a brief review of a lot of material

1. 1
STUDY GUIDE FOR STATE EXAM
NOT MEANT TO REPLACE YOUR TEXTBOOK. CONTINUE TO LOOK AT PICS, HIGHLIGHTS IN TEXT AS WELL.
GOOD LUCK AND TEXT ME WHEN YOU ARE CERTIFIED!!
MEMBERS OF NURSING CARE TEAM
RN- SUPERVISES THE NURSE AIDE, LPN AND NURSE AIDE
NURSE AIDE REGISTRY: OFFICIAL RECORD OF PERSON WHO HAVE PASSED STATE CERTIFICATION EXAM
ANDCONTAINSINFOON ALLEGATIONS OF ABUSE, NEGLECT, THEFT, ALL NAMES USED, ADDRESSES AND
PLACES OF EMPLOYMENT
ORGANIZATION OF NURSING CARE:
FUNCTIONAL NURSING- CHARGE NURSE ASSIGNS AND DIRECTS ALL CARE FOR THE TEAM; ONE NURSE
GIVES MEDS AND ANOTHER DOES VITAL SIGNS, ETC- EACH PERSON HAS A TASK
TEAM NURSING: CHARGE NURSE ASSIGNS A GROUP OF PATIENS TO EACH TEAM, A TEAMLEADER MAY
BE RN OR LPN WHO WORKS WITH SEVERAL NURSE AIDES
PRIMARY NURSING: ONE RN RESPONSIBLE FOR ALL ASPECTS OF CARE FOR ASSIGNED PATIENTS,
PRACTICED IN ICU
MEMBERS OF THE HEALTH CARE TEAM: DOCTORS,NURSES, SOCIALWORKER,DIETICIAN, PHARMACIST,
ACTIVITY DIRECTOR, PATIENT AND FAMILY, CLERGY
PHYSICAL THERAPIST- HELPS PATIENT WITH AMBULATION, BUILDING MUSCLE STRENGTH AND TONE
SPEECH THERAPIST- MAY ALSO EVALUATE THOSE WITH DYSPHAGIA
OCCUPATIONAL THERAPIST- HELPS PERSON TO RELEARN HOW TO SELF CARE OR PERFORMADLs
GERONTOLOGY: STUDY OF PEOPLE OVER 65
GERIATRICS: CARE AND TREATMENT OF PEOPLE OVER 65
GERONTOLOGIST: DOCTOR WHO SPECIALIZES IN CARE OF ELDERLY
PODIATRIST: FOOT DOCTOR
CHAIN OF COMMAND IN NURSING
DON
ADON
NURSING SUPERVISORS
UNIT MANAGERS (HEAD NURSES)
STAFF NURSES

2. 2
LPNS
NURSE AIDES
*ALWAYS FOLLOW CHAIN OF COMMAND WHEN REPORTING A PROBLEM
NURSING HOME ORGANIZATIONAL CHART:
ADMINISTRATOR
MEDICAL DIRECTOR
DON
ADON
ETC……
PAYING FOR HEALTH CARE:
MEDICAID- FOR LOW INCOME
MEDICARE-FOR ELDERLY AND PEOPLE WIT CERTAIN DISABILITIES
HMOs AND PPOs-PRIVATE INSURANCE, CONTRACT BETWEEN EMPLOYER AND EMPLOYEE
DRGs- METHOD OF CONTROLLING COST OF HEALTH CARE, DETERMINES HOW MUCH IT WILL COST TO
TREAT A PARTICULAR ILLNESS AND HOW LONG THE PERSON WILL NEED TO BE HOSPITALIZED
CARE PLANS:
WRITTEN BY REGISTERED NURSE ANDINCLUDES A NURSINGDIAGNOSIS,GOALS,INTERVENTIONSANDA
MANNER TO EVALUATE INDIVIDUALIZED CARE FOR EACH RESIDENT; USED BY THE ENTIRE TEAM
OUT OF SCOPE OF PRACTICE FOR CNAS:
NO STERILE PROCEDURES (NO WOUND DRESSING)
NO INSERTING OR REMOVING TUBES, CATHETERS
NO TAKING ORDERS FROMA DOCTOR
NO BEING IN CHARGE
NO GIVING MEDICATION
NO DISCUSSING DIAGNOSIS AND TREATMENT WITH RESIDENT OR FAMILY
PLACES WHERE NURSE AIDES CAN WORK:
HOSPICE- FOR TERMINALLY ILL
ASSISTED LIVING- APARTMENT LIKE SETTING THAT PROVIDES MEALS, MEDS, TRANSPORTATION,
LAUNDRY AND HOUSEKEEPING; MINIMAL NURSING CARE

3. 3
LONG TERM CARE FACILITY- FOR THOSE LIVING WITH CHRONIC ILLNESSES, NEEDING ASSIST WITH ADLs,
USUALLY 65 OR >
SKILLED NURSING FACILITY- FOR THOSE WHO REQUIRE SPECIAL CARE SUCH AS WOUND CARE,
TRACHEOSTOMY CARE, IV MEDS. THE SKILLED NURSING FACILITY IS IN THE NURSING HOME
REHABS
SUBACUTE FACILITY: PEOPLE NEED SOME HELP WITH ADLS, MEALS, HOUSEKEEPING, LAUNDRY,
ACTIVITIES PROVIDED
SUBACUTE- SHORTER STAY POST HOSPITALIZATION, PERSON STILL SICK, BUT NOT ENOUGH TO BE IN
HOSPITAL, MAY STAY 3-4 MONTH, FOR REHAB, ETC.COMMON PLACE FOR THOSE AFTER HAVING A
STROKE TO GO AND RECOVER
RESPITE IS A SERVICE OFFERED TO FAMILIES WHO TAKE CARE OF THEIR LOVED ONE AT HOME; IT IS A
VACATION FOR THEM- THEY CAN LEAVE THE RESIDENT IN A NURSING HOME FOR APPROX A MONTH OR
HAVE A HOME HEALTH AIDE COME IN WHILE THEY GO AWAY, WHATEVER
TERMS:
ACUTE: ILLNESS THAT COMES ON SUDDENLY ANDLAST A SHORT PERIOD OF TIME, EX HEART ATTACK OR
BROKEN LEG
CHRNONIC: ILLNESS COMES ON SLOWLY AND MAY LAST A LIFETIME, EX. ARTHRITIS, DIABETES OR
HYPERTENSION
EMPATHY: BEING ABLE TO IMAGINE HOW ANOTHER PERSON FEELS; WALKING IN HIS/HER SHOES
OMBUDSMAN- VOLUNTEER ADVOCATE FOR ELDERLY; NOT AN EMPLOYEE OF LTCF; WILL INVESTIGATE
REPORTS OF ABUSE OR NEGLECT
DECONDITIONING: THE BODY BECMES WEAK FROMILLNESS
5 RIGHTS OF DELEGATION:
RIGHT TASK
RIGHT PERSON
RIGHT CIRCUMSTANCES
RIGHT DIRECTIONS
RIGHT SUPERVISION
ETHICAL BEHAVIOR:
BE CONSCIENTOUS- DO THE BEST YOU CAN
ONLY PERFORMTASKS YOU ARE TRAINED TO DO
RESPECT OTHERS BELIEFS

4. 4
DON’T ACCEPT TIPS
KEEP A PROFESSIONAL RELATIONSHIP WITH RESIDENT AND FAMILY
DON’T WASTE SUPPLIES
REPORT ERRORS, AND ACCIDENTS
BE FLEXIBLE, DEPENDABLE, ACCURATE
BE HELPFUL, HONES, TRUSTWORTHY
BE LOYAL TO YOUR EMPLOYER
LEGAL CONSIDERATIONS:
NEGLIGENCE: FAILING TO DO WHAT IS EXPECTED AND TAUGHT; EX. LEAVING A RESIDENT IN A WET
DIAPER- IT IS CARELESS ACTIONS
ABUSE: INTENTIONALLY HARMING ANOTHER BY
PHYSICAL, SEXUAL, VERBAL, MENTAL, OR FINANCIAL ACTIONS- MUST BE REPORTED TO CHARGE NURSE
SLANDER- ORAL DEFAMATION OF CHARACTER, SAYING SOMETHING HARMFUL ABOUT ANOTHER
LIBEL-WRITTEN DEFAMATION
DEFAMATION: INJURING A PERSON’S REPUTATION AND NAME BY MAKING FALSE STATEMENTS
AIDING AND ABETTING- NOT REPORTING A WRONG DOING
INVASION OFPRIVACY- NOTCLOSINGDOOR,NOTKNOCKINGBEFOREENTERINGA ROOM, NOT PULLING
PRIVACY CURTAIN OR EXPOSING THE BODY DURING CARE
FALSE IMPRISONMENT- RESTRAINING WITHOUT A DOCTOR’S ORDER, RESTRICTING WHERE A RESIDENT
CAN AND CANNOT GO
INCIDENTS: ANYTHING THAT HAPPENS OUT OF THE ORDINARY SUCH AS THEFT, LOSS, DAMAGE,
ACCIDENTS;INVOLVINGRESIDENT, VISITORS OR STAFF; COMPLETE INCIDENT REPORT ASAP WITH ONLY
FACTS OF INCIDENT
CONSENT CAN BE IMPLIED (YOU ASK TO TAKE A BP AND PERSON STICKS OUT ARM), VERBAL OR
WRITTEN
INFORMED CONSENT:PERSON HASTO GIVE PERMISSION ON WHAT AND WHO CAN TOUCH THEIR BODY
AND PROVIDE CARE AND TREATMENT
ENTRAPMENT: PART OF BODY GETS CAUGHT IN A THE HOSPITAL BED
ELOPEMENT: PERSON LEAVE NURSING HOME WITHOUT PERMISSION
ACUTE, CHRONIC AND TERMINAL ILLNESS:
ACUTE ILLNESS COMES ON SUDDENLY, IS TEMPORARY AND MAY BE CURED

5. 5
CHRONIC ILLNESS MAY DEVELOP SLOWLY AND WORSEN, MAY BE TREATED BUT MAY LAST A LIFETIME
TERMINAL ILLNESS IS ONE IN WHICH THE PERSON WILL DIE FROM
OBJECTIVE INFORMATION: INFORMATION YOU CAN SEE, FEEL, HEAR, TOUCH OR SMELL- A “SIGN”
SUBJECIVE INFORMATION: INFORMATION THAT YOU CANNOT HEAR, SEE, FEEL, TOUCH OR SMELL,
MUST BE DESCRIBED BY THE PERSON, A “SYMPTOM”
COMMUNICATION:
A 2 WAY EXHANGE OF INFORMATION WITH A SENDER AND A RECIEVER
WITH HEARING IMPAIRED: USE BODY LANGUAGE, WRITE DOWN IMPORTANT MESSAGES; SPEAK WITH
VOICE IN LOWER PITCHE, FACE TO FACE, DON’T SHOUT
WITH VISUALLY IMPAIRED: KNOCK, ANNOUNCE YOUR ENTRANCE AND EXIT, TOUCH LIGHTLY ON
SHOULDER TO GET ATTENTION, NEVER REARRANGE FURNITURE, TELL WHERE CALL BELL IS BEFORE
LEAVING
WITH SPEECH IMPAIRED: LISTEN, DON’T FINISH SENTENCES, GIVE TIME TO COMMUNICATE, USE
PICTURE BOARDS
VERBAL COMMUNICATION- USES WORDS- WRITING, READING, SPEAKING
NONVERBAL- INCLUDES GESTURES, FACIAL EXPRESSIONS, OUTWARD APPEARANCE, GAIT, POSTUREI
IMPROVING COMMUNICATION:
ASK OPEN ENDED QUESTIONS
LISTEN
USE TOUCH
ASK FOR CLARIFICATION IF YOU DON’T UNDERSTAND
SIT, FACE TO FACE
TURN DOWN LOUD TVs OR RADIOS
ORGANIZE WORDS
USE FAMILIAR WORDS
USE WORDS THAT HAVE ONE MEANING
BARRIERS TO COMMUNICATION:
CLICHES
GIVING ADVICE
NOT LISTENING

6. 6
YELLING
CHEWING GUM
PROFANITY
SLANG
NOISE
LANGUAGE
EYEGLASSES- CLEAN WITH LENS PAPER EACH DAY
GLASS EYE-WASH WITH MILD SOAP AND WATER, KEEP IN CONTAINER FILLED WITH SOFT CLOTH TO
AVOID SCRATCHING, WASH EYE SOCKET WITH WARMWATER, DRY – EYE RINSED WITH STERILE WATER
BEFORE PUTTING IN SOCKET
HEARING AIDS-STORE CAREFULLY IN CASE, CHECK BATTERY EACH TURN, ADJUST VOLUME, REMOVE
DURING SHOWER, SHAMPOO, WHEN COMBING HAIR, BEDTIME; NEVER IMMERSE IN WATER; NEVER
INSERT Q-TIPS OR ANYTHING ELSE INTO AN EAR;
RESPECT A SAD OR ANGRY PERSON’S MOOD- DON’T SAY “CALMDOWN” OR “CHEER UP
ADDRESS BY MR, MRS, OR WHATEVER RESIDENT PREFERS
NO TERMS OF ENDEARMENT SUCH AS HONEY
RESIDENT RIGHTS:
TO LEAVE
TO STAY
TO COMPLAIN
TO PERSONAL POSSESSIONS
TO CHOICE
TO SHARE ROOMIF MARRIED
TO WORK/ OR NOT WORK IN HOME
TO ORGANIZE
TO PRACTICE RELIGION
TO SEND/RECEIVE UNOPENED MAIL
TO MANAGE OWN MONEY
TO LIVE IN A CLEAN, SAFE ENVIRONMENT
TO BE FREE FROMABUSE AND NEGLECT

7. 7
TO BE TREATED WITH DIGNITY AND RESPECT
TO PRIVACY
TO CONFIDENTIALITY
TO REFUSE CARE
READ HIS CHART, SEE HIS BILL
OBSERVATION AND REPORTING:
SIGNS: ARE OBJECTIVE FINDINGS NOTED BY USING EYES, EARS, SENSE OF TOUCH OR SMELL
SYMPTOMS: ARE SUBJECTIVE FINDING NOTED WHEN THE RESIDENT TELLS YOU
PAIN: SUBJECTIVE
RASH: OBJECTIVE
REPORT THE FOLLOWING:
*MELENA- BLOOD IN STOOL OR DARK STOOL
*EDEMA- SWOLLEN FEET OR HANDS
*CYANOSIS-BLUE SKIN
DYSPNEA- DIFFICULTY BREATHING
PAIN- WHEN, WHERE, HOW BAD ON SCALE OF 0-10
*NEURO- CHANGES IN BEHAVIOR, ALERTNESS, MOOD, MEMORY OR ORIENTATION
EATING/DRINKING- REFUSES MEALS, DYSPHAGIA, POOR APPETITE
SLEEP PATTERNS- INSOMNIA (ELDERLY NEED 5-6 HOURS/NIGHT)
SKIN- DISCOLORATION, OILY OR DRY SKIN, BRUISING, SKIN TEARS OR SORES
*BREATHING- SOB, DYSPNEA
ABDOMEN- SWELLING, ENLARGED BELLY, CONSTIPATION, FLATUS, DIARRHEA
*IF VOMIT LOOKS LIKE WET COFFEE GROUNDS -
CULTURE: THE THOUGHTS, BELIEFS, VALUES OF A SOCIAL GROUPS, AFFECTS FOOD, MUSIC, STYLE OF
DRESS, HEALTH PRACTICES, BIRTH, MARRIAGE, DEATH, FAMILY RITUALS
LEARN AS MUCH AS POSSIBLE ABOUT A PERSON’S CULTURE, TREAT WITH RESPECT, APOLOGIZE IF YOU
OFFEND SOMEONE
COMFORT AND SLEEP
ACUTE PAIN- HEART ATTACK; CHRONIC PAIN-ARTHRITIS; PHANTOMPAIN-IN A LEG OR ARMTHAT HAS
BEEN AMPUTATED

8. 8
PAIN,STRESS,LIGHTS, STRANGEENVIRONMENTANDEXERCISE AFFECTABILITY TO SLEEP- DON’T ALLOW
RESIDENT TO EXERCISE OR PACE FOR AT LEAST 2 HOURS BEFORE BEDTIME; NO COLAS, CAFFEINE
BEFORE BEDTIME; MAKE BED COMFY, POSITION COMFORTABLE,TOILET,GIVE BACKRUB, WARMDRINK,
KEEP BATHROOMLIGHT ON, KEEP NOISE DOWN TO PROMOTE SLEEP; NEED 5-6 HOURS OF SLEEP /
NIGHT
DIFFICULT BEHAVIORS:
RESIDENTS MAY HIT, SHOUT, BECME AGGRESSIVE BECAUSE OF AN UNMET NEED- THEY ARE IN PAIN,
THEY NEED TO BE TOILETED, THEY ARE AFRAID, ETC.
FIND OUT WHAT IS UPSETTING THE PERSON IF YOU CAN; DON’T YELL, STAY AT LEAST AN ARM’S LENGTH
FROMTHE PERSON, WATCH YOUR BODY LANGUAGE, CALL FOR HELP FROMOTHER STAFF
INFECTION CONTROL:
HANDWASHING IS NUMBER ONE DEFENSE AGAINST SPREAD OF INFECTON- DONE BEFORE AND AFTER
CARE, TOILETING, MEALS, WHENEVER HANDS VISIBLY SOILED
KEEP FINGERNAILSSHORT- KEEP SKIN MOIST-WASH FOR AT LEAST 15-20 SECONDS WITH WARMWATER
AND LIQUID SOAP, HANDS BELOW ELBOWS, USING FRICTION TO DESTROY GERMS- IF INSIDE OF SINK
TOUCHED, BEGIN WASH OVER- ALWAYSWASH HANDSAFTER GLOVES REMOVED; INSPECTHANDSDAILY
AND COVER ANY BREAKS WITH A BANDAGE
MEDICAL ASEPSIS: CLEANS TO REMOVES SOME GERMS- CLEAN/RINSE/DRY/STORE ALL EQUIPMENT;
NEVER SHARE PERSONAL ITEMS LIKE A HAIRBRUSH
SURGICAL ASEPSIS- STERILIZES TO KILL ALL GERMS USING AN AUTOCLAVE OVEN
STANDARD PRECAUTIONS: FOR ALL RESIDENTS AND PATIENTS-INCLUDES PLACE SHARPS IN A
BIOHAZARD CONTAINER, INLCUDES DISPOSABLE RAZOR; RED BAG LINEN AND TRASH THAT HAS BLOOD
ON IT, NEVER RECAPPING NEEDLES, WEARING GLOVES OR SOME OTHER TYPE OF PROTECTIVE BARRIER
WHEN POSSIBILITY OF CONTACT WITH BLOOD OR OTHER BODY FLUIDS (SEMEN, VAGINAL SECRETIONS,
SALIVA, MUCUS, FECES)
INFECTION:
INVASION OF THE BODY BY PATHOGENS (GERMS THAT MAKE YOU SICK) CAUSING DISEASE OR ILLNESS
LOCAL INFECTION SUCH AS CUT FINGER: RED, SWOLLEN, WARM, DRAINAGE
SYSTEMIC INFECTION: DIARRHEA, VOMITING, FEVER, PAIN, FATIGUE
PERSONAL PROTECTIVE EQUIPMENT (PPE):
GLOVES- ONE TIME USE ONLY; SEPARATE PAIR FOR EACH NEW TASK, DON’T WEAR IF TORN
MASK- ONLY TOUCH STRINGS OF A MAKS WHEN REMOVING
GOWNS

9. 9
GOGGLES- IF POSSIBLITY OF SPLASHING
*NEVER WORN IN HALLWAY AFTER USE
PUT ON PPE RIGHT OUTSIDE PATIENT ROOM; REMOVE BEFORE COMING OUT OF ROOM
ORDER FOR DONNING PPE:
GOWN, MASK, GLOVES
REMOVING PPE:
GLOVES, GOWN, MASK
BLOODBORNE PATHOGENS:
INFECTIONS THAT ARE SPREAD BY BLOOD CONTACT-HIV AND HEPATITIS B
METHOD OF TRANSMISSIONS- UNPROTECTEDSEXWITH INFECTED PARTNER,SHARING NEEDLES, MOMS
TO BABIES, BLOOD TRANSFUSIONS
BOTH ARE VIRAL INFECTIONS WITHOUT CURE
HBV HAS A VACCINE TO PREVENT- EMPLOYER WILL OFFER FOR FREE WHEN NURSE AIDE IS HIRED
HBV IS AN INFECTION OF THE LIVER- LOOK FOR JAUNDICE, ENLARGED BELLY, DARK URINE AND LIGHT
STOOLS
TB:
BACTERIAL INFECTION OF THE LUNGS-S/SX INCLUDE COUGHING UP BLOOD, WT LOSS, NIGHTSWEATS
CURABLE WITH MEDS, MUST BE IN AIRBORNE PRECAUTIONS FOR 2-3 WEEKS WHICH MEANS PRIVATE
ROOMWITH DOOR ALWAYS CLOSES, STAFF MSUT WEAR SPECIAL MASK (HEPA MASK OR N95
RESPIRATOR MASK) AND ROOMMUST HAVE NEGATIVE AIR PRESSURE
OTHER TYPES OF PRECAUTIONS:
CONTACT: FOR INFECTIONS IN URINE, FECES, A WOUND, OR ON SKIN- WEAR GOWN AND GLOVES
DROPLET: FOR FLU OR MENINGITIS- WEAR GLOVES, IF WITHIN 3 FEET OF PERSON ALSO WEAR MASK
(REGULAR PAPER ONE)
AIRBORNE FOR TB (SEE ABOVE)
CHAIN OF INFECTION:
CAUSATIVE ORGANISM: THE BUG
RESERVOIR: PLACE FOR BUG TO LIVE AND GROW (CAN BE HUMAN, A VECTOR SUCH AS AN ANIMAL,
BIRD OR INSECT OR CAN BE A FOMITE, SUCH AS A TOILET SEAR)

10. 10
PORTAL OF EXIT: HOW THE BUG GETS OUT OF THE RESERVOIR; THRU BLOOD, SEMEN/VAGINAL FLUIDS,
SALIVA, SNEEZING, COUGHING, VOMIT OR DIARRHEA
METHOD OF TRANSMISSION: CAN BE DIRECT CONTACT, INDIRECT CONTACT, AIRBORNE, DROPLETS,
COMMON VEHICLE (FOOD/WATER)
PORTAL OF ENTRY: HOW THE BUG ENTERS THE NEXT PERSON- THRU BREAK IN SKIN, BREATHED IN OR
EATEN (INGESTED)
SUSCEPTIBLE HOST: PERSON AT GREATEST RISK TO GET SICK, CAN BE BECAUSE OF AGE, LIFESTYLE,
OCCUPATIONS, ETC
DOUBLE BAGGING: ALL LINEN AND TRASH BEING REMOVED FROMAN ISOLATION ROOMSHOULD BE
DOUBLE BAGGED- ONENURSE AIDEHOLDS AN EMPTY BAG WHILE STANDINGOUTSIDE ROOM(IN DOOR
WAY) AND ANOTHER AIDE NSIDE ROOMDROPS FILLED BAG INTO THE EMPTY BAG
NOSOCOMIAL INFECTIONS (HOSPITAL ACQUIRED)- CAUSED BY ROOMMATE, STAFF OR IMPROPERLY
CLEANED EQUIPMENT- THE PATIENT DID NOT HAVE THE INFECTION WHEN ADMITTED, SO MUST BE DUE
TO BEING HOSPITALIZED
NORMAL FLORA: OUR BODY HAS BACTERIA IN IT TO FIGHT INFECTION OR EAT AWAY FOREIGN
INVADERS, ESPECIALL IN THE INTESTINES (E. COLI)
MRSA AND VRE:
INFECTIONS RELATED TO OVERUSE OF ANTIBIOTICS- BODY DEVELOPS A RESISTANCE AND CANNOT
TREAT NEW INFECTION WITH CONVENTIONAL ANTIBIOTICS; CAN BE DEADLY FOR ELDERLY- MUST
RECEIVE POWERUL IV ANTIBIOTICS AND BE PLACED IN CONTACT PRECAUTIONS
SAFETY GUIDELINES:
1. CLEAN UP SPILLS IMMEDIATELY
2. KEEP DOORWAYS, HALLWAYS, ROOMS CLUTTER FREE
3. CALL BELL WITHIN REACH
4. ANSWER CALL BELLS ASAP
5. PUT ALWAYS TOILETRIES AND CLEANING SUPPLIES AFTER USE
6. LOCK BRAKES ON W/C AND BED
7. NONSKID FOOTWEAR
8. IF PILLS NOT TAKEN OR FOUND ON FLOOT-TAKE TO RN
9. SLIDE A FALLING VICTIMTO FLOOR SUPPORTING HEAD
10. NEVER LEAVE AN ACCIDENT VICTIMALONE- CALL FOR HELP
FIRST AID
HEIMLICH MANEUVER OR ABDOMINAL THRUST: FOR CHOKING VICTIM
IF ABLE TO COUGH OR TALK- PERSON IS NOT CHOKING- STAY WITH HIM, OFFER REASSURANCE, BUT
DON’T PAT ON BACK OR GIVE WATER

11. 11
IF UNABLE TO COUGH/TALK- BEGIN ABD THRUSTS UNTIL FOOD COMES OUT OR PERSON PASSES OUT
ALWAYS CALL FOR HELP FIRST
IF OBESE OR PREGNANT- CHEST THRUSTS WILL BE DONE BY NURSE
 CHOKING MAY BE PREVENTED BY HAVING RESIDENT SITTING UP AT LEAST 30 MINUTES AFTER
MEAL TIME, FEEDING SLOWLY, CUTTING FOOD UP WELL, GIVING FOOD WITH LIQUID, MAKE
SURE FOOD ISN’T BEING CHEEKED
EPITAXIS- NOSEBLEED- PINCH BRIDGE OF NOSE AND HAVE PERSON LEAN HEAD FORWARD (NOT BACK!)
SYNCOPE- FAINTING-LEAN FORWARD, HEAD DOWN TOWARD KNEES
HEMORRHAGE-APPLY DIRECT PRESSURE, HOLD ARMOR LEG ABOVE HEART LEVEL, ARTERIAL BLOOD
WILL BE BRIGHT RED AND DIFFICULT TO STOP
SHOCK: RAISE FEET HIGHER THAN HEAD, KEEP WARM
BEFORE BEGINNING CPR DETERMINE IF PERSON IS AROUSABLE- SHAKE AND SHOUT
OXYGEN GUIDELINES:
1. NO SMOKING SIGN ON DOOR
2. KEEP TUBING KINK FREE
3. REMOVE WOOL ITEMS, SMOKING MATERIALS, SM. ELECTRICAL APPLIANCES, FLAMMABLES
FROMROOM
4. NOTIFY NURSE IF HUMIDIFIER BOTTLE NOT BUBBLING OR RUNNING LOW
5. DO NOT INCREASE OR DECREASE FLOW RATE- IF CONCERNS, TELL RN
6. CLEAN INSIDE OF MASK OR NASAL CANNULA
7. DON’T ALLOW STRAPS TO BECOME TOO TIGHT AROUND FACE
RACE: MUST BE IN THIS ORDER IF THERE IS A FIRE…
R-REMOVE TO AREA OF SAFETY
A-ACTIVATE THE ALARM
C-CONTAIN THE FIRE (CLOSE DOORS AND WINDOWS)
E-EXTINGUISH IF YOU CAN
ABC FIRE EXTINGUISHER CAN HANDLE PAPER. GAS OR ELECTRIC FIRE
PASS FOR EXTINGUISHERS
P-PULL THE PIN
A-AIMAT BASE OF FLAMES
S-SQUEEZE HANDLE

12. 12
S-SWEEP BACK AND FORTH
*STAND ABOUT 6FT AWAY, IF PERSON ON FIRE YELL TO DROP AND ROLL, IF CLOTHES ON FIRE, DO NOT
TRY TO REMOVE CLOTHES, JUST POUR COLD WATER OVER CLOTHES
EVACUATION:
TAKE WALKERS FIRST
GUIDELINES FOR FIRE
IN AN EARTHQUAKE: EVERYONE UNDER THE TABLES
PROTECTIVE DEVICES:
RESTRAINTSMUST BE ORDERED BY A MD ANDONLY USED AFTER ALTERNATIVESHAVEFAILEDAS A LAST
RESORT
COMPLICATIONS: FRACTURES, ANGER, INCONTINENCE, DEPRESSION, STRANGULATION, SKIN
BREAKDOWN, CONSTIPATION, DEHYDRATION
TYPES-MITTENS, CHEST, BELT, SIDERAILS, GERIATRIC CHAIR WITH TRAY
ALTERNATIVES: CHAIR AND BED ALARMS, DISTRACTION, LAP BUDDY, WEDGE CUSHION, BED BOLSTERS,
MEETING NEEDS PROMPTLY, LOW MATTRESS, ANKLE BRACELETS
GUIDELINES FOR RESTRAINT USE:
REMOVE EVERY 2 HOURS TO TOILET, AMBULATE, GIVE ROM, HYDRATE
CHECK FOR FIT EVERY 15-30 MINUTES
ATTACH STRAPS TO FRAME OF BED (NOT SIDERAILS)
TIE IN QUICK RELEASE BOW
SLIP 2-3 FINGERS INSIDE TO MAKE SURE NOT TOO TIE
VEST RESTRAINT CRISS CROSSED IN FRONT
RESTRAINT ALTERNATIVES:
IMPROVE SAFETY MEASURES AND LIGHTING
KEEP CALL LIGHT WITHIN REACH
AMBULATE WHEN RESTLESS
PROVIDE ACTIVITIES FOR THOSE WHO WANDER AT NIGHT
TOILET OFTEN
OFFER FOOD AND DRINK

13. 13
USE RELAXATION TECHNIQUES
LAP TRAY/LAP BUDDY
WEDGE CUSHION
BED BOLSTERS (GO ON EACH SIDE OF HIPS)
BED AND CHAIR ALARMS
LOW BED
CANE USE:
HELD ON STRONG SIDE, CAN BE SINGLE OR QUAD CANE (4 TIPS)
WALKERS:
WALKER IS PICKED UP, NEVER SLID ALONG GROUGH UNLESS IT IS A ROLLING WALKER WITH WHEELS
*MUST BE ABLE TO BEAR OWN UNSUPPORTED WEIGHT TO USE CANE OR WALKER
AMBULATION:
DANGLE FIRST- SITTING ON EDGE OF BED WITH FEET SWINGING; TO PREVENT ORTHOSTATIC
HYPOTENSION (DROP IN BP)
AIDE WALKS ON WEAK SIDE, RESIDENT WALKS NEAR HAND RAIL HOLDING ON WITH STRONG SIDE, YOU
ARE SLIGHTLY BEHIND ON ONE SIDE
BODY MECHANICS
1. BEND AT THE KNEES
2. PUSH, PULL INSTEAD OF LIFTING
3. HOLD LOAD CLOSE
4. USE UPPER ARMS, THIGH AND SHOULDER MUSCLES
5. RAISE BED TO WORKING HT
6. STAND WITH FEET APART (WIDE BASE OF SUPPORT)
7. SYNCHRONIZE MOVEMENTS (COUNT 1-2-3)
8. ASK FOR HELP
9. PIVOT INSTEAD OF TWISTING
10. DON’T REACH OVERHEAD FOR ITEMS
11. SMOOTH MOVEMENTS, NO JERKING
12. FACE YOUR WORK
POSITIONS:
SUPINE- LYING ON THE BACK
PRONE-LYING ON THE STOMACHE
LATERAL-ON THE SIDE

14. 14
SIMS-LYING ON LEFT SIDE
TRENDELENBERG-FEET HIGHER THAN HEAD
FOWLERS- SPINE STRAIGHT, SITTING UP IIN 45-90 DEGREE ANGLE
SEMI-FOWLER’S- SITTING UP 30-45 DEGREES
BODY ALIGNMENT: KEEPING THE BODY STRAIGHT, HEAD OVER SHOULDERS, ADJUSTED
LOGROLLING- MOVING THE BODY AS ONE UNIT TO PREVENT INUURY TO NECK AND SPINE- HAND ON
HIP AND SHOULDER
DANGLING- ALLOWING RESIDENT TO SIT ON EDGE OF BED WITH FEET NOT TOUCHING FLOOR FOR FEW
MINUTES WHEN CHANGING POSITIONS TO PREVENT DROP IN BP (ORTHOSTATIC HYPOTENSION) AND
DIZZINESS
ROLE OF NA IN AN ADMISSION:
Id RESIDENT, ORIENT TO SURROUNDING AND ESTABLISH TRUST
BATHE IF NEEDED
OBTAIN WT AND HEIGHT
LABEL CLOTHING AND PLAC ITEMS ON INVENTORY LIST
SECURE VALUABLES IN AN ENVELOPE
ASK NURSE IF URINE SPECIMEN NEEDED
TAKE VITAL SIGNS
WHEELCHAIR USE:
FEET AND ARMS ON RESTS
HIPS BACK IN CHAIR
MOVE INTO ELEVATOR, DOWN RAMP OR THRU DOORWAY BACKWARDS
MECHANICAL LIFTS:
FOR HEAVY RESIDENT, UNABLE TO BEAR WT, PATIENT WITH IVS, TUBES OR LOT OF EQUIPMENT
ONLY USED IF 2 AIDES ARE PRESENT

15. 15
GAIT BELTS:
ALSO CALLED A TRANSFER BELT; PLACED OVER CLOTHES AROUND WAIST, MUST BE SNUG, HELD WITH
HANDS FACING UP
HEMIPLEGIA: PARALYZED ON HALF OR ONE SIDE OF BODY
PARAPLEGIA: PARALYZED FROMWAIST DOWN
QUADRIPLEGIA: PARALYZED FROMNECK DOWN
OTHER EQUIPMENT:
BED CRADLE- METAL BAR ACROSS FOOT OF BED TO KEEP LINEN OFF LOWER LEGS AND FEET; MAY BE
USED TO PREVENT PRESSURE ULCERS
ABDUCTION CUSHION- USED AFTER HIP SURGERY TO KEEP LEGS APART
FOOTBOARD:PLACEDAT FOOT OF BED TO STOP FEET FROM FALLINGFORWARD (FOOTDROP). FEET ARE
FLUSH AGAINST BOARD AND KEPT IN NORMAL POSITION
BEDPAN-STANDARD, WIDE PART TOWARD HEAD; FRACTURE PAN-HANDLE TOWARD FEED
URINAL- MEN ONLY, HUNG ON SIDERAIL AFTER USE
NO BEDPAN OR URINAL EVER PLACED ON OVERBED TABLE!
EMESIS BASIN- KIDNEY SHAPED PAN USED FOR MOUTHCARE, VOMITING, AND NAILCARE
COMMODE-PORTABLE BEDSIDE TOILET
THE RESIDENT ENVIRONMENT:
SHOULD BE CLEAN, ODOR FREE, TEMPERATURE CONTROLLED, VENTILATED, HOME-LIKE WITH GOOD
LIGHTING
ALWAYS REPORT BROKEN EQUIPMENT- DON’T USE UNTIL NURSE GIVES OK
DON’T TOUCH CARDS, PICTURES, PERSONAL ITEMS WITHOUT PERMISSION
STANDARD EQUIPMENT IS BED, PRIVACY CURTAIN, BEDSIDE STAND, OVERBED TABLE, WARDROBE AND
A CHAIR
MANUAL BED OPERATED WITH GATCHES/CRANKS OR HANDLES- CENTER RAISES ENTIRE BED, LEFT
RAISES HEAD AND RIGHT RAISES FEET
GUIDELINES FOR BEDMAKING
1. NEVER ALLOW CLEAN OR DIRTY LINEN TO TOUCH YOUR UNIFORM
2. COLLECT IN ORDER OF USE
3. PLACE ON CLEAN DRY SURFACE- CHAIR OR OVERBED TABLE
4. NO FANNING SHEETS ACROSS BED

16. 16
5. MAKE ONE SIDE AT A TIME
6. MAKE AS WRINKLE FREE AS POSSIBLE
7. NO LINEN ON THE FLOOR
8. DON’T TAKE IN EXTRAS- IF UNUSED, PLACE IN SOILED LINEN HAMPER
9. WEAR GLOVES TO STRIP IF SOILED
10. RAISE SIDE RAIL WHEN MAKING AN OCCUPIDED BED
11. LEAVE BED IN LOW POSIITON WHEN DONE
DRAWSHEET: ½ SHEET PLACED IN CENTER OF BED FOR TURNING AND REPOSITIONING AND KEEPING
OTHER LINEN ANCHORED
INCONTINENT PADS OR CHUX- TO KEEP BED DRY
CLOSED BED- NOT IN USE, TOP BEDDING OVER PILLOW
OPEN BED- READY FOR USE, TOP BEDDING FANFOLDED TO FOOT OF BED
OCCUPIED BED- MADE WITH RESIDENT LYING IN IT
MOUTHCARE:
ROUTINE ORAL HYGEINE- PERSON IN FOWLER’S POSITION; PERFORMED AFTER BREAKFAST AND
BEDTIME
SPECIAL MOUTHCARE- FOR UNCONSCIOUS PERSON- PERSON IN LATERAL POSITION, USE SWABS TO
CLEAN INSIDE OF MOUTH, VASELINE ON LIPS; PERFORMED Q2H
DENTURE CARE: COOL WATER, LINED SINK TO PREVENT DAMAGE AND WARPING; STORED IN COOL
WATER IN DENTURE CUP WITH LID
BATHS:
PARTIAL: EYES, FACE, AXILLAE, PERINEAL AREA, BACK
COMPLETE: ENTIRE BODY WASHED
NO SOAP ON FACE
EYES INNER TO OUTER CANTHUS
WATER TEMP- 110 (105 TO 115)- COOLER FOR PERINEAL AND FOOT CARE!
SOAP RINSED WELL
PAT SKIN DRY
CLEAN TO DIRTY
LOTION OK BUT NOT ON PALMS OF HANDS OR BETWEEN TOES
COVER BODY, DECREASE DRAFTS IN ROOM
CHANGE WATER IF TOO SUDSY, DIRTY OR COLD

17. 17
PERINEAL CARE:
FEMALE-FRONT TO BACK
MALE-PUSH BACK FORESKIN IF NEEDED, CIRCULAR MOTION FROMMEATUS TOWARD SCROTUM
NAIL/FOOT CARE:
SOAK FOR 10 MINUTES-WASH AND DRY FOOT; INSPECT
FOR FINGERNAILS- SOAK, CLEAN WITH ORANGEWOOD STICK, FILE STRAIGHT ACROSS IF NEEDED
ONLY PODIATRIST WILL CLIP TOENAILS
BACKRUBS:
WITH WARMED LOTION
FROMBUTTOCKS ACROSS SHOULDERS
NOT OVER RED AREAS
CHECK WITH NURSE, SOME PEOPLE CANNOT HAVE A BACK RUB
DRESSING:
UNDRESS UNAFFECTED SIDE THEN PLACE NEW CLOTHES ON AFFECTED SIDE FIRST
OFFER CHOICES
MUST BE WELL FITTING, CLEAN, FUNCTIONAL AND SEASONALLY APPROPRIATE
SHAVING:
WET FACE FIRST
TOWEL ACROSS SHOULDERS
SHORT, FIRMSTROKES RINSING BLADE OFTEN
SHAVE IN DIRECTION HAIR GROWS
HOLD SKIN TAUT (TIGHT)
IF NICK- APPLY PRESSURE, TELL RN
IF ON ANTICOAGULANT, USE A SANTIZED ELECTRIC RAZOR INSTEAD
DO NOT TRIM SIDEBURNS, MUSTACHES OR BEARDS
HAIR CARE:
COMB IN SECTIONS
LONG HAIR PULLED UP, PINNED BACK
IF TANGLED, START AT ENDS AND WORK TOWARDS SCALP

18. 18
DO NOT CUT HAIR
USE HAIR CARE PRODUCTS IF AVAILABLE
PRESSURE SORES:
CAUSES: IMMOBILITY, INCONTINENCE, POOR NUTRITION AND DEHYDRATION, FRICTION, SHEARING
PREVENTION: TURN AND REPOSITION Q2H, KEEP SKIN CLEAN AND DRY, USE A DRAWSHEET, POWDER
OR A PRESSURE RELIEVING DEVICE TO PREVENT FRICTION, DON’T LEAVE IN HIGH FOWLERS TOO LONG
TO PREVENT SHEARING, PROVIDE MEALS AND FLUID, MAKE A WRINKLE, CRUMB FREE BED, GIVE ROM
PRESSURE RELIEVING DEVICES: PILLOWS, HEEL AND ELBOW PROTECTORS, SPECIAL MATTRESSES
STAGE ONE- DISCOLORATION (REDNESS)
STAGE TWO- BLISTER
STAGE THREE-OPEN SORE
STAGE FOUR- BONE AND MUSCLE ARE VISIBLE
FRICTION- RUBBING TOGETHER OF 2 SURFACES, LIKE TWO THIGHS
SHEARING-SKIN STICKS TO SURFACE AS BONE SLIDES IN OTHER DIRECTION
CARE OF THE CASTED RESIDENT:
HANDLE CAST WITH OPEN PALMS UNTIL COMPLETELY DRY
KEEP DRY
ELEVATE ON PILLOWS
NOTHING INSERTED INTO CAST
REPORT PAIN, ODOR, BLUE OR COLD FINGERS, HOT OR RED FINGERS, NUMBNESS OR TINGLING,
SWOLLEN FINGERS/TOES, OR COMPLAINTS TO NURSE
USE A BED CRADLE IS LOWER LEG CAST
CARE OF THE RESIDENT AFTER HIP REPLACEMENT:
ASSIST TO USE ELEVATED TOILET SEAT
RESIDENT SHOULD NOT BEND, CROSS LEGS
KEE HIP ABDUCTION PILLOW BETWEEN LEGS
MAY HAVE TROCHANTER ROLLS ON EITHER SIDE OF HIPS
AMBULATING A BLIND PERSON: THEY ARE HOLDING YOUR ARMAND YOU LEAD THEM, YOU ARE IN
FRONT
WALKER: MOVED 6-8 INCHES FORWARD AND SUPPORTS WEAK SIDE

19. 19
CANE IS HELD ON THE STRONGER SIDE
QUAD CANE HAS FOUR POINTS OF SUPPORT
TROCHANTER ROLL IS MADE FROMA BATH BLANKET AND PLACED FROMTHE HIPS TO THE KNEE TO
PREVENTTHE HIPSFROM TURNINGOUTWARD (EXTERNALROTATION) USEDIN POST HIP REPLACEMENT
PATIENTS
CARE OF THE RESIDENT IN TRACTION:
WEIGHTS CANNOT TOUCH FLOOR OR BE ON THE BED, MUST HANG FREELY
ASSIST WITH ADLS, TOILETING AND GOOD SKIN CARE
DO NOT ADJUST WEIGHTS
SKELETAL TRACTION: APPLIED TO BONES WITH PINS AND RODS
SKIN TRACTION: APPLIED TO SKIN ( SPLINTS, BOOTS, WRAPS)
RANGE OF MOTION EXERCISES:
TO PREVENT ATROPHY (DECREASE IN SIZE OF MUSCLE) AND CONTRACTURES (PERMANENT
SHORTENING OF THE MUSCLE)
PASSIVE- AIDE PERFORMS
ACTIVE- RESIDENT PERFORMS
FLEXION- BENDING
EXTENSION-STRAIGHTENING
ABDUCTION- MOVING AWAY
ADDUCTION-MOVING TOWARD
ROTATIO- MOVING AROUND
STOP IS PAIN AND REPORT TO NURSE
SUPPORT ABOVE AND BELOW THE JOINT
SLOW, SMOOTH TO POINT OF RESISTANCE ONLY
*CAN ALSO USE SPLINTS, HAND ROLLS TO PREVENT CONTRACTURES
CARE OF THE RESIDENT WITH AN INDWELLING URINARY CATHETER:
KEEP BAG BELOW LEVEL OF BLADDER
ATTACH BAG TO FRAME OF BED

20. 20
EMPTY AT END OF SHIFT
REPORT DYSURIA OR HEMATURIA
CATHETER CARE BY CLEANING 4 INCHES FROMINSERTION SITE (MEATUS) AWAY FROMBODY WHILE
HOLDING IN PLACE
KEEP TUBING SECURED TO BODY WITH LEG STRAP OR TAPE
KEEP TUBING UNKINKED
CARE OF THE PERSON WITH ANTI-EMBOLISM STOCKINGS:
PLACED ON WHEN RESIDENT IS SUPINE
REMOVED EVERY 8 HOURS
USED TO IMPROVE CIRCULATION AND PREVENT BLOOD CLOTS FROMBREAKING OFF AND TRAVELING
NO TWISTS, WRINKLES IN STOCKINGS
HOT AND COLD APPLICATIONS:
COVER WITH TOWEL OR PILLOWCASE
CHECK EVERY 5 MINUTES
NOT LEFT IN PLACE >15-20 MINUTES
CAN BE DRY OR MOIST APPLICATIONS (HEATING PADS, WARMCOMPRESSES, ICE BAGS, COOLING
BLANKET)
ONLY EXPOSE THE BODY PART BEING TREATED, KEEP DRAPED AND GIVE PRIVACY
HEAT DILATES, BRINGS > BLOOD TO AN AREA
COLD CONSTRICTS, STOPS BLOOD FROMCOMING TO AN AREA
BASIC HUMAN NEEDS:
PHYSICAL-FOOD, WATER, O2, SHELTER
SAFETY AND SECURITY-CALL BELLS, SIDE RAILS, ID BRACELET
LOVE AND BELONGING-GROUPS, FAMILY VISITS, ACTIVITIES
SELF ESTEEM-PROMOTE INDEPENDENCE, COMPLIMENTS, GROOMNICELY
SELF ACTUALIZATION- ASK PERSON ABOUT PAST HISTORY
GUIDELINES FOR DOCUMENTATION:
1. BLUE/BLACK INK
2. NO WHITE OUT OR ERASABLE INK
3. CORRECT MISTAKES WITH ONE LINE AND INITIAL

21. 21
4. DATE, TIME, SIGNED ALL ENTRIES
5. DOCUMENT AFTER THE FACT
6. FACTS ONLY
7. 24 HOUR CLOCK (SEE TEXTBOOK)
8. USE ACCEPTABLE ABBREVIATIONS ONLY
SOME ABBREVIATIONS:
STAT-IMMEDIATEDLY
ASAP
PRN-WHENEVER NECESSARY
NPO-NOTHING BY MOUTH
DNR- DO NOT RESUSCUITATE
BR-BEDREST
W/C-WHEELCHAIR
HS-HOUR OF SLEEP
PC-AFTER MEAL
AC-BEFORE MEALS
Q-EVERY
VS-VITAL SIGNS
HOB-HEAD OF BED
SOB-SHORTNESS OF BREATH
CARE OF THE RESIDENT WITH A FEEDING TUBE:
KEEP HOB ELEVATED DURING FEEDING AND 3O-40 MINUTES AFTER TO PREVENT ASPIRATION
(FOOD/FLUID INTO LUNGS LEADING TO PNEUMONIA)
REPORT NAUSEA, VOMITING, DIARRHEA
KEEP SKIN AROUND TUBE CLEAN AND DRY
KEEP NOSTRIL LUBRICATED IF NGT
KEEP NPO, ESPECIALLY WITH NGT
KEEP TUBE KINK FREE
MOUTHCARE Q2H WITH SWABS
GIVING AN ENEMA:

22. 22
PLACE RESIDENT IN SIMS POSITION
PAD BED
HAVE COMMODE OR BEDPAN NEARBY
BAG FILLED WITH WATER AT LEAST 12 INCHES ABOVE RESIDENT
INSERT LUBRICATED TUBE INTO ANUS
OPEN CLAMP
STOP BRIEFLY IF HAVING CRAMPS AND ENCOURAGE SLOW BREATHING
TELL TO SQUEEZE BUTTOCKS TOGETHER TO HOLD ENEMAL SOLUTION
AFTER COMPLETED, LET NURSE SEE ‘RETURN’ WHAT COMES OUT
CARE OF THE PERSON WITH AN OSTOMY:
COLOSTOMY- STOMA IN LARGE INTESTINE- SOLID STOOL
ILEOSTOMY- STOMA IN SMALL INTESTINES- LIQUID STOOL
GOOD SKIN CARE
TREAT AS ‘NORMAL’ ASSIST WITH ODOR CONTROL BY CHANGING POUCH AS NEEDED
REPORT IF STOMA TURNS BLUE OR BLACK- SHOULD BE PINK, FLESHY AND MOIST
…………..
*PERISTALSIS SLOWS DOWN WITH AGE SO CONSTIPATION MUST BE PREVENTED
A FECAL IMPACTION IS A SERIOUS FORMOF CONSTIPATION WITH OOZING OF LIQUID STOOL, RECTAL
PAIN, ENLARGED STOMACH, AND FLATUS- REMOVED BY RN OR MD BY DIGITAL DISIMPACTIONS (WITH
GLOVED FINGERS)
PREVENT CONSTIPATION BY HYDRATING, ENCOURAGING MOVEMENT/EXERCISE, FIBER IN DIET
PREVENTING DEHYDRATION:
FORCE FLUIDS BY OFFERING A SM. AMOUNT OF A VARIETY OF FLUIDS EVERY 2 HOURS WHILE AWAKE
MANAGING FLUID RETENTION OR EDEMA:
FLUID RESTRICTION- PERSON ONLY ALLOWED A SET AMOUNT OF FLUID/DAY, TAKE AWAY WATER
PITCHER AND CUP
WORD ALERT:
DYSPHAGIA- DIFFICULTY SWALLOWING

23. 23
DSYPHASIA- DIFFICULTY SPEAKING
ESSENTIAL NUTRIENTS:
CARBOHYDRATES- FOR ENERGY- GOOD KIND ARE BROWN SUCH AS WHOLE GRAINS
PROTEIN- FOR HEALING AND GROWTH- FROMANIMAL MEAT, EGGS, MILK, BEANS, NUTS, SEEDS
FAT- FOR STORAGE OF VITAMINS, ENERGY- FROMWHOLE MILK, MEAT, BUTTER
VITAMINS- FAT SOLUBLE STORED IN BODY FAT (A,D,E,K) AND WATER SOLUBLE (NEED TO BE REPLACED
QD BECAUSE THEY ARE LOST IN URINE, SWEAT AND BREATH, B COMPLEX AND C)
MINERALS SUCH IRON, POTASSIUM, SODIUM
WATER
KNOW MYPLATE AND MY PYRAMID FOR FOOD GUIDES…..
THERAPEUTIC DIETS:
CLEAR LIQUIDS- TEA, BLACK COFFEE, APPLE JUICE, GINGERALE, POPSICLES, BROTHS, JELLO
FULL LIQUIDS- MILK, MILKSHAKES, ICE CREAM,HOT CEREALS
LOW SODIUM. FOR HYPERTENSION AND RENAL DISEASE
LOW FAT- FOR HEART AND LIVER DISEASE
PUREED- FOR DYSPHAGIA
SOFT- FOR NO TEETH
REGULAR- NO RESTRICTIONS
DIABETIC DIET- BASED ON CALORIES AND CARBS- TELL RN IF RESDIENT DOESN’T EAT AND HE IS A
DIABETIC
SPECIAL DIET ORDERS:
CALORIE COUNTS AND DAILY WTS IF WT GAIN OR LOSS OF 5 POUNDS OR MORE IN A MONTH
SUPPLEMENTS (ENSURE, BOOST, HEALTHSHAKES) TO INCREASE WEIGHT- MAKE SURE PERSON TAKES
NOURISHMENTS ARE SNACKS THAT ARE OFFERED SHORTLY AFTER EACH MEAL AND AT BEDTIME TO
BOOST INTAKE
NPO: NO ICE CHIPS, NO GUM, NO MINTS, NADA
GUIDELINES FOR FEEDING:
1. SIT TO FEED
2. ALLOW RESIDENT TO CHOOSE WHAT HE WOULD LIKE TO EAT
3. ALTERNATE FOOD WITH LIQUID
4. RESIDENT IN GOOD ALIGNMENT

24. 24
5. FEED SLOWLY
6. ENCOURAGE SWALLOWING
7. TALK TO RESIDENT DURING MEAL
8. CHECK MENU CARD
9. HANDWASHING AND TOILETING BEFORE MEAL
10. LEAVE SITTING UP PC
11. CUT FOOD UP INTO SMALL PIECES
12. FEED WITH SPOON ONLY
13. SEAT RESIDENTS WITH OTHERS TO ENCOURAGE SOCIALIZING
14. USE ADAPTIVE EQUIPMENT (PLATE GUARD, BUILT UP UTENSILS, WIDE MOUTH CUPS_
15. OBSERVE AND REPORT COUGHING, POCKETING FOOD IN MOUTH, GURGLING DURING FEEDING,
VOMITING OR DYSPHAGIA
16. DON’T SERVE STEAMING FOODS OR DRINKS
FLUID INTAKE:
SHOULD BE MINIMUM OF 1500ML/CC/DAY
TO BE AT BEST, TAKE IN 2000-2500ML/DAY
TOO MUCH IN AND NOT ENOUGH OUT=EDEMA
NOT ENOUGH IN OR TOO MUCH OUT=DEHYDRATION
S/SX OF DEHYDRATIONS: DRY GUMS, TONGUE, DRY SKIN, SUNKEN SPACES AROUND EYES, DARK SMALL
AMT OF URINE, THIRST, CONFUSION
MEASURING INTAKE AND OUTPUT (I&O):
I OUNCE = 30ML/CC
1ML=1CC
TO CHANGE OUNCES TO ML/CC, MULTIPLY BY 30
TOM DRANK 4 OUNCES OF TEA OR 4 X 30 = 120CC OF TEA
INTAKE INCLUDES LIQUIDS DRANK, YOGURT, ICE CREAM, SOUP, IV FLUIDS
OUTPUT INCLUDES URINE, EMESIS, DIARRHEA, WOUND DRAINAGE
TO MEASURE OUTPUT TRANSFERFLUID INTOA GRADUATE CONTAINERANDREADON A SOLID SURFACE
AT EYE LEVEL
TOTAL I & O AT END SHIFT
MANAGING INAPPROPRIATE BEHAVIORS:
DON’T TAKE IT PERSONALLY, FIND OUT CASUE, DIRECT TO PRIVATE AREA, RESPOND POSITIVELY TO
APPROPRIATE BEHAVIOR AND REPORT ABUSE TO NURSE

25. 25
IF SEXUAL IN NATURE- BE SENSITIVE, DISTRACT, TAKE TO ROOM
FACTS ABOUT ALZHEIMER’S
MOST COMMON CAUSE OF DEMENTIA IN ELDERLY
WOMEN ARE MORE LIKELY TO HAVE THAN MEN
RISK INCREASES WITH AGE BUT IS not A NORMAL PART OF AGING
IS PROGRESSIVE AND IRREVERSIBLE, NO CURE
TANGLED FIBERS AND PROTEIN DEPOSITS IN THE BRAIN CAUSE DEMENTIA
CAUSE IS UNKNOWN, BUT RUNS IN FAMILIES
CAN LIVE WITH ILLNESS FOR 3 TO 20 YEARS
CARING FOR THE RESIDENT WITH ALZHEIMER’S:
REMEMBER AD IS FATAL, PROGRESSIVE AND AFFECTS DEMENTIA (MEMORY, INSIGHT, JUDGMENT,
SPEECH AND THINKING); NOT A NORMAL PART OF AGING
MANAGING SUNDOWNING (RESTLESSNESS AND CONFUSION IN THE EVENING):
KEEP ACTIVE DURING DAY
NO EXERCISE 2 HOURS HS
WARMDRINK, BACK RUB, NIGHT LIGHT, SOFT MUSIC
HALLUCINATIONS: HEARING VOICES OR SEEING THINGS THAT AREN’T THERE
DELUSIONS: FALSE BELIEFS, LIKE THAT THEY ARE THE PRESIDENT
SU
IGNORE IF HARMLESS, REASSURE, DISTRACTS, DON’T ARGUE OR AGREE WITH BUT LISTEN AND POINT
OUT REALTY
DELIRIUM:
COMES ON SUDDENLY, EXTREME CONFUSION AND DISORIENTATION; A MEDICAL EMERGENCY
DEPRESSION:
2 OR MORE WEEKS OF HOPELESSNESS, SADNESS, ISOLATIONS, CHANGE IN APPETITE AND SLEEP,
THOUGHTS OF DEATH, NOT PERFORMING ADLS- TELL NURSE
NUTRITION AND AD:
BE CONSISTENT WITH MEAL TIME, KEEP NOISE DOWN, USE PLAIN PLATES WITHOUT PATTERNS, SIMPLE
INSTRUCTIONS, PLACE SPOON TO LIPS, LET USE HANDS, USE ADAPTIVE EQUIPMEMNT, SEAT WITH
OTHER TO SOCIALIZE, CHECK INSIDE MOUTH FOR SWALLOWING

26. 26
ORIENTATION:
LARGE CALENDER
LARGE CLOCK
GREET BY NAME, ID SELF
GREET BY “GOOD MORNING, GOOD EVENING” ETC
CARE FOR THE CONFUSED:
DON’T LEAVE ALONE
QUIET ENVIRONMENT
SPEAK IN NORMAL TONE, CLEAR AND SLOW
REMIND: LOCATION, NAME AND DATE
USE SIMPLE INSTRUCTIONS
DON’T RUSH
ENCOURAGE USE OF GLASSES AND HEARING AIDS
PROMOTE SELFCARE AND INDEPENDENCE
DEATH AND DYING:
SIGNS OF APPROACHING DEATH- BLURRED VISION, IMPAIRED SPEECH, DECREASED SENSE OF TOUGH,
LOSS OF MOVEMENT, RISING BODY TEMP, DECREASE BP AND WEAK PULSE, CHEYNE-STOKES
RESPIRATIONS (IRREG BREATHING WITH PERIODS OF APNEA), GURGLING, COLD, PALE SKIN,
PERSPIRATION, INCONTINENCE, CONFUSION
SIGNS OF DEATH:
NO PULSE, NO BREATH, PUPILS FIXED AND DILATED
STAGES OF DYING:
DENIAL “NO, NOT ME”
ANGER “WHY ME”
BARGAINING “YES ME, BUT…..”
DEPRESSION- NEED TO MOURN AND REVIEW LIFE
ACCEPTANCE: PREPARING FOR DEATH
CARE FOR THE DYING:

27. 27
COMFORT MEASURES: TURN AND REPOSITION, SPONGE BATH, TOILETING, SIPS OF WATER, SPIRITUAL
VISITS FROMCLERGY, FAMILY AT BEDSIDE, CLEAN, SOFTLY LIT, ODOR FREE ROOM, VISIT OFTEN, BACK
RUBS, AND MASSAGES
POST MORTEM CARE:
LEAVE DENTURES IN
CLOSE EYES
CHIN STRAP
PERI CARE
REMOVE JEWELRY EXCEPT WEDDING RINGS
NURSE WILL REMOVE TUBES, IVS, ETC
STRAIGHTEN ARMS AND LEGS
WRAP IN SHROUD BEFORE RIGOR MORTIS (STIFFENING BEGINS) IN 2-4 HOURS
TAGS ON TOE AND OUTSIDE BAG
CARE OF THE PERSON AFTER A KNEE REPLACEMENT:
ASSIST WITH STOCKINGS
ENCOURAGE FLUIDS, ESPECIALLY HIGH IN VITAMIN C
ASSIST WITH DEEP BREATHING EXERCISES
REPORT PAIN
ASSIST WITH CPM(CONTINUOUS PASSIVE MOTION) AS ORDERED
REPORT REDNESS, SWELLING, HEAT, DEEP TENDERNESS IN ONE OR BOTH CALVES
CARE AFTER A CVA:
USE TERMS SUCH AS WEAK OR AFFECTED SIDE, NOT ‘BAD’ SIDE
ALWAYS USE GAIT BELT, STAND ON AND SUPPORT WEAK SIDE
DRESS WEAK SIDE FIRST
PLACE FOOD IN HIS FIELD OF VISION
SERVE SOFT FOOD IF DYSPHAGIA
PLACE FOOD IN UNAFFECTED SIDE OF MOUTH
CARE OF THE PERSON WITH PARKINSON’S:
THESE PEOPLE SHAKE OR HAVE TREMORS, WALK WITH A SHUFFLING GAIT, AND HAVE DYSPHASIA

28. 28
PROTECT FROMFALLS
ASSIST WITH ADLS
ASSIST WITH ROMAS ORDERED
BE PATIENT
ASPIRATION- IS INHALATION OF FOOD OR LIQUID INTO THE LUNGS. CAN CAUSE PNEUMONIA AND
DEATH…..
RANGES FOR VITAL SIGNS
TEMP RANGE
AXILLARY 96.6-98.6 LEAST ACCURATE
ORAL 97.6-99.6 WAIT 10-20 MIN IFJUST SMOKED,OR HAD
HOT/COLDLIQUD OR EXERCISED
RECTAL 98.6-100.6 MOST ACCURATE,MUST BE HELD IN PLACE
PULSE 60-100 (DON’TUSE YOUR THUMB, RADIALPULSE IN WRIST ISUSED)
RR 12-20 (DON’TTELL PERSON YOU ARE MEASURING)
BP SYSTOLIC90-138 AND DIASTOLICFROM60-88
HYPERTENSION ISA SYSTOLIC >140 OR A DIASTOLIC>90
SIGNSOF HYPOGLYCEMIA (LOW BLOODSUGAR: HEADACHE,SWEATY SKIN,HUNGER, IRRITABLE,
RESTLESS- “COLD ANDCLAMMY- NEEDS SOME CANDY”
SIGNSOF HYPERGLYCEMIA (HIGH BLOOD SUGAR)-DROWSY,WARM,FLUSHED SKIN,SWEET ODOR TO
BREATH, INCREASEURINATION (POLYURIA), INCREASEDHUNGER(POLYPHAGIA) ANDINCREASEDTHIRST
(POLYPHAGI)-“HOTANDDRY-SUGAR’SHIGH”
NOT PERMITTED:
NURSE AIDES SHOULD NEVER GIVE MEDICATIONS, TAKE ORDERS FROMA DOCTOR, BE IN CHARGE,
DISCUSS DIAGNOSIS/TREATMENT WITH FAMILY OR RESIDENT, INSERT OR REMOVE TUBES, PARTICIPATE
IN STERILE PROCEDURES
PROMOTING SEXUALITY:

29. 29
LIPSTICK, NAIL POLISH, DRESSES, PANTYHOSE, SALON VISIT, JEWELRY, PERFUME FOR FEMALE
MEN LIKE A PART IN HAIR, A TSHIRT UNDER HIS SHIRT, A BELT IN SLACKS, AFTERSHAVE, COLOGN
GIVE PRIVACY DURING INTIMATE VISITS, PUT DO NOT DISTURB SIGN ON DOOR
DON’T TEASE OR DISCUSS ABOUT SEX
Managing difficult behaviors
Inappropriate social behavior- don’t take it personally, stay calm, reassure, find out cause, direct to
private area,respondpositivelyto‘good’behaviorsandreportabuse (residenttoresidentorresidentto
staff) to nurse
Inappropriate sexualbehavior-be matter-of- fact, be sensitive, direct to private area, distract, consider
other ways to provide physical stimulation
Sleepdisturbances-make sure residentgetsmoderate exercise oractivityduringthe day, allow resident
to spendtime innatural sunlightif possible, reduce light and noise during nighttime hours, discourage
daytime sleeping
Pillagingandhoarding-label belongings,place alabel orsymbol on door, don’t tell others that person is
stealing, prepare family, ask family to report unfamiliar items, and provide a rummage drawer
MASLOW’S HIERARCH OF NEEDS: PHYSICAL, SAFETY AND SECURITY, LOVE AND BELONGING, SELF
ESTEEM AND SELF ACTUALIZATION
TERMS:
DYSPHAGIA- DIFFICULTY SWALLOWING
DYSPHASIA- DIFFICULTY SPEAKING
DYSURIA: DIFFICULTY URINATING
ADDUCTION: MOVING A BODY PART TOWARD THE MIDLINE
ABDUCTION: MOVING A BODY PART AWAY FROMTHE MIDLINE
PRONE-LYING ON STOMACH
SUPINE-LYING ON BACK
LATERAL-LYING ON SIDE
SIMS-LYING ON LEFT SIDE WITH TOP LEG SHARPLY FLEXED (FOR ENEMAS AND RECTAL TEMPS)
FOWLER’S- SITTING
TRANSFER BOARD- PLACED AS A BRIDGE BETWEEN WHEELCHAIR AND BED SO PERSON CAN SLIDE
ACROSS FROMONE TO THE OTHER
CONTRACTURE- PERMANENT SHORTENENING OF THE MUSCLE

30. 30
ATROPHY-DECREASE IN THE SIZE OF THE MUSCLE
HYPERTHERMIA- BODY TEMP ABOVE 105
HYPOTHERMIA-BODY TEMP BELOW 95
PERISTALSIS: ALTERNATING CONTRACTIONS AND RELAXATION OF INTERNAL MUSCLES IN
GASTROINTESTINALSYSTEMTHAT MOVES FOODDOWN THE ESOPHAGUSANDTHRU THE INTESTINES- IF
DECREASED CAUSES CONSTIPATION; IF INCREASED CAUSES DIARRHEA
ENTERAL FEEDING MEANS NUTRITION PROVIDED THROUGH THE GASTROINTESTINAL TRACT
PARENTERAL FEEDING MEANS NUTRITION PROVIDED INTRAVENOUSLY
24 HOUR CLOCK
midnight (12:00 AM) – 2400 OR 0000 hrs
1:00 AM -- 0100 hrs
2:00 AM -- 0200 hrs
3:00 AM -- 0300 hrs
4:00 AM -- 0400 hrs
5:00 AM -- 0500 hrs
6:00 AM -- 0600 hrs
7:00 AM -- 0700 hrs
8:00 AM -- 0800 hrs
9:00 AM -- 0900 hrs
10:00 AM -- 1000 hrs
11:00 AM -- 1100 hrs
12:00 PM -- 1200 hrs
1:00 PM -- 1300 hrs
2:00 PM -- 1400 hrs
3:00 PM -- 1500 hrs
4:00 PM -- 1600 hrs
5:00 PM -- 1700 hrs
6:00 PM -- 1800 hrs
7:00 PM -- 1900 hrs
8:00 PM -- 2000 hrs
9:00 PM -- 2100 hrs
10:00 PM -- 2200 hrs
11:00 PM -- 2300 hrs
NEVER TRY TO BREAK A FALL, SIMPLY SLIDE THE PERSON TO FLOOR USING YOUR BODY FOR
SUPPORT AND CALL FOR HELP
PERSON MUST BE SITTING BACK IN A W/C WITH HIPS AGAINST CHAIR, ARMS IN ARMREST, FEET ON
FOOTREST
ALWAYS ASSUME THE UNCONCIOUS PERSON CAN HEAR YOU- EXPLAIN ALL PROCEDURES