for incontinence flipcard, it could be urine or stool. Flipcard stating "small movements such as those in the wrists and hands" repeats this on both sides of the cards- should be "fine motor skills" Double check the answer for "A nursing assistant is providing care for a client in a long term care setting who complains of increased frequency of voiding, pain, and burnin with urination. The nursing assistant notices the client's urine is cloudy and foul smelling. These symptoms are reflective of which of the following diagnoses?" it is marking UTI as incorrect. The drag and drop at the bottom is a bit intense for the NA level. I was not able to complete it on a laptop because I was not able to scroll down to the lower answer blanks while I had a term "grabbed". Not sure if it's just me or what.

fever or cold

confusion is a classic symptom of UTI in elderly

move the picture up by this reference.

move the picture up by this reference or move the reference down by the picture.

This section does not add much other than to say look at another chapter. Perhaps a brief recap of info would be helpful in addition to the referrals, as other sections in this chapter have all had recaps included.

carbohydrates

re-emphasize that NA's should not cut nails on diabetic pts.

carbohydrates

This sentence needs clarification. I think it's saying that if a patient needs insulin in inpt or LTC only a nurse can give it, but it could be interpreted that only inpts or LTC pts can get insulin because a nurse has to give it, which is not accurate as pts give it to themselves at home.

the stoma into a pouch rather than...

unless s/sx of dvt are present.

this is correct but in a previous chapter it was stated as 3 #. Guidelines are 2-3#.

remove pleural

anxiety flipcard is missing the "t" in threat in the definition. Bipolar disorder flipcard states bipolar disorders- remove pleural.

support person

I don't think this is recommended (maybe I'm getting it mixed up with dysphagia guidelines though, so I could be mistaken with dementia).

As noted above by another reviewer, a brief recap of wanderguards would be helpful here.

delete

Along with this, NA's need to realize that they need to be aware of where the pts hands/ feet are and be on guard to not get hit/ kicked/ etc. Avoid retractable lanyards etc that may be strangulation hazards.

line spacing

the resident

the individual

delete

Move to new bullet point. "Increased time for processing conversations and following directions, progressing to unresponsiveness." New bullet point. "modified diet such as thickened fluids and soft to pureed food."

disinhibition (i.e inappropriately acting on sexual desires), or inappropriate laughing.

while walking, progressing to inability to walk.

make this a new bullet point but remove "they eventually will" and change to increasing need for assistance in...

leaving the stove burners on.

this whole section is above the level of a NA- is it necessary for them to distinguish between the different types of dementia on such a high level? I would recommend omitting and picking back up at the stages of dementia.

These are examples of normal thinking tasks rather than altered thinking.

eliminate so much "they". Short, pointed sentences are used throughout in place of "they", such as with bipolar disorder, which is more effective for the chart- I would suggest making all strategy boxes like this.

too much their them... too impersonal and makes the sentence difficult to follow.

the client is

may be diminished.

comma

I'm not sure this is necessary for the level of a NA.

nutritional intake needs.

delete

also sleep promotion- sleep deprivation is a huge factor in delirium!

this is claustrophobia.

delete

is it stigmatization vs lack of resources, lack of funding, lack of access?

assistants

maybe make this section into a chart with bullet points (or a bullet point outline) instead of using they...they...they... etc.

is it just children? Perhaps using people or individuals here would make it more applicable to NA's in LTC?

This is confusing- IQ stands for intelligence quotient, though I get the two are used interchangeably.

I would just get rid of "their" in this sentence.

also mobility, as with CP

problems occurring during fetal development or injury during birth or early infancy https://www.mayoclinic.org/diseases-conditions/cerebral-palsy/symptoms-causes/syc-20353999

in

rapidly (otherwise both sentences ending in "quickly" sounds odd)

many people admitted to acute care are having acute problems with chronic conditions, or have chronic issues along with their acute condition.

involving

re-evaluate wording

delete comma

On OT flipcard, delete comma after "interventions".<br /> For the PROM flipcard, remove "when passive range of motion is applied" from the definition.<br /> In the bottom question with the NA noticing hand contractures and open skin in the palm, should the answers be palm protector and cone? It says SATA but only takes cone as an answer.<br /> For the T/F incentive spirometer question, add "at the end of inspiration" to the statement.

include picture sequence or video for visual learners.

re-word to pertain to TED hose.

include picture sequence or video for visual learners.

these terms should be defined. I don't recall seeing them previous to this, though I could be mistaken.

picture sequence or video for visual learners.

I would make a note to make sure glasses are clean.

adjust font- it appears to be in hyperscript.

items

to prevent tripping hazards.

This is not accurate. Mac degeneration is a dark spot in the center rather than totally blurred. Here is the same pic but comparing mac degeneration and normal vision: https://i0.wp.com/post.medicalnewstoday.com/wp-content/uploads/sites/3/2022/05/age_related_macular_degeneration_side_by_side_1296x728-1024x575.jpg?w=1155&h=1528

omit this

comma

delete

link requiring login to access.

link to section

be quicker

link to section

breath out first, emptying their lungs

Move this to just above the image or move the image up.

alveoli

formatting; also include up in chair as able

Encouraging activity as tolerated would be pertinent here also.

ventilators, CPAP, and Bi-PAP

delete "also"- it makes it seem like RT's were mentioned in the previous sentence and that they are also in the vent units when they weren't.

link to section

discussed in the... Also link to the section.

line spacing

For pressure injury card, it does not have to be in conjunction with sheer. For Fowler's position card, if definition is changed as previously suggested, be sure to change card and glossary also. Typo in sit to stand question in last activity.

video or picture sequence for visual learners. Also, if possible, include name of checklist in link.

make a comment for where to position sling- from shoulders to buttocks. if it is too high or too low there will be issues.

video or picture sequence for visual learners.

In section 8.11 it mentions a second staff member and that driver of the lift should be at least 18. Is this the same for mechanical sit to stand?

make a comment about importance of not putting the brakes on the lift. brakes on the lift can cause the patient's legs to get compressed by the lift as they are lowered to the chair.

I would add a statement to make sure the patient is able to assist with pulling up with their arms and straightening their legs. (If the patient is not able to assist with this, the sit to stand should not be used)

I would add a statement on ask the patient to pull up with their arms and straighten their legs. (If the patient is not able to assist with this, the sit to stand should not be used)

missing a step here- place the sling behind the patient's back and under their armpits on either side. Secure the sling clasp in front of the patient around their chest/waist.

if available- if they're there they should be used.

video or picture sequence for visual learners.

picture sequence or video for visual learners.

video or picture sequence for visual learners.

ankle is not

or becomes covered

unable to open video- it's showing "video is private"

I thought positioning devices were not considered restraints.

great video!

This depends on the type of restraint. seclusion is continuous monitoring, medical restraints are remove q 2 hours for ROM, skin checks, etc.

documentation of application of restraint

might mention standing to the weaker side if the resident has one.

This doesn't sound right. The cane is used with the strong side to support the weak side as the strong leg steps forward.

maybe include a statement as to why? To prevent sheering and injury of residents limbs/ skin- I've unfortunately seen sheets of skin tore by people pulling on arms.

Great picture sequence!

entire

shouldn't the bed be in low position incase the patient slides out while they are dangling?

with position changes

Use

and agency policy

does this need a gait belt?

this is confusing since they are still in the wheelchair

not sure how crucial it is here, but Low Fowler's 15-30 degrees. Semi Fowler's 30-45 degrees. Standard Fowler's 45-60 degrees. High/Full Fowler's 90 degrees.

should this be a separate checklist? Include a video for visual learners showing correct technique.

I don't think it has to be pressure and shear to cause a pressure injury. This is not the case with medical device pressure injuries or heel injuries, etc. Or even if the patient always wants to lay on one side.

some (using other here sounds disjointed)

that

include procedure for non-ambulatory patients.

check line spacing & include picture sequence/video

check line spacing from here down- it looks further apart than other checklists. Also, would recommend picture sequences or video of checklists.

check formatting- #1 looks indented from a laptop.

put in parenthesis

link to section

picture/ words are fuzzy and not readable on laptop device.

for the question below, shouldn't "the pt has just eaten saltine crackers" be selected also?

Great pic to show the thermometer, but is not placed over the temporal artery. This image is a good infographic, but not sure about licensing: https://o.quizlet.com/moCoBzpwNLLsBSkrd6QxZA.png

and correct placement.

see comment in Ch 6- do CNA's use this scale?

modified diet flipcard- remove "modified diet" from the definition.

I'm not sure a 2nd opinion is denial- It's good to get a second opinion. I would say multiple different opinions or leave that out altogether.

Include never massage over red or swollen areas (i.e dvt)

cream

Do NA's use this? If so, give a brief description of how to use it- i.e. total numbers added up is the pain level. Otherwise it's just a chart and they won't know what to do with it. If not, perhaps leave it out.

clarify this- "thickening powder" Also, as a side note, carbonated beverages tend to fizz all over the place and make a giant mess when thickener is added.

I'm not sure it is because Kosher food is healthier- it is because the method of preparation fits with religious guidelines.

pork

choose not to

the food is

Apply or administer?

, razor, and hamper

Include video or picture sequence for visual learners.

Include video or picture sequence for visual learners.

include video or picture sequence for visual learners.

barrier? If the pad is soiled with feces it will get all over the place.

include video or picture sequence for visual learners.

might make a note to keep urinal level to prevent urine spillage while urinating.

Include video or picture sequence for visual learners.

typo here and in link. Also, include video or picture sequence for visual learner.

include video or picture sequence for visual learners.

include video or picture sequence for visual learners: https://youtu.be/wVnGWqqe-6M

This is important, but the NA should perform the choking maneuver immediately rather than looking for the nurse. Maybe say call for help or send someone to find the nurse?

Include video or picture sequence for visual learners.

revise sentence

Include video or picture sequence for visual learners.

Include video or picture sequence for visual learners.

include video or picture sequence for visual learners: https://youtu.be/jPNgwa9ACAU

recommend video for visual learners: https://youtu.be/58wAvY_aF-Y https://youtu.be/QeT1HXFpkqU

Include video or picture sequence for visual learners.

maybe re-emphasize not to get lotion between toes.

Include video or picture guide for visual learners.

Include video or picture sequence for visual learners

Include video or picture steps for visual learners.

warm- this is what is used in other checklists throughout "Have the resident check the water temperature by placing their hand in the basin or putting a wet washcloth on the back of their hand."

Include video or picture sequence for visual learners.

Recommend video or pic sequence for visual learners.

perineal area, not just rectal area

to prevent

spacing off- I think this goes together. Also, these links are requiring a login.

again, a video would be helpful for visual learners.

perineal area, not just rectal area, front to back.

agreed- very confusing. Also, a video addition would be nice for visual learners.

it makes me login to view this link

it's making me log in to follow these links

Would recommend including a video.

Link to chapter?

this links to the current chapter.

link or remove

each device is explained below. (the explanation comes above the figures)

site to read about...

move this paragraph below the picture.

decline in cardiac function which decreases blood flow and oxygen to the skin and...

This is not the definition of skin integrity- this is the definition of impaired/altered skin integrity. Skin integrity the health of the skin.

Not sure this needs to be duplicated here- perhaps just link back to chapter 4?

not always a safe

which may result in (otherwise it sounds like being prepared results in discomfort)

might also consider adding bath/shower here as well per pt preference.

)

coughing/ sneezing

can be brown too- (MRSA is often brownish)

feeling of discomfort, illness, or lack of well-being

revise sentence- maybe a comma? It's worded funny.

definition on the fever flipcard could be revised as it includes fever, same with "moments of hand hygiene". Also, if "moments" is changed to "times" or whatever was suggested earlier in the chapter, it should be changed here as well as the glossary. Re-look at the definition for contact precautions. It seems worded funny. I really like the last drag and drop comparing sanitizer to soap/water!

According to CDC guidelines, remove gloves, then goggles, then gown, then mask: https://www.cdc.gov/hai/pdfs/ppe/ppe-sequence.pdf Not sure if it is different for NA's, but this pdf is a good infographic for donning and doffing.

Recommend including a video for consistency and visual learners. Here is a good example: https://youtu.be/qOzVwVzzXJc

at the back of your neck

Great picture sequence!! I like the opaque gloves so they can see finger placement into the 2nd glove.

inside out while containing the first glove inside...