NC Nurse Aide Written State Exam

Define Nurse Aide 1

-Valued, unlicensed member of the health care team

-Responsible for providing delegated nursing tasks within a defined range of function for residents in a variety of settings

OBRA (Omnibus Budget Reconciliation Act)

-Federal law designed to improve quality of life of residents living in a nursing home environment (law to protect residents)

-Also defines requirements for nurse aide training and competency evaluation, and the nurse aide registry

Who defines the range of function (practice) for Nurse Aides in NC?

North Carolina Board of Nursing

-Provide a list of tasks that fall within the range of function for nurse aides in NC

-Nurses can delegate tasks that fall within the range of function for NA

What is the regulatory body for NA?

The North Carolina Board of Nursing

North Carolina Nurse Aide Registry

-A registry of all people who meet state and federal training and testing requirements to perform NA 1 tasks in the state of North Carolina

What is required to be listed on the Nurse Aide 1 Registry?

Pass the National Nurse Aide Assessment Program

-Computer based testing

-Demonstration of 5 skills

-Completion of state-approved Nurse Aide 1 training program

How do you stay on the Nurse Aide 1 registry?

-Listing are renewed through qualified work experience completed every 24 months

-If you do not work during the 24 month listing period, required to retrain, retake and pass the NNAAP exam

What are the NA 1 renewal responsibilities?

-Renewal form completed online

What are the job responsibilities of a NA?

-Perform delegated basic nursing skills in a competent, caring manner

-Perform delegated personal care skills in a competent, caring manner

-Use appropriate interpersonal skills

Delegation

-the process of assigning part of one's responsibility to another qualified person in a specific situation

OR

-transferring responsibility for the performance of an activity or task while retaining accountability for the outcome

Why is delegation used?

-Improves efficiency and shows trust in others, while the Nurse is still accountable

What are points to remember when it comes to delegation?

-Nurse maintains accountability and responsibility for delivery of safe and competent care

-Decisions regarding delegation of any NA activity are made by nurse on resident-by-resident basis

-Always ask if you do not understand a task, need more information, or if not sure about something

-If you think you do not have the skills necessary to do the task, talk to your supervisor

Basic Nursing skills

-Essential skills required of nurse aide to deliver competent care to residents in health care settings

-Ex.) Monitoring, documenting, and reporting vital signs; management of pain as directed by the nursing care plan; application of warm/cold; dressing changes

-Privacy is key!

Personal Care skills

-Tasks that deal with a person's body, appearance and hygiene

-Done on a daily basis with preferences of each individual --> Activities of Daily Living

-Ex.) toileting, assisting with face/hand wash, mouth care

Hygiene

-Tasks performed to keep bodies clean and healthy

-Ex.) bathing, brushing teeth

Grooming

-Tasks performed to maintain the person's appearance while fostering dignity and choice

-Ex.) caring for fingernails and hair

Activities of Daily Living

-Hygiene, grooming, dressing, eating, transferring, toileting

Interpersonal Skills

-Essential skills used by a person when working with others

-Refers to provider's ability to get along with others while getting the job done

Infection Prevention

-Ways to control and prevent the spread of infection

Infection

-A disease or condition of the body that occurs when harmful germs get into the body and grow in number

Localized Infection

-Infection found in one part of the body and symptoms are limited to that one part of the body

Symptoms: red, painful, hot, puffy, drainage

Systemic Infection

-Infection that affects an entire body part or entire body system

Symptoms: fever, chills, confusion, feeling tired, nausea/vomiting

Ex.) Respiratory infection

What are the symptoms of a respiratory infection?

-Fever and chills

-Sniffling and snorting

-Coughing and sneezing

-Hacking up globs of green or yellow, slimy mucous

This is a type of systemic infection

What are the symptoms of a bladder infection?

-Fever and chills

-Pain during urination

-Bad or strong-smelling urine, with possible blood

-"My urine smells and it hurts when I use the bathroom"

What are the symptoms of a stomach infection?

-Person with a stomach infection will probably have stomach pains and may vomit

Microorganism

-Germs; cause infection

-Live everywhere

-Required to survive: warmth, moisture, some need oxygen, tissue to feed on

-Ex.) bacteria, viruses, parasites, fungi

Medical Asepsis

-Clean technique

-Practices used to remove or destroy microorganisms and to prevent their spread from one person or place to another person or place

Chain of Infection

-Way to explain how infection is passed around from one host to another host

-For an infection to occur and spread, each of the 6 links must be present

What are the 6 links in the chain of infection?

1. Causative agent

2. Reservoir

3. Portal of Exit

4. Mode of Transportation

5. Portal of Entry

6. Susceptible host

Causative Agent

-Link #1 in chain of infection

-A harmful germ that causes an infection (bacteria, virus, fungus, parasite)

Reservoir

-Link #2 in chain of infection

-Place where harmful germs live, grow, and increase in numbers

-Blood, skin, mouth, stomach, intestines, nose, throat, lungs

Portal of exit

-Link #3 in chain of infection

-Any way or route that harmful germs escape from the reservoir

-Ex.) nose, mouth, GI tract, skin

Mode of Transportation

-Link #4 in chain of infection

- How harmful germs travel or get around from place to place

-Number one way is by our hands

-Direct and Indirect contact, animal/insect bites, eating or drinking water that is infected with harmful germs

Direct contact

-Mode of transportation for germs through direct contact with body fluids where germs live

-Ex.) blood, sputum, pus or wound fluid, saliva, stool, vomit

Indirect contact

-Mode of transportation that harmful germs travel by

-Ex.) germs on hands than touching an object or someone else

Portal of Entry

-Link #5 in chain of infection

-Any opening on a person's body that allows harmful germs to enter

-Portals of entry are also portals of exit

Susceptible Host

-Link #6 in chain of infection

-Person who does not have an infection now, but is at risk for becoming next person to get infected from harmful germs bc for some reason cannot fight off infection

-Cannot fight infection because age, chronic illness, not proper vaccinations, open cuts or skin breakdown, fatigue, poor nutrition, stress

Healthcare-associated infection

-An infection that a resident gets while staying or living in a health care setting

Centers for Disease Control and Prevention

-An agency of the federal government in charge of the control and prevention of disease in our country

-Developed a two-level way to prevent and control infections in health care

Standard Precautions

-1st level of CDC prevention to control infections

-Basic tasks that health care workers must do when caring for EACH and EVERY RESIDENT in order to prevent and control the spread of infection

-ALL body fluids, non-intact skin, and mucus membranes are treated as if they were infected

Why must standard precautions be used with every resident?

-Residents have infections that no one knows about

-Resident may be infected and not show signs or symptoms

-Without practicing standard precautions you can get the infection and pass it along to others

Hand hygiene

-Washing hands with soap and water or alcohol-based hand rubs

What is the number one way to stop the transmission of infection?

Hand hygiene

Point of Care

-Should perform hand hygiene at point of care

-Point of care when resident, NA, and care of treatment involving resident contact occurs

When should hand hygiene be performed?

1. Before touching resident

2. Before performing a clean or aseptic procedure

3. After any body fluid exposure risk

4. After touching a resident

5. After touching resident surroundings

Personal Protective Equipment

-A group of items used by a NA to block harmful germs from getting on skin and clothes

-mask, eye-wear, gown, gloves

Transmission-Based Precautions

-2nd level to prevent and control infections

-Specific tasks and measures must be taken when caring for residents who are infected or may be infected with specific types of infections

Contact Precautions

-Prevent spread of harmful germs spread by direct contact

-Ex.) MRSA and Norovirus

Droplet Precautions

-Prevent spread of harmful germs that travel by droplets in the air

-Ex.) influenza, meningitis, and whooping cough

Airborne precautions

-Prevent spread of harmful germs that travel in the air at a distance

-Ex.) tuberculosis, chicken pox, measles

Outbreaks

-More illness in more residents than what is expected or what is normal for the facility

-Healthcare associated infection

Flu

-Respiratory infection

-Risky for people 65 years and older

-Yearly flu vaccination is the first and most important step in protecting against flu

Norovirus

-Gastrointestinal infection

-Dehydration is a major problem and elderly must replace fluids

-Contagious 3 days after vomiting/diarrhea

-No vaccination or specific drug available

Blood-borne infections

-Harmful germs found in human blood that can cause infection and disease

-Ex.) Hepatitis B, Hepatitis C, human immunodeficiency, HIV

Hepatitis B

-Caused by a blood-borne pathogen

-Disease of the liver

-About 1/3 do not show symptoms

-Can live outside body for 7 days

-Vaccine is available to prevent it

Hepatitis C

-Caused by a blood-borne pathogen and is transmitted through blood or body fluids

-There is no vaccine*

Safety in Resident's Environment

When a resident has little risk of illness or injury in the environment to which he/she lives

Resident's Environment

Area of long-term care center that a resident calls home, designed to provide comfort, safety, and privacy for the resident

Hazard

anything in the resident's environment that may cause illness or injury

-Ex.) burns, poisoning, suffocation, equipment, fire, falls

How are elderly more at risk for injury?

-Knee joint instability

-Decreased strength

-Slower movement

-Medication side effects

-Low Blood Pressure

-Impaired coordination

-Hearing impairment

-Reduced sense of smell and touch

-Visual Impairment

-Cognitive Impairment

What are the Nurse Aide's roles in maintaining safety?

-Maintain comfortable room temp and lighting

-Maintain bright light for reading

-Keep unit clean

-Report unsafe conditions or faulty equipment

-Keep bed in lowest position

-Keep call signal within reach

-Lock wheelchair before moving resident

-Always check water temperature

Fall

-Unintentionally coming to rest on the ground, floor, or other lower level

-Any sudden, uncontrollable descent from a higher level to a lower level which may result in injury

What is the leading cause of fatal injury?

A Fall

Intrinsic Risk factors

those risk factors that result from the resident's inner being

-Effects of aging on balance

-Medical conditions and diseases

-Decline in function due to inactivity

-Effects and side-effects of medication

Extrinsic risk factors

risk factors that result from those things outside of the resident

-Hazards of the environment

-Equipment is unsafe

-Unsafe or inaccessible personal items

What are devices that are used to prevent falls?

-Gait belts, canes, walkers

-Handrails in hallways and stairways

-Grab bars located in bathrooms and shower/tub rooms

-Wheel locks located on beds, wheelchairs and stretchers

-Beds that lower to the floor

What are the Nurse Aide's roles in preventing falls?

-Assist with ambulation

-Keep environment free of clutter

-Keep all walkways free from rugs, cords, boxes, equipment

-Report unsafe conditions

-Signal always within reach

-Wipe spilled liquids

-Pick up litter

Elopement

-When a resident leaves a health care facility without the staff's knowledge

What are tactics to prevent elopement?

-Identify residents at risk

-Assign resident to room away from exits + increase staff awareness of risk

-Locked doors with keypads, cameras and door alarms

Medical Emergency

-A dire situation when a person's health or life is at risk

Cerebrovascular Accident (CVA)

-Stroke

-Blood supply to a part of the brain is blocked or blood vessel leaks/breaks in a part of the brain

Acronym BEFAST

-Sudden signs that stroke is occurring

-Balance (loss of balance)

-Eyes (blurred vision)

-Face (side of face is drooping)

-Arms (weakness)

-Speech (difficulty)

-Time (call 911)

Seizure

-Involuntary contractions of muscles caused by abnormal electrical activity in the brain

-Keep resident safe!

Nurse Aide's Role in a Seizure?

-Note time of start and stop

-Send for supervisor, do not leave patient alone

-PUt on gloves

-Cradle head

-Loosen clothing

-Do not restrain resident

-Do not give resident food or liquids

-Turn resident on side when seizure is over

Nurse Aide's role in preventing choking

-Sit resident upright to eat

-Provide assistance at mealtime to prevent spilling hot liquids

-Encourage resident to use dentures

-Cutting food in small pieces

-Report difficulty chewing or swallowing

Acronym RACE

Fire situation

-Remove residents from danger

-Activate alarm

-Contain fire

-Extinguish if possible

Acronym PASS

How to use fire extinguisher

-Pull the pin

-Aim at the base of the fire

-Squeeze the handle

-Sweep back and forth at the base of the fire

Communication

-Successfully sending and receiving messages using signs, symbols, words, drawings, and pictures

Communication - 3 way process

1. Sender communicates the message

2. Receiver receives the message

3. Feedback allows sender and receiver to respond to each other in some way

Verbal communication

-Using written or spoken words, pictures, symbols to send a message

Non-verbal communication

-Using body language to send a message

-Positive: face resident while speaking, stand up straight, smile, nod with approval, place arms at sides, show relaxed movement

-Negative: turn your back during communication, slouch, avoid eye contact, eye roll, frown, cross arms, tense movements

Culture

-Characteristics of a group of people that are passed from one generation to the next

-Includes language, values, beliefs, habits, likes, dislikes and customs

Laws

Rules made by government to help protect public

-Person is liable if laws not obeyed and may be fined or jailed

Tort

-A wrong committed against a person or property

Malpractice

-Giving care for which you are not allowed legally to perform

Negligence

-Actions or failure to act or give proper care, resulting in injury

Assault

-Act of threatening to touch, or attempting to touch a person, without proper consent

Battery

-Touching a person without consent

Consent

-The right to decide what will be done to the body and who can touch the body

-NA can obtain verbal and implied consent, but CANNOT obtain written consent

Invasion of privacy

-violation of right to control personal information or the right to be left alone

False imprisonment

-Unlawful restraining or restricting a person's movement

Defamation

-False statement made to a third person that causes a person shame or ridicule, or ruins the reputation

Diversion of drugs

-Unauthorized taking or use of any drug

Fraud

-An intentional deception or misrepresentation made by a person without knowledge that deception could result in some unauthorized benefit to self or some other person

Nurse Aide's Role in legal matters

-Understand range of function

-Keep skills and knowledge current

-Keep resident's safety and well-being in mind

-Understand directions for use when using equipment, materials, supplies

-Follow long-term care facility's policy

-Do not harm resident or belongings

-Review legal terms

Vulnerable Adults

-Adults who are at risk for abuse or mistreatment because they are not able to protect themselves

Neglect

-A failure to provide goods and services necessary to avoid physical harm, mental anguish, or mental illness

Misappropriation of property

-Illegal or improper use of resident's money, property, assets, by another without consent for personal gain

Abuse

-Willful infliction of injury, unreasonable confinement, intimidation or punishment with resulting physical harm, pain, or mental anguish

Exploitation

-Taking advantage of a resident for personal gain by manipulation, intimidation, threats, or coercion