CNA Test 1
Module A: Overview of Nurse Aide 1 (NA1) Responsibilities
OBRA
Stands for Omnibus Budget Reconciliation Act
Enacted in 1987
Defined as a Federal Law
Nurse Aide Registry Maintenance
The DHSR (Division of Health Service Regulation) is responsible for maintaining the NC Nurse Aide 1 Registry.
Role of the North Carolina Board of Nursing
Defines the range of functions for Nurse Aides in NC.
National Nurse Aide Assessment Program (NNAAP)
Individuals may take the NNAAP Exam three times after completion of a state-approved Nurse Aide 1 training program.
To be placed on the Nurse Aide 1 Registry, individuals must pass both the written and skills sections of the NNAAP.
Continuing Requirements for Nurse Aide 1
To remain on the NC Nurse Aide registry, the NA1 must work under the supervision of a Registered Nurse (RN) for at least 8 hours within the last 24 months.
Job Responsibilities of Nurse Aide 1
Provides personal care (Activities of Daily Living - ADLs)
Reports abnormal vital signs to the RN
Assists with feeding
Examples of Responsibilities Outside Scope of NA1
Inserting a tube into a patient/resident’s body is outside the NA1 scope of practice.
Delegation in Nursing
Delegating: Assigning part of one’s responsibilities to another qualified person.
NAs can refuse to do a delegated task if it is out of their scope of practice or not within their job description.
Five Rights of Delegation (in order):
Right Task
Right Circumstances
Right Person
Right Directions & Communication
Right Supervision & Evaluation
If unsure how to complete a task, the NA should ask their immediate supervisor for help to learn the task.
Module B: Infection Control
Localized Infection
Involves one part of the body, with symptoms limited to that area.
Example: Red, painful, swollen finger.
Systemic Infection
Affects an entire body part or group of organs.
Signs and symptoms may include:
Fever
Nausea
Vomiting
Confusion
Symptoms of Specific Infections
Respiratory Infection:
Fever, chills, green or yellow slimy mucus, coughing, sneezing.
Bladder Infection:
Painful urination, fever, chills, urine with a bad/strong odor.
Microorganisms
Defined as GERMS, including:
Bacteria
Viruses
Parasites
Fungi
Medical Asepsis/Clean Technique
Used to remove or destroy microorganisms and prevent their spread.
Example: Handwashing.
Chain of Infection
Causative Agent: Germs that cause infections (e.g., bacteria, viruses, fungi, parasites).
Reservoir: Carrier or place where harmful germs grow (e.g., blood, skin, GI tract).
Port of Exit: How harmful germs escape (e.g., sneezing/mucus, saliva, stool, vomit).
Mode of Transportation:
Direct Contact: Needle sticks, open sores, body fluid splash.
Indirect Contact: Germs on hands after coughing/sneezing or using the bathroom without handwashing.
Portal of Entry: Openings on a person’s body that allow germs to enter (e.g., nose, mouth, broken skin).
Susceptible Host: Person at risk due to age, chronic illness, stress, etc.
The number one way germs travel: HANDS.
HAI (Healthcare-Associated Infection)
An infection acquired in a healthcare setting.
Example: A patient undergoing knee surgery contracts the flu during their hospital stay.
Standard Precautions
Used on all persons when there is a risk of contact with blood or body fluids.
Most important way to prevent spread of infection: Handwashing.
Use of Alcohol Rub and Soap & Water
Alcohol Rub: Use before/after eating, handling food, and routine patient care.
Soap & Water: Use when hands are visibly dirty, after using the restroom, or blowing nose.
Contact Precautions
Include standard precautions plus gown and gloves.
Example: MRSA, Norovirus.
Droplet Precautions
Particles can travel up to 3 feet or further.
Include standard precautions plus mask and gloves.
Example: Flu, Meningitis, Whooping cough.
Airborne Precautions
Particles can “float” in air.
Include standard precautions plus respirator.
Examples: TB, Chicken Pox, Measles.
Module C: Patient Care and Safety
Dehydration Risk
Alcohol-based hand sanitizer ineffective against certain pathogens, necessitating handwashing with soap and water.
Hepatitis
Disease affecting the liver.
BEFAST Acronym
Used for recognizing signs of a stroke:
Balance
Eyes
Face
Arms
Speech
Time
Hazards in Patient Environment
Characteristics that may place elderly patients at risk include:
Impaired coordination
Hearing impairment
Reduced sense of smell and touch
Visual impairment
Cognitive impairment
Room Temperature Requirement by OBRA
OBRA requires a resident’s room temperature to be between 71-81 degrees Fahrenheit.
Fatal Injuries in Adults
Most fatal injuries are related to falls.
Elopement
Defined as a resident leaving a healthcare facility without the knowledge of staff.
Patient Positioning During Meals
Residents should be in an upright position when eating.
NA1’s Role in Seizures
Record the start and stop time of the seizure.
Medical Emergencies
Defined as situations where a person’s health or life is at risk.
Example: A resident who has no pulse.
Fire Safety Protocols
RACE Acronym:
R – Remove resident
A – Activate alarm/call 911
C – Contain the fire
E – Extinguish the fire
PASS Acronym for using fire extinguishers:
P – Pull the pin
A – Aim at the base
S – Squeeze the handle
S – Sweep back and forth at the base of the fire
Module D: Communication Skills
Communication Definition
Successfully sending and receiving a message using signs, symbols, words, drawings, and pictures.
Elements of Communication
Sender: Communicates the message.
Receiver: Receives the message.
Feedback: Allows sender and receiver to respond to each other.
Types of Communication
Verbal: Sending and receiving a spoken message.
Non-verbal: Use of body language, such as facial expression, gestures, posture, gait, and eye contact.
Barriers to Communication
Inappropriate words or slang.
Giving unsolicited advice.
Speaking too fast.
Belittling.
Cultural differences.
Noise & lack of privacy.
Attitude differences.
Cultural Sensitivity
Show respect for residents’ different values.
Pronounce names slowly and ask for clarification.
Communicate in a non-threatening manner.
Module E: Legal and Ethical Considerations in Nursing
Criminal vs. Civil Law
Criminal Law: Offenses against the public.
Civil Law: Deals with relationships between individuals.
Key Terms
Tort: A wrongful act committed against a person or property, which can be unintentional or intentional.
Neglect: Failure to provide necessary goods/services to avoid harm.
Example: An unanswered call bell leading to a resident lying in soaked sheets.
Negligence: Actions or inactions resulting in injury.
Example: Failure to lock wheelchair brakes, leading to a fall.
Assault: Threatening to touch a patient without consent.
Example: Threatening to restrain a resident.
Battery: Touching a person without consent.
Example: Hitting a resident or performing an unwanted procedure.
Types of Consent
Written Consent: Documented permission.
Verbal Consent: Spoken agreement.
Implied Consent: Assumed consent, such as when a resident extends their arm for a BP check.
Invasion of Privacy
Violation of rights regarding personal information or solitude.
Example: Forcing residents to eat in a common dining area when they prefer solitude.
False Imprisonment
Unlawful restraint of a person's movement.
Example: Restraining without authorization.
Exploitation
Taking advantage of the resident for personal gain through threats.
Misappropriation of Property
Using a resident's belongings or money without consent.
Example: Borrowing money without permission.
Module F: Patient Dignity and Rights
Dignity
Defined as the quality or state of being worthy of esteem and respect.
Promotes a sense of self-importance and quality of life, guiding NA1 in providing care.
Empathy
The ability to identify and understand the feelings of another without feeling sorry for them.
Nurse Aide Role in Respecting Dignity
Explain procedures prior to performing tasks.
Avoid making residents feel rushed.
Respect personal belongings and encourage decision-making.
Example: Asking for preference in clothing color.
Knock before entering a resident’s room and request permission to turn off media.
Module G: Ethical Regulations and HIPAA
HIPAA
Stands for Health Insurance Portability and Accountability Act.
Protects the privacy and security of individuals' health information.
Module H: Abbreviations and Military Time
Abbreviations to know:
ac – before meals
pc – after meals
HS – at bedtime
PRN – as needed
NPO – nothing by mouth
Tx – transfer
RW – rolling walker
BSC – bedside commode
W/C – wheelchair
BP – blood pressure
ROM – range of motion
CATH – catheter
HOB – head of bed
qh – every hour
BID – twice daily
TID – three times daily
QID – four times daily
qd – every day
SOB – shortness of breath
Military Time
Important for healthcare professionals to understand for accurate communication.
Module I: Observations and Nursing Process
Objective vs. Subjective Observations
Objective: Observations using the senses, such as vitals.
Subjective: Information reported by the patient that cannot be validated through senses, e.g., pain report.
Nursing Process Steps
Assessment: Collecting information.
Nursing Diagnosis: Describes a health problem treatable by nursing measures.
Planning: Setting priorities and goals.
Implementation: Performing or executing nursing measures.
Evaluation: Measuring effectiveness of actions and interventions.
Nurse Aide's Role in Nursing Process
NAs are involved in the Implementation phase, performing tasks such as obtaining height/weight, vitals, and recording intake/output.
Nurse aides' observations aid in evaluation processes.
Maslow’s Hierarchy of Needs
Framework to prioritize needs and develop care plans.
Levels include:
Physiological Needs: Basic requirements like nutrition, elimination, breathing, and shelter.
Safety & Security: Protecting from harm, building trust, and ensuring a safe environment.
Love & Belonging: Establishing supportive relationships and avoiding isolation.
Self-Esteem: Gaining acceptance and a sense of achievement.
Self-Actualization: Reaching maximum potential and spiritual growth.
Lower-level needs must be satisfied before higher-level needs can be addressed.