Chapters 21, 22, And 23 Flashcards
Abduction
Moving a body part away from the midline of the body
Assistive devices
Equipment that helps residents perform their activities of daily living (ADLs)
Contracture
The permanent and painful stiffening of a muscle
Deep breathing exercises
Exercises that help expand lungs, clearing them of mucus and preventing infection
Extension
Straightening a body part
Flexion
Bending a body part
Palliative care
Pain relief and comfort
Passive range of motion exercises (PROM)
Exercises used when residents cannot move on their own; a staff member performs these exercises without the residents help. When helping with PROM exercises, support the resident’s joint and move them through the range of motion.
Prothesis
A device that replaces a body part that is missing or deformed because of an accident, injury, illness, or birth defect. Examples: artificial limbs, such as for the hands, arms, feet, and legs; artificial breasts; hearing aids; eyeglasses; artificial eye, or ocular prosthetic, replaces an eye that has been lost to disease or injury; and dentures.
Pulse oximeter
A noninvasive device that uses a light to determine the amount of oxygen in the blood. Normal blood oxygen is 95-100%
Rehabilitation
Care that is managed by professionals to help to restore a person to the highest level of functioning. Doctors and nurses establish goals of care
Restorative care
Care that usually follows rehabilitation. The goal is to keep the resident at the level achieved by rehabilitation services.
Safety devices
Devices that help prevent accidents. Examples include shower chairs, gait or transfer belts, and safety bars/grab bars
Supportive devices
Devices that are used to assist residents with ambulation. Examples include canes, walkers, and crutches.
AAROM
Active assisted range of motion exercises
Know the facts about restorative care
1) Be patient, progress may be slow and will seem slower to you and your residents if you are impatient.
2) Your resident must do as much as possible for themselves. Be positive and supportive. A positive attitude can set the tone for success.
3) Getting dressed may seem overwhelming to some residents. Break down the task into smaller steps. Today’s goal may be putting on a shirt without buttoning it. Next. Well the goal may be buttoning the shirt if it feel manageable.
4) When the resident can put the shirt on without help, congratulate him/her. Recognize that setbacks occur. Reassure residents that setbacks are normal. Be sensitive to the residents needs, and encourage independence. Involve the residents in their own care.
Know the areas that should be observed and reported to the nurse about restorative care
Any increase or decrease in abilities. Any change in attitude or motivation, positive or negative. Any change in general health, such as changes in skin condition, appetite, energy level, or general appearance. Signs of depression or mood changes.
Know the facts about regular ambulation and exercise
Improvement in quality and health of the skin; circulation; strength; sleep and relaxation; mood; self-esteem; appetite; elimination; blood flow; and oxygen level.
Know the facts about new ambulatory aids
Stay close to the resident to make sure that they are using these appliances safely. Observe for signs of dizziness. To avoid falls, clear walkways, and wipe up spills immediately
Know the facts about range of motion exercises
Begin at the head and work down the body. Stop the exercises if the resident complains of pain. Report pain to the nurse. You will not do ROM exercises without an order from a doctor, nurse, or physical therapist. You will repeat each exercise three to five times, once or twice a day.
Know the facts about care for an artificial eye
Artificial eyes are held on by suction. They will come out quickly when pressure is applied below the lower eyelid. Wash the eye with solution and rinse with warm water. NEVER clean or soak the eye in alcohol. It will crack the plastic and destroy it. Moisten the artificial eye and place it far under the upper eyelid. Pull down on lower eyelid and the eye should slide into place.
Know the three categories of surgeries
Elective surgery = surgery that is chosen by the patient is planned in advance. Examples are plastic surgery.
Urgent surgery = surgery that must be performed for health reasons, but it’s not emergency. An example is a coronary artery bypass (CABG)
Emergency surgery = Surgery that is unexpected and on the schedule which is performed immediately to save a patient’s life or limb. Examples are gunshot wound, ruptured appendix, car accident.
Know the categories of anesthesia
Local anesthesia = involves injection of an anesthetic directly into the surgical site or area to block pain.
Regional anesthesia = Involves injection of an anesthetic into a nerve or group of nerves to block sensation in a particular region of the body.
General anesthesia = anesthesia that is inhaled or injected directly into a vein and affects the brain and the entire body
What tasks are performed both preoperatively and postoperatively?
Measuring and recording vital signs
Know the guidelines about telemetry
Report to the nurse if the pads become wet or soiled. Report if pads appear loose or fall off. Report if the alarm sounds. Check the scanner on the pad often, report any of the following: swelling, sores, redness, or irritation; fluid or blood draining from the skin, broken skin
Know the guidelines for artificial airways
Observe the resident closely if the tubing falls out, tell the nurse immediately. Perform oral care often, as directed. Watch for biting and tugging on tube. If a resident is doing this, tell the nurse. Check vital signs in order. Report changes to the nurse, use other methods of communication if the person cannot speak. Try reading notes, drawing pictures, and using communication boards. Nursing assistants do not perform suctioning or tracheostomy care. Your responsibilities will mostly include observing and reporting.
Know the guidelines for mechanical ventilation
If you notice tubing that is disconnected or loose, report it immediately. Answer call lights promptly, family care plan for a position instructions. Check the scanner on the intubation side often, as well as on the rest. Report any of the following: swelling, sores, redness, irritation; fluid or blood draining from skin; broken skin. Report if the resident is pulling on or biting on the tube. Report if the resident is anxious, fearful or upset be patient during communication. Check on the resident often, so that the resident can see you were there. Be supportive, kind and empathetic.
Know the signs of respiratory distress
Gurgling sound of secretions; difficulty breathing; elevated respiratory rate; pale, bluish, or gray skin around eyes, mouth, fingernails or toenails; nostrils flaring; retracting (chest appears to sink below the neck with each breath); sweating; or wheezing.
Know the guidelines about chest tubes
Be aware of the number and location of chest tubes. Tubes may be in the front, back, or side of the body.
Check vital signs as directed. Report any signs of respiratory distress to the nurse immediately. Keep the drainage system below the level of the resident’s chest. Make sure the drainage containers remain upright and level at all times. Make sure tubing is not kinked. If tubing become kinked, report to the nurse immediately.
Observe chest drainage for color and amount. Report any changes in color or amount immediately. Report if there is an increase or decrease in bubbling in the drainage system. Report if there are any blood clots in the tubing.
Know the five stages of grief
Denial, Anger, Bargaining, Depression and Acceptance. Not all residents go through all the stages. Residents may move back and forth between stages during the process.
Know the grief process
Shock, denial, anger, guilt, regret, sadness, and loneliness.
Know the facts about “The Dying Person’s Bill of Rights.”
I have the right to: Be treated as a living human being until I die; maintain and to be cared for by those who maintain a sense of hopefulness, however changing its focus may be; Participate in decisions concerning my care; not die alone; Be free from pain; have any questions answered honestly; die in peace and dignity; discuss and engage my religious and/or spiritual experiences, whatever these may mean to others.
Know the signs of approaching death
Unfocused eyes; decreased sense of touch; a rising to below-normal body temperature; decreased blood pressure; weak pulse is abnormally slow or rapid; slow, irregular respirations or rapid, shallow respirations called Cheyne-stokes respirations; a rattling or gurgling sound as the person breathes; mottling (bruised appearance) spotting, or blotching of the skin caused by poor circulation.
Know the guidelines for how to treat residents and their families with dignity
Respect their wishes in all possible ways. Do not isolate or ignore resident who is dying. Enter his/her room regularly. Be careful not to make promises that cannot or should not be kept. Be resident-centered. Listen if dying resident wants to talk but do not offer advice. Do not battle or be especially careful or sad. Show privacy when it is desired. Respect the privacy of the family and other visitors. Help with the families physical comfort and avoid using clichés. 
Know the guidelines for caring for a resident’s diminished senses.
Reduce glare and keep room lighting low. Hearing is usually the last sense to leave the body. Speak in a normal tone, tell the resident about any procedures that are being done. Describe what is happening in the room. Do not expect an answer. Ask few questions, encourage family to speak to the resident, but to avoid subjects that are disturbing. Observe body language to anticipate a resident’s needs.
Know the guidelines for postmortem care
Rigor mortis may make the body difficult to move. Talk to the nurse if you need help performing postmortem care. Bathe the body. Be gently to avoid bruising, place drainage pads where needed. Do not remove any tubes or other equipment. Close the eyes carefully, strip the bed after the body has been removed. Straighten up. Respect wishes of family and friends. Be sensitive to their needs.
