DCCC Course Learner Guide – Module 3
DCCC Course Learner Guide – Module 3
Table of Contents
Title
Page
Module 3: Maintaining Health,
Safety, and Wellness
4
How to Find the Course Assessment
36
How to Find the Course Evaluation
36
How to Find the Course Certificate
36
APPENDICES
(Opens in a new window)
1 – Emergency Response Sheet
1
2 – Natural Disaster Preparedness Sheet
3
3 – Emergency Recovery Information Sheet
5
4 – Decision Tree for Response to Emergency and
Non-Emergency Situations
8
5 – Drug Information Sheet
9
6 – Bill of Rights for Persons with Developmental
Disabilities Ch. 393.13(3), F.S.
10
DCCC Course Learner Guide – Module 3
Welcome to Module 3 – This module will introduce you to the responsibilities you have to
maintain the health, safety, and wellness of the individuals you serve as a direct support
professional.
Module 3 Objectives
By the end of Module 3 you should be able to:
• List methods of proper food handling and storage
• Describe safety measures involved with emergency situations
• Identify appropriate disaster and emergency procedures
• Demonstrate accurate documentation and reporting
• Describe how oral health can affect individuals with developmental disabilities
• List and describe possible effects of medication
• Apply nutritional guidelines when cooking meals
• Define the five health related responsibilities for direct support providers
Special Diets
When a special diet is needed for the individual you are working with, discuss with the
individual how the special diet can be very important to their health and well-being.
Some medical conditions - such as diabetes, Prader-Willi, swallowing difficulties, and
heart conditions - require special preparations, types, and amounts of foods.
In these cases, a dietician usually provides instructions for the foods that are healthy for
people with these conditions.
Follow the dietician’s guidelines, and be sure to observe, document, and report any
changes in the individual’s behavior or appearance.
The following slides will detail healthful food options and tips that could be included as
part of a healthy special diet plan.
Module 3:
Maintaining
Health,
Safety,
and Wellness
DCCC Course Learner Guide – Module 3
Vegetables
What kinds of vegetables are available? Here are some examples to choose:
• Dark green vegetables: broccoli, spinach, romaine lettuce, bok choy
• Red and orange vegetables: tomatoes, red peppers, butternut squash
• Beans and peas: kidney beans, soy beans, split peas
• Starch: potatoes, corn, green peas, chestnuts
• Other: cabbage, cauliflower, eggplant, celery
Fruits
Fresh, whole fruits are ideal because of the added value of maximum vitamins and fiber
to the diet.
Frozen and dried fruit count, as does 100% fruit juice.
Try a variety of different fruits, such as mangoes, raspberries, kiwi, apples, bananas,
oranges, and other favorites.
Whole Grains
Choosing whole grains is a much healthier option, rather than refined grains. Aim to
have at least half of the grains you use be whole grains.
For example, choose brown rice, whole-grain bread, and whole-wheat pasta over white
rice, white bread, and regular pasta. You can also add whole grains like oatmeal,
muesli, and bulgur wheat to a diet.
Lean Protein
What is lean protein? Lean protein is lower in fat. You should fill only a quarter of your
plate with protein foods. Meat is not the only source of protein.
Choose a variety of proteins to maximize your intake of vitamins and minerals. Try to
limit processed meats like hot dogs, lunch meats, and sausage, which have added fat
and salt. Aim for low-fat proteins to help keep health and weight under control.
Sources of Protein
These examples are heathy choices of lean protein. The list includes: lean cuts of beef,
pork, lamb and other meats, fish and shellfish, beans and peas, tofu/soy products, lean
poultry, eggs, as well as nuts and seeds in limited amounts.
DCCC Course Learner Guide – Module 3
Dairy and Soy
What is soy? The soybean or soya bean is a species of legume native to East Asia,
widely grown for its edible bean which has numerous uses. Whole soy foods contain
high levels of healthy protein and fiber. Fiber helps to reduce bad cholesterol.
What is low-fat dairy? These choices can include fat-free or skim milk, cottage cheese,
or low-fat yogurts.
What does lactose intolerance mean? Lactose can be the cause of sensitivity to dairy,
but it can be managed easily by choosing special diets. The symptoms of lactose
intolerance can include, abdominal pain, diarrhea, gas, and bloating.
Add low-fat milk, cheese, yogurt, and other calcium-rich dairy products to your diet.
Calcium-fortified soy milk and lactose-free milk are widely available for people who are
lactose intolerant.
Healthy Tips
Here are some tips for healthy nutrition choices:
• Switch to nonfat or 1% milk to reduce extra fat calories
• Avoid oversized portions and super-sized meals
• Choose low-salt soups, bread, frozen meals, sauces, and other processed foods
• Check food labels for sodium content, and
• Avoid sugary drinks and sodas, and drink water instead
Food Handling and Storage
To keep food fresh and safe, you and those in your care need to know how to handle
and store food. Simple tasks like washing hands thoroughly with soap before handling
food or tableware such as plates, forks, and knives, can prevent the spread of germs.
The following are generally accepted guidelines for safe food handling, and storage:
• Read food labels. Discard if the food item is past the expiration or sell by date. If
the item has a freshness date, the item may not be as fresh or useable after the
date has passed.
• Store perishable items in temperatures between 35-45 degrees Fahrenheit.
• Arrange dry food items so that oldest items will be used first.
• Cover food securely.
DCCC Course Learner Guide – Module 3
• If food is placed in a container after opening, write the expiration date and name of
the food item on the container.
• Discard leftovers after 48 hours. Discard milk based foods 24 hours after opening.
• Do not store food items on the floor or near a source of heat.
• Do not serve raw eggs or foods with uncooked eggs included.
• Serve pasteurized milk only. All store-bought milk should have been pasteurized
unless otherwise noted.
• Do not use chipped glasses, plates, or dishes. These can hide harmful bacteria.
• If food will not be eaten right after it’s cooked, refrigerate it until ready to serve.
Reheat, if necessary.
Pathogens
Pathogens are organisms such as a virus, fungus, or bacteria that cause disease. These
organisms can be transmitted through: person to person contact, contact with dirty
objects, infected food or water, as well as contact with blood, secretions, excretions,
broken skin and mucous membranes.
Certain parasites can also be spread this way. Some of these organisms can be handled
by the body’s immune system, but are best avoided through the use of standard
precautions designed to prevent the spread of pathogens.
Some of these pathogens include, but are not limited to:
• Colds, flu, chicken pox, measles, respiratory viruses, shingles – spread by coughs,
sneezes, and contact with dirty hands and objects
• Pinkeye – spread by contact with fluids of the eye
• Head lice, scabies, ringworm, cold sores – spread by direct contact with infected
individuals
• Gastrointestinal infections such as salmonella, giardia, and hepatitis A – spread by
contact with stool between individuals, or getting stool in the mouth via dirty
hands, water or food
There are other pathogens spread by contact with blood or bodily fluids that can cause
severe illness, the next slide will discuss these bloodborne pathogens.
DCCC Course Learner Guide – Module 3
Bloodborne Pathogens
Some of the most severe illnesses can be spread by organisms that transmit diseases
through blood or other bodily fluids. These are known as bloodborne pathogens.
Bloodborne pathogens include the hepatitis B virus (HBV), the hepatitis C virus, the
human immunodeficiency virus (HIV) that can lead to acquired immune deficiency
syndrome (AIDS), and others for which there may be no cure.
The following slides will inform you about the standard precautions for infection control, to
prevent exposures to pathogens for both you and the individuals with whom you work.
Standard Precautions
The term Standard Precautions, for infection control, refers to a group of infection
prevention practices that apply to all people.
Standard Precautions are based on the principle that blood, secretions, excretions,
broken skin, and mucous membranes may contain infectious agents.
This includes blood, urine, tears, vaginal discharge, semen, stool, spit, sputum (coughed
up mucus), scrapes, cuts, wounds as well as the insides of the mouth, vagina and
rectum. All potentially have germs that can make you or others sick.
You must apply this practice to all people, regardless of the diagnosed infection. Many of
the things you do to prevent the spread of infection should be done every time you will be
in contact with anything listed in the previous paragraph.
This includes handwashing, wearing gloves to change a diaper, and teaching people to
cover their mouth when coughing/sneezing.
It does NOT mean that you should be afraid to touch normal skin, even if it is sweaty.
Most of the time it is alright to hold someone’s hand, give them a pat on the back, help
them to get dressed, or brush their hair, for example, without taking precautions.
Hepatitis B
Virus
Hepatitis C
Virus
HIV
(can lead to AIDS)
DCCC Course Learner Guide – Module 3
The following slides will go into more detail on ways to protect yourself and others from
infection.
Handwashing
The best way to prevent the spread of germs and pathogens is to wash your
hands, commonly referred to as handwashing.
You must wash your hands:
• Before and after touching anyone
• After touching (even with gloves on) any blood, secretions, excretions, broken
skin, and mucous membranes
• After you touch things like beds, equipment, doorknobs, etc. that are close to
where people are or have been
• After taking your gloves off, and before you put new ones on, and
• After touching dirty linen, diapers, garbage, tissues or other used supplies
Here are the instructions to follow for proper handwashing:
DCCC Course Learner Guide – Module 3
1. Wet hands in clean running water, warm or cold.
2. Apply the soap.
3. Lather your hands by rubbing them together with the soap.
Be sure to lather front and backs of hands, wrists, under the fingernails, and between
the fingers. Then scrub vigorously for 20 seconds – about the amount of time it
takes to sing the Happy Birthday song.
4. Rinse hands well under clean running water for at least 10 seconds, letting water
drain from wrists to fingers until all the soil and soap are gone. Don’t turn off the
water.
5. Dry hands with a fresh, disposable paper towel.
6. Turn off the water with the same paper towel, not with your clean hands, and drop
the paper towel into the trash can.
Protective Equipment
After handwashing, there are other ways to help prevent the spread of infection that
involve protective equipment such as:
• Disposable gloves
• Sterile gowns
• Mouth and nose protection, and
• Eye protection
Disposable Gloves
Wear disposable gloves if:
• You think you will be touching blood, or anything else that comes out of the body
(vomit, stool, urine, etc.).
• You think you will be touching something that has been soiled, like the skin of an
individual who is incontinent of stool or urine, you should wear gloves.
DCCC Course Learner Guide – Module 3
• When you are cleaning equipment, surfaces, or linens that might have been soiled
with anything that comes out of the body.
• You must never use the same pair of gloves to care for more than one individual
and never wash and/or reuse disposable gloves.
However, for cleaning equipment or general cleaning (like washing floors), you may wear
reusable utility gloves.
Take gloves off right away after use, and be sure to do so in the correct way:
• Grab the outside of one glove at the wrist, and pull it down and off of your hand.
• Keep this glove in the palm of the hand that you removed it with.
• With the hand that now doesn’t have a glove on, grab the inner surface of the
remaining glove at the wrist, and pull it down and off of your hand with the other
glove still inside of it, and
• Drop both gloves into the trash.
You must always wash your hands after removing gloves.
Sterile Gowns
Personal protective equipment (PPE), such as sterile gowns, should be used when you
know that an individual has a disease that could be spread though contact with infectious
materials.
Wear a gown when:
• You think you could soil your skin and clothes while caring for an infectious
individual.
• If the individual is vomiting, or has liquid stool.
• If the individual’s hands are visibly dirty (with vomit, stool, blood), and might grab
your arms or clothes.
DCCC Course Learner Guide – Module 3
Remove a gown by:
• Pulling the gown off of your arms, turning it inside out as you do, to catch any soil
or germs on outside of the gown, and
• Folding the gown inside out before putting it in the trash.
Remove the gown and wash your hands before you leave the individual’s room to keep
from moving germs from one place to another.
Goggles & Masks
(eyes, nose & mouth)
Slide 24
Use eye, nose, and mouth protection such as goggles and masks, to protect the mucous
membranes in your eyes, nose, and mouth when there might be splashes or sprays of
anything that may be infected such as, blood, vomit, spittle, sputum, or other body
fluids.
For example, you may wear this protection when giving an enema, or when someone is
spitting at you, or sneezing, or coughing when you are trying to help them dress.
Diaper Changing and Toileting
It is very important to maintain standard precautions when performing diaper changing
and toileting procedures. The following slides will provide instruction for both diaper
changing and toileting procedures.
We will begin with diaper changing instructions:
• Organize all needed supplies within easy reach.
• Wash your hands per the proper handwashing procedures.
• Put on disposable gloves to avoid contact with soiled items.
• Ask the individual to lie down, or help the individual to lie down.
• Remove the soiled diaper and any soiled clothing, folding the soiled surfaces to the
inside.
• Discard soiled diapers in a covered, plastic lined trash can, and place soiled
clothes in a laundry bag that will keep fluids contained (like plastic), this bag
should be marked as soiled linens or bio-hazard, to alert others to take
precautions.
DCCC Course Learner Guide – Module 3
• Clean the individual according to your facility policy, using disposable wipes or
soap and water, wiping back to front.
• Never wipe over the area with an already dirty wipe or cloth. Let air dry.
• Dispose of wipes in the covered, plastic lined trash can. Put wash cloths in the
same laundry bag as clothes.
• Remove and dispose of gloves.
• Apply a clean diaper and assist the individual to dress.
• Wash the client’s hands with soap and running water.
• Put on gloves and change the bed linens. If needed put soiled linens, folded
inward, in the laundry bag.
• Clean and disinfect the area and all equipment or supplies that were soiled.
• Wash your hands thoroughly, per the proper handwashing procedures with soap
and running water.
Next, we will cover the instructions for toileting procedures:
• Toilets should be visibly clean
• Staff must ensure that everyone has easy access to toilet paper, soap, running
water, and paper towels
• Staff will assist people with toileting as needed
• Staff will wear gloves if assisting someone with toileting hygiene, and
• Everyone must use proper handwashing procedures after toileting
First Aid Kits
You need to keep a well-stocked First Aid Kit on hand to be ready for emergencies or
disasters.
Keep the supplies in a box that shuts tightly, is roomy, easy to carry, and clearly labeled.
Keep all the supplies clearly labeled, and replace them as they are used or when their
expiration date has passed.
The best place to store the First Aid Kit is on a high shelf in a high traffic area, such as the
kitchen or a hall closet.
The basic supplies you should keep in your First Aid Kit are:
• Tweezers
• Scissors
• A clearly labeled thermometer (oral, ear, etc.)
• Safety pins
• Medicines – keeping in mind possible allergic reactions – such as acetaminophen,
ibuprofen, Benadryl, and aspirin
• Simple antiseptics such as alcohol
DCCC Course Learner Guide – Module 3
• Antiseptic cream for dressings, such as a triple antibiotic cream
• Basic dressings such as white gauze, absorbent cotton tissues, 2” and 3” plain
bandages
• Various sizes of ready to use sterile dressings
• 2” and 3” wide self-stick dressing strips, cut to length if needed, and
• 1” wide adhesive strapping
Oral Health
Oral health care for individuals with developmental disabilities is important because good
oral health care is a key part of general health and well-being. It is well documented that
there is a direct link between gum disease and certain types of heart disease, obesity,
and diabetes. Speech can be affected by the loss of teeth. Teeth are necessary to make
proper sounds, and to speak clearly and well.
Good oral health is important because it:
• Affects appearance, comfort, speech, chewing, swallowing, and nutrition
• Contributes to an improved quality of life
• Helps maintain fresh breath
• Contributes to a pain-free mouth
• Improves sleep, concentration, and the ability to focus and learn
• Individuals with special needs are almost twice as likely to have oral health issues
• Individuals with compromised immune systems have more frequent oral bacterial,
yeast, or viral infections and ulcers of the soft tissues of the mouth and throat
Providing oral health care to this population requires special knowledge, awareness,
attention, and compassion
Healthy Gums
The pictures on this slide are examples of how the mouth looks in a healthy white or
Caucasian individual and a healthy black or African-American individual. The difference is
the pigmentation or dark coloring of the gums. This is normal.
DCCC Course Learner Guide – Module 3
Healthy gums don’t bleed when teeth are brushed. Gums are coral pink or brown, and
usually lack red areas which may indicate areas of gum irritation or inflammation. The
gums are tight and firmly attached to the underlying bone. The gums often appear
dimpled, like an orange peel. When the gums are unhealthy and swollen, the dimpling
may disappear.
Dental Cavities
Causes of Dental Cavities
There are many causes of dental cavities. Bacteria that live in the mouth feed on sugary
substances held by plaque, and convert it to acid which wears away teeth causing tooth
decay or cavities. Both plaque which is soft, and tartar which is rough, irritate the
sensitive gum tissues. The body’s response to tartar causes the underlying bone beneath
the gums, which supports the teeth, to dissolve in order to reduce contact with the irritant.
Having a dry mouth encourages dental decay. This is because the normal amount of
saliva, which lubricates teeth and helps wash away harmful bacteria, is not present.
Some medicines such as sleeping aids and drugs that help to calm behavior may
reduce the amount of saliva produced in the mouth. This allows the plaque to attach
more firmly to the teeth because the saliva is not there to help clean the teeth. Some
medicines that prevent seizures may cause the gums to overgrow. Other medicines
have a high sugar content, which can promote plaque build-up, and result in an
increase in cavities.
Prevention of Dental Cavities
To help prevent dental cavities, brush regularly with a fluoride toothpaste to remove food
particles and harmful bacteria, and protect teeth from plaque and tartar build-up. Ask the
dental care provider for a fluoride gel, or rinse to help protect the individual’s teeth.
Offer water frequently for medications that cause dry mouth, or contain a lot of sugar, to
wash away bacteria. If high sugar medication is an issue, ask the individual’s physician if
there are alternative medications. You can offer alternatives to sugary foods and
beverages as well, to reduce potential bacteria growth.
Gum Disease
Causes of Gum Disease
Gum disease can be cause by many factors. Poor oral hygiene, or the failure to remove
food particles and plaque from the teeth and gums may result in gum disease. Gingivitis,
or inflammation of the gums may cause bleeding, and untreated gingivitis can lead to
gum disease.
DCCC Course Learner Guide – Module 3
Untreated gingivitis causes periodontitis, or gum disease. It causes loss of the jawbone
that supports the teeth, which can cause teeth to shift, become loose and eventually fall
out. Though the bone cannot be replaced, further loss can be stopped as can gingivitis
with proper care.
Prevention of Gum Disease
To help prevent gum disease, encourage good daily oral hygiene. Ask the dental/oral
health care provider to recommend appropriate brushing and flossing methods.
Also, some individuals may benefit from using an antimicrobial rinse, such as
chlorhexidine, which will help kill disease causing bacteria in the mouth. Ask the
dental/oral health care provider if this may benefit the individual you are helping.
Dental Conditions
There are several dental conditions that can affect the oral health of individuals with
disabilities. This and the following slide will provide a brief overview of these conditions.
Difficulty Swallowing – Dysphagia – inform dental/oral health provider, position
individual upright with head to side, clean the individual’s mouth of excess food after each
meal.
Tooth Grinding – Bruxism – tooth grinding may not cause dental disease, but tooth
wear can sometimes be helped with mouth guards.
Hyperactive Bite and Gag Reflex – inform the dental/oral health provider regarding
strong gag reflexes, and schedule appointments at least 1-2 hours after the individual has
eaten.
Drooling – which can result from poor muscle tone, improper bite or an inability to close
the lips. Affects daily oral care and social interaction. Caregivers should encourage
individuals to swallow frequently, if possible.
Oral Habits – some individuals may have habits that damage oral structures, such as
picking gums, biting lips and/or cheeks, eating non-edible items or grinding and/or
clenching teeth.
Trauma and Injury – ask the oral care provider about tooth saving kits, and what to do if
a permanent tooth is broken or knocked out. Save teeth or tooth pieces in water or milk.
Be aware that oral trauma can be a sign of physical abuse. Make notes of sudden or
gradual changes in appearance or behavior.
DCCC Course Learner Guide – Module 3
General Tips for Caregivers
Here are some general tips for caregivers who provide oral hygiene:
• Make dental home care a routine, e.g., perform at the same time, in the same
place, twice daily.
• If the bathroom is not comfortable for the individual, try sitting at a table, or
supporting the individual in a bed or in a bean bag chair.
• An individual who uses a wheelchair may remain in the wheelchair and the
caregiver may support the head from behind.
• Individuals who are bedridden should have the head of the bed elevated about 30
degrees.
• Make sure the toothpaste, toothbrush, and floss are within easy reach.
• Provide adequate lighting and a mirror so that the individual can watch and learn.
• Provide the individual with a favorite toy and/or play relaxing music to make home
dental care fun and comfortable.
• Acknowledge good behavior with positive reinforcement.
• Always stay positive, be patient, and determined.
Another tip for caregivers is to use the Tell, Show, Do method to help the individual gain
a better understanding and ease potential fear.
• Tell – Communicate to the individual what is going to happen
• Show – Demonstrate what you are going to do, and
• Do – Perform the action – do it
Tooth Brushing Tips
Tooth brushing is a vital part of the oral health of the individual you help, here are some
tips to make the process more effective:
• Brush twice daily – after breakfast and at bedtime.
• Give individual opportunity to brush their own teeth, can use the hand over hand
technique.
• If needed, adapt the toothbrush handle to make it easier to grip.
• Caregivers may have to perform oral hygiene for the individual.
• Wash hands before and after brushing, use disposable gloves.
• Use a soft toothbrush, and a small amount of toothpaste, if needed moisten with
water.
• If individual has heightened taste, use a flavored toothpaste.
• If using a power brush, be sure to allow time for the individual to get used to the
sound and feel
• Be sure to brush ALL teeth, brush all sides and angles, and include the tongue
and roof of mouth.
• Angle the brush at 45 degrees to the gum line, use short back and forth strokes.
• If individual cannot rinse, use gauze or a towel to remove excess toothpaste.
.
DCCC Course Learner Guide – Module 3
Flossing Tips
• There are many types of dental floss: flavored, waxed, un-waxed, and tape. The
tape style is flatter and broad, and may be easier to manipulate. Dental floss
holders may also be used. Choose a type and tool that makes the process easier.
• Wash your hands before and after flossing, and use disposable gloves.
• Use a length of floss about 18 inches long.
• Wrap the floss around the middle fingers of both hands, hold firmly, and guide the
floss with both hands working it gently between the teeth to the gum line. Be sure
not to push hard, or use a saw motion into the gums.
• Don’t give up, it will take time, practice, and patience to floss well.
Rinsing
Using a daily rinse after brushing and/or flossing teeth may be recommended. Common
oral rinses include fluoride mouthwashes or antibacterial mouthwashes such as
chlorhexidine. If an individual cannot rinse, the liquid can be applied to the mouth and
tooth surfaces with gauze or a toothbrush.
Dentures
Some individuals wear full or partial dentures. Dentures should be removed after meals,
and should be rinsed under water to remove food particles. They can also be brushed with
a soft toothbrush and an American Dental Association (ADA) approved denture cleaner if
needed, do not use toothpaste. Once clean the dentures should be replaced in the
individual’s clean mouth, using an appropriate denture adhesive. Dentures placed in the
mouth without adhesive will slide around and cause soreness and injury to the gums.
Dentures should always be removed at bedtime, and left out of the mouth overnight. They
should be thoroughly cleaned and stored overnight in a denture box filled with clean water
or in an ADA approved denture cleaning solution as needed.
Four steps to a healthy mouth
• Brush teeth twice daily -- in the morning and at bedtime -- using a toothpaste that
contains fluoride, which strengthens tooth enamel. Brushing removes plaque from
the teeth, gums and tongue surface. Caregivers should do a quick check of the
mouth to look for and report any changes.
• Brush the top rough surface of the tongue or use a tongue scraper.
• Floss every day if possible. Flossing removes the plaque and food substances
stuck between teeth, where the toothbrush cannot reach.
• Visit the dentist regularly. Every six months is a common interval, but visits may be
more or less frequent as recommended by the dentist or hygienist.
DCCC Course Learner Guide – Module 3
Dental Home
What is a dental home? A dental home is a place where an ongoing relationship with a
dentist and hygienist has been established so that dental care can be obtained by the
same provider over time. This process should begin at 6 months of age, or after the first
tooth erupts, and no later than the first birthday.
The American Dental Association recommends a dental cleaning for most people every 6
months. However, some individuals may need more or less frequent cleanings.
Here are some suggestions for how to select a dentist for an individual with
disabilities:
• Ask the individual’s physician for a referral to a dentist, and consult with other
caregivers for suggestions
• Rule out non-accessible dental offices
• Interview several potential dental providers to be sure you find the right one
• Find out the level of experience the potential providers have in working with
individuals with disabilities
• Ask the provider about the availability of specialized equipment such as slide
boards or papoose boards
• Be up front with the dentist about the individual’s needs so a thorough oral health
assessment and treatment plan can be developed
• Make sure to choose a dentist who is willing to work with you, and is committed to
putting the individual at ease
Here are some tips to guide you in making dental appointments
• Inform the receptionist of any needed accommodations
• Schedule the appointment early in the day, or at a time you know the individual will
be most alert
• Schedule appointments that will cause minimal interruption to the individual’s
routine
• Inform the office staff if special transportation will be used
• Ensure the appropriate number of caregivers accompany the individual to the
office
• Discuss any financial concerns, and bring appropriate documents to each visit
such as insurance and/or medical cards
• Discuss guardianship issues that may be necessary for treatment to happen –
informed consents may need to be signed
DCCC Course Learner Guide – Module 3
Here are some tips to guide you during dental visits:
• The first visit may be only to familiarize the individual with the dentist, and the
office surroundings
• Plan for the possibility that the appointment may be longer than scheduled – pack
necessary items such as a change of clothes if needed
• Make sure to explain in advance what the individual can expect
• Bring a blanket, favorite toy, or favorite music from home to help the individual feel
more comfortable
Most individuals with disabilities can be treated successfully in a general dental practice.
However, a small number may require sedation or other treatment modifications to
receive care. Sedation techniques include medications intended to calm the individual.
They may be gasses that are breathed in, pills or liquids taken by mouth, or liquids given
through the vein-intravenously.
Special Concerns
There are some special concerns that should be taken into consideration to assure the
best and most comfortable dental care visits for individuals with disabilities. Remember
each individual is different. The following slides will detail actions to take to help you
discuss the concerns with the dental care provider.
Seizures – Let your provider know if the individual has seizures, including the type,
duration, and how often they occur. Give permission for the care team to speak with the
individual’s physician to find out more about current medications and conditions. Make
sure that all medicines needed are taken before appointments, and avoid situations that
can trigger seizures.
Unusual/Unpredictable Body Movements – Observe the individual’s movements, and
let the dental team know of any patterns so movements are anticipated. Sedation may be
required to control some movements. Discuss this before the first visit.
When meeting the oral health team let them know the individual’s level of tolerance to
touch, light, and sounds. Inform the team of any tubing or wires attached to the individual,
such as a Foley catheter or feeding tube. Your provider may suggest immobilization
techniques that may be used to protect the individual and the oral health team.
Inform your provider if dimming the lights, or soft music would help comfort the individual.
Be prepared to assist in the transfer of the individual in and out of the dental chair.
Let the oral health provider know of any behavioral problems, and what needs to happen
for the individual to cooperate. Explain to the provider how the individual communicates.
DCCC Course Learner Guide – Module 3
The provider may choose to introduce fingers into the mouth, before dental instruments,
and may try to perform a cleaning before taking x-rays. Make sure the provider explains
each procedure in a manner appropriate for the individual. Suggest the Tell-Show-Do
technique.
Emergency Response: In Home and Natural Disaster
As a direct support professional, you must be prepared for emergencies both in the home
of the individuals you help, and for natural disasters that may impact your consumers.
You must be prepared to respond, and must help the individuals you serve to be
prepared as well.
Home Safety
Most emergencies you will have to respond to within the home, will fall into one of these
categories:
• Residential fire
• Electrical shock
• Chemicals and poisoning, and
• Falls
Be prepared for emergencies or to prevent accidents by creating a safe environment.
Post emergency phone numbers, as well as the numbers of the individual’s health care
contacts and doctors by all telephones. Also, be sure to have first aid and disaster kits in
easily accessible areas of the home. Please note: Appendix 1, of the learner’s guide for
this course has an emergency response sheet, containing information on home based
emergencies to help guide you in the case of an emergency within the home
Residential Fire
Common causes of fire within a residence include, but are not limited to, electrical
malfunctions, defective heaters, cigarettes, and flammable liquids such as gasoline,
cleaning fluids, alcohol, and spot removers.
DCCC Course Learner Guide – Module 3
Preventative measures include the use of smoke detectors in high risk areas such as
kitchens and laundry rooms. Be sure to keep fresh batteries in the detectors. Also, keep
fire extinguishers in easy to reach areas of the home especially in high risk areas.
If there should be a fire that you cannot extinguish, you and the individual should first
evacuate the residence, next call 911, then aid victims if able, until help arrives.
Electrical Shock
Common causes of electric shock injury include, but are not limited to, malfunctioning
appliances or lighting fixtures, frayed cords, poor wiring, and using electrical appliances
incorrectly. For example, using an electrical appliance while standing in water or having
the cord in water.
Preventative measures include making frequent checks of appliances, fixtures, and cords
to assure they are in good working order. Also adding covers on electrical sockets when
not in use.
If there should be a shock accident, remove the electrical source from the individual
using a wooden object like a broomstick and cut the power. Do not touch the injured
person or electrical source with your hands until no power is flowing. Next call 911,
then give CPR as needed until help arrives.
Chemicals and Poisoning
Common causes of chemical exposures and poisonings occur via skin contact with a
toxic chemical or poison, food that contains a poison or toxic chemical, and breathing in
chemical fumes such as bug sprays or cleaners.
Preventative measures include following the directions on chemical containers carefully.
Make sure not to use poisons, such as rat poison, inside the home. Be sure to store
chemicals and poisons out of the reach of anyone who may not understand the danger,
and make sure containers are clearly labeled.
DCCC Course Learner Guide – Module 3
In the case of a chemical exposure or poisoning first call the National Poison Control
Center at 1-800-222-1222 (keep this number near each phone), next administer the
antidote as directed by the center, then call 911 or take the individual to the emergency
room immediately.
Falls
Common causes of falls are poorly lit stairs and rooms, clutter, furniture that restricts
movement, wet surfaces and floors, cords, and carrying too much.
Preventative measures include providing adequate lighting, removing and preventing
clutter on floors and outdoor walkways, arranging furniture for ease of movement, remove
cords from open walkways, keep floors and surfaces dry, and don’t carry too much.
In the case of a fall, examine the individual for injury, if needed call 911 or take the
individual to the emergency room or doctor.
Water Temperature
Another safety issue that is important when caring for individuals with disabilities is water
temperature safety, especially for individuals who cannot bathe independently, and/or
cannot accurately regulate or properly judge the water temperature.
Water temperature should be hand checked for each bath or shower, and it should be
continually checked during bathing to be sure the water is neither too hot, nor too cold. If
you are wearing gloves use an exposed body part, such as an arm, or wrist to judge the
water.
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Natural Disasters
You can help make sure the individuals you help, are prepared for natural disasters. This
should be done before a disaster strikes. Here in Florida we have several common
natural disasters that can threaten residents. They are:
• Hurricanes
• Floods
• Tornadoes
• Forest Fires, and
• Lightning
It is good to keep in mind that Florida is the #1 state for deaths due to lightning strike.
Please note: Appendix 2, of the learner’s guide for this course has a natural disaster
preparedness sheet, containing information on actions to take before, during, and after a
natural disaster, to help guide you in the case of a natural disaster in the future.
Prepare for Disaster
You should consider what you will be able to do to prepare the individuals with disabilities
you serve for the possibility of a natural disaster, and what assistance you may need
before, during, and after a disaster.
Assist the individuals with creating a plan for a potential emergency. Consider needs for
daily living, getting around after a disaster, or evacuating to a safer area.
Develop a support network of people who know the capabilities and needs of your
consumers. The network can include care workers, neighbors, friends, relatives, and co-
workers. The members of the network should be able to provide help within minutes.
You may need to depend on more than one person at each place where your consumers
regularly spend time.
Disaster Preparedness Kit
Just as you need a first aid kit, it is important to have a disaster preparedness kit.
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This kit should be kept in an easily accessible place in the residence, and should include
the following items, if applicable:
• A flashlight, with extra batteries**
• A battery powered radio, with extra batteries**
• A first aid kit
• All necessary prescription medications, in original bottles, and copies of the
prescriptions
• A pair of eyeglasses, with the prescription
• Water, at least one gallon per individual in the home is recommended, more is better
• Foods that do not require refrigeration or cooking
• Items that are required by the individual for daily living
• Medical equipment and devices, such as dentures, crutches, prostheses, etc.
• A change of clothes, and shoes for each household member
• A sleeping bag or bedroll and pillow for each household member
• A checkbook, extra cash, and credit cards, and
• A paper map of the area
** Please note that you should regularly check the batteries, medical supplies,
equipment, and any medications in the kit to be sure they function and are not expired.
Hurricanes
Before a hurricane hits, actively listen to the weather reports for potential evacuation
information, gather the disaster preparedness kit.
If the individual needs electricity to sustain basic needs take them to a nearby hospital or
special needs shelter, be sure to have back up facilities in mind where all occupants of the
home can go if needed.
Secure all outdoor equipment, close any storm shutters or cover the windows and glass
doors. Turn all refrigerators and freezers to their coldest settings and do not open them
unless necessary. Put all valuables in waterproof containers.
If you have not been instructed to evacuate, during the storm stay in the center of the
building, away from windows and doors. Turn off the electricity. If the structure you are in is
damaged and you must leave, follow posted evacuation routes. Be aware of flooded roads
and bridges.
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After the storm, if you have been evacuated, wait for authorities to announce when it is
safe to return. Upon return check for damage to the structure, as well as electric, sewer,
and gas lines. Do not stay in or use the structure until repairs are made. If you are still in
the home report any power outages, downed power lines, or structural damage. Open
doors and windows to ventilate. You may need to leave until repairs are complete.
Floods
If a storm has flood potential, actively listen to the weather reports for flood information in
your area. Have the disaster kit ready. Be ready to evacuate if necessary.
If flooding seems likely, and the individual needs electricity to sustain basic needs, move
them to a safer place in the residence. If it seems the entire structure will flood, take them
to a nearby hospital or special needs shelter.
Turn off all electricity. If possible move necessary items to a safer place within the
structure, if not, put all valuables in waterproof containers.
If evacuated, wait for authorities to announce it is safe to return. Upon return check for
damage to the structure, as well as electric, sewer, and gas lines. Do not stay in or use the
structure until repairs are made. If you are still in the home report any power outages,
downed power lines, or structural damage. Open doors and windows to ventilate. You may
need to leave until repairs are complete.
Tornadoes
If a storm has tornado potential, actively listen to the weather reports for tornado activity in
your area. Have the disaster kit ready. Be sure the battery powered radio works. Take both
with you to the shelter.
Once a tornado warning has been issued for your area, move the individual to an area of
the residence that is close to the center of the building, with no windows, or preferably to a
basement. Once in the sheltered area, be sure to cover the individual and yourself with a
mattress or bedding for extra protection.
Stay in this shelter area until the storm has passed. This will be announced on the radio.
DCCC Course Learner Guide – Module 3
After the storm has passed, check the individual for injuries and call 911 if necessary.
Check for damage to the structure, as well as electric, sewer, and gas lines. Report any
issues if needed. You may need to leave until repairs are complete.
Forest Fires
If the individual lives in a fire prone area, fires often occur quickly and without warning. If
fires are in the area, listen to the radio for information on the fires.
Keep firefighting supplies handy in the residence such as rakes, buckets, handsaws and
chainsaws. Be sure the residence has a reliable source of water, and practice fire drills
regularly. Keep the contact numbers for members of the individual’s emergency support
network by each phone. If possible know who on the team can use what firefighting
equipment, and who can be there quickly to help evacuate. Have a plan for an
emergency location to go to.
You may need to evacuate a home quickly, call contacts, and have the disaster kit in an
easy to reach location. If you have been evacuated, wait for authorities to announce
when it is safe to return. Upon return check for damage to the structure, as well as
electric, sewer, and gas lines. Report any issues if needed. Do not stay in or use the
structure until repairs are made.
Lightning
Another weather safety issue that is important to when caring for individuals with
disabilities, is lightning. Florida is the number one state for deaths due to lightning
strikes. Remember these safety measures if a storm threatens with lightning:
• Stay indoors away from open doors and windows, fireplaces, radiators, stoves,
metal pipes, sinks, and plug-in appliances.
• Do not use electrical equipment or the telephone.
• If travelling – stay in your vehicle.
• If outside – take shelter in a building, do not use metal objects, and stay out of
water.
• If there is no shelter - find a low area with no water and no tall trees, crouch but do
not lie flat.
• A person struck by lightning carries no electrical charge and can be touched – call
911 then perform CPR as it may revive victims.
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Please note: Appendix 3, of the learner’s guide for this course has an emergency
recovery information sheet, to help you keep track of important information such as
insurance, doctors, and support contacts, to help guide you in helping the individuals you
serve to recover and re-establish after emergencies.
Medication
Often the individuals you help will be taking one or more medications prescribed by their
physician, or another health care professional. It is important that you, as a direct support
professional are aware of these medications, are aware of when they are to be taken, and
how they are to be administered. You should also be aware of the possible effects they will
have on the individual both as a single medication or when taken together.
There are four possible effects for each medication:
• Desired effects – when the drug does what it is meant to do.
• No effects – when there is no change after the allotted time for the drug to take
effect. This is note-worthy, and should be mentioned to a doctor. Often the doctor
will prescribe a different medication or increase a dosage.
• Side effects – often expected, can be mild or easily treated, but should be noted.
• Adverse effects – any severe allergic or physical reaction to the medication. Any
adverse effects must be noted and you must immediately make contact with
medical professionals.
Remember to report any medication errors to the appropriate individual.
Drug Interactions
Sometimes an individual will be receiving more than one type of medication at the same
time. Every drug has the potential to react with other drugs, and produce undesired side
effects. This is referred to as a drug interaction.
Three types of drug interactions are:
• Drug Potentiation – The effects of one or more of the drugs are increased. For
example, if a drug may cause drowsiness, the interaction may cause sluggishness
or unresponsiveness.
• Drug Antagonism – The effects of one or more of the drugs are decreased. For
example, if a drug is meant to reduce swelling, the swelling may show little or no
change.
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• New Effects – When two or more drugs are taken together, sometimes new and
possibly undesired effects may occur. For example, a rash may develop after the
addition of a new drug to existing medications that do not usually produce a rash.
Medical Information
If you are responsible for supporting or taking an individual to see a doctor, you must be
sure certain information is provided to the doctor, so he or she can make the best decision
for the individual’s treatment. The following information is what you should have on hand
to send or take to the doctor’s visit:
• Medical fact sheet(s) – The physician will need a comprehensive fact sheet to get
an idea of the individual’s history.
• History of drug allergies – This may be on the medical fact sheet, but if not make
sure it is documented separately.
• Current medication and purpose – A list of all of the medications that the individual
is currently taking with an explanation of each medication and its desired effect. Be
sure to include ALL medications, prescription, over the counter, vitamins, and
herbal remedies.
• Current medical/dental conditions, not under treatment – If the individual has
medical problems not currently being treated. For example, side effects from a
medication such as puffy gums, or pregnancy.
• Observations of recent physical or behavioral changes – Bring along documentation
of observable and measurable changes in the individual.
Physician Information
• Written Prescription: The physician should provide a prescription for each
medication the individual will be taking. You or another support professional may
take this prescription to the pharmacy to get it filled.
• Written Physician’s Order: Every time a new medication is prescribed, the
physician should provide a written order and/or a prescription. Sometimes the
written order is just a duplicate of the prescription; sometimes it is a separate
document from the prescription. A copy of this order/prescription should be kept on
file and in the client’s MAR. If you did not take the individual to the doctor, be sure
the person who did provides you with the necessary documentation.
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• Purpose and Desired Effect of the Drug: The doctor may be accustomed to
explaining this verbally rather than writing it down. Ask for the drug information to be
written down, either by the doctor or whomever accompanied the individual to the
doctor. Ask for the purpose of the drug, what condition(s) the drug was prescribed
for, and what signs to look for to be sure the drug is doing what it’s supposed to do.
• Response Time: The physician should explain how much time should pass before
the desired effect of the drug can be detected. Be sure to write this information
down, if the doctor does not.
Documentation
Before you have a prescription filled, make sure you understand specifically what the
doctor ordered. Note the drug name, dosage, number of refills remaining, etc., so that you
can compare the order with what you receive from the pharmacist. If there is any
difference, tell the pharmacist right away for correction.
When you return from the pharmacist with the individual’s medications, you should have
the following documents and materials:
• The medication in the container supplied by the pharmacist
• A correct and legible label on the container
• A written physician’s order for the medication, and
• Answers to the questions regarding the purpose, effects, etc. of the medications
Once you have these documents, make sure there is a Medication Administration Record
(MAR) available that includes the time, day, individual’s name, dosage, medication name,
and who administered the drug to the individual, and their initials.
A drug information sheet should also be available. This sheet should come from the
pharmacist, or you should have received the information to create one. This sheet should
be used to detail storage information for the medication. For example, if the drug should
be refrigerated, stored in the original container, or kept out of reach of children.
Please note: A drug information sheet can be found in Appendix 5, of the learner’s guide
for this course to help you gather important information regarding medications.
Keep in mind, medication when first taken and when taken with other medications can
cause unwanted side effects. Observe the individual for these side effects. Document and
report the side effects as necessary.
Communicate with other support professionals such as physicians, your supervisor, other
caretakers, and legal representatives to make sure they are aware of the signs or
symptoms you may have observed.
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Five Primary Health Related Responsibilities
Now that we have gone over information regarding the health, safety, and wellness of the
individuals you serve, as a direct support professional you have five primary health
related responsibilities that should be practiced during the times you are with the
individuals:
1. Observe:
Use your senses sight, touch, hearing, and smelling to detect when changes
are taking place with an individual.
2. Document:
Documenting your observations provides a snapshot for how an individual is
doing at a certain point in time. You’ll need to include both behavioral and
physical observations in your documentation.
3. Report:
Along with documentation you’ll often have to tell others such as your
supervisor, the individual’s legal representative, and medical personnel about
an individual you’re caring for. Be ready to discuss changes in an individual
over time, how long the changes have been happening, how often they change,
any new activities or changes in the individual’s diet, or anything else that might
provide clues as to why the individual is different.
4. Take Action:
After you’ve reported an individual’s situation, YOU must make sure the
individual receives the medical attention they need. Learn the difference
between life-threatening and non-life-threatening situations so that you’ll know
what to do in each case.
5. Follow Up:
You must follow up on the people who are receiving medical care to make sure
they return to their best health. Follow-up tasks may include making sure the
individual completes prescribed rounds of medications, documenting changes
in the individual’s health, and pushing for more health care if the individual does
not show a positive response to the current treatment plan.
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Observe
The first of the 5 primary responsibilities is to observe.
You can pick up clues about changes in an individual’s health, by monitoring vital signs,
including:
• Temperature
• Pulse
• Weight
• Blood Pressure, and
• Respiration
Behavioral Observations
Behavior can be an indicator of change. Behavioral observations to look for include:
• Mood Changes such as withdrawal, demanding more affection, more aggressive
physical or verbal behavioral outbursts or abusiveness
• Unusual fatigue or signs of depression including crying spells, not cooperating,
or unusual interactions including grabbing or hanging on to other people
• Becoming more withdrawn and less interested in what others say and do
• Changes in behaviors at any time, and
• Self-harming behavior such as head banging, scratching, and picking at own
hair or skin
External Observations
Changes in the outer, or external, appearance of the individual can be an indicator of
change. External observations to look for include:
• Changes in skin, including scratches, burns, and bruises
• Blood in stool or urine, or on toilet paper
• Blue or purple tipped nails, lips, fingers or toes indicating lack of oxygen in the
blood (cyanosis)
• Any infection that does not respond to treatment after a physician’s recommended
period of time
• Weight gain or loss
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• Conditions that decreases mobility such as a broken bone, strained or sprained
muscle or ligament
• Changes in breathing patterns during sleep, and
• Changes in patterns of either the bowel or the bladder
Internal Observations
Changes within the individual’s body, or internal, which can be reflected in their vital
signs, can be an indicator of change. Internal observations to look for include:
• Increases in sinus and/or lung congestion that can include wheezing, coughing,
gagging, or difficulty breathing
• Increased or decreased blood sugar levels, especially in people with diabetes
• Repeated episodes of high, or low, body temperature, especially if not previously
experienced, and
• Changes in blood pressure, heart rate, or breathing
Document
Documentation of an individual’s condition on a regular basis, helps create a behavioral
and physical snapshot history of the individual’s health over time. This allows changes to
be easily detected. Documenting all of the observations you make will help you track
changes, and provide details of the changes to the individual’s health care providers.
The most important thing to remember when documenting, is that the information you
record should be measurable. Record exact details, rather than general statements. For
example, if the individual’s temperature rose from 98.6 degrees to 99 degrees, record
that rather than stating their temperature was “up slightly today.”
When documenting behavioral changes, it can be difficult to describe them in measurable
terms, however using more details can help. For example, rather than saying the
individual was “more withdrawn today,” say “she would not speak with anyone today,
except for telling me to leave her alone.”
Report
The information gathered regarding an individual’s health over time will be critical. You will
need to be able to report this information to others when necessary.
There are two primary reasons to report changes you’ve observed:
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• First, physicians and other medical staff should be given the information as they
may make decisions based on the changes you’ve observed.
• Second, you must report the changes to family or legal representatives who have
the authority to make decisions about the individual’s medical care.
Using your documentation, you should be able to report on and describe the changes in
specific detail, including: when changes first appeared, how they progressed over time,
and all other factors that you or others have observed that might have caused the
changes.
Take Action
There are times when the changes you notice and document will require immediate
action, because they may be life threatening to the individual, or they might not be life
threatening but require a follow-up and/or medical attention.
How can you know the difference? It’s best to err on the side of caution, especially if you
do not have a background in health care.
Emergency Action
If a change becomes life threatening and requires immediate, emergency action: if able
make an attempt to stabilize the individual and Call 911. Explain the situation and if able
provide medical assistance until help arrives. Only after the individual is receiving help,
should you document and report the emergency to family, legal representatives, etc.
Non-Emergency Action
If a change requires follow-up and/or medical attention, but is not an emergency or life-
threatening, stabilize the situation by providing the necessary aid. Report the situation to
the family, legal representatives, etc., follow their directions and take the appropriate
actions. Document the situation, the recommendations given by the legal representative,
and your actions. Remember to use measurable details.
Follow-up on these situations may include taking the individual directly to the doctor or
emergency room, making sure medical appointments are scheduled and kept, and/or
simply reporting the changes to the appropriate people.
Please note: the decision tree in Appendix 4, of the learner’s guide for this course can
help guide you regarding the difference between life-threatening and non-life threatening
situations, and remind you what actions to take.
DCCC Course Learner Guide – Module 3
Follow Up
Follow up regarding changes, or incidents with health problems is necessary to make
sure an individual is as healthy as possible.
Here are some ways you can provide follow-up:
• Observe to check for changes in signs and symptoms. Make sure the individual
takes all medications as prescribed.
• Document effects of all medications, all events that occurred, and remedies that
were tried in an attempt to restore health.
• Report new orders and/or medications to all who must be notified such as medical
and health care providers, family, and legal representatives.
• Document/track changes to detect new problems and prevent further health
issues.
• Be an advocate for the individual’s health and take action if the individual does
not respond positively to treatment.
Module 3 Review
Let’s review some of what you have learned in this module.
Vegetables, fresh fruits, and whole grains are examples of healthful food options.
True or false?
The answer is true.
What are gloves, gowns, masks, and goggles considered?
They are all considered protective equipment.
What is considered an important step in preparing an individual for a natural disaster?
You should develop a support network of people who can help within minutes.
And, what are the five primary health-related responsibilities for direct support
professionals?
They are observe, document, report, take action, and follow up.
End of Module 3
Congratulations!
You have completed Module 3 of the Direct Care Core Competencies Course –
Maintaining Health, Safety, and Wellness.
You are now ready to start Module 4 – Individual Choices, Rights, and Responsibilities
