Clients or objects which are heavy should never be moved or lifted by one person. The risk for falls or injuries, for both client and nurse aide, increases with heavy loads. Ask for assistance before attempting to pull or roll a heavy patient. Use good body mechanics by using your leg muscles to avoid back injury.
The nurse aide should be familiar with all fire safety policies and protocols. When a fire alarm sounds, all staff must respond to keep clients safe. Remember "R.A.C.E." to quickly act. R = Rescue/Remove all people who can not take care of themselves. A = Alarm, if it has not already been done. Pulling the alarm can be done at the same time as rescue. C = Confine/Contain the fire or smoke by closing doors to prevent or slow the spread. Smoke is especially dangerous for everyone. E = Extinguish the fire if possible, using a handheld fire extinguisher. Attempt to extinguish only small fires, as long as you can remain safe and have an escape route.
Bladder training is a good way to treat urinary incontinence. Residents are placed on a toileting schedule that gradually increases the time between emptying their bladder and the bladder capacity. Fluids are restricted in the evening to prevent incontinence during the night.
When a patent has an indwelling Foley catheter, the bag should be lower than the bladder to prevent backflow. The nurse aide should check that the tubing is open so that the urine can flow from the bladder. After each position change or when the client returns to the bed or chair after being up, ensure that the tubing is not kinked or closed.
The supine (pronounced "soo-pine") position is when the patient is on their back. Hint: both "supine" and "sky" start with an S. "When supine, I look at the sky.").
Clients who have had a stroke often have one-sided weakness or paralysis. They may not be able to use that side of their body, or may not even be aware of the affected side. This is called "one-side neglect." Rehabilitation services will help the patient recover as well as possible, but as the client's caregiver, you can encourage the client to use the unaffected side by placing the signaling device where the client can reach it to call for assistance.
When a physician orders a restraint for a client, staff must strictly follow the protocols to maintain the client's safety. The nurse aide should become familiar with the policies regarding restraints. The policy will state the defined times to monitor the client, directions for reporting on the client's status, as well as directions for documenting all observations.
Stage III of a pressure sore or pressure ulcer involves loss of the full skin thickness. There can be necrosis (dead tissue) as well as damage to muscles, bones, or supporting tissue. Monitoring and reporting reddened areas of skin (Stage I) is important to prevent further skin damage.
Stress incontinence occurs when sudden pressure on the abdomen from laughing, coughing, or sneezing causes the bladder to leak. Weak pelvic floor muscles or the muscle that controls the urinary sphincter cannot keep urine from leaking. It is the most common type of incontinence in women.
NPO is a common medical term that means the client can not eat or drink anything, including water or ice chips. A doctor orders a patient to be NPO for situations such as before surgery or certain lab work. If a client is ill or has a gastrointestinal condition, the doctor may write an order to be NPO until the cause is known. The nurse aide can provide mouth care for a client who is NPO. Placing a "NPO" sign over the client's bed will remind all staff members not to give the client anything to eat or drink.
When helping a client walk who is recovering from a stroke, the nurse aide should stay on the client's weak side. Walk next to, and slightly behind, the client in order to be ready to suddenly support the weak side. If the client is using a walker or cane, allow space for the device. While walking, be alert to avoid possible fall hazards. The client should wear slippers or shoes with rubber soles for traction.
While each person has an individual pattern of bowel movements, after three days, notify the nurse. Feces can become hard and difficult or painful to pass, especially after three days. Constipation is generally defined as fewer than three bowel movements a week.
A Regular diet has no restrictions regarding salt, sugar, or texture. A patient can have any food they wish. Low sodium diets have strict salt limits and diabetic diets restrict sugar and carbohydrates. A soft diet has foods that are easy to chew and swallow.
Client safety during transfer begins with the bed in the lowest position. This allows the client to easily reach the floor when standing and pivoting to sit in the wheelchair. The brakes of the wheelchair should be locked and the footrests completely out of the way.
The Heimlich maneuver (abdominal thrusts) is the first aid method for helping people who have food or an object caught in their upper airway. When a client appears to be choking, the nurse aide must act quickly to clear the airway. Call for help. To perform abdominal thrusts, stand behind the client. Make a fist with your dominant hand. Place this fist just above the client's navel. Wrap your other hand firmly around the fist. Pull inward and upward, pressing into the client's abdomen with quick and forceful upward thrusts, as if you are trying to lift the client off his or her feet from this position. Continue the abdominal thrusts in quick succession until the object is expelled.
When a client is having difficulty breathing, Fowler's position can provide relief. When sitting in Fowler's position, the client is upright at 90 degrees, allowing the chest to expand as much as possible. Prone (on the abdomen), supine (on the back), and lateral (on the side) are all flat positions, which can make respiratory distress worse.
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