Online Nursing Assistant 75 Hour Curriculum 16 Hour Initial Curriculum

Transcription

1 Healthcare Academy (HCA) is a leading online learning company serving the extended care industry. HCA has developed a toolbox using technology and traditional classroom and clinical learning opportunities to provide the initial training (75 and 16 hour curriculums as defined by the Code of Federal Regulations) for nursing assistants. Part one of this manual is the Code of Federal Regulations. This document contains the requirements necessary for the 75 hour nursing assistant course. It also contains the requirements for the 16 hours of training required before direct contact with a resident. Part two contains the curriculum designed by Healthcare Academy to meet the requirements. It is important to note that each organization is responsible for meeting their individual state guidelines. Healthcare Academy provides the tools for you to use. You must know and comply with your state guidelines as you incorporate HCA into your program. 3/2012 Page 1

2 Code of Federal Regulations] [Title 42, Volume 5] [Revised as of October 1, 2009] From the U.S. Government Printing Office via GPO Access [CITE: 42CFR ] Online Nursing Assistant 75 Hour Curriculum [Page 83-85] TITLE 42--PUBLIC HEALTH CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) PART 483_REQUIREMENTS FOR STATES AND LONG TERM CARE FACILITIES-- Table of Contents Subpart D_ Requirements That Must Be Met by States and State Agencies: Nurse Aide Training and Competency Evaluation, and Paid Feeding Assistants Sec Requirements for approval of a nurse aide training and competency evaluation program. (a) For a nurse aide training and competency evaluation program to be approved by the State, it must, at a minimum-- (1) Consist of no less than 75 clock hours of training; (2) Include at least the subjects specified in paragraph (b) of this section; (3) Include at least 16 hours of supervised practical training. Supervised practical training means training in a laboratory or other setting in which the trainee demonstrates knowledge while performing tasks on an individual under the direct supervision of a registered nurse or a licensed practical nurse; (4) Ensure that-- (i) Students do not perform any services for which they have not trained and been found proficient by the instructor; and (ii) Students who are providing services to residents are under the general supervision of a licensed nurse or a registered nurse; (5) Meet the following requirements for instructors who train nurse aides; (i) The training of nurse aides must be performed by or under the general supervision of a registered nurse who possesses a minimum of 2 years of nursing experience, at least 1 year of which must be in the provision of long term care facility services; (ii) Instructors must have completed a course in teaching adults or have experience in teaching adults or supervising nurse aides; (iii) In a facility-based program, the training of nurse aides may be performed under the general supervision of the director of nursing for the facility who is prohibited from performing the actual training; and (iv) Other personnel from the health professions may supplement the instructor, including, but not limited to, registered nurses, licensed practical/vocational nurses, pharmacists, dietitians, social workers, sanitarians, fire safety experts, nursing home administrators, gerontologists, psychologists, physical and occupational therapists, activities specialists, speech/language/hearing therapists, and resident rights experts. Supplemental personnel must have at least 1 year of experience in their fields; (6) Contain competency evaluation procedures specified in Sec (b) The curriculum of the nurse aide training program must include-- (1) At least a total of 16 hours of training in the following areas prior to any direct contact with a resident: (i) Communication and interpersonal skills; (ii) Infection control; (iii) Safety/emergency procedures, including the Heimlich maneuver; (iv) Promoting residents' independence; and (v) Respecting residents' rights. (2) Basic nursing skills; (i) Taking and recording vital signs; (ii) Measuring and recording height and weight; 3/2012 Page 2

3 (iii) Caring for the residents' environment; (iv)recognizing abnormal changes in body functioning and the importance of reporting such changes to a supervisor; (v) Caring for residents when death is imminent. (3) Personal care skills, including, but not limited to-- (i) Bathing; (ii) Grooming, including mouth care; (iii) Dressing; (iv) Toileting; (v) Assisting with eating and hydration; (vi) Proper feeding techniques; (vii) Skin care; and (viii) Transfers, positioning, and turning. (4) Mental health and social service needs: (i) Modifying aide's behavior in response to residents' behavior; (ii) Awareness of developmental tasks associated with the aging process; (iii) How to respond to resident behavior; (iv) Allowing the resident to make personal choices, providing and reinforcing other behavior consistent with the resident's dignity; and (v) Using the resident's family as a source of emotional support. (5) Care of cognitively impaired residents: (i) Techniques for addressing the unique needs and behaviors of individual with dementia (Alzheimer's and others); (ii) Communicating with cognitively impaired residents; (iii) Understanding the behavior of cognitively impaired residents; (iv) Appropriate responses to the behavior of cognitively impaired residents; and (v) Methods of reducing the effects of cognitive impairments. (6) Basic restorative services: (i) Training the resident in self care according to the resident's abilities; (ii) Use of assistive devices in transferring, ambulation, eating, and dressing; (iii) Maintenance of range of motion; (iv) Proper turning and positioning in bed and chair; (v) Bowel and bladder training; and (vi) Care and use of prosthetic and orthotic devices. (7) Residents' Rights. (i) Providing privacy and maintenance of confidentiality; (ii) Promoting the residents' right to make personal choices to accommodate their needs; (iii) Giving assistance in resolving grievances and disputes; (iv) Providing needed assistance in getting to and participating in resident and family groups and other activities; (v) Maintaining care and security of residents' personal possessions; (vi) Promoting the resident's right to be free from abuse, mistreatment, and neglect and the need to report any instances of such treatment to appropriate facility staff; (vii) Avoiding the need for restraints in accordance with current professional standards. (c) Prohibition of charges. (1) No nurse aide who is employed by, or who has received an offer of employment from, a facility on the date on which the aide begins a nurse aide training and competency evaluation program may be charged for any portion of the program (including any fees for textbooks or other required course materials). (2) If an individual who is not employed, or does not have an offer to be employed, as a nurse aide becomes employed by, or receives an offer of employment from, a facility not later than 12 months after completing a nurse aide training and competency evaluation program, the State must provide for the reimbursement of costs incurred in completing the program on a pro rata basis during the period in which the individual is employed as a nurse aide. 3/2012 Page 3

4 Instructor Resources Sources of Information (can be found on the web) 1. State of Tennessee Department of Health 2. Indiana State Department of Health: Nurse Aide Training Program Administrative Standard 3. How to Be a Nurse Assistant Fourth Addition Student Textbook AHCA 4. Nursing Assistant Nurse Aide Exam: 2 nd Edition Learning Express, New York 5. Texas Curriculum for Nurse Aides in Long Term Care Facilities (excellent resource for Skills Exam and Competency Check List Optional text for your course: 1. How to Be a Nurse Assistant Fourth Addition Student Textbook AHCA 2. How to Be a Nurse Assistant Fourth Addition Student Textbook AHCA Student Workbook 3/2012 Page 4

5 Topic 1: Introduction to Healthcare Total 1.5 Introduction to Healthcare 1 What is important for you as a human how do they differ from your resident? How does long term care differ from acute care? What type of residents live in long term care? What is the purpose of a long term care facility? Describe a common belief or feeling about aging and discuss whether it is true. Topic 2: Your Role as a Nursing Assistant Total 1.75 Your Role as a Nursing Assistant 1.5 State the qualities of an effective nurse aide. List the responsibilities of the nurse aide to the residents, the facility and other staff. Discuss the role of the nurse aide in relation to the health care team. What should you do if you are asked to perform a task, which is beyond your scope? What must a CNA do to present a positive image? Explain accountability. Is it acceptable for you to accept a gift of money from a person that you deliver care to? Discuss the differences between an appropriate and an inappropriate relationship. Is it okay for you to carry and conceal a weapon? How can you prevent physical injury for yourself? How can you manage your time? How can you protect yourself legally? How do the needs of those you care for differ from yours? What are the human needs of those you care for? Topic 3: Observing and Reporting Total 2.75 Observing and Reporting 1 How do you help the nurses identify the needs of those that you care for? If you have a concern about a resident, who do you report to? Give some examples of things that you would report. What are the benefits of good reporting? Give examples of what you would report immediately versus the end of shift? Coding and Documentation of ADLs.5 Why is it important to code correctly? Lab: Review 5 current residents and code each /2012 Page 5

6 Topic 4: Communication and Interpersonal Skills Total 3.0 Communication Basics 2.0 What is the difference between verbal and nonverbal communication? Define active listening. What are barriers for you in communicating? What are some of the factors that affect your communication with residents who are impaired? Describe what your day would be like without communication. How do you communicate with families? How do you communicate with other workers? How do you start a conversation? How important is listening skills? How does communication differ if the individual is hard of hearing? Is sight impaired? Has difficulty speaking? Has difficulty understanding? Telephone Etiquette.5 How do you answer a telephone? Topic 5: Infection Control Total 8.75 Breaking the Chain of Infection (30) Understanding Bloodborne Pathogens 1.5 Discussion: What is infection control? What is a pathogen? What is an infection? Why is infection control important? How are infections spread? Describe the difference between dirty and clean..5 What is standard precautions? What is hepatitis? What is HIV? What are blood and body fluids? What is a blood borne pathogen? Safety with Sharps.5 What do you do if you see an uncapped needle on the floor? Hand Hygiene.5 When would you wash your hands with soap and water? Why is hand washing important? Lab: Handwashing steps: 1. Turn on faucet 2. Adjust temperature 3. With hands lower than elbows, wet hands and wrists 4. Apply soap 5. Lather all areas of hands and wrists, rub vigorously for at least 10 seconds 6. Rinse thoroughly, running water down from wrists to fingertips 7. Dry with paper towel 8. Turn off faucet with paper towel and discard towel Personal Protective Equipment (PPE).5 When should you use gloves? Describe the different components of PPE? What does the biohazard emblem look like? Lab: Gloves (applying and removing: 1. Wash hands 2. Apply gloves 3. Perform procedure.5 3/2012 Page 6

7 4. Remove one glove by grasping outer surface just below cuff 5. Pull glove off so that it is inside out 6. Hold the removed glove in your gloved hand 7. Place two fingers of ungloved hand under cuff of other glove and pull down so first glove is inside second glove 8. Dispose of gloves without contaminating hands 9. Wash hands Tuberculosis (TB) 1.0 What are the symptoms of TB? How is TB spread? How is TB detected? Understanding Methicillin resistant Staphylococcus aureus (MRSA).5 What is MRSA? How is MRSA spread? What are the symptoms of MRSA? Describe drug resistant organisms and how they spread? Describe precautions for MRSA. Use of Hand Sanitization.5 When would you use hand sanitizers? Lab: Have individuals practice hand sanitization using product appropriately. Isolation Precautions 1.0 What is isolation precautions? Lab: Practice isolation precautions Practice standard precautions? Topic 6: Body Mechanics and Ergonomics Total 2.5 Back Safety: A lesson in Proper Lifting 1.5 What should you consider before lifting or moving a person? Why is the count of three important when moving a person? Why are proper body mechanics so important? What are the alternatives to lifting an object or person? What should you consider before moving a person or lifting something heavy? What should you do if a back injury occurs? Lab: Lifting Practice; Have participants break into two groups. Have them observe each other lift something heavy. Have them practice lifting a person in bed. Ergonomics.5 What is ergonomics? Topic 7: Safety Total 6.75 Introduction to Safety 1 Discuss the importance of safety in your facility Describe what should you do in the case of: Fainting Falls Vomiting Describe the physical changes associated with aging that increase the risk of accidents. What are some of the things that you might identify in the facility as a safety hazard? How do you make sure that you are delivering care to the right person? What is the safety precautions associated with the use of oxygen? What is the procedure for reporting an incident or an accident? 3/2012 Page 7.5.5

8 What is lock out tag out and how do you implement it? What is the Material Safety Data Sheet (MSDS)? When do you answer a call light? Lab: 1. Call for nurse and stay with person 2. Place padding under head and move furniture away from resident 3. Do not restrain person or place anything in their mouth 4. Loosen residents clothing especially around the neck 5. After seizure stops, position person on their side 6. Note duration of seizure and body areas involved 7. Assist with documentation Fire Safety.5 What is RACE? What is PASS? What three things are necessary for a fire? How do you prevent a fire? Where are the fire extinguishers in your facility? Discussion: 1. Remove residents from area of immediate danger 2. Activate fire alarm 3. Close doors and windows to contain fire 4. Extinguish small fire with a fire extinguisher if possible 5. Follow all facility policies and procedures 6. Where are the fire extinguishers in your facility? Lab: Practice fire extinguisher use outside Environmental Safety.5 List at least five environmental safety issues that may arise in the facility? Describe your role in a natural disaster. Preventing Workplace.5 Name three things that you can do to protect yourself against Violence workplace violence. Risk Management.5 Define risk management. Wandering Elopement Prevention.5 What are the behaviors of a resident that you might see that will make you be concerned about a resident wandering away from the facility?.5 Fall and Restraint Reduction 1.0 Name three things that you can do to reduce the risk of falls in a residents room? Fall procedure discussion: 1. Call for nurse and stay with resident 2. Check for breathing 3. Do not move 4. Talk to the person in a calm and supportive manner 5. Apply direct pressure to bleeding area 6. Take pulse and respiration 7. Assist nurse as directed 8. Assist with documentation 9. Check person frequently.50 3/2012 Page 8

9 Topic 8: Emergencies Total 2.75 Heimlich Maneuver 1.5 What is the universal sign for choking?.5 Lab Practice: 1. Call for nurse and stay with resident 2. Ask if resident can speak or talk 3. If not, move behind resident and slide arms under armpits 4. Place your fist and thumb side against abdomen midway between waist and rib cage 5. Grasp your fist with your other hand 6. Press your fist into abdomen with quick inward and upward thrusts 7. Repeat until object is expelled 8. Do final steps 9. Assist with documentation Code Response.5 What are the emergency codes in your facility? Topic 9: Resident Rights, Privacy Total 7.0 HIPAA 2.0 What is HIPAA? How does it apply to you? What is confidential information? Respecting Residents Rights 1.0 What is the Bill of Rights?.5 What are the rights of the people you care for? What are some of the things that you can do to promote resident rights? What are some things that violate resident rights? How is the right to privacy protected in a health care facility? Explain confidentiality. What is the role of an ombudsman in a long-term care facility? If you suspect resident abuse, what steps must you take? For what reason may a restraint (protective device) be used? What should you do if a resident voices a complaint? Discuss why the persons personal belongings are so important. How do you maintain a respectful environment. Nursing Assistant role: 1. Violating resident rights is against the law 2. Your are THE advocate 3. Encourage the resident to exercise their rights 4. Report anyone who abuses a resident's rights IMMEDIATELY Vulnerable Adult Protection.5 Define vulnerable adult..50 How do your report vulnerable adult incidents? Define abuse. Define neglect. List three signs that an individual might be abused. How do you locate the vulnerable adult hot line? Describe an example of inappropriate sexual behavior or a person s behavior and how to respond. Cultural Diversity.5 Define diversity. Why is it important to understand different cultures in your facility? 3/2012 Page 9

10 Creating a Personalized Activities Program.5 What are activities? How can you participate in the persons individualized plan?.5 What is spiritual care? Spiritual Care What is your role in supporting spiritual care? State a specific religious activity or cultural practice and describe how you can assist the person to participate in this activity. Topic 10: Basic Anatomy Total 1.5 Basic Anatomy Name at least four body systems. What are their functions? Name three structures of the urinary system. What is the bodies first line of defense against infection? Topic 11: Aging Process Total 1.5 Understanding the Aging Process* Caring for the Alzheimer s Client How do you define the aging process? What happens to the senses as you age? What techniques can be used to reduce the effects of Alzheimer's? Describe a major loss associated with aging. How might you help? Describe two normal responses to losses. Topic 12: Cognitive Impairment Total What is Alzheimer's disease? What are the considerations for caring the person with Alzheimer's disease? What is depression? What are the behaviors of a cognitively impaired person? What are the needs of a person in the early, middle and late stages of Alzheimer's? Client Behaviors 1.0 List the types of deterioration that can occur with a person? List the behaviors that are common with advanced dementia. How should your respond to a person exhibiting difficult behaviors? What is your role with behavior management? How can you help with sleep problems? Depression? Yelling? Screaming? Verbal and physical aggression? Topic 13: Families and Significant Others Total 1.5 Working with Families and Those They Care For What are some of the common feelings that family members have when their loved one is admitted to your facility? How can you help family members with their feelings? Topic 14: Residents Environment Total 3.0 Housekeeping 2.0 Lab: Unoccupied Bed 1. Collect linen in order of use 2. Carry linen away from your clothing 3. Place linen on clean surface 4. Put bed in flat position 5. Remove pillow case 6. Loosen soiled linen, roll linen from head to foot of bed and place in hamper 7. Fanfold bottom sheet to center of bed and fit corners 8. Fan fold blanket over top sheet 9. Tuck top linen under foot of mattress and miter corner 10. Move to other side of bed /2012 Page 10

11 Body Positioning: A Welcome Change Online Nursing Assistant 75 Hour Curriculum 11. Fit corners of bottom sheet unfold top linen, tuck it under foot of mattress and miter corner 12. Fold top of sheet over blanket to make a cuff 13. Put on pillowcase and place at head of bed and open end away from door 14. For open bed, make a toe pleat and fanfold top linen to foot of bed with top edge closest to center of bed 15. For closed bed, pull bed stand over pillow and tuck bedspread under lower edge of pillow - make toe pleat Occupied Bed 1. Collect clean linen in order of use 2. Carry linen away from your clothing 3. Place linen on clean surface 4. Lower head of bed 5. Drape person 6. Turn person away from you (toward side rail if present). 7. Loosen bottom linens and roll linen toward resident tucking it snugly against the person 8. Fanfold bottom sheet to center of bed and fit corners over mattress 9. Turn person onto their back, raise the side rail (if present) and move to the other side of the bed and lower side rail (if present) 10. Loosen soiled linen, roll linen from head to foot of bed and place in hamper or bag, at foot of bed or in chair 11. Unfold bottom sheet and fit corners over mattress 12. Place resident in supine position and raise side rail 13. Remove pillow, change pillowcase and place pillow under resident's head with open end away from door 14. Place clean top sheet over person and remove drape 15. Unfold blanket over top sheet and make cuff 16. Tuck top linens under foot of mattress and miter corners 17. Loosen top linens over persons feet Topic 15: Positioning Total Define good body alignment and its benefits. What problems or conditions are prevented by frequent position changes? List the commonly used positions. Why should you NEVER drag or slide a person across the bed linens when you are repositioning? How can you encourage the person to help when moving or positioning? LAB Practice: Supine position 1. Lower head of bed 2. Move person to head of bed if necessary (according to procedure) 3. Position person flat on back with legs slightly apart 4. Align persons shoulders and hips 5. Use supportive padding if necessary.5 3/2012 Page 11

12 Lateral position 1. Place person in supine position (according to procedure) 2. Move person to side of bed closest to you 3. Cross resident's arms over chest 4. Slightly bend knee of nearest leg to you or cross nearest leg over farthest leg at ankle 5. Place your hands under persons shoulder blade and buttock 6. Place supportive padding behind back, between knees and ankles, and under top arm Fowler's position 1. Move person to supine position (according to procedure) 2. Elevate bed 45 to 60 degrees 3. Use supportive padding if necessary Sit on edge of bed 1. Adjust bed height to lowest position 2. Move resident to side of bed closest to you 3. Raise head of bed to sitting position, if necessary 4. Place one arm under persons shoulder blades and the other arm under persons thighs 5. On count of three, slowly turn person into sitting position with legs dangling over side of bed 6. Support for seconds, check for dizziness 7. Assist person to put on shoes or slippers 8. Move person to edge of bed so feet are flat on the floor Assist to move to head of bed 1. Lower head of bed and lean pillow against head board 2. Ask person to bend knees, put feet flat on mattress 3. Place one arm under persons shoulder blades and the other arm under persons thighs 4. Ask person to push with feet on count of three 5. Place pillow under persons head Topic 16: Vital Signs and Measurement Total 4.5 Taking Vital Signs 3.5 What four things are assessed when measuring vital signs? What are the different ways of measuring temperature and what is considered normal? What are the commonly used pulse points in the body? What is considered a normal pulse in adults? How can you measure respirations without the person being aware of the procedure? Why is it important to weigh a person on a regular basis? What is considered a normal pulse? respiration? blood pressure? When do your report? Lab: Practice taking blood pressure, pulse respiration, weight and temperature Topic 17: Bathing Total 2.5 Activities of Daily Living 1.5 What are the benefits of a backrub? What is the purpose of bathing? What is the recommended temperature for bathing? /2012 Page 12

13 Why is perineal care important? What are some of the observations that you should make during bathing? Lab Back rub 1. Person lies on side with back toward you 2. Expose back and shoulders 3. Rub lotion between hands to warm lotion 4. Make long, firm strokes along spine from buttocks to shoulders make circular strokes down on shoulders, upper arms and back to buttocks 5. Repeat for at least 3-5 minutes 6. Gently pat off excess lotion with towel. 7. Cover and position person Shower 1. Clean shower and shower chair 2. Help person remove clothing 3. Drape person with bath blanket 4. Turn on water and have person check water temperature for comfort 5. Assist person into shower and lock wheels of shower chair 6. Let person wash as much as possible starting at face 7. Help person shampoo and rinse hair Bed Bath 1. Offer person bedpan or urinal 2. Drape person (according to procedure) 3. Fill bath basin with warm water and have resident check water temperature 4. If person has open lesions or wounds, put on gloves 5. Fold washcloth and wet 6. Gently wash eye from inner corner out, using a different part of the cloth wash other eye 7. Wet washcloth and apply soap, if requested wash, rinse and pat dry face, neck, ears, and behind ears 8. Remove persons gown 9. Place towel under far arm 10. Wash, rinse, and pat dry hand, arm shoulder and underarm 11. Repeat steps 9-10 with other arm 12. Place towel over chest and abdomen, lower bath blanket to waste 13. Lift towel and wash, rinse and pat dry chest and abdomen 14. Pull up bath blanket and remove towel 15. Place towel under far leg 16. Wash, rinse and pat dry leg and foot 17. Repeat numbers with other leg 18. Change bath water 19. Turn person 20. Wash, rinse, and pat dry from neck to buttocks including anal area 21. Change bath water and gloves. 3/2012 Page 13

14 22. Use clean washcloth and towel 23. Provide perineal care 24. Help person put on clean gown Perineal care 1. Offer person bedpan or urinal 2. Assist person to supine position 3. Place waterproof pad under person's hips 4. Drape person 5. Fill wash basin with warm water and have person check water temperature 6. Put on gloves 7. Assist person to spread legs and lift knees if possible 8. Wet and soap folded washcloth 9. If person has catheter, check for leakage secretions or irritations. Gently wipe four inches of catheter from meatus out 10. Wipe from front to back and from center of perineum to thighs. Change washcloth as necessary For females: 1. Separate labia. Wash urethra area first 2. Wash between and outside labia in downward strokes, alternating from side to side and moving outward to thighs. Use different part of washcloth for each stroke. For males: 1. Pull back foreskin if male is uncircumcised. Wash and rinse the tip of penis using circular motion beginning at urethra 2. Continue washing down the penis to the scrotum and inner thighs 3. Change water in basin, with a clean washcloth, rinse area thoroughly in the same direction as when washing 4. Gently pat area dry in same direction as when washing 5. Assist resident to turn onto side away from you 6. Wet and soap washcloth 7. Clean anal area from front to back, rinse and pat dry thoroughly 8. Remove pad, assist person to turn onto back and undrape person 9. Remove gloves Topic 18: Skin Care Total 2.0 Pressure Ulcer Management 2.0 What are the two most important functions of the skin? What can you do to maintain healthy skin? Describe the changes that occur as we age? Where are people most likely to get pressure ulcers? What special skin care measures can you do for the incontinent person? What are common sites of skin breakdown? How does nutrition effect skin condition? Lab Check skin 1. Drape person.5 3/2012 Page 14

15 2. Check bony areas including ears, shoulder blades, elbows, coccyx, hips, knees, ankles and heels from redness and warmth 3. Check friction areas including under breasts and arms, between buttocks, groin, thighs, skin folds, contracted areas and around any tubing for redness, irritation, moisture and odor 4. Undrape person 5. Report any unusual findings to the nurse immediately Topic 19: Oral Care Total 2.5 Activities of Daily Living 1.5 What are the benefits of good oral hygiene? List the problems that may develop with structures in the mouth and what these problems indicate. Why should persons be encouraged to wear their dentures? What people require more frequent oral care? Lab Denture care 1. Raise head of bed so the person is sitting up. 2. Put on gloves 3. Drape towel under persons chin 4. Remove upper dentures by gently moving them up and down to release suction, turn lower dentures slightly to lift out of mouth 5. Put dentures in denture cup marked with name 6. Take to sink. 7. Line sink with towel and fill halfway with water 8. Hold dentures over sink and brush all surfaces 9. Rinse dentures under warm water, place in cup and fill with cool water 10. Clean person s mouth and swab if necessary. Help person rinse mouth with water or mouthwash diluted with half water if requested. 11. Check teeth, mouth 12. Report any thing unusual or changes Oral care 1. Raise head of bed to sitting position 2. Put on gloves 3. Drape towel below person chin 4. Wet tooth brush and put on small amount of toothpaste 5. First brush upper teeth and then lower teeth 6. Hold emesis basin under person chin 7. Have person rinse mouth with water and spin into basin 8. Check teeth, mouth, tongue and lips for odor, cracking, sores bleeding, and discoloration. Check for loose teeth 9. Report unusual findings to the nurse 10. Remove gloves Oral care for the unconscious 1. Drape towel over pillow 2. Turn person onto unaffected side 3. Put on gloves 4. Place emesis basin under persons chin 5. Hold mouth open with padded tongue blade 1.0 3/2012 Page 15

16 Activities of Daily Living 6. Dip swab in mouth cleaning solution and wipe teeth, gums, tongue and inside surfaces of mouth changing swab frequently 7. Rinse with clean swab dipped in water 8. Check teeth, mouth, tongue and lips for odor, cracking, sores, bleeding, and discolorations. Check for loose teeth 9. Report unusual findings to the nurse 10. Remove gloves Topic 20: Hair and Nail Care Total 1 How should tangles be removed from hair? State the signs and symptoms of head lice that you would report to the charge nurse Describe head lice and how they appear Describe scabies What problems are prevented when nails are clean, trimmed and smooth? Name the types of toe nails that you should NEVER cut? What precautions should you take when cutting toenails? How can you promote the persons independence when providing personal care? Finger nail care 1. Check fingers and nails for color, selling, cuts or splits. Check hands for extreme heat or cold. Report any unusual findings to the nurse before continuing. 2. Raise head of bed so person is sitting 3. Fill bath basin halfway with warm water and have person check water for comfort 4. Soak persons hands and pat dry 5. Put on gloves 6. Clean under nails with orange stick 7. Clip fingernails straight across, then file in a curve 8. Remove gloves Shaving with a safety razor 1. Raise head of bed so person is sitting up 2. Fill bath basin halfway with warm water 3. Drape towel under persons chin 4. Put on gloves 5. Moisten beard with washcloth and put shaving cream over area 6. Hold skin taut and shave beard in downward strokes on face and upward strokes on neck 7. Rinse persons face and neck 8. Apply after shave lotion as requested 9. Remove towel 10. Remove gloves Shaving with electric razor 1. Raise head of bed 2. DO NOT USE ELECTRIC RAZOR NEAR ANY WATER SOURCE, WHEN OXYGEN IS IN USE OR IF PERSON HAS A PACEMAKER 3. Drape towel under persons chin 4. Put on gloves 1 3/2012 Page 16

17 Activities of Daily Living Transferring 5. Apply pre-shave lotion as person wishes 6. Hold skin taut and shave person face and neck according to manufacturers guidelines 7. Apply after-shave lotion as person wishes 8. Remove towel form person 9. Remove gloves Comb hair 1. Raise head of bed so person is sitting up 2. Drape towel over pillow 3. Remove tangles by dividing hair into small sections and gently combing out from ends of hair to scalp 4. Use hair preparations as person wishes 5. Style hair as person wishes 6. Offer mirror Topic 21: Dressing Total 1 When assisting to dress a person with one-sided weakness, what should you be thinking about? What are some things that you need to think about before helping a person with dementia? What should you do if the persons clothes are in need of repair? Who chooses what the person should wear for the day? How do you care for eyeglasses, hearing aides, artificial eyes, artificial limbs, braces, splints? Lab: Change gown 1. Untie the soiled gown 2. Draw top sheet over persons chest 3. Remove arms from gown, unaffected arm first 4. Roll soiled gown from neck down and remove from beneath sheet 5. Slide arms into glean gown, affected arm first 6. Tie gown 7. Remove top sheet from beneath clean gown and cover person Dressing a dependent person 1. Assist person to choose clothing 2. Move person onto back 3. Drape person 4. Guide feet through leg openings of underwear and pants, affected leg first, pull garments up legs to buttocks 5. Slide arm into shirt sleeve, affected side first 6. Turn person onto unaffected side. Pull lower garments over buttocks and hip. Tuck shirt under person. 7. Turn onto affected side. Pull lower garments over buttocks and hip and straighten shirt. 8. Turn person onto back and slide arm into shirtsleeve. Align and fasten garments. Topic 22: Transferring Total 1.5 What problems can occur when moving a resident from a lying to a sitting position? /2012 Page 17

18 What observations should be made before transferring a person? If the person has an affected side due to a stroke, where should the chair be placed during transfer? Lab: Assist to chair: 1. Place chair on resident's unaffected side. Brace firmly against side of bed 2. Assist resident to sit on edge of bed 3. Stand at persons side 4. Have person grasp farthest arm of chair 5. Tell resident to stand on count of three 6. Help resident slowly turn and sit 7. Check body alignment Transfer to wheelchair and transport 1. Place wheelchair on persons unaffected side. Brace firmly against side of bed with wheels locked and foot rests out of the way 2. Assist to sit on edge of bed 3. Stand in front of person and block persons feet with your feet 4. Place your hands under the persons arms and around the persons shoulder blades 5. Ask the person to place their hands on your upper arms 6. On count of three, help the person into standing position by straightening your knees 7. Allow person to gain balance, check for dizziness 8. Move your feet 18 inches apart and slowly turn person 9. Lower person into the wheelchair by bending you knees and leaning forward 10. Align persons body and position foot rests 11. Transport person forward through open doorway after checking for traffic 12. Transport person up to closed door, open door and back wheelchair through doorway 13. Take person to destination and lock wheelchair Topic 23: Mobility Total 1.5 Restorative Care: ROM 1.5 List and define four assistive devices. What are range of motion exercises? Why are ROM exercises important? Besides verbally complaining, how can you tell if the person is having pain? Describe and practice gait belt, cane and walker What is restoration? How can restoration help a person with their quality of life? How can a problem in one area of your life affect another area of your life? What is your role in restorative care? What are the rules for ROM? What precautions must you implement with ROM? Lab: Walking 3/2012 Page 18

19 1. Assist person to sit on the edge of the bed 2. Assist the person to stand on the count of three 3. Allow the person to gain balance 4. Stand to side and slightly behind the person 5. Walk at the persons pace Assist with walker 1. Assist person to sit on edge of bed 2. Place walker in front of person 3. Have person grasp both arms of the walker 4. Brace leg of walker with you foot and place your hand on top of walker 5. Assist person to stand on count of three 6. Stand to side and slightly behind person 7. Have person move walker ahead 6-10 inches then step up to the walker Range of motion 1. Position person in good body alignment 2. Check joints. If swelling, redness or warmth is present, or the person complains of pain, notify the nurse. Continue procedure only if instructed 3. Support limb above and below joint 4. Begin range of motion at shoulders and include the shoulders, elbows, wrists, thumbs, fingers, hips knees, ankles and toes 5. Slowly move joint in all directions it normally moves 6. Repeat movement at least five times 7. Encourage resident to participate as much as possible 8. Stop procedure at any sign of pain and report to the nurse immediately Topic 24: Nutrition and Hydration Total 2.5 Dining Experience 1.5 List the things that you can do to promote a good dining experience for the person. Hydration Needs: Assessment and Care.5 What are the hydration needs of the persons you care for? How can you tell if the person is not receiving enough fluids? What is hydration? What is fluid retention? How much fluid should a person take in a day? What is normal output? Nutritional Care.5 What is adequate nutrition especially important for the elderly? What are the different groups of food? How can you help with eating problems? What are the basic nutrients? On what factors does a person's caloric need depend? Lab Assist to eat 1. Assist person to eliminate if necessary 2. Assist person to wash hands 3. Help person into a comfortable sitting position 4. Check meal card for name and diet. Check tray for correct food, condiments and utensils 5. Serve tray with main course closes to person 3/2012 Page 19

20 Bladder Function /Use of Indwelling Catheter 6. Offer napkin 7. Cut and season food, butter bread, and open cartons as requested 8. Check person frequently 9. Remove napkin and tray 10. Assist person to wash hands and face 11. Measure and record intake if required Feeding 1. Assist person with elimination if necessary 2. Assist person to wash hands 3. Place person in comfortable sitting position 4. Check meal card for name and diet. Check tray for correct food, condiments and utensils 5. Set tray on overbed table and describe food 6. Place napkin or clothing protector under persons chin and across chest 7. Ask person what food is preferred 8. Fill spoon half full with food, direct food to unaffected side of mouth 9. Allow person time to chew and swallow. Offer fluids as the person wishes 10. Wipe persons mouth as needed 11. Remove napkin or clothing protector and tray 12. Wash persons face and hands 13. Measure and record intake if required Topic 25: Elimination Total Define urine. Define feces. How can you assist a person in maintaining normal elimination? What are your responsibilities when caring for a person with an indwelling catheter? What are your responsibilities when caring for a person on a bowel and bladder training program? Describe the changes in urinary function associated with aging. How do you care for a person with an indwelling catheter? How can constipation be avoided? What is fecal impaction? How can it be avoided? What types of changes should you report to the nurse? Why is prompt assistance needed with helping a person with their toileting needs? How do you take a urine specimen? Lab 1. Assist to bathroom 2. Walk with person into bathroom 3. Assist person to lower garments and sit 4. Give person the call light and toilet paper 5. If person is able to be left alone, step out of bathroom and return when called 6. Put on gloves and assist to wipe area from front to back 3/2012 Page 20

21 7. Remove gloves 8. Assist person to raise garments 9. Assist person to wash hands 10. Walk with person to bed or chair Assist to bedside commode 1. Place commode next to the bed on the persons unaffected side 2. Assist person to commode 3. Give person the call light and toilet paper 4. If person is able to be left alone, step behind curtain and return when called 5. Put on gloves 6. Assist person to wipe from front to back 7. Help person into bed 8. Remove and cover pan and take to bathroom 9. Check urine and or feces for color odor, amount and character and report unusual findings to nurse Bedpan/fracture pan 1. Lower head of bed 2. Put on gloves 3. Turn person away from you 4. Place bedpan or fracture pan according to manufacturers directions 5. Gently roll person back onto pan and check for correct placement 6. Cover person 7. Raise head of bed to sitting position 8. Give person the call light and toilet paper 9. Leave person and return when called 10. Lower head of bed 11. Press bedpan flat on bed and turn person 12. Wipe person from front to back 13. Provide perineal care if necessary 14. Check urine and or feces for color, odor, amount, character and report unusual findings to nurse 15. Cover bedpan 16. Dispose of urine and feces, sanitize pan and return pan according to current nursing practices 17. Remove gloves 18. Assist person to wash hands Urinal 1. Raise head of bed to sitting position 2. Put on gloves 3. Offer urinal to resident or place urinal between his legs and insert penis into opening 4. Cover person 5. Give call light and toilet paper 6. Leave person and return when called 7. Remove and cover urinal 8. Take urinal to bathroom, check urine for color, odor, amount and character and report unusual findings to nurse 3/2012 Page 21

22 Death, Dying and Hospice Care 9. Dispose of urine, sanitize and return urinal according to current nursing practices 10. Remove gloves 11. Assist person to wash hands 12. Document output if required Empty urinary drainage bag 1. Put on gloves 2. Place paper towel on floor below bag and place graduate on paper towel 3. Detach spout and put it into center of graduate without letting tube touch sides 4. Unclamp spout and drain urine 5. Clamp spout 6. Replace spout in holder 7. Check urine for color, odor, amount and character and report unusual findings to the nurse 8. Measure and accurately record amount of urine 9. Dispose of urine, sanitize and return graduate according to current nursing practices 10. Remove gloves Topic 26: Care of the Dying Person Total Discuss your thoughts about death How do you meet the person s needs for physical comfort? What are the five stages of grief? How do you provide for the emotional and psychosocial needs of the dying person and their family? Needs of the Caregiver.5 What is stress?.5 How do you deal with stress? Describe ways to stay emotionally healthy. Topic 27: Survey Process Total 2.5 Optional: Introduction to the Quality Indicator Survey 2.0 How should you respond in an interview with a state inspector?.5.5 Note: Review Healthcare Academy QIS Lesson List to determine additional lessons. Additional 32 lessons available. Understanding Restraints Topic 28: Restraints Lab only: Define physical restraints. What are two types of restraints? Why restraints are considered the last resort? State two advantages of not using a restraint. What are 3 things you can do to avoid the use of a restraint. Describe the observation and necessary for safe use of restraints. Practice proper use of a restraint. 3/2012 Page 22

23 abbreviation abrasion abuse accountable Term Online Nursing Assistant 75 Hour Curriculum Glossary of Terms Nursing Assistant A shortened form of a word. Definition An area of the body's surface where outer layer of skin is damaged due to friction. Act that causes harm. accurate Correct exact. Acquired Immune Deficiency Syndrome (AIDS) actively listen activities of daily living (ADL) acute care adequate adjustment process Being responsible for your own choices (words and actions). Set of diseases resulting from infection with Human Immunodeficiency Virus (HIV) which destroys the body s ability to fight infection. Paying attention to what is said in a conversation. Physical activities of everyday life (bathing, grooming, dressing, positioning, toileting, eating). Treatment for illnesses which come on suddenly and are usually of short duration. Enough A series of changes that occur over time to a situation or condition. advocate One who defends the rights of another. aging process agitation alignment Alzheimer's disease ambulate anger anxiety appropriate arthritis Series of physical, sensory and psychosocial changes that occur over many years. Being overly excited. To put in a straight line. Is a disease of the brain affecting memory, judgment, ability to think and, eventually, all physical functions. May begin as early as middle age but usually affects the elderly. Symptoms occur in three phases. Phase One- forgetfulness, particularly of recent events, avoiding unfamiliar situations and seeking the familiar, moodiness. Phase Tworestlessness particularly in the evening, inability to recognize dangerous situations, needs assistance with ADLs, speaks in one or two word responses and repeats, increased agitation. Phase Three-unable to recognize family, staff or self, dependent for all ADLs, incontinent, unable to walk. Death usually results from complications of infection, aspiration or heart failure. To walk A strong feeling of displeasure at a situation. Persistent feelings of fear and nervousness. Suitable for a particular purpose, occasion or person. Is an inflammatory condition of the joints caused by infection, injury or degenerative joint disease. Types of arthritis include: Osteoarthritis-caused by the wear and tear on the smooth covering of the joint. Symptoms include pain, stiffness and swelling. Rheumatoid arthritis-caused by a chronic inflammatory disease of connective tissue in the joints and other parts of the body. Symptoms include redness, swelling, severe pain in the joints, fever, fatigue and weight loss. 3/2012 Page 23

24 arthroplasty aspiration assess assistive devices balance barrier basic diet bath blanket bedpan bedridden bedside stand blood pressure body mechanics bruise call light cancer cardiac arrest catastrophic reactions cerebrovascular accident (CVA, stroke) chair bound character chemical restraint choking chronic obstructive pulmonary disease (COPD) chronological order closed bed closed head injury coccyx cognitively impaired (Total joint replacement) is a surgical procedure that replaces a diseased joint (hip, knee) with an artificial mechanism to re-establish motion. Inhaling a foreign object or substance (food, liquids). To evaluate or check. Equipment used to help the person increase independence. A state of being stable. Anything that hinders or blocks. A regular or general well balanced diet. Flannel sheet used to provide warmth and privacy. A device placed under a bedridden resident to collect urine or feces. Confined to bed. Storage area for personal care items and personal belongings. Measurement of the force the blood exerts against the walls of the arteries. Using the body properly to coordinate balance and movement. Discoloration of skin due to injury. A means of communicating with staff to get help. Is the uncontrolled division of mutated cells resulting in tumors? Malignant cells may spread to other parts of the body through blood and lymph system. Seven warning signs (American Cancer Society) are: change in a wart or mole, lump or thickening in the breast or anywhere in the body, difficulty swallowing or indigestion, change in bladder or bowel habits, persistent cough or hoarseness, sore that does not heal, unusual bleeding or discharge. Heart function and circulation stop. Being abnormally overwhelmed by stimuli; easily startled. Is a decreased blood flow to the brain resulting in brain injury? Symptoms include headache, dizziness, weakness or paralysis of an extremity or one side of the body, inability to talk, incontinence. Confined to a chair. Consistency and clarity (sediment, mucous, blood). Use of chemical means to limit the activity or aggressiveness of a resident where such activity or aggressiveness could be harmful to the resident or others. Complete blockage of the airway requiring immediate action. Is a disorder in which the flow of air into and out of the lungs is restricted as a result of such diseases as emphysema, chronic bronchitis and asthma. Symptoms include shortness of breath, coughing up mucous, fatigue, and with emphysema, the development of a barrel shaped chest. The sequence in which events occur. Made with spread pulled over the pillow. Are injuries to the soft tissue of the brain as a result of falls or blows to the head which result in concussion, cerebral contusion and closed skull fractures. Effects of severe head injuries include paralysis, speech difficulties, personality change, difficulty breathing and incontinence. Triangular bone at the base of the spine. Diminished mental capacity for awareness and ability to make correct judgments. 3/2012 Page 24

25 communicate communication confidentiality congestive heart failure constipation continuity of care coronary artery disease (CAD) corporal punishment cross contamination culture current nursing practices cyanosis death deformities delusion dementia dentures dependent depression developmental disability (DD) diabetes mellitus Exchange information. The exchange of information and messages. Keeping information secret. Is a disorder that develops when heart muscle is weakened and the heart becomes unable to pump enough blood. The weakened heart may be a result of chronic hypertension, myocardial infarction or narrowed blood vessels. Symptoms include difficulty breathing, fluid in the lungs, edema in feet and ankles, confusion, irregular pulse and cyanosis. Hard, dry stool usually occurring infrequently. Getting everyone from every department on all shifts working towards the same goals using compatible methods. Is the narrowing of the coronary arteries causing reduced blood supply to the heart muscle. Angina pectoris (chronic persistent chest pain) may result. A complete blockage of the arteries to the heart muscle results in a myocardial infarction (heart attack). Symptoms include indigestion, nausea, crushing chest pain, perspiration, cool skin, paleness and shortness of breath. Physical punishment inflicting bodily harm. Spread of different pathogens between two surfaces. Values, beliefs and customs passed on from generation to generation by a group of people. To update, proven and accepted ways of providing nursing care. Bluish or grayish discoloration of skin. Stopping of all body functions natural conclusion to life. Abnormally formed parts of the body. False belief not supported by reality. Progressive mental deterioration due to organic brain disease which causes structural changes within the brain. Removable false teeth. Relying on others for help or support. Emotional sadness and withdrawal, usually caused by loss (of person, possession, health, choice, self esteem). Is a disability, which is attributable to: Mental retardation, cerebral palsy, epilepsy or autism. Any other condition found to be closely related to mental retardation because this condition results in similar impairment of general intellectual functioning or adaptive behavior or requires similar treatment or services. Is a disorder in which the pancreas does not produce enough insulin (a hormone which enables glucose to enter the cells). Symptoms include excessive thirst, frequent urination, excessive hunger, weight loss, blurred vision and slow healing of wounds. Immediate action is required if a diabetic exhibits signs of: Hyperglycemia (high blood sugar) which can result in diabetic coma. Symptoms appear gradually and include thirst, increase urination, abdominal pain, cramps, nausea, vomiting, dim vision, confusion, slurred speech, rapid pulse, drowsiness, flushed, hot dry skin, deep labored breathing, fruity breath odor. Hypoglycemia (low blood sugar) which can result in insulin shock. Symptoms include hunger, restlessness, irritability, nervousness, weakness, dizziness, headache, nausea, blurred or double vision, pale, cold or clammy skin, sweaty, shallow breathing, confusion, and strange or unusual behavior. 3/2012 Page 25