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.