Chapter 6

Question 1

Paralysis

Answer 1

the loss of ability to move all or part of the body, which often includes loss of feeling in the affected area.

Question 2

Fracture

Answer 2

a broken bone.

Question 3

Disorientation

Answer 3

Confusion about person, place, or time.

Question 4

Falls:

Answer 4

sudden, uncontrollable descent from a higher to a lower level with or without injury resulting

Question 5

Causes of falls:

Answer 5

-unsafe environment

-loss of abilities

-diseases

-medications

-loss of vision

-gait or balance problems

-weakness

-paralysis

-disorientation

Question 6

Fall Prevention:

Answer 6

*Clear walkways.

*Use rugs or mats with nonslip backing.

*Have residents wear nonskid, sturdy shoes.

*Residents should not wear clothing that is too long.

*Keep frequently-used personal items, including call lights, close.

• Answer call lights promptly.

*Clean up spills.

*Report loose handrails immediately.

*Mark hazardous areas.

*Improve lighting.

*Return beds to lowest positions.

*Lock wheelchairs and remove footrests

*Lock bed wheels

*Get help – 2 person manual transfer

*Offer help with eliminations regularly and respond to requests immediately.

*Leave furniture in same place.

*Pay attention to residents at risk for falls.

*Never try to catch a falling resident – ease to the floor

*Report all falls to the nurse

Question 7

Burns/Scalds (burn caused by hot liquids): Causes:

Answer 7

Causes:

*dry heat (irons, stoves, other electric appliances) – mostly found during home health care

*wet heat (hot water or other liquids, steam) – also known as thermal burns

*Cold or Ice applications – another type of thermal burn

*chemicals (acids)- burns to the skin or eyes

Question 8

Chemical Hazards:

Answer 8

*Caustic chemicals that could splash into the eyes

*Know where to locate the eye wash station!

*Spray disinfectants that could be sprayed into the face

*Disinfectant wipes used on bare skin (such as Cavi-wipes)

*Ingestion of prescription shampoos or other non-food liquids by confused residents

*Ingestion of an oral med found on the floor

Question 9

Prevention (for burns/Scalds):

Answer 9

*Check water temperature.

*Report frayed cords or appliances that look unsafe.

*Communicate about hot liquids.

*Pour hot drinks away from residents.

*Keep hot drinks away from edges of tables. Use lids.

*Make sure residents are sitting before serving hot drinks.

*Monitor heat-producing equipment.

Question 10

Resident Identification

Cause:

Answer 10

not identifying resident properly – wrong treatment or food is given to the wrong resident.

Question 11

Prevention (for identifying resident)

Answer 11

• Identify each resident before care or assisting with meals.
• Check IDs.
• Call resident by name.

Ask staff to correctly identify a confused resident that may be non-verbal

Question 12

Resident Identification:

Answer 12

*LTC residents typically do not wear name bands

*This provides an increased risk of wrong care being given to wrong resident

*Often there are multiple residents with the same first name on a facility wing

*Confused residents that are not orientated to who they are - will answer to any name

Question 13

Remember: #1

Answer 13

Not identifying residents before giving care or serving food can cause serious problems or even death. (a sentinel event)

Medical errors are ranked in the Top 10 causes for death in the U.S.

Question 14

Choking

Causes:

Prevention:

Answer 14

Causes:
*weakened – due to being frail and elderly

*ill

*unconscious residents

*residents with known swallowing problems

*residents with neurological (brain) dysfunction – stroke/ CVA (cerebral vascular accident); Parkinson’s; Alzheimer’s; traumatic brain injury

Prevention:
*Eat sitting upright – at a 90 degree angle

*Follow orders for special diets and thickened liquids

Question 15

Poisoning

Causes:

Prevention:

Answer 15

Causes:
Ingesting harmful substances such as cleaning products, paints, medicines, toiletries, or glues, shampoos, soaps.

Prevention:
*Lock these products away from confused residents or those with limited vision.

*Do not leave cleaning products in rooms.

*Investigate any unusual odors.

*Post Poison Control Center number.

Question 16

Cuts/Abrasions:

Causes:

Prevention:

Answer 16

Def: an injury that rubs off the surface of the skin.

*sharp objects – metal levers that stick out from wheelchairs

*sharp fingernails or rings worn by caregivers

*friction across the skin when residents are moved up in a bed /wheelchair or repositioned from side to side in the bed

*Poor technique when trimming nails of residents

*Handrails with rough surfaces

Prevention:
*Put sharp objects away after use.

*Take care when transferring or repositioning residents

*Push wheelchairs forward.

Question 17

General safety guidelines:

Answer 17

*Do not run. — unless it is an emergency!

*Keep paths clear.

*Wipe up spills immediately.

*Discard trash properly.

*Follow instructions and ask questions as needed.

*Report injuries immediately.

*If you see a suspected hazard among a resident’s possessions, report it to the nurse.

Question 18

Oxygen therapy:

Answer 18

*the administration of oxygen to increase the supply of oxygen to a person’s lungs

*is a medical order just like medications

*licensed nurses are responsible for starting O2 therapy and documenting the use of it every shift in the med record

Question 19

Combustion:

Answer 19

the process of burning (oxygen supports combustion)

Question 20

Flammable =

Answer 20

easily ignited and capable of burning quickly

Question 21

The following are important guidelines for oxygen safety:

Answer 21

*Post No Smoking and Oxygen in Use signs. Do not allow smoking around oxygen equipment.

*Remove fire hazards. Report to nurse if resident does not want a fire hazard removed.

*Do not allow open flames around oxygen (this includes burning candles, lighting matches, and using lighters).

*Do not use an extension cord with an oxygen concentrator.

*Do not place electrical cords or oxygen tubing under rugs or furniture.

*Avoid using fabrics such as nylon and wool – static electricity

*Report skin irritation from cannula or face mask – cheeks, nose, ears

*Do not use any petroleum-based products on resident or on any part of the cannula or mask – potential for combustion

• lip balm products cannot be petroleum based

*Learn how to turn oxygen off in case of fire if facility allows this. Never adjust oxygen setting.

Question 22

Oxygen Safety:

NA’s do not:

NA’s are responsible for:

Answer 22

Do not:
*start oxygen

*stop oxygen - unless briefly during a resident transfer, if indicated

*adjust the flow rate

Responsible for:
*Knowing how the equipment works – reporting problems

*Knowing how to transfer residents between portable tanks to wall mounted room oxygen or oxygen concentrators

*Switching the on/off button back on after a transfer

Question 23

The Safety Data Sheet (SDS)

Answer 23

*Is required by OSHA for all hazardous chemicals

*Details ingredients, dangers, safe handling, storage, disposal, and emergency response procedures

*Some facilities may use a toll-free number to access SDS information

*Must be accessible in work areas for all employees

*Generally found in a binder at the nurses station

Question 24

Restraint:

Answer 24

a physical or chemical way to restrict voluntary movement or behavior.

Question 25

Physical Methods of restraint:

Answer 25

devices that restrict freedom of movement

-vests, belts, wrist or ankle devices, mitts, chairs

Question 26

Chemical Methods of restraint:

Answer 26

medication that calms a person or adjusts their mood or behavior

Question 27

Restraints were often heavily used in the past for the following reasons:

Answer 27

*Prevent the person from wandering

*Prevent falls

*Keep person from hurting self or others

*Keep person from pulling out tubing

Question 28

NAs must know this about restraints:

Answer 28

*they were often overused by caregivers, and residents were injured.

*LTC facilities are now prohibited from using restraints unless they are medically necessary and as a last resort

*It is against the law for staff to apply restraints for convenience or discipline.

Question 29

Enabler:

Answer 29

*equipment that is used to promote safety, comfort, independence and mobility

*Wheelchairs, Geri–chairs with a table

*Cushions, body pillows, special utensils

*Self- releasing wheelchair belts

Question 30

How does one know if equipment is a restraint versus an enabler?

Answer 30

If a resident cannot remove an enabler independently = then it is a RESTRAINT

Examples: bed side rails left elevated

Geri- chairs with tables that the resident cannot remove

Question 31

Problems Associated with Restraint Use:

Answer 31

Lack of regular movement can cause these physical and emotional complications to many body systems:

*Pressure ulcers = injury to the skin/underlying structures due to unrelieved pressure (Chapter 13)

*Pneumonia = fluid accumulation in the lungs

*Risk of suffocation = stoppage of breathing (strangulation from vest restraints)

*Reduced blood circulation = lack of movement causes decreased blood flow to the lower extremities

*Stress on the heart

*Incontinence = not being toileted often enough, skin breakdown from sitting in a wet environment

*Constipation = not enough mobility so the GI tract is not stimulated

*Muscle atrophy = (weakening or wasting away of the muscle) from lack of regular exercise, they become weaker

*Loss of bone mass = lack of exercise leads to loss of bone density - weaker bones

*Poor appetite and malnutrition = loss of weight

*Depression and/or withdrawal

*Sleep disorders

*Loss of dignity

*Loss of independence

*Stress and anxiety

*Increased agitation (anxiety, restlessness)

*Loss of self-esteem

*Severe injury = people try to remove physical restraints and or they try to get out of bed with side rails and get stuck between the bed and rails

*Death

Question 32

Remember #2:

Answer 32

Remember:

If restraints are ordered the care plan will include instructions on frequent monitoring and repositioning. An NA must never use restraints unless his supervisor has instructed him to do so and he has been trained in the proper use of the restraint.

Question 33

restraint-free care

Answer 33

an environment in which restraints are not kept or used for any reason.

Question 34

restraint alternatives

Answer 34

measures used in place of a restraint or that reduce the need for a restraint.

Question 35

Restraint Alternatives:

Answer 35

*Improve safety measures and lighting.

*Keep call light within reach and answer call lights immediately.

*Ambulate the person when he or she is restless.

*Provide activities for those who wander at night.

*Encourage activities and independence.

*Give frequent help with toileting.

*Offer food or drink. Offer reading materials.

*Distract or redirect interest.

*Decrease the noise level. Use relaxation techniques.

*Reduce pain levels through medication. Report complaints of pain immediately.

*Provide familiar caregivers and increase number of caregivers.

*Use a team approach.

*Use special types of pads, belts, chairs, and alarms.

Question 36

Remember #3:

Answer 36

Restraint alternatives need to be indicated in the care plan.

The focus should be on individualizing alternatives for each resident.

Question 37

NAs must remember these guidelines regarding restraints:

Answer 37

*Make sure there is a doctor’s order for restraint use and that it is in the care plan.

*Make sure you have been trained on how to apply the restraint.

*Follow manufacturer’s instructions.

*Make sure restraint is not too tight. You should be able to place your hand in a flat position between the resident and the restraint.

*Be sure not to catch breasts or skin in restraint.

*Place call light within reach. Answer call lights immediately.

*Document properly.

Question 38

When a Resident is Restrained:

Answer 38

*The resident must be checked at least every 15 minutes. Also, at regular, ordered intervals, at a minimum of every 2 hours the following must be done:

*Release the restraint or discontinue use

*Offer help with elimination. Check for episodes of incontinence and provide care.

*Offer fluids and food.

*Check for and report signs of skin irritation immediately.

*Check for and report signs of swelling immediately.

*Reposition the resident.

*Ambulate resident if able.

Question 39

Body mechanics

Answer 39

the way the parts of the body work together when a person moves.

Question 40

Posture

Answer 40

the way a person holds and positions his body.

Question 41

Lever

Answer 41

something that moves an object by resting on a base of support.

Question 42

NAs should remember the following points about alignment:

Answer 42

*Try to keep the body in alignment, with two sides of the body as mirror images of each other.

*Keep object close when carrying or lifting.

*Point feet and body toward the direction you are moving.

*Avoid twisting at waist.

Question 43

NAs should remember the following points about their base of support:

Answer 43

*Wide base is more stable.

*Stand with legs shoulder-width apart (12 inches).

Question 44

NAs should remember the following points about the principle of fulcrum and lever:

Answer 44

*Arm is lever.

*Elbow is fulcrum.

*Rest object against forearm, shortening the lever and making object easier to lift.

Question 45

NAs should remember the following points about their center of gravity:

Answer 45

*When standing, weight is centered in pelvis.

*Low center provides greater base of support.

*Bend knees when lifting, lowering center.

Question 46

Remember #4:

Answer 46

Principles of body mechanics can be applied to daily activities to reduce the risk of injury and to save energy.

Question 47

The following steps demonstrate applying the principles of body mechanics to lifting a heavy object from the floor:

Answer 47

*Spread feet apart.

*Bend knees.

*Use muscles in thighs, upper arms, and shoulders.

*Pull object close to body.

*When standing up, push with hip and thigh muscles.

Question 48

The following techniques will help an NA use proper body mechanics:

Answer 48

*Assess the situation first. Clear the path and remove obstacles.

*Use both arms and hands to lift, push, or carry objects.

*When lifting a heavy object from the floor, spread your feet shoulder-width apart. Bend your knees. Raise your body and the object together.

*Hold objects close to you when you are lifting or carrying them.

*Push or slide objects, rather than lifting them.

*Avoid bending and reaching as much as possible.

*If you are making an adjustable bed, adjust the height to a safe working level, usually waist high.

*When a task requires bending, use a good stance. Bend your knees to lower yourself (squat), rather than bending from the waist.

*Do not twist when lifting or moving an object. Instead, turn your whole body, pivoting with your feet instead of twisting at the waist. Your feet should point toward what you are lifting or moving.

*Get help from coworkers when possible for lifting or helping residents.

*Talk to residents before moving them.

*Agree on a signal. Lift or move on three so that everyone moves together.

*To help a resident sit up, stand up, or walk, place your feet shoulder-width apart. Stand toe to toe with your feet aligning with the resident’s feet, then bend your knees. Your upper body should stay upright and in alignment.

*Never try to catch a falling resident. If the resident begins to fall, assist her to the floor.

*Report to the nurse any task you feel that you cannot safely do.

Question 49

NAs should remember these guidelines for fire safety:

Answer 49

*Never leave smokers unattended. Make sure ashtrays do not contain hot ashes before emptying them.

*E-cigarettes should only be charged using the appliance supplied by the manufacturer.

*Report frayed or damaged cords.

*Report if fire alarms and exit doors are blocked.

*Know how to use fire extinguishers:

*Pull the pin.

*Aim at the base of fire when spraying.

*Squeeze the handle.

*Sweep back and forth at the base of fire.

*In case of fire, use RACE:

*Remove anyone from danger if you are not in danger.

*Activate alarm or call 911.

*Contain fire if possible, by closing doors and windows.

*Extinguish, or fire department will extinguish.

*Know evacuation plan.

*Stay calm and do not panic.

*Follow directions of fire department.

*Know which residents need one-on-one help.

*Know differing abilities of residents.

*Remove blockage from windows or doors.

*Do not get into elevators.

*Stay low in a room to escape a fire.

*Check for heat coming from doors before opening.

*Stop, drop, and roll if clothing catches fire.

*Use damp covering over mouth and nose.

*Leave building if possible, then move away from it.