How do you promote communication with a resident?
asking OPEN ENDED questions- “How are you feeling?” (ch.6)
A resident wants to use the commode, but she needs help… what do you do?
Use a gait belt
What is the temperature of a TEPID bath?
80-93 `F
What is the temperature of a SITZ bath?
Sitz- seat. The perineal and rectal areas are immersed in WARM or HOT water (93-98-106)
What is the oral temperature?
97.6-99.6
A male resident wants to use a urinal, what do you tell him to do when he is done?
use call light/call for help promptly or while waiting for help- place in side rails
A doctor comes in and give an order for a new treatment before leaving, what do you do?
Let the doctor speak to the nurse.
How should you be positioned when applying TED hose?
Wide base of support
Legs between 12-24 inches apart.
Check ever 2 hours.
Remove every 8 hours for 30 min
As a CNA, what can you do to help a resident who is being discharged?
Help in packing resident’s things away.
You are in a resident’s room and you see a bottle of disinfectant that housekeeping left behind, what do you do?
Remove it from the resident’s room immediately.
Calculate the resident’s total INTAKE for the 3-11 shift
there will be an illustration for this question
1 oz = 30 mL
How do you take a random urine specimen?
Used for routine urinalysis
No special measures are needed.
Collected any time during a 24-hour period.
Pour about 120 mL into the specimen container, place the container in a plastic bag, apply Biohazard Label.
The Midstream Specimen
*Clean-voided specimen
1). Perineal is cleaned
2). Start voiding
3). Stop voiding half way
4). Starts voiding in a sterile specimen container
How do you take a 24-hour urine specimen?
Start with an empty bladder
1). Person voids to begin the test with an empty bladder—discard it
2). Save all the voiding for the next 24-hours.
Tes is restarted if:
-a voiding was not saved
-toilet tissue was discarded into the specimen
-the specimen contains stools
You answer the phone but the person meant to call a different unit, what do you do?
Transfer the call.
(pg.56)
A resident wth dementia is getting agitated and thinks he lost his keys, what do you do?
Tell him you will help him find his keys
What do you do to a room when a resident checks out?
Disinfect the room.
A resident is in isolation.
What do you do with their food tray when they done eating?
Double bag outside the room and send it to the kitchen.
What do you do with a residents BM when you empty their colostomy bag?
Flush in the toilet
How many times do you ambulate a resident when the care plan states ambulate with BID?
BID- twice a day
TID- Three times a day
QID- Four times a day
You walk into a room and there is a trash can on fire. What is the first thing you should do?
Remove/protect the residents.
R-remove resident
A-alarm
C-confine, close doors
E-evacuate
How should a gait belt be applied?
Over clothes with buckle off center
How should an cold compress be applied?
With cloth bag = Ice pack
What do you do with person in shock?
Make the person lie down and elevate the legs
When transferring someone with a gait belt, how should your hands be positioned?
Underhand grasp
During rehab, where do you focus:
A). on patient’s abilities
B). on patient’s disabilities
On patient’s abilities- what they can do
Where do you walk if the person has right-sided weakness?
Towards his weak side
How do you apply TED hose?
While residents is lying in bed- supine position
How to read a Fahrenheit and Centigrade thermometer?
F= 0.2 of a degree (short line)
C= 0.1 of a degree (long line)
Blue-oral and axillary thermometers- long/slender tips/pear shaped tip
Red-rectal termometers- stubby tips
Where do you throw away an ostomy?
Facility approved bag
Resident was alert and is now hard to arouse and unresponsive. What do you do?
Tell the nurse
How does a Diabetic diet work?
Give same amount of carbs, protein, fats everyday at the same time.
What is a step you can take as a CNA to prevent resident poisoning?
-Make sure patients and residents cannot reach hazardous material
-Follow agency policy for storing personal care items
-Keep harmful products in their original containers
-Leave the original label on harmful products
-Read all labels carefully before using a product.
Residents with dementia is on the commode, how long should you leave them alone?
Never
Can a urine contaminate a stool sample?
Yes
What is PPE worn for?
Contact precautions
What does rehabilitation and restorative nursing care focus on?
The whole person and what the person can do.
What is a bland diet?
To reduce gastric irrigation
Arm pain is an example of….
Subjective data- the person tells you about that you cannot observe through your senses (symptoms)
[objective- information that is seen, heard, felt, or smelled by an observer (signs)]
A patient with hip injury would use what type of bed pan?
Fracture bed pan
How would you place the call light for a quadriplegic patient?
If not able to reach, check on the person often.
After providing the urinal for a patient….
ask them to close tightly to prevent spills and call for help.
Know PROM
Passive Range of Motion
ex. Flexion
A CNA is aware that for stool collection…
Must be 1/2 cup
must not be contaminated
A resident continues to call you Sally, his daughters name, what do you tell him?
Ask him to tell you about his daughter Sally.
How do you help a resident participate with activities on time?
Make sure they have an activities schedule
be flexible as the CNA, and work the patients routine care around the activities schedule.
When do you give PM care?
After lunch
Before bed
After visitors leave in the evening
A patient that is playing bingo receives a phone call. What do you do?
Bring the phone call to them in the activities area
bring them back to their room and close the door to give privacy
You answer a phone call for a resident while she is in the dining room and it is her daughter, she asks you about her mothers condition and treatment.
What do you do?
Refer daughters questions to nurse
A patient asks you for her blood pressure readings after you check it, What do you do?
Provide her the reading
Before helping a patient stand, you raise the head of the bed and let the patients legs dangle, what does this do?
This prevents orthostatic hypotension- low blood pressure when person stands up
What do you do if a patients temperature is 101.2?
Tell the nurse
What will the nurse most likely ask you to do if a patient is in shock?
Keep the person lying down.
If not injured, raise the feet 6 to 12 inches.—elevate the feet so blood will flow back to the head.
Lower the feet if the position causes pain.
Maintain an open airway and control bleeding.
Begin CPR if cardiac arrest occurs.
What do you do to collect a female urine?
Clean the perineal area with towel.
-Spread the labia with your thumb and index finger.
-Clean down the urethral area from front to back. Use clean towel for each stroke
-Keep the labia separated to collect the urine.
Where do you put catheters?
On the bed frame, below the bladder.
Before shaving a resident, what do you check first?
If they are on blood thinners.
What other information is on their ID bracelet
Their doctors name.
If you have independent patients and you made his/her bed, how should you leave the bed?
In sitting height
When assisting in urinal disposal you should?
Use a standard/universal precautions
When patient is being combative, what should you do?
Leave the room and come back when the patient is not upset.
What items need to be marked as isolation?
When bringing it out
When resident requested for 1 side rail up only, what should you do?
Keep either 1 side rail up
How do you promote communication?
Asking open ended questions
At what point the bacteria disappears in hand washing?
During friction from rubbing
When patient is in cold compress, the CNA will report promptly if?
The skin is cyanotic- bluish discoloration
When talking to a patient with hearing disability, what should you do?
Reduce outside noise
Patients respiration is 33 per minutes
Tachypnea- fast breathing
What should you do with a stool specimen for isolation?
Double bag
How do you avoid poisoning?
Label all toxins and poisonous materials
Back massage
3-5min
Temperature:
Partial & complete bed bath
110-115 `F
Duration:
Shower/tub bath
No more than 20 min
Temperature:
Shower/tub bath
105 `F
Temperature:
Perineal care
105-109 `F
Duration:
Finger soak
5-10min
Duration:
Feet soak
15-20min
Urine production
1500 mL or 3 pints per day
Suppository takes effect (any drugs takes effect in)
30 mins later
Enema volume
750-1000 mL : given over 10-15 min
Enema takes effects in
10-20 min
Enema tubing insertion
2 to 4 inches
Ostomy pouch
Changed every 3 to 7 days when it leaks
1gm fat
1gm protein
1gm carbohydrate
fat = 9 calories
protein = 4 calories
carb = 4 calories
NGT feeding: Maintain semi fowlers/ fowlers
For 1 to 2 hours after the feeding or at all times
NGT feeding: clean nose and nostrils
For every 4 to 8 hours
Oral glass thermometer leave for
2-3 min
Rectal glass thermometer leave for
2 min
Radial pulse count for
30 seconds X 2
Apical pulse count for
1 minute, located under your left nipple
Let the person rest for how long before re measuring their BP
10 to 20 min
Amount of time pain relief drug take effect
30 mins
Hot & cold application observe every
5 min
Hot & cold compress apply no more than
15 to 20 min
Patients or restraints are observed every
15 min
Restraints are released every
2 hours : for 10 min
Patients sitting on chair or wheelchairs should shift positions every
15 min
Reposition bedfast persons at least
2 hours
Reposition chair fast persons every
1 hours
Transfer from wheelchair to car, position wheelchair at
45 degree angle
Deep breathing and coughing every
1-2 hours while awake
Hot
98-106
Warm
93-98
Tepid
80-93
Cool
65-80
Cold
50-65
Rectal Temp
98.6-100.6 (99.6)
Tympanic membrane (ear) temp
98.6
Oral temp
97.6-99.6 (98.6)
Axillary (armpit) temp
96.6-98.6 (97.6)
Pulse
60-100 beats per min
Respiration
12-20 min
Blood Pressure
Normal:
Systolic: 90mm Hg or higher but lower than 120mm Hg
Diastolic: 60mm Hg or higher but lower than 80mm Hg
Fowler’s position
The head of the bed is raised between 45 and 60 degrees
Semi-Fowler’s position
The head of the bed is raised 30 degrees.
High-Fowler’s position
The head of the bed is raised 60 to 90 degrees
Supine position
The back-lying or dorsal recumbent position
Prone postion
Lying on the abdomen with the head turned to 1 side.
Lateral position
The person lies on 1 side or the other; Side-lying position
Sims’ position
A left side-lying position in which the upper leg (right leg) is sharply flexed so it is not on the lower leg (left leg); semi-prone side position
Abduction
Movement away from the midline of the body
Adduction
Movement toward the midline of the body
Opposition
Touching an opposite finger with the thumb
Flexion
Bending a body part
Extension
Straightening a body part
Hyperextension
Excessive straightening of a body part
Dorsiflexion
Bending the toes and foot up at the ankle
Plantar flexion
Bending the toes and foot down at the ankle
Rotation
Turning the joint
Internal rotation
Turning the joint inward
External rotation
Turning the joint outward
Pronation
Turning the joint downward
Supination
Turning the join upward
a
absence
Brady
Slow
Dys
Bad, difficult
Hypo
Under, decreased
Post
After
Stomat(o)
Mouth
Vas(o)
Blood vessel
Cyst
bladder or sac
Gluc(o)
Sweetness
Glyc(o)
Sugar
Hem, Hema, Hemo
Blood
Pyleo
Kidney
Thromb (o)
clot
Emia
Blood condition
-itis
inflammation
ology
study of
-Phagia
Swallowing
pnea
breathing
story, ostomy
Creation of an opening
Trophy
Growth
Uria
Urine
Normal fluid requirements
1500 mL of water daily.
About 2000 to 2500 mL are needed for normal fluid balance
NPO
Nothing by mouth for 6 to 10 hours before surgery.
How much urine is produced
about 1500 mL or 3 pints of urine a day.
some people void every 2 to 3 hours.
Saline enema
a solution of salt and water
cleansing enema
takes effect in 10 to 20 min
cleans the bowel of feces and flatus.
small volume enema
irritates and distend the rectum
causes BM
takes about 5 to 10 min
stay in sims position
oil retention enema
retained for 30 to 60 min (or 1 to 3 hour)
softens feces and lubricates the rectum
leave person in sims or left side-lying.
Defense Mechanisms
1) Compensation- the person makes up for or substitutes a strength for a weakness.
2) Conversion- an emotion is shown as a physical symptom or changed into a physical symptom
3) Denial- the person refuses to face or accept unpleasant or threatening things.
4) Displacement- an individual moves behaviors or emotions from one person, place, or thing to a safe person, place or thing.
5) Identification- a person assumes the ideas, behaviors, and traits of another person.
6) Projection- an individual blames another person or object for unacceptable behaviors, emotions, ideas, or wishes.
7) Rationalization- An acceptable reason or excuse is given for behaviors or actions. the real reason is not given.
8) Reaction formation – A person acts in a way opposite to what he or she truly feels.
9) Regression- The person retreats or moves back to an early time or condition.
10) Repression- The person keeps unpleasant or painful thoughts or experiences from the conscious mind