Flashcards
CNA chapter 14
Cards in this deck (81)
- 1vital signsmeasurements-temperature, pulse, respirations, blood pressure, pain level- that monitor the functioning of the vital
organs of the body. - 24 situations when NA should report the following to the nurse1.resident has a fever.
2. respiratory or pulse rate is too rapid or too slow
3. resident's blood pressure changes
4. pain is worsening or unrelieved. - 3what's the normal, elevated, high blood pressure (stage 1), hypertension stage 2, hypertensive crisisnormal: less than 120/ less than 80
elevated: 120-129/ less than 80
stage 1: 130-139/80-89
stage 2: 140/ 90 or higher
hypertensive crisis: 180/120 - 4what are some factors that is not allowed for a person to get oral temp1. unconscious
2. recently had facial or oral surgery,
3. is younger than 5 years old,
4.is confused,
5.heavily sedated,
6.coughing,
7.using oxygen - 5what are some factors that affect temperatureage, illnes, stress, environment, exercise, and the circadian rhythm affect temperature
- 6thermometer green color or blue?oral
- 7thermometer that is a red colorrectal
- 8Digital or electronic thermometers are commonly used forused for oral, rectal, and axillary temps
- 9what kind of thermometers may be used once and then sicardeddisposable thermometers
- 10which temperate would be most accurate and least accuraterectal temperature and axillary
- 11taking rectal temperate may be necessary in the following situations1. unconscious residents
2. residents with poorly-fitted dentures or missing teeth
3.anyone having trouble breathing through the nose. - 12which kinds of thermometers can be used? What must NA do before performing?mercury-free, digital, or electronic thermometers can be used
make sure to explain what you are going to do with the resident - 13what are 4 important points about taking a rectal temperature1.be reassuring
2. thermometer must be lubricated for this procedure
3. NA must hold on to the thermometer at all times.
4. gloves must be worn. The privacy of the resident is important
5. help resident to be in sim's position - 14how long does tympanic thermometers take? what's the measurement that the thermometer will go into the ear?take fast measurement.
will go into the ear 1/4-1/2 inch - 15Axillary temp is good for residents who areconfused, disoriented, or uncooperative residents or residents with dementia
- 16how do you pull adult and child ear to put the thermometeradult: pull up and pull back
child: pull down and back - 17normal rate for adult60-100
- 18normal rate for small children100-120
- 19normal rate for newborns120-140
- 20what are some risk factors for rapid pulseexercise, fear, anger, anxiety, heat,medications, and pain
- 21rapid pulse may result fromfever,dehydration, or heart failure
- 22slow/weak pulse may indicateinfection
- 23respirationthe process of inhaling air into the lungs and exhaling air out of the lungs
- 24inspirationthe process of inhaling air into the lungs
- 25expirationthe process of exhaling air out of the lungs
- 26systolicfirst measurement of blood pressure; phase when the heart is at work,contracting and pushing the blood out of the left ventricle
- 27diastolicthe second measurement of blood pressure; phase when the heart relaxes or rests
- 28Hypotension and hypertensionlow blood pressure, measuring 90/60 mm Hg or lower
140/90 - 29normal range for systolic and diastolicless than 120/ less than 80
- 30what number is considered as prehypertension120/80 and 139/89
- 31blood pressure is measured with either a ________ or _________ sphygmomanonmetermanual or digital
- 32never measure blood pressure when (slide 26)an arm that has an IV, a dialysis shunt, or any medical equipment.
Avoid a side with a cast, recent trauma, paralysis from a stroke, burns, or mastectomy - 33if nurse asks an NA to take an orthostatic blood pressure measurement, what is he asking forasking for measurements taken first with the resident lying down, then sitting up, and then standing
- 34how can pain greatly affect residentgreatly affect quality of life and ability to perform self-care
- 35true or false pain is not normal part of agingtrue
- 36when residents is in pain make sure toobserve and report carefully since care plans are based on your reports
- 37what kind of questions should NA ask about resident's pain?1. where is the pain
2. when did the pain start?
3. how long does the pain last and how often does it occur?
4. can you describe pain?
5.what makes the pain better - 38factors hesitant to report their pain1. fear of addiction to pain medication
2. feeling that pain is a normal part of aging,
3. worrying about constipation and fatigue from pain medication
4. feeling that caregivers are too busy to deal with their pain
5, feeling that too much pain medication will cause death - 39when the residents are too worried about medication and have question NA shouldreport to the nurse
- 40NA should report the following signs and symptoms associated with pain1.increased pulse, respiration, and blood pressure
2. sweating
3. nausea
4. vomiting
5.tightening the jaw
6. squeezing eyes shut
7. holding or guarding a body part
8. frowning
9. grinding teeth
10. crying
11. groaning
12. pacing
13. breathing heavily
14. difficult walking or moving - 41following ideas to help reduce resident's pain1. report complaints of pain or unrelieved pain immediatly.
2. gently position the body in proper alignment
3. give back rubs
4. ask if the resident would like to take a warm bath or shower
5.encourage slow, deep breathing
6. use soft music to distract the resident
7. be patient caring gentle ,and responsive to residents - 42how is warm application effectiveheat relieves pain and muscular tension. It reduces swelling, elevates the temperature in the tissues, and increases blood flow bring more oxygen and nutrients to the tissues for healing
- 43how is cold application effectve?can help stop bleeding. They prevent swelling, reduce pain, and bring down high fevers .
- 44what kind of residents receiving warm or cold applications should be checked often?residents who has paralysis (stroke), numbness, disorientation, confusion, dementia, and other conditions may make person unable to feel, notice, or understand damage.
- 45sitz batha warm soak of the perineal area to clean perineal wounds and reduce inflammation and pain.
- 46sitz bath (warm or cold?)warm
- 47aquamatic k-pad (warm or cold?)warm or cold
- 48sponge bath (warm or cold?)both
- 49these signs indicate that the application may be causing tissue damage and should be prepared1. excessive redness
2. pain
3. blisters
4. numbness - 50heat compresses are used only _______ and then ______once, discarded
- 51Warm compresses (temperature, timing, special consideration)no higher than 105f, remove after 20 mins, cover with plastic wrap
(arm) - 52warm soaks (temperature, timing, special consideration)no higher than 105f, check temp every 5 minutes, observe for redness soak 15-20 mins
(warmig up a feet) - 53aquamatic k-pad (temperature, timing, special consideration)pre-set, remove after 20 mins, tubing should not hang below bed. Check water level and refill when necessary
- 54sitz bath (temperature, timing, special consideration)no higher than 105f, 20mins (only), fill 2/3 full. Provide privacy
- 55ice packs (temperature, timing, special consideration)check after 10 mins. remove after 20 mins,.
Fill bad 2/3 full of ice. Cover bag; watch for blisters and white or pale skin - 56cold compresses (temperature, timing, special consideration)cold water with ice, check after 5 mins and remove after 20 mins check for blisters, redness, and white or gray skin.
- 57what factors should NA observe for and report on non-sterile and sterile dressing1. skin that has changed color
2. scab that has come off
3. bleeding
4. swelling
5. odor (smells bad)
6. drainage - 58sterile dressingcover new, open, or draining wounds.
a nurse changes these dressings - 59non-sterile dressingsare applied to dry, closed wounds that have less chance of infection, NA may change
- 60NAs do not change sterile dressings, but they may be asked to do any of the follwoing:gather supplies
observe and report
clean the equipment
position the resident
cut tape
dispose of soiled dressing - 61list supplies may be needed when changing a sterile dressing:special gauze, abdominal pads (ABDs), cotton bandages, binders, medical-grade adhesive tape
- 62special gauzehas one side with a shiny, non-stick surface, which will not stick to wounds when removed
- 63abdominal padslarge, heavy gauze dressings that cover smaller gauze dressings and help keep them in place and provide absorbency
- 64cotton bandagescalled kerlix and kling bandages. can stretch and mold to a body part and hold it in place. often used on bony areas
- 65bindersstretchable pieces of fabric that can be fastened
- 66medical-grade adhesive tape panelshelp keep frequently changed dressings in place
- 67NA should remeber the following information about sterile dressings1. if wrapper is torn, the supply is no longer sterile.
2. wrapper cannot be opened and closed again.
3. if wrapper is wet or seems to have been wet, it is no longer sterile.
4. if supply is past expiration, it is no longer sterile - 68elastic bandagesalso called non-sterile bandages, ACE bandages, it is stretchy bandages that are used to hold dressings in place, secure splints, and support and protect body parts
(NA may assists with use of an elastic bandage) - 69NAs should know these guidelines for elastic bandages1. keep area clean and dry
2. apply snugly enough to control bleeding but make sure not to wrap to tightly
3. wrap bandage evenly
4. do not tie the bandages; use special clips
5. remove bandage as often as indicated in care plan - 70make sure the bandage often to be sure it does not become _______ or _____wrinkled or loose
- 71after elastic, check what time? See the sign if there are signs of poor circulation; loosen if any of these signs are presentcheck residents ten to 15 mins after bandage.
1. swelling
2.shiny and tight skin
3. cold skin
4. pale, gray
5. tingling
6. pain or discomfort - 72intravenous therapythe delivery of medication, nutrition, or fluids through a person's vein
- 73NAs only observe a resident's IV site for changes or problems and report if any of the following happensneedle falls out, tubing disconnects, dressing is loose, blood is in tubing or around IV sites, site is swollen or discolored, resident complains of pain, iv bag is broken, IV fluid is not dripping or is leaking, IV fluid is nearly gone, pump is dropped and beeps
- 74when resident has IV, NAs should notmeasure blood pressure on an arm with an IV
2. get the site wet
3. pull or catch the tubing on anything such as clothing
4. leave the tubing curve (kinked)
5. lower the IV bag below the IV site
6. never touch the clamp
7. disconnect IV from pump or turn off alarm - 75oxygen therapythe administration of oxygen to increase the supply of oxygen to a person's lungs
- 76nasal cannulaan oxygen delivery device that consists of a piece of plastic tubing that fits around the face and two prongs that fit inside the nose.
- 77oxygen concentratora box-like device that changes air in the room into air with more oxygen
- 78NAs should follow 6 things guidelines when caring for residents using liquid oxygen1. Turn off supply valves when reservoir is not in use
2. do not tip reservoir on its side
3. make sure reservoir is not in a closet, cupboard, or closed-in space.
4. when lifting, use both hands. Do not roll it or walk it on edge.
5. do not touch frosted parts of equipment
6. do not cover reservoir with anything - 79NAs should follow 5 things guidelines when caring for residents using oxygen tanks1. count and record pulse and respiration before and after oxygen use to see if there are changes
2. flow meter should be set at amount stated in care plan. report to nurse if it is not. do not adjust the level yourself
3. make sure humidifying bottle is filled with distilled water and attached correctly.
4. make sure tank is secured
5. change nasal cannula when ordered - 80why is oxygen a dangerous fire hazardit burns
- 81—
Information
- Description
- Flashcards on CNA chapter 14, created by Alice Sonic on 03/09/2020.
- Created by
- Alice Sonic
- Views
- 0
- Rating