Module 8 Review

What are the different types of indwelling catheters?

"Foley" Retention Suprapubic Straight catheter

Diahrrea

Abnormal excessive frequency of loose or liquid stool

What should you give when your resident is on the commode?

Bath blanket Toilet paper Call light Privacy

Oral hygiene

Care of the mouth cavity which includes brushing the teeth, flossing, and cleansing

What should you report after dressing a resident?

How much help is given How resident tolerated procedure Any complaint from resident Level of cooperation and willingness

Where do you secure the catheter bag?

On the side of the bed frame and below the bladder

How many times can you use a safety razors?

Once; never recap razors

Excoriation

Process of eliminating substances by body organs

What information should be reported at the end of using a bedpan?

Skin integrity and any observations made about stool or urine

How do you apply a standard bedpan?

The wider end is placed under the coccyx and the narrower end goes between the buttocks

How would you bathe a resident on total bed rest and needs complete assistance?

...

After the application of a condom catheter, when do you return to assess the penis?

30 minutes after

When changing a urinary drainage bag, what do you cover the resident with?

A bath blanket

Artificial limbs

A device that allows for a way for an individual to continue to participate in normal day to day activities

Urinal

A device to collect urine from a male

Decubitus ulcer

A pressure sore or bed sore; prevent by turning 82 degrees, keeping sheets wrinkle free, and maintaining good skin care

Abrasion

A scrape on the skin or mucous membrane

Stoma (ostomy)

A surgical opening from an internal organ (intestines, bladder, stomach); the opening is also referred to as an ostomy

Ostomy

A surgical opening from an internal organ (intestines, bladder, stomach); the opening is referred to as a stoma

Colostomy

A surgical opening made into the large intestine to allow passage of stool

Catheter

A tube used to put in or take out fluids

What is the plastic bag used for when applying a dressing?

A waste basket for all soiled dressings, soiled gloves, and dressing wrappers

After a resident uses the bedpan, what observations should you make?

Abnormalities in urine and stool Urine: transparency, color, odor, sediment, and blood Stool: consistency, color, blood, and size

When should a resident have their hearing aids in?

Always, except for when sleeping or bathing

Who should you never leave in a bathroom alone?

Alzheimer's or dementia patients

What does the frequency of urine depend on?

Amount of fluid ingested Personal habits Availability of toilet facilities Physical activities Illness/infection

Prosthesis

An artificial substitute for a missing body part

What do you use to clean under the residents fingernails?

An orange stick

How do you anchor the bag on the stoma for a resident that is ambulatory?

Anchor the bag vertically with the opening toward their feet

Stool

Another name for feces

What precaution must you take when providing hair care?

Apply gloves Place a towel across the resident's back and chest Comb gently from bottom to top Comb hair after each time the resident gets up from sleep or rest

What standard precautions would you implement when applying a dressing?

Apply gloves and any PPE that is required Treat soiled dressings as biohazardous

Non-blanchable

Area of skin that stays red after pressing down upon it

What are the features of a colostomy?

Ascending and transverse are like pureed liquid with slightly acidic content: Stool is consistency of pureed liquid with slightly acidic content Must wear pouch all the time Chew food well with a lot of fluids Descending and sigmoid: Stool formed and in low descending and sigmoid look "normal" Pattern stool drainage - everyday or every other day May irrigate (may become constipated and need an enema) Regular diet May wear small patch, not pouch

As a CNA caring for a resident with a prosthetic limb, you should remember to do what?

Assist patient/resident to apply brace as ordered Maintain body alignment when in chair or bed Keep call bell and personal items within reach Assist patient/resident with ROM to affected muscles Assist patient/resident with aids to foster ADL and independence Use pad brace, if necessary Use stump sock to reduce swelling Give constant praise for rehabilitative efforts Provide skin care at pressure points of device to prevent skin breakdown Observe for complaint of arm/leg pain or numbness, or weakness with use of prosthetic device Encourage physical strengthening exercises for involved and non-involved extremities

What is the CNA's role when caring for a resident with an ostomy?

Assist with personal hygiene Provide for privacy Change appliances Emptying ostomy bag Provide skin care Use universal precautions Encourage patient/resident to assist in the care Reinforce the teaching plan and material shared by the licensed nurse Be aware of cultural differences in attitude about ostomies and their care (privacy, shame, and body image) Do NOT make faces

What supplies do you need to assist a resident to use a bedpan?

Bath blanket One towel Waterproof protectant Gloves Hamper or plastic bag Bed pan (fracture or standard) Bedpan cover Toilet paper (If providing peri-care, you will also need a towel, four washcloths, basin of warm water, and soap)

What are the different types of pressure reducing devices?

Bed cradle (keeps pressure off feet and lower legs) Sheepskin Heel and elbow protectors (shearing effect) Egg crate type pads/gel cushions Alternating pressure mattress Air fluidization bed (ex: Clinitron or KinAir) Trochanter rolls Flotation pads or cushions

What are two appliances used for a colostomy?

Bedpan Ostomy bag

How do you check the batteries of hearing aids?

Before applying a hearing aid, check the batteries Be sure they are the right size for the hearing aid The battery case must close easily or something is wrong To test the batteries, place the control switch to on and turn up the volume control Cup your hand over the hearing aid and you should hear a whistle; if you do not hear the whistle, change the batteries

What are the general guidelines for the daily care of a resident?

Before breakfast: Offer bedpan/urinal or assist to bathroom or incontinence care Linen change Wash face and hands Offer oral hygiene Assist with grooming Straighten bed and unit Position resident for breakfast or take to the dining area After breakfast: Oral hygiene Offer bedpan/urinal or assist to bathroom Bathing (includes foot care) Shaving Hair care Dressing Skin care Assisting with activity (ROM, ambulation) Change bed linens Unit maintenance Afternoon care: Offer bedpan/urinal or assist to bathroom or incontinence are Linen change Wash hands and face Straighten bed and unit Position for meal or take to dining area Evening care (2-10:30 pm): Offer snack when applicable Offer bedpan/urinal or assist to bathroom or incontinence care Linen change Wash hand and face Oral hygiene Back rub Assist into sleepwear Straighten bed and unit

When do you offer snacks?

Between meals and before bed

What are the most common complications that arise from catheters?

Bladder infection (most common) Blockage

What should you report when observing a stoma?

Blue color, pale color, unusual odor, drainage that is not fecal related, bleeding, or if the stoma begins to prolapse out of the abdomen

Cyanosis

Bluish discoloration of the skin, nails, and lips due to a lack of oxygen

What factors may cause dressing a resident hard?

Brain defect or impairment, as in dementia, mental retardation, injury, or coma Weakness Pain from any cause, such as disease or surgery Fractures Contractures Amputation Paralysis Special equipment, IV's, casts, or braces Absence of part of a limb Blindness Psychological factors, such as depression, fear of pain Dementia When assisting, dress weak side first, undress weak side last Pants, pull up legs, roll from side to side

What are some causes of urinary incontinence?

Central nervous system problems Spinal cord injury Aging Confusion/disorientation Medications Weak pelvic muscles Urinary tract infection Prostate problems (male) Prolapse of uterus and bladder (female) Restraints Immobility Unanswered call lights Not having signal light within reach Urinary frequency/urgency Failure to toilet frequently

What should you do or check for when emptying a colostomy bag?

Check pouch every 2 - 4 hours and do not let the pouch get more than one-third full If the pouch is reusable; empty and rinse over toilet with water, dry and reapply Make sure "seal" is tight Observe contents of bag (color, amount, consistency, odor) Report complaints of discomfort

How do you clamp a catheter?

Clamp the tubing with a catheter clamp or rubber band

How do you care for a resident's eyeglasses?

Clean daily or as needed Wash glass lenses with warm water, dry with soft tissue Use special cleansing solution tissue and cloths on plastic lenses Check for intact parts, such as temples and screws Encourage patient/resident to wear eyeglasses as needed Store glasses carefully to protect from breakage and damage Check food trays and bed linens for misplaced eyeglasses Label eyeglasses with resident's name and room number

What kind of care do you give for a prosthetic eye and when?

Clean it in the morning when the resident wakes up and before bed in the evening Remove the prosthetic eye Place it in a storage cup Take it to the sink Line the sink with a towel Begin to wash the eye with warm water and soap Place in a storage cup with the resident's information on it, if storing

How do you clean a leg bag if it has been previously used by the resident?

Clean the tubing with an alcohol swab

What type of dressing can you apply?

Clean, non-sterile dressing

What are the benefits of bathing?

Cleanliness Reduce bacteria and germs Promote skin integrity Stimulate circulation Provide movement and exercise Promote relaxation Sense of well-being Opportunity for communication and observation

What is the purpose for oral hygiene?

Cleanliness of mouth and teeth Prevent mouth odor and infection Prevent dental disease and tooth loss Comfort Pleasant taste Improve taste of food

How do you apply contact lenses?

Cleanse contact lenses as directed Special caution due to fragile nature of contact lenses Store according to package directions Report the following: Redness or drainage from eyes Complaints of eye pain or blurred vision

What guidelines should the CNA follow when dressing a resident?

Clothing fits well Comfortable (including finding out whether the resident is warm enough, but not too warm) Easy to get on and off Neat (looks nice and attractive); respect the resident's own individual taste and choice of what clothing to wear In good condition (no wrinkles or holes, has snaps, fasteners, buckles and buttons, which function as they should)

What is some information about urine that should be reported to the nurse?

Cloudy, stones, gravel, sediment Pinkish or reddish tint Dark color/concentration Res complains of: Urgency Burning on urination Difficulty in urinating Feeling of pressure in area of bladder Frequency Strong odor

What major features are found in the large intestine?

Colon Rectum Anal canal Hepatic flexure Cecum Sigmoid colon Splenic flexure External and internal sphincter Ileocecal junction

What are the common causes of a colostomy?

Colon cancer, bowel obstruction, trauma to the intestines

What observations should you make in regards to urine?

Color Clarity Odor Amount

What observations do you report when bathing a resident?

Color of skin, white of eyes, lips, nail beds Rashes (location and description) Dry skin, bruising, or open areas Pale or reddened areas Drainage or bleeding Swollen legs or feet Complaints of pain or discomfort Skin temperature

What is the most common type of ostomy?

Colostomy

What are some examples of an ostomy?

Colostomy Ileostomy Jejunostomy

What kind of people usually need a catheter?

Complete loss of bladder control Urinary retention (inability to urinate) Before, during, and after surgical procedures Too weak or disabled to use commode, bedpan or bathroom Prevention of urine contamination on wounds and pressure ulcers

Why do you use standard precautions when brushing a resident's teeth?

Contact with mucous membranes Gums may bleed; some residents take anticoagulants Pathogens may exist in the mouth

What are some measures the CNA can implement to prevent pressure sores in residents with sensory or mobility problems?

Control pressure by pressure-reducing devices or special beds Turn every two hours at least Position with proper support of the body and limbs; get pressure off bony prominences Promote active range of motion exercises or assist resident with them Teach or assist resident using a wheelchair to change position frequently Prevent shearing and friction during lifting, moving, transferring and repositioning procedures Keep bed linens clean, crumb free, and avoid wrinkles Watch tubing (like foley catheter) does not cause pressure so that it does not cause pressure underneath res Remove residents from toilets and bedpans promptly; use proper bedpan size Encourage circulation by gentle massage around red area - not over red area Check skin every eight hours Keep head of bed ( H.O.B.) at 30 degrees as much as possible to avoid sacral pressure

How do you change a resident with an IV site on their arm?

Cover them with a bath blanket Remove clothing from unaffected side Remove from affected side by moving the IV bag and tubing through the arm holes of the resident's clothes Do these steps in reverse to apply clothing Make your observations and report and record

What are the characteristics of a stump sock?

Cushion joint and absorbs sweat Sock should be laundered daily Sock should be snug, but not tight Make sure it is wrinkle free before the prosthesis is applied When not in use a special shrink sock or ACE bandage on the limb This prevents swelling

What are residents with an ileostomy at risk for?

Dehydration and malabsorption

How many options for clothing do you give a resident?

Dementia or alzheimer's residents: one option Indecisive residents: two to three options Alert residents: They usually choose

What care should you provide when handling dentures?

Dentures are very costly and fragile Handle with care at all times Report any observed damage to dentures Denture Care (carry out procedure using standard precautions) Clean all surfaces of the dentures Store in cool H2O in a labeled container Place in resident's drawer Clean and observe before breakfast, lunch, supper, HS, prn

Should dentures be wet or dry when inserting into the mouth?

Dentures should be wet

What residents can only use electric razors?

Diabetics Residents on anticoagulants

What are four reasons a person may need prosthetics?

Disease Trauma Congenital (birth defect) Tumor

How do you perform a partial bed bath?

Done on days when complete bed bath not given The partial bath consists of washing the resident's face, hands, axilla, back, buttocks, and genital area (perineal care) Gather equipment ( bath blanket, basin, soap, water, thermometer, wash cloth, bath towels) Wash hands and apply gloves Check resident's personal choices (water, temperature, soap, etc.) Identify resident Identify yourself to resident Provide Privacy Close door Pull curtain around resident Only uncover area being washed Facility policy may vary Follow standard precautions and bloodborne pathogen standards Assure adequate comfort, such as room temperature, freedom from drafts and adequately covered Use comfortably warm water, change it when it becomes soapy, dirty or cold Bathe areas soiled by fecal material or urine with soap and water Wash from cleanest to dirtiest area - hands are extremely dirty (top to bottom; front to back) Rinse off all soap Pat skin dry Encourage resident to help as much as possible

When brushing a resident's teeth, what observations should you report?

Dry, cracked, swollen or blistered lips Redness, swelling, sores or white patches in the mouth or on the tongue Redness, swelling or bleeding gums Any observed damage to dentures Loose broken or chipped teeth Patient Resident complaints

What major features does the small intestine have?

Duodenum Ileum Jejunum

Nits

Eggs of a louse or other type of parasitic insect

What are some measures the CNA can take to prevent skin breakdown in residents with fluid status problems?

Elevate a limb that has edema Monitor compression devices, such as anti-embolic stockings and ace bandages Remove every eight hours, check skin and watch edges do not cut into skin Encourage fluids to 1500 - 2500cc/day or as per care plan

Why is immediate care important when a resident has urinary incontinence?

Embarrassment, shame, anger, frustration, depression Development of odors Patient/Resident is uncomfortable Major cause for skin breakdown (infection, irritation, redness, or rashes) Disposable briefs are to be avoided as it may cause low self-esteem and skin irritation, and encourages incontinence

What should you encourage when a resident has prosthetics?

Encourage ADL's Encourage strengthening exercises Assist with ROM

What are some measures the CNA can take to prevent skin breakdown in residents with nutritional problems?

Encourage and assist with balanced diet Obese resident (check skin folds) Increased blood sugar = fungus Monitor bony prominences especially on thin residents

How can the CNA help to maintain a resident's skin integrity?

Encourage well-balanced diet and fluids Maintain skin care (bathe as necessary, rinse off soap thoroughly, apply lotion as necessary) Massage the skin Keep skin clean and dry Observe high-risk residents for potential problems Give special attention to bony prominences Turn and position the resident correctly Keep pressure off of reddened or irritated areas Do not massage red, purple, or irritated areas Only massage healthy tissue around the area Keep bed free of small objects and linen free of wrinkles and keep clean and dry Prevent shearing and friction Report and record observations

What is the purpose of medicinal shampoo?

Eradicate lice, scabies or similar organisms Soothe/heal irritated skin or pruritus

What is the average frequency and time that a resident has a BM?

Every 2-3 days Morning or evening

What is the average range of urination?

Every 2-3 hours for 8-12 hours

When should the peri area be cleaned?

Everyday

When should you shave a resident?

Everyday

Flatulence

Excessive gas in the stomach and intestines

What do nephrons do?

Excrete bodily wastes

Elimination

Excretion of body wastes occurring through the skin, kidneys, or intestines

What body areas need to be washed every day?

Face Arms and underarms (axilla) Hands Legs and feet Perineal area (genitals and anal area) Back Any area where skin folds or creases

What does the CNA do if the resident complains that they can not hear any sound when the hearing aid is in?

First check if hearing aid is turned on Remove the hearing aid and check the batteries for freshness Check to see if the hearing aid is broken Clean ear mold if necessary

When making a bed, what is the order that you would place the linens?

Fitted sheet/flat sheet Draw sheet (if needed) Waterproof pad (if needed) Top sheet Blanket Comforter (if desired)

What are some considerations the CNA should take into account?

Follow Care plan Observe residents abilities and assist as needed Assess skin integrity upon application and removal Do NOT use the prosthesis until the areas of wounds or scrapes or redness are healed Wash limb daily with mild soap and water dried thoroughly No lotions or creams should be applied to the residual limb Do not shave residual leg Do not forget to report and record

What does the small intestine look like?

Food is less formed here

Where does the suprapubic catheter go?

From the abdomen wall into the bladder or kidneys; used for long periods of time

What are the signs and symptoms of stage 4 skin breakdown?

Full skin loss with major destruction and tissue death Involves subcutaneous tissues (possible fatty tissue, muscle and/or bone) Can see pink healthy cells, necrotic tissue and eschar (leathary, black, green) Wounds can tunnel or have undermining in surrounding skin wound Risk that bone may become infected (osteomyelitis)

What are the general guidelines a CNA should follow when implementing catheter care?

Goal is to regain voluntary control of bowels and bladder Follow standard precautions Follow bowel and bladder training schedule Offer toileting per facility protocol Explain schedule to patient/resident Encourage proper diet Answer call light immediately Provide for privacy Assist with perineal care to prevent skin breakdown Keep accurate record of elimination pattern following facility protocol

How would you make an open bed?

Grasp the cuff of the top linens with both hands and neatly fanfold them to the foot of the bed and smooth them out Invert a clean pillowcase over one hand With that hand, grasp the middle of the end of the pillow With the other hand, pull the case down over the pillow Place the call light within the resident's reach and lower the bed

After the resident uses the commode, what should you offer them?

Hand hygiene

What are the signs and symptoms of stage 3 skin breakdown?

Have a "full-thickness" skin loss with both epidermis and dermis gone and underlying tissues May not be painful Damage extends to, but not through the tissue that covers the muscle Can have part of dermis left with necrotic tissue Possible drainage

If the resident is having difficulting voiding, what should you do?

Have patient/resident lean forward slightly Run water Never rush patient/resident (Follow facility policy for clamping catheters)

What is the purpose of dressing a resident in street clothes?

How a patient/resident looks, has an effect and influences their feelings of dignity and self-esteem as well as how others perceive them It encourages residents to be more independent about their activities in daily living (ADL's) It discourages incontinence

When making an unoccupied bed, how do you stack the linens?

In order of use

Incontinence

Inability to retain urine or stool due to loss of sphincter control

What does it mean for a CNA to provide foot care?

Inspect Clean between toes (rinse and dry)

What is the turn, cough and deep breath used for?

Intervention to prevent development of pneumonia or atelectasis

Urinary incontinence

Involuntary loss of urine

What does the large intestine look like?

It is divided into three sections: Ascending Transverse Descending

Why should the catheter never be placed above the bladder?

It may cause excreted urine to drain back into the bladder (may result in complications such as a UTI)

What does it mean if a resident has a green bruise?

It's an old bruise

What is the use of a prosthetic eye?

It's used to replace a lost eye or to cover a diseased eye; is not functional

What are some measures the CNA can take to prevent skin breakdown in residents with elimination problems?

Keep skin clean and dry, apply powder where skin touches skin Watch diaphoretic (sweaty) patient/resident Check incontinent resident every two hours and ensure dry and clean (even when using adult incontinence garment, like attends) Monitor incontinence garment (plastic edges near skin can cause irritation) Avoid scrubbing, rubbing when bathing/drying Use blankets and pillows to prevent skin from being in contact with skin

How should you treat a resident's clothing?

Label clothes with patient's/resident's name and write on personal belongings list Avoid cutting or tearing Do not discard (put in bag) Store in the patient's/resident's unit Fold neatly or hang on hangers in closet Find out whether family or facility will clean soiled clothing and put into dirty clothes container Assist patient/resident or family to choose clothing that meets physical needs and looks good Do not use resident's clothing or personal items for another residents

How do you clean dentures?

Line the sink with a towel Run cool water until the sink gets to 2/3 full Don't blast the water Rinse and check the dentures Wet dentures, apply toothpaste to denture brush Rinse Place in cup with cool water Offer swish and spit If on thickened liquids, offer toothettes

What are the features of an ileostomy?

Located on small intestine (ilium) Continuous liquid (stool with large acidic content; will become liquid if resident does not eat three meals a day) About 1000 - 1500 cc output every day Empty pouch every 2-4 hours or when one-third full Watch skin for irritation if there is leakage Very special diet Fluid and electrolyte problems

What are the features of a jejunostomy?

Located on the small intestine (jejunum) Similar to ileostomy Liquid output that drains 2000 - 3000 cc a day May attach to a Foley catheter bag to help drainage Need IV nutrition to meet nutritional needs, as very little absorption takes place

What is the purpose of hearing aids?

Makes sound louder Even the best hearing aid cannot restore full, normal hearing ability: The patient/resident may still have trouble hearing Always face the patient/resident when talking to him/her and speak clearly

What should a CNA never do when a resident is on IV therapy?

Measure blood pressure on an arm with an IV line Get the IV site wet Pull or catch the tubing Leave tubing kinked Lower the IV bag below the IV site Disconnect the IV from the pump or turn off the alarm

What guidelines should you follow when weighing a resident?

Measure height and weight on admission and as ordered Resident wears gown or pajamas Should urinate before being weighed Do routine weights at the same time each day if physician ordered Most accurate weights completed during early morning care

What are the different parts of a hearing aid?

Microphone (changes sound waves into electric signals and transmits sound) Battery and battery compartment Amplifier (uses battery energy to make the sound signals strong) Earmold (channels the sound through the external ear canal to the eardrum (tympanic membrane)) Cord (connects the amplifier to the earmold) On/off switch (turns hearing aid on/off and may control volume)

What are the safety guidelines you should implement when bathing a resident?

Monitor correct water temperature (check temp against your own skin) 105 degrees F Use safety equipment, such as grab bars, non-skid surfaces, emergency call buttons (blinking red means emergency) and safety belts Stay with resident Use correct body mechanics

How do you provide nail care?

Nails are easier to clean after soaking in warm, soapy water Cut nails with clippers, not scissors File fingernails with emery board When trimming fingernails, be cautious to prevent damage to tissues Do not trim nails on patient/resident with diabetes or if on medication that affects blood clotting and circulatory problems Do not cut or trim toenails Use orange stick to clean under nails prn Report unusual conditions to licensed nurse such as redness or tenderness of finger tips, cuticles or toes Follow facility procedure

How should you care for hearing aids?

Never wash a hearing aid or immerse in water Report to licensed nurse when the hearing aid needs cleaning or appears damaged Check the battery periodically Never drop the hearing aid Do not attempt to repair hearing aids Do not expose the hearing aid to heat Do not let moisture get into the hearing aid Do not use any kind of hair spray or medical spray on patients/residents while their hearing aids are in place the spray can clog the microphone opening Check food trays and bed linens for misplaced hearing aids

When assisting a resident to the commode, where should the commode be placed?

Next to the bed

Can CNA's insert a chatheter?

No

What are four things a CNA should take into account for when caring for a resident with a prosthetic leg?

Observe the skin's integrity Wash the residual limb daily with mild soap and warm water Do not shave or put lotions or creams on the residual limb Report and record

Once a draining bag is connected to the catheter, where do you position the draining bag?

On the side of bed (on the bed frame) or chair

What is a wafer in regards to appliances used with ostomy care?

One piece: wafer and pouch are together and can not be reused Two piece: wafer that lasts 5 - 7 days and not reusable, paired with a pouch that can be taken off and emptied and cleaned and reused multiple times

How do you apply a prosthetic eye?

Opening procedure Clean Hold the prosthesis in dominant hand, between thumb and index finger With your non-dominant index finger, push the top eyelid upward and work the prosthesis into the socket with dominant hand Adjust with index finger around the upper and lower eyelid as needed Closing procedure

How do you remove a prosthetic eye?

Opening procedure With your dominant hand, run your index finger on the lower lid to break the suction Grasp the prosthesis using thumb and index finger Press down and inward on the lower lid Remove the prosthesis from the socket Place in storage cup Clean Place in storage cup with resident name and room number if storing Closing procedure

How do you shave a resident?

Opening procedures Apply gloves Wet washcloth in warm water Place warm washcloth on resident's face for 1 min Apply shaving cream Prepare razor Shave from ear to ear in short, downward strokes Shave upwards on neck Clean off with damp towel Give them a mirror check Offer aftershave

What are the steps for washing a prosthetic limb?

Opening procedures Identify the proper prosthesis the resident requires by reviewing care plan Ensure it is in good repair; if any defects are noted report and do not use Wash the area that will make contact with the device with gentle soap and water, rinse and thoroughly pat dry Follow the directives found in the care plan on how to properly use the prosthetic device and any supportive materials such as shrink socks Ensure there are no wrinkles in any supportive materials prior to placing the prosthesis Look at the residents skin and report any abnormalities; if no abnormalities, apply the prosthesis Ask the resident if the fit feels correct; if not, remove and reapply Closing procedure

Impaction

Over collection of feces in the bowel which cannot be excreted

What factors place a resident at high risk for skin breakdown?

Paraplegic or quadriplegic CVA (hemiparesis; one sided weakness) Peripheral vascular disease (decrease blood flow to legs and feet) Bed rest or decreased mobility COPD Low oxygen level Continuous high Fowler's position Medications Circulatory problems Diabetes Arterial disease with decreased sensation (neuropathy) Poor circulation and healing Res has incontinence, diarrhea, diaphoresis, dehydrated, leaking tubes or drainage Edema Res is obese, thin, poor appetite, nutritional lab values are low, poor fluid balance, poor nail care Res is on meds that cause fragile skin Cancer Splints, casts, or prosthetic devices Anemia Age

Mastectomy

Partial or complete removal of a breast

How do you wash a resident's hair in bed?

Perform opening procedures Place waterproof pad under head Place shower tray under head Wet hair enough to get wet Use a dime size worth of shampoo Rinse Dry

What do stomas look like?

Pink and moist/red like mucous membrane Size and shape are different depending on area of intestine and patient/resident Can bleed when cleaned

How do you clean a resident's mouth and teeth?

Place a towel across the chest Raise bed to Semi-Fowler's position Use 50/50 mouthwash Use three swabs (toothettes) to clean each side and front of mouth Use lubricant around mouth

How do you soften a resident's hair for shaving?

Place a warm, damp washcloth on their face for 1 min

How does someone apply a prosthetic breast?

Place prosthesis in regular bra or inside special bra designed to hold prosthetics

What is a urinary catheter, specifically?

Plastic or rubber tube used to drain or inject fluid through a body opening Most commonly used to drain the bladder one end is placed in the bladder and the other end is attached by tubing to a drainage bag Catheters are inserted by licensed personnel using sterile technique

What are some factors that effect a resident's ability to defecate?

Privacy (fear of others, hear or smell) Age (as resident ages, more problems) Diet (need balanced diet with regular meals, food stimulates bowel movement) Fluids (need adequate fluid) Activity (stimulates) Medications (most tend to constipate) Personal habits Disabilities

What guidelines should you follow when dressing a resident?

Provide for privacy Encourage the resident to do as much as possible Allow residents to choose what to wear While assisting the patient/resident, be gentle, while supporting all extremities Remove clothing from the strong or good side first Put clothing on the weak side first Follow resident's individual choices in use of makeup, jewelry, perfume, etc.

What are some general rules to follow in order to maintain normal elimination patterns?

Provide the bedpan, urinal, or commode, or help the patient/resident to the bathroom when the request is made (do promptly) Assist the resident to get into normal position (as much as is possible or safe) Cover the resident for privacy and warmth Remain nearby if the person is weak or frail or confused Place the signal light and toilet tissue nearby Allow the person time to carry out the elimination process (check every 10-15 mins. ) If resident has difficulty, ask them what kinds of things they did at home to assist them, i.e., running water, reading or looking at a magazine Provide perineal care as needed Offer the opportunity to eliminate at regular intervals

What are two safety precautions you must take before transferring your resident to the commode?

Put on gloves Apply the resident's robe, non-skid footwear, and gait belt

What are some nursing measures you should take when dealing with urinary incontinence?

Record incontinent episodes Answer call lights promptly Promote normal elimination Record voiding Follow elimination training programs Encourage easy to remove clothing Provide good skin care & perineal care Dry garments and linens Observe for skin breakdowns Use incontinent products as directed Maintain clean, pleasant environment

What are five things you should assess after applying a condom catheter?

Redness Irritation Swelling Discoloration Discomfort

What are six signs of wound infection?

Redness Swelling Warmth Pain or tenderness Drainage (especially yellow, green, or brown) Foul odors

Bowel training may include, what?

Regular suppositories (res is now dependent on them) Increase fluids Diet will affect regularity

What do you do if a residents' gums are bleeding?

Report it to the charge nurse

What are some signs of possible need to go to the bathroom?

Restlessness Fidgeting Pulling at clothes/undressing Holding or pointing at genitals Crying (Especially in dementia patients)

How do you clean a bedpan?

Rinse out the bedpan with water Disinfect and store it according to facility policy

How do you remove soiled linens from an unoccupied bed?

Roll the soiled linens inward towards the middle of the bed from all sides (this ensures that the soiled part of the linens is folded inward and does not contaminate anything else) Place in the designated hamper inside their room

What observations do you report when washing a resident's hair?

Scalp sores Flaking Presence of lice Patches of hair loss Very dry or oily hair How procedure was tolerated

What should healthy stool look like?

Should not contain blood, be gray or light colored, or be hard or loose in consistency Should look like a sausage or snake Should be smooth and soft

What are the three shampoo types?

Shower or tub Sink Bed Medicinal

What are the signs and symptoms of stage 1 skin breakdown?

Skin is not broken The epidermis and dermis are intact Erythema (redness) not resolved within 15-30 minutes

What are the signs and symptoms of stage 2 skin breakdown?

Skin is not intact Partial thickness wound The epidermis is damaged and part of the dermis can be involved Skin can be blistered, cracked, and open with erythema or appear as shallow crater No necrotic or dead tissue is present Wound bed is moist, pink and painful

How would you position your residents for use of a urinal?

Standing position Sitting on the side of the bed Sitting on the bed with the head of the bed elevated or lying on his side or back

Where do you start for back rubs?

Start at the coccyx, work upwards in circular motions

Fecal/feces

Stool

What observations should a CNA make about a residents stool?

Stool shape Size Frequency Color Consistency Complaints of pain with defecation

Is a straight catheter temporary or permanent?

Temporary

Defecation

The act of having a bowel movement

Urination

The act of passing urine

How do you apply a fracture bedpan?

The narrower end is placed under the coccyx and the wider end goes between the buttocks

Perineum/perineal

The region between the vulva and anus on a female or between the scrotum and anus on a male

What does it mean when a resident is COPD?

The resident can only breathe when sitting up (orthopnea)

Peristomal skin

The skin around a stoma (should be clean, intact, and dry)

What are some things to report when a resident is on IV therapy?

The tube/needle falls out or is removed The tubing disconnects The dressing around the IV site is loose or not intact Blood in the tubing or around the IV site The site is swollen, redness, discoloration, abnormal warmth to the site The bag is broken, or level of fluid does not seem to decrease The IV fluid is not dripping or is leaking The IV fluid is nearly gone The pump beeps, indicating a problem The resident has trouble or difficulty breathing

What's the purpose of a colostomy?

To allow passage of stool

Aspiration

To draw fluid, a foreign substance, into the lungs during inspiration

Why do you have a stump sock for artificial limbs?

To prevent and reduce swelling

Why must you always provide peri-care when applying a condom catheter?

To prevent poor hygiene and infection

Always check skin integrity around the ostomy site...

True

Never carry linens close to your uniform...

True

When applying the condom catheter you roll it down 1-2 inches between the tip of the penis and the end of the condom catheter...

True

When you disconnect the tubing for the catheter, make sure the tubing doesn't touch anything, there is no special consideration for the catheter...

True

What are the general rules of catheter care?

Tubing should not be kinked or compressed (urine should flow without obstruction) Coil tubing on the bed Do not pull on catheter tubing Keep drainage bag below level of the bladder Drainage bag should be attached to the bed frame, not the side rail Never allow bag to touch the floor Catheter should be secured to the inner thigh Clean the perineal area and around the catheter; soapy water is adequate (use the procedure for catheter care preferred by facility) Drainage bag should be emptied and measured each shift (or when bag gets to or near halfway full) Report resident complaints promptly to the licensed nurse Follow the rules of asepsis at all times, keep drainage systems closed Check for leaks and report status Use separate measuring containers for each resident Encourage fluids Report observations

How do you make miter corners?

Tuck in the excess sheets, from the top of the bed, under the mattress Pull the new corner (looks more like a triangle) you made on top of the mattress as you tuck in the actual corner of the sheets Straighten out the side of the blankets and sheets

How do you put a hearing aid in?

Turn down the volume before placing the hearing aid in the external ear canal; it should fit tightly but comfortably After the hearing aid is in place, turn it on and adjust the volume so that resident can hear in a normal tone; the resident will tell you when he or she can hear comfortably If the resident complains of an unpleasant whistle or squeal, check the placement in the ear and for a crack or break in the ear mold or wire

How do you store a hearing aid?

Turn the hearing aid off when it is not in use Store a hearing aid in a well-marked container labeled with resident's name and room number Label hearing aids with resident's name

Axilla

Under the arm, the "armpit"

When do you perform oral hygiene?

Upon awakening After each meal At bedtime

When should dentures be cleaned?

Upon awakening, after meals, and before bed

What are five urine abnormalities?

Urine has a strong odor, is cloudy, dark, bloody, or has sediment in it

Before you connect the leg bag to the catheter bag, how would you disinfect before connecting?

Use an alcohol wipe to disinfect the tubing and port services

How do you wash a resident's eyes?

Use damp washcloth and clean from inside of eye to the outside Use different corner with each wipe or eye

How do you clean the stoma?

Use warm water and a clean washcloth or gauze pad to clean the stoma from the inside out Pad dry with a clean towel or gauze pads (if residual stool is present, clean the stoma with toilet tissue and dispose of it in the bedpan)

How do you apply medicinal shampoo?

Verify order for medicinal shampoo Review and clarify manufacturer's procedure for application Follow standard precautions Follow manufacturer's directions for procedure

For a prosthetic limb, what kind of care do you give? (4)

Wash and clean both the affected limb, and every part of the prosthesis it comes in contact with You should always apply any sock or covers that are used with the prosthesis Keep an eye on the resident's weight as any sudden fluctuations may affect the fit on the prosthesis Check for changes in the resident's skin condition

What are two infection control steps that you would implement when assisting a resident to the commode?

Wash hands Wear a different pair of gloves during the first part of the procedure (the original transfer) and the second part of the procedure (the transfer back to bed)

What kind of skin care should you provide when a resident has an ostomy?

Wash skin well with soap and water, and dry well Shave hair (around it, not on it) Observe skin around stoma for redness and irritation

Urine

Waste fluid passed by the kidneys to the bladder for storage until excreted out of the body through the urethra

Fecal impaction

When stool becomes impacted in the bowel This is a serious condition that can cause toxicity to the resident, bowel perforation, and even death

Bowel obstruction

When the bowel is partially or completely blocked preventing food, fluid, gas, and feces from moving through the intestines Causes: tumors, scar tissue, narrowing, or twisting of the bowels A bowel obstruction can be life threatening

Under what circumstances do you perform oral hygiene more often?

When the resident is: A mouth breather On oxygen treatment NG tube Elevated temperature Emesis

When, why, and what do you use to care for a prosthetic limb?

When the resident wakes in the morning and before bed in the evening and prn Done to maintain a clean prosthetic for the resident You need any supportive items such as sock, towel, wash clothes, warm water, basin and gentle soap as needed

When giving mouthwash, does the CNA dilute it?

Yes; dilute with 50% water and 50% mouthwash