Chapter 2 Flashcards
Verbal communication
Use a spoken or written words. Oral reports are an example
Nonverbal communication
Communicating attitudes or emotions without using words.
Examples include:
body language movements
facial expression
posture
Deciding what to report
Anything that endangers residents including:
Falls
chest pain
severe headache
trouble breathing abnormal pulse, respiration, or blood pressure
change in mental status sudden weakness or loss of mobility
fever
loss of consciousness
change in level of consciousness
bleeding
swelling of a body part
change in general condition
bruises, abrasions, or other signs of possible abuse
Different languages (resident’s rights)
Speak in a language that residents can understand or find an interpreter. Picture cards and gestures can help with communication. CNAs should not use a different language when speaking with staff in front of residents
Ask a resident for more information
When they report symptoms, events or feelings. Have them repeat what they have said. Ask open-ended questions that need more than a yes or no answer.
Example: “did you sleep well last night?” should be replaced with “Can you tell me about your night and how you slept?”
Encourage the resident to offer facts and details.
Tips for proper communication
Always greet the resident by his or her preferred name (use first names only if asked to do so)
Identify them
Focus on the topic to be discussed
Face the resident while speaking and avoid talking into space
Talk with the resident, not other staff members while giving care
Listen and respond when the resident speaks
Praise the resident and smile often
Encourage the resident to interact with you and others
Be courteous
Tell the resident when you are leaving the room
Objective information (signs)
Based upon what a person sees, hears, touches or smells
Example: “Mr Hartman is holding his head and rubbing his temples.”
Symptoms
subjective information
Are based on what the resident reports (that may or may not be true.)
Example: “Mr Hartman says he has a headache”
An example of clear reporting of symptoms
“Mr Scott reports pain in left shoulder”
Senses used together information
Sight
hearing
touch
smell
Sight
Look for changes in the resident’s appearance.
Examples:
rashes redness paleness swelling discharge weakness sunken eyes changes in posture or gait
Hearing
Listen to what the resident has to say about their condition, family or needs.
Is the resident speaking clearly and making sense?
Do they show emotions such as anger, frustration or sadness?
Is their breathing normal?
Do they wheeze, gasp or cough?
Is their area quiet enough for him to rest as needed?
Touch
Does the residents skin feel hot or cool?
moist or dry?
Is the pulse rate normal?
Smell
Odors could suggest poor bathing, infections or incontinence.
The breath could suggest use of alcohol or tobacco, indigestion or poor mouth care.
Incontinence
The inability to control the bladder or bowels
Oral reports
Make written notes so that important details are not forgotten while waiting for the charge nurses availability.
After delivery, document when, why, about what and to whom an oral report was given.
Take notes when a member of The Care team gives you an oral report.
Telephone communication
Identify the facilities name, my name and my position.
Ask if it is okay to put a person on hold
Never give out any information about staff or residents
If somebody is calling to give a doctor’s order for a resident, find the nurse or take a message for the nurse.
Call lights
Make sure it’s within reach of the residents stronger hand and that the resident knows how to use it. (Each time you leave the room)
Respond immediately even if the resident is not on your assignment sheet
Overcoming barriers to communication:
If the resident does not hear you, does not hear correctly or does not understand:
face the resident. Speak slowly and clearly. Speak in a low voice using a pleasant tone. Check if they’re hearing aid is on and working.
Overcoming barriers to communication:
Resident is difficult to understand
Be patient. Take the time to listen. Ask the resident to repeat or explain the message. Restate the message in your own words to make sure that you have understood.
Overcoming barriers to communication:
Do not use words that are not understood easily by others
Do not use medical terms with resident’s or their families.
Use simple everyday words. No slang or profanity. (Even if the resident uses them)
Overcoming barriers to communication:
Cliches
Avoid using cliches. Listen to what a resident is really saying and respond with a meaningful message
Overcoming barriers to communication:
Why?”
Avoid asking “why?” When a resident makes a statement. “Why?” questions make people feel defensive.
Overcoming barriers to communication:
Advice
Never offer your opinion or give advice. Giving medical advice is not within the scope of your practice. It could be dangerous.
Overcoming barriers to communication:
Open-ended questions
Yes and no answers end conversations. Avoid them.
Overcoming barriers to communication:
Resident speaks a different language
Speak slowly and clearly. Be patient and calm. Keep messages short and simple. Be alert for words the resident understands as well as signs that the resident is only pretending to understand. Use pictures or gestures to communicate if necessary. Ask the residence family or other staff members who speak the same language for help.
Overcoming barriers to communication:
nonverbal communication
Be aware of body language and gestures. Look for nonverbal messages and clarify them.
Example: “Mr feldman, you say you’re feeling fine but you seem to be in pain. Can I help?”
Overcoming barriers to communication:
Defense mechanisms
Denial
Projection: seeing feelings in others that are really one’s own - “my teacher hates me”
Displacement transferring a strong negative feeling to safer situation. Example: and unhappy employee doesn’t stand up to his boss. He goes home and yells at his wife.
Rationalization colon making excuses to justify situation. Example: after stealing something, saying “everybody does it”
Repression: blocking painful thoughts or feelings from the mind such as a traumatic experience
Regression going back to an old, usually immature behavior. Example: throwing a temper tantrum as an adult
Overcoming barriers to communication:
Culture
When communicating with residents from a different culture ask yourself these questions:
What information do I need to communicate to this person?
Does this person speak English as a first or second language?
Do I need an interpreter?
Does this person have any cultural practices about touch or gestures I should adapt to?
Impairment
A loss of function or ability; it can be a partial or complete loss
Hearing impairment guidelines
Make sure that the hearing aid is turned on/clean daily.
Reduce or remove noise such as tvs, radios and loud speech. Close doors if needed.
Get the residence attention before speaking. Do not startle residence by approaching from behind. Walk in front or touch them lightly on the arm to let them know you are near.
Speak clearly, slowly and in good lighting. Directly face the person. The light should be on your face, not the residents. Ask if they can hear what you are saying
Do not shout. Do not mouth the words in an exaggerated way.
Keep the pitch of your voice low
If they hear better out of one ear try to speak or stand on that side
Use short sentences and simple words. Avoid sudden topic changes
Use picture cards or a notepad as needed
Avoid long, tiring conversations
Don’t pretend to understand if you do not. Ask the resident to repeat what was said. Observe the lips, facial expressions and body language. Then tell the resident what you think you heard. You can also request that the resident write the words down
Be understanding and supportive
Speak clearly slowly and in good lighting. Directly face the person
Vision impairment guidelines
Encourage the use of eyeglasses or contact lenses if worn
Make sure eyeglasses are clean. Make sure eyeglasses are in good condition and fit well. Report to the nurse if they do not.
Knock on the door and identify yourself as soon as you enter the room. Do not touch the resident until you have said your name. Explain why you are there and what you would like to do. Let the resident know when you are leaving the room.
Make sure there is proper lighting in the room. Face the resident when speaking.
When you enter a new room with the resident, Orient him to where things are. Describe the things you see around you. Try not to use words such as “see”, “look” or “watch”
Always tell the resident what you were doing while caring for them. Give specific directions such as “on your right” or “in front of you”. Talk directly to the resident whom you are assisting do not talk to other residents or staff members.
Is the face of an imaginary clock as a guide to explain the position of objects that are in front of the resident. Example: “there’s a sofa at 7:00”
Do not move personal items, furniture or other objects. Put everything back where you found it.
Tell the resident where the call light is and make sure it is within their reach.
Leave doors completely open or completely closed, never partly open.
If the resident needs guidance and getting around, walks slightly ahead. Let them touch or grasp your arm lately. Walk at their pace, not yours
Give assistance with cutting food and opening containers as needed
Large print books, audio books digital books and Braille books are available
If the resident has a guide dog, do not play with, distract or feed it
Encourage the use of other senses, such as hearing touch and smell. Encourage them to feel and touch things, such as clothing furniture or items in the room
Signs of a mental health disorder
Confusion disorientation agitation anxiety depression
Guidelines to communication with residents who have mental health disorders
Speak to them like adults
Use simple, clear statements in a normal tone of voice
Be sure that what you say and how you say it show respect and concern
Be honest and direct, as you would with any resident
Avoid arguments
Maintain eye contact and listen carefully
Combative behavior
Must always be reported and documented so the care team can be aware of it.
Combative behavior guidelines
Never retaliate or threaten a resident
Remain calm. Lower the tone of your voice. Stand at least an arms length away
Allow the resident time to calm down before the next interaction
Stay neutral. Do not respond to verbal attacks. Do not argue or accuse the resident of wrongdoing. If you must respond, say something like “I understand that you’re angry and frustrated. How can I make things better?”
Keep your hands open and in front of you
Be reassuring and supportive
Consider what provoked the resident. Was it a change in caregiver? A change in routine? Get help to take the resident to a quieter place if needed
Report inappropriate behavior to the nurse
Expressions of anger
Yelling threatening throwing things pacing withdrawing being silent sulking
always report angry behavior to the nurse
Anger behavior guidelines
Stay calm. Do not argue or response to verbal attacks
Empathize with the resident. Try to understand what he or she is feeling
Try to find out what caused their anger. It’s an attentively. Remain silent. This may help the resident explain
Treat them with dignity and respect. Explain what you are going to do and when you will do it.
Answer call lights promptly
Stay at a safe distance if the resident becomes combative
Inappropriate behavior
When a resident tries to establish a personal rather than professional relationship
Examples: asking personal questions requesting visits on personal time asking for or doing favors giving tips or gifts lending or borrowing money
Sexual advances may include:
Sexual words, comments or behavior that makes the person to whom they were directed feel uncomfortable
Examples:
removing of clothing
touching themselves (sometimes mentally ill/confused residents may have problems that mimic inappropriate sexual behavior such as an uncomfortable rash, tight clothing or a need to use the bathroom. If you encounter a resident in an embarrassing situation remain professional and do not overreact. Try to distract the resident. If this does not help they should be taken to a private area and the nurse should be notified.)
Address the inappropriate behavior directly by saying something like “that makes me uncomfortable” or “I can’t really talk about my personal life on the job.”
Safety check when exiting a residence room
Is the call light within reach of the residents stronger hand?
Is the room tidy? Are the residents items in their proper places?
Is the furniture in the same place as I found it?
Is the bed in its lowest position?
Does the resident have a clear walkway around the room and into the bathroom?
Guidelines to preventing falls
Clear all walkways of clutter, trash, throw rugs and cords
Use rugs with a non-slip backing
I have residents where non-skid, sturdy shoes. Make sure shoelaces are tied
Residents should not wear clothing that is too long or drags on the floor
Keep items that are used often close to residents, including call lights
Immediately clean up spills on the floor
Report loose handrails immediately
Mark uneven flooring or stairs with tape of a contrasting color to indicate a hazard
Improve lighting where needed
Block wheels and move foot rests out of the way before helping residents into or out of wheelchairs
Lock bed wheels before helping a resident into and out of bed or when giving care
After completing care return beds to their lowest position
Can’t help when moving residents. Keep residents walking aids, such as canes or walkers, within their reach
Offer help with elimination needs often. Respond to these requests immediately
Leave furniture in the same place as you found it
Know which residents are at risk for falls. Pay attention so that you can give help often
If a resident starts to fall, being a good position to help support them. Never try to catch a falling resident. Use your body to slide them to the floor. If you try to reverse the fall, you may hurt yourself and/or the resident
Report report all falls to the nurse and complete an incident report even if they say they are fine
Guidelines to preventing Burns and scalds
Always check water temperature with a thermometer or on the inside of your wrist before using
Immediately report trade electrical cords or appliances that look unsafe. Do not use them and remove them from the room
Let residents know when you are about to pour or sit down a hot liquid
Poor hot drinks away from residents. Keep hot drinks and liquids away from edges of tables. Put lids on them
Make sure residents are sitting down before serving hot drinks
If plate warmers or other equipment that produces heat are used monitor them carefully
Resident identification
Residents must always be identified before giving care or serving food/placing meal trays /or helping with eating
Check the diet card against the residence identification to make sure they match
The resident should be called by name (and asked to State their name if able)
Choking prevention
Presidents should eat in as upright a position as possible
Residence with swallowing problems may need to have liquids thickened to the consistency of nectar, honey or pudding in order to make it easier to swallow
Poisoning prevention
Cleaning products, paints, medicines, toiletries and glues should be stored or locked away from confused residents or those with limited vision
Residents with dementia May hide food and let it spoil and closets, drawers or other places. Investigate any odors that you may notice.
The number for the Poison control center should be posted near all telephones
Cuts / abrasion prevention
Sharp objects such as scissors, nail clippers and razors should be put away after use.
Take care when transferring residents into and out of beds, chairs and wheelchairs.
Do not pull wheelchairs from behind
Back wheelchairs into elevators so that residents are facing forward
Safety data sheet (SDS)
Required by OSHA, the sheet details the chemical ingredients, dangers and safe handling, storage and disposal procedures for the product. Information about emergency response actions to be taken are also included.
Important information about the SDS includes the following:
Employers must have an SDS for every chemical used
Employers must provide easy access to the SDS
Staff members must know where these sheets are kept and how to read them. Ask for help if you don’t know how to do this.
Guidelines to reducing fire hazards and responding to fires
Make sure residents are in the proper area for smoking.
Be sure that cigarettes are extinguished.
Empty ashtrays often and make sure there are no hot ashes or hot matches in the ashtray
Burn resistant aprons for smokers may be available. If a resident wears the apron make sure the buckles and snaps are properly fastened and that the apron covers their torso and lap.
Never leave a smoker unattended
Report freighter damage electrical cords immediately. Report electrical equipment in need of repair immediately.
Fire alarms and exit door should not be blocked. If they are, report this to the nurse
Ecig/vape safety:
Use the charging device supplied by the manufacturer
Batteries may need to be turned off manually and may need to be removed from charges after they are fully charged
How to use a fire extinguisher (PASS)
P. pull the pin
A. aim at the base of the fire when spraying
S. squeeze the handle
S. sweep back and forth at the base of the fire
In case of fire (RACE)
R. remove anyone in danger if you are not in danger
A. Activate alarm or call 911
C. contain fire if by possible closing all doors and windows
E. extinguish the fire, or the fire department will extinguish it. Evacuate the area of constructed to do so
Guidelines for fire emergency
Know the facilities fire evacuation plan
Stay calm. Do not panic.
Follow the directions of the fire department
Know which residents need one-on-one help or assistive devices. Helping mobile residents into wheelchairs, wheel transporters such as carts, bath chairs, stretchers or beds. A blanket can be used as a stretcher or even pulled across the floor with someone on it
Assist us with canes and walkers. Those who have a hearing impairment may not hear the warning and instructions. Staff will need to tell them directly what to do while guiding them to a safe exit. People with vision problems should be moved out of the way of the wheelchairs carts etc and help to the exit. Residents who are confused and disoriented will also need guidance
Remove anything blocking a window or door that could be used as a fire exit
Do not get into an elevator during a fire unless directed to do so by the fire department
Stay low in a room to escape smoke/fire
If a door is closed, check for heat coming from it before opening. If the door do not feels hot stay in the room if there is no safe exit. Plug the doorway with wet towels or clothing to prevent smoke from entering. Stay in the room until help arrives
Stop, drop and roll
He’s a damn covering over the mouth and nose to reduce smoke inhalation
Move away from building after exiting
Disaster situation guidelines
Remain calm
Know the locations of all exits and stairways
Know where the fire alarms and extinguishers are located
Stay informed via internet, television or radio to get the latest information
How to recognize and respond to medical emergencies
Assess the situation: is it safe or too dangerous to assist?
Assess the victim: ask the injured or ill person what has happened. If they are unable to respond, they may be unconscious. Tap them on the shoulders and ask what happened to assess consciousness. Speak loudly and use the person's name if you know it. If there is no response assume the person is unconscious and call send for help right away. If they are able to speak ask them about what happened. Get the person's permission to touch them. Check them for the following: Severe bleeding Changes in consciousness Irregular breathing Unusual color or feel to the skin Swollen places on the body Medical alert tags Pain Call the nurse before doing anything else. The injured person may be frightened. Remain calm listen to them and tell them what is being done to help them. A calm and confident person will help reassure them.
Administer first aid/CPR quickly. Brain damage can occur within 4 to 6 minutes after the heart stops beating and breathing stops. Death can occur within 10 minutes.
Administering help to a choking person
If the resident can continue to speak, breathe or cough encourage them to cough is forcefully as possible to get the object out.
If a resident can no longer speak, breather cough, call for help immediately by using the call light or emergency cord.
Poor air exchange, and increase in trouble breathing, silent coughing, blue-tinged (cyanotic) skin and an inability speak, breathe or cough are signs of a severely obstructed airway. Ask, “Are you choking? I know what to do. Can I help you?” If they’re not yes begin administering abdominal thrusts with intermittent back blows.
If the resident becomes unconscious while choking help them to the floor gently. Lie them on their back face up. Begin CPR. Make sure help is on the way.
Shock
Occurs when organs and tissues in the body do not receive an adequate blood supply. Bleeding,
heart attack, severe infection and falling blood pressure can all lead to shock which can become worse when the person is very frightened or in severe pain.
Signs of shock
Pale or bluish skin Staring Increased pulse and respiration rates Low blood pressure Extreme thirst
Responding to shock
Call for help / notify the nurse immediately.
If controlling bleeding is necessary, put gloves on first.
have the person lie down on their back. Place them on their side if bleeding from the mouth or vomiting. Elevate the legs about 8 to 12 in unless the person has a head, neck, back, spinal or abdominal injury; breathing difficulties or fractures. Elevate The Head and shoulders of the head wound or breathing difficulties are present. Never elevated body part if the person has a broken bone or if it causes pain
Check pulse and respirations if possible. If the person stops breathing or has no pulse begins CPR
Keep the person as calm and comfortable as possible
Maintain normal body temperature. If the weather is cold, place a blanket around the person. If the weather is hot provide shade.
Do not give the person food or liquids.
Myocardial infarction (MI) a/k/a heart attack
Occurs when the heart muscle does not receive enough oxygen because blood vessels are blocked.
Signs and symptoms of a heart attack (MI)
Sudden, severe pain in the chest. Usually on the left side or in the center behind the breastbone
Pain or discomfort in other areas of the body such as one or both arms, the back, neck, jaw or stomach
Indigestion or heartburn
Nausea and vomiting
Dyspnea, or difficulty breathing
Dizziness
Pale or bluish (cyanotic) skin color, indicating lack of oxygen
Perspiration
Cold and clammy skin
Week and a regular pulse rate
Low blood pressure
Anxiety and a sense of Doom
Denial of a heart problem
The victim May describe the pain as crushing, pressing, squeezing, stabbing, piercing pain, or “like someone is sitting on my chest.” Pain may go down the inside of the left arm. It may also be felt in the neck and or in the jaw. It usually does not go away.
Women may experience chest pain or pressure, but can have heart attacks without it. They are more likely to have shortness of breath, nausea, lightheadedness, stomach pain, sweating, fatigue, and back, neck or jaw pain. Some women symptoms are more flu-like and they are more likely to deny but they’re having a heart attack
Responding to an MI
Notify the nurse immediately
Place the person in a comfortable position. Encourage them to rest. Reassure them that you will not leave them alone.
Loosen clothing around the person’s neck
Do not give the person food or liquids
Monitor the person’s breathing and pulse. If the person stops breathing or has no pulse begin CPR
Stay with the person until help arrives
Report and document the incident properly
Controlling bleeding
Notify the nurse immediately
Put on gloves. Take time to do this. If the resident is able, they can hold their bare hand over the wound until you can put on gloves
Hold a thick sterile pad, clean cloth or clean towel against the wound
Press down hard directly on the bleeding wound until help arrives. Do not decrease pressure. Put additional pads or cloths over the first pad of blood seeps through. Do not remove the first pad.
If you can, raise the wound above the level of the heart to slow the bleeding. Prop up the limb if the wound is on an arm, leg, hand or foot and there are no broken bones. Use towels or other absorbent material
When bleeding is under control, secure the dressing to keep it in place. Check for symptoms of shock. Stay with the
Remove and discard gloves. Wash hands thoroughly
Report and document the incident properly
Treating Minor Burns
Notify the nurse immediately. Put on gloves
He was cool, clean water to decrease the skin temperature and prevent further injury. Do not use ice or ice water which may cause further skin damage. Dampen a clean cloth with cool water. Place it over the burn
Once the pain has eased, you may cover the area with the dry, clean dressing or non adhesive sterile bandage
Remove and discard gloves. Wash your hands
Never use any kind of ointment, salve or grease on a burn
Treating Serious Burns
Notify the nurse immediately. Put on gloves
Check for breathing, pulse and severe bleeding. If the person is not breathing and has no pulse begin CPR
Do not use any type of ointment, water, Sam or grease on the burn
Do not try to pull away any clothing from burned areas. Cover the burn with sterile gauze or a clean sheet. Apply the guys with a sheet lately. Take care not to rub the burned area
Monitor vital signs and wait for emergency medical help
Removing discard gloves. Wash your hands
Report and document the incident properly
Syncope
Fainting
Signs and symptoms of fainting
Dizziness Nausea perspiration pale skin weak pulse shallow respirations blackness in the visual field
Responding to fainting
Notify the nurse immediately
If possible, have the person lie down or sit down before fainting occurs
If the person is in a sitting position have them bend forward if able, have them place their head between their knees. If the person is lying on their back, elevate their legs about 12 in
Loosen any tight clothing
Have the person stay in position for at least 5 minutes after symptoms disappear
Help them get up slowly. Continue to observe them for symptoms of painting. Stay with them until they feel better. Use the call light if you need help but cannot leave.
If a person faints lower them to the floor or other flat surface if possible. Position them on their head or back. If there are no head, neck, back, spinal or abdominal injuries elevate their legs 8 to 12 in. If unsure about injuries, leave them flat on their back, loosen any tight clothing. Check to make sure the person is breathing. Keep them lying down for several minutes
Report the incident to a nurse immediately and document the incident properly
Insulin reaction/hypoglycemia
Can result from either too much insulin or too little food. It occurs when insulin is given and the person skips a meal or does not eat all the food required. Vomiting and diarrhea may also lead to insulin reaction in people who have diabetes.
First signs of insulin reaction
Feeling weak or “different”
Nervousness
Dizziness
Perspiration
Immediately report these signs to the nurse. These signs signal that the person needs food in a form that can be rapidly absorbed. A glass of milk, fruit juice or water with sugar dissolved in it should be consumed right away or administer a glucose tablet.
Other signs and symptoms include the following:
Hunger Headache Rapid pulse Low blood pressure Cold, clammy skin Confusion Trembling Nervousness Blurred vision Numbness of the lips and tongue Unconsciousness
Diabetic ketoacidosis (DKA)
Caused by having too little insulin. It can result from undiagnosed diabetes, infection, going without insulin or not taking enough, eating too much, not getting enough exercise, or physical or emotional stress.
Signs and symptoms of diabetic ketoacidosis (DKA)
Signs of the onset include:
increased hunger, first or urination
Abdominal pain
Deep or labored breathing
Breath that smells sweet or fruity
Notify the nurse immediately if the resident show signs of dka
Other signs and symptoms include:
Headache
Weakness
Rapid, weak pulse
Low blood pressure
Dry skin
Flushed cheeks
Drowsiness
Nausea and vomiting
Shortness of breath or air hunger (gasping and being unable to catch their breath)
Unconsciousness
Responding to seizures
Note the time. Put on gloves
Lower the person to the floor. Cradle the head to protect it. If available, place a pillow under the person’s head. Loosen clothing to help with breathing. Try to turn the person’s head to one side to help lower the risk of choking. This may not be possible during a violent seizure
Have someone call the nurse immediately or use the call light. Do not leave the person unless you must do so to get medical help
Move furniture away to prevent injury
Do not try to restrain the person or stop the seizure
Do not force anything between the person’s teeth. Do not place your hands in the person’s mouth for any reason. You could be bitten
Do not give the person food or liquids
When the seizure is over note the time. Gently turn the person to the left side if you do not suspect head, neck, back, spinal or abdominal injuries. This reduces the risk of choking on vomit or saliva. If they begin to choke get help immediately. Check for adequate breathing and pulse. Begin CPR if necessary. Do not begin CPR during a seizure
Remove and discard gloves. Wash your hands
Report and document the incident properly including how long the seizure lasted
Cerebrovascular accident (CVA) AKA stroke
Occurs when blood supply to a part of the brain is blocked or blood vessel leaks or ruptures within the brain. A quick response to suspected stroke is critical. Tests and treatment need to be given within a short time of The strokes onset. Early treatment may be able to reduce the severity of the stroke
Transient ischemic attack (TIA)
A warning sign of a CVA or stroke resulting from a temporary lack of blood supply to the brain. Symptoms May last up to 24 hours.
Signs and symptoms that a TIAor CVA is occurring
Difficulty speaking
Weakness on one side of the body
temporary loss of vision and numbness or tingling
Facial numbness, weakness or drooping, especially on one side
Paralysis on one side of the body (hemiplegia)
Slurred speech or an inability to speak (expressive aphasia)
I’m numbness or weakness, especially on one side (hemiparesis)
Inability to understand spoken or written words (receptive aphasia)
Use of inappropriate words
Severe headache
Blurred vision
Ringing in the ears
Redness in the face
Noisy breathing
Elevated blood pressure
Slow pulse rate
Nausea vomiting
Loss of bowel or bladder control
Seizures
Dizziness
Loss of consciousness
In addition to the symptoms listed above women may have these symptoms:
Pain in the face, arms and legs
Hiccups
Weakness
Chest pain
Shortness of breath
Palpitations
Employ F.A.S.T. in order to assess signs of a stroke
(F)ace: is one side of the face drooping? Is it numb? Ask the person to smile. Is the smile uneven?
(A)rms: is one arm numb or weak? Ask the person to raise both arms. Check to see if one arm drifts downward
(S)peech: is the person’s speech slurred? Is the person unable to speak? Can the person be understood? Ask the person to repeat a simple sentence and see if the sentence is repeated correctly
(T)ime: time is of the utmost importance when responding to a stroke. If the person shows any of the symptoms listed above report it to the nurse immediately. Note the time.
Responding to vomiting (emesis)
Notify the nurse immediately. Put on gloves
Make sure the head is up or turn to one side. Place a basin under the chin. Remove it when vomiting has stopped
Remove soiled linens or clothes and set aside. Replace with fresh linens or clothes
If the residents intake and output (I&O) is being monitored, measure and note the amount of vomitus
First of vomit down the toilet unless the vomit is red, has blood in it, or looks like wet coffee grounds, or if medication/pills are in it. If these signs are observed, show this to the nurse before discarding the vomit. After disposing of the vomit, wash, dry and store the basin
Removing discard gloves. Wash your hands. Put on fresh gloves
Provide comfort to the resident. Wipe their face and mouth. Position them comfortably. Offer a drink of water or oil care.
Put the soil linen in the proper containers.
Remove and discard gloves. Wash your hands again.
Freeport and document the incident properly. Document the time, amount, color, odor and consistency of vomitus
Localized infection
An infection limited to a specific location in the body. It has local symptoms, which means the symptoms are near the site of the infection.
Systemic infection
An infection that affects the entire body. It travels through the bloodstream and is spread throughout the body causing general symptoms such as fever, chills mental confusion, or lower than normal blood pressure
Healthcare-associated infection (HAI)
An infection acquired in a healthcare setting during the delivery medical Care.
Chain of infection
A way of describing how diseases transmitted from one human being to another. The six links are as follows:
1) causative agent: apathogenic microorganism such as bacteria, viruses, fungi and parasites.
2) reservoir: we’re the pathogen lives and multiplies. Examples include the lungs, blood, and large intestine
3) portal of exit: any body opening on an infected person that allows pathogens to leave. These include the nose, mouth, eyes or cut in the skin
4) mode of transmission: describes how the pathogen travels. Transmission can occur through the air or through direct or indirect contact. The primary root of disease transmission within the healthcare setting is via the hands of healthcare workers
5) portal of entry anybody opening on an uninfected person that allows pathogens to enter. These include the nose, mouth, eyes and other mucous membranes, cuts in the skin, and cracked skin. Mucous membranes line body cavities that open to the outside of the body. They include the linings of the mouth, nose, eyes, rectum and genitals
6) susceptible host: is an uninfected person who could get sick.
Transmission of most infectious diseases can be blocked by using proper infection prevention practices such as hand washing. Caregivers should wash their hands often.
Medical asepsis
Measures used to reduce and prevent spread of pathogens in healthcare settings
Surgical sepsis
Also known as sterile technique, makes an object or area free of all microorganisms. This is used for changing catheters
Standard precautions
Treat blood, body fluids, non-intact skin (like abrasions, pimples, or open sores) and mucous membranes as if they were infected. Body fluids include tears, saliva, sputum (mucus coughed up) urine, feces, semen, vaginal secretions, pus or other wound drainage and vomit. They do not include sweat
Standard precaution guidelines
Wash your hands
Wear gloves
Remove gloves
Immediately wash all skin surfaces that have been contaminated by blood and body fluids
Wear a disposable gown: if you may come into contact with blood or body fluids. If a resident has a contagious illness, where gown even if it is not likely you will come into contact with blood or body fluids
Wear a mask and protective goggles and/or a face shield when splashing or spraying of blood or body fluids is likely
Wear gloves and use caution when handling razor blades, needles and other sharps
Play sharps carefully in a biohazard container
Never attempt to recap needles or sharps after use
Carefully bag all contaminated supplies
Clearly label body fluids that are being saved for a specimen with the resident’s name, date of birth, and room number; the date; and a biohazard label. Keep them in a container with a lid. Put in biohazard specimen bag for transportation if required
Dispose of contaminated wastes
Hand hygiene
Wash hands often
Do not wear rings or bracelets while working
Keep fingernails short smooth and clean.
Wash hands after:
When first arriving to work
Whenever they are visibly soiled
Before, between and after all contact with residents
Before putting on gloves and after removing gloves
After contact with anybody fluids, mucous membranes, non intact skin or wound dressings
After handling contaminated items
After contact with objects in the residence room (care environment)
Before and after touching meal trays and/or handling food
Before and after helping residents with meals
Before getting clean linen
Before and after using the toilet
After touching garbage or trash
After picking up anything from the floor
After blowing the nose, wiping the nose or coughing or sneezing into the hands
Before and after eating
After touching areas on the body, such as the mouth, face, eyes, hair, ears or nose
After any contact with pets or any pet care items
Before leaving the facility
Be sure to clean your nails by rubbing them in the palm of your opposite hand. Run water from wrists to fingernails (cleanest to dirtiest). Use a clean, dry paper towel to turn off the faucet. Dry hands starting at the fingertips.
Donning and doffing gowns
Wash hands
Open the gown. Hold it out in front and allow it to open/unfold. Do not shake the gown or touch it to the floor. Facing the back opening of the gown, place your arms through each sleeve
Fasten the neck opening
When removing a gown, remove and discard gloves properly. (?) Unfasten the gown at the waist and neck and remove the gown without touching the outside of the gown. Roll the dirty side in, while holding the gown away from your body dispose of the gown properly and wash your hands.
Masks
Respirators are used for certain diseases such as tuberculosis
Masks can only be worn once before they need to be discarded
Masks that become wet or soiled must be changed immediately without touching the outside of the soiled mask
The same mask should not be worn from one resident to another (?)
Wash hands before putting on a mask
When putting on a mask do not touch the mask where it comes into contact with your face
Gloves must always be worn for the following tasks:
Anytime you might come into contact with blood or anybody fluids, open wounds or mucous membranes
I’m performing or helping with Oral Care or care of any mucous membrane
When performing or helping with perineal care (care of the genitals and anal area)
When performing personal care on non-intact skin (abrasions, cuts, rashes, pimples, lesions, surgical incisions or boils)
If you have open sores or cuts on your hands
When shaving a resident
When disposing of soiled bed linens, gowns, dressings and pads
When touching surfaces or equipment that either is visibly contaminated or may be contaminated
Gloves can only be used once
Not intact areas on the hand should be covered with bandages or gauze before putting on gloves
Donning gloves
Wash hands
After your hands are gloved interlace your fingers. Smooth out folds and create a comfortable fit
Carefully look for tears, holes or spots. Replace the gloves if needed
Pull gloves up over your wrists. If wearing a gown, pull the cuffs of the gloves over the sleeves of the gown
Correct order of donning PPE
Wash hands
Put on gown
Put on mask
Put on goggles or face shield
Put on gloves
Correct order of doffing PPE
Remove and discard gloves
Remove goggles or face shield
Remove and discard gown
Removing discard mask
Wash hands
Handling equipment, linen and clothing guidelines
Handle all equipment in a way that prevents:
Skin/mucous membrane contact
Contamination of your clothing
Transfer of disease to other residents or areas
Do not use reusable equipment again until it has been sterilized
Disinfected items are reusable and include:
Reusable oxygen tanks
Wall mounted blood pressure cuffs
Reusable resident care equipment
Disposable single use, or disposable equipment properly. These include razors, thermometers
Clean and disinfect:
All environmental surfaces
Beds, bed rails and all bedside equipment
All frequently touched surfaces such as door knobs and call lights
Handle, transport and process soiled linens and clothing in a way that prevents:
Skin and mucous membrane exposure
Contamination of clothing (cold linen and clothing away from your uniform)
Do not shake linen or clothes; fold a roll linen so that dirtiest area is inside; do not put soil linen on floor
Bag soiled linen at the point of origin
Short soiled lending away from resident care areas
Place wet linen in leak proof bags
Guidelines to cleaning spills
Don gloves before starting.
Absorb the spill with whatever product is made available by the facility
Scoop up the absorb spill and dispose of it in a designated container
Apply the proper disinfectant to The spill area and allow it to stand for a minimum 10 minutes
Clean up spills immediately with the proper cleaning solution
Do not pick up any pieces of broken glass no matter how large, with your hands. Use a dustpan and broom or other
Waste containing broken glass, blood or body fluids should be properly bagged. Waste containing blood or body fluids may need to be placed in a special biohazard waste bag. Follow facility policy
Transmission based precautions
Use for people who are infected or may be infected with certain diseases
These precautions will always be listed in the care plan and on the assignment sheet
Three types of transmission based precautions
1) Airborne precautions prevent the spread of pathogens that can be transmitted through the air after being expelled. Precautions include wearing n95s or HEPA masks to avoid being infected
2) Droplet precautions are used for diseases that are spread by droplets in the air. Droplets normally do not travel more than 6 ft. Coughing, sneezing, talking, laughing, singing or suctioning can spread droplets. An example of a droplet disease is influenza. Precautions include wearing a face mask during care and restricting visits from uninfected people. Cover your nails and mouth with a tissue when sneezing or coughing and ask others to do the same. Wash hands immediately. Resident should wear masks when being moved from room to room
3) Contact precautions are used when the resident is at risk of spreading an infection by direct contact with a person or object. It may be spread by blood or body fluids or contaminated items such as linen, equipment, supplies. Precautions include wearing gloves and a gown, resident isolation and hand washing. A sign should be placed on the door indicating isolation or contact precautions alerting people to see the nurse before entering the room
Isolation guidelines
When they are indicated, transmission based precautions are always used in addition to standard precautions
Proper PPE will be designated in the isolated residents care plan. Remove PPE and place it in the appropriate container before exiting the residence room. Wash your hands following the removal of PPE. Wash hands again after exiting the residence room.
Do not share equipment between residents. Use disposable supplies that can be discarded after use whenever possible. Is dedicated (one use) equipment when disposable is not an option. Be careful not to contaminate reusable equipment by setting it on furniture accounters within the residence room.
Where the proper ppe, if indicated, when serving food and drink to residents. Do not leave uneaten food uncovered in the residence room. Remove the meal tray when the mail is completed
Follow standard precautions when dealing with body waste removal. Wear gloves when touching or handling waste. Wear gowns and goggles went indicated. The waste must be disposed of in such a manner as to minimize flashing or spraying
When collecting a specimen from a resident and isolation be sure to wear the proper ppe. Place the specimen in the appropriate container without the outside of the container coming into contact with the specimen. Properly remove your PPE and dispose of it in the room. Wash your hands before leaving the room. Take the specimen to the nurse
Residents need to feel that staff understand what they’re going through. Listen to what residents are saying. Allow time to talk with them about their concerns. Reassure residents. Explain why these steps are being taken. Relay any requests outside your scope of practice to the nurse
Hepatitis
Inflammation of the liver caused by certain viruses and other factors. Liver function can be permanently damaged by hepatitis. The most common types of hepatitis are a b and c. Hepatitis b and c are bloodborne diseases that cause death
The HPV vaccine must be offered by employers. It is usually given as a series of three shots.
Tuberculosis
Is a highly contagious disease caused by a bacterium that is carried on mucus droplets suspended in the air. Bacteria usually affects the lungs.
Residents who are infected will be placed in isolation. The door to this type of room should remain closed except when entering or exiting the room. the door should not be opened or closed quickly.
Nursing assistants should help the resident to remember to take all TB medication prescribed. Failure to do so is a major factor in the spread of TB
MRSA (staphylococcus aureus)
A common type of bacteria that can cause infection. Community associated methicillin resistant staphylococcus aureus (CA-MRSA) is a type of MRSA that often manifests as skin infections such as boils or pimples.
It is almost always spread by direct physical contact with infected people. It can also be spread and directly through contact with equipment or supplies contaminated by a person with MRSA.
Hand washing with warm water is the best line of defense. Contact with other people’s wounds or material that is contaminated from their wounds should be avoided
VRE
Enterococci are bacteria that live in the digestive and genital tracts. They can sometimes cause infection. Vancomycin is a powerful antibiotic used to treat infections caused by enterococci. If the enterococci becomes resistant to the vancomycin then the person has vancomycin resistant enterococcus or VRE.
It is spread through direct and indirect contact.
Proper hand hygiene and PPE as directed help prevent the spread.
Nursing assistance must follow standard precautions along with transmission based precautions as ordered
Items may need to be disinfected. That information should be listed in the care plan
Clostridium difficile
C. diff
C. difficile
A spore forming bacteria which can be part of the normal intestinal Flora. When the normal flora is altered C. difficile can flourish in the intestinal tract and cause infection.
Enemas, nassogastric tube insertion and GI tract surgery increase a person’s risk of developing the infection. It can also cause colitis a more serious intestinal condition.
When released into the environment c. Difficile can form a spore that makes it difficult to kill. These spores can be carried on the hands of people who have direct contact with the infected resident or with environmental surfaces such as floors, bed pans, toilets etc. Touching an object contaminated with c. Difficile can transmit the infection. Alcohol-based hand sanitizer is not considered effective. Soap and water must be used each time hand hygiene is performed.
Handling contaminated waste properly can help prevent its spread.
Cleaning services with the proper disinfectant such as a bleach solution can also reduce transmission
Employer infection prevention responsibilities
Established infection prevention procedures and an exposure control plan to protect workers
Provide continuing in service education on infection prevention, including bloodborne and airborne pathogens
Have written procedures to follow shouldn’t exposure occur, including medical treatment and plans to prevent similar exposures
Provide PPE for employees to use and teach them when and how to properly use it
Provide free hepatitis b vaccinations
Employees responsibilities for infection prevention
Father standard precautions
Follow-up facility policies and procedures
Follow care plans and assignments
Use provided PPE as indicated or as appropriate
Take advantage of the free hepatitis b vaccination
Immediately report any exposure to infection, blood or body
Participate in annual education programs covering the prevention of infection
