenalsecretionsdecreasereducingabilitytohandlestress C. Thyroidsecretionsdecreaseslowingmetabolism VI. Role of the Nurse Aide A. Identify residents in your care who are diabetic B. Encourage diabetic resident to consume all meals/snacks; notify nurse if resident refuses meal/snack or consumes less than half of meal/snack C. Notifynurseimmediatelyofsigns/symptomsofhypoglycemia D. Notify nurse if a diabetic resident is consuming foods in conflict with ordered diet which could cause hyperglycemia RCPS: • None

Lesson #23 Content

Content - Nervous System: I. Nervous System - control and message center of the body A. Central Nervous System (CNS) - composed of the brain and spinal cord 1. Brain - sends, receives and interprets messages to make sense of the outside world/stimulus 2. Spinal cord - nerves which transmit information from body organs and external stimuli to the brain and send information from the brain to other areas of the body B. Peripheral Nervous System (PNS) - nerves that extend throughout the body II. ConditionsthatAffectNervousSystem A. Dementia 1. Affects thought process: memory, communication 2. As the process progresses it will make it difficult to perform ADLs: e.g., eating, dressing, bathroom B. Alzheimer's Disease 1. Set up regular schedule for bathing, toileting, exercise 2. Use repetition in daily activities C. Parkinson'sDisease 1. A progressive, degenerative disease that affects the brain 2. As the disease progresses, it will make it more difficult for the resident to perform ADLs. Hands often tremor and limbs and trunk become rigid 3. Assist by placing food and drink close; use assistive devices D. Cerebrovascular Accident (CVA) or stroke 1. Symptoms: may include dizziness, blurred vision, nausea/vomiting, headache, slurred speech 2. Occurs when blood supply is suddenly cut off to the brain caused by a clot or a ruptured blood vessel 3. When dressing a resident, address the weaker side first to prevent unnecessary bending or stretching and when undressing address the stronger side first 4. Use a gait belt when walking or transferring the resident for safety precautions and stand on the weaker side E. Multiple Sclerosis (MS) 1. A progressive disease affecting the central nervous system 2. It may be difficult to perform ADLs; be patient when assisting, as stress can increase MS effects F. Epilepsy 1. Observe for seizure activity; report to nurse G. Cerebral palsy 1. Muscles may become very tight; may develop contractures 2. Muscle weakness or loss of movement (paralysis) 3. Abnormal movements 4. May exhibit speech problems, hearing/vision problems, seizures, drooling, problems swallowing 5. Resident may be totally dependent on staff for ADLs H. Head or spinal cord injuries 1. Dependent upon extent of injury, resident may need assistance or be totally dependent on staff for ADLs III. Normal Nervous System Changes with Age A. Decreased blood flow to certain areas of the brain causes decreased short-term memory. Nerve cells die causing decreased perception of sensory stimuli and less awareness of pain and injury B. Responses and reflexes slow C. Nerve ending decreased sensitivity D. Memory loss - often short-term memory IV. Role of the Nurse Aide A. Observe & Report 1. Shaking or trembling 2. Inability to speak clearly 3 Inability to move one side of the body 4.Changes in vision or hearing 5. Difficulty swallowing 6. Depression or mood changes 7. Memory loss or confusion 8. Behavior changes Content - Circulatory System: I. Circulatory System A. Heart - pumps blood through the body B. Blood - body fluid that carries oxygen to the cells Blood vessels - tubes (arteries, veins, capillaries) through which the blood is transported to and from the heart II. ConditionsthatAffecttheCirculatorySystem A. High blood pressure (hypertension) 1. Symptoms: headache, blurred vision, dizziness B. HeartAttack(MyocardialInfarction) C. CoronaryArteryDisease(CAD) D. Angina (chest pain) E. Cerebrovascular Accident (CVA) - stroke III. Normal Circulatory Changes with Age A. Blood vessels become more rigid and narrow. Heart muscle has to work harder which may result in high blood pressure and poor circulation IV. Role of the Nurse Aide A. Observe and report 1. Complaint of headache 2. Chest pain 3. Blurred vision 4. Dizziness 5. Nausea Content - Musculo-Skeletal System: I. Musculo-Skeletal System - gives the body shape and structure A. Muscles-tissues that contract (shorten) and relax (lengthen) to make motion possible B. Bones- provide the frame for the body. A joint is the point where two bones come together and allow movement C. Ligament - connect bone to bone and support joints D. Tendon - connect muscle to bone E. Cartilage - cushions joints II. ConditionsthatAffectMusculo-SkeletalSystem A. Fracture 1. Symptoms of fracture include: change in skin color, bruising, pain, swelling B. Osteoporosis 1. Bones become brittle and can break easily 2. Take caution when repositioning and/or transferring the resident C. Arthritis 1. Two common types of arthritis include: osteoarthritis and rheumatoid 2. Encourage independence in ADLs to preserve ability 3. As needed, use cane or other aids D. Contracture III. Importance of Exercise or Range of Motion (ROM) A. Maintains physical and mental health B. Preventsproblemsrelatedtoimmobility C. Problems/complications from lack of exercise or range of motion 1. Loss of self- esteem 2. Depression 3. Pneumonia 4. Urinary Tract Infections 5. Constipation 6. Blood clots 7. Dulling of senses 8. Muscle atrophy or contractures IV. Normal Musculo-Skeletal Changes with Age A. Bones become more brittle and porous and may fracture more easily B.Lossofmusclestrengthandtonecausesweaknessandfeelingtired C. Lessflexiblejointsmakemovingmoredifficult D. Changes in spine and feet result in height loss, postural changes and difficulty walking V. Role of the Nurse Aide A. Observe and Report 1. Pain with movement 2. Bruising 3. Change in movement and/or activity 4. Change in range of motion 5. Swelling of joints 6. Aches and/or pains B. Fall Prevention 1. Keep mobile 2. Encourage activities and exercise 3. Participate in care 4. Proper positioning 5. Use of assistive devices RCPs: • Review Passive Range of Motion

Lesson #1 Content

Content: I. Introduction to Long Term Care A. Long Term Care - Acute, chronic and terminal illness: B. SkilledCare C. AdultDayCare D. Assisted Living E. Home Health Care F. Hospice Care G. Palliative Care II. The Role of the Nurse Aide A. Requirements: 1. Limited criminal history performed 2. Mantoux testing or health screen and physical examination 3. Completion of an approved training program B. Professionalism: 1. Accountability 2. Confidentiality 3. Health Insurance Portability and Accountability Act (HIPAA) C. Scope of Practice - Standard 14 - Indiana Specific D. Provide care according to the resident's comprehensive care plan: 1. Direct care needs/Use of a Nurse Aide Assignment Sheet Actively listen and communicate with the resident, the family and the health care team F. Observe and report any change in the resident's appearance, behavior or mood to the nurse: 1. Objective observation/information 2. Subjective observation/information 3. Observations that indicate an acute condition requiring immediate attention from the nurse include but are not limited to: severe pain, fall/accident, seizures, swelling, bleeding, loss of consciousness, difficulty breathing 4. Acute change in mental status - confusion, lethargy, delirium G. Participate in care planning, when requested H. Follow policies and procedures III. The Care Team and the Chain of Command A. Interdisciplinary Team - often includes 1. Activity Director, Certified Nursing Assistant, Licensed Practical Nurse, Medical Doctor, Social Worker, Occupational Therapist, Physical Therapist, Qualified Medication Aide, Dietary Manager and/or Registered Dietitian, Registered Nurse, Speech Therapist, Administrator 2. Resident and Family Member/Responsible Party 3. Ombudsman, upon resident request Chain of Command 1. Director of Nursing 2. Licensed Nurse (charge nurse/supervisor) 3. Certified Nursing Assistant/ Qualified Medication Aide IV. Communication and Interpersonal Skills A. Effective Communication: 1. Formulate the message 2. Receive the message (listen) 3. Observe for feedback B. VerbalandNon-VerbalCommunication C. BarrierstoCommunication: 1. Clichés 2. Slang 3. Impairments a. A person who is visually impaired relies on verbal cues, including words and tone of voice a. State your name before beginning a conversation b. Describe persons, things and environment c. Inform the resident when you are entering or leaving the room d. Explain in detail what you are doing and ask the resident what they would like to do independently e. Touch the resident, if appropriate f. Read resident's mail or personal documents, only if asked g. Sit where resident can easily see you if resident has partial vision b. A person who is hearing impaired relies on nonverbal cues including body language, sign language, and writing a. Speak slowly and distinctly b. Use short sentences c. Face the resident d. Use facial expressions and gestures e. Reduce outside distractions f. Use sign language and communication boards, if appropriate c. Be certain that the resident's hearing aid is in place and is working properly, if applicable d. A person who is cognitively impaired relies on both verbal and nonverbal cues and may need messages repeated frequently, using short sentences and simple words 4. Denial - refusal to acknowledge existence of something: a refusal to believe in something or admit that something exists 5. Displacement - transfer of emotions or behavior: the transfer of emotion from the original focus to another less threatening person or object, or the substitution of one response or piece of behavior for another 6. Rationalization - a defense mechanism whereby people attempt to hide their true motivations and emotions by providing reasonable or self-justifying explanations for irrational or unacceptable behavior 7. Regression - reversion to earlier state: a return to an earlier or less developed condition or way of behaving 8. Repression - a mechanism by which people protect themselves from threatening thoughts by blocking them out of the conscious mind D. Call Lights as the resident's means to Communicate with Staff: 1. Resident access to the call light - place call light on resident's unaffected side. 2. Staff response to the call light E. Promoting resident independence: 1. Activities of Daily Living (ADLs) 2. Independence versus Dependence V. Resident-Centered Care (Person-Centered Care) A. Respecting resident choice/preference: 1. Provide a home-like and safe living environment with daily routines designed to meet the resident's specific needs and in accordance with former lifestyle B. Practices which reflect resident-centered care (include, but not limited to :): 1. Time to awake/retire to bed 2. Frequency of bath/shower 3. Preferred activities 4. Choice of clothing 5. Choice of mealtimes 6. Choice of toileting times C. Cultural Diversity D. Respecting Cultural Differences E. Respecting Religious Preferences

Lesson #18 Content

Content: I. Oxygen Use A. Oxygen is prescribed by a physician; however, a nurse may initiate oxygen in response to a medical emergency B. Nursing assistants never stop, adjust, or initiate the use of oxygen C. Nasal Cannula - Delivery of oxygen from a long tubing from source to cannula with prongs placed in each nostril and tubing tucked behind the ears of the resident 1. Observe for irritation behind the ears, as the tubing can cause skin breakdown. Notify the nurse, if observed 2. Nasal Cannula Care (see RCP) D. Mask - delivery of oxygen from a long tubing from the source to a mask placed on the resident's face with band around the back of the head 1. Observe for irritation around the face mask and notify the nurse, if observed E. Concentrator - a device that sits on the floor and plugs into the wall which changes air in the room into air with more oxygen F. Liquid Oxygen - at extremely cold temperatures, oxygen changes from gas to a liquid. The liquid oxygen is stored in a vessel similar to a thermos. A large central unit is located in an area away from electrical equipment that is well ventilated. Liquid oxygen can be trans-filled to a bedside unit or can be trans-filled into a portable unit. 1. Contact with liquid oxygen or its vapors can quickly freeze tissues. It is common to see vapors when filling a small vessel from the large vessel. The vapors evaporate quickly and then are harmless. To prevent injury, never touch liquid oxygen, or the frosted parts of liquid oxygen vessels. Avoid getting the vapors in your face G. Portable Tank - oxygen that is stored as a gas under pressure in a cylinder equipped with a flow meter and regulator to control the flow rate. This system is generally prescribed when oxygen therapy is required in emergency or for a short period of time (e.g., during transport). Compressed oxygen tanks are under extreme pressure and must be kept upright and handled with care H. Vaporizers/Humidifiers - A vaporizer works by heating water until it turns into hot steam, a humidifier creates a cool mist. Either one may be prescribed by a physician to loosen congestion of the resident 1. When humidifiers and vaporizers are in use, they must be kept clean. Germs thrive wherever there is water, thus, the device must be periodically drained and cleaned according to facility policy. Otherwise, the bacteria that accumulate can become vaporized into the air and affect the resident's lungs, where they can cause infection 2. Prepare vaporizer/humidifier according to manufacturer's instructions 3. Position vaporizer/humidifier on the bedside stand or nearby table 4. Plug vaporizer into electrical outlet 5. Steam should be permitted to flow generally into the room 6. Frequently check the water level; refill as necessary 7. Clean vaporizers/humidifiers routinely according to facility policy I. CPAP/BIPAP - Positive airway pressure (PAP) is respiratory ventilation used to treat breathing disorders and supply a consistent pressure on inspiration and expiration. As mechanical ventilation, CPAP (continuous positive airway pressure), or BIPAP (Bi-level Positive Airway Pressure) machines, are devices which help residents inhale more air into the lungs. Both of these devices are used for the treatment of medical disorders like COPD, pulmonary edema, etc. Settings of the machines are prescribed by the physician and may only be administered and settings adjusted by the licensed nurse J. Ventilator - a machine that supports breathing. These machines are mainly used in hospitals. Ventilators deliver oxygen into the lungs and remove carbon dioxide from the body. Carbon dioxide is a waste gas that can be toxic. The ventilator breathes for people who have lost all ability to breathe on their own. Settings of the ventilator are prescribed by the physician and may only be adjusted by the licensed nurse K. SafetyPrecautions 1. Remember oxygen supports combustion 2. Fire hazards should be removed from the resident's room when oxygen is in use 3. Never allow candles or open flames in the area where oxygen is in use 4. Never allow smoking in the area where oxygen is in use 5. Do not use electrical equipment in an oxygen-enriched environment Examples include electric razors, hairdryers, electric blankets, or electric heaters. Electrical equipment may spark and cause a fire 6. Do not use flammable products such as rubbing alcohol, or oil-based products such as Vaseline® near the oxygen. Use a water-based lubricant to moisten the resident's lips or nose 7. Although the nursing assistant cannot adjust the oxygen level, the nurse aide should learn how to turn oxygen off in case of fire RCPs: • Nasal Cannula Care

Lesson #16 Content

Content: I. Physical Restraint A. Resident Rights- The resident has the right to be free from any physical or chemical restraints imposed for purposes of discipline or convenience, and not required to treat the resident's medical symptoms B. Types-"Physical restraints" include, but are not limited to, leg restraints, arm restraints, hand mitts, soft ties or vests, lap cushions, and lap trays the resident cannot remove easily. Also included as restraints are facility practices that meet the definition of a restraint, such as: 1. Using side rails that keep a resident from voluntarily getting out of bed; 2. Tucking in or using Velcro to hold a sheet, fabric, or clothing tightly so that a resident's movement is restricted; 3. Using devices in conjunction with a chair, such as trays, tables, bars or belts, that the resident cannot remove easily, that prevent the resident from rising; 4. Placing a resident in a chair that prevents a resident from rising; and 5. Placing a chair or bed so close to a wall that the wall prevents the resident from rising out of the chair or voluntarily getting out of bed C. Medical Symptoms/Rationale for Use- an indication or characteristic of a physical or psychological condition for which the device improves the resident's function or quality of life D. Application 1. A restraint shall be applied by an individual who has been properly trained, according to facility policy 2. A restraint shall be applied in a manner that permits rapid removal in case of fire or other emergency E. Monitoring and Release 1. A record of physical restraint and seclusion of a resident shall be kept 2.Each resident under restraint and seclusion shall be visited by a member of the nursing staff at least once every hour and more frequently if the resident's condition requires 3. Each physically restrained or secluded individual shall be temporarily released from restraint or seclusion at least every two (2) hours or more often if necessary except when the resident is asleep. When the resident in restraint is temporarily released, the resident shall be assisted to ambulate, toileted, or changed in position as the resident's physical condition permits F. Self-Releasing Devices - Devices used as a reminder that the resident needs to call for assistance and/or to assist to keep the resident seated; however, the resident can self-release the device upon request. Thus, the device does not restrict freedom of voluntary movement G. Side rails Side rails sometimes restrain residents. The use of side rails as restraints is prohibited unless they are necessary to treat a resident's medical symptoms. Residents who attempt to exit a bed through, between, over or around side rails are at risk of injury or death. The potential for serious injury is more likely from a fall from a bed with raised side rails than from a fall from a bed where side rails are not used. They also potentially increase the likelihood that the resident will spend more time in bed and fall when attempting to transfer from the bed. The same device may have the effect of restraining one individual but not another, depending on the individual resident's condition and circumstances. For example, partial rails may assist one resident to enter and exit the bed independently while acting as a restraint for another. Orthotic body devices may be used solely for therapeutic purposes to improve the overall functional capacity of the resident H. Entrapment 1. FDA Guidance A. Entrapment Zones 1) Zone 1 - within the rail 2) Zone 2 - under the rail, between the rail supports or next to a single rail support 3) Zone 3 - between the rail and the mattress 4) Zone 4 - under the rail at the ends of the rail 5) Zone 5 - between split bed rails 6) Zone 6 - between the end of the rail and side edge of the head or foot board 7)Zone 7 - between the head or foot board and end of the mattress I. An enclosed framed wheeled walker, with or without a posterior seat, would not meet the definition of a restraint if the resident could easily open the front gate and exit the device. If the resident cannot open the front gate (due to cognitive or physical limitations that prevent him or her from exiting the device or because the device has been altered to prevent the resident from exiting the device), the enclosed framed wheeled walker would meet the definition of a restraint since the device would restrict the resident's freedom of movement (e.g. transferring to another chair, to the commode, or into the bed). The decision on whether framed wheeled walkers are a restraint must be made on an individual basis RCPS: • None

Lesson #15 Content

Content: I. Understanding the Integumentary System and Basic Skin Care A. The Integumentary System: 1. The structure a. Skin 1) Epidermis 2) Dermis 3) Subcutaneous tissue b. Hair c. Nails d. Glands 1) Oil 2) Sweat e. Nerve endings 2. Function a. Largest organ of the body b. Sense organ 1) Heat/cold 2) Pain 3) Pressure 4) Touch c. Internal organ protection d. Body temperature regulation e. Bacterial protection f. Excretes waste g. Prevents loss of too much water h. Vitamin D production 3. Changes with age a. Skin dries b. Skin becomes more fragile c. Subcutaneous (fatty) tissue thins d. Brown spots develop e. Wrinkles appear f. Hair grays and becomes thin g. Nails thicken 4. Care of the skin a. Skin should be clean and dry 1) Provide frequent care for residents who are incontinent 2) Change linens/clothing 3) Check resident at least every 2 hours for needed care and encourage to reposition b. Observe for: 1) Rashes 2) Abrasions 3) Dryness 4) Changes in skin color a) Pale b) Red c) Purple/Blue 5) Pressure areas a) Reposition at least every 2 hours b) No wrinkles in bottom sheet 6) Temperature a) Complaints of warmth or burning 7) Bruising 8) Swelling 9) Blisters a) Ensure resident has proper fitting shoes/slippers 10) Scratching 11) Broken skin 12) Drainage 13) Wound or ulcer 14) Redness or broken skin between toes or around nails II.Risk Factors for Skin Breakdown A.Sensory Perception 1. The ability to feel pressure. In general, people move regularly to keep pressure from building up 2. Individuals with limited sensory perception may not realize they have not moved for a while, which increases their risk for pressure ulcers. Medications, medical conditions, or mental status may all cause an individual's sensory perception to change B. Moisture 1. Healthy skin stays clean and dry. Individuals at risk of pressure ulcers may have skin that stays moist because of incontinence (urine or stool) or perspiration (sweat). When an area at risk for a pressure ulcer is moist, a pressure ulcer is more likely to form C. Activity 1. Activity means an individual's ability to physically move (like walking). Individuals who can walk rarely get pressure ulcers. Individuals who are bedfast or chair bound are at higher risk of developing pressure ulcers D.Mobility 1. Mobility refers to the ability to change and control body position. Individuals with good mobility move their bodies regularly. Individuals who are immobile or have limited mobility are at greater risk for developing pressure ulcers because they cannot move to relieve the pressure E. Nutrition 1. Everyone needs to eat the right food and drink enough liquids to stay healthy. Individuals who do not eat enough of the right foods or drink enough of the right liquids are at greater risk for pressure ulcers because their bodies do not have the energy they need F. Friction and Shear 1. Friction happens when skin rubs another surface over and over (like a rough wheelchair seat rubbing the back of the individual's leg). Shear is similar to friction, but it occurs when skin stays in one position but the underlying bone and tissue roll in the opposite direction (like someone sliding across a bed). The rubbing and pulling of friction and shear break down the skin, which contributes to pressure ulcers. Pressure ulcers are more likely to develop when there is increased shear or friction G.Additional Risk Factors 1. Chronic conditions or illnesses (diabetes, cancer)- Higher risk due to body is fighting several problems at once 2. Age- Higher risk due to with age, skin becomes fragile and breaks down easily 3. Medical devices- Higher risk due to the device may rub the skin over and over or cause pressure to that area 4. Depression or mental illness- Higher risk due to individuals neglect their own care 5. History of pressure ulcers- Higher risk due to old pressure ulcer scars make the skin in that area weaker and more likely to break down III. Pressure Ulcer Development A.Skin breakdown can develop when individuals stay in one position for too long (as little as two hours) without shifting their weight B.The pressure of body weight reduces blood supply, causing skin and surrounding tissue to become damaged or even die C.Pressure ulcers can be painful. They can cause infection, damage to muscle and bone, and even death D.Treatment can take weeks, months, or years IV. Prevention A.Observe skin upon admission and during the provision of daily care 1. Skin Inspection a. Drape resident to allow you to see, feel and smell the area you are inspecting. This can easily be done when the individual is dressing or undressing b. Remove pressure-Lift heels, turn or move the individual to inspect the skin. Remove medical devices (with the permission or under the direction of the nurse) to view the skin under the device c. Inspect- Focus on bony prominences, where pressure ulcers are most likely to develop. Observe and prevent skin-to-skin contact. Additional areas at risk are the ears, under the breasts, and the scrotum and any skin- to-skin contact d. Note observations and report to the nurse- When a potential problem is observed, notify the nurse for assessment of the area B.Encourage and maintain nutrition and hydration C.Manage moisture by providing prompt care D.Minimize pressure 1. Pressure-reducing mattress 2. Pressure-reducing cushion to chair a. Heel boots- specialty devices that surround the feet and calves and create a cushion between the heels and the bed. They should not be used with residents who walk. The manufacturer's instructions must be followed b. When using any device, check the other areas of the legs to ensure you are not moving the pressure to another area, like the calves. E. Identify residents who have been assessed by nursing as "at risk" 1. Braden Scale- standardized risk assessment tool completed by the nurse RCPS • Inspecting Skin • Float Heels • Bed Cradle

Lesson #20 Content

Content: IV or PICC Care: I. Purpose of IV or PICC A. Medication administration, such as antibiotics B. Nutritionadministration C. Hydration D. Blood products E. Solutions are administered by gravity or through a portable pump II. Role of the Nurse Aide in caring for IV/PICC A. Observe and Report 1. Line found out or is removed by resident, or accidentally by staff when providing care 2. Blood present anywhere in the tubing 3. Tubing is disconnected 4. Complaint of pain 5. Fluid in bag is not observed dripping 6. Fluid in bag is nearly gone or finished 7. Pump is alarming 8. Site is swollen or discolored 9. Dressing is wet or soiled B. Take special caution when moving or caring for resident - avoid pulling or catching of tubing C. NeverdisconnectIVorPICCfrompump D. Never lower bag below IV/PICC site E. Do not take blood pressure in arm with IV or PICC III. Infection Control A. Use proper hand hygiene B. Observe site for signs of infections and report to the nurse if observed 1. Redness 2. Swelling 3. Pain Content: Pain Control Interventions I. Pain Factors A. Vital Signs should be taken, if directed by nurse to do so B. Information related to pain 1. Location 2. When did it start 3. What was resident doing when pain started 4. Rate the pain, i.e., mild, moderate or severe on scale of 1-10 5. How long has resident been having pain 6. Describe the pain, i.e., ache, stabbing, crushing, dull, constant, burning, 7. Use resident's words/description to report to nurse II. RoleoftheNurseAiderelatedtoPain A. Observe and report to the nurse signs/symptoms of pain, which may include, but are not limited to: 1. Change in vital signs - B/P, Pulse, Respiration 2. Nausea 3. Vomiting 4. Sweating 5. Tearful or frowning 6. Sighing, moaning or groaning 7. Breathing heavy or shortness of breath 8. Restless or having difficulty moving 9. Holding or rubbing a body part 10. Tightening jaw or grinding teeth 11. Anxiety, pacing B. Interventions to reduce pain 1. Report complaints of pain or unrelieved pain (after having been given a pain medication) to the nurse 2. Position the resident's body in good alignment or assist to reposition the resident at the resident's direction in regard to a comfortable position 3. Offer a back rub to the resident 4. Assist the resident to the bathroom or offer the bedpan or urinal 5. Encourage the resident to take slow, deep breaths 6. Provide a quiet and calm environment 7. Use soft music to distract the resident 8. Be patient, caring, gentle and sympathetic in assisting the resident 9. Observe the resident's response to interventions attempted and report to the nurse C. Barriersforresidentregardingpain 1. Fear of addiction to pain medication 2. Feeling caregivers are too busy to deal with pain 3. Fear pain medication will cause other problems, i.e. drowsiness, sleepiness, constipation RCPs: • None

Lesson #12 Conte

Content: I. Dressing A. Residents have their own style and preferences B. Residents should be encouraged to dress in their own clothing of choice each day C. Each piece of the resident's clothing should be inventoried according to facility policy, adding new items and deleting discarded items as necessary D. Resident clothing should be labeled/identified in an inconspicuous place E. Affected limbs should be dressed first and undressed last F. Avoid pullover garments if the resident has an affected side or difficulty with the neck or shoulders, unless requested by the resident G. Change Gown (see RCP) H. Dressing a Dependent Resident (see RCP) II. Toileting A. Assist to Bathroom (see RCP) B. Bedside Commode (see RCP) NOTE *Ensure bedside commode is in good repair and has intact rubber stops to prevent commode from moving with resident weight, potentially causing a fall. C. Bedpan/FracturePan(seeRCP) 1. A fracture pan is a bedpan that is flatter than a normal bedpan. It is used for residents who cannot assist to raise their hips onto a regular bedpan. When using a fracture pan, position with the handle toward the foot of the bed. If the resident cannot help, roll the resident onto the far side, slip the fracture pan under the hips and roll the resident back toward you onto the bedpan. 2. A standard bedpan is positioned with the wider part of the pan aligned with the resident's buttocks D. Urinal (see RCP) E. Bowel and Bladder Training 1. Incontinent residents may be identified as candidates for bowel and bladder training. If so, the following guidelines will apply: a. A record of the resident's bowel and bladder habits will be maintained and then observed for a pattern of elimination. A pattern will predict the frequency in which the resident will need to be assisted to use the bedpan or to toilet b. Explain the training schedule to the resident and attempt to follow the schedule closely c. Offer a trip to the commode or bathroom prior to beginning long procedures, as well as before and after meals d. Encourage residents to drink sufficient fluids. About 30 minutes after fluids are consumed, offer a trip to the bathroom or use of the urinal or bedpan e. Answer the resident's call light promptly, as residents cannot wait long when the urge to void is felt f. Provide privacy for elimination g. Praise successes and attempts to control bowel and bladder F. Emptying urinary drainage bag/leg bag (see RCP) G. Catheter Care (see RCP) 1. If a resident has a catheter, care is normally provided on each shift H. Urine Specimen Collection (see RCP) 1. If a clean-catch (midstream) urine specimen is ordered, using the towelettes supplied, the caregiver will assist the resident to clean the area around the meatus. For females, separate the labia. Wipe from front to back along one side. Discard the towelette. With a new towelette, wipe from front to back along the other side. Using a new towelette wipe down the middle. For males, clean the head of the penis. Use circular motions with the towelettes. Clean thoroughly, changing the towelette after each circular motion. Discard after use. If the male is uncircumcised, pull back the foreskin of the penis before cleaning. Hold it back during urination. Make sure it is pulled back down after collecting the specimen. Ask the resident to begin urination, but to stop before urination is complete. Place the container under the urine stream and ask the resident to begin urinating again. Fill the container at least half full. Remove the container and allow the resident to finish urinating in bedpan, urinal or toilet. I. Stool Specimen Collection (see RCP) 1. Ask the resident to inform you when he or she can have a bowel movement. 2. Be ready to collect the specimen J. Application of Incontinent Brief 1. Ensure brief is appropriate size for resident 2. Ensure appropriate application in a manner not to cause abrasion due to being too tight or having tape applied to skin 3. Monitor frequently for needed perineal care and change of brief RCPS: • Change Gown • Dressing a Dependent Resident

Lesson #6 Content

Content: I. Fire Safety A. General 1. Know the evacuation plan 2. Know how much assistance is needed, and which residents to relocate first (i.e., ambulatory, those who need assistance) 3. Dangers of smoke inhalation a. Stay low and cover mouth with wet cloth b. Shut resident doors 4. Fire drills and procedures a. Role of the nursing assistant during a fire drill and/or evacuation b. Know the locations of all exits and stairways c. Know the locations of fire alarms, extinguishers and fire blankets 5. Never use an elevator in the event of a fire 6. If your clothing catches on fire, STOP, DROP and ROLL to smother the flames 7. A supervisor or charge nurse will give directions during an emergency B. Guidelines in case of fire (See RCP) 1. Remove residents from area of immediate danger 2. Activate the fire alarm 3. Contain the fire, if possible (close doors) 4. Extinguish, if possible C. Use of the fire extinguisher (See RCP) 1. Pull the pin 2. Aim at the base of the fire 3. Squeeze the handle 4. Sweep back and forth at the base of the fire D. Types of fire extinguishers 1. A= paper, wood, cloth B= oil, grease C=electrical E. During an emergency, stay calm, listen carefully and follow directions given II. Side rails/Entrapment A. Purpose of side rail use 1. Enabling or self-(help if used to assist the resident to move independently totally dependent) . Restrictive if their use results in confining the resident in bed; restricting voluntary movement B. Zones/areas of potential bed entrapment III. Resident Elopement A. Exit seeking behavior 1. Frequently remaining at or near exit doors 2. Shaking door handles 3. Pacing to and from the exit doors 4. Voicing a desire to leave the facility and/or return home 5. Packing clothing/belongings 6. Wearing shoes, coat, hat, etc., although in the facility B. Resident identification and monitoring 1. Facility assessment and identification of residents at risk of elopement 2. Pictures, logs or other means to identify residents at risk of elopement C. Electronicbracelets 1. Worn by residents at risk for elopement 2. Checked for presence and function per established facility frequency 3. Exits become secured when a resident with such a bracelet approaches the exit 4. Voicing a desire to leave the facility and/or return home 5. Packing clothing/belongings 6. Wearing shoes, coat, hat, etc., although in the facility D. Coded entries 1. Requires a code to be entered to release/open the door 2. Code should be known/available to alert and oriented residents, visitors and staff 3. Coded entries are unlocked during a fire alarm and must be monitored. E. Alarmed doors 1. Staff should suspect a resident has exited unattended when the alarm is heard 2. Check panel for source door sounding the alarm 3. Immediately assess grounds near exit. If source of alarm sounding is not visualized, conduct a headcount to confirm all residents are safe within the facility 4. Never silence an alarm without knowing "why" the alarm sounded IV. Smoking A. Facilitypolicy 1. Supervised vs. unsupervised smoking per resident assessment of ability 2. If the facility allows unsupervised smoking, the facility should direct how the resident is to store/manage smoking materials (i.e., lighter, cigarettes) 3. The facility may be a "non-smoking" campus B. Potentialsafetyconcerns/assistivedevices 1. Ability to manipulate smoking materials/cigarette extension 2. Smoking apron if concerned with ashes dropped on clothing 3. Appropriate non-flammable ashtrays/containers 4. Oxygen use prohibited when smoking a. Oxygen supports combustion (the process of burning) b. Never allow open flames near oxygen 5. Monitoring for non-compliance with smoking policy a. Smoke odor in room b. Burn holes in clothing/bedding c. Smoking materials supplied by family members 6. Electronic cigarettes RCPS: • Fire • Fire Extinguisher

Lesson #11 Content

Content: I. Grooming/Personal Hygiene A. Points to Remember: 1. Always allow the resident to do as much as possible for themselves 2. Allow the resident to make choices and respect those choices 3. Be sensitive to established routines of the resident, incorporating those routines into daily care, as possible 4. Oral care includes cleaning the teeth, gums, inside of mouth and dentures and must be performed at least daily according to state rule, but recommended to occur more often 5. Oral care reduces the number of pathogens in the mouth, improves the resident's sense of well-being and appearance and improves sense of taste, enhancing appetite 6. Oral care eliminates particles from beneath the gums, preventing injury and improving ability to chew and consume meals 7. Dentures should be handled carefully and stored in cool water in a labeled denture cup when not in use 8. The caregiver should observe for ill-fitting dentures and report concerns to the nurse. Ill-fitting dentures could affect speech and chewing ability, thus, ultimately affecting meal consumption and contributing to potential weight loss 9. More frequent oral care is needed for residents who are unconscious, breathe through their mouth, are being given oxygen, are in the process of dying and/or are NPO 10.Observe and report to nurse: irritation, raised areas, coated or swollen tongue, sores, complaint of mouth pain, white spots, loose/chipped or decayed teeth B. OralCare(seeRCP) C. OralCareforUnconscious(seeRCP) D. Denture Care (see RCP 1. Always follow manufacturer's instructions for cleaning dentures E. Shaving/Electric Razor (see RCP) 1. Points to Remember: a. Be certain that the resident wants you to shave him or assist him to shave before you begin b. Wear gloves when shaving a resident F. Safety Razor (see RCP) G. Combing/Brushing Hair (see RCP) 1. Always use hair care products that the resident prefers for his/her type of hair H. Fingernail Care (see RCP) 1. Nail care is provided when assigned or if nails appear dirty or have jagged edges 2. Check fingers and nails for color, swelling, cuts or splits. Check hands for extreme heat or cold. Report any unusual findings to nurse before continuing procedure I. Foot Care (see RCP) 1. Support the foot and ankle throughout the procedure 2. Poor circulation occurs in the resident with diabetes. Even a small sore on the foot can become a large wound 3. Careful foot care, including regular daily inspection is important 4. During foot care, the feet should be checked for irritation or sores and reported to the nurse, if observed 5. A nurse aide should never trim or clip any resident's toenails, but especially not the diabetic's toenails. Only a nurse or physician should do so RCPS: • Oral Care • Oral Care for Unconscious • Denture Care • Electric Razor • Safety Razor • Comb/Brush Hair • Fingernail Care • Foot Care

Lesson #22 Content

Content: I. Causes of Mental Illness A. Physical factors - illness, disability, aging, substance abuse or chemical imbalance B. Environmental factors - weak interpersonal skills, weak family support, traumatic experiences C. Heredity-possibleinheritedtraits D. Stress - inability to handle or cope with stress II. Response to Behaviors A. Remain calm B. Don't treat like a child C. Beware of body language & bodily functions D. Maintain a normal distance E. Use simple, clear language F. Avoid arguments G. Maintain eye contact H. Listen carefully I. Show respect and concern III. Use of Defense Mechanisms - unconscious behaviors used to release tension or cope with stress or uncomfortable, threatening situations or feelings. A. Denial - rejection of a thought or feeling B. Projection - seeing feelings in others that are really one's own C. Displacement - transferring a strong negative feeling to something or someone else D. Rationalization - making excuses to justify a situation E. Repression - blocking painful thoughts or feelings from the mind F. Regression - going back to an old immature behavior IV. Types of Mental Illness A. Anxiety related disorders 1. Anxiety - uneasiness or fear about a situation or condition that cannot be controlled or relieved when the cause has been removed 2. Panic Disorders - fearful, scared or terrified for no specific reason 3. Obsessive Compulsive Disorders - OCD - uncontrollable need to repeat or perform actions in a repetitive or sequential manner 4. Post-traumatic Stress Disorder - PTSD - anxiety related to a traumatic experience 5. Phobias - intense fear of certain things or situations 6. Symptoms - sweating, dizziness, choking, dry mouth, racing heart, fatigue, shakiness, muscle aches, cold or clammy feeling, shortness of breath or difficulty breathing B. Depression 1. Clinical depression - depression ranges in seriousness from mild, temporary episodes of sadness to severe, persistent depression. The term "clinical depression" is used to describe the more severe form of depression also known as "major depression" or "major depressive disorder" a) Clinical depression symptoms may include: A. Depressed mood most of the day, nearly every day B. Lossofinterestorpleasureinmostactivities C. Significantweightlossorgain D. Sleeping too much or not being able to sleep nearly every day E. Slowed thinking or movement that others can see F. Fatigue or low energy nearly every day G. Feelings of worthlessness or inappropriate guilt H. Loss of concentration or indecisiveness I. Recurring thoughts of death or suicide 2. Bipolar Disorder - sometimes called manic-depressive disorder - is associated with mood swings that range from the lows of depression to the highs of mania. When the resident becomes depressed, he/she may feel sad or hopeless and lose interest or pleasure in most activities. When the resident's mood shifts in the other direction, he/she may feel euphoric and full of energy. Mood shifts may occur only a few times a year, or as often as several times a day 3. Schizophrenia - brain disorder that affects a person's ability to think and communicate. It affects the way a person acts, thinks, and sees the world a) Does not mean "split personality" b) Symptoms - delusions, hallucinations, thought disorder, disorganized behavior, loss of interest in everyday activities, appearing to lack emotion, reduced ability to plan or carry out activities, neglect of personal hygiene, social withdrawal, loss of motivation V. Behaviors associated with mental disorders - actions and interventions A. Combative 1. Actions - hitting, kicking, spitting, pinching, pushing, pulling hair, cursing 2. Interventions - remain calm, don't take personal, step out of way, remove other residents, never strike back or respond verbally, leave resident alone to de-escalate (calm)- but only if safe, report to nurse B. Anger 1. Actions - shouting, yelling, threatening, throwing things, pacing, withdrawal, sulking 2. Interventions - remain calm, do not argue, try to understand what triggered anger, empathize with resident, listen, stay a safe distance, explain what you are doing C. Sexual Behaviors 1. Actions - sexual advances, comments, sexual words or gestures, removing clothing, inappropriate touching of self or others, exposing body parts or masturbation 2. Interventions - do not over-react, be "matter-of-fact", try to redirect, gently direct to private area, report to nurse, maintain safety of other residents 3. Special consideration - check for possible explanation for behavior, such as clothing not fitting, skin irritation, need for toileting, remember to report all inappropriate sexual behavior to the nurse VI. Treatment for Mental Illness A. Medications - numerous medications are available. Physician orders the medication dependent on diagnosis and conditions that need to be addressed. The nursing staff is responsible for monitoring and administration of these medications B. Psychotherapy - involves sessions with mental health professionals during which the residents discuss problems or issues. The mental health professionals work with the resident to identify and address problems and develop interventions for staff to follow when caring for the resident. VII. Special Considerations A. Talk of Suicide or Death - any verbalization of suicide, "death wish" or self- injury REPORT IMMEDIATELY B. Changesinconditions-any changes in mood, activity, eating, extreme behaviors or reactions, more upset or excitable, withdrawn, hallucinations or delusions VIII. Mental Illness and Intellectual Disability (Mental Retardation) A. Intellectual Disability (Mental Retardation) - a developmental disability that causes below -average mental functioning 1. Intellectual Disability (Mental Retardation) vs. Mental Illness: a) Intellectual Disability (Mental Retardation) is a permanent condition; mental illness can be temporary b) Intellectual Disability (Mental Retardation) is present at birth or early childhood; mental illness can develop at any age c) Intellectual Disability (Mental Retardation) affects mental ability; mental illness may or may not affect mental function d) No cure for Intellectual Disability (Mental Retardation). Some mental illness can be cured or controlled with treatment, such as medication or therapy. RCPS: • None

Lesson #13 Content

Content: I. Points to Remember: A. When a resident enters a nursing facility, he/she experiences the loss of home and belongings. Familiar things create a positive and home-like environment. The staff should encourage the resident to bring items from home, as space permits B. The room should be arranged according to resident preference, as possible C. The resident's personal belongings should be safeguarded, as possible D. Types of beds may vary in each facility. Most beds have controls to raise, lower and adjust positions. A low bed may be used for a resident at risk for falls E. Temperature of the resident's room/environment should be considered. The resident's condition and preferences should determine the appropriate temperature F. Lighting should be sufficient for the resident's needs/preferences. Indirect lighting is preferable, in that glare causes fatigue G. The resident's environment should be cleaned of spills immediately, as spills are safety hazards contributing to falls H. Excessive noise levels in the environment can provoke irritation and problematic behaviors. Facilities should maintain equipment in good repair and refrain from overhead paging I. Fresh ice water should be maintained and within reach in the resident's environment, unless the resident's fluids are restricted by the physician, in an effort to encourage hydration J. The resident's call light should be placed within the resident's reach upon completion of care/staff assistance K. Defective or unsafe equipment should be taken out of service and reported to the nurse immediately II. Unoccupied Bed (see RCP) III. Occupied Bed (see RCP) IV. Resident Room/Environment/Fall Prevention A. Each room may have slightly different equipment. Standard room contents include: bed, bedside stand, over bed table, chair, call light and privacy curtains. B. Always ensure the call light is within the residents reach & answered immediately. C. Clean the over bed table after use & place within resident's reach if commonly used items are stored on the table. D. Remove anything that might cause odors or become safety hazards, such as trash, clutter, spilled fluids, etc. E. Clean up spills promptly F. Report signs of insects or pests when observed G. Fall prevention: To reduce risk of falls: 1. Clear all walkways of clutter and cords 2. Use non-skid mats when needed 3. Assist residents to wear non-skid socks or shoes. Make certain shoelaces are tied 4. Monitor to ensure residents wear clothing that is of proper length (e.g., not too tight, not too loose, or not too long) 5. Keep frequently used items within reach of resident 6. If ordered, ensure any devices or alarms are in place and functional as per plan of care 7. Lock wheelchairs before assisting residents to transfer 8. Offer to toilet resident frequently/according to toileting schedule to prevent unassisted attempts to toilet 9. Visual cues or devices may be used for reality orientation such as a large face clock, calendar, etc. Familiar pictures, symbols or personal items may be displayed or hung to assist the resident with cognitive impairment to recognize his/her room, restroom, closet, etc. RCPS: • Unoccupied Bed • Occupied Bed

Lesson #24 Content

Content: I.Respiratory System A. mouth and nose - take in air B. trachea - tube connecting mouth and nose to lungs C. lungs-move oxygen from air into blood and remove carbon dioxide (gaseous waste product) 1. Two functions: a) Inspiration - brings oxygen into the body b) Expiration - eliminates carbon dioxide Common Conditions of the Respiratory System: A. Upper Respiratory Infection (URI) or cold B. Pneumonia - lung infection caused by a bacterial, viral or fungal infection C. Bronchitis - swelling of the main air passages to the lung D. Asthma - disorder that causes the airways to swell and become narrow E. Emphysema - progressive lung disease that causes shortness of breath. A symptom of COPD F. Chronic Obstructive Pulmonary Disease (COPD) - chronic disease in which residents have difficulty breathing, particularly getting air out of lungs. G. LungCancer H. Tuberculosis (TB) - a contagious bacterial infection of the lungs. III. Normal Changes with Age A. Lung capacity decreases as chest wall and lungs become more rigid. Deep breathing is more difficult. Air exchange decreases causing the resident to breathe faster to get enough air when exercising, ill, or stressed. B. Decreasedlungstrength 1. Decreased lung capacity 2. Decreased oxygen in blood 3. Weakened voice IV. Role of the Nurse Aide A. Observe and Report 1. Change in respiratory rate 2. Coughing or wheezing 3. Complaint of pain in the chest 4. Shallow breathing or difficulty breathing 5. Shortness of breath 6. Bluish color of lips or nail beds 7. Spitting or coughing up of thick sputum or blood 8. Need to rest with mild exertion B. Interventions to avoid respiratory problems 1. Encourage fluids 2. Oxygen should be in use, if ordered 3. Encourage exercise and movement 4. Encourage deep breathing and coughing 5. Frequent hand hygiene, especially during cold /flu season Content - Urinary System: I. Urinary System A. Kidneys - filter waste products from blood and produce urine B. Ureters- carry urine from kidneys to bladder C. Urinarybladder-storesurine D. Urethra- carries urine from bladder out of body E. Two functions 1. Eliminates waste products through urine 2. Maintains water balance in the body F. Common Conditions of the Urinary System 1. Urinary Tract Infection (UTI) or cystitis 2. Calculi (kidney stones) III. Normal Changes with Age A. Kidney function decreases slowing removal of waste. Bladder tone decreases resulting in more frequent urination, incontinence, bladder infections and urinary retention B. Decreased ability of kidney to filter blood C. Weakened bladder muscle tone D. More frequent urination due to bladder holds less urine E. Bladder does not empty completely IV. Role of the Nurse Aide A. Observe and Report to the nurse 1. Changes in frequency and amount of urination 2. Foul smelling urine or visible change in color of urine 3. Inadequate fluid intake 4. Pain or burning with urination 5. Swelling in extremities 6. Complaint of being unable to urinate or bladder feeling full 7. Incontinence or dribbling 8. Pain in back/kidney region B. Interventions to avoid urinary problems 1. Encourage fluids 2. Frequent toileting 3. Keep resident clean and dry 4. Avoid anger or frustration if resident is incontinent RCPs: • None

Lesson #5 Content

Content: I. Accidents A. Types of Accidents: 1. Falls/Fainting 2. Burns 3. Poisoning 4. Choking II. Falls - the consequences of falls can range from minor bruises to fractures and life-threatening injuries. A. Risk factors: 1. Personal: a. Medications b. Gait or balance problems c. Diagnosis - paralysis, hemiplegia, weakness, disorientation d. Fainting - the sudden loss of consciousness because of inadequate blood supply to the brain. The cause can be pain, fatigue, hunger or medical conditions. e. Bowel/Bladder status - urgency, incontinence f. Improperly fitting shoes or clothing 2. Environment: a. Clutter b. Slippery/wet floors or floors that have shiny waxed finishes. c. Uneven surfaces d. Poor lighting e. Call light out of reach f. Side rails B. Prevention: 1. Know residents that are at high risk for falls 2. Frequent toileting program 3. Respond to call lights promptly 4. Use of proper shoes/clothing 5. Keep environment clear or free of obstacles C. Intervention: 1. If a resident begins to fall, never try to stop the fall. Gently ease the resident to the floor and: a. Call for help immediately, and b. Keep the resident in the same position until the nurse examines the resident D. (See RCP) - Falling or Fainting: III. Choking - a blockage of the airway. This can occur when eating, drinking or swallowing. The resident often gasps or clutches throat (the universal sign for choking). A. Risk Factors: 1. Diagnosis — stroke, swallowing difficulty 2. Medications 3. Mental Status a. Unconscious b. Cognitive impairment - wandering, eating others' food at an inappropriate consistency B. Prevention: 1. Know residents that are at risk 2. Special diets/thickened liquids a. Soft/mechanical soft/pureed diets b. Liquids - consistencies i. Nectar thick - thicker than water ii. Honey thick - pours very slowly iii. Pudding thick - semi-solid (spoon should stand up straight) C. (SeeRCP)-Choking: IV. Burns/Scalds A. Risk Factors: 1. Diagnosis/Conditions - stroke, paralysis, diabetes 2. Mental Status/Cognitive impairment 3. Heating appliances/equipment 4. Smoking 5. Hot liquids B. Prevention 1. Know residents that are at risk 2. Check/report use of heating appliances 3. Check water temperatures (bath, shower) 4. Supervise smoking, when indicated 5. Encourage use of smoking apron, cigarette extension, etc., when indicated 6. Know location of nearest fire extinguisher or fire blanket 7. Pour hot liquids away from residents 8. Mugs with lids/adaptive devices V. Poisoning A. Risk Factors: 1. Diagnosis/Conditions - Dementia, Alzheimer's Disease, confusion 2. Other factors a. Wandering b. Hoarding B. Prevention: 1. Proper storage of medications/supplies 2. Lock storage/cleaning rooms, closets and carts 3. Material Safety Data Sheet (MSDS) — all chemicals have a sheet that details the ingredients, dangers, emergency response to be taken, and safe handling procedure; required by OSHA VI. Medical Emergency A. Types of Medical Emergencies: 1. Heart Attack/Cardiac Arrest - symptoms may include crushing pain (like someone sitting on the chest) which may go down left arm, be felt in neck or in jaw and doesn't go away a. Notify the nurse immediately b. Loosen clothing around the neck c. Do not give food or fluids d. Be prepared to initiate CPR if qualified e. Remain with resident until help arrives 2. Stroke/Cerebral Vascular Accident (CVA) - symptoms may include dizziness, blurred vision, nausea/vomiting, headache, uneven grip or smile, slurred speech a. Report symptoms to nurse immediately 3. Seizures/Convulsions: a. Call for nurse and stay with resident b. Assist the nurse with positioning the resident on his/her side c. Place padding under head and move furniture away from resident d. Do not restrain resident or place anything in mouth e. Loosen resident's clothing, especially around the neck f. After the seizure stops, assist nurse to check for injury g. Note duration of seizures and areas involved 4. Bleeding/hemorrhage: a. Use Standard Precautions b. Apply direct pressure over the area with a sterile dressing or a clean piece of linen c. Raise the limb above the level of the heart, if possible VII. Safety Measures/Prevention Strategies A. Prevention is the key to safety B. Observe for safety hazards, correct or remove hazard, report needed repair C. Know residents' risk factors for accidents D. Safety measures to follow: 1. Call light available 2. Clean/clear environment 3. Report observations that are unsafe and/or equipment in need of repair. RCPS: • Falling or Fainting • Choking • Seizures

Lesson #27 Content

Content: I. Admitting a New Resident to the Facility A. Role of the Nurse Aide 1. Prepare the room for the resident's arrival 2. Introduce self to resident and family/responsible party and explain role 3. Explain surroundings to resident, including use of call light to summon help, if needed 4. Create a trusting relationship 5. Be available to family 6. Become a resource and support for the family 7. Refer family members requesting information about a resident to the nurse II. Assisting to Transfer a Resident to a Hospital (i.e., Care Transition) A. Role of the Nurse Aide 1. Respond to the directives given by the nurse to prepare the resident for transfer, particularly if the transfer is for an emergent condition 2. If resident is leaving for a non-emergent appointment, ensure that the resident has received appropriate care, assistance with grooming, toileting and is appropriately dressed for the weather conditions during transport 3. Assist emergency medical personnel, as requested, to ensure safe transfer of the resident III. Assisting a Resident to Discharge Home or to Another Facility A. Role of the Nurse Aide 1. Respond to the directives given by the nurse to prepare the resident for discharge 2. Assist to gather personal belongings, as requested, in preparation for transfer/discharge, using the personal inventory as reference to personal items on site RCPS: • None

Lesson #28 Content

Content: I. Advance Directives A. Purpose- by stating health care choices in an advance directive, the resident helps his/her family and physician understand their wishes about the resident's medical care B. Advance directives are normally one or more documents that list the resident's health care instructions. An advance directive may name a person of choice to make health care choices when the resident cannot make the choices for themselves. If desired, the resident may use an advance directive to prevent certain people from making health care decisions on their behalf C.An advance directive will not take away the resident's right to decide his/her current health care. As long as the resident is able to decide and express their own decisions, the resident's advance directive will not be used. This is true even under the most serious medical conditions. An advance directive will only be used when the resident is unable to communicate or when the physician decides that the resident no longer has the mental competence to make their own choices II. Indiana recognizes the following types of advance directives: • Talking directly to your physician and family • Organ and tissue donation • Health Care Representative • Living Will Declaration or Life-Prolonging Procedures Declaration • Psychiatric Advance Directive • Out of Hospital Do Not Resuscitate Declaration and Order • Power of Attorney III. Role of Hospice A. Participation- Resident is not expected to live more than six months B. Licensed nurse, clergy, social service and primary caregiver services may be provided C. Focus is on comfort measures and pain management D. Preserves dignity, respect and choice E. Plan of care is to be coordinated between facility staff and hospice staff F. Offers empathy and support for the resident and the family IV. Care of the Dying Resident A. Place resident in most comfortable position for breathing and avoiding pain. B. Maintain body alignment. C.Batheandgroomresidentasdesiredbytheresident/familytopromoteself-esteem, yet do not be disruptive D. Keep resident's environment as normal as possible, as desired by the resident E. Provide skin care, including back rubs/comfort measures frequently F. Provide frequent oral care as needed. Keep dry/cracked lips lubricated for comfort G. Offer drinking water/fluids frequently H. Keep the resident's skin/linens clean Offer resident's favorite foods I. Communicate with the resident, even if he is not responsive, by identifying self and explaining everything you are doing J. Be guided by the resident's attitude K. Respect each resident's idea of death and spiritual beliefs L. Give the resident and the family privacy, but do not isolate them V. Signs/Symptoms of Impending Death A. Circulation- slows as heart fails; extremities become cool; pulse becomes rapid and weak B. Respiration- irregular, rapid and shallow or slow and heavy; Cheyne Stokes C. Muscletone- jaw may sag ;body becomes limp ;bodily functionality become slow & involuntary D. Senses- sensory perception declines; the resident may stare yet not respond; hearing is believed to be the last sense to be lost VI. Post Mortem Care A. Respect the family's religious restrictions regarding care of the body, if applicable B. Provide privacy and assist a roommate to leave the area until the body is prepared and removed C. Place the body in the supine position with one pillow under the head to prevent facial discoloration D. Put in dentures. Notify nurse to remove any tubes or dressings E. Wash the body, as necessary, and comb hair F. Put on a clean gown and cover perineal area with a pad VII. Disposition of Personal Belongings A. Assist the family/responsible party to gather personal belongings and compare to the personal inventory record to ensure the personal belongings of the resident are accounted for and returned to the family/responsible party B. Send dentures, eyeglasses and prosthetic devices with the body to the mortuary RCPS: • Post Mortem Care

Lesson #21 Content

Content: I. Conditions: A. Confusion - characterized by the inability to think clearly, trouble focusing, difficulty making decisions, feeling of disorientation B. Delirium - state of sudden severe confusion that is usually temporary C. Dementia- a general term that refers to serious loss of mental abilities, such as thinking, remembering, reasoning, and communicating. Dementia is not a normal part of aging D. Alzheimer's disease - a progressive, degenerative and irreversible disease. Alzheimer's disease is caused by the formation of tangled nerve fibers and protein deposits in the brain. Alzheimer's disease is the most common cause of dementia. Alzheimer's disease is characterized by stages: 1. Stage 1 - no impairment (normal function) - the resident does not experience any memory problems 2. Stage 2 - very mild cognitive decline (may be normal age-related changes or earliest signs of Alzheimer's disease) - the resident may feel as if he or she is having memory lapses - forgetting familiar words or the location of everyday objects 3. Stage 3 - mild cognitive decline (early stage Alzheimer's can be diagnosed in some, but not all, individuals with these symptoms) - friends, family or co-workers begin to notice difficulties a) Noticeable problems coming up with the right word or name b) Trouble remembering names when introduced to new people c) Having noticeably greater difficulty performing tasks in social or work settings d) Forgetting material that one has just read e) Losing or misplacing a valuable object f) Increasing trouble with planning or organizing 4. Stage 4 - moderate cognitive decline (mild or early-stage Alzheimer's disease) - at this point, a careful medical interview should be able to detect clear-cut symptoms in several areas: a) Forgetfulness of recent events b) Impaired ability to perform challenging mental arithmetic - for example, counting backward from 100 by 7s c) Greater difficulty performing complex tasks such as planning dinner for guests, paying bills or managing finances d) Forgetfulness about one's own personal history e) Becoming moody or withdrawn, especially in socially or mentally challenging situations 5. Stage 5 - moderately severe cognitive decline (moderate or mid-stage Alzheimer's disease) - gaps in memory and thinking are noticeable, and residents begin to need help with day-to-day activities. At this stage, those with Alzheimer's may: a) Be unable to recall their own address or telephone number or the high school or college from which they graduated b) Become confused about where they are or what day it is 6. Stage 6 - severe cognitive decline (moderately severe or mid-stage Alzheimer's disease) memories continues to worsen, personality changes may take place and individuals need extensive help with daily activities. At this stage, residents may: a) Lose awareness of recent experiences as well as of their surroundings b) Remember their own name but have difficulty with their personal history c) Distinguish familiar and unfamiliar faces but have trouble remembering the name of a spouse or caregiver d) Need help dressing properly and may, without supervision, make mistakes such as putting pajamas over daytime clothes or shoes on the wrong feet e) Experience major changes in sleep patterns - sleeping during the day and becoming restless at night f) Need help handling details of toileting (for example, flushing the toilet, wiping or disposing of tissue properly) g) Having increasingly frequent trouble controlling their bladder or bowels h) Experience major personality and behavioral changes, including suspiciousness and delusions (such as believing that their caregiver is an imposter) or compulsive, repetitive behavior like hand- wringing or tissue shredding i) Tend to wander or become lost 7. Stage 7 - very severe cognitive decline (severe or late-stage Alzheimer's disease) - in the final stages of this disease, residents lose the ability to respond to their environment, to carry on a conversation and, eventually, to control movement. They may still say words or phrases. At this stage, residents need help with much of their daily personal care, including eating or using the toilet. They may also lose the ability to smile, to sit without support and to hold their heads up. Reflexes become abnormal. Muscles grow rigid. Swallowing impaired II. Behaviors, Causes and Interventions A. Agitation -could be caused by noise, other residents' behaviors, pain, hunger etc.) 1. Remove trigger(s), if known 2. Maintain calm environment 3. Stay calm 4. Patting, stroking may reassure resident/may not B. Pacing/Wandering - could be a need to exercise, resident has forgotten location of room or chair, hungry, need to toilet, pain, etc. 1. Ensure resident is in a safe area 2. Ensure resident is wearing appropriate footwear 3. Re-direct to another activity of interest if resident appears tired and may become at risk for falls C. Elopement - may be evident through exit-seeking actions, verbalizing wanting to leave, staying close/near doors, trying to open doors/windows 1. Redirect and engage in other activities 2. Ensure doors remain secured/alarms functional 3. Report missing resident immediately D. Hallucinations/Delusions - may be caused by acute illness or psychiatric diagnosis/condition 1. Ignore harmless hallucinations or delusions 2. Provide reassurance 3. Do not argue 4. Stay calm 5. Redirect to activities or to another discussion 6. Notify nurse of hallucination(s)/delusion(s) E. Sundowning - as this occurs in the evening, consider need for increased activities and/or staffing in the evening 1. Remove trigger(s) 2. Avoid stress in environment 3. Keep environment calm and quiet 4. Reduce/remove caffeine from evening fluids/diet, if possible 5. Redirect; offer activity or favorite food F. Catastrophic Reaction - may be caused by fatigue or over stimulation 1. Remove trigger(s), if possible 2. Offer food or quiet activity 3. Redirect G. Repetitive Phrasing - may be caused by habit or cognitive impairment 1. Be patient and calm 2. Answer question 3. Do not try to silence or stop 4. Redirect H. Violence - may be caused by delusion, hallucination, acute illness, cognitive impairment, provocation by another resident, etc. 1. Step out of reach 2. Block blows with open hand or forearm 3. Do not strike back or grab resident 4. Call for help 5. Stay calm 6. Identify triggers and remove, if possible I. Disruptive actions - may be caused by delusion, hallucination, acute illness, cognitive impairment, provocation by another resident, etc. 1. Remain calm 2. Avoid treating like a child 3. Gently direct to a private area, provide distraction or activity 4. Explain procedure(s) or change in normal pattern 5. Be reassuring J. Challenging Social Acts - may be caused by delusion, hallucination, acute illness, cognitive impairment, provocation by another resident, etc. 1. Remain calm 2. Identify trigger, if possible 3. Gently redirect to private area 4. Report physical or verbal abuse to the nurse K. Challenging Sexual Acts - may be provoked by a thought, visual, etc. 1. Do not over-react 2. Be sensitive 3. Try to redirect or relocate to a private area 4. Ensure the safety of other residents, if potentially involved 5. Report to nurse L. Pillaging/Hoarding - note that either activity is not stealing, rather, a behavior often associated with a psychiatric diagnosis 1. Label personal belongings of all residents 2. Regularly check rooms for items which might belong to others 3. Provide direction to resident's own room (a visual cue could be helpful) 4. Mark other residents' room with symbols or labels to avoid residents from entering III. Methods/Therapies to Reduce Behaviors A. Reality Orientation - using calendars, clocks, or signs to help memory B. ValidationTherapy-allowingtheresidenttoliveinthepastorinimaginary circumstances; to try to convince otherwise is often upsetting C. Reminiscence Therapy - encouraging the resident to remember; to talk about the past D. Activity Therapy - using activities that the resident enjoys to prevent boredom and frustration E. Music Therapy - form of sensory stimulation; hearing familiar songs can cause a response in residents that do not respond to other therapies F. Re-direction - gently and calmly encouraging the resident to do a different action; change focus of attention IV. Tips to Remember when Dealing with Cognitively Impaired Residents A. Not personal - residents do not have control over words or actions B. Talkwithfamily-learnabouttheresident'slife,names of family members, occupation, hobbies, pets, foods, favorites C. Teamwork-reportchangesorobservations;beflexibleandpatient D. Handle behaviors/situations as they occur - remember that the resident has lost the ability to remember prior directions given E. Know your limits - watch for signs of stress, frustration and burnout V. Communication Strategies A. Always identify yourself B. Speak slowly, calmly in a low tone C. Avoid loud, noisy environments D. Avoid startling or scaring; approach from the front, remain visible to the resident E. Allow the resident to determine how close you should be VI. Techniques to Handle Difficult Behaviors A. Anxiety/Fear 1. Stay calm, speak slow 2. Reduce noise or distractions 3. Explain what you are doing 4. Use simple words and short sentences 5. Watch your body language and ensure it is not threatening B. Forgetful/MemoryLoss 1. Repeat, using same words 2. Give short simple instructions 3. Answer questions with brief answers 4. Watch tone, facial expressions and body language C. Unable to express needs 1. Ask to point or gesture 2. Use pictures or written words 3. Offer comfort if resident is becoming frustrated D. Unsafe or abusive language or activities 1. Avoid saying "don't" or "no" 2. Redirect to another activity or discussion 3. Remove hazard, if possible 4. Don't take the resident's actions personally E. Depressed, lonely or crying 1. Take time with resident; do not rush 2. Really listen and provide comfort 3. Try to involve in activities to redirect resident focus 4. If continues or repeats, report to nurse VII. Behavior Interventions A. Bathing 1. Schedule at time that resident is agreeable 2. Be organized 3. Take your time 4. Provide privacy 5. Make sure resident is not afraid of tub/shower 6. Have resident assist, as able 7. Maintain safety; do not leave alone 8. Do not argue with resident; if upset, try again at another time B. Dressing 1. Encourage to choose what to wear 2. Avoid delays, but do not rush 3. Provide privacy 4. Use simple steps; short step-by-step directions 5. Allow resident to assist 6. Take time and be calm C. Toileting 1. Encourage fluids - lack of fluids can cause dehydration and constipation 2. Establish a toileting schedule; for example, take to bathroom every 2 hours 3. Toilet before and after meals 4. If incontinent - watch for patterns to determine resident routine for a 2-3 day period (this is also effective for night time incontinence) 5. Identify bathroom with sign or picture 6. Avoid dark or unlit bathrooms or hallways 7. Check briefs frequently; change when soiled and observe skin 8. Document/track bowel movements (constipation may cause increase in behaviors) D. Eating/Meals 1. Schedule meals at regular times 2. Provide adequate lighting and space 3. Avoid delays - have meal ready, i.e., pre-cut, opened cartons or packages 4. Watch temperatures - avoid very hot foods 5. Simple (white) dishes, no extra items which could confuse resident 6. Avoid overwhelming with too many different foods 7. Give simple instructions 8. If the resident needs to be fed, use slow, calm, relaxed approach 9. Watch for chewing, swallowing or pocketing issues and report to nurse RCPS: • None

Lesson #29 Content

Content: I. Day to Day Time Management/Resident Care A. Beginning of Shift Report B. Use of assignment sheets/communication of resident needs C. Ancillary duties/assignments (e.g., cleaning, stocking supplies, etc.) D. Documentation/Flow Records 1. Resident's name on each page 2. All entries in ink, neat and legible 3. Entries are accurate and in chronological order as they occurred 4. Never document before a procedure is completed 5. Use facility-approved abbreviations 6. No ditto marks 7. Time and date entries; sign with name and title, unless initials are acceptable per facility policy. 8. Never document for someone else 9. If correcting an error, draw a single line through the error, print word "error" above entry and initial and date the correction 10. Some facilities may use military time. In this case, for the hours between 1:00 p.m.to 11:59 p.m., add 12 to the regular time. For example to change 2:00 p.m. to military time, add 2 + 12. The time would be 1400 hours. 11. Some facilities use computers/electronic medical records. When using, make certain information seen on the screen remains private. Do not share confidential information with anyone except other caregivers on the team. 12. Be sure you are documenting on the correct resident E. Reporting 1. Routine reporting 2. Immediate reporting of resident change in condition, unusual occurrence, accident, etc. F. End of Shift Report 1. Report pertinent concerns regarding resident status 2. Communicate any duties unable to be completed on your shift 3. Report any resident condition that will need the attention of the oncoming shift (e.g., resident is on the bedpan, etc.) II. Interdisciplinary Care Plan Meetings A. Revisions of the plan of care/communication to direct caregivers 1. The Care Plan Team reviews the plan at least quarterly and with any significant change in condition. 2. The care plan is reviewed and revised to reflect the current condition(s) and needs of the resident. 3. The care plan must be accessible for review by all caregivers 4. When revisions are made to the care plan, the assignment sheet used by direct care staff should also be updated accordingly. RCPS: • None

Lesson #4 Content

Content: I. Infectious Disease/Infectious Condition A. Acquired Immune Deficiency Syndrome (AIDS): 1. Defintion 2. Transmission - blood or body fluids; usually through contact with blood or sexual contact 3. Prevention- Standard Precautions B. Clostridium Difficile (C-Diff): 1. Definition 2. Transmission- spores which may survive up to six months on inanimate objects 3. Prevention-Contact Precautions; requires caregiver to wash hands; not use alcohol- based hand rubs C. Hepatitis: 1. Definition 2. Transmission-fecal/oral; contaminated blood or needles; sexual intercourse 3. Prevention-Standard Precautions D. Influenza: 1. Definition 2. Transmission- direct or indirect contact; may also be airborne 3. Prevention-Standard Precautions; may require Droplet Precautions E. Methicillin Resistant Staphylococcus Aureus (MRSA): 1. Definition a. infectious-with symptoms b. colonized-without symptoms 2. Transmission-direct or indirect contact 3. Prevention-Standard Precautions (colonized); Contact Precautions (infectious) dependent upon location; Droplet Precautions for a respiratory infection F. Pediculosis: 1. Definition 2. Transmission-direct or indirect contact; common use of combs/brushes, hats, linens 3. Prevention-Contact Precautions 4. Treatment- medications, environmental concerns. G. Scabies: 1. Definition 2. Transmission-direct or indirect contact; common use of linens 3. Prevention-Contact Precautions 4. Treatment- medications, environmental concerns. H. Tuberculosis: 1. Definition 2. Transmission- airborne; a resident who is suspected as having active Tuberculosis will be immediately transferred to a location where respiratory precautions (such as air exchange limited only to the room of the resident and use of respirators by caregivers) can be implemented 3. Prevention-Airborne Precautions; relocation to an appropriate environment I. Vancomycin Resistant Enterococcus (VRE): 1. Definition 2. Transmission-direct or indirect contact 3. Prevention-Standard Precautions; may require Contact Precautions dependent upon location II. Infection Control Practices A. Environmental cleaning: 1. High touch areas- bedrails, bedside equipment, remote control B. Disposalofcontaminateditems/infectiouswaste: 1. Sharps containers 2. Bio-hazardous waste containers C. Linen: 1. Handling clean linen 2. Handling/securing soiled linen III. Review of Personal Infection Control Practices A. Hand washing/Hand Hygiene B. PersonalProtectiveEquipment 1. Gloves 2. Gown 3. Mask RCPS: • Hand washing/Hand rub • Gloves • Gown • Mask

Lesson #7 Cintent

Content: I. Initial Steps- These are consistent steps to be taken prior to executing any procedure with a resident. (See RCP) A. Includes asking the nurse about the resident's needs, abilities and limitations B. Includes following infection control guidelines and providing the resident privacy during care II. Final Steps- These are consistent steps to be taken following the completion of any procedure with a resident. (See RCP) A. Includes ensuring the resident is comfortable and safe B. Includes removing supplies and equipment from the residents room and reporting any unexpected findings to the nurse and documenting care provided. III. Vital signs provide important information A. How the body is functioning B. How the resident is responding to treatment C. How the resident's condition is changing D. Taking and Recording Vital Signs 1. Temperature (oral, axillary, tympanic) - the measurement of heat in the body affected by time of day, age, exercise, emotional state, environmental temperature, medication, illness and menstruation. Types of thermometers include glass, electronic with probe cover, paper/plastic tape, tympanic with probe cover. Glass thermometers are seldom used. NOTE* A facility may have specific instructions in regard to equipment to be used and/or the cleaning and disinfection of common use equipment for those residents who require isolation. The facility policies should be followed in regard to residents in isolation a. Oral (by mouth) - normal range 97.6 to 99.6 F (See RCP) b. Axillary (placed in the armpit)- normal range 96.6- 98.6 F (See RCP) c. Aural/tympanic (placed in ear)- normal range 98.6- 100.6 F (See RCP) 2. Pulse-rate is the measurement of the number of heart beats per minute - Normal range 60 - 100 (See RCP) a. Affected by age, sex, emotions, body position, medications, illness, fever, physical activity and fitness level i. Pulse points most often used are: carotid, apical, radial, brachial ii. When taking the pulse rate - note the rate, rhythm and force. (See RCP) c. Respirations/Respiratory Rate-the measurement of the number of times a person inhales per minute (See RCP) i. Affected by age, sex, emotional stress, medication, lung disease, heat and cold, heart disease, and physical activity ii. When taking respirations, note rate (number of respirations per minute- normal rate is 12-20 per minute); rhythm (the regularity or irregularity of breathing); and character (the type of breathing, such as shallow, deep or labored) iii. When taking respirations, count respirations after finishing taking the pulse, without taking your fingers off the wrist or the stethoscope from the chest so that the resident is unaware you are checking the respirations iv. If resident is agitated or sleeping, place hand on resident's chest and feel chest rise and fall during breathing Blood Pressure - A measurement of the force the blood exerts against the walls of the arteries. Abnormally high blood pressure is called hypertension. Abnormally low blood pressure is called hypotension. Normal range for Systolic blood pressure is 100-139; Normal range for Diastolic blood pressure is 60-89 (See RCP) i. Caution: If resident has a history of mastectomy or has a dialysis access, the blood pressure is not to be taken in the affected side/extremity E. Height (See RCP) a. Residents who are able to stand should utilize a standing balance scale b. Residents who are unable to stand should be measured while lying flat in bed. c. Residents who are unable to lay flat in bed should be measured using a tape measure. F. Weight- Have resident wear the same type of clothing each time he/she is weighed. If daily weights are ordered, attempt to weigh at approximately the same time each day. If resident wears a prosthetic device, the weight should consistently be taken with the device in place, or not in place, to eliminate inaccurate weight changes. Follow the manufacturer's guidelines for use of the scale (See RCP) RCPS: • Review Initial/Final Steps • Oral Temperature • Axillary Temperature • Pulse and Respiration • Blood Pressure • Height • Weight

Lesson #3 Content

Content: I. Introduction to Infection Control A. Definition of Infection Control — prevent and control the spread of infection B. Role of Centers for Disease Control and Prevention (CDC) C. Chain of Infection Links: 1. Causative Agent - a pathogen or microorganism that causes disease 2. Reservoir - a place where a pathogen lives and grows 3. Portal of Exit - a body opening on an infected person that allows pathogens to leave 4. Mode of Transmission - method of describing how a pathogen travels from one person to the next person 5. Portal of Entry - a body opening on an uninfected person that allows pathogens to enter 6. Susceptible Host - an uninfected person who could get sick. D. Types of infections: 1. Systemic - an infection that is in the bloodstream and is spread throughout the body, causing symptoms 2. Localized - an infection that is confined to a specific location in the body and has local symptoms 3. Healthcare Associated Infections (HAIs)/Nosocomial - infections that patients acquire within healthcare settings that result from treatment for other conditions. E. Facility Infection Control Policy: 1. Key components a. Procedures b. Reporting c. Surveillance d. Compliance II. Hand Hygiene A. Hand washing - when hands are visibly soiled B. Alcohol - based hand rub C.nFive Moments for hand hygiene - World Health Organization (WHO) 1. Before resident/patient contact 2. Before aseptic task 3. After exposure to blood/body fluids 4. After resident/patient contact 5. After contact with resident/patient surroundings D. Other Hand washing moments Important factors related to Hand Hygiene 1. Visibly soiled with blood or body fluids 2. Exposure to potential pathogens a. Spores C-Diff - requires hand washing E. Other factors related to Hand Hygiene 1. Finger nails - long fingernails harbor organisms 2. Jewelry 3. Intact skin G. Procedure for hand washing - (See RCP) 1. Demonstrate proper hand washing 2. Explain rationale for each step III. Personal Protective Equipment - PPE A. Purpose of PPE B. Types of PPE: 1. Gloves 2. Gown 3. Mask Procedure for PPE 1. Demonstrate RCP: a. Gloves b. Gown c. Mask IV. Precautions A. Standard Precautions: 1. Hand Hygiene 2. Personal Protective Equipment 3. Disposal of contaminated equipment/supplies B. Transmission Based Precautions: 1. Airborne Precautions 2. Droplet Precautions 3. Contact Precautions RCPS: • Hand washing • Gloves • Gown • Mask

Lesson #14 Content

Content: I. Promoting Proper Nutrition and Hydration A.Proper nutrition 1. Promotes physical health 2. Helps maintain muscle 3. Helps maintain skin & tissues 4. Helps prevent pressure sores 5. Increases energy level 6. Aids in resisting illness 7. Aids in the healing process B. Six basic nutrients 1. Carbohydrates a. Provide energy for the body b. Provide fiber for bowel elimination 2. Fats a. Aid in absorption of vitamins b. Provide insulation and protect organs 3. Minerals a. Build body tissue and cell formation b. Regulate body fluids c. Promote bone and tooth formation d. Affect nerve and muscle function 4. Proteins a. Promote growth and tissue repair b. Found in body cells c. Provide an alternate supply of energy 5. Vitamins a. Two types: water soluble and fat soluble b. Body cannot produce c. Help the body function 6. Water a. Most essential nutrient for life C.Diet specifics 1. Diet cards a. Specific to a resident 2. Basic or "general" diet 3. Therapeutic/special/modified diets a. Soft b. Bland c. High/low fiber d. Low fat e. High/low protein f. Low sodium g. Modified calorie/calorie count h. Liquid i. High potassium j. Diabetic (ADA) k. NPO 4. Mechanically altered diets a. Mechanical soft b. Pureed 5. Thickened liquids (see RCP) a. Nectar thick b. Honey thick c. Pudding thick D.Monitoring meal consumption/recording food consumed 1. Observation 2. Facility policy for recording E. Proper hydration 1. Promotes physical health a. Aids digestion and elimination b. Maintains normal body temperature c. Helps prevent dehydration 2. Force fluids/encourage fluids 3. Fluid restriction a. Implemented by physician order due to concerns with fluid overload b. Daily amount is limited and divided between dietary (for meal service) and nursing 4. Recording Intake and Output (I&O's) a. Approximately 2000-2500cc daily b. Determine resident's total fluid intake 1. Use metric measurement (cubic centimeters = cc) c. Measure output (urine and emesis) 1. Graduated measuring container 2. Use metric measurement (cubic centimeters =cc) 5. Passing Fresh Ice Water (see RCP) F. Role of the Nurse Aide 1. Encourage resident to eat as much of their meal as possible 2. Note foods resident avoids or dislikes and report to the nurse 3. Review diet card before serving meal to resident to confirm correct diet 4. Be aware of food brought in to the resident from an outside source and potential conflict with ordered diet 5. Record food intake according to facility policy 6. Remind resident to drink often or offer ice/popsicles, when not on restriction 7. Have fresh ice water available and within the resident's reach at all times unless fluid restriction 8. Observe for and report to the nurse signs of dehydration: a. mild symptoms (include but are not limited to): thirst, loss of appetite, dry skin, flushed skin, dark colored urine, dry mouth, fatigue or weakness, chills b. advancing dehydration symptoms (include but are not limited to): increased heart rate, increased respirations, decreased sweating, decreased urination, increased body temperature, extreme fatigue, muscle cramps, headaches, nausea c. severe dehydration symptoms (include but are not limited to)- muscle spasms, vomiting, racing pulse, shriveled skin, dim vision, painful urination, confusion, difficulty breathing, seizures 9. Observe for and report to the nurse signs of fluid overload which may include: a. stretched and shiny-looking skin over a swollen area, increased abdomen size (ascites), shortness of breath or difficulty breathing (pulmonary edema), tightness of jewelry, clothing or accessories, low output of urine, even when the resident is drinking as much fluid as normal, a dimple in the skin covering the swollen area that remains for a few seconds after the pressing finger has been released b. Symptoms of more serious fluid overload include difficulty breathing, shortness of breath when lying down, coughing, cold hands or feet 10. Measure Intake & Output accurately II. Promoting the Use of Proper Feeding Technique/Assisting a Resident with Special Needs NOTE* The caregiver should provide any necessary care and offer to assist the resident to toilet prior to meal service in an effort to promote a positive experience A. Feeding (see RCP) B. Assisttoeat(seeRCP) C. AssistiveDevices 1. Plate guards 2. Utensils with enlarged (built-up) handles 3. Drinking cups (nosey cups) 4. Divided plates 5. Non-skid plate/place mat D. Visuallyimpaired 1. Speak in a normal tone while facing the resident 2. Read menu to the resident 3. Position their food on the plate according to hands of a clock. Explain where food items are on plate 4. If feeding the resident, ask them to open their mouth at appropriate time 5. If feeding the resident, tell them what food you are giving them E. History of stroke 1. Place food in resident's sight 2. Supply assistive device(s), as appropriate, to unaffected side 3. Report any difficulty swallowing and observe for signs of choking 4. Report to nurse coughing and/or observed pocketing of food 5. If feeding the resident, make sure the resident swallows before giving more food 6. If resident's mouth is paralyzed, place food on the unaffected side when feeding F. History of Parkinson's Disease 1. Supply assistive devices, as appropriate 2. Food and drinks should be placed within reach 3. Assist the resident as needed; promote independence III. Caring for a Resident with a Tube Feeding and the Resident at Risk for Aspiration A. Tube Feedings 1. Feeding tubes are used when food cannot pass normally from the mouth into the esophagus and then into the stomach. The resident who is unable to take food or fluids by mouth, or is unable to swallow, may be fed through a tube. The two types of tubes most commonly used in long-term care facilities are nasogastric tubes and gastrostomy tubes. 2. A nasogastric (NG) tube is a tube that is placed through the nose into the stomach. ("Naso" is the medical term for nose and "gastric" means stomach.) It may also be called a Levine tube or be abbreviated as NG tube. An NG tube may also be used by the nurse to suction and remove fluids from the body 3. A gastrostomy tube (g-tube) is a tube that is placed directly into the stomach for feeding. A small surgical opening is made through the abdominal wall into the stomach, and the tube is sutured to hold it in place. This type of tube is often used for a resident who may need tube feedings for a long time. The abbreviation for a gastrostomy tube is G-tube. 4. Usually the NG tube or the G-tube will be attached to an electronic feeding pump that controls the flow of fluid. Most pumps have an alarm that sounds when something is wrong. You must notify the nurse immediately if the alarm sounds 5. The resident who has a feeding tube should be observed frequently. If the pump is not working properly, the resident may receive the wrong amount of food or the fluid may enter too quickly. This can cause nausea, vomiting, and aspiration. The NG tube may have moved out of the stomach and into the lungs. Aspiration pneumonia may result if feeding enters the lungs 6. Residents with feeding tubes are often NPO. NPO is the abbreviation for nothing by mouth. PO is the abbreviation used when a person can have something by mouth 7. Do not give the resident who has a feeding tube anything to eat or drink without checking with the nurse 8. The NG tube is uncomfortable and irritating to the nose and throat. The G- tube may become dislodged from the stomach, or the skin may become irritated at the site of insertion. Infection can occur with either tube, if infection control practices are not carefully followed 9. The resident with a feeding infusing should not lie flat. The head of the bed should be elevated at least 30°. Some procedures will need to be changed slightly for the resident with a feeding tube. For example, an occupied bed cannot be flattened to change the linen or to provide incontinence care with the feeding infusing. If the bed must be flattened, seek the nurse's assistance to turn off the pump prior to the procedure and turn the pump back on after the procedure. Your major responsibility concerning the resident with a feeding tube is to make regular observations and promptly report any problem 10. Report any choking or coughing to the nurse immediately B. Observations to be reported to the nurse immediately 1. Nausea 2. Discomfort during the tube feeding 3. Vomiting 4. Diarrhea 5. Distended (enlarged and swollen) abdomen 6. Coughing 7. Complaints of indigestion or heart burn 8. Redness, swelling, drainage, odor, or pain at the tube insertion site 9. Elevated temperature 10. Signs and symptoms of respiratory distress 11. Increased pulse rate 12. Complaints of flatulence (gas) C. Comfort Measures 1. The resident with a feeding tube is usually NPO. Dry mouth, dry lips, and sore throat are sources of discomfort. The resident's care plan will include frequent oral hygiene and lubricant for the lips D. Risk of Aspiration 1. Any resident with ordered thickened liquids, a pureed or mechanical soft diet, or having a diagnosis of esophageal reflux, GERD, or respiratory difficulty is a resident who is at risk of aspiration. The caregiver must always elevate the head of the bed or assist the resident to an upright position prior to offering food or fluids if the resident is at risk of choking/aspiration. Should a resident begin to cough, gurgle or regurgitate, attempts to feed should STOP and the nurse should be alerted immediately to assess the resident 2. Residents at risk of choking/aspiration should be encouraged to sit up or remain with the head of the bed elevated for at least 30 minutes (or as long as tolerated) following consumption of food or fluids 3. Know your residents and ensure residents receive snacks, meals and fluids at the ordered consistency RCPS: •Thickened Liquids • Passing Fresh Ice Water • Feeding • Assist to Ea

Lesson #8 Content

Content: I. Proper positioning and body alignment A. Positioning 1. Frequency of re-positioning a. Recommended every 2 hours or more frequently, if warranted i. Prevent deformities, development of pressure sores, respiratory complications and decreased circulation B. Alignment 1. Proper alignment a. Shoulders above hips, head and neck straight, and arms and legs in natural position b. Promotes i. Physical comfort ii. Relieves strain iii. Promotes blood flow iv. Efficient body function v. Prevention of deformities and complications (i.e., contractures and prevention of pressure sores, etc.) C. Role of the Nurse Aide 1. Provide privacy 2. Check resident's body alignment after position change 3. Keep resident's body in good alignment, as possible 4. Support affected limbs during re-positioning 5. Review care plan a. Know what position is safe for the resident 6. Do not cause the resident pain or injury a. Be gentle b. Do not rush c. Do not slide or drag resident on bed linen d. Use appropriate side rail when turning resident (if side rail is used) i. Side rail up on side of bed resident is turning toward e. Return bed to appropriate height and position 7. Encourage resident to assist with positioning, if able II. Commonly used positions: A. Supine Position (see RCP) - Flat 1. Ensure resident is placed at the head of the bed to prevent resident's feet/heels from touching or resting against the footboard. This will also help keep the trunk in position should the head of the bed be elevated. 2. Procedures which may require supine position a. Bed making b. Bed bath c. Perineal care B. Lateral Position (see RCP) - Resident placed on left or right side 1. Reposition to side 2. Logrolling 3. Reduces pressure on one side C. Fowler's Position (see RCP) 1. Head of bed elevated 45 to 60 degrees a. Promotes breathing b. Caution: this position adds pressure to coccyx 2. Procedures which may require Fowler's position a. Grooming b. Oral care c. Eating D. Semi-Fowler's Position (see RCP) 1. Head of bed elevated 30 to 45 degrees a. Promotes breathing b. Less pressure to coccyx III. Proper transfer: A. Planning and safety 1. Gather equipment 2. Arrange furniture 3. Awareness of catheters, tubing or devices 4. Resident in shoes with non-skid soles, gripper socks, or shoes. 5. Assess need for assistance from coworker; refer to assignment sheet B. From bed to chair (See RCP) 1. Determine if resident has weakness on one side a. Place chair on unaffected side and transfer resident towards his/her side 2. Brace chair firmly against the bed facing the foot of the bed. 3. Lock chair wheels & remove leg rests, if wheelchair 4. Sit on side of bed/dangle (see RCP) A. For approximately 10-15 seconds i. Feet flat on floor ii. Regain balance 4. Prevent self injury by using proper body mechanics A. Place feet 18" or shoulder width apart b. Bend knees and keep back straight c. Keep the weight of the resident close to you d. Lift using thigh muscles in a smooth motion e. Never lift and twist at same time C. Using transfer/gait belt (see RCP) 1. Secure belt around resident's waist and over their clothes 2. Most used when resident has fragile bones or recent fractures 3. May not be used when resident has had abdominal surgery or has difficulty breathing 4. Check for proper fit; not too tight; should not slide 5. Use proper body mechanics D. Ambulation/walking (See RCP): 1. Encourage/assist throughout the day a. Promote physical and mental well being 2. Stand to side and slightly behind the resident a. Weakness on one side, stand on that side 3. Arm on residents back (if no gait belt) E. Assistive devices 1. Fitted to each resident a. Measurements obtained by PT or nurse 2. Walker (see RCP) a. Used by resident who can bear weight b. Used for support/balance c. Design i. Light weight ii. Rubber stops should be in good repair iii. Wheels d. Walking sequence i. Walker is placed at a comfortable distance in front of resident ii. Feet/wheels on ground iii. Resident moves to the walker, weaker side first 3. Cane (see RCP) a. Used by resident to help maintain balance i. Resident should be able to bear weight ii. Not for weight bearing b. Designs i. Curved handle ii. Straight handle iii. Four feet (quad-cane) iv. Rubber stops should be in good repair F. Role of the Nurse Aide 1. Provide for privacy and encourage the resident to help as much as possible to promote independence 2. Use proper body mechanics 4. Be patient and give the resident time to adjust to changes in position 5. Be aware of resident's limbs when transferring 6. Check condition of assistive devices 7. Report any misuse of (or refusal of) device to nurse 8. Observe resident for signs of discomfort or fatigue 9. When assisting resident to walk with cane, stand on weaker side RCPs: • Assist to Move to Head of Bed Supine Position • Lateral Position • Fowler's Position Semi-Fowler's Position • Sit on Edge of Bed • Using a Gait Belt to Assist with Ambulation Assist to Chair • Transfer to Wheelchair • Walking • Assist with Walker • Assist with Cane

Lesson #30 Content

Content: I. Reducing Stress/Burnout A. Manage stress 1. Develop healthy habits of diet and exercise 2. Get sufficient rest/sleep 3. Drink alcohol in moderation 4. Do not smoke 5. Find time for relaxing activities such as taking walks, reading books, etc. B. Signsthatyouarenotmanagingstress 1. Exhibiting anger toward co-workers and/or residents 2. Arguing with a supervisor or co-workers about assignments 3. Complaining about responsibilities 4. Feeling tired, even when you are well rested 5. Difficulty focusing on residents and job duties C. Develop a plan to manage stress 1. Identify the sources of stress in your life 2. Identify when you most often feel stress 3. Identify what effects of stress are evident in your life 4. Identify what can be changed to decrease the stress that you are feeling 5. Identify the things in your life that you will have to learn to cope with due to an inability to change them II. Abuse/Neglect/Misappropriation A. Responsibility to immediately protect the resident should a staff member witness abuse/neglect 1. You must stay with the resident and call for assistance 2. Ask a caregiver to leave the room if he/she is witnessed to be abusive to the resident B.Knowyourfacility'spolicyregardingreportingabuse 1. To whom should the Nurse Aide report? His/her immediate/direct supervisor 2. How should you report? a) Verbally -to your immediate/direct supervisor b) In writing -if requested by your immediate/direct supervisor c) Form used -be familiar with the facility form to report concerns voiced by staff, family or residents 3. When should a Nurse Aide report? a) Immediately! 4. The Nurse Aide Must Report When he/she... a) Actually sees/witnesses an incident that you suspect is abuse or neglect b) Observe signs that "suggest" abuse or neglect may have happened, including a change in the resident's behavior/demeanor (e.g., a resident becomes quiet, withdrawn, or flinches as if fearful when touched), or suspicious injuries such as teeth marks, belt buckle or strap marks, old and new bruises, dislocation, burns of unusual shape and in unusual locations, scratches, etc. If the aide hears of an alleged incident from a resident or co-worker then it should be reported 5. The nurse aide doesn't make a determination that abuse or neglect "has" or "has not" occurred and then decide whether to report. If the resident makes an allegation (even if it doesn't seem that it can't be true) it must be reported to the direct supervisor immediately. If the nurse aide hears of an alleged incident from a resident or co-worker, it must be reported to the direct supervisor immediately 6. NA Investigation a) Conducted by ISDH when abuse has been reported b) May result in revocation of certification III. Nurse Aide Testing/Certification A. To Maintain Certification 1. The CNA must be offered at least 12 hours of in-service education per year 2. The CNA must work for a health care provider at least one eight hour shift every twenty-four months 3. The CNA must never have a verified complaint against them on the registry. If a complaint of abuse or misappropriation of resident's property or funds is found to be valid, the CNA will lose certification in all 50 states permanently 4. The CNA must be evaluated yearly for performance and offered in-service education on any weaknesses identified 5. The nurse aide must remain professional a) Be responsible, calling the facility if unable to work the scheduled shift b) Be on time for your scheduled shift c) Arrive to work clean and neatly dressed and groomed d) Maintain a positive attitude e) Follow facility policies and procedures f) Document and report carefully and correctly g) Always ask questions, if uncertain h) Report anything that keeps you from completing your duties/assignment i) Offer suggestions for improving the living and working environment IV. Certification Renewal A. The CNA must renew certification with the ISDH CNA Registry on-line at the time of expiration B. Proof of continued good standing on the registry must be provided to the employer V. Course Review A. Brief overview of each lesson B. Review of RCPs RCPS: • None

Lesson #2 Content

Content: I. Resident Rights A. Origin - Omnibus Budget Reconciliation Act (OBRA) —Passed in 1987 due to reports of poor care and abuse in nursing homes B. Purpose a. Inform a resident how he/she is to be treated b. Provide an ethical code of conduct for healthcare workers C. Theserightsincludetheresident'srightto: 1. Exercise his or her rights; 2. Be informed about what rights and responsibilities he or she has; 3. If he or she wishes, have the facility manage his or her personal funds; 4. Choose a physician, treatment and participate in decisions and care planning; 5. Privacy and confidentiality; 6. Voice grievances and have the facility respond to those grievances; 7. Examine survey results; 8. Work or not work; 9. Privacy in sending and receiving mail; 10. Visit and be visited by others from outside the facility; 11. Use a telephone in privacy; 12. Retain and use personal possessions to the maximum extent that space and safety permit; 13. Share a room with a spouse or another, if mutually agreeable; 14. Self-administer medication, if the interdisciplinary care planning team determines it is safe; 15. Refuse a transfer from a distinct part, within the institution; 16. Be free from any physical or chemical restraints; and 17. Be free from verbal, sexual, physical and mental abuse, corporal punishment and involuntary seclusion. D. Protection of Resident Rights: 1. Never abuse — know your limits 2. Types of abuse (explained in detail later) 3. Report signs/symptoms of abuse, neglect and misappropriation (examples provided later) E. Privacy: 1. Avoid unnecessary exposure 2. Do not open mail without permission 3. Knock and request permission before entering room F. Confidentiality: 1. No gossip 2. No sharing of resident information except with care team members a. Health Insurance Portability and Accountability Act (HIPAA) - law to keep health information private b. Social Media - posting of resident's is considered abuse G. Resident Care: 1. Involve resident in care 2. Explain procedures 3. Respect refusal in care 4. Report refusal in care Note* Introduce RCPs - "Initial Steps" and "Final Steps" to reinforce acknowledgement of Resident Rights observed when providing care. H. Report and Document: 1. Be honest & truthful 2. Notify supervisor immediately of abuse, neglect and/or misappropriation G. Resident Care 1. Involve resident in care 2. Explain procedures 3. Respect refusal in care 4. Report refusal in care Note* Introduce RCPs - "Initial Steps" and "Final Steps" to reinforce acknowledgement of Resident Rights observed when providing care. II. Abuse, Neglect, and Personal Possessions/Misappropriation A. Types of Abuse 1. Physical 2. Sexual 3. Mental 4. Verbal 5. Financial B. Neglect/Negligence C. InvoluntarySeclusion D. Misappropriation: 1. Personal property 2. Gifts E. Signs and Symptoms Abuse: a. Conditions- suspicious marks, bruises, bite marks, fractures, dislocations, burns, scalp tenderness, nose bleeds, swelling, welts b. Observations- fear, pain, withdrawal, mood changes, acting out, anxiety, guarding Neglect: a. Conditions - pressure ulcers, dehydration, weight loss b. Observations - unclean, soiled bedding or clothing, unanswered call lights, wrong clothes, no glasses/hearing aids, uneaten food/snacks, no water available c. Misappropriation: a. Conditions—anger, sadness, fear b. Observations—missing items, comments from resident or family F. Reporting: 1. Know facility policy 2. Report per your facility policy. RCPS: Introduce the students to: • Initial Steps • Final Steps

Lesson #10 Content

Content: I. Shower Points to Remember: 1. Bathing is an opportunity to observe the resident's skin. Should a concern, such as a new bruise, blister, rash or open area be noted, the nurse should be notified 2. The resident's face, hands, underarms, and perineal area should be washed at least daily 3. The elderly may bathe only twice a week, in that older skin produces less perspiration and oil and frequent bathing could cause excessive dryness 4. Before beginning the bathing process, the caregiver should make certain the room is warm enough and all linens and supplies are gathered so the resident is not left alone. 5. Respect the resident's privacy when transporting to and from the shower room and during the shower or bath. Be certain the resident's body is not unnecessarily exposed. A. Shower/Shampoo (see RCP) B. BedBath/PerinealCare/BackRub(seeRCP) C. Cathetercare(seeRCP) D. Perineal Care (see RCP) E. Back Rub (see RCP) F. Bed Shampoo (See RCP) G. Whirlpool (Type of whirlpool, trolley, etc., may alter actions. Always refer to facility policy and/or manufacturer's instructions) a. Whirlpool Fill tub with water before bringing resident to bathing area b. Help resident remove clothing, drape resident with bath blanket c. Transport resident to tub room via wheelchair, Geri-chair, or lift bath trolley d. Have resident check water temperature for comfort e. If not already on trolley, assist resident into lift bath trolley, secure straps and lower lift bath trolley and resident into bath. Turn system on f. Let resident wash as much as possible, starting with face g. You may shower the resident by using the shower handle to gently spray over the resident's body. Stay with resident during procedure h. Turn system off after completion of bath and return shower handle to hook, if used i.Raise trolley out of tub; give resident towel and assist to pat dry and assist resident to dry areas of resident that had been touching the trolley j.Assist resident out of trolley k. Help resident dress, comb hair and return to room l.Drain and sanitize tub per manufacturer's instructions NOTE* Following assisting a resident to toilet, it may be necessary for the nursing assistant to perform perineal care. If doing so, the nursing assistant must ensure the resident can stabilize while standing, utilizing a walker, side grab bars and/or with the assistance of a second caregiver utilizing a gait/transfer belt. With resident's feet spread apart and standing firmly, the nursing assistant must use the same aforementioned principles (i.e., wiping from front to back, using a different part of the washcloth for each stroke, and changing the washcloth as necessary). The resident's perineum should be rinsed and patted dry prior to raising the undergarment or applying a brief. RCPS: • Shower/Shampoo • Bed Bath/Perineal Care/Back Rub • Bed Shampoo

Lesson #9 Content

Content: I. Using mechanical lifts A. Common names and types a. Sling b. SittoStand B. Manufacturer's instructions - normally requires at least two caregivers C. Facility policy D. Transferring - general principles (but may vary with type of lift) 1. Position sling 2. Base open and under bed 3. Place over head bar 4. Attach the sling 5. Resident's arms across chest. Stabilize resident's head and neck. 6. Raise sling/resident 7. Co-worker support resident's legs 8. Lower sling/resident to chair or stretcher 9. Position for comfort and place sling in a manner to protect the resident's dignity. E. Role of the Nurse Aide 1. Review assignment sheet before transferring 2. Be aware of manufacturer's instructions and facility policy 3. Make sure lift is in proper working order 4. Provide privacy for the resident during the transfer 5. Be aware of catheter or tubing the resident may have II. Transfer resident to stretcher/shower bed A. From bed to stretcher (see RCP) 1. Need at least two co-workers to assist B. Return resident to bed 1. Height of stretcher slightly higher than bed C. Role of the Nurse Aide 1. Explain to the resident what you are about to do prior to transferring 2. Provide the resident with privacy when transferring 3. Keep the resident covered 4. Be aware of any catheter or tubing the resident may have 5. Use proper body mechanics 6. Lock wheels on bed 7. Ensure resident is positioned for comfort prior to exiting the room. III. Transfer - Two Person Lift (see RCP) ONLY TO BE USED IN AN EMERGENCY - IF RESIDENT UNABLE TO BEAR WEIGHT, A LIFT SHOULD BE USED A. For transferring resident unable to bear weight (i.e., history of stroke) B. Role of the Nurse Aide 1. Explain to the resident what you are about to do prior to the transfer 2. Lock wheel chair brakes 3. Be aware of catheter or tubing the resident may have 4. Use proper body mechanics RCPs: • Transfer to Stretcher/Shower Bed • Transfer Two Person/Lift

Lesson #26 Content

Content: I. Common Conditions of the Reproductive System A. Breast, prostate and ovarian cancer B. Vaginitis II. Normal Changes with Age A. Hormone production decreases B. Decreasedestrogeninfemalescausesmenopause C.Decreasedtestosteroneinmalesslowssexualresponse D. Prostate gland may become enlarged causing difficulty when urinating III. Role of the Nurse Aide A. Observe and Report 1. Abnormal bleeding 2. Complaints of pain IV. Common Conditions of the Immune and Lymphatic Systems A. HIV/AIDS 1. Requires Standard Precautions unless coming in contact with blood or body fluids for which Contact Precautions would be necessary B. Lymphoma(canceroftheimmunesystem) C. Resultofcancertreatment/medications V. Normal Changes with Age A. Increased risk of infection B. Increaseddryingoftissue-causes irritation VI. Role of the Nurse Aide A. Observe and Report 1. Fever 2. Diarrhea 3. Increased fatigue/weakness RCPS: • None

Lesson #17 Content

Content: I. Rehabilitation A. Role of Formal Therapy 1. Physical Therapy 2. Occupational Therapy 3. Speech Therapy B. Assistive or Adaptive Devices- devices made to support a particular disability by helping resident complete ADLs (e.g., long-handled brushes and combs, divided plate, built-up silverware, reacher/grabber, etc.) II. Restorative Services A. Ambulation 1. Cane 2. Walker 3. Gait/transfer belt B. Range of Motion (see RCP) 1. Active Range of Motion (AROM) 2. Passive Range of Motion (PROM) C. PointstoRemember: 1. Be patient when working with the resident 2. Be supportive and encouraging 3. Break tasks into small steps to promote small accomplishments 4. Be sensitive to the resident's needs and feelings 5. Encourage the resident to do as much for self as possible D. Observe and report to the nurse 1. An increase or decrease in the resident's ability 2. A change in motivation 3. A change in general health 4. Indication of depression or mood changes E. Splint Application (see RCP) Devices which may be applied per Restorative Nursing Program A. Abdominal Binder (see RCP) - may be used to secure G-tube and prevent resident from picking at the insertion site or to provide support to the abdomen due to hernia or recent surgery B. Abduction Pillow (see RCP) - may be ordered to be in place following a surgical procedure to maintain lower extremities in an abducted position, and prevent the resident from crossing the lower legs or ankles C. Knee Immobilizer (see RCP) - may be ordered to be in place following a surgical procedure to keep the leg straight while the bone is healing. Should only be removed at the direction of the licensed nurse D. Palm Cone (see RCP) - may be ordered to be placed in the palm of a resident who is at risk for developing contractures of the digits (i.e., prevent the fingers/nails from turning into the palm permanently and causing skin breakdown) RCPS: • Passive Range of Motion • Splint Application • Abdominal Binder • Abduction Pillow • Leg Immobilizer • Palm Cones

Lesson #19 Content

Content: Prosthetic Device I. Purpose of a Prosthetic Device A. Improve resident's functional ability B. Improve appearance II. Types of Prosthetic Devices A. Artificial limbs - arm, leg/foot B. Otherprostheticdevices 1. Hearing aids 2. Artificial eyes 3. Eyeglasses 4. Dentures III. Role of the Nurse Aide regarding Amputations & Prosthetic Care A. Be supportive - amputation can be difficult for a resident to accept due to the change in body image B. Follow care plan - know what is required related to care and needs C. Follow instructions regarding applying and removing the prosthesis D. Keep skin under prosthesis clean and dry - follow care plan E. Handle with care - prosthesis is fitted to the resident and specially made. A prosthesis can be very expensive F. Observe skin on stump. Watch for pressure, redness, warmth, tenderness, or open area. Report any concerns to the nurse IV. Role of the Nurse Aide regarding Hearing Aids A. Hearing Aid - small battery operated device that fits into the ear to amplify sound B. AssistingwithHearingAids(seeRCP) 1. Be sure to follow the manufacturer's instructions when inserting the hearing aid into the resident's ear 2. Be sure to follow the manufacturer's instructions on cleaning the hearing aid. V. Role of the Nurse Aide regarding Artificial Eye & Eyeglasses A. Artificial Eye - device that resembles natural eye. The resident cannot see with the artificial eye. The artificial eye is held in the eye socket by suction. B. Careofartificialeye 1. Artificial eye - can be removed and reinserted. This should be done by the nurse or independently by the resident 2. Nurse Aide needs to observe that eye is clean 3. If eye is removed, make sure it is stored in a safe place with proper solution to avoid drying or cracking of artificial eye 4. Follow directions on care plan 5. Provide privacy when assisting with eye care 6. Resident with artificial eye may be able to provide self eye care - follow directions on care plan C. Careofeyeglasses 1. Make sure eyeglasses are clean 2. Make sure resident has eyeglasses on 3. Keep eyeglasses in a safe place when not in use VI. Role of the Nurse Aide regarding Dentures A. Dentures - artificial tooth or teeth, necessary when resident's natural tooth or teeth have been removed due to damage or decay. Dentures may be partial or full B. Careofdentures 1. Make sure resident has dentures in place for meals 2. Resident may want dentures removed at night 3. Make sure dentures are cleaned 4. Make sure dentures are in a safe place when not in use VII. Role of the Nurse Aide regarding Elastic/Compression Stockings (TED Hose) A. Make certain stockings are on when resident is up, if ordered by the physician B. Follow care plan directions in regard to when to be applied and removed C. Elastic/Compression Stocking Application (seeRCP) RCPS: • Assisting with Hearing Aids • TED Hose Application