Assisting in Long-term Care

by Hegner, Barbara; Gerlach, Mary Jo Mirlenbrink

• ISBN13: 9781401899547
• ISBN10: 1401899544
• Edition: 5th
• Format: Paperback
• Copyright: 2006-07-27
• Publisher: CENGAGE Delmar Learning

Summary

This comprehensive, user-friendly book provides the theoretical knowledge and skills content you need to successfully complete a nursing assistant certification exam. The book meets OBRA guidelines and prepares you to work in a variety of long-term care settings or sub-acute units in the hospital. A major goal of this resource is to help you develop an understanding of the principles of safe and effective care of residents in long-term care. Special emphasis is placed on residents' rights, nutrition and hydration, restorative care, resident mobility, and maintaining a safe environment.From Doody's Book Review"This book, written to meet the needs of persons who wish to become CNAs and work in long term care (LTC), provides core concepts and clearly explains the basic principles of nursing care of the elderly.Weighted Numerical Score: 100 - 5 Stars!"

Table of Contents

List of Procedures	p. xxi
About the Authors	p. xxvi
Preface	p. xxvii
Acknowledgments	p. xxxi
How to Use This Book	p. xxxii
The Long-Term Care Setting	p. 1
The Long-Term Care Facility	p. 2
Community Health Care Facilities	p. 3
Types of Long-Term Care Facilities	p. 7
Functional Areas in a Long-Term Care Facility	p. 9
Standards and Regulations	p. 13
Health Insurance Portability and Accountability	p. 13
OBRA Legislation	p. 13
Financing in Long-Term Care	p. 14
The Survey	p. 16
The Caregivers	p. 20
The Interdisciplinary Team Members	p. 21
Administrative Organization	p. 27
Educational Services	p. 28
The Nursing Assistant in Long-Term Care	p. 30
Professionalism	p. 31
Personal Characteristics	p. 31
Attitude	p. 32
Personal Hygiene	p. 33
Uniforms	p. 33
Duties and Responsibilities: The Job Description	p. 35
Staff Relations	p. 35
Assignments	p. 35
Specific Duties	p. 38
Organization of Time	p. 39
Workplace Environment	p. 39
Self-Care	p. 41
Sexual Harassment	p. 42
Continue to Grow	p. 42
Communication Skills	p. 47
Communication and Interpersonal Skills	p. 48
The Communication Process	p. 49
Communicating with Staff Members	p. 50
Oral Communications	p. 50
Written Communications	p. 52
Communicating with Residents	p. 56
Guidelines for Communicating with Residents	p. 57
Communicating Through the Use of Touch	p. 58
Communicating with Residents Who Have Special Needs	p. 59
Communicating with the Potentially Violent Resident	p. 63
The Language of Health Care	p. 67
The Language of Health Care	p. 68
Word Parts	p. 68
Expanding Your Vocabulary	p. 70
Abbreviations	p. 71
Understanding the Body	p. 71
Anatomic Terms	p. 71
Organization of the Body	p. 78
Cells	p. 79
Tissues	p. 79
Organs	p. 79
Systems	p. 79
Membranes	p. 79
Cavities	p. 81
Observation, Documentation, and Reporting	p. 85
Observation	p. 86
Reporting	p. 91
Documentation	p. 92
The Interdisciplinary Health Care Team Process	p. 95
Protecting Residents' Rights and Safety	p. 99
Residents' Rights	p. 100
Purpose of the Residents' Rights Document	p. 101
Residents' Rights	p. 104
Legal Aspects of Health Care	p. 116
Ethics and the Health Care Provider	p. 117
Safety	p. 121
Safety in Health Care Facilities	p. 122
Employee Safety	p. 122
Guidelines for Using Ergonomic Techniques to Reduce the Risk of Having an Incident	p. 123
Hazards in the Work Environment	p. 124
Resident Safety	p. 127
Guidelines for Using Restraints	p. 132
Wheelchair Safety	p. 136
Fire Safety	p. 136
Safety Issues for Disasters/Threats	p. 137
Emergencies	p. 141
General Measures to Follow for Emergencies	p. 142
Cardiac Arrest	p. 142
Guidelines for Responding to an Emergency	p. 143
Foreign Body Airway Obstruction (Choking)	p. 144
Assisting the Conscious Person with Obstructed Airway-Heimlich Maneuver	p. 145
The Recovery Position	p. 145
Early Defibrillation	p. 146
Hemorrhage	p. 146
Obstructed Airway, Unconscious Person	p. 147
Resident Falls	p. 148
One-Rescuer CPR, Adult	p. 149
Seizures	p. 149
Positioning the Resident in the Recovery Position	p. 150
Hemorrhage	p. 150
Care of Falling Resident	p. 151
Burns	p. 152
Orthopedic Injuries	p. 153
Accidental Poisoning	p. 153
Fainting	p. 153
Infection	p. 156
Infectious Disease	p. 157
Microbes	p. 157
The Chain of Infection	p. 158
Normal Body Flora	p. 159
Natural Body Defenses Against Disease	p. 160
Immunity	p. 161
Serious Infections in Health Care Facilities	p. 162
Bacterial Infections	p. 162
Viral Infections	p. 164
Other Important Infections	p. 168
Why Older Residents in Long-Term Care Are at Risk for Infections	p. 169
General Measures to Prevent Infections	p. 169
Outbreak of Infectious Disease in a Long-Term Care Facility	p. 170
Infection Control	p. 173
Medical Asepsis	p. 174
Handcare	p. 177
Handwashing	p. 177
Protecting Yourself	p. 178
Standard Precautions	p. 179
Transmission-Based Precautions	p. 179
Guidelines for Standard Precautions	p. 180
Guidelines for Environmental Procedures	p. 182
Disinfection and Sterilization	p. 188
Donning a Mask and Gloves	p. 189
Removing Contaminated Gloves	p. 189
Donning a Gown	p. 190
Removing Contaminated Gloves, Mask, and Gown	p. 191
Caring for Linens in Isolation Unit	p. 194
Measuring Vital Signs in Isolation Unit	p. 194
Serving a Meal Tray in Isolation Unit	p. 195
Specimen Collection from Resident in Isolation Unit	p. 196
Transferring Nondisposable Equipment Outside of Isolation Unit	p. 198
Transporting Resident to and from Isolation Unit	p. 198
Sterile Procedures	p. 199
Opening a Sterile Package	p. 200
Characteristics of the Long-Term Care Resident	p. 203
The Long-Term Care Resident	p. 204
About Aging	p. 205
The Process of Normal Aging	p. 205
Changes Caused by Aging	p. 205
Illness and Disability	p. 206
Stereotypes and Myths	p. 210
The Younger Resident in the Long-Term Care Facility	p. 213
Guidelines for Caring for Residents with Huntington's Disease	p. 214
Comfort, Rest, and Sleep	p. 214
The Psychosocial Aspects of Aging	p. 219
Basic Human Needs	p. 220
Cultural Influences	p. 222
Spirituality	p. 223
Religion	p. 223
Sexuality and Intimacy	p. 223
Major Challenges to Adjustments	p. 225
Using Defense (Coping) Mechanisms	p. 226
Meeting Residents' Psychosocial Needs	p. 227
Stress Reactions	p. 228
Reactive Behaviors	p. 228
Alternative and Culturally Based Health Behaviors	p. 232
Scientific (Western) Approach to Health Care	p. 233
Alternative and Adjunctive Therapies	p. 233
Cultural Sensitivity	p. 238
Importance for the Nursing Assistant	p. 240
Meeting the Residents' Basic Needs	p. 243
Care of the Residents' Environment	p. 244
Resident Environment	p. 245
Personal Space	p. 245
Resident Unit	p. 246
Extended Resident Environment	p. 247
Guidelines for Ensuring a Safe and Comfortable Environment	p. 249
Critical Procedure Actions	p. 250
Bedmaking	p. 250
Guidelines for Handling Linens and Making the Bed	p. 253
Unoccupied Bed: Changing Linens	p. 254
Occupied Bed: Changing Linens	p. 258
Caring for the Residents' Personal Hygiene	p. 262
Epidermis	p. 263
Dermis	p. 263
Skin Functions	p. 264
Skin Changes Caused by Aging	p. 264
Skin Lesions	p. 265
Guidelines for Preventing Skin Breakdown	p. 268
Backrub	p. 272
Bathing Residents	p. 272
Backrub	p. 272
Bed Bath Using Basin and Water	p. 275
Bed Bath Using a Rinse-Free Cleanser and Moisturizer	p. 278
Tub Bath or Shower	p. 279
Partial Bath	p. 281
Hair Care	p. 282
Female Perineal Care	p. 282
Male Perineal Care	p. 284
Facial Hair	p. 286
Hand and Fingernail Care	p. 287
Daily Hair Care	p. 287
Shaving Male Resident	p. 288
Foot and Toenail Care	p. 288
Hand and Fingernail Care	p. 289
Foot and Toenail Care	p. 290
Oral Hygiene	p. 290
Assisting Resident to Brush Teeth	p. 292
Cleaning and Flossing Resident's Teeth	p. 292
Caring for Dentures	p. 294
Assisting with Oral Hygiene for the Unconscious Resident	p. 295
Dressing Resident	p. 295
Dressing and Undressing Resident	p. 296
Meeting the Residents' Nutritional Needs	p. 300
The Digestive System	p. 301
The Digestive Process	p. 302
Aging Changes	p. 304
Nutrients	p. 304
Electrolyte Balance	p. 305
The 2005 Dietary Guidelines for Americans	p. 305
Nutritional Status	p. 308
Dehydration	p. 309
Intake and Output (I&O)	p. 310
Measuring and Recording Fluid Intake	p. 311
Diets	p. 312
Nursing Assistant Responsibilities	p. 314
Assisting the Resident Who Can Feed Self	p. 316
Feeding the Dependent Resident	p. 319
Nourishments and Supplements	p. 320
Alternate Methods of Feeding	p. 321
Disorders of the Digestive System	p. 322
Meeting the Residents' Elimination Needs	p. 328
Introduction	p. 329
The Continent Resident	p. 329
Equipment to Assist Elimination	p. 330
Giving and Receiving the Bedpan	p. 331
Giving and Receiving the Urinal	p. 333
Assisting with Use of the Bedside Commode	p. 334
Assisting Resident to Use the Bathroom	p. 335
Elimination from the Lower Digestive Tract	p. 336
The Resident with Constipation	p. 336
Bowel Aids	p. 337
Giving an Oil-Retention or Commercially Prepared Enema	p. 338
Giving a Soapsuds Enema	p. 339
Rectal Tube and Flatus Bag	p. 342
Inserting a Rectal Tube and Flatus Bag	p. 342
Ostomies	p. 343
Giving Routine Stoma Care (Colostomy)	p. 344
Fecal Incontinence	p. 347
Collecting a Stool Specimen	p. 347
Collecting a Stool Specimen	p. 347
Urinary System	p. 349
Urine Elimination	p. 350
Changes in the Urinary System Caused by Aging	p. 351
Urinary Retention and Incontinence	p. 351
Internal Urinary Catheter Drainage	p. 352
Giving Indwelling Catheter Care	p. 353
Intake and Output (I&O)	p. 355
Emptying a Urinary Drainage Unit and Disconnecting the Catheter	p. 355
Measuring and Recording Fluid Output	p. 357
Leg Bag Drainage	p. 359
Connecting Catheter to Leg Bag and Emptying the Leg Bag	p. 360
Collecting a Routine or Clean-Catch Urine Specimen	p. 361
External Urinary Drainage (Male)	p. 364
Common Conditions	p. 364
Applying a Condom for Urinary Drainage	p. 364
Special Nursing Assistant Activities	p. 369
Measuring and Recording Residents' Data	p. 370
Measuring Vital Signs	p. 371
Temperature	p. 371
Measuring an Oral Temperature (Glass Thermometer)	p. 374
Measuring a Rectal Temperature (Glass Thermometer)	p. 376
Measuring an Axillary Temperature (Glass Thermometer)	p. 377
Measuring an Oral Temperature (Electronic Thermometer)	p. 378
Measuring a Rectal Temperature (Electronic Thermometer)	p. 378
Measuring an Axillary Temperature (Electronic Thermometer)	p. 379
Measuring a Tympanic Temperature	p. 379
Pulse and Respiration	p. 381
Counting the Radial Pulse Rate	p. 382
Counting the Apical-Radial Pulse	p. 383
Blood Pressure	p. 384
Counting Respirations	p. 384
Guidelines for Preparing to Measure Blood Pressure	p. 387
Taking Blood Pressure	p. 388
Weighing and Measuring the Resident	p. 389
Weighing and Measuring the Resident Using an Upright Scale	p. 391
Measuring Weight with an Electronic Wheelchair Scale	p. 392
Weighing the Resident in a Chair Scale	p. 393
Measuring and Weighing the Resident in Bed	p. 394
Recording Vital Signs	p. 395
Admission, Transfer, and Discharge	p. 398
Admitting the Resident	p. 399
Admitting the Resident	p. 402
Transferring the Resident	p. 404
Transferring the Resident	p. 407
Discharging the Resident	p. 407
Discharging the Resident	p. 408
Warm and Cold Applications	p. 415
Safety	p. 416
Commercial Preparations	p. 416
Use of Warm Applications	p. 417
Applying an Aquamatic K-Pad	p. 418
Use of Cold Applications	p. 419
Applying a Disposable Cold Pack	p. 419
Applying an Ice Bag	p. 420
Assisting with the Application of a Hypothermia Blanket	p. 421
Introduction to Restorative Care	p. 425
Restorative and Rehabilitative Care of the Resident	p. 426
Restorative Care and the Interdisciplinary Healthcare Team	p. 428
Purposes of Restorative and Rehabilitative Care	p. 429
Preventing Complications from Inactivity	p. 430
Activities of Daily Living	p. 430
Setting Up Restorative Programs	p. 433
The Restorative and Rehabilitative Environment	p. 435
Guidelines for Nursing Assistant Responsibilities in General Restorative Program	p. 439
Progressive Mobilization	p. 440
Range of Motion	p. 440
Guidelines for Passive Range-of-Motion Exercises	p. 441
Passive Range-of-Motion Exercises	p. 443
Self Range-of-Motion Exercises	p. 451
Active Range-of-Motion Exercises	p. 451
Positioning the Resident	p. 451
Guidelines for Positioning	p. 452
Turning the Dependent Resident with a Turning Sheet	p. 456
Moving the Resident in Bed	p. 456
Turning the Resident to the Side	p. 458
Logrolling the Resident onto the Side	p. 459
Positioning the Dependent Resident	p. 460
Supine Position	p. 461
Semisupine or Tilt Position	p. 461
Lateral (Side-Lying) Position	p. 462
Lateral Position on the Affected Side	p. 463
Semiprone Position	p. 463
Fowler's Position	p. 464
Chair Positioning	p. 466
Repositioning a Resident in a Wheelchair	p. 467
Wheelchair Activities to Relieve Pressure	p. 467
Independent Bed Movement	p. 468
Assisting with Independent Bed Movement	p. 468
Continuing with Progressive Mobilization	p. 469
Bowel and Bladder Programs	p. 469
Guidelines for Bowel and Bladder Programs	p. 470
Restoring Residents' Mobility	p. 475
Transfers	p. 476
Guidelines for Transfers	p. 477
Using a Transfer Belt (Gait Belt)	p. 477
Bringing the Resident to a Sitting Position at the Edge of the Bed	p. 479
Assisted Standing Transfer	p. 480
Transferring the Resident from Chair to Bed	p. 482
Assisted Standing Transfer/Two Assistants	p. 482
Wheelchair to Toilet and Toilet to Wheelchair Transfers	p. 483
Transferring to Tub Chair or Shower Chair	p. 485
Transferring a Nonstanding Resident from Wheelchair to Bed	p. 486
Using Mechanical Lifts	p. 486
Transferring Resident with a Mechanical Lift	p. 487
Sliding Board Transfer	p. 489
Ambulation	p. 489
Guidelines for Sliding Board Transfers	p. 490
Sliding Board Transfer	p. 490
Using a Wheelchair	p. 493
Guidelines for Ambulation	p. 496
Ambulating a Resident	p. 496
Assisting Resident to Ambulate with Cane or Walker	p. 496
Special Maneuvers with Wheelchairs	p. 498
Positioning the Dependent Resident in the Wheelchair	p. 501
Wheelchair Activity	p. 503
Residents with Specific Disorders	p. 507
Caring for Residents with Cardiovascular Disorders	p. 508
Introduction	p. 509
The Heart	p. 510
Blood Vessels	p. 511
Lymph	p. 512
The Blood	p. 512
Disorders of the Blood	p. 513
Disorders of the Blood Vessels and Circulation	p. 513
Guidelines for Caring for Residents with Peripheral Vascular Disease	p. 517
Heart Disease	p. 517
Applying Elasticized Stockings	p. 521
Caring for Residents with Respiratory System Disorders	p. 525
Introduction	p. 526
The Respiratory Structures	p. 526
Voice Production	p. 527
Changes Caused by Aging	p. 527
Introduction to Pathology	p. 528
Collecting a Sputum Specimen	p. 530
Chronic Obstructive Pulmonary Disease	p. 530
Treatment and Care of Residents with COPD	p. 531
Refilling the Humidifier Bottle	p. 535
Caring for Residents with Endocrine System Disorders	p. 538
Introduction	p. 539
Endocrine Glands	p. 539
Aging Changes	p. 541
Glucose Metabolism	p. 541
Diabetes Mellitus	p. 542
Caring for Residents with Reproductive System Disorders	p. 548
Introduction	p. 549
The Male Reproductive System	p. 549
The Female Reproductive System	p. 551
Menstrual Cycle	p. 552
Menopause	p. 553
Changes in the Reproductive System as a Result of Aging	p. 553
Related Conditions	p. 553
Sexually Transmitted Diseases	p. 555
Caring for Residents with Musculoskeletal System Disorders	p. 559
The Musculoskeletal System	p. 560
Changes in the Musculoskeletal System Caused by Aging	p. 561
Conditions Affecting the Musculoskeletal System	p. 563
Caring for Residents with Nervous System Disorders	p. 573
Components of the Nervous System	p. 574
Central Nervous System	p. 576
Autonomic Nervous System	p. 578
Sense Organs	p. 578
Changes in the Nervous System Caused by Aging	p. 580
Causes of Severe Vision Impairment	p. 580
Care of Eyeglasses	p. 580
Guidelines for Assisting Visually Impaired Residents	p. 581
Hearing Loss	p. 582
Applying and Removing In-the-Ear or Behind-the-Ear Hearing Aids	p. 584
Nervous System Disorders	p. 584
Guidelines for Caring for Residents with Parkinson's Disease	p. 586
Guidelines for Caring for Residents Who Have Had a Stroke	p. 588
Guidelines for Caring for Residents with Multiple Sclerosis	p. 589
Guidelines for Caring for Residents with Huntington's Disease	p. 591
Guidelines for Caring for Residents Who Have Amyotrophic Lateral Sclerosis	p. 591
Guidelines for Caring for Residents Who Have Myasthenia Gravis	p. 592
Residents with Special Needs	p. 597
Alzheimer's Disease and Related Disorders (Caring for the Cognitively Impaired Resident)	p. 598
Definition of Alzheimer's Disease	p. 599
Stages and Symptoms of Alzheimer's Disease	p. 600
Caring for Residents with Dementia	p. 603
Guidelines for Caring for Residents with Alzheimer's Disease	p. 605
Guidelines for Activities of Daily Living	p. 607
Special Problems	p. 610
Special Management Techniques	p. 611
Caring for Residents with Developmental Disabilities	p. 615
Characteristics of a Developmental Disability	p. 616
Mental Retardation	p. 618
Other Forms of Developmental Disabilities	p. 619
Caring for Residents with Developmental Disabilities	p. 622
Caring for the Dying Resident	p. 625
Introduction	p. 626
Hospice Care	p. 626
The Dying Process	p. 627
Signs of Approaching Death	p. 634
Postmortem Care	p. 635
Giving Postmortem Care	p. 636
Caring for the Person in Subacute Care	p. 639
Description of Subacute Care	p. 640
Special Procedures Provided in the Subacute Care Unit	p. 644
Care of the Surgical Patient	p. 644
Guidelines for Electronic Blood Pressure Monitoring	p. 645
Pulse Oximetry	p. 645
Taking Blood Pressure with an Electronic Blood Pressure Apparatus	p. 646
Intravenous Therapy	p. 647
Using a Pulse Oximeter	p. 648
Guidelines for Caring for Residents with Intravenous Lines	p. 651
Pain Management Procedures	p. 651
Changing a Gown on a Resident with a Peripheral Intravenous Line in Place	p. 653
Caring for Residents with Tracheostomies	p. 654
Caring for the Resident Receiving Dialysis Treatments	p. 655
Oncology Treatments	p. 657
Caring for the Person in the Home Setting	p. 661
Benefits of Home Health Care	p. 663
The Home Health Care Team	p. 663
Characteristics of the Home Health Nursing Assistant	p. 664
Home Health Nursing Assistant Duties	p. 664
Time Management	p. 666
Safety in the Home	p. 666
Home Management	p. 669
Communication and Documentation	p. 670
Employment	p. 677
Seeking Employment	p. 678
Congratulations Are in Order	p. 679
Self-Appraisal	p. 679
Job Search	p. 679
The Resume	p. 680
References	p. 681
Taking the Step	p. 681
The Interview (Putting Your Best Foot Forward)	p. 682
Keeping the Job	p. 683
Growing	p. 683
Resigning	p. 685
Glossary	p. 689
Index	p. 711
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