Understand nurse aide’s range of function in rehabilitative/restorative and maintenance care Unit B Resident Care Skills Resident Care Skills Essential Standard NA4.00 Understand nurse aide skills related to the residents’ vital function and movement Understand nurse aide skills related to the residents’ vital function and movement Indicator 4.02 Understand nurse aide’s range of function in rehabilitative/restorative and maintenance care Understand nurse aide’s range of function in rehabilitative/restorative and maintenance care 14.02Nursing Fundamentals 7243

2 Walker… four-point aid with rubber tips Resident stands erect when moving walker forwardResident stands erect when moving walker forward Walker adjusted to height of hip jointWalker adjusted to height of hip joint Elbows at degree angleElbows at degree angle Walker picked up and put down, not slidWalker picked up and put down, not slid 4.02Nursing Fundamentals 7243 AMBULATION AND TRANSFER AIDS

3 Walker… Back legs of walker even with toes so resident walks into walkerBack legs of walker even with toes so resident walks into walker Resident steps toward center of walkerResident steps toward center of walker Leads with weaker legLeads with weaker leg 4.02Nursing Fundamentals 7243

4 Canes…Types: single-tippedsingle-tipped tripod - 3 legstripod - 3 legs quad - four pointquad - four point 4.02Nursing Fundamentals 7243

5 Canes… Used when weakness on one side of body and resident has use of at least one armUsed when weakness on one side of body and resident has use of at least one arm –Provides balance and support 4.02Nursing Fundamentals 7243

6 Canes… –Should be fitted properly: cane handle level with femur (greater trochanter)cane handle level with femur (greater trochanter) elbow flexed at 15 to 30 degree angleelbow flexed at 15 to 30 degree angle shoulders levelshoulders level 4.02Nursing Fundamentals 7243

7 Canes… Gaits ordered by physician or physical therapist:Gaits ordered by physician or physical therapist: –move cane and affected leg together –move cane, then affected leg Used on side of body where leg is strongest (side opposite the injury)Used on side of body where leg is strongest (side opposite the injury) 4.02Nursing Fundamentals 7243

8 Crutches… –Provide support and stability through use of hands and arms. –Used when one or both legs are weak. 4.02Nursing Fundamentals 7243

9 Crutches… –Measured to fit properly by physical therapist. height correct if two fingers fit between armrest and axillaheight correct if two fingers fit between armrest and axilla hand grip adjusted to allow degrees flexion of elbowshand grip adjusted to allow degrees flexion of elbows 4.02Nursing Fundamentals 7243

10 Crutches…Gaits four-point gait three-point gait two-point gait swing-to gait swing-thru gait 4.02Nursing Fundamentals 7243

11 Crutches… Weight supported on hand bar, not axilla 4.02Nursing Fundamentals 7243

12 Wheelchairs… Available in different sizes and models to allow for proper fit and usageAvailable in different sizes and models to allow for proper fit and usage Cleaned with mild detergent and water, rinsed with water and driedCleaned with mild detergent and water, rinsed with water and dried 4.02Nursing Fundamentals 7243

13 Wheelchairs… Periodic maintenance needed with 3 in 1 oilPeriodic maintenance needed with 3 in 1 oil Arm rests adjusted to appropriate heightArm rests adjusted to appropriate height Feet rest flat on floor when chair is not movingFeet rest flat on floor when chair is not moving 4.02Nursing Fundamentals 7243

14 Wheelchairs… Seat should not sag toward center of chairSeat should not sag toward center of chair Seat should not reach back of resident’s bent kneesSeat should not reach back of resident’s bent knees Brakes locked when chair not movingBrakes locked when chair not moving 4.02Nursing Fundamentals 7243

15 Wheelchairs… Wheelchair guided backwards when going downhillWheelchair guided backwards when going downhill Wheelchair pulled backwards over indented or raised areas (i.e., entrance to elevators)Wheelchair pulled backwards over indented or raised areas (i.e., entrance to elevators) 4.02Nursing Fundamentals 7243

16 Wheelchairs… Feet placed on footrests for transportFeet placed on footrests for transport 4.02Nursing Fundamentals 7243

17 Gurneys/Stretchers/Litters Wheels locked when transferring residents on or offWheels locked when transferring residents on or off Safety belts secured prior to transferSafety belts secured prior to transfer Both side rails raised prior to transferBoth side rails raised prior to transfer 4.02Nursing Fundamentals 7243

18 Gurneys/Stretchers/Litters Residents never left alone on stretcherResidents never left alone on stretcher Backed head first into elevatorsBacked head first into elevators 4.02Nursing Fundamentals 7243

19 Gurneys/Stretchers/Litters Always used with assistance when transferring resident on or offAlways used with assistance when transferring resident on or off Pushed feet first during transportPushed feet first during transport 4.02Nursing Fundamentals 7243

20 Guided backwards when going downhillGuided backwards when going downhill Cleaned with mild detergent and water, rinsed with water and driedCleaned with mild detergent and water, rinsed with water and dried Gurneys/Stretchers/Litters 4.02Nursing Fundamentals 7243

21 Gait belt (safety belt, transfer belt) –Used for residents unsteady on feet –Protects resident who loses balance or faints –Held at back 4.02Nursing Fundamentals 7243

22 Must be tight enough to provide support but loose enough to be comfortableMust be tight enough to provide support but loose enough to be comfortable Used to safely transfer residentUsed to safely transfer resident Gait belt (safety belt, transfer belt) 4.02Nursing Fundamentals 7243

23 Correct aids must be used because they are individually fittedCorrect aids must be used because they are individually fitted Resident observed closely to be sure aids are being used as orderedResident observed closely to be sure aids are being used as ordered Faulty equipment reported and not used until repairedFaulty equipment reported and not used until repaired 4.02Nursing Fundamentals 7243

24 Shoes must fit and be in good conditionShoes must fit and be in good condition Skin breakdown reportedSkin breakdown reported Rubber tips on aids in good condition.Rubber tips on aids in good condition. 4.02Nursing Fundamentals 7243 SAFETY – AMBULATORY DEVICES

4.02Nursing Fundamentals MECHANICAL LIFTS LIFTS

26 U.S. Department of Labor Hazardous Order No. 7 (July2010) This order prohibits minors under 18 from operating or assisting in the operation of most power-driven hoists, including those designated to lift and move patients. 4.02Nursing Fundamentals 7243

27 U.S. Department of Labor Hazardous Order No. 7 (July2010) What do we do? NA student regardless of age must demonstrate competence in the classroom.NA student regardless of age must demonstrate competence in the classroom. NA student under 18 MUST NOT OPERATE LIFTS IN THE CLINICAL AREA!NA student under 18 MUST NOT OPERATE LIFTS IN THE CLINICAL AREA! 4.02Nursing Fundamentals 7243

28 Used for transfer of residentsUsed for transfer of residents Lower end of sling positioned behind kneesLower end of sling positioned behind knees Hooks turned away from bodyHooks turned away from body 4.02Nursing Fundamentals 7243 MECHANICAL LIFTS

29 Straps, sling and clasps checked for defectsStraps, sling and clasps checked for defects Enough assistance available to assure safe transferEnough assistance available to assure safe transfer Area checked for safety hazards prior to transfer “CIRCLE THE BED FOR SAFETY’Area checked for safety hazards prior to transfer “CIRCLE THE BED FOR SAFETY’ 4.02Nursing Fundamentals 7243

Restorative/Rehabilitative Care JOINT MOBILITY NEEDS 4.02Nursing Fundamentals

31 Types of range of motion:Types of range of motion: –Active - resident exercises joints without help –Passive - another person moves body part for resident 4.02Nursing Fundamentals 7243 RANGE OF MOTION - ROM

32 Purpose of range of motion:Purpose of range of motion: –Maintains muscle tone –Prevents deformities –Increases circulation –Encourages mobility 4.02Nursing Fundamentals 7243

33 Expose only part of body being exercisedExpose only part of body being exercised Be gentle and STOP if resident complains of PAINBe gentle and STOP if resident complains of PAIN Use good body mechanicsUse good body mechanics 4.02Nursing Fundamentals 7243 ROM - GUIDELINES

34 Follow directions from supervisor on number of times each joint to be exercised and how to perform exercises safely, based on each resident’s conditionFollow directions from supervisor on number of times each joint to be exercised and how to perform exercises safely, based on each resident’s condition 4.02Nursing Fundamentals 7243

35 Each movement is repeated three times unless otherwise ordered.Each movement is repeated three times unless otherwise ordered. Support joint as it is exercisedSupport joint as it is exercised Report complaints of pain or discomfort to supervisorReport complaints of pain or discomfort to supervisor 4.02Nursing Fundamentals 7243

36 Exercise joint slowly, smoothly and gentlyExercise joint slowly, smoothly and gently Do not exercise swollen, reddened joints; report condition to supervisorDo not exercise swollen, reddened joints; report condition to supervisor 4.02Nursing Fundamentals 7243

37 AbductionAbduction AdductionAdduction ExtensionExtension HyperextensionHyperextension FlexionFlexion Plantar flexionPlantar flexion DorsiflexionDorsiflexion RotationRotation 4.02Nursing Fundamentals 7243

38 Pronation Supination Supination Eversion Eversion Inversion Inversion Radial deviation Radial deviation Ulnar deviation Ulnar deviation Encourage residents capable of doing active ROM exercises 4.02Nursing Fundamentals 7243