CNA 1 Ch 22-28

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

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

A healthy plate (myplate symbol):

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

factors affecting urine production: + normal amt per day

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

commodes

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

Enteral nutrition - common causes

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

Partial bath Tub baths and showers Towel bath Bag bath

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

Fluid balance - hydration - input - output - normal requirements

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

Nutrition and nutrients - healthy plate

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

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

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

Ostomy - STOMA - colostomy ileostomy slides

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

Application of lotions and creams - what to verify slide

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

Stool info - normal - abnormal slides

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

Suppositories slides

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

Urinary elimination: - anatomy - urination

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

Denture care:

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

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

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

aspiration signs slides

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

What to report and record: haircare

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

Food labels book

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

Conversions for I&O

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

Skin and scalp conditions

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

stool observations to document slides

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

Prevention/treatment of skin breakdown

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

Observations to record during bathing

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

Common incontinence products book

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

Factors affecting eating and nutrition

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

Types of feeding tubes

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

General precaution when feeding a patient

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

Nutrients book (447 for vit functions)

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

Bowel elimination: Safety and comfort slides

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

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

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

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

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

Bowel training - goals - timing

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

CAtheter use reasons book

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

How to provide assistance with ADLs

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

Change garments:

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

Types of incontinence - functional - reflex - transient book

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

Incontinence products: OBservations ot report nd record

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

Catheters - definition - catheterization - types

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

condom catheter

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

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

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

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

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

Factors affecting Bowel movements (BMs)

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

Oil book

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

Fruit group book

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

Bariatric care (bathing)

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

Bathing

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

+ bedpans - standard - fracture > when to use

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

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

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

Fluid imbalance: Edema

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

Catheter care

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

Fecal impaction

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

Fluid imbalance: dehydration

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

Catheter: what to report

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

Applying incontinence products

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

Fecal incontinence - causes - person needs

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

Incontinence and pressure ulcers risk factors

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

Shampoo - method

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

Feeding the person

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

Oral hygiene (mouth care) -what to report

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

Grains group book

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

Constipation causes + prevention/relieving

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

Preparing for meals slides

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

dysphagia signs slides

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

Enemas - use - who orders - Process

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

Dairy and protein book

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

Diabetic diet

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

Dysphagia diet

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

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

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

Nail and footcare

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

Foodborne illness: - danger zone - safety tips

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

Diarrhea - causes -CNA role

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

Flautulence - causes

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

Managing incontinence

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

Grooming

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

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

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

Intake and output calculations slides

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

Urinary incontinence -causes

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

*Perineal care*

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

Shaving

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

Urine observations to make: + normal urine

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

Special fluid orders NPO Encourage fluids Restrict fluids Thickened liquids

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

Incontinence associated dermatitis slides

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

Measuring food intake

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

Application of lotions and creams slide

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

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

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

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

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

What to report: nail care

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

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

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

Foodborne illness: signs book

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

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

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

Types of assistance to provide with ADLs

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

Soap BAth oils Creams and lotions Powders Deodorants Antiperspirants

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

Sodium controlled diet

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

Urine drainage system

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

Removing indwelling catheters

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

Complete bed bath - who needs them

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

Vegetable group book

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

Mouth care for the Unconscious person

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

Bathing safety

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