Mosby’s Essentials for Nursing Assistants PDF
Preview Mosby’s Essentials for Nursing Assistants
The content and procedures in this book are based on information currently available. They were reviewed by instructors and practicing professionals in various regions of the United States. However, agency policies and procedures may vary from the information and procedures in this book. In addition, research and new information may require changes in standards and practices. Standards and guidelines from the Centers for Disease Control and Prevention (CDC), the Centers for Medicare & Medicaid Services (CMS), and the Occupational Safety and Health Administration (OSHA) may change as new information becomes available. Other federal and state agencies may also issue new standards and guidelines. So may accrediting agencies and national organizations. You are responsible for following the policies and procedures of your employer and the most current standards, practices, and guidelines as they relate to the safety of your work. PROVIDE FOR COMFORT • Make sure the person and linens are clean and dry. The person may have become incontinent during the procedure. • Change or straighten bed linens as needed. • Position the person for comfort and in good alignment. • Provide pillows as directed by the nurse and the care plan. • Raise the head of the bed as the person prefers and as allowed by the nurse and the care plan. • Provide for warmth. The person may need an extra blanket, a lap blanket, a sweater, socks, and so on. • Adjust lighting to meet the person’s needs. • Make sure eyeglasses, hearing aids, and other devices are in place as needed. • Ask the person if he or she is comfortable. • Ask the person if there is anything else you can do for him or her. • Make sure the person is covered for warmth and privacy. COMPLETE A SAFETY CHECK OF THE ROOM • The person is wearing eyeglasses, hearing aids, and other devices as needed. • The call light is plugged in and within reach. • Bed rails are up or down according to the care plan. • The bed is in a low position that is safe and comfortable for the person. Follow the care plan. • The bed position is locked if needed. • Manual bed cranks are in the down position. • Bed wheels are locked. • Assistive devices are within reach. Walker, cane, and wheelchair are examples. • The over-bed table, filled water mug with straw, tissues, phone, TV controls, and other needed items are within reach. • Un-needed equipment is unplugged or turned off. • Harmful substances are stored properly. Lotion, mouthwash, shampoo, after-shave, and other personal care products are examples. • Food and other items brought by the family and visitors are safe for the person. • Floors are free of spills and clutter. Brief Contents 1 Hospitals and Nursing Centers, 1 2 The Person’s Rights, 9 3 The Nursing Assistant, 15 4 Work Ethics, 32 5 Communicating With the Health Team, 44 6 Understanding the Person, 59 7 Body Structure and Function, 70 8 Care of the Older Person, 89 9 Assisting With Safety, 97 10 Assisting With Fall Prevention, 114 11 Restraint Alternatives and Safe Restraint Use, 124 12 Preventing Infection, 139 13 Body Mechanics, 161 14 Assisting With Moving and Transfers, 169 15 Assisting With Comfort, 198 16 Assisting With Hygiene, 227 17 Assisting With Grooming, 251 18 Assisting With Urinary Elimination, 271 19 Assisting With Bowel Elimination, 294 20 Assisting With Nutrition and Fluids, 307 21 Assisting With Assessment, 329 22 Assisting With Specimens, 356 23 Assisting With Exercise and Activity, 367 24 Assisting With Wound Care, 381 25 Assisting With Pressure Ulcers, 399 26 Assisting With Oxygen Needs, 408 27 Assisting With Rehabilitation and Restorative Nursing Care, 419 28 Caring for Persons With Common Health Problems, 426 29 Caring for Persons With Mental Health Disorders, 457 30 Caring for Persons With Confusion and Dementia, 466 31 Assisting With Emergency Care, 482 32 Assisting With End-of-Life Care, 496 Review Question Answers, 504 Appendices, 506 A The Patient Care Partnership: Understanding Expectations, Rights, and Responsibilities, 506 B National Nurse Aide Assessment Program (NNAAP®) Written Examination Content Outline and Skills Evaluation, 507 C Job Application, 508 D Minimum Data Set: Selected Pages, 510 Illustration Credits, 513 Glossary, 515 Key Abbreviations, 522 Index, 523 5 EDITION MOSBY’S ESSENTIALS FOR NURSING ASSISTANTS SHEILA A. SORRENTINO, PhD, RN Delegation Consultant Anthem, Arizona LEIGHANN N. REMMERT, MS, RN Health Occupations Instructor Lincolnland Technical Education Center Lincoln, Illinois 3251 Riverport Lane St. Louis, Missouri 63043 MOSBY’S ESSENTIALS FOR NURSING ASSISTANTS ISBN: 978-0-323-11317-5 Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Previous editions copyright © 2010, 2006, 2001, 1997 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices The content and procedures in this book are based on information currently available. They were reviewed by instructors and practicing professionals in various regions of the United States. However, agency policies and procedures may vary from the information and procedures in this book. In addition, research and new information may require changes in standards and practices. Standards and guidelines from the Centers for Disease Control and Prevention (CDC) and the Occupational Safety and Health Administration (OSHA) may change as new information becomes available. Other federal and state agencies also may issue new standards and guidelines. So may accrediting agencies and national organizations. You are responsible for following the policies and procedures of your employer and the most current standards, practices, and guidelines as they relate to the safety of your work. To the fullest extent of the law, neither the Publisher nor the authors or editors assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Library of Congress Cataloging-in-Publication Data Sorrentino, Sheila A., author. Mosby’s essentials for nursing assistants / Sheila A. Sorrentino, Leighann N. Remmert.—5th edition. p. ; cm. Essentials for nursing assistants Includes index. ISBN 978-0-323-11317-5 (pbk. : alk. paper) I. Remmert, Leighann N., author. II. Title. III. Title: Essentials for nursing assistants. [DNLM: 1. Nurses’ Aides. 2. Nursing Care–methods. WY 193] RT84 610.7306′98–dc23 2013030270 Content Strategist: Nancy O’Brien Senior Content Development Specialist: Maria Broeker Publishing Services Manager: Jeff Patterson Project Manager: Bill Drone Designer: Brian Salisbury Printed in Canada Last digit is the print number: 9 8 7 6 5 4 3 2 1 Dedication To my brother Tony’s children: Carly Marie Sorrentino, BS (Accounting), MA (Accounting), CPA (Certified Public Accountant), Anthony Louis Sorrentino, Certificate in Automotive Technology, and Michael Matthew Sorrentino, BS (Kinesiology and Sports Studies) From babies to now successful, young adults, they bring much joy and laughter. Wishing them a lifetime of health, happiness, and love. With much love, Aunt Sheila Heartfelt congratulations to my sister, Jenn, and brother, Ryan, on the birth of their sons: Sawyer Thomas Phillips and Connor Reilly Dennison May these boys grow to be wise and discerning men. Wishing their expanding families abundant blessings. With love, Leighann About The Authors Sheila A. Sorrentino is currently Leighann N. Remmert is a Health a consultant focusing on effective Occupations Instructor at Lincoln- delegation and partnering with land Technical Education Center in nursing assistive personnel in health Lincoln, Illinois. She teaches high care settings. Her conference presen- school nursing assistant students in tations focus on delegation and other the clinical setting and instructs issues relating to nursing assistive nursing assistant courses for adult personnel. learners. Dr. Sorrentino was instrumental Leighann has a Bachelor of in the development and approval of Science degree in nursing from CNA-PN-ADN career-ladder pro- Bradley University (Peoria, Illinois) grams in the Illinois community college system and has and a Master of Science degree in nursing education from taught at various levels of nursing education—nursing Southern Illinois University Edwardsville (Edwardsville, assistant, practical nursing, associate degree nursing, and Illinois). Leighann’s clinical background includes the roles baccalaureate and higher-degree programs. Her career of nursing assistant/tech, nurse extern, staff nurse, charge includes experiences in nursing practice and higher educa- nurse, nurse preceptor, and trauma nurse specialist. As an tion—nursing assistant, staff nurse, charge and head nurse, RN, Leighann concentrated in the area of emergency nursing faculty, program director, assistant dean, and dean. nursing at Memorial Medical Center (Springfield, Illinois). A Mosby author and co-author of several nursing assis- She is a member of Sigma Theta Tau International, the tant titles since 1982, Dr. Sorrentino has a Bachelor of Honor Society of Nursing and the Certified Nursing Science degree in nursing, a Master of Arts degree in edu- Assistant Educator’s Association (Illinois, Central Region). cation, a Master of Science degree in nursing, and a PhD Leighann has supervised, instructed, and evaluated in higher education administration. She is a member of student learning in long-term care and acute care settings Sigma Theta Tau International, the Honor Society of as a clinical nursing instructor at the Capital Area School Nursing and the Rotary Club of Anthem (Anthem, of Practical Nursing (Springfield, Illinois). In her current Arizona). Her past community activities include serving as position at Lincolnland Technical Education Center, a board member on the Provena Senior Services Board of Leighann guides students in acquiring the skills and knowl- Directors (Mokena, Illinois), the Central Illinois Higher edge they need to succeed as nursing assistants. Through Education Health Care Task Force, the Iowa-Illinois her teaching, she emphasizes the importance of profes- Safety Council Board of Directors, and the Board of Direc- sionalism and work ethics, safety, teamwork, communica- tors of Our Lady of Victory Nursing Center (Bourbonnais, tion, and accountability. Valuing the role of the nursing Illinois). assistant and treating the person with dignity, care, and She received an alumni achievement award from Lewis respect are integral to her instruction in the classroom and University for outstanding leadership and dedication in clinical settings. nursing education. She is also a member of the Illinois Leighann is co-author of Mosby’s Textbook for Medication State University College of Education Hall of Fame. Assistants, Mosby’s Essentials for Nursing Assistants (4e), and Dr. Sorrentino sponsors two nursing scholarships. One Mosby’s Textbook for Nursing Assistants (8e). She was a con- is awarded to a senior student from her high school alma sultant on Mosby’s Textbook for Long-Term Care Nursing mater who intends to major in nursing. The other is Assistants (6e). awarded to a nursing assistant who intends to major or is Leighann and her husband, Shane, have one daughter, majoring in nursing and employed at one of the three Olivia. Leighann and Shane are active in various ministry agencies in which she worked during and after college— areas at Elkhart Christian Church (Elkhart, Illinois). Heritage Health (Peru, Illinois), Illinois Valley Commu- Leighann is certified as a Basic Life Support instructor and nity Hospital (Peru, Illinois), and St. Margaret’s Hospital teaches CPR courses for the church and community. (Spring Valley, Illinois). Terry Farmer Photography, Springfield, Illinois Mike Spinelli Photography, Phoenix, Arizona vi Reviewers Carrie Adams, RN, MSN Mary Therese Galka, RN, BSN Adjunct Instructor – Nursing/Nursing Assistant BNAT Instructor and Program Coordinator Mesa Community College Moraine Valley Community College Mesa, Arizona Palos Hills, Illinois Clare DeVries, RN, BSN Karrie Pater, RN, BSN CNA Instructor Instructor, Certified Nurse Aide Course Joliet Junior College Director of Nursing Joliet, Illinois North Central Michigan College, Bortz Health Care of Petoskey JoAnne M. Franz, RN, MS Petoskey, Michigan CNA Instructor Linda Skroch, RN, BSN Joliet Junior College Joliet, Illinois School Nurse/CNA Instructor Mohave Community College NASN Bullhead City, Arizona Yerington, Nevada vii Acknowledgments As authors, we rely on others to provide assistance and to fulfill their respective roles and responsibilities to ensure an accurate, up-to-date, and timely publication. Therefore we extend a “thank you” and appreciation to the following individuals. • The reviewers who spent time reading, commenting on, and making suggestions to improve our textbook. We found their thoughts and ideas insightful and useful. • Carrie Adams, RN, MSN • Clare DeVries, RN, BSN • JoAnne M. Franz, RN, MS • Mary Therese Galka, RN, BSN • Karrie Pater, RN, BSN • Linda Skroch, RN, BSN • Susan Broadhurst (Rochester, New York) for her role as copy editor. She accommodates our style well. • Jody McBride for her proofreading efforts. The task requires attention to detail and special talents. • The artists at Graphic World (St. Louis, Missouri). They made sense out of “roughs.” • And finally to the Elsevier/Mosby staff involved: • Nancy O’Brien, Content Strategist • Maria Broeker, Senior Content Development Specialist • Kelly Albright, Content Coordinator • Jeff Patterson, Publishing Services Manager • Bill Drone, Project Manager, Book Production • Brian Salisbury, Designer • Emily Ogle, Producer To all individuals who contributed to this effort in any way, we are sincerely grateful. Sheila A. Sorrentino and Leighann N. Remmert viii Instructor Preface The fifth edition of Mosby’s Essentials for Nursing Chapter 2: The Person’s Rights (NEW!) Assistants serves several purposes. As authors, we • FOCUS ON SURVEYS: Residents’ Rights believe the book: • FOCUS ON COMMUNICATION: Information • Prepares students to function as nursing assistants in • FOCUS ON COMMUNICATION: Quality of Life nursing centers and hospitals. • FOCUS ON COMMUNICATION: Activities • Serves the needs of students and instructors in • FOCUS ON SURVEYS: Activities educational settings offering nursing assistant courses. Chapter 3: The Nursing Assistant • Is a valuable resource for individuals preparing for the • Nurse Practice Acts competency evaluation. • Nursing Assistants • Is a useful reference as the certified (licensed or • FOCUS ON COMMUNICATION: The Training Program registered) nursing assistant seeks to review or learn • Certification new information for safe care. • FOCUS ON SURVEYS: Maintaining Competence Foundational principles and concepts are presented in • FOCUS ON COMMUNICATION: Job Description specific chapters while values, objectives, and organiza- • FOCUS ON COMMUNICATION: Refusing a Task tional strategies are intertwined and integrated in content • FOCUS ON COMMUNICATION: Professional Boundaries and key features throughout the book. (See “Student • FOCUS ON COMMUNICATION: Intentional Torts Preface” p. xii for key features.) (Invasion of Privacy) • Patients and residents are presented as persons with • FOCUS ON COMMUNICATION: Reporting Abuse dignity who have a past, a present, and a future. Such • FOCUS ON SURVEYS: Reporting Abuse persons are physical, social, psychological, and • Child Abuse and Neglect spiritual beings with basic needs and protected rights. • Domestic Abuse Their culture and religion influence health and illness practices. Chapter 4: Work Ethics • Nursing assistant roles, range of functions, and • FOCUS ON COMMUNICATION: Attendance limitations are defined and described by federal and state laws and are dependent on effective delegation Chapter 5: Communicating With the Health Team and good work ethics. • FOCUS ON SURVEYS: The Comprehensive Care Plan • Promoting safety and comfort is central to the • Box 5-4 The 24-Hour Clock nursing assistant role. Body structure and function, body mechanics, preventing infection, safety Chapter 6: Understanding the Person practices, and comfort measures form the essential • FOCUS ON COMMUNICATION: Culture and Religion knowledge base. • Paraphrasing • Communication skills are needed to communicate • Persons With Bariatric Needs effectively with the nursing and health teams, patients and residents, and families and visitors. Chapter 7: Body Structure and Function • The nursing process is the basis for planning and • The Lymphatic System delivering nursing care. Nursing assistants play a key role in assisting with the nursing process. Chapter 8: Care of the Older Person • FOCUS ON COMMUNICATION: Social Relationships Content Issues Every edition requires revision and content decisions. Chapter 9: Assisting With Safety Changes in laws or in guidelines and standards issued by • PROMOTING SAFETY AND COMFORT: Assisting With government or accrediting agencies are accommodated. So Safety are changes to state curricula and competency evaluations. • FOCUS ON SURVEYS: Assisting With Safety Every attempt is made to publish an up-to-date book. • FOCUS ON COMMUNICATION: Identifying the Person Often changes are made right before publication. • Box 9-2 Choking—Chest Thrusts for Obese or Student learning needs and abilities, instructor desires, Pregnant Persons work-related issues, course/program and book length, • FOCUS ON OLDER PERSONS: Choking and student cost are among the many factors considered. • PROMOTING SAFETY AND COMFORT: Preventing With such issues in mind, new and expanded content and Equipment Accidents figures are listed in this section. • FOCUS ON SURVEYS: Disasters ix
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