1. Define important words in this chapter

1. 1. Define important words in this chapter • aspiration • the inhalation of food, fluid, or foreign material into the lungs. • atrophy • weakening or wasting of muscles. • body mechanics • the way the parts of the body work together when a person moves. • chemical restraint • medications used to control a person’s behavior.

2. 1. Define important words in this chapter • combustion • the process of burning. • cyanosis • blue or pale skin and/or mucous membranes due to decreased oxygen in the blood. • dysphagia • difficulty in swallowing. • flammable • easily ignited and capable of burning quickly.

3. 1. Define important words in this chapter • hoarding • collecting and putting things away in a guarded manner. • Material Safety Data Sheet (MSDS) • sheet that provides information on the safe use of and hazards of chemicals, as well as emergency steps to take in the event chemicals are splashed, sprayed or ingested. • PASS • acronym for use of a fire extinguisher; stands for Pull-Aim-Squeeze-Sweep. • RACE • acronym for steps taken during a fire; stands for Remove-Activate-Contain-Extinguish.

4. 1. Define important words in this chapter • restraint • a physical or chemical way to restrict voluntary movement or behavior. • restraint alternatives: • measures used instead of physical or chemical restraints. • restraint-free care • an environment in which restraints are not kept or used for any reason. • scalds • burns caused by very hot liquids.

5. 1. Define important words in this chapter • slip knot • a quick-release knot used to tie restraints. • suffocation • the stoppage of breathing from a lack of oxygen or excess of carbon dioxide in the body that may result in unconsciousness or death; also known as asphyxia.

6. 2. List common accidents in facilities and ways to prevent them • There are many types of accidents that can occur in a facility. It is very important that nursing assistants be proactive about preventing accidents from occurring.

7. 2. List common accidents in facilities and ways to prevent them • Fall Prevention • Remember these guidelines for preventing falls: • Identify residents who may be at risk and guard against falls. • Nurses should let you know which medications may cause unsteadiness so you can be aware of residents who are taking these medications. • Respond to call lights promptly. • Wipe up spills immediately. • Remove clutter from walkways. • Get help when moving residents.

8. 2. List common accidents in facilities and ways to prevent them • Fall Prevention • Guidelines for preventing falls (cont’d.): • Lock bed wheels before giving care. Lock wheelchair wheels before transferring residents into or out of them. • Return side rails to ordered position, if used. Leave beds in lowest position when finished with care. • Make sure residents’ clothing fits properly. • Use non-skid mats and rugs. • Report loose hand rails immediately. • Report damage of outdoor furniture, benches, and ramps. • Clearly mark areas where floor is uneven.

9. 2. List common accidents in facilities and ways to prevent them • Fall Prevention • Guidelines for preventing falls (cont’d.): • Keep call lights and other needed items within residents’ reach. • Keep walkers and canes nearby. • Do not move furniture without an order from the nurse. • Offer trips to the bathroom often. • Keep night light on in room if resident wishes. • Make sure eyeglasses are within easy reach. • Never try to catch or stop a falling resident. Use your body to slide him to the floor.

10. 2. List common accidents in facilities and ways to prevent them • REMEMBER: • Most of the accidents in a facility are related to falls. Falls are often caused by unsafe environments, loss of abilities, diseases, muscle weakness, poor vision, or disorientation.

11. 2. List common accidents in facilities and ways to prevent them • Resident Identification • Remember these guidelines for identifying residents: • Identify residents before providing care or serving food. • Failure to identify residents can result in illness or even death. • Disoriented residents may have special bands with alarms on them. • Check resident’s ID and call resident by name. • Check diet cards against resident’s identification.

12. 2. List common accidents in facilities and ways to prevent them • Define the following term: • scalds • burns caused by very hot liquids.

13. 2. List common accidents in facilities and ways to prevent them • Burn/Scald Prevention • Burns are very painful and can occur quickly. Elderly people and those with loss of sensation are at greater risk for burns. • Remember these guidelines for preventing burns and scalds: • Check water temperature before giving a resident a bath or shower. Temperature should not be over 105°F. • Check for proper temperature of warm water applications. • Use low setting on hair dryers. • Let liquids cool before serving. • Serve drinks when residents are seated.

14. 2. List common accidents in facilities and ways to prevent them • Burn/Scald Prevention • Guidelines for preventing burns and scalds (cont’d.): • Tell residents before pouring or setting down hot drinks. • Use lids on hot liquids. • Pour hot liquids away from residents. • Check plates that have been warmed. • Make sure anything that has been in the sun has cooled before use. • Tell residents about smoking precautions.

15. 2. List common accidents in facilities and ways to prevent them • Define the following term: • hoarding • collecting and putting things away in a guarded manner.

16. 2. List common accidents in facilities and ways to prevent them • Poisoning Prevention • Remember these guidelines for poison prevention: • Keep all items that may be poisonous away from disoriented residents. • Do not leave cleaning products in residents’ rooms. • Check dates of foods to ensure that they are fresh. • Check residents’ drawers for hoarded food that has spoiled. • Make sure there is proper ventilation when chemical products are used.

17. 2. List common accidents in facilities and ways to prevent them • Define the following terms: • dysphagia • difficulty in swallowing. • aspiration • the inhalation of food, fluid, or foreign material into the lungs.

18. 2. List common accidents in facilities and ways to prevent them • Choking Prevention • Remember these guidelines for choking prevention: • Residents should be sitting up straight while eating. • Assist with feeding slowly. Never rush a resident during a meal. • Cut food into small pieces. • Report to nurse if you think a resident would be helped by softer foods or thickened liquids. • Make sure dentures are in place and fit properly. • Be aware of residents’ swallowing problems.

19. 2. List common accidents in facilities and ways to prevent them • Cuts and Other Injuries • Remember these guidelines for preventing cuts, scrapes, and other injuries: • Do not leave sharp objects out. • Approach doors slowly. • When moving residents in wheelchairs, protect their arms, legs, hands, and feet. • Push wheelchairs forward. • Wheelchairs should face forward in elevators.

20. 2. List common accidents in facilities and ways to prevent them • Remember these general safety guidelines: • Do not run in a facility. • Do not put your hand into a bed or anywhere else without looking first. • Ask for help when you need it. • Watch combative residents closely. • Follow facility policy if a skin splash or eye splash occurs. • Report all injuries immediately.

21. 3. Explain the Material Safety Data Sheet (MSDS) • Define the following term: • Material Safety Data Sheet (MSDS) • sheet that provides information on the safe use of and hazards of chemicals, as well as emergency steps to take in the event chemicals are splashed, sprayed, or ingested.

22. 3. Explain the Material Safety Data Sheet (MSDS) • The Occupational Safety and Health Administration (OSHA) is responsible for the safety of employees at work. OSHA requires that all dangerous chemicals have a Material Safety Data Sheet (MSDS). These sheets are placed where all staff can access them.

23. 3. Explain the Material Safety Data Sheet (MSDS) • Discussion: • Review a sample MSDS, or look at the one in the textbook on page 110. Look for the places on the sheet where you will find the following important information: • Chemical ingredients of the product • Dangers of the product • Protective items to be worn • How to use and clean up the chemical • Emergency response if product is splashed onto skin or ingested • Safe handling procedures

24. 4. Describe safety guidelines for sharps and biohazard containers • As you learned earlier, sharps and biohazard containers are the containers that hold sharp objects and infectious waste. • Follow these safety guidelines when using sharps and biohazard containers: • Wear gloves when touching a sharps container. • Keep hands above opening at top of container. • Touch the bottom of the container only. • Replace container when it is ¾ full or according to facility policy.

25. 4. Describe safety guidelines for sharps and biohazard containers • Safety guidelines when using sharps and biohazard containers (cont’d.): • Remove gloves and wash hands after putting anything into sharps container. • Use biohazard container or bag for anything contaminated with infectious waste except for sharps. • Wear gloves when disposing of infectious waste. • Remove gloves and wash hands after putting anything into the biohazard container or bag.

26. 5. Explain the principles of body mechanics and apply them to daily activities • Define the following term: • body mechanics • the way the parts of the body work together when a person moves.

27. 5. Explain the principles of body mechanics and apply them to daily activities • REMEMBER: • There are risks of injury on the job that you will face as a nursing assistant. Using proper body mechanics will help prevent injuries.

28. 5. Explain the principles of body mechanics and apply them to daily activities • Good body mechanics help save energy and prevent injury and muscle strain. • When muscles are used correctly to push and lift objects or people, it reduces the risk of injury. • Basic principles of body mechanics will help keep you and your residents safe.

29. Transparency 7-1: Body Alignment

30. 5. Explain the principles of body mechanics and apply them to daily activities • Be familiar with these terms associated with body mechanics: • Alignment • Base of support • Center of gravity

31. 5. Explain the principles of body mechanics and apply them to daily activities • Alignment • Alignment is based on the word “line.” When you stand up straight, a vertical line could be drawn right through the center of your body and your center of gravity. • When the line is straight, the body is in alignment. Whether standing, sitting, or lying down, try to have your body in alignment. • Maintain correct body alignment when lifting or carrying an object by keeping it close to your body. Point your feet and body in the direction you are moving. Do not twist at the waist.

32. 5. Explain the principles of body mechanics and apply them to daily activities • Base of Support • The base of support is the foundation that supports an object. Something that has a wide base of support is more stable than something with a narrow base of support. • The feet are the body’s base of support. Standing with your legs shoulder-width apart gives a greater base of support. You will be more stable than someone standing with his feet together.

33. 5. Explain the principles of body mechanics and apply them to daily activities • Center of Gravity • The center of gravity in your body is the point where the most weight is concentrated. When you stand, your weight is centered in your pelvis. A low center of gravity gives a more stable base of support. • Bending your knees when lifting an object lowers your pelvis. It lowers your center of gravity. This gives you more stability and makes you less likely to fall. • If you are moving or transferring a resident, the center of gravity includes the resident. When you are transferring a resident, the resident needs to be as close to your body as possible.

34. Transparency 7-2: Lifting Heavy Objects from the Floor

35. 5. Explain the principles of body mechanics and apply them to daily activities • Activities on the job that will require moving or lifting: • Lifting a resident • Picking up a bag of laundry • Carrying residents’ luggage • Taking heavy trash bags to appropriate site • Cleaning a floor • Moving a bed into another room

36. 5. Explain the principles of body mechanics and apply them to daily activities • Consider these guidelines when performing your daily activities in order to use good body mechanics: • Raise beds to safe working level. • Stand close to object. • Stand with a wide base of support. • Push or slide objects rather than lifting. • Use muscles of upper arms and upper thighs to lift. • Bend at the knees instead of at the waist.

37. 5. Explain the principles of body mechanics and apply them to daily activities • Guidelines for performing daily activities using good body mechanics (cont’d.): • • Avoid twisting or choppy movements. • • Do not lift with one hand. • • Hold objects close to your body when lifting. • • Avoid bending and reaching. • • Get help when you need it. • • Talk to residents before moving them.

38. 6. Define two types of restraints and discuss problems associated with restraints • Define the following terms: • restraint • a physical or chemical way to restrict voluntary movement or behavior. • chemical restraint • medications used to control a person’s behavior. • suffocation • the stoppage of breathing from a lack of oxygen or excess of carbon dioxide in the body that may result in unconsciousness or death; also known as asphyxia. • atrophy • weakening or wasting of muscles.

39. 6. Define two types of restraints and discuss problems associated with restraints • Common physical restraints are the vest restraint, belt restraint, wrist/ankle restraint, and mitt restraint. Side rails and special chairs, such as geriatric chairs, are also considered physical restraints. • Restraint use has declined in facilities, and laws have been passed restricting their use due to abuse by caregivers. • Overuse of chemical restraints was once a common problem. In the past, residents were routinely restrained for different reasons.

40. 6. Define two types of restraints and discuss problems associated with restraints • REMEMBER:Restraints may never be used without a doctor’s order.

41. 6. Define two types of restraints and discuss problems associated with restraints • Potential negative effects of restraint use: • Bruises and cuts • Pressure ulcers • Pneumonia • Reduced blood circulation • Risk of suffocation • Stress on the heart • Incontinence • Constipation • Muscle atrophy • Loss of bone mass

42. 6. Define two types of restraints and discuss problems associated with restraints • Potential negative effects of restraint use (cont’d.): • Poor appetite and malnutrition • Depression • Sleep disorders • Loss of dignity • Loss of independence • Stress and anxiety • Increased agitation • Loss of self-esteem • Severe injury • Death

43. 7. Define the terms “restraint free” and “restraint alternatives” and list examples of restraint alternatives • Define the following terms: • restraint-free care • an environment in which restraints are not kept or used for any reason. • restraint alternatives • measures used instead of physical or chemical restraints.

44. 7. Define the terms “restraint free” and “restraint alternatives” and list examples of restraint alternatives • The use of restraints is being dramatically reduced in facilities. State and federal agencies encourage facilities to take steps to create restraint-free environments. • Restraint-free care means that restraints are not kept or used for any reason. Creative ideas that help avoid the need for restraints are being used instead. These creative ideas are called restraint alternatives.

45. 7. Define the terms “restraint free” and “restraint alternatives” and list examples of restraint alternatives • REMEMBER: • Studies have shown that restraints are not truly needed. People tend to respond better to the use of creative ways to reduce tension, pulling at tubes, wandering, and boredom.

46. 7. Define the terms “restraint free” and “restraint alternatives” and list examples of restraint alternatives • Think about these questions: • How would it feel to be restrained? Can you think of your own ideas about ways to avoid using restraints?

47. Handout 7-1: Restraint Alternatives • • Answer call lights immediately. • • Improve lighting. • • Use postural devices. • • Add more exercise into the care plan. • • Let confused residents wander in designated safe areas. • • Give frequent help with toileting. • • Encourage independence with all tasks. • • Encourage participation in social activities. • • Involve residents with hobbies. • • Create activities for those who wander at night. • • Offer reading materials, and read to the resident if needed. • • Offer backrubs. • • Increase visits and social interaction. • • Increase the number of familiar caregivers. • • Get the family involved. • • Offer snacks or drinks. • • Redirect interest. • • Decrease the noise level. • • Use soothing music. • • Report complaints of pain immediately.

48. 8. Identify what must be done if a restraint is ordered • Define the following terms: • slip knot • a quick-release knot used to tie restraints. • cyanosis • blue or pale skin and/or mucous membranes due to decreased oxygen in the blood.

49. 8. Identify what must be done if a restraint is ordered • Remember these guidelines for restraint use: • Know state laws and facility rules regarding applying restraints. • Follow manufacturer’s instructions. • Use correct size and style of restraint. • Always use a slip knot. • Never tie restraint to side rails.

50. 8. Identify what must be done if a restraint is ordered • Guidelines for restraint use (cont’d.): • Place hand in flat position between resident and restraint to make sure it is not too tight. • Apply vest or belt style restraint over clothing. • Place call light within resident’s reach. • Document appropriately.