Nursing Assistant Essentials: Chapter Summaries

Chapter 1: The Holistic Nursing Assistant ➔ Patients- people who receive care in a healthcare facility (hospital) ➔ Residents- people who need ongoing care over a long period due to age, illness, or inability to care for themselves at home. ➔ Licenced Practical/Vocational Nurse (LPN/LVN)- monitor, report, give medications and insert catheters ➔ Registered Nurse (RN)- a licensed nursing staff member who delivers nursing care that includes assessment; providing nursing diagnoses; and planning, implementing and evaluating care. ➔ Holistic Care- care that integrates the body, mind, and spirit ➔ Activities of Daily Living (ADLs)- actions that people take during a typical day (bathing, grooming, dressing, eating, toileting, ambulating- moving/walking) ➔ Vital Signs ◆ The rates or values of a person’s temperature, pulse, respiration, and blood pressure ◆ Height and weight ◆ Fluid intake and output ◆ Changes in condition ➔ Infection control (hand hygiene) ➔ Personal Protective Equipment (PPE)- mask, gloves, protective eyewear, and gown ➔ Electronic Medical Record (EMR)- documenting resident information electronically ➔ Specimens- sputum, urine, feces Chapter 2: Understanding Healthcare ➔ Healthcare- prevention, diagnosis, treatment of diseases ➔ Vaccines- injections or oral medications that introduce a mild form of a disease so the body builds immunity, or resistance, to the disease. ➔ Level of care- the type of care needed for a particular resident ➔ Primary Care: the initial medical care a person receives at a doctor’s office or a medical clinic. ➔ Primary Care Provider- a doctor, nurse practitioner, or physician assistant ➔ Secondary Care: care that only focuses on the prevention of disease or the promotion of health and wellness (public health clinic or pharmacy) ➔ Tertiary Care: highly-specialized care, such as treating trauma, burns, cancer. ➔ Acute care- serious, critical, or surgical care ➔ Subacute cure- provided to a person who has a moderate-to-severe illness, injury, or recurrence of a disease ➔ Chronic care- those who have a long-term disease or illness that may never go away ➔ Dementia- severe loss of mental capacity ➔ Ratio- number of residents in a healthcare facility to each member of the healthcare staff ➔ Verbal communication- the use of spoken words to convey a message ➔ Nonverbal communication- the use of gestures, facial expressions, tone of voice, or body movements to convey a message Chapter 3: Legal and Ethical Practice ➔ Regulations- rules or requirements that are based on laws and that healthcare facilities and staff must follow ➔ Accreditation- determines that a healthcare facility meets predetermined professional and community standards ➔ Defamation of character- false statements made about a person that damage his or her reputation ➔ Libel- false written statements made about a person that damage his or her reputation Chapter 4: Maintaining a Safe Environment and Practice ➔ Minimum Data Sets (MDSs)- a complete assessment by the case are licensed nursing staff of a resident’s mobility, transfer skills, and ADLs, which is used to identify health problems. ➔ Culture of safety- the shared commitment of a healthcare facility’s leadership and staff to ensure a safe work environment ➔ Always events- routine activities and processes that are so important they must always be performed consistently and without error ➔ Never events- actions or errors that lead to serious resident harm, disability, or death ➔ Clinically adverse events- medical errors ➔ Quality of care and safety are connected. A healthcare facility must use safe practices to achieve required quality standards and measures. ◆ Be aware and mindful of safety at all times ◆ Always work to prevent errors or harm (intended injury) ◆ Learn from errors that do occur ◆ Demonstrate transparency in reporting safety issues ◆ Work to assure a culture of safety that includes all healthcare staff members, facilities, and residents ➔ Nursing assistants are responsible for making sure residents are safe by avoiding never events, preventing accidents, conducting safety checks, preventing injuries related to sharps, and following facility safety plans. ➔ Safety checks- make sure resident is safe, comfortable, bed or wheelchair is locked ➔ Facility safety plan- outlines policies and procedures that need to be followed by all healthcare staff ➔ Body mechanics- actions that promote safe, efficient movement by using the correct muscles and movements to avoid straining muscles or joints ➔ Hypothermia - a condition of abnormally low body temperature ➔ Osteoporosis- a condition of porous bones ➔ ACT: ◆ be Aware ◆ Correct risks ◆ Take precautions ➔ If a resident falls, do not move them. Tell a nursing staff member and stay with the resident as they get checked. ➔ Incident report- record information about unusual events, such as resident injuries ➔ Alzheimer's Disease- a degenerative brain disease that leads to memory loss, confusion, disorientation, and changes in personality and mood ➔ Restraint- a device or substance that restricts movement ◆ Only used to protect residents from harming themselves or others ➔ RACE ◆ Rescue- remove the resident from danger ◆ Activate alarm- follow the facility’s fire plan and tell a fellow staff member ◆ Confine the fire- close fire doors behind the last person ◆ Extinguish- yourself, a staff member, or in serious cases, a firefighter ➔ Personal Protective Equipment (PPE)- gloves, goggles, and gowns when handling hazardous detergents and chemicals ➔ Oxygen therapy- a lifeline for many ◆ Observe any skin irritations or changes in breathing or vital signs Chapter 5: Emergencies and Disasters ➔ First aid- the process of observing and responding to a medical emergency ➔ If you suspect an individual is contagious, use infection control (wear gloves and mask) ➔ Basic Life Support (BLS)- CPR ➔ Cardiopulmonary resuscitation- emergency, life-saving procedure for a person whose breathing or heartbeat has stopped ➔ Pulse- the beat of the heart as felt through the walls of an artery near the surface of the skin ➔ Conventional CPR- chest compressions, airway, rescue breathing ➔ Automated external defibrillator- shocks the heart to stop fibrillation ➔ Fibrillation- irregular heart rhythm ➔ Angina- chest pain and discomfort ➔ Myocardial infarction (Heart attack)- when blood flow to part of the heart muscle is blocked. ➔ Diabetes mellitus- excessive sugar in one’s blood ➔ Cerebrovascular accident (Stroke)- when a blood vessel carrying oxygen and nutrients to the brain becomes blocked by a clot or ruptures ➔ Anaphylaxis- a severe allergic reaction that can affect the whole body ➔ Asphyxia- a condition in which the body is deprived of oxygen, leading to the loss of consciousness or death ➔ Fainting- a brief loss of consciousness (a drop in blood flow to the brain) ➔ Bioterrorism- the intentional use of pathogens such as viruses and bacteria to cause illness or death Chapter 6: Providing Holistic Nursing Care ➔ Cognitive status- the ability to think clearly, make decisions, and remember ➔ Skilled care requires 24-hour, hands-on care in a healthcare facility ➔ Intermediate care is provided for those who require assistance with ADL’s ➔ Supportive care- residents may require special rehabilitation ➔ Nursing Process: ◆ Assessing- physical examination, medical history, interview with resident ◆ Making a nursing diagnosis- using clinical judgment to identify a health problem or the cause of a health problem ◆ Planning- a plan of care is developed by nursing staff to provide direction and to guide the delivery of care ◆ Implementing- care is carried out by the healthcare and nursing staff based on the plan of care ◆ Evaluating- an ongoing step of evaluating goals and achievements ➔ Admission to a healthcare facility occurs when individuals can no longer take care of themselves or have serious illnesses or conditions ➔ Discharge plan- provides instructions listing medications, activity levels, treatments to continue at home, and follow-up appointments with the doctor Chapter 7: Human behavior and Development ➔ Extrinsic motivation (external)- comes from outside influences that causeare a person to act, such as receiving awards or getting a raise. ➔ Intrinsic motivation (internal)- comes from within a person (self-motivation) like values, beliefs, and emotions ➔ Maslow’s Hierarchy of Needs ➔ Growth charts- utilized by doctors to see average growth patterns ➔ Physical growth ◆ Infancy (birth - 1 year) ◆ Toddlerhood (1 - 3 years) ◆ Preschool Year (4 - 5 years) ◆ School-age Years (6 - 12 years) ◆ Adolescence (13-18 years) ➔ Psychosocial development- mental, social, and emotional changes ➔ Behavior- actions that are responses to a stimulus ➔ Overt- open to view ➔ Covert- internal and not shown openly ➔ Parasympathetic Nervous System (PNS)- a part of the body’s nervous system that controls the automatic daily functions of the cardiovascular, respiratory, and gastrointestinal systems ➔ Sympathetic Nervous System (SNS)- a part of the body’s nervous system that sets off the fight-or-flight Chapter 8: Health and Wellness ➔ Health promotion- helping people improve their health and wellness by showing them ways they can include healthy behaviors in their daily life ➔ Eustress- good stress - can motivate you ➔ Distress- high level of prolonged stress ➔ Hormones- chemical substances that regulate body processes ➔ Stress ◆ Mental Symptoms: inability to concentrate, constant worry, or seeing only the negative ◆ Emotional Symptoms: moodiness, short temper, agitation, loneliness, or depression ◆ Physical Symptoms: aches and pains, dizziness, nausea, rapid heartbeat, frequent colds ◆ Behavioral Symptoms: procrastination, isolation, the use of alcohol or drugs to relax ➔ Stress management- the process of using strategies to handle and control stress Chapter 9: Infection Prevention and Control ➔ Bacteria- single-celled microorganisms that are often harmless but can cause infection ◆ Can enter through skin, nose, mouth, eyes, ears lungs, urethra, and vagina ➔ Infection- invasion by harmful, microorganisms ➔ Bacterial infections most commonly treated with antibiotics ➔ Antibiotic Resistance- develops when bacteria change to resist the effects of an antibiotic ➔ Multidrug-resistant (MDROs)- bacteria that are resistant to more than one antibiotic ➔ Virus- the smallest microorganisms (e.g. Common cold and Flu) ➔ Viral infections cannot be with antibiotics but with antiviral prescription medications ➔ Fungi- an organism that lacks the chlorophyll ➔ Fungal infections are typically treated using OTC or prescription antifungal creams, ointments, or medications ➔ Parasites- organisms that live on or in other organisms (hosts) ➔ Enzymes- chemical substances that cause specific reactions ➔ Mucus- thick slippery fluid that moistens and protects parts of the body ➔ Cells- the smallest structural unit of the body ➔ Tissues- specialized cells that act together to perform specific functions ➔ Antibodies- proteins in the blood that attack themselves to antigens and mark them for destruction by the immune system ➔ Phagocytosis- the process in which antigens are destroyed ➔ Inflammation- swelling and redness that occurs as the body’s responds to an infection ➔ Catheter- a flexible tube that is inserted through a narrow opening into the body ➔ Chain of Infection ◆ Infectious Agent → Reservoir → Portal of Exit → Means of transmission → Portal of entry → Susceptible Host ➔ Noncommunicable diseases- genetic (inherited) diseases, cancers, mental disorders, and heart disease ➔ Communicable diseases- are contagious and can be transmitted between people, objects, and animals ➔ Dormant organism- an organism whose functions have slowed or stopped ➔ Cultures- the process of growing cells in a favorable environment ➔ Asepsis- the absence of infections or infectious material ➔ Epidermis- the outer surface of the skin ➔ Abrasions- scraping of the outer layer of the skin ➔ Contusions- bruises caused by damaged or broken blood vessels; may cause swelling ➔ Exudate- a liquid or semi-solid discharge from body tissues or a blood vessel; drains from a wound and is caused by tissue damage ➔ Lacerations- wounds that tear body tissue and result in ragged edges Chapter 12: Communication and Caring ➔ Body language- a type of nonverbal communication ➔ Health literacy- how well residents fully understand and use the information they learn about their health, diseases, conditions, or treatments ➔ Defense mechanisms ◆ Denial: rejecting the truth (resident insists they feel fine when indeed they do not) ◆ Repression: refusing to remember a traumatic or painful situation ◆ Regression: returning to childlike behaviors (temper tantrums) ◆ Displacement: transferring a bad or negative feeling away from the source onto someone or something else. ◆ Projection: believing that others feel a certain way when in reality, you feel that way ◆ Reaction Formation: feeling one way inside and expressing the opposite on the outside ◆ Intellectualizing: focusing on facts, logic, and reasoning instead of a stressful feeling or uncomfortable emotion ◆ Rationalization: using logic to excuse unacceptable behaviors and feelings ➔ Active listening- involved showing interest in the person speaking and what is being said ➔ Close-ended question- a question that requires a one-word answer (Did you sleep well last night?) ➔ Open-ended question- a question that requires more than a one-word answer (How well did you sleep last night?) Chapter 13: Appreciating Diversity ➔ Ethnocentrism- an outlook in which one judges another culture based on the beliefs and standards of one’s own culture ➔ Cultural Humility- awareness and understanding of one’s own culture, as well as the cultures of others; includes knowledge of personal limitations, barriers, and gaps in knowledge needed to be sensitive to and respectful of other cultures ➔ Cross-cultural Communication- the use of practices and approaches that promote and improve relationships between people from different cultures ◆ Make eye contact and use active listening skills ◆ Avoid using your arms ◆ Smile and listen ◆ Use plain language ◆ Avoid slang ◆ Ask questions ➔ As a CNA, you must be aware of any medical and religious dietary restrictions your residents have and accommodate any special requests, if appropriate Chapter 14: Planning, Observing, and Documenting Care ➔ Plan of care: a written document that licensed nursing staff to develop for each resident ➔ Nursing orders- instructions for achieving care goals such as helping a resident ambulate at least twice per shift ➔ Care conferences- held regularly and bring together all members of the healthcare team who deliver care to a particular resident ➔ Rounds- opportunities to physically monitor and discuss the status of a resident’s condition ➔ Critical observation- the appropriate use of both objective and subjective observation ➔ Deformity- the distortion of a body party ➔ Objective Observations- descriptions based on the facts about a situation ➔ Subjective Observations- descriptions based on feelings or opinions about a situation ➔ Amendment- corrections to a health record ➔ Addendum- a type of amendment in which an item is added to a health record to correct an error ➔ Electronic Health Record (EHR)- an electronic record that includes a person’s entire medical history ➔ Electronic Medical Record (EMR)- a component of an EHR that includes administrative and clinical information about a single stay in a healthcare facility Chapter 15: Promoting Mobility ➔ Body alignment- the best placement of all body parts to allow the bones and muscles to be used efficiently ◆ Shoulder blades are back, the chest is forward, and top of your head is aligned with the ceiling ➔ Ankylosis- stiffening of muscles ➔ Contracture- the tightening or shortening of a body part (such as a muscle, a tendon, or the skin) due to lack of movement ➔ Foot drop- a condition in which the feet and toes drag ➔ Orthostatic Hypotension- a condition in which a person feels dizzy when standing due to a fall in blood pressure ➔ Syncope- temporary unconsciousness; fainting ➔ Trochanter rolls- soft rolls that are placed along the body and that span from above the hip to above the knee; are usually premade or made from a towel or bath blanket and are usually 12-14 inches long ➔ Repositioning- relieves pressure and strain on the skin, helping to prevent the formation of a decubitus ulcer ➔ Fowler’s Position- resident is seated in bed and the head of the bed is raised to a 45degree angle ➔ Semi-Fowler’s Position- resident is seated in bed and the head of the bed is raised to a 30-degree angle ➔ Supine Position- resident is lying face up, flat on the back ➔ Trendelenburg Position- used for residents who need certain medical or surgical procedures, legs are raised above the head and may be aligned extended or bent ➔ Prone Position- the resident is lying face down, flat on the abdomen ➔ Lateral Position- the resident is lying on the left side (left lateral) or the right side (right lateral in lateral position ➔ Slims’ Position- partly left lateral and partly prone position ➔ Ambulation- the ability to walk around ◆ Assist the resident into a dangling position ◆ Assist the resident in standing ◆ The resting begins ambulating ➔ amb- ambulation ➔ BR- bed rest ➔ BRP- bathroom privileges ➔ HOB- head of the bed ➔ OOB- out of bed ➔ Up ad lib- up as desired ➔ W/C- wheelchair ➔ Assistive devices- used for support during ambulation because residents can bear only a limited amount of weight on their legs and feet; includes canes, crutches, and walkers ➔ Restorative care: ◆ Preserve and support improvement accomplished by rehabilitation ◆ Offer adjustment and improvements that help residents to live as independently as possible ➔ Atony- lack of strength ➔ Thrombus- an immobile blood clot ➔ Embolus- a mobile blood clot ➔ Deep vein thrombosis (DVT)- blood clots that may break loose and travel through the bloodstream to cause a pulmonary embolus (PE) or a stroke ➔ Range of Motion (ROM) exercises can help improve heart and lung function, increase flexibility, improve a resident’s mood, and aid a resident in meeting rehabilitation and restorative care goals. ➔ Continuous passive motion (CPV) ➔ Active range of motion (AROM)- resident does not require physical help to perform exercises ➔ Active-assistive range of motion (AAROM)- resident needs help achieving the full range of motion for one or more body parts (muscles are too weak or stiff) ➔ Passive range of motion (PROM)- when a resident cannot move one or more body parts ➔ Flexion- the act of bending a joint ➔ Extension- the act of straightening a joint ➔ Abduction- lateral (sideways) movement away from the midline ➔ Rotation- turning of a body part around an axis or fixed point ➔ Circumduction- rotating a body part in a complete circle ➔ Supination- rotating a body part away from the body ➔ Pronation- rotating a body part toward the body ➔ Prosthetic- an artificial device designed to replace a missing body part ➔ An orthotic- device that supports, aligns or corrects a weak, immobile, injured, or deformed body part Chapter 18: Creating a Restful Environment ➔ Room equipment ◆ Hospital bed ◆ Moveable overbed table ◆ Bedside stand ➔ Traction equipment- weights, pulleys, and tape to treat muscular and skeletal disorders ➔ Mindful presence- the practice of checking your body for thoughts and feelings of stress and then consciously letting go of these stressful feelings and thoughts ➔ Circadian rhythm- our natural sleep-wake cycle ➔ Sleep deprivation- too little sleep ➔ Hallucinations- visual, verbal, or physical perceptions that are not real, but are mistaken for reality ➔ Sleep disorders: ◆ Insomnia- a sleep disorder that causes people to not be able to fall asleep or stay asleep ◆ Sleep apnea- interrupted breathing during sleep ➔ Narcolepsy- severe daytime sleepiness ➔ Restless Legs Syndrome (RLS)- unpleasant creeping, crawling, and prickling sensation in the legs and feet ➔ Dysrhythmia- abnormal heart rhythm Chapter 19: Assisting with Personal Hygiene ➔ Hygiene- routine actions that promote and maintain cleanliness and health ➔ Perineal care- care of the perineum (area between the thighs; pubis, anus, urethra, and external genitals) ➔ Morning care/Evening Care- promotes physical and emotional health at the start of the day (vital signs, assisting with elimination and measuring output, collecting specimens ordered by the doctor, helping residents wash their cases, comb their hair, and performing oral care) ➔ Bathing- helps maintain cleanliness and keeps residents free from sweat irritation, and possible bacterial growth ➔ Sitz bath- a type of therapeutic bath that soaks a person’s perineum, buttocks cause lacks the aligns, and sometimes hips in warm water ➔ Therapeutic- healing ➔ Skin integrity- the condition of the skin ➔ Hemorrhoids- inflamed veins around the anus or inside the rectum ➔ Whirlpool- a bathtub that uses small jets to move warm water ➔ Shaving ◆ Electric razors: should be used if the resident is taking blood-thinning medication ◆ Safety razor: only single or double blade ➔ Podiatrist- the doctor who specializes in foot health ➔ Compresses- pads of material: can be warm, cold, dry, or moist ➔ Cryotherapy- the use of cold applications to reduce swelling and ease pain ➔ Cyanotic- discolored and bluish due to insufficient oxygen ➔ Gangrene- a condition characterized by the death and decay of body tissue due to lack of blood supply ➔ Hydration- a sufficient amount of fluid in the body tissues ➔ Pallor- and usually pale color of the skin ➔ Tepid- slightly warm ➔ Thermotherapy- the use of heat applications to increase circulation and ease pain Chapter 20: Healthy Eating and Nutritional Challenges ➔ Eating patterns- describe how often and how fast people eat, are similarly affected by the experience ➔ Metabolism- the chemical process that converts nutrients into energy ➔ Calories- units of energy ➔ Carbohydrates- the body’s main source of energy ➔ Dietary fats- provide energy for the body; assist in the absorption of vitamins ➔ Proteins- found in every cell, proteins also help produce energy ➔ Vitamins- play a role in the development and growth of cells and are needed for the body to function properly ➔ Recommended Dietary Allowances (RDAs)- recommended levels of intake for each vitamin ➔ Minerals- inorganic substances found in the body ➔ Water- staying hydrated ➔ Malabsorption- can happen if the intestine falls to take in essential nutrients and fluids and transfer them to the bloodstream ➔ MyPlate- a government resource that helps people learn about food groups, food selections, and the proper amounts of food to eat from each group to achieve a healthy diet ➔ Obesity- is a health condition that occurs when a person’s body weight is much greater than what is considered healthy for a certain height ➔ BMI- a calculation of a person’s body fat is based on an adult man’s or woman’s height and current weight ➔ A soft or mechanical soft diet is ordered when a resident has difficulty chewing or swallowing due to weakness or dental difficulties ➔ Residents transitioning from clear liquids to a soft diet who have undergone special procedures or GI surgery will follow a full liquid diet ➔ A clear liquid diet is ordered before certain tests, medical procedures, or surgeries that require the gastrointestinal system to be free from food ➔ A doctor may order a bland diet to help treat ulcers, heartburn, nausea, vomition, diarrhea, or gas ➔ A low-sodium diet is ordered for residents who have kidney problems or heart diseases ➔ A cardiac/heart-healthy diet is ordered for residents with cardiovascular diseases or who are at risk for cardiovascular problems ➔ A diabetic/carb-controlled is ordered for residents with diabetes ➔ A renal diet is ordered for residents who have kidney damage or disease ➔ A high-fiber diet is ordered for residents who have chronic constipation, irritable bowel syndrome, or an elevated risk for colon cancer ➔ A low-fiber diet is ordered when a resident is experiencing GI problems, such as abdominal pain, diarrhea, and diverticulitis ➔ Liquid Consistencies ◆ Extremely thick; puddinglike ◆ Moderately thick; honeylike ◆ Medium-thick; nectarlike ◆ Thin; free-flowing (water) ➔ Adaptive and assistive eating equipment includes devices and products that help residents remain as independent as possible during meals (non skid plates and bowls, weighted utensils, utensil holders, cup holders) ➔ Enteral- by way of the gastrointestinal way ➔ Parental- by way of the veins or intravenous infusion Chapter 16: Vital Signs, Height, and Weight ➔ Vital signs (body temperature, pulse, respiration, and blood pressure) can help doctors diagnose specific diseases, determine treatments and medications, evaluate the effectiveness of treatments and medications. ➔ Temperature- mostly recorded in the ℉ahrenheit scale in the United States ➔ Disposable Oral Thermometers (not used as often)- used with patients in isolation to prevent high risk of infection ➔ Oral temperature- taken under the tongue, the most common method of taking a temperature ➔ Rectal temperature- taken by inserting a lubricated thermometer one inch or less into the anus for three to five minutes ➔ Axillary temperature- taken by placing a thermometer into the axilla ➔ Tympanic temperature- taken in the ear, the thermometer must be placed in the ear for an accurate reading ➔ Temporal temperature- taken on the forehead where the temperature of the temporal arteries on each side of the head can be measured ➔ Pulse- the pressure of the blood against the wall of an artery as the heartbeats ➔ Radial pulse- taken by feeling the radial artery located at the wrist (thumb side of the hand) on bare skin; two fingers are gently placed on the radial artery to take the pulse ➔ Apical pulse- taken by listening to the apical artery located at the apex of the heart. It is usually taken if the radial pulse is difficult to count or if a resident is unconscious. Pulse is taken using a stethoscope. ➔ Pulse rate- measured by feeling or hearing pulse and counting the number of beats in one minute using a watch with a second hand ➔ Resting pulse- taken when a resident is breathing normally and resting (average= 60-100 bpm) ➔ Bradycardia- slow pulse (-60 bpm) ➔ Tachycardia- fast pulse (100+ bpm) ➔ Rate of respiration- measurement of a resident’s breathing cycle (inhalation followed by exhalation) (average= 12-20 breaths per minute) ➔ Pulse oximeter- placed on finger and measures oxygen saturation in the blood ➔ Blood pressure- the force of blood pushing against the body’s arterial walls ◆ 120/80 ➔ Systolic- the pressure when the heart contracts and pushes blood through the artery ➔ Diastolic- the pressure when the heart muscle relaxes ➔ Apical- pulse taken using stethoscope ➔ Rectal body temp: 99.6 Chapter 22: Disabilities, Cognitive Disorders, and Mental and Emotional Health ➔ Nursing Assistants will be responsible for promoting resident independence while keeping them safe ➔ Make sure residents who have vision impairments or loss feel comfortable and familiar in their surroundings. Help the resident become familiar with their environment and surroundings. When ambulating, walk one step ahead of resident and let them know of any obstacles in their way.