A Wonderful Time Of The Year?

This isn’t news to me, or to most aides I suspect.
We see it. We experience it. We hear all about it.
WHAT? The PANIC mode our DON and Administrators go into when it’s THAT time of the year. The biggest pony show is often put onto the stage during these times.

THE ANNUAL SURVEY.
Weeks before they expect the inspections, the leaders go crazy. Everything is painted and cleaned and polished to a high voltage shine.
Suddenly the food is much better- it’s hot when it’s supposed to be, or cold when it should be. More food is served; it looks better and smells better and….YES….it even tastes better. The nice table linens come out. The dishes are apt to be prettier. The cook is suddenly more responsive to resident requests for an alternative. The servers show some respect once again. And the aides HEAR about IT when they’re not in the dining rooms right exactly on (cue) time. The dietitians suddenly show up more at meals and actually taste the food, check it’s temp and go through the motions they’re supposed to have been doing all along.

The DON changes too at this time of the year. She or he goes on a witch hunt, scouring through employee records to see who needs to be updated for in services and background checks and all that. She might realize the nursing home hasn’t offered enough education hours so we the aides are forced to attend stupid movie in services by the half dozen for several weeks. Then we’re coached as to what to say IF the dreaded SURVEYORS ask us questions. An innocent and idealistic aide might ask why she can’t just tell them the truth? Lo and beho, the SIN this person just committed. The DON goes further into herself imposed bitchdom with the resident care plans. And the nurses are the next target of the scorn and attacks. Care plans are re-written; aides and nurses and others are asked, no TOLD, to re-sign endless pages of flow sheets and similar stuff.

The residents get the most out of SURVEY EXPECTATION ANXIETY TIME. They get brand new towels and sheets and linens. They have new toothbrushes with their names on them…and shampoo and soap and creams and lotions. Things they haven’t always had all year long. Their rooms are suddenly really well cleaned- rugs are washed, walls are re painted, much needed repairs are done. Windows might even get screens placed in them; AND, the bathrooms! The toilets are fixed so they stop clogging up; the showers magically spray hot water again. And residents have an endless supply of needed items like briefs and wipes and the likes. The scents of the home are just wonderful too, at this time of the year. Air fresheners and flowers and the smell of baking food is abundant in every nook, corner and crevice.

THE BEST PART of THAT time of the year is the increase in STAFFING. Yes. Everyone benefits now. Not only are there enough aides scheduled, often we have too many. SO many that a couple might be sent home or better yet- put to work doing special things like restorative nursing stuff, or activities. The nursing home appears to be a well oiled, well run shop. Enough staff; good food, excellent building and yards; a great activity program…and perfect care plans with well written goals and all signed off by the right people, at the right time, for the right residents.

Yep.
Too bad this isn’t how it works ALL THE TIME.

Now go this article. And consider my rant above. It’s all relative and yes, some nursing homes are NOT like this (or shall we say, some nursing home management teams) BUT many are. Hide the truth when IT’S THAT TIME OF THE YEAR. Cover up those things that are cosmetic and can be altered for a few days. And forget about the rest of the year.

Spot Light: Range Of Motion

What is Range of Motion? The normal movement of joints.

For many residents, a lack of mobility causes stiffness in their joints. Their muscles shrink and become weak- this is known as atrophy. Gradually, the atrophied muscles become hard and rigid. The muscles shorten in this process, and therefore joint movement is affected. Pain, discomfort and disfigurement occur. These disfigurements are known as contractures. They are, almost always, 100% preventable.


Photobucket - Video and Image Hosting
It is up to nursing staff to maintain a residents range of motion (ROM). For residents who are bed bound, wheelchair bound or who cannot ambulate, it is even more important that range of motion exercises be done correctly and often enough. Many of the activities we assist with will provide ROM for residents…bathing, dressing, grooming activities in particular offer opportunities for joint movement- SO long we we think about what we are doing. When we’re giving a bed bath for example, it makes sense to lift each leg and put it through it’s complete ROM while washing and drying it. But I’ve seen CNA’s turn the resident to the side and wash/dry them from behind, thus eliminating this opportunity for good ROM.

To be effective, ROM exercises should be performed at least twice a day, and each exercise should be done at least five times. The quick, natural opportunities for ROM are an excellent way to enhance what we do, but it should never replace a full program. The only way to fully perform all the exercises, is during AM/PM cares, with a complete focus on this one activity.

Some residents will be able to help. They can move their joints without our help-this is called ACTIVE RANGE OF MOTION. The resident can perform almost all the exercises on their own, through a dedicated program or through normal activities of daily living.

Other residents can perform SOME portion of ROM, but due to weakness, pain, paralysis and the like, they will need limited amounts of assistance. Usually they can tell you exactly what you need to do. This is called ACTIVE ASSISTED ROM.

For most of the residents we deal with, PASSIVE ROM is the norm. These residents cannot assist with this, for many reasons. It’s important to remember that these ROM exercises do not strengthen the muscles; they prevent deformity and maintain movement.

A great way to make ROM a part of AM/PM care might include applying lotion to those body parts being exercised. The lotion is calming and relaxing, and this will help with ROM. Another good time is during a bath. If you note the resident experiences pain during ROM, ask the nurse about pain medications being given 30 minutes or so before the exercises are started.

If ROM is problematic to complete due to time restraints, ask your co workers if they too are having trouble. As a group, you all could seek ways to help each other. Or, seek the advise of the charge nurses. At one nursing home I know of, the aides simply did not have time to complete ALL the ROM for each resident. The aides met with the nurses, who went to the DON to get some ideas and guidance. The DON met with the Activity Director, who implemented an exercise activity designed to provide ROM to those residents the aides could not get to in the morning. The aides marked off who received ROM and who didn’t, and the Activity Staff provided the exercises as part of special “Massages” and other aptly titled programs.

Another nursing home I know of breaks up the ROM requirements for each shift. This means third shift does some of these programs- especially for those residents who are awake during their shift.

Creative minds can ensure that vital care is provided. Dedicate TIME for this very important skill…this task…this care. ROM should not be skimped on, ever.

Spot Light: Medical/Nursing Jargon

In the course of any given shift at work, CNA’s come across words and abbreviations and diseases and conditions we have never heard of before. There are hundreds of terms to learn. In this article we hope to make this task a little easier.

First off, scan this list of common medical abbreviations. We use them with charting. We read them in the medical histories sections of patient charts. Do we understand what they all mean?

Abbreviations are well known in our work; each facility should have it’s own list of accepted abbreviationsused in charting/orders. Without such a list, staff can use many different abbreviations, which are accepted but perhaps mean something else to each member of the team. Confusion can arise and patients can be harmed by misunderstandings.

Some terms we read are based on the human body. Terms associated with certain sections of the body are called descriptive terms.

All references to the body are made in relationship to the anatomical position. This refers to the standing forward facing body. A imaginary line is drawn down the center from head to feet which divides the body into two equal halves.

When we read the word MEDIAL it means the part is closer to to the line/center; LATERAL mean further from the line/center.
Your thumbs are more lateral than your pinky finger…

Imagine another line being drawn- this one dividing the upper and lower body into two halves. The line is right under the navel. When we read the term SUPERIOR it refers to above the line; INFERIOR means below the line.

Further, turn the body to face sideways. A line is drawn down the center, again. We’ll see terms called ANTERIOR, which means VENTRAL, towards the front. We’ll also see terms referring to POSTERIOR, or DORSAL, which mean toward the back.

Abbreviations are well known in our work; each facility should have it’s own list of accepted abbreviationsused in charting/orders. Without such a list, staff can use many different abbreviations, which are accepted but perhaps mean something else to each member of the team. Confusion can arise and patients can be harmed by misunderstandings.

Some terms we read are based on the human body. Terms associated with certain sections of the body are called descriptive terms.

All references to the body are made in relationship to the anatomical position. This refers to the standing forward facing body. A imaginary line is drawn down the center from head to feet which divides the body into two equal halves.

When we read the word MEDIAL it means the part is closer to to the line/center; LATERAL mean further from the line/center.
Your thumbs are more lateral than your pinky finger…

Imagine another line being drawn- this one dividing the upper and lower body into two halves. The line is right under the navel. When we read the term SUPERIOR it refers to above the line; INFERIOR means below the line.

Further, turn the body to face sideways. A line is drawn down the center, again. We’ll see terms called ANTERIOR, which means VENTRAL, towards the front. We’ll also see terms referring to POSTERIOR, or DORSAL, which mean toward the back.

The human abdomen is also divided into four sections, called quadrants. In your work you’re apt to read notes using these terms:
RUQ= Right upper quadrant
RLQ= Right lower quadrant
LUQ = Left upper quadrant
LLQ = Left lower quadrant
It’s pretty self explanatory where these sections are located.

There are many other forms of medical jargon to decipher. Understanding word roots, prefixes and suffixes can help this process a lot.

A word root is the foundation of a medical term.Word roots usually (not always) refer to the body part being described.
A prefix is added to the beginning of the word to change or add to it’s meaning
A suffix is added to the end of the word to change or add to it’s meaning.

Some examples of root words:
aden= gland
bronch=bronchi
chol=bile
crani=skull
dent=tooth
hem=blood
hepat=liver
hyster=uterus
my=muscle
nephr=kidney
pulm=lung
ur=urine

Some common Prefixes and sample meanings:
a=without (AFebrile or without fever)
brady=SLOW (Bradycardia or slow pulse rate)
dys=PAIN, DIFFICULTY (Dysuria or painful urination)
hyper=ABOVE, EXCESSIVE (High blood pressure or hyper tension, Hypothermia or high body temperature)
hypo=LOW, DEFICIENT (Low blood pressure or HYPO tension; HYPOthermia or low body temp)
pan= PANDEMIC (flu, Black Plague)
poly= MANY (polyuria or excessive urine)
post= AFTER (Post Operation, Post seizure)
pre=before, prior (Pre menstrual)
tachy= FAST (TACHYbradia or high pulse rate)

What medical terms can you associate with the above prefixes?

Some common suffixes:
ectomy= REMOVAL (hysterectomy)
itis=INFLAMMATION (bronchitis)
gram=RECORD (electrocardiogram)
emia=BLOOD (Anemia)
logy=STUDY OF (oncology)
oma=TUMOR (Fibroma)
otomy=INCISION (tracheotomy)
plegia=paralysis (Hemiplegia)
pnea=RESPIRATIONS (apnea)
scope=EXAM INSTRUMENT (stethoscope, otoscope)
scopy=EXAM USING A SCOPE (endoscopy)

What other medical terms can you associate with the above suffixes?

For a much more comprehensive resource for medical terms and descriptions, go to THIS SITE.

This resource also lists frequently used medical terms.

THIS SITE has an excellent graphics and descriptions of human anatomy.

HERE You’ll find a detailed list of anatomical terms frequently used.