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CNA Study ch 1-4

Material for CNA certification exam from Hartman's Nursing Assistant Care 4th ed

What is LTC Long Term Care facilities are for people who need 24 hour skilled care
What is Skilled Care Medically necessary care given by a skilled nurse or therapist; Available 24 hrs per day Ordered by a physician Given to people who need a high level of care for ongoing conditions
Terminal illness? A condition that will ultimately end in death
Chronic condition? Last a long period of time, even a lifetime. Includes physical disabilities, heart disease and dementia
Diagnoses Medical conditions determined by a doctor
Assisted living Residences for people who need some help with daily care Do not need 24-hr skilled care Can have memory-care units for mild dementia
Adult day services People who need some assistance and supervision during certain hours but do not live in a facility where care is provided
Acute care 24-hr skilled care for people who require short-term, immediate care for illnesses or injuries or short stays for surgeries Sudden onset, short-term illnesses
Sub-acute care Given in hospitals or LTCs Used for people who need less care than for an acute illness but more than LTC normal care
Rehabilitation Care given by specialists to resotre or improve function after an illness or injury
Hospice care Given in facilities or homes for people who have approximately 6 mo. or less to live
Managed Care Controls cost by limiting plan members' choice of healthcare providers and facilities Increasing emphasis on promoting wellness as a means of reducing the need for healthcare services
Activities of Daily Living (ADL) Daily personal care tasks
What percent of people in LTCs are over 65 yrs old? 85%
What percent of people in LTCs are female? 67%
What percent of people in LTCs are white and non-hispanic? 76%
What percent of people in LTCs are from a private residence? 33%
What percent of people in LTCs are from a hospital or other facility? 50%
What is the length of stay for over 2/3 of LTC residents >= 6 mo.
What group in LTCs have the longest stays Developmentally disabled
What fraction of LTC residents are admitted for terminal care 1/6
What fraction of LTC residents are admitted for rehabilitation or temporary illness (eventually will return to the community)? 1/6
What is a policy? A course of action that should be taken every time a certain situation occurs
What is a procedure? A method or way of doing something
What is a care plan? Plan for resident's care that must be followed by the NA. NAs should not provide any care that is not within the care plan
What is Medicare and name the four parts with their function? US Federal Health Insur, for people >=65 yrs old and people with certain conditions such as advanced kidney disease Part A - Hospitalization costs Part B - Clinical costs Part C - Medicare Advantage supplements Part D - Medication costs
What is "Culture Change" for LTCs? Process of transforming services for elders so that they are based on the values and practices of the person receiving care. Core values are promoting choice, dignity, respect, self-determination, and purposeful living.
What is Person-centered Care? Care that revolves around the person and his/her individual needs and preferences
Who in the care team spends the most time with residents? Nursing assistants
Who coordinates, manages and provides skilled nursing care for residents in a skilled nursing facility? Registered Nurses
Who is a licensed professional that administers medications and gives treatments? Licensed Practical Nurses or Licensed Vocational Nurses (LPN / LVN)
What does a Physical Therapist do? Evaluates and develops treatment to increase movement, improve circulation, promote healing, reduce pain, prevent disability and regain or maintain mobility.
How is a DPT different from a PT? A Doctor of Physical Therapy is most common in the US. Physical Therapists are almost always required to achieve the doctoral level.
What are the NA responsibilities regarding tubes? An NA is NOT allowed to insert or remove tubes, give tube feedings or change sterile dressings. An NA can clean around a tube and observe/report on any changes or other notable item.
What is charting? Noting important information about the resident in the patient's medical record or other procedural report.
Are the resident and resident's family part of the care team? Yes!
If an NA sees a resident who needs help, even if the resident is not on his assignment sheet, should the NA help the resident? Yes!
What is professionalism? Behaving properly on the job, including: Person-centered care Positive attitude, polite / cheerful Assigned tasks in care plan only Listening Never give / accept gifts Explaining care Best care practice No personal problems Confidentiality
What does compassionate mean? Being caring, concerned, considerate, empathetic and understanding
What does it mean to demonstrate empathy? Identifying with the feelings of others Understanding other people's problems Part of being compassionate
What does it mean to show sympathy? Sharing in the feelings and difficulties of others Part of being compassionate
What does it mean to be tactful? Showing sensitivity and having a sense of what is appropriate when delaing with others Ability to speak and act without offending others
What does it mean to be conscientious Trying to do your best Be guided by a sense of right and wrong Alert, observant, accurate and responsible Making accurate observations and reports, following care plan, taking responsibility for one's actions
What is the difference between being unprejudiced and being tolerant? Unprejudiced is giving the same quality care to everyone Tolerant is being respectful of other's differences
What is the chain of command? Line of authority ensuring proper health care. Protects against liability (being held responsible for harming someone)
What does it mean to honor the scope of practice for an NA? Not honoring request to do something not listed on the assignment sheet or in the care plan Not performing procedures that require sterile technique Not diagnosing or prescribing Not talking about diagnosis or treatment with family or res
What is the care plan? A list of tasks that the team members must perform A guide to help the resident reach and maintain the best possible level of health
Should activities outside the care plan be performed? No.
Is the resident involved in formulating the care plan? Yes, the resident has the legal right to participate
Will the resident ever have more than one care plan? Yes, it is possible, but there will be only one care plan for the NA to follow, coordinated by the RN.
What is the nursing process? ADPIE -- Assess, Diagnose, Plan, Implement, Evaluate
What are the Five Rights of Delegation? Task Circumstance Person (is the NA the right person to do the job) Direction / Communication Supervision / Evaluation
What does the NA need to consider before accepting a task? Have all info needed? Can I do it? Have all resources needed? Who is my supervisor for the task? How to reach? Does everyone understand who will do what?
What are time management elements for the NA? PPSCG -- plan, prioritize, schedule, combine, get help
What is the difference between legal and ethical? Legal -- required by law or regulation Ethical -- sense of duty toward others based on a knowledge of right and wrong
What are the guidelines for legal and ethical behavior? Honesty Protect privacy Staff info confidential Report abuse Follow care plan and assignments Reporting and documenting Follow safety / infection rules No gifts No personal/sexual involvement w/ residents
Why was OBRA passed and what does it stand for? Omnibus Budget Reconciliation Act (1987) Response to reports of poor care and abuse Specified minimum standards of care including standardized training of NAs
What are minimum OBRA standards for NAs? Competency evaluation -- written and demonstrated >= 75 hrs training, >= 12 hrs /yr service education classes Listed in state registry
What are minimum OBRA standards for resident assessment? Minimum Data Set completed for each resident within 14 days of admission and annually thereafter. Must be reviewed every 3 months. New MDS if major changes in resident's condition.
Are OBRA survey results available to the public? Yes
What are OBRA rights for residents? Quality of Life Services - high wellness level Fully informed of rights / services Participate in own care Independent choices Privacy/confidentiality Dignity, respect, freedom xfer/discharge - informed / consent Complain Visits Social services
What is neglect? Active? Passive? Failure to provide needed care, resulting in harm to a person Active: purposeful Passive: unintentional
What is negligence? Actions or failure to act or provide proper care for a resident, resulting in unintended injury
What is malpractice? A person is injured due to professional misconduct through negligence, carelessness or lack of skill
What is abuse? Purposeful mistreatment causing pain / injury Physical Psychological Assault (threat to harm) Battery Sexual (incl. unwanted touch) Financial Domestic/workplace violence False imprisonment Involuntary seclusion Sexual harassment Substance abuse
What injuries are considered suspicious and should be reported? Poisoning/traumatic injury Teeth marks buckle / strap marks Bruises Scars Fractures/dislocations Burns scratches scalp tender or missing hair Swelling broken teeth bruising, bleeding, discharge from vagina
What signs could indicate abuse? Yelling obscenities Fear Poor self control Constant pain Threats withdrawal/apathy substance abuse agitation low self esteem mood changes, confusion privacy not permitted by care giver reports of questionable care
What signs could indicate neglect? Pressure injuries Unclean body Body lice Unanswered call lights Soiled bedding Briefs not changed Poorly fitting clothes Hearing aids / glasses not used weight loss / poor appetite / uneaten food dehydration Fluids not offered
What does it mean to an NA to be a Mandated Reporter? NAs are legally required to report suspected or observed abuse or neglect because they have regular contact with vulnerable populations.
How does the NA report abuse? Through the chain of command until action is taken
What are the NA guidelines for protecting residents' rights? Never abuse Use their preferred name Involve in planning Always explain proc before No unnecessary exposure Allow refusal of care Assist w/complaints Truthful doc/rep confidentiality knock / ask permission no gifts respect possessions
What are ombudsmen and what do they do? Legal advocate for residents mandated by the Older American's Act (OOA) Advocate Educate Investigate Appear in court Work with investigators Give info to public
What is HIPAA and what is PHI? Part of HIPAA requires that health providers protect privacy and security of health information. PHI is protected health information = can be used to identify a person and relate to any of their health info (medical, psychological or financial)
Why can't you bring family and friends to the facility to meet residents? Violates privacy of residents
Is it OK to email information about residents? No, not unless you are conforming to facility policy and procedure using the facility's secure email
What is proper document handling? Store, file or shred according to facility policy Do not leave documents where others can see them
What is proper procedure with computers? No confidential info in email Make sure no one can see your screen Log out / exit browser when finished with work
What should you do if you see a resident's family in public? Be careful not to reveal anything that they wouldn't want the public to know, even to the point of greeting them at all. Never talk about a resident in public.
What are Advance Directives? Legal documents allowing people to specify care they want in the event that they can't convey those wishes themselves. They can also designate someone else to make those decisions for them. Living wills and durable power of attorney are examples.
What is a DNR order? It tells medical providers not to perform CPR in the event of cardiac or respiratory arrest.
What are POLSTs? Physician Orders for Life Sustaining Treatment What the person wants to receive, not what he wants to avoid
What is communication? Process of exchanging information with others, sending and receiving messages. Send-receive-feedback
What are barriers to communication? Not hearing, hearing correctly or understanding Not being able to be understood NA uses words not understood (e.g. med terms) Slang, profanity or cliches Why questions Giving advice Yes/no questions Different language Not catching nonverbal clues
What are ways to improve communication accuracy and develop effective interpersonal relationships? Good listener Feedback Bring up topics of concern Pauses Cultural sensitivity Tolerance Appropriate touch Ask for more - don't change subject Hearing aids, dentures, glasses, etc. in working order Don't talk down to them or ignore requests
How should NAs communicate with residents' families? Listen and ask questions to learn more about how to best care for the resident
What is the best body position for an NA to facilitate communication? Appropriately near resident leaning forward in chair, talking directly to them
What is the difference between facts and opinions? Facts are based on objective evidence, opinions are based on beliefs and cannot be proven
What is the difference between objective and subjective information? Objective (signs) is based on observations; subjective (symptoms) is not based on observations. Reports should indicate whether information is subjective or objective.
What doesn't an NA use to observe a resident? Taste
How should the NA handle any questions from a doctor about a resident? Refer the doctor to the nurse. The NA should make sure that the nurse always has all info that the NA knows about any resident.
Should the NA share info about a resident with another NA? Only if the other NA needs that information to render care to that resident
What do the following medical term roots mean: derm, brady, cardia, itis, pathy, neuro derm = skin brady = slow cardia = heart itis = inflammation pathy = disease neuro = nervous system
How should the NA approach a nurse to give an oral report? Wait until the nurse is done with her current task and for the nurse to acknowledge the NA. The NA should give the nurse notes on what is being reported, if possible / appropriate.
What are some examples of information that should be reported immediately falls chest pain severe headache difficulty breathing abnormal vitals change in mental status high fever sudden weakness or loss of mobility bleeding change in consciousness signs of abuse
What are NA guidelines for documentation? document immediately after care given be brief and clear use facts, not opinions black ink one line through mistakes -- initial and date sign full name and title follow care plan follow info security / privacy policies
What is an incident? Accident, problem or unexpected event during the course of care
What are NA guidelines for reporting incidents? Describe what happened along with time and condition of resident Describe the action taken to give care Facts, not opinions Do not duplicate info from the incident report into the medical record
What are guidelines for NA use of the telephone? Always identify yourself first Never ask their name, ask for person you are calling Leave a message if not there Don't give more info than necessary - include name, callback number and brief description of what you want Thank them
When should an NA respond to a call light? immediately after you finish the action you are taking with any other resident
What are signs of hearing loss? Speaking loudly Leaning forward Cupping an ear Responses inappropriate Asking to repeat Speaking in monotone Avoiding social interaction Suspecting others are speaking softly (about them)
What are NA guidelines for caring for people with hearing impairment? Make sure they wear the hearing aid and keep it clean Reduce background noise Get resident's attention before speaking to them use picture cards repeat using diff words if needed Speak clearly, slowly, in good lighting; directly face them
What should the NA not do with hearing impaired residents? Speak loudly or exaggerate mouth movements Raise the pitch of your voice Long, tiring conversations chew gum or eat while talking speak in the side of the weak ear Suddenly change topics pretend you understand them if you don't
What is nearsightedness? farsightedness? Nearsighted = myopia -- can see close better than far Farsighted = hyperopia -- can see far better than close
What are NA guidelines for vision impaired? Encourage use of eyeglasses/ contacts keep glasses clean Knock -- id yourself before touching Proper lighting Tell res what you are doing/going to do Use clock directions don't move stuff walk slightly ahead audible clocks assist w/food
What is stroke? Cerebro-vascular accident (CVA) or brain attack -- blood to brain is blocked (ischemic) or a blood vessel ruptures in brain Can be mild or severe
What is the difference between hemiplegia and hemiparesis? Paralysis on one side of the body vs. weakness on one side of the body (one-sided neglect)
What is expressive aphasia? receptive aphasia? expressive - difficulty expressing self using speech or writing receptive -- difficulty understanding spoken or written words
What is emotional lability? Inappropriate or unprovoked emotional response
What is dysphasia? Difficulty swallowing
What are NA guidelines for stroke? Direct, simple questions Agree on signals Patient, attentive listening Pencil and paper; communic boards and special cards Call signal within reach Verbal and nonverbal messaging stay positive "weaker" or "involved" -- not "bad"
What are NA guidelines for combative behavior? Block or avoid blows Do not hit back Allow calm down before next interact. Stay neutral. Do not respond to accusations or argument; don't accuse Keep hands open and in front of you What provoked the behavior? Report to nurse stay arm's length away
What are NA guidelines for anger? Stay calm Do not argue or respond to attacks Empathize Use silence; listen Dignity and respect; tell what you will do and when you will do it Answer call lights promptly Safe distance if combative
What are NA guidelines for inappropriate behavior (trying to establish personal rather than professional relationship with NA)? Light approach - "I'm not allowed to do that" Direct approach - "That makes me uncomfortable" "I can't talk about my personal life" "I can't help you. I can ask the nurse to engage a social worker to help you" Do not over-react Report to nurse
Created by: lynnevanarsdale
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