Nurse Aide Training School Lisa H Young RN BSN MA Ed Working in LongTerm Care Longterm Care Centers Promote physical and mental health Goal Help the resident maintain the highest possible ID: 775194
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Slide1
CNA Course LectureNAT 101
Nurse Aide Training School
Lisa H. Young RN, BSN MA Ed.
Slide2Working in Long-Term Care
Long-term Care Centers “Promote physical and mental health” Goal: Help the resident maintain the highest possible level of function.Types of Facilities:Board and Care HomesAssisted Living Residences (ALRs)Nursing Centers
Chapter 1
Slide3Working in Long-Term Care
Purpose and Goals of Long-term Care
Promote physical and mental health
Treat chronic illness
Prevent communicable diseases
Rehabilitation or restorative care
Other Services
Hospices
Dementia Care Unit
Subacute Care
Slide4Working in Long-Term Care
The Nursing TeamRegistered NursesLicensed Practical Vocational NursesNursing Assistants
Slide5Working in Long-Term Care
Ombudsman Program
Protect the health, safety, welfare, and rights of residents
Facilities Must Post: names, addresses, and phone numbers of local and state ombudsmen
Nursing Aid Roles and Responsibilities
Centers for Medicare & Medicaid Services (CMS)
Provide rules for the protection of person’s rights and safety
Slide6Working in Long-Term Care
Residents RightsInformationRefusing TreatmentPrivacy and ConfidentialityPersonal ChoiceDisputes and GrievancesWorkTaking Part in Resident and Family GroupsCare and Security of Personal ItemsFreedom from RestraintQuality of LifeActivitiesEnvironmentFreedom from Abuse, Mistreatment, and Neglect
Chapter 2
Slide7The Nursing Assistant in Long-Term Care
Ethical AspectsLegal AspectsCriminal LawsCivil LawsTortsInformed ConsentWillsElder & Domestic AbuseSigns of Abuse
Slide8Work Ethics
ProfessionalismTeamwork on the jobConfidentialityGossiping/LanguageCourtesies Personal MattersJob safety/Drug testingHarassmentResigning from a job
Chapter 3
Slide9Communicating with the Health Team
CommunicationMedical RecordResident Care ConferencesReporting and Recording (24 hour clock)Computers and Electronic DevicesDealing with Conflict
Chapter 4
https://www.youtube.com/watch?v=HRcRx_Ds67Y
Video teaching 24 hour clock or military clock:
Slide10Recording Terms
Abdominal Regions
Directional Terms
https://www.youtube.com/watch?v=KqgTERrYbQ4
https://www.youtube.com/watch?v=rtG7JqshOd4
Slide11Assisting with the Nursing Process
Nursing ProcessAssessmentObjective data (observations)Subjective dataNursing DiagnosisComprehensive Care PlanPlanning, Intervention, Implementation & EvaluationInterdisciplinary TeamMedical Diagnosis
Chapter 5
Slide12Understanding the Resident
Chapter
6
Maslow’s Pyramid of Basic Needs of Life
Slide13Nursing Center Residents
Types of ResidentsBehavior IssuesAngerDemanding behaviorSelf-centeredAggressive WithdrawalInappropriate sexualCommunication VerbalNonverbalBody languageListeningCommunication barriers
Slide14Body Structure and Function
Chapter
7
Integumentary SystemEpidermis & DermisProtective coveringRegulate body temperatureMusculo-skeletal SystemBonesJointsMusclesTendons
CNA needs to know the body’s normal structure and function.
Slide15Body Structure and Function
Nervous SystemCentral Peripheral Sense OrgansEyeEarCirculatory SystemBloodHeartBlood vessels
Slide16Body Structure and Function
Respiratory System
Oxygen 21%RespirationsInhalation/ExhalationInspiration/ExpirationTracheaLungsDigestive System (GI System)Oral cavityStomachIntestines
Slide17Body Structure and Function
Urinary SystemKidneyUreterBladderUrethraMeatusReproductive SystemMaleFemale
Slide18Body Structure and Function
Endocrine SystemHormonesPituitary glandThyroid glandAdrenal glandsPancreasImmune SystemImmunityTumorsSpecific/Nonspecific
Slide19The Older Person
MythsThey are all the sameThey lose interest in sexMental function declinesAll are crabby & rudeCommon physical changes with aging
Chapter 8
Slide20Sexuality
Chapter 9
Sexuality involves the whole person.
Illness and aging can affect sexuality
Nursing team promotes the meeting of sexual needs
Married couples may share the same room
Slide21Safety
Safety is a basic need.Always identify the resident before providing careKnow accident risk factors page 128.
Chapter 10
Slide22Safety
Safety measures in Preventing Burns
Box 10-1 page 130
Higher risk for elderly because of decreased skin thickness, decreased sensitivity to heat, reduced reaction time, decreased mobility, communication problems,
confustion
and dementia
Safety Measures in Preventing Poisoning
Box 10-2 page 131
In adults may be from carelessness, confusion, poor vision when reading labels.
Safety Measures to Prevent Suffocation
Box 10-3 page 131
Causes: choking, drowning, inhaling gas or smoke, strangulation
Slide23Choking
Foreign-body airway obstruction (FBAO)
https://www.youtube.com/watch?v=7CgtIgSyAiU
Slide24Safety
Safety Measures to Prevent Equipment Accidents
Box 10-4 pg. 135
All equipment is unsafe if broken, not used correctly, or not working properly
Wheelchair and stretcher safety
Box 10-5 pg. 136
Never pull a wheelchair backward unless going through a doorway or entering an elevator
Handling hazardous substances
Occupational Safety and Health Administration (OSHA) require that healthcare employees understand the risks of hazardous substances & how to handle them
Slide25Safety
FireR A C EP A S SDisastersWorkplace violenceBox 10-8 page 143
Slide26Preventing Falls
Falls can cause serious injury, can result in disability, decline in function, and reduced quality of lifeMost falls occur in resident rooms and bathroomsCauses: poor lighting, cluttered floors, incorrect bed height, out-of-place furniture, and wet floorsFall Prevention Programs are requiredTransfer/gait belts used to prevent fallsIf a person starts to fall, ease him/her to the floor.If you find a person on the floor, do not move the person.
Chapter
11
Slide27Restraint Alternatives and Safe Restraint Use
RestraintsAlternatives to Restraint UseSafety Measures for Using Restraints Legal AspectsSafety GuidelinesSee page 154Reporting and Recording
Chapter
12
Slide28Preventing Infection
The health team follows certain practices and procedures to prevent the spread of infectionTypes of infectionsMRSAStaphylococcus aureus (“staph”)Vancomycin-resistant (VRE)Clostridium difficile (C. Diff.)Healthcare-Associated Infection (HAI): an infection that develops in a person cared for in any setting where health care is given.
Chapter 13
Slide29Preventing Infection
Medical Asepsis: the practice used to remove or destroy pathogens
Surgical Asepsis: the practices that keep items free of ALL microbes
Hand Hygiene: the easiest and most important way to prevent the spread of infection. Review Box 13-2 Rules of Hand Hygiene
Standard Precautions: Measures to prevent spreading of microbes. Review Box 13-4 page 186
Isolation Precautions: Measures to reduce the risk of exposure. Review Box 13-6 Rules for Isolation page 187
Bloodborne Pathogens: Intended to protect health care workers from HIV and HBV
Slide30Hand-washing Procedure
https://www.youtube.com/watch?v=chAmCnsJcnI
Hand-washing video
Slide31Donning and Doffing
Isolation videos
https://www.youtube.com/watch?v=JP7fEFf6WCc
https://www.youtube.com/watch?v=lZm_XT4G7XI
https://www.youtube.com/watch?v=_o9SxDFPUiA
https://www.youtube.com/watch?v=GQzvS7f__rc
Slide32Body Mechanics and Safety Resident Handling
Chapter 14
https://www.youtube.com/watch?v=zss9jRW4oWw
Good Body Mechanics
Body Alignment
Body mechanics video
Using the body in an efficient and careful way
Body alignment (posture) is the way the head, trunk, arms, and legs are aligned with one another
Slide33Body Mechanics and Safety Resident Handling
Fowler’s Position
Right Lateral Position
Supine Position
https://www.youtube.com/watch?v=eJESfPA4NWM
Fowler’s position: semi-sitting position. “A hen is a fowl and hens sit on their nest.”
Supine position: back-lying position. “Supine is resting on your spine”
Lateral position: side-lying position.
Slide34Body Mechanics and Safety Resident Handling
Reduce friction and shearingRolling the personUsing friction-reducing devices:Lift sheetCotton draw-sheetTurning padsIncontinence productsSlide boardsSlide sheetsMoving to the side of the bedMove in 3 segments: upper body; lower body; legs and feet
Chapter 14
Slide35Body Mechanics and Safety Resident Handling
Chapter 14
Sitting on side of bed and dangling
Bed in lower position with wheels lockedSupport shoulders and thighsMove as a unitSit up on side of bed for 1 – 5 min. to prevent dizziness or faintingWhile dangling take deep breaths, cough and move legs back and forth in circlesProvide support while person sits on side of bed
https://www.bing.com/videos/search?q=cna+skills+dangling+the+patient&qpvt=cna+skills+dangling+the+patient&view=detail&mid=A606B491854F02780378A606B491854F02780378&FORM=VRDGAR
Slide36Body Mechanics & Positioning & Transfers
https://www.youtube.com/watch?v=IDyvt-1IrkU
Video demonstrating transferring from bed to chair
Transfer belts or gait belts are used to support residents during transfers
If the person is weak on one side, transfer the person so that the strong side moves first
Do not pull the person from behind the chair or wheelchair
Slide37Basic Emergency Care
First Aid: the emergency care given to an ill or injured person until medical help arrivesSCA: Sudden cardiac arrestDNR: “Do Not Resuscitate”Recovery Position: used when the person is breathing & has a pulse but not responsiveShock: occurs when organs & tissues do not get enough blood. Death could occur.Stroke: when the brain is suddenly deprived of blood supply. Death could occur.
Chapter 43
Slide38The Resident’s Unit
OBRA and CMS have requirements for Nursing Centers and residents rooms.Rooms must provide comfort, safety, and privacyAll resident’s rooms must be equipped with or near toilet facilitiesEach person’s room must have closet spaceMust have comfortable sound levelsRoom temperature between 71 – 81 degrees F.
Chapter 15
Slide39Admissions, Transfers, and Discharges
Chapter 29
Admission is the official entry of a person
Discharge: the official departure of a person from a nursing center
Transfer: moving a person to another health care setting
Reasons for transfer or discharge occurs when necessary to meet the person’s welfare
Slide40Rehabilitation & Restorative Nursing Care
Chapter 41
Dysphagia
Prosthetics
Slide41Rehabilitation & Restorative Nursing Care
Every part of your job focuses on promoting the person’s independence!
Preventing decline in function is the goal!
Slide42Assisted Living
Chapter 42
Housing option for older persons who need help with activities of daily living (ADLs) but wish to remain independent for as long as possible.
Little or no medical care is provided.
Assistance with meals and ADLs.
24 hour emergency communication system to call for help.
Slide43Bedmaking
Mitered Corners
Chapter
16
Open unoccupied bed
Bottom sheet seam down and even with foot of bed.
Top sheet seam up and even with head of bedNever shake linens.
https://www.bing.com/videos/search?q=Changing+an+Occupied+Bed&&view=detail&mid=0501961BF4A12A7FFEF30501961BF4A12A7FFEF3&FORM=VRDGAR
Video: Making Occupied Bed:
Slide44Hygiene & Oral Care
Chapter
17
Before breakfast is early morning care or AM care
Afternoon care done after lunch and before evening mealEvening care is given at bedtimeOral care or mouth care helps prevent infection and illness
https://www.youtube.com/watch?v=1aTq4UD_7E4
Slide45Hygiene: Oral care for the Unconscious Resident
Helps prevent infection
To prevent aspiration, place the resident in a side-lying position during oral care
Tell the resident each step while providing oral or mouth careNever insert dentures of an unconscious resident!
https://www.youtube.com/watch?v=vQ5UuZsZ70w
Video
Slide46Hygiene: Denture Care
Care for “false teeth”
Use only denture cleaning productsClean with warm water but store in cool waterNever carry dentures in your handsNever attempt to floss denturesLine sink with towel when cleaning dentures
https://www.youtube.com/watch?v=A1I15vV09V0
Slide47Hygiene: Bathing
Chapter 17
Dry skin occurs with aging
Soap also dries the skinComplete bath or shower twice a weekPartial baths are done on other daysRules for Bathing Box 17-1
https://www.youtube.com/watch?v=QYdZ-4rqphI
Video: Full Bed Bath:
https://www.youtube.com/watch?v=xZnP9t1Q6qY
Slide48Hygiene
Back Rub
https://www.youtube.com/watch?v=FTt2WibgprQ
Slide49Hygiene: Perineal Care
Peri-care involves cleaning the genital and anal areas.
Provided daily with bath and whenever the area is soiled with urine or fecesWork with the cleanest area to the dirtiest; “front to back”Urethral cleanest and anal area dirtiest
https://www.youtube.com/watch?v=Edz9o56EgD0
Slide50Grooming: Brushing Hair
Chapter 18
Part of early morning care, morning care and afternoon care
Brushing increases blood flow to the scalpNever cut matted or tangled hairUse a wide-tooth comb for curly hairStart at the neckline and work upward, lift and fluff hair outward toward the forehead
https://www.youtube.com/watch?v=xqimxLsHwRA
Video: Hair Care:
Slide51Grooming: Shampooing
Older persons have dry hair
Shampooing is done weekly during bathing
Use shampoo tray for residents who are bed-ridden
Slide52Grooming: Shaving
Safety razors or electric razors are used
Safety razors are not used with persons who have healing problems or for those who take anticoagulantsNever trim mustache or beard without the person’s consentReview Box 18-1 pg. 300
https://www.youtube.com/watch?v=Mm46MxKuq3I
Video: Shaving
Slide53Grooming: Nail & Foot Care
Prevents infection, injury and odors
Nails are easier to trim and clean right after soakingNever use scissors - only nail clippers Cut nails straignt across with nail clipperSmooth edges with nail fileReview Promoting safety and comfort on page 304
https://www.youtube.com/watch?v=ViiBjtJXZSk
Video: Nail Care
Slide54Grooming: Dressing/Undressing
Chapter 17
Part of morning careDo not expose the personEncourage the person to do as much as possibleLet the person choose what to wearRemove clothing form the strong or “good” side first (unaffected side)Put clothing on the weak side first. (affected side)
https://www.youtube.com/watch?v=aZcmp4HvFGQ
Video: putting on TED hose
https://www.youtube.com/watch?v=ggWi3eZO1K4
Video: Dressing
Slide55Nutrition and Fluids
Chapter 19
Poor nutrition is common with elderly
1/3 teaspoon /biteDysphagia – difficulty swallowing/ slow swallowingAspiration – breathing fluid, food, vomitus or an object into the lungsMonitor for choking, coughing, food “pocketing”
https://www.youtube.com/watch?v=mvys65YVLt0
Slide56Nutrition and Fluids
2000 to 2500 ml fluids needed for normal fluid balance
½ teaspoon = sip of liquid
NPO = nothing by mouth
Thickened liquids to ease swallowing and prevent aspiration
1 ounce = 30 mL
When feeding, tell the person what you are offering. Allow time for chewing and swallowing. Always face the person and be seated.
Slide57Nutritional Support & IV Therapy
Naso
-gastric tube
Jejunostomy
Tube
PEG Tube
Chapter
20
Slide58Urinary Elimination
Chapter 21
Urinary Elimination Problems
DysuriaHematuriaNocturiaOliguriaPolyuriaUrinary frequencyUrinary incontinenceUrinary urgency
Urine dose not have an odor and should be pale, yellow in color.
https://www.youtube.com/watch?v=5DO9hUwOcf0
Video: Providing bedpan
Slide59Urinary Elimination
Urinal
Urine Cap
Fracture Bedpan
Standard Bedpan
Bedside Commode
Slide60Urinary Elimination
Brief
Catheter Cap
Retention catheter
Bladder Scanner
Leg Bag
Sudden confusion and change in behavior may indicate a urinary tract infection (UTI)
Signs of UTI: fever, chills flank pain or tenderness, foul smell, cloudiness, decreased activity
https://www.youtube.com/watch?v=JJMU7_eA9PQ
Video: Catheter Care:
Slide61Bowel Elimination
Factors affecting bowel elimination Privacy Habits Diet-high fiber foods Diet-other foods Fluids Activity Medications Disablitiy Aging
Chapter 22
Slide62Bowel Elimination
Common Problems Constipation Fecal Impaction Diarrhea Fecal Incontinence Flatulence C. Diff
Slide63Bowel Elimination
Enema
Ostomy Stoma
Ostomy
Pouch
Slide64Exercise & Activity
Chapter 23
Hip abduction wedge
Contracture
Bed Cradle
Foot Drop
Hand Roll
Splint
Trochanter Roll
Slide65Exercise & Activity
Wrist ROM
Hip ROM
Elbow ROM
Slide66Exercise & Activity
Walking Aids: Walkers and Canes
Leg Brace
Walking helps prevents contractures and muscle atrophy
Regular walking helps prevent deconditioning
Use a gait belt if the person is weak or unsteady
Gait Belt
Slide67Comfort, Rest, and Sleep
Chapter
24
Rest and sleep restore energy and well-being
The body needs more energy for healing and repair
Comfort is a state of
well-being
Pain or discomfort means to ache, hurt or be sore which interferes with rest and sleep
Slide68Comfort, Rest and Sleep
Types of Pain
Chronic Pain
Radiating Pain
Phantom Pain
Slide69Comfort, Rest, and Sleep
Sleep Disorders Sleep deprivationSleepwalkingSleep ApneaNursing Measures to Promote Sleep Uninterrupted restAvoid physical activity before bedtimeAvoid caffeineFollow bedtime routinesPosition the person in good alignmentGive a back massageProvide measures of pain relief
Slide70Oxygen Needs and Respiratory Therapies
Nurse Aid Role: provide safe care to the resident receiving oxygenNurse/respiratory therapist start and maintain oxygen therapyRespiratory Function Air moves into and out of the lungs Oxygen and CO2 are exchanged Blood carries oxygen
Chapter25
Slide71Oxygen Needs and Respiratory Therapies
Abnormal RespirationsTachypneaHypoxemiaBradypneaApneaHypoventilationHyperventilationDyspneaCheyne-Stokes respirationsOrthopnea
Slide72Oxygen Needs and Respiratory Therapies
Nasal Cannula
Pulse Oximetry
Pursed-lip breathing
Incentive Spirometry
Slide73Oxygen Needs and Respiratory Therapies
Tracheostomy
Oral Suction
Chest Tube
Nebulizer Treatment
Bronchial Inhaler
Slide74Measuring Vital Signs
Temperature98.6 degrees F
Chapter 26
http://wn.com/taking_temperature
Tympanic
Oral
Rectal
Temporal
Axillary
Slide75Measuring Vital Signs
Pulse Rate60 – 100 beats/minCount for 30 sec. & multiply # by 2Radial pulse used most oftenRhythm usually is regularTachycardiaBradycardia
http://www.bing.com/videos/search?q=How+Do+You+Take+Pulse&&view=detail&mid=9F54DCC3131F27502F429F54DCC3131F27502F42&FORM=VRDGAR
Slide76Measuring Vital Signs
RespirationsAdult rate 12-20/minNormally quiet, effortless, and regularCount for 30 sec and multiply # by 2
http://www.bing.com/videos/search?q=video+how+to+count+respirations&qpvt=video+how+to+count+respirations&view=detail&mid=386CF47F5C47A7EC491A386CF47F5C47A7EC491A&FORM=VRDGAR
Slide77Measuring Vital Signs
Blood PressureNormal 120/80HypertensionHypotension
http://www.practicalclinicalskills.com/taking-blood-pressure.aspx
http://www.bing.com/videos/search?q=CNA+Skills+Blood+Pressure&&view=detail&mid=D8EC5E007D09DA569C5DD8EC5E007D09DA569C5D&FORM=VRDGAR
https://www.youtube.com/watch?v=bHXvhOQ0hYc
Slide78Assisting with the Physician Examination
Weight and HeightUsually without footwareVoid before weighingSame time dailyBefore breakfastBalance to zero
Chapter 27
https://www.bing.com/videos/search?q=how+to+read+height+measurement&view=detail&mid=D568ACF8716D851B0616D568ACF8716D851B0616&FORM=VIRE
https://www.youtube.com/watch?v=DZKd5lICyMo
Slide79Assisting with the Physician Examination
Positioning and Draping
Knee-chest
Dorsal recumbent
Slide80Collecting & Testing Specimens
Chapter
28
Urine Specimen Testing
Urine Strainer
Kidney Stones
Urine Dipstick Test
Routine urinalysis
Midstream specimen
24 hr. collection
Females: separate labia
Males: retract foreskin
Only touch outside of container
Slide81Collecting & Testing Specimens
Stool Specimen Testing
Collect about 2 tablespoons
Include pus,
musus, or blood if presentTake specimen from two different sites
No urine in specimenDo not touch the inside the specimen container
Checking for blood
https://www.youtube.com/watch?v=nzlHjdT-7RI
Video: Urine measurement
Slide82Collecting & Testing Specimens
Sputum collection
Studied for blood, microbes and abnormal cells
Cough up from the bronchi and trachea
Best to collect in the morning upon arising
Rinse mouth after specimen collection
Slide83Wound Care: Types of Wounds
Chapter 30
Abrasion
Contusion
Laceration
Penetrating wound
Puncture wound
Ulcer
Stapled Incision
Slide84Wound Care
Prevention
Re-position every 2 hours No elastic hose or socks No tight clothes Good daily skin care Do not scrub or rub skin Keep linens clean, dry and wrinkle free Avoid injury to legs and feet Make sure shoes fit well Keep pressure off the heels & bony areas Check for skin breaks or skin color changes Do not massage over pressure points. Never rub or massage reddened areas Use protective devices Follow care plan for walking and exercise
Skin tears
Slide85Wound Care
Slide86Wound Care
Elastic bandage
Abdominal Binder
Dressing
Arterial ulcer
Observe wounds for site, size, depth, appearance, drainage, odor and surrounding skin.
Slide87Pressure Ulcers
Age-related changes in the skinDrynessFragile and weak capillariesGeneral thinning of the skinLoss of the fatty layer under the skinDecreased sensation to touch, heat, and coldDecreased motilitySitting in a chair or lying in bed most or all of the dayChronic diseases (diabetes, high blood pressure)
Chapter 31
Diseases that decrease circulationPoor nutritionPoor hydrationIncontinence (urinary, fecal)Moisture in dark body areas (skin folds, under breasts, perineal area)Pressure on bony partsPoor fingernail and toenail care Friction and shearing Edema
Skin Breakdown: Common Causes
Slide88Pressure Point Sites
Pressure is the major cause of pressure ulcers
Shearing and friction are important factors
Pressure ulcers occur over bony areas
Pressure from body weight can reduce blood supply to the area
Slide89Pressure Protective Devices
Egg-crate Mattress
Heel Elevator
Elbow protector
Gel pad cushion
Heel Protector
Slide90Mental Health Disorders
Chapter38
Panic Disorders
Phobias
Obsessive-Compulsive Disorder
Post-Traumatic Stress Disorder
Schizophrenia
Slide91Mental Health Disorders
Bipolar Disorders
Major Depression
Antisocial Personality Disorder
Borderline Personality Disorder
Alcoholism and Drug Abuse
Suicide
Slide92Changes in Cognitive Function
Chapter 39
ConfusionDementiaAlzheimer’s Disease
Common Problems with AD
Wandering
Sundowning
Hallucinations and delusions
Paranoia
Catastrophic reactions
Agitation and restlessness
Aggression and combativeness
Repetitive behaviors
Communication problems
Screaming
Rummaging and hiding things
Slide93Hearing, Speech, and Vision Problems
Chapter32
Dysphagia
Hearing
Loss
Vision Changes or Loss
Slide94Cancer, Immune System, and Skin Disorders
Cancer Care
Pain reliefRest & exerciseFluids & nutritionPreventing skin breakdownPreventing bowel problemsDealing with treatment side effectsPsychological & social needsSpiritual needs
Immune Disorder Care
Practice Standard PrecautionsBloodborne Pathogen StandardsDaily hygieneAvoid irritating soapsProvide oral hygieneMeasure intake & ouputMeasure weightEncourage deep-breathing & coughing exercisesAssist with ROM & ambulationChange linens & garments as neededProvide emotional support
Skin Disorder Care
Ease itching Cool moist clothsPain reliefPsychological & social needsFeelings of isolationAllow blisters to heal
Chapter
33
Slide95Nervous System and Musculo-Skeletal Disorders
StrokeKnow warning signs:Sudden numbness or weakness of the face, arm, or leg especially to one sideSudden confusion, trouble speaking Sudden trouble seeingSuddent severe headacheSudden trouble walking, dizziness, loss of balance or coordination
Chapter34
Drooping face
Slide96Nervous System and Musculo-Skeletal Disorders
Care of Persons with ParalysisPrevent fallsBed in lowest position with call light within reachPrevent burnsTurn & re-position every 2 hoursPrevent pressure ulcersAssist with ROM Maintain good body alignment & use supportive devices
Automatic
Dysreflexia
Notify the nurse immediately the following signs:
Hypertension
Throbbing or pounding headache
Bradycardia
Blurred vision
Sweating above the level of injury
Flushing skin above the level of injury
Cold-clammy skin below level of injury
Nasal congestion or stuffiness
“Goose bumps” below the level of injury
Nausea & anxiety
Slide97Nervous System and Musculo-Skeletal Disorders
Care of Persons with FracturesCast care: monitor for pain, swelling and a tight cast, palke skin, cyanosis, odor, inability to move fingers or toes,numbness, temperature changes, draininage on or under the cast, chills,fever, nausea & vomitingTraction care: Good alignment, weights hang freely, check for frayed ropes, ROM exercises to uninvolved joints, use fracture pan for elimination, skin care, monitor pins for redness, drainage, and odors
Care of Person with Limb AmputationRefer to affected limb as residual limbRe-position every 2 hrsObserve residual limb for redness, swelling or skin breakdownGood skin careApply elastic wrapApply prosthesisReport complaints of pain promptlyBe aware person is dealing with body image change; listen to the person’s concern
Slide98Cardiovascular & Respiratory Disorders
Signs & Symptoms of Heart attackSudden severe chest pain:Usually left sideDescribed as crushing, stabbing, squeezing or someone sitting on the chestSever and last longer than anginaNot relieved by rest or nitroglycerinPain or numbness in arms, back, neck jaw or stomachIndigestionDyspneaNauseaDizzinessPerspiration and cold, clammy skinPallor or cyanosisLow blood pressureWeak & irregular pulseFear, apprehension and a feeling of doom
Signs & Symptoms of PneumoniaHigh feverChillsPainful coughChest pain on breathingRapid pulseShortness of breathRapid breathingCyanosisThick, white, green, yellow or rust-colored sputumNauseaVomitingHeadacheTirednessMuscle aches
Chapter
35
Slide99Digestive & Endocrine Disorders
Signs & Symptoms of GERD
Chest pain (lying down)Hoarseness in AMDysphagiaChoking sensationFeeling like food is stuck in throatDry coughTight throatSore throatBad breath
Care of Persons with Hepatitis
Hepatitis A:Handle bedpans, feces and rectal thermometers carefullyGood hand-washingHepatitis B:Bloodborne Pathogen PrecautionsHepatitis C:Bloodborn Pathogen PrecautionsNeedle precautionsHepatitis D & E:Bloodborne Pathogen PrecautionsComplete perineal care
Signs / Symptoms for Blood Sugar Changes
Hypoglycemia:Fatigue, Seating, Trembling, Rapid & Shallow Respirations, Dizziness, Clumsy, Tingling around the mouth, Skin cold & clammy, Convulsions and UnsconsciousnessHyperglycemia:Drowsiness, Thirst, Dry mouth, Frequent urination, Leg cramps, Flushed face, Sweet breath odor, Dry skin, Coma
Chapter
36
Slide100Urinary & Reproductive Disorders
Care of the Person with Chronic Kidney FailureLow protein, potassium. Phosphorus and sodium dietFluid restrictionMeasure BP in the supine, sitting and standing positionsDaily weight measurementIntake and output measurement/recordingROM exercisesPrevent itchingPrevent injury and bleedingRequent oral hygienePrevent infection, diarrhea or constipationMeet emotional needsPromote rest
Chapter37
Slide101Developmental Disablities
A disability occurring before 22 years of age is a developmental disability (DD)Birth defect is an abnormality present at birth that can involve a body structure or functionIntellectual Disabilities involves severe limits in intellectual function and adaptive behaviorDown Syndrome (DS) is a genetic disorderFragile X Syndrome (FXS) is an inherited intellectual disabilityCerebral Palsy (CP) is disorders involving muscle weakness or poor muscle controlAutism is a brain disorder without a cureSpina Bifida (SB) is a defect of the spinal column Hydrocephalus occurs when cerebrospinal fluid collects in and around the brain. Often occurs with SB
Chapter
40
Slide102End-of-Life Care
Stages of Death Denial Anger Bargaining Depression Acceptance
Chapter 44
Slide103End-of-Life Care
Every effort is made to promote physical and
psycholical
comfort
Person is allowed to die in peace and with dignity
Skin care, oral hygiene, back massages and good body alignment promote comfort
Semi-fowlers position to ease breathing
Side-lying position to remove collecting mucus in airway
Vision diminishes so well lit room
Hearing is last function lost; always assume person can hear
Slide104End-of-Life Care
Provide support, understanding, courtesy and respect to the familyAdvance directive is a document stating a person’s wishes about their health careLiving Will is a document about measures that support or maintain life when death is likelyPhysician Orders for Life-Sustaining Treatment (POLST) is a program to supplement advance directives to specifically identify life-sustaining treatmentsDNR-Do Not Resuscitate: orders to not implement interventions to sustain life
Slide105End-of-Life Care
Signs of Impending Death
Restless and agitation
Shortness of breath and pauses
Depression, anxiety, confusion
Nausea, loss of appetite
Swelling in the hands, feet, or other body parts
Constipation or incontinence
As death nears body functions change either fast or slowly
Signs of Death
No pulse, no respirations, and no blood pressure.
Pupils fixed and dilated
Doctors determines death
Slide106End-of-Life Care
Post-mortem CareGood appearance of the bodyValuables and personal items are gathered for the familyRight to privacy and treated with dignity2-4 hours post death rigor mortis develops so good alignment is a mustPrepare the body in a comfortable and natural position for viewingIf autopsy is ordered, post-mortem care is not doneMay require the moving of the body to a storage area.
Slide107End-of-Life Care
It is natural for nursing assistants and other staff members to grow close to the people they care for.
Often caregivers experience grief.
The first experience may be frightening
Confide in a nurse or other staff member your feelings
Remember the other residents may be sad over the loss of their friend; allow time for them to express feelings of grief
Caregivers may attend services