- Oct 2022
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Activities
for incontinence flipcard, it could be urine or stool. Flipcard stating "small movements such as those in the wrists and hands" repeats this on both sides of the cards- should be "fine motor skills" Double check the answer for "A nursing assistant is providing care for a client in a long term care setting who complains of increased frequency of voiding, pain, and burnin with urination. The nursing assistant notices the client's urine is cloudy and foul smelling. These symptoms are reflective of which of the following diagnoses?" it is marking UTI as incorrect. The drag and drop at the bottom is a bit intense for the NA level. I was not able to complete it on a laptop because I was not able to scroll down to the lower answer blanks while I had a term "grabbed". Not sure if it's just me or what.
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creased fatig
fever or cold
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ncreased f
confusion is a classic symptom of UTI in elderly
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See Figure 11.9[4
move the picture up by this reference.
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See Figure 11.8[1] f
move the picture up by this reference or move the reference down by the picture.
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Integumentary System
This section does not add much other than to say look at another chapter. Perhaps a brief recap of info would be helpful in addition to the referrals, as other sections in this chapter have all had recaps included.
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calories
carbohydrates
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n can lead to amputation
re-emphasize that NA's should not cut nails on diabetic pts.
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calories
carbohydrates
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insulin is only administered by a nurse during inpatient care or in long-term care centers.
This sentence needs clarification. I think it's saying that if a patient needs insulin in inpt or LTC only a nurse can give it, but it could be interpreted that only inpts or LTC pts can get insulin because a nurse has to give it, which is not accurate as pts give it to themselves at home.
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this route
the stoma into a pouch rather than...
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prescribed
unless s/sx of dvt are present.
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than 2
this is correct but in a previous chapter it was stated as 3 #. Guidelines are 2-3#.
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s
remove pleural
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Activities
anxiety flipcard is missing the "t" in threat in the definition. Bipolar disorder flipcard states bipolar disorders- remove pleural.
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support
support person
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gently rub their neck
I don't think this is recommended (maybe I'm getting it mixed up with dysphagia guidelines though, so I could be mistaken with dementia).
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anderi
As noted above by another reviewer, a brief recap of wanderguards would be helpful here.
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their
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Ensure safety! Make sure you and the person are safe
Along with this, NA's need to realize that they need to be aware of where the pts hands/ feet are and be on guard to not get hit/ kicked/ etc. Avoid retractable lanyards etc that may be strangulation hazards.
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Try physically demonstrating instead of verbally instructing; use pictures or gestures. Are yo
line spacing
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them
the resident
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they
the individual
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their
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It will take longer for them to process conversations and follow directions, and eventually they will become unresponsive. They may need thickened fluids and a soft or pureed diet.
Move to new bullet point. "Increased time for processing conversations and following directions, progressing to unresponsiveness." New bullet point. "modified diet such as thickened fluids and soft to pureed food."
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or inappropriate laughing. They may act on sexual desires inappropriately with caregivers or in a public area.
disinhibition (i.e inappropriately acting on sexual desires), or inappropriate laughing.
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g. As the disease progresses, they will lose the ability to walk.
while walking, progressing to inability to walk.
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They eventually will require f
make this a new bullet point but remove "they eventually will" and change to increasing need for assistance in...
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leaving on the stove burners.
leaving the stove burners on.
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Types of Dementia
this whole section is above the level of a NA- is it necessary for them to distinguish between the different types of dementia on such a high level? I would recommend omitting and picking back up at the stages of dementia.
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Some examples of altered thinking include the following[2]: Recalling things from their short-term memory Keeping track of a purse or wallet Paying bills Planning and preparing meals Remembering appointments Traveling out of the neighborhood
These are examples of normal thinking tasks rather than altered thinking.
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trategies t
eliminate so much "they". Short, pointed sentences are used throughout in place of "they", such as with bipolar disorder, which is more effective for the chart- I would suggest making all strategy boxes like this.
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Attempt to redirect their attention by carefully encouraging them to engage in another activity that may be more appealing to them or by tactfully changing the subject of a conversation that may be upsetting them.
too much their them... too impersonal and makes the sentence difficult to follow.
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they are
the client is
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is not within their ability
may be diminished.
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e
comma
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Depressive disorders include the following types[14],[15]: Major depressive disorder: A person experiences at least five symptoms of a depressive episode for at least two weeks that causes impairment in social, work, or other areas of functioning. Depressive episodes may also have a seasonal pattern (referred to “seasonal affective disorder”) or occur after the birth of a child (referred to as “postpartum depression”). Persistent depressive disorder (Dysthymia): A person experiences a depressed mood most of the day for at least two years. Premenstrual dysphoric disorder: A person experiences at least five symptoms of a depressive episode the week before the onset of menses in the majority of their menstrual cycles. These symptoms start to improve during menses and become minimal or absent the week after their menses.
I'm not sure this is necessary for the level of a NA.
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get sufficient nutritional intake.
nutritional intake needs.
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everyone’s
delete
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Making
also sleep promotion- sleep deprivation is a huge factor in delirium!
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enclosed spaces
this is claustrophobia.
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their
delete
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de-stigmatize
is it stigmatization vs lack of resources, lack of funding, lack of access?
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assistance
assistants
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ild Inte
maybe make this section into a chart with bullet points (or a bullet point outline) instead of using they...they...they... etc.
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a child
is it just children? Perhaps using people or individuals here would make it more applicable to NA's in LTC?
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Intellectual functioning (IQ)
This is confusing- IQ stands for intelligence quotient, though I get the two are used interchangeably.
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ld, referred to as their
I would just get rid of "their" in this sentence.
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ffect reasoning, problem-solving, plann
also mobility, as with CP
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fetal development
problems occurring during fetal development or injury during birth or early infancy https://www.mayoclinic.org/diseases-conditions/cerebral-palsy/symptoms-causes/syc-20353999
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quickly
rapidly (otherwise both sentences ending in "quickly" sounds odd)
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acute health conditions,
many people admitted to acute care are having acute problems with chronic conditions, or have chronic issues along with their acute condition.
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with
involving
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Assist clients with dementia through environment and activities
re-evaluate wording
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s,
delete comma
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Activities
On OT flipcard, delete comma after "interventions".<br /> For the PROM flipcard, remove "when passive range of motion is applied" from the definition.<br /> In the bottom question with the NA noticing hand contractures and open skin in the palm, should the answers be palm protector and cone? It says SATA but only takes cone as an answer.<br /> For the T/F incentive spirometer question, add "at the end of inspiration" to the statement.
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Application of Compression
include picture sequence or video for visual learners.
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report ROM performed
re-word to pertain to TED hose.
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Range of Motion (ROM)
include picture sequence or video for visual learners.
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Flexion/Extension and Abduction/Adduction
these terms should be defined. I don't recall seeing them previous to this, though I could be mistaken.
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Range of Motion
picture sequence or video for visual learners.
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ribed eyeglasse
I would make a note to make sure glasses are clean.
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eo[14]: Aphasia: The Disorder That Makes You Lose Your Words – Susan Wortman-Jutt.
adjust font- it appears to be in hyperscript.
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things
items
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room.
to prevent tripping hazards.
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See Figure 9.14[
This is not accurate. Mac degeneration is a dark spot in the center rather than totally blurred. Here is the same pic but comparing mac degeneration and normal vision: https://i0.wp.com/post.medicalnewstoday.com/wp-content/uploads/sites/3/2022/05/age_related_macular_degeneration_side_by_side_1296x728-1024x575.jpg?w=1155&h=1528
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by any observer
omit this
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n
comma
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and
delete
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Promoting Joint Mobility and Activity
link requiring login to access.
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Complications of Immobility
link to section
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be timelier
be quicker
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Applying Prosthetics and Orthotics
link to section
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They should
breath out first, emptying their lungs
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See Figure 9.4[4] for an image of a client using an incentive spirometer.
Move this to just above the image or move the image up.
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bronchioles
alveoli
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Respiratory</th Decreased lung function Encouraging incentive spirometry or coughing and deep breathing
formatting; also include up in chair as able
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ncouraging fluids (if not contraindicated) Encouraging fiber in
Encouraging activity as tolerated would be pertinent here also.
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and CPAP
ventilators, CPAP, and Bi-PAP
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also
delete "also"- it makes it seem like RT's were mentioned in the previous sentence and that they are also in the vent units when they weren't.
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Rehabilitation Versus Restorative Care
link to section
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discussed “Members of the Therapy Team” section
discussed in the... Also link to the section.
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slow the progression of healing. Here are some examples of how comorbidities affect healing and recovery: If
line spacing
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tivities
For pressure injury card, it does not have to be in conjunction with sheer. For Fowler's position card, if definition is changed as previously suggested, be sure to change card and glossary also. Typo in sit to stand question in last activity.
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Ambulation
video or picture sequence for visual learners. Also, if possible, include name of checklist in link.
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Position the lift sling
make a comment for where to position sling- from shoulders to buttocks. if it is too high or too low there will be issues.
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Bed to Chair
video or picture sequence for visual learners.
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eelchair, lift, and nonskid footwear
In section 8.11 it mentions a second staff member and that driver of the lift should be at least 18. Is this the same for mechanical sit to stand?
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e chair
make a comment about importance of not putting the brakes on the lift. brakes on the lift can cause the patient's legs to get compressed by the lift as they are lowered to the chair.
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Routine Pre-Procedure Steps:
I would add a statement to make sure the patient is able to assist with pulling up with their arms and straightening their legs. (If the patient is not able to assist with this, the sit to stand should not be used)
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begin raising the lift. Use the lift to ra
I would add a statement on ask the patient to pull up with their arms and straighten their legs. (If the patient is not able to assist with this, the sit to stand should not be used)
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Check that the resident’s feet are completely on the base. Con
missing a step here- place the sling behind the patient's back and under their armpits on either side. Secure the sling clasp in front of the patient around their chest/waist.
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needed
if available- if they're there they should be used.
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Bed to Chair
video or picture sequence for visual learners.
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d to Chair Wi
picture sequence or video for visual learners.
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pine to L
video or picture sequence for visual learners.
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is on
ankle is not
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or covered
or becomes covered
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Tab alarm[14]: Personal Alarm Demonstration
unable to open video- it's showing "video is private"
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supporting an immobile limb)
I thought positioning devices were not considered restraints.
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e a quick-rel
great video!
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The patient must be continually monitored. Generally, the best practice is every 15 minutes for continued use of the restraint, and physical restraints should be removed, and the area assessed every hour. Some agencies require a 1:1 patient sitter when restraints are applied.
This depends on the type of restraint. seclusion is continuous monitoring, medical restraints are remove q 2 hours for ROM, skin checks, etc.
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documentation should
documentation of application of restraint
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The NA should stand to one side of the resident and slightly behind them, with one hand on their gait belt.
might mention standing to the weaker side if the resident has one.
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The resident should step forward with the strong leg and then use the cane and the weaker leg for the next step.
This doesn't sound right. The cane is used with the strong side to support the weak side as the strong leg steps forward.
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resident’s limbs
maybe include a statement as to why? To prevent sheering and injury of residents limbs/ skin- I've unfortunately seen sheets of skin tore by people pulling on arms.
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esident to a Seate
Great picture sequence!
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enter
entire
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Raise the bed to a working height
shouldn't the bed be in low position incase the patient slides out while they are dangling?
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lood pressure t
with position changes
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Do u
Use
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physical therapist.
and agency policy
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e client at all tim
does this need a gait belt?
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feet and ambulate
this is confusing since they are still in the wheelchair
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In Fowler’s positio
not sure how crucial it is here, but Low Fowler's 15-30 degrees. Semi Fowler's 30-45 degrees. Standard Fowler's 45-60 degrees. High/Full Fowler's 90 degrees.
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teps for boos
should this be a separate checklist? Include a video for visual learners showing correct technique.
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intense and prolonged pressure in combination with shear
I don't think it has to be pressure and shear to cause a pressure injury. This is not the case with medical device pressure injuries or heel injuries, etc. Or even if the patient always wants to lay on one side.
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other
some (using other here sounds disjointed)
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edure Steps:
include procedure for non-ambulatory patients.
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utine Pre-Procedure Steps: Knock on the client’s door. Perfor
check line spacing & include picture sequence/video
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Remove the probe from the device. Slide a probe cover (from the attached box) onto the oral thermometer without touching the probe cover with your hands. Place the thermometer under the client’s tongue at either side of the base of the tongue. Instruct the person t
check line spacing from here down- it looks further apart than other checklists. Also, would recommend picture sequences or video of checklists.
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Gather Supplies: Thermometer; probe covers for oral, rectal, axillary, or tympanic thermometer 2.
check formatting- #1 looks indented from a laptop.
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hyperte
put in parenthesis
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Normal Ranges for Vital Signs
link to section
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on Pulse Assess
picture/ words are fuzzy and not readable on laptop device.
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oral Ther
for the question below, shouldn't "the pt has just eaten saltine crackers" be selected also?
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See Figure 7.6
Great pic to show the thermometer, but is not placed over the temporal artery. This image is a good infographic, but not sure about licensing: https://o.quizlet.com/moCoBzpwNLLsBSkrd6QxZA.png
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skin on the forehead
and correct placement.
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“Pain”) t
see comment in Ch 6- do CNA's use this scale?
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Activities
modified diet flipcard- remove "modified diet" from the definition.
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may seek a second opinion
I'm not sure a 2nd opinion is denial- It's good to get a second opinion. I would say multiple different opinions or leave that out altogether.
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ut 3-5 minu
Include never massage over red or swollen areas (i.e dvt)
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creme
cream
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See the PAINAD
Do NA's use this? If so, give a brief description of how to use it- i.e. total numbers added up is the pain level. Otherwise it's just a chart and they won't know what to do with it. If not, perhaps leave it out.
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using powder
clarify this- "thickening powder" Also, as a side note, carbonated beverages tend to fizz all over the place and make a giant mess when thickener is added.
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“kosher” food they consider healthier
I'm not sure it is because Kosher food is healthier- it is because the method of preparation fits with religious guidelines.
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it
pork
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choose to not
choose not to
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things
the food is
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Apply
Apply or administer?
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and razor, and hamper
, razor, and hamper
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Electric Razor
Include video or picture sequence for visual learners.
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Needs Total Assistance
Include video or picture sequence for visual learners.
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Incontinenc
include video or picture sequence for visual learners.
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Remove the soiled
barrier? If the pad is soiled with feces it will get all over the place.
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Urinal
include video or picture sequence for visual learners.
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Place the urinal
might make a note to keep urinal level to prevent urine spillage while urinating.
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Bedpan
Include video or picture sequence for visual learners.
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Bage
typo here and in link. Also, include video or picture sequence for visual learner.
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Catheter
include video or picture sequence for visual learners.
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Choking Maneuver
include video or picture sequence for visual learners: https://youtu.be/wVnGWqqe-6M
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Notify the nurse immediately
This is important, but the NA should perform the choking maneuver immediately rather than looking for the nurse. Maybe say call for help or send someone to find the nurse?
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Meals a
Include video or picture sequence for visual learners.
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Check the check brakes.
revise sentence
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Denture Care
Include video or picture sequence for visual learners.
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Oral Care
Include video or picture sequence for visual learners.
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(Male)
include video or picture sequence for visual learners: https://youtu.be/jPNgwa9ACAU
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(Female)
recommend video for visual learners: https://youtu.be/58wAvY_aF-Y https://youtu.be/QeT1HXFpkqU
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Back Rub
Include video or picture sequence for visual learners.
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dry skin.
maybe re-emphasize not to get lotion between toes.
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Skin Care
Include video or picture guide for visual learners.
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Nail Care
Include video or picture sequence for visual learners
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Foot Care
Include video or picture steps for visual learners.
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uring wat
warm- this is what is used in other checklists throughout "Have the resident check the water temperature by placing their hand in the basin or putting a wet washcloth on the back of their hand."
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mpoo
Include video or picture sequence for visual learners.
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Bath
Recommend video or pic sequence for visual learners.
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legs and rectal
perineal area, not just rectal area
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and avoiding
to prevent
-
“ 5.18 & 5.19 Perineal Care Skills Checklists” for specifics.
spacing off- I think this goes together. Also, these links are requiring a login.
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Shower
again, a video would be helpful for visual learners.
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recta
perineal area, not just rectal area, front to back.
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agreed- very confusing. Also, a video addition would be nice for visual learners.
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“Shampoo Skills Checklist”
it makes me login to view this link
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“5.18 & 5.19 Perine
it's making me log in to follow these links
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Bath
Would recommend including a video.
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Chapter 11
Link to chapter?
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“Assistance With Toileting”
this links to the current chapter.
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Chapter 6.2 “Nutrition and Fluid Needs”
link or remove
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explained below the following figures.
each device is explained below. (the explanation comes above the figures)
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information
site to read about...
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Skin care is important for all clients, but additional moisturizing and frequent repositioning should be performed for clients with increased risk for skin breakdown. See Chapter 8 and 11 for more specific information on risks for skin breakdown and maintaining skin integrity.
move this paragraph below the picture.
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cardiac function
decline in cardiac function which decreases blood flow and oxygen to the skin and...
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Skin integrity refers to skin that is damaged or not healing normally
This is not the definition of skin integrity- this is the definition of impaired/altered skin integrity. Skin integrity the health of the skin.
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Skin is made up of three layers: epidermis, dermis, and hypodermis. See Figure 5.2[1] for an illustration of skin layers. The epidermis is the thin, topmost layer of the skin. It contains sweat gland duct openings and the visible part of hair known as the hair shaft. Underneath the epidermis lies the dermis where many essential components of skin function are located. The dermis contains hair follicles (the roots of hair shafts), sebaceous oil glands, blood vessels, endocrine sweat glands, and nerve endings. The bottommost layer of skin is the hypodermis (also referred to as the subcutaneous layer). It mostly consists of adipose tissue (fat), along with some blood vessels and nerve endings. Beneath the hypodermis layer lies bone, muscle, ligaments, and tendons.[2] Figure 5.2 Layers of the Skin
Not sure this needs to be duplicated here- perhaps just link back to chapter 4?
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not a safe
not always a safe
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resulting
which may result in (otherwise it sounds like being prepared results in discomfort)
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ludes t
might also consider adding bath/shower here as well per pt preference.
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.
)
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coughing
coughing/ sneezing
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Yellow
can be brown too- (MRSA is often brownish)
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uneasy or uncomfortable
feeling of discomfort, illness, or lack of well-being
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or suspected infections specific infections su
revise sentence- maybe a comma? It's worded funny.
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ities
definition on the fever flipcard could be revised as it includes fever, same with "moments of hand hygiene". Also, if "moments" is changed to "times" or whatever was suggested earlier in the chapter, it should be changed here as well as the glossary. Re-look at the definition for contact precautions. It seems worded funny. I really like the last drag and drop comparing sanitizer to soap/water!
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mask by
According to CDC guidelines, remove gloves, then goggles, then gown, then mask: https://www.cdc.gov/hai/pdfs/ppe/ppe-sequence.pdf Not sure if it is different for NA's, but this pdf is a good infographic for donning and doffing.
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With a Mask
Recommend including a video for consistency and visual learners. Here is a good example: https://youtu.be/qOzVwVzzXJc
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behind your head
at the back of your neck
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ove Removal
Great picture sequence!! I like the opaque gloves so they can see finger placement into the 2nd glove.
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inside out
inside out while containing the first glove inside...
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