Chapters 21, 22, And 23

Question 1

Abduction

Answer 1

Moving a body part away from the midline of the body

Question 2

Assistive devices

Answer 2

Equipment that helps residents perform their activities of daily living (ADLs)

Question 3

Contracture

Answer 3

The permanent and painful stiffening of a muscle

Question 4

Deep breathing exercises

Answer 4

Exercises that help expand lungs, clearing them of mucus and preventing infection

Question 5

Extension

Answer 5

Straightening a body part

Question 6

Flexion

Answer 6

Bending a body part

Question 7

Palliative care

Answer 7

Pain relief and comfort

Question 8

Passive range of motion exercises (PROM)

Answer 8

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.

Question 9

Prothesis

Answer 9

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.

Question 10

Pulse oximeter

Answer 10

A noninvasive device that uses a light to determine the amount of oxygen in the blood. Normal blood oxygen is 95-100%

Question 11

Rehabilitation

Answer 11

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

Question 12

Restorative care

Answer 12

Care that usually follows rehabilitation. The goal is to keep the resident at the level achieved by rehabilitation services.

Question 13

Safety devices

Answer 13

Devices that help prevent accidents. Examples include shower chairs, gait or transfer belts, and safety bars/grab bars

Question 14

Supportive devices

Answer 14

Devices that are used to assist residents with ambulation. Examples include canes, walkers, and crutches.

Question 15

AAROM

Answer 15

Active assisted range of motion exercises

Question 16

Know the facts about restorative care

Answer 16

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.

Question 17

Know the areas that should be observed and reported to the nurse about restorative care

Answer 17

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.

Question 18

Know the facts about regular ambulation and exercise

Answer 18

Improvement in quality and health of the skin; circulation; strength; sleep and relaxation; mood; self-esteem; appetite; elimination; blood flow; and oxygen level.

Question 19

Know the facts about new ambulatory aids

Answer 19

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

Question 20

Know the facts about range of motion exercises

Answer 20

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.

Question 21

Know the facts about care for an artificial eye

Answer 21

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.

Question 22

Know the three categories of surgeries

Answer 22

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.

Question 23

Know the categories of anesthesia

Answer 23

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

Question 24

What tasks are performed both preoperatively and postoperatively?

Answer 24

Measuring and recording vital signs

Question 25

Know the guidelines about telemetry

Answer 25

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

Question 26

Know the guidelines for artificial airways

Answer 26

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.

Question 27

Know the guidelines for mechanical ventilation

Answer 27

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.

Question 28

Know the signs of respiratory distress

Answer 28

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.

Question 29

Know the guidelines about chest tubes

Answer 29

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.

Question 30

Know the five stages of grief

Answer 30

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.

Question 31

Know the grief process

Answer 31

Shock, denial, anger, guilt, regret, sadness, and loneliness.

Question 32

Know the facts about “The Dying Person’s Bill of Rights.”

Answer 32

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.

Question 33

Know the signs of approaching death

Answer 33

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.

Question 34

Know the guidelines for how to treat residents and their families with dignity

Answer 34

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. 

Question 35

Know the guidelines for caring for a resident’s diminished senses.

Answer 35

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.

Question 36

Know the guidelines for postmortem care

Answer 36

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.