CNA EXAM 3

Cell Basics

• Cell membrane — outer covering, holds shape
• Nucleus — control center of the cell
• Cytoplasm — surrounds the nucleus

4 Tissue Types

Integumentary System (Skin)

Functions

• Protective covering — prevents microbe entry
• Prevents excess water loss
• Protects organs from injury
• Nerve endings sense stimulation
• Regulates body temperature
• Stores fats and water

Musculoskeletal System

4 Bone Types

Bone marrow forms blood cells.

3 Joint Types

Muscles

• Voluntary muscles — consciously controlled
• Involuntary muscles — work automatically
• Cardiac muscle — involuntary, found only in the heart
• Sphincters — circular muscle bands that constrict (narrow) a passage

3 muscle functions: movement, posture/muscle tone, body heat production

Nervous System

• CNS = brain + spinal cord
• Peripheral nervous system = nerves throughout body
• Brain parts: Cerebrum, Cerebellum, Brainstem
• 12 cranial nerve pairs, 31 spinal nerve pairs

Sense Organs

5 senses: sight, hearing, taste, smell, touch. Touch receptors especially in toes and fingertips.

Eye — 3 Layers

Sclera (outer) → Choroid (middle) → Retina (inner)

Ear

3 parts: external, middle, inner. Functions: hearing AND balance.

Circulatory System

Blood Components

Heart — 3 Layers

Pericardium (outer) → Myocardium (thick muscle) → Endocardium (inner lining)

4 Chambers

Atria (upper) = receive blood. Ventricles (lower) = pump blood.

Blood Vessels

Lymphatic System

• Returns extra lymph to blood (fluid balance)
• Defends against infection (lymphocytes)
• Absorbs fats from intestines

Tonsils/adenoids trap microorganisms in mouth/nose.

Respiratory System

• Brings O₂ in, removes CO₂
• Inhalation = inspiration; Exhalation = expiration
• Alveoli = tiny air sacs in lungs
• Diaphragm = muscle separating lungs from abdomen
• Pleura = two-layered sac covering each lung
• Bony framework: ribs, sternum, vertebrae

Digestive (GI) System

Breaks down food physically & chemically; removes solid waste.

Alimentary canal: mouth → pharynx → esophagus → stomach → small intestine → large intestine

Accessory organs: teeth, tongue, salivary glands, liver, gallbladder, pancreas

Urinary System

Removes waste, maintains water/electrolyte/acid-base balance.

Each kidney has ~1 million nephrons.

Reproductive System

Male

Testes (in scrotum) → sperm → epididymis → vas deferens → seminal vesicles (store sperm, produce semen)

Female

Ovaries → ova (eggs) → ovulation (monthly release) → fallopian tubes → uterus

Immune System

Protects from disease/infection. Key players: Antibodies, Antigens, Phagocytes, Lymphocytes (B cells & T cells).

Body senses an antigen (unwanted substance) → immune system reacts.

Endocrine System

Key Definitions

• Body mechanics — using the body in an efficient and careful way
• Body alignment (posture) — way the head, trunk, arms, and legs align with one another
• Base of support — the area on which an object rests. When standing, your feet = base of support
• Ergonomics — science of designing a job to fit the worker (ergo = work, nomos = law)
• MSDs — injuries/disorders of muscles, tendons, ligaments, joints, cartilage; can involve nervous system

Principles of Body Mechanics

Strongest muscles are in: shoulders, upper arms, hips, and thighs

• Bend knees and squat to lift — NEVER bend from waist
• Hold items close to your body and base of support
• Stand with feet at least 12 inches apart (shoulder-width) for a wider base
• Use an upright working posture
• Face your work area — prevents twisting
• Push, slide, or pull rather than lifting. Pushing is easier than pulling
• Turn your whole body to change direction — do not twist
• Work with smooth and even movements — avoid sudden or jerky motions
• Do not lean over a person to give care
• Get help from a co-worker — do not lift or move alone
• Do not lift objects higher than chest level
• Raise the bed to a comfortable working height to avoid bending

OSHA & Work-Related Injuries

Back Injury Signs/Symptoms

• Pain when trying to assume a normal posture
• Decreased mobility
• Pain when standing or rising from a seated position

Early MSD Signs

Pain, difficulty moving, swelling, tingling, stiff joints, muscle weakness. Always report work-related injuries ASAP.

Positioning — Bed Positions

Chair Position

• Upper body and head held erect
• Back and buttocks against back of chair
• Feet flat on floor or wheelchair footplates — never leave feet unsupported
• Backs of knees and calves slightly AWAY from seat edge
• Small pillow may go between lower back and chair

Key Definitions

• Bed mobility — how a person moves to/from a lying position, turns side to side, and re-positions in bed or other sleeping furniture
• Friction — rubbing of one surface against another
• Shearing — skin sticks to a surface while muscles slide in the direction the body is moving. Causes skin damage and infection
• Logrolling — turning the person as a unit, in alignment, with 1 motion

Before Moving — Info Needed

Get from the nurse and care plan:

• Person's height and weight
• How much help needed / physical abilities
• Problems that increase risk of injury
• Ability to follow directions / behavior problems
• Number of staff needed
• Doctor's orders and procedure to use
• Equipment/devices to use
• What observations to report and record

Safety & Comfort

• Keep person in good alignment at all times
• Face, nose, mouth must never be obstructed
• Protect drainage tubes
• Explain what you will do — be courteous, treat with dignity
• Screen and cover for privacy
• Place signal light and needed items within reach after positioning
• Complete a safety check before leaving the room

OSHA Recommendations

Good body mechanics alone will NOT prevent injury — you also need assist devices, enough staff, and safe handling programs.

Friction-Reducing Devices

Protect the person's skin from friction and shearing. Also prevent work-related injuries.

• Turning pads / turning sheets
• Slide sheets
• Drawsheets or flat sheets folded in half
• Large re-usable waterproof under-pads

Weight Guidelines (Box 17-1)

Logrolling

• Used for: spinal cord injury/surgery, hip fractures, painful joints, arthritis
• Requires 2-3 staff members
• Follow the nurse's directions and the care plan
• Use pillows to support the person after turning

Dangling

Dangling = sitting on the side of the bed with legs over the edge.

• Done before standing, transferring, or walking
• Part of some tasks: transferring, standing, walking
• Legs stimulate circulation and exercise

Report at once:

• Dizziness, lightheadedness
• Pale or bluish color (cyanosis)
• Difficulty breathing
• Weakness or discomfort

Moving Person Up in Bed

• Easier when head of bed is flat
• Person can help by bending knees and pushing with feet
• Use a friction-reducing device
• Move on the "count of 3"
• Use a smooth, even movement — keep the move level

Moving Person to Side of Bed

• Done before turning the person
• Body is moved in segments (upper body, then lower body)
• Prevents reaching across the bed during the turn
• Can use a friction-reducing device

Re-Positioning in Chair/Wheelchair

• Person can slide down — causes poor alignment
• Follow nurse's directions to reposition
• Never pull the person from behind
• A transfer/gait belt may be used

Focus on Older Persons

• Persons with dementia may not understand what you are doing
• Proceed slowly, use a calm pleasant voice
• Distract the person (hold a washcloth or soft object)
• Tell the nurse at once if you have problems moving the person

Transfer Types

• Stand and pivot transfers
• Lateral transfers (surface to surface, e.g. bed to stretcher)
• Mechanical lift transfers

Before Transferring — Info Needed

Same as moving: weight, height, help needed, physical abilities, risk factors, number of staff, equipment, observations to report.

Wheelchair Safety

Stretcher Safety

The Unit

The person's unit = space, furniture, and equipment provided. It is a private area.

Comfort Factors

• Temperature and ventilation
• Odors
• Noise
• Lighting

Bed Positions

Fowler's, High-Fowler's, Semi-Fowler's, Trendelenburg's, Reverse Trendelenburg

Bed Safety — 7 Entrapment Zones

At-risk persons:

• Older, frail, confused/disoriented
• Restless, uncontrolled body movements
• Poor muscle control, small in size
• Restrained

The Call System

4 Bed Types

Linen Handling Rules

Drawsheets & Waterproof Under-pads

• Drawsheet — small sheet over middle of bottom sheet; keeps mattress/linens clean
• Waterproof under-pad — quilted top + waterproof bottom; protects from dampness/soiling; may be used for moving and transfers

General Rules

• Check linens for dentures, eyeglasses, hearing aids, sharp objects
• Straighten linens whenever wrinkled or loose
• Check for food/crumbs after meals
• Don't bring unneeded linens to the room

Purpose

• Keeps mouth and teeth clean
• Prevents mouth odors and infections
• Increases comfort, makes food taste better
• Reduces risk of dental caries (tooth decay) and periodontal disease (gum disease)

Tooth Structure

Adults normally have 32 permanent teeth. Three parts: crown (outer), neck (surrounded by gums/gingivae), root (fits into jaw bone).

Flossing

Removes plaque from areas brushing can't reach. Done before or after brushing. You floss for persons who cannot do so themselves.

Unconscious Person — Mouth Care

Denture Care

• Slippery when wet — hold over a basin lined with a towel
• No hot water — causes warping
• Don't wrap in tissues or napkins (gets thrown away)
• Clean as often as natural teeth

Report Immediately

• Dry, cracked, swollen, or blistered lips
• Mouth or breath odor
• Redness, swelling, irritation, sores, or white patches in mouth/tongue
• Bleeding, swelling, or redness of gums
• Painful areas, loose teeth
• Rough, sharp, or chipped dentures; loose dentures

Why It Matters

Skin = body's first line of defense. Intact skin prevents microbes from entering.

Good hygiene: cleanses, prevents odors, is relaxing, increases circulation.

Daily Care Schedule

Bathing Benefits

• Cleans skin and mucous membranes (genital/anal areas)
• Refreshing and relaxing
• Stimulates circulation, exercises body parts
• Time for observations and communication

Types: complete bath, partial bath, tub bath, shower

Perineal Care (Pericare)

Cleaning genital and anal areas. Prevents infection, odors, promotes comfort.

Report Immediately

• Bleeding, signs of skin breakdown
• Discharge from vagina or urinary tract
• Unusual odors, changes from prior observations

Grooming Basics

• Prevents infection, promotes comfort
• Addresses love, belonging, and self-esteem needs
• Personal choice, influenced by culture
• Allow self-care whenever possible (promotes independence)

Hair Conditions

Shaving

Safety razors or electric shavers used. Follow agency policy for cleaning electric shavers.

Nail & Foot Care

• Prevents infection, injury, and odors
• Hangnails, ingrown nails, torn nails = skin breaks
• Long/broken nails can scratch or snag
• Poor circulation prolongs healing
• Dirty feet/socks harbor microbes

When to Change Garments

• Morning and bedtime
• After bathing
• When wet or soiled
• On admission and discharge

The Golden Rule

Rules for Dressing/Undressing

• Provide for privacy
• Encourage person to do as much as possible
• Let person choose what to wear
• Correct size garments and footwear
• Support arm or leg during changes
• Move and handle body gently
• Never force a joint beyond its range of motion

IV Gowns

• Some agencies have special gowns that open along the sleeve (ties, snaps, or Velcro)
• If injury or paralysis: remove gown from strong arm first, put clean gown on weak arm first

Chapter 9 — Body Structure

Chapter 16 — Body Mechanics

Chapter 17 — Moving the Person

Chapter 21 — Oral Hygiene

Chapter 23 — Grooming