Download Title: Regional Hospital: Infection Control Study Module for the

Title:
Regional Hospital: Infection Control Study Module for the Certified Nursing Assistantl
Purpose:
This study module addresses the issues of infection control in healthcare.
Competency:
Follows policies and procedures to promote a safe environment
Objectives:
Upon completion of this module, the orientee will:
A. Discuss infection control policies applicable to the institution of employment.
B. Discuss proper disposal of waste.
C. Discuss Standard Precautions
D. Define VRE and MRSA.
E. Discuss TB issues.
F. Discuss HIV.
G. Discuss Hepatitis B and C.
Content:
Refer to required Activities.
Required Activities:
1. Read and study policies and procedures related to infection control in the institution of employment.
2. Visit with the Infection Control Nurse about facility policies and procedures.
3. Read in a current text or journal about the following:
Mosby’s Textbook for Certified Nursing Assistant, pages 211-237.
• VRE
• MRSA
• TV
• HIV
• Hepatitis B and C
4. Complete final exam with a minimum score of 90%.
Approved by:
Becky Finch RN
Jodi Asche CNA
Mary Vold RN BSN
Beverly Nelson CNA
Diane Vrieze RN
CBO/NURSE ASSIST/HCMH/8/13/2004/VOLD/80
Name: ___________________
Score: ___________________
Regional Hospitals: Infection Control Final Exam for the Certified
Nursing Assistant
After you have been oriented to your institutions Infection Control/Isolation Manual complete the following quiz.
1.
Infectious waste is disposed of in what color bags? __________________________________________
2.
What 3 diseases require a negative pressure room? __________________________________________
_________________________________________ , _________________________________________
3.
How soon after a blood exposure from an HIV positive source should chemoprophylaxis be initiated?
______________________________________________________
4.
What does VRE stand for? ______________________________________________________________
True or False (Circle Correct Answer)
5.
T
F
Hand washing remains the number one method of infection control
6.
T
F
Antitubercular medication can usually be stopped in one month because TB patients can
become noncontiguous in 2-3- weeks.
7.
T
F
Inactive TB infections always lead to active TB disease.
8.
T
F
Always wash your hands after treating a patient unless wearing gloves.
9.
T
F
MRSA stand for Methicillin Resistant Streptococcus Aureus.
10. T
F
TB test are given to employees every 3 years.
11. T
F
Infectious waste goes directly into a community sewer or landfill.
12. T
F
Standard precautions means treating all blood and potentially infectious body fluids, nonintact
skin, and mucous membranes, as if they are infectious.
13.
VRE:
a. Is resistant to most antibiotics
b. Is spread by direct contact between healthcare workers and patients
c. Can be prevented by practicing good Hand washing techniques
d. Is spread by contact with soiled objects in the environment
e. Can live on a hard surface for a long period of time
f. All of the above
14.
Describe how you would clean up a blood spill in your institution.
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
___________________________________________________________________________
CBO/NURSE ASSIST/HCMH/8/13/2004/VOLD/81
Infection Control Final Exam Answer Key
1.
Red
2.
TB, measles, chicken pox
3.
Before 2 hours
4.
Vancomycin Resistant Enterococci
5.
T
6.
F
7.
F
8.
F
9.
F
10.
F
11.
F
12.
T
13.
F
14.
Each institution will have own answer.
CBO/NURSE ASSIST/HCMH/8/13/2004/VOLD/82
Title:
Regional Hospital: Skin Integrity Study Module for the Certified Nursing
Assistant
Purpose:
This module contains information related to the care of the skin
Competency:
Recognize and provide essential aspects of Certified Nursing Assistant care to the
patient with impaired skin integrity
Objectives:
Upon completion of the study module the Certified Nursing Assistant will be able to:
A. Describe the signs, symptoms, and causes of pressure circulatory ulcers
B. Describe how to prevent pressure and circulatory ulcers
C. Define risks related to pressure and circulatory ulcers
D. Demonstrates importance of preventive measures related to pressure and circulatory ulcers
Content:
A.
B.
C.
D.
E.
F.
G.
H.
Stages of pressure ulcers
Risks for skin breakdown
Prevention measures
Observing changes in skin appearance
Activity
Bowel and bladder incontinence
Diet
Special equipment
Required Activities:
A. Read and study Skin Integrity Study Module
B. Final exam with 85% accuracy
Approved By:
Becky Finch RN
Jodi Asche CNA
Mary Vold RN BSN
Beverly Nelson CNA
Diane Vrieze RN
Page 1
CBO/NURSE ASSIST/HCMH/8/13/2004/VOLD/83
Introduction:
Changes in skin integrity impose staggering expense to society in terms of actual
cost and quality of life. Effective prevention and treatment of pressure ulcers is a key to
reducing the cost and improving the quality of life for those at risk.
Aging, illnesses, disease, decreased oxygen, surgery, poor nutrition, incontinence and
steroids are some of the agents that weaken the skin.
Overview:
Pressure Sores:
Also known as decubitus ulcers or bedsores are painful, slow healing and are easily
infected. Pressure sores are fully preventable.
How do pressure sores develop:
Just like the word pressure means-prolonged sitting or lying in one position exerting
pressure on the skin.
Circulatory Ulcers:
Circulatory ulcers (vascular ulcers) are caused by a decrease in blood flow through
arteries or veins. Persons with diseases affecting the blood vessels are at risk for these
ulcers on the legs and feet. These wounds are painful and hard to heal.
Depriving the skin of oxygen and nutrients
The skin loses its elasticity, strength and fatty tissue layers. This causes the skin to
thin and sag. The skin is fragile and easily injured. Skin breakdown, skin tears and
pressure ulcers are dangerous.
The skin has fewer nerve endings. This affects the person’s ability to sense heat, cold
and pain. Bruising and delayed healing results from a decreased number of blood
vessels. Dry skin is easily damaged and causes itching. Daily showers or tub baths are
avoided. Usually a complete bath is taken twice a week. Partial baths are taken on the
other days.
Circulatory Ulcers:
Circulatory ulcers (vascular ulcers) are caused by a decrease in blood flow through
arteries or veins. Persons with diseases affecting the blood vessels are at risk for these
ulcers on the legs and feet. These wounds are painful and hard to heal.
Content:
A.
Stages of pressure ulcers
Stage 1
The skin is red. The color does not return to normal when the skin is
relieved of pressure
Stage 2
The skin cracks, blisters, or peels. There may be a shallow crater.
Stage 3
The skin is gone, and underlying tissues are exposed. The exposed tissue
is damaged. There may be drainage from the area.
Stage 4
Muscle and bone are exposed and damaged. Drainage is likely.
Page 2
CBO/NURSE ASSIST/HCMH/8/13/2004/VOLD/84
B.
Risks for skin breakdown
1.
a. Confined to bed or chair
b. In the same position more than 2 hours
2. Wrinkles in the sheeting and clothing
3. Ill fitted braces and casts
4. Poor nutrition: even crumbs in bed
5. Shearing force: is caused by moving tissue layers over one another and
friction in bed when sliding
6. Loss of bowel and bladder control:
Moisture: soften the skin layer and provide an environment for bacterial
growth. This causes the skin to break down.
7. Altered mental awareness
8. Problems sensing pain and pressure
9. Circulatory problems
10. Older/frail
11. Obese
12. Very thin or malnourished
C.
Preventive measures
1. Turning and repositioning
2. Range of motion exercises
3. Proper nutrition
4. Skin care: moisturizer and barrier
D.
Observing changes in skin appearance
1. Skin color
2. Skin temperature
3. Excessive moisture or dryness
4. Darkened or reddened area-especially over bony prominences
5. Rashes
6. Swelling
7. Bruising
8. Skin tears
9. Wound/ulcers
10. Other abnormalities
E.
Activity
1. Turning and repositioning in bed every 2 hours
2. Place a pillow or rolled up towels to the back when turning
3. Place knees at angle when on back. Use a turning sheet
4. Reposition in chair every 1 to 2 hours. Have patient move or do push ups, etc.
5. Range of motion exercise
a. Neck-turn and stretch
b. Shoulders-reach up over head
c. Elbow-out in front-bend up
d. Forearm-twist-wrist to elbow
e. Wrist-bend
f. Finger-bend and stretch
g. Hip and knees-lift and bend
Page 3
CBO/NURSE ASSIST/HCMH/8/13/2004/VOLD/85
h. Ankle-hold heel, push ball of foot and pull toes down
i. Foot-twist side to side
j. Toes-bend gently back and forth
F.
Bowel and bladder incontinence
1. Toilet frequently
2. Excessive padding causes maceration/use single layers
3. Clean with gentle soap
4. Pat dry (don’t’ rub)
5. Special attention to drying the skin folds
6. Care with bed pans
a. Friction when moving on and off
b. Don’t sit on too long
c. Be careful not to get urine on skin
G.
Diet
1. Balanced and with adequate fluids. Foods rich in protein as directed by Doctor,
Nurse or dietician
H.
Special equipment
Used to reduce pressure on the skin
Low Risk:
1. Overlays
a. Egg crates
b. Foam mattresses
High risk:
2. Air cushions
a. Foam
b. Gel
c. Air
3. Specialty mattresses
a. Air mattresses
b. Gel mattresses
Round donuts are not recommended because they cause poor circulation
Summary:
Preventing pressure ulcers is much easier than trying to heal them. Good nursing
care, cleanliness, and skin care is essential.
Page 4
CBO/NURSE ASSIST/HCMH/8/13/2004/VOLD/86
Name: ___________________
Score: ___________________
Regional Hospitals: Skin Integrity Final Exam for the Certified
Nursing Assistant
1. Skin that is gone and underlying tissues is exposed. The exposed tissue is damaged. There
may be drainage from the area; is what stage of ulcer?
a.
b.
c.
d.
Stage
Stage
Stage
Stage
1
2
3
4
2. List 3 risk factors for skin break down
1. __________________________________________________________
2. __________________________________________________________
3. __________________________________________________________
3. Preventive measures relating to pressure ulcers include:
a.
b.
c.
d.
High fat diet
Lotions containing high amounts of alcohol
Turning and positioning
Assisting patient in repositioning twice a shift
4. List 3 changes in skin appearance that need reporting to the nurse
1.
_________________________________________________________
2.
_________________________________________________________
3.
_________________________________________________________
5. True or False Frequent positioning is not recommended for skin impairment
6. True or False
Range of motion exercises are not considered the Certified Nursing
Assistant’s responsibility
CBO/NURSE ASSIST/HCMH/8/13/2004/VOLD/87
Regional Hospitals: Skin Integrity Final Exam for the Certified
Nursing Assistant
7. Effective managemtn of bowel and bladder incontinence to reduced skin break down include:
a.
b.
c.
d.
Toileting frequently
Reducing excessive moist padding
Avoid friction when using bed pan
All of the above
8. Special equipment does not include which of the following:
a.
b.
c.
d.
Overlays-egg crate mattress
Doughnuts
Air or gel mattress
Chair cushions
CBO/NURSE ASSIST/HCMH/8/13/2004/VOLD/88
Skin Integrity Final Exam Answer Key
1. C
2.
3.
Risks for skin breakdown
1.
a. Confined to bed or chair
b. In the same position more than 2 hours
2. Wrinkles in the sheeting and clothing
3. Ill fitted braces and casts
4. Poor nutrition: even crumbs in bed
5. Shearing force: is caused by moving tissue layers over one another and
friction in bed when sliding
6. Loss of bowel and bladder control:
Moisture: soften the skin layer and provide an environment for bacterial
growth. This causes the skin to break down.
7. Altered mental awareness
8. Problems sensing pain and pressure
9. Circulatory problems
10. Older/frail
11. Obese
12. Very thin or malnourished
C
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Skin Color
Skin Temperature
Excessive moisture or dryness
Darkened or reddened area-especially over bony prominences
Rashes
Swelling
Bruising
Skin Tears
Wound/ulcers
Other abnormalities
5. False
6. False
7. D
8. B
CBO/NURSE ASSIST/HCMH/8/13/2004/VOLD/89
Title:
Regional Hospital: CVA/Stroke Patient Study Module for the Certified Nursing
Assistant
Purpose:
This module focuses on Certified Nursing Assistant responsibilities for providing care to a
client who has suffered a CVA/Stroke.
Competency:
Provide all essential aspects of Certified Nursing Assistant care to the patient who has
suffered a CVA/Stroke.
Objectives:
Upon completion of this study module the orientee will be able to:
A. Define CVA
B. Define the Certified Nursing Assistant’s role in restorative care
C. Demonstrate effective skills related to activity, mobility and positioning
D. Demonstrates knowledge of aphasia
E. Demonstrate ability to use communication equipment
Content:
A.
B.
C.
D.
E.
F.
Mobility
Communication
Elimination
Skin Integrity
Emotional Support & Motivation
Nutrition/Diet
Required Activities:
A. Read Text: Mosby’s 701-703 and 809
B. View video "Lifting, Moving, Transferring Patient".
C. Read and study the CVA/Stroke Study Module
D. Take the final exam
Approved By:
Becky Finch RN
Jodi Asche CNA
Mary Vold RN BSN
Diane Vrieze RN
Beverly Nelson CNA
Page 1
CBO/NURSE ASSIST/HCMH/8/13/2004/VOLD/90
Introduction and Overview:
A stroke/CVA is an incident in the brain caused by a blood clot or bursting of a blood
vessel, allowing blood to spill out into the brain cavity.
A.
Common risk factors include:
1.
Age
2.
Family history of CVA
3.
Cardiovascular disease
4.
Diabetes
5.
Smoking
B.
Symptoms
1. Weakness of one side of the body
2. Drooping of one side of the mouth or drooling
3. Swallowing difficulties
4. Slurred speech
5. Loss of vision in one eye or double vision
6. Vertigo
7. Memory difficulty
8. Personality changes
C.
The effects of a CVA may be temporary or permanent
D.
Rehabilitation then focuses on the whole person and assisting the patient to adjust to their disability
through the extensive rehabilitation process
A.
Mobility – Proper body mechanics for Certified Nursing Assistant in lifting, positioning and
transferring CVA/Stroke patient
Content:
1.
2.
3.
4.
5.
Body Mechanics means using the body in an efficient and careful way. It involves good posture
and balance and using the strongest and largest muscles for work. Fatigue, muscle strain, and
injury can result from improper use and positioning of the body during activity or rest. (See
skill list)
Ambulating is an excellent form of exercise.
a. When a patient is ambulatory consider the distance, what the patient can tolerate and
proper equipment/see Skill list)
b. When a patient is using a wheelchair consider the proper position and brakes (See Skill
list)
Positioning of the body plays an important part in the proper functioning of the body. Good
body alignment helps prevent the complications of immobility, such as contractures and
muscle atrophy. (See Skill list)
Falls are common emergency issues
a. Certified Nursing Assistant plays an important role in preventing falls. (See Skill list)
Paralysis
a. Common result of a stroke is paralysis resulting in loss of feeling and movement
Page 2
CBO/NURSE ASSIST/HCMH/8/13/2004/VOLD/91
B.
Communication
1. Receptive Aphasia is the inability to understand what others are through speech or written
words
2. Expressive Aphasia is the inability to express needs to others through speech or written words
3. Communication Board
a. The written word is used when a person cannot speak or hear. Provide a way for the
person to send messages. A magic slate, paper, pencil, electronic talking aid, picture
board or communication board can be used.
C.
Elimination - CVA’s can cause the loss of bowel and bladder control. Managing incontinence
is an Active Restorative Effort
D.
1.
Bowel and bladder retraining programs are individually designed for patients who have become
incontinent due to a stroke.
a. The role of the Certified Nursing Assistant is to follow the Bladder/Bowel
program as set up by the RN or Therapist.
b. Answers call lights promptly.
c. Don’t rush the patient when toileting.
d. Give the patient privacy
e. Avoid scolding the patient for accidents
f.
Change briefs as needed.
g. Assist the patient if they cannot physically use the toilet.
h. Keep the skin clean and dry.
i.
Remind patient of Kegel exercises
j.
Follow I&O schedule as ordered
2.
Signs and symptoms to report to the nurse
a. Blood in urine
b. Painful urination
c. Small amounts of urine
d. Urgency of the bladder
e. Unusual odor
f.
Unusual color or clarity
Skin Integrity – Changes in skin integrity cause pain and discomfort. Effective
prevention and treatment is the key to quality life. (See Skin
Integrity Module)
1.
E.
Aging, illnesses, diseases, decreased oxygen, surgery, poor nutrition, incontinence, and
steroids are some of the agents that weaken the skin
Emotional Support & Motivation – Stroke can cause damage to parts of the brain responsible
for memory, learning and awareness
1. Stroke survivors can have reduced attention spans and or deficits in short term memory
2. Stroke survivors may also have difficulties making plans, comprehending meanings, learning
new tasks or engaging other complex mental activities
3. Your attitude affects the patient and has a major affect on the care you deliver
4. A disability often affects self-esteem and relationships
5. Appearance and function changes may cause the person to feel incomplete, unattractive,
unclean or undesirable to others.
6. At first the patient may refuse to accept the disability, which may result in depression, anger or
hostility.
Page 3
CBO/NURSE ASSIST/HCMH/8/13/2004/VOLD/92
F.
Nutrition/Diet – Patients who have had a stroke or a CVA will need extra
time and patience with eating and drinking.
1.
2.
3.
4.
5.
6.
7.
8.
9.
It is an important responsibility of the Certified Nursing Assistant to provide food and fluids
The Certified Nursing Assistant is responsible for delivering food trays, special supplements,
and snacks
The Certified Nursing Assistant will assist the patient in eating or feed the patient if there is a
need
The Certified Nursing Assistant is responsible for passing fresh drinking water and encouraging
patients to drink enough liquid.
If the patient has dysphasia supply the patient with a semi-soft diet. Explain to the patient to
chew on the unaffected side of the mouth
Look for pocketing of food. Add thicket to fluids if necessary
Instruct patient to sit upright when eating and to tilt the head slightly forward
Watch for aspiration as indicated by coughing or short of breath. Use assistance devices as
needed.
Take time when feeding your patient (See text)
Summary or Conclusion:
The Certified Nursing Assistant plays an important role in the care of the patient
with a stroke. The Certified Nursing Assistant must develop sensitivity to the
patient’s abilities. The Certified Nursing Assistant provides what the patient
needs, but not do more than necessary. The Certified Nursing Assistant
provides essential aspects of care to the patient who has suffered a
stroke/CVA.
Page 4
CBO/NURSE ASSIST/HCMH/8/13/2004/VOLD/93
Name: ____________________
Score: ____________________
Regional Hospitals: CVA/Stroke Final Exam
1.
List three types of mobility
A. _________________________________________________
B. _________________________________________________
C.
________________________________________________
1. True or False A common result of a CVA/Stroke is the inability to understand what others are communicating
either through speech or written words.
2. List three ways used to communicate with the patient who cannot speak.
A. __________________________________________________
B. __________________________________________________
C. __________________________________________________
3. The role of the Certified Nursing Assistant for bowel and bladder retraining include:
A.
B.
C.
D.
Give patient privacy during toileting
Scolding the patient for accidents
Restrict fluids
Change briefs every shift
4. True or False Can a stroke cause damage to parts of the brain responsible for memory,
learning and awareness?
5. True or False Patients who have had a stroke or a CVA will not need extra time with eating
and drinking.
CBO/NURSE ASSIST/HCMH/8/13/2004/VOLD/94
CVA/Stroke Patient-Final Exam Answer Key
1.
A. Ambulation
B. Transferring
C. Positioning
2. True
3.
A.
B.
C.
D.
E.
Magic slate
Paper/pencil
Electronic talking aid
Picture board
Communication board
4. A
5. True
6. False
CBO/NURSE ASSIST/HCMH/8/13/2004/VOLD/95
Title:
Regional Hospital: Mandatory Reporting Study Module for the Certified Nursing Assistant
Purpose:
This module outlines what constitutes pediatric and dependent adult abuse and the
reporting process.
Competency:
Recognizes all essential aspects of pediatric and dependent adult abuse.
Objectives:
Upon completion of this module, the orientee will be able to:
A. Discuss the nurse’s role as a mandatory reporter.
Content:
A. Child Maltreatment
B. Elder Neglect and Abuse
C. References
Required Activities:
A. Read and study contents of module
B. Complete final exam with a minimum score of 90%
Note: This study module does not meet Iowa Code education requirements for mandatory reporters.
Approved by:
Becky Finch RN
Jodi Asche CNA
Mary Vold RN BSN
Beverly Nelson CNA
Diane Vrieze RN
Page 1
CBO/NURSE ASSIST/HCMH/8/13/2004/VOLD/96
Content:
A.
Child Maltreatment
A child’s right to grow and develop to full potential and to be free from harm is highly regarded and
protected by all states. Each state has it’s own law pertaining to child maltreatment. The following
categories of maltreatment are clearly defined by each state:
• Physical abuse
• Physical neglect
• Sexual abuse
• Emotional abuse
• Emotional neglect
• Medical deprivation
• Educational deprivation
• Intentional drugging
• Abandonment
• Munchausen syndrome by proxy
•
Definitions
The following are definitions of child maltreatment as stated in the Code of Iowa.
Child-any person under the age of eighteen.
Child abuse-Any non-accidental physical injury, injury which is at variance with the history given of it, or
injury which is suffered by a child as the result of the acts of omissions of a person responsible for the
care of the child. The commission of a sexual offense with or to a child as a result of the acts or
omissions of the person responsible for the care of the child. The failure on the part of a person
responsible for the care of the child to provide adequate food, shelter, clothing, or other care necessary
for the child’s health and welfare when financially able to do so or when offered financial or other
reasonable means to do so. A parent or guardian legitimately practicing religious belief who does not
provide specified medical treatment for a child for that reason alone shall not be considered abusing the
child, however this provision shall not preclude a court from ordering that medical service be provided to
the child where the child’s health requires it.
Person responsible for the care of a child-A parent, guardian, or foster parent, a relative or any other
person with whom the child resides, without reference to the length of time or continuity of such
residence; an employee or agent of any public or private facility providing care for a child, including an
institution, hospital, health care facility, group home, mental health center, residential treatment center,
shelter care facility, detention center, or child care facility, or any person providing care for a child, but
with whom the child does not reside, without reference to the duration of the care.
•
Code of Iowa
The purpose of the Code of Iowa is to provide the greatest possible protection to victims or potential
victims of abuse through encouraging the increased reporting of suspected cases of such abuse, insuring
the thorough and prompt investigation of these reports, and providing rehabilitative services, where
appropriate and whenever possible to abused children and their families which will stabilize the home
environment so that the family can remain intact without further danger to the child.
Page 2
CBO/NURSE ASSIST/HCMH/8/13/2004/VOLD/97
•
Categories of Child Maltreatment
There are three main categories of child maltreatment: neglect, physical abuse, and sexual abuse.
Following is a brief look at these categories and the types of injuries or manifestations that you as a
nurse may see in the hospital setting or encounter in the community at large.
Neglect-One half of all reported cases of child maltreatment is due to neglect. Ignorance or a child’s
needs and lack of resources are the main contributing factors to neglect. Most serious is a parent’s
failure to recognize emotional nurturing as an essential need of children rather than emotional nurturing
as being viewed as spoiling the child by giving him/her attention. Some of the manifestations of physical
neglect include:
• Lack of food and water
• Lack of adequate shelter
• Lack of adequate supervision
• Lack of adequate medical care
• Lack of adequate education
Some
•
•
•
•
•
•
•
of the behavioral indicators of physical neglect may include a child that is:
Dull or inactive
Very passive or sleepy
Demonstrating self-stimulating behaviors such as thumb sucking or rocking back and forth
continually
Begging or stealing food
Absenteeism from school
Drug or alcohol addiction
Vandalism or shoplifting
Emotional neglect can be manifested in various ways and may include:
• Failure to thrive
• Feeding disorders
• Enuresis
• Sleep disorders
Behavior indicators may include:
• Lack of social smile and stranger anxiety withdrawal
• Fearful behaviors
• Antisocial behavior, such as destructiveness, stealing, cruelty
• Lack of emotional and intellectual development
• Suicide attempts
Emotional abuse is the deliberate attempt to destroy or significantly impair a child’s self esteem or
competence. Emotional abuse includes verbal abuse, which is probably the most common type of abuse
suffered by a child. It includes using the child as a scapegoat, using put-downs with a child, humiliating
and labeling the child and also having unreasonable expectations of the child.
Page 3
CBO/NURSE ASSIST/HCMH/8/13/2004/VOLD/98
Failure to thrive is one of the most common types of neglect that the nurse in the hospital will see.
Failure to thrive is used to describe a child who is not growing according to predictable patterns. Failure
to thrive can be brought on by an organic cause such a congenital heat defect, endocrine dysfunction,
or malabsorption syndrome. When all organic causes have been ruled out, then the search for a cause
starts with the parents. Failure to thrive can also be caused by nutritional, parental, or environmental
deprivation. The primary age groups affected with failure to thrive are the infant and toddlers. This is a
period of rapid physical growth, brain growth, and developmental achievements. The impact of poor
nutrition and lack of stimulation can be devastating, but can be reversed if caught early enough. Some
of the characteristics that contribute to failure to thrive in children include:
• A history or a poor childhood experience on the part of the caregiver.
• An infant’s personality that is totally different from what the parents expected.
• Failure of the parents and child to bond at birth. This may be due to a premature birth where
the infant required special care that prevented the parents from participating in the bonding
process with the child. This may never be reversed unless the parents are allowed to participate
in the care of the infant from the time he/she is born.
The clinical criteria for failure to thrive is usually:
• Weight below the third percentile with subsequent weight gain in the presence of adequate
nutrition and nurturing
• Absence of systemic or congenital disease
• Developmental delay that improves with appropriate stimulation
The clinical signs of deprivation may include:
• Flat head
• Patchy hair
• Distended abdomen
• Lack of subcutaneous fat in the gluetal region and cheeks
• Poor skin condition
• Developmental delay in all areas
• Limited ability to engage in social interaction
• Ravenous appetite, or totally uninterested in food
• Posture that is unpliable, stiff, rigid, floppy
Parents usually relate a history of feeding problems and vomiting. Upon assessment, the nurse
may find that the diet history given by the parent is inappropriate for the child based on his/her
age.
The most important contribution that the nurse can make is to educate the parents in proper infant care
and nutrition. Many times failure to thrive can be reversed through education and by encouraging the
parents to assume nurturing roles.
Physical Abuse-This is the category of child maltreatment that most people think of when they hear the
work child abuse. There are three main characteristics that influence the potential of abuse: parental,
child and environmental.
Parental characteristics include:
• Had physical punishment used on them as a child
• Have difficulty controlling aggressive behaviors
• Free expression of violence in the family
• Social isolation
• Few supportive relationships
• Frustration
• Anxious behavior
• Low self-esteem
Page 4
CBO/NURSE ASSIST/HCMH/8/13/2004/VOLD/99
Child characteristics include:
• Temperament that is not tolerated well by parents
• Position in the family
• Physical needs
• Disabilities
• Insensitive to parental needs
• Illegitimacy
• Unwanted pregnancy and/or birth
• Brain damage
• Hyperactivity
• Coming from a broken home
• Prematurity (due to failure to bond)
• Difficult pregnancy, labor, delivery
Environmental characteristics include:
• Chronic stress
• Divorce
• Poverty
• Unemployment
• Poor housing
• Frequent relocation
• Alcoholism
• Drug addition
• Crowded living conditions
When these characteristics combine, there is an increased likelihood of physical abuse. Following
is a body systems review of some of the different types of injuries that you might find on a
physical assessment. It is important to remember that symptoms of physical abuse are not
limited to the following list and should be suspected when the story of the injury does not fit with the
injury itself.
•
The Head
Intracranial injury is the leading cause of death in child abuse. The estimated incidence of head trauma
is 25% among all cases of child abuse. There are two primary mechanisms of injury causing
craniocerebral trauma. First, a direct blow to the head by a hit or a kick. Second, trauma may occur from
violent shaking.
Some
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
of the types of injuries that may be seen are:
Shaken baby syndrome
Subdural hemorrhages
Retinal hemorrhages
Cerebral edema
Bruises
Linear “slap marks”
Bruised ear lobes
Torn frenulum
Broken teeth
Patches of hair missing
Fractures of facial bones or skull
Lacerations
Hemorrhage of the sclera
Bite marks
Burn marks
Page 5
CBO/NURSE ASSIST/HCMH/8/13/2004/VOLD/100
The presence of significant head trauma in infants should be carefully considered as indication of
abuse. Recent studies find that accidental trauma rarely, if ever, causes intracranial injury in
infants.
•
•
•
•
•
•
•
•
•
•
Burns
Linear and parallel lesions from belts or other objects
Bruises
Rib fractures
Abdominal injuries
• Intestinal perforation
• Bladder injuries
• Pancreatic injuries
• Liver injuries
• Kidney injuries
• Pancreatic pseudocysts
Lacerations
Petechia
Welts
Pinch marks
Abrasions
The symptoms of abdominal trauma are:
• Pain
• Tenderness
• Rigidity
• Guarding
• Decreased or absent bowel sounds
• Distention
• Asymmetry of the abdomen
• Positive hemoccult
• Bloody nasogastric drainage
• Vomiting
A common birthmark that may be mistaken for a bruise is Black, Hispanic, Mediterranean, or
Oriental descendants are the Mongolian Spot. The spots are usually located on the lower back
and buttocks and have even color with distinct borders; they do not change color over time.
Bruises that should raise suspicion are in various stages of healing and are located in areas where
a child would not usually sustain a bruise during normal activities.
•
The Extremities
The extremities are a common place that injuries will be seen. Children do have accidents, sometimes
causing serious injury, but the index of suspicion should be raised if the child is not capable of producing
the force necessary to cause the type of injury seen. Some of the injuries that may be seen are:
• Lesions that have well defined borders
• Bruises
• Scratches
• Fractures
• Dislocations
Page 6
CBO/NURSE ASSIST/HCMH/8/13/2004/VOLD/101
•
•
•
•
•
•
•
Abrasions around wrist or ankles
Burns
Periosteal shearing
Subperiosteal hemorrhages
Epiphyseal separation
Metaphyseal fragmentation
Squaring of the metaphysis
Fractures or skeletal injuries to children under two years of age should be suspicious of child
Abuse. Certain types of fractures have been closely identified with inflicted trauma. These are:
• Posterior rib fractures (see in infants that were picked up and squeezed)
• Corner fractures of the long bones (from twisting or yanking)
• Spiral fractures of the long bones (from severe twisting)
A skeletal survey should be done on any child who presents with injuries that indicate possible a
abuse. Bone scans can detect trauma that is only hours old
Burns that are highly suggestive of child abuse are contact burns and submersion burns. Contact
burns may be seen in children of all ages. The distinguishing feature of these burns is the
The regular shape or pattern from the instrument used such as cigarettes, iron, and heaters.
submersion burns usually occur when a child is forcefully held in hot water and have four
common characteristics.
• Distinct lines of demarcation
• Absent splash marks
• Areas of clear skin or mild burn surrounded by second and third degree burned tissue
• The extremities, genitals, and buttocks are commonly involved
Any of the above burns should be reported to the local Department of Human Services.
Another type of physical abuse is chemical abuse. This may be seen when a child is admitted to
the hospital repeatedly for drug overdoses or when a childe has a sudden unexplained
hypoglycemia episode which may be the result of insulin administration.
Some of the behavioral indicators that may be manifested by the child that has been physically
abused include:
• Wary of physical contact
• Fear of parents
• Fear of going home
• Lies very still and surveys the environment
• Inappropriate reaction to injury, such as failure to cry from pain
• Lack of reaction to frightening events
• Apprehension when hearing other children cry
• Indiscriminate friendliness and displays of affection
• Acting out behaviors such as aggression or seeking attention
• Withdrawal
• No reaction during physical exams
Page 7
CBO/NURSE ASSIST/HCMH/8/13/2004/VOLD/102
• Sexual Abuse
Sexual abuse is the least reported by all of the types of child abuse. It is the type of abuse that can
cause the most long-lasting affects and carries the most social stigma. Some of the physical indicators
of sexual abuse include:
• Bruises, bleeding, laceration, or irritation of the external genitalia, anus, mouth or throat
• Torn, stained or bloody underclothing
• Pain on urination or pain, swelling, and itching of the genital area
• Penile discharges
• Sexually transmitted disease, nonspecific vaginitis, or venereal warts
• Difficulty walking or sitting
• Unusual odor of the genital area
• Recurrent urinary tract infections
• Pregnancy in the young adolescent
Behavioral indicators may include:
• Withdrawing or daydreaming
• Pre-occupation with fantasies
• Poor peer relations
• Sudden changes, such as anxiety, weight loss or gain, or clinging behavior
• Excessive anger at the non-abusive parent (for not protecting them from abuse)
• Regression
• Sudden onset of phobias or fears
• Running away from home
• Sudden emergence of sexually-related problems including excessive masturbation, sexual play,
promiscuity, and overtly seductive behavior
• Substance abuse
• Profound personality changes
• Declining school performances
• Suicide attempts or ideation
When sexual abuse occurs it is especially important for the nurse interviewing the child to be sensitive
and discrete and to take every effort to make the child comfortable. If the child becomes upset, then
the interview should stop until after the child has settled down. It is also important not to touch the
child without his/her permission.
•
Nursing Responsibilities
•
•
Legal Issues
As a nurse you are a mandatory reporter in all fifty states. If you suspect child maltreatment you are
required by law to report it to the Department of Human Services in your area. As a mandatory reporter
you are required to make an oral report to the DHS within 24 hours and a written report within 48 hours
from the oral report. A detailed list of what must be included in the report as well as a sample of the
form is included in the policy. As a part of your orientation it is required that you read this policy. The
law also protects you from civil suits in the case that a reported child abuse was unfounded as long as
you had a reasonable cause to report it.
Page 8
CBO/NURSE ASSIST/HCMH/8/13/2004/VOLD/103
•
Care of the Child
When the abused child is admitted to the hospital it is important that he/she feels comfortable and not
threatened during all procedures and interviews. During the interview explain to the child the purpose of
the interview and that the child did nothing wrong. Ask open-ended questions that allow the child to talk
in his/her own terms about what happened. Be sure to allow the child to ask questions and answer them
honestly. The child should be treated as a child with the usual physical needs, developmental tasks, and
play interests; not as a dramatic victim of abuse. The nurse must also encourage and facilitate a
continuing relationship with his or her parents because the goal of treatment for an abused child and
his/her family is to keep the family unit intact.
•
Care of the Family
When interviewing the parents be sure to explain the purpose of the interview; reassure the parents that
they did the right thing by bringing the child for care. Use open-ended questions and ask the parents
how the child was injured. Advise the parent of your legal obligation to report cases of suspected abuse.
Reassure the parents of your continued support. It is important for the nurse to examine his or her own
feelings about abuse. Interviews must be conducted with genuine concern and not with accusations and
punishment. Many times the parents are also victims and need your support and help. Unless the nurse’s
attitude is positive, abusing parents will not be motivated to charge. When parental ignorance of child
rearing practices has played a part in the abuse, the nurse can educate the parent(s) regarding
children’s physical and emotional needs. Because of the parents’ own child rearing, they may not be
aware of nonviolent methods of discipline, such as time out or consequences.
They may also need help in dealing with their frustrations so that they do not take their anger out on
the child. The nurse has a unique opportunity to serve as a positive role model by showing parents the
correct care of a child and by being a nurturing caregiver.
Prevention of child abuse is the ultimate goal of any pediatric area. This is an extremely difficult goal,
but nurses play an important role by providing information on the normal growth and development of
children and routine health care needs as well as by serving as a positive role model and support person.
Referring families to support services when a need for assistance is identified in another way in which
the nurse can help stop the cycle of abuse. These approaches have been helpful in reducing the risk of
abuse.
B.
Elder Neglect and Abuse
The problem of elder abuse and neglect and speculations about its causation has important implications
for nurses working with dependent elders and caregivers of all types. As elders may suffer neglect or
abuse at the hands of themselves, their peers, family members, paid helpers and organizations designed
to help them, nurses have an opportunity to affect the development and consequences of elder abuse
and neglect in many ways.
While working with elderly individuals, whether in the hospital, nursing home, clinic or home setting,
nurses should be alert for signs of abuse or neglect.
Nurses often monitor patient condition and family concerns in the community setting. This is an excellent
opportunity to identify family situations with high potential for abuse. Initial research points to families
with a history of abusive behavior and family caregivers with multiple stressors as at high risk for elder
abuse. It may be important to help the older person identify an alternative source of care so that an
abuse-prone situation is avoided entirely.
Page 9
CBO/NURSE ASSIST/HCMH/8/13/2004/VOLD/104
O’Malley (1979) defines abuse as the willful infliction of physical pain, injury or debilitating mental
anguish, unreasonable confinement, or the willful deprivation by a caretaker of services which are
necessary to maintain physical and mental health.
Neglect refers to an elderly person who is either living alone and not able to provide for him/herself the
services, which are necessary to maintain physical and mental health or is not receiving necessary
services form the responsible caretaker.
See facility’s policy and procedure manual for current mandatory reporting requirements.
C.
References
Code of Iowa. (1999). Sections 232.67-232.70.
Page 10
CBO/NURSE ASSIST/HCMH/8/13/2004/VOLD/105
Name: ___________________
Score: ___________________
Regional Hospitals: Mandatory Reporting Final Exam for the Certified
Nursing Assistant
1.
T
F
As a certified nursing assistant nurse you are a mandatory reporter for child abuse/neglect in all fifty
states.
2.
T
F
As a mandatory reporter suspecting child abuse/neglect, you are required to make
an oral report to the Department of Human Services within 24 hours and a written
report within 48 hours of the oral report.
3.
T
F
The law protects nurses form civil suits in the case that a reported child abuse was
unfounded as long as the nurse had a reasonable cause to report it.
4.
T
F
Abuse is willful infliction of physical pain, injury or debilitating mental anguish,
unreasonable confinement or the willful deprivation by a caretaker of services
which are necessary to maintain physical and mental health.
5.
T
F
Neglect refers t an elderly person who is either living alone and not able to provide
for himself/herself the services which are necessary to maintain physical and mental
health or is not receiving necessary services form the responsible caretaker.
CBO/NURSE ASSIST/HCMH/8/13/2004/VOLD/106
Mandatory Reporting Final Exam Answer Key
1.
False
2.
True
3.
True
4.
True
5.
True
CBO/NURSE ASSIST/HCMH/8/13/2004/VOLD/107
Title:
Regional Hospital: Pain and Comfort Study Module for the Certified Nursing
Assistant
Purpose:
This module focuses on the Certified Nursing Assistant’s role in providing comfort
Competency:
Recognize essential aspects of pain and comfort. Implement measures to promote
comfort
Objectives:
A.
B.
C.
D.
E.
F.
Upon completion of this module, the orientee will be able to:
Recognize that comfort, rest, and sleep are needed for well-being
Acknowledge age, illness, and activity affect comfort.
Recognize that pain is subjective
Evaluate the patients pain
Identify interventions to promote comfort
Content:
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
Pain Recognition
Vital Signs in assessing pain
Quality of pain
Severity of pain
Body Responses to pain
Behaviors
Focus on children
Focus on adults
Certified Nursing Assistant measures to promote comfort and relieve pain
Certified Nursing Assistant measures to promote rest and sleep
Required Activities:
A. Complete final exam with 85% accuracy
B. Provide comfort measures to patients in pain
C. Read and study Pain and Comfort Study Module
Approved by:
Becky Finch RN
Jodi Asche CNA
Mary Vold RN BSN
Beverly Nelson CNA
Diane Vrieze RN
Page 1
CBO/NURSE ASSIST/HCMH/8/13/2004/VOLD/108
Introduction:
Pain is an important condition to observe and report with your patients. Pain is
referred to as the fifth vital sign. It is as important to monitor pain as any other vital
sign.
Pain is a very difficult thing with which to cope. It can affect the patient’s daily life to
the point that their ability to perform ADL’s is restricted. Pain can swiftly drain energy
and hope.
All caregivers are responsible for recognizing pain and taking appropriate action to
provide pain management.
Content:
A. Pain Recognition
1. Notice individual signs of pain specific to each patient.
2. Work with family and friends who can assist with recognition of unrelieved pain
3. Monitor patients responses to pain medications
4. Report to charge nurse changes in pain level. These factors help determine an individual’s perception
of pain, response to the pain, effectiveness of the pain control measures, and tendency to repeat
pain.
5. Pain is whatever the patient says it is, exists whenever he/she says it does. Pain means different
things to different people. An individual may have difficulty-describing pain to others because pain is
a personal experience. Pain can be categorized according to its duration, quality and severity.
B. Vital signs in assessing pain
1. Vital signs that often increase when a patient has pain are:
a. Pulse
b. Respirations
c. Blood pressure
2. Other signs and symptoms that accompany pain are:
a. Dizziness
b. Nausea
c. Vomiting
d. Weakness
e. Numbness
f. Tingling
3. Location
a. Identifying the location of the pain
b. Does the pain spread?
4. Timing
a. When did the pain start, was it sudden or gradual?
b. How long did it last?
c. How much does it bother you?
d. What time of day does it bother you the most?
e. Does it interrupt sleep?
f. Does it happen before, during, or after meals?
Page 2
CBO/NURSE ASSIST/HCMH/8/13/2004/VOLD/109
C. Quality of pain-how does it feel, could it be described as:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Aching
Burning
Sore
Throbbing
Sharp
Twisting
Crushing
Stabbing
Cramping
Squeezing
Binding
Cutting or dull
Pins and needles
Steady pain
Has it changed
D. Severity- a variety of pain assessment tools are available to the health care provider
Visual Pain Scale: Ask patients to rate their pain
Simple Descriptive Pain Distress Scale
No pain
0
Unbearable pain
1
2
3
4
5
6
0-10 Numberic Pain Distress Scale
Page 3
CBO/NURSE ASSIST/HCMH/8/13/2004/VOLD/110
7
8
9
10
FLACC Scale: To be used if patient is unable to use visual scale
Observation
Face
Legs
Activity
Cry
Consol ability
Value = 0
No particular
expression or smile
Normal position or
relaxed
Lying quietly, normal
position, moves easily
No cry (awake or
asleep)
Content, relaxed
Value = 1
Occasional grimace or
frown, withdrawn,
disinterested
Uneasy, restless,
tense
Squirming, shifting
back and forth, tense
Moans or whimpers,
occasional complaint
Reassured by
occasional touching,
hugging, or “talking
to,” distractible
Value = 2
Frequent to constant
frown, clenched jaw,
quivering chin
Kicking or legs drawn
up
Arched, rigid, or
jerking
Crying steadily,
screams or sobs,
frequent complaints
Difficult to console or
comfort
Directions: Observe the behavior in each category. Add up the five “scores” to obtain a number
on a scale of 0-10.
Pain Thermometer: Place a check on the
thermometer to indicate the amount of pain
you are experiencing
Page 3
CBO/NURSE ASSIST/HCMH/8/13/2004/VOLD/111
Signs and Symptoms of Pain
A.
Body Responses to Pain
2.
3.
4.
5.
6.
B.
Behaviors
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
C.
Crying
Gasping
Grimacing
Groaning
Grunting
Holding the body part (splinting)
Irritability
Maintaining one position; refusing to move
Moaning
Quietness
Restlessness
Rubbing
Screaming
Focus on Children
1.
2.
3.
4.
5.
D.
Increased pulse, respirations and blood pressure
Sweating (diaphoresis)
Nausea
Vomiting
Pale skin (pallor)
Children may not understand pain
Children have fewer ways of dealing with pain
Children rely on adults for help
Infants, toddlers, and pre-school age children have difficulty alerting adults to pain
Adults must be alert for behavior and situations that signal pain
Focus on Adults
1.
2.
3.
4.
5.
6.
7.
Older patients may have decreased pain sensations
Some older patients may have health problems that cause pain
Adults and older patients often deny or ignore pain because of what it may mean (denial)
Thinking and reasoning are affected in some older patients
Some adults cannot verbally communicate pain
Changes in usual behavior may indicate pain
Always report any changes in behavior to the charge nurse
Page 4
CBO/NURSE ASSIST/HCMH/8/13/2004/VOLD/112
Comfort Measures
A. Certified Nursing Assistant Measures to Promote Comfort and Relieve Pain
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
B.
Position the patient using good body alignment; use pillows for support
Keep bed linens tight and wrinkle free
Make sure the patient is not lying on drainage tubes
Assist the patient to the bathroom/commode, or offer the bedpan or urinal
Provide blanket for warmth and prevent chilling
Use correct lifting, moving, and turning procedures
Wait until pain medicine is effective before performing procedures (30 min. – 1 hour)
Give back massage
Provide soft music to distract the patient
Use tough to provide comfort
Allow family members and friends at the bedside as requested/tolerated by the patient
Avoid sudden or jarring movements of the bed
Handle the patient gently
Offer a warm bath or shower
Encourage slow, deep breathing
Always be patient, caring and sympathetic
Certified Nursing Assistant Measures to Promote Sleep
Rest means being calm, at ease, and relaxed, free of anxiety and stress.
Sleep is a state of unconsciousness, reduced voluntary muscle activity, and lowered metabolism. Sleep is
a basic need. It lets the body and mind rest. During sleep the body saves energy.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
Organize care to allow for uninterrupted rest
Avoid physical activity before bedtime
Encourage the patient to avoid tending to stressing matters before bedtime
Allow a flexible bedtime. Bedtime is when the patient is tired and fatigued. Not a certain time.
Provide a comfortable room temperature
Allow the patient to take a warm bath or shower
Provide a bedtime snack
Avoid caffeine, (coffee, tea, colas, or chocolate)
Have the patient void before going to bed
Make sure incontinent patients are clean and dry- (change a baby’s diaper)
Follow bedtime rituals
Make sure the patient wears loose-fitting nightwear
Provide adequate warmth, (blanket, socks), offer extra pillows
Reduce noise
Darken the room by closing shades, blinds, and the privacy curtain. Shut off or dim lights
Dim lights in hallways and the nursing unit. Ensure staff activities and conversation aren’t disturbing
sleep
Make sure linens are clean, dry, and wrinkle free
Make sure the patient is in a comfortable position and in good alignment
Support the body parts, elevate/splint extremities as ordered
Give a back massage
Implement measures to relieve pain
Allow the person to read or the Certified Nursing Assistant can read to small children
Allow the person to listen to music/TV
Assist with relaxation exercises as ordered
Page 5
CBO/NURSE ASSIST/HCMH/8/13/2004/VOLD/113
25. Sit and talk with the person-provide emotional support and socialization
26. Practice safety measures if the patient is receiving strong pain medication or sedatives
a. Keep the bed in low position
b. Raise bed rails as directed (Follow the care plan)
c. Check on the patient every 10-15 minutes
d. Provide assistance when the person is up
e. Apply heat or cold applications as directed by the nurse
f. Provide a calm, quiet, darkened environment
g. Bed alarm system activated
Summary:
It is important for the caregiver to evaluate the pain management plan and its
effectiveness towards relieving the patient’s pain and suffering
1.
2.
3.
4.
5.
The patient or caregiver is encouraged to report pain and pain relief
The rating tools/scales are used to evaluate pain
The family/significant other are vital reporters of pain, for patients who are unable to speak for
themselves
The Certified Nursing Assistant must recognize behavioral and physical clues to evaluate pain relief
The Certified Nursing Assistant will report the patient’s rating of pain, and pain relief
Page 6
CBO/NURSE ASSIST/HCMH/8/13/2004/VOLD/114
Name: _____________________
Score: _____________________
Regional Hospitals: Pain Control Final Exam
1. List 3 interventions the Certified Nursing Assistant can do to promote comfort
1. _____________________________________________________________________
2. _____________________________________________________________________
3. _____________________________________________________________________
2. List 3 interventions the Certified Nursing Assistant can do to promote rest and sleep
1. _________________________________________________________
2. _________________________________________________________
3. _________________________________________________________
3. List 5 signs of pain
1. __________________________
2. __________________________
3. __________________________
4. __________________________
5. __________________________
4. List one tool to assess pain
1. __________________________
True or False:
5. True or False
Nurses are responsible for recognizing pain and taking appropriate action
6. True or False
Change in behavior could be an indication of pain
CBO/NURSE ASSIST/HCMH/8/13/2004/VOLD/115
Regional Hospitals: Pain Control Final Exam for the Certified Nursing Assistant
7. True or False
Asking the patient questions about the location, timing and quality of pain
will help the patient describe their pain experience
8. True or False Using the pain scale of 1-10 is the only way to evaluate pain
Multiple Choice:
9. Factors that effect comfort are:
A. Age
B. Illness
C. Activity
D. All of the above
10. The pain experience is
A. Subjective
B. Objective
C. Rejective
D. None of the above
11. The pain experience for the child and the adult is
A. The same
B. Different
C. None of the above
12. Comfort measures that may assist with pain
A. Provide a blanket
B. Provide soft music
C. Give back massage
D. All of the above
CBO/NURSE ASSIST/HCMH/8/13/2004/VOLD/116
Answer Key: Pain Control Final Exam
1. Comfort Measures
A. Certified Nursing Assistant Measures to Promote Comfort and Relieve
Pain
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
Position the patient using good body alignment; use pillows for support
Keep bed linens tight and wrinkle free
Make sure the patient is not lying on drainage tubes
Assist the patient to the bathroom/commode, or offer the bedpan or urinal
Provide blanket for warmth and prevent chilling
Use correct lifting, moving, and turning procedures
Wait until pain medicine is effective before performing procedures (30 min. – 1 hour)
Give back massage
Provide soft music to distract the patient
Use tough to provide comfort
Allow family members and friends at the bedside as requested/tolerated by the patient
Avoid sudden or jarring movements of the bed
Handle the patient gently
Offer a warm bath or shower
Encourage slow, deep breathing
Always be patient, caring and sympathetic
2. Certified Nursing Assistant Measures to Promote Sleep
Rest means being calm, at ease, and relaxed, free of anxiety and stress.
Sleep is a state of unconsciousness, reduced voluntary muscle activity, and lowered metabolism. Sleep is
a basic need. It lets the body and mind rest. During sleep the body saves energy.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
Organize care to allow for uninterrupted rest
Avoid physical activity before bedtime
Encourage the patient to avoid tending to stressing matters before bedtime
Allow a flexible bedtime. Bedtime is when the patient is tired and fatigued. Not a certain time.
Provide a comfortable room temperature
Allow the patient to take a warm bath or shower
Provide a bedtime snack
Avoid caffeine, (coffee, tea, colas, or chocolate)
Have the patient void before going to bed
Make sure incontinent patients are clean and dry- (change a baby’s diaper)
Follow bedtime rituals
Make sure the patient wears loose-fitting nightwear
Provide adequate warmth, (blanket, socks), offer extra pillows
Reduce noise
Darken the room by closing shades, blinds, and the privacy curtain. Shut off or dim lights
Dim lights in hallways and the nursing unit. Ensure staff activities and conversation aren’t disturbing
sleep
Make sure linens are clean, dry, and wrinkle free
Make sure the patient is in a comfortable position and in good alignment
Support the body parts, elevate/splint extremities as ordered
Give a back massage
Implement measures to relieve pain
CBO/NURSE ASSIST/HCMH/8/13/2004/VOLD/117
3.
Signs and Symptoms of Pain
A. Body Responses to Pain
1.
2.
3.
4.
5.
B.
Behaviors
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
4.
Increased pulse, respirations and blood pressure
Sweating (diaphoresis)
Nausea
Vomiting
Pale skin (pallor)
Crying
Gasping
Grimacing
Groaning
Grunting
Holding the body part (splinting)
Irritability
Maintaining one position; refusing to move
Moaning
Quietness
Restlessness
Rubbing
Screaming
Face scale
Thermometer scale
Word scale
Number scale
5.
F
6.
T
7.
T
8.
F
9.
D
10. A
11. B
12. D
CBO/NURSE ASSIST/HCMH/8/13/2004/VOLD/118
CBO/NURSE ASSIST/HCMH/8/13/2004/VOLD/119