CNA California Nursing Assistant Certification Study Notes

CNA California Nursing Assistant Certification Overview

  • Document Date: August 2019
  • Module Focus: Patient Care Procedures

Section 9A: Collection of Specimens

Basic Principles of Collection and Transport

  • Importance of nursing assistant's knowledge of collection:
      - Manner and route of collection
      - Correct container and labeling
      - Specific volume of urine or feces required
      - Timing requirements for collection
      - Storage protocol for specimens

Before Collecting Specimen

  • Necessary steps:
      - Assemble required supplies
      - Don appropriate personal protective equipment (PPE)
      - Label the container or outside of biohazard bag
        - Include:
          - Date
          - Time
          - Resident’s name
          - Date of birth

After Collecting Specimen

  • Post-collection protocols:
      - Refrigerate sample if processing exceeds 2 hours
      - Notify nurse upon completion of the task
      - Document the collection accurately

Urine Specimens

Reasons for Collection
  • Can be utilized for:
      - Detecting bacteria
      - Assessing kidney function
      - Checking for sugar levels
      - Measuring electrolytes
      - Monitoring drug levels
Procedure for Urinalysis Collection
  • Important collection guidelines:
      - Obtain a clean catch sample
      - Residents should not void into: commode, commode hat, urinal, or bedpan
      - Special considerations for incontinent residents
Collecting Procedure
  1. Cleanse perineal area with antiseptic wipe before voiding
       - Wiping technique:
         - Wipe area 3 times, moving from urethra towards anus
  2. Collect sample during middle of the urine stream
  3. Fill collection cup to the amount specified by the nurse
  4. Avoid contact with the inside of the cup or lid
  5. Attend to the resident’s needs
  6. Securely place specimen in designated storage or hand to nurse

Straining for Kidney Stones

  • Collection method:
      - Position commode hat in toilet or commode
      - Advise resident against placing toilet paper in commode
      - Empty commode hat contents through strainer
      - Search for stones within the strainer
      - Place stones in labeled container for lab analysis

Fecal Specimens

Procedure for Stool Sample Collection
  • Collecting guidelines:
      - Use clean commode hat or bedpan
      - Prevent contamination with urine or toilet paper
      - Use a wooden tongue blade or plastic spoon for sample collection
        - Sample should be taken from three different areas of stool
Occult Blood Test Procedure
  • Testing method:
  1. Obtain a small sample of stool with a wooden stick
  2. Apply sample on test card under window A; close flap
  3. Take another sample from a different stool area and apply under window B; close flap
  4. Apply 1-2 drops of developer over the window on the reverse side of the card
      - Positive result indicated by blue coloration
  5. Submit card to nurse
      - Known as stool guaiac, fecal occult blood test, Hemosure, or Hemoccult

Sputum Specimens

  • Nursing assistant's role involves:
      - Reinforcing instructions from nurse
      - Ensuring resident has a sterile container
      - Reminding resident to provide sputum, not saliva

Section 9B: Care of Patients With Tubing

Catheter Care

Types of Catheters
  • Straight Catheter:
      - Used for relieving urinary retention or collecting urine samples
  • Indwelling Catheter:
      - Remains in the bladder for long periods
      - Held in place by an inflated balloon
      - Can be inserted via urethra or abdominal opening
Resident Care Protocols
  • Key responsibilities include:
      - Secure catheter with holder or tape
      - Clean catheter twice daily
      - Change collection bags for ambulatory residents
      - Maintain urinary bag hygiene as per protocol
      - Position collection bag lower than bladder
      - Prevent tugging during repositioning
      - Ensure resident's privacy
      - Measure and record urine output each shift

Intravenous (IV) Therapy

Care Measures
  • Key responsibilities:
      - Ensure IV pole is placed near the resident during transfers
      - Prevent pulling on tubing
      - Dress resident adequately with IV setup
      - Notify the nurse of site complications (redness, swelling, bleeding, pain)

Oxygen Therapy Protocols

Reasons for Supplementary Oxygen
  • Acute Conditions:
      - Short-term illnesses or injuries (e.g. asthma, trauma)
      - Often highly concentrated
  • Chronic Conditions:
      - Long-term diseases (e.g. COPD, emphysema)
      - Supplemental levels typically between 1 and 6 L/min
Nursing Assistant's Responsibilities in Oxygen Therapy
  • Flow Rate:
      - Verify flow rate aligns with resident’s care plan
      - Confirm oxygen delivery before placing device on resident
  • Amount:
      - Ensure sufficient oxygen in portable tanks
  • Availability:
      - Provide extra tanks if resident leaves for an extended time
  • Skin Integrity:
      - Monitor for dryness or irritation, especially behind ears
  • Patient Complaints:
      - Report respiratory distress symptoms
Delivery Routes
  1. Nasal Cannula:
      - Consists of a long tube with prongs
      - Capable of delivering up to 6 L/min
  2. Face Mask:
      - Covers both nose and mouth
      - Fit ensured by metal nosepiece
      - Used for higher oxygen delivery or medication administration
Delivery Systems
  • Portable Tanks:
      - Available in several sizes with different regulators
      - Portable for patient use
  • Oxygen Concentrator:
      - Remains in the resident’s room to deliver up to 6 L/min
Interventions to Alleviate Anxiety Related to Breathing Difficulties
  • Techniques include:
      - Relaxation exercises
      - Timely response to call lights
      - Providing reassurance
      - Assisting in proper positioning
Interventions to Aid Lung Function
  1. Coughing and Deep Breathing Exercises:
      - Important for lung function maintenance
      - Follow care plan regarding frequency
  2. Incentive Spirometer:
      - Medical device to enhance lung function
      - Reinforce nurse's instructions and check care plan for specifics

Section 9C: Intake and Output

Monitoring Intake and Output

Intake Definition
  • Recording all fluids taken orally or via IV, including:
      - Snacks
      - Meals
      - Water at bedside
      - Liquid food items
Output Definition
  • Recording all bodily fluid elimination using:
      - Graduate or commode hat
      - Avoid toilet paper use in commode hat
      - Document total elimination at the end of the shift as per facility protocols

Section 9D: Bedmaking

Importance of Clean Bed Linens

  • Benefits include:
      - Promoting skin health
      - Controlling germ spread
      - Ensuring resident comfort
      - Maintaining a clean facility environment

Types of Linens Needed

  1. Bath blanket
  2. Fitted sheet
  3. Draw (or lift) sheet
  4. Incontinence pad/bed protector
  5. Top sheet
  6. Blanket
  7. Bedspread
  8. Pillowcase(s)

Linen Protocols

  • Linen Collection Guidelines:
      - Reusable incontinence pads for regular mattresses
      - Disposable pads for alternating-pressure beds
      - Avoid use of mattress pads on hospital beds
      - Towel or top sheet may substitute as a bath blanket

Infection Control Measures

  • Essential steps to limit infection spread:
      - Perform hand hygiene prior to linen handling
      - Keep linens away from body
      - Place linens on a clean surface
      - Avoid shaking or flicking linens
      - If linens touch the floor, place in soiled linen bag
      - Always perform hand hygiene after glove removal
      - Use pillow protectors if available
      - Maintain cleanliness of linen usage among residents

Body Mechanics

Injury Prevention Guidelines
  • Steps to reduce risk during bed-making:
      - Move bed from wall for space
      - Raise bed to an ergonomic height
      - Lower side rails for ease of access
      - Keep items close to body
      - Avoid excessive stretching or twisting
      - Bend knees, not waist
      - Involve resident for assistance during occupied bed changes

Types of Bed Changes

Closed Bed
  • Characteristics:
      - All linens in place over mattress
      - Made prior to resident admission or after they arise
      - Use mitered corners to secure linens
Open Bed
  • Characteristics:
      - Linens are fanfolded to the foot of the bed
      - May adjust for resident transfer from a stretcher
      - Prepared for resident admission or lying down
      - Incorporate mitered corners and toe pleat for comfort
Unoccupied Bed Change
  • Occasions to change unoccupied bed:
      - Resident able to get out of bed
      - Linens soiled or wrinkled
      - Resident’s scheduled bath day
      - Discharge from facility
Occupied Bed Change
  • When to change occupied bed:
      - Resident unable to get out of bed
      - Discomfort or pain reported by resident
      - Linens soiled or wrinkled
      - Procedure is more efficient than an unoccupied change
Procedure for Making an Occupied Bed
  1. Remove soiled linens from one side, replace with clean linens
  2. Ask resident to roll over onto clean linens
  3. Repeat on opposite side
  4. Contain soiled linens by rolling inward and tucking clean underneath
  5. Smooth clean linens before resident returns to position
  6. Safety protocols include using side rails and adjusting as necessary

Section 9E: Cleansing Enemas and Laxative Suppositories

Bowel Elimination Protocols

  • Laxatives: Administered if no bowel movement for 3 days
  • Suppositories: Insert wax cone if no movement for 4 days
  • Fleet Enema: Fluid injection if no movement for 5 days
  • High-Volume Enema: Castile soap with approx. 1000 mL of water injected
Administering OTC and High-Volume Enemas
  • Patient positioning:
      - Ensure resident is lying on the left side
  • Complications prompting nurse communication:
      - Resident experiences pain
      - Difficulty during administration
      - Notable changes in vital signs
      - Rectal bleeding observed

Section 9F: Admission, Transfer, and Discharge

Transfer and Discharge Protocols

Long-Term Care Residents
  • Discharge policies:
      - Must provide 30-day notice for nonpayment discharge
      - Notice must include:
        - Reason for discharge
        - Discharge date
        - Destination information
        - Ombudsman contact details
        - Bed-hold/re-admission policies
Hospital and Skilled Nursing Facility Transfers
  • Care responsibilities:
      - Monitor vital signs every 4 hours
      - Facilitate ambulation each shift
      - Record intake and output data
      - Assist with toileting and repositioning every 2 hours
Postsurgical Resident Protocols
  • Outpatient Surgery:
      - Resident is released the same day, requires effective communication
  • Inpatient Surgery:
      - Requires at least one overnight stay, involves higher risks
Diet Protocol for Postsurgical Residents
  • NPO status until bowel sounds or passing flatus
  • Diet progression:
      - NPO
      - Clear liquids
      - Full liquids
      - Soft diet
      - Regular diet
Activity Protocol for Postsurgical Residents
  • Activity limitations include repositioning every 2 hours and ambulation each shift
  • Common complications:
      - Pneumonia
      - Bowel obstructions
      - Atelectasis
      - Constipation
      - Blood clots
Weight-Bearing Status
  • Assigned post-orthopedic surgery by surgeon
  • Include classifications:
      - Non-weight-bearing (NWB)
      - Toe touch
      - Percent allowable weight on affected limb (e.g., 50% WB)
      - Weight bearing as tolerated (WBAT)
Respiratory Complications Prevention
  • Encourage deep breathing exercises and proper use of incentive spirometers
  • Most recurrent issues: atelectasis and pneumonia
Cardiac Complications Prevention
  • Strategies include:
      - Anticoagulant medications
      - TED hose or anti-embolism stockings
      - Sequential stockings for moving fluids from legs to heart
Cardiac Intervention Techniques

  1. TED Hose:
      - Available in different lengths based on individual measurements
      - Used to enhance circulation pre-emptively
      - Must be applied properly without twists or wrinkles
      - Frequency of use dictated by care plan: daily or overnight

  2. Sequential Stockings:
      - Plastic sleeves inflated and deflated to stimulate blood flow
      - Indicated for immobile residents or those on bed rest

Section 9G: Bandages and Nonsterile Dressing Changes

Nursing Assistant Responsibilities

  • Ensure compliance with directed bandage changes
  • Adhere to care plan and clarify uncertainties
  • Confirm use of appropriate dressing supplies
  • Monitor site for changes (redness, drainage, pain)
  • Apply nonprescription ointments if instructed

Additional Notes

  • Source: August Learning Solutions, 2019