Wake Tech Nurse Aide Unit 3 Test

Body Mechanics

the way you hold your body when you move around

Importance of body mechanics

• helps avoid muscle fatigue, strain, and injury as you walk or bend over to lift objects or perform ADL’s

• reduces cost to the resident and facility

• reduces employee absences due ot ack injury and liability for the facility due to workman’s compensation

ABC’s of Body Mechanics

• alignment

• base of support

  • coordination

Alignment

posture - how head trunk, arms, and legs are aligned with one another

Base of Support

foundation that supports an object

Key points of ABC’s

• keep objects closes to body

• point toes in direction you want ot go

• do not twist at the waist

• the feet are the base of support - legs shoulder-length apart

• (for a person standing) pelvis is center of gravity

• low center of gravity gives more stable base of support

• bend at the hips and knees - use wide base of support

• use large muscles (upper arms) and thighs

• push or slide heavy objects and lift as last options

What should NA do when a patient is about to fall

• control direction of fall

• ease patient to the floor

• protect patient’s head

• do not leave - call the nurse

• do not try to hold the patient up

Why take the precautions for when the patient is about to fall?

you can hurt yourself or the patient and lose your balance, causing both of you to fall and both get injured

Supine

flat on back, chest facing ceiling

Prone

laying on abdomen

Fowler’s

reclined sitting position 45-60 degrees

High Fowler’s

sitting up almost straight 60-90 degrees

Lateral

laying on right or left side

How often do you want to reposition the patient?

Every 2 hours or more frequently

What is log rolling?

turning patient as a unit maintaining the head, back, and legs in a straight line

Examples when to use log rolling

problems with neck and back, a patient with a spinal cord injury or recent surgery (back or hips)

Nutrition

when the body takes and uses food and fluids to maintain health

Malnutrition

lack of proper nutrition due to lack of food intake, improper diet, and impaired use of food by the body

Importance of Good Nutrition

• promotes physical and mental health

• increases resistance to illness

• aids in healing

• promotes energy

• helps avoid or manage common diseases such as cancer, type 2 DM, heart disease, heart failure, high BP, obesity, and osteoporosis

Six Nutrients

1. water

2. fats

3. carbohydrates

4. protein

5. vitamins

6. minerals

Water

• moves oxygen and nutrients in the cells

• removes waste

• helps digestion and absorption

• helps maintain temperature by perspiration

Fats

• may increase cholesterol levels and lead to heart disease

• ex: butter, oil, fatty meats

Carbohydrates

• supplies energy and helps use fats

• can help with elimination - added fiber

• ex: breads, fruits, candy, and sugary drinks

Protein

essential for tissue growth and repair

Vitamins

• needed to help the body function normally

• Vitamins A&C

Minerals

• help build bones, make hormones, and help blood formation

• calcium keeps bones and teeth strong

• Iron - helps carry oxygen to all parts of the body

Nutrition Facts

Serving size

• information on the label or packaging in based on 1 serving size

1 serving size of meat, poultry, or fish

deck of cards

Serving size of 1 cup of rice, fruit, veggies, or pasta

baseball

1 cup

hand/fist

1 serving size of meat

palm

1 ounce or 1 tablespoon peanut butter

thumb

1 teaspoon of cooking oil, mayo, or butter

thumb tip

My plate

Designed to help people easily build a healthy plate duringmeal times

• emphasizes on vegetables, fruits, grains, protein, and low fat dairy

• recommends highest proportion should be fruits and vegetables

• HANDOUT 1J

Special Diets

Also called therapeutic or modified diet

• ordered by the MD

• planned by the dietician

• HANDOUT 2J

• tells the nurse/NA which foods are allowed and not allowed

What foods would be allowed on a clear liquid diet?

water, jello, broth

What diet does someone with heart failure have?

low sodium or sodium controlled diet

Advancing diets

when food is gradually re-introduced to patient usually after surgery or medical condition such as a stroke

Starts NPO

• ice chips

• clear liquids

• full liquids

• mech soft

  • regular

Things to watch

Dysphagia: difficulty swallowing, which can lead to aspiration

Signs and symptoms

• vomits or chokes

• difficulty breathing

• watery eyes

• drools or dribbles food from the mouth

• pockets food

What can the NA do to prevent aspiration?

• place patient upright at 90 degrees and keep them there for at least 30 min after feeding

• feed slowly, offer small amounts of food

• make sure food is swallowed after each bit and offer a sip of liquid

• provide thickened liquids such as nectar thick or honey thick

Fluid balance

intake and output

• fluid intake by drinking fluids and eating foods

Output

lose water via urine, liquid stool, diarrhea, vomit, perspiration (sweat), via our lungs as we breathe out, and drainage from wounds or liquids from stomach suctioning (NG Tube)

When does dehydration occur?

When fluid intake is less than fluid output

Signs and symptoms

• severe thirst

• dry mouth and mucus membranes

• cracked lips

• sunken eyes

• dry skin

• constipation

• weight loss

• low BP, weak pulse

May occur during dehydration

• bleeding

• fever

• poor fluid intake

• fluid restriction

• sweating

• vomiting

• increased urination

What can an NA do to prevent dehydration?

• determine patient preferences - What do they like to drink?

• make sure water putcher is full and cups are in reach

• offer assistance

• record accurate I&O’s

What is edema?

Fluid intake greater than output

• the tissues swell with water

• commonly seen in patients with kidney disease or heart disease (HF)

Signs and symptoms of fluid overload

• weight gain

• fatigue

• difficulty breathing

• swelling in the ankles, feet, finger, hands, abdomen

• coughing

• decrease in urine output

What can the NA do to prevent fluid overload?

• restrict fluids (must have MD order)

• accurate weights

• provide extra pillows to prop resident up

• accurate I&O’s

Restraint

physical or chemical way to restrict voluntary movement or behaviorR

Restraint Alternative

measures used instead of physical or chemical restraints (any method to distract patient)

Example of restraint alternative

the NA encourages the patient to attend the activity of the day; use of an activity apron

Restraint free care

an environment in which restraints are not kept or used for any reason

Example of restraint free care

dementia unit in a nursing home

Types of restraints

chemical and physical

Chemical restraint

drugs or drug used to control behavior or restrict movement

Physical restraint

any manual method, physical or mechanical device, material, or equipment attached or near an individual that cannot be removed easily and restricts freedom of movement or normal access to one’s body

Examples of physical restraint

tucking in a sheet tightly around resident

Risks of restraints

• dehydration

• incontinence

• skin breakdown, pressure ulcers

• cuts, bruises, skin tears

• swelling, nerve damage

• aspiration

• infections (pneumonia, UTI’s)

• death from strangulation

Why are restraints used?

used in the event other measures failed to protect the patient

Who orders the restraints?

physician/MD

How often do you check a patient in restraints?

every 15 minutes

How often do you remove restraints, reposition, and attend to basic needs?

every 2 hours for at least 10 minutes

What part of the bed frame should restraints be tied?

• to the movable part of the bed frame so it does not tighten or loosen when the head or foot is raised or lowered

• Leave 1 to 2 inches of slack in the straps to allow some movement of the part, unless instructed otherwise

Seat belt

• reduces falls, used in wheelchars

Jacket

• opening in back, limits mobility of the upper body

Vest

• limits mobility upper body, crisscrosses in front

Leg/Ankle

• limit mobility of the leg/ankle

Arm

• limits mobility of the arm

Hand or Mitt

limits mobility of hand and finger use (used to prevent picking at a dressing)

Wrist

limits arm movement (Used to prevent pulling at tubes or medical devices)

What is the legal term associated with unnecessary restraint use?

False imprisonment

Patient centered care

The practice of basing patient care on individual resident needs, preferences, and expectations

Goals of patient centered care

• to see the person as a unique individual

• respect skills and abilities

• support the person to be successful and maintain independence

• help the person feel like they belong and have a purpose, are in relationships with others

• support person as a member in the community

• honor importance of keeping the person at center of care planning and decision making

Importance of patient centered care

• create a home like atmosphere where the person lives whether home, nursing home, ALF, or a hotel

• honor patient preferences

• encourage personal choices in daily activities such as waking, bathing, dining, and sleeping

Cognition

the ability to store knowledge in memory, recover knowledge fro memory, and use that knowledge to answer questions, respond to requests, and perform tasks

Learning

the gaining of information, skills, and knowledge measure by an improvement

Memory

involves the storing of information in the brain for later use, ability to recall the information when needed

Cognitive changes due to aging

• size of neurons progressively decrease

• physiological and psychological responses slow

• decrease in processing, response time, and reaction time

• cannot adapt as well, especially in a stressful unfamiliar environments with impaired senses

• short term memory loss

• motivation decreases

• difficulty doing more than one task or dealing with more than one request at a time

• more difficulty in learning motor skills

Social breakdown syndrome

• may be more cautious and less willing to respond quickly in situations or choose not to do a tas in fear of failure

• gradually begins to feel incompetent and has decrease in self esteem

• may give up doing things leading to dependence and helplessness

Psychological effects of aging

an exploration of feelings, emotional stress, physical, psychosocial, and psychological adjustments that are part of the aging process

Basic human needs

elements necessary for survival, physical, and mental well being

Physical needs

• oxygen

• food and water

• shelter

• sleep

• elimination

• activity

Safety and security

• provide warmth

• establish familiar surroundings

• maintain order and follow routines

• assist in reducing fear and anxiety

Life in a nursing home

• lack of privacy leads to stress and anxiety

• always knock

• approach resident slowly

• ask resident permission before touching belongings

• be aware of residents reason for admission

• realized major changes in residents is expected to handle

• recognize losses and adjustments

• encourage resident to have as much control as possible

• encourage residents to set own pace and prioritize daily activities

Caring for residents who are depressed

recognize reason for depression

• loss of independence

• death of spouse

• loss of job or home

• decrease memory

• terminal illness

Signs and symptoms of depression

• change in sleep pattern

• loss of appetite and weight loss

• crying

• withdrawal from activities

NA’s role when taking care of a resident with depression

• listen to feeling

• involve them in activities

• encourage friends and family to visit

• report changes in eating, elimination, and sleep patterns

• avoid pitying resident

• promote self-esteem

NA’s role in caring for residents

• encourage residents to make personal choices

• listen to concerns - listen to fears

• treat with dignity and respect

• listen to verbal and non verbal messages

• give consistent care

• encourage resident to talk about fears

• provide a calm environment

• listen to verbal aggression without judgement

Projection

blaming others

Rationalization

false reason for situation

Denial

pretending problem does not exist

Compensation

make up for a situation in another way

Displacement

transferring feelings

Identification

idolizing another/copying them

Sublimation

redirecting feelings

Alzheimer’s Disease

progressive disease characterized by a gradual decline in memory, thinking, and physical ability over several years

Average life span of an Alzheimer’s patient

8 years, progressive into 7 stages