CNA procedures

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jnikrap
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225127
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CNA procedures
Updated:
2013-06-26 18:36:45
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CNA
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CNA
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  1. Blood Pressure
    • 1. Clean ear pieces and diaphragm with antiseptic wipe
    • 2. Position residents arm resting on firm surface with palm up
    • 3. Wrap cuff around arm with bladder over artery 1" above antecubital space- cuff even and snug.
    • 4. place ear pieces in ears and diaphragm over artery
    • 5. Inflate cuff to no more than 180mm/Hg or may use pulse obliteration method
    • 6. Deflate cuff, not systolic reading, note point of diastolic reading
    • 7. Accurate reading within 4mm/Hg window on both systolic and diastolic 
    • 8. Accurately record blood pressure
  2. BEGINNING PROCEDURE ACTIONS
    • 1.Wash hands thoroughly prior to entering room or when in roomHand washing: Demonstrating hand washing is necessary and is evaluated as part of the critical criteria.
    • 2. Assemble needed equipment
    • 3. Go to resident’s room, knock, and pause before entering
    • 4. Introduce self by name and title
    • 5.Identify the resident by facility policies and address them by name
    • 6. Ask visitors to leave the room and inform them where they may wait
    • 7. Provide privacy throughout procedure; pull curtains, shut door, properly cover patient as needed
    • 8. Explain procedure to resident; speak clearly, slowly and directly to resident, maintaining face to face contact whenever possible
    • 9. Answer resident’s questions about the procedure
    • 10. Allow resident to assist as much as possible
    • 11. Raise the bed to a comfortable working height
  3. ENDING PROCEDURE ACTIONS
    • 1. Position resident comfortably
    • 2. Return bed to lowest position
    • 3. Leave signal cord, telephone and water within reach
    • 4. Perform a general safety check
    • 5. Open curtains
    • 6. Care for equipment following policy
    • 7.Wash hands
    • 8. Let visitors know they may return
    • 9.Report completion of task & observation of any abnormalities and record actions and observations
  4. Temperature:
    Tympanic
    • 1. Place tympanic thermometer cover on
    • 2. Ask person to turn his head so ear is in front of you, put new probe cover on
    • 3. Pull back on the ear (gentle, firm) to straighten the ear canal and insert probe gently into ear canal directed toward nose
    • 4. Start the thermometer
    • 5. Wait until you hear a beep or flashing light and remove
    • 6. Read the temperature and record accurately
  5. Temperature:
    Oral/Axillary-
    • 1. Ask the person if they have eaten or consumed a beverage, cold or hot or smoked within the last 15 minutes.
    • 2. Place a sheath on the probe
    • 3. Correct placement for obtaining oral reading or axillary reading
    • 4. If necessary, hold the probe in place for oral
    • 5. Leave the probe in place until the instrument beeps
    • 6. Remove the probe sheath from the probe and dispose of properly
    • 7. Replace the probe
    • 8. Read the temperature and record accurately
  6. RADIAL or APICAL PULSE
    • 1. Locate pulse at the correct site
    • 2. Count pulse for 30 sec. and double or count for 1 full min. accuracy within + or – 4 beats per minute
    • 3. Document accurately
  7. RESPIRATORY RATE
    • 1. Count respirations for 30 sec. and double or count for 1 full min. Accuracy within + or - 2 breaths
    • 2. Document Accurately
  8. HANDWASHING
    • 1. Don’t touch the sink with your uniform
    • 2. Turn water to warm
    • 3. Wet and soap hands
    • 4.Wash hands with fingers down for 15-30 seconds, including wrist, nails and between fingers
    • 5. Rinse with fingertips down
    • 6. Use dry paper towel to dry hands
    • 7.Use a paper towel to turn off faucets
    • 8. Immediately discard paper towels in trash without touching to your other hand
  9. SKILL 1
    PRESSURE ULCER PREVENTION
    • 1.Demonstrate 2 ways to prevent pressure ulcers:
    • For example:
    • a. Proper use of bed cradle
    • b. Elbow/heel protector
    • c. Using pillows to reduce skin to skin contact
    • d. Making sure sheets are wrinkle free
    • 2. Explain 2 other ways to prevent pressure ulcers
    • For example:
    • a. Changing position frequently
    • b. Good nutrition and hydration
    • c. Provide good perineal care (keep resident clean and dry)
    • d. Be careful of the resident’s skin (no shearing or friction)
    • e. Check resident’s skin carefully-provide good skin care
    • f. Assist your resident to the bathroom frequently
    • g. Encourage mobility
    • h. Use pressure reducing devices
  10. SKILL 2
    POSITION FOLEY CATHETER/BAG/TUBING
    • 1. Secure tubing to resident’s inner thigh or abdomen
    • 2.Place tubing over leg
    • 3. Position tubing to facilitate gravitational flow, no kinks
    • 4.Attach to bed frame (not over or on side rail) always-below level of bladder
    • 5. Keep catheter bag from touching floor
  11. SKILL 3 OXYGEN
    • 1. Demonstrate correct placement of O2 nasal cannula (place prongs following the contour of the nasal passage, tubing around ears and under chin (not behind head)
    • 2. When asked by nurse-demonstrate how to check the oxygen flow meter and verbalize actions needed if flowrate is not accurate. Do not adjust the flow of oxygen-if incorrect, alert the nurse immediately
    • 3. Verbalize 3 oxygen use guidelines
    • For Example:
    • a. Avoid lighting matches or smoking around oxygen use
    • b. Ensure that all electrical equipment is in good repair
    • c. No kinks in the tubing
    • d. Make sure the device is placed correctly on the resident
    • e. Do not remove the mask or nasal cannula, unless you are specifically told to do so by a nurse
    • f. Make sure the water level in the humidity bottle does not get too low
    • g. Provide oral care frequently
    • h. Watch for signs of skin irritation behind the person’s ears, over his or her cheeks, or around his or her ears and nose
    • i. Check to make sure oxygen is flowing
  12. SKILL 4
    OCCUPIED DRAW SHEET CHANGE
    • 1. Place clean draw sheet on clean surface within reach (chair, over-the-bed table)
    • 2. Provide privacy throughout procedure
    • 3. Lower head of bed, placing resident in supine position
    • 4.After raising side rail, assist resident to turn onto side, moving toward raised side rail
    • 5. Loosen draw sheet, roll soiled draw sheet toward resident
    • 6. Place and tuck in clean draw sheet on working side (this must be done before turning resident)
    • 7.Raise side rail and assist resident to turn onto clean draw sheet
    • 8. Remove soiled linens/draw sheet, avoiding contact with clothes, and place in appropriate location within room–never on floor
    • 9. Pull and tuck in clean draw sheet, finishing with sheet free of wrinkle
  13. SKILL 5
    APPLY COLD COMPRESS
    • 1. Cover cold compress with towel or other protective cover (compress should not be placed on bare skin without covering)
    • 2. Properly place on correct site as directed by skills examiner
    • 3. When asked by examiner, verbalize frequency of checks and how long you would leave compress on resident(initially check after 5 minutes/do not leave on resident for more than 20 minutes)
    • 4. Assess for redness, swelling, irritation and or pain if this occurs remove compress and report to nurse immediately
  14. SKILL 6
    MEASURE AND RECORD FLUID INTAKE
    • 1. Calculate intake in mL
    • 2. Measure on a flat, level surface
    • 3. Record intake accurately within +/- 25 mL's of nurses reading
  15. SKILL 7
    CONVERTING OUNCES TO ML’S- 30 mL’s = 1 ounce
    • 1. Convert ounces to mL
    • 2. Record amount accurately within +/- 25 mL's of nurses reading
  16. SKILL 8
    MEASURE/RECORD URINE OUTPUT
    • 1. Place container on flat surface, measure accurately in mLs
    • 2. Dispose of properly into toilet
    • 3. Rinse and dry container
    • 4. Remove gloves, wash hands
    • 5. Record output accurately within +/- 25 mL's of nurses reading
  17. SKILL 9
    CONSCIOUS CHOKING
    • 1. Candidate is able to identify symptoms of choking, asks resident “Are you choking?”
    • 2. Call for help
    • 3. Stands behind resident and wraps arms around resident’s waist
    • 4. Places the thumb side of the fist against the resident’s abdomen
    • 5. Positions fist slightly above navel
    • 6. Grasp fist with other hand, press fist and hand into the resident’s abdomen with an inward, upward thrust
    • 7. Candidate should indicate that they would repeat this procedure until it is successful or until the victim losesconsciousness
  18. SKILL 10
    OBTAIN AND RECORD WEIGHT AND HEIGHT WEIGHT(Standing scale only)
    • WEIGHT(Standing scale only) 
    • 1. Move weights to zero before assisting resident on to scale
    • 2. Assist resident to stand on scale
    • 3. Ensure resident is balanced and centered on the scale with arms at side
    • 4. Accurately record weight within +/- 0.25 lbs. of nurse's measurement HEIGHTSTANDING
    • 1. Assist resident to stand on scales
    • 2. Resident is balanced and centered on the scale with arms at side
    • 3. Raise folded measuring bar above residents head, open and lower gently until bar rests on top of the head (not hair)
    • 4.Accurately record height within +/- 0.5 inch of nurse's measurement
  19. SKILL 11
    APPLICATION OF ANTI-EMBOLISM STOCKINGS (TED hose)
    • 1. Explain what position resident should be in when applying stocking- apply while resident is in bed or with feet elevated
    • 2. Hold foot and heel of stocking and gather up stocking – turning the stocking inside out down to the heel, aids inapplication
    • 3. Smooth up and over leg so hose is even, snug and not twisted or wrinkled
    • 4. Heel and toe in proper location
    • 5. The toe hole may be on the top or bottom of the toes, depending on the manufactures design
  20. SKILL 12
    PASSIVE RANGE OF MOTION 2 JOINTS -Examiners choice
    • 1. Exercise passively 2 joints
    • 2. When asked by examiner, explain or demonstrate that you understand to never exercise past the point of painor resistance
    • 3. Provide support for joint
    • 4. Avoid fast jerky movements; demonstrate flexion, extension, adduction, abduction and rotation if applicable
    • 5. Repeat exercise at least 3 times or as ordered
  21. SKILL 13
    MOVING AND POSITIONING RESIDENTS -Examiners choice.
    With each of the above positions you must demonstrate:
    -Raise side rail while turning patient except on side you are working on
    -Demonstrate proper body mechanics
    -Maintain residents proper alignment at all time, for all positions ers choice
    • 1. Draw Sheet: Move using a draw sheet (2 persons): Provide support for resident’s head. Grasp rolled draw sheet near residentsshoulder’s and hips
    • 2. Fowlers: Position in Fowler’s (high Fowler’s is 60 -90 degrees; semi-Fowler’s is 30-45 degrees; knees may be elevatedapproximately 15 degrees
    • 3. Supine: Position in supine, in proper anatomical alignment
    • 4. Chair/Wheelchair: Position in chair or W/C: provide good alignment-upper body and head erect, back and buttocks against back of chair, feet flat on floor or on W/C footrests
    • 5. Sims (Semi Prone): Position in Sims /Semi prone on the correct side as directed by examiner, Left: Resident left side lying, right leg flexed, lower arm behind resident. Right:Resident right side lying, left leg flexed, lower arm behind resident. Provide goodalignment. Place a pillow under the head, upper arm andflexedleg

    6. Lateral: (Right or Left) Position lateral/side-lying on the correct side as directed by examiner. Provide good alignment. Place a pillowbetween legs, behind back and under arm Note: For enema position place resident in left Sims or left lateral position
  22. SKILL 14
    ASSISTING TO AMBULATE Demonstrating proper use of gait belt
    • 1. Resident should have footwear with non-skid soles
    • 2. Sit resident up, allow to dangle
    • 3.Apply gait belt properly around resident's waist; avoid restricting circulation or breathing, or injury to skin
    • 4. Assist resident to stand while holding gait belt. Grasp the gait belt at each side, not the front.Do not allow residentto hold onto you around your neck while transferring
    • 5. Maintain own body mechanics while assisting resident to stand
    • 6. Walk at resident’s side or slightly behind (on weak side, if resident has a weak side)
    • 7. Demonstrate proper use of assistive devices (walker, cane-should be place on resident’s strong side)
  23. SKILL 15
    PIVOT TRANSFER FROM A BED TO A WHEELCHAIR/ Demonstrating proper use of gait belt
    • 1. Lock the bed wheels
    • 2. Resident should have footwear with non-skid soles
    • 3. Position wheelchair close to bed on residents’ strong side
    • 4. Move or remove foot rests from wheelchair
    • 5. Lock wheelchair brakes
    • 6. Lower bed and rails
    • 7. Sit resident up, allow to dangle
    • 8. Apply gait belt properly around resident's waist; avoid restricting circulation or breathing, or injury to skin
    • 9. Assist resident to stand while holding gait belt. Grasp the gait belt at each side, not the front. Do not allow residentto hold onto you around your neck while transferring
    • 10. Maintain own body mechanics while assisting resident to stand
    • 11.Transfer to the strong side by pivoting on the strong side toward the wheelchair, using proper technique
    • 12. Position resident properly in wheelchair with residents hips against back of seat
    • 13. Remove gait belt without harming resident
    • 14. Place foot rests under residents’ feet
  24. SKILL 16
    FEEDING THE DEPENDENT RESIDENT
    • 1. Check that the name and diet on the meal tray matches the name of resident receiving it
    • 2. Positions the resident in an upright position. Minimum 60 degrees
    • 3. Wash and dry resident's hands before feeding
    • 4. If resident wears dentures check to make sure dentures are in
    • 5. Protects clothing from soiling by using napkin, clothing protector, or towel
    • 6. Describes the foods being offered to the resident and maintain eye level contact while feeding resident
    • 7. Offer fluid frequently
    • 8. When asked by examiner, explain the pace and amount when feeding resident (offer food in small amounts, allow resident to chew and swallow)
    • 9. Wipe resident's hands and face during meal as needed
    • 10. When asked by examiner verbalize need to stop feeding when complications occur and report to nurse
    • For Example:
    • a. Choking
    • b. Persistent coughing
    • c. Mouth sores
    • d. Droolinge. Cyanosisf. Difficulty swallowing
    • 11. Leave resident clean and in a position of comfort
  25. SKILL 17
    DENTURE CARE
    • 1. Before handling dentures, protect dentures from possible damage (line the bottom of the sink with a towel/ washcloth or fill with water)
    • 2. When asked by examiner, explain that water for cleaning dentures should be lukewarm (not hot or cold)
    • 4. Brush dentures under running water with brush and paste provided
    • 5. Place dentures in denture cup with water, adding cleaning tablet (if available), and cover with lid and allow to soak
    • 6. Perform mouth care while dentures are out of the mouth
  26. SKILL 18
    LOG ROLLING RESIDENT WITH HIP FRACTURE PRECAUTIONS
    • 1.Use at least 2 persons
    • 2. Lower head of bed as flat as possible
    • 3. Do not roll resident onto injured side
    • 4. Place abduction splint or pillows between legs to support hip
    • 5. On the count of “three” roll person in a single movement, being sure to keep the person’s head, spine and legsaligned
  27. SKILL 19
    ORAL CARE FOR AN UNCONSCIOUS RESIDENT/ASPIRATION PRECAUTIONS
    • 1. Verbalize frequency of oral care (every 2 hours)
    • 2. Place towel or drape under the resident’s head
    • 3. Position resident (as resident’s medical condition indicates) to prevent aspiration:
    • a. Position resident in supine position with head to side or side lying (lateral) to prevent aspiration or with HOB elevated and head turned to side, as resident’s medical conditionindicates
    • 4. Insert swab/sponge tip gently into resident’s mouth
    • 5. Do not use toothpaste/toothbrush unless approved by nurse
    • 6. Rotate against all tooth surfaces, mucous membranes and tongue
    • 7. Clean resident’s lips
    • 8. Moisturize lips
    • 9. Report abnormalities such as bleeding gums
  28. SKILL 20
    BACK RUB/MASSAGE
    • 1. Place resident in a sitting or lateral position
    • 2. Pour small amount of lotion into palm of hand and rub hands together to warm lotion
    • 3. Apply with gentle pressure, using both hands from buttocks to back of neck without pulling skin, using long firmstrokes
    • 4. Use short circular strokes across the shoulders using both hands
    • 5. Perform backrub for 3-5 min. or as ordered
    • 6. Asses skin condition
    • 7. Remove excess lotion
    • 8. When asked by examiner, verbalize actions needed if redness or skin break down are noticed. Do not rubreddened area and report immediately to nurse
  29. SKILL 21
    FOOT/TOENAIL CARE
    • 1. Inspect for cracked, broken nails/skin and between toes
    • 2. Do not clip toenails
    • 3. Soak feet in warm water
    • 4. Dry feet completely including between toes
    • 5. Apply lotion if desired but not between toes
    • 6. Apply socks/shoes
    • 7. Report abnormalities
  30. SKILL 22
    DRESSING/UNDRESSING RESIDENT (Must dress and undress)
    • 1. Demonstrate how to properly dress/undress resident with hemiplegia
    • 2.Provide privacy during entire procedure
    • 3. Dress weak side first
    • 4. Undress weak side last
  31. SKILL 23
    SHAVING WITH RAZOR BLADE
    • 1. Place towel to protect resident’s clothing
    • 2. Soften beard with warm washcloth and apply shaving cream
    • 3.Gently pull skin taut
    • 4. Use short strokes of razor in the direction the hair is growing
    • 5. Rinse razor often
    • 6. Rinse and dry resident’s face
    • 7. Apply after shave if desired
    • 8. Dispose blade in sharps container
  32. SKILL 24
    PROVIDE PERI-CARE :FEMALE
    • 1. Assist resident in removing clothing, only as necessary, exposing only area being washed. Provide privacy(remembering dignity)
    • 2. Obtain bath basin with water of a safe and comfortable temperature
    • 3. Apply appropriate cleanser preferred by resident to wash cloth
    • 4. Separate the labia, clean inside the labia downward fromfront to back (clean to dirty). Then wash the outside ofthe labia from front to back starting outside the labia and then going to the inside of the thighs. Repeat until the area isclean, using a different part of the wash cloth for each stroke
    • 5. Rinse and gently dry each area thoroughly after washing
    • 6. Turn the resident on their side
    • 7. Clean the anal area from front to back
    • 8. Rinse and gently dry each area thoroughly after washing9. Redress resident
  33. SKILL 24
    PROVIDE PERI-CARE: MALE
    • 1. Assist resident in removing clothing, only as necessary, exposing only area being washed. Provide privacy(remembering dignity)
    • 2. Obtain bath basin with water of a safe and comfortable temperature
    • 3. Apply appropriate cleanser preferred by resident to wash cloth. Cleanse the penis from tip to base (clean todirty).Repeat until the area is clean, using a different part of the wash cloth for each strokea. If male is uncircumcised retract the foreskin by gently pushing the skin toward the base of the penis and cleanas directed above. Replace foreskin after drying thoroughly
    • 4. Rinse and gently dry each area thoroughly after washing
    • 5. Turn the resident on their side
    • 6. Clean the anal area from front to back
    • 7. Rinse and gently dry each area thoroughly after washing
    • 8. Redress resident
  34. SKILL 25
    ASSISTING WITH A BEDPAN/FRACTURE PAN
    • 1. Positions the bedpan/fracture pan under the resident correctly (If using a fracture pan, the flat side should betoward the back of the resident)
    • 2. Raises head of bed to a comfortable level
    • 3. Place tissue within reach of resident
    • 4. Position call light within reach of the resident
    • 5. Provide privacy
    • 6. Gently removes bedpan
    • 7. Provide or assist with peri-care as needed
    • 8. Empty bedpan in toilet
    • 9. Rinse, dry and store bedpan in proper location
    • 10. Washes/assists resident to wash and dry hands
    • 11. Record results accurately
  35. SKILL 26
    COLLECTING A STOOL SPECIMEN
    • 1. Properly fill out label given and place on specimen container
    • 2. Using a tongue depressor take a sample of feces from the bedpan or specimen collection device
    • 3. Note color, amount and quality of the feces
    • 4. Dispose of tongue depressor in a disposable bag
    • 5. Empty remaining contents of bedpan or specimen collection device into toilet
    • 6. Put lid tightly on the specimen cup
    • 7. Place specimen cup into transport bag
    • 8. Wash hands
    • 9. Take the specimen cup to the designated location

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