6 Safety and Body Mechanics 1. Identify the persons at greatest risk for accidents and describe...

6 Safety and Body Mechanics

1. Identify the persons at greatest risk for accidents and describe accident prevention guidelines

Define the following terms:paralysis

the loss of ability to move all or part of the body, and often includes loss of feeling in the affected area.

fracturea broken bone.

disorientationconfusion about person, place, or time.



Define the following terms:scalds

burns caused by hot liquids.abrasion

an injury which rubs off the surface of the skin.



REMEMBER:

All staff members, including NAs, are responsible for safety in a facility.



FallsCauses: unsafe environment, loss of abilities, diseases, medications, loss of vision, gait or balance problems, weakness, paralysis, and disorientation Prevention:• Clear walkways. • Use non-skid rugs. • Have residents wear non-skid, sturdy shoes. • Residents should not wear clothing that is too long.



Fall prevention (cont’d):• Keep frequently-used personal items close. • Answer call lights promptly. • Clean up spills. • Report loose hand rails immediately.• Mark hazardous areas. • Improve lighting. • Lock wheelchairs. • Lock bed wheels.



Fall prevention (cont’d):• Return beds to lowest positions. • Get help. • Offer toileting assistance regularly and respond to requests

promptly. • Leave furniture in same place. • Pay attention to residents at risk for falls.• Never try to catch a falling resident. • Report all falls to the nurse.



Burns/ScaldsCauses: dry heat (irons, stoves, other electric appliances), wet heat (hot water or other liquids, steam), or chemicals (lye, acids)Prevention: • Check water temperature. • Report frayed cords. • Communicate about hot liquids. • Pour hot drinks away from residents. • Keep hot drinks away from edges of tables. Use lids. • Make sure residents are sitting before serving hot drinks. • Monitor heat-producing equipment.



Resident IdentificationCause: not identifying resident properly Prevention:• Identify each resident before care or feeding. • Check IDs. • Call resident by name.



REMEMBER:

Not identifying residents before giving care or serving food can cause serious problems or even death.



Choking Causes: weakened, ill, or unconscious residents Prevention: • Eat sitting upright. • Follow orders for special diets and thickened liquids



Poisoning Cause: ingesting harmful substances Prevention: • Store harmful substances carefully. • Do not leave cleaning products in rooms. • Investigate any unusual odors.• Post Poison Control Center number.



Cuts/Abrasions Cause: sharp objects Prevention:• Put sharp objects away after use.• Push wheelchairs forward.



NAs should remember these general safety guidelines, as well: • Do not run. • Keep paths clear.• Wipe up spills immediately.• Discard trash properly.• Follow instructions and ask questions as needed.• Report injuries immediately.• If you see a suspected hazard among a resident’s

possessions, report it to the nurse.


2. List safety guidelines for oxygen use

Define the following terms:combustion

the process of burning.flammable

easily ignited and capable of burning quickly.



The following are important guidelines for oxygen safety: • Post No Smoking and Oxygen in Use signs. Do not allow

smoking around oxygen equipment.• Remove fire hazards. Report to nurse if resident does not

want a fire hazard removed. • Do not allow flames around oxygen (this includes candles). • Do not use an extension cord with an oxygen concentrator.



Guidelines for oxygen safety (cont’d): • Do not place electrical cords or oxygen tubing under rugs or

furniture.• Avoid using fabrics such as nylon and wool.• Report skin irritation from cannula or face mask. • Do not use any petroleum-based products on resident or on

any part of the cannula or mask.• Learn how to turn oxygen off in case of fire if facility allows

this. Never adjust oxygen setting.


3. Explain the Material Safety Data Sheet (MSDS)

The Material Safety Data Sheet (MSDS) • Is required by OSHA for all hazardous chemicals• Details ingredients, dangers, emergency response, safe

handling procedures• Sometimes may be accessed by toll-free number• Must be accessible by all employees



REMEMBER:

NAs must know where these sheets are kept at their facilities and how to use them.



REMEMBER:

OSHA requires that emergency eyewash stations be placed in all hazardous areas in case eye injury. Employees must know where the closest eyewash station is and how to get there with restricted vision.


4. Define the term restraint and give reasons why restraints were used

Define the following term:restraint

a physical or chemical way to restrict voluntary movement or behavior.



Restraints were used in the past for the following reasons: • Keep person from wandering • Prevent falls• Keep person from hurting self or others • Keep person from pulling out tubing



REMEMBER:

Restraints must never be used without a doctor’s order or to punish a resident.


5. List physical and psychological problems associated with restraints

Define the following terms:atrophy

the wasting away, decreasing in size, and weakening of muscles from lack of use.

suffocationthe stoppage of breathing from a lack of oxygen or an excess of carbon dioxide in the body that may result in unconsciousness or death.


Transparency 6-1: Problems Associated with Restraint Use

• Pressure ulcers• Pneumonia• Risk of suffocation• Reduced blood circulation• Stress on the heart• Incontinence• Constipation• Muscle atrophy (weakening or wasting away of the

muscle)• Loss of bone mass• Poor appetite and malnutrition• Depression and/or withdrawal• Sleep disorders• Loss of dignity


Transparency 6-1: Problems Associated with Restraint Use (cont’d)

• Loss of independence• Stress and anxiety• Increased agitation (anxiety, restlessness)• Loss of self-esteem• Severe injury• Death


5. List physical and psychological problems associated with restraints

REMEMBER:

If restraints are ordered the care plan will include instructions on frequent monitoring and repositioning. An NA must never use restraints unless his supervisor has instructed him to do so and he has been trained in the proper use of the restraint.


6. Discuss restraint alternatives

Define the following terms:restraint-free care

an environment in which restraints are not kept or used for any reason.

restraint alternativesany interventions used in place of a restraint or that reduces the need for a restraint.



Think about this question:

Why has restraint-free care become more and more common in LTC facilities?

How might a restraint-free policy increase the safety and quality of residents’ lives?


Handout 6-1: Restraint Alternatives

• Improve safety measures and lighting.

• Keep call light within reach and answer call lights immediately.

• Ambulate the person when he or she is restless.

• Provide activities for those who wander at night.

• Encourage activities and independence.

• Give frequent help with toileting.

• Offer food or drink. Offer reading materials.

• Distract or redirect interest.

• Decrease the noise level. Use relaxation techniques.

• Reduce pain levels through medication. Report complaints of pain immediately.

• Provide familiar caregivers and increase number of caregivers.

• Use a team approach.

• Use special types of pads, belts, chairs, and alarms.



REMEMBER:

Restraint alternatives should be indicated in the care plan, and should be individualized for each resident.


7. Describe guidelines for what must be done if a restraint is ordered

NAs must remember these guidelines regarding restraints:• Make sure there is a doctor’s order for restraint use and that it

is in the care plan.• Follow manufacturer’s instructions. • Never tie restraint to side rails. Only tie to movable part of

bed frame. • Make sure restraint is not too tight. • Be sure not to catch breasts or skin in restraint. • Place call light within reach. Answer call lights immediately.• Document properly.


Transparency 6-2: When a Resident is Restrained

The resident must be checked at least every 15 minutes. At regular, ordered intervals, the following must be done:

•Release the restraint or discontinue use. •Offer help with toileting. Check for episodes of incontinence

and provide care. •Offer fluids and food. •Check for and report signs of skin irritation immediately. •Check for and report signs of swelling immediately. •Reposition the resident. •Ambulate resident if able.


8. Explain the principles of body mechanics

Define the following terms:body mechanics

the way the parts of the body work together when a person moves.

posturethe way a person holds and positions his body.

leversomething that moves an object by resting on a base of support.


Transparency 6-3: Body Alignment



NAs should remember the following points about alignment:• Try to keep the body in alignment, with two sides of the body

as mirror images of each other.• Keep object close when carrying or lifting. • Point feet and body toward the direction you are moving. • Avoid twisting at waist.



NAs should remember the following points about their base of support:• Wide base is more stable. • Stand with legs shoulder-width apart.



NAs should remember the following points about the principle of fulcrum and lever:• Arm is lever. • Elbow is fulcrum. • Rest object against forearm.


8. Explain the principles of body mechanicsNAs should remember the following points about their center of gravity:• When standing, weight is centered in pelvis. • Low center provides greater base of support. • Bend knees when lifting.


9. Apply principles of body mechanics to daily activities

REMEMBER:

Principles of body mechanics can be applied to daily activities to reduce the risk of injury and to save energy.


9. Apply principles of body mechanics to daily activitiesThe following steps demonstrate applying the principles of body mechanics to lifting a heavy object from the floor:• Spread feet apart. • Bend knees. • Use muscles in thighs, upper arms, and shoulders. • Pull object close to body. • When standing up, push with hip and thigh muscles.


Transparency 6-4: Lifting Heavy Objects from the Floor


9. Apply principles of body mechanics to daily activitiesThe following techniques will help an NA use proper body mechanics:• Use both arms and hands to lift, push, or carry objects.• When lifting a heavy object from the floor, spread your feet

shoulder-width apart. Bend your knees. Raise your body and the object together.

• Hold objects close to you when you are lifting or carrying them.

• Push or slide objects, rather than lifting them.• Avoid bending and reaching as much as possible. • If you are making an adjustable bed, adjust the height to a

safe working level, usually waist high.


9. Apply principles of body mechanics to daily activitiesTechniques for proper body mechanics (cont’d):• When a task requires bending, use a good stance. Bend your

knees to lower yourself, rather than bending from the waist. • Avoid twisting at the waist when you are lifting or moving

something. Instead, turn your whole body, pivoting with your feet instead of twisting at the waist. Your feet should point toward what you are lifting or moving.

• Get help from coworkers when possible for lifting or helping residents.

• Talk to residents before moving them. Agree on a signal. Lift or move on three so that everyone moves together.


9. Apply principles of body mechanics to daily activitiesTechniques for proper body mechanics (cont’d):• To help a resident sit up, stand up, or walk, place your feet 12

inches, or shoulder-width, apart. Place one foot in front of the other, and bend your knees. Your upper body should stay upright and in alignment.

• Never try to catch a falling resident. If the resident begins to fall, assist her to the floor.

• Report to the nurse any task you feel that you cannot safely do.


10. Identify major causes of fire and list fire safety guidelines

Think about these questions:

What fire hazards exist in a LTC facility?

What additional fire hazards may exist in a home?


10. Identify major causes of fire and list fire safety guidelinesNAs should remember these guidelines for fire safety:• Never leave smokers unattended. Make sure ashtrays do not

contain hot ashes before emptying them. • Report frayed or damaged cords. • Report if fire alarms and exit doors are blocked. • Know how to use fire extinguishers:

• Pull the pin. • Aim at the base of fire when spraying. • Squeeze the handle. • Sweep back and forth at the base of fire.


10. Identify major causes of fire and list fire safety guidelinesGuidelines for fire safety (cont’d):• In case of fire, use RACE:

• Remove residents from danger. • Activate alarm or call 911. • Contain fire if possible. • Extinguish, or fire department will extinguish.

• Know evacuation plan. • Stay calm. • Follow directions of fire department.• Know which residents need one-on-one help.• Know differing abilities of residents.


10. Identify major causes of fire and list fire safety guidelinesGuidelines for fire safety (cont’d):• Remove blockage from windows or doors. • Do not use elevators.• Stay low in a room to escape a fire.• Check for heat coming from doors. • Stop, drop, and roll if clothing catches fire. • Use damp covering over mouth and nose. • Leave building if possible, then move away from it.


ExamMultiple Choice. Choose the correct answer.1. Which of the following statements is true of preventing falls?

(A) Clear walkways of clutter.(B) Keep lights low.(C) Leave spills for housekeeping to clean.(D) Move call lights further away from residents.

2. One condition or problem that can cause a lack of sensation is(A) Constipation(B) Diabetes(C) Hypertension(D) Vomiting


Exam3. To serve hot liquids to residents, a nursing assistant (NA) should

(A) Pour hot drinks away from residents(B) Place hot drinks on the edges of tables so that they will be easier to

reach(C) Take lids off of hot drinks just before serving them(D) Make sure residents are standing up before serving hot drinks

4. When should a nursing assistant identify a resident? (A) After giving care (B) When collecting meal trays (C) When shifts change (D) Before helping with feeding


Exam5. In which position should a resident be placed for eating?

(A) Lying flat on his back (B) Reclining at a 45-degree angle (C) Sitting as upright as possible (D) Lying on his side with his arm propping up his head

6. Why does working with oxygen require special safety precautions?(A) Oxygen equipment is very difficult to obtain.(B) Oxygen is a dangerous fire hazard.(C) Oxygen levels must be adjusted often.(D) Oxygen equipment is very fragile.


Exam7. Which of the following guidelines is true of working around oxygen

equipment?(A) NAs should not allow open flames around oxygen.(B) NAs should adjust oxygen levels when they are too high or too low.(C) NAs should replace oxygen tubing if it becomes clogged.(D) NAs should prescribe a new oxygen delivery device if the current one is

causing skin problems.

8. What information does a Material Safety Data Sheet (MSDS) contain? (A) Costs of the chemical (B) Comparisons with other chemicals (C) Names of other facilities using the chemical (D) Description of emergency response actions


Exam9. Which of the following is an example of physically restraining a resident?

(A) Asking the resident to stay in his bed (B) Telling the resident’s roommate to press the call button if the resident

gets up (C) Leaving the resident’s door ajar(D) Putting both side rails up on the bed

10. Restraints can be applied (A) As punishment from staff when a resident is not behaving properly (B) Only with a doctor’s order (C) When a staff member does not have time to watch a resident closely (D) When a nursing assistant judges a resident is a danger to himself or

others


Exam11. A serious problem that has been associated with restraint use is

(A) Jaundice (B) Headache(C) Increased activity (D) Pressure ulcers

12. Which of the following statements is true of restraint usage? (A) People tend to respond better to restraint alternatives than to restraints. (B) Laws allow the use of restraints when a facility is short-staffed. (C) Using restraints does not cause negative effects. (D) Restraint-free care means a facility uses restraints only for disciplining

residents.


Exam13. An example of a restraint alternative is

(A) Tying the resident to the bed (B) Removing the resident’s call light (C) Leaving the resident alone for long periods of time(D) Giving the resident a repetitive task

14. If a restraint is applied, a nursing assistant must (A) Tie the restraint to the side rails (B) Leave the area so she won’t hear the resident complain (C) Withhold fluids(D) Check on the resident every 15 minutes


Exam15. Which of the following terms applies to body mechanics?

(A) Gravity effect (B) Outline(C) Pulley (D) Fulcrum and lever

16. Which of the following statements is true of body mechanics?(A) Body mechanics help save energy and prevent injury.(B) The narrower a person’s base of support, the more stable the person is.(C) Proper alignment of the body means that the two sides of the body

should not line up.(D) Twisting at the waist is the best way to maintain body alignment.


Exam17. When helping a resident sit up, stand up, or walk, the NA should

(A) Keep her feet together(B) Bend her upper body(C) Bend her knees(D) Try to catch the resident if he starts to fall

18. Which of the following is a way to use proper body mechanics?(A) The NA should twist at the waist when lifting objects.(B) The NA should stand with her legs shoulder-width apart.(C) The NA should lift objects, rather than pushing them.(D) The NA should carry objects away from her body.


Exam19. RACE is an acronym for a safety rule, and means

(A) Run to A Close Exit(B) Remove residents, Activate alarm or call 911, Contain fire, Extinguish(C) Restore power, Activate alarm or call 911, Call Fire Department, Exit(D) Remove window, Access outside, Call for help, Elderly residents first


CHAPTER 6 PRACTICE1. Why does working with oxygen require special safety precautions?

(A) Oxygen equipment is very difficult to obtain.

(B) Oxygen is a dangerous fire hazard.

(C) Oxygen levels must be adjusted often.

(D) Oxygen equipment is very fragile.

2. A serious problem that has been associated with restraint use is

(A) Jaundice

(B) Headache

(C) Increased activity

(D) Pressure ulcers

3. Which of the following terms applies to body mechanics?

(A) Gravity effect

(B) Outline

(C) Pulley

(D) Fulcrum and lever

4. RACE is an acronym for a safety rule, and means

(A) Run to A Close Exit

(B) Remove residents, Activate alarm or call 911, Contain fire, Extinguish

(C) Restore power, Activate alarm or call 911, Call Fire Department, Exit

(D) Remove window, Access outside, Call for help, Elderly residents first


CHAPTER 6 PRACTICE ANSWERS

1. B- OXYGEN IS A DANGEROUS FIRE HAZARD2. D- PRESSURE ULCERS3. D- FULCRUM AND LEVER4. B- REMOVE RESIDENTS, ACTIVATE ALARAM OR CALL 911,

CALL FIRE DEPARTMENT, EXIT

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