Consider moving video from 4.4 to here to maintain consistency with including videos with skills checklists. (or find another video for here)

all throughout the chapter this is referred to as ABHR rather than sanitizer.

Consider moving video from 4.4 to here to maintain consistency with including videos with skills checklists. (or find another video for here)

NA's are not going to know what this means.

careful using too technical terms with audience- may not know what this means.

also advise to report low temps as these are signs of potential sepsis.

discomfort, illness, or lack of well-being

I think it would be beneficial to include a statement about what to do if the NA is exposed- flush/wash the area, notify the supervising nurse, etc.

Not just this, but it is labor intensive to put on/take off PPE all the time to go into rooms. I would include this as well as social isolation/ loneliness from less frequent interactions, risk for caregiver neglect is higher, and failure to rescue from missing cues that something is wrong.

Include that this is used when N95s don't fit properly due to facial hair or inability to create a tight seal.

insert link to checklist

to be laundered (the NA is not doing the laundering).

and to protect patients from coming into contact with potential contaminants on healthcare worker's hands during certain procedures and treatments.

I think it would make more sense for students to switch this section with section 4.4 so all the PPE are discussed prior to the isolation precautions requiring them.

will students know what this is?

get into bed or are assisted into bed

sneezing too.

For the ABHR steps above- provide option to show answers. They all were marked wrong for me even after adjusting answers, so double check their order. I found the key at the end- Perhaps change the second step to Ensure hands don't have visible soil. I kept putting this at the end due to it saying ensure they are clean, which should be done at the end.

Great video- there is no sound- not sure if there's supposed to be, but it seems like there should be explanations prior to each question.

at

Recommend giving a brief description and explanation of how to use the activity below.

These are nice activities. It would be helpful to provide a brief set of instructions tying it to this text and explaining the activity.

or when there are changes in their immune system defenses.

it's not just medical equipment- include mucous membranes, skin breaks, etc.

maybe give an example, such as MRSA in nares?

extinguish/evacuate is generally used.

add "skin breakdown"

I would recommend this video instead as it shows the provider using gloves, etc. Additionally, it aligns with the recommended video for the unmade bed in the previous section. https://youtu.be/cx5G1VdC9UA

spacing

include not to place linens on the floor.

I would recommend this video instead as it shows beginning to end process, including how to remove linens, hand hygiene, etc. https://youtu.be/WEB_vNsTcX8

keep terminology consistent with either using "one's" or "your" throughout.

place your feet

spacing is off here

is

which resident care needs

privacy, size, and...

breakdown

residents

empathize with and provide peace...

This video is not accurate- it states to continue abdominal thrusts after the patient is unconscious and lying on the ground. Correct technique is CPR. Here is one from Mayo that is accurate: https://youtu.be/wVnGWqqe-6M

injury and death

Figure 3.3 shows RACE, not PASS.

E = extinguish/evacuate. If the fire can't be extinguished, they will need to evacuate the patients and themselves from the area.

A lot of this info may be above the level of a NA. It's important for them to recognize symptoms to report, but maybe using more lay terms would be better for this level? For motor activity maybe "abnormal muscle movements"?

will students understand this? Maybe "abnormal signals in the brain"?

delete one or the other future. Also include a sentence on why it's important to report these "transient" symptoms also.

delete

I would be careful with this. It's true that females may have atypical chest pain, but they also may have crushing chest pain. Males may have atypical chest pain as well, especially if they are diabetic. The way this is worded makes it seem like all males have chest pain and all females have indigestion symptoms, which is not accurate and if we want NA's to cue in on these being important things to notify the nurse, this will be confusing.

are starved of oxygen and begin to die (ischemia causes angina)

Add an introductory paragraph prior to MI to tie concepts of the chapter together.

E= evacuate/extinguish

delete

I would re-word this as it may not make sense in other cultures or just eliminate this sentence all together.

positively impact

Great activities! I would recommend shuffling the nursing process matching items as they go in the order of the nursing process as is. This would make them a bit more challenging.

This is for those in substance abuse recovery as well.

is it advocate or associate?

many or various rather than using "all" which is absolute.

a different, more effective alternative

their delegated interventions in the nursing care plan. (I think this is important to distinguish here because the NA won't be able to implement all the interventions due to scope)

I'm not sure demonstrates is appropriate here- perhaps describes or outlines works better since it is a written document rather than a "procedure". If you update this, be sure to update the glossary and "hover over" definition too.

that

maybe specify interfacility transfer needs vs bed to chair transfer needs.

Caps?

that you do not know and...

are

Unfortunately sometimes it is the nurse- maybe let students know it is ok to go to others as well such as the charge nurse or administration in this event.

This seems out of place unless there is some kind of direct link between these concepts.

related to

For this reason, (or "as a result, etc.)

delete

this is a bit confusing. Perhaps a chart comparing the numbers would make it more clear. Perhaps something like this: https://www.doctemplates.net/wp-content/uploads/2019/05/Military-Time-Chart-Excel-10.jpg instead of the clock below.

Examples that require immediate notification of the nurse include... (otherwise this makes it look like this can wait until handoff, etc.)

add empty

draw only one line through, write error and initials

patient care was completed

Maybe a statement that the NA can suggest the nurse calls chaplain or the NA can just do this? (since it's an NA text). I see this is addressed in the next to last paragraph, so rather than change the sentence, maybe just move this sentence down there.

write out what this is as it hasn't been mentioned.

Should this be added to the TCT table? Would be very pertinent to NA's.

the client

? nurse in NA text?

NA

Add this paragraph to the table and change the heading to Barriers to Communication or Nontherapeutic Responses.

using

reflecting is mirroring what the provider thinks the patient's feelings are behind their words so their feelings can be explored further.

Acceptance

Active listening

more applicable if NA

NA's

compassion is the act here.

This is a good section, but should it be more related to ther. comm in relation to the NA rather then the nurse to make it more applicable?

add end parenthesis to hover over definition.

end parenthesis

This is a great sentence!!!

reword to "resulting in your message not being perceived..."

spacing

"sick, injured, debilitated, cognitively impaired, or need assistance..." Also, compassion and empathy are not the same. Empathy is putting oneself in another's shoes. Compassion is the emotional response to empathy, and includes the desire to help based on this emotional response. Maybe re-word the sentence?

This sentence seems out of place here, since this section is talking about becoming a NA. It would fit better in the next section under "physical stamina".

Revise sentence structure. Perhaps "In 2020 there were 1.4 million nursing assistant jobs in variety of health care facilities..." or something similar.

New guidelines have at risk dx being AMB rather than r/t.

suggest removing "if they are poor"

rather than undergo invasive surgeries or procedures that likely will have no impact on recovery from disease.

review spacing between lines throughout this section.

why do some lines include hyphens and break up words and others just shift the words to keep a full word on each line?

Adverse childhood experiences slide should be (ACEs). Safety plan slide- check wording on definition: ...help lower a person's risk of being hurt...

same with hair pulling- don't pull away- instead pull the client's hand toward your head and push up on the hand bending back the wrist to increase the likelihood of the patient having to let go from pain.

such as infection (UTI is classic here)

see comment above. In my experience lorazepam is associated with CIWA tx, etc.

is this used on a general or BH floor? seems risky. In my experience it's used in the ICU, maybe ED but ativan seems safer on the floor.

also note never to apply pressure to the client's chest or back while holding them down to apply restraints due to asphyxiation risk.

it would be fantastic to have a simulated video of this process included.

Also many facilities require Non-violent crisis intervention training and refresher sessions to practice de-escalation and restraining techniques. might be worth mentioning here or somewhere in this section.

Reminder to check on permission and remove highlighting from below the image.

this is ambiguous. violence committed by patients or family members towards health care workers can occur...

undergoing

concerned

urgent care visits

delete comma

albeit rare, it may be a good idea to include a statement about some diseases that mimic abuse, such as osteogenesis imperfecta where there may be broken bones in various stages of healing through natural means. This can be devastating for families if they are incorrectly reported as suspected abusers.

It's important to note that some injuries are not visible as in shaken baby syndrome

awkward wording. ... in an intentional manner is clearer.

this is listed twice

This is kind of randomly placed here and not described in enough detail. How does it help? what is the purpose? I'd include details such as not requiring identifying info of the parent, parent's won't get in trouble for leaving there newborns here, Safe Haven Laws, etc.

it would help to be consistent with either using "triggered" or "activated" thoughout.

possible dissociating (bold/ add to glossary)

name or role

who is going to provide it? Perhaps re-word to ...psychological safety measures should be considered by the reader.

the definition on the "tolerance" slide is very difficult to follow. the SUD slide should be all caps

Drag and drop for med schedules are all in order from I-V perhaps mix it up for more difficult activity.

for the FITB where it says "type the number" it would clarify more if it said write out the number. I misread this and entered for example "5" when it should have been "five". for the question about Xiong, recovery position is the correct answer but nowhere in this chapter is side-lying referred to as recovery position. This is the correct terminology, so be sure to go back to where it talks about turning a person on their side in the chapter and denote this as being "recovery position" or change the answer selection to "side lying" or lateral recumbent

Syndromes are tricky for students to write out the proper form. Perhaps link to the syndromes part of the Fundamentals OER?

Indicated Prevention Interventions

awkward wording

Not just STI's but also bloodborne pathogens like HIV/AIDS/hepatitis as well as bacterial endocarditis from IV drug abuse/needle sharing.

I would provide links to find AA, NA, etc meetings as well as Al-Anon and Alateen groups- they are everywhere but not everyone knows about them. As a valuable resource, this may help students as well. I know I personally have spoke with students about Al-anon and provided links to find meetings when they have confided in me. This link allows searches for both al-anon and alateen: https://al-anon.org/al-anon-meetings/find-an-al-anon-meeting/ https://www.aa.org/find-aa

It's great that all these interactive tools are embedded throughout this chapter!

pertaining to an individual's alcohol use.

link

delete "and". Actually this would be better as bullet points rather than such a long sentence.

Negative Affect Stage

font

check line spacing

delete or. ..., depression, or the individual may feel physically ill.

why not mention antibuse? I know it's not for withdrawal but is an important part of abstinence for some people. https://www.addictioncenter.com/alcohol/disulfiram/

because of the risk of...

No mention of Buprenorphine/Naloxone (suboxone)- I would inlcude this and would mention this can be used in the outpt setting as an opioid blocker similar to antibuse for ETOH.

synthetic opioid. Important to mention that.

Again, this can be used in the outpt setting in methadone clinics. Would mention due to the extremely long half-life of methadone clients are at risk for OD if the dose is titrated up too quickly or if the client's starting dose is too much compared to their tolerance level of opioids.

and suboxone tx

Some clients undergo detox to get and stay clean. Not all go to residential tx programs. Some just do the detox and then go to NA or outpt tx, some go to detox followed by a few week inpt tx, etc. These are valid reasons as well.

It would be important to list IV thiamine here again as well as it is a standard treatment.

sodium levels would put at risk for seizures. potassium levels risk for cardiac dysrhythmias/ arrest, whereas low platelet levels would put clients at risk for bleeding/ head bleed. This sentence doesn't make sense specifically to risk for seizures.

diarrhea also. I'd mention high fall risk as often patients are trying to get up alone to get to the bathroom or as a result of hallucinations/ dilerium.

add hallucinations/psychosis to list

which

I think it's important to mention synthetic cannabinoids here as well as this seems to have a bigger risk of psychosis, toxicity, etc. https://www.cdc.gov/nceh/hsb/chemicals/sc/default.html

give examples- pain control, increase appetite in chemo patients, etc.

I think it is important to mention that there is increasing risk with other street drugs being laced with fentanyl resulting in higher overdose/death rates. 150 people die a day. Often people taking these laced drugs have no idea they have fentanyl in them. This is a great addition from the CDC: https://www.cdc.gov/stopoverdose/fentanyl/pdf/fentanyl_fact_sheet_508c.pdf

as well as bacterial endocarditis.

to assess for head injuries.

experience

delete

Substance use

that can occur when an individual stops taking a substance.

double check the answer for "Angela with bulimia" below.

perhaps give a few thought provoking questions in this as well.

delete

mention in the definition/glossary that it is specifically related to negligible food intake.

link

I would either link back to that section or just put the s/sx here for reinforcement.

Spacing throughout this section needs to be looked at and made consistent.

that a

are hereditary

spacing

spacing

not really heart attack but cardiac dysrhythmias and cardiac arrest.

restraints

a restraint

break this up into two sentences- one for seclusion and one for restraint definitions.

use

Link to ace's to stay consistent?

art

This wording sounds funny. Recommend "Parents of children with ASD may use complementary or alternative treatments such as special diets...

Add a heading or label after this sentence. For example: Treatment categories include:

Should this be in caps?

bold and add to glossary

Below are some examples of behaviors with ASD.

devise

Didn't previous sections specify some pretty nasty side effects from Clonidine and that is why it's not first-line? Perhaps write about that here.

black box warning

SNRIs

delete and re-structure into two sentences. "ADHD affects a child's ability to pay attention and sit still at school as well as relationships with family and other children due to disruptive behaviors. Psychotherapy can improve...

a checklist rating ADHD symptoms completed by parents, teachers, and the child.

delete

It would be interesting to see stats post covid.

for

this was addressed in the last chapter as well.

give a few examples. Repeated exposure helps students remember.

add infection here also

too many "or's". Either break each up into a sentence or separate with commas.

bold this to remain consistent with critical findings in other chapters. Also put a rationale for immediate provider notification as in other chapters.

this does not match the glossary definition