Certified Nursing Assistant Notes

CNA Exam

Note:  I will posting videos RegisteredNurse.com.  I really like their informative videos.  I believe they can be very beneficial.  Also, I have included the main videos from Prometric’s as well as videos of written test questions.

Partial Bed Bath

Give resident a partial bed bath & backrub.  Wash face, neck, chest, abdomen, back, one arm and hand with soap and water.  Provide for a brief backrub with lotion.  Dress resident in a hospital gown.  Patient is lying on back in center of bed and can roll as directed, but is too weak to assist in bathing.

Supplies:  barrier for table, bath basin, four washcloths, two bath towels, soap, lotion, privacy blanket, clean gown, and gloves.

  1. Knock
  2. Greet patient
  3. Introduce yourself
  4. Pleasantries
  5. State what you will be doing
  6. Close curtain
  7. Place barrier on table
  8. Get supplies
  9. Get water for basin
  10. Use paper towel to turn on water
  11. Test water
  12. Ask if temp is ok
  13. Place privacy blanket
  14. Pull sheet to waist
  15. Place washcloths in water
  16. Ask patient to sit forward
  17. Untie gown
  18. Place towel under patient
  19. Spread towel under arm
  20. Take gown off on the side closest to you and place on other side of body
  21. Put on gloves
  22. Wash cloth for face NO SOAP  Use the four corners method
  23. Wash eye closest to you going from inner to outer using first leaf
  24. Wash opposing eye using the exact same method but use second leaf
  25. Wash the rest of the face with third leaf
  26. Wash the nose with the final leaf
  27. Rinse and pat dry using same sequence
  28. Next use a whole wash cloth with soap for the body.
  29. Wash behind the ear closest to you, under chin, and behind second ear
  30. Wash neck
  31. Then the remainder of torso
  32. Clean front of arm, and hand, then back and finally the underarm
  33. Rinse and pat dry using the same sequence
  34. Place gown on the side closest to you. Spread gown out across the body.
  35. Take off the other side of gown, put gown in dirty linen, and then put on the other side of gown.
  36. Ask patient to scoot towards you, and turn on left side.
  37. Take third wash cloth (put soap on it) and wash back of neck, shoulders, back down to waist.
  38. With final wash cloth, rinse in same method. Then pat dry with towel
  39. Gets some lotion on your hands warming it prior to putting on back. Go up the back three times in circular motion.  Wipe off excess with a towel.
  40. Tie patient’s gown
  41. Remove towel which was under the body.
  42. Have patient turnover and scoot toward the middle. And let patient know what you are doing.
  43. Clean up dirty linens.
  44. Empty basin. Rinse.
  45. Pick up with paper towel.
  46. Dry with another paper towel on the inside. Discard
  47. Dry outside with a paper towel and discard.
  48. Get another paper towel & collect lotion and soap to place in basin.
  49. Store basin using a paper towel to open and close drawer
  50. Discard paper towel and barrier
  51. Remove gloves
  52. Remove privacy blanket while not trying to let it touch your clothes.
  53. Pull sheet up
  54. Place privacy blanket in dirty linen
  55. Give call light and ask if the patient need anything
  56. Open privacy curtain
  57. Wash hands.

Perineal care

The female patient has been incontinent of urine and needs perineal care.  The pad under the patient is wet, but hospital gown and bedding is dry.

Supplies: barrier for table, bath basin, four washcloths, towel, soap, gloves, privacy blanket, and two under pads.

  1. Knock
  2. Greet patient
  3. Introduce yourself
  4. Pleasantries
  5. State what you will be doing
  6. Close curtain
  7. Wash hands
  8. Place barrier on table
  9. Get supplies
  10. Get water for basin
  11. Use paper towel to turn on water
  12. Test water
  13. Ask if temp is ok
  14. Place washcloths in water
  15. Place privacy blanket
  16. Pull sheet to knees
  17. Now get chucks ready for use
  18. Unfold chucks
  19. Roll it up lengthwise Rolling toward you Not touching the body
  20. Repeat (clean rolls toward me, dirty rolls away)
  21. Put on gloves
  22. Place one of the chucks on the bed
  23. Ask patient to scoot toward you
  24. Roll onto left side
  25. Roll dirty chucks toward the patient and tuck under hip
  26. Unroll clean one and tuck under soiled chuck
  27. Ask patient to roll back onto his/her back and scoot to the middle of bed
  28. Go to the other side of bed
  29. Have patient scoot closer to you and roll up on his/her right side
  30. Remove the soil chucks from bed and unroll the clean one
  31. Throw the dirty chucks away
  32. Let patient know you will be rolling the blanket up to the waist and tell him/her to let you know if the patient are uncomfortable
  33. As you are rolling the blanket up, try to get the gown rolled into the blanket exposing only the perineal area.
  34. Cover upper legs with a towel
  35. Get soap out and soap five corners (the fifth corner is the backside of the last corner)
  36. Use the hill of your hand to raise the perineal area.
  37. Use the index and middle finger to slightly open exposing the perineal area, so that you can clean down the inside middle using the first leaf of the washcloth. Top to bottom.
  38. Open next leaf and clean one side of the labia.
  39. Open third leaf and clean other side of labia.
  40. The fourth leaf is to clean the skin fold on one side
  41. The last leaf will be used the other side. Place on table.
  42. Get a rinse washcloth. And follow the same procedure.  Then pat dry.
  43. Unroll the blanket which will put her gown back where it needs to be, removing towel in the process.
  44. Have the patient scoot towards you and roll away from you onto left side.
  45. Take the next washcloth and soap four corners
  46. First leaf go from anal opening and up the middle crease
  47. Second leaf cleans one buttocks
  48. Third leaf cleans the other one.
  49. Fourth and final leaf will clean from anal opening and up crease one last time
  50. Rinse and pat dry in same pattern
  51. Roll chucks that is under her/him away from you and under the patient tucking under hit
  52. Take another chuck and roll it up under the soiled chucks.
  53. Have patient roll back down and scoot to middle
  54. Then once you get to the other side, have patient scoot towards you then turn on his/her side away from you.
  55. Remove soil chucks from the bed and roll out the clean chucks
  56. Ask patient to scoot towards middle. Throw the chucks away.
  57. Let the patient know that you will be cleaning up
  58. Put soiled items in dirty linen basket
  59. Empty basin. Rinse.
  60. Pick up with paper towel.
  61. Dry with another paper towel on the inside. Discard
  62. Dry outside with a paper towel and discard.
  63. Get another paper towel & collect lotion and soap to place in basin.
  64. Store basin using a paper towel to open and close drawer
  65. Discard paper towel and barrier
  66. Remove gloves
  67. Let patient know you will be gathering the privacy blanket up and then pull sheet back up.
  68. Put blanket in dirty linen
  69. Make sure patient is comfortable. Give call light
  70. Open curtain and wash hands

Catheter care

Provide catheter care with soap and water to a female resident with an indwelling urinary catheter.  Clean the catheter tubing and perineal area only.

Supplies:  Barrier for table, towel, privacy blanket, bath basin, soap, under pad, four washcloths, gloves.

  1. Knock
  2. Greet patient
  3. Introduce yourself
  4. Pleasantries
  5. State what you will be doing
  6. Close curtain
  7. Wash hands
  8. Place barrier on table
  9. Get supplies
  10. Get water for basin
  11. Use paper towel to turn on water
  12. Test water
  13. Ask if temp is ok
  14. Place washcloths in water
  15. Place privacy blanket on patient
  16. Pull sheet down to the knees
  17. Get out a chucks and roll the lengthwise edge toward you and place on bed
  18. Put on gloves
  19. Ask patient to scoot towards you and roll away from you
  20. Unroll chucks under the patient. Be careful with the catheter tubing
  21. Ask patient to roll back over and watch to make sure patient doesn’t roll on catheter
  22. Ask patient to scoot towards the middle of bed
  23. Go to other side of bed and have patient scoot towards you and roll up on the other side facing away from you.
  24. Roll out chucks
  25. Ask patient to roll back over and scoot towards middle
  26. Let the patient you will rolling the blanket and gown up into each other so that you can clean the catheter. Be careful not to grab the catheter.
  27. Place towel over thighs leaving only catheter area exposed.
  28. With the first washcloth, apply soap to four leaves
  29. Let patient know you will be cleaning the catheter at this point.
  30. Grab the catheter where it exits the body.
  31. With the other hand and first leaf, wash from area closest to body to away
  32. Take second leaf, and wipe again
  33. Leaf three and four do the same
  34. Rinse in the same method
  35. Dry catheter; Next is perineal care
  36. Next washcloth-soap five corners
  37. Lift the catheter with your pinkie and hold the labia open
  38. Use the index and middle finger to slightly open exposing the perineal area, so that you can clean down the inside middle using the first leaf of the washcloth. Top to bottom.
  39. Open next leaf and clean one side of the labia.
  40. Open third leaf and clean other side of labia.
  41. The fourth leaf is to clean the skin fold on one side
  42. The last leaf will be used the other side. Place on table.
  43. Get a rinse washcloth. And follow the same procedure.  Then pat dry.
  44. Remove towel
  45. Unroll the blanket which will put her gown back where it needs to be. Make sure that the catheter is on the bed, not hanging close to the ground and not under patient, nor kinked.
  46. Let the patient know that you will be cleaning up
  47. Put soiled items in dirty linen basket
  48. Empty basin. Rinse.
  49. Pick up with paper towel.
  50. Dry with another paper towel on the inside. Discard
  51. Dry outside with a paper towel and discard.
  52. Get another paper towel & collect soap to place in basin.
  53. Store basin using a paper towel to open and close drawer
  54. Discard paper towel and barrier
  55. Ask patient to scoot towards you and roll away from you.
  56. Roll soiled chucks towards patient and tuck under
  57. Ask patient to roll back over and scoot towards middle. Make sure the patient is not on catheter.
  58. Go to the other side of bed and ask patient to roll onto his/her side away from you.
  59. Remove chucks
  60. Ask patient to scoot back to middle and throw chucks away
  61. Check catheter
  62. Remove chucks from the table and throw it away
  63. Remove gloves
  64. Let patient know you will be gathering the privacy blanket up and then pull sheet back up.
  65. Put blanket in dirty linen
  66. Make sure patient is comfortable. Give call light
  67. Open curtain and wash hands

Change an occupied bed

Change the top sheet, bottom sheet, and pillow case while the resident remains in bed.  Resident can roll and move as directed but cannot get out of bed.  A bedspread, blanket, draw sheet or under pad is not required for this skill.

Supplies:  Barrier for table, bottom and top sheet, pillowcase, privacy blanket, dirty linen hamper

  1. Knock
  2. Greet patient
  3. Introduce yourself
  4. Pleasantries
  5. State what you will be doing
  6. Close curtain
  7. Wash hands
  8. Place barrier on table
  9. Get supplies
  10. Place blanket over patient
  11. Ask patient to hold onto blanket so that you can remove the sheet from the bed and place it in dirty linen.
  12. Ask patient to scoot towards you and ask him/her to roll away from you.
  13. Remove both corners on the side you are on and roll it towards the patient. Tuck under him/her.
  14. Take the fitted sheet and put the two corners on your side each end of the bed
  15. Roll the clean sheet towards you and tuck under dirty sheet and patient. Keep tight without wrinkles
  16. Ask the patient to roll back on his/her back and scoot towards center.
  17. Go to the other side, have patient scoot towards you and roll onto his/her side looking away from you
  18. Remove soiled sheet and wrap into ball and put in dirty linen
  19. Unroll clean sheet and secure corners on the mattress. Try to reduce wrinkles
  20. Ask patient to roll back on his/her back and scoot towards middle
  21. Put the top sheet over patient and remove blanket in a ball and place in dirty linen
  22. Now to secure sheet. Lift the bottom of the mattress and tuck sheet under.
  23. Make hospital corners on both sides
  24. Loosen the bottom so that the patient can move
  25. Remove pillow from under head, letting the patient know what you are doing.
  26. Remove pillowcase and put pillow on table while you put pillowcase in dirty linen
  27. Put the clean pillowcase (bunching it up like you are putting a sock on a child) on the pillow making sure the labels are on the inside
  28. Place the pillow under patient with opening facing away from the door
  29. Ask the patient if the patient is comfortable. Give call light.  Ask if the patient will need anything further.
  30. Throw barrier away
  31. Open curtain
  32. Wash hands

Dressing a patient

Dress the resident in a long-sleeved button-front shirt, pants and socks.  The resident is lying in bed and has a weak right arm.  Resident is not able to help with dressing.  After dressing, leave the resident in bed.

Supplies:  Barrier for table, clean clothing, bath blanket.

  1. Knock
  2. Greet patient
  3. Introduce yourself
  4. Pleasantries
  5. State what you will be doing
  6. Close curtain
  7. Wash hands
  8. Place barrier on table
  9. Ask patient which outfit the patient would like to wear
  10. Ask if you got the right outfit
  11. Get the privacy blanket and place over patient
  12. Pull sheet down to edge of bed
  13. Put on socks by scrunching up socks as you would be doing for a small child
  14. Now to work with the pants. Make sure tag is in the back.
  15. Insert your arm into the pants and scrunch it up so that you are able to put the pants on easier
  16. Pull that leg over the hill of the foot.
  17. Go to the other side and do the same.
  18. Pull the pants up to the hips.
  19. Ask patient to raise hips as high as the patient can and do it on count of three
  20. Pull pants up over hips, straightening as you go.
  21. Cover the bottom half of patient back up
  22. Elevate the head of the bed
  23. Ask patient to lean forward so that you can untie the gown from the neck
  24. Tuck one corner behind his/her back
  25. Remove the gown from this side (strong arm first).
  26. Go to the other side of the bed.
  27. Undress that arm, supporting the elbow as you lift off the bed.
  28. Remove the soiled gown
  29. Rest the arm on the bed.
  30. Go get the blouse and scrunch up the sleeve for weak arm.
  31. Put your arm through the sleeve and grab patient’s hand as if you are going to shake it, but does not lift arm off bed.
  32. Once you have the sleeve completely on the forearm, grab the sleeve while supporting weak arm at elbow and pull up and over shoulder.
  33. Ask patient to sit forward and assist him/her.
  34. Pull the shirt along the back and to the other side making sure to minimize any wrinkles
  35. Ask patient to lean back.
  36. Go to other side
  37. Ask the patient for assistance to get arm in sleeve. Scrunch up the sleeve so that you put your hand into his/her sleeve and grab his/her hand.
  38. Pull shirt sleeve the rest of the way on.
  39. Let him/her know the patient can now rest his/her arm.
  40. You now let him/her know as you are doing it that you will be straightening his/her blouse and snapping correctly
  41. Ask him/her to lean forward.
  42. Remove privacy blanket.
  43. Put blanket and gown in dirty linen.
  44. Adjust clothing, making sure it is neat.
  45. Make sure the patient has his/her call light and ask if the patient will need anything further.
  46. Throw barrier away
  47. Open curtain
  48. Wash hands

 

Provide foot care

Provide foot care to one foot using soap and water.  Apply lotion to top and bottom of foot.  The resident is sitting in a chair and his/her sock and shoe should be replaced at the end of skill.

Supplies: Barrier for table, towel, soap, gloves, bath basin, soap, socks/shoes, two washcloths, lotion

  1. Knock
  2. Greet patient
  3. Introduce yourself
  4. Pleasantries
  5. State what you will be doing
  6. Close curtain
  7. Wash hands
  8. Place barrier on floor in front of patient
  9. Ask patient to place his/her foot on the barrier
  10. Get the basin, soap, and lotion
  11. Place on barrier
  12. Get two washcloths, towel, and set of gloves
  13. Take the basin to get water.
  14. Get water for basin
  15. Use paper towel to turn on water
  16. Test water
  17. Ask if temp is ok
  18. Place basin on floor
  19. Kneel on barrier and put on gloves
  20. Roll up his/her pants legs
  21. Ask him/her to lift his/her foot so that you can remove his/her sock
  22. Place the foot in basin to soak
  23. Wet washcloth in basin (ring it out)
  24. Put foot on towel
  25. Put soap on washcloth
  26. Wash all surfaces of foot, put the wash cloth off to the side
  27. Rinse and pat foot dry
  28. Take one of the narrow edges to blot between toes dry
  29. Dry the bottom of foot
  30. Take lotion and warm in your hands before applying to foot. DO NOT Put lotion between toes
  31. Wipe off excess lotion
  32. Put the foot back on barrier
  33. Scrunch up sock and put back on foot
  34. Pull down pants leg
  35. Ask the patient to help you slide his/her shoe back on.
  36. Let him/her know that you will be putting your supplies away
  37. Take the dirty linen and place in the dirty linen basket
  38. Empty basin. Rinse.
  39. Pick up with paper towel.
  40. Dry with another paper towel on the inside. Discard
  41. Dry outside with a paper towel and discard.
  42. Get another paper towel & collect soap to place in basin.
  43. Store basin using a paper towel to open and close drawer
  44. Discard paper towel
  45. Collect barrier and dispose of it
  46. Remove gloves
  47. Ask if the patient is comfortable, and if the patient needs anything. Give him/her his/her call light.
  48. Open curtain and wash hands.

Mouth Care – Dentures

A resident with dentures is sitting at an overbed table with his/her dentures in a denture cup.  The resident’s denture needs to be brushed with toothpaste and the resident needs mouth care.  The denture is stored in a denture cup after cleaning.  The resident is not able to provide own mouth or denture care.

Supplies:  Barrier for table, toothpaste, washcloth, denture brush, emesis basin, towel, toothette, cup of water, 2 pairs of gloves.

  1. Knock
  2. Greet patient
  3. Introduce yourself
  4. Pleasantries
  5. State what you will be doing
  6. Close curtain
  7. Wash hand
  8. Place a barrier on the table
  9. Gather supplies
  10. Wet denture brush
  11. Apply toothpaste to both sides
  12. Put denture brush in basin until you need it
  13. Let the patient know that you are going to go clean the dentures
  14. Place the washcloth in bottom of sink, over drain
  15. Put the emesis basin with denture brush down on sink
  16. Put on gloves
  17. Use a paper towel to turn water on – use only cool water
  18. Rinse dentures in cool running water
  19. Brush all surfaces of dentures, removing all food particles
  20. Rinse denture brush and place in basin
  21. Rinse dentures thoroughly with cool running water
  22. Rinse denture cup and fill with cool water
  23. Place dentures in water in cup; cover with lid
  24. Store denture cup on paper towel
  25. Ring out wash cloth and put in dirty linens
  26. Pick up denture cup and basin and place dentures on nightstand beside patient & place basin on barrier on the table
  27. Take denture brush from basin and place on barrier
  28. Remove gloves & throw away
  29. Ask to place towel over chest, then place
  30. Take the toothette out of packaging, wet it
  31. Put toothpaste on one area of the toothette and put in basin
  32. Close toothpaste
  33. Apply gloves
  34. Let the patient know you will be brushing his/her teeth soon
  35. Please open his/her mouth wide, so that you can brush the back teeth
  36. Back bottom, then top, both sides
  37. Ask the patient to bring his/her teeth together
  38. Brush tongue
  39. Throw toothbrush away (blue sponge toothbrush)
  40. Offer water to rinse
  41. Place basin below mouth so that he/she can spit in it.
  42. Wipe mouth
  43. Offer second rinse
  44. Spit and wipe
  45. Offer again At that point if it is no, discontinue
  46. Remove towel and put in dirty linen
  47. Throw away the disposables
  48. Take basin to sink to clean
  49. Rinse basin and clean anything that sticks
  50. Once clean pick up basin with paper towel
  51. With another paper towel dry the inside of the basin
  52. With a second paper towel, dry the outside
  53. Once dry, put the denture brush, toothpaste in the basin and put away using the paper towel to open drawer
  54. Remove and throw away barrier
  55. Remove gloves and throw away
  56. Ask patient if there is anything you can do for him/her, and let him/her know his/her call light is within reach
  57. Open curtain
  58. Wash hands

Mouth care – brush teeth

A resident with natural teeth is lying in bed and needs mouth care.  The resident is not able to provide his/her own mouth care.

Supplies:  barrier for table, toothbrush, toothpaste, towel, emesis basin, cup of water, gloves

  1. Knock
  2. Greet patient
  3. Introduce yourself
  4. Pleasantries
  5. State what you will be doing
  6. Tell the patient that you will be lifting the head of the bed up to a full upright sitting position
  7. Ask him/her to lean forward so that you can move the pillow to bring him/her further forward
  8. Ask if it is comfortable
  9. Close curtain
  10. Wash hand
  11. Place a barrier on the table
  12. Gather supplies
  13. Prepare toothbrush
  14. Get it wet
  15. Put toothpaste on it
  16. Place in basin
  17. Ask if it is alright to put towel on the upper half & place it
  18. Put on gloves
  19. Brush the back on the bottom and top, both sides
  20. Ask him/her to bring his/her teeth together and brush the front
  21. Ask him/her to stick out his/her tongue so that you can brush it as well.
  22. Set the toothbrush aside
  23. Offer the patient a sip of water and ask him/her to rinse the mouth
  24. Tell the patient to sip in the basin and wipe face
  25. Ask if the patient would like another sip
  26. Dispose of wrapper, toothbrush, and cup
  27. Remove the towel and place in dirty linen
  28. Take the basin to be clean. Dump the water and rinse removing an debris
  29. Take a paper towel and hold the basin.
  30. Grab another and dry the inside.
  31. Take another and dry the outside.
  32. Grab another paper towel and pick up toothpaste
  33. Use the paper towel to open the drawer to the basin with the toothpaste away
  34. Clean up work environment
  35. Take off gloves
  36. Ask patient if the patient need anything and give him/her the call light
  37. Open curtain
  38. Wash hands

Hand and Nail Care

Provide hand and nail care to one hand.  The patient is sitting in a chair at the bedside and can move as directed.

Supplies:  barrier for table, towel, bath basin, two washcloths, soap, lotion, orangewood stick, emery board, gloves (optional)

  1. Knock
  2. Greet patient
  3. Introduce yourself
  4. Pleasantries
  5. State what you will be doing
  6. Close curtain
  7. Wash hand
  8. Place a barrier on the table
  9. Gather supplies
  10. Gloves are not required for the state exam because there is no exposure to body fluid, personal skin, or non-intact skin
  11. Inform the patient that you will be getting water for the basin
  12. Turn on faucet with paper towel and test water before putting in basin
  13. Turn off faucet with paper towel and throw the towel away
  14. Get patient to test water
  15. Ask patient to put his/her hand in the water and move if necessary the table toward him/her
  16. Put washcloths in basin
  17. Use one of the washcloths to get the hand wet and set it on the side of basin
  18. Place his/her hand on a towel while you pick up the wet washcloth
  19. Put soap on the washcloth and wash the patient’s hand (top including finger, then palm)
  20. Place hand back into basin to rinse
  21. Take the other washcloth and rinse soap off hand
  22. As you are opening the towelette let the patient know that you will moving his/her hand to the towel.
  23. Pat dry going between fingers then palm of hand
  24. Now take the orange stick and go under each nail. Just cleaning the edge
  25. Ask if it hurts
  26. As you do each nail, wipe the orange stick on the nail.
  27. Next file any rough edges of the nail going from outside to middle
  28. Apply lotion to your hands warming it, then rub it on patient’s
  29. Ask if it feels good and wipe off excess
  30. Set the hand down, asking how it feels and let the patient know you will be putting the soil linen in the dirty laundry
  31. Pour out basin into the sink, turn on water to rinse out, grab paperwork to hold basin with.
  32. Grab another basin and wipe out the inside of basin
  33. Grab another basin to wipe the outside with
  34. With a fourth paper towel, pick up the soap, and lotion and place in basin
  35. Use paper towel to open drawer and put basin away
  36. And throw everything else away
  37. Ask patient if everything is okay
  38. Let the patient know his/her call light is nearby
  39. Open curtain
  40. Wash hands

Transfer

Transfer the resident from bed into the wheelchair.  The resident is unable to walk or take steps, but can stand with support.  A gait belt or transfer belt is required to transfer the resident.  The resident will stay in the room.

Supplies:  Wheelchair, gait belt, non-skid footwear (patient’s own)

  1. Knock
  2. Greet patient
  3. Introduce yourself
  4. Pleasantries
  5. State what you will be doing
  6. Close curtain
  7. Wash hands
  8. Get supplies
  9. Let your patient know that you will be pivoting him around so that you can assist him/her into wheelchair
  10. Ask the patient who is lying down to scoot towards you first
  11. Ask patient to cross his/her arms over his/her chest.
  12. Inform the patient that you will be placing one arm under his/her shoulders and the other arm over the knees while having a wide stance
  13. Let the patient know that on the count of 3 you will be pivoting him/her
  14. Ask if comfortable and to sit up straight and if the patient are dizzy
  15. Tell the patient you will assist him/her putting his/her shoes on.
  16. Ask the patient if his/her feet are securely in the shoes and if his/her feet are flat on the floor
  17. Go get the gait belt
  18. Inform the patient that you are going to put a gait belt around his/her waist to help you lift and pivot the patient into the chair
  19. As you placing the gait belt around his/her waist, ask him/her to lift his/her arms
  20. Tighten the belt-making sure it is four fingers depth
  21. You will be going through the loops in one direction then returning to previous direction to lock it in place on the second bar
  22. Go get the wheelchair and position it at a slight angle close to the bed almost touching the patient
  23. Lock wheels into place
  24. Tell the patient to bring his/her feet together and slightly back
  25. Place your foot perpendicular to his/her feet
  26. Ask the patient to put his/her hands on your shoulders and tell him/her on the count of three you will lifting him/her and placing him/her into the wheelchair
  27. Once he/she has placed his/her arms on your shoulders count to three holding the gait belt firmly in your hands while you lift and pivot him/her into the chair
  28. Remove the gait while asking the patient to lift his/her arms
  29. Unlock the wheelchair and turn the patient around
  30. Lock the wheelchair in place and let the patient know that you will be positioning the leg rest and pedal so that his/her legs are supported.
  31. Put his/her foot on the pedals
  32. Let him/her know where his/her call light is and ask if the patient need further assistance.
  33. Open privacy curtain and wash hands

Bedpan

The resident has requested a bedpan.  The resident is not wearing undergarments and is able to wipe self.

Supplies:  Underpad (chucks), bath blanket, bedpan, toilet paper, hand wipe (towelette), gloves (two pairs)

  1. Knock
  2. Greet patient
  3. Introduce yourself
  4. Pleasantries
  5. Let him/her know that you understand that he/she will need a bedpan
  6. Close curtain
  7. Wash hands
  8. Get supplies
  9. Place the privacy blanket over the patient
  10. Ask if that is alright
  11. Ask patient to hold the privacy blanket so that you can pull the sheet down
  12. Prepare the chucks with lengthwise going crossway – rolling chucks toward you (clean toward, dirty away)
  13. Place it on the bed beside patient
  14. Open the drawer where the bedpan is place
  15. Put on a set of gloves
  16. Inform the patient that you will need him/her to bend his/her knees and lift his/her body as far off the chucks as able to do so that you can roll out chucks
  17. Tell to relax
  18. Go around to the other side and ask him/her to lift his/her body up again so that you can finish unrolling
  19. Make sure it is positioned properly on the bed and let the patient know he/she can relax
  20. Get the bedpan with toilet tissue out of drawer
  21. Ask the patient to lift his/her body so that you can place bedpan under patient
  22. Tell him/her to relax and ask if the patient are comfortable
  23. Tell him/her you will be removing your gloves (dispose of gloves) and raising the head of the bed up
  24. Raise the head of the bed up – asking him/her to let you know when comfortable and the bed pan may need adjustment
  25. Give him/her the toilet paper and call light and explain that you will wait outside and to let you know when he/she are done
  26. Come back in – let he/she know that you understand he/she are finished
  27. Explained to he/she that you will be lowering the head of the bed down
  28. Ask the patient not to lift his/her hips
  29. Put on another set of gloves
  30. Inform the patient that you will need to lift off the bedpan as you hold it flat
  31. Grab one corner of the chucks and use it to grab the bedpan (Count 1-3)
  32. Use the rest of chucks to cover bedpan
  33. Inform the patient that you will now be taking the chucks and bedpan to dispose of its contents
  34. Once in the bathroom uncover chucks
  35. Throw the chucks away
  36. Lift toilet lid and empty bedpan
  37. Rinse the bedpan by turning on water
  38. Put rinse water into the toilet as well
  39. Close toilet seat
  40. Put bedpan in sink
  41. Get a paper towel and grab the outside of bedpan
  42. Dry the inside with a second paper towel and dispose
  43. Dry the outside with a third paper towel and dispose
  44. Get a fourth paper towel and use it for the drawer
  45. Place bedpan with toilet paper inside into the drawer and close with the fourth paper towel
  46. Dispose of gloves
  47. Ask him/her if the patient need to wipe his/her hand with a towelette
  48. Have the towel for him/her to put the towelette into your hand Dispose
  49. Tell the patient to lower the legs
  50. Pull the sheet up while removing blanket into a ball
  51. Give the patient the call light
  52. Explain to the patient that you will be putting the blanket into dirty linen
  53. Ask if comfortable and need anything
  54. Open curtain
  55. Wash hands

Drainage bag

Empty the resident’s urinary drainage bag into a graduate container and measure and record urinary output (in ml’s or cc’s) on intake and output form

Supplies:  Barrier (chucks), gloves, triangular graduate container, documentation sheet

  1. Knock
  2. Greet patient
  3. Introduce yourself
  4. Pleasantries
  5. Let him/her know that you need to empty the urinary drainage bag
  6. Close curtain
  7. Wash hands
  8. Get your supplies
  9. Get a barrier and place on the floor under urinary drainage bag
  10. Get and put on gloves
  11. Get the triangular graduate container & place on the barrier near where you will be working
  12. Inspect the catheter to make sure the patient is not lying on it & check to see if it has any kinks or off on the floor where someone might trip on it
  13. Remove the port from its protective sleeve on the back
  14. Slide the valve to the side
  15. Now you will be able to empty the bag by positioning the port over the triangular graduate container and tilt the bag slightly to the side DO NOT Allow the port to touch any surface
  16. Once the bag is empty slide the valve back to its previous position. Do this carefully
  17. Make sure the bag is hanging on a non movable part of the bed and not touching the floor
  18. Fold the chucks over the graduated container and carry it to the patient’s bathroom
  19. Once in the bathroom set the container with barrier down on a flat surface
  20. Squat at eye level with the container and read the container. Rounding to the nearest line
  21. Once you have measure the amount, document it.
  22. Empty the urinary graduate container into the toilet and throw the barrier away
  23. Rinse the container
  24. Put the rinse water into the toilet
  25. Once you put the rinse water into the toilet, set the container down in the sink
  26. Grab a paper towel to pick it up
  27. Get another paper towel and dry the outside
  28. Get another paper towel and dry the inside
  29. Get a final paper towel and use it to open the drawer to put container away
  30. Throw the paper towels away and remove gloves
  31. Ask the patient if they need anything and give them the call light
  32. Open the curtain
  33. Wash hands
  34. Document on the sheet which you are given (time, type, amount in cc’s, and initials)

Feed Resident

Feed a resident a snack who is unable to feed him/herself.  The resident is sitting in a chair, in an appropriate position for eating.  Document intake on a food and fluid intake form.

Supplies:  Meal tray, Documentation sheet, towelette (hand wipe), clothing protector (towel)

  1. Knock
  2. Greet patient
  3. Introduce yourself
  4. Pleasantries
  5. Ask him/her if he/she would like a snack
  6. Ask them to sit up straight
  7. Wash hands
  8. Get your supplies
  9. Allow the resident to use a hand wipe to cleanse their hand. They will place in your hand that has the paper towel and you will discard
  10. Offer a clothing protector and put it over the patient’s clothes
  11. Open the snack while letting the patient know what it is.
  12. Offer a drink to get started
  13. Offer a spoonful and make conversation (asking them if would like more between bites)
  14. Offer a drink
  15. Offer another bite
  16. Once the patient says he/she has enough, confirm the answer
  17. Let the patient know that if he/she gets hungry that you will be happy to get him/her more food—to only let you know
  18. Take a napkin and wipe the face
  19. Remove clothing protector and put in dirty linen
  20. Take the tray away
  21. Discard any uneaten or unused food and beverage
  22. Place tray on table and ask the patient if there is anything further you can do
  23. Make sure the call light is within reach and let him/her know.
  24. Tell the patient you will go wash your hands and going to go document

Change Position

Position the resident on his left side.  Patient requires support to remain on his side and is unable to assist with turning

Supplies:  Barrier for table, 3 additional pillows, and bath blanket

  1. Knock
  2. Greet patient
  3. Introduce yourself
  4. Pleasantries
  5. Close curtain
  6. Wash hands
  7. Gather supplies, start with a barrier
  8. Lay it on the table
  9. Put 3 pillows on the table
  10. Place blanket
  11. Fold the sheet down under the blanket making sure patient stays covered
  12. Ask patient to scoot towards you
  13. Put the opposing arm above the patient’s head
  14. Take the closest arm and put the hand on the patient’s opposite shoulder
  15. Then bend the closest knee and put the foot flat on the bed
  16. Then angle the opposing leg out a little bit
  17. Now turn the patient on his/her side
  18. Next take a pillow and lay it with one of its long edges on the top of the back, and the rest of the pillow at an angle across the back
  19. Take the top edge and shove it underneath the patient, and fold the bed edge of the pillow on top of that underneath portion and shove underneath the patient
  20. Position a pillow between the legs lengthwise (between knees and ankles)
  21. Place the final pillow under the patient’s upper arm with the arm laying lengthwise on the pillow
  22. Then adjust the pillow under head so that it is not under the shoulder, but only under the head and neck
  23. Finally move the arm into a more comfortable position.
  24. Ask if it is comfortable and as place the call light let him/her know that you are doing so.
  25. Ask if he/she need anything further and that you are pulling the sheet up
  26. Remove the privacy blanket and place in dirty linen
  27. Throw barrier away
  28. Let patient know that you are opening curtain and you will be washing hands

 

Respirations

Patient will be lying in bed for skill.  Count the patient’s respirations for one full minute and record your readings.  Do not tell the patient that you will be counting their respirations or breathing. That will make the patient aware of their breathing and alter their breathing patterns, leading to an inaccurate reading.  Tell the patient you will taking their vital signs instead.

Supplies: watch or clock, pen, documentation sheet

Note:  Placing an alcohol pad on the patient’s abdomen will make it easier to see the rise and fall of this area during breathing (because your eyes are drawn to movement when it is a contrasting color).

Note:  Do not stand over a patient, staring without touching them, when counting their respirations.  Hold the wrist as though you are counting their pulse.  This will help decrease anxiety and regulate the patient’s breathing, allowing you to obtain an accurate reading.

  1. Knock
  2. Greet patient
  3. Introduce yourself
  4. Pleasantries
  5. Tell them that you need to get their vital signs
  6. Close curtain
  7. Wash hands
  8. Ask them to remain quiet and let him/her know you are placing the alcohol pad. Ask if ok
  9. Let them know when you start.
  10. Count how many times the abdomen raises and falls. In and out = one breath
  11. Say stop when it reaches one minute
  12. Let them know that you are finished and ask them if they need anything else and hand them their call light and let them know you are available if needed.
  13. Open curtain and document findings

Pulse

Patient will be lying in bed for skill.  Count the patient’s radial pulse, measured at the wrist, for one full minute and record your readings

Supplies:  Watch or clock, pen and documentation sheet

  1. Knock
  2. Greet patient
  3. Introduce yourself
  4. Pleasantries
  5. Tell them that you need to get their vital signs
  6. Close curtain
  7. Wash hands
  8. When you return, pick up the patient’s wrist (DO NOT USE your thumb to find the pulse.)
  9. Count the thumps that you feel under your fingers for one full minute.
  10. Say stop when it reaches one minute
  11. Let them know that you are finished and ask them if they need anything else and hand them their call light and let them know you are available if needed.
  12. Open curtain, wash hands and document findings

For the exam, you will count again with the second evaluator and record your reading here

Bing offers this for radial pulse Bing Radial Pulse

Ambulation

Ambulate the resident at least 10 steps.  Use a gait belt or transfer belt.  Patient will be sitting in chair at side of bed with shoes on.  Patient is able to walk but needs assistance to stand.

Supplies:  non skid footwear, gait belt

  1. Knock
  2. Greet patient
  3. Introduce yourself
  4. Pleasantries
  5. Ask if they would like to go for a walk
  6. Close curtain
  7. Wash hands
  8. Ask the patient if they are dizzy
  9. Inform patient that you will putting a gait belt around their waist to help you with support
  10. Slide the belt around his/her waist
  11. Ask the patient to lift his/her arms so that you can put into place
  12. Let them know they can relax
  13. As with any belt, put the free end through the first bar
  14. Snug it up to four fingers and bring the free end and bring it through the last bar
  15. Ask your patient to bring their legs closer together and with feet flat on floor
  16. Tell the patient that you will be needing him/her  to put his/her hands on your shoulders while you grab the gait belt and lift
  17. Then put one foot in front and another on the side while grabbing the gait belt
  18. Tell the patient that on the count of three that you will help them rise
  19. Ask if the patient if he/she is dizzy
  20. Stand on the weaker side and inform the patient that you are going to let them lead.
  21. Tell the patient where you both will be walking to and ask if he/she feel dizzy
  22. Help the patient turn around and walk back to the chair
  23. Once in front of the chair, ask the patient to turn around and back up to the chair
  24. Once the above task has been completed, inform the patient that you would like him/her to place his/her hands on your shoulders so that you can assist in sitting
  25. Once you both are ready, inform the patient you will position yourself as before and on the count of three he/she will sit
  26. One-two-three
  27. Ask how he/she feels
  28. Remove the gait belt
  29. Ask if anything else is needed and give him/her the call light
  30. Tell the patient you will be opening the curtain and washing hands

Range of Motion Hip, Knee and Ankle

Range of Motion Shoulder

Range of Motion Elbow and Wrist

Here are a couple videos for the written portion.

Advertisements