Download Appendix A

Appendix A
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Facts about Medicare
 For 65 or older or permanent kidney failure and
disabilities
 Covers nearly 40 million people
 Part A: pays hospitals, skilled nursing facilities,
hospice care, and some home health care
 Part B: pays doctors’ services and equipment
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Handout 1-1
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Chain of Command
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Handout 1-1
Qualities of Great Nursing Assistants
 Compassion
 Empathy
 Sympathy
 Honesty
 Tact
 Conscientiousness
 Dependability
 Respect
 Lack of prejudice
 Tolerance
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Suspicious Injuries
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Military Time
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Body Language
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Using Your Senses
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Barriers to Communication
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Good Communication with
Mentally Ill Residents
 Do not speak to residents as if they were
children.
 Use simple, clear statements.
 Use normal tone of voice.
 Speak with respect.
 Maintain a normal distance.
 Be aware of body language.
 Be honest.
 Avoid arguments.
 Maintain eye contact.
 Listen carefully.
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Body Alignment
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Lifting Heavy Objects from the Floor
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Chest Compressions
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Chain of Infection
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Airborne Precautions
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Droplet Precautions
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Contact Precautions
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Maslow’s Hierarchy of Needs
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Myths about Older Adults and Sexuality
 Older men are not capable of having sexual
relations.
 After menopause, older women are not
interested in sexual relations.
 Any expression of sexuality by older people is
either disgusting or cute.
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Not Permitted
You should never:
 try to change someone's religion
 tell a resident his/her belief/religion is wrong
 express judgments about a religious group
 insist a resident participate in religious activities
 interfere with religious practices
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Benefits of Activity
 Lessens risk of heart disease, colon cancer,
diabetes, and obesity
 Relieves symptoms of depression
 Improves mood and concentration
 Improves body function
 Lowers risk of falls
 Improves sleep quality
 Improves ability to cope with stress
 Increases energy
 Increases appetite and promotes better eating
habits
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True or False?
1. People over 80 years old cannot live by
themselves.
2. Most older adults are lonely and depressed.
3. Older adults are not able to adjust to changes.
4. Most older adults are ill or disabled in some
way.
5. Older adults can stay active by pursuing
favorite hobbies.
6. Good health can help older adults live
independently.
7. Normal changes of aging do not include
diseases, disabilities, or dependence on others.
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Stages of Dying
 Denial
 Anger
 Bargaining
 Depression
 Acceptance
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Signs of Approaching Death
 Blurred vision that gradually fails
 Unfocused eyes
 Impaired speech
 Diminished sense of touch
 Loss of movement, muscle tone, and feeling
 Rising body temperature or below normal
temperature
 Decreasing blood pressure
 Weak pulse that is abnormally slow or rapid
 Slow irregular respirations or rapid, shallow
respirations (Cheyne-Stokes)
 Rattling or gurgling sound as person breathes
 Cold, pale skin
 Mottling, spotting, or blotching of skin
 Perspiration
 Incontinence
 Disorientation or confusion
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Some Residents’ Rights to Remember When
Caring for the Terminally Ill
 The right to refuse treatment
 The right to have visitors of their own choosing
 The right to privacy
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Ways to Treat Dying People and Their
Families with Dignity
 Respect their wishes in all ways possible.
 Listen for ideas on how to provide simple
gestures that may be appreciated.
 Do not make promises that cannot or should not
be kept.
 Listen if they want to talk.
 Do not babble or be especially cheerful or sad.
 Keep them comfortable.
-Pain free, if possible
-Clean and dry
 Do not isolate or avoid them.
 Assure privacy when they want it.
 Respect the privacy of the family and other
visitors.
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The Integumentary System
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Integumentary System:
Normal Changes of Aging
 Skin gets thinner and more fragile.
 Skin is drier and less elastic.
 Hair thins and turns gray.
 Wrinkles and brown spots appear.
 Protective fatty tissue gets thinner, causing
person to feel colder.
 Fingernails and toenails thicken.
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The Musculoskeletal System
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Musculoskeletal System:
Normal Changes of Aging
 Muscles weaken and lose tone.
 Body movement slows.
 Joints are less flexible.
 Bones lose density and become more brittle.
 Height is lost.
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The Nervous System
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Nervous System:
Normal Changes of Aging
 Slower responses and reflexes
 Decrease in sensitivity of nerve endings in skin
 Some memory loss, more often with short-term
memory
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Parts of the Eye
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The Ear
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Sense Organs: Normal Changes of Aging
 Reduced vision and hearing (sense of balance
may be affected)
 Decreased sense of taste and ability to smell
 Decreased sensitivity to heat and cold
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The Circulatory or Cardiovascular System
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Circulatory System:
Normal Changes of Aging
 Loss of heart muscle strength
 Narrowed blood vessels
 Decreased blood flow
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The Respiratory System
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Respiratory System:
Normal Changes of Aging
 Loss of lung strength
 Decreased lung capacity
 Decreased oxygen in the blood
 Weakened voice
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The Urinary System
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Urinary System:
Normal Changes of Aging
 Reduced ability of kidneys to filter blood
 Weakened bladder muscle tone
 Bladder holds less urine causing more frequent
urination
 Bladder may not empty completely causing
more susceptibility to infection
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The Gastrointestinal System
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Gastrointestinal System:
Normal Changes of Aging
 Decrease of saliva and digestive fluids
 Difficulty chewing and swallowing
 Decrease in absorption of vitamins and minerals
 Less efficient process of digestion; more
frequent constipation
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The Endocrine System
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Endocrine System:
Normal Changes of Aging
 Decrease in levels of hormones, such as
estrogen and progesterone
 Less production of insulin
 Less able to handle stress
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The Reproductive System
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Reproductive System:
Normal Changes of Aging
Female:
 Menstruation ends.
 Decrease in estrogen leads to loss of calcium,
causing brittle bones.
 Drying and thinning of vaginal walls occurs.
Male:
 Sperm production decreases.
 Enlargement of the prostate gland occurs.
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The Lymphatic System
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Lymphatic and Immune Systems:
Normal Changes of Aging
 Increased risk of infections
 Decreased response to vaccines
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Personal Care
 Help the resident be as independent as possible.
 Always explain what you will be doing.
 Provide privacy.
 Let the resident make as many decisions as
possible.
 Observe the resident during care.
 Observe mental state of resident.
 Report any changes.
 Leave the resident’s room clean and tidy.
 Leave call light within reach.
 Leave bed in lowest position.
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Grooming
 Residents should do as much for themselves as
they can.
 Let residents make as many choices as possible.
 Follow the care plan.
 Follow residents’ preferred routines.
 Be sensitive.
 Only provide nail care if assigned.
 Never cut toenails.
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Dressing
 Preferences should be followed.
 Allow resident to choose clothing.
 Resident should do as much as possible.
 Provide privacy.
 Roll or fold stockings or socks down when
putting them on.
 Fasten bras in front first.
 Place weak arm or leg through garment first.
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Pressure Sore Danger Zones
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Observing the Skin
 Pale, white, red, purple areas or blisters and
bruises
 Tingling, warmth, burning
 Dry, flaking skin
 Itching and scratching
 Rash or discoloration
 Swelling
 Blisters
 Fluid, blood draining
 Broken skin
 Wounds or ulcers
 Changes in existing wounds or ulcers
 Redness, broken skin between toes or around
toenails
 In ebony skin, look for change in feel or
appearance of skin, such as orange-peel look,
purplish hue, and crust-like areas
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Assisting a Falling Resident
 Widen your stance.
 Bring resident’s body close to you.
 Bend knees and support resident.
 Lower resident to floor.
 Do not try to stop the fall.
 Call for help.
 Do not get resident up.
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Normal Ranges for Adult Vital Signs
Temperature
Oral
Rectal
Axillary
Fahrenheit
97.6-99.6
98.6-100.6
96.6-98.6
Celsius
36.5-37.5
37.0-38.1
36.0-37.0
Pulse: 60-90 beats per minute
Respirations: 12-20 respirations per minute
Blood Pressure: Systolic 100-119
Diastolic 60-79
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Managing Pain
 Report pain promptly to the nurse.
 Position the body in good alignment.
 Help in changes of position.
 Give backrubs.
 Offer warm bath or shower.
 Help the resident to use the bathroom, bedpan,
or urinal.
 Encourage slow, deep breaths.
 Provide calm environment.
 Use soft music.
 Be patient, caring, gentle and sympathetic.
 Note resident’s emotional response to pain.
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When a Resident is Restrained
The resident must be checked at least every 15
minutes. At least every two hours the following
must be done:
 Release the restraint for at least 10 minutes.
 Offer assistance with toileting. Check for
episodes of incontinence. Provide incontinence
care.
 Offer fluids.
 Check skin for irritation. Report any red areas to
the nurse immediately.
 Reposition the resident.
 Ambulate resident if able.
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Conversion Table
A cubic centimeter is a unit of measure equal to 1
milliliter.
1 oz.
2 oz.
3 oz.
4 oz.
5 oz.
6 oz.
7 oz.
8 oz.
1 cup
½ cup
¼ cup
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=
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=
=
=
=
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30 cc or 30 ml
60 cc
90 cc
120 cc
150 cc
180 cc
210 cc
240 cc
8 oz. = 240 cc
4 oz. = 120 cc
2 oz. = 60 cc
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Six Basic Nutrients
1.
2.
3.
4.
5.
6.
Protein
Carbohydrates
Fats
Vitamins
Minerals
Water
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MyPyramid
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Special Diets
 Low-Sodium Diet
 Fluid-Restricted Diet
 Low-Protein Diet
 Low-Fat/Low-Cholesterol Diet
 Modified Calorie Diet for Weight Management
 Dietary Management of Diabetes
 Liquid Diet
 Soft Diet
 Pureed Diet
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Assisting a Resident with Eating
 Never treat the resident like a child.
 Sit at a resident’s eye level.
 Identify the resident.
 Check the temperature by holding your hand
over the dish before offering a bite of food.
 Cut foods and pour liquids as needed.
 Identify food and fluids in front of the the
resident.
 Ask the resident which food he prefers to eat
first. Honor this request.
 Do not mix foods unless resident requests it.
 Do not rush the meal.
 Make simple conversation.
 Give the resident your full attention during
eating.
 Alternate offering food and drink.
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Preventing Aspiration
 Position in a straight, upright position.
 Offer small pieces of food or small spoons of
pureed food.
 Feed resident slowly.
 Place food in the non-paralyzed, or unaffected,
side of the mouth.
 Make sure mouth is empty before next bite of
food or sip of drink.
 Residents should stay in upright position for 30
minutes after eating or drinking.
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Facts about Arthritis
 Arthritis is an inflammation of joints, causing
stiffness, pain, and decreased mobility.
 May be due to aging, injury, or autoimmune
illness
 Two types are osteoarthritis and rheumatoid
arthritis.
 Pain and stiffness increase in cold, damp
weather.
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Care Guidelines for Hip Replacement
 Keep often-used items within reach.
 Dress affected side first.
 Never rush the resident. Use praise and
encouragement.
 Ask the nurse to give pain medication prior to
moving if needed.
 Have the resident sit to do tasks and save
energy.
 Follow the care plan exactly.
 Never perform ROM exercises on a leg on the
side of a hip replacement.
 Caution the resident not to sit with legs crossed
or turn toes inward. Hip cannot be bent more
than 90 degrees. It cannot be turned outward.
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Causes of Dementia
 Alzheimer’s disease
 Multi-infarct or vascular dementia
 Lewy body disease
 Parkinson’s disease
 Huntington’s disease
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Care for Resident with AD
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Don’t take their behavior personally.
Treat residents with dignity and respect.
Work with symptoms and behaviors you see.
Work as a team.
Encourage communication.
Take care of yourself.
Work with family members.
Follow the goals of the resident care plan.
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Facts about Stroke
Facts about Stroke
Cerebrovascular accident (CVA) is also called stroke.
Blood supply to brain is cut off by clot or ruptured vessel.
Lack of oxygen to tissue results in cell death.
Symptoms depend on which side of the brain the stroke
affected.
Warning Signs of Stroke
Dizziness
Ringing in ears
Headache
Nausea and vomiting
Slurring of words
Loss of memory
Signs of Stroke
Loss of consciousness
Redness in face
Noisy breathing
Seizures
Loss of bowel and bladder control
Paralysis on one side of body
Weakness on one side of body
Use of inappropriate words
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Treatment and Care for Stroke Resident
 PT, OT offer therapy for paralysis, weakness, or loss of
movement.
 NAs adapt procedures for paralysis or weakness.
 NAs assist transfers on weaker or involved side. Lead with
stronger side.
 NAs check for harmful situations for residents who have loss of
sensation.
 NAs assist with speech therapy.
 NAs need patience and keep routine of care.
 NAs encourage independence and self-esteem.
 NAs make tasks less difficult.
 NAs notice and praise efforts and successes.
Guidelines for assisting one-sided weakness with dressing:
 Dress weaker side first.
 Undress stronger side first.
 Use adaptive equipment for dressing.
 Encourage self-care.
Communication techniques:
 Keep questions and directions simple.
 Ask “yes” and “no” questions.
 Use agreed-upon signals.
 Give resident time to respond.
 Use pencil and paper.
 Use pictures, gestures, or pointing.
 Keep call light within resident’s reach.
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Care for the COPD Resident
Symptoms
Chronic cough or wheeze
Difficulty breathing
Shortness of breath
Pale or bluish or reddish-purple skin
Confusion
Weakness
Difficulty completing meals
Fear and anxiety
Care Guidelines
Observe and report symptoms getting worse.
Help residents sit upright or lean forward.
Offer fluids and small meals frequently.
Encourage proper nutrition.
Keep oxygen supply available.
Be calm and supportive.
Use good infection control.
Encourage independence.
Remind resident to avoid exposure to infections.
Encourage pursed-lip breathing.
Encourage rest and saving energy.
Observe and Report
Temperature over 101°F
Changes in breathing patterns
Changes in color or consistency of lung secretions
Changes in mental state
Refusal to take medications
Weight loss
Increasing dependence
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Preventing UTIs
 Wipe from front to back after elimination.
 Provide good perineal care.
 Encourage fluids.
 Offer bedpan or trip to toilet regularly.
 Answer call lights promptly.
 Encourage showers rather than baths.
 Report cloudy, dark, or foul-smelling urine or
frequent urination.
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Facts about Diabetes
Facts
 Body does not produce enough or properly use
insulin.
 Glucose collects in blood, causing circulatory
problems.
 Type 1 and Type 2 are main types.
 Pre-diabetes and gestational diabetes are two other
types.
Signs of Diabetes
 Excessive thirst
 Extreme hunger
 Weight loss
 High levels of blood sugar
 Sugar in urine
 Frequent urination
 Sudden vision changes
 Tingling or numbness in hands or feet
 Feeling very tired much of the time
 Very dry skin
 Sores that are slow to heal
 More infections than usual
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Treatment and Care for Diabetes
 Follow diet instructions exactly.
 Follow exercise program.
 Observe management of insulin dose.
 Perform urine and blood tests as directed.
 Perform foot care as directed. Never cut
toenails.
 Encourage comfortable, well-fitting shoes.
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Facts about HIV/AIDS
Facts about HIV/AIDS
 AIDS caused by HIV
 Attacks immune system
 Transmitted by sexual contact, blood and blood products,
infected needles, or from mother to fetus
 Medication slows the progress but does not cure it
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Signs and Symptoms of HIV/AIDS
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Appetite loss
Weight loss
Flu-like symptoms
Night sweats
Swollen lymph nodes
Severe diarrhea
Dry cough
Skin rashes
Painful white spots in mouth
Cold sores or fever blisters
Cauliflower-like warts
Inflamed and bleeding gums
Bruising that does not go away
Low resistance to infection
Kaposi’s sarcoma
 AIDS dementia
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Treatment and Care of AIDS
Weight loss
Favorite foods
High protein, high-calorie
foods
Numbness, tingling, and
pain in feet and legs
Keep tight sheets off feet.
Use bed cradles.
Infection
Wash your hands often.
Keep everything clean.
Emotional problems
Report anxiety and
depression.
Treat resident with
respect.
Offer support.
Mouth infections and
painful swallowing
Soft non-spiced foods
Warm rinses
Good mouth care
Nausea and vomiting
Small frequent meals
Eat slowly.
Encourage fluids.
AIDS dementia complex
Provide a safe
environment.
Assist with ADLs.
Diarrhea
Offer BRAT diet.
Lots of fluids
Low fiber
Avoid milk products and
fats.
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Facts about Cancer
Facts
 Benign tumors (grow slowly)
 Malignant tumors (grow rapidly)
 Spreads to other areas of body
 No known cure
Risk Factors
 Tobacco
 Sunlight
 Alcohol
 Chemicals and industrial agents
 Food additives
 Radiation
 Poor nutrition
 Lack of physical activity
Seven Warning Signs of Cancer
 Change in bowel or bladder habits
 A sore that does not heal
 Unusual bleeding or discharge from a body opening
 Thickening or lump in breast or elsewhere
 Indigestion or difficulty swallowing
 Obvious change in wart or mole
 Nagging cough or persistent hoarseness
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Treatment and Care for Cancer
Treatment
 Surgery
 Chemotherapy
 Radiation
Care Guidelines
 Nutrition
 Pain control
 Comfort
 Skin care
 Oral care
 Self-image
 Psychosocial needs
 Family assistance
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Goals of Rehabilitation
 Help resident regain abilities or recover from
illness.
 Develop and promote a resident’s independence.
 Allow resident to feel in control of his or her
life.
 Help resident accept or adapt to limitations of a
disability.
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Assisting with Rehabilitation
Be patient. Example: Even though you can dress the
resident faster, encourage him to do it for himself.
Have a positive attitude. Example: Create an
atmosphere that motivates the resident to dress
himself.
Focus on small accomplishments and small tasks.
Example: Break the task of dressing himself into small
steps, such as putting on a shirt today, learning to
button it tomorrow.
Recognize that setbacks occur. Example: When he
can’t button the shirt on the expected day, downplay
the setback.
Be sensitive to the resident’s needs. Example:
Encourage him to keep trying a task by showing a real
sense of understanding and acceptance of both
successes and disappointments.
Encourage independence. Example: Use assistive
devices to allow him to do as much as possible for
himself.
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Regular Ambulation and Exercise
Regular ambulation and exercise help
improve:
 Quality and health of skin
 Circulation
 Strength
 Sleep
 Appetite
 Elimination
 Blood flow
 Oxygen level
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Five Basic Body Positions
Supine Position
Lateral Position
Prone Position
Fowler’s Position
Sims’ Position
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Body Movements
Abduction
Extension
Adduction
Dorsiflexion
Flexion
Rotation
Pronation Supination
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