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Wallingford Public Schools - HIGH SCHOOL COURSE OUTLINE Course Title: Certified Nursing Assistant Course Number: 6343 Department: Career and Technical Education Grade(s): 11-12 Level(s): Academic Credit: 2 Course Description The Certified Nursing Assistant program prepares high school students for employment both in hospitals and long-term care settings. Students will develop career entry skills that will enable them to be employed as state certified nursing assistants. This learning environment provides the student with the attitudes, competencies, skills, and exposure to the extensive career pathways available in Allied Health. This course integrates science, mathematics, and language arts with nursing theory and practice. One hundred and twenty-five hours of classroom instruction and sixty hours of clinical experience are required to be eligible for registration and CT certification. Required Instructional Materials Nursing Assistant A Nursing Process Approach Hegner, Acello, and Caldwell 9th Edition 2005 Completion/Revision Date Revisions Approved by Board of Education on November 16, 2009 Introduction to Medical Terminology, Erlich and Schroder 1st Edition 2004 Mission Statement of the Curriculum Management Team The mission of the Career and Technical Education Curriculum Management Team is to ensure that students, as a result of their experiences in K-12, will demonstrate transferable skills, knowledge, and attributes for successful life management, employment, career development, post-secondary educational opportunities, and life long learning. Enduring Understandings for the Course • Healthcare consumers have basic rights to ensure that they will receive quality patient care. • Nursing assistants will be expected to practice the highest legal and ethical standards in all of their daily functions. • Communication is a two-way process involving data sent orally, in writing, and through body language. • The Nursing Process establishes an ongoing format that promotes positive patient outcomes. Certified Nursing Assistant Page 1 of 29 • Attention to safety in the health care environment fosters feelings of security and hastens recovery. • Safety is everyone’s personal responsibility. • Patients in HC facilities are at risk for incidents for a variety of reasons. (impaired mobility, meds that affect mental status, disorientation, and impaired hearing or vision) • Research has shown that side rails and restraints do not always prevent falls and injuries • Understanding how disease spreads provides practices leading to prevention and control. • Microorganisms can adapt to their environment and change in order to survive. • Pediatric patients and the elderly have weaker immune systems and are more susceptible to infectious diseases. • Vital signs are a critical indicator of patient health status. • NA subjective and objective observations are valuable aids to accurate nursing assessments. • • • • • • • • NA must show sensitivity to the individuality and cultural heritage of each patient in his/her care at all times. Nutrition is the process by which the body takes in food for growth and repair and utilizes it to maintain health. Therapeutic diets are designed to improve specific health conditions. Medical terminology is essential when discussing anatomic structure and physiology. these terms are universally known. Knowledge of the major structures and their functions found in each of the major body systems is linked directly to health and quality of life Postsecondary education provides the pathway for advancement in most allied health careers. Continuing education is required for CNA personal, professional, and career growth. With advanced training and experience, CNA assignments are available in several nursing specialty areas. Certified Nursing Assistant Page 2 of 29 LEARNING STRAND 1.0 Interpersonal and Professional Communications Skills and Ethical Considerations ENDURING UNDERSTANDING(S) • Healthcare consumers have basic rights to ensure that they will receive quality patient care. • Nursing assistants will be expected to practice the highest legal and ethical standards in all of their daily functions. • Communication is a two-way process involving data sent orally, in writing, and through body language. • The Nursing Process establishes an ongoing format that promotes positive patient outcomes. ESSENTIAL QUESTION(S) • Why is there the need to establish a Patient’s Bill of Rights? • What is the difference between ethics and legal standards in the health care profession? • Why are interpersonal communications skills critical in health-care delivery? LEARNING OBJECTIVES The student will: 1.1 Summarize the legal and ethical responsibilities of the nursing assistant concerning patient information. a. Tipping b. Theft c. Defamation d. False imprisonment e. Negligence f. Assault and battery g. Abuse 1. Verbal 2. Physical 3. Psychological 4. Sexual 5. Involuntary seclusion 1.2 Explain the types of verbal and nonverbal communication. 1.3 Summarize the responsibilities of health care consumers. a. Maintenance of personal health care records b. Ability to communicate a complete health and family history including past hospitalizations and medications. c. Accept responsibility for payment and providing information for insurance claims d. Accept responsibility for managing one’s own health. INSTRUCTIONAL SUPPORT MATERIALS • My Pocket Mentor, Gaviola, 2004 • Advance For Nurses magazine • Suggested case studies • C N A assignment sheets • Sample nursing care plans • Medical terminology note cards • Patient’s Bill of Rights Certified Nursing Assistant SUGGESTED INSTRUCTIONAL STRATEGIES • Health Occupations Students of America (HOSA) • Role-plays • Laboratory experiences • Guest speakers • Collaboration with the ICE-T students and Anatomy and Physiology classes SUGGESTED ASSESSMENT METHODS • Student anecdotal records • Peer reviews • Quizzes and tests Page 3 of 29 1.4 Summarize what is contained in the Patient’s Bill of Rights. a. The right to privacy b. The right to be adequately informed about their treatment plan c. The right to an advanced directive d. The right to make decisions about their plan of care e. The right to expect reasonable response to a request f. The right to decline participation in education and research g. The right to expect continuity of care h. The right to be made aware of charges for services and available payment records 1.5 Demonstrate the correct way to answer a phone while on duty. 1.6 Identify four tools of communication for staff members. a. Maintain face to face contact b. Speak clearly and articulately c. Be a good listener d. Understand your organization’s chain of command 1.7 Summarize the patient populations that require special communications techniques. a. Hearing impaired b. Visually impaired c. Expressive aphasia d. Disorientation e. Emotionally stressed 1.8 Recognize signs and symptoms that must be accurately reported to licensed staff. 1.9 Extrapolate information from the nursing care plan and apply it to practice. 1.10 Recognize the patient observations that must be reported to licensed nurses during a shift report. a. Vital signs b. Intake and output c. Weight d. Skin assessment e. Level of consciousness f. Activities of daily living g. Pain 1.11 Recognize the purpose of a patient’s medical record. 1.12 Demonstrate application of the rules for written and computerized Certified Nursing Assistant Page 4 of 29 documentation. 1.13 Understand the effective communication techniques for the symptoms of major psychiatric disorders. a. Depression b. Bi-polar c. Anxiety disorders d. Alzheimer’s e. Schizophrenia 1.14 Discuss the legal ramifications behind documentation. 1.15 Select common abbreviations utilized in documentation. 1.16 Demonstrate skill in utilizing a certified nursing assistant assignment sheet. 1.17 Identify legal scope of responsibilities of the Certified NA. Certified Nursing Assistant Page 5 of 29 LEARNING STRAND 2.0 Patient Safety and Mobility ENDURING UNDERSTANDING(S) • Attention to safety in the health care environment fosters feelings of security and hastens recovery. • Safety is everyone’s personal responsibility. • Patients in HC facilities are at risk for incidents for a variety of reasons. (impaired mobility, meds that affect mental status, disorientation, and impaired hearing or vision) • Research has shown that side rails and restraints do not always prevent falls and injuries. ESSENTIAL QUESTION(S) • Why is knowledge of ergonomics essential in the workplace? • Who is responsible for safety in the health care environment? LEARNING OBJECTIVES – The student will: 2.1 Recognize safety risk factors in the health care environment. 2.2 Demonstrate techniques for using ergonomics in the workplace: a. Safe patient transfer from bed to stretcher/chair/wheelchair b. Adapting the environment and using the techniques and equipment to prevent worker injuries 2.3 Demonstrate the correct application of a mechanical lift and a gait belt. 2.4 Assess and report malfunctions in client care equipment and devices. 2.5 Summarize the nursing assistant’s role and responsibilities in an emergency. 2.6 Demonstrate fire safety protocols relevant in all patient care settings. a. Fire hazards and prevention: frayed electrical wires; improper protection during oxygen therapy; overloaded electrical circuits; accumulated clutter b. In case of fire, remember RACE: 1. Remove patients 2. Activate the alarm 3. Contain the fire 4. Extinguish the fire or evacuate the area c. Use of a fire extinguisher: PASS 1. Pull the pin INSTRUCTIONAL SUPPORT MATERIALS • Mosby’s Patient Safety and Mobility VHS • Mechanical lifts • Gait belts • Crutches • Walkers • Physical restraints • Hot and cold packs • Wheelchair • Fire extinguisher • Drawsheets • Slideboards Certified Nursing Assistant SUGGESTED INSTRUCTIONAL STRATEGIES • Simulated patient acre scenarios • Competency skills in the learning lab SUGGESTED ASSESSMENT METHODS • Medical terminology tests and quizzes • Student-made checklists • Competency simulations and evaluations Page 6 of 29 2. Aim the nozzle at the base of the fire 3. Squeeze the handle 4. Sweep it back and forth along the base of the fire 2.7 Recognize that violence can occur in the workplace and expected reactions following OSHA guidelines. 2.8 Identify patients at risk for falls and other accidents. a. Accidental poisoning b. Thermal injuries c. Aspiration d. Skin injuries 2.9 Explain alternatives to the use of physical restraints. 2.10 Explain the guidelines for the use of physical restraints. 2.11 Explain correct use of assistive devices used in ambulating patients (crutches/ walkers/canes). 2.12 Demonstrate safety precautions for wheelchair use. Certified Nursing Assistant Page 7 of 29 LEARNING STRAND 3.0 Infection Control ENDURING UNDERSTANDING(S) • Understanding how disease spreads provides practices leading to prevention and control. • Microorganisms can adapt to their environment and change in order to survive. • Pediatric patients and the elderly have weaker immune systems and are more susceptible to infectious diseases. ESSENTIAL QUESTION(S) • Why is it critical for health care workers to implement infection control practices in the workplace? • Who is responsibility for safety in the health care workplace? • How does the body naturally defend against invading organisms? LEARNING OBJECTIVES – The student will: 3.1 Demonstrate skill in hand washing technique. 3.2 Demonstrate isolation technique using masks, gowns, gloves, and disposal of soiled linens. 3.3 Demonstrate methods of preventing infection. 3.4 List techniques used with universal precautions. 3.5 Explain why patients are at risk for infection. 3.6 List the body’s natural defenses against infection. a. Cilia b. Hydrochloric acid in the stomach c. Earwax d. Inflammation e. Tears f. Mucus membranes lining the respiratory, gastrointestinal, urinary, reproductive g. Coughing and sneezing h. Immune response 3.7 Identify the most common microbes and some of their characteristics. a. Virus b. Bacteria c. Fungus d. Protozoa 3.8 List the ways infectious diseases are spread. 3.9 Describe common treatments for infectious diseases. INSTRUCTIONAL SUPPORT MATERIALS • Introduction to Medical Terminology, Erlich and Schroder, 2004 • Gloves • Masks • Goggles • Gowns • Biohazard bags • Sharp’s container Certified Nursing Assistant SUGGESTED INSTRUCTIONAL STRATEGIES • Guest speaker Sue Paxton from Gaylord Hospital’s Infection Prevention and Control Department • Germs and Viruses DVD • The Immune System at Work DVD • Note cards • Create a “Chain of Infection” graphic organizer • Display HOSA recommended medical reading: (see HOSA Medical Reading Addendum) 1. The Woman with the Worm in Her Head and Other True Stories 2. One Hundred Days: My Unexpected Journey from Doctor to Patient 3. The Germ Freak’s Guide to Outwitting Colds and Flu: Guerilla Tactics to Keep Yourself Healthy at Home, at Work, and in the World • Practice the application of proper personal protective equipment (PPE) Page 8 of 29 3.10 Describe nursing assistant responsibilities related to standard precautions. Certified Nursing Assistant SUGGESTED ASSESSMENT METHODS • Vocabulary and medical terminology quizzes and tests • Create a public health brochure based on rubric criteria • Research an infectious disease topic based on rubric criteria Page 9 of 29 LEARNING STRAND 4.0 Measuring and Recording Vital Signs, Height and Weight ENDURING UNDERSTANDING(S) • Vital signs are a critical indicator of patient health status. ESSENTIAL QUESTION(S) • How does the body provide indicators of health status? LEARNING OBJECTIVES – The student will: 4.1 List the normal range of vital signs for an adult client. a. temperature b. pulse c. respiration d. blood pressure e. pain assessment 4.2 Demonstrate proper procedure for assessing vital signs. 4.3 Demonstrate proper documentation of vital signs. 4.4 Recognize and communicate to RN abnormal vital sign values. a. oral temperature above 99.6 F b. axillary above 98.6 F c. rectal temperature over 100.6 F d. pulse rate below 60 beats per minute or over 100 e. respiratory rate over 22 or under 12 breaths per minute f. blood pressure above 140/90 or below 90/60 g. patient complaints of pain 4.5 List the different types of scales used in health care facilities. a. sling scale b. upright scale c. electronic chair scale d. electronic bed scales e. pediatric scales 4.6 Measure and document weight and height. 4.7 Convert weight measurements recorded in pounds to kilograms. 4.8 Convert height measurements recorded in feet/inches to centimeters. 4.9 Recognize that weight is an indicator of a patient’s nutritional status. 4.10 Conclude that the assessment of weight and height are crucial because medication dose amounts are based on patient size. INSTRUCTIONAL SUPPORT MATERIALS • Maths for Meds, Dosages and Solutions, Curren, 2005 • Mosby’s Measurements VHS • Thermometers • Blood pressure cups • Stethoscopes • Alcohol prep pads • Oxygen saturation machine • Pain assessment charts • Scale • Tape measure • Manikins • Watch with a second hand • Timer Certified Nursing Assistant SUGGESTED INSTRUCTIONAL STRATEGIES • Teacher modeling of vital sign assessment with repeated and continuing practice in the learning lab • Case study scenarios and reportable events to RN • Troubleshooting malfunctioning equipment and reporting problems to RN • Graphic representations of measurement for all vital signs • Practice Celsius and Fahrenheit temperature conversion equivalents SUGGESTED ASSESSMENT METHODS • Performance tasks • Quizzes and tests • Graphic documentation of vital sign assessments Page 10 of 29 LEARNING STRAND 5.0 Patient Care and Comfort Measures ENDURING UNDERSTANDING(S) • NA subjective and objective observations are valuable aids to accurate nursing assessments. • NA must show sensitivity to the individuality and cultural heritage of each patient in his/her care at all times. ESSENTIAL QUESTION(S) • Why are Nursing Assessments (NA) crucial to implementing the nursing care plan? • Why should different ethnic and cultural beliefs of patients be respected? • Why should the “Patient’s Bill of Rights” be considered when delivering care? LEARNING OBJECTIVES – The student will: 5.1 Describe the stages of human growth and development. 5.2 Describe the seven physical needs of patients. a. Oxygen b. Food and fluids c. Exercise d. Sleep, rest, and comfort e. Elimination f. Safety g. Intimacy and sexuality 5.3 Summarize individual socio-cultural differences and adapt care to meet individual’s needs. a. Asian b. Hispanic c. European d. African e. Islamic f. Native g. Catholic h. Protestant i. Judaism j. Hinduism k. Buddhism l. Moslem 5.4 Identify the importance of appreciating and showing sensitivity to a culture other than one’s own. 5.5 Demonstrate skills in providing complete and partial baths, shower, tub bath. 5.6 Demonstrate proper procedure for oral hygiene and denture care, care of hair, nails, back, and perineum. 5.7 Identify the purposes for bathing clients. a. improve circulation b. provides cleanliness INSTRUCTIONAL SUPPORT MATERIALS • Mosby’s Hygiene, Bathing and Comfort Measures VHS • Mosby’s Bedmaking VHS • HOSA recommended reading: (see addendum) 1. Caring for Patients from Different Cultures 2. The Scalpel and the Silver Bear • Dentures • Denture cups • Toothbrushes and toothpaste • Drinking cups • Emesis basin • Bedpans • Various other comfort care items Certified Nursing Assistant SUGGESTED INSTRUCTIONAL STRATEGIES • Field trip to MidState Medical Center • Field trip to CT Children’s Medical Center • Field trip to Yale New Haven Hospital • Allied Health Career Day at Hartford Hospital • Linda Hill, LPN, Masonicare Hospice • Donna Trigilia, APRN, SCI & Neuro/Ortho at Gaylord • Practice patient care competencies in the learning lab • Clinical rotations at Masonicare (Locked Dementia Unit) from November to March • Clinical rotations at Gaylord (Lyman 2/ Medically Complex and Spinal Cord Injured Patients) from March to June • Develop Nursing Care Plans (NCP) • Investigate the cultural and ethnic beliefs of their individual patient Page 11 of 29 c. promotes patient dignity 5.8 Demonstrate male and female perineal care. 5.9 Demonstrate proper procedure for shaving a male patient. 5.10 Demonstrate proper procedure for giving and receiving a bed pan and urinal. 5.11 Demonstrate the ability to assist patients with use of a bedside commode. 5.12 Demonstrate assisting a patient with dressing and undressing. 5.13 Summarize the importance of indwelling Foley catheter care. 5.14 Demonstrate competency in providing Foley catheter care. 5.15 Explain assessments related to patient care that must be communicated to licensed nurses. a. broken skin or rashes b. decrease in urine output c. difficulty breathing d. chest pain e. cyanosis f. development of pressure ulcers g. no bowel movement within six shifts h. decreased appetite i. lethargy or confusion 5.16 Identify the different types of beds and their uses. a. electronically operated b. gatch c. CircOlectric d. low air mattress 5.17 Demonstrate how to make an occupied bed. 5.18 Demonstrate how to make a closed bed with non-fitted flat bottom sheets. a. making a mitered corner 5.19 Demonstrate how to handle clean and soiled linens. 5.20 Discuss personal feelings regarding death and dying. 5.21 Recognize that people cope with the process of death and dying in different ways. 5.22 Conclude that patients go through a series of stages of grief. a. Denial b. Anger c. Bargaining d. Depression Certified Nursing Assistant SUGGESTED ASSESSMENT METHODS • Skills performance tasks • Peer evaluations • Case studies with student reflections • Tests • Clinical reports on a selected patient diagnosis utilizing the nursing process (NP) and research methodology • Clinical reports will utilize proper documentation using APA/MLA process Page 12 of 29 e. Acceptance 5.23 Understand the spiritual and psychological needs of a dying patient and family members. 5.24 Identify the physical changes associated with the dying process. 5.25 Recognize the signs of death. 5.26 Demonstrate postmortem procedures. Certified Nursing Assistant Page 13 of 29 LEARNING STRAND 6.0 Nutrition and Fluid Balance ENDURING UNDERSTANDING(S) • Nutrition is the process by which the body takes in food for growth and repair and utilizes it to maintain health. • Therapeutic diets are designed to improve specific health conditions. ESSENTIAL QUESTION(S) • Why is balancing essential nutrients needed for good health? • What happens in your body once food is ingested? • Why is everyone who consumes food on a diet? LEARNING OBJECTIVES – The student will: 6.1 Describe the recommended daily requirements from the Food Guide Pyramid. 6.2 Identify the five food groups and list foods included in each group. 6.3 Identify the liquids/foods allowed on the four basic facility diets. a. regular b. clear liquid c. full liquid d. soft 6.4 Explain the purposes of the following diets. a. clear liquids b. full liquids c. soft 6.5 Demonstrate the ability to measure and document on a calorie count flow sheet. 6.6 Demonstrate competency in feeding a patient who is at risk for dysphagia (difficult swallowing) and aspiration. a. stroke b. any patient with a tracheotomy c. spinal injury d. dementia e. Alzheimer’s f. Neurological dysfunction g. Multiple Sclerosis h. Parkinson’s 6.7 Evaluate the purposes of therapeutic diets. a. Diabetic b. Sodium-restricted c. Low fat/low cholesterol d. Mechanically altered e. Calorie restricted 6.8 Identify alternative methods of providing patient nutrition. a. Total parenteral (central venous line) INSTRUCTIONAL SUPPORT MATERIALS • Mosby’s Nutrition and Fluid Balance VHS • Grocery Shopping Made Easy DVD • USDA Food Guide Pyramid • Nutrition charts • Therapeutic diets charts • Intake and output sheets • HOSA Math Conversion Sheets • Calorie count sheets • Thickeners to adjust fluid density • Meal trays • Straws and utensils • Drinking cups • IV lines and fluids • Manikins • Gastrostomy tube • Nasogastric tube • 4” by 4” sterile gauze Certified Nursing Assistant SUGGESTED INSTRUCTIONAL STRATEGIES • Guest speaker Deidre Bray, Gaylord Speech Pathologist • Dietician from MMC • Mr. Paquette role-plays a dementia/dysphasic patient to implement feeding techniques • Document intake after role-play in the learning lab • Medical terminology/abbreviation handouts • Personal diet journal entry SUGGESTED ASSESSMENT METHODS • Nutrition test • Internet research on alternative diets • Performance tasks in the learning lab and clinical area Page 14 of 29 b. Enteral feedings (nasogastric, gastrostomy) c. Intravenous line 6.9 Explain the considerations to make when preparing a patient for mealtime. a. Preparing the food tray b. Proper positioning of the patient c. Checking ID band with actual menu card d. Verbal and physical cues e. Supportive devices (swivel spoon; extended handles; plate guards; rubberized fork handles) 6.10 Identify the communications required between nursing staff, speech therapy and occupational therapy for assisting patients with feeding. 6.11 Compute oral fluid intake from ounces to cubic centimeters (milliliters). Certified Nursing Assistant Page 15 of 29 LEARNING STRAND 7.0 Body Systems, Common Disorders and Related Care Procedures ENDURING UNDERSTANDING(S) • Medical terminology is essential when discussing anatomic structure and physiology. These terms are universally known. • Knowledge of the major structures and their functions found in each of the major body systems is linked directly to health and quality of life. • Postsecondary education provides the pathway for advancement in most allied health careers. ESSENTIAL QUESTION(S) • Why do Allied Health personnel communicate using medical terminology? • How does knowledge of body systems and functions impact health and wellness? • Why is it essential to utilize study skills, to practice time management, and to apply test-taking strategies for advancement in health care? LEARNING OBJECTIVES – The student will: 7.1 List the functions of intact skin. a. Protection b. Storage c. Elimination d. Sensory perception 7.2 Identify nursing interventions to prevent skin breakdown. a. Turning and repositioning every two hours and when necessary b. Understanding potential breakdown areas c. Providing adequate fluids and nutrition d. Maintaining the skin clean and dry e. Inspecting the skin every shift f. Frequent bathing g. Range of motion exercises two times a day to encourage circulation h. Reporting signs of infection i. Use of special mattresses and adaptive equipment on chairs and beds j. Check for improperly fitted or worn braces and restraints 7.3 Describe the stages of pressure ulcer formations. a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4 7.4 Identify the nursing assistant interventions related to pressure ulcers. 7.5 Differentiate the classification of burns: INSTRUCTIONAL SUPPORT MATERIALS • Protective barrier ointments • Stages of decubitus ulcer formation charts • Anatomical charts • “Thin Man” Human Body charts • Organ Structure Models (Kidney, Lungs, Heart, Arteries, Brain) • Skeletal model • Human Body Series VHS Series (for each system) • HOSA recommended medical reading: 1. Second Opinions 2. The Last Lecture 3. Better – A Surgeon’s Notes On Performance 4. DARK REMEDY The Impact of Thalidomide and Its Revival as a Vital Medicine • Advance for Nurses Magazine • Who Plays God? Medicine, Money, and Ethics in American Health Care DVD • Adult and baby manikins for CPR • Oxygen Saturation Machine • Artificial airways • Sani-wipes for manikins • Automatic External Defibrillators (AED’s) • ECGs Made Easy, Aehlert, 2006 • Medical terminology lists • Vocabulary Word Wall • Urinary elimination and colostomy supplies Certified Nursing Assistant Page 16 of 29 a. Thermal b. First degree c. Second degree d. Third degree 7.6 Identify the nursing assistant actions in caring for patients with burns. 7.7 Explain the function of each organ of the respiratory system: a. Pharynx (throat) b. Larynx (voice box) c. Trachea (wind pipe) d. Bronchi e. Bronchioles 7.8 Summarize patient care conditions where there is decreased oxygenation. a. Cardiac disease b. Pulmonary disease c. Neuromuscular diseases d. Trauma e. Sleep apnea f. Morbid Obesity g. Kyphoscoliosis (Curvature of the spine) 7.9 Demonstrate nursing assistant interventions related to the care of patients with respiratory conditions. 7.10 Demonstrate proper use of an oxygen saturation machine. 7.11 Analyze the location and functions of the the organs of the circulatory system. a. Heart b. Blood vessels (arteries: veins; capillaries) c. Lymphatic vessels d. Lymph nodes e. Spleen f. Blood (plasma; red blood cells; white blood cells; thrombocytes) 7.12 Select multiple disorders of the cardiovascular system. a. Atherosclerosis b. Hypertension c. Peripheral vascular disease d. Angina pectoris e. Myocardial infarction f. Anemia g. Congestive heart failure h. Leukemia 7.13 Demonstrate the assessments and interventions related to care of patients with disorders of the circulatory system. a. Shortness of breadth Certified Nursing Assistant SUGGESTED INSTRUCTIONAL STRATEGIES • Anatomy of Dissection DVD • Develop graphic organizers or display boards for a body system • Field trip to Body Worlds exhibit • Collaborate with LHHS Anatomy and Physiology classes and Stevens 5th grade classes on selected body system display boards • Web quests to research various body system dissections • Clinical reports with diagnosis, etiology, nursing interventions, and student reflections of care performed • Guest speaker David Knapp to demonstrate orthotic and prosthetic devices • Learning lab practice: 1. Vital signs measurements 2. Urinary catheter care 3. Colostomy care 4. Perineal care • Guest speaker from Masonicare to discuss diabetes and diabetic patient care SUGGESTED ASSESSMENT METHODS • Oral presentations • All lab-based and clinical evaluations • Personal reflections • Tests and quizzes • Clinical reports based on rubrics • HOSA Medical Reading reports based on rubrics Page 17 of 29 7.14 7.15 7.16 7.17 7.18 b. Rapid respirations c. Chest pain d. Absent pedal pulses e. Productive cough f. Nausea and vomiting g. Blood or sediment in the urine h. Drowsiness i. Cyanosis j. Fever k. Dark or strong odor to urine Demonstrate the sequence of skills necessary for cardio-pulmonary resuscitation for adults, children and babies. (CPR) a. Students will earn a two year certification for basic life support for health care providers. (AHA CPR & AED program) Differentiate the location and functions of the musculoskeletal system. a. Bones b. Joints c. Tendons d. Ligaments Recognize various conditions of the musculoskeletal system. a. Arthritis b. Bursitis c. Rheumatoid arthritis d. Osteoporosis e. Fibromyalgia f. Fractures g. Gout h. Compartment syndrome Identify specific medical terminology utilized to describe movements in different joints. a. Flexion b. Extensions c. External and internal rotation d. Abduction e. Adduction Evaluate the nursing assistant actions related to patients with muscular and skeletal system conditions. a. Passive range of motion b. Applying an arm sling c. Maintaining care of patients in traction d. Carrying for patients with total hip arthroplasty (hip replacement and/or degenerative arthritis) Certified Nursing Assistant Page 18 of 29 7.19 7.20 7.21 7.22 7.23 7.24 e. Use of continuous passive motion machine f. Care of an amputated limb Explain the functions of the endocrine glands. a. Pituitary glands b. Pineal body c. Adrenal glands d. Thyroid glands e. Parathyroid glands f. Islets of Langerhans Recognize signs and symptoms of hypoglycemia and hyperglycemia. a. Hypoglycemia: 1. Lethargy 2. Confusion 3. Shallow, rapid respirations 4. Rapid pulse b. Hyperglycemia: 1. Weakness 2. Fruity odor to breath 3. Sugar in the urine (glycosuria) 4. Flushed, dry hot skin Assess and implement nursing assistant actions related to care of patients with endocrine dysfunctions. a. Meticulous foot care of the diabetic patient b. Notifying the RN of signs and symptoms of infection c. Testing urine for sugar and acetone Discuss the location and function of the organs of the nervous system. a. Brain b. Spinal cord c. Meninges d. Sensory receptors Recognize common conditions of the nervous system. a. Stroke b. Transient Ischemic Attacks (TIA) c. Aphasia d. Parkinson’s Disease e. Multiple Sclerosis f. Spinal Cord Injuries g. Autonomic dysreflexia h. Meningitis Identify specific medical terminology. a. Increased intracranial pressure b. Paralysis c. Tremors Certified Nursing Assistant Page 19 of 29 7.25 7.26 7.27 7.28 7.29 d. Akinesia e. Vertigo f. Paraplegia g. Quadriplegia h. Nystagmus I. Glasgow Coma Scale Identify diagnostic test. a. Magnetic Resonance Imaging (MRI) b. Computerized Axial Tomography (CAT) Evaluate the nursing assistant actions related to care of patients with neurological conditions. a. Assessing level of consciousness (LOC) b. Preventing complications that can be caused by immobility c. Implementing pressure ulcer prevention d. Assisting with bowel and bladder training programs e. Reinforce programs provided by therapists Identify six perceptual deficits of the spinal cord injured/cognitively impaired client. a. Inability to organize a task b. Inability to sequence a task c. Lack of judgment d. Agnosia – the inability to identify certain objects e. Apraxia – the inability to use common items f. The inability to initiate a task Describe common disorders of the GI system. a. Malignancies b. Ulcers: Gastric; Duodenal; Ulcerative c. Crohn’s Disease d. Hernias: Inguinal; Umbilical; Incisional; Hiatal e. Cholecystitis; Cholelithiasis; f. Problems with bowel elimination: constipation; diarrhea; fecal impaction Explain the location and functions of the organs of the gastrointestinal system. a. Mouth, teeth, tongue, and salivary glands b. Pharynx c. Esophagus Certified Nursing Assistant Page 20 of 29 7.30 7.31 7.32 7.33 7.34 7.35 d. Stomach e. Small intestine f. Liver g. Gallbladder and pancreas h. Large intestine Explain the rationale for diagnostic Procedures. a. GI series b. Gastroscopy c. Proctoscopy d. Colonoscopy Select nursing assistant actions related to care of patients. a. Collecting a stool specimen b. Assisting the patient with a colostomy c. Assessing for signs of fecal impaction d. Documenting output every shift Identify the location and function of the organs of the urinary system. a. Kidneys b. Urinary bladder c. Urethra d. Urinary meatus Identify common disorders of the urinary system. a. Cystitis b. Hematuria c. Nephritis d. Renal Calculi e. Hydronephrosis Recognize the procedures for diagnostic evaluations. a. Blood chemistry tests b. Urinalysis c. Cat Scan d. Cystoscopy Evaluate nursing assistant actions related to the care of patients with urinary disorders. a. Collecting a urine specimen b. Providing indwelling catheter care c. Monitoring and recording urinary drainage d. Apply and care for a condom catheter e. Applying a leg bag f. Collecting a 24-hour urine specimen Certified Nursing Assistant Page 21 of 29 LEARNING STRAND 8.0 Expanded Role of the Nursing Assistant ENDURING UNDERSTANDING(S) • Continuing education is required for CNA personal, professional, and career growth. • With advanced training and experience, CNA assignments are available in several nursing specialty areas. ESSENTIAL QUESTION(S) • Why will continuing education provide increased earning potential, selfsatisfaction, and quality of life? LEARNING OBJECTIVES – The student will: 8.1 Summarize the concerns of surgical patients. 8.2 Identify types of anesthesia. a. General b. Local c. Intravenous d. Spinal 8.3 Identify the necessary procedures when patients are returned from the recovery room. a. Patient safety and comfort b. Coughing and deep breathing c. Vital signs assessment d. Assess dressings for drainage e. Maintain the patency of drainage tubes f. Measure and record post-op void g. Report patient complaints of pain h. Patient teaching to prevent post-op complications 8.4 Select medical terminology for charting purposes. a. Ted hose b. NPO (Nothing by mouth) c. Atelectasis d. Singultus 8.5 Identify prenatal care of the normal pregnant woman. 8.6 Identify reportable observations of prenatal patients. 8.7 Select nursing assistant actions for the postpartum patient. 8.8 Document and record observations of the patient in the postpartum period. 8.9 Demonstrate care practices for a normal newborn. INSTRUCTIONAL SUPPORT MATERIALS • Tracheostomy care sets • Dressing supplies • Adhesive tapes of assorted sizes and types • Adaptive equipment or devices • Gait belts and walkers • Incentive spirometry device • Ted hose • Blue pads for incontinence • Vital signs charts for pediatric patients (birth to 18 years) • HOSA medical readings: (see addendum) 1. A Cup of Comfort for Nurses 2. My Pocket Mentor 3. Nobody Nowhere, The Extraordinary Autobiography of an Autistic 4. Midwives • Pediatric Assessment DVD • Fight for Life, The Anatomy of Survival DVD • Advance for Nurses Magazine • www.hosa.org • www.cancer.org Certified Nursing Assistant SUGGESTED INSTRUCTIONAL STRATEGIES • Pediatric Nurse Practitioner to discuss pediatric conditions and care of the hospitalized Pedi patient • Child Life Specialist to discuss Pedi patient and family issues • Medical terminology word cards and vocabulary lists • What Is Cancer? DVD • Mrs. Flynn, Oncology RN, MidState Medical Center • Mrs. Montefiore (Birthing Center RN at MMC) to discuss obstetrical nursing Page 22 of 29 8.10 Illustrate measures to prevent misidentification and abduction of infants. 8.11 Demonstrate discharge procedures for mother and infant. 8.12 Identify major developmental tasks for pediatric age groups: a. Understand the normal vital signs assessments for each age and stage of pediatric development. 8.13 Summarize how to foster growth and development of hospitalized pediatric patients. 8.14 Demonstrate the importance of adequate nutrition and healthy lifestyle choices in the prevention of cancer. 8.15 Identify the 7 early warning signs of cancer: a. Change in bowel or bladder habits b. A sore that does not heel c. Unusual bleeding or discharge d. Thickening or lump in breast, testicles, or any part of the body e. Indigestion or difficulty swallowing f. Obvious change in a wart, mole, or skin condition g. Nagging cough or hoarseness 8.16 Summarize the types of cancer treatment. a. Surgery b. Chemotherapy c. Radiation d. Brachytherapy e. Immunotherapy 8.17 Describe and evaluate NA responsibilities related to care of oncology patients. a. Anticipate patient needs b. Assist with ADL/comfort measures c. Validate feelings and avoid giving patient false hope. 8.18 Summarize the differences between overweight, obesity, and morbid obesity. 8.19 Discuss why environmental modifications are needed for the bariatric patient. 8.20 Identify observations to make and methods of meeting bariatric patients’ ADL needs. 8.21 Identify comorbidities related to obesity. a. Atherosclerosis b. Necrotizing skin infections c. Diabetes mellitus Certified Nursing Assistant • • From Conception to Birth DVD HOSA Club fundraiser for the Autism Spectrum Resource Center and service at LHHS Blood Drives SUGGESTED ASSESSMENT METHODS • Medical terminology quizzes and tests • NA challenge (critical thinking activities) written responses • Oral presentations on specialty areas within nursing (Oncology Unit; Psychiatric Unit; Pediatrics Unit) • Peer evaluations • Anecdotal accounts of guest speaker presentations with personalized thank-you notes Page 23 of 29 d. Gallbladder disease / hernias / IBS (irritable bowel syndrome) e. Urinary stress incontinence f. Carpel Tunnel Syndrome g. Depression h. Sleep apnea Certified Nursing Assistant Page 24 of 29 HOSA MEDICAL READING ADDENDUM 2009 – 2010 Better: A Surgeon’s Notes on Performance by Atul Gauwande, January 2008, ISBN-13: 9780312427658 Final Exam: A Surgeon’s Reflections on Mortality by Pauline W. Chen, January 2008, ISBN-13: 9780307275370 Gifted Hands by Ben Carson, M.D., December 2009 ISBN-13: 9780310719038 Dark Remedy: The Impact of Thalidomide and Its Revival as a Vital Medicine by Trent Stephens and Rock Brynner, December 2001, ISBN-13: 9780738205908 The Last Lecture by Randy Pausch and Fefrey Zaslow, May 2008, ISBN-13: 9781410407115 2008 – 2009 Body of Work: Meditations on Mortality from the Human Anatomy Lab by Christine Montross, 2008, ISBN-13: 9781594201257 Small Steps: The Year I Got Polio by Peg Kehret, March 2000, ISBN-13: 9780807574584 The Scalpel and the Silver Bear, The First Navajo Woman Surgeon Combines Western Medicine and Traditional Healing by Lori Arviso, M.D. and Elizabeth Cohen Van Pelt, June 2000, ISBN-13: 9780553378009 Caring for Patients from Different Cultures by Geri-Ann Galanti, August 2008, ISBN-13: 978081222-315 2007 – 2008 Another Day in the Frontal Lobe: A Brain Surgeon Exposes Life on the Inside (Paperback) by Katrina Firlik, Reprint June 12, 2007, ISBN-10: 0812973402 Water With Lemon: An Inspiring Story of Diet-free, Guilt-free Weight Loss! (Paperback) by Zonya Foco and Stephen Moss, January 2007, ISBN-10: 1890926108 A Cup of Comfort for Nurses: Stories of Caring and Compassion (Paperback) by Colleen Sell, March 2006, ISBN-10: 1593375425 Certified Nursing Assistant Page 25 of 29 A Random Act: An Inspiring True Story of Fighting to Survive and Choosing to Forgive (Paperback) by Cindi Broaddus and Kimberly Lohman Suiters, March 2006, ISBN-10: 0060735155 Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying (Paperback) by Maggie Callanan and Patricia Kelley, February 1997, ISBN-10: 0553378767 2006 – 2007 The Pact by Sampson Davis, George Jenkins, Rameck Hunt, Lisa Frazier Page, Riverhead Trade: Reissue edition, May 6, 2003, ISBN: 157322989X Baby ER: The Heroic Doctors and Nurses Who Perform Medicine’s Tiniest Miracles by Edward Humes, Simon & Schuster, May 19, 2004, ISBN: 0743264436 The First Woman Doctor by Rachel Baker, Scholastic Paperbacks; Reissue edition (October 1, 1987) ISBN: 059044767X The Cruelest Miles by Gay Salisbury and Laney Salisbury, W. W. Norton & Company; Reprint edition February 7, 2005, ISBN: 0393325709 The Germ Freak’s Guide to Outwitting Colds and Flu: Guerilla Tactics to Keep Yourself Healthy at Home, at Work and in the World by Allison Janse and Charles Gerba, HCI, September 15, 2005, ISBN: 0757303277 2005 – 2006 Not Fade Away by Laurence Shames and Peter Barton, 2004, ISBN: 006073731X The Woman with a Worm in her Head: and other True Stories by F. Gonzalez-Crussi (Forward) and Pamela Nagami, 2002, ISBN: 0312306016 Second Opinions by Jerome, M.D. Groopman, 2001, ISBN: 0140298622 Sam: The Boy Behind the Mask by Tom Hallman,2003, ISBN: 0425191745 My Pocket Mentor by Sandra Gaviola, 2004, ISBN: 1401835082 2004 – 2005 Complications: A Surgeon’s Notes on an Imperfect Science by Atwul Gawande Dark Remedy by Trent Stephens Certified Nursing Assistant Page 26 of 29 The Traveler’s Gift: Seven Decisions That Determine Personal Success by Andy Andrews. Dead Men Don’t Tell Tales: The Strange and Fascinating Cases of a Forensic Anthropologist by Michael Browning and William R. Maples Power Sleep by James B. Maas 2003 - 2004 Kill as Few Patients as Possible by Oscar London, Ten Speed Press; 10th edition (May 1987), ISBN: 089815197X Five Patients: The Hospital Explained by Michael Crichton, Bt Bound: (May 2000) ISBN: 061321546X Tuesdays with Morrie: An Old Man, a Young Man, and Life’s Greatest Lesson by Mitch Albom and Stacy Creamer, Broadway Books, October 8, 2002, ISBN: 076790592X Love, Greg and Lauren by Greg Manning, Bantam Doubleday Dell Pub (Trd Pap), Updated edition, August 13, 2002, ISBN: 055338189X Gifted Hands by Ben Carson, Zondervan, December 8, 1996, ISBN: 0310214696 2002 – 2003 Anatomy of an Illness as Perceived by the Patient: Reflections on Healing and Regeneration by Norman Cousins, Norton Publishing, ISBN: 0393041905 The Fourteen Friends Guide to Eldercaring: Practical Advice, Inspiration, Shared Experiences, Space for your Thoughts by Fourteen Friends, Broadway Books, ISBN: 0767906004 Follow Your Heart by Andrew Matthews, Price Stern Sloan, ISBN: 0843174919 Born Too Soon by Elizabeth Mehren, Kensington Publishing Corp., ISBN: 1575663155 Ryan White: My Own Story by White and Cunningham, Signet, ISBN: 0451173228 2001 – 2002 Intensive Care: The Story of a Nurse by Echo Heron, Mass Market Paperback, ISBN: 0804102511 Nobody Nowhere: The Extraordinary Autobiography of an Autistic by Donna Williams, Avon Books, ISBN 0380722178 Certified Nursing Assistant Page 27 of 29 One Hundred Days: My Unexpected Journey from Doctor to Patient by David Biro, Vintage, ISBN: 0375706739 My Own Country. A Doctor’s Story by Abraham Verghese, Vintage, ISBN: 0679752927 Get Everyone in Your Boat Rowing in the Same Direction by Bob Boylan, Adams Media Corp., ISBN: 1558505474 2000 – 2001 Stick Figure by Gottlieb, Simon & Schuster, ISBN: 0684863588 Who gets Sick – How Beliefs, Moods and Thoughts Affect Your Health by Blair Justice, Park Printing, ISBN: 0960537678 Mother Teresa, Beyond the Image by Anne Sebban, Doubleday, ISBN: 0385493568 Midwives by Chris Bohjalian, Vintage Books, ISBN: 0375706771 1999 – 2000 Gifted Hands by Ben Carson, Zondervan Pub. House, ISBN: 0310214696 Power Sleep by James B. Maas, HarperCollins, ISBN: 0060977604 Born to Play by Eric Davis, Signet, ISBN: 0670885118 On Duty by Carolyn Parnall Fink, ISBN: 044914965X Caring for Patients from Different Cultures by Geri Ann Galanti, UPA Press, ISBN: 0812216083 1998 – 1999 (Pilot) Gifts of Time by Fred J. Epstein, The Berkley Publishing Group, 1993, ISBN: 0425144038 First, Do No Harm by Lisa Belkin, Ballantine Books, 1993, ISBN: 044922290X The Longevity Strategy by David Mahoney and Richard Restak, John Wiley and Sons, Inc. 1998, ISBN: 0471248673 Your Guide to Complementary Medicine by Larry P. Credit, Sharon G. Hartunian and Margaret J. Nowak, Avery Publishing Group, 1998, ISBN: 0895298317 Certified Nursing Assistant Page 28 of 29 The Drucker Foundation: The Leader of the Future by Frances Hesselbein, Marshall Goldsmith, and Richard Beckhard, editors, Josey-Bass, Inc., Publishers, 1996, ISBN: 0787901806 Certified Nursing Assistant Page 29 of 29