Certified Nursing Assistant Exam: Promotion of Health and Safety

Review of Body Systems Affected  by Aging 
Health means that all systems of the body are working normally. Wellness is defined  by each person who takes into account how he or she views his or her health and  happiness, often described as the sense of well-being, or outlook on the future. 

The human body is made up of systems—a group of organs, each with a specific makeup and  function. Each organ within a system works with other organs to keep the body healthy. For  example, the stomach and intestines are organs of the gastrointestinal system whose function is  to take in, digest, and eliminate food and fluids to keep the body nourished. Body systems are  the backdrop for this chapter as you review disease, the absence of wellness. More important  is your role and responsibility to promote resident health and safety while helping to prevent  the spread of disease. 

As residents age, their body systems do not function as fully as when they were younger. 
This 'wear-and-tear' theory of stress on each body system makes residents more susceptible  to disease or injury. Immunity, the ability to ward off disease, might also decrease due to the  natural aging process. Certain diseases can also affect immunity and medical treatment, such  as cancer and the drugs used to treat it. 

Although health and well-being vary among residents, all share the following common,  age-related changes for which they must adapt: 
- Risk for chronic illness 
- Changes in mobility 
- Decreased vision and hearing 
- Decreased ability to sense pain 
- Change in sleep habits 

It is a myth that healthy older adults, often called elders, lose intellectual abilities; that is,  their wisdom, judgment, and common sense. However, research proves that elders over age 60  might have a slight loss of short-term memory, mathematical calculations, word construction,  and abstract thinking. Although a bit slower, elders can learn new skills. 
Normal aging does not necessarily affect mobility. Age-related changes, however, could affect  muscle strength, flexibility, and stability. Joint changes caused by chronic conditions, such as  arthritis or muscle tremors from Parkinson’s disease, can also affect the ability to stand, stoop,  and walk. When mobility is affected by aging, elders risk falling, which can lead to injury  requiring hospitalization. Many elders might never regain fully functional mobility. Injuries  from falls are the second leading cause of death in elders over age 65 and are the leading cause  of death for those 85 years and older. 
The ability to see clearly and at long distances declines with age. Elders have difficulty seeing  well in dimly lit areas or at night, which puts them at high risk for falls as well. Cataracts, or  a clouding of the lens of the eye, can also contribute to the risk for falls. Unless treated early,  glaucoma, a chronic disease affecting the optic nerve of the eye, can put elders at risk for  blindness. 

Communicable Diseases and Their Effect on Health 
Hearing loss is a normal part of aging, especially if persons are exposed to high noise levels at  a young age. Meniere’s, a chronic disease affecting the inner ear, can put elders at risk for falls  due to dizziness, which interferes with normal movement and ambulation. 
Older adults might ignore signs and symptoms of illness or injury due to a less than normal  ability to feel pain. This can occur in elders with diabetes, who might develop an open sore  or a cut on their foot or lower leg but not feel any discomfort until the injured area becomes  infected. 
Risk factors for chronic illness (those factors affecting particular persons and not others)  can also contribute to illness. These include cultural, racial, and ethnic factors. For example,  diabetes is higher among African Americans, Hispanics, Native Americans, and Native Alaskans than for white Americans. Likewise, obesity is becoming a public health crisis for North American populations compared to persons living in other countries. Access to health  care, or lack of it, affects how timely persons in one cultural or ethnic group seek treatment  for an illness, which, if left untreated, becomes a chronic health problem. Hypertension, or  high blood pressure, is an example of a condition that, if left untreated, can lead to a stroke. 
Economic status also can be considered a risk factor if an individual does not have health  insurance and cannot afford health care. 
Cultural or religious beliefs might prevent individuals from participating in certain traditional  health-care practices. Instead of seeking care from a physician, for example, they rely on others  in the community who can provide care through alternative medical therapies or folk remedies. 
Other chronic diseases, such as dementia, Alzheimer’s disease, circulation problems, or mental  confusion caused by arteriosclerosis or the effects of a stroke, can all affect thinking and  reasoning processes. These chronic conditions can put elders at risk for injury. 

Communicable Diseases and Their Effect on Health 
Diseases can sicken an individual alone or can be communicable, or contagious, in nature, meaning  they can spread from one person to another. In the case of long-term residents, communicable  diseases or infections are transmitted by a pathogen (disease-causing microorganism) that  can infect many residents who live in the same location. Pathogens can include bacteria,  viruses, fungi, and parasites. A common bacterial pathogen that is particularly worrisome  in the long-term care setting is methicillin-resistant Staphylococcus aureus, often referred to as 
MRSA. MRSA is an infection of the skin that can spread to the blood stream and become  life threatening. MSRA is resistant to certain antibiotics (drugs that kill bacteria), such as Methicillin. It is difficult to kill and, if left untreated or a chronic infection develops, MRSA  can strike an entire population of residents. MRSA is also becoming a major health problem  in the general community. 

Other infectious diseases can infect long-term residents, such as tuberculosis (TB), a bacterial  illness; influenza, a viral infection; pneumonia, of viral or bacterial origin; or the most commonly  spread virus, the common cold. Pathogens causing these illnesses can enter the body  by contamination through direct contact (for example, blood or body fluids or open wounds)  or by droplet (for example, inhaled through the air). Specific organ systems become infected,  which give rise to signs and symptoms indicating an acute infection or illness. Unfortunately,  residents often become contagious before their symptoms appear. Signs and symptoms of  infection include but are not limited to fever, chills, elevated white blood cell count, wounds  containing a strong odor or drainage, local heat, and redness around a skin sore or other body  lesion, a general sense of not feeling well (malaise), and mental confusion. 
Infections or conditions involving the skin can become contagious through direct contact. 
Examples of these conditions are scabies, a skin infestation by a tiny mite that causes a rash and  intense itching, and shingles, a skin condition caused by a virus that attacks a nerve path, which  causes pain and disability. The drainage from open shingles blisters can infect others by direct  contact. 

The following is a quick review of common terms regarding communicable disease: 
- Antisepsis: The prevention of sepsis by preventing or slowing the growth of  disease-causing germs. 
- Infection control: Measures to prevent or limit infection; control methods vary  depending on the type of germ and how it is spread. 
- Isolation: An attempt to limit the spread of disease by its mode of transmission  (for example, respiratory precautions for a tuberculosis patient). 
- Medical asepsis: Procedures to reduce the number of germs in the environment. 
- Pathogen: Disease-causing microorganism or germ. 
- Sepsis: Putrefaction; infection. System-wide response to a specific infection. 

Role of the Nursing Assistant to Prevent the Spread  of Communicable Diseases 
You play an important role in reinforcing the nurse’s teaching plan regarding infection control  for residents. You can help explain to residents the reasons for limiting their exposure to other  residents who are ill, why they must not share equipment or supplies with other residents,  how they can avoid cross-contamination when visiting other residents, how to practice good  handwashing and self-care practices, and so on. Residents’ families must also be included in  the teaching plan to help ensure residents’ health. 

You must take responsibility for your own health as well as that of the residents. Following the  facility’s policies and procedures for health screening, including TB surveillance, immunizations  and health history, not working while you are ill, practicing effective hand hygiene, and  other infection control measures are essential for safe practice. 
The following sections outline the infection control guidelines, procedures, and precautions  you must follow to guard residents and yourself from infection. 

Medical Asepsis 
Adhere to specific facility policies and procedures regarding infection control when providing  care for residents, which applies to patients in acute care facilities as well. 
- Use of standard precautions: The following standards set guidelines to prevent and  control disease as recommended by the Center for Disease Control (CDC): 
 

- Hand hygiene and contamination: 

Wash hands when visibly dirty or contaminated with blood or other body fluids. 
Wash hands with plain soap and hot water using friction for at least 30 seconds. 
Wash hands before eating and after using the restroom, before and after entering  a resident’s room, and before and after touching a resident’s belongings or personal  equipment. 
Remember, reinforce handwashing with each resident, encouraging them to wash  their hands as needed to prevent the spread of germs. 

Tip
Handwashing is the most effective precaution used to control infections in residents and staff. It is now  recommended that health-care workers sing the Happy Birthday song twice while washing hands before  and after every resident contact. 
Apply hand lotion to limit breaks in the skin from frequent handwashing and  antiseptic product applications. 
Follow agency policy for approved lotions. To help avoid contamination of the lotion, do not use lotions  from large containers. 

Caution 
Keep nails natural (no artificial nails), with tips trimmed to less than 1/4 inch; no  nail polish or decals allowed. 
Apply an antiseptic hand-rub product. 

Note 
For optimum effect when using hand sanitizers, apply generous amounts to hands, applying friction with  laced fingers, and let the sanitizer dry completely before touching the resident. 
- Hand hygiene in all other clinical situations: All clinical situations include direct  contact with the resident and the resident’s personal articles. 

Gloves: 
Wear gloves when in contact with blood or other potentially infectious materials,  mucous membranes, and non-intact skin. 
Change gloves during resident care as needed when moving from a contaminated body  site to a clean body site. 
Remove gloves when resident care is completed. 
Change gloves with each new resident contact. 

Caution 
Wash hands after removing gloves. 
Mask, Eye Protection, Face Shield, Gowns 
The risk of being splashed with blood and body fluids (including tears, saliva, semen, vaginal  secretions, urine, or fluid drawn from body cavities) is higher in the acute care setting, but  splashes can occur in any setting and should be avoided. Wear a mask, eye protection, or gown  if you risk exposure. To protect against airborne contamination, wear a mask as directed by the  specific isolation procedure required in your facility. You should also protect yourself when such  a disease is suspected but not diagnosed. Chapter 6, 'Clinical Skills Performance Checklists,'  reviews the isolation procedures in detail. Wearing the personal protective equipment (PPE)  described is a type of isolation referred to as contact isolation. 

Extra Tip
Remember the required sequence for donning and removing an isolation gown, gloves, and mask used  in a contact isolation procedure. Review other precautions for specific clinical conditions as outlined  in your facility procedure manual or your textbook. 

Communicable Diseases and Their Effect on Health 
Sharp Objects 
Make every effort to avoid accidental needle sticks or cuts with sharp objects (often referred  to as sharps). 
Keep needles or sharp objects away from residents when not in use. 
Be careful when changing resident linens, because they are a common site for discarded needles. 

Caution 
Promptly report to your supervisor any needle stick or puncture wound by a sharp object. 
You and other health-care workers are at high risk for transmission of Hepatitis B (HBV),  a blood-borne pathogen, or human immunodeficiency virus (HIV). Infection with HIV can  destroy the body’s immune system and lead to other infections and AIDS. Infection caused  by these viruses can result from a needle stick or other skin puncture by an instrument with  contaminated blood on it. 
Follow the procedure outlined in your facility’s procedure manual regarding follow-up care and  observation as directed for accidental exposure. Follow-up procedures in cases of accidental exposure  to blood-borne pathogens is an example of risk management to help ensure resident and employee safety. 

Caution 
Care of residents with HIV infection, AIDS, and other special needs.

If you must handle sharps containers, be careful not to force needles, syringes, or other sharp objects  into the container. Close, seal, and dispose of sharps containers per agency protocol. To avoid accidental  exposure as previously described, never empty sharp containers. 

Caution 
Resident Equipment 
To ensure resident safety, adhere to facility policies regarding the use, care, and disposal of  resident care equipment, because equipment used to care for residents can harbor pathogens  that put them and you at risk. 

- Clean and reprocess reusable equipment if used for multiple residents. 
- Use equipment carefully to prevent exposure to resident blood and body fluids. 
- Protect other residents from cross-contamination (spreading pathogens from one resident  to another). 

Environment 
Follow facility policies and procedures to keep residents’ environment as safe as possible,  which includes keeping equipment, resident furniture, and personal articles free from  contamination. Wipe spills from environmental surfaces promptly, disinfect them, and follow  established procedures for removal of hazardous wastes, defined as any waste material that can  cause infection. Hazardous wastes include any body fluids, such as blood. 

Extra Tip
Remember those articles that must be discarded in a special biohazard container. 

Linens 
Keep resident linen from touching the floor; if it does, change it promptly. When soiled,  remove linen immediately (fold the contaminated side inward and carry linen away from  your body), tie the soiled linen inside a plastic bag, and deposit the bag in the facility’s soiled  linen area. 
Dispose of dirty linen or other contaminated articles immediately. Do not wait for other team members to  do so, because infection control is everyone’s responsibility. 

Caution 
Surgical Asepsis 
Surgical asespsis means using a sterile technique to protect against infection before, during,  and after surgery by removing as many microorganisms as possible. When assisting the nurse  with sterile procedures (for example, positioning the resident), avoid touching equipment  or other objects placed in the sterile field. Touching such equipment or objects causes the  treatment area to be contaminated. 

Resident Safety 
Residents have a right to feel safe and secure in the long-care environment. An important  responsibility of a nursing assistant is to maintain their safety. Safety and security includes the  following: 
- Protection from falls: The most common accident for residents is a fall, often from  a wet, slippery floor, or from equipment or supplies left in the resident’s path, or by  equipment that is damaged or improperly used. Watch constantly for environmental  hazards that can place residents at risk for falls. This includes assuring adequate  lighting of the residents’ rooms; providing residents with reading glasses, canes,  and other ambulation devices in good working order; removing spills and clutter in  residents’ environment; keeping frequently used supplies within easy reach of residents;  assisting at-risk residents with ambulation; and keeping residents’ beds in the lowest  position. Restraints or other devices used to protect residents from harming themselves  or others are discussed in Chapter 5. 
- Proper identification: Mistakes in care can occur by failing to properly check  residents’ identification. Always check residents’ armbands before serving their meals,  performing nursing care, or other tasks that can place residents at risk. 
 

- Fire safety: Protecting residents from fires is of utmost importance, because many  residents cannot protect themselves, especially when a fire requires emergency  evacuation. When a fire occurs, remember the R.A.C.E. system: 
- Remove all residents in the immediate area of the fire. 
- Activate the fire alarm and notify others of the fire. 
- Contain the fire by closing all doors in the area of the fire. 
- Extinguish the fire. 
- Frequent fire drills using the facility’s fire emergency plan is an important strategy to  help prepare all personnel and the residents for a real fire emergency. Residents might  also be evacuated in case of a bomb threat or other environmental crisis; follow the  facility’s evacuation plan for these situations as well. 
- Protection against abuse

Be alert for signs of abuse  or neglect, and immediately report any suspicions you might have to your supervisor. 

Reporting Accidents or Incidents 

1. An incident report must be completed and filed with the facility’s risk manager or other  designated employee whether or not injuries resulted from an accident involving a resident. 
2. Incident reports serve to accurately record what occurred, when it occurred, and all details  of the event, because problems related to the incident might occur sometime later. You must  participate in filing the form if you were directly involved in the accident or witnessed it. 
3. Incident reports provide a record of the accident and offer valuable information leading to  policy changes as needed to improve service to residents.