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181 Cards in this Set

  • Front
  • Back
what is the name of the facility that provides health care and nursing care for residents who have many or severe health problems, or who need rehab
skilled nursing facility (SNF)
an illness that comes on suddenly from which a person should recover
acute
an illness that is ongoing, may develop slowly or gradually
chronic illlness
health care agency or program for persons who are dying
hospice
member of health care team who assists with mobility, ambulation or use of muscles
physical therapist
member of healthcare team who assists with relearning ADLs
occupational therapist
the speech therapist may also help with a person who is having difficulty doing what?
swallowing
health insurance for people who are over 65 or with certain disabilities
medicare
health insurance for low income person
medicaid
name resident rights
to leave
to stay
to share a room if married
to complain without fear
to send/receive unopened mail
to be free from abuse and neglect
to be free from unnecessary restraints
to live in a clean, safe environment
to work
to form groups
to practice religion
to personal choices
to personal possessions
to refuse
to privacy
to confidentiality
what information is listed in the nurse aide registry
name, aliases, addresses, employers, any allegations of abuse or neglect
what are the skills a nurse aide CANNOT perform
give meds
take orders from a doctor
supervise others
insert or remove tubes
participate in sterile procedures
tell a resident/family about diagnosis or treatments
what is delegation and when can you refuse a task that is delegated to you?
delegation is the act of authorizing another person to perform a task- only the RN delegates tasks to you. You can refuse if
a. it is the right task- something you are legally allowed to do
b. you have been taught the task before
c. the nurse will supervise you doing the task if it is the first time
d. it is legal and ethic
e. you have the supplies you need to perform the task
is it ethical to accept tips
no
how can you invade a residents privacy
not knocking before entering a room
not providing privacy by closing door and privacy curtain
exposing the body without need
what should you do if a resident or family ask you to witness a will
refuse.
what are 5 ways a person can be abused
verbal- yelling, cursing at him
physical
mental- name calling, making person feel bad
sexual
financial
what do you do if you observe abuse occurring
stop the abuser and then report
who can you report abuse to
**nurse
ombudsman
abuse hotline
dept. of health
what is a kardex
type of card file that summarizes routine care (diet, toileting, whether side rails are used, etc) as a quick, easy source of info the the CNA
what are the rules for recording in a chart
no erasable ink or white out
blue/black ink
don't leave any spaces
sign, date, time all entries
document after the fact
only document the care you gave
if you make a mistake, draw a line thru it and initial it
what are the parts of a whole person
we are physical beings
we are psychological beings
we are social beings
and we are spiritual beings

when caring for a resident, make sure you attend to the whole person, not just the physical part
what are the basic needs of all humans, according to Maslow?
Physiological (physical) needs: water, food, oxygen, rest, shelter
Safety/Security- call bells, side rails
Love/belonging- good care, encouraging participation in groups and activities, family visit
Self esteem- allow resident to do for self, compliments
Self actualization- ask him to tell you about his past accomplishments
what areas of a person's life are affected by culture
religion, food preferences, beliefs about illness and death, music, style of dress, values, language spoken
how can people communicate NONverbally?
with gestures, posture, gait, outward appearance, facial expressions
should touch and silence be used to communicate
yes. touch is a powerful communicator that is comforting and shows caring, but can mean different things to different people so only use if person is comfortable with touch; silence says you are listening
how can you be a good listener?
lean in, face the person, nod your head, respond with "mmm" and "i see"
what are some barriers to effective communication that you should NOT do
interrupting
changing the subject
failing to listen
giving your opinion
pat answers "don't worry"
illness and disability (blind, deaf)
noise
profanity
foreign language
should you talk to a person in a coma
yes, assume he or she can hear and understand
what are some losses experienced by seniors
loss of income, family/friends. mobility, independence, health, job, private home
how can you promote sexuality for your seniors
groom nicely, makeup, nail polish, perfume or cologne, shave the male, give privacy during visits or when masturbating
what should you do if a resident is sexually aggressive to you
ask the person not to touch you, refuse his request, tell him what behaviors make you uncomfortable and report to nurse
what is the difference between a paraplegic, hemiplegic and a quadriplegic
paraplegia- paralyzed from waist down
hemiplegic- paralyzed on one side of body
quadriplegic- paralyzed from neck down
when should you perform the heimlich maneuver (abdominal thrusts)
when a person is choking- unable to speak or cough
what should you do if a choking victim is pregnant or obese
perform chest thrusts instead of applying pressure to the stomach
why do all electrical plugs in nursing homes have to be three pronged
two prongs carry electrical currents, the third prong is the ground that carries leaking electricity to the earth and away form an electrical item (if ungrounded could carry electricity to the person)
what are safety guidelines for wheelchair use
brakes on when transferring into chair
hips back in chair
feet on footrest
arms on armrest
go down ramps and into elevators backwards
where can you find out about storage, disposable, and care for accidental exposures of chemicals used on your job
the Material Safety Data Sheets (MSDS manual) list every chemical used on the job and what do if accidentally swallowed, splashed in eyes, etc
what are the 3 things needed for a fire
oxygen
a material that burns
a spark or flame (friction)
what should you do if a person is to receive o2
remove smoking materials
remove small electrical appliances (like a hair dryer)
place no smoking sign on door
remove wool products
remove flammables like nail polish
what are two carry's you can use when evacuating a nonambulatory person during a fire
swing carry (requires two people)
or
one rescuer carry - drag person on a blanket, supporting the head
who is evacuated first during a fire
ambulatory residents (the ones that can walk)
what is an incident and when should an incident report be filled out
an incident is any event that has harmed or could harm a resident, a staff member or visitor; it can involve losses, thefts, accidents, errors in care
fill out ASAP after incident while details are still fresh in your mind
during what shift do most falls occur
between 6pm and 9pm
what are some fall prevention measures
clean up spills STAT
floor cushions next to bed
bed and wheelchair alarms
proper fitting clothes and footwear
bed rails
keep clutter free environment
keep call bell within reach
answer call bells ASAP
good lighting in rooms and hallways
no throw rugs
no extension cords (may trip over)
make sure needs are met (toilet, hydrate, give eyeglasses)
brakes on bed before transferring
what are some alternatives to restraints
hip protectors (looks like a girdle)
roll guards
diversional activities
floor cushions
bed/chair alarms
wedge cushions
lap tray
when can a restraint be used
after alternatives have been unsuccessfully tried and a doctor orders to protect the resident from self or to protect others
what is the difference between active and passive restraints
active restraints are attached to the person's body such as a vest restraint

passive restraints are near, but not directly attached such as bed rails or wedge cushions
what are the different types of restraints
vest restraint
wrists
mitten
belt/waist
side rails
geriatric chair with tray attached
what are the guidelines for restraint use
remove every 2 hours for 10 minutes to toilet, hydrate, ambulate, give ROM

check every 15-30 minutes

never tie to side rails

tie in quick release tie (no knots

check skin under restraints for pressure
how do you know if a restraint is not too tight or loose
slip 2-3 fingers inside- if fingers wont fit (too tight) or whole hand slips in (too loose) readjust
what are the links in the chain of infection?
1.causative agent- such as bacteria or virus
2. reservoir- place for bug to live and grow
3. portal of exit- way for germ to get out of reservoir
4. method of transmission- how the germ is spread to others
5. portal of entry- how the germ gets in to next victim
6. susceptible host- person who is most at risk of getting the infection
what are the 3 types of reservoirs
humans

vectors- animals, insects, birds

fomites- objects such as a toilet seat or door knob
what are the 4 portals of exit
1.Respiratory - could cough or sneeze germs out
2. Gastrointestinal- could vomit or have diarrhea
3. Circulatory - could get out through blood, vaginal secretions or semen
4. Skin- break in skin and drainage from a wound
what are the methods of transmission
1. airborne- person breathes it in (TB)
2. direct contact- thru kissing or sex or hugging
3. indirect contact- through touching a contaminated object such as a toilet seat
4. droplets- touching secretions sneezed out, sharing eating utensils
what are the portals of entry
skin- thru a cut or opening in the skin
respiratory- breathed in
gastrointestinal- eat or drink it in
what makes a person more at risk for getting a contagious (communicable) infection
1.they are very young or very old
2.their job
3. their lifestyle (IV drug user, unprotected sex)
4. living with chronic illnesses
5. already being immunosuppressed (like having IAIDS)
what are the guidelines for handwashing
warm water
friction
15 seconds or more
before and after direct contact
hands held below elbows
if inside of sink touch- restart
stand away from sink
wash wrist and fingernails too
what type of precautions are used for all residents and patients
standard precautions- wear personal protective equipment (PPE) if exposure to blood or body fluids possible, clean, dry and store equipment, dispose of sharps properly
what are the guidelines for a person with TB in airborne precautions
private room
door closed at all times
special mask (HEPA filter mask or N95 respirator mask)
negative air pressure (all air vented outside of building from the room)
what are the signs and symptoms of TB
coughing that produces bloody sputum
wt loss
fatigue
night sweats
what are the guidelines for glove use
single pay of gloves for each task (change after bathing, before doing mouthcare)

don't wear if torn

never worn outside of room

never reused

removed by turning inside out
what are the guidelines for body mechanics
1. bend at the knees
2. hold load close to your body
3. pivot instead of twisting
4. synchronize movements by counting to 3
5. smooth movements, don't jerk
6. face your work
7. stand with feet wide apart
8. ask for help
9. don't reach overhead
10. push, pull or slide if you can
what are the strongest muscles of your body that should be used during work
shoulders, upper arms and thighs
what position is back lying
supine
what position is side lying
lateral
what position is lying on the left side with upper leg sharply flexed and lower arm behind the person
Sims- used for enemas, rectal exams
what position is lying on the stomach
prone
what position is feet higher than the head
trendelenberg- used if person going into shock to increase blood flow to brain
what position is sitting completely up with spine straight (90 degree angle)
fowlers
what is logrolling
turning the person as a unit, to prevent injury to neck and spine
what is dangling
allowing the person to sit on the edge of the bed for a few minutes with legs dangling free (not on floor) to prevent orthostatic hypotension (a drop in BP which may cause fainting)
what is standard equipment in a resident room
bed (manual bed is operated by gatches or cranks)
bedside stand with drawers
overbed table (used as CNA workspace and for meals)
chair with arms
wardrobe
privacy curtain
call bell
what are the 2 delivery systems for oxygen
mask or nasal cannula
what are the 3 types of beds you might make
closed- when bed not in use- pillow covered by spread

open- top sheet and spread fanfolded to foot of bed

occupied
what are the guidelines for bedmaking
1. collect linen in order of use
2. place linen on clean dry surface (chair or overbed table)
3. don't fan sheets
4. make one side of bed at a time
5. raise bed to comfortable working height
6. make wrinkle free
7. wear gloves if visibly soiled or wet to strip bed (remove sheets)
8. don't bring in extra linen (considered contaminated and would have to be placed in soiled linen hamper)
9. don't let linen (clean or dirty) touch your uniform
10. no linen on the floor
what skills are performed during early AM care (before breakfast)
wash hands and face
toilet or change diaper
rinse mouth or rinse off dentures and place in
place in fowler's position
what skills are performed with PM (bedtime) care
wash hands and face
comb hair
change in to bedclothes
toilet
back rub
how often is routine mouthcare performed
BID- after breakfast and HS (at bedtime or hour of sleep
what position is used for routine mouthcare
person must be sitting up
what residents may require special mouthcare, every 2 hours
those who are unconscious, in a coma, very confused, NPO, tube feeders
what position is used for special mouthcare
person has head turned to side
what are guidelines for denture care
1.cleaned in cool water
2. stored in a labeled, covered denture cup filled with cool water
3. sink lined to protect from damage during cleaning
what are guidelines for bathing
1, bath water temp 105-115
2. change water if too soapy, cold or dirty
3. wash from clean to dirty body parts
4. rinse well
5. pat skin dry
6. clean eyes from inner to outer
7. no soap on face
8. keep body covered
describe perineal care for male and female
female- from front to back

male- in circular motion from urinary meatus (opening) towards scrotum; if uncircumcised, push back foreskin to clean and replace
how are fingernails filed
straight across
what is washed during a partial bath
eyes
face
hands
axilla
perineal area
back
how is hair combed
if untangled, from roots to ends
if tangled, from ends toward scalp
comb in sections- long hair pulled up, pulled back
what are the guidelines for shaving
hold skin taut
rinse blade often
shave in direction of hair growth
if on an anticoagulant- use electric razor
dispose of razor in sharps container
what should you do if a man is nicked while being shaved
apply direct pressure until bleeding stops and inform nurse
describe dressing a resident with an affected arm or leg
offer choice of clothing items
undress unaffected side
put clean clothes on affected side
what is another term for urination
voiding
how is the fracture pan placed under a person
the handle faces the foot of the bed
where can a urinal be placed after use
the man can hook it to the side rail- never on the overbed table, bedside stand or floor
what are guidelines for a person with an indwelling urinary catheter
1. bag must be kept below level of bladder
2. bag is attached to frame of bed
3. bag cannot touch floor
4. bag emptied at end of shift
5. catheter secured to body (inner thigh of woman or stomach for men)
6. clean catheter after BM or with bath- hold at insertion sight and clean 4 inches down catheter with soap and water)
7. keep catheter and tubing unkined
what is peristalsis
alternating contractions and relaxation of intestinal muscles that moves feces through the large intestines to the rectum
what are signs and symptoms of fecal impaction
passage of liquid stool
stomach enlarged and crampy
rectal bulging
**must be removed by nurse or doctor by hand, with an enema in or in surgery
what is flatulence
excessive formation of gas
(flatus is the passing of gas)
what are measures to remember when giving an enema
1. cover bed with extra padding to keep dry
2. have toilet paper, commode or bedpan nearby
3. insert tubing 2-4 inches and hold in the rectum
4. encourage slow deep breaths if cramping
5. always show the nurse the return (what comes out) before flushing)
what is the difference between a colostomy and an ileostomy
a colostomy will drain solid stool
an ileostomy will drain liquid stool (irritating to skin, can be expelled at any time and has more odor)
what are signs and symptoms of dysphagia
pocketing food, drooling, spitting out food, coughing, food comes up through nose, eating slowly (especially solids)
what are guidelines for preventing aspiration
1. position upright
2. check for pocketing
3. alternate food and liquids
4. feed slow
5. leave sitting up for 1 hour after meals
6. support upper back, neck with pillows
7. give thickened liquids if ordered
how many ounces are equal to 1cc/ml
30
what fluids are included on output
diarrhea
emesis
wound drainage
urine
what are guidelines for care of the resident with a feeding tube
1. HOB raised when feeding going in
2. NPO- give mouthcare Q2h
3. keep tubing unkinked
4. report vomiting to nurse
5. reapply tape over bridge of nose as needed
6. secure tubing (to clothes or under a binder to prevent accidentally coming out)
How are contractures prevented
Range of motion exercises
handrolls
splints
How is footdrop prevented
footboard at foot of bed, feet flush against it
What position should the legs of a person who has had a hip replacement be kept in
abduction
what is the purpose of a bedcradle
keeps the top linen from touching the lower body
what are guidelines for ambulation
1. nonskid footwear
2. CNA walks slightly behind to one side
3. hold gait belt with hands facing upward
how many hours of sleep do seniors require
5-6 hours
during what stage of sleep does dreaming occur
during stage one of nonREM sleep (rapid eye movement_
what is radiating pain
pain that moves from site of tissue damage to nearby sites
what is phantom pain
pain experienced by amputees- is real!
in what position might a person with COPD sleep
orthopneic position or sitting up, leaning over an overbed table
what should you note and report to the nurse if you are caring for a person receiving oxygen
flow rate
whether humidifier bottle is bubbling or empty
what should you do if a residents food is cold
get another tray or reheat in microwave
what is the most accurate and least accurate way to measure body temp
accurate- rectal
least accurate- axillary
what is the most important thing to remember about taking a rectal temp
thermometer must be held in place
what are guidelines for taking a radial pulse
1. don't use your thumb
2. don't press too hard (blocks the pulsation)
3. note rate, rhythm, and force
4. keep fingers on pulse area to begin taking respirations
what is the normal range for pulse
60 to 100
what is the normal range for respirations
12-20
what is the medical term for a pulse greater than 100
tachycardia
why would urine be strained
to collect kidney stones
how would you measure height on a nonambulatory person
using a tape measure from top of head to heel
what tasks are performed by the CNA when a resident is transferred to another unit
pack belongings and toiletries (wash basin, etc).
transport in w/c
introduce to new staff and roommate
wish the person well
what are possible causes of skin tears
rushing when providing care
long fingernails or jewelry
very fragile skin (put resident in long pants, and sleeves)
sharp edges of equipment
how is shearing prevented
keep HOB 30 degrees or less
how is friction prevented
1. light dusting of powder under areas where skin touches skin
2. use a drawsheet to move around in bed
what should you do if you see a red area on a resident's skin
NEVER massage over it- report to nurse
what are causes of skin breakdown or pressure ulcers
1. immobility
2. incontinence
3. poor nutrition and hydration
4. decreased sensation of skin
5. friction
6. shearing
7. wrinkled sheets
what protective devices are used to prevent skin breakdown
1. foam/air/mattresses
2. elbow and heel protectors
3. sheepskin/lambswool on bed
4. pillows
foam wedges
5. bedcradles
6. gel pads in wheelchairs
what is the purpose of antiembolism or TED stockings
to prevent blood clots from breaking free and traveling to the heart, lungs or brain
what residents would benefit from enti-embolism stockings
bedridden
post surgery residents
those with circulatory or heart disorders
what are the guidelines for use of TED stockings
1. put on before getting out of bed
2. keep wrinkle free and untwisted
3. removed every 8 hours or at bedtime
4. wash by hand and let air dry
what are the guidelines for hot or cold aplications
1. never apply directly to skin
2. check every 5 minutes for signs of complications (such as blistering, burning)
3. never leave on for more than 15-20 minutes
what residents might benefit from a sitz bath
residents with hemorrhoids, after vaginal childbirth or residents with genital herpes
what are guidelines for care of the hearing aide
1. remove during showers, shampoos and at bedtime
2. check battery daily- turn on, turn up, listen for loud whistle, then readjust volume
3. clean (follow manufacturers directions)
4. turn off at bedtime
5. report if lost immediately
6. always check sheets before removing from bed for hearing aide
how do you communicate with the hearing impaired
1. gain attention (touch gently on arm)
2. face to face
3. sit in good lighting
4. don't cover your mouth or chew gum
5. use body language
6. write out important messages
7. use communication boards
8. use short sentences and simple words
what is the medical term for difficulty speaking
dysphasia
what are guidelines for communicating with the speech impaired
1. ask person to repeat or rephrase statements as needed
2. be patient
3. don't finish person's sentences
4. if frustrated, ask him to write it down
5. use body language
what are risk factors for glaucoma
1. african american
2. diabetes or hypertension
3. family history
4. over 60 years old
how is glaucoma treated
no cure, only eyedrops to prevent further loss and blindness
describe care of the artificial eye
1. clean with mild soap and water
2. store in a lined container (to prevent scratching) filled with salt water
3. clean the socket with warm water or salt water and dry with washcloth or gauze
4. rinse eyeball before reinserting
which type of tumors have the ability to metastasize or spread
malignant tumors spread to other areas, grow fast and are life-threatening
how is cancer treated
chemotherapy
radiation
surgery
what are guidelines for cast care
1. let dry completely (24 hours)
2. handle with open palms until dry
3. elevate arm or leg on pillow
4. never insert anything into cast
5. report odor, pain, drainage, swelling, cyanosis or redness of fingers/toes to nurse
what are guidelines for care of the person with traction
1. keep body in good alignment
2. never place weights on floor or bed
3. use a fracture pan for toileting
4. encourage ROM exercise
5. never remove traction or change weights
6. prevent skin breakdown
what are guidelines for the person with a hip replacement
1. no bending, no crossing legs
2. use an elevated toilet seat
3. keep legs abducted
4. use a high chair
5. turn to nonoperative side postop
6. apply elastic stockings as ordered
what are warning signs of a stroke
sudden numbness or weakness of face, arm, leg on one side of body

confusion, dysphasia

loss of balance

severe headache
what are two bloodborne pathogens
HIV and Hepatitis B
how are HIV and hepatitis B spread
1. moms to babies
2. blood transfusions
3. unprotected sex
4. sharing needles and syringes
what is a hallucination
false sensory perception such as hearing voices, seeing dead people or feeling ants crawling over you
what is a delusion
false, fixed belief such as believing you can fly
what does cognition involve
ability to memorize, think, reason, understand, judgment, and behaviors
what is dementia
dementia is loss of cognitive function- poor memory, poor judgment, change in behaviors, poor reasoning
number one cause is alzheimer's disease
what is delirium
sudden onset of extreme confusion, a medical emergency
what are signs and symptoms of depression
feelings of hopelessness, isolation, tearfulness, change in appetite and sleep patterns, lack of interest in self or others, thoughts of death- all for at least 2 weeks
what are classic behaviors of people with AD
wandering
pillaging
hoarding
agitation
delusions
hallucinations
sundowning
how do people with AD communicate
screaming
what is sundowning and how is it managed
restless, increased confusion and agitation during evening hours
give back rub, warm drink, finish activities and care early in day, calm quiet atmosphere, no exercise or activity near bedtime
what is the goal of rehab
to restore a person to highest possible level of function
what should you do if a person is having a seizure
call for help
assist person to floor
loosen clothing
note time seizure starts
move away furniture
TURN HEAD TO SIDE
support/protect head on your lap, pillow
what should you NOT do during a seizure
try to stop movements
try to insert anything into the mouth
what position should someone be in if they are feeling faint
head between knees or head as low as it can be
what is a terminal illness
an illness or injury for which there is no reasonable expectation of recovery- the person will die from the illness
what is done to the body during postmortem care
1. eyes closed
2. jaw closed
3. body straightened
4. body bathed
5. diaper applied
6. tied at wrists and ankles
7. dentures may be left in
8. leave wedding rings on, all other jewelry removed
9. toe tag on body
10. wrapped in shroud (plastic sheet)
what is the last sense to leave a dying person
hearing
what are 4 environmental causes of falls


wet floor


clutter


poor lighting


rugs



what should you do if a person is falling

slide to floor down one of your legs, call for help, stay with person and do not touch him
what are 6 guidelines for restraint use


remove every 2 hours


check every 30 minutes


don't tie in a knot


tie to frame of bed


slip2-3 fingers inside




check for irritation/discoloration


what are examples of passive restraints

side rails, geriatric chair
what are types of active restraints

wrists, vest, belt, mittens
how is the vest restraint applied

criss crossed in front
what are 5 complications of restraints


suffocation, depression, constipation


incontinence, fractures, dehydration, skin breakdown

what should be done before performing the Heimlich maneuver

ask person to cough and speak
what does RACE stand for in fire safety


r-remove to area of safety


a-activate the alarm


c-close doors and windows


e-extinguish if you can


what does PASS stand for when using a fire extinguisher


p-pull the pin


a- aim at base of flames


s- squeeze handle


s-sweep back and forth

what info is found in the MSDS manual

how to store, dispose, handle a chemical and what to do if there is an accidental exposure
what are 6 guidelines for good body mechanics


stand with feet apart


push or pull


bend at the knees


raise bed up


pivot

what muscles should be used to lift and move a resident

thigh, shoulder and upper arms