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69 Cards in this Set
- Front
- Back
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___Who___ specify certain minimum levels of staffing which it considers necessary to provide quality service to residents. |
OBRA |
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% of Alzheimer's disease or related dementia diagnosis in nursing homes is _____? |
50% |
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Nursing Staff Requirements per OBRA |
Nursing facilities are mandated to use the services of a RN for 8 consecutive hours, 7 days per week.
The DON may serve as a charge nurse only if the facility has an average of 60 or fewer residents per day.
"sufficient nursing staff to provide nursing and related services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care." |
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Primary role of a CNA is: |
to assist residents with their ADLs |
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The DON must be a : ________
A Charge nurse must be a:_________ |
RN
licensed nurse (either RN or LPN)
(Per OBRA guidelines) |
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Medication Aides |
Only used in some states.
Must be supervised under a licensed nurse.
Can pass routine meds, take BPs, Temps, heart rates. |
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CNAs per OBRA definition |
"Any individual providing nursing or nursing-related services to residents in a facility and who is not a licensed health professional, a registered nurse, a registered dietitian, or someone who volunteers to provide such services without pay."
(Must be certified and continue with education training) |
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Paid Feeding Assistants per State |
CMS approved position.
Must work under a licensed nurse.
Can NOT feed anyone with complications. |
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BIPPA |
Facility's daily staffing is posted in a prominent place that is accessible to visitors as well as residents.
(MUST be kept on file for a minimum of 18 months per fed regulations) |
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Quality of Care definition |
promotes the highest practicable physical, mental, and psychosocial well-being. |
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Highest practicable Definition |
the highest level of functioning and well-being that can be expected considering the resident's functional status at the time, and his potential for improvement, or to reduce the rate of functional decline. |
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__Who__ specifies the facility must ensure the resident's activities of daily living do not diminish unless the resident's condition demonstrates that diminution is unavoidable. |
OBRA |
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List 5 ADLs |
Bathing, dressing, grooming Transfer and ambulate transfer Toileting Eating Communicating |
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Ambulation definition |
how resident moves between locations in her room and adjacent corridor on the same floor. |
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List 5 categories of ADLs |
Independent Supervision Limited Assistance Extensive Assistance Total Dependence |
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When a resident changes physicians, the new physician is required by standards of practice to: |
a) conduct a new history and physical examination b) write new orders c) obtain a written release form the former physician, when possible |
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List 5 actions to be taken when Death Occurs: |
1) Contact family 2) Follow protocol in pronouncing death 3) Complete forms and documents to release body 4) Prepare the body for family viewing 5) Confer with family before release |
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Staff must prepare a discharge summary note under resident rights, that must include 3 things: |
1) a recap of the entire stay 2) a final summary of resident status 3) a post-discharge plan of care |
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Purpose of Infection Control is to: |
prevent the development and transmission of the disease and infection.
(The program must monitor and investigate the cause of infection and how it is spread.) |
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ROM definition |
Range of Motion means the extent of movement of a joint. |
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Flexion and extension definition |
bending of a limb or part of the body to and fro |
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Rotation definition |
turning a limb 180 degrees |
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Abduction definition |
moving a limb outward from the body |
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Adduction definition |
moving a limb back towards the body or the median line of the body
(Adding the limb back to the body) |
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The minute staff puts a hand on a resident to prevent the assaulting behavior, that is considered a RESTRAINT.
Staff MUST do what next: |
*Remove the resident from an area where he can hurt others *Isolate him in a room or physically restrain him from action *Call physician IMMEDIATELY and ask for instructions.
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Physical Restraints Must be monitored: |
at least every 30 minutes
it must be removed at least every 2 hours at a 10 minute interval while the resident is exercised at that time. |
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Gradual drug reductions should be attempted to occur: |
twice a year |
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How often does the nursing home review the appropriateness of restraint use on a nursing home resident? |
at least reviewed quarterly
(a Restraint Reduction Committee include nursing staff, including CNAs, PT/OT staff) |
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What is considered an effective way to promote personal and social relationships among residents? |
a newsletter
(promotes more resident interest in each other than any other approach.) |
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Federal regs require facilities "ensure that residents receive proper treatment and care" for certain services. It is the NH responsibility to assist the resident in securing needed services not covered by the program. Special services that are covered include: |
* Injections * Parenteral and enteral fluids * Colostomy, Ureterostomy, or ileostomy care * Tracheostomy care and suctioning * Foot care * Prostheses |
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Urine Incontinence occurs:
Fecal Incontinence occurs: |
56%
46%
(In NH residents) |
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List 5 types of incontinence: |
Transient- incontinence Stress incontinence Urge or reflex incontinence Overflow incontinence Functional incontinence |
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Methods of handling Urinary Incontinence |
1) Kegel excercises 2) Regular schedule (1-1.5hr for fluid to void) 3) Bladder training 4) Biofeedback 5) Bedpans and commodes 6) Dietary Changes (limit caffeine and alcohol spicy foods, tomatoes, and artificial sweeteners) 7) Medications (avoid diuretics, psychotropics, tranquilizers, antihistamines, sedatives) 8) Surgery 9) Pads, adult briefs, catheters |
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When is it appropriate to use Catheter Care |
1) Urinary retention that causes overflow, infection, or renal dysfunction, or cannot be corrected surgically 2) Skin Wounds, sores, or irritations that are being contaminated 3) Terminal illness |
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Cerebrovascular Accidents (CVA) |
Stroke residents mainly need restorative therapy and rehab.
staff may notice a sudden change in the resident's topics of conversation and his behaviors towards others. |
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Presbycusis definition |
the gradual loss of acute hearing in which the resident may hear what is said but has poor word activity. |
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Conductive definition |
hearing loss results from impairment, damage, or malfunction of any portion of the conductive mechanisms of the ear. |
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Audiology Exams and hearing aids |
Are NOT required or provided by the facility
The facility is to ensure availability of needed services. |
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Fall definition per CMS
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an unintentional coming to rest on the ground, floor, or other lower level but not as a result of an overwhelming external force such as a push from another resident. |
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3 examples of a fall per CMS: |
1) where a resident loses his balance and would have fallen if not for staff intervention 2) A fall without injury 3) unless evidence suggesting otherwise, when a resident is found on the floor, a fall has occurred. |
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Falls are the leading cause of injury-related deaths for people 75 yrs or older |
24% of all people suffering from a hip fracture die within 1 year
and
another 50% never return to their prior level of mobility and independence. |
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5 major reasons NH residents fall: |
1) Muscle weakness 2) Environmental hazards 3) Medications 4) Poor Foot care/ shoes/ walking aides 5) Vestibular Disorders - inner ear balance disorder) |
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5 ways to prevent falls: |
1) Assess the resident's risk factors 2) Educate the staff 3) Review resident's medications 4) Analysis of the facility 5) Provide hip pads |
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Glaucoma definition |
Fluid pressure built up in the eye
(Normal range should be 10-21 mmHg) |
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Legal Blindness |
Visual acuity of 20/200 or less, with correction, constitutes legal blindness |
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ARMD Aged-Related Macular Degeneration |
Commons symptoms are blurred vision or seeing straight lines as crooked.
Elderly are unable to do things that require vision "straight ahead" ex driving, reading.
Tiny yellow deposits known as drusen in the retina. |
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Psychosocial Adjustments dificulties |
applies to problems residents have in adjusting to their life circumstances that lead to declining functional abilities.
ex. adjusting to living in a NH
Resident can not be ignored, for it will only intensify the dependent behaviors. |
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Depression |
"reduces the desire for improvement"
Agitated Depression is where a resident is restless, pacing, wringing their hands, sleeping problems. |
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Treatment of Depression |
1) Anti-depressants medications 2) Counseling 3) Activities |
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Dementia definition |
the loss or decline in memory and other cognitive abilities. It is caused when the brain cells are damaged from various diseases or conditions.
47% of NH residents have a dementia diagnosis |
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8 types of dementia |
1) Alzheimer's 2) Vascular Dementia 3) Mixed Dementia 4) Dementia with Lewy Bodies 5) Parkinson's 6) Frontotemporal Dementia 7) Ceutzfeldt-Jakob 8) Normal pressure Hydrocephalus |
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3 areas that "can make a significant difference in an individual's quality of life" |
1) Food and fluid consumption 2) Pain management 3) Social engagement |
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Remotivation techniques |
used to encourage residents to be more interested in the immediate environment. |
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Reality Orientation |
used to assist the resident in re-establishing firmer contact with reality. |
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Validation therapy |
in validation therapy, staff member reassures and reaffirms a persons feelings and/or thoughts. |
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Wandering |
All residents MUST be assessed for the potential for wandering either prior to admission or immediately upon admit. |
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Fire Marshals will only allow the door lock to hold open for _____ seconds because of danger in case of a fire. |
15 seconds
(A system must be in place to ensure these alarms are checked regularity). |
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Sentinel Health Events |
1) Low risk resident with pressure sores 2) Dehydration 3) Fecal Impactions |
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Skin changes |
older skin becomes thinner, less oily, loses its elasticity, tends to be drier, more susceptible to bruises, tears, infections, and rashes. |
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Pressure Sores or Ulcer |
where the skin and underlying tissues are eroded as the result of a lack of blood flow. It is ischemic ulceration and /or necrosis of tissues overlying a bony prominence that has been subjected to pressure, friction, or shear. |
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Hydration definition |
NH MUST provide all residents with "sufficient fluid intake to maintain proper hydration"
means the amount of fluid to prevent dehydration and to maintain health. |
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Weight Loss |
key words in weight loss is unplanned and undesired.
Most facilities weigh weekly for the first 4 weeks, then monthly. |
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Fecal Impactions definition |
is a mass of stool that can not be moved by colon contractions, resulting in a blocked colon.
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Constipation definition |
bowel movements that do not occur as often as expected or when the stool is hard and difficult to pass.
Occurs in about 30% of NH residents |
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Causes of constipation |
1) Diets in low fiber 2) inadequate fluid intake 3) a sedentary lifestyle 4) long-term misuse of laxatives |
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Tube Feedings |
PEG tube is generally more tolerated than the nasogastric tube.
Food is administered by bolus (syringe inserted into tube), gravity (bag on IV pole), or pump (flow rate of food is controlled).
Pump is recommended due to control rate.
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Restless Leg Syndrome (RLS) |
~8% of the US population suffers form this neurological disorder
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Periodic Limb Movement in Sleep (PLMS) |
80% of RLS victims have a related disease called PLMS which worsens with age.
Caffeine tends to intensify RLS and PLMS symptoms. |
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Sexuality |
OBRA gives rights for residents to have "privacy with whomever the resident wishes to be private" as long as it is consensual.
NH Must provide for full visual privacy and to the degree possible, full auditory privacy. |
