Home Health Aide Exam

Client care obervations that should be reported to the nursing supervisor

• changes in breathing/SOB

• skin breakdown/rashes/wound (pressure ulcer) with signs of infection (such as open skin area, red with oozing yellow drainage)

• changes in eating habits

• changes in bowel/urine output

• falls including when and what happened, check for and report any injuries, report head trauma immediately

• bleeding/bruising

• redness/swelling in any location

• fever

• pain, ask client to describe/rate their pain, report refusal of care because of pain

• level of alertness/ mental changes; talking to or hearing voices, neglect of personal appearance, skipping medications

• observation of verbal/physical/sexual abuse

• safety concerns

• noncompliance of ordered medications

• unsafe environmental conditions: lack of food, heat, water, and pests/insects

• sudden fatigue or weakness in the client

• client is agitated and hallucinating such as seeing bugs crawling on them

Schedule conflicts

always contact staffing manager, never okay to reschedule with the client or skip a shift

Documentation

written source of communication, supports billing purposes for reimbursement for the health care agency, helps meet regulatory requirements, source for review and evaluation of care provided to the patient

Documentation tips

• print neatly full legal name

• use ink

• identify client’s name, time of arrival/departure, and date

• your signature and client’s signature must be on timesheet

• factual, accurate, and specific

• record any refused care, and reason, and notify supervisor

• if a task is not charted it was not done

• if you wrote a mistake, draw a line through it, mark error, and initial

• do not chart activities done by others

• record tasks/observations as soon as possible

• call nursing supervisor for any concerns or questions

Vital Signs

• temp

• pulse

• respiration

• blood pressure

Temperature

• how much heat is in the body

• healthy range 97.8- 99 F

• abnormally high- fever

• abnormally low- hypothermia can occur when exposed to cold or wet environments, body temp below 95 degrees

Assessment of body temperature

• orally- taken by mouth using a digital thermometer (glass thermometers with mercury are no longer recommended), wait at least 10 minutes after consumption of hot/cold liquids

• rectally- digital thermometer, usually 1 degree higher than oral

• axillary- under arm at the armpit/axillary, 1 degree lower than oral

• ear/tympanic- thermometer measures core of ear drum which reflects core body temp

• skin- temperature of skin on forehead

Pulse

• number of times heart beats per minute

• as heart pushes blood through arteries they contract and expand

• normal range 60-100 bpm

• average pulse rate is 80 bpm

• pulse fluctuates with excercise, illness, injury, and emotions

• can be found on carotid or thumb side of wrist

• first and second finger on artery count for 15 seconds and multiply by 4

Respiration

• number of normal breaths a patient takes in a minute

• normal rate for adults is 12-16

• rate can increase with fever, illness, and other respiratory conditions

• do not let client know that you are watching their respiratory rate, continue holding fingers on pulse while taking respirations

Blood pressure

• the force of blood pumping against artery walls during contraction (systolic) and relaxation (diastolic)

• recorded using 2 numbers

• systolic/heart contracting is top number

• diastolic/heart relaxing is bottom number

• pressure recorded in mmHG (millimeters of mercury)- represents how high the mercury column in a manual blood pressure device (sphygmomanometer) is raised by the pressure of the blood

• Hypertension- consistently 140/90 or above

• hypertension can increase risk of heart attack, heart failure, and stroke

Infection control

infection- diseases spread by viruses and bacteria

Routes of transmission

• airborne- passed from one place or person to another through the air, such as sneezing or coughing, tuberculosis, influenza, measles

• sexual- passed through sexual contact, herpes, hepatitis, HIV, syphilis, papillomavirus, and chlamydia

• oral- spread by sharing drinks, food, or kissing, hepatitis

• contact- spread through direct skin contact, when proper hand washing is not done, rhinovirus and E-coli (organism present in feces)

Most important way to prevent spread of infection

washing hands, wash with friction for at least 20 seconds, wash with soap and water or alcohol based sanitizer, keep hands pointed downward while washing, wash hands before and after each client contact, eating, and going to the bathroom

Infection control- assume everyone is infectious

• gloves- should be used with hands-on care such as bathing, use of bedpans, handling of feces, vomit, urine, blood or any other bodily fluid, hands should still be washed before or after use of gloves

• gown- worn when there is a risk of clothing coming into contact with bodily fluids

• googles- worn if there is any fluid splattering near eyes

• mask- worn if client is coughing or has any viral infection

general hygiene/infection control tips

• use standard precautions when providing care for client

• common ways bacteria enter body is nose, mouth, and cuts in skin

• signs of infection include elevated body temperature, fever, pain, redness, or swelling in any area

• cloudy urine could indicate a UTI

• bacteria grow best in warm, dark, and moist places

• older adult’s immune systems are much weaker and leaves them more susceptible to infections such as pneumonia

• always report insects/rodents in home

• fecal stains on the bed that look like a fine tip marker could indicate a flea/bedbug infection

• chain of infection always requires an infectious agent, route of transmission, and susceptible host

• if no sharps container is available for syringes or lancets, acceptable alternative is a heavy plastic container or coffee can

• report any exposure of bodily fluids or needle sticks to supervisor

Circulatory system

• moves blood, nutrients, oxygen, carbon dioxide, and hormones around the body

• consists of heart, blood, arteries, capillaries, spleen, lymph nodes, and vessels

• common disorders: hypertension, congestive heart failure, stroke, blood clot

Digestive system

• breaks down food into small particles to be absorbed into the blood and nourish all the cells of the body.

• aides in removal of food waste through the intestines

• mouth, teeth, tongue, esophagus, salivary glands, stomach, intestines, gallbladder and pancrease

• common disorders: constipation, ulcers, colitis, hepatitis, diarrhea, Crohn’s disease

Endocrine system

• secretes hormones into the blood that travel to different tissues and regulate bodily functions

• adrenal, thymus, thyroid, parathyroid, pituitary, pancreas, testes, and ovaries

• common disorders: diabetes, hypo/hyperthyroidism, addison’s disease, Cushing syndrome, acromegaly, growth hormone deficiency

Immune system

• defends body against bacteria, viruses, and other pathogens that may be harmful

• lymph nodes, spleen, bone marrow, lymphocytes (b-cells and t-cells), thymus, and leukocytes (white blood cells)

• common disorders: HIV/Aids, rheumatoid arthritis, lupus, asthma, eczema, allergic rhinitis

lymphatic system

• plays a role in the body’s defenses

• make and move lymph, a clear fluid that contains white blood cells to help the body fight infection

• lymph nodes, lymph ducts, lymph vessels

• common disorders: lymphedema, lymphoma, castleman disease, lymphangiomatosis

nervous system

• controls voluntary action and involuntary action and sends signals to different parts of the body

• central nervous system- brain and spinal cord

• peripheral nervous system- nerves that connect every part of the body to the CNS

• common disorders: epilepsy, multiple sclerosis, ALS (lou Gehrig’s disease), huntingtons, alzheimer’s, parkinson’s, and meningitis

Muscular system

• aids in movement, blood flow and other bodily functions

• 650 muscles including three types: skeletal muscle (connected to bone), smooth muscle (found inside organs), cardiac muscle (found in heart)

• common disorders: muscular dystrophy, myasthenia gravis

Reproductive system

• allows humans to reproduce

• male reproductive system- penis and testes which produce sperm

• female reproductive system- vagina, uterus, and ovaries which produce eggs

• during conception, a sperm cell fuses with an egg cell which creates a fertilized egg that implants and grows in the uterus

• common disorders: infertility, venereal diseases, HPV, endometriosis, and cancer

Safety

home health aide must be aware of safety first and foremost, safety for client, members of household, and oneself

Safety precautions

• maintain clean environment

• if client’s home is full of clutter, maintain a clean pathway through the home

• maintain proper infection control and good handwashing

• be aware of fire and electrical safety

• soiled items should be placed in a laundry basket and pre-soak all clothing that needs it

• be aware that smoking should not be done by a client that is oxygen dependent, report to supervisor

• wash dishes, from cleanest to dirtiest. Scrape and rinse dishes before putting dishwasher. If unable to wash dishes right away, rinse them and let the pans soak

• if client is experiencing aggression, you should remain calm and delay the task for when the client is calm. If possible remove self and client from the situation

• when cleaning the bathroom, it is best to clean the sink and counter first before floors

• if your client can reheat foods, most appropriate food storage method for client is arrange meal-sized portions on a plate and wrap in plastic

• the client’s financial resources, dietary needs and list of food allergies are important when grocery shopping with client

• handle food carefully to prevent infection. do not leave food at room temperature for more than 2 hours.

• keep drawers and cupboards closed. clean spills immediately

• keep raw meat products separate from other items when you store them

• if your client has an infectious disease keep their laundry separate from other family members and take directly to laundry area

• wear gloves when handling laundry. keep away from your clothes and body

• cleaning is removing dirt, debris, and other materials from a surface

• sanitizing or disinfecting is killing or microorganisms through heat or chemicals

• it is not okay to use liquid bleach on all clothing

• keep client’s sheets wrinkle free to prevent pressure ulcers

• protect the privacy of the client when bathing and making an occupied bed

• multiple throw rugs on wood or slick floors can pose a huge fall risk

• when cleaning your new client’s home always ask if the room meets their expectations and if not how you can fix it

• never mix ammonia and bleach

• cleaning supplies should be stored out of reach of children and disoriented adults

• counters and utensils having contact with meat products should be disinfected

Recognizing emergencies

HHA must remain calm, professional, and attend to their client. appropriate emergency responses include calling for help and providing care for:

• help to restore breathing

• help a heart attack victim

• stop heavy bleeding

• heimlich maneuver for choking

• burns

• seizures

• poisoning

• falls with injuries

• bites/stings

• stroke

• asthma/allergic reactions

• head, neck, or back injuries

Emergency tips

• if client complains of chest pain and dizziness, you should call for help immediately

• checking the airway and pulse is always the first thing you should do if you find your client is unconscious

• always call the agency if you arrive at a client’s home and they do not answer the door. do not just leave

• if there is a fire in the client’s home always get your client and yourself out of the house immediately and call 911

• 911 is the most important number to call in an emergency

• you should always check if the client can speak or cough when suspecting they are choking. this means they still have an airway and may be able to dislodge the item themselves

• using cool water over a minor burn is the best emergency procedure

• a diabetic reaction may include symptoms of excessive thirst, frequent urination, and drowsiness

• when client complains of chest pain and SOB you should call 911 immediately

• coughing during meals, taking multiple swallows for food to go down and pocketing food in cheeks are all signs that client is having difficulty swallowing

• if you think your client is being abused always report your observations and client’s explanation to your supervisor. Report what you saw, heart, and were told

Basic human needs

• food

• water

• shelter

• oxygen

• sleep

• touch/intimacy

psychological needs

• love

• affection

• recognition

• acceptance

• security

• trust

• socializing

• privacy

Other things to remember

• the client’s bill of rights states that the client has a right to respectful care, confidentiality, and to refuse treatment

• when in the client’s home the most important thing to remember is to do the assigned tasks in the order that is most comfortable for the client

• different cultures/people, have different ideas about family involvement. Always be aware of your client’s wishes. Ask the client who information should be given and who to consult for decision-making

• client’s name, photo, diagnosis, and social security number are protected under HIPPA

• client must give written consent to allow agency to release any records

• electronic methods of communication, conversations about a client’s diagnosis, and printed patient documents are considered protected health information

• confidentiality refers to only sharing information with those involved with client’s care

• always respect your client’s religious beliefs and customs

• non-verbal communication does not fall into the category of protected health information

• to protect your client’s health information, you should; access client information, only as necessary for your direct job responsibility

• no texting information to office, keep any documents/devices with client information secure to prevent unauthorized access

• never accept tips or gifts from client or family members. Always politely refuse.

• You should always keep your personal life separate from your professional work life. Always be aware of professional boundaries.

• When your client has a complaint, you should notify your supervisor. All complaints are documented according to agency policy. Care for the client must continue with no retaliation or change for the client.

• Humiliating the client, denying the client access to finances, and ignoring or neglecting the client are examples of verbal, emotional, and financial abuse

• always report to your supervisor any information that may potentially cause harm to your client or others. Even if client doesn’t want you to report.

Personal hygiene care and grooming

• encourage your client to do as much for themselves as possible and assist as needed.

• only do what is directed by your RN supervisor on the care plan, even applying lotion must be on the care plan

• use a patting motion when drying a client after a bath/shower to avoid any trauma to the skin

• always make sure skin is clean and dry with no wrinkles in linens/clothing

• good oral hygiene/mouth care is needed to prevent tooth decay and infections because it helps decrease the number of bacteria

• it is important to keep the mouth clean and gums stimulated even on clients that have dentures

• the drainage bag for an indwelling urinary catheter must always be placed below the bladder to promote drainage and to prevent infection. keeping the tubing and area around the catheter clean, can prevent infection as well

• always notify your supervisor if you notice dark, cloudy urine, or blood in catheter tubing or bag

• clients with a urinary catheter may want to use a leg bag when up and out of bed

• encourage your client with occasional incontinence to go to the bathroom at least every two hours

• always watch for fragile skin, skin break down, and infection in clients with urinary and or bowel incontinence

• if your client can not lift their bottom off the bedpan, it is best to turn client on his side while firmly holding the bedpan taking care not to spill contents

• wash your hands and wear gloves when assisting with any toileting tasks

• always maintain your client’s privacy and dignity and encourage them to maintain whatever independence and decision making they can

Transfer techniques and ambulation

• safety is the most important factor when helping assist with client transfers and ambulation

• use proper body mechanics to prevent injury to yourself

• follow client’s plan of care and report any changes or transfer techniques no longer appropriate

• if client requires mechanical or hoyer lift, it is unsafe to move or lift the client manually

• mechanical lifts are used on clients that are quadriplegic, paraplegic, obese, or other diseases that cause paralysis

• gait belt is worn around client’s waist and can be securely held during transfer/ambulation

Guidelines for safe transfer/mobility/ambulation

• be realistic about your abilities, muscle strength and limitations. Always observe client’s strengths before attempting transfer

• explain to client what you are doing. “stand on cout of 3 etc”

• allow time for client to sit on edge of bed and get their balance before transfer assist. If they become dizzy support in a sitting position until it resolves

• when transferring to wheelchair don’t forget to lock brakes and fold footrests up

• when ambulation or transferring support client on their weakest side

• make sure client is wearing shoes or no skid slippers during transfers or when ambulation

ROM and positioning

• ROM exercises keep joints flexible, prevent contractures of the muscles and improve joint stiffness and deformities

• ROM also improves muscle strength, tone, and increases circulation/blood flow to the skin

• ROM involves moving shoulders, elbows, forearms, wrists, fingers, knees, hips, legs, ankles and toes

• never provide if not assigned on the care plan

2 types of ROM

active- the client does the exercise themselves and no assistance other than instruction or encouragement. Active ROM is the best or preferred, as strength and flexibility will return faster

passive- client needs the HHA to move/support all their joints through full ROM. Always support above and below the joint being moved. Move joints in a slow, steady manner, never forcing joint. Never push movement and always stop if client reports pain

proper positioning

• maintains the body as straight, or in alignment as possible, use pillows or props as needed.

• promotes more effective breathing and ventilation, circulation, comfort, and prevents injury.

• Frequent position changes of at least every two hours can prevent skin breakdown injury and aids in client’s comfort

• When positioning in bed avoid friction and shearing on skin surface as much as possible.

• Always use proper body mechanics and have client assist pulling themselves up or rolling as much as they can: when client needs to move up to head of bed have them bend knees and push up with heels if they are able

Positioning continued

• remember proper body mechanics

• use pillows and props and remember to support nonfunctional/paralyzed limbs

• make sure weight is equally distributed on the buttocks and thighs while up in chair

• turn and reposition the client at least every 2 hours

• when moving client in bed avoid friction and shearing of the skin

• encourage client to get out of bed if they are able

• back rubs can be another way to improve blood flow to skin

fluids and nutrition

• fluids maintain hydration in the body, every part of body needs water to function, helps to regulate temperature, carry nutrients, and dispose/eliminate wastes, prevents constipation and dehydration

• dehydration occurs when a person losses more water than is supplied

• most adults should consume at least 6-8 glasses of water per day

signs of dehydration

• reduced kidney function, causing dark, colored urine with a strong odor

• low blood pressure/dizziness

• dry mouth, tongue and lips

• dry, sunken eyes

• confusion/irritability

• constipation

• dry skin and poor skin elasticity

• weakness

• headache

• thirst

edema

• can occur when a person takes in more water than they can eliminate, can occur with congestive heart failure, kidney disease, and other diseases

• swelling of feet and ankles

• weight gain that can be sudden

• SOB

Nutrition

• provides energy for maintenance and regulation of bodily functions

• provides energy for tissue growth and repair

• eat from fruits, vegetables, protein, grains, and dairy

• limit sugars, high carbohydrates, high fat and high sodium foods

Special diets

• following nutrition labels can help you pick appropriate foods for your client.

• nutrition labels include number of servings, ingredients, calories per serving, daily value needed for a specific nutrient, how fats are broken down in to different types, and other helpful information

• diabetic-diabetes (insulin dependent and oral hypoglycemic agents)

• low salt/sodium- high blood pressure, heart disease, kidney disease

• low fat- heart disease, obesity

• low calorie- overweight/obese

• high fiber- IBS, diabetes, constipation

• high protein- those are malnourished and are prone to wounds/pressure sores or have wounds already

• always encourage fresh fruit, vegetables, and lean meats for those with diabetes. discourage desserts and high sugar treats

• spinach is high on vitamin K, clients that are on anticoagulants need this in their diet regularly

• ham, deli meats, and canned soup have very high sodium levels

• always follow client’s care plan and report dietary, nutritional, hydration, contipation etc. concerns to supervisors

recognizing and reporting skin changes

• skin is the largest organ in our body, first line of protection and defense against organisms that could cause infection

• when there is a break in the skin, there is an increased risk of infection and illness

• proper and diligent skin care are essential

• signs of skin changes- tenderness/burning sensations, warm areas on the skin, discoloration, redness, blister formation

aging and the elderly

• inability to hear high-pitched sounds is part of a normal hearing loss in aging

• eyes that take longer to adjust to light, decreased tear production, need for more light

• central vision loss is not a normal sign of aging

• decreased oil production in the skin causes dryness, skin thins and becomes less elastic and blood vessels that nourishes the skin more fragile

• it is important to promote good skin health by keeping skin clean and well moisturized

• there is a decrease in bone mass, making the elderly more susceptible to fractures

• sleep difficulties are common, especially inability to fall into deep sleep

• poor circulation, balance and slower reflexes are additional concerns you should take into consideration when providing care

• a decrease in appetite is normal. serving smaller portions of food that they like in a pleasant environment should improve their food intake

• always identify yourself when entering your client’s home

• never use patronizing forms of communication to the elderly, such as speaking in a high-pitched voice, using we instead of you, or call the client honey sweetheart etc.

Alzheimer’s disease

• progressive, degenerative disease that attacks the brain and results in impaired memory, thinking and behavior

• slow progression with continued functional decline going through a mild, moderate, and severe stage

• loss of ability to make judgements is typically found in moderate dementia

• it is important to stay calm, be agreeable, and try to re-direct, distract, or entertain a client that has become agitated

• it is common for a client with Alzheimer’s disease to try to leave their home. If your attempt to re-direct them fails, always remain with the client to keep them safe and report to your supervisor as soon as possible

• use simple verbal cue to encourage client to complete tasks. help them maintain their independence as much as possible

death and dying

• attitudes about death can be influenced by background, culture, and religion

• attitudes about death can also differ, depending on whether death is sudden or expected

• when an illness is prolonged the individual and family go through a series of reactions or stages- 5 stages of grief

5 stages of grief

1. denial- first reaction, talk about future and avoid illness

2. anger- finally recognizing illness is real and angry others are alive

3. bargaining- making promises to a higher power to do something special in exchange for one’s life to be spared

4. depression- a deep sadness as one becomes weaker and closer to death

5. acceptance- final reaction having mourned their loss and they are ready to make all final plans

individuals may go back and forth among the 5 stages of grief, always tell the unconscious dying client what you are doing when providing care, be aware that hearing may be the last sense to go after death