Study Guide – Comprehensive Exam IV – Final Exam
Thrombus – blood clot
Topical – on the surface (topical ointment put on the surface of the skin)
Sundowning – Alzheimer’s behaviors worsen in the late afternoon & evening
Shift report – at the end of your shift at a hospital / nursing center – you will report pertinent information to the next shift – must be detailed of what was done / what needs to be done and any other info
Catastrophic reaction – Alzheimer’s patients over react to situations “like it was a catastrophe” .. usually caused by being over stimulated
Gangrene – death of the tissues from lack of circulation (blood flow)
Jaundice - in liver (hepatitis) and gall bladder problems the patient’s skin and sclera (white of the eyes) becomes yellow in color
Congestive heart failure – when the heart is weakened and unable to put blood adequately – right sided failure blood backs up into circulation and you get leg swelling and left sided failure blood backs up into the lungs and you get lung / chest congestion & difficulty breathing
Coronary artery disease – heart (coronary) arteries become “clogged” with plague (fatty deposits) and makes circulation to & from the heart more difficult
Cyanosis –bluish tinge to the skin, lips and around mouth area
Prosthesis –artificial limb following an amputation
Aphasia –inability to speak (expressive – patient understands what is said to them but unable to respond with appropriate words or speak at all / receptive – patient does not understand what is said to them)
Polyuria –“a lot” of urine…more than what would be normally expected
Angina –chest pain (burning, stabbing, crushing)
Metastasis –malignant tumor spreads to other body parts / organs
Cataract - clouding of the eye lens
Renal Calculi – kidney stone
Edema - excess fluid held in the tissues
Chapter 4 – Communicating With the Health Team
Rules for charting – WRITTEN ACCOUNT of CARE & OBSERVATIONS -- medical record can be either written or electronic, each page must have patient’s name, room # and any other identifying information your facility uses, information must be accurate, legible, objective & subjective data (pt expressed to me….said to me…..related to me….) you are not allowed to DIAGNOSE, use only approved abbreviations,
- Whenever a change in normal
- When a nurse asks you to document
- When you leave unit before reporting off
- Before the end of your shift
- Prompt & accurate
- Report only what you did or what you observed personally – never HEAR SAY
- NOTES are specific, concise and clear
Subjective and Objective observations – subjective are TOLD TO YOU while objective YOU CAN SEE
Non verbal communication – communication without words, smiles, grimaces, crying etc
CNA participation in nursing process – the 5 steps in the nursing process are assessment (RN), nursing diagnosis (RN), planning (RN & CNA), implementation (RN & CNA), and evaluation (RN & CNA)
Guidelines for computerized charting – log in with your unique “user” identification, must be password protected, make sure time is accurate, all documentation is accurate, SAVE your entries, following your agency’s policy & protocol for making changes to the record, LOG OFF after you are finished so that no one can document under YOUR NAME….be sure that your computer if set up for if you are called away BEFORE logging off – it quickly goes to a password protected screen
Resident care conferences– OBRA requires 2 different types of care conferences. Interdisciplinary to regularly review & update the resident’s care plan (nurse, doctor, CNAs and other health team members participate in this conference) and problem focused when a problem affects the resident’s care. Only staff directly involved with resident’s care attends this conference.
Reporting & recording – your responsibility is to report & record the following information”
- Whenever there is a change in resident’s condition – report these immediately
- When the RN asks you to
- When you leave the unit for breaks &/or meals
- Before the end of the shift report
Abbreviations : BR Bedrest PRN as needed BRPbathroom privilege TID3x a dayQDevery day
QOD every other dayO2 oxygen CVA stroke MI heart attackStatimmediately
Hepatliver relatedCOPDchronic obstructive pulmonary diseaseQID 4x per day ALS amyotrophic lateral sclerosis TPRtemperature pulse & respiration
Chapter 5 – Understanding the Person
Body language – messages you send through facial expressions, gestures, posture, hand and body movements
Culture – characteristics of a group of people – values, beliefs, habits, likes & dislikes, customs passed down through the generations
Holism – concept that considers the whole person physically, socially, psychologically and spiritually
Need – something necessary or desired for life & mental well being
Communication – VERBAL – communication that uses spoken words / NON VERBAL- communication that does not use words
How will you address your residents? Use their title Mr. or Mrs. Do not use their first name unless they ask you to. Do not use anyother names – honey, sweetie, grandpa etc.
What is the hierarchy of needs? Maslow’s basic needs for lite?
Physical needs – oxygen, food, water, elimination, rest & shelter needed for life
Safety & security –feeling safe & free of danger or fear
Love & belonging – love, closeness, affection, meaningful relationships
Self –esteem – you think well of yourself, you feel useful and that you have value as a person
Self actualization – you are experiencing your potential – it involves learning, understanding and creating
Disability – many accept illness, injury & disability. Others do not adjust well. Some of the following are potential behaviors – understand where these behaviors are coming from and you will be better able to cope.
- Anger
- Demanding behavior
- Self centered behavior
- Aggressive behavior
- Withdrawal
- Inappropriate sexual behavior
Communication tips:
- Use words that have the same meaning to you and the resident
- Avoid medical terms that only you will understand
- Communicate in a logical & orderly manner
- Give facts, be specific
- Understand and resident your resident
- Appreciate the problems and frustrations
- Respect their rights, religion & culture
- Give the resident time to process what you have said
- Repeat information as much as your need to
- Ask questions to see if the resident understood
- Be patient, residents with memory issues may ask you the same questions over & over
- Include everyone in the conversation – do not exclude
Communication methods
- Listen
- Ask direct questions
- Ask open ended questions
- Clarify as many times as needed
- Silence – in sad times, you just need to be with the person
- Ask simple yes & no questions
Communication barriers –
- Language
- Cultural differences
- Changing the subject
- Giving opinions
- Talking a lot when others are silent
- Failing to listen
- Pat answers “everything will be OK” when it might not be OK
- Illness & disability
- Age
Communicating with a comatose resident –
- Always knock before entering
- Tell resident your name & title
- Give care according to schedule every day
- Explain step by step what you are doing
- Tell the resident when you are finished
- Use touch to communicate concern, care and comfort
- Tell the resident when you will be back (the time) and be sure to return on time
- Tell the resident when you are leaving the room
Disability – many accept illness, injury & disability. Others do not adjust well. Some of the following are potential behaviors – understand where these behaviors are coming from and you will be better able to cope.
- Anger
- Demanding behavior
- Self centered behavior
- Aggressive behavior
- Withdrawal
- Inappropriate sexual behavior
Communication tips:
- Use words that have the same meaning to you and the resident
- Avoid medical terms that only you will understand
- Communicate in a logical & orderly manner
- Give facts, be specific
- Understand and resident your resident
- Appreciate the problems and frustrations
- Respect their rights, religion & culture
- Give the resident time to process what you have said
- Repeat information as much as your need to
- Ask questions to see if the resident understood
- Be patient, residents with memory issues may ask you the same questions over & over
- Include everyone in the conversation – do not exclude
Communication methods
- Listen
- Ask direct questions
- Ask open ended questions
- Clarify as many times as needed
- Silence – in sad times, you just need to be with the person
- Ask simple yes & no questions
Communication barriers –
- Language
- Cultural differences
- Changing the subject
- Giving opinions
- Talking a lot when others are silent
- Failing to listen
- Pat answers “everything will be OK” when it might not be OK
- Illness & disability
- Age
Communicating with a comatose resident –
- Always knock before entering
- Tell resident your name & title
- Give care according to schedule every day
- Explain step by step what you are doing
- Tell the resident when you are finished
- Use touch to communicate concern, care and comfort
- Tell the resident when you will be back (the time) and be sure to return on time
- Tell the resident when you are leaving the room
Chapter 7 - Care of the Older Person
Physical changes of aging in the:
Skin – gets dry, wrinkled, less elastic, thinner & more easily bruised, less oil and less sweat
Musculoskeletal – muscles get weaker and bones more fragile and brittle and easier to break
Nervous- memory takes a little longer to remember, thinking process slows down
Eyes – vision gets weak, most need glasses – remember: the cloudy covering of the lens is called a CATARACT and can be removed
Smell – sense of smell is decreased and is the sense of taste making the biggest risk to seniors eating or drinking spoiled food because they can’t smell or taste that it’s gone bad
Circulation – it’s more difficult for the heart to pump all the necessary blood to our fingers & feet – feet become discolored (brown, blue or purple) and swell. Seniors often feel “COLD”
Digestion – peristalsis slows down, causing constipation
Urinary bladder – becomes less elastic and shrinks in size making seniors need to urinate more often or perhaps have difficulty controlling urination becoming incontinent
Reality orientation – remind patient of day, time & place – their name & yours every single time you interact with them, but no not argue….there are times when you have to be in “their reality”
Care of person with Alzheimer’s Disease – be aware of delusions (false beliefs) & hallucinations (visual, auditory, smelling or feeling something not real)….watch for increasing behaviors late afternoon / evening when sundowning occurs, watch for wandering, repetition, aggression, agitation, restlessness, confusion, catastrophic reactions, screaming, yelling, abnormal sexual behaviors….if you aren’t aware that they are “normal” with Alzheimer’s patients…..you will not be able to care for them appropriately.
Chapter 23 – Assisting With Wound Care
CNAs are allowed to do simple dressing changes – remember 3 tape method (tape at the top, middle & bottom)
Remove dressing TOWARD the incision – remember drainage should not be visible for the patient
Montgomery straps – for frequent dressing changes and patients who are allergic to tape…..the expectation is that you remove the ties for each dressing change and then reapply them (you do not have to use new ties unless there are visibly soiled)
Heat and Cold Applications – HEAT for spasms / cold to relieve pain & reduce swelling – moist makes the applications penetrate deeper
Pressure ulcers – Prevention and treatment turn & reposition frequently, good skin care, frequent observation of skin
TED hose –thrombo -embolic hose to prevent blood clots and prevent embolus/ must be fitted / put on 1st thing in the morning before getting out of bed / taken off every 8 hours for 30 minutes – pt must be in bed during off time / wash out every night and hang up to dry
Elastic bandage – ace bandage used to wrap arms or legs – always start wrapping from the distal end to the proximal
Sitz bath – warm bath for patients to sit in that have had rectal / perineal surgery—water is warm so watch for dizziness and fainting
Chapter 24 – Assisting with Oxygen Needs
Oxygen safety - no smoking, do not discontinue, do not adjust flow rate –
CNA responsibilities - that patient is wearing the oxygen when care plan indicated patient on oxygen, be sure tank if not EMPTY, be sure the flow rate is correct, be sure humidifiers are bubbling and not empty
Use of a pulse oximeter – clip that can be placed on the end of the fingers, toes etc that measure the amount of oxygen in ARTERIAL blood – should be 95-100%.....if less…..your patient is not getting enough oxygen
Chapter 29 – Emergency Care
Objecti ves of first aid – prevention of death and keep the patient from getting any worse
Chain of survival – early CPR, early defibrillation, early advanced care and early advanced cardiovascular care
CAB – circulation, airway and breathing with defibrillation
Chest compression 30:2 for a rate of 100 per minute minimum / push hard fast & deep
Open airway – head tilt – chin lift (never use thumb for chin lift)
Safest way & preferred way to give breaths – mouth to barrier
Recovery position – turned on side, head turned with hand supporting head / NEVER place in recovery position if you suspect a neck injury
AED – automated external defibrillator – know how to use it
Hemorrhage – excessive loss of blood over a short period of time
Arterial bleeding – spurts bright right
Venous bleeding – slow steady trickle of dark red blood
For bleeding – apply PRESSURE – if bleeding does not stop - apply pressure ABOVE the area of the wound
Shock – falling blood pressure, rapid & weak pulse, rapid respirations, cold & moist and very pale, thirsty, resless and confusion
Anaphylactic shock – SEVERE allergic reaction to an antigen – should be carrying epi pen / problem is that throat closedcompletely and patient cannot breathe
Seizures – 3 types -PARTIAL involves 1 body part / Grand Mal (tonic – clonic) patient loses consciousness, muscle started to contract and relax, incontinent of bowel and bladder, deep sleep after and confused with headache when they wake up – Petit Mal (absence) lasts a few seconds, staring, eye lids twitching
Fainting – recovery position sit them down, head between legs
Stroke – medical emergency – REMEMBER “FAST” face droop, arm weak, speech slurred and time is extremely important, get them to ER
Chapter 30 – Caring for the Dying Person –
Postmortem care – care given after death AFTER the MD has pronounced the person DEAD or EXPIRED. No postmortem care if autopsy. Leave all tubes, clothing, dressing alone.
Stages of Dying –Denial, Anger, Bargaining, Depression & Acceptance….some will never go through all the stages, some may stay locked in 1 stage the entire time, some may go back & forth between the stages frequently during the end of their illness
Understand room does not need to be DARK, but not bright either – lighting is good so that the patient as vision dims is still able to see loved ones
Hearing is the last sense to remain
Your goal – a peaceful & pain free death – we keep the patient turned every 2 hours very gently, keep them clean & dry, oral hygiene every 2 hours, what for redness or crusty sores around nose (oxygen is very drying), be aware if they are producing urine or have a BM
Hospice care – for those not expected to recover. The focus is totally on pain free and peace with themselves and family. The patient will not be undergoing any chemo or radiation; they have accepted that there is not further treatment available to them that will allow them to survive
Signs of death – loss of muscle tome & movement, mouth stays open as jaw muscles relax, abdomen may swell, nausea and vomiting are not uncommon, body temperature rises, patient feels cool and looks pale and will have profuse diaphoresis (sweating) and circulation will fail – pulse fast & weak, pulse will be irregular and blood pressure falls. Legs will mottle. (become blotchy and purple due to circulation shut down)
Respirations start to slow and become irregular (Cheyne Stokes), mucous collects in the bronchus and a death rattle sound is heard, PAIN DECREASES as the patient loses consciousness.
Pupils will be DILATED & FIXED