CNA Comprehensive Lecture Notes: Safety, Emergency Care, and Ethics

Hazard Management and Chemical Safety

Choking Risks and Signs * Most sick or ill patients are at a high risk for choking due to nausea and difficulties in swallowing. * Difficulties can arise when taking large medications, such as a "horse pill" antibiotic. * Universal Sign for Choking: A person clutching their throat with one or both hands.
Poisoning and Harmful Substances * Facilities contain many harmful substances that must not be swallowed. * Sani-Cloth Wipes (Sandy Cloth): These are all-purpose, highly effective disinfectant wipes used extensively in healthcare environments. They are color-coded by purpose: * Purple Top: All-purpose, kills virtually all pathogens. * Pink Top: Specifically "seeded." * Red Top: Specifically for blood-borne pathogens. * Green Top: Hydrogen peroxide-based wipes. * Orange Top: Bleach-based wipes. * Usage Warnings: These are not skin or baby wipes and must be used on hard surfaces only. Proper Personal Protective Equipment (PPE), specifically gloves, must be worn when handled. * Dangers: These chemicals can cause cancer and chemical burns. Leaving a container in an unsupervised patient room is hazardous, particularly for hospice patients or those who are confused/not of sound mind. To prevent poisoning, all items brought into a room must leave with the healthcare worker.
Cuts and Abrasions * Definiton (Cut): A slice through the skin. * Definition (Abrasion): A result of falling or skidding, causing a "shearing" effect on the skin. * Safety Precaution: Personal grooming tools like nail clippers and scissors should be monitored as they can cause injury or be pulled by confused patients.

Fire Safety and Evacuation Protocols

Fire Safety Plan: All facilities have a specific plan. Unlike school environments where a teacher leads, in long-term care, the nurse or CNA is responsible for the safety of the residents.
Extinguishing fires (PASS Acronym): * P: Pull the pin. * A: Aim at the base of the fire. * S: Squeeze the handle. * S: Sweep back and forth.
Responding to Fires (RACE Acronym): * R: Remove anyone from danger (Rescue). * A: Alert (Hit the fire alarm, call $911$ ). * C: Contain the fire (Close doors and windows). * E: Extinguish the fire if possible and if it is small (e.g., a trash can fire in the shower).
Critical Thinking in Evacuation: * Prioritization: In an emergency, practitioners follow the principle of "the many over the few." If forced to choose, move mobile patients (e.g., $10$ mobile patients in a TV room) before returning for total care (bedridden) patients. * In-Room Rescue: If thick black smoke is billowing from a room and you cannot see inside, do not enter; close the door to contain it. If you can see the patient inside through the smoke, get low to the floor, rescue the patient, and then shut the door. * Survival Priorities: As a lone worker with up to $15$ patients, you cannot risk your life and leave the others without assistance if a room is non-navigable due to fire.

Disaster Guidelines and Man-Made Dangers

Natural Disasters: * Tornadoes: Common in the DFW (Dallas-Fort Worth) area. * Tornado Watch: Conditions are favorable for a tornado; one has not touched down. * Tornado Warning: A tornado has been spotted or is on the ground; immediate action is required. * Sheltering: Move to the lowest area, central rooms without windows, or bathrooms/tubs with a protective covering. In facilities, central shower rooms without windows are often designated shelters. * Hurricanes: Usually allow for several days of advance notice for evacuation orders. * Floods: Seek the highest ground possible. These can occur rapidly due to dam breaks or river overflows (e.g., the Trinity River). * Earthquakes: Not common in North Texas. If caught in one, seek shelter under a sturdy doorway or heavy oak furniture.
Man-Made Dangers: * Active Shooter: If the threat is in a different hall, evacuate immediately. If the threat is in your hall and you cannot leave, shelter in place (lock doors, lights off, hide). * Weaponization: A fire extinguisher can be used for self-defense. Pull the pin and spray at the attacker's face. This removes oxygen from the immediate vicinity, causing the individual to pass out.
Psychological Responses: Individuals experience Fight, Flight, or Freeze. Flight is useful in natural disasters for finding exits; those who Freeze should follow the instructions of a coworker who is "moving and grooving."

Medical Emergencies and Physical Assessment

Initial Scene Assessment: Before approaching a victim (e.g., a patient face down), ensure the scene is safe (check for water, electrical shorts, etc.).
Physical Signs and Skin Color Analysis: * Cyanotic: Blue-tinged skin, meaning a lack of oxygen (Cyan is a sky-blue shade). * White (Pale): Indicates a lack of circulation or loss of blood. * Red (Bright Cherry Red): Specifically indicates Carbon Monoxide ( $CO$ ) poisoning. The skin capillaries break and become hyper-oxygenated. This is also visible in mucous membranes (mouth, nose, tongue). * Swelling: Large, distended, or discolored (red and black) areas on the abdomen may indicate a rupture or internal bleeding.
The Sternum Rub: Used as a pain stimulant to check consciousness by rubbing knuckles into the sternum. * Contraindication: NEVER perform a sternum rub on geriatric patients, as their fragile skin and bones can tear or crack. It is only for young, healthy bodies.
Blood Volume: The average human adult has approximately $1.5\,\text{gallons}$ of blood.
CPR and Basic Life Support (BLS): * Certification through the American Heart Association (AHA) is standard for healthcare workers. * The Good Samaritan Law protects people performing CPR if they have called $911$ and are being talked through the process by an operator. * In jail or correctional environments, automatic CPR devices may be used to provide compressions while protecting staff.

Specific Clinical Emergencies

Choking Intervention: For partial or full obstruction, perform abdominal thrusts (formerly the Heimlich maneuver). Place a fist with the thumb outside on the diaphragm and pull up and in.
Shock: Occurs when organs do not receive adequate blood. Symptoms include low blood pressure, lightheadedness, and paleness. Treatment involves laying the patient down and elevating the legs to return blood to the core.
Myocardial Infarction (MI/Heart Attack): * Definition: Heart muscle dies due to blocked blood vessels preventing oxygen flow. * Male Symptoms: Chest pain, pressure, and sharp pain radiating down the left arm. * Female Symptoms: Lower abdomen and lower back pain (often mistaken for menstrual cramps), along with intense anxiety and a "sense of impending doom." * Response: Notify the nurse, place in a comfortable position, loosen clothing, do not provide food or drink, and take vital signs.
Burns and Scalds: Treat with cool, room-temperature water. Do not use very cold water (it causes shock) and do not use grease, oils, or ointments.
Syncope (Fainting): Fainting is a symptom, not a standalone condition. It is usually preceded by dizziness or low blood sugar.
Diabetic Emergencies: * Hypoglycemia (Insulin Reaction): Result of too much insulin or too little food. Symptoms: Nausea, dizziness, lethargy. * Hyperglycemia (Diabetic Ketoacidosis/DKA): Result of not enough insulin. Symptoms: Extreme thirst (polydipsia), flushed skin, and a distinct fruity/chemical breath odor (compared to the smell of Froot Loops left in milk overnight).
Seizures: * Absence Seizure: Brief "zoning out" lasting seconds; common and often caused by stress or dehydration. * Petite Seizure: Involves a localized twitch; may cause brief confusion. * Grand Mal Seizure: High-intensity thrashes and drooling. * Protocol: Notify the nurse, secure the patient's area (pad rails, move furniture), and START A TIMER. If a seizure lasts longer than $5\,\text{minutes}$ , it is life-threatening. Never put objects in the mouth; the human jaw exerts $200\text{--}400\,\text{lbs}$ of pressure per square inch.
CVA (Cerebrovascular Accident/Stroke): * TIA (Transient Ischemic Attack): A "mini-stroke" where symptoms resolve within $24\,\text{hours}$ . These are predictive of a major CVA. * FAST Acronym: * F (Face): Does one side of the face droop? * A (Arms): Can they lift both arms equally? * S (Speech): Is speech slurred (half of tongue is paralyzed)? * T (Time): Golden window is $6\,\text{minutes}$ from onset for permanent damage prevention.
Vomiting (Emesis): Always report to a nurse. If caught in a basin, do not discard it immediately so the nurse can inspect the color and consistency.

Infection Prevention and Control

Microorganisms (MO): Small living things visible only under a microscope. Harmful ones are called Pathogens.
Infection Types: * Localized: Limited to one area (e.g., an infected cat bite on a hand). * Systemic: Spreads throughout the entire body via the bloodstream. * Healthcare Associated Infection (HAI/Nosocomial): Contracted while in a healthcare setting (e.g., developing pneumonia because breathing exercises were ignored).
Chain of Infection (6 Links): 1. Causative Agent: The pathogen (HIV, Flu, etc.). 2. Reservoir: The person carrying the pathogen (Patient Zero). 3. Portal of Exit: How it leaves (blood, mucous membranes). 4. Mode of Transmission: Direct (touch) or Indirect (air/surfaces). 5. Portal of Entry: How it enters a new host (cuts, breathing it in). 6. Susceptible Host: An uninfected person (broken by vaccines).
Hand Hygiene: The single most important way to prevent the spread of disease. Wash hands before and after glove changes and patient contact.
Asepsis: * Medical Asepsis: Removal of $99.9999\%$ of bacteria (hand washing/disinfection). * Surgical Asepsis (Sterile Technique): Removal of $100\%$ of bacteria (Autoclaving tools).
Standard Precautions: Treating all bodily fluids (except sweat) as if they are infected.
Transmission-Based Precautions: * Airborne: Requires keeping the door shut and wearing an $N95$ or respirator (e.g., Tuberculosis). * Droplet: Requires at least a surgical mask. * Contact: Requires full kit (gown and gloves) because the pathogen is on surfaces (e.g., MRSA, C. Diff).
PPE Donning and Doffing: * Donning (On): Mask → Gown → Goggles/Face Shield → Gloves. * Doffing (Off): Gloves → Gown → Goggles/Face Shield → Mask.
Cleaning Spills: Fluids must be absorbed (cat litter, sawdust, or specialized polymers) before being wiped with disinfectant.

Common Infectious Pathogens

Hepatitis Types: * Hep A: Curable and reversible. * Hep B: Non-curable but treatable; preventable with a vaccine. Employers must provide the vaccine by federal law. Titers can be drawn to check for immunity. * Hep C: No cure and no vaccine; primarily spread through blood-to-blood contact (shared needles/tattoos).
Tuberculosis (TB): Formerly called "Consumption." Airborne and droplet disease that scars the lungs. It was the leading killer of mankind until the $21st$ century (excepting the Black Plague years).
Drug-Resistant Infections: * MRSA: Staph infection resistant to methicillin. Requires contact precautions and frequent dressing changes. * VRE: Resistant bacteria causing symptoms similar to $E.\,Coli$ (vomiting and diarrhea from both ends). * C. Diff (Clostridioides difficile): Highly infectious, spore-forming bacteria. It creates a distinct smell described as "sweet, rotting meat" or "a dead dog in the sun." It causes constant watery stool. It is difficult to kill because it behaves like a fungus/spore.

Human Growth, Development, and Psychosocial Needs

Needs Hierarchy (Maslow): 1. Physiological: Water, food, oxygen, rest. 2. Safety/Security: Shelter, income. 3. Love/Belonging: Affection, contact with others. 4. Self-Esteem: Success. 5. Self-Actualization: Reaching full potential.
Stages of Development: * Infancy (Birth- $12$ months): Growth from the head down. * Toddler ( $1\text{--}3$ ): Coordination and bowel/bladder control. * Preschool ( $3\text{--}5$ ): Social groups and sense of right/wrong. * School Age ( $5\text{--}10$ ): Brain size increases; development of conscience and self-esteem. * Adolescence ( $12\text{--}18$ ): Puberty (starts earlier for females) and strong peer influence. * Adulthood ( $18\text{--}65+$ ): Career, mate selection, and coping with aging/loss.
Holistic Care: Caring for both the mind and body. This includes respecting religious and spiritual choices (e.g., Scientology, Mormons, Jehovah’s Witnesses) without judgment or interference.
Cultural Sensitivity: Understanding race (physical ancestry) versus ethnicity (language/culture).
Mental Health Disorders: * Depression: Loss of interest (Apathy). * Bipolar: Mood swings between high (manic) and low (depressive). * Anxiety: Includes Phobias, OCD (repetitive thoughts/actions), and PTSD (trauma-related). * Schizophrenia: Involves Hallucinations (seeing things) or Delusions (believing things that aren't true, such as being the President).

End-of-Life Care and Death

Five Stages of Grief (Kübler-Ross): Denial, Anger, Bargaining, Depression, Acceptance. Not everyone goes through every stage or in order.
Advanced Directives: * Living Will: Written document of a person's medical wishes. * Durable Power of Attorney for Healthcare: A designated proxy to make decisions. * DNR (Do Not Resuscitate): A legal order to not perform CPR. Tattoos are not legally binding; the document must be on file.
The Dying Process: * Cheyne-Stokes Breathing: Irregular breathing patterns characterized by shallow breaths and periods of apnea (no breathing). Usually indicates death within $72\,\text{hours}$ . * Death Rattle: A gurgling sound caused by air passing through thickened mucus in the throat. * Mottling: A bruised, blotchy appearance on the skin due to failing circulation.
Postmortem Care: Involves cleaning the body, changing gowns, and positioning the patient to look like they are sleeping. This must be done quickly before Rigor Mortis (body stiffness) sets in, which can occur $1\text{--}6\,\text{hours}$ after death (faster in emaciated patients).
Care Philosophy: * Hospice: Care for the terminally ill focusing on a "good death." * Palliative: Focuses on pain relief and comfort for chronic or terminal conditions.

Questions & Discussion

Footwear in Healthcare: Discussion on non-porous shoes (leather or combat boots) versus porous ones (HOCAs or mesh). Porous shoes absorb vomit, pus, and blood, making them unsanitary.
Sundowning and Dementia: How to handle confused patients at night. Strategy involves redirection and distraction rather than direct confrontation or corrections.
Consensual Intimacy: Healthcare workers should mind their own business regarding consensual relationships between geriatric residents, regardless of age or gender.
Final Class Notes: The instructor clarifies that the upcoming test will be multiple choice, closed-book/closed-note, and will focus heavily on the key terms and clinical scenarios discussed.