CNA- RCP's

Procedure 3: Handwashing/ Handrub

- How to Hand wash - 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. 5. Rub hands palm to palm. 6. Right palm over top of left hand with interlaced fingers and vice versa. 7. Palm to palm with fingers interlaced. 8. Backs of fingers to opposing palms with fingers interlocked. 9. Rotational rubbing, of left thumb clasped in right palm and vice 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 wrists to fingertips. 12. Dry thoroughly with single use towels. 13. Use towel to turn off faucet and discard towel. - How to use hand rub- 14. Apply a quarter sized amount of the product in a cupped hand and cover all surfaces. 15. Rub hands palm to palm. 16. Right palm over left dorsum with interlaced fingers and vice versa. 17. Palm to palm with fingers interlaced. 18. Backs of fingers to opposing palms with fingers interlocked. 19. Rotational rubbing of left thumb clasped in right palm and vice versa. 20. Rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm and vice versa. 21. Allow hands to dry. Waterless hand rubs must be rubber for at least 10 seconds or until dry to be effective.

Procedure 1: Initial Steps

1. Ask nurse about resident's needs, abilities, and limitations, if necessary and gather supplies. 2. Knock and identify yourself before entering the resident's room. Wait for permission to enter the resident's 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 area of resident's 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 side rails (if raised).

Procedure 8: Choking

1. Call for 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 first 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 thrust. 7. Repeat until object is expelled. 8. Assist with documentation.

Procedure 7: 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 yo facility policy and procedures. Assist in documentation.

Procedure 9: Seizures

1. Call for nurse and stay with resident. 2. Place padding under head and move 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 residents clothing especially around neck 5. Note duration of seizure and are was involved.

Procedure 15 Blood Pressure

1. Do initial steps 2. Clean earpieces and diaphragm I've said a scope with antiseptic wipes. 3. Uncover residents arm to shoulder. 4. Rest residence arm, level with heart, palm upward on comfortable surface. 5. Wrap proper sized sphygmomanometer cuff around upper unaffected arm approximately 1-2 inches above the elbow. 6. Put your 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 20 mm/hg above the usual reading. If blood pressure is unknown, inflate cuff 260 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 nurse.

Procedure 22: Semi-Fowler's position

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

Procedure 23: Sit on edge of bed

1. Do initial steps. 2. Adjust paid height to lowest position. 3. Move resident to side of bed closest to you. 4. Raise had a bed to sitting position, if necessary. 5. Place one arm under resident shoulder blades in the other arm under residence 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. Assess resident to put on shoes or slippers. 9. Move resident to edge of bed so feet are flat on the floor. 10. Do final steps.

Procedure 45: Dressing a dependent resident

1. Do initial steps. 2. Assist resident to choose clothing. 3. Move resident onto back. 4. 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 shirtsleeves, affected side first. 7. Turn resident onto affected side. Pulled over garments over buttocks and hips. Textured under resident. 8. Turn resident onto affected side. Whole lower garments over buttocks and hips and straighten shirt. 9. Turn resident onto back and slide arm into shirt sleeve, align and fasten garments. 10. Do final steps

Procedure 46: 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 a 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. Wash hands. 9. Assist resident to raise garments. 10. Assist resident to wash hands. 11. Walk with resident back to chair or bed. 12. Do final steps.

Procedure 47: Bedside Commode

1. Do initial steps. 2. Assist resident to put on nonskid sock/footwear. 3. Place commode next to bed on resident 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 attend by staff. 6. Put on gloves. 7. Assist resident to wipe from front to back. 8. Wash hands and change gloves. 9. Assist resident to bed or chair. 10. Remove and cover pan and take to bathroom. 11. Prior to disposal, observe urine and or feces for color, odor, amount and characteristics and report unusual findings to nurse. 12. Dispose of urine and or feces, sanitize pan and return pan according to facility policy. 13. Remove gloves. Wash hands. 14. Assist resident to wash hands. 15. Do final steps.

Procedure 28: 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 grass both arms of Walker. 5. Brace leg of walker with your foot and place your hands 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 week or injured leg forward to the middle of the walker I'll pushing down on the handles of the walker, and then bringing the unaffected leg forward even with a weak/injured leg. 9. Do final steps.

Procedure 27: 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 residence pace. 7. Do final steps.

Procedure: 24 Using a 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 residence waist with the buckle in front (on top of residence clothes) and adjust to a snug fit ensuring that you can get your hands under the belt. Position one hand at the belt of the resident side and the other hand at the residence back. 4. Assist the resident to stand on count of three. 5. Allow resident to gain balance. Ask resident if dizzy. 6. Stand to side and slightly behind resident while continuing to hold onto belt. 7. Walk at residence pace. 8. Return resident to chair or bed and remove belt. 9. Do final steps.

Procedure 17: 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 foot rest or transport wheelchair onto scale in lock brakes. 4. When using a standard scale lower wait to 50 pound mark that causes arm to drop. Move it back to previous Mark. Move upper Mark 2 pound mark that balance as pointer and middle of square. Add lower and upper marks when using a digital scale press weigh button. Wait until the numbers remain constant. 5. Subtract weight of wheelchair from total weight, if applicable. 6. Accurately record residence wait. 7. Do final steps. 8. Report unusual readings to nurse.

Procedure 42: 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 had a bed so resident is sitting up. 4. Fill bath basin halfway with warm water and have resident check water temperature for comfort. 5. Soak residence hand and pat dry. 6. Put on gloves. 7. Clean under nails with orange stick. 8. Clip fingernail straight across then file in a curve. 9. Remove gloves. 10. Do final steps.

Procedure 29: Assist with cane

1. Do initial steps. 2. Check the cane for presence of rubber tips. 3. Assist resident to sit on the edge of the bed. 4. Assist resident to stand on 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 residence hip. 7. Stand to the affected side and slightly behind the resident. 8. Have resident move cane forward about 4-6 inches, step forward with weak (affected) leg to a position even with a cane. Then have resident move strong leg forward and beyond the week leg and cane. Repeat the sequence. 9. Do final steps.

Procedure 32: 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. Get her supplies and take them into the shower area. 3. Help resident remove clothing. Provide resident privacy. 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 and transfer resident to shower chair. You safety belt to secure resident stability, 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 ball in residence ears if desired. 7. With the residence hair. 8. Put a small amount of shampoo into the palm of your hand and work it into the residents hair and scalp using your fingertips. 9. Rinse residence here thoroughly. 10. Use the conditioner if the resident desires you to do so. 11. Let resident wash as much as possible starting with face. Assist in the needing to wash and rinse the entire body going from head to toe. Use a separate washcloth to a cleanse that peroneal area last. 12. Turn off the water. Cover resident with bath blanket. 13. Remove the cotton balls from the resident ears, if utilized. 14. Towel dry the residents hair neck and ears. 15. Give residents towel and assist to pat dry under the brass, between skin folds, and the peroneal area in between toes. 16. Ensure floor area is dry and non-slip devices in place assist resident out of the shower. 17. Use a dryer on the residents hair, if desired. 18. Apply lotion to skin, help resident dress, comb hair and return to room. 19. Do final steps. Report skin abnormalities to the nurse.

Procedure 37: Oral care for an unconscious resident

1. Do initial steps. 2. Drape towel over pillow and residents chin. 3. Turn resident on unaffected side. 4. Put on gloves. 5. Place emesis basin under residents chin. 6. Dip swab in a solution of half water half mouthwash and wipe teeth, gums, tongue, and inside surface 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 and usual findings to nurse. 9. Cover lips with thin layer of lip moisturizer. 10. Remove gloves. 11. Do final steps.

Procedure 43: Foot care (basin)

1. Do initial steps. 2. Fill the base and halfway with warm water. Have resident check the water temperature. 3. Place base in on towel or bathmat. 4. Remove resident socks. Completely submerged residence feet in water and soap for 5 to 10 minutes. 5.Put on gloves. 6. Remove 1 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 steps with the other foot. 10. Place lotion and hand, warm lotion by rubbing hands together, and then massage lotion into entire foot (top and bottom) except between toes, remove excess with a towel. 11. Assist resident to replace socks. 12.Do final steps. 13. Report any cuts, sores, or other findings to the nurse.

Procedure 35: Bed shampoo

1. Do initial steps. 2. Gently comb and brush residents here. 3. Provide the resident privacy. 4. Remove residents gown or pajama top. Place a towel around residence neck and shoulder. Lower head of bed. 5. Have resident check temperature of water to be used for comfort if able. 6. Place spare shampoo base and other residents had according to manufacturers instructions. 7. Place wash 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 thoroughly. Apply conditioner to residence hair if requested. Rinse thoroughly. 10. Squeeze excess water from here. Tell dry. 11. Replace down or pajama top. 12. Comb and brush residents here. Dry hair with the dryer president wishes. 13. Do final steps.

Procedure 30 transfer: Two stretcher/shower bed

1. Do initial steps. 2. Loosen sheet directly under resident and roll edge as 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 or at the same height. Then lower side rails. 4. Staff should be present at the bedside as well as on the opposite side of the stretcher/shower bed. (Requires a minimum of two staff member; however the number of staff required will depend on the size of the resident). 5. Staff should grasp sheet on each side of resident. On the count of three, slide resident laterally onto stretcher/shower bed. 6. Center and align resident. Place pillow under his/her head and cover with a blanket and raise the rails at the shower/stretcher bed. 7. Do final steps.

Procedure 19: Supine position

1. Do initial steps. 2. Lower head of bed. 3. Move resident to head to bed if necessary. 4. Position resident flat on back with leg slightly apart. 5. Align residence shoulders and hips. 6. Use support of padding and/or float heals, if necessary.

Procedure 48: Bedpan/Fracture Pan

1. Do initial steps. 2. Lower head of bed. 3. Put on gloves. 4. Turn resident away from you. 5. Place bedpan or fracture pain under buttocks according to manufacturers 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 to 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 characteristics and report unusual findings to nurse. 17. Dispose of urine and or feces, sanitize pan and return pan according to facility policies. 18. Remove gloves. Wash hands. 19. Assist resident to wash hands. 20. Do final steps

Procedure 21: Fowlers position

1. Do initial steps. 2. Move resident to supine position. 3. Elevate had a bad 45 to 60°. 4. You support of padding if necessary. 5. Do final steps.

Procedure 33: Bed Bath/Perineal Care

1. Do initial steps. 2. Offer resident urinal or bedpan.. 3. Provide residence privacy. 4. Fill bath basin with warm water and have resident check water temperature for comfort, if able. 5. Put on gloves. 6. Fold washcloths and wet. 7. Gently wash eye from inner corner to outer corner, using a different part of the washcloth with the other eye. 8. Wet washcloth and apply so, if requested. Wash, rinse and pat dry face, neck, ears and behind ears. 9. Remove residence gown. 10.Place towel under far arm. 11. Wash, rinse and pat dry hand, arm, shoulders and under arm. 12. Repeat steps with other arm. 13. Place towel over chest and admin. Lower bath blanket to waste. 14. Lift towel and wash, rinse and pat dry chest and abdomen. 15. Pull up bath blanket and remove towel. 16. Under cover in place towel under far leg. 17. Wash rants and pat dry leg and foot. Be sure to wash, rinse and dry well between the 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 catheter, check for leakage, secretions or irritability. Gently wipe 4 inches of catheter from Gillis out. Perineal care: 23. wipe from front to back in from centra perineum to thighs. If washcloth is visibly soiled, change cloths. For females: A. Separate labia. Wash urethral area first. B. Wash between an outside labia and downward stroke, alternating from side to side and moving at work to thighs. Use different part of washcloth for each stroke. For males: A. Pull back foreskin if mail is uncircumcised. Wash and rinse the tip of penis using circular motion beginning with urethra. B. Continue watching down the penis to the scrotum in the inner thighs. Rinse off soap and dry. Return foreskin or the tip of the penis. 24. Change water in basin. Wash hands and change gloves. With a clean washcloth, rinse air thoroughly in the same direction as when washing. 25. Gently pat area dry and towel in same direction as when washing. 26. Assist resident to lateral position, facing away from you. 27. Wet soap washcloth. 28. Clean anal area from front to back rents 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 down. 34. Do final steps. 35. Report any red areas, abrasions or bruises to the nurse.

Procedure 14: Pulse and Respiration

1. Do initial steps. 2. Place residence hand on comfortable surface. 3. Feel for pulse above wrist on thumb side with tips at first three fingers. 4. Count beats for 60 seconds, noting rate, rhythm and force. 5. Continue position as a feeling for pulse. Count each rise and fall of chest as one respiration. 6. Count respirations for 60 seconds noting rate, regularity and sound. 7. Record pulse and respiration rate. 8. Report unusual findings to nurse. 9. Do final steps.

Procedure 34: Back rub

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

Procedure 20: Lateral position

1. Do initial steps. 2. Place resident and supine position. 3. Move resident to side of bed closest to you. 4. Cross residence arms over chest. 5. Slightly bent knee of nearest leg to you or cross nearest leg over for this leg at ankle. 6. Place your hands under resident shoulder blades and buttocks. 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.

Procedure 26: Transfer to wheelchair

1. Do initial steps. 2. Place wheelchair on residence and affected side. Brace firmly against side of bed with wheels locked and foot rest out-of-the-way. 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 in applied gait belt around residence abdomen. 5. Grasp the gate 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 the resident into standing position by straightening your knees. Stay in toe to toe with resident. 8. Allow resident to gain balance, check for dizziness. 9. Move your feet shoulder width apart and slowly turn resident. 10. Lower resident into wheelchair by bending your knees and leaning forward. 11. Align residence body position and foot rest. Remove gait belt. 12. Unlock wheels. Transport resident forward through open doorway after checking for traffic. 13. Transport resident up to closed door, open door and back wheelchair through doorway. 14. Take resident to destination and lock wheelchair. 15. Do final steps

Procedure 31 Transfer: Two-person lift *only to be used in emergencies

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

Procedure 25: Transfer to chair

1. Do initial steps. 2. Placed chair on residence and affected 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 residence abdomen. 5. Grasp the gate 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 residence body and position foot rest. Remove gait belt. 12. Do final steps.

Procedure 50: Empty Urinary Drainage Bag

1. Do initial steps. 2. Put on gloves. 3. Place paper towel on the floor beneath bag in place graduated cylinder on paper towel. 4. Detach spout and put the drainage tube into center of graduated cylinder without letting tube touch sides. 5.Unclamp spout and drain urine. 6.Clamp spout. 7.Replace spout and hold her. 8. Check urine for color, odor, amount and characteristics and report and usual findings to nurse. 9.Measure and accurately record amount of urine. 10.Dispose of urine, rents, sanitize and return graduated cylinder according to facility policies. 11.Remove gloves. 12.Do final steps.

Procedure 40: Safety razor

1. Do initial steps. 2. Raise had a bed to resident is sitting up. 3. Fill bath basin halfway with warm water. 4. Drape towel under residence chain. 5. Put on gloves. 6. Moisten beard with washcloth and spread shaving cream over area. 7. Hold skin tight and shave beard and downward strokes on face and upward strokes on neck. 8. Rinse residence face and neck with washcloth. 9. Pat dry with towel. 10. Apply aftershave lotion, as requested. 11. Remove towel. 12. Remove gloves. 13. Do final steps.

Procedure 49: Urinal

1. Do initial steps. 2. Raise had a 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 characteristics and report unusual findings to nurse. 10. Dispose of urine, rinse urinal, sanitize and return urinal according to the facility policies. 11. Remove gloves. Wash hands. 12. Assist resident to wash hands. 13. Two final steps.

Procedure 38: Denture care

1. Do initial steps. 2. Raise had a better a resident sitting up. 3. Put on gloves. 4. Drape towel under residence chain. 5. Remind resident that you were going to remove their dentures. Remove upper dentures by placing your index finger at the ridge on top of the right upper denture and gently moving them up or down to release suction. Turn lower denture slightly and lift out of the mouth. 6. Put dentures and denture cup marked with residence name and take to sink. 7. Line sink with a towel and fill halfway with water. 8. Apply denture cleaner to toothpaste. 9. Hold denture over sink and brush all surfaces. 10. Rinse dentures under warm water, place in a clean cup and fill with cold water. 11. Clean residence 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 and usual findings to nurse. 13. Help resident place dentures in mouth, if requested moisturize lips. 14. Remove gloves. 15. Do final steps.

Procedure 41: Comb/brush hair

1. Do initial steps. 2. Raise had a better resident is sitting up. 3. Drape towel over pillow. 4. Remove residence glasses and any hairpins or clips. 5.Remove tangles by dividing hair to small sections and gently coming out from the ends to of hair to scalp. 6. Use hair products, as resident request. 7. Style hair as residents request. 8. Offer Mirror. 9. Do final steps

Procedure 39: Electric razor

1. Do initial steps. 2. Raise had a better resident sitting up. 3. Do not use electric razor near any water source, when the oxygen is in use or if resident has pacemaker. 4. Drape towel under residence chain. 5. Put on gloves. 6. Apply pre-shave lotion as resident request. 7. Hold skin taut and shave residence face and neck according to manufacturers guidelines. 8. Check for any breaks in the skin. Apply aftershave lotion as residence request. 9. Remove towel from resident. 10. Remove gloves. 11. Two final steps.

Procedure 44: Changing residents gown

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

Procedure 16: 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 stay on straight. Raise the rod to the level above the residents head. Lower the height measurement device until it rests flat on the residence head. 3. When resident is unable to stand: flatten the bed and place resident in supine position. Play some mark on the sheet at the top of the head and another at the bottom of the feet. Measure the distance. 4. If the resident has unable to lay flat due to the contractures: utilize a tape measure and begin at the top of the head, follow the curves of the spine and legs, measuring to the base of the heel. 5. Accurately record resident. 6. Do final steps.

Procedure 18: Assist residents to move to the head of the bed.

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

Procedure 36: Oral care for the alert and oriented resident

1. Do initial steps. Check with nurse if the resident is on swallowing precautions. 2. Raise had a bed to resident is sitting up. 3. Put on gloves. 4. Drape Tallinder residence Jen. 5. Wet toothbrush and apply small amount of toothpaste. 6. First brush upper teeth and then lower teeth. 7. Hold emesis basin under residents chin. 8. Ask resident to rinse mouth of 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 and usual findings to nurse. 11. Remove towel and wipe residence mouth. 12. Remove gloves. 13. Two final steps.

Procedure 11: Fire extinguisher

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

Procedure 2: Final Steps

1. Remove gloves, if applicable, and wash your hands. 2. Be certain resident is comfortable and in good body alignment. Use proper body mechanics. 3. Lower bed height and position side rails (if used) as appropriate. 4. Place call light and water within resident's 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 resident's wishes. 9. Perform a visual safety check of resident and environment. 10. Report unexpected findings to nurse. 11. Document procedures according to facility procedure.

Procedure 10: Fire

1. Remove residence from area 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 facilities policies.

Procedure 12: Oral Temperature (electronic)

1. Remove thermometer from storage/battery charger. 2. Do initial steps. 3. Position resident comfortably in bed or chair. 4. Put on disposable sheath in place thermometer under the tongue into one side, press button to activate a thermometer. 5. The resident should be directed to breathe 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 the temperature has been obtained. 8. Read the temperature reading on the face of the electron it device, remove the thermometer, discard the sheath, and record the reading. 9. Do final steps. 10. Return thermometer to storage/battery charger. 11. Report and usual readings to nurse.

Procedure 13: Axillary temperature

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 residence arms from sleeve of down, wipe armpit and ensure it's dry. Hold thermometer in place with ends and center of armpit and fold residents arm over chest. 5. Press button to activate a thermometer. 6. Hold them on her in place until signal is heard, indicating the temperature has been obtained. 7. Read the temperature reading on the face of the electron device, remove the thermometer, discard the sheath, and record the reading. 8. Assist the resident to return arm through sleeve of clothing/gown. 9. Do final steps. 10. Return thermometer to storage/battery charger. 11. Report unusual readings to nurse.

Procedure 4: 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 the 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 other glove, just below cuff and pulling down. 9. Pull glove off so that it is inside out. 10. Hold removed glove in a ball of the palm of your gloved hand. Do not dangle the glove is inside second glove. 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.

Procedure 5: Gown (PPE)

1. Wash your 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. Unit 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 your hands.

Procedure 6: Mask

1. Wash your 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 toes 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 your 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 your hands.

Procedure 65: Abdominal binder

1.Do initial steps. 2.Check the skin for redness, open areas, or needed incontinence care. 3.Placed binder flat on the bed and ask resident to lie down with ever 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 to 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 strips out of the binder fit snugly. 5.Ensure that there are no wrinkles or see creases in the binder. 6.Do final steps

Procedure 68: Palm cones

1.Do initial steps. 2.Cleans and thoroughly dry resident hand. 3.Placed cone with clean cover and resident palm. 4.Observe hand every shift; cleanse and thoroughly dry hands. Observed for areas of redness, swelling or open areas and report to the nurse, if noted. 5.Note covering a palm cone and send to laundry when soiled, recovering con with a clean covering, as needed. 6.Do final steps.

Procedure 55: Occupied 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.Lower head of bed and adjust bed to a safe working level, usually waist high. Lock wheels of bed. 6.Drape the resident. 7.The caregiver will make the bed one side at a time. The caregiver will raise the side rail on the far side of the bed (if rail not in use, ensure there is a second caregiver on the opposite side of the bed to ensure that the resident does not roll over the side of the bed). Assist resident to turn onto side moving away from you toward raise rail. 8.Loosen bottom soiled linen on the side of bed on which you were working. 9.Roll bottom soiled linen toward resident and tech it snugly against the residence back. 10.Place clean bottom linen on occupied 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 under the residence body. 12Raise the side rail nearest you (or remain in place of a second caregiver is being utilized) and assist a resident to turn onto clean bottom sheet. Move to opposite side of bed as resident will not be facing away from you. 13.Well resident is lying on side, loose and soiled linen and rolling in from head to foot of bad, avoiding contact with your scanner clothing. 14.Play soiled linen and barrel or bag and put a bed or in chair. 15.Pull clean bottom linen as was done on the 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 sleeping the bath blanket or previous sheet out from clean sheet. 18.Assist resident with blanket over the top sheet and took the bottom edges of the top sheet and blanket under the bottom of the mattress. Mirror the corners and loosen the top linens over resident's feet. 19.Remove pillow and remove the soil pillowcase by turning it inside out. 20.With one hand grasp the clean pillowcase 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 pillowcase over it with your free hand. 22.Placed a 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 linens from room carry away from uniform. 25.Do final steps.

Procedure 63: Passive range of motion

1.Do initial steps. 2.Position resident and good body alignment. 3.Observe joints. If swelling, redness or warmth is present, or if resident complained of pain, notify nurse. Continue procedure only if instructed. 4.Support lame above and below join. 5.Begin range of motion as soldiers and include the soldiers, elbow, wrist, thumbs, fingers, hips, knees knees, ankles and toes. 6.Slowly move join in all directions if 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 paying and report to nurse immediately. 10.Do final steps

Procedure 54: Unoccupied Bed

1.Do initial steps. 2.Collect clean linen in order of use. 3.Carry linen away from your uniform. 4.Placed linen on clean surface like a bedside stand, over 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 back in place at the foot of the bed or chair. 7.Fanfold bottom sheet to center of bed and fit corners. 8.Fanfold top sheet to center a bed. 9.Fanfold blanket over top sheet. 10.Tuck top linen under foot of mattress and miter corner. 11.Move to the other side of the bed. 12.Fit corner of bottom sheet, unfold top linen, Tuck it under foot of mattress, and miter corner. 13.Fold top of sheet over blanket on make cuff. 14.With one hand, grasp the clean pillow case at the closed in, turning it into hell for your arm. 15.Using the same hand that has the pillowcase over it, grass one narrow edge of the pillow and pull the pillowcase over it with your free hand. 16.Place a pillow at the head of the bed open edge away from the door. 17.For open bed: make toe pleat and fanfold top line into foot of the bed with toe edge closest to central bed. 18.For clothes bed: Pull bedspread over pillow and took bedspread under lower edge of pillow. Make a tow pleat. 19.Remove soiled linens. 20.Do final steps.

Procedure 58: 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 an affected side I level with the resident and face in them. 6.Residents had to be elevated at least 45°, if in bed. 7.Protect the residence clothing with a cloth in projector or per facility policy and procedure. 8.Offer different food; ask residence preference. 9.Food should be in bite-size pieces are with a spoon half full. Food should be fed with the unaffected side of the mouth. 10.Allow time for resident to chew an empty mouth between bites. Notify nurse immediately if choking occurs. 11.Frequently offer beverage. It requires measurements of I&O's and percentage of food eaten. 12.Make conversation with the resident; atmosphere should be pleasant. 13.Cleanse the residents hands/face as needed during the meal and after. 14.Do final steps.

Procedure 59: Assist to Eat

1.Do initial steps. 2.Confirm diet/tray. Check name, diet, utensils and condiments. 3.Confirm any of dad with equipment is present, if indicated. 4.Assess to protect the residence clothing, if desired. 5.Assist to open cartons, arrange food items within reach, season foods for residence preference, etc. 6.Offer assistance of resident appears to be having difficulty during meal. 7.Offered to assist in cleaning residence hands/face following the mail. 8.Assess resident to room or location of choice. 9.Do final steps. Measure I&O's if required.

Procedure 70: Assisting with hearing aids

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

Procedure 61: Float heels

1.Do initial steps. 2.Left residence lower extremity. 3.Inspect the skin, especially the hills. 4.Place at four pillow under calves, leaving Hill's in the air and free from pressure. (Do not use rolled pillows or blankets). 5. Do final steps.

Procedure 64: Splint application

1.Do initial steps. 2.Observe affected joints. It's swelling, redness, or warmth is present or if resident complains of pain, notify nurse.Continue procedure only if instructed. 3.Apply splint according to therapies recommendation in physicians order. 4.Remove splint after designated period of time. Cleanse the skin, dry thoroughly and again observe for swelling, redness, warmth, complaints of pain or open area. Notify the nurse at present. 5.Two final steps.

Procedure 71 Elastic/compression stockings application or Ted hose

1.Do initial steps. 2.Observe skin prior to applying the stockings for any redness, warmth, swelling, excessive dryness or open areas. Notify nurse of 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 areas. 8.Remove the hose at least twice daily for skin care unless otherwise indicated by physician. 9. Do final steps.

Procedure 57: Passing Fresh Ice Water

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

Procedure 56: Thickened liquids

1.Do initial steps. 2.Obtain thickener and measuring spoon. 3.Thickened 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.

Procedure 62: 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 steps.

Procedure 66: Abduction pillow

1.Do initial steps. 2.Place the pillow between the supine residence legs. Slide it with an arrow and pointing toward the groin until it touches a leg all along it's length. 3.Place the upper part of both legs and the pillows 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 residence and tolerance or complaints of pain upon application to the nurse.

Procedure 51: 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 or urinal. 5.Provide Perry care to the resident. 6.Ask resident to avoid into the year and had 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 residence hands. Change your gloves and wash your hands. 8.Take bad pain, urinal, and commode pale to bathroom in Port Huron in to the specimen container. The container should be at least half full. 9.Cover the urine container with its lid. Do not touch the inside of the container. Wipe off the outside with a paper towel. 10.Place a 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.

Procedure 52: 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 the resident is ready to move vowels, ask him or her not to urinate at the same time. Ask the resident not to put toilet paper with the sample. 5.Provide the resident with the 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 2 tablespoons of stool and put in the container. Try to collect material from different areas of the stool. 9.Cover the container with lid. Label as directed purpose still any policy and procedure in place in the plastic bag supplied by the lab for transport. Dispose of remaining stool; clean and disinfect equipment as per facility policy. Notify nurse of collection. 10. Do final steps

Procedure 60: Inspecting Skin

1.Do initial steps. 2.Provide the 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 breast in arms, between buttocks, groin, thighs, skin folds, contracted areas, and around any tubing for redness, irritation, moisture and odor. 5.And drape resident. 6.Report any unusual findings to the nurse immediately. 7.Do final steps.

Procedure 53: Application of Incontinent Brief

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

Procedure 69: 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 irritation of the nears or behind the ears and notify nurse if present. Continue procedure only if instructed. 5.Replace nasal cannula. Do not cinch side up to tightly. 6.Remove gloves. 7.Do final steps.

Procedure 72: Post Mortem Care

1.Do initial steps. 2.Put on gloves. 3.Respect the families religious restrictions regarding the care of the body, if applicable. 4.Assist roommate to leave the area until body is prepared to remove, if applicable. 5.Place body in supine position. 6.Place one pillow beneath residence head. 7.Close the eyes. 8.Insert dentures, if this is the facilities policy, and close the mouth. 9.Cleanse body as necessary. Comb hair. 10.Place a pad under the barracks 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 remove the body, strip the bed and clean the room according to facility policy..

Procedure 67: Knee Immobilizer

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