1. Define important words in this chapter

1. 1. Define important words in this chapter • abdominal girth • a measurement of the circumference around the abdomen at the umbilicus (navel). • admission pack • personal care items supplied upon a resident’s admission. • baseline • initial value that can be compared to future measurements. • bedridden • confined to bed.

2. 1. Define important words in this chapter • contracture • the permanent and often painful shortening of a muscle, usually due to a lack of activity. • dorsal recumbent • position with the person flat on her back with knees flexed and slightly separated and her feet flat on the bed. • kilogram • a unit of mass equal to 1000 grams; one kilogram equals 2.2 pounds. • knee-chest • position in which a person is lying on his abdomen with knees pulled up towards the abdomen and with legs separated; arms are pulled up and flexed and the head is turned to one side.

3. 1. Define important words in this chapter • lithotomy • position in which a person is on her back with her hips at the edge of the exam table; legs are flexed and feet are in padded stirrups. • metric • system of weights and measures based upon the meter. • pound • a unit of weight equal to 16 ounces.

4. 2. List factors for families in choosing a facility • REMEMBER: • Choosing the right facility for a loved one can be a challenging, emotional, and difficult process.

5. 2. List factors for families in choosing a facility • Here are some of the questions families might consider when choosing a facility for a loved one: • Do the staff seem courteous and friendly? • Do most of the staff speak the resident’s native language? Is an interpreter available? • Are there enough staff members on duty at the facility? What is the ratio of nurses and nursing assistants to residents? How is the facility staffed on evenings and weekends? • Are foul odors present?

6. 2. List factors for families in choosing a facility • Questions families might consider when choosing a facility for a loved one (cont’d.): • What is the food like at the facility? Is attention paid to individual food preferences? Is a dietician available for meetings? • Are residents up and dressed in the morning? • Do staff interact positively with the residents? • Do staff speak courteously to other staff members? • Do residents look groomed, taken care of, and happy?

7. 2. List factors for families in choosing a facility • Questions families might consider when choosing a facility for a loved one (cont’d.): • How are residents’ complaints resolved? • Is the facility licensed? • Have the state survey and other inspection results been satisfactory? • Does the facility explain Residents’ Rights? • Are physical, occupational, and speech therapists available? • How often do falls, infections, and pressure ulcers occur?

8. 2. List factors for families in choosing a facility • Questions families might consider when choosing a facility for a loved one (cont’d.): • Do volunteers work with residents? If so, are their interactions positive? • How involved can the family be in creating the resident’s care plan? • Does the facility provide the level of care the resident needs? What about future needs? • Does the facility provide assistance with activities of daily living (ADLs)? If so, how is it provided, and what are the associated fees?

9. 2. List factors for families in choosing a facility • Questions families might consider when choosing a facility for a loved one (cont’d.): • Is the environment safe, functional, and homelike? • Is there an activities department? What kinds of activities are offered? • What are the steps to take if a resident wants to move out of the facility? • What policies does the facility have on advance directives and end-of-life decisions?

10. 2. List factors for families in choosing a facility • Think about this question: • If you were choosing a facility for a loved one, which factors would matter most to you?

11. 3. Explain the nursing assistant’s role in the emotional adjustment of a new resident • REMEMBER: • Moving into a facility requires a big adjustment. New residents may have been independent for a long time, and they may be moving from their own or a family member’s home. It can be a time of loss.

12. Handout 9-1: Quiz: You are Moving! • Your house has been sold and you need to move in with your sister and her family for about six months or more. You need to work out some problems; perhaps you will even be staying with them permanently. You don’t know for sure. You will share a room with your niece. Your space is six feet wide by 12 feet long. • There is a single bed, a chest of drawers, and a soft chair that you can use. There is also a screen available for your privacy. Decide what you will take with you. You can store anything you don’t take, but you will not have access to any stored items until you move again. • Name six things you will take with you. (Seven outfits of clothing count as one item.) Think of space. All six items must fit into your small room, or in your half of the closet, which is a 5x3 feet space. • 1. • 2. • 3. • 4. • 5. • 6.

13. Handout 9-1: Quiz: You are Moving! (cont’d.) • During the first week, your niece, who is five years old, is looking at one of your treasured things, and accidentally drops and breaks it. How do you feel? • It is now the second week. You have still not received any of your mail, even though you notified the post office to forward it. You mention this to your sister and she says offhandedly, “Oh, I did see some here yesterday. I don’t know where it got to.” Then she walks out of the room. What is your response?

14. 3. Explain the nursing assistant’s role in the emotional adjustment of a new resident • After reviewing the Quiz (Handout 9-1), think about these questions: • How did you feel when deciding what to take and what to leave behind? • What did you decide to take, and what are some things that you would be upset about leaving behind? • How did you feel about the loss of your mail and your sister’s response?

15. 3. Explain the nursing assistant’s role in the emotional adjustment of a new resident • There are many losses which residents may experience when moving into a facility. Here are some of the reasons why adjusting to life in a facility may be difficult for residents: • Move may have been sudden, due to health reasons. • Resident may have had to leave home and give up personal belongings and beloved pets. • Resident may have had loved ones who have died. • Residents may be experiencing a decline in health and independence.

16. 3. Explain the nursing assistant’s role in the emotional adjustment of a new resident • REMEMBER: • As a nursing assistant, it is important to empathize with residents to help make the adjustment to facility life easier. Your sensitivity will make this change easier.

17. 3. Explain the nursing assistant’s role in the emotional adjustment of a new resident • Remember these guidelines for helping new residents adjust: • Have a positive attitude. • Be tactful. • Communicate clearly. • Show respect for residents’ belongings. • Be responsible.

18. 3. Explain the nursing assistant’s role in the emotional adjustment of a new resident • Guidelines for helping new residents adjust (cont’d.): • Be honest. • Listen to residents. • Pay attention to residents’ wishes. • Respect residents’ privacy. • Be patient and kind.

19. 4. Describe the nursing assistant’s role in the admission process • Define the following terms: • admission pack • personal care items supplied upon a resident’s admission. • baseline • initial value that can be compared to future measurements.

20. 4. Describe the nursing assistant’s role in the admission process • REMEMBER: • Admission is often the first time you meet a new resident. When the resident arrives, give a good first impression of the staff and the facility. Welcome the new resident in a friendly manner.

21. 4. Describe the nursing assistant’s role in the admission process • Remember these guidelines for admission: • Wash hands and gather necessary equipment to bring to resident’s room. • Prepare the resident’s room before he arrives. • Prepare the bed and open curtains or blinds. • Notify roommate of new resident’s arrival. • Introduce yourself to resident and call him by his formal name. • Do not rush the process.

22. 4. Describe the nursing assistant’s role in the admission process • Guidelines for admission (cont’d.): • Introduce the new resident to other residents. • Explain day-to-day life in the facility. • Show resident how to work bed controls. • Make sure call light is close to bed and explain how to use it. • Explain how to work television and phone. • Handle personal items with care and respect.

23. Admitting a resident • Equipment: may include admission paperwork (checklist and inventory form), gloves, and vital signs equipment 1. Identify yourself by name. Identify the resident. Greet the resident by name. 2. Wash your hands. 3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.

24. Admitting a resident 4. Provide for the resident’s privacy with a curtain, screen, or door. Ask the family to step outside until the initial admission process is complete. Show them where they may wait and let them know approximately how long they will have to wait. Tell them where they can get refreshments.

25. Admitting a resident 5. If instructed, do these things: Take the resident’s height, weight, and vital signs. (Height and weight procedures follow; vitals signs are in Chapter 13.) Most facilities require baseline height, weight, and vital sign measurements. Baseline signs are initial values that can be compared to future measurements. Document on admission form and elsewhere per facility policy.

26. Admitting a resident Obtain a urine specimen if required (see Chapter 16). Complete the paperwork. Take an inventory of all of the personal items. Help the resident put personal items away. Label each item if it is facility policy. If the resident has valuables, ask the nurse for instructions. Fill the water pitcher with fresh water. Add ice if requested.

27. Admitting a resident 6. When the initial portion of the admission is complete, locate the family and let them know they may return to the resident’s room. 7. Show the resident the room and bathroom. Explain how to work the bed controls and the call light. Point out the lights, telephone, and television and how to work them. Give the resident information on menus, dining times, and activity schedules.

28. Admitting a resident 8. Introduce the resident to his roommate, if there is one. Introduce other residents and staff. 9. Make resident comfortable. Remove privacy measures. 10. Leave call light within resident’s reach.

29. Admitting a resident 11. Wash your hands. 12. Be courteous and respectful at all times. Let the resident know when you are leaving. Ask if he needs anything else. 13. Document procedure using facility guidelines.

30. 4. Describe the nursing assistant’s role in the admission process • Define the following terms: • pound • a unit of weight equal to 16 ounces. • kilogram • a unit of mass equal to 1000 grams; one kilogram equals 2.2 pounds. • metric • system of weights and measures based upon the meter.

31. 4. Describe the nursing assistant’s role in the admission process • Define the following terms: • bedridden • confined to bed. • contracture • the permanent and often painful shortening of a muscle, usually due to a lack of activity. • abdominal girth • a measurement of the circumference around the abdomen at the umbilicus (navel).

32. 4. Describe the nursing assistant’s role in the admission process • Think about this question: • Why should any change in a resident’s weight be reported right away?

33. Measuring and recording weight of an ambulatory resident • Equipment: standing/upright scale, pen and paper to record your findings 1. Identify yourself by name. Identify the resident. Greet the resident by name. 2. Wash your hands. 3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Provide for the resident’s privacy with a curtain, screen, or door.

34. Measuring and recording weight of an ambulatory resident 5. Make sure resident is wearing non-skid shoes before walking to scale. 6. Start with the scale balanced at zero. If you do not know how to balance the scale, ask the nurse. 7. Help the resident step onto the center of the scale, facing the scale. Once on the scale, his arms must hang free.

35. Measuring and recording weight of an ambulatory resident 8. Determine resident’s weight. This is done by balancing the scale by making the balance bar level. Move the small and large weight indicators until the bar balances. Read the two numbers shown (on the small and large weight indicators) when the bar is balanced. Add these two numbers together. This is the resident’s weight.

36. Measuring and recording weight of an ambulatory resident 9. Help the resident off the scale before recording weight. 10. Record the resident’s weight. 11. Remove privacy measures. 12. Leave call light within resident’s reach. 13. Wash your hands. 14. Be courteous and respectful at all times. 15. Report any changes in the resident to the nurse. Document procedure using facility guidelines.

37. Measuring and recording weight of a bedridden resident • Equipment: scale, pen and paper to record findings • Have another co-worker assist you. 1. Identify yourself by name. Identify the resident. Greet the resident by name. 2. Wash your hands. 3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Provide for the resident’s privacy with a curtain, screen, or door.

38. Measuring and recording weight of a bedridden resident 5. Adjust the bed to a safe level, usually waist high. Lock the bed wheels. 6. Start with the scale balanced at zero. If you do not know how to balance the scale, ask the nurse. 7. Examine the sling, straps, chains, and/or pad for any damage. Do not use the scale if you find damage. 8. Turn linen down so that it is off the resident.

39. Measuring and recording weight of a bedridden resident 9. Turn resident to one side away from you (Chapter 11) or if flat pad scale is used, slide resident onto pad using a helper. If a sling is used, remove from the scale and place underneath the resident without wrinkling it. 10. When using a sling, turn the resident back on his back and straighten sling. 11. Attach the sling to the scale or, if using a flat pad scale, position resident securely on the pad.

40. Measuring and recording weight of a bedridden resident 12. Check the straps or other connectors, and raise the sling or the pad until the resident is clear of the bed. With some scales, you can keep the resident directly over the bed while weighing him. With others, you have to move the scale away from the bed. Secure the resident before moving the scale. 13. For digital scales, turn them on and note reading. With other scales, move the weights until you get a reading. Note the weight.

41. Measuring and recording weight of a bedridden resident 14. Lower the resident back down on the bed. If using a sling, turn resident to both sides to remove the sling. If using a pad scale, carefully slide the resident back onto the bed. 15. Record the resident’s weight. 16. Make resident comfortable. Replace bed linens. 17. Return bed to lowest position. Remove privacy measures.

42. Measuring and recording weight of a bedridden resident 18. Leave call light within resident’s reach. 19. Wash your hands. 20. Be courteous and respectful at all times. 21. Report any changes in the resident to the nurse. Document procedure using facility guidelines.

43. Measuring and recording height of an ambulatory resident • Equipment: standing/upright scale, pen and paper to record your findings 1. Identify yourself by name. Identify the resident. Greet the resident by name. 2. Wash your hands. 3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Provide for the resident’s privacy with a curtain, screen, or door.

44. Measuring and recording height of an ambulatory resident 5. Help the resident to step onto scale, facing away from the scale. 6. Ask the resident to stand straight, if possible. Help as needed. 7. Pull up measuring rod from back of scale. Gently lower measuring rod until it rests flat on the resident’s head. 8. Determine resident’s height.

45. Measuring and recording height of an ambulatory resident 9. Help the resident off scale before recording height. Make sure measuring rod does not hit resident in the head while helping resident off the scale. 10. Record height. 11. Remove privacy measures. 12. Leave call light within resident’s reach. 13. Wash your hands. 14. Be courteous and respectful at all times.

46. Measuring and recording height of an ambulatory resident 15. Report any changes in the resident to the nurse. Document procedure using facility guidelines.

47. Measuring and recording height of a bedridden resident • Equipment: measuring tape, pencil, pen and paper to record your findings 1. Identify yourself by name. Identify the resident. Greet the resident by name. 2. Wash your hands. 3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Provide for the resident’s privacy with a curtain, screen, or door.

48. Measuring and recording height of a bedridden resident 5. Adjust the bed to a safe level, usually waist high. Lock the bed wheels. 6. Turn linen down so it is off the resident. 7. Position resident lying straight in the supine (back) position. Be sure the bed sheet is smooth underneath the resident. 8. Using a pencil, make a small mark on the bottom sheet at the top of the resident’s head.

49. Measuring and recording height of a bedridden resident 9. Make another pencil mark at the resident’s heel. 10. Using the tape measure, measure the area between the pencil marks. This is the resident’s height. 11. Record the resident’s height. 12. Make resident comfortable. Replace bed linen. 13. Return bed to lowest position. Remove privacy measures.

50. Measuring and recording height of a bedridden resident 14. Leave call light within resident’s reach. 15. Wash your hands. 16. Be courteous and respectful at all times. 17. Report any changes in the resident to the nurse. Document procedure using facility guidelines.