Final Flashcards
Cna scope of practice are _____ and _______ that I are permitted to follow
Skills
Responsibilities
Nursing assistant programs are regulated by _______ code
The state and federal
It’s your responsibility to know
What my scope of practice is
Cna scope of practice includes (5)
Basic personal care (bathing/grooming)
Restorative tasks
Offering emotional/social support
Providing dementia care
Assisting with ADLs
What are the 3 ways cnas learn basic nursing skills?
Textbook, in class training , clinical
What’s not in your scope of practice? (5)
Delivering medicine
Placing indwelling medical device - catheters & Ivs
Changing a care plan
Teaching
Delegation
Can new skills be added to the cna scope of practice?
Yes, depending on the facility they may ask you to do more
How to refuse a delegated task since it’s not in your scope of practice
Explain to nurse it’s not in your scope of practice, then document refusal
How many CEUs (continuing education units) are needed to renew/maintain your license?
48 hours of In service training w/in 2 year period (24 months)
-
What’s the minimum of hours that can be completed each year w/in 2 year renewal?
12 per year
How many CEUs can be completed online
24 - by a CDPH approved training
What is title 22
The California code that provides info about regulations regarding cna programs & other health care related programs
California nursing assistants must abide by _____ & ______
Obra
Title 22
Tittle 22 are laws that govern what 3 things
Health care facilities
Nursing assistant programs
Minimum standard of care for long term facilities
Cna training programs must include
60hr of theory
100 hr clinical
Does tittle 22 include nursing assistant programs must have an orientation the 1st eight hours at a facility
TRUE or FALSE
True : it allOws you to become familiar with facility
Residents, emergency procedures and any/ all equipment
The 2nd 8hrs of orientation requires to cover
Patient care, how to keep a resident comfortable & legal/ ethical considerations
Residents have the right to receive care that is unbiased regarding culture and race and creed
TRUE or FALSE
True
The federal law protects residents rights by allowing
Access to medical records, making informed consent
Keeping medical info/ records private
What law protects individuals medical info from being shared
HIPPA
Health insurance portability and accountability act
HIPPA protects what type of info
Spoken , written, heard, read
If HIPPA is violated what will happen
Given a large fine and have to submit a plan of correction
- sometimes loss of license
What is informed concent
The right to know what treatments are available and the risks associated with them
Who’s job is it to give information about treatments and teaching the resident about medication
Dr or nurse
What are Medicare rights in a long term facility (9)
When should a resident be given a copy of their rights
When admitted
Ombudsman can help with what 4 things
Residents rights / dignity concerns
- poor quality of care
- use of restraints
What 4 things is ombudsman responsible for
Teaching residents/ family about their rights
- teaching public of long term care rights
- advocating for quality of life in long term facilities
- promoting resident councils
Invasion of privacy is
Not respecting an individuals right to keep items personal/ private ( entering the room w/o knocking)
Misappropriation of funds
Intentionally using another persons money or belongings w/o permission
Negligence is when
A caregiver doesn’t not follow the standards of their job
(Failing to toilet a resident)
Abandonment is when
A caregiver walks away from assignment either before end of shift or before replacement
False imprisonment is
Limiting a residents ability to move freely ( locking brakes of wheelchair)
Neglect is
When care or treatment is not provided causing the resident to get hurt ( ignoring physical, emotional, mental needs)
- not giving water causing them to get dehydrated
Assault is
Threatening a resident with physical, mental or emotional harm
( giving an ultimatum)
Battery is
Physically touching a resident who didn’t give you permission to touch ( showering / changing a resident who refuses )
Abuse is
A single or repeated action that is purposely done to inflict harm
Examples of abuse
- not repositioning the resident
- with holding care
Who is more vulnerable to abuse?
Residents with physical, developmental, or communication disabilities
Having good communication will
Help reduce resident stress
Improve resident comfort
Make job easier
What are the 2 ways people communicate with each other?
Verbal / nonverbal
What communication is combined with verbal and nonverbal
Therapeutic communication
What does therapeutic communication help decrease?
Conflict / tension
Therapeutic communication help make people fell more _____ & ______
Valued
Cared
Therapeutic communication is a combination of what specifically
Active listening & acknowledging feelings
Therapeutic communication involves empathy
TRUE or FALSE
True
What are the 4 ways to improve active listening?
- making eye contact
- no negative expressions
- occasionally repeating self / rephrasing
- summarize what speaker said
What are the 3 techniques involved in therapeutic communication
- use “I” statements
- open to suggestions
- brainstorm ideas to improve / avoid difficult situations
If nonverbal communication dos t match verbal communication how do you fix this?
Ask an open ended question
How to improve speaking to a hearing impaired resident?
- speak clearly
- be face to face @ eye level
- speak in normal pitch
- allow time to read lips
- use whiteboard
What is the leading cause of death?
Cardiovascular disease
What is hand sanitizer ineffective against?
C Diff
When should you use hand hygiene (that’s not already obviously dirty)
- before going on break
- unpin returning from break
- before smoking
- at end of resident contact
What are Maslow’s hierarchy of needs?
Self actualization
Self esteem
Love/ belonging
Safety/ security
Physiological
What is included in Maslow’S hierarchy of needs for safety/ security
- money (employment)
- safety of body/mind
- morality/ ethics
What is part of physiological needs
- food
Water
Homeostasis
Expressive aphasia
The inability to speak
What should you do if someone has expressive aphasia and you’re trying to communicate?
Use a picture board or a computer
Receptive aphasia
The inability to understand spoken language
What are some interventions you can take for individuals with receptive aphasia
Break tasks into small steps
- going slowly to decrease confusion
What should be included in an oral report
Anything important!
- vital signs, behavior any pain
If anything is out of normal range for a resident when should you notify the nurse?
Right away
Who can you give oral reports to?
The nurse & person taking oVer shift
What are the 4 things to include in your oral report?
Any info to help ease interaction
- resident preferences
- updated on care plan
- any new info occurred during shift
What type of data should you report during reporting?
Subjective followed by objective data
What a re the 5 stages of death (grief)
Denial
Anger
Bargening
Depression
Acceptance
Denial is when
A person with feel shocked, disbelief or numb
- unwilling to accept love one has passed
Anger is when
A person feels upset or angry with the person who passed, the healthcare team, other family member, themselves or god
When a person is experiencing anger they tend to
Question why this happens and believe it’s unfair
Bargaining is
A series of “what if’s” and “what only”
Bargaining stage is usually associated which feeling
Guilt
Depression stage will make a person feel
Empty, alone and overwhelmingly sad
When experiencing depression a person tends to ________ from others
Withdraw
The acceptance stage is
When an individual accepts their “new normal “
- okay with loved one being gone
What is the normal urine output?
1200-1500ml a day
50-60ml per hour
Should a persons intake or output be higher?
Intake should be higher
(Up to 500ml)
- water is used throughout body: for organs to function
When is military time used for
Documentation & communication
Why is military time used?
To reduce confusion
When do you measure liquids
For intake during meals/snacks
- urinary output
How to properly measure liquid
Pour into graduate
Place on a flat surface
Measure @ eye level
When is it okay to use restraints
To prevent falls
To prevent patient from hurting themselves / others
- prevent from pulling on and pulling out tubing
When should restraints NOT be used?
To prevent falls, and outbursts
And to make job more convenient
When should restraints be removed if not approved by a dr?
Every 2 hours for at least 10 min to help with bathroom
How often should you check a resident in restraints?
15 min
When checking restraints you should look that the skin is
Warm
Has color
Has circulation ( no numbness or tingling)
Can still move
Restraints can only be used if they are
Order by a physician
What are some things you should help with when removing a restraint every 2 hrs?
Toileting
Rom exercises
Ambulating
Repositioning
Encourage socialization
How should you apply a restraint
Quick release knot - tie to movable bed frame or chair NOT side rail
When are side rails considered restraint?
When they do not use it to help move themselves
If a resident wants to use side rails what must happen
They need to sign a waiver acknowledging the risks of using it or their pose of attorney
What are so,e alternatives to restraints ?
Ambulation
Distraction
Decrease noise
Message
Team approch
What time other then the every 2 hours is it only to remove a restraint?
Meal time
Restraints are considered
Anything that represents a resident to move freely around their environment
Restraints can increase the risk of physical and emotional harm
TRUE or FALSE
True
What are the 2 types of restraints
Physical - vest, wrist
chemical - medication
What is a cnas role in oxygen therapy
- ensure flow rate is coming out
- ensure flow amount is correct ( if amount in tank is low let the nurse know)
- check skin integrity
- report any complaints to the nurse / anything wrong
Oxygen used for acute reasons usually have a higher concentration
TRUE or FALSE
True : acute = short term
Chronic = lower
Chronic conditions usually have oxygen flow rate at
1-6 liters per minute
You can’t administer oxygen but you can
Change from portable tank to concentrator
What are ways that oxygen can be delivered
Nasal cannula (up to 6 liters)
Face mask
Are you allowed to adjust a nasal cannula
Yes
When should oxygen tubing be replaced
Once a week
Common side affects of continuous o2 use
Nose bleeds
What should not happen around o2 use
Smoking
Sparks
Alcohol
Static electricity
Petroleum based products
What should be checked before and after the use of o2
Heart rate & respirations
A portable tank should be kept _____
Upright standing up
How often should you weigh a resident
Once a week in the morning after voiding
Why is weighing a resident an important?
To determine medication doses & fluid intake
When should you weigh a dialysis patient
Before / after dialysis
Can you use a gait belt when measuring a resident?
Yes, just try not to put pressure
What is considered out of range weight
+/- 3 pounds
CNS footwear be worn when taking weight
Yes, on an upright scale
What can be used to weight a bed bound / dependent resident?
Mechanical lift & bed scale
What type of environment does bacteria/ fungi grow best in?
Warm, dark moist area
OSHA ensures that
Employees have a safe and healthy working conditions
What does osha stand for?
Occupational safety and health administration
What does osha require healthcare entities to provide their employees
Ppe
Hepatitis b vaccines
When was osha created
1970
Where should sharps be put? And why is this important
Sharps bin
- protects from blood borne pathogen
What should be put into a biohazard bag?
Anything containing bodily fluids
What 2 ways does intake recording include
Orally
& via IV
Output recording includes
Urine
Vomit
Feces
( sweat, tears)
When recording fluid intake what should you include
Anything that would be liquid at room temp
- ice cream, jello, pudding
When do you officially document I’s and o’s?
At the end of the shift
- keep track in notebook throughout shift
What should you do if there is a large difference b/w input and output?
Tell the nurse
Fluid overload is when
Intake is more than output
What are some causes of fluid overload
Congestive heart failure
Impaired kidney function
How many ml is 8oz
240ml
How many ml is 1oz
30 ml
How many ml is 4oz
120 ml
How should you position an unconscious resident for oral care?
Side laying w/ head of bed slightly elevated
And make sure head is looking down to allow drainage of excess. Water
When doing oral care on an unconscious resident it is important to
Drain all excess water from swab
& do opening / closing steps
How do you remove dentures
Position in high Fowler
Ask to resident to remove them - if need assistance use tongue depressed w/ cloth wrapped around it
Place inside emesis basin
Proper way to clean dentures
Place washcloth in sick - prevents damage if dropped
Rinse dentures w/ warm water
Put pea sized amount of toothpaste on brush
Clean each tooth & rinse
Put warm water in denture cup
What to do after cleaning residents dentures
- offer mouth wash
- wash tongue ( back to front)
- place top ➡️ bottom denture
When should a colostomy bag be emptied
When 1/2 full or when requested
Is changing a colostomy appliance in your scope of practice?
Yes
Just not changing faceplate / starting one
What position should a resident be in when changing a colostomy bag?
Side laying/ sitting
What foods are high in protein
Meat
Poultry
Eggs
Nuts
Seafood
Soy
Peas
Beans
What patients should eat a low protein diet?
Ones with chronic kidney disease
What types of protein are best for lowering your risk of obesity, heart disease and some cancers
Nuts, seeds, beans and peas
What are ways to prevent falls
- keep hallways free of clatter
- keep equipment on one side of hallway
- clean up any spills
- answer call lights promptly
- instal grab bars in showers/ bathrooms
- ensure vision / hearing aids are being used
- assist with daily activities
Where can you find if a person is a fall risk
Care plan
What type of training can help with falls
Balance retaining & strengthening
What are ways to help with fall risk patients
Alarm systems
Antiroll back brakes on wheelchair
- pads near bed
If a resident falls what should you do
Call for help and keep them on the floor until help arrives
- make sure to provide emotional support
During ambulating a resident falls what should you do?
Assist to ground and protect their head
How should a gait belt be held
Underhand
How to assist resident off the floor
Ask to get on hands/ knees
Place chair in front of them - have grab and stand
If a resident hits their head during a fall you need to take vitals every
15 min for 1st hr
30min for 2nd hr
Every hour for rest of shift .
Every shift for next 3 days
What is the first question that is asked when a fall is noticed?
Was it witnessed - if not assume hit head
Who evals / assesses a resident when they are admitted into a new facility
Pt / Ot
What is the purpose of Rom exercises?
To prevent atrophy and contractures
- help keep Muscle toneness
Who should have ROM exercises?
Bed bound patients
- patients with weakness
Rom exercises move ______ through it’s natural position
Joints
When doing rom exercises what should you be asking the resident
If they have any pain/ discomfort
Where should you support when doing ROM exercises
At the joints
During restorative care what should be reported to the nurse?
- increased / decreased ability
- change in attitude
Change in health
During active ROM exercises what should you remind the resident
What exercises they need to do and how many
Race and pass mean
R- rescue/ remove residents
A - activate alarms
C - contain fire
E - evacuate/ extinguish
P- pull pin
A - aim @ base of fire
S- squeeze handle
S- sweep back and forth
How do you correct documentation errors
Cross it off and put your initials next to it
What happens to a dying residents heart rate
It increases - above 100 beats per min
Signs and symptoms of a dying resident
- breathing is deeper / pauses
- motting
- deletions / hallucinations
- decreased appetite/ thirst
- dark urine / incontinent
How to care for a dying resident
Provide emotional/ spiritual support for them/ family
- reposition every 2 hrs
- provide oral care w/ swab
- provide layers if cold
What’s the main goal of caring for a dying resident?
To keep them comfortable
