Chapter 2: Foundations of Resident care

Communication:
The process of exchanging information with others.

Verbal communication:
Written or spoken messages.

Nonverbal communication:
communication without using words.

Objective information:
Information based on what is seen, heard, touched or smelled.

Subjective information:
Information that cannot be observed; this information is based on what a person thinks, or feels, Ex: I feel hungry

Incontinence:
The inability to control the bladder or bowels

Consider these barriers of communication:

Not heard correctly or not understood. (different language) Resident cannot hear Resident has difculty understanding Message uses word reciever does not understand Use of slang Use of cliches Resident becomes defensive yes/no questions used

Defense Mechanisms:
unconscious behavior used to release tension, cope with stress or attempt to seem powerful

These are common Defense Mechanisms behaviors:

Denial Projection Displacement Rationalization Repression Regression

Culture:
A system of learned behaviors, practiced by a group of people, that are considered to be the tradition of that people and are passed from one generation to the next

Impairment:
Loss of function or ability

Combative:
Violent or hostile behavior.

How can a NA assist resident with hearing impairment?

Make sure hearing aid is working Reduce or remove noise Get residents attention rst Speaking 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

How can a NA assist resident with vision impairment?

was

Make sure glasses are on, clean and in good condition Identify self when entering room Tell resident what you are doing at all times Orient resident where the call light is Use imaginary clock as a guide Do not move items, put anything you move back where it

A person who is mentally healthy:

love Deals with situations that cause anxiety, dissapointment and frustration Takes responsibility for decisions, feelings and actions Controls and llls desires and impulses in an appropriate manner

Functions & interacts effectively with other Adapts to change, cares for self & others, & gives and accepts

Remember:
choose to be well Mental illness is a disease like any physical illness

People who are mentally ill cannot control their illness and

Remember these guidelines when assisting residents with mental illness:

body language Be honest and direct, as with any resident Avoid arguments Maintain eye contact Listen carefully

Do not speak to residents as if they were children Use simple, clear statements. use normal tone of voice Speak with respect maintain a normal distance from the resident; be aware of

NAs should never respond in these ways to combative residents:

safe

Remain calm, Lower tone of voice Block physical blows or step out of the way Be exible and patient Stay nutral 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. Leave resident alone if it is

When dealing with angry behavior:

Stay calm Do not respond to verbal attacks or argue Empathize Try to nd out cause Be respectful. Explain what you are going to do Answer call lights promptly Stay at a safe distance

When dealing with inappropriate behavior:

Report behavior Be matter-of-fact Do not over-react Try distraction Gently direct resident to private area
Remember:

Prevention is the key to safety Always report unsafe conditions before accidents occur

Body Mechanics: The way the parts of the body work together whenever a person moves. Posture: The way a person holds and positions his body

To have a strong base of support remember:

A wide base is more stable Stand with legs shoulder-with apart

Fracture:
A broken bone

Disorientation:
Confusion about time or place

Scalds:
Burns caused by hot liquids

Abrasion:
An injury that rubs off the surface of the skin

Falls are the most common Accidents in LTC facilities: Causes: Unsafe environment Loss of abilities Disease Medication Prevention: Clear walkways Use non-skid mats or carpeting Have residents wear non-skid, properly tting shoes Answer call lights promptly & keep frequently- used items nearby.

Burns and scalds: Causes: Stoves Electric appliances Hot water heating devices Prevention: Check water temperature Report frayed or damaged electrical cords Let residents know before pouring or setting down hot liquids make sure residents are sitting down before serving hot drinks Pour hot liquids away from residents Keep hot drinks & liquids away from edges of table and put a lid on them

Mistake in resident Identication: Causes: Failure to verify information before giving care or serving food Prevention:

Identify each resident before giving care or feeding Check IDs Call the resident by name
Remember:

Not identifying resident before giving care or serving food can

cause serious problems or even death

Choking: Causes:

Weakness Illness Unconscious resident

Prevention:

problems

Make sure resident are in upright positions to eat Special diets with thickened liquids help residents with swallowing

Poisoning: Causes: Ingesting harmful substances

Prevention:

Store harmful substances carefully Do not leave cleaning products in rooms Post control center number 1(800) 222-1222

Cuts/Abrasions: Causes: Sharp objects

Prevention: Put sharp objects away after use Push wheelchairs forward Approach doors slowly

OSHA (Occupational Safety and Health Administration):

A federal government agency that makes rules to protect workers from hazards on the job.

MSDS (Material Safety Data Sheet):

A sheet detailing the chemical ingredients, chemical dangers, emergency response actions to be taken, and safe handling procedures for a product

NAs play a role in re safety, remember:

Never leave a smoker unattended Make sure ashtrays do not contain hot ashes before emptying Report frayed or damaged electrical cords Report if re alarms and exit doors are blocked
Know how to use a re extinguisher:

Pull the pin Aim at the base of the re when spraying Squeeze the handle Sweep back and forth at the base of the re

In case of re, use RACE:

Remove residents from danger Activate 911 Contain re if possible Extinguish, or re department will extinguish

Memorize these steps and always follow them when responding to an emegency:
note the time Assess the victim, check the victims level of consciousness. Call for help or send someone to get it Remain calm and condent Properly document the emergency after it is over

Assess the situation. Make sure you are not in danger and

Watch for the following symptoms of injury:

Severe bleeding Changes in consciousness Irregular breathing unusual color or feel to the skin Swollen places on the body Madical alert tags Anything the resident says is painful

First aid:
Emergency care given immediately to an injured person

Cardiopulmonary Resuscutation (CPR):

Medical procedures used when a persons heart or lungs have stopped working.

Obstructed airway:
A condition in which the tube through which air enters the lungs is blocked.

Shock:
A condition that occurs when organs and tissues in the body do not recieve adequate blood supply.

Cyanotic:
Skin that is pale, blue or gray

Dyspnea:
Difculty breathing

Insulin reaction:
Complication of diabetes that can result from either too much insulin or too little food; also known as hypoglycemia.

Diabetic Ketoacidosis:
Complication of diabetes that is caused by having too little insulin; Also called hyperglycemia or diabetic coma

Cerebrovascular accident (CVA):

A condition that occurs when blood supply to a part of the brain is cut off suddenly by a clot or a ruptured blood vessel; it is also called a stroke

Transient ischemic attack:

A warning sign of a CVA resulting from a temporary lack of oxygen in the brain; symptoms may last up to 24 hours.

Emesis:
The act of vomiting, or ejecting stomach contents through the mouth.

Signs of shock include the following:

Pale bluish skin Staring Increased pulse and respiration Low blood pressure Extreme thirst
Signs of Heart attack include the following:

Sudden, severe pain in the chest, usually left side Pain or discomfort in other areas of the body Dyspnea Cold clammy Skin which may be pale, gray or cyanotic Perspiration Low blood pressure Anxiety and a sense of doom Denial of a heart problem

Signs of Hypoglycemia include the following:

Weakness Rapid pulse Headache Low blood pressure Sweating

Signs of Hyperglycemia include the following:

Hunger Frequent urination Excessive thirst Sweet, fruity breath odor nausea blurred vision

The following are signs of seizures:

Severe shaking Thrusting arms and legs uncotrollably Jaw clenching Drooling Inability to swallow
Remember:
the resident safe

The primary goal of the caregiver during a seizure is to keep

Signs that a stroke is occurring include:

Facial numbness or weakness, especially on one side Arm numbness or weakness, especially on one side Slurred speech or difculty speaking Use of inappropriate words Inability to understand spoken or written words Redness in the face Noisy breathing Dizziness Blurred vision Headache Seizures Loss of bowel and bladder control Elevated blood pressure loss of consciousness

Infection Control:
Measures practiced in healthcare facilities to prevent and control the spread of disease.

Microorganism:
A living thing or organism that is too small that it can be seen only through a microscope

Infection:
The state resulting from pathogens invading the body and multiplying

Pathogens:
Harmful microorganisms

Systemic infection:
An infection that is in the bloodstream & is spread through the body

Localized infection:
An infection that is conned to a specic part of the body and has local symptoms

Healthcare-associated infection:
Infections that patients acquire within healthcare setting

Medical Asepsis:
The process of removing pathogens, or the state of being free of pathogens

Clean:
In healthcare, a condition in which objects are not contaminated with pathogens

Dirty:
In healthcare, a condition in which objects have been contaminated with pathogens

Surgical Asepsis:
The state of being free of all microorganisms, also called sterile technique

Causitive agent:
a pathogen or microorganism that causes disease.

Clean:
In healthcare, a condition in which objects are not contaminated with pathogens

Dirty:
In healthcare, a condition in which objects have been contaminated with pathogens

Surgical Asepsis:
The state of being free of all microorganisms, also called sterile technique

Causitive agent:
a pathogen or microorganism that causes disease.

Reservoir:
A place where a pathogen lives and grows

Portal of entry:
Any body opening on an infected person that allows pathogens to leave

Mode of transmission:
Method of describing how a pathogen travels from one person to the next

Direct contact:
Touching an infected person or his secretions

Direct contact:
Touching an infected person or his secretions.

Indirect contact:
Touching something contaminated by an infected person

Portal of entry:
Any body opening on an uninfected person that allows pathogens to enter.

Sputum:
The uid a person coughs up from the lungs

Mucous membrane:
The membrane that line body cavities, such as the mouth, nose, eyes, rectum, or genitals.

Susceptible host:
An uninfected person who could get sick

Transmission:
Movement of a pathogen from one person to another.

Sharps:
Needles or other sharp objects

Centers for Disease Control and Prevention (CDC):

A government agency under the Department of Health and Human Services (HHS) that issues information to protect the health of individuals and communities A method of infection control in which all blood, body uids, non-intact skin, & mucous membranes are treated as if they were infected with a infectious disease

Standard Precautions:

Body Fluids:
Under Standard Precautions, includes saliva, sputum, urine, feces, semen, vaginal secretions, and pus or other wound drainage; does not include sweat.

Remember these guidelines for Standard Precautions:

Wear gloves when appropriate Wash hands Remove gloves immediately when nished with a procedure Immediately wash skin surfaces Wear disposable gown when appropriate Wear mask and goggle when appropriate Wear gloves and use caution when handling sharp objects NEVER attempt to cap needles or syringe Avoid nicks and cuts when shaving residents Bag all contaminated supplies Clearly label body uids Dispose of contaminated waste properly

Hand Hygiene:
Washing hands with either plain or antiseptic soap & water and using alcohol-based hands rubs.

Hand antisepsis:
Washing hands with water & soap or other detergents that contain an antiseptic agent

Remember:
Handwashing is the singl most important thing you can do to prevent the spread of disease

Personal Protective Equipment (PPE):

Equipment that helps protect employees from serious workplace injuries or illnesses resulting from contact with workplace hazards

Perineal Care:
Care of the genitals and anal area

Non-intact skin:
Skin that is broken by abrasions, cuts, rashes, acne, pimples or boils

When should gloves be worn?

Sterilization:
A measure that destroys all microorganisms, including pathogens

Disinfection:
Process that kills pathogens, but not all microorganisms; it reduces the organisms count to a level that is generally not considered infectious.

Disposable:
only to be used once and then discarded.

Remember these guidelines for handling equipment, linen and clothing:

properly dispose of all single-use equipment properly

Prevent skin/mucous membrane contact Prevent contamination of your clothing Prevent transfer of disease to other residents or environments Do not use re-usable equipment until it has been cleaned

Remember these guidelines for cleaning spills involving blood, body uids, or glass:

containers Apply disinfectant Use tools to pick up glass, never hands

Put on industrial strength gloves over disposable gloves Use proper product to absorb spill Scoop up absorbed spill and dispose of it in designated

Transmission-Based Precautions:
Method of infection control used when caring for persons who are infected or suspected of being infected with a disease

Antimicrobial:
Capable of destroying or resisting pathogens

Remember:
Transmission-Based Precautions are always used in addition toStandard Precautions.

Diseases that can be transmitted through the air after being expelled:

TB Measles Chicken Pox

Precautions:

Special face mask (N95 Respirator)

Diseases that can bespread by touching skin, wounds or infection:

Lice Scabies Pink eye

Precautions:

PPE Hand washing Avoiding touching infected surfaces without gloves Avoid touching uninfected surfaces with dirty gloves

Bloodborne pathogens:
Microorganisms found in human blood, body uid, draining wounds, & mucous membranes that can cause infection and disease in humans.

Hepatitis:
Inammation of the liver caused by different infection

Tuberculosis (TB):
An airborne disease that affects the lungs; causes coughing, trouble breathing, fever, and fatigue

Bloodborne diseases are transmitted in these ways:

healthcare settings

Infected blood Infected semen or vaginal secretions Sexual contact Needle sharing Infected mothers Contact with infected blood or certain other body uids in

Remember these following guidelines for TB:

Follow Standard Precautions and Airborne Precautions Wear mask and gown Handle sputum or phlegm carefully Ensure proper ventilation If resident in in AFB isolation room, open & close door slowly Follow isolation procedures if ordered Help resident remember to take medications

Employer's responsibility regarding infection control include the following:

Provide infection control procedures and exposure control plan Provide in-service education Provide written procedures to follow Provide PPE for employees Provide free Hepatitis B vaccine

Employees responsibility regarding infection control include the following:

Follow Standard Precautions Follow Facility Policies and procedures Follow care plans and assignments Use PPE when appropriate Take advantage of free Hep. B vaccine Immediately report exposure Participate in education programs