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Foundations of resident care

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Foundations of resident care

Healthcare
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2 Foundations of Resident Care 1. Understand the importance of verbal and written communications Define the following terms: communication the process of exchanging information with others by sending and receiving messages. verbal communication communication involving the use of spoken or written words or sounds. nonverbal communication communicating without using words.
2 Foundations of Resident Care Transparency 2-1: Body Language
2 Foundations of Resident Care 1. Understand the importance of verbal and written communications Think about these questions: Can you think of a situation where someone was sending one message with verbal communication and a completely different message with nonverbal communication? How can an NA use observation as a form of nonverbal communication with a resident? Can you think of an example of how an NA would use verbal or nonverbal communication to reach a specific goal?
2 Foundations of Resident Care 1. Understand the importance of verbal and written communications REMEMBER: When caring for residents, NAs should speak in a language residents can understand or find someone who speaks the resident’s language. Never use a language the resident does not understand when speaking to staff in front of the resident.
2 Foundations of Resident Care 1. Understand the importance of verbal and written communications How might an NA give an oral report of the following situations? • Resident falls • Resident complains of chest pain • Resident complains of severe headache • Resident is having difficulty breathing • NA observes abnormal pulse, respiration, or blood pressure • Change in resident’s mental status
2 Foundations of Resident Care 1. Understand the importance of verbal and written communications How might an NA give an oral report of the following situations? (cont’d) • Resident experiences sudden weakness or loss of mobility • NA finds resident has high fever • Loss of or change in resident’s consciousness • Resident is bleeding • Change in resident’s condition • Resident shows signs of abuse
2 Foundations of Resident Care 1. Understand the importance of verbal and written communications When communicating with residents the NA should • Always greet the resident by his or her preferred name. • Identify himself. • Focus on the topic to be discussed. • Face the resident while speaking and avoid talking into space. • Talk with the resident, not other staff members, while giving care.
2 Foundations of Resident Care 1. Understand the importance of verbal and written communications When communicating with residents the NA should (cont’d) • Listen and respond when the resident speaks. • Praise the resident and smile often. • Encourage the resident to interact with him and others. • Be courteous. • Tell the resident when he is leaving the room.
2 Foundations of Resident Care 1. Understand the importance of verbal and written communications REMEMBER: When communicating with residents it is important to use the name the resident prefers. NAs should not use residents’ first names unless the resident has asked them to do so.
2 Foundations of Resident Care 1. Understand the importance of verbal and written communications Define the following terms: objective information information based on what a person sees, hears, touches, or smells; also called signs. subjective information information that a person cannot or did not observe, but is based on something reported to the person that may or may not be true; also called symptoms. incontinence the inability to control the bladder or bowels.
2 Foundations of Resident Care Transparency 2-2: Using Your Senses
2 Foundations of Resident Care 1. Understand the importance of verbal and written communications Define the following terms: root the part of a word that contains its basic meaning. prefix the word part that comes before the root to help form a new word. suffix the word part added to the end of a root that helps form a new word.
2 Foundations of Resident Care Handout 2-1: Abbreviations a before AAROM active-assistive range of motion abd abdomen ABR absolute bedrest ac, a.c. before meals AD Alzheimer’s disease ADC AIDS dementia complex ad lib as desired ADLs activities of daily living adm. admission AED automated external defribrillator AHA American Heart Association AIDS acquired immune deficiency syndrome am, AM morning AMA against medical advice, American Medical Association amb ambulate, ambulatory AMD age-related macular degeneration amt. amount ANS autonomic nervous system ant. anterior a.p./AP apical pulse approx. approximately AROM active range of motion ASAP as soon as possible assist assistance as tol as tolerated A, T, D admission, transfer, and discharge
2 Foundations of Resident Care Handout 2-1: Abbreviations BKA below-knee amputation bld blood BLS basic life support BM bowel movement BP, B/P blood pressure BPH benign prostatic hypertrophy BPM beats per minute BR bedrest BRP bathroom privileges BSC bedside commode BSE breast self examination C centigrade, Celsius c with Ca/CA calcium, cancer, carcinoma CBI continuous bladder irrigation CBR complete bedrest CCMS clean-catch midstream CDC Centers for Disease Control and Prevention CDE certified diabetes educator C. diff clostridium difficile CEP competency evaluation (testing) programs CEU continuing education unit CHD coronary heart disease CHF congestive heart failure chol cholesterol ck check
2 Foundations of Resident Care Handout 2-1: Abbreviations CMS Centers for Medicare and Medicaid Services CNA certified nursing assistant CNP certified nurse practitioner CNS central nervous system c/o complains of, in care of CO2 carbon dioxide COLD chronic obstructive lung disease COPD chronic obstructive pulmonary disease CP cerebral palsy CPM continuous passive motion CPR cardiopulmonary resuscitation CRF chronic renal failure C.S. Central Supply CVA cerebrovascular accident, stroke CVP central venous pressure CVS cardiovascular system CXR chest x-ray DAT diet as tolerated DJD degenerative joint disease DKA diabetic ketoacidosis DM diabetes mellitus DNR do not resuscitate DO doctor of osteopathy DOA dead on arrival DOB date of birth DON director of nursing Dr. doctor
2 Foundations of Resident Care Handout 2-1: Abbreviations ECG, EKG electrocardiogram ED emergency department EENT eye, ear, nose, and throat e.g. for example EMS emergency medical services ER emergency room ESRD end-stage renal disease et al. and other things ETOH alcohol exam examination F Fahrenheit, female FBS fasting blood sugar FDA Food and Drug Administration Fe iron FS fingerstick FSBS fingerstick blood sugar ft foot F/U, f/u follow-up FUO fever of unknown origin FWB full weight-bearing fx fracture FYI for your information g gram GAD generalized anxiety disorder gal gallon GB gallbladder GERD gastroesophageal reflux disease geri chair geriatric chair
2 Foundations of Resident Care Handout 2-1: Abbreviations GU genitourinary GYN/gyn gynecology h, hr, hr. hour H20 water H202 hydrogen peroxide H/A headache HAART highly active anti-retroviral therapy H&P history and physical HAV hepatitis A virus HBV hepatitis B virus HCV hepatitis C virus HDV hepatitis D virus HEV hepatitis E virus Hg mercury HIV human immunodeficiency virus HMO health maintenance organization HOB head of bed HOH hard of hearing HPV human papillomavirus HS/hs hours of sleep ht height HTN hypertension H.U.C. Health Unit Coordinator Hx history hyper above normal, too fast, rapid hypo low, less than normal I&D incision and drainage I&O intake and output
2 Foundations of Resident Care Handout 2-1: Abbreviations ICU intensive care unit ID identification i.e. that is IICU intermediate intensive care unit IM intramuscular in inch inc incontinent inf inferior IQ intelligence quotient irr., irrig irrigation isol isolation I.V., IV intravenous K potassium kg kilogram lab laboratory lb pound LBP low back pain LE lower extremity lg large liq liquid LLE left lower extremity LLQ left lower quadrant LOC level of consciousness, level of care Low-cal low-calorie Low-fat/ low-fat, low-calorie Low-cal Low-Na low-sodium LPN Licensed Practical Nurse
2 Foundations of Resident Care Handout 2-1: Abbreviations LVN Licensed Vocational Nurse M.D. medical doctor MD muscular dystrophy MDROs multidrug-resistant organisms MDR-TB multidrug-resistant tuberculosis MDS minimum data set meds medications med-surg medical-surgical mg milligram MI myocardial infarction min minute mL milliliter mm millimeter mm Hg millimeters of mercury MRI magnetic resonance imaging MRSA methicillin-resistant staphylococcus aureus MS multiple sclerosis MSDs musculoskeletal disorders MSDS material safety data sheet MSW medical social worker MUFA monounsaturated fat MVA motor vehicle accident Na sodium N/A not applicable NA nursing assistant NaCl sodium chloride NAS no added salt NATCEP Nurse Aide Training and
2 Foundations of Resident Care Handout 2-1: Abbreviations neg negative NF nursing facility NG, ng nasogastric NIBP non-invasive blood pressure monitoring NKA no known allergies NKDA no known drug allergies no number noc night NPO nothing by mouth NVD nausea, vomiting, and diarrhea NWB non-weight-bearing O2 oxygen O&P ova and parasites occ occasionally OCD obsessive-compulsive disorder OD overdose O.D. right eye OG orogastric OOB out of bed OPD outpatient department O.R. operating room ord. orderly, ordered ORIF open reduction, internal fixation ortho orthopedics os mouth O.S. left eye OSHA Occupational Safety and Health Administration
2 Foundations of Resident Care Handout 2-1: Abbreviations OTC over-the-counter (medication) O.U. both eyes oz ounce p after P.A. physician’s assistant PAD peripheral artery disease pc, p.c. after meals PCA patient-controlled anesthesia PDR Physician’s Desk Reference PE pulmonary embolism Peds/peds pediatrics PEG percutaneous endoscopic gastrostomy peri care perineal care PET positron emission tomography pH parts hydrogen PH past history PHI protected health information phy. ex. physical exam PID pelvic inflammatory disease PM/pm afternoon PMH past medical history PNS peripheral nervous system PO (per os) by mouth pos. positive post op after surgery PPD purified protein derivative (test for tuberculosis) PPE personal protective equipment
2 Foundations of Resident Care Handout 2-1: Abbreviations p.r.n., prn when necessary prog. Progress PROM passive range of motion Pt/pt patient pt. pint PT physical therapist, physical therapy PTH parathyroid hormone PTSD post-traumatic stress disorder PUFA polyunsaturated fat PVD peripheral vascular disease PWB partial weight-bearing q every q2h, q3h, every two hours, q4h every three hours, Q&A questions and answers qd every day qh, qhr every hour qhs every night at bedtime q.o.d. every other day qt. quart quad quadrant, quadriplegic R respirations, rectal R, rt. right RA rheumatoid arthritis RBC red blood cell RDT registered dietician reg. regular rehab rehabilitation
2 Foundations of Resident Care Handout 2-1: Abbreviations RLQ right lower quadrant RN registered nurse RNA restorative nursing assistant R/O rule out ROM range of motion RR respiratory rate RT respiratory therapy/therapist RUE right upper extremity RUQ right upper quadrant Rx prescription, treatment s without S&A sugar and acetone S&S, S/S signs and symptoms s.c. subcutaneously sl sublingually SLE systemic lupus erythematosus SLP speech-language pathologist sm. small SNAFU situation normal, all fouled up (slang) SNF skilled nursing facility SNS somatic nervous system SOB shortness of breath SP Standard Precautions S.P.D. Supply, Processing, and Distribution spec. specimen ss one-half SSE soapsuds enema ST standard, speech therapy
2 Foundations of Resident Care Handout 2-1: Abbreviations STAT/stat immediately Std prec Standard Precautions STDs sexually-transmitted diseases STIs sexually-transmitted infections strep streptococcus supp. suppository surg. surgery T., temp temperature TB tuberculosis tbsp. tablespoon T, C, DB turn, cough, and deep breathe THR total hip replacement TIA transient ischemic attack t.i.d., tid three times a day TPN total parenteral nutrition T.P.R. temperature, pulse, and respiration trach. tracheostomy tsp. teaspoon TWE tap water enema Tx, tx traction, treatment U/A, u/a urinalysis UE upper extremity UGI upper gastrointestinal UNK, unk unknown URI upper respiratory infection US ultrasound USDA United States Department of Agriculture UTI urinary tract infection
2 Foundations of Resident Care Handout 2-1: Abbreviations VD venereal disease VRE vancomycin-resistant enterococcus VS, vs vital signs W/A, WA while awake WBC white blood cell/count w/c, W/C wheelchair WNL within normal limits wt. weight yr. year
2 Foundations of Resident Care Handout 2-2: Prefixes, Roots, Suffixes Prefixes a, an: without, not, lack of analgesic = without pain ante: before, in front of antepartum = before delivery bi: two, twice, double bifocal = two lenses brady: slow bradycardia = slow pulse, heartbeat contra: against contraceptive = prevents pregnancy dis: apart, free from dys: bad, painful dysuria = painful urination endo: inner endoscope = instrument for examining the inside of an organ epi: on, upon, over epidermis = outer layer of skin erythro: red erythrocyte = red blood cell ex: out, away from exhale = to breathe out hemi: half hemisphere = one of two parts of the brain
2 Foundations of Resident Care Handout 2-2: Prefixes, Roots, Suffixes Prefixes (cont’d) hyper: too much, high hypertension = high blood pressure hypo: below, under hypotension = low blood pressure inter: between, within interdisciplinary = between disciplines leuk: white leukocyte = white blood cell mal: bad, illness, disorder malformed = badly made micro: small olig: small, scant oliguria = small amount of urine patho: disease, suffering pathology = study of disease per: by, through perforate = to make a hole through peri: around pericardium = sac around the heart poly: many, much polyuria = much urine post: after, behind postmortem = period after death
2 Foundations of Resident Care Handout 2-2: Prefixes, Roots, Suffixes Prefixes (cont’d) pre: before, in front of prenatal = period before birth sub: under, beneath subcutaneous = beneath the skin supra: above, over suprapelvic = located above the pelvis tachy: swift, fast, rapid tachycardia = rapid heartbeat
2 Foundations of Resident Care Handout 2-2: Prefixes, Roots, Suffixes Roots abdomin(o): abdomen abdominal = pertaining to the abdomen aden(o): gland adenitis = inflammation of a gland angi(o): vessel angioplasty = surgical repair of a vessel using a balloon arterio: artery arteriosclerosis = hardening of artery walls arthr(o): joint brachi(o): arm brachial = pertaining to the arm bronchi, bronch(o): bronchus bronchopneumonia = inflammation of lungs card, cardi(o): heart cardiology = study of the heart cephal(o): head cephalalgia = headache cerebr(o): cerebrum cerebrospinal = pertaining to the brain and spinal cord
2 Foundations of Resident Care Handout 2-2: Prefixes, Roots, Suffixes Roots (cont’d) chole, chol(o): bile cholecystitis = inflammation of the gall bladder colo: colon colonoscopy = examination of the large intestine or colon with a scope cost(o): rib costochondral = pertaining to a rib crani(o): skull craniotomy = cutting into the skull cyan(o): blue cyanosis = blue, gray, or purple tinge to the skin due to lack of oxygen in the blood cyst(o): bladder, cyst cystitis = inflammation of the bladder derm, derma: skin dermatitis = inflammation of the skin duoden(o): duodenum duodenal = pertaining to the duodenum, the first part of the small intestine
2 Foundations of Resident Care Handout 2-2: Prefixes, Roots, Suffixes Roots (cont’d) encephal(o): brain encephalitis = inflammation of the brain gaster(o), gastro: stomach gastritis = inflammation of the stomach geron: aged gerontology = study of the aged gluco: sweet glucometer = device used to measure blood glucose glyco, glyc: sweet gyneco, gyno: woman gynecology = study of diseases of the female reproductive organs hema, hemato, hemo: blood hematuria = blood in the urine hepato: liver hepatomegaly = enlargement of the liver hyster(o): uterus hysterectomy = surgical removal of the uterus
2 Foundations of Resident Care Handout 2-2: Prefixes, Roots, Suffixes Roots (cont’d) ile(o), ili(o): ileum ileorrhaphy = surgical repair of the ileum laryng(o): larynx laryngectomy = excision of the larynx lymph(o): lymph lymphocyte = type of white blood cell mamm(o): breast mammogram = x-ray of the breast mast(o): breast mastectomy = excision of the breast melan(o): black melanoma = mole or tumor, may be cancerous mening(o): meninges; membranes covering the spinal cord and brain meningitis = inflammation of the membranes of the spinal cord or brain necro: death necrotic = dead tissue
2 Foundations of Resident Care Handout 2-2: Prefixes, Roots, Suffixes Roots (cont’d) nephr(o): kidney nephrectomy = removal of a kidney neur(o): nerve neuritis = inflammation of a nerve onc(o): tumor oncology = study of tumors ophthalm(o): eye ophthalmologist = eye doctor oste(o): bone ot(o): ear otology = science of the ear pharyng(o): pharynx pharyngitis = inflammation of the throat, sore throat phleb(o): vein phlebitis = inflammation of a vein pneo/pnea: breathing tachypnea = rapid breathing pneum: air, gas, respiration pneumonia = inflammation of the lung pod(o): foot
2 Foundations of Resident Care Handout 2-2: Prefixes, Roots, Suffixes Roots (cont’d) proct(o): anus, rectum proctology = study of the rectum pulm(o): lung pulmonary = relating to the lungs splen(o): spleen splenomegaly = enlarged spleen stomat(o): mouth stomatitis = inflammation of mouth therm(o): hot, heat thorac(o): chest thoracotomy = incision into chest wall thromb(o): blood clot thrombus = blood clot blocking a vessel toxic(o), tox(o): poison toxicology = study of poisons trache(o): trachea, windpipe tracheostomy = incision to make an artificial airway urethr(o): urethra urethritis = inflammation of urethra
2 Foundations of Resident Care Handout 2-2: Prefixes, Roots, Suffixes Suffixes -cyte: cell leukocyte = white blood cell -ectomy: excision, removal of splenectomy = removal of spleen -emesis: vomiting hyperemesis = excessive vomiting -emia: blood condition anemia = lack of red blood cells -ism: a condition -itis: inflammation stomatitis = inflammation of the mouth -logy: study of hematology = study of the blood -megaly: enlargement splenomegaly = enlarged spleen -oma: tumor melanoma = mole or tumor, may be cancerous -osis: condition halitosis = bad breath
2 Foundations of Resident Care Handout 2-2: Prefixes, Roots, Suffixes Suffixes (cont’d) -ostomy: creation of an opening ileostomy = creation of an opening into the ileum -otomy: cut into laparotomy = cutting into the abdomen -pathy: disease myopathy = disease of the muscle -penia: lack leukopenia = a lack of white blood cells -phagia: to eat dysphagia = difficulty swallowing -phasia: speaking aphasia = absence of speaking -phobia: exaggerated fear acrophobia = fear of high places -plasty: surgical repair angioplasty = surgical repair of a vessel using a balloon -plegia: paralysis paraplegia = paralysis of lower portion of the body
2 Foundations of Resident Care Handout 2-2: Prefixes, Roots, Suffixes Suffixes (cont’d) -scopy: examination using a scope colonoscopy = examination of the large intestine or colon with a scope -stomy: creation of an opening colostomy = opening into the colon -tomy: incision, cutting into thoracotomy = incision into chest wall -uria: condition of the urine dysuria = painful urination
2 Foundations of Resident Care 1. Understand the importance of verbal and written communications Nursing assistants need to remember these steps for answering the phone at work: • Identify the facility’s name and one’s own name and position. • Place caller on hold if need be. Write down messages. Ask for correct spelling of names. Get a number. • Say, “Thank you,” and “Goodbye.”
2 Foundations of Resident Care 1. Understand the importance of verbal and written communications REMEMBER: It is a violation of confidentiality to give out information about staff or residents over the phone.
2 Foundations of Resident Care 2. Describe barriers to communication Define the following term: clichés phrases that are used over and over again and do not really mean anything.
2 Foundations of Resident Care Transparency 2-3: Barriers to Communication
2 Foundations of Resident Care 2. Describe barriers to communication Think about these questions: What are some examples of slang expressions? Why should slang not be used when communicating with residents?
2 Foundations of Resident Care 2. Describe barriers to communication Think about these questions: Can you imagine what life would be like without communication? Have you ever wasted time and effort because of a miscommunication? When has effective communication resulted in a positive outcome for you?
2 Foundations of Resident Care 2. Describe barriers to communication Define the following term: defense mechanisms unconscious behaviors used to release tension or cope with stress.
2 Foundations of Resident Care 2. Describe barriers to communication All of these defense mechanisms can be barriers to effective communication: • Denial • Projection • Displacement • Rationalization • Repression • Regression
2 Foundations of Resident Care 2. Describe barriers to communication Define the following term: culture a system of learned behaviors, practiced by a group of people, that is considered to be the tradition of that people and is passed on from one generation to the next.
2 Foundations of Resident Care 2. Describe barriers to communication Culture can influence all of these aspects of communication: • Need for distance/personal space • Level of comfort with touch • Meaning of or desire for eye contact
2 Foundations of Resident Care 2. Describe barriers to communication Think about this question: From your own experience, do you know of other examples of how culture influences communication?
2 Foundations of Resident Care 3. List guidelines for communicating with residents with special needs Define the following terms: impairment a loss of function or ability. mental health the normal functioning of emotional and intellectual abilities. mental illness a disorder that affects a person’s ability to function at a normal level in the family, home, or community. combative violent or hostile behavior.
2 Foundations of Resident Care 3. List guidelines for communicating with residents with special needs NAs should remember the following when communicating with residents with hearing impairment: • Make sure hearing aid is on and working. Clean hearing aid as instructed. • Reduce or remove noise. • Get residents’ attention first. • Speak clearly, slowly, and in good lighting. • Do not shout or mouth words in an exaggerated way. • Lower pitch of voice. • Keep hands away from face while talking. • Speak to side with better hearing.
2 Foundations of Resident Care 3. List guidelines for communicating with residents with special needs Communicating with residents with hearing impairment (cont’d): • Use short sentences and simple words. • Repeat what was said using different words if necessary. • Use picture cards or notepads. • Be patient and empathetic. • Ask resident to repeat what was said when necessary. Observe body language. • Be understanding and supportive.
2 Foundations of Resident Care 3. List guidelines for communicating with residents with special needs These techniques are useful in communicating with residents with vision impairment: • Make sure eyeglasses are clean, being worn, and are in good condition. Leave contact lens care to resident if possible. • Identify self when entering room. • Make sure there is proper lighting. Face resident when speaking. • Orient residents to new areas. • Tell resident what you are doing. Talk directly to resident. • Use imaginary clock as a guide. • Do not move items. Put anything you move back where it was found.
2 Foundations of Resident Care 3. List guidelines for communicating with residents with special needs Techniques for communicating with residents with vision impairment (cont’d): • Tell resident where the call light is. • Leave door completely open or closed. • When assisting resident with walking, walk slightly ahead, letting resident grasp your arm. • Encourage use of other senses. • Use large clocks, clocks that chime, or radios. • Offer large-print books, audiobooks, digital books, and Braille books if necessary. • Do not play with guide dogs.
2 Foundations of Resident Care 3. List guidelines for communicating with residents with special needs When working with residents with mental illness it’s important to remember the following: • Do not talk to adults as if they were children. • Use simple, clear statements and a normal tone of voice. • Be sure that what you say and how you say it show respect and concern. • Sit or stand at a normal distance from the resident. Be aware of your body language. • Be honest and direct, as with any resident. • Avoid arguments. • Maintain eye contact and listen carefully.
2 Foundations of Resident Care 3. List guidelines for communicating with residents with special needs REMEMBER: Mental illness is a disorder like any physical disorder. People who are mentally ill cannot just choose to change their behavior and be well.
2 Foundations of Resident Care 3. List guidelines for communicating with residents with special needs When dealing with combative residents, remember these tips: • Block blows or step out of way. • Allow resident time to calm down before next interaction. • Give resident space; stand at least an arm’s length away. • Stay calm. Lower tone of voice. • Be flexible and patient. • Stay neutral. Do not respond to verbal attacks or argue. • Do not use gestures that could frighten or startle resident. • Be reassuring and supportive. • Find out what provoked resident. • Report inappropriate behavior.
2 Foundations of Resident Care 3. List guidelines for communicating with residents with special needs It is difficult to communicate with angry residents. These suggestions will help: • Stay calm. Do not argue or respond to verbal attacks. • Empathize with the resident. • Try to find out what caused the angry reaction. • Be respectful. Explain what you are going to do. • Answer call lights promptly. • Stay at a safe distance.
2 Foundations of Resident Care 3. List guidelines for communicating with residents with special needs When an NA encounters inappropriate behavior it is important to remember the following: • Report behavior. • Be professional and do not overreact. • Try distraction. • Gently direct resident to private area.
2 Foundations of Resident Care 3. List guidelines for communicating with residents with special needs REMEMBER: An NA must never hit a resident, no matter how the resident may have provoked him. Hitting is considered abuse and may result in termination and/or legal action.
2 Foundations of Resident Care 3. List guidelines for communicating with residents with special needs REMEMBER: Residents’ physical and psychological health can depend a great deal on how NAs communicate. NAs should be comforting and kind with residents, and listen if the residents want to talk.
2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies REMEMBER: Prevention is the key to safety. Unsafe conditions should be reported before accidents occur.
2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies Define the following terms: body mechanics the way the parts of the body work together when a person moves. posture the way a person holds and positions his body.
2 Foundations of Resident Care Transparency 2-4: Body Alignment
2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies Principles of body mechanics related to alignment include the following: • Try to keep the body in alignment, with two sides of the body mirror images of each other. • Keep object close when carrying or lifting. • Point feet and body toward the direction you are moving. • Avoid twisting at waist.
2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies These principles of body mechanics relate to a person’s base of support: • Wide base is more stable. • Stand with legs shoulder-width apart.
2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies NAs should remember these points about body mechanics and a person’s center of gravity: • When standing, weight is centered in pelvis. • Low center provides more base of support. • Bend knees when lifting.
2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies As an example of how to apply proper body mechanics, consider this method for lifting a heavy object from the floor: • Spread feet shoulder-width apart. • Bend knees. • Use muscles in thighs, upper arms, and shoulders. • Pull object close to body. • When standing up, push with hip and thigh muscles.
2 Foundations of Resident Care Transparency 2-5: Lifting Heavy Objects from the Floor
2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies Remember these guidelines for using proper body mechanics: • Assess the situation and remove obstacles. • Use both arms and hands to lift, push, or carry objects. • When lifting a heavy object from the floor, spread your feet shoulder-width apart. Bend your knees. Raise your body and the object together. • Hold objects close to you when you are lifting or carrying them. • Push or slide objects, rather than lifting them. • Avoid bending and reaching as much as possible.
2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies Guidelines for using proper body mechanics (cont’d): • If you are making a bed, adjust the height to a safe working level, usually waist high. • When a task requires bending, use a good stance. Bend your knees to lower yourself, rather than bending from the waist. • Avoid twisting at the waist when you are lifting or moving something. Instead, turn your whole body. Your feet should point toward what you are lifting or moving. • Get help from coworkers when possible for lifting or helping residents.
2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies Define the following terms: fracture a broken bone. disorientation confusion about person, place, or time. scalds burns caused by hot liquids. abrasion an injury that rubs off the surface of the skin.
2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies Falls may be caused by • Unsafe environment • Loss of abilities • Disease • Medication • Loss of vision • Gait or balance problems • Weakness • Paralysis • Disorientation
2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies Falls can be prevented in these ways: • Clear walkways. • Use non-skid rugs. • Have resident wear non-skid shoes. • Have resident wear clothing that fits. • Keep frequently-used personal items close. • Answer call lights promptly. • Clean up spills. • Report loose hand rails immediately. • If used, check bed and body alarms to see if they are working.
2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies Fall prevention (cont’d): • Mark hazardous areas. • Improve lighting. • Lock wheelchairs. • Lock bed wheels. • Return beds to lowest positions. • Get help. • Offer toileting assistance and respond to requests promptly. • Leave furniture in same place. • Pay attention to residents at risk for falls.
2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies REMEMBER: An NA should never try to catch a falling resident. This could result in greater harm to both the NA and the resident.
2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies REMEMBER: Report all falls to the nurse.
2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies Burns and scalds are caused by • Dry heat (irons, stoves, other electrical appliances) • Wet heat (hot water or other liquids, steam) • Chemicals (lye, acids)
2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies To help prevent burns and scalds NAs can do the following: • Check water temperature. • Report frayed cords. • Communicate about hot liquids. • Pour hot drinks away from residents. • Keep hot drinks away from edges of tables. Use lids. • Make sure residents are sitting before serving hot drinks. • Monitor heat-producing equipment.
2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies To prevent accidents resulting from not identifying residents properly, NAs should always • Identify each resident before care or feeding. • Check IDs. • Call resident by name.
2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies REMEMBER: Not identifying residents before giving care or serving good can cause serious problems or even death.
2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies Choking is a greater risk when residents are • Weak • Ill • Unconscious
2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies NAs can help prevent choking by • Making sure residents eat in an upright position • Following orders for special diets and thickened liquids
2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies Poisoning occurs when a person ingests a harmful substance. It may be prevented by • Storing harmful substances carefully • Not leaving cleaning products in rooms • Investigating any unusual odors
2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies REMEMBER: It is important to know the phone number for the Poison Control Center. The number should be posted at facilities.
2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies To help prevent cuts and abrasions, NAs should do the following: • Put sharp objects away after use. • Push wheelchairs forward.
2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies Remember these points about Safety Data Sheets (SDSs): • Required by OSHA for all hazardous chemicals • Detail ingredients, dangers, emergency response, safe handling procedures • Sometimes accessed by toll-free number • Must be accessible by all employees
2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies REMEMBER: It is very important that NAs know where SDSs are kept at their facilities and know how to use them.
2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies NAs play an important role in a facility’s fire safety. They must • Make sure smokers are in proper area for smoking. Never leave smokers unattended. Make sure ashtrays do not contain hot ashes before emptying them. Use burn-resistant aprons properly and as instructed. • Report frayed or damaged cords. • Report if fire alarms and exit doors are blocked. • Know how to use fire extinguishers: • Pull the pin. • Aim at the base of fire when spraying. • Squeeze the handle. • Sweep back and forth at the base of fire.
2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies In case of fire at a facility, NAs should remember the following: • Use RACE: • Remove residents from danger. • Activate alarm or call 911. • Contain fire if possible. • Extinguish, or fire department will extinguish. • Know the evacuation plan. • Stay calm. • Follow directions of fire department.
2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies In case of fire at a facility (cont’d): • Know which residents need one-on-one help. • Know differing abilities of residents. • Remove blockage from windows or doors. • Do not use elevators. • Stay low in a room to escape fire. • Check for heat coming from doors. • Stop, drop, and roll if clothing catches fire. • Use damp covering over mouth and nose. • Leave building if possible, then move away from it.
2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies REMEMBER: Electronic cigarettes (e-cigarettes) are becoming more common. They may be allowed at some facilities. They do not contain tobacco. They contain liquid nicotine that is heated and turned into a vapor. Research on e-cigarettes is ongoing and rules and regulations regarding their use may change.
2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies Think about these questions: Are there certain natural disasters that are especially likely to occur in your area? Have you ever experienced this type of disaster? What did you do?
2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies The following guidelines are helpful in any type of disaster: • Listen carefully and follow instructions. • Remain calm. • Know where exits and stairways are. • Know where alarms and extinguishers are. • Learn appropriate action to take. • Stay informed via internet, radio, or TV.
2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies Define the following term: conscious the state of being mentally alert and having awareness of surroundings, sensations, and thoughts.
2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies NAs should memorize these steps for responding to a medical emergency: • Assess the situation. Make sure you are not in danger and note the time. • Assess the victim. Check the victim’s level of consciousness. • Call for help or send someone to get help. • Remain calm and confident. • Properly document the emergency after it is over.
2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies These are signs and symptoms of injury NAs should observe for in an emergency: • Severe bleeding • Changes in consciousness • Irregular breathing • Unusual color or feel to the skin • Swollen places on the body • Medical alert tags • Anything the resident says is painful
2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies Define the following terms: first aid emergency care given immediately to an injured person. cardiopulmonary resuscitation (CPR) medical procedures used when a person’s heart or lungs have stopped working.
2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies REMEMBER: People who are not trained to perform CPR must never attempt to perform it. Not all facilities permit NAs to start CPR, even if they are trained to do so. It is important to know the facility’s policy.
2 Foundations of Resident Care Handout 2-3: CPR Review This handout is not meant to replace a CPR course. The following is a brief review for people who have had CPR training. It is a procedure to use on adults, not children. This may not be the procedure that your facility uses. Follow your facility’s policies and procedures. 1.After making sure that the scene is safe, check whether the person is responsive. Tap the person on the shoulder and shout, “Are you all right?” 2.If there is no response, call 911 immediately or send someone to call 911. Stay calm. 3.After calling 911, get an automated external defibrillator (AED) (if available and if trained in its use). Return to the person to provide CPR. More information on the AED is in step 10. 4.The person should be on his back on a hard surface (if he has no spinal injuries) before CPR is started.
2 Foundations of Resident Care Handout 2-3: CPR Review (cont’d) 5.Open the airway. Tilt the head back slightly. Lift the chin with one hand while pushing down on the forehead with the other hand (head tilt-chin lift method). This method is used if a neck injury is not suspected. 6.Look, listen, and feel for signs of life for no longer than 10 seconds: • Look for the chest to rise and fall. • Listen for sounds of breathing. Put your ear near the person’s nose and mouth. • Feel for the person’s breath on your cheek.
2 Foundations of Resident Care Handout 2-3: CPR Review (cont’d) 7.If you do not detect adequate breathing within 10 seconds, you will have to breathe for the person. Give two rescue breaths. To give rescue breaths, do the following: • Pinch the nose to keep air from escaping. Cover the person’s mouth completely with your mouth. • Blow into the person’s mouth slowly, watching for the chest to rise. Blow one breath for about one second, take a “regular” (not a deep) breath, and give a second rescue breath for about one second. Turn your head to the side to listen for air. If the chest does not rise when you give a rescue breath, reopen the airway using the head tilt-chin lift method. Try to give rescue breaths again.
2 Foundations of Resident Care Handout 2-3: CPR Review (cont’d) 8.After giving rescue breaths, look for signs of circulation. The person may start moving, breathing normally, or coughing. If they do not respond to the rescue breaths, give 30 chest compressions only if you have been trained to do so. Be sure the person is lying flat on a hard surface. To give chest compressions, do the following: • Place the heel of one hand on the sternum (in the center of the person’s chest between the nipples). Place the heel of the other hand on top of the positioned hand. Interlace your fingers. • Position your body directly over your hands. Lock your elbows and shoulders. Look down at your hands. • Use the heels of your hands to give 30 chest compressions. Push in two inches with each compression. Push hard and fast. Allow the chest to recoil completely after each compression. Do not take your hands off the chest between compressions.
2 Foundations of Resident Care Handout 2-3: CPR Review (cont’d) 9. Continue giving CPR in cycles of 30 compressions to two breaths, with five cycles taking about two minutes. Do not stop CPR to recheck anything. Continue until the scene becomes unsafe, the person recovers, paramedics arrive with an AED and take over, help arrives to assist you, or you become too tired to continue. If you do see signs of life, stop compressions. Maintain an open airway. Turn the person onto his side in the recovery position. 10. The automated external defibrillator (AED) may be used together with CPR. The AED is a computerized device that checks a person’s heart rhythm. It is able to recognize a rhythm that requires a shock. The AED uses voice prompts, lights, and text messages to relay instructions to the rescuer. You must be trained in its use. If you are not trained, do not try to use the AED. When medical help arrives, follow their directions. Assist them as necessary.
2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies Define the following terms: obstructed airway a condition in which the tube through which air enters the lungs is blocked. abdominal thrusts method of attempting to remove an object from the airway of someone who is choking.
2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies REMEMBER: A person who is choking usually puts her hands to her throat. As long as a person can speak, breathe, or cough, she should be encouraged to cough as forcefully as possible to get the object out.
Performing abdominal thrusts for the conscious person 1. Stand behind the person and bring your arms under her arms. Wrap your arms around the person’s waist. 2. Make a fist with one hand. Place the flat, thumb side of the fist against the person’s abdomen, above the navel but below the breastbone. 3. Grasp the fist with your other hand. Pull both hands toward you and up, quickly and forcefully.
Performing abdominal thrusts for the conscious person 4. Repeat until the object is pushed out or the person loses consciousness. 5. Report and document the incident properly.
2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies Define the following terms: shock a condition that occurs when organs and tissues in the body do not receive an adequate blood supply. cyanotic skin that is blue or gray.
2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies The following are signs of shock: • Pale or cyanotic skin • Staring • Increased pulse and respiration • Low blood pressure • Extreme thirst
Responding to shock 1. Notify the nurse immediately. Victims of shock should always receive medical care as soon as possible. 2. If you need to control bleeding, put on gloves first. This procedure is described later in the chapter. 3. Have the person lie down on her back. If the person is bleeding from the mouth or vomiting, place her on her side (unless you suspect that the neck, back, or spinal cord is injured). 4. Check pulse and respirations if possible (Chapter 7). Begin CPR if breathing and pulse are absent and if you are trained to do so. 5. Keep the person as calm and comfortable as possible. 6. Maintain normal body temperature. If the weather is cold, place a blanket around the person. If the weather is hot, provide shade.
Responding to shock 7. Elevate the legs about eight to 12 inches unless the person has a head, neck, back, spinal, or abdominal injury, breathing difficulties, or fractures. Elevating the legs allows blood to flow back to the brain (and other vital areas.) Elevate the head and shoulders if a head wound or breathing difficulties are present. Never elevate a body part if the person has a broken bone or if it causes pain.
Responding to shock 8. Do not give the person anything to eat or drink. 9. Report and document the incident properly.
2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies Define the following term: dyspnea difficulty breathing.
2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies The following are signs of a heart attack (myocardial infarction or MI): • Sudden, severe pain in the chest, usually on the left side or in the center behind the sternum • Pain or discomfort in other areas of the body, such as the arms, back, neck, jaw, or stomach • Indigestion or heartburn • Nausea and vomiting • Dyspnea • Dizziness
2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies Signs of a heart attack/MI (cont’d): • Skin color that is pale or cyanotic • Perspiration • Cold and clammy skin • Weak and irregular pulse rate • Low blood pressure • Anxiety and a sense of doom • Denial of a heart problem
2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies Women may have a heart attack without chest pressure or pain. Common symptoms in women include the following: • Shortness of breath • Pressure or pain in the lower chest or abdomen • Dizziness • Lightheadedness • Fainting • Pressure in the upper back • Extreme fatigue • Flu-like symptoms
Responding to a heart attack 1. Notify the nurse immediately. 2. Place the person in a comfortable position. Encourage him to rest. Reassure him that you will not leave him alone. 3. Loosen the clothing around the person’s neck. 4. Do not give the person liquids or food.
Responding to a heart attack 5. Monitor the person’s breathing and pulse. If the person stops breathing or has no pulse, begin CPR if trained and allowed to do so. 6. Stay with the person until help arrives. 7. Report and document the incident properly.
2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies REMEMBER: Severe bleeding must be controlled immediately, but it is still essential that NAs take time to put on gloves before trying to control bleeding.
Controlling bleeding 1. Notify the nurse immediately. 2. Put on gloves. Take time to do this. If the resident is able, he can hold his bare hand over the wound until you can put on gloves. 3. Hold a thick sterile pad, clean cloth, handkerchief, or towel against the wound. 4. Press down hard directly on the bleeding wound until help arrives. Do not decrease pressure. Put additional pads over the first pad if blood seeps through. Do not remove the first pad.
Controlling bleeding 5. If you can, raise the wound above the level of the heart to slow the bleeding. If the wound is on an arm, leg, hand, or foot, and there are no broken bones, prop up the limb. Use towels or other absorbent materials. 6. When bleeding is under control, secure the dressing to keep it in place. Check the person for symptoms of shock (pale skin, increased pulse and respiration rates, low blood pressure, and extreme thirst). Stay with the person until help arrives. 7. Remove and discard gloves. Wash hands thoroughly. 8. Report and document the incident properly.
2 Foundations of Resident Care Handout 2-4: Burns Care of a burn depends on its depth, size, and location. There are three types of burns: first-degree, second- degree, and third-degree burns. First-degree burns involve just the outer layer of skin. The skin becomes red, painful, and swollen, but no blisters occur. Second-degree burns extend from the outer layer of skin to the next deeper layer of skin. The skin is red, painful, and swollen, and blisters appear.
2 Foundations of Resident Care Handout 2-4: Burns (cont’) Third-degree burns involve all three layers of the skin and may extend to the bone. If the nerves are destroyed, no pain occurs. The skin is shiny and appears hard. It may be white in color. Always notify the nurse when a resident is burned. Burns may require emergency help in any of the following situations: • An elderly, ill, or weak person has been burned, unless burn is very minor. • The burn occurs on the head, neck, hands, feet, face, or genitals, or burns cover more than one body part. • The person who has been burned is having trouble breathing. • The burn was caused by chemicals, electricity, or explosion. Chemical burns require special care. Call for help immediately. The chemical must be washed away thoroughly. A shower or a hose may be needed when the burns cover a large area.
2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies REMEMBER: It is very important to do no harm to severe burns, which could later cause infection or damage to skil that could be saved. Do not put ice, ointment, salve, or grease on any burn.
Treating burns To treat a minor burn: 1. Notify the nurse immediately. Put on gloves. 2. Use cool, clean water to decrease the skin temperature and prevent further injury. Do not use ice or ice water, as ice may cause further skin damage. Dampen a clean cloth with cool water. Place it over the burn. 3. Once the pain has eased, you may cover the area with dry, sterile gauze or clean dressing. 4. Remove and discard gloves. Wash your hands. 5. Never use any kind of ointment, salve, or grease on a burn.
Treating burns For more serious burns: 1. Remove the person from the source of the burn. If clothing has caught fire, have the person stop, drop, and roll, or smother the fire with a blanket or towel to put out flames. Protect yourself from the source of the burn. 2. Notify the nurse immediately. Put on gloves. 3. Check for breathing, pulse, and severe bleeding. If the person is not breathing and has no pulse, begin CPR if trained and allowed to do so. 4. Do not use any type of ointment, water, salve, or grease on the burn. 5. Do not try to pull away any clothing from burned areas. Cover the burn with thick, dry, sterile gauze, a clean cloth, or a clean white sheet. A dry, insulated cool pack may be used over the dressing. Take care not to rub the burned area.
Treating burns 6. Ask the person to lie down and elevate the affected part if this does not cause greater pain. 7. Wait for emergency medical help. 8. Remove and discard gloves. Wash your hands. 9. Report and document the incident properly.
2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies Signs and symptoms of fainting include the following: • Dizziness • Nausea • Perspiration • Pale skin • Weak pulse • Shallow respirations • Blackness in visual field
Responding to fainting 1. Notify the nurse immediately. 2. Have the person lie down or sit down before fainting occurs. 3. If the person is in a sitting position, have him bend forward. He can place his head between his knees if he is able. If the person is lying flat on his back, elevate the legs. 4. Loosen any tight clothing. 5. Have the person stay in position for at least five minutes after symptoms disappear.
Responding to fainting 6. Help the person get up slowly. Continue to observe him for symptoms of fainting. Stay with him until he feels better. If you need help but cannot leave the person, use the call light. 7. If a person does faint, lower him to the floor or other flat surface. Position him on his back. Elevate his legs eight to 12 inches. Loosen any tight clothing. Check to make sure the person is breathing. He should recover quickly, but keep him lying down for several minutes. Report the incident to the nurse immediately. 8. Report and document the incident properly. Fainting may be a sign of a more serious medical condition.
2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies Define the following terms: insulin reaction complication of diabetes that can result from either too much insulin or too little food; also known as hypoglycemia. diabetic ketoacidosis (DKA) a complication of diabetes that is caused by having too little insulin; also called hyperglycemia.
2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies Signs and symptoms of insulin reaction include the following: • Hunger • Weakness • Rapid pulse • Headache • Low blood pressure • Perspiration • Cold, clammy skin
2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies Signs and symptoms of insulin reaction (cont’d): • Confusion • Trembling • Nervousness • Blurred vision • Numbness of lips and tongue • Unconsciousness
2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies Signs and symptoms of diabetic ketoacidosis include the following: • Increased thirst • Increased urination • Abdominal pain • Deep or labored breathing • Breath that smells fruity or sweet • Hunger • Headache
2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies Signs and symptoms of diabetic ketoacidosis (cont’d): • Weakness • Rapid, weak pulse • Low blood pressure • Dry skin • Flushed cheeks • Drowsiness • Nausea and vomiting • Air hunger • Unconsciousness
2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies Seizures are involuntary, often violent, contractions of muscles. They can involve a small area or the entire body. Any of the following may cause a seizure: • High fever (especially in young children) • Serious illness (older children and adults) • Head injury • Seizure disorder such as epilepsy
2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies Signs of seizures include the following: • Severe shaking • Thrusting arms and legs uncontrollably • Jaw clenching • Drooling • Inability to swallow
2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies REMEMBER: The primary goal when caring for a resident who is having a seizure is to keep him safe. Do not try to force anything into the mouth of a person who is having a seizure.
Responding to seizures 1. Note the time. Put on gloves. 2. Lower the person to the floor. Loosen clothing to help with breathing. Try to turn the person’s head to one side to help lower the risk of choking. This may not be possible during a violent seizure. 3. Have someone call the nurse immediately or use the call light. Do not leave the person unless you must do so to get medical help. 4. Move furniture away to prevent injury. If a pillow is nearby, place it under his head. 5. Do not try to restrain the person or stop the seizure. 6. Do not force anything between the person’s teeth. Do not place your hands in the person’s mouth for any reason. You could be bitten. 7. Do not give the person liquids or food.
Responding to seizures 8. When the seizure is over, note the time. Gently turn the person to his left side if you do not suspect a head, neck, or spinal injury. This reduces the risk of choking on vomit or saliva. If the person begins to choke, get help immediately. Check for adequate breathing and pulse. Begin CPR if breathing and pulse are absent and if you are allowed and trained to do so. Do not begin CPR during a seizure. 9. Remove and discard gloves. Wash your hands. 10. Report and document the incident properly, including how long the seizure lasted.
2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies Define the following terms: cerebrovascular accident (CVA) a condition that occurs when blood supply to a part of the brain is blocked or a blood vessel leaks or ruptures within the brain; also called stroke. transient ischemic attack (TIA) a warning sign of a CVA/stroke resulting from a temporary lack of oxygen in the brain; symptoms may last up to 24 hours.
2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies The signs that a stroke is occurring include the following: • Facial numbness, weakness, or drooping, especially on one side • Arm numbness or weakness, especially on one side • Slurred speech or inability to speak • Use of inappropriate words • Inability to understand spoken or written words • Redness in face • Noisy breathing • Dizziness
2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies Signs of stroke (cont’d): • Blurred vision • Ringing in ears • Headache • Nausea/vomiting • Seizures • Loss of bowel and bladder control • Paralysis on one side of the body • Elevated blood pressure • Slow pulse rate • Loss of consciousness
2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies Women may experience these additional symptoms in the case of stroke: • Pain in the face, arms, and legs • Hiccups • Weakness • Chest pain • Shortness of breath • Palpitations
2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies The acronym F.A.S.T. is a good reminder of the signs of stroke and what to do in case of stroke: • Face: Is one side of the face drooping? Is it numb? Ask the person to smile. Is the smile uneven? • Arms: Is one arm numb or weak? Ask the person to raise both arms. Check to see if one arm drifts downward. • Speech: Is the person’s speech slurred? Can the person be understood? Ask the person to repeat a simple sentence and see if the sentence is repeated correctly. • Time: Time is very important when responding to a stroke. If the person shows any of the symptoms listed above, get help immediately.
2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies REMEMBER: The websites for the American Stroke Association (strokeassociation.org) and the National Stroke Association (stroke.org) have more information.
2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies Define the following term: emesis the act of vomiting, or ejecting stomach contents through the mouth and/or nose.
Responding to vomiting 1. Notify the nurse immediately. 2. Put on gloves. 3. Make sure the head is up or turned to one side. Place an emesis basin under the chin. Remove it when vomiting has stopped. 4. Remove soiled linens or clothes and set aside. Replace with fresh linens or clothes. 5. If resident’s intake and output (I&O) is being monitored (Chapter 7), measure and note amount of vomitus. 6. Flush vomit down the toilet unless vomit is red, has blood in it, or looks like wet coffee grounds, or if medication/pills are in vomit. If these signs are observed, show this to the nurse before discarding the vomit. After disposing of vomit, wash, dry, and store basin. 7. Remove and discard gloves. 8. Wash your hands. 9. Put on fresh gloves.
Responding to vomiting 10. Provide comfort to resident. Wipe face and mouth. Position comfortably. Offer a drink of water. Provide oral care. It helps get rid of the taste of vomit in the mouth. 11. Put soiled linen in proper containers. 12. Remove and discard gloves. 13. Wash your hands again. 14. Report and document the incident properly. Document time, amount, color, odor, and consistency of vomitus.
2 Foundations of Resident Care Handout 2-5: Nosebleeds A nosebleed can occur suddenly when the air is dry, when injury has occurred, or when a person has taken certain medications. The medical term for a nosebleed is epistaxis. Responding to a nosebleed 1. Notify the nurse immediately. 2. Elevate the head of the bed, or tell the person to remain in a sitting position, leaning forward slightly. Offer tissues or a clean cloth to catch the blood. Do not touch blood or bloody clothes, tissues, or cloths without gloves.
2 Foundations of Resident Care Handout 2-5: Nosebleeds 3. Put on gloves. Apply firm pressure over the bridge of the nose. Squeeze the bridge of the nose with your thumb and forefinger. Have the resident do this until you are able to put on gloves.
2 Foundations of Resident Care Handout 2-5: Nosebleeds 4. Apply pressure until the bleeding stops. 5. Use a cool cloth or ice wrapped in a cloth on the back of the neck, forehead, or upper lip to slow the flow of blood. Never apply ice directly to skin. 6. Remove and discard gloves. Wash your hands. 7. Report and document the incident properly.
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Define the following terms: infection prevention the set of methods practiced in healthcare facilities to prevent and control the spread of disease. microoranism/microbe a living thing or organism that is so small that it can be seen only through a microscope. infection the state resulting from pathogens invading the body and multiplying.
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Define the following terms: pathogens microorganisms that are capable of causing infection and disease. localized infection an infection that is limited to a specific location in the body and has local symptoms. systemic infection an infection that is in the bloodstream and is spread throughout the body, causing general symptoms.
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Define the following terms: healthcare-associated infection (HAI) an infection acquired within a healthcare setting during the delivery of medical care. chain of infection way of describing how disease is transmitted from one being to another. causative agent a pathogenic microorganism that causes disease.
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Define the following terms: reservoir a place where a pathogen lives and grows. portal of exit any body opening on an infected person that allows pathogens to leave. mode of transmission the method of describing how a pathogen travels.
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Define the following terms: direct contact a way of transmitting pathogens through touching the infected person or his or her secretions. indirect contact a way of transmitting pathogens by touching something contaminated by the infected person. portal of entry any body opening on an uninfected person that allows pathogens to enter.
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Define the following terms: mucous membranes the membranes that line body cavities that open to the outside of the body, such as the linings of the mouth, nose, eyes, rectum, or genitals. susceptible host an uninfected person who could get sick. transmission passage or transfer.
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Define the following terms: infectious contagious. medical asepsis refers to practices such as handwashing that reduce, remove, and control the spread of microorganisms. surgical asepsis the state of being free of all microorganisms; also called sterile technique.
2 Foundations of Resident Care Transparency 2-6: The Chain of Infection
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Think about this question: Can you think of an example of each of the six links in the chain of infection?
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices REMEMBER: If even one of the links in the chain of infection is broken - by washing hands, for example - then the spread of infection is stopped.
2 Foundations of Resident Care Handout 2-6: Infection Prevention Definitions Microorganism: Microorganisms are single-celled organisms that only can be viewed with the aid of a microscope. Microorganisms can be divided into five basic categories— bacteria, viruses, fungi, protozoa, and helminths. Most microorganisms are harmless—some are even beneficial. Others are capable of causing infection or disease. Microorganisms are often classified as either pathogenic or nonpathogenic. Nonpathogenic microorganism: A nonpathogenic microorganism is a type of microorganism that does not (is unable to) cause infection or disease. Pathogenic microorganism: A pathogenic microorganism is a type of microorganism that is capable of causing infection or disease; it is also called a pathogen.
2 Foundations of Resident Care Handout 2-6: Infection Prevention Definitions (cont’d) Bacteria: Bacteria are single-celled microorganisms that lack nuclei and organized cell structures. Bacteria can exist independently (on their own) or as parasites, dependent upon a host for life. Bacteria can be found in three basic shapes—round, rod, or spiral. While some bacteria are capable of causing disease, most are non-infectious and many have critical roles in decay, fermentation, and nutrient recycling. Bacteria help people digest food. Some bacteria destroy disease- causing cells, and some produce important vitamins in the gastrointestinal tract. Bacteria also play a role in food processing, such as in the production of yogurt and cheeses. Pathogenic bacteria can cause cell damage or death by producing substances known as toxins. Other cell damage can occur when the host’s immune system produces substances to eliminate bacteria, and these substances damage the infected cells and adjacent cells.
2 Foundations of Resident Care Handout 2-6: Infection Prevention Definitions (cont’d) Virus: Viruses are small packages of DNA or RNA encased in protein shells that invade a cell (host cell) and incorporate themselves into the host cell’s DNA. When the infected host cell begins to produce (replicate) new viral particles, the infected cell dies. Fungi: Fungi are multi-celled or single-celled organisms. They can be pathogenic, causing infections in healthy persons, or opportunistic, causing infections in people with weakened immune systems. Fungi can be nonpathogenic as well, and some types of fungi are even beneficial, such as those used to make antibiotics. A few types of fungi are considered delicacies, such as truffles and edible mushrooms. Yeasts and molds are examples of fungi. Fungi are the most common causes of disease in crops and plants. Fungi receive their nourishment by secreting enzymes that break down surrounding cells. When this happens on living tissue, it is irritating and uncomfortable.
2 Foundations of Resident Care Handout 2-6: Infection Prevention Definitions (cont’d) Parasite: A parasite is an organism that lives on or in an organism of a different species. Infection: An infection occurs when microorganisms enter and multiply within the tissue of a host, causing damage to that tissue. Symptoms may be apparent, or the host may display no symptoms. Disease: A disease occurs when tissue that has been damaged due to the entry and multiplication of microorganisms results in clinical signs and symptoms of a recognizable process. Host: A host is an organism or cell on or in which a microorganism lives or feeds.
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Define the following terms: Centers for Disease Control and Prevention (CDC) a government agency under the U.S. Department of Health and Human Services that issues information to protect the health of individuals and communities. Standard Precautions a method of infection prevention in which all blood, body fluids, non-intact skin, and mucous membranes are treated as if they were infected with an infectious disease. sputum thick mucus coughed up from the lungs. sharps needles or other sharp objects.
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices CDC defines body fluids to include the following: • Saliva • Sputum (mucus coughed up) • Urine • Feces • Semen • Vaginal secretions • Pus or other wound drainage • Vomit
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Think about this question: Why should Standard Precautions be followed on every resident in your care?
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices The following measures are all part of Standard Precautions: • Wash hands. • Wear gloves if you may come into contact with blood, body fluids, or broken skin. • Remove gloves immediately when finished with a procedure. • Immediately wash contaminated skin surfaces. • Wear a disposable gown if you may come into contact with blood or body fluids. • Wear a mask and goggles if splashing or spraying blood or body fluids is likely.
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Standard Precautions (cont’d): • Wear gloves when handling sharp objects. • Never attempt to recap needles or sharps. • Avoid nicks and cuts. • Bag all contaminated supplies. • Clearly label body fluids being saved for a specimen. • Dispose of contaminated waste properly.
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Define the following terms: hand hygiene washing hands with either plain or antiseptic soap and water and using alcohol-based hand rubs. antimicrobial an agent that destroys, resists, or prevents the development of pathogens.
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices REMEMBER: It is very important not to rely only on alcohol-based hand rubs for hand hygiene. Wash hands with antimicrobial soap and water when first arriving at work and any time they are visibly soiled.
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices NAs should wash their hands at these times: • When first arriving at work • Whenever hands are visibly soiled • Before, between, and after all resident contact • Before putting on gloves and after removing gloves • After contact with body fluids, mucous membranes, non-intact skin, or wound dressings
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Times to wash hands (cont’d): • After handling contaminated items • After contact with objects in resident’s room • Before and after touching meal trays or handling food • Before and after feeding residents • Before getting clean linen • Before and after using the toilet • After touching garbage or trash • After picking up things from the floor
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Times to wash hands (cont’d): • After blowing nose, coughing, or sneezing into hands • Before and after eating • After smoking • After touching areas on the body, such as the mouth, face, eyes, hair, ears, or nose • Before and after applying makeup • After any contact with pets/pet care items • Before leaving facility
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices REMEMBER: Handwashing is the single most important thing NAs can do to prevent the spread of disease.
Washing hands (hand hygiene) Equipment: soap, paper towels 1. Turn on water at sink. Keep your clothes dry. 2.Wet hands and wrists thoroughly. 3. Apply soap to hands.
Washing hands (hand hygiene) 4. Keep your hands lower than your elbows and your fingertips down. Rub hands together and fingers between each other to create a lather. Lather all surfaces of wrists, hands, and fingers, using friction for at least 20 seconds. Lather and friction loosen skin oils and allow pathogens to be rinsed away. 5. Clean your nails by rubbing them in palm of your other hand. Most pathogens on hands are under the nails.
Washing hands (hand hygiene) 6. Keep your hands lower than your elbows and your fingertips down. Being careful not to touch the sink, rinse thoroughly under running water. Rinse all surfaces of your wrists, hands, and fingers. Run water down from wrists to fingertips. Do not run water over unwashed arms down to clean hands. Water should run from cleanest to dirtiest. Wrists are cleanest, fingertips dirtiest. 7. Use a clean, dry paper towel to dry all surfaces of your hands, wrists, and fingers. Do not wipe towel on unwashed forearms and then wipe clean hands. Dispose of towel into waste container without touching the container. If your hands touch the sink or wastebasket, start over.
Washing hands (hand hygiene) 8. Use a clean, dry paper towel to turn off the faucet (Fig. 2-28). Dispose of paper towel into waste container. Do not contaminate your hands by touching the surface of the sink or faucet. Hands will be recontaminated if you touch the dirty faucet or sink with clean hands.
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Define the following terms: personal protective equipment (PPE) equipment that helps protect employees from serious workplace injuries or illnesses resulting from contact with workplace hazards. don to put on. doff to remove.
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Define the following terms: perineal care care of the genitals and anal area. non-intact skin skin that is broken by abrasions, cuts, rashes, acne, pimples, lesions, surgical incisions, or boils.
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices REMEMBER: PPE must be worn if an NA could come into contact with body fluids, mucous membranes, or open wounds. Gowns, masks, goggles, or face shields must be worn when splashing or spraying of body fluids or blood could occur.
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Remember these points about gowns: • They protect exposed skin • They prevent soiling of clothing • They should fully cover the torso, and the sleeves should fit snugly
Putting on (donning) and removing (doffing) gown 1. Wash your hands. 2. Open gown. Hold out in front of you and allow gown to open/unfold. Do not shake it (Fig. 2-29). Facing the back opening of the gown, place your arms through each sleeve. 3. Fasten the neck opening.
Putting on (donning) and removing (doffing) gown 4. Reach behind you. Pull the gown until it completely covers your clothing. Secure gown at waist (Fig. 2-30). 5. Use a gown only once and then remove and discard it. If gown becomes wet or soiled during care, remove it. Check clothing. Put on a new gown. OSHA requires non-permeable gowns—gowns that liquids cannot penetrate —when working in a bloody situation.
Putting on (donning) and removing (doffing) gown 6. Put on your gloves after putting on gown. The cuffs of gloves should overlap the cuffs of the gown (Fig. 2-31).
Putting on (donning) and removing (doffing) gown 7. When removing a gown, remove and discard gloves properly (see procedure later in the chapter). Unfasten gown at neck and waist. Remove the gown without touching the outside of gown. Roll the dirty side in, while holding gown away from your body. Dispose of gown properly and wash your hands. Rolling puts dirtiest surface inward, lessening the risk of contamination.
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Remember these points about masks and goggles: • Masks are worn when the resident has a respiratory illness. • Masks should fully cover the nose and mouth. • Masks should fit snugly over nose and mouth. • It is important to change masks between residents. • Goggles should fit snugly over eyes or eyeglasses.
Putting on (donning) mask and goggles 1. Wash your hands. 2. Pick up mask by top strings or elastic strap. Do not touch mask where it touches your face. 3. Pull elastic strap over your head, or if mask has strings, tie top strings first, then bottom strings. Do not wear a mask hanging from only the bottom tie or strap. Masks must always be dry or they must be replaced. 4. Pinch the metal strip at the top of the mask (if part of mask) tightly around your nose so that it feels snug.
Putting on (donning) mask and goggles 5. Put on the goggles over your eyes or eyeglasses. Use the headband to secure them to your head. Make sure they are on snugly. 6. Put on gloves after putting on mask and goggles.
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Gloves should be worn in all of the following situations: • If you might touch blood or any body fluid • During mouth care or care of any mucous membrane • During perineal care • When providing personal care on non-intact skin • When providing personal care if NA has cuts on hands • When shaving resident • When disposing of soiled linens, gowns, dressings, and pads • • When touching contaminated surfaces or equipment
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Gloves should be changed • Immediately before contact with mucous membranes or broken skin • If gloves become soiled, torn, or damaged
Putting on (donning) gloves 1. Wash your hands. 2. If you are right-handed, slide one glove on your left hand (reverse if left- handed). 3. Using your gloved hand, slide the other hand into the second glove. 4. Interlace fingers. Smooth out folds and create a comfortable fit. 5. Carefully look for tears, holes, or spots. Replace the glove if needed. 6. If wearing a gown, pull the cuff of the gloves over the sleeves of the gown.
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Gloves should be removed • After use • Before caring for another resident • Before touching non-contaminated items or surfaces
Removing (doffing) gloves 1. Touch only the outside of one glove. With one gloved hand, grasp the other glove at the palm and pull the glove off (Fig. 2-34). 2. With the fingertips of your gloved hand, hold the glove you just removed. With your ungloved hand, slip two fingers underneath cuff of the remaining glove at wrist. Do not touch any part of the outside of glove (Fig. 2-35). The outside of the glove is contaminated.
Removing (doffing) gloves 3. Pull down, turning this glove inside out and over the first glove as you remove it. 4. You should now be holding one glove from its clean inner side. The other glove should be inside it. 5. Drop both gloves into the proper container without contaminating yourself. 6. Wash your hands.
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Define the following terms: clean in health care, a condition in which objects are not contaminated with pathogens. dirty in health care, a condition in which objects have been contaminated with pathogens. sterilization a method used to decrease the spread of pathogens and disease by destroying all microorganisms, including those that form spores.
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Define the following terms: disinfection process that kills pathogens, but not all pathogens; it reduces the pathogen count to a level that is considered not infectious. disposable only to be used once and then discarded.
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices The following are guidelines for equipment, linen, and clothing: • Prevent skin/mucous membrane contact. • Prevent contamination of clothing. • Prevent transfer of disease to other residents or environments. • Do not use reusable equipment until it has been cleaned properly. • Dispose of all single-use equipment properly.
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Guidelines for equipment, linen, and clothing (cont’d): • Clean and disinfect all environmental surfaces, beds, bedrails, bedside equipment, and all frequently touched surfaces (doorknobs and call lights are good examples). • Handle, transport, and process soiled linens and clothing in a way that prevents skin and mucous membrane exposure, contamination of clothing (hold linen away from uniform), and transfer of disease to other residents and environments. • Bag soiled linen at point of origin. • Sort soiled linen away from resident care areas. • Place wet linen in leakproof bags.
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices It is important to follow these guidelines for cleaning spills involving blood, body fluids, or glass: • Put on gloves (industrial strength). • Use proper product to absorb spill. • Scoop up absorbed spill and dispose of it in designated container. • Apply disinfectant. • Use proper cleaning solution. • Use tools, never hands, to pick up glass. • Properly bag waste.
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices REMEMBER: Spills should be absorbed and removed without placing disinfectant directly on the fluid.
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Define the following term: Transmission-Based Precautions method of infection prevention used when caring for persons who are infected or suspected of being infected with a disease.
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices REMEMBER: Transmission-Based Precautions are always used in addition to Standard Precautions.
2 Foundations of Resident Care Transparency 2-7: Airborne Diseases
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Remember these facts about airborne diseases: • Transmitted through the air after being expelled • Can remain floating for some time • Examples include tuberculosis (TB), measles, and chickenpox • Precautions include • Face mask • Gown • Handwashing • Proper ventilation
2 Foundations of Resident Care Transparency 2-8: Droplet Diseases
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Remember these facts about droplet diseases: • Can be spread by coughing, sneezing, talking, laughing, or suctioning • Mumps are one example • Precautions include • Face mask • Covering nose and mouth when sneezing or coughing • Handwashing
2 Foundations of Resident Care Transparency 2-9: Contact Diseases
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Remember these facts about contact diseases: • Spread by touching skin, wound, or infection • Examples include conjunctivitis (pink eye), C. diff., lice, scabies • Precautions include • Handwashing with antimicrobial soap • Not touching infected surfaces without gloves • Not touching uninfected surfaces with contaminated gloves • Not sharing towels, linens, or clothing • Using disposable equipment when possible
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Guidelines for isolation include the following: • Transmission-Based Precautions are always used in addition to Standard Precautions. • Use PPE as instructed. Do not wear PPE outside resident’s room and perform hand hygiene following removal of PPE. • Do not share equipment between residents. • Wear proper PPE when serving food and drink. • Follow Standard Precautions in dealing with body waste removal. • Wear proper PPE if required to take specimen. • Reassure residents that the disease, not the person, is being isolated.
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Define the following terms: bloodborne pathogens microorganisms found in human blood, body fluid, draining wounds, and mucous membranes that can cause infection and disease in humans. hepatitis inflammation of the liver caused by certain viruses and other factors, such as alcohol abuse, some medications, and trauma. Tuberculosis (TB) a highly contagious lung disease caused by a bacterium that is carried on mucous droplets suspended in the air.
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Define the following terms: Methicillin-resistant Staphylococcus aureus (MRSA) an infection caused by specific bacteria that have become resistant to many antibiotics. Vancomycin-resistant enterococcus (VRE) bacteria (enterococci) that have developed resistance to antibiotics as a result of being exposed to the antibiotic vancomycin. Clostridium difficile (C. diff, C. difficile) bacterial illness that can cause diarrhea and colitis.
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Bloodborne diseases can be spread in these ways: • Contact with infected blood • Contact with infected semen or vaginal secretions contacting mucous membranes • Sexual contact with an infected person • Sharing needles with an infected person • From infected mothers to their babies • Contact with infected blood or certain other body fluids in healthcare setting
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices REMEMBER: Standard Precautions, handwashing, isolation, and use of PPE can all help prevent the spread of bloodborne diseases.
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices There are two common types of hepatitis: • Hepatitis B is transmitted through contaminated blood or needles or by sexual contact with an infected person. Discuss the vaccine. • Hepatitis C is transmitted through blood and possibly sexual intercourse.
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices REMEMBER: Employers must offer NAs a free vaccine to protect them from hepatitis B. NAs should take the vaccine when it is offered.
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices It is important to follow these guidelines when a resident has TB: • Follow Standard Precautions and Airborne Precautions. • Wear PPE as instructed. • Handle sputum or phlegm carefully. • Ensure proper ventilation. • If resident is in AIIR isolation room, open and close door slowly. • Follow isolation procedures if ordered. • Help resident remember to take medications.
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices There are two different types of MRSA: • Hospital-associated MRSA (HA-MRSA) • Community-associated MRSA (CA-MRSA)
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices MRSA can be spread by • Direct contact • Indirect contact
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices REMEMBER: Proper handwashing is the single most important measure to control the spread of MRSA.
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices VRE is spread by • Direct contact • Indirect contact
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices REMEMBER: Prevention of VRE is very important. Proper handwashing is an important part of prevention.
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices C. Difficile is spread • By spores via direct contact • When intestinal flora is altered due to enemas, nasogastric tubes, GI tract surgery, and overuse of antibiotics
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices REMEMBER: Proper handwashing and proper handling of wastes can help prevent C. Diff. Hand sanitizers are not effective in preventing the spread of this disease. Soap and water must be used each time hand hygiene is performed.
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices The following are employers’ responsibilities regarding infection prevention: • Establish procedures and exposure control plan. • Provide in-service education. • Have written procedures for exposures. • Provide proper PPE. • Provide HBV vaccination.
2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices The following are employees’ responsibilities regarding infection prevention: • Follow Standard Precautions. • Follow facility’s policies and procedures. • Follow care plans and assignments. • Use PPE. • Take advantage of free hepatitis B vaccine. • Report any exposure immediately. • Participate in education programs.

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Foundations of resident care

  • 1. 2 Foundations of Resident Care 1. Understand the importance of verbal and written communications Define the following terms: communication the process of exchanging information with others by sending and receiving messages. verbal communication communication involving the use of spoken or written words or sounds. nonverbal communication communicating without using words.
  • 2. 2 Foundations of Resident Care Transparency 2-1: Body Language
  • 3. 2 Foundations of Resident Care 1. Understand the importance of verbal and written communications Think about these questions: Can you think of a situation where someone was sending one message with verbal communication and a completely different message with nonverbal communication? How can an NA use observation as a form of nonverbal communication with a resident? Can you think of an example of how an NA would use verbal or nonverbal communication to reach a specific goal?
  • 4. 2 Foundations of Resident Care 1. Understand the importance of verbal and written communications REMEMBER: When caring for residents, NAs should speak in a language residents can understand or find someone who speaks the resident’s language. Never use a language the resident does not understand when speaking to staff in front of the resident.
  • 5. 2 Foundations of Resident Care 1. Understand the importance of verbal and written communications How might an NA give an oral report of the following situations? • Resident falls • Resident complains of chest pain • Resident complains of severe headache • Resident is having difficulty breathing • NA observes abnormal pulse, respiration, or blood pressure • Change in resident’s mental status
  • 6. 2 Foundations of Resident Care 1. Understand the importance of verbal and written communications How might an NA give an oral report of the following situations? (cont’d) • Resident experiences sudden weakness or loss of mobility • NA finds resident has high fever • Loss of or change in resident’s consciousness • Resident is bleeding • Change in resident’s condition • Resident shows signs of abuse
  • 7. 2 Foundations of Resident Care 1. Understand the importance of verbal and written communications When communicating with residents the NA should • Always greet the resident by his or her preferred name. • Identify himself. • Focus on the topic to be discussed. • Face the resident while speaking and avoid talking into space. • Talk with the resident, not other staff members, while giving care.
  • 8. 2 Foundations of Resident Care 1. Understand the importance of verbal and written communications When communicating with residents the NA should (cont’d) • Listen and respond when the resident speaks. • Praise the resident and smile often. • Encourage the resident to interact with him and others. • Be courteous. • Tell the resident when he is leaving the room.
  • 9. 2 Foundations of Resident Care 1. Understand the importance of verbal and written communications REMEMBER: When communicating with residents it is important to use the name the resident prefers. NAs should not use residents’ first names unless the resident has asked them to do so.
  • 10. 2 Foundations of Resident Care 1. Understand the importance of verbal and written communications Define the following terms: objective information information based on what a person sees, hears, touches, or smells; also called signs. subjective information information that a person cannot or did not observe, but is based on something reported to the person that may or may not be true; also called symptoms. incontinence the inability to control the bladder or bowels.
  • 11. 2 Foundations of Resident Care Transparency 2-2: Using Your Senses
  • 12. 2 Foundations of Resident Care 1. Understand the importance of verbal and written communications Define the following terms: root the part of a word that contains its basic meaning. prefix the word part that comes before the root to help form a new word. suffix the word part added to the end of a root that helps form a new word.
  • 13. 2 Foundations of Resident Care Handout 2-1: Abbreviations a before AAROM active-assistive range of motion abd abdomen ABR absolute bedrest ac, a.c. before meals AD Alzheimer’s disease ADC AIDS dementia complex ad lib as desired ADLs activities of daily living adm. admission AED automated external defribrillator AHA American Heart Association AIDS acquired immune deficiency syndrome am, AM morning AMA against medical advice, American Medical Association amb ambulate, ambulatory AMD age-related macular degeneration amt. amount ANS autonomic nervous system ant. anterior a.p./AP apical pulse approx. approximately AROM active range of motion ASAP as soon as possible assist assistance as tol as tolerated A, T, D admission, transfer, and discharge
  • 14. 2 Foundations of Resident Care Handout 2-1: Abbreviations BKA below-knee amputation bld blood BLS basic life support BM bowel movement BP, B/P blood pressure BPH benign prostatic hypertrophy BPM beats per minute BR bedrest BRP bathroom privileges BSC bedside commode BSE breast self examination C centigrade, Celsius c with Ca/CA calcium, cancer, carcinoma CBI continuous bladder irrigation CBR complete bedrest CCMS clean-catch midstream CDC Centers for Disease Control and Prevention CDE certified diabetes educator C. diff clostridium difficile CEP competency evaluation (testing) programs CEU continuing education unit CHD coronary heart disease CHF congestive heart failure chol cholesterol ck check
  • 15. 2 Foundations of Resident Care Handout 2-1: Abbreviations CMS Centers for Medicare and Medicaid Services CNA certified nursing assistant CNP certified nurse practitioner CNS central nervous system c/o complains of, in care of CO2 carbon dioxide COLD chronic obstructive lung disease COPD chronic obstructive pulmonary disease CP cerebral palsy CPM continuous passive motion CPR cardiopulmonary resuscitation CRF chronic renal failure C.S. Central Supply CVA cerebrovascular accident, stroke CVP central venous pressure CVS cardiovascular system CXR chest x-ray DAT diet as tolerated DJD degenerative joint disease DKA diabetic ketoacidosis DM diabetes mellitus DNR do not resuscitate DO doctor of osteopathy DOA dead on arrival DOB date of birth DON director of nursing Dr. doctor
  • 16. 2 Foundations of Resident Care Handout 2-1: Abbreviations ECG, EKG electrocardiogram ED emergency department EENT eye, ear, nose, and throat e.g. for example EMS emergency medical services ER emergency room ESRD end-stage renal disease et al. and other things ETOH alcohol exam examination F Fahrenheit, female FBS fasting blood sugar FDA Food and Drug Administration Fe iron FS fingerstick FSBS fingerstick blood sugar ft foot F/U, f/u follow-up FUO fever of unknown origin FWB full weight-bearing fx fracture FYI for your information g gram GAD generalized anxiety disorder gal gallon GB gallbladder GERD gastroesophageal reflux disease geri chair geriatric chair
  • 17. 2 Foundations of Resident Care Handout 2-1: Abbreviations GU genitourinary GYN/gyn gynecology h, hr, hr. hour H20 water H202 hydrogen peroxide H/A headache HAART highly active anti-retroviral therapy H&P history and physical HAV hepatitis A virus HBV hepatitis B virus HCV hepatitis C virus HDV hepatitis D virus HEV hepatitis E virus Hg mercury HIV human immunodeficiency virus HMO health maintenance organization HOB head of bed HOH hard of hearing HPV human papillomavirus HS/hs hours of sleep ht height HTN hypertension H.U.C. Health Unit Coordinator Hx history hyper above normal, too fast, rapid hypo low, less than normal I&D incision and drainage I&O intake and output
  • 18. 2 Foundations of Resident Care Handout 2-1: Abbreviations ICU intensive care unit ID identification i.e. that is IICU intermediate intensive care unit IM intramuscular in inch inc incontinent inf inferior IQ intelligence quotient irr., irrig irrigation isol isolation I.V., IV intravenous K potassium kg kilogram lab laboratory lb pound LBP low back pain LE lower extremity lg large liq liquid LLE left lower extremity LLQ left lower quadrant LOC level of consciousness, level of care Low-cal low-calorie Low-fat/ low-fat, low-calorie Low-cal Low-Na low-sodium LPN Licensed Practical Nurse
  • 19. 2 Foundations of Resident Care Handout 2-1: Abbreviations LVN Licensed Vocational Nurse M.D. medical doctor MD muscular dystrophy MDROs multidrug-resistant organisms MDR-TB multidrug-resistant tuberculosis MDS minimum data set meds medications med-surg medical-surgical mg milligram MI myocardial infarction min minute mL milliliter mm millimeter mm Hg millimeters of mercury MRI magnetic resonance imaging MRSA methicillin-resistant staphylococcus aureus MS multiple sclerosis MSDs musculoskeletal disorders MSDS material safety data sheet MSW medical social worker MUFA monounsaturated fat MVA motor vehicle accident Na sodium N/A not applicable NA nursing assistant NaCl sodium chloride NAS no added salt NATCEP Nurse Aide Training and
  • 20. 2 Foundations of Resident Care Handout 2-1: Abbreviations neg negative NF nursing facility NG, ng nasogastric NIBP non-invasive blood pressure monitoring NKA no known allergies NKDA no known drug allergies no number noc night NPO nothing by mouth NVD nausea, vomiting, and diarrhea NWB non-weight-bearing O2 oxygen O&P ova and parasites occ occasionally OCD obsessive-compulsive disorder OD overdose O.D. right eye OG orogastric OOB out of bed OPD outpatient department O.R. operating room ord. orderly, ordered ORIF open reduction, internal fixation ortho orthopedics os mouth O.S. left eye OSHA Occupational Safety and Health Administration
  • 21. 2 Foundations of Resident Care Handout 2-1: Abbreviations OTC over-the-counter (medication) O.U. both eyes oz ounce p after P.A. physician’s assistant PAD peripheral artery disease pc, p.c. after meals PCA patient-controlled anesthesia PDR Physician’s Desk Reference PE pulmonary embolism Peds/peds pediatrics PEG percutaneous endoscopic gastrostomy peri care perineal care PET positron emission tomography pH parts hydrogen PH past history PHI protected health information phy. ex. physical exam PID pelvic inflammatory disease PM/pm afternoon PMH past medical history PNS peripheral nervous system PO (per os) by mouth pos. positive post op after surgery PPD purified protein derivative (test for tuberculosis) PPE personal protective equipment
  • 22. 2 Foundations of Resident Care Handout 2-1: Abbreviations p.r.n., prn when necessary prog. Progress PROM passive range of motion Pt/pt patient pt. pint PT physical therapist, physical therapy PTH parathyroid hormone PTSD post-traumatic stress disorder PUFA polyunsaturated fat PVD peripheral vascular disease PWB partial weight-bearing q every q2h, q3h, every two hours, q4h every three hours, Q&A questions and answers qd every day qh, qhr every hour qhs every night at bedtime q.o.d. every other day qt. quart quad quadrant, quadriplegic R respirations, rectal R, rt. right RA rheumatoid arthritis RBC red blood cell RDT registered dietician reg. regular rehab rehabilitation
  • 23. 2 Foundations of Resident Care Handout 2-1: Abbreviations RLQ right lower quadrant RN registered nurse RNA restorative nursing assistant R/O rule out ROM range of motion RR respiratory rate RT respiratory therapy/therapist RUE right upper extremity RUQ right upper quadrant Rx prescription, treatment s without S&A sugar and acetone S&S, S/S signs and symptoms s.c. subcutaneously sl sublingually SLE systemic lupus erythematosus SLP speech-language pathologist sm. small SNAFU situation normal, all fouled up (slang) SNF skilled nursing facility SNS somatic nervous system SOB shortness of breath SP Standard Precautions S.P.D. Supply, Processing, and Distribution spec. specimen ss one-half SSE soapsuds enema ST standard, speech therapy
  • 24. 2 Foundations of Resident Care Handout 2-1: Abbreviations STAT/stat immediately Std prec Standard Precautions STDs sexually-transmitted diseases STIs sexually-transmitted infections strep streptococcus supp. suppository surg. surgery T., temp temperature TB tuberculosis tbsp. tablespoon T, C, DB turn, cough, and deep breathe THR total hip replacement TIA transient ischemic attack t.i.d., tid three times a day TPN total parenteral nutrition T.P.R. temperature, pulse, and respiration trach. tracheostomy tsp. teaspoon TWE tap water enema Tx, tx traction, treatment U/A, u/a urinalysis UE upper extremity UGI upper gastrointestinal UNK, unk unknown URI upper respiratory infection US ultrasound USDA United States Department of Agriculture UTI urinary tract infection
  • 25. 2 Foundations of Resident Care Handout 2-1: Abbreviations VD venereal disease VRE vancomycin-resistant enterococcus VS, vs vital signs W/A, WA while awake WBC white blood cell/count w/c, W/C wheelchair WNL within normal limits wt. weight yr. year
  • 26. 2 Foundations of Resident Care Handout 2-2: Prefixes, Roots, Suffixes Prefixes a, an: without, not, lack of analgesic = without pain ante: before, in front of antepartum = before delivery bi: two, twice, double bifocal = two lenses brady: slow bradycardia = slow pulse, heartbeat contra: against contraceptive = prevents pregnancy dis: apart, free from dys: bad, painful dysuria = painful urination endo: inner endoscope = instrument for examining the inside of an organ epi: on, upon, over epidermis = outer layer of skin erythro: red erythrocyte = red blood cell ex: out, away from exhale = to breathe out hemi: half hemisphere = one of two parts of the brain
  • 27. 2 Foundations of Resident Care Handout 2-2: Prefixes, Roots, Suffixes Prefixes (cont’d) hyper: too much, high hypertension = high blood pressure hypo: below, under hypotension = low blood pressure inter: between, within interdisciplinary = between disciplines leuk: white leukocyte = white blood cell mal: bad, illness, disorder malformed = badly made micro: small olig: small, scant oliguria = small amount of urine patho: disease, suffering pathology = study of disease per: by, through perforate = to make a hole through peri: around pericardium = sac around the heart poly: many, much polyuria = much urine post: after, behind postmortem = period after death
  • 28. 2 Foundations of Resident Care Handout 2-2: Prefixes, Roots, Suffixes Prefixes (cont’d) pre: before, in front of prenatal = period before birth sub: under, beneath subcutaneous = beneath the skin supra: above, over suprapelvic = located above the pelvis tachy: swift, fast, rapid tachycardia = rapid heartbeat
  • 29. 2 Foundations of Resident Care Handout 2-2: Prefixes, Roots, Suffixes Roots abdomin(o): abdomen abdominal = pertaining to the abdomen aden(o): gland adenitis = inflammation of a gland angi(o): vessel angioplasty = surgical repair of a vessel using a balloon arterio: artery arteriosclerosis = hardening of artery walls arthr(o): joint brachi(o): arm brachial = pertaining to the arm bronchi, bronch(o): bronchus bronchopneumonia = inflammation of lungs card, cardi(o): heart cardiology = study of the heart cephal(o): head cephalalgia = headache cerebr(o): cerebrum cerebrospinal = pertaining to the brain and spinal cord
  • 30. 2 Foundations of Resident Care Handout 2-2: Prefixes, Roots, Suffixes Roots (cont’d) chole, chol(o): bile cholecystitis = inflammation of the gall bladder colo: colon colonoscopy = examination of the large intestine or colon with a scope cost(o): rib costochondral = pertaining to a rib crani(o): skull craniotomy = cutting into the skull cyan(o): blue cyanosis = blue, gray, or purple tinge to the skin due to lack of oxygen in the blood cyst(o): bladder, cyst cystitis = inflammation of the bladder derm, derma: skin dermatitis = inflammation of the skin duoden(o): duodenum duodenal = pertaining to the duodenum, the first part of the small intestine
  • 31. 2 Foundations of Resident Care Handout 2-2: Prefixes, Roots, Suffixes Roots (cont’d) encephal(o): brain encephalitis = inflammation of the brain gaster(o), gastro: stomach gastritis = inflammation of the stomach geron: aged gerontology = study of the aged gluco: sweet glucometer = device used to measure blood glucose glyco, glyc: sweet gyneco, gyno: woman gynecology = study of diseases of the female reproductive organs hema, hemato, hemo: blood hematuria = blood in the urine hepato: liver hepatomegaly = enlargement of the liver hyster(o): uterus hysterectomy = surgical removal of the uterus
  • 32. 2 Foundations of Resident Care Handout 2-2: Prefixes, Roots, Suffixes Roots (cont’d) ile(o), ili(o): ileum ileorrhaphy = surgical repair of the ileum laryng(o): larynx laryngectomy = excision of the larynx lymph(o): lymph lymphocyte = type of white blood cell mamm(o): breast mammogram = x-ray of the breast mast(o): breast mastectomy = excision of the breast melan(o): black melanoma = mole or tumor, may be cancerous mening(o): meninges; membranes covering the spinal cord and brain meningitis = inflammation of the membranes of the spinal cord or brain necro: death necrotic = dead tissue
  • 33. 2 Foundations of Resident Care Handout 2-2: Prefixes, Roots, Suffixes Roots (cont’d) nephr(o): kidney nephrectomy = removal of a kidney neur(o): nerve neuritis = inflammation of a nerve onc(o): tumor oncology = study of tumors ophthalm(o): eye ophthalmologist = eye doctor oste(o): bone ot(o): ear otology = science of the ear pharyng(o): pharynx pharyngitis = inflammation of the throat, sore throat phleb(o): vein phlebitis = inflammation of a vein pneo/pnea: breathing tachypnea = rapid breathing pneum: air, gas, respiration pneumonia = inflammation of the lung pod(o): foot
  • 34. 2 Foundations of Resident Care Handout 2-2: Prefixes, Roots, Suffixes Roots (cont’d) proct(o): anus, rectum proctology = study of the rectum pulm(o): lung pulmonary = relating to the lungs splen(o): spleen splenomegaly = enlarged spleen stomat(o): mouth stomatitis = inflammation of mouth therm(o): hot, heat thorac(o): chest thoracotomy = incision into chest wall thromb(o): blood clot thrombus = blood clot blocking a vessel toxic(o), tox(o): poison toxicology = study of poisons trache(o): trachea, windpipe tracheostomy = incision to make an artificial airway urethr(o): urethra urethritis = inflammation of urethra
  • 35. 2 Foundations of Resident Care Handout 2-2: Prefixes, Roots, Suffixes Suffixes -cyte: cell leukocyte = white blood cell -ectomy: excision, removal of splenectomy = removal of spleen -emesis: vomiting hyperemesis = excessive vomiting -emia: blood condition anemia = lack of red blood cells -ism: a condition -itis: inflammation stomatitis = inflammation of the mouth -logy: study of hematology = study of the blood -megaly: enlargement splenomegaly = enlarged spleen -oma: tumor melanoma = mole or tumor, may be cancerous -osis: condition halitosis = bad breath
  • 36. 2 Foundations of Resident Care Handout 2-2: Prefixes, Roots, Suffixes Suffixes (cont’d) -ostomy: creation of an opening ileostomy = creation of an opening into the ileum -otomy: cut into laparotomy = cutting into the abdomen -pathy: disease myopathy = disease of the muscle -penia: lack leukopenia = a lack of white blood cells -phagia: to eat dysphagia = difficulty swallowing -phasia: speaking aphasia = absence of speaking -phobia: exaggerated fear acrophobia = fear of high places -plasty: surgical repair angioplasty = surgical repair of a vessel using a balloon -plegia: paralysis paraplegia = paralysis of lower portion of the body
  • 37. 2 Foundations of Resident Care Handout 2-2: Prefixes, Roots, Suffixes Suffixes (cont’d) -scopy: examination using a scope colonoscopy = examination of the large intestine or colon with a scope -stomy: creation of an opening colostomy = opening into the colon -tomy: incision, cutting into thoracotomy = incision into chest wall -uria: condition of the urine dysuria = painful urination
  • 38. 2 Foundations of Resident Care 1. Understand the importance of verbal and written communications Nursing assistants need to remember these steps for answering the phone at work: • Identify the facility’s name and one’s own name and position. • Place caller on hold if need be. Write down messages. Ask for correct spelling of names. Get a number. • Say, “Thank you,” and “Goodbye.”
  • 39. 2 Foundations of Resident Care 1. Understand the importance of verbal and written communications REMEMBER: It is a violation of confidentiality to give out information about staff or residents over the phone.
  • 40. 2 Foundations of Resident Care 2. Describe barriers to communication Define the following term: clichés phrases that are used over and over again and do not really mean anything.
  • 41. 2 Foundations of Resident Care Transparency 2-3: Barriers to Communication
  • 42. 2 Foundations of Resident Care 2. Describe barriers to communication Think about these questions: What are some examples of slang expressions? Why should slang not be used when communicating with residents?
  • 43. 2 Foundations of Resident Care 2. Describe barriers to communication Think about these questions: Can you imagine what life would be like without communication? Have you ever wasted time and effort because of a miscommunication? When has effective communication resulted in a positive outcome for you?
  • 44. 2 Foundations of Resident Care 2. Describe barriers to communication Define the following term: defense mechanisms unconscious behaviors used to release tension or cope with stress.
  • 45. 2 Foundations of Resident Care 2. Describe barriers to communication All of these defense mechanisms can be barriers to effective communication: • Denial • Projection • Displacement • Rationalization • Repression • Regression
  • 46. 2 Foundations of Resident Care 2. Describe barriers to communication Define the following term: culture a system of learned behaviors, practiced by a group of people, that is considered to be the tradition of that people and is passed on from one generation to the next.
  • 47. 2 Foundations of Resident Care 2. Describe barriers to communication Culture can influence all of these aspects of communication: • Need for distance/personal space • Level of comfort with touch • Meaning of or desire for eye contact
  • 48. 2 Foundations of Resident Care 2. Describe barriers to communication Think about this question: From your own experience, do you know of other examples of how culture influences communication?
  • 49. 2 Foundations of Resident Care 3. List guidelines for communicating with residents with special needs Define the following terms: impairment a loss of function or ability. mental health the normal functioning of emotional and intellectual abilities. mental illness a disorder that affects a person’s ability to function at a normal level in the family, home, or community. combative violent or hostile behavior.
  • 50. 2 Foundations of Resident Care 3. List guidelines for communicating with residents with special needs NAs should remember the following when communicating with residents with hearing impairment: • Make sure hearing aid is on and working. Clean hearing aid as instructed. • Reduce or remove noise. • Get residents’ attention first. • Speak clearly, slowly, and in good lighting. • Do not shout or mouth words in an exaggerated way. • Lower pitch of voice. • Keep hands away from face while talking. • Speak to side with better hearing.
  • 51. 2 Foundations of Resident Care 3. List guidelines for communicating with residents with special needs Communicating with residents with hearing impairment (cont’d): • Use short sentences and simple words. • Repeat what was said using different words if necessary. • Use picture cards or notepads. • Be patient and empathetic. • Ask resident to repeat what was said when necessary. Observe body language. • Be understanding and supportive.
  • 52. 2 Foundations of Resident Care 3. List guidelines for communicating with residents with special needs These techniques are useful in communicating with residents with vision impairment: • Make sure eyeglasses are clean, being worn, and are in good condition. Leave contact lens care to resident if possible. • Identify self when entering room. • Make sure there is proper lighting. Face resident when speaking. • Orient residents to new areas. • Tell resident what you are doing. Talk directly to resident. • Use imaginary clock as a guide. • Do not move items. Put anything you move back where it was found.
  • 53. 2 Foundations of Resident Care 3. List guidelines for communicating with residents with special needs Techniques for communicating with residents with vision impairment (cont’d): • Tell resident where the call light is. • Leave door completely open or closed. • When assisting resident with walking, walk slightly ahead, letting resident grasp your arm. • Encourage use of other senses. • Use large clocks, clocks that chime, or radios. • Offer large-print books, audiobooks, digital books, and Braille books if necessary. • Do not play with guide dogs.
  • 54. 2 Foundations of Resident Care 3. List guidelines for communicating with residents with special needs When working with residents with mental illness it’s important to remember the following: • Do not talk to adults as if they were children. • Use simple, clear statements and a normal tone of voice. • Be sure that what you say and how you say it show respect and concern. • Sit or stand at a normal distance from the resident. Be aware of your body language. • Be honest and direct, as with any resident. • Avoid arguments. • Maintain eye contact and listen carefully.
  • 55. 2 Foundations of Resident Care 3. List guidelines for communicating with residents with special needs REMEMBER: Mental illness is a disorder like any physical disorder. People who are mentally ill cannot just choose to change their behavior and be well.
  • 56. 2 Foundations of Resident Care 3. List guidelines for communicating with residents with special needs When dealing with combative residents, remember these tips: • Block blows or step out of way. • Allow resident time to calm down before next interaction. • Give resident space; stand at least an arm’s length away. • Stay calm. Lower tone of voice. • Be flexible and patient. • Stay neutral. Do not respond to verbal attacks or argue. • Do not use gestures that could frighten or startle resident. • Be reassuring and supportive. • Find out what provoked resident. • Report inappropriate behavior.
  • 57. 2 Foundations of Resident Care 3. List guidelines for communicating with residents with special needs It is difficult to communicate with angry residents. These suggestions will help: • Stay calm. Do not argue or respond to verbal attacks. • Empathize with the resident. • Try to find out what caused the angry reaction. • Be respectful. Explain what you are going to do. • Answer call lights promptly. • Stay at a safe distance.
  • 58. 2 Foundations of Resident Care 3. List guidelines for communicating with residents with special needs When an NA encounters inappropriate behavior it is important to remember the following: • Report behavior. • Be professional and do not overreact. • Try distraction. • Gently direct resident to private area.
  • 59. 2 Foundations of Resident Care 3. List guidelines for communicating with residents with special needs REMEMBER: An NA must never hit a resident, no matter how the resident may have provoked him. Hitting is considered abuse and may result in termination and/or legal action.
  • 60. 2 Foundations of Resident Care 3. List guidelines for communicating with residents with special needs REMEMBER: Residents’ physical and psychological health can depend a great deal on how NAs communicate. NAs should be comforting and kind with residents, and listen if the residents want to talk.
  • 61. 2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies REMEMBER: Prevention is the key to safety. Unsafe conditions should be reported before accidents occur.
  • 62. 2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies Define the following terms: body mechanics the way the parts of the body work together when a person moves. posture the way a person holds and positions his body.
  • 63. 2 Foundations of Resident Care Transparency 2-4: Body Alignment
  • 64. 2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies Principles of body mechanics related to alignment include the following: • Try to keep the body in alignment, with two sides of the body mirror images of each other. • Keep object close when carrying or lifting. • Point feet and body toward the direction you are moving. • Avoid twisting at waist.
  • 65. 2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies These principles of body mechanics relate to a person’s base of support: • Wide base is more stable. • Stand with legs shoulder-width apart.
  • 66. 2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies NAs should remember these points about body mechanics and a person’s center of gravity: • When standing, weight is centered in pelvis. • Low center provides more base of support. • Bend knees when lifting.
  • 67. 2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies As an example of how to apply proper body mechanics, consider this method for lifting a heavy object from the floor: • Spread feet shoulder-width apart. • Bend knees. • Use muscles in thighs, upper arms, and shoulders. • Pull object close to body. • When standing up, push with hip and thigh muscles.
  • 68. 2 Foundations of Resident Care Transparency 2-5: Lifting Heavy Objects from the Floor
  • 69. 2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies Remember these guidelines for using proper body mechanics: • Assess the situation and remove obstacles. • Use both arms and hands to lift, push, or carry objects. • When lifting a heavy object from the floor, spread your feet shoulder-width apart. Bend your knees. Raise your body and the object together. • Hold objects close to you when you are lifting or carrying them. • Push or slide objects, rather than lifting them. • Avoid bending and reaching as much as possible.
  • 70. 2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies Guidelines for using proper body mechanics (cont’d): • If you are making a bed, adjust the height to a safe working level, usually waist high. • When a task requires bending, use a good stance. Bend your knees to lower yourself, rather than bending from the waist. • Avoid twisting at the waist when you are lifting or moving something. Instead, turn your whole body. Your feet should point toward what you are lifting or moving. • Get help from coworkers when possible for lifting or helping residents.
  • 71. 2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies Define the following terms: fracture a broken bone. disorientation confusion about person, place, or time. scalds burns caused by hot liquids. abrasion an injury that rubs off the surface of the skin.
  • 72. 2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies Falls may be caused by • Unsafe environment • Loss of abilities • Disease • Medication • Loss of vision • Gait or balance problems • Weakness • Paralysis • Disorientation
  • 73. 2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies Falls can be prevented in these ways: • Clear walkways. • Use non-skid rugs. • Have resident wear non-skid shoes. • Have resident wear clothing that fits. • Keep frequently-used personal items close. • Answer call lights promptly. • Clean up spills. • Report loose hand rails immediately. • If used, check bed and body alarms to see if they are working.
  • 74. 2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies Fall prevention (cont’d): • Mark hazardous areas. • Improve lighting. • Lock wheelchairs. • Lock bed wheels. • Return beds to lowest positions. • Get help. • Offer toileting assistance and respond to requests promptly. • Leave furniture in same place. • Pay attention to residents at risk for falls.
  • 75. 2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies REMEMBER: An NA should never try to catch a falling resident. This could result in greater harm to both the NA and the resident.
  • 76. 2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies REMEMBER: Report all falls to the nurse.
  • 77. 2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies Burns and scalds are caused by • Dry heat (irons, stoves, other electrical appliances) • Wet heat (hot water or other liquids, steam) • Chemicals (lye, acids)
  • 78. 2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies To help prevent burns and scalds NAs can do the following: • Check water temperature. • Report frayed cords. • Communicate about hot liquids. • Pour hot drinks away from residents. • Keep hot drinks away from edges of tables. Use lids. • Make sure residents are sitting before serving hot drinks. • Monitor heat-producing equipment.
  • 79. 2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies To prevent accidents resulting from not identifying residents properly, NAs should always • Identify each resident before care or feeding. • Check IDs. • Call resident by name.
  • 80. 2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies REMEMBER: Not identifying residents before giving care or serving good can cause serious problems or even death.
  • 81. 2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies Choking is a greater risk when residents are • Weak • Ill • Unconscious
  • 82. 2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies NAs can help prevent choking by • Making sure residents eat in an upright position • Following orders for special diets and thickened liquids
  • 83. 2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies Poisoning occurs when a person ingests a harmful substance. It may be prevented by • Storing harmful substances carefully • Not leaving cleaning products in rooms • Investigating any unusual odors
  • 84. 2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies REMEMBER: It is important to know the phone number for the Poison Control Center. The number should be posted at facilities.
  • 85. 2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies To help prevent cuts and abrasions, NAs should do the following: • Put sharp objects away after use. • Push wheelchairs forward.
  • 86. 2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies Remember these points about Safety Data Sheets (SDSs): • Required by OSHA for all hazardous chemicals • Detail ingredients, dangers, emergency response, safe handling procedures • Sometimes accessed by toll-free number • Must be accessible by all employees
  • 87. 2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies REMEMBER: It is very important that NAs know where SDSs are kept at their facilities and know how to use them.
  • 88. 2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies NAs play an important role in a facility’s fire safety. They must • Make sure smokers are in proper area for smoking. Never leave smokers unattended. Make sure ashtrays do not contain hot ashes before emptying them. Use burn-resistant aprons properly and as instructed. • Report frayed or damaged cords. • Report if fire alarms and exit doors are blocked. • Know how to use fire extinguishers: • Pull the pin. • Aim at the base of fire when spraying. • Squeeze the handle. • Sweep back and forth at the base of fire.
  • 89. 2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies In case of fire at a facility, NAs should remember the following: • Use RACE: • Remove residents from danger. • Activate alarm or call 911. • Contain fire if possible. • Extinguish, or fire department will extinguish. • Know the evacuation plan. • Stay calm. • Follow directions of fire department.
  • 90. 2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies In case of fire at a facility (cont’d): • Know which residents need one-on-one help. • Know differing abilities of residents. • Remove blockage from windows or doors. • Do not use elevators. • Stay low in a room to escape fire. • Check for heat coming from doors. • Stop, drop, and roll if clothing catches fire. • Use damp covering over mouth and nose. • Leave building if possible, then move away from it.
  • 91. 2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies REMEMBER: Electronic cigarettes (e-cigarettes) are becoming more common. They may be allowed at some facilities. They do not contain tobacco. They contain liquid nicotine that is heated and turned into a vapor. Research on e-cigarettes is ongoing and rules and regulations regarding their use may change.
  • 92. 2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies Think about these questions: Are there certain natural disasters that are especially likely to occur in your area? Have you ever experienced this type of disaster? What did you do?
  • 93. 2 Foundations of Resident Care 4. Identify ways to promote safety and handle non-medical emergencies The following guidelines are helpful in any type of disaster: • Listen carefully and follow instructions. • Remain calm. • Know where exits and stairways are. • Know where alarms and extinguishers are. • Learn appropriate action to take. • Stay informed via internet, radio, or TV.
  • 94. 2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies Define the following term: conscious the state of being mentally alert and having awareness of surroundings, sensations, and thoughts.
  • 95. 2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies NAs should memorize these steps for responding to a medical emergency: • Assess the situation. Make sure you are not in danger and note the time. • Assess the victim. Check the victim’s level of consciousness. • Call for help or send someone to get help. • Remain calm and confident. • Properly document the emergency after it is over.
  • 96. 2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies These are signs and symptoms of injury NAs should observe for in an emergency: • Severe bleeding • Changes in consciousness • Irregular breathing • Unusual color or feel to the skin • Swollen places on the body • Medical alert tags • Anything the resident says is painful
  • 97. 2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies Define the following terms: first aid emergency care given immediately to an injured person. cardiopulmonary resuscitation (CPR) medical procedures used when a person’s heart or lungs have stopped working.
  • 98. 2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies REMEMBER: People who are not trained to perform CPR must never attempt to perform it. Not all facilities permit NAs to start CPR, even if they are trained to do so. It is important to know the facility’s policy.
  • 99. 2 Foundations of Resident Care Handout 2-3: CPR Review This handout is not meant to replace a CPR course. The following is a brief review for people who have had CPR training. It is a procedure to use on adults, not children. This may not be the procedure that your facility uses. Follow your facility’s policies and procedures. 1.After making sure that the scene is safe, check whether the person is responsive. Tap the person on the shoulder and shout, “Are you all right?” 2.If there is no response, call 911 immediately or send someone to call 911. Stay calm. 3.After calling 911, get an automated external defibrillator (AED) (if available and if trained in its use). Return to the person to provide CPR. More information on the AED is in step 10. 4.The person should be on his back on a hard surface (if he has no spinal injuries) before CPR is started.
  • 100. 2 Foundations of Resident Care Handout 2-3: CPR Review (cont’d) 5.Open the airway. Tilt the head back slightly. Lift the chin with one hand while pushing down on the forehead with the other hand (head tilt-chin lift method). This method is used if a neck injury is not suspected. 6.Look, listen, and feel for signs of life for no longer than 10 seconds: • Look for the chest to rise and fall. • Listen for sounds of breathing. Put your ear near the person’s nose and mouth. • Feel for the person’s breath on your cheek.
  • 101. 2 Foundations of Resident Care Handout 2-3: CPR Review (cont’d) 7.If you do not detect adequate breathing within 10 seconds, you will have to breathe for the person. Give two rescue breaths. To give rescue breaths, do the following: • Pinch the nose to keep air from escaping. Cover the person’s mouth completely with your mouth. • Blow into the person’s mouth slowly, watching for the chest to rise. Blow one breath for about one second, take a “regular” (not a deep) breath, and give a second rescue breath for about one second. Turn your head to the side to listen for air. If the chest does not rise when you give a rescue breath, reopen the airway using the head tilt-chin lift method. Try to give rescue breaths again.
  • 102. 2 Foundations of Resident Care Handout 2-3: CPR Review (cont’d) 8.After giving rescue breaths, look for signs of circulation. The person may start moving, breathing normally, or coughing. If they do not respond to the rescue breaths, give 30 chest compressions only if you have been trained to do so. Be sure the person is lying flat on a hard surface. To give chest compressions, do the following: • Place the heel of one hand on the sternum (in the center of the person’s chest between the nipples). Place the heel of the other hand on top of the positioned hand. Interlace your fingers. • Position your body directly over your hands. Lock your elbows and shoulders. Look down at your hands. • Use the heels of your hands to give 30 chest compressions. Push in two inches with each compression. Push hard and fast. Allow the chest to recoil completely after each compression. Do not take your hands off the chest between compressions.
  • 103. 2 Foundations of Resident Care Handout 2-3: CPR Review (cont’d) 9. Continue giving CPR in cycles of 30 compressions to two breaths, with five cycles taking about two minutes. Do not stop CPR to recheck anything. Continue until the scene becomes unsafe, the person recovers, paramedics arrive with an AED and take over, help arrives to assist you, or you become too tired to continue. If you do see signs of life, stop compressions. Maintain an open airway. Turn the person onto his side in the recovery position. 10. The automated external defibrillator (AED) may be used together with CPR. The AED is a computerized device that checks a person’s heart rhythm. It is able to recognize a rhythm that requires a shock. The AED uses voice prompts, lights, and text messages to relay instructions to the rescuer. You must be trained in its use. If you are not trained, do not try to use the AED. When medical help arrives, follow their directions. Assist them as necessary.
  • 104. 2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies Define the following terms: obstructed airway a condition in which the tube through which air enters the lungs is blocked. abdominal thrusts method of attempting to remove an object from the airway of someone who is choking.
  • 105. 2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies REMEMBER: A person who is choking usually puts her hands to her throat. As long as a person can speak, breathe, or cough, she should be encouraged to cough as forcefully as possible to get the object out.
  • 106. Performing abdominal thrusts for the conscious person 1. Stand behind the person and bring your arms under her arms. Wrap your arms around the person’s waist. 2. Make a fist with one hand. Place the flat, thumb side of the fist against the person’s abdomen, above the navel but below the breastbone. 3. Grasp the fist with your other hand. Pull both hands toward you and up, quickly and forcefully.
  • 107. Performing abdominal thrusts for the conscious person 4. Repeat until the object is pushed out or the person loses consciousness. 5. Report and document the incident properly.
  • 108. 2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies Define the following terms: shock a condition that occurs when organs and tissues in the body do not receive an adequate blood supply. cyanotic skin that is blue or gray.
  • 109. 2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies The following are signs of shock: • Pale or cyanotic skin • Staring • Increased pulse and respiration • Low blood pressure • Extreme thirst
  • 110. Responding to shock 1. Notify the nurse immediately. Victims of shock should always receive medical care as soon as possible. 2. If you need to control bleeding, put on gloves first. This procedure is described later in the chapter. 3. Have the person lie down on her back. If the person is bleeding from the mouth or vomiting, place her on her side (unless you suspect that the neck, back, or spinal cord is injured). 4. Check pulse and respirations if possible (Chapter 7). Begin CPR if breathing and pulse are absent and if you are trained to do so. 5. Keep the person as calm and comfortable as possible. 6. Maintain normal body temperature. If the weather is cold, place a blanket around the person. If the weather is hot, provide shade.
  • 111. Responding to shock 7. Elevate the legs about eight to 12 inches unless the person has a head, neck, back, spinal, or abdominal injury, breathing difficulties, or fractures. Elevating the legs allows blood to flow back to the brain (and other vital areas.) Elevate the head and shoulders if a head wound or breathing difficulties are present. Never elevate a body part if the person has a broken bone or if it causes pain.
  • 112. Responding to shock 8. Do not give the person anything to eat or drink. 9. Report and document the incident properly.
  • 113. 2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies Define the following term: dyspnea difficulty breathing.
  • 114. 2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies The following are signs of a heart attack (myocardial infarction or MI): • Sudden, severe pain in the chest, usually on the left side or in the center behind the sternum • Pain or discomfort in other areas of the body, such as the arms, back, neck, jaw, or stomach • Indigestion or heartburn • Nausea and vomiting • Dyspnea • Dizziness
  • 115. 2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies Signs of a heart attack/MI (cont’d): • Skin color that is pale or cyanotic • Perspiration • Cold and clammy skin • Weak and irregular pulse rate • Low blood pressure • Anxiety and a sense of doom • Denial of a heart problem
  • 116. 2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies Women may have a heart attack without chest pressure or pain. Common symptoms in women include the following: • Shortness of breath • Pressure or pain in the lower chest or abdomen • Dizziness • Lightheadedness • Fainting • Pressure in the upper back • Extreme fatigue • Flu-like symptoms
  • 117. Responding to a heart attack 1. Notify the nurse immediately. 2. Place the person in a comfortable position. Encourage him to rest. Reassure him that you will not leave him alone. 3. Loosen the clothing around the person’s neck. 4. Do not give the person liquids or food.
  • 118. Responding to a heart attack 5. Monitor the person’s breathing and pulse. If the person stops breathing or has no pulse, begin CPR if trained and allowed to do so. 6. Stay with the person until help arrives. 7. Report and document the incident properly.
  • 119. 2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies REMEMBER: Severe bleeding must be controlled immediately, but it is still essential that NAs take time to put on gloves before trying to control bleeding.
  • 120. Controlling bleeding 1. Notify the nurse immediately. 2. Put on gloves. Take time to do this. If the resident is able, he can hold his bare hand over the wound until you can put on gloves. 3. Hold a thick sterile pad, clean cloth, handkerchief, or towel against the wound. 4. Press down hard directly on the bleeding wound until help arrives. Do not decrease pressure. Put additional pads over the first pad if blood seeps through. Do not remove the first pad.
  • 121. Controlling bleeding 5. If you can, raise the wound above the level of the heart to slow the bleeding. If the wound is on an arm, leg, hand, or foot, and there are no broken bones, prop up the limb. Use towels or other absorbent materials. 6. When bleeding is under control, secure the dressing to keep it in place. Check the person for symptoms of shock (pale skin, increased pulse and respiration rates, low blood pressure, and extreme thirst). Stay with the person until help arrives. 7. Remove and discard gloves. Wash hands thoroughly. 8. Report and document the incident properly.
  • 122. 2 Foundations of Resident Care Handout 2-4: Burns Care of a burn depends on its depth, size, and location. There are three types of burns: first-degree, second- degree, and third-degree burns. First-degree burns involve just the outer layer of skin. The skin becomes red, painful, and swollen, but no blisters occur. Second-degree burns extend from the outer layer of skin to the next deeper layer of skin. The skin is red, painful, and swollen, and blisters appear.
  • 123. 2 Foundations of Resident Care Handout 2-4: Burns (cont’) Third-degree burns involve all three layers of the skin and may extend to the bone. If the nerves are destroyed, no pain occurs. The skin is shiny and appears hard. It may be white in color. Always notify the nurse when a resident is burned. Burns may require emergency help in any of the following situations: • An elderly, ill, or weak person has been burned, unless burn is very minor. • The burn occurs on the head, neck, hands, feet, face, or genitals, or burns cover more than one body part. • The person who has been burned is having trouble breathing. • The burn was caused by chemicals, electricity, or explosion. Chemical burns require special care. Call for help immediately. The chemical must be washed away thoroughly. A shower or a hose may be needed when the burns cover a large area.
  • 124. 2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies REMEMBER: It is very important to do no harm to severe burns, which could later cause infection or damage to skil that could be saved. Do not put ice, ointment, salve, or grease on any burn.
  • 125. Treating burns To treat a minor burn: 1. Notify the nurse immediately. Put on gloves. 2. Use cool, clean water to decrease the skin temperature and prevent further injury. Do not use ice or ice water, as ice may cause further skin damage. Dampen a clean cloth with cool water. Place it over the burn. 3. Once the pain has eased, you may cover the area with dry, sterile gauze or clean dressing. 4. Remove and discard gloves. Wash your hands. 5. Never use any kind of ointment, salve, or grease on a burn.
  • 126. Treating burns For more serious burns: 1. Remove the person from the source of the burn. If clothing has caught fire, have the person stop, drop, and roll, or smother the fire with a blanket or towel to put out flames. Protect yourself from the source of the burn. 2. Notify the nurse immediately. Put on gloves. 3. Check for breathing, pulse, and severe bleeding. If the person is not breathing and has no pulse, begin CPR if trained and allowed to do so. 4. Do not use any type of ointment, water, salve, or grease on the burn. 5. Do not try to pull away any clothing from burned areas. Cover the burn with thick, dry, sterile gauze, a clean cloth, or a clean white sheet. A dry, insulated cool pack may be used over the dressing. Take care not to rub the burned area.
  • 127. Treating burns 6. Ask the person to lie down and elevate the affected part if this does not cause greater pain. 7. Wait for emergency medical help. 8. Remove and discard gloves. Wash your hands. 9. Report and document the incident properly.
  • 128. 2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies Signs and symptoms of fainting include the following: • Dizziness • Nausea • Perspiration • Pale skin • Weak pulse • Shallow respirations • Blackness in visual field
  • 129. Responding to fainting 1. Notify the nurse immediately. 2. Have the person lie down or sit down before fainting occurs. 3. If the person is in a sitting position, have him bend forward. He can place his head between his knees if he is able. If the person is lying flat on his back, elevate the legs. 4. Loosen any tight clothing. 5. Have the person stay in position for at least five minutes after symptoms disappear.
  • 130. Responding to fainting 6. Help the person get up slowly. Continue to observe him for symptoms of fainting. Stay with him until he feels better. If you need help but cannot leave the person, use the call light. 7. If a person does faint, lower him to the floor or other flat surface. Position him on his back. Elevate his legs eight to 12 inches. Loosen any tight clothing. Check to make sure the person is breathing. He should recover quickly, but keep him lying down for several minutes. Report the incident to the nurse immediately. 8. Report and document the incident properly. Fainting may be a sign of a more serious medical condition.
  • 131. 2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies Define the following terms: insulin reaction complication of diabetes that can result from either too much insulin or too little food; also known as hypoglycemia. diabetic ketoacidosis (DKA) a complication of diabetes that is caused by having too little insulin; also called hyperglycemia.
  • 132. 2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies Signs and symptoms of insulin reaction include the following: • Hunger • Weakness • Rapid pulse • Headache • Low blood pressure • Perspiration • Cold, clammy skin
  • 133. 2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies Signs and symptoms of insulin reaction (cont’d): • Confusion • Trembling • Nervousness • Blurred vision • Numbness of lips and tongue • Unconsciousness
  • 134. 2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies Signs and symptoms of diabetic ketoacidosis include the following: • Increased thirst • Increased urination • Abdominal pain • Deep or labored breathing • Breath that smells fruity or sweet • Hunger • Headache
  • 135. 2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies Signs and symptoms of diabetic ketoacidosis (cont’d): • Weakness • Rapid, weak pulse • Low blood pressure • Dry skin • Flushed cheeks • Drowsiness • Nausea and vomiting • Air hunger • Unconsciousness
  • 136. 2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies Seizures are involuntary, often violent, contractions of muscles. They can involve a small area or the entire body. Any of the following may cause a seizure: • High fever (especially in young children) • Serious illness (older children and adults) • Head injury • Seizure disorder such as epilepsy
  • 137. 2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies Signs of seizures include the following: • Severe shaking • Thrusting arms and legs uncontrollably • Jaw clenching • Drooling • Inability to swallow
  • 138. 2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies REMEMBER: The primary goal when caring for a resident who is having a seizure is to keep him safe. Do not try to force anything into the mouth of a person who is having a seizure.
  • 139. Responding to seizures 1. Note the time. Put on gloves. 2. Lower the person to the floor. Loosen clothing to help with breathing. Try to turn the person’s head to one side to help lower the risk of choking. This may not be possible during a violent seizure. 3. Have someone call the nurse immediately or use the call light. Do not leave the person unless you must do so to get medical help. 4. Move furniture away to prevent injury. If a pillow is nearby, place it under his head. 5. Do not try to restrain the person or stop the seizure. 6. Do not force anything between the person’s teeth. Do not place your hands in the person’s mouth for any reason. You could be bitten. 7. Do not give the person liquids or food.
  • 140. Responding to seizures 8. When the seizure is over, note the time. Gently turn the person to his left side if you do not suspect a head, neck, or spinal injury. This reduces the risk of choking on vomit or saliva. If the person begins to choke, get help immediately. Check for adequate breathing and pulse. Begin CPR if breathing and pulse are absent and if you are allowed and trained to do so. Do not begin CPR during a seizure. 9. Remove and discard gloves. Wash your hands. 10. Report and document the incident properly, including how long the seizure lasted.
  • 141. 2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies Define the following terms: cerebrovascular accident (CVA) a condition that occurs when blood supply to a part of the brain is blocked or a blood vessel leaks or ruptures within the brain; also called stroke. transient ischemic attack (TIA) a warning sign of a CVA/stroke resulting from a temporary lack of oxygen in the brain; symptoms may last up to 24 hours.
  • 142. 2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies The signs that a stroke is occurring include the following: • Facial numbness, weakness, or drooping, especially on one side • Arm numbness or weakness, especially on one side • Slurred speech or inability to speak • Use of inappropriate words • Inability to understand spoken or written words • Redness in face • Noisy breathing • Dizziness
  • 143. 2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies Signs of stroke (cont’d): • Blurred vision • Ringing in ears • Headache • Nausea/vomiting • Seizures • Loss of bowel and bladder control • Paralysis on one side of the body • Elevated blood pressure • Slow pulse rate • Loss of consciousness
  • 144. 2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies Women may experience these additional symptoms in the case of stroke: • Pain in the face, arms, and legs • Hiccups • Weakness • Chest pain • Shortness of breath • Palpitations
  • 145. 2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies The acronym F.A.S.T. is a good reminder of the signs of stroke and what to do in case of stroke: • Face: Is one side of the face drooping? Is it numb? Ask the person to smile. Is the smile uneven? • Arms: Is one arm numb or weak? Ask the person to raise both arms. Check to see if one arm drifts downward. • Speech: Is the person’s speech slurred? Can the person be understood? Ask the person to repeat a simple sentence and see if the sentence is repeated correctly. • Time: Time is very important when responding to a stroke. If the person shows any of the symptoms listed above, get help immediately.
  • 146. 2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies REMEMBER: The websites for the American Stroke Association (strokeassociation.org) and the National Stroke Association (stroke.org) have more information.
  • 147. 2 Foundations of Resident Care 5. Demonstrate how to recognize and respond to medical emergencies Define the following term: emesis the act of vomiting, or ejecting stomach contents through the mouth and/or nose.
  • 148. Responding to vomiting 1. Notify the nurse immediately. 2. Put on gloves. 3. Make sure the head is up or turned to one side. Place an emesis basin under the chin. Remove it when vomiting has stopped. 4. Remove soiled linens or clothes and set aside. Replace with fresh linens or clothes. 5. If resident’s intake and output (I&O) is being monitored (Chapter 7), measure and note amount of vomitus. 6. Flush vomit down the toilet unless vomit is red, has blood in it, or looks like wet coffee grounds, or if medication/pills are in vomit. If these signs are observed, show this to the nurse before discarding the vomit. After disposing of vomit, wash, dry, and store basin. 7. Remove and discard gloves. 8. Wash your hands. 9. Put on fresh gloves.
  • 149. Responding to vomiting 10. Provide comfort to resident. Wipe face and mouth. Position comfortably. Offer a drink of water. Provide oral care. It helps get rid of the taste of vomit in the mouth. 11. Put soiled linen in proper containers. 12. Remove and discard gloves. 13. Wash your hands again. 14. Report and document the incident properly. Document time, amount, color, odor, and consistency of vomitus.
  • 150. 2 Foundations of Resident Care Handout 2-5: Nosebleeds A nosebleed can occur suddenly when the air is dry, when injury has occurred, or when a person has taken certain medications. The medical term for a nosebleed is epistaxis. Responding to a nosebleed 1. Notify the nurse immediately. 2. Elevate the head of the bed, or tell the person to remain in a sitting position, leaning forward slightly. Offer tissues or a clean cloth to catch the blood. Do not touch blood or bloody clothes, tissues, or cloths without gloves.
  • 151. 2 Foundations of Resident Care Handout 2-5: Nosebleeds 3. Put on gloves. Apply firm pressure over the bridge of the nose. Squeeze the bridge of the nose with your thumb and forefinger. Have the resident do this until you are able to put on gloves.
  • 152. 2 Foundations of Resident Care Handout 2-5: Nosebleeds 4. Apply pressure until the bleeding stops. 5. Use a cool cloth or ice wrapped in a cloth on the back of the neck, forehead, or upper lip to slow the flow of blood. Never apply ice directly to skin. 6. Remove and discard gloves. Wash your hands. 7. Report and document the incident properly.
  • 153. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Define the following terms: infection prevention the set of methods practiced in healthcare facilities to prevent and control the spread of disease. microoranism/microbe a living thing or organism that is so small that it can be seen only through a microscope. infection the state resulting from pathogens invading the body and multiplying.
  • 154. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Define the following terms: pathogens microorganisms that are capable of causing infection and disease. localized infection an infection that is limited to a specific location in the body and has local symptoms. systemic infection an infection that is in the bloodstream and is spread throughout the body, causing general symptoms.
  • 155. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Define the following terms: healthcare-associated infection (HAI) an infection acquired within a healthcare setting during the delivery of medical care. chain of infection way of describing how disease is transmitted from one being to another. causative agent a pathogenic microorganism that causes disease.
  • 156. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Define the following terms: reservoir a place where a pathogen lives and grows. portal of exit any body opening on an infected person that allows pathogens to leave. mode of transmission the method of describing how a pathogen travels.
  • 157. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Define the following terms: direct contact a way of transmitting pathogens through touching the infected person or his or her secretions. indirect contact a way of transmitting pathogens by touching something contaminated by the infected person. portal of entry any body opening on an uninfected person that allows pathogens to enter.
  • 158. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Define the following terms: mucous membranes the membranes that line body cavities that open to the outside of the body, such as the linings of the mouth, nose, eyes, rectum, or genitals. susceptible host an uninfected person who could get sick. transmission passage or transfer.
  • 159. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Define the following terms: infectious contagious. medical asepsis refers to practices such as handwashing that reduce, remove, and control the spread of microorganisms. surgical asepsis the state of being free of all microorganisms; also called sterile technique.
  • 160. 2 Foundations of Resident Care Transparency 2-6: The Chain of Infection
  • 161. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Think about this question: Can you think of an example of each of the six links in the chain of infection?
  • 162. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices REMEMBER: If even one of the links in the chain of infection is broken - by washing hands, for example - then the spread of infection is stopped.
  • 163. 2 Foundations of Resident Care Handout 2-6: Infection Prevention Definitions Microorganism: Microorganisms are single-celled organisms that only can be viewed with the aid of a microscope. Microorganisms can be divided into five basic categories— bacteria, viruses, fungi, protozoa, and helminths. Most microorganisms are harmless—some are even beneficial. Others are capable of causing infection or disease. Microorganisms are often classified as either pathogenic or nonpathogenic. Nonpathogenic microorganism: A nonpathogenic microorganism is a type of microorganism that does not (is unable to) cause infection or disease. Pathogenic microorganism: A pathogenic microorganism is a type of microorganism that is capable of causing infection or disease; it is also called a pathogen.
  • 164. 2 Foundations of Resident Care Handout 2-6: Infection Prevention Definitions (cont’d) Bacteria: Bacteria are single-celled microorganisms that lack nuclei and organized cell structures. Bacteria can exist independently (on their own) or as parasites, dependent upon a host for life. Bacteria can be found in three basic shapes—round, rod, or spiral. While some bacteria are capable of causing disease, most are non-infectious and many have critical roles in decay, fermentation, and nutrient recycling. Bacteria help people digest food. Some bacteria destroy disease- causing cells, and some produce important vitamins in the gastrointestinal tract. Bacteria also play a role in food processing, such as in the production of yogurt and cheeses. Pathogenic bacteria can cause cell damage or death by producing substances known as toxins. Other cell damage can occur when the host’s immune system produces substances to eliminate bacteria, and these substances damage the infected cells and adjacent cells.
  • 165. 2 Foundations of Resident Care Handout 2-6: Infection Prevention Definitions (cont’d) Virus: Viruses are small packages of DNA or RNA encased in protein shells that invade a cell (host cell) and incorporate themselves into the host cell’s DNA. When the infected host cell begins to produce (replicate) new viral particles, the infected cell dies. Fungi: Fungi are multi-celled or single-celled organisms. They can be pathogenic, causing infections in healthy persons, or opportunistic, causing infections in people with weakened immune systems. Fungi can be nonpathogenic as well, and some types of fungi are even beneficial, such as those used to make antibiotics. A few types of fungi are considered delicacies, such as truffles and edible mushrooms. Yeasts and molds are examples of fungi. Fungi are the most common causes of disease in crops and plants. Fungi receive their nourishment by secreting enzymes that break down surrounding cells. When this happens on living tissue, it is irritating and uncomfortable.
  • 166. 2 Foundations of Resident Care Handout 2-6: Infection Prevention Definitions (cont’d) Parasite: A parasite is an organism that lives on or in an organism of a different species. Infection: An infection occurs when microorganisms enter and multiply within the tissue of a host, causing damage to that tissue. Symptoms may be apparent, or the host may display no symptoms. Disease: A disease occurs when tissue that has been damaged due to the entry and multiplication of microorganisms results in clinical signs and symptoms of a recognizable process. Host: A host is an organism or cell on or in which a microorganism lives or feeds.
  • 167. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Define the following terms: Centers for Disease Control and Prevention (CDC) a government agency under the U.S. Department of Health and Human Services that issues information to protect the health of individuals and communities. Standard Precautions a method of infection prevention in which all blood, body fluids, non-intact skin, and mucous membranes are treated as if they were infected with an infectious disease. sputum thick mucus coughed up from the lungs. sharps needles or other sharp objects.
  • 168. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices CDC defines body fluids to include the following: • Saliva • Sputum (mucus coughed up) • Urine • Feces • Semen • Vaginal secretions • Pus or other wound drainage • Vomit
  • 169. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Think about this question: Why should Standard Precautions be followed on every resident in your care?
  • 170. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices The following measures are all part of Standard Precautions: • Wash hands. • Wear gloves if you may come into contact with blood, body fluids, or broken skin. • Remove gloves immediately when finished with a procedure. • Immediately wash contaminated skin surfaces. • Wear a disposable gown if you may come into contact with blood or body fluids. • Wear a mask and goggles if splashing or spraying blood or body fluids is likely.
  • 171. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Standard Precautions (cont’d): • Wear gloves when handling sharp objects. • Never attempt to recap needles or sharps. • Avoid nicks and cuts. • Bag all contaminated supplies. • Clearly label body fluids being saved for a specimen. • Dispose of contaminated waste properly.
  • 172. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Define the following terms: hand hygiene washing hands with either plain or antiseptic soap and water and using alcohol-based hand rubs. antimicrobial an agent that destroys, resists, or prevents the development of pathogens.
  • 173. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices REMEMBER: It is very important not to rely only on alcohol-based hand rubs for hand hygiene. Wash hands with antimicrobial soap and water when first arriving at work and any time they are visibly soiled.
  • 174. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices NAs should wash their hands at these times: • When first arriving at work • Whenever hands are visibly soiled • Before, between, and after all resident contact • Before putting on gloves and after removing gloves • After contact with body fluids, mucous membranes, non-intact skin, or wound dressings
  • 175. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Times to wash hands (cont’d): • After handling contaminated items • After contact with objects in resident’s room • Before and after touching meal trays or handling food • Before and after feeding residents • Before getting clean linen • Before and after using the toilet • After touching garbage or trash • After picking up things from the floor
  • 176. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Times to wash hands (cont’d): • After blowing nose, coughing, or sneezing into hands • Before and after eating • After smoking • After touching areas on the body, such as the mouth, face, eyes, hair, ears, or nose • Before and after applying makeup • After any contact with pets/pet care items • Before leaving facility
  • 177. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices REMEMBER: Handwashing is the single most important thing NAs can do to prevent the spread of disease.
  • 178. Washing hands (hand hygiene) Equipment: soap, paper towels 1. Turn on water at sink. Keep your clothes dry. 2.Wet hands and wrists thoroughly. 3. Apply soap to hands.
  • 179. Washing hands (hand hygiene) 4. Keep your hands lower than your elbows and your fingertips down. Rub hands together and fingers between each other to create a lather. Lather all surfaces of wrists, hands, and fingers, using friction for at least 20 seconds. Lather and friction loosen skin oils and allow pathogens to be rinsed away. 5. Clean your nails by rubbing them in palm of your other hand. Most pathogens on hands are under the nails.
  • 180. Washing hands (hand hygiene) 6. Keep your hands lower than your elbows and your fingertips down. Being careful not to touch the sink, rinse thoroughly under running water. Rinse all surfaces of your wrists, hands, and fingers. Run water down from wrists to fingertips. Do not run water over unwashed arms down to clean hands. Water should run from cleanest to dirtiest. Wrists are cleanest, fingertips dirtiest. 7. Use a clean, dry paper towel to dry all surfaces of your hands, wrists, and fingers. Do not wipe towel on unwashed forearms and then wipe clean hands. Dispose of towel into waste container without touching the container. If your hands touch the sink or wastebasket, start over.
  • 181. Washing hands (hand hygiene) 8. Use a clean, dry paper towel to turn off the faucet (Fig. 2-28). Dispose of paper towel into waste container. Do not contaminate your hands by touching the surface of the sink or faucet. Hands will be recontaminated if you touch the dirty faucet or sink with clean hands.
  • 182. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Define the following terms: personal protective equipment (PPE) equipment that helps protect employees from serious workplace injuries or illnesses resulting from contact with workplace hazards. don to put on. doff to remove.
  • 183. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Define the following terms: perineal care care of the genitals and anal area. non-intact skin skin that is broken by abrasions, cuts, rashes, acne, pimples, lesions, surgical incisions, or boils.
  • 184. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices REMEMBER: PPE must be worn if an NA could come into contact with body fluids, mucous membranes, or open wounds. Gowns, masks, goggles, or face shields must be worn when splashing or spraying of body fluids or blood could occur.
  • 185. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Remember these points about gowns: • They protect exposed skin • They prevent soiling of clothing • They should fully cover the torso, and the sleeves should fit snugly
  • 186. Putting on (donning) and removing (doffing) gown 1. Wash your hands. 2. Open gown. Hold out in front of you and allow gown to open/unfold. Do not shake it (Fig. 2-29). Facing the back opening of the gown, place your arms through each sleeve. 3. Fasten the neck opening.
  • 187. Putting on (donning) and removing (doffing) gown 4. Reach behind you. Pull the gown until it completely covers your clothing. Secure gown at waist (Fig. 2-30). 5. Use a gown only once and then remove and discard it. If gown becomes wet or soiled during care, remove it. Check clothing. Put on a new gown. OSHA requires non-permeable gowns—gowns that liquids cannot penetrate —when working in a bloody situation.
  • 188. Putting on (donning) and removing (doffing) gown 6. Put on your gloves after putting on gown. The cuffs of gloves should overlap the cuffs of the gown (Fig. 2-31).
  • 189. Putting on (donning) and removing (doffing) gown 7. When removing a gown, remove and discard gloves properly (see procedure later in the chapter). Unfasten gown at neck and waist. Remove the gown without touching the outside of gown. Roll the dirty side in, while holding gown away from your body. Dispose of gown properly and wash your hands. Rolling puts dirtiest surface inward, lessening the risk of contamination.
  • 190. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Remember these points about masks and goggles: • Masks are worn when the resident has a respiratory illness. • Masks should fully cover the nose and mouth. • Masks should fit snugly over nose and mouth. • It is important to change masks between residents. • Goggles should fit snugly over eyes or eyeglasses.
  • 191. Putting on (donning) mask and goggles 1. Wash your hands. 2. Pick up mask by top strings or elastic strap. Do not touch mask where it touches your face. 3. Pull elastic strap over your head, or if mask has strings, tie top strings first, then bottom strings. Do not wear a mask hanging from only the bottom tie or strap. Masks must always be dry or they must be replaced. 4. Pinch the metal strip at the top of the mask (if part of mask) tightly around your nose so that it feels snug.
  • 192. Putting on (donning) mask and goggles 5. Put on the goggles over your eyes or eyeglasses. Use the headband to secure them to your head. Make sure they are on snugly. 6. Put on gloves after putting on mask and goggles.
  • 193. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Gloves should be worn in all of the following situations: • If you might touch blood or any body fluid • During mouth care or care of any mucous membrane • During perineal care • When providing personal care on non-intact skin • When providing personal care if NA has cuts on hands • When shaving resident • When disposing of soiled linens, gowns, dressings, and pads • • When touching contaminated surfaces or equipment
  • 194. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Gloves should be changed • Immediately before contact with mucous membranes or broken skin • If gloves become soiled, torn, or damaged
  • 195. Putting on (donning) gloves 1. Wash your hands. 2. If you are right-handed, slide one glove on your left hand (reverse if left- handed). 3. Using your gloved hand, slide the other hand into the second glove. 4. Interlace fingers. Smooth out folds and create a comfortable fit. 5. Carefully look for tears, holes, or spots. Replace the glove if needed. 6. If wearing a gown, pull the cuff of the gloves over the sleeves of the gown.
  • 196. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Gloves should be removed • After use • Before caring for another resident • Before touching non-contaminated items or surfaces
  • 197. Removing (doffing) gloves 1. Touch only the outside of one glove. With one gloved hand, grasp the other glove at the palm and pull the glove off (Fig. 2-34). 2. With the fingertips of your gloved hand, hold the glove you just removed. With your ungloved hand, slip two fingers underneath cuff of the remaining glove at wrist. Do not touch any part of the outside of glove (Fig. 2-35). The outside of the glove is contaminated.
  • 198. Removing (doffing) gloves 3. Pull down, turning this glove inside out and over the first glove as you remove it. 4. You should now be holding one glove from its clean inner side. The other glove should be inside it. 5. Drop both gloves into the proper container without contaminating yourself. 6. Wash your hands.
  • 199. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Define the following terms: clean in health care, a condition in which objects are not contaminated with pathogens. dirty in health care, a condition in which objects have been contaminated with pathogens. sterilization a method used to decrease the spread of pathogens and disease by destroying all microorganisms, including those that form spores.
  • 200. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Define the following terms: disinfection process that kills pathogens, but not all pathogens; it reduces the pathogen count to a level that is considered not infectious. disposable only to be used once and then discarded.
  • 201. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices The following are guidelines for equipment, linen, and clothing: • Prevent skin/mucous membrane contact. • Prevent contamination of clothing. • Prevent transfer of disease to other residents or environments. • Do not use reusable equipment until it has been cleaned properly. • Dispose of all single-use equipment properly.
  • 202. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Guidelines for equipment, linen, and clothing (cont’d): • Clean and disinfect all environmental surfaces, beds, bedrails, bedside equipment, and all frequently touched surfaces (doorknobs and call lights are good examples). • Handle, transport, and process soiled linens and clothing in a way that prevents skin and mucous membrane exposure, contamination of clothing (hold linen away from uniform), and transfer of disease to other residents and environments. • Bag soiled linen at point of origin. • Sort soiled linen away from resident care areas. • Place wet linen in leakproof bags.
  • 203. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices It is important to follow these guidelines for cleaning spills involving blood, body fluids, or glass: • Put on gloves (industrial strength). • Use proper product to absorb spill. • Scoop up absorbed spill and dispose of it in designated container. • Apply disinfectant. • Use proper cleaning solution. • Use tools, never hands, to pick up glass. • Properly bag waste.
  • 204. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices REMEMBER: Spills should be absorbed and removed without placing disinfectant directly on the fluid.
  • 205. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Define the following term: Transmission-Based Precautions method of infection prevention used when caring for persons who are infected or suspected of being infected with a disease.
  • 206. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices REMEMBER: Transmission-Based Precautions are always used in addition to Standard Precautions.
  • 207. 2 Foundations of Resident Care Transparency 2-7: Airborne Diseases
  • 208. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Remember these facts about airborne diseases: • Transmitted through the air after being expelled • Can remain floating for some time • Examples include tuberculosis (TB), measles, and chickenpox • Precautions include • Face mask • Gown • Handwashing • Proper ventilation
  • 209. 2 Foundations of Resident Care Transparency 2-8: Droplet Diseases
  • 210. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Remember these facts about droplet diseases: • Can be spread by coughing, sneezing, talking, laughing, or suctioning • Mumps are one example • Precautions include • Face mask • Covering nose and mouth when sneezing or coughing • Handwashing
  • 211. 2 Foundations of Resident Care Transparency 2-9: Contact Diseases
  • 212. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Remember these facts about contact diseases: • Spread by touching skin, wound, or infection • Examples include conjunctivitis (pink eye), C. diff., lice, scabies • Precautions include • Handwashing with antimicrobial soap • Not touching infected surfaces without gloves • Not touching uninfected surfaces with contaminated gloves • Not sharing towels, linens, or clothing • Using disposable equipment when possible
  • 213. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Guidelines for isolation include the following: • Transmission-Based Precautions are always used in addition to Standard Precautions. • Use PPE as instructed. Do not wear PPE outside resident’s room and perform hand hygiene following removal of PPE. • Do not share equipment between residents. • Wear proper PPE when serving food and drink. • Follow Standard Precautions in dealing with body waste removal. • Wear proper PPE if required to take specimen. • Reassure residents that the disease, not the person, is being isolated.
  • 214. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Define the following terms: bloodborne pathogens microorganisms found in human blood, body fluid, draining wounds, and mucous membranes that can cause infection and disease in humans. hepatitis inflammation of the liver caused by certain viruses and other factors, such as alcohol abuse, some medications, and trauma. Tuberculosis (TB) a highly contagious lung disease caused by a bacterium that is carried on mucous droplets suspended in the air.
  • 215. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Define the following terms: Methicillin-resistant Staphylococcus aureus (MRSA) an infection caused by specific bacteria that have become resistant to many antibiotics. Vancomycin-resistant enterococcus (VRE) bacteria (enterococci) that have developed resistance to antibiotics as a result of being exposed to the antibiotic vancomycin. Clostridium difficile (C. diff, C. difficile) bacterial illness that can cause diarrhea and colitis.
  • 216. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices Bloodborne diseases can be spread in these ways: • Contact with infected blood • Contact with infected semen or vaginal secretions contacting mucous membranes • Sexual contact with an infected person • Sharing needles with an infected person • From infected mothers to their babies • Contact with infected blood or certain other body fluids in healthcare setting
  • 217. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices REMEMBER: Standard Precautions, handwashing, isolation, and use of PPE can all help prevent the spread of bloodborne diseases.
  • 218. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices There are two common types of hepatitis: • Hepatitis B is transmitted through contaminated blood or needles or by sexual contact with an infected person. Discuss the vaccine. • Hepatitis C is transmitted through blood and possibly sexual intercourse.
  • 219. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices REMEMBER: Employers must offer NAs a free vaccine to protect them from hepatitis B. NAs should take the vaccine when it is offered.
  • 220. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices It is important to follow these guidelines when a resident has TB: • Follow Standard Precautions and Airborne Precautions. • Wear PPE as instructed. • Handle sputum or phlegm carefully. • Ensure proper ventilation. • If resident is in AIIR isolation room, open and close door slowly. • Follow isolation procedures if ordered. • Help resident remember to take medications.
  • 221. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices There are two different types of MRSA: • Hospital-associated MRSA (HA-MRSA) • Community-associated MRSA (CA-MRSA)
  • 222. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices MRSA can be spread by • Direct contact • Indirect contact
  • 223. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices REMEMBER: Proper handwashing is the single most important measure to control the spread of MRSA.
  • 224. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices VRE is spread by • Direct contact • Indirect contact
  • 225. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices REMEMBER: Prevention of VRE is very important. Proper handwashing is an important part of prevention.
  • 226. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices C. Difficile is spread • By spores via direct contact • When intestinal flora is altered due to enemas, nasogastric tubes, GI tract surgery, and overuse of antibiotics
  • 227. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices REMEMBER: Proper handwashing and proper handling of wastes can help prevent C. Diff. Hand sanitizers are not effective in preventing the spread of this disease. Soap and water must be used each time hand hygiene is performed.
  • 228. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices The following are employers’ responsibilities regarding infection prevention: • Establish procedures and exposure control plan. • Provide in-service education. • Have written procedures for exposures. • Provide proper PPE. • Provide HBV vaccination.
  • 229. 2 Foundations of Resident Care 6. Describe and demonstrate infection prevention practices The following are employees’ responsibilities regarding infection prevention: • Follow Standard Precautions. • Follow facility’s policies and procedures. • Follow care plans and assignments. • Use PPE. • Take advantage of free hepatitis B vaccine. • Report any exposure immediately. • Participate in education programs.