MP

Units 9 and 10 Study Notes: Admission, Transfer and Discharge / Bedmaking and Sleep

Positive impression on a family visiting a facility

  • First impressions matter: cleanliness, organization, and calm, respectful staff interactions set the tone.
  • Staff demeanor: friendly, approachable, and attentive; use clear, honest communication without jargon.
  • Safety and privacy: visible safety practices, hand hygiene, and respect for resident privacy during tours and conversations.
  • Resident-centered care: evidence of individualized care plans, respect for preferences, and opportunities for family input.
  • Responsiveness: prompt attention to questions or concerns during the visit; provide contact points and follow-up plans.
  • Transparency: honest discussion of routines, meal options, activities, and resident rights.
  • Quality indicators: up-to-date vaccinations, infection-control practices, fall-prevention measures, and accessible accommodations.
  • Daily life snapshot: demonstration of meals, activities, visiting policies, and transportation options.
  • Documentation and credentials: clear identification of staff, credentials, and roles during the visit.
  • Real-world relevance: examples of successful family communication, care planning, and transition support.
  • Ethical considerations: dignity, autonomy, informed consent for care planning, and confidentiality.
  • Practical takeaways for families: what to bring, questions to ask, and how to participate in care planning.
  • Example scenario: during a tour, a family asks how a resident with mobility limitations will manage daily activities; demonstrate adaptive equipment, care staff skills, and a sample daily schedule.

Helping a resident adjust to life in assisted living

  • Assessment and welcome: greet warmly, introduce resident to the facility layout, and identify personal routines.
  • Autonomy and choices: involve the resident in daily schedules, room selection, meal choices, and activity participation.
  • Orientation and familiarization: provide a simple, step-by-step orientation to rooms, common areas, and safety features.
  • Social integration: encourage participation in group activities, hobby clubs, and peer support, while respecting introversion or privacy needs.
  • Coping with change: acknowledge feelings of loss or nostalgia; offer reassurance, consistent routines, and reassurance about safety.
  • Family involvement: update families regularly, invite them to participate in care planning, and provide clear contact points.
  • Safety and accessibility: assess fall risks, ensure assistive devices are available, and train on safe transfers and positioning.
  • Routine consistency: maintain familiar routines where possible to reduce stress and confusion.
  • Professional boundaries and ethics: respect resident autonomy, confidentiality, and informed consent in all transitions.
  • Follow-up and monitoring: schedule check-ins to adjust care plans as needs evolve.
  • Hypothetical scenario: a resident who valued cooking at home; explore in-room cooking activities or supervised kitchen access to preserve a sense of independence.

Weight-pound to kilogram conversion

  • Core formula: the relationship between pounds (lb) and kilograms (kg) is:
  • 1\ \text{kg} = 2.20462\ \text{lb}
  • Equivalently: 1\ \text{lb} = 0.453592\ \text{kg}
  • Practical example: convert a weight of W = 180\ \text{lb} to kilograms:
  • W\text{(kg)} = \frac{180}{2.20462} \approx 81.65\ \text{kg}
  • Quick rule of thumb: divide pounds by ~2.2 to estimate kilograms.
  • Note on rounding: report to the nearest 0.1 kg in clinical records; convert with a calculator for precision.
  • Why this matters: dosing, equipment sizing, and monitoring (e.g., bed weight limits, transfers).

Measuring height and weight of a bedridden patient

  • Weight measurement options:
  • - Bed scale (most common for bedridden patients): ensure scale is zeroed before placing the patient.
  • - Chair or wheel-chair scale if the patient is able to transfer briefly.
  • - Consistency: weigh at the same time of day and with similar clothing (or clothing removed as per protocol).
  • - Record to an appropriate precision (e.g., to the nearest 0.1 kg).
  • Height measurement options for bedridden patients:
  • - Supine length measurement: with a measuring tape from head to heel while the patient lies flat; align the body and straighten legs.
  • - Alternative methods when full length isn’t possible:
  • - Demi-span (arm span approximation) or knee height methods to estimate stature; apply appropriate conversion tables.
  • - Documentation: record height in centimeters (cm) or inches, as your facility uses.
  • Considerations:
  • - Maintain patient comfort and privacy; explain each step; never force positions.
  • - Check for edema, contractures, or presence of devices that may affect measurement accuracy.
  • - Use standard zeroing and calibration for scales.

Measuring abdominal girth

  • Purpose: monitor abdominal distention or edema; assess for obvious changes in body composition.
  • Procedure:
  • - Have the patient breathe normally or exhale to a comfortable level to minimize variability.
  • - Locate the level of the umbilicus (navel).
  • - Place non-elastic tape measure around the abdomen at the level of the umbilicus; keep tape horizontal (parallel to floor) and snug but not compressing.
  • - Read measurement at the end of normal expiration for consistency.
  • - Record in appropriate units (cm or inches) per facility standard.
  • Considerations:
  • - Ensure patient comfort; check for skin integrity where tape rests.
  • - Note abdominal girth changes over time as clinically relevant.

CNA’s role in transfer, admission, and discharge

  • Transfer preparation:
  • - Verify patient identity and destination; communicate with receiving staff.
  • - Ensure transfer equipment is ready (gurney, wheelchair, slide sheets, transfer belts, hoyer lift if needed).
  • - Maintain safety: lock wheels, appropriate side adjustments, and patient dignity during transfer.
  • - Protect clothing and undergarments; provide privacy during transfer.
  • - Document vitals, reason for transfer, and any special instructions.
  • Admission responsibilities:
  • - Welcome the patient, verify demographic and medical information, and explain routines.
  • - Assist with orientation, placement of belongings, and safety checks (call light, bed rails, etc.).
  • - Communicate any immediate needs to the care team; ensure charting is accurate.
  • - Respect patient autonomy; obtain consent for care plans and procedures.
  • Discharge responsibilities:
  • - Ensure patient has necessary prescriptions, medications, and aftercare instructions.
  • - Provide a summary of care plan to patient and family; arrange transportation if needed.
  • - Ensure home-care supplies or follow-up appointments are scheduled.
  • - Complete all required documentation and communicate with the receiving facility when applicable.
  • General CNA roles across transitions:
  • - Use proper body mechanics and safety devices; follow infection control protocols.
  • - Verify patient identity, maintain dignity, and protect privacy.
  • - Communicate clearly with patients, families, and interdisciplinary team members.
  • - Document accurately and timely; report changes in condition.
  • Connections to foundational principles:
  • - Infection control, patient safety, and proper lifting techniques.
  • - Ethical duties around autonomy, confidentiality, and consent.

Positions discussed in class for exams and the CNA role in positioning

  • Common exam positions:
  • - Supine (lying on back)
  • - Prone (lying face down)
  • - Lateral (side-lying; left or right)
  • - Sims’ (left side with right knee and thigh flexed; used for certain exams/ enemas)
  • - Fowlers (upright sitting position; commonly 45-60 degrees)
  • - Semi-Fowler's (approximately 30-45 degrees)
  • - High Fowler's (60-90 degrees; often used for eating or respiratory clearance)
  • - Trendelenburg (lying on back with body tilted so head is lower than feet) and Reverse Trendelenburg (head higher than feet)
  • - Orthopneic (positions to facilitate breathing, with patient leaning forward over an overbed table)
  • - Knee-chest (on abdomen with hips flexed, used for certain exams)
  • CNA role in positioning:
  • - Safely move and position patients using proper body mechanics and asking for assistance as needed.
  • - Use pillows, wedges, and supports to promote comfort and alignment; prevent pressure injuries.
  • - Check for contraindications (e.g., recent surgeries, spinal precautions, pressure ulcers risk).
  • - Reassess after positioning for comfort, circulation, and airway/respiratory status.
  • - Document positioning and any skin changes or discomfort.

Circadian rhythm

  • Definition: roughly a 24-hour internal clock regulating sleep-wake cycles and many physiological processes.
  • Core mechanism: governed by the suprachiasmatic nucleus (SCN) in the hypothalamus; responds to light-dark cues.
  • Role of light: morning light reinforces wakefulness; darkness promotes sleep via melatonin secretion.
  • Practical nursing implications: support regular sleep schedules, light exposure plans, and environment optimization to align with circadian cues.

Sleep in the elderly and age-related changes in sleep patterns

  • Common age-related changes:
  • - Increased nighttime awakenings and shorter total sleep time.
  • - Decreased deep sleep (N3 stage) and possibly reduced REM sleep.
  • - Earlier bedtimes and earlier morning awakenings (phase advance).
  • - More nighttime trips to the bathroom (nocturia) and medical condition considerations.
  • Consequences:
  • - Daytime sleepiness, reduced daytime functioning, and potential mood or cognitive effects.
  • - Higher risk of falls if safety lighting and assistance are inadequate.
  • Nursing considerations:
  • - Encourage consistent sleep routines, comfortable sleep environment, and limiting caffeine late in the day.
  • - Address pain, restless legs syndrome, sleep apnea risk, and other sleep disorders.

Sleep disorders (common categories)

  • Insomnia: difficulty falling or staying asleep; daytime consequences.
  • Sleep apnea: breathing interruptions during sleep; often requires position management or medical devices (e.g., CPAP).
  • Restless legs syndrome: uncomfortable sensations with urge to move legs, worsening at rest.
  • Narcolepsy: excessive daytime sleepiness and sudden sleep attacks.
  • Parasomnias: abnormal behaviors during sleep (e.g., sleepwalking, REM sleep behavior disorder).
  • Evaluative note: assess symptoms, duration, and impact on safety and function; refer for medical evaluation when indicated.

Encouraging dietary changes to promote sleep

  • General dietary practices:
  • - Avoid caffeine and nicotine close to bedtime.
  • - Limit alcohol late in the day; it can disrupt sleep architecture.
  • - Have a light snack that combines complex carbohydrates and a small amount of protein if hungry before bed.
  • - Maintain hydration without overfilling to reduce nocturnal awakenings.
  • - Create a sleep-friendly environment: temperature, light, and noise control.
  • Foods and timing:
  • - Include tryptophan-containing foods (e.g., dairy, turkey, yogurt) in the evening as appropriate.
  • - Schedule meals to avoid heavy or spicy meals right before bed.
  • Practical nursing strategies:
  • - Collaborate with dietitians to tailor meal plans for sleep quality.
  • - Monitor caffeine sources and timing, including tea, chocolate, and certain medications.

Bedside stand vs. overbed table: uses and differences

  • Bedside stand:
  • - Usually placed beside the bed; stores personal items, small personal care items, and often patient belongings.
  • - Keeps items within easy reach and promotes independence.
  • Overbed table:
  • - Positioned over the bed; adjustable height and angle.
  • - Used for meals, writing, charting, or small tasks; often supports equipment like a tray or lamp.
  • Key differences:
  • - Mobility: overbed table is adjustable and can be moved over the bed; bedside stand is generally stationary.
  • - Primary function: personal storage vs. workstation/meal surface.

Dirty linens handling

  • Core safety and hygiene steps:
  • - Wear appropriate gloves; follow facility infection-control protocols.
  • - Do not shake linens to avoid dispersing contaminants.
  • - Gather and bag/transport linens in designated containers; place in proper laundry hampers.
  • - Handle linens away from clothing and skin; perform hand hygiene after removal.
  • - Ensure linens are changed promptly and disposed of according to policy.

Bariatric bed

  • Definition: a bed designed to accommodate patients with higher body weight; wider width, higher weight capacity, and reinforced frame.
  • Features: wider surface, secure rails, adjustable height/positioning for comfort and safety.
  • Rationale: enhances safety during transfers, decreases risk of equipment failure, and improves patient comfort.

Alternate pressure bed

  • Definition: a mattress system that alternates pneumatic support to relieve pressure points.
  • Purpose: prevention and management of pressure ulcers, especially in immobile or high-risk patients.
  • Basic operation: cycles of inflation/deflation create shifting pressure patterns; reduces sustained pressure on any single body area.
  • Nursing considerations: monitor skin integrity, ensure proper tubing/air supply, and adjust settings as prescribed.

Bariatrics: overview and relevance in care

  • Definition: the branch of medicine dealing with obesity; includes prevention, evaluation, and treatment of obesity-related conditions.
  • Relevance to care: requires specialized equipment (e.g., bariatric beds, wide wheelchairs), tailored transfer and positioning, and heightened sensitivity to weight-related health risks.
  • Practical implications: awareness of comorbidities (e.g., diabetes, hypertension), nutritional considerations, and psychosocial support.

Connections to foundational principles and real-world relevance

  • Safety: fall prevention, safe transfers, and proper positioning are core CNA duties.
  • Infection control: gloves, hygiene, and handling contaminated linens protect residents and staff.
  • Dignity and autonomy: involve residents in decisions about care, routines, and transfers; maintain privacy.
  • Communication: clear, respectful dialogue with residents, families, and the care team.
  • Evidence-based practice: align with standard procedures for transfers, positioning, and sleep hygiene.
  • Ethical and practical implications: balancing safety with independence, respecting cultural preferences, and supporting mental well-being during transitions.

Quick reference checklist (summary)

  • Positive family impression: cleanliness, safety, communication, transparency.
  • Adjustment support: autonomy, orientation, social integration, coping strategies.
  • Measurement basics: weight conversion formulae; bed-scale and supine height methods; abdominal girth technique.
  • Transitions: verify identity, privacy, and proper equipment; document and communicate; involve family.
  • Positions: list common positions and CNA positioning duties.
  • Circadian rhythm: SCN, light cues, melatonin; support routines.
  • Sleep in aging: common changes, disorders, and nursing strategies.
  • Diet and sleep: caffeine, meals, timing, and sleep-friendly foods.
  • Equipment distinctions: bedside stand vs overbed table.
  • Linens: safe handling and hygienic practices.
  • Bariatrics and beds: specialized equipment and goals.