Nebraska CNA Skills: Critical Steps

Handwashing (3)

* Rubs hands together in fingers between each other to create a lather. Ladders all surfaces of fingers and hands producing friction for at least 20 seconds.

* Rinses all surfaces of hands and wrists. Runs water down from wrists to fingertips.

* Uses clean, dry paper towel to turn off faucet, without contaminating hands.

Removing disposable gloves (3)

* Touches only the outside of one glove. With gloved hand grasps the other glove at the palm and pulls glove off. a glove comes off the hand it should be turned inside out.

* With gloved hand holds glove just removed. With ungloved hand, reaches two fingers underneath cuff of remaining glove at wrist, does not touch any part of the outside of glove.

* Pulls down turning glove inside out over the first glove. Should be holding one glove from its clean inner side with the other glove inside.

Handling soiled equipment (3)

* Applies gloves.

* Holds and carries soiled equipment away from Clothing

* Clean soiled equipment with cold water and appropriate disinfectant, according to facility policy

Handling soiled waste (3)

* Applies gloves

* Cleans contaminated surfaces with disinfectant per facility policy

* Ties the bag closed, touching only the inside of the waste container.

Handling soiled bed linens (3)

* Applies gloves

* Rolls soiled linen away from the body being careful not to touch linen to clothing

* Closes and ties the linen bag shut, touching only outside of the bag.

Abdominal thrusts (3)

* "Are you choking? I know what to do, can I help?"

If they cannot verbally answer continue with procedure.

* Makes a fist with one hand. Places flat thumb side of the fist against person's abdomen, above belly button but below sternum.

* Grasps fist with other hand. Pulls both hands toward self and upwards, quickly and forcefully.

Application of Support Stockings (2)

* Places foot of stocking gently over toes, foot, and heal. Ensure heal is in the right place (heal should fall on the heal square space).

* Ensures there are no twists or wrinkles in stocking.

Changing an unoccupied bed (4)

* Raises bed to a safe working level and locks wheels.

* Applies gloves

* Remove and discard gloves. Applies sanitizer.

* Returns bed to lowest position and ensures wheels are locked.

Changing an occupied bed (5)

* Raises bed to a safe working level and locks wheels.

* Applies gloves (loosen and remove old bedding FROM ONE SIDE)

* Remove and discard gloves. Sanitizes hands, and applies new pair of gloves ( to apply new bedding TO ONE SIDE, and remove old FROM OTHER SIDE)

* Remove and discard gloves. Sanitizes hands , and applies new pair of gloves ( to apply new bedding TO OTHER SIDE + pillow case)

* Returns bed to lowest position and ensures wheels are locked.

Oral temperature (2)

* Reads the temperature on the display screen. Removes the probe cover. Remembers the temperature reading.

* Verbalizes normal range of oral temperature (97.6-99.6)

Radial pulse with respirations (3)

PULSE:

* Counts beats for full minute. Reports reading accurately within 4 beats of instructor count.

RESPIRATIONS:

* Keeping fingertips on resident's wrist, counts respirations for 1 full minute. Student must be accurate within 2 breaths of instructor count.

* Verbalizes normal ranges

- (60-100 BPM)

- (12-20 breaths)

Height and weight (2)

* Determines resident's weight within 1 lb.

* Determine's resident's height within 1/4 inch

Routine oral care (5)

* Assist resident into an upright sitting position.

* Applies gloves.

* Cleans entire mouth (Including tongue and all surfaces of teeth). Uses gentle, circular strokes.

* Returns bed to lowest position and makes sure wheels are locked.

* Removes and discards gloves and sanitizes hands.

Oral care for the unconscious resident (6)

* Applies gloves.

* Turns resident's head towards nursing assistant.

* Dips swab and cleaning solution. Squeezes excess solution to prevent aspiration. Cleans teeth, gums, tongue and inside surfaces of mouth. Changes swabs often, placing used swabs in emesis basin. Repeats until the mouth is clean.

* Removes excess fluid in the resident's mouth with a dry swab.

* Returns bed to lowest position and ensures wheels are locked.

*Remove and discard gloves. Sanitizes hands.

Care of dentures (3)

* Applies gloves.

* Lines the sink with washcloth/towel and fills with cool water.

* Remove and discard gloves. Sanitizes hands.

Dressing and undressing (3)

* Asks resident what he or she would like to wear.

* Covers resident with bath blanket and removes gown without completely exposing them. Removes clothing from unaffected/stronger extremity first when undressing. Then, removes from affected/weaker extremity

* Assists resident to put clothing on the affected/weak extremity first. Then, places garment on unaffected/strong extremity. Ensures that clothing is right side out and zippers and buttons are fastened

Nail care (3)

* Applies gloves.

*Clips nails if allowed, according to resident care plan (fingernails rounded/toenails straight across). Smooths the rough edges with an emery board.

* Removes and discards gloves. Sanitizes hands.

Shaving with an electric razor (3)

* Applies gloves.

(WITH THREE HEADED):

* Turns on razor and holds skin taught/tight. Shaves beard in circular motion with smooth, even movements.

(WITH FOIL RAZOR):

Shaves beard in direction of beard growth.

* Removes and discards gloves. Sanitizes hands.

Bed bath

Fill basin with warm (105*) water

Text on wrist and bath thermometer

Resident checks water temp (adjust if necessary)

Raise bed to safe working level, lock wheels

Applies gloves

Face

Arms

Hands

Chest

Abdomen

Legs

Feet

Front peri care

BACKRUB

Back peri care

Return bed to lowest, lock wheels

Removes and discards bloated, SANITIZES HANDS

Partial Bed bath

Basin warm water (105)

Check with thermometer or wrist

Resident checks, change if necessary

Bed to safe working level

GLOVES

Face

Axillae

Hands

Front peri care

Back peri care

Bed to lowest, locks wheels

discard GLOVES, SANITIZES HANDS.

male perineal care

Basin warm water (105)

Check with thermometer or wrist

Resident checks, change if necessary

Bed to safe working level

GLOVES (for set up)

( before actually starting) REMOVES, SANITIZES, NEW GLOVES

Tip of penis, circular motions around urinary meatus. Work towards base

Rinse and pat dry. SCROTUM, GROIN, MONS. Rinse, pat dry.

If UNCIRCUMCISED, gently push back foreskin, return to its position,

REMOVE AND DISCARD, SANITIZES, NEW GLOVES. (To do back peri care)

REMOVE AND DISCARD, SANITIZES.

Lowest position, wheels locked.

female perineal care

Basin warm water (105)

Check with thermometer or wrist

Resident checks, change if necessary

Bed to safe working level

GLOVES (for set up)

( before actually starting) REMOVES, SANITIZES, NEW GLOVES

Separate labia —> drainage, irritation, pain

Down the center from urinary meatus. Front to back.

Wash Each side of labia minora.

Rinse.

Wash each side of labor majora

Rinse.

Wash/rinse MONS and GROIN

Dry the whole area with BLOTTING motion, FRONT TO BACK

REMOVES, SANITIZES, NEW GLOVES (for back peri care)

REMOVES, SANITIZES