Modules 5/6 Flashcards
Ergonomics
workstyle and environment are adapted to min. discomfort and max safety
equipment to aid in moving resident
Gait belts and walking belts
* Sit-to-stand and full-sling lift machines
* Toilet seat with handles and grab bars in bathrooms
* Friction-reducing repositioning devices
* Slide boards
* Trapeze bars
* Pivot discs
Dangling
- allow resident to sit on side of bed a few minutes before transfers or ambulation
- permits blood pressure to normalize before standing
stand next to or in front of resident
gait belt
Device used for transfers and ambulation
* Prevents pulling or tugging on resident’s shoulders or arms
* Must be used for residents requiring one or two assist
* Place around resident’s waist over clothing
one-assist transfer to wheelchiar
ring wheelchair close, remove leg rests, and lock brakes
* Ensure resident’s feet are flat on floor
* Stand directly in front of resident
* Grasp gait belt with both hands above resident’s hips
Bend at the knees and assume wide stance
* Ask resident to stand on count of 3
* After resident stands, pivot them toward wheelchair
* Assist resident to sitting position after they feel wheelchair against the back of
their legs
* Remember to communicate with the resident
one assist technique to wheelchair
Bend at the knees and assume wide stance
* Ask resident to stand on count of 3
* After resident stands, pivot them toward wheelchair
* Assist resident to sitting position after they feel wheelchair against the back of
their legs
* Remember to communicate with the resident
two assist transfer (to wheelchair)
Same principles as one-assist transfer
* One assistant places right foot on outside of resident’s right foot and
grasps gait belt with right hand
* Second assistant does the same on the resident’s left side
* Each assistant has one hand free to complete tasks
* Assistants and resident all pivot toward wheelchair as one unit
mechincal devices are used to transfer residents who
have fragile skin
obese
unable to bear weight
unpredictable during transfers
sit to stand device (WHY)
for residents who can bear some weight but may be unpredictable during transfers
can be hydraulic. Eletric, or both
each resident should have their own sling
can be frightening to some residents
sit to stand device (HOW TO pt 1)
allow resident to dangle and put on their footwear
place machine in front of them
assist resident to place their feet on foot plate
place sling behind resident and under arms
sit to stand device (HOW TO PT 2)
attach sling to machine
clip belt at resident waist and tighten belt
raise the resident to standing position
move the resident until they are over the locked bed/wheel
sit to stand device (PT 3)
ensure back of residents legs are against chair
lower resident to sitting position
unclip belt buckle and remove sling
assist the resident as needed
log rolling (why)
done when spinal trauma is suspected/confirmed
keep residents body straight and aligned
prevents further injury
required 3 cna
log roll standard
one person at head of bed
second/third on one side of bed
place pillow between residents leg
on 3 one fluid movement
transfer from bed to stretcher
required 4 staff
bed is raise to match height of stretch
remove top linens
remove iv or catheters
use backboard/fitted sheet to transfer
two assistant stand on one side and two on one side
on 3 lift sheet slightly and move resident
strap resident for safety
cover resident
use backboard/fifth assistant to stabilize resident head if spinal injury is suspected
method to transfer obsese pt
always transfer with two or more assitant
ask resifent to do as much as possible
do not rush
have all preparations ready in advanced
Bariatric (obsese) resident specialty equipment
special beds, walker, commodes, wheelchair
bariatric lift/sling
extended gait belts
use tops of sheet, bath blanket, or bed blanket as a draw sheet
method to transport a resident in a wheelchair
remind resident to keep elbows in
let resident know when you are starting or stopping
ambulation
- Provide more assistance if resident requires it
- Update nurse if resident repeatedly needs more or less assistance than
indicated on care plan - Use good body mechanics
- Always use gait belt as indicated on care plan
- Ensure resident is wearing appropriate footwear
- Have necessary assistive devices close by
- Lock brakes on wheelchair or bed before resident stands
reposition resident and frequency
every 2 hours in bed
every hour in wheelchair
risk of skin breakdown
fragile skin
presence of skin breakdown
supine
lying on back: comfortable for most residents
used for sleeping and comfort
* Areas of pressure include back of skull, sacrum, coccyx, and heels
* Place pillow between back of resident’s knees and the heels
* Ensure heels are not touching the bed
prone
lying on stomach
sed only for certain medical issues or if requested by resident
* Pressure areas include ears, hips, knees, and tops of toes
* Use thin pillow under resident’s head
* Place pillow under shins
fowlers
lying on back while head of bed is elevated
Head of bed raised 45 to 60 degrees
* May be used to watch TV, visit with others, or ease breathing
* Risk of friction and shearing injury to back, sacrum, coccyx, elbows, and heel
high fowlers
head of bed raised 80-90 degrees
used while resident is eating or drinking
high risk of friction and sheering injury due to sliding down in bed
residents with poor body/muscle control may fall out of bed
semi fowlers
head of bed raised 35 to 40 degrees
used to help ease breathing or watch TV
fowlers positions pillow positioning
place pillow under residents head/lower legs
may place pillow under elbows to reduce friction
ensure residents heels are not touching mattress
side lying
pressure areas: malleolus, inner part of knees, shoulder, ears
place pillow under resident’s head and between knees and back
* Place pillow behind back to keep pressure off the trochanter
sims
form of side lying positions when giving an enema Used for enema administration
* May not be tolerated by older adults
* Pressure areas include malleolus, shoulder, and hip
* Place pillow under resident’s top leg, under head, and in front of chest
tripod
resident is sitting in wheelchair or chair theyre hands are holding their head up
helps them breath
place pillow, towel, or folded blanket on table to prevent sore elbows
proper wheelchair positioning
ensure resident is sitting with hips against back of wheelchair
* Make sure wheelchair is appropriate size
* Feet should touch floor
* Use leg rests, alternating-pressure pads, and positioning devices as directed
move a resident in bed w one cna
head of bed is flat, with resident’s knees bent and feet flat on bed
* Ask resident to grasp either the trapeze or raised side rails
* On count of 3, have resident push with legs and pull with arms
* Assist resident by placing your arm beneath resident’s thighs and exerting
upward pressure
* Lower side rails after use, or adjust as indicated on care plan
move resident in bed with two cna
Place head of bed flat
* One assistant stands on either side of bed
* Ask resident to place hands across stomach or chest
* Grasp draw sheet close to resident’s body
* Assume wide stance and use hip, thigh, and buttock muscles
* On count of 3, move resident up in bed using draw sheet
* Keep shearing to a minimum
* Replace pillow under resident’s head
lift sheet
Most common tool used when repositioning residents
* Grasp the lift sheet as close to resident’s body as possible
* Assume a wide stance
* Use the large muscles of hips, thighs, and buttocks
* Ask resident to place hands across their stomach or chest
* Limit shearing as much as possible
iganz semmelweis
doctor in Hungary in mid 1800s
determined medical students were transferring matter onto bodies
made students wash hands
idea rejected by medical community
Louis Pasteur
used semmelweis theory
hand hygiene was accepted
invented vaccines for anthrax, rabies, modern-day pasteurization process
4 types of germs
Bacteria: single cell
- can be helpful or cause disease
Viruses: spread easily
- can cause common cold and HIV
fungi: plant like
those with immune problems are vulnerable to Fungai infections
Protozoa: often spread in infected food/water
- tend to affect GI system
chain of infection
infectious agent- use hand sanitizer/ disinfectant to kill germs
reservoir: prompt storage of food
portal of entry: maintain intact skin, prevent open sores or skin breakdown
portal of exit: contain wound drainage w dressings
susceptible host: healthy lifestyle
gowns
worn to protect the workers from splashing
must cover front/back
PPE contingency capacity
Used when future PPE supply capacity is uncertain
* Facilities can:
* Give a mask only to those who arrive without one
* Cancel elective procedures
* Extend worker use of masks
* Allow workers to use cloth masks for source control
* Have residents use other barriers
* Restrict mask use to only when needed as PPE
PPE crisis capacity
Used when supply is insufficient
* Workers can:
* Use expired masks
* Reuse masks, preferably those with elastic behind the ears—remove and replace
carefully; store in clean, breathable bag
* Wear face shield if no masks are available
* Wear cloth mask if no face shields are available
risks for acquiring drug resistant infections
being older
* having a weakened immune system
* having chronic illness
* a history of antibiotic use
* a recent surgery
* repeated or long hospital stays
* open wounds
* having tubes in the body (i.e., catheters or drains
drug resistant MRSA - Methicllim- resitant staphylococcus aureus
- Most infections occur on the skin
- May also be found in the nose, respiratory tract, urinary tract, and wound
drainage
VRE- vancomyin resitant enterococci
Vancomycin-resistant enterococci
* Most infections occur in hospitals
* Can be found in surgical wounds, urinary tract, or blood
* Contact precautions recommended
* Risk factors:
* Hospital stays
* Indwelling medical devices
* Prior treatment with vancomycin
* Immunosuppressed status
Specialty precautions airborne
Used when germs are light enough to
float on air currents
* Requires particulate (N95) respirator
mask and negative pressure room
* Used for illnesses such as
tuberculosis (TB)
specialty precaution droplet
Used when germs are transmitted via
sneezing, coughing, or talking
* Requires wearing a surgical mask if
within 3 feet of the resident
* Used for illnesses such as influenza
and whooping cough
contact- specialty precautions
sed when illness may be spread via
direct or indirect contact
* May require performing hand
hygiene with soap and water
* Check with nurse to verify if hand
sanitizers are permitted
* Examples include MRSA and C.
difficile
specaialty precuation clostriduim difficile
infectious gastrointestinal illness
occurs as a result of multiple rounds of antibiotics
* Causes abdominal bloating and diarrhea
* Can lead to infection in colon, bowel perforation, dehydration, or death
* Can live on surfaces for months
* Requires cleaning with bleach solution
* Requires contact precautions with handwashing
* Hand sanitizers are not effective
Specialty precautions Enhanced barrier precaution (EBP)
used if resident has a drug-resistant
infection, indwelling device, or wound
* Wear gown and gloves and perform
hand hygiene before and after high-
contact activities
* Examples: Resident transfer in common area
like shower; hygiene care like brushing
teeth; therapy exercises
* EBP not needed for low-contact activities
* Examples: Resident transfer in common area
like dining room; hair brushing; putting on glasses
transportation from isolation room
resident wears a surgical mask if on airborne or droplet precautions
* Contain any drainage or cover the infectious area of resident’s body if they
are on contact precautions
* Alert receiving staff prior to leaving the resident’s room
* Ensure any used equipment is disinfected after use
blood spill kit
consist of a germicidal agent, gloves, and biohazard bag
double bagging technique
intervetions that alllows for contaimed material to be removed from resident romm while maintain infection control
body defense mechanism
specific:
body develops antibodies against specific germ
acquired through vaccination or by contracting actual disease
body defense mechanisms nonspecific
intact skin
tears
cilia in lunges/nose
mucous membranes
bacterial flora of the digestive tract
