Module two
- 1. Welcome to Module Two!
- 2. Medical procedures given stat to an injured person by first people to respond to an ER • The first step in CPR is to determine unresponsiveness: shake and shout! • Never leave an ER victim, stay with him/her and offer reassurance • When doing CPR, you give 2 breaths for every 30 chest compressions • Brain damage can occur within 4-6 minutes after the heart stops beating and breathing stops
- 3. Equipment used in CPR • Crash cart • AED (automated external defibrillator) • LUCAS • https://www.youtube.com/watch?v=HAz0suSEL7w • https://www.youtube.com/watch?v=1Po0IRR-0uM
- 4. ER care and First Aid • If a resident doesn’t respond- shake and shout- if still no response yell for help and if CPR certified initiate • Never leave a victim, never move unless they are in immediate jeopardy (gas or electrical hazard)
- 5. Choking • To help a choking victim, perform the Heimlich maneuver or Abdominal Thrusts 1. Monitor for universal sign- clutching the throat 2. “can you cough?” “can you speak?” 3. “She’s choking, I need help!” 4. Explain that you are going to help 5. Perform abdominal thrusts until food comes out or person loses consciousness (hands placed under arms, around waist)
- 6. Choking continued • If a person is obese or pregnant, instead of abdominal thrusts you will perform chest thrusts • Never perform heimlich manuever if the person is able to speak or cough • Stay with person, offer reassurance, do not pat on back or give liquids • F.y.i. choking on thin liquids more likely than thick ones • https://www.youtube.com/watch?v=2dn13zneEjo
- 7. Shock • Occurs when organs and tissue in the body don’t get enough blood • Causes include heart attack (cardiogenic shock), severe infections (TSS), psychogenic shock, hemorrhage • Look for cyanosis (blue skin), low BP, extreme thirst, increased pulse and fast breathing, confusion • Call for help • If person is bleeding- control with thick pad or clean cloth • Place on back with feet elevated, cover with blanket to maintain normal body temp • Keep NPO
- 8. Myocardial Infarction • AKA- heart attack • Causes-blockage of blood supply and O2 to heart’s muscle dt blood clot, buildup of plaque, aneurysm • s/sx crushing or stabbing (can be burning) chest pain that radiates to arm and jaw, SOB, pallor, diaphoresis, feeling of doom, nausea • Call for help, lie down, loosen clothes, NPO • https://www.youtube.com/watch?v=3_PYnWVoUzM
- 9. Hemorrhage • Standard precautions (wear gloves!) • Call for help • Apply direct pressure • If bright red blood, don’t release- arterial blood is high in oxygen and is pumped out with force • elevate arm or leg above heart level
- 10. Minor burns • Call nurse • Nurse may apply a cool, clean water (no ice) on a cloth • No ointments will be used, unless ordered by MD • Once pain has eased, area covered with sterile dressing and gauze • If a serious burn- do not attempt to remove clothes • First degree burn is superficial- involves just the outer layer of skin
- 11. A bit on other ERs • Nosebleed (epitaxis)- standard precautions, head forward, pinch bridge of nose • *Bleeding-if bright red blood suggests ARTERIAL bleed- apply direct pressure and do not release, std. precautions, call for help • If arm or leg bleeding raise above heart level • Fainting- have person lean forward, head as low as possible or lower to floor and position on his/her side
- 12. seizures • Involuntary contractions of muscles can be due to high fever, tumor in brain, epilepsy, drug OD, etc • Call for help, note time, put on glove • Person on floor • Move away furniture • Head to the side- supported by pillow • Don’t restrain • NOTHING in the mouth • https://www.youtube.com/watch?v=jJWfHHqfSbk
- 13. Cerebrovascular Accident (CVA) • AKA “stroke” • Causes may include brain trauma or tumor, hypertension, diabetes • s/sx: slurred speech, facial drooping and weakness on one side of body (L CVA would cause R sided weakness), incontinence, confusion, loss of consciousness • May complain of bad headache and elevated BP before CVA occurs • Act FAST- a quick response
- 14. Transient Ischemic Attacks (TIAs) • Looks and feels like a stroke except it resolves quickly • Can be a warning of a CVA • Symptoms last up to 24 hours • Report immediately • Transient means momentary or brief
- 15. Emesis • Head to side • If appears like wet coffee grounds- notify nurse to see stat (internal bleeding) • Note amount • Assist with oral hygiene • Assist to change linens and clothes
- 17. Disaster guidelines • Tornado- stay away from windows; stand in hallway, take cover under heavy furniture, get inside a concrete shelter • Lightening- get inside; stay away from anything metal; stay in car; stay out of water • Floods- fill bathtub with fresh water, have a portable, battery operated radio, flashlights; don’t drink the water; don’t turn off gas • Hurricanes- board up windows; evacuate • Earthquakes- drop to ground; get under heavy furniture, crouch in corners
- 18. Test taking tip……. • Be aware of questions that contain the words Best or First. • You wake up on the morning you are scheduled for your first day on the new job with a fever and diarrhea. The best thing to do is • A. take medication and get yourself to work • B. make an appointment to see your doctor • C. call your employer and explain the situation • D. go to the emergency room
- 19. Positioning, Transfers and Ambulation
- 20. drawsheets • An extra sheet placed on top of bottom sheet when bed is made • Helps prevent skin damage from shearing (rubbing or friction that results from skin moving one way and the bone underneath it remaining fixed or moving in opposite direction) • Placed from mid-waist to knee area
- 21. Logrolling • Moving the body as a unit • Keeps the body aligned (straight) • Prevents injury to neck and spine • Raise side rail before turning • May require 2 people • https://www.youtube.com/watch?v=Dxuba14bUEA
- 22. Dangling • Resident sits on side of bed with legs hanging over the side • Don’t to prevent dizziness and drop in blood pressure from changing positions too fast (orthostatic hypotension) • Helps resident to regain balance before standing • If resident becomes dizzy, lie him down again and a • ssist back into bed, notify nurse • https://www.youtube.com/watch?v=O8CIforASTA
- 23. Gait or transfer belt • Used to assist with ambulation and transfer from bed to w/c • Placed around waist, over clothes, tightened • Held with hands facing up • https://www.youtube.com/watch?v=4bhfjCCcjyo
- 24. Slideboard • Or transfer board, may be used to transfer residents who are unable to bear weight on their legs • Never used against bare skin and be sure resident’s fingers aren’t under the board • Remove armrest on side of w/c nearest to resident • https://www.youtube.com/watch?v=IFUW7He43_g
- 25. Transfer bed to w/c • Place w/c on resident’s STRONG side • Fold up or remove footrest • Brakes on bed and w/c • Must have on nonskid footwear • Use a transfer belt • https://www.youtube.com/watch?v=5TagT0vQvl
- 26. Stretchers • Or gurney, used to move an injured or ill person • May need 4 or more people • Bed at stretcher height, use a drawsheet • Secure straps on resident once on stretcher • Ergo slide or sheet may be used • https://www.youtube.com/watch?v=wuXfdpXlU38
- 27. Mechanical Lifts & Sit-to-Stands • Aka “hoyer lift” • Secured with a sling which can be full body (amputee) or divided leg • Never used alone and without training • https://www.youtube.com/watch?v=0bQl0uqjvyo • To use a sit-to-stand the resident must be able to bear some wt on his legs and have some arm strength, 2 staff members to use • https://www.youtube.com/watch?v=5zMhd0QS5Lk
- 28. ambulation • Hold onto gait belt • Stand slightly behind to one side, if resident has a weak side, walk on that side • If person is blind, walk slightly in front with resident holding your one arm
- 29. Quad cane, rolling w/c, broad, rollator
- 30. • Admitting, Discharge and Transfer
- 31. Admission •Feelings at this time may be: Fear, depression, anxiety, happiness, anger •Paperwork will be completed by admissions, resident rights reviewed and explanation of PSDA reviewed, polaroid photo taken
- 32. LGTBQ community and admissions • Fear of acceptance • Fear partner may be treated fairly • “who is important in your life?” vs “husband” or “wife” • No judgments!
- 33. Prep before arrival • Obtain admissions kit • Open bed (fanfold top sheet and spread to foot of bed) • Need scale, vital signs equipment, gown, extra blanket and pillow, urine specimen cup • Ask about oxygen therapy, IV, etc. • Need belongings or inventory checklist form
- 35. Upon Admission • Greet and call by name the person prefers (start with formal name) • Take to room and assist into gown • Obtain weight and ht, VS if requested by RN • Complete inventory checklist, count and secure money, document valuables, give meds to nurse • Orient to room/unit- call bell, BR, DR, nurse’s station, activity room, chapel, review dining schedule • Introduce to others, including roommate
- 36. Scales- wt measured in pounds 1 kg- 2.2 lbs • Types of scales: ambulatory, chair, mechanical lifter, wheelchair • https://www.youtube.com/watch?v=Lc-Y99iGGpQ
- 37. Rule of thumb for most accurate wt • Same amount of clothing • Same time of day • Same scale
- 38. Measuring height • 12 inches in a foot • 5’4= 12 x 5=60 +4=64 inches • Of unable to stand, use tape measure from head to heel
- 39. Transfer • May be to another facility or unit • Pack up belongings, can take admission kit, water pitcher, etc with him • Use inventory list to pack personal belongings • Obtain transport • May experience same feelings as did at time of admission • Intro to new unit and staff • Be sure you know what unit, what room, what bed
- 40. Discharge • Don’t pack until nurse tells you discharge is for sure • Obtain discharge vital signs • Pack up belongings • Obtain transport • Document who resident left with, time, vs, condition and by what type of transport
- 41. Assisting with physical exams • You may be asked to bring resident to exam room, gather equipment or provide emotional support to the resident • Dorsal recumbent position- on back, knees flexed, feet flat • Lithotomy- for pelvic exam, on back, legs flexed, feet on stirrups • Knee-chest • Use drapes for privacy
- 44. THE RESIDENT’S UNIT • Should be comfortable temperature (71-81 degrees) • Odor free • Ventilated • Quiet • Well-lit • Should be homelike • Have essential furniture; bed, bedside stand, overbed table, wardrobe (with shelves and a clothes rack) , privacy curtain (goes all the way around bed), stationary chair (with armrest), call bell, sink and toilet
- 45. Promoting comfort • Keep it quiet! • Answer phones, call bells in a timely manner • Turn off tvs if not in use • Layer for warmth • Cut down the drafts
- 47. • Manual beds operated by cranks or gatches. Center raises bed up or down, right operates head of bed and left operates knees • Always fold gatches/handles/cranks in to avoid accidents • Siderails can be full or half- always check care plan before raising
- 48. Bed Positions • Fowler’s- HOB raided 45-60 degrees- for mouthcare, shaving. meals, when SOB, watching TV • Hi- Fowler’s- HOB raised 60-90 degrees • Semi-Fowler’s- HOB raised 15-30 degrees • Trendelenberg- foot raised higher than head- ordered by MD • Reverse trendelenberg- Head raised and feet lowered • Sims- always on left side, top leg flexed, lower arm extended behind- for enemas, rectal temp and rectal exam • *Side rails are dangerous and use must be ordered by MD and approved by resident or family- can cause entrapment
- 51. Other equipment • Privacy curtain- completely obstructs public view • Chair- stationary, with arms • overbed table- never place bedpan or urinal on it! • Call bell- never wrapped around side rail • Bedside stand- tope drawer for money, glasses, hearing aids, dentures • Middle shelf for toiletries • Bottom shelf for bedpan, urinal • On top- family photos, flowers, etc
- 52. Sleep • Allows body and mind to rest • Repairs, restores, organizes for next day • Elderly may have irregular sleep patterns dt noise, stress, medication, diet, new environment • Is there pain? Uncomfortable position? Overactive during early PM hours? Incontinent? • Require approximately 6-7 hours/night
- 53. Why can’t I sleep? • Sleeping too much in daytime • Caffeine? • Wearing nightclothes during the day • Eating a heavy meal late at night • New meds • TV, radio, computer or light on late at night • Pain • Lumpy mattress
- 54. Bedmaking Guidelines: • strip bed wearing gloves • change when visibly wet or soiled • raise bed up to make, make one side at a time to conserve energy • never fan sheets • no linen on floor • if extra linen brought in and not used- contaminated (place in soiled linen hamper) • collect in order of use • Place on clean, dry surface such as chair or overbed table • Check for eyeglasses, hearing aids, dentures before stripping a bed • Don’t allow clean or soiled linen to touch your body
- 55. When making an occupied bed: raise side rails and keep resident covered!
- 56. Surgical or postop bed • Fanfold top sheet and spread to SIDE of bed opposite the door • Leave bed raised to stretcher height • May require 3-4 people to transfer onto bed** • https://www.youtube.com/watch?v=jo9byabri2w
- 57. Check your knowledge!! • https://cna.plus/infection-control-test/ • https://cna.plus/cna-practice-test-legal-ethical-2/ • https://cna.plus/cna-practice-test-legal-ethical/ • https://cna.plus/residents-rights/ • https://cna.plus/residents-rights-2/
- 59. Human Needs and Human Development
- 60. Caring for the (whole) Person the parts of who we are cannot be separated, are dependent upon each other and when one part fails, other parts suffer too…
- 61. John suffers from depression • How is the emotional part of John affected? • How is the physical part of John affected? • How is the spiritual part of John affected? • How is the social part of John affected? • ***When one part suffers, they all suffer***
- 62. Basic Needs (according to Maslow)
- 63. MEETING BASIC HUMAN NEEDS • Physical needs- provide meals, snacks, fresh drinking water, clean bed, oxygen, rest and sleep • Safety & Security-answer call bells, raise side rails, clean up spills, report safety hazards, check ID bracelet, clutter free environment, infection control precautions • Love and belonging- give good care, encourage participation in activities, family visits, support groups • Self esteem- allow resident to do as much as possible for self, groom nicely, compliments • Self actualization- allow resident to discuss past accomplishments, interests
- 64. Losses with aging • Spouse, family, friends • work • Mobility to favorite places, including church • Home • Health • pets
- 65. Loss of independence can lead to…. • Depression • Anger toward caregivers • Helplessness and hopelessness • Feeling useless • Poor self image
- 66. Culture makes a difference…. • Cultural background effects music, food • and style of dress preferences, attitudes, • values, religion, language, health practices, • death rituals • The best way to respect a person’s cultural beliefs is to educate yourself, ask questions and attempt to support as much as possible
- 67. For Extra Credit…… Create a cultural tree • What is your culture? • Name one dish/food that is associated ONLY with your culture? • What style of dress, music, religion is practiced in your culture? • What is valued in your culture? • What health concerns are common in your culture? • What death rituals are practiced in your culture? • What language is spoken in your culture?
- 68. Cultural Tree for Russian Culture…. • Language: Russian • Food: Pirozhkis (small baked buns that can be filled with potatoes, meat, cabbage or cheese) ; Borscht (beet soup) • Style of dress: • Music: Dumka and Slavic folk • Values: stability and security • Religion: Russian Orthodox and Islam • Health concerns: Alcoholism, heart disease • Death rituals:Traditionally, men carry the coffin on their backs to the cemetery where the funeral will take place. At the funeral, a priest performs the “seeing off” ceremony, praying over the body and allowing mourners to throw dirt on the grave, symbolically incorporating the corpse into the earth.
- 69. A word about religion… • Listen, but don’t share your own beliefs and opinions…. • make referrals to nurse for clergy visits….. • you can pray with a person if they request it….. • be respectful of person’s religious beliefs….. • Respect religious items • Respect practices • Make referrals to nurse…social services can help • Agnostic- not sure if there is a God • Atheist- believes there is no God
- 70. Dietary restrictions based on religion • Buddhists- vegetarian • Jewish- no pork or shellfish, food is Kosher and kosher cannot come into contact with non-kosher food on the plate • Mormons- no alcohol, coffee or tea • Muslims- no pork, practice Ramadan • Catholics- fish on Fridays and may abstain from certain foods during Lent • Vegan diet- no animals or animal products
- 71. Sex and sexuality • Sex • Sexuality- promote by makeup, jewelry, grooming, privacy during relations • Types: heterosexual-opposite sex, homosexual- same sex, bisexual- both sexes, transvestite-cross dresser, transgender- identifies with opposite sex, transgender-undergoing sexual reassignment • Refer to by chosen gender • Give privacy during intimate times, post do not disturb sign on door • Privacy during masturbation
- 72. Family • Nuclear- mom, dad, kids • Single parent • Married couple without kids • Extended families- parents, grands, aunts, uncles, cousins • Blended family- through divorced or widowed parents
- 73. Middle Adulthood, 40 to 65 • Time of midlife crises, menopause, empty nest syndrome • Many physical changes to the body such as slowing of metabolism, wrinkles, gray hair, loss of vitality •
- 74. Late Adulthood (65 and older) • Time of many losses • Must deal with own mortality • Make new friends, find new interests • Decline in health
- 75. Ageism • Prejudice or stereotyping of and discrimination against elderly person • “She has that old people smell” • “Old men are grumpy” • “Old people don’t have sex” • “Old people don’t like water” • “Old people are forgetful and frail”
- 76. Every system of the body responds to aging • Skin wrinkles, age spots, skin breaks easier and is dryer, nails thicken, hair thins, is dryer and grays, balding, • Bones lose density and become more brittle • Muscles weaken and lose tone • Heat regulation is off • Nerve endings less sensitive • Reflexes are slower • Heart doesn’t pump as well • Lungs are less elastic, secretions aren’t cleared as we and capacity decreases • Appetite decreases
- 77. • Urinary output is more frequent • Oxygen in blood decreases • Digestion takes longer and is less efficient • Levels of hormones decrease • Immunity weakens • Lifestyle changes occur • Memory might slip • Joints stiffen • Height is lost • THESE ARE NORMAL CHANGES!!
- 78. A WORD ABOUT DEVELOPMENTAL DISABILITIES • Cerebral Palsy- mostly rt lack of O2 in the fetus- leads to muscle coordination problems, intelligence may be affected • Down’s syndrome- mostly in advanced age moms- children have distinct facial features, short, webbed fingers, intelligence may be affected, aka Trisomy 21 • Spina bifada- part of spinal cord is outside, may not Be able to walk, may have hydrocephaly
- 80. CHAPTER 19: CONFUSION, DEMENTIA and ALZHEIMER’S DISEASE • Changes in the nervous system with aging: • Nerve cells are lost • Nerve conduction slows • Responses and reactions slow • Reflexes slow • Taste and smell decrease • Hearing and vision decrease • Touch and sensitivity to pain decrease • Sleep patterns change • Memory is shorter • Forgetfulness occurs
- 81. Dementia • Dementia is impaired cognition • Memory, thinking, reasoning, ability to understand, judgment, communication and behavior are effected ■ An be caused by drugs. ETOH, tumors depression, CV problems, infection, head injuries, MS, PD, stroke, syphilis, AIDS ■ No.1 cause of dementia is Alzheimer’s Disease (AD)
- 82. Delirium & Depression • State of sudden, severe confusion and rapid brain changes • Occurs with a mental or physical illness and is considered a medical ER • It is temporary and reversible • Causes include an acute illness, heart or lung diseases • Look for changes in alertness, sensation, awareness, movement and memory, problems concentrating, speech nonsensical, and emotional changes • Depression characterized by 2-4 weeks of helpless, hopeless feelings, tearful, anhedonia, change in sleep and appetite, thoughts of death, withdrawal •
- 83. Alzheimer’s Disease (AD) • Progressive • Fatal, familial, avg life expectancy 8-10 years • Early onset is inherited • Affects more women than men • Includes dementia, depression and delirium • Gradual loss of short-term memory may be first symptom
- 85. Warning signs of AD • Perseveration • Repeating same story over and over • Forgetting how to cook, play cards, pay bills, dress self, balance checkbook • Getting lost in familiar places • Losing household items • Neglecting to bathe, wearing same clothes
- 86. Stages of AD • Mild: memory loss, poor judgment, disoriented to place and time, moodiness, difficulty with everyday tasks, poor concentration, but can still function independently, drive and work • Moderate: restlessness,> memory loss, wandering, dulled senses, incontinence, needing help with ADLS, loses impulse control, perseveration, agitation, violence, communication problems (dysphasia), forgetting past, moody, withdrawn • Severe: seizures, aphasia, total care, dysphagia, bedbound, coma,death
- 87. Hooray For Hollywood!! • Still Alice** • Away From Her • Savages • Iris • The Notebook • Aurora Borealis • Cocoon 2
- 88. Strategies for working with AD • Follow a routine • Promote self-care • Explain procedures • Call by name throughout conversation • Know triggers (loud TV or music, crowds, fatigue, hunger/thirst • Don’t tease • Don’t tire out • Be empathetic
- 89. More strategies • Schedule bath when least agitated, be organized • Give him washcloth to hold • Give finger foods • Use contrasting color place mat under food plate • Describe the food • Toilet after fluids given
- 90. Communicating with someone with AD • Be patient, calm and kind • People change with AD- quiet become chatty, prim become obscene, fathers forget daughters • Approach from the front, say your name, eye to eye • Treat with the respect that a lifetime of experience on earth deserves! • Speak clearly, use words SPARINGLY, gesture more • Hold her hand, sing to him, play some music • Don’t rely so heavily on language
- 91. Behaviors common in AD • Delusions- false, fixed beliefs- • Hallucinations- false sensory preceptions • Sundowning- restlessness and agitation in PM hours • Pacing • Hoarding- collecting things • Pillaging- taking what belongs to another • Inappropriate sexual behaviors • Catastrophic reactions- over-reaction to something • Perseveration- repetitive words or behaviors • Elopement- leaving the building or wandering off
- 92. Managing behaviors • Don’t argue- distract or let person discuss feelings • Allow pacing in safe area with regular breaks • Place stop signs outside rooms to prevent pillaging, return items without resident being aware to avoid agitation • Ankle bracelets for wanderers
- 93. “I want to go home!” • Redirect • Talk about home • Gently remind him that he will be staying ‘here’ for awhile • Don’t argue, don’t play along
- 94. Reality Orientation • Keeping residents who suffer from dementia aware of who, what and why is important • Call by name each time you address them • ID yourself each day • Use phrases like “good morning”, tell them where you are taking them, what you are doing to them • The facility should post large calendars, clocks and orientation boards throughout the facility
- 95. Validation Therapy • Therapy based on these principles: 1. All behavior has meaning 2. A person may return to the past to resolve issues and emotions 3. Caregivers need to listen and provide empathy 4. Attempts are NOT made to correct the person’s thoughts or bring back to reality
- 96. Examples of Validation Therapy • Mrs. Johannson goes room to room looking for her infant son. In reality, he died 45 years ago. Instead of telling her this, the CNA says, “tell me about your baby” • Mrs. Lewis sits in the hallway all day waiting for the train. She believes her husband is due home, but in reality he died in WWII. The caregiver asks, “what is your husband’s name?”
- 97. Other therapies • Pet • Music • Reminiscence • Art • Exercise • Aroma • Cooking
- 98. The Unspooling Mine……. • https://www.youtube.com/watch?v=kkvIZaSfUxc