Prepariugfor Tl,E Competency Eva/Uat,O,I You If You Are Late

Prepariugfor tl,e Competency Eva/uat,o,i you if you are late. Know the exact locationof the test site After completing your state's training program, you need and room. Actually drive or take transportation to the test to pass the competency evaluation. The purpose of the site a few days or a week beforethe test. Making a "dry competency evaluation is to make sure you can do your run" lets you know how much ti.me you need to travel, job safely. This section will help you prepare for the test. park, and get to the test site. It will also help decrease your anxiety level on the test day. To be admitted to the test, you need two pieces of Competency Ei1aluatio11 identification (ID). The first form of ID is a government The competency evaluation has a written test and a skills issued documentsuch as a driver's license or passport. test. The number of questions varies with each state. Each Jt must have a current photo and your signature. The question has 4 answer choices. Although some questions name on the ID must be the same as the name on your If may appear to have more than one possible answer, there application form. your name has changed and you is only 1 best answer. You will have about 1 minute to have not been able to have the name changed on your read and answer each question. Some questions take Jess identification documents, ask your instructoror employer time to read and answer. Other questions take longer. You what to do. The second form of ID must include your should have enough ti.meto take the test without feeling name and signature. Examples include a library card, rushed. hunting license, or credit card. The content of the written test varies depending on Take several sharpened Number 2 pencils to the test. your state. Content may include: For the skills test you will need a watch with a second • Activities of Daily Living-hygiene, dressing and hand. You may need a person to play the role of the grooming, nutrition and hydration, elimination, rest/ patient or resident. Ask your instructor or employer how sleep/comfort this is done in your state. • Basic Nursing Skills-infection control, safety/ Taking the written test and skills test may take several emergency, therapeutic/technical procedures (e.g., vital hours. You may want to bring snacks or lunch and a signs, bedmaking),data collection and reporting beverage to the testing site. Eating and drinking are not • Restorative Skills-prevention, self-care/independence allowed during the test. However, you may be told where • Emotional and Mental Health Needs you can eat while waiting for the test. • Spiritual and Cultural Needs You cannot bringtextbooks, study notes, or other • The Person's Rights materials into the testing room. The only exception may • Legal and Ethical Behavior be a language translation dictionary that you show to the • Being a Member of the Health Care Team proctor (a person who monitors the test) before the test • Communication begins. Cellphones, pagers, calculators, or other electronic The written test is given as a paper and pencil test in devices are not permitted during testing. Children and most states. Some test sites may use computers. You do not pets are not allowed in the testing areas. need computer experience to take the test on the computer. If you have difficulty reading English, you may request to take an oral test. Ta lk with your instructor or employer Stt1d)'it1�fi.r ,J.c ( w, {.)l'teuc, Ei•alu t10 , about detajls for computer testingor oral testing. You began to prepare for the written test and skills test The skills test involves performing 5 nursing skills during your training program. You learned the basic that you learned in your training program. These skills nursing content and skills needed to provide safe, quality are chosen randomly. You do not select the skills. You are care. The following suggestions can help you study for the allowed about 30 minutes to do the skills. See p. 503 for competency evaluation. more information about the skills test. • Begin to study at least 2 to 3 weeks before the test. Plan to study for 1 to 2 hours each day. • Decide on a specific time to study. Choose a study time Taki11g tl,e Compete11cy Evafoatio11 that is best for you. This may be early in the morning To register for the test, you need to complete an before others are awake. It may be in the evening after application. Your instructor or employer tells you when others go to sleep. Try to choose a time when you are and where the tests are given. There is a fee for the mentally alerl evaluation. If you work in a nursing center, the employer • Choose a specific area to study in. This area should may pay this fee. If you pay the fee, you may need to be quiet, well lit, and comfortable. You should have purchase a money order or certified check. Make sure enough room to write and to spread out your books, your name is on the money order or certified check. Cash notes, and other study aids. The area does not need to and personal checks may not be accepted. be noise-free. The testing site is not absolutely quiet. Plan to arrive at the test site about 15 to 30 minutes You want to concentrate and not be distracted by the before the evaluation begins. Most centers do not admit noise around you.

• Collect everything you need before settling down usually results in some action. To overcome anxiety before to study. This includes your textbool-.,notes, paper, the test: highlighter:.,and pens or pencils. • Study and prepare for the test. That helps increase • Take short breaks when you need them. Take a break your confidence as you recall or clarify what you have when your mind begins to wander or if you feel sleepy. learned.Anxiety decreases as confidence increases. • Develop a study plan. Write your plan down so you can When you think you know the information, keep refer to it. Study l content area before going on to the studying. This reinforces your learning. next. For example, study personal hygiene before going • Develop a positive mental attitude. You can pass this on to vital signs. Do not jump from 1 subject to another. test. You took tests in your training program and passed • Use a variety of ways to study. them. Praise yourself. Talk to yourself in a positive way. Use index cards to help you review abbreviations and If a negative thought enters your mind, stop it at once. terminology. Put the abbreviation or term on the front Challenge the mentaJ thought and tell yourself you wiU of the card and place the meaning on the back. Take pass the test. the cards with you and review them whenever you • Visualize success. Think about how wonderful you will have a break or are waiting. feel when you are notified that you have passed the test. Record key points. You can listen to the recording • Perform breathing exercises. Breathe ,;lowlyand deeply. while cooking or while riding in the car. • Perform regular exercise. Exercise helps you stay Study groups are another way to prepare for a test. physically fit. Jt also helps keep you calm. Croup members can quiz each other. • Good nourishment helps you think clearly. Eat a • To remember what you are learning,try these ideas. nourishing meal before the test. Do not skip breakfast. Relax when you study. When relaxed, you learn Vitamin C helps fight short-term stress. Protein and information quickly and recall it with greater ease. calcium help overcome the effects of long-term stress. Repeat what you are learning.Say it out loud. This Complex carbohydrates (pasta, nuts, yogurt) can help helps you remember the idea. settle your nerves. Eat familiar foods the day before and Make the information you are learningmeaningful. the day of the test. Do not eat foods that could cause Think about how the infom1ation will help you be a stomach or intestinal upset. good nursing assistant. • Maintain a normaJ routine the day before the test. Write down what you are learning.Writing helps you • Get a good night's sleep before the test. Go to bed early remember information. Prepare study sheets. enough so you do not oversleep or are too tired to get Be positive about what you are learning. You up. Set your alarm clock properly. You may want to set remember what you find interesting. two alarm clocks. • Suggestions for studying if you have children: • Do not "cram" the evening before or the day of the When you first come home from work or school, test. Last-minute cramming increases your anxiety. Do spend time with your children. Then plan study something relaxing with family and friends. time. • Avoid drinking large amounts of coffee, colas, water, or '' Select educational programs on TV that your children other beverages. You do not want to be uncomfortable can watch as you study. with a full bladder when you take the test. When you take your study breaks, spend time with • Wear comfortable clothe:,. Dress in layers so that you are your children. prepared for a cold or warm room. Ask other adults to take care of the children while • If you are a woman, remember that worry and anxiety you study. can affect your menstrual cycle. Wear a panty Liner, • Take the hvo 75-question practice tests in this section. sanitary napkin, or tampon if you think your period Each question has the correct answer and the reason may start. This eliminates worry about soiling your why an answer is correct or incorrect. If you practice clothing during the test. taking tests, you are more Likely to pass them. Take the • Allow plenty of time for travel, traffic, and parking. practice tests under conditions similar to the real test. • Arrive early enough to use the restroom before the test Work within time limits. begins. • If your state has a practice test and a candidate • Do not talk about the test with others. Their panic or handbook, study the content. Some states have practice anxiety may affect your self-confidence. tests on-line.

Taking tl,e Test Managing Auxiety Follow these guidelines for taking the test. Almost everyone dreads taking tests. It is common and • Listen carefully and follow the instructions given by the normal to experience anxiety before taking a test. If used proctor (person administering the test). wisely, anxiety can actually help you do welJ. When you • When you receive the test, make certain you have all the are anxious, that means you are concerned. You may be test pages. concernedabout how prepared you are to take the test. • Read and follow all directions carefully. Or you may be concerned about how you will feel about • You are not allowed to ask questions about the content yourself if you do not pass the test. Being concerned of the test questions.

• Do deep-breathing and muscle-relaxation exercises as • Look for key words in every guestion. Sometimes needed. key words are in italics, highlighted, or underlined. • Cheating of any kind is not allowed. If the proctor sees Common key words are always, never,first,except, best, you giving or receiving any type of assistance, your test not, correct, incorrect, true, and false. booklet is taken and you must leave the testing site. • Know which words can make a statement correct (e.g., • Tf using a computer answer sheet, completely fill in the may, can, usually, most, at least, sometimes). The word bubble. "except" can make a question a false statement. • If you make a mistake, erase the wrong answer • Be careful of answers wilh these key words or phrases: completely. Do not make any stray marks on the paper. always, never, every, only, all, none, at all times, or at Not erasing completely or leaving stray marks could 110 time. These words and phrases do not allow for cause the computer to misread your answer. exceptions. In nursing, exceptions are generally present. • Do not worry or get anxious if people finish the test However, sometimes answers containing these words before you do. Persons who finish a test early do not are correct. For example, which of the following is necessarily have a better score than those who finish correct and which are incorrect? later. a. AJways use a turning sheet. • You cannot take any evaluation materials or notes out of b. Never shake linens. the testing room. c. Soap is used for aU baths. d. The call light must always be attached to the bed. The correct answer is b. Incorrect answers are a, c, and d. • Omit answers that are obviously wrong. Then choose Answering Multip/e-Clroice Qt1estio11s Pace yourself during the test. First, answer all the the best of the remaining answers. questions that you know. Then go back and answer • Go back to the questions you skipped. Answer all skipped questions. Sometimes you will remember the questions by eliminating or narrowing your choices. answer later. Or another test question may give you a Always mark an answer even if you are not sure. due to the one you skipped. Spending too much time on • Review the test a second time for completeness and a question can cost you valuable time later. To help you accuracy before turning it in. answer the questions or statements: • Make sure you have answered each question. Also • AJways read the questions or statements carefully. Do check that you have given only 1 answer for each not scan or glance at questions. Scanning or glancing question. can cause you to miss important key words. Read each • Remember, the test is not designed to trick or confuse word of the question. you. The written competency evaluation tests what you • Before reading the answers, decide what the answer know, not what you do not know. You know more than is in your own words. Then read all 4 answers to the you are asked. question. Select the 1 best answer. • Do not read into a question. Take the question as it is asked. Do not add your own thoughts and ideas to the On-Line Testi11g question. Do not assume or suppose "what if." Just The test may be given by computer at the test site. Ask respond to the information provided. your instructor what computer skills you will need. You • Trust your common sense. If unsure of an answer, select usually do not need keyboard or typing skills. You will your first choice. Do not change your answer unless use a computer mouse to select answers. Also, you will you are absolutely sure of the correct answer. Your first usually receive instruction before the test begins. This will reaction is usually correct. let you practice using the computer before starting the test.

CHAPTER 1 INTRODUCTION TO HEALTH • Follows the direction of the registered nurse (RN) CARE AGENCIES leading the team. llet1lth Care Agency Purposes The Nursing Team • Health promotion • Provides quality care to people. • Disease prevention • Care is coordinated by an RN. • Detection and treatment of disease Nursing Assistants • Rehabilitation and restorative care • Report to the nurse supervising their work. • Perform delegated tasks under the supervision of a Hosp,tnls licensed nurse. • Hospitals provide emergency care, surgery, nursing • Have passed a nursing assistant training and care, x-ray proceduresand treatments, and laboratory competency evaluation program. testing. • Hospitals also provide respiratory, physical, \.leetmg St n lards occupational, speech, and other therapies. Survey Process • Persons cared for in hospitals are called patients. • Surveys are done to see if agencies meet standards for Hospital patients have acute, chronic, or terminal licensure, certification, and accreditation. illnesses. • A License is issued by the state. A center must have a license to operate and provide care. Rd1t1b1lit11tw11 and Sub-Awte Care Agemies • Certification is required to receive Medicare and • Provide medical and nursing care for people who do Medicaid funds. not need hospital care but are too sick to go home. • Accreditation is voluntary. It signals quality and excellence.

l.011g-Term Care Centers Your Role • Provide care for people who do not need hospital care • Provide quality care. but cannot care for themselves at home. • Protect the person's rights. • Provide medical and nursing, dietary, recreational, • Provide for the person's and your own safety. rehabilitative, and social services. Housekeeping and • Help keep the center clean and safe. laundry services are also provided. • Conduct yourself in a professional manner. • Residents are older or disabled. • Have good work ethics. • Skilled nursing facilities provide more complex care. • Follow agency policies and procedures. • Some residents are recovering from illness, injury, or • Answer questions honestly and completely. surgery. • Some residents return home when well enough. Some CHAPTER l REVIEW QUESTIONS residents need nursing care until death. Circle the BEST answer. 1. Nursing assistants do all of the following except A sisted Ln•mi Fan/mes a. Provide quality care • Provide housing, personal care, support services, health b. Follow agency policies and procedures care, and social activities in a home-like setting for c. Conduct themselves in an unprofessional manner persons needing help with daily activities. d. Help keep the agency clean and safe 2. Nursing assistants report to Ocher Healtl, Agencies a. Other nursing assistants • Other health agencies include mental health centers, b. Licensed nurses home care, hospice, and health care systems. c. The administrator d. The medical director f/1( Heall/, Jeam 3. All the following are true about the health team except • Involves many health care workers whose skills and a. Involves many health care workers knowledge focus on total care. b. Follows the direction of the physician • Works together to provide coordinated care to meet c. Works together to provide coordinated care each person's needs. d. Follows the direction of the RN Answers to tlrese questions are on p. 516.

CHAPTER 2 THE PERSON'S RIGHTS o Choose activities, schedules, and care based on their • Centers must protect and promote residents' rights. preferences. Residents must be free to exercise their rights without o Choose when to get up and go to bed, what to wear, interference. If residents are not able to exercise their how to spend their time, and what to eat. rights, legal representatives do so for them. o Choose friends and visitors inside and outside the center. The Omnibus BUtlget Reconciliation Act of 1987(0BRA) Grievances • OBRA is a federal law. • Residents have the right to voice concerns, questions, • OBRA requires that nursing centers provide care in a and complaints about treatment or care. manner and in a setting that maintains or improves • The center must try to correct the matter promptly. each person's quality of life, health, and safety. • No one can punish the person in any way for voicing • OBRA requires nursing assistant training and the grievance. competency evaluation. • Resident rights are a major part of OBRA. Work Information • The person is not required to work or perform services • The right to information includes: for the center. 0 Access to all records about the person, including • The person has the right to work or perform services if medical records, incident reports, contracts, and he or she wants to. financial records • Residents volunteer or are paid for their services. 0 Information about the person's health condition o Information about the person's doctor, including Taking Part in Resident Groups name, specialty, and contact information • The person has the right to: • Report any request for information to the nurse. ° Form and take part in resident and family groups. 0 Take part in social, cultural, religious, and community Refusing Treatment events. The resident has the right to help in getting to • The person has the right to refuse treatment. and from events of their choice. • A person who does not give consent or refuses treatment cannot be treated against his or her wishes. • The center must find out what the person is refusing Personal Items and why. • The resident has the right to: • Advance directivesare part of the right to refuse treatment. o Keep and use personal items, such as clothing and • Report any treatment refusal to the nurse. some furnishings. o Have his or her property treated with care and Privacy and Confidentiality respect. Items are labeled with the person's name. • Residents have the right to: • Protect yourself and the center from being accused 0 Personal privacy. The person's body is not exposed of stealing a person's property. Do not go through a unnecessarily. Only staff directly involved in care and person's closet, drawers, purse, or other space without treatments are present. The person must give consent the person's knowledge and consent. If you have to for others to be present. A person has the right to use inspect closets and drawers, follow center policy for the bathroom in private. Privacy is maintained for all reporting and recording the inspection. personal care measures. o Visit with others in private-in areas where others Freedom From Abuse, Mistreatment, cannot see or hear them. This includes phone calls. and Neglect 0 Send and receive mail without others interfering. • Residents have the right to be free from: No one can open mail the person sends or receives 0 Verbal, sexual, physical, or mental abuse without his or her consent. Unopened mail is given to 0 Involuntary seclusion-separating a person from the person within 24 hours of delivery to the center. others against his or her will, confining a person to a • Information about the person's care, treatment, and condition is kept confidential. So are medical certain area, or keeping the person away from his or and financial records. Consent is needed to release her room without consent • No one can abuse, neglect, or mistreat a resident. information to other agencies or persons. This includes center staff, volunteers, staff from other Personal Choice agencies or groups, other residents, family members, • Residents have the right to make their own choices. friends, visitors, and legal representatives. They can: • Nursing centers must investigate suspected or reported ° Choose their own doctors. cases of abuse. 0 Take part in planning and deciding their care and treatment.

Freedom From Restraint CHAPTER 3 THE NURSING ASSISTANT • Residents have the right to not have body movements Federal and State Laws restricted by restraints or drugs. Nurse Practice Acts • Restraints are used only if required to treat the person's • Each state has a nurse practice act. It regulates nursing medical symptoms or if necessary to protect the person practice in that state. or others from harm. If a restraint is required, a doctor's order is needed. Nursing Assistants • A state's nurse practice act is used to decide what Quality of Life nursing assistants can do. Some nurse practice acts also regulate nursing assistant roles, functions, education, • Residents must be cared for in a manner that promotes dignity and self-esteem. Physical, and certification requirements. Some states have psychological, and mental well-being must be separate laws for nursing assistants. promoted. Review Box 2-3, OBRA-Required Actions • Nursing assistants must be able to function with skill to Promote Dignity and Privacy, in the Textbook. and safety. They canhave their certification, license, or • Centers must provide activity programs that promote registration denied, revoked, or suspended. physical, intellectual, social, spiritual, and emotional T1,e Omnibus Budget Reconciliation Act of l987 (OBRA) well-being. • The purpose of OBRA, a federal law, is to improve the • Residents have the right to a safe, clean, comfortable, quality of life of nursing center residents. and home-like setting. The center must provide a • OBRA sets minimum training and competency setting and services that meet the person's needs and evaluation requirements for nursing assistants. Each preferences. The setting and staff must promote the state must have a nursing assistant training and person's independence, dignity, and well-being. competency evaluation program (NATCEP). A nursing assistant must successfully complete a NATCEP to work Ombudsman Program in a nursing center, hospital, long-term care unit, or • The Older Americans Act requires a long-term care home care agency receiving Medicare funds. ombudsman program in every state. • OBRA requires at least 75 hours of instruction. Some • Ombudsmen are employed by a state agency. states have more hours. At least 16 hours of supervised They are not nursing center employees. Some are training in a laboratory or clinicalsetting are required. volunteers. 0 The competency evaluation has a written test and a • Ombudsmen protect the health, safety, welfare, and skills test. rights of residents. They also may investigate and 0 The written test has multiple-choice questions. resolve complaints, provide support to resident and 0 The number of questions varies from state to state. family groups, and help the center manage difficult 0 The skills test involves performing certain skills problems. learnedin your training program. • OBRA requires that nursing centers post the names, • OBRA requires a nursing assistant registry in each addresses, and phone numbers of local and state state. It is an official record that lists persons who have ombudsmen where the residents can easily see it. successfully completed the NATCEP. • Because a family member or resident may share a • Re-training and a new competency evaluation concern with you, you must know the state and center program are required for nursing assistants who have policies and procedures for contacting an ombudsman. not worked for 24 months. To work in another state, nursing assistants must meet that state's NATCEP. CHAPTER2 REVIEW QUESTIONS • Each state's NATCEP must meet OBRA requirements. Circle the BESTanswer. Roles and Responsibilities 1. Residents have all the following rights except • Nurse practice acts, OBRA, state laws, and legal and a. Refusing a treatment advisory opinions direct what nursing assistants can do. b. Making a telephone call in private • The range of functions for nursing assistants varies c. Choosing activities to attend among states and agencies. Before performing a nursing d. Being punished for voicing a grievance task make sure that: 2. OBRA does not require nursing assistant training and 0 The state allows nursing assistants to do that task. competency evaluation. 0 It is in the job description. a. True 0 You have the necessary education and training. b. False 0 A nurse is available to answer questions and to 3. The person has a right to take part in planning and supervise the task. deciding their care and treatment. a. True • Rules nursing for assistants to follow are in Box 3-2 in b. False the Textbook. 0 You are an assistant to the nurse. 4. The person is required to work for the center. a. True 0 A nurse assigns and supervises your work. 0 b. False You report observations about the person's physical and mental status to the nurse. Report changes in the Answers to these questions are on p. 516. person's condition or behavior at once.

o The nurse decides what should be done for a person. 2. A resident asks you about his or her medical condition. You do not make these decisions. You o Review directions and the care plan with the nurse a. Tell the nurse about the resident's request before going to the person. b. Tell the resident what is in his or her medical record 0 Perform only those nursing tasks that you are trained c. Ignore the question to do. d. Tell another nursing assistant about the resident's o Ask a nurse to supervise you if you are not request comfortable performing a nursing task. 3. You answer the telephone. The doctor starts to give you o Perform only the nursing tasks that your state and job an order. You description allow. a. Take the order from the doctor • State laws and rules limit nursing assistant functions. b. Politely give your name and title, ask the doctor to State laws differ. Know what you can do in the state in wait for the nurse, and promptly find the nurse which you are working. c. Politely ask the doctor to call back later ... • Role limits for nursing assistants are in Box 3-3 in the d. Ask the doctor if the nurse may call him or her back Textbook. 4. When should you refuse a task? o Never give drugs. a. The task is not in your job description. o Never insert tubes or objects into body openings. Do b. The task is within the legal limits of your role. not remove tubes from the body. c. The directions for the task are clear. o Never take oral or telephone orders from doctors. d. A nurse is available for questions and supervision. o Never perform procedures that require sterile Answers to these questions are on p. 516. technique. o Never tell the person or family the person's diagnosis or treatment plans. CHAPTER 4 DELEGATION o Never diagnose or prescribe treatments or drugs for Who Can Delegate anyone. • Registered nurses (RNs) can delegate tasks to nursing o Never supervise others, including other nursing assistants. In some states, licensed practical nurses/ assistants. licensed vocational nurses (LPNs/LVNs) can delegate o Never ignore an order or request to do something. tasks to nursing assistants. This includes nursing tasks that you can do, those • The delegating nurse is legally responsible for his or you cannot do, and those that are beyond your legal her actions and the actions of others who performed the limits. delegated tasks. • Nursing assistants cannot delegate. You cannot delegate Nursing Assistant Standards any task to other nursing assistants or to any other worker. • OBRA defines the basic range of functionsfor nursing assistants. The Delegation Process • All NATCEPs include those functions. Some states • Delegation decisions must protect the person's health allow other functions. and safety. • Review Box Nursing Assistant Standards, in the 3-4, • If you perform a task that places the person at risk, you Textbook. may face serious legal problems. • Step I-Assessment and Planning. The nurse assesses Job Description and Job Titles the person's needs and then decides if it is safe to • Always obtain a written job description when you delegate the task. apply for a job. Do not take a job that requires you to: • Step 2--Communication. The nurse must give clear 0 Act beyond the legal limits of your role. and complete directions about the task and you must ° Function beyond your training limits. understand the directions to give safe care. After the 0 Perform acts that are against your morals or religion. task, you report and record the care that was given. • For job purposes, agencies often use other titles for • Step 3-Surveillance and Supervision. The nurse nursing assistants who have completed a NATCEP and observes the care you give and makes sure you are on a state registry. Your job title depends on the complete the task correctly. The nurse must follow up setting and your roles and functions in the agency. on problems or concerns if you did not perform the task according to expectations or there is a change in the CHAPTER 3 REVIEW QUESTIONS person's condi ti.on. Circlethe BEST answer. • Step 4-Evaluation and Feedback. The nurse decides if 1. Nursing assistants perform nursingtasks delegated to the delegation was successful by observing if the task them by a registered nurse (RN) or licensed practical was done correctly and the outcome and the person's .l nurse/licensed vocational nurse (LPN/LYN) . response were as expected. The nurse should provide a. True feedback to the nursing assistant about what was done b. False correctly and what errors should be corrected.

Tire Five Riglrrs of Delegation 3. You may perform a task that is not in your job • The right task. Can the task be delegated and is the nurse description as long as a nurse has delegated the task. allowed to delegate the task? ls the task in your job a. True description? b. False • Tlte right circumstances. What are the person's physical, Answers to these questions are on p. 516. mental, emotional, and spiritual needs at the time? • Tlte right person. Do you have the training and experience to perform the task safely? CHAPTER 5 ETHICS ANO LAWS • The right directions and co1111111mication. The nurse gives Ftl, ical Asp "cts clear directions and instructions. The nurse allows • Ethics is the knowledge of what is right conduct and questions and helps you set priorities. wrong conduct. It also deals with choices or judgments • The right supervision. The nurse guides, directs, and about what should or should not be done. An ethical evaluates the care you give. The nurse demonstrates person does not cause a person harm. tasks as needed and is available for questions. The nurse • Ethical behavior involves not being prejudiced or assesses how the task affected the person and how well biased. To be prejudiced or biased means to make you performed the task and tells you what you did well judgments and have views before knowing the facts. and how to improve your work. You should not judge a person by your values and standards. Also, do not avoid persons whose standards Ytw Role , , Delegation and values differ from your own. • When you agree to perform a delegated task on a • Ethical problems involve making choices. You must person, you must protect the person from harm. You are decide what is the right thing to do. responsible for your own actions. You must complete the task safely. You must ask for help if you have Codes off l11cs questions or are unsure. Report to the nurse what you • Professional groups have codes of ethics. A code of did and the observations you made. ethics has rwes, or standards of conduct, for group • You should refuse to perform a task when: members to follow. o The task is beyond the legal limits of your role. • Rules of conduct for nursing assistants can be found in The task is not in your job description. Box 5-1 in the Textbook. You were not trained to perform the task. The task could harm the person. Boundaries The person's condition has changed. • Professional boundaries separate helpful behaviors ' You do not know how to use the supplies or from beha\'iors that are not helpful. equipment. • A boundary crossing is a brief act of over-involvement Directions are not ethical or legal. with the person in order to meet the person's needs, 0 Directions are against agency policies. such as giving a crying patient a hug. Directions are unclear or incomplete. • A boundary violation is an act or behavior that meets A nurse is not available for supervision. your needs, not the person's. The act or behavior is • Never ignore an order or refuse a task because you do LLnethical. Boundary violations include abuse, keeping not Like it or do not want to do it. Tell the nurse about secrets with a person, or giving a lot of personal your concerns. information about yourself to another. • Professional sexual misconduct is an act, behavior, Cl-\PTER,1 REVIEWQUESTIONS or comment that is sexual in nature. lt is sexual E Circle the BST a,1swer. misconduct even if the person consents or makes the 1. A nurse delegates a task that you did not learn in your first move. training. The task is in yoLLr job description. What is • To maintain professional boundaries, review Box 5-2, your appropriate response to the nurse? Rules for Maintaining Professional BoLLndaries. Be alert a. "I cannot do that task." to (acts, behaviors, or thoughts that boundarysigns b. "J did not learn that task in my training. Can you warn of a boundary crossing or violation). show me how to do it?" c. "I will ask the other nursing assistant to watch me I.es .I AsJ s do the task." • Ethics is about what you should or should not do. Laws d. "I will ask the other nursing assistant to do the task tell you what you can and cannot do. for me." • Negligence is an Llnintentional wrong. The negligent 2. You are busy with a new resident. lt is time for another person did not act in a reasonable and careful manner. resident's bath. You may delegate the bath to another As a result, the person or person's property was nursing assistant. harmed. The person causing harm did not mean to a. True cause harm. b. False • Malpractice is negligence by a professional person.

• You are legally responsible (liable) for your own actions. • Persons who cannot give consent are persons who The nurse is liable as your supervisor. are under the legal age or are mentally incompetent. Unconscious, sedated, or confused persons cannot give • Defamation is injuring a person's name and reputation by making false statements to a third person. Libel is consent. Informed consent is given by a responsible making false statements in print, writing (including party-wife, husband, daughter, son, or legal e-mails and texts), or through pictures or drawings. representative. Slander is making false statements orally. Never • You are never responsible for obtaining written consent. make false statements about a patient, resident, family member, co-worker, or any other person. Reporting Abuse • False imprisonment is the unlawful restraint or • Abuse is restriction of a person's freedom of movement. It o The willful infliction of injury, unreasonable involves threatening to restrain a person, restraining confinement, intimidation, or punishment that a person, and preventing a person from leaving the results in physical harm, pain, or mental anguish. agency. Intimidation means to make afraid with threats of • Invasion of privacy is violating a person's right not to force or violence. have his or her name, photo, or private affairs exposed ? Depriving the person (or the person's caregiver) of or made public without giving consent. Review Box 5-4, the goods or services needed to attain or maintain Protecting the Right to Privacy, in the Te xtbook. well-being. • The Health Insurance Portability and Accountability • Abuse also includes involuntary seclusion. Act (HIPAA) of 1996 protects the privacy and security • Vulnerable adults are persons 18 years old or older of a person's health information. Protected health who have disabilities or conditions that make them information refers to identifying information and at risk to be wounded, attacked, or damaged. They information about the person's health care that is have problems caring for or protecting themselves maintained or sent in any form (paper, electronic, oral). due to: Direct any questions about the person or the person's o A emotional, mental, physical, or developmental care to the nurse. disability • Fraud is saying or doing something to trick, fool, or o Brain damage deceive a person. The act is fraud if it does or could � Changes from aging cause harm to a person or the person's property. • All residents are vulnerable. Older persons and children • Assault is intentionally attempting or threatening to are at risk for abuse. touch a person's body without the person's consent. The • Elder abuse is any knowing, intentional, or negligent person fears bodily harm. act by a caregiver or another person to an older • Battery is touching a person's body without his or her adult. It may include physical abuse, neglect, verbal consent. Protect yourself from being accused of assault abuse, involuntary seclusion, financial exploitation or and battery. Explain to the person what you are going to misappropriation, emotional or mental abuse, sexual do and get the person's consent. abuse, or abandonment. Review Box 5-7, Signs of Elder Abuse, in the Textbook. Jng ul ·e of �lee nnic Commrmicat,on • Federal and state laws require the reporting of elder • Electronic communications include e-mail, text abuse. messages, faxes, websites, video sites, and social media • If you suspect a person is being abused, report your sites. Video and social media sites include Facebook, observations to the nurse. Tw itter, Linked.In,YouTube, Instagram, Pinterest, Tumblr, blogs and comments to blog postings, chat CHAPTER5 REVIFW QUESTIONS rooms, bulletin boards, and so on. Circle the BEST answer. • Wrongful use of electroniccommunications can result offers you a gift certificate for being kind to in job loss and loss of your certification (license, 1. A resident registration) for: her. You should o Defamation a. Say "thank you" and accept the gift o Invasion of privacy b. Accept the gift and give it to charity o HIPAA violations c. Thank the resident for thinking of you and then o Violating the right to confidentiality explain it is against policy for you to accept the � Patient or resident abuse gift Unprofessional or unethical conduct d. Accept the gift and give it to your daughter 2. To protect a person's privacy, you should do the following except 11110 �med Cc nsent a. Keep all information about the person confidential • A person has the right to decide what will be done to his b. Discuss the person's treatment or diagnosis with the or her body and who can touch his or her body. Consent nurse supervising your work is informed when the person clearly understands all c. Open the person's mail aspects of treatment. d. Allow the person to visit with others in private

3. What should you do if you suspect an older person is • Personal hygiene needs careful attention. Bathe daily, being abused? use deodorant or antiperspirant, and brush your teeth a. Report the situation to the health department. often. Shampoo often. Keep fingernails dean, short, and b. Notify the nurse and discuss the observations with neatly shaped. him or her. • Review Box 6-2, Practices for a Professional Appearance, c. Notify the doctor about the suspected abuse. in the Textbook. d. Ask the family why they are abusing the person. 4. A resident needs help going to the bathroom. You do Teamwork not answer her call light promptly. She gets up without • Practice good work ethics-work when scheduled, be help, falls, and breaks a leg. This is an example of cheerful and friendly, perform delegated tasks, be kind a. Negligence to others, and be available to help others. b. Defamation • Be ready to work when your shift starts. Arrive on your c. False imprisonment nursing unit a few minutes early. Stay the entire shift. d. Slander When it is time to leave, report off duty to the nurse. 5. Examples of defamation include all the following except • A good attitude is needed. Review Box 6-1, Qualities a. Implying or suggesting that a person uses drugs and Traits for Good Work Ethics, in the Textbook. b. Saying that a person is insane or mentally ill • Gossiping is unprofessional and hurtful. To avoid being c. Implying that a person steals money from staff a part of gossip: d. Burning a resident with water that is too hot � Remove yourself from a group or setting where 6. Which statement about ethics is false? people are gossiping. a. An ethical person does not judge others by his or her " Do not make or repeat any comment that can hurt values and standards. another person or the agency. b. An ethical person avoids persons whose standards ' Do not make or repeat any comment that you do not and values differ from his or her own. know is true. c. An ethical person is not prejudiced or biased. Do not talk about residents, family members, d. An ethical person does not cause harm to another patients, visitors, co-workers, or the agency at home person. or in social settings. 7. Examples of false imprisonment include all of the • Confidentiality means trusting others with personal following except and private information. The person's information is a. Threatening to restrain a resident shared only among staff involved in his or her care. b. Restraining a resident without a doctor's order Agency, family, and co-worker information also is c. Treating the resident with respect confiden tia I. d. Preventing a resident from leaving the agency • Your speech and language must be professional. 8. To protect yourself from being accused of assault and Do not swear or use foul, vulgar, or abusive battery, you should explain to the resident what you language. plan to do before touching him or her and get consent. <' Do not use slang. a. True Speak softly, gently, and clearly. b. False Do not shout or yell. Answers to tliese questions are 011 p. 516. Do not fight or argue with a person, family member, visitor, or co-worker. • A courtesy is a polite, considerate, or helpful comment CHAPTER 6 STUDENT AND WORK ETHICS or act. • Professionalism involves following laws, being ethical, o Address others by Miss, Mrs., Ms., Mr., or Doctor. having good work ethics, and having the skills to do Use a first name only if the person asks you to do so. your work. " Say "please" and "thank you." Say "I'm sorry" when • Work ethics deals with behavior in the workplace. you make a mistake or hurt someone. Work ethics also applies to students in nursing < Let residents, families, and visitors enter elevators assistant training and competency evaluation programs first. (NATCEPs). Be thoughtful-compliment others, give praise. • To be a successful student, practice good work ethics ' Wish the person and family well when they leave the in the classroom and clinical setting and in your center. relationships with instructors and fellow students. Hold doors open for others. ' Help others willingly when asked. Heal 11, Hygiene and Appearance Do not take credit for another person's deeds. Give • To give safe and effective care, you must be physically the person credit for the action. and mentally healthy. You need a balanced diet, sleep • Keep personal matters out of the workplace. and rest, good body mechanics, and exercise on a Make personal phone calls during meals and breaks. regular basis. Smoking, drugs, and alcohol can affect Do not let family and friends visit you on the unit. performance and safety. 0 Do not use the agency's computers and other equipment for personal use.

o Do not take agency supplies for personal use. collecting information about the problem, identifying 0 Do not discuss personal problems at work. possible solutions, carrying out the best solution, and o Control your emotions. evaluating the results. o Do not borrow money from or lend money to co • Communication and good work ethics help prevent and workers. resolve conflicts. 0 Do not sell things or engage in fund-raising al work. • Burnoutis a job stress resulting in physical or mental 0 Do not have wireless phones or personal pagers on exhaustion and doubts about your abilities or the value while at work. of your work. Managing stress can prevent burnout. o Do not text message. • Leave for and returnfrom breaks and meals on time. Harassment Tell the nurse when you leave and returnto the unit. • Harassment means to trouble, torment, offend, or worry • Protect yourself and others from harm. a person by one's behavior or comments. 0 Understand the roles, functions, and responsibilities • Harassment can be sexual or it can involve age, race, in your job description. ethnic background, religion, or disability. ° Follow agency rules, policies, and procedures in the • You must respect others. Do not offend others by your employee handbook or policy and procedure manual. gestures, remarks, or use of touch. Do not offend others 0 Know what is right and wrong conduct and what you with jokes, photos, or other pictures. can and cannot do. o Follow the nurse's directions and instructions and CHAPTER6 REVIEW QUESTIONS question unclear directions and things you do not understand. Ask for any training you might need. Circle the BEST answer. 1. You believe you have good work ethics. This means o Help others willingly when asked. you do the following 0 Report accurately. This includes measurements, except observations, the care given, the person's complaints, a. Work when scheduled and any errors. b. Act cheerful and friendly c. Refuse to help others o Accept responsibility for your actions. Admit when you are wrong or make mistakes. Do not blame d. Perform tasks assigned by the nurse others. Do not make excuses for your actions. Learn 2. A nursing assistant is gossiping about a co-worker. You what you did wrong and why. Always try to learn should from your mistakes. a. Stay with the group and listen to what is being said o Handle the person's property carefully and prevent b. Repeat the comment to your famiJy damage. c. Remove yourself from the group where gossip is o Always follow safety measures. occurring • Planning your work involves setting priorities. Decide: d. Repeat the comment to another co-worker c Which person has the greatest or most life- 3. You want to maintain confidentiality about others. You threatening needs. do the following except o What task the nurse or person needs done first. a. Share information about a resident with a nurse who 0 What task:, need to be done at a certain time. i:, on another unit 0 What tasks need to be done when your shift starts. b. Avoid talking about a resident in the elevator, o What tasks need to be done at the end of your shift. hallway, or dining area 0 How much time it takes to complete a task. c. Avoid taJking about co-workers and residents when 0 How much help you need to complete a task. others are present o Who can help you and when. d. Avoid eavesdropping • Priorities change as the person's needs change. 4. When you are at work, you should do which of the following? Managing Stress a. Swear and use foul language. b. Use slang. • These guidelines can help you reduce or cope with c. Argue with a visitor. stress. d. Speak clearly and softly. Exercise regularly. 5. To give safe and effective care, you do all of the 0 Get enough sleep or rest. o Eat healthy. following except a. Eat a balanced diet Plan personal and quiet time for yourself. o b. Get enough sleep and rest Use common sense about what you can do. c. Exercise on a regular basis v Do 1 thing at a time. d. Drink too much alcohol 0 Do not judge yourself harshly. o Give yourself praise. 6. While at work, you should do all of the following except -: Have a sense of humor. a. Be courteous to others b. Make personal phone calls 0 Talk to the nurse if your work or a person is causing too much stress. c. Admit when you are wrong or make mistakes d. Respect others • Conflict in the workplace can cause stress and care can suffer. Resolving conflict involves defining and Answers to tl,esequestions are on p. 516.

CHAPTER 7 COMMUNICATING WITH THE o Report any changes from normal or changes in the person's condition at once. . _ . HEALTH TEAM o Use your written notes to give a specific, concise, and 1t1P I(. clear report. • For good communication: o Use words that mean the same thing to you and the Recording • When recording or documenting, communicate clearly receiver of the message. o Use familiar words. and thoroughly what you observed, what you did, and o Be brief and concise. the person's response. • The general rules for recording are: o Give information in a logical and orderly maimer. . o Give facts and be specific. o Always use ink. Use the color reqU1Ccd by the center. o Include the date and time for every recording. Tire Medical Rewrcl o Make sure writing is readable and neat. o Use only agency-approved abbreviations. • The medical record, chart, or clinical record is the o Use correct spelling,grammar, and punctuation. permanent, legal account of the person's condition and o Do not use ditto marks. response to treatment and care. Medical records can be o Never erase or use correction fluid. Follow agency written or stored electronically. The electronic health procedure for correcting errors. record (EHR) or electronic medical record (EMR) is the . o Sign all entries with your name and title as reqmred electronic version of the person's medical record. It is a by agency policy. permanent legal document. o Do not skip lines. • The medical record is a way for the health team to share o Make sure each form has the person's name and information about the person. Agencies have policies other identifying information. about medical records and who can see them. Some o Record only what you observed and did yourself. agencies allow nursing assistants to read and/or rec rd � o Never chart a procedure, treatment, or care measure observations in medical records. Follow your agency s until after it is completed. policies. o Be accurate, concise, and factual. Do not record • Medical records can include the person's admission judgments or interpretations. record, health history, graphic and flow sheets for o Record in a logical and sequential manner. recording measurements and observations, and o Be descriptive. Avoid terms with more than one progress reports. meaning. • The Kardex or care summary a summary of the is o Use the person's exact words whenever possible. Use person's medical record. The summary can be in a quotation marks to show that the statement is a direct type of card file or computers organize the record in an quote. electronic summary. o Chart any changes from normal or changes in the person's condition. Also chart that you informed the l?epo1 .l. nurse (include the nurse's name), what you told the • The health team communicates by reporting and nurse, and the time you made the report. recording. o Do not omit information. Reporting o Record safety measures. Example: Reminding a • You report care and observations to the nurse. Report to person not to get out of bed. the nurse: • Review the 24-hour dock, Figure 7-6, and Box 7-1 in the o Whenever there is a change from normal or a change Te xtbook. in the person's condition. Report these changes at • Review Box 7-3 for recording rules on paper and on once. computer. o When the nurse asks you to do so. o When you leave the unit for meals, breaks, or other Computu and Otlier Electronic Devices reasons. • Computers contain vast amounts of informa ti.on o Before the end-of-shift report. about a person. Therefore the right to privacy must • Follow the rules of reporting. be protected. If allowed access, you must follow the o Be prompt, thorough, and accurate. agency's policies. o Give the person's name and room and bed numbers. • Review Box 7-4, Computers and Other Electronic o Give the time your observations were made or the Devices, in the Textbook. care was given. o Report only what you observed or did yourself. Pltone Commimications o Report care measures that you expect the person to • Guidelines for answering phones: need. o Answer the call after the first ring if possible. o Report expected changes in the person's condition. o Do not answer the phone in a rushed or hasty o Give reports as often as the person's condition mariner. requires or when the nurse asks you to.

"' Give a courteous greeting. Identify the musing unit and your name and title. CHAPTER 8 ASSISTING WITH THE NURSING PROCESS When taking a message, write down the caller's • The nursing process is the method nurses use to plan name, phone number, date and time, and message. and deliver nursing care. lt has 5 steps: assessment, o Repeat the message and phone number back to the nursing diagnosis, planning, implementation, and caller. evaluation. Ask the caller to "Please hold" if necessary. • Assessment involves collecting information about the o Do not lay the phone down or cover the receiver with person. A health history is taken. A registered nurse your hand when not speaking to the caller. The caller (RN) assesses the person's body systems and mental may hear confidential information. systems. Although the nursing assistant does not c Return to a caller on hold within 30 seconds. assess, you play a key role in assessment. You make t Do not give confidential information to any caller. many observations as you give care and talk to the Transfer a call if appropriate. Tell the caller you are going person. to transfer the call. Give the name and phone number in • Observation is using the senses of sight, hearing, touch, case the call getsdisconnected or the line is busy. and smell to collect information. End the conversation politely. • Basic observations are outlined in Box 8-2 in the Give the message to the appropriate person. Textbook. Observations you need to report lo the nurse at once are (see Box 8-1 in the Textbook): Medical Trmninology and Abbrei iations " A change in the person's ability to respond • Medical terminology and abbreviations are used in o A change in the person's mobility health care. Someone may use a word or phrase that o Complaints of sudden, severe pain you do not understand. If so, ask the nurse to explain its A sore or reddened area on the person's skin meaning. o Complaints of a sudden change in vision • Review Box 7-6, Medical Terminology, and Box 7-7, o Complaints of pain or difficulty breathing Common Health Care Terms and Phrases, in the Abnormal respirations Textbook. o Complaints of or signs of difficulty swallowing • Use only the abbreviations accepted by the center. If you o Vomiting are not sure that an abbreviation is acceptable, write o Bleeding the term out in full. See the inside back cover of the �signs Vital outside their normal ranges Textbook for common abbreviations. • Objective data (signs) are seen, heard, felt, or smelled by an observer. For example, you can feel a pulse. CHAPTER REVIEWQLESTIONS 7 • Subjective data (symptoms) are things a person tells Circle the BEST answer. you about that you cannot observe through your 1. For good communication, you should do the following senses. For example, you cannot see the person's except nausea. a. Use words with more than 1 meaning • The nurse uses assessment data to form a nursing b. Use words familiar to the person or family diagnosis, or a health problem that can be treated by c. Give facts in a brief and concise manner nursing measures. d. Give information in a logical and orderly manner • The nurse will then conduct planning to set priorities 2. When you record in a person's chart, you do the and goals for the person's care. following except • Nursing interventions or implementations are the a. Record what you observed and did actions taken by the nursing team to help the person b. Record the person's response to the treatment or reach a goal. procedure • The nursing diagnoses, goals, and actions for each goal c. Use abbreviations that are not on the accepted list are recorded in the nursing care plan. The care plan for the center is a communication tool. Each agency has a care plan d. Record the time the observation was made or the tool. treatment performed • The RN may conduct a care conference with the health 3. When reporting care and observations to the nurse, you care team to share information and ideas about the do the following except person's care. a. Give the person's name and room and bed numbers • The nurse will evaluate the planning and b. Report only what you observed or did yourself implementation based on the person's progress toward c. Report any changes from normal or changes in the the stated goal. person's condition at once • The nurse may delegate tasks to the nursing assistant d. Report any changes from normal or changes in the via the assignment sheet during any step of the nun,ing person's condition at the end of the shift process. Answers to these q11estions are on p. 516.

CHAPTER8 REVIEW QUESTIONS Culture and Religion • Culture is the characteristics of a group of people. Circle the BEST answer. 1. Which statement about observations is false? People come from many cultures, races, and a. You make observations as you care for and talk with nationalities. Family practices, food choices, hygiene people. habits, clothing styles,and language are part of their b. Observation uses the senses of smell, sight, touch, culture. The person's culture also influences health and hearing. beliefs and practices. c. A reddened area on the person's skin is reported to • Religion relates to spiritu;iJ beliefs, needs, and practices. the nurse at once. A person's religion influences health and illness d. You report observations to the doctor. practices. Many may want to pray and observe religious 2. Objective data include all the following except practices. Assist residents to attend religious services a. The person has pain in his abdomen as needed. If a person wants to see a spiritual leader or b. The person's pulse is 76 the adviser, tell nurse. Provide privacy during the visit. c. The person's urine is dark amber • A person may not follow all the beliefs and practices d. The person's breath has an odor of his or her culture or religion. Some people do not Answers to these q11estions areon p. practice a religion. 516. • Respect and accept the person's culture and religion. Learn about practices and beliefs different from your own. Do not judge a person by your standards. CHAPTER 9 UNDERSTANDING THE PERSON Communicating Witlrthe Person Caring for the Person • For effective communication between you and the • The whole person needs to be considered when you person, you must: provide care-physical, social, psychological, and o Follow the rules of communication in Chapter 7 in spiritual parts. These parts are woven together and the Textbook. cannot be separated. o Understand and respect the patient or resident as a • Follow these rules to address persons with dignity and person. respect. o View the person as a physical, psychological, social, o Call persons by their titles-Mrs. Dennison, Mr. and spiritual human being. Smith, Miss Turner, or Dr. Gonzalez. o Appreciate the person's problems and frustrations. o Do not caJ1 persons by their first names unless they o Respect the person's rights. ask you to. o Respect the person's religion and culture. o Do not call persons by any other name unless they o Give the person time to understand the information ask you to. that you give. o Do not call persons Grandma, Papa, Sweetheart, Repeat information as often as needed. Honey, or other names. o o Ask questions to see if the person understood you. o Be patient. People with memory problems may ask Basic Needs the same question many times. • A need is something necessary or desired for o Include the person in conversations when others are maintaining life and mental well-being. present. • According to Maslow, basic needs must be met for a person to survive and function. Needs are arranged in Verbal Communication order of importance, lower level to higher level. • When talking with a person, follow these rules. o Physiological or physical needs-are required for life. o Face the person. Look directly at the person. They are oxygen, food, water, elimination, rest, and yourself o Position at the person's eye level. shelter. o Control the loudness and tone of your voice. o Safety and security needs-relateto feeling safe from Speak clearly, slowly, and distinctly. harm, danger, and fear. o o Do not use slang or vulgar words. o Love and belonging needs-relateto love, closeness, " Repeat information as needed. affection, and meaningful relationships with others. o Ask 1 question at a time and wait for an answer. Family, friends, and the health team can meet !0ve o Do not shout, whisper, or mumble. and belonging needs. o Be kind, courteous, and friendly. o Self-esteem needs-relate to thinking well of oneself • Use written words if the person cannot speak or hear and to seeing oneself as useful and having value. but can read. Keep written messages brief and concise. People often lack self-esteem when ill, injured, older, Use a black felt pen on white paper and print in large or disabled. letters. o TIie need for self-actualization-involveslearning, • Some persons cannot speak or read. Ask questions that understanding, and creating to the limit of a person's have "yes" or "no" answers. A picture board may be capacity. Rarely, if ever, is it totally met. helpful.

Nonverbal Communication • Talking n lot when others are silent. Talking too much is • Messages are sent with gestures, facial expressions, usually because of nervousness and discomfort with posture, body movements, touch, and smeU. Nonverbal silence. messages more accurately reflect a person's feelings • Failure to listen. Do not prelend to listen. lt shows lack of than words do. A person may say one thing but act caring and interest. You may miss complaints of pain, another way. Watch the person's eyes, hand movements, discomfort, or other symptoms that you must report to gestures, posture, and other actions. the nurse. • Touch conveys comfort, caring, love, affection, interest, • Pat answers. "Don't worry." "Everything will be okay." trust, concern, and reassurance. Touch should be gentle. These make the person feel that you do not care about Touch means different things to different people. Some his or her concerns, feelings, and fears. people do not like to be touched. To use touch, follow • ll/ness mid disability. Speech, hearing, vision, cognitive the care plan. Maintain professional boundaries. function, and body movements may be affected. Verbal • People send messages through their body language and nonverbal communication is affected. facial expressions, gestures, posture, hand and body • Age. Values and communication styles vary among movements, gait, eye contact, and appearance. Your age-groups. body language should show interest, enthusiasm, caring, and respect for the person. Often you need to Persons With Special Needs control your body language. Control reactions to odors • Common courtesies and manners apply to any person from body fluids, secretions, or excretions. with a disability. Review Box 9-1, Disability Etiquette, in the Textbook. Communication Metllods • Listening means to focus on verbal and nonverbal • The person who is comatose is unconscious and cannot communication. You use sight, hearing, touch, and respond to others. Often the person can hear and feel smell. To be a good listener: touch and pain. Assume that the person hears and , Face the person. understands you. Use touch and give care gently. Have good eye contact with the person. Practice these measures. Lean toward the person. Do not sit back with your Knock before entering the person's room. arms crossed. o Tell the person your name, the time, and the place Respond to the person. Nod your head and ask every time you enter the room. questions. ' Give care on the same schedule every day. 0 Avoid communication barriers. o Explain what you are going to do. • Paraphrasing is re-stating the person's message in your Tell the person when you are finishing care. own word!>. Use touch to communicate care, concern,and • Direct questions focus on certain information. You ask comfort. the person something you need to know. 0 Tell the person what time you will be back to check • Open-ended questions lead or invite the person to share on him or her. thoughts, feelings, or ideas. The person chooses what to ; Tell the person when you are leaving the room. talk about. • Clarifyinglets you make sure that you understand the Family and Friends message. You can ask the person to repeat the message, • If you need to give care when visitors are there, protect say you do not understand, or re-state the message. the person's right to privacy. Politely ask the visitors • Focusing deals with a certain topic. It is useful when a to leave the room when you give care. A partner or person wanders in thought. family member may help you if the patient or resident • Silence is a very powerful way to communicate. Silence consents. gives time to think, organize thoughts, choose words, • Treat family and visitors with courtesy and respect. make decisions, and gain control. Silence on your part • Do not discuss the person's condition with family and shows caring and respect for the person's situation and friends. Refer questions to the nurse. A visitor may feelings. upset or tire a person. Report your observations to the nurse. Communication Barriers • Language. You and the person must use and understand Behavior Issues the same language. • Many people do not adjust well to illness, injury, and • Cultural differences.A person from another country disability. They have some of the following behaviors. may attach different meanings to verbal and nonverbal Anger. Anger may be communicated verbally communication than what you intended. and nonverbally. Verbal outbursts, shouting, and • Changing the subject. Avoid changing the subject rapid speech are common. Some people are silent. whenever possible. Others are uncooperative and may refuse to answer • Giving your opinio11s. Opinions involve judging values, questions. Nonverbal signs include rapid movements, behaviors, or feelings. Let others express feelings and pacing, clenched fists, and a red face. Glaring and concerns without adding your opinion. Do not make getting close to you when speaking are other signs. judgments or jump to conclusions. Violent behaviors can occur.

o Demanding behavior. Nothing seems to please the 6. A person is angry and is shouting at you. You should person. The person is critical of others. do the following except 0 Seif-centeredbehavior. The person cares only about his a. Stay calm and professional or her own needs. The needs of others are ignored. b. Yell so the person will listen to you The person becomes impatient if needs are not met. c. Listen to what the person is saying o Aggressive behavior. The person may swear, bite, hit, d. Report the person's behavior to the nurse pinch, scratch, or kick. Protect the person, others, and 7. A person tries to scratch and kick you. You should yourself from harm. a. Protect yourself from harm 0 Withdrawal. The person has little or no contact with b. Argue with the person family, friends, and staff. Some people are generally c. Become angry with the person not social and prefer to be alone. d. Refuse to care for the person 0 Inappropriate sexual behavior. Some people make 8. When speaking with another person, you do the inappropriate sexual remarks or touch others in the following except wrong way. These behaviors may be on purpose. Or a. Position yourself at the person's eye level they are caused by disease, confusion, dementia, or b. Speak slowly, clearly, and distinctly drug side effects. c. Shout, mumble, and whisper • You cannot avoid persons with unpleasant behaviors d. Ask 1 question at a time or lose control. Review Box 9-2, Dealing With Behavior 9. Which statement about listening is false? Issues, in the Textbook. a. You use sight, hearing,touch, and smell when you listen. CHAPTER9 REVIEWQUESTIONS b. You observe nonverbal cues. Circle the BESTanswer. c. You have good eye contact with the person. d. You sit back with your arms crossed. 1. While caring for a person, you need to 10. Which statement about silence is false? a. Consider only the person's physical and social needs a. Silence is a powerful way to communicate. b. Consider the person's physical, social, b. Silence gives people time to think. psychological, and spiritual needs c. You should talk a lot when the other person is c. Consider only the person's cultural needs silent. d. Ignore the person's spiritual needs d. Silence helps when the person is upset and needs 2. When referring to residents, you should to gain control. a. Refer to them by their room number b. Call them ''Honey" 11. A person speaks a foreign language. You should do except c. Call them by their first name the following d. Call them by their name and title a. Keep messages short and simple 3. Based on Maslow's theory of basic needs, which b. Use gestures and pictures person's needs must be met first? c. Shout or speak loudly a. The person who wants to talk about her d. Repeat the message in other words granddaughter's wedding 12. When caring for a person who is comatose, you do the b. The person who is uncomfortable inthe dining room following except c. The person who wants mail opened a. Tell the person your name when you enter the room d. The person who asks for more water b. Explain what you are doing 4. Which statement about culture is false? c. Use touch to communicate care and comfort a. A person's culture influences health beliefs and d. Make jokes about how sick the person is practices. 13. A person is in a wheelchair. You should do all of the b. You must respect a person's culture. following except c. You should ignore the person's culture while you a. Lean on a person's wheelchair give his or her care. b. Sit or squat to talk to a person in a wheelchair or d. You should learn about another person's culture chair that is different from yours. c. Think about obstacles before giving directions to a 5. Which statement about religion and spiritual beliefs is person in a wheelchair false? d. Extend the same courtesies to the person as you a. A person's religion influences health and illness would to anyone else practices. 14. A person's daughter is visiting and you need to b. You should assist a person to attend services in the provide care to the person. You nursing center. a. Expose the person's body in front of the visitor c. Many people find comfort and strength from b. Politely ask the visitor to leave the room religion during illness. c. Decide to not provide the care at all d. A person must follow all beliefs of his or her d. Discuss the person's condition with the visitor religion. Answers to these questions are on p. 516.

CHAPTER 11 GROWTH AND So do hobbies, religious and community events, and new friends. DEVELOPMENT • Growth is the physical changes that are measured and • Children as caregivers. Some older persons feel more that occur in a steady and orderly manner. secure when children care for them. Others feel • Development relates to changes in mental, emotional, unwanted and useless. Some lose dignity and self and social function. respect. Tensions may occur among the child, parent, • Growth and development occur in a sequence, and other household members. order, and pattern. Review the stages of growth and • DeatJ, and grievi11g Death of an adult child or a partner development detailed in the Textbook. can cause immense grief. Emotion.ii needs will be great. • Middle adulthood (40 to 65 years old). At this stage, The pen,on may be left with few family and friends to developmental tasks are adjusting to physical changes, provide support. having grown children, developing leisure-time activities, and adjusting to aging parents. PJ,yc;icalChange • Late adulthood (65 years and older). At this stage, • Body processes slow down. Energy level and body developmental tasks are adjusting to decreased strength efficiency decline. and loss of health, adjusting to retirement and reduced • The integumentan; system. The skin lo::.esits elasticity, income, coping with a partner's death, developing new strength, and fatty lissue layer. Wrinkles appear. Dry friends and relationships, and preparing for one's own skin occurs and may cause itching The skin is fragile death. and easily injured. The person is more sensitive to cold. Nails become thick and tough. Feet may have poor CHAPTER 11 REVIEW QUESTIONS circulation. White or gray hair is common. Hair thins. Facial hair may occur in women. Hair is drier. The risk Circle the BESTariswer. of skin cancer increases. 1. Growth and development occur in a sequence, order, • The m11sc11lo-skeletal system. Muscle and bone strength and pattern. are lost. Bones become brittle and break easily. Vertebrae a. True shorten. Joints become stiff and painful. Mobility b. False decreases. There is a gradual loss of height. 2. Growth relates to changes in mental, emotional, and • Tlte nervous system. Confusion, dizziness, and fatigue social function. may occur. Responses are slower. The risk for falls a. True increases. Forgetfulness increases. Memory is shorter. b. False Events from long ago are remembered better than recent 3. Which is a developmental task of late adulthood? ones. Older persons have a harder time falling asleep. a. Accepting changes in appearance Sleep periods are shorter. Older persons wake often b. Adjusting to decreased strength during the night and have less deep sleep. Less sleep is c. Developing a satisfactory sex life needed. They may rest or nap during the day. They may d. Performing self-care go to bed early and get up early. Answers to tJ,ese questions are on p. 516. • The senses. Hearing and vision losses occur. Taste and smell dull. Appetite decreases. Touch and sensitivity to pain, pressure, hot, and cold are reduced. CHAPTER 12 CARE OF THE OLDER • The circulatory system. The heart muscle weakens. PERSON Arteries narrow and are less elastic. Poor circulation • Aging is normal. It is not a disease. Normal changes occurs in many body parts. occur in body structure and function. Psychological and • The respiratory system. Respiratory muscles weaken. Lung social changes also occur. tissue becomes less elastic. Difficult, labored, or painful breathing may occur with activity. The person may lack Psychological and Social Changes strength to cough and clear the airway of secretions. • Physical reminders of growing old affect self-esteem Respiratory infections and diseases may develop. and may threaten self-image, feelings of self-worth, and • Tlie digesfit>esystem. Less saliva is produced. The independence. person may have difficulty swallowing (dysphagia). • People cope with aging in their own way. How they Indigestion may occur. Loss of teeth and ill-fitting cope depends on their health status, life experiences, dentures cause chewing problems and digestion finances, education, and social support systems. problems. Flatulence and constipation can occur. Fewer • Retirement. Many people enjoy retirement. Others are calories are needed as energy and activity le\ els decline. in poor health and have medical bills that can make More fluids are needed. retirement hard. • The urinary system. Urine is more concentrated. • Reduced income. Retirement usually means reduced Bladder muscles weaken. Bladder size decreases. income. The retired person still has expenses. Reduced Urinary frequency or urgency may occur. Urinary tract income may force life-style changes. One example is the infections are risks. Many older persons have to urinate person avoids health care or needed drugs. at night. Urinary incontinence may occur. In men, • Social relationships.Social relationships change the prostate gland enlarges. This may cause difficulty throughout life. Family time helps prevent loneliness. urinating or frequent urination.

• The reproductive system. In men, testosterone decreases. 5. Which statement about the digestive system and aging An erection takes longer. Orgasm is less forceful. is false? Women experience menopause. Female hormones of a. Appetite decreases. estrogen and progesterone decrease. The uterus, vagina, b. Less saliva is produced. and genitalia shrink (atrophy). Vaginal walls thin. There c. Flahilence and constipation may decrease. is vaginal dryness. Arousal takes longer. Orgasm is less d. Te eth may be lost. intense. 6. Which statement about the urinary system and aging is false? Housing Options a. Urine becomes more concentrated. • A person's home is more than a place to live. It holds b. Urinary frequency may occur. memories, is a link to neighbors and communities, and c. Urinary urgency may occur. d. Bladder muscles become stronger. brings pride and self-esteem. Aging can lead to changes Answers to these questions are on 516. in a person's home setting. p. • Most older people live in their own homes. Others need help from family or community agencies. Review Box 12-3, In-Home and Community-Based Services, in the CHAPTER 13 SAFETY Textbook. Accident Risk Factors • Age. Older persons are at risk for falls and other injuries. Nursing Centers • Awareness of surroundings. People need to know their • The person needing nursing center care may suffer surroundings to protect themselves from injury. Agitated and aggressive behaviors. Pain, confusion, fear, some or all of these losses. • and decreased awareness of surroundings can cause o Loss of identity as a productive member of a family these behaviors. and community • Vision loss. Persons can fall or trip over items. Some o Loss of possessions-home, household items, car, and have problems reading labels on containers. so on • Hearing loss. Persons have problems hearing Loss of independence o explanations and instructions. They may not hear o Loss of real-world experiences-shopping, traveling, cooking, driving, hobbies warning signals or fire alarms. They do not know to move to safety. o Loss of health and mobility • The person may feel useless, powerless, and hopeless. • Impaired smell and touch. Illness and aging affect smell The health team helps the person cope with loss and and touch. The person may not detect smoke or gas or improve quality of life. Treat the person with dignity may be w1aware of injury. Burns are a risk. and respect. Also practice good communication skills. • Impaired mobility. Some diseases and injuries affect Followcare the plan. mobility. A person may know there is danger but cannot move to safety. Some persons are paralyzed. Some persons cannot walk or propel wheelchairs. CHAPTER 12 REVIEWQUESTIONS • Drugs. Drugs have side effects. Reduced awareness, Circle the BEST answer. confusion, and disorientation can occur. Report 1. Which statement is false? behavior changes and the person's complaints. a. Physical changes occur with aging. b. Energy level and body efficiency decline with age. Identifying tlie Person c. Some people age faster than others. • You must give the right care to the right person. To d. Normal aging means loss of health. identify the person: 2. As a person ages, the integumentary system changes. o Compare identifying information on the assignment Which statement is false? sheet or treatment card with that on the identification a. Dry skin and itching occur. (10) bracelet. b. Nails become thick and tough. ° Call the person by name when checking the ID c. The person is less sensitive to cold. bracelet. Just calling the person by name is not d. Skin is injured more easily. enough to identify him or her. Confused, disoriented, 3. Which statement is false about the musculo-skeletal drowsy, hard-of-hearing, or distracted persons may system and aging? answer to any name. a. Strength decreases. • Use at least 2 identifiers. Agencies have different b. Vertebrae shorten. requirements. Some may require the person to state c. Mobility increases. and spell his or her name and give a birth date. Others d. Bone mass decreases. require using the person's ID number. Always follow 4. Which statement about the nervous system and aging agency policy. is false? a. Reflexes slow. Preventing Bums b. Memory may be shorter. • Smoking, spilled hot liquids, very hot water,and electrical c. Sleep patternschange. devices are common causes of burns. SeeBox 13-1 in the d. Forgetfulness decreases. Textbook for safety measures to pre-,rentburns.

Preventing Poisoning • Check the material safety data sheet (MSDS) before • Drugs and household products are common poisons. using a hazardous substance, cleaning up a leak or Poisoning in adults may be from carelessness, spill, or disposing of the substance. Tell the nurse about confusion, or poor vision when reading labels. To a leak or spill right away. Do not leave a leak or spill prevent poisoning: unattended. Review Box 13-8 in the Textbook. Make sure patients and residents cannot reach hazardous materials. Disasters o Follow agency policy for storing personal care items. • A disaster is a sudden catastrophic event. The agency • See Box 13-2 in the Te xtbook for safety measures to has procedures for disasters that could occur in your prevent poisoning. area. Follow them to keep patients, residents, visitors, staff, and yourself safe. Preventing Suffocntio11 • Natural disasters include tornadoes,hurricanes, blizzards, • Suffocation is when breathing stops from the lack earthquakes, volcanic eruptions, floods, and some fires. of Death oxygen. occurs if the person does not start • Human-made disasters include auto, bus, train, and breathing. airplane accidents. They also include fires, bombings, • To prevent suffocation, review Box 13-5, Preventing nuclear power plant accidents, gas or chemical leaks, Suffocation, in the Textbook. explosions, and wars. • Follow agency protocol for a bomb threat or if you find Cl1oki11g an item that looks or sounds strange. • Choking or foreign-body airway obstruction (FBAO) occurs when a foreign body obstructs the airway. Air Fire SClfety cannot pass through the air passages into the lungs. • Faulty electrical equipment and wiring, over-loaded The body does not get enough oxygen. This can lead to electrical circuits, and smoking are major causes of fires. cardiac arrest. • Safety measures are needed where oxygen is used and • Choking often occurs during eating. A large, poorly stored. chewed piece of meat is the most common cause. Other • Review Box13-9, Fire PreventionMeasures, in the Textbook. common causes include laughing and talking while • Know your center's policies and procedures for fire eating. emergencies. Know where to find fire alarms, fire • With mild airway obstruction, some air moves in and extinguishers, and emergency exits. Remember the out of the lungs. The person is conscious. Usually the word RACE. person can speak. Often, forceful coughing can remove R-rescue. Rescue persons in immediate danger. the object. Move them to a safe place. • With severe ainvny obstruction, the conscious person 0 A-a.la.nn. Sound the nearest fire alarm. Notify the clutches at the throat-the "universal sign of choking." telephone operator. The person has difficulty breathing. Some persons � C-confine.Close doors and windows. Turn off cannot breathe, speak, or cough. The person appears oxygen or electrical items. pale and cyanotic (bluish color). Air does not move in � E-extinguisJ,. Use a fire extinguisher on a small fire. and out of the lungs. If the obstruction is not removed, • Remember the word PASS for using a fire extinguisher. the person will die. Severe airway obstruction is an ) P-pull the safety pin. emergency. , A-aim low. Aim at the base of the fire. • Use abdominal thrusts to relieve severe choking. Chest S-squeeze the lever. This starts the stream of water. thrusts are used for very obese persons and pregnant -:, $-sweep back and forth. Sweep side to side at the women. base of the fire. • Call for help when a person has an obstructed airway. • Do not use elevators during a fire. Report and record what happened, what you did, and the person's response. Elopement • Elopement is when a resident leaves the agency without Preventing Equipment Accidents staff knowledge. The Centers for Medicare & Medicaid • All equipment is unsafe if broken, not used correctly, or Services (CMS) requires that an agency's disaster plan not working properly. Inspect all equipment before use. address elopement. Review Box 13-7, Preventing Equipment Accidents, in • The agency must: the Textbook. o Identify persons at risk for elopement. Monitor and supervise persons at risk. Hnznrdous Chemica!s '- Address elopement in the person's care plan. • A hazardous substance is any chemical in the workplace c, Have a plan to find a missing patient or resident. that can cause harm. Hazardous substances include oxygen, mercury, disinfectants, and cleaning agents. Workplace Violence • Hazardous substance containers must have a warning • Workplace violence is violent acts (including assault label. If a label is removed or damaged, do not use the or threat of assault) directed toward persons at work or substance. Take the container to the nurse. Do not leave while on duty. Review Box 13-10, Workplace Violence the container unattended. Safety Measures, in the Textbook.

CHAPTER 13 REVIEW QUESTIONS 10. When using a fire extinguisher, you do the following except Circle the BEST answer. a. Pull the safety pin on the fire extinguisher 1. You see a water spill in the hallway. What will you b. Aim at the top of the flames do? c. Squeeze the lever to start the stream a. Ask housekeeping to wipe up the spill right away. d. Sweep the stream back and forth b. Wipe up the spill right away. Answers to these questions are on p. c. Report the spill to the nurse. 516. d. Ask the resident to walk around the spill. 2. An electrical outlet in a person's room does not work. What will you do? CHAPTER 14 FALL PREVENTION a. Tell the administrator about the problem. • Falls are a leading cause of injuries and deaths among b. Te ll another nursing assistant about the problem. older persons. A history of falls increases the risk of c. Try to repair the electrical outlet. falling again. d. Follow the center's policy for reporting the • Most falls occur in resident rooms and bathrooms. problem. • Causes for falls are poor lighting, cluttered floors, 3. Accident risk factors include all of the following except throw rugs, needing to use the bathroom, out-of a. Walking without difficulty place furniture, wet and slippery floors, bathtubs, and b. Hearing problems showers. Review Box 14-1, Fall Risk Factors, in the c. Dulled sense of smell Te xtbook. d. Poor vision • Agencies have fall prevention programs. Review Box 4. To prevent a person from being burned, you should 14-2, Safety Measures to Prevent Falls, in the Textbook. do the following except The person's care plan also lists measures specific for a. Supervise the smoking of persons who are the person. confused • Bed and chair alarms alert staff when the person is b. Turn cold water on first; turn hot water off first moving from the bed or chair. c. Do not let the person sleep with a heating pad d. Allow smoking in bed Bed Rails bed rail 5. To prevent suffocation, you should do the following • A (side rail) is a device that serves as a guard or except barrier along the side of the bed. a. Make sure dentures fit properly • The nurse and care plan tell you when to raise bed rails. b. Check the care plan for swallowing problems They are needed by persons who are unconscious or before serving food or liquids sedated with drugs. Some confused and disoriented c. Leave a person alone in a bathtub or shower people need them. If a person needs bed rails, keep d. Position the person in bed properly them up at all times except when giving bedside 6. Which statement about mild airway obstruction is nursing care. false? • Bed rails present hazards. The person can fall when a. Some air moves in and out of the lungs. trying to get out of bed. Or the person can get caught, b. The person is conscious. trapped, entangled, or strangled. c. Usually the person cannot speak. • Bed rails are considered restraints if the person cannot d. Forceful coughing will often remove the object. get out of bed or lower them without help. 7. The "universal sign of choking" is • Accrediting agency standards and state and federal a. Clutching at the chest laws affect bed rail use. They are allowed when the b. Clutching at the throat person's condition requires them. The need for bed rails c. Not being able to talk is carefully noted in the person's medical record and the d. Not being able to breathe care plan. If a person uses bed rails, check the person 8. Which of the following is not a safety measure with often. Record when you checked the person and your oxygen? observations. a. NO SMOKING signs are placed on the resident's door • To prevent falls: and near the bed. o Never leave the person alone when the bed is raised. b. Lit candles and other open flames are permitted in o Always lower the bed to its lowest position when you the room. are done giving care. c. Electrical items are turned off before being o If a person does not use bed rails and you need to unplugged. raise the bed, ask a co-worker to stand on the far side d. The person wears a cotton gown or pajamas. of the bed to protect the person from falling. 9. You have discovered a fire in the nursing center. You �. If you raise the bed to give care, always raise the far should do the following except bed rail if you are working alone. a. Rescue persons in immediate danger 0 Be sure the person who uses raised bed rails has b. Sound the nearest fire alarm access to items on the bedside stand and over-bed c. Open doors and windows and keep oxygen on table. The call light, water pitcher and cup, tissues, d. Use a fire extinguisher on a small fire that has not phone, and TV and light controls should be within spread to a larger area the person's reach.

Hand Rails and Grab Bars 4. Which statement about bed rails is false? • Hand rails give support to persons who are weak or a. The nurse and care plan tell you when to raise bed unsteady when walking. rails. • Grab bars provide support for sitting down or getting b. Bed rails are considered restraints. up from a toilet. They also are used for getting in and c. You may leave a person alone when the bed is raised out of the shower or tub. and the bed rails are down. d. Bed rails can present hazards because people try to WheelLocks climb over them. • Bed wheels are locked at all times except when moving 5. Which statement about transfer/ gait belts is false? a. To use the belt safely, follow the manufacturer's the bed. • Wheelchair and stretcher wheels are locked when instructions. transferring a person. b. Always apply the belt over clothing. c. Tighten the belt so it is very snug and breathing is impaired. Transfer/Gait Belts d. Place the belt buckle off-center so it is not over the • Use a transfer belt (gait belt) to support a person spine. who is unsteady or disabled. Always follow the 6. A person becomes faint in the hallway and begins to manufacturer's instructions. Apply the belt over fall. You should do the following except clothing and under the breasts. The belt buckle is neve: a. Ease the person to the floor positioned the person's spine. Tighten the belt so 1t over b. Protect the person's head is snug. You should be able to slide your open, flat hand c. Let the person get up before the nurse checks him or her under the belt. Tuck the excess strap under the belt. d. Help the nurse complete the incident report Remove the belt after the procedure. Answers these questions are on p. 516. • Check with the nurse and care plan before using a to transfer/ gait belt if the person has: o A colostomy, ileostomy, gastrostomy, or urostomy o A gastric tube CHAPTER 15 RESTRAINT ALTERNATIVES o Chronic obstructive pulmonary disease AND SAFE RESTRAINT USE o An abdominal wound, incision, or drainage tube • The Centers for Medicare & Medicaid Services (CMS) o A chest wound, incision, or drainage tube has mles for using restrajnts. These rules protect the o Monitoring equipment person's rights and safety. o Ahernia • Restraints may be used only to treat a medical symptom o Other conditions or care equipment involving the or for the immediate physical safety of the person chest or abdomen or others. Restraints may be used only when less restrictive measures fail to protect the person or others. Tlie Falling Person They must be discontinued at the earliest possible time. • If a person starts to fall, do not try to prevent the fall. • The CMS uses these to define restraints. You could injure yourseli and the person. Ease the o A physical restraint is any manual method person to the floor and protect the person's head. or physical or mechanical device, material, or • Do not let the person get up before the nurse checks for equipment attached to or near the person's body injuries. An incident report is completed after all falls. that he or she cannot remove easily and that restricts freedom of movement or normal access to one's body. CHAPTER 14 REVIEW QUESTIONS o A chemical restraint is a drug that is used for discipline or convenience and not required to treat Circle the BESTanswer. medical symptoms. The drug or dosage is not a 1. Most falls occur in standard treatment for the person's condition. a. Resident rooms and bathrooms o Freedom of movement is any change in place or b. Dining rooms position of the body or any part of the body that the c. Hallways person is able to control. d. Activity rooms o Remove easily is the manual method, device, 2. Which statement about falls is false? material, or equipment used to restrain the person a. Poor lighting, cluttered floors, and throw rugs may that can be removed intentionally by the person in cause falls. the same manner it was applied by staff. b. Improper shoes and needing to use the bathroom o Convenience is any action taken to control or manage may cause falls. a person's behavior that requires less effort by the c. Most falls occur between 4:00 PM and 8:00 PM. staff; the action is not in the person's best interest. d. Falls are less likely to occur during shift changes. o Discipline is any action taken by the agency to 3. You note the following after a person got dressed. punish or penalize a patient or resident. Which is unsafe? • Federal, state, and accrediting agencies have guidelines a. Non-skid footwear is worn. about restraint use. They do not forbid restraint use. b. Pant cuffs are dragging on the floor. They require considering or trying all other appropriate c. Clothing fits properly. alternatives first. d. The belt is fastened.

• Every agency has policies and procedures about • Observe for increased co11fusio11 and agitation. Restraints restraints. They include identifying persons at risk for can increase confusion and agitation. Restrained harm, harmful behaviors, restraint alternatives,and persons need repeated explanations and re-assurance. proper restraint use. Staff training is required. Spending time with them has a calming effect. • Protect the person's quality of life. Restraints are used for Restraint Alternatives as short a time as possible. You must meet the person's • Knowing and treating the cause for harmful behaviors physical, emotional, and social needs. can prevent restraint use. There are many alternatives to • Follow the manufactul'er's instructions. The restraint must restraints, such as answering the call light promptly. For be snug and firm but not tight. You could be negligent if other alternatives see Box 15-1, Restraint Alternatives. you do not apply or secure a restraint properly. • Apply restraints with enough help to protect the person and Safe Restraint Use stafffrom injury. • Restraints are used only when necessary to treat a • Observe the person at least every 15 minutes or more often as person's medical symptoms-physical, emotional, or noted in the care plan. Injuries and deaths can result from behavioral problems. Sometimes restraints are needed improper restraint use and poor observation. to protect the person or others. • Remove or release the restraint, re-position the person, and meet basic needs at least even; 2 hours or as often as noted in the care plan. The restraint is removed for at least Physical and Chemical Restraints 10 minutes. Provide for food, fluid, comfort, safety, Physical restraints • are applied to the chest, waist, elbows, hygiene, and elimination needs and give skin care. wrists, hands, or ankles. They confine the person to a Perform range-of-motion exercises or help the person bed or chair. Or they prevent movement of a body part. walk. Some furniture or barriers prevent free movement. • Drugs or dmg dosages are chemical restraints if they: ° Control behavior or restrict movement. Reporting and Recording • Report and record the following: 0 Are not standard treatment for the person's condition. o Type of restraint applied o Body part or parts restrained o Reason for the application Risks From Restraints Safety measures taken • Restraints can cause many complications. Injuries occur o 0 Time you applied the restraint as the person tries to get free of the restraint. Injuries 0 Time you removed or released the restraint also occur from using the wrong restraint, applying Care given when restraint was removed it wrong, or keeping it on too long. Cuts, bruises, and ° o Person's vital signs fractures are common. The most serious risk is death Skin color and condition from strangulation. Review Box 15-2, Risks From o Condition of the limbs Restraint Use, in the Textbook. o 0 Pulse felt in the restrained part o Changes in the person's behavior Legal Aspects • Report these complaints to the nurse at once: complaints • Restraints must protect the person. A restraint is used only of discomfort; a tight restraint; difficulty breathing; or when it is the best safety measure for the person. pain, numbness, or tingling in the restrained part. • A doctor's order is required. The doctor gives the reason for the restraint, what body part to restrain, what to use, and how long to use it. CHAPTER15 REVIEW QUESTIONS • The least restrictive method is used. It allows the greatest Circle the BEST answer. amount of movement or body access possible. 1. A geriatric chair or a bed rail may be considered a • Restraints are used only after other measures fail to protect restraint if free movement is restricted. the person. Box 15-1 in the Textbook lists alternatives to a. Tr ue restraint use. b. False • Unnecessary restraint is false imprisonment. If you 2. Restraints can be used for staff convenience. apply an unneeded restraint, you could face false a. True imprisonment charges. b. False • Informed consent is required. The person must understand 3. Restraints can increase a person's confusion and the reason for the restraint. If the person cannot give agitation. consent, his or her legal representative must give a. Tme consent before a restraint can be used. The doctor or b. False nurse provides the necessary information and obtains 4. The person with a restraint should be observed at least the consent. every a. 15 minutes Safety Guidelines b. 30 minutes • Review Box 15-3, Safety Measures for Using Restraints, c. Hour in the Te xtbook. d. 2 hours

5. Restraints need to be removed at least every settings are examples. HAis also are called nosocomial a. Hour infections. b. 2 hours • The health team must prevent the spread of HAis by: c. 3 hours o Medical asepsis. This includes hand hygiene. d. 4 hours o Surgical asepsis. 6. You should record all the following except o Standard Precautions and Transmission-Based a. The type of restraint used Precautions. b. The consent for the restraint o The Bloodborne Pathogen Standard. c. The time you removed the restraint d. The care you gave when the restraintwas removed Medical Asepsis Answers to these questions are on p. 516. • Asepsis is being free of disease-producing microbes. • Medical asepsis (clean technique) refers to the practices used to: CHAPTER 16 PREVENTING INFECTION o Remove or destroy pathogens. • An infection is a disease state resulting from the o Prevent pathogens from spreading from 1 person or invasion and growth of microbes in the body. Infection place to another person or place. is a major safety hazard. Common Aseptic Practices • The health team follows certain practices and • To prevent the spread of microbes, wash your hands: procedures to prevent the spread of infection (infection o After urinating or having a bowel movement. control). o After changing tampons or sanitary pads. 0 After contact with your own or another person's Microorganisms blood, body fluids, secretions, or excretions. This • A microorganism (microbe) is a small (micro) living includes saliva, vomitus, urine, feces, vaginal plant or animal (Or{?anism). discharge, mucus, semen, wound drainage, pus, and • Some microbes are harmful and can cause infections respiratory secretions. (pathogens). Others do not usually cause infection o After coughing, sneezing, or blowing your nose. (non-pathogens). o Before and after handling, preparing, or eating food. Multidrug-Resistant Organisms o After smoking. • Multidrug-resistant organisms (MDROs) can resist the • Also do the following: effects of antibiotics. Such organisms are able to change o Provide all persons with their own linens and their structures to survive in the presence of antibiotics. personal care items. The infections they cause are harder to treat. ° Cover your nose and mouth when coughing, • MDROs are caused by prescribing antibiotics when they sneezing, or blowing your nose. are not needed (over-prescribing). Not taking antibiotics o Bathe, wash hair, and brnsh your teeth regularly. for the prescribed length of time is also a cause. 0 Wash fruits and raw vegetables before eating or • Two common types of MDROs are resistant to many serving them. antibiotics. o Wash cooking and eating utensils with soap and o Methicillin-resistant Staphylococcus aureus (MRSA) water after use. o Vancomycin-resistant Enterococc11s (VRE) Hand Hygiene • Hand hygiene is the easiest and most important way to Infection prevent the spread of infection. Practice hand hygiene • A local infection is in a body part. before and after giving care. Review Box 16-3, Rules of • A systemic infection involves the whole body. Hand Hygiene, in the Textbook. • Older persons may not show the normal signs and Supplies and Equipment symptoms of infection. The person may have only a • Most hea Ith care equipment is disposable. Bedpans, slight fever or no fever at all. Redness and swelling may urinals, wash basins, water pitchers, and drinkingcups be very slight. The person may not complain of pain. are multi-use items. Do not "borrow" them for another Confusion and delirium may occur. person. • Infections can become life-threatening before the • Non-disposable items are cleaned and then disinfected. older person has obvious signs and symptoms. Be Then they are sterilized. alert to minor changes in the person's behavior or Other Aseptic Measures condition. • Report any concerns to the nurse at once. Review Box • Review Box 16-4, Aseptic Measures, in the Textbook. 16-1, Signs and Symptoms of Infection, in the Textbook. Isolation Precautions Healthcare-Associated Infection • Isolation precautions prevent the spread of communicable diseases (contagious diseases). They • A healthcare-associated infection (HAD is an infection that develops in a person cared for in any setting are diseases caused by pathogens that spread easily. where health care is given. Review Box 16-2 in the • The Centers for Disease and Control and Prevention's Textbook. The infection is related to receiving health (CDC's) isolation precautions guideline has 2 tiers of care. Hospitals, nursing centers, clinics, and home care precautions.

o Standard Precautions ° Change gloves whenever moving from a 0 Transmission-Based Precautions contaminated body site to a clean body site. Standard Precautions ° Change gloves if interacting with the person involves • Standard Precautions reduce the risk of spreading touching portable computer keyboards or other pathogens and known and unknown infections. mobile equipment that is transported from room to Standard Precautions are used for all persons whenever room. care is given. They prevent the spread of infection from: 0 Put on gloves last when worn with other PPE. 0 0 Blood. Make sure gloves cover your wrists. If you wear a 0 All body fluids, secretions, and excretions even if gown, gloves cover the cuffs. blood is not visible. Sweat is not known to spread 0 Remove gloves so the inside part is on the outside. infections. The inside is clean. 0 Practice hand hygiene after removing gloves. o Non-intact skin (skin with open breaks). 0 Mucous membranes. • Latex allergies are common and can cause skin rashes. • Review Box 16-5, Standard Precautions, in the Textbook. Asthma and shock are more serious problems. Report skin rashes and breathing problems at once. If you or a Transmission-BasedPrecautions resident has a latex allergy, wear latex-free gloves. • Some infections require Transmission-Based Precautions. Review Box 16-6, Transmission-Based Donning and Removing PPE Precautions, in the Te xtbook. • According to the CDC, PPE is donned in the following • Agency policies may differ from those in the Textbook. order. The rules in Box 16-7, Rules for Isolation Precautions, in 0 Gown the Te xtbook are a guide for giving safe care. 0 Mask or respirator o Eyewear (goggles or face shield) o Gloves Personal Protective Equipment (PPE) • Removing PPE (removed at the doorway before leaving • The PPE needed -gloves, a gown, a mask, and goggles the person's room): or a face shield-depends on the task, the procedures, 0 Method 1 care measures, and the type of Transmission-Based 1. Gloves Precautions used. The nurse will tell you what 2. Eyewear (goggles or face shield) equipment is needed. 3. Gown • Gowns must completely cover you from your neck to 4. Mask or respirator (respirator is removed after your knees. The gown front and sleeves are considered contaminated. A wet gown is contaminated. Gowns are leaving the person's room and closing the door) 0 Method 2 used once. When removing a gown, roll it away from 1. Gown and gloves you. Keep it inside out. • Masks are disposable. A wet or moist mask is 2. Eyewear (goggles or face shield) contaminated. When removing a mask, touch only 3. Mask or respirator (respirator is removed after the ties or elastic bands. The front of the mask is leaving the person's room and closing the door) contaminated. • Review Figure 16-18 Donning and Removing PPE, in • The front of goggles or a face shield is contaminated. the Textbook. Use the device's ties, headband, or ear-pieces to remove • Practice hand hygiene after removing PPE. Practice the device. hand hygiene between steps if your hands become contaminated. Then practice hand hygiene again after Gloves removing all PPE. • Wear gloves whenever contact with blood, body fluids, • NOTE: Some state competency tests require hand secretions, excretions, mucous membranes, and non hygiene after removing each PPE item. And some states intact skin is likely. Wearing gloves is the most common use a different order for donning and removing PPE. protective measure used with Standard Precautions Follow the procedures used in your state and agency. and Transmission-Based Precautions. Remember the • Some infections such as Ebola are very severe and following when using gloves. deadly. Such infections require additional PPE. 0 The outside of gloves is contaminated. Bagging Items 0 Gloves are easier to put on when your hands are dry. • Contaminated items, linens, and trash are bagged 0 Do not tear gloves when putting them on. 0 You need a new pair for every person. to remove them from the person's room. Leak-proof 0 Remove and discard tom, cut, or punctured gloves at plastic bags are used. They have the BTOHAZARD symbol. once. Practice hand hygiene. Then put on a new pair. Double-bagging is not needed unless the outside of the 0 Apply a new pair for every person. bag is wet, soiled, or may be contaminated. 0 Wear gloves once. Discard them after use. 0 Put on clean gloves just before touching mucous Rloodborne Pathogen Standard membranes or non-intact skin. • The health team is at risk for exposure to human 0 Put on new gloves whenever gloves become immunodeficiency virus (HIV) and the hepatitis B virus contaminated with blood, body fluids, secretions, or (HBV). HIV and HBV are bloodbome pathogens found excretions. A task may require more than 1 pair of in the blood. gloves.

• The Bloodborne Pathogen Standard is intended to Laundry protect you from exposure. • OSHA requires these measures for contaminated • Staff at risk for exposure to HIV and HBV receive free laundry. training. o Handle it as little as possible. • Hepatitis B vaccination. You can receive the hepatitis B o Wear gloves or other needed PPE. vaccination within 10 working days of being hired. The o Bag contaminated laundry where it is used. agency pays for it. If you refuse the vaccination, you o Mark lanndry bags or containers with the BIOHAZARD must sign a statement. You can have the vaccination at symbol for laundry sent off-site. a later date. o Place wet, contaminated laundry in leak-proof Work Practice Controls containers before transport. The containers are color BIOHAZARD • Work practice controls reduce employee exposure in coded in red or have the symbol. the workplace. All tasks involving blood or other Exposure Incidents potentially infectious materials (OPIM) are done in • An exposure incident is any eye, mouth, other mucous ways to limit splatters, splashes, and sprays. The membrane, non-intact skin, or parenteral contact with Occupational Safetyand Health Administration blood or OPIM (other potentially infectious materials). (OSHA) requires these work practice controls. • Report exposure incidents at once. Medical evaluation, o Do not eat, drink, smoke, apply cosmetics or lip balm, follow-up, and required tests are free. Your blood is or handle contact lenses in areas of occupational tested for HIV and HBV. Confidentiality is important. exposure. o Do not store food or drinks where blood or OPIM are CHAPTER 16 REVIEW QUESTIONS kept. Circle the BEST answer. o Practice hand hygiene after removing gloves. 1. A healthcare-associated infection (nosocomial o Wash hands as soon as possible after skin contact infection) is with blood or OPfM. a. An infection free of disease-producing microbes o Never re-cap, bend, or remove needles by hand. b. An infection that develops in a person cared for in o Never shear or break needles. any setting where health care is given o Discard needles and sharp instruments (razors) in c. An infection acquired by health care workers containers that are closable, puncture-resistant, and d. An infection acquired only by older persons leak-proof. Containers are color-coded in red and 2. Which statement about hand hygiene is false? BIOHAZARD have the symbol. a. Hand hygiene is the easiest way to prevent the PersonalProtective Equipment (PPE) spread of infection. • This includes gloves, goggles, face shields, masks, b. Hand hygiene is the most important way to prevent laboratory coats, gowns, shoe covers, and surgical caps. the spread of infection. OSHA requires these measures for PPE. c. Hand hygiene is practiced before and after giving o Remove PPE before leaving the work area. care to a person. o Remove PPE when a garment becomes contaminated. d. If hands are visibly soiled, hand hygiene can be 0 Place used PPE in marked areas or containers when done with an alcohol-based hand rub. being stored, washed, decontaminated, or discarded. 3. When washing your hands, you should do the o Wear gloves when you expect contact with blood or following except OPIM. a. Stand away from the sink so your clothes do not o Wear gloves when handling or touching touch the sink contaminated items or surfaces. b. Keep your hands lower than your elbows o Replace worn,punctured, or contaminated gloves. c. Wash your hands for at least 15 seconds o Never wash or decontaminate disposable gloves for d. Dry your arms from the forearms to the fingertips re-use. 4. Which statement about wearing gloves is false? 0 Discard utility gloves that show signs of cracking, a. The insides of gloves are contaminated. peeling, tearing, or puncturing. Utility gloves are b. You need a new pair of gloves for each person you if decontaminated for re-use the process will not ruin care for. them. c. Change gloves when moving from a contaminated Equipment body site to a clean body site. • Contaminated equipment is cleaned and d. Gloves need to cover your wrists. decontaminated. Decontaminate work surfaces with a 5. Which statement is false? proper disinfectant: a. Gowns must cover you from your neck to your o Upon completing tasks waist. 0 At once when there is obvious contamination b. A moist mask is contaminated. o After any spill of blood or OPIM c. The outside of goggles is contaminated. 0 At the end of the work shift when surfaces become d. You should wash your hands after removing a contaminated since the last cleaning gown, mask, or goggles.

6. Which statement about PPE is false? 0 Place the call light within reach after positioning. a. Remove PPE when a garment becomes -.> Complete a safety check before leaving the room. contaminated. • Fowler's position is a semi-sitting position. In semi b. Wear gloves when handling or touching Fowler's position, the head of the bed is raised 30 contaminated items or surfaces. degrees but some agencies define semi-Fowler's c. Wash or decontaminate disposable gloves for re-use. position as raising the head of the bed 30 degrees and d. Remove PPE before leaving the work area. the knee portion 15 degrees. In high-Fowler's position, Answers to tliese questions are on p. 516. the head of the bed is raised between 60and 90 degrees. • The supine position (dorsal recumbent position) is the back-lying position. CHAPTER 17 BODY MECHANICS • A person in the prone position lies on the abdomen Principles of Body Mecl1a11ics with the head turned to 1 side. • A person in the lateral position (side-lying position) • Your strongest and largest muscles are in the shoulders, lies on 1 side or the other. upper arms, hips, and thighs. Use these muscles to lift • Theposition Sims' (semi-prone side position) is a left and move persons and heavy objects. side-lying position. The upper (right) leg is sharply • For good body mechanics: flexed so it is not on the lower (left) leg. The lower (left) 0 Bend your knees and squat to lift a heavy object. Do arm is behind the person. not bend from your waist. • Persons who sit in chairs must hold their upper bodies Hold items close to your body and base of support. and heads erect. For good alignment: • Review Box 17-1, Rules for Body Mechanics, in the 0 The person's back and buttocks are against the back Textbook. of the chair. ' Feet are flat on the floor or wheelchair footplatE:s. Work-RdlltedIn1uries Never leave feet unsupported. • Work-related musculo-skeletal disorders (MSDs) 0 Backs of the knees and calves are slightly away from are injuries and disorders of the muscles, tendons, the edge of the seat. ligaments, joints, and cartilage. • The Occupational Safety and Health Administration CHAP'/ER 17 REVIEWQUESTIONS (OSHA) identifies MSD risk factors as: ° Force: the amount of physical effort needed to Circle the BEST answer. perform a task. 1. To lift and move residents and heavy objects you � Repeating action: doing the same motions or series of should motions continually or frequently. a. Use the muscles in your lower arms -' Awkward postures: assuming positions that place b. Use the muscles in your legs stress on the body. c. Use the muscles in your shoulders, upper arms, 0 Heavy lifting: manually lifting people who cannot lift hips, and thighs themselves. d. Use the muscles in your abdomen • According to the U.S. Department of Labor, nursing 2. For good body mechanics, you should do all of the assistants are at the greatest risk of MSDs. following except • Always report a work-related injury as soon as possible. a. Bend your knees and squat to lift a heavy object Early attention can help prevent the problem from b. Bend from your waist to lift a heavy object becoming worse. Review Box 17-2, Preventing Work c. Hold items close to your body and base of support Related Injuries, in the Te xtbook. d. Bend your legs; do not bend your back 3. Which statement is false? Positioning tlze Person a. A person must be properly positioned at all times. • The person must be properly positioned at all times. b. Regular position changes and good alignment Regular position changes and good alignment promote promote comfort and well-being. comfort and well-being. Breathing is easier. Circulation c. Regular position changes and good alignment is promoted. Pressure ulcers and contractures are promote pressure ulcers and contractures. prevented. d. When a person is in good alignment, breathing is • Whether in bed or in a chair, the person is re-positioned easier and circulation is promoted. at least every 2 hours. To safely position a person: 4. In high-Fowler's position ::: Use good body mechanics. a. The head of the bed is raised to 30 degrees 0 b. The head of the bed is raised between 30and Ask a co-worker to help you if needed. 0 Explain the procedure to the person. 45 degrees 0 Be gentle when moving the person. c. The head of the bed is raised between 45 and Provide for privacy. 60degrees 0 Use pillows as directed by the nurse for support and d. The head of the bed is raised between 60 and alignment. 90 degrees Provide for comfort after positioning. Answers to tlzese questions are on p. 516.

CHAPTER 18 SAFELY MOVING THE Turnmg Persous PERSON • Turning persons onto their sides helps prevent Preveuti11g ¼ork-Related lu)ltries complications from bedrest. Certain procedures and care measures also require the side-lying position. • Good body mechanics alone '"'Villnot prevent injury. After the person is turned, position him or her in good The Occupational Safety and Health Administration alignment. Use pillows as directed to support the (OSHA) recommends person in the side-lying position. o Minimizing manual lifting in all cases. . . . • Logrolling is turning the person as a urut, m alignment, Eliminating manual lifting whenever possible. with 1 motion. The spine is kept straight. Getting help from other staff. • Careful planning is needed to move the person safely. You must know the person's functional status, the Sittmg on the Side of the Be,I (Dangling) number of staff needed, what procedure to use, and the • Many persons become dizzy or faint when getting out of equipment needed. fast. bed too They may need to sit on the side of the bed for 1 to 5 minutes before walking or transferring. Some persons increase activity in stages-bedrest, to sitting on J>roieding r/w .Skiu the side of the bed, to sitting in a chair, to walking. • Protect the person's skin from friction and shearing. • While dangling, the person coughs and deep breathes. He Both cause infection and pressure ulcers. To reduce or she moves the legs back andforth in circles to stimulate friction and shearing: circulation. Provide for warmth during dangling. o Roll the person. • If dizziness or faintness occurs, lay the person down. :> Use friction-reducing devices such as a lift sheet (turning sheet), turning pads, and slide sheets. Re-Positioning ill" Chair or Wlieelcl1air Movwg Persotts in Ued • Some persons slide down into the chair. For good alignment and safety, the person's back and buttocks • Know how much help and what equipment or friction- must be against the back of the chair. reducing devices are needed. . • Review Box 18-2, Guidelines for Moving Persons m Bed, • Follow the nurse's directions and the care plan for in the Textbook. the best way to re-position a person in a chair or wheelchair. Do not pull the person from behind the chair or wheelchair. Uaiswg tlie Person's Hemt aud Shoulders • If the chair reclines, have a co-worker assist, recline the • You can raise the person's head and shoulders easily chair, put an assist device under the person, and use the and safely by locking arms with the person (do not pull assist device to move the person up. on the person's arm or shoulder). • If the person is in a wheelchair and has strength to • Have help with older persons and with those who are theassist, lock wheels of the wheelchair and move the heavy or hard to move. foot rests to the sides. Position a transfer belt around the person, stand in front of the person, and grasp the �o 1 ,g tJ,e A rso11 l.,pm Be t transfer belt with both hands. Ask the person to push • You can sometimes move light-weight adults up in bed with his or her feet and arms on the count of 3 and alone if they can assist using a trapeze. move the person back into the wheelchair while the • Two or more staff members are needed to move heavy, person pushes with his or her feet and arms. weak, and very old persons up in bed. Always protect the person and yourself from injury. CHAPTER 18 REVIEW QUESTIONS Moving tl1e Person Up in Be,I Witl, Circle the BEST answer. 1. Friction and shearing are reduced by doing all the an . b.si.srDei ,ce following except • Assist devices are used to reduce shearing and friction. a. Rolling the person Such assist devices include a drawsheet (lift sheet), flat b. Using a lift sheet or tt1rning pad sheet folded in half, turning pad, slide sheet, and large c. Using a pillow incontinence product. d. Using a slide board or slide sheet • Assist devices are used to move most patients and 2. After a person is turned, you must position him or her residents and at least 2 staff members are needed to in good alignment. position and use the assist device. a. True • Moving the person to the side of the bed can be done b. False alone if the person is small enough. You move the 3. Which statement aboutdangling is false? person in segments by placing your hands and arms a. Many older persons become dizzy or faint when underneath the person. Move the upper body first they first dangle. (while supporting the person's neck), then the lower b. The person should cough and deep breathe while body, and finally the legs and feet. dangling.

c. The person moves his or her legs before dangling • Use friction-reducing devices to protect the skin from d. You should cover the person's shoulders with a robe friction and shearing during lateral transfers. or blanket while dangling. • When moving a person from a bed to a stretcher, A11swers to these questions are on p. 516. use a friction-reducing device and at least 2 or 3 staff members to assist. If the person weighs more than 200 pounds, a mechanical lift with supine sling, mechanical CHAPTER 19 SAFELY TRANSFERRING THE lateral device, or inflatabledevice is used. • Persons who cannot help themselves are transferred PERSON • A transfer is how a person safely moves to and from with mechanical lifts. So are persons who are too heavy surfaces-bed, chair, wheelchair, toilet, or standing for the staff to transfer. position. • Before using a mechanical lift, you must be trained in its • The amount of help needed and the method used vary use. The sling, straps, hooks, and chains must be in good with the person's ability. repair. The person's weight must not exceed the lift's capacity. At least 2 staff members are needed. Always follow the manufacturer's instructions for using the lift. \1 I c'ia St¥ I w Saret• • Falling from the lift is a common fear. To promote the • Wheelchairs are used for persons who cannot walk or person's mental comfort, always explain the procedure who have severe problems walking. Stretchers are used before you begin. Also show the person how the lift to transfer persons who arc seriously ill, cannot sit up, works. or must stay in a lying position from 1 area to another. • Review Box 19-2, Wheelchair and Stretcher Safety, in the Textbook. CHAPTER 19 REVIEW QUESTIONS Circle the BEST answer. ':>u ,d anrl O "OI Tro11 J �s 1. You are transferring a person from the bed to a • Some persons are able to stand and pivot {move one's wheelchair. Which statement is false? body from a set standing position). Use this transfer if a. The person should wear non-skid footwear. the person's legs are strong enough to bear weight and b. The person may put his or her arms aroW1dyour neck. the person is cooperative and can follow directions and c. You should use a gait/transfer belt. assist in the transfer. d. You should lock the wheelchair wheels. • Transfer belts (gait belts) are used to support persoru. 2. A person has a weak left side and a strong right side. In during transfers and to re-position persons in chairs and transferring the person from the bed to the wheelchair, wheelchairs. his or her strong (right) side moves first. • Arrange the room so there is enough space for a safe a. True transfer. Correct placement of the chair, wheelchair, or b. False other device also is needed for a safe transfer. 3. Before using a mechanical lift, you do all of the • Have the person wear non-skid footwear for transfers. following except • Lock the wheels of the bed, wheelchair, stretcher, or a. Check the sling, straps, and chains to ensure good other assist device. repair • The person must not put his or her arms around your b. Check the person's weight to be sure it does not neck when assisting the person to stand. exceed the lift's capacity • After the transfer, position the person in good c. Follow the manufacturer'sinstructions for using the lift alignment. d. Operate the lift without a co-worker • For bed to chair or wheelchair transfers, the strong side Answers to tl,ese questions are 011 p. 516. moves first. Help the person out of bed on his or her strong side. When transferring the person from the chair or wheelchair back to bed, the same rules apply. Help CHAPTER 20 THE PERSON'� UNIT the person from the wheelchair to the bed on his or her • A person's unit is the personal space, furniture, and strong side. If the person is weak on 1 side, position the equipment provided for the person by the agency. The chair or wheelchair so that the person's strong side is Omnibus Budget Reconciliation Act of 1987 (OBRA) nearest the bed. The strong side moves first. requires that resident units be as personal and home • Transferring the person to and from the toilet is often like as possible. hard because bathrooms are small. If the wheelchair • Keep the person's room clean, neat, safe, and can fit in the bathroom, place it at a 90-degree angle to comfortable. Follow the rules in Box 20-1, Maintaining the toilet and use a sliding board or the stand and pivot the Person's Unit, and Box 20-2, OBRA and CMS transfer from the wheelchair to the toilet. Requirements for Resident Rooms, in the Textbook.

rs Comfort • A lateral transfer moves a person ben,vcen 2 horizontal • Age, illness, and activity are factors that affect com.fort. surfaces, such as from a bed to a stretcher. The person • Temperature, ventilation, noise, odors, and lighting are slides from 1 surface to the other. factors that arc controlled to meet the person's needs.

Temperature and Ventilation o Semi-Fowler's position-the head of the bed is raised 30 • Older persons and those who are ill may need higher degrees. Some agencies define semi-Fowler's position temperatures for comfort. Ventilation systems provide as when the head of the bed is raised 30 degrees fresh air and move air within the room. and the knee portion is raised 15 degrees. Know the • To protect older and ill persons from drafts, make sure definition used by your agency. the person wears enough clothing, offer lap robes to o Trendelenburg's position-the head of the bed is cover the legs, provide blankets, cover the person with a lowered and the foot of the bed is raised. A doctor bath blanket when providing care, and move the person orders the position. from drafty areas. o Reverse Trendelenburg's position-the head of the bed Odors is raised and the foot of the bed is lowered. A doctor • To reduce odors in nursing centers: orders the position. o Empty, clean, and disinfect bedpans, urinals, Bed Safety commodes, and kidney basins promptly. • Entrapment means the person can get caught, trapped, o Check to make sure toilets are flushed. or entangled in spaces created by bed rails, the o Check incontinent people often. mattress, the bed frame, or the head-board and foot o Clean persons who are wet or soiled from urine, board. Serious injuries and deaths have occurred from feces, vomitus, or wound drainage. entrapment. If a person is at risk for entrapment, report o Change wet or soiled linens and clothing promptly. your concerns to the nurse at once. If a person is caught, o Keep laundry containers closed. trapped, or entangled, try to release the person. Call for o Follow agency policy for wet or soiled linens and the nurse at once. clothing. The Over-Bed Table 0 Dispose of incontinence and ostomy products • Only clean and sterile items are placed on the table. promptly. Never place bedpans, urinals, or soiled linens on the o Provide good hygiene to prevent body and breath over-bed table or on top of the bedside stand. odors. • Clean the table and bedside stand after using them for a o Use room deodorizers as needed and as allowed by work surface and before serving meal trays. agency policy. PrivacyCurtains you smoke, practice hand-washing after handling • If • Always pull the curtain completely around the bed smoking materials and before giving care. Give careful before giving care. Privacy curtains do not block sound attention to your uniforms, hair, and breath because of or conversations. smoke odors. The Call System Noise • To decrease noise: • The call light must always be kept within the person's Control your voice. reach-in the room, bathroom, and shower or tub room. o You must: o Handle equipment carefully. ° Keep equipment in good working order. o Place the call light on the person's strong side. 0 Remind the person to signal when help is needed. 0 Answer phones, call lights, and intercoms promptly. 0 Answer call lights promptly. Lighting 0 Answer bathroom and shower or tub room call lights • Adjust lighting to meet the person's needs. Glares, at once. shadows, and dull lighting can cause falls, headaches, • Persons with limited hand mobility may need special and eyestrain. A bright room is cheerful. Dim light is communication measures. better for relaxing and rest. Persons with poor vision • Be careful when using the intercom. Remember need bright light. Always keep light controls within the confidentiality. Persons nearby can hear what you and person's reach. the person say. Room Furniture and Equipment TheBatliroom • Grab are bars by the toilet so persons can use them to • Rooms are furnishedand equipped to meet basic needs. get on and off the toilet. TlieBed • Some toilet seats are raised to make transfers easier and • Beds are raised horizontally to give care. This reduces for persons with joint problems. bending and reaching. • A call light or button is within reach of the toilet if the • Bed wheels are locked at all times except when moving person needs assistance. the bed. Closet a,id Drawer Space • Use bed rails as the nurse and care plan direct. • The person must have free access to the closet and its • Basic bed positions: contents. You must have the person's permission to Flat-the usual sleeping position. o open or search closets or drawers. Fowler's position-a semi-sitting position. The head of o • Agency staff can inspect a person's closet or drawers the bed is raised between 45 and 60 degrees. if hoarding is suspected. The person is informed of the 0 High-Fowler's position-a semi-sitting position. The inspection and is present when it takes place. Have a co head of the bed is raised 60 to 90 degrees. worker present when you inspect a person's closet.

CHAPTER 20 REVIEWQUESTIONS o An open bed is in use. Top linens are fan-folded back so the person can get into bed. A closed bed becomes Circle tlie BEST answer. an open bed by fan-folding back the top linens. 1. Serious injuries and death have occurred from 0 An occupied bed is made with the person in it. entrapment. o A surgical bed is made to transfer a person from a. True a stretcher. This bed is also made for persons who b. False arrive by ambulance. 2. You should never place bedpans, urinals, or soiled linens on the over-bed table. a. True Linens b. False • When handling linens and making beds: 3. You should clean the bedside stand if you use it for a o Practice medical asepsis. work surface. 0 Always hold linens away from your body and a. True uniform. Your uniform is considered dirty. b. False o Never shake linens. 4. The following protect a person from drafts except o Place clean linens on a clean surface. a. Wearing enough clothing o Never put clean or used linens on the floor. b. Lap robes • Collect enough linens. Do not bring unneeded linens c. Using a sheet when giving care to the person's room. Once in the room, extra linens d. Providing blankets are considered contaminated. They cannot be used for 5. To reduce odors, you do the following except another person. a. Empty bedpans and commodes promptly • Roll each piece of used linens away from you. The side b. Keep laundry containers open that touched the person is inside the roll and away from c. Check to make sure toilets are flushed you. d. Clean persons who are wet or soiled from urine or feces Making Beds 6. Which statement about the caH light is false? • When making beds, safety and medical asepsis are a. The call light must always be within the person's important. Use good body mechanics. Follow the rules reach. for safe resident handling, moving, and transfers. b. Place the call light on the person's strong side. Practice hand hygiene before handling clean linens and c. You have to answer the call lights only for residents after handling used linens. To save time and energy, assigned to you. make beds with a co-worker. d. Answer call lights promptly. • Review Box 21-1, Rules for Bedrnaking, in the Textbook. 7. You suspect a person is hoarding food in her closet. • Closed beds are made for nursing center residents who Before you inspect the closet, what do you do? are up and away from the bed for all or most of the a. Tell another nursing assistant what you suspect. day. Change linens as needed. For beds awaiting new b. Inspect the closet without telling the resident. residents or patients, the entire bed requires clean linens c. Tell the family. after the bed system has been cleaned and disinfected. ct. Ask the resident if you can inspect the closet. • The dosed bed becomes an open bed by fan-folding Answers to these questions are on p. 516. back the top linens so the person can get into bed with ease. • An occupied bed is made while the person stays in bed. CHAPTER 21 BEDMAKING Keep the person in good alignment. Follow restrictions • Clean, dry, and wrinkle-free linens promote comfort. or limits in the person's movement or position. Explain Skin breakdown and pressure ulcers are prevented. each procedure step to the person before it is done. This • To keep beds neat and clean: is important even if the person cannot respond to you. o Change linens whenever they become wet, soiled, or damp. CHAPTER 21 REVIEWQUESTIONS 0 Straighten linens whenever loose or wrinkled and at Circle the BEST answer. ° bedtime. 1. Once in the person's room, extra linens are considered Check for and remove food and crumbs after meals contaminated. They can be used for another person. and snacks. a. True o Check linens for dentures, eyeglasses, hearing aids, b. False sharp objects, and other items. 2. Roll each piece of used linens away from you. The side o Follow Standard Precautions and the Bloodborne that touched the person is inside the roll. Pathogen Standard. a. True b. False Types ofBeds 3. Wear gloves when removing linens from the person's • Beds are made in these ways. bed. 0 A closed bed is not in use or the bed is ready for a a. True new resident. Top linens are not folded back. b. False

4. To keep beds neat and dean, do the following except • Use sponge swabs to apply the cleaning agent. To a. Straighten linens whenever loose or wrinkled prevent cracking of the lips, apply a lubricant to the b. Check for and remove food and crumbs after meals lips. Check the care plan. c. Check linens for dentures, eyeglasses, and hearing • To prevent aspiration on the unconscious person: aids 0 Position the person on 1 side with the head turned d. Change linens monthly well to the side. 5. Which statement is false? 0 Use only a small amount of fluid to clean the mouth. a. Practice medical asepsis when handling linens. o Do not insert dentures. Dentures are not worn when b. Always hold linens away from your body and the person is unconscious. uniform. • When giving oral hygiene, keep the person's mouth c. Shake linens to remove crumbs. open with a padded tongue blade. d. Put used linens in the used laundry bin. • Mouth care is given at least every 2 hours. Follow the Answers to these questions are on p. 516. nurse's direction and the care plan.

Deuture Care CHAPTER 22 PERSONAL HYGIENE • Mouth care is given and dentures are cleaned as often as • Besides cleansing, good hygiene prevents body and natural teeth. Dentures are usually removed at bedtime. breath odors. It is relaxing and increases circulation. Some persons remove dentures at meal time. Remind • Culture and personal choice affect hygiene. people not to wrap dentures in tissues or napkins at meal time, as they could be discarded accidentally. Daily Care • Dentures are slippery when wet. Hold them firmly. • Most people have hygiene routines and habits. Hygiene During cleaning, hold them over a basin of water lined measures are often done before and after meals and at with a towel. Use a cleaning agent and follow the bedtime. You assist with hygiene whenever it is needed. manufacturer's instructions. Protect the person's right to privacy and to personal • Hot water causes dentures to lose their shape. If choice. dentures are not worn after cleaning, store them in a container with cool water or a denture soaking solution. Oral Hygiene • Label the denture cup with the person's name, room • Oral hygiene keeps the mouth and teeth clean. It number, and bed number. Report lost or damaged prevents mouth odors and infections, increases comfort, dentures to the nurse at once. Losing or damaging and makes food taste better. Mouth care also reduces dentures is negligent conduct. the risk for cavities and periodontal disease. • Many people do not like being seen without their • Assist with oral hygiene after sleep, after meals, and at dentures. Privacy is important. If you dean dentures, bedtime. Follow the care plan. return them to the person as quickly as possible. • Follow Standard Precautions and the Bloodbome • Persons with partial dentures have some natural teeth. Pathogen Standard. They need to brush and floss the natural teeth. • Report and record: 0 Dry, cracked, swollen, or blistered lips Bathing 0 Mouth or breath odor • Bathing cleans the skin. The mucous membranes of 0 Redness, swelling, irritation, sores, or white patches the genital and anal areas are cleaned as well. A bath in the mouth or on the tongue is refreshing and relaxing. Circulation is stimulated o Bleeding, swelling, or redness of the gums and body parts exercised. You have time to talk to the o Loose teeth person and make observations. 0 Rough, sharp, or chipped areas on dentures • Review Box 22-2, Rules for Bathing, in the Textbook. • Soap dries the skin. Therefore older persons usually Brushing and Flossing Teeth need a complete bath or shower twice a week. Partial • Flossing removes plaque and tartar from the teeth as baths are taken the other days. Some bathe daily but well as food from between the teeth. Flossing is usually not with soap. Thorough rinsing is needed when using done after brushing. If done once a day, bedtime is the soap. Lotions and oils keep the skin soft. • Water temperature for complete bed baths and partial best time to floss. ° ° • Some persons need help gathering and setting up bed baths is between 1l0 F and 115 F. Older persons equipment for oral hygiene. You may have to perform have fragile skin and need lower water temperatures. oral care for persons who are weak, cannot move their Measure water temperature according to agency policy. arms, or are too confused to brush their teeth. • Report and record: 0 The color of the skin, lips, nail beds, and sclera Moutl, Care for the Unconscious Person (whites of the eyes) • Unconscious persons have dry mouths and crusting 0 Ii the skin appears pale, grayish, yellow Qaundice), or bluish (cyanotic) on the tongue and mucous membranes. Oral hygiene keeps the mouth clean and moist. It also helps prevent o The location and description of rashes infection. 0 Skin texture-smooth, rough, scaly, flaky, dry, moist

0 Diaphoresis-profuse (excessive) sweating • Perineal and perineum are not common terms. Most o Bruises or open areas people understand privates, private parts, crotch,genitals, o Pale or reddened areas, particularly over bony parts or the area between the legs. Use terms the person e, Drainage or bleeding from wounds or body openings understands. o Swelling of the feet and legs • Standard Precautions, medical asepsis, and the o Corns or calluses on the feet Bloodborne Pathogen Standard are followed. o Skin temperature • Work from the cleanest area to the dirtiest---commonly o Complaints of pain or discomfort called cleaning from "front to back." On a woman, clean • Use caution when applying powders. Do not use from the urethra (cleanest) to the anal (dirtiest) area. powders near persons with respiratory disorders. Do On a male, start at the meatus of the urethra and work not sprinkle or shake powder onto the person. To safely outward. apply powder: • Use warm water. Use washcloths, towelettes, cotton o Tum away from the person. balls, or swabs according to agency policy. Rinse ° 0 Sprinkle a small amount onto your hands or a cloth. thoroughly. Pat dry. Water temperature is usually 105 F ° o Apply the powder in a thin layer. to 109 F. 0 Make sure powder does not get on the floor. Powder • Report and record: is slippery and can cause falls. o Bleeding, redness, swelling, irritation, discharge The Complete Bed Bath o Complaints of pain, burning, or other discomfort • The complete bed bath involves washing the person's '" Signs of urinary or fecal incontinence entire body in bed. Wash around the person's eyes with v Signs of skin breakdown water. Do not use soap. Gently wipe from the inner o Odors to the outer aspect of the eye. Use a dean part of the washcloth for each stroke. Ask the person if you should CHAPTER 2 ... FVIEWR QUESTIONS use soap to wash the face. Let the person wash the Circle the BESTanswer. genital area if he or she is able. 1. Oral hygiene does the following except • Give a back massage after the bath. Apply deodorant or a. Keep the mouth and teeth clean antiperspirant, lotion, and powder as requested. Comb b. Prevent mouth odors and infections and brush the hair. Empty and dean the wash basin. c. Decrease comfort The PartialBatl1 d. Make food taste better • The partial bath involves bathing the face, hands, axillae 2. When giving oral hygiene, you should report and (underarms), back, buttocks, and perinea! area. You record the following except assist the person as needed. Most need help washing a. Dry, cracked, swollen, or blistered lips the back. b. Redness, sores, or white patches in the mouth Tub Baths and Sl1owers c. Bleeding, swelling, or redness of the gums • Falls, burns, and chilling from water are risks. Review d. The number of fillings a person has Box 22-2, Rules for Bathing, and 22-3, Tub Bath and 3. A person is unconscious. When you do mouth care, Shower Safety, in the Textbook. you do the following except • A tub bath can cause a person to feel faint, weak, or a. Use only a small amount of fluid to clean the tired.person The may need a transfer bench, a tub with mouth a side entry door, a wheelchair or stretcher lift, or a b. Use your fingers to keep the mouth open mechanical lift to get in and out of the tub. c. Explain what you are doing • Some people can use a regular shower. Have the person d. Give mouth care at least every 2 hours use the grab bars for support during the shower. Use a 4. Which statement about dentures isfalse? bath mat if the shower does not have non-skid surfaces. a. Dentures are slippery when wet. Never let weak or unsteady persons stand in the b. During cleaning, hold dentures over a basin of shower. They may need to use shower chairs, shower water lined with a towel. stalls or cabinets, or shower trolleys. Some shower c. Store dentures in cool water. rooms have 2 or more stations. Protect the person's d. Remind people to wrap their dentures in tissues or privacy. Properly screen and cover the person. napkins. • Water temperature for tub baths and showers is 5. Bathing does the following except usually 105°F. Report and record dizziness and light a. Cleanses the skin headedness. b. Stimulates circulation • Clean and disinfect the tub or shower before and after use. c. Makes a person tense d. Permits you to observe the person's skin 6. The water temperature for a complete bed bath is Permeal Care ° ° a. 102 F to 108 F • Perinea] care involves cleaning the genital and anal ° ° areas. It is done daily during the bath and whenever b. 110 F to 115 F c. 115°F to l 20°F the area is soiled with urine or feces. The person does ° ° perinea! care if able. d. 120 F to 125 F

• Follow Standard Precautions and the Bloodbome 7. Which statement is false? a. Use powder near persons with respiratory Pathogen Standard. ° disorders. • Water temperature is usually 105 F. b. Before applying powder, check with the nurse and • Hair is dried and styled as soon as possible after the the care plan. shampooing. c. Before applying powder, sprinkle a small amount • During shampooing, report and record: of powder onto your hands. o Scalp sores d. Apply powder in a thin layer. o Flaking 8. When washing a person's eyes, you should do the o Itching following except o Presence of nits or lice a. Use only water o Patches of hair loss b. Gently wipe from the inner to the outer aspect of o Hair falling out in patches the eye o Very dry or very oily hair c. Gently wipe from the outer to the inner aspect of o Matted or tangled hair the eye o How the person tolerated the procedure d. Use a clean part of the washcloth for each stroke 9. When giving female perineal care, you should work Shaving from the urethra to the anal area. • Many men shave for comfort and well-being. Many a. True women shave their underarms and legs. b. False • Electric shaver or safety razors are used. Some persons 10. When giving male perineal care, start at the meatus have their own shavers. Do not use safety razors on and work outward. persons with healing problems or persons taking a. True anticoagulant drugs. Older persons with wrinkled skin b. False are at risk for nicks and cuts. Safety razors are not used Answers to these questions are on p. 516. to shave them or persons with dementia. • Wash and comb mustaches and beards daily and as needed. Ask the person how to groom his mustache CHAPTER 23 GROOMING or beard. Never trim a mustache or beard without the • Hair care, shaving, nail and foot care, and clean person's consent. garments prevent infection and promote comfort. They • Many women shave their legs and underarms. This also affect love, belonging, and self-esteem needs. practice varies among cultures. Legs and underarms are shaved after bathing when the skin is soft. Hair Care • Review Box 23-1, Rules for Shaving, in the Textbook. • You assist patients and residents with brushing and combing hair and with shampooing as needed and Nail and Foot Care according to the care plan. The nursing process reflects • Nail and foot care prevent infection, injury, and odors. the person's culture, personal choice, skin and scalp • Nails are easier to trim and clean right after soaking or condition, health history, and self-care ability. bathing. Brushing and Combing Hair • Use nail clippers to cut fingernails. Never use scissors. • Encourage residents to brush and comb their own hair Use extreme caution to prevent damage to nearby tissues. but assist as needed. • Some agencies do not let nursing assistants cut or trim • Daily brushing and combing prevent tangled and toenails. Follow agency policy. matted hair. • Follow Standard Precautions and the Bloodborne • When brushing and combing hair, start at the scalp and Pathogen Standard. brush or comb to the hair ends. • Report and record: • Never cut hair for any reason. 0 Dry, reddened, irritated, or callused areas • Special measures are needed for curly, coarse, and dry o Breaks in the skin hair. Check the care plan. ° Corns on top of and between the toes • When giving hair care, place a towel across the person's o Blisters back shoulders and to protect garments from falling o Very thick nails hair. If the person is in bed, give hair care before o Loose nails changing the linens and pillowcase. • You do not cut or trim toenails if a person has diabetes or circulation poor to the legs and feet or takes drugs Shampooing that affect blood clotting. Also, do not cut or trim • Shampooing frequency depends on the person's needs toenails if the person has very thick nails or ingrown and preferences. toenails. The nurse or podiatrist cuts toenails and • Keep shampoo away from and out of eyes. Have the provides foot care for these persons. person hold a washcloth over the eyes. • When doing foot care, check between the toes for cracks • Wear gloves if the person has scalp sores. and sores. If left untreated, a serious infection could occur.

• The feet of persons with decreased sensation or 5. A person takes an anticoagulant. Therefore he shaves circulatory problems may easily bum because they do with a blade razor. not feel hot temperatures. a. True • After soaking, apply lotion to the feet. Because the b. False lotion can cause slippery feet, help the person put on 6. You should wear gloves when shaving a person with non-skid footwear before you transfer the person or let a safety razor. the person walk. a. True b. False Clianging Garments 7. Never trim a mustache or beard without the person's • Garments are changed after the bath and whenever wet consent. or soiled. a. True • When changing clothing: b. False o Provide for privacy. 8. Mustaches and beards need daily care. o Encourage the person to do as much as possible. a. True o Let the person choose what to wear. Make sure the b. False right under-garments are chosen. 9. A person has diabetes. You can cut his or her toenails. o Make sure garments and footwear are the correct a. True size. b. False o Remove clothing from the strong or "good" 10. Fingernails are cut with (unaffected) side first. a. Scissors o Put clothing on the weak (affected) side first. b. Nail clippers o Support the arm or leg when removing or putting on c. An emery board a garment. d. A nail file o Move or handle the body gently. Do not force a joint 11. Which statement is false? beyond its range of motion or to the point of pain. a. Provide privacy when a person is changing clothes. • When changing gowns, remove the gown from the b. Most residents wear street clothes during the day. strong arm first while supporting the weak arm. Put a c. Let the person choose what to wear. clean gown on the weak arm first and then the strong d. You may tear a person's clothing. arm. Answers to these questions are on p. 516. • To change the gown of a person with an intravenous (IV) bag, gather the sleeve of the arm with the IV bag and slide it over the IV site and tubing. Remove the IV CHAPTER 24 URINARY ELIMINATION bag, draw it through the sleeve, and re-hang the IV bag. Normal Urination Gather the sleeve of the clean gown, remove the IV bag, • The healthy adult produces about 1500 milliliters (mL) slide the sleeve over the IV bag, then re-hang the bag. of urine a day. Slide the sleeve over the tubing, hand, arm, and JVsite. • The frequency of urination is affected by amount Do not pull on the tubing. of fluid intake, habits, availability of toilet facilities, • Have the nurse check the flow rate after changing the activity, work, and illness. People usually void at gown of a person with an IV. If the person is on an IV bedtime, after sleep, and before meals. Some people pump, do not changethe gown. void every 2 to 3 hours. The need to void at night disturbs sleep. Some persons need help getting to CHAPTER 23 REVIEW QUESTIONS the bathroom and others use bedpans, urinals, or Circle the BEST answer. com.modes. Review Box 24-1, Rules for Normal 1. Hair care, shaving, and nail and foot care prevent Urination, in the Textbook. infection and promote comfort. Observations a. True • Observe urine for color, clarity, odor, amount, particles, b. False and blood. Nom1al urine is pale yellow, straw-colored, 2. If a person's hair is matted, you may cut the hair. or amber. It is clear with no particles. A faint odor is a. True normal. b. False • Some foods and drugs affect urine color. Ask the nurse 3. When giving hair care, place a towel across the to observe urine that looks or smells abnormal. person's back and shoulders to protect garments from • Report the following urinary problems. falling hair. 0 Dysuria-painful or difficult urination a. True o Hematuria-blood in the urine b. False 0 Nocturia-frequent urination at night 4. You should wear gloves when shampooing a person c Oliguria-scant amount of urine; less than 500ml in who has scalp sores. 24 hours a. True 0 Polyuria-abnormally large amounts of urine b. False 0 Urinary frequency-voiding at frequent intervals

Urinary incontinence-involuntary loss or leakage Bladder Trammg of urine • Bladder training helps some persons with urinary Urinary urgency-the need to void at once incontinence. Control of urination is the goal. Bladder • Follow Standard Precautions and the Bloodbome control promotes comfort and quality of life. It also Pathogen Standard when handling bedpans, urinals, increases self-esteem. commodes, and their contents. • You assist with bladder training as directed by the nurse • Thoroughly clean and disinfect bedpans, urinals, and and the care plan. The care plan may include one of the commodes after use. following: bladder rehabilitation, prompted voiding '. • Men stand or sit at the side of the bed to use the urinal. habit training/scheduled voiding, or catheter clamping. Some men need support when standing. • You may have to place and hold the urinal for some CHAPTER 24 REVIEW QUESTIONS men. This may embarrass both the person and you. Act in a professional manner at all times. Circle the BEST answer. • Remind men to hang urinals on bed rails and to signal 1. Which statement isfnlse? after using them. a. Normal urine is yellow, straw-colored, or amber. • Commodes are chairs or wheelchairs with an opening b. Urine with a strong odor is normal. for a container. Persons unable to walk to the bathroom c. A person normally voids 1500 mL a day. often use commodes. d. Observe urine for color, clarity, odor, amount, and particles. 2. Which observation does not need to be reported to the UrinnryJncontmence nurse promptly? • Urinary incontinence is the involuntary loss or leakage a. Complainu, of urgency of urine. b. Burning on urination • U urinary incontinence is a new problem, tell the nurse c. Painful or difficult urination at once. d. Clear amber urine • Incontinence is embarrassing. Garments are wet 3. Which statement and odors develop. Skin irritation, infection, and isfnlse? a. Incontinence is embarrassing. pressure ulcers are risks. The person's pride, dignity, b. Caring for persons with incontinence may be stressful. and self-esteem are affected. Social isolation, loss of c. Incontinence is a personal choice. independence, and depression are common. d. Be kind and patient to persons who are incontinent. • Good skin care and dry garments and linens are 4. A person with a catheter complains of pain. You should essential. Promoting normal urinary elimination notify the nurse at once. prevents incontinence in some people. Other people a. True may need bladder training. b. False • Review Box 24-3, Nursing Measures for Urinary 5. The goal of bladder training is to Incontinence, in the Te xtbook. a. Allow the person to use the toilet • Caring for persons with incontinence is stressful. b. Keep the catheter Remember, the person does not choose to be c. Gain control of urination incontinent. If you find yourself becoming short d. Decrease self-esteem tempered and impatient, talk to the nurse at once. Kindness, empathy, understanding, and patience are Answers to these questio11sare on p. 516. needed. Applying lrlcontinenu Products CHAPTER 25 URINARY CATHETERS • Incontinence products are used to keep the person dry. • A catheter is a tube used to drain or inject fluid through Most are disposable and only used once. a body opening. A urinary catheter is inserted through • Incontinence products include a complete incontinence the ur�thra into the bladder and is used to drain urine. brief, a pad and under-garment, pull-on underwear, • The types of catheters are a which or a belted under-garment. Follow the manufacturer's straight catheter, is used to drain the urine and then removed, and an instructions for applying incontinence products. • Observations to report and record: indwelling catheter (retention or Foley catheter), which is left in the bladder and drains urine constantly Complaints of pain, burning, irritation, or the need to into a drainage bag. void v Signs and symptoms of skin breakdown, including redness, irritation, blisters, and complaints of pain, Catheter Car" burning, itching, or tingling • The risk of a urinary tract infection (UTI) is high. o The amount of urine and urine color Review Box 25-1, Indwelling Catheter Care, in the Blood in the urine Textbook. o • The catheter must not pull at the insertion site. Hold the ..> Leakage or a poor product fit • Review Box 24-4,Applying Incontinence Products, in catheter securely during catheter care. Then properly the Textbook. secure the catheter. Also make sure the tubing is not under the person. Besides obstructing urine flow, lying

on the tubing is uncomfortable. It can also cause skin • The balloon of an indwelling catheter is inflated with breakdown. water injected with a syringe. A syringe is also used • Follow Standard Precautions and the Bloodbome to remove the water. Before removing the indwelling Pathogen Standard. catheter, learn the size of the balloon before deflating • Report and record: it. If the balloon is 5 mL in size, you must withdraw o Complaints of pain, burning, irritation, or the need to 5 mL of water with the syringe. Do not remove the void (report at once) catheter if water remains in the balloon. Call the o Crusting, abnormal drainage, or secretions nurse. o The color, clarity, and odor of urine • Report and record the following observations. o Particles in the urine o The amount of urine in the drainage bag o Blood in the urine o The color, clarity, and odor of urine o Cloudy urine o Particles in the wine o Urine leaking at the insertion site o Blood in the urine o Drainage system lea ks o How the person tolerated the procedure o Complaints of pain, burning,irritation, or the need Urine Drainage Systems to void • A closed urinary drainage system is used for indwelling catheters. Infections can occur if microbes enter the Condom Catheters drainage system. The two types of drainage bags are • Condom catheters are often used for incontinent men. standard drainage bags and leg bags. They are also called externalcatheters, Texas catheters, • The standard drainage bag hangs from the bed frame, and urinary sheaths. chair, or wheelchair. It must not touch the floor. The bag • These catheters are changed daily after perinea) care. is always kept lower than the person's bladder. Do not • To apply a condom catheter, follow the manufacturer's hang the drainage bag on a bed rail. instructions. Thoroughly wash and dry the penis before • If the drainage system is disconnected accidentally, tell applying the catheter. the nurse at once. Do not touch the ends of the catheter • Some condom catheters are self-adhering. Other or tubing. Do the following: catheters are secured in place with elastic tape in a o Practice hand hygiene. Put on gloves. spiral manner. Never use adhesive tape to secure o Wipe the end of the drainage tube with an antiseptic catheters. It does not expand. Blood flow to the penis is wipe. cut off, injuring the penis. o Wipe the end of the catheter with another antiseptic • When removing or applying a condom catheter, report wipe. and record the following observations. o Do not put the ends down. Do not toucl1 the ends o Reddened or open areas on the penis after you clean them. o Swelling of the penis o Connect the drainage tubing to the catheter. o Color, clarity, and odor of urine o Discard the wipes into a biohazard bag. o Particles in the urine o Remove the gloves. Practice hand hygiene. o Blood in the urine • Check with the nurse and care plan about when to o Cloudy urine empty and measure the urine in the drainage bag. • Do not apply a condom catheter if the penis is red, is Follow Standard Precautions and the Bloodborne irritated, or shows signs of skin breakdown. Report Pathogen Standard. your observations to the nurse at once. • A leg bag is a drainage system that attaches to the thigh or calf. Empty and measure a leg bag when it is half full. CHAPTER 25 REVIEW QUESTIONS • Report and record: Circle the BEST answer. The amount of urine measured o 1. Which statement is false? o The color, clarity, and odor of urine Particles in the urine a. The urine drainage system should hang from the o bed frame or chair. 0 Blood in the urine b. The urine drajnage system should hang on a bed o Cloudy urine ° Complaints of pain, burning, irritation, or the need to rail. urinate c. The urine drainage system must be off the floor. Drainage system leaks d. The urine drainage system must be kept lower than o the person's bladder. 2. If the drainage system becomes accidentally Removing Indwelling Catheters disconnected, you need to • Before removing an indwelling catheter, be sure that a. Call the nurse your state allows you to perform this procedure, the b. Put on gloves and use antiseptic wipes to clean the procedure is in your job description, you know how to ends of the tubing use the supplies and equipment, and you review the c. Pub on gloves and clamp the tubing procedure with the nurse. d. Put the ends of the tubing on paper towels

3. Before removing an indwelling catheter, what do you • Common causes of constipation are a low-fiber diet do first? and ignoring the urge to defecate. Other ca�ses include a. Tug on the catheter to see if it will come out. decreased Auid intake, inactivity, drugs, aging, and b. Wipe the meatus with an antiseptic wipe. certain diseases. c. Drain the balloon with a syrmge. • Dietary changes, fluids, and activity prevent or. d. Check the balloon size. relieve constipation. So do stool softeners, laxatives, suppositories, and enemas. 4. Which statement is false? . a. Condom catheters arc changed daily. • A fecal impaction is the prolonged retention and b. Follow the manufacturer's instructions when buildup of feces in the rectum. applying a condom catheter. • Fecal impaction results if constipation is not relieved. c. Use adhesive tape to securecondom a catheter m place. The person cannot defecate. Liquid feces pa�s �ound d. Report and record open or reddened areas on the the hardened fecal mass in lhe rectum. The hqwd feces penis at once. seep from the anus. Answers to tJiese questions are on p. 516. • Abdominal discomfort, abdominal distention, nausea, cramping, and rectal pain are common. Older persons have poor appetite or confusion. CHAPTER 26 BOWEL ELIMINATION Some persons have a fever. Report these si!J1s and Normal Jjowel I /,mit1atio11 symptoms to the nurse. • Checking for and removing a fecal impaction can be • Stools are normally brown, soft, formed, moist, and dangerous, because the vagusnerve can be stim lated, shaped like the rectum. They have a normal odo � � resulting in a slowing of the heart rate. Check with caused by bacterial action in the intestines. Certain your state and agency policies to determine if you may foods and drugs cause odors. perform this procedure. • Carefully observe stools before disposing of them. • is the frequent passage of liquid !>tools. Observe and report the color, amount, consistency, Diarrhea • The need to have a BM is urgent. Some people cannot odor, and shape of stools. Also observe and report the get to a bathroom in time. Abdominal cramping, pre!>enceof blood or mucus, the time the person had the nausea, and vomiting may occur. bowel movement (BM), the frequency of BMs, and any • Assist with elimination need-; promptly, dispose of complaints of pain or discomfort. stools promptly, and give good skin care. Liquid stools Factors Elimination irritate the skin. So does frequent wiping with toilet 4/fectm<>Bowel paper. Skin breakdown and pressure ulcers are risks. • Privacy. Bowel elimination is a private act. • Follow Standard Precautions and the Bloodbome • Habits. Many people have a BM after breakfast. Some Pathogen Standard when in contact with stools. read. Defecation is easier when a person is relaxed. • Report signs of diarrhea at once. Ask the nurse to • Diet-high-fiberfoods. Fiber helps prevent constipation. observe the stool. • Diet-otherfoods. Some foods cause constipation. Other • Fecal incontinence is the inability to control the passage foods cause frequent stools or diarrhea. of feces and gas through the anus. Drinking 6 8 glasses water daily promotes • Fluids. to of • Fecal incontinence affects the person emotionally. normal bowel elimination. Warm fluids-coffee, tea, hot Frustration, embarrassment, anger, and humiliation are cider, warm water-increase peristalsis. common. The person may need: • Activity. Exercise and activity maintain muscle tone and Bowel training stimulate peristalsis. , Help with elimination after meals and every 2 to 3 • Drugs can prevent constipation or control Dmgs. hours diarrhea. Some have diarrhea or constipation as side Incontinence products to keep garments and linens effects. clean • Disability. Some people cannot control BMs. A bowel Good skin care training program is needed. • is the excessive formation of gas or air in the • Aging. Older persons are at risk for constipation. Flatulence stomach and intestines. Some older persons lose bowel control and have fecal • Causes include swallowing air while eating and incontinence. drinking and bacterial action in the intestines. Other • To provide comfort and safety during bowel causes may be gas-forming foods, constipation, bowel elimination, review Box 26-1, Safety and Comfort and abdominal surgeries, and drugs that decrease During Bowel Elimination, in the Textbook. Follow peristalsis. Standard Precautions and the Bloodbome Pathogen • If flatus is not expelled, the intestines distend (swell Standard. or enlarge from the pressure of gases). Abdominal cramping or pain, shortne&; of breath, and a swollen C mo 'i>rc Im,. abdomen occur. "Bloating" is a common complaint. • Common problems include constipation, fecal Exercise, walking, mO\ ing in bed, and the left side-lying impaction, diarrhea, fecal incontinence, and flatulence. position often produce flatus. Enemas and drugs may • Constipation is the passage of a hard, dry stool. be ordered.

Bowel Training • The pouch is changed every 3 to 7 days and when it • Bowel training has 2 goals. leaks. Frequent pouch changes can damage the skin. o To gain control of BMs. • Many pouches have a drain at the bottom that closes o To develop a regular pattern of elimination. Fecal with a clip, clamp, or wire closure. The drain is opened impactions, constipation, and fecal incontinence are to empty the pouch. The drain is wiped with toilet prevented. tissue before it is dosed. • Factors that promote elimination are part of the care • Observations to report and record include signs of skin plan and bowel training program. breakdown, color, amount, consistency, and odor of stools, and complaints of pain or discomfort. Suppositories • A suppository is a cone-shaped, solid drug that is CHAPTER 26 REVIEW QUESTIONS inserted into a body opening. A rectal suppository is Circle the BEST answer. inserted into the rectum. Suppositories melt at body 1. Which statement is false? temperature. a. Lack of privacy can prevent defecation. • A BM occurs about 30 minutes after inserting a b. Low-fiber foods promote defecation. suppository. c. Drinking 6 to 8 glasses of water daily promotes • Check with your state and agency policies to determine normal bowel elimination. if you can insert a suppository. d. Exercise stimulates peristalsis. 2. Which of the following does not prevent constipation? Enemas a. A high-fiber diet • An enema is the introduction of fluid into the rectum b. Increased fluid intake and lower colon. c. Exercise • Doctors order enemas to: d. Ignoring the urge to defecate o Remove feces. 3. A person has fecal incontinence. You should do the 0 Relieve constipation, fecal impaction, or flatulence. following except o Clean the bowel of feces before certain surgeries and a. Be patient diagnostic procedures. b. Help with elimination after meals • Review Box 26-2, Giving Enemas, in the Textbook. c. Provide good skin care • The preferred position for an enema is the Sims' or left d. Scold the person for being incontinent side-lying position. 4. The preferred position for an enema is the • A cleansing enema is used to clean the bowel of a. Sims' position or the left side-lying position feces and flatus and to relieve constipation and fecal b. Prone position impaction. Cleansing enemas take effect in 10 to 20 c. Supine position minutes. d. Trendelenburg's position • A small-volume enema irritates the bowel and distends Answers to tl1ese questions are on p. 516. the rectum, causing a BM. The person should retain the enema solution until he or she needs to have a BM, which usually takes 5 to 10 minutes. CHAPTER 27 NUTRITION AND FLUIDS • An oil-retention enema relieves constipation and fecal • Food and water are necessary for life. A poor diet and impaction by softening the feces and lubricating the poor eating habits: rectum so the feces can pass. The oil is retained for 30 0 Increase the risk for disease and infection. minutes to 1 to 3 hours. ° Cause chronic illnesses to become worse. o Cause healing problems. The Person With a11 Ostomy 0 Increase the risk of accidents and injuries. • Sometimes part of the intestines is removed surgically. An ostomy is sometimes necessary. An ostomy is a Basic Nutrition surgically created opening for the elimination of body • Nutrition is the process involved in the ingestion, wastes. The opening is called a stoma. The person wears digestion, absorption, and use of foods and fluids by the an ostomy pouch over the stoma to collect stools and body. Good nutrition is needed for growth, healing, and flatus. body functions. • Stools irritate the skin. Skin care prevents skin • A nutrient is a substance that is ingested, digested, breakdown around the stoma. The skin is washed and absorbed, and used by the body. dried. Then a skin barrier is applied around the stoma. • A calorie is the fuel or energy value of food. It prevents stools from having contact with the skin. The DietaryGuidelines forAmericans skin barrier is part of the ostomy pouch or a separate • The Dietary Guidelines help people attain and maintain device. a healthy weight, reduce the risk of chronic disease, and • The pouch has an adhesive backing that is applied to promote overall health. The Dietary Guidelines focus the skin. Sometimes pouches are secured to ostomy on consuming fewer calories, making informed food belts. choices, and being physically active.

MyPlate • Appetite. Illness, drugs, anxiety, pain,and depression • The MyPlate symbol, issued by the United States can cause loss of appetite. Unpleasant sights, thoughts, Department of Agriculture (USDA), helps you make and smells are other causes. wise food choices by balancing calories, increasing • Personal choice. Food likes and dislikes are influenced certain foods like fruits and vegetables, and reducing by foods served in the home. Usually food likes expand certain foods with excess salt and sugar. with age and social experiences. Nutrients • Body reactions. People usually avoid foods that cause • A well-balanced diet ensures an adequate intake of allergic reactions. They also avoid foods that cause essential nutrients. nausea, vomiting, diarrhea, indigestion, gas, or • Protein-is needed for tissue growth and repair. headaches. Sources include meat, fish, poultry, eggs, milk and milk • Illness. Appetite usu.ally decreases during illness and products, cereals, beans, peas, and nuts. recovery from injuries. However, nutritional needs are • Carbohydrates-provide energy and fiber for bowel increased. elimination. They are found in fruits, vegetables, breads, • Drugs. Drugs can cause loss of appetite, confusion, cereals, and sugar. nausea, constipation, impaired taste, or changes • fats-provide energy, add flavor to food, and help the in gastro-intestinal (GI) function. They can cause body use certain vitamins. Sources include meats, lard, inflammation of the mouth, throat, esophagus, and butter, shortening, oils, milk, cheese, egg yolks, and stomach. nuts. • Chewing problems. Mouth, teeth, and gum problems • Vitamins-are needed for certain body functions. The can affect chewing. Examples include oral pain, dry or body stores vitamins A, D, E, and K. The vitamin C sore mouth, gum disease, and dentures that fit poorly. and the B complex vitamins are not stored and must be Broken, decayed, or missing teeth also affect chewing, ingested daily. especially the meat group. • Minerals-are needed for bone and tooth formation, • Swallowing problems. Many health problems can affect nerve and muscle function, fluid balance, and other swallowing. They include stroke, pain, confusion, body processes. dry mouth, and diseases of the mouth, throat, and • Water-is needed for all body processes. esophagus. • Review Tables 27-2, Common Vitamins, and 27-3, • Disability. Disease or injury can affect the hands, wrists, Common Minerals, inthe Textbook. and arms. Adaptive equipment lets the person eat independently. OBRA Dietary Requirements • Impaired cognitive function. Impaired cognitive function • The Omnibus Budget Reconciliation Act of 1987 (OBRA) may affect the person's ability to use eatingutensils. has requirements for food served in nursing centers. And it may affect eating, chewing, and swallowing. 0 Each person's nutritional and dietary needs are met. 0 The person's diet is well-balanced. It is nourishing Special Diets and tastes good. Food is well-seasoned. The Sodium-Controlled Diet ° Food is appetizing. It has an appealing aroma and is • A sodium-controlled diet decreases the amount of attractive. sodium in the body. The diet involves: o Hot food is served hot. Cold food is served cold. 0 Omitting high-sodium foods. Review Box 27-3, High- o Food is served promptly. Sodium Foods, in the Textbook. ° Food is prepared to meet each person's needs. Some 0 Not adding salt when eating. people need food cut, ground, or chopped. Others o Limiting the amount of salt used in cooking. have special diets ordered by the doctor. o Diet planning. 0 Other foods are offered if the person refused the Diabetes Meal Planning food served. Substituted food must have a similar • Diabetes meal planning is for people with diabetes. nutritional value to the first foods served. It involves the person's food preferences and calories 0 Each person receives at least 3 meals a day. A bedtime needed. It also involves eating meals and snacks at snack is offered. regular times. 0 The center provides needed adaptive equipment and • Serve the person's meals and snacks on time to maintain utensils. a certain blood sugar level. • Always check the tray to see what was eaten. Tell the Factors AffectingEating and Nutrition nurse what the person did and did not eat. If not all the • Culture. Culture influences dietary practices, food food was eaten, a between-meal nourishment is needed. choices, and food preparation. The nurse tells you what to give. Tell the nurse about • Religion. Selecting, preparing, and eating food often changes in the person's eating habits. involve religious practices. A person may follow all, The Dysphagia Diet some, or none of the dietary practices of his or her faith. • Dysphagia means difficulty swallowing. Food thickness • Finances. People with limited incomes often buy the is changed to meet the person's needs. Review Box 27-4, cheaper carbohydrate foods. Their diets often lack Dysphagia, in the Textbook. protein and certain vitamins and minerals.

• You may need to feed a person with dysphagia. To Measuring Intake and Outp11t (I&O) promote the person's comfort: • To measure l&O, you need to know: 0 Know the signs and symptoms of dysphagia. Review 0 1 cubic centimeter (cc) equals 1 mL. Box 27-4 in the Textbook. 0 1 teaspoon equals 5 mL. o Feed the person according to the care plan. o 1 ounce (oz) equals 30mL. 0 Follow aspiration precautions (see Box 27-5, 0 A pint is about 500mL. Aspiration Precautions, in the Textbook) and the care o A quart is about 1000mL. plan. 0 The serving sizes of bowls, dishes, cups, pitchers, o Report changes in how the person eats. glasses, and other containers. o Report choking, coughing, or difficulty breathing • An l&O record is kept at the bedside. Record l&O during or after meals. Also report abnormal breathing measurements in the correct column. Amounts are or respiratory sounds. Report these observations at totaled at the end of the shift. The totals are recorded in once. the person's chart. They are also shared during the end of-shift report. Food Intake • The urinal, commode, bedpan, or specimen pan is used • Food intake is measured in different ways. Follow for voiding. Remind the person not to void in the toilet. agency policy for the method use. Also remind the person not to put toilet tissue into the • Percentageof food eaten. Some agencies measure the receptacle. percent of the whole meal tray. Other agencies measure the percent of each food item eaten. Meeting Food and Fluid Needs • Calorie counts. Note what the person ate and how much. • Preparing residents for meals promotes their comfort. A nurse or dietitian converts the portion amounts into o Assist with elimination needs. calories. 0 Provide oral hygiene. Make sure dentures are in place. 0 Make sure eyeglasses and hearing aids are in place. Fluid Balance 0 Make sure incontinent persons are clean and dry. • Fluid balance is needed for health. The amount of fluid o Position the person in a comfortable position. 0 taken in (intake) and the amount of fluid lost (output) Assist the person with hand-washing. must be roughly equal. If fluid intake exceeds fluid • Food is served in containers that keep foods at the output, body tissues swell with water (edema). correct temperature. Hot food is kept hot. Cold food is • Dehydration is a decrease in the amount of water in kept cold. body tissues. fluid output exceeds intake. Review Box • Prompt serving keeps food at the correct temperature. 27-6, Common Causes of Dehydration, in the Te xtbook. Nonna/ Fluid Requirements Feeding the Person • An adult needs 1500 milliliters (mL) of water daily • Serve food and fluid in the order the person prefers. to survive. About 2000 to 2500 mL of fluid per day is Offer fluids during the meal. needed for normal fluid balance. Water requirements • Use teaspoons to feed the person. increase with hot weather, exercise, fever, illness, and • Persons who need to be fed are often angry,humiliated, excess fluid loss. and embarrassed. Some are depressed or refuse to eat. Let • Older persons may have a decreased sense of thirst. them do as much as possible. lf strong enough, let them Their bodies need water but they may not feel thirsty. hold milk or juice glasses. Never let them hold hot drinks. Offer fluids according to the care plan. • Tell the visually impaired person what is on the tray. Special Fluid Orders Describe what you are offering. For persons who feed themselves, use the numbers on the clock for the • The doctor may order the amount of fluid a person location of foods. can have in 24 hours. Intake and output (l&O) • Many people pray before eating. Allow time and measurements may be ordered by the doctor or nurse. privacy for prayer. • Encourage fluids. The person drinks an increased amount of fluid. • Meals provide social contact with others. Engage the • Restrict fluids.Fluids are limited to a certain amount. person in pleasant conversations. Also sit facing the person. Allow time for chewing and swallowing. The • Nothing bymouth (NPO). The person cannot eat or drink. • Thickened liquids. All liquids are thickened, including person will eat better if not rushed. Wipe the person's water. hands, face, and mouth as needed during the meal. • Report and record: 0 The amount and kind of food eaten Intake and Output ° Complaints of nausea or dysphagia • All fluids taken by mouth are measured and recorded 0 Signs and symptoms of dysphagia water, milk, and so forth. So are foods that melt at room o Signs and symptoms of aspiration temperature-ice cream, sherbet, custard, pudding, • Many special diets involve between-meal snacks. These gelatin, and Popsicles. snacks are served upon arrival on the nursing unit. • Output includes urine, vomitus, diarrhea, and wound Follow the same considerations and procedures for drainage. serving meal trays and feeding persons.

Providmg Drinking Water 9. The soup bowl holds 6 ounces. A person ate all of the • Patients and residents need fresh drinking water each soup. You record his intake as shift. Follow the agency's procedure for providing fresh a. 50mL water. b. 120mL • Water mugs and pitchers can spread microbes. To C. 180ml prevent the spread of microbes: d. 200mL o Label the water mug with the person's name and Answers to tlzese questions are on p. 516. room and bed number. 0 Do not touch the rim or inside of the mug or lid. \ o Do not let the ice scoop touch the mug, lid, or straw. CHAPTER 29 MEASURING VITAL SIGNS o Place the ice scoop in the holder or on a towel, not in Vital Signs the ice container or dispenser. • The signs vital of body function are temperature, pulse, .. o Make sure the person's water mug is clean and free of respirations, blood pressure, and, in some agencies, cracks and chips. Provide a new mug as needed. pain. • Accuracy is essential when you measure, record, and CTIAPTER27 REVIEW QUESTIONS report vital signs. If unsure of your measurements, Circle the BEST answer. promptly ask the nurse to take them again. 1. A person is on a sodium-controlled diet. Which • Report the following at once. statement is true? o Anysign vital that is changed from a prior a. High-sodium foods are allowed. measurement b. Salt is added at the table. o Vital signs above or below the normal range c. Pretzels and potato chips are a good snack. d. The amount of salt used in cooking is limited. Body Temperature 2. A person is a diabetic. You should do the following • Thermometers are used to measure temperature. It is except measured using the Fahrenheit (F) and centigrade or a. Serve his meals and snacks late Celsius (C) scales. b. Always check his tray to see what he ate • Temperature sites are the mouth, rectum, axilla c. Tell the nurse what he ate and did not eat (underarm), tympanic membrane (ear), and temporal ct. Provide a between-meal snack as the nurse directs artery (forehead). 3. A person has dysphagia. You should do the following • Review Box 29-2, Temperature Sites, in the Textbook. except • Normal range for body temperatures depends on the a. Report choking and coughing during a meal at once site. b. Report difficulty in breathing during a meal at the o Oral: 97.6°F to 99.6°F ° ° end of the shift 0 Rectal: 98.6 F to 100.6 F ° ° c. Report changes in how the person eats 0 Axillary: 96.6 F to 98.6 F ° d. Follow aspiration precautions 0 Tympanic membrane: 98.6 F ° 4. Older persons have a decreased sense of thirst. o Temporal artery: 99.6 F a. True • Older persons have lower body temperatures than b. False yow1ger persons. 5. When feeding a person, you do the following except Thermometers a. Use a teaspoon to feed the person • Electronic thermometers show the temperature on the b. Offer fluids during the meal front of the device when the temperature is registered. c. Let the person do as much as possible • Electronic thermometers include: d. Stand so you can feed 2 people at once 0 Standard electronic thermometers with a blue probe 6. A person is visually impaired. You do the following except for oral and axillary temperatures and red probes for a. Tell the person what is on the tray rectal temperatures. A disposable cover protects the b. Use the numbers on a clock to tell the person the probe. location of food 0 Tympanic membrane thermometer, which measures c. If feeding the person, describe what you are offering body temperature at the tympanic membrane in the d. Let the person guess what is served ear. 7. A person is on intake and output. He just ate ice cream. o Temporal artery thermometer, which measures body This is recorded as intake. temperature at the temporal artery in the forehead. a. True 0 Digital thermometers, which measure body b. False temperature at the oral, axillary, or rectal sites. 8. A person drank a pint of milk at lunch. You know she 0 Pacifier thermometers, which look like a baby drank pacifier. The baby sucks on the device to record a. 250ml of milk temperature. b. 350mLofmilk • Other thermometers include disposable thermometers, c. 500ml of milk temperature-sensitive tape, and glass thermometers. d. 750 ml of milk

Taking Temperatures Blood Pressure • The oral site. Place the thermometer under the person's Normal and Abnormal Blood Pressures tongue and to the side. • Blood pressure has normal ranges. • The rectal site. Lubricate the bulb end of the rectal o Systolic pressure (upper nurnber)-90mm Hg and thermometer. Insert the probe½ inch into the rectum. higher but lower than 120mm Hg Privacy is important. o Diastolic pressure (lower number)-60 mmHg and • The axillary site. The axilla must be dry. Place the probe higher but lower than 80 mm Hg in the center of the axilla and place the person's arm • Hypertension-blood pressure measurements that over the chest to hold the probe in place. remain above a systolic pressure of 140mmHg or a • Ty mpanic membrane thermometers are inserted gently diastolic pressure of 90mmHg. Report any systolic into the ear. Pull the adult ear up and back to straighten measurement above 120mm Hg. Also report a diastolic the ear canal. pressure above 80mm Hg. • Glass thermometers are rarely used in hospitals and • Hypotension-when the systolic blood pressure is nursing centers but may be used in the home. Review below 90mm Hg and the diastolic pressure is below Box 29-3, Glass Thermometers. 60mm Hg. Report a systolic pressure below 90mmHg. Also report a diastolic pressure below 60mm Hg. Pulse • Review Box 29-6, Guidelines for Measuring Blood • The adult pulse rate is between 60 and 100 beats per Pressure, in the Textbook. minute. Report these abnormal rates to the nurse at once. CHAPTER 29 REVIEW QUESTIONS o Tachycardia-the heart rate is more than 100 beats per Circle the BEST answer. minute. 1. Which statement about taking a rectal temperature is false? o Bradycardia-the heart rate is less than 60 beats per a. The bulb end of the thermometer needs to be minute. lubricated. • The rhythm of the pulse should be regular. Report and b. The thermometer is inserted 1 inch into the rectum. record an irregular pulse rhythm. c. Privacy is important. • Report and record if the pulse force is strong, full, d. The normal range is 98.6°P to 100.6°F. bounding, weak, thready, or feeble. 2. Which pulse rate should you report at once? a. A pulse rate of 52 beats per minute Taking Pulses b. A pulse rate of 60 beats per minute • The radial pulse is used for routine vital signs. Place c. A pulse rate of 76 beats per minute the first 2 or 3 fingers against the radial pulse. Do not d. A pulse rate of 100 beats per minute use your thumb to take a pulse. Count the pulse for 30 3. Which statement isfalse? seconds and multiply by 2 if the agency policy permits. a. An irregular pulse is counted for 1 minute. If the pulse is irregular, count it for 1 minute. Report b. You may use your thumb to take a radial pulse rate. and record if the pulse is regular or irregular, strong or c. The radial pulse is usually used to count a pulse rate. weak. d. Tachycardia is a fast pulse rate. • The apical pulse is on the left side of the chest slightly 4. Which blood pressure should you report? below the nipple. A stethoscope is used to measure the a. 120/S0mmHg apical or the apical-radial pulse. Count the apical pulse b. 88162mm Hg for 1 minute. c. 110/70mm Hg d. 92/68mm Hg Respirations Answers to these questions are on p. 516. • The healthy adult has 12 to 20 respirations per minute. Respirations are normally quiet, effortless, and regular. Both sides of the chest rise and fall equally. CHAPTER 30 EXERCISE AND ACTIVITY • Count respirations when the person is at rest. Count respirations right after taking a pulse. Bedrest • Count respirations for 30 seconds and multiply • The doctor may order bedrest to treat a health problem. the number by 2 if the agency policy perm.its.If an • Bedrest is ordered to: abnormal pattern is noted, count the respirations for 1 o Reduce physical activity. minute. o Reduce pain. • Report and record: o Encourage rest. o The respiratory rate o Regain strength. o Equality and depth of respirations • Promote healing. o If the respirations were regular or irregular Complications From Bedrest o If the person has pain or difficulty breathing • Pressure uJcers, constipation, and fecal impactions can o Any respiratory noises result. Urinary tract infections and renal calculi (kidney o An abnormal respiratory pattern stones) can occur. So can blood clots and pneumonia.

• The musculo-skeletal system is affected by lack of Ambulatio11 exercise and activity. These complications must be • Ambulation is the act of walking. prevented to maintain normal movement. • Follow the care plan when helping a person walk. Use a o A contracture is the lack of joint mobility caused gait (transfer) belt if the person is weak or unsteady. The by abnormal shortening of a muscle. Common sites person uses hand rails along the wall. Always check the are the fingers, wrists, elbows, toes, ankles, knees, person for orthostatic hypotension. and hips. The person is permanently deformed and • When you help the person walk, walk to the side and disabled. slightly behind the person on the person's weak side. , Atrophy is the decrease in size or the wasting away Encourage the person to use the hand rail on his or her ... of tissue. Tissues shrink in size. strong side . • Orthostatic hypotension (postural hypotension) is Walking Aids abnormally low blood pressure when the person stands • A cane is held on the strong side of the body. The cane up suddenly. The person is dizzy and weak and has tip is about 6 to 10 inches to the side of the foot. It is spots before the eyes. Fainting can occur. To prevent about 6 to 10 inches in front of the foot on the strong orthostatic hypotension, have the person change slowly side. The grip is level with the hip. To walk: from a lying or sitting position to a standing position. o Step A: The cane is moved forward 6 to 10 inches. Positioning o Step B: The weak leg (opposite the cane) is moved • Supportive devices are often used to support and forward even with the cane. maintain the person in a certain position. � Step C: The strong leg is moved forward and ahead of Bed-boards-are placed under the mattress to prevent the cane and the weak leg. the mattress from sagging. • A walker gives more support than a cane. Wheeled o Foot-boards-are placed at the foot of mattresses to walkers are common. They have wheels on the front prevent plantar flexion that can lead to footdrop. legs and rubber tips on the back legs. The person Troclumter rolls-prevent the hips and legs from pushes the walker about 6 to 8 inches in front of his or turning outward (external rotation). her feet. o Hip abduction wedges-keep the hips abducted (apart). • Braces support weak body parts, prevent or correct Hand rolls or hand grips-prevent contractures of the deformities, or prevent joint movement. A brace is thumb, fingers, and wrist. applied over the ankle, knee, or back. Skin and bony Splints-keep the elbows, wrists, thumbs, fingers, points under braces arc kept clean and dry. Report ankles, and knees in normal position. redness or signs of skin breakdown at once. Also report Bed cradles-keep the weight of top linens off the feet complaints of pain or discomfort. The care plan tells and toes. you when to apply and remove a brace.

Range-of-MotionExercises CHAPTER 30 REVIEWQUE STIONS • Range-of-motion exercises involve moving the (ROM) Circle the BESTanswer. joints through their complete range of motion without 1. To prevent orthostatic hypotension, you should causing pain. They are usually done at least 2 times a day. a. Move a person from the lying position to the sitting c Active ROM�xercises are done by the person. position quickly �, Passive ROM-you move the joints through their range of motion. b. Move a person from the sitting position to the u Active-assistive ROM-the person does the exercises standing position quickly with some help. c. Move a person from the lying or sitting position to a • Review Box 30-2, Range-of-Motion Exercises, in the standing position slowly Textbook. d. Keep the person in bed • ROM exercises can cause injury if not done properly. 2. Exercise helps prevent contractures and muscle Practice these rules. atrophy. a. True :.. Exercise only the joints the nurse tells you to exercise. b. False Expose only the body part being exercised. 3. \Vhen performing ROM exercises, you should force a o Use good body mechanics. Support the part being exercised. joint to the point of pain. MoYe the joint slowly, smoothly, and gently. a. True Do not force a joint beyond its present range of b. False motion. 4. A person's left leg is weaker than his right. The person 0 Do not force a joint to the point of pain. holds the cane on his right side. Ask the person if he or she has pain or discomfort. a. True Perform ROM exercises to the neck only if allowed by b. False Answers to these questions are p. 516. your agency and if the nurse instructs you to do so. 011

CHAPTER 31 COMFORT, REST, AND SLEEP 0 Vital signs. Increases often occur with acute pain. • Comfort is a state of well-being. Many factors affect They may be normal with chronic pain. comfort. o Other signs and symptoms. Dizziness, nausea, • Pain or discomfort means to ache, hurt, or be sore. Pain vomiting,weakness, numbness, and tingling. is subjective. You cannot see, hear, touch, or smell pain • Review Box 31-2, Signs and Symptoms of Pain, and or discomfort. You must rely on what the person says. Box 31-3, Comfort and Pain-Relief Measures, in the • Pain is often considered the fifth vital sign. Report the Textbook. person's complaints of pain and your observations to the nurse. The Back Massage • The back massage can promote comfort and relieve Factors AffectingPtlin pain. It relaxes muscles and stimulates circulation. , • Past experience. The severity of pain, its cause, how long • A good time to give a massage is after baths and it lasted, and if relief occurred all affect the person's showers and with evening care. Massages last 3 to 5 ., current response to pain. minutes. • Anxiety. Pain and anxiety are related. Pain can cause • Observe the skin for breaks, bruises, reddened areas, anxiety. Anxiety increases how much pain the person and other signs of skin breakdown. feels. Reducing anxiety helps lessen pain. • Lotion reduces friction during the massage. It is • Rest and sleep. Pain seems worse when a person is tired warmed before applying. or restless. Pain often seems worse at night. • Use firm strokes. Keep your hands in contact with the • Attention. The more a person thinks about pain, the person's skin. worse it seems. • After the massage, apply some lotion to the elbows, • Personal and family duties. Often pain is ignored when knees, and heels. there are children to care for. Some deny pain if a • Back massages are dangerous for persons with certain serious illness is feared. heart diseases, back injuries, back and other surgeries, • The value or meaning of pain. To some people, pain is skin diseases, and some lung disorders. Check with the a sign of weakness. For some persons, pain means nurse and the care plan before giving back massages to avoiding work, daily routines, and people. Some people persons with these conditions. like dotingand pampering by others. The person values • Do not massage reddened bony areas. Reddened areas pain and wants such attention. signal skin breakdown and pressure ulcers. Massage • Support fromothers. Dealing with pain is often easier can lead to more tissue damage. when family and friends offer comfort and support. • Wear gloves if the person's skin is not intact. Always Facing pain alone is hard for persons. follow Standard Precautions and the Bloodbome • Culture. Culture affects pain responses. Non-English Pathogen Standard. speaking persons may have problems describing pain. • Report and record skin breakdown, redness, bruising, • Illness. Some diseases cause decreased pain sensations. and breaks in the skin. • Age. Older persons may have chronic pain that masks new pain. They may deny or ignore new pain, thinking Rest it is related to a known problem. Or they may deny • Rest means to be calm, at ease, and relaxed with no or ignore pain because they are afraid of what it may anxiety or stress. Rest may involve inactivity. Or the mean. For persons who cannot tell you about pain, person does things that are calming and relaxing. changes in usual behavior may signal pain. Loss of • Promote rest by meeting physical, safety, and security appetite also signals pain. Report any changes in a needs. person's usual behavior to the nurse. 0 Thirst, hunger, pain or discomfort, and elimination needs can affect rest. A comfortable position and Signs and Symptoms good alignment are important. A quiet setting • You cannot see, hear, touch, or smell the person's pain. promotes rest. Rely on what the person tells you. Promptly report any 0 The person must feel safe from falling or other information you collect about pain. Use the person's injuries. The person is secure with the call light exact words when reporting and recording pain. within reacl1. Understanding the reasons for care and • The nurse needs the following information. knowing how care is given also help the person feel o Location. Where is the pain? safe. 0 Onset and duration. When did the pain start? How • Many persons have rituals or routines before resting. long has it lasted? Follow them whenever possible. 0 Intensity. Ask the person to rate the pain. Use a pain • Love and belonging are important for rest. Visits or calls scale. from family and friends may relax the person. Reading 0 Description. Ask the person to describe the pain. cards and letters may also help. ° Factors causing pain. Ask what the person was doing • Meet self-esteem needs. before the pain started and when it started. • Some persons are refreshed after a 15- or 20-minute rest. ° Factors affecting pain. Ask what makes the pain better Others need more time. and what makes it worse.

• Ill or injured persons need to rest more often. Do not b. Massages are given after the bath and with evening push the person beyond his or her limits. care. c. You can observe the person's skin before beginning Sleep the massage. • Sleep is a basic need. Tissue healing and repair occur d. You should use cold lotion for the massage. 4. You can promote rest for a person by doing the during sleep. Sleep lowers stress, tension, and anxiety._ It refreshes and renews the person. The person regains following except energy and mental alertness. The person thinks and a. Asking the person if he or she would like coffee or functions better after sleep. tea b. Placing the call light within reach Factors Affecti,igSleep c. Providing a quiet setting • Age.The amount of sleep needed decreases with age. d. Following the person's routines and rituals before • lllness. illness increases the need for sleep. rest • Nutrition. Sleep needs increase with weight gain. Foods 5. To promote sleep for a person, you should do the with caffeine prevent sleep. • Exercise. People feel good after exercise. Eventually they following except a. Follow the person's wishes tire, which helps people sleep well. Avoid exercise at b. Follow the care plan least 2 hours before bedtime. c. Follow the person's rituals and routines before • E,ivironmeut. People adjust to their usual sleep settings. • Drugs and other substances. Sleeping pills promote sleep. bedtime d. Tell the person when to go to bed Drugs for anxiety, depression, and pain may cause the Answers to these qi1estio11s are p. person to sleep but may interfere with the quality of 011 516. sleep. • Life-style changes. Changes in daily routines may affect sleep. CHAPTER 32 ADMISSIONS, TRANSFERS, • Emotionalproblems. Fear, worry, depression, and anxiety AND DISCHARGES affect sleep. • Admission is the official entry of a person into a health Sleep Disorders care setting. It can cause anxiety and fear in patients, • Insomnia is a chronic condition in which the person residents, and families. cannot sleep or stay asleep all night. • Transfer is moving the person to another health care • Sleep deprivation means that the amount and quality setting or moving the person to a new room within the of sleep are decreased. Sleep is interrupted. agency. • Sleepwalking is when the person leaves the bed and • Discharge is the official departure of a person from a walks about. If a person is sleepwalking, protect the health care setting. person from injury. Guide sleepwalkers back to bed. • During the admission process: They startle easily. Awaken them gently. o Identifying information is obtained from the person or family. Promotiflg Sleep o A nurse or social worker explains the resident's rights • To promote sleep, allow a flexible bedtime, provide a to the person and family. comfortable room temperature, and have the person o The person is given an identification (ID) number and void before going to bed. Review Box 31-6, Promoting bracelet Sleep, in the Textbook for other measures. o The person signs admitting papers and a general consent form. CHAPTER 31 REVIEW QUESTIONS • You prepare the person's room before the person arrives. Circle the BEST a,iswer. ] . A person complains of pain. You will do the following Admitting tie _.,t rs except • Admission is your first chance to make a good a. Ask where the pain is impression. You must: b. Ask when the pain started o Greet the person by name and title. Use the c. Ask what the intensity of the pain is on a scale of 1 admission form to find out the person's name. to 10 o Introduce yourself by name and title to the person, d. Ask why the person is complaining about pain family, and friends. 2. Older persons or persons who cannot communicate o Make roommate introductions. may not complain of pain. Which of the following o Act in a professional manner. might be a signal of pain? o Treat the person with dignity and respect. a. Illness • During the admission procedure the nurse may ask you b. Mental alertness to: c. Loss of appetite o Collect some information for the admission form. d. Forgetfulness 0 Measure the person's weight and height. 3. Which statement is false? o Measure the person's vital signs. a. A back massage relaxes and stimulat� circulation. o Obtain a urine specimen (if needed).

o Complete a clothing and personal belongings list. b. Weigh the person at the same time of day. 0 Orient the person to the room, nursing unit, and c. Balance the scale at zero before weighing the person. agency. d. Have the person wear shoes when being weighed. 4. Awants person to leave the nursing center without the Weight and Height doctor's permission. You should tell the nurse at once. • When weighing a person, follow the manufacturer's a. True instructions and center procedures for using the scales. b. False Follow these guidelines when measuring weight and Answers to tl1ese questions are on p. 516. height. 0 The person wears only a gown or pajamas. No footwear is worn. CHAPTER 35 THE PERSON HAVING o The person voids before being weighed and a dry SURGERY incontinence product is worn if needed. • Surgery may be in-patient, requiring a hospital stay, o Weigh the person at the same time of day. Before or same-day surgery, also called out-patient, 1-day, or breakfast is the best time. ambulatory surgery. The person is prepared for what o Use the same scale for daily, weekly, and monthly happens before, during, and after surgery. weights. o Balance the scale at zero before weighing the person. Pre-Operative Care • The person may have special tests such as chest x-ray or Moving tltePerson to a New Room electrocardiogram (ECG). Nutrition and fluids may be • Sometimes a person is moved to a new room because of restricted 6 to 8 hours before surgery. a change in condition or care needs, the person requests a • Personal care before surgery includes: room change, or roommates do not get along. Support and o A complete bath, shower, or tub bath and shampoo. reassure the person moving to a new room with new staff. A special soap or shampoo may be ordered to reduce • The person is transported by wheelchair, stretcher, or the number of microbes and the risk of infection. the bed. 0 Make-up, nail polish, and fake nails are removed. o Hair accessories, wigs, and hairpieces are removed Transfers and Discharges and a surgical cap keeps the hair out of the faceand • When transferred or discharged, the person leaves the the operative site. agency. He or she goes home or to another health care o Dentures, eyeglasses, contact lenses, hearing aids, setting. and other prostheses are removed. • Transfers and discharges are usually plaimed in • Skin prep before surgery may include cleansing with an advance by the health team. anti-microbial soap, clipping the hair at and around the • For discharges, the health team teaches the person and site, or removing the hair at and around the site. family about diet, exercise, and drugs. They also teach • After skin prep, report and record the following: the them about procedures and treatments and arrange for area prepped; any cuts, nicks, or scratches from skin home care, equipment, and therapies as needed. shaving; bleeding; and sites of non-intact skin. • The nurse tells you when to start the transfer or discharge procedure. The doctor must give the order Post-Operative Care before the person can leave. Usually a wheelchair is • The person's room must be ready. Make a surgical bed, used. If leaving by ambulance, a stretcher is used. place supplies in the room, and move furniture out of • If a person wants to leave the agency without the the way for a stretcher. doctor's permission, teU the nurse at once. The nurse or • Your role in post-operative care depends on the person's social worker handles the matter. condition. Often vital signs and pulse oximetry are taken. The nurse tells you how often to check the CHAPTER 32 REVIEW QUESTIONS person. Review Box 35-2, Post-Op Complications and Circle the BEST answer. Observations, in the Textbook. 1. When admitted, you explain the resident's rights to the • The person is positioned for comfort and to prevent person and family. complications. The person is re-positioned every a. True 1 to 2 hours to prevent respiratory and circulatory b. False complications. Turning may be painful. Provide support 2. When a person is admitted, you do the following except and use smooth, gentle motions. a. Greet the person by name and title • Coughing and deep-breathing exercises help prevent b. Treat the person with dignity and respect respiratory complications. c. Introduce the person to his or her roommate • Circulation must be stimulated for blood flow in the d. Rush the admission procedure legs. If blood flow is sluggish, blood clots may form. • Report the following at once. 3. Which statement is false? a. Have the person void before being weighed. o Swollen area of a leg.

h Pain or tenderness in a leg. Tis may occur only • Skin tears are painful. They are portals of entry for when standing or walking. microbes. Wound complications can develop. Te ll the .., Warmth in the part of the leg that is swollen or painful. nurse at once if you cause or find a skin tear. -: Red or discolored skin. • Review Box 36-2, Preventing Skin Te ars, in the Textbook.

• Elastic stockings exert pressure on the veins. The pressure promotes venous blood return to the heart. The • Circulatory ulcers (vascular 11/cers) are open sores on the stockings help prevent blood clots in the leg veins. lower legs or feet. They are caused by decreased blood • Elastic stockings also are called AE stockings (anti flow through the arteries or veins. embolism or anti-embolic). They also are called TED • Review Box 36-3, Preventing Circulatory Ulcers, in the hose. TED means thrombo-embolic disease. Textbook. • The nurse measures the person for the correct size of • Venous ulcers (stasis ulcers) are open sores on the lower elastic stockings. Most stockings have an opening near legs or feet. They are caused by poor blood flow the toesthat is used to check circulation, skin color, and through the veins. The heels and inner aspect of the skin temperature. ankles are common sites for venous ulcers. • The person usually has 2 pairs of stockings. One pair is • Arterial ulcers are open wounds on the lower legs or washed; the other pair is worn. feet caused by poor arterial blood flow. They are found • Stockings should not have twists, creases, or wrinkles between the toes, on top of the toes, and on the outer after you apply them. Twists can affect circulation. side of the ankle. Creases and wrinkles can cause skin breakdown. • A din be tic foot ulcer is an open wound on the foot • Loose stockingsdo not promote venous bloodreturn to caused by complications from diabetes. When nerves the Stockings heart. that are too tight can affect circulation. are affected, the person can lose sensation in a foot Tell the nurse if the stockingsare tooloose or too tight. or leg. The person may not feel pain, heat, or cold. Therefore the person may not feel a cut, blister, burn, or \ other trauma to the foot. Infection and a large sore can develop. When blood flow to the foot decreases, tissues Circle the BEST answer. and cells do not get needed oxygen and nutrients. A 1. A person with a swollen calf with red, discolored skin sore does not heal properly. Tissue death (gangrene) is at risk for a blood clot. can a. True occur. Review Box 36-4, Diabetes Foot Care, in the b. False Textbook. Prevention and Treatment 2. Which statement about elastic stockings is true? a. Elastic stockings should be loose to promote venous • Check the person's feet and legs every day. Report any blood return to the heart. sign of a problem to the nurse at once. Follow the care b. Stockings should not have twists, creases, or plan to prevent and treat circulatory ulcers. wrinkles after you apply them. • Some agencies let you apply simple, dry, non-sterile c. The doctor measures the person for the correct size dressings to simple wounds. Follow the rules in Box 36- of elastic stockings. 6, Applying Dressings, in the Textbook. d. The person should have only 1 pair of stockings. Answers to these questions are on p. 516. l1 f QC <,7fON Circle the BEST answer. 1. The following can cause a skin tear except a. Friction and shearing • A wound is a break in the skin or mucous membrane. b. Holding a person's arm or leg too tight • The wound is a portal of entry for microbes. Infection c. Rings, watches, bracelets is a major threat. Wound care involves preventing d. Trimmed, short nails infection and further injury to the wound and nearby 2. A person is diabetic. Which statement is false? tissues. a. The person may not feel pain in her feet. b. The person may not feel heat or cold in her feet. c. You need to check her feet weekly for foot problems. • A skin tear is a break or rip in the skin. d. The person is at risk for diabetic foot ulcers. • Skin tears are caused by friction, shearing, pulling, or 3. Which statement about elastic stockings is false? pressure on the skin. Bumping a hand, arm, or leg on a. Elastic stockingsare also called anti-embolic stockings. any hard surface can cause a skin tear. Beds, bed rails, b. Elastic stockings should be wrinkle-free after being chairs, wheelchair footplates, and tables are dangers. So applied. is holding the person's arm or leg too tight, removing c. A person usually has 2 pairs of elastic stockings. tape or adhesives, bathing, dressing, and other tasks. d. Elastic stockings are applied after a person gets out Buttons, zippers, jewelry, or long or jagged finger or of bed. toenails can also cause skin tears. Answers to tltese questions are 011 p. 516.

CHAPTER 37 PRESSURE ULCERS CHAPTER 37 REVIEWQUESTIONS • A pressure ulcer is defined by the National Pressure Circle the BEST answer. Uker Advisory Panel as a localized injury to the skin 1. You may expect to find a pressure ulcer at all of the and/ or underlying tissue. The Centers for Medicare following sites except & Medicaid Services (CMS) define pressure ulcers as a. Back of the head any caused lesion by unrelieved pressure that results in b. Ears damage to underlying tissues. c. Top of the thigh • Pressure ulcers usually occur over a bony d. Toes prominence-the back of the head, shoulder blades, 2. Which of the following is not a protective device used elbows, hips, spine, sacrum, knees, ankles, heels, and to prevent and treat pressure ulcers? toes. a. Heel elevator • Decubitus ulce,� bed sore, and pressure sore are other terms b. Bed cradle for pressure ulcer. c. Draw sheet • Pressure, shearing, and friction are common causes d. Elbow protector of skin breakdown and pressure ulcers. Risk factors 3. In obese people, pressure ulcers can occur between include breaks in the skin, poor circulation to an area, abdominal folds. moisture, dry skin, and irritation by urine and feces. a. True b. False Persons at Risk 4. Pressure ulcers never occur over a bony prominence. • Persons at risk for pressure ulcers are those who: a. True o Are confined to a bed or chair. b. False o Need some or total help in moving. Answers to these questions are on p. 516. o Are agitated or have involuntary muscle movements. o Have loss of bowel or bladder control. o Are exposed to moisture. CHAPTER 38 HEAT AND COLD o Have poor nutrition or poor fluid balance. o Have limited awareness. APPLICATIONS 0 Have problems sensing pain or pressure. Heat Applications o Have circulatory problems. • Heat relieves pain, relaxes muscles, promotes o Are obese or very thin. healing, reduces tissue swelling, and decreases joint o Have a medical device. stiffness. 0 Have a healed pressure ulcer. Complications Pressure Ulcer Stages • High temperatures can cause burns. Report pain, • 1n persons with Light skin, a reddened bony area is the excessive redness, and blisters at once. Also observe for first sign of a pressure ulcer. In persons with dark skin, pale skin. a bony area may appear red, blue, or purple. The area • Metal implants pose risks. Pacemakers and joint may feel warm or cool. The person may complain of replacements are made of metal. Do not apply heat to pain, burning, tingling, or itching in the area. an implant area. • Box 37-2 in the Textbook describes pressure ulcer stages. • Heatapplied is not to a pregnant woman's abdomen. • Figure 37-5 in the Textbook shows the stages of pressure The heat can affect fetal growth. ulcers. Moist and Dry Heat Applications Prevention and Treatment • In moist heat applications, water is in contact with the • Preventing pressure ulcers is much easier than trying to skin. Moist heat applications include hot compresses, heal them. Review Box 37-3, Preventing Pressure Ulcers, hot soaks, sitz baths, and hot packs. in the Textbook. • Dry heat applications do not use water, allowing the • The person at risk for pressure ulcers may be placed on application to stay at the desired temperature longer. a foam, air, alternating air, gel, or water mattress. Some hot packs and warming therapy pads are dry heat • Protective devices are often used to prevent and treat applications, as well as aquathermia pads. pressure ulcers and skin breakdown. Protective devices include: Cold Applications o Bed cradle • Cold applications reduce pain, prevent swelling, and 0 Heel and elbow protectors decrease circulation and bleeding. 0 Heel and foot elevators • Complications include pain, burns, blisters, and poor 0 Gel or fluid-filled pads and cushions circulation. Burns and blisters occur from intense cold. o Special beds They also occur when dry cold is in direct contact with o Other equipment-pillows, trochanter rolls, and foot the skin. boards

Applying Heat and Cold Pulse Oximetry • Protect the person from injury during heat and cold • Pulse oximetry measures the oxygen concentration in applications. Review Box 38-1, Applying Heat and Cold, arterial blood. in the Textbook. • A sensor attaches to a finger, toe, earlobe, nose, or forehead. CHAPTER 38 REVIEW QUESTIONS • Avoid swollen sites and sites with skin breaks. Do not use a finger site if blood flow to the fingers is poor, the Circle rhe BEST answer. person has fake nails, or the pen,on has movements 1. Complications from a heat application include the from shivering, seizures, or tremors. foUowing except a. Excessive redness b. Blisters Promoting Oxygenation c. Pale skin • Breathing is usually easier in semi-Fowler's and d. Cyanotic (bluish) nail beds Fowler's positions. Persons with difficulty breathing 2. When applying heat or cold, you should do the often prefer the orthopneic position (sitting up and following except leaning over a table to breathe). a. Ask the nurse what the temperature of the • Deep breathing moves air into most parts of the application should be lungs. Coughing removes mucus. Deep breathing and b. Cover dry heat or cold applications before applying coughing are usually done every 1 to 2 hours while the them person is awake. They help prevent pneumonia and c. Observe the skin every 2 hours atelectasis (the collapse of a portion of the lung). d. Know how long to leave the application in place Answers to tlrese questions are 011 p. 516. Oxygen Devices • A nasal cannula allows eating and drinking. Tight prongs can irritate the nose. Pressure on the ears and CHAPTER 39 OXYGEN NEEDS cheekbones is possible. • A simple face mask covers the nose and mouth. Talking Altered Respiratory Function and eating are hard to do with a mask. Listen carefully. • Hypoxia means that cells do not have enough oxygen. Moisture can build up under the mask. Keep the face • Restlessness, dizziness, and disorientation are signs of clean and dry. Masks are removed for eating. Usually hypoxia. oxygen is given by cannula during meals. • Report signs and symptoms of hypoxia to the nurse at once. Hypoxia is life-tl1reatening. • Review Box 39-1, Altered Respiratory Function, in the Oxygen Flow Rates Textbook. • When giving care and checking the person, always check the flow rate. Tell the nurse at once if it is too high or too low. A nurse or respiratory therapist will adjust Abuormal Respirntio11s the flow rate. • Adults normally have 12 to 20 respirations per minute. They are quiet, effortless, and regular. Both sides of the chest rise and fall equally. Report these observations at Oxygen Safety once. • You do not give oxygen. You assist the nurse in 0 Tachypnea-rapid breathing. Respirations are 20 or providing safe care. more per minute. • Always check the oxygen level when you are with 0 Bradypnea-slow breathing. Respirations are fewer or near persons using oxygen systems that contain a than 12 per minute. limited amount of oxygen. Oxygen tanks and liquid 0 Apnea-lack or absence of breathing. oxygen systems are examples. Report a low oxygen v Hypoventilatfon-respirations are slow, shallow, and level to the nurse at once. sometimes irregular. • Follow the rules for fire and the use of oxygen in 0 Hyperventilation-respirations are rapid and deeper Chapter 13 in the Textbook. than normal. • Never remove the oxygen device. However, turnoff the 0 Dyspnea-difficult, labored, painful breathing. oxygen flow if there is a fire. ° Cheyne-Stokes respirations-respirations gradually • Make sure the oxygen device is secure but not tight. increase in rate and depth. Then they become shallow • Check for signs of irritation from the oxygen device and slow. Breathing may stop for 10 to 20 seconds. behind the ears, under the nose, around the face, and on 0 Orthopnea-breathing deeply and comfortably only the cheekbones. when sitting. • Keep the face clean and dry when a mask is used. o Biot's respirations-rapid and deep respirations • Never shut off the oxygen flow. followed by 10 to 30 seconds of apnea. • Do not adjust the flow rate unless allowed by your state o Kussmaul respirations-very deep and rapid and agency. respirations. • Tell the nurse at once if the flow rate is too high or too low.

• Tell the nurse at once if the humidifier is not bubbling. is on improving abilities. This promotes function at the • Secure tubing to the person's garment. Follow agency highest level of independence. policy. • Make sure there are no kinks in the tubing. Rehabilitation and the Wl,ole Person • Make sure the person does not lie on any part of the • Rehabilitation takes longer in older persons. Changes from tubing. aging affecthealing, mobility, vision, hearing, and other • Report signs of hypoxia, respiratory distress, or functions. Chronic health problems can slow recovery. abnormal breathing to the nurse at once. • Give oral hygiene as directed. Follow the care plan. Physical Aspects • Make sure the oxygen device is dean and free of mucus. • Rehabilitation starts when the person first seeks health • Make sure the oxygen tank is secure in its holder. care. Complications, such as contractures and pressure ulcers, are prevented. CHAPTER 39 REVIEW QUESTIONS • Elimination. Bowel or bladder training may be needed. Circle the BEST answer. Fecal impaction, constipation, and fecal incontinence are 1. Which statement is false? prevented. a. Restlessness, dizziness, and disorientation are signs • Self-care. Self-care for activities of daily living (ADL) is a of hypoxia. major goal. Self-help devices are often needed. b. Hypoxia is life-threatening. • Mobility. The person may need crutches, a walker, a c. Report signs and symptoms of hypoxia at the end of cane, a brace, or a wheelchair. the shift. • Nutrition. The person may need a dysphagia diet or d. Anything that affects respiratory function can cause enteral nutrition. hypoxia. • Communication. Speech therapy and communication 2. Adults normally have devices may be helpful. a. 8 to 10 respirations per minute b. 12 to 20 respirations per minute Psychological and Social Aspects c. 10 to 12 respirations per minute • A disability can affect function and appearance. Self d. 20 to 24 respirations per minute esteem and relationships may suffer. The person 3. Dyspnea is may feel unwhole, useless, unattractive, unclean, or a. Difficult, labored, or painful breathing undesirable. The person may deny the disability. The b. Slow breathing with fewer than 12 respirations per person may expect therapy to correct the problem. He minute or she may be depressed, angry, and hostile. c. Rapid breathing with 24 or more respirations per • Successful rehabilitation depends on the person's minute attitude. The person must accept his or her limits and d. Lack or absence of breathing be motivated. The focus is on abilities and strengths. 4. Which statement about positioning is false? Despair and frustration are common. Progress may be a. Breathing is usually easier insemi-Fowle r's or slow. Old fears and emotions may recur. Fowler's position. • Rem.ind persons of their progress. They need help b. Persons with difficulty breathing often prefer the accepting disabilities and limits. Give support, re orthopneic position. assurance, and encouragement. Spiritual support helps c. Position changes are needed at least every 4 hours. some people. Psychological and social needs are part of d. Follow the person's care plan for positioning the care plan. preferences. 5. A person has a nasal cannula. Which statement is false? The Rehabilitation Team a. You will leave the nasal cannula on while the person • Rehabilitation is a team effort. The person is the key is eating. member. The health team and family help the person set b. You will watch the nose area for irritation. goals and plan care. All help the person regain function c. You will watch the ears and cheekbones for skin and independence. breakdown. d. You will take the nasal cannuJa off while the person Your Role is eating. • Every part of your job focuses on promoting the Answers to these questions are on p. 516. person's independence. Preventing decline in function also is a goal. Review Box 41-2, Assisting With Rehabilitation and Restorative Care, in the Te xtbook. CHAPTER 41 REHABILITATION AND RESTORATIVE NURSING CARE Quality of Life • A disabilityis any lost, absent, or impaired physical or • To promote quality of life: mental function. 0 Protect the right to privacy. The person re-learns old or Rehabilitation • is the process of restoring the person practices new skills in private. Others do not need to to his or her highest possible level of physical, see mistakes, falls, spills, clumsiness, anger, or tears. psychological, social, and economic function. The focus 0 Encourage personal choice. This gives the person control.

o Protect the right to be free from abuse and mistreatment. • Obvious signs and symptoms of hearing loss include: Sometimes improvement is not seen for weeks. 0 Speaking too loudly Repeated explanations and demonstrations may have o Leaning forward to hear little or no results. You and other staff and family c Turningand cupping the better ear toward the may become upset and short-tempered. However, no speaker one can shout, scream, or yell at the person. Nor can o Answering questions or responding inappropriately they call the person names or hit or strike the person. " Asking for words to be repeated Unkind remarks are not allowed. Report signs of abuse o Asking others to speak louder or to speak more or mish·eatment slowly and clearly " Learn to deal with your anger and frustration. The person 0 Having trouble hearing over the phone does not choose loss of function. If the process upsets o Finding it hard to follow conversations when 2 or you, discuss your feelings with the nurse. more people are talking Encourage activities. Provide support and re-assurance o Turning up the TV, radio, or music volume so loud to the person with the disability. Remind the person that others complain that others with disabilities can gjve support and • Persons with hearing loss may wear hearing aids or understanding. lip-read (speech-read). They watch facial expressions, o Provide a safe setting. The setting must meet the gestures, and body language. Some people learn person's needs. The over-bed table, bedside stand, American Sign Language (ASL). Others may have and call light are moved to the person's strong side. hearing assistance dogs. o Show patience, understanding, and sensitivity. The • Review Box 42-3, Measures to Promote Hearing, in the person may be upset and discouraged. Give support, Textbook. encouragement, and praise when needed. Stress the • Hearing aids are battery-operated. If they do not seem person's abilities and strengths. Do not give pity or to work properly: sympathy. ° Check if the hearing aid is on. It has an on and off switch. CHAPTER 41 REVIEW QUESTJONS " Check the battery position. � Insert a new battery if needed. Circle the BEST answer. 1. Successful rehabilitation depends on the person's o Clean the hearing aid. Follow the nurse's direction attitude. and the manufacturer's instructions. a. True • Hearing aids are turned off when not in use. The battery b. False is removed. 2. A person with a disability may be depressed, angry, • Handle and care for hearing aids properly. If lost or and hostile. damaged, report it to the nurse at once. a. True b. False Speed, Disorders 3. A person needs rehabilitation. You should do the Aphasia followingexcept • Aphasia is the total or partial loss of the ability to use or a. Let the person re-learn old skills in private understand language. b. Let the person practice new skills in private • Expressive apltnsiarelates to difficulty expressing or c. Encourage the person to make choices sending out thoughts. Thinking is clear. The person d. Shout at the person knows what to say but has difficulty or cannot speak 4. You saw a family member hit and scream at a person. the words. You need to report your observations to the nurse. • Receptive aphasia relates to difficulty understanding a. True language. The person has trouble understanding what b. False is said or read. People and common objects are not 5. A person has a weak left arm. You will recognized. a. Place the call light on his left side b. Place the call light on his right side Eye Disorders c. Give him sympathy • Cataract. Cataract is a clouding of the lens in the eye. d. Give him pity Signs and symptoms include cloudy, blurry, or dimmed Answers to these questions are on p. 517. vision. Persons may also be sensitive to light and glares or see halos around lights. Poor vision at night and double vision in 1 eye are other symptoms. Surgery is CHAPTER 42 HEARING, SPEECH, AND the only treatment. VISION PROBLEMS • Age-related macular degeneration (AMO). AMD blurs Hearing Loss central vision needed for reading, sewing, driving, and seeing faces and fine detail. Risk factors include • Hearing loss is not being able to hear the normal range smoking and family history. Whites are at greater risk of sounds associated with normal hearing. Deafness is than any other group. Treatment may stop or slow the the most severe form of hearing loss. disease progress.

• Diabetic retinopathy. Diabetic retinopathy causes blood • Surgery, radiation therapy, and chemotherapy are the vessels in the retina to become damaged. Usually both most common treatments. eyes are affected. It is the leading cause of blindness. • Persons with cancer have many needs. They include: Control of diabetes, blood pressure, and cholesterol can o Pain relief or control control diabetic retinopathy. o Rest and exercise • Glaucoma. Glaucoma results when fluid builds up in the o Fluids and nutrition eye and causes pressure on the optic nerve. The optic o Preventing skin breakdown nerve is damaged. Vision loss with eventual blindness 0 Preventing bowel problems (constipation, diarrhea) occurs. Drugs and surgery can control glaucoma 0 Dealing with treatment side effects and prevent further damage to the optic nerve. Prior 0 Psychological and social needs damage cannot be reversed. o Spiritual needs Impaired Vision and Blindness o Sexual needs • Birth defects, injuries, accidents, and eye diseases • Anger, fear, and depression are common. Some are among the many causes of impaired vision and surgeries are disfiguring. The person may feel unwhole, blindness. They also are complications of some diseases. unattractive, or unclean. The person and family need • Review Box 42-6, Caring for Blind and Visually support. Impaired Persons, in the Textbook. • Talk to the person. Do not avoid the person because you are uncomfortable. Use touch and listening to show that Corrective Lenses you care. • Clean eyeglasses daily and as needed. • Spiritual needs are important. A spiritual leader may • Protect eyeglasses from loss or damage. When not provide comfort. worn,put them in their case. • Contact lenses are cleaned, removed, and stored according to the manufacturer's instructions. Immune System Disorders • The immune system protects the body from microbes, CHAPTER 42 REVIEW QUESTIONS cancer cells, and other harmful substances. It defends against threats inside and outside the body. Circle the BESTanswer. HIV/AIDS 1. A person is hard-of-hearing. You do the following • Acquired immunodeficiency syndrome (AIDS) is except caused by the human immunodeficiency virus (HIV). a. Face the person when speaking The virus is spread through body fluids-blood, semen, b. Speak clearly, distinctly, and slowly vaginal secretions, rectal fluids, and breast-milk. HIV c. Use facial expressions and gestures to give clues is not spread by air, saliva, tears, sweat, sneezing, d. Use long sentences coughing, insects, casual contact, closed mouth or social 2. A person has taken his hearingaid out for the evening. kissing, or toilet seats. You do the following except • Persons with A£DS are at risk for pneumonia, a. Make sure the hearing aid is turned off tuberculosis, Kaposi's sarcoma (a cancer), nervous b. Keep the battery in the hearing aid system disorders, mental health disorders, and c. Place the hearing aid in a safe place dementia. d. Handle the hearing aid carefully 3. A person is blind. You do the following except • To protect yourself and others from HIV, follow Standard Precautions and the Bloodbome Pathogen a. Identify yourself when you enter her room Standard. b. Describe people, places, and things thoroughly • Review Box 43-4, Caring for the Person With AIDS, in c. Re-arrange her furniture without telling her the Textbook. d. Encourage her to do as much for herself as possible • Older persons also get AIDS. They get and spread 4. Fluid buildup in the eye that causes pressure on the optic nerve is HIV through sexual contact and intravenous (IV) drug a. Cataract use. Aging and some diseases can mask the signs and b. Cerumen symptoms of AIDS. Older persons are less likely to be c. Glaucoma tested for HIV/ AIDS. d. Tinnitus Answers to these questions are on p. 517. Skin Disorders-Shingles • Shingles is caused by the same virus that causes chicken pox. A rash or blisters can occur. Pain is mild to intense CHAPTER 43 CANCER, IMMUNE SYSTEM, and itching is a common complaint. • Shingles is most common in persons over 50 years of AND SKIN DISORDERS age. Persons at risk are those who have had chicken pox Cancer as children and who have weakened immune systems. • Cancer is the second leading cause of death in the Shingles lesions are infectious until they crust over. United States. • Treatments include anti-viral and pain-relief drugs. A • Review Box 43-1, Cancer: Signs and Symptoms, inthe vaccine is not available. Textbook.

CHAPTER 43 REVIEW QUESTIONS o Slow movements-the person has a slow, shuffling gait. Circle tl1e BEST answer. o Stooped posture and impaired balance-it is hard to 1. A person with cancer may need all the following except walk. Falls are a risk. a. Pain relief or control o Mask-like expression-the person cannot blink and b. Avoidance by you smile. A fixed stare is common. c. Fluids and nutrition • Other signs and symptoms that develop over d. Psychological support time include swallowing and chewing problems, 2. Which statement about HlV is false? constipation, and bladder problems. Slee probl ms, a. HIV is spread through body fluids. � � depression, and emotional changes (fear, insecurity) b. Standard Precautions and the Bloodbome Pathogen can occur. So can memory loss and slow thinking. The Standard are followed. person may have slurred, monotone, and soft speech. c. Older persons cannot get and spread H[V. Some people talk too fast or repeat what they say. d. Older persons are less likely to be tested for HNI • Drugs are ordered to treat and control the disease. AIDS. Exercise and physical therapy improve strength, 3. The immune system defends against threats inside and posture, balance, and mobility. Therapy is needed for outside the body. speech and swallowing problems. The person may a. True need help with eating and self-care. Safety measures are b. False needed to prevent falls and injury. 4. Shingles lesions are not infectious. a. True Multiple Sclerosis b. False • Multiple sclerosis (MS) is a chronic disease. Th� myelin Answers to these questions are on p. 517. (which covers nerve fibers) in the brain and spmal cord is destroyed. Nerve impulses are not sent to and from the brain in a normal manner. Functions are impaired or CHAPTER 44 NERVOUS SYSTEM AND lost. There is no cure. • Symptoms usually start between the ages of 20 and MUSCULO-SKELETAL DISORDERS 40. Signs and symptoms depend on the damaged area. Nervous Systen, Disorders They may include vision problems, muscle weakness Stroke in the arms and legs, and balance problems that • Stroke is also called a brain attack or cerebrovascular affect standing and walking. Tingling, prickling, or accident (CVA). 1t is the third leading cause of death numb sensations may occur. Also, partial or complete in the United States. Review Box 44-1, Stroke: Warning paralysis and pain may occur. . Signs, in the Te xtbook. • Persons with MS are kept active as long as possible • The effects of stroke include: and as independent as possible. Skin care, hygiene, and o Loss of face, hand, arm, leg, or body control range-of-motion (ROM) exercises are important. So are Hemiplegia-paralysis on 1 side of the body turning,positioning, and deep breathing and coughing. o Changing emotions (crying easily or mood swings, Bowel and bladder elimination is promoted. Injuries sometim�:. for no reason) and complications from bedrest are prevented. o Difficulty swallowing (dysphagia} Head Injuries o Aphasia or slowed or slurred speech • Traumatic brain injury (TBI) occurs from violent injury o Changes in sight, touch, movement, and thought to the brain. Common causes include falls, traffic o Impaired memory accidents, violence, sports, explosive blasts, and combat o Urinary frequency, urgency, or incontinence injuries. Review Box 44-3, Traumatic Brain Injury: Signs o Loss of bowel control or constipation and Symptoms, in the Te xtbook. o Depression and frustration • Disabilities from TBI include cognitive problems, o Behavior changes sensory problems, communications problems, and • The health team helps the person regain the highest emotional problems. possible level of function. Review Box 44-2, Stroke Care Measures, in the Textbook. Spinal Cord Injury Parkinson's Disease • Spinal cord injuries can permanently damage the nervous system. Common causes are motor vehicle • Parkinson's disease is a slow, progressive disorder with crashes, falls, no cure. Persons over the age of 50 are at risk. Signs and violence, sports injuries, alcohol use, and symptoms become worse over time. They include: cancer and other diseases. • The higher the level of injury, the more functions lost. o Tremors-often start in 1 finger and spread to the whole arm. Pill-rolling movements-rubbing the o Lumbar injuries--sensoryand muscle function in the legs is lost. The person paraplegia-paralysis thumb and index finger-may occur. The person has and may have trembling in the hands, arms, legs, jaw, loss of sensory function in the legs and lower trunk. and face. o Thoracic injuries-sensory and muscle function below the chest is lost. The person has paraplegia. o Rigid, stiffmuscles-in the arms, legs, neck, and trunk.

o Cervical injuries-sensory and muscle function of the arms, legs, and trunk is lost. Paralysis in the arms, legs, and trunk is called quadriplegia or tetraplegia. • Review Box 44-4, Care of Persons With Paralysis, in the Textbook. • Hypertension. Hypertension (high blood pressure) occurs Sk /eta/ V -.ord when the systolic pressure is 140 mm Hg or higher or the diastolic pressure is 90 mm Hg or higher. Narrowed Arthritis blood vessels are a common cause. Review Box 45-1, • Arthritis means joint inflammation. Cardiovascular Disorders: Risk Factors, in the Textbook. • Osteoarthritis (degenerative joint disease). The fingers, • Coronary artery disense (CAD). In CAD, the coronary spine (neck and lower back), and weight-bearing joints artery become hardened and narrow and the heart (hips, knees, and feet) are often affected. Treatment muscle gets less blood and oxygen. The most common involves pain relief, heat applications, exercise, rest and cause is atherosclerosis, or plaque buildup on artery joint care, weight control, and a healthy life-style. Falls walls. Complications of CAD are heart attack, irregular are prevented. Help is given with activities of daily heartbeats, and sudden death. CAD complications may living (AOL) as needed. Toilet seat risers are helpful require cardiac rehabilitation, which consists of exercise when hips and knees are affected. So are chairs with training and education, counseling, and training for life higher seats and armrests. Some people need joint style changes. replacement surgery. • Angina. Angina is chest pain. lt is caused by reduced • Rheumatoid arthritis. Rheumatoid arthritis (RA) causes blood flow to part of the heart muscle. Chest pain is joint pain, swelling, stiffness, and loss of function. Joints described as tightness, pressure, squeezing, or burning are tender, warm, and swollen. Fatigue and fever are in the chest. Pain can occur in the shoulders, arms, neck, common. The person does not feel well. The person's jaw, or back. The person may be pale, feel faint, and care plan may include rest balanced with exercise, perspire. Dyspnea is common. Nausea, fatigue, and proper positioning, joint care, weight control, measures weakness may occur. Some persons complain of "gas" to reduce stress, and measures to prevent falls. Drugs or indigestion. Rest often relieves symptoms in 3 to 15 are ordered for pain relief and to reduce inflammation. minutes. Chest pain lasting longer than a few minutes Heat and cold applications may be ordered. Some and not relieved by rest and nitroglycerin may signal persons need joint replacement surgery. Emotional heart attack. The person needs emergency care. support is needed. Persons with RA need to stay as • Myocardial infarction (Ml). Ml also is called Jzeart attack, active as possible. Give encouragement and praise. acute myocardial infarction and acute coronary Listen when the person needs to talk. (AMT), syndrome (ACS). Blood flow to the heart muscle is suddenly blocked. Part of the heart muscle dies. Ml is an emergency. Sudden cardiac death (s11dden Circle the BESTanswer. cardiac arrest) can occur. Review Box 45-2, Myocardial 1. The person had a stroke. Care includes all the following Infarction: Signs and Symptoms, in the Textbook. except • Heart failure. Heart failure or congestive heart failure a. Place the call light on the person's strong side (CHF) occurs when the heart is weakened and cannot b. Re-position the person every 2 hours pump normally. Blood backs up. Tissue congestion c. Perform ROM exercises as ordered occurs. Drugs are given to strengthen the heart. They d. Place objects on the affected side also reduce the amount of fluid in the body. A sodium 2. The person with hemiplegia controlled diet is ordered. Oxygen is given. Semi a. ls paralyzed on 1 side of the body Fowler's position is preferred for breathing. Intake and b. Has both arms paralyzed output (I&O), daily weight, elastic stockings, and range c. Has both legs paralyzed of-motion (ROM) exercises are part of the care plan. d. Has all extremities paralyzed • Dysrhythmias. Dysrhythmias are abnormal heart 3. The person with multiple sclerosis should be kept rhythms. Rhythms may be too fast, too slow, or active as long as possible. irregular. Dysrhythmias are caused by changes in the a. True heart's electrical system. Some abnormal rhythms are b. False treated with a pacemaker. 4. The person has paralysis in the legs and lower trunk. • Viral ltemorrliagic fevers (VHFs). VHFs are a group of This is called illnesses caused by viruses. Ebola is a severe and deadly a. Quadriplegia VHF caused by the Ebolavirus. Signs and symptoms b. Paraplegia can appear 2 to 21 days after exposure and include c. Hemiplegia fever greater than 101.5°F, severe headache, muscle d. Tetraplegia pain, weakness, diarrhea and vomiting, abdominal 5. Fever is a common symptom of osteoarthritis. pain, and hemorrhage. The virus is contagious and a. True is spread through direct contact with blood or body b. False fluids, contaminated objects, and infected animals. Answers to these questions are on p. 517. The health team must prevent the spread of infection.

Hand hygiene, Standard Precautions,Transmission-Based speaking, singing, or laughing. Those who have close, Precautions, and the Bloodbome Pathogen Standard frequent contact with an infected person are at risk. TB are followed. Special training is needed to care for is more likely to occur in close, crowded areas. Age, such patients and for donning and removing personal poor nutrition, and human immunodeficiency virus protective equipment (PPE). (HIV) infection are other risk factors. • Signs and symptoms are tiredness, loss of appetite, weight loss, fever, and night sweats. Cough and sputum Cliro11ic Obstructive PulmonaryDisease production increase over time. Sputum may contain • Two disorders are grouped under chronic obstructive blood. Chest pain occurs. pulmonary disease (COPD). They are chronic bronchitis • Drugs for TB are given. Standard Precautions and and emphysema. These disorders obstruct airflow. Lung isolation precautions are needed. The person must function is gradually lost. cover the mouth and nose with tissues when sneezing, • Chronic bronchitis. Bronchitis means inflammation of coughing, or producing sputum. Tissues are flushed the bronchi. Chronic bronchitis occurs after repeated down the toilet, placed in a BIOHAZARD bag, or placed in episodes of bronchitis. Smoking is the major cause. a paper bag and burned. Hand-washing after contact Smoker's cough in the morning is often the first with sputum is essential. symptom of chronic bronchitis. Over time, the cough becomes more frequent. The person has difficulty breathing and tires easily. The person must stop Circlethe BESTanswer. smoking. Oxygen therapy and breathing exercises are 1. Which statement about angina is false? often ordered. If a respiratory tract infection occurs, the a. Angina is chest pain. person needs prompt treatment. b. The person may be pale and perspire. • Emphysema. 1n emphysema, the alveoli enlarge and c. Rest often relieves the symptoms. become less elastic. They do not expand and shrink d. You do not report angina to the nurse. normally when breathing in and out. Air becomes 2. A person has heart failure. You do all of the following trapped when exhaling. Smoking is the most common except cause. The person has shortness of breath and a cough. a. Measure intake and output Sputum may contain pus. Fatigue is common. The b. Measure weight daily person works hard to breathe in and out. Breathing c. Promote a diet that is high in salt is easier when the person sits upright and slightly d. Restrict fluids as ordered forward. The person must stop smoking. Respiratory 3. Which position is usually best for the person with therapy, breathing exercises, oxygen, and drug therapy pneumonia? are ordered. a. Semi-Fowler's Astlima b. Prone • ln asthma, the airway becomes inflamed and narrow. c. Supine Extra mucus is produced. Dyspnea results. Wheezing d. Trendelenburg's and coughing are common. So are pain and tightening 4. A bacterial infection in the lungs is in the chest. Asthma usually is triggered by allergies. a. Asthma Other triggers include air pollutants and irritants, b. Bronchitis smoking and second-hand smoke, respiratory tract c. Tuberculosis infections, exertion, and cold air. Asthma is treated with d. Emphysema drugs. Severe attacks may require emergency care. Answers to tlzese questions are on p. 517. Pneumonia • Pneumonia is an inflammation and infection of lung tissue. Bacteria, viruses, and other microbes are causes. CHAPT 46 DI ESTIV AN • High fever, chills, painful cough, chest pain on DISORD RS breathing, and rapid pulse occur. Shortness of breath and rapid breathing also occur. Cyanosis may be Gastro-EsophagealReflux Disease (GERD) present. Sputum is thick and white, green, yellow, or • GERD occurs when stomach contents flow back up rust-colored. Other signs and symptoms are nausea, into the esophagus. Drugs to prevent stomach acid vomiting, headache, tiredness, and muscle aches. production or to promote stomach emptying may be • Drugs are ordered for infection and pain. Fluid intake is increased. Intravenous (IV) therapy and oxygen may ordered. Life-style changes include Urnitingsmoking and alcohol, losing weight, eating small meals, wearing be needed. The semi-Fowler's position eases breathing. Rest is important. Standard Precautions are followed. loose belts and clothing, and sitting upright for 3 hours Isolation precautions are used depending on the cause. after meals. Tuberculosis Vomiting • These measures are needed. • Tu berculosis (TB) is a bacterial infection in the lungs. TB o Follow Standard Precautions and the Bloodbome is spread by airborne droplets with coughing, sneezing, Pathogen Standard.

' Tum the person's head well to 1 side. This prevents 2. A person with diabetes is trembling, sweating, and feels aspiration. faint. You Place a kidney basin under the person's chin. a. Tell the nurse immediately o Move vomitus away from the person. b. Tell the nurse at the end of the shift Provide oral hygiene. c. Tell another nursing assistant � Observe vomitus for color, odor, and undigested d. Ignore the symptoms food. lf it looks like coffee grounds, it contains 3. All of the following are signs and symptoms of undigested blood. This signals bleeding. Report your hepatitis except observations. a. Itching Measure, report, and record the amount of vomitus. b. Diarrhea Also record the amount on the intake and output c. Skin rash (I&O) record. d. Increased appetite o Save a specimen for laboratory study. Answers to tltese questions are on p. 517. c, Dispose of vornitus after the nurse observes it. Eliminate odors. Provide for comfort. CHAPTER 47 URINARY AND Hepatitis REPRODUCTIVE DISORDERS • Hepatitis is an inflammation of the liver. It can be mild Urinary System Disorders or cause death. Signs and symptoms are listed in Box UrinaryTtact Infections (UTls) 46-1, Hepatitis, in the Textbook. Some people do not • UTis are common. Catheters, poor perinea! hygiene, have symptoms. immobility, and poor fluid intake arc common causes. • Protect yourself and others. Follow Standard Precautions and the Bloodbome Pathogen Standard. Prostate Enlargement Isolation precautions are ordered as necessary. Assist • The prostate grows larger as a man grows older. This is the person with hygiene and hand-washing as needed. called benign prostatic hyperplasia (BPH). The enlarged prostate presses against the urethra. This obstructs urine I llfiocrin 'JJi.-;orders flow through the urethra. Bladder function is gradually lost. Most men in their 60s and older have some Diabetes symptoms of BPH. • In this disorder the body cannot produce or use insulin properly. Insulin is needed for glucose to move from KidneyStones the blood into the cells. Sugar builds up in the blood. • Kidney stones (calculi) are most common in white men Cells do not have enough sugar for energy and cannot 40 years of age and older. Bedrest, immobility, and poor function. fluid intake are risk factors. Review the list of symptoms • Diabetes must be controlled to prevent complications. on p. 752 in the Textbook. Complications include blindness, renal failure, nerve • Stones vary in size from grains of sand to golf ball damage, and damage to the gums and teeth. Heart and sized. blood vessel diseases are other problems. They can lead KidneyFailure to stroke, heart attack, and slow healing. Foot and leg • In kidney failure (renal failure) the kidneys do not wounds and ulcers are very serious. function or are severely impaired. Waste products are • Good foot care is needed. Corns, blisters, calluses, not removed from the blood. Fluid is retained. and other foot problems can lead to an infection and • Acute kidney failure is sudden. Blood flow to the amputation. kidneys is severely decreased. Causes include severe • Blood glucose is monitored for: injury or bleeding, heart attack, heart failure, burns, J Hypoglycemia-lowsugar in the blood. infection, and severe allergic reactions. o Hyperglycemia-high sugar in the blood. • With chronic kidney failure the kidneys cannot meet • Review Table 46-1 in the Textbook for the causes, signs, the body's needs. Hypertension and diabetes are and symptoms of hypoglycemia and hyperglycemia. common causes. Infections, urinary tract obstructions, Both can lead to death if not corrected. You must call for and tumors are other causes. Review Box 47-3, the nurse at once. Chronic Kidney Disease: Signs and Symptoms, in the Textbook. ?-£: t REVIF.WS QUESTIONS Circle the BEST amwer. l{eproductiveDisorders 1. A person is vomiting. You should do all of the Sexually Transmitted Diseases following except • A sexually transmitted disease (STD) is spread by oral, a. Follow Standard Precautions and the Bloodbome vaginal, or anal sex. Some people do not have signs and Pathogen Standard symptoms or are not aware of an infection. Others know b. Keep the person supine but do not seek treatment because of embarrassment. c. Provide aral hygiene Standard Precautions and the Bloodborne Pathogen d. Observe the vomitus for color, odor, and undigested Standard are followed. food

CHAPTER47 REVIEW QUESTIONS • Post-traumatic stress disorder (PTSD). PTSD occurs after a terrifying ordeal. The ordeal involved physical harm Circle the BESTanswer. or the threat of physical harm. Review Box 48-3, Post 1. Which statement isfa/se? Traumatic Stress Disorder: Signs and Symptoms, in a. Older persons are at high risk for urinary tract the Textbook. Flashbacks are common. A flashback infections. is reliving the trauma in thoughts during the day and b. Skin irritation and infection can occur if urine leaks in nightmares during sleep. He or she may be!ieve onto the skin. that the trauma is happening all over agam. Signs and c. Benign prostatic hypertrophy may cause urinary symptoms usually develop about 3 months after the problems in women. harmful event. Or they may emerge years later. PTSD d. Some people may not be aware of having a sexually can develop at any age. transmitted disease. 2. An STD is spread by oral, vaginal, or anal sex. Schizophrenia a. True b. False • Schizophrenia means split mind. It is a severe, chroruc, 3. A person with an STD always has signs and symptoms. disabling brain disorder that involves: a. Tr ue o Psychosis-a state of severe mental impairment. The b. False person does not view the real or unre� correctly: Answers to these questions are on p. 517. o Hallucinations-seeing, hearing, smelling, or feelmg something that is not real. o Delusion-a false belief. o Delusion of grandeur-an exaggerated belief about CHAPTER 48 MENTAL HEALTH DISORDERS one's importance, wealth, power, or talents. • The whole person has physical, social, psychological, o Delusion ofpersecution-the false belief that one is and spiritual parts. Each part affects the other. being mistreated, abused, or harassed. • Stress is the response or change in the body caused by o Thought disorders-trouble organizing thoughts or any emotional, physical, social, or economic factor. connecting thoughts logically. • Mental health means the person copes with and adjusts o Movement disorders-include agitated body movements; to every-day stresses in ways accepted by society. repeating motions over and over; and sitting for hours • Mental disorder is a disturbance in the ability to cope without moving, speaking, or responding. with or adjust to stress. Behavior and function are . . o Emotional and befmvioral problems-normal functions impaired. Mental illness, emotional illness, and psychmtnc are impaired or absent, including losing motivation disorder also mean mental disorder. or interest in daily activities, being unable to plan, AnxietyDisorders lacking emotions, neglectingpersonal hygiene, and • Anxiety is a vague, uneasy feeling in response to withdrawing socially. stress. The person may not know the cause. The person o Cognitive problems-trouble paying attention, senses danger or harm-real or imagined. Some understanding, or remembering information. anxiety is normal. Review Box 48-1, Anxiety: Signs and • The person with schizophrenia has problems relating Symptoms, in the Te xtbook. . to others. He or she may be paranoid. The person may • Coping and defense mechanisms are used �o reli�ve have difficulty organizing thoughts. Responses are anxiety. Review Box 48-2, Defense Mecharusms, m the inappropriate. Communication is disturbed. The person Textbook. may withdraw. Some people regress to an earlier time • Some common anxiety disorders are panic disorder, or condition. Some persons with schizophrenia attempt phobias, obsessive-compulsive disorder, and post suicide. traumatic stress disorder. • Panic disorder. Panic is an intense and sudden feeling of Bipolar Disorder fear, anxiety, terror, or dread. Onset is sudden with no • The person with bipolar disorder has severe extremes obvious reason. The person cannot function. Signs and in mood, energy, and ability to function. There are symptoms of anxiety are severe. emotional lows (depression) and emotional highs • Phobias. Phobia means an intense fear. The person has (mania). This disorder is also called manic-depressive an intense fear of an object, situation, or activity that illness. This disorder must be managed throughout has little or no actual danger. The person avoids what is feared. When faced with the fear, the person has high life. Review Box 48-4, Bipolar Disorder: Signs and anxiety and cannot function. Symptoms, in the Te xtbook. Bipolar disorder can damage relationships and affect school or work • Obsessive-compulsive disorder (OCD). An obsession performance. Some people are suicidal. is a recurrent, unwanted thought, idea, or image. Compulsion is repeating an act over and over again. The act may not make sense but the person has much Depression anxiety if the act is not done. Some persons with OCD • Depression involves the body, mood, and thoughts. also have depression, eating disorders, substance abuse, Symptoms affect work, study, sleep, eating, and other and other anxiety disorders. activities. The person is very sad.

• Depression is common in older persons. They have many 4. A person talks about suicide. You must do the losses-death of family and friends, loss of health, loss following except of body functions, and loss of independence. Loneliness a. Call the nurse at once and the side effects of some drugs also are causes. b. Stay with the person Review Box 48-5, Depression in Older Persons: Signs and c. Leave the person alone Symptoms, in the Textbook. Depression in older persons d. Take the person seriously is often overlooked or a wrong diagnosis is made. 5. Which statement about depression in older persons is false? S11bstm1ce Abuse Disorder a. Depression is often overlooked in older per�ons. Alcoholism b. Depression rarely occurs in older persons. • Alcohol affects alertness, judgment, coordination, and c. Loneliness may be a cause of depression in older reaction time. Over time, heavy drinking damages persons. the brain, central nervous system, liver, kidneys, d. Side of effects some drugs may cause depression in heart, blood vessels, and stomach. Tt also can cause older persons. forgetfulness and confusion. Alcoholism is a chronic 6. Which statement is false? disease. Alcoholism can be treated but not cured. a. Communication is important when caring for a Alcohol recovery, support programs, and drugs are person with a mental health disorder. used to help the person stop drinking. The person must b. You should be alert to nonverbal communication avoid all alcohol to avoid a relapse. when caring for a person with a mental health • Alcohol effects vary with age. Even small amounts disorder. can make older persons feel "high." Older persons c. The care plan reflects the needs of the person. are at risk for falls, vehicle crashes, and other injuries d. The focus is only on the person's emotional needs. from drinking. Mixing alcohol with some drugs can Answers to tlrese questions are on p. 517. be harmful or fatal. Alcohol also makes some health problems worse. CHAPTER 49 CONFUSION AND DEM f'JTIA • Changes in the brain and nervous system occur with Sui< ule • Suicide means to kill oneself. aging. Review Box 49-1, Nervous System Changes From • Suicide is most often linked to depression, alcohol or Aging, in the Textbook. substance abuse, or stressful events. Review Box 48-7, • Changes in the brain can affect cognitive function Suicide Risk Factors, in the Te xtbook. memory, thinking, reasoning, ability to understand, • If a person mentions or talks about suicide, take the judgment, and behavior. person seriously. Call for the nurse at once. Do not leave the person alone. ( 011J11sicm • Confusion has many causes. Diseases, infections, ( an. and lreatmeut hearing and vision loss, brain injury, and drug side • Treatment of mental health disorders involves having effects are some causes. the person explore his or her thoughts and feelings. This • When caring for the confused person: is done through psychotherapy and behavior, group, Follow the person's care plan. occupational, art, and family therapies. Often drugs are Provide for safety. ordered. Face the person and speak clearly. • The care plan reflects the person's needs. The physical, w Call the person by name every time you are in contact safety and security, and emotional needs of the person with him or her. must be met. o State your name. Show your name tag. • Communication is important. Be alert to nonverbal c Give the date and time each morning. Repeat as communication. needed during the day and evening. Explain what you are going to do and why. Cl IAPTER 48 llEVJEWQUEST IONS 0 Give clear, simple directions and answers to questions. Circle the BESTanswer. Break tasks into small steps. 1. A person may not know why anxiety occurs. Ask clear, simple questions. Allow time to respond. a. True � Keep calendars and clocks with large numbers in b. False the person's room. Remind the person of holidays, 2. Panic is an intense and sudden feeling of fear, anxiety, birthdays, and otherevents. terror, or dread. a. True c Have the person wear eyeglasses and hearing aids as b. False needed. o Use touch to communicate. 3. A person with an obsessive-compulsive disorder has a Place familiar objects and pictures within the person's ritual that is repeated over and over again. view. a. True Provide newspapers, magazines, TV, and radio. Read b. False to the person if appropriate.

Discuss current events with the person. Paranoia. The person has false beliefs and suspicion Maintain the day-night cycle. about a person or situation. Provide a calm, relaxed, and peaceful setting. Catastrophic reactions. The person reacts as if there is a Follow the person's routine. disaster or tragedy. " Do not re-arrange furnitureor the person's o Agitation and aggression. The person may pace, hit, or belongings. yell. Encourage the person to take part in self-care. Comm11nicatio11 changes. The pen,on has trouble 0 Be consistent. expressing thoughts and emotions. Screaming. Persons with AD may scream to

' ( d communicate. • Dementia is the loss of cognitive function that interferes Repetitivebehaviors. Persons with AD repeat the same with routine personal, social, and occupational motions over and over again. activities. � Rummaging and J,iding tJ,ings. The person may search • Dementia is not a normal part of aging. Most older for things by moving things around, turning things people do not have dementia. over, or looking through something such as a drawer • Some early warning signs include problems with or closet. The person may hide things, throw thing� language, dressing, cooking, personality changes, poor away, or lose something. or decreased judgment, and driving as well as getting o Changes in intimacy and sexuality. The person with Jost in familiar places and misplacing items. AD may depend on and cling to his or her partner • Alzheimer's disease is the most common type of or may not remember life with or feelings for his or permanent dementia. her partner. Sexual behaviors may involve the wrong person, the wrong time, and the wrong place. Persons with AD cannot control behavior. M 1e1 £ ')f�{ ( • Alzheimer's disease (AD) is a brain disease. Memory, thinking,reasoning, judgment, language, behavior, Care of Persons With AD aud Otl,e, I>eme11tit1s mood, and personality are affected. • People with AO do not choose to be forgetful, agitated, or rude. Nor do they choose Signs ofAD incontinent, to have other behaviors, signs, and symptoms of the • The classic sign of AD is gradual loss of short-term disease. The disease causes the behaviors. memory. Warning signs include: • Safety, hygiene, nutrition and fluids, elimination, and '' Asking the same questions over and over again. activity needs must be met. So must comfort and sleep " Repeating the same story-word for word, again and again. needs. Review Box 49-10, Care of Persons With AD and ' Forgetting activities that were once done regularly Other Dementias, in the Textbook. with ease. • The person can have other health problems and Losing the ability to pay bills or balance a checkbook. injuries. However, the person may not recognize pain, Getting lost in familiar places. Or misplacing fever, constipation, incontinence, or other signs and household objects. symptoms. Carefully observe the person. Report any " Neglecting to bathe or wearing the same clothes over change in the person's usual behavior to the nurse. and over again. Meanwhile, the person insists that a • Infection is a risk. Provide good skin care, oral hygiene, bath was taken or that clothes were changed. and perinea) care after bowel and bladder elimination. ,., Relying on someone else to make decisions or answer • Supervised activities meet the person's needs and questions that the person would have handled. cognitive abilities. • Review Box 49-5, Signs of Alzheimer's Disease, in the • Impaired communication is a common problem. Avoid Textbook for other signs of AD. giving orders, wanting the truth, and correcting the person's errors. • Always look for dangers in the person's room and in Bd1m 10r.s the hallways, lounges, dining areas, and other areas on • The following behaviors are common with AD. the nursing unit. Remove the danger if you can. Wandering. Persons with AD are not oriented to • Everymember staff must be alert to persons who wander. may wander away person, place, and time. They Such persons are allowed to wander in safe areas. from home and not find their way back. The person cannot tell what is safe or dangerous. Sundowning. With sundowning, signs, symptoms, and 1I,e Fmmly behaviors of AD increase during hours darkness. • The family may have physical, emotional, social, and of financial stresses. The family often feels hopeless. No As_ daylight ends, confusion, restlessness, anxiety, agitation, and other symptoms increase. matter what is done, the person only gets worse. Anger Hallucinations. The person with AD may sec, hear, or and resentment may result. Guilt feelings are common. feel things that are not real. • The family is an important part of the health team. They Delusions. People with AO may think they are some ma� help plan the pe�son's care. For many persons, other person. A person may believe that the caregiver family members provide comfort. The family also needs is someone else. support and understanding from the health team.

CHAPTER49 REVIEWQUESTIONS o Tell the person that you will not do what he or she wants. Circle the BESTanswer. o Tell person the what behaviors make you uncomfortable. 1. Cognitive function involves all of the following except Politely ask the person not to act that way. a. Memory and thinking o Allow privacy if the person is becoming aroused. b. Reasoning and understanding 0 Discuss the matter with the nurse. The nurse can help Personality and mood c. you understand the behavior. d. Judgment and behavior ° Follow the care plan. It has measures to deal with 2. When caring for a confused person, you do the sexually aggressive behaviors. They are based on the following except cause of the behavior. a. Provide for safety b. Maintain the day-night schedule c. Keep calendars and docks in the person's room Protecting the Person d. Ask difficult-to-understand questions and give • The person must be protected from unwanted sexual complex directions comments and advances. This is sexual abuse (see Chapter 5 in the Textbook). Tell the nurse right away. 3. Which statement about dementia is false? a. Dementia is a normal part of aging. • No one should be allowed to sexually abuse another b. The person may have changes in personality. person. This includes staff members, patients, residents, c. Alzheimer's disease is the most common type of family members or other visitors, and volunteers. dementia. d. The person may have changes in behavior. CHAPTER51 REVIEW QUESTIONS 4. When caring for persons with AO, you do the following Circle the BEST answer. except 1. A resident touches you in a sexual way. You should do a. Provide good skin care the following except b. Talk to them in a calm voice a. Ask the person not to touch you c. Observe them closely for unusual behavior b. Discuss the matter with the nurse d. Allow personal choice in wandering c. Te ll the person what behaviors make you Answers to these questions are on p. 517. uncomfortable d. Yell at the person immediately 2. Unwanted sexual comments and advances are forms of CHAPTER 51 SEXUALITY sexual abuse. Sex and Sexuality a. True • Sexuality involves the whole person. Illness, injury, and b. False aging can affect sexuality. Answers to these questions are on p. 517.

Sexuality and Older Persons • Love, affection, and intimacy are needed throughout CHAPTER 54 BASIC EMERGENCY CARE Emer enc Care life. Older persons love, fall in love, hold hands, and g y embrace. Many have intercourse. • Rules for emergency care include: • Reproductive organs change with aging. Frequency of 0 Know your limits. Do not do more than you are able. sex decreases for many older persons. o Stay calm. • Sexual partners are lost through death, divorce, and o Know where to find emergency supplies. relationship break-ups. Or a partner needs hospital or o Follow Standard Precautions and the Bloodborne nursing center care. Pathogen Standard to the extent possible. ° Check for life-threatening problems. Check for Meeting Sexual Needs breathing, a pulse, and bleeding. • The nursing team promotes the meeting of sexual ° Keep the person lying down or as you found him or her. needs. 0 Move the person only if the setting is unsafe. If the • Review Box 51-1, Promoting Sexuality, in the Textbook. scene is not safe enough for you to approach, wait for help to arrive. The Sexually Aggressive Person 0 Perform necessary emergency measures. • Some persons want the health team to meet their sexual o Call for help. needs. They flirt or make sexual advances or comments. o Do not remove clothes unless necessary. Some expose themselves, masturbate, or touch the staff. ° Keep the person warm. Cover the person with a This can anger and embarrass the staff member. These blanket, coat, or sweater. reactions are normal. 0 Re-assure the person. Explain what is happening and • To uch may have a sexual purpose. You must be that help was called. professional about the matter. 0 Do not give the person food or fluids. 0 Ask the person not to touch you. State the places ° Keep on-lookers away. They invade privacy. where you were touched. • Review Box 54-1, Emergency Care Rules, in the Textbook for more information.

Basic Life Support for Adults o Keep the person lying down if fainting has occurred. • Cardiopulmonary resuscitation (CPR) supports Raise the legs. breathing and circulation. It provides blood and oxygen 0 Do not let theperson get up quickly. to the heart, brain, and other organs until advanced o Help the person to a sitting position after recovery emergency care is given. CPR is done if the person does from fainting. not respond, is not breathing, and has no pulse. • Provide Basic Life Support (BLS) if there is no response • CPR involves: or breathing. ° Chest compressions-the heart, brain, and other organs mu:,t receive blood. Chest compressions force blood Seizures through the circulatory system. • You cannot stop a seizure. However, you can protect the o Airway-the airway must be open and clear of person from injury. obstructions. The head tilt-chin lift method opens the o Follow the Emergency Care Rules in Box 54-1 in the airway. Te xtbook. o Breathing-air is not inhaled when breathing stops. o Do not leave the person alone. The person must get oxygen. The person is given c-. Lower the person to the floor. breaths by a rescuer inflating the person's lungs. " Note the time the seizure started. o Oe.fibrillatio11-ventricular fibrillation (VF, V-fib) is o Place something soft under the person's head. an abnormal heart rhythm. Rather than beating in a 0 Loosen tight jewelry and clothing around the regular rhythm, the heart shakes and quivers. The person's neck. heart does not pump blood. The heart, brain, and Tum the person onto his or her side. Make sure the other organs do not receive blood and oxygen. A head is turned to the side. defibrillator is used to deliver a shock to the heart. 0 Do not put any object or your fingers between the This allows the return of a regular heart rhythm. person's teeth. Defibrillation as soon as possible after the onset of VF 0 Do not try to stop the seizure or control the person's (V-fib) increases the person's chance of survival. movements. '-' Move furniture, equipment, and sharp objects away Hemorrhage from the person. • Hemorrhage is the excessive loss of blood in a short o Note the time when the seizure ends. time. It can be internal or external. o Make sure the mouth is clear of food, fluids, and • Internal bleeding cannot be seen but can cause pain, saliva after the seizure. shock, vomiting of blood, coughing up blood, cold ' Provide BLS if the person is not breathing after the and moist skin, and loss of consciousness. Follow the seizure. Emergency Care Rules in Box 54-1 in the Te xtbook; this includes activating the Emergency Medical Services Concussion (EMS) system; keeping the person warm, flat, and quiet • Head injuries can be minor or serious and life until help arrives; and not giving fluids. threatening. A concussion results from a bump or blow • To control external bleeding: to the head or jolt to the head or body. The head and " Follow the Emergency Care Rules in Box 54-1 in the brain move quickly back and forth. Te xtbook. This includes activating the EMS system. • Symptoms can last for days, weeks, or longer. Symptoms o Do not remove any objects that have pierced or include difficultythinking and concentrating, headaches, stabbed the person. fuzzy or blurred vision, nausea and vomiting, sensitivity Place a sterile dressing directly over the wound. Or to noise or light, feelings of tiredness or low energy, use any clean material. irritabiHty and sadness, mood swings, and more or less 0 Apply firm pressure directly over the bleeding site. sleep than usual. Do not release pressure or remove the dressing. • The following danger signs signal the need for " Bind the wound when bleeding stops. emergency care: 0 Headache that gets worse or does not go away Fainting o Stiff neck • Fainting is the sudden loss of consciousness from an " Weakness, numbness, or decreased coordination inadequate blood supply to the brain. c Nausea or vomiting more than once • Warning signals are dizziness, perspiration, and o Slurred speech blackness before the eyes. The person looks pale. The o Very sleepy; drowsy; cannot be awakened pulse is weak. Respirations are shallow if consciousness o One eye pupil is larger than the other is lost. Emergency care includes: ° Convulsions or seizures 0 Have the person sit or lie down before fainting ° Ca1u1ot recognize people, places, or things occurs. Increased confusion, restlessness, or agitation 0 If sitting, the person bends forward and places the c Unusual behavior head between the knees. 0 Loss of consciousness 0 If the person is lying down, raise the legs. • Follow the Emergency Care Rules in Box 54-1 in your o Loosen tight clothing. Te xtbook. This includes activating the EMS system.

o n rr \\ Ql / 110\\ Stage 3: Bargaining. Often the person bargains with God or a higher power for more time. Circle tl1e BESTanswer. Stage 4: Depression. The person is sad and mourns 1. During an emergency, you do all of the following except o things that were lost. a. Perform only procedures you have been trained to Stage 5: Acceptance. The person is calm and at peace. do o The person accepts death. b. Keep the person lying down or as you found him or • Dying persons do not always pass through all 5 stages. her A person may never get beyond a certain stage. Some c. Let the person become cold move back and forth between stages. d. Re-assure the person and explain what is happening 2. During an emergency, you keep on-lookers away. a. True b. False • Comfort is a basic part of end-of-life care. It involves 3. Which statement about fainting is false? physical, mental and emotional, and spiritual needs. Comfort goals are to: a. If standing, have the person sit down before . fainting. o Prevent or relieve suffering to the extent possible. b. lf sitting, have the person bend forward and place o Respect and follow end-of-life wishes. his head between his knees before fainting occurs. • Dying persons may want to talk about their fears, c. Tighten the person's clothing. worries, and anxieties. You need to listen and use touch. d. Raise the legs if the person is lying down. o Listening. Let the person express feelings and 4. During a seizure, you do the following except emotions in his or her own way. Do not worry about a. Tum the person's body to the side saying the wrong thing or finding the right words. b. Place your fingers in the person's mouth You do not need to say anything. c. Note the time the seizure started and ended o Touch. Touch shows caring and concern. Sometimes d. Tum the person's head to the side the person does not want to talk but needs you 5. The symptoms of a concussion are gone within 24 nearby. Silence, along with touch, is a meaningful hours. way to communicate. a. True • Some people may want to see a spiritual leader. Or they b. False may want to take part in religious practices. Answers to tl1ese questions are on p. 517.

• As the person weakens, basic needs are met. The person CHA FND-OF LI may depend on others for basic needs and activities of daily Jiving (ADL). Every effort is made to promote physical and psychological comfort. The person is • Attitudes about death often change as a person grows allowed to die in peace and with dignity. older and with changing circumstances. Culture and Spiritual Needs • Practices and attitudes about death differ among • Some dying persons do not have pain. Others may have cultures. severe pain. Always report signs and symptoms of pain • Attitudes about death are closely related to religion. at once. Pain management is important. The nurse can Many religions practice rites and rituals during the give pain-relief drugs. Preventing and controUing pain dying process and at the time of death. is easier than relieving pain. Age • Adults fear pain and suffering, dying alone, and the invasion of privacy. They also fear loneliness and • Shortness of breath and difficulty breathing (dyspnea) separation from loved ones. Adults often resent death are common end-of-life problems. The semi-Fowler's because it affects plans, hopes, dreams, and ambitions. position and oxygen arc helpful. • Older persons usually have fewer fears than younger • Noisy breathing (death rattle) is common as death adults. Some welcome death as freedom from pain, nears. This is due to mucus collecting in the airway. The suffering, and disability. Death also means reunion with side-lying position, suctioning by the nurse, and drugs those who have died. Like younger adults, they often to reduce the amount of mucus may help. fear dying alone.

• Vision blurs and gradually fails. Explain what you are • Dr. Kubler-Ross described 5 stages of dying. They are: doing to the person or in the room. Provide good eye care. o Stage 1: Denial. The person refuses to believe he or she • Hearing is one of the last functions lost. Always assume is going to die. that the person can hear. o Stage 2: Anger. There is anger and rage, often at • Speech becomes difficult. Anticipate the person's needs. fa.mily, friends, and the health team. Do not ask questions that need Jong answers.

Mofltlt, Nose, and Skin • You may not agree with care and resuscitation • Frequent oral hygiene is given as death nears. decisions. However, you must follow the person's or • Crusting and irritation of the nostrils can occur. famiJy's wishes and the doctor's orders. These may be Carefully clean the nose. against your personal, religious, and cultural values. If • Skin care, bathing, and preventing pressure ulcers are so, discuss the matter with the nurse. An assignment necessary. Change linens and gowns whenever needed. change may be needed.

Nutrition Signs of Deatl, • Nausea, vomiting, and loss of appetite are common at • There are signs that death is near. the end of hfe. The doctor can order drugs for nausea Movement, muscle tone, and sensation are lost. and vomiting. o Abdominal distention, fecal incontinence, nausea, • Some persons are too tired or too weak to eat. You may and vomiting are common. need to feed them. Body temperature rises. The person feels cool, looks • As death nears, loss of appetite is common. The person pale, and perspires heavily. may choose not to eat or drink. Do not force the person to The pulse is fast or slow, weak, and irregular. Blood eat or drink. Report refusal to eat or drink to the nurse. pressure starts to fall. 0 Slow or rapid and shallow respirations are observed. Elimination Mucus collects in the airway. This causes the death • Urinary and fecal incontinencemay occur. Give perinea( rattle that is heard. care as needed. -i Pain decreases as the person loses consciousness. Some people are conscious until the moment of death. Tire Person's Room • The signs of death include no pulse, no respirations, • The person's room should be comfortable and pleasant. and no blood pressure. The pupils are dilated and It should be well Lit and well ventildted. Remove fixed. unnecessary equipment. • Mementos, pictures, cards, flowers, and religious items provide comfort. The person and famiJy arrange the Care of tire Body AfterDeath room as they wish. • Post-mortem care is done to maintain a good appearance of the body. • Moving the body when giving post-mortem care The Family can cause remaining air in the lungs, stomach, and • This is a hard time for family. The family goes through intestines to be expelled. When air is expelled, sounds stages like the dying person. Be available, courteous, are produced. and considerate. • When giving post-mortem care, follow Standard • The person and family need time together. However, Precautions and the Bloodbome Pathogen Standard. you cannot neglect care because the family is present. Most agencies let family members help give care. CHAPTER 55 REVIEW QUESTIONS Legal Issues Circle the BESTanswer. • Advance directives. Advance directives give persons 1. Which statement is false? rights to accept or refuse treatment. The advance a. Adults fear dying alone. directive is a document stating a person's wishes about b. Older persons usually have fewer fears about dying health care when that person cannot make his or her than younger adults. own decisions. c. Adults often resent death. • Living wills. A living will is a document about measures d. All adults welcome death. that support or maintain Life when death is likely. A 2. Persons in the denial stage of dying living will may instruct doctorsnot to start measures that a. Are angry promote dying or to remove measures that prolong dying. b. Bargain with God • Durable power of attorneyf or lrealtli care. This gives the c. Refuse to believe that they are dying power to make health care decisions to another person. d. Are calm and at peace When a person cannot make health care decisions, the 3. When caring for a person who is dying, you should do person with durable power of attorney can do so. the following except • "Do Not Resuscitate" (DNR) order. This means the person a. Listen to the person will not be resuscitated. The person is allowed to die b. Talk about your feelings about death with peace and dignity. The orders are written after c. Provide privacy during spiritual moments consulting with the person and family. d. Use touch to show care and concern

4. When caring for a dying person, you provide all of the 6. A document that states a person's wishes about health following except care when that person cannot make his or her own a. Eye care decisions is a b. Oral hygiene a. Living will c. Good skin care b. Advance directive d. Physical exercise c. Durable power of attorney for health care 5. When giving post-mortem care, you should wear d. "Do Not Resuscitate" order gloves. Answers to these questions are on p. 517. a. True b. False

Copyright© 2017, Elsevier Inc. All rights reserved. This test contains 75 questions. For each question, circle tlie BEST answer. 1. Amuse asks you to give a person his drug when he is 9. A per!>onwho was admitted to the nursing center done in the bathroom. Your response to the nurse is yesterday does not feel safe. You A. "I will give the drug for you." A. Arc rude as you care for the person B. '1 will ask the other nursing assistant to give thedrug." 8. Ignore the person's requests for information C. "I am sorry but I cannot give that drug. I will let C. Show the person around the nursing center you know when he is out of the bathroom." D. Act rushed as you care for the person 0. "I refuse to give that drug." 10. A person is angry and is shouting at you. You 2. An ethical person should A. Does not judge others A. Yell back at the person B. Avoids persons whose standards and values are B. Stay calm and professional different from his or hers C. Put the person in a room away from others C. Is prejudiced and biased D. Call the family D. Causes harm to another person 11. When speaking with another person, you 3. You smell alcohol on the breath of a co-worker. You A. Use medical terms that may not be familiar to the A. ignore the situation person B. Tell the co-worker to get counseling 8. Mumble your words as you talk C. Take a break and drink some alcohol too C. Ask several questions at a time D. Tell the nurse at once D. Speak clearly and distinctly 4. A person's call light goes unanswered. He gets out of 12. To use a transfer or gait belt safely, you should bed and falls. His leg is broken. This is A. Ignore the manufacturer's instructions A. Neglect B. Leave the excess strap dangling B. Emotional abuse C. Apply the belt over bare skin C. Physical abuse D. Apply the belt under the breasts D. Malpractice 13. When you are listening to a person, you .. 5. Your mom asks you about a person on your unit. How A. Look around the room should you respond? B. Sit with your arms crossed A. "She is walking better now that she is receiving C. Act and rushed not interested in what the person physical therapy." is saying 8. "I'm sorry but 1 cannot talk about her. It is D. Have good eye contact with the person unprofessional and violates her privacy and 14. When caring for a person who is comatose, you confidentiality." A. Make jokes about how sick the person is C. "Don't tell anyone I told you but she is getting 8. Care for the person without talking to him or her worc;e." C. Explain what you are doing to him or her D. "She has been very sad recently and needs visitors." D. Discuss your problems with the other nursing 6. You are going off duty. The nursing assistant coming assistant in the room with you on duty is on the unit with you. A person puts her call 15. You need to give care to a person when a visitor is light on. Your response is present. You A. "I'm ready to go. I will let you answer that light." A. Politely ask the visitor to leave the room 8. "I've been here all day so I am not answering that B. Do care the in the presenceof the visitor light." C. Expose the person'!> body in front of the visitor C. "No one helped me answer lights when I came on D. Rudely tell the visitor where to wait while you duty." care for the person D. "I will answer that light so you can get organized 16. A person tells you he wants to talk with a minister. for the shift." You 7. When recording in the medical record, you A. Ignore the request A. Write in pencil B. Tell the nurse B. Spell words incorrectly C. Ask what the person wants to discuss with the C. Use only center-approved abbreviations mm.ister D. Record what your co-worker did D. Tell the person there is no need to talk with a 8. You are answering the phone in the nurses' station. You minister A. Answer in a rushed manner 17. When you care for a person who has a restraint, you B. Give a courteous greeting A. Observe the person every 15 minutes C. End the conversation and hang up without saying B. Remove the restraint and re-position the person good-bye every 4 hours D. Give confidential information about a resident to C. Apply the restraint tightly the caller D. Apply the restraint incorrectly

18. As a person ages 28. A person's beliefs and values are different from your A. The skin becomes less dry views. What should you do? B. Muscle strength increases A. Refuse to care for the person. B. Delegate care to another nursing assistant. C. Reflexes are faster D. Bladder muscles weaken C. Tell the nurse about your concerns. 19. A person you are caring for touches your buttocks D. Tell the person how you feel. several times. You 29. You find a person smoking in the nursing center. You A. Tell the person you like being touched should B. Ask the person not to touch you again A. Ignore the situation C. Tell the person's daughter B. Tell the person to leave D. Tell the person's girlfriend C. Tell another nursing assistant 20. You are transporting a person in awheelchair. You D. Ask the person to put out the cigarette and show A. Pull the chair backward him or her where smoking is permitted B. Let the person's feet touch the floor 30. During a fire, the first thing you do is C. Push the chair forward A. Rescue persons in immediate danger D. Rest the footplates on the person's leg B. Sound the nearest fire alarm 21. You cannot read the person's name on the C. Close doors and windows to confine identification (ID) bracelet. You the fire A. Tell the nurse so a new bracelet can be made D. Extinguish the fire B. Ignore the fact that you cannot read the name 31. A person with Alzheimer's disease has increased C. Ask another nursing assistant to identify the restlessness and confusion as daylight ends. You person should D. Tell the family the person needs a new ID bracelet A. Try to reason with the person 22. The universal sign of choking is B. Ask the person to tell you what is bothering him A. Holding your breath or her B. Clutching at the throat C. Provide a calm, quiet setting late in the day C. Waving your hands D. Complete the person's treatments and activities 0. Coughing late in the day 23. A person is on a diabetic diet. You 32. To prevent suffocation, you should A. Serve the person's meals late A. Make sure dentures fit loosely B. Let the person eat whenever he or she is hungry B. Cut food into large pieces C. Sometimes check the tray to see what was eaten C. Make sure the person can chew and swallow the D. Tell the nurse about changes in the person's eating food served habits D. Ignore loose teeth or dentures 24. With mild airway obstruction 33. When using a wheelchair, you should A. The person is usually unconscious A. Lock both wheels before you transfer a person to B. The person cannot speak and from the wheelchair C. Forceful coughing often does not remove the B. Lock only 1 wheel before you transfer a person to object and from the wheelchair D. Forceful coughing often can remove the object C. Let the person's feet touch the floor when the chair 25. To relieve severe airway obstruction in a conscious is moving adult, you do D. Let the person stand on the footplates A. Abdominal thrusts 34. A person begins to fall while you are walking him or B. Back thrusts her. You should C. Chest compressions A. Try to prevent the fall D. A finger sweep B. Ease the person to the floor 26. Faulty electrical equipment C. Let the person fall to avoid injury to yourself A. Can be used in a nursing center D. Tell the nurse at the end of the shift B. Should be given to the nurse 35. A person has a restraint on. You know that C. Should be taken home by you for repair A. Restraints are used for staff convenience D. Should be used only with alert persons B. Death from strangulation is a risk factor from 27. A warning label has been removed from a hazardous using a restraint substance container. You C. Restraints may be used to punish a person A. May use the substance if you know what is in the D. A written nurse's order is required for container a restraint B. Leave the container where it is 36. Before feeding a person, you C. Take the container to the nurse and explain the A. Tell the other nursing assistant problem B. Go to the restroom D. Tell another nursing assistant about the missing C. Wash your hands label D. Tell the nurse

37. When wearing gloves, you remember to 47. Call lights are A. Wear them several limes before discarding them A. Placed on the person's strong side 8. Wear the same ones from room to room B. Answered when time permits Kept on the bedside table C. Wear gloves with a tear or puncture C. D. Change gloves when they become contaminated D. Kept on lhe person's weak side with urine 48. A nurse asks you to inspect a person's closet. You 38. When washing your hands, you A. Tell the nurse you cannot do this A. Use hot water 8. Inspect the closet when the person is in the 8. Let your uniform touch the sink dining room C. Ask the person if you can inspect his or her closet C. Keep your watch at your wrist D. Keep your hands and forearms lower than your D. Tell the nurse to inspect the closet elbows 49. When changing bed linens, you 39. You need to move a box from the floor to the counter A. Hold the linens close to your uniform in the utility room. You 8. Shake the sheet when putting it on the bed A. Bend from your waist to pick up the box C. Take only needed linens into the person's room 8. Hold the box away from your body as you pick it up D. Put used linens on the floor SO. To use a fire extinguisher, you C. Bend your knees and squat to lift the box D. Stand with your feet close together as you pick up A. Keep the safety pin in the extinguisher the box 8. Direct the hose or nozzle at the top of the fire .W. The nurse asks you to place a person in Fowler's C. Squeeze the lever to start the stream position. You D. Sweep the stream at the top of the fire A. Put the bed flat 51. When doing mouth care for an unconscious person, 8. Raise the head of the bed between 45 and 60 degrees you A. Do not need to wear gloves C. Raise the head of the bed between 80 and 90 degrees D. Raise the head of the bed 15 degrees 8. Give mouth care at least every 2 hours 41. You accidentally scratch a person. This is C. Place the person in a supine position A. Neglect D. Keep the mouth open with your fingers 8. Negligence 52. A person is angry because he did not get to the C. Malpractice activity room on time because a co-worker did not D. Physical abuse come to work. How should you respond to him? 42. You positioned a person in a chair. For good body A. "It's not my fault. A co-worker called off today and alignment, you we are short-staffed." A. Have the person's back and buttocks against the B. 'Tm sorry you were late for activities. I will try to back of the chair plan better." 8. Leave the person's feet unsupported C. "I am doing the best I can." C. Have the backs of the person's knees touch the D. "I'm just too busy." edge of the chair 53. You are asked to clean a person's dentures. You D. Have the person sit on the edge of the chair A. Use hot water 43. You need to transfer a person with a weak left leg B. Hold the dentures firmly and line the basin with a from the bed to the wheelchair. You towel A. Get the person out of bed on the left side C. Wrap the dentures in tissues after cleaning 8. Get the person out of bed on the right side D. Store the dentures in a denture cup with the C. Keep the person in bed person's room number on it D. Ask the person what side moves first 54. When bathing a person, you notice a rash that was not 44. A person tries to scratch and kick you. You should there before. You A. Protect yourself from harm A. Do nothing 8. Argue with the person 8. Tell the person C. Become angry with the person C. Tell the nurse and record it in the medical record D. Ignore the person D. Tell the person's daughter 45. When moving a person up in bed 55. When washing a person's eyes, you A. Window coverings may be left open so people can A. Use soap look in B. Clean the eye near you first 8. Body parts may be exposed C. Wipe from the inner to the outer aspect of the eye C. Ask the person to help D. Wipe from the outer aspect to the inner aspect of D. Ask the person to lie still the eye 46. For comfort, most older persons prefer 56. When giving a back massage, you A. Rooms that are cold A. Use cold lotion B. Restrooms that smell of urine 8. Use light strokes C. Loud talking and laughter at the nurses' station C. Massage reddened bony areas D. Lighting that meets their needs D. Look for bruises and breaks in the skin

57. You need to give perineal care to a female. You 66. On which person would you take an oral A. Separate the labia and clean downward from front temperature? to back A. An unconscious person B. Separate the labia and clean upward from back to B. The person receiving oxygen front C. The person who breathes through his or her mouth C. Wear gloves only if there is drainage D. A conscious person D. Only use water 67. When caring for a person who is blind or visually 58. When giving a person a tub bath or shower, you impaired,you A. Do not give the person a call light A. Offer the person your arm and have the person B. Tum the hot water on first, then the cold water walk a half step behind you C. Stay within hearing distance if the person can be B. Do as much for the person as possible left alone C. Shout at the person when talking with him or her D. Direct water toward the person while adjusting D. Touch the person before indicating your presence the water temperature 68. You are caring for a person with dementia. You 59. A person is on an anticoagulant. You A. Misplace the person's clothes A. Use a safety razor B. Choose the activities the person attends B. Use an electric razor C. Send personal items home C. Let him grow a beard D. Let the family make choices if the person cannot D. Let him choose which type of razor to use 69. When providing rehabilitation and restorative care for 60. A person with a weak left arm wants to remove his or a person, you her sweater. You A. Can shout or scream at the person A. Let the person do it without any assistance B. Can hit or strike the person B. Help the person remove the sweater from his or C. Can call the person names her right arm first D. Discuss your anger with the nurse C. Help the person remove the sweater from his or 70. While bathing a person, you her left arm first A. Keep doors and windows open D. Tell the person to keep the sweater on B. Wash from the dirtiest areas to the cleanest areas 61. When talking with a person, you should call the C. Encourage the person to help as much as possible person D. Rub the skin dry A. "Honey" 71. When a person is dying B. By his or her first name A. Assume that the person can hear you C. By his or her title-Mr. or Mrs. or Miss B. Oral care is done every 5 hours D. "Grandpa" or "Grandma" C. Skin care is done weekly 62. A person has an indwelling catheter. You D. Re-position the person every 3 hours A. Let the person lie on the tubing 72. A person is on intake and output. You B. Disconnect the catheter from the drainage tubing A. Measure only liquids such as water and juice every 8 hours B. Measure ice cream and gelatin as part of intake C. Secure the catheter to the lower leg C. Measure intravenous (IV) fluids D. Measure and record the amount of urine in the D. Measure tube feedings drainage bag 73. A person has been on bedrest. You need to have the 63. A person needs to eat a diet that contains person walk. What will you do first? carbohydrates. Carbohydrates A. Help the person move quickly. A. Are needed for tissue repair and growth B. Have the person dangle before getting out of bed. B. Provide energy and fiber for bowel elimination C. Have the person sit in a chair. C. Add flavor to food and help the body use certain D. Walk with the person as soon as he or she gets out vitamins of bed. D. Are needed for nerve and muscle function 74. Your ring accidentally causes a skin tear on an elderly 64. You are taking a rectal temperature with an electronic person. You thermometer. You A. Tell yourself to be more careful the next time A. Insert the thermometer before lubricating it B. Tell the nurse at once B. Leave the privacy curtain open C. Do nothing C. insert the thermometer 1 inch into the rectum D. Hope no one finds out D. Insert the thermometer ½ inch into the rectum 75. To protect a person's privacy, you should 65. A person has a blood pressure (BP) of 86/58rnmHg. You A. Keep all information about the person confidential A. Report the BP to the nurse at once B. Discuss the person's treatment with another B. Record the BP but do not tell the nurse nursing assistant in the lunch room C. Ask the unit secretary to tell the nurse C. Open the person's mail D. Retake the BP in 30 minutes before telling the D. Keep the privacy curtain open when providing nurse care to the person

Copyright© 2017, Elsevier Inc. All rights reserved. This test contains 75 questions. For eaclr question, circle the BEST answer. l. You can refuse to do a delegated task when 11. When making a bed, you A. You are too busy A. Keep the bed in the low position 8. You do not like the task 8. Wear gloves when removing linens C. The task is not in your job description C. Raise the head of the bed D. It is the end of the shift D. Raise the fool of the bed 2. Mr. Smith does not want life-saving measures. You 12. To give perinea! care to a male, you A. Explain to Mr. Smith why he should have life A. Use a circular motion and work toward the meatus saving measures B. Use a circular motion and start at the meatus and B. Respect his decision work outward C. Explain to Mr. Smith's family why life-saving C. Wear gloves only if there is drainage measures are needed D. Use only water D. Tell your friend about Mr. Smith's decision 13. A person with a weak left arm wants to put on his or 3. You are walking by a resident's room. You hear a her sweater. You nurse shouting at a person. This is A. Let the person do it without any assistance A. Battery B. Help the person put the sweater on his or her right B. Malpractice arm first C. Help the person put the sweater on his or her left C. Verbal abuse D. Neglect arm first 4. When communicating with a foreign-speaking person, D. Tell the person to keep the sweater off you 14. A person has an indwelling catheter. You A. Speak loudly or shout A. Let the drainage bag touch the floor 8. Use medical terms the person may not understand B. Keep the drainage bag higher than the bladder C. Use words the person seems to understand C. Hang the drainage bag on a bed rail D. Speak quickly and mumble D. Have the drainage bag hang from the bed frame or 5. To protect a person from getting burned, you chair A. Allow smoking in bed 15. A person needs to eat a diet that contains protein. Protein B. Turn hot water on first, then cold water A. Ts needed for tissue repair and growth C. Assist the person with drinking or eating hot food B. Provides energy and fiber for bowel elimination D. Let the person sleep with a heating pad C. Adds flavor to food and helps the body use certain 6. To prevent equipment accidents, you should vitamins A. Use 2-pronged plugs on all electrical devices D. Is needed for nerve and muscle function B. Follow the manufacturer's instructions 16. Older persons C. Wipe up spill-; when you have time A. Have an increased sense of thirst D. Use unfamiliar equipment without training 8. Need less water than younger persons 7. To prevent a person from falling, you should C. May not feel thirsty A. Ignore call lights D. Seldom need to have water offered to them 8. Use throw rugs on the floor 17. A person is NPO. You C. Keep the bed in a high position A. Post a sign in the bathroom D. Use grab bars in showers B. Keep the water pitcher filled at the bedside 8. You need to wash your hands C. Remove the water pitcher and glass from the room A. Before you document a procedure D. Provide oral hygiene every day B. After you remove gloves 18. A person drank 3oz of milk at lunch. He or she drank C. After you talk with a person A. 30ml D. After you talk with a co-worker 8. 60mL 9. You need to move a person weighing 250 pounds in C. 90mL bed. You D. 120mL A. Do the procedure alone 19. When feeding a person, you B. Keep the privacy curtain open A. Offer fluids at the end of the meal C. Ask the person to lie still B. Use forks D. Ask for assistance from at least 2 other staffmembers C. Do not talk to the person 10. When transferring a person from a bed to a D. Allow time for chewing and swallowing wheelchair, you never 20. You need to do range of motion (ROM) to a person's A. Ask a co-worker to help you right shoulder. You B. Use a transfer or gait belt A. Force the joint beyond its present ROM C. Have the person put his or her arms around your 8. Move the joint quickly neck C. Force the joint to the point of pain D. Lock the wheels on the wheelchair D. Support the part being exercised

21. A person has a weak left leg. The person should 30. When taking a person's height and weight, you A. Hold the cane in his or her left hand A. Let the person wear shoes B. Hold the cane in his or her right hand B. Have the person void before being weighed C. Hold the cane in either hand C. Weigh the person at different times of the day D. Use a walker D. Balance the scale every 6 months 22. To promote comfort and relieve pain, you 31. A person is bedfast. To prevent pressure ulcers, you A. Keep wrinkles in the bed linens A. Re-position the person at least every 3 hours B. Position the person in good alignment B. Massage reddened areas C. Talk loudly to the person C. Let heels and ankles touch the bed D. Use sudden and jarring movements of the bed or D. Keep the skin free of moisture from urine, stools, chair or perspiration 23. A person is receiving oxygen through a nasal cannula. 32. A person has a hearing problem. When talking with You the person, you A. Turn the oxygen higher when he or she is short of A. Keep the TV or radio on breath B. Shout B. Fili the humidifier when it is not bubbling C. Face the person C. Check behind the ears and under the nose for D. Speak quickly signs of irritation 33. When caring for a person who is blind or visually D. Remove the cannula when the person goes to the impaired, you dining room A. Place himiture and equipment where the person 24. You accidentally dropped a mercury glass walks thermometer and broke it. You B. Keep the lights off A. Tell the nurse at once C. Explain the location of food and beverages B. Put the mercury in your pocket D. Re-arrange furniture and equipment C. Pick up the pieces of glass with your hands 34. You are caring for a person with dementia. You D. To uch the mercury A. Share information about the person's care 25. When taking a person's pulse, you B. Share information about the person's condition A. Use the brachia! pulse C. Protect confidential information B. Take the pulse for 30 seconds if it is irregular D. Expose the person's body when you C. Tell the nurse if the pulse is less than 60 provide care D. Use your thumb to take a pulse 35. When caring for a confused person, you 26. You are counting respirations on a person. You A. Call the person "Honey" A. Tell the person you are counting his or her B. Do not need to explain what you are doing respirations C. Ask clear, simple questions B. Count for 1 minute if an abnormal breathing D. Remove the calendar from the person's room pattern is noted 36. A person with Alzheimer's disease likes to wander. C. Report a rate of 16 to the nurse at once You D. Count for 30 seconds if an abnormal breathing A. Keep the person in his or her room pattern is noted B. Restrain the person 27. You are taking blood pressures on people assigned C. Argue with the person who wants to leave to you. An older person has a blood pressure (BP) of D. Exercise the person as ordered 158/96mm Hg. You 37. Restorative nursing programs A. Report the BP to the nurse at once A. Help maintain the lowest level of function B. Finish taking all the blood pressures before telling B. Promote self-care measures the nurse C. Focus on the disability, not tl1e person C. Retake the BP in 30 minutes before telling the D. 1 Ielp the person lose strength and independence nurse 38. When caring for a person with a disability, you D. Ask the unit secretary to tell the nurse about A. Focus on his or her limitations the BP B. Expect progress in a rehabilitation program to 28. When would you take a rectal temperature? be fast A. The person has diarrhea. C. Remind the person of his or her progress in the 8. The person is confused. rehabilitation program C. The person is unconscious. D. Deny the disability D. The person is agitated. 39. After a person dies, you 29. A person has been admitted to the nursing center A. Can expose his or her body unnecessarily recently. You B. Can discuss the person's diagnosis with your A. Look through his or her belongings family B. Ignore his or her questions C. Can talk about the family's reactions to your C. Speak in a gentle, calm voice friends D. Enter the person's room without knocking D. Respect the person's right to privacy

40. You person's enter a room and find a fire in the 49. When moving a person up in bed, you should wastebasket. Your first action is to A. Raise the head of the bed A. Remove the person from the room B. Ask the person to keep his or her legs straight B. Close the door C. Cause friction and shearing 0. Ask co-worker a to help you C. Call for help 0. Activate the fire alarm SO. A person is on a sodium-controlled diet. This means 41. You leave a person lying in urine and he or she A. Canned vegetables are omitted from his or her diet develops a bedsore. This is 8. Salt may be added to food at the table A. Fraud C. Large amounts of salt are used in cooking B. Neglect 0. Ham is eaten regularly C. Assault 51. Elastic stockings 0. Battery A. Arc applied after a person gets out of bed 42. A nurse asks you to place a drug and a sterile dressing B. Shouldhave wrinkles not or creases after being on a small foot wound. You applied A. Agree to do the task C. Come in 1 size only B. Ask another nursing assistant to do the task D. Are forced on the person C. Politely tell the nurse you cannot do that task 52. While walking, the person begins to fall. You 0. Report the nurse to the director of nursing A. Call for help 43. You observe a person's urine is foul-smelling and dark B. Reach for a chair amber. Your first action is to C. Ease the person to the floor A. Tell the other nursing assistant 0. Ask a visitor to help B. Tell the person 53. Before bathing a person, you should A. Offer the bedpan or urinal C. Tell the nurse 0. Record the observation B. Partially undress the person 44. A daughter asks you for water for her mom. Your C. Raise the head of the bed response is D. Open the privacy curtain A. "I am not caring for your mom. I will get her 54. When taking a rectal temperature with an electronic nursing assistant for you." thermometer, you insert the thermometer 8. "I do not have time to do that." A. ½ inch C. "That's not my job." B. 1½inches 0. "I will be happy to do that." C. 2 inches 45. A person has a restraint on. You D. 2½inches A. Observe the person for breathing and circulation 55. Touch complications every 30 minutes A. ls a form of nonverbal communication B. Know that unnecessary restraint is false B. ls a form of verbal communication imprisonment C. Means the same thing to everyone C. Use the most restrictive type of restraint D. Should be used for all persons D. Know thdt restraints decrease confusion and 56. You may share information about a person's care and agitation condition with 46. The nurse asks you to place a person in the supine A. The staff caring for the person position. You B. The person's daughter A. Elevate the head of the bed 45 degrees C. Your family members B. Elevate the foot of the bed 15 degrees 0. The volunteer in the gift shop C. Place the person on his or her back with the 57. A person tells you he or she has pain upon urination. You bed flat A. Tell the nurse D. Place the person on his or her abdomen B. Let the nurse document this information 47. The most important way to prevent or avoid C. Ask the person to tell you if it happens again spreading infection is to D. Tell the person's son A. Wa!>h hands 58. A person's culture and religion are different from B. Cover your nose when coughing yours. You C. Use disposable gloves A. Laugh about the person's customs 0. Wear a mask B. Tell your family about the person's customs 48. You are eating lunch and a nursing assistant begins to C. Ask the person to explain his or her beliefs and gossip about another person. You practices to you A. Join the conversation and talk about the person D. Tell the person his or her beliefs and customs are silly B. Remove yourselffrom the group 59. You need to wear gloves when you C. Tell your roommate about the gossip you heard at A. Do range-of-motion exercises lunch B. Feed a person D. Tell nursing another assistant about the gossip you C. Give perineaJ care heard D. Walk a person

60. An older person is normally alert. Today he or she is 68. When doing mouth care on an unconscious person, confused. What should you do? you A. Ask the person why he or she is confused. A. Use a large amount of fluid 8. Ignore the confusion. B. Position the person on his or her side C. Check to see if the person is confused later in the C. Do the task without telling the person what you day. are doing D. Tell the nurse. D. Insert his or her dentures when done 61. While walking with a person, he tells you he feels 69. When brushing or combing a person's hair, you faint. What do you do first? A. Cut matted or tangled hair A. Have the person sit down. B. Encourage the person to do as much as possible 8. Call for the nurse. C. Style the hair as you want C. Open the window. D. Perform the task weekly D. Ask the person to take a deep breath. 70. When providing nail and foot care, you 62. You are asked to encourage fluids for a person. You A. Cut fingernails with scissors A. lncrease the person's fluid intake 8. Trim toenails for a diabetic person 8. Decrease the person's fluid intake C. Trim toenails for a person with poor circulation C. Limit fluids to meal times D. Check between the toes for cracks and sores D. Keep fluids where the person cannot 71. An indwelling catheter becomes disconnected from reach them the drainage system. You 63. Communication fails when you A. Reconnect the tubing to the catheter quickly A. Use words the other person understands without gloves 8. Talk too much B. Tell the nurse at once C. Let others express their feelings and concerns C. Get a new drainage system D. Talk about a topic that is uncomfortable D. Touch the ends of the catheter 64. During bathing, a person may 72. Urinary drainage bags are A. Decide what products to use A. Hung on the bed rail B. Be exposed in the shower room B. Emptied and measured at the end of each shift C. Have visitors present without his or her C. Kept on the floor permission D. Kept higher than the person's bladder D. Have no personal choices 73. A person needs a condom catheter applied. You 65. People in late adulthood need to remember to A. Adjust to increased income A. Apply it to a penis that is red and irritated B. Adjust to their health being better 8. Use adhesive tape to secure the catheter C. Develop new friends and relationships C. Use elastic tape to secure the catheter D. Adjust to increased strength D. Act in an unprofessional manner 66. When measuring blood pressure, you should do the 74. For comfort during bowel elimination following except A. Have the person use the bedpan rather than the A. Apply the cuff to a bare upper arm bathroom or commode if possible 8. Turn off the TV B. Permit visitors to stay C. Locate the brachia! artery C. Keep the door and privacy curtain open D. Use the arm with an intravenous (IV) infusion D. Leave the person alone if possible 67. You find clean linens on the floor in a person's room. 75. You are transferring a person with a weak right side You from the wheelchair to the bed. You A. Use the linens to make the bed A. Place the wheelchair on the left side of the bed B. Returnlinens the to the linen cart B. Place the wheelchair on the right side of the bed C. Put the linens in the laundry C. Keep the person in the wheelchair D. Tell the nurse D. Ask the person what side moves first

Copyright© 2017, Elsevier lnc. All rights reserved. Each state has its own policies and procedures for the • Make sure the call light is within the person's reach. skills test. The following information is an overview of Attaching it to the bed or bed rail does not mean the what to expect. person can reach it. • To pass the skills evaluation, you will need to perform 5 • Use good body mechanics. Raise the bed and over-bed of all the skills available. table to a good working height. • To pass the skills evaluation, you must perform all 5 • Provide for comfort. skills correctly. u Make sure the person and linens are clean and dry. • A nurse evaluates your performance of certain skills. The person may have become incontinent during the Having someone watch as you work is not a new procedure. experience. Your instructor evaluated your performance o Change or straighten bed linens as needed. during your training program. While you are working, Position the person for comfort and in good your supervisor evaluates your skills. alignment. • Mannequins and people are used as "patients" or o Provide pillows as directed by the nurse and the care "residents," depending on the skills you arc performing. plan. Speak to the person as you would a patient or resident. o Raise the head of the bed as the person prefers and • If you make a mistake, tell the evaluator what you did allowed by the nurse and the care plan. wrong. Then perform the skill correctly. Do not panic. � Provide for warmth. The person may need an extra • Take whatever equipment you normally take to or use blanket, a lap blanket, a sweater, socks, and so on. at work. Wear a watch with a second hand. You may :) Adjust lighting to meet the person's needs. need it to measure vital signs and check how much time Make sure eyeglasses, hearing aids, and other devices you have left. are in place as needed. Ask the person if he or she is comfortable. before and During tlzeProcedure o Ask the person if there is anything else you can do for • Hand-washing is evaluated at the beginning of the him or her. skills test. You are expected to know when to wash your o Make sure the person is covered for warmth and hands. Therefore you may not be told to do so. Follow privacy. the rules for hand hygiene during the test. • Before entering a person's room, knock on the door. Greet the person by name and introduce yourself before Skill.� beginning a procedure. Check the identification (ID) or Ask your instructor to tell you which of the following the photo ID to make certain you are giving care to the skills are tested in your state. Place a checkmark in the right person. box in front of each tested skill so it will be easy for you • Explain what you are going to do before beginning the to reference. TI1e skills marked with an asterisk (") are procedure ond as needed throughout the procedure. used with permission of National Council of State Boards • Always follow the rules of medical asepsis. For of Nursing (NCSBN). These skills are offered as a study example, remove gloves and dispose of them properly. guide to you. The word "client" refers to the resident or Keep clean linens separated from used linens. person receiving care. You are responsible for following • Always protect the person's rights throughout the skills the most current standards, practices, and guidelines in test. your state. • Communicate with the person as you give care. Focus The steps in boldface type are critical element steps. on the person's needs and interests. Always treat the Critical element steps must be done correctly to pass person with respect. Do not talk about yourself or your the skill. If you miss a critical element step, you will personal problems. not pass the skills evaluation. For example, you are to • Provide privacy. This involves pulling the privacy transfer a client from the bed to a wheelchair. You will fail curtain around the bed, closing doors, and asking if you do not lock the wheels on the wheelchair before visitors to leave the room. transferring the person. An automatic failure is one that • Promote safety for the person. For example, lock the could potentially cause harm to a person. Your state may wheelchair when you transfera person to and from it. Place mark critical element steps in another way-underline the bedin the lowest horizontal position when the person or italics. Tf your state has one, review the candidate's must get out of bed or when you are done giving care. handbook.

0 *Hanel Hygiene (Hand-Washing) 5. Before assisting to stand, client is assisted to sitting 16) position with feet flat on the floor (Chapter 6. Before assisting to stand, applies transfer belt securely 1. Addresses client by name and introduces self to client at the waist over clothing/gown by name 7. Before assisting Lo stand, provides instructions 2. Turns on water at sink to enable client to assist in standing including 3. Wets hands and wrists thoroughly prearranged signal to alert client to begin standing 4. Applies soap to hands 8. Stands facing client positioning self to ensure safety of 5. Lathers all surfaces of wrists, hands, and fingers, candidate and client during transfer. Counts to three producing friction for at least 20 (twenty) seconds (or says other prearranged signal) to alert client to keeping hands lower than the elbows and the begin standing fingertips down 9. On signal, gradually assists client to stand by grasping 6. Cleans fingernails by rubbing fingertips against palms transfer belt on both sides with an upward grasp of the opposite hand (candidate's hands are in upward position), and 7. Rinses all surfaces of wrists, hands, and fingers, maintaining stability of client's legs keeping hands lower than the elbows and the 10. Walks slightly behind and to one side of client for a fingertips down distance of ten (10) feet, while holding onto the belt 8. Uses clean, dry paper towel/towels to dry all surfaces 11. After ambulation, assists client to bed and removes of hands, wrists, and fingers then disposes of paper transfer belt towel/towels into waste container 12. Signaling device is within reach and bed is in low 9. Uses clean, dry paper towel/towels to turn off faucet position then disposes of paper towel/towels into waste 13. After completing skill, washes hands container or uses knee/foot control to turn off faucet 10. Does not touch inside of sink at any time U "'Assist.s With Use of Bedpan (Cl,apter 24) 1. Explains procedure speaking clearly, slowly, and U*Applies One Knee-Higli Elastic Stockitrg directly, maintaining face-to-face contact whenever (Cliaprer 35) possible 1. Explains procedure,speaking clearly, slowly, and directly, 2. Privacy is provided with a curtain, screen, or door maintaining face-to-face contact whenever possible 3. Before placing bedpan, lowers head of bed 2. Privacy is provided with a curtain, screen, or door 4. Puts on clean gloves before handling bedpan 3. Client is in supine position (lying down in bed) while 5. Places bedpan correctly under client's buttocks stocking is applied 6. Removes and disposes of gloves (without 4. Tums stocking inside-out, at least to heel contaminating self) into waste container and washes 5. Places foot of stocking over toes, foot, and heel hands 6. Pulls top of stocking over foot, heel, and leg 7. After positioning client on bedpan and removing 7. Moves foot and leg gently and naturally, avoiding gloves, raises head of bed force and over-extension of limb and joints 8. Toilet tisi,ueis within reach 8. Finishes procedure with no twists or wrinkles and 9. Hand wipe is within reach and client is instructed to heel of stocking (if present) is over heel and openfog clean hands with hand wipe when finished in toe area (if present) is either under or over toe area 10. Signaling device within reach and client is asked to 9. Signalingdevice iswithin reach and bed isin low position signal when finished 10. After completing skill, washes hands 11. Puts on clean gloves before removing bedpan 12. Head of bed is lowered before bedpan is removed 13. Av oids overexposure of client U*Assists to Ambulate Using a Transfer Belt 14. Empties and rinses bedpan and pours rinse into toilet Clrapter 19) 15. After rinsing bedpan, places bedpan in designated 1. Explains procedure, speaking clearly, slowly, and dirty supply area directly, maintaining face-to-face contact whenever 16. After placing bedpan in designated dirty supply possible area, removes and disposes of gloves (without 2. Before assisting to stand, client is wearing shoes contaminating self) into waste container and washes 3. Before assisting to stand, bed is at a safe level hands 4. Before assisting to stand, checks and/or locks bed 17. Signaling device is within reach and bed is in low wheels position

�itCJeans Upper or Lower Denture U*Dresses Client Witlr Affected (Weak) Right (Clwpter 22) Arm (Clzapter 23) 1. Puts on clean gloves before handling dentures 1. Explains procedure, speaking clearly, slowly, and 2. Bottom of sink is lined and/or sink is partia 11 y filled directly, maintaining face-to-face contact whenever with water before denture is held over sink possible 3. Rinsesdenture in moderate temperature running 2. Privacy is provided with a curtain, screen, or door water before brushing them 3. Asks which shirt he/she would like to wear and 4. Applies toothpa�te to toothbrush dresses him/her in shirt of choice 5. Brushes surfaces of denture 4. While avoiding overexposure of client, removes gown 6. Rinses surfaces of denture under moderate from the unaffected side first, then removes gown temperattire running water from the affected side and disposes of gown into 7. Before placing denture into cup, rinses denture cup soiled linen container and lid 5. Assists to put the right (affected/weak) arm through 8. Places denture in denture cup with moderate the right sleeve of the shirt before placing garment temperature water solution and places lid on cup on left (unaffected) arm 9. Rinses toothbrush and places in designated 6. While putting on shirt, moves body gently and toothbrush basin/ container naturally, avoiding force and over-extension of limbs 10. Maintains clean technique with placement of and joints toothbrush and denture 7. Finishes with clothing in place 11. Sink liner is removed and disposed of appropriately 8. Signaling device is within reach and bed is in low and/or sink is drained position 12. After rinsing equipment and disposing of sink liner, 9. After completing skill, washes hands removes and disposes of gloves (without contaminating self) into waste container and washes hands :J*FeedsClient lV1w Cannot Feed Self it (Clzapter 21) �J Counts and Records Radial Pulse 1. Explains procedure to client, speaking dearly, (( lwpi •r 79) slowly, and directly, maintaining face-to-face contact 1. Explains procedure, speaking clearly, slowly, and whenever possible directly, maintaining face-to-face contact whenever 2. Before feeding, candidate looks at name card on tray possible and asks client to state name 2. Places fingertips on thumb side of client's wrist to 3. Before feeding client, client is in an upright sitting locate radial pulse position (75-90 degrees) 3. Counts beats for one fuU minute 4. Places tray where the food can be easily seen by 4. Signaling device is within reach client 5. Before recording, washes hands 5. Candidate cleans client's hands with hand wipe 6. After obtaining pulse by palpating in radial artery before beginning feeding position, records pulse rate within plus or minus 4 6. Candidate sits facing client during feeding beats of evaluator's reading 7. Tells client what foods are on tray and asks what client would Like to eat first ,. 8. Using spoon, offers client one bite of each type of food '...J Coimts and Records Respirations on tray, telling client the content of each spoonful (Chapter 29)' 9. Offers beverage at least once during meal 1. Explains procedure (for testing purposes), speaking 10. Candidate asks client if they are ready for next bite of clearly, slowly, and directly, maintaining face-to-face food or sip of beverage contact whenever possible 11. At end of meal, candidate cleans client's mouth and 2. Counts respirations for one full minute hands with wipes 3. Signaling device is within reach 12. Removes food tray and places tray in designated dirty 4. Wa shes hands supply area 5. Records respiration rate within plus or minus 2 13. Signaling device is within client's reach breaths of evaluator's reading 14. After completing skill, washes hands

•Reproduced and used with permh,s1on from the N11r.;eAsmtnnl Candidate Handbookfrom National Council of State Boards of Nursing (NC.SN) Chicago,ill,� 2011. .. Count for 1 full minute. ·count for 1 full minute. For testing purposes yuu may explain to the chent that you will be counting the respirations.

..J*GivesModified Bed Bath (Face and One 12. Pulls and tucks in clean bottom linen, finishing with bottom sheet free of wrinkles Arm, Hand, aud Underarm) (Chapter 22) 13. Client is covered with dean top sheet and bath 1. Explains procedure, speaking clearly, slowly, and blanket/used top sheet has been removed directly, maintaining face-to-face contact whenever 14. Changes pillowcase possible 15. Linen is centered and tucked at foot of bed 2. Privacy is provided with a curtain, screen, or door 16. Avoids contact between candidate's clothing and used 3. Removes gown and places in soiled linen container linens while avoiding over exposure of the client 17. Disposes of used linens into soiled linen container and 4. Before washing, checks water temperature for safety avoids putting linens on floor and comfort and asks client to verify comfort of water 18. Signaling device is within reach and bed is in low 5. Puts on clean gloves before washing client position 6. Beginning with eyes, washes eyes with wet 19. Washes hands washcloth (no soap), using a different area of the washcloth for each stroke, washing inner aspect to outer aspect, then proceeds to wash face '::J*Measuresand Records Blood Pressure 7. Dries face with towel 29) 8. Exposes one arm and places towel underneath arm (Chapter 9. Applies soap to wet washcloth 1. Explains procedure, speaking clearly, slowly, and 10. Washes arm, hand, and underarm,keeping rest of directly, maintaining face-to-face contact whenever body covered possible 11. Rinses and dries arm, hand, and underarm 2. Before using stethoscope, wipes bell/ diaphragm and 12. Moves body gently and naturally, avoiding force and earpieces of stethoscope with alcohol over-extension of limbs and joints 3. Client's arm is positioned with palm up and upper 13. Puts clean gown on client arm is exposed 14. Empties, rinses, and dries basin 4. Feels for brachia! artery on inner aspect of arm, at 15. After rinsing and drying basin, places basin in bend of elbow designated dirty supply area 5. Places blood pressure cuff snugly on client's upper 16. Disposes of linen into soiled linen container arm with sensor/ arrow over brachia} artery site 17. Av oids contact between candidate clothing and used 6. Earpieces of stethoscope are in ears and bell/ linens diaphragm is over brachia! artery site 18. After placing basin in designated dirty supply area, 7. Candidate inflates cuff between 160mm Hg to and disposing of used linen, removes and disposes 180mm Hg. (lf beat heard immediately upon cuff of gloves (without contaminating self) into waste deflation, completely deflate cuff .) Re-inflate cuff to no container and washes hands more than 200mm Hg . 8. Deflates cuff slowly and notes the first sound (systolic 19. Signaling device is within reach and bed is in low position reading), and last sound (diastolic reading) (If rounding needed, measurements are rounded UP to the nearest 2mm of mercury) � Makes an Occupied Bed (Client Does Not 9. Removes cuff Need Assistance to Turn) (Chapter 21) 10. Signaling device is within reach 11. Before recording, washes hands 1. Explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever 12. After obtaining reading using BP cuff and possible stethoscope, records both systolic and diastolic pressures each within plus or minus 8mm Hg of 2. Privacy is provided with a curtain, screen, or door evaluator's reading 3. Lowers head of bed before moving client 4. Client is covered while linens are changed 5. Loosens top linen from the end of the bed D*Measures and Records Urinary Output 6. Raises side rail on side to which client will move and 27) client moves toward raised side rail (Chapter 7. Loosens bottom used linen on working side and 1. Puts on clean gloves before handling bedpan moves bottom used linen toward center of bed 2. Pours the contents of the bedpan into measuring 8. Places and tucks in clean bottom linen or fitted bottom container without spilling or splashing urine outside sheet on working side and tucks under client of container 9. Before going to other side, client moves back onto 3. Measures the amount of urine at eye level with dean bottom linen container on flat surface 10. Raises side rail then goes to other side of bed 4. After measuring urine, empties contents of measuring 11. Removes used bottom linen container into toilet

rod NurseAssistant Candidate Handbook •R�p u ced nd used with permission from the from National Council of State Boards of Nursing (NCSBN) C h n _.: ' 1cago, 1, .., 2011.

5. Rinses measuring container and pours rinse water 2. Privacy is provided with a curtain, screen, or door into toilet 3. Before washing checks water temperature for safety 6. Rinses bedpan and pours rinse into toilet and comfort and asks client to verify comfort of water 7. After rinsing equipment, and before recording 4. Puts on clean gloves before washing output, removes and disposes of gloves (without 5. Places linen protector under perinea! area before contaminating self) into waste container and washes washing hands 6. Exposes area surrounding catheter while avoiding 8. Records contents of container within plus or minus overexposure of client 25mUcc of evaluator's reading 7. Applies soap to wet washcloth 8. While holding catheter at meatus without tugging, cleans at least four inches of catheter from meatus, O>t-Measures and Records Weight of Ambulatory moving in only one direction (i.e., away from Client (CIJapter 32) meatus) using a clean area of the cloth for each l. Explains procedure, speaking clearly, slowly, and stroke directly, maintaining face-to-face contact whenever 9. While holding catheter at meatus without tugging, possible rinses at least four inches of catheter from meatus, 2. Client has shoes on before walking to scale moving only in one direction, away from meatus, 3. Before client steps on scale, candidate sets scale to using a clean area of the cloth for each stroke zero 10. While holding catheter at meatus without tugging, 4. While client steps onto scale, candidate stands next to dries at least four inches of catheter moving away scale and assists client, if needed, onto center of the from meatus scale; then obtains client's weight 11. Empties, rinses, and dries basin 5. While client steps off scale, candidate stands next 12. After rinsingand drying basin, places basin in to scale and assists client, if needed, off scale before designated dirty supply area recording weight 13. Disposes of used linen into soiled linen container and 6. Before recording, washes hands disposes of linen protector appropriately 7. Records weight based on indicator on scale. Weight 14. Avoids contact between candidate clothing and used is within plus or minus 2 lbs of evaluator's reading linen (If weight recorded in kg, weight is within plus or 15. After disposing of used linen and cleaning minus 0.9 kg of evaluator's reading) equipment, removes and disposes of gloves (without contaminating self) into waste container and washes hands :J·Positions on Side (Chapter 18) 16. Signaling device is within reach and bed is in low 1. Explains procedure, speaking clearly, slowly, and position directly, maintaining face-to-face contact whenever possible 2. Privacy is provided with a curtain, screen, or door :l Provides Fingemail Care on One Hand 3. Before tu.ming, lowers head of bed (Chapter 23) 4. Raises side rail on side to which body will be turned 1. Explains procedure, speaking clearly, slowly, and 5. Slowly rolls onto side as one unit toward raised side rail directly, maintaining face-to-face contact whenever 6. Places or adjusts pillow under head for support possible 7. Candidate positions client so that client is not lying on 2. Before immersing fingernails, checks water arm temperature for safety and comfort and asks client to 8. Supports top arm with supportive device verify comfort of water 9. Places supportive device behind client's back 3. Basin is in a comfortable position for client 10. Places supportive device between legs with top knee 4. Puts on clean gloves before cleaning fingernails flexed; knee and ankle supported 5. Fingernailsare immersed in basin of water 11. Signaling device is within reach and bed is in low 6. Cleans under each fingernailwith orangewood stick position 7. Wipes orangewood stick on towel after each nail 12. After completing skill, washes hands 8. Dries fingernailarea 9. Candidate feels each nail and files as needed 10. Disposes of orangewood stick and emery board into 0 *Provides Catheter Care for Female waste container (for testing purposes) (Chapter 25) 11. Empties, rinses, and dries basin 1. Explains procedure, speaking clearly, slowly, and 12. After rinsing basin, places basin in designated used directly, maintaining face-to-face contact whenever supply area possible 13. Disposes of used linens into used linens container

·R�prod.uced and used with permission from the N11rse Assista11t Ca11didale Handbookfrom National Council of State Boards of Nursing (NCSBN), Chicago, Ill, C 2011.

14. After cleaning nails and equipment and disposing of 11. Candidate wipes mouth and removes clothing used linens, removes and disposes of gloves (without protector contaminating self) into waste container and washes 12. After rinsing toothbrush, empty, rinse, and dry the hands basin and place used toothbrush in designated basin/ 15. Signaling device is within reach container 13. Places basin and toothbrush in designated dirty supply area O*Provides Foot Care on One Foot 14. Disposes of used linen into soiled linen container (Chapter 23) 15. After placing basi11 and toothbrush in designated dirty 1. Explains procedure, speaking clearly, slowly, and supply area, and disposing of used linen, removes and directly, maintaining face-to-face contact whenever disposes of gloves (without contaminating self) into possible waste container and washes hands 2. Privacy is provided with a curtain, screen, or door 16. Signaling device is within reach and bed is in low 3. Before washing, checks water temperature for safety position and comfort and asks client to verify comfort of water 4. Basin is in a comfortable position for client and on protective barrier O*Provides Perineal Care (Peri-Care) for 5. Puts on clean gloves before washing foot Female (Chapter 22) 6. Client's bare foot is placed into the water 1. Explains procedure, speaking clearly, slowly, and 7. Applies soap to wet washcloth directly, maintaining face-to-face contact whenever 8. Lifts foot from water and washes foot (including possible between the toes) 2. Privacy is provided with a curtain, screen, or door 9. Foot is rinsed (including between the toes) 3. Before washing checks water temperature for safety 10. Dries foot (including between the toes) and comfort and asks client to verify comfort of 11. Applies lotion to top and bottom of foot, removing water excess (if any) with a towel 4. Puts on clean gloves before washing perinea I area 12. Supports foot and ankle during procedure 5. Places pad/linen protector under perinea! area before 13. Empties, rinses, and dries basin washing 14. After rinsing and drying basin, places basin in 6. Exposes perinea! area while avoiding overexposure of designated dirty supply area client 15. Disposes of used linen into soiled linen container 7. Applies soap to wet washcloth 16. After cleaning foot and equipment, and disposing of 8. Washes genital area, moving from front to back, used linen, removes and disposes of gloves (without while using a clean area of the washcloth for each contaminating self) into waste container and washes stroke hands 9. Using clean washcloth, rinses soap from genital area, 17. Signaling device is within reach moving from front to back, while using a clean area of the washcloth for each stroke 10. Dries genital area moving from front to back with O*Provides Mouth Care (Chapter 22) towel 1. Explains procedure, speaking clearly, slowly, and 11. After washing genital area, turnsto side, then directly, maintaining face-to-face contact whenever washes and rinses rectal area moving from front to possible back using a clean area of washcloth for each stroke. 2. Privacy is provided with a curtain, screen, or door Dries with towel 3. Before providing mouth care, client is in upright 12. Repositions client sitting position (75-90degrees) 13. Empties, rinses, and dries basin 4. Puts on clean gloves before cleaning mouth 14. After rinsing and drying basin, places basin in 5. Places clothing protector across chest before providing designated dirty supply area mouth care 15. Disposes of used linen into soiled linen container and 6. Secures cup of water and moistens toothbrush disposes of linen protector appropriately 7. Before cleaning mouth applies toothpaste to 16. Avoids contact between candidate clothing and used moistened toothbrush linen 8. Cleans mouth (including tongue and surfaces of 17. After disposing of used linen, and placing used teeth) using gentle motions equipment in designated dirty supply area, removes 9. Maintains clean technique with placement of and disposes of gloves (without contaminating self) toothbrush h into waste container and washes hands 10. Candidate holds emesis basin to cin while client 18. Signaling device is within reach and bed is in low rinses mouth position

O*Transfers From Bed to Wheelchair Using 6. Supports foot and ankle close to the bed while performing range of motion for ankle TransferBelt (Chapter 19) 7. Pushes/pulls foot toward head (dorsiflexion), 1. Explains procedure, speaking clearly, slowly, and and pushes/pulls foot down, toes point down directly, maintaining face-to-face contact whenever (plantar flexion) (AT LEAST 3 TIMES unless pain is possible verbalized) 2. Privacy is provided with a curtain, screen, or door 8. While supporting the limb, moves joints gently, 3. Before assisting to stand, wheelchair is positioned slowly, and smoothly through the range of motion, along side of bed, at head of bed, facing the foot, or discontinuing exercise if client verbalizes pain foot of bed facing head 9. Signaling device is within reach and bed is in low 4. Before assisting to stand, footrests are folded up or position removed 10. After completing skill, washes hands 5. Before assisting to stand, bed is at a safe level 6. Before assisting to stand, locks wheels on wheelchair O*Performs Modified Passive Range-of-Motion 7. Before assisting to stand, checks and/ or locks bed wheels (PROM) for One Shoulder (Cliapter 30) 8. Before assisting to stand, client is assisted to a sitting 1. Explains procedure, speaking dearly, slowly, and position with feet flat on the floor directly, maintaining face-to-face contact whenever 9. Before assisting to stand, client is wearing shoes possible 10. Before assisting to stand, applies transfer belt securely 2. Privacy is provided with a curtain, screen, or door at the waist over clothing/gown 3. Instructs client to inform candidate if pain is 11. Before assisting to stand, provides instructions experienced during exercise to enable client to assist in transfer including 4. Supports client's upper and lower arm while prearranged signal to alert when to begin standing performing range of motion for shoulder 12. Stands facing client, positioning self to ensure safety 5. Raises client's straightened arm from side position of candidate and client during transfer. Counts to upward toward head to ear level and returns arm three (or says other prearranged signal) to alert client down to side of body (flexion/extension) (AT LEAST to begin standing 3 TIMES unless pain is verbalized). Supporting 13. On signal, gradually assists client to stand by grasping the limb, moves joint gently, slowly, and smoothly transfer belt on both sides with an upward grasp through the range of motion, discontinuing exercise (candidates hands are in upward position) and if client verbalizes pain maintaining stability of client's legs 6. Moves client's straightened arm away from the side 14. Assists client to turn to stand in front of wheelchair of body to shoulder level and returnsto side of body with back of client's legs against wheelchair (abduction/adduction) (AT LEAST 3 TIMES unless 15. Lowers client into wheelchair pain is verbalized). Supporting the limb, moves joint 16. Positions client with hips touching back of wheelchair gently, slowly, and smoothly through the range of and transfer belt is removed motion, discontinuing exercise if client verbalizes pain 17. Positions feet on footrests 7. Signaling device is within reach and bed is in low 18. Signaling device is within reach position 19. After completing skill, washes hands 8. After completing skill, washes hands

O*Performs ModifiedPassive Range-of 0 Performs Passive Range-of-Motion of Lowe, Motion (PROM) for One Knee and One Ankle Extremity (Hip, Knee, Ankle) (Chapter 30) 1. Washes hands before contact with client ( Chapter 30) 2. Identifies self to client by name and addresses client 1. Explains procedure, speaking clearly, slowly, and by name directly, maintaining face-to-face contact whenever 3. Explains procedure to client, speaking clearly, possible slowly, and directly, maintaining face-to-face contact 2. Privacy is provided with a curtain, screen, or door whenever possible 3. Instructs client to inform candidate if pain is 4. Provides for client's privacy du.ring procedure with experienced during exercise curtain, screen, or door 4. Supports leg at knee and ankle while performing 5. Positions client supine and in good body alignment range of motion for knee 6. Supports client's leg by placing one hand under knee 5. Bends the knee then returns leg to client's normal and other hand under heel position (extension/flexion) (AT LEAST 3 TIMES 7. Moves entire leg away from body (performs AT unless pain is verbalized) LEAST 3 TIMES unless pain occurs)

8. Moves entire leg toward body (performs AT LEAST 3 13. Before leaving client, places signaling device within TIMES unless pain occurs) client's reach 9. Bends client's knee and hip toward client's trunk 14. Washes J,ands (performs AT LEAST 3 TIMES unless pain occurs) 10. Straightens knee and hip (performs AT LEAST 3 TIMES unless pain occurs) :.J Makes an Unoccupied (Closed) Bed 11. Flexes and extends ankle through range-of-motion (Chapter 21) exercises (performs AT LEAST 3 TlMES unless pain 1. Washes hands occurs) 2. Collects clean linens 12. Rotates ankle through range-of-motion exercises 3. Places clean linens on a clean surface (performs AT LEAST 3 TIMES unless pain occurs) 4. Raises the bed for good body mechanics 13. While supporting limb, moves joints gently, slowly, 5. Puts on gloves and smoothly through range-of-motion to point of 6. Removes linens without contaminating uniform. Rolls resistance, discontinuing exercise if pain occurs each piece away from self 14. Provides for comfort 7. Discards linens into laundry bag 15. Before leaving client, places signaling device within 8. Moves the mattress to the head of the bed client's reach 9. Applies mattress pad 16. Washes hands 10. Applies bottom sheet, keeping it smooth and free of wrinkles 11. Places the top sheet and bedspread on the bed, 0Passive Performs Range-of-Motion of Upper keeping them smooth and free of wrinkles Extremity (Shoulder, Elbow, Wrist, Finger) 12. Tucks in top linens at the foot of the bed. Makes (Chapter 30) mitered corners 1. Washes hands before contact with client 13. Applies clean pillowcase with zippers and/or tags to 2. Identifies self to client by name and addresses client inside of pillowcase by name 14. Lowers the bed to its lowest position. Locks the bed 3. Explains procedure to client, speaking dearly, wheels slowly, and directly, maintaining face-to-face contact 15. Washes hands whenever possible 4. Provides for client's privacy during procedure with curtain, screen, or door :J*Donningand Removing PPE (Gown arid 5. Supports client's extremity above and below joints Gloves) (Chapter 16) while performing range-of-motion 1. Picks up gown and unfolds 6. Raises client's straightened arm toward ceiling and 2. Facing the back opening of gown, places arms back toward head of bed and returns to flat position through each sleeve (flexion/extension) (performs AT LEAST 3 TIMES 3. Fastens the neck opening unless pain occurs) 4. Secures gown at waist making sure that back of 7. Moves client's straightened arm away from client's clothing is covered by gown (as much as possible) side of body toward head of bed, and returns 5. Puts on gloves client's straightened arm to midline of client's body 6. Cuffs of gloves overlap cuffs of gown (abduction/adduction) (performs AT LEAST 3 TTMES 7. Before removing gown, with one gloved hand, unless pain occurs) grasps the other glove at the palm, removes glove 8. Moves client's shoulder through rotation range-of 8. Slips fingers from ungloved hand underneathcuff motion exercises (performs AT LEAST 3 TIMES unless of remaining glove at wrist, and removes glove pain occurs) turning it inside out as it is removed 9. Flexes and extends elbow through range-of-motion 9. Disposes of gloves into designated waste container exercises (performs AT LEAST 3 TIMES unless pain without contaminating self occurs) 10. After removing gloves, unfastens gown at neck and at 10. Provides range-of-motion exercises to wrist (performs waist AT LEAST 3 TIMES unless pain occurs) 11. After removing gloves, removes gown without 11. Moves finger and thumb joints through range-of touching outside of gown motion exercises (performs AT LEAST 3 TIMES unless 12. While removing gown, holds gown away from body, pain occurs) without touching the floor, turns gown inward and 12. While supporting body part, moves joint gently, keeps it inside out slowly, and smoothly through range-of-motion to 13. Disposes of gown in designated container without point of resistance, discontinuing exercise if pain contaminating self occurs 14. After completing skill, washes hands

•Reproduced and used with permission from the Nurse Assisumt Candidate Handbookfrom National Council of State Boards of Nursing (NCSBN), Chicago, Ill,()2011.

D Performs Abdominal Thrusts (Chapter 13) 4. Asks client how he or she wants his or her hair styled 1. Asks client if he or she is choking 5. Combs/brushes hair gently and completely 2. Stands behind the client 6. Leaves hair neatly brushed, combed, and/or styled 3. Wraps arms around client's waist 7. Removes towel 4. Makes a fist with one hand 8. Removes hair from comb or brush 5. Places thumb side of fist against the client's abdomen 9. Before leaving client, places signaling device within 6. Positions fist in middle above navel and well below client's reach sternum(breastbone) 10. Washes hands 7. Grasps fist with other hand 8. Presses fist and other hand into client's abdomen with quick upward thrusts :J Transfers a Client Using a Meclzanical Lift 9. Repeats thrusts until object is expelled or client (Chapter 19) becomes unresponsive 1. Assembles required equipment; performs safety check of slings, straps, hooks, and chains 2. Checks client's weight to ensure it does not exceed the 0 Ambulation With Cane or Walker lift's capacity ( Chapter 30) 3. Asks a co-worker to help 1. Explains procedure to client, speaking clearly, 4. Explains procedure to client, speaking clearly, slowly, and directly, maintaining face-to-face contact slowly, and directly, maintaining face-to-face contact whenever possible whenever possible 2. Locks bed wheels or wheelchair brakes 5. Provides for privacy during procedure with curtain, 3. Assists client to a sitting position screen, or door 4. Before ambulating,puts on and properly fastens 6. Locks the bed wheels non-skid footwear 7. Raises the bed for proper body mechanics 5. Positions cane or walker correctly. Cane is on the 8. Lowers the head of the bed to a level appropriate for client's strong side the client 6. Assists client to stand, using correct body mechanics 9. Stands on one side of the bed; co-worker stands on the 7. Stabilizes cane or walker and ensures that client other side stabilizes cane or walker 10. Lowers the bed rails if up 8. Stands behind and slightly to the side of client on the 11. Centers the sling under the client following the person's weak side manufacturer's instructions 9. Ambulates client at least 10 steps 12. Ensures that the sling is smooth 10. Assists client to pivot and sit, using correct body 13. Positions the client in semi-Fowler's position mechanics 14. Positions a chair to lower the client into it 11. Before leaving client, places signaling device within 15. Lowers the bed to its lowest position client's reach 16. Raises the lift to position it over the client 12. Washes hands 17. Positions the lift over the client 18. Attaches the sling to the sling hooks and checks fasteners for security U Fluid Intake (Chapter 27) 19. Crosses the client's arms over the chest 1. Observes dinner tray 20. Raises the lift high enough w1til the client and sling 2. Determines, in milliliters (mL), the amount of fluid are free of the bed consumed from each container 21. Instructs co-worker to support the client's legs as 3. Determines total fluid consumed in mL candidate moves the lift and the client away fromthe bed 4. Records total fluid consumed on intake and output 22. Positions the lift so the client's back is toward the (1&0) sheet chair 5. Calculated total is within required range of 23. Slowly lowers the client into the chair evaluator's reading 24. Places client in comfortable position, in correct body alignment 25. Lowers the sling hooks and unhooks the sling D Brushes or Combs Client's Hair (Chapter 23) 26. Removes the sling from under the client unless 1. Explains procedure to client, speaking clearly, otherwise indicated. Moves lift away from client slowly, and directly, maintaining face-to-face contact 27. Puts footwear on the client whenever possible 28. Covers the client's lap and legs with a lap blanket 2. Collects brush or comb and bath towel 29. Positions the chair as the client prefers 3. Places towel across client's back and shoulders or 30. Places signaling device within client's reach across the pillow 31. Washes hands

.:l ProvidesMouth Care for an Unconscious 11. Rinses the area with another washcloth 22) 12. Returns the foreskin to its natural position Client (Chapter 13. Cleans the shaft of the penis with firm, downward I. Explains procedure to client, speaking clearly, strokes and rinses the area slowly, and directly, maintaining face-to-face contact 14. Cleans the scrotum whenever possible 15. Pats dry the penis and the scrotum 2. Provides for privacy during procedure with curtain, 16. Cleans the rectal area screen, or door 17. Removes the waterproof pad 3. Washes hands 18. Lowers the bed 4. Positions client on side with head turnedwell to one side 19. Removes and djscards the gloves 5. Puts on gloves 20. Washes hands 6. Places the towel under the client's face 21. Before leaving, places signaling device within client's 7. Places the kidney basin under the chin reach 8. Uses swabs or toothbrush and toothpaste or other cleaning solution 9. Cleans inside of mouth including the gums, tongue, :J Empties and Records Content of Urinary and teeth Drainage Bag (Chapter 25) 10. Cleans and dries face I. Explains procedure to client, speaking dearly, 11. Removes the towel and kidney basin slowly, and directly, maintaining face-to-face contact 12. Applies lubricant to the lips whenever possible 13. Positions client for comfort and safety 2. Washes hands 14. Removes and discards the gloves 3. Puts on gloves 15. Places signaling device within the client's reach 4. Places a paper towel on the floor 16. Washes hands 5. Places the graduate on the paper towel 6. Places the graduate under the collection bag .JProvides Drinking Water (Chapter 27) 7. Ensures that the bag is below the bladder and the 1. Washes hands drainage tube is not kinked 2. Assembles equipment-ice, scoop, pitcher, cup, straw 8. Opens the clamp on the drain 3. Explains procedure to client, speaking clearly, 9. Lets all urine drain into the graduate-does not let the slowly, and directly, maintaining face-to-face contact drain touch the graduate whenever possible 10. Closes and positions the clamp 4. Uses the scoop to fill the pitcher with ice; does not let 11. Measures urine the scoop touch the rim or inside of the pitcher 12. Removes and discards the paper towel 5. Places scoop in appropriate receptacle after each use 13. Empties the contents of the graduate into the toilet 6. Adds water to pitcher and flushes 7. Places the pitcher, disposable cup, and straw (if used) 14. Rinses the graduate on the over-bed table, within the person's reach 15. Returns the graduate to its proper place 8. Before leaving, places signaling device within client's 16. Removes the gloves reach 17. Washes hands 9. Washes hands 18. Records the time and amount on the intake and output (I&O) record 19. Provides for client comfort 0 Provides Perinea[ Care for Uncircumcised 20. Places the signaling device within reach of client Male (Chapter 22) I. Explains procedure to client, speaking clearly, 0 Applies a Vest Restraint (Chapter 15) slowly, and directly, maintaining face-to-face contact whenever possible 1. Obtains the correct type and size of restraint 2. Provides for privacy during procedure with curtain, 2. Checks straps for tears or frays screen, or door 3. Washes hands 3. Washes hands 4. Explains procedure to client, speaking clearly, 4. Fills basin with comfortably warm water slowly, and directly, maintaining face-to-face contact 5. Puts on gloves whenever possible 6. Elevates bed to working height 5. Provides for privacy during procedure with curtain, 7. Places waterproof pad under buttocks screen, or door 8. Gently grasps penis 6. Makes sure the client is comfortable and in good 9. Retracts the foreskin alignment 10. Using a circular motion, cleans the tip by starting at 7. Assists the person to a sitting position the meatus of the urethra and working outward 8. Applies the restraint following the manufacturer's instructions-the "V" part of the vest crosses in front

9. Makes sure the vest is free of wrinkles in the front and 3. Explains procedure to client, speaking clearly, back slowly, and directly, maintaining face-to-face contact 10. Brings the straps through the slots whenever possible 11. Makes sure the client is comfortable and in good 4. Provides for privacy during procedure with curtain, alignment screen, or door 12. Secures the straps to the chair or to the movable part 5. Positions the client for the procedure of the bed frame 6. Covers cold pack or warm compress with towel or 13. Uses a secure knot that can be released with one pull other protective cover 14. Makes sure the vest is snug-slide an open hand 7. Properly places cold pack or warm compress on site between the restraint and the client 8. Checks the client for complications every 5 minutes 15. Places the signaling device within the client's reach 9. Checks the cold pack or warm compress every 16. Washes hands 5 minutes 10. Removes the application at the specified time-usually after 15 to 20 minutes D Performs a Back Rub (Massage) (Chapter 31) 11. Provides for comfort 1. Washes hands 12. Places the signaling device within reach 2. Explains procedure to client, speaking clearly, 13. Washes hands slowly, and directly, maintaining face-to-face contact whenever possible 3. Provides for privacy during procedure with curtain, ::J Positions for an Enema (Cl,apter 26) screen, or door 1. Washes hands 4. Raises the bed for good body mechanics 2. Explains procedure to client, speaking clearly, 5. Lowers the bed rail near the candidate, if up slowly, and directly, maintaining face-to-face contact 6. Positions the person in the prone or side-lying position whenever possible 7. Exposes the back, shoulders, upper arms, and buttocks 3. Provides for privacy 8. Warms the lotion 4. Positions the client in Sims' position or in a left side- 9. Rubs entire back in upward, outward motion for lying position approximately 2 to 3 minutes; does not massage 5. Covers client appropriately reddened bony areas 6. Provides for comfort 10. Straightens and secures clothing or sleepwear 7. Places the signaling device within reach 11. Returnsclient to comfortable and safe position 8. Washes hands 12. Places the signaling device within reach 13. Lowers the bed to its lowest position 14. Washes hands D Positions Client for Meals (Chapter 27) 1. Washes hands 2. Explains procedure to client, speaking clearly, D Positions a Foley Catheter (Chapter 25) slowly, and directly, maintaining face-to-face contact 1. Explains procedure to client, speaking clearly, whenever possible slowly, and directly, maintaining face-to-face contact 3. If the person will eat in bed: whenever possible a. Raises the head of the bed to a comfortable 2. Washes hands position-usually Fowler's or high-Fowler's 3. Puts on gloves position is preferred 4. Secures catheter and drainage tubing according to b. Removes items from the over-bed table and cleans facility procedure the over-bed table 5. Places tubing over leg c. Adjusts the over-bed table in front of the person 6. Positions drainage tubing so urine flows freely into d. Places the client in proper body alignment drainage bag and has no kinks 4. If the person will sit in a chair: 7. Attaches bag to bed frame, below level of bladder a. Positions the person in a chair or wheelchair 8. Washes hands b. Provides support for the client's feet c. Removes items from the over-bed table and cleans the table :l Applies a Cold Pack or Warm Compress d. Adjusts the over-bed table in front of the person (Chapter 38) e. Places the client in proper body alignment 1. Washes hands 5. Places the signaling device within reach 2. Collects needed equipment 6. Washes hands

and_J Takes Records Axillary Temperature, b. Without transferbelt: Stands in front of client, 29) positioning self to ensure safety of candidate and Pulse, "nd Respirations (Chapter client during transfer (for example, knees bent, 1. Washes hands before contact with client feet apart, back straight, arms around client's torso 2. Identifies self to client by name and addresses client under arms) by name 11. Provides instructions to enable client to assist in 3. Explains procedure to client, speaking clearly, transfer, including prearranged signal to alert client to slowly, and directly, maintaining face-to-face contact begin standing whenever possible 12. Braces client's lower extremities to prevent shppmg. . 4. Provides for client's privacy during procedure with 13. Counts to three (or says other prearranged signal) to curtain, screen, or door alert client to begin transfer 5. Turns on digital oral thermometer 14. On signal, gradually assists client to stand 6. Dries axilla and places thermometer in the center of 15. Assists client to pivot and sit on bed in manner that the axilla ensures safety 7. Holds thermometer in place for appropriate length of time 16. Removes transfer belt, if used 8. Removes and reads thermometer 17. Assists client to remove non-skid footwear 9. Records temperature on pad of paper 18. Assists client to move to center of bed 10. Recorded temperature is within required range 19. Provides for comfort and good body alignment 11. Discards sheath from thermometer 20. Before leaving client, places signaling device within 12. Places fingertips on thumb side of client's wrist to client's reach locate radial pulse 21. Washes hands 13. Counts beats for 1 full minute 14. Records pulse rate on pad of paper 15. Recorded pulse is within required range 0 Applies an Incontmence Brief (Cltapter 24) 16. Counts respirations for 1 full minute 1. Washes hands before contact with client 17. Records respirations on pad of paper 2. Identifies self to client by name and addresses client 18. Recorded respirations are within required range by name 19. Before leaving client, places signaling device within 3. Explains procedure to client, speaking clearly, client's reach slowly, and directly, maintaining face-to-face contact 20. Washes hands whenever possible 4. scale Starts with balanced at zero before weighing client S. Chooses correct brief and size per facility instructions _J Tmnsfers Client From Wl1eelcl1air to Bed 6. Provides privacy for the resident (Clwpter 19) 7. Elevates bed to comfortable working height 1. Washes hands before contact with client 8. Puts on gloves 2. Identifies self to client by name and addresses client 9. Places waterproof pad under client, asking client to by name raise buttocks or turning the client to the side 3. Explains procedure to client, speaking clearly, 10. Loosens tabs on each side of the product slowly, and directly, maintairung face-to-face contact 11. Tums the client away from you whenever possible 12. Removes the product from front to back, rolling the 4. Provides for client's privacy during procedure with product up and placing the product into trash bag curtain, screen, or door 13. Opens the new brief, folding it in half, length-wise S. Positions wheelchair close to bed with arm of along the center, and inserts it between the client's legs wheelchair almost touching bed from front to back; unfolds and spreads the back panel 6. Before transferring client, ensures client is wearing 14. Turns the client onto his or her back, with the product non-skid footwear under buttocks with top of absorbent pad aligned just 7. Before transferring client, folds up footplates above the buttocks crease 8. Before transferring client, places bed at safe and 15. Grasps and stretches the leg portion of front panel to appropriate level for client extend elastic for groin placement 9. Before transferring client, locks wheels on 16. Rolls ruffles away from groin wheelchair and locks bed brakes 17. Snuggly places bottom tabs angled toward abdomen 10. a. Witlr transfer (gait) belt: Stands in front of client, on both sides positioning self to ensure safety of candidate 18. Places top tabs on each side angled toward bottom tabs and client during transfer (for example, knees 19. Removes gloves bent, feet apart, back straight), places belt around 20. Washes hands client's waist, and grasps belt. Tightens belt so that 21. Covers client appropriately and provides for comfort fingers of candidate's hand can be slipped between 22. Places signaling device within reach transfer/ gait belt and client

Afterthe Procedure • Unneeded equipment is unplugged or turned off. After you demonstrate a skill, complete a safety check of • Harmful substances are stored properly. Lotion, the room. mouthwash, shampoo, after-shave, and other personal • The person is wearing eyeglasses, hearing aids, and care products are examples. other devices as needed. • The call light is plugged in and within reach. • Bed rails are up or down according to the care plan. Afterthe Test • The bed is in the lowest horizontal position. • Celebrate--you have completed the competency • The bed position is locked if needed. evaluation! The length of time for you to get your test • Manual bed cranks are in the down position. results varies with each state. In the meantime, try • Bed wheels are locked. to relax. Continue your daily routine and be the best • Assistive devices are within reach. Walker, cane, and nursing assistant you can be. wheelchair are examples. • The over-bed table, filled water pitcher and cup, tissues, phone, TV controls, and other needed items are within reach.