Safety and Injury Prevention

Introduction

This module will explore different types of injuries that may occur in the home while a HHA/PCA is providing care for a patient. This module will teach how to prevent and provide first aid for falls, burns, cuts, poisoning, and choking. It will also cover fire safety and prevention, and what to do in case of a fire. Lastly, it will cover what to do in case of a serious medical emergency. We will pay special attention to how to handle heart attacks, seizures, and strokes.

Unit A: Injuries

The home is a common place for many unintentional injuries. Unintentional injuries are injuries that happen accidentally and are not on purpose. Over 11,000 people die each year in the United States from unintentional injuries, such as falls, drownings, poisonings, and fires (CDC, 2014a). The most common household injuries include: falls, burns, cuts, poisoning, and choking. We will discuss each of these common injuries and focus on how to prevent them.

Falls

A fall is a situation in which a person accidentally and suddenly moves from a higher to a lower position, in which injury may or may not occur (Leahy, Fuzy & Grafe, 2013). Worldwide falls are the second leading cause of accidental injury (WHO, 2012). Each year approximately 424,000 people die from a fall globally, with about 80% of these falls occurring in low to middle income countries (WHO). Falls can be caused by many different things. Poor mobility, cognitive impairment, the ingestion of alcohol or drugs, poor balance and coordination, vision loss, and unsafe environments are some of the many possible causes of falls. Side effects from medications, neurological and cardiovascular diseases, and physical disabilities are other reasons why people may fall in the home. Confusion and improperly using assistive devices, such as walkers and canes, also put people at risk for an unintentional injury from a fall.

Developmental changes that occur as children grow and as adults age are also important contributing factors for unintentional injuries from falls. Deaths from falls are highest for adults over the age of 60 years across the globe (WHO, 2012). Adults over 65 years, young adults aged 15-29 years, and children 15 years and younger have the highest morbidity rates across the world (WHO).

Injuries from falls can range from relatively mild (such as a bruise) to life-threatening (such as suffering from a hip fracture or brain injury). Fall prevention strategies are the best way to prevent accidental injury from falls. Home Health Aides/Personal Care Aides play a crucial role in preventing falls in the home.

Guidelines for Fall Prevention:

  • Keep walkways free of clutter, throw rugs, and loose cords.
  • Wipe or mop up spills immediately. Close off areas with wet floors until dry to prevent people from walking on wet areas.
  • Do not use wax or use other floor cleaners which will leave the floor slippery.
  • Ensure all carpeting is tacked down securely and all rugs have non-skid backing.
  • Use non-skid mats in the tub.
  • Ensure handrails and grab bars are installed in the shower. Home Health Aides/Personal Care Aides should teach patients how to use them.
  • Use good lighting in all rooms of the home. Replace light bulbs that have dimmed or are no longer working.
  • Ensure stairwells are properly lit and stairs are sturdy.
  • Have patients wear non-skid shoes with tied laces.
  • Ensure clothing fits and that pant or dress hems are not so long as to possibly cause the patient to trip.
  • Teach patients how to properly use ambulatory devices, such as walkers and canes.
  • Have patients use glasses and hearing aids in order to better see and hear what is going on in their surroundings.
  • Check for disorientation frequently and report any concerns to a supervisor immediately.
  • Allow the patient to slowly rise to a standing position by first sitting at the edge of the bed to prevent falls that result from dizziness due to rapid changes in position. This is called orthostatic hypotension.
  • Always lock wheelchair, chair, and bed brakes before completing transfers.
  • Keep beds in their lowest position and ensure side rails are up in proper position.
  • Frequently ask the patient if they need to use the bathroom and stay close while they are in the restroom to quickly respond to requests for help.
  • Assist the patient with muscle strengthening exercises and walking as prescribed by the Care Plan to improve balance, coordination, and strength.
  • Keep the home picked up and do not allow shoes, toys, or other items to be left on the floor.
  • Keep items such as tissues, the phone, remote controls, and drinks within close reach of the patient so they do not have to reach far to retrieve them.

If a fall does happen, Home Health Aides/Personal Care Aides must report it immediately to their supervisor. The patient needs to be checked for medical issues prior to helping them up from the floor. Home Health Aides/Personal Care Aides should NOT move their patient until they have been thoroughly checked for injury and their supervisor has given them permission to move them.

Home Health Aides/Personal Care Aides may be asked to complete an incident report if their patient falls. If this occurs, remember to only report the facts. Report the situation in a matter of fact manner, without being judgmental or emotional. The agency will provide with specific training as to their requirements in the event of a patient fall.

Self-Check Activity M11-1

True or False:

1. It is okay for the Home Health Aide to move a patient when they have fallen. True or False? _______________

Multiple Choice

2. Which of the following are ways to prevent a fall?

a). Keep the home clutter free

b). Ensure patient uses their walker correctly.

c). Tell patients to stand quickly when they are seated.

d). Have patients wear non-skid shoes and ensure laces are tied.

Burns

Burns are another common unintentional household injury. Burns can be caused by dry or wet heat, chemicals, or electricity. Burns from dry heat can occur from fire, irons, hair dryers, curling irons, and stoves (American Institute for Preventive Medicine, 2012; Leahy, Fuzy & Grafe, 2013). Burns from wet or moist heat occur from hot liquids, such as hot water or steam (American Institute for Preventive Medicine; Leahy, Fuzy & Grafe). These types of burns are called scalds. Scalds can occur within seconds and cause serious injury.Chemical burns occur from chemical sources and can also cause serious burns when exposed to skin, or if swallowed, whether intentionally or unintentionally. Electrical burns can cause very serious injury as they can burn both the outside and inside of the person’s body, causing injury that cannot be seen, and which can be life threatening. Radiation burns can also occur from sources of radiation such as sunlight (American Institute for Preventive Medicine).

Types of Burns

Burns are divided into first, second, and third degree burns.

First degree burns affect only the outer layer of the skin (epidermis). These types of burns are the least serious as they are only on the surface of the skin. First degree burns usually appear red, dry, and slightly swollen (MedlinePlus, 2014). Blisters do not occur with this type of burn. They should heal within a couple of days (American Institute for Preventive Medicine, 2012).

Second degree burns affect the top layer of the skin and the second layer of skin underneath (dermis). These are more serious than first degree burns. The skin may appear very swollen, red, moist, (MedlinePlus, 2014) and may have blisters or look watery and weepy (American Institute for Preventive Medicine, 2012).

Third degree burns are the most serious burn. A third degree burn affects all layers of the skin and may affect the organs below the surface of the skin. The skin may appear white or black and charred (MedlinePlus, 2014). The person may deny pain because the nerve endings in their skin have been burned away (American Institute for Preventive Medicine, 2012). Third degree burns require immediate medical treatment. If Home Health Aides/Personal Care Aides suspect their patient has a third degree burn, they should immediately call 911. Emergency services should also be called anytime a patient was exposed to smoke. They need to have their airway checked for possible injury.

Chemical burns can occur anytime a liquid or powder chemical comes into contact with skin or mucous membranes that line the eyes, nose, or throat. Chemical burns may also occur if a chemical is swallowed. These burns can cause serious injury and emergency services should be contacted. If a person receives a chemical burn, the chemical should be removed from the skin by using a gloved hand to brush it off and then wash the area with plenty of cool water. Electrical burns can occur if a person has been using an electrical appliance and is exposed to water or if an electrical short occurs while using the electrical appliance. Using faulty or frayed cords on electrical appliances can result in electrical burns. Electrical burns are a serious injury. Emergency medical services (EMS) should be immediately activated.

Never use oils such as butter or vegetable oil on any type of burn as this can cause further injury. For first or second degree burns flush the area with plenty of cool (not ice cold) water for about 15 minutes or until the pain decreases and cover with a clean, dry bandage. Using ice or ice cold water can cause frostbite (American Institute for Preventive Medicine, 2012). For major burns remove any clothing that is not stuck to the skin, cover the burned area with a dry, clean cloth, and seek emergency assistance.

Guidelines to Prevent Burns:

  • Never allow children or confused adults to use electrical appliances unsupervised.
  • Never use electrical appliances near water sources.
  • Never use electrical appliances in which the cord appears to be damaged or frayed.
  • Never pull a plug from the cord. Always remove a cord from an outlet by holding the base of the plug.
  • Electrical appliances should NEVER be used in the bathtub, sink, or near running or standing water.
  • Cover electrical outlets with child-proof plugs. Never allow children to put anything inside an electrical outlet.
  • Never place a metal object inside an electrical appliance while it is plugged in.
  • Ensure stoves and other appliances are turned off when finished with them.
  • Turn pot handles inward so that a person cannot accidentally bump a handle and spill hot liquids.
  • Check water temperature prior to bathing or showering a patient.
  • Take care that any hot liquids served are cooled to the point where a patient can safely drink them. Burns can very easily happen from spilling or drinking liquid that is too hot.
  • Do not keep hot drinks, soups, or other liquids at the edges of tables or countertops.
  • Always inform a patient when giving them something hot to drink or eat.
  • Do not allow patients to walk with hot beverages or food in their hands. Have them seated while consuming hot liquids.
  • Do not use space heaters and other personal heaters close to a patient where they could accidentally touch or fall against it.
  • Check to be sure the hot water heater is not set too high. To avoid scalds from hot tap water, hot water heaters should be set to 120 degrees or less (MedlinePlus, 2014).
  • Do not allow children or confused adults to use lighters or matches.
  • Discourage smoking in the home, and especially in bed, where a person is at more risk of falling asleep with a lit cigarette.
  • Keep chemicals and cleaning solutions securely locked and out of reach of children and confused adults.

Self-Check Activity M11-2

True or False:

1. First degree burns are the worst types of burns to have. True or False? _______

2. It is okay to use oils on a burn to help soothe the pain. True or False? _______

3. If a chemical burn occurs, you should flush the area of the burn with water. True or False? _______

4. It is okay to stand on a wet floor and use a hair dryer, as long as it is not a big puddle. True or False? _______

Cuts

Cuts can occur whenever a sharp object pierces through the surface of the skin. Some cuts may be minor and only pierce the surface layer of the skin. An example of a minor cut would be a paper cut. Other cuts can be so deep as to reach muscle, bone, or even an organ. These types of cuts can result in serious injury, and possibly death due to blood loss or internal injury.

Guidelines for Preventing Cuts:

  • Keep sharp objects such as knives, razors, blades from kitchen appliances (such as blender or food processor blades), scissors, nail clippers, food graters, and household items that slice and prepare foods (such as a mandolin), out of reach of children and confused adults.
  • Teach children how to use scissors and knives safely.
  • Never hand a person a sharp object, such as scissors or a knife, with the blade pointing toward them.
  • When preparing food using a knife, use a sturdy cutting board that will not slip.
  • Ensure your hands are not wet or oily when using knives. Always cut with the blade facing away from you.
  • Keep your fingers away from the knife’s edge while chopping and cutting foods.
  • Put knives toward the back of the counter when you step away from the prepping area.
  • Do not throw away metal can lids, broken glass, or other sharp items without first carefully wrapping them in a container that will prevent accidental cuts.
  • Never push garbage down in a garbage pail with your hands. Teach others to avoid doing the same.

Poisoning

There are many hazards in the home which put people at risk for accidental poisoning. Poisoning can occur any time a harmful substance is intentionally or unintentionally ingested. Poisons come in many forms including plants, cleaning supplies, spoiled food, and medications. Children, who are naturally curious and like to explore, are in particular at risk for poisoning. Adults who may be confused or who have vision problems are also at risk for accidentally ingesting a substance that could potentially be poisonous. Never allow children or confused adults to have access to potentially harmful chemicals or medications.

Guidelines to Prevent Poisoning:

  • Keep all cleaning supplies and chemicals locked.
  • All medications should be kept in a locked storage area, out of reach.
  • Check medications periodically for expiration dates and properly dispose of expired medications. Some medications become toxic when they are past their expiration date.
  • Do not tell children that medication is “candy” as this makes it look more attractive to them.
  • Ensure all medications and chemicals are properly labeled. Childproof caps should be on medicine bottles.
  • Ensure the patient uses visual aids, such as glasses, when taking their medications and any time they use a household cleaner or chemical.
  • Check the refrigerator weekly and dispose of spoiled, moldy, or otherwise compromised food.
  • Never use cans that have bulges or deep dents in them.
  • Keep poisonous plants out of reach of children and pets.
  • Keep the number for Poison Control near a telephone and ensure the family knows who to call in case of an emergency.

Self-Check Activity M11-3

True or False

1. The best way to prevent poisoning is to keep cleaning supplies and medications locked and out of the reach of children and confused adults. True or False? ______

2. You should keep the phone number to Poison Control near the telephone. True or False? _____

Choking

Choking can occur while a person is eating, drinking, taking medications, or if an object is put into the mouth and accidentally swallowed. Choking means the person’s airway is compromised and they are unable to breathe. Some signs of choking include a bluish skin color, inability to talk, cry, or to make any sounds, a weak, ineffective cough, soft or high-pitched sounds while inhaling, ribs and chest pulling inward as the person is having difficulty breathing, and loss of consciousness if left without air (MedlinePlus, 2015). Young children and infants, who love to explore their environment, are especially prone to choking as they often place small objects in their mouth.

Guidelines to Prevent Choking:

  • Keep small objects out of reach of children.
  • Use age appropriate toys for children. Avoid those with small pieces with young children.
  • Cut food into bite-sized pieces for children and those with chewing or swallowing difficulties.
  • Prepare food that is of appropriate consistency (such as pureed or special diets), and as according to the Care Plan.
  • Ensure patients eat, drink, and take medications in a fully upright position.
  • Keep patients who are at risk for choking in an upright position for 30-60 minutes after eating to prevent aspiration of food or liquids.
  • Encourage patients to completely chew and swallow food and to eat slowly.
  • Discourage patients from talking while eating, as this puts them at risk for choking.
  • Do not allow children to play, run, or walk while eating.
  • Do not let children have lollipops and other candy with sticks in their mouths while playing or while riding in a car.
  • Place babies on their backs while sleeping. Do not allow excessive bedding, pillows, or any stuffed animals in the crib to prevent suffocation. Infants can die from a condition called Sudden Infant Death Syndrome (SIDS). Placing a baby on their back while asleep reduces this risk.
  • Avoid food items such as popcorn, nuts, pretzels, gum, and hot dogs with small children and those with swallowing difficulties.
  • Never allow children to play with plastic bags, and other small items that can easily be swallowed, like soda bottle caps, rubber bands, balloons, and paper clips.

Self-Check Activity M11-4

True or False

1. It is okay to let kids have a lollipop in the car as long as you are watching them. True or False? _______

2. Babies should be placed face down in their crib to get the most rest. True or False? _______

Factors Contributing to Injuries among Older Adults

As people age, they may experience physical, sensory, and cognitive changes that make them more likely to suffer an injury.Adults over the age of 65 are the most likely age group to fall (WHO, 2012).Older adults tend to have more physical diseases and take more medications. The more medications a person takes, the more they are at risk for potential medication interactions and side effects. Muscle weakness, injury, disability, coordination, or balance problems also put older adults at risk for falls. Home Health Aides/Personal Care Aides should teach patients to properly use ambulatory aids such as walkers and canes. Encourage good non-skid footwear while ambulating.

Older adults who experience confusion, as a result of dementia or illness, may not be completely aware of their surroundings and may not be as cautious while moving about as they normally would. Sensory impairments, such as vision problems and hearing loss, also put older adults at risk for falls as they may not adequately see or hear what is going on in their surroundings.As we age, we also have a reduction in our ability to taste and smell. This makes us more likely to not smell smoke if there is a fire, or to eat food that is spoiled without being aware.

Factors Contributing to Injuries Involving Young Children

Children are another high risk group for falls. Their natural curiosity, and the developmental tasks they are experiencing, in which independence and risk-taking behaviors come about, makes them prone to accidents involving falls. Ensure that stairways are blocked off from small children with gates. Do not allow children to climb stairs, ladders, or other surfaces unsupervised. Teach them to tie their shoelaces and ensure they wear good non-skid shoes.

Children are also especially prone to choking as they like to put items into their mouth as they explore the world. Ensure that toys are age appropriate and that very young children are not allowed to play with toys and games with very small pieces. Keep medications and cleaning solutions locked and out of reach. Use child-proof covers for outlets, child-proof locks for cabinets which hold cleaning supplies, and child-proof caps on medications.

Children are developing their gross motor skills and may not have very good balance and coordination. Teach them to use rails when walking on stairs. Teach children to hold your hand and to look both ways when crossing a street. Supervise children while they are playing outdoors and in activities such as bike riding, skating, or skateboarding. Never allow young children to bathe or swim unsupervised in order to prevent possible drowning.

With infants, keep in mind that they must always be supervised. Never leave a baby unattended. Never walk away from a baby while giving a bath as they do not have the muscle development to keep their head out of water and could potentially drown. Feed babies with their heads higher than their bodies and burp them in between feedings to prevent choking. Do not keep stuffed animals and excessive bedding in a baby’s crib. Keep babies on their backs while sleeping to prevent possible suffocation.

As children tend to lack a sense of fear and have a strong desire to explore their world, Home Health Aides/Personal Care Aides must always be watching for potential hazards in their environment. Keep the environment clutter free and teach children to pick up their toys and shoes.

Where Household Injuries Commonly Occur

Two areas in the home, the kitchen and the bathroom, are the places where most household injuries occur (Leahy, Fuzy & Grafe, 2013). People tend to spend a lot of time in both of these areas in the home. They are also places where many dangers lie.

In the kitchen, using appliances improperly or near water could result in electrical injury. Other hazards in the kitchen include walking on a wet or greasy floor, improperly using knives, fire hazards while using the stove, and ingesting spoiled food or dangerous chemicals.

In the bathroom, potential hazards involve slipping on a wet floor or in the bathtub, using appliances such as hair dryers near water, unsafe use of razors or scissors, and the ingestion of medications and other potentially dangerous substances.

Home Health Aides/Personal Care Aides should take special precautions in the kitchen and bathroom to ensure that floors are dry, non-skid rugs and bath mats are utilized, handrails and grab bars are available, and sharp objects are put away when not in use. Cleaning solutions, chemicals, and medications should be kept in locked cabinets and out of reach of children and confused patients.

Self-Check Activity M11-5

1. Which of the following is the most common place for an injury to occur in the home?

a). Bathroom

b). Living room

c). Bedroom

d). Laundry room

2. Which of the following is a way to prevent an injury in the kitchen?

a). Leave to go to the bathroom while you are cooking on the stove.

b). Keep knives on the counter with the blades pointing out.

c). Turn pot handles inward.

d). Wait to mop up spills on the floor until you are done cooking.

Unit B: Role of the Home Care Worker in Injury Prevention

Managing the Environment

As the eyes and ears of the healthcare team, the Home Health Aide/Personal Care Aide plays a very important role in preventing patient injuries. They will be the person spending the most time in the home, and will become very knowledgeable about their patient, their family, and any changes in their condition and within their environment.

The key for Home Health Aides/Personal Care Aides in preventing injury with patients is to properly manage the environment, and to use all of their senses as they observe the patient within their environment. By completing household tasks within the home, they will be helping to keep the patient’s home free from clutter, dirt, pests, and infection. By assisting their patient with daily living tasks, such as bathing, they will help to maintain their well-being and general health.

Proper Body Mechanics

The use of proper body mechanics is an important way to prevent injury to the health care worker as well as to the patient. Home Health Aides/Personal Care Aides should always keep in mind proper body mechanics during their work with patients, whether it is while bathing, ambulating, or assisting with transfers. Ensure all the equipment used with the patient is in good working order. Always keep in mind the importance of ensuring locks are braked on wheelchairs, chairs, and beds, to prevent accidental injuries.

Handwashing

To prevent the transmission of disease, proper hand washing is of utmost importance and is the number one way to prevent the spread of infection (CDC, 2014b). Home Health Aides/Personal Care Aides must wash their hands prior to and after contact with patients and their belongings. Ensure that they wash their hands after contact with body fluids such as blood, urine, feces, and vomit. Gloves should be worn whenever they come into contact with body fluids, food, or while performing household chores such as laundry in which body fluids may be present. Remember to wash hands when removing gloves and to change gloves whenever they are soiled or ripped.

Home Health Aides/Personal Care Aides have an important role in educating their patients and their families about the importance of handwashing. Encourage the patients to wash their hands after using the bathroom, before preparing food or eating, after contact with any body fluids, or whenever they are soiled. For patients who are immobile or who have difficulty with mobility, Home Health Aides/Personal Care Aides can provide them with a wet, soapy washcloth or alcohol sanitizer to use to keep their hands clean and free of germs.

Self-Check Activity M11-6

True or False

1. Handwashing is the best way to prevent the spread of infection. True or False? ______

2. Gloves should be worn whenever the HHA/PCA may come into contact with bodily fluids and when performing household tasks such as cooking and laundry. True or False? ______

Fire Safety

In addition to preventing accidental injuries from falls, burns, cuts, choking, and poisoning, Home Health Aides/Personal Care Aides also play an important role in fire prevention and fire safety. They must be aware of potential fire hazards and take steps to prevent fires.

Guidelines for Fire Prevention:

  • Ensure smoke detectors and carbon monoxide detectors are present on every floor in the home, including the basement. The batteries should be changed at least once per year (CDC, 2014a). If their patient’s home does not have detectors, discuss their concern with their supervisor. There may be community and agency resources available to provide these to the patient.
  • Check batteries in smoke and carbon monoxide detectors several times a year to ensure they are properly working.
  • Encourage and assist families to develop fire safety plans and to practice fire drills.
  • Every family should have a designated safe meeting place in the event they must leave the home during a fire.
  • Every bedroom should have at least two exits (CDC, 2014a).
  • Teach children fire safety.
  • Teach patients to stop, drop, and roll if their clothing ever catches on fire.
  • Never leave unattended candles or items such as incense that have a flame where a potential burn can occur. Discourage patients to use these items if they require supervision to do so.
  • Do not smoke in the home and discourage patients and family from doing so. Ensure cigarettes are fully extinguished. Prior to emptying ashtrays, ensure there are no hot ashes.
  • Never leave the stove unattended while cooking.
  • Pay attention that pots do not boil over.
  • Take care not to splash oil while cooking to prevent grease fires.
  • Empty the lint trap after every use of the dryer. Never run the dryer when you are not home.
  • Never leave space heaters, electric heaters, kerosene, or gas heaters on unattended and when someone is not home. Ensure all these types of appliances are in good working order.
  • Ensure fire extinguishers are in the home, that they have not expired, and that you and others in the family know how to use them.
  • Do not store fire extinguishers near the stove where you may not be able to reach it if there is a fire on the stove.
  • Do not wear loose clothing while working on the stove. Teach patients to roll up sleeves and to also avoid wearing loose clothing while cooking.
  • Ensure hallways and exits, such as doorways and windows are not cluttered to prevent emergency exit.
  • Keep emergency numbers near the phone for easy access.

How to Use a Fire Extinguisher:

When using a fire extinguisher, the acronym PASS should be kept in mind.

  • P: Pull the pin
  • A: Aim at the base of the fire
  • S: Squeeze the handle
  • S: Sweep back and forth at the base of the fire

In Case of Fire:

In case of fire, remember the acronym RACE.

  • R: Remove patients from danger
  • A: Activate 911
  • C: Contain the fire if safe and possible to do so
  • E: Extinguish fire or call the fire department to do so

Other Things to Remember in Case of a Fire:

  • The first priority is to get you and the patient to safety.
  • Remain calm and direct the patient and others in the home to safety.
  • Never try to put out a large fire or put yourself or others in danger.
  • Stay low in rooms with fire.
  • Close doors and if possible, plug doorways with blankets to prevent smoke from entering.
  • Place a wet towel over the patient’s face and your face to decrease smoke inhalation.
  • Should a person’s clothing catch on fire, remember to tell them to stop, drop, and roll.
  • Keep the patient and all others far away from the home once you have left.
  • Wait for instruction from the fire department.
  • Notify the supervisor once you have reached a safe destination.

Self-Check Activity M11-7

1. Put in order how you should use a fire extinguisher:

1). Pull the pin

2). Sweep back and forth at the base of the fire

3). Squeeze the handle

4). Aim at the base of the fire

True or False

2. The first priority is to get the patient and yourself to safety. True or False? _________

Multiple Choice

3. Which of the following is not a way to prevent fires?

a). Teach children fire safety

b). Do not smoke in the home

c). Check batteries in smoke detectors at least twice per year

d). Turn the dryer on right before you leave the house

True or False

4. You should call the fire department if there is a fire before you call a supervisor or anyone else. True or False? _________

Personal Safety

It is important that Home Health Aides/Personal Care Aides take precautions to keep themselves safe while working within the community and in the patient’s home. They should follow these guidelines to protect their safety.

  • Always know the route. Have maps and directions with you and know where you are going in advance. If needed, call the patient for directions or obtain them from the agency prior to leaving for the destination.
  • If you have a cell phone, keep it charged and with you. Do not use it while driving.
  • Do not take unsafe shortcuts while driving or walking to and from a patient’s home.
  • Never alter your route without telling the agency. Always inform a supervisor about your whereabouts.
  • Observe surroundings at all times and remain vigilant. Do not become distracted by talking, music, or using a cell phone.
  • Keep your eyes on the road while driving and look around at your surroundings while walking to and from a patient’s home.
  • Do not carry a purse, large amounts of money, or wear expensive jewelry. This makes you a target for possible thieves. If you must carry a purse or belongings, hold them securely against your body.
  • Lock your car and keep valuables hidden in the trunk, out of sight.
  • Carry your keys in your hand so that you can quickly unlock your door.
  • Park in well-lit areas and try to park as close to the patient’s home as possible to reduce walking time.
  • If you ever feel unsafe, leave the area immediately and go to a safer location. Call a supervisor for assistance.

Self-Check Activity M11-8

True or False

1. It is okay to use your cell phone while driving as long as it is to call a supervisor. True or False? ____________

Multiple Choice

2. Which of the following are ways to keep safe? Select all.

a). Do not carry a purse.

b). Lock car doors.

c). Always inform a supervisor if there is a change in route or appointment.

d). Keep aware of your surroundings while walking or driving.

e). Park in well-lit areas.

f). Leave an area if you feel unsafe.

Pets

Some patients may have pets in their home. Find out prior to going to a patient’s home for the first visit if they have pets on the premises. Ask the patient how their pet is around strangers. If the patient says that the pets are aggressive or do not like strangers, Home Health Aides/Personal Care Aides should inform their supervisor and seek direction from him or her. Ask the patients to place their pets in a secured area during a visit. When being introduced to a pet, such as a dog, remain calm. Home Health Aides/Personal Care Aides should allow the pet to become familiar with them. Do not begin petting him or her before they become acquainted with you. Some pets are more friendly and accepting of strangers.

While walking to and from their car, Home Health Aides/Personal Care Aides should be aware of pets in the neighborhood. Should there be a loose dog, try to stay away from the dog. Do not start panicking or running. This will make it more likely that the animal will run toward you. A Home Health Aide/Personal Care Aide should cross the street or return to their car if they are concerned about their safety.

If Home Health Aides/Personal Care Aides should receive a dog bite from any dog, wash the area with water and soap for several minutes to wash away the saliva and accompanying bacteria. Do not squeeze the site of the bite. This pulls bacteria inside the wound. Inform the supervisor of the incident. Seek medical attention if necessary. Obtain the identifying information about the dog and vaccination records, such as rabies vaccination. If the pet is not up to date with immunizations, Home Health Aides/Personal Care Aides will need to get the rabies vaccination when they seek medical treatment.

Self-Check Activity M11-9

True or False:

1. If you get bitten by a dog, you must see a copy of a recent rabies vaccination. True or False? ________

2. It is okay to pet any dog that walks up to you as long as it looks friendly. True or False? ________

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.

Self-Check Activity M11-10

1. Which of the following are ways to keep safe while using transportation?

a). Keep distractions to a minimum while driving.

b). Always wear a seatbelt.

c). All children under 8 years of age must use a car seat.

d). Always obey the speed limit.

e). Drive with car doors locked.

f). Never use alcohol or drugs before or while driving.

g). Keep your car in good working order.

h). Always know the route to your destination.

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.

Self-Check Activity M11-11

1. A person on anticoagulants will bleed:

a). for a longer time

b). for a shorter time

2. The acronym RICE, which is used to treat bruises and injuries, stands for which of the following?

a). Reassure, Inquire, Cold compress, Elevate

b). Rest, Ice, Compression, Elevate

c). Rest, Ice, Cool water, Emergency

d). Reassure, Instill heat, Calm, Electricity

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? _______

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? ______

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? _____________

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? __________

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? ________

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? ________________

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

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.

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/