CNA

Long Term Care Centers

Designed for persons who cannot care for themselves: Medical, nursing, dietary, recreational, rehabilitative, and social services are provided

Residents

Persons in long-term care centers; Center is their permanent or temporary home; Most residents are older and have chronic diseases, poor nurtrition, or poor health; Some residents are disabled from birth defects, accidents, or diseases;

Alert, oriented residents

Resident knows who & where they are, the year, and time of day. They have physical problems. Disability level affects the amount of care required. Some require complete care, others need help with daily activities

Confused & disoriented residents

Resident is mildly to severely confused & disoriented. Some simply have trouble remembering where the dining room is, the month, or year. Others are more confused & disoriented--they do not know who or where they are. Sometimes the problem is short term. For others it is permanent and becomes worse

Complete care residents

Residents who are disabled, confused, and disoriented. They cannot meet their own needs or tell you what they need. They need to be kept clean, safe, and comfortable

Short-term residents/Respite Care

Residents who need to recover from surgery, fractures, or illnesses and regain strength & mobility to return to their former living situations. Home care-giver is given a rest.

Life-long Residents

Residents with birth defects & childhood injuries & diseases can cause disabilities such as mental retardation & Down syndrome. Person has limited function in at least 3 ares: self-care, understanding, or expressing language, learning, mobility, self-direction, independent living, & financial support. Person needs lifelong assistance, support and special services.

Developmental Disability

A disability occurring before 22 years of age; May be a physical impairment, intellectual impairment, or both

Mentally ill residents

Residents with problems coping or adjusting to stress affecting behavioral and function.

Terminally ill residents

Residents who are going to die from terminal illness (cancer, AIDS, liver/heart/kidney/respiratory disease.

Nursing Team

RN's, LPN's (LVN's), & Nursing Assistant's

Nursing Process

1) Assessment - Collects information. 2) Nursing Diagnosis - Describes health problems. 3) Planning - Setting priorities and goals. 4) Implementation - Carries out the plan (goals). 5) Evaluation - Measures if the goals of the planning step were met.

Medicare

A federal health insurance program for persons 65 yrs of age or older

Medicaid

A health care payment program sponsored by federal & state governments

OBRA-Residents Rights

Right to all his or her information records; Right to refuse treatment; Right to privacy & confidentiality; Right to personal choice; Right to voice concerns, questions, & complaints about care; Right to not have to work for care, care items, or other things or privileges; Right to form & take part in resident & family groups; Right to keep and use personal items; Right to be free from all abuse, mistreatment, & neglect; Right to be free of restraint; Right to a quality of life that promotes dignity & self esteem; Promotes physical, psychological, and mental well-being for quality of life

Quality of Life Activities

Nursing center provides activity programs that allow personal choice. They must promote physical, intellectual, social, spiritual, & emotional well being. Religious services promote spirtual health

Quality of Life Environment

Nursing centers environment must promote quality of life by being clean, safe & as home-like as possible.

OBRA Requirements for Dignity & Privacy

1. Courteous & Dignified Interactions (right tone of voice, good eye contact, stand or sit close, use proper name & title, gain attention before interacting with resident, use touch IF person approves, respect social status, listen with interest, DO NOT yell, scold, or embarrass resident) 2. Courteous & Dignified Care (grooming, dressing, clothing is personal choice, promote independence & dignity in dining, respect private space & property, assist with walking, transfers, bathing & hygiene preferences) 3. Privacy & Self-Determination (avoid exposure & embarrassment, keep person properly draped at all times, use curtains & screens during all care & procedures, knock before entering, close bathroom door when person uses it) 4. Maintain Personal Choice & Independence (Person smokes in allowed areas, takes part in activities according to interests, involved in scheduling activities & care, gives input to care plan about preferences & independence, involved in room or roommate change)

OBRA Requirements (all 50 states)

Nursing Assistant training and competency evaluation program must be completed to work in nursing centers and hospital long-term care units.

OBRA Training Program

Requires at least 75 hours of instruction (16 hrs are supervised practical training); includes knowledge & skills needed to give basic nursing care; takes place in a laboratory or clinical setting

OBRA Competency Evaluation

After training program you take a written test that has multiple-choice questions and a skills test that is performing certain skills learned in training program. OBRA allows at least 3 attempts to successfully complete the evaluation

OBRA Nursing Assistant Registry

An official record or listing of persons who have successfully completed a competency evaluation; Each state must have a nursing assistant registry; all information stays in registry for at least 5 years

OBRA other requirements & provisions

Retraining & new competency evaluation program are required for NA who have not worked for 2 consecutive years. It does not matter how long you worked, it is how long you did NOT work: Requires new competency evaluation OR Both retraining & new competency evaluation; Nursing agencies must provide 12 hrs of educational programs to NA's every year

Delegation

RN's can delegate tasks to LPNs/LVNs, & NA's (Right Task, Right Circumstances, Right Person, Right Directions & Communication, Right Supervision)

Refusing a Task

Have the right to refuse when: Task is beyond legal limits of your role, Is not in your job description, You were not prepared to perform the task, Task could harm the person, Person's condition has changed, You do not know how to use the supplies or equipment, directions are unethical, illegal, or against agency policy, directions are unclear or incomplete, nurse is not available for supervision

Ethical Aspects

Knowing difference between right & wrong conduct; behaves and acts in the right way and does not harm anyone; not being prejudiced or biased

Good Work Ethics

Caring, Dependable, Considerate, Cheerful, Empathetic, Trustworthy, Respectful, Courteous, Conscientious, Honest, Cooperative, Enthusiastic, Self-aware

5 Steps of Nursing Process

Assessment, Nursing diagnosis, Planning, Implementation, & Evalualtion

Assessment

Involves collecting information about the person; Nursing history is taken from family's health history, info from doctor, test results, & past medical records

Signs

Objective data that is seen, heard, felt, or smelled (you can feel a pulse, see urine)

Symptoms

Subjective data is things a person tells you about that you cannot observe through your senses (you cannot see pain, fear, or nausea)

Nursing Evaluation

Involves measuring if goals in planning step were met: progress is evaluated; changes in nursing diagnoses, goals & care plan may result; NA has keep role as NA's observations are used for this step

Safety & Security Needs

Feeling safe from harm, danger, & fear; People feel safe and more secure if they know told what is or going to happen (Tell them - Why it is needed, who will do it, how it will be done, what sensations or feelings to expect)

Dealing with Behavior Issues

Recognize frustrating & frightening situations; Treat person with dignity & respect; Answer questions clearly and thoroughly and have nurse answer questions you cannot answer; Keep person informed about what you are going to do and when; Do NOT keep person waiting, answer signal lights promptly; explain reason for long waits and ask if you can get or do something to increase person's comfort; Stay calm & professional if person is angry or hostile (usually angry at another person or situation); Listen & use silence as person may feel better if able to express feelings); Report person's behavior to the nurse and discuss how you should deal with the person

Family & Visitors

Family & friends help meet safety, security, love, belonging, self-esteem, support, & comfort needs. Presence or absence of family or friends can affect recovery & quality of life; Person has the right to visit with family & friends in private and without unnecessary interruptions; If visitor upsets person, report observations to the nurse

Accident Risk Factors

Age (decreased strength, move slowly & less steady); Awareness of surroundings (person in coma); Impaired vision (may not see toys, rugs, furniture or cords and may have problems reading labels on cleaners, drugs, and other containers); Impaired hearing (may not hear warning signals, fire alarms, approaching meals cards, drug carts, stretchers, or persons in wheelchair; Impaired smell & touch (senses may be dulled and they cannot detect smoke or gas odors, burns are a risk because of decreased pain sensation; Impaired mobility (cannot move quickly or safely away from danger; Drugs (side effects could include loss of balance, drowsiness, lack or coordination, reduced awareness, confusion, & disorientation)

Preventing Burns

Smoking in bed, spilling hot liquids, electrical devices and and very hot bath water are common causes of burns. Do following for prevention: Person smokes only in smoking areas; NO smoking in bed; NO smoking near oxygen equipment: Supervise persons smoking who cannot protect themselves; DO NOT use heating pads or electric blankets; Turn cold water on first, then hot - - turn hot water off first, then cold; Measure bath water temperature (110-115 degrees F) and check it before person gets in; Check for "hot spots" in water moving hand back and forth; Follow measures to prevent equipment accidents

Wheelchair Safety

Check wheel locks; Check for flat or loose tires; Check wheel spokes; Be sure casters point forward for balance and stability; Be sure person's feet are on footplates before pushing or repositioning (feet cannot touch or drag on floor); Push chair forward when transporting person, going backward ONLY through a doorway; Lock both wheels before you transfer person to or from the wheelchair; Follow care plan for keeping wheels locked when not mving wheelchair (locking would keep person from moving or getting out of chair is so desired); DO NOT let person stand on footplates; DO NOT let footplates fall back onto person's legs; Make sure person has needed safety belt, pouch, tray, lapboard or cushions; Remove armrests (if able) when transferring person to bed, toilet, commode, tub, or car; Swing front rigging out of way to transfer to & from wheelchair (some detach); Clean wheelchair according to agency policy; Ask nurse or PT to show you how to propel wheelchair up steps, ramps, and over curbs; Follow measure to prevent equipment accidents

Stretcher Safety

Ask 2 co-workers to help with transfer; Lock stretcher wheels before transfer; Fasten safety straps when person is properly positioned on stretcher; Ask co-worker to help with transport; Raise side rails and keep up during transport; Be sure person's arms, hands, legs, and feet stay on stretcher; Stand at head of stretcher and co-worker stands at foot; Move stretcher FEET FIRST; DO NOT leave person alone; Follow measure to prevent equipment accidents

Restorative Nursing/Rehabilitation

Involves promoting: Self-care, Elimination, Positioning, Mobility, Communication, Cognitive function; Focus's on the whole person

Whole Person

Has physical, social, psychological, and spiritual parts

Self-Help Devices

Often needed when the hands, wrists, & arms are affected. Equipment is changed, made, or bought to meet person's needs; Includes - Eating devices, Electric toothbrushes, Longer handles attached to combs, brushes, & sponges; Self-help devices for cooking, dressing, writing, phone calls

Rehab & Restorative Focus on PERSON

1. Provide Comfort - Practice good communication skills - just be there to listen, often you do not need to say anything 2. Ethical behavior: Personal choice is important but do not let person control you; Letting person control you is wrong and problems must be reported to nurse. 3. Remaining Independent: Focus on what the person CAN do: Independence to the greatest extent possible is goal of rehab & restorative care. 4. Speaking Up: Use the nurse or therapist words, guides and directions as this helps the person learn & remember what to do. 5. OBRA and other laws: Requires centers to provide services required by person's comprehensive care plan. 6. Nursing Teamwork: Rehab process can frustrate person, you, and other nursing team members. Help each other with care and emotional support

Restraint Use

Restraints are used ONLY as a LAST RESORT to protect persons from harming themselves or others: DO NOT use for discipline or convenience

Restraint Risks

Agitation, Anger, Cuts & Bruises, Constipation, Dehydration, Depression, Embarrassment & Humiliation, Fractures, Incontinence, Infections (pneumonia & urinary tract), Mistrust, Nerve Injuries, Pressure Ulcers, Strangulation

Restraint Safety

(Doctors order is required for restraint.) Use correct size as noted in care plan; Apply only after being instructed about its proper use (demonstrate to nurse); must have manufacturer instructions & warning labels (note front & back sides); Follow manufactures instructions and warnings (different restraints for different equipment); DO NOT use sheets, towels, tape, rope, straps, bandages, or other items; Use intact restraints (look for tears, cut or frays); DO NOT position person on toilet; Follow agency policies & procedures; Position in good alignment before application; Pad bony areas and skin; Secure restraint - should be snug but allow some movement); Check for snugness - - a.) Chest or waist restraint-Flat hand should slide between restraint & person's body b.) Wrist & Mitt restraints-Should be able to slide 1 or 2 fingers under restraint; Criss-Cross vest restraints in FRONT - Can cause strangulation; Tie restraints according to agency policy-quick release ties or buckles are used; Secure straps out of person's reach; Leave 1-2 in. of slack in straps to allow for some movement; Secure restraint to MOVABLE part of bed frame at waist level; NEVER secure restraints to bed rails; Make sure straps will not slide in any direction (could cause strangulation); Use bed rail covers or gap protectors according to nurse instructions as they prevent entrapment; Entrapment can occur between: a.) bars of bed rail b.) Space between half-length (split) bed rails c.) Bed rail & mattress d.) Headboard or footboard & mattress

Hand Washing Procedure

1.) Have soap, paper towels, orange stick or nail file, and a wastebasket. 2.) Push watch, and sleeves up arm 4-5 inches 3.) Stand away from sink so soap & faucet are easy to reach. DO NOT let clothes touch sink! 4.) Turn on and adjust water until warm 5.) Wet wrists & hands, keeping hands BELOW elbows 6.) Apply 1 teaspoon of soap 7.) Rub palms together and wash for 15-20 seconds 8.) Wash each hand & wrist thoroughly, cleaning well between fingers 9.) Clean under fingernails rubbing against palms 10.) Clean under nails with file or orange stick first washing of day or when hand are highly soiled 11.) Rinse wrists and hands well letting water flow DOWN from arms to hands 12.) Pat dry with paper towels starting from fingertips working up 13.) Discard paper towels 14.) Turn off faucets with clean paper towels 15.) Discard paper towels into wastebasket

Standard Precaution Rules

1.) HANDS-Follow rules for hand hygiene; DO NOT wear fake nails or extenders 2.) PERSONAL PROTECTIVE EQUIPMENT (PPE) - Wear when in contact with blood or body fluids is likely; DO NOT touch surfaces near the person when giving care; DO NOT contaminate your clothing or skin when removing PPE; Remove & discard PPE before leaving the person's room or bed area 3.) GLOVES-Wear gloves when in contact with blood, potentially infectious materials (body fluids, secretions, & excretions), mucous membranes: non-intact skin, skin that may be contaminated; Wear gloves that are appropriate for task - A. disposable gloves to provide direct care to person B. Disposable or utility gloves for cleaning equipment or care settings; Remove gloves after contact with person, person's care setting, or care equipment; DO NOT wear the same pair of gloves to care for more than one person and remove before going to next person; DO NOT wash gloves for reuse; Change gloves during care if hands move from a contaminated body site to a clean site 4.) MOUTH, NOSE, & EYE PROTECTION - Wear PPE masks, goggles, face shield for procedures & tasks likely to cause splashes and sprays of blood, body fluids, secretions, excretions and all appropriate procedures or tasks; For likely sprays of respiratory secretions wear Gloves, Gown, Faceshield or mask & goggles 6.) RESPIRATORY HYGIENE/COUGHING ETIQUETTE - Cover nose & mouth when coughing or sneezing; Use tissues to contain respiratory secretions; Dispose of tissues in the nearest waste container; Practice hand hygiene 7.) CARE EQUIPMENT - Wear appropriate PPE when handling care equipment that is visibly soiled or may have been in contact with blood, body fluids, secretions, or excretions 8.) CARE OF ENVIRONMENT - Follow agency policies & procedures for cleaning and maintaining surfaces 9.) TEXTILES & LAUNDRY - H

Rules for Isolation Precautions

1. Collect all needed items before entering room. 2. Prevent contamination of equipment and supplies. Floors and any object on floor is contaminated. 3. Use mops wetted with a disinfectant solution to clean floors. Floor dust is contaminated. 4. Prevent drafts as they carry pathogens in the air. 5. Use paper towels to handle contaminated items. 6. Remove items from room in leak-proof plastic bags. 7. Double bag items if the outer part of bag is or may be contaminated 8.) Follow agency policy for removing & transporting disposable & reusable items. 9.) Return reusable dishes, eating utensils, & trays to food service dept. Discard disposable dishes, utensils and trays in person's room. 10.) DO NOT touch your hair, nose, mouth, eyes, or other body parts 11.) DO NOT touch any clean area or object if your hands are contaminated. 12.) Wash hands if visibly dirty or contaminated with blood, body fluids, secretions, or excretions. 13.) Place clean items on paper towels. 14.) DO NOT shake linens. 15.) Use a paper towel to turn on/off faucets, 16.) Use paper towel to open door to person's room and discard at you leave. 17.) Tell nurse if you have any cuts, open skin areas, sore throat, vomiting, or diarrhea.

Person's Unit/Room

Residents rooms are as personal and home-like as possible. This space is like the person's home and is private and treated with respect.

Person's Room Temperature & Ventilation

OBRA requires the temperature range of 71 - 81 degrees F. Protect older and ill person from cool areas and drafts. Keep room temps war, Make sure they wear warm clothing, Provide enough blankets for warmth, Use bath blankets when giving personal care, Offer lap blankets to those in chairs or wheelchairs, Move them from drafty areas

Call System & Safety

Always keep signal light within the person's reach -- in the room, bathroom, shower or tub (even if person cannot use it, keep it within reach for use by visitor or staff who may need to signal for help); Place signal on strong side; Remind person to signal when help is needed; Answer signal lights promptly (means they needs help); Answer bathroom & shower/tub signal lights AT ONCE (these are red and have a loud ring)

Rules for Making Bed

Use good body mechanics at all times; Follow rules of medical asepsis; Follow Standard Precautions & Bloodborne Pathogen Standard; Practice hand hygience before handling clean linen; Practice hand hygiene after handling dirty linen; Bring enough linen to person's room (DO NOT bring extra); Extra linen in a person's room is considered contaminated and is NOT used for other people. Put it with the dirty laundry; Do not use torn linen; Hold linens AWAY from your uniform. Dirty & clean linen must NOT TOUCH your uniform; NEVER shake linens, it spreads microbes; NEVER put dirty linens on the floor or clean linens; Follow agency policy for dirty linen; Keep bottom linens tucked in and wrinkle-free; Cover a plastic drawsheet with a cotton drawsheet -- plastic drawsheet must not touch person's body; Straighten & tighten loose sheets, blankets, and bedspreads; Make as much of one side of bed as possible before going to the other side to save time & energy; Change wet, damp, & soiled linen right away

Denture Care

Dentures easily break or chip if dropped on hard surface. Hold firmly during cleaning over a basin of water lined with a towel. DO NOT use hot water - this causes dentures to (warp) lose their shape. Store dentures in a container with cool water or denture soaking solution; Remove at bedtime; Keep denture cup in top drawer of bedside stand

Perineal Care Guidelines - Female

(Warm Temp: 105 to 109 degrees F) Use standard precautions, medical asepsis, and the Bloodborne Pathogen Standard; Work from cleanest area to dirtiest (from front to back); Urethral area is cleanest, anal area is the dirtiest: Separate labia and clean downward (front to back) with one stroke; Repeat until are is clean using clean part of washcloth for each stroke when cleaning & rinsing, using more than one washcloth if necessary; Pat area dry from front to back

Perineal Care Guidelines - Male

(Warm Temp: 105 to 109 degrees F) Use standard precautions, medical asepsis, and the Bloodborne Pathogen Standard; Work from cleanest area to dirtiest. Retract foreskin (if uncircumcised), Clean tip using a circular motion; Start at meatus or urethra and work outward clean, using a clean part of washcloth for each time (do same when rinsing). Return foreskin to its natural position; Clean the shaft of the penis using firm downward strokes; Clean scrotum; Pat area dry from front to back

Dressing Person with Weak Side

Always undress the strong side first, weak side last (person can help assist with weak side), Always dress the weak side first, strong side last (person can assist with that side); Person always has two choices of clothing to pick from

Shaving Rules

Use electric shavers for persons taking anticoagulant drugs (NEVER use safety razors); Protect bed linens by placing a towel under the part being shaved or place towel across shoulders to protect clothing; Soften skin before shaving; Encourage the person to do as much as safely possible; Hold skin taut as needed; Shave in the direction of hair growth when shaving the face and under arms; Shave up from the ankles when shaving legs (this is against hair growth); DO NOT cut, nick, or irritate the skin; Rinse the body part thoroughly; Apply direct pressure to nicks or cuts.

Epidermis

Outer layer of the skin and has living & dead cells. Living cells of the epidermis contain pigment which gives skin its color. Epidermis has no blood vessels and few nerve endings.

Dermis

Inner lay of the skin. It has blood vessels, nerves, sweat glands, oil glands, and hair roots. Oil glands, sweat glands, hair, and nails are skin appendages. Only palms of hands and soles of feet have no hair.

Skin Functions

Body's protective covering; Prevents bacteria & other substances from entering the body; Prevents excess amounts of water from leaving the body; Protects organs from injury; Nerve endings in the skin sense pleasant and unpleasant stimulation. Nerve endings are over the entire body and sense cold, pain, touch, & pressure to protect the body from injury; Skin helps regulate body temperature. Blood vessels dilate (widen) when temp outside body is high. More blood comes to the body surface for cooling during evaporation. When blood vessels constrict (narrow) the body retains heat because less blood reaches the skin

Tendons

Strong, tough connective tissue that connects muscles to bones

Cartilage

The connective tissue at the end of long bones; Cushions the joint so that bone ends do not rub together

Ligaments

Strong bands of connective tissue that hold bones together at the joint

Joints

The point where two or more bones meet: Joints allow movement.

Joint Types

1. Ball -and-Socket joint: Allows movement in all directions (hip & shoulder joints) 2. Hinge Joint: Allows movement in one direction (elbow) 3. Pivot Joint: Allows turning from side to side (a pivot joint connects the skull to the spine)

Cerebrum

Largest part of the brain; Center of thought and intelligence

Cerebellum

Regulates and coordinate body movements: Controls balance and smooth movement of voluntary muscles

Brainstem

Connects the cerebrum to the spinal cord

Heart

A muscle that pumps blood through the blood vessels to the the tissue and cells

Pericardium

Outer layer of the heart; Thin sac covering the heart

Myocardium

Second layer of the heart; Thick muscular part of heart

Endocardium

Inner layer of the heart; Membrane that lines the inner surface of the heart

Right atrium

Receives blood from body tissues

Left atrium

Receives blood from the lungs

Right ventricle

Pumps blood to the lungs

Left ventricle

Pumps blood to all parts of the body

Diastole

Resting phase; Heart chamber fills with blood

Systole

Working phase; Blood is pumped through the blood vessels when the heart contracts

Trachea

The windpipe; Divides at its lower end into the right & left bronchus, then into smaller branches called bronchioles which then end up in tiny one-cell sacs alveoli

Food absorption

Takes place in the small intestine (jejunum and ileum)

Testes

Male sex glands or gonads that produce the male sex cells - sperm

Testosterone

Male hormone, testosterone, is produced in the testes

Scrotum

Sac (made of skin & muscle) that holds testes suspended between the thighs

Prostate Gland

Gland that secrete fluid into the semen

Urethra

Outlet for urine and semen. The urethra is contained within the penis

Ovaries

Secrete female hormones estrogen and progesterone

Fundus

Main part of uterus

Endometrium

Tissue lining the uterus

Uterus

A hollow, muscular organ

Menstruation

Endometrium breaks up and is discharged from the body

Fertilization

Male sex cell (sperm) unites with female sex cell into one cell (46 chromosomes -- 23 from each).

Skin Changes for Older Person

Skin loses its elasticity; Fatty tissue layer is lost and makes person more sensitive to cold (protect from drafts); Oil & sweat glands decrease; Dry skin occurs and causes itching and is easily damaged; Skin is fragile and easily injured; Skin breakdown & pressure sores are risks; Skin has fewer nerve endings affecting senses of heat, cold and pain; Nails become thick & tough; Hair turns white or gray and thins

Digestive System for Older Person

Produce less saliva which can cause difficulty swallowing (dysphagia); Taste & smell dull; Appetite decreases; Secretion of digestive juices decreases; Loss of teeth & ill fitting dentures cause chewing problems; Peristalsis decreases, stomach & colon empty slower, flatulence & constipation can occur; Dry, fried, & fatty foods avoided to help with swallowing and digestion problems; Oral hygiene and denture care improve tase; High-fiber foods are hard to chew & can irritate intestines; Persons with chewing problems or constipation often need foods providing soft bulk (whole grain cereal, cooked fruits & veggies)

Closed Fracture

Bone is broken but the skin in intact

Open Fracture (compound fracture)

Broken bone has come through the skin

Closed Reduction

Moving the bone back into place - skin is not open

Open Reduction

Involves surgery. The bone is exposed and brought back into alignment with nails, rods, pins, screws, plates, or wires

Arthritis

Joint inflammation; Pain and decreased mobility occur in the affect joints

Osteoarthritis

Degenerative joint disease that occurs with aging, joint injury and obesity. Hips, knees, spine, fingers, and thumbs are affected. Joint stiffness occurs with rest and lack of motion. Pain occurs with weight bearing and joint motion. Pain affects rest, sleep, and mobility. Cold weather & dampness seem to increase symptoms