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Providing Comfort and Care to Terminal Patients
Working in hospice care can be a rewarding yet challenging position, and it takes a exceptional kind of person to succeed within this workforce. However, for those who do, they know that they are truly an integral part of something special. Hospice is primarily designed to serve people that are nearing the end of their life, whether through old age, terminal illness, or a chronic condition. Naturally, these patients will have special needs, and hospice care is designed to help enhance these individuals remaining time through support, pain management, and other services. As a hospice worker with CNA certification, you will be an important part of each patient’s hospice experience, and possibly one of the most involved participants. After all, it is the CNA who regularly attends to patient’s grooming, feeding, and other essential duties for those under hospice care.
Choosing a Work Setting: Personal Homes or Care Facilities
The primary focus of hospice is to focus on keeping patients as contented as possible, which is why services will be available in a patient’s home, an assisting living facility, nursing home, or hospital. Patients with families will often choose to remain in their home, while others will choose a facility to not be a burden on their loved ones. Realistically, an overseeing physician for each patient’s case will ultimately make a recommendation, but the final choice is typically left up to the patient or his or her guardian.
Many hospice care providers will offer their nurses and nurse aides the opportunity to choose whether they prefer to work within the primary care establishment or in a patient’s home. Naturally, your access to reliable transportation and possessing a good driving record will be essential to work in the home setting. Depending on the size of your city and the span of the hospice care’s servicing area, expect to do a good bit of driving if you choose to work in private homes. As a CNA, expect the working conditions to vary between providing care for patients at home vs. facility care, so see our in-depth article discussing the differences.
Working with Hospice Staff to Foster Patient Comfort
A dedicated team of caregivers is assigned to handle each hospice care patient’s case. There will be a primary medical physician, and typically, a team of two on-call nurses that will be your contacts in case of emergency, and they are whom you will report patient’s changes in status to when necessary. You will be required to work closely with these medical providers to ensure that the patient is properly medicated and being properly cared for by family members if they are receiving home care. A social worker and chaplain is often assigned to help families and patients deal with the inevitable passage of life, so be prepared to process requests and information provided to you by them, as well.
However, there will often be several different people with CNA certification assisting to a particular patient’s needs. You may only see a certain patient once during the course of their time under the care of hospice, or you might be assigned to regularly care for them. Every situation is different, and your scheduling will be highly dependent upon your choice of work settings. Because of the constant shift in nurses aides, keeping good notes is essential to performing your work duties. Documenting the procedures you perform, the medications the patient is taking, and their personal and physical demeanor is important to keep all of these staff members on the same page, so to speak. You will find that you heavily rely on the notes of previous staff to keep you informed, and the benefits of keeping paperwork current are obvious.
Is Becoming a Hospice CNA Right for You?
Naturally, in this position, you will be performing the duties you learned in your CNA training classes, but hospice care often serves up a few additional challenges. For this reason, many states and certain facilities prefer to hire nurse aides that have undergone specific enhancement training for hospice care. Working as a hospice CNA is ideal for those with a good deal of compassion for the well-being of others, and it certainly takes a lot of patience, especially when dealing with those very close to death. Emotionally, this work can be trying, as you must understand that inevitably, your patients will pass away. It is not uncommon for nurse aides to become emotionally attached to their patients, and you need to be prepared to cope with grief yourself as you help patients and families do the same. Those up for the challenges of hospice will find themselves the recipient of personal rewards, as well as a higher CNA salary.
As a hospice CNA, you will have some liberty when you are job hunting in choosing the work environment that best suits your abilities and level of comfort. The way that the hospice care system is designed, people seeking services typically also have a choice concerning where they will receive the care and services from hospice. There are four primary level of hospice care that have been clearly defined partly due to the changes in benefits offered under the Medicare program, particularly Part A, and its newly defined limitations that do not cover hospitalization charges for hospice patients. Here, we will discuss these four levels, which fall under the categorization of routine home care, continuous home care, general inpatient care, and respite care. Keep in mind, that the level of services required for a patient may change at any time as their needs change, and you will encounter even more rapid changes in status with patients receiving palliative care.
Routine Home Care
Routine home care is the most basic level of care one can receive under the hospice benefit; however, patients that reside in a nursing home facility can also be considered under this category, as that is their home. During the course of this type of care, there-
are a number of things that occur involving all parts of the interdisciplinary team, and many of the procedures are carried by out by hospice and palliative CNA team members. A registered nurse will typically visit the residents between one and three times per week based on each patient’s needs, but can occur more often as necessary.
Physicians rarely make house calls to patients, as they have generally already met with the patient prior to their enrollment in hospice care; however, nurses stay in constant contact with the overseeing physician concerning the patient’s status. Counseling and social work services are dispatched as needed to the patient’s home or care facility to address pastoral, bereavement, and financial services.
Continuous Home Care
As a hospice CNA, many tasks will ultimately fall upon your shoulders, as you will encounter patients more often than they will encounter any other medical caregiver, especially within the home. Expect to visit patients at least two to three times per week to assist with grooming, bed linen changes, and light housekeeping in addition documenting the patient’s status concerning pain, medication availability, and emotional standing. You will also behelping family members and patients become familiar with any medical equipment ordered, and you may need to show them how it operates after delivery to the home. You will also need to ensure that all equipment works during your visits, and take special care with vital equipment such as oxygen tanks, nebulizers, and other essentials that contribute to patient comfort. Home care does have its challenges, but it also gives you a chance to bond with patients and families on a level that other medical providers do not have the opportunity to.
When a patient develops emotional or physical symptoms that are not easy to manage under routine care, the next option is continuous home care. Some examples of the symptoms that call for continuous care are increased levels in pain, new symptoms, breathing problems, nausea and vomiting, emotional troubles, or a breakdown within the primary caregiver support system. This level of hospice provides additional care within the patient’s home environment, and the need for this care is reevaluated every 24 hours. Depending on the status of the charge, nurses or CNAs will remain in the residence with the patient for a minimum of 8 hours per day up to round the clock care. Because CNAs cannot administer medications, you would likely be filling in during the hours when a family member or nurse authorized to administer medication is not available. Of course, this depends on whether the patient is in a private home or a nursing home. When working a case requiring continuous care you will need to bring a lunch to work and something to occupy the down hours such as a book, puzzle, or personal project.
General Inpatient Care
Some patients have symptoms so severe that inpatient care is the most reasonable solution for both the charge and the caregivers. Inpatient care is anexcellent way to ensure that the patient has continuous access to a full medical staff armed to handle any problem that may arise at any time. Essentially, the approach to caring for the patient will not differ from any other level of hospice care, as only the patient’s location is changed. Facilities that offer inpatient hospice services include:
• Hospitals – Space may be leased to hospice providers where patients can receive both the benefits of a full medical facility under the supplemetal assistance of the hospice provider’s staff.
• Free Standing Facilities – These are owned and operated by the hospice company and staffed by medical providers under the employ of the institution.
• Long Term Care Facilities – Similar to the agreement made with hospitals, hospice providers may lease space and provide care to their own charges within this environment.
Respite Care
This particular level of care is actually designed to be more for families that care for the patient on a continuous basis within the home than for the actual patient. Caring for an ill person at home is a 24 hour a day job, and families can grow weary over time, especially if their loved one has been ill for an extended period. Respite care is a temporary placement of the patient into inpatient care to allow the family a much needed break, or respite. These services are limited to five consecutive days, and then the patient is discharged back to their home.
CNA's Working in Hospice Care
Challenges Nursing Assistants Face Working in Hospice Care
Because hospice care is designed to alleviate patient discomfort and to help them cope with facing death, your role as a CNA can become quite trying at times. Whether you see patients on a daily or weekly basis, you will often find their status to be ever changing. Depending on the nature of their illness, rapid degeneration in the physical state can occur rather quickly, and you could face a variety of situations each shift. Arrive for home visits or at your work facility physically and mentally prepared to make a judgment call on patients’ physical and emotional status, care for their hygiene needs, and serve as an emotional support system. These are a few challenges concerning the support services you should be prepared to monitor and handle as a hospice CNA.
Pain Management
Pain management is frequently a component of the hospice process, especially when handling cases involving palliative care, which is primarily for terminally ill patients with a life expectancy of six months or less. For the most part, you will encounter cancer patients within this type of care, but many patients with organ failure and other issues often seek palliative assistance. However, as a CNA or nursing assistant, you not be qualified to administer medications to patients, but that does not lessen the importance of your role when it comes to patient care.
Inpatient care lessens your workload to some extent, as registered nurses, vocational nurses, and physicians will be on hand to keep track of medication dosages and their administration. Home care hospice changes your role significantly, as you will likely be overseeing patients self-administering medications or observing family members doing so. You will need to document the time and dosage of all administered medications that occur in your presence, as well as the patient’s levels of pain during your visits. Recording this information is essential to assisting nurses and doctors trying to find the best approach to managing the patient’s pain.
Medications aside, you can make patients feel comfortable with light massages during grooming duties, which certainly can assist with their pain. One of the benefits of being a hospice nursing assistant or care administrator, is the personal effect your kind actions can have on improving one’s quality of life. Just a few extra minutes of special attention from you can mean something special to those you care for.
Personal Care
The level of personal care and grooming each patient requires will depend on his or her level of illness. If you have the benefit of working for a hospice that attempts to keep you assigned to a specific set of patients, then you will know what to expect each visit. New patients, or filling in for someone else could present new challenges, as you will not be familiar with their typical personality, habits, routine, or medication regimen. This is just one reason why nurses and nurse aides keep such good notes, and you will certainly find yourself counting on other staff members to keep you apprised of each patient’s condition.
When working in a routine or continuous home care situation, you will find the experience to differ drastically from providing services for inpatient or respite care. Within a facility, everything you need to perform your duties is readily available. Home care requires you to bring along any necessary hygiene supplies, or ensure that they are already on hand at the patient’s residence. Essentially, you may need family members to offer you guidance as to where supplies are kept if the patient is unable to. When working in home care, you will discover that you rely on family members’ assistance as much as they do yours. Naturally, paperwork involving staff communication, billing, and reordering these supplies become a part of your job description.
One part of this position that people often find surprising, is that they essentially become educators for family members of patient’s in hospice care. Bedridden patients in the home setting will need someone to change adult diapers, bedding, and perform grooming duties during times when support services are not there. Part of what you will do is offer instructions to the patient’s caregivers on how to handle these actions, as there are tricks to the trade that only trained professionals can explain.
Emotional Support
Social workers and chaplains are traditionally the primary emotional support providers assigned to patients; however, as a hospice CNA, you will discover that you will spend much more time with the patients than they have the capacity to. Essentially, terminal patients and their families will often 
turn to you when they have questions concerning death, the process of the body failing, and for support when the situation worsens. Realistically, you cannot always have the right answers, as no two situations are precisely the same. Spirituality may certainly be a factor, and you will likely be apprised of the patient’s religious beliefs through paperwork, and you have to keep these things in mind if your charges attempt to discuss these issues with you.
These situations may cause you to feel as though you are toeing the line, so to speak, and it is necessary for you to use caution with your responses. Keep in mind that if in doubt, you should contact the case supervisor who can order the appropriate personnel to make a visit to the patient or family members to assist with situations you feel uncomfortable responding to. With time on the job and experience with hospice situations, you will likely find yourself more capable that you ever realized when it comes to handling the emotional needs of charges in a compassionate manner. Every passing day will provide you with new insight, and you can take comfort in knowing that you made a real difference in people’s lives.
Autism in Old Age
Autism is a condition that many have trouble coping with. When you’re small, you are lucky in the sense you have your parents, guardians or teachers looking out for you and making sure you’re doing ok. However, what does this condition mean for the elderly?
In fact, not a lot is known about autism in the elderly as studies tend to focus on children dealing with the condition, but the care and treatment through the ages is always necessary.
The Autistic population have to deal with the ageing process, pensions and health just like the rest of the elderly population, but with intellectual and learning difficulties on top. How can we help people affected by this situation?
- Many elderly people are living with Autism without realising it. For this reason it’s important for all elderly people to be checked and assessed by medical professionals to see if they suffer from the symptoms which include difficulty in social interaction, inability to speak if it is low-functioning autism and a lack of empathy. Some are able to live and work independently without much help but others cannot so it is important to discover early on who needs the most assistance.
- Supported living – Supported living is where a person lives in their own home but cannot cope with some of the everyday tasks that they need to live completely independently. This is where carers or trained medical professionals come in and help clean, cook and administer medicine. For those living with autism, this supported living helps them live in a familiar environment as well getting the help they need.
This is especially true of people living with low-functioning autism where they have difficulty speaking. Autism care is provided then to help people living with this condition cope. It should be noted that people with high-functioning autism usually have higher-than-average intelligence but lack common sense or ‘street smarts’ for living independently – another reason why supported living is so important; it helps those with autism stay safe and secure in their own home without having their independence compromised.
- Support Groups – While most elderly people enjoy socialising in large groups, for those with autism it is much more of a necessity. Social groups are greatly therapeutic for those with autism and they have the opportunity to take part in creative and innovative past-times like painting, crafts and music. This helps them maintain strong social bonds with others which they would otherwise have difficulty with as autism sufferers have great difficulty maintain social relationships. Social groups allow them to interact without pressure and frustration.
Autism care for the elderly is extremely important as they age and go about their lives. While there is still a great amount of research to be done about how the condition affects them in their elder years, with people to go to for support and access to the right treatments and therapies there is no reason why those with autism can’t enjoy their golden years like the rest of them.
This article was written by James Harper on behalf of Voyage, who provide autism care and supported living services.
Managing a Diabetic Patient as a CNA or HHA
Diabetes is a very common disease today in America. We see diabetes not only in our patients, but we may deal with it with our family members as well.
So before we can treat and manage diabetes we should understand exactly what diabetes is, and how it affects the body of our patients.
There are two categories of diabetes, Type 1 diabetes, and Type 2 diabetes. Type 1 Diabetes is a relatively rare form of diabetes. This form of diabetes is commonly diagnosed during childhood. Type 1 Diabetes is caused by the patient not having the insulin hormone produced in his or her body. This form of diabetes is easily managed as long as the person stays on his or her insulin medication.
The second form of diabetes is Type 2 Diabetes. Type 2 Diabetes is an acquired form of the disease, in which the persons body has become resistant to its own insulin. This is
Managing a Fall Victim as a CNA
How should I manage a fall victim as a CNA?
Great question!! Ok, so if you dont already know, falling is one of the number one causes of traumatic deaths for elderly people.
Elderly people often have poor equilibrium, poor musculature, and very frail bones. This leads to quite a dangerous situation. Really one of the biggest jobs we have as CNAs is making sure that our patients do not, under any circumstances, fall.
Elderly patients do however tend to fall. Sometimes it is just inevitable for them to sooner or later fall down. It happens all the time, even under CNA supervision.
So first off lets discuss what falling down does to our elderly patients. So elderly patients bones are often times very frail and brittle. These bones, tend to break easily during a fall. It is very common to see extremity fractures, spinal fractures, and hip and pelvic fractures.
The first thing we should be aware of is the fact that lots of blood can be lost due to a fracture. Bones carry a large amount of blood within them, not to mention a fractured bone can tear into tissues and muscles very easily. So as soon as an elderly person does fall, were going to consider it an emergency.
The fall itself does not usually kill elderly patients, at least not patients under supervision. It can however, be very dangerous for elderly people to fall alone at home and not be able to get help. Usually what kills elderly people after they have fallen is the time it takes for them to get back on their feet.
Lets say an elderly person has fallen down and broken his or her hip. Now they have to lay in bed for a month while the broken bone mends. During this time what happens is the patients muscles quickly begin to atrophy. When these muscles begin going away it is very, very difficult to get them back with physical training. Often times the patient suffers from these falls in a variety of ways including, loss of independance, loss of confidence, falling paranoia, and of course inactivity. At this point our patient is opening his or herself to a variety of different illnesses, and possibly a shorter life because of it.
So obviously the best way to help a patient is to try our best to keep the patient from falling. Prevention is key. We can of course help to keep our patients from falling by being attentive and watchful of them while they are walking. Using handrails appropriately and making sure our patient is safe and secure while sleeping.
Treatment for Patient Falls
For a patient that has fallen these are the steps we should take:
If a patient has fallen, it is an emergency, have another CNA call an ambulance, or if needed call an ambulance yourself.
Unless the patients airway is compromised, or he is for some reason in a dangerous position or environment, DO NOT MOVE the patient. This patient is considered at danger for spinal fracture, in this case only a doctor will be able to clear them of that possibile injury. The paramedics will immediately put the patient in spinal precaution upon arrival.
If you do move the patient you are putting the patient at risk of furthering his or her back injury, and putting yourself at risk for law suits. Be very careful with elderly falls.
Check the patient for any bleeding, and obvious broken bones. Control any bleeding if possible, A lot of elderly patients are taking blood thinners due to atrial fibrillation, so controlling any bleeding is a priority.
The best way to control bleeding is putting pressure on the wound with a sterile dressing.
Keep the patient calm, keep the patient from moving, especially from moving his or her head.
Managing a Choking Victim as a CNA
OK so choking is a truly, live or die situation. No doubt about it, its very scary when a person is choking to intervene. Of all of the scary things to do for a patient this is definitely one of the toughest.
The main reason why this scenario is especially scary for all healthcare workers, not just CNAs, is that a choking person can, and will die, if we do not intervene. A person can only go without oxygen to their brain for about 3-5 minutes. So once this person is choking we are on a timeline. 3-5 minutes truly goes by in a flash. Often times its going to be up to us to step up and perform for our patients.
Check out our video:
Choking Patient Treatment Steps
1. Ask the patient is he is choking…. if he answers yes vocally, encourage him to cough. If he cannot speak and is alert start the heimlich maneuver.
2. If the Heimlich Maneuver is unsuccessful at clearing the patients airway, the patient will quickly become unconcious. This is due to lack of oxygen to the brain.
The next step will be to lay the patient on the firm ground. We are then going to do chest compressions, 30 compressions with 2 breaths. The reason were doing this is to create a pressure gradient in the patients lung cavity.
Its a lot like a ballon that has no where for the air to leak out. When you press on the ballon, the air puts pressure on the exit to escape. Were hoping that pressure can clear the airway.
3. Assess the airway every 30 compressions until you are sure you have cleared the airway and air is entering the lungs. You should be able to see the lungs rise.
If the airway is not cleared, our patient will likely be gone by the time the paramedics arrive. So its important to be very aggressive.
4. Once the airway is cleared, assess breathing and pulse. Breath for the patient if needed. Perform CPR if needed.
Caring for a Heart Attack Victim as a CNA
OK so today I want to discuss the topic of heart attacks. With our patients often times being elderly, it can be quite common for us to be in a situation where heart attacks happen, and we need to be able to respond quickly. First I want to discuss what a heart attack is.
What is a Heart Attack?
A Heart attack is caused from a portion of the heart not receiving enough oxygen. This can happen for a variety of reasons. It can be caused by an embolus or blood clot that is traveling through the arteries and blocks a portion of the artery. It can also be caused by a slow build up of cholesterol in the artery, this weakens the artery wall, and can sooner or later dislodge and block the artery or it can continue to become more and more dense which can also cause blockage. Either way, whats important for us to know is that the problem lies in a portion of the hearts tissue being unoxygenated, (ischemic), due to poor blood supply to the tissues, and more or less the tissue is starting to die.
Assessment of a Heart Attack
The first step to treating a patient for a heart attack is always going to be realizing that the patient is actually having a heart attack. These are some common signs of a heart attack that you may see in your patients.
Pressure/pain in the chest, this is the most obvious and common sign of a heart attack. This can of course be caused by a variety of conditions such as a pulmonary embolism, heart burn, and sometimes trauma. Often
times for our heart attack patients the pain will be a sudden onset, the pain often radiates to the left arm but can really radiate anywhere. Often times female patients will have the pain radiating to their backs, and sometimes they will present as having abdominal pain and not chest pain. Women can be a bit more tricky then male patients to assess. The pain is often described as crushing pain, or a pressure in the chest.
Increased Breathing Rate: Often times you will find an increased breathing rate, or shortness of breath in a heart attack victim. This shortness of breath comes from the lack of oxygen going to the heart. The patients body goes into overdrive to try and save itself. So the heart starts pumping faster and harder, and the brain tries to increase oxygen levels in the blood by increasing the respiratory rate.
Profuse Sweating: Also called diaphoresis , the patients body is working hard to stay alive, also there is a release of adrenaline (epinephrine) that is causing the body to work even harder, even though the patient may be at rest.
Treatment of a Heart Attack
Call 911!!! Get the Paramedics out there immediately. There are certain drugs that the paramedics can give that can really help out in a heart attack situation. Its important to get them there immediately.
Getting the acute chest pain victim oxygen is a priority. This is a medication, so you must assist your patient with his or her current prescribed dosage or call your nurse to get permission to administer oxygen. We want to get this patient’s blood as oxygenated as possible, 100% oxygen via nasal cannula or non-rebreather is the treatment of choice. Increased oxygen may help to oxygenate the ischemic tissues. Also be mindful of your facilities protocols in this situation and always follow what they have set forth as protocols for treatment.
Keep the patient calm, do not have the patient exercise in any way shape or form. Do not walk him to his bed, do not have him do anything except lay down and get comfortable.
As a CNA you are not able to give a patient medications, however if they are on certain medications, you may assist them with those medications. If your patient takes nitroglycerine, and or aspirin, and has been told to take these pills by his or her doctor in this type of emergency, you may get the pills and hand them to the patient. There are certain important things such as blood pressure, allergies, and use of sexually enhancing drugs to consider when your patient tries to take these meds. Thus it’s best to ask the RN to help, or to make sure the patient knows what he or she is doing.
Lastly get all paper work ready for the paramedics. The Paramedic will want to get this patient out and to the hospital immediately. So the faster you can give him a report and get him out of there the better.
Test Your Heart Attack Knowledge
Heart Attack Quiz
Managing A Stroke as a CNA
Ok so I wanted to go over a very common ailment that we see in elder care facilities and as home health aides. One of the more common emergencies I saw CNA’s deal with were Strokes. Stroke patients really can be scary. A lot of times the emergency can be confusing and frustrating. So I think it would be best if we talked a bit about what exactly a stroke is, and how we can help our patients during this emergency.
A Stroke is caused by a part of the patients brain being deprived of oxygen. This can happen in a few different ways.
Types of Strokes
Ischemic Strokes
One way is called an Ischemic Stroke. The Ischemic stroke essentially is a blockage in the arteries leading to the brain. This kind of stroke is very similiar to what occurs in a patient that is having a heart attack, however in this case it doesnt cause ischemia to the heart but to the brain. A blood clot, or embolus, can dislodge, and move through the blood, this blood clot can effect many different areas, however if it blocks the cerebral arteries it can cause a stroke.
Hemorrhagic Strokes
The second Kind of stroke that can occur is called a hemorrhagic stroke. These strokes are causes from burst blood vessels within the brain. What essentially happens is an artery bursts within the patients brain, this can also be called an aneurysm. The blood flows out of the vasculature and into space between the brain and the skull. The brain is kept at a certain pressure, called the ICP or inter cranial pressure. This pressure is increased drastically as more blood flows into this space. The brain is slowly pushed to one side as the pressure increases. The pushing of the brain to one side can cause damage, and lack of blood flow and oxygenation to the brains tissues.
Transient Ischemic Strokes
The Third type of stroke that can be seen is called a TIA or Transient Ischemic Attack. This is similiar to an ischemic stroke, however in the case of a TIA, the embolus or blood clot blocks the artery for a time, and then passes through. So the patient presents as possibly having a stroke, but then the signs go away and the patient returns to normal. This type of stroke often will reoccur as an ischemic stroke in approximately 70% of patients. So it is important that patients who presented as having a stroke are still taken to a hospital.
Recognizing a Stroke
There are a few different things that we as CNA’s should look for when checking to see if our patient may have had a stroke. Signs and symptoms of a stroke can vary, and if you ever have any concerns about whether a patient has had a stoke it is best to call 911.
Altered mental Status: If a patient is altered there is a chance he or she may of had a stroke. There are many reasons a patient could become altered, and it is definitely not always a stroke. But if a patient becomes altered it is important that you consider that it might very well be a stroke. Talk to the patient, ask them if they know where they are, their names, the day of the week. You probably know the patient better then most people, so if they seem different from what you are used to, then it is time to get them help.
Unilateral Weakness: This is a fancy term for one sided weakness. Often times strokes will cause a weakness in one side of the body. Often we can see facial droop on one side of the face, or we will see inability of the patient to use one side of his or her body. A great way to assess for this is to have the patient give you a great big smile, asking them to show you their teeth. This will often show the patients facial droop, if there is any.
Assessing for unilateral weakness can be done by asking the patient to squeeze your fingers on both hands at the same time. You can easily tell if one side is stronger then the other by doing this. One other great method is to hold the patients hands up, palms up in front of them. Often this will show a weak side, the patients arm will drift down back to his or her side if the arm lacks the strength to keep itself up, this may indicate a stroke.
Dilated Pupil: If you see unequal pupil size on your patient it may be indicative of a stroke. Often times in hemorrhagic strokes the increased intercranial pressure can cause one sided pupil dilation.
Aphasia: Often times people that have had strokes may not be able to speak properly. They are either unable to speak the words, or the words they speak will not make any sense.
Incontinence: Often times patients who have had a stroke will be incontinent, this can be a helpful clue in determining if you patient has had a stroke.
Vital Signs: Often times patients that have had strokes will have high blood pressures. This is not always the case, however in most stroke cases that I have seen the patients blood pressure will be at a systolic BP of 170+. A lot of times we will see an increased pulse rate, this can be due to the heart responding to the decreased oxygenation of the brain or it can be simply due to the fear and anxiety that is involved with having a stroke. It can be common to see a change in the patients respiratory rate, this can be due to the same reasons the heart rate increased, increased need for oxygen and fear and anxiety.
Treatment Plan
Ok so we think our patient has had a stroke…. what should we do.
Call 911!! There isnt a great deal that we can do to help a patient with a stroke, the best thing we can do is get them to a hospital quickly. There are very effective treatments for patients who have had strokes, but they need to be done fast.
Ischemic strokes can be helped with antithrombolytics. This medication can break up the clot that is causing the damage and allow for oxygenation of the damaged area. This must be done within 2 hours of the patients stroke onset, so time is of the essence!!
Hemmorghic Strokes can also be treated, the doctors will try to control the bleeding and control the inter cranial pressure of the patient, time is also of the essence for these patients.
Assist the patient with his or her oxygen if this is already prescribed, putting the patient on a nasal canula and giving them 100% oxygen can be very helpful for this patients current condition. Always remember to follow your protocols as a CNA and of your facility. Remember this patients emergency is all about lack of oxygen to certain tissues, so increasing oxygen supply in the blood can help. Once again, do not give unprescribed Oxygen to a patient unless you have consent from a doctor or your RN.
Protect your patients airway, Often times patients who have had strokes are going to be drooling, sometimes they have difficulties swallowing. You can make sure that the patients airway is not compromised by removing excessive saliva by either utilizing suctioning, or helping clear the excess saliva with a clean and sterile cloth or dressing.
If possible grab a quick set of vital signs to hand off to the paramedics that arrive to treat the patient.
IMPORTANT Write down the exact time that the patient’s emergency began. Give this your best shot, but it’s extremely important information for the coming paramedic and the ER doctor that will be treating this patient. Possibly the most important information you can give to the medical professionals.
Test Your Stroke Care Knowledge
Stroke Quiz
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CNA HHA Training
In order to begin your career as a CNA or HHA, you should have a clear background record and be ready to prove it by giving a fingerprint test at the local FBI station. After which, you can apply with any of the approved training programs. You do not need to have a diploma or GED as according to law however, some schools will still ask when you are enrolled. Furthermore, age requirements will vary with each state and school as well. You should also expect to take a health exam and be up to date on all required health shots/records. The training program for the CNA certification requires a federal minimum of 75 hours in studies. In addition to this, your state will likely require extra hours. This includes both class and hands on training which, are both required for certification. For an HHA, you would simply need to attend an additional 40 hours or more of studying depending on your state requirements.
Course studies typically provided during training for a CNA/HHA position include patient care and nurse assistant basics. They will cover a range of subjects from patient hygiene to patient privacy and even working under a registered nurse supervisor.
Once you have finished your training courses, you will be allowed to attempt the CNA state exam for your certification. Many exams are offered through the Red Cross though, you will have to check with your local nurse register to get a current list of approved testing sites in your area. The exam is typically from 60 to 75 multiple choice questions related to what you learned in your training and has both a written and physical demonstration portion that must be passed in order to earn certification. Upon passing the exam, you may receive a certificate in some states otherwise, you will simply be placed on the nurse register aide. You may need to apply for admission to the register.
The average CNA salary in the United States is reported to be between $19,000 and $27,000 a year. Having the additional HHA credentials however, can increase this pay even more. The average HHA is told to make between $24k and $29k a year. Both positions have very positive outlooks and are expected to increase by more than 30% over the next 5 years according to national labor records.