7 Safety and Body Mechanics aspiration the inhalation of food, fluid, or foreign material into the lungs. atrophy weakening or wasting of muscles. body

7Safety and Body Mechanics

aspiration the inhalation of food, fluid, or foreign material into the lungs.

atrophy weakening or wasting of muscles.

body mechanicsthe way the parts of the body work together when a person moves.

chemical restraint medications used to control a person’s behavior.

1. Define important words in this chapter



combustion the process of burning.

cyanosis blue or pale skin and/or mucous membranes due to decreased oxygen in the blood.

dysphagia difficulty in swallowing.

flammable easily ignited and capable of burning quickly.



hoardingcollecting and putting things away in a guarded manner.

Material Safety Data Sheet (MSDS) sheet that provides information on the safe use of and hazards of chemicals, as well as emergency steps to take in the event chemicals are splashed, sprayed or ingested.

PASS acronym for use of a fire extinguisher; stands for Pull-Aim-Squeeze-Sweep.

RACE acronym for steps taken during a fire; stands for Remove-Activate-Contain-Extinguish.



restraint a physical or chemical way to restrict voluntary movement or behavior.

restraint alternatives: measures used instead of physical or chemical restraints.

restraint-free care an environment in which restraints are not kept or used for any reason.

scalds burns caused by very hot liquids.



slip knot a quick-release knot used to tie restraints.

suffocation the stoppage of breathing from a lack of oxygen or excess of carbon dioxide in the body that may result in unconsciousness or death; also known as asphyxia.


2. List common accidents in facilities and ways to prevent themThere are many types of accidents that can occur in a facility. It is very important that nursing assistants be proactive about preventing accidents from occurring.


2. List common accidents in facilities and ways to prevent themFall PreventionRemember these guidelines for preventing falls:

• Identify residents who may be at risk and guard against falls.

• Nurses should let you know which medications may cause unsteadiness so you can be aware of residents who are taking these medications.

• Respond to call lights promptly.• Wipe up spills immediately.• Remove clutter from walkways.• Get help when moving residents.


2. List common accidents in facilities and ways to prevent themFall PreventionGuidelines for preventing falls (cont’d.):• Lock bed wheels before giving care. Lock wheelchair wheels before transferring residents into or out of them.

• Return side rails to ordered position, if used. Leave beds in lowest position when finished with care.

• Make sure residents’ clothing fits properly.• Use non-skid mats and rugs.• Report loose hand rails immediately.• Report damage of outdoor furniture, benches, and ramps.

• Clearly mark areas where floor is uneven.


2. List common accidents in facilities and ways to prevent themFall PreventionGuidelines for preventing falls (cont’d.):

• Keep call lights and other needed items within residents’ reach.

• Keep walkers and canes nearby.• Do not move furniture without an order from the nurse.

• Offer trips to the bathroom often.• Keep night light on in room if resident wishes.• Make sure eyeglasses are within easy reach.• Never try to catch or stop a falling resident. Use your body to slide him to the floor.


2. List common accidents in facilities and ways to prevent themREMEMBER:Most of the accidents in a facility are related to falls. Falls are often caused by unsafe environments, loss of abilities, diseases, muscle weakness, poor vision, or disorientation.


2. List common accidents in facilities and ways to prevent themResident IdentificationRemember these guidelines for identifying residents:

• Identify residents before providing care or serving food.

• Failure to identify residents can result in illness or even death.

• Disoriented residents may have special bands with alarms on them.

• Check resident’s ID and call resident by name.• Check diet cards against resident’s identification.


2. List common accidents in facilities and ways to prevent themDefine the following term:scaldsburns caused by very hot liquids.


2. List common accidents in facilities and ways to prevent themBurn/Scald PreventionBurns are very painful and can occur quickly. Elderly people and those with loss of sensation are at greater risk for burns.

Remember these guidelines for preventing burns and scalds:• Check water temperature before giving a resident a bath or shower. Temperature should not be over 105°F.

• Check for proper temperature of warm water applications.

• Use low setting on hair dryers.• Let liquids cool before serving.• Serve drinks when residents are seated.


2. List common accidents in facilities and ways to prevent themBurn/Scald PreventionGuidelines for preventing burns and scalds (cont’d.):

• Tell residents before pouring or setting down hot drinks.

• Use lids on hot liquids.• Pour hot liquids away from residents.• Check plates that have been warmed.• Make sure anything that has been in the sun has cooled before use.

• Tell residents about smoking precautions.


2. List common accidents in facilities and ways to prevent themDefine the following term:hoarding collecting and putting things away in a guarded manner.


2. List common accidents in facilities and ways to prevent themPoisoning PreventionRemember these guidelines for poison prevention:

• Keep all items that may be poisonous away from disoriented residents.

• Do not leave cleaning products in residents’ rooms.

• Check dates of foods to ensure that they are fresh.

• Check residents’ drawers for hoarded food that has spoiled.

• Make sure there is proper ventilation when chemical products are used.


2. List common accidents in facilities and ways to prevent themDefine the following terms:dysphagia difficulty in swallowing.

aspirationthe inhalation of food, fluid, or foreign material into the lungs.


Choking PreventionRemember these guidelines for choking prevention:

• Residents should be sitting up straight while eating.

• Assist with feeding slowly. Never rush a resident during a meal.

• Cut food into small pieces.• Report to nurse if you think a resident would be helped by softer foods or thickened liquids.

• Make sure dentures are in place and fit properly.• Be aware of residents’ swallowing problems.

2. List common accidents in facilities and ways to prevent them


2. List common accidents in facilities and ways to prevent themCuts and Other InjuriesRemember these guidelines for preventing cuts, scrapes, and other injuries:

• Do not leave sharp objects out.• Approach doors slowly.• When moving residents in wheelchairs, protect their arms, legs, hands, and feet.

• Push wheelchairs forward.• Wheelchairs should face forward in elevators.


2. List common accidents in facilities and ways to prevent themRemember these general safety guidelines:

• Do not run in a facility.• Do not put your hand into a bed or anywhere else without looking first.

• Ask for help when you need it.• Watch combative residents closely.• Follow facility policy if a skin splash or eye splash occurs.

• Report all injuries immediately.


Define the following term:Material Safety Data Sheet (MSDS)sheet that provides information on the safe use of and hazards of chemicals, as well as emergency steps to take in the event chemicals are splashed, sprayed, or ingested.

3. Explain the Material Safety Data Sheet (MSDS)



The Occupational Safety and Health Administration (OSHA) is responsible for the safety of employees at work. OSHA requires that all dangerous chemicals have a Material Safety Data Sheet (MSDS). These sheets are placed where all staff can access them.



Discussion:Review a sample MSDS, or look at the one in the textbook on page 110. Look for the places on the sheet where you will find the following important information:

• Chemical ingredients of the product• Dangers of the product• Protective items to be worn• How to use and clean up the chemical• Emergency response if product is splashed onto skin or ingested

• Safe handling procedures


4. Describe safety guidelines for sharps and biohazard containersAs you learned earlier, sharps and biohazard containers are the containers that hold sharp objects and infectious waste.

Follow these safety guidelines when using sharps and biohazard containers:

• Wear gloves when touching a sharps container.• Keep hands above opening at top of container.• Touch the bottom of the container only.• Replace container when it is ¾ full or according to facility policy.


4. Describe safety guidelines for sharps and biohazard containersSafety guidelines when using sharps and biohazard containers (cont’d.):

• Remove gloves and wash hands after putting anything into sharps container.

• Use biohazard container or bag for anything contaminated with infectious waste except for sharps.

• Wear gloves when disposing of infectious waste.• Remove gloves and wash hands after putting anything into the biohazard container or bag.


Define the following term:body mechanicsthe way the parts of the body work together when a person moves.

5. Explain the principles of body mechanics and apply them to daily activities


REMEMBER:There are risks of injury on the job that you will face as a nursing assistant. Using proper body mechanics will help prevent injuries.




Good body mechanics help save energy and prevent injury and muscle strain.

When muscles are used correctly to push and lift objects or people, it reduces the risk of injury.

Basic principles of body mechanics will help keep you and your residents safe.

7 Safety and Body Mechanics

Transparency 7-1: Body Alignment


Be familiar with these terms associated with body mechanics:

• Alignment • Base of support• Center of gravity



Alignment Alignment is based on the word “line.” When you stand up straight, a vertical line could be drawn right through the center of your body and your center of gravity.

When the line is straight, the body is in alignment. Whether standing, sitting, or lying down, try to have your body in alignment.

Maintain correct body alignment when lifting or carrying an object by keeping it close to your body. Point your feet and body in the direction you are moving. Do not twist at the waist.




Base of SupportThe base of support is the foundation that supports an object. Something that has a wide base of support is more stable than something with a narrow base of support.

The feet are the body’s base of support. Standing with your legs shoulder-width apart gives a greater base of support. You will be more stable than someone standing with his feet together.


5. Explain the principles of body mechanics and apply them to daily activitiesCenter of GravityThe center of gravity in your body is the point where the most weight is concentrated. When you stand, your weight is centered in your pelvis. A low center of gravity gives a more stable base of support.

Bending your knees when lifting an object lowers your pelvis. It lowers your center of gravity. This gives you more stability and makes you less likely to fall.

If you are moving or transferring a resident, the center of gravity includes the resident. When you are transferring a resident, the resident needs to be as close to your body as possible.


Transparency 7-2: Lifting Heavy Objects from the Floor



Activities on the job that will require moving or lifting:

• Lifting a resident• Picking up a bag of laundry• Carrying residents’ luggage• Taking heavy trash bags to appropriate site• Cleaning a floor• Moving a bed into another room



Consider these guidelines when performing your daily activities in order to use good body mechanics:

• Raise beds to safe working level.• Stand close to object.• Stand with a wide base of support.• Push or slide objects rather than lifting.• Use muscles of upper arms and upper thighs to lift.

• Bend at the knees instead of at the waist.



Guidelines for performing daily activities using good body mechanics (cont’d.):• Avoid twisting or choppy movements.• Do not lift with one hand.• Hold objects close to your body when lifting.• Avoid bending and reaching.• Get help when you need it.• Talk to residents before moving them.


6. Define two types of restraints and discuss problems associated with restraints

Define the following terms:restraint a physical or chemical way to restrict voluntary movement or behavior.

chemical restraint medications used to control a person’s behavior.

suffocation the stoppage of breathing from a lack of oxygen or excess of carbon dioxide in the body that may result in unconsciousness or death; also known as asphyxia.

atrophy weakening or wasting of muscles.



Common physical restraints are the vest restraint, belt restraint, wrist/ankle restraint, and mitt restraint. Side rails and special chairs, such as geriatric chairs, are also considered physical restraints.

Restraint use has declined in facilities, and laws have been passed restricting their use due to abuse by caregivers.

Overuse of chemical restraints was once a common problem. In the past, residents were routinely restrained for different reasons.



REMEMBER:Restraints may never be used without a doctor’s order.



Potential negative effects of restraint use:• Bruises and cuts• Pressure ulcers• Pneumonia• Reduced blood circulation• Risk of suffocation• Stress on the heart• Incontinence• Constipation• Muscle atrophy• Loss of bone mass



Potential negative effects of restraint use (cont’d.):• Poor appetite and malnutrition• Depression • Sleep disorders • Loss of dignity• Loss of independence• Stress and anxiety• Increased agitation• Loss of self-esteem• Severe injury• Death


7. Define the terms “restraint free” and “restraint alternatives” and list examples of restraint alternativesDefine the following terms:restraint-free care an environment in which restraints are not kept or used for any reason.

restraint alternatives measures used instead of physical or chemical restraints.


7. Define the terms “restraint free” and “restraint alternatives” and list examples of restraint alternativesThe use of restraints is being dramatically reduced in facilities. State and federal agencies encourage facilities to take steps to create restraint-free environments.

Restraint-free care means that restraints are not kept or used for any reason. Creative ideas that help avoid the need for restraints are being used instead. These creative ideas are called restraint alternatives.


7. Define the terms “restraint free” and “restraint alternatives” and list examples of restraint alternativesREMEMBER:Studies have shown that restraints are not truly needed. People tend to respond better to the use of creative ways to reduce tension, pulling at tubes, wandering, and boredom.


7. Define the terms “restraint free” and “restraint alternatives” and list examples of restraint alternativesThink about these questions:How would it feel to be restrained? Can you think of your own ideas about ways to avoid using restraints?


Handout 7-1: Restraint Alternatives

• Answer call lights immediately. • Improve lighting.• Use postural devices.• Add more exercise into the care plan.• Let confused residents wander in designated safe areas.• Give frequent help with toileting. • Encourage independence with all tasks. • Encourage participation in social activities.• Involve residents with hobbies.• Create activities for those who wander at night.• Offer reading materials, and read to the resident if needed.• Offer backrubs.• Increase visits and social interaction. • Increase the number of familiar caregivers. • Get the family involved. • Offer snacks or drinks. • Redirect interest. • Decrease the noise level. • Use soothing music. • Report complaints of pain immediately.


8. Identify what must be done if a restraint is ordered Define the following terms:slip knota quick-release knot used to tie restraints.

cyanosisblue or pale skin and/or mucous membranes due to decreased oxygen in the blood.


8. Identify what must be done if a restraint is ordered Remember these guidelines for restraint use:• Know state laws and facility rules regarding applying restraints.

• Follow manufacturer’s instructions.• Use correct size and style of restraint.• Always use a slip knot.• Never tie restraint to side rails.


8. Identify what must be done if a restraint is ordered Guidelines for restraint use (cont’d.):• Place hand in flat position between resident and restraint to make sure it is not too tight.

• Apply vest or belt style restraint over clothing.• Place call light within resident’s reach.• Document appropriately.


Transparency 7-3: When a Resident is Restrained

• Residents in physical restraints require care at least every two hours.

• The restraint must be released for at least 15 minutes.

• Provide help with elimination and related hygiene needs, food and/or fluids, skin care, and range of motion exercises.

• Take vital signs. • Offer comfort measures as needed. • Report blue-tinged, gray, pale skin (cyanosis), or dark or purple skin.

• Report redness or swelling.


8. Identify what must be done if a restraint is ordered REMEMBER:It is your job and it is the law to do the things outlined on Transparency 7-3 to promote the safety and comfort of a resident who is restrained.

Applying a physical tie restraint safely

Equipment: correct size and type of restraint

1. Identify yourself by name. Identify the resident. Greet the resident by name.

2. Wash your hands.

3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.

4. Provide for the resident’s privacy with a curtain, screen, or door.


5. Apply the restraint carefully. Follow manufacturer’s directions and facility policy. For each type of restraint, make sure that it is not too tight.

CHEST or BELT-STYLE RESTRAINTS: Make sure you do not catch breasts or skin in the restraints. Double-check before actually tying together or attaching buckle.

VEST: The criss-cross in the vest restraint must be placed on the front of the body.


MITT: Place a rolled-up washcloth or commercial hand roll in the mitt restraint. This helps the hand stay in proper alignment and helps prevent contractures (permanent and painful shortening of a muscle).

WRIST/ANKLE: Make sure the restraint will not slide off the wrist or ankle.


6. Use a slip knot to tie the restraint. Make sure it is not too tight. If restraint is used on a resident who is in bed, tie it to the movable part of the bed frame. Do not tie it to the side rail.

7. Make resident comfortable.

8. Leave call light within resident’s reach.

9. Wash your hands.

10. Be courteous and respectful at all times.


11. Report any changes in the resident to the nurse. Document procedure using facility guidelines.


9. List safety guidelines for oxygen use

Define the following terms:combustionthe process of burning.

flammable easily ignited and capable of burning quickly.


9. List safety guidelines for oxygen use• Oxygen is used by residents who have breathing problems.

• Oxygen use is prescribed by a doctor, and nursing assistants do not turn off or adjust oxygen levels.

• Working with oxygen requires special safety precautions because oxygen is a dangerous fire hazard.



REMEMBER:Nursing assistants do not turn off or adjust oxygen levels. This is the nurse’s responsibility.



Remember these guidelines for safety with oxygen:• Post “No Smoking” and “Oxygen in Use” signs.• Remove fire hazards from room.• Remove flammable liquids from the area.• Do not allow candles, lighters, or matches around oxygen.



Guidelines for safety with oxygen (cont’d.):• Check nasal area and ears for signs of irritation from tubing.

• Make sure that the resident is not lying on the oxygen tubing and that there are no kinks in it.

• Learn how to turn off oxygen in case of fire, if facility allows.


10. Identify safety guidelines for intravenous (IV) lines“IV” is an abbreviation for “intravenous,” which means into a vein. A resident with an IV is receiving medication, nutrition, or fluids through a vein.


10. Identify safety guidelines for intravenous (IV) linesThink about this question:Why should you always wear gloves when touching an IV area?


10. Identify safety guidelines for intravenous (IV) linesRemember these things that a nursing assistant should not do when caring for a resident with an IV:

• Take blood pressure on the arm with the IV• Get the IV site wet• Pull on or catch tubing in anything• Leave tubing kinked• Lower IV bag below IV site• Touch the clamp• Disconnect IV from pump or turn off alarm


10. Identify safety guidelines for intravenous (IV) linesBe sure to report any of the following observations to the nurse:

• Needle or catheter has fallen out • The armboard or handboard becomes loose• Tubing is disconnected• Blood appears in tubing• IV fluid in bag or container is gone or almost gone


10. Identify safety guidelines for intravenous (IV) linesReport any of the following observations to the nurse (cont’d.):

• IV fluid is dripping or leaking, or bag breaks• IV pump is beeping• Area around IV is wet, bleeding, swollen, red, or hot to the touch

• Resident complains of pain or has difficulty breathing

• Resident pulls out or attempts to pull out IV


11. Discuss fire safety and explain the “RACE” and “PASS” acronyms

REMEMBER:Heat, fuel, and oxygen must all be present for a fire to occur.



There are many potential causes of a fire in facilities, including: • Smoking • Frayed or damaged electrical cords • Electrical equipment in need of repair • Overloaded electrical plugs • Oxygen use • Careless cooking • Flammable liquids or rags with oils on them • Stacks of newspapers or other clutter



Think about this question:Can you think of additional causes of fire within a facility and ways to prevent them?



Know these guidelines for fire prevention:• Stay with a resident who is smoking.• Check ashtrays for lit cigarettes or matches.• Make sure that cigarettes or smoking materials do not fall in an area where a fire may start.

• Make sure there are no hot ashes, matches, or cigarette butts in an ashtray before emptying it.

• Report unsafe electrical equipment and cords immediately.



Make sure you know the location of fire alarms in your facility. Two acronyms will help you remember what to do.

The first is the RACE acronym, which outlines what to do in case of a fire: Remove residents from danger. Activate alarm (or call 911). Contain the fire by closing all doors and windows, if possible. Extinguish the fire, or fire department will extinguish. Evacuate if instructed to do so.



The second is the PASS acronym, which explains how to use a fire extinguisher in case of fire. There will be many fire extinguishers in every facility. Learn where they are located. In case you need to use a fire extinguisher, do the following:Pull the pin. Aim at the base of the fire when spraying. Squeeze the handle. Sweep back and forth at the base of the fire.



Know these general procedures to follow in case of fire:• Call for help.• Know the location of the fire evacuation plan.• Remain calm.• Remove all persons in immediate area.• Check closed doors for heat before opening them.



General procedures to follow in case of fire (cont’d.):• Stay low in room to escape a fire.• Use wet towels to block doorways.• Cover face to reduce smoke inhalation.• Stop, drop, and roll if clothing catches fire.• Never get into an elevator during a fire.• Turn off oxygen and electrical equipment, if facility policy allows.


12. List general safety steps to protect yourself and residents in a facility

REMEMBER:Living or working in a facility may sometimes put a person at risk of crime. Many people go in and out of a facility during the day. It is best to watch for any suspicious behavior. If you notice any suspicious behavior, report it immediately.


12. List general safety steps to protect yourself and residents in a facility

Remember these guidelines for safety in a facility:• Watch for and report any suspicious behavior.• Keep valuables at home.• Ask nurse to lock up residents’ valuables.• If a visitor or staff member makes you uneasy, do not leave the person alone with a resident.

• Follow guidelines for number of visitors allowed in residents’ rooms.

• Do not share confidential information with anyone.

• Report any situation or person who makes you feel unsafe.


ExamMultiple Choice. Choose the correct answer.1. Most of the accidents in a facility are related to:(A) Falls(B) Burns(C) Poisoning(D) Choking

2. To prevent falls, a nursing assistant should:(A) Clear walkways of clutter(B) Keep lights low(C) Have residents wear long pants(D) Leave spills for housekeeping to clean


Exam (cont’d.)3. One way to prevent burns and scalds is to:(A) Check water temperature before giving a bath or shower(B) Serve residents drinks while they are standing (C) Leave warm water applications on for 30 minutes at a time(D) Use higher settings on hair dryers so residents’ hair is not wet for too long

4. When should a nursing assistant identify a resident?(A) After giving care(B) When collecting meal trays(C) When shifts change(D) Before helping with feeding


Exam (cont’d.)5. How should residents be positioned while they eat?(A) Lying flat on their backs(B) Reclining at a 45-degree angle(C) Sitting as upright as possible(D) Lying on their sides

6. What information does a Material Safety Data Sheet (MSDS) contain?(A) Costs of the chemical(B) Comparisons with other chemicals(C) Names of other facilities using the chemical(D) Description of emergency response actions


Exam (cont’d.)7. Which of the following needs to be disposed of in a biohazard container?(A) Trash(B) Food(C) Aluminum cans(D) Sharps

8. To maintain good body mechanics while lifting or carrying an object, a nursing assistant should:(A) Hold the object out and away from her body(B) Face the object or person she is moving(C) Twist at the waist as she picks up the object(D) Try to keep her center of gravity as high as possible


Exam (cont’d.)9. One way to use proper body mechanics on the job is to:(A) Stand back from an object while lifting it(B) Keep feet close together when lifting(C) Use the muscles of the back to lift(D) Bend at the knees to lift something

10. Restraints may be used:(A) Whenever it is convenient for the facility staff(B) When a resident is being uncooperative(C) When there are not enough staff members to watch all the residents(D) Only with a doctor’s order


Exam (cont’d.)11. Which of the following statements is true of restraints?(A) People tend to respond better to restraint alternatives than to restraints.(B) Laws allow the use of restraints when a facility is short-staffed.(C) Using restraints does not cause negative effects.(D) Restraint-free care means a facility uses restraints only for disciplining residents.

12. An example of a restraint alternative is:(A) Tying the resident to the bed(B) Removing the resident’s call light(C) Locking the resident’s door from the outside(D) Give frequent help with toileting


Exam (cont’d.)13. Restraint-free care means that:(A) Restraints are only used if a resident is in danger of hurting himself or others(B) Restraints are only used with a doctor’s order(C) Restraints are only used when restraint alternatives fail(D) Restraints are not kept or used at the facility for any reason

14. At least every _____ hours, the restraints must be removed for at least _____ minutes.(A) 2, 5(B) 2, 15(C) 3, 5(D) 3, 15


Exam (cont’d.)15. Why does working with oxygen require special safety precautions?(A) Oxygen can burn easily.(B) Oxygen makes other things burn.(C) The oxygen level must be adjusted often.(D) Oxygen equipment is very fragile. 16. Which of the following is a flammable liquid?(A) Water(B) Sweat(C) Nail polish remover(D) Urine


Exam (cont’d.)17. Which of the following guidelines is true of working around oxygen equipment?(A) Never allow open flames around oxygen.(B) Nursing assistants should adjust oxygen levels.(C) Electric razors are not considered a fire hazard.(D) Smoking is allowed around oxygen if it is done about two feet away from the oxygen tank.

18. When caring for residents who have IVs, a nursing assistant should:(A) Keep the IV site dry(B) Leave the tubing kinked(C) Touch the clamp(D) Lower the IV bag below the IV site


Exam (cont’d.)19. RACE as a safety rule means:(A) Run to A Close Exit(B) Remove residents, Activate 911, Contain fire, Extinguish(C) Residents Are to be Cared for Excellently(D) Remove A Canister Extinguisher

Documents

7 Safety and Body Mechanics aspiration the inhalation of food, fluid, or foreign material into the lungs. atrophy weakening or wasting of muscles. body