In addition to classroom and clinic training, CNA’s (Certified Nurse Aide’s) are required to pass a background check in order to receive their CNA Certification. Although criteria may differ from state to state, background checks are required to ensure the general safety of the patient and their belongings. As CNA’s, personnel may be given access to a patient’s personal, financial, or medical records, as well as their living environment and medications. In a background check, misdemeanors from up to 5 years previous and any previous felony record will be investigated. All convictions, whether the applicant served any jail time or not are considered.

Generally, a waiver may be granted for CNA applicants if you meet certain qualifications.
* You must have paid all your court fines and competed any probation without incident
* You must have two or more years of sobriety
* You have had only one non-violent crime in the last 5 years
* You had three or fewer convictions that occurred more that 5 years passed

A waiver may be rejected if you meet any of the following criteria:
* If you are still on parole, probation, or incarcerated
* If you were convicted of a crime against an elderly or disabled person
* If you have been convicted of two or more similar crimes within the prior 5 years
* If you have been convicted of two or more violent crimes within the prior 5 years
* If you have been convicted of any type of sexual offense or murder
* If you have been sober for less than two years

Although some convictions can be waived by appealing the state in which you are applying, many are considered to be disqualifying. Some non disqualifying convictions are:
* Prostitution
* Possession of marijuana or other controlled substances
* DUI or DWI
* Deceptive practices (Deceptive practices can be described as knowingly writing or passing checks on your personal account without sufficient funds)
Convictions that are considered to be disqualifying are:
* Possession with intent to sell controlled substances
* Unlawful use of a weapon
* Arson
* Any form of vehicular hijacking
* Manufacturing or delivering controlled substances
* Criminal neglect of a child or elderly person
* Ritualized abuse of a child
* Home invasions
* Any sexual assault or abuse
* Child endangerment
* Battery or Assault
* Kidnapping
* Tampering with food or drugs
* Stalking
* Theft
* Burglary or robbery (armed or unarmed)
* Criminal Trespassing
* Financially exploiting disabled persons or the elderly
* Any form of murder or manslaughter

CNA candidates may also be subject to a check of past employment. You should always be completely honest on your employment application even if your past is less than perfect. Be consistent and truthful with any information that you provide to a hospital or any hiring agency. These background checks are in place to protect the patient as well as potential co-workers. Questions regarding waivers and exceptions may be obtained through the state in which you are seeking certification.

Criminal background checks are a requirement for employment in the health care field. It is only intelligent for health care organizations to maintain security for their patients, visitors and employees. Some health care positions may involve working with children. States regulations require hospitals and medical centers to screen the background of potential employees to ensure the safety of children as well as the general patient population. Skilled nursing facilities and assisted living facilities will require background checks for nursing assistants working with elderly or disabled patients, as these patients can be abused much easier than most other patients.

Today’s background checks required for working in health care can include driving records and credit checks. The driving records search would be for serious types of moving violations. Credit checks are used to prove a pattern of responsibility regarding one’s finances. Having a large debt load, a history of bankruptcies, or even a credit report full of late payments will lead some employers to the assumption that the person applying for the nursing assistant position is at the very least irresponsible.

If you have had past problems, be upfront about it. Not all conviction will affect employment opportunities. Anyone considering a career in health care can be certain that they will need to subject themselves to a criminal background check. If you have a criminal history, you may want to consider checking with CNA programs and health care system to find out what effect your particular criminal record may have on employment.

In most areas there are a variety of CNA training options to choose from. CNA courses are held at hospitals, community college, vocational schools as well as the American Red Cross. Tuition for the training generally runs from $200 to $1000.00. The course can run anywhere form 4 to 12 weeks or longer depending on the region you live in and the program you choose.

In most cases you will have to pass a criminal background check and drug screening to apply for a CNA program. Some of the certified nursing assistant course covers basic legal and ethical concerns, anatomy and physiology, pharmacology, basic emergency care, as well as lifting, moving, and transferring patients. Upon successful completion of the course, CNA candidates must pass a state administered written and practical exam in order to become officially certified as a nurse’s assistant.

Once certified, there are many different opportunities available for the newly certified professional. CNA’s can find employment at hospitals, nursing facilities, assisted living facilities, and can also obtain employment with families and in private settings caring and assisting those in need.

It takes patience and compassion to be a care giver, and not all are up to the task. Those who have early patient contact experience are more likely to determine if they are cut out for a life of care giving ahead of time, and ensure that heading down the health care road is going to take them to the desired destination.

Commonly pulmonary embolisms are caused by a clot being transferred from smaller vessels in the leg, arm or heart (Fell, 2005). The blood clot travels around the venous system until it reaches a point where it can no longer travel freely. As a result of this, blood flow is reduced to the affected area of the lung.

Symptoms of a pulmonary embolism

Shortness of breath – the patient may struggle to complete a sentence.

Perspiration – the patient may be sweaty and clammy

Change in pallor – in severe cases of pulmonary embolism the patient may look pale and ashen.

If the blood clot is large, or the patient has not received medical assistance in adequate time, a pulmonary embolism can result in a cardiac arrest.

The following are the common presenting symptoms of a pulmonary embolism:

Diagnostic Tests

Electrocardiogram

(ECG) – ECG changes can be present in a patient presenting with a pulmonary embolism. Pulmonary embolism should not be ruled out in cases where there are no significant ECG changes. Inverted anterior T-waves on an ECG can be indicative of a P.E however this is usually in the case of a ‘massive’ embolism.

Erect chest x-ray

- In most cases of a suspected P.E a physician will request a chest x-ray. This test is unlikely to display any abnormality which will assist the diagnosis of a P.E however it can highlight other potential conditions which may be causing the symptoms.

Arterial Blood Gases –

This test involves the physician taking a small sample of blood from the radial artery. If the patient is cyanosed or hemodynamically unstable then a sample may need to be taken from the femoral artery. The blood sample is analyzed within minutes, on a machine usually available in the E.R. Arterial blood gases may be helpful in the overall assessment and management decisions of a dyspneic patient, but will not help rule in or out a P.E (Stein, 1996).

C.T Scan –

This involves a contrast dye being injected into a venous cannula, images are then taken to observe the flow of the dye through the venous system and into the pulmonary vessels. If there are any areas blocked or poorly perfused then a C.T scan will indicate this.

Pulmonary Angiography –

This test requires the insertion of a catheter into a large vein located in the groin (inferior vena cava). Contrast dye is then injected into the catheter and images of the dye are then observed to identify its course and

Because the symptoms of a pulmonary embolism can mimic other medical conditions (such as acute myocardial infarction), specific diagnostic tests are required to give a definitive diagnosis. The following tests are carried out when the patient is taken into medical care:determine any poor filling or blocked areas. Pulmonary angiography is the accepted “gold standard” test, but it is invasive and difficult to interpret, and can give false-negative results (Walling, 2003).

Chest pain – often exacerbated by taking a deep breath.

In cases where preeclampsia symptoms appear mild (traces of protein in the urine, with minimal elevation of the blood pressure), anti-hypertensive therapy is recommended to regain control of the blood pressure. In some cases this treatment is sufficient to allow a pregnant woman to progress to a more viable stage of pregnancy for delivery in the event that the preeclampsia worsens.

In the event that blood pressure begins to rise despite the administration of anti-hypertensive medication, intravenous anti-hypertensives are the next treatment choice. Hydralazine is the drug of choice in most cases. Ace-inhibitors are advised against as research indicates a risk of fetal harm. Treatment is then titrated to the blood pressure, which itself will need to be monitored frequently. Anticonvulsant medication such as that of intravenous Magnesium Sulphate, is usually introduced at this stage, as a prophylactic measure, its function is to reduce vascular spasm. The drug is not recommended for use unless it is clear that the preeclamsia is progressing toward a situation where the mother and baby are at immediate risk (Warden, 2005).

Despite advances in so many areas of medicine, prevention of preeclampsia has still not been fully established. The introduction of prophylactic dose Aspirin, 75mgs daily, is a treatment exercised by some (not all) obstetricians and general practitioners, when a woman is identified as being in one or more of the risk groups. The benefits of Aspirin are believed to result in less placental aggregation and therefore less placental ischaemia which is the reason why the baby is at risk of death (Redman et al, 1978).

When a woman with a history of preeclampsia presents with any subsequent pregnancy, it is common practice that she be offered more frequent maternal monitoring, by means of blood pressure and urine checks, as well as the likelihood that she may have a planned (booked) induced labor or cesarean section earlier than 40 weeks in the event that preeclampsia develops once again. Booked procedures are usually performed at around 37 or 38 weeks gestation.

http://www.vitalethics.org/classes.html

Preeclampsia directly affects the blood supply to the fetus, therefore the condition often produces low birth weight, or in many cases premature babies due to a need to deliver the baby early, to avoid further complications. The problems associated with premature birth are well documented, therefore early treatment of preeclampsia is favorable in an attempt to reduce symptoms and risks, and allow the pregnancy to continue for as long as is possible, without putting the mother or her unborn child at risk.

When hospitalization is necessary due to the onset of preeclampsia, a woman will normally be advised to maintain bed-rest. Frequent fetal monitoring will be conducted to ensure the baby is progressing well and in no apparent distress. The pregnant woman will be required to provide a urine sample daily, to test for protein, and blood pressure is checked 4-6 hourly in the ‘stable’ patient. All of these tests are repeated more frequently if it appears that the preeclampsia is escalating.

It is a misconception that preeclampsia always resolves immediately that the baby and placenta have been delivered. A woman can remain at very high risk up to 48 hours after delivery, therefore monitoring is essential in the post-natal period. Preeclampsia can occur up to 2 weeks after the delivery. In some cases the preeclampsia can become significantly worse in the immediate post-natal phase, in such cases women require ‘high dependency’ post natal care.

Michael Morales

http://www.vitalethics.org/pals.html

http://www.vitalethics.org

Often patients with a decreased level of consciousness are in serious trouble. They may respond inappropriately to verbal commands or may only respond to physical stimuli. Many times bystanders have no idea what is wrong, and at other times a bit of medical history can provide some valuable clues and shed some light on the situation. Care for the victim with a decreased level of consciousness includes management of the airway and breathing. Generally, the recovery position is the best position for the person as long there is no indication of head, neck or back injury. However, if the victim is in a comfortable position on something like a sofa chair or in any position where there is no risk of them falling, then that would be acceptable. As long as the victim is breathing they are alive, and CPR must not be performed on someone who is breathing.

Quite often the problem can be related to blood sugar levels, electrolyte imbalance or other type of blood chemistry disorder. It may also be a stroke, medication over dose or serious infection. Sometimes it can be difficult for EMS providers to determine what exactly is wrong, and in many cases the answer may only be proved after extensive hospital assessment. In any case, decreased level of consciousness is a true medical emergency and should prompt bystanders to call 911 or the local emergency number in addition to providing appropriate basic life support care.

Michael Morales EMT-Paramedic

http://www.vitalethics.org

As soon as you a dispatcher answers and asks you “do you have an emergency?” you need to affirm and make a very clear statement. Talking to a dispatcher could be looked at like doing an internet search. If you are looking for “apples” you would not type in “fruit”. In order to help the dispatcher prioritize the call, think of an exact match type of phrase. “I have a family member having chest pain.” Is much more clear then “I have a family member who is sick.” Below I have included an example of exact phrases. Please note that these are note all inclusive.

“I have a man who is unconscious in a vehicle.”

“My mother is having difficulty breathing.”

“My friend’s child was found at the bottom of the pool and is unresponsive.”

“My uncle is confused and disoriented.”

“There has been a serious vehicle accident.”

“My student is having a seizure“

When accessing resources by calling 911, make your initial statement very clear, and allow the dispatcher to ask the questions from that point. The call will be much more effective when the dispatcher is allowed to ask the questions after having received a clear initial statement from the caller. Try to avoid being ambiguous.

Taking a basic level CPR and First Aid class can help with understanding how to identify life threatening emergencies and appropriately responding until help arrives. Most emergency dispatchers are trained to provide basic instructions to help callers manage their situation. Dispatchers however are very limited in what they can do and it should be understood that they are not in a position to provide solutions to all emergencies. There will always be situations where there is nothing the dispatcher can do except to summon the appropriate resources.

Michael Morales EMT-Paramedic

http://www.vitalethics.org