Nurse Aide I Test 4 review

• Restraints

  A physical or chemical way to restrict voluntary movement or behavior
• Physical restraints

  • Any manual method or physical or mechanical device, material, or equipment attached to or near the resident's body that the individual cannot remove easily which restricts freedom of movement or normal access to one's body
• Chemical restraints

  -Any drug/drug dose used to control behavior or restrict movement

  -used for discipline or convenience and not required to treat medical symptoms
• Unnecessary restraints are considered false imprisonment
• Criteria that can be considered for using restraints

  • Pain
  • Mental/physical illness/impairments
  • Injury
  • Discomfort
  • Uncomfortable clothing
  • Wound dressings
  • Body positioning
  • Anger/loss of control
  • Fear of environment, family members, caregivers, self-image, death
  • Phobias or obsessions
  • Sleep disorders
  • Confusion or disorientation
  • Hunger
  • Thirst
  • Temperature changes
• Everyday practices that can be considered a restraint

  • Over-bed table placed across a resident sitting in a chair or wheelchair
  • Sheets placed around and under a resident
  • Geri-chair
  • Wheelchair locked - residents that cannot unlock it
  • Both side rails up
• Consequences of restraining patients


  • Cuts
  • Bruises
  • Skin tears
  • Skin breakdown
  • Pressure ulcers
  • Fractures
  • Aspiration
  • Death from strangulation
  • Constipation
  • Contractures
  • Decreased ability to walk
  • Dehydration
  • Inconvenience
  • Infections (pneumonia/UTI)
  • Swelling (edema)
  • Nerve damage
  • Agitation
  • Anger
  • Delirium
  • Depression
  • Reduced social contact
  • Withdrawal
  • Embarrassment
  • Humiliation
  • Loss of dignity
  • Confidence
  • Self worth
• Alternatives to restraints

  • Lap tray
  • Side rails
• Safety guidelines for restraints

  • Resident safety is the highest priority
  • Restraints must be applied properly
  • Check size and condition of restraint - no defects
  • Ensure the restraint fastens correctly and securely
  • Secure the restraint to moveable parts of the bed frame so it does not tighten or loosen when the head or foot is raised or lowered
• How often and for how long should restraints be removed?

  Take off every 2 hours for 10 minutes long
• How often do we check on patients in restraints?

  Check on them every 15 minutes
• Safe applications for all types of restraints

  • Leg/ankle - 1 finger space
  • Arm - 1 finger space
  • Mitt - limits mobility of hand, prevents finger use - 1 finger space
  • Wrist - prevents pulling tubes or medical devices or scratching the skin or a wound - soft part on skin, 1 finger space
  • Seat belt - decreases falls while sitting - 45 degree angle over thighs when sitting, residents hips should touch back of the chair, allows the resident to turn from side to side or sit up in bed
  • Jacket - limits upper body movement - opening is in back, should be snug but allow for movement, should allow resident to breathe easily, should allow a flat hand to slide between the restraint and the resident's body
  • Vest - limits mobility of upper body - "V" is in the front, criss cross in front, should be snug but allow for movement, should allow the resident to breathe easily, should allow a flat hand to slide between the restraint and their body
  • Lap tray - prevents them from leaning forward and falling out of chair - should be secured properly, residents hips should touch the back of the chair, observe often to prevent the resident from sliding down under the tray
  • Side rails - are prohibited unless they are necessary to treat a resident's medical symptoms
  • Enablers - are allowed to promote independence and in place for the resident to grasp to help turn or assist with standing
• The highest priority for restraints is resident safety
• Family


  A group of individuals related by blood, marriage, or a feeling of closeness
• NA's role in family support

  • Orient family to the facility and how it works
  • Learn family names and address by name
  • Get to know family, their likes and dislikes
  • Get familiar with family routines
  • Work to build positive and trusting relationship with family
  • Let family know role is supported
  • Keep lines of communication open
  • Always be respectful and kind to family
  • Encourage expressions of emotions
  • Reassure family members as they cope with resident's actions, problems and concerns
  • Provide explanations when asked and refer to supervisor to assist the family when necessary
  • Refer family concerns to supervisor
  • Incorporate and honor family wishes, if possible
  • Allow time for privacy during visits
  • Permit family members to assist with care if resident does not object
  • Encourage family to assist with feeding/dining if safe and resident agrees
  • Encourage family to bring special foods or beverages for resident, if allowed
  • Use tact in dealing with family complaints and requests that you cannot honor
  • Avoid involvement in family affairs
  • Be tactful when asking family member to leave resident's room
  • Observe effects visit had on the resident and report to supervisor
• Cognition

  The manner in which messages from the 5 senses are changed, stored in memory, recovered from memory, and later used to answer questions, respond to requests, and perform tasks
• Normal cognitive changes of aging

  • Size of neurons decreases
  • Total brain mass decreases
  • Physical/psychological responses slow down
  • Increased learning time needed for new activities
  • More difficulty in learning motor skills
  • Decreased processing, response time and reaction time, making fast-paced instruction more challenging
  • More deliberate, less frequent responses and less effective performance when pace is fast-particularly in stressful/unfamiliar surroundings
  • Slow with tasks when response speed is needed
  • Cannot adapt as well, especially in stressful/unfamiliar environments and with impaired senses
  • Easily confused when too many changes or losses happen at one time or when moved to a different environment
  • Mild short term memory loss often occurs
  • Forgetting names
  • Misplacing items
  • Poor recall of recent conversations
  • Motivation to learn decreases
  • Feels threatened more when declining cognitive abilities may be publicly demonstrated
  • Difficulties in doing more than one task or dealing with more than 1 request at a time occur
  • Unable to ignore irrelevant stimuli
• Reaction time

  The time it takes for a person to begin an answer or a movement after someone asks him/her a question or makes a request
• Reaction time slows gradually after 60 years
• Patience

  The ability to deal with slowness, delay, or boredom without complaining or appearing rushed
• Pacing

  The awareness and adjustment of nursing care based on how slow or how fast a person is functioning
• NA's role in patience and pacing

  • Slow down pace when working with residents
  • Let the resident set the pace
  • Ensure that the resident is wearing hearing aid and/or glasses before beginning a task
  • Tell the resident ahead of time about the task
  • Allow time for resident to think about what has been said
  • Give clear, short, easy instructions that are based on what the resident already knows
  • Relate new information or tasks with past experiences
  • Use simple words that resident can understand
  • Show the resident what is to be done
  • If something has just been learned, allow resident to look at it
  • Praise resident when a task is done
• The effects of patience and pacing are good, while a fast pace can lead to social breakdown syndrome which is bad
• Stages of Alzheimer's

  • Stage 1 - No impairment, Alzheimer's not evident, no memory problems
  • Stage 2 - Very mild decline, minor memory problems, lose things around the house, unlikely to be noticed by family members
  • Stage 3 - Mild decline, family members and friends may begin to notice cognitive problems, difficulty finding the right word during conversations, difficulty organizing and planning, difficulty remembering names of new individuals
  • Stage 4 - Moderate decline, difficulty with simple math, poor short-term memory, inability to manage finances
  • Stage 5 - Moderately severe decline, impaired functionality, usually able to bathe and toilet independently, still know their family members, difficulty dressing appropriately, inability to recall simple details such as their own address or number, significant confusion
  • Stage 6 - Severe decline, need constant supervision, usually require professional care, confusion or unawareness of environment and surroundings, inability to remember most details of personal history, loss of bladder and bowel control
  • Stage 7 - Very severe, final stage and nearing death, lose ability to communicate or respond to their environment, may be able to utter words or phrases, no awareness regarding their condition, need assistance with all ADLs, may lose ability to swallow - feeding tubes
• Dementia

  Usually progressive condition marked by development of multiple cognitive deficits, such as memory impairment, aphasia, and inability to plan and initiate complex behavior
• Delirium

  A state of severe confusion that occurs suddenly and is usually reversible
• The differences between dementia and delirium are that dementia is a progressive disease and non-reversible, while delirium is sudden onset, severe, and usually reversible. People with dementia can experience delirium.
• Goals of activity-based care

  • Care focused on assisting resident to find meaning in his or her day, rather than doing activities just to keep the person busy
  • Goal in care of residents with Alzheimer's disease is to give support needed so that they participate in the world around them to the best of their ability
  • NA must focus on the fact that the resident is involved and satisfied, not on the task or activity
• Activity-based care

  Care focused on assisting resident to find meaning in his or her day, rather than doing activities just to keep the person busy
• Goal in care of residents with ALZ's disease

  To give support needed so that they participate in the world around them to the best of their ability
• Wandering

  Moving about the facility with no purpose and is usually unaware of safety
• Sundowning

  A behavioral symptom of dementia that refers to in agitation, confusion, and hyperactivity that begins in late afternoon and builds throughout the evening
• Taking sundowning residents to the bathroom is a priority
• Activities are done in the morning for sundowning residents
• Behaviors associated with Alzheimer's

  • Agitation
  • Disruptive verbal outbursts (screaming, swearing, crying, shouting, loud requests for attention, talking to self, and negative remarks to other residents or staff)
  • Anger and aggression due to anxiety and fear
  • Catastrophic reaction (out of proportion response to activities or situations)
  • Sudden mood changes or uncontrollable crying
  • Increased agitation, restlessness
• NA's role in caring for those with Alzheimer's

  • Patience
  • Show interest in subject
  • Offer comfort and reassurance
  • Listen for a response
  • Avoid criticizing or correcting
  • Avoid arguments
  • Offer a guess as to what resident wants
  • Focus on the feelings, not the truth
  • Limit distractions
  • Encourage non-verbal communication
  • Address them by their name
  • Speak slowly and calmly
  • Be clear and concise
• NA burnout

  Extremely stressful caring for people with Alzheimer's or dementia, that demographic is prone to abuse and neglect
• Mental health

  A resident's ability to cope with and adjust to everyday stresses in ways that society accepts
• Importance of mental health caregiving

  Great day to day relationships are at the heart of de-escalation, the NA can come to know what is normal for a particular resident and what signs the resident may have that they are becoming agitated
• Objective for de-escalating an agitated patient

  To de-escalate the situation with the agitated resident while keeping others safe