Indiana CNA Skills/RCPs -- 72 SKILLS

*Assisting with Hearing Aids*

1. Do initial steps. 2. Gently clean residents ear with a damp washcloth. Clean hearing aid of wax and dirt when needed according to manufacturers instructions. 3. Insert hearing aid into residents ear. 4. Assist to adjust the volume control to desired level. 5. Do final steps. 6. Report any abnormalities to nurse. 7. Keep hearing aid in safe place when not in use.

*Initial Steps*

1. Ask nurse about residents NEEDS, ABILITIES and LIMITATIONS, if necessary. 2. KNOCK and IDENTIFY YOURSELF before entering residents room. WAIT for permission to enter residents room. 3. Greet resident by NAME per resident preference. 4.Identify yourself by NAME and TITLE. 5. Explain what you will be doing. Encourage resident to help as able. 6. Gather supplies and check equipment. 7. Close curtains, drapes and doors. Keep resident covered, expose only the area of residents body necessary to complete procedure. 8. Wash your hands 9. Wear gloves as indicated by standard Precautions. 10. Use proper body mechanics. raise bed to appropriate height and lower bed rails (if raised)

*Falling or Fainting*

1. Call for nurse and stay with resident. 2. Check if resident is breathing. 3. Do not move resident. Leave in same position until the nurse examines the resident 4. Talk to resident in calm and supportive manner. 5. Apply direct pressure to any bleeding area with a clean piece of linen 6. Take pulse and respiration. 7. Assist nurse as directed. Check resident frequently according to current facility policy. Assist with documentation

*Seizures*

1. Call for nurse and stay with resident. 2. Place padding under head and remove furniture away from resident. 3. Do not restrain resident or place anything in mouth. Assist nurse with placing resident on his/her side 4. Loosen resident's clothing especially around neck. 5. Note duration of seizure and areas involved. 7. Assist with documentation

*Choking*

1. Call nurse and stay with resident. 2. Ask if resident can speak or cough. 3. If not able to speak or cough, move behind resident and slide arms under resident's armpits. 4. Place your fist with thumb side against abdomen midway between waist and ribcage. 5. Grasp your fist with your other hand. 6. Press your fist into abdomen with quick inward and upward thrusts. 7. Repeat until object is expelled. 8. Assist with documentation

*Transfer; Two Person Lift* (EMERGENCY ONLY)

1. Do initial steps 2. Place chair at bedside. Brace it firmly against side of bed. Lock wheels of wheelchair or Geri chair. 3. Assist resident to sit on edge of bed. Ensure there is staff on each sides of the resident. 4. Reach around residents back and grasp other assistants forearm above wrist. Have a resident place arms around your shoulders (not your neck) or on upper arms. 5. Each NA should reach under residents knees and grasp other assistants forearm above wrist. 6. On the count of three lift resident. 7. Pivot and lower resident into chair. 8. Align resident in chair. 9. Do final steps

*Changing Residents Gown*

1. Do initial step. 2. Untie soiled gown. 3. Raise top sheet over resident's chest. 4. Remove resident's arms from gown, unaffected arm first. 5. Roll soiled gown from neck down and remove from beneath top sheet. Place soiled gown in dirty linen bag 6. Slide resident's arms into clean gown, affected arm first. 7. Tie gown. 8. Remove top sheet from beneath clean gown and cover resident. 9. Do final steps.

*Height*

1. Do initial steps 2. *Using standing balance scale:* Assist the resident onto the scale, facing away from the scale. Ask the resident to stand straight. Raise the rod to a level above the residents head. Lower the height measurement device until it rests flat on the residents head. 3. *When a resident is unable to stand:* Flatten the bed and place resident in supine position. Place a mark on the sheet at the top of the head and another at the bottom of the feet. Measure the difference. 4. *If the resident is unable to lay flat due to contractures:* Utilize a tape measure and beginning at the top of the head, follow the curves of the spine and legs, measuring to the base of the heel. 5. Accurately record residents height. 6. Do final steps

*Occupied Bed*

1. Do initial steps 2. Collect linen in order of use. 3. Carry linen away from your uniform. 4. Place linen on a clean surface (bedside stand, over bed table, or back of chair). 5. Lower head of bed and adjust bed to a safe working level, usually waist high. Lock bed wheels 6. Drape resident. 7.The caregiver will make the bed one side at a time. The caregiver will raise the side rail on far side of bed (if rail not in use, ensure there is a second caregiver on the opposite side of bed to insure that the resident does not roll over the side of bed). Assist resident to turn onto side moving away from you toward raised side of rail ( or second caregiver). 8. Loosen bottom soiled linen on the side of bed on which you are working. 9. Roll bottom soiled linen toward resident and tuck it snugly against the residents back. 10. Place clean bottom linen on unoccupied side of bed and roll remaining clean linen under resident in the center of the bed. 11. Smooth bottom sheet out and ensure there are no wrinkles. Roll all extra material toward resident and tuck it under the residents body. 12. Raise the side rail nearest you (or remain in place if a second caregiver is being utilized) and assist the resident to turn onto clean bottom sheet. Move to opposite side of bed, as resident will now be facing away from you. 13. While resident is lying on side, loosen soiled linen and roll linen from head to foot of bed, avoiding contact with your skin or clothing. 14. Place soiled linen in barrel or bag at foot of bed or in chair. 15. Pull clean bottom linen as was done on opposite side. 16. Assist resident to roll onto back, keeping resident covered and comfortable. 17. Unfold the top sheet placing it over the resident. Request the resident to hold the clean top sheet. While slipping the bath blanket or previous sheet out from underneath the clean sheet. 18. Assist resident with blanket over the top sheet and tuck the bottom edges of the top sheet and blankets under the bottom of the mattress. Miter the corners and loosen the top linens over the residents feet. 19. Remove pillow and remove the soiled pillow case by turning it inside out. 20. With one hand, grasp the clean pillow case at the closed end, turning it inside out over your arm. 21. Using the same hand that has the pillow case over it, grasp one narrow edge of the pillow and pull the pillow case over it with your free hand. 22. Place the pillow under residents head with open edge away from the door. 23. Assist resident to comfortable position and return the bed to the appropriate position. 24. Remove soiled linen from room-carrying away from uniform. 25. Do initial steps.

*Transfer to stretcher/Shower bed*

1. Do initial steps 2. Loosen sheet directly under resident and roll edges close to resident. 3. Place stretcher/shower bed at bedside. *Note:* Make certain wheels are locked. After locking wheels, ensure bed and stretcher/shower bed are at the same height. Then lower side rails. 4. Staff should be present at the bedside as well as the oposite side of the stretcher/shower bed. Requires a minimum of two staff members; however the number of staff required will be depended on the size of the resident). 5.Staff should grasp sheet on each side of resident. On the count of three, slid the resident laterally onto stretcher/shower bed. 6. Center and align resident. Place pillow under his/her head cover with a blanket and raise the rails of stretcher/shower bed. 7. Do final steps.

*Using gait belt to assist with ambulation*

1. Do initial steps 2. Assist resident to sit on the edge of bed. Encourage resident to sit for a few seconds to become steady. Check for dizziness. 3. Place belt around resident wait with the buckle in front (on top of residents clothing) and adjust to a snug fit ensuring that you can get your hands under the belt. Position one hand on the belt at the residents side and the other hand at the residents back 4. Assist the resident to stand on the count of three. 5. Allow resident to gain balance. Ask the resident if dizzy. 6. Stand to the side and slightly behind resident while continuing to hold onto the belt. 7. Walk at residents pace. 8. Return resident to chair or bed and remove belt. 9. Do final steps.

*Sit On Edge of Bed*

1. Do initial steps. 2. Adjust bed height to lowest position. 3. Move resident to side of bed closest to you. 4. Raise head of bed to sitting position, if necessary. 5. Place one arm under resident's shoulder blades and the other arm under resident's thighs. 6. On count of three, slowly turn resident into sitting position with legs dangling over side of bed. 7. Allow time for resident to become steady, check for dizziness. 8. Assist resident to put on shoes or slippers. 9. Move resident to edge of bed so feet are flat of floor. 10. Do final steps.

*Dressing a Dependent Resident*

1. Do initial steps. 2. Assist resident to choose clothing. 3. Move resident onto back. 4. Drape resident to provide privacy 5. Guide feet through leg openings of underwear and pants, affected leg first. Pull garments up legs to buttocks. 6. Slide arm into shirt sleeve, affected side first. 7. Turn resident onto unaffected side. Pull lower garments over buttocks and hip. Tuck shirt under resident. 8. Turn resident onto affected side. Pull lower garments over buttocks and hip and straighten shirt. 9. Turn resident onto back and slide arm into shirt sleeve. Align and fasten garments. 10. Do final steps.

*Bedside Commode*

1. Do initial steps. 2. Assist resident to put on non-skid socks/footwear 3. Place commode next to bed on resident's unaffected side. 4. Assist resident to transfer to commode by transferring the safest way the resident is able. 5. Give resident call light and toilet tissue.If resident has been identified as safe to be provided privacy and not mandated 6. Put on gloves 7. Assist resident wipe from front to back. 8. Wash hands and change gloves 9. Assist resident into bed or chair 10. Remove and cover pan and take to the bathroom. 11. Prior to disposal, observe urine and/or feces for color, odor, amount and characteristics and report ant unusual findings to nurse. 12. Dispose of urine and.or feces, sanitize pan and return pan to current facility policy. 13. Remove gloves and wash hands 14. Assist resident to wash hands. 15. Do final steps.

*Assist to Bathroom*

1. Do initial steps. 2. Assist resident to put on non-skid socks/footwear 3. Walk with resident into bathroom. 4. Assist resident to lower garments and sit. 5. Provide resident with call light and toilet tissue.If resident has been identified as safe to be provided privacy and not mandated to remain attended by staff 6. Put on gloves 7. Assist resident to wipe area from front to back. 8. Remove gloves 9. Assist resident to raise garments. 10. Assist resident to wash hands. 11. Walk with resident back to bed or chair. 12. Do final steps.

*Assist With Walker*

1. Do initial steps. 2. Assist resident to sit on edge of bed 3. Place walker in front of resident as close to the bed as possible. 4. Have resident grasp both arms of walker. 5. Brace leg of walker with your foot and place your hand on top of walker. 6. Assist resident to stand on count of three.Check for balance and dizziness 7. Stand to side and slightly behind resident. 8. Have resident move walker ahead 6 to 10 inches then step up to walker moving the weak or injured leg forward to the middle of the walker while pushing down on the handles of the walker, and then bringing the unaffected leg forward even with the week/injured leg 9. Do final steps.

*Walking*

1. Do initial steps. 2. Assist resident to sit on edge of bed. Encourage resident to sit for a few seconds to become steady. Check for dizziness 3. Assist resident to stand on count of three. 4. Allow resident to gain balance. Check for dizziness 5. Stand to side and slightly behind resident. 6. Walk at resident's pace. 7. Do final steps.

*Weight*

1. Do initial steps. 2. Balance scale. 3. Depending on scale used, assist resident to stand on platform or sit in chair with feet on footrest or transport wheelchair onto scale and lock brakes. 4. When using a standard scale - lower weight to fifty pound mark that causes arm to drop. Move it back to previous mark. Move upper weight to pound mark that balances pointer in middle of square. Add lower and upper marks.When using digital scale- press weight button. Wait until numbers remain constant 5. Subtract weight of wheelchair from total weight, if applicable. 6. Accurately record resident's weight 7. Do final steps. 8. Report unusual reading to nurse.

*Fingernail Care*

1. Do initial steps. 2. Check fingers and nails for color, swelling, cuts, or splits. Check hands for extreme heat or cold. Report any unusual findings to nurse before continuing procedure. 3. Raise head of bed so resident is sitting up. 4. Fill bath basin halfway with warm water and have resident check water temperature for comfort. 5. Soak residents hands and pat dry. 6. Put on gloves 7. Clean under nails with orange stick. 8. Clip fingernails straight across, then file in a curve. 9. Remove gloves 10. Do final steps.

*Assist with Cane*

1. Do initial steps. 2. Check the cane for presence of rubber tips 3. Assist resident to sit on edge of bed 4. Assist resident to stand on the count of three. 5. Allow resident to gain balance. Check for dizziness. 6. Have resident place cane approximately 4 inches to the side of his/her stronger/unaffected foot. The height of the cane should be level with the residents hip. 7. Stand to the affected side and slightly behind resident. 8. Have resident move cane forward about 4-6 inches, step forward with weak/affected leg to a position even with the cane. Then have the resident move strong leg forward and beyond the weal leg and cane. Repeat the sequence. 9. Do final steps.

*Abdominal Binder*

1. Do initial steps. 2. Check the skin for redness, open areas, or needed incontinence care. 3. Place binder flat on the bed and ask resident to lie down with upper border at the upper waist and lower border at the level of the gluteal fold. If resident is in bed, assist him/her to roll side-to-side while placing binder underneath him/her in the same position. 4. Bring the ends of binder around the resident, and overlap them. Beginning at the bottom of the binder, secure the Velcro fastener strip so that the binder fits snugly 5. Ensure that there are no wrinkles or creases in the binder. 6. Do final steps.

*Blood Pressure*

1. Do initial steps. 2. Clean earpieces and diaphragm of stethoscope with antiseptic wipe. 3. Uncover resident's arm to shoulder. 4. Rest resident's arm, level with heart, palm upward on comfortable surface. 5. Wrap proper sized Sphygmomanometer cuff around upper unaffected arm approximately 1-2 inches above elbow. 6. Put ear pieces of stethoscope in ears. 7. Place diaphragm of stethoscope over brachial artery at elbow. 8. Close valve on bulb. If blood pressure is known inflate cuff to 20mm/hg above the usual reading. If blood pressure is unknown, inflate cuff to 160 mm/hg. 9. Slowly open valve on bulb. 10. Watch gauge and listen for sound of pulse. 11. Note gauge reading at first pulse sound. 12. Note gauge reading when pulse sound disappears. 13. Completely deflate and remove cuff. 14. Accurately record systolic and diastolic readings 15. Do final steps. 16. Report unusual readings to the nurse.

*Shower/Shampoo*

1. Do initial steps. 2. Clean/disinfect shower area and shower chair as per facility policy. Prep the bathing area per facility policy. Gather supplies and take them into the shower area 3. Help resident remove clothing. Drape resident with bath blanket. 4. Turn on water and have resident check water temperature for comfort, if able 5. Assist resident into shower via wheelchair. Lock wheels of shower chair. Use safety belt to secure resident security, if indicated.Never take your eyes off the resident or turn your back to the resident while in the shower *Shampoo* 6. Give resident a washcloth to cover his/her eyes during the shampoo, if he/she desires. Place cotton balls in residents ears if desired. 7. Wet the residents hair 8. Put a small amount of shampoo into the palm of you hand and work it into the residents hair and scalp using your fingertips 9. Rinse the residents hair thoroughly 10. Use conditioner if the resident desires you to do so. 11. Let resident wash as much as possible, starting with face. Assist as needed to wash and rinse the entire body going from head to toe. Use a separate washcloth to cleans the perineal area last. 12. Turn off the water. Cover resident with bath blanket. 13. Remove cotton balls from the residents ears, if utilized 14. Towel dry the residents hair, neck and ears 15. Give resident towel and assist to pat dry. Ensure to thoroughly pat dry under breast, between skin folds, in the perineal area and between toes 16. Ensure floor area is dry and non-slip device is in place. Assist resident out of shower 17. Use a dryer on the resident hair, if desired. 18. Apply lotion to skin, help resident dress, comb hair and return to room 19. Do final steps. Report any abnormalities to the nurse

*Palm Cones*

1. Do initial steps. 2. Cleanse and thoroughly dry resident hands. 3. Place clean cone with cover in residents palm. 4. Observe hands every shift; cleanse and thoroghly dry hand. Observe for area of redness, swelling or open areas and report to the nurse, if noted. 5. Note covering of palm cone and send to laundry when soiled, re-covering cone with clean covering, as needed. 6. Do final steps

*Feeding*

1. Do initial steps. 2. Confirm diet card/tray. Check name, diet, utensils and condiments. 3. Explain procedure 4. Have resident wash hands, help the resident if needed 5. Sit on unaffected side eye level with resident facing them. 6. Residents head should be elevated at least 45 degrees, if in bed 7. Protect the residents clothing with a clothing protector or per facility policy procedures 8. Offer different foods; ask residents preference' 9. Food should be in bite sized pieces or with the spoon half full. Food should be feed to the unaffected side of mouth 10. Allow time for the resident to chew and empty mouth between bites. Notify nurse immediately should choking occur 11. Frequently offer beverage. If required, measure I&O's and percentage of food eaten 12. Make conversation with resident; atmosphere should be pleasant 13. Cleanse the residents hands/face as needed during the meal and after 14. Do final steps

*Oral Care for the Unconscious*

1. Do initial steps. 2. Drape towel over pillow and a towel under residents chin 3. Turn resident onto unaffected side. 4. Put on gloves 5. Place an emesis basin under resident's chin. 6. Dip swab in cleaning solution of 1/2 mouthwash and 1/2 water and wipe teeth, gums, tongue and inside surfaces of mouth, changing swab frequently. 7. Rinse with clean swab dipped in water. 8. Check teeth mouth, tongue, and lips for odor, cracking, sores, bleeding and discoloration. Check for loose teeth. Report any unusual findings to the nurse. 9. Cover lips with a thin layer of moisturizer. 11. Remove gloves 12. Do final steps.

*Foot Care* (Basin)

1. Do initial steps. 2. Fill the basin halfway with warm water. Have resident chect the water temperature. 3. Place basin on towel or bathmat. 4. Remove residents socks. Completely submerge residents feet in water and soak for 5 to 10 minutes. 5. Put on gloves. 6. Remove one foot from water. Wash entire foot, including between the toes and around the nail beds using a soapy washcloth. 7. Rinse entire foot, including between the toes. 8. Dry entire foot, including between the toes. 9. Repeat with the other foot. 10. Place lotion in hand, warm lotion by rubbing hands together, and then message lotion into entire foot (top and bottom) except between the toes, removing excess with a towel. 11. Assist resident to replace socks. 12. Do final steps 13. Report any cuts, sores, or other findings to nurse.

*Bed Shampoo*

1. Do initial steps. 2. Gently comb and brush residents hair. 3. Provide resident privacy. 4. Remove residents gown or pajama top. Place towel around residents neck and shoulders. Lower head of bed. 5. Have resident check temperature of water to be used for comfort, if able. 6. Place bed shampoo basin under residents head according to manufacturers instructions. 7. Place was basin on chair to catch water flowing from shampoo basin. 8. Pour water carefully over residents hair. 9. Lather hair with shampoo using fingertips. Rinse throughly. Apply conditioner to residents hair if requested. Rinse throughly. 10. Squeeze excess water from hair. Towel dry hair. 11. Replace gown or pajama top. 12. Comb and brush residents hair. Dry hair with dryer if resident wishes. 13. Do final steps

*Float Heels*

1. Do initial steps. 2. Lift residents lower extremity. 3. Inspect the skin, especially the heels. 4. Place pillow under calves, leaving heels in the air and free from pressure. (do not use rolled pillow's or blankets.) 5. Do final steps.

*Bedpan/Fracture Pan*

1. Do initial steps. 2. Lower head of bed. 3. Put on gloves (according to procedure 2). 4. Turn resident away from you. 5. Place bedpan or fracture pan according to manufacturer's directions. 6. Gently roll resident back onto pan and check for correct placement. 7. Cover resident with sheet/blanket 8. Raise head of bed to comfortable position for resident 9. Give resident call light and toilet paper. 10. Leave resident and return when called. 11. Lower head of bed. 12. Press bedpan flat on bed and turn resident. 13. Wipe resident from front to back.Wash hands and change gloves 14. Provide perineal care if necessary 15. Cover bedpan and take to bathroom 16. Check urine and or feces for color, odor, amount, and character and report unusual findings to nurse. 17. Dispose of urine and/or feces, sanitize pan and return according to current facility policies. 18. Remove gloves and wash hands 19. Assist resident to wash hands. 20. Do final steps.

*Fowler's Position*

1. Do initial steps. 2. Move resident to supine position 3. Elevate bed 45 to 60 degrees. 4. Use supportive padding if necessary. 5. Do final steps.

*Semi-Flowers*

1. Do initial steps. 2. Move resident to supine position 3. Elevate head of bed 30 to 45 degrees. 4. Use supportive padding if necessary. 5. Do final steps.

*Splint Application*

1. Do initial steps. 2. Observe joints. If swelling, redness or warmth is present, or if resident complains of pain, notify nurse. continue procedure only if instructed. 3. Apply splint according to therapy recommendations and physicians order. 4. Remove splint after designated period of time. Cleanse the skin, dry thoroughly and again observe for swelling, redness, warmth, complaint of pain or open area, Notify the nurse if presents. 5. Do final steps.

*Passing Fresh Ice Water*

1. Do initial steps. 2. Obtain cart, ice container, ice scoop and go to the ice machine. Keep ice scoop covered. 3. Fill container with ice using scoop. 4. Replace ice scoop in proper covered container, or cover it with a clean towel or plastic bag to prevent contamination. 5. Proceed to residents rooms, noting and fluid restrictions prior to pass and any residents who require thickened liquids. 6. Empty water from pitcher and bedside glass into the sink. If resident is on I&O's record intake of water. 7. Take pitcher into hall and fill it with ice. *Note:* do not touch the pitcher with the ice scoop. 8. Replace the scoop in covered container, clean towel or plastic bag between rooms prevent contamination. 9. Return to residents room and fill pitcher with water at bathroom sink, not allowing pitcher to touch faucet. 10. Pour fresh water into bedside glass and leave a straw with the glass, if needed. 11. Offer the resident a drink of fresh water if resident is present. 12. Repeat procedure until all residents have been provided with fresh ice water. 13. Do final steps.

*Thickened Liquids*

1. Do initial steps. 2. Obtain thickener and measuring spoon. 3. Thicken liquids to desired consistency following manufacturers instructions. 4. Offer thickened fluid to resident. Encourage resident to consume thickened fluids. 5. Ensure the water pitcher has been removed from the bedside unless facility policy states otherwise. 6. Do final steps.

*Bed Bath/Perineal care*

1. Do initial steps. 2. Offer resident urinal or bedpan. 3. Drape resident. 4. Fill bath basin with warm water and have resident check water temperature for comfort if able. 5.Put on gloves 6. Fold washcloth and wet. 7. Gently wash eye from inner corner to outer corner, Using a different part of cloth wash other eye. 8. Wet washcloth and apply soap, if requested. Wash, rinse, and pat dry face, neck, ears, and behind ears. 9. Remove resident's gown. 10. Place towel under far arm. 11. Wash, rinse, and pat dry hand, arm, shoulder, and underarm. 12. Repeat steps with other arm. 13. Place towel over chest and abdomen. Lower bath blanket to waist. 14. Lift towel and wash, rinse, and pat dry chest and abdomen, 15. Pull up bath blanket and remove towel. 16. Uncover and Place towel under far leg. 17. Wash, rinse, and pat dry leg and foot. Be sure to wash, rinse and dry well between toes 18. Repeat with other leg and foot. 19. Change bath water and gloves, wash hands and use clean gloves and towel 20. Assist resident to spread legs and lift knees if possible 21. Wet and soap folded washcloth *Catheter care* 22. If resident has a catheter, check for leakage, secretions or irritations. Gently wipe four inches of catheter from meatus out *Perineal care* 23. Wipe from front to back and from center of perineum to thighs. If washcloth is visibly soiled, change cloths *For Females:* * separate labia. Wash urethral area first * Wash between and outside labia in downward strokes, alternating from side to side and moving outward to thighs. Use different part of washcloth for each stroke *For Males:* A. Pull back foreskin if male is uncircumcised. Wash and rinse the tip of penis using circular motion beginning with urethra B. Continue washing down the penis to the scrotum and inner thighs. Rinse off soap and dry. Return foreskin over the tip of the penis 24. Change water in basin. Wash hands and change gloves. With a clean washcloth, rinse area thoroughly in the same direction as when washing 25. Gently pat dry with a towel in the same direction as when washing 26. Assist resident to lateral position, facing away from you 27. Wet and soap washcloth 28. Clean anal area from front to back. Rinse and pat dry thoroughly 29. Change bath water and gloves. Use clean washcloth and towel 30. Wash, rinse and pat dry from neck to buttocks 31. Return to supine position 32. Wash hands and change gloves 33. Help resident put on clean gown 34. Do final steps 35. Report any reddened area's, abrasions or bruises to the nurse.

*Bed Cradle*

1. Do initial steps. 2. Place bed cradle on bed according to manufacturers instructions 3. Cover bed cradle with top sheet and bedspread/blanket. 4. Do final step's.

*Lateral Position*

1. Do initial steps. 2. Place resident in a supine position 3. Move resident to side of bed close to you. 4. Cross resident's arms over chest. 5. Slightly bend knee of nearest leg to you or cross nearest leg over farthest leg at ankle. 6. Place your hands under resident;s shoulder blade and buttock. Turn resident away from you onto side. 7. Place supportive padding behind back, between knees and ankles, and under top arm. 8. Do final steps.

*Back Rub*

1. Do initial steps. 2. Place resident in lateral position with neck/back toward you. 3. Expose back and shoulders. 4. Rub lotion between your hands. 5. Make long, firm strokes along spine from buttocks to shoulders. Make circular strokes down on shoulders, upper arms and back to buttocks. 6. Repeat for at least 3-5 minutes. 7. Gently pat off excess lotion with towel. Cover and position resident as requests. 8. Do final steps.

*Pulse and Respiration*

1. Do initial steps. 2. Place resident's hand on comfortable surface. 3. Feel for pulse above wrist on thumb side with tips of first three fingers. 4. Count beats for 60 seconds, noting rate, rhythm and force. 5. Continue position as if feeling for pulse.Count each rise and fall of chest as on respiration. 6. Count respiration for 60 seconds noting rate, regularity and sound. 7. Record pulse and respiration rates 9. Do final steps. 10. Report any unusual findings to the nurse.

Abduction Pillow**

1. Do initial steps. 2. Place the pillow between the supine residents legs. Slide it with the narrow end pointing toward the groin until it touches the legs all along its length. 3. Place the upper part of both legs in the pillow's indentations. Raise each leg slightly by lifting under the knee and ankle to bring straps under and around leg and then secure the straps to the pillow. 4. Do final steps. 5. Report resident intolerance or complaint of both pain upon application to the nurse.

*Transfer to Wheelchair*

1. Do initial steps. 2. Place wheelchair on resident's unaffected side. Brace firmly against side of bed 3. Assist resident to sit on edge of bed. Encourage resident to sit for a few seconds to become steady, check for dizziness. 4. Stand in front of resident and and apply gait belt around residents abdomen. 5. Grasp the gait belt securely on both sides of resident 6. Ask resident to place his hands on your upper arms. 7. On the count of three, help resident into a standing position by straightening your knees. 8. Allow resident to gain balance, check for dizziness. 9. Move your feet 18 inches apart and slowly turn resident. 10. Lower resident into wheelchair by bending your knees and leaning forward. 11. Align resident's body and position foot rests.Remove gait belt 12. Do final steps.

*Passive Range of Motion*

1. Do initial steps. 2. Position resident in good body alignment. 3. Observe joints. If swelling, redness or warmth is present, or if resident complains of pain, notify nurse. continue procedure only if instructed. 4. Support limb above and below joint. 5. Begin range of motion at shoulders and include the shoulders, elbows, wrists, thumbs, fingers, hips, knees, ankles, and toes. 6. Slowly move joint in all directions it normally moves. 7. Repeat movement at least five times. 8. Encourage resident to participate as much as possible. 9. Stop procedure at any sign of pain and report to nurse immediately. 10. Do final steps.

*Urine Specimen Collection*

1. Do initial steps. 2. Prepare label for specimen with appropriate information and place it on specimen container, not the lid. 3. Put on gloves 4. Assist resident to bathroom or commode, or offer bedpan urinal. 5. Provide peri-care to the resident. 6. Ask resident to void into the urine hat placed on the toilet, or to urinate in the bedpan. Ask the resident not to put toilet paper with the sample. 7. After urination, assist the resident as necessary with perineal care and to wash the residents hands. Change your gloves and wash your hands. 8. Take bedpan, urinal, and commode pail to the bathroom and pour urine into the specimen container. The container should be half full. 9. Cover the urine container with it's lid. Do not touch the inside of the container. Wipe off the outside with a paper towel. 10. Place the specimen container in the bag supplied by the lab for transport. 11. Discard excess urine in bedpan or urinal; clean and disinfect equipment as per facility policy. 12. Do final steps.

*Stool Specimen Collection*

1. Do initial steps. 2. Prepare label for specimen with appropriate information and place it on specimen container, not the lid. 3. Put on gloves 4. When resident is ready to move bowels, ask him/her not to urinate at the same time. Ask the resident not to put toilet paper with the sample. 5. Provide resident with a bedpan, assisting if needed. 6. After the bowel movement, assist as needed with perineal care. 7. Remove gloves, wash hands and put on clean gloves. 8. Using two tongue blades, take about two tablespoons full of stool and put it in the container, Try to collect material from different areas from the stool. 9. Cover the container with lid. Label as directed per facility policy and procedure and place in the plastic bag supplied by the lab for transport. Dispose the remaining stool; clean and disinfect equipment as per facility policy. Notify nurse of collection. 10. Do final steps

*Inspecting Skin*

1. Do initial steps. 2. Provide resident privacy. 3. Check bony areas including ears, shoulder blades, elbows, coccyx, hips, knees, ankles, and heels for redness and warmth. 4. Check friction areas including under breasts and arms, between buttocks, groin, thigh, skin folds, contracted areas, and around any tubing for redness, irritation, moisture and odor. 5. Undrape resident 6. Report any unusual findings to the nurse immediately. 7. Do final steps.

*Application of Incontinent Brief*

1. Do initial steps. 2. Put on gloves 3. Provide resident privacy. 4. Unfasten and remove brief resident is currently wearing and place in small plastic trash bag for disposal in soiled utility bag. 5. Provide perineal care as indicated. 6. Wash hands and change gloves. 7. Place back of brief under residents hips, plastic side of disposable brief away from residents skin. 8. Bring front of brief between residents legs and up to his/her waist. 9. Fasten each side of brief and adjust to fit. 10. Apply residents clothing. 11. Do final steps.

*Empty Urinary Drainage Bag* remember c.o.c.a

1. Do initial steps. 2. Put on gloves 3. Place paper towel on floor below bag and place graduate cylinder on paper towel. 4. Detach spout (if bag has one) and point the drainage tube into center of graduate cylinder without letting the tube touch the sides. 5. Unclamp spout and drain urine. 6. Clamp spout. 7. Replace spout in holder. 8. Check urine for color, odor, amount and character and report any unusual findings to the nurse. 9. Measure and and accurately record amount of urine. 10. Dispose of urine, rinse, sanitize and return graduate cylinder according to facility policy. 11. Remove gloves 12. Do final steps.

*Nasal Cannula Care*

1. Do initial steps. 2. Put on gloves. 3. Remove nasal cannula and clean nostrils with a soft cloth or tissue once each shift or as needed. 4. Note any redness or irration of the nares or behind the ears and notify nurse if present. Conitnue procedure only if instructed. 5. Replace nasal cannula. Do not cinch sides up to tightly. 6. Remove gloves. 7. Do final steps.

*Post Mortem Care*

1. Do initial steps. 2. Put on gloves. 3. Respect the families religious restrictions regarding the care of body, if applicable. 4. Assist roommate to leave the area until body is prepaired and removed, if applicable. 5. Place body in supine position. 6. Place one pillow beneath residents head. 7. Close the eyes. 8. Insert dentures, if this is the facilities policy, and close the mouth. 9. Cleanse the body as necessary. Comb hair. 10. Place a pad under the buttocks to collect any drainage. 11. Put a clean hospital gown on resident and place body in comfortable looking position to allow family and friends to view the body. 12. Remove gloves. 13. Do final steps. 14. After the mortuary has removed the body, strip the bed and clean the room according to facility policy.

*Electric Razor*

1. Do initial steps. 2. Raise head of bed so resident is sitting up. 3. Do not use electric razor near any water source, when oxygen is in use or if resident has a pacemaker. 4. Drape towel under resident's chin. 5. Put on gloves 6. Apply pre-shave lotion as resident requests. 7. Hold skin taut and shave residents face and neck according to manufacturers guidelines. 8. Check for any breaks in skin. Apply after-shave lotion as residents requests 9. Remove towel from resident. 10. Remove gloves 11. Do final steps.

*Comb/brush Hair*

1. Do initial steps. 2. Raise head of bed so resident is sitting up. 3. Drape towel over pillow. 4. Remove resident's glasses and any hairpins or clips. 5. Remove tangles by dividing hair into small sections and gently combing out from ends of hair to scalp. 6. Use hair products as resident wishes. 7. Style hair as resident requests. 8. Offer mirror. 9. Do final steps.

*Safety Razor*

1. Do initial steps. 2. Raise head of bed so resident is sitting up. 3. Fill bath basin halfway with warm water. 4. Drape towel under resident's chin. 5. Put in gloves 6. Moisten beard with washcloth and spread shaving cream over area. 7. Hold skin taut and shave beard in downward in downward strokes on face and upward strokes on neck. 8. Rinse resident's face and neck with washcloth. 9. Pat dry with towel. 10. Apply after-shave lotion as requested. 11. Remove towel 12. Remove gloves 13. Do final steps.

*Denture Care*

1. Do initial steps. 2. Raise head of bed so resident is sitting up. 3. Put on gloves. 4. Drape town under resident's chin. 5. Remind resident that you are going to remove their dentures. Remove upper dentures by placing you index finger at the ridge on top of the right upper denture and gently moving them up and down to release suction. Turn lower denture slightly to lift out of mouth. 6. Put dentures in the denture cup marked with residents name and take to sink 7. Line sink with towel and fill halfway with water. 8. Apply denture cleaner to toothbrush. 9. Hold dentures over sink and brush all surfaces. 10. Rinse dentures under warm water, please in cup and fill with cool water. 11. Clean resident's mouth with swab if necessary. Help resident rinse mouth with water or mouthwash diluted with half water if requested. 12. Check teeth, mouth, tongue, and lips for odor, cracking, sores, bleeding, and discoloration. Check for loose teeth. Report any unusual findings to nurse. 13. Help resident place dentures in mouth if requested. Moisturize lips 14. Remove gloves 15. Do final steps.

*Urinal*

1. Do initial steps. 2. Raise head of bed to sitting position. 3. Put on gloves 4. Offer urinal to resident or place urinal between his legs and insert penis into opening. 5. Cover resident. 6. Give resident call light and toilet paper. 7. Leave resident and return when called. 8. Remove and cover urinal. 9. Take urinal to bathroom, check urine for color, odor, amount and character and report unusual findings to nurse. 10. Dispose of urine, rinse urinal ,sanitize and return urinal according to current facility policy. 11. Remove gloves and wash hands. 12. Assist resident to wash hands. 13. Do finals steps.

*Knee Immobilizer*

1. Do initial steps. 2. With resident lying supine in bed, one caregiver will support the leg above the knee and at the ankle and lift the leg in one motion, providing enough height for second caregiver to place the immobilizer under the affected leg. Check skin prior to applying the immobilizer. 3. The caregiver will lower leg into the open immobilizer, keeping the leg straight. 4. Pull both sides of the immobilizer to the center of front of leg and wrap one side over the other, securing the Velcro strap holding the immobilizer in place. Make sure the Velcro stabilizer bar staps are attached to the opposite sides of the immobilizer to prevent any motion of the knee medially or laterally. 5. Bring straps around each side and secure to stabilize the immobilizer. 6. When removing the immobilizer for bathing/care, support the leg in the same manner, keeping the leg straight at all times. Observe for any redness areas, particularly at the upper and lower edge of the immobilizer, which is in contact with the residents skin 7. Report to nurse any skin irritations, open area, or complaint of pain. 8. Do final steps

*Transfer to Chair*

1. Do initial steps. 2.Place chair on resident's UNAFFECTED side. Brace Firmly against side of bed. 3. Assist resident to sit on edge of bed. Encourage resident to sit for a few seconds to become steady. Check for dizziness. 4.Stand in front of resident and apply gait belt around residents abdomen. 5. Grasp the gait belt securely on both sides of the resident 6. Ask resident to place his hands on your UPPER ARMS. 7. On the count of three, help resident into standing position by straightening your knees. 8. Allow resident to gain balance, check for dizziness. 9. Move your feet 18 INCHES APART and slowly turn resident. 10. Lower resident into chair by bending your knees and leaning forward. 11. Align resident's body and position foot rests. Remove gait belt. 12. Do Final Steps

*Fire extinguisher* (P.A.S.S.)

1. Pull the pin 2. Aim at the base of the fire. 3. Squeeze the handle. 4. Sweep back and forth at the base of the fire.

*Assist to Eat*

1. Do initial steps. 2. Confirm diet card/tray. Check name, diet, utensils and condiments. 3. Confirm any adaptive equipment is present, if indicated 4. Assist to protect the residents clothing, if desired. 5. Assist to open cartons, arrange food items withing reach, season foods per residents preferences. etc 6. Offer assistance if resident appears to be having difficultly during meal. 7. Offer to assist in cleansing residents hands/face following the meal. 8. Assist resident to room or location of choice. 9. Do final steps. Measure I&O's if required.

*Supine Position*

1. Do initial steps. 2. Lower head of bed. 3. Move resident to head of bed if necessary 4. Position resident flat on back with legs slightly apart. 5. Align resident's shoulders and hips. 6. Use supportive padding and /or float heels if necessary. 7. Do final steps.

*Elastic/Compression Stocking Application*

1. Do initial steps. 2. Observe skin prior to applying the stocking for any redness, warmth, swelling, excessive dryness, or open area. Notify nurse if abnormalities present. Continue procedure only if instructed. 3. Apply the hose before resident gets out of bed. 4. Hold heel of stocking and gather the rest in your hand turning hose inside out to mid foot area. 5. Support foot at the heel and slip the front of the stocking over the toes, foot and heel. 6. Pull the stocking up until it is fully extended. 7. Smooth away any wrinkles or twisted area. 8. Remove the hose at least twice daily for skin care unless otherwise instructed by physician. 9. Do final steps

*Assist Resident to Move to Head of Bed*

1. Do initial steps. Ask another CNA to assist you if needed 2. Lower head of bed and lean pillow against head board. 3. Ask resident to bend knees, put feet flat of mattress. 4. Place one arm under resident's shoulder blades and the other arm under resident's thighs. If a draw sheet or pad is under resident, 2 caregivers should grasp the sheet or pad firmly, with trunk centered between hands. 5. Ask resident to push with feet on count of three. 6. Place pillow under resident's head. 7. Do final steps.

*Oral Care*

1. Do initial steps. Check with nurse if the resident is on swallowing precautions. 2. Raise head of bed so resident is sitting up. 3. Put on gloves 4. Drape towel under resident's chin. 5. Wet brush and put on small amount of toothpaste. 6. First Brush upper teeth and then lower teeth. 7. Hold emesis basin under resident's chin. 8. Ask resident rinse mouth with water and spit into emesis basin. 9. If requested, give resident mouthwash diluted with half water. 10. Check teeth, mouth, tongue, and lips for odor, cracking, sores, bleeding, and discoloration. Check for loose teeth. Report any unusual findings to nurse. 11. Remove towel and wipe resident's mouth. 12. Remove gloves 13. Do final steps.

*Final Steps*

1. Remove gloves, if applicable, and wash hands. 2. Be certain resident is comfortable and in good alignment. Use proper body mechanics. 3. Lower bed height and position side rails as appropriate. 4. Place call light and water within patients reach. 5. Ask resident if anything else is needed. 6. THANK RESIDENT. 7. Remove supplies and clean equipment according to facility procedure. 8. Open curtains, drapes and door according to residents wishes. 9. Perform a safety check of resident and environment. 10. REPORT unexpected findings to nurse. 11. DOCUMENT procedures according to facility procedure.

*Fire* (R.A.C.E.)

1. Remove residents from are of immediate danger. 2. Activate fire alarm. 3. Close doors and windows to contain fire. 4. Extinguish fire with fire extinguisher if possible. 5. Follow all facility policies.

* Handwashing/Handrub* (wash hands when visibly soiled or prior to giving care)

1. Turn on faucet with a CLEAN paper towel. 2. Adjust water to acceptable temperature. 3.Angle arms down holding hands lower than elbows. Wet hands and wrists. 4. Apply enough soap to cover all hand and wrist surfaces. Work up a lather. NOTE: Direct caregivers must rub hands together vigorously, as follow's for at least 20 SECONDS, covering all surfaces of the hands and fingers. 5. Rub hands palm to palm. 6. Right palm over top of left hand with interlaced fingers and visa versa. 7.Palm to palm with fingers interlaced. 8.Back of fingers to opposing palms with fingers interlocked. 9.Rotational rubbing, of left thumb clasped in right palm and visa versa. 10. Rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm and vice versa. Clean finger nails. 11.Rinse hands with water down from wrist to fingertips. 12. Dry thoroughly with a single use towels. 13. Use towel to turn off faucet and discard towel. 14. Apply about a quarter sized amount HOW TO USE HAND RUB (otherwise use hand rub) Allow hands to dry. Waterless HAND RUB must be rubbed for at least 10 SECONDS or until dry to be effective.

*Gloves*

1. Wash hands 2. If right handed, slide one glove on left hand. (reverse, if left handed.) 3. With gloved hand, slide opposite hand in the second glove. 4. Interlace fingers to secure gloves for a comfortable fit. 5. Check for tears/holes and replace glove if necessary. 6. If wearing a gown, pull the cuff of the gloves over the sleeves of the gown. 7. Perform procedure. 8. Remove first glove by grasping outer surface of the other glove, just below the cuff and pulling down. 9. Pull glove off so that it is inside out. 10. Hold the removed glove in a ball of the palm or your hand. Do not dangle the glove downward. 11. Place two fingers of ungloved hand under cuff of other glove and pull down so first glove is inside second glove. 12. Dispose of gloves without touching outside of gloves and contaminating hands. 13. Wash hands

*Gown (PPE)*

1. Wash hands 2. Open gown and hold out in front of you. Let the clean gown unfold without touching any surface 3. Slip your hands and arms through the sleeves and pull the gown on. 4. Tie neck ties in a bow. 5. Overlap back of the gown and tie waist ties. 6. Put on gloves; extend to cover wrist of gown. 7. Perform procedure. 8. Remove gloves. 9. Untie the neck, then waist ties. 10. Pull away from neck and shoulders, touching inside of gown only. 11. Fold gown with clean side out and place in laundry or discard if disposable. 12. Wash hands.

*Mask*

1. Wash hands 2. Place upper edge of the mask over the bridge of your nose and tie the upper ties. If mask has elastic bands, wrap the bands around the back of your head and ensure they are secure. 3. Place the lower edge of the mask under your chin and tie the lower ties at the nape of your neck. 4. If the mask has a metal strip in the upper edge, form it to your nose. 5. Perform procedure. 6. If the mask becomes damp or if the procedure takes more than 30 minutes, you must change your mask. 7. If wearing gloves, remove them first. 8. Wash hands 9. Untie each set of ties and discard the mask by touching only the ties. Masks are appropriate for one use only. 10. Wash hands

*Unoccupied Bed*

1.Do initial steps 2. Collect clean linen in order of use. 3. Carry linen away from your uniform. 4. Place linen on clean surface (bedside stand, over bed table, or back of chair). 5. Place bed in flat position. 6. Loosen soiled linen. Roll linen from head to foot of bed and place in barrel at door or room or in bag and place at foot of bed or chair. 7. Fanfold bottom sheet to center of bed and fit corners. 8. Fanfold top sheet to center of bed. 9. Fanfold blanket over top sheet. 10. Tuck top linen under foot of mattress and miter corner. 11. Move to other side of bed. 12. Fit corners of bottom sheet, unfold top linen, tuck it under foot of mattress and miter corner. 13. Fold top of sheet over blanket to make cuff. 14.With one hand, grasp the clean pillow case at the closest end, turning it inside out over your arm 15.Using the same hand that has the pillow case over it, grasp one narrow edge of the pillow and pull the pillow case over it with your free hand 16. Place the pillow at head of bed with open edge away from door. 17.* FOR OPEN BED*: make toe pleat and fanfold top linen to foot of bed with top edge closest to center of bed. 18.* FOR CLOSED*: pull bedspread over pillow and tuck bedspread under lower edge of pillow. Make tow pleat. 19.Remove soiled linens 18.Do final steps.

*Oral Temperature Electronic*

Do not take oral temperature for a resident who is unconscious, uses oxygen, or who is confused/disoriented 1. Remove thermometer from storage/battery charger 2. Do initial steps. 3. Position resident comfortably in bed or chair. 4. Put on disposable sheath, and place thermometer under the tongue and to one side, press button to activate the thermometer 5. The resident should be directed to breath through their nose 6. Instruct resident to hold thermometer in mouth with lips closed. Assist as necessary 7. Leave thermometer in place until signal is heard, indicating temperature has been obtained 8. Read the temperature reading on the face of the electronic device, remove the thermometer, discard the sheath, and record the reading 9. Do final steps. 10. Return thermometer to storage/battery 11. Report any unusual findings to the nurse.

*Axillary Temperature*

Often taken when inappropriate to take an oral temperature; particularly if a resident is confused or combative. 1. Remove thermometer from storage/battery charger 2. Do initial steps. 3. Position resident comfortably in bed or chair. 4. Put on disposable sheath, Remove resident's arm from sleeve of gown and wipe armpit and ensure it is dry. Hold thermometer in place with end in center of armpit and fold residents arm over chest 5. Press button to activate the thermometer 6. Hold thermometer in place until signal is heard, indicating the temperature has been obtained 7. Read the temperature reading on the face of the electronic device, remove the thermometer, discard the sheath, and record the reading 8. Assist the resident to return arm though sleeve of gown/clothes. 9. Do final steps. 10 Return thermometer to storage/battery 11. Report any unusual findings to the nurse.