Nursing Assistant: Resident Care

Resident Rights and Respect

• A female resident's husband should be allowed private visits in her room.
• NAs should acknowledge the difficulty of ROM exercises and encourage residents to work slowly, resting often

Responding to Resident Needs

• If a resident gets out of restraints and is partly out of bed, call for help to get the resident back into bed and reapply the restraint.
• If a resident reports a sore mouth, leave the dentures out and inform the nurse to check the resident's mouth.
• To help a resident who cannot fall asleep, giving a back rub is an appropriate first step.
• If a resident says they are going to faint, assist the resident to sit slowly on the floor.
• Give portions from each food, if a resident is on a pureed diet.
• Elderly residents often have vision problems
• Dehydrated residents require increased fluid intake, "force fluids".
• A resident's plan of care is the best source of information.
• A resident being discharged may be worried, so encourage them to discuss their feelings.

Safety and Emergency Procedures

• After a resident dies, the NA prepares the resident's body.
• When performing ROM exercises, move each joint to its fullest range until the resident feels discomfort.
• An NPO sign means a resident is not to be given anything by mouth.
• If a resident keeps dropping a cigarette in their lap, stay with the resident until finishing.
• For a resident on bedrest unable to turn themselves, the maximum time to leave them in one position is 2 hours.
• If a NA discovers a fire in a waste can, first act to move residents out of immediate danger.
• If a resident is lying on the floor having a seizure, first, move objects that could cause injury and support the resident's head.
• For a choking resident, ask if they can talk.
• In case of fire, first remove any residents near the fire.
• A disposable razor should be placed in a sharps container immediately after use.
• If hot tea splashes on a resident's hand, wet a towel or napkin with cool water and place against the injured area.
• If a resident is having a seizure during personal care in bed, call the charge nurse and remain with the resident.
• if a resident falls state: "Ask the resident to stay still while the NA calls for help".
• The heart is an important muscle for the Circulatory body system

Observation and Reporting

• If a resident says she thinks she is dying, ask why she feels this way.
• If a normally alert resident suddenly seems confused, report the change to the charge nurse.
• Make rounds to see each resident briefly after receiving shift assignments.
• If a resident on oxygen says they are not getting enough, check the tubing first.
• Report pain and burning with an indwelling catheter.
• Should a NA see a nurse swallow resident medication, report it to the administrator.
• Elderly residents often have problem with vision

Assisting Residents

• If a resident is slow dressing, start the resident dressing earlier.
• If a resident is unable to ambulate, allow them to choose a better time to do so.
• Apply lotion after washing and drying feet for residents with dry skin.
• Always put the call light within reach.
• Make a special sign, if a resident has trouble finding their room.
• To assist a resident with poor vision, help them become familiar with the furniture in the room.
• Attach a paper bag to the bed, for a resident with a cold to put the used tissues in.
• Ask "Do you want to take your bath now or after breakfast?" to encourage resident involvement.
• Check to see that the hearing aid is turned on.
• Encourage the resident to express her feelings, if a resident is grieving over the recent death of her husband.
• Attach a paper bag to the resident's bed, for the use of tissues, to control teh spread of infection

Communication and Empathy

• If a resident is upset after a family visit, ask "Can you tell me why you are so upset?"
• Allow a resident to talk about the death, if they want to speak about the death of another resident.
• Let a resident hold a stuffed animal whenever they want to.
• Ask the resident what is wrong, if a NA hears a resident crying softly at 3:00 a.m.
• If called away from the bedside resulting in a resident screaming, apologize for leaving and offer assistance.
• To understand why a resident is saving moldy food say, "Why are you saving this food? Do you get hungry between meals?"
• An NA's best response if a resident states they are frightened by a dark room is, "I will leave the door open so the light can come in."
• IF the resident is grieving, encourage them to express their feelings
• If a resident wants to hold the stuffed animal let them!
• if the resident is grieving, encourage them to express their feelings
• A NA'S most helpful response when bringing the resident back is "Let me walk with you"

Professional Boundaries and Ethics

• Clean linen found on the floor should be discarded in the soiled linen hamper.
• If a resident is found in bed with a confused resident, report this to the charge nurse.
• An NA should refuse to perform tasks outside their scope of practice.
• HIPAA identifies protected health information that must remain confidential.
• Sundowning is a term used to describe when residents become restless and agitated late in the day
• If the resident calls the na and states that they cant move their arm, the first thing they should do is. "Ask the resident to stay still while the NA calls for help"

Mobility and Body Mechanics

• Move it to its fullest range or until the resident feels discomfort, when performing ROM exercises.
• A gait or transfer belt helps steady and support a resident when transferring or walking.
• A resident who remains primarily in their bed, is at risk of Footdrop
• If a resident is experiencing weakness on their right side, always stand on their left side.
• The gait or transfer belt is to steady/support the resident, not to protect your back

Nutrition and Elimination

• Increase the resident's fluid intake, if they are dehydrated.
• Ask if this is a normal pattern for the resident's body and Report this to the charge nurse, if a resident reports having a very large bowel movement two days ago.
• Offer more food, if a resident is eating very little lunch.
• Provide a routine time for the resident to use the toilet, as a way to help residents have regular bowel movements
• If the resident cant stand, his height is generally obtained by taking the measurement from head to heels while the resident is flat in bed
• Meat and eggs are foods found on a high protein diet

Catheter Care

• Keep the area where the catheter enters the body clean.
• Check if the tubing is kinked and draining properly, if a resident has an indwelling catheter, says, "I need to urinate."
• With a wheel chair, the drainage bag it attached to the resident seat below the bladder

Skin Integrity

• A resident must stay in bed for long periods of time, prevent ulcers by turning and positioning the resident according to a schedule.
• Avoid pulling or sliding the resident when moved, to prevent s kin tears or shearing when moving the resident

Safety of Residents

• Assist the resident to sit slowly on the floor, if a resident says she is going to faint.
• If a resident is smoking in the smoking area on the outside porch of the nursing home. The resident keeps dropping the cigarette in his lap. The first thing the NA does is: Stay with the resident until he is finished smoking.
• Stop the feeding and report the coughing to the change nurse right away, when feeding a resident, the NA notices that the resident coughs after each drink of fluids.
• The first step a NA should take when discovering a fire is to remove any residents near the fire.
• Place large stop signs on doors, to help prevent residents who are confused from accidentally leaving the nursing home

Other:

• Check what scale is usually used for this resident, when trying to obtain a resident's weight
  • Weigh the resident using the same scale each time as scales may differ by one or more pounds.
• "Look at the time. Lunch is in 30 minutes. Are you feeling hungry?", using reality orientation for a resident with early dementia.
• Providing opportunities for activity and periods for rest is important and best describes daily routine needs of residents with dementia
• A resident sitting in a shower chair begins to have a fit and states I feel weak, the first thing to do is Keep the resident safe and comfortable
• If you walk into a residents room and they are lying on the floor and states they cannot move their arm, the first thing you should do is Notify the charge nurse, then assist the resident to stay still