STUDY GUIDE, ONE

USE THIS TO REVIEW FOR STATE EXAM!!!!!!!
I. COMMUNICATION
1.TO IMPROVE COMMUNICATION
 FACE TO FACE
 SPEAK IN A LOGICAL MANNER
 USE FAMILIAR WORDS
 GIVE FEEDBACK BY SAYING ””OH”, “AND THEN
WHAT HAPPENED”, “PLEASE GO ON”
 USE CLARIFICATION “ARE YOU SAYING…..”
 USE PARAPHRASING- REPEAT THE SENDERS
MESSAGE BACK IN YOUR OWN WORDS
 USE TOUCH (BUT NOT IF PERSON IS ANGRY)
 LISTEN
 EMPATHY “I CAN IMAGINE YOU ARE SCARED”

1.BARRIERS TO COMMUNICATION
 FOREIGN LANGUAGE- USE BODY LANGUAGE,
COMMUNICATION BOARDS AND INTERPRETER
 NOISE- TURN TV/RADIO DOWN
 CLICHES- “DON’T WORRY”, “IT’LL BE OK”
“DON’T BE SAD”
 PROFANITY
 NOT LISTENING
 INTERUPPTING
 SLANG
2.SIGNS ARE OBJECTIVE FINDINGS- CAN BE SEEN
(A RASH) , HEARD (A COUGH), FELT ( A LUMP)
OR SMELLED (STRONG ODOR OF URINE
3.SYMPTOMS ARE SUBJECTIVE FINDINGS- MUST
BE DESCRIBED BY THE CLIENT SUCH AS PAIN
AND DIZZINESS
4.KNOW THESE TERMS:
 DEFECATION- TO HAVE A BM
 VOIDING- TO URINATE
 EMESIS- VOMIT

 JAUNDICE- YELLOW SKIN, USUALLY FROM
LIVER DISEASE SUCH AS HEPATITIS
 CYANOSIS- BLUE SKIN FROM LACK OF OXYGEN-
TELL THE NURSE
 INCONTINENCE- LOSS OF BOWEL OR BLADDER
CONTROL
 HEMIPLEGIA- WEAKNESS ON ONE SIDE OF
BODY
 PARAPLEGIA- WEAKNESS FROM WAIST DOWN
 QUADRIPLEGIA- WEAKNESS FROM NECK
DOWN
 PERISTALSIS- CONTRACTIONS THAT MOVE
FECES ALONG THE GI TRACT
 ATROPHY- MUSCLES BECOME SMALLER FROM
NONUSE, REVERSIBLE
 CONTRACTURES- MUSCLES BECOME SHORTER,
PERMANENT
 PROSTHESIS- ARTIFICIAL ARM, LEG, EYE
 MELENA- BLACK, TARRY STOOL

5.KNOW THESE PREFIXES
 TACHY-FAST
 BRADY-SLOW
 HYPER-HIGH
 HYPO-LOW
 A- ABSENCE OF
 DYS- DIFFICULTY
 POLY- EXCESSIVE
6.KNOW THESE
 CARDIA- REFERS TO THE HEART
 PNEA- REFERS TO BREATHING
 PHAGIA- REFERS TO SWALLOWING
 PHASIA- REFERS TO SPEAKING
 URIA- REFERS TO URINE

7.THE CARE PLAN IS CREATED BY THE RN USING
THE NURSING PROCESS (ADPIE). IT TELLS YOU
HOW TO CARE FOR THE RESIDENT
A-ASSESSMENT
D- DIAGNOSIS
P- PLAN (OR GOAL)
I-IMPLEMENTATION (WHAT CNA DOES TO
FIX/PREVENT THE DIAGNOSIS
E-EVALUATION
8.THE KARDEX TELLS THE AIDE WHAT CARE THE
RESIDENT NEEDS (TOILETING, DENTURES, ETC)

9.ABBREVIATIONS
 NPO
 AC-BEFORE MEAL
 PC-AFTER MEAL
 HS- HOUR OF SLEEP, BEDTIME
 STAT
 PRN-WHENEVER NECESSARY
 Q-EVERY
 W/C-WHEELCHAIR
 DNR
 ADL
 HOB-HEAD OF BED
 SOB-SHORTNESS OF BREATH
10. COMMUNICATING WITH HEARING
IMPAIRED
 LOWER PITCH OF YOUR VOICE IF YOU HAVE A
HIGH PITCHED VOICE
 SPEAK INTO UNAFFECTED EAR

 USE BODY LANGUAGE, WRITE DOWN
IMPORTANT MESSAGES
 SPEAK IN NORMAL VOLUME, RATE (DON’T
SHOUT)
 CHECK HEARING AID BY TURNING ON AND UP-
SHOULD HEAR A HIGH PITCHED SOUND, IF NOT
THE BATTERY NEEDS TO BE CHANGED
 REMOVE HEARING AID AND BATTERIES AT
BEDTIME, REMOVE HEARING AID WHEN
SHAMPOOING AND SHOWERING
11. COMMUNICATING WITH THE VISUALLY
IMPAIRED
 ANNOUNCE SELF AT DOOR, ANNOUNCE EXIT
 TOUCH PERSON LIGHTLY ON ARM ONCE YOU
HAVE ANNOUNCED YOURSELF
 SPEAK IN NORMAL VOLUME WITH GOOD
LIGHTING
 AVOID SAYING “LOOK” OR “SEE”
 PLACE PERSONAL ITEMS (CALL BELL, REMOTE
CONTROL) LIKE FACE OF IMAGINARY CLOCK

12. COMMUNICATING WITH THE SPEECH
IMPAIRED
 BE PATIENT, DON’T FINISH HIS SENTENCES,
DON’T PRETEND TO UNDERSTAND
 DYSPHASIA- DIFFICULTY SPEAKING
 APHASIA- LOSS OF LANGUAGE
 RECEPTIVE APHASIA- CANNOT UNDERSTAND
WHAT IS BEING SAID TO HIM
 EXPRESSIVE APHASIA- CANNOT MAKE SELF
UNDERSTOOD
 GLOBAL APHASIA IS BOTH RECEPTIVE AND
EXPRESSIVE
13. DOCUMENTATION
 BLUE/BLACK INK
 NO WHITE OUT, CORRECT MISTAKES WITH ONE
LINE, AND “ERROR” AND INITIALS
 DOCUMENT AFTER CARE IS GIVEN
 ONLY DOCUMENT THE WORK YOU DID
 DATE, TIME, SIGN

 KNOW THE 24 HOUR CLOCK
 STATE FACTS, NOT YOUR OPINION “SHE SEEMS
UPSET” SHOULD BE WRITTEN AS “SHE IS
CRYING”
II. INFECTION CONTROL
1. HANDWASHING IS NO# DEFENSE AGAINST
SPREAD OF DISEASE
 WASH BEFORE AND AFTER CARE
 HANDS BELOW ELBOWS- DON’T TOUCH INSIDE
OF SINK WITH BODY OR HANDS (START OVER IF
THIS HAPPENS)- FRICTION IS WHAT KILLS THE
GERMS-WARM WATER- SEPARATE PAPER
TOWEL TO TURN OFF WATER
2.STANDARD PRECAUTIONS- USED ON ALL
RESIDENTS, EVEN HIV AND HEPATITIS B
 HANDWASHING
 COVER OPEN AREAS ON YOUR BODY

 SHARPS IN BIOHAZARD CONTAINER
 DOUBLE BAG (2 AIDES), IF NEEDED
 RED BAG LINEN/TRASH IF BLOOD IS ON IT
 GLOVES IF POSSIBILITY OF CONTACT WITH A
BODY FLUID
 CLEAN ALL EQUIPMENT (COLD RINSE, HOT
WATER WASH, WARM WATER RINSE, DRY AND
STORE)
 DON’T RECAP NEEDLES- PLACE IN SHARPS AND
TELL NURSE
3.BACTERIA LIVE AND GROW IN A WARM, MOIST,
DARK, PLACE WITH OR WITHOUT OXYGEN
4.AEROBIC BACTERIA- WITH OXYGEN
5.ANAEROBIC- WITHOUT OXYGEN
6.PUTTING ON PPE- GOWN, MASK, GOGGLE,
GLOVES
7.TAKING OFF (DOFFING) PPE- GLOVES, GOWN,
GOGGLES, MASK

8.ONE SET OF PPE FOR EACH RESIDENT, NEVER
REUSED
9.MEDICAL ASEPSIS DISINFECTS OR CLEANS TO
REMOVE SOME GERMS
10. SURGICAL ASEPSIS STERILIZES TO KILL ALL
GERMS
11. RESERVOIRS IN CHAIN OF INFECTION ARE
HUMANS, VECTORS (AN ANIMAL, BIRD OR
INSECT) OR A FOMITE (AN OBJECT, LIKE A TOILET
SEAT)
12. TRANSMISSION BASED PRECAUTIONS ARE
USED ON PERSONS WHO HAVE A KNOWN
INFECTION, BASED ON HOW IT IS
TRANSMITTED, CERTAIN PPA MUST BE WORN

 DROPLET PRECAUTIONS (FOR THE FLU)-
SURGICAL MASK WHEN WITHIN 3 FEET OF
PERSON
 AIRBORNE PRECAUTIONS (FOR TB)- N95 OR
HEPA MASK AT ALL TIMES
 CONTACT PRECAUTIONS (FOR MRSA. C-DIFF
AND SHINGLES)- GOWN AND GLOVES
13. MRSA (METHICILLIN RESISTANT STAPH
AUREUS)- BACTERIAL WOUND INFECTION THAT
CANNOT BE DESTROYED WITH AN ANTIBIOTIC
CALLED METHICILLIN-CONTACT PRECAUTIONS
14. C-DIFFICILE IS A BACTERIAL INFECTION OF
THE INTESTINES THAT CAUSES RUNNY,
GREENISH, BAD SMELLING DIARRHEA- BESIDES
CONTACT PRECAUTIONS USE GOOD
HANDWASHING FOR YOU AND RESIDENT
15. SHINGLES- VIRAL INFECTION; CHICKEN POX
THAT WAS SLEEPING IN PERSON WAKES UP

AND CAUSES PAINFUL RASH ON BODY, LASTS 1-
3 WEEKS, CONTACT PRECAUTIONS
16. HIV/HEPATITIS B- BLOODBORNE
PATHOGENS, YOU CAN ONLY GET BY COMING
INTO CONTACT WITH AN INFECTED PERSON’S
BLOOD- BOTH ARE VIRAL, REQUIRE NO
PRECAUTIONS OTHER THAN STANDARD
PRECAUTIONS, VACCINE AVAILABLE FOR HEP B
17. LOCAL INFECTION- SUCH AS A CUT FINGER-
WARM, RED, PAINFUL, HAS DRAINAGE,
SWELLING
18. SYSTEMIC INFECTION SUCH AS PNEUMONIA,
CAUSES FEVER, NAUSEA, VOMITING, DIARRHEA,
LOSS OF APPETITE, FATIGE

III. SAFETY
1.KEEP RESIDENT SAFE BY THE FOLLOWING
 NON SKID FOOTWEAR
 PROPER FITTING CLOTHES
 RAISING BEDRAILS ACCORDING TO CARE PLAN
 CLEAN UP SPILLS RIGHT AWAY
 REPORT AND DON’T USE BROKEN EQUIPMENT
 KEEP BED IN LOW POSITION
 PADDED SIDE RAILS IF USED TO PREVENT
ENTRAPMENT OF BODY
 CHECK ID BRACELET
 CLUTTER FREE ROOM
 ADEQUATE LIGHTING
 FOLD IN CRANKS/GATCHES/HANDLES ON
MANUAL BED
 NO EXTENSION CORDS
 NO SCATTER RUGS

 ELECTRICAL APPLIANCES BROUGHT FROM
HOME SHOULD BE APPROVED FOR USE AND
GROUNDED
 NO HEATING PADS
 NO CANDLES
 NO SMOKING IN THE BUILDING
 CHECK BATH WATER TEMP
 DON’T PLACE HOT LIQUIDS NEAR EDGE OF
TABLE
2.PREVENTING SUFFOCATION/OTHER ACCIDENTS
 CUT FOOD UP INTO SMALL PIECES
 MAKE SURE DENTURES ARE WELL FITTING AND
REMOVE AT BEDTIME
 NEVER LEAVE ALONE IN SHOWER- BE RIGHT
OUTSIDE CURTAIN
 USE RESTRAINTS ACCORDING TO
MANUFACTURER’S INSTRUCTIONS

3.PREVENTING POISONING
 DON’T USE A BOTTLE IF YOU CANNOT READ THE
LABEL
 DON’T REUSE BOTTLES
 NEVER LEAVE TOILETRIES OUT AFTER USE
4.CHOKING (COMPLETE FOREIGN BODY AIRWAY
OBSTRUCTION OR FBAO)- HAPPENS WHEN
PERSON CANNOT SPEAK OR COUGH; LOOK FOR
UNIVERSAL SIGN OF PERSON CLUTCHING
THROAT
5.WHEELCHAIR SAFETY
 HIPS BACK IN CHAIR
 ARMS ON ARMREST
 FEET ON FOOTRESTS
 PUSH FORWARD UNLESS GOING DOWN A
RAMP OR INTO AN ELEVATOR
 BRAKES ON W/C DURING TRANSFERS

6.CHAIR SAFETY- FEET FLAT ON FLOOR
7.SAFE USE OF CHEMICALS- ALL LISTED IN SDA
(SAFETY DATA SHEETS) MANUAL
 TELLS YOU HOW TO TREAT AN ACCIDENTAL
EXPOSUR
 WHAT PPE TO WEAR WHEN CLEANING UP A
CHEMICAL
8.IF YOU HAVE AN ACCIDENTAL EXPOSURE,
ESPECIALLY INVOLVING BLOOD- CLEAN WITH
SOAP AND WATER THEN REPORT INCIDENT TO
NURSE
9.INCIDENT REPORTS DOCUMENT ACCIDENTS
AND INCIDENTS (SOMETHING WAS LOST,
STOLEN, BORKEN) THERE WAS AN ERROR IN
CARE, A STAFF, RESIDENT OR VISITOR GETS
HURT ON THE JOB

 FILL OUT INCIDENT REPORT ASAP
 USED TO TRACK PATTERNS AND TRENDS AND
IMPROVE QUALITY OF CARE
10. IF YOU SEE OR SMELL SMOKE- ACTIVATE
THE R-A-C-E SYSTEM
 R-REMOVE EVERYONE FROM THE AREA (DO
THIS FIRST!!)
 A-ACTIVATE THE ALARM
 C-CLOSE ALL DOORS EVERYWHERE IN THE
BUILDING
 E-EXTINGUISH THE FIRE IF YOU CAN
11. IF A RESIDENT IS ON FIRE, HAVE HIM DROP
AND ROLL IN A BLANKET
12. TO USE A FIRE EXTINGUISHER REMEMBER
P-A-S-S
 P-PULL THE PIN
 A- AIM AT THE BASE OF THE FLAMES (THE
BOTTOM OF THE FLAMES)

 S-SQUEEZE THE HANDLE
 SWEEP BACK AND FORTH
ABC FIRE EXTINGUISHERS PUT OUT PAPER/WOOD,
ELECTRICAL AND GREASE FIRES
13. EVACUATE PERSONS WHO CAN WALK
(AMBULATE) FIRST
14. RESTRAINTS ARE ORDERED BY THE DOCTOR
IS THE RESIDENT IS DANGEROUS TO SELF OR
OTHERS; NOT FOR STAFF CONVENIENCE OR TO
PUNISH THE RESIDENT
15. RESTRAINTS ARE DANGEROUS- CAN CAUSE
STRANGULATION, DEATH, PRESSURE ULCERS,
INCONTINENCE, FRACTURES, ANGER,
DEPRESSION, CONSTIPATION, DEHYDRATION,
ETC.
16. ALTERNATIVES TO RESTRAINTS ARE
CHAIR/BED ALARMS, WEDGE CUSHION, BED
BOLSTERS, HIP PROTECTORS, LOW BEDS

17. PASSIVE RESTRAINTS ARE NOT ATTACHED
TO THE BODY: SIDERAILS AND GERIATRIC CHAIR
WITH TRAY LOCKED IN PLACE
18. ACTIVE RESTRAINTS ARE ATTACHED TO THE
BODY: MITTENS, WRIST, BELT, VEST
(CRISSCROSSED IN FRONT)
19. GUIDELINES FOR RESTRAINT USE
 REMOVE EVERY 2 HOURS (Q2H)
 CHECK EVERY 15 MINUTES
 TIE STRAPS TO NONMOVABLE PART SUCH AS
FRAME OF BED
 SLIP FINGERS INSIDE TO MAKE SURE NOT TOO
TIGHT
 CHECK FOR IRRITATION UNDER RESTRAINT
 REMOVE AT MEAL TIME AND SIT NEXT TO
PERSON TO KEEP SAFE

20. IF A RESIDENT BEGINS TO FALL, WIDEN
YOUR STANCE (SPREAD YOUR LEGS) AND EASE
THE PERSON TO THE FLOOR SUPPORTING HIS
HEAD
21. NEVER MOVE/TOUCH A FALL VICTIM- CALL
FOR HELP AND STAY WITH HIM
22. WHEN AMBULATING A PERSON WITH A
WEAK SIDE- YOU ARE ON THE WEAK SIDE
23. WHEN TRANSFERRING A PERSON WITH A
WEAK SIDE INTO A W/C- PLACE THE W/C ON
THE STRONG SIDE AND YOU STAND ON THE
WEAK SIDE
24. WHEN AMBULATING A PERSON WITH A
GAIT BELT, PUT IT ON OVER CLOTHES, UNDER
BREAST, TIGHTENED AND HELD WITH YOUR
HANDS UPWARD

25. WALK SLIGHTLY BEHIND A PERSON TO ONE
SIDE
26. A CANE IS HELD ON THE STRONG SIDE
27. A QUAD CANE HAS 4 TIPS
28. WHEN AMBULATING A BLIND PERSON, YOU
ARE SLIGHTLY IN FRONT, TO ONE SIDE AND
THEY ARE HOLDING YOUR ARM
29. BODY MECHANICS HELP YOU TO NOT HURT
YOUR BODY ON THE JOB. YOU SHOULD
 BEND AT THE KNEES
 HOLD THE LOAD CLOSE
 USE THIGH, SHOULDER AND UPPER ARM
MUSCLES
 ASK FOR HELP
 COUNT OUTLOUT “1-2-3”
 PIVOT INSTEAD OF TWISTING
 PUSH OR PULL INSTEAD OF LIFTING

 DON’T REACH OVERHEAD
 STAND WITH FEET APART (A WIDE BASE OF
SUPPORT)
IV. DATA COLLECTION
 TEMPERATURE CAN BE MEASURED 3 WAYS
USING A MANUAL THERMOMETER
ROUTE TIME RANGE NOTES
AXILLARY
(UNDER
ARM
7 TO 10
MINUTES
96.6-
98.6
LEAST ACCURATE
ORALLY 3 TO 5
MINUTES
97.6-
99.6
WAIT 15-20
MINUTES AFTER
HOT/COLD
LIQUIDS; DON’T
USE IF
UNCONCIOUS,
VERY CONFUSED,
MOUTHBREATHER,
HAS SEIZURES,

CHILD UNDER 4,
MOUTH SURGERY
OR DISEASE
RECTALLY 1 TO 3
MINUTES
98.6-
100.6
MOST ACCURATE
SIMS POSITION
USED
HOLD
THERMOMETER IN
RECTUM
USED FOR
UNCONSCIOUS,
DYING PERSONS
 TYMPANIC MEMBRANE OR AURAL TEMP-
DIGITAL THERMOMETER PLACED IN EAR, FIRST
PULL UP AND BACK
 PULSE- MEASURES NO# OF TIMES HEART BEATS
IN A MINUTE
 NORMAL RATE IS 60-100
 TACHYCARDIA IS OVER 100

 BRADYCARDIA IS UNDER 60
 IF ABNORMAL RATE OR IRREGULAR RHYTHM,
TELL THE NURSE
 USE THE RADIAL PULSE (THUMB SIDE OF THE
WRIST
 KEEP ARM AT HEART LEVEL
 DON’T USE YOUR THUMB
 An APICAL RADIAL-DEFICIT IS THE DIFFERENCE
BETWEEN THE APICAL AND RADIAL
HEARTBEATS.
 TAKES TWO PEOPLE TO MEASURE, NURSE
LISTENING TO APICAL AND AIDE FEELING
RADIAL
 START AND STOP TOGETHER FOR ONE FULL
MINUTE
 COMPARE NUMBERS
 SUBTRACT RADIAL FROM APICAL
 SAMPLE: APICAL AND 100 AND RADIAL IS 90.
THE DEFICIT (FOUND BY SUBTRACTING) IS 10

 RESPIRATIONS MEASURE NUMBER OF TIMES
AND PERSON BREATHES IN AND OUT IN A
MINUTE
 NORMAL RATE IS 12-20
 TACHYPNEA IS OVER 20
 BRADYPNEA IS UNDER 12
 APNEA IS NO BREATHING
 DYSPNEA IS DIFFICULTY BREATHING
 KUSSMAUL’S RESPIRATIONS ARE ASSOCIATED
WITH VERY HIGH HYPERGLYCEMIA (HIGH
BLOOD SUGAR)
 CHEYNE-STOKES RESPIRATIONS ARE SHALLOW
BREATHING WITH PERIODS OF APNEA AND ARE
ASSOCIATED WITH DYING
 DON’T TELL A PERSON YOU ARE COUNTING
THEIR BREATHING, INSTEAD AFTER TAKING THE
PULSE KEEP FINGERS ON WRISTS AND
MEASURE BREATHING
6.BLOOD PRESSURE IS THE FORCE OF BLOOD IN THE
WALLS OF AN ARTERY

 THE TOP NUMBER IS CALLED THE SYSTOLIC
NUMBER AND IS THE FIRST SOUND HEARD
WHEN THE HEART CONTRACTS
 THE BOTTOM NUMBER IS CALLED THE
DIASTOLIC NUMBER AND IS THE LAST SOUND
HEARD WHEN THE HEART RELAXES
 HYPERTENSION IS A SYSTOLIC OF 140 OR
GREATER AND A DIASTOLIC OF 90 OR GREATER
 HYPOTENSION IS A SYSTOLIC OF LESS THAN 90
OR A DIASTOLIC OF LESS THAN 60
 IF A WOMAN HAS HAD A MASTECTOMY
(REMOVAL OF HER BREAST) DON’T TAKE BP ON
THE OPERATIVE SIDE
 IF A PERSON GOES FOR HEMODIALYSIS DON’T
USE THEIR DIALYSIS ARM FOR BP
 HYPERTENSION CALLED THE SILENT KILLER,
MAY BE ASYMPTOMATIC OR HAVE A
HEADACHE, BLURRED VISION, FATIGUE,
NOSEBLEEDS AND DIZZINESS

7.WEIGHTS ARE TAKEN ON ADMISSION AND
EVERY MONTH, TO GET AN ACCURATE WT-
 USE SAME SCALE EACH TIME
 SAME AMOUNT OF CLOTHING EACH TIME
 GET AT SAME TIME OF DAY EACH TIME
 BALANCE THE SCALE BY MOVING WEIGHTS TO
ZERO BEFORE GETTING THE WEIGHT
 IF A W/C SCALE IS USED, SUBTRACT THE WT OF
THE SHARE FROM THE READING
8.HEIGHT
 THERE ARE 12 INCHES IN EACH FOOT
 TO CHANGE FEET TO INCHES, MULTIPLY BY 12
AND ADD WHAT IS LEFT
 EXAMPLE: A PERSON IS 5’10 (12 X 5=60) + 10=
70 INCHES
 IF PERSON CANNOT STAND AT HEIGHT BAR,
USE A TAPE MEASURE FROM TOP OF HEAD TO
HEEL

9.MEASURING INTAKE AND OUTPUT
 INTAKE INCLUDES ALL LIQUIDS AND ANY FOOD
THAT BECOMES A LIQUID AT ROOM TEMP SUCH
AS JELLO, ICE CREAM, YOGURT AND SOUP;
ALSO IVS AND TUBE FEEDINGS
 OUTPUT IS URINE, DIARRHEA, EMESIS AND
WOUND DRAINAGE
 MEASURE OUTPUT IN A GRADUATE CONTAINER
(EACH RESIDENT MUST HAVE OWN)- READ AT
EYE LEVEL ON HARD SURFACE
 1 OUNCE=30MLS/CCS
 1 ML IS THE SAME AS 1 CC
 TOM HAS 4 OUNCES OF COFFEE OR 120 CCS
10. PULSE OXIMETER IS THE MACHINE USED TO
MEASURE THE SATURATION (AMOUNT) OF
OXYGEN IN A PERSON’S BLOOD
 REMOVE NAIL POLISH ON ONE NAIL
 WARM FINGER IF COLD
 IF FAKE NAILS, USE EAR LOBE
 SHOULD BE CLOSE TO 100%

11. DIETARY INTAKE IS DONE ON ALL
RESIDENTS. DOCUMENTED AS A PERCENTAGE
 MEAT IS 25%
 MILK IS 25%
 GRAINS/VEGGIES ARE 25%
 BREAD IS 25%
12. CALORIE COUNTS ARE ORDERED BY THE
DIETICIAN IF A PERSON IS EATING POORLY AND
LOSING WT. INSTEAD OF WRITING DOWN THE
PERCENTAGE THAT WAS TAKEN IN, RECORD
EXACTLY HOW MUCH OF EVERYTHING WAS
EATEN
 EXAMPLE: 4 BITES OF MEAT LOAF AND 3
TEASPOONS OF RICE

V. RESIDENT RIGHTS
1.OBRA, 1987 IS A FEDERAL ACT. ENFORCED BY
CMS (CENTERS FOR MEDICARE AND MEDICAID)
TO ENSURE NURSING HOMES PROVIDE CARE IN
SUCH A MANNER AND SETTING THAT IT
MAINTAINS OR IMPROVES THE PERSON’S
QUALITY OF LIFE, HEALTH AND SAFETY
2.OBRA REQUIRES AIDES TO HAVE AT LEAST 75
HOURS OF TRAINING, TAKE A SKILLS AND
WRITTEN EXAM, WORK AT LEAST 7.5 HOURS
EVERY 2 YEARS, COMPLETE A CBI, RENEW CERT
EVERY YEAR AND BE LISTED IN THE NURSE AIDE
REGISTRY
3.AIDES MUST COMPLETE 12 HOURS OF IN-
SERVICE EDUCATION EVERY YEAR TO RENEW
CERT
4.RESIDENT RIGHTS ARE POSTED IN THE
BUILDING AND REVIEWED UPON ADMISSION
5.RESIDENT RIGHTS ARE EXPLAINED AND AN
INTERPRETER IS PROVIDED IF NEEDED

6.RESIDENTS HAVE THE RIGHT TO
 BE TREATED WITH DIGNITY AND RESPECT
 EXERCISE RIGHTS AS A CITIZEN
 SEE HIS CHART AND BILLS
 REFUSE TREATMENT
 REFUSE TO BE A PART OF EXPERIMENTAL
RESEARCH
 HAVE ADVANCE DIRECTIVES
 CHOOSE HIS DOCTOR
 COMPLAIN WITHOUT FEAR
 BE INFORMED OF A ROOM CHANGE,
DISCHARGE OR TRANSFER
 MANAGE HIS OWN MONEY
 PRIVACY
 CONFIDENTIALITY
 SEE SURVEY RESULTS
 PERFORM SERVICES OR REFUSE TO PERFORM
SERVICES FOR THE HOME
 SEND AND RECEIVE UNOPENED MAIL
 PRIVATE VISITS AND PHONE CALLS
 SHARE A ROOM WITH SPOUSE

 HAVE PERSONAL POSSESSIONS
 BE OFFERED CHOICES
 BE FREE FROM PHYSICAL RESTRAINTS
 BE FREE FROM ABUSE AND NEGLECT
 LIVE IN A CLEAN, SAFE HOME
 PARTICIPATE IN ACTIVITIES OF HIS CHOOSING
 PRACTICE RELIGION
 FORM GROUPS
 HAVE OWN CLOSET SPACE
3. HIPAA SAYS YOU CANNOT DISCUSS THE
RESIDENT WITH ANYONE WHO IS NOT INVOLVED IN
THE PERSON’S CARE
4. AN OMBUDSMAN VOLUNTEERS TO PROTECT
RESIDENT RIGHTS, TO SERVE AS AN ADVOCATE FOR
THE ELDERLY AND RESOLVE GRIEVANCES
5. NEVER TOUCH A RESIDENT WITHOUT FIRST
EXPLAINING WHAT IS GOING TO HAPPEN
 THREATENING OR ATTEMPTING TO TOUCH
WITHOUT PERMISSION IS ASSAULT
 TOUCHING WITHOUT PERMISSION IS BATTERY

 YOU ARE MANDATED TO REPORT ABUSE TO
YOUR CHARGE NURSE
 VERBAL ABUSE- YELLING
 MENTAL ABUSE- NAME CALLING,
THREATENING, TEASING
 PHYSICAL
 SEXUAL
 FINANCIAL
 IF YOU SEE IT, STOP IT, THEN REPORT
 DON’T SAY OR WRITE ANYTHING THAT COULD
DAMAGE A PERSON’S REPUTATION, STICK TO
THE FACTS
 SLANDER IS SAYING SOMETHING HARMFUL
ABOUT A PERSON
 LIBEL IS WRITING SOMETHING HARMFUL
ABOUT A PERSON

 DON’T RESTRAIN ANYONE WITHOUT A
DOCTOR’S ORDER. THIS WOULD BE FALSE
IMPRISONMENT
 IF A RESIDENT TRIES TO LEAVE, ATTEMPT TO
REDIRECT VERBALLY. WE CANNOT RESTRAIN A
PERSON TO KEEP THEM IN THE HOME
 ELOPEMENT IS THE MEDICAL TERM FOR TRYING
TO LEAVE A FACILITY WITHOUT PERMISSION
 DON’T TELL A RESIDENT HE MUST SIT IN A
CORNER OR STAY IN HIS ROOM, THIS IS
INVOLUNTARY SECLUSION
 DON’T ENTER A ROOM WITHOUT KNOCKING
FIRST, OR GIVE CARE WITHOUT GIVING
PRIVACY, OR TAKE A PICTURE OF A RESIDENT
THIS IS INVASION OF PRIVACY
 DON’T FAIL TO DO YOUR JOB AND DO IT
PROPERLY, THIS IS NEGLECT; NEGLIGENCE IS AN
UNINTENTIONAL WRONG; THE NEGLIGENT

PERSON DOESN’T ACT IN A REASONABLE WAY
AND SOMEONE IS HARMED
 ACTIVE NEGLECT- YOU INTENTIONALLY DIDN’T
DO YOUR JOB
 PASSIVE NEGLECT- YOU FORGOT OR MADE A
MISTAKE DOING YOUR JOB
VI. ROLE AND RESPONSIBILITY
1. YOU ARE AN ASSISTANT TO THE NURSE
 REPORT OBSERVATIONS ABOUT YOUR
RESIDENT’S PHYSICAL AND MENTAL STATUS
AND CHANGES IN CONDITIONS AT ONCE TO
NURSE
 YOU DO NOT MAKE DECISIONS FOR RESIDENT
CARE
 PERFORM ONLY TASK YOU ARE TRAINED TO DO
2. LEGAL LIMITS (OUT OF SCOPE OF PRACTICE) FOR
AIDES INCLUDE

 YOU CANNOT GIVE MEDICATION
 YOU CANNOT BE IN CHARGE, SUPERVISE OR
MENTOR OTHERS
 YOU CANNOT TAKE ORDERS FROM A DOCTOR
 YOU CANNOT DISCUSS CARE/DIAGNOSIS OF
THE RESIDENT WITH FAMILY OR THE RESIDENT
 YOU CANNOT PRESCRIBE TREATMENT
 YOU CANNOT INSERT OR REMOVE TUBES AND
CATHETERS
 YOU CANNOT ASSIST IN STERILE PROCEDURES
 **YOU CANNOT IGNORE A REQUEST TO DO
SOMETHING
3. THE NURSE DELEGATES TASKS TO YOU. YOU ARE
RESPONSIBLE FOR ACCEPTING OR SAYING NO TO
THE TASK BASED ON THE 5 RIGHTS OF DELEGATION.
IT MUST BE
 THE RIGHT TASK
 YOU MUST BE THE RIGHT PERSON
 YOU MUST HAVE THE RIGHT SUPERVISION
 YOU MUST HAVE THE RIGHT INSTRUCTIONS

 YOU MUST HAVE THE RIGHT CIRCUMSTANCES
IF YOU SAY NO, EXPLAIN TO THE NURSE
DELEGATING THE TASK WHY YOU HAVE CONCERNS
WHEN YOU AGREE TO PERFORM A TASK, YOU ARE
RESPONSBILE FOR YOUR OWN ACTIONS.
SAY NO IF DIRECTIONS ARE NOT ETHICAL OR LEGAL
REMEMBER TO DO NO HARM AND DO GOOD (THAT
IS CALLED BENEFICENCE)
4. DON’T GOSSIP, HAVE A POSITIVE ATTITUDE
(‘THAT’S NOT MY JOB”, “NOBODY TOLD ME”, “IM
TIRED OF THIS PLACE” , IT’S NOT MY FAULT” ALL
SHOW A POOR ATTITUDE. BE A TEAM PLAYER
5. IN A SURVEY, IF YOU DON’T KNOW THE ANSWER
SIMPLY SAY “I DON’T KNOW BUT I WILL FIND OUT
AND REPORT BACK TO YOU”
6. NURSING CARE PATTERNS- OR HOW CARE IS
DELIVERED VARY DEPENDING ON WHERE YOU
WORK.

 FUNCTIONAL- OR TASK-ORIENTED; EACH
MEMBER OF TEAM HAS CERTAIN TASK- ONE
NURSE GIVES MED, ONE AIDE DOES BATHS
 MOST OFTEN PRACTICED IN NURSING HOME
7.REMEMBER! YOU MAKE ALL REFERRALS TO THE
NURSE- DO NOT GO TO CLERGY, MAKE
REFERRALS FOR THE DIETICIAN OR APPROACH
THE DIETICIAN WITH RESIDENT CONCERNS- GO
TO THE NURSE!
8.THE STATE NURSE PRACTICE ACT DECIDES
WHAT AN AIDE CAN DO IN HIS/HER STATE.
9. OSHA IS AN ORGANIZATION THAT MAKES SURE
EMPLOYEES ARE SAFE ON THE JOB- HAVE PPE,
HAVE TRAINING, ACCIDENTAL EXPOSURE
TREATMENT AND HEP B VACCINE AVAILABLE

10. YOUR CERTIFICATION CAN BE REVOKED FOR
SUBSTANCE ABUSE, ABANDONING YOUR
RESIDENTS, ABUSE, FRAUD, GIVING UNSAFE
CARE, STEALING, DOING SOMETHIMG OUT OF
SCOPE OF PRACTICE, BEING CONVICTED OF
CERTAIN CRIMES, VIOLATING PRIVACY
11. NURSE AIDES CAN WORK IN
 ASSISTED LIVING RESIDENCES- PROVISION OF
HOUSING, PERSONAL CARE, ACTIVITIES, MEALS,
LAUNDRY, ETC IN AN APARTMENT-LIKE
SETTING
 HOSPICE- FOR THE TERMINALLY ILL
 SKILLED NURSING FACILITY-AKA NURSING
HOME
 HOSPITAL AKA ACUTE CARE FACILITY
12. IT IS THE AIDES RESPONSIBILITY TO
 GET ADEQUATE REST AND EAT PROPERLY TO
STAY HEALTHY

 FOLLOW FACILITY DRESS CODE
 BE ON TIME
 NOT CALL OUT UNLESS ABSOLUTELY
NECESSARY
 BE FLEXIBLE
 ACCEPT THE VALUES, CULTURE AND RELIGION
OF OTHERS WITHOUT IMPOSING YOURS
 NOT BECOME PERSONALLY INVOLVED WITH
RESIDENT OR HIS FAMILY
 NOT HAVE FAVORITES
 NOT SHOW LOYALTY TO EMPLOYER
 BE HONEST
 ACCEPT CONSTRUCTIVE CRITICISM
 NOT ACCEPT TIPS
 VII DISEASE PROCESS
1.THE PERSON AFTER CATARACT SURGERY
 DON’T REMOVE EYE SHIELD, EVEN DURING
NAPS
 PLACE ITEMS IN FRONT OF UNAFFECTED EYE
 REPORT DRAINAGE AND PAIN STAT

 REMIND NOT TO BEND, STOOP, COUGH OR LIFT
THINGS
2.THE PERSON WITH A PROSTHETIC EYE
 WASH EYE WITH MILD SOAP AND WATER,
RINSE WELL
 WASH SOCKET WITH WARM WATER AND
SALINE INNER TO OUTER CANTHUS
3.THE CVA (STROKE) PERSON
 MONITOR FOR FACIAL DROOPING AND
WEAKNESS ON ONE SIDE OF BODY WITH
SLURRED SPEECH, CONFUSION
 POSITION ON SIDE TO PREVENT ASPIRATION
 PLACE OBJECTS ON UNAFFECTED SIDE
 ENCOURAGE SELF CARE
 ASSIST WITH AMBULATION AND TRANSFERS

4.THE PERSON WITH MULTIPLE SCLEROSIS
 NEED HELP WITH INCONTINENCE
 ASSIST WITH MOBILITY
 PROTECT FROM ACCIDENT/INJURY
 MAY BE DEPRESSED
 MAY HAVE PROBLEMS WITH VISION
 MUSCLES WEAK IN ARMS AND LEGS- GIVE ROM
5.THE PERSON WITH PARKINSONS
 ASSIST WITH AMBULATINg DT SHUFFLING GAIT
 ASSIST AT MEALS, MAY HAVE DYSPHAGIA
BECAUSE OF STONY FACE
 ASSIST WITH ADLS DT TREMORS
6.CAST CARE
 ALLOW TO DRY AND HANDLE WITH OPEN
PALMS UNTIL DRY
 TURN ARM OR LEG TO ALLOW FOR ALL
SURFACES TO DRY
 ELEVATE ON PILLOW

 NOTHING IS INSERTED INTO CAST
 KEEP DRY
 USE A BEDCRADLE IF CAST ON LEGS
 REPORT CHANGE IN TEMP, COLOR, NUMBNESS
OF FINGERS OR TOES, ALSO ODOR AND PAIN
ARE REPORTED
 REPORT ROUGH CAST EDGES TO NURSE
7. HIP REPLACEMENT
 DON’T TURN ON OPERATIVE SIDE
 ROM TO UNAFFECTED ARMS AND LEG
 KEEP LEGS APART (ABDUCTED) WITH WEDGE
 NO BENDING, NO CROSSING LEGS
 ELEVATED TOILET SEAT AND HIGH CHAIR USED
 GIVE GRABBER FOR REACHING THINGS
 APPLY TED STOCKINGS
 ASSIST WITH COUGH AND DEEP BREATHING
EXERCISES AND USE OF INCENTIVE SPIROMETER

8.TRACTION
 DON’T TOUCH THE WEIGHTS, PUT THEM ON
BED OR LET THEM TOUCH THE FLOOR
 ASSIST WITH TOILETING (PERSON ON CBR OR
COMPLETE BEDREST)- USE FRACTURE PAN!
 PREVENT SKIN BREAKDOWN
 KEEP BODY IN GOOD ALIGNMENT
 IF SKELETAL TRACTION- MONITOR WHERE
TRACTION GOES INTO BONE FOR SWELLING,
REDNESS, DRAINAGE AND REPORT
9. AMPUTATION
 CLEAN STUMP WITH MILD SOAP AND WATER
 ASSIST WITH PUTTING SOCK ON
 CHECK STUMP FOR REDNESS, IRRITATION,
SWELLING, DRAINAGE
 ENCOURAGE EXERCISE TO STRENGTHEN OTHER
LIMBS
 MONITOR FOR AND REPORT PHANTOM PAIN
 OFFER EMOTIONAL SUPPORT BY LISTENING

10. OSTEOPOROSIS
 CAN LEAD TO FRACTURES, BONE ARE BRITTLE
 CAUSES PAIN AND LOSS OF HEIGHT
 STOOPED POSTURE
11. MYOCARDIAL INFARCTION (HEART ATTACK)
 MONITOR FOR CHEST PAIN THAT RADIATES TO
ARM/NECK/JAW (IT MOVES
 SOB, PALE, CLAMMY SKIN (DIAPHORESIS
MEANS INCREASED SWEATING), NAUSEA
 STAY WITH PERSON, CALL FOR NURSE, LOOSEN
CLOTHING, REASSURE THAT HELP IS COMING,
KEEP NPO, IF VOMITING, PLACE ON SIDE
12. CONGESTIVE HEART FAILURE
 WILL GAIN WEIGHT, HAVE EDEMA FROM FLUID
RETENTION, TIRE EASILY AND HAVE SOB
 PLACED ON FLUID RESTRICTION- REMOVE
WATER PITCHER AND CUP, ONLY GIVEN A SET
AMOUNT OF FLUID

 DAILY OR WEEKLY WEIGHTS, I&O MONITORED,
DON’T TIRE OUT, LET HIM REST BETWEEN
ACTIVITY
13. CHRONIC OBSTRUCTIVE PULMONARY
DISEASE (COPD)
 WILL HAVE BARREL SHAPED CHEST, COUGH UP
A LOT OF MUCUS, SOB, ANXIETY
 WILL NEED OXYGEN
 SHOULD NOT SMOKE
 SLEEPS, RESTS IN ORTHOPNEIC POSITION
(SITTING UP)
 CANT GET AIR IN, CANT GET CARBON DIOXIDE
OUT
 USES INCENTIVE SPIROMETER AND DOES
BREATHING EXERCISES
14. GASTROESOPHAGEAL REFLUX DISEASE
(GERD)- FOOD COMES BACK UP FROM
STOMACH INTO ESOPHAGUS CAUSING

BURNING, BAD BREATH, SORE THROAT,
HOARSE VOICE AND PAIN IN CHEST/STOMACH
 GIVE SMALL MEALS INSTEAD OF ONE BIG ONE
 NO SMOKING OR ALCOHOL USE
 DRESS IN LOOSE CLOTHES
 SIT UP FOR 3 HOURS AC
 AVOID FATTY FOODS
15. DIABETES- PANCREAS DOESN’T MAKE
ENOUGH OR ANY INSULIN AND GLUCOSE
(SUGAR) BUILDS UP IN BLOOD
 MAY COMPLAIN OF BLURRED VISION, WEIGHT
LOSS, POLYURIA (INCREASE URINATION),
POLYDIPSIA (INCREASE THIRST) AND
POLYPHAGIA (INCREASED APPETITE, MAY HAVE
FREQUENT INFECTIONS AND WOUNDS WON’T
HEAL
 TREATED WITH INSULSIN, PILLS, WT LOSS AND
DIET
 TELL NURSE IF DIABETIC DOESN’T EAT OR
VOMITS HIS FOOD

 WASH AND INSPECT FEET EVERYDAY
 NEVER GOES BAREFOOT, SOCKS WITH SHOES,
SEES PODIATRIST
 GETS EYES EXAMINED EVERY YEAR
 HYPERGLYCEMIA CAUSES SKIN TO BE WARM
AND DRY AND PERSON IS DROWSY
 HYPOGLYCEMIA CAUSES SKIN TO COLD AND
MOIST AND PERSON HAS HEADACHE AND IS
IRRITABLE
16. KIDNEY STONES
 FLANK (BACK) PAIN EXPERIENCED
 STRAIN ALL URINE FOR STONES- TAKE TO
NURSE IN CUP, SENT TO LAB
17. ENLARGED PROSTATE GLAND
 MAN WILL COMPLAIN OF URGENCY,
FREQUENCY, NOCTURIA, FEELING LIKE HE
HASN’T EMPTIED HIS BLADDER COMPLETELY
AND HIS STREAM OF URINE DRIBBLES OUT

18. HEPATITIS B, LIVER INFECTION, VIRAL,
BLOODBORNE PATHOGEN
 PERSON ON STANDARD PRECAUTIONS
 LIVER WILL BE ENLARGED (HEPATOMEGALY),
JAUNDICE OF SKIN AND EYES, DARK URINE AND
LIGHT COLORED STOOLS
 NO CURE, BUT VACCINE AVAILABLE
19. ANGINA PECTORIS, CHEST PAIN DESCRIBED
AS TIGHTNESS—NOT A HEART ATTACK BUT IS
NOT
 CHEST PAIN AFTER EXERTING SELF, ESPECIALLY
ON A HOT OR COLD DAY, OR OVEREATING
 TREATED WITH REST AND NITROGLYCERIN
TABLETS TAKEN UNDER THE TONGUE
20. ARTHRITIS
 PAIN CONTROL- TELL NURSE

 HOT OR COLD APPLICATIONS
 EXERCISE
 USE OF ADAPTIVE DEVICES (WALKER, CANE,
SPLINTS)
 WEIGHT CONTROL
 ASSIST WITH ADLS
21. INCONTINENCE
 NEVER A NORMAL PART OF AGING
 STRESS TYPE: PERSON SNEEZES, COUGHS,
URINE LEAKS OUT AS PRESSURE IS PUT ON
BLADDER
 FUNCTIONAL: PERSON HAS BLADDER CONTROL
BUT CANNOT USE TOILET IN TIME- CAN’T WALK

VIII. MENTAL HEALTH
1.BIPOLAR ILLNESS
 PERSON HAS PERIODS OF DEPRESSION AND
PERIODS OF MANIA (OVERLY EXCITED)
 WHEN MANIC, CANT SLEEP, CONCENTRATE,
WIRED UP, POOR JUDGMENT, SPENDING
SPREES, AGGRESSIVE BEHAVIOR, RACING
THOUGHTS AND RAPID SPEECH
 TREATED WITH MEDICATION, CAUSED BY A
CHEMICAL IMBALANCE
2.SCHIZOPHRENIA, A SPLIT MIND
 BEGINS BETWEEN 12-20 YEARS
 INCLUDES HALLUCINATIONS, DELUSIONAL
THINKING, POOR SELF CARE
 DELUSIONS OF GRANDEUR “IM GOD”
 DELUSIIONS OF PERSECUTION “EVERYONE IS
AFTER ME”
 MOVEMENT AND THOUGHT DISORDERS

3.ANXIETY DISORDERS
 INCLUDES PTSD, PANIC ATTACKS AND PHOBIAS
 OCD- OBSESSIVE THOUGHTS AND COMPULSIVE
BEHAVIOR (CLEANING AND CLEANING TO
RELIEVE ANXIETY)
4.SUICIDE
 YOU MUST REPORT STAT, STAY WITH PERSON
 MORE IN ELDERLY MEN THAN OTHER GROUPS
5.DEFENSE MECHANISMS
 HOW HUMANS MANAGE OR COPE WITH
UNPLEASANT OR THREATENING FEELINGS
IX. PERSONAL CARE
1.BATHING

 EARLY AM CARE IS DONE BEFORE BREAKFAST-
RINSE MOUTH OR DENTURES, WASH HANDS
AND FACE, TOILET, PLACE IN FOWLER’S
 PARTIAL BEDBATH- WASH EYES, FACE, HANDS,
AXILLAE, FEET, BACK, PERINEAL AREA
 BATHE FROM CLEANEST TO DIRTIEST AREAS
 RINSE SOAP OFF TO PREVENT DRYING
 ALLOW PERSON TO PARTICIPATE AS ABLE TO
 TEMP OF WATER 105-115
 EYES CLEANED FROM INNER TO OUTER
CANTHUS WITH SEPARATE PART OF
WASHCLOTH FOR EACH EYE
 NO SOAP ON FACE, UNLESS REQUESTED
 REDUCE DRAFTS IN ROOM, COVER WITH BATH
BLANKET
 ONLY EXPOSE AREA BEING WASHED
2.PERINEAL CARE
 MALE- PUSH BACK FORESKIN IF
UNCIRCUMCISED (RETURN WHEN FINISHED),

WASH IN CIRCULAR MANNER FROM MEATUS
(TIP) TOWARDS SCROTUM
 FEMALE- FROM FRONT TO BACK, SEPARATE
PART OF WASHCLOTH FOR EACH SIDE OF LABIA
3.NAIL CARE
 SOAK
 FILE AFTER SOAKING (STRAIGHT ACROSS)
 USE ORANGEWOOD STICK TO CLEAN UNDER
EACH NAIL
4.FOOT CARE
 DO NOTHING TO THE TOENAILS, SIMPLE SOAK
FEET AND WASH THEM
 LOTION TO TOP AND BOTTOM OF FOOT, NOT
BETWEEN THE TOES
5.SHAVING
 WET THE FACE
 HOLD SKIN TAUT

 SHAVE IN THE DIRECTION OF HAIR GROWTH
 IF ON AN ANTICOAGULANT OF BLOOD THINNER
(OR A DIABETIC) USE AN ELECTRIC RAZOR
 IF NICK, APPLY PRESSURE UNTIL BLEEDING
STOPS AND THEN TELL NURSE
 PLACE DISPOSABLE RAZOR IN SHARPS
CONTAINER
 LEAVE MUSTACHES, BEARDS AND SIDE BURNS
UNTOUCHED
6.HAIR CARE
 IF UNTANGLED AND NOT MATTED, START AT
SCALP
 IF TANGLED, START AT ENDS AND WORK
TOWARDS SCALP IN SECTIONS
 STYLE LONG HAIR UP, BRAIDED
 DO NOT CUT HAIR
7.ROUTINE MOUTHCARE FOR PERSON WHO CAN
EXPECTORATE (SPIT)

 FOWLER’S POSITION
 DONE AFTER BREAKFAST AND AT BEDTIME
 BRUSH TEETH AND TONGUE
 SHORT STROKES FROM GUM TO CROWN BACK
AND FORTH
8.MOUTHCARE FOR UNCONSCIOUS (ALSO WITH
ALZHEIMER’S, DYING, AFTER A CVA OR NPO
PERSON)
 LATERAL POSITION
 DONE Q2H
 USE SWABS
9.DENTURE CARE
 BRUSHED AFTER BREAKFAST AND AT BEDTIME
 USE TEPID OR COOL WATER TO BRUSH
 LINE SINK WITH A TOWEL
 STORE IN DENTURE CUP WITH NAME AND LID
ON IT

10. DRESSING
 THE AFFECTED SIDE IS DRESSED FIRST
 THE UNAFFECTED SIDE IS UNDRESSED FIRST
 OFFER CHOICES OF WHAT TO WEAR
 IF PERSON HAS AN IV: REMOVE GOWN FROM
ARM WITHOUT IV FIRST, DO NOT HOLD IV
LOWER THAN BODY- HAVE NURSE CHECK IV
AFTERWARDS
11. SHOWERS
 CLEAN, DISINFECT BEFORE AND AFTER USE
 MAKE SURE WATER IS WARM ENOUGH
 USE SHOWER CHAIR- MAY BECOME DIZZY
FROM HEAT
 IF ABLE TO BE LEFT ALONE, STAY WITHIN
HEARING DISTANCE OF PERSON
 BED IS STRIPPED AND NEW LINEN APPLIED ON
SHOWER OR COMPLETE BEDBATH DAY

X. BASIC NURSING SKILLS
 SAFE MOVING
 LOGROLLING PROTECTS NECK AND SUPINE BY
MOVING THE BODY AS ONE UNIT
 MOVE BODY IN SECTIONS (UPPER, MIDDLE AND
THEN LEGS AND FEET)
 TO MOVE UP COULD USE TRAPEZE BUT BETTER
TO GET 2ND
PERSON IF HEAVY OR OLD- HAVE
PERSON FLEX KNEES
 CAN USE A DRAWSHEET OR SLIDE SHEET
 ALWAYS PLACE BED BRAKES ON
A. IF TURNING AWAY FROM YOU, RAISE SIDE
RAIL FIRST
 DANGLING- DONE TO PREVENT ORTHOSTATIC
HYPOTENSION (A DROP IN BLOOD PRESSURE

WHEN GOING FROM LYING TO SITTING UP,
ESPECIALLY AFTER EXTENDED BEDREST
 HAVE RESIDENT SIT ON EDGE OF BED WITH
FEET NOT TOUCHING FLOOR BUT DANGLING
(SWINGING FREELY)
 MONITOR FOR DIZZINESS, OTHER COMPLAINTS
 IF PERSON HAS A WEAK SIDE, STAND ON THAT
SIDE
 MECHANICAL LIFTS
 REQUIRES TWO STAFF
 MUST BE TRAINED TO USE
ACE WRAPS
 PUT ON USING FIGURE EIGHT TURNS
 MAKE SURE IT IS SNUG BUT NOT TOO TIGHT
 CHECK AFTER APPLYING

NONSTERILE DRESSING CHANGE
 WASH HANDS AND PUT ON GLOVES
 REMOVE OLD DRESSING
 WASH HANDS AND PUT ON CLEAN GLOVES TO
APPLY NEW DRESSING
COLOSTOMY CARE
 COLOSTOMY DRAINS FORMED STOOL, IN LARGE
INTESTINE
 ILEOSTOMY DRAINS LIQUID STOOL, IN SMALL
INTESTINE
 KEEP STOMA CLEAN, REPORT IF NOT MOIST
AND PINK
 EMPTY POUCH WHENEVER FECES IS PRESENT
CATHETER CARE
 EMPTY URINE DRAINAGE BAG AT END OF SHIFT
 ALWAYS KEEP BAG BELOW BLADDER
 ATTACH BAG TO FRAME OF BED, NEVER THE
SIDE RAIL
 KEEP BAG OFF FLOOR

 MAKE SURE TUBING UNKINKED
 MOVE BAG TO OTHER SIDE ID BED WHEN
PERSON IS TURNED
 SECURE CATHETER TO MAN’S STOMACH
 SECURE CATHETER TO WOMAN’S INNER THIGH
 PROVIDE CATHETER CARE BY HOLDING
CATHETER WHERE IT ENTERS BODY AND
CLEANING 4 INCHES AWAY FROM BODY WITH
SOAP AND WATER
 CATHETER CARE IS DONE WITH AM/PM CARE
AND AFTER EVERY BM
 WHEN CHANGING A LEG BAG TO A STANDARD
BAG, CLEAN THE TUBING WITH ALCOHOL
WIPES

CONDOM CATHETERS
 LEAVE 1 INCH BETWEEN TIP OF PENIS AND
CATHETER
 USE ONLY ELASTIC TAPE TO HOLD IN PLACE TO
ALLOW BLOOD FLOW TO THE PENIS
ASSISTING WITH USE OF BEDPAN

 FRACTURE PAN USED FOR PATIENTS AFTER HIP
REPLACEMENT OR IN TRACTION OR CAST-
HANDLE PLACED TOWARDS FEET
 STANDARD PAN WIDE PART TOWARDS HEAD
 PLACE IN FOWLER’S POSITION TO USE
ENEMAS
 MAY BE ORDERED TAP WATER OR SOAP SUDS
 PLACE IN SIMS POSITION
 GIVE SLOWLY, LOWERING BAG TO SLOW DOWN
IF CRAMPING STARTS
 ENCOURAGE PERSON TO BREATH SLOWLY TO
RELAX
 SHOW NURSE THE ‘RETURN’ ONCE DONE
FECAL IMPACTION
 NOT HAVING BM, ONLY BROWN, LIQUID OOZES
OUT
 ENLARGED BELLY, FLATUS (PASSING GAS),
CRAMPING, RECTAL PAIN

 MUST BE MANUALLY REMOVED BY NURSES
FINGERS
FEEDING
 SERVE FOOD IN ORDER PREFERRED
 DO NOT HAVE TO WEAR CLOTHING
PROTECTOR, OFFER
 PUT 1/3 FOOD ON A TEASPOON
 ALLOW TO PARTICIPATE WITH FINGER FOODS
 SET FOOD UP LIKE FACE OF CLOCK FOR THE
BLIND
 USE ADAPTIVE UTENSILS
 SIT TO FEED, FACING THE PERSON
 MAKE SURE MOUTH IS EMPTY
FEEDING THE PERSON WITH DYSPHAGIA
 MONITOR FOR POCKETING, DROOLING,
SPITTING FOOD OUT, COUGHING, EATING
SLOWLY, GURGLING AT MEAL TIME AND
REPORT
 FEED IN GOOD ALIGNMENT, SUPPORT HEAD
AND SHOULDERS WITH PILLOWS

 GIVE VERBAL CUES TO SWALLOW
 CHECK FOR POCKETING
 ALTERNATE FOOD AND LIQUID
 LEAVE SITTING UP FOR AT LEAST 1 HOUR AC
ASSISTING WITH THERAPEUTIC DIETS
 LOW SALT FOR HYPERTENSION, RENAL AND
HEART DISEASE
 LOW FAT FOR HEART AND LIVER DISEASE
 PUREED FOR DYSPHAGIA
 MECHANICAL SOFT FOR EDENTULOUS PERSON
(NO TEETH)
 DIABETIC
 THICKENED LIQUIDS (NECTAR, HONEY, YOGURT-
LIKE AND PUREE)
 CLEAR LIQUIDS- TEA, GINGERALE, BROTH,
JELLO, APPLE JUICE, BLACK COFFEE
MY PLATE.GOV
 DIETARY GUIDE THAT ENCOURAGES WELL-
BALANCEDMEALS FROM 5 FOOD GROUPS

 EAT LESS, INCREASE WHOLE GRAINS, DRINK
SKIM MILK
ESSENTIAL NUTRIENTS
 CARBOHYDRATES FOR ENERGY
 PROTEIN FOR HEALING AND GROWING
 MINERALS
 FAT TO STORE VITAMINS AND FOR ENERGY
 VITAMINS
ASSISTING WITH HYDRATION
 FORCE OR ENCOURAGE FLUIDS- OFFER ABOUT
6 OUNCES OF A VARIETY OF FLUIDS EVERY 2
HOURS WHILE AWAKE FOR DEHYDRATION
 FLUID RESTTRICTION FOR EDEMA OR FLUID
RETENTION- REMOVE WATER PITCHER AND
CUP, RESIDENT ONLY DRINKS A SET AMOUNT
OF FLUID THAT IS SERVED BY STAFF,
MOUTHCARE Q2H
 NPO- REMOVE WATER PITCHER AND CUP, SIGN
OVER BED, GIVE MOUTH CARE Q2H

 WHEN PROVIDING DRINKING WATER LABEL
CONTAINER WITH NAME AND ROOM NUMBER,
DON’T TOUCH RIM OR INSIDE OF MUG OR LID
 DON’T LEAVE ICE SCOOPER IN ICE
CONTAINER/DISPENSER- MUST HAVE AN
HOLDER
ASSISTING WITH TUBE FEEDINGS (ENTERAL
FEEDINGS)
 GASTROSTOMY TUBE IS IN THE STOMACH
 NASOGASTRIC TUBE IS DOWN NOSE TO
STOMACH
 JEJUNOSTOMY TUBE IS IN THE SMALL
INTESTINES
 CAN BE FED INTERMITTNTLY BY A SYRINGE-
BOLUS FEEDINGS
 CAN BE FED CONTINUOUSLY BY A MACHINE
(PUMP)
 KEEP NPO, MOUTHCARE Q2H ( LUBRICATE LIPS
TOO)

 HOB MUST BE RAISED DURING FEEDINGS AND
2-3 HOURS AFTER
 REPORT NAUSEA, VOMITING, REGURGITATION
 SECURE TUBING WITH TAPE AND SAFETY PIN TO
GOWN
 NEVER STOP FEEDING OR PUT ON HOLD
 SECURE TUBE TO NOSE WITH TAPE
ASSISTING WITH PARENTERAL FEEDINGS (IV)
 ASSIST WITH ADLS
 PROTECT IV FROM COMING OUT
 ASSIST WITH AMBULATION AND PUSHING IV
POLE
 REPORT REDNESS, WARMTH OR COLD AT SITE,
SWELLING, WETNESS, PAIN
 NEVER REMOVE NEEDLE
 WHEN RESIDENT TURNS, MOVE IV POLE TOO,
ASSIST WITH BED MOBILITY
 TELL NURSE IF IV COMES OUT STAT

ASSISTING WITH EXERCISE
 ACTIVE ROM IS PERFORMED BY THE RESIDENT
 PASSIVE ROM IS PERFORMED BY THE AIDE
 ADDUCTION- MOVING TOWARD
 ABDUCTION- MOVING AWAY
 FLEXION- BENDING
 EXTENSION- STRAIGTENING
 DORSIFLEXION- BENDING UP
 PLANTAR FLEXION- BENDING DOWN
 EXERCISE TO POINT OF RESISTANCE, NEVER
FORCE
 SUPPORT ABOVE AND BELOW THE JOINT
 STOP, REPORT PAIN
 NEVER EXERCISE THE NECK
ASSISTING WITH CANE USE
 CANE HELD ON STRONG SIDE
 CANE MOVES 6 INCHES FORWARD
 WEAK LEG MOVED EVEN WITH CANE
 STRONG LEG MOVES AHEAD OF CANE

 REPEAT
 SHOULD BE EVEN WITH THE HIPS
 QUAD CANE HAS 4 TIPS
PREVENTING SKIN BREAKDOWN
 PRESSURE ULCERS RESULT FROM IMMOBILITY-
TURN AND REPOSITION Q2H
 CAUSED BY INCONTINENCE- KEEP SKIN CLEAN
AND DRY, USE MOISTURE BARRIER CREAM ON
DIAPER AREA
 CAUSED BY FRICTION- USE PILLOWS BETWEEN
AREAS THAT TOUCH, DUST WITH A LITTLE
POWDER FROM YOUR HANDS ONTO SKIN, AND
USE A DRAWSHEET TO MOVE IN BED
 CAUSED BY SHEARING WHEN SKIN STICKS TO
SURFACE AND BONE SLIDES IN OPPOSITE
DIRECTION- KEEP FROM SLIDING BY LEAVING IN
LOW FOWLER’S
 CAUSED BY POOR NUTRITION AND HYDRATION-
ENCOURAGE FLUIDS AND HYDRATE
 STAGE ONE- DISCOLORATION
 STAGE TWO- BLISTER

 STAGE THREE- OPEN SORE
 STAGE FOUR- BONE AND MUSCLE VISIBLE
 APPLY LOTION TO ALL BONY PROMINENCES
(ELBOWS, SHOULDERS, ETC)
PROMOTING SLEEP/REST
 BACK MASSAGE WITH WARMED LOTION, USE
FIRM STORKES
 OBSERVE SKIN BEFORE MASSAGE FOR RED
AREAS AND BRUISING
 NEVER MASSAGE OR RUB OVER RED AREAS-
TELL NURSE
 REPORT LOCATION, DURATION, CAUSE (IF
KNOWN), SEVERITY OF PAIN (ON SCALE OF 0-
10) TO NURSE
 ELDERLY NEED 7 TO 9 HOURS OF SLEEP- TOILET,
GIVE LIGHT SNACK, LEAVE NIGHT LIGHT ON AT
BEDTIME, PLACE IN COMFORTABLE POSITION,
CALM, QUIET SETTING
ASSISTING WITH POSITIONING

 HI-FOWLER’S-60 TO 90 DEGREES SITTING UP
 SEMI-FOWLER’S IS 30 DEGREES
 FOWLER’S IS SEMI SITTING OR 45 TO 60
DEGREES
 SIMS- LEFT LATERAL WITH TOP LEG FLEXED AND
BOTTOM ARM EXTENDED BEHIND BODY FOR
RECTAL TEMPS AND ENEMAS
 TRENDELENBERG- FEET HIGHER THAN HEAD
FOR PERSON GOING INTO SHOCK OR FEELING
FAINT
 SUPINE- LYING ON BACK
 PRONE- LYING ON STOMACH
ASSISTING WITH SPECIMEN COLLECTION
 24 HOUR URINE TO DETERMINE KIDNEY
FUNCTION- FIRST VOID OF DAY IS DISCARDED,
COLLECTION BEGINS WITH SECOND VOID,
RESTART IF A SPECIMEN NOT SAVED, FECES IN
URINE OR TOILET PAPER

 MIDSTREAM CLEAN CATCH- PERFORM
PERINEAL CARE, BEGIN VOIDING THEN IN
MIDDLE OF STREAM COLLECT URINE
 STOOL FOR HEMOCCULT- SIMPLE TEST TO
DETECT HIDDEN BLOOD IN FECES
 SPUTUM TEST FOR TB- IN MORNING PERSON
RINSES MOUTH WITH WATER, SITS UP, TAKES 2
DEEP BREATHS AND ON 3RD
DEEP BREATH
COUGHS OUT FORCEFULLY INTO CUP
 SPECIMENS MUST BE LABELED, HAVE A
REQUISITION SLIP, BE IN A BIOHAZARD BAG
 DON’T TOUCH LID OR INSIDE OF SPECIMEN
COLLECTION CUP
 WEAR GLOVES!
PREVENTING SKIN TEARS
 RIPS IN THE OUTER LAYERS OF SKIN WHEN
EPIDERMIS (TOP LAYER) SEPARATES FRM
UNDERLYING TISSUES

 CAUSES INCLUDE FRICTION, SHEARING, BEDS,
BEDRAILS, JEWELRY, HOLDING A PERSON TOO
TIGHT, REMOVING TAPE, DRESSING, LONG
FINGERNAILS, EQUIPMENT
 ARE VERY PAINFUL AND POSE A RISK FOR
INFECTION
 TELL NURSE STAT IF YOU CAUSE OR FIND A SKIN
TEAR
ASSISTING THE HEMORRHAGING CLIENT
 CALL FOR HELP
 PUT ON GLOVES AND APPLY PRESSURE, DO NOT
RELEASE
 ARTERIAL BLOOD IS BRIGHT RED, HIGH IN O2
AND WILL SPURT OUT
 RAISE ARM OR LEG ABOVE HEART LEVEL TO
SLOW BLEEDING DOWN
ASSISTING THE PERSON WHO FEELS FAINT
 CALL FOR HELP

 HAVE HIM SIT AND LEAN FORWARD, HEAD
TOWARDS KNEES
 OR IF LYING, RAISE HIS LEGS UP
ASSISTING THE SEIZURE VICTIM
 CALL FOR HELP
 PLACE ON FLOOR
 MOVE FURNITURE
 TURN HEAD TO SIDE AND SUPPORT ON PILLOW
 DON’T RESTRAIN
 NOTHING IN THE MOUTH
 TIME SEIZURE
 WEAR GLOVES- MAY BECOME INCONTINENT,
HAS INCREASE SALIVATION, MAY BE BLEEDING
IF TONGUE OR LIP BITTEN
ASSISTING THE PERSON HAVING A NOSEBLEED
(EPITAXIS)
 CALL FOR HELP
 PUT ON GLOVES

 HAVE PERSON TUCK CHIN IN
 YOU PINCH BRIDGE OF HIS NOSE
ASSISTING WITH CPR
 ESTABLISH UNRESPONSIVENESS
 CALL FOR HELP
 IF YOU ARE CERTIFIED, THE CADENCE IS 30
COMPRESSIONS TO 2 BREATHS
 USE THE CAROTID ARTERY IN NECK TO CHECK
FOR PULSELESSNESS
ASSISTING THE POST OP PATIENT
 MAY BE ON CBR- PREVENT SKIN BREAKDOWN
 ENCOURAGE USE OF INCENTIVE SPIROMETER
AND DEEP BREATHING EXERCISES
 SPLINT INCISION WITH A “HUG ME” PILLOW
WHEN COUGHING OR MOVING ABOUT

 PUT ON TED STOCKINGS AS ORDERED- LYING IN
SUPINE POSITION, NO TWISTS OR WRINKLES,
REMOVE EVERY 8 HOURS, DON’T SEND TO
LAUNDRY
ASSISTING WITH OXYGEN THERAPY
 NASAL CANNULA (NC) O2 GOES IN NOSTRILS
 MAKE SURE MASK OR NC ISN’T TOO TIGHT AND
IRRITATING FACE
 REMOVE FLAMMABLES, HAIR DRYER, WOOL
PRODUCTS AND SMOKING MATERIALS FROM
ROOM
 PLACE NO SMOKING SIGN ON DOOR
 DO NOT CHANGE FLOW RATE OR STOP O2
 TELL NURSE IS HUMIDIFIER NOT BUBBLING,
KEEP TUBING UNKINKED
 GOOD MOUTH CARE AND BECAUSE O2 IS
DRYING VASELINE ON LIPS
 CAN BE DELIVERED THROUGH WALL O2,
CONCENTRATOR, OR A PORTABLE TANK

XI. AGING PROCESS/ RESTORATIVE CARE
LATE ADULTHOOD (65 AND OLDER)
 MUST ADJUST TO DECREASED STRENGTH AND
LOSS OF HEALTH
 RETIREMENT AND LESS INCOME
 DEATH OF SPOUSE, FAMILY AND FRIENDS
 PREPARING FOR OWN DEATH
 DEVELOP NEW RELATIONSHIPS
ACCORDING TO MASLOW ALL HUMANS HAVE
 PHYSICAL NEEDS- O2, WATER, FOOD, SHELTER,
ELIMINATION AND INTIMACY
 SAFETY AND SECURITY NEEDS (CALL BELLS,
EXPLAINING PROCEDURES)
 LOVE AND BELONGING (TAKE TO ACTIVITIES,
PRIVATE VISITS)
 SELF ESTEEM (COMPLIMENTS AND
INDEPENDENCE, TO BE NICELY GROOMED)
 SELF ACTUALIZATION (ACHIEVEMENTS IN LIFE)

HOLISTIC CARE TAKES CARE OF ALL PARTS OF THE
PERSON
 PHYSICAL
 MENTAL
 SPIRITUAL
 SOCIAL
CULTURE AFFECTS
 CLOTHING
 MUSIC
 FOOD
 LANGUAGE
 HEALTH AND DEATH RITUALS

 VALUES
 RELIGION
ASK A PERSON TO TELL YOU ABOUT THEIR CULTURE
AND RESPECT THE DIFFERENCES
SEXUALITY IS HOW A PERSON EXPRESSES GENDER
 WOMEN LIKE MAKEUP, JEWELRY, DRESSING UP,
STOCKING, GETTING HAIR AND NAILS DONE
 MEN LIKE AFTERSHAVE, A SHAVE, A HAIR CUT
 IF TWO RESIDENTS WANT TO BE INTIMATE,
PLACE A DO NOT DISTURB SIGN ON THE DOOR,
TELL NO ONE EXCEPT THE NURSE, MAKE NO
COMMENTS AFTERWARDS
 IF A RESIDENT IS MASTURBATING, QUIETLY
TAKE HIM TO HIS ROOM AND GIVE HIM
PRIVACY, TELL THE NURSE

SYSTEM CHANGES (NORMAL)
INTEGUMENTARY SKIN IS DRY WRINKLES,
FRAGILE, LESS SWEAT
AND OIL GLAND
PRODUCTION, HAIR
GRAYS, THINS, BALDING,
HEAT REGULATION IS
OFF, AGE SPOTS
DECREASED SENSITIVITY
TO PAIN, SKIN SAGS
MUSCULO-SKELETAL ATROPHY, MUSCLES
WEAKER, STIFFER,
BONES WEAKER,
VERTEBRAE SHORTEN,
JOINTS STIFF AND
PAINFUL, HIP AND KNEE
JOINTS BECOME FLEXED,
DECREASED MOBILITY
CIRCULATORY HEART PUMPS WITH
LESS FORCE, HEART
ENLARGES, ARTERIES
NARROW AND BECOME
STIFFER, LESS BLOOD
FLOW THRU ARTERIES

NERVOUS FORGETFULNESS,
DIZZINESS, CONFUSION,
PUPILS REACT TO LIGHT
SLOWER, REFLEXES
SLOWER, HEARING LOSS
(ESPECIALLY HI
PITCHES), SMELL AND
TASTE DECREASE, SLEEP
PATTERNS CHANGE,
LESS TEARS, EYELIDS
THIN AND WRINKLE,
SLOWER TO RESPOND
RESPIRATORY RESPIRATORY MUSCLES
WEAKEN, LUNGS LESS
ELASTIC, CHEST DOESN’T
STRETCH AS MUCH,
DYSPNEA, DECREASED
STRENGTH TO COUGH
AND CLEAR SECRETIONS
IN AIRWAY
DIGESTIVE LOSS OF TEETH, LESS
SALIVA, DECREASED
APPETITE, DECREASED
SECRETION OF GASTRIC

ACIDS, INDIGESTION,
DECREASED PERISTALSIS
LEADING TO GAS AND
CONSTIPATION
URINARY REDUCED BLOOD
SUPPLY TO KIDNEYS,
BLADDER DOESN’T
STRETCH AS MUCH,
MAY NOT EMPTY
COMPLETELY,
FRQUENCY, URGENCY,
NIGHT TIME URINATION
REPRODUCTIVE LESS SPERM
PRODUCTION,
ERECTIONS TAKE
LONGER AND LAST
SHORTER, MENOPAUSE,
BREAST SAG, VAGINAL
DRYNESS

REHABILITATION
 PROCESS OF RESTORING A PERSON TO HIS
HIGHEST POSSIBLE LEVEL OF PHYSICAL,
PSYCHOLOGICAL, SOCIAL AND ECONOMIC
FUNCTION
 INVOLVES THE WHOLE PERSON
 PREVENTS OR REDUCES THE DEGREE OF THE
DISABILITY
 IMPROVES ABILITIES
RESTORATIVE CARE
 CARE THAT HELPS PERSONS REGAIN HEALTH,
STRENGTH AND INDEPENDENCE
 WHERE CNA COMES IN TO HELP WITH
POSITIONING, ELIMINATION,
COMMUNICATION, SELF CARE AND MOBILITY
ADAPTIVE EQUIPMENT
 SLIDEBOARD FOR GETTING IN/OUT OF BED
 BEDCRADLE- TO KEEP LINEN OFF LEGS AND
FEET, RELIEVES PRESSURE

 FOOTBOARD- TO PREVENT FOOTDROP
(PLANTAR FLEXION OF FOOT)
 SPLINTS
 TRAPEZE
 HAND ROLL
 BEDBOARDS- PLACED UNDER MATTRESS TO
PREVENT SAGGING
ASSISTING WITH REHAB AND RESTORATIVE
 KEEP IN GOOD ALIGNMENT
 ROM AS ORDERED
 NO PITY, JUST EMPATHY
 GIVE PRAISE EVEN FOR A LITTLE PROGRESS
 LISTEN
 STRESS WHAT PERSON CAN DO, NOT WHAT HE
CANNOT DO
 FOLLOW THE CARE PLAN
 HAVE A HOPEFUL OUTLOOK
END OF LIFE CARE

 DEATH IS PRONOUNCED WHEN NO
BREATHING, HEART RATE OR BP IS PRESENT
 STAGES OF DYING ARE DENIAL, ANGER,
BARGAINING, DEPRESSION AND ACCEPTANCE.
 COMFORT MEASURES LEADING UP TO DEATH
 DON’T WITNESS WILLS
 POST MORTEM CARE DONE WITH DIGNITY,
GIVING PRIVACY AND ASAP
 RIGOR MORTIS (STIFFENING OF BODY) BEGINS
IN 2-4 HOURS
 HEARING IS LAST SENSE TO GO AFTER DEATH
 TALK TO PERSON EVEN IF UNRESPONSIVE AND
EXPLAIN PROCEDURES
 STRAIGHTEN ARMS/LEGS, CLOSE MOUTH AND
EYES, BATH, PLACE IN SHROUD (PLASTIC SHEET)

XII. CARE IMPAIRED
CARING FOR THE CONFUSED
 PROVIDE SAFETY
 CALL BY NAME EVERY TME
 STATE YOUR NAME
 ASK CLEAR AND SIMPLE QUESTIONS
 KEEP CALENDARS AND CLOCKS AVAILABLE
 CALM, RELAXED SETTING
 BE CONSISTENT WITH ROUTINE
DEMENTIA- LOSS OF COGNITIVE FUNCTIN
INTERFERRING WITH ABILITY TO SOCIALIZE, SELF
CARE AND WORK
 NOT A NORMAL PART OF AGING, MUST
DETERMINE THE CAUSE- COULD BE BRAIN
TUMOR, MANY THINGS INCLUDING
ALZHEIMER’S DISEASE (AD)

 CAUSES MEMORY LOSS, FORGETTING SIMPLE
WORDS, MISPLACING THINGS, GETTING LOST,
MOOD CHANGES, POOR JUDGMENT,
PROBLEMS WITH EVERYDAY TASKS LIKE
SHOWERING, CANT PROCESS INFORMATION
AD
 PROGRESSIVE, FATAL ILLNESS WITH PRESENCE
OF PLAQUE AND TANGLES IN THE BRAIN
 MORE COMMON IN PEOPLE OVER 65 AND
WOMEN
 WANDER- ALLOW TO PACE IN SAFE AREA,
PLACE WANDERGUARD ON ANKLE
 SUNDOWNING- MORE CONFUSED IN EVENING-
KEEP ACTIVE DURING DAY, NO ACTIVITY CLOSE
TO BEDTIME, NIGHT LIGHT, SNACK, BACK RUB
 HALLUCINATIONS- SEE THINGS OR HEAR VOICES
THAT AREN’T REAL- DON’T ARGUE, DISTRACT,
REASSURE HIM HE IS SAFE, ELIMINATE NOISE,
PUT ON LIGHTS, GO TO ANOTHER PLACE,
COVER MIRRORS

 DELUSIONS- BELIEVE THINGS THAT AREN’T
TRUE- DON’T ARGUE, DISTRACT, REASSURE,
 CATASTROPHIC REACTIONS- EXTREME
RESPONSE TO NORMAL EVENTS- SCREAMING
AND CRYING OVER TAKING A BATH- SPEAK
SOFTLY, GIVE A TIME OUT, APPROACH FROM
FRONT, DON’T RUSH
 PERSEVERATION (REPETITIVE BEHAVIORS)
RESPOND EACH TIME, CANNOT CONTROL SELF,
ALLOW HARMLESS ACTS, ANSWER QUESTIONS
EVERY TIME
 RUMMAGING AND PILLAGING- RETURN ITEMS
WHEN RESIDENT IS OUT OF ROOM, GIVE A
RUMMAGING BOX
 HOARDING- CHECK FOR FOOD HOARDING,
REDUCE CLUTTER
USING VALIDATION THERAPY- SHOW THAT
PERSON’S FEELING AND NEEDS ARE FAIR AND HAVE
MEANING

 DON’T TRY AND CORRECT DELUSIONS, PLAY
ALONG
 DON’T BRING HER BACK TO REALITY, LET HER
LIVE THERE
 REQUIRES TRAINING AND SHOULD BE ON CARE
PLAN TO USE
DELIRIUM- SUDDEN ONSET OF SEVERE CONFUSION
AND RAPID CHANGES IN BRAIN FUNCTION
 RELATED TO A STRESSOR SUCH AS A ROOM
CHANGE, A PHYSICAL ILLNESS
 CONSIDERED A MEDICAL EMERGENCY
DEPRESSION
 2 TO 4 WEEKS OF SYMPTOMS
 TEARFUL
 HOPELELESS
 THOUGHTS OF DEATH
 ISOLATION

 NO INTERESTS
 CHANGE IN SLEEP AND EATING HABITS
 LISTEN, TELL NURSE, ASSIST WITH ADLS
 KEEP SAFE

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