Understand safety and emergency care skills within the nurse aide range of function.

Understand safety and emergency care skills within the nurse aide range of function.

Unit A Nurse Aide Workplace FundamentalsEssential Standard NA3.00 Understand infection control, safety and emergency skills within the nurse aide scope of practice. Indicator 3.02 Understand nurse aide’s safety and emergency care skills within the nurse aide range of function

3.02 Nursing Fundamentals 7243 1

Nurse aide students must hold current certification in HEALTHCARE PROVIDER BASIC LIFE SUPPORT and be assessed for skill retention prior to clinical!

REQUIREMENT:


1 OUNCEPREVENTION

1 POUND

CURE

PR

EV

EN

TIO

N


The Bottom Line

Prevention, Prevention, Prevention, Prevention, Prevention, Prevention,Prevention, Prevention, Prevention.


National Patient Safety Goals for Long Term Care:1. Identify residents correctly2. Use medicines safely3. Prevent Infection4. Check residents medications5. Prevent residents from falling6. Prevent bed sores

NPSG impacted greatly by Nurse Aide Work3.02 Nursing Fundamentals 7243 5

National Patient Safety Goals for Long Term Care:

Identify residents correctly NPSG.01.01.01

Use at least two ways to identify residents. For example, use the resident’s name and date of birth or last four digits of SS number.




Provide care to right resident

Use identification bracelets Ask resident to state name




Use I.D. systems that involve photographs

Realize that care to wrong resident can threaten life



Prevent Infection NPSG.07.01.01

Use the hand cleaning guidelines from the Centers for Disease Control and Prevention or World Health Organization.



Prevent residents from falling NPSG.09.02.01

Find out which residents are most likely to fall. For example, is the resident taking any medications that might make them weak, dizzy, or sleepy? Take action to prevent falls for these residents.


Greater Risk of Falls

• Age related factors

• Awareness of surroundings

• Decreased Vision

• Hearing Impaired

• Decreased ability to smell

• Decreased sensitivity to touch

• Immobility

• Medications


Nursing Fundamentals 7243 12

Report observations to supervisor that lead you to believe a resident is prone to falling

Preventing Falls

3.02

Falls account for 70%

of accidents in healthcare facilities

For Your Information


Answer call signals promptly

Keep frequently used articles within reach of resident

Preventing Falls



Lock brakes on movable equipment

–wheel chairs–stretchers and mechanical

lifts–beds –commodes

Preventing Falls

3.02


Properly position residents in:–bed–wheel chair

Preventing Falls

3.02


OBSERVE NO LIFT OR LIMITED LIFT POLICIES

TO PREVENT FALLS AND INJURY TO RESIDENT

AND NURSE AIDE

Preventing Falls

3.02


Report any facility structure hazard immediately that could lead to falls

– frayed carpeting– loose or broken side rails– lights that don’t work

Preventing Falls

3.02


Prevent bed sores NPSG.14.01.01

Find out which residents are most likely to have bed sores. Take action to prevent bed sores in these residents.

Bed sores will be discussed in Indicator 5.02 3.02 Nursing Fundamentals 7243 19

GENERAL SAFETY RULES



Walk in halls and on stairs - never runKeep to the right-hand side of the hallApproach swinging doors with cautionUse handrails going up and down stairs3.02 Nursing Fundamentals 7243 21


Pick up litter and place it in the proper container

Follow instructions of your supervisor for resident care

Report injuries promptly

Never use damaged or frayed electrical cords



TAG and TAKE OUT OF SERVICE!!!!

Report broken or malfunctioning equipment immediately



Check linen for personal items contained in folds prior to sending to the laundry

Report unsafe conditions immediately



Keep halls and stairs free of obstaclesCheck labels on all containers prior to using contentsWipe up spilled liquids immediately



Ask for an explanation of things you don’t understand

Elevate side rails for residents at risk of falling, per facility policy3.02 Nursing Fundamentals 7243 26

FAC

TO

RS

TH

AT

INC

RE

AS

E T

HE

R

ES

IDE

NT

’S R

ISK

OF

INJU

RY

Age related

Decreased strength

Slower movement

Difficulty maintaining balance

Tremors that may affect balance


FAC

TO

RS

TH

AT

INC

RE

AS

E T

HE

R

ES

IDE

NT

’S R

ISK

OF

INJU

RY

Awareness of surroundings

Some totally unaware

unconscious

coma

Some suffer from dementia

confused

disoriented3.02 Nursing Fundamentals 7243 28

FAC

TO

RS

TH

AT

INC

RE

AS

E T

HE

R

ES

IDE

NT

’S R

ISK

OF

INJU

RY

Decreased vision

Difficulty seeing objects

In danger of falling or tripping

Difficulty reading labels or containers


FAC

TO

RS

TH

AT

INC

RE

AS

E T

HE

R

ES

IDE

NT

’S R

ISK

OF

INJU

RY

Hearing impaired– May not hear

warning signals or alarms

– May not hear approaching equipment


FAC

TO

RS

TH

AT

INC

RE

AS

E T

HE

R

ES

IDE

NT

’S R

ISK

OF

INJU

RY

Smell and touchReduced smell

unaware of smoke or gas fumes

Decreased sensitivity to heat and cold easily burned


FAC

TO

RS

TH

AT

INC

RE

AS

E T

HE

R

ES

IDE

NT

’S R

ISK

OF

INJU

RY

Inability to move independentlyCrippling

diseasesArthritisParalysis


FAC

TO

RS

TH

AT

INC

RE

AS

E T

HE

R

ES

IDE

NT

’S R

ISK

OF

INJU

RY

Medications can:

Affect balance

Reduce awareness

Cause confusion or disorientation

Cause drowsiness

Affect coordination

Make fearful and uncooperative


PREVENTING BURNS

Burns are the second most

common hazard to residents


Preventing Burns

• Check water temperature in bath or shower with bath thermometer or with your hand


Preventing Burns

Water temperature should be NO HOTTER than

105 degrees F3.02 Nursing Fundamentals 7243 36

Preventing Burns

• Resident must verify that the temperature of the water is comfortable or not.

This is a little

to warm!


Preventing Burns

• Report areas where water temperature seems too hot

• Monitor smoking practices


Preventing Burns

When bathing the resident or providing a soak,

1) ASK THE RESIDENT TO FEEL THE WATER

2) AND VERIFY THAT THE TEMPERATURE OF THE WATER IS COMFORTABLE TO THEM


Preventing Burns

• Provide assistance at mealtime to prevent spilling hot liquids

• Use facility equipment according to written policies


Preventing Burns

• Monitor use of electrical appliances used by resident

• Avoid overexposure to sunlight



PREVENT

POISONING

Preventing Poisoning

• Store toxins in locked cabinets• Store toxins away from resident

areas• Never leave toxic products where

they might be ingested


Preventing Poisoning

• Have identifying labels on all containers

• Never use unlabeled substance


Preventing Choking

• Encourage residents to use their dentures when eating

• Assist to cut food into small pieces

• Report difficulty in swallowing


Be certain the HOB is

elevated before attempting

to feed a resident!

Prevent Choking


Preventing Choking

Residents with feeding tubes usually have the HOB elevated 30-45 degrees.


Be certain the resident has swallowed before continuing to feed.

Prevent Choking


Preventing Choking

Residents with feeding tubes should never have the bed flat for extended periods of time. Follow instructions regarding residents’ position to prevent residents from aspirating.


Preventing Suffocation

• Never leave unattended in bathtub

• Immediately transport from areas where smoke or gas fumes are noticed

• Properly apply and check vest and safety belt restraints


Preventing Spread of Microorganisms

Follow Standard Precautions and Transmission Based Precautions.

Wash hands before and after care


Preventing Other Injuries

• Move equipment around corners with caution

• Be careful of residents’ feet, hands, arms, and elbows when transporting residents in wheelchairs



• Monitor residents who wander away

• Follow instructions when providing care

• Keep bed in lowest position except when giving bedside care



• Use night lights in rooms• Have residents wear

shoes/slippers with non-skid soles

• Check crutches, canes and walkers for non-skid tips



• Keep call signal within easy reach

• Report immediately any observations indicating resident is a danger to himself or others.


BODY MECHANICS



There is intentional repeat of some HSII course content in Nursing Fundamentals.

Academic and skill competence must be maintained at a very high level for direct resident care.

Repeating course content distributes learning over time and increases long term memory.


Body Mechanics

• Body mechanics: the coordination of body alignment, balance and movement

• Job requirements for nurse aides include lifting, moving and transferring resident and lifting, moving and carrying objects


Body Mechanics

• Purpose of Good Body Mechanics–Maximize strength–Minimize fatigue–Avoid muscle strain

and injury–Assure personal and

resident safety3.02 Nursing Fundamentals 7243 59

Body Mechanics

• Never bend over from waist to pick up object

• Lift firmly and smoothly • Keep object close to body• Keep back straight


Body Mechanics

• Bend at hips and knees and get close to object prior to lifting

• Grip objects firmly with both hands

• Lift by pushing up with strong leg muscles


Body Mechanics

• Get help if object or resident appears too heavy

• Keep feet apart to provide wide base of support

• Pivot or turn with feet


Body Mechanics

• Use short steps to turn• Turn entire body without

twisting back and neck• Pull or push when

possible instead of lifting• Use body weight to help

push or pull


Body Mechanics

• When reaching for an object, evaluate distance

• Face in direction you are working to prevent twisting


Body Mechanics

• Adjust beds to waist level when giving resident care

• Be sure body is in good alignment at all times


FIRESAFETY



There is intentional repeat of some HSII course content in Nursing Fundamentals.

Academic and skill competence must be maintained at a very high level for direct resident care.

Repeating course content distributes learning over time and increases long term memory.


Fire SafetyEveryone is responsible for

preventing fires

If fire occurs, know what to do3.02 Nursing Fundamentals 7243 68

Fire Safety

• Major fire hazards–faulty electrical

equipment and wiring–overloaded electrical

circuits–plugs not properly

grounded–clutter - paper/rags


Fire Safety

• Major fire hazards (continued) –unsafe practices when

oxygen is in use–smoking–spontaneous combustible

materials


Fire Safety

• Elements necessary to start fire–fuel - material that

will burn–heat - flame or spark–oxygen


Fire Safety

• Fire safety activities– Locate and learn

•escape routes and fire escapes•use of all fire control equipment

–fire doors–sprinkler system controls–fire extinguishers

• fire drill procedures3.02 Nursing Fundamentals 7243 72

Fire Safety

• Fire Safety Activities– Be aware of all fire

hazards and report them immediately


Fire Safety

• Watch for frayed electrical wires

• Never overload circuits• Use three-prong

grounded plugs• Never use extension

cords• Control clutter


Fire Safety

• Dispose of rags properly• Empty ashtrays in metal

containers• Empty wastebaskets in

proper receptacles• Report odors of smoke

or burning• Keep fire exits clear3.02 Nursing Fundamentals 7243 75

Fire Safety

• Control smoking practices:– limit to specific areas– never allow smoking in

bed– have large ashtrays

available


Fire Safety

• Control smoking practices:– observe use of

matches/lighters– directly supervise

residents when smoking, as necessary


In Event Of Fire

Stay calm as you

RACE3.02 Nursing Fundamentals 7243 78

R A C E

Remove residents from IMMEDIATE DANGER; otherwise, DEFEND IN PLACE


R A C E

Activate the ALARM


R A C E

Confine the fire

Close all windows and doors

Choke off oxygen3.02 Nursing Fundamentals 7243 81

R A C E

Extinguish if you can

Empty the extinguisher3.02 Nursing Fundamentals 7243 82

Use of Fire Extinguisher

• Carry upright then PASS• Pull the safety pin• Aim at the base of the fire• Squeeze handle down• Spray in a sweeping motion at base

of fire

FIRE


R A C E R

Relocate residents per evacuation policy if directed to do so.

Some agencies teach RACE plus an addition “R”


R A C E R2

Remember these important Guidelines:

G Shut off air conditioningG Shut off oxygenG Shut off lightsG Never use elevators


OXYGEN SAFETY


Oxygen Precautions

• Oxygen precautions– Never have open flames

or smoking in area– Remove flammable

liquids from area– Do not use electrical

equipment in area


Oxygen Precautions

• Oxygen precautions– Post “Oxygen in Use”

sign– Remove cigarettes and

matches from room– Use cotton blankets

and clothing


Oxygen Precautions

DO NOT LET THE RESIDENTS’ NASAL CANNULA TOUCH THE FLOOR. Pathogens on the floor will contaminate the cannula.


DISASTERS / CATASTROPHES


Disaster / Catastrophe Types

• Natural origin–flood–earthquake–hurricane/tornado


Disaster / Catastrophe Types

• Human disasters–airplane/bus/train

accidents–explosions–nuclear waste

accident–blackouts


Workplace Violence… a potential Disaster!


Healthcare is impacted by verbally and sometimes physically abusive patients, families and visitors.


Verbal abuse often goes unreported and is thought to be “just part of the job”.

70% of Nurses are assaulted on duty during their career.

The majority of healthcare worker violence takes place on evening and night shifts.

OSHA [1996]. Guidelines for preventing workplace violence for health care and social service workers. Washington, DC: U.S. Department of Labor,

Workplace Violence… a potential Disaster!


Stop this PowerPoint and view the PowerPoint produced by Vanderbilt University Medical Center. Then, return to this PowerPoint.

Disaster Plans

Facilities are required to have disaster plans


Disaster Plans• Responsibilities in a disaster

–Remove residents from immediate danger

–Report to facility and follow directions for your role

–Know your facility’s disaster plan

–Assist with evacuation


Disaster Plans

–Help remove and secure equipment, supplies, and records

–Think before you act; don’t waste time

–Remain calm–Carry out responsibilities in

confident manner


MEDICAL EMERGENCIES


The Choking Resident


The Choking Resident - Cause

Choking occurs when the throat is blocked or closed up and air cannot get to the airway.


The Choking Resident

Airway may be blocked by: –Food or liquids (meat

most common food)–Blood or mucus–Foreign objects

including the tongue–Vomitus


Treating a Choking Resident

–Stay near–Encourage coughing - most

effective way to dislodge obstructions

–Never slap coughing resident on back: can cause object to fall lower into trachea

If victim is coughing, do not intervene:



Signs of severe foreign body airway obstruction

–Unable to speak–No air movement–Grasping throat -

distress signal

Abdominal thrusts, chest thrusts and back blows are effective for relieving severe foreign body airway obstruction.



Tilting head back in

unconscious person may clear airway since this pulls tongue forward



SKILL 3.02AForeign Body Airway Obstruction

(FBAO) Relief: Conscious Resident

Training Lab AssignmentEngage in the Skill Acquisition Process for:

Heart Attack - Signs and Symptoms

• Chest discomfort–pressure, fullness, squeezing, or

pain–in center of chest behind

breastbone or spread to either shoulder, neck, jaw, or arm

–usually lasts longer than a few minutes – comes and goes


Heart Attack - Signs and Symptoms

• Fainting• Sweating• Nausea• Shortness of breath


Accident/Emergency Scene

• If certified in CPR, offer assistance• Defer to those with more experience

and training



• Seek assistance–in facility

•use emergency light•use call signal•send another resident for help

•call for help



• Seek assistance –at home or at accident scene

• dial 911 operator or emergency number

• give location• give phone number• relate type of emergency• give number of people needing help• relate requested information


Cardiopulmonary Resuscitation

• Agencies providing CPR curriculum:–American Heart Association–American Red Cross



• You must be trained to administer CPR

• Activate the emergency medical system or your facility’s emergency plan



• CPR must be started immediately to be effective

• Follow facility policy for Advanced Care Directive



• Methods of administering CPR–one-person CPR–two-person CPR


Convulsive Disorders (Seizures)

• Causes:–infectious disease–omitted medication–head injury–stroke–seizure syndrome


Convulsive Disorders (Seizures)

• Types–Partial–General

•Tonic-clonic (grand mal)

•Absence (petit mal)–Unclassified


Convulsive Disorders (Seizures)Take Action

• Summon help• Stay with resident



• Protect from injury–lower to floor if appropriate–move objects away that might

cause injury• Do not restrain or put any object

into mouth



• Loosen constricting clothing (around neck)

• Place pillow under head and turn face to one side

• Note time and type of seizure



• Provide rest for resident after seizure–very tired–may be confused–often disoriented


Loss of Consciousness – Fainting

•Caused by temporary reduction of blood to brain


Loss of Consciousness – Fainting

• Early signs and symptoms:–dizziness–decreased pulse and BP–pallor and perspiration–nausea–cold skin–numbness and tingling of extremities


Loss of Consciousness – FaintingTake Action

• Summon help• Stay with resident• Have resident sit or lie down• Loosen tight clothing• Position head lower than heart

–sitting - head between legs–lying down - elevate legs


Loss of Consciousness – FaintingTake Action

• Monitor pulse and respirations• Have resident rest for 5-10

minutes before moving• Provide blanket if cold


SHOCK – Causes

• Severe injury• Excessive loss of body

fluids• Pain• Respiratory and/or cardiac

arrest• Anxiety


• Low or falling blood pressure

• Weak, rapid pulse• Cold, moist, pale

skin• Rapid respirations


SHOCK – Signs and Symptoms

SHOCK – Signs and Symptoms

•Thirst•Restlessness•Confusion and loss of consciousness


SHOCK – Take Action

• Summon help• Stay with resident• Keep resident lying

down• Control hemorrhage• Keep resident warm


Hemorrhage

•Types–Internal–External


Hemorrhage

• Signs and Symptoms– Internal

• pain• shock• vomiting blood• loss of

consciousness–External

• can usually be seen


Hemorrhage – Take Action

• Internal–Summon help–Stay with

resident–Keep warm,

flat and quiet until help arrives



• External–Summon help–Stay with resident–Identify location of bleeding–Apply continuous, direct

pressure over bleeding



• External–If bleeding not controlled, apply

pressure over artery above bleeding site

–If no pain or broken bones, elevate wounded area above heart while maintaining pressure



• External–keep resident

comfortable, warm and quiet until help arrives


Reporting Emergencies

• Never panic; remain calm–Try few slow deep

breaths–Observe surroundings–Assess resources

available



• Evaluate situation–check victim –determine safety of

environment• Call or send for help immediately• Determine treatment priorities



• Report emergencies accurately–If help is not available, contact:

•911 or emergency number•Police•Fire department•Telephone operator•Local EMS



–Name–Location–Description

of scene–Information

about injuries

–Type of help needed

–Number of people needing help

•Report emergencies accurately by stating:



•Know your limitations•Provide care and reassure victims•Keep bystanders away from victims


Understand safety and emergency care skills within the nurse aide range of function.

141

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3.02 Nursing Fundamentals 7243

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Understand safety and emergency care skills within the nurse aide range of function.

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