cna - davis school district / overvie certified nursing assistant has completed an approved nursing...
TRANSCRIPT
CNA
SKILLS
WORKBOOK
Revised 08/2016
Page | 2
Table of Contents
Table of Contents…………………………………………………2
OBRA & Utah State Requirements……………………………….3
Important information regarding the registry……………………..5
State Certification Exam………………………………………….7
Important Testing Details…………………………………………9
Important Skills Exam
Information……………………………...11 2
Certified Nursing Assistant Skills List 3
Beginning and Ending Procedure Actions 4
Unit 2 14
Unit 3 18
Unit 4 26
Unit 5 36
Unit 6 44
Unit 7 52
Page | 3
OBRA AND UTAH STATE
REQUIREMENTS ********************************************************************************************
What is a nursing assistant?
A nursing assistant is a person who assists licensed nursing personnel in the provision of nursing
care. They primarily assist with activities of daily living such as; bathing, dressing, ambulating,
transferring, positioning, feeding, and toileting. They also measure vital signs and may assist with
other nursing tasks if appropriately delegated by a licensed nurse.
What is a CNA?
A certified nursing assistant has completed an approved nursing assistant training and competency
evaluation program and successfully passed the state’s written and skills certification exams.
How do I become a CNA?
To become a CNA in the state of Utah you must complete a UNAR approved NATCEP consisting
of a minimum of 100 hours of training, and pass the state written and skills certification exams.
What is OBRA?
The Omnibus Budget Reconciliation Act of 1987 is a federal law established to improve the quality
of care given in long term care facilities. Each state is responsible for following the terms of this
federal law.
Page | 4
What is UNAR?
The Utah Nursing Assistant Registry (UNAR) is the state agency created as a result of the OBRA
requirement. UNAR approves nursing assistant training & competency evaluation programs
(NATCEP), certifies nursing assistants who have completed an approved NATCEP and passed the
state written and skills certification exams, renews certifications of qualified CNA’s, monitors all
UNAR test sites, and maintains an abuse registry for all substantiated allegations of abuse, neglect,
or misappropriation of property by a CNA.
Nursing Facility Requirements
Nursing Assistants who work in a nursing facility that participates in the Medicare and Medicaid
programs are required by law to have a valid Utah CNA certificate. Facilities may hire uncertified
nursing assistants for up to 120 days. This means you may get a job working for a facility before
completing a NATCEP but you are expected to complete the NATCEP and certification exams
within those 120 days.
This is a one-time opportunity only.
Page | 5
IMPORTANT INFORMATION
REGARDING THE REGISTRY
***********************************************************************
How long is my certification valid?
Your certification must be renewed every two years. Keeping your certification current is
your responsibility, you should not depend entirely upon UNAR or your place of
employment to notify you of your upcoming expiration.
You will be mailed a renewal notice as a courtesy only, to the last address on record at
UNAR approximately 45 days prior to your expiration.. If you do not receive this notice
you must contact UNAR.
Once you have received this notice you must have a licensed nurse verify and sign that
you have completed a minimum of 200 paid hours in nursing or nursing related duties
under the direction of a licensed nurse. If your place of employment does not have a
licensed nurse to verify that you have met this requirement you will not be able to renew
your certification without taking and passing the state’s written and skills exam again.
Return the completed form to the UNAR and it will be processed and updated in the
system*.
Page | 6
What do I do if my certificate is expired?
You should not be working in a nursing facility that participates in Medicare/Medicaid
programs with an expired certificate and should be aware of your expiration date and plan
accordingly.
If you do allow your certification to expire you have up to 6 months to recertify by
returning a renewal notice that includes verification by a licensed nurse that you have
completed the minimum of 200 hours as stated above and paying a late fee that
accumulates monthly.
If you are more than 6 months expired but less than 12 months, you may recertify by
successfully completing the state written and skills certification exams.
Expired certification forms can be found at www.utahcna.com . This form must be
returned along with any required fees to recertify, or receive vouchers to retest.
Contact info or name change?
You must keep UNAR informed of any changes to your contact information by
completing and submitting a change form available online at www.utahcna.com or by
contacting UNAR by phone.
*Note that updating the system can take as long as 5 days.
Page | 7
STATE CERTIFICATION EXAM ************************************************************************
What is the State certification exam?
The state certification exam is a measure of nursing assistant’s knowledge and skill level.
There are two parts to this exam, a written portion and a skills portion.
The skills exam
Your ability to properly complete skills will be evaluated by a state approved RN skills
examiner. The skills examiner will give you up to 2 helpful prompts if needed during the
exam. You have a maximum of 40 minutes to complete the exam. You will be expected
to complete;
Verbalization of beginning and ending procedures
A set of vital signs
Handwashing
5 randomly selected skills of the 26 skills listed in this handbook
The written exam
Consists of 100 multiple choice questions. You must receive a minimum
score of 75%. This exam will be administered on a computer with audio
available through the use of headphones. If you have a documented disability
this exam may also be administered in a paper form.
Page | 8
ADA, Vocational Rehabilitation, Special Education, 504 Information
All testing sites are expected to comply with the American Disabilities Act.
Any accommodations that you are requesting at the testing site must have been
made in your training program and you must provide appropriate
documentation as proof. It is suggested that you contact the testing site ahead of
time to make them aware of your needs.
How do I register for the exam?
UNAR must receive your completed testing application signed by your course
instructor. This application is given out by the instructors only. Your instructor
will send them to the UNAR. A specific date is scheduled for your entire class
to test at the same time.
If you need to retest or are testing on an expired certificate it is the same
procedure, but you will only need to complete the retest voucher form or
expired certification forms. Please note that on average it takes 20 days for you
to receive testing vouchers, this includes mail speed, so please plan
accordingly. Priority processing is available for an additional fee by
contacting UNAR.
How long will it take to receive my test results?
After completing both tests it takes approximately 8-10 days to receive your
results by mail. We will not disclose your results over the phone. If you have
passed both the written and skills exam you may be listed on the registry before
you receive your results. Check for your name on the registry and wait at least
10 days after completing both tests to contact the registry if you have not
received your results. The registry is at www.utahcna.com.
Page | 9
IMPORTANT TESTING DETAILS
************************************************************************
Testing vouchers
You will not be allowed to test under any circumstances without a
picture ID
If your test requires an appointment, arrive 10 to 15 minutes early
Only the testing candidate is allowed into the testing area
Testing staff, including skills examiners, are prohibited from
disclosing results Valid picture ID
Must be a picture ID
Current, valid driver’s license from any state
Current, valid driving learner permit or temporary operator card
Current, valid ID card issued by any branch, department, or agency
of the United States Government or State of Utah
Current, valid ID from a high school, technical school, college, or
professional school located within the State of Utah
Current, valid Utah concealed weapons permit
Current, valid United States passport
Current, valid tribal ID card
What is allowed during testing?
Calculator for both skills and written
Translation dictionary for written only
Translation dictionary’s must be provided to testing center in advance for
inspection
Page | 10
Dress appropriately for skills exam
Scrubs
Hair tied back
Closed toe shoes
No dangling jewelry
Who will be the resident?
A mannequin or another testing candidate
Speak to the resident as you would a real person
Page | 11
IMPORTANT SKILLS EXAM INFO.
Please arrive at your confirmed test site at least 10 to 15 minutes before you are
scheduled to start
All students must be wearing their appropriate attire to the skills test
Only the CNA testing candidate is allowed into the testing area
Each candidate will be given 5 skills in a scenario and be required to complete a set
of vitals and handwashing
Only 2 prompts will be given by the skills examiner during the entire test
After the two prompts have been given the student will be failed if they miss
another critical point
Page | 12
Certified Nursing Assistant Skills Workbook
To qualify for the State Certificate Exam you must show competency in
all of the skills in this workbook. The state has selected 26 of these skills
that you may be tested on for your State Certification. You will
demonstrate 5 of these skills along with the required skills.
When you have completed the CNA course, you will have to go through
a final exam skills pass-off. You will have to be ready to demonstrate
each skill correctly and in a scenario.
BOLDED statements are very, very important and cannot be left out
when performing the skill.
REQUIRED State Certification skills included:
● Beginning and Ending Procedures
● Hand-washing
● Vital Signs.
** Indicates it is a skill that you could be tested on for your
State Certification
Page | 13
BEGINNING PROCEDURE ACTIONS
1. Wash your hands thoroughly before entering the room or when you are in the room
Hand washing is necessary and is evaluated as part of the critical criteria 2. Assemble needed equipment 3. Go to the resident’s room, knock and pause before entering 4. Introduce yourself by name and title 5. Identify the resident by facility policies and address them by name 6. Ask visitors to leave the room and inform them where they may wait 7. Provide privacy throughout the procedure
This means pulling the curtains, shutting the door, and properly covering the resident as needed
8. Explain the procedure to the resident,
Speak clearly, slowly, and directly
Maintain face-to-face contact whenever possible 9. Answer the residents questions about the procedure 10. Allow the resident to assist as much as possible 11. Raise the bed to an appropriate working height
ENDING PROCEDURE ACTIONS 1. Position the resident comfortably 2. Return the bed to its lowest position 3. Leave the signal cord, telephone and water within reach 4. Perform a general safety check 5. Open the curtains 6. Care for equipment following policy 7. Wash your hands 8. Let the visitors know they can return 9. Report completion of task and observation of any abnormalities and record those
actions and observations
CRITICAL CRITERIA ***Critical criteria include behaviors that are part of EVERY skill. They include:
1. Infection control and universal precautions (Following all rules of medical asepsis) 2. Safety (Protecting resident and self from physical harm) 3. Residents’ rights (Taking action to prevent or minimize emotional stress to resident) 4. Communication (Explaining procedure to resident prior to initiating it) 5. Recognizing and reporting changes (Observing and reporting abnormalities)
Page | 14
Unit 2
Communication Skills General communication concept/techniques: a. listening b. face the person c. touch d. speak slowly and clearly (don’t yell) e. be brief and concise f. use familiar terms g. provide feedback h. ask one question at a time I. be kind, patient, courteous and friendly
Assisting a Resident with a Hearing Aid 1. Place the hearing aid into the ear with the volume low 2. Slowly turn the volume up until it is comfortable for the resident
3. If whistling occurs, turn the volume down until it stops and check for proper positioning of the earpiece in the ear
4. To remove the hearing aid, turn it off with the volume set on low and pull it towards you by holding the earpiece
5. Check the resident’s ear for irritation and wax build-up 6. Check the tubing of the hearing aid for ear wax. 1. Clean the earpiece by:
a. Wiping it with soap and water. b. Keeping water out of the tubing. c. Not placing the hearing aid in water.
2. Check the battery regularly. 3. Do not use hair spray or medical spray when the resident is wearing a hearing aid. 4. Keep the hearing aid away from heat.
Assisting a Resident with a Eyeglass care 1. Eyeglasses are glass or plastic 2. Clean them daily and as needed. 3. Glass lenses are cleaned with warm water and dried with a soft tissue 4. Plastic lenses scratch easily and need to be cleaned with cleaning solutions, tissues, or a special cloth
5. Place the eyeglasses in the eyeglass case and put the case in the top drawer
Page | 15
Skill # 10 Height & Weight Weight-Standing Scale
1. Move the weights to zero before assisting the resident onto the scale
2. Assist the resident on the scale
3. Ensure the resident is balanced and centered on the scale with their arms at their side
4. Accurately record the weight within + or - .25lbs of the examiners measurement
Height-Standing 1. Assist the resident to stand on the scale
2. Resident should be balanced and centered on the scale with their arms at their side
3. Raise the folded measuring bar above the residents head. Open and lower it gently until the bar rests on top of their head, not their hair.
4. Accurately record the height within + or - .5 inch of the examiners measurement **Supine (not a state skill)
1. Body extended, bed flat, and pillow removed. 2. Mark sheet at top of head and bottom of heel (not toes) – then measure the distance
between the marks on the sheet, not over patient body. 3. Accurately record measurement within ½ inch or .5 inches 4. Safely return patient to position of comfort and safety.
Occupied Bed Making 1. Gather your linen in correct order: bath blanket, mattress pad, bottom sheet, water-
proof pad, draw sheet, top sheet, blanket or bedspread, pillowcase. 2. Place clean linen on clean surface within reach (chair, over-the-bed table). 3. Provide privacy throughout procedure. 4. Lower head of bed, placing patient in supine position. 5. If you are working alone raise the side rails on the side you are not working on. 6. Raise the bed to a comfortable working height. 7. Loosen top linen from end of bed or working side. Remove the blanket. Unfold the bath
blanket over the top sheet. 8. Ask the resident to hold the top of the bath blanket or tuck the top edges under the
resident’s shoulders. Roll the sheet out from under the bath blanket to the foot of the bed and remove.
9. Loosen the bottom linen. 10. Assist resident to turn onto their side, moving patient toward the raised side rail.
Page | 16
11. Roll soiled bottom linens toward patient and tuck the linen under the resident’s body. 12. Place and tuck in clean linen, starting with mattress pad, then bottom sheet or flat sheet
on your working side (if flat sheet is used, tuck in at top and make a mitered corner and tuck in the bottom).
13. If using a draw sheet, place it on the top of the sheet between the patient’s shoulders and thighs. Tuck it under the mattress on one side if there is enough draw sheet to do so.
14. Raise side rail and assist resident to turn onto clean bottom sheet. Tell the resident that you will be rolling them over a bump. Adjust the pillow.
15. Remove soiled bottom linen, avoiding contact with clothes, and place in appropriate location within room – never on floor. Roll the soiled linen from the top to the foot of the bed and always away from you.
16. Pull and tuck in clean bottom linen, making sure sheets are free of wrinkles. 17. Roll the resident to their back in a comfortable position. 18. Cover resident with clean top sheet and appropriately remove bath blanket. 19. Cover the resident with appropriate bedspread. Tuck in the bottom of the bed (both
their sheet and bedspread) making a mitered corner. 20. Loosen the top linen over the resident’s make a --toe pleat. 21. Put on clean pillowcase: First remove the soiled pillowcase. Grasp the clean pillowcase
at the center of the seamed end. Turn the pillowcase back over that hand. Grasp the pillow in the center with the hand that is inside the pillowcase. Pull the pillowcase down over the pillow with your free hand.
22. Place the pillow under the resident’s head with the closed end towards the door. 23. Return the bed to the lowest position, and reposition side rails according to care plan.
Open the curtains and door. Dispose of soiled linen. Be certain that the resident is comfortable and in proper alignment.
Skill # 4 OCCUPIED DRAW SHEET CHANGE 1. Don gloves
2. Place clean draw sheet on a clean surface within reach
3. Lower the head of the bed and place the resident in supine position
4. After raising the side rail, assist the resident to their side moving them toward the raised side rail
5. Loosen the draw sheet, roll the soiled draw sheet toward the resident
6. Place and tuck in the clean draw sheet on the working side(this must be done before turning the resident)
7. Raise the side rail and assist the resident to turn onto a clean draw sheet
Page | 17
8. Remove the soiled linens and draw sheet. Avoid contact with your scrubs and place them in an appropriate location within the room. Do not ever put them on the floor.
9. Pull and tuck in the clean draw sheet finish with a sheet that is free of wrinkles
10. Remove gloves and wash hands *Change gloves anytime they become soiled. Placement of Foot Board and Bed Cradle
1. Bed Cradle: Prevents the weight of the linens from falling on some part of the body. It can be used therapeutically or as a comfort device. It is used:
● Over fractured limbs. ● When there are burns. ● To prevent skin lesions. ● Over widespread skin conditions, such as psoriasis or eczema. ● To prevent contractures of the feet. ● Over a wet cast until it dries.
2. Foot Board: A device placed between the mattress and bed to keep the feet at right angles to the legs (natural standing position). A footboard is always padded. It is used to prevent a type of contracture called foot drop. If a footboard is not available, a pillow folded lengthwise may be placed against the foot of the bed.
Call Light Placement
● Always place the call light within the patient’s/resident’s reach. ● Also place alternative monitoring devices (i.e. intercoms, electronic devices, bed alarms,
lifelines, etc.) within reach. ● Make frequent visual checks of the patient/resident and anticipate needs. ● Answer call lights as soon as possible (ASAP). Answer the emergency signal immediately
Page | 18
Unit 3
**HANDWASHING (Required) 1. Do not touch the sink with your uniform 2. Turn the water to warm 3. Wet and soap your hands 4. Wash your hand with your fingers pointing down for a minimum of 20 seconds
This must include your wrist, nails and in between your fingers
5. Rinse with your fingertips down 6. Use a dry paper towel to dry your hands 7. Use a paper towel to turn off the faucets 8. Immediately discard the paper towels in a trash without touching it to your other hand
Correct Use of Hand Sanitizer 1. Apply enough product to the palm of one hand to wet your hands completely. 2. Rub hands together covering all surfaces until dry- or up to 25 seconds. 3. Only use hand sanitizer 3 (three) times and then wash your hands. 4. NEVER use if caring for a person with C-Diff (Clostridium Difficile is a bacterium that
can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon. Illness from C. difficile most commonly affects older adults in hospitals or in long term care facilities and typically occurs after use of antibiotic medications.)
Page | 19
(Donning) Putting on and (Doffing) Removing PPE Step 1: Putting on Gown
1. Overlap edges of gown so your uniform is completely covered
Step 2: Putting on Mask:
1. Make sure that the mask fits snugly around your face Step 3: Putting on Gloves (LAST to go ON)
1. Put on gloves- the cuffs of the gloves should extend over the cuffs of the gown
Step 4: Remove Gloves (FIRST to go OFF) 1. Make sure glove touches only glove 2. Grasp a glove just below the cuff 3. Hold the removed glove with the other gloved hand 4. Reach inside the other glove with the first two fingers of your ungloved
hand 5. Pull the glove down (inside out)over your hand and the other glove 6. Discard the gloves in trash
Step 5: Removing Gown: 1. Untie the ties of gown 2. Untie the neck tie and loosen the gown at the neck 3. Removing Gown: ↓
a. Slip the fingers of your dominant hand under the cuff of the gown on the opposite sleeve and pull the sleeve over your hand. Be Careful not to touch the outside of the gown with either hand.
b. Use you gown-covered hand to pull the cuff and sleeve over your other hand, and then pull the gown off both arms.
OR a. Because your hands are clean, you may use your dominant hand to grab the
cuff (which is clean), and pull the sleeve over your hand, then b. Use your gown covered hand to pull the cuff and sleeve over your other
hand, and then pull the gown off both arms. 4. Pull the gown inside out as it is removed 5. Roll up the gown away from you 6. Discard of gown in residents room
Step 6: Removing Mask: Step 7: Wash Hands
Page | 20
Transmission-Based (Isolation) Precautions
Are used when caring for persons who are infected or suspected of being infected
with a disease. *They are used in addition to: STANDARD PRECAUTIONS
Airborne • Transmitted via the air • Wear a N95 mask • Meningitis, Tuberculosis (TB), Varicella
Droplet • Transmitted via DROPLETS IN AIR, 3-6 FT., (COUGHING, SNEEZING, LAUGHING, TALKING,
SUCTIONING) • Wear a surgical mask (and goggles ifs splashing) • Diseases include: Pertussis, Mumps
Contact • Transmitted via TOUCHING INFECTED OBJECT OR PERSON • Wear gown and gloves (if splashing mask and goggles) • Diseases include: MRSA, RSV, C DIFF
Double Bagging from an Isolation Room
1. All items in isolation should be removed using the double bagging technique which requires 2 people to perform, one in the room, and one outside the room.
a. Person outside holds clean, impermeable bag with the ends of bag covering their hands.
b. Person inside the room seals the bag and places into the clean bag. c. Person outside the room seals and labels with appropriate warning.
2. The bag is disposed of in a designated area container for biohazard waste. Vital Signs ****Normal ranges for the adult: (do not use ranges in the book) Temperatures Oral/Tympanic – 97.6 degrees - 99.6 degrees F (36 degrees – 37 degrees C) Rectal/Temporal – 98.6 degrees – 100.6 degrees F (37 degrees – 38 degrees C) Axillary – 96.6 degrees – 98.6 degrees F (35 degrees – 36 degrees C) Pulse /Heart Rate 60-100 beats per minute
Page | 21
Respirations 12-20 breaths per minute Blood Pressure Systolic (first beat that you hear) – 100-120 Diastolic (last beat that you hear) – 60-80
**TEMPERATURE
Tympanic 1. Place the tympanic thermometer cover on 2. Ask the patient to turn their head so the ear is in front of you and put a new probe cover on 3. Pull back on the ear (gently but firmly) to straighten the ear canal and insert
the probe gently in the ear canal directly towards the nose
4. Start the thermometer 5. Wait until you hear a beep or see the flashing light and then remove 6. Obtain and record an accurate temperature
Electronic or Digital (Blue or Green for Oral—Red for Rectal) 1. Don gloves 2. Ask the patient if they have eaten or consumed a beverage, either hot or cold,
or smoked within the last 15 minutes
3. Place the sheath on the probe 4. Correct the placement for obtaining an oral or axillary reading 5. If necessary hold the probe in place for an oral reading 6. Leave the probe in place until the instrument beeps 7. Remove the probe sheath from the probe and dispose of it properly 8. Replace the probe 9. Obtain and record an accurate temperature
Page | 22
**RADIAL PULSE 1. Locate the pulse at the correct site (thumb side of wrist) 2. Count the pulse for 30 seconds and double or count for one full minute 3. Accuracy within + or – 4 beats per minute 4. Obtain and record and accurate pulse
**APICAL PULSE 1. Clean the earpieces and diaphragm of a stethoscope. Place it snugly into your ears. 2. Put the diaphragm of the stethoscope flat against the skin on the left side of the chest,
just below the left nipple. 3. Count the heartbeats for one full minute. 4. Accurately record.
**RESPIRATIONS 1. Count respirations for 30 seconds and double or count for one full minute 2. Accuracy must be within + or – 2 breaths 3. Obtain and record and accurate respiratory rate
**BLOOD PRESSURE 1. Clean ear pieces and diaphragm with antiseptic wipes
2. Position the residents arm with it resting on a firm surface and the palm facing up
3. Wrap the cuff around the arm with the bladder over the artery, 1 inch above antecubital
space make sure the cuff is even and snug
4. Place the ear pieces in your ears (directed forward towards your eardrums) and place
the diaphragm over the artery
5. Inflate the cuff to no more than 180mm/Hg
Or you may use the pulse obliteration method (candidates choice)
6. Deflate the cuff and note systolic reading and the point of diastolic reading
7. This reading must be accurate within a 4mmHg window on both the systolic and
diastolic
8. Accurately record blood pressure
Page | 23
Pulse Obliteration (2 step) Blood Pressure Method (Optional Method) 1. Follow steps 1-5 as above. 2. Inflate cuff while palpating (feeling) the radial artery pulse until the pulse is obliterated
(goes away). Make a mental note of the pulse obliteration number. This number will closely approximate the systolic blood pressure.
3. Calculate peak inflation by adding 30 mmHg to the level at which the radial pulse is obliterated. Deflate the cuff fully, wait 30 seconds and then re-inflate to the peak inflation level.
Example: Pulse Obliteration number 124 mmHg
+ 30 Peak Inflation Level 154 mmHg
4. Allow at least 30 seconds between pulse obliteration and auditory measurement. Instead of deflating the cuff fully and then re-inflating after 30 seconds, people who have had more experience and are able to control the valve so that no air escapes from the cuff after pulse obliteration can immediately continue to inflate the cuff to the peak inflation level. This takes some practice to learn how to control the valve so no air escapes.
5. Place the stethoscope over the brachial artery. Avoid allowing the stethoscope to bump the cuff or tubing. Make sure the entire surface of the stethoscope is against the surface of the arm. Apply as little pressure on the head of the stethoscope as possible.
6. Rapidly inflate the cuff to peak inflation level (with small quick puffs). 7. Deflate cuff, note systolic reading (when you first hear the pulse sound). Note point of
diastolic reading (pulse sound disappears). 8. Completely deflate and remove the cuff. Avoid re-inflating the cuff after deflation has
begun. 9. Accurately read within 4 mmHg window both systolic & diastolic. 10. Accurately record blood pressure. If sounds were faint:
● Recheck placement of stethoscope in your ears. ● Recheck the placement of the stethoscope on the arm. Make sure entire
surface of the stethoscope is against the arm. ● Eliminate extra noise. Make sure patient is not talking during procedure. ● Inflate cuff more rapidly
Page | 24
Skill # 3 OXYGEN
1. Demonstrate correct placement of O2 nasal cannula
a. Place prongs following the contour of the nasal passage and tubing around
the ears and under the chin, not behind the head
2. When asked by the examiner, demonstrate how to check the oxygen flow meter and
verbalize actions needed if the flow rate is not accurate
a. Never adjust the flow of oxygen, alert the nurse immediately if it is
incorrect
3. Verbalize three oxygen use guidelines
For example:
a. Avoid lighting matches or smoking around oxygen use
b. Ensure that all electrical equipment is in good repair
c. No kinks are in the tubing
d. Make sure the device is place correctly on the resident
e. Do not remove the mask or nasal cannula, unless you are specifically told to
do so by a nurse
f. Make sure the water level in the humidity bottle does not get too low
g. Provide oral care frequently
h. Watch for signs of skin irritation behind the residents ears, over their cheeks
or around their ears and nose
Page | 25
Skill # 5 APPLY COLD COMPRESS 1. Cover the cold compress with a towel or other protective cover (never place
on bare skin without a covering)
2. Properly place on the correct site as directed by the skills examiner
3. When asked by the examiner, verbalize the frequency of checks and how
long you would leave the compress on the resident. Initially check after 5
minutes. Do not leave on resident for more than 20 minutes.
4. Assess the site for redness, swelling, irritation and pain, if this occurs remove
the compress and report it to the nurse immediately
Skill # 11 APPLICATION OF ANTI-EMBOLISM STOCKINGS (TED hose)
1. When asked by examiner, explain what position the resident should be in
when applying the stocking. Apply while resident is in bed or with feet
elevated.
2. Hold the foot and heel of the stocking and gather up the stocking, turning the
stocking inside out down to the heel, aids in application
3. Smooth the stocking up and over the leg so the hose is even, snug and not
twisted or wrinkled
4. Be sure that the heel and toe are in the proper location
5. The toe hole may be on the top, or bottom of the toes depending on the
design
Page | 26
Unit 4
BEGINNING PROCEDURE ACTIONS
1. Wash your hands thoroughly before entering the room or when you are in the room
Hand washing is necessary and is evaluated as part of the critical criteria
2. Assemble needed equipment 3. Go to the resident’s room, knock and pause before entering 4. Introduce yourself by name and title 5. Identify the resident by facility policies and address them by name 6. Ask visitors to leave the room and inform them where they may wait 7. Provide privacy throughout the procedure
This means pulling the curtains, shutting the door, and properly covering the resident as needed
8. Explain the procedure to the resident,
Speak clearly, slowly, and directly
Maintain face-to-face contact whenever possible 9. Answer the residents questions about the procedure 10. Allow the resident to assist as much as possible 11. Raise the bed to an appropriate working height
Ending Procedure Steps
1. Position the resident comfortably 2. Return the bed to its lowest position 3. Leave the signal cord, telephone and water within reach 4. Perform a general safety check 5. Open the curtains 6. Care for equipment following policy 7. Wash your hands 8. Let the visitors know they can return 9. Report completion of task and observation of any abnormalities and record
those actions and observations
Page | 27
Skill # 9 CONSCIOUS CHOKING 1. Candidate is able to identify the symptoms of choking, asks the resident, “Are you choking?”
2. When asked by examiner, verbalize the need to call for help
3. Stands behind resident and wraps arms around residents waist
4. Places the thumb side of the fist against the residents abdomen
5. Positions fist slightly above navel
6. Grasp fist with other hand, press fist and hand into the resident’s abdomen with an inward, upward thrust
7. Candidate should indicate that they would repeat this procedure until it is successful or until the victim loses consciousness
Restraints
1. Apply restraint properly to individuals; secure but not tight (1-2 finger width). 2. You must secure restraint to stable foundation (bed frame if patient is in bed) 3. Must have a quick-release knot. 4. Check and Assess every 15 minutes for signs of circulation or breathing problems which
include: ● Cold, pale, or bluish skin ● Absence of a pulse ● Complaint of pain ● Numbness or tingling ● Chafing or indentation of the skin ● Breathing problems
5. Remove the restraints every 2 hours for at least 10 minutes; provide exercise, skin care, toileting, nutrition, and repositioning. (All ADL’s needed)
6. Observe for complications, comfort, and body alignment. 7. Reassure the patient frequently, and make sure the call light is in reach.
Page | 28
Safety/Fire Procedures 1. Demonstrate or explain:
● RACE o R- rescue /remove o A- alarm /alert o C- contain /confine o E- extinguish /evacuate
● PASS
o P- pull o A- aim o S- squeeze o S- sweep
Care of a Falling Resident
1. Widen your stance. 2. Bring the resident’s body close to you. 3. Bend knees and support the resident. 4. Lower the resident to the floor. 5. Do not try and stop the fall. 6. Call for help. 7. DO NOT get the resident up. Leave in the position that you find them or that they fell.
Positioning, Transfers, & Exercise
Assist Resident to Move to the Head of Bed 1. Raise side rail on the side you are not working on and the bed to a good working height.
If you have an assistant each of you should stand on different sides of the bed. Side rails will not be used if you have a partner.
2. Lower head of bed. 3. Lean pillow against headboard and lower side rail. The pillow provides for the resident’s
safety by preventing resident’s head from hitting headboard. 4. Face head of bed, one foot in front of other and 12 inches apart. 5. Keep your knees bent and back straight. 6. Place one arm under resident’s shoulder blades and the other arm under resident’s
thigh. 7. Ask resident to bed knees, put feet flat on mattress.
Page | 29
8. Tell your resident that on the count of three, resident should push with feet and arms as you lift and shift weight from your back foot to your front foot.
9. Place pillow under resident’s head. Lower the height of the bed. Reposition side rails according to care plan.
Assist Resident to Move to the Head of Bed Using Lift Sheet and Assistant
1. Raise the bed to working height. 2. Lower head of bed. 3. Lean pillow against headboard. The pillow provides for the resident’s safety by
preventing resident’s head from hitting headboard. 4. You and the assistant stand on both sides of the bed. 5. Face head of bed, one foot in front of other and 12 inches apart. 6. Keep your knees bent and back straight. 7. Be sure lift sheet is under resident’s shoulders and hips. Roll the lift sheet up close to
the resident. Grasp the lift sheet with one hand at the resident’s shoulder and the other at resident’s hip.
8. On the count of three, both you and the assistant move the resident to the head of the bed by shifting your weight from the back foot to the front foot.
9. Put the pillow under resident’s head. Unroll, straighten, and tuck the lift sheet under the mattress.
10. Lower the height of the bed and reposition side rails according to the care plan. Move Resident to One Side of Bed
1. Raise side rails on the side of the bed you are not working on and raise bed to working height.
2. Lower head of bed. . 3. Place your feet apart, knees bent, back straight. 4. Place resident’s arm over their chest. Have resident tuck chin into chest. 5. Place your arm under resident’s head and shoulder. Move upper section of the body
towards you. 6. Place your arms under resident’s shoulder & thighs. Move middle of the body towards
you. 7. Place your arms under resident’s thigh and lower legs. Move lower part of the body
towards you. 8. Lower the height of the bed. If transferring resident begin transfer.
Turning Resident Away From You
1. Place resident in supine position. Raise bed to a working height. 2. Move resident to the side of the bed nearest you.
Page | 30
3. Bend resident’s farthest arm next to their head and place their other arm across their chest.
4. Cross the resident’s near leg over the far leg or bed knee slightly. 5. Place one hand under the resident’s shoulder blade and the other hand under the
buttocks. Do not move a resident by grasping a joint because you may pull the joint out of alignment and cause pain or injury.
6. On the count of three, roll resident away from you onto their side. Lower the height of the bed and reposition side rails according to care plan.
Turning a Resident Towards You
1. Place resident in supine position. Raise bed to a working height. 2. Move resident to the side of the bed nearest you and raise the side rail. 3. Go to the other side of the bed. Bend resident’s farthest arm next to their head and place
their other arm across their chest. 4. Cross the resident’s near leg over the far leg or bed knee slightly. 5. Place one hand over the resident’s shoulder blade and the other hand over the buttocks.
Do not move a resident by grasping a joint because you may pull the joint out of alignment and cause pain or injury.
6. On the count of three, roll the resident towards you onto their side. Lower the height of the bed and reposition side rails according to the care plan.
Assisting a Resident to Sit on the Edge of the Bed (Dangling)
1. Place the bed in the lowest position and lock the wheels. 2. Move the resident to the side of the bed closest to you. 3. Raise the head of the bed and allow the resident to sit up for several minutes. Allowing
residents to sit up for a few minutes before moving to the edge of the bed may prevent dizziness from sudden change of posture. (Orthostatic hypotension)
4. Place one arm under the resident’s shoulder and the other under the resident’s knees. Holding the resident under the shoulders and knees allows you to move the body in good alignment. Never pull the resident’s legs or arms.
5. On the count of three, turn the resident towards you so legs dangle over the side of the bed.
6. Lower the bed so the resident’s feet are flat on the floor.
Page | 31
Skill # 18 LOGROLLING A RESIDENT WITH HIP FRACTURE PRECAUTIONS 1. Use at least two people
2. Raise the side rails as needed
3. Lower the head of the bed to the flattest position possible
4. Do not roll the resident onto the injured side
5. Place an abduction splint or pillows between the legs to support
the residents hips
6. On the count of “three” roll the person in one single movement
7. Make sure to keep the residents head, spine and legs aligned
Using a Mechanical Lift
1. Assemble equipment and get help from 1-2 more co-workers. 2. Position the chair next to the bed and lock the wheels. 3. Lock the wheels on the bed. Roll the resident towards you and
position the sling under the body. The lower part of the sling should be behind the knees and the upper part beneath the upper shoulders.
4. Position the lift frame over the bed in an open position. Lock the legs and wheels. 5. Attach the sling to the lift. Make sure the open edges of the hooks are facing away from
the resident. 6. Ask the resident to fold their arms across their chest. Talk to them as you lift them from the bed. 7. Move the resident away from the bed as your co-workers support the resident’s legs. 8. Position the resident above the chair. Gently lower the resident as your co-worker’
Skill # 15 PIVOT TRANSFER FROM A BED TO A WHEELCHAIR/ CHAIR OR TOILET Demonstrating proper use of gait belt 1. Lock the bed wheels
2. Positon the wheelchair close to the bed on the residents strong side
3. Move or remove the footrests from the wheelchair
Page | 32
4. Lock the wheelchair brakes
5. Lower the bedrail
6. Sit the resident up on the side of the bed, allowing resident to adjust to the upright
position
7. Apply a gait belt properly around the residents waist (as directed in skill 14)
8. The resident should have footwear with non-skid soles
9. Lower bed until residents feet are on the floor
10. Assist the resident to stand while you are holding the gait belt. Grasp the gait belt at
each side, not the front.
11. Do not allow the resident to hold onto you around your neck while you are
transferring them
12. Maintain your own body mechanics while assisting the resident to standing
13. Transfer the resident to the strong side by pivoting on the strong side toward the
wheelchair using the proper techniques
14. When asked by the evaluator, state the need to position the resident properly in the
wheelchair. Provide good alignment with the upper body and head erect, the back and
buttocks against the back of the chair and feet flat on the floor or on footrests with the
residents hips against the back of the seat.
15. Remove the gait belt without harming the resident
Skill #14 ASSISTING TO AMBULATE - Demonstrating the proper use of the gait belt
Check that bed wheels are locked.
1. Resident should have footwear with non-skid soles
2. Sit the resident up on the side of the bed allowing resident to adjust to the upright position
3. Apply the gait belt properly around the residents waist
a. Avoid restricting circulation or breathing along with any injury to the skin
4. Lower the bed until residents feet touch the ground
5. Assist the resident to stand while holding the gait belt
a. Grasp the gait belt at each side, not the front. Do not allow the resident to
hold onto you around your neck while transferring.
6. Maintain your own body mechanics while assisting the resident to stand
7. Walk at the residents side or slightly behind them on the weak side if the resident has
one
Page | 33
8. Demonstrate proper use of assistive devices
a. Walker
b. Cane, remember canes should be placed on residents strong side
Walker: provides more support. Moved walker 6-8 inches in front of the person. The
person then moves the weak foot and then the strong foot up to the walker. Cane: used for weakness on one side of the body. The cane is held on the strong
side of the body. The cane 6 to 10 inches to the side of foot. Blind: ambulate slightly ahead of the person. Offer your right or left arm. Never push,
pull, or guide the person in front of you. Let the person know when coming to a curb, steps, doors, turns, or objects in the way. Give specific directions
Skill # 1 PRESSURE ULCER PREVENTION 1. Demonstrate two ways to prevent pressure ulcers
For Example: a. Proper use of a bed cradle b. Elbow and heel protector c. Use pillows to float heels off of the bed d. Place pillow under arm to cushion elbow e. Place pillow between the legs to prevent skin to skin contact f. Making sure sheets are wrinkle free
2. Explain two other ways to prevent pressure ulcers For Example:
a. Changing position frequently, at least every 2 hours b. Good nutrition and hydration c. Provide good perineal care by keeping the resident clean and dry d. Be careful of the residents skin with emphasis on no shearing or friction e. Check the residents skin carefully and provide good skin care f. Assist your resident to the bathroom frequently g. Encourage mobility h. Use pressure reducing devices i. Backrubs
Page | 34
Skill # 13 - MOVING AND POSITIONING RESIDENTS With each of the following positions you must demonstrate:
Raising the side rail while turning the resident except on the side you are
working on
Demonstrate proper body mechanics
Maintain the residents proper alignment at all times, for all positions
1. Draw sheet
Must use 2 people a. Lay the bed flat b. Provide support for the residents head c. Grasp the rolled draw sheet near residents shoulders and hips d. On the count of “three” lift and move resident up toward the top of the
bed (make sure you keep the persons head, spine and legs aligned)
2. Fowlers positions: provide good alignment High fowler’s _ Fowler’s Semi-fowler’s (60-90 degrees (45-60 degrees) (30-45 degrees)
3. Supine: Prone:
Page | 35
4. Chair or Wheelchair: provide good alignment- ➊Upper body and head erect ➋Back and buttocks are against the back of the chair ➌Feet flat on floor or on W/C footrest ➍Calves do not touch the edge of wheelchair or chair.
5. Lateral (Right or Left)
a. Lay the bed flat b. Position lateral/side lying on the
correct side as directed by the examiner
c. Provide good alignment d. Place a pillow between the legs,
behind the back and under the arm
*****(6-9 are not state tested skills) 6. Sims/Enema/Semi prone position: left side lying *left side lying, right leg flexed, lower arm behind resident. Provide good body alignment by placing a pillow under head, upper arm and upper leg
7. Trendelenburg: 8. Reverse Trendenlenburg: 9. Lithotomy
Page | 36
Unit 5 Providing AM Care
1. Assemble equipment. 2. Awaken the patient by placing a hand on the arm and saying their name. 3. Offer bedpan or urinal, or assist to bathroom. 4. Take routine vital signs if ordered. 5. Help the resident wash their face and hands and comb their hair. 6. Assist with oral hygiene. 7. Provide fresh drinking water. 8. Tighten the lower sheets and straighten the top linens. Change the linens if soiled. 9. Change the patient’s gown or bedclothes. 10. Clear the over bed table and position it so it is set up for the breakfast tray.
Providing PM Care
1. Assemble equipment. 2. Offer the resident a snack if permitted. 3. Offer bedpan or urinal, or assist to bathroom. 4. Help the resident wash their face and hands and comb their hair. 5. Assist with oral hygiene. 6. Offer a back rub 7. Tighten the lower sheets and straighten the top linens. Change the linens if soiled. 8. Change the patient’s gown or bedclothes. 9. Place the over bed table parallel to the bed. Put fresh drinking water within reach
Baths Partial or complete bed bath
1. Assist resident in removing clothing, only as necessary, exposing only area being washed, providing privacy (remembering dignity) while keeping patient warm.
3. Partial: face, hands, axillary, back, buttocks, and perineal area. 4. Complete: partial, plus trunk and extremities. (The entire body) 5. Using washcloth, wash front to back/clean to dirty. 6. Rinse and gently dry each area thoroughly after washing.
Bed Bath
1. Gather supplies and offer resident urinal or bedpan. 2. Raise the bed to a comfortable height. 3. Drape the resident with bath blanket. 4. Fill the basin with warm water (95-105 degrees).
Page | 37
5. Make a bath mitt. 6. Start with the eyes, gently washing from the inner corner out. Wash the other eye with
a different part of the washcloth. 7. Wash, rinse and pat dry face, neck, ears, and behind ears. 8. Place towel under far arm. Wash, rinse, and pat dry hand, arm, shoulder, and underarm. 9. Repeat with other arm. 10. Place a towel over chest and abdomen and lower bath blanket to the waist. 11. Lift towel and wash, rinse and pat dry chest and abdomen. 12. Place towel under far leg. Wash, rinse, and pat dry leg from hip to foot. 13. Repeat with other leg. 14. Change water in basin when cool, soapy, or dirty. 15. Turn patient on their side so they are away from you. Wash, rinse, pat dry from neck to
lower back, finishing with the buttocks. 16. Roll patient back onto their back and change bath water as needed. 17. Provide perineal care. 18. Reposition resident and lower bed.
Sitz Bath
1. Make sure you have an order for a sitz bath- check with nurse. 2. Assemble equipment. 3. Fill the sitz bath 1/2-to 2/3 full. 4. Raise resident’s gown and secure it above the waist. Help them sit in the sitz bath. 5. Cover the resident’s legs and shoulders with a bath blanket. 6. Check on resident every 5 minutes. Stay with them if they are unsteady. 7. Pat resident dry and reposition clothing. Help the resident return to bed. 8. Dispose or clean equipment according to facility policy.
Shower or Tub Bath
1. Gather supplies and assist resident to bathing area. 2. Help resident to remove their clothing and drape the resident with a bath blanket. 3. Turn on the water. Temperature should be no higher than 105 degrees. 4. For Shower: Assist resident to shower chair. Remove drape. Push chair in to shower and
lock wheels. 5. For Tub Bath: lay bath mat on the floor beside the tub and place a no-slip mat inside the
tub. Assist the resident into the tub. 6. Let the resident wash as much as possible starting with their face—assist as necessary. 7. Help the resident shampoo and rinse their hair, if necessary. If the resident has their
hair done by a beautician, do not wash their hair unless directed by a nurse.
Page | 38
8. Turn off the water, and pat dry the resident. Help them dress, comb their hair, and return to their room.
Oral Care for a Conscious Resident
1. Raise the head of the bed to a sitting up position. 2. Wash hands and put on gloves. 3. Drape a towel under the resident’s chin. 4. Prepare toothbrush with toothpaste. 5. Clean all tooth surfaces in an up and down/circular motion paying special attention to
gum lines holding the toothbrush at a 45 degree angle. 6. Allow resident to expectorate (spit) into appropriate container. 7. Assist resident to rinse mouth, wiping lips and mouth. 8. Moisturize lips. 9. Report abnormalities such as bleeding gums.
Skill # 19 ORAL CARE FOR AN UNCONSCIOUS RESIDENT/ASPIRATION PRECAUTIONS 1. Don gloves
2. When asked by examiner, verbalize the frequency of oral care (every 2 hours)
3. Place the towel or drape under the residents head
4. Position the resident, as the residents medical condition indicates, to prevent aspiration a. Position the resident in a supine position with the head to the side or side
lying to prevent aspiration b. Or with HOB elevated and their head turned to the side as the residents
medical condition indicates
5. Wet sponge, roll sponge along rim of cup to remove excess fluid
6. Insert a swab or sponge tip gently into the residents mouth
7. Do not use a toothbrush or toothpaste
8. Rotate the swab or sponge against all tooth surfaces, mucous membranes and the tongue
9. Clean the residents lips
10. Moisturize the lips
11. Remove gloves and wash hands
12. When asked by the examiner, report any abnormalities such as bleeding gums
Page | 39
Skill # 17 DENTURE CARE 1. Don gloves
2. Before handling the residents dentures, protect them from possible damage a. Line the bottom of the sink with a towel or washcloth or fill the sink with
water
3. When asked by the examiner, explain that the water for cleaning the dentures should be lukewarm
4. Brush the dentures under running water with a toothbrush and toothpaste that has been provided
5. Be sure to remove all adhesive from the dentures
6. Place the dentures in a denture cup with water, adding a cleaning tablet if available and cover with a lid and allow them to soak
7. Remove gloves and wash hands
8. Always store dentures in water to avoid warping
9. After soaking the dentures always rinse them prior to reinserting them into the residents mouth
10. When asked by the examiner, verbalize the need to perform oral care while the dentures are out of the residents mouth
Assisting in Washing Resident’s Hair (Bed shampoo)
1. Resident’s hair must be shampooed at least once a week. 2. Ask the nurse before shampooing hair, because some residents prefer to have their hair
done by a beautician. 3. Hair may be shampooed in the shower, bath, or bed. 4. Protect the resident’s ears and eyes. 5. Massage the scalp while washing their hair. 6. Thoroughly rinse the shampoo out. 7. Dry and style their hair according to the resident’s preference.
Page | 40
Skill #23 SHAVING WITH RAZOR BLADE (Simulate) 1. Don gloves
2. Place a towel to protect the residents clothing
3. Soften the beard with a warm washcloth and apply shaving cream liberally
4. When asked by examiner, verbalize need to gently pull the skin taut
5. Use short strokes of the razor in the direction the hair is growing (downward strokes on the face and upward strokes on the neck)
6. Rinse the razor often
7. Rinse and dry the residents face
8. Apply after shave if desired by the resident
9. Remove gloves and wash hands
10. When asked by the examiner, verbalize the treatment needed if the resident is cut (apply direct pressure and notify the nurse immediately)
11. When asked by examiner, verbalize the need to dispose the blade in a sharps container
Skill # 24 PERINEAL CARE
Female
1. Don gloves
2. Assist the resident in removing their clothing, only as necessary and exposing only the area being washed
3. Place waterproof pad under the resident
4. Obtain no-rinse perineal wipes
5. Separate the labia and clean inside the labia in a downward motion from front to back (clean to dirty)
6. Wash the outside of the labia from front to back starting outside the labia and then going to the inside of the thighs
7. Repeat until the area is clean using a different part of the wipe for each stroke. Obtain clean wipes as they become soiled.
Page | 41
8. Turn the resident onto their side
9. Clean the anal area from front to back
10. Apply moisturizers or moisture barrier products as ordered
11. Remove gloves and wash hands
12. Re-dress the resident
Male
1. Don gloves
2. Assist the resident in removing their clothing, only as necessary and exposing only the area being washed
3. Obtain no-rinse perineal wipes
4. Cleanse the penis from tip to base (clean to dirty)
5. Repeat until the area is clean using a different part of the wipe for each stroke. Obtain clean wipes as they become soiled.
6. If the male resident is uncircumcised retract the foreskin by gently pushing the skin toward the base of the penis and clean as directed above. Replace the foreskin after drying area if needed.
7. Turn the resident onto their side
8. Clean the anal area from front to back
9. Apply moisturizers or moisture barrier products as ordered
Page | 42
Skill # 20 RUB/ MASSAGE 1. Place the resident into a position they desire, either sitting or a lateral position
2. Provide lotion if it is desired by the resident
3. Pour a small amount of lotion into the palm of your hands and rub your hands together to warm the lotion
4. Apply the lotion with gentle pressure using both hands from buttocks to the back of the neck without pulling the skin
5. Use long firm strokes
6. Perform the backrub for 3-5 minutes, or as ordered
7. Asses the skin condition
8. Remove any excess lotion
9. When asked by the examiner, verbalize the actions needed if redness or skin breakdowns are noticed. Do not rub any reddened areas and report them immediately to the nurse.
Hand/Nail Care 1. Inspect nails to determine care needed/report to nurse any abnormal findings. 2. Instruct the patient to put hands in the basin and soak for approximately 5 minutes. 3. Wash the patient’s hands. Push cuticles back gently with a washcloth or orangewood
stick. Use a soft brush or orangewood stick to clean under nails. 4. Dry the patient’s hands with a towel. Remember to dry between the fingers. 5. Use nail clippers to cur fingernails straight across, only if permitted by facility policy. 6. Smooth and shape any rough or sharp edges with emery board.
Page | 43
Skill # 21 FOOT/TOENAIL CARE 1. Don gloves
2. When asked by examiner, verbalize the need to inspect the feet and toes. Identify cuts, sores, redness or swelling.
3. When asked by the examiner, verbalize that you would not clip toenails
4. Wash the residents feet in warm water, do not soak them
5. Dry the residents feet completely, including between the toes
6. Apply lotion if desired but do not put lotion between the toes
7. Apply socks and shoes if desired by resident
8. Remove gloves and wash hands
9. Report any abnormalities
Skill # 22 DRESSING/UNDRESSING RESIDENT (SKILL #22) (Must dress and undress)
1. Don gloves if the clothing could possibly be soiled
2. Allow the resident to choose clothing if they are able
3. Demonstrate how to properly undress and dress the resident with hemiplegia
4. When undressing, be sure to undress the strong side and then the weak side
5. When dressing, be sure to dress the weak side then the strong side
Page | 44
Unit 6 Position Resident for Meals
In bed ● High Fowler’s ● Proper anatomical alignment Chair or wheelchair ● High Fowler’s ● Feet support ● Proper anatomical alignment
Serving Food 1. Before serving food, help the resident:
● With toileting. ● Wash hands and perform oral care, if needed. ● With grooming. ● With glasses, hearing aids, and dentures. ● To the dining room whenever possible.
2. When serving trays: ● Wash your hands. ● Check the meal card for the resident’s name, correct diet, likes and dislikes. ● Check the tray for correct food and beverages. ● Make certain the name on the menu card matches the resident’s ID. ● Unwrap silverware and napkin. ● Encourage the use of special equipment if needed. ● Open cartons and remove covers only once the meal is placed in front of the
resident ● Assist by buttering bread or cutting meat if needed.
3. Estimating the percentage of meal eaten ● Record the percentage of the total meal that was eaten. ● Ate everything: 100% Ate most everything: 75%
Ate about half: 50% Ate a small portion: 25% Ate nothing or refused: 0%
● May have to record percentage of each food item ● Report any intake less than 75% to the nurse
4. Thickened Liquids Three basic thickened consistencies include:
Page | 45
● Nectar Thick: This consistency is thicker than water. It is the thickness of a thick juice, such as a pear or tomato juice. A resident can still drink this from a cup.
● Honey Thick: This consistency has the thickness of honey. It will pour very slowly and a resident will usually use a spoon to consume it.
● Pudding Thick: With this consistency; the liquid has been thickened so much that is has become semi-solid much like pudding. A spoon should stand up straight in the glass when put into the middle of the drink. A resident must consume these liquids with a spoon.
Skill # 16 FEEDING THE DEPENEDENT RESIDENT 1. Check that the name and diet on the meal tray matches the name of resident receiving it
2. Position the resident in an upright position at a minimum of 60 degrees
3. Wash and dry the residents hands before feeding them
4. If the resident wears dentures check to make sure they are in
5. Offer the resident a clothing protector. Place clothing protector if the resident desires.
6. Describe the food being offered to the resident and maintain eye level contact while feeding the resident
7. Allow the resident to choose food as they are able
8. Offer fluid frequently
9. When asked by the examiner, explain the pace and amount of food when feeding the resident
a. Offer food in small amounts and allow the resident to chew and swallow
10. Wipe the residents hands and face during the meal as needed
11. When asked by the examiner, verbalize the need to stop feeding when complications occur and report them to the nurse
For example: a. Choking b. Persistent coughing c. Mouth sores d. Drooling e. Cyanosis f. Difficulty swallowing g. Resident refusing food
Page | 46
12. When asked by the examiner, explain the need to leave the resident clean and in a position of comfort
Skill # 7 CONVERTING OUNCES TO ML’S- 30 mL’s = 1 ounce
1. Convert ounces to mL’s 2. Record intake accurately within +/- 25 mL's of nurses reading
Skill # 6 MEASURE & RECORD FLUID INTAKE 1. Calculate intake in mL. 2. Measure on a flat, level surface looking at eye level. 3. Record intake accurately within +/- 25 mL's of nurses reading
Assisting a Male Resident with a Urinal
1. Put on gloves. 2. Give the urinal to the resident or place the urinal between the resident’s leg. Put the call
light and toilet tissue within reach. 3. Take off your gloves, wash hands, and leave the room. 4. At the resident’s signal, return to the room, wash your hands, and put on gloves. 5. Remove and cover the urinal. 6. Cover the resident. 7. Take the urinal to the bathroom. Check for color, odor, amount, and clarity. 8. Empty the urine into the toilet. Measure the output if ordered. 9. Clean the urinal. 10. Remove your gloves and wash your hands. 11. Help the resident wash his hands.
Skill # 25 ASSISTING WITH A BEDPAN/FRACTURE PAN 1. Don gloves
2. Position the bedpan or fracture pan under the resident correctly. (If you are using a fracture pan the flat side should be towards the back of the resident.)
3. Raise the head of the bed to a comfortable level
4. Place a tissue within reach of the resident
5. Position the call light within reach of the resident
6. Gently remove the bedpan or fracture pan
7. Provide or assist with any perineal/anal care as needed
Page | 47
8. Empty the bedpan into the toilet. Rinse, dry and store the bedpan in a proper location.
9. Remove gloves and wash hands
10. Wash or assist with washing the residents hands (if resident requires assistance don gloves)
11. Record the results accurately Assisting with Use of a Bedside Commode
1. Assemble equipment. Place the commode next to the patient’s bed. Open the commode cover and make sure the container is in place. Lock the wheels.
2. Help the resident to the edge of the bed and then to the commode. 3. Put a bath blanket on their lap for privacy and warmth. 4. If the resident can be safely left alone, place the call button and toilet paper within
reach. 5. Wash your hands and leave the room. Tell the resident to call when finished. 6. When the resident is finished, wash your hands and put on gloves. 7. Help the resident clean the genital and anal areas, if needed. 8. Help the resident back to bed. Make sure they are comfortable. 9. Cover and remove the container from under the commode. 10. Check urine and feces and measure output if needed. 11. Empty the container into the toilet. Clean the container per facility policy. 12. Replace the container in the commode, place on the cover, and lower the lid. Position
the commode in its proper place.
Assisting the Patient/Resident to the Bathroom
1. Help the resident to sit on the edge of the bed (dangle). Put on non- skid footwear. 2. Help the resident stand and walk to the bathroom. 3. Adjust the resident’s clothing so they can sit comfortably on the toilet. 4. If the resident is safe to be alone, place the call light within reach. Have the resident
signal when done.
Page | 48
5. Wash your hands and leave the room. 6. When the resident signals, return to the bathroom. Wash your hands and put on gloves. 7. Assist as needed to clean the perineal area. 8. Assist the resident with hand washing. 9. Help the resident back to bed. Position them comfortably.
Skill # 2 INDWELLING FOLEY CATHETER CARE 1. Don gloves
2. When asked by the examiner, verbalize the need to
a. Clean the catheter tubing (with a cleansing wipe according to facility
policy, but not alcohol) at least twice a day. Including during
perineal care and after each bowel movement.
3. Wash the tubing 4 inches, beginning at the urinary meatus and working
downwards
4. Secure the tubing to the residents inner thigh or abdomen
5. Place the tubing over the leg
6. Position the tubing to facilitate gravitational flow, meaning no kinks
7. Attach tubing to the bed frame (not over or on the side rail) and always
below the level of the bladder
8. When asked by the examiner, verbalize the need to empty the catheter bag
frequently (According to facility policy or when the bag is over 1/2 full)
9. Keep the bag from touching the floor and provide privacy cover for the bag
10. Remove gloves and wash hands
11. Document all catheter care
Page | 49
Skill #12 EMPTY DOWN DRAIN BAG & MEASURE / RECORD URINE OUTPUT 1. Don gloves 2. Collect paper towel/measuring container/and alcohol swab 3. Place paper towel on floor and place measuring container on paper towel 4. Remove drainage tube from storage sheath 5. Unclamp while directed toward container and facilitate gravity flow 6. Empty the contents- and ensure the drainage tube does not touch side of the
container 7. Re-clamp and clean the tip of drainage tube with alcohol swab 8. Reinsert tube into storage sheath 9. Place on flat surface, measure accurately, leave on flat surface and read at eye level 10. Dispose of properly into toilet 11. Rinse and dry container 12. Remove gloves, wash hands 13. Record intake accurately within +/- 25 mL's of nurses reading
Skill # 8 MEASURE/RECORD URINE OUTPUT 1. .Don gloves
2. Measure the urinary output in a urinal/graduated container
3. Place on a flat surface and measure accurately, reading at eye level
4. Dispose of the urine properly into a toilet
5. Rinse the container
6. Remove gloves, wash hands
7. Record output accurately within + or - 25 ml’s of examiners reading
Changing a Down Drainage Bag to Leg bag
5. Wash your hands and put on gloves. Place a bed protector on the connection between the catheter and the drainage bag.
6. Clamp the catheter and disconnect the catheter and drainage tubing. DO NOT ALLOW THEM TO TOUCH ANYTHING.
7. Place a clean cap over the exposed end of the drainage tube. 8. Insert the end of the new bag tubing into the catheter. 9. Secure the tubing bag to the patient’s leg.
Page | 50
10. Take down drain bag into bathroom and empty it. Record results if needed. Clean Catch/ Midstream Urine Specimen Female
1. Remove all necessary clothing 2. Wash hands and put on gloves 3. Separate labia with one hand. With the other hand, take a single cleansing towelette
and cleanse using a downward stroke (front to back). Discard towelette in wastebasket. 4. Begin to urinate in the toilet, then catch a stream of urine directly in the container.
Avoid any contact with rim or inside container. 5. Place lid on container tightly and wipe excess urine from the
outside of the container. Place urine in biohazard bag. 6. Wash hands. 7. Take the specimen cup to the designated location
Male
1. Remove all necessary clothing 2. Wash hands and put on gloves 3. Hold foreskin back with one hand. With the other take a single cleansing towelette and
cleanse using a circular stroke from the center outward. Discard towelette in the wastebasket.
4. Begin to urinate in the toilet, and then catch a stream of urine directly in container. Avoid any contact with rim or inside of container.
5. Place lid on container tightly and wipe excess urine from the outside of the container. Place urine in a biohazard bag.
6. Wash hands and take specimen cup to the designated area
Ostomy Care Do not perform unless properly trained and authorized to do so.
1. Be sensitive to the resident’s emotional needs. 2. Wash your hands and put on gloves. 3. Carefully and gently remove appliances that are applied to the skin. 4. Gently wipe the stoma with toilet paper to remove any feces or drainage. Clean around
the stoma with soap and water or other solution as directed by the nurse. 5. Empty and clean reusable bag with soap and water or product the patient has chosen. 6. Observe the skin around the stoma for redness and irritation. 7. Use skin protector or skin cream around the stoma as ordered.
Page | 51
8. Measure the stoma site to make sure the opening of the appliance is the correct size. Attach the appliances securely to prevent leaking.
9. Place the deodorant in the ostomy appliance if used. Fasten the clamp securely when finished.
10. Observe and note the contents for color, odor, consistency, and amount.
11. Report and record.
Skill #26 – BRIEF CHANGE (Bedbound) 1. Don gloves 2. Provide privacy 3. Place the resident in a supine position with the bed flat 4. Place a waterproof pad under the resident 5. Undo the front tabs on the brief and roll the brief down to between their legs. This is done rolling inward from front to back. 6. Wipe front genital area with a disposable wipe, wiping from front to back. Repeat until the area is clean, using a different part of the wipe for each stroke. Obtain clean wipes as they become soiled. Discard the soiled disposable wipe in a plastic bag or trash can. 7. Roll the resident onto their side 8. Wipe the anal area with a disposable wipe, wiping from front to back. Discard the disposable wipe in a plastic bag or trash can. 9. Roll the waterproof pad under the resident rolling the soiled side in 10. Remove the soiled brief being careful not to drop the contents. Apply clean gloves if the gloves have become soiled. 11. Tuck the clean brief under the resident. Apply protective cream or powder if ordered. 12. Roll the resident back onto their back and secure the brief in place 13. Remove the waterproof pad 14. Remove gloves 15. When asked by examiner, verbalize the need to remove the trash can liner or plastic bag and dispose of it outside of the residents room. Also verbalize the need to check a residents brief every 2 hours.
Page | 52
Unit 7 PASSIVE RANGE OF MOTION (ROM)
1. Exercise passively 2 joints 2. Explain and demonstrate that you understand to never exercise past the point of pain or
resistance. 3. Provide support for each joint being exercised. 4. Avoid fast jerky movements 5. Demonstrate: Abduction, adduction, flexion, extension, and rotation. 6. Repeat exercise at least 3 times or as ordered.
1. Exercise the shoulder: 2. Elbow
3. Hips: place one hand under the knee and the other under the ankle to support the leg.
Page | 53
4. Thumb & Fingers 5. Ankles: place one hand under the foot and the other under the ankle to support the part.
Page | 54
Death and Dying
Signs of Approaching Death or Signs of Declining Condition ● Changes in Vital signs: Blood pressure, Pulse, Respirations, Temperature. ● Blurred vision that gradually fades, unfocused eyes. ● Impaired speech. ● Diminished sense of touch, loss of movement, muscle tone, and feeling. ● Rising body temperature or below normal temperature. ● Decreasing blood pressure, weak pulse that is abnormally slow or rapid. ● Slow irregular respirations or rapid, shallow respirations. ● “Rattling” or “gurgling” sound as person breathes. ● Cold, pale skin, mottling, spotting, or blotching of skin. ● Perspiration. ● Incontinence. ● Disorientation or confusion.
Postmortem Care
1. Position the body. Place the body in a supine position in proper body alignment. Lower the head of the bed so the person is lying flat.
2. Bathe soiled areas and dry thoroughly. 3. Place a clean gown on the body. 4. Gently pull eyelids over eyes. (You can apply a moistened cotton ball on each eye if the
lids don’t remain shut.) 5. Insert dentures if this is your facility’s policy. 6. Remove jewelry according to facility policy. 7. List all jewelry removed and secure according to facility policy. 8. Brush and comb hair as necessary 9. If the family is to view the body. Cover the body to the shoulders with a sheet. 10. Make sure room is neat. 11. Allow family to view the body, provide privacy 12. Give the person’s belongings to the family. 13. Close the mouth- if needed place a rolled towel under the chin to support the mouth if
necessary 14. Remove and dispose of gloves. Wash your hands. 15. Report the completion of postmortem care according to your facility.