Exam 2 Study Guide Flashcards
Abuse
willful infliction of injury, unreasonable confinement, intimidation or punishment with resulting physical harm, pain, or mental anguish
There is both Physical and Psychological (Emotional) Abuse.
Assault
act of threatening to touch, or attempting to touch a person, without proper consent
Basic Human Rights
TEST QUESTION
protected by the Constitution of the United States; a person has the right to be treated with respect, live in dignity, pursue a meaningful life and be free of fear
Battery
touching a person without consent
Civil Law
law that deals with relationships between people
Code of Ethics
o Rules of conduct for particular group
o May differ from one facility to another, but revolves around idea that resident is valuable person who deserves ethical care
o Helps employees deal with issues of right and wrong
Confidentiality
not disclosing or telling information that is personal or private about a resident, except to authorized people
Define Consent, the types of Consent and give examples for each.
– the right to decide what will be done to the body and who can touch the body
• written consent – signs a form (nurse aide does not obtain this)
• verbal consent – a verbal “yes” or “ok” (nurse aide can obtain this)
• implied consent – resident extends arm after nurse aide asks to check blood pressure (nurse aide can obtain this)
Criminal Law
offenses against the public and society
Defamation and the types
False statement made to a third person that causes a person shame or ridicule, or ruins their reputation
- Written is called Libel
- Verbal is called Slander
Disclosure
making known to the public
Diversion of Drugs
unauthorized taking or use of any drug
Exploitation
taking advantage of a resident for personal gain using manipulation, intimidation, threats, or coercion.
(A type of Psychological/Emotional Abuse)
Signs and Symptoms
• Inconsistent with longstanding values/beliefs
• Wills, living wills, trusts, income flow altered with new caretaker or friend as beneficiary/executor
• Begins using new bankers, physician, attorneys
• Increasingly helpless, frightened, despondent, feeling only caretaker or friend can prevent further decline
• Resident does not see true nature of the caretaker or friend
Examples
• New friend or caretaker appears to have restrictive control and dominance over resident
• Visitors are denied access to resident
• New friend or caretakers makes all decisions for resident
• Resident mistrusts family members and long-time friends
Are you allowed to trim nails with clippers?
NO!
What could a blister on the feet mean?
Could be a pressure ulcer indicating Diabetes.
False Imprisonment
TEST QUESTION
unlawful restraining or restricting a person’s movement
Fraud
an intentional deception or misrepresentation made by a person with knowledge that deception could result in some unauthorized benefit to self or some other person
Invasion of Privacy
violation of right to control personal information or the right to be left alone
Laws
rules made by government to help protect public
Malpractice
giving care for which you are not allowed legally to perform
Misappropriation of Property
– illegal or improper use of resident’s money, property, assets; by another, without consent, for personal gain
- deliberate misplacement, exploitation, or wrongful, temporary, or permanent use of a resident’s belongings or money without the resident’s consent
• Signs and Symptoms
o The sudden appearance of a staff member’s name on a bank signature card
o The discovery of a forged version of the resident’s name
o The sudden and unauthorized withdrawal of money using an ATM card or other means
o Unexplained disappearance of the resident’s personal property or money from the resident’s room
o Resident’s report of missing personal property, assets, or money
• Examples
o Cashing a resident’s checks without permission
o Forging a resident’s name on documents
o Misusing or stealing a resident’s money or personal property
Neglect
TEST QUESTION
a failure to provide goods and services to a resident that are necessary to avoid physical harm, pain, mental anguish, or emotional distress
Negligence
actions or failure to act or give proper care, resulting in injury
Nondisclosure
not making known to the public
Privacy
the personal responsibility and activities done to prevent the intrusion of one person onto another
o Example – pulling suspended curtains completely around a resident’s bed during care provides physical barrier from others
o Example – lowering one’s voice when talking in the hall about a resident’s condition
Resident’s Rights
rights that have been written into Federal law (OBRA) that identify how a resident must be treated while living in a long-term care facility
Sexual abuse
non-consensual sexual contact of any type with a resident
Vulnerable Adults
adults who are at risk for abuse or mistreatment because they are not able to protect selves from harm due to mental, emotional, developmental disability; or brain damage; or changes from aging
Mistreatment of Vulnerable Adult – Points to Remember
• Abuse is cause for immediate dismissal of the perpetrator and posted on Nurse Aide Registry, if substantiated
• Not reporting abuse is aiding and abetting
Gait
a manner of walking or moving on foot
Incident
any event that has harmed or could harm a resident, visitor, or staff member
Incident Report
documentation of facts surrounding any unexpected event in healthcare setting; also called an occurrence report, accident report or event report.
- Required by the facility based upon State and Federal guidelines
- Completed by individuals involved at the scene, those on duty at the time, and those who observed incident
- Based on factual, objective account of what occurred
- Are confidential and intended for use between the facility and facility legal team
- Detailed accurate account of who was involved, what, when and where the incident occurred, what immediate actions and additional steps were taken to prevent recurrence
Punitive
inflicting, involving, or aiming at punishment
Critical Thinking
“Critical thinking is important because it is what makes us adaptable, enables us to act independently, and allows us to move beyond what we already know or guess.”
- Exercising or involving careful judgment based on facts and observations
- Required to provide safe, competent care to residents in a variety of situations
- Developed through real-life experiences, education, communication, observation and practical application
- Incorporated into thought processes and daily activities
Benign tumor
(non-cancerous) – do not spread to other body parts; may grow large, but nonlife-threatening; do not grow back when removed
Cell Theory
- Basic unit of all living tissues or organisms
- All living organisms made of cells
- Cellular function is essential process of living things
- Cells have several functioning structures called organelles, that carry on work of cell
Cells
are building blocks of the human body; when grouped together, cells become tissue
Chemotherapy (or chemo)
a medical treatment that affects the whole body. Kills both caner cells and normal cells. Medications can be given orally or intravenously, which may require a port (implanted device in a vein allowing for medications and/or IV fluids to be given and blood drawn)
• Side effects depend on drugs used
o Hair loss (alopecia)
o Digestive disturbances, such as poor appetite, nausea, vomiting, diarrhea, and loss of appetite
o Stomatitis – inflammation of the mouth
o Decreased blood cell production, resulting in potential for bleeding and infection; weakness and tiredness
o Changes in thinking and memory
o Emotional changes
o Targeting chemotherapy can also raise blood pressure
Connective tissue
tissue that anchors, connects, and supports other tissues; located in every part of the body; bones, tendons, ligaments, and cartilage; blood is a form of connective tissue
Epithelial tissue
tissue that covers internal and external body surfaces; lines nose, mouth, respiratory tract, stomach, and intestines; skin, hair, nails, and glands
Malignant tumor
(cancerous) – invade and destroy nearby tissues; can also spread to other parts of body (metastasis) by breaking off and travelling; may be life-threatening; may grow back when removed
Metastasis
when a cancer spreads to other parts of the body by breaking off and travelling to other parts of the body
Muscle tissue
tissue that stretches and contracts to let body move
Nerve tissue
tissue that receives and carries impulses to the brain
Organ
made of tissue, may be several different types of tissue, that carry on a special function, when grouped together, organs become a system
• Carries on a special function; examples are heart, stomach, bladder
• Some are paired; examples are kidneys, lungs
Organelle
carry on work of cell
Organism
made up of systems functioning together to perform activities of daily living needed for continued life
BODY STRUCTURE of an ORGANISM Cells (the basic unit of body structure), then Tissues, then Organs, then Systems
Radiation
a medical treatment that kills cancer cells using X-ray beams aimed at the tumor, or radioactive material implanted at or near the tumor
• Side effects
o At site – sore, irritated, redness, and blistering
o Head and neck – dry mouth and sore throat
o Tiredness
o Discomfort, nausea, vomiting, diarrhea, and loss of appetite
System
made of groups of several organs functioning together for a specific purpose or purposes; when grouped together, systems become organisms
• Systems of the body include urinary, musculoskeletal, nervous, respiratory, cardiovascular, digestive, integumentary, endocrine, and reproductive
Tissue
cells grouped together to carry out a particular activity or function; when grouped together, tissues become organs
Tumor
growth of abnormal cells which may be benign or malignant
Avoidable pressure injury
one that develops from improper use of the nursing process
Bedfast
confined to bed
Bony Prominences
areas of body where bone is close to the skin, such as elbows, shoulder blades, sacrum
Deep tissue pressure injury
purple or deep red localized area of discolored intact skin or blood-filled blister; usually due to damage of underlying soft tissue from pressure and/or shear
Dermatitis
inflammation of skin
Eczema
red, itchy areas on the surface of skin
Friction
rubbing of one surface against another; skin is dragged across a surface
Integumentary System, what is it’s function and what makes it up?
the skin; the largest organ and system in the body, responsible for providing a natural protective covering of the body
- Protects body from injury and pathogens
- Regulates body temperature
- Eliminates waste through perspiration
- Contains nerve endings for cold, heat, pain, pressure and pleasure
- Stores fat and vitamins
Made up of 3 Layers
- Epidermis: 1st layer of Integumentary System – the outer layer; has living and dead cells; living cells push dead cells up as they divide and dead cells flake off; living cells contain pigment that give the skin its color; does not have blood vessels and only few nerve cells
- Dermis: 2nd layer of Integumentary System – layer of skin under the epidermis; made up of connective tissue; blood vessels, nerves, sweat glands, oil glands, and hair roots located there
- Subcutaneous: 3rd layer of Integumentary System – (fatty) tissue; thick layer of fat and connective tissue
Pressure injury (or pressure ulcer) and the Stages
Pressure injury (or pressure ulcer) – any lesion caused by unrelieved pressure that results in damage to underlying tissues
Stage 1 – intact skin; redness over bony prominence
Stage 2 – skin loss (partial-thickness); may see a blister or shallow reddish-pink ulcer; the blister may be intact or open
Stage 3 – skin loss (full-thickness); skin gone; may see subcutaneous fat; slough (dead soft tissue, often moist and varies in color – white, yellow, green, or tan) may be present; could be attached or stringy loose
Stage 4 – full-thickness skin and tissue loss with muscle, tendon, and bone exposure; slough and eschar (thick, leathery dead tissue that may be loose or attached to skin); often black or brown
Shear
when layers of skin rub up against each other; or it could be when skin remains in place, but tissues underneath move and stretch causing damage to capillaries and blood vessels
Shingles (or Herpes Zoster)
a disease caused by a virus, most common in people over 50, with signs that include a rash or blisters on one side of the body, burning pain, numbness, and itching
*Infectious until lesions are crusty
SIGNS – rash or blisters on one side of body, burning pain, numbness, and itching; lasts about 3 to 5 weeks; Centers for Disease Control (CDC) states that the following should avoid contact with infected resident: never had chicken pox or immunization, have a weakened immune system, is pregnant never had chicken pox or immunization
Stasis Dermatitis
- Skin condition affecting lower legs and ankles
- Occurs from buildup of fluid under skin
- Problems with circulation resulting in fragile skin
- Can lead to open ulcers and wounds
EARLY SIGNS – scaly, red, itchy areas; later signs – swelling of legs, ankles, or other areas; thin skin; darkening skin, leg pain
The 30 degree lateral position
position of a resident when the bed is not raised more than 30 degree and pillows are placed under the head, shoulder, and leg to lift up the hip at about a 30 degree angle to avoid pressure on the hip
Unavoidable pressure injury
a pressure injury occurs despite efforts to prevent one through proper use of the nursing process
Unstageable pressure injury
full-thickness tissue loss with injury covered by slough and/or eschar
Abduction
moving a body part away from the midline
Adduction
moving a body part toward the midline
Amputation
removal of all or part of a limb because of a disease or an accident
Arthritis and the types
Inflammation or swelling of the joints causing stiffness, pain, and decreased mobility
o Osteoarthritis (degenerative joint disease); affects the elderly and may occur with aging or joint injury; usually weight-bearing hips and knees involved, but may also include fingers, thumbs, and spine; pain and stiffness typically increase with damp, cold weather
o Rheumatoid arthritis – affects any age; starting with smaller joints then progressing to larger ones; joints become red, swollen, and very painful, fever, tiredness, and weight loss occur; severe and painful deformities can result with eventual movement restricted; considered an autoimmune disease when normal tissue is attacked by the immune system
Bone Marrow
soft and spongy tissue located in the inside part of the bone
Bones
hard and rigid structures that make up the skeleton and together form the framework of the body
Cardiac Muscle
striated, involuntary muscle of the heart
Cartilage
connective tissue that cushions bones at the joints and keeps them from rubbing together
Closed fracture
a broken bone that does not break the skin
Contracture
permanent shortening of muscle resulting in immovable joints
Dorsiflexion
bending the toes and foot upward at the ankle
Extension
straightening a body part
External Rotation
turning the joint outward
Flexion
bending a body part
Fracture
break in the bone caused by an accident or osteoporosis
Hip Fracture
a serious condition involving a break in the hip bone due to an accidental fall or a fall from weakened bones
Internal Rotation
turning the joint inward
Involuntary muscle
a muscle that works automatically and cannot be controlled
Joints and the types
the point where bones meet, made up of connective tissue called cartilage that cushions bones and keeps them from rubbing together during movement
- Ball-and-socket – allows movement in all directions; made up of rounded end of one bone fitted into the hollow end of another bone; examples – hips and shoulders
- Hinge – allows movement in one direction; example – elbow and knee
- Pivot – allows turning from side to side; example – skull connected to spine
Ligaments
connect bone to bone
Muscle atrophy
the wasting away of a muscle due to disuse, causing a decrease in size and increase in weakness of the muscle
Muscle Strain
damage of the muscle caused by trauma
Muscles
structure of the body that powers movement of skeleton and helps body stay erect
Musculoskeletal System
system of the body that provides structure and movement for the body
Open fracture (or compound fracture)
a broken bone that breaks through the skin
Opposition
touching the thumb to a finger of the same hand
Osteoporosis
loss of bone density causing bones to become porous and brittle, resulting in bones breaking easily
- CAUSE – lack of calcium in diet, lack of regular exercise, decrease in mobility, decrease in female hormones
- SIGNS – low back pain, stooped posture, becoming shorter, and broken bones
Phantom pain
pain experienced in the area that a body part has been amputated possibly due to damaged nerve endings
Phantom sensation
the feeling that an amputated body part is still there
Plantar Flexion
bending the foot downward at the ankle
Pronation
turning downward
Prosthesis
TEST QUESTION
device that replaces body part that is missing or deformed, specifically fitted to one person
- IS A RESTORATIVE DEVICE
Examples:
implanted lens, cochlear implant, hip prosthesis, artificial body part such as a leg or hand
Skeletal muscle
striated voluntary muscles attached to the bones that powers movement of the skeleton
Smooth Muscle
involuntary muscle of the inner linings of organs, such as the stomach, intestines, blood vessels, and others
Sprain
stretched or torn ligaments or tendons
Supination
turning upward
Synovial membrane
lining of the joints that secretes synovial fluid that acts as lubricant allowing joints to move smoothly
Tendons
connect muscle to bone
Total Knee Replacement (or TKR)
surgical replacement of the knee with a prosthesis performed to relieve pain and restore mobility, damaged by arthritis or injury
Voluntary muscle
a muscle that can be controlled
Brain
located in the skull and consists of three parts – cerebrum, cerebellum, and the brainstem
Brainstem
part of the brain that controls breathing, opening and closing of blood vessels, heart rate, swallowing, gagging, and coughing
Cerebral cortex
outer layer of the cerebrum where ideas, thinking, analysis, judgment, emotions, and memory occurs; also guides speech, interprets messages from senses, and controls voluntary muscle movement
Cerebrovascular accident (CVA or stroke)
damage to part of the brain due to blood clot or hemorrhage cutting blood supply off
Caused when (1) a blood vessel leaks or breaks in the brain; or (2) when oxygen to an area is disrupted, brain cells die
Cerebellum
part of the brain located just below the cerebrum that controls balance and regulates movement
Cerebrum
center of the brain where thought and intelligence occur and is divided into 2 hemispheres and each has 4 lobes
HEMISPHERES
o Right hemisphere controls movement and function of left side
o Left hemisphere controls movement and function of right side
*Any illness or injury to right hemisphere affects function of left side; any illness or injury to left hemisphere affects function of right side
LOBES
o Frontal lobe is important for cognitive functions and control of voluntary movement or activity
o Parietal lobe processes information about temperature, taste, touch and movement
o Occipital lobe is primarily responsible for vision
o Temporal lobe processes memories, integrating them with sensations of taste, sound, sight and touch
Cognitive impairment
poor judgment, memory loss, inability to solve problems, confusion
Dysphagia
difficulty swallowing
Emotional Lability
aka Pseudobulbar Affect (PBA)
inappropriate or uncalled for laughing, crying, or expressions of anger
Expressive Aphasia
trouble communicating thoughts by speech or writing
Head and spinal cord injuries
injuries resulting from diving accidents, sports injuries, motor vehicle accidents, and war injuries, resulting in mild concussion to coma, paralysis, and death
Hemiparesis
weakness on one side of body
Hemiplegia
paralysis on one side of body
Nerves
structures that are made up of nerve cells or neurons that carry messages to and from the brain and to and from the rest of the body
Nervous System
the control and message center of the body; coordinate all body functions
Consists of two main divisions
o Central nervous system (CNS) – brain and spinal cord
o Peripheral nervous system – includes nerves that travel throughout the body
Neurons
nerve cells and basic unit of the nervous system
Carry messages or impulses through spinal cord to and from the brain
o Fragile and take long time to heal if injured;
o Some are covered and insulated with a protective fiber, called the myelin sheath; also allows for speed of conduction of impulses
Paraplegia
complete loss of function occurs to the lower body
Paresis
loss of use of muscle function affecting only part of body
Parkinson’s Disease
progressive, incurable disease that causes a part of the brain to degenerate, resulting in stiffening muscles, shuffling gait, bent posture, pin-rolling with finger and thumb, tremors, and shaking; mask-like facial expression may develop
Quadriplegia
complete loss of function occurs to lower and upper body, plus trunk
Receptive aphasia
difficulty understanding spoken or written words
Sensory Organs
receive impulses from environment and relay impulses to brain including skin, tongue, nose, eyes, and ears
Spinal Cord
located within the spine, connected to the brain and conducts messages between the brain and the body by pathways
Cardiovascular System Angina Pectoris (aka Angina)
chest pain occurring when the heart muscle is not getting enough oxygen due to narrowed blood vessels, brought about by exercise, stress, excitement, or digesting a big meal
Arteries
blood vessels that carry blood with oxygen and nutrients away from the heart and to the cells
Atherosclerosis
arteries harden due to plaque build-up from fatty deposits; what lay people refer to as “hardening of the arteries”
Cardiovascular System
also called the circulatory system and is the continuous movement of blood though the body
Congestive Heart Failure (CHF)
when one or both sides of the heart stop pumping effectively
Left side damage causes blood to back up into lungs; right side damage causes blood to back up into legs, feet, or abdomen
Coronary Artery Disease (CAD)
a condition in which blood vessels in the coronary arteries narrow, lowering blood supply to the heart and depriving it of oxygen
Myocardial Infarction (MI or heart attack)
a condition where the heart muscle does not receive enough blood and lacks oxygen, causing damage or death to that area of the heart
Peripheral Vascular Disease (PVD)
poor circulation of legs, feet, arms, hands due to fatty deposits that harden in blood vessels
Varicose Veins
enlarged, twisted veins usually in the legs
Veins
blood vessels that carry blood with waste products away from the cells and to the heart
Asthma
chronic inflammatory disease occurring when the respiratory system reacts quickly and strongly to irritants, such as pollen and dust, characterized by difficulty breathing, wheezing, and a sense of tightness or constriction in the chest due to spasm of the muscles
Dignity
TEST QUESTION
quality or state of being worthy of esteem or self-respect
*An important component in OBRA’s Residents’ Rights
Empathy
TEST QUESTION
identifying with and understanding the feelings of another without feeling sorry for the person
Assistive (Adaptive) Devices
Special equipment that helps a disabled or ill resident perform Activities of Daily Living (ADLs)
Examples:
o for Positioning
• regular pillows, cylindrical pillows, and/or wedge-shaped foam pillows
• Bed cradles – keep bed covers off legs and feet
• Footboards – help prevent foot drop
• Heel protectors – help with foot alignment
o for Eating
• Angled utensils – for limited arm or wrist movement
• Sipper cup
• Large grip handled utensils
• Plate with lip around the edge – keeps food on plate
• Snap on food guard – keeps food on plate
o for Dressing • Shirt and jacket pull • Zipper pull • Button fastener • Socks and stocking aid • Long-handled shoe horn
o for Hygiene • Electric toothbrush • Denture care kit • Fingernail brush • Extra-long sponge
o for Reaching
Amputation
surgical removal of a body part
Basic Restorative Care
care provided after resident’s highest possible functioning is restored (rehabilitation) following illness or injury
Importance
• Goals are to maintain function that has been restored through rehabilitation and to increase independence
• Emphasis on maintaining and/or improving existing abilities
• Important to prevent any further complications
• Aimed at moving individual toward independence as much as possible and to encourage residents do as much as they can, as long as they can, as often as they can
• Team effort to assist resident to develop a productive lifestyle
• Important to assist individual to accept
Bladder/Bowel Training
measures taken to restore function of voiding and defecating by resident, with ultimate goal of continence
Defecation
process of emptying the rectum of feces
Functional Loss
partial or complete loss of the function of a body part
Orthotic Device
device that helps support and align a limb and improve its functioning
Examples:
splints, braces, and shoe inserts
Incontinence
the inability to control urination or defecation
Prosthetic Device
artificial replacement device for body part that is missing or deformed; improves person’s function and/or appearance
Rehabilitation
restoration of a resident’s highest possible functioning following illness or injury
Supportive Device
special equipment that helps a disabled or ill resident with movement
Examples:
canes, walkers, crutches, wheelchairs, and motorized chairs
Urination
process of emptying the bladder
Chronic Obstructive Pulmonary Disease (COPD)
chronic, progressive disease of the lungs causing trouble breathing, particularly getting air out of lungs; includes chronic bronchitis and emphysema
o Chronic bronchitis – irritation and inflammation of bronchi usually caused by smoking; signs – productive cough that brings up sputum (phlegm) and mucus, breathlessness, and wheezing
o Emphysema – chronic disease of lungs usually results from chronic bronchitis and smoking; signs – problems breathing, coughing, breathlessness, and rapid heartbeat; no cure and irreversible; is usually on oxygen
Cyanosis
changes in skin color, pale or bluish color of lips and extremities
Dyspnea
difficulty breathing
Exhale
when carbon dioxide is expelled out of the nose and the mouth from the lungs
Expiration
involves the breathing out of carbon dioxide
Inhale
when air (or oxygen) is pulled in through the nose and down into the lungs
Inspiration
involves the breathing in of oxygen
Lungs
elastic, spongy, cone-shaped air-filled structures involved in respiration
The right lung consists of 3 lobes:
the right upper lobe (RUL)
the right middle lobe (RML)
the right lower lobe (RLL)
The left lung consists of 2 lobes:
the left upper lobe (LUL)
the left lower lobe (LLL)
Pneumonia
acute infection of the lung or lungs caused by bacteria, virus, or fungus
Pursed-lip breathing
TEST QUESTION
an assistive breathing pattern for residents with chronic lung disease that requires inhaling slowly through nose and exhaling slowly through pursed lips (as if about to whistle)
Respiratory System
involves the breathing in of oxygen (inspiration) and the breathing out of carbon dioxide (expiration)
Upper Respiratory Infection (URI or a cold)
viral or bacterial infection of nose, sinuses, and throat with nasal drainage, sneezing, sore throat, fever, and tiredness
Bowel Movement (BM or feces or stool)
semi-solid material made of water, solid waste, bacteria, and mucus that is eliminated via the anus
Colostomy
a surgically created opening (stoma) through the abdomen into large intestine to allow stool to be expelled into a bag affixed to the abdomen
Constipation
inability to have a stool or infrequent, difficult, and possibly painful elimination of a hard, dry stool
Defecation (bowel elimination)
the passage of the bowel movement from the large intestines out of the body through the anus
Diarrhea
liquid stool
Gastrointestinal (GI) system
also known as the digestive system, extends from the mouth to the anus, and responsible for digestion, absorbing nutrients, and elimination
• Upper GI structures include the mouth, pharynx, esophagus and stomach
• Lower GI structures include the small intestines and large intestines
Esophagus
the food tube of the body between the throat and the stomach
Fecal Impaction
hard stool stuck in the rectum and cannot be expelled, resulting in ongoing constipation
Feces
tubular shaped stool passed from the rectum
Flatulence
gas
Gastritis
inflammation of the stomach lining
Gastric Ulcer (or peptic ulcer)
raw sores in stomach caused by excessive acid secretion
Gastroesophageal reflux disease (GERD)
chronic condition when liquid contents of the stomach back up into the esophagus and that can damage the lining of the esophagus
Incontinence of stool
not able to control bowel movements, leading to an unintentional, spontaneous passage of stool
Peristalsis
involuntary contractions that move food through the digestive system
Ulcerative Colitis
chronic inflammatory disease of large intestine; serious condition that can result in a colostomy
Benign Prostatic Hypertrophy (BPH)
enlargement of prostate gland, a donut-shaped structure around the male urethra, leading to urinary dysfunction
Chronic Kidney Disease (CKD)
damage of the kidneys that worsens gradually
Cystitis
inflammation of bladder due to infection
Dysuria
painful urination
Functional incontinence
loss of urine caused by cognitive, physical, or environment reasons
Hematuria
blood in the urine
Kidney Stones (or Renal Calculi)
jagged stones formed when urine crystallizes in the kidneys that can block kidneys and ureters causing excruciating pain
Kidneys
paired organs responsible for filtering waste products from the blood and producing urine
Nephritis
inflammation of kidney due to infection
Overflow incontinence
loss of urine due to bladder overflow or distention
Retention
inability to completely empty the bladder
Stress incontinence
loss of urine with sneezing or coughing
Ureters
narrow tubes that connect the kidneys to the urinary bladder
Urethra
a tube located between the urinary bladder to the outside of the body
Urge incontinence
involuntary loss of urine from a sudden urge to void
Urinary Bladder
muscular sac that stores the urine until it passes from the body
Urinary Incontinence
inability to control the bladder leading to an involuntary loss of urine
Urinary System
the filtering system of the body, responsible for ridding body of waste products from blood
Urinary Tract Infection (UTI)
an infection of urethra, bladder, ureter, or kidney typically caused by E. coli, a bacteria found in the digestive system
Urination (micturition)
the passing of urine from the bladder through the urethra to the outside of the body
Urine
made up of water, salt, and waste substances filtered from the blood by the kidneys that passes out of the body via the urethra
Urine straining
process of pouring urine into a fine filter strainer to catch any particles, particularly kidney stones
Pelvic Organ Prolapse and the types
when a pelvic organ drops (prolapses) into the vaginal canal
o Cystocele – when bladder drops down
o Rectocele – when rectum shifts downward
o Uterine prolapse – when uterus shifts downward
Reproductive System
system that allows human beings to create a new human life
Female reproductive system:
uterus, fallopian tubes, ovaries, and vagina
Male reproductive system:
penis, testicles, scrotum, and urethra
Define Diabetes Mellitus (DM or Diabetes) and the Types
TEST QUESTION
the most common disorder of the endocrine system and occurs when the pancreas produces too little insulin or does not use insulin properly causing sugar build up in the blood
Type 1 diabetes – a lifelong condition typically beginning during childhood and early adult when the pancreas does not produce insulin
Type 2 diabetes – a type of diabetes that develops after about age 35 when the pancreas secretes insulin, but does not use it well
Gestational diabetes – occurs during pregnancy
Endocrine System
system of glands that secrete chemicals directly into the bloodstream to regulate body functions
Glands
an organ that secretes chemicals, called hormones that regulate bodily function
Hyperglycemia
TEST QUESTION
high blood sugar
SIGNS
weakness, drowsiness, thirst, dry mouth, hunger, frequent urination, flushed face, sweet breath odor, respirations rapid and deep, blood pressure low, skin dry, headache, blurred vision, convulsions, coma (do not let it get that far)
Hypoglycemia
TEST QUESTION
low blood sugar
SIGNS
hunger, vomiting, weakness, shakiness, sweating, headache, dizziness, fast pulse, low blood pressure, fast respirations, confusion, cool and clammy skin, convulsions, unconsciousness (do not let it get that far)
Pancreas
organ of the body that produces insulin
Acquired Immune Deficiency Syndrome (AIDS)
disease caused by a virus, HIV and attacks the immune system and destroys infection-fighting and cancer-fighting cells of the body
• Spread through body fluids including blood, semen, vaginal secretions, and breast milk
Graves Disease
immune system attacks thyroid gland which causes it to secrete more thyroid hormone
Immune System
system made up of antibodies and white blood cells that defends threats both inside and outside the body
Lupus
when immune system attacks tissues causing redness, pain, swelling, and damage
Tort
a wrong committed against a person or property
Signs, Symptoms, and Examples of Neglect
- Dehydration, malnutrition, untreated pressure ulcers, and poor personal hygiene
- Unsanitary and unclean conditions, such as being dirty, having to lie in feces or urine, inadequate clothing
- Resident’s report of neglect
Physical Abuse
• Signs and Symptoms o Sprains, dislocations, broken bones, skull fractures o Bruises of face, upper arms, upper thighs, abdomen o Fearfulness o Withdrawn, paranoid behavior o Bruises, black eyes, welts, lacerations o Rope marks, restraint marks o Open wounds, cuts, punctures o Internal injuries/bleeding o Repeated “unexplained” injuries o Sudden change in resident’s behavior o Resident’s report of physical abuse
• Examples
o Hitting, beating, pushing, kicking, slapping, pinching, shaking
o Burning
o Handling or moving the resident roughly
o Withholding personal or medical care
o Inappropriate use of drugs and physical restraints
o Force-feeding
Emotional or Psychological Abuse
• Signs and Symptoms
o Emotionally upset or agitated
o Extremely withdrawn, will not talk, or is non-responsive
o Deferent, passive, acting shamed
o Depressed, voices feelings of helplessness and hopelessness
o Trembling, clinging, cowering, minimal eye contact
o Unusual behavior (sucking, biting, rocking) that may be mistakenly attributed to dementia
o Resident’s report of emotional or psychological abuse
• Examples o Instilling fear through intimidation o Not answering call signal o Mocking or making mean remarks to resident o Sexual harassment o Demands to perform demeaning acts o Verbal threats of harm, insults, threats o Humiliation o Harassment o Treating resident like a baby o Enforced social isolation
Health Care Personnel Registry (HCPR)
- Lists pending allegations and substantiated findings of nurse aides and other unlicensed personnel
- HCPR listings can lead to negative consequences for the nurse aide
- Substantiated finding of abuse, neglect and misappropriation of resident property will cause a finding on the HCPR
- Nurse aides cannot be employed in a nursing home with a substantiated finding on the HCPR
Ethics
o Is knowledge of what is right conduct and wrong conduct, or knowing right from wrong
o Inner knowledge that assists us in making choices or judgments
OBRA
(Omnibus Budget Reconciliation Act) of 1987 – Federal Law, enacted by Congress, in 1987, to improve quality of life of residents living in a nursing home environment; comprehensive review/update of regulations, effective November 28, 2016
Ombudsman
every resident living in a North Carolina long-term care facility has access to a person assigned to their district who supports or promotes their interests
Incident Reports are required when…
TEST QUESTION
• A resident falls, verbalizes or shows fear or signs of harm, develops unusual signs of pain, has a visible misalignment of an extremity or develops a noticeable change in gait
o Resident may not put weight on a leg because a fracture has occurred during an unwitnessed event
• A resident is reported missing from the facility
• A mistake is made while providing resident care
• An item or personal belonging breaks, becomes damaged or is missing
• A request is made that is outside the NA’s scope of practice
• The NA is made to feel uncomfortable, threatened or unsafe
• Inappropriate actions, sexual advances or remarks are made
• An angry outburst occurs by family members or staff
What are the Incident Report Guidelines?
- Describe in detail what was seen or heard
- Document the time the incident occurred
- Describe the person’s reaction to the incident
- State the facts; do not include opinions
- Describe the action taken to give care
- Describe the outcomes noted from actions taken
As critical thinkers, the nurse aide should ask questions…
• What problem do I need to solve?
o Who should be involved in the process?
• What information do I need?
o How do I determine it is accurate?
• How do I solve the problem?
o What are the advantages and disadvantages?
• What am I missing?
Why is Dignity Important?
TEST QUESTION
- Promotes sense of self-importance
- Promotes quality of life
- Promotes feelings of positive self-worth
- Guides nurse aide in giving care
How can a nurse aide demonstrate respectful behaviors toward a resident’s private space and property?
o By not changing the radio or television station without the resident’s permission
o By knocking on doors and requesting permission to enter
o By closing doors as requested by resident
o By not moving or inspecting resident’s personal possessions without permission
Assistive (Adaptive) Devices – Recording and Reporting
- What activity was attempted
- What assistive devices were used
- How successful was the activity as this relates to the activity goal
- Any increase/decrease in ability noted
- Any changes in attitude or motivation, both positive and negative
- Any changes in health as evidenced by skin color, respirations, energy level, et
What may be ordered during bowel training?
enemas, laxatives, suppositories, and stool softeners
How long can Bowel and Bladder Training take before it is successful?
8 to 10 weeks
What times when attempts to void should me made?
o When resident awakens o One hour before meals o Every two hours between meals o Before going to bed o During night as needed
What is the Structure and Function of Cells?
- Are building blocks of the human body
- Have same basic structure; function, size, and shape may differ
- Need food, water, and oxygen to live and function
- Microscopic in size
- Divide, grow, and die, renewing tissues and organs
- Reproduce for tissue growth and repair in an orderly manner
- Combine to form tissue
Malignant Tumors can occur almost anywhere in or on the body, but where do they commonly occur?
skin lung colon breast prostate uterus ovary bladder kidney
What is the second largest cause of death?
Cancer
What are Cancer Risk Factors?
- Age – getting older most important risk factor
- Tobacco – actual use (smoke, chew, dip) and second-hand (being around it)
- Radiation – sunlight, x-rays, and radon gas
- Infections – certain viruses and bacteria
- Immuno-suppressive drugs – lower body’s natural defense of stopping cancer from forming (organ transplant)
- Alcohol
- Diet – high in fat, protein, calories, and red meat (colon and rectal)
- Hormones – female hormones
- Obesity
- Environment – air pollution, second-hand smoke, and asbestos
CAUTION
Cancer – Seven Warning Signs
• C- Change in bowel or bladder habits
• A - A sore that does not heal
• U- Unusual bleeding or discharge from any body
opening
• T - Thickening or lump in breast or elsewhere
• I - Indigestion or difficulty swallowing
• O - Obvious change in a wart or mole
• N - Nagging cough or hoarseness
After admission to a facility how quickly do pressure ulcers typically occur?
4 Weeks
CMS
The Centers for Medicare and Medicaid Services
What temperature should water be when providing personal care to residents?
105 degrees Fahrenheit
How many muscles are in the body?
Over 600
Involuntary vs Voluntary Muscles
• Involuntary – work automatically; cannot control
o Cardiac – in the heart; striated
o Smooth – control action of organs, such as stomach, intestines, blood vessels, and others; smooth
• Voluntary – can be controlled
o Skeletal – attached to the skeleton; include the arm and the legs; striated
How many bones are in the human body?
Infants have 270 which fuse together to make 206 to 213 in Adults.
What are Musculoskeletal System changes due to aging?
- Muscles weaken and lose tone
- Bones lose density and become brittle
- Slower muscle and nerve interaction
- Joints stiffen, become less flexible, and become painful causing decrease in range of motion and flexibility
- Height decreases from 1 to 2 inches, between age 20 and 70
- Slowed recovery from position changes and sudden movement
- Pain when moving
- Reaction time, movement speed, agility, and endurance decrease
- Poorer response to stimuli
What is the structure of the Respiratory System?
• Thorax
o Closed cavity of the body that contains the structures needed for respiration
o Extends from the base of the neck to the diaphragm, and surrounded by muscles and ribs
• Upper Respiratory Tract
o Consists of nose, mouth, sinuses, pharynx, larynx, and top of trachea
• Lower Respiratory Tract
o Consists of lower trachea, bronchi, and lungs
What are the sizes of the Large and Small Intestines?
Small Intestine:
23’ Long
1” Diameter
Large Intestine:
5’ Long
3” Diameter
Enema
Specific amount of water that may or may not have an additive and is inserted into the colon to stimulate passage of stool
Urinary – Structure and Function
The filtering system of the body responsible for ridding body of waste products from blood
• Kidneys
o Bean-shaped paired organs
o Located at the back of abdominal cavity, slightly above the waist
o About four or five inches long and an inch thick
o Filter waste from the blood and produces urine
o Help maintain water balance and blood pressure in the body
o Regulate amounts of electrolytes in the body
• Ureters
o Narrow tubes
o Connect the kidneys to the urinary bladder
o About a foot long
• Bladder
o Muscular sac
o Stores the urine until it passes from the body
• Urethra
o A tube located between the urinary bladder to the outside of the body
o About 7 or 8 inches long in males and about 1-1/2 inches long in females
What is a normal amount of daily urination?
1,000 - 1,500 mL per day
Lysis
the disintegration of a cell by rupture of the cell wall or membrane
The client’s family member is visiting for the day. The nurse aide notices a bruise on the clients face during rounds. The nurse aide should…
(TEST QUESTION)
Report the findings to the nurse.
The nurse aide finds the signaling device on the floor next to the client’s bed. The nurse aide should place the signaling device…
(TEST QUESTION)
on the side table. (answer for Exam)
WITHIN REACH
The nurse aide is attempting to preform a bed bath on the client. The client refuses to have the bed bath. The nurse aide should first…
(TEST QUESTION)
stop and notify the nurse.
Frequent turning and repositioning of the client helps prevent…
(TEST QUESTION)
pressure injuries.
The client tells the nurse aide to apply medicated ointment to the right arm. The nurse aide should…
(TEST QUESTION)
notify the nurse of the clients request.
While preforming denture care for the client, the dentures fall into the sink and break. What should the nurse aide do first…
(TEST QUESTION)
report the incident to the charge nurse.
When assisting a client who has right-sided weakness to transfer from a wheelchair, the nurse aide should support the clients…
(TEST QUESTION)
right side.
When transferring a client, MOST of the client’s weight should be supported by the nurse aide’s…
(TEST QUESTION)
legs.
What is the FIRST area of the client’s body that the nurse aide should wash when providing a bed bath?
(TEST QUESTION)
Face
Which of the following equipment should the nurse aide have available when caring for a client’s beard?
(TEST QUESTION)
Towel, Gloves, Razor, and Shaving Cream
When getting ready to make a bed, the nurse aid should place the clean linens on…
(TEST QUESTION)
a chair or table beside the bed.
Mouth care for a client who is unconscious MUST be done every…
(TEST QUESTION)
2 hours.
Nurse Aide’s Role - Cancer
TEST QUESTION
- Resident’s needs include pain relief or control, rest and exercise, fluids and nutrition, prevention of skin breakdown, prevention of bowel problems, dealing with side effects of treatment, psychologic and social needs, and spiritual needs
- Understand that each case is different; the residents you care for may live several months or many years; treatment effects each resident differently; never make assumptions about the resident or the resident’s treatment
- Social interaction – resident may want to talk or not; listen if resident wants to share feelings or experiences; never push resident to express self; be honest, sensitive; be positive, comment if resident is eating more of diet or seems stronger
- Proper nutrition – follow care plan; encourage a variety of foods with small portions if appetite is poor; for nausea or swallowing complaints, soups or gelatin may be tolerated; use plastic utensils if resident is receiving chemo (food tastes better)
- Pain control – watch for signs and report to nurse; provide comfort measures, such as repositioning and distraction
- Assist with comfort and circulation – try a variety of positioning devices, assist to chair if care plan directs, reposition at least every 2 hours if weak or immobile
- Skin care – watch for signs of pressure injury, keep skin clean and dry; never wash off markings; avoid applying lotion to radiation site; follow skin care directives on care plan
- Mouth care – understand that chemo, nausea, vomiting, mouth infections can cause pain and bad taste in mouth; soft toothbrush, mouth care cleaning per care plan but avoid mouthwash with alcohol (can increase irritation); and gentle swabbing with oral swabs dipped in a rinse for mouth sores
- Observe for and report to the nurse the following – increased weakness, tiredness fainting; nausea, vomiting, diarrhea, weight loss, change in appetite; depression, confusion, change in mental state; blood in mouth, urine, or bowel movement; changes in skin, new lumps, sores, rash; and increase in pain or pain that is not relieved by medication
- Self-image – may be an issue if weakened and has had change in appearance; hair loss common side effect, assist with grooming, show concern and interest
- Visitors and family – if visit is positive one, do not intrude; check with nurse about support groups in community if requested by visitors; watch for and report negative interactions to the nurse during visits
Nurse Aide’s Role - COPD
TEST QUESTION
- Help sit up or forward leaning supported with pillows
- Offer fluids and small, frequent meals
- Support pursed-lip breathing taught by nurse – inhaling slowly through nose and exhaling slowly through pursed lips (as if about to whistle)
- Observe oxygen in use (NEVER adjust)
- Be supportive of fears, carefully
- Follow infection prevention principles during care
- Encourage rest period
Nurse Aide’s Role - Urination
TEST QUESTION
- Residents with incontinence must be kept clean and dry; follow infection prevention concept of wiping from front to back; assist resident with handwashing
- Important for nurse aide to provide privacy when attending to elimination needs of resident; should not be rushed or interrupted
- To promote normal urination, nurse aide should encourage residents to drink fluids often and should offer fluids each time nurse aide enters room (unless fluid restricted)
- Ideal position for urination for men is standing; for women is a sitting position; if resident cannot get out of bed, assist with positioning so that resident is sitting up and by doing so allows for the process to work with gravity
Nurse Aide’s Role - Diabetes
TEST QUESTION
- Follow care plan directives closely; ensure meals are served and resident eats his diet, report to nurse if resident refuses a meal, observe intake of meal and document carefully; if meal is delayed for lab or other reason, retrieve meal as soon as resident is allowed to eat
- Encourage resident to follow exercise program which assists with circulation
- Observe for signs of low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia); low blood sugar may result from refusal of meal, delay of meal, increase in exercise; report immediately to nurse
- Provide for foot care as directed and observe for irritation or sores, report immediately to nurse
Nurse Aide’s Role - Fecal Impaction
TEST QUESTION
- Provide fluids with meals
- Encourage daily bowel movements
- Residents with fecal incontinence must be kept clean and dry; follow infection prevention concept of wiping from front to back; assist resident with handwashing
- Important for nurse aide to provide privacy when attending to elimination needs of resident; should not be rushed or interrupted
- Fiber and drink plenty of fluids; should offer fluids each time nurse aide enters room (unless fluid restricted); healthy resident should drink about 64 ounces of fluid each day
- Regular physical activity is very beneficial to elimination; strengthens muscles of abdomen and pelvic which help with peristalsis; immobility and lack of exercise weakens these muscles slowing down peristalsis and elimination; encourage regular activity as tolerated and assist if needed
- Understand bowel habits for each resident is individual and personal; determine bowel habits of resident; preferred time or times of day; typically, though elimination usually happens after meals
- Ideal position for elimination is in a leaning forward, squatting position; if resident cannot get out of bed, assist with positioning so that resident is sitting up and by doing so allows for the resident to contract muscles and to work with gravity
How can a nurse aide demonstrate respectful behaviors (dignity) toward a resident’s private space and property?
(TEST QUESTION)
o By not changing the radio or television station without the resident’s permission
o By knocking on doors and requesting permission to enter
o By closing doors as requested by resident
o By not moving or inspecting resident’s personal possessions without permission
What are the Risk Factors for getting Pressure Injuries?
TEST QUESTION
- Immobility, breaks in skin, poor circulation to area, moisture, dry skin, and urine and feces irritation
- Older residents and disabled residents are at risk due to skin changes due to age, chronic disease, and frailty
- Bedfast (confined to bed) residents
- Requires some or total help moving (coma, paralysis, hip fracture)
- Agitated or have involuntary muscle movement
- Urinary or fecal incontinence
- Exposed to moisture
- Poor nutrition; poor fluid balance
- Lowered mental awareness
- Problems sensing pain or pressure
- Have circulatory problems
- Are older
- Are obese or very thin
- Refuse care
- History of pressure injuries
