CNA Terminologies

Describe the anatomy of the bone, joints, and muscle and its functions

Bone: Hard structures made of connective tissue cells
Joints: Point at which two or more bones meet; permits movement
Muscle: Allows movement, heat production, posture

Describe physiology

Gives shape and form, posture, permits movement, protects organs, stores calcium, and phosphorus
Forms framework that support the body and allows movement

Musculoskeletal System: Arthritis

Define arthritis, rheumatoid, osteoarthritis, gout
What are some signs and symptoms of arthristis
What are the NA duties and observations of arthritis, rheumatoid, osteoarthritis, gout?

What is Title 42 Code of Federal Regulations Resident Rights

Residents have the right to be treated with respect, dignity, and autonomy, and encompass areas like freedom from abuse and neglect, the right to make decisions about their care, and the right to manage their personal affairs

Ombudsman

An impartial advocate for a resident

What are the 11 Psychological Defense Mechanisms?
Which are unconscious?

denial, projection, anger, rationalization, regression, displacement, conversion, repression, sublimation, identification, substitution

DENIAL - Refuse to face a negative behavior / Blocking external events from awareness

PROJECTION - Attributing one’s unacceptable feelings and thoughts to others and not yourself

ANGER - Response we have to the unmet expectation or disappointment or perceived threat

RATIONALIZATION - Excuse and justify mistake

REGRESSION - Act much younger to feel better

DISPLACEMENT - Redirecting unacceptable feelings from the original source to a safer, substitute target

CONVERSION - Anxiety caused by repressed impulses and feelings are 'converted' into a physical complaint such as a cough or feelings of paralysis

REPRESSION - Unconscious mechanism employed by the ego to keep disturbing or threatening thoughts from becoming conscious

SUBLIMATION - Replacing socially unacceptable impulses with socially acceptable behavior

IDENTIFICATION - Attach to something positive

SUBSTITUTION - Unattainable or unacceptable goal, emotion or object is replaced by one that is more attainable or acceptable

What does the codes DNR, DNI, and full code mean?

DNR - Do not resuscitate
DNI - Do not intubate
Full code: do CPR, administer shock

Dysphasia vs Aphasia

Dysphasia: difficulty communicating through speech, writing or signs; often follows a stroke (dys - bad)

Aphasia: loss of the ability to communicate through speech, writing or signs; frequently follows a stroke

Confusion vs Dementia

Confusion: disorientation to person, place and/or time; it may be temporary or long term

Dementia: chronic decline in memory and other thought processes

What are the Four Es of giving constructive feedback?

Engage, empathize, educate, enlist

what are the 6 principles of care? Think Discipline

Dignity
Infection Control
Safety
Communication
Independence
Privacy

What are the common emergency color codes
Red, orange, blue, yellow, gray, silver

Code Red – fire
Code Blue – adult medical emergency (cardiac/pulmonary)
Code Yellow – bomb threat
Code Gray – combative person
Code Silver – person with weapon or hostage
Code Orange – hazardous waste spill or release

What’s RACE and PASS

R - Remove the resident from the fire area and close the room door
A - Activate the fire alarm system
C - Contain the fire
E - Extinguish if possible

P - Pull the safety pin
A - Aim at base of fire
S - Squeeze the lever
S - Sweep low

What’s OSHA and MSDS

OSHA - Occupational Safety and Health Administration (Gov agency that makes and enforces regulations to protect health care and other workers)
MSDS - Materials Safety and Data Sheet

Asphyxia

Suffocation (Asphyxia): a condition in which an extreme decrease in the concentration of oxygen in the body accompanied by an increase in the concentration of carbon dioxide leads to loss of consciousness or death

Patient Bedridden positions

Techniques?
Basic positions? Describe supine, prone, lateral, sim’s, left sim’s, fowler’s, semi-fowler’s, trendelenberg’s, reverse tredelenberg’s

Technique:
- Every 2 hours
- Turn and position
- Use supportive devices to provide comfort and support limb position (pillows and foam wedges)

Supine: Lying flat on the back
Prone: lying flat on the abdomen
Lateral: patient lies on one side of the body (away from the midline; side)

Sim’s: lying with the upper knee and thigh drawn upward to the chest; a modified form of prone or lateral position where the patient is positioned at his/her side, such that the upper leg is bent inside towards the chest while the upper arm is bent at the elbow

Left Sim’s: position of choice for administering an enema or other rectal procedures

Fowler’s: Head bed raised 45-90º angle
Semi-Fowler’s: Head bed raised 30-45º angle
Trendelenberg: 15-30º Positive Incline
Reverse Trendelenberg: Opposite

Different types of patient transfers

Gurney, Mechanical Lift, Trapeze, slide board, gait belt

Before performing any task, how should NA elevate the bed?
When giving bedside care, bed should be level at where?
Always what when doing procedures to prevent falls and ensure safety

Comfortable position
Your waist
Lock wheels

Conversions
Weight:
1 kg = ___ pounds

Length:
1 inch = ___ cm
1 cm = ___ inches
1 foot = ___ cm and ___ inches

Volume:
1 oz = ___ ml
1 cup = ___ ml and ___ oz
1 pint = ___ ml and ___ oz
1 quart = ____ ml = 1 L = ___ oz
1 tsp = ___ ml
1 tbsp = ___ ml

Weight:
1 kg = 2.2 pounds

Length:
1 inch = 2.5 cm
1 cm = 0.39 inches
1 foot = 30.48 cm and 12 inches

Volume:
1 oz = 30 ml
1 cup = 240 ml and 8 oz
1 pint = 500 ml and 16 oz
1 quart = 1000 ml = 1 L = 32 oz
1 tsp = 5 ml
1 tbsp = 15 ml

Colostomy
Ostomy
Stomy

is a surgical procedure that brings one end of the large intestine out through an opening (stoma) made in the abdominal wall

Surgery that makes a temp or permanent opening

Cyanosis
Decubitus Ulcer
Range of motion

is a bluish or purplish tinge to the skin and mucous membranes

are an open skin wound sometimes known as a pressure ulcer, bed sore or pressure sore

is the extent of movement of a joint

What does AM care consist of?

Bathroom, incontinence care, linen change
wash face and hands
Offer oral hygiene
Assist with grooming
Straighten bed and unit
Breakfast

what does after breakfast (AM) care consist of?

Oral hygiene
Offer bedpan/urinal or assist to bathroom
Bathing (includes foot care)
Shaving
Hair care
Dressing
Skin care
Assisting with activity: ROM, ambulation
Linen change
Unit maintenance

What does afternoon care consist of? (prep for lunch and dinner)

Offer bedpan/urinal or assist to bathroom
Incontinence care/linen change
Wash hands/face
Straighten bed/unit
Position for meal/take to dining area

What does evening (PM) care and hour of sleep (H.S.) care consist of?

Offer snack when applicable
Offer bedpan/urinal or assist to bathroom
Incontinence care/linen change
Wash hands/face
Oral Hygiene
Back rub
Assist into sleepwear
Straighten bed/unit

Body areas that require bathing?

Face

Arms/underarms (axilla)

Hands

Legs/feet

Perineal area (genitals and anal area)

Back

Any area where skin folds or creases (ie. under breasts)

General steps for bed bath
Complete bed bath vs partial bed bath
What equipment needed?

Describe general procedure

Equipment: bath blanket, basin, soap, water thermometer, wash cloths, bath towels
Check their personal choices (water temp, soap, etc)

Opening procedure
Identify, introduce, privacy, standard precautions, adjust to their comfort, assist, change water when soapy/dirty, bathe areas soiled, wash from cleanest to dirtiest area, rinse, dry, encourage them to help

Paraplegia vs Quadriplegia

paralysis of the lower part of the body involving both legs and sometimes the lower trunk
paralysis of all four extremeties

Cerebral Vascular Accident (CVA) vs Peripheral Vascular Disease (PVD) vs Chronic Obstructive Pulmonary Disease (COPD)

Cerebral Vascular Accident (CVA): a stroke or "brain attack" caused by a blockage or bleed in the brain

Peripheral Vascular Disease (PVD): includes all diseases caused by the obstruction of arteries or veins in the arms and legs

COPD: commonly co-existing diseases of the lungs in which the airways become narrowed; chronic bronchitis, asthma, and/or emphysema

Pressure sores

areas of damaged skin caused by staying in one position for too long. They commonly form where your bones are close to your skin, such as your ankles, back, elbows, heels and hips.

Nercrosis
Erythema
Epidermis
Dermis
Osteomyelitis
Eschar

Death of tissue
redness
Thin outer layer of skin
Layer under epidermis
Infection of the bone
Dead tissue that sheds or falls off from the skin

Describe the 3 stages of pressure sores

Stage 1:
Skin is not broken. Epi & derm are intact
Erythema that does not resolve within 15-30 minutes (Non-Blanchable)

Stage 2:
Skin not intact
Partial skin loss (epi damage, part of derm)
Blistered, cracked, and open erythema or shallow skin
No dead tissue
Wound bed is moist, pink, and painful

Stage 3:
Full thickness skin loss with epi n derm gone
Damage doesn’t extend to muscle
Possible drainage

Stage 4:
Full skin loss, major destruction
Grangene

When to perform oral Hygiene?

When waking up, after each meal, bed time

When giving oral care to unconscious patients, they should be what?

Side-lying to avoid choking and aspiration

types of prosthetic devices

Cosmetic - provide live-like rep of absent body part
Adaptive - Controls to provide amputee with a gait to change in speed
Restorative - return to health or replacement of a part to normal position

Things to observe in sputum

Color, odor, consistency, blood

Assisting the resident in raising a sputum specimen

Rinse mouth with water
Label specimen: name, room, bed number, time and date collected

Collecting a urine specimen

Methods of collection
Things to observe
Rules to follow in urine collection

Methods:
Mid-stream, clean catheter urine specimen, 24-hour urine specimen

Observe:
Difficult obtaining specimen, color, clarity, odor, particles, complaints

Rules:
Wash hands, standard precautions
Label: name, room, bed number, date and time

Ask them not to poop while collecting
ask them to place toilet tissue in toilet or wastebasket

Collecting a stool specimen

Things to observe
Rules

Observations:
Diffciulty obtaining, color, amount, consistency, discomfort

Don’t contaminate
Label

Things to know about side rails

Prevent falls
Considered restraints, must be noted in their care plan

The different bed positions and what they’re used for

High Position: giving care to residents, moving residents to stretchers, or when making the bed

Low position: in and out of bed

Fowlers: eat and breathe easily in respiratory/cardiac conditions

Semi Fowlers: keep resident from sliding down in bed

Trendelenburg position: requires doctor order

Reverse trendelenburg position: requires doctor order

Elastic stockings

Increases circulation by improving venous return from legs to heart

5 vital signs

Temperature, pulse, respirations, blood pressure, pain

How is heat conserved by body?

Reduced perspiration, dec flow of blood to skin, shivering

How is heat lost from body?

Sweating, increase blood flow to surface, elimination, increase respiratory rate

How is heat produced from out body? What factors can elevate temperature?

Heat is produced by cellular activity, food metabolism, muscle activity, and hormones

Infection, brain injury, external factors(hot drinks, air, clothing, exercise), and internal factors(dehydration) can elevate temp

Main sites for temperature measurement

Oral - most common
Rectal - most accurate
Tympanic - Ear
Axillary - arm pit
Temporal

Normal temperature ranges for adult in the main sites

Adult Normal resting Range: 97F – 99F or 36C – 37.5C
Tympanic or temporal or Oral: 98.6F
Rectal: 99.6 F (one degree higher than oral)
Axillary: 97.6 F (one degree lower than oral)

Contraindications for taking oral temp

• Confused

• Disoriented

• Restless

• Unconscious

• Coughing

• Unable to breathe through his/her nose

• Prone to seizures

• Receiving oral/nasal oxygen

• Has difficulty breathing

• Receiving nasogastric tube feeding

Contraindications for taking Rectal Temperature

ë Diarrhea

ë Rectal bleeding

ë Surgical rectal closure

ë Fecal impaction

ë Hemorrhoids

Describe the 7 major pulse sites

1. Carotid – pulse is located in the neck

2. Apical – it is located in the left chest area (pulse taken with use of stethoscope)

3. Brachial – pulse in the inner part of elbow

4. Radial – it is where the thumb side of wrist

5. Femoral – pulse felt in the groin area

6. Popliteal – located behind the knee

7. Dorsalis pedis – (pedal) top of the foot

Tachcardia vs Bradycardia

Factors that increase pulse
Factors that decrease pulse

Factors that increase pulse
Tachycardia: over 100 beats per minute

• Exercise, Fever, Hemorrhage, Pain, Shock, Strong emotions (anger, fear, laughter, excitement)

Factors that decrease pulse
Bradycardia: below 60 beats per minute

• Sleep/rest, Depression, Drugs (digitalis, morphine), Athletes in good physical condition have a lower pulse, probably below 60 beats/min

Observations to be made when measuring respirations

Rate, rhthym, depth

Rate: Number of respirations per min, 12-20 for adult

Labored, orthopnea, stertorous, abdominal abnormal breathing patterns

• Labored: the resident struggles or works hard to breathe

• Orthopnea: breathing possible only when person sits or stands

• Stertorous: resident makes snoring sounds while breathing (indicates partial airway obstruction)

• Abdominal: breathing using mostly the abdominal muscles

Abnormal breathing patterns - Shallow, dyspnea, tachypnea, bradypnea

• Shallow: breathing with only the upper part of the lungs

• Dyspnea: painful or difficult breathing

• Tachypnea: respiratory rate above 24/minute

• Bradypnea: respiratory rate less than 10/minute

Abnormal breathing patterns - Apnea and Cheyne-stokes

• Apnea: absence of breathing

• Cheyne-stokes respirations: gradually increase in rate and depth and then become shallow and slow, then a period of apnea

Temperature, Pulse, and Respiration (TPR)

a Combined Procedure

• The temperature is taken first, then pulse, then respirations.

• Remember the pulse rate while counting the respirations to doc tgt

• Try not to stop to record the pulse before counting the respirations

Systolic pressure (first number of reading) vs Diastolic pressure (second number of reading)

Systolic pressure (first number of reading)

▪ Heart contracts forcing blood into the artery

▪ Pressure at highest in arteries

Diastolic pressure (second number of reading)

▪ Heart at rest

▪ Pressure at lowest in arteries; arteries completely open

Normal ranges of blood pressure

Range for systolic, diastolic
Reading that classifies as pre-hypertensive

Normal: 120/80 mm Hg
90 - 140 range for systolic
- Systolic reading of 139 is classified as pre-hypertensive
60-90 range for diastolic
- Diastolic reading of 89 is classified as pre- hypertensive

Hypertension vs hypotension

Hyper - above
Hypo - below

Guidelines in taking BP

1. Commonly measured in brachial artery sometimes popliteral artery (above knee)

2. BP at site other than brachial must be ordered

3. At rest

4. Reads 0, no air in cuff

5. Appropriate sized cuffs

6. Don’t take bp on arm or side with injury or med equip present

7. Apply bp cuff to bare arm

8. Position sphygmomanometer at eye level

Types of pain

Acute pain
Chronic pain
Phantom pain: from body part that’s no longer there

Min amts of fluid per day for an adult

1500ml

Nutrition, food sources, and functions

Nutrients, Food Sources, and Functions

★ Carbohydrates

• Grains, pastas, breads, cereals, fruits, vegetables

• Main source of energy

• Provides dietary fiber

★ Proteins

• Eggs, milk, meat, fish, nuts, poultry, cheese, beans, peanut butter, and soy products

• Essential for tissue growth and repair

• Made up of amino acids

★ Fats

• Oils, milk, cream, cheese, meat, fats, butter, mayonnaise

• Provide energy, carry vitamins, conserve body heat, and protect internal organs

★ Vitamins

• Found in almost all foods, especially vegetables and fruits

• Do not contain calories

• Essential for building and repairing body tissues, assisting in regulation of body functions

★ Minerals

• Found in almost all foods

• Do not contain calories

• Essential for regulation of body functions, building and repairing body tissue

★ Dietary fiber

• Raw fruits and vegetables, whole grain breads and cereals

• Provides bulk to assist in maintaining normal bowel elimination

★ Fluids

• Water, juices, other beverages

• May or may not provide calories and nutrients

• Water is essential for normal body functioning

• All chemical reactions in the body take place

in water

My plate food guidance system

Grain Group
Whole grain bread, cereal, crackers, rice and pasta group
Minimum 5-6 ounces/day (women), 6-8 ounces/day (men)

Vegetable Group
Eat more dark green and orange vegetables, dry beans and peas
Minimum 2-2 ½ cups/day (women), 2 ½-3 cups (men)

Fruit Group
Fresh, frozen, canned or dried fruits
Limit fruit juices
Minimum 1 ½-2 cups/day (women), 2 cups (men)

Dairy Group
Milk, yogurt, cheese
Choose low fat or non-fat
Minimum 3 cups/day (women and men)

Protein
Meat, poultry, fish, dry beans, eggs, and nuts
Minimum 5-5 ½ ounces/day (women), 5 ½-6 ½ ounces/day (men)

Oil Group
Make most oil choices from fish, nuts and vegetable oil
Limit solid fats such as butter, lard, and shortening
5-6 teaspoons/day (women), 6-7 teaspoons/day (men)

Vegan Basic Food Groups

Vegan Basic Food Groups
Whole grains: 5 or more servings each day
Rich in fiber and complex carbs, protein, B vitamins and zinc.

Vegetables: 3 or more servings each day
provide vitamin C, beta-carotene, riboflavin and other vitamins, iron, calcium, and fiber.

Fruits: 3 or more servings each day
Rich in fiber, vitamin C and beta-carotene.

Legumes: 2-3 servings each day
fiber, protein, iron, calcium, zinc, and B vitamins.

Therapeutic diets, responsibilities of NA

Ensure they receive their ordered diet
Check armbands
Report any problems related to diet
Monitor and doc intake n output
Calc and rec food intake
Don’t offer extra w/o checking in

NA responsibilities of tube feeding

Monitor for pressure on or kinking of tubing
Monitor level of feeding, report when low
Keep head of bed elevated at least 20-30º at all times
Don’t lower bed when repositioning
Never turn off pump

IV infusion and NA responsibilities

Ordered by physician

Ensure no kinks, twisting, pressure, or obstruction
Report IV alarm ringing, complaints, swelling, redness, fever, difficulty breathing, bleeding, leakage, disconnected, empty IV

Never adjust or turn off IV monitoring equipment

Make sure resident and family don’t handle, adjust, or stop infusion

What is insulin shock and what is it called?
Signs and symptoms?
NA role

Severe low blood sugar caused by too much insulin or too little food
Hypoglycemia: abnormally low level of glucose in the blood stream

Signs and symptoms
Pale, moist skin, rapid bounding pulse, headache, confusion, weakness, anxiety, excitement, hunger, low BP, unconscious

NA role
Stay with resident, calm, help
administer orange juice, milk, or snack if LN says yes

Heart Attack
Sign and symptoms
NA role

Signs and Symptoms
Chest pain, shortness of breath, excessive sweating(diaphoresis), wet, cold, clammy skin, confusion, mental status change, faint, weak, nausea, irregular pulse

NA Role
Help, EM light, calm, stay with res, Reassure res, assess, and vital signs

Cardiac Arrest
Signs and symptoms
NA Role

Absence of heart function

Signs and symptoms
No pulse, no circulation, loss of consciousness, no effective breathing, enlargement of pupils, gray color skin, cyanotic nail beds

NA Role
Calm, help, charge nurse 911, remain with res, intervene if directed, reassure, AED

Cerebrovascular attack (CVA, stroke, or brain attack)
Signs and symptoms
Give me 5 for stroke
FAST
NA Role

Signs and symptoms
Hemiplegia: weakness oof one side, numbness, tingling
Aphasia
Headache, vision changes, facial changes, eye droop, drooling, loss of bowel control, shaking, trembling

Walk - is their balance off?
Talk - Is their speech slurred or droopy face?
Reach - one side weak or numb?
See - vision all or partly lost?
Feel - headache severe?

FAST
F - face drooping, A - Arm weakness, S - Speech Difficulty, T - Time to call 911

NA Role
Same as others

Syncope (fainting) signs and symptoms

Dizzy, temp loss of vision, paleness of skin, cool, sweaty, eyes may roll back, weak pulse

Types of seizures and signs n symptoms

Seizure: involuntary shaking
Epilepsy: disorder resulting in many seizures

Absence or partial seizure: mild blackout, looks like daydreaming
Generalized or grand mal seizure: uncontrolled muscular contractions, violent head jerking, frothing at mouth, loss of bowel and bladder control

Cushion head, lay down