Module 9 - Patient Care Procedures

What are the 3 specimens that CNAs are responsible to collect?

1. sputum

2. urine

3. stool samples

What are the 6 steps to collecting sputum specimens?

1. Best collected in the morning when secretions accumulate overnight

2. Patients should rinse their mouth with water only (not mouthwash) to reduce saliva contamination.

3. The sample is obtained by coughing deeply into a sterile container.

4. Label the container correctly with patient name, date, and time of collection.

5. Observe color, consistency, odor, and any presence of blood in the specimen.

6. If the patient has difficulty producing a sample, humidified air or postural drainage may help.

What is sputum and why is taking a sample of it helpful?

• sputum is mucus that is coughed up from the lungs, bronchi, and trachea

• helps diagnose respiratory infections, TB, and lung diseases

What do urine samples help diagnose?

diagnose:

• infections

• kidney conditions

• diabetes

What are the 4 different methods of collecting urine specimens?

1. random specimen

2. mid-stream (clean catch)

3. catheter specimen

4. 24-hr urine collection

Define “Random specimen”

Collected at any time

Define “Mid-stream (clean catch)”

The patient voids a small amount first, then collects the sample mid-stream

Define “Catheter specimen”

Collected from a catheterized patient to ensure sterility

Define “24-hr urine collection”

Requires collecting all urine within a 24-hr period in a designated container

What are the 5 key guidelines for collecting urine specimen?

1. wash hands and wear gloves

2. ensure the container is sterile and labeled correctly

3. the sample should not be contaminated with tp or feces

4. store the specimen as per facility protocol (some require refrigeration)

5. observe color, clarity, odor, and presence of particles

Why is collecting stool specimens helpful?

Help detect digestive disorders, infections, parasites, or blood in stool

What are the 5 measures to collecting stool specimens?

1. the patient should not mix the sample with urine or tp

2. use a clean container or a special collection pan

3. the sample should be labeled correctly and sent the lab promptly

4. observe color, consistency, odor, and presence of blood or mucus

5. some stool tests require dietary restrictions before collection, such as avoiding red mat or certain medications

What are the 5 types of beds?

1. occupied beds

2. unoccupied bed

3. open bed

4. closed bed

5. surgical bed

Define “Occupied bed”

Made while the patient remains in bed; requires careful rolling o the patient to one side to change linens

Define “Unoccupied bed”

Made when the bed is empty; allows for full linen replacement and disinfection

Define “Open bed”

Designed for a patient who will be getting back into bed soon, with top linens folded back for easy entry

Define “Closed bed”

Fully made up with top linens in place for a new patient

Define “Surgical bed”

Prepared for a patient returning from surgery, often in an elevated position for ease of transfer

What are the 6 guidelines to proper bed making?

1. keep linens wrinkle free to prevent skin irritation and pressure ulcers

2. use clean sheets and proper layering to enhance comfort

3. ensure bed rails are secure if needed for patient safety

4. life, do not twist when positioning linens to prevent back strain

5. change soiled linens immediately to prevent infection

6. ensure infection control measures such as using gloves when handling contaminated bedding

Why is it important to assist with bowel care with patients?

Helps manage:

• constipation

• fecal impaction

• bowel preparation for medical procedures

Define “Enema”

A fluid into the rectum to stimulate a bowel movement or cleanse the colon

What are the 3 types of enemas?

1. cleaning enema

2. oil retention enema

3. commercial enema (Fleet’s)

Define “Cleaning enema”

Removes feces using tap water or soap suds

Define “Oil retention enema”

Lubricates stool for easier passage

Define “Commercial enema (Fleet’s)”

Contains medication to promote bowel movements

What are the 4 steps to administering enemas?

1. position the patient in left-side Sim’s position

2. use lubricated tubing and insert 2-4 inches into the rectum

3. administer the solution slowly to prevent cramping

4. have the patient hold the liquid for several minutes before expelling

Define “Suppositories”

A small medicated insert placed into the rectum to stimulate a bowel movement

What are the 5 steps for administering suppositories?

1. ensure patient privacy and explain the procedure

2. place the patient in left-side Sim’s position

3. use a gloved hand to insert the suppository 1-1.5 inches into the rectum

4. encourage the patient to hold the suppository in place as long as possible

5. observe for results and document the procedure

What are the 2 types of GI tubes?

1. Nasogastric Tube (NGT)

2. Gastrostomy Tube (G-Tube or PEG Tube)

Define “Nasogastric Tube (NGT)”

Inserted through the nose into the stomach for short-term feeding or stomach draining

Define “Gastrostomy Tube (G-Tube or PEG Tube)”

Surgically placed through the abdominal wall for long-term feeding

What are the 5 roles CNAs have for GI Tube Care?

1. keep the patient’s head elevated to at least 30-40 degrees during and after feedings to prevent aspiration

2. ensure the tube is secure to prevent accidental removal

3. provide frequent oral hygiene to prevent dryness

4. report any signs of infection at the insertion site (redness, swelling, or discharge)

5. monitor for signs of discomfort, bloating, or nausea

What are the 4 rules for measuring and recording fluid intake?

1. fluid intake includes all liquids consumed

   1. water, soup, ice cream, IV fluids

2. use ML as the standard unit

3. keep an accurate record by noting time and amount of liquid intake

4. encourage adequate hydration for patients

What are the 5 measures for recording fluid output?

1. fluid output includes

   1. urine, vomitus, drainage from wounds, liquid stool

2. always use measuring containers to record urine and other fluids accurately

3. report any abnormalities in color, consistency, amount, or odor

4. normal urine output is at least 30 ml/hr

5. patient with fluid restrictions require special monitoring to avoid overload

What are the 2 signs of fluid imbalance?

1. dehydration

2. fluid overload

Define “Dehydration”

1. dry mouth, thirst

2. low urine output, dark urine

3. sunken eyes, confusion

4. rapid heart rate and low blood pressure

Define “Fluid Overload”

1. swelling (edema) in feet, hands, or face

2. shortness of breath

3. rapid weight gain

4. increased blood pressure

What are the 4 guidelines for Intravenous (IV) Therapy?

1. do not touch or adjust IV sites, tubing, or infusion rates

2. monitor for complications

3. report any abnormalities to the nurse immediately

4. ensure the IV pole is positioned properly and not tangled

What are the 3 types of oxygen delivery systems?

1. nasal cannula (small tubes placed in the nose)

2. face mask (covers nose and mouth)

3. oxygen tent or hood (used for infants)

What are the 6 CNA responsibilities during oxygen therapy?

1. DO NOT change the oxygen flow rate—only the nurse or respiratory therapist can do this

2. ensure oxygen tubing is not kinked or obstructed

3. observe for signs of oxygen toxicity, such as confusion, drowsiness, or blue skin (cyanosis)

4. keep oxygen tanks secured upright to prevent accidents

5. NO smoking or open flames near oxygen, as it is highly flammable

6. provide frequent oral care, as oxygen therapy can dry out the mouth and lips

What are the 4 types of wounds?

1. Surgical Wounds

2. Pressure Ulcers

3. Trauma Wounds

4. Diabetic Ulcers

Define “Surgical Wounds”

Result from surgical incisions, requiring sterile care

Define “Pressure Ulcers”

Caused by prolonged pressure, common in bed-bound patients

Define “Trauma Wounds”

Caused by injury (cuts, burns, abrasions, or punctures)

Define “Diabetic Ulcers”

Common in diabetic patients, often found on the feet

What are the 5 CNA responsibilities in wound care?

1. observe for signs of infections (redness, foul smell, increased fever)

2. ensure clean and dry dressings and notify the nurse if they become loose or soiled

3. reposition patients every two hrs to prevent pressure ulcers

4. encourage proper nutrition and hydration

5. assist with range-of-motion (ROM) exercises to improve circulation

What are the 6 steps to patient admission?

1. prepare the patient’s room, bed, and supplies before arrival

2. greet patient and help them change into hospital gown if needed

3. assist with height, weight, and vital sign measurements

4. label the patient’s belongings and secure valuables

5. explain the call light system, bed controls, and facility layout

6. observe for any signs of anxiety or distress and report concerns to the nurse

What are the 4 rules to transferring patients?

1. ensure all patient records and medication are sent with the transfer

2. use proper body mechanics when assisting with stretcher or wheelchair transfers

3. assist in packing the patient’s personal belongings

4. provide emotional support, as transfers can be stressful for patients

What are the 4 rules to discharging patients?

1. help the patient gather personal belongings and discharge instructions

2. ensure they understand any follow-up appointments or medications

3. assist them into a wheelchair or assistive device if needed

4. escort the patient to their transportation vehicle safely

What are the 7 signs of pain for residents?

1. facial grimacing, frowning, or clenched teeth

2. restlessness, pacing, or inability to stay still

3. moaning, crying, or whimpering

4. changes in breathing patterns (rapid, shallow breathing)

5. guarding or protecting an area of the body

6. increased agitation or withdrawal from activities

7. difficulty sleeping or reduced appetite

What are the 6 non-medicated ways to comfort patients?

1. repositioning

2. massage

3. apply warm or cold compresses

4. providing distraction techniques

5. assisting with breathing exercises

6. ensuring proper body alignment

Define “Repositioning”

Changing a patient’s position every 2 hrs helps relieve pressure and improves circulation

Define “Massage”

Gentle back rubs or applying light pressure to sore areas can promote relaxation and blood flow

Define “Applying Warm or Cold Compresses”

Depending on the condition, a warm towel or ice pack may provide relief

Define “Providing Distraction Techniques”

Engaging in conversation, playing soothing music, or offering books/magazines can shift focus away from pain

Define “Assisting with Breathing Exercises"

Deep breathing can help manage pain levels

Define “Ensuring Proper Body Alignment”

Support with pillows or positioning devices can relieve discomfort from musculoskeletal issues

What are the 4 environmental adjustment for comfort?

1. adjust room lighting, noise levels, and temperature to meet patient’s needs

2. offer comfortable bedding and clothing

3. provide extra pillows or positioning aids for additional support

4. assist the patients in personal hygiene to maintain cleanliness and reduce irritation

Define “Hospice care”

For patients with a terminal illness and a life expectancy of six months or less; focus on comfort rather than curative treatments

Define “Palliative care”

Can begin at any stage of illness and focus on pain relief, symptom management, and quality of life

What are the 4 CNA responsibilities in end-of-life care?

1. providing comfort measures (frequent repositioning, oral hygiene, etc)

2. maintaining a calm and supportive presence by being patient, listen, etc

3. observing for signs of impending death (shallow breathing, cold skin, decreased urine output)

4. supporting family members by offering emotional reassurance and answering questions within your scope of practice

What are the 6 post-mortem care steps?

1. bathing and preparing the body before it is transferred to the mortuary

2. removing medical equipment

3. placing the body in a supine position

4. covering the body with a clean sheet, leaving face visible for family viewing

5. documented time of death and any belongings left with the patient

6. providing support to grieving families

What are the 6 ways to provide emotional support

1. active listening

2. providing reassurance

3. engaging in meaningful conversations

4. encouraging socialization

5. supporting cultural and spiritual beliefs

6. identifying signs of depression or suicidal thoughts

What are the 5 basic patient rights?

1. right to dignity and respect

2. right to privacy and confidentiality

3. right to make healthcare decisions

4. right to be informed

5. right to safety

What are the 4 ethical considerations in patient care?

1. maintaining professional boundaries

2. report abuse or neglect

3. following advanced directives

4. respecting cultural diversity

What are the 4 goals of rehabilitation and restorative care?

1. help patients regain mobility and strength

2. encourage independence in daily activity

3. prevent complications such as contractures, pressure ulcers, and muscle atrophy

4. promote emotional well-being and self-confidence

What are the 7 CNA responsibilities in rehabilitation?

1. assist with range-of-motion (ROM) exercises

2. encourage patients to perform daily activities as independently as possible

3. use assistive devices properly and safely

4. provide positive reinforcement to boost patient confidence and motivation

5. monitor signs of fatigue, pain, or difficulty in movement

6. support speech, occupational, and physical therapy goals

7. encourage social engagement to help with emotional and psychological recovery

What are the 3 types of therapy in rehabilitation?

1. physical therapy (PT)

2. Occupational therapy (OT)

3. Speech therapy

Define “Physical therapy (PT)”

Focuses on improving strength, mobility, and coordination

Define “Occupational Therapy (OT)”

Help patients regain skills needed for daily activities like dressing, cooking, and grooming

Define “Speech therapy”

Assists with communication, swallowing difficulties, and cognitive function

What are the 4 common prosthetic devices?

1. artifical limbs (prosthetic arms or legs)

2. hearing aids

3. dentures

4. eye prostheses (glass eye)

What are the 3 measures for “Artificial limbs”

1. require regular skin checks to prevent irritation or pressure sores

2. ensure the prosthetic is properly aligned and fitted

3. encourage proper use and gradual adaptation to the device

What are the 3 measures for “Hearing aids”

1. need daily cleaning and battery checks

2. ensure proper storage and handling to prevent damage

3. assist with insertion and volume adjustments if needed

What are the 2 measures for dentures?

1. should be removed and cleaned daily to prevent gum infection

2. ensure dentures fit properly and are stored in water or a denture solution when not in use

What are the 2 measures to “Eye prostheses (glass eye)”

1. must be handled with care and proper hygiene

2. assist in regular cleaning and placement as needed

What are the 3 common orthotic devices?

1. braces and splints

2. compression stockings (TED Hose)

3. neck and back supports

What are the 3 measures when dealing with “Braces and splints”?

1. help with joint support and muscle alignment

2. must be worn according to prescribed duration

3. ensure skin underneath remains clean and irritation-free

What are the 3 measures when dealing with “Compression stockings (TED Hose)”?

1. improve circulation and reduce swelling in the legs

2. should be applied in the morning before swelling begins

3. ensure there are no wrinkles or folds to prevent pressure sores

What are the 2 measures when dealing with “Neck and back supports”?

1. provide spinal stability and pain relief

2. adjust properly to avoid discomfort and misalignment

What are the 5 CNA responsibilities for prosthetic and orthotic devices?

1. Assist patients in applying and removing devices properly.

2. Inspect skin for redness, blisters, or irritation under the device.

3. Ensure devices are kept clean and in good working condition.

4. Encourage patients to use devices consistently as recommended by therapists.

5. Report any changes in comfort or function of the device to the nurse.

What are the 8 physical changes CNAs should observe?

1. Vital sign abnormalities (fever, rapid pulse, irregular breathing)

2. Skin changes (redness, swelling, bruising, or new wounds)

3. Difficulty swallowing or speaking

4. Changes in bowel or bladder habits (constipation, diarrhea, incontinence)

5. Signs of infection (increased pain, swelling, or unusual discharge)

6. New pain complaints or worsening discomfort

7. Sudden weakness or loss of movement

8. Unexplained weight loss or gain

What are the 6 behavioral and emotional changes CNAs should observe?

1. Increased confusion or disorientation

2. Sudden mood changes (withdrawal, agitation, crying)

3. Loss of appetite or refusal to eat

4. Unusual fatigue or excessive sleepiness

5. Refusal to participate in activities

6. Expressions of sadness, hopelessness, or suicidal thoughts

What are the 5 steps to reporting changes in patients?

1. Document specific observations, time, and any patient complaints.

2. Notify the nurse or healthcare provider immediately.

3. Follow facility procedures for incident reports if necessary.

4. Communicate with family members if required and approved by the nurse.

5. Monitor for further changes and update reports as needed.

Activities of Daily Living (ADL)

Basic self-care tasks such as bathing, dressing, grooming, and eating.

Aspiration

Inhalation of food, liquid, or saliva into the lungs, which can cause choking or pneumonia.

Bedpan

A container used for toileting by bedridden patients.

Body Mechanics

The correct use of posture and movement to prevent injury while lifting or moving patients.

Catheter

A flexible tube inserted into the bladder to drain urine.

Compression Stockings (TED hose)

Elastic stockings used to improve circulation and prevent blood clots.

Confusion

A state of disorientation affecting a patient’s ability to think clearly.

Contracture

A permanent tightening of muscles, tendons, or joints due to immobility.

Denture

A removable set of artificial teeth.

Discharge

The process of releasing a patient from medical care.

Dysphagia

Difficulty swallowing, often seen in patients with neurological conditions or post-stroke.

Edema

Swelling caused by fluid retention in the body’s tissues.

Elimination

The process of removing waste from the body, including urination and defecation.

Fall Precautions

Strategies to prevent falls in patients, including bed alarms and proper footwear.

Feeding Tube

A tube inserted through the nose or abdomen to provide nutrition to patients who cannot eat normally.

Fluid Balance

The proper level of hydration in the body, maintained through fluid intake and output monitoring.