CNA SKILLS

Hand washing

Steps:

1. Address client by name and introduce

   • Hi my name is abriana, I will be your CNA today. I am going to be performing hand washing.

2. Turns on water

3. wet hands and wrists throughly

4. Applies soap to hands

5. Laters all surfaces of wrists, hands, and fingers, producing friction, for at least 20 seconds ( count in head)

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

7. Use a clean dry paper towel to dry all surfaces of hands, and wrists starting at fingertips then disposes of paper towel into waste container

8. Uses clean paper towel to turn of faucet then throw out the paper towel

SKILL COMPLETE

Applies one knee-high elastic stocking (TED)

1. Introduce CNA, state what task is being done, wash hands and provide privacy

2. Make sure bed is locked before hand. Client has to be laying down while stocking is applied.

3. Turn stocking portion inside out, AT THE HEEL

4. Places foot of stocking over toes, foot, and heel

5. Pulls top of stocking over foot, heel, and leg

6. Moves foot and leg gently and naturally, avoiding force and over-extension of limb and joints

7. Make sure there are no wrinkles or twist in the stocking

8. Give call bell, and make sure bed is in low and locked

WASH HANDS AND SKILL COMPLETE

Assists to ambulate using transfer belt

1. Explains procedure, and introduce, wash hands, grab supplies and provide privacy

2. Make sure bed is locked and raise the bed if needed

3. Before assisting to stand, make sure client has their feet flat on the floor

4. Have the client lift arms, and secure the transfer belt around them

5. Make sure the transfer belt is used on the teeth side, and it has just enough space for 2 fingers

6. Before assisting to stand, provides instructions to let client know that you will be assisting them to stand

7. Counts to three to alert the client before standing, and have the client stand

8. Assists client to stand by grabbing the transfer belt on both sides with an upward grab, and clients hands are raised upwards, and maintaining stability of clients legs by standing knee to knee

9. Walks slightly behind and one side of the client, walk 10 steps with client

10. Assists client to bed and removes transfer belt

    Give client call bell and wash hands, skill complete !

Cleans upper/lower denture

1. Introduce, wash hands, and, grab supplies put on clean gloves

2. Make sure the bottom of the sink is partially filled with water before denture is held over sink

3. Line the sink with paper towels, and underneath denture containers, basin/toothbrush holder

4. Rinses denture in running water before brushing them

5. Applies denture toothpaste on toothpaste

6. Brush all surfaces of dentures

7. Rinse the dentures

8. RINSE DENTURE CAP AND LID

9. Places denture cup in water/ solution and places lid on cup

10. Rinses toothbrush and places in designated toothbrush basin/container

11. Maintains a clean placement of toothbrush and denture

12. Sink liner and other paper towels is removed

13. Dispose of gloves, and wash hands

Counts and records RADIAL PULSE

1. Introduce, grab supplies, provide privacy, wash hands

2. Place fingertips on THUMB side of client’s wrist to locate RADIAL pulse

3. Count beats for one full minute

4. Give client call bell

5. BEFORE recording, wash hands

6. Records pulse rate within PLUS or MINUS 4 bears of evaluator readings

WASH HANDS AND SKILL COMPLETE

Counts and records respirations

1. Introduce, grab supplies, provide privacy, wash hands

2. Count respirations for one full minute

3. Call bell is within reach

4. BEFORE recording wash hands

5. Records respirations rate within (+2 or -2 form evaluators)

Donning and removing PPE

1. Pick up gown and unfolds

2. Facing the pack opening of the gown places arms through each sleeve

3. Fastens the neck opening

4. Secures gown at waist making sure that back of clothing is covered by down as much as possible

5. Puts on gloves, and cuffs of gloves overlap cuff of gown

6. Before removing the gown with one hand, grasps the other glove at the palm, remove glove

7. Put fingers from ungloved hand underneath cuff of remaining glove at wrist, and removes glove turning it inside out

8. Dispose of gloves

9. Unfasten gown at waist and neck

10. After removing gloves, remove gown without touching outside of gown

11. While removing gown, hold gown away from body and turn it inside out

12. Dispose of gown in designated dirty area

    WASH HANDS and SKILL COMPLETE

Dresses client with affected arm

1. Introduce, grab supplies, provide privacy, wash hands

2. Ask which shirt he/she would like to wear

3. Avoid overexposure of client by ensuring client’s chest is covered

4. Removes gown from the left (unaffected) side first, then removes gown from the right (affected /weak) side

5. Dispose of gown into linen container

6. Assists to put the right (affected /weak) arm through the right sleeve of the shirt before placing garment on the left (unaffected) arm

7. While putting a shirt on moves body gently and naturally avoiding force and over extension of limbs and joints

8. finishes with clothing in place

9. Call bell is within reach and bed is in low position

WASH HANDS AND SKILL COMPLETE

Feeds clinet who cannot feed self

1. Introduce, grab supplies, and wash hands

   1. SUPPLIES: A clothing protector, wipes, and MAYBE A TOWEL

2. BEFORE feeding ask, the client to state their name, confirm on the notecard

3. Before feeding, have the client sit upright (75-90 degrees)

4. Place tray where the food can be easily seen by the client

5. Wipe clients hands before feeding

6. Tells client what foods and beverages on tray

7. Ask client what they would like to eat first

8. Using spoon, offers client one bite of each type of food on tray, telling the client what is in each spoonful

9. Offers a beverage during the meal

10. Asks client if they are ready for the next bite for the next food or beverage

11. At the end of meal, clean client’s mouth with the clothing protector, and wipe hands,

12. Removes food tray

13. Leave client upright position, give client call bell

WASH HANDS AND SKILL COMPLETE

Gives modified bed bath ( face and one arm)

1. Introduce, grab supplies, provide privacy, wash hands

   1. SUPPLIES: 2 towels, 4 wash clothes, basin, soap, water, gloves

2. Removes gown and places directly into solid linen while keeping chest and body covered

3. Before washing, have the client check the water temperature

4. Put on clean gloves

5. Start with washing the face, use a washcloth, and fold with 4 conners

6. Wipe under the eye with one conner, and with another wipe the upper and the ear with the other parts of the washcloths.

7. Dries face with the dry wash cloth

8. Exposes one arm, and put towel under the arm

9. Applies soap to wash cloth, and wash hand arm, underarm, and fingernails, while keeping the body covered

10. Rinses with one washcloth and dry area

11. Puts clean gown on client

12. Emptie, rinses, and drains basin

13. Places everything in designated dirty area, and puts linen in dirty linen container

14. Avoids contact between clothing and used linen

15. Removes and disposes of gloves without containing anything

16. Give call bell, and make sure bed is in low position

17. WASH HANDS AND SKILL COMPLETE

Measures and records urinary output

1. Puts on clean gloves before handling bedpan

2. Purs the contents of the bed pan into measuring container without spilling or splashing urine outside of the container

3. Rinses bedpan and pours rinses into toilet

4. Measures the amount of urine at eye level with container on flat surface (if between measurement lines, round up to the nearest 25ml/c)

5. After measuring urine, empties contents of measuring, container into toilet

6. Rinses measuring container and pours it into toilet

7. Before recording output, removes and disposes of gloves ( without contaminating self) into waste container and washes hands

8. WASH HANDS BEFORE RECORDING

9. Records contents of container within plus or minus 25 ml of evaluator’s reading

Wash hands after, and skill complete

Measure and records weight of ambulatory client

1. Introduce CNA, state what task is being done, wash hands and provide privacy

2. Make sure client has non-skid shoes/footwear on before walking to scale

3. Before client steps on scale, make sure scale it set to zero

4. Asks client to step on the center of the scale, and obtains clients weight

5. Make sure you are recording in the weight in LBS/ POUNDS

6. Make sure weight is balanced to get the correct weight

7. BEFORE RECORDING. WASH HANDS

8. record weight

9. WASH HANDS AND SKILL COMPLETE

Performs modified passive range of motion for one knee and one ankle

1. Introduce CNA, state what task is being done, wash hands and provide privacy

2. Ensure that client is supine in bed and instruct client to inform if there is any pain**

3. While supporting the leg at the knee and ankle, bends the knee and then returns leg to normal position REPEAT 3 TIMES

4. While supporting the foot and ankle close to the bed, pushes/pulls foot towards head and pulls foot down toes pointing down

5. Moves joints slowly and smoothly through the range of motion

6. Make sure call bell is within reach of the bed and bed is in low position and locked

7. WASH HANDS AND SKILL COMPLETE

Performs modified passive range of motion (PROM) for one shoulder

1. Introduce CNA, state what task is being done, wash hands and provide privacy

2. Instruct client to state if there is any pain during this exercise

3. Support arm at the elbow and at the wrist, raises client’s straightened arm from side position upward toward head to ear level and returns arm down to side of body ( flexion/ extension) AT LEAST 3 TIMES

4. Moves joints gently, slowly, and smoothly, through the range of motion

5. While supporting arm at the elbow and at the wrist moves client’s straightened arm away from the side of the body to shoulder level ( OUTWARDS) AT LEAST 3 TIMES

6. Give client call bell and make sure bed is lowered

7. WASH HANDS AND SKILL COMPLETE

Position on one side

1. Introduce CNA, state what task is being done, wash hands and provide privacy

   1. GRAB SUPPLIES: 4 pillows, one towel

2. Before turning client, lowers the head of the bed

   1. REMEMBER ASK CLIENT TO CROSS ARMS AND LEGS

3. Raises side rail on side which the body will be turned

4. Assists client to slowly roll onto side, have the client hold onto the side rail

5. Places or adjust pillow underneath the head

6. REPOSITION ARM AND SHOULDER SO THAT CLIENT IS NOT LYING ON ARM

7. Supports top arm with a pillow

8. Places supportive device behind clients back

9. Places supportive device between legs with top knee flexed and ankle supported

10. GIVE CALL BELL, BED IS IN LOW POSITION, WASH HANDS SKILL COMPLETE

Provides catheter care for female

1. Introduce, grab supplies, provide privacy, wash hands

   1. SUPPLIES: Basin, water, soap, 2 towles (one for the table), 3 wash cloths, linen protector

2. TEST WATER BEFOREHAND, THEN HAVE CLIENT TEST WATER

3. Put on clean gloves

4. Place linen protect under perineal area including buttock

   1. Have the patient hold onto the side rail before hand, roll the linen protector underneath the client

5. Put towel on clients chest to ensure privacy and only expose above the knees, and peri area

6. Fold the washcloth in four corners, wet the cloth, then apply soap ON THE CLOTH

7. Hold the top of the Catheter and then wipe down, use a clean corner each time while wiping down the catheter

8. RINSE THE AREA WITH A CLEAN WASHCLOTH, again using the washcloth folded in four corners

9. Dry the area

10. Cover the client up, and removes the linen protector

11. Disposes linen in designated dirty area, while avoiding contact between candidate clothing and used linen

12. removes gloves without containing oneself, waste container

13. Give call bell, make sure bed is locked and at a low position

14. WASH HANDS AND SKILL COMPLETE

Provides foot care on one foot

1. Introduce, provide privacy, wash hands, grab supplies

   1. SUPPLIES: Linen protector, basin, 4 wash cloths, water, soap, and lotion

2. BEFORE washing, and have client check the temperature of the water

3. Ask Client to have their feet flat on the floor, and put linen protector on the ground

4. Put on clean gloves

5. Place foot into basin, Applies soap to wet wash cloth ( remember 4 corners)

   1. first corner washes the top of the foot, second corner washes the sides of the foot, third washes the bottom, and fourth washes in between of the toes

6. RINSE USES THE SAME FOUR CORNER METHOD

7. Dries the foot including in between of the toes with dry wash cloth/ towel

8. Applies lotion to top and bottom of foot( DO NOT PUT LOTION IN BETWEEN OF THE TOES)

9. Supports foot and ankle during this process

10. empties, rinses, and dries basin

11. Places basin in designated dirty supply area

12. Disposes of used linen into soiled linen container'

13. Removes gloves without contaming oneself

14. Give call bell, and wash hands

SKILL COMPLETE

Provides mouth care

1. Introduce, provide privacy, wash hands, grab supplies

   1. SUPPLIES NEEDED: Toothbrush, toothpaste, a cup of water, a clothing protector, small basin, and a wash cloth

2. Make sure client is sitting in an upright position ( 75-90 degrees)

3. Put on clean gloves before cleaning mouth

4. Places clothing protector

5. Wets toothbrush by pouring a small amount of water over basin

6. Applies toothpaste to toothbrush

7. Cleans mouth including tongue and all surfaces of the teeth using gently motion

8. Maintain clean technique with placement of toothbrush

9. Candidate holds small basin to chin while client rinses mouth

10. Wipe the mouth and removes clothing protector

11. Dispose of linen used and placed in designated dirty area, and everything used

12. Removes gloves and puts into trash

13. Give call bell and WASH HANDS SKILL COMPLETE

Provides perineal care (peri-care) for female

1. Introduce, provide privacy, wash hands, grab supplies

   1. SUPPLIES: 4 wash cloths, 2 towels, a linen protector, basin, soap, water,

2. Test the water, and then have the client check the water

3. Puts on clean gloves, and have client turn to the side, while grabbing the side rails

4. Put all wash cloths in the water

5. Grab the first wash cloth and fold it into four corners and apply soap

6. Washes genital area moving from front to back, while using a clean area of the washcloth for each stroke

7. Using clean washcloth, rinses soap from genital area. moving from front to back while using a clean washcloth for each stroke

8. Dries genital area moving from front to back with a clean towel

9. Have the client turn to the side, washes rectal area, uses a different washcloth

10. Apply soap to wash cloth and wipe one side of the rectal area, moving from front to back using a clean side of the washcloth for each side

11. Dries rectal area moving from front to back with dry cloth/wash cloth

12. reposition client

13. Empties, rinses, and dry basin

14. Place basin in designated dirty area

15. Disposes of used linen into soiled linen container

16. removes gloves and place into waste container

17. give call bell, bed is in low position, and wash hands skill complete

Transfer from bed to wheelchair using transfer belt

1. Introduce, provide privacy, wash hands, grab supplies

2. Before assisting to stand, wheelchair is positioned alongside of bed, at head of bed facing foot

3. Before assisting to stand, make sure footrests are folded up or removed

4. MAKE SURE THE WHEELCHAIR IS LOCKED

5. Make sure the bed is at a safe level

6. Check to see if bed is locked

7. Make sure client is sitting position feet flat on the floor

8. Make sure client is wearing shoes

9. Applies transfer belt securely at the waist over clothing. TEETH SIDE IN AND SECURE THE BELT

10. Provides instructions to enable client to assist in transfer including prearranged signal to alert client ( example 1, 2, 3 stand up please)

11. Stands facing the client positioning self to ensure safety of candidate and during transfer

12. On the signal (1,2,3) gradually assists client to stand by grasping transfer belt on both sides with an upward motion and maintaining ability of clients leg by standing knee to knee

13. Assists client to turn to stand in front of the wheelchair with back of client’s legs against wheelchair.

14. ASK THE CLIENT IF THEY CAN FEEL THE WHEELCHAIR BEHIND THEIR KNEES AND HANDS ARE ON THE ARM REST

15. Lowers client into wheelchair

16. positions client with hips touching back of wheelchair and transfer belt is removed

17. positions feet on footrest

18. give call bell

19. wash hands and skill complete

measures and records manual blood pressure

1. Introduce, provide privacy, wash hands, grab supplies

   1. SUPPLIES: Stethoscope, alcohol wipes, and blood pressure cuff

2. Wipe of stethoscope using alcohol wipes, ( WIPE BELL, DIAPHRAGM, AND EAR PIECES)

3. Client’s arm is positioned with palm up and upper arm is exposed

4. Feels for brachial artery on inner aspect of arm at the bend of elbow ( BRACHIAL = PINKY SIDE)

5. Places Blood pressure cuff snugly on clients arm, with sensor/arrow over brachial artery site

6. Ear pieces of stethoscope are in ears and bell/ diaphragm is over brachial artery site

7. Inflates cuff between 160mmHg to 180mmHG

8. If beat heard upon cuff deflation completely deflate cuff. Re-inflate cuff to no more than 200mmHg

9. Deflates cuff SLOWLY and notes the first sound ( systolic reading) and last sound ( diastolic reading)

10. If rounded needed measurements are rounded UP to the nearest 2mm of mercury

11. Removes cuff

12. Give client call bell

13. WASH HANDS

14. Records and write down BP with a pen

15. Wash hands again and skill complete