Chapter 4 CNA

8/19/2019 Chapter 4 CNA

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Communication and Cultural Diversity

1. Define the term communication

Define the following term:communication

the process of exchanging information with others by sending

and receiving messages.

4 Communication and Cultural Diversity

Transparency 4-1: Communication Process

4


1. Define the term communication

Remember these points about the communication process:

•

All three steps must occur before the process is complete.

•

During a conversation the process is repeated over and over.

• Effective communication is a critical part of an NA’s job.


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2. Explain verbal and nonverbal communication

Define the following terms:verbal communication

communication involving the use of spoken or written words

or sounds.

nonverbal communication

communicating without using words.


Transparency 4-2: Body Language

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2. Explain verbal and nonverbal communication

Think about these questions:

Are there ever conflicts between what a person is communicatingverbally and nonverbally?

How can an NA use observation as a form of nonverbalcommunication with a resident?


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4. Identify barriers to communication

Define the following term:clichés

phrases that are used over and over again and do not really

mean anything.


Transparency 4-3: Barriers to Communication

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4. Identify barriers to communication

Think about this question:

What are some examples of slang expressions?

Do residents and NAs have the same understanding of slang?


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5. List ways to make communication accurate and explain how to

develop effective interpersonal relationshipsThese techniques can help an NA communicate clearly andeffectively:

•

Be a good listener.

•

Provide feedback.

•

Bring up topics of concern.

•

Allow pauses.

•

Tune in to other cultures.

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5. List ways to make communication accurate and explain how todevelop effective interpersonal relationships

Techniques to help an NA communicate clearly and effectively(cont’d):

•

Accept residents’ religion or lack of religion.

•

Understand touch.

•

Ask for more information.

•

Make sure communication aids are clean and working.

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REMEMBER:

Providing excellent care requires good communication and also

requires that NAs build effective relationships with residents,family members, and the care team.


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5. List ways to make communication accurate and explain how to

develop effective interpersonal relationshipsThe following tips are helpful in building positive relationships:

•

Avoid changing the subject.

•

Do not ignore requests.

•

Do not talk down to people.

• Sit near the resident.

•

Lean forward when a resident is speaking.

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Tips for building positive relationships (cont’d):

•

Talk directly to the resident you are assisting.

•

Approach the person who is talking.

• Be empathetic.

•

Have time for residents’ families and friends too.

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6. Explain the difference between facts and opinions


What are some examples of facts? Examples of opinions?


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6. Explain the difference between facts and opinions

REMEMBER:

Understanding the difference between facts and opinions will helpan NA communicate her observations of residents in a moreprofessional way.

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7. Explain objective and subjective information and describe howto observe and report accurately

Define the following terms:

objective information

information based on what a person sees, hears, touches, orsmells; also called signs.

subjective information

information that a person cannot or did not observe, but isbased on something reported to the person that may or maynot be true; also called symptoms.

incontinence

the inability to control the bladder or bowels.


Transparency 4-4: Using Your Senses


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7. Explain objective and subjective information and describe how

to observe and report accurately


What are some specific observations an NA might make usingeach of the senses shown on the transparency (smell, sight,hearing, touch)?

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8. Explain how to communicate with other team members

NAs should keep the following in mind when communicating withtheir team members:

• Keep the nurse informed of all important issues during theshift.

•

Communicate with other care team members as needed toprovide quality care.

•

Always respect residents’ privacy when communicating with

other care team members.

•

Be careful with communication—do not share informationabout diagnoses/condition changes.

• When in doubt about what you can or should communicate,ask the nurse.

•

Use the chain of command to voice complaints.

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9. Describe basic medical terminology and abbreviations


cyanotic

skin that is blue or gray.

root

part of a word that contains its basic meaning or definition.

prefixthe word part that precedes the root to help form a newword.

suffix

the word part added to the end of a root that helps form anew word.


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Handout 4-1: Abbreviations

a before

AAROM active-assistive range ofmotion

abd

abdomen

ABR absolute bedrest

ac, a.c. before meals

AD Alzheimer’s disease

ADC AIDS dementia complex

ad lib as desired

ADLs activities of daily living

adm. admission

AED automated externaldefribrillator

AHA American Heart Association

AIDS acquired immunedeficiencysyndrome

AIIR airborne infection isolationroom

AKA above-knee amputation,also known as

am, AM morning

AMA against medical advice,American MedicalAssociation

amb ambulate, ambulatoryAMD age-related macular

degeneration

amt. amount

ANS autonomic nervous system

ant. anterior

a.p./AP apical pulse

approx. approximately

AROM active range of motion

ASAP as soon as possible

assist assistance

as tol as tolerated

A, T, D admission, transfer, anddischarge

ax axillary

BID, b.i.d. two times a day



BKA below-knee amputation

bld blood

BLS basic life support

BM bowel movement

BP, B/P blood pressure

BPH benign prostatichypertrophy

BPM beats per minute

BR bedrest

BRP bathroom privileges

BSC bedside commode

BSE breast self examination

C centigrade, Celsius

c with

Ca/CA calcium, cancer, carcinoma

CAD coronary artery disease

cal calorie

cath. catheter

CBC complete blood count

CBI continuous bladder irrigation

CBR complete bedrest

CCMS clean-catch midstream

CDC Centers for Disease ControlandPrevention

CDE certified diabetes educator

C. diff clostridium difficile

CEP competency evaluation(testing)

programs

CEU continuing education unit

CHD coronary heart disease

CHF congestive heart failure

chol cholesterol

ck check

cl liq clear liquid

cm centimeter



CMS Centers for Medicare andMedicaid Services

CNA certified nursing assistant

CNP certified nurse practitioner

CNS central nervous system

c/o complains of, in care of

CO2 carbon dioxide

COLD chronic obstructive lungdisease

COPD chronic obstructive

pulmonarydisease

CP cerebral palsy

CPM continuous passive motion

CPR cardiopulmonaryresuscitation

CRF chronic renal failure

C.S. Central Supply

CSF cerebrospinal fluid

CVA cerebrovascular accident,stroke

CVP central venous pressure

CVS cardiovascular system

CXR chest x-ray

DAT diet as tolerated

DJD degenerative joint disease

DKA diabetic ketoacidosis

DM diabetes mellitus

DNR do not resuscitate

DO doctor of osteopathy

DOA dead on arrival

DOB date of birth

DON director of nursing

Dr. doctor

DRG diagnostic related group

drsg dressing

DVT deep vein thrombosis

Dx/dx diagnosis


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ECG, EKG electrocardiogram

ED emergency department

EENT eye, ear, nose, and throat

e.g. for example

EMS emergency medicalservices

ER emergency room

ESRD end-stage renal disease

et al. and other things

ETOH alcohol

exam examination

F Fahrenheit, female

FBS fasting blood sugar

FDA Food and DrugAdministration

Fe iron

FF force fluids

FH family history

fld fluid

FS fingerstick

FSBS fingerstick blood sugar

ft foot

F/U, f/u follow-up

FUO fever of unknown origin

FWB full weight-bearing

fx fracture

FYI for your information

GAD generalized anxiety disorder

gal gallon

GB gallbladder

GERD gastroesophageal refluxdisease

geri chair geriatric chair

GI gastrointestinal

g gram

GP general practitioner

GSW gunshot wound

GTT glucose tolerance test



GU genitourinary

GYN/gyn gynecology

h, hr, hr. hour

H20 water

H202 hydrogen peroxide

H/A headache

HAART highly active anti-retroviral therapy

HAV hepatitis A virus

HBV hepatitis B virus

HCV hepatitis C virus

HDV hepatitis D virus

HEV hepatitis E virus

Hg mercury

HHA home health aide

Hi-cal high calorie

HIPAA Health InsurancePortability and

Accountability Act

HIV human immunodeficiencyvirus

HMO health maintenanceorganization

HOB head of bed

HOH hard of hearing

H&P history and physical

HPV human papillomavirus

HS/hs hours of sleep

ht height

HTN hypertension

H.U.C. Health Unit Coordinator

Hx history

hyper above normal, too fast, rapid

hypo low, less than normal

IBD irritable bowel disease

IBS irritable bowel syndrome



IICU intermediate intensivecare unit

ICU intensive care unit

ID identification

I&D incision and drainage

i.e. that is

IM intramuscular

In inch

inc incontinent

inf inferior

I&O intake and output

IQ intelligence quotient

irr., irrig irrigation

isol isolation

I.V., IV intravenous

K+ potassium

kg kilogram

KS Kaposi’s sarcoma

l, L liter

L, lt left

lab laboratory

lb pound

LBP low back pain

LE lower extremity

lg large

liq liquid

LLE left lower extremity

LLQ left lower quadrant

LOC level of consciousness, levelof care

Low-cal low-calorie

Low-fat/ low-fat, low-calorie

Low-cal

Low-Na low-sodium

LPN Licensed Practical Nurse

LTC long-term care

LTCF long-term care facility

LUQ left upper quadrant


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LVN Licensed Vocational Nurse

M.D. medical doctor

MD muscular dystrophy

MDROs multidrug-resistantorganisms

MDR-TB multidrug-resistanttuberculosis

MDS minimum data set

meds medications

med-surg medical-surgical

mg milligram

MI myocardial infarction

min minute

mL milliliter

mm millimeter

mm Hg millimeters of mercury

MO microorganism

mod moderate

MRI magnetic resonance imaging

MRSA methicillin-resistantstaphylococcus aureus

MS

multiple sclerosis

MSDs musculoskeletal disorders

MSDS material safety data sheet

MSW medical social worker

MUFA monounsaturated fat

MVA motor vehicle accident

Na sodium

N/A not applicable

NA nursing assistant

NaCl sodium chloride

NAS no added salt

NATCEP Nurse Aide Training andCompetency Evaluation

Program

N/C no complaints, no call

NCS no concentrated sweets



neg negative

NF nursing facility

NG, ng nasogastric

NIBP non-invasive bloodpressuremonitoring

NKA no known allergies

NKDA no known drug allergies

no number

noc night

NPO nothing by mouth

NVD nausea, vomiting, anddiarrhea

NWB non-weight-bearing

O2 oxygen

OB obstetrics

ob/gyn obstetrics and gynecology

OBRA Omnibus BudgetReconciliation Act

occ occasionally

OCD obsessive-compulsivedisorder

OD overdose

O.D. right eye

OG orogastric

OOB out of bed

O&P ova and parasites

OPD outpatient department

O.R. operating room

ord. orderly, ordered

ORIF open reduction, internalfixation

ortho orthopedics

os mouth

O.S. left eye

OSHA Occupational Safety andHealth Administration

OT occupational therapist,occupational therapy



OTC over-the-counter(medication)

O.U. both eyes

oz ounce

p after

P.A. physician’s assistant

PAD peripheral artery disease

pc, p.c. after meals

PCA patient-controlledanesthesia

PDR Physician’s DeskReference

PE pulmonary embolism

Peds/peds pediatrics

PEG percutaneousendoscopicgastrostomy

peri care perineal care

per os by mouth

PET positron emissiontomography

pH parts hydrogen

PH past history

PHI protected health information

phy. ex. physical exam

PID pelvic inflammatory disease

PM/pm afternoon

PMH past medical history

PNS peripheral nervous system

PO (per os) by mouth

pos. positive

post op after surgery

PPD purified protein derivative(test for tuberculosis)

PPE personal protectiveequipment

pre op before surgery

prep preparation


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p.r.n., prn when necessary

prog. Progress

PROM passive range of motion

Pt/pt patient

pt. pint

PT physical therapist,physical therapy

PTH parathyroid hormone

PTSD post-traumatic stressdisorder

PUFA polyunsaturated fat

PVD peripheral vasculardisease

PWB partial weight-bearing

q every

q2h, q3h, every two hours,q4h every three hours,

every four hours

QA quality assurance

Q&A questions and answers

qam every morning

qd every day

qh, qhr every hour

qhs every night at bedtime

q.o.d. every other day

qt. quart

quad quadrant, quadriplegic

R respirations, rectal

R, rt. right

RA rheumatoid arthritis

RBC red blood cell

RDT registered dietician

reg. regular

rehab rehabilitation

REM rapid eye movement

req. requisition

res. resident

resp. respiration

RF restrict fluids

RLE right lower extremity



RLQ right lower quadrant

RN registered nurse

RNA restorative nursingassistant

R/O rule out

ROM range of motion

RR respiratory rate

RT respiratory therapy/therapist

RUE right upper extremity

RUQ right upper quadrant

Rx prescription, treatment

s without

S&A sugar and acetone

s.c. subcutaneously

SCA sudden cardiac arrest

SCDs sequential compressiondevices

SIDS sudden infant deathsyndrome

sl sublingually

SLE systemic lupuserythematosus

SLP speech-language pathologist

sm. small

SNAFU situation normal, all fouledup (slang)

SNF skilled nursing facility

SNS somatic nervous system

SOB shortness of breath

SP Standard Precautions

S.P.D. Supply, Processing, andDistribution

spec. specimen

ss one-half

S&S, S/S signs and symptoms

SSE soapsuds enema

ST standard, speech therapy

staph staphylococcus



STAT/stat immediately

Std prec Standard Precautions

STDs sexually-transmitteddiseases

STIs sexually-transmittedinfections

strep streptococcus

supp. suppository

surg. surgery

T., temp temperature

TB tuberculosistbsp. tablespoon

T, C, DB turn, cough, and deepbreathe

THR total hip replacement

TIA transient ischemicattack

t.i.d., tid three times a day

TKR total knee replacement

TLC tender loving care

TPN total parenteral nutrition

T.P.R . temperature, pulse, andrespiration

trach. tracheostomy

tsp. teaspoon

TWE tap water enema

Tx, tx traction, treatment

U/A, u/a urinalysis

UE upper extremity

UGI upper gastrointestinal

UNK, unk unknown

URI upper respiratory infection

US ultrasound

USDA United States Departmentof Agriculture

UTI urinary tract infection

vag. vaginal

VAP ventilator-acquiredpneumonia


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VRE vancomycin-resistantenterococcus

VS, vs vital signs

W/A, WA

while awake

WBC white blood cell/count

w/c, W/C wheelchair

WNL within normal limits

wt. weight

yr. year


Handout 4-2: Prefixes, Roots, Suffixes

Prefixes

a, an: without, not, lack ofanalgesic = without pain

ante: before, in front ofantepartum = before delivery

bi: two, twice, doublebifocal = two lenses

brady: slowbradycardia = slow pulse,heartbeat

contra: againstcontraceptive = preventspregnancy

dis: apart, free fromdisinfected = free from

microorganisms

dys: bad, painfuldysuria = painful urination

endo: innerendoscope = instrument forexamining the inside of an organ

epi: on, upon, overepidermis = outer layer of skin

erythro: rederythrocyte = red blood cell

ex: out, away fromexhale = to breathe out

hemi: halfhemisphere = one of two parts of

the brain

hyper: too much, high

hypertension = high bloodpressure



Prefixes (cont d)

hyper: too much, highhypertension = high bloodpressure

hypo: below, underhypotension = low blood pressure

inter: between, withininterdisciplinary = between

disciplinesleuk: whiteleukocyte = white blood cell

mal: bad, illness, disordermalformed = badly made

micro: smallmicroscopic = too small for theeye to see

olig: small, scantoliguria = small amount of urine

patho: disease, sufferingpathology = study of disease

per: by, throughperforate = to make a hole

through

peri: around

pericardium = sac around theheart

poly: many, muchpolyuria = much urine

post: after, behindpostmortem = period after death


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Prefixes (cont d)

pre: before, in front ofprenatal = period before birth

sub: under, beneathsubcutaneous = beneath the skin

supra: above, oversuprapelvic = located above thepelvis

tachy: swift, fast, rapidtachycardia = rapid heartbeat



Roots

abdomin(o): abdomen

abdominal = pertaining to the

abdomen

aden(o): gland

adenitis = inflammation of agland

angi(o): vessel

angioplasty = surgical repair of avessel using a balloon

arterio: artery

arteriosclerosis = hardening ofartery walls

arthr(o): joint

arthrotomy = cut into a joint

brachi(o): arm

brachial = pertaining to the arm

bronchi, bronch(o): bronchus

bronchopneumonia =inflammation of lungs

card, cardi(o): heart

cardiology = study of the heart

cephal(o): head

cephalalgia = headache

cerebr(o): cerebrum

cerebrospinal = pertaining to the

brain and spinal cord



Roots (cont d)

chole, chol(o): bile

cholecystitis = inflammation ofthe gall bladder

colo: colon

colonoscopy = examination of the

large intestine or colon with ascope

cost(o): rib

costochondral = pertaining to arib

crani(o): skull

craniotomy = cutting into the

skull

cyan(o): blue

cyanosis = blue, gray, or purpletinge to the skin due to lack ofoxygen in the blood

cyst(o): bladder, cyst

cystitis = inflammation of the

bladder

derm, derma: skin

dermatitis = inflammation of theskin

duoden(o): duodenum

duodenal = pertaining to theduodenum, the first part of the

small intestine


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Roots (cont d)

encephal(o): brain

encephalitis = inflammation of

the brain

gaster(o), gastro: stomach

gastritis = inflammation of the

stomach

geron: aged

gerontology = study of the aged

gluco: sweet

glucometer = device used tomeasure blood glucose

glyco, glyc: sweet

glycosuria = glucose (sugar) inthe urine

gyneco, gyno: woman

gynecology = study of diseases ofthe female reproductive organs

hema, hemato, hemo: blood

hematuria = blood in the urine

hepato: liver

hepatomegaly = enlargement ofthe liver

hyster(o): uterus

hysterectomy = surgical removalof the uterus



Roots (cont d)

ile(o), ili(o): ileum

ileorrhaphy = surgical repair of

the ileum

laryng(o): larynx

laryngectomy = excision of thelarynx

lymph(o): lymph

lymphocyte = type of white bloodcell

mamm(o): breast

mammogram = x-ray of thebreast

mast(o): breast

mastectomy = excision of thebreast

melan(o): black

melanoma = mole or tumor, maybe cancerous

mening(o): meninges;membranes covering the spinal

cord and brain

meningitis = inflammation of themembranes of the spinal cord orbrain

necro: death

necrotic = dead tissue



Roots (cont d)

nephr(o): kidney

nephrectomy = removal of akidney

neur(o): nerve

neuritis = inflammation of a

nerve

onc(o): tumor

oncology = study of tumors

ophthalm(o): eye

ophthalmologist = eye doctor

oste(o): bone

osteoarthritis = disease of the

joints

ot(o): ear

otology = science of the ear

pharyng(o): pharynx pharyngitis= inflammation of the throat, sorethroat

phleb(o): vein

phlebitis = inflammation of a vein

pneo/pnea: breathing

tachypnea = rapid breathing

pneum: air, gas, respiration

pneumonia = inflammation of the

lung

pod(o): foot

podiatrist = foot doctor


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Roots (cont d)

proct(o): anus, rectum

proctology = study of the rectum

pulm(o): lung

pulmonary = relating to the lungs

splen(o): spleen

splenomegaly = enlarged spleen

stomat(o): mouth

stomatitis = inflammation ofmouth

therm(o): hot, heat

thermoplegia = heatstroke

thorac(o): chest

thoracotomy = incision into chestwall

thromb(o): blood clot

thrombus = blood clot blocking avessel

toxic(o), tox(o): poison

toxicology = study of poisons

trache(o): trachea, windpipe

tracheostomy = incision to makean artificial airway

urethr(o): urethra

urethritis = inflammation of

urethra



Suffixes

-cyte: cell

leukocyte = white blood cell

-ectomy: excision, removal of

splenectomy = removal of spleen

-emesis: vomiting

hyperemesis = excessivevomiting

-emia: blood condition

anemia = lack of red blood cells

-ism: a condition

hyperthyroidism = conditioncaused by an excessive

production of thyroid hormones

-itis: inflammation

stomatitis = inflammation of themouth

-logy: study of

hematology = study of the blood

-megaly: enlargement

splenomegaly = enlarged spleen

-oma: tumor

melanoma = mole or tumor, maybe cancerous

-osis: condition

halitosis = bad breath



Suffixes (cont d)

-ostomy: creation of an opening

ileostomy = creation of an

opening into the ileum

-otomy: cut into

laparotomy = cutting into theabdomen

-pathy: disease

myopathy = disease of themuscle

-penia: lack

leukopenia = a lack of whiteblood cells

-phagia: to eat

dysphagia = difficulty swallowing

-phasia: speaking

aphasia = absence of speaking

-phobia: exaggerated fear

acrophobia = fear of high places

-plasty: surgical repair

angioplasty = surgical repair of a

vessel using a balloon

-plegia: paralysis

paraplegia = paralysis of lower

portion of the body

-rrhage: excessive flow

hemorrhage = excessiveflow of blood


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Suffixes (cont d)

-scopy: examination using ascope

colonoscopy = examination of thelarge intestine or colon with a

scope

-stomy: creation of an opening

colostomy = opening into the

colon

-tomy: incision, cutting into

thoracotomy = incision into chestwall

-uria: condition of the urine

dysuria = painful urination

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10. Explain how to give and receive an accurate report of aresident’s status

All of the following occurrences should be reported immediately:

•

Falls

•

Chest pain

• Severe headache

•

Difficulty breathing

•

Abnormal pulse, respiration, or blood pressure

•

Change in mental status

•

Sudden weakness or loss of mobility

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Occurrences to report immediately (cont’d):

•

High fever

• Loss of or change in consciousness

•

Bleeding

•

Change in condition• Signs of abuse


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10. Explain how to give and receive an accurate report of a

resident’s status

REMEMBER:

An NA must use facts, not opinions, in making reports.

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Why should an NA make written notes about reports given to asupervisor?

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An NA should document the following about an oral report:

•

When

• Why

•

About what

•

To whom


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11. Explain documentation and describe related terms and forms

A medical chart is a legal record of a resident’s care. It includes

the following information:

•

Admission sheet

•

Resident’s medical history

•

Doctor’s orders

•

Progress notes

•

Lab/test results

•

Graphic sheet

• Nurse’s notes

•

Flow sheet/ADL sheet (see Figure 4-9, p. 44 of text)

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Current documentation is very important for many reasons:

• Guarantees clear and complete communication

• Provides legal record of treatment

• Protects NA and employer

• Provides up-to-date record of resident’s status

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NAs should always follow these guidelines for documentation:

• Document care immediately after it is given.

• Think before writing. Be brief and clear.

• Use facts, not opinions.

• Write neatly with black ink.

• Correct errors properly (see Figure 4-10, p. 45 of text).• Sign full name and title.

• Document per care plan.


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REMEMBER:

If something is not documented, legally speaking it was notdone. It is very important for NAs to document carefully, andimmediately after care is given.


Transparency 4-5: 24-hour Clock

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These guidelines are helpful when converting regular time tomilitary time:

• To change the regular hours between 1:00 p.m. to 11:59p.m. to military time, add 12 to the regular time.

• Minutes and seconds do not change.

• Midnight may be written as 0000 or 2400; NAs should followfacility policy.


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12. Describe incident reporting and recording

Define the following terms:incident

an accident, problem, or unexpected event during the course

of care that is not part of the normal routine in a healthcarefacility.

sentinel event

an accident or incident that results in grave physical orpsychological injury or death.

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The following events are considered incidents:

• Falls

• Damage

• Mistakes in care

• Requests outside scope of practice

• Sexual advances or remarks

• Unsafe or uncomfortable situations

• Injuries

• Blood or body fluids exposure

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NAs must follow these guidelines for incident reporting:

• Tell what happened.

• Tell how the person tolerated the incident.

• State facts only.

• Do not write about anything in the incident report on the

medical record.• Describe action taken.

• Include suggestions for change.


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13. Demonstrate effective communication on the telephone

Effective telephone communication involves the following steps:• Identify yourself politely before asking to speak to someone.

• Ask for the person with whom you need to speak.

• State the reason for your call.

• Leave a brief message if the person you are calling is notavailable.

• Thank the person who takes the message for you.

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The following steps are important when answering the telephone:

• Identify the facility’s name, self, and position.

• Place caller on hold if necessary.

•

Write down messages. Ask for correct spelling of names. Geta number.

• Say, “Thank you,” and “Goodbye.”

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REMEMBER:

NAs should never give out information about staff or residentsover the phone.


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4


14. Understand guidelines for basic office machines and

computersThe following office machines may be in use at LTCFs:

• Photocopier

• Fax machine

• Calculator

• Computer

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14. Understand guidelines for basic office machines andcomputers

REMEMBER:

HIPAA privacy guidelines apply to computer use. If a facility usescomputers for documentation, the NAs must make sure thatnobody can see private information on the screen.

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15. Explain the resident call system

REMEMBER:

An NA must always answer call lights, no matter what. Call lights

must be left within residents’ reach and answered promptly

every time the resident pushes the button.


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4


16. List guidelines for communicating with residents with special

needsDefine the following terms:

impairment

a loss of function or ability.

farsightedness

the ability to see objects in the distance better than objectsnearby; also known as hyperopia.

nearsightedness

the ability to see things near but not far; also known asmyopia.

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16. List guidelines for communicating with residents with specialneeds


cerebrovascular accident (CVA)

a condition that occurs when blood supply to a part of thebrain is blocked or a blood vessel leaks or ruptures within thebrain; also called a stroke.

hemiplegia

paralysis on one side of the body.

hemiparesis

weakness on one side of the body.

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expressive aphasia

slurred speech or an inability to speak.

receptive aphasia

inability to understand spoken or written words.emotional lability

laughing or crying without any reason, or when it isinappropriate.


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needsDefine the following terms:

dysphagia

difficulty swallowing.

combative

violent or hostile behavior.

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The following guidelines are important when communicating withresidents with hearing impairment:

• Make sure hearing aid is on and working. Clean hearing aid asinstructed.

• Reduce or remove noise.

• Get residents’ attention first.

• Speak clearly, slowly, and in good lighting.

• Do not shout or mouth words in an exaggerated way.

• Lower pitch of voice.

• Keep hands away from face while talking.

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Guidelines for communicating with residents with hearingimpairment (cont’d):

• Speak to side with better hearing.

• Use short sentences and simple words.

• Repeat what was said using different words if necessary.• Use picture cards or notepads.

• Be patient and empathetic.

• Ask resident to repeat what was said when necessary.Observe body language.

• Be understanding and supportive.


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needsThe following guidelines are important when communicating withresidents with vision impairment:

• Make sure eyeglasses are on, clean, and in good condition.

• Identify self when entering room.

• Make sure there is proper lighting. Face resident whenspeaking.

• Orient residents to new areas.

• Use imaginary clock as a guide.

• Tell resident what you are doing. Talk directly to resident.

• Do not move items. Put anything you move back where it wasfound.

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Guidelines for communicating with residents with visionimpairment (cont’d):

• Tell resident where the call light is.

• Leave door completely open or closed.

• When assisting resident with walking, walk slightly ahead,

letting resident grasp your arm.

• Encourage use of other senses.

• Use large clocks or clocks that chime.

• Offer large-print books, audio books, digital books, and Braille

books if necessary.

• Do not play with guide dogs.

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The following guidelines are important when communicating withresidents who have experienced CVA/stroke:

• Keep questions and directions simple.

• Phrase questions that can be answered with a “yes” or “no.”

• Agree on signals.• Give residents plenty of time to respond.

• Use a pencil and paper if possible.


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needsGuidelines for communicating with residents who haveexperienced CVA/stroke (cont’d):

• Use terms weaker or involved to refer to affected side.

• Keep call light within reach.

• Use verbal and nonverbal communication.

• Use communication boards or special cards.

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REMEMBER:

Even if residents are not able to speak, it is important that careteam members not talk about them as if they are not there.

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The following guidelines are important when communicating withresidents who are demonstrating combative behavior:

• Block blows or step out of way.

• Allow the resident time to calm down before the next

interaction.• Ensure resident is safe and give him space.

• Remain calm. Lower tone of voice.

• Be flexible and patient.

• Stay neutral. Do not respond to verbal attacks or argue.

• Do not use gestures that could frighten or startle resident.

• Be reassuring and supportive.

• Consider what provoked the resident.


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needsThe following guidelines are important when communicating withresidents who are demonstrating angry behavior:

• Stay calm.

• Do not respond to verbal attacks or argue.

• Empathize.

• Try to find out cause.

• Be respectful. Explain what you are going to do.

• Answer call lights promptly.

• Stay at a safe distance.

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There is a difference between assertive and aggressive behavior.A person is behaving assertively when he

•

Expresses thoughts, feelings, and beliefs in a direct andhonest way.

• Respects his own needs and feelings and those of otherpeople.

A person is behaving aggressively when he

•

Expresses thoughts, feelings, and beliefs in ways thathumiliate, disgrace, or overpower the other person.

•

Shows little or no respect for the needs or feelings of others.

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REMEMBER:

NAs should report aggressive behavior from residents.


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needsThe following guidelines are important when communicating withresidents who are demonstrating inappropriate behavior:

• Report behavior.

• Be professional and do not overreact.

• Try distraction.

• Gently direct resident to private area.

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REMEMBER:

An NA must never hit a resident, no matter how the residentbehaves. Hitting is considered abuse and may result intermination and/or legal action.

4


Exam

Multiple Choice. Choose the correct answer.

1. What is the correct order of the three-step communication process?

(A) Sender sends message. Receiver receives message. Receiver providesfeedback.

(B) Receiver sends message. Receiver receives message. Sender providesfeedback.

(C) Sender sends message. Sender receives message. Receiver provides

feedback.(D) Receiver sends message. Receiver receives message. Receiver provides

feedback.

2. Which of the following is an example of nonverbal communication?

(A) Asking for a cookie

(B) Pointing to a cookie

(C) Writing a note requesting a cookie

(D) Shouting for a cookie


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Exam

3.

Types of verbal communication include(A) Reading

(B) Nodding one’s head

(C) Crossing one’s arms

(D) Writing

4. Which of the following is an example of a barrier to communication?

(A) NA uses medical terminology with the resident.

(B) NA asks the resident to repeat a sentence.

(C) NA speaks the same language as the resident.

(D) NA speaks clearly using a professional tone of voice.

4


Exam

5. Which of the following are ways f or NAs to avoid barriers to communication?

(A) The NA should use slang so that the resident understands more easily.

(B) The NA should respond with “Why?” when resident makes a statement.

(C) The NA should use medical terminology when talking with the residentso the resident will more easily understand his condition.

(D) The NA should ask open-ended questions that require more than yes orno responses.

6. An example of active listening is

(A) NA looking around the room while the resident is speaking

(B) NA finishing the resident’s sentences to make communication faster

(C) NA focusing on the resident and providing feedback

(D) NA talking constantly so that there are no pauses in the conversation

4


Exam

7. Which of the following statements is an example of a fact?

(A) Mrs. Silva needed help to get to the bathroom today.

(B) Mrs. Silva needs more friends.

(C) Mrs. Silva looks happy when her daughter visits.

(D) Mrs. Silva is too thin.

8.

Which of the following is an example of objective information?(A) “Mrs. Johnson says she has a rash on her torso.”

(B) “There are raised, red marks the size of pinpricks on Mrs. Johnson’storso.”

(C) “Mrs. Johnson must have a rash because she looks uncomfortable.”

(D) “Mrs. Johnson needs some lotion.”


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Exam

9.

Why is it important for an NA to consider a resident’s cultural backgroundwhen communicating with him?

(A) It is not important to consider cultural background.

(B) Because the resident will certainly want to tell stories about his culture.

(C) Because the NA might know somebody with the same background andshe can tell the resident about that person.

(D) Because cultural background helps determine how people communicateand can help the NA communicate better with the resident.

10. What is a proper way for an NA to respond if a resident does not hear her or

does not understand her?

(A) The NA should speak more quickly.

(B) The NA should speak more softly or whisper.

(C) The NA should speak slowly and clearly.

(D) The NA should shout.

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Exam

11. Which of the following statements is true of touch?

(A) All people like to be touched.

(B) Nursing assistants do not need to touch residents.

(C) Nursing assistants can softly pat residents’ shoulders to communicatecaring.

(D) All residents will feel more comfortable when there is little physicalcontact.

12. Positive responses to cultural diversity include

(A) Valuing and respecting each person as an individual

(B) Seeing all people from a certain culture as being the same

(C) Preferring people of one culture over those of other cultures

(D) Making assumptions about a person based on stereotypes about theirculture

4


Exam

13. Which of the following senses is not used in making observations?

(A) Sight

(B) Touch

(C) Smell

(D) Taste

14.

With whom should nursing assistants use medical terms and abbreviations?(A) Residents

(B) Nurses

(C) Residents’ friends

(D) Visitors


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Exam

15.

Which of the following should an NA report about a resident to the nurseimmediately?

(A) Family fighting

(B) Chest pain, high fever

(C) Watching too much TV

(D) Acting lonely

16. The part of the word that is added to the end of a root to form a new wordis called a(n)

(A) Root

(B) Prefix

(C) Suffix

(D) Abbreviation

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Exam

17. When should documentation be recorded?

(A) Immediately after care is given

(B) At the end of the shift

(C) Whenever there is time

(D) Before the care is given

18. Careful charting is important because

(A) The NA does not want to get in trouble.

(B) The resident must be able to read the chart.

(C) The family will want to take the chart home regularly to study it.

(D) It is the only way to guarantee clear and complete communicationamong the care team.

4


Exam

19. Which of the following shows the correct conversion of 0530 to regulartime?

(A) 12:30 a.m.

(B) 12:30 p.m.

(C) 5:30 a.m.

(D) 5:30 p.m.

20. Which of the following shows the correct conversion of 2:35 p.m. to militarytime?

(A) 2435 hours

(B) 1435 hours

(C) 2235 hours

(D) 1235 hours


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Exam

21.

Which of the following occurrences is considered an incident and requires areport to be completed?

(A) A resident uses the call light frequently.

(B) A resident yells at a family member.

(C) A resident accuses an NA of abusing her.

(D) The NA arrives 10 minutes late to work.

22. Which of the following is an example of proper telephone communication atwork?

(A) “Good morning, Linda Manor Care Facility, Susan Jones speaking.”

(B) “We’re all really busy right now. You’ll have to call back later.”

(C) “Sandra is not working today. Her cell phone number is 555-1212.”

(D) “Jeanie no longer works here. She was fired two months ago.”

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Exam

23. A nursing assistant may ignore a resident’s call light when

(A) The resident uses it too often for unimportant reasons

(B) The nursing assistant has had conflict with the resident in the past

(C) The nursing assistant just finished giving care to that resident

(D) Never

24. Why must an NA be concerned about privacy if documentation is done on acomputer?

(A) Because it is common for computer hackers to target long-term carefacilities

(B) Because the federal government is monitoring all computers in LTCfacilities to ensure that HIPAA is f ollowed

(C) Because residents will probably try to sneak a look at other residents’ information

(D) Because the information is confidential and somebody who is not partof the care team might see the screen

4


Exam

25. If a resident has a hearing impairment, the NA should

(A) Face away from the resident when speaking

(B) Face the resident with the light on the NA’s face

(C) Shout so that the resident can hear the NA

(D) Exaggerate the words so that the resident can read the NA’s lips

26.

One way that an NA can help a resident who is visually impaired is to(A) Move the furniture to make it easier for the resident to get around

(B) Keep the lights very low

(C) Use the face of an imaginary clock to explain the position of objects

(D) Walk behind the resident, lightly pushing the client forward


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Exam

27.

What can a nursing assistant do to help with communication with a residentwho has had a stroke?

(A) The NA should ask questions that require longer answers to help keepthe resident mentally active.

(B) The NA should refuse to use pictures to communicate so that theresident will be motivated to speak more.

(C) The NA should talk constantly so the resident won’t feel uncomfortableif speaking is difficult for him.

(D) The NA should use smiles or gestures to convey information.

4


Exam

28. What is the best way a nursing assistant can respond to a combativeresident?

(A) The NA should tell the resident that he will be discharged from thefacility if he does not stop what he is doing.

(B) The NA should let the resident know that other NAs will refuse to carefor him if he continues the behavior.

(C) The NA should remain calm and lower the tone of her voice.

(D) The NA should stand as close as possible to the resident.

29. Why is it important for a nursing assistant not to overreact when a resident

behaves inappropriately?

(A) It may actually reinforce the behavior.

(B) Other residents may then copy the behavior.

(C) The NA’s supervisor will be angry with him.

(D) The NA might surprise the resident.

Chapter 4 CNA

Documents

Transcript of Chapter 4 CNA