Comprehensive NC Nurse Aide I Certification Study Guide - TEST 1

Module A: North Carolina Nurse Aide I (NA I)

• Definition of Nurse Aide I (NA I):     * Unlicensed Personnel: A Nurse Aide I is an unlicensed health care provider.     * Delegated Tasks: Responsible for providing delegated nursing tasks within a defined range of functions for residents in a variety of healthcare settings.

• Omnibus Budget Reconciliation Act (OBRA):     * Purpose: Federal legislation designed to improve the quality of life for residents living in nursing homes.     * Requirements: Defines the mandatory requirements for nurse aide training and competency evaluation.

• Range of Function for Nurse Aides:     * Authorization: Refers to the specific tasks authorized by the North Carolina Board of Nursing (NCBON) for a NA I to perform.     * Scope of Practice: It is vital never to perform any task outside of your designated scope of practice.

• NC Nurse Aide I Registry:     * Registry Definition: A official listing of all individuals who have met the state and federal training and testing requirements to perform NA I tasks in North Carolina.

• NC Health Care Personnel Registry (NCH CPR):     * Listing Criteria: A listing of unlicensed health care personnel who are currently being investigated for, or have been found to have committed, the following:         * Neglect and Abuse.         * Misappropriation of Property: Belonging to a resident or a health care facility.         * Diversion of Drugs.         * Fraud: Against a resident or a health care facility.     * Employment Restriction: If an individual is on this list, they are legally prohibited from working in a nursing home.

• Nurse Aide I Tasks (Range of Function Part 2):     * Bathing.     * Mouth care.     * Use of side rails.     * Cardiopulmonary Resuscitation (CPR).     * Post-mortem care.     * Hair and nail care.     * Positioning and transferring.     * Perineal and catheter care.

• NC NA I Registry Requirements:     * Training: Successful completion of a State-approved NA I training program.     * State Competency Test: Passing a two-part exam consisting of:         1. Written/Oral Exam.         2. Skills Exam: Consists of $5$ skills. Vital signs are guaranteed to be on the test; continuous practice is required.     * Listing Renewals: Formal processes are required to maintain active registry status.

Job Responsibilities and Professional Skills

• Basic Nursing Skills:     * Monitoring Vital Signs.     * Caring for the resident's environment.     * Recognizing changes in a resident's condition and reporting them immediately to the nurse.     * Performing pre- and post-mortem care.     * Privacy: Privacy is a key component when providing any nursing skills.     * Documentation: Following the resident care plan, reporting findings, and documenting data accurately is essential.

• Personal Care Skills:     * Hygiene: Tasks performed to keep bodies clean and healthy (e.g., bathing and brushing teeth).     * Grooming: Tasks performed to maintain the person's appearance while fostering dignity and choice.     * Independence: Always encourage resident independence and self-care.     * Professionalism: Maintain a professional manner and provide privacy.     * Observation: During personal care, observe the resident's skin, mobility, comfort level, and cognition.

• Interpersonal Skills:     * Definition: In health care, this refers to the ability to get along with others while getting the job done.     * Empathy: Viewing things as the resident views them.     * Needs Anticipation: Anticipate what the resident may need before they ask.     * Uniqueness: Treat all residents as unique individuals and honor their requests whenever possible.     * Family Interaction: Be respectful to family members and listen to their concerns.

• Work Ethic and Professionalism:     * Care for Others: Maintain a focus on caring for others.     * Professional Appearance: Follow the established dress code and maintain personal hygiene.     * Gossip: Avoid gossip and be careful with whom you are talking to.     * Honesty: Speak honestly, say only what you mean, never lie, and be careful with jokes.

• Defining a Team:     * Definition: A group of people with a common purpose, assigned tasks, and coordinated effort to get a job done.     * Coordination: Members must work together, communicate, coordinate with each other, and receive specific assignments.

Module C: Safety and Emergency

• The Resident's Environment:     * Hazards: Refers to anything in the resident's environment that may cause illness or injury.     * Risk Groups: The elderly are at a high risk for injury.

• Nurse Aide's Role in Safety:     * Oxygen Safety: Be aware when "Oxygen in Use" signs are posted.     * Bed Positioning: Keep the bed in its lowest position unless providing direct care. This must be remembered and stated during evaluations.     * Call Signals: Always keep the call signal within easy reach for the resident.     * Room Temperature (OBRA): Maintain a temperature range between $71^\circ F$ and $81^\circ F$.     * Wheelchair Safety: Lock wheelchair brakes before moving a resident into or out of it.     * Water Temperature: Always check water temperature before resident use, ensuring it is between $100^\circ F$ and $109^\circ F$.

• Falls and Prevention:     * Statistics: Over $14\text{ million}$ adults aged $65+$ report falling each year.     * Mortality: Falls are a leading cause of death among older adults, with one death occurring every $19\text{ minutes}$.     * Risk Factors:         * Intrinsic: Results from the resident's inner being.         * Extrinsic: Results from external environmental factors.     * Prevention: Assist with ambulation whenever necessary.

• Emergency Response (Seizures and Stroke):     * Stroke Signs: Weakness in the arms is a critical sign to call $911$.     * Seizure Care:         * Do not restrain the resident.         * Do not put anything in the resident's mouth.         * Put on gloves for protection.         * Send for a supervisor immediately.

• Fire Safety (RACE and PASS):     * RACE (Response Sequence):         * R: Remove residents from danger.         * A: Activate the alarm.         * C: Contain the fire by closing windows and doors.         * E: Extinguish the fire.     * PASS (Extinguisher Use):         * P: Pull the pin.         * A: Aim at the base of the fire.         * S: Squeeze the handle.         * S: Sweep back and forth.

Module AA: Measurements (Vital Signs)

• Purpose of Vital Signs:     * Indicate how well vital organs (heart, lungs) are functioning and the regulation of body temperature.     * Includes: Temperature, pulse, respiration, and blood pressure.     * The 5th Vital Sign: Pain is considered the fifth vital sign. It is subjective (whatever the patient says it is) and responses vary by patient. Use a pain scale of $0\text{ to }10$ to identify pain levels and report to the nurse.

• Importance and Equipment:     * Changes can indicate a worsening condition or reflect how a body responds to medication/treatment.     * Accuracy: Accuracy is crucial.     * Equipment needed: Blood pressure cuff, stethoscope, analog watch (must have a secondhand to count respirations and pulse rate).

• Body Temperature:     * Definitions: Febrile (with fever); Afebrile (without fever).     * Factors Affecting Temp: Age, illness, stress, environment, exercise, and time of day.     * Values and Sites:         * Oral: Baseline $98.6^\circ F$. Normal range: $97.6^\circ F\text{ to }99.6^\circ F$.         * Rectal: Baseline $99.6^\circ F$. Normal range: $98.6^\circ F\text{ to }100.6^\circ F$.         * Axillary: Baseline $97.6^\circ F$. Normal range: $96.6^\circ F\text{ to }98.6^\circ F$.         * Tympanic membrane: Baseline $98.6^\circ F$. Normal range: $97.6^\circ F\text{ to }99.6^\circ F$.         * Temporal: Baseline $98.6^\circ F$. Normal range: $97.6^\circ F\text{ to }99.6^\circ F$.

• Pulse Dynamics:     * Pulse Rate: Number of heartbeats per minute.     * Pulse Rhythm: The regularity of heartbeats.     * Pulse Force: The strength of the pulse.     * Location: Radial pulse is found on the thumb side of the wrist.

• Blood Pressure (BP):     * Site: Upper arm for cuff placement.     * Normal Values: Less than $120/80$.     * Systolic range: $90\text{ to }119\text{ mmHg}$.     * Diastolic range: $60\text{ to }79\text{ mmHg}$.     * Triple Senses Technique:         1. Seeing: Watch the needle's movement on the manometer.         2. Hearing: Use stethoscope to listen for changes in blood flow in the brachial artery.         3. Touching: Control inflation and deflation of the cuff.     * Sounds: First sound heard is Systolic; the last sound (bump) heard is Diastolic.     * Manometer Markings: Long lines represent $10\text{ mmHg}$; short lines represent $2\text{ mmHg}$.

• Height and Weight:     * Orthostatic Hypotension: Blood pressure drop that occurs when standing up. Take BP lying down, then take it standing up.     * Weight: Use a mechanical beam scale. Crucial to obtain accurately and consistently. Weigh at similar times each day, using the same scale and similar clothing.

• Intake and Output (I&O):     * Fluid Balance: When intake equals output.     * Calculation: Calculated at the end of each shift and totaled every $24\text{ hours}$.     * Units: Measured in milliliters ($mL$).         * $1\,mL = 1\,cc = 1\,cm^3$         * $1\,oz = 30\,mL$ (Standard for testing; multiply oz by 30 to get mL).     * Intake Sources: Liquids (water, milk, soup); Semi-liquids (milkshake, ice cream, gelatin); IV fluids and tube feedings.     * Clear Liquid Diet: Passes through the stomach without leaving residue.     * Output Sources: Urine, vomitus, diarrhea, wound drainage, gastric suction material.

Module B: Infection Control

• Basic Concepts:     * Infection: A disease occurring when germs enter the body and grow.     * Localized Infection: Found in one specific part of the body.     * Systemic Infection: A body-wide infection.     * Symptoms by Site:         * Respiratory: Fever, coughing, sneezing.         * Bladder: Pain during urination, blood in urine, foul odor/discharge.         * Stomach: Stomach pain, vomiting.

• Microorganisms:     * Requirements for survival: Warmth, moisture, tissue to feed on, and oxygen (though some are anaerobic).     * Includes: Bacteria, viruses, parasites, and fungi.     * Medical Asepsis: A cleaning technique used to destroy microorganisms.

• Chain of Infection (6 Links):     1. Causative Agent: The germ causing the infection.     2. Reservoir: Where germs live/grow. Groups include: healthy people, symptomatic people, and carriers. Treat everyone and all body fluids as infected.     3. Portal of Exit: How germs escape the reservoir.     4. Mode of Transportation: Direct contact or indirect contact (contaminated surfaces, food, water, insects).     5. Portal of Entry: Body openings allowing germs to enter (often the same as portals of exit).     6. Susceptible Host: Person at risk (elderly in long-term care are most likely).     * Prevention: Breaking any single link in the chain stops the infection.

• Standard and Precautions:     * Healthcare-Associated Infection (HAI): Infection acquired while staying in a health care setting.     * Standard Precautions: Tasks done for all patients to prevent infection; all fluids are treated as infected.     * Sharps Safety: Wear gloves; dispose in sharps container; NEVER recap a needle; NEVER put sharps in regular trash.     * Spill Procedure: Put on gloves, clean spill, apply disinfectant, discard waste properly, and place a warning sign/cone.

• Transmission-Based Precautions (3 Types):     1. Contact Precautions: PPE includes standard precautions plus gowns and gloves.     2. Droplet Precautions: Prevents germs that travel by air.     3. Airborne Precautions: Prevents germs that travel in the air by a distance.

• Bloodborne Infections:     * Hepatitis B: Affects the liver. $1/3$ of patients show no symptoms. Highly resilient; can live outside the body on surfaces for $7\text{ days}$.     * Hepatitis C: There is no vaccine available.     * HIV: Human Immunodeficiency Virus.