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Table of
Contents
Contents
Table of
Contents ........................................................... 4
C H A P T E R 1............................................................
34
Health Care
Agencies.................................................. 34
C H A P T E R 2............................................................
58
The Person's
Rights ..................................................... 58
21 C H A P T E R 3.......................................................
81
The Nursing Assistant ................................................
81
C H A P T E R 4 Delegation......................................
104
C H A P T E R 6..........................................................
171
Student and Work .....................................................
171
Ethics .......................................................................
.... 171
C H A P T E R 7..........................................................
205
Communicating With the Person ............................
205
C H A P T E R 8..........................................................
243
Health Team Communications................................
243
C H A P T E R 9..........................................................
285
Medical Terminology................................................
285
112 C H A P T E R 1 0................................................
309
Body Structure and Function ...................................
309
145 C H A P T E R 1 2................................................
387
The Older Person.......................................................
387
191 C H A P T E R 1 4................................................
423
Preventing Falls .........................................................
424
204 C H A P T E R 1 5................................................
455
Restraint....................................................................
.. 455
Alternatives and Restraints ......................................
455
C H A P T E R 1 6.......................................................
493
Preventing Infection..................................................
493
C H A P T E R 1 7.......................................................
539
Isolation Precautions .................................................
539
C H A P T E R 1 8.......................................................
568
Body
Mechanics ......................................................... 568
CHAPTER1
9 .......................................................594
Moving the
Person.....................................................594
286 C H A P T E R 2
0 ................................................633
Transferring
the..........................................................633
Person ......................................................................
....633
CHAPTER2
1 .......................................................676
The Person's
Unit .......................................................676
323 C H A P T E R 2
2 ................................................710
Bedmaking ................................................................
..710
C H A P T E R 2 3 Oral Hygiene ..............................740
351 C H A P T E R 2
4 ................................................765
Daily Hygiene
and.....................................................765
Bathing......................................................................
...765
375 C H A P T E R 2
5 ................................................819
Grooming ..................................................................
..819
CHAPTER2
6 .......................................................852
Dressing and
Undressing..........................................852
C H A P T E R 2 7 Urinary Needs ............................875
CHAPTER2
8 .......................................................918
Urinary
Catheters.......................................................919
CHAPTER2
9 .......................................................955
Bowel
Needs ...............................................................955
C H A P T E R 3 0 Nutrition Needs .......................1003
C H A P T E R 3 1 Fluid Needs...............................1072
489 C H A P T E R 3
2 ..............................................1095
Nutritional Support and IV Therapy.....................1095
C H A P T E R 3 3 Vital Signs .................................1126
CHAPTER3
4 .....................................................1190
Exercise
and ..............................................................1190
Activity ......................................................................
1190
CHAPTER3
5 .....................................................1230
Comfort, Rest,
and ...................................................1230
Sleep.........................................................................
..1230
CHAPTER3
6 .....................................................1258
Admissions, ..............................................................
1258
Transfers, and
Discharges.......................................1258
CHAPTER3
7 .....................................................1285
Assisting With
the....................................................1285
Physical
Examination ..............................................1285
CHAPTER3
8 .....................................................1300
Collecting
and...........................................................1300
Testing
Specimens....................................................1300
CHAPTER3
9 .....................................................1348
The Person Having..................................................
1348
Surgery......................................................................
1348
C H A P T E R 4 0.....................................................
1383
Wound Care .............................................................
1383
633 C H A P T E R 4 1..............................................
1422
Pressure Injuries ......................................................
1422
647 C H A P T E R 4 2..............................................
1450
Heat and Cold Applications...................................
1450
655 C H A P T E R 4 3..............................................
1469
Oxygen Needs..........................................................
1469
671 C H A P T E R 4 4..............................................
1507
Respiratory ...............................................................
1507
Support and Therapies............................................
1507
679 C H A P T E R 4 5..............................................
1526
Rehabilitation ...........................................................
1526
Needs........................................................................
. 1526
687 C H A P T E R 4 6..............................................
1545
Hearing, Speech, and Vision Problems ................
1545
C H A P T E R 4 7.....................................................
1585
Cancer, Immune.......................................................
1585
System, and Skin Disorders ...................................
1586
C H A P T E R 4 8.....................................................
1618
Nervous System and MusculoSkeletal Disorders1619
736 C H A P T E R 4 9..............................................
1665
Cardiovascular,........................................................
1665
Respiratory, and.......................................................
1665
Lymphatic Disorders...............................................
1665
751 C H A P T E R 5 0..............................................
1699
Digestive and ...........................................................
1699
Endocrine Disorders................................................
1699
762 C H A P T E R 5 1..............................................
1727
Urinary and ..............................................................
1727
Reproductive Disorders..........................................
1727
770 C H A P T E R 5 2..............................................
1746
Mental Health Disorders ........................................
1746
782 C H A P T E R 5 3..............................................
1779
Confusion and Dementia........................................
1779
799 C H A P T E R 5 4..............................................
1824
Intellectual and ........................................................
1824
Developmental Disabilities ....................................
1824
814 C H A P T E R 5 6..............................................
1860
Caring for Mothers and Babies ..............................
1860
C H A P T E R 5 7 Assisted Living ........................ 1910
865 C H A P T E R 5
9 ..............................................1978
End-of-Life
Care.......................................................1978
CHAPTER6
0 .....................................................2000
Getting a
Job .............................................................2000
Review Question
Answers......................................2021
Glossary....................................................................
.2071
Index .........................................................................
.2107

CHAPTER1
Health Care
Agencies
OBJECTIVES
KEY TERMS
acute illness An illness of rapid onset and short
duration; the
person is expected to recover assisted living
residence (ALR)
Provides housing, personal care, support services,
health care,
and social activities in a home-like setting to persons
needing
some help with daily activities case management A
nursing
care pattern; services for the person’s care needs are
obtained
and monitored from admission through discharge and
into the
home or longterm care setting
• Define the key terms and key abbreviations in this
chapter.
• Describe the types, purposes, and organization of
health
care agencies.
• Describe the health team and nursing team
members.
• Describe the nursing service department.
• Describe 5 nursing care patterns.
• Describe the programs that pay for health care.
• Explain your role in meeting standards.
• Explain how to promote PRIDE in the person, the
family,
and yourself.
chronic illness A long-term health condition that may
not have a cure; it
can be controlled and complications prevented with
proper treatment
functional nursing A nursing care pattern focusing on
tasks and jobs; each
nursing team member is assigned certain tasks and
jobs health team The
many health care workers whose skills and knowledge
focus on the
person's total care; interdisciplinary health care team
hospice A health
care agency or program that promotes comfort and
quality of life for the
dying person and his or her family licensed practical
nurse (LPN) A nurse
who has completed a practical nursing program and
has passed a licensing
test; called licensed vocational nurse (LVN) in
California and
Texas licensed vocational nurse (LVN) See “licensed
practical nurse
(LPN)” nursing assistant A person who has passed a
nursing
assistant training and competency evaluation
program (NATCEP);
performs delegated nursing tasks under the
supervision of a licensed
nurse nursing team Those who provide nursing care—
RNs,
LPNs/LVNs, and nursing assistants patient-focused
care A
nursing care pattern; services are
moved from departments to the bedside primary
nursing A nursing
care pattern; an RN is responsible for the person's
total care registered
nurse (RN) A nurse who has completed a 2-, 3-, or
4-year nursing program and has passed a licensing
test survey The
formal review of an agency through the collection of
facts and
observations surveyor A person who collects
information by observing
and asking questions team nursing A nursing care
pattern; an RN leads a
team of nursing staff; the RN decides the amount and
kind of care each
person needs terminal illness An illness or injury from
which the person
will not likely recover
Key Abbreviations
ALR Assisted living residence
APRN Advanced practice registered nurse
DON Director of nursing
LPN Licensed practical nurse
LVN Licensed vocational nurse
PPS Prospective Payment Systems
RN Registered nurse
SNF Skilled nursing facility
Health care agencies (Box 1-1, p. 2) vary in size,
services, and staff. The
person is always the focus of care.
Box 1-1
Types of Health Care Agencies
• Hospitals
• Long-term care centers (nursing homes, nursing
facilities,
nursing centers)
• Memory care facilities
• Home care agencies; home health care agencies
• Surgery centers
• Urgent care centers
• Adult day-care centers
• Assisted living residences
• Board and care homes
• Rehabilitation and sub-acute care facilities
• Hospices
• Doctors' offices
• Clinics
• Centers for persons with mental health disorders
• Centers for persons with intellectual and
developmental
disabilities
• Drug and alcohol treatment centers
• Crisis centers for rape, abuse, suicide, and other
emergencies
Health care agencies must follow local, state, and
federal
laws and rules. This is to ensure safe care.
Agency Purposes
Some agencies have a narrow focus. Surgery centers
are an
example. Surgeries and medical procedures are done
in a
non-hospital setting. The person returns home the
same day
or the next day. Other agencies have many purposes
and
services. The purposes of health care are:
2
• Health promotion. The goal is to reduce the risk of
physical or mental illness. People learn about healthy
living—diet, exercise, and the warning signs and
symptoms of illness are included. They learn how to
manage and cope with health problems.
• Disease prevention. Immunizations prevent some
infectious diseases. Polio, measles, mumps,
smallpox, and hepatitis B are examples. Life-style
changes can promote health. For example, high blood
pressure can cause heart attacks and strokes. Diet
and
exercise help to lower blood pressure.
• Detection and treatment of disease. Diagnostic
tests,
physical exams, surgery, emergency care, and drugs
are used. Respiratory, physical, and occupational
therapies are common. The nursing team observes
signs and symptoms and gives care.
• Rehabilitation and restorative care. This involves
returning persons to their highest possible level of
physical and mental function and to independence.
Independence means not relying on or needing care
from
others. The process starts when the person first seeks
health care. The person learns or re-learns skills
needed to live, work, and enjoy life. Maintaining
function is important. Help is given to make needed
home changes.
These purposes are related. For example: having
chest
pain, a person goes to an emergency room. After an
exam and
tests, the doctor diagnoses a heart attack. The person
is admi
ed to the hospital for treatment. He or she learns
about heart
attack risk factors, diet, drugs, life-style, activity, and
coping
with fears and concerns. A rehabilitation program
begins.
Activity starts slowly and may progress from walking
to
jogging and swimming. Successful treatment and
rehabilitation promote health and may prevent
another heart
attack.
Student Learning
Agencies are often learning sites for students.
Students assist in the
purposes of health care. They are involved with and
provide care.
Types of Agencies
Nursing assistants work in many settings. Some work
in doctors' offices
and clinics. Most work in the following agencies.
Hospitals
Hospitals provide emergency care, surgery, nursing
care, x-ray
procedures and treatments, and laboratory testing.
Respiratory,
physical, occupational, speech, and other therapies
are provided.
Hospital care is either in-patient or out-patient.
• In-patient care—health care a person receives
when admi ed to an agency. At least 1 over-night
stay is involved. See Figure 1-1.
FIGURE 1-1 A hospital room.
• Out-patient (ambulatory) care—medical or
surgical care received when a person is not admi
ed to an agency. The person does not stay over-
night.
People of all ages need hospital care. They have
babies,
surgery, physical and mental health disorders, and
broken
bones. Some are dying.
Hospital patients have acute, chronic, or terminal
illnesses.
• Acute illness is an illness of rapid onset and
short duration. The person is expected to recover. A
heart attack is an example. • Chronic illness is a
long-term health condition that may not have a cure.
The illness can be controlled and complications
prevented with proper treatment. Arthritis is an
example.
• Terminal illness is an illness or injury from
which the person will not likely recover. The person
will die (Chapter 59). Cancers not responding to
treatment are examples. Rehabilitation and
Sub-Acute Care
3
Agencies
Hospital stays are often short. Some people do not
need
hospital care but are too sick or disabled to go home.
Care
needs fall between hospital care and long-term care.
Along
with rehabilitation, complex equipment and care
measures
are often needed. See Chapter 45.
Some hospitals and long-term care centers have
rehabilitation and sub-acute care units. Others are
separate
agencies. Many persons are able to return home.
Others need long-term care.
Long-Term Care Centers
Some persons cannot care for themselves at home
but do not
need hospital care. Long-term care centers are
designed to
meet their needs. Care needs range from simple to
complex.
Medical, nursing, dietary, recreation, rehabilitation,
and
social services are provided.
Persons in long-term care centers are called
residents. They
are not patients. The center is their short- or longterm
home.
Most residents are older. Many have chronic diseases,
poor
nutrition, memory problems, or poor health. Not all
residents
are old. Some are disabled from birth defects,
accidents, or
disease. Hospital patients are often discharged while
recovering from illness or surgery. Some need home
care.
Others need long-term care until able to go home.
Others
need end-of-life care (Chapter 59).
Nursing Centers.
A nursing center (nursing facility, nursing home)
provides medical,
nursing, dietary, recreation, rehabilitation, and social
services. Skilled
nursing facilities (SNFs) provide complex care for
severe health
problems. SNF residents need time to recover or
rehabilitation. Others
never go home.
Memory Care Units.
A memory care unit is designed for persons with
Alzheimer's disease
and other dementias (Chapter 53). Such persons
suffer increasing
memory loss and confusion. Over time, they cannot
tend to simple
personal needs. Wandering is common. The unit is
usually closed off
from other parts of the center. The closed unit
provides a safe setting
where residents can wander freely.
Assisted Living Residences
An assisted living residence (ALR) provides housing,
personal care, support services, health care, and
social activities in a home-like
setting to persons needing some help with daily
activities (Chapter 57). Some
ALRs are part of nursing centers or retirement
communities (Chapter
12).
The person has a room, an apartment, or a co age.
Three meals a day
and 24-hour supervision are provided. So are
housekeeping, laundry,
social, recreational, transportation, and some health
care services. Help
is given with personal care and drugs.
Mental Health Centers
Some persons have problems with life events. Others
present dangers to
themselves or others because of how they think and
behave. Out-patient
mental health care is common. Some need short-term
or long-term in-
patient care.
Home Care Agencies
Health care services are provided to people where
they live. Services
range from health teaching and supervision to bedside
nursing care.
Physical therapy, rehabilitation, and food services are
common.
Hospitals, health care systems, public health
departments, and private
businesses offer home care.
People of all ages need home health care. Some
persons need end-of-
life care at home.
Hospices
A hospice is a health care agency or program that
promotes comfort and quality
of life for the dying person and his or her family.
Hospice patients no longer
respond to treatments aimed at cures. Usually they
have less than 6
months to
live.
The physical, emotional, social, and spiritual needs of
the person and
family are met. The focus is on comfort, not cure.
Children and pets can
visit. Family and friends can assist with care.
Hospice care is provided by hospitals, nursing
centers, and home care
and hospice agencies.
Health Care Systems
Agencies join together as 1 provider of care. A system
usually has
hospitals, nursing centers, home care agencies,
hospice settings, and
doctors' offices (Fig. 1-2, p. 4). An ambulance service
and medical supply
store for home care are common. The system serves a
community or
larger region.
FIGURE 1-2 Parts of a health care system.
The goal is to meet all health care needs. A person
uses system
providers as needed. See Box 1-2 for an example.
Box 1-2
Using a Health Care System
A health care system owns:
• 3 hospitals
• Doctors' offices
• A home care service
• An ambulance service
• A medical supply store
• A nursing center
A patient sees a hospital emergency room doctor
because of sudden dizziness and right-sided
weakness.
Admi ed to the hospital, the patient was having a
stroke.
After 2 weeks of rehabilitation, the patient returns
home by ambulance. The family obtains needed care
items from the medical supply store—hospital bed,
wheelchair, and other items.
The home care agency arranges for the patient's
nursing
needs. A nursing assistant will help with daily hygiene
and grooming needs. A nurse will visit 3 times a week.
Because of another stroke, the patient is taken to the
hospital by ambulance. After hospital care and
rehabilitation, the patient and family agree to nursing
center care.
4 Organization
An agency has a governing group called the board of
trustees
or board of directors. The board makes policies. The
focus is
safe care at the lowest possible cost. Local, state, and
federal
laws are followed.
An administrator manages the agency. He or she
reports
directly to the board. Directors or department heads
manage
certain areas (Fig. 1-3). For example, a director of
nursing
manages the nursing department. A human resources
director handles personnel matters such as hiring
staff. A
social services director meets the social needs of the
person
and family.
FIGURE 1-3 Sample organizational chart of
a health care agency. Titles and
departments may vary among states and
agencies.
See Focus on Long-Term Care and Home Care:
Organization.
Focus on Long-Term Care and Home
Care
Long-Term Care
Nursing centers are usually owned by an individual or
a
corporation. Some are owned by county or state
health
departments. The U.S. Department of Veterans Affairs
(Veterans Administration; VA) also has nursing
centers.
By law, nursing centers must have a doctor as a
medical
director. This doctor consults with the staff about
medical
Organization
problems not handled by a resident's doctor.
Guidance is
given about resident care policies and programs.
The Health Team
5
The health team (interdisciplinary health care team)
involves the
many health care workers whose skills and knowledge
focus on the
person's total care (Table 1-1, p. 6). The goal is to
provide
quality care. The person is the focus of care.

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