Quick CNA Guide: Aspiration Prevention

As a Certified Nursing Assistant, you get to work in almost any possible healthcare settings. You get to work with different kinds of patients, most especially the elderly since they are the kind of people who needs assistance the most. As part of your job as a Certified Nursing Assistant, it is your duty to assist your patient in everything that they do like feeding, bathing and grooming themselves. You tend to their needs and make sure that you meet all of it. It is also your job to make sure that they would be in the best possible health condition by preventing the occurrence of threats such as bed sores. As people aged, they lose some of the vigor that they have as a young people, this may be emotionally as well as physically, which is in terms of expected deterioration on their health such as elasticity of the skin and also on the other parts of their body. It is then your duty to prevent the effects that this may cause. One of the things that a care giver should remember to watch out for is the risk for Aspiration.

Aspiration can usually occur among older people since as they ages, they also develop slow swallowing rate which may result to dysphagia or difficulty in chewing and swallowing. This is may be due to existing condition such as Dementia and Parkinson’s disease. Therefore, as the one who took care of them, it is important that you know something about Aspiration Prevention.

Some of the things that you can do are:

  • Providing a 30 minute break before feeding your patient as a rested person has a less possibility of difficulty in swallowing.
  • Position your patient so as to avoid aspiration by having him sit on a chair during meals or if he is bedridden, you could then elevate the head of the bed up to 90 degrees.
  • Do not be in a hurry in feeding your patient. Let him chew his food on his own time and pace.
  • Serve him food on a small amount or if how much he can tolerate.
  • If the patient is experiencing facial paralysis, put the food on the unaffected side of his face.
  • Also avoid things that may distract the patient during his meal time.
  • Also provide oral care to the patient before and after his meal.
  • Do not also try feeding a patient that was heavily sedated.

These are the things that could help you prevent aspiration however, remember that a proper assessment could also be very helpful so as to know the early signs of aspiration or any possible factors that could lead to aspiration.

6 Basic Skills Performed by a CNA

There are a lot of things that a Certified Nursing Assistant performs based on her job description. It is her task to assist or help patients in doing their activity of daily living especially if the patient is unable to do it himself or alone. For one, she needs to help them bathe, groom and fed themselves. Assisting and accompanying patient whenever they need to go to the laboratory for some test is another important activity to do. Turning comatose patients and executing passive or active range of motion exercises to residents are usually routine assignments for these professionals to prevent bed sores and promote blood circulation.

In addition, CNA’s should maintain and keep the room of the patient clean by changing the bed linens. Vital signs of the patient are not only monitored but are mandated to be documented. Certified Nursing Assistants are individuals responsible for assisting patient on about almost everything. However, there is what we call basic skills that every Nurse Aide should learn and apply on her daily work. This is what really made up their job.

The six basic skills performed by a Certified Nursing Assistant are:

  • Awareness and Observation

Since they are the constant presence during a patient’s stay in the hospital and the direct link of the nurse, they need to be constantly aware of any deterioration or changes in a patient’s status. They need to carefully observe and report whatever they notice to the nurse especially if it requires immediate action.

  • Critical Thinking

This requires knowledge and proper observation enough to do sound decision. Nurse Aide is required to think accurately and in a timely manner since life is always at stake.

  • Communication

They are always at the bed side of the patient; therefore, they need to have good communication skills in order to communicate effectively with patients and their family. They also need to communicate as well with the other member of the health team.

  • Following Protocol

They also need to learn how to follow protocol, directions or guidelines that are established by the hospital since it is done to protect the patient and their employees as well.

  • Timeliness

As what was mentioned, Nurse Aide are dealing greatly with lives therefore everything should be done in a timely manner such as turning patient every two hours to avoid or prevent the formation of bed sores.

  • Body Mechanics

This is a skill which every Nurse Aide should learn since they are the first line who will assist the patient, therefore, knowing how to properly position the patient is a requisite and it is also a way to prevent injuries to themselves.

No matter what was included in the job description, these six skills would always accompany a CNA’s task although not stated or listed. After all, these are really what this job calls and ask for.

Practical Recommendations on Helping De-escalate A Client’s Angry Behavior

Although anger is normal, it is often perceived as a negative feeling. Many people are not comfortable expressing anger directly. Nevertheless, anger can be a normal and healthy reaction when situations or circumstances are unfair or unjust, personal rights are not respected, or realistic expectations are not met. If only the person can express his or her anger assertively, problem solving or conflict resolution then becomes possible. A client’s angry behavior can be very alarming for a nursing assistant since things can get out of control and might cause chaos on the facility as a whole.

Anger becomes negative when the person denies it, suppresses it, or expresses it inappropriately. A person may deny or suppress angry feelings if he or she is uncomfortable expressing anger. Possible consequences are physical problems such as migraine headaches or ulcers and emotional problems such as depression and low self-esteem. Anger that is expressed inappropriately can lead to hostility and aggression. The nurse can help clients express anger appropriately by serving as a model and by role-playing assertive communication techniques. Assertive statements allow appropriate expression of anger and can lead to productive problem-solving discussions and reduced anger.

angry_man4 signs that a client is in a state of being angry:

  1. The anger is vented out either verbally or non-verbally.
  2. The client advances in such as a way that he or she invades your personal space.
  3. The actions seems to be threatening to the others and caregivers.
  4. The eye contact is fierce and the tone of their voice is very different when they are on a calm state.

Hostile and aggressive behavior can be sudden and unexpected. Behavior escalation may lead to physical aggression. Therefore, interventions during the triggering and escalation phases are keys to preventing physically aggressive behavior.

7  practical recommendations on helping de-escalate a client’s angry behavior:

  1. The nurse assistant should approach the client in a calm, nonthreatening manner.
  2. Try to convey empathy for the client’s anger or frustration.
  3. Encourage the client to express his or her feelings verbally or in a constructive way, suggesting that the client is still in control and can maintain that control.
  4. Use clear, simple, short statements when talking to the client.
  5. The nurse should allow the client time to express himself or herself.
  6. The nurse can suggest that the client go to a quiet area or may get assistance to move other clients to decrease stimulation.
  7. Medications can be offered.

When the above steps are unsuccessful in lowering the client’s temper, a plan B must be employed:

  1. The nurse assistant should be directive in giving instructions to the client in a calm, firm voice.
  2. Try to use break periods or “time-out” in order to allow the client to cool down and may realize what he or she is doing might be wrong.
  3. The nurse assistant must recognize that an escalating angry behavior of the patient means that he or she is asking for help. Assist the client to services or needs that might answer his or her angry actions.
  4. With the supervision of a registered nurse, observe and encourage the client to take anti-anxiety medications to calm his or her state.

As a nursing care assistant, remember to be aware of yourself as well as how you may vent out angry feelings so that you can also understand why your patient is in an escalating state of angry behavior. In this manner, you can take control and de-escalate the client’s angry behavior.

Quick CNA Guide: Safe Transfer Techniques

As a certified nursing assistant, you are very hands on with your client. You are responsible for the very basic needs of your client including his or her mobility. As the primary caregiver of the client, one of your duties is the safety of your clients when transferring them from bed to chair, bed to stretcher and vice versa. Strength is not only necessary, but also the proper and safe transfer techniques so you’ll not be physically strained. Proper transferring will not only benefit your client, but also yourself.

Before the transfer, here are the general considerations a CNA can follow:

  • Plan the transfer well. Determine the sequence, space used, number of assistants necessary, the skill and strength of the CNA, and the assessment of the client’s capabilities and tolerance.
  • Make sure your equipment is complete and ready and safe to use.
  • Remove unnecessary obstacles from the area used for transfer.
  • Explain the transfer to the client and assisting personnel, including specific directions of their participation.
  • Always support and hold the client, rather than the equipment.
  • During the transfer, explain to the client what he or she should do step by step.

For the equipments to be used, the CNA may keep this in mind:

  • Walking belts for transfer provide the greatest safety since the CNA can grasp the belt to control the movement of the client during the transfer.
  • Slings, lapboards, bath blankets, pillows and nonskid shoes may help in facilitating efficient and effective transfer.
  • For bed to wheelchair transfer, position the chair parallel or on a 45 degree angle to the bed, depending the ability to walk of the client. Ensure that the wheelchair’s brakes are locked, the footplates are removed, and the bed brakes are also locked.
  • For bed to stretcher transfer, position stretcher parallel to the bed, lock the stretcher and the bed brakes.
  • For a mechanical or hydraulic lift, use a frame, canvas strips or chains, and a hammock or canvas strips.

Bed-Chair Technique:

  1. Assuming that the client is capable of sitting, place the bed in the lowest position with the client’s feet resting flat on the floor.
  2. Ask or assist the client to: move, sit at the edge of the bed, slightly lean forward from the hips, place the stronger foot beneath the edge of the bed, and the other foot forward. Place the client’s hand on the bed or on the CNA’s shoulder to push while standing.
  3. The can stands directly in front of the client, leans forward from the hips, knees and ankles, and assumes a broad stance, placing one foot forward and one foot back.
  4. Encircle client’s waist with arms and grasp the transfer belt at the back.
  5. Assist client to stand and move together toward the wheelchair.
  6. Assist the client to sit. Ensure that the client’s legs are placed against the chair.
  7. Secure client’s safety. The back of the client must rest well on the chair, feet are on lowered footplates and seat belt is applied as required.

Bed-Stretcher Technique:

  1. Lower the head of the bed until it is flat or until the client can tolerate.
  2. Raise the bed until it is slightly higher than the surface of the stretcher.
  3. Pull the drawsheet out from the both sides of the bed and roll it as close to the client as possible.
  4. Move the client to the edge of the bed and position it parallel to the bed.
  5. Transfer the client to the stretcher by asking the client to flex his neck and to place arms over his chest during the transfer. In unison, press the body against the stretcher, pull drawsheet against the client, flex hips, and pull client towards the CNA and the stretcher.
  6. Ensure client comfort and safety. Raise side rails and fasten safety straps.