1. Promotion of function and health
of residents
Chapter 4
PERSONAL CARE SKILLS
RESTORATIVE SKILLS
PSYCHOSOCIAL SKILLS
RECORDING AND
REPORTING
2. Activities of daily living
(ADLs)
Assistant residents with
activities of daily living,
Is your primary
responsibilities.
4. Daily Hygiene Needs
Bathing Shampooing
Skin care hair
Back care Hair care
Oral Nail care
hygiene Perineal care
Shaving Dressing and
undressing
5. HYGIENE
Important for residents to feel clean and fresh
To keep the residents free from disease due to
harmful bacteria that can enter the body through
any skin break.
Includes: mucous membranes that line any body
cavity.
With aging skin produces less oil, Which makes it
dry, requiring less frequent bathing.
This does not mean that a daily partial bath is not
needed to freshen the mouth and perineal area (
area of the body that includes the male and
female genital and the anus)
6. Cleanliness
Removes body sweat, odors and other
secretions.
Morning care ( AM CARE )
Including washing face and hands, tooth
brushing or denture care before eating
breakfast helps to decrease harmful
bacteria.
Helps to maintain a pleasant appearance
and increase a sense of well-being for
resident.
7. Hygiene care before bedtime
Called HS ( hour of sleep) care
Accomplishes the same goals and
promotes rest and sleep.
HS care might include a back rub to
relax the resident.
10. Factors That Affect Hygiene
Practices
Culture
Family Practices
Illness
Individualpreferences
–Bath in morning or before
going to bed
–Frequency of bathing, shaving
–Shampooing hair daily or
weekly
11. Factors That Affect Hygiene
Practices
(continued)
Economics
–Unable to afford
deodorant, shampo
o, etc.
–Unable to afford
utilities
19. Guidelines for Bathing
Receive instructions
from supervisor
regarding method of
bathing and skin care
products to use
Provide privacy
Reduce drafts by
closing windows,
drapes and doors
19
20. Guidelines for Bathing
(continued)
Use good body mechanics
Keep covered for warmth and
privacy
Protect safety of resident:
–never leave unattended in
bathtub or shower
–take precautions to prevent
slips and falls
–have temperature no higher
than 105 F for tub or shower
20
21. BATHING
Resident’s bath schedule as determined by
the care plan
Might require a complete bath, shower, or
a partial bath.
General goals of skin care is to remove
pathogens, promote
comfort, cleanliness, help improve
circulation and opportunity to inspect the
skin, mobility.
Helps increase self-esteem.
22. General principles that apply to
bathing
Standard precautions for personal
care
Keep bathwater temperature at a
safe level
Use mild soap or other cleansers per
facility policy
Watching for resident allergies to
bath products
23. When cleansing the body
Wash from the cleanest area to the
dirtiest area
For complete bed bath, change
water, wash cloth, and gloves prior to
bathing the lower extremities.
Always provide privacy
Caution for residents who become weak
dizzy or faint during the bath stop the
bath process, stay with the resident and
call for assistant, and report the incident
to the licensed nurse immediately
26. Perineal Care
Used to clean genital and anal
areas
–Prevents infection
–Prevents odors
–Promotes comfort
26
27. Perineal Care
Rules
of medical asepsis and
Standard Precautions followed
–Work from cleanest to dirtiest
area (front to back)
urethral area – cleanest
anal area – dirtiest
27
28. Perineal Care
(continued)
Delicate area that needs special
care
–Use warm water
–Wash gently
–Rinse well
–Pat dry
28
30. Oral Hygiene
(continued)
Purpose
–Prevent odors
–Prevent infections
–Prevent tooth decay
and loss of teeth
–Prevent gum disease
–Increase comfort
–Enhance taste of
food
30
31. Oral Hygiene
(continued)
Oralhygiene is
provided:
–Before breakfast
–After meals
–At bedtime
–Other times as
requested or
necessary
31
32. Oral Hygiene
(continued)
Observationsto report:
–Foul mouth odors
–Bleeding
–Loose or broken teeth or
dentures
–Sores in or around mouth
–Coated tongue
–Complaints of pain
32
34. Principles For Brushing Teeth
Hold brush at 45 degree angle
Use circular motion to brush
teeth
Brush well where teeth and
gums meet
Brush all surfaces
Brush upper teeth first
Brush gently
Offer diluted mouth wash
DHSR Approved Curriculum-Unit 9 34
35. Special Mouth Care Products
Swabs
Toothettes:
–usually soaked in
mouthwash or plain
water
–hydrogen peroxide,
salt water solution if
specified on care plan
Petroleum jelly for dry
lips 35
36. Denture Care
Handle carefully –
expensive to replace
Clean as often as natural
teeth
Protect from loss or
breakage
Store safely, when out of
mouth, in labeled container
Never use hot water, which
can warp dentures 36
37. Denture Care
(continued)
Store dry, in water or in
special solution
For long term storage, put
container holding dentures
in bedside stand
37
39. Grooming
Nurse aides are the
members of the health care
team responsible for
providing personal care and
grooming for the resident.
They encourage the
resident to do as much as
possible for themselves, but
assist as needed with
personal cleanliness, oral
hygiene, nail care, shaving,
dressing, care of hair and
skin care.
40. Grooming: Relationship To Self-
Esteem
Introduction
(continued)
Personal grooming is
important for a positive self-image
and every effort should be made
to encourage and assist the
resident to maintain a pleasing
and attractive appearance.
40
41. Provide for the resident’s
personal care and grooming
needs and identify the role of
the nurse aide in meeting
these needs.
List the daily hygienic needs of
an individual.
41
42. Daily Hygiene Needs
Bathing Shampooing
Skin care hair
Back care Hair care
Oral Nail care
hygiene Perineal care
Shaving Dressing and
undressing
42
43. Personal Care and Grooming:
Role of the Nurse Aide
Assist to follow their
personal hygiene
practices
Encourage to do as much
of their daily care as
possible
Assist residents to select
their own clothing
43
44. Personal Care and Grooming:
Role of the Nurse Aide
(continued)
Promote independence and self
esteem
Encourage use of deodorant,
perfume, aftershave lotion, and
cosmetics
Be patient and encouraging
44
49. Assisting Resident With Shaving
Factors to consider:
–Electric razor provides greatest
safety
–Use own equipment or a
disposable safety razor
–Soften beard and skin prior to
shaving
49
52. Nail Care
Requires daily cleaning
and trimming of
fingernails and toenails
as needed
Maintain nails by keeping
nails:
–short
–clean
–free of rough edges 52
56. Nail Care: Factors To Consider
Easier to trim and clean
after soaking
Nail clipper used to cut and
trim nails
Clip nails straight across
Softened cuticle can be
pushed back with orange
stick
56
57. Nail Care: Factors To Consider
(continued)
Diabetics and residents with
circulatory problems will have
their nails trimmed only by a
licensed nurse or podiatrist
Reviewresident care plan and
check with supervisor prior to
trimming nails
57
59. Factors To Consider In Foot Care
Wash feet using warm
water and mild soap
Dry feet carefully,
especially between the toes
Apply lotion to tops and
bottoms of feet only, not
between the toes to
prevent skin breakdown
59
60. Factors To Consider In Foot Care
(continued)
Do not use a heating
pad on resident’s
feet
Keep footwear on;
residents never go
barefoot
Change socks and
shoes daily
60
61. Factors To Consider In Foot Care
(continued)
Foot injuries and
infections can lead to
gangrene and
amputation,
especially in diabetics
Notify supervisor
immediately of any
unusual observations
of the feet
61
66. Factors To Consider For
Daily Hair Care
Because hair style is
personal preference,
ask about style
Make brushing and
combing part of
morning care
66
67. Factors To Consider For
Daily Hair Care
(continued)
Protect resident’s
clothing by placing
towel around
shoulders
Cover pillow with
towel for residents
confined to bed
67
68. Factors To Consider For
Daily Hair Care
(continued)
Brushing hair:
–refreshes resident
–improves morale
–stimulates circulation
–distributes natural oils evenly
–removes lint and dust
Handle hair gently when
brushing or combing
68
69. Factors To Consider For
Daily Hair Care
(continued)
Section hair and work on
one area at a time
Note appearance of scalp
and hair
Hair style should be age
appropriate
69
70. Factors To Consider For
Daily Hair Care
(continued)
Residents are encouraged to do
as much as possible for
themselves
Comb and brush are cleaned
after use
Combs and brushes are never
shared
70
72. Shampooing Considerations
Frequency
individualized
Resident’s shampoo,
conditioner and other
hair care products are
used
Resident assisted to
beauty shop if
available 72
74. Shampooing Considerations
(continued)
Methods of shampooing:
–during shower
–at sink
–using stretcher
–in bed
74
75. Shampooing Considerations
(continued)
Eyes and ears
protected
Hair dried as fast as
possible
Cold or drafty areas
eliminated
Female residents
assisted to curl or set
hair
75
76. Shampooing Considerations
(continued)
Barbers or beauticians
may be contacted by
facility to care for hair
of residents
Care plan to be
checked for any
special instructions
prior to shampooing
76
79. Dressing And Undressing
Encourage resident to
choose own clothing
Dress daily own clothing
and underwear
Make sure clothes are in
good repair
For confused resident
take 2 cloths to choose
79
80. Dressing And Undressing
(continued)
Dress weak or affected
side first
Undress weak or
affected side last
Ensure clothing is
appropriate for weather
and environment
80
81. Dressing And Undressing
(continued)
Encourage resident to
wear clothing that
matches and is clean
and neat
Dress should be age
appropriate
Do not put clothing on
backwards
81
82. Dressing And Undressing
(continued)
Be gentle
Always be patient
and provide time
for residents to do
as much as
possible for
themselves
82
86. Nutrition and Hydration
Introduction
This unit introduces the nurse
aide to the basic principles of
nutrition and emphasizes the
functions of the major nutrients
required for health.
86
87. Nutrition and Hydration
Introduction
(continued)
This unit covers the Food Guide
Pyramid, the use of therapeutic
diets, adaptive devices,
alternative methods of feeding,
providing water and
nourishments, the procedure for
feeding a resident, and the effects
of good nutrition and poor
nutrition. 87
88. Nutrition and Hydration
Introduction
(continued)
Knowledge of nutrition will enable
the nurse aide to recognize the
important relationship between
food and good health.
88
96. Culture and Dietary Practices
The diets of Chinese,
Japanese, Koreans
and people from Far
East include rice and
tea
The diets of Spanish-
speaking people
include spicy dishes
containing rice, beans 96
97. Culture and Dietary Practices
(continued)
The Italian diet
includes spaghetti,
lasagna, and other
pastas
Scandinavians have a
lot of fish in their diets
97
98. Culture and Dietary Practices
(continued)
Americans eat a lot
of meat, fast foods,
and processed foods
Use of sauce and
spices are culturally
related
98
99. Culture and Dietary Practices
(continued)
Americans eat a lot
of meat, fast foods,
and processed foods
Use of sauce and
spices are culturally
related
99
101. Nutrients
Nutrients are essential
Four classifications of nutrients
1.Fats - provide energy, help
body use certain vitamins,
conserve body heat and
protect organs from injury
2.Proteins – build and repair
tissue
101
102. Nutrients
(continued)
Four classifications of nutrients
(continued)
3. Carbohydrates - provide
energy and fiber that help in
bowel elimination
4. Vitamins and minerals -
ingested through food and
are necessary for carrying out
and maintaining specific body
functions 102
103. Nutrients
(continued)
Fats,
proteins and carbohydrates
measured in calories
103
104. Nutrients
(continued
Water- solvent for nutrients
and metabolic waste products
–Found in all body tissue
–Essential for digestion of
food
–Makes up most of blood
plasma
–6 to 8 glasses necessary per
day
–Has no caloric value 104
108. Age Related Changes/Factors
Affecting Nutrition
Need for fewer calories
Vitamin and mineral
requirements change
Drugs that affect how
nutrients are absorbed and
used
Teeth/dentures affect
ability to chew food 108
109. Age Related Changes/Factors
Affecting Nutrition
(continued)
Diminished sense of taste and
smell
Assistance required with eating
Decreased saliva and gastric
juices production
Discomfort caused by
constipation
Decreased appetite and thirst
109
110. Signs Of Good Nutrition
(continued)
Restfulsleep
patterns
Healthy appetite
Regular elimination
habits
Appropriate body
weight
110
116. Discuss the six basic food
groups from the Food Guide
Pyramid that contribute to
balanced nutrition.
116
117. Dietary Guide For Americans
Guidelines are the foundation of
the Food Guide Pyramid and
include nine key
recommendations.
Key recommendation #1:
Consume nutrient-dense foods
and beverages within calories
needed for age, sex and activity
level. 117
118. Dietary Guide For Americans
Key recommendation #2: To
maintain health body weight,
balance calories consumed with
calories expended.
Key recommendation #3:
Engage regularly in a variety of
physical activities and reduce
sedentary activities.
118
119. Dietary Guide For Americans
Keyrecommendation #4:
Encourage the following:
–Choose variety of fruits and
vegetables daily.
–Half of daily grains should come
from whole grains.
–Consume 3 cups fat-free or low
fat milk or equivalent milk
products daily.
119
120. Dietary Guide For Americans
Key recommendation #5:
Consume foods and beverages
that are low in saturated fats,
trans fats and cholesterol.
Key recommendation #6: For
carbohydrates: Choose fiber-rich
foods, vegetables and grains
often. Reduce intake of sugar- and
starch-containing foods.
120
121. Dietary Guide For Americans
Key recommendation #7:
Consume less than a teaspoon of
salt per day.
Key recommendation #8:
Consume alcoholic beverages in
moderation if alcohol intake is
permitted.
Key recommendation #9: Prepare
foods in a safe manner to avoid
microbial foodborne illness. 121
122. Six Basic Food Groups From the
Food Pyramid Guide
Meat
GRAINS Vegetables Fruits Milk &
Beans
122
124. Food Pyramid Guide
Grain Group
(breads, cereal, rice, pasta)
(continued)
1 ounce equivalent is
about 1 slice of
bread, about 1 cup of
breakfast cereal or ½
cup cooked rice,
cereal or pasta.
124
125. Food Pyramid Guide
Grain Group
(breads, cereal, rice, pasta)
(continued)
Daily:
–6 ounce
equivalents for
males over 60
–5 ounce
equivalents for
females over 60
125
126. Food Guide Pyramid
Vegetable Group
Provides:
–vitamins
–minerals
–fiber (roughage)
Easier to chew if cooked,
chopped or diced
126
127. Food Guide Pyramid
Vegetable Group
(continued)
Chosefrom all five vegetable
subgroups:
–dark green
–orange
–legumes
–starchy
–other vegetables
127
128. Food Guide Pyramid
Vegetable Group
(continued)
Daily:
–2½ cups for males over 60
–2 cups for females over
60
128
129. Food Pyramid Guide
Fruit Group
Provides
–vitamins
–minerals
–fiber
Chose fresh, frozen, canned
or dried fruits
129
130. Food Pyramid Guide
Fruit Group
(continued)
Daily:
–2 cups daily for males over 60
–1½ cups daily for females
over 60
130
131. Food Pyramid Guide
Milk, Yogurt and Other Milk Products
Provides
–proteins
–vitamins (A)
–minerals (calcium)
–carbohydrates
–Fat
Choose low-fat or fat-free milk
and milk products
131
132. Food Pyramid Guide
Milk, Yogurt, Cheese Group
(continued)
Daily:
–3 cups for males over
60
–3 cups for females over
60
132
133. Food Pyramid Guide
Meat, Poultry, Fish and Beans Group
Provides
–protein
–fats
–vitamins
–Minerals
–1 ounce of meat, poultry or
fish is about ¼ cup cooked
beans, 1 egg, 1 tablespoon of
peanut butter or ½ ounce
nuts or seeds 133
134. Food Pyramid Guide
Meat, Poultry, Fish and Beans Group
(continued)
Daily:
–5½ ounce equivalents daily
for males over 60
–5 ounce equivalents daily for
females over 60
134
135. Food Pyramid Guide
Oil Group = fats that are liquid at
room temperature
Provides essential
fatty acids
High in calories
Use sparingly
Keeptotal fat intake
between 20% to
35% of calories
135
136. Food Pyramid Guide
Oil Group = fats that are liquid at
room temperature
Most fats consumed should be
polyunsaturated and
monounsaturated.
Make most fat sources from
fish, nuts and vegetable oils.
Limit solid fats like butter, stick
margarine, shortening and lard.
136
137. Types of Therapeutic Diets
Clear liquid
Full liquid
Bland
Low residue
Controlled carbohydrate
(Diabetic)
Low fat/low cholesterol
137
138. Types of Therapeutic Diets
Clear liquid
Full liquid
Bland
Low residue
Controlled carbohydrate
(Diabetic)
Low fat/low cholesterol
138
139. Types of Therapeutic Diets
(continued)
High fiber
Low calorie
High calorie
Sodium restricted
High protein
Mechanical soft, chopped,
pureed
139
140. Types of Therapeutic Diets
(continued)
Residents may have
difficulty accepting
special diets.
140
143. Adaptive Devices
Food Guards
Divided Plates
Built-up handled
utensils
Easy grip
Residents have to be
mugs/glasses
taught how to use
these devices.
143
145. Parenteral Fluids
(Intravenous Infusion)
Fluids
administered
through vein.
Little nutritional
value
Responsibility of
licensed nurse
145
146. Parenteral Fluids
(Intravenous Infusion)
(continued)
Observationsto report
–Near-empty bottle/bag
–Change in drip rate
–Pain at needle site, and/or
redness and/or swelling, if
observable
–Loose, non-intact, or damp
dressing
146
147. Enteral Feeding
Residents unable to take
nutrients by mouth
•Depressed
•Comatose
•Swallowing problem (stroke,
Alzheimer’s or other medical
conditions)
•Disorders of digestive tract
147
148. Enteral Feeding
(continued)
Liquid formula
administered through
tube by licensed nurse
•Nose to stomach -
nasogastric tube
•Directly into stomach
- gastrostomy tube
148
149. Nurse Aide Responsibilities in
Alternative Nutrition
Ensure that there is no
tension or pulling on tube
Keep resident’s nose
clean and free of mucus
Check that tube is
securely taped to nose
Perform frequent oral
care with nasogastric
tube 149
150. Nurse Aide Responsibilities in
Alternative Nutrition
(continued)
Report any signs or symptoms
related to aspiration or GI
problems
Mitts may be ordered to prevent
resident from dislodging tube
150
152. Identify the responsibilities of
the nurse aide in preparing
residents for meals.
Serve prepared food as
instructed.
152
153. Preparing Residents for Meals
Meals enjoyable, social
experience
Provide pleasant environment
–Clean area
–Odor-free area
–Adequate lighting
Flowers/decorations and music
add interest to dining area 153
154. Preparing Residents for Meals
(continued)
Allresidents clean and
dressed for meals
Hair combed
Oral care provided
Encourage to use
bathroom or
urinal/bedpan
Cleanse and dry
incontinent residents 154
155. Preparing Residents for Meals
Face and hands
washed
Provide for comfort
–Raise head of bed
–Position in chair
–Transport to dining
area
Provide clothing
protector if
appropriate 155
156. Preparing Residents for Meals
(continued)
Check to be certain resident
receives right tray and has
correct diet
Food should be attractively
served and placed within
reach
Check tray to see that
everything needed is there
156
157. Preparing Residents for Meals
(continued)
Assistresident as needed with:
–cutting meat
–pouring liquids
–buttering bread
–opening containers
157
158. Preparing Residents for Meals
(continued)
Blind residents made
aware of food
placement according
to face of clock
Stroke residents
approached from
non-effected side
158
159. Preparing Residents for Meals
(continued)
Residents should be
encouraged to do as
much as possible for
themselves
Provide time for
resident to complete
meal
Display pleasant,
patient attitude
159
160. Preparing Residents for Meals
(continued)
Remove tray when
meal finished
Report unconsumed
food to supervisor
Record fluid intake if
ordered
Assist to position of
comfort
160
161. Preparing Residents for Meals
(continued)
Call signal and supplies
positioned within reach
Area should be left clean and
tidy
Hands washed before and
after care of each resident =
because resident might touch
the food or their mouth.
161
171. Providing Fresh Drinking Water
Fresh water should
be provided
periodically
throughout day
Encourage to drink
6-8 glasses daily if
appropriate
171
172. Providing Fresh Drinking Water
(continued)
Noteresidents who have
special fluid orders
–N.P.O.
–Fluid restrictions:
Schedule 24-hour intake
Remind resident
172
173. Providing Fresh Drinking Water
(continued)
Note residents who have special
fluid orders
–Force fluids
Offer fluids in small
quantities
Offer fluids (resident
preference) without being
asked
Remind resident of
importance of fluids in bodily173
174. Aging
Can affect the nervous system that
controls elimination of body wastes
Like urine and feces ( also known as
stool or solid waste)
The urge or need to void, or urinate
(pass urine from the body) or
defecate ( pass feces from the body)
Decreases with age,
175. elimination
Decreased appetite and thirst,
coupled with less food and fluid
intake as well as slower digestion of
foods, contribute to elimination
problems.
176. Factors interfere with normal
elimination
Medications that could cause
constipation or diarrhea, inactivity,
pelvic muscle weakness due to
aging, and nervous disorders
Small watery leakage of stool could
indicate a fecal impaction, a
condition in which hard feces is
trapped in the large intestine and
rectum and cannot be pushed out by
the resident.
177. Elimination
Diarrhea is when food pass too
quickly through the intestine so that
water is not reabsorbed adequately.
This causes a watery brown liquid to
be expelled.
180. Bowel And Bladder Retraining
Incontinence: Inability to
control urination or defecation
–Embarrassing for resident
–Uncomfortable
180
181. Bowel Retraining
Plan developed to assist to
return to normal elimination
pattern and recorded on care
plan
Information collected:
–bowel pattern before
incontinence
–present bowel pattern
–dietary practices
181
182. Bowel Retraining
(continued)
Participants in plan
–resident
–family
–all staff members
182
183. Guidelines For Bowel Retraining
Enemas may be ordered by
physician and given by nurse
aide, as directed by supervisor (
(follow facility policy before
giving enema)
Regular, specific times to
evacuate bowels established
Fluids encouraged on regular
basis 183
184. Guidelines For Bowel Retraining
(continued)
High bulk foods given, if not
restricted
– fruits – bread
– vegetables – bran
cereals
184
185. Guidelines For Bowel Retraining
(continued)
Bowelaids ordered by physician
and administered by licensed
nurse only:
– laxatives
– suppositories
stool softeners
–
•Regular exercise encouraged
185
186. Guidelines For Bowel Retraining
(continued)
Ways nurse aide can assist with
defecation process:
–offer bedpan on set
schedule
–assist to bathroom when
request is made
–provide privacy
–display unhurried
attitude 186
187. Guidelines For Bowel Retraining
(continued)
Ways nurse aide can assist
with defecation process
(continued):
– offer warm drink
– be patient
– encourage with positive
remarks
– do not scold when accidents
happen (abuse)
– check on resident frequently 187
188. Bladder Retraining
Plan developed to
assist to return to
normal voiding
pattern and recorded
on care plan
Staff must be
consistent and follow
plan
188
189. Bladder Retraining
Individualized plan
includes:
–schedule that specifies
time and amount of
fluids to be given
–schedule for attempting
to void
189
190. Guidelines for Bladder Retraining
Get resident’s cooperation
Record incontinent times
Provide with opportunities to
void:
–when resident awakens
–one hour before meals
–every two hours between
meals
–before going to bed
–during night, as needed 190
191. Guidelines for Bladder Retraining
Get resident’s cooperation
Record incontinent times
Provide with opportunities to
void:
–when resident awakens
–one hour before meals
–every two hours between
meals
–before going to bed
–during night, as needed 191
192. Guidelines for Bladder Retraining
(continued)
Provide stimuli as
needed:
–run water in sink
–pour water over
perineum
–offer fluids to drink
–place hands in warm
water
192
193. Guidelines for Bladder Retraining
(continued)
Provide good skin care to
prevent skin breakdown
Retraining may take 6-10 weeks
–be patient
–be supportive
–ignore accidents
–respect resident’s feelings
193
194. Guidelines for Bladder Retraining
(continued)
Followfacility
procedure for use
of:
–incontinent pads
–adult protective
pants
–incontinent briefs
194
195. Observing/reporting
Black or bloody stool, constipation
and diarrhea
Dark concentrated urine, bloody or
no urine output
Report to the nurse any abnormality
Never put bed pan or urinal to
overhead table
196. Rest, Sleep and Comfort
Elders need as much sleep as other
adults
Ability to sleep might influenced by
the long-term care environment,
especially when new admitted,
Their activity level, their general
state of health, and their individual
habits.
197. Interfere with sleep
Pain or discomfort
Be careful to accept a resident’s
report of pain or discomfort at face
value
Report any abnormal reactions
(known as adverse drug effects to
analgesia can include a sudden drop
in blood pressure or respirations,
dyspnea (rapid breathing)
198. reporting
Rash on the body, unresponsive and
emotional distress.
Using positioning devices to increase
comfort.
Offer emotional support
This signs require immediate
intervention, so report them
immediately to the nurse.
199. Self-care and independence
Omnibus Budget and Reconciliation
Act ( OBRA) of 1987 requires all
long-term facilities to use every
resource to help residents to reach
or maintain their highest level of
physical, psychological, and mental
functioning.
The act requires that all residents
have a right to have as many choices
about their lives their care, and their
200. Life style routine possible.
It is not only legal requirement
determined by OBRA but as ethical
principle as well.
201. Mobility/Immobility
Being able to move by one’s self, to
walk, and to exercise to help
maintain muscle function and
improve a sense of independence
and self-worth.
Moving, ambulating, and exercising
help improve blood circulation and
proper musculoskeletal functioning.
202. Immobility
Opposite of being mobile, effects the
total well-being of the resident, that
is, by exposing the resident to
alteration in almost every body
system.
In the circulatory system- an
increased risk of blood clots
(thrombi) and edema in the lower
extremities, causing undue stress on
the heart.
203. Immobility
Respiratory complications like
pneumonia, other infections of the
respiratory tree, or failure to expand
the lungs
In the digestive system, amorexia or
Decreased appetite, and constipation
The musculoskeletal system suffers
due to loss of calcium in the bones
(called osteopenia)
204. IMMOBILITY
Atrophy, or muscle wasting and
contractures (deformities of the
limbs due to immobility
Pressure ulcers on the skin
Mentally and emotionally, the
immobility resident might feel
frustrated, isolated, depressed and
helpless
206. Basic Nursing Skills
Introduction
This unit introduces the basic
nursing skills the nurse aide will
need to measure and record the
resident’s vital signs, height and
weight, and intake and output.
The vital signs provide
information about changes in
normal body function and the
resident’s response to treatment.
206
207. Basic Nursing Skills
Introduction
(continued)
The resident’s weight,
compared with the height, gives
information about his/her
nutritional status and changes in
the medical condition.
Intake and output records
provide information on fluid
balance and kidney function.
207
209. Health maintenance and
restoration
Includes measuring vital signs,
height, and weight. Vital signs
include temperature, pulse,
respiration, and blood pressure
Accurate measurement and
recording are important skills in
determine the overall health of the
resident.
Careful attention to vital signs can
save life
211. Vital Signs
Reflect
the function of three body
processes that are essential for
life.
–Regulation of body temperature
–Heart function
–Breathing
211
212. Explain the meaning of vital
signs and the abbreviations
used for each vital sign.
212
213. Vital Signs
(continued)
Abbreviations:
–Temperature – T
–Pulse – P
–Respirations – R
–Blood Pressure – BP
–Vital signs - TPR and
BP
213
214. Vital Signs
(continued)
Purpose
–Measured to
detect any
changes in
normal body
function
–Used to
determine
response to
treatment 214
217. Temperature –
Measurement Of Body Heat
Heat Heatloss
production –respiration
–muscles –perspiratio
–glands n
–oxidation of –excretion
food
217
218. Temperature –
Measurement Of Body Heat
(continued)
Balance between heat
production and heat loss is
body temperature
218
220. Factors Affecting Temperature
Exercise Infection
Illness Emotions
Age Hydration
Time of Clothing
day Environment
Medication temperature/
air
movement
220
221. Equipment - Thermometer
Instrumentused to measure
body temperature
Types
–Non-mercury glass
oral
rectal
221
223. Normal Temperature Range For
Adults
Oral- 97.6 - 99.6 F
(Fahrenheit) or 36.5
-37.5 C (Celsius)
Rectal - 98.6 -
100.6 F or 37.0 -
38.1 C
Axillary - 96.6 -
98.6 F or 36.0 -
37.0 C 223
225. To Read A Non-mercury Glass
Thermometer
Hold eye level
Locate solid column of liquid in
the glass
Observe lines on scale at
upper side of column of liquid
in the glass
225
226. To Read A Non-mercury Glass
Thermometer
(continued)
Read at point where liquid ends
If liquid falls between two lines,
read it to closest line
–long line represents degree
–short line represents 0.2 of a
degree Fahrenheit
226
228. Sites To Take A Temperature
Oral – most common
Rectal – registers one degree
Fahrenheit higher than oral
Axillary – least accurate;
registers one degree Fahrenheit
lower than oral
Tympanic – probe inserted into
the ear canal
228
230. Temperature: Safety Precautions
Hold rectal and axillary
thermometers in place
Stay with resident when taking
temperature
Check glass thermometers for
chips
Prior to use, shake liquid in glass
down
Shake thermometer away from
resident and hard objects 230
231. Temperature: Safety Precautions
(continued)
Wipe from end to tip of
thermometer prior to
reading
Delay taking oral
temperature for 10 -
15 minutes if resident
has been smoking,
eating or drinking
hot/cold liquids.
231
234. Measurement of Pulse
Pulseis pressure of
blood pushing
against wall of
artery as heart
beats and rests
Pulseeasier to
locate in arteries
close to skin that
can be pressed
against bone 234
235. Sites For Taking Pulse
Radial – base of
thumb
Temporal – side of
forehead
Carotid – side of
neck
Brachial – inner
aspect of elbow
Femoral – inner
aspect of upper thigh
235
236. Sites For Taking Pulse
(continued)
Popliteal - behind
knee
Dorsalis pedis – top of
foot
Apical pulse – over
apex of heart
–taken with
stethoscope
–left side of chest
236
240. Measurement of Pulse
Normal pulse
range/characteristics: 60 -100
beats per minute and regular
Documenting pulse rate
–Noted as number of beats per
minute
–Rhythm - regular or irregular
–Volume - strong, weak,
thready, bounding
240
247. Measuring Respirations
(continued)
Qualitiesof normal respirations
–12-20 respirations per minute
–Quiet
–Effortless
–Regular
247
248. Measuring Respirations
(continued)
Documenting respiratory rate
–Noted as number of
inhalations and exhalations per
minute (one inhalation and
one exhalation equals one
respiration)
–Rhythm – regular or irregular
–Character: shallow, deep,
labored 248
251. Measuring Blood Pressure
Blood pressure is the force of
blood pushing against walls of
arteries
–Systolic pressure: greatest
force exerted when heart
contracting
–Diastolic pressure: least force
exerted as heart relaxes
251
252. Measuring Blood Pressure
Blood pressure is the force of
blood pushing against walls of
arteries
–Systolic pressure: greatest
force exerted when heart
contracting
–Diastolic pressure: least force
exerted as heart relaxes
252
258. Measuring Blood Pressure
Normalblood pressure range
–Systolic: 90-140 millimeters
of mercury
–Diastolic: 60-90 millimeters
of mercury
258
259. Guidelines for Blood Pressure
Measurements
Measure on upper
arm
Have correct size
cuff
Identify brachial
artery for correct
placement of
stethoscope
259
260. Guidelines for Blood Pressure
Measurements
(continued)
Firstsound heard
– systolic pressure
Last sound heard
or change -
diastolic pressure
260
261. Guidelines for Blood Pressure
Measurements
(continued)
Record -
systolic/diastolic
Resident in relaxed
position, sitting or lying
down
Blood pressure usually
taken in left arm
261
262. Guidelines for Blood Pressure
Measurements
(continued)
Donot measure
blood pressure in
arm with IV, A-V
shunt (dialysis), cast,
wound, or sore
262
263. Guidelines for Blood Pressure
Measurements
(continued)
Apply cuff to bare
upper arm, not
over clothing
Room quiet so
blood pressure can
be heard
Sphygmomanomet
er must be clearly
visible 263
264. Blood Pressure: Reading Gauge
(continued)
Gauge should be
at eye level
300
290
280
270
260
250
240
230
220
Mercury column
210
200
190
180
170
160
150
140
gauge must not be
130
120
110
100
90
80
70
60
tilted
50
40
30
20
10
Reading taken
from top of
column of mercury
264
269. Measuring Height and Weight
(continued)
Reasons for obtaining height and
weight
–Indicator of nutritional status
–Indicator of change in medical
condition
–Used by doctor to order
medications
269
271. Measuring Height and Weight
(continued)
Guidelinesfor weighing
residents
–Use same scale
each time
–Have resident
void, remove
shoes and outer
clothing
–Weigh at same
time each day 271
272. Measuring Height and Weight
(continued)
Scales
–Remain more accurate if moved
as little as possible.
–Various types of scales
bathroom scale
standing scale
scales attached to hydraulic
lifts
wheelchair scales
bed scales
272
277. Edema
Edema – fluid intake exceeds
fluid output
–Retention of fluids frequently
caused by kidney or heart
failure or excessive salt intake
277
278. Edema
(continued)
Symptoms
–weight gain
–swelling of feet, ankles,
hands, fingers, face
–decreased urine output
–shortness of breath
–collection of fluid in
abdomen (ascites)
278
285. Measuring and Recording
Intake/Output
Physician orders intake and
output
Intake includes:
–All liquid taken by mouth
–Food items that turn to liquid at
room temperature
–Tube feedings into stomach
through nose or abdomen
–Fluids given by intravenous 285
286. List the liquids that would
be measured and recorded
as fluid output.
286
287. Measuring and Recording
Intake/Output
(continued)
Output includes
–Urine
–Liquid stool
–Emesis
–Drainage
–Suctioned
secretions
–Excessive
perspiration 287
294. Rehabilitation/Restoration
(continued)
NurseAide’s Role
–Encourage resident
–Praise
accomplishments
–Review skills taught
–Report progress or
need for additional
teaching
294
295. Rehabilitation/Restoration
(continued)
Nurse Aides Role
(continued)
–Promote independence
praise all attempts at
independence
overlook failures
show confidence in
resident’s ability
295
296. Rehabilitation/Restoration
(continued)
Nurse
Aides Role (continued)
–Promote independence
(continued)
be patient and allow time
for residents to do things for
themselves
–Be sensitive and
understanding
296
298. Provide training in and the
opportunity for self-care
according to the resident’s
capabilities.
298
299. Self-Care According To
Resident’s Capabilities
Training in self-care requires that
three questions be answered
prior to starting:
1. What is the goal to be
achieved?
2. What approaches are used to
help the resident achieve the
goal?
3. How will progress or lack of
progress be measured? 299
300. self-Care According To
Resident’s Capabilities
Residentincluded in goal-setting
process, whenever possible
302. Guidelines To Assist With
Restorative Care And Training
Assist resident to do as much
as possible for himself/herself
Be realistic
Never offer false hope
Explain what is going to be
done
Begin tasks at resident’s level
of functioning
302
303. Guidelines To Assist With
Restorative Care And Training
(continued)
Provide encouragement
and reinforcement
Praise successes
Emphasize abilities
Treat resident with respect
Explain what resident
needs to accomplish, and
how you will help.
303
304. Guidelines To Assist With
Restorative Care And Training
(continued)
Accept residents and
encourage them to
express their feelings
Help to put new skills
into use immediately
Assist the resident to
recognize his or her
progress 304
305. Self-Care According To
Resident’s Capabilities
Treatment initiated
by:
–Physical therapist
–Occupational
therapist
–Speech therapist
–Licensed nurse
305
306. Self-Care According To
Resident’s Capabilities
(continued)
ADL considerations for
resident:
–Resident to control
how and when
activities carried out,
when possible
–Use tact in making
resident aware of
hygiene needs 306
307. Self-Care According To
Resident’s Capabilities
(continued)
ADL considerations for
resident (continued):
–Encourage use and
selection of clothing
–Be patient and allow
time for slower
paced activities
307
308. Self-Care According To
Resident’s Capabilities
(continued)
ADL considerations for resident
(continued):
–Provide for rest periods
–Assist to exercise
–Promote independence by
having do as much of activity,
as possible
–Encourage use of adaptive
devices 308
309. New admission
Findout from the nurse before get a
resident out bed to chair or ambulate
and exercising. Even giving anything
to eat or drink find out from the
nurse
311. Psychological Effects Of Aging
This unit deals with the
feelings, emotional stress and
psychological adjustments that
are part of the aging process.
It explores the physical and
psychosocial needs of residents,
and teaches the skills that the
nurse aide will need to develop
to provide understanding and
compassionate care.
311
312. Psychological Effects Of Aging
(continued)
Other topics covered
include: age appropriate
behavior, sexuality, reality
orientation, dementia,
Alzheimer’s disease, confusion
and developmental disabilities.
312
313. Culture needs
Be aware of unique needs, desires,
meaning in life based on their
cultural practices.
Look on page 56 table 4.1
315. Discuss ways to meet the
resident’s basic human
needs for life and mental
well-being.
315
316. Physical Needs For Survival And
Care To Be Given
Oxygen
–elevate head of bed
–assist to sit up in
chair
–report to supervisor
if resident is
cyanotic or short of
breath
–assist with 316
317. Physical Needs For Survival And
Care To Be Given
(continued)
Food
–Feed residents unable to
feed themselves
317
318. Physical Needs For Survival And
Care To Be Given
(continued)
Food
–Serve food
with proper temperature
in friendly manner
in pleasant environment
in appropriate amounts
–Make sure dentures are in
place 318
319. Physical Needs For Survival And
Care To Be Given
(continued)
Water
–make available within
resident’s reach
–provide fresh water at
periodic intervals
319
320. Physical Needs For Survival And
Care To Be Given
(continued)
Shelter
–provide for warmth
with extra blankets
–be sure residents are
dressed properly
–avoid drafts or drafty
areas
320
321. Physical Needs For Survival And
Care To Be Given
(continued)
Sleep
–Minimize noise and lights
during hours of sleep
–Give back rub to relax
resident
321
322. Physical Needs For Survival
And Care To Be Given
Sleep(continued)
–Report complaints of pain to
supervisor
–Listen to concerns or worries
the resident may wish to
express
–Leave night light on in the
resident’s room, if requested
323. Physical Needs For Survival And
Care To Be Given
(continued)
Elimination
–Assist to bathroom
as needed
–Provide bedpan
and/or urinal
–Provide for privacy
323
324. Physical Needs For Survival And
Care To Be Given
(continued)
Elimination (continued)
–Change soiled linen
immediately
–Following routine for
bowel and bladder
retraining as
directed
324
325. Physical Needs For Survival And
Care To Be Given
(continued)
Activity
–ROM exercises as
directed
–Turn and
reposition at least
every two hours
325
326. Safety And Security Needs
Provide for warmth
Establish familiar surroundings
–explain procedures
–talk about “their” room
–keep your promises
–provide a safe environment
–promote use of personal
belongings
326
328. Spiritual Needs
(continued)
Guidelines for the nurse
aide:
–respect resident’s
beliefs
–respect resident’s
religious objects
–inform residents of the
time and place for
religious services 328
331. Sexuality
Expressed by individuals of all
ages
A way to show feminine or
masculine qualities
–Clothing styles and colors
–Hairstyles
–Hobbies and interests
–Sexual habits (continue into
old age)
–Gestures 331
332. Sexuality
(continued)
May be expressed
by:
–Sexual intercourse
–Caressing,
touching, holding
hands
–Masturbation
Is a right of all
residents to 332
333. Guidelines For The Nurse Aide In
Dealing With Resident Sexuality
Assist to maintain
sexual identity by
dressing residents
in clothing
appropriate for
men or women
Assist with
personal hygiene 333
334. Guidelines For The Nurse Aide In
Dealing With Resident Sexuality
(continued)
Assistto prepare for
special activities by
“dressing up”
–selecting attractive
clothing
–fixing hair in a special
way
–applying cosmetics 334
335. Guidelines For The Nurse Aide In
Dealing With Resident Sexuality
(continued)
Help to develop a positive self-
image
Show acceptance and
understanding for resident’s
expression of love or sexuality
–provide privacy
–always knock prior to entering
a room at any time
–assure privacy when 335
336. Guidelines For The Nurse Aide In
Dealing With Resident Sexuality
(continued)
Never expose the resident
Accept the resident’s sexual
relationships
336
337. Guidelines For The Nurse Aide In
Dealing With Resident Sexuality
(continued)
Provide protection for the non-
consenting resident
Be firm but gentle in your
rejection of a resident’s sexual
advances
337
338. Possible Effects Of Injury Or
Illness On Sexuality
Disfiguringsurgery
may cause a person to
feel:
–unattractive and
ugly to others
–mutilated and
deformed
–unworthy of love or
affection 338
339. Possible Effects Of Injury Or
Illness On Sexuality
(continued)
Chronicillness and
certain medications
can affect sexual
functioning
339
340. Possible Effects Of Injury Or
Illness On Sexuality
(continued)
Disorders that cause
impotence
–diabetes mellitus
–spinal cord injuries
–multiple sclerosis
–alcoholism
340
341. Possible Effects Of Injury Or
Illness On Sexuality
(continued)
Surgerycan have both physical
and/or psychological effects
–removal of prostate or testes
–amputation of a limb
–removal of uterus
–removal of ovaries
–removal of a breast
–colostomy
–ileostomy
341
342. Possible Effects Of Injury Or
Illness On Sexuality
(continued)
Disorders affecting the ability
to have sex:
– stroke
– nervous system disorders
– heart disease
342
343. Possible Effects Of Injury Or
Illness On Sexuality
(continued)
Disorders affecting the ability
to have sex:
–chronic obstructive
pulmonary disease
–circulatory
disorders
–arthritis or
conditions affecting
mobility/ flexibility 343
344. Reporting collection and
reporting
Reportingany abnormalities to the
nurse read page 61 for more info.
