Initial Steps
1. Ask nurse about residents NEEDS, ABILITIES and LIMITATIONS, if necessary.
2. KNOCK and IDENTIFY YOURSELF before entering residents
... [Show More] room. WAIT for permission to enter residents room.
3. Greet resident by NAME per resident preference.
4.Identify yourself by NAME and TITLE.
5. Explain what you will be doing. Encourage resident to help as able.
6. Gather supplies and check equipment.
7. Close curtains, drapes and doors. Keep resident covered, expose only the area of residents body necessary to complete procedure.
8. Wash your hands
9. Wear gloves as indicated by standard Precautions.
10. Use proper body mechanics. raise bed to appropriate height and lower bed rails (if raised)
Final Steps
1. Remove gloves, if applicable, and wash hands.
2. Be certain resident is comfortable and in good alignment. Use proper body mechanics.
3. Lower bed height and position side rails as appropriate.
4. Place call light and water within patients reach.
5. Ask resident if anything else is needed.
6. THANK RESIDENT.
7. Remove supplies and clean equipment according to facility procedure.
8. Open curtains, drapes and door according to residents wishes.
9. Perform a safety check of resident and environment.
10. REPORT unexpected findings to nurse.
11. DOCUMENT procedures according to facility procedure.
Handwashing/Handrub (wash hands when visibly soiled or prior to giving care)
1. Turn on faucet with a CLEAN paper towel.
2. Adjust water to acceptable temperature.
3.Angle arms down holding hands lower than elbows. Wet hands and wrists.
4. Apply enough soap to cover all hand and wrist surfaces. Work up a lather.
NOTE: Direct caregivers must rub hands together vigorously, as follow's for at least 20 SECONDS, covering all surfaces of the hands and fingers.
5. Rub hands palm to palm.
6. Right palm over top of left hand with interlaced fingers and visa versa.
7.Palm to palm with fingers interlaced.
8.Back of fingers to opposing palms with fingers interlocked.
9.Rotational rubbing, of left thumb clasped in right palm and visa versa.
10. Rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm and vice versa. Clean finger nails.
11.Rinse hands with water down from wrist to fingertips.
12. Dry thoroughly with a single use towels.
13. Use towel to turn off faucet and discard towel.
14. Apply about a quarter sized amount
HOW TO USE HAND RUB (otherwise use hand rub)
Allow hands to dry. Waterless HAND RUB must be rubbed for at least 10 SECONDS or until dry to be effective.
Gloves
1. Wash hands
2. If right handed, slide one glove on left hand. (reverse, if left handed.)
3. With gloved hand, slide opposite hand in the second glove.
4. Interlace fingers to secure gloves for a comfortable fit.
5. Check for tears/holes and replace glove if necessary.
6. If wearing a gown, pull the cuff of the gloves over the sleeves of the gown.
7. Perform procedure.
8. Remove first glove by grasping outer surface of the other glove, just below the cuff and pulling down.
9. Pull glove off so that it is inside out.
10. Hold the removed glove in a ball of the palm or your hand. Do not dangle the glove downward.
11. Place two fingers of ungloved hand under cuff of other glove and pull down so first glove is inside second glove.
12. Dispose of gloves without touching outside of gloves and contaminating hands.
13. Wash hands
Gown (PPE)
1. Wash hands
2. Open gown and hold out in front of you. Let the clean gown unfold without touching any surface
3. Slip your hands and arms through the sleeves and pull the gown on.
4. Tie neck ties in a bow.
5. Overlap back of the gown and tie waist ties.
6. Put on gloves; extend to cover wrist of gown.
7. Perform procedure.
8. Remove gloves.
9. Untie the neck, then waist ties.
10. Pull away from neck and shoulders, touching inside of gown only.
11. Fold gown with clean side out and place in laundry or discard if disposable.
12. Wash hands.
Mask
1. Wash hands
2. Place upper edge of the mask over the bridge of your nose and tie the upper ties. If mask has elastic bands, wrap the bands around the back of your head and ensure they are secure.
3. Place the lower edge of the mask under your chin and tie the lower ties at the nape of your neck.
4. If the mask has a metal strip in the upper edge, form it to your nose.
5. Perform procedure.
6. If the mask becomes damp or if the procedure takes more than 30 minutes, you must change your mask.
7. If wearing gloves, remove them first.
8. Wash hands
9. Untie each set of ties and discard the mask by touching only the ties. Masks are appropriate for one use only.
10. Wash hands
Falling or Fainting
1. Call for nurse and stay with resident.
2. Check if resident is breathing.
3. Do not move resident. Leave in same position until the nurse examines the resident
4. Talk to resident in calm and supportive manner.
5. Apply direct pressure to any bleeding area with a clean piece of linen
6. Take pulse and respiration.
7. Assist nurse as directed. Check resident frequently according to current facility policy. Assist with documentation
Choking
1. Call nurse and stay with resident.
2. Ask if resident can speak or cough.
3. If not able to speak or cough, move behind resident and slide arms under resident's armpits.
4. Place your fist with thumb side against abdomen midway between waist and ribcage.
5. Grasp your fist with your other hand.
6. Press your fist into abdomen with quick inward and upward thrusts.
7. Repeat until object is expelled.
8. Assist with documentation
Seizures
1. Call for nurse and stay with resident.
2. Place padding under head and remove furniture away from resident.
3. Do not restrain resident or place anything in mouth. Assist nurse with placing resident on his/her side
4. Loosen resident's clothing especially around neck.
5. Note duration of seizure and areas involved.
7. Assist with documentation
Fire (R.A.C.E.)
1. Remove residents from are of immediate danger.
2. Activate fire alarm.
3. Close doors and windows to contain fire.
4. Extinguish fire with fire extinguisher if possible.
5. Follow all facility policies.
Fire extinguisher (P.A.S.S.)
1. Pull the pin
2. Aim at the base of the fire.
3. Squeeze the handle.
4. Sweep back and forth at the base of the fire.
Lateral Position
1. Do initial steps.
2. Place resident in a supine position
3. Move resident to side of bed close to you.
4. Cross resident's arms over chest.
5. Slightly bend knee of nearest leg to you or cross nearest leg over farthest leg at ankle.
6. Place your hands under resident;s shoulder blade and buttock. Turn resident away from you onto side.
7. Place supportive padding behind back, between knees and ankles, and under top arm.
8. Do final steps.
Axillary Temperature
Often taken when inappropriate to take an oral temperature; particularly if a resident is confused or combative.
1. Remove thermometer from storage/battery charger
2. Do initial steps.
3. Position resident comfortably in bed or chair.
4. Put on disposable sheath, Remove resident's arm from sleeve of gown and wipe armpit and ensure it is dry. Hold thermometer in place with end in center of armpit and fold residents arm over chest
5. Press button to activate the thermometer
6. Hold thermometer in place until signal is heard, indicating the temperature has been obtained
7. Read the temperature reading on the face of the electronic device, remove the thermometer, discard the sheath, and record the reading
8. Assist the resident to return arm though sleeve of gown/clothes.
9. Do final steps.
10 Return thermometer to storage/battery
11. Report any unusual findings to the nurse.
Pulse and Respiration
1. Do initial steps.
2. Place resident's hand on comfortable surface.
3. Feel for pulse above wrist on thumb side with tips of first three fingers.
4. Count beats for 60 seconds, noting rate, rhythm and force.
5. Continue position as if feeling for pulse.Count each rise and fall of chest as on respiration.
6. Count respiration for 60 seconds noting rate, regularity and sound.
7. Record pulse and respiration rates
9. Do final steps.
10. Report any unusual findings to the nurse.
Blood Pressure
1. Do initial steps.
2. Clean earpieces and diaphragm of stethoscope with antiseptic wipe.
3. Uncover resident's arm to shoulder.
4. Rest resident's arm, level with heart, palm upward on comfortable surface.
5. Wrap proper sized Sphygmomanometer cuff around upper unaffected arm approximately 1-2 inches above elbow.
6. Put ear pieces of stethoscope in ears.
7. Place diaphragm of stethoscope over brachial artery at elbow.
8. Close valve on bulb. If blood pressure is known inflate cuff to 20mm/hg above the usual reading. If blood pressure is unknown, inflate cuff to 160 mm/hg.
9. Slowly open valve on bulb.
10. Watch gauge and listen for sound of pulse.
11. Note gauge reading at first pulse sound.
12. Note gauge reading when pulse sound disappears.
13. Completely deflate and remove cuff.
14. Accurately record systolic and diastolic readings
15. Do final steps.
16. Report unusual readings to the nurse.
Height
1. Do initial steps
2. Using standing balance scale: Assist the resident onto the scale, facing away from the scale. Ask the resident to stand straight. Raise the rod to a level above the residents head. Lower the height measurement device until it rests flat on the residents head.
3. When a resident is unable to stand: Flatten the bed and place resident in supine position. Place a mark on the sheet at the top of the head and another at the bottom of the feet. Measure the difference.
4. If the resident is unable to lay flat due to contractures: Utilize a tape measure and beginning at the top of the head, follow the curves of the spine and legs, measuring to the base of the heel.
5. Accurately record residents height.
6. Do final steps
Weight
1. Do initial steps.
2. Balance scale.
3. Depending on scale used, assist resident to stand on platform or sit in chair with feet on footrest or transport wheelchair onto scale and lock brakes.
4. When using a standard scale - lower weight to fifty pound mark that causes arm to drop. Move it back to previous mark. Move upper weight to pound mark that balances pointer in middle of square. Add lower and upper marks.When using digital scale- press weight button. Wait until numbers remain constant
5. Subtract weight of wheelchair from total weight, if applicable.
6. Accurately record resident's weight
7. Do final steps.
8. Report unusual reading to nurse.
Assist Resident to Move to Head of Bed
1. Do initial steps. Ask another CNA to assist you if needed
2. Lower head of bed and lean pillow against head board.
3. Ask resident to bend knees, put feet flat of mattress.
4. Place one arm under resident's shoulder blades and the other arm under resident's thighs. If a draw sheet or pad is under resident, 2 caregivers should grasp the sheet or pad firmly, with trunk centered between hands.
5. Ask resident to push with feet on count of three.
6. Place pillow under resident's head.
7. Do final steps.
Supine Position
1. Do initial steps.
2. Lower head of bed.
3. Move resident to head of bed if necessary
4. Position resident flat on back with legs slightly apart.
5. Align resident's shoulders and hips.
6. Use supportive padding and /or float heels if necessary.
7. Do final steps.
Oral Temperature Electronic
Do not take oral temperature for a resident who is unconscious, uses oxygen, or who is confused/disoriented
1. Remove thermometer from storage/battery charger
2. Do initial steps.
3. Position resident comfortably in bed or chair.
4. Put on disposable sheath, and place thermometer under the tongue and to one side, press button to activate the thermometer 5. The resident should be directed to breath through their nose
6. Instruct resident to hold thermometer in mouth with lips closed. Assist as necessary
7. Leave thermometer in place until signal is heard, indicating temperature has been obtained
8. Read the temperature reading on the face of the electronic device, remove the thermometer, discard the sheath, and record the reading
9. Do final steps.
10. Return thermometer to storage/battery
11. Report any unusual findings to the nurse.
Fowler's Position
1. Do initial steps.
2. Move resident to supine position
3. Elevate bed 45 to 60 degrees.
4. Use supportive padding if necessary.
5. Do final steps. [Show Less]