1. 1. Identify the persons at greatest risk for accidents and describe accident prevention guidelines
Define the following terms: paralysis the loss of ability to move all or part of the body, and often includes loss of feeling in the affected area. fracture a broken bone. disorientation confusion about person, place, or time.

2. 1. Identify the persons at greatest risk for accidents and describe accident prevention guidelines
Define the following terms: scalds burns caused by hot liquids. abrasion an injury which rubs off the surface of the skin.

3. 1. Identify the persons at greatest risk for accidents and describe accident prevention guidelines
REMEMBER: All staff members, including NAs, are responsible for safety in a facility.

4. 1. Identify the persons at greatest risk for accidents and describe accident prevention guidelines
Falls Causes: unsafe environment, loss of abilities, diseases, medications, loss of vision, gait or balance problems, weakness, paralysis, and disorientation Prevention: • Clear walkways. • Use non-skid rugs. • Have residents wear non-skid, sturdy shoes. • Residents should not wear clothing that is too long.

5. 1. Identify the persons at greatest risk for accidents and describe accident prevention guidelines
Fall prevention (cont’d): • Keep frequently-used personal items close. • Answer call lights promptly. • Clean up spills. • Report loose hand rails immediately. • Mark hazardous areas. • Improve lighting. • Lock wheelchairs. • Lock bed wheels.

6. 1. Identify the persons at greatest risk for accidents and describe accident prevention guidelines
Fall prevention (cont’d): • Return beds to lowest positions. • Get help. • Offer toileting assistance regularly and respond to requests promptly. • Leave furniture in same place. • Pay attention to residents at risk for falls. • Never try to catch a falling resident. • Report all falls to the nurse.

7. 1. Identify the persons at greatest risk for accidents and describe accident prevention guidelines
Burns/Scalds Causes: dry heat (irons, stoves, other electric appliances), wet heat (hot water or other liquids, steam), or chemicals (lye, acids) Prevention: • Check water temperature. • Report frayed cords. • Communicate about hot liquids. • Pour hot drinks away from residents. • Keep hot drinks away from edges of tables. Use lids. • Make sure residents are sitting before serving hot drinks. • Monitor heat-producing equipment.

8. 1. Identify the persons at greatest risk for accidents and describe accident prevention guidelines
Resident Identification Cause: not identifying resident properly Prevention: • Identify each resident before care or feeding. • Check IDs. • Call resident by name.

9. 1. Identify the persons at greatest risk for accidents and describe accident prevention guidelines
REMEMBER: Not identifying residents before giving care or serving food can cause serious problems or even death.

10. 1. Identify the persons at greatest risk for accidents and describe accident prevention guidelines
Choking Causes: weakened, ill, or unconscious residents Prevention: • Eat sitting upright. • Follow orders for special diets and thickened liquids

11. 1. Identify the persons at greatest risk for accidents and describe accident prevention guidelines
Poisoning Cause: ingesting harmful substances Prevention: • Store harmful substances carefully. • Do not leave cleaning products in rooms. • Investigate any unusual odors. • Post Poison Control Center number.

12. 1. Identify the persons at greatest risk for accidents and describe accident prevention guidelines
Cuts/Abrasions Cause: sharp objects Prevention: • Put sharp objects away after use. • Push wheelchairs forward.

13. 1. Identify the persons at greatest risk for accidents and describe accident prevention guidelines
NAs should remember these general safety guidelines, as well: • Do not run. • Keep paths clear. • Wipe up spills immediately. • Discard trash properly. • Follow instructions and ask questions as needed. • Report injuries immediately. • If you see a suspected hazard among a resident’s possessions, report it to the nurse.

14. 2. List safety guidelines for oxygen use
Define the following terms: combustion the process of burning. flammable easily ignited and capable of burning quickly.

15. 2. List safety guidelines for oxygen use
The following are important guidelines for oxygen safety: • Post No Smoking and Oxygen in Use signs. Do not allow smoking around oxygen equipment. • Remove fire hazards. Report to nurse if resident does not want a fire hazard removed. • Do not allow flames around oxygen (this includes candles). • Do not use an extension cord with an oxygen concentrator.

16. 2. List safety guidelines for oxygen use
Guidelines for oxygen safety (cont’d): • Do not place electrical cords or oxygen tubing under rugs or furniture. • Avoid using fabrics such as nylon and wool. • Report skin irritation from cannula or face mask. • Do not use any petroleum-based products on resident or on any part of the cannula or mask. • Learn how to turn oxygen off in case of fire if facility allows this. Never adjust oxygen setting.

17. 3. Explain the Material Safety Data Sheet (MSDS)
The Material Safety Data Sheet (MSDS) • Is required by OSHA for all hazardous chemicals • Details ingredients, dangers, emergency response, safe handling procedures • Sometimes may be accessed by toll-free number • Must be accessible by all employees

18. 3. Explain the Material Safety Data Sheet (MSDS)
REMEMBER: NAs must know where these sheets are kept at their facilities and how to use them.

19. 3. Explain the Material Safety Data Sheet (MSDS)
REMEMBER: OSHA requires that emergency eyewash stations be placed in all hazardous areas in case eye injury. Employees must know where the closest eyewash station is and how to get there with restricted vision.

20. 4. Define the term restraint and give reasons why restraints were used
Define the following term: restraint a physical or chemical way to restrict voluntary movement or behavior.

21. 4. Define the term restraint and give reasons why restraints were used
Restraints were used in the past for the following reasons: • Keep person from wandering • Prevent falls • Keep person from hurting self or others • Keep person from pulling out tubing

22. 4. Define the term restraint and give reasons why restraints were used
REMEMBER: Restraints must never be used without a doctor’s order or to punish a resident.

23. 5. List physical and psychological problems associated with restraints
Define the following terms: atrophy the wasting away, decreasing in size, and weakening of muscles from lack of use. suffocation the stoppage of breathing from a lack of oxygen or an excess of carbon dioxide in the body that may result in unconsciousness or death.

24. Transparency 6-1: Problems Associated with Restraint Use
• Pressure ulcers • Pneumonia • Risk of suffocation • Reduced blood circulation • Stress on the heart • Incontinence • Constipation • Muscle atrophy (weakening or wasting away of the muscle) • Loss of bone mass • Poor appetite and malnutrition • Depression and/or withdrawal • Sleep disorders • Loss of dignity

25. Transparency 6-1: Problems Associated with Restraint Use (cont’d)
• Loss of independence • Stress and anxiety • Increased agitation (anxiety, restlessness) • Loss of self-esteem • Severe injury • Death

26. 5. List physical and psychological problems associated with restraints
REMEMBER: If restraints are ordered the care plan will include instructions on frequent monitoring and repositioning. An NA must never use restraints unless his supervisor has instructed him to do so and he has been trained in the proper use of the restraint.

27. 6. Discuss restraint alternatives
Define the following terms: restraint-free care an environment in which restraints are not kept or used for any reason. restraint alternatives any interventions used in place of a restraint or that reduces the need for a restraint.

28. 6. Discuss restraint alternatives
Think about this question: Why has restraint-free care become more and more common in LTC facilities? How might a restraint-free policy increase the safety and quality of residents’ lives?

29. Handout 6-1: Restraint Alternatives
Improve safety measures and lighting.
Keep call light within reach and answer call lights immediately.
Ambulate the person when he or she is restless.
Provide activities for those who wander at night.
Encourage activities and independence.
Give frequent help with toileting.
Offer food or drink. Offer reading materials.
Distract or redirect interest.
Decrease the noise level. Use relaxation techniques.
Reduce pain levels through medication. Report complaints of pain immediately.
Provide familiar caregivers and increase number of caregivers.
Use a team approach.
Use special types of pads, belts, chairs, and alarms.

30. 6. Discuss restraint alternatives
REMEMBER: Restraint alternatives should be indicated in the care plan, and should be individualized for each resident.

31. 7. Describe guidelines for what must be done if a restraint is ordered
NAs must remember these guidelines regarding restraints: • Make sure there is a doctor’s order for restraint use and that it is in the care plan. • Follow manufacturer’s instructions. • Never tie restraint to side rails. Only tie to movable part of bed frame. • Make sure restraint is not too tight. • Be sure not to catch breasts or skin in restraint. • Place call light within reach. Answer call lights immediately. • Document properly.

32. Transparency 6-2: When a Resident is Restrained
The resident must be checked at least every 15 minutes. At regular, ordered intervals, the following must be done: • Release the restraint or discontinue use. • Offer help with toileting. Check for episodes of incontinence and provide care. • Offer fluids and food. • Check for and report signs of skin irritation immediately. • Check for and report signs of swelling immediately. • Reposition the resident. • Ambulate resident if able.

33. 8. Explain the principles of body mechanics
Define the following terms: body mechanics the way the parts of the body work together when a person moves. posture the way a person holds and positions his body. lever something that moves an object by resting on a base of support.

34. Transparency 6-3: Body Alignment

35. 8. Explain the principles of body mechanics
NAs should remember the following points about alignment: • Try to keep the body in alignment, with two sides of the body as mirror images of each other. • Keep object close when carrying or lifting. • Point feet and body toward the direction you are moving. • Avoid twisting at waist.

36. 8. Explain the principles of body mechanics
NAs should remember the following points about their base of support: • Wide base is more stable. • Stand with legs shoulder-width apart.

37. 8. Explain the principles of body mechanics
NAs should remember the following points about the principle of fulcrum and lever: • Arm is lever. • Elbow is fulcrum. • Rest object against forearm.

38. 8. Explain the principles of body mechanics
NAs should remember the following points about their center of gravity: • When standing, weight is centered in pelvis. • Low center provides greater base of support. • Bend knees when lifting.

39. 9. Apply principles of body mechanics to daily activities
REMEMBER: Principles of body mechanics can be applied to daily activities to reduce the risk of injury and to save energy.

40. 9. Apply principles of body mechanics to daily activities
The following steps demonstrate applying the principles of body mechanics to lifting a heavy object from the floor: • Spread feet apart. • Bend knees. • Use muscles in thighs, upper arms, and shoulders. • Pull object close to body. • When standing up, push with hip and thigh muscles.

41. Transparency 6-4: Lifting Heavy Objects from the Floor

42. 9. Apply principles of body mechanics to daily activities
The following techniques will help an NA use proper body mechanics: • Use both arms and hands to lift, push, or carry objects. • When lifting a heavy object from the floor, spread your feet shoulder-width apart. Bend your knees. Raise your body and the object together. • Hold objects close to you when you are lifting or carrying them. • Push or slide objects, rather than lifting them. • Avoid bending and reaching as much as possible. • If you are making an adjustable bed, adjust the height to a safe working level, usually waist high.

43. 9. Apply principles of body mechanics to daily activities
Techniques for proper body mechanics (cont’d): • When a task requires bending, use a good stance. Bend your knees to lower yourself, rather than bending from the waist. • Avoid twisting at the waist when you are lifting or moving something. Instead, turn your whole body, pivoting with your feet instead of twisting at the waist. Your feet should point toward what you are lifting or moving. • Get help from coworkers when possible for lifting or helping residents. • Talk to residents before moving them. Agree on a signal. Lift or move on three so that everyone moves together.

44. 9. Apply principles of body mechanics to daily activities
Techniques for proper body mechanics (cont’d): • To help a resident sit up, stand up, or walk, place your feet 12 inches, or shoulder-width, apart. Place one foot in front of the other, and bend your knees. Your upper body should stay upright and in alignment. • Never try to catch a falling resident. If the resident begins to fall, assist her to the floor. • Report to the nurse any task you feel that you cannot safely do.

45. 10. Identify major causes of fire and list fire safety guidelines
Think about these questions: What fire hazards exist in a LTC facility? What additional fire hazards may exist in a home?

46. 10. Identify major causes of fire and list fire safety guidelines
NAs should remember these guidelines for fire safety: • Never leave smokers unattended. Make sure ashtrays do not contain hot ashes before emptying them. • Report frayed or damaged cords. • Report if fire alarms and exit doors are blocked. • Know how to use fire extinguishers: • Pull the pin. • Aim at the base of fire when spraying. • Squeeze the handle. • Sweep back and forth at the base of fire.

47. 10. Identify major causes of fire and list fire safety guidelines
Guidelines for fire safety (cont’d):
• In case of fire, use RACE:
• Remove residents from danger.
• Activate alarm or call 911.
• Contain fire if possible.
• Extinguish, or fire department will extinguish.
• Know evacuation plan.
• Stay calm.
• Follow directions of fire department.
• Know which residents need one-on-one help.
• Know differing abilities of residents.

48. 10. Identify major causes of fire and list fire safety guidelines
Guidelines for fire safety (cont’d):
• Remove blockage from windows or doors.
• Do not use elevators.
• Stay low in a room to escape a fire.
• Check for heat coming from doors.
• Stop, drop, and roll if clothing catches fire.
• Use damp covering over mouth and nose.
• Leave building if possible, then move away from it.

49. Exam Multiple Choice. Choose the correct answer.
Which of the following statements is true of preventing falls?
(A) Clear walkways of clutter.
(B) Keep lights low.
(C) Leave spills for housekeeping to clean.
(D) Move call lights further away from residents.
One condition or problem that can cause a lack of sensation is
(A) Constipation
(B) Diabetes
(C) Hypertension
(D) Vomiting

50. Exam
To serve hot liquids to residents, a nursing assistant (NA) should
(A) Pour hot drinks away from residents
(B) Place hot drinks on the edges of tables so that they will be easier to reach
(C) Take lids off of hot drinks just before serving them
Make sure residents are standing up before serving hot drinks
When should a nursing assistant identify a resident?
(A) After giving care
(B) When collecting meal trays
(C) When shifts change
(D) Before helping with feeding

51. Exam In which position should a resident be placed for eating?
(A) Lying flat on his back
(B) Reclining at a 45-degree angle
(C) Sitting as upright as possible
(D) Lying on his side with his arm propping up his head
Why does working with oxygen require special safety precautions?
(A) Oxygen equipment is very difficult to obtain.
(B) Oxygen is a dangerous fire hazard.
(C) Oxygen levels must be adjusted often.
(D) Oxygen equipment is very fragile.

52. Exam
Which of the following guidelines is true of working around oxygen equipment?
(A) NAs should not allow open flames around oxygen.
(B) NAs should adjust oxygen levels when they are too high or too low.
(C) NAs should replace oxygen tubing if it becomes clogged.
(D) NAs should prescribe a new oxygen delivery device if the current one is causing skin problems.
What information does a Material Safety Data Sheet (MSDS) contain?
(A) Costs of the chemical
(B) Comparisons with other chemicals
(C) Names of other facilities using the chemical
(D) Description of emergency response actions

53. Exam
Which of the following is an example of physically restraining a resident?
(A) Asking the resident to stay in his bed
(B) Telling the resident’s roommate to press the call button if the resident gets up
(C) Leaving the resident’s door ajar
(D) Putting both side rails up on the bed
Restraints can be applied
(A) As punishment from staff when a resident is not behaving properly
(B) Only with a doctor’s order
(C) When a staff member does not have time to watch a resident closely
(D) When a nursing assistant judges a resident is a danger to himself or others

54. Exam A serious problem that has been associated with restraint use is
(A) Jaundice
(B) Headache
(C) Increased activity
(D) Pressure ulcers
Which of the following statements is true of restraint usage?
(A) People tend to respond better to restraint alternatives than to restraints.
(B) Laws allow the use of restraints when a facility is short-staffed.
(C) Using restraints does not cause negative effects.
(D) Restraint-free care means a facility uses restraints only for disciplining residents.

55. Exam An example of a restraint alternative is
(A) Tying the resident to the bed
(B) Removing the resident’s call light
(C) Leaving the resident alone for long periods of time
(D) Giving the resident a repetitive task
If a restraint is applied, a nursing assistant must
(A) Tie the restraint to the side rails
(B) Leave the area so she won’t hear the resident complain
(C) Withhold fluids
(D) Check on the resident every 15 minutes

56. Exam Which of the following terms applies to body mechanics?
(A) Gravity effect
(B) Outline
(C) Pulley
(D) Fulcrum and lever
Which of the following statements is true of body mechanics?
(A) Body mechanics help save energy and prevent injury.
(B) The narrower a person’s base of support, the more stable the person is.
(C) Proper alignment of the body means that the two sides of the body should not line up.
(D) Twisting at the waist is the best way to maintain body alignment.

57. Exam When helping a resident sit up, stand up, or walk, the NA should
(A) Keep her feet together
(B) Bend her upper body
(C) Bend her knees
(D) Try to catch the resident if he starts to fall
Which of the following is a way to use proper body mechanics?
(A) The NA should twist at the waist when lifting objects.
(B) The NA should stand with her legs shoulder-width apart.
(C) The NA should lift objects, rather than pushing them.
(D) The NA should carry objects away from her body.

58. Exam RACE is an acronym for a safety rule, and means
(A) Run to A Close Exit
(B) Remove residents, Activate alarm or call 911, Contain fire, Extinguish
(C) Restore power, Activate alarm or call 911, Call Fire Department, Exit
(D) Remove window, Access outside, Call for help, Elderly residents first

59. CHAPTER 6 PRACTICE
1. Why does working with oxygen require special safety precautions? (A) Oxygen equipment is very difficult to obtain. (B) Oxygen is a dangerous fire hazard. (C) Oxygen levels must be adjusted often. (D) Oxygen equipment is very fragile. 2. A serious problem that has been associated with restraint use is (A) Jaundice (B) Headache (C) Increased activity (D) Pressure ulcers 3. Which of the following terms applies to body mechanics? (A) Gravity effect (B) Outline (C) Pulley (D) Fulcrum and lever 4. RACE is an acronym for a safety rule, and means (A) Run to A Close Exit (B) Remove residents, Activate alarm or call 911, Contain fire, Extinguish (C) Restore power, Activate alarm or call 911, Call Fire Department, Exit (D) Remove window, Access outside, Call for help, Elderly residents first

60. CHAPTER 6 PRACTICE ANSWERS
B- OXYGEN IS A DANGEROUS FIRE HAZARD
D- PRESSURE ULCERS
D- FULCRUM AND LEVER
B- REMOVE RESIDENTS, ACTIVATE ALARAM OR CALL 911, CALL FIRE DEPARTMENT, EXIT