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.
- Knock
- Greet patient
- Introduce yourself
- Pleasantries
- State what you will be doing
- Close curtain
- Place barrier on table
- Get supplies
- Get water for basin
- Use paper towel to turn on water
- Test water
- Ask if temp is ok
- Place privacy blanket
- Pull sheet to waist
- Place washcloths in water
- Ask patient to sit forward
- Untie gown
- Place towel under patient
- Spread towel under arm
- Take gown off on the side closest to you and place on other side of body
- Put on gloves
- Wash cloth for face NO SOAP Use the four corners method
- Wash eye closest to you going from inner to outer using first leaf
- Wash opposing eye using the exact same method but use second leaf
- Wash the rest of the face with third leaf
- Wash the nose with the final leaf
- Rinse and pat dry using same sequence
- Next use a whole wash cloth with soap for the body.
- Wash behind the ear closest to you, under chin, and behind second ear
- Wash neck
- Then the remainder of torso
- Clean front of arm, and hand, then back and finally the underarm
- Rinse and pat dry using the same sequence
- Place gown on the side closest to you. Spread gown out across the body.
- Take off the other side of gown, put gown in dirty linen, and then put on the other side of gown.
- Ask patient to scoot towards you, and turn on left side.
- Take third wash cloth (put soap on it) and wash back of neck, shoulders, back down to waist.
- With final wash cloth, rinse in same method. Then pat dry with towel
- 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.
- Tie patient’s gown
- Remove towel which was under the body.
- Have patient turnover and scoot toward the middle. And let patient know what you are doing.
- Clean up dirty linens.
- Empty basin. Rinse.
- Pick up with paper towel.
- Dry with another paper towel on the inside. Discard
- Dry outside with a paper towel and discard.
- Get another paper towel & collect lotion and soap to place in basin.
- Store basin using a paper towel to open and close drawer
- Discard paper towel and barrier
- Remove gloves
- Remove privacy blanket while not trying to let it touch your clothes.
- Pull sheet up
- Place privacy blanket in dirty linen
- Give call light and ask if the patient need anything
- Open privacy curtain
- 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.
- Knock
- Greet patient
- Introduce yourself
- Pleasantries
- State what you will be doing
- Close curtain
- Wash hands
- Place barrier on table
- Get supplies
- Get water for basin
- Use paper towel to turn on water
- Test water
- Ask if temp is ok
- Place washcloths in water
- Place privacy blanket
- Pull sheet to knees
- Now get chucks ready for use
- Unfold chucks
- Roll it up lengthwise Rolling toward you Not touching the body
- Repeat (clean rolls toward me, dirty rolls away)
- Put on gloves
- Place one of the chucks on the bed
- Ask patient to scoot toward you
- Roll onto left side
- Roll dirty chucks toward the patient and tuck under hip
- Unroll clean one and tuck under soiled chuck
- Ask patient to roll back onto his/her back and scoot to the middle of bed
- Go to the other side of bed
- Have patient scoot closer to you and roll up on his/her right side
- Remove the soil chucks from bed and unroll the clean one
- Throw the dirty chucks away
- 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
- As you are rolling the blanket up, try to get the gown rolled into the blanket exposing only the perineal area.
- Cover upper legs with a towel
- Get soap out and soap five corners (the fifth corner is the backside of the last corner)
- Use the hill of your hand to raise the perineal area.
- 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.
- Open next leaf and clean one side of the labia.
- Open third leaf and clean other side of labia.
- The fourth leaf is to clean the skin fold on one side
- The last leaf will be used the other side. Place on table.
- Get a rinse washcloth. And follow the same procedure. Then pat dry.
- Unroll the blanket which will put her gown back where it needs to be, removing towel in the process.
- Have the patient scoot towards you and roll away from you onto left side.
- Take the next washcloth and soap four corners
- First leaf go from anal opening and up the middle crease
- Second leaf cleans one buttocks
- Third leaf cleans the other one.
- Fourth and final leaf will clean from anal opening and up crease one last time
- Rinse and pat dry in same pattern
- Roll chucks that is under her/him away from you and under the patient tucking under hit
- Take another chuck and roll it up under the soiled chucks.
- Have patient roll back down and scoot to middle
- Then once you get to the other side, have patient scoot towards you then turn on his/her side away from you.
- Remove soil chucks from the bed and roll out the clean chucks
- Ask patient to scoot towards middle. Throw the chucks away.
- Let the patient know that you will be cleaning up
- Put soiled items in dirty linen basket
- Empty basin. Rinse.
- Pick up with paper towel.
- Dry with another paper towel on the inside. Discard
- Dry outside with a paper towel and discard.
- Get another paper towel & collect lotion and soap to place in basin.
- Store basin using a paper towel to open and close drawer
- Discard paper towel and barrier
- Remove gloves
- Let patient know you will be gathering the privacy blanket up and then pull sheet back up.
- Put blanket in dirty linen
- Make sure patient is comfortable. Give call light
- 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.
- Knock
- Greet patient
- Introduce yourself
- Pleasantries
- State what you will be doing
- Close curtain
- Wash hands
- Place barrier on table
- Get supplies
- Get water for basin
- Use paper towel to turn on water
- Test water
- Ask if temp is ok
- Place washcloths in water
- Place privacy blanket on patient
- Pull sheet down to the knees
- Get out a chucks and roll the lengthwise edge toward you and place on bed
- Put on gloves
- Ask patient to scoot towards you and roll away from you
- Unroll chucks under the patient. Be careful with the catheter tubing
- Ask patient to roll back over and watch to make sure patient doesn’t roll on catheter
- Ask patient to scoot towards the middle of bed
- Go to other side of bed and have patient scoot towards you and roll up on the other side facing away from you.
- Roll out chucks
- Ask patient to roll back over and scoot towards middle
- 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.
- Place towel over thighs leaving only catheter area exposed.
- With the first washcloth, apply soap to four leaves
- Let patient know you will be cleaning the catheter at this point.
- Grab the catheter where it exits the body.
- With the other hand and first leaf, wash from area closest to body to away
- Take second leaf, and wipe again
- Leaf three and four do the same
- Rinse in the same method
- Dry catheter; Next is perineal care
- Next washcloth-soap five corners
- Lift the catheter with your pinkie and hold the labia open
- 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.
- Open next leaf and clean one side of the labia.
- Open third leaf and clean other side of labia.
- The fourth leaf is to clean the skin fold on one side
- The last leaf will be used the other side. Place on table.
- Get a rinse washcloth. And follow the same procedure. Then pat dry.
- Remove towel
- 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.
- Let the patient know that you will be cleaning up
- Put soiled items in dirty linen basket
- Empty basin. Rinse.
- Pick up with paper towel.
- Dry with another paper towel on the inside. Discard
- Dry outside with a paper towel and discard.
- Get another paper towel & collect soap to place in basin.
- Store basin using a paper towel to open and close drawer
- Discard paper towel and barrier
- Ask patient to scoot towards you and roll away from you.
- Roll soiled chucks towards patient and tuck under
- Ask patient to roll back over and scoot towards middle. Make sure the patient is not on catheter.
- Go to the other side of bed and ask patient to roll onto his/her side away from you.
- Remove chucks
- Ask patient to scoot back to middle and throw chucks away
- Check catheter
- Remove chucks from the table and throw it away
- Remove gloves
- Let patient know you will be gathering the privacy blanket up and then pull sheet back up.
- Put blanket in dirty linen
- Make sure patient is comfortable. Give call light
- 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
- Knock
- Greet patient
- Introduce yourself
- Pleasantries
- State what you will be doing
- Close curtain
- Wash hands
- Place barrier on table
- Get supplies
- Place blanket over patient
- Ask patient to hold onto blanket so that you can remove the sheet from the bed and place it in dirty linen.
- Ask patient to scoot towards you and ask him/her to roll away from you.
- Remove both corners on the side you are on and roll it towards the patient. Tuck under him/her.
- Take the fitted sheet and put the two corners on your side each end of the bed
- Roll the clean sheet towards you and tuck under dirty sheet and patient. Keep tight without wrinkles
- Ask the patient to roll back on his/her back and scoot towards center.
- Go to the other side, have patient scoot towards you and roll onto his/her side looking away from you
- Remove soiled sheet and wrap into ball and put in dirty linen
- Unroll clean sheet and secure corners on the mattress. Try to reduce wrinkles
- Ask patient to roll back on his/her back and scoot towards middle
- Put the top sheet over patient and remove blanket in a ball and place in dirty linen
- Now to secure sheet. Lift the bottom of the mattress and tuck sheet under.
- Make hospital corners on both sides
- Loosen the bottom so that the patient can move
- Remove pillow from under head, letting the patient know what you are doing.
- Remove pillowcase and put pillow on table while you put pillowcase in dirty linen
- 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
- Place the pillow under patient with opening facing away from the door
- Ask the patient if the patient is comfortable. Give call light. Ask if the patient will need anything further.
- Throw barrier away
- Open curtain
- 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.
- Knock
- Greet patient
- Introduce yourself
- Pleasantries
- State what you will be doing
- Close curtain
- Wash hands
- Place barrier on table
- Ask patient which outfit the patient would like to wear
- Ask if you got the right outfit
- Get the privacy blanket and place over patient
- Pull sheet down to edge of bed
- Put on socks by scrunching up socks as you would be doing for a small child
- Now to work with the pants. Make sure tag is in the back.
- Insert your arm into the pants and scrunch it up so that you are able to put the pants on easier
- Pull that leg over the hill of the foot.
- Go to the other side and do the same.
- Pull the pants up to the hips.
- Ask patient to raise hips as high as the patient can and do it on count of three
- Pull pants up over hips, straightening as you go.
- Cover the bottom half of patient back up
- Elevate the head of the bed
- Ask patient to lean forward so that you can untie the gown from the neck
- Tuck one corner behind his/her back
- Remove the gown from this side (strong arm first).
- Go to the other side of the bed.
- Undress that arm, supporting the elbow as you lift off the bed.
- Remove the soiled gown
- Rest the arm on the bed.
- Go get the blouse and scrunch up the sleeve for weak arm.
- 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.
- Once you have the sleeve completely on the forearm, grab the sleeve while supporting weak arm at elbow and pull up and over shoulder.
- Ask patient to sit forward and assist him/her.
- Pull the shirt along the back and to the other side making sure to minimize any wrinkles
- Ask patient to lean back.
- Go to other side
- 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.
- Pull shirt sleeve the rest of the way on.
- Let him/her know the patient can now rest his/her arm.
- You now let him/her know as you are doing it that you will be straightening his/her blouse and snapping correctly
- Ask him/her to lean forward.
- Remove privacy blanket.
- Put blanket and gown in dirty linen.
- Adjust clothing, making sure it is neat.
- Make sure the patient has his/her call light and ask if the patient will need anything further.
- Throw barrier away
- Open curtain
- 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
- Knock
- Greet patient
- Introduce yourself
- Pleasantries
- State what you will be doing
- Close curtain
- Wash hands
- Place barrier on floor in front of patient
- Ask patient to place his/her foot on the barrier
- Get the basin, soap, and lotion
- Place on barrier
- Get two washcloths, towel, and set of gloves
- Take the basin to get water.
- Get water for basin
- Use paper towel to turn on water
- Test water
- Ask if temp is ok
- Place basin on floor
- Kneel on barrier and put on gloves
- Roll up his/her pants legs
- Ask him/her to lift his/her foot so that you can remove his/her sock
- Place the foot in basin to soak
- Wet washcloth in basin (ring it out)
- Put foot on towel
- Put soap on washcloth
- Wash all surfaces of foot, put the wash cloth off to the side
- Rinse and pat foot dry
- Take one of the narrow edges to blot between toes dry
- Dry the bottom of foot
- Take lotion and warm in your hands before applying to foot. DO NOT Put lotion between toes
- Wipe off excess lotion
- Put the foot back on barrier
- Scrunch up sock and put back on foot
- Pull down pants leg
- Ask the patient to help you slide his/her shoe back on.
- Let him/her know that you will be putting your supplies away
- Take the dirty linen and place in the dirty linen basket
- Empty basin. Rinse.
- Pick up with paper towel.
- Dry with another paper towel on the inside. Discard
- Dry outside with a paper towel and discard.
- Get another paper towel & collect soap to place in basin.
- Store basin using a paper towel to open and close drawer
- Discard paper towel
- Collect barrier and dispose of it
- Remove gloves
- Ask if the patient is comfortable, and if the patient needs anything. Give him/her his/her call light.
- 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.
- Knock
- Greet patient
- Introduce yourself
- Pleasantries
- State what you will be doing
- Close curtain
- Wash hand
- Place a barrier on the table
- Gather supplies
- Wet denture brush
- Apply toothpaste to both sides
- Put denture brush in basin until you need it
- Let the patient know that you are going to go clean the dentures
- Place the washcloth in bottom of sink, over drain
- Put the emesis basin with denture brush down on sink
- Put on gloves
- Use a paper towel to turn water on – use only cool water
- Rinse dentures in cool running water
- Brush all surfaces of dentures, removing all food particles
- Rinse denture brush and place in basin
- Rinse dentures thoroughly with cool running water
- Rinse denture cup and fill with cool water
- Place dentures in water in cup; cover with lid
- Store denture cup on paper towel
- Ring out wash cloth and put in dirty linens
- Pick up denture cup and basin and place dentures on nightstand beside patient & place basin on barrier on the table
- Take denture brush from basin and place on barrier
- Remove gloves & throw away
- Ask to place towel over chest, then place
- Take the toothette out of packaging, wet it
- Put toothpaste on one area of the toothette and put in basin
- Close toothpaste
- Apply gloves
- Let the patient know you will be brushing his/her teeth soon
- Please open his/her mouth wide, so that you can brush the back teeth
- Back bottom, then top, both sides
- Ask the patient to bring his/her teeth together
- Brush tongue
- Throw toothbrush away (blue sponge toothbrush)
- Offer water to rinse
- Place basin below mouth so that he/she can spit in it.
- Wipe mouth
- Offer second rinse
- Spit and wipe
- Offer again At that point if it is no, discontinue
- Remove towel and put in dirty linen
- Throw away the disposables
- Take basin to sink to clean
- Rinse basin and clean anything that sticks
- Once clean pick up basin with paper towel
- With another paper towel dry the inside of the basin
- With a second paper towel, dry the outside
- Once dry, put the denture brush, toothpaste in the basin and put away using the paper towel to open drawer
- Remove and throw away barrier
- Remove gloves and throw away
- Ask patient if there is anything you can do for him/her, and let him/her know his/her call light is within reach
- Open curtain
- 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
- Knock
- Greet patient
- Introduce yourself
- Pleasantries
- State what you will be doing
- Tell the patient that you will be lifting the head of the bed up to a full upright sitting position
- Ask him/her to lean forward so that you can move the pillow to bring him/her further forward
- Ask if it is comfortable
- Close curtain
- Wash hand
- Place a barrier on the table
- Gather supplies
- Prepare toothbrush
- Get it wet
- Put toothpaste on it
- Place in basin
- Ask if it is alright to put towel on the upper half & place it
- Put on gloves
- Brush the back on the bottom and top, both sides
- Ask him/her to bring his/her teeth together and brush the front
- Ask him/her to stick out his/her tongue so that you can brush it as well.
- Set the toothbrush aside
- Offer the patient a sip of water and ask him/her to rinse the mouth
- Tell the patient to sip in the basin and wipe face
- Ask if the patient would like another sip
- Dispose of wrapper, toothbrush, and cup
- Remove the towel and place in dirty linen
- Take the basin to be clean. Dump the water and rinse removing an debris
- Take a paper towel and hold the basin.
- Grab another and dry the inside.
- Take another and dry the outside.
- Grab another paper towel and pick up toothpaste
- Use the paper towel to open the drawer to the basin with the toothpaste away
- Clean up work environment
- Take off gloves
- Ask patient if the patient need anything and give him/her the call light
- Open curtain
- 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)
- Knock
- Greet patient
- Introduce yourself
- Pleasantries
- State what you will be doing
- Close curtain
- Wash hand
- Place a barrier on the table
- Gather supplies
- Gloves are not required for the state exam because there is no exposure to body fluid, personal skin, or non-intact skin
- Inform the patient that you will be getting water for the basin
- Turn on faucet with paper towel and test water before putting in basin
- Turn off faucet with paper towel and throw the towel away
- Get patient to test water
- Ask patient to put his/her hand in the water and move if necessary the table toward him/her
- Put washcloths in basin
- Use one of the washcloths to get the hand wet and set it on the side of basin
- Place his/her hand on a towel while you pick up the wet washcloth
- Put soap on the washcloth and wash the patient’s hand (top including finger, then palm)
- Place hand back into basin to rinse
- Take the other washcloth and rinse soap off hand
- As you are opening the towelette let the patient know that you will moving his/her hand to the towel.
- Pat dry going between fingers then palm of hand
- Now take the orange stick and go under each nail. Just cleaning the edge
- Ask if it hurts
- As you do each nail, wipe the orange stick on the nail.
- Next file any rough edges of the nail going from outside to middle
- Apply lotion to your hands warming it, then rub it on patient’s
- Ask if it feels good and wipe off excess
- Set the hand down, asking how it feels and let the patient know you will be putting the soil linen in the dirty laundry
- Pour out basin into the sink, turn on water to rinse out, grab paperwork to hold basin with.
- Grab another basin and wipe out the inside of basin
- Grab another basin to wipe the outside with
- With a fourth paper towel, pick up the soap, and lotion and place in basin
- Use paper towel to open drawer and put basin away
- And throw everything else away
- Ask patient if everything is okay
- Let the patient know his/her call light is nearby
- Open curtain
- 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)
- Knock
- Greet patient
- Introduce yourself
- Pleasantries
- State what you will be doing
- Close curtain
- Wash hands
- Get supplies
- Let your patient know that you will be pivoting him around so that you can assist him/her into wheelchair
- Ask the patient who is lying down to scoot towards you first
- Ask patient to cross his/her arms over his/her chest.
- 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
- Let the patient know that on the count of 3 you will be pivoting him/her
- Ask if comfortable and to sit up straight and if the patient are dizzy
- Tell the patient you will assist him/her putting his/her shoes on.
- Ask the patient if his/her feet are securely in the shoes and if his/her feet are flat on the floor
- Go get the gait belt
- 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
- As you placing the gait belt around his/her waist, ask him/her to lift his/her arms
- Tighten the belt-making sure it is four fingers depth
- You will be going through the loops in one direction then returning to previous direction to lock it in place on the second bar
- Go get the wheelchair and position it at a slight angle close to the bed almost touching the patient
- Lock wheels into place
- Tell the patient to bring his/her feet together and slightly back
- Place your foot perpendicular to his/her feet
- 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
- 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
- Remove the gait while asking the patient to lift his/her arms
- Unlock the wheelchair and turn the patient around
- 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.
- Put his/her foot on the pedals
- Let him/her know where his/her call light is and ask if the patient need further assistance.
- 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)
- Knock
- Greet patient
- Introduce yourself
- Pleasantries
- Let him/her know that you understand that he/she will need a bedpan
- Close curtain
- Wash hands
- Get supplies
- Place the privacy blanket over the patient
- Ask if that is alright
- Ask patient to hold the privacy blanket so that you can pull the sheet down
- Prepare the chucks with lengthwise going crossway – rolling chucks toward you (clean toward, dirty away)
- Place it on the bed beside patient
- Open the drawer where the bedpan is place
- Put on a set of gloves
- 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
- Tell to relax
- Go around to the other side and ask him/her to lift his/her body up again so that you can finish unrolling
- Make sure it is positioned properly on the bed and let the patient know he/she can relax
- Get the bedpan with toilet tissue out of drawer
- Ask the patient to lift his/her body so that you can place bedpan under patient
- Tell him/her to relax and ask if the patient are comfortable
- Tell him/her you will be removing your gloves (dispose of gloves) and raising the head of the bed up
- Raise the head of the bed up – asking him/her to let you know when comfortable and the bed pan may need adjustment
- 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
- Come back in – let he/she know that you understand he/she are finished
- Explained to he/she that you will be lowering the head of the bed down
- Ask the patient not to lift his/her hips
- Put on another set of gloves
- Inform the patient that you will need to lift off the bedpan as you hold it flat
- Grab one corner of the chucks and use it to grab the bedpan (Count 1-3)
- Use the rest of chucks to cover bedpan
- Inform the patient that you will now be taking the chucks and bedpan to dispose of its contents
- Once in the bathroom uncover chucks
- Throw the chucks away
- Lift toilet lid and empty bedpan
- Rinse the bedpan by turning on water
- Put rinse water into the toilet as well
- Close toilet seat
- Put bedpan in sink
- Get a paper towel and grab the outside of bedpan
- Dry the inside with a second paper towel and dispose
- Dry the outside with a third paper towel and dispose
- Get a fourth paper towel and use it for the drawer
- Place bedpan with toilet paper inside into the drawer and close with the fourth paper towel
- Dispose of gloves
- Ask him/her if the patient need to wipe his/her hand with a towelette
- Have the towel for him/her to put the towelette into your hand Dispose
- Tell the patient to lower the legs
- Pull the sheet up while removing blanket into a ball
- Give the patient the call light
- Explain to the patient that you will be putting the blanket into dirty linen
- Ask if comfortable and need anything
- Open curtain
- 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
- Knock
- Greet patient
- Introduce yourself
- Pleasantries
- Let him/her know that you need to empty the urinary drainage bag
- Close curtain
- Wash hands
- Get your supplies
- Get a barrier and place on the floor under urinary drainage bag
- Get and put on gloves
- Get the triangular graduate container & place on the barrier near where you will be working
- 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
- Remove the port from its protective sleeve on the back
- Slide the valve to the side
- 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
- Once the bag is empty slide the valve back to its previous position. Do this carefully
- Make sure the bag is hanging on a non movable part of the bed and not touching the floor
- Fold the chucks over the graduated container and carry it to the patient’s bathroom
- Once in the bathroom set the container with barrier down on a flat surface
- Squat at eye level with the container and read the container. Rounding to the nearest line
- Once you have measure the amount, document it.
- Empty the urinary graduate container into the toilet and throw the barrier away
- Rinse the container
- Put the rinse water into the toilet
- Once you put the rinse water into the toilet, set the container down in the sink
- Grab a paper towel to pick it up
- Get another paper towel and dry the outside
- Get another paper towel and dry the inside
- Get a final paper towel and use it to open the drawer to put container away
- Throw the paper towels away and remove gloves
- Ask the patient if they need anything and give them the call light
- Open the curtain
- Wash hands
- 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)
- Knock
- Greet patient
- Introduce yourself
- Pleasantries
- Ask him/her if he/she would like a snack
- Ask them to sit up straight
- Wash hands
- Get your supplies
- 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
- Offer a clothing protector and put it over the patient’s clothes
- Open the snack while letting the patient know what it is.
- Offer a drink to get started
- Offer a spoonful and make conversation (asking them if would like more between bites)
- Offer a drink
- Offer another bite
- Once the patient says he/she has enough, confirm the answer
- 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
- Take a napkin and wipe the face
- Remove clothing protector and put in dirty linen
- Take the tray away
- Discard any uneaten or unused food and beverage
- Place tray on table and ask the patient if there is anything further you can do
- Make sure the call light is within reach and let him/her know.
- 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
- Knock
- Greet patient
- Introduce yourself
- Pleasantries
- Close curtain
- Wash hands
- Gather supplies, start with a barrier
- Lay it on the table
- Put 3 pillows on the table
- Place blanket
- Fold the sheet down under the blanket making sure patient stays covered
- Ask patient to scoot towards you
- Put the opposing arm above the patient’s head
- Take the closest arm and put the hand on the patient’s opposite shoulder
- Then bend the closest knee and put the foot flat on the bed
- Then angle the opposing leg out a little bit
- Now turn the patient on his/her side
- 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
- 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
- Position a pillow between the legs lengthwise (between knees and ankles)
- Place the final pillow under the patient’s upper arm with the arm laying lengthwise on the pillow
- Then adjust the pillow under head so that it is not under the shoulder, but only under the head and neck
- Finally move the arm into a more comfortable position.
- Ask if it is comfortable and as place the call light let him/her know that you are doing so.
- Ask if he/she need anything further and that you are pulling the sheet up
- Remove the privacy blanket and place in dirty linen
- Throw barrier away
- 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.
- Knock
- Greet patient
- Introduce yourself
- Pleasantries
- Tell them that you need to get their vital signs
- Close curtain
- Wash hands
- Ask them to remain quiet and let him/her know you are placing the alcohol pad. Ask if ok
- Let them know when you start.
- Count how many times the abdomen raises and falls. In and out = one breath
- Say stop when it reaches one minute
- 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.
- 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
- Knock
- Greet patient
- Introduce yourself
- Pleasantries
- Tell them that you need to get their vital signs
- Close curtain
- Wash hands
- When you return, pick up the patient’s wrist (DO NOT USE your thumb to find the pulse.)
- Count the thumps that you feel under your fingers for one full minute.
- Say stop when it reaches one minute
- 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.
- 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
- Knock
- Greet patient
- Introduce yourself
- Pleasantries
- Ask if they would like to go for a walk
- Close curtain
- Wash hands
- Ask the patient if they are dizzy
- Inform patient that you will putting a gait belt around their waist to help you with support
- Slide the belt around his/her waist
- Ask the patient to lift his/her arms so that you can put into place
- Let them know they can relax
- As with any belt, put the free end through the first bar
- Snug it up to four fingers and bring the free end and bring it through the last bar
- Ask your patient to bring their legs closer together and with feet flat on floor
- 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
- Then put one foot in front and another on the side while grabbing the gait belt
- Tell the patient that on the count of three that you will help them rise
- Ask if the patient if he/she is dizzy
- Stand on the weaker side and inform the patient that you are going to let them lead.
- Tell the patient where you both will be walking to and ask if he/she feel dizzy
- Help the patient turn around and walk back to the chair
- Once in front of the chair, ask the patient to turn around and back up to the chair
- 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
- Once you both are ready, inform the patient you will position yourself as before and on the count of three he/she will sit
- One-two-three
- Ask how he/she feels
- Remove the gait belt
- Ask if anything else is needed and give him/her the call light
- 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.