Understand safety and emergency care skills within the nurse aide range of function.
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Understand safety and emergency care skills within the nurse aide range of function.
Unit A Nurse Aide Workplace FundamentalsEssential Standard NA3.00 Understand infection control, safety and emergency skills within the nurse aide scope of practice. Indicator 3.02 Understand nurse aide’s safety and emergency care skills within the nurse aide range of function
3.02 Nursing Fundamentals 7243 1
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Nurse aide students must hold current certification in HEALTHCARE PROVIDER BASIC LIFE SUPPORT and be assessed for skill retention prior to clinical!
REQUIREMENT:
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1 OUNCEPREVENTION
1 POUND
CURE
PR
EV
EN
TIO
N
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The Bottom Line
Prevention, Prevention, Prevention, Prevention, Prevention, Prevention,Prevention, Prevention, Prevention.
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National Patient Safety Goals for Long Term Care:1. Identify residents correctly2. Use medicines safely3. Prevent Infection4. Check residents medications5. Prevent residents from falling6. Prevent bed sores
NPSG impacted greatly by Nurse Aide Work3.02 Nursing Fundamentals 7243 5
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National Patient Safety Goals for Long Term Care:
Identify residents correctly NPSG.01.01.01
Use at least two ways to identify residents. For example, use the resident’s name and date of birth or last four digits of SS number.
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National Patient Safety Goals for Long Term Care:
Identify residents correctly NPSG.01.01.01
Provide care to right resident
Use identification bracelets Ask resident to state name
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National Patient Safety Goals for Long Term Care:
Identify residents correctly NPSG.01.01.01
Use I.D. systems that involve photographs
Realize that care to wrong resident can threaten life
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National Patient Safety Goals for Long Term Care:
Prevent Infection NPSG.07.01.01
Use the hand cleaning guidelines from the Centers for Disease Control and Prevention or World Health Organization.
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National Patient Safety Goals for Long Term Care:
Prevent residents from falling NPSG.09.02.01
Find out which residents are most likely to fall. For example, is the resident taking any medications that might make them weak, dizzy, or sleepy? Take action to prevent falls for these residents.
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Greater Risk of Falls
• Age related factors
• Awareness of surroundings
• Decreased Vision
• Hearing Impaired
• Decreased ability to smell
• Decreased sensitivity to touch
• Immobility
• Medications
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Nursing Fundamentals 7243 12
Report observations to supervisor that lead you to believe a resident is prone to falling
Preventing Falls
3.02
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Falls account for 70%
of accidents in healthcare facilities
For Your Information
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Answer call signals promptly
Keep frequently used articles within reach of resident
Preventing Falls
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Nursing Fundamentals 7243 15
Lock brakes on movable equipment
–wheel chairs–stretchers and mechanical
lifts–beds –commodes
Preventing Falls
3.02
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Nursing Fundamentals 7243 16
Properly position residents in:–bed–wheel chair
Preventing Falls
3.02
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Nursing Fundamentals 7243 17
OBSERVE NO LIFT OR LIMITED LIFT POLICIES
TO PREVENT FALLS AND INJURY TO RESIDENT
AND NURSE AIDE
Preventing Falls
3.02
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Nursing Fundamentals 7243 18
Report any facility structure hazard immediately that could lead to falls
– frayed carpeting– loose or broken side rails– lights that don’t work
Preventing Falls
3.02
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National Patient Safety Goals for Long Term Care:
Prevent bed sores NPSG.14.01.01
Find out which residents are most likely to have bed sores. Take action to prevent bed sores in these residents.
Bed sores will be discussed in Indicator 5.02 3.02 Nursing Fundamentals 7243 19
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GENERAL SAFETY RULES
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GENERAL SAFETY RULES
Walk in halls and on stairs - never runKeep to the right-hand side of the hallApproach swinging doors with cautionUse handrails going up and down stairs3.02 Nursing Fundamentals 7243 21
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GENERAL SAFETY RULES
Keep halls and stairs free of obstaclesCheck labels on all containers prior to using contentsWipe up spilled liquids immediately
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GENERAL SAFETY RULES
Pick up litter and place it in the proper container
Follow instructions of your supervisor for resident care
Report injuries promptly
Never use damaged or frayed electrical cords
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GENERAL SAFETY RULES
TAG and TAKE OUT OF SERVICE!!!!
Report broken or malfunctioning equipment immediately
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GENERAL SAFETY RULES
Check linen for personal items contained in folds prior to sending to the laundry
Report unsafe conditions immediately
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GENERAL SAFETY RULES
Ask for an explanation of things you don’t understand
Elevate side rails for residents at risk of falling, per facility policy3.02 Nursing Fundamentals 7243 26
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FAC
TO
RS
TH
AT
INC
RE
AS
E T
HE
R
ES
IDE
NT
’S R
ISK
OF
INJU
RY
Age related
Decreased strength
Slower movement
Difficulty maintaining balance
Tremors that may affect balance
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FAC
TO
RS
TH
AT
INC
RE
AS
E T
HE
R
ES
IDE
NT
’S R
ISK
OF
INJU
RY
Awareness of surroundings
Some totally unaware
unconscious
coma
Some suffer from dementia
confused
disoriented3.02 Nursing Fundamentals 7243 28
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FAC
TO
RS
TH
AT
INC
RE
AS
E T
HE
R
ES
IDE
NT
’S R
ISK
OF
INJU
RY
Decreased vision
Difficulty seeing objects
In danger of falling or tripping
Difficulty reading labels or containers
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FAC
TO
RS
TH
AT
INC
RE
AS
E T
HE
R
ES
IDE
NT
’S R
ISK
OF
INJU
RY
Hearing impaired– May not hear
warning signals or alarms
– May not hear approaching equipment
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FAC
TO
RS
TH
AT
INC
RE
AS
E T
HE
R
ES
IDE
NT
’S R
ISK
OF
INJU
RY
Smell and touchReduced smell
unaware of smoke or gas fumes
Decreased sensitivity to heat and cold easily burned
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FAC
TO
RS
TH
AT
INC
RE
AS
E T
HE
R
ES
IDE
NT
’S R
ISK
OF
INJU
RY
Inability to move independentlyCrippling
diseasesArthritisParalysis
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FAC
TO
RS
TH
AT
INC
RE
AS
E T
HE
R
ES
IDE
NT
’S R
ISK
OF
INJU
RY
Medications can:
Affect balance
Reduce awareness
Cause confusion or disorientation
Cause drowsiness
Affect coordination
Make fearful and uncooperative
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PREVENTING BURNS
Burns are the second most
common hazard to residents
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Preventing Burns
• Check water temperature in bath or shower with bath thermometer or with your hand
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Preventing Burns
Water temperature should be NO HOTTER than
105 degrees F3.02 Nursing Fundamentals 7243 36
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Preventing Burns
• Resident must verify that the temperature of the water is comfortable or not.
This is a little
to warm!
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Preventing Burns
• Report areas where water temperature seems too hot
• Monitor smoking practices
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Preventing Burns
When bathing the resident or providing a soak,
1) ASK THE RESIDENT TO FEEL THE WATER
2) AND VERIFY THAT THE TEMPERATURE OF THE WATER IS COMFORTABLE TO THEM
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Preventing Burns
• Provide assistance at mealtime to prevent spilling hot liquids
• Use facility equipment according to written policies
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Preventing Burns
• Monitor use of electrical appliances used by resident
• Avoid overexposure to sunlight
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PREVENT
POISONING
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Preventing Poisoning
• Store toxins in locked cabinets• Store toxins away from resident
areas• Never leave toxic products where
they might be ingested
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Preventing Poisoning
• Have identifying labels on all containers
• Never use unlabeled substance
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Preventing Choking
• Encourage residents to use their dentures when eating
• Assist to cut food into small pieces
• Report difficulty in swallowing
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Be certain the HOB is
elevated before attempting
to feed a resident!
Prevent Choking
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Preventing Choking
Residents with feeding tubes usually have the HOB elevated 30-45 degrees.
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Be certain the resident has swallowed before continuing to feed.
Prevent Choking
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Preventing Choking
Residents with feeding tubes should never have the bed flat for extended periods of time. Follow instructions regarding residents’ position to prevent residents from aspirating.
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Preventing Suffocation
• Never leave unattended in bathtub
• Immediately transport from areas where smoke or gas fumes are noticed
• Properly apply and check vest and safety belt restraints
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Preventing Spread of Microorganisms
Follow Standard Precautions and Transmission Based Precautions.
Wash hands before and after care
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Preventing Other Injuries
• Move equipment around corners with caution
• Be careful of residents’ feet, hands, arms, and elbows when transporting residents in wheelchairs
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Preventing Other Injuries
• Monitor residents who wander away
• Follow instructions when providing care
• Keep bed in lowest position except when giving bedside care
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Preventing Other Injuries
• Use night lights in rooms• Have residents wear
shoes/slippers with non-skid soles
• Check crutches, canes and walkers for non-skid tips
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Preventing Other Injuries
• Keep call signal within easy reach
• Report immediately any observations indicating resident is a danger to himself or others.
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BODY MECHANICS
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For Your Information
There is intentional repeat of some HSII course content in Nursing Fundamentals.
Academic and skill competence must be maintained at a very high level for direct resident care.
Repeating course content distributes learning over time and increases long term memory.
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Body Mechanics
• Body mechanics: the coordination of body alignment, balance and movement
• Job requirements for nurse aides include lifting, moving and transferring resident and lifting, moving and carrying objects
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Body Mechanics
• Purpose of Good Body Mechanics–Maximize strength–Minimize fatigue–Avoid muscle strain
and injury–Assure personal and
resident safety3.02 Nursing Fundamentals 7243 59
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Body Mechanics
• Never bend over from waist to pick up object
• Lift firmly and smoothly • Keep object close to body• Keep back straight
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Body Mechanics
• Bend at hips and knees and get close to object prior to lifting
• Grip objects firmly with both hands
• Lift by pushing up with strong leg muscles
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Body Mechanics
• Get help if object or resident appears too heavy
• Keep feet apart to provide wide base of support
• Pivot or turn with feet
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Body Mechanics
• Use short steps to turn• Turn entire body without
twisting back and neck• Pull or push when
possible instead of lifting• Use body weight to help
push or pull
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Body Mechanics
• When reaching for an object, evaluate distance
• Face in direction you are working to prevent twisting
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Body Mechanics
• Adjust beds to waist level when giving resident care
• Be sure body is in good alignment at all times
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FIRESAFETY
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For Your Information
There is intentional repeat of some HSII course content in Nursing Fundamentals.
Academic and skill competence must be maintained at a very high level for direct resident care.
Repeating course content distributes learning over time and increases long term memory.
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Fire SafetyEveryone is responsible for
preventing fires
If fire occurs, know what to do3.02 Nursing Fundamentals 7243 68
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Fire Safety
• Major fire hazards–faulty electrical
equipment and wiring–overloaded electrical
circuits–plugs not properly
grounded–clutter - paper/rags
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Fire Safety
• Major fire hazards (continued) –unsafe practices when
oxygen is in use–smoking–spontaneous combustible
materials
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Fire Safety
• Elements necessary to start fire–fuel - material that
will burn–heat - flame or spark–oxygen
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Fire Safety
• Fire safety activities– Locate and learn
•escape routes and fire escapes•use of all fire control equipment
–fire doors–sprinkler system controls–fire extinguishers
• fire drill procedures3.02 Nursing Fundamentals 7243 72
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Fire Safety
• Fire Safety Activities– Be aware of all fire
hazards and report them immediately
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Fire Safety
• Watch for frayed electrical wires
• Never overload circuits• Use three-prong
grounded plugs• Never use extension
cords• Control clutter
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Fire Safety
• Dispose of rags properly• Empty ashtrays in metal
containers• Empty wastebaskets in
proper receptacles• Report odors of smoke
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Fire Safety
• Control smoking practices:– limit to specific areas– never allow smoking in
bed– have large ashtrays
available
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Fire Safety
• Control smoking practices:– observe use of
matches/lighters– directly supervise
residents when smoking, as necessary
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In Event Of Fire
Stay calm as you
RACE3.02 Nursing Fundamentals 7243 78
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R A C E
Remove residents from IMMEDIATE DANGER; otherwise, DEFEND IN PLACE
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R A C E
Activate the ALARM
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R A C EConfine the fire
Close all windows and doors
Choke off oxygen3.02 Nursing Fundamentals 7243 81
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R A C E
Extinguish if you can
Empty the extinguisher3.02 Nursing Fundamentals 7243 82
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Use of Fire Extinguisher
• Carry upright then PASS• Pull the safety pin• Aim at the base of the fire• Squeeze handle down• Spray in a sweeping motion at base
of fire
FIRE
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R A C E RRelocate residents per
evacuation policy if directed to do so.
Some agencies teach RACE plus an addition “R”
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R A C E R2Remember these
important Guidelines:G Shut off air conditioningG Shut off oxygenG Shut off lightsG Never use elevators
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OXYGEN SAFETY
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Oxygen Precautions
• Oxygen precautions– Never have open flames
or smoking in area– Remove flammable
liquids from area– Do not use electrical
equipment in area
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Oxygen Precautions
• Oxygen precautions– Post “Oxygen in Use”
sign– Remove cigarettes and
matches from room– Use cotton blankets
and clothing
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Oxygen Precautions
DO NOT LET THE RESIDENTS’ NASAL CANNULA TOUCH THE FLOOR. Pathogens on the floor will contaminate the cannula.
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DISASTERS / CATASTROPHES
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Disaster / Catastrophe Types
• Natural origin–flood–earthquake–hurricane/tornado
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Disaster / Catastrophe Types
• Human disasters–airplane/bus/train
accidents–explosions–nuclear waste
accident–blackouts
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Workplace Violence… a potential Disaster!
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Healthcare is impacted by verbally and sometimes physically abusive patients, families and visitors.
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Verbal abuse often goes unreported and is thought to be “just part of the job”.
70% of Nurses are assaulted on duty during their career.
The majority of healthcare worker violence takes place on evening and night shifts.
OSHA [1996]. Guidelines for preventing workplace violence for health care and social service workers. Washington, DC: U.S. Department of Labor,
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Workplace Violence… a potential Disaster!
3.02 Nursing Fundamentals 7243 95
Stop this PowerPoint and view the PowerPoint produced by Vanderbilt University Medical Center. Then, return to this PowerPoint.
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Disaster Plans
Facilities are required to have disaster plans
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Disaster Plans• Responsibilities in a disaster
–Remove residents from immediate danger
–Report to facility and follow directions for your role
–Know your facility’s disaster plan
–Assist with evacuation
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Disaster Plans
–Help remove and secure equipment, supplies, and records
–Think before you act; don’t waste time
–Remain calm–Carry out responsibilities in
confident manner
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MEDICAL EMERGENCIES
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The Choking Resident
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The Choking Resident - Cause
Choking occurs when the throat is blocked or closed up and air cannot get to the airway.
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The Choking Resident
Airway may be blocked by: –Food or liquids (meat
most common food)–Blood or mucus–Foreign objects
including the tongue–Vomitus
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Treating a Choking Resident
–Stay near–Encourage coughing - most
effective way to dislodge obstructions
–Never slap coughing resident on back: can cause object to fall lower into trachea
If victim is coughing, do not intervene:
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Treating a Choking Resident
Signs of severe foreign body airway obstruction
–Unable to speak–No air movement–Grasping throat -
distress signal
Abdominal thrusts, chest thrusts and back blows are effective for relieving severe foreign body airway obstruction.
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Treating a Choking Resident
Tilting head back in
unconscious person may clear airway since this pulls tongue forward
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SKILL 3.02AForeign Body Airway Obstruction
(FBAO) Relief: Conscious Resident
Training Lab AssignmentEngage in the Skill Acquisition Process for:
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Heart Attack - Signs and Symptoms
• Chest discomfort–pressure, fullness, squeezing, or
pain–in center of chest behind
breastbone or spread to either shoulder, neck, jaw, or arm
–usually lasts longer than a few minutes – comes and goes
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Heart Attack - Signs and Symptoms
• Fainting• Sweating• Nausea• Shortness of breath
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Accident/Emergency Scene
• If certified in CPR, offer assistance• Defer to those with more experience
and training
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Accident/Emergency Scene
• Seek assistance–in facility
•use emergency light•use call signal•send another resident for help
•call for help
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Accident/Emergency Scene
• Seek assistance –at home or at accident scene
• dial 911 operator or emergency number
• give location• give phone number• relate type of emergency• give number of people needing help• relate requested information
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Cardiopulmonary Resuscitation
• Agencies providing CPR curriculum:–American Heart Association–American Red Cross
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Cardiopulmonary Resuscitation
• You must be trained to administer CPR
• Activate the emergency medical system or your facility’s emergency plan
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Cardiopulmonary Resuscitation
• CPR must be started immediately to be effective
• Follow facility policy for Advanced Care Directive
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Cardiopulmonary Resuscitation
• Methods of administering CPR–one-person CPR–two-person CPR
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Convulsive Disorders (Seizures)
• Causes:–infectious disease–omitted medication–head injury–stroke–seizure syndrome
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Convulsive Disorders (Seizures)
• Types–Partial–General
•Tonic-clonic (grand mal)
•Absence (petit mal)–Unclassified
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Convulsive Disorders (Seizures)Take Action
• Summon help• Stay with resident
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Convulsive Disorders (Seizures)Take Action
• Protect from injury–lower to floor if appropriate–move objects away that might
cause injury• Do not restrain or put any object
into mouth
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Convulsive Disorders (Seizures)Take Action
• Loosen constricting clothing (around neck)
• Place pillow under head and turn face to one side
• Note time and type of seizure
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Convulsive Disorders (Seizures)Take Action
• Provide rest for resident after seizure–very tired–may be confused–often disoriented
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Loss of Consciousness – Fainting
•Caused by temporary reduction of blood to brain
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Loss of Consciousness – Fainting
• Early signs and symptoms:–dizziness–decreased pulse and BP–pallor and perspiration–nausea–cold skin–numbness and tingling of extremities
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Loss of Consciousness – FaintingTake Action
• Summon help• Stay with resident• Have resident sit or lie down• Loosen tight clothing• Position head lower than heart
–sitting - head between legs–lying down - elevate legs
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Loss of Consciousness – FaintingTake Action
• Monitor pulse and respirations• Have resident rest for 5-10
minutes before moving• Provide blanket if cold
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SHOCK – Causes
• Severe injury• Excessive loss of body
fluids• Pain• Respiratory and/or cardiac
arrest• Anxiety
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• Low or falling blood pressure
• Weak, rapid pulse• Cold, moist, pale
skin• Rapid respirations
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SHOCK – Signs and Symptoms
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SHOCK – Signs and Symptoms
•Thirst•Restlessness•Confusion and loss of consciousness
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SHOCK – Take Action
• Summon help• Stay with resident• Keep resident lying
down• Control hemorrhage• Keep resident warm
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Hemorrhage
•Types–Internal–External
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Hemorrhage
• Signs and Symptoms– Internal
• pain• shock• vomiting blood• loss of
consciousness–External
• can usually be seen
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Hemorrhage – Take Action
• Internal–Summon help–Stay with
resident–Keep warm,
flat and quiet until help arrives
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Hemorrhage – Take Action
• External–Summon help–Stay with resident–Identify location of bleeding–Apply continuous, direct
pressure over bleeding
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Hemorrhage – Take Action
• External–If bleeding not controlled, apply
pressure over artery above bleeding site
–If no pain or broken bones, elevate wounded area above heart while maintaining pressure
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Hemorrhage – Take Action
• External–keep resident
comfortable, warm and quiet until help arrives
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Reporting Emergencies
• Never panic; remain calm–Try few slow deep
breaths–Observe surroundings–Assess resources
available
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Reporting Emergencies
• Evaluate situation–check victim –determine safety of
environment• Call or send for help immediately• Determine treatment priorities
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Reporting Emergencies
• Report emergencies accurately–If help is not available, contact:
•911 or emergency number•Police•Fire department•Telephone operator•Local EMS
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Reporting Emergencies
–Name–Location–Description
of scene–Information
about injuries
–Type of help needed
–Number of people needing help
•Report emergencies accurately by stating:
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Reporting Emergencies
•Know your limitations•Provide care and reassure victims•Keep bystanders away from victims
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Understand safety and emergency care skills within the nurse aide range of function.
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