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1. Describe how residents may feel when entering a facility

Residents may have to make many emotional adjustments before entering a facility and may be experiencing any or all of the following:• Fear • Uncertainty • Anger • Loss of health, mobility, independence, family, friends, pets,

plants

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1. Describe how residents may feel when entering a facility

REMEMBER:

Lesbian, gay, bisexual and transgender (LGBT) residents may experience additional challenges when moving into a facility. They may fear they will not be accepted or understood by staff or other residents.

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1. Describe how residents may feel when entering a facility

Think about these questions:

What can an NA do to make LGBT residents feel welcomed and accepted?

How should an NA behave if she believes homosexuality is wrong?

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1. Describe how residents may feel when entering a facility

REMEMBER:

A LTCF is a resident’s home. It is essential for an NA to make every resident feel as comfortable as possible, even if the resident’s culture or lifestyle is very different from his own.

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Handout 11-1: 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 do not take, but you will not have access to any stored items until you move again.

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Handout 11-1: Quiz: You Are Moving! (cont’d.)

Think of space. All six items must fit into your small room, or in your half of the closet, which is a five foot by three foot space. Name six things you will take with you. (Seven outfits of clothing count as one item.) 1. _________________________________________________

_________________________________________________2. _________________________________________________

_________________________________________________3. _________________________________________________

_________________________________________________4. _________________________________________________

_________________________________________________5. _________________________________________________

_________________________________________________6. _________________________________________________

_________________________________________________

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Handout 11-1: Quiz: You Are Moving! (cont’d.)

During the first week, your niece, who is 5 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, which you had notified the post office to forward. You mention this to your sister, and she says offhandedly, “Oh, I did see some here yesterday. I don’t know where it is.” Then she walks out of the room. What is your response?

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1. Describe how residents may feel when entering a facility

Think about these questions:• What did you decide to take with you to your sister’s? • How did you feel as you tried to decide what to take? • Did you get angry? Sad? Frustrated? • How did you feel about your mail and your sister’s response to

you?

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1. Describe how residents may feel when entering a facility

REMEMBER: • In many ways, our homes are our personal museums. They

house the souvenirs of our lives, the pictures of our families, the decorative items we like, the furnishings we have chosen. It can be very difficult to part with these things, even for a short time.

• Residents’ Rights recognizes how important personal property is by assuring that residents can bring belongings into the facility as space permits, unless doing so would infringe on the rights, health, or safety of other residents.

• You can probably understand why Residents’ Rights state that the resident has the right to privacy in written communications, including the right to send and promptly receive mail that is unopened.

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1. Describe how residents may feel when entering a facility

Think about this question:

What might this exercise teach us about residents’ experiences when they are admitted to a facility?

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2. Explain the nursing assistant’s role in the admission process

Define the following term:baseline

initial values that can be compared to future measurements.

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2. Explain the nursing assistant’s role in the admission process

NAs should remember these guidelines for admission: • Prepare the room before the resident arrives. • When resident arrives, note the time and resident’s condition. • Introduce yourself, giving your position. Address the resident

by his formal name. • Do not rush the admission process. • Make sure the new resident feels welcome.

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2. Explain the nursing assistant’s role in the admission process

Guidelines for admission (cont’d): • Explain daily operations in facility. Offer a tour. Introduce

resident to everyone. • Handle personal items with care. • Honor resident preferences when setting up the room.• Observe the resident for any problems that are missed during

admission.

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 by name.

2. Wash your hands.

3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.

Admitting a resident

4. Provide for the resident’s privacy with curtain, screen, or door. If the family is present, ask them to step outside until the admission process is over. Show them where they can wait and let them know approximately how long the process will take.

Admitting a resident

4. If part of facility policy, do these things:

• Measures the resident’s height and weight (see procedures below).

• Measures the resident’s baseline vital signs (see Chapter 14). Baseline signs are initial values that can then be compared to future measurements.

• Obtain a urine specimen if required (see Chapter 16).

• Complete the paperwork. Take an inventory of all the personal items.

• Help the resident put personal items away.

• Provide fresh water.

Admitting a resident

6. Show the resident the room and bathroom. Explain how to work the bed controls and the call light. Show the resident the telephone, lights, and the television controls.

7. Introduce the resident to his roommate, if there is one. Introduce other residents and staff.

8. Make sure resident is comfortable. Remove privacy measures. Bring the family back inside if they were outside.

Admitting a resident

9. Place call light within resident’s reach.

10. Wash your hands.

11. Document procedure using facility guidelines.

Measuring and recording weight of an ambulatory resident

Equipment: standing/upright scale or bathroom scale, pen and paper

1. Identify yourself by name. Identify 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 resident’s privacy with curtain, screen, or door.

Measuring and recording weight of an ambulatory resident

5. 5. If using a bathroom scale, set the scale on a hard surface in a place the resident can get to easily.

6. 6. Make sure resident is wearing non-skid shoes that are securely fastened before walking to scale.

7. 7. Start with scale balanced at zero before weighing the resident.

Measuring and recording weight of an ambulatory resident

8. Help resident to step onto the center of the scale as needed. Be sure she is not holding, touching, or leaning against anything. This interferes with weight measurement. Do not force someone to let go. If you are unable to obtain a weight, notify the nurse.

Measuring and recording weight of an ambulatory resident

9. Determine the resident’s weight.

Using a standing scale: Balance 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.

Measuring and recording weight of an ambulatory resident

10. Help resident to safely step off scale before recording weight.

11. Record the resident’s weight.

12. Remove privacy measures.

13. Place call light within resident’s reach.

14. Wash your hands.

15. Report any changes in resident’s weight (when weighing resident after admission) to the nurse.

16. Document procedure using facility guidelines.

Measuring and recording height of an ambulatory resident

For residents who can get out of bed, you will measure height using a standing scale.

Equipment: standing scale, pen and paper

1. Identify yourself by name. Identify 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.

Measuring and recording height of an ambulatory resident

4. Provide for resident’s privacy with curtain, screen, or door.

5. Make sure resident is wearing non-skid shoes that are securely fastened before walking to scale.

6. Help resident to step onto scale, facing away from the scale.

7. Ask resident to stand straight if possible. Help as needed.

8. Pull up measuring rod from back of the scale and gently lower the rod until it rests flat on the resident’s head

Measuring and recording height of an ambulatory resident

9. Determine the resident’s height.

10. Assist the resident in stepping off scale before recording height. Make sure that the measuring rod does not hit the resident in the head while trying to help the resident off of the scale.

11. Record height.

12. Remove privacy measures.

13. Place call light within resident’s reach.

14. Wash your hands.

15. Document procedure using facility guidelines.

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2. Explain the nursing assistant’s role in the admission process

REMEMBER:

NAs will weigh residents repeatedly during their stay, and any change in weight should be reported immediately.

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3. Explain the nursing assistant’s role during an in-house transfer of a resident

REMEMBER:

It is a resident’s legal right to be informed of transfers. The nurse should explain the details of the transfer, and the NA will pack the resident’s personal items carefully. Residents must always be informed of any room or roommate change, as well.

Transferring a resident

Equipment: may include a wheelchair, cart for belongings, the medical record, all of the resident’s personal care items and packed personal items

1. Identify yourself by name. Identify 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.

Transferring a resident

4. Collect the items to be moved onto the cart. Take them to the new location. If the resident is going into the hospital, they may be placed in temporary storage.

5. Help the resident into the wheelchair (stretcher may be used). Take him or her to proper area.

6. Introduce new residents and staff.

7. Help the resident to put personal items away.

Transferring a resident

8. Make sure that the resident is comfortable.

9. Place call light within resident’s reach.

10. Wash your hands.

11. Report any changes in resident to the nurse.

12. Document procedure using facility guidelines.

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4. Explain the nursing assistant’s role in the discharge of a resident

The nurse may discuss the following with a resident who is being discharged:• Doctor or physical therapy appointments • Home care or skilled nursing care• Medications • Ambulation instructions • Medical equipment needed• Medical transportation• Restrictions on activities • Special exercises • Special dietary requirements • Community resources

Discharging a resident

Equipment: may include a wheelchair, cart for belongings, discharge paperwork, including the inventory list from admission, resident’s care items

1. Identify yourself by name. Identify 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 resident’s privacy with curtain, screen, or door.

Discharging a resident

5. Compare the inventory checklist to the items there. If all items are there, ask the resident to sign.

6. Put the personal items to be taken onto the cart and take them to pick-up area.

7. Help the resident dress and then into the wheelchair or onto stretcher if used.

8. Help the resident to say his goodbyes to the staff and residents.

Discharging a resident

9. Take resident to the pick-up area. Help him into vehicle. You are responsible for the resident until he is safely in the car and the door is closed.

10. Wash your hands.

Discharging a resident

11. Document procedure using facility guidelines. Include the following:

• Time of discharge

• Method of transport

• Who was with the resident

• The vital signs at discharge

• What items the resident took with him (inventory checklist)

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5. Describe the nursing assistant’s role in physical exams

REMEMBER:

NAs can help lessen residents’ fear and discomfort during exams. Listening, talking, and light touching may all help.

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5. Describe the nursing assistant’s role in physical exams

NAs may have to gather the following equipment for the nurse or doctor:• Sphygmomanometer • Stethoscope • Alcohol wipes • Flashlight • Thermometer • Tongue depressor • Eye chart • Tuning fork

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5. Describe the nursing assistant’s role in physical exams

Equipment an NA may gather for the nurse or doctor (cont’d):• Reflex hammer • Otoscope • Ophthalmoscope • Specimen containers • Lubricant • Special card to test for blood in stool• Vaginal speculum • Gloves • Drape

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5. Describe the nursing assistant’s role in physical exams

Define the following terms:dorsal recumbent position

body position in which a person is flat on her back with her knees flexed and her feet flat on the bed.

lithotomy positionbody position in which a person lies on her back with her hips at the edge of an exam table; legs are flexed, and feet are in padded stirrups.

knee-chest positionbody position in which the person is lying on her abdomen with her knees pulled towards the abdomen and her legs separated; arms are pulled up and flexed, and the head is turned to one side.

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5. Describe the nursing assistant’s role in physical exams

REMEMBER:

NAs should communicate to residents why exam positions are needed and how long the resident can expect to stay in the position.

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Transparency 11-1: Body Positions for Exams

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5. Describe the nursing assistant’s role in physical exams

NAs should remember these guidelines for physical exams:• Wash hands before and after. • Ask resident to urinate and collect urine if needed. • Provide privacy throughout. • Listen to and reassure the resident. • Follow directions. • Help resident into proper position. • Protect the resident from falling. • Provide light to examiner.

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5. Describe the nursing assistant’s role in physical exams

Guidelines for physical exams (cont’d):• Put instruments in proper places. • Take and label specimens. • Follow Standard Precautions. • Assist with vision screenings as ordered.• Help resident clean up, get dressed, and return to room. • Dispose of trash and equipment. • Clean and store equipment. • Take labeled specimens to proper place.

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ExamMultiple Choice. Choose the correct answer.1. Which of the following is a reason that new residents may have trouble

adjusting to life in a care facility?(A) They will have more independence in a facility.(B) Their health is improving.(C) They have had to leave their home.(D) The other residents and staff are people they already know well.

2. Which of the following should a nursing assistant do during a resident’s admission? (A) The NA should get the admission process completed as quickly as

possible.(B) The NA should allow the resident to introduce himself to everyone in the

facility. (C) The NA should explain how to work the call light and bed controls. (D) The NA should place the resident’s personal items where the NA thinks is

best.

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Exam3. What is a nursing assistant’s responsibility during an in-house transfer of a

resident? (A) The NA decides that the resident must be transferred. (B) The NA must keep the fact that a transfer will occur a secret. (C) The NA should pack all of the resident’s belongings. (D) The NA should tell the resident’s roommate about the transfer.

4. When a resident is going to be discharged, a nursing assistant should (A) Give the resident ambulation instructions from the doctor (B) Be positive and assure the resident that he is ready for this change (C) Give the resident his last medication (D) Decide which dietary requirements the resident will need

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Exam5. Before weighing a resident, the scale should be balanced at

(A) Zero(B) Five pounds(C) The resident’s last known weight(D) Negative two pounds to account for clothing

6. During a physical exam, a nursing assistant can help a resident by (A) Avoiding a resident’s question if he asks why a position is needed (B) Chatting with the doctor to pass the time (C) Telling the resident funny stories (D) Covering the resident and not exposing him more than is necessary

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Exam7. Baseline vital signs are

(A) Initial values that can be compared to future measurements (B) Normal ranges for vital signs (C) Vital signs that are out of normal range (D) Changes in vital signs from one measurement to another

8. How will a nursing assistant measure the height of a resident who cannot get out of bed? (A) The NA will use a scale. (B) The NA will use a tape measure. (C) The NA will estimate height by looking at the resident. (D) The NA will not be able to measure height.

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Exam9. In which position is the resident placed for examination of the breasts, chest,

and abdomen?(A) Knee-chest position(B) Lithotomy position(C) Dorsal recumbent position(D) Trendelenburg position

10. Why might a resident need emotional support during a physical exam? (A) Residents are always frightened of exams. (B) Doctors are not very sensitive to their patients’ emotions.(C) The resident has probably never had a physical exam before.(D) The resident may fear what the examiner will find.

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CHAPTER 11 PRACTICE1. Which of the following is a reason that new residents may have trouble adjusting to life in a care facility?

(A) They will have more independence in a facility.

(B) Their health is improving.

(C) They have had to leave their home.

(D) The other residents and staff are people they already know well.

2. Baseline vital signs are

(A) Initial values that can be compared to future measurements

(B) Normal ranges for vital signs

(C) Vital signs that are out of normal range

(D) Changes in vital signs from one measurement to another

3. In which position is the resident placed for examination of the breasts, chest, and abdomen?

(A) Knee-chest position

(B) Lithotomy position

(C) Dorsal recumbent position

(D) Trendelenburg position

4. Why might a resident need emotional support during a physical exam?

(A) Residents are always frightened of exams.

(B) Doctors are not very sensitive to their patients’ emotions.

(C) The resident has probably never had a physical exam before.

(D) The resident may fear what the examiner will find.

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CHAPTER 11 PRACTICE ANSWERS1. C- THEY HAVE HAD TO LEAVE THEIR HOME2. A- INITIAL VALUES THAT CAN BE COMPARED TO FUTURE MEASUREMENTS3. C- DORSAL RECUMBENT POSITION4. D- THE RESIDENT MAY FEAR WHAT THE EXAMINER WILL FIND