NCLEX: Promotion of Health and Safety

Promotion of Health and Safety: Review of Body Systems Affected by Aging

Focus topic:Promotion of Health and Safety

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 as well as his or her 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 make-up 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 leads to injury requiring hospitalization. For many elders, they 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.

Hearing loss is a normal part of aging, especially if 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 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.

Promotion of Health and Safety: Communicable Diseases and Their Effect on Health

Focus topic:Promotion of Health and Safety

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 methicillinn-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, 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.

Promotion of Health and Safety: Role of the Nursing Assistant to Prevent the Spread of Communicable Diseases

Focus topic:Promotion of Health and Safety

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 hand washing 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.

Promotion of Health and Safety: Medical Asepsis

Focus topic:Promotion of Health and Safety

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.

TIP:

Focus topic:Promotion of Health and Safety

Hand washing 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 hand washing and antiseptic product applications.

CAUTION:

Focus topic:Promotion of Health and Safety

Follow agency policy for approved lotions. To help avoid contamination of the lotion, do not use lotions from large containers.

Keep nails natural (no artificial nails), with tips trimmed to less than 1/4 inches.
Apply an antiseptic hand-rub product.

NOTE:

Focus topic:Promotion of Health and Safety

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.

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.

  • 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.

CAUTION:

Focus topic:Promotion of Health and Safety

Change gloves with each new resident contact.

  • Wash hands after removing gloves.

Promotion of Health and Safety: Mask, Eye Protection, Face Shield, Gowns

Focus topic:Promotion of Health and Safety

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 you 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.

EXAM ALERT:

Focus topic:Promotion of Health and Safety

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.

Promotion of Health and Safety: Sharp Objects

Focus topic:Promotion of Health and Safety

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.

CAUTION:

Focus topic:Promotion of Health and Safety

Be careful when changing resident linens because they are a common site for discarded needles.

Report any needle stick or puncture wound by a sharp object to your supervisor promptly. You and other health-care workers are 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.

CAUTION:

Focus topic:Promotion of Health and Safety

Follow the procedure outlined in your facility’s procedure manual for accidental exposure regarding followup care and observation as directed. 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.

Care of residents with HIV infection, AIDS, and other special needs is discussed in , “Specialized Care.”

CAUTION:

Focus topic:Promotion of Health and Safety

If you must handle sharps containers, be careful not to force needles, syringes, or other sharp objects into the container. Empty per safety protocol.

Promotion of Health and Safety: Resident Care Equipment

Focus topic:Promotion of Health and Safety

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).

Promotion of Health and Safety: Environment

Focus topic:Promotion of Health and Safety

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.

EXAM ALERT

Focus topic:Promotion of Health and Safety

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

Promotion of Health and Safety: Linens

Focus topic:Promotion of Health and Safety

Keep resident linen from touching the floor and, if so, 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.

CAUTION:

Focus topic:Promotion of Health and Safety

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.

Promotion of Health and Safety: Surgical Asepsis

Focus topic:Promotion of Health and Safety

Use a sterile technique to protect against infection before, during, and after surgery or for specific medical procedures to remove as many microorganisms as possible (for example, inserting a urinary catheter, inserting a central vein catheter, and applying sterile dressings). 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.

Promotion of Health and Safety

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Promotion of Health and Safety: Resident Safety

Focus topic:Promotion of Health and 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

  • 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.
  • 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: “The Roles and Responsibilities of the Nursing Assistant.” Be alert for signs of abuse or neglect and report any suspicions you might have to your supervisor immediately.

Promotion of Health and Safety: Reporting Accidents or Incidents

Focus topic:Promotion of Health and Safety

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. 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. Incident reports provide a record of the accident and offer valuable information leading to policy changes as needed to improve service to residents.

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