nursing assistant test 2 review

Bathing, perineal care, and body care order

  • Order of washing during bathing: wash the eyes first, then inner to outer (eye → inner eye → outer eye), then proceed to perineal care front to back.

  • Perineal care vs bathing

    • Perineal care is a part of a full bed bath focusing on the genital and anal area; bathing can be a full bed bath when washing the entire body.

  • Full bed bath vs partial bed bath

    • Full bed bath: washing the entire body.

    • Partial bed bath: washing select areas (e.g., face, hands, arms, underarms, back, buttocks, perineal area); sometimes only face or feet and legs are washed.

    • Probing questions from class: would you ever just wash feet and legs, or back and buttocks, or just the face? Partial baths are used depending on patient needs, mobility, and tolerance.

  • Back rub during a bed bath

    • Purpose beyond removing perspiration and odor: promotes relaxation, improves circulation, and helps prevent pressure injuries through improved skin perfusion.

Bed bath equipment and room setup

  • Bed pad use and containment of moisture during baths.

  • Equipment for transfers and toileting

    • Discussion of a transfer device with a bucket underneath it (likely a bedside commode or bedpan setup).

    • Mention of a shower chair as an alternative.

    • Importance of having appropriate equipment ready for transfers to minimize risk of injury.

  • Commode use in home care

    • Homecare clients may use a commode on the main floor if stairs or bathroom location makes upstairs access difficult (e.g., after a hip issue).

Transfers, mobility, and end-of-life planning

  • Lifting and transfer steps discussed (referencing a device like a gurney/shower chair and bucket under it)

  • End-of-life care

    • Hospice as the term for end-of-life care when prognosis is poor and focus shifts to comfort.

  • Power of attorney and decision-making

    • If someone has dementia and cannot make health care or financial decisions, a healthcare power of attorney is appointed to make medical decisions.

    • A financial power of attorney handles financial affairs.

    • Sometimes a judge or the courthouse may appoint an independent person; the decision-maker may be a family member, a nurse, or another designated individual.

Special care considerations: ADLs, feeding, and nutrition

  • Activities of Daily Living (ADLs)

    • Include basic personal care: bathing, dressing, feeding, toileting, mobility/transfers, grooming, etc. These are addressed to maintain independence where possible and ensure safety.

  • Assisting with feeding for dependent patients

    • If the patient is totally dependent, staff must adapt: describe the food to them (verbal), use positive verbal approaches, and use nonverbal cues when needed.

    • Consider textures and visibility: example with pureed meat, some people dislike how it looks; still provide assistance and reassurance.

Diets, intake, and nutrition knowledge

  • Abbreviations and diet types

    • NPO = Nothing By Mouth.

    • Diet types to recognize: clear liquid diet, full liquid diet, diabetic diet.

    • You don’t need to memorize every diet detail, but know when each is appropriate (e.g., pre-procedure for NPO, transitional diets post-procedure, diabetic diet for glucose control).

  • Diet considerations and examples

    • Low sodium diet vs low cholesterol diet: what would stand out in each case; implications for fluid balance and cardiovascular risk.

    • Carbohydrates and sugars

    • Distinction between "bad sugars" and "good carbs." Mediterranean diet and emphasis on whole grains vs white flour.

  • Fluid balance and retention

    • Fluid retention and possible fluid overload (e.g., congestive heart failure or kidney issues).

    • Doctors may order diuretics like Lasix to reduce excess fluid and may place a fluid restriction as needed.

  • Dehydration and constipation risk

    • Constipation can be common in elderly patients, especially with poor fluid intake; ensure adequate hydration to maintain bowel movement and overall comfort.

Nutrition and eating assistance specifics

  • Barriers to eating for residents

    • Several factors can make eating difficult: cognitive impairment, vision loss, dental problems, taste changes, mouth pain, or swallowing difficulties.

    • Caregivers should adapt feeding practices accordingly and still provide a positive, supportive environment.

Oral care, grooming, and daily care frequency

  • Oral care

    • Usually performed at least twice daily; ensure patient’s teeth are brushed unless contraindicated.

  • Hair care

    • Combing hair or grooming should be done to maintain dignity and hygiene; frequency varies, but aim for regular care.

  • Daily care minimums

    • At a minimum, basic care should occur at least once a day; more frequent care as needed based on patient condition.

  • Back rub and skin care during bathing

    • Regular back rubs help with relaxation and circulation, reducing risk of skin breakdown.

Pressure ulcers and turning schedules

  • What pressure ulcers are

    • Also called pressure sores or bed sores.

    • Caused by damage to the skin and underlying tissue due to prolonged pressure on bony prominences, resulting from poor circulation and immobility.

  • Prevention through repositioning

    • Regular repositioning is essential: commonly a schedule like every 2 hours; some guidelines suggest hourly turning depending on risk level.

  • Skin and circulation concepts

    • Emphasize maintaining circulation to vulnerable sites to prevent tissue necrosis and breakdown.

Urinary and bowel health: common elderly concerns

  • Urinary tract infections and bacteremia

    • In elderly patients, infections in the urinary tract can progress to the bloodstream if not promptly treated, especially in those with incontinence or immobility.

  • Constipation and bowel regularity

    • Constipation is a frequent issue due to reduced activity, medications, dehydration, and dietary factors; address hydration and fiber as appropriate.

Common clinical scenarios and terms from the lecture

  • Full code vs DNR (do not resuscitate)

    • Full code: resuscitation attempts should be made in the event of cardiac arrest.

    • DNR: do not resuscitate; patient or surrogate decision to withhold CPR.

  • Dementia and healthcare decisions

    • If a patient cannot make healthcare decisions, designate a healthcare power of attorney; finances may be handled by a separate financial power of attorney; in some cases a judge or appointed official may intervene.

Quick reference: key numeric concepts and rough guidelines discussed

  • Intake calculations from foods and fluids

    • If a beverage volume is $V$ cc and a fraction $f$ is consumed, the intake is ext{intake} = f imes V. For example, a $V = 240$ cc beverage consumed by fraction $f = frac{1}{4}$ yields ext{intake} = frac{1}{4} imes 240 = 60 ext{ cc}.

  • Repositioning frequency

    • Common guideline: reposition every 2 hours; some settings may aim for every 1 hour depending on patient risk and care setting.

  • Hospice eligibility (life expectancy reference)

    • Hospice care is considered when a patient is not expected to live more than about ext{six months}, though individual prognoses vary.

Connections, implications, and real-world relevance

  • Ethical and practical implications of end-of-life decisions

    • Balancing patient autonomy with surrogate decision-making and medical judgment; importance of clear communication with family and care team.

  • Practical caregiving implications

    • Ensuring continuity of care across shifts (bathing, ADLs, transfers), using appropriate equipment (bedpans, commodes, shower chairs), and maintaining patient dignity.

  • Preventive care in geriatrics

    • Regular repositioning, skin checks, oral care, hydration, and nutrition are foundational to reducing complications like pressure ulcers, infections, and malnutrition.