CNA RCP's

Initial Steps

1. Ask about needs, abilities, and limitations of resident. 2. Knock and identify yourself. Wait for permission to enter. 3. Greet resident by name. 4. Identify yourself by name & title. 5. Explain procedure. 6. Gather supplies & check equipment. 7. Close curtains/doors. Keep resident covered. 8. Wash your hands. 9. Wear gloves per Standard Precautions. 10. Use proper body mechanics.

Bed Shampoo

1. Do initial steps. 2. Gently comb & brush hair. 3. Provide privacy. 4. Remove gown. Place towel around neck & shoulders. Lower head of bed. 5. Have resident check temperature of water to be used. 6. Place bed shampoo basin under head. 7. Place wash basin on chair to catch water flowing from shampoo basin. 8. Pour water carefully over resident's hair. 9. Lather hair with shampoo using fingertips. Rinse thoroughly. Apply conditioner if requested. Rinse thoroughly. 10. Squeeze excess water from hair & towel dry. 11. Replace gown. 12. Comb & brush hair. Dry hair with a dryer if requested. 13. Do final steps.

Seizures

1. Call for nurse & stay with resident. 2. Place padding under head & move furniture away. 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 & areas involved.

Choking

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

Falling or Fainting

1. Call for nurse and stay with resident. 2. Check if resident is breathing. 3. Leave resident in same position until nurse examines patient. 4. Talk to resident in a calm & supportive manner. 5. Apply direct pressure to any bleeding with clean piece of linen. 6. Take pulse & respiration. 7. Assist nurse. Assist in documentation.

Application of Incontinent Brief

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

Assisting with Hearing Aids

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

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. 5. Place one arm under resident's shoulder blades & the other arm under resident's thigh. 6. On count of three, slowly turn resident into sitting position & dangle. 7. Allow time for resident to become steady. Ask if dizzy. 8. Assist resident to put on shoes or slippers. 9. Move resident to edge of bed so feet are flat on floor. 10. Do final steps.

Bedside Commode

1. Do initial steps. 2. Assist resident to put on non-skid shoes. 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 & toilet paper. 6. Put on gloves. 7. Assist resident to wipe from front to back. 8. Wash hands & change gloves. 9. Assist resident to bed or chair. 10. Remove & cover pan & take to bathroom. 11. Prior to disposal, observe urine/feces for color, odor, amount, & characteristics & report unusual findings to nurse. 12. Dispose of urine/feces, sanitize pan & return pan. 13. Remove gloves. 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 shoes. 3. Walk with resident to bathroom. 4. Assist resident to lower garments & sit. 5. Provide resident with call light & toliet paper. 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 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 bed as possible. 4. Have resident grasp both arms of walker. 5. Brace walker with your foot & place your hand on top of walker. 6. Assist resident to stand on count of three. Check for dizziness. 7. Stand to side & slightly behind resident. 8. Have resident move walker ahead 6-10 inches. Step up to walker moving weak leg forward to middle of walker while pushing down on handles & bring unaffected leg forward even with weak leg. 9. Do final steps.

Walking

1. Do initial steps. 2. Assist resident to sit on edge of bed. Check for dizziness. 3. Assist resident to stand on count of three. 4. Check for dizziness. 5. Stand to side & slightly behind resident. 6. Walk at resident's pace. 7. Do final steps.

Using a Gait Belt to Assist with Ambulation

1. Do initial steps. 2. Assist resident to sit on edge of bed. Check for dizziness. 3. Place belt around resident's waist with buckle in front and adjust to snug fit. Position one hand on belt at resident's side & other hand at resident's back. 4. Assist resident to stand on count of three. 5. Allow resident to gain balance. Check for dizziness. 6. Stand to side & slightly behind resident while continuing to hold onto belt. 7. Walk at resident's pace. 8. Return resident to chair/bed & remove belt. 9. Do final steps.

Weight

1. Do initial steps. 2. Balance scale. 3. Assist resident to stand on platform or sit in chair with feet on footrest or transport wheelchair onto scale & lock brakes. 4. Press weigh 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 & nails for color, swelling, cuts, or splits. Check hands for extreme heat or cold. Report unusual findings to nurse before continuing. 3. Raise head of bed so resident is sitting up. 4. Fill bath basin with warm water & have resident check temperature. 5. Soak hands & pat dry. 6. Put on gloves. 7. Clean under nails with orange stick. 8. Clip fingernails straight across & file in a curve. 9. Remove gloves. 10. Do final steps.

Blood Pressure

1. Do initial steps. 2. Clean earpiece & 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 sphygmomanometer cuff around upper unaffected arm approximately 1-2 inches above elbow. 6. Put earpieces of stethoscope in ears. 7. Place diaphragm of stethoscope over brachial artery at elbow. 8. Close valve. If BP is known, inflate cuff to 20 mm/hg above usual rating. If BP is unknown, inflate cuff to 160 mm/hg. 9. Slowly open valve. 10. Watch gauge and listen for sound of pulse. 11. Note gauge reading at first pulse sound. 12. Note gauge reading when pulse disappears. 13. Completely deflate & remove cuff. 14. Accurately record systolic & diastolic readings. 15. Do final steps. 16. Report unusual readings to nurse.

Shower/Shampoo

1. Do initial steps. 2. Clean/disinfect shower & shower chair. Prep bathing area. Gather supplies & take them into shower area. 3. Help resident remove clothing. Provide privacy. 4. Turn on water & have resident check water temperature for comfort. 5. Assist resident into shower via wheelchair. Lock wheels of shower chair & transfer resident to shower chair. Use safety belt to secure stability. 6. Give resident a washcloth to cover his eyes during shampoo. Place cotton balls in his ears if desired. 7. Wet resident's hair. 8. Put small amount of shampoo into palm of your hand & work it into resident's hair & scalp using fingertips. 9. Rinse hair thoroughly. 10. Use a conditioner if resident desires. 11. Let resident wash as much as possible starting with face. Assist as needed to wash/rinse entire body from head to toe. Use a separate washcloth to cleanse perineal area last. 12. Turn off water. Cover resident with bath blanket. 13. Remove cotton balls from ears if needed. 14. Towel dry hair, neck, & ears. 15. Give resident towel & assist to pat dry. Ensure to thoroughly pat dry under breasts, between skin folds, in perineal area, & between toes. 16. Ensure floor area is dry & non-slip device is in place. Assist resident out of shower. 17. Use a dryer on hair if desired. 18. Apply lotion to skin, help dress, comb hair, & return to room. 19. Do final steps. Report any skin abnormalities to nurse.

Palm Cones

1. Do initial steps. 2. Cleanse & thoroughly dry hand. 3. Place cone with clean cover in palm. 4. Observe hand every shift. Clean & thoroughly dry hands. Observe for redness, swelling, or open area & report to nurse if noted. 5. Note covering of palm cone & send to laundry when soiled, recovering cone with a clean covering as needed. 6. Do final steps.

Unoccupied Bed

1. Do initial steps. 2. Collect clean linen in order of use. 3. Carry linen away from uniform. 4. Place linen on clean surface. 5. Lay bed in flat position. 6. Loosen soiled linen. Roll linen from head to foot of bed & place in bag & place at foot of bed/chair. 7. Fanfold bottom sheet to center of bed & fit corners. 8. Fanfold top sheet to center of bed. 9. Fanfold blanket over top sheet. 10. Tuck top linen under food of mattress & miter ocrner. 11. Move to other side of bed. 12. Fit corners of bottom sheet, unfold top linen, tuck it under foot of mattress, & miter corner. 13. Fold top of sheet over blanket to make a cuff. 14. With one hand, grasp clean pillow case at closed end & turn it inside out over your arm. 15. With the same hand that has the pillow case over it, grasp one narrow edge of pillow & pull pillow case over it with your free hand. 16. Place pillow at head of bed with open edge away from door. 17. Remove soiled linens. 18. Do final steps.

Occupied Bed

1. Do initial steps. 2. Collect clean linen in order of use. 3. Carry linen away from uniform. 4. Place linen on clean surface. 5. Lower head of bed & adjust bed to waist high level. Lock bed wheels. 6. Drape resident. 7. Raise side rail on far side. Assist resident to turn onto side moving away from your toward rail. 8. Loosen bottom soiled linen on side you are working on. 9. Roll bottom soiled linen toward resident & tuck it snuggle against back. 10. Place clean bottom linen on unoccupied side of bed & roll remaining clean linen under resident in center of bed. 11. Smooth bottom sheet out & ensure there are no wrinkles. Roll all extra material toward resident & tuck it under body. 12. Raise side rail nearest to you & assist resident to turn onto clean bottom sheet. Move to opposite side of bed. 13. While resident is lying on side, loosen soiled linen & roll linen from head to foot of bed & avoid contact with your skin/clothing. 14. Place soiled linen in bag at foot of bed/chair. 15. Pull clean bottom linen as was done to opposite side. 16. Assist resident to roll onto back, keeping resident covered. 17. Unfold top sheet placing it over resident. Request resident hold top sheet while sleeping previous sheet out from underneath clean sheet. 18. Assist resident with blanket over top sheet & tuck bottom edge of top sheet & blanket under mattress. Miter corners & loosen top linens over feet. 19. Remove pillow & remove soiled pillow case by turning it inside out. 20. With one hand, grasp clean pillow case at closed end, turning it inside out over your arm. 21. Using same hand that has the pillow case over it, grasp one narrow edge of pillow & pull pillow case over it with free hand. 22. Place pillow under head with open edge away from door. 21. Assist resident to comfortable position & return bed to appropriate position. 22. Remove soiled linens from room & carry away from uniform. 23. Do final steps.

Feeding

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

Assist to Eat

1. Do initial steps. 2. Confirm diet card/tray. Check name, diet, utensils, & condiments. 3. Confirm any adaptive equipment is present. 4. Assist to protect resident's clothing. 5. Assist to open cartons, arrange food items within each, season foods as per preference. 6. Offer assistance if resident appears to be having difficulties. 7. Offer to assist in cleansing resident's hands/face following the meal. 8. Assist resident to room/location of choice. 9. Do final steps. Measure I&O's if needed.

Oral Care (Unconscious)

1. Do initial steps. 2. Drape towel over pillow & a towel under chin. 3. Turn resident onto unaffected side. 4. Put on gloves. 5. Place emesis basin under chin. 6. Dip swab in half water/half mouthwash solution & wipe teeth, gums, tongue, & inside surfaces of mouth, changing swab frequently. 7. Rinse with clean swab dipped in water. 8. Check teeth, mouth, tongue, & lips for odor, cracking, sores, bleeding, & discoloration. Check for loose teeth. Report unusual findings to nurse. 9. Cover lips with lip balm. 10. Remove gloves. 11. Do final steps.

Foot Care (Basin)

1. Do initial steps. 2. Fill basin halfway with warm water & have resident check temperature. 3. Place basin on towel. 4. Remove socks. Completely submerge feet in water & soak for 5-10 minutes. 5. Put on gloves. 6. Remove one foot from water. Wash entire foot, including in between toes & around nail beds using soapy washcloth. 7. Rinse entire foot, including in between toes. 8. Dry entire foot, including in between toes. 9. Repeat steps with other foot. 10. Place lotion in hand, warm lotion by rubbing hands together & massage lotion into entire foot, except in between toes, remove excess with towel. 11. Assist resident to replace socks. 12. Do final steps. 13. Report any cuts, sores, or other findings to nurse.

Height

1. Do initial steps. 2. Flatten bed & place resident in supine position. Place a mark on the sheet at top of head & another at the bottom of the feet. Measure the distance. 3. Accurately record resident's height. 4. Do final steps.

Float Heels

1. Do initial steps. 2. Lift resident's lower extremities. 3. Inspect skin, especially heels. 4. Place a full pillow under calves, leaving heels in air & free from pressure. 5. Do final steps.

Supine Position

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

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/fracture pan under buttocks. 6. Gently roll resident back onto pan & check for correct placement. 7. Cover resident with sheet/blanket. 8. Raise head of bed to comfortable position. 9. Give resident call light & toilet paper. 10. Leave resident & return when called. 11. Lower head of bed. 12. Press bedpan flat on bed & turn resident. 13. Wipe resident from front to back. Wash hands & change gloves. 14. Provide perineal care. 15. Cover bedpan & take to bathroom. 16. Check urine/feces for color, odor, amount, & characteristics & report unusual findings to nurse. 17. Dispose of urine/feces, sanitize pan, & return pan. 18. Remove gloves. Wash hands. 19. Assist resident to wash hands. 20. Do final steps.

Semi-Fowler's Position

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

Fowler's Position

1. Do initial steps. 2. Move resident to supine position. 3. Elevate head of bed to 45-60 degrees. 4. Use supportive padding if necessary (under neck, shoulders, arms, hands, ankles, lower back). 5. Do final steps.

Splint Application

1. Do initial steps. 2. Observe affected joints for swelling, redness, warmth, & complaints of paint & notify nurse. Continue only if instructed. 3. Apply split according to therapy recommendation & physician orders. 4. Remove split after designated period of time. Cleanse skin, dry thoroughly, & observe for swelling, redness, warmth, complaint of pain, or open area. Notify nurse if present. 5. Do final steps.

Elastic/Compression Stocking Application

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

Passing Fresh Ice Water

1. Do initial steps. 2. Obtain cart, ice container, ice scoop, & go to ice machine. Keep ice scoop covered. 3. Fill container with ice using ice scoop. 4. Replace ice scoop in proper covered container. 5. Proceed to resident rooms, noting fluid restrictions prior to pass & any thickened liquid requirements. 6. Empty water from pitcher & bedside glass into sink. Record intake of water if resident is on I&O's. 7. Take pitcher into hall & fill with ice. Do not touch pitcher with ice scoop. 8. Replace scoop in covered container. 9. Return to resident's room & fill pitcher with water at bathroom sink, not allowing pitcher to touch faucet. 10. Pour fresh water into bedside glass & leave straw with glass. 11. Offer resident a drink. 12. Repeat procedure until all residents have been provided with fresh ice water. 13. 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. Check for dizziness. 4. Stand in front of resident & apply gait belt around resident's abdomen. 5. Grasp gait belt securely on both sides of resident. 6. Ask resident to place his hands on your upper arms. 7. On count of three, help resident into standing position by straightening your knees. 8. Check for dizziness. 9. Move your feet 18 inches apart & slowly turn resident. 10. Lower resident into chair by bending your knees & leaning forward. 11. Align resident's body & position foot rests. Remove gait belt. 12. Do final steps.

Back Rub

1. Do initial steps. 2. Place resident in lateral position with neck/back toward you. 3. Expose back & 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, & back to buttocks. 6. Repeat for 3-5 minutes. 7. Gently pat off excess lotion with towel. Cover & position per resident's requests. 8. Do final steps.

Lateral Position

1. Do initial steps. 2. Place resident in supine position. 3. Move resident to side of bed closest 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 hands under resident's shoulder blade & buttock. Turn resident away from you onto side. 7. Place supportive padding behind back, between knees & ankles & under top arm. 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, & force. 5. Continue position as if feeling for pulse. Count each rise & fall of chest as one respiration. 6. Count respiration for 60 seconds noting rate, regularity, & sound. 7. Record pulse & respiration rates. 8. Report unusual findings to nurse. 9. Do final steps.

Tranfer to Wheelchair

1. Do initial steps. 2. Place wheelchair on resident's unaffected side. Brace firmly against side of bed with wheels locked & foot rests out of way. 3. Assist resident to sit on edge of bed. Check for dizziness. 4. Stand in front of resident & apply gait belt. 5. Grasp gait belt on both sides of resident. 6. Ask resident to place his hands on your upper arms. 7. On count of three, help resident into standing position by straightening your knees. Stand toe to toe with resident. 8. Check for dizziness. 9. Move your feet to shoulder width apart & slowly turn resident. 10. Lower resident into wheelchair by bending your knees & leaning forward. 11. Align resident's body & position foot rests. Remove gait belt. 12. Unlock wheels. Transport resident forward. 13. Transport resident to closed door, open door, & back wheelchair through doorway. 14. Take resident to destination & lock wheelchair. 15. Do final steps.

Passive Range of Motion

1. Do initial steps. 2. Position resident in good body mechanics. 3. Observe joints for swelling, redness, or warmth as well as resident complaints of pain & notify nurse. Continue only if instructed. 4. Support limb above & below joint. 5. Begin ROM at shoulders & include shoulders, elbows, wrists, thumbs, fingers, hips, knees, ankles, & toes. 6. Slowly move joint in all directs it normally moves. 7. Repeat motion at least five times. 8. Encourage participation. 9. Stop at any signs of pain & notify nurse immediately. 10. Do final steps.

Urine Specimen Collection

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

Stool Specimen Collection

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

Inspecting Skin

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

Empty Urinary Drainage Bag

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

Nasal Cannula Care

1. Do initial steps. 2. Put on gloves. 3. Remove cannula & clean nostrils with a soft cloth or tissue every shift or as needed. 4. Note any redness or irritation of nares or behind the ears & notify nurse if present. Continue procedure only if instructed. 5. Replace cannula. Do not cinch side up too tightly. 6. Remove gloves. 7. Do final steps.

Post Mortem Care

1. Do initial steps. 2. Put on gloves. 3. Respect family's religious restrictions. 4. Assist roommate to leave until body is prepared & removed. 5. Place body in supine position. 6. Place one pillow beneath head. 7. Close eyes. 8. Insert dentures & close mouth. 9. Cleanse body. Comb hair. 10. Place pad under buttocks to collect drainage. 11. Put clean hospital gown on resident & place body in a comfortable looking position to allow viewing of body. 12. Remove gloves. 13. Do final steps. 14. After body has been removed, strip bed & clean room.

Electric Razor

1. Do initial steps. 2. Raise head of bed so resident is sitting up. 3. Don't use electric razor near water, oxygen, or if resident has a pacemaker. 4. Drape towel under chin. 5. Put on gloves. 6. Apply pre-shave lotion if requested. 7. Hold skin taut & shave face & neck. 8. Check for any breaks in skin. Apply after-shave if requested. 9. Remove towel. 10. Remove gloves. 11. Do final steps.

Assist with Cane

1. Do initial steps. 2. Check cane for presence of rubber tips. 3. Assist resident to sit on edge of bed. 4. Assist resident to stand on count of three. 5. Check for dizziness. 6. Have resident place cane 4 inches to side of unaffected foot. Height of cane should be level with resident's hip. 7. Stand to affected side & slightly behind resident. 8. Have resident move cane forward about 4-6 inches, step forward with affected leg to a position even with cane. Have resident move strong leg forward & beyond weak leg & cane. Repeat sequence. 9. 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 towel under chin. 5. Remind resident you are going to remove dentures. Remove upper dentures by placing index finger at ridge on top of right upper denture & gently moving them up & down to release suction. Turn lower denture slightly to lift out of mouth. 6. Put dentures in denture cup marked with resident's name & allow them to soak. 7. Line sink with towel & fill halfway with water. 8. Apply denture cleaner to toothbrush. 9. Hold dentures over sink & brush all surfaces. 10. Rinse dentures under warm water, place in clean cup, & fill with cool water. 11. Clean resident's mouth with swab if necessary. Help resident rinse with diluted mouthwash solution. 12. Check teeth, mouth, tongue, & lips for odor, cracking, sores, bleeding, & 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.

Oral Care (Alert)

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

Urinal

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

Changing Resident's Gown

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

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 & 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 & hips. Tuck shirt under resident. 8. Turn resident onto affected side. Pull lower garments over buttocks & hip & straighten shirt. 9. Turn resident onto back & slide arm into shirt sleeve, align, & fasten garments. 10. Do final steps.

Thickened Liquids

1. Do initial steps. 2. Obtain thickener & measuring spoon. 3. Thicken liquids to desired consistency. 4. Offer thickened fluid to resident. Encourage consumption. 5. Ensure water pitcher has been removed from bedside. 6. Do final steps.

Bed Bath/Perineal Care

1. Do initial steps. 2. Offer resident urinal or bedpan. 3. Provide privacy. 4. Fill bath basin with warm water & have resident check temperature. 5. Put on gloves. 6. Fold washcloth & wet. 7. Gently wash eye from inner corner to outer corner, using a different part of washcloth to wash other eye. 8. Wet washcloth & apply soap if requested. Wash, rinse, & pat dry face, neck, ears, & behind ears. 9. Remove gown. 10. Place towel under far arm. 11. Wash, rinse, & pat dry hand, arm, shoulders, & underarms. 12. Repeat steps with other arm. 13. Place towel over chest & abdomen. Lower bath blanket to waist. 14. Lift towel & wash, rinse, & pat dry chest & abdomen. 15. Pull up bath blanket & remove towel. 16. Uncover & place towel under far leg. 17. Wash, rinse, & pat dry leg & foot. Be sure to wash, rinse, & dry well between the toes. 18. Repeat with other leg & foot. 19. Change bath water & gloves, wash hands & use clean gloves & towel. 20. Assist resident to spread legs & lift knees. 21. Wet and soap folded washcloth. 22. If resident has a catheter, check for leakage, secretions, or irritation. Gently wipe four inches of catheter from meatus out. 23. Wipe from front to back & from center of perineum to thighs. If washcloth is visibly soiled, change cloths. 24. Change water in basin. Wash hands & change gloves. With a clean washcloth, rinse area thoroughly in same direction. 25. Gently pat area dry with towel in same direction. 26. Assist resident to lateral position, facing away. 27. Wet & soap washcloth. 28. Clean anal area from front to back. Rinse & pat dry thoroughly. 29. Change bath water & gloves. Use clean washcloth & towel. 30. Wash, rinse, & pat dry from neck to buttocks. 31. Return to supine position. 32. Wash hands & change gloves. 33. Help resident put on clean gown. 34. Do final steps. 35. Report any redness, abrasions, or bruises to nurse.

Bed Cradle

1. Do initial steps. 2. Place bed cradle on bed. 3. Cover bed cradle with top sheet & bedspread/blanket. 4. 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 & any hairpins or clips. 5. Remove tangles by dividing hair into small sections & gently combing out from ends of hair to scalp. 6. Use hair products as requested. 7. Style hair as requested. 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 chin. 5. Put on gloves. 6. Moisten beard with washcloth & spread shaving cream over area. 7. Hold skin taut & shave beard in downward strokes on face & upward strokes on neck. 8. Rinse face & neck with washcloth. 9. Pat dry. 10. Apply after-shave lotion if requested. 11. Remove towel. 12. Remove gloves. 13. 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 & lean pillow against headboard. Adjust bed height. 3. Ask resident to bed knees, put feet flat on mattress. 4. Place one arm under resident's shoulder blades & other arm under resident's thighs. 5. Ask resident to push with feet on count of three. 6. Place pillow under resident's head. 7. Do final steps.

Fire Extinguisher

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

Final Steps

1. Remove gloves & wash hands. 2. Ensure resident is comfortable per proper body mechanics. 3. Lower bed height & position side rails. 4. Place call light & water within resident's reach. 5. Ask resident if anything else is needed. 6. Thank resident. 7. Remove supplies and clean equipment. 8. Open curtains/door per resident's requests. 9. Perform visual safety check. 10. Report unexpected findings to nurse. 11. Document procedures.

Fire

1. Remove residents from area. 2. Activate fire alarm. 3. Close doors/windows to contain fire. 4. Extinguish fire with fire extinguisher. 5. Follow all facility polices.

Oral Temperature

1. Remove thermometer from storage/battery charger. 2. Do initial steps. 3. Position resident comfortably. 4. Put on disposable sheath & place thermometer under tongue & to one side. Activate thermometer. 5. Direct resident to breathe through nose. 6. Instruct resident to hold thermometer in mouth with lips close. 7. Leave thermometer in place until signal is heard. 8. Read temperature, remove thermometer, discard sheath, & record reading. 9. Do final steps. 10. Return thermometer to storage/battery charger. 11. Report unusual reading to nurse.

Axillary Temperature

1. Remove thermometer from storage/battery charger. 2. Do initial steps. 3. Position resident comfortably. 4. Put on disposable sheath, remove resident's arm from gown, wipe armpit, & ensure it is dry. Hold thermometer in place with end in center of armpit and fold resident's arm over chest. 5. Press button to activate thermometer. 6. Hold thermometer in place until signal is heard. 7. Read temperature reading, remove thermometer, discard sheath, & record reading. 8. Assist resident to return arm to gown. 9. Do final steps. 10. Return thermometer to storage/battery charger. 11. Report unusual reading to nurse.

Gown

1. Wash hands. 2. Open gown and allow gown to unfold without touching it. 3. Slip hands & arms through sleeves and pull gown on. 4. Tie neck ties in a bow. 5. Overlap back of gown & tie waist ties. 6. If gloves are required, put them on last. 7. Perform procedure. 8. Untie/break waist ties. 9. Untie/break neck ties. 10. Pull sleeve off by grasping each shoulder and turn sleeves inside out. 11. Fold gown with clean side out and dispose. 12. Remove gloves. 13. Wash hands.

Mask

1. Wash hands. 2. Place upper edge over bridge of nose and tie upper ties. If mask has elastic bands, wrap bands around back of head. 3. Place lower edge of mask under chin & tie lower ties at nape of neck. 4. If mask has a metal strip in upper edge, form it to your nose. 5. Perform procedure. 6. Change mask if it becomes damp or if procedure takes more than 30 minutes. 7. Remove gloves first if applicable. 8. Wash your hands. 9. Untie each set of ties and discard mask by only touching ties. 10. Wash your hands.

Gloves

1. Wash hands. 2. Slide one glove on left hand. 3. Slide opposite hand in second glove. 4. Interlace fingers to secure gloves. 5. Check for tears/holes. 6. Pull cuff of gloves over sleeves of gown. 7. Perform procedure. 8. Remove first glove by grasping outer surface of other glove and pulling down. 9. Pull glove off so it is inside out. 10. Hold removed glove in a ball of the palm of your gloved hand. 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. 13. Wash hands.