Comprehensive Nursing Assistant Study Notes

Independence and Resident Care

  • Allow residents to perform tasks independently, such as washing their face, brushing their teeth, and combing their hair, regardless of how long it takes.
  • Enable residents to pick their own clothes and feed themselves, promoting autonomy.

Key Considerations for Licensing Exam

  • Prioritize resident independence to the greatest extent possible.

Admission, Transfer, and Discharge of Residents

Admission Process

  • CNAs play a vital role in the admission of a new resident.
  • Unlike hospitals with 24/7 housekeeping, nursing homes may require CNAs to prepare the resident's room, including wiping down surfaces and making the bed.
  • Fancy nursing homes provide a brief bio of the resident, often prepared by the activities director, to help staff get to know them beforehand.
  • An admission kit is created, containing items like a basin, water pitcher, toiletries (toothpaste, toothbrush, comb, brush), emesis basin, and denture cup.
  • All items, including equipment and clothing, are labeled for identification.
  • Clothing is inventoried to ensure all items are accounted for, especially if families or the facility handles laundry.
    • Record the number and type of clothing items (e.g., "five collared shirts").

Admission Kit Items

  • Basin: A large pink bucket.
  • Emesis Basin: A small, kidney-shaped container.
  • Water Pitcher: A standard pitcher for water.

Room Orientation

  • Orient the resident to the room, showing them the location of the doorbell, bathroom, dresser, call light, and TV remote.
  • Emphasize a smooth transition to minimize stress during admission.

Resident Rights

  • Inform residents of their rights upon admission, reinforcing that these rights are expectations.

Step-by-Step Admission Procedures

  • Explain mealtimes and the location of essential items to the resident.
  • Nurses will take baseline vital signs (temperature, pulse, respirations, blood pressure, pulse oximetry).
    • Baseline vital signs include temperature, pulse, respirations, blood pressure, and pulse oximetry.
  • Nurses may also measure height and weight.
  • CNAs may be asked to obtain a urine specimen and provide fresh water.

Transfer Process

  • Residents may be transferred to another room or floor within the facility if the initial placement is not a good fit.
  • Move all of the resident’s items from the old location to the new one, including wheelchairs, canes, and personal belongings.
  • Transfers may occur due to resident incompatibility.

Discharge Process

  • Discharge can be a positive event, with residents returning home or moving to another facility.
  • Pack up the resident's belongings and compare them to the initial inventory of clothing.
  • Inventory valuable items such as money, rings, hearing aids (which can cost 2,000 to 6,000), and dentures (custom-made and expensive).
  • If a resident has valuables, inform the nurse and have a witness present during inventory and storage.

Restraints

Types of Restraints

  • Restraints can be physical or chemical.
    • Chemical: Administering medication to calm an agitated resident.
    • Physical: Using methods or devices to restrict movement.
  • Physical restraint: Any method, device, material, or equipment that restricts an individual's freedom of movement.
  • Examples of physical restraints:
    • Chest posies: Vest-like devices with ties to secure the resident.
    • Wrist restraints: Sheepskin-type material that goes around the wrist and ties to the bed rails.
    • Mittens: Adult-sized mittens that limit finger movement.
    • Raising all four side rails on a bed (in a nursing home setting).
    • Jerry chair: A specialized chair that becomes a restraint when the table in front of it prevents movement.
    • Chair alarms and bed alarms that clip to a person's clothing.

Policies and Procedures

  • Restraints require a doctor's order; nurses cannot independently decide to restrain a resident.
  • The doctor must be informed of the resident's behavior and the danger they pose to themselves.

Potential Complications

  • Restraints can cause pressure sores, suffocation, incontinence, depression, loss of dignity, stress, and anxiety.

Alternatives to Restraints

  • Learn resident cues to anticipate needs, such as frequent getting up indicating a need to use the bathroom.
  • Adjust the environment to reduce agitation, such as moving a dementia resident from a busy day room to a quiet room.
  • Offer alternatives like ambulation for restless residents.
  • Ensure confused residents have access to the call light.

Examples of Alternatives

  • Adjusting bedtime routines for residents who are used to going to bed early.
  • Providing tea and cookies at night for residents who wander.

Monitoring and Release

  • Restraints must be checked every 15 minutes and released every two hours.

Communication

Communication Model

  • Communication involves a sender, a message, and a receiver.
  • The sender initiates the conversation and formulates the message.
  • The message is delivered to the receiver, who processes it and provides feedback.

Barriers to Communication

  • Hearing loss, language differences, and vision impairments can impede communication.
  • Medical jargon can confuse patients.

Types of Communication

  • Verbal: Involves spoken or written words.
  • Nonverbal: Communication that does not use words, including body language and facial expressions.

Nonverbal Communication

  • Body language, such as walking with your head down or keeping hands in pockets, can convey disinterest.
  • Smiling and leaning in can show interest, even if you're not genuinely interested.
  • Maintaining eye contact is generally considered polite in American culture, but may be seen as disrespectful in other cultures.

Cultural Sensitivity

  • Be aware of cultural differences in communication styles and norms.
  • In some cultures, a specific family member may communicate on behalf of the patient.

Objective vs. Subjective Information

  • Objective information: Based on observations using the five senses (hear, see, touch, smell, taste).
    • Objective observations are considered signs.
    • Example: Describing a resident as slumped over or noting dark yellow urine with a strong odor.
  • Subjective information: Is based on what the resident says, their description.
    • Subjective statements are considered symptoms.
    • Example: A resident saying they feel like they have a fever or that their back hurts.

Medical Terminology

  • Familiarize yourself with medical terminology, including root words, prefixes, and suffixes.
  • Root word: Refers to a body part.
  • Prefix: Is at the beginning of the word.
  • Suffix: Is at the end of the word.
  • Abbreviations are used to communicate efficiently (e.g., NPO for "nothing by mouth," DNR for "do not resuscitate").

Barriers and Misinterpretations

  • Barriers can cause misinterpretation of messages.
  • Address sensory impairments, such as hearing loss and vision problems.
  • Avoid slang or terms of endearment (sweetie, honey, bae) when addressing residents; use mister or missus.
  • Do not give the residents advice
  • Use translation services or picture boards to communicate with residents who speak different languages.

Defense Mechanisms

  • Unconscious behaviors used to cope with or release tension; can sometimes be considered barriers.
    • Denial is rejecting a thought or feeling.
    • Projection is attributing one's feelings to others.
    • Displacement is transferring emotions to someone else.
    • Rationalization is justifying actions with excuses.
    • Repression is blocking out traumatic experiences.
    • Regression is going back to old behaviors.

Culture Impact

  • Culture influences communication styles and norms.
  • Cultural traditions and beliefs are passed down through generations.
  • Healthcare providers should be mindful of cultural differences in communication and customs.

Impairments

  • An impairment is a loss of function or ability.
  • Common impairments include hearing loss, vision loss, and mental health disorders.

Hearing Impairment

  • Communicate by facing the person, speaking clearly and slowly, and minimizing background noise.
  • Approach from the front to avoid startling them.
  • Use hearing aids to amplify sound; ensure they are charged and properly handled.
  • Be extremely careful with hearing aids as there are very expensive
  • When doing AM or PM care, put their hearing aids on so that they can hear your instructions.

Vision Impairment

  • Approach from the front, knock on the door, and introduce yourself.
  • Use the clock method to orient them to the room and describe the placement of food on their plate.
  • Do not move items in their room.
  • Assist with cutting their food and let them know where things are placed.
  • If they can't see when doing AM or PM care, put their glasses on.

Mental Health Disorders

  • Mental health disorders can manifest in combative or agitated behaviors.
  • Sundowning is a condition where dementia patients become confused and agitated in the late afternoon or evening.

Managing Combative Residents

  • Identify and eliminate triggers.
  • Always maintain a quick exit route.
  • Remain calm and allow them to verbalize their feelings.
  • Reassure them and ensure they feel safe.
  • Do not take anything personal and maintain a professional conduct.

Inappropriate Resident Behavior

  • Do not engage in inappropriate conversations or behavior.
  • Use therapeutic diversions or change the subject.
  • It is okay to tell a resident that a comment is inappropriate and change the subject