CNA Chap 3 Video Part 1, 2 PDF

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Understanding Residents...

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Chapter 3: Video #1- Understanding Residents

Notes: 1. Define the following terms: o Psychosocial needs – needs that involve social interaction, emotions, intellect, and spirituality o Masturbation – to touch or rub sexual organs in order to give oneself or another person sexual pleasure o Holistic care – a type of care that involves caring for the whole person- the mind as well as the body o Cultural diversity – the different groups of people with varied backgrounds and experiences who live together in the world

2. All human beings have the same basic physical needs o Food and water o Protection and shelter o Activity o Sleep and rest o Comfort, freedom from pain

3. Some nursing assistant tasks address the resident’s physical needs, including the following: o Assisting with eating o Assisting with elimination o Assisting with bathing o Assisting with grooming

4. Psychosocial needs of human beings include the following: o Love and affection o Acceptance by others o Safety and security o Self-reliance and independence in daily living o Contact with other people o Success and self-esteem

5. When a person’s psychosocial needs are not met, the response may include: o Stress o Frustration o Fear

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Anxiety Anger Aggression Withdrawal Indifference Depression

6. Maslow’s Hierarchy of Needs

7. REMEMBER: respect and privacy are essential when encountering any sexual situation involving a resident

8. It is important for NAs to remember the following about residents’ sexual needs and sexual situations: o People continue to have sexual needs throughout their lives o Humans express their sexuality through different behaviors o Knock and wait for a response before entering a resident’s room o Provide privacy if you encounter a sexual situation o Be open and nonjudgmental o Respect residents’ sexual orientation and gender identity o Use the pronouns and names that transgender residents wish to use o Respect resident’s sexual orientation and gender identity o Honor ‘Do not Disturb’ signs o Do not view expression of sexuality by the elderly as disgusting or cute

9. Myths about Older Adults and Sexuality o Myth #1: older men are not capable of having sexual relations

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May need more direct contact, may take longer, and may need longer in between sexual activities ▪ Many men continue to have sexual relations well into old age Myth #2: after menopause, women are not interested in sexual relations ▪ Women feel much freer ▪ Less lubrication, but there are remedies available ▪ Communication with physicians is important ▪ The reason many older women stop having sex is because they lose their partners when their partners die Myth #3: any expression of sexuality by older people is either disgusting or cute ▪ This attitude deprives older people of their right to dignity and respect ▪ Older adults have the same needs and rights to express their sexuality as other age groups ▪ Society makes them feel wrong for expressing their sexuality

10. REMEMBER: residents must be protected from unwanted sexual advances. If an NA sees sexual abuse happening, he should remove the resident from the situation and take the resident to a safe place. He should then report to the nurse immediately

11. NAs can help residents meet their spiritual needs in these ways: o Learn about resident's religions or beliefs o Listen carefully to what residents say o Respect resident's decisions to participate in or refrain from rituals o If residents are religious, encourage participation in religious services o Respect all religious items o Report to the nurse or social worker if the resident desires to see clergy o Allow privacy for clergy visits o If asked, read religious materials aloud o Refer resident to spiritual resources if requested

12. The following are not permitted regarding residents’ spiritual/religious needs: o Trying to change someone’s religion o Telling residents their belief or religion is wrong o Expressing judgements about a religious group o Insisting residents join religious activities o Interfering with religious practices o Discussing your personal beliefs or opinions either directly or indirectly

13. Residents in LTC facilities may be experiencing any of these losses: o Loss of spouse, family members, and friends due to death

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Loss of workplace and its relationships due to retirement Loss of ability to go to favorite places Loss of ability to attend services and meetings at their faith communities Loss of home and personal possessions Loss of health and ability to care for themselves Loss of ability to move freely Loss of pets LGBTQ residents may fear the loss of a comforting, safe, accepting environment

14. Loss of independence can cause: o Poor self-image o Anger toward caregivers, others, and self o Feelings of helplessness, sadness, and hopelessness o Feelings of being useless o Increased dependence o Depression

15. NAs promote independence in residents when they do the following: o Encourage residents to do as much as possible for themselves no matter how long it takes o Be patient o Allow residents to make choices

16. Culture plays a part in determining all the following: o Language o Religion o Food preferences o Touch

17. Understanding a little bit about common religious groups may be useful. Common religions are listed below:

18. Spirituality concerns a person’s beliefs about the spirit or the soul. It may center on how a person relates to his community, to nature, or to the divine. It may involve reflection and contemplation and a search for inner peace. It may relate to a person’s beliefs about the meaning of life. Spirituality does not have to encompass religious beliefs.

19. Many religious beliefs include dietary restrictions. These are rules about what and when followers can eat. Some examples are: o Many Buddhists are vegetarians, though some include fish in their diet o Some Christians, particularly Roman Catholic, do not eat meat on Fridays during Lent o Many Jewish people eat kosher foods, do not eat pork, and do not eat shellfish o Mormons may not drink alcohol, coffee, or tea. They may not use tobacco in any form o Muslims do not eat pork and may avoid certain birds. They may not drink alcohol. Muslims may have regular periods of fasting. o Some people are vegetarians and do not eat any meat o Some people are vegans and do not eat animals or any animal products

20. REMEMBER: NAs should focus on respectful, compassionate, and culturally sensitive care. An NA should treat residents as residents wish to be treated, not as the NA would want to be treated. This is a part of person-centered care.

21. Physical activity has the following positive effects: o Lessening the risk of heart disease, colon cancer, diabetes, and obesity o Relieving symptoms of anxiety and depression o Improving mood and concentration o Improving body function o Lowering the risk of falls o Improving sleep quality o Improving the ability to cope with stress o Increasing energy and appetite o Promoting better eating habits

22. Inactivity and immobility can result in physical and mental problems, such as the following: o Loss of self-esteem o Anxiety o Depression o Boredom o Pneumonia o Urinary tract infections

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Skin breakdown and pressure injuries Constipation Blood clots Dulling of the senses

23. There are many different kinds of families: o Nuclear families o Single parent families o Married or committed – couples of the same sex or opposite sex o Extended families o Blended families

24. Family members may participate in the care of residents in these ways: o Helping residents make care decisions o Communicating with the care team o Giving support and encouragement o Connecting the resident to the outside world o Offering assurance to dying residents

25. REMEMBER: Residents’ families are likely experiencing significant adjustments. NAs should be respectful. They should allow privacy for visits and observe and report the effect of visits on residents.

Chapter 3: Video #2- Understanding Residents

Notes: 1. Stages of development o Infancy (birth to 12 months) ▪ Grow and develop quickly ▪ Development is from head down o Toddlerhood (1-3) ▪ Formerly dependent, now gaining independence and body control ▪ Learn to speak, gain coordination, and develop bowel and bladder control ▪ May have tantrums or whine to get their way o Preschool years (3-6)

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▪ More social relationships ▪ Play cooperatively and learn language ▪ Learn right from wrong School age (6-10) ▪ Cognitive development (thinking and learning) ▪ Learn to get along with others and their peer group ▪ Develop a conscience and self-esteem Preadolescence (10-13) ▪ Growing sense of identity ▪ Strong identity with peers ▪ Relatively calm period ▪ Imaginary fears give way to fears based in the real world Adolescence (13-19) ▪ Onset of puberty ▪ Secondary sex characteristics ▪ Reproductive organs begin to function ▪ Concern for body image and peer acceptance ▪ Changing moods Young adulthood (19-40) ▪ Select an education ▪ Select a career ▪ Select and live with a mate ▪ Raise children ▪ Develop a satisfying sex life Middle adulthood (40-65) ▪ More comfortable and stable ▪ Physical changes related to aging occur Late adulthood (65+) ▪ Many physical and psychological changes ▪ Loss of physical health ▪ Loss of friends and jobs

2. Define the following terms: o Ageism – prejudice toward, or stereotyping of, and/or discrimination against older persons or the elderly o Developmental disabilities – disabilities that are present at birth or emerge during childhood that restrict physical and/or mental ability o Major depressive disorder – a type of mood disorder that causes pain, fatigue, apathy, sadness, irritability, anxiety, sleeplessness, and loss of appetite, as well as other symptoms; also called depression or clinical depression o Apathy – a lack of interest in activities

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Bipolar disorder – a type of mood disorder that causes mood swings, changes in energy levels, and the ability to function, periods of extreme activity and periods of extreme depression Anxiety - uneasiness, worry, or fear often about a situation or condition Generalized anxiety disorder (GAD) - an anxiety disorder that is characterized by chronic anxiety and worry, even when there is no because for these feelings Panic disorder – a disorder characterized by a person having regular panic attacks or living with constant anxiety about having another attack Obsessive compulsive disorder (OCD) - an anxiety disorder characterized by obsessive behavior or thoughts, which may cause the person to repeatedly perform a behavior or routine Posttraumatic stress disorder (PTSD) - an anxiety disorder caused by experiencing or witnessing a traumatic event Phobia - an intense irrational fear of or anxiety about objects, places, or situations Schizophrenia – a type of psychotic disorder that causes problems with thinking, communication, and the ability to manage emotions, make decisions, and understand reality Hallucinations - false or distorted sensory perceptions Delusions – persistent false beliefs Psychotherapy – a method of treating mental health disorders that involves talking about one’s problems with mental health professionals Cognitive behavior therapy (CBT) - type of psychotherapy that is often used to treat anxiety and depression and focuses on skills and solutions that a person can use to modify negative thinking and behavior patterns Terminal illness – a disease or conditions that will eventually cause death Grief – deep distress or sorrow over a loss Advance directives – legal documents that allow people to choose what medical care they wish to have if they are unable to make those decisions for themselves Living will – a document that outlines the medical care a person wants, or does not want, in case he or she becomes unable to make those decisions Durable power of attorney for healthcare – a signed, dated, and witnessed legal document that appoints someone else to make the medical decisions for a person in the event she becomes unable to do so Do-not-resuscitate (DNR) - a medical order that instructs medical professionals not to perform CPR in the event of respiratory arrest Cheyne-Stokes respirations – alternating periods of slow, irregular breathing and rapid, shallow breathing, along with periods of not breathing (apnea) Postmortem care – care of the body after death Hospice care - term for the special care that a dying person receives if they have approximately 6 months or less to live; compassionate way to care for dying people and their families Palliative care – care given to people who have serious diseases or who are dying that emphasizes relieving pain, controlling symptoms, and preventing side effects

3. Remember these facts about aging: o Older adults have different capabilities o Stereotypes are false o Older people are usually active o Aging is a normal process, not a disease o Aging people need to adjust to change o They do not need to be dependent

4. Normal changes of aging include the following: o Skin is thinner, drier, more fragile, and less elastic o Muscles weaken and lose tone o Bones lose density and become more brittle o Sensitivity of nerve endings in the skin decreases o Responses and reflexes slow o Short term memory loss occurs o Senses of vision, hearing, taste, touch, and smell weaken o Heart pumps less efficiently o Lung strength and lung capacity decrease o Oxygen in the blood decreases o Appetite decreases o Urinary elimination is more frequent o Digestion takes longer and is less efficient o Levels of hormones decrease o Immunity weakens o Lifestyle changes occur

5. Some changes that are NOT considered normal changes of aging and that should be reported to the nurse include: o Signs of depression o Suicidal thoughts o Loss of ability to think logically o Poor nutrition o Shortness of breath o Incontinence

6. The following are important points about intellectual disabilities: o Not a disease or psychiatric illness o Below-average mental functioning o May have limited ability to live independently o Have the same emotional and physical needs as others

7. NAs should remember the following when caring for residents with an intellectual disability, including meeting emotional and physical needs: o Treat adult residents as adults o Praise and encourage often, especially for positive behavior o Help teach ADLs by breaking up a task into smaller units o Promote independence o Assist residents with activities and motor functions that are difficult o Encourage social interaction o Repeat what you say to make sure they understand o Be patient

8. NAs should remember the following when caring for residents who have mental health disorders: o Observe residents for changes. Document and report o Support the resident and his family and friends o Encourage residents to do as much as possible for themselves o Remember that mental health disorders can be treated

9. When caring for residents with mental illness, it is important to observe for and report the following: o Changes in ability o Positive or negative mood changes o Behavior changes o Comments about hurting self or others (including jokes) o Failure to take medicine o Real or imagined physical symptoms o Events, situations, or people that provoke certain reactions

10. Kubler-Ross' 5 stages of dying: o Denial o Anger o Bargaining o Depression o Acceptance

11. When an advance directive is in place: o NAs may be asked to continue to monitor vital signs and report readings to the nurse o Comfort measures, such as pain medication, will continue to be used

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Depending on the details of the advance directive, CPR and extraordinary measures may be prohibited

12. All these factors can influence feelings and attitudes about death: o Experience with death o Personality type o Religious beliefs o Cultural background

13. When caring for a dying resident, NAs should be aware of these concerns: o Diminished senses – lighting should be kept low; hearing is usually the last sense to leave the body o Care of mouth and nose – mouth care should be provided every 2 hours o Skin care – skin should be kept clean and dry, and sheets wrinkle-free o Comfort – pain relief is critical o Environment – the dying resident should be made comfortable, even if he or she is unaware of their surroundings o Emotional and spiritual support – dying residents may need someone to listen more than anything else

14. There are some legal rights to remember when caring for people that are dying: o The right to refuse treatment o The right to have visitors o The right to privacy

15. Dying Persons’ Bill of Rights: I have the right to... o Be treated as a living human being until I die o Maintain hopefulness, however changing this may be o Be cared for by those who can maintain helpfulness, however changing this may be o Express my feelings and emotions about my approaching death in my own way o Participate in decisions concerning my care o Expect continuing medical and nursing attentions, even though cure goals must be changed to comfort goals o Not die alone o Be free from pain o Have my questions answered honestly o Not be deceived o Have help from and for my family accepting my death o Die in peace and dignity o Retain my individuality and not be judged for my decisions

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Discuss and enlarge my religious and/or spiritual experiences Expect that the sanctity of the human body will be respected after death Be cared for by caring, sensitive, knowledgeable people who attempt to understand my needs and who will be able to help me gain some satisfaction in helping me face my death

16. Guidelines for treating residents who are dying with dignity o Respect the residents’ wishes in all possible ways o Be careful not to make promises that cannot or should not be kept o Continue to involve the resident in his care and facility activities o Be person-centered o Listen if a resident wants to talk o Do not babble, or act especially cheerful or sad --> be professional o Keep the resident as comfortable as possible o Assure privacy when it is desired o Respect the privacy of the family and other visitors o Help with the family’s physical comfort

17. The following are signs of approaching death: o Blurred and failing vision o Unfocused eyes o Impaired speech o Diminished sense of touch o Loss of movement, muscle tone, and feeling o Rising or below normal body temperature o Decreasing blood pressure o Weak pulse that is abnormally slow or rapid o Alternating periods of slow, irregular respiration, shallow respirations, along with periods of not breathing o Rattling or gurgling sound as the person breathes o Cold, pale skin o Bruised appearance o Mottling, spotting, or blotching of skin caused by poor circulation o Perspiration o Incontinence o Disorientation or confusion

18. NAs should remember these postmortem care guidelines: o Rigor mortis may make the body difficult to move. Talk to the nurse if you need assistance o Bathe the body gently. Place drainage pads where needed

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Do not remove any tubes or equipment attached to the body Put in dentures if instructed by the nurse Close the eyes Position the body with a small pillow under the head Follow facility policy in personal items Strip the bed after body is gone Open windows to air the room. Straighten the room Document procedure

19. These are common reactions to death o...