1. 1 & 2: Understanding Healthcare Settings & The Nursing Assistant and the Care Team
1.1. What is a nursing home?
1.1.1. long-term care: 24- hour skilled care
1.1.2. terminal illness: illness that will eventually cause death
1.1.3. chronic illness: conditions that last a long period of time, even a lifetime
1.2. What different types of care are there?
1.2.1. home health care
1.2.2. assisted living
1.2.3. adult day services
1.2.4. acute care
1.2.5. subacute care
1.2.5.1. less care than acute care but more than long-term care
1.2.6. outpatient care
1.2.7. rehabilitation
1.2.8. hospice care
1.3. NAs Responsibilities
1.3.1. help residents with ADLs
1.3.2. follow policies and procedures
1.3.3. follow the chain of command
1.3.4. remain inside your scope of practice
1.3.5. follow the care plan
1.3.6. provide person-centered care that addresses the individual's needs
1.3.7. keep things professional
1.3.8. be compassionate, sympathetic, tactful, conscientious, dependable, respectful, proactive, and unprejudiced
1.4. What is Medicare and Medicaid?
1.4.1. Medicare: federal health insurance program for people 65 and older, people with permanent kidney failure, and people with certain disabilities
1.4.2. Medicaid: medical assistance program for people with low income
1.5. Who makes up the care team?
1.5.1. NAs
1.5.2. RNs
1.5.3. LPNs
1.5.4. APRNs
1.5.5. MDs
1.5.6. PAs
1.5.7. PTs
1.5.8. OTs
1.5.9. Speech Language Pathologists
1.5.10. Registered Dieticians
1.5.11. Medical Social Worker
1.5.12. Activities Director
1.5.13. Resident and Resident's Family
2. 3: Legal and Ethical Issues
2.1. What is ethics versus laws?
2.1.1. Ethics: the knowledge of right and wrong
2.1.2. Laws: rules that tell us what we must do
2.2. What is OBRA?
2.2.1. Omnibus Budget Reconciliation Act: sets minimum standards of care, which includes standardized training of NAs
2.3. What are some resident rights?
2.3.1. right to participate in their own care
2.3.2. right to make independent choices
2.3.3. right to privacy and confidentiality
2.3.4. right to dignity, respect, and freedom
2.3.5. right to complain
2.3.6. right to visits
2.3.7. rights during transfers and discharges
2.3.8. rights with regard to social services
2.4. What is an NA's responsbility in regards to abuse?
2.4.1. watch for signs of neglect or abuse
2.4.2. they are mandated reporters: must report any knowledge or suspicion of abuse
2.5. What is an ombudsman?
2.5.1. legal advocate for residents assigned by law
2.6. What is PHI?
2.6.1. Protected Health Information: information that can be used to identify a person and relates to the patient's condition, any healthcare a person has had, and payment for that healthcare
2.6.1.1. name, address, telephone number, social security number, email address, and medical record number
2.6.1.2. can only be shared with the care team and people designated by the resident
2.7. What are advance directives?
2.7.1. Advance Directives: legal documents that allow people to decide what kind of medical care they wish to have in the event they are unable to make those decisions themselves
2.7.1.1. living will, durable power of attorney for health care, Physician Orders for Life-Sustaing Treatment, DNRs, DNIs, and DNHs
3. 14: Basic Nursing Skills
3.1. What are vital signs?
3.1.1. Temperature
3.1.1.1. Ear: 96.6 - 99.7 degrees
3.1.1.2. Forehead: 97.2 - 100.1 degrees
3.1.1.3. Mouth: 97.6 - 99.6 degrees
3.1.2. Pulse Rate
3.1.2.1. 60 - 100 bpm
3.1.3. Respirations
3.1.3.1. 12 - 20 rpm
3.1.4. Blood Pressure
3.1.4.1. Systolic: 90 - 119 mmHg
3.1.4.2. Diasoltic: 60 - 79 mmHg
3.2. What is the benefit of heat?
3.2.1. relieves pain and muscular tension, reduces swelling, elevates the temperature in the tissues, and increased blood flow
3.3. What is the benefit of cold?
3.3.1. can help stop bleeding, prevent swelling, reduce pain, and bring down high fevers
3.4. What is the NA's responsibility with IV therapy and oxygen therapy?
3.4.1. observe and report
4. 4: Communication and Cultural Diversity
4.1. What should the NA consider when communicating?
4.1.1. what message they are sending with their verbal and nonverbal communication
4.2. What should a NA understand about culture?
4.2.1. residents will have different cultures
4.2.2. cultures must be respected and care provided without bias
4.3. What is a NA's responsibility when communicating with residents and their families and friends?
4.3.1. know what limitations they have for communicating and adjust to address them
4.3.2. do no use medical terminology, slang, profanity, cliches, or why questions
4.3.3. ask open-ended questions
4.3.4. listen, be respectful, address questions and concerns within scope of practice
4.3.5. know what information can be shared
4.4. What is objective information?
4.4.1. information based on what a person sees, hears, touches, or smells
4.5. What is subjective information?
4.5.1. information that was not or could not be observed, and was instead reported by the resident
4.6. How should an NA communicate with team members?
4.6.1. be professional and report necessary information in a factual manner
4.6.2. know and use proper medical abbreviations
4.6.3. always document care
4.6.4. know and use military time
4.7. What should be done when there is an incident?
4.7.1. report and document
5. 5: Infection Prevention and Control
5.1. What is infection prevention?
5.1.1. set of methods practiced in healthcare facilities to prevent and control the spread of disease
5.1.1.1. follow OSHA and CDC recommendations and guidelines
5.1.1.2. observe Standard Precautions
5.1.1.2.1. use PPE
5.1.1.2.2. wash hands
5.1.1.2.3. treat blood, other body fluids, nonintact skin, and mucous membranes as if they are infected
5.1.1.2.4. use Transmission-Based Precautions in addition as needed
5.1.1.3. follow facility policies and guidelines for dealing with dirty vs clean materials
5.1.1.4. follow disinfection, sterilization, and disposal policies
5.1.1.5. know the disease or illness you are dealing with and act accordingly
6. 6 & 7: Safety and Body Mechanics & Emergency Care and Disaster Preparation
6.1. What is proper body mechanics used for?
6.1.1. used to help save time and prevent energy
6.1.1.1. maintain good posture and base of support
6.1.1.2. understand and utilize fulcrum, lever, and center of gravity
6.2. What can an NA do to promote resident safety?
6.2.1. know what injuries or dangers the residents are at risk for
6.2.2. reduce as many safety hazards as possible
6.2.3. observe and report any hazards or injuries
6.3. When can restraints be used?
6.3.1. with a doctor's order
6.4. What is PASS?
6.4.1. P : pull the pin
6.4.2. A : aim at the base of the fire when spraying
6.4.3. S : squeeze the handle
6.4.4. S : sweep back and forth at the base of the fire
6.5. What is RACE?
6.5.1. R : remove anyone in danger if you are not in danger
6.5.2. A : activate alarm or call 911
6.5.3. C : contain the fire if possible
6.5.4. E : extinguish the fire or the fire department will
6.6. How should a CNA respond to an emergency?
6.6.1. assess the scene
6.6.2. assess the victim
6.6.3. know how to recognize different emergencies and which measures to take to address them
6.6.4. know how to provide first aid, CPR, and the Heimlich
6.6.5. know how to report and document for emergencies
6.6.6. know the facility emergency plans and preparations for designated emergencies
7. 10: Positioning, Transfers, and Ambulation
7.1. What should a CNA utilize when moving a resident or object?
7.1.1. proper body mechanics
7.2. What should a CNA know about positioning?
7.2.1. reposition every 2 hours
7.2.2. make sure the resident is comfortable and in a position that suits their condition
7.2.3. know the different positions and what they are used for
7.2.4. know how to use pillows and other devices to provide support and comfort
7.3. What should a CNA know about transfers?
7.3.1. always promote safety
7.3.1.1. always lock wheels
7.3.1.2. know how to prevent and address falls
7.3.2. use a transfer method that suits the resident's needs
7.3.3. use cue words to signal when to move
7.4. What should a CNA know about ambulation?
7.4.1. know which method of ambulation meets the resident's needs
7.4.2. if a resident needs assistance, stand slightly behind and to one side of the resident
7.4.3. if the resident has a weaker side, stand on that side
7.4.4. know if a resident needs an assistive device and aid in the use of it
7.4.4.1. canes go on the stronger side
8. 12 & 13: The Resident's Unit & Personal Care Skills
8.1. What should a CNA know about the resident's unit?
8.1.1. it is their home, treat it as such
8.1.1.1. be respectful and courteous
8.1.2. promote their comfort and wants as long as it is safe to do so
8.1.3. help assist in keeping it clean and clutter free
8.1.3.1. make the bed
8.2. What should a CNA know about helping a resident with sleep?
8.2.1. know their sleep patterns
8.2.2. help establish a routine
8.2.3. observe and report issues
8.3. What should a CNA know about personal care?
8.3.1. assist the residents with their ADLs, but let the do as much as they can for themselves
8.3.1.1. dressing, grooming, hygiene eating, drinking, and elimination
8.3.2. know and promote their preferences
8.3.3. provides time for the CNA to observe and talk to the resident about things that might need to be reported
8.3.4. know how to properly provide skin care and prevent pressure injuries
8.3.4.1. repostion every two hours
8.3.4.2. use methods and positioning devices that take pressure off the skin
8.3.5. always report signs of skin breakdown/pressure injuries
8.3.6. address the individual needs of the resident when it comes to assisting or providing care
8.3.6.1. if the resident has a weaker side, put clothes on that side first
8.3.6.2. oral care is different for residents who are unconscious and who have dentures
9. 16 & 17: Urinary Elimination & Bowel Elimination
9.1. What should a CNA know about urinary and bowel elimination?
9.1.1. urine is normally light, pale yellow or amber
9.1.2. stool is normally brown, soft, and formed in a tubular shape
9.1.3. encourage fluids
9.1.4. observe and report any changes in the appearance or smell
9.1.5. incontinence is not normal
9.1.6. know the normal changes of aging that relate to urination and bowel movements
9.1.7. know what factors influence urination and bowel movements and how to address them
9.1.8. know how the resident's condition will affect how they urinate and have bowel movements
9.1.9. use PPE
9.1.10. always wipe from front to back and keep the skin dry
9.1.11. observe and report on catheters and know how to maneuver them for dressing
9.1.12. know how to collect specimens and when they need to be done
9.1.13. be professional and respectful when assisting with elimination
9.1.14. know about the illnesses and diseases that affect bowel movements
9.1.15. know about and understand the rules of providing an enema
9.1.16. know about responsibility with ostomies
10. 15: Nutrition and Hydration
10.1. What should an NA know about nutrition and hydration?
10.1.1. make sure the residents are consuming all of the essential nutrients in proportional amounts
10.1.2. understand and respect dietary choices or restrictions
10.1.3. observe and report unintended weight loss or gain
10.1.4. know and understand role in care for residents with tube for feeding
10.1.5. always check diet cards
10.1.6. know how to use thickened liquids
10.1.7. work to make mealtime enjoyable for the residents
10.1.8. always be professional and respectful when assisting with eating
10.1.9. know how to recognize and address special needs, dysphagia, and other signs of swallowing issues
10.1.10. monitor and document intake and output for fluids and foods
11. 9 & 18: The Healthy Human Body & Common Chronic and Acute Conditions
11.1. What should a CNA know about the healthy human body?
11.1.1. know and understand how the body systems work together to function
11.1.2. know what signs and symptoms to report about each body system
11.1.3. know normal signs of aging for each system
11.1.4. know the differences between the male and female systems
11.2. What should a CNA know about common chronic and acute conditions?
11.2.1. know and understand common illnesses and diseases of each system
11.2.2. know how to meet the needs of residents with certain illnesses and diseases
11.2.3. understand your role in care for individuals with certain diseases and illnesses
11.2.4. observe and report anything that is out of the usual
12. 8: Human Needs and Human Development
12.1. What does a CNA need to know about human needs and development?
12.1.1. understand how to meet physiological and psychosocial needs
12.1.2. care for the whole individual
12.1.3. promote independence and self-care
12.1.4. address the losses the residents may have experienced
12.1.5. be respectful of sexual orientation and needs
12.1.6. accommodate and respect cultural and religious differences
12.1.7. understand the importance of family and friends
12.1.8. support and respond to the emotional needs of the resident and their family
12.1.9. know and understand the stages of development for a human
12.1.10. know what is outside of normal development and report it
12.1.11. know how to address different intellectual and physical disabilities
13. 19: Confusion, Dementia, and Alzheimer's Disease
13.1. What does a CNA need to know about confusion, dementia, and Alzheimer's?
13.1.1. understand signs and symptoms of these conditions
13.1.2. provide support
13.1.3. recognize the reality of the situations
13.1.4. know what to look for and report
13.1.5. know how to meet the resident's needs and to deal with combative behavior
13.1.6. acknowledge how the family and friends are feeling and provide comfort
14. 11 & 20: Admitting, Transferring, and Discharging & Mental Health and Mental Health Disorders
14.1. What does a CNA need to know about admitting, transfering, and discharging?
14.1.1. understand and address the concerns the resident may be feeling about the change in environment
14.1.2. be welcoming to new residents and give them time to adjust
14.1.3. take base line vital signs if needed
14.1.4. answer questions and provide explanations within scope of practice
14.1.5. help pack when it is time to transfer or leave
14.1.6. provide reassurance
14.2. What does an CNA need to know about physical exams?
14.2.1. provide comfort and privacy
14.2.2. answer questions within scope of practice
14.3. What does a CNA need to know about mental health and mental health disorders?
14.3.1. there are a variety of contributing factors that impact mental health
14.3.2. mental health issues are a like a physical illness - cannot be controlled
14.3.3. mental health is vitally important
14.3.4. know how to recognize and address signs and symptoms of mental health disorders
14.3.5. provide respect and comfort
14.3.6. know what to observe and report
15. 21 & 22: Rehabilitation and Restorative Care & Special Care Skills
15.1. What does a CNA need to know about rehabilitation and restorative care?
15.1.1. used to return residents to their highest possible level of functioning and then keep them there
15.1.2. need to provide lots of support
15.1.3. understand limitations and setbacks
15.1.4. observe and report anything out of the ordinary
15.1.5. promote independence and exercise
15.1.6. help with assistive devices and ROM exercises
15.1.7. know about and understand deep breathing exercises
15.2. What does a CNA need to know about special care skills?
15.2.1. understand your role in the hospital for surgery
15.2.2. know what to observe and report
15.2.3. know about artificial airways, suctioning, and chest tubes
16. 23: Dying, Death, and Hospice
16.1. What does a CNA need to know about dying, death, and hospice?
16.1.1. everyone grieves differently and will experience the stages in different ways
16.1.2. provide support and comfort for the residents and their families
16.1.3. know how to care for someone who is dying and how to care for them after they have died
16.1.4. promotes rights and wishes
16.1.5. be respectful
16.1.6. understand the goals of hospice and palliative care
16.1.7. know the signs of approaching death
16.1.8. understand and respect different practices after death
16.1.9. know that it is okay to grieve and express your grief in healthy ways