CNA State Review
End of Year Review
1
Illness
Acute
Sudden illness, expected to recover
Chronic
Slow, no known cure but can be controlled
Terminal
Illness or injury from which the person will not likely recover
Person’s Rights
Information
Refuse treatment
Privacy/confidentiality
Personal choice
Disputes/grievances
Work
Participate in resident and family groups
Care and security of personal possessions
Freedom from abuse, mistreatment, and neglect
Freedom from restraints
Quality of life
Right to exercise citizenship
THERE IS NO RIGHT TO FREE HEALTH CARE!!!!!!!!
Which is TRUE regarding resident’s rights?
Resident’s mail can be opened by any employee
Residents have the right to have a telephone conversations in private
Residents’ closets and drawers can be searched to look for lost items
Residents may only visit with others in an area where they can be seen and heard by others
Which is TRUE regarding resident’s rights?
Resident’s mail can be opened by any employee
Residents have the right to have a telephone conversations in private
Residents’ closets and drawers can be searched to look for lost items
Residents may only visit with others in an area where they can be seen and heard by others
The following statements are about the care of residents. Which is FALSE?
Residents must be free from abuse, neglect, and mistreatment
Residents can be restrained to prevent them from leaving the facility
Participation in activities is important for residents’ quality of life
Allowing personal choice is important for residents quality of life
The following statements are about the care of residents. Which is FALSE?
Residents must be free from abuse, neglect, and mistreatment
Residents can be restrained to prevent them from leaving the facility
Participation in activities is important for residents’ quality of life
Allowing personal choice is important for residents quality of life
Under the OBRA, a resident has all the following rights except one. Which is FALSE?
The right to be treated with respect
The right to visit with others in private
The right to have a private room in which to live
The right to have an environment that is clean and safe
Under the OBRA, a resident has all the following rights except one. Which is FALSE?
The right to be treated with respect
The right to visit with others in private
The right to have a private room in which to live
The right to have an environment that is clean and safe
Who decides how the resident’s hair should be styled?
The nurse
The family
The resident
The NA
Who decides how the resident’s hair should be styled?
The nurse
The family
The resident
The NA
The Nursing Assistant NEVER:
Give medications of any kind
Take orders from the doctor
Performs sterile procedures
Tells the person/family the dx or medical or surgical plans
Inserts or removes tubes or objects from the person’s body
Diagnose or prescribe treatment or meds
Supervises another nursing assistant
IGNORES an order
A nurse assigns you a task. You do not understand the instructions. You should
Try your best
Ask the resident what to do
Ask the nurse for clarification
Refuse to carry out the request
A nurse assigns you a task. You do not understand the instructions. You should
Try your best
Ask the resident what to do
Ask the nurse for clarification
Refuse to carry out the request
Nursing assistants
Never give medications
Can supervise other nursing assistants
Do not perform personal hygiene measures
Must perform all tasks and procedures as directed
Nursing assistants
Never give medications
Can supervise other nursing assistants
Do not perform personal hygiene measures
Must perform all tasks and procedures as directed
Who is responsible for telling the resident and family about diagnosis and treatment?
The nurse
The physician
Any staff member
The nursing assistant
Who is responsible for telling the resident and family about diagnosis and treatment?
The nurse
The physician
Any staff member
The nursing assistant
You are planning and organizing your assignment. Which is FALSE?
Collect supplies as you need them
List necessary care or procedures on a schedule
Plan care around meals, visiting hours, therapies, and activities
Ask a co-worker for help when needed. Give the approximate time you will need assistance.
You are planning and organizing your assignment. Which is FALSE?
Collect supplies as you need them
List necessary care or procedures on a schedule
Plan care around meals, visiting hours, therapies, and activities
Ask a co-worker for help when needed. Give the approximate time you will need assistance.
OBRA---Omnibus Budget and Reconciliation Act of 1987
Set minimum training and competency evaluation requirements (OBRA - 75 hours)
Illinois----80hrs theory, 40 hrs clinical
85 multiple choice questions
You have 3 attempts
Nurse Aide Registry
Retesting if you have not worked in 24 months
Resident Rights and Quality of life for nursing home residents (NOT for hospitals)
Ethics and Laws
Boundary Issues:
Avoid caring for someone you do business with
Don’t borrow from resident
Don’t accept gifts, loans, money
Don’t help them with their finances
Don’t take the resident home with you
Neglect or negligence
Unintentional wrong
Person did not act in a reasonable and careful manner and the person or their property was harmed
Examples
Not answering a call light and the person falls going to the bathroom
Not following manufacturer's instructions on mechanical lift and the person slips out of the sling
Not reporting to the nurse any changes in status
Not identifying the resident and perform care to wrong person
These statements are about negligence. Which is TRUE?
It is an intentional tort
Harm was caused to a person or a person’s property
The negligent person acted in a reasonable manner
NA’s cannot be held liable for any negligent acts
These statements are about negligence. Which is TRUE?
It is an intentional tort
Harm was caused to a person or a person’s property
The negligent person acted in a reasonable manner
NA’s cannot be held liable for any negligent acts
Which of the following would probably NOT be negligent conduct?
A resident’s dentures break after being dropped by the nursing assistant
A resident is burned because a nursing assistant applied a warm water bottle what was too hot
A nursing assistant reports a resident’s complaint of chest pain and difficulty breathing
The side rails have been ordered for the confused resident. The NA leaves the side rails down. The resident falls out of bed and breaks a hip.
Which of the following would probably NOT be negligent conduct?
A resident’s dentures break after being dropped by the nursing assistant
A resident is burned because a nursing assistant applied a warm water bottle what was too hot
A nursing assistant reports a resident’s complaint of chest pain and difficulty breathing
The side rails have been ordered for the confused resident. The NA leaves the side rails down. The resident falls out of bed and breaks a hip.
A resident refuses to have a bath. The nursing assistant tells her that she is going to have a bath whether she likes it or not. This is an example of
Assault
Battery
Defamation
False imprisonment
A resident refuses to have a bath. The nursing assistant tells her that she is going to have a bath whether she likes it or not. This is an example of
Assault
Battery
Defamation
False imprisonment
A nurse tells you to give Mr. Smith a sleeping pill. You tell the nurse that you are not allowed to give medications. She tells you to go ahead and not to worry because no one else will know. She also tells you she will accept blame if anything goes wrong. Which statement is TRUE?
You have to give the pill because the nurse directed you to do so.
You have nothing to worry about. The nurse said she would take the blame.
You are legally responsible for your own actions. Mr. Smith can sue you for causing harm.
Mr. Smith cannot sue you. He can only sue the nurse because she is legally responsible for your actions.
A nurse tells you to give Mr. Smith a sleeping pill. You tell the nurse that you are not allowed to give medications. She tells you to go ahead and not to worry because no one else will know. She also tells you she will accept blame if anything goes wrong. Which statement is TRUE?
You have to give the pill because the nurse directed you to do so.
You have nothing to worry about. The nurse said she would take the blame.
You are legally responsible for your own actions. Mr. Smith can sue you for causing harm.
Mr. Smith cannot sue you. He can only sue the nurse because she is legally responsible for your actions.
Defamation
Injuring a person’s name and reputation by making false statements to a third person.
Libel: in print, writing, or through pictures or drawings
Slander: oral
Examples:
Implying that a person uses drugs
Saying the they are insane
Suggesting that they are stealing money
False Imprisonment
Unlawful restraint or restriction of a person’s freedom of movement
Examples:
Threatening to restrain a person
Restraining a person without consent
Preventing a person from leaving the agency
The intentional attempt or threat to touch a person’s body without the person’s consent is
Assault
Battery
Defamation
False imprisonment
The intentional attempt or threat to touch a person’s body without the person’s consent is
Assault
Battery
Defamation
False imprisonment
Protecting the Right to Privacy
Keep all information about the person confidential
Cover the person when being moved in the hallways
Screen the person. Pull the curtain. Close the door and window coverings
Expose only the body part involved in the task
Don’t discuss about the person to anyone else except the nurse supervising you
Don’t open the person’s mail
Allow the person to visit/use phone in private
Which is an invasion of privacy?
A resident is covered while being moved on a stretcher
The door to the resident’s room is closed while a treatment is being given
A resident is being given a back rub. Only the resident’s back is uncovered
The resident’s condition and treatment are discussed with the resident’s cousin who works in the dietary department
Which is an invasion of privacy?
A resident is covered while being moved on a stretcher
The door to the resident’s room is closed while a treatment is being given
A resident is being given a back rub. Only the resident’s back is uncovered
The resident’s condition and treatment are discussed with the resident’s cousin who works in the dietary department
Which will not protect the person’s right to privacy?
Asking visitors to leave the room when care must be given
Exposing only the body part involved in a treatment or procedure
Making sure the person is covered when being moved in corridors
Staying with the person while he or she use the telephone or visits with others
Which will not protect the person’s right to privacy?
Asking visitors to leave the room when care must be given
Exposing only the body part involved in a treatment or procedure
Making sure the person is covered when being moved in corridors
Staying with the person while he or she use the telephone or visits with others
Ombudsman
Act on the behalf of persons receiving health care at home and in facilities
They protect a person’s health, safety, welfare, and rights!
Investigate and resolve complaints
Provide assistive services
Monitor nursing center care
Support resident and family groups
Represent older persons’ interests before local, state, and fed governments
Abuse
It’s a CRIME!
We are mandatory reporters!
Never promise to keep an abuse secret
If you suspect abuse (even if by the person’s partner)---tell the nurse
If the nurse doesn’t do anything about it, you need to go to the Administrator
Signs of Elder Abuse
Living conditions unsafe, unclean, inadequate
Poor personal hygiene
Weight loss
Broken or missing assistive devices (glasses, hearing aids, dentures, walkers, etc.)
Old or new injuries
c/o pain, itching in genital area
Pressure ulcers
Fearful, withdrawn depressed
Signs of Elder Abuse (continued)
Person is restrained
Private conversations is not allowed
Anxious around caregiver
Meds not taken properly (too much or too little)
Frequent ER visits
Frequent change of doctors
Actions to Take if Abuse is Suspected
The matter is reported at once to the administrator
All claims must be thoroughly investigated
Center must prevent further potential of abuse while it’s investigated
Investigation results are reported to the center administrator within 5 days
Corrective actions are taken place if claim is true
Medical Record
Written or electronic account of person’s condition and response to treatment or care
It’s a permanent and legal document
Admission record – identifying information (name, DOB, address, nearest relative and legal rep, allergies, dx, Dr.)
Health History (nursing hx)– chief complaint, illness hx, past health hx, meds, allergies, assistive devices
Medical Record (continued)
Graphic Sheet– used to record daily, q shift, or 3 to 4 times/day (ex. VS, I & O)
Progress Note– Nurse records sx, tx, drugs, teaching, procedures, and visits by health team members
Flow sheets– frequent measurements (ex. VS q 30 min. Or a bedside I & 0)
The main purpose of the residents record is to
Serve as evidence of resident care in court
Communicate information about the resident care
Serve as a history or the resident’s illness and treatment
Provide the family with a written account of the resident’s care and treatment
The main purpose of the residents record is to
Serve as evidence of resident care in court
Communicate information about the resident care
Serve as a history or the resident’s illness and treatment
Provide the family with a written account of the resident’s care and treatment
Each page of the residents record
Is the same
Must be numbered
Must be signed by the doctor
Must have the resident’s identifying information
Each page of the residents record
Is the same
Must be numbered
Must be signed by the doctor
Must have the resident’s identifying information
Reporting
Whenever there is a change from normal
When you leave unit
Report only what you did or observed yourself
Recording
What you observed
What you did
The person’s response
General rules:
Always use date and time
Only agency approved abbreviations
Sign all entries with name and title
Chart after care is given—not before
Avoid terms with more than one meaning (not “small”, “short”, “big”)
Record safety measures (call light in place, bed lowered, alarm on, etc.)
End-of-Shift Report
Nurse gives a report at the end of the shift to the oncoming staff
What would you do if : You just walk into work and many call lights are on. Should you answer the call lights before you get report?
Yes, go ahead BUT;
Check with the Kardex/care plan before granting the request
Ask a nurse about care needs of a new patient
Do not take directions from another NA---remember NA’s cannot supervise or delegate other NAs
24-hour clock
Has 4 digits and NO a.m. or p.m.
First two digits—hour
Second two digits—minutes
Hour is the same in the morning (except you may have to a “0” at beginning)
If after 12 noon---add 12 to the hour
Example:
1:23 PM=1323
7:41 AM=0741
Abdominal Regions
Directional Terms
Using the computer
Don’t tell anyone your user name or password
Change your password often
Prevent others from seeing what’s on the screen
Log off after finished
Don’t email confidential information
Don’t us it for your personal use
Answering the Phone
Be courteous
Give name and title in a health care setting
Don’t put callers with an emergency on hold
Don’t lay the phone down when not speaking to the caller (may overhear)
Don’t give confidential info to any caller
CNA’s Don’t take orders from the Doctor
Observation--Using the senses of sight, hearing, touch and smell to collect information
Objective (signs)
Observed: Seen, heard, felt, or smelled
Examples:
Vital signs
Color of urine
Smell of drainage
Subjective (symptoms)
What the person TELLS you
Examples:
Pain
Nausea
headache
Observations to report at once
Change in person’s ability to respond
Change in person’s mobility
Complaints of sudden, severe pain
Sore or reddened area on skin
Sudden change in vision
c/o pain or difficulty breathing
Vomiting
Bleeding
Difficulty swallowing
Abnormal VS
Safety
Identify the person!
Some have ID bracelets, some use a photo ID system
Prevent poisoning
Keep harmful products locked up
Leave original label on harmful products
The best way to identify a resident before giving care is to
Ask the nurse
Call the resident by name
Read the resident’s identification bracelet
Check the name on the door to the resident’s room
Answer
The best way to identify a resident before giving care is to
Ask the nurse
Call the resident by name
Read the resident’s identification bracelet
Check the name on the door to the resident’s room
Choking --- FBAO
If coughing (mild airway obstruction)—encourage to continue coughing
Not speaking, breathing, or coughing (severe airway obstruction)—abdominal thrusts to the abdomen
If obese or pregnant– chest thrusts
Wheelchair Safety
Make sure wheels can lock
Check for flat or loose tires
Casters point forward—keeps w/c stable
Keep person’s feet from dragging the floor when pushing
Only push forward. Don’t pull
Lock!—before transfer
Don’t let person stand on footplates
Remove armrests (if removable) for transfers
Swing front rigging out of way for transfers
Stretcher Safety
Three people to transfer—two to pull and one to “push”
Keep side rails up during transfer
Never leave someone alone on a stretcher!
Keep person’s arms, hands, and legs inside the “vehicle” at all times ☺ (don’t let them dangle through the side rails
Raise the bed to the height of the stretcher
Stretcher Transfer
A resident is being transported on a stretcher. Which is FALSE?
Safety straps are applied
The resident is moved feet first
The side rails are kept up when transporting the resident
The resident can be left alone if the safety straps are in place
A resident is being transported on a stretcher. Which is FALSE?
Safety straps are applied
The resident is moved feet first
The side rails are kept up when transporting the resident
The resident can be left alone if the safety straps are in place
MSDA
Material Safety Data Sheets
Know where this is located!
Provides detailed info about substance
Chemical name and common name
Ingredients
Health hazards including symptoms
ER and first aid procedures
How to clean up a spill
Hazardous Substances
Read all warning labels
Use leak proof container
Wear PPE to clean up spills
Use cleaning products in well-ventilated area
Don’t mix products
Fire and Oxygen
Remind visitors not to smoke in room
Cigarettes/lighters removed from room
Wool blankets or synthetic fabrics that cause static are removed
Person wears cotton P.J.’s
No lit candles or open flames
No nail polish remover, grease, oil (ignite easily)
Fire--RACE
R--rescue. Rescue persons in immediate danger
A—alarm. Sound the nearest alarm
C—confine. Close doors and windows to confine the fire. Turn off oxygen!
E—extinguish. Use a fire extinguisher on small fire
Never use elevators if there is a fire!!!!
Fire Extinguisher--PASS
P– pull the safety pin
A—aim low (at base of fire)
S—squeeze the lever
S—sweep back and forth
The fire alarms rings in the facility. What should you do first?
Locate the fire
Pull the closet alarm
Take the fire extinguisher to scene
Move all resident’s out of the building
The fire alarms rings in the facility. What should you do first? (RACE)
Locate the fire
Pull the closet alarm
Take the fire extinguisher to scene
Move all resident’s out of the building
Since the alarm has already sounded, the first thing you should do is locate the fire. There is no need to pull the alarm again. After the fire has been located, a fire extinguisher can be taken to the scene. Determine if the resident should be evacuated.
Personal Belongings
Count money with the person
Put money and jewelry items in envelope.
Fill out a personal belongings list
Label items if possible
Dentures, glasses, hearing aids, etc. are kept at bedside
Preventing Falls
Answer call lights promptly
Report anything unsafe to the nurse at once
Meet basic needs
Floors free from clutter
Non-skid footwear
Call lights, phone, and personal belongings
within reach
Bed at correct height
Alarms in place and working
Bed Rails
Considered restraints if:
The person can’t get out of bed
The person can’t lower them without help
Follow the care plan
Entrapment is a risk!
Never leave the person alone when the bed is raised
May have to have a co-worker assist is there are no side rails
Transfer/Gait Belts
Around the waist
Over clothing
Above a wound, G-tube---check with the nurse if one is used.
Under the breasts
Buckle never over the spine
Snug-slide an open hand under
Tuck excess strap
Falling Person
Don’t injure yourself trying to prevent the fall
Ease them to the floor
Don’t move them until the nurse checks for injuries
May need to help with an incident report
Restraints
Must protect the person
Requires a doctor’s order
Least restrictive method
Used only after other measures have failed
Unnecessary restraint is false imprisonment
Informed consent is required
Restraints (continued)
Follow manufacturer’s instructions
Observe q15 minutes
Remove restraint q 2 hours for at least 10 minutes
Vest restraint—”V” neck is in the front
Never attach restraint to the bedrails
Use a Quick-Release tie to secure
Attach to the moveable part of bed frame
Which statement about restraints is FALSE?
Restraints require a doctor’s order
A restraint should prevent all movement of the body part
Bony areas need to be padded when a restraint is applied
A resident may become more confused and agitated after restraints are applied
Which statement about restraints is FALSE?
Restraints require a doctor’s order
A restraint should prevent all movement of the body part
Bony areas need to be padded when a restraint is applied
A resident may become more confused and agitated after restraints are applied
Notify the nurse immediately if
The restraint is secured to the bed frame
The resident is having difficulty breathing
The resident keeps pulling at the restraint
The resident’s fingers and toes are warm and pink
Notify the nurse immediately if
The restraint is secured to the bed frame
The resident is having difficulty breathing
The resident keeps pulling at the restraint
The resident’s fingers and toes are warm and pink
The resident complains of numbness and tingling in the restrained part. You should
Remove the restraint
Reposition the resident
Tell the nurse immediately
Reassure the resident and explain why the restraint is needed
The resident complains of numbness and tingling in the restrained part. You should
Remove the restraint
Reposition the resident
Tell the nurse immediately
Reassure the resident and explain why the restraint is needed
S/S of Infection
Fever
Chills
Increased pulse
Increased respirations
Fatique
N/V/D
Redness/swelling
Heat/warmth at site
Head ache
Aches
Confusion
Loss of appetite
Rash
HAI
Healthcare-associated infection
Infection cared for in any setting where healthcare is given
Also called– nosocomial
Possible HAI’s:
Clostridium difficile
Hepatitis A,B, and C
HIV
Influenza
MRSA
TB
VRE
Medical vs. Surgical
Medical asepsis
(clean technique)
Surgical asepsis
(sterile technique)
Removes or destroys pathogens
Prevents spreading of pathogens
Keeps items free from ALL microbes
Destroys ALL microbes (pathogens and non-pathogens
The practices that prevent the spread of pathogens from one person or place to another are called
Sterilization
Handwashing
Contamination
Medical asepsis
The practices that prevent the spread of pathogens from one person or place to another are called
Sterilization
Handwashing
Contamination
Medical asepsis
All microorganisms are destroyed. This process is
Sterilization
Disinfection
Contamination
Medical asepsis
All microorganisms are destroyed. This process is
Sterilization
Disinfection
Contamination
Medical asepsis
Hand Hygiene
Soap and Water
Alcohol-based hand rub
When visibly soiled
Before eating or after using the restroom
If alcohol-based hand rub is not available
Before and after contact with person
After contact (if not visibly soiled)
Moving from contaminated body site to clean
After contact with objects
After removing gloves
Hand Washing
Warm water
Don’t touch sink
Hands lower than elbows
Good lather
Friction is key
Don’t forget thumbs, wrists, and under nails
Wash for at least 15 seconds
Dry from fingertips to forearm
Use clean, dry paper towel for EACH faucet.
Alcohol-Based Hand Rub
Apply to palm of one hand
Rub together
Make sure you cover all surfaces of hands and fingers
Continue rubbing until hands are dry.
Standard Precautions
Used for ALL persons whenever giving care.
Includes:
Hand hygiene
PPE
You are going to clean a bedpan. Which should you do FIRST?
Rinse the bedpan with cold water
Use a brush to clean the bedpan
Wash the bedpan with hot water and soap
Ask the nurse if you should clean the bedpan
You are going to clean a bedpan. Which should you do FIRST?
Rinse the bedpan with cold water
Use a brush to clean the bedpan
Wash the bedpan with hot water and soap
Ask the nurse if you should clean the bedpan
Handwashing is an example of
Sterilization
Disinfection
Contamination
Medical asepsis
Handwashing is an example of
Sterilization
Disinfection
Contamination
Medical asepsis
Isolation Precautions
Used to prevent the spread of communicable disease (contagious disease)
Always includes Standard Precautions and Transmission Based Precautions
Types:
Contact
Droplet
Airborne
Contact—Transmission Based
Gloves
Gown whenever clothing may have direct contact
Masks if splashes are likely
Droplet—Transmission Based
Used for persons that pathogens are spread by respiratory droplets
Coughing, sneezing, or talking
Use PPE and a mask
Airborne—Transmission Based
Transmitted person to person by airborne route
Examples: TB, chicken pox, small pox, severe acute respiratory syndrome
AIIR (airborne infection isolation room)
Respirator mask (TB mask or N95 mask)
Transmission-Based Precautions
Person’s usually stay in room
May have to instruct (or have nurse instruct) visitors what PPE to wear. Don’t tell others the diagnoses. Just how to protect themselves.
Remove PPE before leaving room
May have to double-bag
Remove items in leak-proof bags
Transmission-based precautions are ordered. You should do all the following EXCEPT
Place clean items or objects on paper towels
Wash your hands if they become contaminated
Bag linens, equipment, and garbage before leaving room
Use paper towels to handle contaminated equipment and objects
Transmission-based precautions are ordered. You should do all the following EXCEPT
Place clean items or objects on paper towels
Wash your hands if they become contaminated
Bag linens, equipment, and garbage before leaving room
Use paper towels to handle contaminated equipment and objects
Use gloves to handle contaminated items
PPE Donning and Removing
Donning
Gowns
Mask
gloves
Removing
Gloves
Gown
Mask
If glove is torn---hand hygiene and apply another glove
Only wear them once-discard after use
Gloves go over the gown cuffs
Remove so the inside part is on the outside
Hygiene after gloves removed
Wet gown or mask is contaminated
What should you do first when removing a gown?
Wash your hands
Untie the neck strings
Untie the waist strings
Pull the gown down from the shoulders
What should you do first when removing a gown?
Wash your hands
Untie the neck strings
Untie the waist strings
Pull the gown down from the shoulders
Waist strings first, then neck strings, then remove gown from shoulders, then wash hands.
Transmission-based precautions
Prevent infection
Destroy pathogens
Destroy pathogens and non-pathogens
Keep pathogens in a specific area
Transmission-based precautions
Prevent infection
Destroy pathogens
Destroy pathogens and non-pathogens
Keep pathogens in a specific area
They prevent the spread of infection
Rules for Body Mechanics
Body good alignment with wide base of support
Avoid unnecessary bending and reaching. Raise the bed
Bed at your hips and knees
Get enough co-workers to help
Push, slide, or pull to avoid lifting
You are going to move a resident up in bed. The bed should be
As flat as possible
Raised at the foot
Raised at the head
In the low horizontal position
You are going to move a resident up in bed. The bed should be
As flat as possible
Raised at the foot
Raised at the head
In the low horizontal position
Fowler’s 45-60˚
Semi-Fowler’s 30-45º
High-Fowler’s 60-90º
Supine (or Dorsal Recumbent)
Prone
Lateral (side-lying position)
Sims
Left side-lying. Right leg sharply flexed. Left arm behind the person.
Often used for rectal procedures and enemas
Moving the Person to the Side of Bed
You are going to move a resident up in bed with assistance. Your co-worker should stand
At the foot of the bed
At the head of bed
On the same side of the bed as you
On the side of the bed opposite you
You are going to move a resident up in bed with assistance. Your co-worker should stand
At the foot of the bed
At the head of bed
On the same side of the bed as you
On the side of the bed opposite you
You are going to move a resident to the side of the bed. You should NOT
Raise the side rail on your side
Cross the resident’s arms over his or her chest
Move the resident in segments beginning with the neck and shoulders.
Stand on the side of the bed to which you will be moving the resident
You are going to move a resident to the side of the bed. You should NOT
Raise the side rail on your side
Cross the resident’s arms over his or her chest
Move the resident in segments beginning with the neck and shoulders.
Stand on the side of the bed to which you will be moving the resident
Logrolling
Logrolling involves
Using a mechanical lift
Always using a turning sheet
Moving the resident in segments
Turning the resident over in one motion
Logrolling involves
Using a mechanical lift
Always using a turning sheet
Moving the resident in segments
Turning the resident over in one motion
Dangling
Sitting on the side of bed
Orthostatic hypotension
Exercise the legs
A resident is dangling at the bedside. You observe that the resident has cyanosis, is pale, and is having difficulty breathing. What should you do?
Return the resident to the lying position
Immediately report your observations to the nurse
Encourage the resident to take a few deep breaths
Ask the resident to push both fists into the bed for support
A resident is dangling at the bedside. You observe that the resident has cyanosis, is pale, and is having difficulty breathing. What should you do?
Return the resident to the lying position
Immediately report your observations to the nurse
Encourage the resident to take a few deep breaths
Ask the resident to push both fists into the bed for support
Transferring
Transfer belt applied correctly
Non-skid shoes
Wheels locked
Transfers on the STONG side (strong side moves first)
Grasp the belt and don’t allow resident to grab around the neck
Bend knees NOT back!
Mechanical Lift
Follow Manufacturer’s Instructions
Must be trained to use the lifts
Have at least 2 people (Follow agency policy)
Make sure lift is in good working order
Make sure slings are safe
Battery is charged
BED POSITIONS
Fowler’s
BED POSITIONS
Semi-Fowler’s
BED POSITIONS
High-Fowler’s
BED POSITION
Trendelenburg- Doctored Ordered!!!
The head of bed is elevated on blocks and the foot is lowered. This position is called
Fowler’s
Semi-Fowler’s
Trendelenburg’s
Reverse trendelenburg’s
The head of bed is elevated on blocks and the foot is lowered. This position is called
Fowler’s
Semi-Fowler’s
Trendelenburg’s
Reverse trendelenburg’s
Entrapment
OBRA Requirements for Rooms
1-4 persons
Direct access to an exit corridor
At least 1 window
Closet for each person
Call system in room and bathroom
Toilet nearby
Proper bed with clean, comfortable mattress
Linens in good condition
OBRA Requirements for Rooms
Rooms clean
Room temp of 71-81
Sound and lighting comfortable
Free of pests/rodents
Hand rails in good repair
Personal items labeled and stored appropriately
Space for w/c or walker
Raised toilet seat if needed
Rules for Bedmaking
Good body mechanics
Medical asepsis
Hand hygiene before and after
Bring enough, but not extra linens
Extra linens are put in dirty utility
Clean linens on a clean surface
NEVER SHAKE
Keep bottom linen wrinkle-free
Make as much of ONE SIDE of bed as possible
Hold linens AWAY FROM UNIFORM
ROLL dirty linens AWAY from you
Bed Making
Types:
Closed-Linens are not folded back (like a hotel bed)
Open-top linens folded back and is ready for the resident
Occupied-a bed with a person in it
Surgical-linens folded to one side
Mr. Jones is sitting in a chair while his bed is being made. The top linens are folded back so that he can get into bed. This is a(an)
Open bed
Closed bed
Surgical bed
Occupied bed
Mr. Jones is sitting in a chair while his bed is being made. The top linens are folded back so that he can get into bed. This is a(an)
Open bed
Closed bed
Surgical bed
Occupied bed
When making a bed, the NA should follow the rules of
Surgical asepsis
Sterile asepsis
Medical asepsis
Isolation precautions
When making a bed, the NA should follow the rules of
Surgical asepsis
Sterile asepsis
Medical asepsis
Isolation precautions
The following observations are made about the closed bed. Which is INCORRECT?
The top linen is tucked in on the sides
The top sheet is tucked down over the blanket
The open end of the pillow is away from the door
The signal light is attached on top of the bed within resident reach
The following observations are made about the closed bed. Which is INCORRECT?
The top linen is tucked in on the sides
The top sheet is tucked down over the blanket
The open end of the pillow is away from the door
The signal light is attached on top of the bed within resident reach
Oral Hygiene
Wear gloves
Sit the person upright
Cover chest with towel
Brush teeth at a 45 degree angle
Brush tongue
Use a KIDNEY BASIN
Unconscious Mouth Care
Prevent aspiration by turning head to side
Use a padded tongue blade to hold mouth open
Use a sponge tipped applicator to clean mouth (make sure it is tight on the stick)
Done EVERY 2 HOURS
Dentures
Costly
Denture cup labeled
Never carry them in your hands! Slippery when wet!
Cover the sink or basin with a towel/wash cloth
Use cool or warm water. NEVER HOT!
Rules for Bathing
Allow personal choice whenever possible
Follow Standard Precautions and Bloodbourne Pathogen Standard
Collect all needed item BEFORE
Provide PRIVACY
Know the WATER TEMP
Wash from CLEANEST TO DIRTIEST
Pat dry
Dry under the breasts, in skin folds, peri, and between toes
Keep bar of soap out of the wash basin
Complete Bed Bath
Bath blanket and towels/wash cloths
Bath basin 2/3 full to 110-115 degrees
Wash in this order COVERING the body parts to provide privacy:
Start at inner cannula of eye
Face/neck
Far arm and hand then nearest arm and hand
Chest then abdomen
Far leg then the nearest arm
Complete Bed Bath - Continued
Change water (also change prior to this is cool or soapy)
Wash back
CHANGE WATER TO 105-109 degrees
Perineal area
Back massage
Tub Baths and Showers
Clean before and after use
Floor should be dry and bath mat used
Cover the person
Turn COLD water on FIRST
Direct water away from the person when adjusting temperature
DO NOT LEAVE WEAK PERSONS UNATTENDED. Stay within hearing distance if left alone
Drain the tub before the person gets out
BACK MASSAGE
Last 3-5 minutes
Warm lotion
Firm strokes with constant contact with skin
DO NOT massage reddened bony areas
Side-lying position for the elderly is more comfortable
Perineal Care - Female
Water temp 105-109 degrees F
Keep covered with a bath blanket in the diamond shape
Perineal Care - Female
Perineal Care - Male
Clean tip in a circular motion
Start at meatus and work outward
Clean the shaft
Perineal Care - Uncircumcised
Retract foreskin
Clean tip
Rinse the area
Return the foreskin
Clean the shaft
Lice (Pediculosis)
Spreads easily through clothing, head coverings, furniture, linens, and sexual contact
Nits are tan to grayish-white and about the size of a sesame seed
REPORT
c/o tickling feeling or something moving in hair
Itching
Irritability
Sores or rash on head or body
Treated with medicated shampoo
Scabies
Mite is a small spider-like organism
High contagious and transmitted by close contact
S/S:
Rash and intense itching
Common between fingers, around wrists, underarms, thighs, and genital areas
Hair Care
Increases blood flow to scalp and brings oils to the hair shafts
Start at scalp unless tangled
Need consent to braid hair
Never cut matted hair
Use a wide-toothed comb for curly hair and start at the neckline
Protect clothing by using a towel or change the pillowcase if hair is present
Shaving
NEVER use SAFETY (disposable) razor on persons confused or on ANTICOAGULANTS
Soften skin by applying warm, moist washcloth
Hold skin taut
Shave IN THE DIRECTION with hair growth on the face
Apply direct pressure to nicks
Nail Care and Foot Care
NEVER cut the toenails of a DIABETIC
Soak fingernails 5-10 minutes and toenails 15-20 minutes
Cut straight across
Use a file or Emory board to shape
Use an ORANGE STICK to clean and push back cuticles
Jagged nails can cut the skin
Dressing
POW
Put on weak side first
TOSS
Take off strong side first
Undress the Unaffected side first
Dress the Affected side first
Urinary System
Bedpans
Used for persons who can’t get OOB
Fracture pan used for: casts, traction, limited back motion, hip fracture or surgery
Urinal
Men can use them when sitting, lying or standing
Commode
Catheters
NO kinks
Drainage bag below the level of the bladder
Attached to the bed frame-never the rail
Coil tubing on the bed
Secure the catheter to the inner thigh
Empty at the end of shift
If it becomes disconnected, wipe the ends with antiseptic wipe before reconnecting
Catheter Observations
c/o pain, burning, irritation
Crusting, abnormal drainage
Color, clarity, and odor
Urine leaking at the drainage site
Drainage bag
Clostridium difficile
Microbe that causes diarrhea and intestinal infections
Can cause death
Signs/Symptoms:
Watery diarrhea with a foul odor
Loss of appetite
Nausea
SPREADS BY CONTACT
WASH HANDS WITH SOAP AND WATER
Ostomies
Drain them at the bottom
Secure drain with a clip or clamp
Change the pouch every 3-7 days
Ileostomies need excellent skin care because of highly irritating liquid stool
Which can be used to clean the skin around a stoma?
Alcohol
Detergent
Soap and water
Hydrogen peroxide
Which can be used to clean the skin around a stoma?
Alcohol
Detergent
Soap and water
Hydrogen peroxide
All other agents are too harsh
Nutrients
Protein- tissue growth and repair
Carbohydrates- energy and fiber
Fats- energy and flavor
Vitamins- needed for body functions
Minerals- bone formation, nerve and muscle function, fluid balance
Aspiration S/S
Avoid food that needs chewing
Tires during a meal
Food spills out of mouth while eating
Food pockets or is “squirreled” in the person mouth
Eats slowly
Complains that food won’t go down or that its getting “stuck”
Frequently coughing or choking before, during, or after swallowing
Regurgitates food after eating
Food comes up through the person’s nose
Hoarse after eating
Makes gargling sounds while talking or breathing
Runny nose, sneezes, or has excessive drooling of saliva
Complains of frequent heartburn
Decreased appetite
Preventing aspiration
Help the person with meals and snacks
Position the person upright for at least 1 hour after eating
Support the back, shoulders, and neck with a pillow
Check the person’s mouth after eating for pocketing
Provide mouth care after eating
Report and record your observations
Measuring Intake and Output
Intake – all fluids taken by mouth, including foods that melt at room temp. (ice cream, sherbet, custard, pudding, gelatin, and Popsicles)
Output-
Urine
Vomitus
Diarrhea
Wound drainage
Measuring Intake and Output
1 oz. = 30 mL
A person drank ½ of an 8 oz. glass, how much fluid did the person drink in mL?
A person urinated three times during your shift. 250 mL, 125 mL, and 300mL. What was the total output?
1 oz. = 30 mL
A person drank ½ of an 8 oz. glass, how much fluid did the person drink in mL? 120 mL
A person urinated three times during your shift. 250 mL, 125 mL, and 300mL. What was the total output? 675 mL
Temperature
97.6 – 99.6ºF
Oral, rectal, tympanic, temporal, axillary
Know the sites
Do not do an oral temp if:
Unconscious
Oxygen
Mouth-breather
Confused
Seizure disorder
Thermometers
Glass thermometer is in .02 degrees
Use a sheath to cover thermometer
If doing a rectal temp, HOLD in place
Use a RED for rectal
Use a probe cover for a digital therm.
Carotid
Used for
Brachial
Located
Used for
Radial
Located
Used for
Apical
Located
Used for
Pulse
Pulse rate
Number of heartbeats or pulses felt in 1 minute
Tachycardia
Brachycardia
Taking a APICAL pulse
Must use a stethoscope
Must listen for a full minute
Because of irregular heart pulse or cardiac disorder
A resident’s pulse is very hard to feel. Report that the pulse is
Regular
Irregular
Full and bounding
Weak and thready
A resident’s pulse is very hard to feel. Report that the pulse is
Regular
Irregular
Full and bounding
Weak and thready
Which artery is normally used to measure a blood pressure?
Carotid
Brachial
Radial
Femoral
Which artery is normally used to measure a blood pressure?
Carotid
Brachial
Radial
Femoral
Respiration
12-20 is normal range
Done without the person knowing that the respirations are being measured (hand is kept on wrist to pretend that you are taking the pulse)
An inhalation and exhalation is ONE respiration
Counted for 30 seconds and multiplied by two
If irregular, count for full minute
Blood pressure
Systole (top number) is when the heart is contracting
Diastole (bottom number) is when the heart is relaxing and filling
Hypertension
Hypotension
Apical-Radial Pulse
Takes two people
One takes the apical pulse while the other takes the radial pulse
SHOULD be the same pulse, BUT if there is a difference, it could indicate a heart/circulatory disorder
NEVER would the radial pulse be higher than the apical pulse
Apical – Radial = the pulse deficit
Taking a BP
Clean stethoscope
Find brachial artery
Put cuff at least 1 inch above
Inflate 160 mmHg to 180 mmHg
Deflate at 2-4 mmHg per second
Read in 2 mmHg (should never get an odd number with an aneroid type—not digital)
NEVER do a BP in an arm with an IV or in the same side after breast surgery
Complications from Bedrest
Pressure ulcers
Constipation
UTIs
Blood clots
Pneumonia
Contractures
Atrophy
Orthostatic hypotension
Orthostatic hypotension
a.k.a. postural hypotension
Blood pressure drops upon standing or change in position
S/S
BP drops when position changes
Fainting (syncope)
Treatment
Change positions SLOWLY
Fowler’s-dangle-stand-ambulate
Positioning Devices
Foot boards – prevent plantar flexion (foot drop)
Trochanter rolls – prevent external rotation of the hips
Hip abductor wedges – keep hips abducted. Often used after hip surgery
Hand rolls/grips – prevent contractures of the thumb, fingers, and wrist
Bed cradles- keep top linens off the feet
Footboards
Trochanter Rolls
Prevent the hips and legs from turning outward (external rotation)
A bath blanket is folded to the desired length and rolled up
Loose end is placed under the person from the hip to the knee.
The roll is tucked along side the body
Hip abduction wedges
Keep the hips abducted (apart)
Wedge is placed between the person’s legs
Common after hip replacement surgery
Hand rolls or Hand grips
Prevent contractures of the thumb, fingers, and wrist
Foam rubber sponges, rubber balls, and finger cushions also are used
Bed cradles
Keep the weight of top linens off the feet and toes
Weight of top linens can cause footdrop and pressure ulcers on the tips of toes.
When you move a joint during ROM exercises and the person complains of pain, what should you do?
Continue performing ROM exercises
Stop the movement at the point the pain occurs
Give the resident pain medication before you continue
Push the resident to continue the exercises to restore movement
When you move a joint during ROM exercises and the person complains of pain, what should you do?
Continue performing ROM exercises
Stop the movement at the point the pain occurs
Give the resident pain medication before you continue
Push the resident to continue the exercises to restore movement
Cover the person with a bath blanket for warmth/privacy
Exercise only the joints the nurse tells you
Expose only the body part being exercised
Use good body mechanics
Support the part being exercised (proximally and distally)
ROM Safety
Move the joint slowly, smoothly, and gently
DO NOT force a joint beyond its present ROM
DO NOT force a joint to the point of pain
Ask the person to tell you if there is pain or discomfort
Observe for signs of pain
Know agency policy about doing ROM on the neck
ROM Safety (continued)
Use a gait belt!!!!
Walk to the side and slight behind the person’s weak side
Canes are held on the strong side
Ambulation safety
Pain
Acute, Chronic, Radiating, Phantom
Nurse will assess:
Location
Onset and duration
Intensity(0-10 or mild, moderate, severe)
Description
Factors causing pain (precipitating factors like moving in bed or coughing
Factors affecting pain (what makes it better or worse)
Vital signs (increase with acute pain)
Other s/s: dizziness, nausea, vomiting, weakness, numbness
Admitting a person
Prepare the room
Vital signs
Height and Weight
Height and Weight
Raise height rod
Move the weights to zero
Have person remove robe and footwear
Read weight
Read height
Collecting Specimens
Label the container accurately
Don’t touch the inside of the container
Collect the specimen at the time specified
No BM in a urine specimen
No toilet paper in the specimen
Urine Specimens
Random
Anytime with NO special measures
Midstream (clean-catch)
CLEAN FIRST; start urination; collect urine
24-hour urine
All urine voided in 24 hours
Stored in a large collection container and must be CHILLED (kept in fridge or on ice in BR)
If a voiding missed, MUST START OVER
Stool Specimens
Use a tongue blade to a take about 2 tablespoons from the middle of the stool (or from 2 different places)
NO urine can be in the stool
Sputum specimens
Person must rinse the mouth out with water prior to collecting sputum
Best if done in morning
Make sure your collecting sputum and not spit!
Preventing complications from surgery/immobility
Position and reposition
Leg exercises/exercise
Elastic stockings/TED hose
SCD
Cough and Deep Breathing
Incentive spirometer
Binders and Embolic Stockings
Apply binders and bandages so that firm, even pressure is exerted over the area.
They should fit snugly yet not interfere with breathing
Reapply binders is loose, wrinkled, or out of position
Leave toes or fingers exposed, if possible.
Check every hour (circulation, temp, color)
Binders are applied to
Prevent wound infections
Prevent blood clots in the legs
Decrease circulation and swelling
Provide support or hold dressings in place
Binders are applied to
Prevent wound infections
Prevent blood clots in the legs
Decrease circulation and swelling
Provide support or hold dressings in place
Elastic stockings are worn to
Increase swelling
Increase venous blood flow
Decrease venous blood flow
Encourage blood clot formation
Elastic stockings are worn to
Increase swelling
Increase venous blood flow
Decrease venous blood flow
Encourage blood clot formation
Preventing Pressure Ulcers
30-degree lateral position
Turn q 2 hours
Protective devices
Bed cradle, heel/elbow protectors, heel elevators, cushions
Apply powder where skin touches skin
Apply lotion to dry areas such as elbows, ankles, heels, hands, and legs
Hot/Cold Applications
Do not apply VERY HOT (106˚)
Measure temperature of moist applications
Cover dry applications before applying them
OBSERVE EVERY 5 MINUTES!
Not left on for longer than 20 minutes
Warm water is in contact with the skin. This a called a
Complication
Dry heat application
Local heat application
Moist heat application
Warm water is in contact with the skin. This a called a
Complication
Dry heat application
Local heat application
Moist heat application
Hot compresses are generally left in place
For 5 to 10 minutes
For 20 minutes
For 2 hours
continuously
Hot compresses are generally left in place
For 5 to 10 minutes
For 20 minutes
For 2 hours
continuously
Oxygen
YOU DON’T GIVE OXYGEN (it’s a drug)
Don’t remove O2 device
Don’t shut off O2 (unless there’s a fire)
Make sure there is no kinks in tubing
Report if flow rate is too high/low or if humidifier is not bubbling
A resident is receiving supplemental oxygen. You may
Adjust the flow rate of the oxygen
Give oral hygiene as directed by the nurse
Turn off oxygen until care is completed
Change the face mask to nasal cannula if the resident prefers
A resident is receiving supplemental oxygen. You may
Adjust the flow rate of the oxygen
Give oral hygiene as directed by the nurse
Turn off oxygen until care is completed
Change the face mask to nasal cannula if the resident prefers
Goal of REHABILITATION
Restoring the person to his or her highest possible level of physical, psychological, social, and economic function
Rehab begins when the resident enters the health care facility
Traction
Steady pull from two directions to keep bones in place
NEVER REMOVE
Weights must HANG freely
Fx pan
Linens changed from top to bottom
Hip Fracture Care
Parkinson’s
Communication for Dementia
Approach in calm, quiet manner
Approach from front
Point to objects
Speak slowly. Use simple words
Don’t “baby talk”
Give time to respond
Repeat as needed with consistent responses
CPR Basics
Goal: To keep oxygenating every organ until help arrives. (Not to determine if they are dead)
Determine if scene is safe (ex. downed wires).
Check responsiveness with a hard shake. Do not shake a person if you suspect a neck or spinal injury—do a sternal rub instead.
Look to see if they are breathing (do not need to do the head tilt-chin lift at this time) and check pulse (for no more than 10 sec.)
Activate EMS (call 911) or assign a helper to call while you begin CPR.
Compressions
Straight elbows and hands locked in middle of nipples.
Compress at least 2 inches
100 per minute (this is referring to the speed of compressions)
Airway
Head tilt-chin lift. If you suspect trauma- do a jaw thrust
Pinch nostrils and give 2-3 seconds per breath
Breathing
30:2 (30 compressions then 2 breaths) and repeat. Continue until help arrives
Recovery Position:
A good CNA!
Understand the roles, functions, and responsibilities
Ask for clarification
Don’t discuss your personal problems
Estimate how much time is needed for each procedure, person, and task
Identify when you will need help
You are legally responsible for your own actions
Keep all resident information confidential
The hearing impaired person
Gain attention as you approach
Face the person directly
State the topic of conversation first
Reduce or eliminate background noise
Watch your body language
If hearing aid doesn’t work: check the battery, on-off switch, earpiece placement, and cleanliness of earpiece
Culture and Religion
If a person requests a visit from their spiritual leader, be sure to promptly report that request to the nurse
Remember that each person is unique. Don’t judge the person by your own standards
Mrs. Greene refuses to eat certain food because of her religious beliefs. The NA should
Tell the doctor
Respect her religious beliefs and notify the nurse
Tell Mrs. Greene that she will not receive anything else to eat
Tell Mrs. Greene that she should eat the food because the doctor wants her to
Mrs. Greene refuses to eat certain food because of her religious beliefs. The NA should
Tell the doctor
Respect her religious beliefs and notify the nurse
Tell Mrs. Greene that she will not receive anything else to eat
Tell Mrs. Greene that she should eat the food because the doctor wants her to
Which statement is FALSE
Dietary practices may be influenced by both culture and religion
A person’s cultural background probably influences health and illness practices
A person’s religious and cultural practices are not allowed in the health care facility
A person may not follow all the beliefs and practices of his or her religion or culture
Which statement is FALSE
Dietary practices may be influenced by both culture and religion
A person’s cultural background probably influences health and illness practices
A person’s religious and cultural practices are not allowed in the health care facility
A person may not follow all the beliefs and practices of his or her religion or culture
The Dying Person
Always assume the dying or unconscious person can hear you
Provide oral hygiene, position changes, and linen/clothing changes as often as needed
Keep room well lit and ventilated. Remove unnecessary equipment
NO pulse, NO respirations, NO BP = death
Postmortem care is given after death to maintain body’s appearance
Put body in normal alignment before rigor mortis sets in
Treat the body with dignity and respect
Mouth care for the dying person is
Not necessary because the resident is not eating
Only done if the resident appears uncomfortable
Not done because it is painful and interrupts
Done frequently because secretions tend to accumulate
Mouth care for the dying person is
Not necessary because the resident is not eating
Only done if the resident appears uncomfortable
Not done because it is painful and interrupts
Done frequently because secretions tend to accumulate
Communicable Disease Control
Floors are contaminated. Anything that falls on the floor is contaminated
Don’t touch your hair, nose, mouth, or eyes when caring for a person
Double bagging may be needed when removing linens, trash, or equipment
Items removed from isolation room are bagged and labeled
Items that are contaminated with blood, body fluids, or body substances are referred to as Biohazardous Waste