oygen needs (10220

- oxygen therapy handled as same way as any medication (o2 gas - never adjust flow
unless directed)

Make sure that:

- your province allows you to perform task
- task is in job description
- you have necessary training
- you know how to use the equipment
- you have reviewed task with nurse
- nurse or respiratory technician will SUPERVISE you

PSW can adjust flow to match care plan only - always document
Factors affecting oxygen needs
- Respiratory system function (COPD, Asthma, Flu, Pneumonia)
- Cardiovascular system function (congestive heart failure)
- Red blood cells count (level of hemoglobin - Anemia)
- Nervous system function (MS, Parkinson's)
- Aging (increase of chronic illnesses)
- Exercise (body requires more O2, respiratory rate and depth increases)
- Fever (Infection - normal is 37.5°C)
- Pain
- Drugs (narcotics such as morphine can slow and induce respiratory depression and
respiratory arrest from overdose)
- Smoking (can damage lung tissue and cause COPD)
- Allergies (irritants, immune inflammation)
- Pollutant exposure
- Nutrition
- Alcohol

ANYONE GETTING NARCOTICS MUST MEASURE VITALS AND RR IMMEDIATELY

(intravenously) or 30 MINS AFTER (orally)
00:0303:06
Respiratory Patterns
- normal range in adults 12-20 bpm
- infants and children should have faster rr
- both sides of chest should rise and fall equally
Following respiratory patterns are ABNORMAL
Tachypnea (rapid breathing, respiration's are more than 24pm. Fever, exercise, pain,
airways obstruction and hypoxemia are common causes)

Bradypnea (slow breathing, respiration's are less than 12pm. Drug overdose and
nervous system disorders are common causes)

Apnea (the lack or absence of breathing, occurs in cardiac arrest and respiratory arrest)
Kuusmaul Respiration's (deep and rapid respiration's characteristics of diabetes or other
conditions causing ACIDOSIS - sign of high blood sugar)

Hypoventilation (slow, hypo, shallow, sometimes irregular respiration's. Common cause

lung disorders such as pneumonia , obesity, airway obstruction, side effects of drugs,
nervous system and musculoskeletal disorders)

Hyperventilation (fast, rapid, hyper, and deeper than normal respiration's. Common
cause include asthma, infection, fever, anxiety, pain and some drugs and hypoxia)

Dyspnea (difficult, laboured, or painful breathing. Heart disease, exercise, anxiety)

Cheyne-Stokes (respiration's that gradually increase in rate and depth and then become
shallow and slow. Breathing may stop for 10-20 seconds. Drug overdose, heart failure
and brain disorders, COMMON WHEN DEATH IS NEAR)

Orthopnea (breathing deeply and comfortably only in a sitting position. Emphysema,

asthma, pneumonia, heart and respiratory disorders)
Hypoxia
deficiency in the amount of oxygen reaching the tissues
- life threatening condition that leads to cell damage and death
- brain is very sensitive To an in adequate supply of oxygen. restlessness dizziness and
disorientation early signs of hypoxia
- other signs and symptoms include confusion anxiety, fatigue, agitation, difficulty
concentrating and following directions

- cyanosis is an abnormal condition evidenced by blueish colour in the skin, lips,

mucous membranes and nailbeds it is a sign of hypoxia
promoting oxygenation
Oxygen therapy as ordered
position and providing periods of rest repositioning every two hours
relaxation
dust free environment
proper hydration and oral care
fragrance free environment
Coughing & Deep Breathing
Exercises help persons with repiratory problems. They are done after surgery & during
bedrest and are painful at this time - Breaking an incision open while coughing is a fear.
Usually done every 2 hours

Report and record the number of times the client coughed and took deep breath's
the clients ability to tolerate the procedure
review steps for assisting with coughing and deep breathing exercises
Incentive spirometry
a common postoperative breathing therapy using a specially designed spirometer to
encourage the patient to inhale and hold an inspiratory volume to exercise the lungs
and prevent pulmonary complications

- Incentive means encouragement

- Spirometer is a machine that measures the amount of volume inhaled

Helps with lung function, prevents respiratory complications

Assisting with oxygen
As a PSW you do not give oxygen, you assist in providing safe care to clients receiving
oxygen

NO SMOKING SIGN IN ROOM

BE FAMILIAR WITH SAFETY GUIDELINES AND FIRE SAFETY
KEEP OXYGEN SOURCE AND TUBING AWAY FROM HEAT SOURCES AND OPEN
FLAMES

ONLY TURN OFF OXYGEN IF THERE IS A FIRE

Oxygen sources
Oxygen concentrator - making oxygen by taking room air and filtering out oxygen. Must
be plugged into electricity and is also portable

Oxygen cylinder - tank of compressed oxygen

Liquid oxygen system - system stores oxygen in liquid form

MAKE SURE CONTAINERS ARE ALWAYS FULL

Oxygen administration devices
1. Nasal cannula
2. Face mask
3. Partial-rebreather mask (collects exhaled air)
4. Non-rebreather mask
5. Venturi mask
Oxygen Administration
Flow rate: amount of oxygen ordered by the MD
- is measured in litres per minute (L/min) and range is from 2-15L/min
- care plan always specifies flow rate
- always check flow rate and report if too high or too low
- if employer allows to adjust flow rate, follow employer policies and procedures
- oxygen is a dry gas and can dry the mucous if ADMINISTERED WITHOUT
HUMIDIFIER
00:0403:06
pulse oximetry
An assessment tool that measures oxygen saturation of hemoglobin in the capillary
beds (using LED light on finger)
Normal range is 95-100%
Don't use when blood pressure cuff is on
Report and measure accurately
Sp02 = saturated pulse oxygen
ALWAYS INDICATE IF CLIENT IS ON ROOM AIR (R/A) or CLIENT RECEIVES
OXYGEN

EXAMPLE: Sp02 = 96% on 3L/m of oxygen via nasal cannula

Common respiratory tests
Chest X-ray - taken to evaluate changes in lungs

Lung scan - taken to see which areas are not getting air or blood

Bronchoscopy - scope passed into trachea and bronchi. Airways checked for tumours,
bleeding. Tissue sample or biopsy are taken and mucus plugs and foreign objects are
removed

Thoracentesis - pleura is punctured and air or fluid is removed from it

Pulmonary function tests - tests that measure the amount of air air moving into and out
of lungs (volume) and how much air lungs can hold (capacity)

Arterial blood gases - arterial blood is taken to measure the amount of oxygen in it

Sputum specimen - collected from client in community or hospital setting, asked to

cough up sputum from bronchi and trachea (not saliva)

COMMUNICATION SKILL 1023 (MIDTERM)

What is e-mail used for?

used for many purposes and dictates formality, intended audience and desired outcome
of the message
when do we use e-mail?
1. when the person is hard to reach by phone
2. when the person doesn't come to campus regularly
3. when the person is physically far away
4. information being shared is not time-sensitive
5. when sending an electronic file
6. when you need to send to a large group of people
7. when you need a written record of the communication
tips for writing more effective emails
-consider the tone of your message
-make sure the message is clear and brief
-use paragraphs to separate thoughts
What is intrapersonal communication?
communication that happens internally (with self)
-ex. making to do lists, journaling, writing in a calendar
What is interpersonal communication?
-the process by which people exchange information, feelings and meaning through
verbal and non-verbal messages
-essential in healthcare
-ex. explaining procedures and tasks
what is interprofessional communication?
communication existing or occurring between persons (specifically) on a professional
level
what is ISBAR?
-Identify, Situation, Background, Assessment, and Recommendation
-a technique used to clarify communication and is often to support telephone
communications
what is important to include in an email?
-a subject line
-greeting
-cc
What is in the RUQ?
right upper quadrant

What is the LUQ?

left upper quadrant
What is in the RLQ?
right lower quadrant
What is in the LLQ?
left lower quadrant
Name the following quadrants
A: RUQ
B: LUQ
C: RLQ
D: LLQ

what is anterior/ventral?
located at or toward the front of the body
what is posterior/dorsal?
at the back of the body
What is distal?
the part farthest from the centre or from the point of attachment
What is proximal?
nearest to the trunk of the body or point of origin
what is lateral?
side of the body or part
what is medial?
near the midline
cap
capsule
gtt
drop
tab
tablet
amp
ampoule
sol
solution
susp
suspension
elix
elixir
supp
suppository
ung
ointment
PO
by mouth
top
topically
sl
sublingual (under the tongue)
ID
intradermal
subQ/subc
subcutaneous
IM
intramuscular
IV
intravenous
NG or NGT
nasogastric tube
PR/R
rectally
ac
before meals
pc
after meals
stat
immediately
hs
at bedtime
qhs
every bedtime
prn
when necessary
od
once a day
b.i.d/B.I.D
twice a day
t.i.d/T.I.D
three times a day
q.i.d/Q.I.D
four times a day
q1h
every hour
q2h
every 2 hours
q3h
every three hours
q4h
every 4 hours
q6h
every 6 hours
q8h
every 8 hours
q12h
every 12 hours
NPO
nothing by mouth (nil per os)
What is ADPIE?
-Assessment, Diagnosis, Planning, Implementation, Evaluation
-the nursing diagnosis
what is assessment?
-collecting information about the client
-assessment of the clients emotional, social, intellectual and spiritual health
-once assessment is completed, the team members gather to set goals
how do PSWs play a role in assessment?
-make observations as you give care and talk to the client
-collect objective/subjective data
what is diagnosis (or nursing diagnosis)?
-RN/RPN uses assessment information to make a nursing diagnosis
-describes a health problem that can be treated using nursing measures
what is planning?
-involves setting priorities and goals
-needs are arrange in order of importance
-goals are then set and aimed at the clients highest level of well-being and function
-nursing interventions are chosen after goals are set
what is implementation?
-performing or carrying out nursing measures in the care plan
-care can range from simple to complex
-nurse delegates tasks within legal limits
-support workers report the care given to the nurse
what are the 4 main functions of implementation?
1. Providing the care
2. Observing the client during care
3. Report and record the care
4. Report and record observations during the care
what is evaluation?
-step that involves measuring whether the goals in the planning step were met
-progress is evaluated
what is the PSWs role in evaluation?
-provide valuable information toward this evaluation which may result in changes being
made to the care plan
what is the nursing care plan (care plan)?
-a written guide to client's care
-has the clients nursing diagnosis and goals
-has the measures or actions for each goal
-used by staff to see what care to give
The care plan in a community setting
-case managers coordinate and manage client care
-meetings take place in clients home
-case manager establishes priorities, sets goals and determines available resources
what happens in community care planning?
-nurse uses an assignment sheet or the telephone to communicate delegated measures
and tasks to the PSW
what does the assignment sheet for community care planning tell you about?
-each client's care
-what measures and tasks need to be done
-which nursing tasks to do
what is the support workers role in the care planning process?
-uses PSW observations and feedback in the care planning process
-uses senses for objective data gathering
how to develop observation skills
-listen to the client breathe
-noticing flushed or pale skin or red swollen ankles
-smelling unusual odours from urine or BMs
how to describe observations
-be precise and accurate by using subjective data
-use medical terminology
-give facts and be specific
-don't make assumptions for the client
ANATOMICAL AND TERMINOLOGY
Anterior (ventral)
Toward or at the front of the body; in front of
Posterior
Back of the body
00:0703:06
Medial
Middle or towards median plane
Lateral
Away from median plane or middle
Proximal
Closer to the origin of the body part or the point of attachment of a limb to the body
trunk
Distal
Farther from the origin of a body part or the point of attachment of a limb to the body
trunk
superficial
near the surface
deep
away from the surface of the body
anatomical position
erect, feet forward, arms at side with palms facing forward, head facing forward
Anatomical Planes
Imaginary lines drawn through the body at various parts to separate the body into
sections
Flexion
Bending a body part
extension
straightening at the joint so that the angle between the bones is increased
00:0203:06
Abduction
Movement away from the midline of the body
Adduction
Movement toward the midline of the body
Supination
movement that turns the palm up
Pronation
Palms down
Circumduction
circular movement of a limb at the far end
Anatomy
The study of body structure
Physiology
Study of function
internal rotation
rotation of a joint toward the middle of the body
external rotation
outward rotation (turning around an axis) of a joint
Inversion
Turning the sole of the foot inward
Eversion
turning the sole of the foot outward
plantar flexion
bends the foot downward at the ankle
Dorsiflexion
Backward flexion, as in bending backward either a hand or foot
Opposition
Occurs when the thumb comes into contact with one of the other fingers
Reposition
When the thumb is returned back to anatomical position
Superior
Higher on the body, nearer to the head
Inferior
Lower on the body, farther from the head
superficial
on/ near the surface
Deep (internal)
Away from the surface of the body
Exercise Physiology
The study of changes in cell and organ functions as a result of muscular activity
frontal plane (coronal)
divides body into front and back
saggital plane
divides the body into left and right halves
transverse plane
a horizontal plane that divides the body into superior (upper) and inferior (lower)
portions
Antero-posterior axis
Extends from the front of the body to the back
horizontal axis
Extends from one side to another
longitudinal axis
directed vertically and around which rotational movements occur

MUSCLE: Types of muscles

Skeletal, cardiac, smooth
Properties of muscle fibres
-excitability/irritability: ability to send, receive and respond to stimulus
-contractibility
-elasticity
-extensibility
-conductivity: transmit nerve impulses
skeletal muscle
Long, cylindrical and striped appearance; striated and voluntary
smooth muscle
-Long, spindle shaped fibres arranged in dense sheets
-involuntary
cardiac muscle
Long, cylindrical and striped appearance; striated and involuntary
Fibre type: slow twitch
-Can do continuous work at low or moderate intensity.
-muscular endurance (aerobic exercises)
Fibre type: fast twitch
-TYPE 2A: can be trained to increase indurance
-TYPE 2B: can only be explosive
Strength ratio
Concentric: 1
Isometric: 1:2
Eccentric: 1:4
all or none principle
the law that the neuron either fires at 100% or not at all
MIDTERM MEDICATION MANAGEMENT

What are 3 different types of medication?

1. Prescription
2. OTC (over the counter)
3. Herbal Medications

What are prescription medications?

-medication ordered by a doctor or NP and filled at a pharmacy
-prescriptions can either be "generic" or "brand name"

What are OTC medications?

-over the counter medications, sold without a prescription.
-include aspirin, laxatives( thuốc nhuận tràng) , cold medicines and others

What are herbal medications?

-sold at pharmacies, health food stores or botanicals( thực vật)
-include vitamins, dietary supplements, and herbal teas
-can come in the form of a pill, liquid, patches, creams, inhalers etc.

What is polypharmacy?
the simultaneous use of multiple drugs to treat a single ailment or condition
what is the definition of medication?
a substance used for medical treatment
what is the definition of management?
process of controlling and organizing of something (aka monitoring)

what is medication management?

patient-centred care to optimize safe, effective and appropriate drug therapy.
this includes monitoring medications that a patient takes to confirm that they are complying with
the regimen

what is involved in monitoring medication?

-ensure medication is taken at specific doses at set intervals
-check for harmful drug interactions
-confirm that client is following the directions of the drug use
-observe, report and record any side effects

what does it mean to assist with medication?

-reach for or bring pill container to client
-provide water to the client
-assist the client to read the label
-assist client by removing cap off a pill container
-returning medication to the appropriate spot
-assist client in recording when their medication has been taken

what is the exception to the rule: aka delegation?

-PSWs can help to administer medication that is injected, inserted or inhaled if the administration
of such medication is routine.

conditions to be met:
-administration is performed regularly
-clients health condition is stable
-the expected outcomes of the medication are known
-the PSW has been taught to help administer, either by the client or a health professional
what is the PSW role in medication management
-asses client and need for medication
-have basic knowledge of the medication being given to the client
-evaluate the effectiveness of the medication

What are the routes of medication?

1. oral route (incl. sublingual)
2. topical route
3. nasal route
4. parenteral route (injections)
5. vaginal route
6. anal route
7. via eye
what is oral medication?
-substance taken through mouth
-taken orally because they are intended to have a systemic effect
-buccal is dissolved inside the cheek
-sublingual administration is dissolved under the tongue

what is topical medication?

-medication applied onto the skin
-one of the safest routes
-advantage is that it can show local effects
-ex. powders, ointments, lotions

what is the nasal route for medication?

-drugs are given by nose
-can be used to clean poisons from stomach or for delivery of nutrition to the body bypassing the
mouth
-ex. sinus medication ( thuốc trị xoang)

what is the injection route?

-injection directly into blood vessels
-used for quick action and achieving immediate response
-disadvantages: risk, pain and wounds, expensive route and minimal chances of self medication
-ex. insulin in diabetic patients

what is the vaginal route of medication?

-only used in women
-used for local infection in the genital parts of women
what is the anal route of medication?
-passing of medicament into the anus to affect the large intestine
-useful in cases of IBS

what are the 4 forms of medication?

1. oral
-capsules, lozenges, tablets
2. oral liquids
-elixirs, suspensions, syrups
3. topical
-ointment/creams
4. suppositories:
-vaginal or rectal
how does medication work?
-can interfere with microorganisms that invade body
-destroy abnormal cells which cause cancer
-replace deficient substances
-change the way that cells work in your body

What are the types of medications used to treat cancer?

1. Chemotherapy
-attacks cancer cells directly and stops or slows their growth and spread
2. biological therapy
-helps your body's immune system fight cancer
3. antiangiogenic therapy
-blocks growth of new blood vessels to a tumor, which may cut off a tumor's supply of oxygen
and nutrients

All above can be used in combination with each other.

How is medication prepared in a facility setting?

1. MD writes prescription

2. transcribed by nurse on clients chart and ordered with pharmacy

3. dispensed by pharmacist and sent to unit for administration of medication to patient

4. written into MAR

How is medication prepared in a community setting?

1. MD writes prescription

2. Client goes to pharmacy to fill

3. Medication dispensed by pharmacy to give to client

4. client responsible for medication regime

5. compliance and documenting

6. PSW may be asked to assist, administer and ORR’

How is medication given to a client in a facility?

-pills and syrups are "poured"into medicine cups
How is medication given to a client in a community?
-pills may come in blister packs
what is the MAR?
-a medical administration record
-legal document listing the clients prescribed medications and the care he/she receives that is
specific to medications
what are the 5 drug actions?
Route: how the medication enters the body

Absorption: the medication enters the blood stream

Distribution: the medication travels throughout the body to reach the intended tissues to cause
the desired effect

Metabolization: after medication has accomplished its desired effect, it is broken down or
metabolized (usually in the liver or kidneys)

Excretion: removal of the medication from the body (usually in urine or stool)
What are drug interactions?
-defined as the way the medications interact with other drugs/ substances in the body (ex.
alcohol)
What is drug synergism?
the combined effect of two drugs is greater than the effect of either drug being given alone
What is drug antagonism?
the combined effect of two drugs may counteract the effect of the other drug
how is medication stored?
-cool, dry place
-out of reach from children or adults with dementia
-in orignial container
-with lids slightly closed
-following special storage instructions
medication safety:

when do i report to my supervisor?

-if client does not take medication correctly
-if client does not understand why the medication should be taken
-if client refuses to take medication
-if client forgets or omits a dose
-if client shows adverse affects
-client takes other meds or recreational drugs or alcohol
-client complains the medication isn't working
-client wants to take medications that aren't listed in the MAR or care plan
what are drug classifications?
medications that are classified according to how they work

-anti-hypertensive medication is taken to decrease high BP

-analgesics are given to alleviate pain
what are the common medication classifications?
-anti alzheimer's
-analgesics (nonnarcotic and narcotic)
-analgesics
-diuretics
-anti-anxiety
-anti-hypertensives
-laxatives
what are adverse affects?
an unwanted or dangerous side effect
what are side effects?
effects that are not the desired effect, in addition to the intended effect
what are drug allergies?
-symptoms ranging from mild, moderate to severe anaphylaxis shock and cardiac arrest
what are the signs and symptoms of anaphylaxis?
-severe restlessness
-increase anxiety
-sweating
-low BP
-irregular pulse
-swelling of larynx
-shortness of breath
what are some factors affecting drug action?
-age
-size
-gender
-genetic inheritance
-physical/emotional condition
PO by mouth
TOP topically
SL sublingual (under the tongue)
Sub Cut subcutaneous
IM intramuscular
IV intravenous
NG nasogastric
PR per rectum
Cap capsule
Tab tablet
Gtt drop
Sol solution
Susp suspension
Elix elixir
Ung ointment
a.c before meals
p.c after meals
stat immediately
qHs at bedtime
PRN as needed
OD once a day
BID twice a day
TID three times a day
QID four times a day
q1h every hour
q2h every 2 hours
q3h every 3 hours
q4h every 4 hours
q6h every 6 hours
q8h every 8 hours
q12h every 12 hours

MIDTERM 1011 : CLIENT CARE

Why is the topic of conflict resolution important?

-conflict will arise between you and: classmates, professors, clients, colleagues,
management and family
What are examples on conflict?
-a fight, battle or struggle, especially a prolonged struggle
00:0203:06
what are the types on conflict?
1. controversy; quarrel: conflicts between parties

2.discord of action, feeling; antagonism or opposition: a conflict of ideas

3. incompatibility or interference of one idea, desire or event: a conflict in the schedule

what are examples of problems?
-any question or matter involving doubt, uncertainty, or difficulty
- a question proposed for a solution
What is ADPIE?
-Assess, Diagnose, Plan, Implement, and Evaluate

-the nursing process which includes identifying the problem, analyzing it, finding a
solution, and creating a plan to implement the solution
What do we think about when we identify the problem?
-is this a situation i should get involved in?
-can i be a part of the positive outcome?
-is this an emergency that requires immediate attention?
What do we think about when we analyze the problem?
-do i need assistance to solve this?
-is this within your scope of practice?
-involves communication, asking questions to clarify and active listening
How do we find a solution when problem solving?
-think of as many solutions as possible
-decide which is the safest and promotes best practice
How do we make a plan when problem solving?
-process may involve creativity but it is important to be safe
How do we evaluate when problem solving?
-pass on best practice in report when dealing with client issues
why does conflict happen?
-pain, POV, bad behaviour, poor communication etc.
what is the PSW role in conflict resolution?
-determine if conflict is something you are responsible for, can solve your own, or if you
need to contact your supervisor for support
00:0203:06
steps to conflict resolution
1. clarify what the conflict is
2. determine with the other person, what is the purpose of trying to resolve this?
3. discuss ways to reach those goals and determine if there are barriers to reaching this
goal
4. agree on the strategies chose to resolve the conflict
5. be clear on each person's part in this resolution
what are sources of stress?
-changes
-pressure
-lack of control
-conflict
-daily frustrations
what is stress?
-the emotional, behavioural or physical response to an event or situation
what is a stressor?
an event or situation that causes stress
what are the dimensions of stress?
-physical
-emotional
-intellectual
-social
-spiritual
factors in response to stress
-gender
-health
-past experience
-number of stressors one is facing
-nature, severity and duration of stressor
what are forms of chronic stress?
-chronic headache
-mood swings
-anxiety
-substance abuse
-bowel disorders
-sleeplessness
what are forms acute stress?
-changes in vital signs
-changes in speech
-dry mouth
-sweaty palms
-sore muscles
-changes in weight
what are the affects of stress?
-loss of self esteem
-fatigue
-forgetfulness
-smoking, drinking
what are some defense mechanisms?
-behaviours people use to separate themselves from unpleasant events, actions or
thoughts
-helps people to put distance between themselves and threats or unwanted feelings
what is conversion?
changing an emotion into a physical symptom
what is denial?
refusal to accept an unpleasant or threatening reality
What is displacement?
transfer of feelings to a less threatening person or thing that is the source of emotion
what is projection?
assigning one's feelings to someone or something else
what is rationalization?
making excuses for ones behaviour or a situation while ignoring the real reason
what is reaction formation?
acting in a way that is opposite to what one feels
what is regression?
reverting or moving back to earlier behaviours
what is repression?
keeping unpleasant or painful thoughts/experiences from the conscious mind
how do we manage stress?
-develop self awareness
-take care of your needs
-think positively
-assert yourself
-learn to accept the things you cannot change
-ask others for support
what are signs of burnout?
-changed sleep habits
-change in appetite
-less patience with others
-self medicating
-trouble getting projects/work/ day started
what are some self-soothing coping strategies for touch?
-soaking in a warm bath
-getting a massage
-stretching
what are some self-soothing coping strategies for taste?
-eating a comforting meal
-sipping herbal tea
-eating healthy food
what are some self-soothing coping strategies for smell?
-shopping for flowers
-smelling lavender or vanilla
-lighting a candle
what are some self-soothing coping strategies for sight?
-seeing a funny movie or tv show
-reading a good book
-watching the clouds
-looking at old photos
what are some self-soothing coping strategies for sound?
-listening to music
-singing to yourself
-saying positive statements or self encouragement
what is the purpose of time management?
-to reduce stress
-organize self
-be safe
when do we use time management?
-in all aspects of life
-work and recreation
what are the benefits of time management?
-better work habits
-better use of time
-effective care for clients
what is time management?
the ability to use one's time effectively or productively, especially at work
what are the principles of time management?
-each activity should bring you closer to your goals
-break big tasks into smaller pieces
-unpleasant and small things first
-pomodoro technique
how do we balance our personal life and manage time?
1. plan the day
2. learn to say no
3. wake up early
4. delegate effectively
5. turn off work mode
6. indulge in hobbies
7. take a vacation
8. pay attention to your body
what are the biggest management issues for students?
1. planning
2. procrastination
3. perfectionism
time management for the PSW
1. arrive early
2. make a note
3. estimate how long something will take
4. prioritize
5. avoid tasks that aren't on your list
6. learn to say "no"
how can you keep track of your PSW work?
-use a POP (personal organizational plan)

-follow the assignment sheet/care plan

-remember clients needs and priorities
-develop routines
-remain flexible
-start with what HAS to get done
What are SMART goals?
Specific, Measurable, Attainable, Relevant, Timely
what is the S in smart goals?
SPECIFIC: must be clear, give direction, have focus (date, time, measurement)
what is the M in smart goals?
MEASUREABLE: how will you know if you are making progress, what can you
measure?
what is the A in smart goals?
ACHIEVABLE: goals should be challenging yet achievable
what is the R in smart goals?
REALISTIC: do you have time, money, skills etc to make this goal work?
what is the T in smart goals?
TIMELY: target a date for meeting goals
why is decision making important as a PSW?
you decide:
-which task to do first
-what supplies/equipment you need
-the amount of time for client/charting etc.
-when something should be reported
what is acute care?
-health care provided for a relatively short time (days-weeks)
-intended to diagnose and treat immediate health issues
-mainly provided in hospitals
what is acute illness?
-appears suddenly
-lasts a short amount of time (usually less than 3 months)
-symptoms can be severe
-ex. pneumonia, influenza, fractures, stroke
what is chronic care?
-health care provided for a longer period of time (years)
-intended to promote quality of life and previous complications
-mainly provided in LTC settings
what is chronic illness?
-ongoing illness or disability
-slow or gradual onset (may or may not get worse over time)
-aka. chronic
what is sub-acute care?
-a place where care is provided and clients condition is stable, but still needs support
requiring complex equipment or procedures
-ex. rehab or LTC environments provide this
who are the receivers of care?
1. Patient: person who receives care in a hospital setting

2. Resident: person who receives care in a home setting (LTC, retirement home)

3. Client: person who receives care in a community (and can be used if you are unsure)
What is offered at a facility based setting?
-designed for specific care and treatment
-historically referred to as institutional based setting
-ex. hospitals and LTC
what happens in a hospital?
-clients usually have serious illnesses or injuries
-treatment required is urgent
-skilled professionals are required
the PSW in hospital settings
-job increase in the last 5 years
-departments include: ICU, Critical care, dialysis, palliative care etc.
Long term care facilities
-provide 24 hour care to residents living in the facility
-goal is to maintain resident health and independence as much as possible
-provided to stable clients, unable to live independently
what does resident care include?
-assist with challenges of mobility, eating and personal care
-support emotionally/socially
-24 hour professional service
how do LTC facilities operate?
Licensed LTCs: regulated and funded by province/territory

Not for profit: run by the government or local charities

Privately Owned: run on a for-profit basis

What is respite care? (facility based setting)
-temporary care for a high level support, care and supervision, gives clients' caregiver a
break (vacation/ day)
What is rehabilitation? (facility based setting)
-therapeutic programs that assist in restoring and improving clients independence and
functionality
-ex. cardiac, stroke and post surgery
What is palliative or hospice care? (facility based setting)
-both related to end of life care (EOL)
-for people who have an illness and no cure for it
-goal of service is to relieve and reduce uncomfortable symptoms
what is the mental health service in a facility based setting?
-in patient and out patient service
-community based and support services
-dealing with difficult clients
what is the residential facilities in a facility based setting?
-retirement homes, supportive housing, assisted living or group homes
-vary in size and accommodation
-comfortable, home like atmosphere
what are some PSW considerations when working in a facility based setting?
-structured environment (8-12 hours)
-working with distressed people
-time constraints
-meeting multiple demands
what do you need to know in LTC settings?
-working and living conditions of LTCs are not always optimal
what are examples of community based settings?
-home visits
-adult day programs
-group homes
-client's homes
what types of clients are served in community settings?
-people with disabilities
-people recovering from surgery
-seniors with limited cognition
-respite care
what is home care?
-through agency or self employment
-direct care provided in clients home
-PSW works independently on site
what is the PSW scope of practice?
-no standard
-varies by setting
-varies by province or territory
-dependent on client needs
what is medicare?
-term that refers to canada's publicly funded health care system
-all Canadians have reasonable access without having to pay out of pocket
what services does medicare include?
-vision care
-dental care
-prescription drugs
-ambulance services
how do people who do not qualify for medicare, pay for services?
-out of pocket
-private health insurance
when was the Canada Health Act created?
-federal legislation in 1984
what was the primary objective of Canada Health Act?
-protect, promote and restore the well-being of residents and facilitate reasonable
access to health services without financial or other barriers
what is an iadl?
instrumental activity of daily living
-more complex skills
-laundry
-finances
-housework
-home maintenance
what is an adl?
activities of daily living
-eating
-bathing
-dressing
-mobility
-grooming
-toileting

MIDTERM ALINA

what is the definition on health?

a state of complete physical, mental, and social well-being and not merely the absence
of disease or infirmity
what is the definition of wellness?
refers to promoting good health and reducing risk of disease with a holistic approach
what is holism?
a concept that considers the whole person
What are the dimensions of health?
-physical
-emotional
-social
-spiritual
-cognitive
what factors contribute to physical health?
-genetics and lifestyle
-regular exercise
-maintaining optimal body weight
-healthy diet
-safety practices
what factors contribute to emotional health?
-when people feel good about themselves
-have strong-self esteem, self-control, and self awareness
what factors contribute to social health?
-stable relationships
-approaching others with respect, warmth, openness and trust
what factors contribute to spiritual health?
-believing in a purpose greater than the self
-may involve being a member of a formal religion
what factors contribute to cognitive health?
-keeping the mind active and creative
-cognitively healthy people maintain curiosity throughout life
-they analyze, question, reason and solve problems
how can we promote our clients cognitive health?
-take part in activities like reading, puzzles, crosswords, sudoku, knitting, crafting
what are the 5 main factors that influence our health?
1. personal lifestyle choices
2. stress
3. personal beliefs about healthcare
4. social relationships and belonging
5. sense of control
What are the 12 determinants of health?
1. Income & social status - most influential
2. Social Support networks
3. Education & Literacy
4. Employment & working conditions
5. Physical environments
6. Biology & genetic endowment
7. Individual health practices and coping
8. Healthy child development
9. Health services
10. Gender
11. Culture
12. Social environments
expand on Income and Social status (determinant of health)
high income determines living conditions, such as safe housing, good nutrition
expand on Social Support Networks (determinant of health)
support from friends, family and community is associated with better health
expand on Education and Literacy (determinant of health)
-health status improves with level of education
-education is closely connected to socioeconomic status
expand on Employment and Working Conditions (determinant of health)
unemployment, underemployment, stressful or unsafe work are associated with poor
health
expand on Physical Environments (determinant of health)
-All aspects of physical environment (both natural and manmade) directly affect our
environmental health.
-Some aspects include: air quality, noise level, water and soil conditions, presence of
pests.
expand on Personal Health Practices and Coping Skills (determinant of health)
Individuals can take actions to prevent diseases and promote self- care, cope with
challenges, develop self-reliance, solve problems and make choices that enhance
health.
expand on Healthy Child Development (determinant of health)
Child's development is greatly affected by the housing condition, environment, family
income, the level of parents' education, access to dental and medical health, access to
nutritious food.
expand on Biology and Genetic Endowment (determinant of health)
Genetic endowment is a person's tendency towards a wide range of individual
responses that affect health status.
expand on Gender (determinant of health)
Gender refers to the role, personality, traits, attitudes, behaviour, values, and relative
power and influence assigned to the sexes by society.
What is the holistic approach?
-mind, body, spirit
-look at the whole person, not just where the pain is
-each part relates to and depends on the other
Illness VS. Disability
-Illness is the loss of physical or mental health

-Disability is the loss of physical or mental function

Acute vs. Chronic illness
- Acute Illness: short term, appear suddenly, subside quickly, may not require medical
attention (COPD flare up)
-Chronic Illness (aka. persistent) : usually cannot be cured, develop gradually, require
continuous medical attention, may be lifelong (COPD)
Clients with illnesses and/or disabilities
-usually affects all aspects of a persons life
-no two clients will experience illness and disabilities in the same way
what are factors affecting a clients experience of illness?
-nature of illness or condition
-age
-level of physical fitness
-amount and degree of pain and discomfort the client experiences
-cultural background
-level of support
what are some changes and losses associated with illness and disabilities?
-change in routine
-change in work life
-change in family life
-change in sexual function

-loss of independence
-loss of dignity
-change in self-image
what are common reactions to illness and disabilities?
-fear and anxiety
-sadness and grief
-depression
-denial
-anger
What is DIPPS?
-Dignity, Independence, Preference, Privacy and Safety

-Always apply DIPPS

the basics of safety
-safety is a basic need and right of all humans
-common sense and safety measures can prevent most accidents
-protect patients and residents, yourself and co-workers
Safety risk in falls
-risks of falling increases with age
-history of falls increases the risk of repeated falls
-most common accident
Risk factors in falls
-impaired awareness
-vision and hearing loss
-impaired taste, smell and touch
-impaired mobility
-medication
-age
How do we identify the right client?
-use two identifiers
-compare information on the assignment sheet to the ID of the material
-call the client by name when checking the ID bracelet
what is used to identify the client in a facility based setting?
-and ID bracelet, photograph ID or room recognition
what are the common causes to falls and injuries?
-poor lighting
-cluttered floors
-out-of-place furniture
-wet and slippery floors
-needing to use the bathroom
when and where do most falls occur?
WHEN: 1800 to 2100

WHERE: in patient/resident rooms and in bathrooms

what are restraints?
-any device, garment , barrier, furniture or medication that limits or restricts freedom of
movement or access to one's body

-require a physicians order

what are the affects to the use of restraints?
-can make people more combative, agitated and confused
-can cause emotional harm and serious physical injury
what are the legal issues to using restraints?
-threatening a client with applying a restraint is ASSAULT

-using a restraint on a client without a doctor's order is BATTERY

-unnecessary restraint is FALSE IMPRISONMENT

when are restraints NEVER used?
-to discipline a client
-for staff convenience
what do we record and report when using restraints?
-the type of restraint applied
-the reason for the application
-safety measures taken
-time which the restraint was applied and removed
-clients vital signs
-care given when restraint was removed
-skin colour and condition
-condition of the limbs
-complaints of discomfort
what are the types of restraints?
-physical restraints
-environmental restraint
-chemical restraint
what are common causes of poisoning?
-carelessness, confusion
-difficulty reading medication labels
-confusion or disorientation
-some are suicide attempts
how can we suspect poisoning?
-finding empty pill bottles or hazardous products lying around
-client suddenly collapses, vomits or has difficulty breathing
what do we do when we suspect poisoning?
-contact EMS
-gather evidence of poisoning, remain with the client and stay calm
what is a first degree burn?
-red and painful skin that is not blistered
what is a second degree burn?
-affects epidermis and dermis layers
-resulting in pain, redness, blistering and swelling of the skin
what is a third degree burn?
-extends below the dermis to underlying layers and nerves (resulting in blackened and
charred skin)
what are burns caused by?
-Dry Heat: fire, stove heaters
-Moist Heat: hot liquids
-Chemicals: oven and drain cleaner
-Electricity
-Radiation
when will a burn require emergency help?
-when burns are on the head, face, neck, hands, feet or genitals
-are spread over a large part of the body
-if client is under 2 or over 50 with pre-existing medical conditions
-depending on size and depth
what is the first aid for minor burns?
-immediately cool injured area (use cool water)
-cover burn with dry, clean cloth
-do NOT apply oil, butter, salve or ointments
-report to supervisor
-call 911 if burns appear serious
what is the first aid for chemical burns?
-brush off any loose chemicals
-flush area with large amounts of cool water
-call 911
what is the first aid for electrical burns?
-secure your own safety first
-do not touch the person until the power source has been turned off
-do not apply water
what is the first aid for heat source burns?
-roll the person into a blanket to stop the burning process
-keep skin cool with water
-keep burn covered
-remove jewelry or tight clothing before area swells
-start CPR as needed
-call 911
when does suffocation occur?
when breathing stops due to lack of oxygen- brain damage or death may occur
what are common causes of suffocation?
-choking
-drowning
-inhaling gas or smoke
-strangulation
-electrical shock
-chewing and swallowing difficulties
what is carbon monoxide poisoning?
-aka the Silent Killer
-colourless, odourless, tasteless gas produced by common household appliances or
fireplaces
what are the symptoms of carbon monoxide poisoning?
-headaches
-nausea
-fatigue
how do we prevent accidents with equipment?
-electrical items must all be in proper working condition
-do not use damaged items on patients or residents
what are major causes of fires?
-unsafe smoking
-cooking accidents
-faulty electrical equipment
what are 3 things needed for a fire
-a spark or flame
-a material that will burn
-oxygen
what do you do during a fire?
-RACE

-Rescue (people to safe place)

-Alarm (activate alarm or call 911)
-Confine (the fire)
-Extinguish or Evacuate
what is a class A fire?
-Ash
-material that burn and leave
what is a class B fire?
-Burn or Boil
-material that can burn or boil
what is a class C fire?
-Current
-materials that have an electric current, causing electrical fires
how do you use a fire extinguisher?
-PASS
-Pull the safety pin
-Aim low at the base
-Squeeze the handle
-Squeeze from side to side
what is the call bell?
-a call system that is connected to an intercom system
-system is connected to cordless phones carried by staff
how do we position the clients call bell?
-place the call bell on the client's strong side
what are included in warning labels?
-product info
-supplier info
-hazard symbols
-risk factors
-precautionary statements first aid
when do you check the MSDS (Material Safety Data Sheet)
-when using a hazardous substance
-cleaning up a leak or spill
-disposing of the substance
what is abuse?
-physical or mental harm caused by someone in a position trust
-abuse implies a relationship between the abuser and the abused
-abuser has control over the victim
what does the Canadian charter of rights and freedom state?
-Canada values equality and diversity and that no one should be abused or has the right
to treat others unfairly
-Canadians are legally obligated to respect your rights and the rights of others
Types of abuse
-physical
-sexual
-emotional
-financial
-neglect
what is physical abuse?
-force or violence causing pain, injury and sometimes death
what is sexual abuse?
-unwanted sexual activity, including sexual harassment
what is emotional abuse?
-words or actions that inflict mental harm
what is financial abuse?
-misuse of money or property
what is neglect?
-failing to meet basic needs
what is the cycle of abuse?
- tension-building phase
-abuse phase
-honeymoon phase
-time between episodes gradually shortens overtime, and abuse becomes more
frequent and intense
the role of support workers in abuse
-responsible for recognizing signs of abuse BUT are not qualified to judge whether or
not a client is being abused

-report suspicions and observations of abuse to supervisor

what is spousal abuse?
-abuse that occurs between intimate partners in marriage or common-law relationships
what is child abuse?
-occurs when parent, guardian or caregiver mistreats or neglects a child
-abused children are at a greater risk of themselves becoming abusers and criminals
what is physical abuse in a child?
-deliberate application of force on any part of the body
-includes shaking, choking, biting, kicking
what is emotional abuse in a child?
-not meeting child's need for affection, humiliating, rejecting, name calling
-forcing a child into social isolation or intimidating
what is child sexual abuse?
-rape
-molestation
-incest
What is child neglect?
-physical: depriving a child of food, clothing, medical care
-emotional: when a child's need to be loved, wanted and safe is not met
what are situations that increase the risk of child abuse?
-family crisis
-single parenting
-isolation
what can be done to prevent child abuse?
-child abuse prevention programs
-being supportive
-teach children to recognize and say no to abusive or exploitive behaviour
-report abuse if you witness it
what are some factors that may increase the risk of abuse in the elderly?
-stress
-ageism
-vulnerability
Abuse of clients by Health Care Workers
-can happen in facilities or home care setting
-abuse includes violation of client rights
-often happens when workers are under stress or lack the education
what should you do when clients speak of abuse?
-listen attentively
-do not deny or ignore their problem
-let the client decide if they would like to accept help
how should you report abuse?
-record all observations and be specific when making a report
-keep all notes for later recall
-record victim's and abuser's names and information
-protect privacy
what are the legal responsibilities of a PSW when reporting abuse?
-child abuse or suspected child abuse must be reported to the authorities
-failure to report child abuse may result in fines or imprisonment
what is culture?
-a way of being; it influences how we view the world and how we interact with other
humans
-refers to characteristics of a group of people, the language, value, beliefs, habits and
way of life
what is diversity?
a state of different individuals and cultures coexisting
what is ethnicity?
refers to groups of people who share a common history, language, geography, religion
or identity
what is prejudice?
an attitude toward or an opinion of a person based upon the person's membership in a
group
when does bias occur?
when a person is unable to impartially judge the issues at hand because of a preformed
point of view
what is stereotyping?
an overly simple view of a group of people
-racism, sexism, ageism
body language in culture and communication
expressed through gestures, postures and facial expressions

QUIZ 2 CHRISTINE

what are the observations we need to make about urine?

1. colour
2. clarity
3. odour
4. amount
5. particles
what do we report when observing urine?
-complaints of urgency, burning or pain
what are the characteristics of normal urine?
1. pale/straw yellow, or amber in colour
2. clear with no particles
3. faint odour
Define urinary incontinence
inability to control the passage of urine from the bladder
What is dysuria?
painful or difficult (dys) urination (uria)
What is hematuria?
blood (hemat) in the urine (uria)
What is oliguria?
Less than 500 cc of urine in 24 hours
What is polyuria?
production or abnormally large amounts of urine
what is urinary frequency?
the need to urinate at frequent intervals
What is overflow incontinence?
the leaking of urine when the bladder is too full
what is urinary urgency?
the need to void immediately
Why are urinary catheters used?
Urinary catheters are used in many clinical situations for patients who are unable to void
or need constant monitoring of fluid status.
00:0303:06
what are situations where a catheter is used?
-before, during or after surgery
-clients who are too weak or disabled to use the bedpan, urinal, commode or toilets
-to protect wounds and pressure ulcers from contact with urine
-hourly output measurements
what is the risk factor for catheters?
infection
what are the types of catheters?
1. straight catheter (drains the bladder and then is removed)
2. indwelling catheter aka retention or Foley catheter (left in the bladder)
3. suprapubic catheter (surgically inserted through the abdomen above the pubic bone)
what are the two types of urinary drainage bags?
1. Leg bag
2. Drainage system bag
Drainage System Bag
-used for indwelling catheters
-nothing can enter the system from the catheter to the drainage bag
-system is sterile
Leg bag
-strapped to clients thigh
-used when the client is out of bed
care considerations for drainage bags
-always keep the drainage bag lower than the clients bladder
-drainage bag must not touch the floor
-never hang the drainage bag on the bed rail (it will be higher than the bladder if the bed
is repositioned and can even pull out the catheter)
-cover the drainage bag to reduce visibility
how do we empty a drainage bag?
-empty urine into a separate container with an incontinence pad underneath, then take
urine to the bathroom and flush it down the toilet
how do we measure and record urine?
-empty urine into a measuring cup or use the urometer attached to the bag for
measurement
-read measurement at eye level
-note and record characteristics of urine
what are the signs and symptoms of a UTI?
-painful or difficult urination
-cloudy or smelly urine
-blood in urine
-sudden urge to urinate more often
-change in behaviour like agitation and confusion in older adults
How can UTIs be prevented?
-wipe from front to back
-drink plenty of fluids
-do not resist the urge to urinate
-urinate before and after sex
what are the types of incontinence briefs?
1. brief
2. pant liner
3. pull-on briefs
what are the risks associated with briefs?
-skin breakdown
-psychological distress like depression, anger, frustration
what are the normal bowel movements?
-most bowel movements are every 2-3 days
-time and frequency varies
what are the factors affecting bowel movements?
-privacy
-personal habits
-diet
-fluids
-activity
-medication
-aging
-disability
what are the observations you need to make about stool?
-colour
-amount
-consistency
-shape and size
-frequency of defecation
-pain or discomfort
what are normal stool characteristics?
-brown
-soft
-formed
-moist
-shaped like the rectum
describe constipation and its risks
-the passage of a hard, dry stool with less frequency than normal
-risk of hemorrhoids
-caused by low-fibre diets, ignoring the urge to defecate and decreased fluid intake
Describe fecal impaction and its risks
-the prolonged retention and build up of feces in the rectum
-risks are fever, nausea or vomiting and abdominal swelling
describe diarrhea and its risks
-the frequent passage of liquid stools
-risks are dehydration which may lead to death
describe fecal incontinence and its risks
-the inability to control the passage of feces and gas through the anus
-risk of client resisting care which makes washing and changing the client difficult
describe flatulence and its risks
-excessive formation of gas or air in the stomach and intestines
-risks of client is if flatus is not expelled, the intestines distend
how can the PSW promote bowel movements?
by using bowel training, it will teach the client to gain control of bowel movements and to
develop a regular pattern of elimination
describe the use of enemas
enemas are used to:
-remove feces
-relieve constipation, fecal impaction or flatulence
-clean the bowel of feces before certain surgeries and diagnostic procedures
what are enemas and who orders them?
-enema is the introduction of fluid into the rectum and lower colon
-ordered by doctor
what do commercial enemas do?
-they stimulate and distend the rectum and cause defecation
-the solution is usually administered at room temperature
-this is a delegated act
what is an ostomy?
an ostomy is a surgically created opening
what is the opening of an ostomy called?
-stoma
-the client wears a pouch over the stoma to collect stools and flatus
What is a colostomy?
-a surgically created opening between the colon and the abdominal wall
-the colostomy site depends on the site of disease or injury
what happens in a permanent colostomy?
The diseased part of the colon is removed
what happens in a temporary colostomy?
-a TEMPORARY colostomy gives the diseased or injured bowel time to heal
-after healing, surgery is done to reconnect the bowel
What is an ileostomy?
a surgically created opening between the ileum and the abdominal wall
what happens in an ileostomy?
-the entire colon is removed
-very little water is absorbed
-liquid stools drain constantly from an ileostomy
what observations should you make for an ostomy?
-discarge
-leaking
-rashes
what should be considered when caring for a client with an ostomy?
-use the right size pouch and skin barrier opening
-change the pouching system regularly
-clean the skin around the stoma
what materials are required for ostomy care?
-a new pouch and clip
-scissors
-stoma powder
-stoma paste or ring seal
-skin wipes
-clean towels or paper towel
how can a PSW help clients maintain regular urination?
-offer regular use of the bathroom, urinal, bedpan or commode
-be quick to help the client use the bathroom when they ask
-help the client to use a normal position for elimination as much as possible
-provide privacy, warmth and relaxation

Chapter 5: intergumentary system

what does integument mean?

to cover
what are the components of the integumentary system?
skin, hair, nails and glands
what are the functions of the integumentary system?
1. protection
2. sensation
3. excretion
4. lipid storage
5. immunity
6. blood reservoir
7. vitamin D production
8. temperature regulation
how is protection served through this system?
protection from water loss, microbes entering, abrasion, UV light, hair, damage
how is sensation served through this system?
receptors detect hot and cold, pain and pressure
how is excretion served through this system?
removes waste through sweat
how is lipid storage served through this system?
fat cells are stored in the hypodermis
how is immunity served through this system?
skin has immune cells that protect
how are blood reservoirs served through this system?
because its the largest organ, there are lots of blood vessels in it and can easily be
shunted
how is vitamin D production served through this system?
-UV light causes skin to produce vitamin D
-vitamin D can also be ingested through fish oils, fortified milk, eggs and butter
-vitamin D stimulates intestines and absorbs calcium and phosphate
how is temperature regulation through this system?
cools the body by sweating, warms the body by constricting blood vessels and keeping
warmth at the core
What is the epidermis? what is the tissue type?
Outer layer of skin, stratified squamous epithelial

What is keratinization?
-process in which new cells (with keratin) push old cells to surface
-this cycle is about 40-56 days to reach the surface
Layers of the epidermis: Stratum Basale
-deepest layer of the epidermis
-single layer of cells
-firmly attached to cells
-cuboidal
-mitosis rapidly occurs (every 19 days)
Layers of the epidermis: Stratum Corneum
-outermost layer of the epidermis
-20 to 30 layers of dead squamous cells filled with keratin
-accounts for 75% of epidermal thickness
-calluses form when there is a high amount of friction
What is the dermis?
-middle layer of skin, papillary and reticular layer
-dense irregular connective tissue
what does the dermis contain?
contains fibroblasts, nerve endings, smooth muscle, glands, blood vessels and hair

what are cleavage lines?

areas where skin is most resistant to stretching, due to orientation of collagen fibers.
this is important in scarring

What is the papillary layer?

-a thin connective tissue layer containing blood vessels
-includes the dermal papillae

What is the dermal papillae? what does it do? what is an example of this?
-projections of the dermis that indent the epidermis
-removes waste, provide nutrients and help regulate body temp
-an example of this are the ridges of the hands and feet (fingerprints). the patterns are
unique for everyone

what is the reticular layer? how much percent of this is the dermis?
-the deepest layer of the dermis
-accounts for 80%
What is the hypodermis?
A layer of adipose (fat) tissue that stores energy and cushions other organs

What are the accessory structures for the integumentary system?

hair, glands nails
Accessory Structure: Hair
-flexible strands of keratinized cells
-contains an arrector pilli (smooth muscle around each hair follicle which contracts and
makes the hairs stand)

Accessory Structure: Glands

sebaceous glands, eccrine glands, apocrine glands

where are eccrine glands found?

all over the body
Where are apocrine glands found?
axillary and genital areas
(this only becomes active during puberty and causes body odor)
Accessory Structure: Nails
composed of keratin synthesized by dead stratum corneum cells

Skin Pigments
1. Melanin
2. Carotene
3. Hemoglobin
What is melanin?
-the colouring of the skin
-responsible for the color of the skin, hair and eyes
-all races have the same number of melanocytes

where do freckles come from?

an accumulation of melanin
What is albanism?
the absence of melanin (can occur in any race)
What is carotene?
yellow-orange pigment found in plants
Where does carotene accumulate?
stratum corneum
What is hemoglobin?
A protein in red blood cells that carries oxygen and gives a pinkish-red color
Skin Colour and Disease: Redness
fever, hypertension, inflammation, allergies
Skin Colour and Disease: Pallor (pale)
anemia, or low BP
Skin Colour and Disease: Jaundice
liver disorder
Skin Colour and Disease: Bronzing
Addisons Disease (kidney disease) (orangey, fake tan appearance)
Skin Colour and Disease: Bruising
broken blood vessels
Skin Colour and Disease: Cyanosis
impaired circulation or respiratory function (low O2)
what happens with aging in the integument?
-blood flow decreases and skin becomes thinner
-decreased activity of sweat glands make it more difficult to maintain temperature
-loss of elasticity
-loss of sebaceous glands, making skin very dry and itchy
Classification of Burns
first degree, second degree, third degree
Superficial thickness burns
-first degree
-only damages the epidermis
-redness, slight swelling
-heals within 2-3 days
-includes sunburns or exposure to cold
Partial thickness burn
-2nd degree
-blisters, swelling, redness, pain
-heals in 2 weeks with some scarring
Full thickness burns
-3rd degree
-destroys epidermis and dermis
-burned areas are cherry red to black
-nerve endings are destroyed and a skin graft may be necessary
What is skin cancer?
-uncontrolled growth of abnormal skin cells
-most common type
-caused by UV light exposure
-UVA cause tans (associated with malignant melanomas), UVB cause sunburns
What are the types of skin cancer
basal cell carcinoma, squamous cell carcinoma, malignant melanoma
basal cell carcinoma
malignant tumor of the basal cell layer of the epidermis

squamous cell carcinoma

malignant tumor of the squamous epithelium, can cause death

malignant melanoma
cancerous growth composed of melanocytes

TISSUE
What is a tissue?
group of cells with similar structure and function
Define histology
study of tissues
00:0403:06
what are the types of tissues
epithelial, connective, muscle, nervous

what are the functions of epithelial tissues

protection, absorption, filtration, secretion
what are the shapes of epithelial tissues
squamous, cuboidal, columnar, transitional
what are the layers of epithelial tissues
simple and stratified
What is a free surface? what do they contain?
surface exposed to the outside or to an open space internally. They contain microvilli,
cilia and goblet cells
What does microvilli do?
increase surface area
What does cilia do?
short, hair-like projections used for movement

What do goblet cells do?

produce mucus
what are the type of cell junctions
tight junctions, desmosomes, hemidesmosomes, gap junctions

What do tight junctions do?

form a water tight seal between cells that can block water, ions, and other molecules
from moving past the cells
00:0303:06
What do desmosomes do?
connects two cells together by linking their cytoskeleton.
What do hemidesmosomes do?
attach cells to basement membrane
what do gap junctions do?
allow molecules to bass between the cell as communication
types of glands in epithelial tissue
endocrine and exocrine
What do endocrine glands do?
secrete hormones into the blood, directly through the bloodstream (no ducts)
what do exocrine glands do?
Release secretions into ducts which open onto an epithelial surface.
what are the types of exocrine glands
unicellular, simple and compound
What is connective tissue?
the supporting networks of all parts of the body
how care connective tissues classified?
based on its type of extracellular matrix and function
What is the matrix?
the nonliving material between cells
what is the matrix composed of?
water, fibers and hard minerals
what are the 3 components of the matrix
protien fibers, ground substance, fluid
what are the types of protein fibers?
collagen, reticular, elastic
what are the functions of connective tissues?
1. enclose and separate around organs and muscles
2. connects tissues
3. support and movement
4. storage
5. cushion and insulate
6. transport blood
7. protect immune cells
what does muscular tissue do?
produces movement via contractions of muscle fibers
what are the types of muscular tissues?
skeletal, cardiac, smooth
What does nervous tissue do?
controls and coordinates body movements
where is nervous tissue found?
brain, spinal cord, peripheral nerves

what does nervous tissue include?

axons, dendrites and cell bodies
what is tissue repair?
substitution of dead cells for viable cells
What is regeneration?
replacement of lost cells and tissues with cells of the same type (no scar)
What is replacement?
cells of a different type develop (scars)
What is inflammation?
localized tissue response to injury
what are the chemical mediators of inflammation?
released energy, dilation of blood vessels
what are the symptoms of inflammation?
redness, swelling, heat, pain

1022:
As a PSW, who will you communicate with?
Clients (every time you give care),
Co-workers (before, during and after a shift),
Supervisors (for direction, attention and guidance)
before communicating, we should consider:
-what the situation is
-always show respect
-emotions like stress and frustration can affect the message
Factors that affect communication
-perception of those involved experiences
-physical and mental health (values, beliefs, emotions, gender, age, culture)
communication etiquette requires everyone to:
-behave professionally
-ethical
-friendly
-respectful at all times, even when on breaks
Breaches of etiquette include:
-gossiping about clients or team members
-not maintaining confidentiality
-non supportive facial expressions
-bullying/ horizontal violence
etiquette of verbal communication
-use simple, everyday language
-choose words carefully
-ask one question at a time
-be clear and concise
-determine and understanding
-don't pretend to understand
in what ways can we non-verbally communicate?
-body language
-touch
-silence
what are some communication methods?
-active listening (paying close attention to a person's communication)
-paraphrasing (restating a persons message into your own words)
-empathetic listening (being attentive to a person's feelings, not feeling sorry for them)
-clarifying (understanding what has been said and repeat the message)
-focusing (limiting the conversation to a certain topic
what are some communication barriers?
-interrupting
-answering own question
-giving advice
-minimizing problem
what are the causes of anger?
-frustration
-pain
-anxiety
-treatment or disease can make someone less friendly
how to communicate with an angry client:
-Recognize (that the client is feeling frustrated)
-Empathize (how would you feel in their situation?)
-Be respectful
-Address the client's questions clearly and fully
-Stay calm and professional
-Do not argue with the client
-Listen and use silence
-Protect yourself from violent behaviour
What are the two approaches to communication?
assertive and agressive
What is Aggressive Behaviour?
-Negative behaviour that can cause physical , emotional or mental harm
-ex. (include but are not limited to) fighting, swearing, hitting
What is Assertive behaviour?
-when you positively express your thoughts or feelings
-done in a way that is respectful and professional
what are some communication suggestions?
-avoid judgement based on intelligence
-always show respect
-use simple, everyday terms
what is validation therapy?
A type of therapy for people with dementia that focuses on empathy and advocates
accepting the affected person's perception of reality.
Validation therapy history*
-developed by Naomi Feil from 1963 to 1980
-first published in 1982
-practiced worldwide
-supports the client in their reality
-does not challenge or disagree with the client
what are the 10 principles of validation therapy?
1. 1.All people are unique and must be treated as individuals.
2. 1.All people are valuable
3. There is a reason behind the behaviour of disoriented old-old people.
4. behaviour in old-old age reflects a combination of physical, social and psychological
changes that take place over the lifespan
5. old-old people cannot be forced to change their behaviours. It is only if they want to
change
6. old-old people must be accepted non-judgementally
7. Failure to complete a task at the appropriate stage of life may lead to psychological
problems
8. When more recent memory fails, older adults try to restore balance, in their lives by
retrieving earlier memories (when eyesight fails, they use the minds eyes to see)
9. Painful feelings that are expressed, acknowledged, and Validated by a trusted
listener will diminish. Painful feelings that are ignored or suppressed will gain strength.
10. Empathy builds trust, reduces anxiety, and restores dignity.
What is reflective journaling?
•reflective practice where we can learn to think reflectively and practice personal insight
into our own actions by writing reflectively
why is reflective journaling practice helpful?
-Reflective Practice is a great way to deal with our stress and emotions positively so
that we learn and grow
what are the basic components of reflective journals?
Describe, Interpret, Reflect, Plan for the future (DIRP)

MEDICATION FINAL
PO
by mouth
TOP
topically
00:0203:06
SL
sublingual (under the tongue)
sub cut
subcutaneous
IM
intramuscular
NG
nasogastric
PR
per rectum
cap
capsule
tab
tablet
gtt
drop
sol
solution
susp
suspension
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elix
elixir
ung
ointment
a.c
before meals
p.c
after meals
stat
immediately
qHs
at bedtime
PRN
as needed
OD
once a day
BID
twice daily
TID
three times a day
QID
four times a day
q1h
every hour
q2h
every 2 hours
q3h
every 3 hours
q4h
every 4 hours
q6h
every 6 hours
q8h
every 8 hours
q12h
every 12 hours
Medication Classifications
-analgesics
-antacids (relieve heartburn)
-anti-anxiety
-antibiotics (eliminate or reduce harmful bacteria)
-antivirals (reduce virus reproduction)
-bronchodilators (reduce spasm in breathing passages)
-diuretics (lower BP and body swelling by increasing urinary output)
8 Rights of Medication
1. Right client
2. Right medication
3. Right time
4. Right dose
5. Right route
6. Right reason
7. Right documentation
8. Right expiration date
what is an adverse effect?
an unwanted or dangerous side effect
what is a side effect?
effects that are not the desired effect
what does delegation mean?
A process by which a regulated health care professional who has legal authority to
perform a controlled act transfers that authority to an unauthorized person
when do you accept a delegated task?
-when you know you can perform the task safely, having met the criteria of the 5 rights
to delegation
when do you refuse a delegated task?
-when you refer to the 5 rights of delegation and it does not meet the criteria
-you cannot refuse because you simply don't want to, you need a sound reason
how can you refuse a delegated task?
I'm flattered that you trust me to perform these procedures however, I do not feel
comfortable enough to perform these skills. Also, I was taught at school that being
delegated to one client does not mean that it applies to all other clients.
What are the 5 rights of delegation?
1. Right task- can it be delegated
2. Right Circumstance- Should it be delegated
3. Right person- can this person do the task
4. Right direction/ communication- is the task being conveyed in a clear manner
5. Right supervision- is the task being followed up on once complete.
Military time
24 hour clock
What should prescription labels read?
-pharmacy name
-file number
-patients name
-drug name and dose
-amount of times it can be refilled
-physicians name
-expiration date
-date filled

when should an incident report be done?

-if you believe you made a drug error
-you notice a drug error was made by someone else
-a medication was documented incorrectly
when should you notify your supervisor?
-client doesn't take medication correctly
-client doesn't understand the rational for taking medication
-client refuses to take medication
-client shows adverse effects
-client wants to take medication not identified on the MAR
-client is taking other meds/alcohol/recreational drugs
what is a MAR?
medication administration record
how do we properly dispose of expired medication?
-take-back programs in Ontario collect prescriptions and OTC medication
-in the garbage disposal, remove medication from original containers, hide it in
something unappealing and place it in a sealed bag/container
what does a MAR always contain?
-client name
-the name, dose time and administration instructions for each medication
-a place to sign or initial after administration
-may also list allergies
How do we assist clients with topical medication?
What is the pre-procedure for assisting oral medication?
-ensure that you have the right client
-explain what you will be doing
-perform HH and have client do the same
-collect supplies
-provide for patient privacy
How do we assist clients with oral medication? (blister packs)
-check blister pack and review 8 rights
-instruct client to open the pack by pushing against the bubble (you can do this for the
client if they are unable to do so)
How do we assist clients with medication? (PO Route)
-start with a sip of water to assist the client with easier swallowing
-support clients hand if necessary
-give client liquids after the medication is placed in the mouth
-tell client to lower chin when swallowing to reduce the risk of aspiration
How do we assist clients with oral medication? (sublingual)
-client should place medication under the tongue, close their mouth and let medication
dissolve
-do not chew or swallow
-do not give food or fluid when client is dissolving as it will not absorb properly
what is the post-procedure for PO medication assistance?
-close container after use
-have client document that the medication was taken properly
-store in proper location
-HH
-report and record
How do we assist clients with oral medication? (tablet)
-loosen lid if client cannot do so
-hand them the container or place in a location they can reach
-have client read medication label to you
How do we assist clients with eye drops?
What is the pre-procedure for assisting in eyedrops and eye ointment?
-identify client
-explain the procedure
-HH for yourself and the client
-collect supplies such as medication, tissues, hand mirror and disposable gloves
-provide privacy
How do we assist our clients with eyedrops?
-have client remove any drainage from the eye by providing a warm washcloth
-observe if the client looks up and releases the drops of medication into the lower lid
-the dropper should not touch the clients eyes, to prevent damage to the eye or
contamination to the dropper
How do we assist our clients with eye ointment?
-guide clients hand to grasp the lower eyelid
-observe that the client is looking up and squeezing a small ribbon of ointment onto their
lower lid from the inner to the outer corner of the eye
-make sure tip of tube doesn't touch the eye surface
-observe the client closing their eye
What is the post-procedure for assisting in eyedrops and eye ointment?
-reseal the container
-assist the client to wash their hands
-have client record the medication or record for them
-store the medication in the proper location
-remove privacy measures
-wash hands
-record and report
what are ear drops used for?
-can be used to treat or prevent ear infections or to help remove earwax
-ear drops may be either prescribed by a doctor or may be bought OTC
What is the pre-procedure for assisting in ear drops?
-identify the client
-explain the procedure to the client
-HH for self and client
-collect supplies such as medication, tissues, small hand mirror, disposable gloves
-provide privacy
How do we assist our clients with in-ear drops?
-check the label and follow the 8 rights of medication
-loosen the lid on the container if the client cannot do so by themselves
-place container by the client within their reach or hand it to the client
-assist the client to lie on the side, exposing the ear that is to receive the medication
-hold the mirror so client can self administer or assist as needed
-the external ear should be pulled upward and outward
-ensure the drops go into the ear canal
-gently massage the outside of the ear
-place a cotton ball in the ear and remove after a few minutes
What is the post-procedure for assisting in ear drops?
-reseal the container
-assist the client wash their hands
-have client record the medication
-store the medications in the proper location
-wash your hands
-record and report
what is the purpose of rectal suppositories/ enemas?
-solid forms of medication that are inserted into the rectum, they come in different
shapes but usually narrowed at one end
-form of medication is often used to treat constipation, but may be given for other
reasons such as rectal acetaminophen to treat a fever
-enemas are often used to treat constipation, involves inserting a medicated source of
fluid into the intestine by way of the rectum
what is the pre-procedure for assisting with suppository administration?
-identify client
-explain the procedure to the client
-hand hygiene
-collect supplies such as the suppository, a water soluble lubricant, disposable gloves,
toilet paper
-provide privacy
how do we assist our clients with suppository administration?
-check the label and follow 8 rights of medication
-assist client into bed and position into a 'Sims' position on the left side
-sims position will best allow the medication to enter the colon from the rectum
-help client lower or remove clothing to expose anal area
-unwrap the suppository
-apply lubricant
-provide a glove to the client
-hand the suppository to the client to be inserted in the rectum
-if required, you can assist by guiding the client's hand
-observe the client insert the suppository (narrow end inserted first)
-clients should wipe their anus following insertion with the toilet paper, but may need
assistance completing this task
-observe client remove and discard the glove
-client should be reminded to remain on their side for 15-20 mins
what is the post-procedure for suppositories
-discard used materials in the waste container
-assist the client to wash hands
-provide privacy to allow client to defecate
-have client record the medication
-store medication in proper location
-remove privacy measures
-wash hands
-record and report
guidelines in enema administration
-only perform this task if it is delegated to you
-perform this skill if you are properly trained
how do we assist a client in enema administration?
-remove the enema from its packaging and remove the cap covering the insertion tip
-lubricate insertion tip with water soluble jelly
-insert the tip into the clients rectum up to the end of the tip
-gently squeeze the content of the enema into the client
-ask the client to take slow, deep breaths during this time
-frequently check clients comfort level
-if the client develops cramping, STOP immediately and consult supervisor
-after completion of the enema, remove and wipe the rectal area
-assist client to the toilet, commode or bedpan
-ensure client is sitting as upright as possible to help bowel evacuation.
what is the post-procedure for assistance in enema administration?
-discard used materials in the waste container
-assist client to wash hands
-provide privacy to allow client to defecate
-have client record the medication
-store medication in the proper location
-remove privacy measures
-wash hands
-record and report

About us
CHRISTIEN FINAL
what are the observations you need to make about urine?
-colour
-odour
-amount
-clarity
-particles
what are normal characteristics of urine?
Color - pale yellow to amber
Clarity - clear to only slightly cloudy
Odor - none to mild

what characteristics of urine are concerning and should be report?

-cloudy or dark in colour
-blood in the urine
-strong odour
-increased urgency
-pain in the pelvis
-burning sensation
Define urinary incontinence
loss of bladder control
COMMUNICATION
FINAAL

Final everything
Holistic Care
Considering the whole person. Considering their physical, social, emotional, cognitive
and spiritual dimensions.
Professionalism
an approach to work that demonstrates respect for others, commitment, competence,
and appropriate behaviours.
Professional Boundaries
Appropriate limitations on behaviour, meant to protect the vulnerable client from the
caregiver who has access to private knowledge about him or her.
Regulation of a PSW
The PSW is an unregulated profession. For an unregulated care provider there are
clearly identified services we provide under the supervision of the client, family member,
regulated health care provider or employer. There is no legislation to regulate PSW's or
an organization of professional college that governs the role. There is no official code of
ethics but they must adhere to the codes of behaviour from their employer.
Regulated Health Professions Act
Regulated Health Professions. In Ontario, regulated health professions are governed
under the Regulated Health Professions Act, 1991 (RHPA) and health profession Acts
(i.e., Medicine Act, 1991). This legislative framework establishes health regulatory
colleges, which regulate the professions in the public interest. i.e. the college of nurses.
Role of the occupational therapist
Focuses on rehabilitation; teaches clients skills needed to perform ADLs; designs
adaptive equipment for ADLs
Role of the physical therapist
Focuses on rehabilitation; assist clients with musculo-skeletal impairments; focuses on
restoring function and preventing disability from illness or injury
Role of Registered Nurse (RN)
assesses, makes nursing diagnoses, plans, implements, and evaluates nursing care.
Tends to clients with unstable health conditions; provides direct client care, administers
medications, supervises support workers
Role of RPN Licenced practical nurse (LPN)
a health care provider licensed and regulated by the province or territory to carry out
nursing techniques and provide client care. Known as a registered practical nurse
(RPN) in Ontario.
ALL RULES REGARDING DELEGATION
Only regulated health care providers like nurses have the authority (legal right) to
perform certain tasks because they have the knowledge, skill and training to perform
them. They are called controlled acts and are considered harmful if they are performed
by unqualified people. In some circumstances some acts will be delegated to you. In
order to do this, specific conditions called "exceptions" must be met for delegation to be
permitted. The nurse must feel confident the support worker understands what the
responsibilities are when performing the task, knowns when and who to ask for
assistance, and knowns when, how and whom to report the outcome of the task.
Tasks that may be delegated to support workers must be routine ones with predictable
outcomes that require little supervision and can only be delegated for stable clients.
Delegation tasks may include: suctioning a permanent tracheotomy in and out
catherization; administering glucometers, dressings, tube feedings and medication.
Only some nursing tasks can be delegated. Your employer's policies and guidelines,
your job description and provincial or territorial legislation determine what tasks can be
delegated to you.
Sometimes these rules vary between community and LTC.
In Ontario an RN, RPN and LPN can delegate.
A delegated task is not transferrable to another client. Just because you did it for one
person, does not mean you are able to perform the SAME task on another client without
training.
Before delegating tasks, the nurse must know the following:
• What tasks your province or territory allows support workers to perform.
• The tasks included in your job description.
• What you were taught in your training program.
• What skills you have learned and how they were evaluated.
• Your work experiences.
A nurse who delegates a task is required to:
• Have the knowledge, skill, and judgement to perform the task competently.
• Have the additional knowledge, skill and judgement to teach the task to others. The
delegating nurse is responsible for providing all necessary teaching, but not everyone is
able to teach others how to perform something. Good communication skills and
patience required.
• Accept responsibility for teaching the task to the support worker. The nurse must first
determine the risks and benefits of teaching the task and be able to confidently predict
its outcome.
• Assess your performance. The nurse must determine if you're able to perform the task
correctly.
• Determine if the task that is taught can be performed for more than one client. Each
client is unique.
• Monitor you over time to ensure you remain able to perform the task correctly and
safely.
In the community the nurse may provide you with written instructions, predicted
outcome and what to record.
You can refuse a task to be delegated to you if:
• you have concerns about your ability to do the task
• it is beyond your scope of practice
• the client's condition changes
5 RIGHTS OF DELEGATION
right task
right circumstance
right person
right direction/communication
right supervision/evaluation
The right task
Can the task be delegated? Does the provincial nursing act or health professions act
allow the nurse to delegate the task? Is the task in your job description? Have you been
trained to do the task? A job description should be available.
The right circumstances
What are the client's physical, emotional, social, spiritual and cognitive needs currently?
Do you understand the purpose of the task for the client? Do you have the equipment
and supplies needed to perform the task? Do you know how to use the equipment and
supplies?
The right person
Do you have the training and experience to safely perform the task for this client? Do
you have concerns about performing the task?
The right directions and communication
has the nurse provided clear directions and instruction? Has the nurse told you what to
do, when to do it, what observations to make and when to report back? Are the
directions legal, ethical, and consistent with employer policies? Can you review the task
with the nurse? Do you understand what the nurse expects?
The right supervisions and evaluation
Is a nurse available to answer questions? Is a nurse available if a client's condition
changes or if problems occur? After the task is completed, does the nurse assess how
the task affected the client? Does the nurse discuss your performance with you, telling
you what you did well and how to improve your work?
culture: the characteristics of a group of people, including
language, values, beliefs, customs, habits, ways of life, rules for behaviour, music and
tradition
CULTURE
makes a society distinctive. It refers to the characteristics of a group of people, the
language, values, beliefs, way of life, habits, implied rules and behaviours, music and
traditions that are shared or perhaps even passed down generation to generation.
Culture may be influences by age, race, gender, occupation sexual orientation or
lifestyle.
Everyone is part of a culture. Some people belong to more than one culture. Cultural
characteristics which are learned by living in a group influence a person's behaviours
and attitudes.
Ethnicity is an important influence on a person's culture but it is not the only influence.
Some people have chosen to assimilate their styles of dress, eating habits, or other
behaviours when with people from another culture.
A person's culture can change over time as the person leaves one group and joins
another or encounters new life experiences.
Culture and Religion
In most cultures, religion is very important. Religion relates to spiritual beliefs, needs,
and practices and ay promote beliefs and practices related to daily living habits,
behaviours relationships with others, diet, healing, days of worship, birth and birth
control, medicine and death. Many people rely on religion for comfort during illness.
They may want to pray, observe certain practices and may want a visit from a spiritual
leader/advisor. Promptly report this request to your supervisor. Never try to convert a
client and treat all religious items with respect - do not touch unless permitted.
Maslow's Hierarchy of Needs
A need is something that is necessary or desirable for maintaining life and psychosocial
well-being. According to Maslow, certain basic needs must be met for a person to
survive and function. These needs are arranged in a hierarchy, or order or importance.
Lower-level needs must be met before higher-level needs.

The basic needs from the lowest-level to the highest-level as follows:

• Physical needs (must be met first): oxygen, food, water, elimination, rest and shelter.
• Need for safety: protection from harm, danger, fear and pain.
• Need for love and belonging: Romantic and physical love. The need for a rightful place
in society, in a peer group and in family
• Need for self-esteem: thinking well of oneself and being well thought of by others.
When self-esteem is fulfilled, a person feels confident, adequate and useful.
• Need for self actualization, or the fulfillment of one's potential (last need to be met)
Learning, understanding, and creating one's best life.
Charter or Rights and Freedoms: federal legislation that applies to all Canadians
regardless of where they live. It includes the following:
• freedom of conscience and religion
• freedom of thought, belief, opinion, and expression
• freedom of peaceful assembly and association (usually associated with the right to
form a union and strike)
• the right to vote
• the right to enter, stay in, or leave Canada
• the right to life, liberty and security
• the right to equality before and under the law, without discrimination based on race,
ethnic origin, colour, religion, gender, age, or mental or physical disability.
Assault
identified in identified in Canada's Criminal Code and can be defined as intentionally
attempting or threatening to touch a client's body without the client's consent, causing
the client to fear bodily harm.Canada's Criminal Code and can be defined as
intentionally attempting or threatening to touch a client's body without the client's
consent, causing the client to fear bodily harm.
Battery
(part of tort law) is the actual intentional touching of a client's body without the client's
consent.
Slander
making harmful false statements orally.
negligence
when a person fails to act in a careful or competent manner and thereby harms the
client or damages property. It is an unintentional wrong, but the person failed to do what
a reasonable or careful person would have done or not done.
false imprisonment
the unlawful restraint or restrictions on a person's freedom of movement. (preventing
someone from leaving a facility or the unnecessary use of restraints.)
harassment
troubling, tormenting, offending, or worrying a person through one's behaviour or
comments.
autonomy
have the freedom and choice to make decisions that affect one's life. Also known as
self-determination.
dependence
The state of relying on others for support; being unable to manage without help.
interdependence
the state of relying on one another
independence
the state of not relying on others for control or authority
CLIENTS RIGHTS
• The right to be treated with dignity and respect
• the right to privacy and confidentiality
• the right to give or withhold informed consent
• the right to autonomy
RIGHTS OF LONG-TERM CARE CLIENT
Residents' Bill of Rights Every licensee of a long-term care home shall ensure that the
following rights of residents are fully respected and promoted.
1. EVERY RESIDENT HAS THE RIGHT to be treated with courtesy and respect and in
a way that fully recognizes the resident's individuality and respects the resident's
dignity.
2. EVERY RESIDENT HAS THE RIGHT to be protected from abuse.
3. EVERY RESIDENT HAS THE RIGHT not to be neglected by the licensee or staff.
4. EVERY RESIDENT HAS THE RIGHT to be properly sheltered, fed, clothed, groomed
and cared for in a manner consistent with his or her needs.
5. EVERY RESIDENT HAS THE RIGHT to live in a safe and clean environment.
6. EVERY RESIDENT HAS THE RIGHT to exercise the rights of a citizen.
7. EVERY RESIDENT HAS THE RIGHT to be told who is responsible for and who is
providing the resident's direct care.
8. EVERY RESIDENT HAS THE RIGHT to be afforded privacy in treatment and in
caring for his or her personal needs.
9. EVERY RESIDENT HAS THE RIGHT to have his or her participation in decision-
making respected.
10. EVERY RESIDENT HAS THE RIGHT to keep and display personal possessions,
pictures and furnishings in his or her room subject to safety requirements and the rights
of other residents.
11. EVERY RESIDENT HAS THE RIGHT to i. participate fully in the development,
interpretation, review and revision of his or her plan of care, ii. give or refuse consent to
any treatment, care or services for which his or her consent is required by law and to be
informed of the consequences of giving or refusing consent, iii. participate fully in
making any decision concerning any aspect of his or her care, including any decision
concerning his or her admission, discharge or transfer to or from a long-term care home
or a secure unit and to obtain an independent opinion with regard to any of those
matters, and iv. have his or her personal health information within the meaning of the
Personal Health Information Protection Act, 2004 kept confidential in accordance with
that Act, and to have access to his or her records of personal health information,
including his or her plan of care, in accordance with that Act.
12. EVERY RESIDENT HAS THE RIGHT to receive care and assistance towards
independence based on a restorative care philosophy to maximize independence to the
greatest extent possible.
13. EVERY RESIDENT HAS THE RIGHT not to be restrained, except in the limited
circumstances provided for under this Act and subject to the requirements provided for
under this Act.
14. EVERY RESIDENT HAS THE RIGHT to communicate in confidence, receive
visitors of his or her choice and consult in private with any person without interference.
15. EVERY RESIDENT who is dying or who is very ill HAS THE RIGHT to have family
and friends present 24 hours per day.
16. EVERY RESIDENT HAS THE RIGHT to designate a person to receive information
concerning any transfer or any hospitalization of the resident and to have that person
receive that information immediately.
17. EVERY RESIDENT HAS THE RIGHT to raise concerns or recommend changes in
policies and services on behalf of himself or herself or others to the following persons
and organizations without interference and without fear of coercion, discrimination or
reprisal, whether directed at the resident or anyone else, i. the Residents' Council ii. the
Family Council iii. the licensee, and, if the licensee is a corporation, the directors and
officers of the corporation, and, in the case of a home approved under Part VIII, a
member of the committee of management for the home under section 132 or of the
board of management for the home under section 125 or 129, iv. staff members v.
government officials vi. any other person inside or outside the long-term care home.
18. EVERY RESIDENT HAS THE RIGHT to form friendships and relationships and to
participate in the life of the long-term care home.
19. EVERY RESIDENT HAS THE RIGHT to have his or her lifestyle and choices
respected.
20. EVERY RESIDENT HAS THE RIGHT to participate in the Residents' Council.
21. EVERY RESIDENT HAS THE RIGHT to meet privately with his or her spouse or
another person in a room that assures privacy.
22. EVERY RESIDENT HAS THE RIGHT to share a room with another resident
according to their mutual wishes, if appropriate accommodation is available.
23. EVERY RESIDENT HAS THE RIGHT to pursue social, cultural, religious, spiritual
and other interests, to develop his or her potential and to be given reasonable
assistance by the licensee to pursue these interests and to develop his or her potential.
24. EVERY RESIDENT HAS THE RIGHT to be informed in writing of any law, rule or
policy affecting services provided to the resident and of the procedures for initiating
complaints.
25. EVERY RESIDENT HAS THE RIGHT to manage his or her own financial affairs
unless the resident lacks the legal capacity to do so.
26. EVERY RESIDENT HAS THE RIGHT to be given access to protected outdoor areas
in order to enjoy outdoor activity unless the physical setting makes this impossible.
27. EVERY RESIDENT HAS THE RIGHT to have any friend, family member, or other
person of importance to the resident attend any meeting with the licensee or the staff of
the home.
Positive communication techniques
active listening, paraphrasing, empathetic listening, asking closed questions, asking
open-ended questions, clarifying, and focusing.
Active Listening
Paying close attention to a client's verbal and nonverbal communication - listening o the
content, the intent and feelings behind the words. The following are guidelines for active
listening:
• face the client: the client will often need to see your facial expressions and body
language to be assured you are listening
• make eye contact: however, consider cultural preferences in regards to eye contact.
• lean toward the client: Do not sit back with your arms crossed as this can be
interpreted as an indication that you are not open and receptive to what the client is
telling you.
• respond to your client: note however that sometimes your client may just need to vent
• avoid communication barriers (interrupting, answering your own questions, giving
advice, minimizing problems, using patronizing language, failing to listen)
Paraphrasing
Restating another person's message is one's own words. It is usually fewer words than
the original message. It serves three purposes:
1. It shows that you are listening.
2. It lets both you and the sender known that you understood the message.
3. It promotes further communication.
People usually respond well to paraphrasing. It's important not to interpret the client's
words.
Empathetic Listening
This technique requires being attentive to the speaker's feelings. Empathy means being
open to and trying to understand the experiences and feelings of others. It involves
acknowledging the other person's point of view without judging. Empathy can reduce
feelings of loneliness and sadness and can create trust between the support worker and
clients they support.
Avoid quick, thoughtless responses like "I know how you feel," "I feel sorry for you," "I
wouldn't want to be in your shoes."
Asking Closed Questions
Focuses on specific information, so you use them when you need to learn something
precise. Some closed responses require a yes or no answer, others require a brief
response.
Asking Open-Ended Questions
These types of questions invite a person to share thoughts, feelings, or idea. Answers
must be more than a yes or a no. The person being questioned chooses and controls
what is talked about and the information given. It shows that you are interested in
hearing about their life.
Use both open and closed ended questions help find out about a client's needs and
preferences and to find out if a client is satisfied with your care.
Clarifying
Ensures that you understand a person's message. You can ask the client to repeat the
message, say you don't understand or restate the message as a question:
• could you say that again?
• I'm sorry Mr. Smith. I don't understand what you mean?
• Are you saying that you want to go home?
Focusing
Limits the conversation to a certain topic. It's useful when a client rambles or wanders in
thought.
Give the client 2 choices. "Let's talk about ..."
Objective Data (signs):
The data you gather while using your senses.
Subjective Data (symptoms):
information reported by a client but not directly observed by the support worker. When
reporting subjective data, do not interpret the client's words, quote the client directly.
Always be alert to changes in the client's condition or behaviour.

REVIEW USE OF RESTRAINTS

A restraint is any device, garment, barrier, furniture, or medication that limits or restricts
freedom of movement or access to one's own body.
Every effort is to be made to protect the clients without resorting to the use of restraints.
Restraints can cause emotional harm and serious physical injury.
Restraints require a physician's order, after consultation with the client's family.
Support workers never decide if restraints are to be used.
Guidelines Regarding the Use of Restraints:
• Unnecessary restraint is false imprisonment. There must be written consent in the
client's chart for using restraints.
• Restraints are never used to discipline a client.
• Restraints are never used for staff convenience and only in the way the physician
ordered.
• Always try and determine the reason for the client's agitation or behaviour. Knowing
and addressing the reason for this usually prevents the need for use of restraints.
Ask yourself:
- Is the client injured or in pain?
- Is the client afraid?
- Is the client seeing, hearing or feeling things that are not there?
- Is the client confused or disoriented?
- Are medications causing the behaviours? (new meds can affect the client in this way
and should be reported immediately to the supervisor.)
- Has the client not taken their medication?
- Does the client need to urinate or defecate?
- Is the client's position comfortable?
- Is the client too hot or cold? Are they hungry or thirsty?
• Restraint use should always me avoided. Restraint alternatives should always be part
of the care plan.
• Informed consent is required. The client must understand the reason for the restraint.
How the restraint will help and what the risks of the restraint are. (only nurses and
doctors can get informed consent.)
• Restraints are used only in extreme cases and when necessary to prevent harm.
• Restraints require a physician's order
• The least restrictive method is used.
• The manufacturers instructions must be used. You are never to use non restraint items
(like bedsheets) to restrain a client.
• Restraints are only to be applied by trained and knowledgeable staff.
• The client's basic needs are met.
• More than one staff member may be needed in order to apply a restraint correctly and
safely.
• The client's quality of life is protected.
• The client is observed at least every 15 minutes or more often as required by the care
plan.
• The restraint is removed, the client is repositioned, and basic needs are met at least
every 2 hours.
• Information about restraints must be recorded in the client's care plan
REVIEW FIRE SAFETY
It's essential to have working fire detectors on ever floor of the home and ideally outside
of the sleeping area. Identify where the smoke detectors are and notify your supervisor
if they are not working.
THINK ABOUT SAFETY:
• smoke only in designated areas. Do not smoke in the clients' home.
• Supervise clients who smoke. This is especially important if the client is confused,
disoriented or sedated.
• Provide ashtrays for clients who are allowed to smoke.
• check smoking areas for dropped cigarettes / ashes (especially furniture)
• Be sure all cigars and cigarettes are put out before emptying ashtrays.
• Empty ashtrays into metal containers with sand or water, not into plastic or paper lined
wastebaskets.
• Do not allow clients to smoke in bed or while lying down.
• Do not ignite lighters or matches near flammable liquids or materials
• Keep matches and lighters out of the reach of children
• Avoid deep-frying in oil, since oil is highly flammable.
• Do not drape tea towels or other materials over the oven door.
• Use potholders, NOT tea towels to remove hot items from the oven.
• Follow manufacturers instructions when using space heaters. keep at least 1m (3ft)
from curtains, drapes and furniture. DO NOT leave them unattended.
• keep flammable materials / liquids away from fireplaces, radiators, heat registers, and
other sources of heat or flame.
• store flammable liquids in their original containers
• Do not run electrical cords under carpets.
• Use extension cords only as a temporary measure.
During a fire practice the acronym RACE
R - for rescue. Rescue people in immediate danger. Move them to a safe place.
A - for alarm. Sound the nearest fire alarm. Call 911 if in a client's home.
C - for confine. Close doors and windows to confine the fire. Turn off oxygen or
electrical equipment in use in the general area of the fire.
E- for extinguish / evacuate. Use a fire extinguisher on a small fire that hasn't spread to
a larger area. If it cannot be extinguished, evacuate!
The first time you enter a client's home, plan at least 2 fire escape routes from every
room. If in an apartment building, identify the fire alarms in the hallways in case you
need them.
Standard Practices
guidelines to prevent the spread of infection from blood, bodily fluids, secretions,
excretions, non-intact skin, and mucous membranes. Also called Routine Practices or
Standard Precautions
Hand Hygiene
• Wash hands after touching blood, bodily fluids, secretions, excretions, non-intact skin,
mucous membranes and contaminated items - even if you wore gloves
• Immediately before and after wearing gloves
• Between clients
• Between tasks and procedures on the same client to avoid cross contamination
• Use plain soap for routine hand washing
Gloves
• Wear gloves when touching blood, bodily fluids, secretions, excretions, non-intact skin,
mucous membranes and contaminated items. (clean nonsterile gloves are adequate)
• Change gloves between tasks and procedures on the same client
• Change after contact with material that may be highly contaminated
• Remove gloves promptly after use
• Remove gloves before touching uncontaminated items and surfaces
• Remove gloves before going to another client
• Practice hand hygiene immediately after removing gloves
Masks and Eye Protection
• Wear during procedures and tasks that are likely to cause splashes of blood, body
fluids, secretions or excretions to protect your eyes and mouth from contact with sprays
or splashes
Gowns
• Wear during procedures and tasks that are likely to cause splashes of blood, body
fluids, secretions or excretions to protect your eyes and mouth from contact with sprays
or splashes
• Protects contamination of clothing
• A clean nonsterile gown is adequate
• Remove gown as soon as possible
• Practice hand hygiene after removing gown to prevent spread of microbes
Care of Equipment
• Handle equipment carefully. Do not let it touch your skin, mucous membranes or
clothing
• Do not use reusable items for another client. The item MUST be disinfected or
sterilized first
• Discard disposable (single use) items properly
Environmental Control
• Follow your employer guidelines for regular disinfection of surfaces
Linen
• Follow employer policy for dealing with soiled linens
• Do not touch soiled linen with your skin, mucous membranes, or clothing
• Do not shake linens as to prevent the spread of microbes
Occupational Health and Blood-Borne Pathogens
• Use extreme care when handling sharps (anything that can pierce the skin)
• Use extreme care when handling, cleaning or disposing of sharp instruments
• Never recap used needles, do not handle with both hands. Do not hold it with the
sharp pointing towards the body
• Do not bend or break needles, do not remove the needle from a disposable syringe or
needle.
• Place used sharps in the proper disposable containers
• Use barrier devices for rescue breathing in emergencies
Client Placement
• A private room is used if the client contaminates the area, do not or cannot assist in
maintaining hygiene or environmental control
• Follow your supervisors' instructions if a private room is not available.
Signs and Symptoms of Infection
• fever and chills
• increased pulse and respiratory rates
• aches, pain, or tenderness
• fatigue and loss of energy
• loss of appetite
• nausea
• vomiting
• diarrhea
• rash
• sores on mucous membranes
• redness and swelling of a body part
• discharge or drainage from the infected area that may have a foul odour
• new or increased cough, sore throat or runny or stuffy nose
• burning pain when urinating or the need to urinate more often or with increased
urgency
• behavioural changes in older adults
FALL PREVENTION
Falls are the most common cause of all accidental injuries in all settings and children
and older adults are at greatest risk. While you should always supervise your clients,
pay special attention to children, clients in wheelchairs, clients with a history of injuries,
sedated clients, older clients and those cognitively impaired as they are at greatest risk.
The risk for falls increases with age and illness. Falls may result in death, serious injury
or changes to the older person's quality of life. Clients in long term care are at greater
risk for a call than those clients who live at home. these clients tend to be older, use
more medication and require more assistance. Some have other impairments which
increase their risk for a fall.
Some strategies to prevent falls are:
• the client will be assessed to determine their falls risk. Those at high risk are provided
extra supervision and assistance.
• Staff is kept up to stay with education on how to safely move a client and the
equipment used to avoid getting injured themselves.
• Methods to identify the falls risk are can be colour coded bracelets, posted above the
client's bed, and is done in a way that is respectful and protects the client's privacy.
• Most falls happen in bedrooms, bathrooms and on the stairs - make sure these areas
are as safe as possible.
• Falls can happen when the client feels rushed, provide adequate time, reminders to
ask for help if they need it.
• Most falls happen between 1800-2100 hours when the hallways may be darker. Keep
hallways well lit and free of clutter.
• Falls are also most likely during shift changes as the 2 shifts are giving/receiving
reports. To mitigate this risk, overlap shifts.
THINK ABOUT SAFETY (falls)
• Report unsecured small rugs or mats. Use carpet tape or a non-skid pad. Small rugs
should not be used in high traffic areas.
• Report any damaged flooring, lumpy carpet
• Keep cords off the floor. (Tape them to the wall)
• Keep hallways and stairs clutter free and well lit.
• use only non-glare and nonslip floor wax
• Keep a clear path from the bedroom to the bathroom
• Do not rearrange the client's furniture.
• Make sure clothing and shoes fit well.
• Remember that clients have the right to live at risk of injuring themselves.
• Make sure that wheelchair locks are in working order.
• Position the client properly
• Encourage clients to wear hearing aids and glasses whenever applicable.
• Electric warning devices may be appropriate.
• Respond to alarms promptly
• Some people that are high risk often wear hip or coccyx protectors to minimize injury.
• keep call bells, urinals and bedpans within reach.
• Never leave the client alone when the bed rails are raised.
• Use bedrails strictly according to the care plan.
• Floor cushions provide a softer landing if the client does fall out of bed.
• Be careful when turning corners in facilities as you can't always see around the
corners.
• Do a safety check after visitors have left. they may not be aware of the precautions
involved with your client.
Good body alignment
enables the body to move and function with strength and efficiency, reduces strain on
the muscles and joints, and prevents injury.
For people with limited mobility, correct body alignment helps prevent disabling
complications such as atrophy and contractures.
A client placed in poor body alignment may develop serious effects on all body systems,
including but not limited to not being able to breath deeply and bring oxygen into the
lungs.
Body balance is achieved when there is a relatively low centre of gravity (the point in the
body in which weight is evenly distributed on either side) is balanced over a wide, stable
base.
Good posture in a standing position has the following traits
• The head and neck are erect and straight
• Shoulders and hips are parallel to each other.
• Shoulders are back
• The chest is out
• The spine maintains a natural lumbar curve
• The abdomen is tucked in and the pelvis is tilted in (aka pelvis tilt) This positioning
helped improve the posture, strengthen the lower spine and reduce the risk for back
injury.
• Knees are slightly flexed
• Arms are hanging comfortably at the sides
• Feet are about shoulder width apart
• Toes are pointing forward; one foot is slightly forward.
Lying down and sitting also require good alignment.
The strongest and largest muscles are in the shoulders, upper arms, hips and thighs.
These muscles should be used for lifting and moving. Using smaller and weaker
muscles, such as those in the lower back, will strain your back and lead to back fatigue
and injury.
TRANSFERRING A CLIENT FROM THE BED TO A CHAIR OR WHEELCHAIR
It's important to ensure safety, prevent falls and protect your back from injury. Always
hold the client securely and ensure the client is wearing non-skid footwear to prevent
sliding or slipping. The chair or wheelchair must be able to support the client's weight.
Some agencies use transfer boards to assist with sliding from the bed to a chair or
wheelchair. Transfer boards are used when the client can assist with the transfer. Make
sure there is adequate padding on the buttons and the staff must ensure shearing does
not happen. Most chairs have vinyl seats and backs, because vinyl holds in body heat
and can stick to the client, you should cover the back and seat of the chair with a folded
blanket. Place a small pillow or cushion behind the client if instructed to do so. A
support workers responsibility is to promote comfort, prevent pressure ulcers and
maintain proper posture in the client.
Bones that weight bear are called
long bones
Turning the immobile patient - frequency:
at least every 2 hours, or as directed by the care plan
Friction
the resistance the skin encounters when it rubs against another surface, such as
clothing, bedding or another fold of skin.
Shearing
the tearing of skin tissues caused when the skin sticks to a surface (usually the bed or
chair) and deeper tissues move downward, exerting pressure on the skin. Shearing can
happen when a client slides down in bed, or is moved in bed. Shearing can be very
painful and can lead to serious skin and health problems.
Body alignment
the way in which body parts (head, trunk, arms and legs) are positioned in relation to
one another, whether lying, sitting, or standing. Also known as posture.
muscular atrophy
the decrease in size or wasting away of muscles. It's a complication from lack of
exercise and must be prevented.
Contracture
the lack of joint mobility caused by abnormal shortening of a muscle
Flexion
Bending a body part
Abduction
Movement away from the midline of the body
Adduction
Movement toward the midline of the body
abuse
physical or mental harm caused by someone in a position of trust.
Types of Abuse:
Physical abuse, sexual abuse, psychological (emotional) abuse, financial abuse, and
neglect.
physical abuse
force or violence that causes pain, injury and sometimes death. Examples: pinching,
hairpulling, kicking, choking, burning poisoning, throwing things.
sexual abuse
unwanted sexual activity such as rape and attempted rape. Unwanted touching,
fondling, kissing and exposure are also considered sexual abuse. Sexual Harassment -
another form of sexual abuse, it's any conduct, comment, gesture, threat or suggestion
that is sexual in nature
emotional (psychological) abuse
words or action that cause mental harm. It usually involves an attack on a person's self
esteem, insulting, humiliating or rejecting a person. These cause harm to a person's
self-worth and self-confidence. Emotional abuse can happen to infants, children, teens,
adults and older adults.
The client may not be allowed to do their preferred activities, or visit with friends and
family. Threatening to harm someone or something the victim loves.
financial abuse
the misuse of a person's money or property, usually for the abuser's financial gain. It
includes stealing, forging signatures, selling property or possessions without
permission, and persuading or tricking victims to change their wills or give up control of
their finances.
neglect
the failure to meet basic needs of a dependent person. Victims of neglect are usually
children, people with disabilities, and frail older adults. Neglect occurs when a clean,
comfortable and safe environment is not provided. Neglect can be intentional or
unintentional.
the cycle of abuse
1. The tension-building phase. every day events and comments irritate the abuser. The
abuser becomes more aggressive and the victim may try to calm soothe and please the
abuser or try and stay out of the abuser's way.
2. The abusive phase. Tension explodes into an abusive event. It may involve neglect
or physical, sexual, emotional or financial abuse. Often the abuse is triggered by an
even unrelated to the victim's behaviour.
3. The honeymoon phase. The abuser feels ashamed or sorry. He apologizes and
never to do it again. perhaps offering presents or be very loving. At this stage, the
abuser and the victim may believe the abuser can change.
Role of the PSW and Abuse:
You should be prepared for the possibility of a client or child telling you about being
abused. It's important you know how to offer immediate help. Follow your employer's
guidelines and policies. Here are some general guidelines:
• Listen attentively. Let your clients tell you what happened in your own words.
• Reassure the client that you believe what they have said. Stay calm, do not show
anger or disgust. Do not ignore the problem.
• Assure your clients that you will do whatever you can do to help. Notify your supervisor
at once. Follow your employer's policies. Helpful resources include the police, women's
shelters, counselling services, telephone helplines and legal clinics.
• Provide emotional support no matter that they decide to do. You cannot force a client
to make a certain decision. Those who can make their own decisions have the right to
and those who cannot must get the help of a professional.
Your Legal Responsibility:
Every Canadian province and territory has legislation that imposes a duty to report if a
child, a person with physical or mental challenges, or an older adult is being abused by
a parent, adult child, caregiver or guardian. Support workers have this duty as well.
Report your concerns to the child welfare agency, the provincial / territorial social
services department or the police. Reporting is not time consuming and can be done
anonymously. There are laws to protect against legal action providing the reports are
not falsely made and motivated by malice.
Nutrition
Food and water are necessary for life and affect our current and future health. For all
age groups, a poor diet will affect your physical and mental health growth and function,
increase the risk for disease and slow healing.
Food and drink also contribute to social and emotional health.
BASIC NUTRITION:
Nutrition refers to the processes involved with ingestion, digestion, absorption, and use
of foods and fluids by the body.
Ingestion is the process of taking food and fluids into the body. Digestion is the process
of physically and chemically breakdown nutrients so that they can be absorbed for the
use by the cells.
Absorption is the process by which substances pass through the intestinal wall into the
blood.
Good nutrition is needed for growth, healing and maintenance of body functions.
Those who follow the recommendations in the Canadian Food Guide will obtain all the
nutrients they need for a balanced diet.
NUTRIENTS:
Food and fluids contain nutrients - substances that are ingested, digested, absorbed
and used by the body. They are grouped into 6 categories: Protein, Carbohydrates,
Fats, Vitamins, Minerals and Water

Proteins, fats and carbohydrates give the body fuel for energy. The amount of energy
provided by a nutrient are measured in calories (a unit of measurement for the amount
of energy produced as food is burned by the body).
PROTEIN:
Needed for tissue growth and repair.
Sources: meat, fish, eggs, milk, peas, nuts etc. Animal products are the highest in
proteins, so those who do not eat meat must ensure they are taking in enough protein.
Protein deficiency can result in severe malnutrition. This effects children and older
adults more.
CARBOHYDRATES:
Provide energy for the body and fibre for bowel elimination. Most carbohydrates come
from plants. There are 3 kinds of carbohydrates.
Simple sugars: found in table sugar, fruits, and fruit juices
Starches: found in bread, pasta, rice and potatoes
Fibre: found in bran, nuts, seeds, and raw fruits with skin. Fibre cannot be digested and
is passed through the intestines undigested.
During digestion, most carbohydrates (except fibre) are broken down into sugars, which
are then absorbed into the bloodstream.
FATS:
Provide energy, help the body to use certain vitamins, and add flavour to food. Some fat
is needed, but fat that is not needed will be stored as body fat.
There are 3 types of fat:
Saturated fat: found in animal and dairy products (meat, butter, cheese)
Trans fat: (margarine, cookies, pies etc.) Created when liquid oil is chemically alerted to
form a more solid substance. It is used to increase flavour and shelf life.
Unsaturated fat: (fish and vegetable oils) Healthier than saturated fat or trans fat.
VITAMINS:
Needed daily for normal function and growth, but they do not provide calories. Each
Vitamin is needed for specific body functions. Excess doses of fat-soluble vitamins (A,
D, E and K) can cause complications. Vitamins C and B in excess amounts are
excreted through your urine. (These are known as water soluble vitamins). Older adults
are at risk of developing deficiencies because of issues with aging and absorption.
MINERALS:
Chemical substances found in both plant and animal foods. Each Mineral is needed for
specific body functions. For example, calcium and phosphorus are used to form strong
bones and teeth.
WATER:
The most important nutrient necessary for life. The body needs water for maintaining
cell function, regulating body temperature, delivering nutrients, removing waste and
performing other bodily processes. Water enters through food and fluids and is excreted
through urine, feces, perspiration and respiration (expiration of the lungs). The amount
of fluid taken and lost must be in a balance. Death can result from inadequate water
intake or from excessive fluid loss.
Fluid requirements:
1500 ml / day for survival
2000-2500 ml / day for normal fluid balance.
Guidelines for Feeding Clients:
• to ensure safety, check care plans to be aware of any food or liquid allergies or
intolerances your client may have
• if shopping for a client, review and check expiry dates
• do not substitute ingredients when cooking without your client's permission.
• Follow the care plan when feeding a client
• Use spoons not forks.
• sit facing the client so you can see signs of choking, swallowing difficulty
• offer fluids during the meal as they help with chewing and swallowing
• some clients may fall asleep while eating, gently stroke their cheek to rouse them.
The number of older adults is increasing as people
are living longer. Older people have knowledge, wisdom and experience that we can all
benefit from.
Baby boomers (people born during post WWII) from, 1946 - the mid 1960's age,
Canada is increasing it's efforts to better understand the implications of the aging
population
on health and long-term care needs and costs. "Active Aging" is becoming the norm,
meaning that older adults are increasingly contributing to society through pain and
unpaid activities.
See more

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Medical Term
Bradycardia
slow heart rate
dysuria
painful or difficult urination
00:0604:07
hemiplegia
paralysis of one side of the body
ileostomy
creation of an artificial opening into the ileum
cyanosis
bluish discoloration of the skin
tracheostomy
creation of an artificial opening into the trachea
neuralgia
pain in a nerve
arthroscopy
examination of a joint with a scope
Tachypnea
rapid breathing
cholecystectomy
removal of the gallbladder
gastrostomy
incision into the stomach
gastritis
inflammation of the stomach
00:0604:07
enteritis
inflammation of the intestine
bacteriogenic
caused by bacteria
glossitis
inflammation of the tongue
Cyanotic
bluish colour
dermatology
study of the skin
oophorectomy
excision of an ovary
nephritis
inflammation of the kidney
bronchoscope
instrument used to examination of the bronchi
hepatomegaly
enlarged liver
neuropathy
disease of the nervous system
polyuria
excessive urination
pyorrhea
discharge of pus
erythrocytopenia
a deficiency of red blood cells
Leukocyte
white blood cell
encephalopathy
disease of the brain
stomatitis
inflammation of the mouth
laparotomy
incision into the abdomen
dysphagia
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https://quizlet.com/ca/387533741/psw-final-exam-study-set-flash-cards/

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(1) CrashCourse - YouTube
(2) Symptoms of Anaphylactic Reaction - YouTube
(3) wel elimination
(4) - excretion of solid waste
- privacy, age, diet and fluids, activity, medications can affect elimination
(5) normal bowel movement
(6) - foods and fluids that are partially digested in stomach is CHYME
- they pass from stomach into small intestine and enter large intestine where
fluids are absorbed
- chyme becomes more solid in consistency
- feces also known as STOOL
- people normally have BM every day or everyb2-3 days, some have BM 2-3
times a day
- stool at different times, after breakfast or in evening
- irregularity causes concern
- normally brown in colour
- bleeding in stomach can cause stools to look black or tar in colour
- bleeding in lower colon and rectum or eating beets will make stools look appear
red
- some diseases and infection can cause it to look clay coloured, white, orange,
pale, green
- normally soft, formed, moist
(7) 5 Sanity-Saving Tips for Arguing on the Internet
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(11) Observations for bowel movement
(12) - report abnormal stool findings to clients nurse
- colour
- amount
- consistency
- odour
- shape
- size
- frequency
- complains of pain
(13) Factors affecting bowel movement
(14) - privacy
- personal habits
- diet
- fluids
- activity
- medications
- aging
- disabilities
(15) Comfort and safety during defecation
(16) - standard practice
- assist client to toilet or commode or provide with bedpan
- position commode over toilet
- ensure clients skin doesn't rub
- close doors, close curtains
- make sure bedpan is warm
- cover client
- position client well
 - allow enough time for defecation
- place call bell and toilet paper within reach
- stay around if client weak and unsteady
- provide perineal cafe afterwards
- assist client with hand washing
- follow care plan if have fecal incontinence
(17) common problems
(18) Constipation (stool is hard, dry and difficult to pass)
Fecal impaction (stool builds up in rectum)
Diarrhea (frequent passage of liquid stools- dehydration)
Fecal incontinence (inability to control passage of feces and gas)
Flatulence (excessive formation of gas)
(19) Enemas
(20) The introduction of fluid into the rectum and lower colon
- ordered by MD to relieve constipation or fecal impaction by removing feces
- also to clean bowel before certain surgeries or procedures
- can give to themselves at home
- can be dangerous for those with certain heart and kidney diseases
- invasive and involve inserting tube into body opening

Consider if you are able to perform an edema legally, and have had the proper
training and education
(21) Commercial edemas (suppositories)
(22) - edemas that stimulate and DISTEND rectum and cause defecation
- ready to administer and in room temp
- squeeze and roll up plastic from bottom, do not realease pressure onto bottle
Encourage client to retain solution until urge to defecate is felt
- 5 to 10 minutes to take effect
- SIMS POSITION
(23) Client with an ostomy
(24) - surgical removal part of the intestines is necessary for cancer, diseases
of bowel, or trauma
-wears a pouch over stoma to collect feces
(25) colostomy
(26) the surgical creation of an artificial excretory opening between the colon
and the body surface
- part of colon is brought to abdominal wall and stoma is created
- feces pass through stoma and NOT ANUS
- can be permanent or temporary
- stools are liquid or formed
-
(27) ileostomy
(28) creation of an artificial opening into the ileum and the abdominal wall
- entire colon is removed and liquid feces drain constantly
- Water is not absorbed because colon has been removed
- ileostomy pouch must fit well
 (29) ostomy pouch
(30) - Adhesive backing that applies to skin
- has drain at bottom and is opened to empty when full with feces or flatus
- change every 3 - 7 days or when leaking
- do not bathe or shower for 1 - 2 hrs after new pouch applied so adhesive can
stick
- DO NOT flush pouch down toilet
- odours can be managed by good hygiene, emptying pouch regularly, avoiding
gas forming foods
(31) Stool specimen
(32) examined by the lab, usually to check for ova and parasites (eggs and
worms)
- when internal bleeding is suspected
- identify fat, microbes, parasites
- must not be contaminated with urine
- hemorrhoids, cuts, abrasions in anal and lower GI tract = bright red blood
- bleeding in stomach or upper GI tract = black and tar blood

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