Unit B
Resident Care Skills
Essential Standard NA4.00
Understand nurse aide skills related to the residents’ vital function and movement
Indicator 4.02
Understand nurse aide’s range of function in rehabilitative/restorative and maintenance care
Understand nurse aide’s
range of function in
rehabilitative/restorative
and maintenance care
4.02
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AMBULATION AND TRANSFER AIDS
Walker… four-point aid with rubber
tips
• Resident stands erect when moving
walker forward
• Walker adjusted to height of hip joint
• Elbows at 15-30 degree angle
• Walker picked up and put down, not
slid
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Walker…
• Back legs of walker even
with toes so resident
walks into walker
• Resident steps toward
center of walker
• Leads with weaker leg
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Canes…
Types:
• single-tipped
• tripod - 3 legs
• quad - four point
4.02
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Canes…
• Used when weakness
on one side of body and
resident has use of at
least one arm
–Provides balance and
support
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Canes…
– Should be fitted properly:
• cane handle level with
femur (greater
trochanter)
• elbow flexed at 15 to 30
degree angle
• shoulders level
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Canes…
• Gaits ordered by physician or
physical therapist:
–move cane and affected leg
together
–move cane, then affected leg
• Used on side of body where leg is
strongest (side opposite the
injury)
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Crutches…
–Provide support and
stability through use of
hands and arms.
–Used when one or both
legs are weak.
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Crutches…
–Measured to fit properly by
physical therapist.
• height correct if two fingers
fit between armrest and
axilla
• hand grip adjusted to allow
20-30 degrees flexion of
elbows
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Crutches…
Gaits
four-point gait
three-point gait
two-point gait
swing-to gait
swing-thru gait
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Crutches…
Weight supported on
hand bar, not axilla
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Wheelchairs…
• Available in different
sizes and models to allow
for proper fit and usage
• Cleaned with mild
detergent and water,
rinsed with water and
dried
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Wheelchairs…
• Periodic maintenance
needed with 3 in 1 oil
• Arm rests adjusted to
appropriate height
• Feet rest flat on floor
when chair is not moving
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Wheelchairs…
• Seat should not sag
toward center of chair
• Seat should not reach back
of resident’s bent knees
• Brakes locked when chair
not moving
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Wheelchairs…
• Wheelchair guided backwards when
going downhill
• Wheelchair pulled backwards over
indented or raised areas (i.e.,
entrance to elevators)
4.02
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Wheelchairs…
• Feet placed on
footrests for
transport
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Gurneys/Stretchers/Litters
• Wheels locked when
transferring residents on or off
• Safety belts secured prior to
transfer
• Both side rails raised prior to
transfer
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Gurneys/Stretchers/Litters
• Residents never left alone on
stretcher
• Backed head first into elevators
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Gurneys/Stretchers/Litters
• Always used with assistance
when transferring resident on or
off
• Pushed feet first during transport
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Gurneys/Stretchers/Litters
• Guided backwards
when going downhill
• Cleaned with mild
detergent and water,
rinsed with water and
dried
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Gait belt (safety belt, transfer belt)
–Used for residents unsteady on
feet
–Protects resident who loses
balance or faints
–Held at back
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Gait belt (safety belt, transfer belt)
• Must be tight
enough to provide
support but loose
enough to be
comfortable
• Used to safely
transfer resident
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• Correct aids must be used
because they are individually
fitted
• Resident observed closely to
be sure aids are being used
as ordered
• Faulty equipment reported
and not used until repaired
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SAFETY – AMBULATORY DEVICES
• Shoes must fit and be in
good condition
• Skin breakdown reported
• Rubber tips on aids in
good condition.
4.02
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MECHANICAL
LIFTS
4.02
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U.S. Department of Labor
Hazardous Order No. 7 (July2010)
This order prohibits minors
under 18 from operating or
assisting in the operation of
most power-driven hoists,
including those designated
to lift and move patients.
4.02
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U.S. Department of Labor
Hazardous Order No. 7 (July2010)
What do we do?
• NA student regardless of age must
demonstrate competence in the
classroom.
• NA student under 18 MUST NOT
OPERATE LIFTS IN THE
CLINICAL AREA!
4.02
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MECHANICAL LIFTS
• Used for transfer of
residents
• Lower end of sling
positioned behind
knees
• Hooks turned away
from body
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• Straps, sling and clasps checked
for defects
• Enough assistance available to
assure safe transfer
• Area checked for safety hazards
prior to transfer “CIRCLE THE
BED FOR SAFETY’
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Restorative/Rehabilitative Care
JOINT MOBILITY
NEEDS
4.02
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RANGE OF MOTION - ROM
• Types of range of motion:
– Active - resident
exercises joints without
help
– Passive - another person
moves body part for
resident
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• Purpose of range of motion:
–Maintains muscle tone
–Prevents deformities
–Increases circulation
–Encourages mobility
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ROM - GUIDELINES
• Expose only part of
body being exercised
• Be gentle and STOP if
resident complains of
PAIN
• Use good body
mechanics
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• Follow directions from
supervisor on number
of times each joint to
be exercised and how
to perform exercises
safely, based on each
resident’s condition
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• Each movement is repeated three
times unless otherwise ordered.
• Support joint as it is exercised
• Report complaints of pain or
discomfort to supervisor
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• Exercise joint slowly, smoothly
and gently
• Do not exercise swollen, reddened
joints; report condition to
supervisor
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•
•
•
•
•
•
•
•
4.02
Abduction
Adduction
Extension
Hyperextension
Flexion
Plantar flexion
Dorsiflexion
Rotation
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• Pronation
• Supination
• Eversion
• Inversion
Encourage
• Radial deviation residents capable
• Ulnar deviation of doing active
ROM exercises
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