CNA Skills from North Carolina Handbook Latest updated version with expert curated questions and answers (GUARANTEED SUCCESS)

INDIRECT CARE

1. COMMUNICATE: greet w\ name, introduce yourself, give procedure overview, explain each step while doing it

2. PATIENT RIGHTS: knock before entering, pull curtain while performing care, ask about their preference, always be gentle

3. SAFETY: lower bed while rendering care, ensure side rails are raised, call light always within reach, bed locked

4. SANITARY: always wash hands before and after, use gloves when potential body fluid contact, avoid contact w\ floor

LAST STEPS OF EVERY SKILL

1. If gloved, dispose w\ out contaminating self

2. Signaling device within reach (ask if they need anything)

3. Bed locked & in lowest position

4. Wash hands (wash before if already at sink rinsing basin)

5. Say "my skill is complete"

FIRST STEPS OF EVERY SKILL

1. knock & wait

2. introduce yourself

3. explain procedure clearly, slowly while maintaining eye contact

4. pull back privacy curtain

REMOVE GLOVES W\ OUT CONTAMINATING SELF

1. Grasp outer surface of one glove near wrist, curl back towards self, pulling glove off without touching exposed wrist

2. Bunch up removed glove in hand that pulled off first glove

3. Face gloved hand down & bend wrist to create gap at top of glove

4. Slip two ungloved fingers under wrist of remaining glove without touching outside surface of the remaining glove, pull off

5. Safely dispose in designated biohazard container

6. Wash hands

HAND WASHING

1. Turns on water at sink

2. Wets hands and wrists thoroughly

3. Applies soap to hands

4. Lathers all surfaces of wrists, hands, and fingers producing friction, for at least 20 seconds, keeping hands lower than the elbows and the fingertips down

5. Cleans fingernails by rubbing fingertips against palms of the opposite hand

6. Rinse all surfaces of wrists, hands, and fingers, keeping hands lower than the elbows and the fingertips down

7. Uses clean, dry paper towel/towels to dry all surfaces of hands, wrists, and fingers then disposes of paper towel/towels into waste container

8. Uses clean, dry paper towel/towels to turn off faucet then disposes of paper towel/towels into waste container or uses knee/foot control to turn off faucet

9. Does not touch sink or countertop at any time

KNEE HIGH ELASTIC STOCKING (TED HOSE)

Supplies: Elastic Stocking

1. supine position (lying down in bed), check for skin irritation

2. turn stocking inside out

3. pull over toe, foot & heel

4. gently pull up leg

5. no twists or wrinkles, heel of stocking (if present) is over heel and toe opening over toe area

[hold knee down to prevent flexion, ask if too tight]

ASSIST TO AMBULATE W/ TRANSFER BELT

Supplies: Transfer Belt

1. before assisting to stand, ensure client is wearing shoes

2. check bed is at safe level and locked

3. before standing, assist client to sitting position with feet flat on floor

4. apply transfer belt over clothes at the waist (ask if too tight)

5. explain again and arrange signal ("1, 2, 3... on 3")

4. face client, hold belt upward (hands face up), give signal, maintain stability of client's legs (by putting your feet in front of client's)

5. while holding belt, walk slightly behind & to one side for 10 ft (ask if dizzy)

6. assist to bed & remove belt

ASSIST W/ USE OF BEDPAN

Supplies: Bedpan, Toilet Paper, Hand Wipes, 2 Sets of Gloves, Trash can w/ in reach

1. lower head of bed

2. raise opposite bed rail

3. put on gloves

4. roll client toward rail

5. place bedpan under buttocks

6. discard gloves & wash hands

7. raise head of bed

8. instruct on hand wipes & signal when finished; call light, hand wipes, & toilet paper w/ in reach

9. put on clean gloves

10. lower head of bed

11. put up rail & roll client while holding bedpan

12. remove bedpan, empty in toilet, rinse empty in toilet, & place in dirty area

13. remove gloves & wash hands

DENTURE CARE

Supplies: Tooth brush, tooth paste, gloves, paper towel, small wash cloth, basin, dentures & cup

1. Put on gloves

2. Line sink w/ liner (e.g. wash cloth) or partially fill with water

3. Pickup dentures, rinse under warm running water

4. Apply toothpaste to toothbrush

5. Brush dentures

6. Rinse dentures under warm running water

7. Rinse cup and lid, place dentures in cup, fill with warm water, lid on cup

8. Rinse toothbrush, put back

9. Remove sink liner or drain sink

10. Dispose gloves & wash hands

COUNT & RECORD RADIAL PULSE

Supplies: watch w/ second hand

1. place finger on thumb side of client's wrist

2. count beats for 1 full minute

3. wash hands

4. record within 4 bpm of evaluator

COUNT & RECORD RESPIRATIONS

Supplies: watch w/second hand

1. have client cross their arms across chest

2. count for 1 full minute

3. wash hands

4. record within 2 of evaluator

DONNING & REMOVING PPE (GOWN & GLOVES)

Supplies: Gown & Gloves

1. unfold gown

2. place arms through sleeve, fasten neck opening

3. secure at waist, ensuring clothing is covered by gown

4. put on gloves (over cuff)

5. remove & dispose gloves w\ out contaminating

6. untie gown at neck & waist

7. roll off dirty side in (w\ out touching outside of gown or floor)

DRESSING CLIENT W/AFFECTED RIGHT ARM

Supplies: two options (shirts or gowns)

1. give client choice of clothing

2. remove gown from unaffected arm (left arm) 1st, then affected side (right arm)

3. help dress affected side (right arm) 1st, then unaffected side (left arm)

4. place soiled linens in hamper

FEEDING CLIENT

Supplies: food tray, hand wipes

1. pick up name card & ask client to state name

2. set bed upright and ensure client is in a 75-90 degree position

3. clean clients hands w/wipes

4. inform food options & ask about order preference

5. offer one bite of each food, tell them what it is

6. offer beverage at least once

7. after eating, wipe mouth & hands w/wipes

8. place food in trash & tray in dirty area

MODIFIED BED BATH (FACE, 1 ARM, HAND, UNDERARM)

Supplies: Basin with water, Soap, Gloves, 3 Towels, 3, Washclothes, & 1 Gown

1. remove gown & place in soiled while avoiding overexposure

2. check water temperature, verify w\ client

3. put on gloves

4. wash eyes (inner to outer aspect) then rest of face, using different part of cloth for each stroke (NO SOAP)

5. dry face

6. expose arm & place towel under arm

7. apply soap to wet cloth

8. gently wash arm, hand, & underarm (underarm last) then rinse and dry in that order

9. put on clean gown

10. empty, rinse, & dry basin then place in dirty area

11. dispose linens in soiled, avoiding contact w\ clean

12. gloves in trash, wash hands, then call light

BLOOD PRESSURE

Supplies: stethoscope, bp cuff, 6 alcohol wipes

1. Wipe stethoscope ear & bell

2. Follow pinky to bend of elbow for brachial artery

3. Place cuff pointer to brachial artery

3. Make sure to close valve

4. Pump to 160-180

5. If beat heard immediately upon deflating, fully deflate and start again

6. Note mm on first and last sound (round up if needed)

7. Wash hands then record within 8 mm of evaluator

MEASURE & RECORD URINARY OUTPUT

Supplies: Gloves

1. pour the contents from bedpan into measuring container over toilet

2. place container flat, record at eye level

3. empty into toilet

4. rinse bedpan & measuring container, pour rinse into toliet

5. trash gloves w\ out contaminating

6. wash hands

7. record within 25 ml/cc of evaluator (30 ml/cc = 1 oz)

MEASURE WEIGHT OF AMBULATORY CLIENT

1. ensures client has shoes on

2. walk to scale & set scale to zero

3. stand on side and assist if need be

4. determine weight

5. stand to side and assist if need be

6. wash hands

7. record weight w\ in 2 lbs/.9 kg of evaluator

RANGE OF MOTION (ROM) KNEE & ANKLE

1. "tell me if you experience pain at any time"

2. support leg at knee & ankle while peforming ROM for knee

3. bend knee and then return to normal position 3x (ask about pain)

4. support foot & ankle close to the bed while performing ROM for ankle

5. foot towards head and down, toes point down 3x (ask about pain)

6. move gently and slowly through exercise

RANGE OF MOTION (ROM) SHOULDER

1. "tell me if you experience pain at any time"

2. support arm at elbow & wrist while performing ROM on shoulder

3. gently raise client's straightened arm away from side position upward towards head to ear level, return arm down to side 3x (ask about pain)

4. move straightened arm away from side of body to shoulder level & return to side of body 3x (ask about pain)

POSITION ON SIDE

Supplies: 4 pillows

1. do not touch clean pillows against your clothing or bare surface (use a sanitary barrier)

2. lower head of bed if not down

3. raise side rail on side body will be turned

4. assist client slowly roll onto that side

5. adjust or place pillow under head

6. make sure not lying on arm

7. pillow #1 under top arm, fold in half

8. fold pillow #2 lengthwise & tuck by their back, having them lay on it

9. pillow #3 between legs and ankle w\ top knee flexed naturally

10. ask if comfortable

CATHETER CARE FOR FEMALE

Supplies: basin water, soap, 2 washclothes, 1 towel, 2 chuck pads

1. have client check water temp

2. put on gloves

3. place linen protector (chuck) under peri area

4. wet 1st washcloth then apply soap

5. hold cath at meatus without tugging, and clean 4 in. of cath moving towards self using a clean area of cloth for each stroke

6. wet 2nd washcloth hold cath and rinse w\ same method

7. hold cath at meatus and dry

8. empty, rinses, & dry basin and put in dirty area

9. dispose of linens in soiled

FOOT CARE ON ONE FOOT

Supplies: 1 chuck pad, 1 towel, 1 washcloth, soap, lotion, water basin

1. have client check water temp with toe

2. place basin on protective barrier at comfortable position for client

3. put on gloves

4. place foot in water & apply soap to wet washcloth

5. lift and wash foot, including between toes

6. rinse foot in water, including between toes

7. dry foot, including between the toes

8. apply lotion on top and bottom of foot (NOT between toes) & dry off excess

9. empty, rinse & dry basin but in dirty area

10. dispose of dirty linens

MOUTH CARE

Supplies: emesis basin (c shape basin), tooth brush, tooth paste, small cup of water, cloth protector, gloves, paper towel

1. ensure client is upright (75-90 degrees)

2. put on gloves

3. place clothing protector across clients chest

4. moisten toothbrush & apply toothpaste

5. gently clean mouth including tongue & surfaces of teeth

6. place toothbrush on paper towel

7. while placing basin under chin, have client rinse mouth

8. wipe mouth & remove clothing protector

9. empty, rinse, & dry basin; place toothbrush in basin & then in dirty area

10. dispose of clothing protector

PERI-CARE FOR FEMALE

Supplies: water basin, chuck pad, 4 washclothes, 2 towels, 1 bath blanket, soap, gloves

1. have client check water temp

2. put on gloves

3. discretely place pad/linen protector under perineal area

4. apply soap to wet 1st washcloth & wash genital area from front to back using clean area of cloth with each stroke

5. w\ 2nd clean washcloth, rinse soap from genitals, moving from front to back w\ a clean area of washcloth

6. dry genitals moving front to back

7. raise side rail and have client turn over on their side

8. apply soap to wet 3rd washcloth & wash rectal area from front to back using clean area of cloth with each stroke

9. use 4th washcloth to rinse (no soap) from front to back using clean area of cloth with each stroke and pat dry

10. dry rectal area front to back

11. reposition client

12. empty, rinse, and dry basin; put in dirty area

13. dispose of dirty linens

TRANSFER FROM BED TO WHEELCHAIR USING TRANSFER BELT

Supplies: transfer belt & wheelchair

1. place wheelchair on side of bed at the head of the bed and facing the foot of the bed

2. wheelchair is locked and footrests folded up or removed

3. bed locked & at safe level

4. assist client to sit, apply shoes & belt, feet flat on floor before proceeding

5. prearrange signal to stand ("1, 2, 3, on 3")

6. on signal, pull transfer belt up to assist client to stand

7. turn client so that their legs are back against wheelchair

8. lower client into wheelchair, position hips to back of wheelchair

9. remove transfer belt

10. put feet on footrest