Blood unable to pass clot Blood clot Blood vessel Area of brain deprived of blood © Body Scientifi c International f Medical Summary Demographics History Prescriptions Client Appointment Details Chief Complaint HPI Past/Soc/Fam Hx Review of Systems Physical Exam Lab Diagnoses Plan Immunizations EMR FIND Chief Complaint Care Plan (Chart–wide) Medications Type 2 diabetes mellitus, complications Current Medications Print Display: All Statuses Edit Client Julio Sanchez 74 yrs, 6 mos 3/28/1943 M Previous Next Sign Close Save Save + Exit Bill 09/19/2019 Goals Diabetes action plan—medication, diet, exercise, circulation Actions • Deficient knowledge about his oral medication: Management of compliance with medication regimen through education. • Imbalanced nutrition resulting in obesity: Diet adjustment with weekly weight-reduction goals and incentives. • Activity intolerance: Increase ambulation and activity daily to level of tolerance. • Risk for impaired skin integrity: Instruct on foot and skin care. Next Steps Mr. Sanchez, a new resident of two months, did not regularly take his medication at home. He is 60 pounds overweight and tires quickly during activity. On admission, he had dry skin and cracks in his heels. Provide teaching about the importance of medication provide medication with monitoring consult with dietitian about meals that consider his culture, likes, and dislikes set weekly weight-reduction goals increase ambulation to 20 minutes a day as tolerated provide guidelines on foot and skin care and keep feet clean, dry, and moisturized. Care Coordination Notes Mr. Sanchez has taken his medication regularly for the last month without prompting, has lost 10 pounds, and can ambulate 15 minutes a day. He attended an after-dinner event and danced, and his feet have improved and are no longer cracked. Action steps will continue, providing incentives to continue weight reduction, increase ambulation, and maintain foot care monitoring. Created by Sylvia Smith 9/19/2017 9:32 a.m. Mark as Reviewed Goodheart-Willcox Publisher 14 1 Thi i l f l t i l f Features In addition to the Becoming a Holistic Nursing Assistant features, the text contains other special topics of interest in nurse assisting. • Culture Cues prompt prospective nursing assistants to examine cultural considerations for improved care. • Healthcare Scenarios introduce concepts using lifelike situations and ask students to analyze and apply knowledge to dilemmas. • Think About This features throughout each chapter provide additional information about healthcare topics of interest. BECOMING A HOLISTIC NURSING ASSISTANT Cultural Humility and Cross-Cultural Communication The following list includes qualities of holistic nursing assistants who practice cultural humility and use cross- cultural communication skills. Read through this list and determine whether you have each quality. • I have a good understanding of my own cultural and ethnic identity. • I use self-reflection and avoid making assumptions or believing stereotypes. • I respect others and do not make others accept my values and beliefs. • I work hard at understanding differing perspectives. • I know that person’s skill in the English language has nothing to do with his or her level of intelligence or literacy. • I ask questions and seek training when I am uncertain about a cultural group or religion. • I always use cross-cultural communication skills when working with residents, their families, and staff from different cultures or religions.. Apply It 1. Which of the qualities in this list do you already have? 2. Consider which qualities you do not have and identify ways you can develop your knowledge and skills so you can use them in the future. y values and beliefs. w k n f 2 Consider which qualities you do no y values and beliefs. w k n 2 Consider which qualities you do no Ca ULTURE C UES Valuing Diversity The following guidelines will help you recognize and appreciate diversity as a holistic nursing assistant: • Treat people respectfully by paying attention to the way they wish to be treated, not the way you wish them to be treated. • Question your own assumptions and the assumptions of others. This will help you avoid limiting your opportunities to understand another person. • Offer to assist others whose backgrounds and experiences are different from your own. • When asking someone to explain a point of view or an opinion that is different from your own, let the person know that you are asking because you want to understand, not because you want person to justify the opinion.. • Do not about or make fun of people’s differences. When you see another person joking this way, be direct and ask him or her to stop. • Welcome ideas are different from your own.. • Look at issues from another person’s point of view before making decisions. • Continually monitor your thoughts and language for any assumptions or stereotypes you might have. • Always use facility policies and procedures. Healthcare facilities often have resources, including staff members who have expertise in diversity. Apply It 1. Which of these guidelines do you follow as part of your typical interactions with others? 2. Which of these guidelines do you not often follow? Which guidelines would you like to include in your interactions with others? Explain. 3. How can you include the guidelines you do not often follow into your interactions with others? h eir f amilies, and religions do you alread y t h d id tifone ot hav e and i dentify tthat hat are diff erent f rom your own rom another person ’s point of ot hav e and i dentify THINK ABOUT THIS The Centers for Disease Control and Prevention recently reported that 75 million American adults (29 percent) have high blood pressure. This means that about in every three adults has hypertension. Approximately one-half (54 percent) of those with high blood pressure have their condition under control. Supine position Lateral position Heels Sacrum Elbows Abdomen Toes Shoulders Back of head Heel Leg Thigh Knees Ankle Prone position High Fowler’s position Thigh Genitalia (men) Anterior superior iliac spines Ribs Elbows Collar bone Cheek and ear Breasts (women) Knees Toes Heels Toes Shoulders Back of head Buttocks Sacrum Hip Shoulder Side off head Ear Pressure Points for Decubitus Ulcers © Body Scientifi c International Fi 11 5 D bit l lik l t d l t i t B d li t i t th t Strong Visuals Numerous colorful photographs demonstrate important care guidelines. These images help students visually understand the concepts being presented. Detailed illustrations bring anatomical concepts to life, helping students comprehend body positions and the complex structure of the human body. Si de o B. Start at one corner of the bed. Grasp the hem of the sheet with one hand, approximately a foot in from the end of the bed, and pull it up vertically, creating a triangle. Place the triangle on top of the mattress. Mitered Corners C. Tuck the hanging, or bottom, part of the sheet underneath the mattress with both hands. A. Tuck the top of the fl at sheet underneath the head of the mattress and the bottom of the sheet underneath the foot of the mattress. The sides of the sheet should remain untucked. D. Lift the triangle corner of the sheet off the mattress with one hand and pull it down toward the fl oor. Smooth out any wrinkles your other E. Tuck the sheet under the mattress one while smoothing out the mitered corner with the other Miter each corner of the bed.. © Tori Soper Photography Fi 18 8 Mit d h ld b d ith fl t b tt h t t h t d b d d le corner o f the sheet off w i th one h an d an d ttightlyly ig h t oward the fl oo r. Sm oot h fl les wwithh i t your ot h er hhand. an d. E. Tuck the shee t under the matt ress titightlyly g h t wwithh i t one hhand,, an d w hil e smo othing out the m ite red co rn er w ith the other hhand.. a n d Mi te r eac h co rn er of t h e bed d ith fl t b tt h t t h t d b d d Mask-like face Arms flexed at elbows and wrists Stooped posture Hips and knees slightly flexed Short, shuffling steps Tremor Tremor © Body Scientifi c International a nt to understand, not because y ou want tthe he e rson to justi fy the opinion o not jjoke oke about or make f un o f pe ople’s ff erences. When you see another person joking is wa y, be direct and ask him or her to stop. Which guidelines would you like to include in you r interactions with others? Exp lain . 3. How can you include the guidelines you do not of ten f ollow into y our interactions with others? HEALTHCARE S CENARIO An Ethical Dilemma Recently, a medical journal reported that an ethics committee was asked to meet about a resident who had a massive (serious and damaging) stroke and was transferred to a local hospital. After hospitalization, the resident was returned to the skilled nursing and rehabilitation unit in the long-term care facility in which he had been living. He was on a ventilator, and was maintained with an intravenous and tube feedings. He had total right-side paralysis and was not able to communicate with his family. He was also recently diagnosed with early-stage dementia. The family asked the committee to meet because there was conflict about how to continue care. The man’s grown children wanted to see if he would recover, but his wife believed he would want to die and was requesting that he be taken off the ventilator. There was no documentation to determine what the resident would prefer. To address this ethical dilemma, the committee followed its typical procedure: • clarifying and assessing the facts, issues, and goals to determine if there was enough information to help make a decision • identifying what steps to take, what the consequences were for each potential action, and if actions violated core ethical values or principles • making a recommendation and implementing it • monitoring and evaluating to see if changes were needed Apply It 1. Which ethical principles would the committee be considering in this situation? 2. According to the sample code of ethics in this section, how should a nursing assistant practice ethically while caring for this resident and communicating with his wife and children?