CNA: quiz 3 preparation: C14-C18 (up to C23 actually)

ORAL TEMPERATURE IS

97.6-99.6

RECTUM’S MINIMUM TEMPERATURE

IS ONE UNIT HIGHER THAN AVERAGE MINIMUM ORAL TEMPERATURE

RECTAL’S TEMPERATURE IS HIGHER THAN ORAL

ARMPIT’S MINIMUM TEMPERATURE

IS ONE UNIT LOWER THAN MINIMUM ORAL TEMPERATURE

EAR’S MINIMUM TEMPERATURE IS THE SAME AS

ARMPIT MINIMUM TEMPERATURE

TEMPORAL ARTERY TEMPERATURE IS

97.2

EAR’S MAXIMUM TEMPERATURE

IS ONE UNIT HIGHER THAN ARMPIT’S MAXIUMUM TEMPERATURE

MAXIMUM EAR TEMPERATURE IS

99.7

ORAL TEMPERATURES SHOULD NOT BE DONE ON ANYONE UNDER

THE AGE OF 5

DO NOT TAKE THE ORAL TEMPERATURE OF

• anyone under age 5

• is unconsious

• has recently had facial or oral surgery

• is confused or disoriented

• heavily sedated

• is likely to have a seizure

• is coughing

• is on oxygen

• has face paralysis

• has a nasogastric tube (a feeding tube that is inserted through the nose and goes into the stomach)

• has sores, redness, swelling, or pain in the mouth

• has an injury to the face or neck

RECTAL TEMPERATURES CAN BE NECESSARY FOR RESIDENTS WHO ARE…

UNCONSCIOUS, HAVE MISSING TEETH OR DENTURES THAT DONT FIT PROPERLY, OR HAVE TROUBLE BREATHING THROUGH THE NOSE

MEASURING AND RECORDING RECTAL TEMPERATURE [GO TO PAGE 234 AND 235]

• Identify yourself by name

• Wash your hands

• Explain the procedure

• Provide for privacy

• Adjust the bed to a safe level, usually waist high. Lock the bed wheels.

• Help the resident to the left-lying (Sims’) position

• Fold the linens to expose only the rectal area

• Put on gloves

• Digital thermomete: PUT ON THE DISPOSABLE SHEATH. TURN ON THE THEMOMETER AND WAIT UNTIL THE “READY” SIGN APPEARS

• ELECTRONIC THERMOMETER: REMOVE THE PROBE FROM THE BASE UNIT. PUT ON THE PROBE COVER.

• MERCRURY-FREE THERMOMETER: HOLD THERMEMETER BY THE STEM. SHAKE THE THERMOMETER DOWN TO BELOW THE LOWEST NUMBER, PUT ON THE DISPOSABLE SHEATH,

• Apply a small amount of lubricant to the tip of the bulb or probe cover (or apply a pre-lubricated cover)

• Separate the buttocks. Gently insert the themometer into the rectum ½ to 1 inch. Stop if you meet resistance. Do not force the thermoometer into rectum

• Replace the sheet over the buttocks while holding onto the themometer at all times.

• DIGITAL THEMOMETER: HOLD IN PLACE UNTIL THE THERMOMETER BEEPS

• ELECTRONIC THERMOMETER: HOLD IN PLACE UNTIL YOU HEAR A TONE OR SEE A FLASHING OR STEADY LIGHT

• MERCURY-FREE THERMOMETER: HOLD IN PLACE FOR AT LEAST THREE MINUTES

• Gently remove the thermometer. Remove and discard the sheath or cover

• Read the thermometer at eye level as you would for an oral temperature. Remember the temperature reading

• DIGITAL THERMOMETER: Clean the thermometer according to facility guidelines. Replace the thermometer in case.

• ELECTRONI THHERMOMETER: PRESS THE EJECT BUTTON TO DISCARD THE COVER. RETURN THE PROBE TO ITS HOLDER

• MERCURY-FREE THERMOMETER: CLEAN THERMOMETER ACCORDING TO FACILITY GUIDELINES. RINSE WITH CLEAN WATER AND DRY. RETURN IT TO THE CASE.

• Remove and discard gloves

• Assist the resident to a safe, comfortable position. Return the bed to it’s lowest position

• Wash your hands

• Immediately record the temperature, date, time, and method used (in this case, the method is rectal).

• Remove the privacy measures. Place the call light within the resident’s reach

• Report any changes in the resident to the nurse

THE RECTAL THERMOMETER SHOULD BE LUBRICATED

1 ½ INCHES

MEASURING AND RECORDING AN AXILLARY (ARMPIT) TEMPERATURE

• IDENTIFY YOURSELF BY NAME. IDENTIFY THE RESIDENT ACCORDING TO FACILITY POLICY

• WASH YOUR HANDS

• EXPLAIN THE PROCEDURE TO THE RESIDENT

• PROVIDE FOR THE RESIDENT’S SAFETY

• ADJUST THE BED TO A SAFE LEVEL, USUALLY WAIST HIGH

• PUT ON GLOVES

• REMOVE THE RESIDENT’S ARMS FROM THE SLEEVE OR GOWN TO ALLOW SKIN CONTACT WITH THE END OF THE THERMOMETER

• DIGITAL THEROMETER: PUT ON DISPOABLE SHEETH. TURN ON THE THERMOMETER AND WAIT UNTIL THE “READY” SIGN APPEARS.

• ELECTRONIC THERMOMETER: REMOVE THE PROBE FROM THE BASE UNIT. PUT ON THE PROBE COVER.

• MERCURY FREE THERMOMETER: HOLD THE THERMOMETER BY THE STEM. SHAKE THE THERMOMETER DOWN TO BELOW THE LOWEST NUMBER. PUT ON DISPOSABLE SHEETHH.

• POSITION THE THERMOMETER (BULB END FOR MERCURY-FREE) IN THE CENTER OF THE ARMPIT. FOLD THE RESIDENT’S ARM OVER HIS CHEST

• DIGITAL THEMOMETER: HOLD IN PLACE UNTIL THE THERMOMETER BLINKS OR BEEPS

• ELECTRONIC THERMOMETER: HOLD IN PLACE UNTIL YOU HEAR A TONE OR SEE A FLASHING OR UNSTEADY LIGHT

• MERCURY FREE THERMOMETER: HOLD IN PLACE WITH THE ARM CLOSE AGAINST THE SIDE, FOR 8 TO 10 MINUTES

• DIGITAL THERMOMETER: REMOVE THE THERMOMETER. REA THE TEMPERATURE ON THE DISPPLAY SCREEN. REMEMBER THE TEMPERATURE READING.

• ELECTRONIC THERMOMETER: READ THE TEMPERATURE ON THE DISPLAY SCREEN. REMEMBER THE TEMPERAURE READING. REMOVE THE PROBE

• MERCURY-FREE THERMOMETER: REMOVE THE THERMOMETER. REMOVE AND DISCARD THE SHEATH. READ THE THERMOMETERR AT EYE LEVEL AS YOU WOULD FOR AN ORAL TEMPERATURE. REMEMBER THE TEMPERATURE READING

• LECTRONI THHERMOMETER: PRESS THE EJECT BUTTON TO DISCARD THE COVER. RETURN THE PROBE TO ITS HOLDER

• MERCURY-FREE THERMOMETER: CLEAN THERMOMETER ACCORDING TO FACILITY GUIDELINES. RINSE WITH CLEAN WATER AND DRY. RETURN IT TO THE CASE.

• Remove and discard your gloves

• Wash your hands

• Put the resident’s arm back into the sleeve of the gown

• Immediately record the temperature, date, time, and method used (axillary in this case)

• Return the bed to its lowest position. Remove the privacy measurs.

• Place the call light within the resident’s reach

• Wash your hands

• Report any changes in the resident to the nurse

Radial pulse

is on the wrist, extending from the artery from the thumb

Brachial pulse

is the pulse inside the elbow, about 1 to 1/1 inches above the elbow

Temporal pulse

on your temples

Cartoid pulse

on the neck

Apical pulse

on the chest, near the heart

Femoral pulse

is found on the sides near the groin

Popliteal pulse

on the inside of knee

Pedal pulse

on the foot

auscultation

is the medical practice of listening to the internal sounds of the body—primarily the heart, lungs, and abdomen—to evaluate their condition

DIFFERENT TYPES OF RESPIRATIONS

• Apnea: the absence of breathing

• Dyspnea: difficulty breathing

• Eupnea: normal respirations

• Orthopnea: shortness of breath when lying down that is relieved by sitting up

• Tachypnea: rapid respirations

• Bradypnea: slow respirations

• Cheyne-Stokes: alternating periods of slow, irregular respirations and rapid, shallow respirations, along with short periods of apnea

• Apnea:

• the absence of breathing

• Dyspnea

• difficulty breathing

Eupnea

• normal respirations

Orthopnea:

• shortness of breath when lying down that is relieved by sitting up

Tachypnea:

• rapid respirations

Bradypnea:

slow respirations

Cheyne-Stokes:

•  alternating periods of slow, irregular respirations and rapid, shallow respirations, along with short periods of apnea

WHAT IS DIFFICULTY WITH BREATHING BUT NOT THE ABSENCE OF BREATHING?

DYSPNEA

WHAT IS THE ABSENCE OF BREATHING?

APNEA

WHAT IS ATERNATING PERIODS OF RAPID AND SHALLOW BREATHING?

CHEYNE-STOKES

HYPERTENSION

HIGH BLOOD PRESSURE

HYPOTENSION

LOW BLOOD PRESSURE

WHAT DOES IT MEAN TO TAKE ORTHOSTATIC BLOOD PRESSURE?

IT MEANS TO BE TAKEN ON THREE LEVELS:

1. LYING DOWN

2. SITTING

3. STANDING

ALL THREE BLOOD PRESSURE MEASUREMENTS SHOULD BE REPORTED TO THE NURSE

A pulse oximeter

IS USED TO DETERMINE OXYGEN

GUIDELINES: PAIN MANAGEMENT

DO THESE IINSTEAD OF REPORTING TO THE NURSE IMMEDIATELY

• Report all complaints of pain or unrelieved pain immediately. Do not doubt or minimize resident reports of pain

• Gently position the body in proper alignment. Use pillows for support. Assist in frequent changes of position if the resident desires it

• Give back rubs

• Ask if the resident would like to take a warm bath or shower

• Assist the resident to the bathroom or commode or offer the bedpan or urinal

• Encourage slow, deep breathing

• Provide a calm and quiet enviornment. Use soft music to distract the resident

• Be patient, caring, gentle, empathetic, and responsive to residents who are in pain

BENEFITS OF COLD APPLICATIONS

constricts blood vessels to reduce swelling, inflammation, and tissue damage in fresh injuries. It also numbs the area to provide immediate pain relief.

They help prevent swelling, reduce pain, and bring down high fevers. Apply ice bags or cold

compresses immediately after an injury can stop bleeding and prevent swelling.

BENEFITS OF WARM APPLICATIONS

relieve pain and muscle tension by expanding blood vessels (vasodilation) to increase blood flow. This enhanced circulation delivers vital oxygen and nutrients to tissues while removing metabolic waste. It is ideal for soothing chronic conditions, joint stiffness, and overworked muscles

A Nutrient

is a necessary substance that provides energy, promotes growth and health, and helps regulate metabolism.

Water

is the most essential nutrient for life; it is needed by every cell in the body.

Complex carbohydrates

are found in bread, cereal, potatoes, rice, pasta, vegetables, and fruits

Simple carbohydrates

are found in sugars, sweets, syrups, and jellies

Vitamins:

are substances that are needed by the body to

function. The body cannot make most vitamins; they can only be

obtained by eating certain foods.

Minerals:

maintain body functions. Minerals help build bones make hormones, and help in blood formation.

Identify nutritional problems of the elderly or ill

 Metabolism slows. Muscles weaken and lose tone, and body

movement slows. Reduced activity or exercise affects appetite.

 A loss of vision may affect the way food looks, which can decrease

appetite.

 Weakened senses of smell and taste affect appetite. Medication

may impair these senses.

 Less saliva production affects chewing and swallowing.

 Dentures, tooth loss and poor dental health can make chewing

difficult.

 Digestion takes longer and is less efficient.

 Certain medication such as pain medication and limited activity

cause constipation. Constipation often interferes with appetite.

IF A RESIDENT EATS LESS THAN 75% OF MEALS SERVED

THAT CAN SIGNAL UNHEALTHY WEIGHT LOSS

GUIDELINES: PREVENTING UNINTENDED WEIGHT LOSS

• report observations and warning signs to the nurse

• food should look, taste, and smell good. Particularly since the resident may have a lower sense of taste and smell

• Encourage residents to eat

• Honor residents’ food likes and dislikes

• Offer different kinds of foods and beverages

• Help residents who have trouble feeding themselves

• Season food to residents’ preferences

• Allow time for residents to finish eating

• Tell the nurse if a resident has trouble using utensils

• Record meal/snack intake

• Provide oral care before and after meals.

• Position residents sitting upright for eating

• If a resident has had a loss of appetite and/or seems sad, ask about it

OBSERVING AND REPORTING: UNINTENDED WEIGHT LOSS

• Resident needs help eating or drinking

• resident eats less than 75% of meals served

• Resident has mouth pain

• Resident has dentures that do not fit properly

• Resident has difficulty chewing or swallowing

• Resident coughs or chokes while eating

• Resident is sad, has crying spells, or withdraws from others

• Resident is confused, wanders, or paces

Parenteral nutrition (PN)

Solution of nutrients is administered directly into the blood stream

Solution of nutrients is administered directly into the blood stream

Parenteral nutrition (PN)

Nasogastric tube (NG)

is inserted into the nose and goes into the stomach

is inserted into the nose and goes into the stomach

Nasogastric tube (NG)

Percutaneous endoscopic gastronomy (PEG) tube

is inserted through the abdominal wall (through a surgically created opening) into the stomach

is inserted through the abdominal wall (through a surgically created opening) into the stomach

Percutaneous endoscopic gastronomy (PEG) tube

WHAT ARE SPECIAL DIETS?

RESIDENTS WHO HAVE CERTAIN ILLNESSES MAY BE PLACED ON SPECIAL DIETS

Low- Sodium Diet:

People are most familiar with sodium as one of the

two components of salt. Salt is restricted first in a low – sodium diet

because it is high in sodium.

Clear-liquid diet

ONLY CLEAR FLUID: LIKE JUICES OR POPSCILES

So NO MILK

Full liquid diet

All fluids: includes milk and ice cream also

Fluid-restricted diet

fluids restricted

High-Potassium Diet

generally recommended to help manage high blood pressure and promote heart health.

FOODS HIGH IN POTASSIUM INCLUDE BANANAS, ORANGES, ORANGE JUICE, PRUNE JUICE, PRUNE, DRIED APRICOTS, FIGS, RASISINS, DATES, CANTALOUPES….

Diabetic diet

Calories and carbohydrates must be carefully controlled: AND OF COURSE, SUGAR

Bland diet

emphasizes foods that are low in fiber, low in fat, and mildly seasoned to rest the gastrointestinal tract.

THIS IS RECOMMENDED FOR PEOPLE WITH CROHNS DISEASE OR IRRITABLE BOWEL SYNDROME (IBS)

Low-Residue (Low Fiber) Diet

RESTRICTS FIBER

It is often used to rest the digestive system during bowel flare-ups or after surgery.

High residue (High-Fiber) Diet:

HIGH FIBER DIET FOR PEOPLE WHO ARE CONSTIPATED OR HAVE BOWEL DISORDERS

Gluten-Free Diet

strictly excludes gluten, a protein found in wheat, barley, and rye. It is medically essential for managing Celiac disease and non-celiac gluten sensitivity.

Soft Diet and Mechanical Soft Diet:

SOFT DIET - is often low in fiber and lacking in spices, while emphasizing simple carbohydrates. (e.g, pureed food, canned vegetables, white rice)

MECHANICAL SOFT DIET - the mechanical soft diet does not restrict spices, fat, fiber or seasonings, and focuses more on texture and consistency (e.g, ground meats, flaky fish, tofu)

WHAT DIET IS LOW IN FIBER AND LACKING IN SPICES WHILE EMPHASIZING SIMPLE CARBOHYDRATES?

Soft diet

WHAT DIET does not restrict spices, fat, fiber or seasonings, and focuses more on texture and consistency?

Mechanical diet

SOFT DIET

is often low in fiber and lacking in spices, while emphasizing simple carbohydrates. (e.g, pureed food, canned vegetables, white rice)

MECHANICAL SOFT DIET

the mechanical soft diet does not restrict spices, fat, fiber or seasonings, and focuses more on texture and consistency (e.g, ground meats, flaky fish, tofu)

Pureed Diet

Means to blend or grind it into a thick paste of baby food consistency

GUIDELINES: PROMOTING APPETITES

• Assist residents with grooming and hygeine tasks before dining as needed

• Give oral care before eating if requested

• Offer a trip to the bathroom or help with elimination needs before eating

• Help residents wash their hands before eating

• Encourage the use of dentures, eyeglasses, and hearing aids

• Check the enviornment. The temperature should be comfortable

• Seat residents next to their friends or people they ahve similar interests to

• Properly position residents for eating, at a 90-degree angle

• Serve foods promptly to maintain correct temperature

• Plates and trays should look appetizing. If they do not, inform your supervisor

• Give the resident the proper eating tools. Use assistive utensils if needed

• Be cheerful, positive, and helpful

• Honor requests regarding food. Residents have the legal right to ask for and recieve different food.

CH16

Urination

also known as voiding

A standard bedpan

should be positioned with the wider end aligned with the resident’s buttocks.

A fracture pan

should be positioned with the handle toward the foot of bed.

Urinary Tract Infection (UTI)

is a bacterial infection of the urethra, bladder, urethra, or kidney. This results in pain or burning during

urination and the frequent feeling of needing to urinate.

GUIDELINES FOR PREVENTING UTIs

• Encourage the resident to wipe from front to back after elimination

• Give careful perineal care when changing incontinence briefs

• Encourage plety of fluids. Drinking water and other fluids helps prevent UTIs.

• Offer a bedpan or a trip to the toilet at least every two hours. Answer call lights promptly.

• Taking showers, rather than baths, helps prevent urinary tract infection

• Report cloudy, dark, or foul-smelling urine, or if a resident urinates often and in small amounts

• Report if the resident has a fever. Report new or worsening confusion.

Kidney stones,

also called renal calculi, from when urine crystallizes in the kidneys. The stones can block the kidneys and ureters, causing

severe pain.

Renovascular Hypertension

is a condition in which a blockage of

arteries in the kidneys causes high blood pressure.

is a condition in which a blockage of

arteries in the kidneys causes high blood pressure.

Renovascular Hypertension

Chronic renal failure (CRF),

Also called chronic kidney failure, occurs because the kidney becomes unable to eliminate certain waste products from the body.

Renal

means kidney

A straight catheter

is a type of urinary catheter that is inserted to drain

urine from the bladder and is removed after urine is drained. It does not

remain inside the person.

WHAT TYPE OF CATHETER DOES NOT REMAIN INSIDE THE PERSON?

A straight catheter

An indwelling catheter (also called a Foley

catheter)

remains inside the bladder for a period of time. The urine

drains into a bag.

WHAT CATHETER REMAINS INSIDE THE BLADDER FOR AN EXTENDED PERIOD OF TIME?

Indwelling catheter (Foley catheter)

WHAT CATHETER IS IN TEMPORARILY AND WHAT CATHETER REMAINS IN THE PERSON FOR AN EXTENDED PERIOD OF TIME?

TEMPORARY - STRAIGHT CATHETER

EXTENDED PERIOD OF TIME - INDWELLING CATHETER (FOLEY CATHETER)

Condom catheters

are for males

it is changed daily or as needed

A specimen

is a sample that is used for analysis in order to make a diagnosis

Clean-catch specimen (CCMS) (midstream specimen)

THE SPECIMEN CANT CONTAIN THE FIRST FEW SECONDS AND LAST FEW SECONDS OF URINE

• YOU GET THEM TO URINATE INTO THE TOILET FOR A FEW SECONDS

• THEN YOU HAVE THEM URINATE INTO THE SPECIMEN CUP

• THEN YOU HAVE THEM STOP MID-URINATION, AND FINISH THE REST INTO THE TOILET

YOU ARE ESSENTIALLY COLLECTING A MIDSTREAM SPECIMEN “Does not

include the first and last urine voided in the sample,” DOES NOT INCLUDE THE FIRST AND LAST FEW SECONDS OF PEE!!

WHAT TYPE OF SPECIMEN CANT CONTAIN THE FIRST FEW SECONDS AND LAST FEW SECONDS OF URINE?

Clean-catch specimen (CCMS) (midstream specimen)

24-hour urine specimen

collects all urine voided by a resident in a 24 hour period, EXCEPT FOR THE FIRST URINE

THE FIRST URINE MUST BE DISCARDED

WHAT TYPE OF SPECIMEN NEEDS TO HAVE THE FIRST URINE DISCARDED?

24-HOUR URINE SPECIMEN

CH17

Defecation

pooping

Peristalsis

is an involuntary, wave-like series of muscle contractions that propels contents through your digestive tract and other tubular organs in the body

WHAT AFFECTS DEFECATION?

• PSYCHOLOGICAL FACTORS

• FOODS AND FLUIDS

• PHYSICAL ACTIVITY

• PERSONAL HABITS

• MEDICATIONS

Constipation

is the inability to eliminate stool (have a bowel movement) or the infrequent, difficult and often painful

elimination of hard, dry stool.

An enema

is a specific amount of water, with or without an additive, that is introduces into the colon to stimulate the elimination of stool.