1. Explain admission, transfer, and discharge of a resident
REMEMBER:
Moving into a facility is a big adjustment.
New residents may have been independent for a long time, and they may be moving from their own or a family member’s home. It can be a time of loss and many strong emotions.
1. Explain admission, transfer, and discharge of a resident
Take 5 minutes to read and complete Handout 7-1.
Then we will discuss these questions:
- What did you decide to take with you to your sister’s?
- How did you feel as you tried to decide what to take?
- Did anyone get angry? Sad? Frustrated?
- How did you feel about your mail and your sister’s response to you?
1. Explain admission, transfer, and discharge of a resident
REMEMBER:
Admission is often the first time a nursing assistant meets a new resident.
When the resident arrives, the NA can give a good first impression of the staff and the facility.
He should welcome the new resident warmly.
1. Explain admission, transfer, and discharge of a resident
Why do you think it is important for new residents to receive written copies of Residents’ Rights and advance directive information?
REMEMBER:
Transfers can be difficult for residents. Nursing assistants can help by trying to make these moves as smooth as possible.
Mrs. Gao has been at Hartman Hills for a month. She was transferred to Hartman Hills from a hospital and is now being discharged. She will be staying with her son for some time, but she is still nervous about leaving.
What tasks may be assigned to NA Simona related to Mrs. Gao’s discharge? Can she do anything to help Mrs. Gao feel more confident?
2. Explain the importance of monitoring vital signs
vital signs measurements—temperature, pulse, respirations, and blood pressure that monitor the functioning of the vital organs of the body.
2. Explain the importance of monitoring vital signs
NAs monitor, document, and report the following vital signs:
- Temperature
- Pulse
- Respiratory rate
- Blood pressure
They also monitor, document, and report resident pain levels.
2. Explain the importance of monitoring vital signs
NA Sloane is helping Mrs. Inman with a.m. care. She is also measuring vital signs and chatting with Mrs. Inman. All of Mrs. Inman’s vital signs are within normal ranges, but her blood pressure is higher than it usually is. She tells Sloane that she woke up with a bad headache.
Does Sloane need to report any of this to the nurse?
2. Explain the importance of monitoring vital signs
REMEMBER:
A change in vital signs is often the first indication that someone is ill.
Key Material 7-1: Ranges for Adult Vital Signs
Temperature Site Fahrenheit Celsius
| Rectum (rectal ) | 98.6° – 100.6° | 37.0° – 38.1° |
| Armpit (axillary) | 96.6°- 98.6° | 35.9° – 37.0° |
| Ear (tympanic ) | 96.6°- 99.7° | 35.9° – 37.6° |
| Temporal Artery (forehead) | 97.2°- 100.1° | 36.2° – 37.8° |
2. Explain the importance of monitoring vital signs
Key Material 7-1: Ranges for Adult Vital Signs (cont’d)
Blood Pressure
Normal Systolic 90–119 mm Hg and
Diastolic 60–79 mm Hg
| Elevated | Systolic | 120–129 mm Hg and |
| Diastolic | Less than 80 mm Hg | |
| Stage 1 hypertension | Systolic | 130–139 mm Hg or |
| Diastolic | 80–89 mm Hg | |
| Stage 2 hypertension | Systolic | At or over 140 mm Hg or |
| Diastolic | At or over 90 mm Hg | |
| Hypertensive crisis | Systolic | Over 180 mm Hg and/or |
| Diastolic | Over 120 mm Hg |
Low (hypotensive) Systolic Below 90 mm Hg or
Diastolic Below 60 mm Hg
2. Explain the importance of monitoring vital signs
REMEMBER:
It is important to protect residents’ privacy when taking vital signs. NAs must provide
privacy while taking measurements, and must not discuss residents’ vital signs within earshot of others.
2. Explain the importance of monitoring vital signs
What factors do you think might affect body temperature?
Where on the body can temperature be measured?
What kind of thermometer do you have at home?
What kinds of thermometers have you seen at doctors’ offices and other medical facilities?
How are they different?
2. Explain the importance of monitoring vital signs
Mr. Glass just returned to Hartman Hills from an oral surgery appointment. He had a dental implant placed.
What should NAs who care for Mr. Glass know about measuring his temperature?
2. Explain the importance of monitoring vital signs
REMEMBER:
Rectal temperatures are the most accurate, but the procedure can be uncomfortable and embarrassing for the resident.
Privacy and tact are very important.
How far into the ear is a tympanic thermometer inserted?
After his oral surgery Mr. Glass develops an infection. He becomes confused and disoriented.
What is the best way for NAs to measure his temperature?
2. Explain the importance of monitoring vital signs
radial pulse the pulse located on the inside of the wrist, where the radial artery runs just beneath the skin.
brachial pulse the pulse located inside the elbow, about one to one-and-a-half inches above the elbow.
respiration the process of inhaling air into the lungs and exhaling air out of the lungs.
inspiration the process of inhaling air into the lungs.
expiration the process of exhaling air out of the lungs.
2. Explain the importance of monitoring vital signs
What is pulse?
What factors do you think might affect a person’s pulse rate?
Someone tells you,
“I’m going to count your breaths now. Don’t think about it. Just breathe naturally.” How are you going to breathe?
2. Explain the importance of monitoring vital signs
systolic first measurement of blood pressure; phase when the heart is at work, contracting and pushing blood out of the left ventricle of the heart.
diastolic second measurement of blood pressure; phase when the heart relaxes or rests.
2. Explain the importance of monitoring vital signs
Why does a blood pressure measurement have two numbers? What does each one measure?
2. Explain the importance of monitoring vital signs
REMEMBER:
It can be difficult to perfect the skill of hearing the first and last sounds of blood pressure.
Practice will help build this skill.
Mrs. Stephens has COVID-19 and has had a lot of respiratory problems. In addition to measuring her vital signs, NAs must measure and report her blood oxygen levels.
What device is used to take this measurement?
2. Explain the importance of monitoring vital signs
True or False?
Some amount of pain is just a normal part of aging.
What questions could a nursing assistant ask to get more information about a resident’s pain?
2. Explain the importance of monitoring vital signs
Residents may not always tell you they are in pain.
What observations might indicate a resident is in pain?
2. Explain the importance of monitoring vital signs
How will each of the actions listed in the pain management guidelines on p. 192 help a resident who is in pain?
3. Explain how to measure weight and height
True or False?
A kilogram is a metric unit of mass that equals 2.2 pounds.
Why should any change in a resident’s weight be reported right away?
3. Explain how to measure weight and height
Why is height measured less often than weight?
4. Explain restraints and how to promote a restraint-free environment
restraint a physical or chemical way to restrict voluntary movement or behavior.
restraint-free care an environment in which restraints are not kept or used for any reason.
restraint alternatives measures used in place of a restraint or that reduce the need for a restraint.
4. Explain restraints and how to promote a restraint-free environment
What is a restraint?
What is the difference between a physical restraint and a chemical restraint?
When might side rails or a chair with a tray be considered restraints?
4. Explain restraints and how to promote a restraint-free environment
REMEMBER:
Restraint use has declined in facilities, and laws have been passed restricting their use due to abuse by caregivers.
Restraints may never be used without a doctor’s order.
4. Explain restraints and how to promote a restraint-free environment
Can restraints be used if staff do not have enough time to care for residents?
Can restraints be used if the resident has made a staff member mad by arguing with the staff member or being in a bad mood?
How would you feel if you were restrained in your chair or by side rails or other devices?
Can restraints be used if staff do not have enough time to care for residents?
Can restraints be used if the resident has made a staff member mad by arguing with the staff member or being in a bad mood?
How would you feel if you were restrained in your chair or by side rails or other devices?
Key Material 7
-2: Problems from Restraint Use
- Pressure ulcers
- Pneumonia
- Risk of suffocation
- Reduced blood circulation
- Stress on the heart
- Incontinence
- Constipation
-2: Problems from Restraint Use (cont’d)
- Weakened muscles and bones
- Muscle atrophy (weakening or wasting away of the muscle)
- Loss of bone mass
- Poor appetite and malnutrition
- Depression and/or withdrawal
- Sleep disorders
- Loss of dignity
- Loss of independence
- Stress and anxiety
- Increased agitation (anxiety, restlessness)
- Loss of self-esteem
- Severe injury
- Death
4. Explain restraints and how to promote a restraint-free environment
How could each of these residents’ challenges be addressed without using restraints?
Mr. Fritz, who has a high risk for falls, gets impatient quickly after using his call light and gets up without help.
Mrs. Kibbel gets angry when she is served food she dislikes. She sometimes hits NAs.
Mr. Case wanders at the same time every evening, entering other residents’ rooms.
4. Explain restraints and how to promote a restraint-free environment
What must be done if a doctor has ordered that a restraint be used?
Key Material 7-3: When a Resident is Restrained
The resident must be checked at least every 15 minutes. At regular, ordered intervals the following must be done:
- Release the restraint or discontinue use.
- Offer help with elimination. Check for episodes of incontinence and provide care.
- Offer fluids and food.
Key Material 7-3: When a Resident is Restrained (cont’d)
- Check for and report signs of skin irritation immediately.
- Check for and report signs of swelling immediately.
- Reposition the resident.
- Ambulate resident if able.
intake (input) the fluid a person consumes; also called input.
output all fluid that is eliminated from the body; includes fluid in urine, feces, vomitus, perspiration, moisture that is exhaled in the air, and wound drainage.
5. Define fluid balance and explain intake and output (I&O)
fluid balance taking in and eliminating equal amounts of fluid.
REMEMBER:
Most people maintain fluid balance naturally.
However, residents on special diets or who have certain illnesses may need to have their intake and output (I&O) measured. This means staff record and add together all of the fluids the resident takes in and eliminates within 24 hours.
Key Material 7-4: Conversion Table
One milliliter (mL) is a unit of measure equal to one cubic centimeter (cc).
- ounce (oz) = 30 milliliters (mL) or 30 cubic centimeters (cc)
- oz = 60 mL
- oz = 90 mL
- oz = 120 mL
- oz = 150 mL
- oz = 180 mL
- oz = 210 mL
- oz = 240 mL
1/4 cup = 2 oz = 60 mL
1/2 cup = 4 oz = 120 mL
1 cup = 8 oz = 240 mL
5. Define fluid balance and explain intake and output (I&O)
specimen
a sample that is used for analysis in order to try to make a diagnosis.
routine urine specimen a urine specimen that can be collected any time a person voids.
voids urinates.
hat in health care, a collection container that can be inserted into a toilet bowl to collect and measure urine or stool.
clean-catch specimen a urine specimen that does not include the first and last urine voided; also called midstream specimen.
5. Define fluid balance and explain intake and output (I&O)
Use information from this learning objective to finish these sentences:
A _______________ urine specimen can be collected any time a person voids and does not require any special preparation.
A _______________ specimen does not
include the first and last urine voided in the sample.
A _______________ specimen is collected when a resident has a bowel movement.
5. Define fluid balance and explain intake and output (I&O)
REMEMBER:
It is very important that NAs wear gloves when collecting specimens.
They must wash their hands and discard their gloves afterwards.
6. Explain care guidelines for urinary catheters, oxygen therapy, and IV therapy
catheter a thin tube inserted into the body to drain or inject fluids.
urinary catheter a type of catheter that is used to drain urine from the bladder.
straight catheter a type of urinary catheter that is removed immediately after urine is drained or collected.
indwelling catheter a type of urinary catheter that remains inside the bladder for a period of time; also called Foley catheter.
condom catheter a type of urinary catheter that has an attachment on the end that fits onto the penis; also called Texas catheter.
6. Explain care guidelines for urinary catheters, oxygen therapy, and IV therapy
What different types of catheters may be used for residents who are unable to urinate normally?
Why is careful cleaning especially important when catheters are used?
REMEMBER:
NAs never insert, irrigate, or remove catheters.
6. Explain care guidelines for urinary catheters, oxygen therapy, and IV therapy
NA Chris is caring for Mrs. Hudson, who has an indwelling catheter. What steps will they need to follow while providing catheter care?
What should they observe for and report?
REMEMBER:
It is very important to wear gloves while providing catheter care and to wash hands carefully afterwards.
6. Explain care guidelines for urinary catheters, oxygen therapy, and IV therapy
oxygen therapy the administration of oxygen to increase the supply of oxygen to the lungs.
combustion the process of burning.
flammable easily ignited and capable of burning quickly.
6. Explain care guidelines for urinary catheters, oxygen therapy, and IV therapy
Mrs. Agarwal has COPD. Her doctor prescribes oxygen therapy.
How can NAs who care for Mrs. Agarwal promote safety when oxygen is in use?
6. Explain care guidelines for urinary catheters, oxygen therapy, and IV therapy
intravenous (IV) therapy the delivery of medication, nutrition, or fluids through a person’s vein.
6. Explain care guidelines for urinary catheters, oxygen therapy, and IV therapy
What role do NAs have in caring for residents with IVs?
What should NAs observe for and report?
6. Explain care guidelines for urinary catheters, oxygen therapy, and IV therapy
It is Matteo’s first day as an NA at Hartman Hills. Sarai, an experienced NA, is shadowing him for the morning. When he starts to put a blood pressure cuff on the arm where Mrs. Walsh has an IV, Sarai reminds him to use the other arm.
What else should Matteo remember while providing care to Mrs. Walsh?
6. Explain care guidelines for urinary catheters, oxygen therapy, and IV therapy
REMEMBER:
Extra care is required when performing some care procedures on a resident with an IV. NAs must be careful never to pull or catch on IV tubing when assisting with care.
7. Discuss a resident’s unit and related care
What equipment would you expect to find in a
standard long-term care resident room?
REMEMBER:
A resident’s room is her home. Residents’ living spaces and personal possessions should always be respected.
How would you feel if someone put a urinal on your dining room table?
Or on your kitchen counter?
7. Discuss a resident’s unit and related care
Mrs. Agarwal’s COPD makes her very anxious. She uses her call light often for help getting herself propped up in a position that lets her breathe comfortably. She is often agitated. How should NAs respond to this?
7. Discuss a resident’s unit and related care
Imagine that you are 85 years old. You lived alone for 10 years after your spouse died. Now you live in an LTCF and share a room. You need help with care you had done for yourself since you were a small child. An NA comes in to help you change an incontinence brief. She does not close the privacy curtain. She says loudly, “OK, lets get that diaper changed.”
7. Discuss a resident’s unit and related care
Imagine you are in a resident’s room providing care.
Before you leave, what should you do to make sure the resident is comfortable and safe?
8. Explain the importance of sleep and perform proper bedmaking
Why do we need sleep?
Why do you think good sleep is especially important to residents in long-term care?
8. Explain the importance of sleep and perform proper bedmaking
Imagine you are a new resident at a long-term care facility.
Aside from occasional vacations, you have slept in your own bed at your own home for many years.
What factors might affect your sleep at the LTCF?
8. Explain the importance of sleep and perform proper bedmaking
How do you feel when you don’t get enough sleep?
How does it affect your functioning during the next day?
What are some ways you can improve your sleep?
8. Explain the importance of sleep and perform proper bedmaking
occupied bed a bed made while a person is in the bed.
unoccupied bed a bed made while no person is in the bed.
8. Explain the importance of sleep and perform proper bedmaking
closed bed a bed completely made with the bedspread and blankets in place.
open bed a bed made with linen folded down to the foot of the bed.
8. Explain the importance of sleep and perform proper bedmaking
A well-made bed with dry, wrinkle-free sheets can help a resident sleep better.
Can you think of any other benefits of careful bedmaking?
8. Explain the importance of sleep and perform proper bedmaking
The textbook lists 12 guidelines for bedmaking. How many can you list without looking at the book?
9. Discuss dressings and bandages
NAs should remember these points about dressings:
- NAs do not change sterile dressings, which cover open or draining wounds.
- Nonsterile dressings are for wounds that have less chance of infection.
- NAs may change nonsterile dressings.
True or False?
Elastic bandages should be wrapped very tightly.