Check your answers!

Transportation Safety

It is important for Home Health Aides/Personal Care Aides to stay safe while driving to and from their patient’s home. Follow these guidelines for transportation safety.

• Be familiar with the roads and stay aware of surroundings.
• Have directions and a map handy.
• Ensure there is always enough fuel in the car. This helps to prevent unwanted stops in strange areas.
• If using your personal car, ensure it stays in good operating condition. Keep up to date with your annual inspection and keep insurance and registration materials current and in the car.
• Ensure that tires are inflated to the appropriate pressure and obtain vehicle maintenance on a regular basis.
• Know how to drive in inclement weather.
• Drive the appropriate speed limit to prevent accidents and tickets.
• Drive with the car doors locked.
• Never use a cell phone while driving. To avoid other distractions, limit talking and music.
• Always wear a seat belt. Ensure other car occupants wear their seat belt.
• Remember that there should be no children under the age of 12 riding in the front seat.
• All children must wear seat belts in the car.
• Child safety seats must be used with children under 8 years of age. Inspect the child safety seat frequently to ensure it is in good working order. Make sure you know how to use it. If you do not, ask the patient or a supervisor for instructions.
• Never ingest alcohol or drugs prior to or during driving.

Check your answers!

Unit C: What to Do When Injuries and Emergencies Happen

While Home Health Aides/Personal Care Aides work to keep their patient and their home safe, there are situations where an accident may occur. It is important that Home Health Aides/Personal Care Aides are aware of their agency’s policies regarding incidents. Most agencies will have provided them with training in how to deal with emergency situations. This will include the agency’s policies and procedures and an emergency contact list.If Home Health Aides/Personal Care Aides have not been informed about their agency’s policies and procedures, they should speak with their supervisor to find out what the procedures are in dealing with emergencies. Whenever in doubt, call a supervisor.

First Aid Techniques

Falls

If a patient falls, it is important to immediately assess them and for Home Health Aides/Personal Care Aides to inform their supervisor.

• If they are trained to take vital signs, such as blood pressure, they should do so.
• Check to see if the patient has hit their head.
• Never move someone who appears to have hit their head or who may have a back injury. This could do more damage.
• Check for cuts, bleeding, and any obvious injuries.
• If there is an injury, try to determine the extent of the injury. Report any observations made to a supervisor or to emergency medical services, if there is a need for emergency help.
• If there is bleeding, put on gloves and apply pressure to the wound with a clean and dry towel.
• Note how long it takes for the blood to saturate the towel and report this to a supervisor and/or emergency medical services.
• If there is a need for additional towels, place another clean towel on top of current one. Do not let up pressure on the bleed.
• Never leave a patient alone who has fallen. Stay with the patient until additional help arrives.
• Document all injuries and steps taken to provide care.

Bruises

A bruise forms when blood vessels below the skin’s surface break and blood leaks into the tissue beneath the skin (Mayo Clinic, 2014). Bruises can range from very small to quite large, covering large areas of the body. Bruises change color as they heal. Remember the acronym RICE when treating bruises (WebMD, 2014a).

• R (Rest): Encourage the patient to rest the affected area to prevent further injury and to allow it to heal.
• I (ice): If the skin is not broken, Home Health Aides/Personal Care Aides should immediately apply a cool cloth or ice pack (wrapped in a towel to protect the patient’s skin) to the area for about 20 minutes. This can be repeated several times a day, as directed by the Care Plan. Remember to never apply ice directly on skin as this could cause injury to the skin. Do not use heat and encourage the patient to avoid hot showers and baths for the first 48 hours after injury as this will encourage swelling (WebMD, 2014a).
• C (compression): Wrap the area of injury with an ACE bandage, if directed by the Care Plan or a supervisor. Compression helps to relieve swelling and pain. Remember not to wrap the area too tightly as this could cause further injury. Signs the bandage is too tight are numbness, tingling, coolness in the affected area, increased pain, or swelling below the area that is wrapped (WebMD, 2014a).
• E (elevate): Elevate the bruise above the level of the person’s heart if possible. This will help to decrease swelling.

Seek further guidance from a supervisor. Remember to inform him or her of ANY injury a patient has sustained. Document all injuries and steps taken to provide care.

If the bruise covers a large area of the body and appears to be serious, or if a hematoma has developed, or if skin has broken and the patient is bleeding profusely (a lot), activate emergency services. Call 911. Calmly inform EMS of the situation and the observations made. It is also important to inform EMS if the patient is on any anticoagulants (blood thinners). Anticoagulants cause blood to take a longer time to clot. This will result in a longer bleed time and could be potentially life threatening to the patient.

Check your answers!

Cuts and Scrapes

For minor cuts and scrapes, basic first aid at home may be adequate. Home Health Aides/Personal Care Aides should still inform their supervisor of the situation and seek guidance from them in caring for the wound.

• Always wash hands and apply gloves when performing first aid.
• Basic first aid for caring for cuts and scrapes includes first washing the area with cool water. The cool water will wash away any debris that may be in the wound and will help blood vessels to constrict (become narrow), which helps to stop bleeding. Do not use soap.
• Once the area is clean and the blood has decreased, place gentle pressure on the wound with a clean and sterile gauze pad. Add additional gauze if the first gauze saturates with blood. Do not remove the gauze pad as this could cause any clots that have begun to form to be removed and bleeding to continue.
• When the wound has stopped bleeding, dress the area with a clean bandage.
• Document all injuries and steps taken to provide care.

Dizziness/Fainting

• Should a patient report that they feel dizzy, immediately lower them to a seated or lying down position.
• Remember to always allow a patient time to sit on the edge of a bed or chair and dangle their legs before rising to a standing position. This will help prevent falls from feeling light-headed or dizzy if the patient experiences orthostatic hypotension.
• If a patient is standing or walking and reports they feel faint, Home Health Aides/Personal Care Aides should lower them to a chair or to the ground if a chair or bed is not nearby.
• If possible, Home Health Aides/Personal Care Aides can wrap their arms around the patient’s waist securely, and using good body mechanics, lower them to the floor.
• Avoid having their head hit the ground or nearby objects.
• While lowering the patient to the floor, keep a wide stance to provide a strong base of support, and bend using the knees to slowly and carefully lower the patient to the floor.
• Document all injuries and instances when patients report dizziness or faintness and the steps taken to provide care.

Self-Check Activity M11-12
True or False

1. If a patient feels faint, attempts should be made to lower them to a chair or the ground to prevent a fall. True or False? _______

2. It is important to allow a patient time to sit on the edge of the bed before standing to prevent dizziness and falls. True or False? _______

Check your answers!
Burns
The treatment of burns depends on the type of burn.
Treating Minor Burns:
The first step in providing first aid to a patient who has suffered a burn is to remove them from the source of the heat.
For first and second degree burns that are limited to a small area, apply a clean, cool towel or cloth to the area of the burn for about 15 minutes to help decrease pain.
Do not use ice as this could result in frostbite (American Institute for Preventive Medicine, 2012).
Once the pain from the burn has subsided, allow the area to dry for a few minutes, and then apply a clean, dry sterile piece of gauze to the area. Tape the edges down.
Never apply ointments or grease to the area of the burn. Do not use margarine, butter, or oil on the burn.
A supervisor should be informed and the patient should be examined with further treatment provided if necessary.
While the burn is healing over the next few days, keep the area clean and dry. Apply clean dressings to the area as directed by the Care Plan.
If blisters form, do not break them. Allow blisters to heal naturally. Until the skin is healed, avoid using lotion, soaps, and perfumes directly on the area.
Treating Third Degree or Large Burns:
For third degree burns, remove the person from the heat source.
Ensure that their airway is kept open and they continue to breathe.
If they stop breathing, or they can no longer feel a pulse, Home Health Aides/Personal Care Aides should perform CPR immediately if they are trained in CPR.
Stay with the patient at all times.
Keep the patient calm and call 911 immediately.
Do not remove clothing that is stuck on the person as you risk tearing skin off with the clothing.
Keep the area of the burn clean. Cover it with a clean bandage or sheet until help arrives.
Do not put pressure on the burn and protect it from friction (MedlinePlus, 2014).
To prevent shock if a serious burn has occurred, keep the person warm and lay them flat.
If they have not suffered from a head, neck, or back injury, elevate their feet and stay with them until help arrives.
Do not immerse the person in water as this could cause the person to go into shock.
Treating Chemical Burns:
If a patient is exposed to a chemical, remove the chemical from their skin immediately.
Activate EMS by calling 911.
Flush their skin with cool water for 20 minutes.
If their clothing has come into contact with the chemical, remove the affected clothing.
Treating Electrical Burns:
In the case of electrical burns, special precautions must be made.
NEVER touch a person who has been electrocuted with bare hands.
911 should be called immediately.
The appliance should be unplugged if it can be done safely.
Do not use anything metal or wet to remove the electrical source.
If possible, switch off the main power supply.
If the appliance is standing in water, do NOT touch it.
Never stand in any water, even if it is a small puddle, while touching an electrical appliance.

It is important to remember that the person suffering the electrical burn should be removed from the source of electricity only if it can be done safely. If so, stand on a dry surface such as a rubber mat, pile of papers or books, and use a dry wooden object such as a broom handle to push the person away from the electricity source (WebMD, 2014b). Never use anything with metal or that is wet.

Remember, Home Health Aides/Personal Care Aides should report ANY burn to their supervisor. The patient needs to be examined and further treatment provided. Always call 911 for any serious burn, for any burn that occurs on a large area of the body, on the head, neck, hands, feet, face, genitals, for burns that occur on more than one part of the body, if smoke has been inhaled, if the person is having trouble breathing after a burn, or if an infant, child, or a very elderly person has suffered from a burn. Home Health Aides/Personal Care Aides should also call for help if the burn was caused by chemicals or electricity. Document all injuries and steps taken to provide care. An incident report will likely need to be completed.
Self-Check Activity m11-13

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Self-Check Activity M11-13
True or False

1. You should never use any electrical appliance near or while standing in water. True or False? ______

2. You should first remove the heat source if a patient has received a burn. True or False? ______

3. You should always call 911 if a person has received an electrical burn. True or False? ______

4. Ice should be used instead of cool water to soothe a minor burn. True or False? ______

5. It is very important to keep any burn clean and covered. True or False? ______

6. EMS should be activated if a burn occurs on a large area, on young children or the very old, or if smoke has been inhaled. True or False? ______

7. It is okay to break a blister from a burn after a couple of days to help the wound heal. True or False? ______

Check your answers!
Choking
If a patient is choking and is unable to breathe, cough, or speak, Home Health Aides/Personal Care Aides must take immediate action and call 911. Permanent brain damage could occur in as little as 4-6 minutes if the person is unable to breathe (MedlinePlus, 2015a). Providing first aid quickly can save a person’s life.
Try to encourage them to cough to remove the object or food.
Stay with them at all times while you are waiting for help.
Use your senses of observation to determine the cause and extent of the choking. Did the person swallow an object or did the choking happen while they were eating, drinking, or taking medicine? Are they able to breathe? Are they turning blue (cyanotic)? Do you hear soft or high pitched sounds when they are trying to breathe? Are they unable to make any sound or cry? Are they unable to cough or is the cough weak and ineffective (not working)?
Heimlich Maneuver
If needed, Home Health Aides/Personal Care Aides must be prepared to perform abdominal thrusts to help dislodge the object from the person’s airway. This method is called the Heimlich maneuver. Thrusts are given slightly above the belly button. Each thrust pushes air from the lungs, which can help remove an object that is blocking the airway (American Heart Association, 2011).

Remember to only do this if the person cannot breathe, cough, or speak. A person who is choking might use the choking sign (holding the neck with one or both hands (American Heart Association, 2011). Ask if they need help and if they are choking prior to performing abdominal thrusts.
Performing the Heimlich maneuver for a person who is standing or seated, according to American Heart Association (2011) guidelines:
Ask, “Are you choking?” If the person nods or indicates yes, tell them you are going to help.
Stand behind the person and wrap your arms around their waist so your hands are in front.
Make a fist with one hand, and place your thumb against the person’s abdomen, just above their belly button. Make sure your hand is well below the breast bone.
With your other hand, grasp the fist that is against their abdomen and quickly thrust upward into the person’s abdomen.
Give thrusts until the object is forced out and the person can breathe, cough, or talk, or until the person stops responding.
If the person loses consciousness, lower them to the floor and begin CPR if trained to do so.
Keep the person in a lying up position so that their head is facing up.
Ensure their airway is not blocked.

If a person is lying on their back you may also straddle a person facing their head and push your grasped fist inward and upward in a similar manner to performing abdominal thrusts on a person who is standing (MedlinePlus, 2015a).
Performing the Heimlich maneuver for a person who is pregnant or very large and you can’t wrap your arms fully around the waist, according to American Heart Association (2011) guidelines:
Follow the same steps for performing the Heimlich maneuver except for where you place your hands.
Ask, “Are you choking?” If the person nods or indicates yes, tell them you are going to help.
Put your arms under the person’s armpits and your hands on the lower half of the breastbone.
Pull straight back to give chest thrusts.
Performing the Heimlich maneuver for a person who has lost consciousness, according to American Heart Association (2011) guidelines:
If a person stops responding while you are giving abdominal thrusts, lower them gently to the ground. Ensure their airway remains free and they are in a face up position.
Check to see if the person needs CPR. If you do not know how to give CPR, give hands-only CPR.
Emergency medical services should be contacted immediately.
Continue CPR until the person is able to speak, moves, or breathes, or someone with more advanced training takes over.
Performing hands-only CPR:
Your agency may provide training or require you to receive CPR certification. You should only provide CPR if you are trained to do so. For those who are not trained to provide CPR, hands–only CPR can be performed until someone with more advanced training arrives.Hands-only CPR has two easy steps (American Heart Association, 2014). If you see a teen or adult suddenly collapse:

1. Call 911 or the emergency medical services phone number in your area.

2. Push hard and fast in the center of the chest. You should push at a rate of 100 compressions per minute.

It is helpful to push following the beat to a popular disco song by the Bee Gees called, “Stayin’ Alive”. You can watch a video of Hands-only CPR published by the American Heart Association at: http://cpr.heart.org/AHAECC/CPRAndECC/Programs/HandsOnlyCPR/UCM_473196_Hands–Only–CPR.jsp

Performing abdominal thrusts on an infant is a different process than that used for adults. Choking in infants is usually caused by the infant putting something in their mouth (MedlinePlus, 2015b).
Performing the Heimlich maneuver in an infant according to American Heart Association (2011) guidelines:
Kneel or sit with the infant in your lap.
Lay the infant face down on your forearm, across your lap or thigh.
Provide support to his or her head and neck by placing your one hand under their chin to hold it steady. Be sure to not compress the soft tissues of the infant’s throat.
The baby’s head should be facing downward, lower than their body. This helps to provide gravity so the object can be removed.
Using the heel of your hand (bottom part of your hand) provide 5 back slaps to the baby’s back, between the shoulder blades.
If the object becomes dislodged, you can stop.
If the object is still stuck, turn the baby face side up. Take care to turn the baby as one unit, supporting the head and neck as you do so.
Provide support to his or her back with your forearms, resting the baby on your lap or thigh.
Provide support to the infant’s head and neck with the palm of your hand.
Provide 5 downward chest thrusts at a rate of 1 per second, by using 2 fingers in the center of their breastbone and quickly press down, compressing their chest about 1 ½ inches (4 cm).
You can repeat this process until the infant expels the object or until they lose consciousness.
Remember, 5 back slaps with the baby face down, and then 5 chest thrusts with the baby face up.

Document all instances of choking and steps taken to provide care. The supervisor should always be informed about any instances of choking. A patient who has experienced choking or has had the Heimlich maneuver performed should be assessed by a healthcare provider.

Self-Check Activity M11-14
Put the steps in order

1. Put the steps of performing the Heimlich maneuver on an adult in order:

a). Make a fist with one hand.

b). Thrust inward and upward.

c). Grasp the fist against the abdomen with your free hand.

d). Place your thumb against the person’s abdomen, just above their belly button.

e). Stand behind the person.

True or False

2. When performing the Heimlich maneuver on an infant, you should provide 5 back thrusts with the baby face down and then 5 chest thrusts with the baby face up until the object is dislodged. True or False? _____________

Check your answers!
Poisoning
If Home Health Aides/Personal Care Aides suspect or know that poisoning has occurred, they should try to determine the source of the poison. This is important information which they will need to provide to Poison Control in order for them to best help. Look for nearby medications, chemicals and cleaning solutions that the patient may have ingested.

Immediately call Poison Control and follow their directions. The treatment for poisons depends on the type of poison that was ingested. Notify a supervisor as soon as feasible. Never try to make a patient vomit, unless specifically instructed to do so. Some chemicals may cause severe harm if they come back up the esophagus (throat) during vomiting.

If the poison is a dry powder or solid substance, and you can safely do so, with a gloved hand brush off the poison and rinse the contaminated area with plenty of water for at least 20 minutes (American Heart Association, 2011).

If the poison affected the eye, the person should rinse their eye with plenty of water, making sure the eye containing the poison is the lower eye, the closest to the bottom of the sink while rinsing (American Heart Association, 2011). This will prevent the unaffected eye from getting poison in it.

If the poison is within the air, such as a chemical or if a person has experienced exposure to carbon monoxide, contact emergency medical services, and get the person out of the area and into an area with fresh air, if it is safe to do so.

Document all poisonings and steps taken to provide care. You may be asked to complete an incident report, if required by your agency. All patients who have suffered from poisoning should be assessed by their healthcare provider.
What to Do in Serious Medical Emergencies
Should a serious medical emergency occur, Home Health Aides/Personal Care Aides should assess the situation using their observational senses. Note what is seen, heard, felt, and smelled. Immediately call for help. Activate emergency medical services (EMS) by dialing 911. Inform them in a calm and matter of fact way what occurred and the observations made. Never leave the victim unattended.
ABCs of First Aid
Keep in mind the ABCs of first aid. The ABCs of first aid stand for A (Airway), B (Breathing), and C (Circulation). It is important to remember this acronym as any delay in treatment when a patient has a compromised airway, breathing, or circulation could result in serious injury, and possibly death.
Assessing the ABCs:
Airway
Is the patient’s airway (mouth, nose), open?
Is there an obstruction which makes it impossible for them to breathe?
If there is an obstruction and the person is unable to breathe, activate EMS and perform the Heimlich maneuver to try to remove the obstruction.
Breathing
Is the person breathing?
Can you see the chest rise and fall as they breathe?
Can you feel air move in and out of their mouth or nose?
If the answer is no to any of these questions, Home Health Aides/Personal Care Aides should activate EMS and begin CPR if trained to do so. Hands-only CPR can be performed if you are not trained in CPR.
Circulation
Do they have a pulse?
How is their color? Are they blue from lack of oxygen?
Does their skin feel warm to the touch or cold? Cold skin means not enough blood is pumping through the body.
If the person does not have a pulse, Home Health Aides/Personal Care Aides should activate EMS and perform CPR if trained to do so.

Take note of the ABCs of first aid. Activate emergency medical services if any of the ABCs are compromised. Report your observations to EMS. Stay with the patient. If trained, perform CPR.
Myocardial Infarction (Heart Attack)
A myocardial infarction, also known as a heart attack, is a situation when the heart loses adequate oxygen supply.A myocardial infarction is a medical emergency and help must be obtained immediately. The first few minutes of a heart attack are the most important and treatments given during this time will be most successful (American Heart Association, 2011).
Signs of a heart attack:
Chest pain
Pain that radiates (extends) to the jaw, arm, or back
Nausea, vomiting
Intense chest pressure (a feeling of heaviness and pressure)
Diaphoresis (intense sweating)
The patient clutches their chest
Dyspnea (difficulty breathing)
Shortness of breath
Cyanosis (blue or gray appearance of the skin)
Indigestion or heartburn
Cold and clammy skin
Weak and irregular pulse
A sense of anxiety or impending doom
What to do:
Immediately call 911 or the emergency medical services number in your area to obtain help.
Follow all instructions provided to you by emergency services.
Loosen any clothing around the patient’s neck.
Place them in a comfortable position and encourage them to rest. Activity uses oxygen, which the heart does not have enough of during a heart attack.
Do not give the patient anything to eat or drink.
Observe their breathing rate and pulse. If trained to take vital signs, do so.
If the patient stops breathing or no longer has a pulse, perform CPR if trained to do so. Perform hands-only CPR if you are not trained in CPR.
Stay with the patient until help arrives.
Inform a supervisor as soon as possible about the incident.
Document the situation and all steps taken to provide care.
Self-Check Activity m11-15

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Self-Check Activity M11-15
Multiple Choice

1. Which of the following are signs of a heart attack? Select all that apply.

a). Diaphoresis

b). Jaw pain

c). Indigestion

d). Nausea

e). Anxiety

f). Shortness of breath

g). Cyanosis

h). Left arm pain

i). Chest pain

True or False

2. True or False: You should call 911 immediately if you suspect a person is having a heart attack. True or False? __________

Check your answers!
Seizures
A seizure is disorder in which there is increased electrical activity of the brain. There are a variety of causes of seizures, such as head injury, low blood sugar, a heat-related injury, medical conditions, or poisonings (American Heart Association, 2011). In some types of seizures, the person has uncontrollable muscle movements. Tonic–clonic seizures have two phases: tonic and clonic. In the tonic phase, the person’s muscles contract and spasm. In the clonic phase, the person has repeated muscle movements, and their arms, legs, and torso may jerk violently.
Signs of a seizure:
Signs of a seizure depend on the type of seizure disorder the patient has. Home Health Aides/Personal Care Aides may notice:
Suddenly falling or dropping from a seated or standing position
Loss of muscle control
Repeated blinking of the eyes, smacking of the lips, or repeated swallowing
The person is not able to follow commands
Inability to swallow
Drooling
Repeated contractions and movements of the arms, legs, or torso
Shaking or jerking of the body
The person stops responding
What to do:
If a patient has a seizure, it is important to obtain medical help immediately. Remember to never put anything in the person’s mouth during a seizure and never try to hold them down. The Home Health Aide/Personal Care Aide’s job during a seizure is to contact emergency medical services and to try to protect the patient from injury. Never leave a person during a seizure.
Immediately call 911.
Note the time the seizure began. Provide this information to 911.
Place the patient in a comfortable position. Keep their head face up so they can breathe.
Loosen any tight clothing.
If possible, place a pillow, blanket, or towel under the patient’s head to prevent injury.
Clear the area of any possible hazard for which the patient could become injured.
Never put anything, including fingers, in the patient‘s mouth during a seizure.
If they begin to vomit, roll them onto their side. Make sure their mouth is not obstructed.
Never try to hold a patient down while they are having a seizure.
Keep the area clear of objects and people.
Do not give the patient food or fluid.
Note the time when the seizure is over. Check for adequate breathing and pulse.
If the person stops breathing or no longer has a pulse, perform CPR if trained to do so. If not trained in CPR, perform hands-only CPR.
Inform a supervisor as soon as possible about the incident.
Document the seizure and all steps taken to provide care.

Self-Check Activity M11-16
True or False

1. EMS should be activated if a person is having a seizure. True or False? ________

2. A person should never put any objects or fingers inside a person’s mouth while they are having a seizure. True or False? ________

3. Never restrain a person during a seizure. True or False? ________

4. It is important to time when the seizure starts and stops. True or False? ________

5. All furniture and other dangerous objects should be removed from the area while a person is having a seizure to prevent any injury. True or False? ________

Check your answers!
Cerebrovascular Accident (Stroke)
A cerebrovascular accident is also known as a stroke. A stroke can occur when the brain loses adequate oxygen supply. A stroke is a medical emergency. Obtain help immediately by calling 911. Remember the acronym FAST when assessing someone for possible stroke.

FAST:

F: Facial drooping. Is one side of the face drooping down and appear uneven?

A: Arm weakness. Can the person raise one arm or is one side weak or paralyzed?

S: Speech difficulties. Is the speech slurred or difficult to understand?

T: Time. Time is critical. If Home Health Aides/Personal Care Aides suspect a possible stroke, they should call 911 immediately!
Signs of a stroke:
Drooping of the eye, face, or mouth
Sudden weakness or paralysis of a hand, arm, leg, or foot. This usually occurs on one side of the body.
Sudden inability to speak or swallow
Tingling or numbness in an arm, hand, leg, or foot
Sudden headache
The patient reports suddenly having trouble seeing
Sudden weakness
Problems with balance, coordination
Difficulty concentrating, remembering things
Dizziness, fainting
What to do:
Immediately call 911 and obtain emergency assistance.
Keep the person in a comfortable, resting position.
Loosen any tight clothing.
Do not give the patient any food or liquid to drink.
Note the time the stroke began. This is important information to provide to emergency services as it will help determine the course of treatment the person can receive.
See if the person needs CPR. If they do, perform CPR if trained to do so. If not trained in CPR, perform hands-only CPR.

Self-Check Activity M11-17
Multiple Choice

1. Which of the following are signs of a possible stroke? Select all that apply.

a). Facial drooping

b). Tingling or numbness in a hand or foot

c). Difficulty speaking

d). Sudden weakness

e). Trouble seeing

f). Paralysis of an arm or leg

True or False

2. If a patient has any signs of having a stroke, 911 should be called immediately. True or False? ________________

Check your answers!
Diabetes and Low Blood Sugar
Diabetes is a condition in which the person is unable to make enough insulin to properly use glucose. Too much or too little glucose (sugar) can cause serious problems for a person. Some diabetics take insulin to manage their diabetes. In some instances they may have taken too much insulin or took their insulin but either did not eat enough or waited too long to eat or if they have been exercising too much without enough food. This can cause their blood sugar levels to drop. If a person goes for too long with too low of a blood sugar level they can have a seizure, go into a coma, and even die. It is important that the HHA/PCA act quickly and be observant for signs of low blood sugar for patients who have diabetes.
Signs of low blood sugar:
A change in behavior such as confusion or irritability
Sleepiness or drowsiness
Hunger or thirst
Weakness
Sweating
Pale skin color
Seizures
What to do:
If the person can sit up and swallow, give them something that contains sugar to eat or drink.
Allow the person to rest and sit or lie down.
Contact emergency medical services
Inform your supervisor and document the incident.
It is important to remember when giving someone with low blood sugar to eat or drink that the food or drink contains sugar. Foods or drinks to use include: fruit juice, soda, honey, milk, or sugar packets mixed in juice. Never give a person with low blood sugar a diet drink or food as it does not contain sugar in it. The goal is to increase their sugar levels. If in doubt whether the patient has too high or too low blood sugar, it is better to give them something with sugar to prevent seizures or coma. Too high blood sugar levels are less dangerous than too low blood sugar levels.

Self-Check Activity M11-18
1. Which of the following items could be used to increase blood sugar levels of a person with low blood sugar? Select all that apply.

a). salad

b). diet soda

c). milk

d). orange juice

e). sugar packets or honey

 

Check your answers!
Post-test

1. Which of the following are ways a HHA/PCA can prevent falls? Select all that apply.
   1. Have patients dangle legs at the edge of the bed prior to standing.
   2. Keep living areas clutter free.
   3. Use non skid mats in the bathtub.
   4. Ensure handrails in the bathroom are in good working order.
   5. Encourage patients to put on glasses and use ambulation aids correctly.
2. True or False: It is okay for a HHA/PCA to immediately help a patient up who has fallen, before calling a supervisor.
3. This is the most serious type of burn, in which skin may be white or black, organs below the skin may be visible and 911 should be contacted immediately.
   1. First degree burn
   2. Second degree burn
   3. Third degree burn
4. Which is the best way to prevent a burn?
   1. Use hair dryers while brushing teeth.
   2. Pull electrical appliances from the outlet by the cord.
   3. Check temperatures of bath water and hot drinks.
   4. Keep pot handles facing outward so they can be easily reached.
5. Put in order how you should use a fire extinguisher:
   1. Sweep back and forth at the base of the fire
   2. Pull the pin
   3. Squeeze the handle
   4. Aim at the base of the fire
6. True or False: The best way to prevent poisoning is to keep cleaning solutions, chemicals, and medications locked and out of the reach of children and confused adults.
7. True or False: If a suspected or known poisoning has occurred, Poison Control should be immediately contacted and the HHA/PCA should not make the person vomit, unless specifically instructed to do so.
8. Which of the following are ways to keep children safe? Select all that apply.
   1. Provide age appropriate toys.
   2. Supervise outdoor play.
   3. Never leave babies or children in a bathtub unsupervised.
   4. Never leave a baby unattended.
   5. Feed babies with their heads higher than their bodies and burp often.
   6. Keep babies on their backs while sleeping and avoid placing stuffed animals and a lot of bedding in cribs.
9. Which of the following are ways to keep safe while using transportation? Select all that apply.
   1. Keep distractions to a minimum while driving.
   2. The driver and all passengers must wear a seatbelt.
   3. All children under 8 years of age must use a car seat.
   4. Always obey the speed limit.
   5. Drive with car doors locked.
   6. Never use alcohol or drugs before or while driving.
   7. Keep your car in good working order.
   8. Always know the route to your destination.
10. Put the steps of performing the Heimlich maneuver on an adult in order:
    1. Make a fist with one hand.
    2. Thrust inward and upward.
    3. Grasp the fist with your free hand against the abdomen.
    4. Place your thumb against the person’s abdomen, just above their belly button.
    5. Stand behind the person.
11. True or False: When performing the Heimlich maneuver on an infant, you should provide 5 back thrusts with the baby face down and then 5 chest thrusts with the baby face up until the object is dislodged.
12. Which of the following is the best way to prevent an injury in the bathroom?
    1. Leave medications out on the counter for an easy reminder.
    2. Ensure handrails are installed in showers and bath mats are used.
    3. Leave towels and dirty clothing on the bathroom floor.
    4. Keep scissors and razors on the bathroom sink for easy access.
13. Which of the following are signs of a heart attack? Select all that apply.
    1. Diaphoresis
    2. Pain that radiates to the jaw, arm, or back
    3. Chest pain or pressure
    4. Nausea and/or vomiting
    5. Shortness of breath
    6. Patient clutches their chest
14. Which of the following are signs of a possible stroke? Select all that apply.
    1. Facial drooping
    2. Tingling or numbness in a hand or foot
    3. Difficulty speaking
    4. Sudden weakness
    5. Trouble seeing
    6. Paralysis of an arm or leg
15. True or False: If a patient has a seizure, the HHA/PCA should immediately activate EMS, remove dangerous objects from the patient’s area, avoid putting objects into the patient’s mouth, and time the seizure.
16. True or False: You should call 911 immediately if you suspect a person is having a heart attack or stroke.
17. True or False: The ABCs of first aid include: Airway (checking for an open airway), Breathing (checking if the patient is breathing), and Circulation (checking if the patient has a pulse and good skin color).
18. True or False: Gloves should always be worn whenever the HHA/PCA will come into contact with body fluids such as blood, urine, or feces.
19. True or False: A supervisor should be informed any time there has been an injury, no matter how insignificant the HHA/PCA thinks it was.
20. True or False: All injuries and steps taken to provide care for the patient after the injury should be accurately documented.

Check your answers!

Self-Check M11-1 Answers:

1. False

2. A, B, & D

FEEDBACK:

1. Home Health Aides/Personal Care Aids should never move a patient when they have fallen without informing a supervisor to ensure that the patient is appropriately assessed.

2. Preventing falls is an important task of the HHA/PCA. Keeping the home clutter free, ensuring ambulatory devices such as canes and walkers are used properly, and encouraging patients to wear non-skid shoes and that shoe laces are tied are ways to prevent falls. HHA/PCAs should have patients rest in a sitting position for a couple of minutes prior to standing to prevent orthostatic hypotension, which can cause a fall.

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Self-Check M11-2 Answers:

1. False

2. False

3. True

4. False

FEEDBACK:

1. First degree burns are the least serious type of burn, although the person should always be assessed and treated if necessary as these types of burns can be serious. The HHA/PCA should always inform a supervisor for any burn that has occurred, regardless of how serious they believe the burn to be. Second degree burns are the second most serious type of burn as these burns go through the epidermis and dermis. Third degree burns are the most serious type of burn, going through all layers of the skin and affecting structures and organs below the skin.

2. Never use oil, butter, or margarine to treat a burn. These can cause further injury. Wash a burn with cool water and seek assistance from a supervisor or from emergency services, if necessary.

3. You should immediately wipe away any chemical residue and flush the area with plenty of water. Seek assistance from emergency services and inform a supervisor.

4. Never stand in any water no matter how small it appears while using an electrical appliance. This can result in electrocution which can cause serious injury and even death.

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Self-Check M11-3 Answers:

1. True

2. True

FEEDBACK:

1. Keeping cleaning supplies and medications locked and out of reach of children and confused adults is the best way the HHA/PCA can prevent poisonings.

2. The number to Poison Control should be kept in an easily accessible place, such as near a telephone.

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Self-Check M11-4 Answers:

1. False

2. False

FEEDBACK:

1. Never let children have lollipops in the car. If the car stops suddenly, the lollipop can lodge into the child’s throat and cause choking. This could cause a serious injury or even death.

2. Babies should always be placed on their backs during sleep. Stuffed animals, pillows, and a lot of bedding should be removed from a crib or where the infant is sleeping. Infants can die from a condition called Sudden Infant Death Syndrome (SIDS). Placing a baby on their back while asleep reduces this risk.

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Self-Check M11-5 Answers:

1. A

2. C

FEEDBACK:

1. The kitchen and bathroom are two of the most common places for an injury to occur in the home. There are many hazards in both rooms for which the HHA/PCA should be observant to protect their patient from.

2. Turning pot handles inward helps to prevent burn injuries in the kitchen. If a pot handle is facing outward, there is a higher risk that someone could knock into it or burn their hands on the handle. This is especially true when there are children and confused adults within the home. Never leave food unattended while cooking on the stove, always keep knife blades pointing inward, and always immediately wipe up spills to prevent accidents.

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Self-Check M11-6 Answers:

1. True

2. True

FEEDBACK:

1. Handwashing is the number one way to prevent the spread of infection. HHA/PCAs should take care to always wash their hands prior to and after contact with patients and their belongings. They also have an important role in educating patients and their families about the importance of handwashing.

2. Gloves should always be worn when there is a chance of contact with bodily fluids such as while performing patient care and doing laundry. Gloves should also be worn when using cleaning supplies and when preparing food for others.

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Self-Check M11-7 Answers:

1. 1, 4, 3, and 2

2. True

3. D

4. True

FEEDBACK:

1. Remember the acronym PASS for how to use a fire extinguisher. Pull the pin, aim at the base of the fire, squeeze the handle, and sweep back and forth at the base of the fire.

2. Safety is always the first priority when dealing with a fire. Do not go back in the home or stall leaving in order to retrieve belongings. The most important thing is to get yourself and the patient to safety.

3. Home Health Aides/Personal Care Aides play an important role in preventing fires and educating patients and their families about fire prevention. Teach children and adults fire safety, do not smoke in the home, and check batteries in smoke detectors at least once per year. The dryer should never be on when leaving the house. The HHA/PCA should also be sure to empty the lint trap prior to using the dryer every time in order to prevent fires.

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Self-Check M11-8 Answers:

1. False

2. All answers are correct

FEEDBACK:

1. Never use your phone while driving, regardless of reason. Always pull into a safe location and stop driving if you must use your phone.

2. Ways the HHA/PCA can keep safe include not carrying a purse, locking car doors while driving or parked, inform others such as a supervisor if you have a change in your route, be observant of your surroundings, park in well-lit areas, and never stay in an area if you feel unsafe.

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Self-Check M11-9 Answers:

1. True

2. False

FEEDBACK:

1. Rabies is a fatal disease if left untreated. If the HHA/PCA should get bitten by a dog, they should ask the owners to see a copy of the rabies vaccination to ensure they are up to date with their immunizations. If they are not, the HHA/PCA will need to seek immediate medical attention to receive the rabies vaccination.

2. Never pet any dog you do not know even if it appears friendly and walks right up to you. Keep your safety in your awareness at all times.

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Self-Check M11-10 Answers:

1. All are correct

FEEDBACK:

The Home Health Aide/Personal Care Aide should follow safety precautions while driving to and from work. Keep distractions such as talking and music to a minimum. Never use a phone while driving. Always ensure you and others in the car are wearing a seatbelt. All children under the age of 8 must be in a car seat. Obey the speed limit, keep your car in good working order with a full tank of gas, and drive with the doors locked. Obey the speed limit at all times, never use alcohol or drugs prior to or while driving, and know the route to your destination to avoid stopping in unfamiliar areas.

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Self-Check M11-11 Answers:

1. A

2. B

FEEDBACK:

1. People taking anticoagulants will bleed for a longer period of time as this type of medication is used to prevent blood clots. It can present a serious issue if an injury occurs as a person can potentially lose a lot of blood.

2. The acronym RICE is used to treat bruises. It stands for Rest, Ice, Compression, and Elevation. The person should rest the injured area, ice should be applied for 20 minutes at a time, and the area can be wrapped with a bandage, and elevated to reduce swelling.

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Self-Check M11-12 Answers:

1. True

2. True

FEEDBACK:

1. If a patient reports feeling faint the HHA/PCA should have them sit immediately or assist with lowering them to a chair or the floor to prevent a fall.

2. To prevent orthostatic hypotension, always allow a patient to sit and dangle their legs at the edge of a bed prior to standing.

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Self-Check M11-13 Answers:

1. True

2. True

3. True

4. False

5. True

6. True

7. False

FEEDBACK:

1. Electrical appliances should never be used while near or standing in water. Electrocution can occur, causing severe injury or death.

2. The source of the heat should be immediately removed from a patient who has suffered a burn, if it is safe for the HHA/PCA to do so. Continuous contact with a heat source will cause the patient to suffer continuous burning and increase the severity of the injury.

3. Due to the fact that burns from electrical sources can cause internal injury which is not visible to the naked eye, anyone suffering an electrical burn should be seen by a physician. Emergency medical services should be contacted immediately.

4. Cool water should be used to soothe a burned area. Never use ice as this could cause frostbite, which can be damaging.

5. It is important for burns to be kept clean and covered with dry dressings immediately after the burn once it has been cooled and during the healing process. A person with a burn is at an increased risk for infection as their skin has been compromised. Keeping the area clean and dry will help to prevent infection.

6. Burns that cover a large area of the body, or that have been experienced by a person who is older or very young should receive medical attention and emergency medical services should be contacted. Older people and younger people are more at risk for loss of body water and body heat. They are also at greater risk for infection. When smoke has been inhaled, it is important to seek medical attention as the airway could be compromised which could result in a person suffering serious injury or even death.

7. Never break a blister on a healing burn. Blisters keep the skin intact, which helps to prevent infection. Breaking a blister allows microorganisms to enter the person’s body.

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Self-Check M11-14 Answers:

1. E, A, D, C, B

2. True

FEEDBACK:

1. The order of performing abdominal thrusts, otherwise known as the Heimlich maneuver are as follows: Stand behind the person; make a fist with one hand; place your thumb against the abdomen just above the belly button; grasp the fist with your other hand; and thrust inward and upward until the object is dislodged.

2. Performing abdominal thrusts on an infant is different than an adult. Five back slaps and then 5 chest compressions are performed until the object is dislodged. Care should always be taken to support the head and neck of the infant.

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Self-Check M11-15 Answers:

1. All are signs of a heart attack.

2. True

FEEDBACK:

1. Diaphoresis (sweating), chest pain which radiates to the jaw or arm, dyspnea (shortness of breath), nausea, anxiety, cyanosis (blue-gray appearance to the skin), and indigestion are all possible signs of a heart attack. The HHA/PCA should immediately contact emergency services and remain with the patient until help arrives. Keep the patient calm, seated, and as relaxed as possible.

2. Emergency medical services (911) should be contacted immediately if the HHA/PCA suspects a heart attack. The first minutes of a heart attack are the most crucial. Help during this time could save the person’s life.

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Self-Check M11-16 Answers:

1. True

2. True

3. True

4. True

5. True

FEEDBACK:

1. Emergency medical services should be contacted as soon as a person has a seizure. The person needs medical attention.

2. Never put objects or fingers inside a person’s mouth during a seizure. They will likely bite down although they will not be able to help it.

3. A person having a seizure should never be restrained. Rapid and repeated muscle contractions and jerky movements are common during a seizure. Restraining a person while they are having a seizure can cause them serious injury.

4. The HHA/PCA should time when the seizure starts and stops and provide this information to emergency medical services and the healthcare team. This will help give important information about the severity of the seizure.

5. After contacting emergency services the most important thing the HHA/PCA can do for a person during a seizure is to protect them from injury. Removing furniture, dangerous objects, and people from the area will help prevent further injury to the person having the seizure.

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Self-Check M11-17 Answers:

1. All are signs of a possible stroke

2. True

FEEDBACK:

1. Signs of a stroke include: facial drooping, tingling or numbness in the hands or feet, difficulty speaking, sudden weakness or difficulty seeing, or paralysis of an arm or leg.

2. 911 or emergency medical services should be contacted at the first sign of a person having a stroke. Time is of utmost importance for a person having a stroke. The types of treatments are affected by how much time has elapsed since the stroke started. The sooner a person having a stroke receives help, the more likely they will have a better outcome.

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Self-Check M11-18 Answers:

C, D, and E

FEEDBACK:

It is important to remember when giving someone with low blood sugar to eat or drink that the food or drink contains sugar. Never give a person with low blood sugar a diet drink or food as it does not contain sugar in it. Salad and diet soda does not contain sugar. Milk, orange juice, and sugar packets or honey all contain sugar.

Always inform a supervisor of any medical emergency. Report all injuries and incidents, no matter how insignificant (small) they seem. Always call for help for any serious medical emergency. Document all injuries and steps taken to provide care carefully and accurately. Whenever in doubt, seek guidance from a supervisor.

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Post-Test Answers:

1. All are ways HHAs/PCAs can prevent falls

2. False

3. C

4. C

5. B, D, C, A

6. True

7. True

8. All are ways to keep children safe

9. All are correct

10. E, A, D, C, B

11. True

12. B

13. All are signs of a heart attack

14. All are signs of a possible stroke

15. True

16. True

17. True

18. True

19. True

20. True

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References
American Heart Association. (2011). BLS for healthcare providers: Student manual.Dallas, Texas: American Heart Association.
American Heart Association. (2011). Heartsaver first aid: Student workbook. Dallas, Texas: American Heart Association.
American Heart Association. (2014). 2014 Hands-only CPR fact sheet. Retrieved from http://www.heart.org/idc/groups/heartpublic/@wcm/@ecc/documents/downloadable/ucm_441302.pdf
American Institute for Preventive Medicine. (2012). Burns. Retrieved from http://www.healthylife.com/online/HealthierAtHome/ASEA/Burns.html
Centers for Disease Control and Prevention. (2014a, May 19). Injury prevention. Retrieved from http://www.cdc.gov/healthyhomes/bytopic/injury.html
Center for Disease Control. (2014b, October 17). When & how to wash your hands. Retrieved from www.cdc.gov/handwashing/when-how-handwashing.html
Leahy, W., Fuzy, J., & Grafe, J. (2013). Providing home care: A textbook for home health aides (4th ed.). Albuquerque, NM: Hartman.
Mayo Clinic. (2014). Bruise: First aid. Retrieved from http://www.mayoclinic.org/first-aid/first-aid- bruise/basics/art-20056663
MedlinePlus (2014, July 22). Burns. In A.D.A.M. Medical Encyclopedia. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/000030.htm
MedlinePlus (2015a, April 12). Abdominal thrusts. In A.D.A.M. Medical Encyclopedia. Retrieved from https://www.nlm.nih.gov/medlineplus/ency/article/000047.htm
MedlinePlus (2015b, April 14). Choking-Infant under 1 year. In A.D.A.M. Medical Encyclopedia. Retrieved from https://www.nlm.nih.gov/medlineplus/ency/article/000048.htm
WebMD. (2014a, November 14). Bruises and blood spots under the skin: Home treatment. Retrieved from http://www.webmd.com/first-aid/tc/bruises-and-blood-spots-under-the-skin-home-treatment
WebMD. (2014b, November 14). First aid for electrical burns: Topic overview. Retrieved from http://www.webmd.com/first-aid/tc/first-aid-for-electrical-burns-topic-overview
World Health Organization. (2012, October). Falls fact sheet (No. 344). Retrieved from http://www.who.int/mediacentre/factsheets/fs344/en/