Foundations of Resident Lecture Notes 1-4 Part 2

o o o o o o o o o o o ▪ Report to the nurse any task you cannot safely do To help a resident sit up, stand up, or walk, place your feet shoulder width apart, put one foot in front of the other, and bend your knees ▪ Your upper body should stay upright and in alignment Fall – any sudden, uncontrollable descent from a higher to a lower level, with or without injury resulting Falls make up most of the accidents that occur in care facilities Falls can be caused by an unsafe environment, loss of abilities, diseases, and medications Fracture – a broken bone Falls are particularly common among the elderly ▪ Older people are often more seriously injured by falls because their bones are more fragile NAs should be especially alert to the risk of falls All falls must be reported to the supervisor These factors increase the risk of falling: ▪ Clutter ▪ Throw rugs ▪ Exposed electrical cords ▪ Slippery or wet floors ▪ Uneven floors or stairs ▪ Poor lighting ▪ Call lights that are out of reach or not promptly answered Personal conditions that increase the risk of falling include: ▪ Medications ▪ Loss of vision ▪ Gait, walking, or balance problems ▪ Weakness ▪ Paralysis ▪ Disorientation Guidelines for preventing residents from falling: ▪ Clear pathways of potential hazards ▪ Use rugs with a nonslip backing ▪ Have residents wear non-skid, sturdy shoes ▪ Make sure shoelaces are tied ▪ Residents should not wear clothing that is too long or drags on the floor ▪ Keep items that are used often close to residents ▪ Answer call lights right away ▪ Report loose handrails immediately ▪ Mark uneven surfaces with tape of a contrasting color to indicate a hazard ▪ Lock wheels and move footrests out of the way before helping residents into or out of a wheelchair ▪ Lock bed wheels before helping a resident into and out of bed, or when giving care ▪ After completing care, return beds to their lowest position o o o o o o o o o o o o o o o o o ▪ Get help when moving residents ▪ Keep residents walking aids (canes, walkers, etc.) within their reach ▪ Offer help with elimination needs often ▪ Respond to requests for help immediately ▪ Leave furniture in the same place as you found it ▪ Know which residents are at risks for falls ▪ Pay attention so that you can give help often ▪ Never try to catch a falling resident Whenever a resident falls, it must be reported to the nurse Always complete an incident report, even if the resident says he or she says they are fine Burns can be caused by dry heat ▪ Ex: a hot iron, stove, other electrical appliances Burns can be caused by wet heat ▪ Ex: hot water or other liquids or steam Burns can be caused by chemicals ▪ Ex: lye, acids Small children, older adults, or people with loss of sensation are at greatest risk of burns Scalds – burns caused by hot liquids It takes 5 seconds or less for a serious burn to occur when the temperature of a liquid is 140 degrees Fahrenheit ▪ Coffee, tea, and other hot drinks are usually served at 160 degrees F to 180 degrees F, and these temperatures can cause almost instant burns that require surgery Guidelines for preventing burns and scalds: ▪ Always check water temperature with a water thermometer or the inside of your wrist before using ▪ Immediately report frayed electrical cords or appliances that look unsafe --> do not use them and remove them from the room ▪ Let residents know when you are about to pour or set down a hot liquid ▪ Pour hot drinks away from residents ▪ Keep hot drinks and liquids away from edges of tables ▪ Put lids on hot liquids ▪ Make sure residents are sitting down before serving hot drinks Residents must always be identified before giving care or serving food Facilities have different methods of identification ▪ Some have pictures to identify residents ▪ Some have signs outside residents’ doors NAs must identify the resident before starting any procedure or giving any care Identify residents before placing meal trays or helping with eating The diet card should be checked against the resident’s identification to make sure they match Choking – can occur when eating, drinking, or taking medication People who are weak, ill, or unconscious can choke on their own saliva A person’s tongue can also become swollen and obstruct the airway o o To guard against choking, residents should eat in as upright a position as possible Residents with swallowing issues may need to have liquids thickened to the consistency of nectar, honey, or pudding --> easier to swallow o There are many harmful substances in facilities that should not be swallowed, these include: ▪ Cleaning products ▪ Paints ▪ Medicines ▪ Toiletries ▪ Glues Harmful substances should be stored or locked away from confused residents or those with limited vision Cleaning products should not be left in resident’s rooms NAs should investigate any odors they notice o o o o o o o o o o o o o o o o o Cuts and abrasions typically occur in a bathroom at a facility Abrasion – an injury that rubs off the surface of the skin Sharp objects, such as scissors, nail clippers, and razors should be put away after use NAs should take care when transferring residents into and out of beds, chairs, and wheelchairs When moving residents in wheelchairs, NAs should push the wheelchair forward, wheelchairs should not be pulled from behind When using elevators, wheelchairs should be turned around before entering so that residents are facing forward OSHA – federal government agency that makes rules to protect workers from hazards on the job OSHA requires that all hazardous chemicals have a safety data sheet (SDS) Safety data sheet (SDS) - details the chemical ingredients, chemical dangers, and safe handling, storage, and disposal procedures for the product ▪ Information about emergency response actions that should be taken is also included Important information about SDS includes the following: ▪ Employer's must have an SDS for every chemical used ▪ Employer's must provide easy access to the SDS ▪ Staff members must know where the SDS is kept and how to read them All facilities have a fire safety plan, and all workers need to know this plan Evacuation routes are posted in facilities A fast, calm, and confident response from the staff saves lives Guidelines for reducing fire hazards and responding to fires: ▪ If residents smoke, make sure they are in the proper area ▪ Be sure that cigarettes are extinguished ▪ Empty ashtrays often and make sure there are no hot ashes or hot matches in it ▪ Use burn resistant aprons if they are available ▪ Never leave any smoker unattended ▪ Report frayed or damaged electrical cords immediately o o o o o o o o ▪ Do not block fire alarms and exit doors How to use a fire extinguisher ---> “PASS” acronym: ▪ P = pull the pin ▪ A = aim at the base of the fire when spraying ▪ S = squeeze the handle ▪ S = sweep back and forth at the base of the fire In case of fire, the “RACE” acronym is a good rule to follow: ▪ R = remove anyone in danger if you are not in danger ▪ A = activate alarm or call 911 ▪ C = contain fire, if possible, by closing all doors and windows ▪ E = extinguish the fire Know the facility's fire evacuation plan Know which residents need one-on-one help or assistive devices Immobile residents can be moved in several ways ▪ If they have a wheelchair, help them into it Remove anything blocking doors or exits Do not get into an elevator unless directed to do so by the fire department Stop, drop, and roll technique when clothes are on fire Chapter 2: Audio #4- Demonstrate how to Recognize and Respond to Medical Emergencies Notes: o o o o o Medical emergencies may be the result of accident or sudden injuries Heart attacks, strokes, diabetic emergencies, choking, automobile accidents, and gunshot wounds are all medical emergencies Falls, burns, and cuts can also be emergencies In an emergency, responders should remain calm, act quickly, and communicate clearly These steps show the correct response to emergencies: ▪ Assess the situation and try to find out what has happened ▪ Assess the victim and ask them what happened if they are conscious ▫ Speak loudly and use the person’s name ▪ Call for help right away ▪ If a person is conscious and able to speak, then they are breathing and have a pulse and the responder should talk to them about what happened ▪ The person should be checked for the following: ▫ Severe bleeding ▫ Changes in consciousness ▫ Irregular breathing ▫ Unusual color or feel to the skin ▫ Swollen places on the body ▫ Medical alert tags o o o o o o o o o o o o o ▫ Pain Implied consent – if the person were able or the parents were present, they would have given consent to the treatment, etc. An NA should ALWAYS get help --> she should call the nurse before doing anything else If the injured or ill person is conscious, he or she may be frightened --> the responder should listen to the person and tell them what is being done to help him ▪ A calm and confident response is the most reassuring After the emergency is over, the NA will need to document what happened and complete an incident report ▪ Include as many details as possible and include only facts First aid – emergency care given immediately to an injured person by the first people to respond to an emergency Cardiopulmonary resuscitation (CPR) - refers to medical procedures used when a person’s heart or lungs have stopped working ▪ Used until medical help arrives ▪ Must be started immediately to prevent or lessen brain damage ▪ Brain damage can occur within 4-6 minutes after the heart stops beating and breathing stops ▪ The person can die within 10 minutes NAs need to know their facility’s policies on initiating CPR ▪ Some facilities do not allow NAs to begin CPR without direction of the nurse Choking – when something is blocking the tube by which air enters the lungs, the person has an obstructed airway ▪ When people are choking, they usually put their hands to their throat If the resident can speak, breathe, or cough, the NA should only encourage her to cough as forcefully as possible to get the object out ▪ Stay with the resident until they stop choking If a resident can no longer speak, breathe, or cough, the NA should call for help immediately by using the call light or emergency cord ▪ The choking victim should NOT be left alone Abdominal thrusts – a method of attempting to remove the object from the airway of someone who is choking ▪ Thrusts work to remove the blockage upward and out of the throat ▪ The resident must show signs of a severely obstructed airway, these signs include: ▫ Poor air exchange ▫ An increase in troubled breathing ▫ Silent coughing ▫ Blue-tinted, cyanotic skin ▫ Inability to speak, breathe, or cough The NA should ask, “Are you choking? I know what to do. Can I help you?” Abdominal thrusts should never be performed on a person who is not choking o o o o o o o o o o ▪ Risk injury to the ribs and internal organs Procedure for performing abdominal thrusts on 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, and pull both hands toward you and up quickly and forcefully 4. Repeat until the object is pushed out or the resident loses consciousness 5. Report and document the incident properly If the resident becomes unconscious while choking, she should: ▪ Be helped to the floor gently, ▪ Be laying on her back on a hard surface ▪ The NA should begin CPR if trained and allowed to do so ▪ The NA should make sure help is on the way The NA should always stay with the victim until help arrives Shock – occurs when organs and tissues in the body do not receive an adequate blood supply Bleeding, heart attack, severe infection, and falling blood pressure can all lead to shock Shock can become worse when the person is very frightened or in severe pain Shock is a dangerous, life-threatening situation Signs of shock include: ▪ Pale or bluish skin ▪ Staring ▪ Increased pulse or respiration rates ▪ Low blood pressure ▪ Extreme thirst An NA should always call for help if she suspects a resident is in shock Procedure for 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 3. Have the person lay down on their back, and elevate the legs about 8-12 inches, unless the person has a head, neck, back, spinal, abdominal injury, breathing difficulties, or fractures. Elevate the head and shoulders if a head wound or breathing difficulties are present ▫ If the person is bleeding from the mouth or vomiting, place them on their side ▫ Elevating the legs allows blood to flow back to the brain and other vital areas ▫ Never elevate a body part if a person has a broken bone or if it causes pain 4. Check pulse and respirations if possible ▫ If the person stops breathing or has no pulse, begin CPR 5. Keep the person as calm and as comfortable as possible 6. Maintain normal body temperature 7. Do not give the person food or liquids 8. Report and document the incident properly o o o o o o o o o Myocardial infarction or heart attack Myocardial infarction (MI)/ heart attack – occurs when the heart muscle itself does not receive enough oxygen because blood vessels are blocked ▪ Emergency that can result in serious heart damage or death The following are signs and symptoms of MI: ▪ Sudden, severe pain in the chest (usually on the left side or in the center) ▪ Pain or discomfort in other areas of the body, such as one or both arms, the back, neck, jaw, or stomach ▪ Indigestion or heartburn ▪ Nausea and vomiting ▪ Dyspnea or difficulty breathing ▪ Dizziness ▪ Pale or blueish, cyanotic skin (indicating lack of oxygen) ▪ Perspiration ▪ Cold and clammy skin ▪ Weak and irregular pulse rate ▪ Low blood pressure ▪ Anxiety and a sense of doom ▪ Denial of a heart problem The pain of a heart attack is commonly described as a pain of “crushing, pressing, squeezing, stabbing, piercing” pain, or like someone is sitting on someone’s chest The pain may go down the inside of the left arm ▪ May also feel the pain in the neck or jaw ▪ Pain usually does not go away Women can have heart attacks without chest pressure ▪ Women are more likely to have shortness of breath, nausea, lightheadedness, stomach pain, sweating, fatigue, and back, neck, or jaw pain ▪ Some women’s symptoms seem more flu-like and women are more likely to demy that they are having a heart attack Procedure for responding to a myocardial infarction: 1. Notify the nurse immediately 2. Place the person in a comfortable position. Encourage them to rest. Reassure them that you will not leave them alone. 3. Loosen clothing around the person’s neck 4. Do not give the person food or liquids 5. Monitor the person’s breathing and pulse ▫ If the person stops breathing or has no pulse, begin CPR 6. Stay with the person until help arrives 7. Report and document the incident properly Severe bleeding can cause death quickly and must be controlled Procedure for 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, or clean 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 other pads if blood seeps through. Do not remove the first pad. 5. If you can, raise the wound above the level of the heart to slow the bleeding. Prop up the limb if the wound is on an arm, leg, hand, or foot (and if there are no broken bones) 6. When bleeding is under control, secure the dressing to keep it in place. Check for symptoms of shock. Stay with the person until help arrives. 7. Remove and discard gloves, and wash hands thoroughly 8. Report and document the incident properly o o o Care of a burn depends on its depth, size, and location Burns may require emergency help Procedure for 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. Dampen a clean cloth with cool water and place it over the burn. ▫ Do not use ice or ice water, as ice may cause further skin damage 3. Once the pain has eased, you may cover the area with a dry, clean dressing or non-adhesive sterile bandage 4. Remove and discard gloves, and wash your hands 5. Never use any kind of ointment, salve, or grease on a burn ▪ For more serious burns: 1. Remove the person from the source of the burn, and protect yourself from the source of the burn 2. Notify the nurse immediately and put on gloves 3. Check for breathing, pulse, and severe bleeding ▫ If the person is not bleeding and has no pulse, begin CPR 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 sterile gauze or a clean sheet. Apply the gauze or sheet lightly ▫ Take care NOT to rub the burned area 6. Monitor vital signs and wait for emergency medical help 7. Remove and discard gloves and wash your hands 8. Report and document the incident properly o Fainting – also called syncope; occurs as a result of decreased blood flow to the brain, causing a loss of consciousness May be the result of hunger, hypoglycemia, dehydration, fear, pain, fatigue, standing for a long time, poor ventilation, certain medications, pregnancy, or overheating o o o o o o o o o Signs and symptoms of fainting include: ▪ Dizziness ▪ Nausea ▪ Perspiration ▪ Pale skin ▪ Weak pulse ▪ Shallow respirations ▪ Blackness in the visual field Procedure for responding to fainting: 1. Notify the nurse immediately 2. Have the person lay down or sit down before fainting occurs 3. If the person is in a sitting position, have him bend forward and place his head between his knees. If the person is lying flat on his back, elevate his legs about 12 inches. 4. Loosen any tight clothing 5. Have the person stay in position for at least 5 minutes after symptoms disappear 6. Help the person get up slowly and continue to observe them for more symptoms of fainting. Stay with them until they feel better. 7. If a person does faint, lower them to the floor or other flat surface. Position them on their back. If they have no head, neck, back, spinal, or abdominal injuries, elevate their legs 8-12 inches. Loosen any tight clothing and check to make sure the person is breathing. 8. Report and document the incident properly Report fainting to the nurse immediately, as it may be a sign of a more serious condition Insulin reaction and diabetic ketoacidosis are problems of diabetes that can be life-threatening Insulin reaction, or hypoglycemia, can result from either too much insulin, or too little food ▪ Occurs when insulin is given and a person skips a meal, or does not eat all the food that is required ▪ Vomiting and diarrhea may also lead to insulin reactions in people with diabetes Even when a normal, regular amount of food is eaten, physical activity may rapidly metabolize the food --> causes too much insulin to be in the body The first signs of insulin reaction include: ▪ Feeling weak or different ▪ Nervousness ▪ Dizziness ▪ Perspiration ▫ The NA should immediately report these signs to the nurse ▫ Signal that the resident needs food that can be rapidly absorbed → Ex: a glass of milk, fruit juice, water with sugar dissolved in it, glucose tablet, etc. Other signs and symptoms of insulin reactions include the following: ▪ Hunger ▪ Headache ▪ Rapid pulse o o o o o o o o ▪ Low blood pressure ▪ Cold, clammy skin ▪ Confusion ▪ Trembling ▪ Nervousness ▪ Blurred vision ▪ Numbness of the lips and tongue ▪ Unconsciousness Diabetic ketoacidosis (DKA) - caused by having too little insulin; can result from undiagnosed diabetes, infection, going without insulin or not taking enough, eating too much, not getting enough exercise, or physical and emotional stress The signs of the onset of DKA include: ▪ Increased hunger, thirst, or urination ▪ Abdominal pain ▪ Deep or labored breathing ▪ Breath that smells sweet or fruity Other signs and symptoms of DKA include the following: ▪ Headache ▪ Weakness ▪ Rapid, weak pulse ▪ Low blood pressure ▪ Dry skin ▪ Flushed cheeks ▪ Drowsiness ▪ Nausea and vomiting ▪ Shortness of breath ▪ Unconsciousness Seizures – involuntary, often violent, contractions of muscles --> can involve a small area or the entire body; caused by abnormalities in the brain ▪ They can occur in young children who have a high fever, older children and adults who have a serious illness, fever, head injury, or a seizure disorder (epilepsy) Main goal during a seizure is to make sure the resident is safe During a seizure, a person may shake severely and thrust arms and legs uncontrollably; he may clench his jaw and drool and be unable to swallow Most seizures only last a short amount of time Procedure for responding to seizures: 1. Note the time and put on a pair of gloves 2. Lower the person to floor and cradle their head to protect it. Loosen clothing to help with breathing. Try to turn the person’s head to one side to help lower the risk of choking. ▫ If a pillow is nearby, place it under the person’s head 3. Have someone call the nurse immediately, do not leave the person unless you must do so to get medical help 4. Move furniture away to prevent injury 5. Do not try to restrain the person or stop the seizure 6. Do not force anything between the person’s teeth, and do not place your hands in the person’s mouth 7. Do not give the person food or liquids 8. When the seizure is over, note the time. Gently turn the person over on his left side if you do not suspect head, neck, back, spinal, or abdominal injuries. Check for adequate breathing and pulse. ▫ Turning the person reduces the risk of choking on vomit or saliva ▫ If the person begins to choke, get help immediately ▫ Do not begin CPR during a seizure 9. Remove and discard gloves, and wash your hands 10. Report and document the incident properly, including how long the seizure lasted o o o o Cerebral vascular accident (CVA) or stroke – occurs when blood supply to a part of the brain is blocked, or a blood vessel leaks or ruptures within the brain A quick response to a suspected stroke is critical ▪ Tests and treatment need to be given within a short time of the stroke’s onset ▪ Early treatment may be able to reduce the severity of the stroke Transient ischemic attack (TIA) - one of the warning signs of a CVA; it is the result of a temporary lack of oxygen in the brain ▪ Symptoms may last up to 24 hours, and they include: ▫ Difficulty speaking ▫ Weakness on one side of the body ▫ Temporary loss of vision ▫ Numbness or tingling ▪ Make sure to report any of these symptoms to the nurse immediately These are all signs that a TIA or CVA is occurring ▪ Facial numbness, weakness, or drooping (especially on one side) ▪ Paralysis on one side of the body (hemiplegia) ▪ Arm numbness or weakness, especially on one side (hemiparesis) ▪ Slurred speech or inability to speak (expressive aphagia) ▪ Inability to understand spoken or written words (receptive aphagia) ▪ Use of inappropriate words ▪ Severe headache ▪ Blurred vision ▪ Ringing in the ears ▪ Redness in the face ▪ Noisy breathing ▪ Elevated blood pressure ▪ Slow pulse rate ▪ Nausea or vomiting ▪ Loss of bowel and bladder control ▪ Seizures o o o o o o o ▪ Dizziness ▪ Loss of consciousness In addition to the symptoms listed above, women may have these symptoms: ▪ Pain in the face, arms, and legs ▪ Hiccups ▪ Weakness ▪ Chest pain ▪ Shortness of breath ▪ Palpitations The acronym “FAST” can be used to remember the sudden signs that a stroke is occurring ▪ F = face ▫ Is one side of the face drooping? ▫ Is it numb? ▫ Ask the person to smile. Is the smile uneven? ▪ A = arms ▫ Is one arm numb or weak? ▫ Ask the person to raise both arms. Check to see if one arm drifts downward. ▪ S = speech ▫ Is the person’s speech slurred? ▫ Is the person unable to speak? ▫ Can the person be understood? ▫ Ask the person to repeat a simple sentence, and see if they repeat the sentence correctly ▪ T = time ▫ If the person shows any of the symptoms listed above, report to the nurse immediately Vomiting or emesis – the act of ejecting stomach content through the mouth and/or nose Can be the sign of a serious illness or injury Because an NA might not know when a resident is going to vomit, he may not have time to explain what he is going to do and assemble supplies ahead of time The NA should talk to the resident soothingly as he or she helps them clean up ▪ Tell the residents what you are doing to help them Procedure for 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 and remove it when the vomiting has stopped 4. Remove soiled linens or clothes and set them aside, and replace them with fresh linens or clothes 5. If resident’s intake and output (I&O) is being monitored, measure and note the amount of vomit 6. Flush the vomit down the toilet, unless the vomit is red, has blood in it, or looks like wet coffee grounds, or if medications and pills are in the vomit 7. 8. 9. 10. 11. 12. 13. 14. ▫ Show this to the nurse before discarding the vomit Remove and discard gloves Wash your hands Put on fresh gloves Provide comfort to the resident. Wipe their face and mouth and position them comfortably. Offer a drink of water or oral care Put soiled linens in the proper containers Remove and discard gloves Wash your hands again Report and document the incident properly ▫ Document time, amount, color, odor, and consistency of vomit