English homecare curriculum part1 by FUTURA

FIRST CARE of New York, Inc.

Home Health Aide Training Program

(Home Care Curriculum)

HOME CARE CURRICULUM

NEW YORK STATE DEPARTMENT OF HEALTH 161 Delaware Avenue Delmar, New York 12054 Office of Health Systems Management Division of Home and Community Based Services Bureau of Home Care and Hospice Surveillance and Quality Indicators/Evaluation April 2006; January 2007

ACKNOWLEDGEMENTS We wish to express our gratitude and appreciation to all the people who helped in the development of this revision of the Home Care Health Related Tasks Curriculum. Staff from the New York State Department of Health (NYSDOH):  Marjorie Brier-Lynch, RN, BSN  Suzanne Broderick, RN, Ph.D  Maureen Duffy, RN, MA  Priscilla Ferry, RN, BS  Rebecca Fuller Gray, RN, MBA  Mary G. Graziano, RN, BS  Kathleen Sherry  Frances Stevens  Margaret Wiliard, MS  Janice Zautner, RN  Elaine Zervos, MS, RD, CDN Representatives from Licensed Home Care Service Agencies (LHCSA):  Roberta Chapman, RN, BSN, Caregivers  Joyce Donohue, RN, BSN, MSP, Gentiva Health Services  Caroline Kenny, RN, BSN and Joyce Traina, RN, BS,  Metropolitan NY Coordinating Council on Jewish Poverty  Susan Trocchia, RN, People Care  Elizabeth Jaiswal, RN, BSN, Partner's in Care Representatives from Certified Home Health Agencies (CHHA):  Kathleen Marcais, RN, BS, Community Health Center  Molly Williams, Director of Public Policy, New York State Association of Health Care Providers, Inc.  Melodie Bell-Cavailino, MS, RD, CDN, FADA; Chair, Nutrition Science Department; Associate Professor; Director Dietetic Internship; Sage Graduate School; The Sage Colleges

INTRODUCTION TO HOME CARE CURRICULUM OUTLINE The Home Care Curriculum is a revision of the Home Care Core Curriculum that was originally developed by the State University of New York at Buffalo under contract with the New York State Department of Social Services in 1992. This curriculum revision is designed to replace outdated content with current standards. The revised curriculum contains the Basic Caregiver Core Curriculum Outline [BASIC CORE]. This basic core was developed in 2002 by a workgroup composed of staff members of the New York State Department of Health, New York State Education Department county health departments, home care providers, home care provider associations and representatives of various labor organizations. The 16-hour Basic Core Curriculum provides the basis for all of the paraprofessional curricula: Personal Care Aides, Personal Care Staff (Adult Care Facilities), Home Health Aides and Certified Nurses Aides. It has been integrated into the modules of the revised curriculum and identified in the applicable objective sections. The Home Care Curriculum contains standard written tests that must be used in combination with Performance checklists to determine the worker's successful completion of each Module. A Personal Care Aide certificate will be issued to the student upon successful completion of the 40hour training program. The original Home Care Core Curriculum may be used as an adjunct to the information contained in the revised objectives and outline. Other resources may be used at the discretion of the Registered Professional Nurses supervising the approved Personal Care Aide/Home Health Aide Training Programs.

Infection Control The Center for Disease Control (CDC) standard precaution guidelines, especially handwashing and personal protective equipment must be strictly adhered to and is included throughout all Modules

MANUAL USE This manual has been developed in an outline format. Each Module covers a specific subject and contains: â&#x20AC;˘ Objective section including a Module title, description of each unit, minimum time required to complete objectives, objectives, some measurable performance criteria and suggested teaching and evaluation methodologies â&#x20AC;˘ Outline section â&#x20AC;˘ Evaluation section consisting of test questions with an answer key. The Appendix includes all Procedures. These procedures are to be taught and demonstrated to the student. The minimum time required includes time it takes to instruct and demonstrate the required skills.

Required and Optional Procedures: Each of the procedures in Module XII has a companion checklist for evaluation purposes. As a practical matter it may not be possible to evaluate the trainee on every procedure. However, there are certain basic procedures the trainee should be required to demonstrate. It is recommended that the trainee pass twelve required procedures plus at least two other optional procedures of the trainers choosing. These optional procedures should be related to the typical caseload or other needs of the agency. Asterisks on the summary chart and on the individual procedures indicate the twelve required procedures* The major modules of the Home Care Curriculum are derived from the Level I and II, Personal Care Aide, Scope of Functions and Tasks, developed by the New York State Department of Social Services and last amended on 12/1/94. The revised objectives and outline must be followed and all material must be covered.

TABLE OF CONTENTS Pages Acknowledgements

Introduction to Home Care Curriculum

Manual Use

Table of Contents

Appendix

Core Value Statement Module I.

10 Introduction to Home Care

Unit A Home Care Worker and the Client UnrtB. What is a Home Care Worker? UnitC. Providing Home Care Module I —A,B,C-pages 1-8 Module II.

15 15 16 17-19 20 21 22-23

Working with the Elderly

Unit A What is Aging Unit B. Aging and the Body/Body Systems Unit C. Aging and the Mind Module III —A,B,C,- pages 1-18

Module IV.

12 13 14

Working Effectively with Home Care Clients

Unit A. Theories of Basic Human Needs Unit B. Diversity Unit C. Communication and Interpersonal Skills Unit D. Caregiver Observation, Recording and Reporting Unit E. Confidentiality Outline Module II —A,B,C.D, E- pages 1-24 Module III.

24 25-26 25-26 25-26

Working with Children

Unit A. Family Situations in which children may need home care workers 28-29 Unit B. How children develop and how to work with them 28-29 Unit C. Problems that affect the family and how children react to stress 28-29 Unit D. How you can help strengthen families through work with parents or caregivers 28-29 Module IV-A,B,C,D-pages 1-12 5

Module V. Working with People who are Mentally ill Unit A. What is Mental Health? Unit B. What is Mental illness? Unit C. Mental Hearth, Mental Illness, and the Home Care Worker Module V-A,B,C -pages 1-14 Module VI.

Working with People with Developmental Disabilities

Unit A. Understanding Developmental Disabilities Unit B. Developmental Disabilities and Home Care Module VI A,B,-pages 1-9

30-32 31 31 -32 32

33 34 35

Module VII Working with People with Physical Disabilities Unit A What is a physical disability? Unit B. How the Home Care Worker can help the physically disabled. Module VII AB,-pages 1-8

36-37 37 37

Module VIII Food Nutrition and Meal Preparation Unit A The Major Nutrients Unit B. Meal Planning Unit E. Food Preparation and Serving Unit D. Food Shopping, Storage and Handling Food Safely Unit E. Modified Diets * " Module VllI-A,B!C,D,E,-pages 1-35

38-49 39-40 41-42 43-44 44-46 46-49

Module IX. Family Spending and Budgeting Unit A, The role of the Home Care Worker in family spending and budgeting Unit B. Ways to make the most effective use of the families finances Module lX-A,B,-pages 1-12

50-51

Module X Care of the Home and Personal Belongings Unit A Importance of Housekeeping in Home Care Unit B. Performing housekeeping in the Home Unit C. Ways to be safe and save energy and time Unit D. How to get the job done Module X -A, B.C,D-pages 1-19

52-55 53 53 53-54 54-55

Module XI. Safety and Injury Prevention Unit A Injuries Unit B. Injury Prevention Unit C. What to do when injuries and emergencies happen Module XI-A,BA-pages 1-17

56-59 57 58-59 59

51 51

Module XII. Personal Care Unit A. Defining Personal Care Unit B. Personal Care Skills 62 A) Handwashing B)

Infection Control

60-61

Lesson 1. Process of Infection

Lesson 2. Standard Precautions Lesson 3. Bloodborne Pathogens Lesson 4. Exposure incidents Module XII-A,B,-pages 1-14

64 64 64

C) Freedom from Pain Lesson 1- Pain Management Lesson 2. Recognizing and Reporting Pain Module Xll-C, page 1 D)

Urinary Systems

67-72

Lesson 1 Assisting with Bedpan/Urinal/Fracture Pan Lesson 2. Bedside Commode/Toilet Lesson 3. Incontinence Module XII-D-pages 1-16 E)

Digestive Systems

Integumentary System

73 74-75 76-77

78-81

Lesson 1. Skin Care and Alterations in skin Module XII-F-pages 1-12 G)

68 69-70 71-72

73-77

Lesson 1. Nutrition and a Balanced Diet (see Module VIII) Lesson 2. Assisting with Eating and Hydration Lesson 3. Measuring and Recording Weight Module XlI-E-pages 1-4 F)

65-66

Musculoskeietal System

79-81

82-93

Lesson 1. Transfers, positioning and turning a) Body mechanics Module XII-G-pages 1-4 b) Turning and positioning in bed and chair Module XII-G-pages 1-4 c) Transfer with one assist Module XII-G-pages 1-7 Lesson 2. Ambulation Module Xll-G- pages 1 - 5 7

82-83 84-85 86-88 90-91

Musculoskeletal System Lesson 3. Range of Motion Module Xll-G-page 1

92-93

Bathing

94-95

Lesson 1. Processes a) Partial/Sponge bath b) AM/PMcare c) Shower d) Tub Module XII-G- pages 1-4 I)

Grooming

96-97

Lesson 1 Haircare a) Shampooing b) Brushing/Combing Module XlI-l-page 1 Lesson 2. Mouthcare a) Conscious resident/client patient 1) partial assistance 2) total assistance b) Dentures c) Edentulous Module Xll-I-pages 1-3 Lesson 3. Shaving Module XII-I- page 1 Lesson 4. Hand and nail care Lesson 5. Footcare Module Xll-I-page 1-2 J)

Dressing

105-106 107-108 109-110

111-113

Lesson 1. Assisting the client Module XlI-J- page 1-3 Lesson 2. Adaptive Equipment Module XII-J- page 1 K)

98-104

114

The Clients1 Environment

115-118

Lesson 1. Components and care of the environment Drawers, closets and immediate environment Lesson 2. Unoccupied bed Lesson 3. Occupied bed Module Xll-K- page 1-5 8

115 116-117 118

Unit C. Persona! Care for the Well Baby Module Xll-C-pages 1 - 6

119-120

Unit D. Special Equipment use by Home Care Clients Module XII-D-pages 1-9

121-123

Unit E. Assisting with the Self-Administration of Medications Module XII-E-pages 1-17

124-125

Vocabulary List Module Xli

126

Appendix

127

CORE VALUE STATEMENT All care given must demonstrate core values. Core values underlie all aspects of care, in all care settings and profoundly influence effectiveness and satisfaction across the full range of performance.

All students/candidates must incorporate and demonstrate in their skills and knowledge the understanding and integration of the following core values: (1) the dignity and worth of each resident/client/patient as an individual; (2) respect for the range of diversity of individuals; (3) a demonstration of a therapeutic relationship (i.e.,) the value of autonomy and control, adapting to resident/client/patient's preferences and routines and limits, maintaining privacy and confidentiality, providing care in a caring compassionate manner and encouraging individuals to be as independent as possible). In addition, the impact of the actual setting/environment on the care recipient and the care recipient's adjustment to care must be understood and responded to throughout the program.

Module I INTRODUCTION TO HOME CARE

MODULE I

Introduction to Home Care Home Care, the Home Care Worker and the Client What is a Home Care Worker? Providing Home Care

TIME:

90 minutes

OBJECTIVES: At the completion of this Module the student will be able to: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.

14. 15. 16. 17. 18.

Define home health care. Describe the growth of home care throughout the years. Verbalize the goals of home care. Recognize the types of individuals who would qualify for home care. Describe the necessity and benefits of home care services for the patient/family/community. Verbalize the skills and qualities required to be a Home Health Worker. Describe accountability required when caring for a patient in their home, including confidentially and patient rights. List reasons why a home care worker would be terminated. List tasks associated with being a home care worker. Provide examples of meeting the home care patient's emotional and physical needs. List the members of the health care team and explain their respective roles. Discuss the interaction among health care team members. Define the purpose and goals of the patient's care plan including: a. Development of the plan by the team members. b. Case Manager's role. c. Tasks on the plan. Describe observing and reporting responsibilities. Maintain a copy of the care plan in the home/confidentiality. Identify the role of the home care supervision or coordinator. Verbalize reasons to contact supervisor/coordinator or RN/Case Manager. Understand and be sensitive to basic human needs.

SUGGESTED TEACHING METHODOLOGIES:

Lecture, Handouts, Role Play

SUGGESTED EVALUATION METHODOLOGIES:

Group Participattng/Written/Oral Quiz

MODULE I

introduction to Home Care

Unit A Home Care, the Home Care Worker and the Client 1. Home health care - What is it? 2. Physical, psycho-social benefits of home care a. Providing safe care at home for people who suffer from illness or injury who might otherwise be placed in the hospital or nursing home, i. Keeping people who need support in the home out of institutions for the physically or mentally disabled; eliminating the need to place persons (particularly children) in foster care. ii. Allowing families to remain intact. iii. Maintaining involvement with family, neighborhood and community. b.

Encourage independence, dignity and comfort at home.

3. a. b. c. d.

History of home care 1930's training began for homemakers to assist families with children. Home health aides: Focusing more on health related needs. 1960's: Medicaid/Medicare provides payment for coordinated home care services. Changing of the HHA role in the 70fs, 80's, 90's and currently.

4. a. b.

Two categories of home care clients Person with specific injury/illness. Persons in need of support in the home.

5. a. bc. d.

Home care clients include: Frail and elderly. Acute and Chronically ill. Physically and mentally challenged. Adults and children in need of protection. 12

MODULE I- UNIT -B What is a Home Care Worker 1.

Qualities of home care workers

a. Dependable b. People oriented c. Honest d. Objective e. Caring f. Patient gRespectful h. Knowledgeable Reasons a Home Care Worker could be dismissed a. Unreliability b. Untrustworthiness c. Disrespectful of the privacy of others. d. Non-compliant with agency specific protocols. Success as a Home Care Worker depends on one's ability to: a. Work without constant supervision. b. Get along well with clients. c. Organize time in order to complete all the necessary tasks. d. Be observant and sensitive to the client's physical, social, spiritual and cultural needs. Personal care tasks that Home Care Work must be able to perform: a. Personal care services i. Bathing in bed, tub or shower. ii. Dressing iii. Grooming and care of teeth and mouth. iv. Toileting v. Walking vi. Transferring vii. Preparation of meals. viii. Feeding ix. Assist/remind with medication. b. Nutritional support and home maintenance which includes: i. Assistance with making/changing beds. ii. Dusting and vacuuming. iii. Light cleaning of kitchen, bedroom and bathroom, iv. Dishwashing. v. Listing needed supplies, vi. Shopping for the patient. vii. Patient's laundering/necessary ironing, viii. Payment of bills and other essential errands. ix. Provide family support - communicate with client.

MODULE I-UNIT C Providing Home Care 1. Who is part of the team a. b. c.

Examples of team members. Home care takes a joint effort/team approach Communication with team.

a. b. c.

2. Observing, recording and reporting responsibilities What to observe for; e.g. any changes in condition/behavior. What to record. What to report.

a. b. c. d.

3. The care plan Plan developed by the team, coordinated by the case manager. Contains list of duties and responsibilities including special circumstances. Includes goal(s). Includes special observations of the client

Present in the client's home.

4. a. b. c. d. e. f. g.

Role and responsibilities of RN Supervisor as related to the Home Care Worker Visits client's home to ensure follow-up. Ensures the worker understands the care plan. Reviews all procedures with the worker. Provides instruction when extra know-how is needed. Solves problems that may arise on the job. Provides a communication link with other team members and with the agency. Evaluates the worker's performance periodically.

5. a. b. c. d.

Working with your supervisor Phone calls to discuss immediate problems. Home visits. Team conferences. Importance of client's understanding of goals/care plan.

The Home Care Team 1. 2.

Definition: Made up of everyone who can help the patient at home return to his highest level of activity. Members (examples) a. Doctors b. Public Health Nurse (PHN) . c. Registered Nurses (RN) d. Therapists e. Nutritionist/Dietitians f. Social Workers g. License Practical Nurse (LPN) h. Home Health Aides (HHA) *Remember YOU are to take direction from your nursing supervisor only.

The Cooperative Effect a. Remember all members are essential for the patient's well-being.

4. a.

Health care in the home Purpose: To allow the patient to remain home in a safe, comfortable environment while he is recuperating and receiving treatment for his illness. b. Patient Safety: Any patient who is exposed to unsafe conditions should not remain at home. c. Patient comfort: Both physical and emotional comfort is important. d. Medical Treatment: All home care patients must be under the treatment of a physician. Some patients may have specific illness or injury while others need support in the home. e. History of Home Care: Training for home care workers goes back as far as the 1930's but has been evolving since. It has become increasingly focused on health related needs and since the 1960's became funded by Medicare and Medicaid. Today the HHA is a sophisticated, professional part of the home care team. Mod 1-page 1

f. a. b. c.

Community Involvement: Volunteer groups. Senior Citizens. Meals on Wheels.

5. a. b. c. d. e.

Home Care Clients (may include) Frail elderly. Chronically ill. Physically and mentally disabled. Adults and children in need of protection. Short term recuperative care.

6. a. i. ii. iii. iv.

Benefits of Home Care The Patient Allows the patient to be cared for in familiar surroundings, Allows for socialization with friends and family, Independence from his family. Recovering in the home is more meaningful, more natural and far less fearful.

b. i. ii. iii.

The Family Allows their loved one to remain at home. Allows them some relief time from responsibilities. More cost effective than Nursing Home.

Home Care vs. Alternatives to Home Care Home Care Alternatives to Home Care a. More cost effective. a. More expensive. b. Remains integrated with family, b. Separated from family. c. More patient independence. c. More structured. d. Requires family commitmentd. Less family responsibility. e. Able to maintain community e. Socialization within facility only, involvement. f. Patient must be able to f. Nursing home personnel assume advocated for himself or have responsibility for patient safety. a responsible family member present so that they may be maintained in a safe environment. 8. a.

Duties and Responsibilities of the Personal Care Aide Chief Responsibility: Help patient reach/maintain his optimum level of ADL while maintaining Safety. Mod 1-page 2

Methods of Care: i. Active participation: Allow patient to perform all functions he can safely handle himself. ii. Assistance: Provide assistance in all areas that patient cannot or should not provide for himself. iii. Encourage Independence. iv. Provide family support: Teaching home management. Acting as temporary parent substitute.

The nursing care plan: i. Definition: An outline of duties that the aide will perform or assist the patient with. The Nursing Supervisor will initiate the care plan upon her first visit. No changes are to be made to this care plan by anyone else. ii.

The Nursing Supervisor: The RN responsible for direct supervision of all field personnel. She is your immediate supervisor. iii.

Using the nursing care plan: You are to follow the nursing care plan exactly. There are to be no changes made by anyone other than the nursing supervisor. iv.

Limitations of the PCA: Refer to functions on PCA duty sheets.

Remember - No part of the nursing care plan may be changes by the PCA/HHA, the patient, family, or other team member without the permission of your nursing supervisor. Mod 1-page 3

The Supervisor's Job Duties include; a. Making sure worker understands the care plan. b. Reviewing all procedures with the worker. c. instructing the worker when extra know-how is needed. Helping the worker when problems arise on the job. e. Fostering contact with other team members. f. Evaluating the workers performance periodically. Supervisor visits client's home: a. To check on client's progress. b. To observe how worker completes tasks, suggesting changes if necessary. c. To monitor worker's adjustment to home care situation. d. To report information to other team members. Working With Your Supervisor Phone calls to discuss immediate problems. 2. Home visits. Team conferences. Need for patience and understanding. a. Problems cannot always be resolved right away. b. Remember that your supervisor is interested in the same goal as you; giving the client good care. Skills and Qualities of a Personal Care Aide 1.

Do not become emotionally involved with the client and his or her family.

2. Know how to stay out of family disputes. 3. Are flexible about working conditions. 4.

Leave their own problems outside the door.

Can stick to a work plan and schedule.

Remember that they are guests in the client's home 7. Are competent and, know how to do the job. 8.

Are dependable and reliable. Mod 1-page 4

Show respect for the client's privacy, belongings, culture and religion.

10.

Are thrifty and able to use what is available in the client's home.

11.

Treat clients with dignity.

12.

Know the limits of their job.

13.

Are friendly, cheerful and polite.

14.

Are clean and well-groomed.

In brief, agencies seek person who are mature, sensitive and honest. PCA's must be able to: 1. Work without constant supervision. 2.

Get along well with clients.

Organize time in order to complete all the necessary tasks.

Be observant and sensitive to the client's needs.

Personal Care Aide duties: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19.

Bathing of the patient in the bed, the tub or the shower. Dressing. Grooming - including care of hair, shaving and ordinary care of nails. Toileting - assisting the patient on and off bedpan, commode or toilet. Walking within the home and outside. Transferring - bed to chair or wheelchair. Use of medical supplies and equipment â&#x20AC;&#x201D; walker, wheelchair, hydraulic lift, etc. Preparing meals, regular and modified diets. Feeding. Routine skin care. Changing simple dressings for stable surface wounds. Weighing the patient. Measuring intake and output. Assist with emptying of the urinary drainage bag. Assist with daily catheter care. Assist with condom catheter. Assist with the use of elastic support hose. Assisting patient with medication. Observation, reporting and recording.

Mod 1-page 5

Household Duties (involving patient use and areas only 1. Making and changing the bed 2. Dusting and vacuuming 3. Dishwashing 4. Tidying the kitchen 5. Tidying the bedroom 6. Tidying the toilet facilities/bathroom. 7. Listing needed supplies 8. Shopping if no other arrangement is possible (usually limited to once a week). 9. Laundering, including necessary ironing and mending. 10. Assisting with payments of bills and other essential errands "PCA WILL PERFORM ONLY THOSE DUTIES LISTED ABOVE AND DESIGNATED ON THE NURSING CARE PLAN. ANY QUESTIONS, CONTACT YOUR NURSING SUPERVISOR IMMEDIATELY Family Aides, Inc. are NOT permitted to 1. 2. 3. 4. 5.

Transport patient in their cars. Make judgments or give advice on medical or nursing problems . Give any care not included by the nurse in plan of care. Alter the number of hours present in the patientâ&#x20AC;&#x2122;s home per day or per week. Accept gratuities.

Mod 1- page 6

VOCABULARY LIST

Module 1

Care Plan

an outline of duties aide will perform or assist the patient with.

Home Care

a range of services needed to maintain individuals and families within the community.

Home care workers maintenance

people who provide personal care services, nutrition and home services and family support services to individuals and families in their own homes.

Nursing Supervisor

The Nursing Supervisor will initiate the care plan upon first visit, no changes are to be made to this care plan by anyone else. Nursing Supervisor is the R.N. responsible for the director Supervisor for all field personnel she is your immediate supervisor.

Mod 1-page 7

THINK SHEET -Mod 1 1. What is a home care team?

2. What is a care plan?

3. What are some duties of your nursing supervisor?

4. What are some goals of home care?

5. What are some qualities of a home care worker?

6. What tasks can a home care worker be assigned to?

Who are you supervised by?

Who do you report problems to?

How is the community involved in home care?

Mod 1-page 8

Module II WORKING EFFECTIVELY WITH HOME CARE CLIENTS

MODULE II

Working Effectively with Home Care Clients

UNIT A:

Theories of Basic Human Needs

TIME:

45 minutes

[BASIC CORE]

OBJECTIVES: The student will: 1. Understand and be sensitive to basic human needs. 2. Discuss how human needs are, or can be met. 3. Recognize the dignity and worth of each resident/client/patient. 4. Discuss how the caregiver can meet each person's different needs. 5. Explain how the care recipient may express unmet needs. MEASURABLE PERFOMANCE CRITERIA: The student will: 1. Demonstrate through the use of scenarios how the caregiver recognizes the dignity and worth of each resident/client/patient, and demonstrates respect and compassion in relating to them as total persons. 2. State one example of how the caregiver can assist a care recipient to meet his/her needs. 3. State three ways the caregiver can assist the care recipient to meet /achieve their needs. 4. State three behaviors of care recipients that may result from their unmet needs. SUGGESTED TEACHING METHODOLOGIES:

Lecture, Handouts, Role Play

SUGGESTED EVALUATION METHODOLOGIES:

Group Participation , Written/ Oral Quiz

MODULE II UNIT B:

Diversity

TIME:

30 minutes

Working Effectively with Home Care Clients [BASIC CORE]

OBJECTIVES:

The student will: 1. Identify factors that contribute to individuality. 2. Discuss the dignity and worth of each resident/client/patient as an individual. 3. Develop an awareness of, and respect for, the range of diversity in oneself as well as in others, including, but not limited to: race, spiritual/ religious beliefs, national origin, sexual orientation, age. 4. Discuss other cultures and how elements of diversity affect caregtving including such examples as: verbal and non-verbal communication, health-related beliefs, food choices, family relating and systems of support and pain and pain management. 5. Discuss how elements of diversity affect quality of life. MEASURABLE PERFORMANCE CRITIERIA:

The student will: 1. Name three factors that contribute to individuality. 2. Give two examples of how the following factors impact behavior and lifestyle: race, spiritual/ religious beliefs, national origin, sexual orientation, age. 3. Identify by the use of scenarios, cultural differences in communication and interpersonal interactions. 4. Demonstrate how elements of diversity affect care giving including such examples as: verbal and non-verbal communication, health-related beliefs, food choices, family relating and systems of support. 5. Name two ways elements of diversity affect quality of life. SUGGESTED TEACHING METHODOLOGIES:

Lecture; Scenarios/Critical Thinking; Role play

SUGGESTED EVALUATION METHODOLOGIES:

Class participation; Written / Oral Quiz

MODULE II

Working Effectively with Home Care Clients

UNIT C:

Communication and Interpersonal Skills

LESSON:

1. 2. 3.

TIME:

45 minutes total for Lessons 1-5

[BASIC CORE]

Types of communication Effective communication Active listening

OBJECTIVES: The student will: 1. Define communication and its importance 2. Define different methods of communication 3. Identify the principles of effective communication 4. Discuss physical and emotional barriers to effective communication. 5. Discuss communication techniques to use with individuals having special needs (e.g. Vision, hearing, aphasia, and cognitive impairment) 6. Discuss active listening and barriers to effective communication.

MEASURABLE PERFORMANCE CRITERIA: The student will 1. Verbalize the definitions of communication and feedback 2. List three different methods of communication (verbal and non-verbal) 3. List two examples of communication barriers. 4. List two examples through scenarios of effective communication with persons with special needs. 5. State three ways the caregiver can be a good listener 6. Demonstrate active listening skills while providing care SUGGESTED TEACHING METHODOLOGIES:

Lecture; Demonstration; Scenarios; Role play

SUGGESTED EVALUATION METHODOLOGIES:

Class Participation Written/oral quiz

MODULE II

Working Effectively with Home Care Clients

UNIT C:

Communication and Interpersonal Skills

LESSON:

4. Clients are people too/Developing a therapeutic relationship

TIME:

45 minutes total for Lessons 1-5

[BASIC CORE]

OBJECTIVES: The student will 1. Define a therapeutic relationship. 2. Discuss ways to establish a therapeutic relationship; planned, purposeful, built on trust. 3. Discuss how personal attitudes of illness and dependency affect establishing a therapeutic relationship. 4. Identify the caregiver's role in ways to foster independence for the care recipient. MEASURABLE PERFORMANCE CRITIERIA: The student will 1. Demonstrate a therapeutic relationship through the use of scenarios and role playing include the value of individual autonomy and control by showing how to work together with clients/residents/patients in providing care, and taking into account their desire to be as independent as possible. 2. Name 3 examples of how to establish a therapeutic relationship. 3. Demonstrate personal attitudes and identify 2 ways they affect establishing a therapeutic relationship. 4. Name three losses attributed to illness and decreased independence and ways the caregiver can foster independence for the care recipient. SUGGESTED TEACHING METHODOLGIES:

Lecture; Discussion; Scenarios; Role Play

SUGGESTED EVALUATION METHODOLOGIES:

Group participation Written /Oral quiz

MODULE I!

Working Effectively with Home Care Clients

UNIT C:

Communication and interpersonal Skills

LESSON:

5. The Client and Significant Others

TIME:

45 minutes total for Lessons 1-5

[BASIC CORE]

OBJECTIVES: The student will: 1. Discuss the impact of the actual care setting/ environment on the following: the care recipient, the therapeutic relationship, and care recipient's adjustment to care. 2. Discuss individual rights in terms of autonomy, privacy, confidentiality, and freedom from abuse, neglect and mistreatment in the care setting. 3. Understand the impact on a person in becoming a recipient of care. 4. Appreciate the impact of the actual care setting/ environment, MEASURABLE PERFORMANCE CRITERIA:

The student will 1.

Describe the impacts on a recipient of care to illness (e.g. losses attributed to decreased independence, etc.) and how the care setting impacts the care recipient, the therapeutic relationship, and care recipient's adjustment to care. 2. Describe ways caregivers must allow recipients to exercise their individual rights in terms of autonomy, privacy, confidentiality, and freedom from abuse, neglect and mistreatment in the care setting. 3. Through role playing, demonstrate two different responses to becoming a recipient of care. 4. Demonstrate how. changes in the care setting/environment can influence the recipient's quality of life and care. SUGGESTED TEACHING METHODOLOGIES:

Lecture, Demonstration, Role Playing

SUGGESTED EVALUATION METHODOLOGIES:

Group participation

Written /Oral quiz

MODULE I! UNIT D: TIME:

Working Effectively with Home Care Clients Caregiver Observation, Recording and Reporting

[BASIC CORE]

30 minutes

OBJECTIVES: The student will: 1. Describe the components of trained observation using the senses (sight, smell, hearing, and touch) and know the normal. 2. Discuss guidelines for reporting changes in client condition and/or environment. 3. Discuss the components of documentation including legible handwriting, spelling and grammar, and factual information about observations. MEASURABLE PERFORMANCE CRITIERIA: The student will: 1. List the components necessary for accurate observations. 2. Identify situations that should be reported. 3. Demonstrate the ability to report effectively by writing legibly, using correct terminology, and describing an observation using factual information. SUGGESTED TEACHING METHODOLOGIES:

Lecture, class discussion, role-play, and video

SUGGESTED EVALUATION METHODOLOGIES:

Class participation, worksheet, and quiz

MODULE II

Working Effectively with Home Care Clients

UNIT E

Confidentiality

TIME:

30 minutes

[BASIC CORE]

OBJECTIVES: The student will 1. Discuss the scope and importance of confidentiality including conversations, observations, and reporting 2. Discuss responsibility for maintaining confidentiality 3. Identify the importance of confidentiality as it pertains to personal and medical information 4. Identify guidelines for protecting information of the resident/client/patient MEASURABLE PERFORMANCE CRITERIA: The student will 1. State three types of information covered by confidentiality 2. Identity three reasons confidentiality is important 3. List three ways the caregiver can preserve confidentiality of personal information 4. List three ways medical information is protected 5. Demonstrate awareness of and maintenance of confidentiality during personal conduct, (e.g. conversations with co-workers, other residents/clients/patients, supervisors, etc.) SUGGESTED TEACHING METHODOLOGIES:

Lecture

SUGGESTED EVALUATION METHODOLOGIES:

Group participation Written/Oral quiz

Discussion Video; Role play

MODULE II

Working Effectively with the Home Care Client

OUTLINE:

Unit A 1.

Theories of Basic Human Needs

Theories of basic human needs

Needs motivate OUT behavior and feelings

b. Unmet needs i. Can create stress ii. Reactions to stress 2. How patient client, resident may respond to unmet needs 3. Basic human needs a. Physical needs b. Safety and security needs c. Belonging needs d. Self-worth needs e. Self-fulfillment needs. f. Physical safety and security needs come first, higher needs next

Unit B

Diversity

1. The individual, the family and home care a. The role of family in society i. Reproduction ii. Care and nurturing children iii. Meeting the needs of individual members iv. Passing on a culture and system of values b. How families differ i. Each family is unique ii. Serious problems that may affect the family iii. Individual family members may differ from each other iv. Other family differences v. Cultural heritage (and effect on care giving) vi. Family values and customs vii. Sexual differences viii. Finances ix. Age

UNIT C 1. 2. 3. 4. 5. 6. 7. 8.

Communication and Interpersonal Skills

Types of communication Effective communication Active listening Clients are people too/Developing a therapeutic relationship The client and significant others Adjusting to becoming a recipient of care and adjustment to care setting/environment Barriers to effective communication Communication techniques to use with individuals having special Needs, i.e., vision, hearing, aphasia, cognitive impairment

UNIT D

Observing, Recording, Reporting

1. Observing, recording, reporting 2. a. b. c.

What the home care worker should observe, record and report Changes in the client's condition Environmental conditions and changes that affect the client Changes in supportive relationships with relatives/friends

3. a. b. c.

Building observation skills Of patient/client/resident Of physical conditions of the home Of relationship with family or friends

4. a. b. c.

Importance of recording and reporting Helps home care team know client status May be needed for referral to other services Reduces possibility of forgetting what happened

Building recording skills

Write only what you see

b. c. d.

Write only what you hear Write only what you do Date all of your observations

Sign your name

UNIT E 1. 2. 3.

Confidentiality

Scope of confidentiality including conversations, observations and reporting Home care workers' role in maintaining confidentiality HIPAA guidelines and compliance

What are the Five Basic Human Needs? BASIC HUMAN NEEDS: 1. Physical needs 2. Safety and security needs 3. Belonging needs 4. Self-worth needs 5. Self-fulfillment needs - Physical needs include food, clothing, shelter, rest and avoidance of pain and danger. The other needs include the need to belong and to enjoy a sense of self-worth and selffulfillment - When basic needs are not met or are threatened, people experience stress. They may feel angry, anxious, discouraged, fearful, depressed, aggressive, or sick. - Human needs work according to levels. As the more basic needs are met, the needs at the next level become important. - By understanding basic human needs, home care workers can take positive measures to see that needs are met, as much as possible, in the home care situation. You need to know & understand how to attend to peoples needs. No matter what the situation is. To do that you must understand;

I. II.

- The needs all people have. - How to account for differences in individuals & families. - How to work with families whose values may be different from yours. - How to communicate effectively with your client. - How to observe, report, & record in home care situation. Needs motivate our behavior and feelings Unmet needs a) Can create stress b) Can lead to reactions to stress (discouragement, anxiety, physical ailments, fear anger, depression, and aggression)

III. Basic human needs a) Physical needs b) Safety and security needs. c) Belonging needs d) Self-worth needs e) Self-fulfillment needs IV. Physical safety and security needs come first, higher needs next. Mod II-page 1

1. Physical needs - Assisting with personal care - Shopping for food - Making sure the clients clothing is appropriate for the weather 2. Safety and security needs - Letting the client know when you are scheduled to be there again. - Removing or moving loose rugs, electrical cords, small tables or chairs that might present a hazard to a client with limited vision - Reminding the client that you are there to assist, not to take over 3. Belonging need - Never criticizing a client's family situation - Encouraging the client to make choices (in clothing for example) - Asking for the client's opinion on a news item that you both have heard or read about.

4. Self-worth needs - Encouraging the client to do as much for himself or herself as possible (within guidelines of the care plan, of course) - If a client appears sad or angry, trying to find something good or positive that they have done or experienced and talk about that Not discussing your own physical or personal problems

5. Self-fulfillment need - Recognizing small accomplishments - Complimenting a client - Making sure the client's family is aware of his or her accomplishments

Mod II-page 2

Physical needs include food, clothing, shelter, rest, and avoidance of pain and danger. The other needs include the needs to belong and to enjoy a sense of self-worth and self-fulfillment. 

When basic needs are not met or are threatened, people experience stress They may feel angry, anxious, discouraged, fearful, depressed, aggressive or sick.

 Human needs work according to levels. As the more basic needs are met, the needs at the next level become important.  By understanding basic human needs, Home Care Workers can take positive measures to see that needs are met, as much as possible, in the Home Care situation.

BASIC HUMAN NEEDS SELF-FULFILLMENT NEEDS SELF-WORTH NEEDS BELONGING NEEDS SAFETY AND SECURITY NEEDS PHYSICAL NEEDS

Mod II-page 3

THE ROLE OF THE FAMILY Some of the primary responsibilities of the family include; - Reproduction - Care and nurturing of children in their early years - Meeting the needs of individual members for affection, acceptance, security and trust - Passing on a culture and system of values Every family in the community is also a community in itself. Members are bound together by common interest, loyalties and affection. If the family's stability is threatened, the life of the community is also affected. This relationship between family and community has existed down through the ages.-It is the reason there are home care workers. It is also the reason why every worker needs to understand the many kinds of problems that threaten family stability and the many ways in which he or she can help preserve it. Serious problems that may affect the family include: - Physical illness of the mother, breadwinner, or other family member. - Breakdown of the marriage through death, desertion, infidelity alcoholism - Mental illness - Unemployment - Delinquency, crime These problems often disrupt the household routine, family finances, family goals, or the relationship of one member of the family with others. They may cause stress and the neglect of the physical and emotional needs of the individual members of the family. They may last a short time or become very-serious and deep-seated. Every individual and every family copes with problems in different ways. Within the community, no two families are alike. Within the family, no two individuals are identical. Individuals may differ from each other in: - Disposition, personality - Attitudes, beliefs - Interests, likes and dislikes - Ambitions, wants - Responsibility - Physical resources

Mod II-page 4

THE ROLE OF THE FAMILY

(CONT.)

Families may differ from each other in: - Cultural or ethnic background - Political views - Resources - Living standards - Community standing - Religion and religious practices - Goals I. The role of the family in society A. Reproduction B. Care and nurturing of children C. Meeting the needs of individual members D. Passing on a culture and system of values II. How families differ A. Each family is unique B. Serious problems that may affect the family 1. Illness of parent, breadwinner, or other family member 2. Breakdown of marriage (desertion, alcoholism) 3. Mental illness 4. Unemployment 5. Delinquency, crime C. Individual family members may differ from each other in 1. Disposition, personality 2. Attitudes, beliefs 3. Interests, like and dislikes 4. Ambitions, wants 5. Responsibility 6. Physical resources " D- Families may differ from each other in: 1. Cultural or ethnic heritage, customs 2. Politics 3. Resources 4. Living standards 5. Community standing 6. Religion 7. Goals E- Cultural or ethnic heritage 1. Preparation of food, eating habits 2.Reaction to pain or loss 3. Language and frequently-used expressions 4. Taboos (cultural, religious) Mod II-page 5

THE ROLE OF FAMILY (CONT) F. Family values and customs 1. Attitudes towards money 2. Raising or disciplining children 3. Educational goals 4. Meal preparation 5. Attitudes towards elders 6. How spare time is spent 7. How they take care of their possessions 8. How they practice their religion 9. How these practices continue as habit G. Sexual differences 1. Traditional roles 2. Non-traditional roles 3. Conflicts when role changes are imposed by illness or stress. H. Finances I. Age

Mod ll-page 6

BASIC THINGS THAT MAKE ALL PEOPLE DIFFERENT: What makes clients and families so different? Just as there are basic needs that all people share, there are other basic things that make all people different; 1. Their cultural or ethnic heritage makes them different It makes a difference whether they come from Puerto Rico, Europe, a midwestern farm, or an inner-city neighborhood. Some examples of differences related to cultural or ethnic heritage are; - What, when, and how food is prepared and eaten; the use of spices, seasonings; whether meat is eaten; the time the main meal is eaten; the types of utensils used (chopsticks, for instance). - Reactions to pain or loss. In some cultures, children are taught never to show they are in pain or to cry; in others people are encouraged to cry. scream, and express their pain. - Language and frequently used expressions - Cultural (or religious) taboos 2. Family values and customs also make families different. What a family considers important is what it values. Family values are passed on from one family member to another and are reflected in; - How they spend their money - How they raise or discipline their children - Their educational goals - How they prepare meals - How they feel about older generations - How they spend their spare time - How they take care of their possessions - How they practice their religion Families or individuals may outgrow these customs but continue the habit without thinking. Examples of habits would be; - Having dinner at night, rather than at mid-day - Trading in a car every three years and buying another - Ironing sheets and pillowcases - Waxing a floor on hands and knees 3. Whether a person is male or female may make a difference in the role he or she is expected to play in a family. For example, men may resent having to assume what they consider to be woman's duties. Women may feel uncomfortable earning more than their husband. 4. It is obvious an individual's financial situation will greatly influence his or her feelings about a long-term illness. 5. Age also makes a difference. The reaction to a major illness or accident, and the resulting needs, are different for a three-year-old toddler, a 16-year-old teenager, a 35-year-old husband and father, and a 70-year-old retiree. Mod II-page 7

FAMILY INVOLVEMENT IN HOME CARE Clients in trouble often mean families in trouble. Individuals and families may need practical help with specific problems, but they also need to maintain their self-respect. - They want to feel that other family members are there to help - They need to feel confident about their ability to cope with their own problems; and, although outside help is needed, they want to remain as independent as is safely possible. - They may need to be reassured about what is happening to them, so that they can feel secure about the care that is being given. - They want their customs and traditions respected and their confidences honored. As a home care worker, you can help if you: - Find ways to share some responsibilities with members of the family - Make simple household and personal tasks exciting for the children - Turn to the older family members in the household for services and advice, making them feel useful. - Try to maintain a pleasant environment in the home in order to encourage family members to continue or increase their involvement in the family. - Respect and learn about the family's cultural heritage and traditions - Take the time to do with the client rather than for the client REMEMBER: Remember to look for strengths and resources within the family; this supports the goal of home care. 

Families shape individual differences in clients and help to meet their basic needs.



Families can help support the goals of home care. However, families in crisis place special demands on the home care situation.



Home care workers should respect differences among individuals and families, work with those differences, and always look for strengths within the individual and family when providing home care.

Mod II-page 8

COMMUNICATION I. Communication is sharing information, activities, and feelings A. Methods of communication 1. Visual (written) 2. Verbal (speaking) B. Tools used in verbal communication 1. Tone of voice 2. Body postures (" body language") 3. Facial expressions II. Keys to good communication A. Making a good first impression 1. Preparation before first visit (be aware of clients fears) 2. Dressing appropriately 3. Approaching client 4. Making sure the client understands whom the home care worker is 5. Getting acquainted 6. Using the care plan 7. Explaining what you are going to do B. Showing acceptance 1. Eye contact 2. Active listening 3. Use of touch 4. Being relaxed and comfortable 5. Using appropriate terms of address (some clients do not want to be call by their first names, some do) 6. Avoiding criticism of life styles or customs 7. Complimenting clients when it is appropriate (for example upon completing tasks) 8. Asking clients advice or opinions C. Building a helping relationship 1. Relationship should be positive (helping clients without making them dependent upon worker) 2. Worker should be interested in each family member, but not try to become part of the family 3. Respecting cultural differences 4. Encouraging independence 5. Involving clients in decision-making D. Handling special problems 1. Jealousy 2. Testing by clients 3. Over-dependency 4. Depression 5. When to call your supervisor Mod II-page 9

REMEMBER ► ► ► ► ► ► ► ►

Never get involved in family problems. Listen carefully and patiently. Always tell the client what you are going to do before you do it. Don't blame the client for mistakes he or she can't help. Be sincere. Be honest. Be patient. Respect your client's privacy.

Mod II –page 10

Here are some examples of ways in which a Home Care Worker can build a good helping relationship with clients: Situation Client begins to tell long involved story about his childhood.

Ineffective response "I don't have time to listen now."

Client hates his diet for "Well, if you're going diabetes and wants to to be that way, go eat a candy bar. ahead make yourself sick! I'll tell my supervisor tomorrow." Client wants worker to take her side in an argument with her daughter.

" I'll call your daughter and tell her just how upset you are and that she should apologize."

Client dresses self before worker arrives.

"Don't you look funny! You've got the buttons done all wrong again!"

Client complains that your stew is not as good as hers.

" Nobody could please you. You're such a picky eater!"

Client complains that she is too tired to get out of bed.

"That's okay, honey. You stay there as long as you like."

Effective response " How interesting! Come into the kitchen and tell me while I fix dinner." (Listening) " I know it's hard to stay away from sweets. You must miss them. Would an orange or a pear taste good instead?" (Showing understanding) " I know you're upset Later on, when you have calmed down, why don't you call her? You will both feel better if you talk about it" (Encouraging independence) " How great that you can get yourself dressed! Now I can fix breakfast sooner. You look so nice!" (Giving encouragement/praise) "This is the way I make stew for my family. Next time you tell me how you make it. Then we will both learn a new recipe." (Showing patience, willingness to learn) "It must be hard to get up when you've had a bad night, but the nurse feels it's so important to keep moving. Let me help." (Showing consistency)

Mod II-page 11

OBSERVING, RECORDING, AND REPORTING I.

What the home care worker should observe, record, and report

A. Changes in the client's condition B. Environmental conditions and changes that affect the client C. Changes in supportive relationships with relatives or friends II.

Building observation skills

A. Of clients 1. Signs of physical discomfort 2. Changes in basic abilities 3. Unusual changes in behavior 4. Changes in physical appearance B. Of physical condition of home 1. Potential hazards 2. Health hazards 3. Client access to conveniences C. Of relationships with family and friends 1. Changes in relationships 2. Completion of tasks as outlined in care plan III.

Importance of recording and reporting

A. Help home care team know client status B. May be needed for referral to another service C. Provides permanent record D. Reduces possibility of forgetting what happened IV. Building recording skills A. Write only what you see B. Write only what you hear C. Write only what you do D. Date all your observations E. Sign your name

Mod ll-page 12

OBSERVING, RECORDING, AND REPORTING

Home care workers should observe changes in the client's condition; physical conditions within the home that may cause problems, and any changes in those conditions; and changes in the client's relationship with relatives or friends who provide home care support that may affect the client or home care situation.

General observation includes: in the client, physical discomfort or changes in abilities, behavior, or physical appearance; in the home, potential safety and health hazards and obstacles to client convenience; in family or friends, any changes affecting the care plan.

Home care workers should record and report only what they see, hear, or do, without making an interpretation. It is also important to date and sign the record

Mod ll-page 13

OBSERVE AND REPORT

A personal care aide is responsible for reporting all problems, symptoms, complaints or changes in the patient's condition TO THE OFFICE IMMEDIATELY. The aide is also responsible for seeing that the patient is well cared for and safe at all times whether she does the care herself or if it is done by the patient or family membersEACH WORK DAY ASK YOURSELF THE FOLLOWING QUESTIONS -Has the patient changed in anyway since you last saw him? IF YES REPORT -Has the patient told you of any problems or complaints he has had recently- falls,' illness, pain, constipation, incontinence, etc? IF YES- REPORT -Does the patient eat the foods and drink fluids according to his diet? IF NO - REPORT -Does the patient look ill, weak, pale, tired, and uncomfortable? IF YES- REPORT -Is the patient confused or behaving differently? IF YES- REPORT -Do you understand and follow the instructions on the Home Care Plan every workday? IF NO-REPORT -Does the patient and family understand and follow their instructions on the Home Care Plan? ' IF NO-REPORT -Should the Home Care Plan instructions be changed so that the patient would have better care or be safer? IF YES- REPORT -Do you have supplies you need to do patient care and household tasks as they should be done? -IF NO-REPORT -Do you see any safety or health hazards in the patient's home- fire hazards, safety problems, poor plumbing or heating, insects, rodents, broken equipment? IF YES- REPORT -Have you double-checked the patient's skin (especially skin folds and pressure areas) even if the patient bathes himself? Is there any change in skin temperature, color or condition- redness, sores, rash, bruises, cuts, bleeding, and odor? IF YES- REPORT -Does the patient refuse to let you do things that you have been told you should be doing? " IF YES-REPORT -Do you have any questions or worries about the patient, his home, your duties, or anything else that you are not sure of? IF YES- REPORT -ARE YOU SURE THAT YOUR NURSING SUPERVISOR KNOWS ALL ABOUT THE PATIENT'S CONDITION, COMPLAINTS, PROBLEMS, AND CHANGES? IF YOU ARE NOT SURE- REPORT REMEMBER: EVEN MINOR SYMPTOMS OR CHANGES IN THE PATIENT'S CONDITION OR BEHAVIOR CAN BE A SIGN OF MORE SERIOUS PROBLEMS. REPORT ALL SYMPTOMS, CHANGES, OR QUESTIONS IMMEDIATELY BY CALLING THE OFFICE. DO NOT WAIT FOR THE NURSE TO VISIT. AFTER YOU CALL, THEN WRITE ABOUT YOUR REPORT ON YOUR AIDE ACTIVITY LOG OR A SEPARATE PIECE OF PAPER. BE SURE YOUR NAME AND THE PATIENT'S NAME AND THE DATE ARE ON THE WRITTEN REPORT Mod ll-page 14

C. SIGNS AND SYMPTOMS to be observed for and reported accordingly AREA/FUNCTION FOCUS SIGNS & SYMPTOMS GENERAL APPEARANCE Changes sloppy, neat, tired, restless, nervous, pale PHYSICAL ACTIVITIES

MENTAL STATE

EATING & DRINKING

Movement

ambulatory, in wheelchair, bed

Abilities

needs assistance, independent, unable to perform task

ADL

functions performed, assisted with, unable to do

General

weak, shaky, unsteady, dizzy, needs encouragement cheerful, depressed, irritated, angry

Mood Attitude

friendly, aggressive, disgusted, argumentative, helpful

Orientation

aware of surroundings, confused, knows people, place, date, alert

Appetite

poor, good, excessive

Diet

nutritious, adequate, special (specify), poor, supplements preferences, allergies, satisfaction, quality, snacks adequate, poor, alcohol intake, always thirsty

Food Fluids

SLEEPING HABITS

Quality

sufficient, restful, drugs used, insomnia, little

Rest periods

needed, frequency, aid to activity, restful, restless appears tired, tires easily, groggy, alert satisfied

Effect SKIN

Character Color Irregularities

dry, rough, oily, pliable, scaly, itchy, normal pale, normal, bluish tinge, yellow tinge, red Rash, puffiness, redness, breakdown, bruises, swelling oozing SPECIFY AREA & DESCRIBE

Mod II-page 15

EYES, EARS, NOSE & MOUTH

Eyes

spots, light flashes, sensitive to light, unable to see in dimness. Redness, itching, rubbing, discharge-

Ears

ability to hear, unusual wax build-up, discharge, blockage, pressure, balance, pain.

Nose

unusual discharge, bleeding, frequent sneezing, redness, stuffiness, blockage. teeth healthy, missing teeth, difficulty chewing, dentures fit properly, in good condition, breathe fresh, foul smelling, tongue coated, bad taste

Mouth

BREATHING

Character

regularity, rate

Quality

shortness of breath (when, how often), frequent sighs, frequent yawning. cough, sputum production (amount, frequency, color), pain wheezing, difficulty inhaling, exhaling, tightness.

Irregularities

ABDOMEN, BOWELS, & BLADDER

Abdomen'

stomach "puffy", pain, heartburn, nausea, vomiting, gassiness, belching, and indigestion.

Bowels

regular, constipated, diarrhea, flatus, bleeding, mucus in stool, unusual straining, incontinence.

Bladder

frequency of urination, amount, color, blood-tinged, large amount particles in urine, foul smelling urine, difficulty starting or stopping urination, pain, pressure, incontinence (when, how often)

Mod II-page 16

PAIN

Location Strength Time Medication Effect

CIRCULATION

Quality

Pulse General

Pressure

area, shooting, deep, superficial sharp, knife-like, dull, aching frequent, constant, when, did it start, duration effective, not effective, does doctor know interferes with activities, body functions, sleep normal skin color, temperature of extremities, sensitivity to cold regularity, rate, strength swelling of ankles or legs, "pins and needles", numbness, blotching of skin, reddened, tender areas or red lines (especially on legs), varicose veins, heart fluttering or palpitations, pain light-headedness, frequent headache, thumping sound in ears, dizziness or pressure in head after lowering and raising head.

Mod ll-page 17

Confidentiality As a homecare worker you will be exposed to all kinds of information about your patient, his diagnoses, treatment options, family matters and finances. It is important that you remain vigilant in keeping all of this information confidential. In fact, it is the law. This information is not to be discussed with the patient's friends or family that may visit or call and question you. Do not assume that family and /or friends already know this information. You will be signing a pledge of confidentiality to this effect You may or may not have heard about HEPAA (Health Insurance Portability & Accountability Act) it has to do with the confidentiality & privacy of a patient's medical record Every agency has a privacy officer whose responsibility is to understand HIPAA and help others follow the rules. Know who your privacy officer is, and how to contact him/her if you have questions about the right thing to do. My privacy officer is: The Quality Assurance Nurse Phone number: (516-681-2300 (#2 Nursing Department) Q: What does HIPAA mean to the home care worker?

A: It means being very careful about sharing information about your patients with others. It is their right to share their personal information, but not yours unless you have their permission each time.

Mod ll-page 18

The rule:

Some cases aren't so easy:

"Mum's the word." Say as little as possible to others about your patient's personal health information, which is also called "PHI". When in doubt, check with your supervisor or privacy officer. Keep your voice as low as possible in the home, or anywhere you accompany a patient, and keep information to a minimum.

Patient to worker: "Please don't tell my family about my high blood pressure. They worry too much about me." Right: "Why don't we talk about it with the nurse when she comes later?" Wrong: "OK, Mrs. Baretsky, I won't"

EXAMPLES OF KEEPING

Exceptions: Sometimes it's okay to disclose information about a patient to help him or her. Examples are to emergency medical personnel like

INFORMATION TO A MINIMUM: Example: At reception desk in doctor's office: Right: "Mrs. Smith is here for her 10 o' clock appointment" Wrong: "Mrs. Smith is here for her chemotherapy." Example: In Drug Store: Right: "I'm here to pick up Mrs. Smith's prescription." Wrong: "I'm here to pick up Mrs. Smith's prescription for Prozac." EXAMPLE: In general conversation: Right: "Goodbye Mrs. Mendoza. I'll see you tomorrow." Wrong: "Goodbye Mrs. Mendoza. I'm leaving to go take care of Mrs. Martinez and Mr. Harper."

firemen or the police in case of emergency or to authorities if you suspect someone might be abusing your patient. Other important points

> Don't leave any paperwork where it can be found by anyone who does not have the right to see it- This can include anything from prescription receipts to patient records. When you are done writing down information about a patient promptly put it away where it belongs. Keep your patient information with you, or store it in a safe place when you don't need it > Do not answer any questions about the patient without checking to make sure it's okay. Better to be safe than sorry!

EXAMPLE: With neighbors of the patient: Neighbor to worker: "How is Mr. Munoz?" Right: "Why don't you drop in and see himhe'd love the company." Wrong: "He's not looking so good. His

doctor is worried about his heart" Mod II-page 19

> When you are with a patient, always check to make sure it is okay with the

patient before you discuss his or her personal health information with, or in front of a family member or friend. Don't talk in front of anyone unless you know it is okay with the patient for this person to hear what is being said. If the patient is competent or unconscious, HIPAA permits discussion of patient care with a designated family member or close personal friend who is in charge of the patient's care. Ask your supervisor with whom you can discuss your patient's care.

> You are NOT responsible for what patients say or do. It is their choice to talk about their personal information.

> Do not discuss specific patients outside of work, especially by name!

Example: Worker to friend. Right: "I had a tough day with a sick patient!" Wrong: "Mrs. Jones' heart is getting worse. She was so bad this morning I had to call the nurse and they sent her to the hospital."

Mistakes happens: If you slip up, make sure you tell your supervisor or privacy officer so he or she can try to do whatever needs to be done to fix the problem.

Mod II-page 20

NEW YORK STATE HIV/AIDS CONFIDENTIALITY LAW PHL. Article 27-F (63.6) No person who obtains confidential HIV related information in the course of providing any health or social service or pursuant to a release of confidential HIV- related information may disclose or be compelled to disclose such information. Protected individuals- include not just those who are diagnosed with HIV or a related illness, but those who have undergone any HIV related test- even if the test results are not yet known, are negative, or are given to the person tested. Confidential HIV- related information Any information concerning whether a person has been tested for or diagnosed with HIV infection, HIV related illness, or AIDS. Any information that identifies or reasonably could identify a person as having HIV infection, HIV related illness, or AIDS, including. Information pertaining to such a person's contact (s) or partners. SIGNIFICANT RISK Three factors are necessary to create a significant risk of contracting or transmitting HIV infection. They are: 1. The presence of a significant risk body substance (blood, semen, vaginal secretions, breast milk, tissue and the following body fluids- cerebrospinal, amniotic, peritoneal, synovial, pericardial and pleural.) 2. A circumstance which constitutes significant risk for transmitting or contracting HIV infection: A) sexual intercourse (vaginal, anal, oral) "which exposes non- infected individuals to blood, semen, or vaginal secretions of an infected individual. B) Sharing of needles or other paraphernalia used for injection of drugs between infected and non-infected individuals. C) The gestation, birthing or breast-feeding of an infant by an HIV infected mother. D) Transfusion or transplant of blood, organs, or other tissues from an infected individual to an uninfected individual. E) Other circumstances such as significant risk body substances coming in contact with non-intact skin of a non-infected person. 3. The presence of an infectious source and a non- infected personSignificant risk factors do not include: 1. Exposure to urine, feces, sputum, nasal secretions, saliva, sweat, tears or vomitus that does not contain blood. 2. Human bites where there is no direct blood-to-blood contact 3. Exposure of intact skin to blood or any other body substance. 4. Occupational settings where accepted barrier techniques are used. (Universal Precautions) BASIC CONFIDENTIALITY RULE: You may not to disclose any confidential HlV-related information about a protected individual unless: 1. You have special proper, written HIV-specific consent required by the law, or 1. You are permitted to disclose it under one of the laws specific exceptions authorizing the information to be disclosed without an HIV-specific consent Any unauthorized disclosure in violation of state law may result in a fine or jail sentence or both.

Mod II-page 21

Affidavit of Confidentiality As an employee of an agency involved in providing care to patients/clients in their home or community, I am aware of my obligation to maintain their privacy and to protect their confidentiality in regards to their medical records and disclosure of any information related to them or their care. I am also aware that this obligation of confidentiality extends to personnel files of all employees. I am aware that it is my responsibility to take reasonable security measures to safeguard the patient/client's home care record (activity sheets, notes, assessment, etc) or employee personnel files against loss, defacement, tampering and unauthorized disclosure or use. This includes the following measures: • I am not to chart or expose patient/client information in public places where others may have the ability to see the information. • I am not to expose the patient/client's record or discuss information about one patient/client in another patient/client's home where others may have access to or over hear the information. • I am not to discuss any information about our patient/clients with any unauthorized persons. This includes any information related to HIV. • I am to keep patient/client information in a secure place in my home, a place that I alone have access to and is inaccessible to unauthorized persons including my family members or visitors to my home. • When I discard patient/client or employee related information, including weekly activity sheets, it must be put through a shredder. If I am outside the agency and do not have access to a shredder, I am aware that I can return the documents to the agency for shredding. • I am never to leave the patient/client or personnel records in a public place unattended. • I am to enclose all activity sheets/notes in an envelope marked CONFIDENTIAL for delivery to the Home Health Agency. • I am to refuse the release of any record (patient/client/employee) outside the agency except in the case of the patient/client's transfer to another health care provider, or as required by law or third party contract. I have been oriented to the agency policies on Confidentiality including their policy on confidentiality and release of HIV related information and agree to abide by all policies and understand that violation of these policies are subject to disciplinary action up to and including termination.

Employee Signature:

Date:

THINK SHEET - Mod II

1. What are the basic human needs & what does each need mean?

2. How would you introduce yourself to a new client?

3. What are some primary responsibilities of the family? 4. What are some ways you can calm a frightened client?

5. What would you do if your client yelled at you- hit you?

6. What would you do if your client refused to eat?

7. What are some things you would report to your nursing supervisor? What are some differences between individuals & families- will this influence the way you do your job?

Mod II-page 24

Module III

WORKING WITH THE ELDERLY

MODULE III UNIT:

Working with the Elderly A. What is Aging? B. Aging and the Body C. Aging and the Mind

TIME:

2 hours

OBJECTIVES: At the completion of this Module the student will be able to: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

Identify common attitudes towards aging. Recognize social factors that affect the elderly including family, finances, sex role differences, cultural and spiritual diversities. Identify the changes of aging on the body systems. Identify common health problems for each system. Observe and report any changes in the body. Recognize temporary changes in mental functioning and possible causes. Discuss permanent changes in mental functioning and give examples. Examine possible causes of stress. Identify physical and mental symptoms of stress on the body. Describe methods to handle stress.

SUGGESTED TEACHING METHODOLOGIES:

Lecture, Group Discussion

SUGGESTED EVALUATION METHODOLOGIES:

Written Exam, Class Participation

MODULE III UNIT A:

Working with the Elderly

What is Aging?

1. a. b. c. d.

Aging and the individual. Aging as a normal process. Individual variations in the aging process, Physical/Mental process. Influences related to the aging process.

2. a. b. c. d.. e. f. g.

Social factors and the elderly. The family. Finances. Sex role differences. Cultural/Spiritual differences. Communication and interpersonal skills and the elderly. Observing and reporting unmet needs. Maintaining confidentiality/ethical behavior.

Attitudes towards aging - personal/societal.

UNIT B: Aging and the Body/Body Systems 1. Define effects of aging, common health problems, care of the client and symptoms to report. a. Immune System. b. Respiratory System. c. Cardiovascular System. d. Skin (Integumentary System). e. Musculoskeletal System. f. Sensory System. g. Digestive System. h. Urinary System. i. Endocrine System. jNeurological System. k. Reproductive System. UNIT C: Aging and the Mind 1. a. b. c.

Mental and personality changes. Temporary changes in mental functioning and causes. Permanent changes in mental functioning and common problems. Caring for clients with memory loss or confusion.

Stress a. Causes and effects, i. Mental. ii Physical. b. c.

Coping mechanisms. Techniques to reduce stress.

3. Observe, record and report.

The Elderly Attitudes About Aging. What does the term "old" mean to you? A teenager may consider anyone over age 30 as old. A 30-year-old may think "old" begins at retirement age. An active 65-year-old may say that "old" is really just a state of mind. The ideas of old and aging are relative. Our attitudes and beliefs about aging are shaped by many factors: our past experience with older people, how society views aging, the state we are in, in our own life. When we label people as "old" we often fail to see them as unique individuals. We may forget that older people have different backgrounds, interests, and abilities. Think about your attitudes and beliefs regarding aging. ■

Do you think that old people:

• • • • • • • • • • • • •

are interesting to be with suffer from loss of hearing, poor eyesight and poor balance want to be waited on and cared for worry more about financial matters than younger people want to have social activities planned for them are set in their ways can manage their own affairs as well as anyone else are more suspicious and mistrustful of strangers than younger people can learn new things act very much alike are cranky and more complaining than younger people are almost always depressed enjoy life

Mod III-page 1

Aging and the Individual, a. Aging is a normal, gradual process. b. Each person ages in his or her own way. c. Aging is physical/mental rather than a matter of years. d. Aging is influenced by inherited factors, life, experiences, stress, diseases.

ii.

Basic human needs and the elderly. a. Basic human needs (self-fulfillment, self-worth, belonging) are the same for the elderly. b. Desire for independence. c. Home care workers can assist the elderly in meeting these needs by: 1. Respecting the older client as an adult, not treating him or her as a child. 2. Addressing the older client as Mr., Mrs. or Miss. 3. Encouraging the older client to make his or her own plans/decisions.

III.

Social factors and the elderly. a. The family. 1. Today many elderly persons live alone rather than with their children. 2. Most children care about aging parents but may be unable to provide the help they need. 3. With home care services, many children can and do provide part of their parent's care. b. Finances. 1 Problems related to living on a small, fixed income. 2. Home care worker is often the key team member in observing signs of an elderly person's financial problems. c. Sex role differences. 1. May have prevented a man or woman from learning how to perform various tasks earlier in life. 2. Home care workers need to be aware of own attitudes regarding what tasks a man or woman should perform. REMEMBER: • Aging is a normal and gradual process. It happens but, at different rates for each individual. •

Age does not reduce the basic human needs of belonging, self-worth and selffulfillment

•

With help, elderly persons can learn, change, direct their own affairs, and remain in their homes and communities.

•

Social factors, such as family changes, financial pressures, and sex role differences, can affect the home care needs of the elderly. Mod Ill-page 2

Physical Changes of Aging-Systems of the Body, a. Immune system may become less effective. 1. Results: more likely to develop colds, flu, other infections; more time needed to recover from illness. 2. Needs: prevention of respiratory problems through basic hygiene. b-

Lung capacity may be reduced. 1. Results: inability to inhale as much air as before, difficulty raising mucous, pneumonia. 2. Needs: prevention of respiratory problems through basic hygiene.

Heart and blood vessels become less elastic, blood vessels may become clogged. 1. Results: decrease in circulation, increase in blood pressure. 2. Needs: regular physical activity, through certain strenuous activities may have to be limited.

Skin becomes thinner, wrinkled, drier. 1. Results: difficulty in maintaining body temperature, possibility of bedsores. 2. Needs: extra liquids in hot weather, extra clothing and heat in cold weather, limited baths, care for redness and small breaks in skin.

Bones may become brittle. 1. Results: bones break more easily, damage to joints may occur, movement may be more difficult. 2. Needs: more calcium in the diet, exercise, alertness to conditions that may cause falls.

Sensory changes may affect vision and hearing. 1. Results: cataracts, need for glasses, difficulty hearing wax buildup, loss of balance. 2. Needs: basic household safety measures, assistance with movement, alertness for indicators of failing vision or hearing.

Stomach and digestive tract may decrease in activity. 1. Results: constipation, other digestion problems. 2. Needs: tact and acceptance; alertness for painful, frequent, or decreased urination.

Age-related sexual changes. 1. Results: although sex ability and interest are highly individual, physical health may affect sexual ability. 2. Needs: respect for privacy of older couples. Mod Ill-page 3

Organs/Systems of the body Skin

Expected changes with age Fatty layer thins. Skin wrinkles, becomes dry and more fragile. Body temperature can be hard to maintain.

Bones (and joints)

Bones may become brittle. Arthritis may decrease movement and cause pain. Muscles of bladder and bladder opening may weaken. Bladder infections may occur.

Urinary System

Sense Organs

Digestive System

Cardiovascular System

Cataracts and/or farsightedness may occur Nerve damage and/or wax buildup may decrease hearing. Vision and hearing loss may affect balance. Slowed digestion and/or constipation may occur. Dental problems may make eating difficult. Heart and blood vessels may become less elasticVessels may become clogged with fatty deposits-

Guidelines for care Extra liquids in hot weather. Extra clothing and heat in cold weather. Limit number of baths. Watch for redness and small breaks in skin. Home must be kept safe and accident-free. Proper footwear. Accept loss of bladder control with tact. Be alert for painful, frequent, or decreased urination and report to supervisor. Observe actions for signs of vision and/or hearing loss.

Use diet high in fiber to prevent constipation. If eating becomes difficult, be alert for dental problems. Need to watch for shortness of breath, swelling in feet and ankles.

Mod Ill-page 4

REMEMBER: Colds and infections are more common. Basic hygiene and other preventive measures are necessary. The heart and blood vessels lose their strength. Major physical stress should be avoided. However, simple exercise such as walking should be encouraged. The skin thins. Care is needed to maintain body temperature and avoid sores. Bones break more easily. Accident prevention is therefore important. Vision and hearing loss may occur. Balance and communication problems can result. Digestion may slowdown. Constipation can be a problem. Changing diet and meal time may help. Encourage to drink water. Bladder control may be affected. Sensitivity to this problem is important. Sex can still be part of an elderly person's life. Privacy must be respected.

Mod III-page 5

Just as each elderly client with whom you work will have different physical abilities, each client will have different mental abilities and a unique personality as well. You learned how aging affects the body. Now let's look at how aging affects the mind. Do we automatically become more forgetful with age? Are confusion and depression normal mental states of the elderly? Do we lose he ability to concentrate as we get older? The answer to all these questions is no! Yet the label "senile" is often applied to people on the basis of age alone. There are many incorrect ideas about how aging affects the mind. Few, if any, changes in personality or mental function occur as a result of the natural aging process alone. And, just as the physical effects of aging vary from person to person, the psychological effects vary as well. For example, some older people may react more slowly to what is said to them. But does this mean that their mental functioning is impaired? Not necessarily. Reactions may slow simply because the elderly person takes more time to answer thoughtfully or act carefully. Physical problems such as hearing loss or poor eyesight can cause slower reactions too. (Although physical problems may also slow the learning process, old age does not lessen the basic ability to learn.) Normally, an individual's personality stays fairly stable throughout his or her lifetime. The easily irritated baby may become a "difficult" adult, then, in later life, a "cranky" senior citizen. Likewise, an easygoing baby may become the adult who can "roll with the punches" and a relaxed senior citizen who seldom gets upset over daily annoyances.

Mod III-page 6

Temporary Changes in Mental Functioning Temporary changes may be caused by: Mild Strokes. A stroke is a break in a blood vessel of the brain. Prior to a major stroke, a series of small strokes often occur. Symptoms of a mild stroke include dizziness, minor blackouts (even for just a few seconds), and sudden lapses in memory (for example, a person suddenly has trouble remembering your name when he or she had no problem doing so before). A major cause of strokes is high blood pressure. Certain diseases of the heart, lungs, liver and kidneys. These conditions reduce blood circulation and the brain's oxygen supply. Diabetes and certain other conditions affecting sugar levels in the body. The energy supply to the brain is reduced. Mental functioning declines. Head injuries, brain infections or tumors, high fever. Poor nutrition. Eating the wrong foods or not enough food can affect normal mental and physical functions. Alcohol use. Some elderly people find that moderate alcohol use (a glass of wine before a meal) can help them feel more relaxed and alert. Alcohol increases blood circulation. However, excess blood slows brain functioning. Drugs and drug interaction. Mental confusion, depression, or other symptoms associated with senility can often be traced to drug-related problems. Most elderly people take one or more prescription drugs. They often use "over the counter" (OTC) drugs as well. (OTC drugs can be purchased in drugstores without a prescription. They include aspirin, laxatives, cold remedies, and sleeping or digestive aids.) All drugs, prescription or OTC, can cause side effects. As more drugs are used, the chances of drug-related problems increase. Improper drug use, such as taking too much or too little medicine, can also cause problems. Alcohol is also a drug. When used with other drugs, such as sedatives or tranquiiizers, the results may be dangerous. As a home care worker, you should be alert to any sudden or unusual changes in personality, behavior, or mental functioning. When you are assigned to help an elderly client who has been labeled "senile", keep an open mind and an open eye. Discuss your observations with your supervisor. With proper treatment, normal personality and mental functioning can be restored or improved. The changes of recovery are best when observations are noted early and treatment begins promptly. A better diet, a change in drugs, drug dosage, or other care may be all that is needed to improve or restore mental functioning. Mod Ill-page 7

Permanent Changes in Mental Functioning Not all changes in mental functioning can be treated. Some conditions cause permanent brain damage. Different parts of the brain control vital functions such as speech, movement, memory and mental ability. Other areas of the brain control the emotions. When permanent brain damage occurs, the effects that will be observed depend on two factors: 1. 2.

How much brain damage has occurred? The location of the brain damage.

Permanent damage may be caused by: Disease of the blood vessels. As some people age, fatty deposits build up in the blood vessels of he brain. (This condition is sometimes called "hardening of the arteries.") The blood vessels narrow and the brain receives less oxygen. This reduces mental functioning. Memory loss is common. Generally, forgetfulness relates to very recent events. Major strokes are caused by high blood pressure and blood clots to the brain. A major stroke may leave a person unable to move or speak, yet his or her mental functioning may not be affected. The after-effects of a major stroke are often permanent particularly in elderly persons, in some cases, however, proper treatment can improve a person's physical and/or mental state. Head injuries, tumors, or alcoholism can permanently damage brain cells. Changes in mental functioning and personality may occur. Alzheimer's disease which most often strikes people between the ages of 40 and 60, permanently effects mental functioning. This disease causes a progressive decline in mental ability; over a ten-year period, normal adult mental functioning declines to the level of a young child. The cause of Alzheimer's disease is unknown. So far, there is no treatment that can prevent or cure this illness. Even though some elderly clients may have permanent brain damage, you can usually help them improve and enjoy their lives at home. What could you do to help a forgetful elderly person? â&#x20AC;˘ devising simple reminder systems (calendars, notes, timers or even a string tied around a finger) for appointments and medications â&#x20AC;˘

keeping belongings in the same place inside the home

Mod IlI-page 8

â&#x20AC;˘ establishing set routines during your home visit. A regular schedule will help the elderly person know what to expect when you arrive Where possible, praise accomplishments, no matter how small. Overlook confused statements. Remember that even when mental functioning declines, emotional needs and feelings do not. The Confused Patient 1. Changes in mental state may be the first sign of illness in the elderly (stroke, pneumonia, cardiac failure). 2.

Aging doesn't mean senility in most cases.

3. a) b) c)

A new environment may bring on senile behavior: Be optimistic, may be temporary. Accept the patient's criticism. Pay attention to what the patient is saying, often confusion is only temporary and a great deal of what he says makes sense. Call him by name each time contact is made. Touch him when you speak to him. Talk directly to him. Tell him your name. Answer questions in simple, short sentences. Remind him of time, date, and place. Keep a calendar and clock, both with easily readable numbers within his range of vision. Keep the room well lit to reduce confusion and fear. Keep his personal belongings where he can see and use them, Maintain a calm environment, remove stressful stimuli, Arrange visits from family and friends, have them sit by patient so he can see them and touch them, many aged patients have no one to touch them Try warm baths, warm milk, back massage, understanding and compassion, See that the patient wears his glasses, hearing aid, dentures or other prosthesis. Be sure he's drinking enough fluids, Do not argue with confused statements, avoid letting the patient ramble direct him back to reality, be consistent, Schedule patient's daily activities and adhere to a schedule (to promote security).

d) e) f) g) h) i) j) k) I) m) n) o) p) q) r) s)

Mod Ill-page 9

Stress and the Elderly When you become excited, anxious, or upset, how do you feel physically? Does your mouth become dry? Does your heart start to pound? Do your muscles tense? These are a few of the physical reactions to stress. Stress also affects the mind. When people are under stress, they may have trouble thinking clearly. They may find it hard to concentrate or make decisions. Each day you face situations that make physical and emotional demands on you. Stress is the physical and emotional response to those demands. Both "good" and "bad" events, such as losing a job, can be stressful. Both types of events involve making changes and adjustments in daily life. What causes stress? Listed below are some life events that produce stress: • • •

• • •

Marital problems Death of a spouse, family member, or friend Separation of or changes in families Personal illness or injury Moving to a new residence Change in eating or sleeping habits Change in normal daily activities (examples: boredom, a vacation) Retirement or change of job Change in income (increase or decrease) Limited financial resources

Look at the list again. Check the causes of stress that often apply to elderly persons. Sometimes little attention is paid to the fact that elderly people can suffer from stress. Consequently, the stress they are experiencing may be misdiagnosed or overlooked. As a home care worker, you not only need to understand the causes of stress in the elderly, but you also need to know its effects and how you can help your clients to cope with stress. The effects of stress Some stress in life is helpful. The stress of starting a new job can make your work harder and help you do your best. But stress has a harmful side. Doctors have found that too much stress can harm a person's physical or mental health, either by causing problems or making them worse.

Mod Hi-page 10

The following is a list of symptoms that may mean stress is a problem. Physical Symptoms skin rashes headaches upset stomach, heartburn sleep problems (sleeps a lot, can't sleep) muscle spasms poor appetite

Mental Symptoms confusion forgetfulness irritability inability to concentrate or make decisions anxiety lack of interest in normal activities or in life in general

As a home care worker, it is important for you to recognize these signals. Whenever they occur suddenly or persist over time, physical or mental problems may be starting. Those problems may be related to stress. Because stress affects both the mind and the body, symptoms in one area can mean problems in another. For example, many older clients suffer from depression. Confusion can be a sign of depression. However, poor appetite and sleeping problems can also be signs of depression. Coping with Stress During our lives, we each develop ways to cope with stress. When you feel sick, do little things upset you? When you are well and strong, it is easier to cope with stress. Physical problems and fatigue often make it harder for elderly people to cope with stress. Do you find it easier to handle problems when you have the help of family and friends? The social support of others can ease the harmful effects of stress. As a home care worker, you may be an elderly client's basic source of social support. When you show warmth and personal interest in your client, you give him or her social support. Your support alone may help reduce stress and prevent physical or mental health problems. You can also help reduce stress for your elderly client in other ways. Try to provide extra support during periods of change. Remember that an upcoming family visit can be just as stressful as when a family fails to call. Whenever possible, encourage and help with elderly to become involved with family and friends, and the community. Phone calls, letter-writing and other activities can help maintain or strengthen social support. Home Safety Checklist for Seniors Household mishaps rank second only to highway accidents as a cause of accidental death in the U.S. and nearly 10,000 adults age 65 or older die each year from accidents in the home. Falls are the leading cause of accidental death at home among those 65 or older, followed by fires and burns. Here are some home safety tips for seniors:

MOD III -page 11

Around the house o Install carbon monoxide detectors. o install smoke detectors; replace batteries every year. o Keep fire extinguishers in the workshop, kitchen, and garage. o Make sure all stairways are well lit. o Keep a medical encyclopedia or first-aid guide available in case of  accidental injuries.  Remove scatter rugs. Kitchen o Never use a chair, table or box as a ladder. Use a small ladder or step o stool, and, if possible, have someone hold it for you. Store heavy objects o on low shelves. o Install smoke detectors; replace batteries every year. o Keep fire extinguishers in the workshop, kitchen, and garage. o Make sure all stairways are well lit. o Keep a medical encyclopedia or first-aid guide available in case of  accidental injuries.  Remove scatter rugs. Bathroom o Use a rubber mat or adhesive-backed appliques in the bathtub or shower stall and install sturdy handrail on the wall over the tub. Use only nonskid rugs in the bathroom and throughout the house; avoid small throw rugs. o Because of the possibility of error, never take medicines in a dark room. o Don't take medicine prescribed for someone else, and throw out old medications. o Never bring a portable heater into the bathroom, never use a hairdryer near the bathtub. Bedroom o Set central heating at a temperature low enough to prevent a burn if the radiator is accidentally touched. o Don't hang clothes to dry over a portable heater or place a heater near curtains, and never dim a lamp by covering it with clothes. Discard electric blankets if their electrical parts become worn or broken, and never smoke in bed. o Make sure that carpets or the floor coverings are in good repair. Watch for loose rugs on a polished floor. The Garage and the Yard o Keep the garage well-ventilated and never smoke in the garage. o Keep barbecues away from combustible materials, and never leave fires unattended. o Secure ladders and sharp tools to prevent them from falling, and never leave lawn and garden tools lying around. o Keep outside steps clean, adequately lit and in good condition.

Mod Ill-page 12

GROWING OLD-A SPECIAL TIME IN LIFE'S PROCESS Society in this country thinks that growing old is a tragedy. Yet today 1 out of 10 people are over 65. Many people over 65 are employed, live full, active lives. The people you will be caring for have had some illness which has changed their life style, both physically and emotionally. You will be an important part of their returning to active, happy life styles as their condition merits. Remember this man or woman you will be caring for is not your Granny, Pop, Uncle Bill or Aunty Sue, anymore than you are Sis, Girlie, the Maid, or housekeeper, so introduce yourself in a pleasant manner. "Good Morning Mr. _____ , Mrs. _____ , I'm Mrs. Kelly." A smile, a quiet manner, a confident approach, will generally calm any fears and reassure the patient. Important things to know and remember in caring for the elderly: Stress: Pressure of society, lack of income, physical changes, of growing old deprives the elderly of their independence and often their dignity. Condition Helplessness Older people feel powerlessness; unable to change themselves or their situation. They may be bitter, fear dependency, refuse to accept responsibility, lose confidence and interest in routine tasks. Physical deterioration. Lack of Mobility Older persons with loss of movement leads to feelings of inadequacy and poor seif-image, remembering how they once were can discourage them from accepting reality and adjusting to their new limitation. Example, increased time, effort, and energy required to carry out a simple task. They may lose their enthusiasm for doing anything involving physical activity.

Solution Allow each person to make choices and decisions whether in selection of meal planning, choice of clothing, etc. Attempt to involve them in Senior Citizens, Church groups, etc.

You must encourage support and teach them how to use remaining abilities. In some cases, equipment and devices may aid in increasing their comfort and making simple tasks easier.

Mod III-page 13

Condition

Forqetfulness Unlike young people who are forgetful, older people feel guilty if they cannot remember dates, events, etc. They may cover up their frustrations by making up answers, withdrawing or ignoring you. Remember their forgetfulness may have another explanation, loss of sight, hearing, or they simply may never have heard or have knowledge of information they are supposed to know. Loss of Senses Many older people have loss sight, hearing, and sense of touch. This may be accelerated by diseases, e.g. diabetes, strokes, cataracts, etc.

Loneliness Loss of hearing, vision, physical changes have a way of isolating older people.

"I cannot change yesterday, I do not know what tomorrow will bring, I will make today special."

Solution

Write down on a calendar or in a notebook, record appointments, mark off each day. This helps remind older people (or younger ones) of passing days or events. Have them read newspapers, watch T.V., listen to the radio to keep in touch. When talking with an older person, speak clearly, allow time for response.

Encourage safety, confidence and security- Attempt to keep their environment safe. Moving furniture from accustomed places may cause a blind person to fall. When talking to someone with a hearing loss, face them directly, speak in a low clear voice. Do not cover your mouth. Use written aids with the hard of hearing. Encourage people with poor eyesight to touch objects in their surroundings. Those with loss of touch may need reminding about dangers of a hot stove, hot water radiators, etc.

Stimulate, keep calendar appointment books and clocks in room to remind them of time and dates. Listen to the radio, watch T.V., and read newspapers to keep them involved with events. Contact with others, Senior Citizens, and church groups for socialization. They need to feel needed, capable and wanted. Mod III â&#x20AC;&#x201C; page 14

When you work with the elderly, apply the information you have learned in this unit. • Report and record any sudden or persistent changes in mental functioning, personality, or behavior. • Observe habits related to nutrition and alcohol and drug use that may cause problems. • Provide help to forgetful elderly clients by devising simple reminder systems and establishing set routines. • Provide social support to your elderly clients to help them cope with stress.

Mod IIl-page 16

Vocabulary List Module III Alzheimer's Disease:

A disease that causes permanent brain damage, strikes people between the ages of 40 and 60. Cause is unknown.

Cardiovascular System:

The system that carries blood throughout the body.

Cataract:

A clouding of the lens of the eye which prevents good vision.

Digestive System:

The system that breaks down food into parts that can be absorbed by the body.

Disoriented:

Not able to identify the correct time, person or place.

Immune System:

The system that defends the body against infections.

Osteoporosis:

Loss of calcium from the bones which make them weak. They break more easily. The older person needs to increase calcium in the diet to keep bones strong.

Reproductive System:

The body system involved in the process of producing children.

Respiratory System:

The body system involved with breathing and bring oxygen into the body.

Senility: Sedatives:

A word used to mean mental aging or confusion. Medications that calm nervousness, irritability and excitement. These often cause drowsiness.

Stress:

Conditions that cause strain or tension.

Stroke:

A break in a blood vessel or a blood clot in the brain. This often causes confusion, paralysis and other symptoms. Medications that calm nervousness, but usually do cause drowsiness.

Tranquilizers:

Urinary System:

This system removes waste from the body.

Mod III- page 17

Think Sheet Module lIl 1. What determines aging?

2. Some causes of temporary mental changes?

3. What can cause stress in the elderly?

4. Elderly people can learn new roles around their home?

5. Older people want others to make decisions for them?

6. What are some permanent causes of mental changes?

7. What are some things you should report to your nursing supervisor regarding your elderly patient.

8. If your patient forgets something or accidentally wets him or herself, what are some thing you can say or do to handle this situation?

9. What can occur in the systems (cardiovascular, skeletal, skin, pulmonary, immune, digestive) as we age? MOD III â&#x20AC;&#x201C;page 18

Module IV WORKING WITH CHILDREN

MODULE IV UNIT:

T I ME:

Working with Children

Family Situations in which Children May Need Home Care Workers

How Children Develop and How to Work with Them

Problems that affect the Family and How Children React to Stress

How You Can Help Strengthen Families through Work with Parents or Caregivers

60 minutes

OBJECTIVES: At the completion of this Module the student will be able to: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

Describe the situations in which children may need Home Care Workers Identify at least one way a Home Care Worker can assist a caregiver in meeting each of the five basic human needs List the five stages of child development List some typical behaviors of children at each stage of development Describe ways in which the Home Care Worker can help children in all five stages of development Identify ways to use the four keys to good communication when working with children at different ages List several stressful problems that occur in families Describe how young children, school-age children, and adolescents may react to family problems/stress Describe how stress may affect a family's ability to meet basic human needs Identify several ways to work with parents and caregivers to strengthen families

SUGGESTED TEACHING METHODOLOGIES:

Lecture, group discussion

EVALUATION METHODOLOGIES:

Written exam, class participation 27

MODULE IV

Working With Children

OUTLINE:

Unit A

Family Situations in Which Children May Need Home Care Workers

1. a. b. c. d. e. f. g.

Family situations in which children may need Home Care Workers: Chronic illness of child or parent Disability Prematurity Post-trauma Inexperienced or overwhelmed parent Death or desertion of a parent Domestic violence, abuse, neglect, drug abuse or alcoholism by either parent

2. a. b. c. d. e.

Five basic needs: Physical needs Safety and security needs Belonging needs Self-worth needs Self-fulfillment needs

Unit B 1. a. b. c. d. e.

How Children Develop and How to Work with Them

Child growth and development - physical, psychosocial and play Infant - Birth to 12 months Toddler- 1 to 3 years Preschool - 3 to 6 years School age - 6 to 11 or 12 years Adolescent - 11 years to 19 years

Unit C

Problems That Affect the Family and How Children React to Stress

1. a. b. c. d. e. f.

Environment Socioeconomic status of family Family dynamics Illness and injuries Mentally challenged Alcoholism and drug abuse Domestic violence

2. a.

Stress Effects on family 28

Unit D

Effects on children in all stages of development

How You Can Help Strengthen Families Through Work With Parent or Caregivers

Keys factors in working with parents and families a. Understanding family roles and functions b. Understanding family dynamics and responses to illness and stress c. Working with families i. Show respect for family's resources, lifestyle and culture ii. Address caregiver's needs at beginning of each visit iii. Model positive parenting techniques

Role of the Home Care Worker a. Observing/Reporting b. Communicating with the home health team

Children I.

Examples of family situations in which children may need Home Care Workers. a. Chronic illness of parent or child. b. Disability. c. Prematurity. d. Post-trauma. e. Overwhelmed parent. f. Death or desertion of parent. g. Domestic violence, abuse, neglect, parental drug or alcohol abuse.

II.

Role of the Home Care Worker in family in which mother is hospitalized or incapacitated. a. Feed and care for children, get them to school, supervise homework. b. Keep house clean and orderly, cook, shop. c. Provide support to children (comforting, understanding, helping them emotionally).

HI.

Role of Home Care Worker in family in which healthy development of children is in danger. a. Care for children, keep house clean and orderly, cook, shop, etc. with the parent(s). b. Encourage and motivate parents to take care of the family themselves. c. Demonstrate, explain to parents how to do things (role model). d. Show respect for family's resources, lifestyles, culture etc.

IV.

Always remain aware of the child's Five Basic Needs. a. Physical. b. Safety and Security. c. Belonging. d. Self-worth. e. Self-fulfillment.

REMEMBER: There are two types of family situations that require a Home Care Worker to work with children. â&#x20AC;˘

When the caregiver is absent or incapacitated due to illness, injury, or disability, the Home Care Work provides care directly to the children.

â&#x20AC;˘

When home management has broken down and the children's healthy development is threatened, the Home Care Worker assists and teaches the caregiver how to care for the children and manage the home.

Mod IV page -1

Working with Parents I.

Working with Parents a. Key factors: 1. "Work with" rather than "do for". 2. Demonstrate and perform skills. 3. Suggest and lead, rather than order. 4. Have patience. 5. Recognize progress and change, even when slow. 6. Show respect. 7. Motivate parents to make changes. To feel a sense of accomplishment when working with parents. Home Care Workers will need: a. Understanding of human behavior. b. Common sense. c. Sense of humor. d. Ability to work closely with others on home care team. e. Self-awareness. 1. Acceptance of own feelings. 2. Acceptance of parent's behavior.

III.

Home Care Worker's understanding and acceptance of families with stressful problems lead to ability to: a. Communicate confidence to the parents. b. Establish climate that encourage change. c. Encourage planning and goal-setting. d. Begin where parent is and build from there.

Mod IV page 2

Working with Children I.

Family problems that cause stress: a. Retarded or inexperienced parent. b. Illness or death of either parent c. Overwhelmed parent. d. Parents who abuse alcohol, drugs. e. Handicapped family member who requires extensive care. f. Abuse or neglect.

II.

Effects of stress on family: a. Basic human needs are not met. 1. Parent's needs. 2. Children's needs. b. Factors that affect child's response to stress. 1. Age of child. 2. Cause(s) of stress. 3. Severity and duration of stress. 4. Frequency of occurrence of stress.

III.

Tvpical stress responses in young children: a. Excessive crying, clinging, b. Fears of the dark, nightmares. c. Refusal to eat, nap. d. Change in toilet habits.

IV.

Tvpical stress response in school-age children a. Rebellion against usual routines (school, dressing, bathing). b. Truancy from school. c. Guilty feelings. d. Daydreaming. e. Lying, cheating, stealing.

Tvpical response of adolescents a. Staying out late or all night. b. Becoming involved with anti-social groups. c. Dropping out of school. d. Abusing drugs or alcohol. e. Running away from home.

VI. Role of home care workers with parents who are inexperienced or have limited learning ability a. Begin with basics. b. Respond to basic human needs. c. Use four keys to good communication. Mod IV page 3

VII.

Parents with alcoholism or drug abuse problems a. Discuss with supervisor. b. If not known to agency, report observations to supervisor.

VIII.

Domestic violence a. Report suspicious bruises or injuries to supervisor. b. Pian with supervisor when to leave, if necessary, and how to get help if you are threatened.

REMEMBER: •

Stressful family situations include:

•

Physical or mental illness of either parent or other family member.

•

Death or desertion of either parent.

•

Parents who need guidance and instruction in the needs of the family because of inexperience or limited learning ability.

•

Single parent who become overwhelmed with large family.

•

Alcoholism or drug abuse by caregiver or other in the family.

•

Physically or mentally handicapped family member who requires a great amount of care.

•

Domestic violence.

•

Abuse or severe neglect of children.

Also: •

That children respond to stress in different ways when their basic needs are threatened.

•

That you can help children cope with stress in the family by learning to see the signs of stress in children and helping to meet their basic needs.

•

That it is important to work closely with your supervisor when alcoholism, drug abuse, or domestic violence has occurred or is suspected.

Mod IV page 4

You can help strengthen families You can help strengthen families by: •

"Working with" rather than "doing for"

•

Demonstrating skills as well as performing them

•

Suggesting and leading, rather than ordering

•

Having the patience to go slowly and repeat if necessary

•

Recognizing progress and change

•

Accepting progress that is slow

•

Showing respect for individuals and families with whom you work

•

Motivating them to want to make changes in themselves and in their surroundings

Mod IV page 5

Developmental Guidelines

STAGE Infancy

APPROXIMATE AGE Birth to one year

Toddler

One to three years

Pre-school

Three to five years

Middle childhood

Six to twelve years

Adolescence

Thirteen to Seventeen years

CHARACTERISTICS Period of rapid growth. Totally dependent on others. Develops trust when needs are met gently and lovingly. Learns to differentiate mother from others.Birth weight doubles at six months, triples at one year. Great curiosity. Developing a sense of self. "No" is a favorite word. Toilet training period. Can learn limits of permissible behavior. Fears of thunder, engines, the dark, or strangers may develop. ___________ Imaginative and curious. Learning to play with others. Young pre-schoolers may be possessive. Imaginary friends are common. Very active. Can be taught to pick up toys or run simple errands. Imitate older children and adults. Period of exploration of outside world. Start to move away from strong emotional dependence of earlier years. Opinions of teachers and certain other adults become importantWant to be with friends. Team sports are popular. Need for privacy. Puberty begins. Time of rapid physical change-Struggling to be independent Very sensitive, tend to have unexplained emotional outbursts. May feel selfconscious and awkward. Influenced by peer pressure. Idealism often develops, with a keen sense of values. Need to be listened to, accepted, and encouraged by adults.

Mod IV page 6 M o d I V

General Guidelines For Working More Effectively With Children A. Develop good relationships 1.

Don't force yourself upon the child:

Create a friendly, interested atmosphere, and the child will usually come to you. Children have a sense of knowing when you do not care for them. 2. Treat each child as an individual: Respect his or her feelings, wishes, etc. as you would want to have yours respected. Be kind, sympathetic, and understanding. All persons react favorably to these attitudes. Children thrive on them. 3. Speak softly and quietly; this invites friendship. Smile often. B. Discipline constructively. Good discipline often makes punishment unnecessary. 1. Don't play one child against another. This tends to create jealousy. 2. Emphasize each child's good points instead of his or her bad ones. 3. Don't compare children within the family. Instead, emphasize individual progress. 4. Use discipline with affection and love. 5. Use positive suggestions in working with children, such as "let's do this." Avoid using "no" and "don't" as much as possible. 6. Understand that behavior reactions often occur without any apparent reason. 7. Be consistent.

C. Promote desirable behavior 1. Gentleness and firmness help to establish self-discipline in children. 2. Use suggestions and requests instead of commands. Reward desired behavior with praise or in other ways. 3. Explanations and directions should be clear and simple. Be sure that the child understands what you want.

Mod IV page 7

Comfort the child who is hurt or upset 1.

An outstretched hand or the touch of a hand often soothes a disturbed or upset child.

A warm bath may relax an overly tired, fussy child.

Encourage good health habits and cleanliness 1.

Emphasize washing hands before meals, brushing teeth, basic grooming.

Bathe children daily before bedtime, or as necessary. Always test the water. Never leave young children alone in the bathtub.

Encourage children to assume some responsibility for themselves and to participate in family chores suitable to their age level 1. They can pick up and put away their toys, dress themselves, hang up clothes, and so on. 2.

They can help with dishes, run errands.

Remember that with young children, interest wanes after a short time. Don't overburden them.

4. G.

Make a game out of work. Use imagination in working with children.

Make mealtime a happy time 1.

Encourage children to eat, but don't force them. Like adults, children have "off' days when food isn't interesting.

Make food attractive but serve plain, simple dishes.

Encourage children to help plan and prepare "special treats" such as pudding for dessert, if they are old enough to do so.

Use common sense about "between-meal snacks." There is no harm if the right kind of food is given at a sensible hour.

Recognize that individual reguirements for sleep vary 1.

Follow the sleeping habits established in the family.

Going to bed should be a happy, relaxing time.

Respect the child's ritual before bedtime.

Don't overexcite the child before naptime or bedtime: avoid stories that might over stimulate him or her, avoid very active play. Mod IV page 8

Encourage play, a natural part of childhood 1.

A suitable place and materials that interest children are important. Emphasize activities other than watching television.

Participating in play activities with other children should be arranged.

Answer questions when they are asked 1.

Try to make your answer(s) simple, clear and direct.

Don't evade.

Mod IV page 9

Working with Children

Role of Home Care Worker A. Be alert for signs of delayed development. B.

Report observations to supervisor.

C. 1. 2. 3. 4.

Communicate with children. Make a good first impression. Show acceptance. Build a helping relationship. Handling special problems.

Establish routines.

Model positive parenting techniques.

Communicating with the home care team.

REMEMBER: Stages of development: • Infancy • Toddler • Pre-school • Middle childhood • Adolescence

Also: • It is important to discuss any questions about the growth, development, or behavior of children with whom you are working with your supervisor. • You can use the four major keys to good communication in working with children.

Mod IV page 10

Vocabulary List Module IV

Developmental stages:

Childhood divided into age spans: infancy (birth to one year), toddler (one to three years), pre-school (three to five years), middle (six to twelve years) and adolescence . (thirteen to seventeen years).

Epilepsy:

A disorder of the nervous system, which sometimes causes a loss of consciousness and convulsions.

Epileptic Seizure:

An attack suffered by an individual who has epilepsy. During an attack an individual loses consciousness and has very light or very severe spastic movement of the body.

Motor Development:

Having to do with the movement of the body's muscles. This includes such things as a child's gestures, facial expressions and mannerisms.

Multiple Sclerosis:

A chronic disease that causes nerve damage. It can affect many different parts of the body.

Psychological Development:

Mental growth and how it is related to the behavior of an individual.

Puberty:

The stage of childhood in which reproductive organs become functional and when secondary sex characteristics develop. Delayed mental development.

Retarded:

MOD IV page 11

Think Sheet Module IV

What are some keys to good communication?

What are some behaviors you might find in a toddler - pre-schooler adolescent?

Why do people feel stress?

How may children respond to stress?

What is your role in caring for children where home management has broken down and the children are at risk?

6. In a home where the caregiver is unable to meet a child's needs, what would be your main function?

7. Do all children grow and develop at the same rate?

Mod IV page 12

Module V WORKING WITH PEOPLE WHO ARE MENTALLY ILL

MODULE V UNIT:

Working with People who are Mentally III

A. What is Mental Health?

What is Mental Illness?

Mental Health, Mental Illness, and the Home Care Worker

TIME:

60 minutes

OBJECTIVES: At the completion of this Module the student will: 1 List four behaviors that indicate mental health 2. Discuss different coping mechanisms and techniques to handle stress 3. Compare mental health and mental illness 4. List three factors that are believed to cause mental illness 5. List two ways of treating mental illness 6. State the guidelines for observing and reporting unusual behavior 7. Describe different ways the Home Care Worker can help care for the mentally ill client 8. Describe ways that the Home Care Worker can maintain safety for the mentally ill client SUGGESTED TEACHING METHODOLOGIES:

Lecture, group discussion

EVALUATION METHODOLOGIES:

Written exam, class participation

MODULE V Unit A 1. a. b. c. d. e.

Working with People who are Mentally III OUTLINE:

What is Mental Health?

Mentally healthy people are able to; adapt to change give and accept affection develop good relationships control their impulses and accept responsibility for their actions accept disappointment tolerate a certain amount of anxiety and frustration respect themselves and enjoy the respect of others

2. Coping mechanisms that may be used by individuals to protect oneself from unpleasantness, shame, anxiety, or loss of self-esteem: a. make excuses b. blaming others c. making up for a lack in one area by being good in another d. avoiding unfavorable situations e. reverting to a less mature level f. transferring feelings from one person or situation to another g. blocking out thoughts or events

Unit B

What is Mental Illness?

1. a. b.

Describe mental illness Severe mild

2. a. i. ii.

Causes of mental illness physical factors brain injury chemical imbalance

b. environmental Factors c.

heredity

abnormal stress

Effects of mental illness

a. b.

Individuals families

4. a. b. c. d. e.

Types of mental illness abnormal anxiety abnormal fears (Phobias) abnormal sadness or grief (Depression.) abnormal ideas (Paranoia) abnormal thinking

5. a. b. c. d.

Treating mental illness mentally ill people can recover and lead normal lives typical outpatient treatment major treatment methods professional teams

Unit C

Mental Health, Mental Illness and the Home Care Worker

1. General guidelines for observing behavior a. Describe unusual behavior. When does it occur? How often does it occur? How long does it last? b. Does this behavior indicate a change in personality? c. Is this behavior or thought extreme? Is it appropriate to the situation? Is the behavior or thought harmful to the client or Home Care Worker? d. Do not draw conclusions about the causes of behavior 2. a. b. c. d. e. f.

Role of the Home Care Worker with mentally ill clients and their families Assist client with medication and report any changes Observe, record, and report what is happening in the home Assist with home management and personal care Promote mental health through reassurance, encouragement, guidance Preserve mentally ill person's authority and affection in the family Assist in the recovery process

3. Maintain safety for the client and the Home Care Worker a. Discuss plan of care with the nurse supervisor b. Maintain a safe home environment. Don't leave client unattended if the plan of care requires constant supervision c. Observe/ report noncompliance with medication or psychiatric treatment d. Call 911 for extreme behavior changes

Mental Health There is no single definition of mental health. Professionals agree that good mental health is indicated by such traits as the ability to: A. B. C. D. E. F. G. H.

Adapt to change. Give and accept affection. Develop good relationships with others. Control impulses and accept responsibility for their actions. Accept disappointment. Tolerate a certain amount of anxiety and frustration. Deal with problems of daily living in a constructive way. Respect themselves and enjoy the respect of others.

Ways to cope: Techniques used to safeguard mental health and protect oneself from unpleasantness, shame, anxiety, or loss of self-esteem. A. B. C. D. E. F. G.

Making excuses. Blaming others. Making up for a lack in one area by being good in another area. Avoiding unfavorable situations. Reverting to a less mature level. Transferring feelings from one person or situation to anther. Blocking out thoughts or events.

Mod V page 1

Coping With Stress How do you cope with life's stresses? At times, everyone uses different ways to cope with stressful situations. This is normal behavior. In a sense, these ways of coping with stress safeguard mental health. For a short time, they protect you against uncomfortable feelings of anxiety, guilt, and loss of self-esteem. Let's look at a few common ways of coping with stress that are a part of everyday normal behavior for all of us. •

A person makes excuses as a substitute for his or her real reasons for an action. Example: A secretary forgets to set the alarmclock, and oversleeps. Driving to work, she gets caught in rush-hour traffic. She arrives late and explains, "I was caught in a traffic jam."

•

A person blames others to cover up personal failure. Example: A Home Care Worker does not adequately review the care plan and omits a scheduled duty. She tells herself "The supervisor should have given more detailed instructions."

•

A person makes up for lack in one area by being good in another area. Example: A client who has lost the use of his legs learns how to paint, and becomes a skilled artist.

•

A person avoids an unfavorable situation. Example: A babysitter is caring for several active children who are indoors because it is raining. The children have been fighting all morning in the living room. The babysitter decides to go to the kitchen to prepare lunch.

•

A person reverts to a less mature level adjustment. Example: A Home Care Worker refuses a teenager permission to watch television until his homework is done. The teenager reacts childishly and throws a temper tantrum. He yells, throws a book on the floor, and slams his bedroom door.

•

A person transfers his or her feelings from one situation or person to another. Example: A Home Care Worker has had a very hard day with a difficult client. She feels angry toward the client but doesn't express it. Instead, she goes home and yells at her husband.

•

A person blocks out unpleasant thoughts or events. Example: Parents with a mentally retarded newborn insist that the child will someday attend college. Mod V page-2

Coping With Stress In these examples, different ways of coping helped ease stress temporarily. They helped people briefly avoid the reality of a situation. Think about how you have used different ways of coping with stress. For example: were you ever not invited to a party? Did you tell yourself that is wasn't really important anyway? If you did, you were making excuses. Have you ever "forgotten" to do a task that you found unpleasant? You were blocking out an unpleasant event Different ways of coping are but one example of the wide range of human behavior. Some are always positive and relate to mental health. Others, like transferring feelings from one situation or person to another, can be negative or positive, depending on the individual and the particular circumstance. For example, if you feel very happy about your home life, your good feelings may be transferred to your job. You may even feel like "whistling while you work." Since everyone uses these ways of coping at times, it can be helpful to recognize these behaviors not just in others but also in ourselves. Learning to observe and recognize them can help you handle situations in a more constructive manner. Consider the example of reverting in a less mature level of behavior that you just read. The Home Care Worker who observes and recognizes this behavior as a way of coping will react calmly in this situation. Once the teenager has cooled down, the Home Care Worker can discuss television viewing with him. She can explain her reason for restricting his viewing. Then can find out whether his avoidance of homework perhaps relates to difficulties in school. She would then report the situation to her supervisor so that proper help could be obtained for the teenager. Now, let's consider the example of blocking out unpleasant thoughts or events that you read. The Home Care Worker who observes and recognizes this behavior will be able to call it to the supervisor's attention. The supervisor, perhaps working with another team member, such as the social worker, can develop a plan that will help the family adjust to the difficult situation of having a mentally retarded child. These ways of coping are only a few of the means that all of us use to deal with stressful situations. As mentally healthy individuals, we also use other means, such as talking over the situation with a friend, taking part in strenuous physical exercise to release tension, or finding a rewarding hobby to relax us and give us a sense of accomplishment. As you have learned, one aspect of mental health is the ability to deaf with daily problems in a constructive way.

Mod V page-3

REMEMBER: Behavior that is related to mental health: â&#x20AC;˘

There are different degrees and signs of mental health. In general mentally healthy people can get along with others and cope with stress in life.

â&#x20AC;˘

All people use ways of coping at times as a means of dealing with stress. Recognizing these ways of coping in yourself and your clients can help you become a more effective Home Care Worker.

Mod V-page 4

Mental Illness What is mental illness? When we think of mental illness, we are usually thinking of an illness which affects a person's mind. A person who is mentally ill can't cope with his life situation any longer. He may show this in many different ways. Perhaps he threatens to kill himself or he tries to escape through alcohol or drugs. He may do the same thing over and over, such as washing his hands dozens of times a day or he imagines he sees and hears things. Causes: a)

Heredity

Age

Mental illness rises sharply during adolescence, menopause and after age 65.

Alcohol

Excessive intake is both a cause and a symptom.

Drugs

When used frequently results in personality disorder.

Trauma

Damage to brain tissue may cause mental symptoms.

Psychological Factors

Include situations that give rise to sense of insecurity, injury to self-esteem and feelings of guilt.

Definitely has significance, however, not all forms of mental illness are transmitted through the genes.

Description of mental illness a) Ranges from severe to mild. b) Severe forms: psychosis 1. loss of contact with reality 2. inability to function at home, work, elsewhere 3. loss of abilities to think, communicate, remember, feel emotions, make decisions c) Mild forms 1. most mental illnesses are mild 2. persons are able to function, but below their full capacity

Mod V page-5

Causes of Mental Illness Why do some people become mentally ill while others remain sound? Mental health experts cannot fully answer this question. Mental illness can strike anyone: People of all ages, race, nationalities and economic level can be affected. Mental illness has nothing to do with intelligence. People, who are very smart, as well, as those who are not can suffer from mental illness. These causes of mental illness are still being studied. However, it is believed that one or more of the following factors is involved: • Physical factors. Whenever the brain is injured or damaged, changes in personality and behavior may occur These changes may be permanent or temporary. Accidents, high fever or infections, strokes, certain diseases, abuse of alcohol or drugs, and poor nutrition are some physical factors that can affect the brain. Many experts think that the discovery of natural chemicals in the brain indicate that mental illness is really a physical problem. • Environment. A person's home or social environment, particularly during childhood and adolescence, may have a strong effect upon his or her later behavior. Children who grow up in an atmosphere of constant tension may not develop a healthy self-image because their basic needs are not being met. They may suffer from a damaging loss of self-esteem, which can lead to mental illness. • Heredity. Some aspects of mental illness such as depression occur more often in certain families. Experts disagree on what this fact means. Some think it means that a tendency toward mental illness may be inherited. (This would be like the tendency toward poor eyesight that runs in certain families.) In the case of mental illness, the familiar predisposition may be toward a chemical imbalance. • Stress. We all experience some stress in our lives. Some people are better able to cope with stress than others; some people experience more stress in their lives than others. Just needing help because of an illness or disability can be stressful to many people. The stressful events we face every day call for us to adjust the way we think, feel, and act. When stress becomes overwhelming and attempts to cope do not work, physical or mental health problems can occur.

Mod V page-6

Effects of Mental Illness How does mental illness affect the individual? Think back to the five basic human needs discussed in Module II. Mental illness affects all of these needs. For the mentally ill person, normal daily activities become a struggle to survive. Life itself seems threatening. The basic sense of security is lost. As the person's illness disturbs his or her ability to get along with others, isolation grows, and belonging needs are not met Self-worth decreases. Without self-worth, self-fulfillment is impossible. The affects of mental illness do not stop with the individual. Mental illness affects the family as well. Family members may feel guilty and upset or blame themselves for causing the illness. Some may fear that they will become mentally ill, too. They may be worried about the mentally ill person, but also angry and resentful about the changes and upset in their lives. Normal family life is disrupted, adding stress to the family's worries. Children may not understand and/or accept the situation. A wage earner may lose time and income from work trying to cope with family problems. In this way, mental illness places a financial strain on the family in the same way that physical illness does. However, there may be one important difference between physical and mental illness: Physical illness is accepted as a normal fact of life; often, mental illness is not. Misunderstandings about mental illness often lead to unhealthy attitudes and actions. Sometimes friends may shy away, or families themselves may feel ashamed and embarrassed and cut off normal social contacts. The member's sense of belonging and self-worth can be hurt. This increases the family's burdens even more. Types of Mental Illness Abnormal anxiety Anxiety is the inner fear we all experience in certain situations. Like all fear, anxiety produces strong physical reactions. The muscles tense, the heart pounds and blood pressures rises. When we feel anxious, we can usually identify the reason for our feelings. When anxiety is abnormal, the causes are often not apparent to the sufferer. A person may feel anxious all the time without really knowing why. Abnormal fears (phobias) As a child, were you afraid of the dark? This is a common phobia among youngsters. Phobias are intense, unreasonable fears of certain things or situations. To some extent, most people experience certain phobias. Fear of death and fear of snakes are common ones. Most phobias do not interfere with normal activity, but some can. One disabling phobia is the fear of being in public place, agoraphobia. Mod V page-7

Abnormal sadness or grief (depression) Usually, when people experience sadness, the feeling is short-lived. In cases of depression, however, normal sadness or grief becomes intense and lasting, turning into despair. The sufferer gradually withdraws and becomes isolated from family, friends, and usual activities. He or she loses interest in him or herself and his or her environment Basic personal care, bathing, brushing teeth, combing hair, changing clothes, is overlooked. Eating and sleeping habits change. People may either lose their appetite or overeat; they may either sleep most of the time or be unable to sleep. .Abnormal ideas (paranoia) When people suffer from irrational ideas of being persecuted, that others don't like them, talk about them, this state is called paranoia. Like all mental illnesses, it ranges from mild to severe. Paranoia may occur at any age. Hearing loss often contributes to mild paranoia. When people cannot clearly hear what is being said, they misunderstand conversation. They may think others are out to make them look foolish. Abnormal thinking People that think they are sick, although they have no physical problems, suffer from hypochondria. People with hypochondria may go from doctor to doctor, looking for physical causes for their problems. People with hypochondria can often persuade unsuspecting doctors to prescribe drugs for their "ailments." As a result of seeing many doctors, a person may be taking several different drugs at once, all of them unnecessary. Do you see why this practice is dangerous? Treating Mental Illness With proper treatment, mentally ill persons can recover and five normal lives once again. Most people do not need to be hospitalized for treatment; they receive it as outpatients in: •

Private practitioners offices

•

Community mental health centers

•

Psychiatric clinics of general hospitals

•

Crisis intervention centers

When hospital care is necessary, the treatment is usually brief but intense.

Mod V page-8

What is treatment like? It varies with the patient and the problem. The major ways of treating mental illness are: • Psychotherapy, which involves talking over one's problems with mental health professional to get to the root of their problem and learn to cope and move on. •

Drug therapy, the use of mood-changing drugs to alter behavior.

•

Combination of psychotherapy and drug therapy.

Treating mental illness often requires not only the cooperation of patient and family, but also the efforts of a professional team. Such a team may include: • Doctors (the patient's medical doctor and/or a psychiatrist, a medical doctor who specializes in mental disorders) •

Psychologists (mental health specialists who have studied human behavior)

•

Psychiatric nurses, private health nurses, or mental health nursing consultants

•

Social workers

Home care personnel may be part of the team as well. Home Care services can give mentally ill persons and their families the extra support they need during stressful periods. This can eliminate the necessity for hospital care. Home care can also provide mentally ill persons the added boost they often need while readjusting to life after hospital treatment. REMEMBER: •

When carried to extremes, any pattern of behavior can be a sign of mental illness.

• The degree of mental illness ranges from mild to severe. When mental illness is severe, individuals lose touch with reality. Most people with mental illness, however, can function in life to some degree. • Mental illness can strike anyone. Its causes are still being studied. Physical factors, environment, heredity, and stress may be involved. • Abnormal anxiety, fears, sadness, ideas, and ways of thinking suggest mental health problems. • With psychotherapy and drug treatment, mentally ill persons can recover. Home care can help eliminate the need for hospital care through extra support during stressful periods or by providing assistance to the mentally ill person and his or her family during the period of readjustment after hospital treatment. Mod V page 9

Mental Illness Mental health, mental illness, and the home care worker As a home care worker, you must be concerned about mental health and mental illness in every home care situation. Since you work most closely with the client and his or her family, you may be the first person the home care team to observe behavior that may be related to mental health problems. Your role is not to diagnose: it is to recognize behavior that indicates trouble and report that behavior to your supervisor. This is an important responsibility. Your careful observation and reporting can help a person obtain needed professional care. General guidelines for observing behavior 1. How often does the unusually behavior occur? Is it long-lasting? Remember, we all have days when we feel sad, angry, or upset. These emotions can be observed in our expressions and behavior. Our reactions to these emotions are perfectly normal, and people usually "bounce back" within a reasonable time. But when unusually behavior occurs often or lasts a long time, you should report it to your supervisor. 2. Does the unusual behavior indicate a change in personality? Often, behavior that seems strange at first glance may be normal behavior for the individual. A person may have developed lifelong habits that seem strange to outsiders. Some observed personality traits may represent lifelong patterns, too; for example, the elderly person who is very irritable may have been a "grouchy" person for his or her entire adult life. However, behavior that demonstrates a change in a person's usual personality can be a warning sign of mental illness. Any observation of this type should be reported to your supervisor. 3. Is the behavior extreme? Is it "right" for the situation? Most people act within a range of expected behavior. A person who flies into a rage over a minor upset exceeds those normal limits. Likewise, a person who laughs when told about a death, or is fearful and anxious without reason, shows abnormal behavior. Extreme and/or unsuitable behavior can mean a mental health problem. Observation of this type of behavior should be reported to your supervisor.

Do not draw conclusions about the nature and cause of the problem from your observations. Remember that unusual behavior may result from many different causes.

Mod V-page 10

You must be alert to changes in personality and behavior when you work with children as well as adults. Change is certainly a normal part of growing up; during the teen years, a child's mood may change daily. However, you must keep in mind that not all of these changes are normal. Alcohol and drug abuse can also produce noticeable changes in mood and behavior. Youngsters with these problems are not mentally ill, but they still need help. Their unusual behavior must be observed, recognized, and reported so that help can be obtained. Your role with mentally ill clients and their families What can you expect when you are assigned to work with mentally ill clients? During your home care career you may work with people who are seriously mentally ill. You will assist persons who need help for different reasons. Particularly in cases of mental illness, home care workers become the eyes and ears of the home care agency. They observe, record, and report what is happening in the home. If medications have been prescribed for the mentally ill person, the worker must carefully monitor them. Unusual behavior must be recognized and reported. REMEMBER: In all home care situations, you must be alert to unusual behavior. When "it occurs frequently, persists, is extreme or not appropriate for the situation, or shows a change in personality, it may signal mental health problems. These observations should be reported to your supervisor. Your role in dealing with mentally ill clients involves observing the individual and the home situation, recognizing signs of problems, and reporting those signs as necessary. You also have the responsibilities of assisting with home management and personal care; promoting mental health in the home through reassurance, encouragement, and guidance; preserving the mentally ill person's authority and affection within the family unit; educating family members on the nature of the illness; and helping in the recovery process.

Mod V page-11

Mental Illness General guidelines for observing behavior A.

How often does the unusual behavior occur? How long does it last?

Does the unusual behavior indicate a change in personality?

Is the behavior extreme? Is it appropriate to the situation?

Do not draw conclusions about the cause of unusual behavior.

Role of home care worker with mentally ill clients and their families A.

Observe, record, and report what is happening in the home.

Assist with home management and personal care,

Promote mental health through reassurance, encouragement and guidance.

Preserve mentally ill person's authority and affection within family unit.

Education family members on the nature of the mental illness.

Assist in the recovery process.

Call 911 for extreme behavior changes.

Mod V page-12

Vocabulary List Module V Acutely Mentally III :

Anxiety:

Very sick and needing a lot of professional help for a period of time.

A fearful feeling, nervousness which the person can't control. The anxious person really can't say what is making him or her nervous

Depression:

A mental illness in which people feel very sad and often take no interest in caring for themselves. There is often a disturbance of sleep patterns (sleep all day and can't sleep at night) and lack of appetite

Environment:

A person's surroundings including the family and neighborhood in which he or she lives

Harass: Heredity:

To keep annoying or bothering. The passing down of traits from parents to children; for instance, the color of hair and eyes are inherited from parents

Hypochondria:

A person thinking that he or she is sick although there are no real physical problems.

Mature:

Acting in a responsible, realistic way

Paranoid:

Suffering from irrational ideas of being persecuted. Fearful that others are out to harm them.

Phobia:

Intense, unreasonable fears of certain things or situations, such as fear of garden snakes

Psychiatrist:

Mental health specialists who have studied human behavior.

Psychotherapy:

Talking over one's problems with mental health professionals.

Recluse:

A person who keeps to himself, avoids being with other people.

Mod V page 13

â&#x2013;

Think Sheet Module V 1. What are some causes of mental illness?

2. What is a phobia, what is paranoia, what is psychotherapy?

What are your roles in working with a mentally ill patient?

4. What are your roles in working with a family of a mentally ill patient?

Mod V page-14

Module VI WORKING WITH PEOPLE WITH DEVELOPMENTAL DISABILITIES

MODULE VI: Working with People with Developmental Disabilities UNIT:

A. B.

TIME:

Understanding Developmental Disabilities Developmental Disabilities and Home Care

60 minutes

OBJECTIVES: At the completion of this Module the student will be able to: 1. Define a developmental disability 2. List at least three types of developmental disabilities 3. Discuss three possible differences in the functioning of people with developmental disabilities 4. List two possible causes of developmental disabilities. Describe several ways in which developmental disabilities differs from mental illness 5. Describe two reasons why an individual with developmental disabilities or their families might need home care 6. Identify three current trends in the field of developmental disabilities and how this might affect the home care worker tasks 7. Identify at least three skills of the home care workers in assisting individuals with developmental disabilities and/or their families 8. List at least three performance standards and provide a positive example of each SUGGESTED TEACHING METHODOLOGIES:

Lecture, group discussion

EVALUATION METHODOLOGIES:

Written exam, class participation

MODULE VI:

Working with People with Developmental Disabilities

OUTLINE:

Unit A

Understanding Developmental Disabilities

1. Definition of developmental disabilities a. List ways in which developmental disabilities affect normal development i. Self care ii. Communication skills iii. Movement iv. Self direction (control over life) v. Potential for independent life vi. Potential for financial independence 2. a. b. c. d. e.

Types of developmental disabilities Mental retardation Cerebral Palsy Autism Neurological impairments Multiple disabilities

3. a. b. c. d.

Levels of functioning Mild Moderate Severe Profound

How developmental disabilities effect growth and development

5. a. b.

Causes of developmental disabilities Congenital â&#x20AC;&#x201D; chromosomal or genetic defects (Down's Syndrome) Acquired i. Infections during pregnancy ii. Brain damage during delivery iii. Alcohol, drug abuse or poor nutrition during pregnancy iv. Premature birth (low birth weight) v. Lead poisoning

Differences from mental illness a. Developmental disabilities are permanent, mental illness may be temporary b. Developmental disabilities occur before the age of 22, mental illness can occur at any time in a person's lifetime

UNIT B Developmental Disabilities and Home Care 1. 2. 3. 4.

Developmental disabilities at home A child with developmental disabilities An adult with developmental disabilities Expectations and attitudes a. Family b. Culture c. Individual

Philosophy and current trends in the field a. Address the person, not the disability b. Focus on independence, productivity and integration c. Promote self-determination and community participation

Care a. b. c.

Performance standards a. Speak to all people politely b. Include people in conversations; speak with them, not about them c. Use positive verbal and non-verbal communication; avoid being negative d. Explain things in a way that people can understand and observe how the information is received e. Encourage people to think by asking questions rather than giving commands f. Encourage individuals to do as much as possible for themselves rather than doing for them g. Include people in making decisions and provide choices when possible h. Respect differences and an individual's desires, needs and values i. Consider others' feelings and concerns, even if different from your own

needs Disability is not an illness though it may increase care needs.. Five basic needs Role of the Home Care Worker i. Importance of assistance and home care ii. Required skills:  Personal care  Child care  Communication  Observing and recording

Developmental Disabilities Mental Retardation Did you have trouble with math in school? Do you find it hard to understand engines or machines? Most of us can identify areas where we have problems learning. Mastering these areas may take a lot of time and effort on our part. And sometimes, even with our best efforts, we can only progress to a certain point and no farther. For example, a person may learn to budget a paycheck with ease, yet not grasp algebra. When it comes to learning, we all have different strengths and weaknesses. We all have a range of abilities. This same basic concept can be applied to people with Developmental Disabilities. Developmental disabilities can slow down the ability to learn and limit the capacity to understand what are called abstract concepts. For example, a moderately mentally disabled adult may not be able to tell time by looking at a clock that has the traditional hands and face. However, the same person may be able to tell time by looking at a digital clock. The important thing to remember is that mental developmental disability effects all areas of learning, not just one or two. Developmental disabilities are a group of physical conditions that occur before, during, or shortly after birth. Other conditions such as cerebral palsy, cystic fibrosis, and muscular dystrophy are also developmental disabilities. However, mental retardation is the most common one. Mental retardation affects a person's normal development in at least three of the -following areas: • • • • • •

Self-care Communication skills Movement Self-direction (control over life) Potential for independent living Potential for financial independence

Look closely at this list. Notice one basic human ability, the ability to feel emotions, is missing. Mentally retarded people experience the same emotions that we all have. They feel love, anger, sadness, joy. They fee! these emotions as deeply as anyone else. Because their disability may effect their ability to communicate, however, they may have trouble expressing their emotions.

Mod Vl-page 1

Mental Retardation

Many factors can interfere with normal brain development before, during and after birth. These factors can cause mental retardation. They include:

•

Certain infections during pregnancy, such as German measles

•

Poor nutrition during pregnancy

•

Premature birth (birth weight is the important factor)

•

Brain damage during delivery

•

Alcohol or drug abuse during pregnancy

•

Lead poisoning (baby eats lead paint chips from walls or furniture)

Inherited or other defects in the baby's genes (Genes are the part of a cell that determines eye color, skin tone, height, etc.) One example is Down's Syndrome, which is marked by widely spaced eyes and somewhat flat nose. These known causes explain less than half of all cases of retardation. In most cases, the cause is not known. Retardation can occur in families of any race, nationality, or economic level.

Mod Vl-page 2

Information Sheet VI-1 Stages of Development of the Mentally Retarded Degree of Retardation Mild

Infancy and Early Childhood Slow to walk, talk, and self-feed. Generally not recognized as retarded by casual observation.

Moderate

May show noticeable delays in speech and motor development.

Severe

Marked delay in motor development. Few communication skills.

Profound

Obvious delays in most areas of development. Shows little response to environment. Physical handicaps frequent

School Years (ages 6-20) With special education, usually capable of acquiring practical skills and useful reading and arithmetic from a third to sixth grade level. Learns simple communication and educational skills; can become independent in familiar surroundings.

Adulthood (Age 21) With guidance and support, can usually achieve social and vocational skills that are adequate for self-maintenance.

May be able to walk and have primitive speech.

May need nursing care and skilled training in motor functions. May require help in feeding and selfmaintenance.

Can function in semi-skilled employment in structured work conditions. With some supervision and assistance, may live in community. Can be trained in Can acquire simple elementary self-help skills. With good such as self-feeding, supervision, able to toilet training and work in highly dressing. Capable of structured work some understanding setting. of and response to speech.

Mod Vl-page 3

Mental Retardation Differences between mental retardation and mental illness Mental retardation and mental illness are often confused. Simply defined, mental retardation is a deficit in intellectual ability that is severe enough to interfere with a person's daily functioning. Mental retardation is not a kind of mental illness; it is a different problem entirely.

Mental retardation differs from mental illness in several ways: â&#x20AC;˘

Mental retardation is a permanent condition. Mental illness can be a temporary problem.

â&#x20AC;˘

Mental retardation occurs at or near birth. Mental illness may occur any time during life.

â&#x20AC;˘ Mental retardation always lessens mental ability. Mental illness may or may not affect mental ability. â&#x20AC;˘ There is no cure for mental retardation, although mentally retarded persons can be helped. Many mental illnesses can be cured with prompt and proper treatment.

Although mental retardation and mental illness are different problems, they do have one important thing in common: both mentally retarded and mentally ill persons need support, understanding, and proper treatment and care.

Mod Vl-page 4

Mental Retardation Mental retardation and the family Family reactions How do you think parents react when they learn that their child mentally retarded? They may feel depressed or they may feel shock, anger or grief. They may deny that there anything wrong or feel guilty that somehow they are to blame. They may even feel ashamed and neglect the child. Adjustment can be especially difficult when the mentally retarded child has physical disabilities as well. Some parents react differently. Even though they feel sorrow, they may see their child's; condition as a chance for them to give special love. They may focus all their energies on helping the child reach his or her full potential. Family members can react to a mentally retarded member in many different ways, And their reactions may change with time, as they learn to focus on their child's capabilities instead of his or her disabilities. As home care worker, you may be assigned to assist a family in which one of the members is mentally retarded. You may be there to provide relief for parents who need to get away by themselves for a while. You may be there to give temporary assistance to a parent or caretaker in the day-to-day care of a mentally retarded adult. Whatever the reason, the home care worker can help all of the members of the family. How home care can help Imagine for a minute what your day would be like if you were caring for a severely retarded eight year old. Let's say that the child also has deformed hips and cannot walk. How do you picture this situation? You may have thought of many daily tasks that would require your assistance. A typical eight year old would not need help to go to the bathroom, dress, wash, or eat. However, the severely retarded eight year old might need assistance in all of these areas. The child's physical disability would also limit his or her basic ability to get around within the home environment; this would certainly add to the work of providing care. Do you think that you would feel physically and emotionally tired at the end of 1 day? Now project this image into weeks and years. How do you think you might feel then' Do you think you might feel depressed, exhausted, resentful, or discouraged about having to provide daily care? It is important for you, the home care worker, to understand and accept these feelings as being normal and not unusual. Mod Vl-page 5

Mental Retardation Guidelines in caring for the mentally retarded 1. Inquire as to what exactly need to be done, at what time, and how. 2. Let the patient know what to expect. Introduce each new activity and repeat it if necessary. 3. Praise a task well done as we all take cooperative behavior for granted. 4. Usually an individual who can feed himself can remove his clothing. If available have him dress or undress in front of a mirror. He can watch what he is doing and it adds interest. Break the job into parts, first shirt, then pants, etc. 5. Allow them to do as much for themselves as possible. Give lots of encouragement. 6. Ask yourself how you would if you were him. Tired? Bored? Warm? How can you make his day more interesting? 7. The more severe the retardation, the more supervision will be needed. Safety is of primary importance.

Mod VI -page 6

Mental Retardation Parents normally work hard to meet their youngsters basic needs. Children grow and eventually become independent. Mentally retarded children need extra attention, however. And, when children are moderately to profoundly retarded, they may need lifetime help. This can place a strain on even the most loving and supportive of families.

REMEMBER: â&#x20AC;˘ Families vary in their reactions to retardation. They also vary in their ability to cope with it â&#x20AC;˘ Home care services for retarded persons can give families much-needed relief from providing daily care. â&#x20AC;˘ As a home care worker, you may use many skills to assist the mentally retarded person and/or the family. These include skills in personal care, child care, teaching, guidance, communication, and observing and reporting.

Mod Vl-page 7

Vocabulary List Module VI Abstract Concepts: Thinking in terms of ideas such as "love".

Developmental Disability: A group of physical conditions that occur before, during and shortly after birth. Mental retardation is the most common developmental disability. Down's Syndrome: A type of inherited mental disability.

Genes:

Genetic cells that are responsible for passing on family traits.

Mental Retardation: A decreased ability to learn with a limited capacity to understand. Also called a developmental disability. Premature Births: The birth of a baby before the expected delivery date or a baby weight under 51/2 pounds.

Mod Vl-page 8

Think Sheet

Module VI

Define mental retardation?

Can a mildly retarded person be educated and be independent?

3. Do mentally retarded people have the same basic human needs as we do?

What are some causes of mental retardation?

What are some areas that are affected in people with developmental disabilities

Mod Vl-page 9

Module VII WORKING WITH PEOPLE WITH PHYSICAL DISABILITIES

MODULE VII Working with People with Physical Disabilities UNIT:

A. What is Physical Disability? B. How the Home Care Worker Can Help the Physically Disabled

TIME:

60 minutes

OBJECTIVES:

At the completion of this Module the student will be able to: 1. Define temporary and permanent disabilities 2. List how family and environments can help people with disabilities achieve a better quality of life 3. Describe how lack of social and emotional support can impact a person with a physical disability 4. Identify the broad goals of care for people with physical disabilities 5. Identify the Home Care Worker's role in promoting goals 6. Describe social, cultural and environmental influences in caring for people with physical disabilities 7. Describe situations in which people with physical disabilities may need home care services

SUGGESTED TEACHING METHODOLOGIES:

. Lecture, group discussion

EVALUATION METHODOLOGIES:

Written exam, class participation

MODULE VII Working with People with Physical Disabilities OUTLINE:

UNIT A

What is Physical Disability?

1. a.

Define a physical disability Differences based on cause and timing I. Developmental (at or near birth) II. Injury-related III. b. Temporary or permanent c. Diagnosis does not indicate level of function d. Impact on function e. Activities of daily living f. Instrumental activities of daily living 2. a.

b. c. d. e. f.

Disease related

impact of physical disability on quality of life Supports I. Family II. Environmental supports III. Social supports Stresses Coping mechanisms of individual Coping mechanisms of family Other stresses, i.e. lack of opportunities for socialization Stress as related to basic needs

UNIT B

How the Home Care Worker Can Help the Physically Disabled

1. a. b. c.

Home care goals for people with physical disabilities Promoting self-care and independence Maintenance of dignity and self-worth Preservation of normal life style

2. a. bc. d.

The role of the home care worker Plan of care for services provided Emotional support Encourage as much independence as possible Assist client in making the environment as supportive as possible

Social, cultural and environmental influences in caring for people with physical disabilities

Situations in which people with physical disabilities may require home c

Physically Disabled What is physical disability? How would you define the term physical disability? A physical disability can be permanent or temporary and is generally a stable condition wherein normal function is reduced. Once permanent disability occurs, function does not return with time. Blindness, deafness and paralysis are examples of physical disabilities. Except for the specific loss of function, a physically disabled person may enjoy good health. Some disabilities such as cerebral palsy, result from conditions that affect the brain before, during and shortly after birth. These may also be referred to as developmental disabilities. Other physical disabilities result from accidents, injuries, or other problems that can occur at any time during life. Disease are often physically disabling; that is, they too can produce a loss of function. For example, multiple sclerosis (MS) can cause paralysis or blindness. Unlike other physical disabilities, in cases of disease, a person's functioning may improve or become worse with time; it is not necessarily a constant state. Have you ever seen a sick person's functioning change as his or her disease progressed or was cured? Do not confuse physical disability with the term handicap. A handicap results when a person allows a loss in function to limit his or her personal life unnecessarily. Handicap are very individual conditions: Two people may suffer the same loss of function because of a physical disability or disease, yet one person may be handicapped while the other is not. A physical disability is a major life stress for individuals and families. It is a situation that people must learn to adjust to and cope with in one way or another. How well they cope and the actual impact of this stressful event depend on several factors. These include: â&#x20AC;˘ The individual's and family's general ability to cope with stress: Can they usually mange daily problem fairly well? Can they adjust to most situations? As a rule, people who can adapt to daily stress under normal circumstances adjust more readily to physical disability. â&#x20AC;˘ The specific nature of the problem: How does the physical disability affect normal ability to function? Is it severe and limiting? Are there multiple problems? Less severe problems or those that do not dramatically change normal function are easier to cope with. Mod Vll-page 1

• The amount of social support available: Is the person or family isolated? Are there caring relatives, friends, neighbors available for support? Are social, community, religious, or other organizations providing support? Social support eases the impact of physical disability. •

The presence of other existing stresses in daily life: Are there financial pressures in the household? Marital strain? Inadequate living conditions? Do other family members have physical, emotional or behavioral problems? Extra stresses in the household add to the burden of coping with physical disability.

•

The individual's and family's understanding of the problem: Have they had other personal experiences with disability? Are they mature enough to understand the nature of the problem? Have they received accurate information on the condition? It's outlook? Necessary care? A good understanding of the problem is an important key to personal and family management of physical disability.

Even under the best of circumstances, the stress of a physical disability greatly affects individuals and families. It disrupts normal home life, which in turn causes additional stress. Do you recall the five basic human needs? When these needs are not met, stress occurs. How do you think a physical disability might interfere with the meeting of these needs? •

Physical disability can cause financial hardships. Wage earners may lose their jobs. Wage earners may quit their jobs in order to provide needed care. In either case, family income is reduced. The ability to provide for basic physical needs can be threatened.

•

Financial and other stresses related to physical disability may lead to marital strain. Often, children cannot fully understand the tension between their parents They may express their confusion through problem behavior. The normal security of home life is disrupted.

•

Physical disability may lead to social isolation. Some people may feel that a physical disability makes them different. They may withdraw from their own families. Frequently, the isolation results from limitations caused by the problem itself. For example, a person who must stop work because of physical disability loses more than just income. A job also provides a social support network and a sense of belonging, which can be diminished or even lost when physical disability occurs. Similarly, a mother whose disability keeps her from fully participating in her husband's and children's activities may feel that she is no longer really a pa of the family. Mod VII –page 2

Emotional reactions The stress of disability produces strong emotional reactions. Our minds and bodies are interrelated: What affects one can affect the other. For example, when you have a headache, does your personality suffer too? You may find that despite your best efforts, you become irritated and upset more easily. Imagine how hard it might be to maintain healthy emotions if a physical disability were part of your life every day. There are common responses to physical disability. People experience a wide variety of emotions. So do their families. And these feelings may change over time. Some emotional responses to physical disability include: •

Fear and anxiety, prompted by such concerns as, "what will happen to me? To my family?"

• Anger, sparked by the issue, "Why is this happening to me?" Frustration grows from the inability to function as before. • Depression, which may stem from the loss of the ability to perform normal life activities independently. • Guilt, which may arise from feelings that the problem was self-induced or from concern that disability burdens the family. These emotions are expressed in many ways. A physically disabled person may become impatient, irritable, or overly dependent. A physically disable person and his or her family may use defense mechanisms during the initial adjustment to their situation. This is a normal reaction in emotionally, stressful situations. By recognizing defense mechanisms, you will be better prepared to handle situations involving physically disabled persons. We all have defense mechanisms that we use in emotionally stressful situations. Rationalization — someone who has had an amputation of the arm, making excuses) who was a chef, tells you "I really hated to cook." Projection - you overslept and are late for work, "I'm late because blaming others) the traffic was so heavy." Compensation - carpenter who has lost the use of his legs, becomes making up for a lack of) a draftsman. Mod VII -page 3

Withdrawal - a husband who is unable to adjust to his wife's disability, (avoid stressful situation) works all the overtime he can get. Regression - a teenager who has temper tantrum, when told he cannot (Reverting to a less mature level) use the family car. Displacement - a homemaker who is no longer able to care for her home (transferring feelings) blames her husband for her frustration and anger. Denial - a husband who denies that his wife's disability will not allow (blocking out unpleasant thought or events) her to manage the home. "She is a very capable woman - she doesn't need help managing the home."

Remember â&#x20AC;˘ A physical disability is a temporary or permanent and stable condition in which normal function is reduced or lost. A handicap results when someone allows a loss in function to limit his or her activities unnecessarily. â&#x20AC;˘ Emotional responses to physical disabilities vary. Fear, anger, depression, and guilt are common ones. â&#x20AC;˘ Physically disabled persons may often rely on defense mechanisms as a means of expressing their emotions during the initial adjustment period.

Mod Vll-page 4

Physically Disabled Home Care Goals I. a. b. c.

Home care goals with the physically disabled. Promotion of self-care and independence. Maintenance of dignity and self-respect. Preservation of normal lifestyle to greatest degree possible.

II. a. b. c. d. e. f. g.

The home care worker's role. Personal care services, as outlined in care plan. Housekeeping. Shopping. Meal planning and preparation. Providing relief to caretakers. Accompanying client to medical or other appointments. Teaching clients or family members how to manage daily life activities.

III. Home care in action a. Purposes. 1. earlier return home from hospitals or nursing homes 2. avoidance or delay of admission to hospitals or nursing homes 3. assistance in rehabilitation programs 4. respite for family members of caretakers b. Range of home care services needed. 1. depends on client's abilities and needs. 2. varies from many services and constant care to only a few services on an infrequent but regular basis.

Promotion of self-care and independence This goal is reached by encouraging physically disabled persons to participate in activities, by discussing with them what they can do for themselves, and by avoiding performing for them the tasks they can perform themselves.

Maintenance of dignity and self-respect For some people, having a physical disability may less their sense of self-worth. Respecting the privacy of clients, treating them appropriately for their age, and talking to them rather than about them when others are present helps them maintain dignity and self-respect. Special sensitivity is needed when help in personal care tasks such as bathing, feeding, and toileting is required.

Mod Vll-page 5

Preservation of normal lifestyle to the greatest degree possible The disruption of normal living is a major stress associated with physical disability. All care plans must be carried out within the framework of normal home life as much as possible. Some of the ways in which you can do this include: learning about and respecting the living patterns of clients and their families; planning your work around their needs; and striving to provide care in a way that supports, rather than interferes with, normal daily activities. Review each of these overall goals. You have probably noticed that, for the most part, achieving them depends on doing "little" but important things. Your tone of voice, your encouragement, and your caring are as important as following detailed care plans. â&#x20AC;˘

The home care worker's role extends beyond the physical aspects of the disability. Such home care services as personal care, housekeeping, meal preparation, and shopping must be provided within the framework of promotion of self-care and independence, maintenance of dignity and self-respect, and preservation of normal lifestyle to the greatest degree possible.

â&#x20AC;˘

Home care may prevent or delay hospital or nursing home admission, make an early return home possible, aid in rehabilitation, or relieve caretakers.

â&#x20AC;˘

Physically disabled persons vary in their abilities and in their need for home health care services.

Mod Vll-page 6

Vocabulary List Module VII Defense Mechanisms:

Handicap:

Multiple Sclerosis:

mannerisms that people have that represent the way they deal with stress in their lives.

to be put at a disadvantage. Any disadvantage

a chronic disease that causes nerve damage. It can affect many different parts of the body. Sometimes the person goes into remission and the effects of the disease decrease

Physical Disability: a permanent or temporary, generally stable condition wherein normal functioning is reduced.

Rehabilitation Program: the process of increasing or maintaining the level of physical ability of someone who is temporarily or permanently disabled.

Mod Vll-page 7

Think Sheet Module VII 1.

Is a physical disability always permanent?

What is a handicap?

What are some emotional reactions to a physical disability?

What are some goals of home care when caring for a person with a physical disability?

What is a defense mechanism, when do we use them?

What effect does additional stress in a home, have on a physical disability?

Mod Vll-page 8

Module VIII FOOD, NUTRITION & MEAL PREPARATION

MODULE VIII Food Nutrition and Meal Preparation UNIT:

A. B. C. D. E.

TIME:

The Basics of Nutrition Meal Planning Food Preparation and Serving Food Shopping, Storage and Handling Food Safely Modified Diets

240 minutes (4 hours)

*See Mod XIl -E Digestive Systems Lesson 1. The Objectives and Measurable Performance Criteria from The Digestive System, Lesson 1, Nutrition and a Balanced Diet are to be fulfilled as part of the 240 minutes allotted for this Module. OBJECTIVES:

At the completion of this Module the student will be able to:

1. Describe the five major categories of nutrients 2. Identify the importance of nutrients in promoting and maintaining good health. 3. Use MyPyramid in meal planning. 4. Plan well-balanced diets using the five major food groups 5. Recall the Dietary Guidelines for Americans 2005 6. State the guidelines for food preparation and serving, 7. Identify ways to improve food shopping, storage, and handling 8. Define the term "modified diet" 9. Give examples of foods that should be avoided or encouraged for a variety of modified diets 10. Describe ways to mechanically alter foods for easier chewing and swallowing

SUGGESTED TEACHING METHODOLOGIES: Lecture, group discussion EVALUATION METHODOLOGIES: Written exam, class participation

MODULE VIII FOOD, NUTRITION AND MEAL PREPARATION OUTLINE:

Unit A 1

The Basics of Nutrition

THE MAJOR NUTRIENTS A. Nutrients: individual elements that combine to make foods and enable us to live B. Proteins: 1. 2. 3.

Function: to build and repair body tissues Sources: meats, fish, eggs, milk, soy and legumes Amount needed: varies according to size, age, activity level and state of health

Carbohydrates: 1. Function: to provide fuel for heat and energy 2. Starches: grains, potatoes, beans, and peas 3. Sugar: fruit, vegetables, and sweeteners 4. Fiber: assist in digestion

Fat: 1. 2. 3. 4.

Function: protect vital organs, insulate the body, prevent heat loss, and carrier of nutrients Sources: meat, fish, eggs, nuts, milk, and butter Polyunsaturated fats: com, soy, safflower and sunflower oils: Saturated fats: butter, coconut oil and peanut oil.

Vitamins: 1. Functions: to promote tissue growth and to help body use other nutrients

Vitamin A: helps keep skin in good condition and facilitates bone growth

Vitamin B: helps nervous and digestive systems function properly

4. Vitamin C: strengthens walls of blood vessels and aids in healing of wounds and bones

Vitamin D: builds strong bones and teeth

Vitamin E: anti-oxidant

Minerals:

Functions: to strengthen certain tissues and help in body functions

2. Calcium: needed for strong bones and teeth, helps blood to clot, and important for muscle contraction 3.

Potassium: helps heart to function properly

Iron: combines with protein to make hemoglobin and helps cells use oxygen

Iodine: needed for functioning of thyroid gland

Sodium: maintains normal balance of water between fluids and cells

Water:

Considered a nutrient: absolute necessity for life

Need for water: digestion, elimination, and control of body temperature

Nutrients work together:

The body needs nutrients from each category, not just one or two

Available in a variety of foods

Unit B I.

II.

WELL-BALANCED DIET A.

Definition: a daily diet that contains nutrients needed for proper body functioning and energy

Can be planned by using food groups

MY PYRAMID AND DIETARY GUIDELINES A.

Milk Group: 1.

Foods included

Recommended daily amounts

Meat, Poultry, Fish, Dry Beans and Peas and Nuts Group: 1.

Foods included

Recommended daily amounts

Fruit: 1.

Foods included in fruit

Amounts needed daily

Vegetable Group: 1.

Foods included .

Recommended daily amounts

Grains: 1.

Foods included

Recommended daily amounts

Fats, Oils, and Sugar Group: 1.

III.

Meal Planning

Foods included

USING MyPvramid IN MEAL PLANNING

Basic menu plan: includes a food from each group in the food guide.

MyPyramid plan

IV. DIETARY GUIDELINES FOR AMERICANS A.

E. F. G. H.

Consume a variety of foods within and among the basic food groups while staying within energy needs. Control calorie intake to manage body weight. Be physically active every day. Increase daily intake of fruits and vegetables, whole grains and nonfat or low-fat milk and milk products. Choose fats wisely for good health. Choose carbohydrates wisely for good health. Choose and prepare foods with little salt. If you drink alcoholic beverages, do so in moderation. Keep food safe to eat.

OTHER CONSIDERATIONS IN MEAL PLANNING

A. B. C. D.

Involving clients in meal planning with using keys to good communication Serving size: what counts as service size Special nutrient needs Cost

B. C. D.

Summary In Unit B, you have learned how to use the basics of nutrition in meal planning. MyPyramid is a consumer friendly guide to help health people over 2 years of age make healthful food choices. It is meant to be flexible and easy to use. My Pyramid is based on the Dietary Guidelines for Americans 2005 and represents the most current scientific information about diet and physical activity. The Dietary Guidelines answer the questions: What should Americans eat? How should we prepare food to keep it safe and wholesome? The guidelines are designed to help Americans choose diets that will meet nutrient requirements, promote health, support active lives and reduce disease. The Dietary Guidelines are the foundation of MyPyramid.

The Dietary Guidelines for Americans 2005 provides science-based advice to promote health and to reduce risk for major chronic diseases through diet and physical activity. When planning for their clients, home care workers should include a variety of foods, consider calories to help maintain the client's healthy weight, limit saturated fat

and moderate total fat, sugar and sodium and increase fruits, vegetables and whole grains. Meal planning must also take into account food preferences and eating habits. These are based on cultural and/or religious background, past experience, the availability and cost of foods, and the convenience of preparation. Calorie needs and special nutrient needs must be considered, also.

Unit C

Food Preparation and Serving

FOOD PREPARATION

A. 1. 2. 3. 4. 5.

Use the basics of good nutrition Eat a variety of foods Choose foods low in fat, saturated fat, and cholesterol Use more lean meats, fish, and poultry Use sugar and salt in moderation Choose plenty of fruit, vegetable, and grain products

Avoid frying

Steam cook vegetables

Bake, broil or microwave

Avoid convenience foods

Find out how clients like food seasoned

II.

CLIENT INVOLVEMENT

Promotes independence

Builds a helping relationship C. Provides stimulation, relaxation, and increases sense of worth

III-

AVAILABLE COOKING EQUIPMENT

Equipment may be limited

Need to be creative and discuss with supervisor

IV.

SERVE QUALITY FOOD 43

A. B. C. D. E.

Cook food only until tender as this protects nutrients Use toaster oven or use oven to prepare more than one food at a time Use double boiler to cook two items Use fresh fruits and vegetables Serve eye-appealing foods

V. A. B.

SERVING MEALS Use as a time to share with others Plan to sit and talk with clients

VI. A. B. C. D. 12. 3. 4. 5.

FOOD APPEARANCE, TEXTURE, AND PORTION SIZE Use contrasting colors and textures Arrange foods attractively Serve small portions, but allow for second servings Be alert to a poor appetite: May signal illness or depression Dissatisfaction with food Improper mouth care Chewing problems Medications

Unit D

I A. B. C.

Food Shopping, Storage, and Handling Food Safely

HOW TO SAVE ON FOOD COSTS Use coupons and weekly specials Compare prices among brands Avoid convenience foods

Check food labels for nutritional value E.

Look for seasonal items

Consider availability of storage space

Take a shopping list, and follow it

Use meat substitutes Keep within the allowed food budget

II-

FOOD STORAGE (Include temperature guide for refrigerated foods) A.

Promptly rewrap and refrigerate meat, fish, or poultry

Store dry foods in covered containers, and use older purchases first. Store separate from cleaning supplies

DO NOT store food beneath plumbing

Refrigerate eggs, milk products, margarine, cooking oils, salad dressings, and mayonnaise

DO NOT refrigerate fresh fruit until ripe

III.

IV.

Keep refrigerator and freezer units in good working order. Keep the temperature in refrigerator at 36° F - 40° F, and the temperature in freezer at 0° F. (See temperature guide.)

Cover and date all refrigerated food

Use frozen foods within six months. Don't thaw frozen food on counter at room temperature.

FOOD MONEY PROCEDURES A.

Follow agency's policy procedures

Save all receipts

Account for all money spent as soon as possible after shopping

SAFE FOOD HANDLING A.

Wear clean clothes and/or apron

Always wash hands before handling food

Wear gloves if you have a cut or infection on hands

Avoid coughing or sneezing around food

Clean work spaces before and after preparing food

Use clean dish towels and dish cloths

Use hot water and soap to wash utensils

Never taste and stir food with the same spoon

Put warm foods in refrigerator immediately

DO NOT use damaged cans with bulging ends

Avoid eating raw eggs. NEVER use cracked eggs. NEVER undercook eggs

Use cooked meat, poultry, fish, and baked dishes within three to four days

DO NOT use foods that have become moldy

Clean and sanitize food preparation area

Keep hot foods hot (above 140Â° F)

Keep cold foods cold (below 40Â° F)

Keep refrigerator clean

Use food within recommended time

DO NOT refreeze food

Unit E Modified Diets I. BEING SPECIFIC WHEN IT COMES TO THE DIET A. B.

Be specific about changes made in a client's diet Promote the good health of the client

C. Definition of "modified diet": one nutrient change in a client's diet ordered by the doctor, changes in amount of calories, or mechanically altered. II

DECREASING THE INTAKE OF CERTAIN FOODS

A-

Low calorie and low fat:

Limiting the amount and types of food a client eats

Not recommended for an extended period

Compliance is difficult

Low sodium/salt:

Read labels

Eliminate processed and prepared foods high in sodium

No salt added during preparation and serving

III.

INCREASING THE INTAKE OF CERTAIN FOODS

High protein and high calorie

You would add more protein and calories to an already balanced diet

Small frequent feedings are encouraged

IV.

TYPES OF MODIFIED DIETS

List of diets appears on chart:

List specific diets

Reasons why diet is used

Foods that should be encouraged

Foods not allowed

Some special notes

The meaning of "high" and "low":

"High" means 'to increase a nutrient in a diet'

"Low" means 'to decrease a nutrient in a diet or cut it out altogether1

Soft and liquid diets:

Think about consistency

"Soft": foods requiring almost no chewing

3. "Liquid": can be clear liquids, such as Jell-O, or full liquid, such as liquids at room temperature 4.

Importance of positioning client

Bland:

1. Eliminate foods assumed to irritate gastric mucous, such as pepper, spices, alcohol, and caffeine E.

Low fat and low cholesterol:

Limit fat and cholesterol

2. Choose lean cuts of meat, one-percent (1%) or low-fat milk and dairy products, and unsaturated oils and light or diet margarine F.

Preparing mechanically altered diets:

For clients who have limited chewing ability or have swallowing difficulty

Chopping, grinding, mashing, or pureeing can modify the texture of foods:

"Chopped" means to cut into small pieces

"Ground" means to cut into even smaller pieces

c. "Pureed" means to run cooked foods through blender or processor, adding enough liquid for appropriate consistency 3. Mechanically altered diets are specifically designed to meet the client's special needs 4.

Nutritional concerns with mechanically altered diets."

Food loses its appeal

Nutrients may be lost

Lack of fiber may cause constipation

Caloric needs

Choking

Equipment:

Chopping can be done with a sharp knife on a ceramic or wooden board

Grinding and pureeing can be done in a food processor or blender

c. Fruits and vegetables can be pureed by pushing them through a colander or sieve with the back of a spoon d.

Equipment must be kept absolutely clean

e. Appropriate thickness and temperature of food depends on patient condition and tolerance 6.

Process tips:

Cook food first when instructed to do so

DO NOT combine foods before pureeing or grinding

Add fluid when instructed to do so

Add seasonings, sauces, and condiments to enhance flavor

Serve some foods, such as puddings, that do not need to be altered

Provide a bib or other protective covering

Serve hot foods hot and cold foods cold

Identify each food for your client

i. j. k.

Allow your client enough time to swallow each bite Offer plenty of extra liquids to prevent constipation and dehydration Use blenderized food immediately or freeze to prevent bacterial growth

FOOD/NUTRITION The major nutrients Nutrients are the individual substances that combine to make foods and to supply our bodies with everything we need to live, move, and grow. Each nutrient has its own special function in keeping the body healthy. These are about 50 different nutrients, and they fall into major categories: Proteins, carbohydrates, fats, vitamins, and minerals. Water is another substance that is very important to good nutrition. Proteins Proteins build and repair body tissue. Proteins also help make hemoglobin, the red substance in the blood that delivers oxygen to and removes carbon dioxide from cells. Finally, proteins help form antibodies to fight infections. Food sources rich in protein are beef, lamb, pork, poultry, fish, shellfish, eggs, and milk. These are called animal proteins. Additional food sources rich in protein are lima and kidney beans, chick peas (garbanzo), split and black-eyed peas, peanuts, and peanut butter. These are called vegetable proteins. Larger quantities of vegetable protein foods must be eaten in order to provide the same amount of protein present in animal protein foods. In meal planning, animal and vegetable proteins can be combined to furnish the proper amount of protein. Some of these popular combinations are macaroni and cheese, beans and rice, cereal and milk, rice and fish, spaghetti and meatballs, baked beans and brown bread, vegetable stew with meat, and a peanut butter sandwich. The amount of protein a person needs is determined by his or her size, age, amount of activity, and the state of health he or she is in. Carbohydrates The primary function of carbohydrates is to provide energy. When we eat foods that contain them, our bodies become able to use the energy from proteins for growth and maintenance. There are simple carbohydrates, (the sugars), and complex carbohydrates, (starches and fibers). The starches include all grains and the products made from the (flours, bread and other baked goods, macaroni, spaghetti, noodles, and breakfast cereals), potatoes, sweet potatoes, beans, and peas. Fiber (sometimes called bulk) does not provide energy, but does assist in digestion. It is found in grains, vegetables, and fruits, but not in sweets.

Mod VIII-page 1

Fats Fat is part of our cell structure; it forms protective cushions around our vital organs; it lets proteins go their work of building and repair by providing food energy; and, in a thin layer under the skin, it insulates the body and prevents loss of heat. It is the carrier of the nutrients. Fats are a concentrated energy source. They digest more slowly than proteins or carbohydrates; therefore, they delay a feeling of hunger. Meat, fish, chicken, eggs, nuts. milk products, butter, margarine, salad oils, and mayonnaise all contain fats. Are you familiar with the term polyunsaturated? Polyunsaturated fats are found in products made from corn, soy, safflower, sesame, and sunflower seed. (Olive, peanut, and cottonseed oils do no contain these fats.) Polyunsaturated fats are believed to have a desirable effect on the heart and blood vessel: by helping to reduce cholesterol, a waxy, fat-like substance that can build up inside the blood vessels. Research suggests that cholesterol is found only in the fat animal foods, such as meat, milk products, eggs, and shellfish. It is very high in "organ" meats (liver. sweetbreads, and kidneys.) Saturated fats increase cholesterol in the blood. Beef is high in saturated fats, as are whole milk, butter, cream, coconut palm oil, and lard. Vitamins Vitamins are essential to life and well-being. They help our bodies make use of other nutrients (proteins, fats, minerals and carbohydrates.) Vitamins are necessary for the proper functioning of many of our body processes: They promote tissue growth, allow the nerves and muscles to function as they should, help the reproductive system to work properly, and may help the body resist infections. Since our bodies cannot manufacture most vitamins, we must get them from a variety of foods. The most important vitamins are vitamins A, B, C, D and E. ď&#x201A;ˇ

Vitamin A helps keep the skin in good condition, facilitates normal bone growth, and allows the eyes to adjust to dim light. Liver, eggs, butter, whole milk, and cheese as well as yellow and dark green vegetables and fruits, supply vitamin. A.

ď&#x201A;ˇ

Vitamin B is actually a group of vitamins. (Riboflavin, thiamin, and niacin are wellknown B vitamins.) B vitamins help the nervous and digestive systems function properly. They are also good for the skin. Milk, whole grains, peas, beans, meat (especially lean pork), and some breads or cereals are sources of B vitamins.

Mod VIII-page 2



Vitamins C helps the healing of wounds and bones. It plays a part in forming and maintaining the material that holds living cells together and strengthens the walls of blood vessels. Citrus fruits, like oranges and grapefruits, and such vegetables as tomatoes, broccoli, green peppers, and potatoes provide Vitamin C. Cantaloupe, orange juice, and strawberries are Vitamin C sources that contain other nutrients and provide fiber, which is necessary for digestion. Vitamin D builds strong bones and teeth. The action of sunlight on the skin causes the body to make its own vitamin D. Milk with added vitamin D is the most common source of this vitamin in the diet. Some vitamin D is also found in egg yolks, butter, and liver. Certain fish, particularly sardines, salmon, herring, and tuna, are excellent sources of vitamin D. Vitamin E is an antioxidant. It aides our bodies to fight against cancer.

Minerals Minerals are the substances our bodies require to strengthen certain tissues and to help in many bodily functions. Some important minerals are;  Calcium (Kal-see-um) which is needed for strong bones and teeth. It also helps blood to clot and nerves and muscles to react normally. We have a lifelong need for calcium, which can be obtained from milk and milk products, fish bones ( such as those eaten in salmon and sardines), and dark green leafy vegetables (collards, mustard, turnip, kale, and dandelion greens). People who cannot digest milk or milk products should not overlook the other sources of calcium. 

Potassium (poe-tass-see-um), which work with calcium to keep the heart functioning properly. It is found in bananas, prunes and oranges, as well as potatoes that have been cooked in their skins.



Iron, which combines with protein to make hemoglobin (as mentioned earlier, the red substance in the blood that carries oxygen from the lungs to the entire body). Iron helps cells use oxygen.

Mod VIII-page 3

PAGE 4 was blank

In the next unit, you will learn how to put knowledge of nutrition into action through meal planning.

Remember Nutrition is how the body uses food. Food contains substances called nutrients that nourish the body. Protein is the major tissue builder in the body. Carbohydrates are the major sources of energy in the diet. Fats provide energy too. Water aides in digestion and elimination and helps control body temperature. Nutrients work together to keep the body functioning smoothly. Your knowledge of nutrition can improve your client's well-being. The Well-Balanced Diet Have you ever heard of a "well-balanced" diet? This term means a daily diet that contains enough essential nutrients to allow proper body function and enough calories for energy. There is a simple system you can use to make planning a well-balanced diet easy. The system is based on putting foods that contain similar nutrients into different groups. (These groups are identified in the MyPyramid and are the basis for planning a well balanced diet.)

The groups are: 1. 2. 3. 4. 5.

Milk Meat Fruit Grain Vegetable s Mod VIII-page 5

Fix these five food groups firmly in your mind. They will form the basis for your meal planning. The Five Food Groups The milk group The milk group includes all types of milk and milk products except butter and cream: cheese, cottage cheese, ice cream, custards, yogurt, soups made with milk, and puddings. Food in the milk group provide many nutrients. The major ones are protein and the mineral calcium. Milk itself comes in many varieties: Whole milk contains 3.5 percent milk fat (also called butterfat). It is pasteurized (a sterilization process) and usually homogenized (a process that distributes the milk evenly in liquid). Two percent milk contains two percent milk fat. One percent milk contains one percent milk fat. Usually, some nonfat milk solids are added for flavor and body. Nonfat dry milk is a skim milk with the water removed. Evaporated milk is milk reduced to half its volume, homogenized, fortified with vitamin D, and canned. Sweetened condensed milk is canned milk that has had 60 percent of the water removed and sugar added. Milk group portions are calculated as "servings", which are one-cup (eight ounces) portions. You should have 3 cups from this group daily. Use lowfat or fat free when selecting milk, yogurt and other milk products. If you cannot tolerate milk, choose lactose free products or calcium fortified food and beverages. Mod VIII-page 6

The meat group Go lean with protein The meat group includes beef, lamb, veal, pork, organ meats (liver, kidney, brains, heart fish, eggs, poultry, and shellfish. Other foods in this group are dried beans and peas (so; pinto, navy, lima, and kidney beans, chick peas, split or black-eyed peas), lentils, nuts, and peanut butter. This food group supplies protein as well as vitamins and the mineral iron. Vary your protein routine. Choose more fish, beans, peas, nuts, and seeds. You should eat 514 oz from this group daily. The fruit group Focus on fruit The fruit maybe fresh, canned, frozen, or dried. When planning a menu, you should focus on those fruits that are especially high in vitamin A and vitamin C. (You will remember from unit A of this module that vitamin A helps keep the skin in good condition, allows the eyes to adjust to dim light, and facilitates normal bone growth, and that vitamin C helps the healing of wounds and bones and plays a part in forming and maintaining the material that holds living cells together). Fruits also supply other vitamins, minerals, and carbohydrates in addition to fiber, which is important for good digestion. Eat a variety of fruits. Limit fruit juices. You should eat 2 cups from this group per day. The grain group The grain group (also called the bread and cereal group) includes all types of grains (wheat, oats, barley, corn, rice, and rye) and foods made from these grains, such as bread, cereal, spaghetti, and noodles. The grain group is a source of vitamin B, minerals, and starchy carbohydrates. Preferably, grain group food should be made from whole grains because whole grains have the best nutrient value: They retain most vitamins and minerals, and they are high in natural fiber. When grains are processed, vitamins and minerals are lost. (For example whole wheat bread contains more nutrients than white bread.) To make up for nutrient losses, many grain products are "fortified" or "enriched", this means that vitamins and minerals are added to the product after processing. At least half of your intake from this group should be whole grains. When purchasing processed foods such as flour or white bread, read the package labels. Look for statements that say the product has been fortified or enriched. These products will be more nutritious than non-fortified processed foods. You should eat 6oz from this group every day. Mod VIII-page 7

Miscellaneous This group consists of foods not included in the first five groups. Examples of these foods are sugars (candy, soft drinks, honey, gelatin desserts, alcoholic beverages, and margarine, oils, and other fats. These foods provide fat, sugar, and calories but no other nutrients. They also add flavor to other foods. Often they are ingredients in a recipe or are added at the table. Foods from this group should be used in moderation. In a normal diet, only two or three tablespoons of fat are needed each day. Using the five food groups in meal planning When you plan meals, include a food from the milk, meat, fruit and vegetables, and graiz groups whenever possible. Limit the use of the "other" group. This will help balance the diet, (some dishes, such as stews or casseroles, combine foods from several groups. Count these foods as if they were eaten separately; you need not include an additional item from the same food group at the same meal.) You can supplement meals with nutritious snacks such as raisin, bananas, graham crackers, or toast with peanut butter. Mod Vlll-page 8

VEGETABLES

GRAINS Make half your grains whole

Eat at least 3 oz. of whole-grain cereals, breads ,crackers, rice; or pasta every, day

Vary your veggies

Eat more darkgreen, veggies like broccoli /spinach, and; other Eat more orange vegetables like carrots and sweatpotatoes

FRUITS Focus on fruits

MILK Get your calcium rich foods

MEAT & BEANS Go lean with protien

Eat a variety of fruit

Go low fat or fat free when you choose milk, yogurt and other milk products

Choose low fat and lean meats and poultry

Choose fresh, frozen , dried or canned

Bake it, Broil it or Grill it

Vary your protein routine – If you don’t or choose more fish, beans, peas, Go easy on fruit can’t consume nuts and seeds juices milk choose Eat more dry lactose free beans and peas products or other like pinto calcium sources beans, kidney such as fortified beans and foods and lentils beverages For a 2000 calorie diet, you need the amounts below from each food group. To find the amounts that are right for you , go to mypyramid.gov 1 oz, is about 1 slice of Bread/about 1 cup of breakfast cereal ,. or ½ cup of cooked rice, cereal

Eat 6 oz., every day

Eat 2 ½ cups every day

Eat 2 cups every day

Find your balance between food and physical activity

Get 3 cups every Eat 5 ½ oz every day day For kids age 2 to 8 it is 2 Know the limits on fats, sugar and salt ( sodium)

• Be sure to stay within your daily calorie needs • Be physically active for at least for 30 minutes most days of the week • About 60 minutes a day of physical activity may be needed to prevent weight gain • For sustaining weight loss, at least 60 to 90 minutes a day of physical activity may be required • Children and teenagers should be physically active for 60 minutes every day or most days

• Make most of your fat sources from fish, nuts and vegetable oils • Limit solid fats like butter, margarine, shortenings,and lard as well as foods that contain these • Check the Nutrition Food label to keep saturated fats , trans fats and sodium low • Choose food and beverages low in added sugars. Added sugars contribute calories with few, if any numbers

MyPyramid.gov STEPS TO A HEALTHIER YOU U.S. Department of Agriculture Center for Nutrition Policy and Promotion April 2005 CNPP-15

MOD VIII - page 10

The following menu is a basic meal plan that you can use as a general guidelines. Basic menu Breakfast Fruit or fruit juice Cereal with milk and/or egg or other protein food Bread and butter or margarine Beverage Lunch or supper Meat or other high-protein food Vegetable (in salad, soup, or casserole combined with meat) Bread or other grain products, butter or margarine Simple dessert (fruit or pudding) Beverage, including milk

Dinner Meat or other high-protein food Potatoes or other carbohydrate food Green or yellow vegetable (may be in salad) Dessert (fruit or milk dessert) Beverage, including milk These guidelines were issued because research has shown there is a connection between diet and certain chronic diseases such as hear disease and cancer. While the final answer to the cause(s) of these aliments is not yet known, there is enough evidence to recommend broad changes in the diet. These changes can help maintain or even improve health. The dietary guidelines are recommended for healthy people of all ages and for people with no dietary restrictions. Mod VIII-page 11

Of course, people with certain health problems such as high blood pressure, heart disease or diabetes should always be guided by diets recommended by their doctors or other trained health professionals. Let's look briefly at the dietary guidelines and how you can apply them to menu planning for your home care clients. Dietary Guidelines 1. Eat a variety of foods This simply means that in planning meals you should remember to choose foods from the five key food groups. The greater the variety of foods in client's diet, the less likely it is that he/she will lack essential nutrients. 2. Maintain ideal weight Obesity, too much fat in the body, adds to the risk of disease. Unused calories increase body weight Therefore, you should plan menus with your client's calorie needs in mind. 3. Avoid too much fat, saturated fat, and cholesterol Do you remember the sources of fat and cholesterol discussed in unit A? To apply this guideline, you should modify, as much as possible, your choices of high fat and cholesterol foods from the milk and meat group. This will reduce your client's chance of heart disease and overweight. For example: -Substitute skim or low-fat milk for whole milk. Use low-fat cheese and yogurt. Limit ice cream. - Use more fish, turkey, veal, chicken, or alternate protein sources. Limit red meats. - Limit egg yolks, including those used in cooking,:: about three or four per week. (This amount can be increased for children and the elderly.) -

Avoid cream, butter, and lard.

- Use polyunsaturated margarine and vegetable oils (corn, safflower, or soybean oils, for example). - Avoid using egg-enriched products or commercially baked products that contain lard, or cottonseed or coconut oils. -

Avoid fatty foods

Mod VIII-page 12

Dietary Guidelines 4. Eat foods that contain adequate starch and fiber The average diet contains more carbohydrates in the form of sugar instead of starch, which can lead to dental disease. In addition, many people eat too little fiber, which can cause bowel problems. When planning menus for your clients, choose whole grain breads or cereals and use more beans, peas, nuts, and seeds. These changes will increase both starch and fiber. For added fiber, include fresh fruits and vegetables in the diet as much as possible. 5. Avoid too much sugar When planning meals, try to avoid sugary foods in the "other" food group category (candy, soft drinks, ice cream, cakes, cookies, jellies, jams, alcoholic beverages). Do not use fruits canned in heavy syrup. Many commercially prepared foods not thought of as "sugary", such as commercial salad dressings, catsup, canned vegetables, and many breakfast cereals, are in fact high in sugar. Read food labels for clues on sugar content; look for the words sucrose, glucose, maltose, dextrose, lactose, fructose, and syrup. 6. Avoid too much sodium The average diet contains far too much sodium, which is found in salt. Excess sodium in the diet may contribute to the development of high blood pressure. One simple way to help your clients cut down on sodium is to encourage them to taste their food before salting it. Do you know which foods are high in sodium? For a start, any salty foods such as pretzels, potato chips, bacon, or ham contain a lot of sodiumSodium is also found in:  Smoked and processed fish and meats such as hot dogs and luncheon meats. 

Sauerkraut, pickles, pickled vegetables



Monosodium glutamate (MSG), onion, garlic, and other seasoning salts, baking soda



Condiments such as salad dressings, catsup, mayonnaise, soy sauce, steak sauce



Commercially prepared foods such as breads, canned or frozen fruits and vegetables, soups, bouillon, baked goods, ready-toeat breakfast cereals



Cheeses, salted margarine and butter



Gelatin desserts Mod VIII-page l3

Much of the sodium people consume in foods is hidden. The foods may not be thought of as "salty", yet they indeed contain a lot of sodium. Look for the words salt or sodium on the food label. Other considerations in Meal Planning Food preferences and eating habits What are your favorite foods? Are there other foods that you dislike and would never think of eating? Food preferences and eating habits are highly personal matters. Our eating patterns are influenced by many factors: our cultural backgrounds, past experiences, and religious practices, the availability of foods, their cost, and convenience of preparation. Calorie needs Calories are the units of energy that food provides. Energy needs (and, therefore, calorie; needs) vary according to the individual's size, amount of activity, age, and health. Size A six foot-tall man needs more calories daily than a five foot tall woman. A large framed person may need more calories than a small framed person of equal height. Age Pound for pound of body weight, children need more calories than adults. Can you think of a reason for this? Children need extra energy for growth. When growth stops, energy needs decline. During the adult years, this decline occurs gradually. An adult at age 40 will not need as many calories as he or she needed at age 20. Likewise, a person at age 60 will need fewer calories to maintain his or her normal weight than he or she needed at age 40. When calories eaten equal calories burned, weight remains constant. When a person eats more calories than his or her body uses, he or she gains weight. When not enough calories are eaten to meet everyday needs, the person loses weight As people age and their energy needs decline, they also usually become less active, which further reduces their energy needs. At the same time, they may not change their eating habits. Although they need fewer calories to maintain normal weight, they often consume the same number of calories they did when they were younger. The added weight that results places an extra burden on the heart. It also stresses the bones and joints. One thing doe not change with age: Although people do not need as many calories as they once did, they still need the same daily nutrients. This means that every calories counts, and foods that provide the best nutrition for the fewest calories should be selected. For example, a slice of apple pie, which would constitute one serving from the fruit group, contains about 377 calories. A fresh apple, however, has only 100 calories And while an eight-ounce glass of whole milk has 150 calories, an equal serving of skim milk has only 90 calories, and it contains the same nutrients as whole milk. ModVIII-page l4

FOOD/NUTRITION Amount of activity The more a person is, the more calories he or she needsHealth The amount of calories a person needs also depends on his or her physical condition. The body needs more calories when it is undergoing tissue repair because the process requires more energy. Special nutrient needs Injury and illness often call for extra nutrients as well as additional calories. And when people take certain medications, their needs for specific nutrients may change. For example, some drugs prescribed for high blood pressure increase the body's need for potassium. As a home care worker, you will not be expected to know which specific changes in the five basic food group diet will be needed. If your client is suffering from an illness or injury, always discuss any questions you have about meal planning with your supervisor. Cost When it comes to meal planning, few people can overlook cost. This is true for families as well as single people. Sometimes, when income is limited, people try to stretch their food budgets. Often they needlessly sacrifice good nutrition. Equipment/facilities available A client may have only a hot plate and/or toaster. Whenever you are planning meals with a client, the equipment that is available needs to be considered. Physical limitations A client may not be able to chew well due to poor dental health, or ill fitting or missing dentures. There may be clients who can only use one arm due to paralysis from a stroke. Remember The five food groups provide a simple standard for meal planning. The federal government's dietary guidelines supplement the five food groups in meal planning. When planning meals for their clients, home care workers should include a variety of foods; watch calories to help maintain the client's ideal weight; avoid too much fat, saturated fat, cholesterol, sugar, and sodium, and increase starch and fiber in the diet. Meal planning must also take into account food preferences and eating habits. These are based on cultural and/or religious background, past experience, the availability and cost of foods, and convenience of preparation. Calorie need and special nutrient needs must be considered too. Mod VIII-page l5

FOOD GROUP EQUIVALENTS-EXCHANGES Milk group One serving of milk is one cup (eight ounces) of Milk Butter milk Skim milk Two percent milk Reconstituted nonfat dry milk Reconstituted whole or skim evaporated milk Chocolate-flavored milk drink Homemade cocoa Yogurt Custard The following equal one serving from the milk group: One one-ounce slice of Swiss cheese Two one-ounce slices of processed American cheese Two one-inch cubes of cheddar-type cheese 1 1/2 cups of ice cream or ice milk 1 1/2 cups creamed cottage cheese 1 1/2 cups milk-based pudding Two tablespoons of cream cheese are comparable to one tablespoon of milk. Meat group The following equal one serving from the meat group: Two - three ounces of lean boneless cooked meat Two hot dogs One three-inch hamburger patty Two medium slices of chicken One medium fillet of fish Two postcard-sized slices of roast beef Half of a seven-ounce can of tuna fish 8 medium shrimp One thick port chop, lamb chop, or veal cutlet Two slices of bologna Other one-serving equivalents are: Two eggs One-quarter cup peanut butter One cup baked beans One cup cooked dried peas or lentils Mod VIII-page 16

Fruit and vegetables group The following equal one serving from the fruit or vegetable group: One medium-size apple, orange, pear, peach, banana, potato Two small fruits (such as plums) One-half cantaloupe or grapefruit One cup fresh berries One cup raw leafy vegetables One-half cup fruit juice Fruits and vegetables high in vitamin C include: Grapefruit or grapefruit juice Orange or orange juice Cantaloupe Fresh strawberries Papaya Mango Guava Broccoli Brussels sprouts Sweet green or red peppers Lesser amounts of vitamin C are provided by: Collard greens Mustard greens Kale Kohlrabi Potatoes (both white and sweet, cooked in skins) Rutabaga Spinach Cauliflower Cranberry juice

Honeydew melons Lemons Limes Tangerines Raspberries Watermelon Asparagus Cabbage Tomatoes or tomato juice Turnip greens

Two servings of these foods will provide as much vitamin C as one serving of the foods that are High in vitamin C Fruits and vegetables high in vitamin A are dark green and deep yellow vegetables and deep yellow fruits. These include: Cantaloupe Mango Carrots Pumpkin Spinach Broccoli

Sweet potatoes Winter squash Collard greens Mustard greens Turnip greens Other dark green leafy vegetables Mod VIII-page 17

Fruit and vegetable group (Cont) Lesser amount of vitamin A provided by: Apricots Persimmons

Watermelon Beet greens

Some fruits and vegetables provide both vitamins A and C; one serving of these can count as a serving of both an A and a C fruit or vegetable.

Grain group The following equal one serving from the grain group: One ounce (about one cup): ready-to-eat cereal 1/2 to 3/4 cup: cooked cereal cornmeal grits macaroni noodles rice spaghetti One: slice of bread roll, biscuit, muffin pancake waffle popover bagel Two: tortillas

"Other" group No recommended servings. Use sparingly after nutrient needs are met. Mod VIII-page 18

Food preparation & serving How do you like to prepare foods? Do you fry, sautĂŠ, or broil chicken? Boil or steam vegetables? Roast or braise meat? You may be familiar with some of these methods with others, you may not. Cooking Terms Bake or roast - to cook with dry heat at any temperature and usually in a confined space, such as a oven. Boil - to cook in a liquid that is hot enough for bubbles to break on the surface Braise - a long slow cooking method that makes use of moist heat in a tightly covered vessel at a temperature just below boiling. Braising is a good way to tenderize tough meats and vegetables, since the long cooking breaks down their fibers. The cooking liquid should just barely cover the food to be braised. Broil â&#x20AC;&#x201D; to cook directly under or above a source of radiant heat (gas, electric, or an open fire). Fry - to cook food in pieces or serving-size units in fat or oil. When only a small amount of fat is used, the process is called pan-frying or sautĂŠing. When larger amounts of fat are used (enough to cover food) the process is called deep frying or deep fat frying. Poach - a method of cooking used to preserve the delicate texture and prevent the toughening of such foods as fish, chicken, and eggs. The food is immersed more or less completely in water or some other liquid. Depending on the type of food being cooked, the liquid may be either at the boil or at the boiling point; it is important to maintain a low temperature to preserve the texture of the food. Vinegar or lemon juice can be added to the liquid for flavor and to assist in maintaining the shape of the food. Vegetables and seasonings such as salt and herbs can be added for flavor. Steam - a method of cooking by exposure to the vapor of boiling water. The food must be above the liquid, never in it. The container is closed during cooking to let the steam accumulate. Steaming is one of the methods used to cook rice, fish, dried fruits, vegetables, breads, and puddings. It retains a high proportion of the original flavor and texture of the foods because the nutrients are not dissolved in the cooking liquid as is the case with boiling or poaching. It should be the method of choice for preparing vegetables. Stew - a method of long, slow cooking food in liquid in a covered pot. Good for cheaper, tougher cuts of meat. Client Involvement Involving your client in meal preparation helps: Promotes independence Builds helping relationships Provides stimulation, relaxation Increases sense of self-worth

Mod VIII-page 19

Available cooking equipment Often, meal planning may be limited by the kitchen equipment on hand. Some clients may live in a single room or very tiny apartment. They may lack the usual kitchen equipment such as stoves and refrigerators or pots and pans. The only equipment available may be a hot plate and a large pot. (What would you do in such a situation?) The client had no refrigerator? The client only had a hot plate? Keeping fuel costs in mind The cost of fuel used for cooking can be an important concern to anyone living on a low income -Cook food only until tender -Use the oven to prepare two things at one time -Use a toaster oven, if available, to avoid heating the entire oven for just a single food item -Use a double boiler to cook two items (using the same amount of heat) -Include raw vegetables and fruits in each meal Serving meals For most people, mealtime is a time to be shared with others. It is often thought of as a time for relaxing family conversation. When people are socially isolated because they are elderly, ill. or disabled, mealtime can be lonely. Children whose parents are absent may feel their loss ever more at mealtime. Make mealtime pleasant and relaxing Plan to sit and talk with your client Food Appearance, Texture, Portions: Use contrasting colors & textures, using different colors & textures makes the meal more appealing. For example, you would not serve broccoli & green beans at the same meal. You might substitute carrots for one or the other; the contrasting colors would be appealing. Serving two foods of the same texture would be similar and uninteresting. Instead of serving mashed potatoes & mashed turnips, serve a baked potato & mashed turnip.

Mod VIII â&#x20AC;&#x201C; page 20

Food Appearance. Texture- Portions: Arrange food attractively on the plate, people seem to have better appetites when foods are pleasing to the eye. Serve small portions, but allow enough extra food for seconds. It may be necessary to plan four or five small meals a day when working with ill or elderly people, who complain of being to tired to eat. A nap before mealtime may also help overcome the problem of being to tired to eat. Be alert to a consistently poor appetite, this may be a sign of illness or depression. This should be discussed with your nursing supervisor. Poor appetite may be caused by: Dissatisfaction with the food. This often happens when the client must follow a restricted diet, such as one with reduced salt. In these situations, try harder to make your client understand how this diet benefits their health. This better understanding sometimes helps to correct the problem. At other times, clients may be too shy to say that they do not like how something was cooked. Use communication skills to encourage them to express their feelings, and let them know you can change your meal plans or cooking methods. Improper mouth care, A person may have a bad taste in his or her mouth, so food tastes bad. Encourage a more frequent tooth brushing or a mild salt water rinse to improve oral health. Chewing problems. Missing teeth or faulty dentures can make eating a chore. In these cases, plan meals that use softer foods, such as ground meats. Remember We should strive to; cut down on salt, sugar, and fats in meals and food preparation involve clients in food preparation and menu planning be alert to consistently poor appetite that may signal physical or mental health problems adapt meals according to available cooking equipment ModVIII-page21

Food Shopping. Storage & Handling: I. How to save on food costs A- Use coupons and weekly specials B. Compare prices among brands C. Avoid convenience foods D. Check food labels for nutritional value E. Look for seasonal items F. Consider availability of storage space G. Calculate the cost per serving H. Use meat substitutes I. Stay within the food budget II. Food storage A. Rewrap and refrigerate meat, fish, or poultry promptly B. Store dry foods in covered containers and use older purchases first C. Refrigerate eggs, milk products, margarine, cooking oils, salad dressings-mayonnaise D. Do not refrigerate fresh fruit until ripe E. Keep refrigerator and freezer units in good working order. Keep refrigerator at 36-40째, freezer at 0째. F. Cover all refrigerated food and date them G. Use frozen foods within six months H. Do not thaw food at room temperature III Food money procedures A. Follow agency's policy procedures B. Save all receipts C. Account for all money spent as soon as possible after shopping IV. Safe food handling A. Keep hair covered or pinned back B. Wear clean clothes or apron C. Always wash hands before handling food D. Wear gloves if you have cut or infection on hands E. Avoid coughing or sneezing around food F. Clean work spaces before and after food preparation G. Use clean dish towels and cloths H. Use hot water and soap to wash utensils I. Never taste and stir with the same spoon J. Put warm foods in refrigerator immediately K. Do not use damaged cans with bulging ends L. Avoid eating raw eggs; never use cracked eggs; never undercook eggs M. Use cooked meat, poultry, fish, and baked dishes within three to four days N. Do not use foods that have become moldy O. Clean and sanitize food preparation area P. Keep hot food hot (above 140째 F) and cold foods cold (below 40째F) Q. Keep the refrigerator clean R. Use food within the recommended dates for freshness S. Do not refreeze food Mod VIII-page 22

Remember When shopping, use a list, read food labels, and shop for both price and good nutrition After shopping, store foods promptly and use them as soon as practical. These practices help keep foods at their best and help ensure that they will be used before they spoil. Follow agency policy and procedure when handling food money. Always account for money as soon as possible after shopping. Practice the basics of safe food handling to prevent illness and reduce food spoilage. Simple Modified Diets: A simple modified diet is a diet that has been changed in only one way. The change would be ordered by the clientâ&#x20AC;&#x2122;s doctor. Types of simple modified diets Let's take a look at the types of diet changes that a client may have. Remember that these changes are called simple because a client would have only one of these. The chart that follows is a list of commonly prescribed modified diets, the reasons why they are used, foods that are to be encouraged, food not allowed, and in some cases special notes. These are only general statements, however. Remember that modified diets are carefully figured to meet client's individual needs and each person's diet will differ from every other diet. The specifics of a client's diet will be on the care plan located in the client's home. Mod Vlll-page 23

The following chart shows the characteristics of some of the more commonly prescribed modified diets. These are only general statements, however. Remember that modified diets are carefully figured to meet clients' individual needs and each person's diet will differ from every other diet. TYPES OF SIMPLE MODIFIED DIETS NAME OF DIET

IS USED WHEN:

FOODS ENCOURAGE

Soft

Client has difficulty chewing and swallowing

Soft foods, custards, Raw vegetables whole meats soups, apple sauce, mashed veggies Any food that is liquid All other foods at room temperature, clear; jello, clear soups, full juices, ice cream

Liquid clear -

full

Bland

Low fiber, low residue High fiber, high residue Low fat

Low cholesterol

Low sodium (salt)

Low calorie

High calorie

High protein

Client is recovering from surgery, needs to keep intestinal tract relaxed and free of food

FOODS NOT ALLOWED

Client has difficulty digesting spicy or other foods: Prescribed sometimes when clients have ulcers Client has bowel disturbances Client has constipation problems

Mildly seasoned foods, Spicy foods, raw vegetables puddings, eggs, milk or fruit whole grains, highly seasoned foods, sometimes cabbage

Client has high cholesterol levels in the bloodstream, heart disease Client has heart disease, high blood pressure, kidney problems

Fruits & vegetables, grains, fish, chicken, skim milk, margarine Fresh vegetables & fruits unprocessed, foods

NOTE: May cause constipation This not a nutritionally sound diet and clients should not stay on this very long

Low fiber foods

Whole grains, raw fruits and vegetables Whole grains, raw fruit, No dietary restrictions vegetables, prunes, prune juice Client has trouble digesting Chicken, fish, skim Bacon, butter and margarine, fats as in gall bladder or milk, veal, vegetables, cheese, eggs, fried foods, ice liver problems fruit cream, chocolate Animal fats, eggs, fatty meat, butter Processed foods such as TV dinners, canned soups, ham, bacon, sauerkraut, lunch meats, most cheese

Client needs to lose weight Fruits, vegetables, skim, Rich deserts, fried foods, milk, lean meats, fish sauces and gravy, fatty foods chicken, some grains & cereals, a variety of foods in moderation Client is recovering from All nutritious foods plus No dietary restrictions illness, needs to gain eggnogs, milk shakes weight nutritious snack such as; ice cream, rice pudding & pizza Client is recovering from All nutritious foods plus No dietary restrictions illness or injury to bones or extra protein such as muscle milk, eggs, cheese and/or a protein supplement

Mod VIII - page 24

Preparing mechanically altered diets Chopping can be done with a sharp knife on a wooden or ceramic chopping board. Grinding and pureeing can be done in a food processor or blender. Fruits and vegetables can be pureed by pushing them through a colander or sieve with back of a spoon. All equipment used in mechanically altering food must be kept absolutely clean. Take the blender or food processor apart after every use. Wash each piece that has come in contact with food in warm sudsy water, rinsing thoroughly. The chopping board must also be washed after each use. This is especially important after chopping raw meat. 

Cook the food before pureeing. Sometimes your instructions will indicate cooking the food before grinding it as well.



Do not combine foods. Puree or grind foods one at a time and serve separately for variety of flavor.



In some cases fluid must be added; an example would be adding broth to some meats. In other cases, such as in pureeing fruits the natural juices of the food provide enough fluid.



Amounts of food are decreased with pureeing- Three ounces of cooked meat does not yield three ounces of pureed meat-Seasonings, condiments and sauces can be added to increase flavor and interest.



Some foods, such as puddings, custards and soups can be served in their regular shape. The client will appreciate the sense of eating foods that they are used to.



Eating pureed foods is messy. Provide a bib or other covering and avoid making an issue of spilled food.



Serve hot foods hot and cold food cold.



Identify each food for your client so he or she knows what it is.



Allow the client enough time to swallow the food.



Sometimes it helps to offer your client a piece of soft bread while he or she is eating a pureed diet. It makes soft food easier to swallow.



Clients on pureed or soft diets may have problems with constipation. Watch for indications and offer plenty of extra liquids.

Mod VIII-page 25

Simple Modified Diets: Notice on the chart, some diets are called low and some are called high. What do you think is the difference between a low fiber and a high fiber diet? Now to answer the question about high and low fiber. It's just as it is stated. A high fiber die: means that a diet would be changed so that there is an increase in the usual amount of fiber. On the other hand a low fiber diet means that there would be a decrease in the amount of fiber in the regular well-balanced diet. What about the soft and liquid diet? You could remember these two diets by thinking about the consistency of food you would encourage the client to have. If you had a client who was on a soft diet because she had difficulty chewing, what could you : with a baked potato? Think about it. You probably came up with the right answer. You would simply take the potato and remove the skin and mash it with a fork. See how easy it is? Making modifications in a client's diet is not that difficult. Sometimes a client has a clear liquid diet ordered. The clear liquid diet is usually ordered for a client only for a very short period of time, because it's so limited in nutrients. The client would only be allowed to have clear jello, soda pop, or clear soups. Clear soup is not very nourishing If the client has an order for a full liquid diet he is allowed foods that are liquid at room temperature. A prescribed bland diet will include very little seasoning. Let's say that you had a client who was on a bland diet. This client loves custard pudding. You always put cinnamon on top for a touch of color whenever you make custard. For this client, would you add any cinnamon? If you answered no, you are right. See how simple it is to change a diet? If you noticed from the chart, there are reasons given for different diets. These reasons are usually related to some health condition. This is true for the low fat, low cholesterol, low sodium (salt) and low calorie diets. Notice that the low fat and low cholesterol diets seem simple, but they are not You can remember the difference between these two diets if you think about the foods that have fat in them. In a low fat diet the client has to avoid all kinds of fat; such as, sausage, bacon, foods cooked in butter or oil.

Mod VIII-page 26

Decreasing the intake of certain foods You probably have known someone who has had difficulty keeping their weight down. Often a client who needs to lose weight is put on a low calorie diet Don't be surprised if a client complains about the diet You can be very encouraging and supportive when it come to weight loss. You might use a statement like "if you stick to your low calorie diet, you will soon see a change in your weight." Sometimes it's difficult for a client to reduce food intake in the beginning. "Pass the salt please." How many times have you heard that said? A client who is on a low sodium diet is not allowed to have free salt added at the table. This is not the only restriction. Notice from the chart that any food that has had salt added during processing is to be avoided also. You need to pay attention to how food has been processed, when considering whether or not it is allowed on a low sodium diet Always read the label. The nice thing about this diet is that there are quite a few food products available on the market today that are processed without any added salt. Increasing the intake of certain foods The two diets that have been not been mentioned are high calorie and high protein. If a client had either one of these diets you would have to add either calories or protein to a normally balanced diet. To remember these diets is really easy; the client would be encouraged to eat more of the nutritious foods he or she normally eats. Foods high in calories will be found in the grain group. Foods high in protein will be found in the meat group. Using foods found in these two groups is an easy way to increase calories and protein. Preparing mechanically altered diets Occasionally a home care client may have difficulty chewing and swallowing many solid foods. This difficulty may occur because of an obstruction in the throat, recent surgery, general weakness, loss of teeth or dentures, or paralysis. If the condition is temporary and is only expected to last a few days or a week, the doctor will suggest a temporary liquid, full liquid or a soft diet. For more variety and better nutrition, your client may be advised to mechanically alter the foods. Mechanically altering can mean chopping, grinding or pureeing. Chopped foods are foods that have been cut up into very small pieces. Grinding breaks the foods up into even smaller particles. Pureed foods are cooked foods that have been ground very fine or strained and enough liquid added to give them the consistency of thick soup or baby food. When the normal texture of food is changed it loses its appeal. Many nutrients are lost in the pureeing process so that when a client must eat pureed foods over a long period of time he or she may need vitamin supplements. A diet of pureed foods may also cause constipation and even dehydration. Therefore it is important to follow directions exactly. Mod VIII-page 27

NUTRITION SUMMARY CUT DOWN ON FATS BY: Broiling, baking or steaming foods instead of frying them Eating less beef, pork and lamb by eating smaller portions and eating them less frequently Taking the skin off poultry and fish after cooking and throwing it away Eating smaller portions of all animal flesh foodsâ&#x20AC;&#x201D;meat, poultry or fishâ&#x20AC;&#x201D;and eating more vegetables and natural starch foods like brown rice Adding very little or no butter, oil, margarine, drippings or other fats to sauces, starches vegetables and other foods CUT DOWN ON SALT BY: Avoiding fast foods, canned foods - especially soups, soy sauce, Chinese foods, pizza. cold cuts, T.V. dinners and other frozen convenience foods CUT DOWN ON SUGAR BY: Drinking seltzer or water instead of soda Diluting a glass of fruit juice with half seltzer Eating fruit instead of rich desserts more often Sharing a dessert in a restaurant with several friends instead of eating the whole thing DO EAT: Salads with very little dressing Vegetables that are lightly cooked Liberal amounts of fresh fruit Whole grains like oats, brown rice, whole wheat and rye Potatoes with their skins Beans prepared with little if any fat Lowfat (1%) milk and lowfat unflavored yogurt Small amounts of fish and chicken Smaller amounts of meats and eggs Mod VIII-page 28

SUGGESTIONS FOR FEEDING SOMEONE WHO IS ILL Respect patient's eating habits i.e. his likes and dislikes. Don't impose yours on him. Be artistic, fix all food trays with a little special touch to perk patient's appetite and emotions. Remember COLOR, TEXTURE, FLOWERS! The patient may have no appetite or be constantly hungry due to boredom or medication. Try to help. Goal is to maintain ideal weight Be alert to medicine and food interactions. Some medicines must be served with meals, before meals, after meals.....read labels, ask questions, serve food on TIME!! If directions states serve with milk don't substitute juice and vice a versa. Eating in bed creates problems. Serve on a tray or at least place a towel or cloth on patient. Crumbs in bed are a nuisance. Remember to offer a bent straw with beverages, especially if patient is on his back. Milk intake is important for all ages. If patient has no taste for milk try to jazz it up with fruit (strawberry float, etc.) or offer cheeses, and other milk group food frequently. Be alert to dietary restrictions, however. Smoking; Your smoking may bother the patient especially at mealtime. Be courteous; be sure to smoke in an area far from where the patient is located. Remember most people don't like to complain. Try to put yourself in your patient's place and cater to his needs. People get upset when they can't do for themselves and emotions are often taken out on the one person who is trying to help. Your efforts are appreciated!!!

Mod VIII-page 29

Feeding the patient: Wash your hands before feeding the patient Sit next to the patient. If he is in bed, support his head, if necessary, by placing your a under the pillow. Feed the patient from the midline. It is difficult for the patient to swallow with his he^: turned at a 45-degree angle. Test the temperature of the food by placing a drop on the back of your wrist. Soup, coffee, and other hot items should not be allowed to bum the patient's mouth. Identify food for the patient as you give it. Do not mix food together. It is unpleasant for a patient to eat a combination such as peas and spinach. Place the food into the patient's mouth and allow him sufficient time to chew and swallow between bites-cut food into small pieces, if necessary. If a patient is paralyzed on one side of the body, put food in the side of the mouth that is not paralyzed. Alternate liquids with solid food to help make meals more enjoyable-Offer the patient an opportunity to wash his hands and face and brush his teeth. Remember that it is not pleasant for an adult to be fed. Your attitude sets the mood : the single most important factor in the amount of food consumed by the patient who requires feeding.

Mod VIII -page 30

TIPS TO SAVE NUTRIENTS IN FOOD PREPARATION 

Use a sharp blade when trimming, cutting or shredding fresh vegetables or fruits. Vitamin losses occur when tissues are bruised.



Leave skins on fruits and vegetables when possible. This helps preserve vitamins.



Keep leafy green vegetables refrigerated after cleaning and trimming until served. They keep their nutrients best if placed in a crisper or moisture-proof bag that keeps moist air around them.



Cover and refrigerate diced or grated vegetables and fruits immediately after preparation if they are not to be eaten right away. This will minimize loss of vitamins



Cook vegetables only until tender. If vegetables are boiled, use only as much water as needed to given an acceptable product and use a tight-fitting lid. However, strong flavored greens will retain better flavor and color if cooked in boiled water without lid.



Cook vegetables just before serving time, if possible. If serving time is long, cook small amounts as needed to minimize holding time.



Canned vegetables need only be heated to 140F-150F, as they are already cooked. Never add soda to vegetables. It is alkaline and destroys vitamin C.



Save excess liquid on canned and cooked vegetables and use it in soups, gravies, or in other ways. Some of the nutrients originally in the vegetables end up in the cooking liquid.



Prepare cooked, enriched rice, macaroni, spaghetti and noodles without rinsing or using excessive amounts of water, saving those nutrients that dissolve in water.



Use low temperatures for cooking meats. This contributes to the retention of the B vitamins. Precooking can reduce the B vitamins by as much as one-third.



Use meat drippings (remove fat if desired) in gravies or pour over the meat

Mod VIII-page 31

REMEMBER Simple modified diets: 

Simple modified diets are diets that have a single nutrient change to be made, a change in the amount of calories or have no nutrient changes but are mechanically altered.



The types of simple modified diets are: soft, liquid, bland, low fiber (residue), high fiber (residue), low fat, low cholesterol, low sodium (salt) . low calorie, high calorie, high protein and mechanically altered.



There are different ways to remember the types of diets; high means to increase an amount of food; low means to decrease the amount of food : avoid it altogether, soft and liquid diets mean you pay attention to the consistency and whether or not a client can easily swallow or chew the food; bland means you decrease or eliminate the seasoning.



You should not confuse low fat with low cholesterol diets; low fat means any fat; low cholesterol means animal fat.



With low sodium you are concerned about the amount of salt contained I the food.



In a high protein or high calorie diet you are adding protein or calories to an already well balanced diet.

Mod VIII-page 32

Basics of nutrition Why is food the foundation of health? If you think about your daily activities, you will have the answer. Food provides the energy you need for work and play. It also provides the energy needed for growth and repair of tissues. The food you shop for and the meals you prepare as a home care worker can help; - Children grow, develop, and reach their mental and physical potential - Expectant and nursing mothers maintain their health - Adults and the elderly stay active and prevent them from developing certain health problems - The ill recover more quickly and stay healthy - The disabled maintain or improve their strength and overall health When people feel better physically, their general outlook on life often improves. In this sense, nutrition can contribute to mental as well as physical well-being. Take a few moments to think about the different foods you ate yesterday. Then list them on this page. Note approximate serving sizes. Be sure to include any snacks or beverages you consumed in addition to your regular meals, as well as the number of glasses of water you drank. Yesterday I ate the following foods Breakfast

Lunch

Dinner

Other snacks/beverages

Water ModVIII-page33

VOCABULARY LIST MODULE VIII Calorie â&#x20AC;&#x201D; the measure of energy food supplies to the body. Cholesterol - a fatty substance present in animal fat. Consistency â&#x20AC;&#x201D; the firmness of thickness of a food. Convenience Foods - already prepared food requiring very little preparation before eating. Dietary Guidelines - recommended dietary changes for the American diet, published by the federal government. Fiber - residue or the indigestible part of plants; it occurs naturally in some foods Sometimes fiber is referred to as bulk. Generic - low cost food items found in supermarkets. These foods are nutritionally the same as the brand name foods that cost more. Mechanically Altered Diet - a diet of foods which have been ground, chopped or pureed for those persons who have trouble swallowing or chewing. Nutrients - chemical substance obtained from foods during digestion. Obesity - the condition of having too much fat stored in the body. Polyunsaturated - refers to the type of fat found in vegetables and fish. Recommended Daily Allowances â&#x20AC;&#x201D; the number and size of servings of food from all four food groups based on a 1200 calorie diet. Saturated Fat - a fat found in meat, poultry, and dairy products. Simple Modified Diet - a type of diet that has a single nutrient change, has a change in the amount of calories or is mechanically altered. Sodium - another word for salt. Unit Pricing - the price paid for the unit or measure of a food such as; cost per ounce, pound or dozen. In a supermarket it makes it easy to make price comparisons between foods. Mod VIII-page 34

THINK SHEET - MOD VIII 1.

What are some foods to reduce on a low salt diet?

Define a simple modified diet?

What foods would you avoid to reduce sugar in the diet?

What is a bland diet?

What foods should be avoided on a low fat diet?

How can you reduce saturated fats & cholesterol in a diet?

What are some forms of carbohydrates?

What are some alternate sources of protein?

What are some good sources of vitamin A?

10.

What type of client would need an increase in calories?

11.

How could you prepare meat?

12.

Would you involve your client in meal preparation?

13.

What does the texture of food mean?

Mod VIII-page 35

Module IX FAMILY SPENDING AND BUDGETING

MODULE IX

Family Spending and Budgeting

UNIT:

A. B. C.

The Role of the Home Care Worker in Family Spending and Budgeting Ways to Make the Most Effective Use of the Family's Finances

TIME:

30 Minutes

OBJECTIVES: At the completion of this Module the student will be able to: 1. 2. 3. 4.

Describe two possible roles of the Home Care Worker in handling the client's money. Record accurately the expenditures for which the Home Care Worker is responsible. Name ways of shopping effectively for food and household supplies. List ways in which best values can be found when shopping for clothes or supplies.

SUGGESTED TEACHING METHODOLOGIES:

Lecture, Group Discussion

SUGGESTED EVALUATION METHODOLOGIES:

Written Exam, Class Participation

MODULE IX

Family Spending and Budgeting

OUTLINE: Unit A

1. 2.

Unit B 1. 2. 3. 4. 5.

The Role of the Home Care Worker in Family Spending and Budgeting Assistance with shopping, buying, and baking assistance. Aide record keeping requirements when handling patient's money for errands outlined in Plan of Care. Ways to Make the Most Effective Use of the Family's Finances Buying food and household supplies. Buying drugs and medicine. Buying clothes. Looking for bargains/comparing prices and products (generic brands). Buying in quantities.

Budgeting/Spending The role of the home care worker in family spending & budgeting. In order for anyone to manage money successfully, it is important to develop a specific, carefully-thought-out budget. The purpose of a budget is to meet the financial goals and needs of a particular individual or family; it outlines how money will be spent before it is spent. •

income one expects to receive

•

expense one expects to have

•

profit or loss expected after the income is received and expenses are paid

Many people may already have a rough budget plan in their mind, but a written budget plan will show accurately (and often surprisingly) exactly where the money is going. No two budgets look exactly alike because, as you learned in Module II, each family has its own values and preferences. These individual values and preferences as well as the family's income level, priorities and previous spending habits help determine how a family spends its money and selects its financial goals. As a home care worker, it is always important that you respect the family's financial goals and preferences when you assist them with money management. Teaching a family how to manage money. A budget is designed to meet the goals and needs of a particular family. The budget fists the family's sources of income as well as expenses. Which may include: • Food • Rent or mortgage payments • Utilities • Telephone • Transportation • Household goods

• Taxes and/or insurance • Medical care • Clothing • Past debts • Recreation • Donations

Some of these expenses, such as food, rent or mortgage payments, telephone and utilities are essential. They occur regularly and in fairly fixed amount, and must be paid first. Other expenses (past debts, clothing, household goods, and recreation) may vary; the funds left after the essential expenses have been paid can be used to handle these expenses. If possible, some amount, no matter how small, should be set aside each month to take care of emergencies or unusual expenses. Mod IX-page 1

In the process of learning to follow a budget, difficult choices are often necessary. When there are choices to make. It is important to consider the client's values and preferences. A budget helps clients meet all of the basic expenses of living. It can also reduce debts and provide for emergencies or special needs as they arise. Encourage the family to assume as much responsibility as possible for its own affairs. Assistance with buying, shopping, and banking. Very few individuals or families ever want to give up any of their financial responsibilities. Yet there are a growing number of older or disabled persons who are physically unable to get around and have no relatives or friends nearby. They may need a home care worker to assist them with shopping and spending their limited income wisely. In some cases, you and the client will make up a shopping list and estimate the total cost of the items. The client may give you cash, or food stamps to cover the cost of the purchases. The care plan will outline if you are to do the shopping for groceries or other shopping. You may also be assigned to do banking or to mail checks the client has written. Whether you are assigned to these tasks will depend on your client's physical ability and the availability of family or other people to help. Whenever you handle client's money it is important to keep accurate financial records in order to prevent misunderstanding. Records are a good practice in all home care situations that involve the exchange of money. They protect the home care worker, the agency, and the client. Financial records should be: • • • • •

Simple Current Accurate Easy to read Readily available

Financial records should include: •

The date you received money from the client

•

The total amount of money received and whether it was in cash, a check, or food stamps

•

The items the money was spent on (groceries, appliances, clothing)

•

The exact cost of each item

•

The exact amount of change returned to the client

Mod IX-page 2

•

The clients signature agreeing to the above

•

Your signature

REMEMBER: •

When you receive shopping money from a client, recount it in his or her presence. When there is change to return to the client, count it directly into the client's hands.

•

As soon as you return from your shopping trip, account for all purchases made and explain any changes from the original shopping list that were necessary. This will keep your client involved in this important activity and will also help to avoid confusion.

•

Have the client assist you in putting away groceries or other purchased items, to the degree that he or she is able.

•

A budget plan needs to include both income and expenses.

•

No two budgets are exactly alike, because each family has its own values, preferences, income level, priorities, and spending habits.

•

The home care workers, work related to family spending and budgeting are:

•

Assistance with shopping, buying, and banking. This may be your role with families who are able to manage their money but due to age, illness, or disability are physically unable to perform these tasks and have no one else to do it for them.

•

Teaching a family how to use budget and spend money carefully in order to meet its financial goals.

You have also learned that it is important to: •

Keep financial records.

•

Know and follow your agency's policy in relation to keeping records.

Mod IX-page 3

Budgeting/Spending Ways to make the most effective use of the family's finances In this unit, you will learn ways to make the most effective use of a family's finances so that as many of their goals and needs as possible are met. This information will be useful when you shop for clients or when you help them learn how to spend money carefully. You are not always spending money most when you stretch the budget and buy the cheapest product. There are many things besides price that influence our buying habits: Value systems, culture background, and lifestyle all play a part. Some people cook only with fresh foods, others prefer canned foods, still others prefer frozen foods. Price alone might not make people change these habits. Some families choose to spend their extra money hosting special dinners every weekend for family and friends. Others may prefer to spend their money on movies, clothes, or other things that give them pleasure. Vacation means so much to some people that it's worth scrimping all year to save money to get away for those few days. In short, how we spend our money is a very personal matter. Many of us do not even realize that there is a pattern to how we spend our money. Think about yourself. After all of the bills are paid (or even before), what do you most enjoy spending your extra cash on? (The important word in this question is enjoy.) What items in your budget would you scrimp on so that you could spend money on the things you most enjoy? Your clients will also have very specific likes and dislikes in food, in clothing, and how they choose to spend their money. However, no one wants to pay more for an item then he or she needs to. For this reason, learning how to shop carefully and spend wisely will mean a great deal to your client, especially those who live on fixed or very limited incomes. Buying food and household supplies The first step in shopping is to make a list, one that begins with mean planning, list the items that are needed for the meal, and consider the needs and wants of your client Consumer experts who have studied the buying habits of Americans also recommend that shoppers: â&#x20AC;˘ Shop after eating (shopping when you are hungry leads to impulse buying). â&#x20AC;˘

Try to shop without children, who are easily tempted by food ads seen on television. Mod IX-page 4

Budgeting/Spending Buying foods and household supplies Where to buy It may be necessary for you to make a quick survey of the community in which your client lives. Observe the pricing policies of the different stores, including supermarkets, independently owned shops, and chain stores. Find out which stores accept food stamps, if your client uses them. To help your clients, you should try to get the best buys. Remember, however, that your time is valuable, too. Grocery shopping is only one of the important services you may provide, and the extra time spent and money saved in shopping in two or three different markets must be weighed against the other services the client needs. Try to find the store that consistently offers the best value for a broad range of food and household goods. In addition, shop only in stores that clearly post the unit price, as required by New York State law. The posted unit price means that the store has divided the price of the item by the number of units and arrived at the cost per unit. Using the unit price, you can compare the costs of the various sizes of the same item. Unit price

Price of item Number of units

By always checking the posted unit price, you will know which size and/or brand is the "best buy". What to buy Coordinate your shopping with your client's meal plans and the major meat, chicken or fish items on the menu. Be alert to foods that are in season, since this when they are usually your best buy for cost and quality. You may also want to buy season foods for canning, freezing, or preserving. Most newspapers carry ads announcing which foods are plentiful. Your client's preferences can decide which in-season foods to buy. Ready-mixed foods products are often more expensive than buying the product's ingredients separately and making the dish yourself. However, some clients may prefer to use mixes because it is easier, there is no waste, and it saves time. For them, the ready-mixed products may be worth the higher cost.

Mod IX-page 5

Budgeting/Spending Buying in quantity You and the client must decide what the client can afford to buy in quantity. Does the client have enough storage space? How frequently will the product be used? (The item may be a good buy, but if it's not used, it ends up being very expensive.) When thinking of storage, it is important to keep in mind that a well-stocked freezer less electricity than one that is empty. However, the opposite is true of a refrigerator, so do not overfill the refrigerator to the point that the cold air cannot circulate freely around the stored foods. More and more foods are being marked with a "last date of purchase." Be alert to these dates, particularly on bread, milk, yogurt, and other items that spoil quickly. Try to buy the freshest, more recent products. Avoid those whose "last date of purchase" shows that they will soon be removed from the shelves. Evaluate "health foods." They sometimes cost more and may not be any more "natural" than similar foods sold in supermarkets. Health foods are not necessary for a nutritious balanced diet. When your client is on a special diet, such as a low sodium diet, you can avoid buying certain foods or look for specially marked products that can add variety to the menu (provided they are not too costly). Some store brands of food and household items may offer quality equal to that of highly advertised brands, but may cost less. Also more stores now carry what are called generic or "no-frills" products, food and household items with plain labels that state only the products name and list of ingredients. These foods are wholesome but often not as attractive; for example, peaches may not be evenly sliced and may contain irregular pieces. Generic foods such as tomatoes should be considered especially if they are to be used in casseroles or stews, where such irregularities are not important. .Sign up for and use U.S.D.A. food stamps, WIC coupons, surplus foods or any government supplement program your client is eligible for. Food stamps and WIC coupons are paper coupons issued to qualified individuals and families to supplement their food budgets. They can be redeemed for food items and thus substantially increase low-income family's ability to buy nutritious food. Buying drugs and medicines Generic drugs (which, like generic foods, are less expensive) can be substituted for many brand name prescriptions when so authorized by the ordering physician and in accordance with state education law. Many non-prescription or over-the-counter drugs are also available in generic form. Discuss the use of these drugs with your supervisor and the client. Generic drugs can be significantly cheaper, but they have to be prescribed by the physician who signs the prescription form authorizing a generic substitution. Mod IX-page 6

Always keep medicines in their original labeled container and store them away from direct heat and sunlight. Over-the-counter and non-prescription drugs are labeled with an expiration date; beyond that date, they may lose their effectiveness and should not be used. The best way to dispose of medications in most parts of New York State is by flushing them down the toilet. Buying clothes When shopping for clothing, evaluate the individual's or family's wants and preferences first. Comparison shop for those items that best fit the family's choices and needs. When buying items that are on sale, remember: •

Try to shop at the beginning of the sale, when the selection is wider.

•

Be sure the sale price is an actual reduction.

•

Watch out for imperfect or damaged articles or merchandise that is below the store's usual quality. Some imperfections will not affect the usefulness or style of the garment. You will have to evaluate whether or not a damaged item is truly a bargain.

•

Be aware of styles. Items that are unlikely to go out of style may be a poor buy. Nothing is a bargain unless the client will wear it

Buying appliances & household items Consider the client's color, type, or brand preferences. Know the store with which you do business. Select practical items. Make sure discount houses are what they claim to be. Evaluate product advertisements and warranties. REMEMBER: • • • • • • • •

When you shop for a client or teach a client how to shop you should: Consider the client's preferences and choices. Learn the policies and price range of stores in the client's community. Compare prices and products. Use the unit price to determine value. When possible, buy generic (no-frills) products, including generic prescription and over-the-counter drugs when this is stated on the care plan. Read warranties. Check sales and shop early.

Mod IX-page 7

shopping Tips

•

Compare different brands of the same food. A store brand may be cheaper than a nationally advertised one.

•

Consider the way in which the food will be used. For example, use a cheaper brand of tomatoes for a casserole dish, where appearance is not so important.

•

Read the label to be sure that you are getting the kind and amount of product you need.

•

Consider cost per serving.

•

Buy with cash and/or food stamps. It is more economical in the long run.

•

Compare prices. Most stores offer "specials" priced below regular levels. These suggest best buys. Don't be tempted, however, by what appears to be a "good buy" on an item that is out of your price range (for example, buying steak when you should be buying hamburger).

•

Fresh fish is a budget-stretcher. When you shop, inquire about the varieties of fish available in plentiful supply. Whole fish are cheaper than steaks and fillets. And remember to think in terms of price per serving rather than price per pound, just as you do for meat. You will find that there is little or no waste in fish, steak or fillet; on the other hand, if you are preparing a fish chowder, you can use the head and other parts. Perhaps most important of all, be sure that the fish you buy is fresh and has been properly stored and refrigerated.

•

Chicken is a good buy. A few years ago, chicken was a luxury; now, it is one of the better food buys. With very few exceptions, today's fryer is an all-purpose bird that can be prepared by most cooking methods. It is also the best bargain in buying chicken. You can save a few pennies by purchasing a chicken whole instead of cut up. Parts not used in the main dish, such as the neck, back, gizzard, and liver, make excellent broth or gravy, and the meat from these parts can be used in casserole dishes.

•

Choose wisely among canned and frozen foods. You can often use second or "utility" quality canned foods when you are buying for use in stews and casseroles. Reserve your purchases of top-quality vegetables for "as is" or plain cooked dishes. Avoid nationally advertised brands and buy cheaper, are usually as good, store brands. Compare carefully the cost per serving when choosing among fresh, canned, and frozen forms of the same food; for example, a pound of fresh peas in the pod will make only about two half-cup servings, but a regularsize package of frozen peas will serve three or four. When buying frozen food, be sure that what you are buying is frozen solid and shows no evidence of having thawed. Refreezing lowers the quality of frozen foods. Mod IX-page 8

Cost of item Number of servings

Cost per serving

It is usually cheaper to buy staples and plain ingredients rather than processed or readymixed foods. For example, buy a head of cabbage instead of a package of cole slaw, plain macaroni and plain cheese instead of packaged mix, potatoes and mayonnaise instead of potato salad. There will be occasions, however, when the savings in time or the lack of use for leftovers (or a place to store them) makes it worthwhile to buy labor-saving foods. Buy in quantities as large as is practical. Don't buy more than you can store adequately and use in a reasonable time. Buy foods that are in plentiful supply. Seasons don't mean as much as they did a few years ago, but the supplies of many items will increase seasonally, which means that their prices go down. Foods, particularly fresh fruits and vegetables, are cheaper and better at their seasonal peaks. Buying meat requires consideration of quality, cut, and especially, amount of waste. The amount of inedible bone, fat, and gristle is an important factor in buying beef, pork, lamb, and veal. Also, think in terms of cost per serving instead of cost per pound; short ribs may cost less per pound than hamburger but yield only one-third or one-naif as many servings per pound. Remember the lower grades of meat have less fat and offer more for your money. Consider more inexpensive cuts of meat: flank, neck, shin, chuck, heart, liver, and kidney; skillfully cooked, these are delicious and offer excellent nutritional value. Finally, remember that you can "stretch" meat flavor by using small quantities in casserole dishes with such "extenders" as vegetables, potatoes, macaroni, and rice. Lower grades of eggs. The B and C grades are good to use when appearance and delicate flavor are not of primary importance, such as in baked dishes, custards, cakes, sauces, and salad dressings. Top-quality eggs would be used when they are to be served poached, fried, or soft-cooked. In the late summer and fail, it is usually cheaper to buy medium or small eggs instead of large ones, but you will want to compare prices before making this decision. Milk can be bought in many forms. Choose the best one for the family. Milk is cheaper when bought at carry-home stores or supermarkets than when delivered to the home. Skimmed, one-percent, or two-percent milk is usually cheaper than whole fresh milk and is equivalent in nutritive value (except for fat content). Evaporated milk is usually cheaper than whole milk and can be substituted for any use to which milk is put, but it is particularly useful in cooking. Instant, nonfat dry milk is even cheaper and can be used in many ways. It is easily reconstituted and is palatable when well-chilled; it can be added to many dishes to improve their nutritive value. Instant, nonfat dry milk lacks the butterfat content of whole milk, but can be safely used by whole family (except children under age two) if the rest of the family's diet includes sufficient butter or fortified margarine. It is an excellent food for a weight-reducing diet. Mod IX-page 9

Fresh fruit and vegetables in season are usually cheaper than the same items canned. This is not always true, however, so compare the prices of fresh and canned items using the price-per-serving rule. Apparent freshness and eye appeal form as good a standard as any in selecting fruits and vegetables. Consider also the possibility of buying slightly damaged or bruised produced that has been reduced in price for quick sale; if you can use it promptly; it may be a good buy. Even bread and cereal offer a choice. Loves of bread are generally a better buy than rolls or crackers. Think about whether you could use day-old bread, which is usually sold at reduced prices. Be sure to buy enriched bread, and vary your routine with whole wheat or other dark varieties from time to time. Cereals that require cooking, such as oatmeal, are cheaper per serving than read-to-eat cereals, select the quick-cooking varieties for maximum convenience not economy. Should you use butter or margarine? Margarine that is fortified is nutritionally a good substitute for butter and may cost less than half as much. Use it where you can if your budget is limited. And remember that you can use leftover drippings for a variety of cooking purposes, so save and reuse beef and bacon fat if you want to save even more.

Mod IX-page 10

Vocabulary List Module IX Brand Name:

A product purchased and advertised to emphasize its company name.

Budget:

A buying and spending plan designed to meet the financial goals and needs of a particular family.

Clothing Seconds and Irregulars:

Clothing items which are not up to the manufacturer's standards because of errors in production. These can usually be purchased at reduced cost.

Comparison Shopping:

Examining similar items so that their features and prices can be rated against each other.

Financial Records:

Any system for accurately recording transactions involving money between a home care worker and client.

Generic Products:

Products purchased without special brand identity. Usually sold at reduced cost.

â&#x20AC;&#x153;Last Date of Purchase" Nutritive Value:

A date stamped on perishable food products showing the last date it can safely be sold. The degree of healthful content in a food item.

Over-the-Counter:

The general name given to drug products that can be bought without a doctor's prescription.

Quantity Buying:

Buying more of a food item than is currently planned for. May be economical when food items are on sale.

Receipts:

A written statement that money or good have been received.

Serving Size:

The amount of a food which typically served to one person.

Staples:

Foods that are used frequently and continuously for many dishes or purposes, such as sugar, flour, coffee, tea, spices, etc.

Unit Price:

The price of a product per standard unit, such as an ounce or a pound. Mod IX-page 11

Think Sheet Module IX 1.

What is a budget?

What may be your role with our client's budget?

What are some good shopping tips?

Why is it important to keep a financial record?

What are some economical food buys?

Is it always best to buy food in large quantities?

Mod IX-page12

Module X CARE OF THE HOME AND PERSONAL BELONGINGS

MODULE X

Care of the Home and Personal Belongings

UNIT:

A. Importance of Housekeeping in Home Care B. Performing housekeeping in the Home C. Ways to be Safe and Save Energy and Time D. How to Get the Job Done

TIME:

90 minutes*

"See Mod XII-K-lesson 1. â&#x20AC;&#x201D;The Objectives and Measurable Performance Criteria from The Clients' Environment, Components and Care of the Environment â&#x20AC;&#x201D; drawers, closets. immediate environment are to be fulfilled as part of the 90 minutes allotted for this Module. OBJECTIVES: At the completion of this Module the student will be able to: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.

Discuss why assistance with housekeeping is important in home care List three reasons why a clean comfortable home is beneficial to home care clients Explain three ways housekeeping in home care differs from the housekeeping one does in their own home Discuss how the client's home, culture, religion relate to housekeeping Recognize the client's sensitivity to his own limitations and list two ways how to meet his basic needs and promote independence List three rules for proper body mechanics List five ways to maintain safety when lifting or moving an object identify four basic guidelines to conserve time Discuss two ways the aide can promote the client's independence List and discuss the principles of infection control relating to housekeeping Identify the basic cleaning supplies needed to do housekeeping Verbalize and/or demonstrate how to perform four to five common household tasks List four to five safety measures when doing household tasks

SUGGESTED TEACHING METHODOLOGIES:

Lecture, group discussion

EVALUATION METHODOLOGIES:

Written exam, class participation

MODULE X

Care of the Home and Personal Belongings

OUTLINE:

Unit A 1.

Unit B 1.

Unit C

Importance of Housekeeping in Home Care Purposes of housekeeping in home care a. Enhances quality of life b. Promotes independence and self-sufficiency c. Maintains the home during family crisis Importance of maintaining a clean home a. Infection control - keeps bacteria, fungus under control b. Safety and security - less accidents likely to occur c. Basic needs are met - comfort, belonging, pride, higher self esteem, self-fulfillment

Performing Housekeeping in the Home Why housekeeping in home care differs from housekeeping at home a. Respect relating to client's customs, religion, and personal belongings b. Respect relating to client's housekeeping habits and equipment and supplies c. Physical differences among homes dEquipment supplies will differ e. Sensitivity and attitude relating to client's limitations f. Meeting client's basic needs g. Promoting independence

Ways to be Safe and Save Energy and Time

Safety - Proper body mechanics - refer to Procedure Xll - 2 a. Lifting or moving a person or object. i. feet apart - one foot slightly in front of the other ii. bend at hips and knees when lifting or stooping iii. carry weight close to body iv. turn whole body when turning or while carrying object/person v. remember good posture vi. push, pull or roll object/person when possible

Time management a. Prioritize planning and organize tasks b. Follow care plan c. Encourage client's assistance whenever possible d. Keep track of time needed to accomplish tasks on care plan

Basic guidelines a. Make a task schedule 53

b. c. d. e. f.

Unit D

Break down a large job into smaller tasks Revise task schedule as needed Do two things at once when possible Do different tasks together that can be handled in the same place Economical with client's supplies

How to Get the Job Done

Infection control a. Proper hand washing before and after each task b. Rubber or housekeeping gloves used for cleaning c. Clean gloves after each day's use d. Keep clean and dirty areas separate e. Use separate cloth for bathroom f. Use disposable cloth or wipe for toilet

Basic supplies and equipment needed a. Broom, dust pan b. Mop c. Cleanser soap, disinfectant, baking soda, bleach d. Always read directions when using cleaning products; do not mix products e. Rags, scrub brush f. Vacuum, dust buster

Safety tips when using equipment/supplies a. Unfamiliar with equipment, supplies, ask client or family how to use b. Don't overload equipment c. Avoid electrical equipment near water, sink/bathtub d. Unplug small appliances before cleaning e. Don't try to repair or poke electrical equipment with metal objects f. Never use electrical equipment with frayed cord g. Keep equipment clean and dry

Kitchen a. Wipe up spills b. Dispose of garbage daily c. Observe ail safety precautions

Bathroom a. Clean sink, tub/shower, toilet, and floor as needed b. Wipe up water spills c. Observe all safety precautions

Living room a. Vacuum carpets b. Tack down loose rugs

Dust and handle personal belongings with care and place in original spot

Bedroom a. Clean, dust, vacuum once a week , as needed b. Change linens once a week or as needed Washing floors a. Sweep or vacuum first b. Dry mop wooden floors and use special wood cleaner c. Dry wet floors Keep pests under control a. Keep things clean as possible b. Store food properly c. Notify supervisor/family of needed screen windows, repairs, or exterminator Laundry a. Wear gloves when handling clothes/linens soiled with body fluids b. Check with client about what is to be washed in machine c. Ask how to operate washer or dryer d. Check pockets for coins or sharp objects e. Sort dark, white, clothes and delicates separately f. Check with client what clothes are to be machine dried or air dried

Care of Home The Importance of housekeeping in home care Housekeeping can: •

Assist elderly persons to maintain their homes and their independence for as long as is safety possible.

•

Encourage disabled persons to adapt their home environment so they can continue to be as self-sufficient as possible.

•

Encourage ill persons to assume appropriate home management responsibilities when they recover.

•

Help and teach the disorganized family to solve problems of home maintenance that are due to lack of knowledge or skills.

•

Maintain the home during a family crisis such as the death, desertion or hospitalization of the caregiver.

• Overall enhance quality of life. A clean, safe, comfortable home is important to the people you serve for a variety of reasons: • Cleaning keeps bacteria under control. By cleaning often, especially in the bathroom, you reduce the spread of disease. • Storing food properly and wiping up spills promptly keeps insects and others pests from becoming a problem. • Clean rooms contribute to an orderly way of living. When things are stored in specific places, you spend less time and energy looking for them. • Accidents are less likely to happen in areas that are kept neat and clean. • Pleasant surroundings lift the spirit and encourage a feeling of well-being and contentment. • Clean environments tend to make us feel better When things are in order, we are usually more comfortable and relaxed. Mod X-page 1

REMEMBER: Housekeeping can: â&#x20AC;˘

Support the basic, overall goals of home care, that is, to promote or maintain client's independence and restore or maintain family life during times of personal difficulty.

â&#x20AC;˘

Help meet the client's basic human needs, such as safety, belonging, and selfworth.

You have also learned that home care assistance with housekeeping tasks can enable many elderly or ill persons to remain in their own homes; assist disabled persons in learning to cope with limitations; help parents and children learn new ways of caring for their own homes, leading to an increase in their self-esteem and sense of dignity; and keep family members together in the event of the death or illness of the primary caregiver. Performing Housekeeping tasks in the client's home At an early age, we begin to develop the characteristics of being either neat or tidy or casual and indifferent about ourselves and our belongings. Think back on your own experiences while growing up or raising your children. Did you have to share a bedroom, or did your children have to "double up?" Did you find that, no matter how thoughtfully you tried to pair children, the compulsively neat one ended by with the one who lived happily in chaos and confusion? It is also not unusual for married couples to be people who have opposite habits. One carefully organizes closets or drawers, while the other may just jam things in and pull them out when needed. One may keep only bare essentials in a cabinet, whiie the other feels that if it fits, it belongs. Often, it is difficult for close family members to understand each other's habits or ideas about housekeeping. Simply stated, people have different ideas about what "clean" means, knowing this, you can appreciate how hard it might be for home care workers to understand their client's housekeeping preferences. Yet, if the care plan is to work, the home care worker must respect all aspects of the client's home: not only his or her personal belongings, but also his or her housekeeping habits. This is one major factor that makes housekeeping in home care different and, sometimes, more difficult than housekeeping in one's own home. Another factor that the home care worker must keep in mind is the client's feelings when age, illness, or disability limits his or her ability to keep house. Mod X-page 2

REMEMBER: •

There are physical differences among homes. Chances are that the home in which you work will often be very different from your own home. Some clients may live in small apartments or just one room, so space will be limited. Others may live in hotels or rooming houses, where they share kitchens and bathrooms, in some rural areas, clients rely on outdoor toilets or pumps for water. You will have to adjust from one home to another. This will require you to be very flexible.

•

The equipment and materials available will differ. In some homes equipment or bedding may be very limited, old, and non-functional, or even non-existent. Your client may not want, or may not be able to replace it. You may need to improvise such cleaning equipment as dust pans or garbage can liners, or make do with old vacuum cleaners or other items that no longer work as they should.

•

The housekeeping routine will differ. The housekeeping tasks that you and the client should perform will be outlined in the care plan. No matter how minor some tasks may seem, they are important. REMEMBER: You may have to: • Change your attitudes or approach to housekeeping tasks in order to stimulate and involve your clients in the management of their homes. •

Work in homes that are physically different from yours.

•

Follow a different housekeeping routine as outlined in the care plan and adapt the tasks to your client's wishes and special needs.

Do's - Keep a straight back Lifting - Bend with your knees, not your back! Lift with your legs and hold object close to your body. Lift objects only chest-high. When load is heavy, get help and plan ahead to avoid sudden load shifts. Always be sure of your footing. Standing * Walking - Stand with one foot up; change positions often. Bend with knees to keep back straight. Walk with good posture keeping head high, chin tucked in, pelvis forward, toes straight ahead. Wear comfortable shoes. Driving - Move car seat forward to keep knees bent and higher than hips. Sit straight; drive with both hands on the wheel. Sitting - Sit in chairs low enough to place both feet on the floor with knees higher than hips. You may cross your legs or put your feet up on a stool. Sit firmly against back of chair. Sleeping - A good night's sleep on a firm mattress is good for your and your back. Sleep on your side with knees bent, or on your back with a pillow under your knees. Mod X-page 3

1 SQUAT DOWN 2 BEND KNEES 3 BACK STRAIGHT 4 ARMS CLOSE 5 KEEP LOAD CLOSE Mod X- page 4

Care of Home Ways to save energy and time Proper Body Mechanics Body mechanics refers to the ways in which the body and its parts function while you are standing, moving, and doing various jobs. Good body mechanics, when learned and applied, will reduce fatigue, and muscle strain, will help your work go much more smoothly, and will help to conserve strength and energy. Principles of Good Body Mechanics: •

Use as many muscles or groups of muscles as possible to perform a task. Distributing the workload between more muscles means that individual muscles will not have to work as hard, and the job will not be as tiring i.e. use both hands, rather than one, to pick up a heavy package.

•

Avoid lifting objects whenever possible, when you have to move a heavy object. It is better to push or roll it than to lift or carry it. Once the object is moving, keep it going. Avoid unnecessary stops and starts.

•

When lifting is necessary, your arm muscles, not your back muscles should do most of the work. It is very easy to strain or even injury the muscles of the back if you do not follow the proper procedure for lifting. When lifting an object from the floor, kneel or squat so that the lifting is done by leg muscles rather than back muscles.

•

Position yourself in the direction of the work. Avoid twisting your body. Face in the direction of the work area, place feet comfortably apart, keep knees loose and ready to bend. When turning is necessary, pivot with your feet, not with your waist

•

When holding a heavy object, keep your elbows relaxed and hold object close to your body. Keep your feet about 18 inches apart so that they give you good support and balance. Stand up straight whenever you can, try to avoid bending over for more than a few minutes. If you must bend forward, bend at the hips, not at the waist.

Managing your time What is proper time management? •

Time management means your being in control of time, not the other way around.

•

It involves planning your time and organizing jobs to make them simple and more efficient.

Mod X-page 5

•

When working in a client's home, time management becomes especially important for several reasons: * you must perform the tasks indicated on the care plan * you have other tasks to do, in addition to housekeeping * your housekeeping time in the home will be limited * you must have energy for your next assignment

Guidelines for time management •

Make a plan. This involves setting priorities with the client. Decide which tasks are most important and least important and then schedule your activities accordingly. For example, if a client tells you that he suffers from allergies, dusting would be a high priority.

•

Break down a large job into smaller tasks. Dealing with smaller more manageable tasks and shorter periods of time is easier. For examples, instead of making Monday afternoon's goal "cleaning the kitchen" (which can be an overwhelming job in some homes) try breaking the task down with the client into smaller tasks (washing the dishes, emptying the trash, sweeping the floor) that will eventually accomplish the larger goal.

•

Keep the end of your assignment in view and revise your plan as needed. If you know that you have only one more hour before you must leave, rearrange some tasks. Set new priorities so that the essential tasks that cannot wait until your next visit will be done.

•

Do two things at once. For example, while preparing lunch start the laundry. Also, while tackling such tasks as setting a table, use both hands at once.

•

Put together tasks that can be handled in the same place. Throw the dirty Venetians blinds into the bathtub with soapy water, while they are soaking, clean the sink and toilet. Then, scrub the blinds and the tub at the same time. Let the water drain, rinse everything and you're done. • Stop following in your own footsteps! Are you making several trips from the kitchen to the bedroom with one item in each hand? Use a utility cart or a box to carry what you need from room to room. Keep your tools handy to the place where you are working . Mod X-page 6

REMEMBER: To conserve energy and time use: Proper body mechanics to prevent muscle strain and fatigue. Good posture proper shoes and techniques to protect the back from injury are the essentials of body mechanics. Time management so that all assigned tasks will be completed. Tips for time management include: • • • • • •

make a plan break large jobs in to smaller tasks keep the end of the assignment in view and revise as needed do two things at once when possible put tasks together that can be handled together don't follow in your own footsteps

A thorough understanding of the care plan and the tasks normally done on a daily, weekly, or occasional basis is important Any doubts or problems should be discussed with the client and with your supervisor, if necessary.

Mod X-page 7

Care of Home When housekeeping tasks should be performed. Daily jobs 1.

Kitchen a. b. c. d. e. f. g.

Bathroom a. b. c. d.

empty wastebaskets wash sink and toilets wet-mop floor if necessary observe all safety precautions

Bedrooms a. b. c. d. e.

wash dishes clean tables and counters clean stove top and spills in oven empty trash clean sink sweep floor observe all safety precautions

air beds and make them up put clothes away or into laundry straighten room and empty trash dry-mop floor dust furniture and windowsills

Living room a. b. c. d. e.

tidy up; throw out papers, empty-wastebaskets dry-mop floor dust furniture and windowsills vacuum carpets secure loose rugs Mod X-page 8

Care of Home How to get the job done What is the best way to get a job done? Everyone has his or her own answer. When you find the way to do a task that is most comfortable for you, and the task "comes out right", that way is the best one for you. Be economical with the patient's supplies. Also, when you work, remember to use proper body mechanics and time management. Stoop and bend as little as possible. Try to take fewer steps. I.

Basic supplies and equipment needed A. B. C. D. E. F. G.

II.

Tips when using equipment A. B. C. D. E. F. G.

III.

Wipe up spills at once. Soak dishes and pots. Dispose of garbage daily.

In the bathroom A. B.

Avoid putting electrical equipment in water. Don't overload equipment. Keep equipment clean and dry. Unplug small appliances before cleaning. Never poke electrical equipment with metal objects. Never use an appliance with a frayed cord. Never use an electrical appliance near the sink or bathtub,

In the kitchen A. B. C.

IV.

Broom Scrub pad Rags Mop Cleanser or soap Baking soda Whisk broom or scrub brush

Glean regularly to prevent odors and bacteria. Watch out for water spills.

In the living room A. B.

Vacuum carpets often. Tack down loose rugs. Mod X-page 9

VI.

In the bedroom A. B.

VII.

When washing floors A. B. C.

VIII.

Move everything off of them that can be moved and then sweep or vacuum. Don't clean wood floors with water. Never let water stand on the floor.

To keep pests under control A. B. C.

IX.

Clean, dust, vacuum, and air bedroom daily. Change linens once a week.

Keep things as clean as possible Don't leave food out in the open - store food properly. Take notice of screens and windows that need repair and notify your supervisor or the family.

Laundry A. B. C. D. E.

If you are unfamiliar with machine, ask client how to use it. Wear gloves when handling clothes/linens soiled with body fluids. Check and empty pockets before washing. Sort dark and white items as well as delicate items to be washed separately. Check with client to identify clothing that is not be machine dried.

Mod X-page 10

Care of Home Homemade cleaning products Tile Cleaner: Sprinkle baking soda on a damp sponge. Rub tiles and rinse. Furniture polish (for leather and wood): Mix together 1 cup turpentine, 1 cup linseed oil, 1/2. cup rubbing alcohol and 1/2 cup vinegar. Shake well before using. Apply with a soft cloth, then buff. Windows and painted surfaces: Mix together 1/2 cup sudsy ammonia, one pint of rubbing alcohol, 1 teaspoon detergent, and 5 cups water. For a concentrated cleaner, use only 2 cups water. Carpet shampoo: Put a generous amount of detergent into a large bowl of warm water. Add a teaspoon of ammonia and stir the mixture to get as much foam as possible. Rub the foam not the water, over the carpet with a sponge mop. Let dry and vacuum. Carpet stain remover: Add 1 teaspoon white vinegar to 1 pint of the carpet shampoo above. Lather with a sponge. Rub the stain gently until it gone. Rinse gently with clear water. Dustless dust cloth: Mix together 1 tablespoon liquid furniture wax and 1 cup water. Place 2 or 3 cloths in this solution. Wring out cloths and let dry. Store them in a glass jar or can with a lid for safety. Bathtub stain remover: Rub the stain hard with a cloth dipped in vinegar, or mix equal amounts of hydrogen peroxide and baking powder into a paste and leave on the stain overnight. Mattress stain cleaner Mix 1/2 cup water with 1/2 cup white vinegar. Dab the mixture on the stain and let dry. Rub the stain gently with warm water and liquid detergent. Leave for 10 minutes, then blot dry. Rinse with cool water. Mod X-page 11

Care of Home How to keep the home free of bugs and rodents Sanitation in the home No one likes to live with bugs or rodents. But sometimes people forget that these pests don't come to an area unless they are invited. And once the come, they travel from apartment to apartment and from house to house. So, the best idea is to keep them out in the first place. •

Starve household pests to keep them out. Any food you leave out uncovered is an open invitation to bugs or rodents.

•

Wipe up spilled food from counters, shelves, tables, chairs, or floors using a slightly damp cloth. Even small crumbs can be a meal for a roach or an ant.

•

Scrape any scraps from dishes if you can't wash them right away. Put the scraps into a garbage can or plastic bag. Rinse the dishes in hot water. Dirty dishes can attract bugs.

•

When you store food, be sure to keep it covered. After you open flour or Sugar, put it in a jar or container with a lid you can close. Keep all jars closed.

Keeping garbage cans clean You will need: Soap or detergent, a cloth or long-handled brush, hot water, ammonia and chlorine bleach. •

Keep kitchen garbage cans clean by lining them with a heavy paper bag, a plastic bag, or newspaper. Then, you can lift out the garbage bag or paper bag together so that the can won't get too dirty.

•

Scrub the can once a week to keep it sanitary and clean smelling. You can do this with a cloth and hot suds or with a brush in a washtub or bathtub. Rinse the can with water and ammonia or chlorine bleach. Be sure to clean the outside of the can, too, since spills often drip onto the outside and can attract bugs. And remember to wash the lid.

•

Don't leave garbage out; pests will find it. See that clients use a garbage can with a cover, and empty can when full. Or, use a plastic bag strong enough that garbage can't leak out onto the floor. Teach children to put garbage in the can or bag.

•

Report immediately to your supervisor any signs of insects, rodents or other potential spreaders of disease.

Mod X-page12

If an exterminator is called and insecticides are used, know your agency's policy and follow the exterminator's instructions. Also follow these precautions: • Make sure clients, children, and pets are out of the room when chemicals are used. • If the chemicals are to be kept in the home, keep them in a safe place, away from the children and pets. Do not keep them near food, under the sink (if there are children in the home), or in the medicine chest. In addition, certain products have to be kept away from heat. How to clean floors You will need: Broom and dustpan or vacuum cleaner Mop (string or sponge) Soap and detergent Pail for sudsy water Pail for rinse water Scouring powder, if needed For all floors except cement, concrete, or wood • •

• •

• • •

Clear the floor as much as you can. Take lightweight furniture, clothes hampers, movable rugs, and wastepaper baskets out of room. Fill both pails with warm water. Add detergent or soap to one pail and make suds. (Some special floor and wall cleaners make little or no suds, and still do a good job of cleaning. Some floor care products both clean and polish.) Vacuum the floor or sweep it using broom and dustpan. Wring the mop from the sudsy water and mop with long, even strokes. Be sure to get all corners clean and be careful not to spatter walls. Scrub stubborn spots with scouring powder. Mop the floor with clean water to rinse. Work so that you won't have to walk on the rinsed floor. Let the floor dry for at least 20 minutes before putting furniture back.

For cement and concrete floors • •

Dip a stiff broom in the sudsy water. Use it to scrub the floor all over. Rinse the floor with a mop dipped into clean water.

For wood floors • • •

Do not use water on wood floors. If you must wipe up something that has spilled, use a sudsy cloth that has been wrung until it is nearly dry. Sweep with long, easy strokes, raising the broom at the end of each stroke. That way, you won't scatter dust. Use a liquid cleaner for wood floors that both cleans and shines. Mod X-page 13

Care of Home Doing the laundry There are some basic steps in laundering that should be followed regardless of the kind of clothes washed, the equipment used, the size of the family, or the geographic location. These procedures are extremely important to keep clothes looking best and make them last longer. You will need: •

Soaps and detergents You must use soap or a detergent in your wash if you want to get the clothes clean; water alone will not do the job. But what should you use, soap or detergent? Soap is a fine cleaner in soft water, but hard water contains minerals that react with soap to leave gray scum on your clothes, much like ring around the bathtub, that's one reason why today most people use detergents. If your client has all-purpose detergent, use that in the wash.

•

Chlorine bleach Chlorine bleach is a disinfectant which also whitens clothes. Chlorine bleach can be used on white and colorfast cottons, linens, and most permanent press and wash-andwear garments. Chlorine bleach cannot be used on silks, woolens, or blends of these materials. Its use shortens the life of fabric and it should only be used when necessary. Never pour liquid bleach right onto clothes. Either measure the bleach and add it to the wash water before the clothes are put in, or mix the bleach with water in a measuring cup.

•

Fabric softener Fabric softeners make clothes, softer, fluffier, and less likely to wrinkle. Fabric softener also makes ironing easier and resists clinging (static electricity). Some people are allergic to fabric softeners. Most fabric softeners should be added to the final rinse water. Fabric softeners that are used in the dryer are also available. Mod X-page 14

How to wash by automatic washer Follow these steps: •

Sort clothes *By color, (white, colorfast, noncolorfast). if colors bleed dye, wash these items alone or with items of the same color. *By type of fabric and construction (cottons and linens, washable wools, delicates, permanent press and manmade fibers). *By amount and kind of soil (heavy, normal, light) *By size (heavy, bulky items - blankets, bedspreads, or slip-covers - should be washed alone).

•

Check clothes close zippers, fasten hooks empty and brush out pockets remove pins, ornaments, heavy buckles mend rips, tears remove spots and stains Loosen ground-in dirt by making a paste of detergent or soap and a little water, or use a liquid laundry detergent or bar soap. Dampen the soiled area with cool water and gently rub in the solution. Use on collars and cuffs, feet of socks and knees of pants.

•

Measure and add washing products read and follow package directions use the right kind of products

How to wash by hand Most fabrics that are washable can be machined laundered. Whenever hand washing is necessary, the same basic procedures should be followed. •

Sort by color (whites with whites, similar colors together).

•

Check and pretreat stains. Rub stained and heavily soiled areas with bar soap or the washing product. Mod X-page 15

•

Use detergent or soap. All purpose or light-duty detergents or soaps may be used for hand washing. In hard water, it is always best to use detergent. When using a powdered detergent, dissolve it in warm water before adding clothes.

•

Wash carefully. Some items such as woolens, loose knits, acetates, and silks require little or no agitation and handling. Squeeze suds through fabrics gently; do not wring or twist Colored fabrics in these categories should not be soaked more than five minutes.

•

Rinse thoroughly. Rinse fabrics at least twice. If fabric softener is used, add to the last rinse.

•

Special tip: To reshape a woolen sweater to its original size, draw an outline of it before washing. Place the sweater on clean paper, such as a brown paper bag. and use a pencil to trace its outline. After the sweater is washed, block it to match the outline. It may be necessary to reshape the sweater several times as it dries.

Drying tips In an automatic dryer •

Don't overload the dryer. Clothes need room to tumble dry more quickly. Also : they will be less likely to wrinkle.

•

Take items out of the dryer before they are "bone dry". If they get too dry, they wrinkle and feel stiff. Some may even shrink.

•

In order to reduce wrinkling, remove permanent-press items as soon as the dryer stops.

•

Don't use the dryer for anything cleaned at home with a dry cleaning solution, knitted woolens, or fiberglass curtains and draperies (unless the label states that the item is machine washable and dryable).

•

Clean the lint filter after each use. Read and follow the instructions in the manual for your dryer.

Mod X-page 16

On a Line: •

Be sure the clothesline is clean. Wipe it with a damp cloth.

•

Use clothespins to secure clothes. A hanging clothespin bag is handy.

•

Shake and smooth clothes out as you hang them. Straighten seams.

•

Hang clothes by the firmest part.

•

Take the clothes off the line before they are completely dry to avoid the need for extra dampening to make ironing easier.

On a flat surface: •

Dry woolen and leather items on a clean surface and away from direct heat.

•

Block woolen sweaters.

Ironinq tips After your clothes are clean and dry, some may need ironing or a little touch-up to look ieir best. •

Irons have dials that allow you to select the amount of heat needed. For example, silks and synthetics need low heat; cotton and linens need higher heat Pick the right heat for each item so that wrinkles come out of clothes but are not scorched.

•

Iron some items that need low heat first, then iron the items that need more heat Turn off the iron, you can iron the remaining items that need little heat while the iron is cooling.

Tips for keeping drains open Alert all family members to these precautions: •

Watch what is emptied into the sink drain. Don't pour liquid fat or grease, coffee grounds or bits of food down the drain. (Pour fat or grease into a can and dispose of it with the garbage.) When washing hair in the sink, use the stopper and remove loose hair before it is washed down the drain.

•

Don't drop pins, combs, refuse, or other items into the toilet.

•

Pour hot water down the sink drain once a day to help keep it clean. Keep drains running free by using a commercial drain cleaner every two months, if a drain cleaner is used by the client or recommended by your supervisor. Follow the label directions carefully. Mod X-page 17

Vocabulary List Module X Body Mechanics: The process of moving your body and maintaining balance. Cleaning Products: Any substance intended to remove dirt. Debris: An accumulation of waste material or trash.

Environment: A person's surroundings, a client's home, or the area in which he or she stays. Exterminator: An agency or person whose job is to get rid of household pests such as mice or cockroaches. Improvise: To manage by using materials conveniently at hand.. Incinerator: A device used to burn garbage and trash in apartment buildings Prioritize: To rank by importance Time management: To utilize time as effectively as possible Mod X-page 18

Think Sheet Module X 1.

How would you pick up a heavy object?

What are something's that attract household pests?

Does cleaning reduce the spread of disease?

Is it possible to do two tasks at the same time?

Is it important to wrap garbage before putting it in an incinerator?

Can keeping areas neat and clean prevent accidents?

Is making a schedule for cleaning important?

What are some good ways to organize cleaning your client's home?

Mod X-page 19

Module XI SAFETY AND INJURY PREVENTION

MODULE XI UNIT:

Safety and Injury Prevention injuries

Injury Prevention

What to Do When Injuries and Emergencies Happen

TIME:

90 minutes

OBJECTIVES: At the completion of this Module the student will be able to: 1.

identify common factors that contribute to accidents in the home

Discuss the Home Care Worker's role in injury prevention and fire safety

Discuss methods of ensuring own safety in the field

Describe basic home fire prevention and response actions

Describe basic first aid techniques for common emergencies

Know agency policies that relate to safety issues

Identify situations that require immediate attention by self or EMS/911 services

SUGGESTED TEACHING METHODOLOGIES:

Lecture, group discussion

EVALUATION METHODOLOGIES:

Written exam, class participation

Module XI

Safety and Injury Prevention

OUTLINE:

UNIT A 1.

Injuries

Most frequent home injuries a. Falls b. Burns c. Cuts d. Poisoning e. Choking f. Electrical injury Factors that may contribute to injuries among older adults a. Difficulties with balance b. Vision problems c. Mental confusion d. Hearing loss e. Effects of medication f. Reduced sensations of taste and smell g. Cultural practice h. Inappropriate footwear Factors that may contribute to injuries involving young children a. Age related behavior b. Age related physical/mental development c. Natural curiosity to explore, touch, try and taste new things d. Undeveloped sense of balance e. Lack of experience coupled with little or no fear Where household injuries occur most frequently a. Kitchen b. Bathroom 5. Other hazards a. Poor lighting b. Stairs c. Scatter rugs, no skid resistant backing d. Well-traveled traffic areas e. Clutter f. Non compliance with physical devices and medication g. Lack of handrails in bathroom

Unit B 1

The role of the Home Care Worker in injury prevention a. Maintain clean environment in the home - free of safety hazards handle food properly b. Use proper body mechanics c. Prevent transmission of disease d. Fire prevention e. Keep emergency phone numbers posted close to the phone Personal safety in the community a. Basic safety principles i. Have the correct address and clear directions ii. Be aware of surroundings; avoid unsafe shortcuts iii. Know the location of public telephones, fire alarm boxes iv. Don't carry a purse, large sums of money, or wear expensive jewelry v. Become familiar with residents in your area vi. Don't alter your schedule without telling office b.

Pets

Transportation safety i. Keep car in good operating condition; have sufficient fuel ii. Have keys ready when approaching car iii. Keep car doors locked at all times iv. Know how to drive in inclement weather v. Consider membership in an auto club Transportation accidents i. Seat belt use for all occupants ii. No children under 12 in front seat iii. Child safety seats for children 0-8 years of age iv. Obey speed limits v. No alcohol or drug use

Injury Prevention

In the event of fire:

a. Rescue: Get your client and yourself to safety

Alarm; call Fire Department (911)

Confine: close doors, plug doorways to prevent smoke from entering

d. Extinguish/Evacuate: if clothing catches fire, make the victim fie on floor and roll to smother flames. Do not attempt to put fire out yourself unless it is minor e.

Notify home care supervisor as soon as practical

Unit C 1. a. b.

What to do When injuries and Emergencies Happen

Know your agency's policy regarding incidents Policies and procedures Whom to contact

2. First aid techniques for a. Burns b. Choking c. Poisoning d. Sprains or broken bones e. Bruises f.

Cuts and scrapes

g. Dizziness/fainting 3.

What to do in serious medical emergencies

Assess the situation

Assess the victim

Call for help

Remember the ABC's of first aid

Home Safety/Injury Prevention The need to feel secure both emotionally and physically is one of the basic human needs. Good safety habits that prevent accidents in the home are one method for increasing one's sense of physical security. Your first responsibility to your client is to ensure his safety. There are certain things you can do to make your client's home safer. Types of accidents Considering the amount of time we spend in our homes, and the types of activities that we do there, it is no wonder that safety experts say "Home is where the majority of accidents occur." Each year, millions of people suffer from household accidents. About four million are seriously injured, many of them permanently disabled. The most frequent home accidents include: • falls • burns • cuts • poisoning • choking • electrical injury As a home care worker, you must always be alert to the possibility of these accidents, and ways to prevent them, while you are on the job. Elderly & young children are more often the victims of accidents: In elderly persons, the following factors may contribute to accidents: • difficulties with balance • vision problems • mental confusion • hearing loss • effects of medication • reduced sensations of taste and smell • inappropriate footwear • cultural practices

Mod Xl-page 1

Accidents involving young children are related to such factors as; •

natural curiosity to explore, touch, try, and taste new things

•

undeveloped sense of balance

•

lack of experience and little or no fear

•

age related behavior

•

age related physical/mental development

Both the elderly and young children are especially likely to suffer falls or burns. For different reasons, the skin of each is more sensitive to heat. Temperatures that would not burn the average adult may burn an elderly person or a young child. While accidents happen more often to the elderly and children, remember that they can occur in any home, to anyone, at any time. You must always be alert to household hazards and take action whenever necessary. Home safety must become a regular habit and a state of mind. Household hazards and accident prevention Safety habits for the kitchen •

Keep clothing, paper, and kitchen towels away from burners.

• Keep pot handles turned towards the back of the stove and use pot holders when handling hot items. These actions prevent accidental spills that can cause burns: slips, or even fires. •

Be careful not to overheat fats and oils. This can cause fires.

• When using gas, make sure the burner is properly lit. Watch out for escaping gas. • When clients have poor vision, it might be helpful to use red nail polish to mark the "off" position on stove controls. • When you have finished cooking, double check to see that all burners and the over are turned off. • Store all knives carefully. When using knives, always hold the blade facing away from the body. When cutting foods, make sure your hands are dry; greasy or wet hands make accidental cuts more likely.

Mod Xl-page 2

• Keep frequently used kitchen supplies on lower shelves where they can be easily seen and reached. • To prevent slips and falls, do not wax kitchen floor. Use a rubber kitchen floor mat the sink area. Wipe all spills promptly to prevent slips and falls. • Keep electrical appliances in good working order. Use them in areas away from water to prevent electrocution. •

Do not leave food cooking on stove or in oven unattended. The bathroom

•

install hand grip rails for the bathtub and around the toilet.

•

Place a non-slip mat or surface fixture inside the bathtub.

• Remove the bathroom scatter rug and replace it with non-movable wall-to-wall carpeting and non-skid mat • Check water tank temperature. Reduce heat, if necessary, to 110 to 120 degrees to prevent scalding. (This saves money too.) Always test water temperature before bathing. •

Use a night light in the bathroom.

•

Use a shower stool or bench in the bathtub for greater safety while showering.

•

Keep the floor dry and wipe up wet areas after showering or bathing.

•

Wash, but never wax, bathroom floors.

•

Keep all electrical appliances away-from the sink or bathtub.

Other potential household hazards Reducing the potential for falls & accidents on stairways • impress upon clients that they should avoid placing items on stairs, even on a temporary basis. Check to ensure that clients are practicing this safety habit. • Check the lighting on stairways in hallways. If necessary, add a brighter wattage light bulb. Consult with your supervisor if the lighting remains inadequate • Test the sturdiness of the banisters and/or handrails. If they are not sturdy and can't be easily fixed, alert your supervisor to the situation. • In homes where there are young children, block off the heads of stairways by a gate-type device. Make sure that clients use the device regularly. Mod Xl-page 3

REMEMBER: 

The home is the most common place where accidents occur.



Falls, burns, cuts, poisoning, and electrical injury are types of common home accidents.



Home care workers should use extra safety prevention measures with elderly clients and small children. These groups are at high risk of accidents in the home.



Home care workers should be alert to potential hazards in the home, particularly in the kitchen and bathroom areas where accidents are most likely to occur.



Remember that there are many ways to reduce and prevent home accidents, including the removal of obstructions on stairs and in traffic patterns, proper storage of potentially dangerous household items, installation of special devices in bathrooms, and installation of smoke detectors.

Mod Xl-page 4

Home Safety/Accident Prevention What to do when accidents and emergencies happen Agency's Policy In an emergency (Medical): Assess the need for treatment: • Must it be immediate or can the patient wait for expert medical attention available in minutes by ambulance personnel? • Is it necessary to perform simple emergency control measures until help arrives? • If you are alone with the patient and he cannot help himself, should you call for help first, or perform controls first? • Is the injury serious, or potentially serious, or can it be handled by simple measures at home? In an emergency (Accidents): If the patient should have an accident, call your supervisor. If patient appears to be seriously injured, in pain, or having difficulty of any kind, call for an ambulance immediately. Even if patient shows no signs of injury, and complains of no difficulty or discomfort, call your nursing supervisor and report occurrence. Accidents and injuries Millions of accidents occur each year; most of them are only minor injuries, a bruise, a burn, a cut, knowing how to handle these situations is important not only for you, but also your clients. You may be responsible for giving first aid care when accidents occur. Basic guidelines in all emergency situations • In cases of serious accidents, or emergency situations, call for help immediately. Notify the policy or other appropriate community service organization, such as poison control center. • If there is a fire, remove the client to a safe location and then call the fire department. • Then, take necessary action (as outlined in the material on serious medical and fire emergencies appearing later in this unit). Mod Xl-page 5

Home Safety/Accident Prevention â&#x20AC;˘

Finally notify your home care supervisor as soon as is practical.

On all cases the aide is responsible for preparing a list of emergency services and their telephone numbers i.e. important phone number:

a. b. c. d. e.

police fire department ambulance relatives doctors

These numbers should be kept handy in case they are needed. Most communities have a "911" emergency telephone system. When reporting an emergency remember to: Stay calm Clearly state the problem Give the correct home address, nearest cross street Telephone number Identify yourself, the condition or injury Medical Emergencies Everyone hopes that a serious accident or emergency will never happen. Yet whether you are in your own home or performing your job in someone else's, it is important that you know how to respond in these situations. Your prompt and proper action can help prevent more serious damage to a client's health. Often it is what happens in the first few minutes before professionally trained help arrives that makes the critical difference. You will learn later in this unit about the proper first aid measures for minor injuries. When a serious emergency occurs, act on these important first aid priorities: 1. Assess the situation. By assessing the situation before acting, you protect yourself. For example, when a plugged in electrical appliance falls in to water, an electrical discharge can occur whether the appliance is on or off. Anyone who comes in contact with the water may be electrocuted. You must disconnect the appliance before you give aid. Remember, never attempt to remove a victim from a serious situation (water, fire smoke, carbon monoxide) until you have evaluated the scene with your own safety in mind.

Mod Xl-page 6

Home Safety/Accident Prevention 2. Assess the victim, is he or she conscious? Unconscious (unaware of surroundings, does not respond to questions, has no pulse just below the left breastbone)? Breathing? Bleeding? Call For Help! Medical Emergencies 3.

Remember the ABC's of first aid priorities in treating victims:

A. Airway. If the victim is not breathing, check the airway for obstruction carefully with your finger. Make certain the tongue is not blocking the airway. B. Breathing. Apply mouth to mouth resuscitation as shown on the preceding page. C. Control bleeding. Apply firm, direct pressure on the wound with a clean cloth, dressing, or even your hand. Do not remove the cloth even if it becomes soaked with blood; instead, add another pad. (Removing the pad disrupts the natural blood-clotting process and causes increased bleeding.) Elevate the bleeding limb or body part. Never apply a tourniquet. 4.

Never give an unconscious or semi-conscious person anything to drink.

It is a good idea to become CPR certified by attending a program. Burns

Serious burns can be caused by dry heat (a hot iron, for example); wet heat, such as steam or scolding liquid or gases, or chemicals, such as lye or acids. Remember that when blisters cover an area larger than a quarter, apply cold water and follow your agency's procedures. Contact your supervisor for advice on further care. When burns cause charring of the skin, prompt first aid and then medical attention is always required. Often, there is little or no pain, since the nerve endings in the skin may be destroyed or severely damaged. In these cases, protect the burned area from the air. Cover it with a thick dressing, cloth, or clean white sheet (if available). Do not strip away any clothing from burned areas. Call for help.

Mod Xl-page 7

Home Safety/Accident Prevention Chemical burns require special care. Thoroughly wash away the chemical. A shower or hose may be used when the burns cover a large area. Check the product label for special first aid instructions. Call for help. Choking Anytime an object, such as a piece of food, become lodged in the airway of the throat, chocking can occur. Choking in children frequently happens when they eat food, suck on candy, or chew gum while running. Children may also choke when they place small objects in their mouths. To help prevent choking, never feed children under age one small, hard foods. Remind children never to run when they have anything in their mouths. Choking is not just a children's problem; adults may choke too. This usually happens when partially chewed foods are accidentally inhaled into the airway or become lodged in the throat. The victim may panic. Bystanders often mistakenly assume that the victim is having a heart attack. You can avoid making this mistake by remembering an important clue: In cases of choking, the victim cannot speak. A choking victim quickly loses consciousness. When a child is found unconscious, choking should always be suspected. Prompt action can save a choking victim's life: •

Encourage the conscious victim to cough. This may dislodge the blockage.

• Follow the procedures shown on the following page to dislodge the object. These are accepted first aid methods. (The Heimlich maneuver) Poisoning Accidental poisoning commonly involves children. They may eat or drink toxic substances such as detergent, ammonia, bleach, or pesticides. They may ingest medications, such as aspirin, that can be harmful even in small doses. When you suspect poisoning, check the substance's label for any poison first aid instructions. If there is a poison control center in your community, call it immediately; if there is no poison control center, call the hospital emergency room for advice. Report: •

The name of the suspected poison.

•

The make of the product. Mod Xl-page 8

Repeat cycles of 30 compressions and 2 rescue breaths until the scene becomes unsafe, you find a sign of life, an AED is ready to use, you are too exhausted to continue or A trained responder arrives and takes over.

1 Compress chest 30 times

2 Give 2 rescue breaths

ADULTS Age 12 or older Repeat cycles of 30 compressions and 2 rescue breaths until the scene becomes unsafe, you find a sign of life, an AED is ready to use, you are too exhausted to continue or A trained responder arrives and takes over.

Compress chest 30 times

â&#x2013;ş Give 2 rescue breaths

START HERE If infant cannot cough, cry or breathe (choking)

1 Give 5 back blows 2 If the object is not forced out-give 5 chest thrusts If infant becomes unconscious,..

1 Try 2 rescue breaths; if air does NOT go in 2 Give 30 chest compressions TIP; Remove breathing barrier

3 Look for an object in the mouth and remove if one is seen

Home Safety/Accident Prevention •

When and how much of the substance was taken.

•

The victim's symptoms.

•

What action, if any, you have taken. Sprains or broken bones

When a person falls, a serious sprain or break or crack in the bone (called a "fracture") may occur. Sprains or fractures occur more often in elderly persons. A person with a serious sprain or fracture may complain of pain, have difficulty moving, or may not be able to move the affected area at all. Sometimes swelling and bruising may be present. In a case of a sprain, call the supervising RN to see if she can come over to assess the situation and decide if any additional medical attention is needed. In the meantime, whenever a sprain or fracture occurs: •

Keep the injured area in one position

•

Do not attempt to move the person

•

Cover the person with a blanket to prevent chills Proper first aid care

First aide is care given to a client after an injury or sudden illness. Even if the injury seems very minor, you must report and document any incident that occurs, following your agency's procedures for reporting and recording. Do you remember what those procedures are? You learned them in Module II, Unit D. If you have forgotten what they are, you may want to refer back to them at this time. Bruises Although a bruise can be painful, most do not need first aid attention; they disappear in time. However, all bruises, regardless of their severity, should be brought to your supervisor's attention. If swelling occurs immediately after a fall, apply a cold pack or ice wrapped in a towel or cloth to the area; this reduces swelling. Report the swelling to your supervisor right away. I the client's head has been injured, consult with your supervisor immediately. Often, seemingly minor bumps to the head cause more serious damage than can be observed. Mod Xl-page 9

Home Safety/Accident Prevention Cuts and scrapes When cuts and scrapes occur, you need to guard against germs that can cause infection. Wash that area with water and apply a clean dressing or band-aid. (Small cuts and scrapes often heal best when left uncovered.) In the event of heavy bleeding, consult the medical emergencies section of this unit where you learned how to control bleeding. Except in the case of very small cuts, consult your supervisor about the need for stitches or other additional care. Burns Minor burns cause skin redness or blisters in a very small skin area. Sometimes there may be swelling. Apply cold water directly to the burn, or place clothes dipped in cold water on the burn; do not apply butter, ointment, or salves. Do not break blisters. When skin blistering extends to more than just a small area (say the size of a quarter), consult your supervisor about the need for further care. Dizziness and fainting When the normal blood supply to the brain decreased, dizziness and fainting can occur The person may become temporarily unconscious, which means that he or she is no longer aware of the immediate surroundings and will not respond to questions. Dizziness and fainting can result in falls. If there is no furniture immediately available, you can assist the client to the ground. Support the client by placing your arm around his or her back, your arm under his or her armpit. Place your other hand under the client's other elbow and then lower him or her to a sitting position. First aid for dizziness and fainting consists of returning the blood supply to the brain: Have the client either bend over the knees to increase blood flow or help him or her to a reclining position. Do not give the client anything to drink until he or she is fully conscious. Fire emergencies Fire prevention: â&#x20AC;˘ If possible plan two different escape routes in the home to be used in case of fire (Some apartments might not allow for this.) â&#x20AC;˘

Discuss fire prevention measures with your client-

Mod Xl-page 10

Home Safety/Accident Prevention • When working with clients you smoke, be extra alert always mare sure that their cigarettes are fully extinguished. Discourage smoking in bed. If your client smokes in bed, stay with them. • Smoke detectors can save lives. In homes with smoke detectors, double check to ensure that they are working properly. In homes without detectors, discusses what action to take with her supervisor. • At bedtime, recommend that bedroom doors be closed. This will prevent spread of fire and hold back smoke if fire does occur. Safety when fire breaks out • When a fire occurs, all household members should be taken out of the house. The fire department should be called right away. • A client should only attempt to put out a fire that is small, for example a kitchen grease fire. • During a fire, if the doorknob feels hot to the touch, it is best not to leave the room if there is no safe exit. Instead, plug the doorway to prevent smoke from entering. •

Stay in the room until help arrives.

• If a client's clothing (or your own) catches fires, have the victim lie down and roll on the floor to smother the flames.

Mod Xl-page 11

Home Safety/Accident Prevention Accident Prevention Common safety hazards in the home: Fails â&#x20AC;&#x201D; most common cause of accidental death in people over 65. Cause minor to permanent injury in all age groups. Hazards Solutions Stairs Keep well lit. Keep free of clutter and obstacles. Carpeting or treads tacked down securely. Free of grease spots, spills. Gate for small children.

Floors

Skid proof rugs. Scatter rugs tacked or taped. Carpet free of tears that catch heels. Spills and grease wiped up immediately. Free of clutter and obstruction. Avoid highly waxing â&#x20AC;&#x201D; very slippery.

Bathroom

Use mats in and outside tub or shower. Wipe up spills immediately.

Climbing

Use sturdy step stool or ladder. Always use steady, firm base for climbing. Set ladder firmly, close to objects, do not lean or reach long distances from ladder, move ladder.

Fire - losses, in terms of life, disability, "and property damage, are staggering. Prevention is a must in the home. Saving life must always be first consideration when fire breaks out. Do not attempt to put out fire, EVACUATE house and call fire department from neighbor's home. (If fire is very small and in no danger of spreading, and the proper fire fighting equipment is available, you may attempt to put out fire.) Hazards Solutions Wiring Check outlets to see that they are working. Watch outlets for sparks, blackening, smoldering. Know how to shut off power in emergency. Check outlets near known leaks to see that they have not been wet. Check to see that outlet is firmly set in wall. Watch light fixture for dimming or flickering. Electric Appliances

Know how to operate-read instructions. Check for frayed wires, loose plugs. Unplug immediately if appliance malfunctions. If removable cord, unplug from wall first, then from appliance. Make sure "HOT" appliances are on protected surface and clear of flammable materials. Never attempt to repair inner workings of appliance, leave that to experts.

Mod Xl-page 12

Cooking

Know how to operate stove safely. Keep stove and oven free of grease. Keep flammable materials away from cooking surface. Know how to turn off power or fuel in emergencies. Never pour water on grease fire, cover if possible, or use baking soda. Avoid reaching over lit burners. Avoid loose sleeves or clothing while cooking. Never allow a child to use stove unsupervised. Place pot handles inward, and out of reach of children and traffic. If knobs in reach of small children shield or remove them so child cannot turn on stove unknowing. Supervisor patients with poor eyesight or those who are easily confused or forgetful.

Smoking

Never smoke in bed or when drowsy. Keep sufficient number of ashtrays available. Keep ashtrays empty as possible. Always check ashtray for lit ashes before dumping. Do not leave cigarettes burning in ashtray unattended.

Escape plan

Know all possible exit routes. Check escape route from upper floors. If fire alarms, check to see that they are working. Practice exiting house, meeting point for all family members. If you cannot remove patient from house unassisted, know where you can go for help. Know number of local firehouse, address, directions to the house from main roads.

Rubbish

Never allow garbage to collect in house. Throw away oily rags, or store in fire-proof containers. Do not allow rubbish, newspapers, etc. to accumulate in basement or garage.

Accidental Poisoning - young children especially toddler, will put anything in their mouths, regardless of taste or appearance. Poison control Number (516) 542-2323 (for all of New York State) has listing of all poisonous substances and their remedies. If someone should be accidentally poisoned and is experiencing difficulty of any kind, call for ambulance immediately. Bring poison and its container (even if empty) with you to the hospital, it will speed treatment. If there is a question as to whether a substance is actually poison, (no symptoms in person who ingested it) call poison control number immediately and name or describe substance. Do Not Wait for Symptoms To Develop, If In Doubt-Call!! Mod Xl-page 13

Hazards Medicines

Solutions Keep child proof caps on properly. Keep out of reach of children. If client is confused or has poor vision, assist him to take medicine that has been prepared.

Chemicals

Know the danger of mixing bleaches with ammonia, vinegar, and other household cleaners. Keep all poisonous chemicals out of reach of children (cleaning; workshop, garden). Use chemicals only as directed.

Danger from Ingestion and Fumes Sickness - illness and infirmity can cause a special group of hazards by virtue of the client's weakness, unsteadiness, slowed or poor responses and reflexes. Hazards Solutions Falls Keep side rails or barriers in place when needed. Be sure they are sturdy. Supervise client when he is walking. Assist him when necessary as instructed. Wheel chairs: Lock wheels when transferring client. Remove obstacles from floor. Move furniture, if necessary, to make pathways. If required, be sure safety straps are secured. Never attempt to transport wheelchair (with client) up and down stairs by yourself. When using ramps, back client down, push client forward going up ramp. Back client in and out of elevators (front wheel may catch and throw client out of chair). If while transferring a client or assisting him to walk, he begins to fall to the ground - if you cannot support him without injuring yourself, slowly and carefully lower client to ground. Make him comfortable and get someone to help you get him up.

Burns

Always test water before it comes in contact with client. After you have tested it, have client carefully test it himself. Never submerge clients or body parts in water that has not been tested. Never run water from faucet directly on client. Check client's skin in tub water with faucet running. Check client's skin frequently during hot or cold applications. Discourage client from smoking in bed. If he must, stay with him until he is finished. Remember: Client's senses may be poor, he may not realize he is being burned. Watch skin carefully.

Mod Xl-page 14

Hazards Oxygen

Solutions Oxygen is highly flammable and combustible. No smoking signs should be inside room and on door even if oxygen is not in use. Do not use electric appliances in room - sparks could cause explosion. Do not use oil, alcohol or other burnable solutions to rub client when oxygen is in use.

Remember 

The agency has its own policy and procedures that you should follow in case of minor accidents and injuries.



In all emergencies, remember these basic guidelines: take needed action as outlined in the unit. Call for help and call your supervisor as soon as possible. When calling for help, stay calm, state the problem clearly, give the correct home address and telephone number, and identify yourself.



First aid care for minor emergencies is as follows: 1. For swelling, apply cold packs. 2. For minor cuts and scrapes, wash the wound with water and apply a dressing, if needed. 3. For minor burns, apply cold water and call your supervisor if blistered area is larger than a quarter. 4. For fainting, bend the persons head over his or her knees or have the person recline.



In medical emergencies, assess the situation for personal safety, assess the victim, and give first aid according to the ABCs of first aid priorities. Know how to apply the basics of first aid in case of burns, choking, poisoning, sprains, and broken bones.



Practice fire prevention: Plan two different escape routes (if possible), discuss fire prevention with clients, fully extinguish all cigarettes, avoid smoking in bed, sleep with bedroom doors closed, and, in homes with smoke detectors, ensure that they are working properly.

Mod Xl-page 15

Vocabulary List Module XI Accident: An unexpected event, often due to carelessness, which can result in injury or death Assess: Find out information to determine a problem and its importance

Emergency: An unexpected event or situation which calls for immediate action or relief.

First aid: Immediate care for victims of injuries or sudden illness.

Heimlich Maneuver: A method for giving first aid for choking. Obstruction: Something that clogs or blocks. Potential: Something that can develop or become real; possible Prevent: To keep from happening. Priority: In order of importance. Semi-conscious: Not fully aware or responsive. Resuscitation: A procedure that restores breathing to or revives a person. Tourniquet: A strip of cloth or other material used to check the flow of blood to a body part. It is applied only by someone who has received special advanced first aide and safety training Unconscious: Being unaware of immediate surroundings; unresponsive

Mod Xl-page 16

Think Sheet Module XI 1.

Why are the elderly more prone to accidents?

What are some ways to help prevent accidents?

in a fire, if the door or doorknob felt hot, what would you do?

In a fire, what is the first thing you should do?

What is the Heimlich Maneuver?

What would you do for a chemical burn?

What would you do for bleeding?

What would you do for someone who has swallowed poison? Mod Xl-page 17

Module Xll PERSONAL CARE

MODULE XII Personal Care Skills UNIT A Defining Personal Care TIME: 90 minutes OBJECTIVES: The student will: 1. identify activities that are part of personal care. 2. Give examples of cases where personal care may be needed. 3. Describe at least two ways in which personal care can meet a client's basic human needs. 4. Explain how good communication improves personal care

SUGGESTED TEACHING METHODOLOGIES:

EVALUATION METHODS:

Lecture, group discussion

Written exam, class participation

Module XII UNIT A

Personal Care Defining Personal Care

Persona! Care

Define

II.

Tasks related to .client's body, appearance , hygiene and movement

When

Bathing

Toileting

teeth and mouth care

ambulation

dressing/grooming

eating

7. transferring and Who Needs Personal Care A. Recovering from an illness/accident B. Long term chronic condition C. Frail advanced age D. Permanently disabled

E. The dying client III. Meeting Client's Basic Human Needs Through Personal Care A. Physical Needs B. Safety and Security Including Emotional Security C. Belonging Needs - valuing and showing acceptance for cultural, religious and Socioeconomic differences D. Self Worth Needs - building confidence and encouraging independence in doing specific tasks E. Self Fulfillment Needs - recognition and acknowledgement of past accomplishments and setting new goals IV Communication Keys in Providing Personal Care A. Making A Good Impression B. Showing Acceptance C. Building A Helping Relationship D. Handling Special Problems 61

Module Unit B

TIME:

XII

Personal Care Personal Care Skills

Hand washing

Didactic:

10 minutes

Lab: 10 minutes [BASIC CORE] OBJECTIVES: The student will 1. Discuss the importance of hand washing in infection control 2. Discuss when it is appropriate for the caregiver to wash hands 3. Describe proper procedure for hand washing with soap and water 4. Identify alternate sources of hand washing when soap and water is not available MEASURABLE PERFORMANCE CRITERIA: The student will 1. List two ways hand washing aids in preventing infection 2. List three instances from the time the caregiver comes to work until end of shift when they should wash their hands 3. Demonstrate hand washing using principles of infection control A. Name two alternate sources of hand washing when soap and water is not available 5. Demonstrate Procedure XII-1, Proper Hand washing SUGGESTED TEACHING METHODOLOGIES: Lectures; Video; Demonstration; Glow germ SUGGESTED EVALUATION METHODOLOGIES: Group participation Written/ oral quiz Skills performance checklist mandatory for all levels 62

Module XII Personal Care Unit B Personal Care Skills B) Infection Control [BASIC CORE] LESSON: 1. Process of Infection 2. Standard Precautions 3. Blood borne Pathogens 4. Exposure Incidents TIME: 40 minutes OBJECTIVES: At the completion of this Module the student will be able to: 1. Define microorganisms 2. Define infection control 3. Describe the chain of infection 4. List 4 types of infections 5. List 3 risk factors of infections 6. List 5 modes of transmission of infections 7. Verbalize importance of hand washing with soap and water or antiseptic hand cleaner 8. Describe concept of clean and dirty and demonstrate appropriate care of supplies ana equipment 9. Define Standard/Universal Precaution 10. List the appropriate use of Personal Protective Equipment (PPE) 11 Define blood borne pathogen and 3 common diseases 12. List work practice to prevent exposure to : a. Sharps b. Sharps containers c. Contaminated supplies d. Cleaning/decontamination of body fluids/spills 13. State procedures for all exposure incidents, i.e.: a. Blood exposures b. Airborne c. Allergy/latex SUGGESTED TEACHING METHODOLOGIES:

Lecture, group discussion

SUGGESTED EVALUATION

MODULE XII Unit B

LESSON:

Personal Care Personal Care Skills B)

Infection Control

Process of Infection

2. 3. 4.

Standard Precautions Blood borne Pathogens Exposure Incidents

OUTLINE: A. Process of Infection 1. Chain of infection 2. Risk factors a. Age b. Chronic illness c. Immunosuppressant 3.

Types of Infection a. UTI b. Respiratory c. Wound/skin d. Gl

. Transmission of Infection a. Contact 1) Indirect 2) Direct b. Airborne c. Common Vehicle

d. Vectorborne B. Standard Precautions 1. Concept of clean and dirty a. Handwashing-Demonstration (Current CDC Guidelines) Refer to Procedure Xll-1 b. Care of supplies and equipment c. Waste and sharps disposal d. PPE/Gloves C. Bloodborne Pathogens 1. Bloodborne diseases 2. Hepatitis B and C 3. HIV 4. Vaccination D. Exposure Incidents 1. Blood 2. Airborne 3. Allergy/latex 64

PERSONAL CARE Defining Personal Care: Unit A Daily we perform many personal tasks that maintain our appearance, cleanliness. & general well being. We wash, comb our hair, brush our teeth, without thinking. If someone is unable to do these tasks it threatens their sense of self, their independence. Providing personal care requires understanding & sensitivity. HOW you provide personal care is as important as what you do. Personal care is different from cleaning, shopping, meal preparation, or other tasks that the home care worker performs. The term "personal" refers to tasks that are concerned with the person's body, appearance, and hygiene and suggests a concern for privacy. Most people want to wash, groom, and care for themselves. They may feel uncomfortable about having anyone, especially a stranger, do or help them do these tasks. Some clients may not even like to be touched by someone else. Therefore, it is important that you understand how stressful some people may feel about having you help them with personal care. People react differently to being helped with personal care. Your client may never have been sick before & have had no experience with illness. Personal refers to tasks that are concerned with the client's body, hygiene, appearance, and movement. Your tasks may include bathing, care of teeth & mouth toileting, shaving, walking, dressing, eating, transferring from bed, chairs and tub Your care plan will outline the tasks you are to do. When personal care may be needed Personal care may be needed when someone is recovering from an illness or accident has a long-term chronic condition - is frail because of advance age is permanently disabled - is dying All care provided regardless of the reason for servicing your client, will be outlined on your care plan. The care plan must be followed carefully. No changes are to be made by anyone other than your nursing supervisor. Before starting any personal care assignments, your supervisor will have reviewed with you what you are to do . If : you don't understand, ask for a clearer explanation.

Mod Xll-A- page 1

Meeting client's basic human needs through personal care Personal care goes beyond just the physical hands on care. Personal care provides an opportunity to: - ease emotional discomfort - engage the client in stimulating activity - demonstrate affection and build a helping relationship - show acceptance of the client as an individual assist the client in becoming more independent Knowing & understanding people, their needs & differences, your communication skills will help provide you with a good foundation for giving personal care. Your care plan will outline the tasks required to meet a clients physical needs. Remember the clients psychological needs must also be met. You will be involved closely with another human being. Personal care will involve meeting the clients basic needs as follows: Physical needs form the basis for providing personal care. Without this assistance, a person's well-being could be threatened. Safety needs are critical too. A client should fee! safe and secure while the home care worker is providing care. When people are sick or disabled and must rely on others for their care, they may feel insecure in such situations as taking a bath or getting out of bed. Unless they are reassured by your skill in assisting them with such tasks, these activities of daily living can become stressful experiences. Belonging needs can be met if clients receive sensitive, understanding care. If care is indifferent and clients are treated impersonally, they may feel that they are no longer valued as individuals. Therefore, your acceptance of the client becomes most important. You must show acceptance and respect for cultural, religious and socioeconomic differences. Self-worth and Self-fulfillment may be threatened when a client requires assistance with personal care. People who have been independent may suddenly see themselves as weak or helpless because of chronic disease or disability. Their goals may be altered by their changed physical state. However, if you involve them in their own persona! care to whatever degree possible, you can help them fee! more independent. Self-fulfillment needs maybe met by recognition and acknowledgement of past accomplishments and setting new goals.

Mod XII-A-page 2

Communication in providing personal care Communication is very important in home care, it is extremely important when providing personal care. Personal care requires a good relationship with your client It is important that you understand your own reactions to providing personal care. If you are uncomfortable with certain personal care tasks, you may communicate your discomfort to your client. It is important for you to understand and accept your reactions. Making a good first impression may determine how to carry out your responsibilities for personal care. Remember that the client may be anxious about what you are going to do. Always explain the tasks you are going to perform. Showing acceptance helps the client feel that he or she is valued as a person. You should talk with your supervisor and become fully aware of the home care client's physical condition before you go to his or her home for the first time. By doing this, you can discuss any questions or concerns about the client's condition with your supervisor. This forms the foundation for an accepting relationship. Building a helping relationship, that is, helping clients without making them dependent, is an important key to being a successful home care worker. You build a relationship by listening, showing understanding, encouraging independence, praising small accomplishments, and involving the client in his or her personal care. Be sincere, honest, and patient, and respect the client's privacy. Handling Special Problems Treating each client as an individual by accepting their differences is of extreme value in forming a therapeutic relationship.

Mod XII-A-page 3

Remember: Home care workers have many specific tasks to perform in personal care. These tasks include assisting with bathing, toileting, care of the teeth and mouth, walking, dressing, eating, and transferring to and from bed, chair, and tub. There is a persona! and private nature to many personal care tasks because they relate to the care of the client's body. Therefore, an accepting and comfortable relationship is needed between the home care worker and the client. The personal care tasks that should be performed will be described in the care plan. Persona! care services can help meet the client's needs for physical care, safety, belonging, self-worth, and self-fulfillment. Important communication skills needed in providing persona! care include making a good first impression, showing acceptance, and building a helping relationship by * always explaining to the client the tasks you are going perform * listening and showing understanding * respecting as much as possible the client's need for privacy * encouraging independence * praising small accomplishments * involving the client in his or her personal care as much as possible

Mod XlI-A- page 4

Personal care skills Genera! principles of personal care. When personal care services are provided there are general principles that are important to remember. These principles are to be used with all the personal care skills you will leam. Safety: The client's safety should be a priority for both you and your client in all personal care tasks. Comfort: Make every task as comfortable as possible for you and the client For example, the client should be asked whether the water temperature for a bath is comfortable. Organization: Assemble all necessary equipment prior to performance of a specific task. Economy; Save time, your effort as well as the client's and supplies. Sometimes all the supplies and equipment you need may not be available, and you may need to use and find substitutes. Neatness: The client's appearance and home environment should be weltmaintained. Neatness and organization also save time and effort. Effectiveness: Every task should be evaluated to make sure that it has accomplished its purpose which is to promote or maintain the client's health. Persona! care should give the client a feeling of comfort and well-being. Explain all tasks to the client before they are performed. Independence: Encourage clients to care for themselves as best they can. Assist only in tasks the client cannot perform. Privacy: The client should be given as much privacy as possible during the performance of personal care tasks. This shows your respect for him or her as an individual. Cleanliness: In the health care system cleanliness means more than the absence of dust or dirt. It also means the absence of disease-causing germsProper handwashing is the most important activity you can perform to promote cleanliness. A client has the right to refuse personal care. If this happens, do not argue or insist that you must do the task. Try to find out why the client is refusing and attempt to settle the situation. If everything you try to do fails, discuss this with your nursing supervisor.

Mod Xll-A- page 9

Handwashing & infection control We all have our own ideas & values on cleanliness. Your clients are no different. In health care: cleanliness means more than the absence of dust and dirt, it also means the absence of disease producing organisms or germs. Germs are everywhere - in the air, food, water, on our skin, inside our bodies. We can't see these germs because they are to small. They can only be viewed with a microscope. That is why they are called microorganism. Most microorganisms are harmless to healthy normal people. Some help us (organisms in the intestines help digest food, some form the basis of antibiotics). Some germs can cause people to become iff. These are called disease producing organisms, "pathogenic organisms". These germs can be transferred from person to person in ordinary daily activities. Infectious diseases are a problem among certain high risk groups in our population. These individuals can become ill from organisms that are harmless to normal, healthy people. Recognizing the potential that may exist for infectious disease and taking steps to protect your patient is important-Pathogenic organisms can be spread to other persons in different ways. Direct person to person spread can occur as the result of sneezing, coughing, and even speaking. Germs are transferred directly in the secretions through the air or on the hands that touch the secretions. In addition, blood, stool, urine or wound discharges can soil hands which in turn can directly spread germs to another person through touching. Indirect spread occurs when food or water becomes soiled with discharges from an infected person. That is why people should always wash their hands before handling food. Soiled tissues, linen, and personal laundry can also spread disease. Methods for preventing the spread of infectious disease include: 1. Don't come to work when you have an infectious disease yourself. Although you may not feel very sick, you could cause the client to become ill. 2. Wear a uniform, cover-up, apron or other special clothing which is used only for work. Keep this clothing clean (daily wash is preferred). 3. Maintain proper control of the environment through an understanding of "clean" and "dirty" areas and objects.

Mod XIl-B- page 6

Methods for preventing the spread of infectious disease include:(Cont) 4. A clean object is one that is free from pathogenic (disease-causing) organisms. (NOTE if something is free from all organisms, it is called "sterile".) A dirty object is one that has been in contact with disease-causing agents. The floor is always considered dirty and therefore, anything that comes in contact with the floor always becomes dirty. Other dirty objects include: • Saliva and other discharges from the mouth and nose; also included would be anything that comes in contact with these discharges such as hands, sinks, toothbrushes, handerkerchiefs, napkins, pillowcases, cigarettes, cigars, pipes, and eating utensils • Stool and anything that comes in contact with it such as toilet paper, underwear, bed linens, and toilets. (Note: urine is normally sterile and does not contain any organisms, but it quickly becomes dirty when exposed to the air and should be treated the same as stool.) • Drainage from wounds and object that come in contact with them such as dressings, tissues, cloths, clothing, and bed linens. • Spoiled food and such contact objects as other food, dishes, cooking utensils and kitchen working areas. Keep objects and areas clean. Handle and throw away objects appropriately, or keep them in carefully designated areas. 5. Wash your hands before and after personal contact with the client and after handling any dirty objects. Handwashing is an activity which you must perform frequently. Of all the measures you can take to prevent the occurrence and spread of pathogenic organisms, proper handwashing is the most important. Even when wearing protective gloves proper handwashing technique is still important. When should you wash your hands? • before and after any personal body contact with a client such as assisting with personal care • before assisting with medication • before assisting with eating • before you eat Mod XII-B-page 7

When should you wash your hands? • after handling soiled material such as: bed linens and towels personal laundry dressings tissues, handkerchiefs, napkins dentures, tooth brushes anything that has been on the floor cleaning materials - mop, pails, cloths • after assisting the client with toileting (Note: The toilet should always be considered a dirty object.) • after cleaning or doing laundry • after you use the bathroom • after you eat or smoke See procedure XII-1 For proper handwashing technique When soap and water is not available the liquid sanitizers are an excellent substitution. 6. Bloodborne Pathogens - there are a number of diseases transmitted by organisms that are in the blood. These are transmitted blood to blood-that is, the patients blood to the caregivers blood through a curt or open sore. Wearing gloves will protect against this. Examples of such diseases are Hepatitis and HIV. Vaccine to protect against Hepatitis is available. Exposure Incidents All exposure incidents must be reported to your nursing supervisor immediately. She will advise you as to the appropriate medical intervention for your situation.

Mod Xll-B-page 8

UNIVERSAL PRECAUTIONS Protect yourself: Wear Gloves Any time you come in contact with blood or other body fluids. When touching any mucous membrane or broken skin. When handling items (i.e. Laundry, etc.) or areas soiled with blood or other body fluids. Change your gloves if they are torn. Do not re-use disposable gloves. Use Masks & Eye Protection - If there is any chance that blood or other body fluids may splash into your eyes, nose or mouth. Wear an Impervious Gown or Apron - (Impervious - incapable of being penetrated by moisture) if splashing of blood or other body fluids is likely. Wash your hands & other skin areas immediately after; - Direct contact with blood or other body fluids. -Removing gloves, gowns or other PPE. -Handling potential contaminated items. Open wounds & broken skin should be covered. If you have sores with a discharge, or open weeping dermatitis, you should refrain from direct patient care or handling the patient care equipment (if your, supervisor O.K.'s your working, you MUST wear gloves). Remember to: Use disposable equipment whenever possible. Clean up spills promptly; clean your work surface anytime it is contaminated with blood or body fluid. Clean up work areas after you have completed your work. Use an approved disinfectant. Don't reach into waste containers, etc.; dump it out onto a newspaper, etc. and search with your eyes. It could have a sharp object in it (i.e. glass, needle, etc. and you could cut yourself. Ask questions if you don't understand something; always follow safety procedures. If you are exposed to blood or body fluids: - Wash exposed area immediately. - Report it to the nursing supervisor; she will inform you of what has to be done. Mod Xll-B - page 9

Remember: Always wash your hands after removing gloves. If your glove tears, remove the glove and wash your hands and replace the glove with a new one. All patients are considered potentially infected. Use universal precautions whenever contact with blood or other infectious body fluid is possible.

Universal precautions help prevent disease. Follow safe work practices Take precautions with all patients. Use PPE as required. Report any possible exposure. ** P.P.E. (Personal Protective Equipment)

Mod Xll-B-page10

Checklist for Procedure XII-1 *PROPER HANDWASHING Hand Hygiene *Remember to wash your hands *Stop the Spread of Infection 1. Assembles equipment: soap, paper towels. (liquid soap if possible) 2. Uses towel if no paper towels are available. 3. Rolls up sleeves. ***Rings: Leave on. Move rings up to wash skin underneath. Wash rings. Taking rings off can cause contamination to rings-Which are then placed back on to cleaned fingers. 4. Wets hands under warm, running water. 5. Applies a generous amount of soap and lathers hands well, for at least 15 seconds. 6. Washes entire surface of hands, between the fingers, around and under the fingernails, up to and above the wrist, according to current CDC guidelines. 7. Rinses hands thoroughly under warm, running water with hands lower than wrist. 8. Dries hands using a clean cloth or paper towel. 9. Turns off the tap with paper towel. Using Alcohol-based hand cleaners in situations where there is no running water or hands are not visibly soiled. 1. Applies product to one hand (amount determined by product instructions). 2. Rubs hands together, covering all surfaces of hands, under your nails and between fingers, until your hands are dry. Mod XII-B-page 11

REMOVING GLOVES PROPERLY: 1. Grasp a glove near the cuff and pull down until it comes off inside-out. Cup it in the palm of your gloved hand. 2. Insert 2 fingers of your bare hand inside the cuff of the remaining glove. 3. Pull down so this glove also comes off inside-out, with the first glove tucked inside.

WASH YOUR HANDS, after removing gloves and other PPE, as well.

Mod XII-B-page 12

Checklist for Procedure XII-1 â&#x2122;ŚPROPER HANDWASHING 1. Assembles equipment: soap, paper towels.(liquid soap if possible) 2. Uses towel if no paper towels are available. 3. Rolls up sleeves. ***Rings: Leave on. Move rings up to wash skin underneath. Wash rings. Taking rings off can cause contamination to rings-Which are then placed back on to cleaned fingers. 4. Wets hands under warm, running water. 5. Applies a generous amount of soap and lathers hands well, for at least i seconds. 6. Washes entire surface of hands, between the fingers, around and under the fingernails, up to and above the wrist, according to current CDC guidelines. 7. Rinses hands thoroughly under warm, running water with hands lower than wrist. 8. Dries hands using a clean cloth or paper towel. 9. Turns off the tap with paper towel. Using Alcohol-based hand cleaners in situations where there is no running water or hands are not visibly soiled. 1. Applies product to one hand (amount determined by product instructions). 2. Rubs hands together, covering all surfaces of hands, under your nails and between fingers, until your hands are dry. Mod XII-B-page 13

THINK SHEET - Mod XII Unit A 1. What are some personal care activities you may do for your client? 2. Is the only basic human need you meet when giving personal care, the physical need? 3. What are some reasons a client may need help with personal care? 4. When giving personal care, what are some things you could communicate to your client? Mod XII- A-page 14

Module XII Personal Care Unit B Personal Care Skills C) Freedom from Pain [BASIC CORE] LESSON: 1. Pain management 2. Recognizing and reporting pain TIME: 40 minutes OBJECTIVES: The Student will: 1 Discuss the effects of pain on client functionality. 2. Discuss the cultural differences in responding to pain and pain management 3. Discuss the impact of pain management on resident/client/patient functionality. 4. Discuss how clients demonstrate pain and relief from pain. 5. Discuss the characteristics of pain and how to report (site, duration and triggers). MEASURABLE PERFORMANCE CRITERIA: The Student will: 1 Name three ways individuals indicate pain. 2. Name three effects of pain on client functionality. 3. Show how to gather more information from the client about their 4. Demonstrate how to report pain effectively. SUGGESTED TEACHING METHODOLOGIES: Lecture, scenarios and role play SUGGESTED EVALUATION METHODOLOGIES: Class participation, quizzes

Module XII Personal Care Unit B Personal Care Skills C) Freedom from Pain OUTLINE: 1. Effects of pain on client's functionality 2. Cultural differences in responding to pain and pain management 3. Impact of pain management on client functionality 4. Client's demonstration of pain and relief from pain 5. Characteristics of pain 6. Observe record and report

Pain Management Pain has a negative effect on your clients ability to function to his potential. For this reason it is important that you observe, record and report it accurately so that an effective pain management plan can be established by the healthcare team. It is important to remember that there are cultural differences in the way people react to pain and medication. Some cultures support a stoic approach to pain and are resistant to accept pain medication for relief. Others are the complete opposite, reacting emotionally to pain, verbalizing their discomfort and are very accepting of any method to relieve the pain. In many situations it is important for the patient to follow a physical therapy exercise plan but can only do so if the pain is minimized by medication (example-joint replacement). In order for the physician to have a clear understanding of the patients pain it is necessary for you to observe and report it accurately. Pain has several characteristics including the following: a. Site - Is it localized (in one place) or is it diffuse (an entire area) b. Type of pain- Is it sharp and knife like, is it a burning pain, is it a dull ache, is it a stabbing pain? When you ask your patient what it feels like-look at his hand gestures c. Duration- Is it constant, intermittent, occasional (frequent or infrequent) d. Intensity - Ask patient to describe pain on a scale of 0-10, 0 being no pain and 10 being the worst pain imaginable e. Triggers- What action, motion, event etc. Initiates the pain (example standing bending, turning, eating, lifting) Gather this information and report to your supervisor

Mod Xll-C -page-1

Module

XII

Personal Care

Unit B

LESSON

Personal Care Skills D)

Urinary System

Assisting with Bed pan

[BASIC CORE] TIME: Didactic: 20 minutes Lab: 15 minutes OBJECTIVES: The student will: 1. Discuss who needs to use a bedpan/urinaI/fracture pan. 2. Identify the equipment used. 3. Demonstrate the process of positioning and removing a bedpan. 4. Demonstrate the process of positioning and removing a urinal. 5. Demonstrate the process of positioning and removing a fracture pan. 6. Demonstrate aftercare of equipment. 7. Demonstrate aftercare of resident/client/patient. MEASURABLE PERFORMANCE CRITERIA: The student will: 1 Give 2 examples of when a bedpan/urinal/fracture pan is indicated for use 2. Gather equipment 3. Assist with a bedpan 4. Assist with a urinal 5. Assist with fracture pan 6. Clean, dry and put away equipment 7. Wash hands SUGGESTED TEACHING METHODOLOGIES: Lecture, Display equipment, Show video SUGGESTED EVALUATION METHODOLOGIES: Written/Oral unit quiz Skills Performance Checklist Demonstrate: • Procedure Xll- 17, Use of a Bedpan • Procedure Xll- 18, Use of a Urinal 67

Module XII Personal Care Unit B Personal Care Skills D) Urinary System Lesson: 1. Assisting with Bedpan/urinal/fracture pan OUTLINE: 1. Types of patients needing assistance with toileting. 2. Types of equipment used by patients requiring assistance with toileting 3. Preparation for Procedure a. Assemble equipment b. Positioning patient and removing equipment c. Safety measures d. Infection Control measures e. Aftercare of patient and equipment 4. Demonstrate the use of equipment 5. Refer to Procedure XII-17, Use of a Bedpan 6. Refer to Procedure Xll-18, Use of a Urinal

Module Unit B

XII

Personal Care Personal Care Skills

Urinary System

Lesson:

Bedside commode/toilet

TIME:

Didactic:

20 minutes

Lab: 15 minutes [BASIC CORE] OBJECTIVES: The student will: 1 Define the parts of a bedside commode/toilet. 2. Demonstrate the process of using a commode. 3. Demonstrate aftercare of equipment. 4. Demonstrate aftercare of resident/client/patient. MEASURABLE PERFORMANCE CRITERIA: The student will: 1. Assemble and disassemble a commode. 2. Assist with a commode. 3. Rinse bucket utilizing infection control principles and reassemble commode. 4. Wash hands after. SUGGESTED TEACHING METHODOLOGIES: Lecture Display equipment Show video SUGGESTED EVALUATION METHODOLOGIES: Written/Oral Unit Quiz Skills Performance Checklist 69

Module Unit B

LESSON:

XII

Personal Care Personal Care Skills D)

Urinary System

Bedside commode/toilet

OUTLINE 1. 2. 3. 4.

Define parts of and demonstrate assembling and disassembling bedside commode Assist patient with using commode/toilet Aftercare of patient and equipment Infection Control Measures 70

Module XII Personal Care Unit B Personal Care Skills D) Urinary System LESSON: 3. Incontinence TIME: Didactic: 30 minutes Lab: 20 minutes OBJECTIVES: The student will: 1 State the meaning of incontinence 2. Describe the care given to a client wearing adult diapers 3. State the use of condom, indwelling and straight catheters 4. Demonstrate measuring of patient's urinary output 5. Describe information that should be reported to supervisor MEASURABLE PERFORMANCE CRITERIA: The student will demonstrate: • Procedure XII — 19 Assisting with the Use of Condom Catheter • Procedure XII — 20 Assisting with cleaning the skin and catheter tubing • Procedure XII — 21 Assisting with the emptying of the urinary drainage bag • Procedure XII — 33 Measuring Urinary Output SUGGESTED TEACHING METHODOLOGIES: Lecture Display equipment Show video Demonstration SUGGESTED EVALUATION METHODOLOGIES: Written/Oral Unit Quiz 71

Module XII Unit B

Personal Care Personal Care Skills

Urinary System

LESSON:

Incontinence

OUTLINE: Incontinence 1.

2. a. b. 3. a. b. 4. a. b. c. 5. a. b. c. 6. a. b. c. 7. 8. 9. 10.

Reasons for incontinence a. Bladder b. Bowel Care of the client wearing adult diapers Guidelines for changing Skin care Emotional problems associated with incontinence Embarrassment Loss of dignity Types of Catheters Condoms Indwelling Straight Indwelling/Straight Catheters Safe use of catheters Assisting with the use of catheters Infection control Observing, reporting, recording Color, odor of urine Comfort of patient (pain, chills, sweating) Leakage around catheter Refer to Procedure Xll-19, Assisting with the Use of the Condom Catheter Refer to Procedures Xll-20, Assisting with Cleaning the Skin and Catheter Tubing Refer to Procedure Xll-21, Assisting with the Emptying of the Urinary Drainage Bag Refer to Procedure Xll-33, Measuring Urinary Output

Toileting & Elimination Elimination refers to the process by which the body rids itself of waist material. Elimination includes: - Urination, the process or discharging urine from the bladder; this is also called voiding, to void or to pass water. -Defecation, the process of discharging stool from the rectum, this is sometimes called a bowel movement or to move the bowel. Toileting is concerned primarily with urination & defecation since those are primarily done in a toilet Toileting is a private matter so when assisting your client you need to be sensitive & ensure as much privacy as possible. You need to recognize your own embarrassment when assisting with toileting. You may need to assist your client in removing clothing, or helping the client clean themselves. In cleaning the genital area, keep these principles in mind; - Wear gloves. - Ensure the client's privacy and be sensitive to embarrassment. - Wash your hands before and after this procedure. - In females always wipe or wash from front (the urinary opening) to back (the anus or recta! opening). This prevents soiling the vagina and urinary system with stool which contains disease causing germs. - Spread the buttocks and get a clear view of what you are doing. - Wash the area with warm water and soap if necessary. - Wash the client's hands. Under some circumstances your client may need to use a commode, urinal, or bedpan. Normally people sit upright or even lean forward, with feet on the floor when eliminating. Men normally stand to urinate. The abnormal position required to use a bedpan or urinal can cause problems. Normal urine & stool have certain characteristics; Urine 째 clear liquid yellow in color characteristic odor Stool 째formed, soft mass 째brown in color 째characteristic odor When emptying the commode, bedpan or urinal, observe the contents and record and report any problems. Mod XII-D-page 1

Checklist for Procedure Xll-17 USE OF A BEDPAN 1. Explains procedure to client. 2. Washes hands. 3. Assembles equipment. 4. Puts on gloves, as necessary. 5. Warms and powders bedpan. 6. Places protector pad near client's hips. 7. Places bedpan on bed near client's hips. 8. Maintains client's privacy. 9. Assists client in lifting hips or assist client to roll if unable to hips. 10. Places bedpan under hips. 11. Assists client to sit, if possible. 12. Provides toilet paper and call signal. 13. Assists verbally or manually with wiping, if necessary. 14. Assists client in raising hips. 15. Removes bed pan carefully. 16: Assists client to wash hands. 17. Adjusts bed cover. 18. Removes bedpan to bathroom. 19. Observes, measures (if indicated), and disposes of contents. 20. Cleans bedpan. 21. Washes hands. 22. Observes, records and reports any changes in condition or behavior.

Mod XII-D-page 2

Checklist for Procedure XII-18 USE OF URINAL 1. Explains procedure to client 2. Washes hands. 3. Assembles equipment. 4. Puts on gloves, as necessary. 5. Maintains client's privacy. 6. Places bed protector under client's hips. 7. Gives client urinal. 8. Places urinal to collect urine. 9. Provides toilet paper and signal bell. 10. Assists with hand washing, as necessary. 11. Empties urinal. 12. Cleans urinal. 13. Washes hands. 14. Observes,-records and reports any changes in condition or behavior.

Mod XII-D-page 3

Incontinence Incontinence is a special problem with regard to elimination. Incontinence means that the client urinates and/or moves the bowels involuntarily. This is a difficult problem. It is difficult for the client who may feel embarrassed and childlike. It is difficult for the care giver who must try to keep the client clean and dry. Both urine and stool can be very irritating and harmful to the skin and should be cleaned away promptly. Incontinence may be dealt with in a number of different ways. The client, family and health professionals involved will find an acceptable solution. Your client may choose to use an "incontinent pant." These look very much like plastic pants used for babies, except they are usually lined with a disposable absorbent material. Some styles look like disposable diapers. For minor dribbling problems, some women may be able to use a simple sanitary pad. Be sensitive to how clients must feel who have to use these devices. Never belittle them or treat them like babies. Sometimes a catheter is used by people who have lost the ability to control urination because of injury or stroke or other disease. Catheters drain urine into a container so that a person who has lost the ability to control urination can remain dry. There are two types of catheters: external catheters known as condom or Texas catheters and internal catheters that go into the bladder. Sometimes a male client who is incontinent of urine will require the use of a condom catheter. The condom catheter consists of a sheath or condom held on the penis by tape or adhesive cement and a tube attached to the condom that drains urine into a drainage bag. Condon catheters are available in any drugstore. Condom Catheter drainage bag tube

sheath (condom)

tape Mod XII-D-page 4

Remember The genital area should be washed and dried thoroughly before applying the condom catheter. This prevents the development of red, raw skin and sores which are common problems in clients who use condom catheters. If this problem occurs it should be reported to the supervisor. The tip of the tubing should be about 1 or 2 inches below the tip of the penis so that the penis will not be irritated by the tubing. The condom may be attached with surgical cement or by double-sided adhesive tape. The condom should not be attached so tightly it cuts off circulation to the penis. The condom should be removed at least every 48 hours and the skin washed and dried carefully before it is reapplied. If the client is uncircumcised the foreskin should be pushed back gently, the penis washed and dries and the foreskin pushed forward. Sometimes the condom becomes twisted at the tip of the penis. This prevents the urine from draining as it should. The condom should be checked every few hours to see that it is not twisted and that the urine is flowing into the drainage bag as it should.

Mod XII-D-page 5

Checklist for Procedure Xll-19 ASSISTING WITH THE USE OF THE CONDOM CATHETER 1. Explains procedure to client. 2. Washes hands. 3. Assembles equipment. 4. Puts on gloves. 5. Maintains client's privacy. 6. Exposes genital area only. 7. Washes and dries penis carefully. 8. Observes skin of penis for sores. 9. Attaches condom to tubing, if necessary. 10. Rolls condom catheter onto penis as directed on the Care Plan or by supervising nurse. 11. Checks that tubing is one to two inches below tip of penis. 12. Checks that tip of condom is not twisted 13. Washes hands. 14. Records the application of condom catheter and presence of sores or raw areas. 15. Reports presence of any sores or raw areas on or around penis.

Mod XII-D-page 6

Internal Catheters (Catheter That Goes into the Urinary-Bladder) There are two types of catheters that go into the bladder: indwelling catheters and straight catheters. They are both thin rubber tubes that go into the bladder to drain urine from it. The indwelling catheter can be used by both men and women. The indwelling catheter is left in the bladder for a period of time. The straight catheter is removed when, the bladder is emptied. The indwelling catheter has a balloon at the tip that is inflated when the catheter is in the urinary bladder. This balloon will hold the catheter in place.

The catheter has two openings. The smaller one is used to inflate the balloon in the bladder. The larger one is used to connect the end of the catheter to plastic tubing going to a drainage bag. The drainage bag can either be a leg bag or a larger one which hangs on the bed or wheelchair. TAPE

MOD XII D â&#x20AC;&#x201C;page 7

The straight catheter has no balloon on the end to hold the catheter in the bladder of a client. The catheter is placed in the bladder and urine drained into a container such as a measuring pitcher. A drainage bag is not used.

Then the catheter is removed from the bladder. Safe Use of the Indwelling or Straight Catheter Here are some safety precautions you should follow when assisting a client with the use of the indwelling or straight catheter: - the most important thing for you to remember is the need for cleanliness. Germs can grow in the drainage bag and go up the catheter tube into the bladder when the client uses an indwelling catheter. - never pull on the catheter. - tape an indwelling catheter to the client as indicated on the Care Plan. The catheter should not be pulled tight but have a little give in it. - always keep the drainage bag of an indwelling catheter lower than the catheter and bladder so urine won't flow back up the tube. - check to be sure the tubing of an indwelling catheter is not .kinked, preventing urine from flowing into the drainage bag. - keep the client's urinary opening clean. Wash the genital area and tubing every day when your client has an indwelling catheter. Check the client's Care Plan for specific directions. - attach the drainage bag of an indwelling catheter to the bed or chair when the client is not walking. (The client can walk with the drainage bag as long as it is held lower than the bladder.) the urinary drainage bag should be emptied before the bag is completely full. The Care Plan will tell you how frequently your client's drainage bag should be emptied.

Mod XII-D-page 8

Your Role in Assisting with the Use of the Straight and. Indwelling Catheter As part of your role in assisting a client with the use of a straight or indwelling catheter, you should know the activities you are allowed to do. These activities are only to be performed if they appear on the client's Care Plan. Dos - gather the equipment for daily catheter care - position client for care - perform routine skin and catheter care - empty drainage bag - measure and record urinary output - dispose of used supplies - clean reusable equipment - store reusable equipment - observe, record and report the use of the catheter You should also know the activities you are not allowed to do. Don'ts - set-up a sterile area used when inserting a catheter - cleanse around the urinary opening to prepare for insertion of catheter - apply topical medication to skin around insertion site - insert catheter, straight or indwelling Observing, Recording and Reporting When you assist a client with an indwelling catheter, you should always observe: - the color of the urine (should be clear, pale yellow) - odor of the urine (normally has a mild ammonia smell) Mod XII-D-page 9

• • • •

whether any mucus or blood is present in the urine the condition of the drainage bag and tubing - the condition of the urinary opening: sores crusting leaking of urine around the catheter bleeding

Record according to the directions of your supervising nurse and agency guidelines. In general, record what you saw and what you did including: - the time when you did daily catheter care color and odor of the urine - condition of the tubing such as "is clear" or "has sandy particles in it" - urine leaking around the catheter - sores, bleeding, crusting around the urinary opening - the amount of urine if directed by the Care Plan - little or no urine draining from catheter Report to your supervisor: - cloudy urine - blood in urine - odor in urine - if the catheter comes out of the bladder - if catheter or tubing is cracked - client feels like his/her bladder is full or that he/she needs to urinate - client feels pain in bladder or urinary opening - client has chills and is sweating heavily - urine leaking around the catheter - sores, bleeding or crusting around the urinary opening - little or no urine draining from catheter Turn to Procedure XII-20 and XII-21. Study the steps carefully Mod XII-D-page 10

Checklist for Procedure XII-20 ASSISTING WITH CLEANING THE SKIN AND CATHETER TUBING 1. Explains procedure to client. 2. Washes hands. 3. Assembles equipment. 4. Puts on gloves. 5. Maintains client's privacy. 6. Places client on his/her back so that the catheter and urinary opening are exposed. 7. Puts towel or disposable bed protector under client. 8. Washes the genital gently with soap and water. Does not pull on the catheter, but holds with one hand while wiping it with the other. Gently pushes back foreskin on uncircumcised male before cleaning. 9. Observes area around the catheter for sores, crusting, leakage, or bleeding. 10. Dries area with a towel. 11. Cleans the catheter tubing as directed by the Care Plan starting with the tubing nearest to the client 12. Positions the client so that the catheter and tubing does not pull and are free from kinks or pulling. 13. Tapes tubing to the client as directed in the Care Plan. 14. Disposes of dirty water into the toilet 15. Discards any disposable equipment. 16. Removes the bed protector or towel. 17. Cleans and stores re-usable equipment 18. Washes hands. 19. Records time catheter care was done. 20. Observes, records and reports any changes in condition or behavior. Mod XII-D-page 11

Checklist for Procedure XII-21 ASSISTING WITH THE EMPTYING OF THE URINARY DRAINAGE BAG 1. Explains procedure to client 2. Washes hands. 3. Assembles equipment 4. Puts on gloves. 5. Puts measuring pitcher below the drainage bag. 6. Observes condition of tubing: clear or has particles in it. 7. Takes the drainage tube on the bag out of its holder. 8. Unclamps and opens the drainage tube on the bag being careful not to touch the end of the tube. 9. Drains urine from the bag into a container. 10. Cleans the end of the drainage tube as directed by the Care Plan. 11. Clamps the drainage tube and puts it back into its holder being careful not to touch the end with hand or anything else. 12. Measures the amount of urine, if directed by the Care Plan. 13. Observes the color, odor of the urine, whether mucus or blood was present in the urine, and condition of the drainage bag. 14. Empties urine into the toilet 15. Rinses pitcher with coo! water. Cleans with soap and brush. 16. Stores clean pitcher. 17. Washes hands. 18. Records amount of urine (if directed by the Care Plan) and observations. 19. Reports cloudy, strong smelling, or bloody urine. Reports if there is only a small amount or no urine in the drainage bag when it is scheduled to be drained-

Mod XII-D-page 12

PERSONAL CARE Measuring intake & output Intake & output is a measurement of all the fluids taken into the body & all the fluids the body gets rid of. Most humans take in 2i to 3i quarts of fluid a day & get rid of the same amount. This is called fluid balance; that is intake equals output. In some disease something goes wrong with this balance. Too much fluids may be kept in the body or too much fluid may be lost. If such a situation goes on too long or becomes too severe, the client may become seriously ill just from the fluid imbalance. A client may be taking medications which increase the fluid output. This increase in output may be part of the treatment plan. The doctor or nurse may want to check the client's daily intake & output of fluid to prevent serious problems from developing or to check on the medication treatment. Fluid intake includes all liquids & also foods which become liquid at body temperature (jello, ice cream, yogurt, pudding, etc.) Output includes all fluid eliminated from the body. (Urine, vomit, blood, diarrhea, perspiration It is generally not possible to measure the exact amount of fluid that is eliminated in anything except urine. For that reason we usually measure output only. Intake & output can be measured with measuring cups or pitchers, which have measurement lines on them. Utensils used to measure output should be labeled with a "urine only" sign & should be kept separate from other measuring utensils Record the intake & output right after you measure them, so you don't forget. Record Date Time, specifying A.M. or P.M. Type of intake and amount (for example, soup-three ounces, milk four ounces) Type of output and amount (for example, urine in bedpan - 12 ounces liquid stool in commode -12 ounces) Usual observations such as poor appetite or abnormal color of urineSignature and title. Immediately report to your supervisor if the client does not drink liquids or does not eliminate urine in a 24hour period. Mod XII-D-page 13

Checklist for Procedure Xll-33 MEASURING URINARY OUTPUT 1. Explains to client the need to measure urinary output. Asks client to use bedpan, urinal, or commode when has the urge to pass urine. Gets client's cooperation by asking client to report when has to pass urine. (This will not be necessary if client has urinary drainage bag.) 2. Washes hands. 3. Assembles equipment. 4. Puts on gloves, as needed. 5. Pours or drains urine from bedpan, urinal, commode, or urinary drainage bag into measuring pitcher that is on flat surface. 6. Records amount that is in pitcher or urinary drainage bag. 7. Discards urine unless a specimen is needed. 8. Cleans re-usable equipment 9. Stores re-usable equipment. 10. Washes hands. Observes records and reports any changes in condition or behavior, such as strong smelling urine, cloudy urine, blood in the urine, very small amount of urine, or if client has pain or difficulty when passing urine.

Mod XII-D-page l4

EQUIVALENTS:

RECORD

Soup Bowl = 120 c Sherbet = 50 cc Fruit Juice or sm paper cup - 120 cc Ice Cream = 65 cc Water glass or Ig paper cup = 216 cc Coffee Cup = 200cc Jello = 150 cc Milk Carton = 2l6cc Patient Name:

INTAKE TIME

OUTPUT TIME EMESfS NGT

PO and/or IV FLUIDS T.F. TYPE & MED

INFU LIB S

D A Y

8HR TOTA L NURSE SiG.:

EV EN

l N G

8HR TOTA

TOTAL

TOTAL OUT

Date

URIN Stool Other E

L NURSE SIG:

TOTAL

TOTAL OUT

TOTAL

TOTAL OUT: TOTAL OUT24Hrs.:

N I

G H T

8HR TOTA L NURSE SiG.: TOTAL IN 24Hrs.

Mod XII-D-page l5

FAMILY AIDES, INC. THINK SHEET Mod XII - Unit D Urinary System 1. Where does a condom catheter go? 2. What are some things you would do to prevent a client with an indwelling catheter from developing an infection? 3. If a client asks you to do something not on the care plan, who should you check with? Mod XII-D-page 16

Module XII Personal Care Unit B Personal Care Skills E) Digestive System

[BASIC CORE]

Lesson: 1. Nutrition and a Balanced Diet * * This should be used in conjunction with Module VIII - Food, Nutrition and Meal Preparation. TIME: 4 hours (20 minutes of the 4 hours required in Module VIII) OBJECTIVES: The Student will: 1 Define a well-balanced diet using the food guide pyramid 2 Describe the 6 Basic Nutrients. 3 Explain functional-age-related changes that can effect appetite MEASURABLE PERFORMANCE CRITERIA: The Student will: List the 5 Basic Food Groups. Identify 3 Nutrients. Describe what to observe in the care recipient that would indicate a changed appetite. SUGGESTED TEACHING METHODOLOGIES: Lecture; Food Pyramid diagram, discussion video. SUGGESTED EVALUATION METHODOLOGIES: Class participation, Written or oral quiz

Module XII Personal Care Unit B Personal Care Skills E) Digestive System [BASIC CORE] LESSON: 2. Assisting with Eating and Hydration a. Proper Feeding Techniques 1. Positioning 2. Assistance for independent eaters 3. Partial assistance with eating TIME: Didactic: 35 minutes Lab: 30 minutes OBJECTIVES: The Student will: 1. Describe proper positioning to prevent choking at mealtime. 2. Define independent and partial assistance with eating. 3. Demonstrate various ways of tray set-up (clock method). 4. Discuss the need for and different adaptive equipment for meal time 5. Discuss ways to maintain resident/client/patient dignity, promote autonomy and respect diversity during mealtimes. MEASURABLE PERFORMANCE CRITERIA: The Student will: 1 Demonstrate proper body posture for safe eating. 2. State the differences between independent and partial assistance with eating. 3. Display the clock-method of tray set-up. 4. Name 2 pieces of adaptive eating equipment 5. Demonstrate ways to promote comfort, safety, and dignity when assisting with meals. SUGGESTED TEACHING METHODOLOGIES: Lecture; role play, discussion, video. SUGGESTED EVALUATION METHODOLOGIES: Class participation, return demonstration 74

Module XII Personal Care Unit B Personal Care Skills E) Digestive System LESSON: 2. Assisting with Eating and Hydration a. Proper Feeding Techniques 1. Positioning 2. Assistance for independent eaters 3. Partial assistance with eating OUTLINE: 1. Proper positioning 2. Types of patients 3. Assistance for independent eaters 4. Tray set-up 5. Adaptive Equipment 6. Promoting pleasant mealtime 7. Plan menu with patient (choices, when possible) - Refer to Care Plan for type of client 8. Refer to Procedure XII-11, Assisting with Eating 9. Measuring Intake XII-32

Module XII

Personal Care

Unit B

Personal Care Skills E) Digestive System

LESSON:

TIME:

Didactic: Lab:

[BASIC CORE]

Measuring and Recording Weight 10 minutes 5 minutes

OBJECTIVES: The Student will: 1. Identify the principles for measuring weight accurately using a balance scale and/or a chair scale. 2. Identify proper positioning of the resident/client/patient to achieve balance when using scales. 3. Identify how to correctly report and record weight.

MEASURABLE PERFORMANCE CRITERIA: The Student will: 1. State the principles for measuring weight accurately using a balance scale and/or a chair scale. 2. Correctly demonstrate maintaining principles of safety while using scales. 3. Accurately record weight. 4. Demonstrate Procedure Xll-31, Weighing a Client

SUGGESTED TEACHING METHODOLOGIES: Lecture Performance checklist Demonstration on balance and chair scales Video Demonstration of weighing on balance and chair scales Sample recording form for weight SUGGESTED EVALUATION METHODOLOGIES: Quiz Return demonstration of weighing on balance and chair scales and recording results 76

Module XII Personal Care Unit B Personal Care Skills E)

Digestive System

LESSON:

Measuring and Recording Weight

OUTLINE: 1. Purpose of weighing 2. Patient's feelings about weight 3. Types of Scales a. Chair scale b. Bathroom scales Typesâ&#x20AC;&#x201D;Digital; Standard 4. Refer to Procedure XlI-31, Weighing a Client 5. Observing, recording and reporting

77 Digestive System In Module VIII we learned about Nutrition, Shopping, Meal Preparation and special diets. From what we learned you should have a good understanding of the five basic food groups, (Grains, Vegetable, Fruits, Milk, Meat and Beans) and how to create a balanced diet for your patient. Unfortunately your patients will not always have the appetite, good eating habits and physical ability to eat and enjoy their food. We need to find ways to overcome these obstacles as best we can. Hydration is an important part of your responsibility too. Due to decreased activity bowel functions maybe slowed down and constipation may occur. Proper hydration will aid in preventing this outcome. Your patient may require various amount of assistance with feeding. It is uncomfortable and unsafe to eat while reclining. Your patient should be raised to a sitting position to eat. (Preferably at the table). They may require assistance in cutting up their food. Make sure that you cut it into small enough pieces so that it is not a choking hazard. If your patient wears dentures make sure they are in place. If you notice that the patient is having difficulty chewing or swallowing their food-you may have to cut the food into smaller pieces or pick softer, easier to manage choices. The food should be served in as appetizing a manner as possible. If the patient can feed themselves, they may enjoy having company (you sitting with them). Some may enjoy listening to music or watching T.V. while eating. You always must respect their individual wishes, customs and routines. Some patients will need to be fed. If that is the case, have them assist in any way they are able to (examplegive them the napkin to wipe their mouth or perhaps they can hold a piece of bread and feed it to themselves while you feed them their soup.) If adaptive feeding equipment will enable them to feed themselves, it is preferable to you feeding them. Sometimes a spill proof cup or special utensils are enough to make them more independent. Ask your patient for input when planning meals-it makes them feel independent and it helps ensure food choices that will please them. There may be medical situations that will require you to monitor the patient's weight. If this is required it will be written on the care plan and the frequency of this task will be noted there as well (for example it may say weigh patient daily and record.) Since you are in a patient's home they probably do not have a "doctors scale". You will have to use whatever they have available (if digital, standard, chair scale.) It is important to always use the same scale when weighing the patient and to check that it is set at "0" before you begin. Mod XII-E-page 1

Checklist for Procedure XII-11 ASSISTING WITH EATING 1. Explains the procedure to client 2. Washes hands. 3. Assembles equipment. 4. Puts gloves on, as necessary. 5. Arranges food attractively on the plate. 6. Allows the client to choose foods to be eaten. 7 Encourages the client to do as much as capable. Assists only when it is necessary. 8. Cuts food into small pieces if the client is unable. 9. Uses forks and spoons gently. 10. Wipes the client's mouth, if needed. 11. Uses straws or a training cup for liquids. 12. Explains where food is located on plate, and what is on eating utensil. 13. Feeds to the strong side (in case of a facial weakness or paralysis on one side). 14. Washes hands. 15. Observes, records and reports any changes in condition or behavior.

Mod XII-E-page 2

Checklist for Procedure XII-32 MEASURING INTAKE 1. Explains to client the need to keep track of intake. Gets client's cooperation by asking client to tell when they have had something to drink and to report how much they have had. 2. Washes hands. 3. Assembles equipment. 4. Serves liquids in containers (bowls, glasses, or cups), measured ahead of time. 5. Measures serving containers ahead of time: 6. Assembles equipment (measuring cup, bowl, cup and/or glasses that will be used each time client drinks or eats something; paper; and pencil). a. Fills first serving container with water. b. Pours water into measuring cup. c. Writes down this amount on paper. d. Discards water. e. Repeats steps b, c, d, and e for each serving container. f. Keeps this list for use each time client's intake is measured. 7. Writes down types and amounts of liquids served to client. 8. When client is finished, removes serving containers. 9. Measures each type of liquid that is left. 10. Subtracts leftover amount from amount served to client. Adds ail of these together Writes this down. 11. Cleans measuring and serving equipment. 12. Stores measuring and serving equipment 13. Washes hands. 14. Records total amount of intake for a particular time. 15. Observes, records and reports any changes in condition or behavior. Mod Xll-E-page 3

THINK SHEET - MOD XII- E-Digestive System 1. What are some foods to reduce on a low salt diet? 2. Define a simple modified diet? 3. What foods would you avoid to reduce sugar in the diet? 4. What is a bland diet? 5. What foods should be avoided on a low fat diet? 6. How can you reduce saturated fats & cholesterol in a diet? 7. What are some forms of carbohydrates? 8. What are some alternate sources of protein? 9. What are some good sources of vitamin A? 10. What type of client would need an increase in calories? 11. How could you prepare meat? 12. Would you involve your client in meal preparation? 13. What does the texture of food mean?

Mod XII-E-page 4

Module XII Personal Care Unit B Personal Care Skills F) Integumentary System [BASIC CORE] LESSON: 1. Skin Care and Alterations in Skin a. Healthy Skin TIME: Didactic: 20 minutes Lab: 20 minutes OBJECTIVE: The student will: 1. Describe healthy skin and age related changes in the skin. 2. Identify the risk factors, which compromise healthy skin (i.e. immobility, poor nutrition, illness, etc.) 3. Describe procedures/preventive devices utilized to maintain good skin integrity. 4. Identify the supplies needed to give a back rub MEASURABLE PERFORMANCE CRITERIA: The student will: 1. List two characteristics of healthy skin. 2. Name three risk factors that affect healthy skin. 3. Identify four daily measures to promote healthy skin.

SUGGESTED TEACHING METHODOLOGIES:

Lecture; charts of Integumentary system

SUGGESTED EVALUATION METHODOLOGIES:

Written or oral quiz, class participation

Demonstrate: Procedure XlI-7, Giving a Back Rub Demonstrate: Procedure Xll-34, Assisting with Changing a Clean Dressing

Module XII Unit B

LESSON:

Personal Care Personal Care Skills F)

Integumentary System

Skin Care and Alterations in Skin a.

Healthy Skin

Outline: Normal skin functions and characteristics Components of routine skin care Back Rub 4. Importance of a back rub a. Observe record and report any reddened or open areas to supervisor: b. Perform back rub according to the Plan of Care c. Refer to PROCEDURE XII-7 5. Risk factors which compromise skin integrity 6. Preventative measures 7. Healthcare worker's role in assisting with special skin care a. Refer to PROCEDURE XII-34 8. Observing, recording and reporting.

Module XII Unit B

LESSON:

Personal Care Person Care Skills

Integumentary System

Skin Care and Alterations in Skin b.

TIME:

[BASIC CORE]

Alterations in Skin

60 mintues

OBJECTIVES: The

student will:

1. Define the following skin alterations and the possible causes of each: A. Skin tears B. Moisture related problems C. Circulatory problems D. Pressure 2. Describe the caregiver's role in the prevention and of the following skin alterations: A. Skin tears B. Moisture related problems C. Circulatory problems D. Pressure 3. Identify pressure points on the body and the signs of a beginning pressure ulcer. MEASURABLE PERFORMANCE CRITERIA: The student will: 1. Identify two contributing factors for each of the following alterations in skin: A. Skin tears B. Moisture related problems C. Pressure related problems D. Circulatory problems 2. Describe two preventive measures for each of the following: A. Skin tears B. Moisture related problems C. Pressure related problems D. Circulatory problems 3. Locate four pressure points on the body. 4. Identify two signs of early skin breakdown. 5. Dressings. 6. Assisting in changing a clean dressing (Using Standard Precautions Xll-34.) SUGGESTED TEACHING METHODOLOGIES: Demonstration, diagrams of pressure ulcers, anatomy charts SUGGESTED EVALUATION METHODOLOGIES: 80

Lecture

Class participation Written or oral quiz

Module XII Unit B

LESSON:

Personal Care Personal Care Skills F)

Integumentary System

Skin Care and Alterations in Skin b. Alterations in Skin

Alterations in Skin

OUTLINE:

a. skin tears b. moisture related problems c. pressure related problems d. circulatory problems 2. Preventive measures for each of the following: a. Skin tears b. Moisture related problems c. Pressure related problems d. Circulatory problems 3. Pressure points on the body: a. coccyx b. heals c. sacrum d. ischial tuberosities e. back of skull f. elbows Signs of early skin breakdown: a. b. c. d.

redness warmth rash itching

Checklist for Procedure XII-7 BACK RUB 1. Explains procedure to client. 2. Washes hands, 3. Assembles equipment. 4. Removes client's clothing. 5. Positions client on stomach or side. 6. Positions self appropriately. . 7. Warms lubricant before applying. 8. Lubricates hands. 9. Rubs back with appropriate pressure. 10. Rubs back rhythmically. 11. Rubs back in correct direction. 12. Observes and massages bony or reddened areas. 13. Times procedure according to client's wishes. 14. Removes excess lotion. 15. Assists client with dressing. 16. Returns equipment. 17. Washes hands. 18. Observes, records and reports any changes in condition or behavior MOD XII- F page 1

Checklist for Procedure XII-34 ASSISTING WITH CHANGING A CLEAN DRESSING (using Standard Precautions) 1. Explains procedure to client 2. Washes hands. 3. Assembles equipment. 4. Provides privacy. 5. Assists client to comfortable position. 6. Provides good lighting. 7. Removes clothing over dressing, if necessary. 8. Places waste bag near client for disposal of dressing/waste products. 9. Puts on gloves. 10. Removes wrappings from new dressing. 11. Cuts tape. 12. Removes and discards old dressing and used gloves. 13. Washes hands. 14. Puts on new gloves. 15. Cleans skin around wound according to directions on Care Plan. 16. Hands requested items to client. 17. Applies new dressing to wound. 18. Tapes new dressing in place. 19. Removes and discards waste bag. 20. Washes hands. 21. Stores unused supplies. 22. Observes, records and reports any changes in condition or behavior, such as changes in the appearance of the wound. Mod Xll-F-page-2

PERSONAL CARE Skin care The skin consists of hair, nails, mucous membrane, oil & sweat glands. The outer layer of skin is constantly shedding & replacing itself. The inner layer is thicker, it contains blood vessels, nerves & nerve endings, hair follicles, sweat & oil glands are in this layer of the skin. The skin is normally warm, smooth, slightly oily & elastic. Skin color varies from person to person. The skin: - protects the body from infection and injury - eliminates body wastes through perspiration - insulates the body from heat and cold - senses heat, cold, pain and pressure The skin is the outer covering of the body. It is the first line of defense. Any break in the skin allows germs to enter the body. To protect the skin it must be kept clean, dry & lubricated. As people become older changes in their skin occur. The skin loses its ability to stretch and becomes dry, wrinkled, thin and easily damaged. This fragile skin tears and scrapes easily. Gentle handling is necessary. Obese clients may have skin that is stretched and they may have poor circulation. They may have folds of skin. The area under the folds may be irritated from sweating and rubbing. Cleaning under these folds is very important. Very thin clients may have poor nutrition. This often means their skin is very thin and easily injured. Gentle handling is very important for these clients. Other problems of the skin include: wounds or openings in the skin- cuts, lesions, bruises poor circulation which causes the skin to break down or heal poorly effects of too much pressure which cuts off circulation and causes skin to break down effects of immobility or inactivity causing decreased circulation to the skin

Mod XlI-F-page 3

Skin care Breaks or openings through the skin can cause serious problems for the individual, especially if that person is already ill, frail, or elderly. It is better to try to prevent problems and keep the skin healthy, than it is to try to treat skin problems. The home care worker can help prevent problems by: Keeping the client's skin clean by washing and bathing with mild, non-drying soap and warm water. Keeping the client's skin dry by changing clothes, bed linen and supportive equipment such as sheepskin and cushions that become damp with sweat or wet with urine or stool. Keeping rough, scratchy fabrics such as linens and towels away from the client's skin. Drying the client's skin by patting, not rubbing. Not using caustic laundry detergents on any material (clothes, towels, linens) that comes in contact with the skin. Keeping bottom bed sheets pulled tight and free from crumbs, etc. - Keeping the client's skin lubricated with lotion or creams. - Gently massaging unbroken areas that are reddened or that receive a lot of pressure, such as over bony areas. - Turning and changing positions frequently so that no area of the body receives constant pressure. - Not allowing the client's skin to come in direct contact with plastic or rubber which prevents air from circulating and causes the skin to sweat. - Serving the client well-balanced meals.

Mod XII-F-page 4

OBSERVE, RECORD AND REPORT Observing and recording and reporting changes or problems with the client's skin is another way of preventing problems. Things to observe, record and report include: - Any breaks in the skin - Reddened areas or areas that are lighter in color than the surrounding area (skin color should return to normal after pressure has been removed.) - Black and blue marks - Dryness, chapping, irritation, scales - Rashes - Reddening Blue, grey or pale color to the skin - Changes in warts or moles - Client complaints about the skin-pain, itching, burning, etc. Redness or breaks in the skin over pressure areas such as elbows, hips, heels, ankles and lower back

Mod XII-F-page 5

SKIN CARE It is important to pay special attention to pressure areas because the skin in these areas can break down more easily when body weight is placed on them for any period of time. These areas most frequently have bony prominences which result in pressure being applied both internally and externally at the same time. When pressure is exerted; the skin tissue is squeezed or crushed between bone and external surface, preventing blood, with its oxygen and nutrients to flow freely through the area, removing waste materials as it flows. This lack of oxygen will cause the area to become reddened. If circulation is not stimulated, and pressure is not removed, the skin in the area will begin to break down, growing wider and deeper and causing the patient a great deal of pain. This skin breakdown is called a decubitus ulcer or bedsore. It can occur when a patient remains in one position for long periods of time in or out of bed. Common Pressure Areas: back, shoulders, heels, elbows, sacrum (lower back), knees. We call these the most common because of the obvious bony structure below the skin. However, any area of the body may be subject to the breakdown. Prevention: is the key to good patient care. No patient should ever develop a bedsore. Good nursing care is all that is needed. Guidelines: be sure that the patient changes his position regularly. In-bed (active)-at least once every two hours In-bed (helpless)-at least once very one hour Wheelchair-bound-either lift up and shift weight hourly, or get out of chair and into bed after no more than four hours skin care-through, daily bathing stimulates skin circulation, removes bacteria, and refreshes skin. Backrubs, preferably daily, if not more often, also are a great stimulant. Reddened areas-whenever you. bathe or perform a procedure of any kind on a patient, be especially aware to examine the patient's skin for signs of redness. When redness occurs, keep patient off of that area for long periods of time, rub area with lotion. Expose area to open air as often as possible. If red area persists, notify your nursing supervisor. Be sure to call her attention to red areas when she is making her regular visits. Note reddened areas and their progress in your weekly progress notes as to: location, onset, size, progress. positioning-when it is absolutely necessary for the patient to be placed on reddened area, try as best you can to support areas surrounding the redness so as to guard pressure from the area. Pillows, bed cradles, rubber rings, donuts may be necessary to guard the area. Remember the skills you learned in properly positioning a patient. Use various positions alternately so that no one area will be constantly subject to pressure. Decubitus ulcers-at the first sign of skin breakdown, CALL YOUR NURSING SUPERVISOR IMMEDIATELY. She will contact your patient's doctor for directions in treatment Usually, the ulcer is cleansed, dried, and exposed to the air. Pressure of all kinds must be kept away from the area. In some cases, a clean dressing (bandage) is applied over the affected area. Mod XII-F-page-6

Special Skin Careâ&#x20AC;&#x201D;continued The incontinent patient-one who is unable to control urination and/or defecation. It is very important to keep this patient's skin clean and dry as much as possible. Absorbent pads under the patient will draw some of the moisture from the body area - but not in sufficient amounts to totally keep the patient dry. The HHA must check this patient frequently to see that he is dry. If he is not, remove soiled pads and bed linen (clothing also if necessary), wash, rinse, and dry the genital and buttock areas thoroughly. Apply a lubricant to the area (lotion) and replace linen and clothing. Bed making-sheets on bed, if tucked in smoothly and tightly, do not wrinkle, and therefore do not cause unnecessary pressure to an area. Also be especially aware of foreign matter in bed, particularly under patient. Crumbs, pieces of food, combs, hair pins can cause reddened areas and breakdown in a very short amount of time. bedpans-be very careful when placing pan and removing it from patient. NEVER use pan with chipped or rough edge. Remove pan promptly from under patient never allow patient to sit on pan for long periods of time. Check to see that bed linen under pan is dry after pan has been removedâ&#x20AC;&#x201D;damp under sheets can cause irritation and breakdown. .

Mod XII-F-page 7

The Decubitus Ulcer What cause it? How does it develop? Immobility, especially in paralyzed and comatose patients, anemia, spasticity, age, malnutrition (hypoproteinemia), infection even the patient's morale â&#x20AC;&#x201D; all are important factors in the development of what are called decubitus ulcers, dermal ulcers, pressure sores, or bedsore. But, especially the extent and duration of pressure-is the true enemy. In spite of the high quality of nursing care generally provided in our hospitals and nursing homes, you will still be confronted with decubitus ulcer problems. For example, you can easily "inherit" decubitus problemsulcers that patients already suffer upon, admittance. Also, the decubitus ulcer can and does develop rapidly. In many cases, so rapidly that its early signs are missed as you try to cope with a patient's primary illness. Physicians recognize three stages of development: threatened, inevitable and ulcer. Threatened â&#x20AC;&#x201D; In this first stage, there will usually be a redness or erythema of the pressure site. However, erythema may be absent if circulation is greatly impaired. The skin and underlying tissue are still soft and the redness will disappear upon the application hard pressure. Inevitable- Now the skin has become dusky, a livid bluish color indicating local cyanosis, a circulatory disorder caused by inadequate oxygenation of the blood. Skin tissue may feel hard to the touch; blisters at this stage are uncommon but may occasionally be observed. Ulcer- First, there is a necrotic breakdown of skin and subcutaneous tissue. If the process continues, the breakdown may Involve connective tissue, muscle and even bone. Dead or necrotic tissue is evident from the time the ulcer is first observed. There is almost always a larger ulcer under the skin than one would suspect, judging from the size of the visible portion. Infection is almost certain. Pressure inhibits blood flow ,cutting off vital oxygen and nutrients And suppressing the elimination of waist

Like an iceberg the decubitus ulcer is almost always larger than its surface would suggest Typically, decubitus ulcers attack at the bony prominences of the body. Watch for redness at the occiput (back of head), ears, shoulder blades, sacrum, crest of pelvis, elbows, knees, ankles and heels Mod XII-F-page 8

These are the most common sites of pressure sores in bedfast and wheelchair patients Redness and softness in tissue under a pressure site have been observed after a mere two hours of patient immobility The development of a dermal ulcer has been observed within long hours after surgery In a bed or chair a patients boney prominences exert heavy pressure against small areas of skin and soft tissue until blood vessels and capillaries collapse. Without adequate blood flow tissue cells die from a lack of oxygen and nutrients. Ulceration is the visible result of this process. Pressure is always the villain. Its allies are localized body heat, moisture, perspiration, urine, vaginal discharge, and irritating substances and materials. But its strongest ally is duration â&#x20AC;&#x201D; the length of time a patient remains in a single pressure-inducing position. Young, old; male, female; thin or overweight â&#x20AC;&#x201D; all are susceptible. In the aged, especially those suffering from several disease states that discourage or totally prevent ambulation, the frequency of dermal ulceration is alarming. With pressure sores, secondary infection is almost always present. It may prolong illness, even lead to death. Clearly, it will at least lead to distress and discomfort for the patient, not to mention an increase in the cost of health care.

Poor nutrition â&#x20AC;&#x201D; particularly the absence Of adequate protein substantially heightens risk. Mod XII-F-page 9

The main objective — Prevention Only you-because of the frequency of your contact with the patient-can have major impact on the decubitus ulcer problem. 1. Relieve pressure • For patients unable to move or at risk because of their debilitated condition, establish a turning schedule that ensures a full change of body position at two-hour intervals. The complete series of changes must relieve pressure at all potential ulcer sites. • For patients who are ambulatory or able to turn, clearly explain the importance of relieving pressure. Enlist their aid in prevention. A little verbal recognition and encouragement will often spur them to even greater effort. • Bony prominences of the body can and should be protected by fleece-lined boots, elbow pads, and sheepskin and foam pads. A two-inch thick sponge rubber pad under the legs will relieve pressure on the posterior area of the heel. • Remember that pressure is intensified when bed linens are wrinkled and when food crumbs and other foreign particles are present. 2. Keep the patient clean and dry • Maceration-the reduction of tissue to a soft mass through soaking- will speed the decubitus process. Be certain, therefore, that the patient's skin is kept clean and dry at all times. • Routine care includes keeping bedclothes clean and taut; bathing , as necessary, with mild, non-detergent soap and warm water; thorough drying after baths, and gentle massage with a lotion or emollient, such as baby oil or Dermas sage, to moisturize and lubricate the skin

If it is not done gently, the very act of turning a paiient can abrade the skin and lead to ulceralion Mod XII-F-page 10

PERSONAL CARE Dressings A dressing may be applied when an area of skin becomes unhealthy. A dressing is a protective covering over a wound which serves as a continuation of the skin, until healing occurs. Dressing serve many purposes. They: Protect the wound and the surrounding area from further injury. Prevent germs from entering the wound. Provide protection from exposure to extremes of heat or cold. Control swelling and bleeding when applied with pressure. Prevent drying and cracking that results from exposure to the air. Absorb drainage. Provide a surface for the application of medications. Provide emotional comfort by covering the wound and improving the client's outlook and body image. Dressings may be applied to stable or unstable surface wounds. A stable surface wound is an area of skin that is healing. A stable surface wound is a closed area of skin. That means there are no rough edges because the wound is crusted or has a scab. Stable surface wounds have no drainage and are not infected. The wound and the area around the wound are not red or swollen. An unstable wound surface is an open area of skin that is not healed or has just recently occurred. It would have no scab or crust. It might be draining or bleeding. It might be infected and have a bad smell. The wound and the area around the wound might be red and swollen. Either stable or unstable surface wounds may need a dressing. There are two types of dressing that might be ordered, sterile or clean. Sterile dressings use a very special technique, sterile technique, that protects the wound from all germs. Sterile dressings can only be changed by the doctor, nurse, client or client's family member. Clean dressings do not require the use of sterile technique. You may be asked to assist in changing a clean dressing. You may only assist in changing a clean, dressing when it occurs on a stable wound surface. That means changing a band aid or gauze pad with tape. You may never apply any medication to a wound. When assisting with changing a dressing it is very important not to spread infection. USE UNIVERSAL (STANDARD) PRECAUTIONS. Mod XII-F-page 11

THINK SHEET-MOD Xll-UNIT F 1. What is a good definition for a stable wound? 2. What is a good definition of an unstable wound? 3. Why should the client's bed be free from wrinkles? Mod XII-F-page12

Module XII Personal Care Unit B Personal Care Skills G) Musculoskeletal System LESSON:

[BASIC CORE]

1 Transfers, Positioning and Turning a. Body Mechanics

TIME: Didactic: 15 minutes Lab: 20 minutes OBJECTIVES: The student will: 1 Define body mechanics and explain the basic rules of proper body mechanics. 2. Use correct body mechanics when assisting in moving and with all aspects of daily care. MEASURABLE PERFORMANCE CRITERIA: The student will: e. State four basic rules of body mechanics. f. Demonstrate use of correct body mechanics during a transfer. g. Demonstrate Procedure XII-2, Proper Body Mechanics SUGGESTED TEACHING METHODOLOGIES: Lecture Demonstration SUGGESTED EVALUATION METHODOLOGIES: Return demonstration Class participation

Module XII Unit B

Personal Care Personal Care Skills G)

LESSON:

Musculoskeletal System

1. Transfers, Positioning and Turning a. Body Mechanics

Outline:

1. A. B.

Define body mechanics: The way the body moves and maintains its balance. Makes the best use of the body's strength and avoids straining muscles and joints.

2. A. B. C. D. E. F. G. H. I.

Basic rules of proper body mechanics Proper posture Use wide base of support Bend at knees and hips not waist Carry objects close to body Face your work Place one foot ahead of the other while working Do not twist For prolonged standing, stand with one foot up Refer to Procedure Xll-2, Proper Body Mechanics

Body Mechanics refers to the ways in which the body and its parts function while you are standing, moving, and doing various jobs. Good body mechanics, when learned and applied, will reduce fatigue, and muscle strain, will help your work go much move smoothly. and will help to conserve strength and energy. Principles of good body mechanics : o Use as many muscles or groups of muscles as possible to perform a task. Distributing the workload between more muscles means that individual muscles will not have to work as hard, and the job will not be as tiring. Ex. use both hands, rather than one, to pick up a heavy package. o Avoid lifting objects whenever possible. When you have to move a heavy object, it is better to push or roll it than to lift or carry it. Once the object is moving, keep it going. Avoid unnecessary stops and starts. o When lifting is necessary, your arm muscles, not your back muscles should dc most of the work. It is very easy to strain or even injure the muscles of the back if you do not follow the proper procedure for lifting. When lifting an object from the floor, kneel or squat so that the lifting is done by leg muscles rather than back muscles. o Position yourself in the direction of the work. Avoid twisting your body. Face in the direction of the work area, place feet comfortably apart, keep knees loose and ready to bend. When. turning is necessary, pivot with your feet, net with your waist. o When holding a heavy object, keep your elbows relaxed and hold the object close to your body. Keep your feet about 18 inches apart so that they give you good support and balance Stand up straight whenever you can, try to avoid bending over for more than a few minutes. If you bend forward, bend at the hips, not at the waist. o Good body mechanics begin with good posture. You should hold your head erect, keep your shoulders back and chest out, and pull in the muscles of your stomach. Another basic of good body mechanics is to wear comfortable, low-healed shoes.

Mod Xll-G-page 1

PERSONAL CARE Proper body mechanics As you work, be careful to give yourself a firm base of physical support by placing your feet apart and centering your body over them keep your body as straight as possible and your feet flat on the floor face the direction in which you intend to move the client, and place one foot slightly in front of the other in that direction keep your arms and the client or object your lifting close to your body use the weight of your body to do the heavy work when pushing or pulling bend at the knees and hips so that the trunk and thighs do the work, not the arms and back keep the client's body as straight as possible when lifting. Firmly grasp the trunk and hip areas, not the arms and legs.

Mod XII-G-page 2

l.SQUAT DOWN 2. BEND KNEE 3. BACK STRAIGHT 4. ARMS CLOSE 5. KEEP LOAD CLOSE Mod XII-G-page 3 Checklist for Procedure XII-2 PROPER BODY MECHANICS Uses firm base of support

RIGHT 2. 3. 4. 5. 6. 7. 8.

Keeps back straight Faces in direction of movement Places one foot ahead of the other. Keeps objects being lifted close to body Uses weight of his/her body when pushing or pulling Bends at knees and hips Turns with feet, does not twist at waist

Mod XII-G-page 4

Module XII Personal Care Unit B Personal Care Skills G) Musculoskeletal System [BASIC CORE] LESSON: 1. Transfers, Positioning and Turning b. Turning and positioning in bed and chair TIME:

Didactic; Lab:

15 minutes 20 minutes

OBJECTIVES: The student will: 1. Identify reasons when specific body positions are indicated. 2. Discuss the following basic body positions: A. Fowlers position B. Supine position C. Prone position D. Lateral position 3. Identify anatomically correct and comfortable chair positioning. MEASURABLE PERFORMANCE CRITERIA: The student will: 1 Name two reasons why one would be placed in a Fowlers position 2. Name reasons for the following positions: A. Supine position B. Prone position C. Lateral position 3. Demonstrate: • Procedure XII-4, Turning the Client in Bed • Procedure XII-22, Positioning the Client in Bed • Procedure XII-27, Positioning Client in Chair or Wheelchair SUGGESTED TEACHING METHODOLOGIES: Demonstration . SUGGESTED EVALUATION METHODOLOGIES:

Lecture

Return demonstration 84

Module XII Personal Care Unit B Personal Care Skills G) Musculoskeletal System LESSON: 1. Transfers, Positioning and Turning b. Turning and positioning in bed and chair Outline: 1 Specific body positions: a. Fowlers Position b. Supine Position c. Prone Position d. Lateral Position 2. Refer to Procedure XII-4, Turning the Client in Bed 3. Refer to Procedure XII-22, Positioning the Client in Bed 4. Refer to Procedure XII-27, Positioning Client in Chair or Wheelchair

Checklist for Procedure XII-4 TURNING THE CLIENT IN BED 1. Explains procedure to client. 2. Washes hands. 3. Puts on gloves, as necessary. 4. Moves client to appropriate side of bed. 5. Places arms of client correctly. 6. Places legs correctly. 7. Supports legs correctly. 8. Rolls client appropriately from opposite side of bed while ensuring the client's safety.

9. Adjusts pillow for head correctly. 10 Ensures client's comfort. 11. Washes hands. 12. Observes, records and reports any changes in condition or behavior. Mod XII-G-1-b page 1

Checklist for Procedure XII-22 POSITIONING THE CLIENT IN BED CLIENT ON BACK 1. Explains procedure to client. 2. Washes hands. 3. Assembles equipment. 4. Puts on gloves, as necessary. 5. Centers client safely in bed. 6. Turns client safely on back. 7. Aligns client's body. 8. Places pillows or folded towels appropriately: under head; under small of back; alongside hips. 9. Positions arms appropriately. 10. Supports and covers feet appropriately. 11. Makes client comfortable and safe. 12. Washes hands. 13. Observes records and reports any changes in condition or behavior.

CLIENT ON SIDE 1. Explains procedure to client. 2. Washes hands. 3. Assembles equipment. 4. Puts on gloves, as necessary. Mod XII-G-1-b page 2

5. Centers client safely in bed. 6. Turn client onto side. 7. Aligns client's body. 8. Places pillows or folded towels/blankets appropriately: under head and neck; at back; under top leg and foot; under top arm. 9. Positions hips and legs appropriately. 10. Covers client, making comfortable and safe. 11. Washes hands. 12. Records and reports appropriately. CLIENT ON ABDOMEN 1. Explains procedure to client. 2. Washes hands. 3. Assembles equipment. 4. Puts on gloves, as necessary. 5. Moves client to side of bed. 6. Turns client onto abdomen. 7. Aligns head and turns to side. 8. Place pillow under client's head. 9. Place arms appropriately. 10. Supports lower legs and feet 11. Covers client appropriately. 12. Washes hands. 13. Observes, records and reports any changes in condition or behavior. Mod XII-G-l-b page 3

Checklist for Procedure XII-27 POSITIONING CLIENT IN CHAIR OR WHEELCHAIR 1. Explains procedure to client. 2. Washes hands. 3. Assembles equipment 4. Puts on gloves, as necessary. 5. Places client's hips back in chair. 6. Places feet appropriately. 7. Checks for position of male genitals. 8. Places pillows appropriately. 9. Supports arms. 10. Makes client comfortable and safe. 11. Washes hands. 12. Observes, records and reports any changes in condition or behavior.

Mod XlI-G-1-b page 4

Module XII Unit B G)

Musculoskeletal System

LESSON:

TIME:

Personal Care Personal Care Skills

[BASIC CORE]

Transfers, Positioning and Turning b. Transfer with One Assist Didactic; Lab:

15 minutes 20 minutes

OBJECTIVES: The student will: 1 List the guidelines for the following transfers using one assist: A. Stand and pivot B. Bed to chair C. Chair to bed D. On/off toilet/commode 2. Safely perform the following one assist transfers: A. Stand and pivot B. Bed to chair C. Chair to bed D. On/off toilet/commode MEASURABLE PERFORMANCE CRITERIA: The student will; 1 Explain the safety, body mechanics and positioning guidelines for the following one assist transfers; A. Stand and pivot B. Bed to chair C. Chair to bed D. On/off toilet/commode 2. Demonstrate: • Procedure Xll-23, Transfer to the Sitting Position • Procedure XII-24, Helping the Client to Sit at the Side of the Bed • Procedure XII-25, Helping the Client to Stand • Procedure XII-26, Transfer to Wheelchair, Chair or Commode • Procedure XII-28, Transfer from Wheelchair to Toilet • Procedure XII-29, Transfer from Wheelchair to Shower and Assisting with Shower • Procedure Xll-30, Transfer from Wheelchair to Stool or Chair in Tub

SUGGESTED TEACHING METHODOLOGIES: SUGGESTED EVALUATION METHODOLOGIES:

Lecture, Demonstration Return demonstration, Class participation

Module XII Personal Care Unit B Personal Care Skills G) Musculoskeletal System LESSON: 1. Transfers, Positioning and Turning c. Transfer with one assist OUTLINE: 1. Safety and body mechanics guidelines; 2. Demonstrate safe transfers 3. Refer to; • Procedure XII-23, Transfer to the Sitting Position  Procedure Xll-24, Helping the Client to Sit at the Side of the Bed • Procedure Xll-25, Helping the Client to Stand • Procedure XII-26, Transfer to Wheelchair, Chair or Commode ; • Procedure XII-28, Transfer from Wheelchair to Toilet • Procedure XII-29, Transfer from Wheelchair to Shower and Assisting with Shower • Procedure Xli-30, Transfer from Wheelchair to Stool or Chair in Tub 88

Checklist for Procedure XII-23 TRANSFER TO THE SITTING POSITION IN BED 1. 2. 3. 45. 6. 7. 8. 9. 10. 11.

Explains procedure to client. Washes hands. Put on gloves, as necessary. Faces head of bed, outer foot forward. Raises head of bed or locks arms with client Has client bend knees. Pulls client to sitting position by rocking. Places pillows behind head. Checks client for dizziness, weakness, etc. Washes hands. Observes, records and reports any changes in condition or behavior.

Mod XII-G-1-c page 1 Checklist for Procedure XII-24 HELPING THE CLIENT TO SIT AT THE SIDE OF THE BED 1. Explains procedure to client. 2. Washes hands 3. Puts on gloves, as necessary. 4. Rolls the client on side facing self. Bends client's knees. 5. Reaches one arm over to hold him/her in back of knees. 6. Places other arm under the neck and shoulder area. 7. Positions feet with a wide base of support. 8. On the count of "three" shifts weight to back leg. While doing this, swings the client's legs over the edge of the bed while pulling his/her shoulders to a sitting position. 9. Remains in front of the client with both hands on him/her until is sure the client is able to safely sit alone. 10. Washes hands. 11. Observes, records and reports any changes in condition or behavior.

Mod XII-G-1 c page 2

Checklist for Procedure XII-25 HELPING A CLIENT TO STAND 1. Explains procedure to client (client is sitting at edge of bed). 2. If necessary, puts bed in lowest position3. Washes hands. 4. Puts on gloves, as necessary. 5. Places one foot forward between client's feet. If the client has a weak knee, braces knee against his/hers. 6Tells client to put strongest foot under him/her self. 7 Bends knee and leans onto forward foot. Places both arms around the client's waist. Holds client closely. 8. Tells client to push down on bed with arms and lean forward. On the count of "one â&#x20AC;&#x201D; two â&#x20AC;&#x201D; three" assists client to stand. Assists client by rocking weight to back foot and lifting as reaches three. Supports client until is sure he/she is able to safely stand alone. 9. Washes hands. 10. Observes, records and reports any changes in condition or behavior.

Mod XII-G-1c page 3

Checklist for Procedure X1I-26 TRANSFER TO WHEELCHAIR, CHAIR, OR COMMODE 1. Explains procedure to client 2. Washes hands. 3. Puts on gloves, as necessary. 4. Angles wheelchair next to bed. 5. Locks brakes. 6. Places safety belt on client, if needed. 7. Dangles client's legs over side of bed. 8. Stands client up. 9. Rotates client until back is facing wheelchair. 10. Backs up client until client feels the chair with the back of legs. 11. Maintains good body mechanics. 12. Lowers client into wheelchair. 13. Adjusts footrests 14. Releases brakes. 15. Covers client as needed. 16. Washes hands. 17. Observes, records and reports any changes in condition or behavior.

Mod XII-G-lc page 4

Checklist for Procedure Xll-28 TRANSFER FROM WHEELCHAIR TO TOILET Explains procedures to client 2. Washes hands. 3. Puts on gloves, as necessary. 4. Checks bathroom for supports and grab bars. 5. Places wheelchair, facing toilet. 6. Locks wheels. 7. Raises footrests. 8. Assists client to stand. 9Rotates client until back is toward toilet, 10. Arranges clothing. 11. Assists client to sit on toilet 12. Allows privacy. 13. Assists in cleaning client after toileting. 14. Washes hands. 15. Reverses steps six to nine. 16. Assists client to wash hands. 17. Washes hands. 18. Observes, records and reports any changes in condition or behavior.

Mod XII-G-1c page 5

Checklist for Procedure Xll-29 TRANSFER FROM WHEELCHAIR TO SHOWER AND ASSISTING WITH SHOWER 1. Explains procedure to client 2. Washes hands. 3. Assembles equipment 4. Puts on gloves, as necessary. 5. Positions wheelchair at appropriate angle to shower. 6. Places towel on shower chair/stool. 7. Locks wheels. 8. Raises footrests. 9. Stands client up appropriately. 10. Pivots client so back is toward shower chair. 11. Assists client to sit in shower chair. 12. Places toilet articles within client's reach. 13. Allows client privacy. 14. Ensures that soap is rinsed off client. 15. Assists in drying client. 16. Gets clean clothing ready. 17. Reverses steps seven to nine. 18. Covers client to avoid chilling. 19. Washes hands. 20. Observes, records and reports any changes in condition or behavior.

Mod Xll-G-1c page 6

Checklist for Procedure Xll-30 TRANSFER FROM WHEELCHAIR TO STOOL OR CHAIR IN TUB 1. Explains procedure to client 2. Washes hands. 3. Assembles equipment 4. Puts on gloves, as necessary. 5. Places not-slip mat in tub. 6. Places covered chair/stool in tub. 7. Fills tub with water. 8. Positions chair parallel to tub. 9. Provides for privacy. 10. Assists in removing clothing. 11. Assists client in sliding to edge of tub. 12. Pushes wheelchair out of the way. 13. Assists client onto chair in tub. 14. Assists with bathing and drying upper body. 15. Reverses steps ten to twelve. 16. Dries lower body. 17. Assists with dressing and grooming. 18. Makes client comfortable and safe. 19. Cleans area. 20. Washes hands. 21. Observes, records and reports any changes in condition or behavior.

Mod XII-G-1C page 7

Module XII Unit B

Personal Care Personal Care Skills G) Musculoskeietal System LESSON: 2. Ambulation a. one assist b. assistive devices (canes, walkers, etc.) c. safety principles

[BASIC CORE]

TIME: Didactic: 20 minutes Lab: 10 minutes OBJECTIVES: The student will: 1. Identify the importance of maximizing the highest level of independent ambulation for the resident/client/patient for the following: increase self-esteem well-being, prevent complications of immobility, gain strength and build endurance. 2. Discuss the components of safe ambulation and the levels of assistance. 3. Identify the various assistive devices and their purposes. 4. Discuss safety guidelines for ambulation. MEASURABLE PERFORMANCE CRITERIA: The student will: 1. Describe how ambulation increases self-esteem and well-being, prevents complications of immobility, and improves ones strength and endurance. 2. Describe the components of safe ambulation and the differences between minimal and maximum assistance. 3. Identify 3 devices and their purposes. 4. State the safety guidelines for ambulation. 5. Demonstrate ProcedureXII-14, Helping the Client to Walk SUGGESTED TEACHING METHODOLOGIES: SUGGESTED EVALUATION METHODOLOGIES:

lecture Demonstration Return demonstration Class participation 90

Module XII

Personal Care

Unit B Personal Care Skills G) Musculoskeletal System

LESSON: 2. Ambulation a. one assist b. assistive devices (canes, walkers, etc.) c. safety principles Outline: Importance of ambulation: a. Increases self-esteem b. Promotes circulation c. Strengthens joints and muscles d. Prevents atrophy and contractors 2. Components of safe ambulation and differences between minima! and maximum assistance: a. Maximum Assist b. Minimal Assist 3. Devices and their purposes: a. Cane b. Walker c. Crutches 4. Safety guidelines for ambulation a. Refer to Procedure Xll-14, Helping the Client to Walk

Ambulation Ambulation is something we all tend to take for granted. If we want to get something or go somewhere, we just get up and do it. Imagine how different it must be to be unable to do that There are many patients that you will come in contact with that are impaired in, their ability to ambulate. It is your responsibility to help them become as mobile as possible by helping them to attain the highest level of independent ambulation as they are able. This is important for the following reasons: 1. Increase self esteem and well being. By being able to get up and about the patient will feel more independent and his life will feel more "normal". 2. Prevents complications from immobility. The movement involved in ambulation will help prevent atrophy and contractures (a permanent shortening of the muscles and ligaments) which we will talk about in a little while. 3. Gains strength and builds endurance. If you've ever been sick and in bed for just a day or two you will recall how weak you felt when you got up to go to the bathroom. The short walk there and the effort involved were exhausting. Clearly, some patients are unable to ambulate on their own and need assistance. They may need minimal assistance (perhaps just help to get into a standing position) or they may need maximal assistance (using both devices and you). As you can imagine, there is a wide range in between. There are numerous devices to assist the patient toward his maximum independence. Mod XII-G-2 page 1

Mobility Equipment Often clients will use some kind of mechanical device or piece of equipment which helps them move around more easily and increases their independence. These include: Trapeze - a mechanical device, frequently in the shape of a triangle, which is attached to a bar on the bed and hangs suspended over a client's head. The client can use his or her arms to grasp the trapeze bar, lift the body off the bed, turn from side-to-side, and move up in bed. Canes- canes are used mainly for balance, come in many sizes and shapes an may be made of wood, or metal. Some canes, have a single tip; others, which offer more support, have a wide base and four tips (quad cane). The end of a cane should always be covered with a rubber tip to prevent slipping. You should check the tips for wear periodically. A cane should be measured to fit the person using it This should be done by a professional who knows how to do it. The cane should be carried in the hand on the stronger side of the body. The client should receive instructions on how to walk with a cane from a qualified health professional (physical therapist, nurse, doctor). The client is instructed to: Hold the cane in the stronger hand Hold the cane six inches to the side of the foot Move the cane and weak leg forward Move the stronger leg forward When not in use, a cane should be stored out of the way so it does not trip other people in the house. Crutches- crutches also come: in a variety of styles. They are used by clients who need more support than a cane can offer. Crutches require strong arms and may not be suitable for weak clients. The client also has to be measured for crutches to get the right fit, and taught how to use them by a professional, usually a physical therapist Crutches should be stored out of the way when not in use. Walker - a walker offers more stability than canes or crutches. The tips of the walker should be rubber, and you should check periodically for wear. Check for missing parts and breakage also. Some walkers may have wheels and even a seat Mod Xll-G-2 page 2

MOBILITY EQUIPMENT (CONTINUED) The client will be instructed in the proper use of the walker by a health professional. He or she is taught to: Stand inside the three sides of the walker Grasp the upper bar of the walker on each side lift the walker and move it forward slightly Step into the walker Brace- this is a device that is applied to a specific body part such as the neck, back, knee, ankle, leg, elbow or arm. Braces are used to increase strength in a weakened part of the body, to keep the body part in a position, which will allow it to be used more easily, or to limit movement in a part of the body. Clients who wear braces usually wear a light, smooth fitting layer of clothing under the brace. This prevents the skin underneath free becoming irritated. Clothing that is worn over the brace must be larger than normal for that client The skin under the brace should be kept clean and dry. You should check skin for redness, blisters and signs of irritation. Note places where the brace and the skin come in contact or places where the brace applies pressure. You should also check the brace for breakage and to make sure no parts are missing. Report any problems with the brace or with the client's skin to your supervisor. Splint- this is a lightweight device, usually molded plastic that holds a part of the body, such as the arm, elbow or hand in proper position. The splint may allow the part to be used more easily, keep it from developing contractures, or limit movement of the body part You have to observe the skin under the splint for redness or soreness. It should be removed once a day to wash and exercise the part of the body. Sling-this is a doth device used to support a part of the body, usually the arm or hand. It limits movement of the body part, or allows it to be used more easily. There are several types of slings. The most common sling is a triangular piece of cloth used to support the arm. It is fed around the neck, at the side of the head. Another type of sling supports the weight of the arm on a metal bar over the bed or wheelchair arm. The sling should be removed a least once a day to observe the skin for redness or soreness and to bathe that part of the body.

Mod XIl-G-2 page 3

MOBILITY EQUIPMENT (CONTINUED! Wheelchair- wheelchairs help clients who can no longer walk to move around. Thus, they are able to maintain some degree of independence. Wheelchairs may run with a battery-operated motor. They may also move by pushing the chair or by having the client turn the large side wheels. You may change or charge the battery in an electric wheelchair. But you cannot repair broken equipment Wheel chairs should have brakes that work. The mechanism for operating the brake is usually located near the arm rests so that the client can get to it easily. Brakes should always be locked before the client gets into or out of the chair. Footrests should be swung out of the way at these times also. You will need to check the wheelchair to make sure it works properly. Clean the wheelchair when necessary by using mild soap and water. Transfer/Sliding Board - this is a sturdy, smooth piece of wood, plastic or other suitable materials which allows the sitting client to move more easily from one place to another. The board is used as a bridge between the place the client is coming from and where the client wants to move, It can be used between bed and chair, between two chairs or between chair and bathtub. The board should be strong enough to hold the client, ft should be smooth and free from splinters and the edges and comers should be rounded. When using the transfer board you must be sure that enough of the board is supported at each end so that it does not slide onto the floor when the client uses it The client pushes down on the board with his/her hand to lift and shift the buttocks. Gradually the client slides across the board to the other surface. Safety Belt - A strong belt made of fused webbing is placed around the client's waist and helps support the client during walking. The home care worker firmly grasps the belt with one hand in the middle of the clients back and walks behind and slightly to the side of the client. You can also firmly grasp the client's waist band on a pair of trousers or slacks.

Mod XIl-G-2 page 4

Checklist for Procedure XII-14 HELPING THE CLIENT TO WALK 1. Explains procedure to client. 2. Reassures client 3. instructs client regarding shoes to wear. 4. Assists client in practicing standing and shifting weight 5. Walks slowly, taking small steps. 6. Walks with client on client's weak side using correct positioning. 7. Walks for short distances. 8. Observes, records and reports any changes in condition or behavior.

Mod XII-G-2 page 5

Module XII Unit B

Personal Care Personal Care Skills G) Musculoskeletal System [BASIC CORE] LESSON: 3. Range of motion TIME: Didactic: 20 minutes Lab: 10 minutes OBJECTIVES: The student will: 1. Identify the functions of the muscles and identify the effects of disuse 2. Discuss contractures 3. Describe Active Range of Motion exercises 4. Describe Passive Range of Motion exercises 5. Describe Resistive Range of Motion exercises MEASURABLE PERFORMANCE CRITERIA: The student will: 1. Define disuse syndrome and related terms of paralysis, contracture, and atrophy. 2. Show examples of contractures. 3. Define active Range of Motion. 4. Define passive Range of Motion 5. Define Resistive Range of Motion SUGGESTED TEACHING Lecture-possibly by PT METHODOLOGIES: Demonstration Video Role Play SUGGESTED EVALUATION METHODOLOGIES: Quiz, class participation 92

Module XII Unit B LESSON:

TIME:

Personal Care Personal Care Skills H) Bathing 1.

Didactic: Lab:

[BASIC CORE]

Processes a.

partial/sponge bath

b. c. d.

AM and PM Care Shower Tub 30 minutes

60 minutes

OBJECTIVES: The Student will: 1. Learn how to provide privacy. 2. Learn why to properly regulate water temperature. 3. Learn differences between a partial bed bath, AM/PM care, shower and tub bath (purposes, equipment). 4. List the observations about skin conditions that must be reported to a supervisor. MEASURABLE PERFORMANCE CRITERIA: The Student will: 1 State the importance of privacy when bathing. 2. State the importance of water temperature before one enters water. 3. State 3 differences between each process. 4. Describe skin conditions to report (redness, sores, bruising or swelling). 5. Demonstrate: • Procedure XII-3, Tub or Shower Bath • Procedure XII-5, Bed Bath • Procedure XII-7, Back Rub • Procedure Xll-10, Mouth Hygiene and Care SUGGESTED TEACHING METHODOLOGIES: Lecture, pictures, demonstrations SUGGESTED EVALUATION METHODOLOGIES:

Written/Oral Unit Quiz, class participation 94

Module XII Personal Care Unit B Personal Care Skills H) Bathing LESSON: 1. Processes a. partial/sponge bath b. AM and PM Care c. Shower d. Tub OUTLINE: I. Respect Clients' Rights II. Purpose of Bathing III. Define complete bed bath, partial sponge bath, shower/tub bath, and PM care IV. Factors Affecting Frequency of Bathing V. Safety Precautions A. Properly regulate water temperature and assess for environmental/equipment safety B. Observe for physical and emotional changes while bathing and report to supervisor 1. List skin changes 2. Dizziness/Weakness 3. Mental statues changes 4. Refusal of service VI. Bathing Procedures • Refer to Procedure XII-3, Tub or Shower Bath • Refer to Procedure XII-5, Bed Bath • Refer to Procedure XII-7, Back Rub • Refer to Procedure XIl-10, Mouth Hygiene and Care VII Observe, Record and Report

PERSONAL CARE BATHING Proper skin care is achieved through many of the personal care procedures you will fearn. As you read through and learn about the various personal care skills, be alert for activities promote skin care. Pay special attention to the procedures concerned with: - bathing - turning - hair care - back rub - grooming (nails and shaving) - bedmaking - toileting - positioning Bathing How do you feel after taking a bath? Do you feel refreshed - not just clean, but also in a more relaxed frame of mind? A bath serves many purposes: -it helps eliminate waste and dirt from the skin it stimulates circulation it provides movement and exercise -it provides relaxation and eases tension -it provides an opportunity to observe the body and skin How often should baths be given? That depends upon the physical condition, age, and skin type of the client. Older people have less skin oil and perspiration. Therefore, they may not -need.a daily bath or may only need a sponge bath. When you bathe an elderly person, use less soap, because soap increases skin dryness. Also elderly people may have fragile skin that requires a gentle touch when bathing. Because it almost always makes a son feel and look better, a bath is part of the care plan of many clients. Knowing how, to assist clients with the kind of bath specified in the care plan is an important responsibility of the home care worker. . The care plan will state whether bathing is required or not. If persona! care includes bath assistance, the care plan will tell you whether a shower, tub, or bed bath should be provided. It may also include any special bath instructions that apply to the individual client. The type of bath a person takes and the amount of help needed depends upon his or her physical condition and strength. Remember these guidelines: - Prevent the client from becoming chilled. - Encourage the client to do as much as possible for him or herself. - Allow plenty of time. - Provide privacy. Mod Xll-H page 1

Checklist for Procedure XII-3 TUB OR SHOWER BATH 1. Explains procedure to client. 2. Washes hands. 3. Assembles equipment. 4. Ensures warmth in bathroom. 5. Removes loose rugs from floor, if necessary. 6. Checks for safety devices, (ex. grab bars) 7. Places rubber mats and chairs appropriately. 8. Tests water temperature. 9. Washes hands, as necessary. 10. Puts on gloves, as necessary. 11. Assists client into tub or shower appropriately. 12. Assists client to wash, if necessary. 13. Shampoos hair, if necessary. 14. Assists with drying, if necessary. 15. Assists client out of tub or shower. 16. Assist with dressing as needed. 17. Drains and cleans tub/shower area. 18. Removes gloves. 19. Washes hands. 20. Observes, records and reports any changes in condition or behavior. Never leave an elderly person or young child alone while in tub or shower. DO NOT USE BATH OILS. They can make the tub slippery. Mod Xll-H page 2

Checklist for Procedure XII-5 BED BATH 1. Explains procedure to client 2. Washes hands. 3. Assembles equipment. 4. Provides for privacy and warmth. 5. Puts on gloves, as necessary. 6. Prepares bedding for bath, protecting bed with towels, as necessary. 7. Tests temperature of water. 8. Forms mitt with washcloth. 9. Washes and dries from head to toe; cleanest to least clean. 10. Washes and dries one part at a time. 11. Keeps exposure to a minimum. 12. Soaks and dries hands and feet appropriately. 13. Allows client to participate as much as possible. 14. Changes water when needed. 15. Washes genitals and buttocks last. 16. Applies lotion, if ordered. 17. Assists with dressing. 18. Allows client to rest. 19. Cleans area and equipment. 20. Removes gloves. 21. Washes hands. 22. Observes, records and reports any changes in condition or behavior.

Mod XII-H page 3

Checklist for Procedure XII-7 BACK RUB Explains procedure to client. Washes hands. Assembles equipment. Removes client's clothing. Positions client on stomach or side. 6. Positions self appropriately. 7. Warms lubricant before applying. ., 8. Lubricates hands. 9. Rubs back with appropriate pressure. 10. Rubs back rhythmically. 11. Rubs back in correct direction. 12. Observes and massages bony or reddened areas. 13. Times procedure according to client's wishes. 14. Removes excess lotion. 15. Assists client with dressing. 16. Returns equipment. 17. Washes hands. 18. Observes, records and reports any changes in condition or behavior.

Mod XII-H page 4

Module XII Personal Care Unit B Personal Care Skills 1) Grooming [BASIC CORE] LESSON: 1. Hair Care a. Shampooing b. Brushing and Combing TIME:

Didactic: Lab:

10 minutes 10 minutes

OBJECTIVE: The Student will: 1. Seek information and guidance about resident/client/patient hairstyle and care preferences and routines. 2. Assist the resident/client/patient who cannot care for own hair. 3. Follow proper infection control principles when choosing the appropriate hair care tool. 4. Discuss how, why and when it is appropriate to shampoo hair. 5. Identify changes in condition of scalp and hair. MEASURABLE PERFORMANCE CRITERIA: The Student will: 1. Provide hair care that incorporates resident/client/patient preferences and routines and has a neat appearance. 2. Use resident/client/patient own brush or comb to provide hair care. 3. Shampoo the hair. 4. Report sores, crusts, dandruff or hair loss to supervisor. 5. Demonstrate Procedure XII-6, Shampoo in Bed. SUGGESTED TEACHING METHODOLOGIES:

SUGGESTED EVALUATION METHODOLOGIES:

Display equipment Lecture, Demonstration

Written/Oral Unit Quiz, return demonstration

Module XII Unit B

LESSON:

Personal Care Personal Care Skills I)

Grooming

Hair Care a. Shampooing b. Brushing and Combing

OUTLINE: 1. Assist the client with shampooing a. Importance of good hair care b. Seek information and guidance about client's hairstyle and care preferences. Promote self-care through appropriate level of assistance. c. Observe, record and report redness, irritation, sores, crusts, dandruff, etc to the supervisor. d. Safety factors (i.e. use of hair dryer/ curling iron, sharp bristles on brushes, use of sprays and hair care products) e. Refer to Procedure Xll-6, Shampoo in Bed 2. Assisting the client brushing and combing hair a. Provide hair care according to client's preference b. Promote self-care c. Care of matted or knotted hair

Checklist for Procedure XII-6 SHAMPOO IN BED 1. Explains procedure to client. 2. Washes hands. 3. Assembles equipment Asks client which products to use to prevent allergies or reactions. 4. Makes trough, a hollowed-out depression that allows the water to flow and helps keep the bed dry. 5. Checks room temperature. 6. Places towel appropriately. 7. Places trough appropriately. 8. Puts on gloves 9. Wets hair and works up a good lather, working from front to back. Protect eyes and ears. 10. Rinses thoroughly. 11. Dries hair. 12. Cleans area and equipment. 13. Removes gloves. 14. Washes hands. 15. Observes, records and reports any changes in condition or behavior.

Mod XII-I page 1

Module XII Unit B

Personal Care Personal Care Skills 1) Grooming [BASIC CORE] LESSON: 2) Mouth Care a. Conscious Resident/Client/Patient (1) partial assistance (2) total assistance TIME: Didactic: 30 minutes for 2 a-c Lab: 30 minutes for 2 a-c OBJECTIVES: The Student will: 1. Identify the reasons for providing mouth care. 2. Identify the equipment needed to provide mouth care. 3. Provide mouth care for one who requires partial assistance. 4. Provide mouth care for one who requires total assistance. 5. Identify the frequency mouth care is to be administered for one with no oral complications. 6. State conditions, which would require increasing frequency of mouth care. 7. Identify conditions that when observed must be reported to the supervisor. MEASURABLE PERFORMANCE CRITERIA: The Student will: 1 State 2 reasons for providing mouth care/denture care. 2. Gather towel, toothbrush, toothpaste, cup, emesis basin and mouthwash. 3. Assist one who requires partial assistance. 4. Assist one who requires total assistance. 5. State number of times mouth care is to be provided. 6. Name 3 conditions, which would require mouth care be provided every two hours. 7. Inspect mouth and report to supervisor any signs of sores, caries, and irritations, bleeding gums, broken or loose teeth. 98

SUGGESTED TEACHING METHODOLOGIES:

SUGGESTED EVALUATION METHODOLOGIES: Checklist

Display equipment Lecture

Written/Oral Unit Quiz at end of Unit Skills Performance

Demonstrate: Procedure Xll-10, Mouth Hygiene and Care

Module XII Unit B

LESSON:

Personal Care Personal Care Skills 1)

Grooming

2.)

Mouth Care a.

Conscious Resident/Client/Patient (1) partial assistance (2) total assistance

OUTLINE: 1. Importance of good oral hygiene. 2. Mouth care for the person requiring a. Partial assistance b. Total assistance 3. Identify the frequency that mouthcare should be administered for the patient with: a. No oral complications b. Complications 4. Observe and Report Conditions to Supervisor a. Cracked bleeding dry lips, sores/lesions, inner/outer mouth, tongue and gums. b. Swollen, bleeding reddened tongue or gums or white, brown or discolored patches inside mouth area. c. Loose teeth or grinding down of teeth's surfaces. d. Decreased or excess saliva or drooling. e. Difficulty swallowing f. Client c/o pain/discomfort of mouth, teeth, throat or ear area. 5.

Refer to: Procedure Xll-10, Mouth Hygiene and Care

100

Module XII Unit B LESSON:

TIME:

Personal Care Personal Care Skills I) Grooming 2. Mouth Care b. Dentures Didactic: Lab:

[BASIC CORE]

30 minutes for 2 a-c 30 minutes for 2 a-c

OBJECTIVES: The Student will: 1. Demonstrate proper technique used to remove dentures from one's mouth. 2. Demonstrate how to protect dentures while cleaning. 3. Demonstrate how to clean dentures. 4. Demonstrate how to insert dentures back into one's mouth. 5. Demonstrate how to care for dentures when not in use. MEASURABLE PERFORMANCE CRITERIA: The Student will: 1. Remove dentures using a gloved hand and a gently rocking and downward pulling motion for upper dentures and an upward pulling motion for bottom dentures. 2. Place dentures in a denture cup immediately after removal and lines sink with washcloth while brushing. 3. Clean dentures by brushing with toothbrush and toothpaste and then denture cleaner. 4. Insert top dentures first and bottom dentures last. 5. Place dentures in a denture cup and cover with water when not in use. 6. Demonstrate: Procedure Xll-10, Mouth Hygiene and Care

SUGGESTED TEACHING METHODOLOGIES: SUGGESTED EVALUATION METHODOLOGIES:

Display equipment Lecture Demonstrate Written/Oral Unit Quiz at end of Unit Skills Performance Checklist 101

Personal Care

Module XII Unit B

Personal Care Skills I)

LESSON:

Grooming 2.

Mouth Care b. Dentures

OUTLINE: 1. Mouth care for the patient with dentures b. Mouth care following the removal of dentures c. Care of dentures or dental appliances d. Removing and reinserting dentures for those patients whom are not independent with the tasks. 2.

Refer to Procedure XII-10, Mouth Hygiene and Care

102

Module XII

Personal Care

Unit B

Personal Care Skills

LESSON:

Grooming

Mouth Care c.

TIME:

[BASIC CORE]

Edentulous

Didactic:

30 minutes for 2 a-c

Lab:

30 minutes for 2 a-c

OBJECTIVE:

The Student will: Demonstrate how to clean a mouth of one who has no teeth or has dentures removed. MEASURABLE PERFORMANCE CRITERIA: The Student will: 1. Clean and massage mouth and gums with lemon glycerin swab or . moistened toothed 2. Demonstrate: Procedure XII-10, Mouth Hygiene and Care

SUGGESTED TEACHING METHODOLOGIES:

SUGGESTED EVALUATION METHODOLOGIES:

Display equipment Lecture Demonstrate

Written/Oral Unit Quiz at end of Unit Skills Performance Checklist

103

Module XII

Personal Care

Unit B

Personal Care Skills

Grooming LESSON:

Mouth Care c. Edentulous

OUTLINE:

Refer to Procedure XII-10, Mouth Hygiene and Care 104

MOUTH CARE Oral care, or care of the mouth, teeth, and gums, is performed at least twice each day to cleanse the mouth of food particles and secretions. Oral care should be done after breakfast and after the last meal or snack of the day. Oral care includes brushing teeth and gums, flossing teeth, and caring for dentures. Dental floss is a special kind of string used to clean between teeth. Mod XII â&#x20AC;&#x201C;l-2 page 1

Checklist for Procedure XII-10 MOUTH HYGIENE AND CARE CLIENTS WHO CAN BRUSH OWN TEETH 1. Explains procedure to client 2. Washes hands. 3. Assembles equipment. 4. Puts on gloves, as necessary. 5. Provides rinse water. 6. Gives client tissue/towel for wiping. 7. Observes client to ensure proper tooth care. 8. Observes, records and reports any changes in condition or behavior CLIENTS UNABLE TO BRUSH OWN TEETH 1. Explains procedure to client. 2. Washes hands. 3. Assembles equipment. 4. Puts on gloves, as necessary. 5. Places client upright or on side. 6. Places towel under head. 7. Places basin at side of head. 8. Brushes teeth gently with up and down circular strokes. 9. Helps client rinse mouth. 10. Ensures mouth and neck are dry. 11. Helps make client comfortable. 12. Cleans and stores supplies. 13. Washes hands. 14. Observes, records and reports any changes in condition or behavior. Mod XII-l-2 page 2

DENTURE CARE 1 Explains procedure to client. 2. Washes hands. 3. Assembles equipment. 4. Puts on gloves, as necessary. 5. Receives dentures from client in tissue or breaks suction and removes dentures with a tissue. 6. Places dentures in a water-filled container, 7. Carries dentures to sink. 8. Cushions sink with washcloth and adds water. 9. Cleans dentures appropriately. 10. Assists client in rinsing mouth. 11. Applies denture cream or adhesive as needed. 12. Inserts dentures in client's mouth or stores dentures in water without adhesive. 13. Wipes client's mouth. 14. Washes hands. 15. Observes, records and reports any changes in condition or behavior..

Mod XII-l-2 page 3

Module XII Unit B

Personal Care Personal Care Skills 1)

Grooming

LESSON:

Shaving

TIME:

Didactic:

20 minutes

Lab:

20 minutes

[BASIC CORE]

OBJECTIVES: The Student will: 1. Identify the equipment needed to shave a resident/client/patient. 2. Demonstrate how to shave using a safety razor. 3. Demonstrate how to shave using an electric razor. 4. List skin conditions that must be reported when observed. MEASURABLE PERFORMANCE CRITERIA: The Student will: 1. Gather basin, warm water, mirror, wash cloth, towel, shaving cream and safety razor or electric razor. 2. Shave one in the clinical setting using a safety razor. 3. Shave one in the clinical setting using an electric razor. 4. Report any skin irritation, redness or scaling to the supervisor. 5. Demonstrate: Procedure Xll-9, Shaving the Client

SUGGESTED TEACHING METHODOLOGIES:

SUGGESTED EVALUATION METHODOLOGIES:

Display equipment Lecture Demonstrate

Written/Oral Unit Quiz at end of Unit Skills Performance Checklist

105

Module XII

Personal Care

Unit B

Personal Care Skills

Grooming LESSON:

Shaving

OUTLINE: 1. Shaving the client with: A. Safety Razor B. Electric Razor Observe, record, and report any skin irritations, redness, or scaling to the supervisor. 3. A.

Refer to Procedure XII-9, Shaving the Client Add Standard Precautionsâ&#x20AC;&#x201D;wash hands, don gloves before shaving.

106

Checklist for Procedure XII-9 SHAVING THE CLIENT 1. Explains procedure to client. 2. Washes hands. 3. Assembles equipment 4. Puts on gloves, as necessary. 5. Places towel under client's chin. 6. Washes client's face; leaving it wet. 7. Rubs shaving cream into client's beard. 8. Pulls skin tightly in the area to be shaved. 9. Shaves, using gentle, short strokes in the same direction. 10. Rinses razor often. 11. Rinses face. 12. Pats face dry. 13. Applies after-shave lotion. 14. Washes hands. 15. Observe, record and report any skin irritations, redness, scaling, etc. to the supervisor. Electric Razor Procedure: 1. Explains procedure to client. 2. Washes hands. 3. Assembles equipment. 4. Puts on gloves, as necessary. 5. Washes face with soap and water and dries. 6. Shaves with electric razor. 7. Applies after-shave lotion if client desires. 8. Washes hands. 9. Observe, record and report any skin irritations, redness, scaling, etc. to the supervisor

Mod Xll-l-3 page 1

Module XII

Personal Care

Unit B

Personal Care Skills

[BASIC CORE]

Grooming LESSON: TIME:

4. Hand and Nail Care Didactic: 10 minutes Lab: 10 minutes

OBJECTIVES: The Student will: Identify the supplies needed to provide hand and nail care. Demonstrate the procedure for providing hand and nail care.

MEASURABLE PERFORMANCE CRITERIA: The Student will: 1. Gather the basin, soap, water, towel, orange stick and nail file. 2. Soak hands, clean under nails with orange stick, and apply lotion when providing hand and nail care. 3. Demonstrate: Procedure XII-8, Nail Care

SUGGESTED TEACHING METHODOLOGIES: Lecture Demonstrate

Display equipment

SUGGESTED EVALUATION METHODOLOGIES: Written/Oral Unit Quiz at end of Unit Skills Performance Checklist

107

Module XII Unit B Grooming LESSON:

Personal Care Personal Care Skills

Hand and Nail Care

OUTLINE: 1. Describe the appearance of healthy hands 2. Importance of good hand and nail care 3. Observe, record and report to supervisor pain, reddened areas, open areas, dry, scaly skin, and/or cracked nails. 4. Do not cut or trim fingernails. Fingernails may only be filed. Discuss Plan of Care with RN. 5. Refer to Procedure XII-8, Nail Care 6. Identify the symptoms of hand problems and report

108

Module XII Unit B

Personal Care Personal Care Skills [BASIC CORE] 1)

Grooming

LESSON:

Foot Care

TIME:

Didactic: Lab;

20 minutes

OBJECTIVES: The Student will: 1. Describe the appearance of healthy feet. 2. Identify the equipment needed for foot care. 3. Demonstrate foot care competently. 4. Identify the symptoms of foot problems.

MEASURABLE PERFORMANCE CRITERIA: The Student will: 1. Describe and identify healthy feet. 2. Gather basin, warm water, soap and towel. 3. Provide competent foot care on a resident. 4. Report any redness, sores or cracks in the skin of the feet to the supervisor. 5. Demonstrate: Procedure XII-8, Nail Care

SUGGESTED TEACHING METHODOLOGIES: Lecture Video on Foot Care Demonstrate

SUGGESTED EVALUATION METHODOLOGIES: Skills Performance Checklist

Display equipment

Written/Oral Unit Quiz at end of Unit

109

Module XII Unit B

Personal Care Personal Care Skills I)

LESSON:

Grooming Foot Care

OUTLINE: 1. Describe the appearance of healthy feet 2. Importance of good foot and nail care 3. Observe, record and report to supervisor pain, reddened areas, open areas, dry, scaly skin, and/or cracked nails. 4. Do not cut or trim toenails. Toenails may only be filed. Discuss Plan of Care with R N. 5. Refer to Procedure XII-8, Nail Care 6. Identify the symptoms of foot problems and report 7. Observe, report and record

110

NAIL CARE Nail care should only be provided by the home care aide if It has specifically been assigned. Follow your care plan. Do not cut or trim nails, fingernails may only be filed. *ln some clients, poor circulation can lead to infection if skin is accidentally cut while caring for nails. In a diabetic client, such an infection can lead to a severe wound or even amputation. Observe, record and report to supervisor pain, reddened areas, open areas, dry, scary skin and or cracked nails. Identify symptoms of hand problems and report immediately.

Mod XII - 4,5 page 1

Checklist for Procedure XII-8 NAIL CARE 1. Explains procedure to client. 2. Washes hands. 3. Assembles equipment 4. Puts on gloves, as necessary. FINGERNAILS 1. Soaks client's hands in tepid water. 2.. Dries carefully. 3. Pushes cuticles back. 4. Cleans under nails. 5. Files nails, if necessary. 6. Massages hands with lotion. 7. Observes for irritation. 8. Washes hands. 9. Observes, records and reports any changes in condition or behavior. TOE NAILS 1. Observes clients feet 2. Soaks feet first if only foot care is being given. (Check Care Plan) 3. Cleans under nails 4. Uses emery board to smooth nails. 5. Washes hands. 6. Observes, records and reports any changes in condition or behavior. Mod XII -l- 4,5 page 2

Module XII Unit B

Personal Care Personal Care Skills J) Dressing LESSON: 1. Assisting the client a. Dependent b. Needing assist TIME:

Didactic: Lab:

[BASIC CORE]

10 minutes 20 minutes

OBJECTIVES: The Student will: 1. Recognize the value of resident/client/patient choice in daily wear. 2. Demonstrate how to put on clothes when the resident/client/patient cannot. 3. Demonstrate how to remove clothes when the resident/client/patient cannot. 4. Demonstrate how to assist resident/client/patient with a weak/paralyzed side put on clothes. 5. Demonstrate how to assist resident/client/patient with weak/paralyzed side remove clothes. 6. Recognize that dressing (i.e., clothes and devices) can be adapted to promote maximum ADL function. MEASURABLE PERFORMANCE CRITERIA: The Student will: 1. Dress/assist resident/client/patient with complete set of clothes in proper sequence. 2. Undress/assist resident/client/patient in proper sequence. 3. Assist with shirt/pants on weak side first. 4. Remove shirt/pants from strong side first. 5. Utilize adapted clothing or devices when part of care plan. 6. Demonstrate: â&#x2013; Procedure XII-12, Assisting with Dressing â&#x2013; Procedure XII-13, Assisting with the use of Elastic Support Stockings

111

SUGGESTED TEACHING METHODOLOGIES: Display equipment Lecture Demonstrate in the clinical setting

SUGGESTED EVALUATION METHODOLOGIES: Written/Oral Unit Quiz at end of Unit Skills Performance Checklist

112

Module XII Unit B

Personal Care Personal Care Skills J) Dressing LESSON: 1. Assisting the Resident/Client/Patient a. Dependent b. Needing assist OUTLINE: 1. Assisting the patient with dressing: a. Choosing clothing and footwear. b. Promoting self-care through appropriate level of assistance. c. Dressing techniques for patients i. Needing some assistance; ii. Who have one-sided weakness; iii. Totally dependent. 2. a. b. c. d. 3.

Adaptive equipment: *(see next page for objectives) Glasses Hearing aid Prostheses Dressing aides Refer to Procedure XII-12, Assisting with Dressing. 113

DRESSING Follow patient care plan regarding dressing. Assist the patient with dressing: • Choose appropriate clothing and footwear (appropriate for the weather) Check to see clothing is dean and in good condition Promote self-care through appropriate level of assistance. Dressing techniques for patients • May need some assistance • May have one-sided weakness • Totally dependent

Mod XII -J-1-page1

Checklist for Procedure XII-12 ASSISTING WITH DRESSING 1. Explains procedure to client. 2. Washes hands. 3. Assembles clothes in the order they are to be put on. 4. Puts on gloves, as necessary. 5. Encourages and allows the client to do as much self-dressing as possible. 6. Assists when the client asks or shows signs of fatigue, frustration, or inability to perform the task. 7. Washes hands. 8. Observes, records and reports any changes in condition or behavior. FOR CLIENTS WHO ARE PARTIALLY PARALYZED, WEAK, OR FRAIL 1. Explains procedure to client. 2. Washes hands. 3. Assembles clothing in the order they are to be put on. 4. Puts on gloves, as necessary. 5. Moves client to center of bed. 6. Removes night clothing, if necessary. 7. Covers client with a sheet 8. Uncovers upper body first. 9. Assists with shirt. 10. Uncovers lower body. 11. Assists with underpants or shorts and remainder of clothes. 12. Assists with socks and shoes as needed. 13. Washes hands. 14. Observes, records and reports any changes in condition or behavior. Mod XII-J-1 page 2

Checklist for Procedure XII-13 ASSISTING WITH THE USE OF ELASTIC SUPPORT STOCKINGS 1. Explains procedure to client. 2. Washes hands. 3. Assembles equipment. 4. Puts on gloves, as necessary. 5. If client has been up and around have client lie down with legs elevated for 15 minutes before applying stockings. 6. Makes sure legs are clean and dry. The legs may be lightly powdered or, if the skin is dry, lotion may be used. 7. Puts on stockings as Care Plan directs: smoothly with no wrinkles. 8. Makes sure heel of foot is in heel of stocking. 9. If stockings have no toe opening, pulls on the tip of stocking to relieve pressure. 10. Removes at least once a day or as frequently as directed by the Care Plan. Bathe the skin underneath, dry, and reapply. 11. Observes for changes in skin color, skin temperature, swelling, or sores on legs. 12. Washes hands. 13. Records use, changes in skin color, skin temperature, swelling, or sores on legs, and client complaints. 14. Reports any changes in skin color, skin temperature, swelling, or sores on legs, and client complaints. Mod XII-J-1-page 3

Module XII Unit B

Personal Care Personal Care Skills J) Dressing [BASIC CORE] 2. Adaptive equipment *(see previous page for outline)

LESSON: a. Glasses b. Prostheses TIME: Didactic: 10 minutes Lab: 5 minutes OBJECTIVES: The Student will: 1. Define prosthesis/adaptive equipment. 2. Discuss the care giver responsibility in making sure glasses/prostheses are properly identified and in good working order. MEASURABLE PERFORMANCE CRITERIA: The Student will: 1 List 4 types of prostheses/adaptive equipment. 2. Demonstrate how to care for eyeglasses. 3. Monitor/check that belongings are properly identified and report any changes in equipment. SUGGESTED TEACHING METHODOLOGIES: Display equipment Lecture Demonstrate jn the clinical setting SUGGESTED EVALUATION METHODOLOGIES: Skills Performance Checklist

Written/oral unit quiz 114

Prosthesis Prosthesis is an artificial replacement for a missing part of the body. It is used to improve the client's appearance and/or ability to function. Examples of prosthesis include: Artificial Limbs (hands, arms, feet, legs)- these resemble the part they are replacing; they are usually made of plastic, metal and leather; they contain hinged parts held together with screws. Straps and buckles fasten the prosthesis to the body. The care plan may require you to assist the client in applying a prosthesis, You will need to follow the client's need to follow the client's directions when doing this. Special instructions for cleaning the prostheses will be given to you by your supervisor if it becomes part of the care plan. Prosthesis Important points about hearing aides include". - Don't expose the hearing aid to heat-for example, radiator, sun - Don't get the inside wet - Don't use aerosols, such as hair spray, on client wearing a hearing aid - Don't drop the hearing aid - Turn off when not in use and remove battery when storing The battery should be checked before the client puts on the hearing aid. Turn up the . volume control until you hear a whistle. Never do this while the hearing aid is in the client's ear. If you do not hear a whistle, replace the battery and check for whistle again. Eye Glasses - Since so many people wear glasses, it is hard to think of them as prosthesis, but that is what they are. Glasses should be kept clean, in good repair and should be stored in a safe place when not in use. Clean glasses with special solutions or liquid detergent mixed in warm water. Dry with a lint-free, nonabrasive cloth.

Mod XII-J-2-page 1

Module XII Unit B

Personal Care Personal Care Skills K) The Clients' Environment * [BASIC CORE] LESSON: 1. Components and Care of the Environment - drawers, closets, immediate environment *Outline for this Lesson is contained in Module X - Care of the Home and Personal Belongings. This lesson should be used in conjunction with Module X. TIME: Didactic: 20 minutes** Lab: 20 minutes** **This 40 minutes is counted as part of the 90 minutes (1.5 hours) in Module X. OBJECTIVES: The Student will: 1. Be able to identify the components of the clients' environment which include the room and equipment, and elements for communication and to provide comfort. 2. Identify how the clients' rights affect their functioning in their environment including right to privacy, expression of individuality, possession of personal belongings and furnishings and availability of locked storage. 3. Be able to identify the care giver role in admissions, transfers and discharges (other than death) of a clients. MEASURABLE PERFORMANCE CRITERIA: The Student will: 1. List 5 components of the environment. 2. State 3 ways to promote clients' rights related to their environment. 3. List 5 duties performed by a caregiver in admissions, transfers and discharges (other than death) of a residents/clients/patients. SUGGESTED TEACHING METHODOLOGIES: Lecture Videos for Rights, Performance Checklists SUGGESTED EVALUATION METHODOLOGIES: Quiz Return Demonstrations 115

Module Unit B

LESSON TIME:

XII

Personal Care Personal Care Skills

The Clients' Environment [BASIC CORE]

Unoccupied Bed

Didactic:

10 minutes

Lab:

20 minutes

OBJECTIVES: The Student will: 1. Identify the steps of making an unoccupied bed. MEASURABLE PERFORMANCE CRITERIA: The Student will: 1. Correctly demonstrate making an unoccupied bed. 2. Demonstrate: Procedure Xll-15, Making an Unoccupied Bed

SUGGESTED TEACHING METHODOLOGIES: Lecture Bed making Demonstration Performance Checklists SUGGESTED EVALUATION METHODOLOGIES: Quiz Return Demonstrations

116

Module XII Unit B

LESSON:

Personal Care Personal Care Skills K)

The Clients' Environment

Unoccupied Bed

OUTLINE: Unoccupied Bed 1. Assemble correct equipment to make bed 2. Correctly demonstrate making an unoccupied bed 3. Refer to Procedure XII-15, Making an Unoccupied Bed Occupied Bed: 1. Assemble correct equipment to make bed 2. Explain procedure to patient 3. Correctly demonstrate making the occupied bed a. positioning patient 4. Refer to Procedure XII-16, Making an Occupied Bed Maintain all infection control procedures

117

Module XII Unit B

Personal Care Personal Care Skills K)

LESSON:

The Clients Environment

Occupied Bed*

*Outline can be found on previous page with "Unoccupied Bed' TIME:

Didactic Lab:

10 minutes 10 minutes

OBJECTIVES: The Student will: 1. Identify the steps of making an occupied bed.

MEASURABLE PERFORMANCE CRITERIA: The Student will: 1. Correctly demonstrate making an occupied bed. 2. Demonstrate Procedure XII-16, Making an Occupied Bed SUGGESTED TEACHING METHODOLOGIES:

Lecture Bedmaking Demonstration Performance Checklists

SUGGESTED EVALUATION METHODOLOGIES: Quiz Return Demonstrations

118

Checklist for Procedure XII-15 MAKING AN UNOCCUPIED BED 1. 2. 3. 4. 5. 6. 7.

8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23.

Washes hands. Assembles equipment. Puts on gloves, as necessary. Removes and folds bedding to be re-used. Smoothes mattress pad. Places bottom sheet in correct position. Tucks in top-

Miters corner. Tucks in side. Positions top covers correctly. Tucks in at bottom. Miters corner. Goes to opposite side of bed. Repeats steps 4 to 10, pulling and smoothing sheets. Adds spread, and tucks in at bottom. Turns soiled pillowcase inside out. Opens clean pillowcase. Grasps clean pillowcase in center of bottom seams. Folds pillowcase over hand. Grasps end of pillow through pillowcase in the center. Pulls clean case over pillow with other hand. Removes soiled linen. Washes hands. Mod XII-K-2,3- page 1

Checklist for Procedure XII-16 MAKING AN OCCUPIED BED 1.

2. 3. 45. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23.

Explains procedure to client.

Washes hands. Assembles equipment. Puts on gloves, as necessary. Removes and neatly folds bedspread. Loosens bedding on one side. Loosens top sheet at foot. Slides top sheet under blanket, leaving blanket on client. Removes all pillows except one under client's head. Turns client onto side. Folds/rolls bottom sheet(s) up to and under client's head, back, and legs. Smoothes mattress. Positions clean bottom sheet. Folds clean bottom sheet next to and under soiled sheets. Tucks in bottom sheet at head. Miters corner at head. Tucks in bottom sheet along side. Positions draw sheet, folds under soiled bottom sheet, and tucks in along side. Turns client to clean side of bed. Goes to opposite side of bed. Loosens and removes bedding. Places soiled linen appropriately. Smoothes mattress pad.

Mod XII-K-2,3- page 2

24. 25. 26. 27. 28. 29. 30.

Pulls clean linen through and straightens. Tucks in at head, comer, and sides. Removes soiled pillowcases appropriately. Puts on clean pillowcases correctly. Removes soiled linen. Washes hands. Observes, records and reports any changes in condition or behavior.

ModXII-K-2,3-page3

THINK SHEET - Mod XII - Unit B 1. When using good body mechanics, is good posture necessary? 2.

When washing your hands, how many times do you wash them, before drying?

3. Is it O.K. to leave your wedding ring on, as long as you have removed all other jewelry? 4.

Where does a condom catheter go?

When transferring a patient from bed to a wheel chair, where do you place the wheel chair?

When is the best time to put elastic stockings on?

What are some things you would do to prevent a client with an indwelling catheter from

developing an infection?

Mod XII-K-2,3-page 4

THINK SHEET - Mod XII - Unit B

When we say something is clean, what do we mean - give some examples of a clean object?

If your client has weakness on the left side, where would you walk?

10. Is it important to weigh your client at the same time each day, using the same scale?

11. When checking water temperature, where on your body is the best place to check it?

12. Which way should you turn the bed bound patient?

13. If a client asks you to do something not on the care plan, who should you check with?

14. What is a good definition for a stable wound?

Mod XII-K-2,3-page 5

Module XII

Personal Care Skills

Unit C Personal Care of the Well Baby TIME: 120 minutes OBJECTIVES: The student will: 1. Describe when assistance with well-baby care may be required. 2. Describe how persona! care meets an infant's basic human needs. 3. Demonstrate how to handle an infant including how to safely position in crib and in transporting. 4. Demonstrate the basic principles in breastfeeding, bottle- feeding, burping and feeding solid foods to an infant. 5. Demonstrate how to bathe, shampoo and change an infant. 6. Discuss cultural, religious and/or social differences clients may have in care giving. 7. Observe, record and report

SUGGESTED TEACHING METHODOLOGIES:

EVALUATION METHODS: Demonstrate:

Lecture, group discussion

Written exam, class participation

ď&#x201A;ˇ

Procedure Xll-35, Handling the Infant

ď&#x201A;ˇ

Procedure Xll-36, Infant Bath 119

Module XI!

Personal Care Skills

Unit C Personal Care of the Well Baby OUTLINE: I. When Personal Care Assistance may be needed A. No other caretaker is available and mother is unavailable II.

III. A. B. C. D. E.

Understanding cultural, religious, and social diversity pertaining to childcare.

Meeting Infant's Basic Needs Though Personal Care Physical Safety and Security Belonging Needs Building of Self Esteem - Infant Responds to Caregiver Self-Fulfillment

IV. Safe Handling of an Infant A. Hand washing B. Support of head, neck and back â&#x2013; Refer to Procedure XII-35, Handling the Infant C. Conserving Infant's Body Heat D. Safe Positioning E. Safe Transportation V. Basic Principles in Feeding A. Breast/Bottle Feeding 1. Benefits 2. Basic Principles in Feeding 3. Techniques in Feeding 4. Feeding Schedules B. Solid Foods 1. General Guidelines VI. Guidelines in Bathing â&#x2013; Refer to PROCEDURE XII-36, Infant Bath VII. Follow care plan and observe, record and report any concerns related to child health and safety to RN supervisor. IMMEDIATELY

120

Checklist for Procedure XII-35 HANDLING THE INFANT PICKING UP AN INFANT 1. Washes hands. 2. Puts on gloves, as needed. 3. Puts one hand under buttocks. 4. Puts other hand under head, .neck, and shoulders. 5. Raises baby appropriately.. SHIFTING BABY TO "FOOTBALL" HOLD 1.

Supports baby's head, neck, and buttocks.

Swing baby to the side so that infant rests on hip while the hand and arm cradle the

infant, providing support. 3. Washes hands. Observes, records and reports any changes in condition or behavior.

Mod Xll-Unit C-page 1

Checklist for Procedure XII-36 INFANT BATH 1. Washes hands. 2. Assembles equipment. 3. Ensures proper temperature of room. 4. Prepares changing area. 5. Prepares bath water at correct temperature. 6. Puts on gloves, as needed. 7. Brings baby to bath area. 8. Undresses and covers baby. 9. Lowers baby into water. 10. Shampoos, rinses, and dries head. 11. Washes body, going from head to foot 12. Washes genitals correctly. 13. Dries baby. 14. Applies lotion as directed on Care Plan. 15. Diapers and dresses baby. 16. Gives nail care, if needed. 17. Washes hands. 18. Observes, records and reports any changes in condition or behavior.

Mod XII-Unit C-page 2

PERSONAL CARE Personal care for the well baby As home care worker, you may be assigned to care for an infant. Baby care may be required, where no other caretaker is available & the parent is: - Recovering from childbirth - ill or disabled - Hospitalized or otherwise absent from the home - Overwhelmed because of lack of experience with infant care Baby care is a special type of personal care. Infants are totally dependent upon others for all their basic needs. Infancy is a critical time in human development. When you care for infants, you should keep in mind that, despite their helplessness, they are extremely sensitive to their environment They can see, taste, and smell. They react sharply to noises. They are very sensitive to touch. Most babies love to be held and fondled. When you are assisting in the personal care of infants, talk to them. They respond well to such stimulation. In caring for infant, you should apply the general principles for all personal care services: safety, comfort, organization, economy, neatness, effectiveness, privacy, cleanliness and independence. However, independence does not refer to the infants themselves; it refers to those cases where home care is needed because the mother or other family members are unable to totally care for the baby. In these situations, your goal is to help the caretaker be as independent and assume as much responsibility as possible for the baby's care. You may have to guide the caretaker and teach basic skills of baby care. Teaching requires patience and understanding. Remember that the closeness that often develops between an infant and the home care worker can pose problems as well as provide pleasure. You must always remember that you are not the parent Be on guard for feelings of possessiveness toward the child. This could seriously interfere with your ability to help the parent or other caretaker assume responsibility for the child. Baby care skills Handling the baby For people who have had little experience with babies, picking up and holding an infant is the first concern in baby care. Feeding the baby Feeding provides nourishment for the baby. It is also a time for building closeness between mother and child. Baby experts believe that babies should be fed when they are hungry, not according to a rigid schedule. Newborns may be hungry every two hours. By one month of age, feeding time may decrease to every three hours; by three months, every four hours. Infants may be breast or bottle fed. Mod XII-Unit C-page 3

PERSONAL CARE Baby care skills Breast feeding Breast feeding provides the best nourishment for the baby. Aside from health advantages, breast feeding has a cost advantage over formula. Most nursing mothers need not worry about lack of milk, but they do have to eat property and drink more liquids then they usually consume. The body naturally produces enough milk for the growing infant. Frequent nursing stimulates milk production; bottle feeding, on the other hand, reduces the baby's sucking reflex, thereby decreasing the milk supply. For this reason, supplementary bottle feedings are not necessary and should be avoided. When the care plan includes infant feedings and the baby is being breast fed, the home care worker's task primarily concerns guidance and encouragement. New mothers are often anxious about breast feeding. The breast feeding routine is usually established in the hospital; however once home a young mother may feel unsure about what to do. A home care worker can provide support Remind the mother to: - Wash her hands and nipples before nursing, avoiding harsh soaps that can cause dryness and skin cracking around the nipples - Find a comfortable position for nursing - Tickle the baby's cheek-so that the infant can find the nipple With proper encouragement & support, most mothers can successfully nurse their babies Bottle feeding Bottle feeding requires several extra steps. Most newborns require special formulas. Regular whole milk does not supply all the nourishment an infant needs. Unless more expensive pre-mixed formula is used, baby formula will have to be prepared. Follow the instructions in the care plan. Baby bottles, rubber nipples, and nipple covers must be extremely clean before filling, in some cases, these items must be sterilized. Your care plan will specify if you are to sterilize. If refrigeration space is available, you may prepare a 24 hour supply of formula-filled bottles. When instructing new parents in bottle feeding, Remember to: - Wash hands before preparing formula and filling bottles - Refrigerate filled bottles - Warm the bottle before serving and test the temperature on the inner wrist. It should feel comfortably warm, not hot - Find a comfortable position for feeding - Cradle the baby for support - Hold the bottle at an angle so the baby sucks in the milk, not a lot of air baby always "drain the bottle" Avoid giving the baby a bottle in his or her bed. The natural sugar in the milk will remain in the baby's mouth and cause tooth decay. Mod XII-Unit C-page 4

PERSONAL CARE Burping the baby Both breast and bottle fed babies need burping. When babies suck during feedings, they take in air as well as milk. If this air is not expelled, it collects in the intestines. Painful cramps can occur. Burping expels air so babies remain comfortable- Burping is a simple but important task: Babies should be burped more than once during feeding. Hold the baby so that the baby's buttocks are supported by your forearm. The baby lies against your upper shoulder area of your chest With your free hand gently pat the back until you hear a burp. Remember to protect your shoulder with a diaper or towel. Solid food The nurse or doctor will advise when solid foods should be started. Usually this is not until about five months of age. Solid food feeding often starts with iron-enriched cereals. A baby spoon should be used, if possible. Put very tiny portions on the spoon. Do not mix several foods together; babies should learn to distinguish different tastes. Feed the baby slowly, Do not rush. Talk to the infant. Make feeding a happy time. Encourage babies to hold a spoon as soon as they are able. Let them try to feed themselves despite the mess. Of course, you must continue to feed them as well. Never give a baby small hard foods such as nuts or small chunks of carrots to chew on. This may cause choking. Bathing the baby Bath time should be a happy time. For someone who has little experience with babies, giving a bath may seem difficult For someone with physical limitations it may be very difficult. The first rule in bathing; never leave a baby or young child alone in the water, for even a minute. Newborns are to be sponge bathed until the navel heals,. Male infants who are circumcised, will also be sponge bathed until the penis heals. Your care plan, may include special instructions until the penis heals. As babies grow older, they love to splash & play during bath time. This is an excellent opportunity for the parent & baby to bond. Changing the baby Babies should be checked frequently for wet and soiled diapers. Wet diapers can cause rashes and uncomfortable skin irritations. Some mothers prefer disposable diapers even though they cost more than cloth. Cloth diapers are equally suitable and cost less, but must be washed. Cloth diapers require rubber pants for protection against soiling and wetness. Safety pins are also required. When using safety pins, use care to prevent hurting the infant Place a couple of fingers between the section of diaper being pinned and the baby's body so when you put the pin in it wont stick the baby. If you find it difficult to put the safety pin in the diaper, run the pin through a bar of soap. If soap is not easily accessible, run the pin through your hair. The oil in your hair will lubricate the pin. Always keep one hand on the infant when changing him or her on a table, bed, or other raised area. During changes, wipe the genital area with a warm, wet cloth. Remember to wipe baby girls from front to back. Use powder or lotions as specified in the care plan. If powder is recommended, apply sparingly and close to the baby's body. Avoid making clouds of baby powder that the baby will breathe in. If you observe a persistent rash, report it to your supervisor. Mod XII-Unit C-page 5

THINK SHEET - Mod XII - Unit C

l. Who is the only one who can change a baby's formula?

2. What is the most important thing to remember when bathing infants or children?

3. Should you refrigerate formula?

4. Picking up a baby too frequently, is not good for the baby?

Mod XII-Unit C-page 6

Module XII

Personal Care

Unit D Special Equipment used by Home Care Clients TIME: 60 minutes OBJECTIVES: After completing this Unit, the trainee will be able to: 1. Identify special equipment used by Home Care Clients 2. Explain how this special equipment is used 3. Identify the Home Care Worker's role in assisting the clients who use special equipment SUGGESTED TEACHING METHODOLOGIES: Lecture, group discussion EVALUATION METHODS:

Written exam, class participation

Demonstrate:

■ ■

Procedure XII-37, Assisting with the use of the Hydraulic Lift Procedure XII-38, Slide Board Transfer Procedure

121

Module XII Unit D: OUTLINE:

Personal Care Special Equipment used by Home Care Clients

I. Bed Equipment A. Hospital Beds B. Bed Hardware C. Special Mattresses D. Special Pillows E. Special pads II Mobility Equipment A. Canes B. Crutches C. Walker D. Brace/Splint/Slings E. Wheelchairs F. Trapeze G. Transfer/ sliding board â&#x20AC;˘ Refer to Procedure XII-38, Slide Board Transfer H. Safety Belt I. Electric Lift Chair J. Hydraulic Lift (Hoyer Lift) â&#x20AC;˘ Refer to Procedure XII-37, Assisting with the use of the Hydraulic Lift III A. B. C. D.

Toileting Equipment Bedpan Urinal Commode Catheters

IV A. B. C. D. E. F. G.

Prosthesis Definition Artificial limbs Artificial Breast Artificial Eye Hearing Aid Eye Glasses/ Contacts Dentures

V. ADL Equipment

122

A. B. VI

Assistive Eating Utensils Assistive Dressing Devices Environmental Support A. Humidifier/ Vaporizer

VII

Testing Equipment

A. Glucometer VIII

Home Care Worker's Role A. Check Plan of Care for special Instructions B.

Read operating instructions that come with special equipment.

Do not use if unfamiliar with the use of required equipment. Request instruction and demonstration from the supervisor/nurse or therapist if needed. (Demonstration of equipment as indicated for specific case assignment)

Encourage client to be as Independent as possible in use of equipment.

Change or charge batteries of electrical equipment

Maintain and store equipment as per operating instructions.

Dispose of disposable or non- reusable equipment.

H. Observe the state of repair of equipment e.g.. worn, missing or broken equipment I.

Observe for problems the client may have with equipment, e.g. skin irritation, malfunctioning equipment

Record and Report observations and problems to supervisor/ nurse

123

Checklist for Procedure XII-37 ASSISTING WITH THE USE OF THE HYDRAULIC LIFT 1- Explains procedure to client. 2-

Washes hands

3Assembles equipment 4. Puts on gloves, as needed. 5. Checks whether valves are working on lift 6. Clears the floor around the area you are working. 7. Opens legs of lift stand to widest position 8. Brings wheelchair or chair close to bed. Locks wheels of wheelchair and bed (if hospital bed). 9. If possible, raises or lowers height of bed to accommodate height of lift. 10. If available, raises side rails on far side of bed. 11. Rolls one edge of the sling up to one-half of width. 12. Places sling on bed on the far side of the client. Sling should be midway between head and thigh of client. 13. Rolls the client toward self and moves sling so it covers one-half of client's back. 14. Rolls client back onto the sling and over on other side (over the hump of the sling). 15. Keeping the client rolled away from self, unrolls the sling, making sure it is flat and unwrinkled. 16. Rolls client onto back and adjusts sling so that it is midway between client's head and thigh 17. Raises the lift (closes valve and pumps up the lift arm). 18. Steadies the swinging bar as it is positioned over the client. 19. Lowers arm and attaches the chains or hangers to the sling (longer chain to the thigh part of the sling and shorter chain to the head area), being sure the chain or hangers are away from the client's body. 20. Tells client when starting to pump up the lift. Mod XII -D -page 1

21. After lifting the client a few inches and before moving the lift away, checks all connections to make sure they are fastened tightly and working properly. 22. Pumps us the lift until the client is in a half-sitting position. 23. Lifts client's feet and removes from bed. 24. Moves to the handles or bar of the lift for steering. 25. Gently and slowly moves the base of the lift out from under the bed, and slowly turns it toward the wheelchair or chair. 26. Positions the lift so client is over the wheelchair or chair. 27. Lowers the client to the seat by slowly opening the valve until client is just above the seat. 28. Holds the sling near the head and puts knees against the client's knees. Supports the client's upper body against self. Uses knees to push gently on the client's knees. Then, releases the valve so that the client sits in the wheelchair or chair. 29. Removes the S-shaped hooks while holding onto the bar. 30. Closes the valve and pumps the lift up out of client's way. 31. Moves lift away. 32. Washes hands. 33. Observes, records and reports any changes in condition and behavior or problems with equipment

Mod XII -D-page 2

Checklist for Procedure XII-38 SLIDE BOARD TRANSFER PROCEDURE 1. Explains procedure to client. 2. Washes hands. 3. Assembles equipment. 4. Puts on gloves, as necessary. 5. Places wheelchair or chair at a 45 degree angle to the bed or alternate chair. 6. If wheelchair, locks brakes and removes armrest if able. 7. If client is without clothing, the board should be covered with a pillowcase. 8. Places slide board like a bridge between bed and wheelchair, chair to chair, etc. 9. Has client lean away from slide board. 10. Places slide board under buttocks, transferring towards the client's strong side possible. 11. Ensures that the slide board is securely placed before client begins transfer. 12. Directs client to place hands on the slide board at each side adjacent to thighs. 13. Directs client to take a series of small push-ups across the board until client reaches the other side of the board. 14. Assists client, as necessary, with each push-up. 15- Uses gait belt, as necessary. 16. Cleans and stores slide board when transfer is complete. 16. Washes hands. 17. Observes, records and reports any changes in condition or behavior.

Mod XII-D-page 3

PERSONAL CARE Special Mattresses Bed-fast clients frequently have special mattresses which help prevent problems which can develop due to prolonged bed rest. Eggcrate mattress - a mattress made out of spongy (foam rubber) material which looks like an egg carton; the mattress itself should not get soiled and should be protected with a plastic sleeve-like covering. When making the bed, apply the bottom sheet loosely over this type of mattress. Water mattress -a mattress which-looks-like a large plastic bag filled with water be careful not to puncture the mattress or to over - or under-fill it. This type of mattress may have a heater-like attachment which keeps the water warm. Air mattress - (alternating pressure)-- an electrically operated mattress which moves air through the mattress automatically. In marking with this type of mattress - Read the instructions which come with the mattress - Do not puncture the mattress - Apply bottom sheet loosely over this type of mattress - Check for :safety as with other electrical appliances Special Pillows Some clients may have water cushions, plastic cushions filled with water. Often they will be used to sit on in a wheelchair. The client should never sit directly on the plastic as this can irritate the skin. The water pillow should be covered with a cloth pillowcase. Be careful not to puncture the cushion with pins, etc. Other pillow devices include rubber or plastic rings filled with air and-:rings made out of foam rubber. These should always be covered with a case or piece of cloth before use by the client Air rings should be neither too full of air nor too low. They should be flexible and comfortable to sit on. In blowing them up, use a clean straw. Do not place your mouth directly on the intake valve. Special Pads Occasionally a client may need special pads to protect the skin and/or the bed. Sheepskin Pads may be made out of real sheepskin or a man-made material which looks and feels like sheepskin. This type of padding can reduce friction or rubbing against the skin. They are frequently used under the buttocks or the shoulders - areas where a great deal of friction can occur. There is also sheepskin booties and elbow protectors which can be fastened on the client Incontinent pads - are frequently used if the client wets or soils the bed. These pads are placed on the bottom sheet and they protect the bed and bedding and make changing the bed easier. Incontinent pads may be disposable (throw-aways) or re-usable. If re-useable, they must be properly washed and dried before re-use. Mod XII-D-page 4

PERSONAL CARE Toileting Equipment A urinal is a specially-made container into which the client can urinate. Although there are special female urinals, urinals are usually used by men. You can improvise a urinal by using a large jar or milk carton. Urinals are emptied, cleaned and stored like the bedpan. Commode A commode looks like a free standing toilet It has a seat like a toilet, but the waste contents go into a pail-like receptacle, instead of the plumbing system. The pail is emptied, and cleaned like the bedpan The pail is put back under the seat after clearing ..Cover the commode or store It in an out of-the-way place when not in use. If a commode is not available, you can improvise one by placing a bedpan on a straight char. Be sure to protect the chair against spillage from the bedpan if you do this. Prostheses A prostheses is an artificial replacement for a missing part of the body. It is used to improve the client's appearance and/or ability to function Examples of prostheses include: Artificial Limbs (hands, arms, feet, legs) - these resemble the part they are replacing; they are usually made of plastic, metal and feather; they contain hinged parts held together with screws. Straps and buckles fasten the prosthesis to the body. The care plan may require you to assist the client in applying a prosthesis You will need to follow the client's directions when doing this. Special instructions for cleaning the prostheses will be given to you by your supervisor if it becomes part of the care plan Artificial Breast -this is made of a soft spongy material which feels very much like the human breast ft usually fits into a pocket in a special brassiere. Instruction for cleaning and storing the breast prosthesis will be provided by the client and /or your supervisor. Hearing Aid - many elderly clients have hearing aids. There are several different styles: - Those that fit behind the ear - Those that fit in the ear - Those that fit on the eyeglasses Mod XII-D-page 5

Prostheses Artificial Eye- occasionally a client will have an artificial eye. He or she cannot See out of this eye, but it can improve appearances. The client should take care of removing the eye and cleaning the socket. The care plan may instruct you to clean the eye. Be sure to check with your supervisor for instructions and a demonstration before you do this. They should be stored in a padded box in a safe place. Dentures - dentures are like eye glasses; they are so common we do not think of them as prostheses. Many elderly clients will have dentures.

Environmental Supports Humidifier-a humidifier is a machine that puts moisture into the air. Clients who use oxygen equipment or who have breathing problems frequently will have humidifiers in their homes. The humidifier makes them more comfortable. Humidifiers come in different sizes and may differ in other ways depending on the manufacturer. Some humidifiers put warm moisture into the air and some put out cool moisture. In taking care of a humidifier you will need to follow the directions which come with it. You will need to add water to the humidifier when the water level goes down. It may be necessary to add special tablets to the water to prevent mineral build-up. Because germs grow in the water tank of the humidifier, the humidifier must be washed frequently. The humidifier directions, the client or your supervising nurse are the best sources of information on how to do this.

Mod XII -D-page 6

PERSONAL CARE Remember - There is a wide variety of special personal care equipment which is often used with home care clients. - This equipment relates to five areas of personal care : • The client's bed • The mobility of the client • Toileting • Artificial replacement of missing body parts (prostheses) • Environment - Each piece of equipment may have to be demonstrated on-the-job for each client because of individual variations. - Safety precautions may need to be taken when the client is using this equipment. The-home care worker's role with the equipment includes understanding the use and operation of the equipment, cleaning and storing equipment, observing for problems, and reporting these to the supervisor.

Mod XII-D-page 7

PERSONAL CARE REMEMBER You have learned some genera! principles used in performing all personal care tasks. You also learned about infection control and the procedures for hand washing and how to utilize proper body mechanics. You have learned about skin care and how various personal care skills promote skin care. You have also learned how to perform the various personal care skills: Handwashing Body mechanics Skin care - Bathing (including the tub bath, the shower, and the bed bath) Turning the client in bed Hair care Back rub Nail care Shaving Mouth hygiene and care Assisting with eating Assisting with dressing Assisting with elastic support stockings Assisting with walking Making the bed (unoccupied and occupied) Toileting Assisting with a condom catheter Assisting with indwelling and straight catheters Positioning in bed and chair Transferring to a sitting position, wheelchair to toilet, shower to tub Weighing Measuring intake and output Assisting with clean dressing change Remember that the overall goal in all personal care services is to foster the client's independence by encouraging them to do as much as possible for themselves. Mod XII-D-page 8

THINK SHEET-Mod XII-Unit D 1.

Name some prosthetic devices?

What are some devices that help a patient move?

3. 4. 5.

When using, walkers, crutches, canes, what must be done before they are used? What is an important safety feature to check before using the hydraulic lift? What is a commode, sliding board, humidifier, foot board, side rails, sheep skin, egg crate

mattress? 6.

What would you use a backrest for?

Mod XII-D-page 9

Module XII

Personal Care

Unit E Assisting with the Self-Administration of Medication TIME: 120 minutes OBJECTIVES: By the end of this unit, the student will be able to: 1. Describe the difference between administering medications and assisting with medications. 2. Define assistance with seff-administration of medication 3. List information found on medication labels: over the counter and prescription. 4. State the 5 Medication Rights: • Right person • Right medication • Right dose • Right time • Right route 5. Describe the specific tasks required when assisting clients with self-administration of medication. 6. Describe what to observe, record and report when assisting with the self-administration of medication. SUGGESTED TEACHING METHODOLOGIES: Lecture, group discussion EVALUATION METHODS: Written exam, class participation Demonstrate:  Procedure XII-39, Checking the Right Person  Procedure XII-40, Checking the Right Medication  Procedure XII-41, Checking the Right Dose  Procedure XII-42, Checking the Right Time  Procedure XII-43, Checking the Right Route 124

Module XII

Personal Care Skills

Unit E Assisting with the Self-Administration of Medication OUTLINE: 1. Difference between administering medications and assisting with self-administration of medications 2. Basic Assistance Skills a. Standard Precautions b. Reading labels - Check expiration date c. Checking the Five Medication Rights Refer to: ■ Procedure XII-39, Checking the Right Person ■ Procedure XII-40, Checking the Right Medication ■ Procedure XII-41, Checking the Right Dose ■ Procedure XII-42, Checking the Right Time ■ Procedure XII-43, Checking the Right Route d. Medication storage and disposal e. Techniques for assisting with medications administered 3. Specific Tasks of the Home Care Worker a. Remind the client of time b. Bring the medication to the client c. Bring other equipment to the client needed to prepare and self-administer the medication d. Read or show label to client to check right person, right medication right dose, right time and right route e. Position the client for medication administration f. Open the container or package so client can self-administer • Do not crush or add medications to other food such as applesauce or ice cream • If nurse or family is pre-pouring medication, follow directions on Plan of Care g. Provide appropriate liquids for swallowing medications h. Pour pre-measured medication into bath water (as prescribed) i. Storage of medication in the appropriate place j. Clean and store/dispose of special medication equipment (after use ) k. Wash hands 4. Observing, recording and reporting a. Review general principles b. Record and report immediately if client: • Does not take medication or is taking improperly • Takes medications/supplements/herbs not ordered by physician• Has a reaction to a medication that is unusual for the client • If medications are dropped or mixed up 125

PERSONAL CARE Role of medication in our lives Medications provide an effective way of: Treating, curing or controlling illness Relieving symptoms of pain Controlling troublesome behavior Preventing disease Medication can improve life, if you have taken medication that has "cured" you, you will have a good feeing about medication. When something bothers you, do you have a tendency to hunt for a "pill" to cure you? Classifications of Medications Prescription medications - available only with written prescriptions of a licensed person-usually a doctor. A prescription is taken into or called into a pharmacy. The prescription will contain the patients name and instructions for taking medication. In New York State doctors, dentists, osteopaths, veterinarians, and podiatrists are allowed to prescribe medications. The pharmacist reads and interprets the doctors order as written on the prescription. The. pharmacist "fills" or makes up the medication for the patient to use. Some medication may be filled with generic or brand names. Registered pharmacists are the only ones who are able to dispense medication in New York State. Saving medications left over from a previous prescription can be a dangerous and illegal practice. People may decide that the symptoms they or a member of their family are having are the same as that previous illness and that the old medication is O.K. to take. This is something a doctor should decide. Medicine can change chemically with age and may become weaker, stronger or useless. Nonprescription Medication - can be bought without a prescription. These medications are called OTC (over-the-counter). Examples of OTC medication are; aspirin, tylenol, vitamins, maalox, etc... Some people "treat" or "doctor" themselves with OTC medications. Why clients need assistance Many people rely on old favorites that have worked for them before, or word-of-mouth advise from pharmacists, friends, or family. It is important to remember that overdoses and side effects can occur with all medication, whether OTC or prescribed. OTC medications may interact with a prescribed medication. The client should be encouraged to tell the doctor if they are taking any OTC medications. If a client is taking a lot of non-prescription medication or is taking them frequently report this to your nursing supervisor. Mod XII-Unit E-page1

Why clients need assistance Medications can be beneficial, but keep in mind that medications are powerful and can be dangerous. Many of your clients may take up to five or six medications a day. It may be difficult for clients to keep track of their medication and know what to take when. Some clients have difficulty taking medications accurately and safely. This can make self administration of medication a problem. As a home care worker, you can provide an extra pair of hands or eyes to assist your client .The assistance may make it possible for your client to stay home. The following are some com problems and the help that is needed: Problems Help Needed 1. Problems with seeing reading label; identifying container ,pouring liquids; applying non-prescription skin products 2. Limited mobility

bringing medicine from storage and Returning

3. Limited ability to use hands

opening/closing containers; observing patient pouring and using drops accurately applying non-prescription skin products

4. Lack of strength

opening/closing containers

5. Tremors (shaking)

observing patient pouring and using drop accurately; applying non-prescription skin products

6. Occasional forgetfulness or

reminding of time distractedness

Role of the home care worker As a home care worker, you may be asked to assist some of your clients with the self-administration of medications. What does this mean? Self-Administration means that a client directly swallows, applies, inhales, inserts or injects a medication into his or her own body. Assistance with self-administration means that you can help the client with certain parts of this activity. The help may consist of some limited hands-on assistance as well as verbal support and reminding. Your role is one of assisting. Under no circumstances should you take on the total responsibility of setting up and/or administering medications. You should do only those things that the client canâ&#x20AC;&#x2122;t do alone and which are written on the Care Plan. Mod XII- Unit E-page 2

PERSONAL CARE What tasks can you assist the client in doing? When the care plan specifies, you are allowed to; 1. Remind the client when it's time to take medication. 2. Bring the medication to the client at the client's request. 3. Bring other equipment to the client that may be needed to prepare -and self-administer the medication. 4. Read or show the label to the client to check the right person, medication, dose, expiration date, time and route. 5. Open the container or package so the client can take the medication. 6. Position the client for medication administration. 7. Provide appropriate liquids for swallowing oral medications as requested by the client. 8. Pour pre-poured medication into bath water. 9. Store medication in the appropriate place. 10. Clean and store or dispose of special medication equipment after use. 11. Observe, record and report. Your role will differ with each case. Some clients may need little or no assistance; others 'may need more. The exact tasks and responsibilities regarding medication will be written for every client on the care plan. You should not assist the client with medications unless the instructions are written there. The care plan, along with your supervisor, are the most important sources of information you have about your responsibilities. If you have questions about your role you should discuss these with your supervisor. Problems with the medication regimen should be recorded and reported' to the supervisor also. Assisting with self-administration of medication is an extremely important task. Above all you should act carefully. Safety and accuracy should be uppermost in your mind. Work slowly and do not allow yourself to become distracted by other activities, conversations, TV or radio. Your hands should always be washed prior to handling medications. Medication is never to be touched by your hands. Medications should be stored in a clean place away from pets and children. Read labels very carefully. Call your supervisor with any questions you may have. Mod XII-E-page 3

Reading Labels Every medication dispensed from a pharmacy must be kept in the container with the labels attached. The medicine label is a source of information for the person assisting with. administering the medicine. The label should state certain essential information: 1. the name of the person for whom the medication is intended 2

the name of the medication (this may include both the generic and the brand name)

3 the dose of the medication to be taken each time 4

how often each day the medication should be taken

name, telephone number, address and LD. number of pharmacy 6. doctor's name

date prescription is filled 8. number of the prescription

DRUG

STORE USA

ANY STREET

ANY CITY ,N .Y.

123-4567

DEA No.AW

7654321

#6..............

369

Oakwood

Timothy Salter

------#1

#3Take one tablet

#4 four times a day until

Erythromycin-----#2

ALL are gone.

250 mg

3/30/84---------#7 In addition, the pharmacist may put certain additional information on the label: special precautions or instructions for taking the medication; these may be on a special sticker, for example • "take one-half hour before meals" • "take when needed" • "take with food or milk" • "do not take food or dairy products with medicine" • "take on an empty stomach" • "may cause drowsiness" •"keep refrigerated"

Mod XIl-E-page 4

â&#x20AC;˘ "shake well" â&#x20AC;˘ "POISON" â&#x20AC;˘ "do not drink alcohol when taking this medication" - the expiration date of the medication - the route for taking the medication; for example, place on skin - special instructions for storing the medication (may be on a sticker also) - how many times the prescription may be refilled Certain abbreviations may appear on the label. The most common abbreviations and their meaning are listed below: - B.I.D., bid., bid - twice a day - T.I.D., t.i.d., tid- three times a day - Q.I.D., qxd.,qid- four times a day - H.S., h.s., hs - at bed time - P.O., p.o., po - by mouth - P.R.N., p.m., prn - as necessary As long as the container has the medication, the label and stickers should not be removed nor should they be damaged or covered in any way. For containers that have liquids to be poured, it is best to hold the label side of the bottle against the hand so no liquid can spill on the label, and thus make it difficult to read. You should observe that the client does this and help the client to protect the label if necessary. The color of the label may be significant. Most prescription medicines contain white labels. An orange label means the medication is a controlled substance. Controlled substances may also be marked by a special sticker on the label. Controlled substances are a group of powerful medications that are carefully controlled by the State because there is potential for harm, abuse or addiction when they are used. Medications should NEVER be poured from one bottle into another, even if both contain the same medicine. Pouring from one bottle to another is considered dispensing medicine and this can only be done legally by a registered pharmacist.

Mod XII-E-page 5

The following activities will give you a chance to practice reading labels. Below are three simulated or pretend labels for medication containers. Underneath each label are eight questions. Use the label to answer the questions. A. DRUG STORE USA Any Street Any City, N.Y. 123-4567 DEA No.AW 7654321 Rx No. 525956

Date 8-8-84

Deborah Trumble Take one tablet at

bedtime

Haldol 5mgm Dr. Metcalf 1. 2. 3. 4. 5. 6. 7. 8.

What is the name of the pharmacy? What is the name of the patient?___ What is the doctor's name? What is the name of the medication? What form does this medicine come in? How much medicine should this patient receive each time? (dose) How often should the medicine be taken a day?_ When was the prescription filled?____________

Mod XII-E-page 6

DRUG STORE USA

Any Street 123-4568

Any City, N.Y. DEA No.AW 7654321

RxNo. 523438

Dr. Dy

Oldenburg, Irene 2744 Caledonia St.

8/7/84

Take 1 capsule twice a day Serax 10 mg capsules 1. 2 1. 2. 3. 4. 5. 6.

What is the name of the pharmacy? What is the name of the patient?__ What is the doctor's name? What is the name of the medication? What form does this medicine come in? How much medicine should this patient receive each time? (dose) How often should the medicine be taken a day?_ When was the prescription filled?___________

Mod XII-E-page 7

c. DRUG STORE USA Any Street Any City, N.Y. 123-4567 DEA No. AW 7654321 Rx No. 525951 Dr. Juan Allcorn, Karla 212 Sexton 08/07/84 Take 1 Capsule at bedtime as needed. Dalmane 15 mg capsules Do not drink alcoholic beverages when taking this Medication. 1. What is the name of the pharmacy? 2. What is the name of the patient?__ 3. What is the doctor's name? 4. What is the name of the medication? 5. What form does this medicine come in? 6. How much medicine should this patient receive each time? (dose) 7. What special precaution should be taken with this medication? 8. How often should the medicine be taken a day?. 9. When was the prescription filled?____________

Mod XII-E-page 8

CHECKING THE FIVE RIGHTS As you have seen, the medication label contains certain important information. You can assist the client in making sure that taking medicine is done in an ACCURATE and SAFE manner. You do this by checking the information on the label with information about the medication that in on the Care Plan. The "Five Rights" is a system that provides a way of double-checking medications. This system makes learning about medication assistance easier and turns it into a routine procedure.

The "Five Rights" means that: The RIGHT PERSON is getting The RIGHT MEDICATION in The RIGHT AMOUNT/DOSE at The RIGHT TIME by way of The RIGHT ROUTE Checking the Five Rights is an important part of your role in assisting with the self-administration of medications. We will be discussing each of the Five Rights in the following pages. REFER To Procedures XII-39, XII-40, XII-41, XIl-42. They outline the steps in checking for the Right Person, Right Medication, Right Amount, Right Time and Right Route. Review and study and practice them carefully.

Mod XIl-E-page 9

CHECKING FOR THE RIGHT PERSON By checking for the RIGHT PERSON you are making sure that the person who is taking a particular medication is the person who should be taking it. Sometimes people will take medicine that has been prescribed for someone else. They do this because they think or have been told it will help them. This is a very dangerous practice because the medication may harm them or interact unfavorably with other medications they may be taking. Only a doctor should tell a client what medications to take. If you are assisting a client with medications you must make absolutely sure that the person's name on the medication container label is the same as: the name of the person on the Care Plan the name of the person you are assisting You must check the name of the person on the container every time you assist the client and not just the first few times.

Do's

Donts

Do check the person's name on the label every time you assist

Don't assist the person with self-administration of medicine if person's name is different from that on the label

Do check the person's name whose on the Care Plan

Don't assist with any medication if label has been removed or changed

Do call your supervisor if there are problems or questions.

Mod XII-E-page10

CHECKING FOR THE RIGHT MEDICATION

It is not unusual for chronically ill clients to be taking five or six different medications a day, and at different times. It can be confusing for them to know what to take when. When checking for the right medication you must know what the client should be taking at this point in time - not last week or last month. You must check for two things 1. The medication name that is written on the label should be exactly the same as the medication name on the Care Plan. Some medication names look or sound alike (For example, digitoxin and digitalis; or Aldomet and Aldoril) and errors can be made easily. 2 . The prescription has not been discontinued or changed. Medication should not be kept and used past the expiration date because their chemical nature may change and they may become either more or less powerful than before. The label may state the expiration date and you should remind the client if you see that a medication has expired. Checking for the right medication involves comparing the medication name on the container label with the medication name on the Care Plan. This comparison checking should be done every time you assist the client with medications. Changes can occur in the clients medication regimen from one day to the next. If there is a difference between the medication name on the Care Plan and on the container label, you should not assist the client to take the medication. To clear this matter up check with your supervisor. If clients have been taking the same medication over a long period of time, they- may become familiar with the appearance of the medications. Certainly if the client has been taking a small, orange tablet and all of a sudden the tablet is blue, you should be alert to the possibility of medication error. Clear this up before the person takes the medication. If there is any doubt in your mind about whether the client is taking the right medication, ask your supervisor. Every time you assist the client with medication, check to be sure the medication name on the container label is the same as the medication name on the Care Plan.

Do's

Don'ts

Do check that the medication

Don't assist with medicine

name on label matches the medication name on the Care Plan

if medication names are different

Do check the medication name

Don't use appearance as the only

every time you assist

way of identifying a medication

Do check the expiration date

Don't mix medications in the same

of the medication

container even if they are labeled as the same medication Mod Xll-E-page 11

CHECKING FOR THE RIGHT AMOUNT/DOSE Dosage refers to the amount and strength of a medication. Amount can mean the number of tablets or capsules which the client should take each time the medication is administered. Normally, this will be one or two at a time. Amount can also refer to the length of a ribbon of ointment that the client applies or to the quantity of liquid medicine the client should use. Measuring liquids for medication administration is tricky because it needs to be done very carefully. Some liquids may be brawn up into a dropper and squeezed out drop by drop when the medication is administered. Clients frequently have difficulty seeing or lack the manual skills to do these things properly. In addition, the system of measurement may be unfamiliar. This system is called the metric system. Below is a comparison of some common measurements in the household system and the metric system. Household 1 tsp (teaspoon)

Metric 5cc (cubic centimeters) or 5 ml (milliliters)

1Tsp (tablespoon)

15ccor15ml

1 oz. (ounce)

30ccor30ml

1c (cup)

250 cc or 250 ml

1qt (quart)

1000ccoM000ml

A measuring utensil that is specially calibrated ( a special medicine cup, dropper or other utensil which has standardized, graduated markings) may be used with metric dosages. If the client's medication is taken in household measurement, he or she should use special household measuring spoons or cups and not regular tableware to measure the dosage. Strength means how much of the actual medication is present in the tablet, capsule, suppository, liquid, ointment, etc. Again, the metric system will probably be the way it is measured. Grams (abbreviated gm), milligrams (abbreviated mg) and grains (abbreviated gr] are common measurements used to show the strength of medications. A safe and accurate way to check the dosage of a client's medication is to see that the information on the label is the same as the information on the Care Plan. Each time you assist the client with selfadministration of medications you must check that the dosage on the label is the same as the dosage on the Care Plan.

Mod XII-E-page 12

Sometimes a liquid medication needs to be shaken up before it is taken so that all the ingredients are evenly mixed. This prevents the client from taking too strong or too weak a dose. If a medication needs to be shaken, there should be instructions on the label. If the client cannot shake the container, the Care Plan may state that you should do so. Dosages may be changed by the doctor. The doctor may te||_ the client what changes to make. The written instructions on the label may not be changed until the client has the prescription re-filled. Even then the container label may not be changed if the pharmacist does not know about the changed dosage. If this kind of confusion occurs you should record this and report to your supervisor immediately. Do not assist with that medication until the supervisor and/or the case manager are aware of the situation and tell you what to do. Neither the Home Care Worker nor anyone else in the home should re-label the container or alter the label or container in anyway. Only a pharmacist is allowed by law to do this. Every time you assist the client with medications, check to be sure the medication dose on the container label is the same as the medication dose on the Care Plan. Do's Do check that the dose of medication on label matches dose for that medication on Care Plan. Do check the dose every time you assist.

Don'ts Don't assist client in taking more or less of a medication than is ordered. Don't remove or change a medication label.

Do shake liquid medications if ordered by the Care Plan. Do record and report to your supervisor If there are problems or questions.

Mod Xll-E-page 13

CHECKING FOR THE RIGHT TIME It is not unusual for chronically ill and elderly clients to use 5 or 6 different medications a day. Scheduling when medicines are to be used, and remembering the times can be difficult However, medications must be used according to a schedule. The doctor should write the schedule on the prescription and the pharmacist should write those instructions on the medication label. The reason scheduling is important is that in order for most medications to have the desired effect, a certain amount of the medication must be in the body. Using medications at the correct time will ensure this. In addition, some medications should be used at particular times of the day, for example with meals or on an empty stomach. Medications should not be used whenever the client feels like it A special problem that arises with the proper timing of medicine is the administration of PRN medications. PRN medications are medicines that are used as needed by the client The time intervals between doses are specified by the doctor (for example, every four hours). You can only assist with PRN medications if they are written on the Cane Plan. You should not assist with any-medication to a client that has not been ordered. Every time you assist the client with medication, check to be sure the time on the container label is the same as the time specified in the Care Plan.

Do's Do check that the time on the label matches time when it is not ordered.

Don'ts Donâ&#x20AC;&#x2122;t assist client in using medicine at a the time on Care Plan.

Do Check the time whenever you assist Do record and report to your supervisor if there are problems or Questions

Mod XII-E-page 14

CHECKING FOR THE RIGHT ROUTE The route refers to the way a medication is used, for example by mouth. The form of a medication refers to the appearance of the medication, for example tablet, liquid capsule, ointment cream or suppository. Sometimes the client has to use special equipment to self-administer medication by certain routes. Usually the container label does not tell the route to be used. This is especially true if the medication is taken by mouth. Other routes, which are more unusual, may be written on the label. The Care Plan should be your source of information on the route for using a medication. Mistakes can easily occur. Oral capsules can look like suppositories. Liquid medicine intended for use with a nebulizer can look like eye, ear or nose drops or like some liquid medicines to be taken by mouth. Ointments, creams or salves can be used in the eye, in the vagina or on the skin. If you have any doubt about the route, you should check with your supervisor before assisting the client with the medication. Sometimes changing the form of a medicine changes its action. This means that capsules should not be broken apart and mixed. An important point to remember about the form of medicine is that it should not be changed unless the client family or health professional checks with the doctor and/or the pharmacist If the doctor orders it the pharmacist will dispense the medicine in liquid form. Every time you assist the client with medication, check the Care Plan to determine the route by which it is to be used. The chart on the following pages summarizes seven common routes by which medications are administered, common forms of medications used by those routes and any special equipment required.

Mod XII-E-page 15

SUMMARY CHART OF COMMON ROUTES Special Equipment Routes Medication Forms oral (by mouth)-

tablets

calibrated utensil for measuring,

medication is swallowed or dissolved in mouth

capsules liquids powders mixed with liquid

such as measuring cup, spoon, Dropper

topical-

powder

medication is applied to the skin

ointment cream paste salve liquid

tongue blade for removing calibrated utensil for measuring such as measuring cup, spoon

oil

gauze squares or cotton for

lotion pre-medicated tape or disc

applying or covering plastic for applicator paper

insertion-

suppositories

Applicators

medication is put into a body cavity (vagina or rectum )

liquids tablets creams ointment

nozzles finger cot or rubber glove lubricant

instillation-medication is

liquids

dropper

dropped into a body cavity (eyes, ears or nose)

(drops) ointment salve oil

clean cotton balls/ tissue spray bottles

inhalation-medication is

liquids

inhaler

inhaled or breathed

aerosol

nebulizer IPPB

injection-medication is

liquids

put into the body with a needle

syringe needle alcohol and sponges

premeasure medicated

powders

baths

tablet liquid

measuring device

Mod XlI-E-page 16

Do's

Don'ts

Do check the label(s) for special route instructions. Don't assist the client in changing the form of a medication by breaking it apart or crushing it, unless doctor has ordered ft.

Do check the Care Plan for the route by which a medication is to be used.

Don't provide incorrect liquids for swallowing medications.

Do check the route every time you assist

Don't put medication into the client's mouth.

Do provide appropriate and sufficient liquid to swallow medications.

Don't draw up solution for injections.

Do record and report to your supervisor if there are problems or questions.

Don't give the client an injection.

Don't dispose of used injection needles other than insulin needles. Don't insert suppositories or other medication into the rectum.

Don't insert or apply vaginal medication. Don't perform special cleaning of the clients eyelids or eyelashes to prepare for eye medications. Don't instill drops into the eye, ear or nose.

Don't apply prescription medications to the skin.

Mod XII-E-page 17

Checklist for Procedure Xll-39 CHECKING THE RIGHT PERSON 1.

Washes hands.

Reads the container label.

Checks the name on the label to make sue it is the same as the client's name.

Checks the name on the label against the name on the Care Plan.

If they are the same, gives container to client and/or assists with administration as ordered on

the Care Plan. 6.

If they are not the same, contacts supervisor for further instructions:

Explains to client the reason for this.

Records and reports any problems about the medication in question.

Mod XII-E-page 18

Checklist for Procedure XII-40 CHECKING THE RIGHT MEDICATION 1.

Washes hands.

Reads the container label.

Checks the expiration date.

Checks the name of the medication on the label to make sure it is the same as the medication

name on the Care Plan. 5.

If they are the same, gives container to client and/or assists with administration as ordered by

the Care Plan. 6.

If they are not the same, contacts the supervisor for further instructions:

Explains to client the reason for this.

Records and reports any problems about the medication in question.

Mod XII-E-page 19

Checklist for Procedure XII-41 CHECKING THE RIGHT DOSE 1.

Washes hands.

Reads the container label.

Checks the dose on the label against the dose for that medication on the Care Plan.

If they are the same, gives container to client and/or assists with administration as ordered

by the Care Plan. 5.

If they are not the same, contacts the supervisor for further instructions:

Explains to the client the reason for this. 6.

Records and reports any problems about the medication in question. Mod XII-E-page 20

Checklist for Procedure Xll-42 CHECKING THE RIGHT TIME 1.

Washes hands.

Reads the container label.

Checks the time for taking the medication against the time specified in the Care Plan.

If they are the same, gives container to client and/or assists with administration as ordered by

the Care Plan. 5.

If they are not the same, gives container to client and/or assists with administration as

ordered by the Care Plan. 6.

Explains to the client the reason for this.

Records and reports any problems about the medication in question.

Mod XII-E-page 21

Checklist for Procedure XII-43 CHECKING THE RIGHT ROUTE 1.

Washes hands.

Reads the container label to determine if it lists any information regarding the by which the

medication should be given. 3.

Checks the Care Plan to determine the route that is specified for the medication.

If available, checks to make sure the route specified on the label matches the route specified

on the Care Plan. 5.

Gives the container to the client and/or assists with administration as order in the Care Plan

if: 6. a. b.

the route is specified in the Care Plan; or the route specified in the Care Plan and on the label match. If they are not the same or there is no information, contact the supervisor for further

instructions: â&#x20AC;&#x201D; Explains to the client the reason for this. 7

Records and reports any problems about the medication in question. Mod XII-E-page 22

THINK SHEET- Mod Xll-Unit E 1. Should you the aide, ever put your clients medications in one bottle? 2. How do you know when your client should take their medication? 3. Would it be O.K. to break apart or crush your clients medication? 4. Why would you never remove a label from a clients medication? 5. What does a pharmacist do? 6. Define O.T.C. medication? 7. In assisting your client with medications, what are some of the things you may do? 8. What are some of the things you may never do, when assisting your client with medications? Mod XII-E-page 23

VOCABULARY LIST MODULE XII

126

VOCABULARY LIST Module XII Accuracy - free from error; correct Amount- number of tablets or capsules; quantity of liquid. Anesthetic -a substance causes numbing or loss of feeling. Anus - an opening between the buttocks through which stool passes to the outside. Assistance with Self-Administration of Medication - specific helping tasks which home care workers are permitted to perform with clients who administer their own medication. Back Rub - a procedure in which the back is gently massaged with lotion or powder . Bed Bath -a sponge bath given to a client while he or she lies in bed. Bed pan-specially made container which a client can use for elimination. B.I.D. - twice a day. Body Mechanics - principles by which the body moves and maintains its balance. Bowel Movement (BM) - see stool Brace -a device applied to part of the body to increase strength or to keep the body in position or limit movement Buttocks -the part of the body where a person sits; rump. Calibrated -standardized, graduated markings. Circumcised -the covering at the tip of the male penis is removed in a special surgical procedure. Clean - an object or area that has no disease producing germs. Commode- a free standing toilet that uses a pail for waste and can be emptied into a toilet Condom Catheter - an external catheter used by males. A sheath or condom is held on the penis by tape or adhesive cement and a tube attached to the condoms that drains urine into a drainage bag. Contaminate- to soil or infect through contact. Contractures -muscle and joint stiffness which results in an inability to stretch a body part. Controlled Substance -a group of powerful medications that are carefully controlled by the State because of their potential for harm, abuse, or addiction.

Dentures - false or artificial teeth. Dirty-an object or area that has been in contact with disease-producing germs. Dispensing - preparing or making up a medication according to the doctor's prescription so that the patient can use it. Disposable â&#x20AC;&#x201D; designed to be used once and then thrown away. Dosage- amount and strength of a medication. Draw Sheet- a sheet that is approximately half the size of a regular sheet; used under the client between the shoulders and the knees. Dressing- covering for a wound. Elastic Support Stockings- stockings made of material that applies firm, steady pressure to keep fluid from collecting in the legs. Electric Lift Chair- a motorized chair that helps lift a client to his or her feet. Elimination - process by which body gets rid of waste materials, including urination and defecation. Environmental Supports â&#x20AC;&#x201D; equipment used to improve the living area of the client Finger Cot- a rubber or plastic covering for one finger similar to one finger of a rubber glove. Five Rights - a system for insuring accuracy and safety in medication administration. Flossing â&#x20AC;&#x201D; a procedure of cleaning between the teeth with a specially treated thread-like material called floss. Football Hold- a way of carrying a baby with one arm, much like carrying a football. Foreskin- a loose fold of skin that covers the end of the penis. Formula- a special mixture of milk or milk-like products which are used to feed babies. Fragile- easily broken or destroyed; weak. Genitals- the private area of male or female; external sex organs. Germ- a very small organism which can cause disease. Grooming- activities involved in keeping a person neat or attractive, H.S.- at bed time.

VOCABULARY LIST Module XII Hydraulic Lift -a mechanical device used to lift and move clients. Incompatible - two or more items unsuitable for use together Incontinence - inability to control bladder and bowel action. Incontinent Pants - plastic pants lined with a disposable absorbent material. Indwelling Catheter - a thin rubber tube that goes into the urinary bladder to drain urine into drainage bag. The indwelling catheter is left in place for a period of time. Infant - very young child, usually under 1 year of age; baby. Infection - condition in which germs have multiplied and destroyed cells. Inhaler-a small device that allows liquid medicine to be breathed in. Injection -medication that is introduced into the body by way of needle and syringe. Intake - amount of fluid taken into the body in a 24-hour period. Labia - folds of skin around the vagina. Medication (drug) Regimen -a systematic plan for taking medication which is set up to improve or maintain health. Metric System - a system of weights and measures based on the meter and the kilogram rather than the yard and the pound. Microscope - a machine that magnifies tiny objects so they can be seen through a viewer. Mobility - capable of moving from place to place, getting around. Navel - belly button; slight indentation in abdomen where baby's cord was attached. Nebulizer - a machine that turns liquid medication into a mist to be inhaled. Nursing Mother- a mother who is breast feeding her baby. Output- amount of fluid the body rids itself of in a 24-hour period. Over-the-Counter (OTCs Non-Prescription Drugs) - medications which can be purchased in pharmacies and other stores without a doctors prescription Penis- male genital (sex) organ through which the male also urinates. Personal Care - every-day activities performed by a person which maintain appearance, cleanliness and sense of well-being; they are activities that are concerned with care of the person's body

VOCABULARY LIST Module XII Positioning - a procedure by which parts of the clients body are lined up correctly when the client is sitting or lying down. Possessiveness - desire to own or be in charge of something. Potential - possible; something that might occur in the future. Pm-Filled Syringes - syringes that have been filled with the proper amount of medication several hour;-: or days ahead of the time they will be administered. P.R.N. - as necessary. Pre-Poured Medication - correct doses of all oral medications to be taken at a certain time on a given day placed together in envelops, egg cartons or other receptacles by a nurse or family member. Prescription Drugs - drugs that are available only with the written order (prescription) of a license-physician. Principle - a reason why something is done in a certain way. Procedure - step-by-step method for getting a task done. Prostheses - artificial replacement for a missing body part. Q.I.D. - four times a day. Regimen- plan designed to improve health. Route -the way in which a medication is taken into the body. "Safety Belt -a strong piece of webbing placed around a client to provide support. Self Medicating - prescribing drugs for yourself based on your owns diagnosis of the problem. Sling -a cloth device used to support part of the body. Splint- a lightweight device that holds part of the body in proper position. Stable Surface Wound - a area of skin that is healing. Sterile -free from all organisms. Straight catheter - a thin rubber tube which is placed in the urinary bladder is removed as soon as the bladder is empty.

VOCABULARY LIST Module XII Stool - a body waste made in the intestines, stored in the rectum and eliminated from the body through the anus. Strength - how much drug is in each tablet or capsule or a specific quantity of liquid. Suppository - medication in solid form which melts when inserted into body cavities like the vagina or rectum. T.I.D. - three times a day. Toileting - an activity concerned with elimination of body waste into a toilet. Topical -surface of the skin; a route by which medications are administered through the skin. Transfer- a procedure in which a client is assisted in safely moving from one stationary place to another (for example, from bed to chair, from chair to toilet, etc.). Transfer Board - (sliding) a sturdy, smooth piece of wood or plastic which allows the sitting client to move easily from one place to another. Uncircumcised -referring to a male who has not had the foreskin removed from the penis. Unstable Surface Wounds - an open area of skin. Urinal -a specially-made container into which the client can urinate. Urination - process of discharging urine from the bladder. Urinate - to discharge or eliminate urine. Vagina - the birth canal. Voiding - discharging urine from the bladder. Vulnerable -easily hurt or wounded; susceptible. Weighing - measuring how heavy a person is. Wheelchair - a specially built chair on wheels which allows a client to move more easily from one place to another. Wound -an abnormal opening through the surface of the body.

APPENDIX PROCEDURE CHECKLIST: * XII-1, Proper Handwashing XII-2, Proper Body Mechanics XII-3, Tub or Shower Bath XII-4, Turning the Client in Bed * XlI-5, Bed Bath XI1-6, Shampoo in Bed XII-7, Back Rub XII-8, Nail Care Xll-9, Shaving the Client * XII-10, Mouth Hygiene and Care XII-11, Assisting with Eating XIl-12, Assisting With Dressing XII-13, Assisting with the Use of Elastic Support Stockings *XII-14, Helping the Client to Walk XI1-15, Making an Unoccupied Bed * XII-16, Making an Occupied Bed * XII-17, Use of a Bedpan XlI-18, Use of Urinal XII-19, Assisting with the Use of the Condom Catheter XII-20, Assisting with Cleaning the Skin and Catheter Tubing XII-21, Assisting with the Emptying of the Urinary Drainage Bag XII-22, Positioning the Client in Bed XII-23, Transfer to the Sitting Position Xli-24, Helping the Client to Sit at the Side of the Bed XII-25, Helping a Client to Stand * XII-26, Transfer to Wheelchair, Chair or Commode XII-27, Positioning Client in Chair or Wheelchair XII-28, Transfer from Wheelchair to Toilet XII-29, Transfer from Wheelchair to Shower and Assisting with Shower Xll-30, Transfer from Wheelchair to Stool or Chair in Tub XII-31, Weighing a Client XII-32, Measuring Intake Xll-33, Measuring Urinary Output XII-34, Assisting with Changing a Clean Dressing XII-35. Handling the Infant XII-36, Infant Bath XII-37, Assisting with the Use of the Hydraulic Lift Xll-38, Slide Board Transfer * Xil-39, Checking the Right Person * Xll-40, Checking the Right Medication * Xll-41, Checking the Right Dose *XII-42, Checking the Right Time * XII -43, Checking the Right Route â&#x20AC;¢ required procedures 127

Checklist for Procedure A-l PROPER HAND WASHING Hand Hygiene *Remember to wash your hands *Stop the Spread of Infection 1. Assembles equipment: soap, paper towels.(liquid soap if possible) 2. Uses towel if no paper towels are available. 3. Rolls up sleeves. ***Rings:

Leave on. Move rings up to wash skin underneathWash rings. Taking rings off can cause contamination to rings-Which are then placed back on to cleaned ringers.

4. Wets hands under warm, running water. 5. Applies a generous amount of soap and lathers hands well, for at least 15 seconds. 6. Washes entire surface of hands, between the fingers, around and under the fingernails, up to and above the wrist, according to current CDC guidelines. 7. Rinses hands thoroughly under warm, running water with hands lower than wrist 8. Dries hands using a clean cloth or paper towel. 9. Turns off the tap with paper towel. Using Alcohol-based hand cleaners in situations where there is no running water or hands are not visibly soiled. 1. Applies product to one hand (amount determined by product instructions). 2. Rubs hands together, covering all surfaces of hands, under your nails and between fingers, until your hands are dry.

Required and Optional Procedures: Each of the procedures in Module XII has a companion checklist for evaluation purposes- As a practical matter it may not be possible to evaluate the trainee on every procedure. However, there are certain basic procedures the trainee should be required to demonstrate. It is recommended that the trainee pass twelve required procedures plus at least two other optional procedures of the trainer's choosing. These optional procedures should be related to the typical caseload or the other needs of the agency. Asterisks on the summary chart on page one and on the individual procedures that follow indicate the twelve required procedures.

Checklist for Procedure XII-2 PROPER BODY MECHANICS 1. Uses firm base of support

2. Keeps back straight 3- Faces in direction of movement 4. Places one foot ahead of the other.

5. Keeps objects being lifted close to body 6. Uses weight of his/her body when pushing or pulling

7. Bends at knees and hips 8. Turns with feet, does not twist at waist

Checklist for Procedure XII-3 TUB OR SHOWER BATH 1. Explains procedure to client. 2. Washes hands. 3. Assembles equipment. 4. Ensures warmth in bathroom. 5. Removes loose rugs from floor, If necessary. 6. Checks for safety devices, (ex. grab bars) 7. Places rubber mats and chairs appropriately. 8. Tests water temperature. 9. Washes hands, as necessary. 10. Puts on gloves, as necessary. 11. Assists client into tub or shower appropriately. 12. Assists client to wash, if necessary. 13. Shampoos hair, if necessary. 14. Assists with drying, if necessary. 15. Assists client out of tub or shower. 16. Assist with dressing as needed. 17. Drains and cleans tub/shower area. 18. Removes gloves. 19. Washes hands. 20. Observes, records and reports any changes in condition or behavior. Never leave an elderly person or young child alone while in tub or shower. DO NOT USE BATH OILS. They can make the tub slippery.

Checklist for Procedure XII-4 TURNING THE CLIENT IN BED 1. 2. 3. 4. 5. 6. 7. 8.

Explains procedure to client. Washes hands. Puts on gloves, as necessary. Moves client to appropriate side of bed. Places arms of client correctly. Places legs correctly. Supports legs correctly. Rolls client appropriately from opposite side of bed while ensuring the client's safety.

9. 10. 11. 12.

Adjusts pillow for head correctly. Ensures client's comfort Washes hands. Observes, records and reports any changes in condition or behavior.

Checklist for Procedure XII-5 BED BATH 1. Explains procedure to client. 2.

Washes hands.

Assembles equipment

Provides for privacy and warmth.

Puts on gloves, as necessary.

Prepares bedding for bath, protecting bed with towels, as necessary.

Tests temperature of water.

Forms mitt with washcloth.

Washes and dries from head to toe; cleanest to least clean.

10.

Washes and dries one part at a time.

11.

Keeps exposure to a minimum.

12.

Soaks and dries hands and feet appropriately.

13.

Allows client to participate as much as possible.

14.

Changes water when needed.

15.

Washes genitals and buttocks last.

16.

Applies lotion, if ordered.

17.

Assists with dressing.

18.

Allows client to rest.

19.

Cleans area and equipment.

20.

Removes gloves.

21.

Washes hands.

22.

Observes, records and reports any changes in condition or behavior.

Checklist for Procedure Xll-6 SHAMPOO IN BED 1. Explains procedure to client. 2. Washes hands. 3. Assembles equipment Asks client which products to use to prevent allergies or reactions. 4. Makes trough, a hollowed-out depression that allows the water to flow and helps keep the bed dry. 5. Checks room temperature.

6. 7. 8. 9. 10. 11. 12. 13. 14. 15.

Places towel appropriately. . Places trough appropriately. Puts on gloves Wets hair and works up a good lather, working from front to back. Protect eyes and ears. Rinses thoroughly. Dries hair. Cleans area and equipment Removes gloves. Washes hands. Observes, records and reports any changes in condition or behavior.

Checklist for Procedure XII-7 BACK RUB 1. Explains procedure to client. 2. Washes hands. 3. Assembles equipment 4. Removes client's clothing. 5. Positions client on stomach or side. 6. Positions self appropriately. 7. Warms lubricant before applying. 8. Lubricates hands. 9. Rubs back with appropriate pressure. 10. Rubs back rhythmically. 11. Rubs back in correct direction. 12. Observes and massages bony or reddened areas. 13. Times procedure according to client's wishes. 14. Removes excess lotion. 15. Assists client with dressing. 16. Returns equipment 17. Washes hands. 18. Observes, records and reports any changes in condition or behavior.

DENTURE CARE 1 Explains procedure to client 2. Washes hands. 3. Assembles equipment. 4. Puts on gloves, as necessary. 5. Receives dentures from client in tissue or breaks suction and removes dentures with a tissue. 6. Places dentures in a water-filled container. 7. Carries dentures to sink. 8. Cushions sink with washcloth and adds water. 9. Cleans dentures appropriately. 10. Assists client in rinsing mouth. 11. Applies denture cream or adhesive as needed. 12. Inserts dentures in client's mouth or stores dentures in water without adhesive. 13. Wipes client's mouth. 14. Washes hands. 15. Observes, records and reports any changes in condition or behavior.

Checklist for Procedure XII-8 NAIL CARE 1.

Explains procedure to client.

Washes hands.

Assembles equipment.

Puts on gloves, as necessary.

FINGERNAILS 1.

Soaks client's hands in tepid water.

Dries carefully.

Pushes cuticles back.

Cleans under nails-

Files nails, if necessary.

Massages hands with lotion.

Observes for irritation.

Washes hands.

Observes, records and reports any changes in condition or behavior.

TOENAILS 1.

Observes client's feet

Soaks feet first if only foot care is being given. (Check Care Plan)

Cleans under nails

Uses emery board to smooth nails.

Washes hands.

Observes, records and reports any changes in condition or behavior.

Washes hands.

Observe, record and report any skin irritations, redness, scaling, etc. to the supervisor

Checklist for Procedure XII-10 MOUTH HYGIENE AND CARE

CLIENTS WHO CAN BRUSH OWN TEETH 1.

Explains procedure to client.

Washes hands.

Assembles equipment.

Puts on gloves, as necessary.

Provides rinse water.

Gives client tissue/towel for wiping.

Observes client to ensure proper tooth care.

Observes, records and reports any changes in condition or behavior

CLIENTS UNABLE TO BRUSH OWN TEETH,

Explains procedure to client.

Washes hands.

Assembles equipment.

Puts on gloves, as necessary.

Places client upright or on side.

Places towel under head.

Places basin at side of head.

Brushes teeth gently with up and down circular strokes.

Helps client rinse mouth.

10.

Ensures mouth and neck are dry.

11.

Helps make client comfortable.

12.

Cleans and stores supplies.

13.

Washes hands.

14.

Observes, records and reports any changes in condition or behavior.

Checklist for Procedure XII-11 ASSISTING WITH EATING 1. Explains the procedure to client. 2. Washes hands.

3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15.

Assembles equipment Puts gloves on, as necessary. Arranges food attractively on. the plate. Allows the client to choose foods to be eaten. Encourages the client to do as much as capable. Assists only when it is necessary. Cuts food into small pieces if the client is unable. Uses forks and spoons gently. Wipes the client's mouth, if needed. Uses straws or a training cup for liquids. (For visually impaired) Explains where food is located on plate, and what is on eating utensil. Feeds to the strong side (in case of a facial weakness or paralysis on one side). Washes hands. Observes, records and reports any changes in condition or behavior.

Checklist for Procedure XII-12 ASSISTING WITH DRESSING 1.

Explains procedure to client.

Washes hands.

Assembles clothes in the order they are to be put on.

Puts on gloves, as necessary.

Encourages and allows the client to do as much self-dressing as possible.

Assists when the client asks or shows signs of fatigue, frustration, or inability to perform the

task. 7.

Washes hands.

Observes, records and reports any changes in condition or behavior.

FOR CLIENTS WHO ARE PARTIALLY PARALYZED, WEAK, OR FRAIL 1.

Explains procedure to client.

Washes hands.

Assembles clothing in the order they are to be put on.

Puts on gloves, as necessary.

Moves client to center of bed.

Removes night clothing, if necessary.

Covers client with a sheet.

Uncovers upper body first

Assists with shirt.

10.

Uncovers lower body.

11.

Assists with underpants or shorts and remainder of clothes.

12.

Assists with socks and shoes as needed.

13.

Washes hands.

14.

Observes, records and reports any changes in condition or behavior.

Checklist for Procedure XII-13 ASSISTING WITH THE USE OF ELASTIC SUPPORT STOCKINGS 1. Explains procedure to client 2. Washes hands. 3. Assembles equipment. 4. Puts on gloves, as necessary. 5. If client has been up and around have client lie down with legs elevated for 15 minutes before applying stockings. 6. Makes sure legs are clean and dry. The legs may be lightly powdered or, if the skin is dry, lotion may be used. 7. Puts on stockings as Care Plan directs: smoothly with no wrinkles. 8. Makes sure heel of foot is in heel of stocking. 9. If stockings have no toe opening, pulls on the tip of stocking to relieve pressure. 10. Removes at least once a day or as frequently as directed by the Care Plan. Bathe the skin underneath, dry, and reapply. 11. Observes for changes in skin color, skin temperature, swelling, or sores on legs. 12. Washes hands. 13. Records use, changes in skin color, skin temperature, swelling, or sores on legs, and client complaints. 14. Reports any changes in skin color, skin-temperature, swelling, or sores on legs, and client complaints.

Checklist for Procedure XII-14 HELPING THE CLIENT TO WALK 1. Explains procedure to client 2. Reassures client 3. Instructs client regarding shoes to wear. 4. Assists client in practicing standing and shifting weight 5. Walks slowly, taking small steps. 6. Walks with client on client's weak side using correct positioning. 7. Walks for short distances. 8. Observes, records and reports any changes in condition or behavior.

Checklist for Procedure XII-15 MAKING AN UNOCCUPIED BED 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23.

Washes hands. Assembles equipment. Puts on gloves, as necessary. Removes and folds bedding to be re-used. Smoothes mattress pad. Places bottom sheet in correct position. Tucks in top. Miters corner Tucks in side. Positions top covers correctly. Tucks in at bottom. Miters corner. Goes to opposite side of bed. Repeats steps 4 to 10, pulling and smoothing sheets. Adds spread, and tucks in at bottom. Turns soiled pillowcase inside out. Opens clean pillowcase. Grasps clean pillowcase in center of bottom seams. Folds pillowcase over hand. Grasps end of pillow through pillowcase in the center. Pulls clean case over pillow with other hand. Removes soiled linen. Washes hands.

Checklist for Procedure XII-16 MAKING AN OCCUPIED BED 1.

Explains procedure to client.

Washes hands.

3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. side. 19. 20. 21. 22. 23.

Assembles equipment. Puts on gloves, as necessary. Removes and neatly folds bedspread. Loosens bedding on one side. Loosens top sheet at foot Slides top sheet under blanket, leaving blanket on client. Removes all pillows except one under client's head. Turns client onto side. Folds/roils bottom sheet(s) up to and under client's head, back, and legs. Smoothes mattress. Positions clean bottom sheet. Folds clean bottom sheet next to and under soiled sheets. Tucks in bottom sheet at head. Miters corner at head. Tucks in bottom sheet along side. Positions draw sheet, folds under soiled bottom sheet, and tucks in along Turns client to clean side of bed. Goes to opposite side of bed. Loosens and removes bedding. Places soiled linen appropriately. Smoothes mattress pad.

24.

Pulls clean linen through and straightens.

25.

Tucks in at head, corner, and sides.

26.

Removes soiled pillowcases appropriately.

27.

Puts on clean pillowcases correctly.

28.

Removes soiled linen.

29.

Washes hands.

30.

Observes, records and reports any changes in condition or behavior.

Checklist for Procedure XII-17 USE OF A BEDPAN 1. Explains procedure to client. 2. Washes hands. 3. Assembles equipment. 4. Puts on gloves, as necessary. 5. Warms and powders bedpan. 6. Places protector pad near client's hips. 7. Places bedpan on bed near ctienfs hips. 8. Maintains client's privacy. 9. Assists client in lifting hips or assist client to roll if unable to li hips. 10. Places bedpan under hips. f1 Assists client to sit, if possible. 12. Provides toilet paper and call signal. 13- Assists verbally or manually with wiping, if necessary. 14. Assists client in raising hips. 15. Removes bed pan carefully. 16. Assists client to wash hands. 17. Adjusts bed cover. 18. Removes bedpan to bathroom. 19. Observes, measures (if indicated), and disposes of contents. 20. Cleans bedpan. 21. Washes hands. 22. Observes, records and reports any changes in condition or behavior.

Checklist for Procedure XII-18 USE OF URINAL 1. Explains procedure to client 2. Washes hands. 3. Assembles equipment 4. Puts on gloves, as necessary. 5. Maintains client's privacy, 6. Places bed protector under client's hips. 7. Gives client urinal, 8. Places urinal to collect urine, 9. Provides toilet paper and signal bell. 10. Assists with hand washing, as necessary. 11. Empties urinal. 12. Cleans urinal 13. Washes hands. 14. Observes, records and reports any changes in condition or behavior.

Checklist for Procedure XII-19 ASSISTING WITH THE USE OF THE CONDOM CATHETER 1. Explains procedure to client. 2. Washes hands. 3. Assembles equipment. 4. Puts on gloves. 5. Maintains client's privacy, 6. Exposes genital area only. 7. Washes and dries penis carefully. 8. Observes skin of penis for sores. 9. Attaches condom to tubing, if necessary. 10. Rolls condom catheter onto penis as directed on the Care Plan or by supervising nurse. 11. Checks that tubing is one to two inches below tip of penis. 12. Checks that tip of condom is not twisted 13. Washes hands. 14. Records the application of condom catheter and presence of sores or raw areas. 15. Reports presence of any sores or raw areas on or around penis.

Checklist for Procedure XII-20 ASSISTING WITH CLEANING THE SKIN AND CATHETER TUBING 1. Explains procedure to client 2 Washes hands. 3Assembles equipment 4. Puts on gloves. 5. Maintains client's privacy. 6. Places client on his/her back so that the catheter and urinary opening are exposed. 7. Puts towel or disposable bed protector under client. 8. Washes the genital gently with soap and water. Does not pull on the catheter, but holds with one hand white wiping it with the other. Gently pushes back foreskin on uncircumcised male before cleaning. 9. Observes area around the catheter for sores, crusting, leakage, or bleeding. 10. Dries area with a towel. 11. Cleans the catheter tubing as directed by the Care Plan starting with the tubing nearest to the client. 12. Positions the client so that the catheter and tubing does not pull and are free from kinks or pulling. 13. Tapes tubing to the client as directed in the Care Plan. 14. Disposes of dirty water into the toilet 15. Discards any disposable equipment 16. Removes the bed protector or towel. 17. Cleans and stores re-usable equipment 18. Washes hands. 19. Records time catheter care was done. 20. Observes, records and reports any changes in condition or behavior.

Checklist for Procedure XII-21

ASSISTING WITH THE EMPTYING OF THE URINARY DRAINAGE BAG 1. Explains procedure to client 2. Washes hands. 3-

Assembles equipment.

4Puts on gloves. 5. Puts measuring pitcher below the drainage bag. 6. Observes condition of tubing; clear or has particles in it. 7. Takes the drainage tube on the bag out of its holder. 8. Unclamps and opens the drainage tube on the bag being careful not to touch the end of the tube, 9. Drains urine from the bag into a container. 10. Cleans the end of the drainage tube as directed by the Care Plan. 11. Clamps the drainage tube and puts it back into its holder being careful not to touch the end with hand or anything else. 12. Measures the amount of urine, if directed by the Care Plan. 13. Observes the color, odor of the urine, whether mucus or blood was present in the urine, and condition of the drainage bag. 14. Empties urine into the toilet 15. Rinses pitcher with cool water. Cleans with soap and brush. 16. Stores dean pitcher. 17. Washes hands. 18. Records amount of urine (if directed by the Care Plan) and observations. 19. Reports cloudy, strong smelling, or bloody urine. Reports if there is only a small amount or no urine in the drainage bag when it is scheduled to be drained.

Checklist for Procedure XII-22 POSITIONING THE CLIENT IN BED CLIENT ON BACK 1. Explains procedure to client. 2. Washes hands, 3. Assembles equipment. 4. Puts on gloves, as necessary. 5. Centers client safely in bed. 6. Turns client safely on back. 7. Aligns client's body. 8. Places pillows or folded towels appropriately:  under head;  under small of back;  alongside hips. 9. Positions arms appropriately. 10. Supports and covers feet appropriately. 11. Makes client comfortable and safe. 12. Washes hands. 13. Observes records and reports any changes in condition or behavior.

CLIENT ON SIDE 1. Explains procedure to client 2. Washes hands. 3. Assembles equipment. 4. Puts on gloves, as necessary.

5. 6. 7. 8.

   

Centers client safely in bed. Turn client onto side. Aligns client's body. Places pillows or folded towels/blankets appropriately: under head and neck; at back; under top leg and foot; under top arm.

9. Positions hips and legs appropriately. 10. Covers client, making comfortable and safe. 11. washes Hands. 12. Records and reports appropriately. CLIENT ON ABDOMEN 1. Explains procedure to client2. Washes hands. 3. Assembles equipment. 4. Puts on gloves, as necessary. 5. Moves client to side of bed. 6. Turns client onto abdomen. 7. Aligns head and turns to side. 8. Place pillow under client's head. 9. Place arms appropriately. 10. Supports lower legs and feet. 11. Covers client appropriately. 12. Washes hands. 13. Observes, records and reports any changes in condition or behavior.

Checklist for Procedure XII-23 TRANSFER TO THE SITTING POSITION IN BED 1. Explains procedure to client 2. Washes hands. 3. Put on gloves, as necessary. 4. Faces head of bed, outer foot forward. 5. Raises head of bed or locks arms with client 6. Has client bend knees. 7. Pulls client to sitting position by rocking. 8. Places pillows behind head. 9. Checks client for dizziness, weakness, etc. 10. Washes hands. 11. Observes, records and reports any changes in condition or behavior.

Checklist for Procedure XII-24 HELPING THE CLIENT TO SIT AT THE SIDE OF THE BED 1.

Explains procedure to client.

Washes hands

Puts on gloves, as necessary.

Rolls the client on side facing self. Bends client's knees.

Reaches one arm over to hold him/her in back of knees.

Places other arm under the neck and shoulder area.

Positions feet with a wide base of support.

On the count of "three" shifts weight to back leg. While doing this, swings the client's legs

over the edge of the bed while pulling his/her shoulders to a sitting position. 9.

Remains in front of the client with both hands on him/her until is sure the client is able to

safely sit alone. 10.

Washes hands.

11.

Observes, records and reports any changes in condition or behavior.

Checklist for Procedure XII-24 HELPING THE CLIENT TO SIT AT THE SIDE OF THE BED 1.

Explains procedure to client.

Washes hands

Puts on gloves, as necessary.

Rolls the client on side facing self. Bends client's knees.

Reaches one arm over to hold him/her in back of knees.

Places other arm under the neck and shoulder area.

Positions feet with a wide base of support.

On the count of "three" shifts weight to back leg. While doing this, swings the client's legs

over the edge of the bed while pulling his/her shoulders to a sitting position. 9.

Remains in front of the client with both hands on him/her until is sure the client is able to

safely sit alone. 10.

Washes hands.

11.

Observes, records and reports any changes in condition or behavior.

Checklist for Procedure XII-25 HELPING A CLIENT TO STAND 1.

Explains procedure to client (client is sitting at edge of bed).

If necessary, puts bed in lowest position.

Washes hands.

Puts on gloves, as necessary.

Places one foot forward between client's feet. If the client has a weak knee, braces knee against

his/hers. 6.

Tells client to put strongest foot under him/her self.

Bends knee and leans onto forward foot. Places both arms around the client's waist. Holds client closely.

Tells client to push down on bed with arms and lean forward. On the count of "one â&#x20AC;&#x201D; two â&#x20AC;&#x201D; three",

assists client to stand. Assists client by rocking weight to back foot and lifting as reaches three. Supports client until is sure he/she is able to safely stand alone. 9.

Washes hands.

10.

Observes, records and reports any changes in condition or behavior.

Checklist for Procedure XII-26 TRANSFER TO WHEELCHAIR, CHAIR, OR COMMODE 1. Explains procedure to client. 2. Washes hands. 3. Puts on gloves, as necessary. 4. Angles wheelchair next to bed. 5. Locks brakes. 6. Places safety belt on client, if needed. 7. Dangles client's legs over side of bed. 8. Stands client up. 9. Rotates client until back is facing wheelchair. 10. Backs up client until client feels the chair with the back of legs. 11. Maintains good body mechanics. 12. Lowers client into wheelchair. 13. Adjusts footrests. 14. Releases brakes. 15. Covers client as needed. 16. Washes hands. 17. Observes, records and reports any changes in condition or behavior.

Checklist for Procedure XII-27 POSITIONING CLIENT IN CHAIR OR WHEELCHAIR 1. Explains procedure to client 2. Washes hands.

3. 4. 5. 6. 7. 8. 9. 10. 11. 12.

Assembles equipment Puts on gloves, as necessary. Places client's hips back in chair. Places feet appropriately. Checks for position of male genitals. Places pillows appropriately. Supports arms. Makes client comfortable and safe. Washes hands. Observes, records and reports any changes in condition or behavior.

Checklist for Procedure XII-28 TRANSFER FROM WHEELCHAIR TO TOILET 1. Explains procedures to client 2. Washes hands. 3. Puts on gloves, as necessary. 4. Checks bathroom for supports and grab bars. 5. Places wheelchair, facing toilet 6. Locks wheels. 7. Raises footrests. 8. Assists client to stand. 9.

Rotates client until back is toward toilet

10. Arranges clothing. 11. Assists client to sit on toilet

12. 13. 14. 15. 16. 17. 18.

Allows privacy. Assists in cleaning client after toileting. Washes hands. Reverses steps six to nine. Assists client to wash hands. Washes hands. Observes, records and reports any changes in condition or behavior.

Checklist for Procedure XII-29 TRANSFER FROM WHEELCHAIR TO SHOWER AND ASSISTING WITH SHOWER 1. Explains procedure to client 2. Washes hands. 3.

4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20.

Assembles equipment

Puts on gloves, as necessary. Positions wheelchair at appropriate angle to shower. Places towel on shower chair/stool. Locks wheels. Raises footrests. Stands client up appropriately. Pivots client so back is toward shower chair. Assists client to sit in shower chair. Places toilet articles within client's reach. Allows client privacy. Ensures that soap is rinsed off client Assists in drying client Gets clean clothing ready. Reverses steps seven to nine. Covers client to avoid chilling. Washes hands. Observes, records and reports any changes in condiition or behavior.

Checklist for Procedure XII-30 TRANSFER FROM WHEELCHAIR TO STOOL OR CHAIR IN TUB 1. Explains procedure to client 2. Washes hands. 3. Assembles equipment. 4. Puts on gloves, as necessary. 5. Places not-slip mat in tub. 6. Places covered chair/stool in tub. 7. Fills tub with water. 8. Positions chair parallel to tub. 9. Provides for privacy. 10. Assists in removing clothing. 11. Assists client in sliding to edge of tub. 12. Pushes wheelchair out of the way. 13. Assists client onto chair in tub. 14. Assists with bathing and drying upper body. 15. Reverses steps ten to twelve. 16. Dries lower body. 17. Assists with dressing and grooming. 18. Makes client comfortable and safe. 19. Cleans area. 20. Washes hands. 21. Observes, records and reports any changes in condition or behavior.

Checklist for Procedure XII-31 WEIGHING A CLIENT 1. Explains procedure to client 2. Washes hands. 3. Assembles equipment. 4. Puts on gloves, as necessary. 5. Checks that the needle of the scale is at "0". If not, re-adjust 6. Helps client onto scale. 7. Provides support while client steadies self 8. Notes weight after dial stops moving. 9. Observes for any problems the client has during this procedure, such as inability stand on scale. 10. Helps client off the scale. 11. Records the weight. 12. Reports any changes in any condition or behavior (such as a gain or loss of more than five pounds or client concerns about weight). 13. Stores the equipment in a safe place.

Checklist for Procedure XII-32 INSURING INTAKE 1. Explains to client the need to keep track of intake. Gets client's cooperation by asking client to tell when they have had something to drink and to report how much they have had. 2. Washes hands. 3. Assembles equipment. 4. Serves liquids in containers (bowls, glasses, or cups), measured ahead of time. 5. Measures serving containers ahead of time: 6. Assembles equipment (measuring cup, bowl, cup and/or glasses that will be used each time client drinks or eats something; paper; and pencil). a. Fills first serving container with water. b. Pours water into measuring cup. c. Writes down this amount on paper. d. Discards water. e. Repeats steps b,c, d, and e for each serving container. f. Keeps this list for use each time client's intake is measured. 7. Writes down types and amounts of liquids served to client. 8. When client is finished, removes serving containers. 9. Measures each type of liquid that is left. 10. Subtracts leftover amount from amount served to client. Adds all of these together Writes this down. 11.Cleans measuring and serving equipment. 12. Stores measuring and serving equipment 13. Washes hands. 14. Records total amount of intake for a particular time. 15. Observes, records and reports any changes in condition or behavior.

Checklist for Procedure XII-33 MEASURING URINARY OUTPUT 1. Explains to client the need to measure urinary output- Asks client to use bedpan, urinal, or commode when has the urge to pass urine- Gets client's cooperation by asking client to report when has to pass urine. (This win not be necessary if client has urinary drainage bag.) 2. Washes hands. 3. Assembles equipment 4. Puts on gloves, as needed, 5. Pours or drains urine from bedpan, urinal, commode, or urinary drainage bag into measuring pitcher that is on flat surface. 6. Records amount that is in pitcher or .urinary drainage bag. 7. Discards urine unless a specimen is needed. 8. Cleans re-usable equipment 9. Stores re-usable equipment. 10. Washes hands. Observes records and reports any changes in condition or behavior, such as strong smelling urine, cloudy urine, blood in the urine, very small amount of urine, or if client has pain or difficulty when passing urine.

Checklist for Procedure XII-34 ASSISTING WITH CHANGING A CLEAN DRESSING {using Standard Precautions) 1. Explains procedure to client2. Washes hands. 3. Assembles equipment. 4.

Provides privacy.

5. Assists client to comfortable position. 6. Provides good lighting. 7. Removes clothing over dressing, if necessary. 8. Places waste bag near client for disposal of dressing/waste products. 9. Puts on gloves. 10.

Removes wrappings from new dressing.

11. Cuts tape. 12. Removes and discards old dressing and used gloves. 13. Washes hands. 14. Puts on new gloves. 15. Cleans skin around wound according to directions on Care Plan. 16. Hands requested items to client. 17. Applies new dressing to wound. 18. Tapes new dressing in place. 19. Removes and discards waste bag. 20. Washes hands. 21. Stores unused supplies. 22. Observes, records and reports any changes in condition or behavior, such as changes in the appearance of the wound.

SHIFTING BABY TO "FOOTBALL" HOLD 1. Supports baby's head, neck, and buttocks. 2. Swing baby to the side so that infant rests on hip while the hand and arm cradle the infant, providing support. 3. Washes hands. Observes, records and reports any changes in condition or behavior.

Checklist for Procedure XII-36 INFANT BATH 1. Washes hands. 2. Assembles equipment. 3. Ensures proper temperature of room. 4. Prepares changing area. 5. Prepares bath water at correct temperature. 6. Puts on gloves, as needed. 7. Brings baby to bath area. 8. Undresses and covers baby. 9. Lowers baby into water. 10. Shampoos, rinses, and dries head. 11. Washes body, going from head to foot. 12. Washes genitals correctly. 13. Dries baby. 14. Applies lotion as directed on Care Plan. 15. Diapers and dresses baby. 16. Gives nail care, if needed. 17. Washes hands. 18. Observes, records and reports any changes in condition or behavior.

Checklist for Procedure XII-37

ASSISTING WITH THE USE OF THE HYDRAULIC LIFT 1. Explains procedure to client. 2 Washes hands 3. Assembles equipment 4. Puts on gloves, as needed. 5. Checks whether valves are working on lift 6. Clears the floor around the area you are working. 7. Opens legs of lift stand to widest position 8. Brings wheelchair or chair close to bed. Locks wheels of wheelchair and bed (if hospital bed). 9. If possible, raises or lowers height of bed to accommodate height of lift. 10. If available, raises side rails on far side of bed. 11. Rolls one edge of the sling up to one-half of width. 12. Places sling on bed on the far side of the client. Sling should be midway between head and thigh of client. 13. Rolls the client toward self and moves sling so it covers one-half of client's back. 14. Rolls client back onto the sling and over on other side (over the hump of the sling). 15. Keeping the client rolled away from self, unrolls the sling, making sure it is flat and unwrinkled. 16. Rolls client onto back and adjusts sling so that it is midway between client's head and thigh. 17. Raises the lift (closes valve and pumps up the lift arm). 18. Steadies the swinging bar as it is positioned over the client. 19. Lowers arm and attaches the chains or hangers to the sling (longer chain to the thigh part of the sling and shorter chain to the head area), being sure the chain or hangers are away from the client's body. 20. Tells client when starting to pump up the lift.

21. After lifting the client a few inches and before moving the lift away, checks all connections to make sure they are fastened tightly and working properly. 22. Pumps us the lift until the client is in a half-sitting position. 23. Lifts client's feet and removes from bed. 24. Moves to the handles or bar of the lift for steering. 25. ' Gently and slowly moves the base of the lift out from under the bed, and slowly turns it toward the wheelchair or chair. 26. Positions the lift so client is over the wheelchair or chair. 27. Lowers the client to the seat by slowly opening the valve until client is just above the seat 28. Holds the sling near the head and puts knees against the client's knees. Supports the client's upper body against self. Uses knees to push gently on the client's knees. Then, releases the valve so that the client sits in the wheelchair or chair. 29. Removes the S-shaped hooks while holding onto the bar. 30. Closes the valve and pumps the lift up out of client's way. 31. Moves lift away. 32. Washes hands. 33. Observes, records and reports any changes in condition and behavior or problems with equipment.

Checklist for Procedure XII-38 SLIDE BOARD TRANSFER PROCEDURE 1. Explains procedure to client. 2. Washes hands. 3. Assembles equipment 4. Puts on gloves, as necessary. 5. Places wheelchair or chair at a 45 degree angle to the bed or alternate chair. 6. If wheelchair, locks brakes and removes armrest if able. 7. If client is without clothing, the board should be covered with a pillowcase. 8. Places slide board like a bridge between bed and wheelchair, chair to chair, etc. 9. Has client lean away from slide board. 10. Places slide board under buttocks, transferring towards the client's strong side possible 11. Ensures that the slide board is securely placed before client begins transfer. 12. Directs client to place hands on the slide board at each side adjacent to thighs. 13. Directs client to take a series of small push-ups across the board until client reaches the other side of the board. 14. Assists client, as necessary, with each push-up. 15. Uses gait belt, as necessary. 16. Cleans and stores slide board when transfer is complete. 16. Washes hands. 17. Observes, records and reports any changes in condition or behavior.

Checklist for Procedure XII-39 CHECKING THE RIGHT PERSON 1.

Washes hands.

Reads the container label.

Checks the name on the label to make sue it is the same as the client's name.

Checks the name on the label against the name on the Care Plan.

If they are the same, gives container to client and/or assists with administration as ordered on

the Care Plan. 6.

If they are not the same, contacts supervisor for further instructions;

Explains to client the reason for this.

Records and reports any problems about the medication in question.

Checklist for Procedure XII-40 CHECKING THE RIGHT MEDICATION 1.

Washes hands.

Reads the container label.

Checks the expiration date.

Checks the name of the medication on the label to make sure it is the same as the medication

name on the Care Plan. 5.

If they are the same, gives container to client and/or assists with administration as ordered by

the Care Plan. 6.

If they are not the same, contacts the supervisor for further instructions:

Explains to client the reason for this.

Records and reports any problems about the medication in question.

Checklist for Procedure XII-41 CHECKING THE RIGHT DOSE 1.

Washes hands.

Reads the container label.

Checks the dose on the label against the dose for that medication on the Care Plan.

If they are the same, gives container to client and/or assists with administration as ordered

by the Care Plan. 5.

If they are not the same, contacts the supervisor for further instructions: Explains to the client the reason for this.

Records and reports any problems about the medication in question.

Checklist for Procedure XII-42 CHECKING THE RIGHT TIME 1.

Washes hands.

Reads the container label.

Checks the time for taking the medication against the time specified in the Care Plan.

If they are the same, gives container to client and/or assists with administration as ordered

by the Care Plan. 5.

If they are not the same, gives container to client and/or assists with administration as

ordered by the Care Plan. 6.

Explains to the client the reason for this.

Records and reports any problems about the medication in question.

Checklist for Procedure XII-43 CHECKING THE RIGHT ROUTE 1.

Washes hands.

Reads the container label to determine if it lists any information regarding the route by which the

medication should be given. 3.

Checks the Care Plan to determine the route that is specified for the medication.

if available, checks to make sure the route specified on the label matches the route specified on the

Care Plan. 5.

Gives the container to the client and/or assists with administration as order in the Care Plan if:

the route is specified in the Care Plan; or

the route specified in the Care Plan and on the label match.

If they are not the same or there is no information, contact the supervisor for further instructions:

â&#x20AC;&#x201D; Explains to the client the reason for this. 7

Records and reports any problems about the medication in question.