4.02 ppt rehab restore maintenance care

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4.02 ppt rehab restore maintenance care

  1. 1. Understand nurse aide’s range of function in rehabilitative/restorative and maintenance care Unit B Resident Care Skills Essential Standard NA4.00 Understand nurse aide skills related to the residents’ vital function and movement Indicator 4.02 Understand nurse aide’s range of function in rehabilitative/restorative and maintenance care 14.02 Nursing Fundamentals 7243
  2. 2. 2 4.02 Introduction This indicator explores various aspects of rehabilitative/restorative care and the role of the nurse aide in this process. Disease, injuries and surgery are often responsible for the loss of a body part or the loss of bodily function. 4.02 Nursing Fundamentals 7243
  3. 3. 3 Working with the elderly and disabled requires a great deal of patience, caring and understanding from health care workers. Working together to assist the resident to attain the highest possible level of functioning can be a very challenging and rewarding experience. 4.02 Nursing Fundamentals 7243 4.02 Introduction
  4. 4. 4.02 Nursing Fundamentals 7243 4 Body Systems Related to Restorative/Rehabilitative Care
  5. 5. There is intentional repeat of some HSII course content in Nursing Fundamentals. Repeating course content distributes learning over time and increases long term memory. Academic and skill competence must be maintained at a very high level for direct resident care. Be GREEN. Recycle knowledge and build on it! Nursing Fundamentals 7243 54.02
  6. 6. 4.02 Nursing Fundamentals 7243 6 SKELETAL SYSTEM
  7. 7. Nursing Fundamentals 7243 7 • Comprises the bony framework of the body • Has 206 bones SKELETAL SYSTEM 4.02
  8. 8. 8 FUNCTIONS: • Support • Protect • Movement • Mineral storage • Blood cell production Nursing Fundamentals 72434.02
  9. 9. 9 JOINTS - point where bones meet: • Immovable – cranium • Slightly movable - vertebral discs • Freely movable - shoulder, knee, wrist Nursing Fundamentals 72434.02
  10. 10. 10 COMPOSITION OF JOINTS: • Ligament - connects bone to bone • Tendon - connects muscle to bone Nursing Fundamentals 72434.02
  11. 11. 11 COMPOSITION OF JOINTS: • Bursa - fluid filled sac that allows bones to move easily over others • Cartilage – connective tissue that cushions the joint at end of bones and between bones Nursing Fundamentals 72434.02
  12. 12. 12 • Osteoporosis - porous bone that breaks easily SKELETAL SYSTEM – COMMON DISORDERS Nursing Fundamentals 72434.02 http://www.mayoclinic.com/health/medical/IM02980
  13. 13. 13 • Fracture - break in bone –simple - bone broken, skin intact –compound - bone broken, penetrates skin –comminuted - bone broken, fragments in tissue –greenstick - incomplete break Nursing Fundamentals 72434.02
  14. 14. 14 • Arthritis - inflammation of the joints –osteoarthritis due to stress on joints •usually affects weight bearing joints: knees, hips, vertebrae and fingers •aching, stiffness, limited motion Nursing Fundamentals 72434.02
  15. 15. 15 –rheumatoid arthritis - systemic disease •causes inflammation, deformity and crippling •joints painful, stiff, swollen, red and warm • Arthritis - inflammation of the joints Nursing Fundamentals 72434.02
  16. 16. 16 • Amputation – removal of all or part of limb • Sprain - stretched or torn ligaments or tendons • Bursitis - inflammation of bursa causing pain on movement Nursing Fundamentals 72434.02
  17. 17. 17 • Bones more porous or brittle • Joints less flexible • Postural changes • Awkward walking patterns • Slowed recovery from position changes and sudden movements SKELETAL SYSTEM – EFFECTS OF AGING Nursing Fundamentals 72434.02
  18. 18. 18 • Slow and unsteady body movement • Difficulty holding objects • Complaint of pain in joints • Swelling, redness and warmth in joints • Inability to move joints OBSERVATIONS TO REPORT Nursing Fundamentals 72434.02
  19. 19. 19 • Complaint of pain with movement • Complaint of neck or head pain • Resident who has fallen (stay with resident, call for help, do not move resident or allow resident to move) Nursing Fundamentals 72434.02
  20. 20. 20 • Resident with cast on arm or leg –complaint of pain in limb –swelling of fingers or toes –pale skin of fingers or toes –cyanosis and coolness of fingers or toes Nursing Fundamentals 72434.02
  21. 21. 21 • Resident with cast on arm or leg –odor or drainage from cast –inability to move toes or fingers –complaint of numbness of fingers or toes –drainage from cast Nursing Fundamentals 72434.02
  22. 22. 4.02 Nursing Fundamentals 7243 22 MUSCULAR SYSTEM
  23. 23. 23 • Provides body with ability to move • Over 650 different muscles that comprise nearly half the body weight MUSCULAR SYSTEM Nursing Fundamentals 72434.02
  24. 24. 24 • Functions of muscles –Allow movement –Help body stay erect – posture –Produce most of body’s heat –Give body form –Provide movement of internal organs Nursing Fundamentals 72434.02
  25. 25. 25 • Paralysis - loss of voluntary movement due to neurological damage such as stroke or trauma • Multiple sclerosis – weakness of muscles due to loss of covering on nerves that control them • Atrophy – muscle mass decreases in size MUSCULAR SYTEM – COMMON DISORDERS Nursing Fundamentals 72434.02
  26. 26. 26 • Contracture - permanent shortening of muscle; joints become ankylosed (frozen) • Muscle strain – damage caused by trauma • Myalgia - muscle pain • Torn muscle - tear caused by trauma Nursing Fundamentals 72434.02
  27. 27. 27 • Poorer response to stimuli • Pain when moving, therefore muscles not used as often • Less active • Muscle strength and bulk loss • Slower muscle - nerve interaction Nursing Fundamentals 72434.02
  28. 28. 28 • Difficulty holding or lifting objects • Inability to move a body part • Difficulty walking • Loss of muscle strength and tone MUSCULAR SYSTEM – EFFECTS OF AGING Nursing Fundamentals 72434.02
  29. 29. 29 • Edema of tissue or joint • Complaint of muscle pain • Generalized weakness and fatigue • Slow, unsteady body movement Nursing Fundamentals 72434.02
  30. 30. 4.02 Nursing Fundamentals 7243 30 NERVOUS SYSTEM
  31. 31. 31 • Controls and organizes all body activities • Divided into two parts –Peripheral nervous system –Central nervous system •brain •spinal cord NERVOUS SYSTEM Nursing Fundamentals 72434.02
  32. 32. 32 • Basic unit of structure - neuron or nerve cell –Most complex cell in body –Does not reproduce; if destroyed, it is not replaced Nursing Fundamentals 72434.02
  33. 33. 33 • Nervous system enables you to –Speak –Hear –Taste –See –Smell –Think –Respond/move –Learn –Remember Nursing Fundamentals 72434.02
  34. 34. 34 • Central nervous system –brain • cerebrum –largest portion of brain –responsible for judgment, memory, association and discrimination –divided into left and right hemispheres Nursing Fundamentals 72434.02
  35. 35. 35 • Central nervous system (continued) –brain •cerebellum - responsible for coordination of muscles, balance and posture, and muscle tone •thalamus - monitors sensory stimuli Nursing Fundamentals 72434.02
  36. 36. 36 • Central nervous system (continued) –brain • hypothalamus - controls the autonomic nervous system, the cardiovascular system, body temperature, appetite, water balance, the GI system, sleep, emotional state Nursing Fundamentals 72434.02
  37. 37. 37 • Central nervous system (continued) –brain •pons - responsible for reflex actions like chewing, and production of saliva •medulla oblongata - regulates heartbeat, respirations, swallowing, coughing, blood pressure Nursing Fundamentals 72434.02
  38. 38. 38 • Central nervous system – spinal cord • 18 inches long • extends from brain to small of back • carries messages to and from brain • relays messages to body through spinal nerves • handles reflexes Nursing Fundamentals 72434.02
  39. 39. 39 • Peripheral nervous system – nerves leaving the spinal cord and going throughout the body –digestion –secretion of glands –heart beat and breathing Nursing Fundamentals 72434.02
  40. 40. 40 • CVA – Stroke or cerebrovascular accident - damage to part of brain due to blood clot or hemorrhage cutting off blood supply • Head or spinal cord injuries NERVOUS SYSTEM – COMMON DISORDERS Nursing Fundamentals 72434.02
  41. 41. 41 • Dementia from nutritional deficiencies, exposure to toxic substances, reduced blood flow to brain or unknown causes • Alzheimer’s disease - common cause of organic disease Nursing Fundamentals 72434.02
  42. 42. 42 • Parkinson’s disease – progressive nervous disease associated with destruction of brain cells • Multiple sclerosis - loss of covering around nerve fibers interfering with nerve impulses to and from brain Nursing Fundamentals 72434.02
  43. 43. 43 • Loss of nerve/brain cells • Increase in reaction time • Changes in memory • Receptors become less sensitive, so require increased stimuli for response NERVOUS SYSTEM – EFFECTS OF AGING Nursing Fundamentals 72434.02
  44. 44. 44 • Reduced sense of touch and sensitivity to pain • Reduced blood flow to brain • Forgetfulness Nursing Fundamentals 72434.02
  45. 45. 45 • Jerking motions • Speech changes • Complaint of numbness • Complaint of dizziness • Complaint of nausea Nursing Fundamentals 72434.02
  46. 46. 46 • Confusion • Complaint of loss of feeling on one side • Incontinence • Deranged thought processes • Tremors Nursing Fundamentals 72434.02
  47. 47. 47 • Muscular rigidity • Complaint of visual disturbances or changes • Paralysis • Seizures Nursing Fundamentals 72434.02
  48. 48. 4.02 Nursing Fundamentals 7243 48 SENSORY ORGANS
  49. 49. 49 • Part of nervous system • Sensory neurons make one aware of changes in the environment • Changes known as stimuli SENSORY ORGANS Nursing Fundamentals 72434.02
  50. 50. 50 • Functions of the sensory system –Vision –Hearing –Smell –Taste –Touch Nursing Fundamentals 72434.02
  51. 51. 51 • Specialized functions –Eye •sense of sight •receives images and sends to brain –Ear •sense of hearing •transmits sounds to brain Nursing Fundamentals 72434.02
  52. 52. 52 • Nose - (sense of smell) – allows recognition of odors and improves taste of food • Taste buds on tongue - (sense of taste) – allows recognition of sweet, sour, bitter, salty Nursing Fundamentals 72434.02
  53. 53. 53 • Skin - (sense of touch) – allows recognition of objects, pressure, heat, cold, pain, and pleasure Nursing Fundamentals 72434.02
  54. 54. 54 • Cataract - lens of eye loses its transparency • Glaucoma - increased pressure in the eye due to an excess of aqueous humor • Conjunctivitis - inflammation of the eyelid lining SENSORY ORGANS – COMMON DISEASES Nursing Fundamentals 72434.02
  55. 55. 55 • Sty - tiny abscess at the base of an eyelash • Otitis media - infection of the middle ear • Deafness - partial or complete hearing loss Nursing Fundamentals 72434.02
  56. 56. 56 • Lens in eye becomes thick and cloudy • Sclera becomes more yellow • Less light reaches inner eye • Hearing structures of ear become less moveable • Soft wax production decreases SENSORY ORGANS – EFFECTS OF AGING Nursing Fundamentals 72434.02
  57. 57. 57 • Progressive hearing loss of high- pitched sounds occurs • Peripheral vision and night vision decreases • Eye adjusts more slowly to changes in distance • Sense of smell decreases Nursing Fundamentals 72434.02
  58. 58. 58 • Sense of taste (sweet and salty first) decreases • Accommodation to light and dark decreases • Sense of touch, heat, cold, pain and pressure awareness decreases Nursing Fundamentals 72434.02
  59. 59. 59 • Sclera (white of eye) suddenly reddened or yellow • Lens of eye becomes cloudy • Complaint of pain in or around ear or eye • Red, swollen eye lid • Drainage from eyes • Complaint of difficulty seeing objects Nursing Fundamentals 72434.02
  60. 60. 60 • Comment that rainbows apparent around lights • Drainage from ear canal • Complaint of feeling of fluid or noise in ear • Complaint of sudden flashes of light or loss of sight Nursing Fundamentals 72434.02
  61. 61. REHABILITATION is care that is managed by professionals to help restore a person to the highest possible level of function. RESTORATIVE care usually follows rehabilitation. The goal is to keep the resident at the level achieved by rehabilitation services. From Hartman’s Nursing Assistant Care ©2010 page 371 Nursing Fundamentals 7243 614.02
  62. 62. Rehabilitation Restoration Nursing Fundamentals 7243 624.02
  63. 63. Regardless of the classification of the resident; rehabilitation or restorative, the nurse aide responsibilities are the same. HELP RESIDENTS FEEL SAFE AND SECURE BY BEING KIND, PATIENT, POSITIVE, SUPPORTIVE, SENSITIVE TO RESIDENTS NEEDS, AND HELPFUL. Nursing Fundamentals 7243 634.02
  64. 64. 64 Rehabilitative/Restorative Care Any increase or decrease in abilities Any change in attitude or motivation Any change in general health Signs of depression or mood changes Progress or need for additional teaching 4.02 Nursing Fundamentals 7243
  65. 65. 65 • Emphasis on existing abilities • Encourages independence • Promotes productive lifestyle 4.02 Nursing Fundamentals 7243
  66. 66. 66 • Goals include: –Prevention of complications –Retraining in lost skills –Learning new skills 4.02 Nursing Fundamentals 7243
  67. 67. 67 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? 4.02 Nursing Fundamentals 7243
  68. 68. 68 Resident included in goal-setting process, whenever possible. 4.02 Nursing Fundamentals 7243
  69. 69. 69 Treatment initiated by: • Physical therapist • Occupational therapist • Speech therapist • Licensed nurse 4.02 Nursing Fundamentals 7243
  70. 70. 70 Functional losses cause: • Resentment • Anger • Frustration • Withdrawal • Depression • Grief 4.02 Nursing Fundamentals 7243
  71. 71. 71 Nurse Aide’s Role: 1. Provide encouragement and reinforcement 2. Praise all attempts at independence, over look failures 3. Praise accomplishments 4. Help resident see their progress 4.02 Nursing Fundamentals 7243
  72. 72. 72 Nurse Aide’s Role: 4. Be patient and allow time for residents to do things for themselves 5. Be sensitive and understanding 6. Accept residents and encourage them to express their feelings 4.02 Nursing Fundamentals 7243
  73. 73. 73 Nurse Aide’s Role: 7. Show confidence in resident’s ability 8. Review skills taught by allied health professionals 9. Treat with respect 10.Help to put new skills into use immediately 4.02 Nursing Fundamentals 7243
  74. 74. 74 Nurse Aide Role: 11.Begin tasks at resident’s level of functioning 12.Assist resident to do as much as possible for himself/herself 13.Be realistic, never offer false hope 14.Explain what resident needs to accomplish, and how you will help. 4.02 Nursing Fundamentals 7243
  75. 75. 75 Activities of Daily Living considerations for resident: • Resident to control how and when activities carried out, when possible • Use tact in making resident aware of hygiene needs 4.02 Nursing Fundamentals 7243
  76. 76. 76 Activities of Daily Living considerations for resident: • Encourage use and selection of clothing • Be patient and allow time for slower paced activities 4.02 Nursing Fundamentals 7243
  77. 77. 77 Activities of Daily Living considerations for resident: • Provide for rest periods • Assist to exercise • Encourage use of adaptive devices 4.02 Nursing Fundamentals 7243
  78. 78. Restorative/Rehabilitative Care ADL & MOBILITY NEEDS 4.02 Nursing Fundamentals 7243 78 Adaptive Devices For Assisting With Activities of Daily Living (ADL)
  79. 79. 79 • Special utensils available to help with eating • Electric toothbrushes for brushing teeth • Long-handled brushes and combs for hair care 4.02 ADAPTIVE DEVICES FOR ASSISTING ADL Nursing Fundamentals 7243
  80. 80. 80 • Supportive devices to assist with walking – canes, crutches, walkers • Wheelchairs and motorized chairs to provide movement from place to place 4.02 Nursing Fundamentals 7243
  81. 81. 81 • Prosthesis to replace missing body parts • Successful use of adaptive devices depends on the resident’s: –attitude –acceptance of limitations –motivation –support from others 4.02 Nursing Fundamentals 7243
  82. 82. 82 Walker… four-point aid with rubber tips • Resident stands erect when moving walker forward • Walker adjusted to height of hip joint • Elbows at 15-30 degree angle • Walker picked up and put down, not slid 4.02 Nursing Fundamentals 7243 AMBULATION AND TRANSFER AIDS
  83. 83. 83 Walker… • Back legs of walker even with toes so resident walks into walker • Resident steps toward center of walker • Leads with weaker leg 4.02 Nursing Fundamentals 7243
  84. 84. 84 Canes… Types: •single-tipped •tripod - 3 legs •quad - four point 4.02 Nursing Fundamentals 7243
  85. 85. 85 Canes… • Used when weakness on one side of body and resident has use of at least one arm –Provides balance and support 4.02 Nursing Fundamentals 7243
  86. 86. 86 Canes… –Should be fitted properly: • cane handle level with femur (greater trochanter) • elbow flexed at 15 to 30 degree angle • shoulders level 4.02 Nursing Fundamentals 7243
  87. 87. 87 Canes… • Gaits ordered by physician or physical therapist: –move cane and affected leg together –move cane, then affected leg • Used on side of body where leg is strongest (side opposite the injury) 4.02 Nursing Fundamentals 7243
  88. 88. 88 Crutches… –Provide support and stability through use of hands and arms. –Used when one or both legs are weak. 4.02 Nursing Fundamentals 7243
  89. 89. 89 Crutches… –Measured to fit properly by physical therapist. •height correct if two fingers fit between armrest and axilla •hand grip adjusted to allow 20-30 degrees flexion of elbows 4.02 Nursing Fundamentals 7243
  90. 90. 90 Crutches… Gaits four-point gait three-point gait two-point gait swing-to gait swing-thru gait 4.02 Nursing Fundamentals 7243
  91. 91. 91 Crutches… Weight supported on hand bar, not axilla 4.02 Nursing Fundamentals 7243
  92. 92. 92 Wheelchairs… • Available in different sizes and models to allow for proper fit and usage • Cleaned with mild detergent and water, rinsed with water and dried 4.02 Nursing Fundamentals 7243
  93. 93. 93 Wheelchairs… • Periodic maintenance needed with 3 in 1 oil • Arm rests adjusted to appropriate height • Feet rest flat on floor when chair is not moving 4.02 Nursing Fundamentals 7243
  94. 94. 94 Wheelchairs… • Seat should not sag toward center of chair • Seat should not reach back of resident’s bent knees • Brakes locked when chair not moving 4.02 Nursing Fundamentals 7243
  95. 95. 95 Wheelchairs… • Wheelchair guided backwards when going downhill • Wheelchair pulled backwards over indented or raised areas (i.e., entrance to elevators) 4.02 Nursing Fundamentals 7243
  96. 96. 96 Wheelchairs… • Feet placed on footrests for transport 4.02 Nursing Fundamentals 7243
  97. 97. 97 Gurneys/Stretchers/Litters • Wheels locked when transferring residents on or off • Safety belts secured prior to transfer • Both side rails raised prior to transfer 4.02 Nursing Fundamentals 7243
  98. 98. 98 Gurneys/Stretchers/Litters • Residents never left alone on stretcher • Backed head first into elevators 4.02 Nursing Fundamentals 7243
  99. 99. 99 Gurneys/Stretchers/Litters • Always used with assistance when transferring resident on or off • Pushed feet first during transport 4.02 Nursing Fundamentals 7243
  100. 100. 100 • Guided backwards when going downhill • Cleaned with mild detergent and water, rinsed with water and dried Gurneys/Stretchers/Litters 4.02 Nursing Fundamentals 7243
  101. 101. 101 Gait belt (safety belt, transfer belt) –Used for residents unsteady on feet –Protects resident who loses balance or faints –Held at back 4.02 Nursing Fundamentals 7243
  102. 102. 102 • Must be tight enough to provide support but loose enough to be comfortable • Used to safely transfer resident Gait belt (safety belt, transfer belt) 4.02 Nursing Fundamentals 7243
  103. 103. 103 • Correct aids must be used because they are individually fitted • Resident observed closely to be sure aids are being used as ordered • Faulty equipment reported and not used until repaired 4.02 Nursing Fundamentals 7243
  104. 104. 104 • Shoes must fit and be in good condition • Skin breakdown reported • Rubber tips on aids in good condition. 4.02 Nursing Fundamentals 7243 SAFETY – AMBULATORY DEVICES
  105. 105. 4.02 Nursing Fundamentals 7243 105 SKILL 4.02A Ambulate Resident with Walker/Cane Training Lab Assignment Engage in the Skill Acquisition Process for:
  106. 106. 4.02 Nursing Fundamentals 7243 106 MECHANICAL LIFTS
  107. 107. 107 U.S. Department of Labor Hazardous Order No. 7 (July2010) This order prohibits minors under 18 from operating or assisting in the operation of most power-driven hoists, including those designated to lift and move patients. 4.02 Nursing Fundamentals 7243
  108. 108. 108 U.S. Department of Labor Hazardous Order No. 7 (July2010) What do we do? • NA student regardless of age must demonstrate competence in the classroom. • NA student under 18 MUST NOT OPERATE LIFTS IN THE CLINICAL AREA! 4.02 Nursing Fundamentals 7243
  109. 109. 109 • Used for transfer of residents • Lower end of sling positioned behind knees • Hooks turned away from body 4.02 Nursing Fundamentals 7243 MECHANICAL LIFTS
  110. 110. 110 • Straps, sling and clasps checked for defects • Enough assistance available to assure safe transfer • Area checked for safety hazards prior to transfer “CIRCLE THE BED FOR SAFETY’ 4.02 Nursing Fundamentals 7243
  111. 111. 4.02 Nursing Fundamentals 7243 111 SKILL 4.02B Using Mechanical Resident Lift Training Lab Assignment Engage in the Skill Acquisition Process for:
  112. 112. Restorative/Rehabilitative Care JOINT MOBILITY NEEDS 4.02 Nursing Fundamentals 7243 112
  113. 113. 113 • Types of range of motion: –Active - resident exercises joints without help –Passive - another person moves body part for resident 4.02 Nursing Fundamentals 7243 RANGE OF MOTION - ROM
  114. 114. 114 • Purpose of range of motion: –Maintains muscle tone –Prevents deformities –Increases circulation –Encourages mobility 4.02 Nursing Fundamentals 7243
  115. 115. 115 • Expose only part of body being exercised • Be gentle and STOP if resident complains of PAIN • Use good body mechanics 4.02 Nursing Fundamentals 7243 ROM - GUIDELINES
  116. 116. 116 • Follow directions from supervisor on number of times each joint to be exercised and how to perform exercises safely, based on each resident’s condition 4.02 Nursing Fundamentals 7243
  117. 117. 117 • Each movement is repeated three times unless otherwise ordered. • Support joint as it is exercised • Report complaints of pain or discomfort to supervisor 4.02 Nursing Fundamentals 7243
  118. 118. 118 • Exercise joint slowly, smoothly and gently • Do not exercise swollen, reddened joints; report condition to supervisor 4.02 Nursing Fundamentals 7243
  119. 119. 119 • Abduction • Adduction • Extension • Hyperextension • Flexion • Plantar flexion • Dorsiflexion • Rotation 4.02 Nursing Fundamentals 7243
  120. 120. 120 • Pronation • Supination • Eversion • Inversion • Radial deviation • Ulnar deviation Encourage residents capable of doing active ROM exercises 4.02 Nursing Fundamentals 7243
  121. 121. 4.02 Nursing Fundamentals 7243 121 SKILL 4.02C Range of Motion Training Lab Assignment Engage in the Skill Acquisition Process for:
  122. 122. Restorative/Rehabilitative Care PROSTHETIC DEVICES 4.02 Nursing Fundamentals 7243 122
  123. 123. 123 • Artificial Eye (glass eye) –encourage resident to remove, clean and replace eye prosthesis if able 4.02 Nursing Fundamentals 7243 PROSTHETIC DEVICES
  124. 124. 124 • Eyeglasses –Lens made of glass or plastic –Stored in protective case to prevent damage when not in use –Held by frames 4.02 Nursing Fundamentals 7243
  125. 125. 125 • Eyeglasses (continued) –Washed under running water using mild detergent. •rinsed with clear water •dried with tissue or soft cloth 4.02 Nursing Fundamentals 7243
  126. 126. 126 • Eyeglasses… –Tops of ears and nose observed for redness or irritation from glasses • Wash hands before and after cleansing resident’s glasses 4.02 Nursing Fundamentals 7243
  127. 127. 127 • Contact Lenses (hard or soft) –Resident encouraged to care for lenses 4.02 Nursing Fundamentals 7243
  128. 128. 128 • Contact Lenses (hard or soft) Unusual observations to be reported: • redness • itching • swelling • complaints of pain, blurring, or scratching sensations 4.02 Nursing Fundamentals 7243
  129. 129. 129 • Hearing Aid –Ear piece cleaned daily with soap and water; this is the only washable part –Ear piece and tubing should be soft –Wax cleaned from tubing with special equipment 4.02 Nursing Fundamentals 7243
  130. 130. 130 • Hearing Aid… • Batteries checked for power –Skin observed for redness or irritation in or around ear –Ear wax build-up reported to supervisor 4.02 Nursing Fundamentals 7243
  131. 131. 131 • Inserting hearing aid: –turn volume toward maximum until whistle is heard –replace batteries if whistle cannot be heard –turn volume to low setting 4.02 Nursing Fundamentals 7243
  132. 132. 132 • Inserting hearing aid (continued): –gently insert ear piece into ear canal and adjust for comfort –loop over ear for over-the-ear models –adjust volume to resident’s satisfaction 4.02 Nursing Fundamentals 7243
  133. 133. 133 • Removing hearing aid: –turn volume to lowest level or off –gently lift ear piece up and out of ear –use tissues to wipe wax off ear piece –store in safe place –remove battery when not in use or open battery case 4.02 Nursing Fundamentals 7243
  134. 134. 134 • Braces –Uses •support a weak part of the body •prevent movement of joint •correct deformities •prevent deformities 4.02 Nursing Fundamentals 7243
  135. 135. 135 • Braces (continued) –Materials • metal leather plastic –Bony parts under brace require protection in order to prevent skin irritation –Report any wear noticed and when brace parts are loose or missing 4.02 Nursing Fundamentals 7243
  136. 136. 136 • Braces (continued) –Shoes custom fitted and checked for: • broken shoe laces • heels and soles that are worn • leather that is worn or torn • damage from perspiration – odors – stains 4.02 Nursing Fundamentals 7243
  137. 137. 137 • Devices for use with amputation –Definition of amputation - partial or complete removal of a body part • usually arm or leg • below knee most common amputation 4.02 Nursing Fundamentals 7243
  138. 138. 138 • Devices for use with amputation (continued) –Examples of prosthetic devices: •artificial leg •artificial foot •artificial arm •artificial hand 4.02 Nursing Fundamentals 7243
  139. 139. 139 • Devices for use with amputation (continued) –Prosthesis fitted and made for each individual. –Devices must be handled with care and stored in appropriate place when not in use. 4.02 Nursing Fundamentals 7243
  140. 140. 140 Assisting with artificial limbs: –have right device –check all parts for damage –evaluate resident’s limb for irritation and swelling –pad area of prosthesis touching resident 4.02 Nursing Fundamentals 7243
  141. 141. 141 Assisting with artificial limbs (continued): –clean according to individual instructions –report any needed repairs to supervisor –observe and report any skin changes to supervisor 4.02 Nursing Fundamentals 7243
  142. 142. 142 • Breast Forms – used following removal of breast –Assist female residents with adjustments of forms when dressing –Follow care suggested by manufacturer –Keep form separate and in safe place when handling clothing for laundry 4.02 Nursing Fundamentals 7243
  143. 143. Restorative/Rehabilitative Care MOBILITY NEEDS 4.02 Nursing Fundamentals 7243 143
  144. 144. 144 • Broad base of support leads to better balance and stability • Keep weight the same on both feet • Stoop using the hips and knees 4.02 Nursing Fundamentals 7243 BODY MECHANICS FOR RESIDENTS
  145. 145. 145 • Keep the back straight • Lift and carry objects close to body for better balance. • Use both hands to lift or move objects • Use smooth, even movements 4.02 Nursing Fundamentals 7243
  146. 146. 146 • Do not bend or reach if injury possible; ask for help • Do not twist body to reach an object • Keep body in good alignment 4.02 Nursing Fundamentals 7243
  147. 147. 147 • Dangling - sitting on edge of bed before getting up –Standing up too quickly may cause feeling of dizziness and fainting may occur 4.02 Nursing Fundamentals 7243 DANGLING
  148. 148. 148 • Dangling for several minutes allows resident to progress to standing and walking without feeling faint • Taking deep breaths helps to prevent light-headedness 4.02 Nursing Fundamentals 7243
  149. 149. 149 • Most common signs/symptoms if feeling faint: –pale face –complaints of dizziness or weakness 4.02 Nursing Fundamentals 7243
  150. 150. 150 • Return resident to supine position if they have difficulty dangling • If dangling is well tolerated, progress to standing position 4.02 Nursing Fundamentals 7243
  151. 151. 151 • Get assistance if resident is weak or unsteady • Assist resident to stand by placing your hands under the resident’s arms with hands around the shoulder blades, and use good body mechanics to assist to standing position 4.02 Nursing Fundamentals 7243 STANDING
  152. 152. 152 • Have resident stand by side of bed for several minutes prior to ambulating • Return to bed or assist to chair if having difficulty standing • If standing tolerated, progress to ambulating 4.02 Nursing Fundamentals 7243
  153. 153. 153 • Effects on body – stimulates circulation – strengthens muscles – relieves pressure on body parts – increases joint mobility – improves function of digestive and urinary systems 4.02 Nursing Fundamentals 7243 AMBULATING – WALKING
  154. 154. 154 • Effects on body (continued) – increased independence leads to more positive self-image – provides sense of accomplishment – prevents lung congestion 4.02 Nursing Fundamentals 7243
  155. 155. 155 • Encourage to ambulate as much as possible • Suggest use of handrails for support 4.02 Nursing Fundamentals 7243
  156. 156. 156 • If resident starts to fall, ease to the floor by: –grasping gait belt –resting buttocks against nurse aide’s leg –sliding down aide’s leg to floor 4.02 Nursing Fundamentals 7243
  157. 157. 157 • Be prepared to assist, but allow the resident to do as much as possible • Safety considerations: –use gait belt –get assistance if needed –allow adequate time for walking so resident does not feel rushed 4.02 Nursing Fundamentals 7243
  158. 158. 4.02 Nursing Fundamentals 7243 158 SKILL 4.02D DANGLE, STAND, WALK Training Lab Assignment Engage in the Skill Acquisition Process for:
  159. 159. 4.02 Nursing Fundamentals 7243 159 SKILL 4.02E TRANSFER BED TO WHEELCHAIR (CHAIR) Training Lab Assignment Engage in the Skill Acquisition Process for:
  160. 160. 4.02 Nursing Fundamentals 7243 160 SKILL 4.02F TRANSFER BED TO STRETCHER Training Lab Assignment Engage in the Skill Acquisition Process for:
  161. 161. Restorative/Rehabilitative Care CAST CARE 4.02 Nursing Fundamentals 7243 161
  162. 162. 162 • Cast used to immobilize body part, providing time for part to heal 4.02 Nursing Fundamentals 7243 CAST CARE
  163. 163. 163 • Cast materials –Plaster of Paris •24-48 hours to dry •expands and gives off heat while drying –Fiberglass •dries rapidly •lighter than plaster casts –Plastic 4.02 Nursing Fundamentals 7243
  164. 164. 164 • Care of Casts –Allow to air dry –Keep cast uncovered –Use pillows to support cast –Support cast with palms of hands 4.02 Nursing Fundamentals 7243
  165. 165. 165 • Care of Casts –Never put pressure on cast –Turn and position frequently to allow air to circulate around cast 4.02 Nursing Fundamentals 7243
  166. 166. 166 • Maintain good body alignment • Keep cast dry • Observe cast for rough edges and report • Over-bed trapeze provided if appropriate 4.02 Nursing Fundamentals 7243
  167. 167. 167 • Vomiting • Elevated temperature • Skin irritation around edge of cast 4.02 Nursing Fundamentals 7243
  168. 168. 168 • Drainage • Odors • Swelling of fingers or toes, inability to move parts • Change in color of skin: paleness, cyanosis 4.02 Nursing Fundamentals 7243
  169. 169. 169 • Resident with cast reports of: – Pain – Numbness – Tingling sensations – Chills – Hot or cold skin –Itching –Tightness –Inability to move fingers or toes –Nausea 4.02 Nursing Fundamentals 7243
  170. 170. 4.02 Nursing Fundamentals 7243 170 COUGHING AND DEEP BREATHING
  171. 171. Nursing Fundamentals 7243 171 • Purposes –To prevent respiratory complications in certain at-risk residents •persons on bed rest or reduced activity •following surgery •person with respiratory disorders COUGHING AND DEEP BREATHING 4.02
  172. 172. Nursing Fundamentals 7243 172 • Purposes –Two major complications prevented by coughing and deep breathing: •pneumonia - inflammation of lung •atelectasis - collapse of portion of lung 4.02
  173. 173. Nursing Fundamentals 7243 173 • Physiology –Deep Breathing •increases level of oxygen in blood •increases lung expansion 4.02
  174. 174. Nursing Fundamentals 7243 174 • Physiology –Coughing •removes mucus from airways and lungs •may cause collapse of lung if congestion not present 4.02
  175. 175. Nursing Fundamentals 7243 175 • Considerations with deep breathing and coughing –Doctors order exercises –Frequency of performing exercise varies per doctor’s order 4.02
  176. 176. Nursing Fundamentals 7243 176 • Considerations with deep breathing and coughing –Nurse aides receive instructions from supervisor –Coughing may cause pain and be difficult to perform 4.02
  177. 177. 4.02 Nursing Fundamentals 7243 177 SKILL 4.02G COUGH AND DEEP BREATH Training Lab Assignment Engage in the Skill Acquisition Process for:
  178. 178. 4.02 Nursing Fundamentals 7243 178 ANTI-EMBOLIC STOCKINGS/HOSE
  179. 179. Nursing Fundamentals 7243 179 • Purpose –Provide support –Provide comfort –Promote circulation by providing pressure –Reduce risk of thrombus formation ANTI-EMBOLITIC STOCKINGS/HOSE 4.02
  180. 180. Nursing Fundamentals 7243 180 • Indications for use –Residents with heart disease and circulatory disorders –Residents on bed rest –Residents who recently had surgery 4.02
  181. 181. Nursing Fundamentals 7243 181 • Prevention of blood clots (thrombi) –blood clots form (blood flow is sluggish) –usually develop in deep leg veins –can break loose and travel though blood stream (then known as embolus) 4.02
  182. 182. Nursing Fundamentals 7243 182 • Prevention of blood clots (thrombi) –embolus can travel to the lungs and possibly cause death –elastic stockings exert pressure on veins, promoting venous blood flow to heart –also known as anti-embolitic stockings or TED hose 4.02
  183. 183. Nursing Fundamentals 7243 183 • Fitting of stockings –Come in thigh high or knee high lengths –Resident must be measured to ensure proper fit 4.02
  184. 184. 4.02 Nursing Fundamentals 7243 184 SKILL 4.02H ANTI-EMBOLITIC STOCKING Training Lab Assignment Engage in the Skill Acquisition Process for:
  185. 185. Understand nurse aide’s range of function in rehabilitative/restorative and maintenance care. 185  END  4.02 4.02 Nursing Fundamentals 7243

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