Assisting in Long Term Care

by Hegner,Barbara

• ISBN13: 9780766834798
• ISBN10: 0766834794
• Format: Paperback
• Copyright: 2001-09-05
• Publisher: Cengage Learning

Summary

This best-selling resource provides the theoretical and skills content nursing assistants require for the successful completion of the certification test. A major goal of the content is to help nursing assistants develop an understanding of the principles on safe and effective care of residents in long-term care. Core values stressed include empathy, caring, communication skills, and respect for residents and their families. Special emphasis is placed on ensuring resident's rights, adequate nutrition and hydration, maintenance of mobility, psychosocial interactions, and a safe environment. Liberal illustrations aid in visual learning.

Author Biography

Barbara Robinson Hegner, RN, MSN, was a graduate of a three-year diploma nursing program where direct and total care was the focus. She earned a BSN at Boston College and an MS in nursing from Boston University, with a minor in biologic sciences. She was Professor Emeritus of Nursing and Life Sciences at Long Beach City College, Long Beach (CA). Throughout her professional career, she had a deep interest in both hospital-based and long-term care nursing. Ms. Hegner believed that to ensure the rights and well-being of residents in long-term care requires the care of competent, caring nursing assistants under the supervision of professional nurses. The nursing assistants who provide this care should be thoroughly trained and consistently encouraged, evaluated, and given the opportunity for continued learning. Providing the tools to prepare these health care providers in the most effective and efficient way is the goal of Assisting in Long-Term Care, fourth edition. Other texts by Barbara R. Hegner, also from Delmar Publishers are: Geriatrics, A Study of Maturity, fifth edition, and Nursing Assistant, A Nursing Process Approach, eighth edition. Joan Fritsch Needham, MSEd, RNC, is a contributing author to the fourth edition of Assisting in Long-Term Care. She also graduated from a three-year diploma nursing program. She received her BS from the College of Saint Francis and her MS from Northern Illinois University. She is certified by the American Nurses Association in Gerontological Nursing. Ms. Needham was Director of Education at a long-term care facility where she was responsible for staff development, curriculum development and instruction for basic and advanced nursing assistant training, and development and instruction in continuing education courses for licensed nurses. In addition, she is a consultant on nursing assistant education and nursing continuing education. She contributed to Nursing Assistant, A Nursing Process Approach, sixth, seventh, and eighth editions and is the author of Gerontological Nursing -- A Restorative Approach (Delmar) and Plans of Care for Specialty Practice, Gerontological Nursing (Delmar).

Table of Contents

About the Authors	xix
Preface	xxi
Acknowledgments	xxiii
About This Book	xxiv
Section 1 The Long-Term Care Setting	1	(48)
The Long Term Care Facility	3	(18)
Community Health Care Facilities	4	(4)
Types of Long-Term Care Facilities	8	(2)
Functional Areas in a Long-Term Care Facility	10	(4)
Standards and Regulations	14	(1)
OBRA Legislation	14	(1)
Financing in Long-Term Care	15	(1)
The Survey	16	(5)
The Caregivers	21	(12)
The Interdisciplinary Team Members	22	(6)
Administrative Organization	28	(1)
Educational Services	29	(4)
The Nursing Assistant in Long-Term Care	33	(16)
Professionalism	34	(1)
Personal Characteristics	34	(1)
Attitude	35	(1)
Personal Hygiene	36	(1)
Uniforms	36	(1)
Duties and Responsibilities: The Job Description	37	(2)
Staff Relations	39	(1)
Assignments	40	(1)
Specific Duties	40	(1)
Organization of Time	41	(1)
Violence in the Workplace	42	(1)
Self-Care	43	(1)
Sexual Harassment	44	(1)
Continue to Grow	44	(5)
Section 2 Communication Skills	49	(50)
Communication and Interpersonal Skills	51	(16)
The Communication Process	52	(1)
Communicating with Staff Members	53	(1)
Oral Communications	53	(2)
Written Communications	55	(1)
Communicating with Residents	56	(4)
Guidelines for Communicating with Residents	58	(2)
Communicating Through the Use of Touch	60	(1)
Communicating with Residents Who Have Special Needs	61	(3)
Communicating with the Potentially Violent Resident	64	(3)
The Language of Health Care	67	(18)
The Language of Health Care	68	(1)
Word Parts	68	(1)
Expanding Your Vocabulary	69	(1)
Common Word Parts	69	(3)
Common Abbreviations	72	(4)
Understanding the Body	76	(1)
Anatomic Terms	76	(2)
Organization of the Body	78	(1)
Cells	78	(1)
Tissues	79	(1)
Organs	79	(1)
Systems	79	(1)
Membranes	79	(2)
Cavities	81	(4)
Observation, Documentation, and Reporting	85	(14)
Observation	86	(5)
Reporting	91	(1)
Documentation	92	(2)
The Interdisciplinary Health Care Team Process	94	(5)
Section 3 Protecting Residents' Rights and Safety	99	(98)
Residents' Rights	101	(22)
Purpose of the Residents' Rights Document	102	(1)
Residents' Rights	103	(14)
Legal Aspects of Health Care	117	(1)
Ethics and the Health Care Provider	118	(5)
Safety	123	(16)
Safety in Health Care Facilities	124	(1)
Employee Safety	124	(3)
Guidelines for Using Ergonomic Techniques to Reduce the Risk of Having an Incident	125	(2)
Hazards in the Work Environment	127	(3)
Resident Safety	130	(5)
Guidelines for the Use of Restraints	132	(3)
Wheelchair Safety	135	(1)
Fire Safety	135	(4)
Emergencies	139	(16)
General Measures to Follow for Emergencies	140	(1)
Guidelines for Responding to an Emergency	140	(1)
Cardiac Arrest	141	(1)
Foreign Body Airway Obstruction (Choking)	142	(1)
The Recovery Position	143	(1)
Early Defibrillation	143	(1)
Assisting the Conscious Person with Obstructed Airway---Heimlich Maneuver	143	(2)
Obstructed Airway, Unconscious Person	145	(2)
One-Rescuer CPR, Adult	147	(1)
Positioning the Resident in the Recovery Position	148	(1)
Hemorrhage	148	(1)
Resident Falls	148	(1)
Seizures	148	(1)
Hemorrhage	149	(1)
Care of Falling Resident	150	(1)
Burns	151	(1)
Orthopedic Injuries	152	(1)
Accidental Poisoning	152	(1)
Fainting	152	(3)
Infection	155	(14)
Infectious Disease	156	(1)
Microbes	156	(1)
The Chain of Infection	157	(1)
Body Flora	158	(1)
Natural Body Defenses Against Disease	158	(1)
Immunity	159	(1)
Inmmunizations	160	(1)
Serious Infections in Health Care Facilities	160	(1)
Bacterial Infections	160	(2)
Viral Infections	162	(3)
Other Important Infections	165	(1)
Why the Elderly in Long-Term Care Are at Risk for Infections	165	(1)
General Measures to Prevent Infections	166	(1)
Outbreak of Infectious Disease in a Long-Term Care Facility	167	(2)
Infection Control	169	(28)
Medical Asepsis	170	(2)
Handwashing	172	(1)
Handwashing	172	(2)
Protecting Yourself	174	(1)
Standard Precautions	174	(4)
Guidelines for Standard Procautions	175	(1)
Guidelines for Environmental Procedures	176	(2)
Transmission-Based Precautions	178	(5)
Putting on a Mask and Gloves	183	(1)
Removing Contaminated Gloves	183	(1)
Putting on a Gown	184	(1)
Removing Contaminated Gloves, Mask, and Gown	185	(3)
Caring for Linens in Isolation Unit	188	(1)
Measuring Vital Signs in Isolation Unit	188	(1)
Serving a Meal Tray in Isolation Unit	189	(1)
Specimen Collection from Resident in Isolation Unit	190	(2)
Transferring Nondisposable Equipment Outside of Isolation Unit	192	(1)
Transporting Resident to and from Isolation Unit	192	(1)
Disinfection and Sterlization	193	(1)
Sterile Procedures	194	(1)
Opening a Sterile Package	194	(3)
Section 4 Characteristics of the Long-Term Care Resident	197	(38)
The Long-Term Care Resident	199	(14)
About Aging	200	(1)
The Process of Normal Aging	200	(1)
Changes Caused by Aging	200	(3)
Illness and Disability	203	(2)
Stereotypes and Myths	205	(3)
The Younger Resident in the Long-Term Care Facility	208	(1)
Guidelines for Caring for Younger Residents	209	(1)
Comfort, Rest, and Sleep	209	(4)
The Psychosocial Aspects of Aging	213	(14)
Basic Human Needs	214	(2)
Cultural Influences	216	(1)
Spirituality	216	(1)
Religion	217	(1)
Sexuality and Intimancy	217	(2)
Major Challenges to Adjustments	219	(1)
Using Defense (Coping) Mechanisms	220	(1)
Meeting Residents' Psychosocial Needs	221	(1)
Stress Reactions	222	(1)
Reactive Behaviors	222	(5)
Alternative Health Practices	227	(8)
Scientific (Western) Approach to Health Care	228	(1)
Alternative and Adjunctive Therapies	228	(4)
Importance for the Nursing Assistant	232	(3)
Section 5 Meeting the Residents' Basic Needs	235	(132)
Care of the Residents' Environment	237	(18)
Resident Environment	238	(1)
Personal Space	238	(1)
Resident Unit	239	(1)
Extended Resident Environment	240	(2)
Guidelines for Ensuring a Safe and Comfortable Environment	242	(1)
Critical Procedure Actions	242	(3)
Bedmaking	245	(1)
Guidelines for Handling Lines and Making the Bed	245	(1)
Unoccupied Bed: Changing Linens	246	(4)
Occupied Bed: Changing Linens	250	(5)
Caring for the Residents' Personal Hygiene	255	(36)
Epidermis	256	(1)
Dermis	256	(1)
Skin Functions	257	(1)
Skin Changes Caused by Aging	257	(1)
Skin Lesions	257	(7)
Guidelines for Preventing Skin Breakdown	261	(3)
Backrub	264	(1)
Bathing Residents	264	(1)
Backrub	265	(2)
Bed Bath Using Basin and Water	267	(3)
Bed Bath Using a Rinse-Free Cleanser and Moisturizer	270	(1)
Tub Bath or Shower	271	(1)
Partial Bath	272	(2)
Female Perineal Care	274	(1)
Male Perineal Care	275	(1)
Daily Hair Care	276	(1)
Facial Hair	277	(1)
Daily Hair Care	278	(1)
Shaving Male Resident	279	(1)
Hand and Fingernail Care	279	(1)
Hand and Fingernail Care	280	(1)
Foot and Toenail Care	280	(1)
Foot and Toenail Care	281	(1)
Oral Hygiene	281	(2)
Assisting Resident to Brush Teeth	283	(1)
Cleaning and Flossing Resident's Teeth	284	(1)
Caring for Dentures	285	(1)
Assisting with Oral Hygiene for the Unconscious Resident	286	(1)
Dressing Resident	286	(1)
Dressing and Undressing Resident	287	(4)
Meeting the Residents' Nutritional Needs	291	(28)
The Digestive System	292	(1)
The Digestive Process	293	(2)
Aging Changes	295	(1)
Nutrients	295	(1)
Electrolyte Balance	296	(1)
Food Groups	297	(2)
Nutritional Status	299	(1)
Dehydration	300	(1)
Intake and Output (I&O)	301	(1)
Measuring and Recording Fluid Intake	302	(1)
Diets	303	(2)
Nursing Assistant Responsibilities	305	(2)
Assisting the Resident Who Can Feed Self	307	(2)
Feeding the Dependent Resident	309	(1)
Nourishments and Supplements	310	(1)
Alternate Methods of Feeding	311	(1)
Disorders of the Digestive System	312	(7)
Meeting the Residents' Elimination Needs	319	(48)
Introduction	321	(1)
The Continent Resident	321	(1)
Equipment to Assist Elimination	321	(2)
Giving and Receiving the Bedpan	323	(2)
Giving and Receiving the Urinal	325	(1)
Assisting with Use of the Bedside Commode	326	(1)
Assisting Resident to Use the Bathroom	326	(1)
Elimination from the Lower Digestive Tract	327	(1)
The Resident with Constipation	328	(1)
Bowel Aids	328	(2)
Giving an Oil-Retention Enema or Commercially Prepared Enema	330	(1)
Giving a Soapsuds Enema	331	(6)
Rectal Tube and Flatus Bag	337	(1)
Inserting a Rectal Tube and Flatus Bag	338	(1)
Ostomies	338	(2)
Giving Routine Stoma Care (Colostomy)	340	(2)
Fecal Incontinence	342	(1)
Collecting a Stool Specimen	343	(1)
Collecting a Stool Specimen	343	(1)
Urinary System	344	(2)
Changes in the Urinary System Caused by Aging	346	(1)
Urine Elimination	347
Changes in the Urinary System Caused by Aging	346	(1)
Urine Elimination	347	(1)
Urinary Retention and Incontinence	347	(1)
Internal Urinary Catheter Drainage	347	(2)
Giving Indwelling Catheter Care	349	(3)
Emptying a Urinary Drainage Unit and Disconnecting the Catheter	352	(1)
Intake and Output (I&O)	352	(1)
Measuring and Recording Fluid Output	353	(3)
Leg Bag Drainage	356	(1)
Connecting Catheter to Leg Bag and Emptying the Leg Bag	357	(3)
Collecting a Routine or Clean-Catch Urine Specimen	360	(1)
External Urinary Drainage (Male)	361	(1)
Applying a Condom for Urinary Drainage	362	(1)
Common Conditions	363	(4)
Section 6 Special Nursing Assistant Activities	367	(60)
Measuring and Recording Residents' Data	369	(32)
Measuring Vital Signs	370	(1)
Temperature	371	(2)
Measuring an Oral Temperature (Glass Thermometer)	373	(2)
Measuring a Rectal Temperature (Glass Thermometer)	375	(1)
Measuring an Axillary Temperature (Glass Thermometer)	376	(1)
Measuring an Oral Temperature (Electronic Thermometer)	377	(1)
Measuring a Rectal Temperature (Electronic Thermometer)	378	(1)
Measuring an Axillary Temperature (Electronic Thermometer)	379	(1)
Measuring a Tympanic Temperature	380	(1)
Pulse and Respiration	381	(1)
Counting the Radial Pulse Rate	382	(1)
Counting the Apical-Radial Pulse	383	(2)
Counting Respirations	385	(1)
Blood Pressure	385	(4)
Guidelines for Preparing to Measure Blood Pressure	387	(2)
Taking Blood Pressure	389	(2)
Weighing and Measuring the Resident	391	(2)
Weighing and Measuring the Resident Using an Upright Scale	393	(1)
Measuring Weight with an Electronic Wheelchair Scale	394	(1)
Weighing the Resident in a Chair Scale	395	(1)
Measuring and Weighing the Resident in Bed	396	(1)
Recording Vital Signs	396	(5)
Admission, Transfer, and Discharge	401	(16)
Admitting the Resident	402	(3)
Admitting the Resident	405	(2)
Transferring the Resident	407	(2)
Discharging the Resident	409	(1)
Transferring the Resident	410	(1)
Discharging the Resident	411	(6)
Warm and Cold Applications	417	(10)
Safety	418	(1)
Commercial Preparations	418	(1)
Use of Warm Applications	419	(1)
Applying an Aquamatic K-Pad	420	(1)
Use of Cold Applications	421	(1)
Applying a Disposable Cold Pack	421	(1)
Applying an Ice Bag	422	(1)
Assisting with the Application of a Hypothermia Blanket	423	(4)
Section 7 Introduction to Restorative Care	427	(90)
Restorative/Rehabilitative Care of the Resident	429	(54)
Restorative Care and the Interdisciplinary Health Team	431	(1)
Purposes of Restorative/Rehabilitative Care	432	(1)
Preventing Complications from Inactivity	433	(3)
Activities of Daily Living	436	(1)
Setting Up Restorative Programs	437	(7)
Guidelines for Nursing Assistant Responsibilities in General Restorative Program	443	(1)
The Restorative/Rehabilitative Environment	444	(1)
Progressive Mobilization	445	(1)
Range of Motion	445	(3)
Guidelines for Passive Range of Motion Exercises	445	(3)
Passive Range of Motion Exercises	448	(8)
Self Range of Motion Exercises	456	(1)
Active Range of Motion Exercises	456	(1)
Positioning the Resident	457	(4)
Guidelines for Positioning	457	(4)
Turning the Dependent Resident with a Turning Sheet	461	(1)
Moving the Resident in Bed	462	(2)
Turning the Resident to the Side	464	(1)
Logrolling the Resident onto the Side	465	(2)
Positioning the Dependent Resident	467	(1)
Supine Position	467	(1)
Semisupine or Tilt Position	468	(1)
Lateral (Side-Lying) Position	468	(1)
Lateral Position on the Affected Side	469	(1)
Semiprone Position	470	(1)
Fowler's Position	470	(2)
Chair Positioning	472	(1)
Repositioning a Resident in a Wheelchair	473	(1)
Wheelchair Activities to Relieve Pressure	474	(2)
Independent Bed Movement	476	(1)
Assisting with Independent Bed Movement	476	(1)
Continuing with Progressive Mobilization	477	(1)
Bowel and Bladder Programs	477	(6)
Guidelines for Bowel and Bladder Programs	478	(5)
Restoring Residents' Mobility	483	(34)
Transfers	484	(1)
Guidelines for Transfers	485	(1)
Using a Transfer Belt (Gait Belt)	485	(2)
Bringing the Resident to a Sitting Position at the Edge of the Bed	487	(2)
Assisted Standing Transfer	489	(1)
Transferring the Resident from Chair to Bed	490	(1)
Assisted Standing Transfer/Two Assistants	491	(1)
Wheelchair to Toilet and Toilet to Wheelchair Transfers	492	(2)
Transferring to Tub Chair or Shower Chair	494	(1)
Transferring a Nonstanding Resident from Wheelchair to Bed	495	(1)
Using Mechanical Lifts	496	(1)
Transferring Resident with a Mechanical Lift	496	(3)
Sliding Board Transfer	499	(1)
Guidelines for Sliding Board Transfers	499	(1)
Sliding Board Transfer	499	(1)
Ambulation	500	(4)
Guidelines for Ambulation	504	(1)
Ambulating a Resident	504	(1)
Assisting Resident to Ambulate with Cane or Walker	505	(1)
Using a Wheelchair	506	(1)
Special Maneuvers with Wheelchairs	507	(4)
Positioning the Dependent Resident in the Wheelchair	511	(2)
Wheelchair Activity	513	(4)
Section 8 Residents with Specific Disorders	517	(98)
Caring for Residents with Cardiovascular System Disorders	519	(20)
Introduction	520	(1)
The Heart	521	(1)
Blood Vessels	522	(1)
Lymph	523	(3)
The Blood	526	(1)
Disorders of the Blood	526	(1)
Disorders of the Blood Vessels and Circulation	526	(5)
Guidelines for Caring for Residents with Peripheral Vascular Disease	529	(2)
Heart Disease	531	(2)
Applying Elasticized Stockings	533	(6)
Caring for Residents with Respiratory System Disorders	539	(12)
Introduction	540	(1)
The Respiratory Organs	540	(1)
Voice Production	541	(1)
Changes in the Respiratory System Caused by Aging	542	(1)
Introduction to Pathology	542	(2)
Collecting a Sputum Specimen	544	(1)
Chronic Obstructive Pulmonary Disease	545	(1)
Treatment and Care of Residents with COPD	545	(3)
Refilling the Humidifier Bottle	548	(3)
Caring for Residents with Endocrine System Disorders	551	(12)
Introduction	552	(1)
Endocrine Glands	553	(1)
Aging Changes	554	(1)
Glucose Metabolism	555	(1)
Diabetes Mellitus	556	(7)
Caring for Residents with Reproductive System Disorders	563	(14)
Introduction	564	(1)
The Male Reproductive System	564	(2)
The Female Reproductive System	566	(2)
Menstrual Cycle	568	(1)
Menopause	568	(1)
Changes in the Reproductive System as a Result of Aging	568	(1)
Related Conditions	569	(2)
Sexually Transmitted Diseases	571	(6)
Caring for Residents with Musculoskeletal System Disorders	577	(14)
The Musculoskeletal System	578	(3)
Changes in the Musculoskeletal System Caused by Aging	581	(1)
Conditions Affecting the Musculoskeletal System	581	(10)
Caring for Residents with Nervous System Disorders	591	(24)
Components of the Nervous System	593	(1)
Central Nervous System	594	(2)
Autonomic Nervous System	596	(1)
Sense Organs	596	(2)
Changes in the Nervous System Caused by Aging	598	(1)
Causes of Severe Vision Impairment	598	(1)
Care of Eyeglasses	599	(1)
Guidelines for Assisting Visually Impaired Residents	600	(1)
Hearing Loss	600	(2)
Applying and Removing In-the-Ear or Behind-the-Ear Hearing Aids	602	(1)
Nervous System Disorders	602	(13)
Guidelines for Caring for Residents with Parkinson's Disease	604	(2)
Guidelines for Caring for Residents Who Have Had a Stroke	606	(2)
Guidelines for Caring for Residents with Multiple Sclerosis	608	(1)
Guidelines for Caring for Residents with Huntington's Disease	609	(1)
Guidelines for Caring for Residents Who Have Amyotrophic Lateral Sclerosis Amyotrophic Lateral Sclerosis	610	(1)
Guidelines for Caring for Residents Who Have Myasthenia Gravis	610	(5)
Section 9 Residents with Special Needs	615	(50)
Alzheimer's Disease and Related Disorders (Caring for the Cognitively Impaired Resident)	617	(16)
Definition of Alzheimer's Disease	618	(2)
Stages and Symptoms of Alzheimer's Disease	620	(2)
Caring for Residents with Dementia	622	(6)
Guidelines for Caring for Residents with Alzheimer's Disease	623	(3)
Guidelines for Activities of Daily Living	626	(2)
Special Problems	628	(1)
Special Management Techniques	629	(4)
Caring for Residents with Developmental Disabilities	633	(10)
Characteristics of a Developmental Disability	634	(1)
Mental Retardation	635	(2)
Other Forms of Developmental Disabilities	637	(2)
Caring for Residents with Developmental Disabilities	639	(4)
Caring for the Dying Resident	643	(10)
Introduction	644	(1)
Hospice Care	644	(1)
The Dying Process	644	(4)
Signs of Approaching Death	648	(1)
Postmortem Care	648	(2)
Giving Postmortem Care	650	(3)
Caring for the Person in Subacute Care	653	(12)
Description of Subacute Care	654	(1)
Special Procedures Provided in the Subacute Care Unit	655	(1)
Care of the Surgical Patient	655	(1)
Pulse Oximetry	655	(1)
Pain Management Procedures	655	(1)
Intravenous Therapy	656	(2)
Guidelines for Caring for Residents with Intravenous Lines	658	(1)
Changing a Gown on a Resident with a Peripheral Intravenous Line in Place	658	(2)
Caring for Residents with Tracheostomines	660	(1)
Caring for the Resident Receiving Dialysis Treatments	661	(1)
Oncology Treatments	662	(3)
Section 10 Employment	665	(20)
Seeking Employment	667	(18)
Congratulations Are in Order	675	(1)
Self-Appraisal	676	(1)
Possibility Search	676	(1)
The Resume	677	(1)
References	678	(1)
Taking the Step	678	(1)
The Interview (Putting Your Best Foot Foreward)	678	(1)
Keeping the Job	679	(1)
Growing	680	(1)
Resigning	681	(4)
Glossary	685	(20)
Index	705