Beginning And Ending Steps In Care Procedures

Question 1

Beginning steps of a care procedure

Answer 1

1) identify yourself by name. Identify the resident by name.
2) wash your hands
3) explain the procedure to the resident
4) provide for the residence privacy with a curtain, screen, or door
5) adjust the bed to a safe level, usually waste high. Lock the bed wheels.

Question 2

Ending steps of a care procedure

Answer 2

1) Return bed to lowest position. Remove privacy measures.
2) place call light within residence reach
3) wash your hands
4) report any changes in resident to the nurse. Document procedure using facility guidelines.

Question 3

Why should you identify yourself and the resident by name?

Answer 3

Residents have a legal right to privacy.

1) knock and wait for permission to enter the residence room
2) upon entering identify yourself and state your title.
3) identify and greet the resident showing courtesy and respect. (This prevents care from being performed on the wrong person)

Question 4

Explaining procedures to the resident

Answer 4

1) speak clearly, slowly and directly
2) maintain face-to-face contact whenever possible
3) residents have a legal right to know exactly what care is being provided
4) residents are able to do more for themselves if they know what needs to happen

Question 5

Reporting changes in resident to the nurse

Answer 5

1) document procedure using facility guidelines

A) every time you provide care, observe the residents physical and mental capabilities as well as the condition of his or her body.

B) do not record care before it is given. If you do not document the care you gave, legally it did not happen

Question 6

Long-term care (LTC)

Answer 6

Is given in long-term care facilities for people who need 24-hour skilled care

Question 7

Skilled care

Answer 7

Care that is medically necessary given by a skilled nurse or therapist

A) ordered by a doctor and involves a treatment plan

B) given to people who need a high level of care for ongoing conditions

Question 8

Other names for long-term care facilities

Answer 8

1) skilled nursing facilities
2) rehabilitation centers
3) extended Care facilities

Question 9

Chronic conditions

Answer 9

A patient’s condition lasting a long period of time, even a lifetime. They include…

Physical disabilities
Heart disease
Dementia

Question 10

Diagnosis

Answer 10

Medical condition determined by a doctor

Question 11

Home Health Care

Answer 11

Care provided in a person’s home. Generally given to people who are older and chronically ill, but who are able and wish to remain at home.

May also be given when a person is weak after a recent hospital stay.

Question 12

Assisted living facilities

Answer 12

Residences for people who need some help with daily tasks such as showering, eating and dressing. People who live in these facilities do not need 24-hour skilled care.

Help with medications may also be given.

ALF allow for more independent living in a home like environment

Question 13

Adult Day services

Answer 13

Are for people who need some help and supervision during certain hours, but who do not live in the facility where care is provided.

They are for people who need some help, but are not seriously ill or disabled.

They often provide a break for spouses, family members and Friends

Question 14

Subacute care

Answer 14

Is care given in hospitals or long-term care facilities. It is used for people who need less care than for an acute (sudden onset, short-term) illness, but more care than for a chronic (long-term) illness.

Treatment usually ends when the condition is stabilized or after the set time for treatment has been completed.

Question 15

Outpatient Care

Answer 15

Is usually given to people who have had treatments, procedures, or surgeries and need short-term skilled care.

They do not require an overnight stay in a hospital or other Care facility

Question 16

Rehabilitation

Answer 16

Is caregiving by specialists.

Physical, occupational and speech therapists help restore or improve function after an illness or injury.

Question 17

Hospice care

Answer 17

Is given in facilities or homes for people who have about 6 months or less to live.

Hospice workers give physical and emotional care and comfort until a person dies.

They also support families during this process.

Question 18

Personal care

Answer 18

also known as Activities of Daily Living or ADLs

These include:

Bathing
Skin, nail and hair care
Mouth care
Assistance with walking
Assistance with eating and drinking
Assistance dressing, transferring and elimination

Question 19

Common services offered at long-term care facilities

Answer 19

ADL’s

Physical, occupational and speech therapy

Wound care

Tube care
Such as catheters (tubes inserted into the body to drain/inject fluids)

Nutrition therapy

Management of chronic diseases including:

Alzheimer’s
Acquired immunodeficiency syndrome (AIDS)
Diabetes
Chronic obstructive pulmonary disease (COPD)
Cancer
Congestive heart failure (CHF)

Question 20

Culture change

Answer 20

Culture change is a term given to the process of transforming services for elders so that they are based on the values and practices of the person receiving care. It involves respecting both elders and those working with them. Core values are promoting choice, dignity, respect, self-determination and purposeful living. This may result in organizations changing their practices, physical environments and relationships.

Question 21

Person-centered care

Answer 21

Emphasizes the individuality of the person who needs care, recognizing and developing his or her capabilities.

It promotes the residents individual preferences, choices, dignity and interests.

Each person’s background, culture, language, beliefs and traditions are respected.

Question 22

CMS

Answer 22

The centers for Medicare and Medicaid services is a federal agency within the US Department of Health and human services

Question 23

Medicare

Answer 23

Is a federal health insurance program covering people of any age with permanent kidney failure or certain disabilities.

Question 24

The four parts of Medicare

Answer 24

A) helps pay for care in a hospital or skilled nursing facility or for care from home Health agency or hospice

B) helps pay for Doctor services and other medical services and equipment

C) allows Private health insurance companies to provide Medicare benefits

D) helps pay for medications prescribed for treatment.

Question 25

Medicaid

Answer 25

A medical assistance program for people who have a low-income, as well as for people with disabilities. It is funded by both the federal government and each state. Eligibility is determined by income and special circumstances.

Question 26

Nursing Assistant titles

Answer 26

Nurse aide Certified nurse aide Patient care Certified nursing assistant

Question 27

The role of a nursing assistant

Answer 27

Provides personal care and also promotes Independence and self-care They act as the "eyes and ears" of the team. Observing/reporting changes in a residents condition Charting (documenting)

Question 28

Nursing assistant duties

Answer 28

Bathing residents Assisting with elimination needs Assisting with range of motion exercises and ambulation Transferring residents from a bed to a chair or wheelchair Measuring vital signs (temperature, pulse rate, respiratory rate, and blood pressure) Assisting with meals Helping residents dress and undress Giving back rubs Helping with mouth care Making and changing beds Keeping residents living area neat and clean Caring for supplies and equipment

Question 29

Nursing assistants are not allowed to

Answer 29

Insert or remove tubes Give tube feedings Change sterile dressings

Question 30

Nursing assistants and administering medication

Answer 30

Some states allow nursing assistants to give medications if they have completed an additional, specialized course for medications and meet the requirements of the individual facility.

Question 31

Responsibility for ALL residents

Answer 31

A nursing assistant should provide care for all residents who are in need even if they are not on their personal assignment sheet

Question 32

Chain of command

Answer 32

Doctor (or other member of the care team) Nurse (acts on the instructions of the doctor) Nursing assistant (C/NA) The line of authority ensures that residents get proper Health Care while protecting employees and employers from liability.

Question 33

Scope of practice

Answer 33

Defines the tasks that healthcare providers are legally allowed to do as permitted by state or federal laws Laws and regulations about what NA's can and do vary from state to state It is imperative that NA's know which tasks are outside their scope of practice and not perform them

Question 34

Care plan

Answer 34

Tasks that the team members, including NA's must perform. The care plan States how often these tasks should be performed and how they should be carried out It should involve input from the resident (person-centered care) and/or the family, as well as from health professionals

Question 35

Policy

Answer 35

A course of action that should be taken every time a certain situation occurs Ex: HIPPA

Question 36

Procedure

Answer 36

A method, or way of doing something. Ex: what form to complete, when and how often to complete it and to whom it is given

Question 37

Common policies

Answer 37

All resident information must remain confidential (HIPPA) Always follow the care plan and do not execute tasks that are not listed in the care plan or approved by the nurse A Nursing assistant should not do tasks that are not included in their job description A Nursing assistant must report important events or changes in residents to a nurse A Nursing assistant should not discuss their personal problems with residents or residents families A Nursing assistance should not take money or gifts from residents or their families A Nursing assistant must be on time for work and must be dependable

Question 38

Nursing assistant professionalism

Answer 38

Follow the care plan Make careful observations Report/chart accurately

Question 39

A professional relationship with residents includes:

Answer 39

Providing person-centered care Keeping a positive attitude Doing only the assigned tasks that are in the care plan and that the nursing assistant is trained to do Keeping all residents information confidential Always being polite and cheerful Never discussing personal problems Not using personal phones in a residents room or in any resident care area Not using profanity, even if a resident does Listening to the resident Calling a resident Mr, Mrs, Ms, or Miss and his or her last name, or by the name he or she prefers.. do not use terms such as sweetie or honey, etc Never giving or accepting gifts Always explaining care before providing it Following practices such as hand-washing to protect oneself and residents

Question 40

Professional relationship with employers includes:

Answer 40

Completing tasks efficiently Always following all policies and procedures Documenting and reporting carefully and correctly Reporting problems with residents or tasks Reporting anything that keeps a nursing assistant from completing duties Asking questions when you do not know or understand something Being available to direction or feedback without becoming upset Being clean and neatly dressed and groomed Always be on time Notify the employer if you cannot report for work Following the chain of command Participating in education programs Being a positive role model for the facility

Question 41

Residents rights include:

Answer 41

Quality of life Services and activities to maintain a high level of wellness The right to be fully informed about rights and services The right to participate in their own care The right to make independent choices The right to privacy and confidentiality The right to dignity, respect and freedom The right to security of possessions Rights during transfers and discharges The right to complain The right to visits Rights with regard to social services

Question 42

The right to quality of life

Answer 42

The facility must give equal access to quality Care regardless of a resident's condition, diagnosis or payment source ensuring that the residents dignity, choice and Independence are integral

Question 43

The right to services and activities in order to maintain a high level of wellness

Answer 43

The baseline care plan which includes instructions for providing person-centered care must be developed within 48 hours of admission. Residents Health should not decline as a direct result of the caregiving at the facility

Question 44

The right to be fully informed about rights and services

Answer 44

Residents must be told what services are available to them. They must be told the fee for each service and informed of charges both verbally and in writing. Residents must be given a written copy of their legal rights, along with the facilities rules. Residents must be provided with contact information for state agencies relating to quality of care (ombudsman program). Residents have the right to be notified about any change of room or roommate. They have the right to communicate with someone who speaks their language. They have the right to assistance for any sensory impairment, such as vision loss.

Question 45

The right to participate in their own care

Answer 45

Residents have the right to participate in planning their treatment, care and discharge. Residents have the right to see and sign their care plans after all significant changes. The right to refuse and/or discontinue treatment and care. The right to refuse restraints. The right to refuse participation in experimental research.

Question 46

Informed consent

Answer 46

Process by which a person with the help of a doctor, makes informed decisions about his or her health care

Question 47

The right to make independent choices

Answer 47

Residents can make choices about their doctors, care and treatments. They can make choices as to how to spend their time. They have a right to reasonable accommodation of their needs and preferences. They have the right to participate in resident or family groups, such as a resident council

Question 48

The right to privacy and confidentiality

Answer 48

The residents medical, personal and financial information cannot be shared with anyone but the care team

Question 49

The right to dignity, respect and freedom

Answer 49

Residents must not be abused, mistreated or neglected in any way

Question 50

The right to security of possessions

Answer 50

Residents' personal possessions must be safe at all times. Facilities must make an effort to protect residents property from loss or theft. Residents have the right to manage their own finances or choose someone else to do it for them. Residents can request that the facility handle their money.

Question 51

Rights during transfers and discharges

Answer 51

The facility must develop an effective discharge plan for residents that involves each residents goals and preferences. If the resident is planning to stay at the facility long-term, discharge planning still needs to occur, keeping the residents preferences in mind.

Question 52

The right to complain

Answer 52

Residents have the right to make complaints and voice grievances without fear for their safety or care. Facilities must work quickly to address their concerns

Question 53

The right to visits

Answer 53

Residents have the right to visits which cannot be restricted, limited or denied in any manner

Question 54

Rights with regards to social services

Answer 54

The facility must provide residents with access to social services including counseling, assistance in solving problems with others and help contacting legal and financial professionals

Question 55

False imprisonment

Answer 55

Not allowing a resident to leave the facility

Question 56

Involuntary seclusion

Answer 56

Is the separation of a person from others against that person's will. An example is an NA confining a resident to his room

Question 57

Negligence

Answer 57

Actions, or the failure to act or provide the proper care for a resident, resulting in unintended injury. Ex: An NA forgetting to lock a residents wheelchair before transferring them. The resident falls and is injured.

Question 58

Malpractice

Answer 58

Is what occurs when a person is injured due to professional misconduct through negligence, carelessness, or lack of skill

Question 59

Observing and reporting: abuse and neglect

Answer 59

The Following injuries are considered suspicious and should be reported: Poisoning or traumatic injury Teeth marks Belt buckle or strap marks Bruises, contusions or welts Scars Fractures or dislocations Burns of unusual shape and in unusual locations, or cigarette Burns Scalding Burns Scratches or puncture wounds Scalp tenderness or patches of missing hair Swelling in the face, broken teeth or nasal discharge Bruises, bleeding, or discharge from the vaginal area

Question 60

Signs that could indicate abuse

Answer 60

Yelling obscenities Fear, apprehension or fear of being alone Poor self control Constant pain Threatening to hurt others Withdrawal or apathy Alcohol or drug abuse Agitation, anxiety or signs of stress Low self-esteem Mood changes, confusion or disorientation Private conversations are not allowed, or the family member/caregiver is present during all conversations Reports of questionable Care by the resident or their family

Question 61

Signs that could indicate neglect

Answer 61

Pressure injuries Unclean body Body lice needs relating to hearing aids, eyeglasses, etc Weight loss or poor appetite Uneaten food Dehydration Freshwater or beverages not being offered regularly Reports of not receiving prescribed medication by the resident or their family

Question 62

Reporting abuse or neglect

Answer 62

Observe for signs of abuse and report suspected cases to the proper person. Follow the chain of command. If action is not taken, the NA should keep reporting up the chain of command until action is taken. If no action is taken at the facility level they can call the state abuse hotline or contact the proper state agency. Abuse can be reported anonymously. If a life or death situation is witnessed the NA should remove the resident to a safe place if possible. The NA should get help immediately or have someone go for help. The resident should not be left alone.

Question 63

If abuse is suspected or observed

Answer 63

The NA should give the nurse as much information as possible. If a resident wants to make a complaint of abuse, the NA must help them in every way. This includes telling the resident about the process of their rights. If an NA observes someone being cruel or abusive to a resident who made a complaint they must report it.

Question 64

Ombudsman

Answer 64

Is assigned by law as the legal advocate for residents. They monitor care and conditions at LTC facilities. They help resolve conflicts and settle disputes concerning residents health, safety, welfare and rights.

Question 65

Health Insurance Portability and Accountability Act (HIPPA)

Answer 65

A law that keeps a person's health information private and secure.

Question 66

Protected Health Information (PHI)

Answer 66

Information that identifies a person and relates to the patient's condition, any healthcare that person has had, and payment for that healthcare. PHI must be kept confidential Examples of PHI include a person's name, address, telephone number, social security number, email address and medical record number.

Question 67

Guidelines to protecting privacy

Answer 67

Make sure you are in a private area when you listen to or read your messages Know with whom you are speaking on the phone. If you're not sure, get a name and number. Call back after you find out it is all right to share information with this person. Do not talk about residents in public areas Use confidential rooms for reports to other care team members If you see a residents family member or a former resident in public, be careful with your greeting. They may not want others to know about the family member or that he or she has been a resident Do not bring family or friends to the facility to meet residents Make sure nobody can see PHI or personal information on your computer screen. Log out and/or exit the browser when finished with any computer work. Do not give confidential information in emails. Do not share resident information, photos, or videos on any social media Make sure fax numbers are correct before faxing information. Use a cover sheet with a confidentiality statement. Do not leave documents where others may see them Store, file or shred documents according to facility policy. If you find documents with a resident's information, give them to the nurse

Question 68

Careful charting is important for these reasons:

Answer 68

If it was not documented, legally it was not done It is the only way to guarantee clear and complete communication among all the members of The Care team Documentation is a legal record of every part of a resident's treatment. Medical charts can be used in court as legal evidence Documentation helps protect nursing assistants and their employees from liability by proving what they did when caring for residents Documentation gives an up-to-date record of the status and care of each resident

Question 69

Guidelines to careful documentation

Answer 69

Document care immediately after it is given. This makes details easier to remember. DO NOT RECORD ANY CARE BEFORE IT HAS BEEN DONE. Think about what you want to say before documenting. Be as brief and clear as possible. Use facts, not opinions. Use Black ink when documenting by hand. Right as neatly as possible If you make a mistake, draw one line through it. Write the correct information. Put your initials and the date. Do not erase what you have written. Do not use correction fluid. Documentation done on a computer is time stamped; it can only be changed by entering another notation Sign your full name and title. write the correct date Document as specified in the care plan.

Question 70

Guidelines for computer documentation

Answer 70

Do not share your login information with anyone Don't have someone else enter information for you, even if it is more convenient. Double check to make sure you are logged into the correct residents chart before beginning documentation. Double check to make sure autofill entries are accurate. Recheck your entries before exiting a residents chart Do not use the facilities computers or tablets to browse the internet or access any personal accounts

Question 71

Minimum Data Set (MDS)

Answer 71

A detailed form with guidelines for assessing residents. It also lists what to do if resident problems are identified. Nurses must complete the MDS for each resident within 14 days of admission and again each year. The MDS for each resident must be reviewed every 3 months A new MDS must be done when there is any major change in the residents condition NA's contribute to the MDS by reporting changes in residents promptly and by documenting accurately. Doing this means a new MDS can be completed when needed

Question 72

When to file an incident report

Answer 72

When there is an accident, problem or unexpected event during the course of care. It documents the incident and the response to it. Examples of when to file a report: Feeding resident from the wrong meal tray A resident fall or injury (even if they report they are fine) Accusations made by residents against staff Employee injuries An NA or resident breaks or damages something An NA makes a mistake in care A resident or a family member makes a request that is outside the NA's scope of practice A resident or a family member makes sexual advances or remarks Anything that happens to make an NA feel uncomfortable, threatened or unsafe An NA gets injured on the job An NA gets exposed to blood or body fluids

Question 73

Guidelines to filing an incident report

Answer 73

Report any incident immediately to the charge nurse. Complete the report as soon as possible and give it to the charge nurse If a resident falls and the NA did not see it, they should not document "Mr G fell". Instead they should document "Found Mr G on the floor" or "Mr G states that he fell" Do not place blame or liability within the report Tell what happened. State the time and the mental and physical condition of the person Describe the person's reaction to the incident State the facts; do not give opinions Do not document that an incident report was completed on the medical record Describe the action taken to give care