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CNA Skills

If you are looking forward to being a certified nursing assistant, here are some of the necessary skills that you will need to possess. These are important as they are skills that you would have to use on the job everyday.  These CNA skills can be learned or acquired and you will find that with proper training and practice things will come more easily.

Certified nursing assistants are expected to take care of elderly people, the physically incapacitated, as well as patients who are in the process of recovery.  They are needed to assist nurses and physicians in some aspects of their job, and duties will often be performed under their guidance.

To become a good CNA, you have to learn these basic skills:

  • Basic care for patients
  • Understanding of medical terminology
  • Following proper safety regulations
  • Observing patients
  • Reporting incidents regarding patients
  • Looking after some of the requirements for your patient
  • Looking after the needs or requests of your patient and knowledge of CPR

These are the basic skills that you need to know once you become certified.  They will be the daily tasks and routines that you will need to perform that you will encounter in your daily rounds.

Basic care includes:

  • Bathing the patient
  • Helping them with their bathroom activities
  • Cleaning them and dressing them
  • Feeding and nourishment
  • Measuring and recording vital signs
  • Maintaining emotional support and well-being

These duties need some proper discretion as to avoid making the patient feel embarrassed and that would need some time to develop. You also will be the one to handle your patient’s requests.  You have to be immediate and quick in your response as they can sometimes be for emergencies and may mean a matter of life and death.  You also need to alert regarding any changes that a patient may have after taking some medication or food so that you could report them immediately to the nurse or physician available.

Minor incidents need to be reported as well and a keen observation would be one of the necessary skills that you would need for it.  Knowledge of CPR is a good thing to have in such cases especially when there is nobody else around who is capable of administering it to the patient. You would also need to fill-out forms for your patient’s charts and also to check for their vital signs as well.  These skills are all taught in school and a good grasp of them is required before you become certified. Knowing the terminologies and the proper information to fill is a necessary part of your job.

Becoming a certified nursing assistant is a major responsibility.  You will be the one to be in constant contact with the patient and so would be the first to notice any sign of change in them.  Knowing what to do in emergency cases and giving the proper information to the person in charge would be some of the major skills that you would have to master in order to be efficient in your job.  Handling your patients both emotionally and physically well is also another skill that you need to master to have a good relationship with them.

health-care-exam-room-bed-44065CNA Clinical Skills Test Checklist

One of the most important things to learn and take to heart when you are getting your certification is the clinical skills test checklist.  It accounts for more than half of the passing grade in some states which gives you more reason to focus on this particular aspect well.  Most test takers find the theoretical exam much easier than the practical skills test, where they will be scrutinized very carefully on how well they can deliver the skills that they have learned for the few months of CNA training.  Execution can sometimes be very tricky especially if you have not practiced well during your clinical sessions at the training center.

The certification exam is your day of judgment on your path to becoming a full-fledged nursing assistant.  By being able to pass this test successfully, you will gain the opportunity to work as a nurse aide in any public of private health institution in your state.  Taking the type of work that a health care professional will be involved with in their future employment, the state has made stringent rules on the certification exams.  One will be tested carefully if they really know the nature of the undertaking that lies ahead.

This can be determined more carefully during the clinical skills test which can usually be the second part of the certification exam.  In this test, you will be asked to demonstrate predetermined or randomly selected skills which you have learned during your training.  It is at this point where you will be assessed on whether you can really do the tasks that shall be demanded from you once you get hired.

You may be tested on any of the following skills depending on the state where you will be taking your exam: Hand washing, assisting patients with the use of a bedpan, using transfer belts for ambulating patients, cleaning dentures both upper and lower, feeding, dressing, and giving bed baths to patients, giving passive types of exercises to the patient, positioning the patient on his or her side, putting snit-embolism stockings to the patient, counting a patient’s radial pulse and respiration, using protective personal equipment, measuring solid and liquid outputs of the patient, determining a patient’s blood pressure, providing nail, mouth and foot care to the patient, giving catheter and perineal care to the patient, and transferring a patient to a wheelchair with the use of transfer belt.

Mastering each of these CNA skills is very important if your state requires you to perform randomly selected skills during the certification exams.  You need to pay careful attention to each and every task that you are required to do as well as perform all of the required skills with ease and perfection.  It will be the only way to make sure that you pass the test.  Prepare your mind well before taking the exam.  Panic, which is a very common experience among first time test takers, can be avoided if you are mentally as well as physically prepared to do all of the said tasks.

CNA Clinical Skills Help

Here is a list of the common CNA skills & tasks you will perform as a certified nursing assistant:

Passive Range of Motion Exercises

It is important to help exercise a patient’s passive range of motion especially when they do not spend a lot of time outdoors or getting physically active.  These motions serve to provide a sort of physical exercise for the patient and they help keep their blood circulation to function properly as well as prevent any infection which may be caused by being sedentary or confined to the bed for extended periods of time. Through these checks as well, you will be able to assess just how slow or fast the patient is recovering from their illness.

The first thing that you have to do when you are about to administer these checks on a patient is to knock on the patient’s door and greet them by their name.  Introduce yourself to the patient and explain to them why you are there at that time. It is important that you do not try to invade the patient’s privacy by entering the room without their permission or without calling out their name first.  It can cause some degree of anxiety to the patient especially if they are not familiar with you.

passive-range-of-motion-exercises-by-nurse-022Next, you have to place the patient on a position which will make them easily accessible to you and this can be accomplished in a variety of forms: the high-Fowler position, the supine position, and the semi-Fowler position.  Whichever of these positions are comfortable to your patient should be the one adapted.

After getting them into their desired position, start checking the patient’s range of motion starting with the head.  Ask them to move their head from left to right and up and down.  You should take note however whether your patient is suffering from a head or spinal injury before asking them to do so.

Next, move to the patient’s arms. Ask them to extend and contract their arms moving forward and bending them at the elbow joints.  Let them do this for a couple of times and then proceed to having them to bring their arms towards their body and to do this in a way that their arms would be crossed in front of them.

After this, tell them to move their wrists and fingers and to flex and move them in the most convenient manner.  Then, ask them to move their knees and extend them and then bring them back again near to their body.  Ask them to do this for at least ten times before proceeding.

The last thing to check on a patient’s passive range of motion is their feet and ankle movement.  Ask them to move and twist their ankles and toes in a way that is most convenient to them going left and right to make sure that they maintain a healthy range of motion.  This check usually should be done about two to three times daily and can be incorporated with other CNA tasks such as dressing.  You need to make sure that you do this regularly to avoid letting the patient have stiff joints and muscles.

You can visit this page to learn more about providing ROM exercises to the hip, leg, and ankle, or visit this page to learn more about providing ROM for one shoulder.

 

Providing Mouth Care for a Patient

One of the most important aspects of caring for a nursing home resident is providing oral or mouth care for a patient.  This is a necessity as most infections and diseases can start by having a dirty mouth or having leftover bits and pieces of food stuck in the gums or in between teeth.  Providing this type of care can be done even in unconscious patients as well to help keep them in the best health condition as well as to make sure that they feel well taken care of.  This is a very sensitive process especially if the patient has already developed some sores or pus in the mouth.

The first step to providing oral care for a patient is to knock on their door and introduce yourself to the patient courteously.  Address them by name and let them know why you are there and try to explain to them the step-by-step process which will be involved.  Prepare all the materials that will be needed for the process and then proceed to wash your hands thoroughly and put the appropriate personal protective equipment that you will need.  Allow the patient to participate in the process as much as they can to promote their independence.

oral-health-care-with-toothbrushAfter this, raise the level of the patient’s head up to a 30-degree angle to make it more comfortable for you and for them to get the cleaning process done.  Do not try to raise the head of the patient at a greater angle as this may cause them some discomfort.

Next, turn the patient’s head towards your direction and then ask them to open their mouth.  With a toothbrush with a small amount of toothpaste, begin to brush the patient’s teeth, gums, and tongue.  Make sure that you cover all of the areas of the mouth in order to ensure a thorough cleaning.

Do not use an excessive amount of toothpaste as this may cause the patient to swallow some of it and cause further health problems.  Just a pea sized amount would do.

Next, give the patient with a glass of water to rinse the toothpaste out of their mouth and have a basin ready where they can spit it out.  If the patient is unconscious, have a suction equipment ready and then proceed to rinse the mouth of the patient while applying the suction hose to prevent them from swallowing the toothpaste.

When you have finished rinsing the patient’s mouth, get a clean piece of towel and dry their mouth.  If the patient can do this by himself, then let them do so.  It will help develop his sense of independence and may contribute to a speedy recovery.

Put the patient in their original position, i.e. lower the bed, and then ask them if they need anything else or if they are feeling comfortable.  Put their call lights within their reach and proceed to disposing the things that are non-reusable and put soiled linens in the hamper.  Put back the materials to their original placements as well.

Transfer Patient from Bed to Wheelchair

It is important for a CNA to learn how to transfer a patient from the bed to a wheelchair as this is one of the trickiest tasks for a health care worker.  It requires a lot of balance and strength from a nursing assistant that they must be able to provide perfectly and comfortably for the patient in order to achieve the best results.  Attention to detail and the safety of the patient are of utmost importance about this task.  The patient must also be given a chance for their own preferences where applicable and must be provided with a comfortable transfer to the best of the abilities of the CNA.

The first step is to knock on the patient’s door and to call their name.  The worker must introduce himself or herself to the patient after coming in and should explain to the patient why they are wheelchair-in-health-care-centerthere as well. They must provide the patient with the step-by-step process of how the procedure will be carried out before, during, and after the procedure is done.  This will help the patient to become more relaxed and cooperative throughout the process.

Next, the CNA then washes his or her hands thoroughly and puts on their personal protective equipment to help prevent the spread of disease and infection.

Place the wheelchair alongside the bed near to where the resident will be sitting, then lock the wheels into place.  Fold the footrests of the wheelchair so it does not stand in the way when the resident is being transferred.

Then, assist the patient to get to a sitting position without having to pull their arms or hands.  Let them take some time to orient their body in this new position as some patients may experience nausea or discomfort afterwards.

Place a pair of non-slip footwear on the patient’s feet and put their feet flat on the floor.

Apply the transfer or gait belt on the resident properly.  It should have a gap where you can easily slip your flat hand between the gait belt and the resident, and it must not also come into contact with the patient’s skin for a safer and more comfortable transfer.  Make sure that the belt does not catch any fold of the skin.

When the patient is comfortable, assist them in standing up by standing in front of the patient and reaching under the arms of the resident in order to grasp the gait belt at the back or at the sides.

Brace the resident’s legs and maintain your balance while pulling them up to assist them in standing, turn them towards the wheelchair, and lower them to a sitting position.  The wheelchair must be placed properly that you will not have to put it nearer to the back of the resident’s leg.

Place the resident on an appropriate position, with the hips against the back of the chair and with their feet on the footrests. Remove the gait belt from around the patient’s waist and ask them if they are comfortable. Remove personal protective equipment and proceed to wash your hands.

Watch the video on how to transfer a resident from a bed to a wheelchair using a gait belt:

https://www.youtube.com/watch?v=4CBIEmgt_rQ

Wearing Personal Protective Equipment

Wearing personal protective equipment or PPE is one of the most important duties that a CNA has.  This is to help prevent any chances of infection to spread from patient to CNA and vice versa.  There are different types of PPE but most CNAs usually make use of only one – the gloves.  But, usually, all of these PPEs are required to be worn in order to provide the best protection for the CNA as well as for the patient.  You will have to wear PPE whenever you will come into contact with bodily fluids as well as when coming into direct contact with infectious materials.

The first step to wearing personal protective equipment is to put the gown on first.  This is a type of gown which is made of a very thin fabric which is water resistant and is disposable in nature.  gown-an-gloves-ppeThey are made to be used only once and then to be thrown into the trash after use.

First, unfold the gown and then then wear it with the opening at your back.

Place your hands inside the sleeves and then proceed to close the gown at the neck area.  You can do this by tying it.  After this, you also have to tie the gown at the waist area.

The next thing that you will have to do is to wear the personal protective equipment for your face.  These include the goggles and the face mask.  You should be able to wear them without distracting you or making you uncomfortable in any way and they should also fit snugly not loosely.  The goggles should not distort your vision as well.  The mask must sit comfortably on your face and should sufficiently cover your nose and mouth.

The last thing that you will have to wear is the gloves.  You have to put it on very well and they should also sufficiently cover your wrists and should come over the sleeves.  This is to help protect you better from any type of contact with infectious materials and fluids.

Remember to put these PPEs on before entering the room of the patient and to remove them before getting out of their room. Removing these PPE correctly is also important and you should also follow the step by step process of removing them.

You will have to proceed in a reverse manner starting from the gloves which you have to ball up, and then proceed with the gown and lastly take off the PPE for your face such as the goggles and the face mask. You will have to dispose of these properly in order to prevent the spread of disease.

After removing these PPEs, wash your hands thoroughly and then dry them as usual.  You will need these PPEs but it should not reach the level where you will be unnecessarily occupied with your own protection that you neglect your patient’s needs and feelings.  There are some patients who will feel uneasy when they see you worried about getting contaminated with their ailments.

Watch the video on how to put on and remove PPE – gown and gloves:

https://www.youtube.com/watch?v=SBtfh7d0TAg

Provide Perineal Care to a Female

The process of providing perineal care to a female is a significant part of the day to day task of a CNA.  Perineal care is one of the most sensitive tasks that a health care worker can perform as it involves cleaning the private body parts of the patient as well as making sure that they are sufficiently cleaned in order to prevent any disease or infection from developing.  At times, it can be hard for a patient to allow a CNA to do this task especially if she does not know the person well. It is therefore important to assure the patient that you are doing it for health purposes and that you are providing them with sufficient privacy for their own sake.

First, the CNA has to greet the patient and introduce themselves as well as their purpose of being there in the patient’s room.  They have to be clear that they will be providing perineal care to the female patient and they should also inform the patient as to the step-by-step process with which it will be done.  The worker then gathers all the materials that will be needed for the process such as clean towels, a basin of water, soap, and lotion.  After this, the worker then proceeds to wash their hands thoroughly and to apply the appropriate personal protective equipment for the process.

shower-faucetAfter this, the CNA then proceeds to the bed of the patient and removes any dirty underpads from the patient.  Replace the waterproof underpads with fresh and clean ones in order to avoid getting the bed wet from the process.  The nurse aide then asks the patient to part their legs in order to gain access to the front perineal area more easily.  Part the folds of the labia and clean the inner sides using a clean piece of washcloth which has been dipped in warm water and applied with soap.

Clean the inner labia with a front to back motion using a gentle pressure.  Use a different spot from the washcloth for each stroke that will be done.  This is to ensure that the labia is well-cleaned and to prevent the transfer of bacteria from one point to another.  The front to back motion also ensures that bacteria from the anal area would not be transferred to the urethra of the patient which can cause some serious infection.

The next step is to rinse the area with a new piece of washcloth which has been dipped in warm water. Use a different area in the washcloth for each rinsing stroke as well.  When this is finished, pat the perineal area dry with a clean piece of towel and apply some lotion if the patient wishes to or if it is required.

Make sure that you have provided sufficient covering for the patient during the whole process to protect her privacy.  Dispose of any non-reusable items in the proper container and put dirty linens in the hamper.  Put the patient in a comfortable position and make sure that their call lights are within their reach.  Wash your hands thoroughly.

How to Measure and Record Respiration

A CNA will be performing various skills when caring for residents or patients such as measure and record a resident’s respiration.  This task is an important part of healthcare as it helps track the patient’s current health condition and also measure their progress.  A nurse aide is an important part of a nursing facility as they provide some of the direct healthcare services that are administered to patients.  If you are one of these healthcare services workers, it is important to follow the right steps in administering this task in order to provide the best services.

This process involves measuring the number of breaths that a resident or patient takes for one full minute.  It is done separately from the recording a patient’s pulse rate and this allows the CNA to inform the patient to tell him or her that it is the patient’s pulse which is being taken. This is to avoid the possibility that the patient would be altering or changing his breathing patterns to gain a worse or better respiration count.  You have to prepare the Measurement Form and have it with you before taking the respiration count.

stop-watch-for-health-care

The first step is to greet the patient and to introduce yourself when you enter their room.  Make sure to address them by their first name and not by any nickname that you may have known or invented for them.

Explain to the resident why you are there as well as the steps that will be taken for procedure.  Remember that you have to tell the patient that you will be taking their pulse and not their respiration rate in order to prevent them from manipulating their breathing patterns.  Measure the patient’s rate of respiration without telling them how to breathe and giving them any insinuation that you will be counting their respiration.

Measure their respiration for one full minute and then record the patient’s respiration rate on the Measurement Form.  This should be indicated in a scale of + or -2 respirations based on a nurse’s measurement.

Make sure that you take the resident’s needs and preferences during the whole procedure.  Ask them if they are feeling comfortable with how they are positioned and that they are on a safe position on the bed or chair that they are in.  This should be done before and during the whole time when you are taking the patient’s respiration rate.

Make sure that you have taken all the necessary steps for standard precaution procedures as well infection control when you are measuring the patient’s respiration.  This is to help preserve the health of the infection and prevent the spread of communicable disease.  Ask the patient about his comfort and his preferences or needs during the procedure.  Make sure that you have also conserved the patient’s rights to privacy as well as to independence by taking their preferences into consideration.  Preserve the patient’s safety by placing them in a secure position in the bed or chair while you are administering respiration count.

Provide Catheter Care to a Female

In order to provide catheter care to a female resident, it is important to follow several steps which will help you to perform the process more safely and more efficiently.  This process should be done regularly to prevent any chances of infection to develop as well as to maintain the cleanness of the part of the body which is directly affected.

Cleaning the front perineal area is what these steps are concerned about and not about the rear or back perineal area.  Soap and water will suffice as cleaning materials for this process.

using-sink-for-healthcare-procedureThe first step is to introduce yourself to the patient and to explain to them why you are there. Try to give them a mental picture of the step-by-step process which will be performed and try to inform them of the materials that will be used.

After that, proceed to wash your hands and then put on your gloves as protective equipment especially since the process involves getting into contact with body fluids and soiled underpads.  Make sure that you have the materials that you will need for the process within your reach so you can perform the job will lesser distraction.

The next step is to place a new set of underpads under the patient’s thighs or buttocks in order to prevent soiling the bed.  Make sure that you have properly placed the underpads in order to catch any drip of water which may result from the cleaning process.

The next step is to rinse the whole area to be cleaned with warm water in the most comfortable temperature to the patient.  After this, apply some soap to a wet washcloth, dipped in the warm rising water, to give it some lather.  Use this washcloth to clean the inner labia of the patient.

Clean the inner labia by changing the spots in the washcloth used for cleaning.  Make gentle strokes in cleaning the labia with a front to back movement. This is to prevent any chances of spreading bacteria and infection towards the labia.  Make uniform movements in cleaning and try to clean the area as thoroughly as possible.

Try to apply the right amount of pressure in order to prevent any pain or of injuring the patient.  Use a different spot in the washcloth for every cleaning stroke. After this, clean the catheter up to about 3 to 4 inches downwards.

When this is done, start rinsing the soapy areas by using another piece of clean and wet washcloth.  Use the same type of strokes that were used for the cleaning, changing the places used in the washcloth for each rinsing stroke.  Make sure that you are rinsing the area inside the labia thoroughly and removing any soapy residue.  Do the same with the catheter and remove any obstruction or kinks away from the catheter.

Dry the area thoroughly with a clean towel.  When doing catheter care to a female resident, make sure that the tubing and the urinary bag are kept away from the floor and in a level which is lower than the bladder. Dispose all non-reusable materials to their proper containers. Wash hands thoroughly.

Watch the video on how to perform catheter care on a female patient:

https://www.youtube.com/watch?v=ZWYFM8TG2Ds

How to Measure and Record Radial Pulse

A certified nursing assistant provides different types of personal care to residents and patients such as measure and record radial pulse.  This particular task is important in order to keep track of the patient’s health progress.  Nursing assistants are often delegated with these minor tasks as they have already earned these skills during the CNA training program.  They have undergone both a theoretical class as well as sufficient clinical experience during the program to administer such services.  If you are a CNA who will be doing these skills, there are certain points that you should remember either when you are doing it for the certification exam or in your work.

check-pulse-using-wrist-watch-8877It is important to remember that when you are performing this particular skill, you should incorporate both the direct and the indirect skills that have been taught during the training.  There are some who tend to forget about the indirect skills and focus more on the actual taking of the radial pulse.  You should take care to incorporate indirect skills during the process if you want to pass the exam or if you want to retain your job.  Respecting the privacy, independence, and the safety of your patient are all as important as the direct skill themselves.

Radial pulse is found on the wrist of the patient and should be taken for one whole minute.  You will need to have the Measurement Form ready before you take the pulse.  As you enter the room of the resident, greet them by name and introduce yourself.

Explain to the resident what procedure you will be doing before and during the taking of the pulse. When taking the pulse, you should do all that you can to position and support the arm of the patient that it does not dangle in any way while you are taking their pulse.  Do use your thumb when taking the pulse as it may confuse you as to which pulse you are taking, either yours or the patient’s.

By placing your fingers on the patient’s wrist, measure their radial pulse for a full minute.  Write down your findings on the Measurement Form on a scale of + or – 4 beats a minute on a nurse’s measurement.  Make sure that you have used all standard precautions and methods of infection control while administering this type of care to the patient.  Ask the resident also if they are feeling comfortable and any other needs that they may have with regards to the procedure while you are taking their pulse.

While doing this procedure, make sure that you have promoted the resident’s rights such as their privacy and independence by making sure that you take their needs and requests into consideration.  Protect the resident also by ensuring that they are in a safe position during the administration of the care.  Taking a radial pulse is one of the various skills that are needed from a certified nursing assistant.  You must therefore make sure that you can perform this job effectively.

Range of Motion Exercises to One Shoulder

When a resident cannot perform shoulder exercises on their own, a CNA will be asked to provide passive range of motion exercises to one shoulder. This is to make the resident’s shoulder in a healthy condition and to stimulate blood flow in that area. This will also help to maintain the muscle tone of the arms and to preserve their flexibility as well. If you are being asked to perform this skill, make sure that you pay attention to indirect care skills as well. They are an important part of the whole exercise and it may determine just how successful the whole process will be in the end.

The first thing is to knock on the patient’s door and to call out the name of the patient. This is to ensure that you are in the right room and that the patient will not be surprised with your presence in the room. The next thing is to greet the patient and introduce yourself to the patient. Explain why you are there and provide a step-by-step description of how the procedure will be conducted and what is the purpose of the exercise. Make sure that the patient understands you correctly and that they have heard what you are saying clearly.

shoulder-range-of-motionAfter this, wash your hands thoroughly and put on your personal protective equipment. This is to avoid the spread of infection and to protect the patient as well.

After this, proceed to support the arm of the patient where the passive motion exercise is to be done. Raise and lower the arms of the patient towards the side first and ask if they are experiencing any pain or discomfort while doing it.

Repeat this process as necessary. Make sure that you are providing the patient with sufficient instruction or are informing them as to what shall be done to their arm.

The next step is to extend their arms toward the head of the bed and then towards the back to give them some flexion and extension exercises in the arm. Do not apply a lot of force and never overextend the arms to the patient’s capacity. Do the process in a slow and smooth movement to prevent injuring the patient. The next step is to take the arms of the patient away from the side and then back in order to provide abduction and abduction exercises to the arms.

After the whole process is done, return the patient to a comfortable position and give their call lights within their reach. The next step is to remove your personal protective equipment and to wash your hands thoroughly.

The CNA should provide this care in a slow and non-forceful manner in order to prevent any injury or damage to the arm of the patient that is being exercised. It is important to provide passive range of motion exercises to one shoulder in order to provide the patient with the necessary movements to help keep their arms in a healthy condition and a normal blood flow.

 

Measure the Weight of an Ambulatory Patient

It is an important task of a CNA to measure the weight and height of an ambulatory patient as these measurements often indicates some serious health-related issues about the patient.  If a patient cannot be raised or cannot stand up due to some physical condition, the health care worker will have to measure it while the patient is lying down with the help of a fellow nurse aide.  The materials that will be used are a bath blanket and a bed scale in order to get to know the patient’s weight and height.  It is important that the CNA conduct this skill with sufficient care and provide the patient with the privacy that they need.

The first step is to knock on the patient’s door and to call out their name.  This is to let the patient know about your presence and to make sure that you are with the right patient as well.  After that, greet them in a polite manner and introduce yourself and your fellow worker.  Explain to the patient why you are there and try to give them the step by step process that will be done to the patient to make them less anxious and to make them more cooperative.

hospital-weight-scaleYou and the other employee must both wash your hands first and use the appropriate personal protective equipment before handling the patient.  Then lower the bed if it is raised on one side until it is on a parallel position with the floor.

Raise the side rails in order to protect the patient from rolling off and then put them in a bath blanket by rolling them to one of their sides.

Mark the area where the patient’s head and feet end as this will serve as the measurement for the height of the patient.  Place the bed scale on the bed and with the help of your colleague place the patient in it.  Take note of the weight and record that on the appropriate form.

Remove the bed scale from the bed and then return the patient to a comfortable position. Proceed to measuring the patient’s height.  Measure the length or distance between the marks for the head and the foot and then write them down on the form.

After you are finished recording the measurements, remove your personal protective equipment and proceed to handwashing.  Before you leave the room make sure that the patient is comfortable or that you have addressed any of their needs.  Place their call lights within their reach as well.

Measuring a patient’s height and weight can be done much easier if you know the steps on how to do it well. Remember that you will need the help of another CNA and they also have to practice proper safety precautions and infection control when handling the patient.  As much as possible explain to the patient what is being conducted at the moment in order to remove their apprehensiveness.  Always be polite and respectful to the patient while conducting the whole process.

Assist with a Bedpan

Patients who are not able to ambulate themselves often need a nurse aides help in assisting with the use of a bedpan.  Their incapacity can be great enough to render it impossible for them to walk and use the toilet normally so it would need the help of a nursing assistant for them to do that.  It is however, not encouraged in other cases where the patient has the capacity to go to the toilet even when they need minimal assistance in walking towards it.  It requires a lot of careful attention to perform this job and so paying heed not just to your job but to your patient as well will be very important.

bedpan-for-resident-09002As with other tasks, you will need to greet and introduce yourself to the resident after you entered the room.  Make sure that you explain your task very well to the patient so that he would not be surprised when you start with the bedpan.  Tell them exactly what you will be doing in each single step of the procedure and then ask them if you can pull the curtains down in order to provide them with some privacy.  You always have to ask for their permission before doing anything in their room.

After this, wash your hands according to standard procedure making sure that you do not touch the sink or any other unclean area after drying them off. You can now put on a fresh pair of gloves in order to assist the patient.

Lower the resident’s bed so you can perform your duty better.  Then, place or assist the patient to get into a supine position and then get him to lie on one of his sides.

Place the bedpan against the patient’s rear and then tell them to get on a lying position again.  Make sure that the bedpan would be between the patient’s legs and ask them to spread them apart in order to know if it is really in the middle. This will make it easier for them to use the bedpan and avoid any spillage.  Raise the upper part of the bed, the one where their head is resting, so they can manage the process more easily.  Step away from the patient to give them room for his privacy and make them feel more at ease.

After this, remove your gloves and dispose of them accordingly.  Wash your hands again and put on a new set of gloves. Go back to the patient and lower the bed so you can easily reach the bedpan.  Do this carefully so as to avoid spillage of the contents of the bedpan.

Ask the patient to turn to one side once again and then carefully remove the bedpan. Wash the patient’s genital area as well as the perineal area. Get them in a position where they will be most comfortable and give them some wet towel if they want to clean their hands. Measure and dispose the contents of the bedpan and clean it thoroughly also.   Dispose your gloves and wash your hands again.

Assisting with Dressing a Dependent Patient

Assisting with dressing a dependent patient can be done easily when you know how to do the step by step process thoroughly.  If you are unfamiliar with these steps, chances are you will be doing it the wrong way which can either harm your resident or fail you in your CNA certification exam.  Make sure that you have studied these steps well in order to provide the best possible CNA service that you can give to your patients.  After applying these steps for a couple of times, you will surely be able to handle this task very easily.

The first step is to greet your patient and introduce yourself after knocking on their door.  This is to ensure that you are not violating their rights to privacy and that you are respecting their need for personal space.  After this, explain to your patient what you will be doing, which is to assist them with dressing themselves, and then try to describe what the process would take.  Wash your hands thoroughly before handling the patient and wear protective gloves. This is to make sure that you do not contaminate the patient with bacteria that you may be carrying from the outside.

assisting-patient-00232344234The next step is to tell your patient that you will be undressing them first on their weak side.  Depending therefore in which side the patient’s weaker part is, you will start to undress them first.  Do not try to do all of the undressing by you and get the patient to participate as much as they can on the whole process.  Ask them also if they want to undress by themselves or if they want sufficient privacy while they do so.  You should try to maintain as much space as can be comfortable for the patient.  Encourage them to take initiative on their own and to exercise themselves in the care of themselves.

The new set of clothes should already be close by when you start to undress the patient.  After the patient is fully undressed try to dress them starting from the stronger side of his body first.  This is the complete reverse of undressing them starting from the weaker side.  For example if his weaker side is in the left side, then you should start dressing the patient from their right.  It is also important to encourage the patient to exert as much effort as they can when dressing in order to develop his personal independence.

You will have to notice any sign of fatigue in the patient during the whole process.  Try to make them sit once they start to get tired or experience difficulty with the dressing process.

After dressing, you also have to place the patients dirty clothes in the hamper and then remove your gloves and wash your hands thoroughly.  Make sure that their call light is within his reach and everything that they may need is easily accessible to them.  Explain that you are going and that the procedure is finished before you leave.

Cleaning Upper and Lower Dentures

Maintaining your patient’s health involves cleaning lower and upper dentures of patients and residents.  It is important to maintain a good mouth care for residents who cannot clean their own dentures.  It has to be done regularly and with the best care taken as can be possible in order to prevent any type of infection to develop on the patient’s mouth.  Make sure that you make use of the most hygienic procedure possible in order to keep their oral health in good condition and also to make sure that they can enjoy their food every time they eat.

The first thing that one has to do in cleaning upper and lower dentures is of course to greet the patient and introduce yourself first.  This is to eliminate any type of apprehension from the patient.  You also need to explain why you are there and what the possible step-by-step procedures will be for the whole process.  Wash your hands thoroughly and ask your patient to give you their dentures or you can try to remove them if they are having difficulty removing them from their mouth.  You can do this by gently manipulating the dentures up and down until they become loose.

denture-cleaning-care-0222The next step is to bring the two pieces of dentures to the cleaning area or the sink and then line the bottom of the sink with a washcloth.  Try to get a warm temperature of water by mixing the hot and cold waters and then try to fill the sink partly with the warm water.  After that, clean the dentures using a regular toothbrush and denture cleaning substances.  Remove as much dirt as you can from the dentures and try to contact all of the surfaces in the denture.  The most important parts to clean are those which come in direct contact with the gums as any leftover bacteria or food can cause infection.

Next, rinse the dentures thoroughly under tap water and try to remove as much of the cleaning material as possible.  After that, put the dentures into a denture cup that contains cold clean water.  This is to help eliminate any chances of contamination.  Help the resident get his mouth cleaned before inserting the dentures again.  Try to look for signs of infection or swelling and report to your supervising nurse if there are any.  Do not try to fit the dentures when these are present in the gums.

When you have finished with the task, you should remove your gloves and wash your hands thoroughly.  Check if your patient is in the most convenient position before you leave them and that their call lights and everything that they need is within their reach.  Cleaning your patient’s dentures is an important task that a CNA should do daily in order to maintain the oral health of the resident.  Make sure that you have also respected their rights to privacy and independence during the whole process asking them about their preferences and taking note that they are comfortable.

Watch the video on how to clean upper and lower dentures:

https://www.youtube.com/watch?v=JkYX3qMpcwU

Part 2 of the cleaning dentures CNA skill:

https://www.youtube.com/watch?v=p5dUu2sAJMU

Providing Nail Care for a Patient

Providing nail care for a patient is an important task of a CNA in order to help prevent the spread of disease and infection which can come from having dirty nails and hands.  As most health care provider knows, the hands are one of the areas of the body which is more exposed to dirt and bacteria and which can be the easiest ways to spread it. By providing the appropriate nail care, the patient is thus kept in better health and it also helps to encourage them to take care of themselves for a faster recovery period.

The first step is to knock and greet the patient by their name and tell them that you are there to provide nail care for them.  You should introduce yourself as well to the patient.  After this, proceed to collect all the things that you will need for the nail care such as towels, washcloths, a basin of warm water, lotion, orange wood stick for cleaning under the nails, nail cutters, and nail file.

After this, proceed to wash your hands thoroughly and after drying them well, put a fresh pair of gloves on.

hands-nail-careThe next step is to let the patient soak their fingers in warm water making sure that they are in a comfortable temperature for the patient.  Let them do this for a couple of minutes to loosen up the dirt which may be on the nails.

After this, proceed to clean the hands of the patient on both the top and bottom part using a clean piece of wet soapy washcloth.  Clean the areas between the fingers as well making sure that they are all thoroughly cleaned.

Next, clean the areas under the nails of the patient using an orangewood stick.  Try to clean each and every nail and wipe any dirt which may have stuck to the stick on a clean cloth.

After the process is done, rinse the hands of the patient by letting them dip their hands into the basin full of warm water.  Rub the hands well in order to remove any soap.

Next, remove the patient’s hand from the basin and towel-dry them.  Proceed to cut their nails making sure that they are all evenly cut with no crooked or sharp edges that may cut the skin.  After this, use a nail file on the cut edges to ensure a smooth ended nail.

Apply a sufficient amount of lotion of the hands of the patient to prevent dryness and to moisturize the nails too.  Make sure that you have provided ample support for the hands of the patient throughout the process and that you have asked their personal preferences when it comes to nail care.

Make sure that they are in the most comfortable position and that their call lights are within their reach right before you leave the patient.  Remove your gloves and proceed to wash your hands thoroughly.  Dispose of any non-reusable item and put dirty linens and towels on the hamper before you leave.

Range of Motion Exercises for Knee and Ankle

It is important for a CNA to learn how to provide passive range of motion exercises to hip, knee, and ankle as it is a very common care which is provided for non-ambulatory patients.  This exercise is important in that it helps to maintain a proper blood circulation in this area and in order to exercise the muscles as well.  This skill should be done with utmost care and attention in order to prevent damaging or injuring the patient.  It will also help if the CNA would be mindful about indirect skills while providing this care to the patient.

The first step is to knock on the patient’s door and to call out their name.  This will help the patient to learn about your presence and will prevent any apprehension or surprise when they see you in the room.  Greet them and then introduce yourself properly and explain to them why you are there.  Inform them about the purpose of the exercise and tell them about the step-by-step process with which it shall be accomplished.  This will help the patient to become more relaxed during the process and to make them cooperative as well.  Make sure that you provide the patient with sufficient privacy and that you ask for their preferences during the whole procedure.

patients-legsm,The next step is to wash your hands and wear personal protective equipment.  This will help to prevent the spread of infection or disease to your patient.  Then, with the patient in a lying position, raise the patient’s knee toward their torso and then back to the mattress.  This will provide a flexion and extension exercise to the patient’s hips and knees will help maintain flexibility and blood circulation.

Ask the patient if they are experiencing any pain or discomfort and ask them how they wish this process to be done. Do this exercise in a slow and smooth motion in order to prevent any damage or injury to the patient.

Next, raise the resident’s foot upwards towards the head and then replace them towards the mattress in a slow and non-forceful manner.  Do not force the foot of the patient to a much higher height than they can endure as it may cause some injuries.  Provide sufficient covering on the mattress to prevent their feet from having too much friction with the mattress.  Ask the patient if they are feeling any pain or discomfort during the process.

After the procedure, return the patient to a comfortable position and raise the side rails to keep them from falling. Give them their call lights and ask them if they are in need of anything. Remove your personal protective equipment and wash your hands thoroughly and put the non-reusable items in their proper container.

When doing this procedure, make sure that you support the patient’s extremities well in order to prevent further injury.  You should also provide them with sufficient privacy and promote resident’s rights especially as to their own preferences to make the procedure more comfortable. Visit this page to read more about providing ROM exercises for the shoulder.

Empty Drainage Bag and Measure Urinary Output

To empty resident’s urinary drainage bag and measure and record output, there are several steps that should be followed.  It is important to keep to these instructions as they are what is required in order to pass a nursing assistant certification exam and they are also the best way to provide this type of care to a patient.  Not only will missing one or more activities lessen your chances of obtaining a CNA certification, it may also lead to complaints being filed against you if the resident is not satisfied with your work.

To help you recall the steps and procedure needed in this particular set of activity, there are some candidate handbooks which are given by testing centers to nurse aide candidates right before taking the exam.  They include concise instructions which will help you remember the important points that should be done when performing this activity.  It is also good to research about them through the internet or through the CNA pages of the Department of Health of your state.  They will provide you with the necessary information that you need as well as provide you with tips on how to pass the exam successfully.

urinary-drainage-bag-02232To perform this activity, do the following steps.  First, you have to greet the resident by his or her name and then introduce yourself and your purpose of coming to their room.  Try to inform the resident about the necessary steps that will be taken in order to empty their urinary drainage bag as well as measure and record their output.  After that, you should proceed to wash your hands thoroughly and then put on a fresh set of gloves. The gloves are important when handling the urinary drainage bag, graduate, and bedpan for infection control.

After that, set the graduate or bedpan on a barrier on the floor and then proceed to empty the contents of the urinary drainage bag on the graduate or bed pan.  Do not allow the drainage bag to become contaminated by allowing any part of it to touch the transfer containers.  Next, close the drain again by clamping it and replacing it on their designated pocket.  To read the right amount of content, place the graduate on an eye-level area with a flat surface that has a barrier.  Complete the process by emptying the contents of the graduate on the toilet.

Rinse and dry the container pouring all the rinsing water to the toilet after each rinse.  After that, remove your gloves and wash your hands.  Record the measurement of the output on the I&O form in term of + or – 50 ccs. Leave the drainage bag on hanging on the bed frame, the drainage and the tubing not having any contact with the floor but in a position lower than the bladder of the patient during and after the care.

Replace the equipment on their proper storage places, disposing of garbage and putting soiled linen on the hamper.  Make sure that you have applied indirect care during the process such as infection control, standard precautions, taking the resident’s comfort, needs, and privacy, as well as promote resident rights and safety.

Giving Partial Bath to Patient

Giving a partial bath to a patient is an important aspect of CNA care.  Maintaining your patient’s cleanliness is one of the first steps to his recovery and you can also encourage him to do his best to get well by providing this care especially if he is not able to do it on his own.  It may not be done on a daily basis as it varies from case to case, but the clean feeling that it leaves your patient will definitely help him to recover faster and to care more about his health.  This bath is recommended for patients who have difficulty going from their bed to the bathroom.

The first step is to wash your hands thoroughly using the standard handwashing technique for health care providers.  After that, greet your patient and tell him why you are there and explain to him the steps that will be taken during the process.  This will help him to relax and be more cooperative during the process.  After that, start filling a basin with warm water which will be used for the bathing.  Check the temperature by dipping your inner wrist in the water and the ideal temperature is from 105 to 115 degrees.

soapy-wash-bucket-for-bed-bathThe next step is to prepare the room to provide the patient with sufficient privacy.  Pull the curtains down on his windows or close the doors to avoid any untoward incidents.  You should also clean the area by removing any unneeded equipment from the bed.  After that, ask them to remove their clothes if they are capable or help them out with the process if they cannot.  Give them enough independence in this task to their level of ability in order to develop their confidence and independence.

Proceed with the bath by cleaning his face with a clean washcloth dipped in the warm basin water. After that, wash his arms, chest, back, belly, legs, and lastly the perineal area.  It is recommended that for each of the enumerated body parts, a different washcloth should be used in order to prevent the spread of bacteria and infection.  You should also change any wet linen as this could cause infection to spread.  After bathing, apply some lotion to the parts where the patient wants them to be applied.  This will help him to feel relieved and more refreshed especially if they have any dry parts in the body.

Help your patient to dress up after the procedure either lying down or on a sitting position.  Allow the patient to do as much as they can when dressing to promote their independence.  Dispose of the non-reusable items which were used during the bathing procedure to their proper receptacle and proceed to washing your hands.  This is to prevent the spread of any contagious disease or infection.  It is important to follow these steps carefully in order to pass a certification exam as well as to provide the best health care services for a patient when you are working as a CNA.

A related CNA skill you may need to know is how to give a shower to a seated patient.

Watch the video on how to give a shower to a patient:

https://www.youtube.com/watch?v=lf-LG5d7_AY

Dress a Resident with a Weak Arm

The steps required in CNAs to dress a resident with a weak arm include the basic direct and indirect care skills that you will learn in a CNA class.  It is important to take note, that it is not only the direct process of dressing the patient which will be assessed by the evaluator during the skills part of the exam, the indirect care skills would also possess a significant weight in your test scores.  You should therefore take all the care and effort to try to perform and include all the required skills that the evaluator will require.

The steps for dressing a resident with a weak arm is as follows.  Make sure to provide the appropriate indirect skill to the given situation.  The first is to greet the resident by his or her name, and then introduce yourself and what is the purpose of your presence in their room.  Tell them that you are there to assist them in their dressing.  After that, inform the patient about the steps that will be done for dressing them right before and during the activity.  Ask them about their personal preference as to the type, color, and shape of clothing that they want.  This is one of the rights of a resident and you should be careful to include them.  Try to collect these pieces of clothing right before you undress the resident.

woman-in-hospital-reading-0333Next, you have to make sure that you are providing sufficient support for the weak arm of the resident while you are undressing and afterwards, dressing them.  You should dress the weak arm first taking care that you perform all the necessary steps to lessen the amount of stress that you will put in it while dressing.  Make sure that you have gathered up the sleeve of the clothing before trying to put their arm in it. Afterwards, you can proceed with the other pieces of clothing such as the pants and the socks.  Do not try to overextend the legs and arms of the resident.

Try to put the clothes in as appropriate a manner as possible meaning perform the necessary adjustments so the clothes fit comfortably on the body of the resident such as adjusting the sleeves and aligning them correctly.  Try to make it look as neat as possible and close the areas that need to be closed.  After this, put the dirty clothing in a hamper and wash your hands.

It is important to take note that you have given the patient with the proper method of care and dressing.  Try to keep them on a safe position on the bed where the distance will not let them roll over. Try to incorporate as much of the resident’s preferences as possible and use the necessary precautions for infection control and standard precautions.

Ensure that the patient is feeling comfortable with how you are dressing them and what other needs they may require while dressing them.  You should also be careful to protect the patient’s rights to privacy as well as to safety during the activity.

Position a Patient on their Side

It can be quite important to position a patient on their side especially if it is to prevent health issues such as pooling of blood due to lying in bed for extended periods of time.  This skill will come very handy also if the patient that you will be caring for is an invalid and does not have the capacity to move his body around by himself.  Positioning a patient on their side is also important if you want to avoid any infection from developing on his back part of the patient’s body.

The procedure is quite easy and you will be able to do this even without the help of another nursing assistant.  The first thing that you have to do is of course, to greet and introduce yourself to the patient. Explain to the patient why you are there and tell him the step by step process.  This will make it easier for the patient to understand what is being done to him and will help him feel at ease.  After this, you must proceed to washing your hands and then put on a clean set of gloves.

hospital-bed-97765Elevate the bed so you can move the patient on a side lying position much easier.  Raise the handrails on the side of the bed so as to ensure your patient’s safety.  Make sure that you are telling the resident all the while what you will be doing next so that he will not be taken by surprise when you move his body suddenly.

Next, grab the edge of the draw sheet near you and then pull it towards you.  Do this as to have the patient on the side of the bed where he will have his back turned to.  This is important so that when you move the patient to lie on his side, he will still be at the center of the bed.

After this, ask the patient to grab the handrail on the side of the bed which he is facing and to slowly roll on his side.  Do this only if the patient is physically capable of doing so.  If he cannot do this procedure all by himself, then raise the draw sheet slowly in order to turn his body to a side position.

Do this slowly also so the patient will not fall to the other side of the bed. Place a pillow on his backside under the sheets as well as on the area below his bottoms and also between his legs.  You can also place one under his free arm if he requests for it.

After doing this procedure, place the call light within the patient’s reach. Remove your gloves and dispose of them properly.  Wash your hands thoroughly and then politely ask your leave from the patient. As you can see, it is a pretty fast and easy task to do which can be done even if you are alone assisting a patient.  You only have to make sure that you do the steps properly in order to avoid injuring your patient.

Making an Occupied Bed

Changing sheets in an occupied can be performed in a breeze if you know how to do it well.  It may seem an impossible task at first but if you know the right way of proceeding, you can have the sheets changed in no time even if there is somebody lying on top of it.  It is important to change sheets every now and then to prevent the accumulation of bacteria as well as other impurities on the bed.  This can be brought on by perspiration and the warmth of the patient’s body can help these to reproduce and grow if the sheets are not removed.

You will have to perform this task especially if the patient is bedridden and cannot afford to move around a lot anymore.  If you think that this is a problem, then don’t worry here are the steps into changing sheets in an occupied bed.

occupied-bed-09977First, you will have to greet and introduce yourself to the patient as you enter his or her room.  You will also have to explain what procedure you will be doing, which is to change his sheets.  Letting the patient know what will be done will help him relax rather than having him anticipate what you will be doing.  It will also provide an outlet for you to get a permission to do so.  After this, proceed to washing your hands properly in order to help prevent contagious diseases from spreading to your patient.  Wear a fresh pair of gloves before handling any of the patient’s things or bed sheets.

Next, you will have to lower the bed to a comfortable position where you can reach both sides easily.  Also make sure that your new sheets are within easy reach from where you are standing.  Raise the side rails of the bed to make sure that the patient will not fall out after you move him to one side of the bed.

Next, ask or assist the patient to lie down on his side and then pull the bed sheet towards the center to make sure that he will not roll over the sides accidentally.   After this, pull the ends of the sheet which are towards the back of the patient and begin to roll them towards the patient.  Roll them going inside and then tuck them near the back of the patient.

Place the ends of the new sheet at the edge of the bed making sure that there will be space enough for you to tuck the sheet under the bed.  Then, roll the remainder of the sheet towards the patient leaving the other half unrolled near the edge of the old sheet.  Have the patient lie down in a supine position and then ask him to roll towards the opposite side of his original position.  Then, roll the other side of the dirty sheet towards the edge of the bed and then place it in the appropriate container.  Unroll the clean sheet towards the end of the bed also and then tuck the edges underneath.  Put the patient in a supine position again and then place a blanket on him. Take off your gloves and dispose of them properly.

Watch this video on this CNA skill to learn how to change the sheets in an occupied bed:

https://www.youtube.com/watch?v=XWtvfeWY3qQ

Hand Washing Techniques for Nursing Assistants

If you wish to become a CNA, one of the most important skills that you would need to learn is hand washing techniques for nursing assistants which can be said to be the most basic yet, the most significant skill that you should learn.  Hand washing is an important task that you need to do before performing all the other tasks that you will be required of you.  It is an important step in preventing the spread of disease and infection which can be one of the distinguishing factors between getting worse and getting well.

Hand washing not only removes the visible dirt that you can see on your hands, it also destroys and removes microbial infections that you may be carrying under your nails and other parts of your hands.  That said, it is therefore needful for you to do this very simple task before handling your patient or any of his or her things.  You will need to this before and after those tasks that you will do on your patient. Prevention of the spread of disease is one of the goals of a nursing assistant, and through this task, you will be doing this very significant aim a huge favor.

washing-hands-in-sink-0900To start washing your hands, you need first to remove all jewelries and accessories that you may have on your wrists or hands.  This is to be better able to remove all the dirt, both visible and invisible, which may be hiding on hard to reach areas as well as to prevent any of those which are in your accessories from contaminating the patient.  The sweat that accumulates on such accessories are good breeding grounds for some bacteria which may not be removed if you wash your hands wearing them.

Next, turn on the water on the tap and make sure that it will not be too hot or too cold for your skin.  Wet your hands up to your wrists and then use a sufficient amount of soap to give your hands a good lather.  The time allotted for this task is usually from 15 to 30 seconds depending on the rules of the state where you will be taking the test.  Rub your hands vigorously against each other for the duration of that period making sure that you apply significant time in each and every area of your hands such as the spaces between your fingers, the area around your nail cuticles, beneath your nails, and area which are immediately surrounding the wrists.

After this, with the water still turned on, start rinsing your hands under the water with your hands on a downward direction.  Allow the water to flow from your wrists to the tips of your fingers as this would prevent any bacteria from contaminating other parts of your hands.  Take a disposable or paper towel and dry your fingers starting from your fingers and ending in your wrist area.

Use the paper towel to turn the water off and then dispose of accordingly. Following these steps carefully will help you not just pass the certification test, but improve you and your patient’s health as well.

Video of the proper nurse aide hand washing technique:

https://www.youtube.com/watch?v=vaIVOX0Fy60

Measuring and Recording Blood Pressure

Measuring and recording blood pressure is very important as diseases and any health problems in a patient can be easily determined by fluctuations in their blood pressure.  It is therefore important for a CNA to learn this skill as maintaining a constant record of a patient’s blood pressure is one of their more important tasks.  Having an accurate and timely record will help the physician to determine the proper type of medication and treatment that the patient would need.  This is a more technical skill than other CNA tasks but it also entails a good glimpse into the physical condition of the patient.

The first step is to knock on the patient’s door and introduce yourself and explain to them why you have come to their room.  Be courteous in greeting the patient and also explain the step-by-step process of taking and recording blood pressure so they will know what will be done and which can also help them relax and cooperate with the process. Help the patient to get into a comfortable position either in a lying or sitting position whichever is more comfortable to the patient.  Make sure that the equipment that you will be using is also within your reach.

blood-pressure-monitorStart by washing your hands and cleaning your equipment.  Make sure that you also use the proper personal protective equipment for the procedure.  After this, make sure that your patient is in a very peaceful and comfortable surroundings by turning down the volume of the radio or by closing the door to eliminate the noise coming from outside the room.  Then, select the appropriate size of cuffs that you will be using on the patient.  Wrap it around the arm of the patient just above the elbow area.

Make sure that you have an easy access to the cuffs and the device that will release the air pressure from it.  Next, try to find the brachial artery in the arms which is located in the area where the elbow bends and then put the stethoscope’s bell over it.  Start pumping air into the cuffs by pressing the bulb of the device and then watch the dial until the needle points to the appropriate point.  It should be between 150 and 180 mmHg and then stop. After this start releasing the air from the cuffs slowly and watch the dial as well.

Listen carefully to the earpiece and watch where the needle is during the first pulse.  Take note of it and write it down on your form.  Continue listening for the pulse until you come to the last and record also the level to which the needle was pointed for that.  The first number is the systolic number while the last one is the diastolic.  Remove the cuffs from the patient carefully and then proceed to get them in a comfortable position.  Dispose of your gloves in the trash can and wash your hands thoroughly after use.  Clean the earpiece of the stethoscope well with the appropriate cleaning solution.

Watch the video on how to measure and record the blood pressure of a patient:

https://www.youtube.com/watch?v=ZMY0khfMUZg

Providing Foot Care for Patient

Providing foot care for a patient is an important task of a CNA as it is one of the processes which can prevent infection and other diseases from developing in a patient.  The foot is considered to be one of the dirtiest parts of the human body due to its contact with the floor which is one of the most common areas where bacteria and other microorganisms are sometimes left by other people.  It is important to provide a regular foot care for a patient in order to maintain their cleanliness as well as to prevent any infection from developing.

The first step is to knock politely on the resident’s door and to greet them.  Next, introduce yourself and your purpose of visiting them and explain to the resident the procedures that shall be done for providing foot care.  This is to help them be more relaxed and cooperative during the process and also as a sign of respecting their privacy.

When you have done these, proceed to gathering all the materials that you will need for the process by putting them near the bed of the resident.  They include a basin of warm water, washcloths, a towel, protective cloth, soap, and lotion.

foot-care-physical-therapyThe next thing is to wash your hands and use the proper protective equipment for the procedure. Get the patient on a comfortable sitting position but avoid having their foot touch the bare floor.

Set the basin on a comfortable position relative to the patient.  Use the proper amount of warm temperature for the water and let them check if it is warm enough for them.

Allow the resident to soak their feet on the water for a few minutes then proceed to wash them with a piece of soapy washcloth.

Take the patient’s foot and provide sufficient support for it. Then using a soapy washcloth, clean the patient’s foot from the top to the bottom part and make sure that you clean the area between the toes as well.

After doing that, replace their feet on the warm basin of water to rinse the soap away from their foot.  Next, proceed to drying their feet using a clean towel making sure that the top and bottom part of the foot is thoroughly dry as well as in between the toes.  Apply some lotion in order to prevent the foot from getting too dry due to the washing procedure.

Remove any excess lotion with a towel and find a smooth and soft pair of socks to fit over the patient’s foot. Makes sure that the feet do not have any excess lotion and that the socks are well smoothed over.  Dispose of the non-reusable items in their proper container and put used lines and socks in the hamper.  Remove any personal protective equipment and proceed to wash your hands thoroughly.  Ask the patient if he is feeling comfortable and then make the necessary adjustments to make them more comfortable and put their call lights beside them before leaving the room.

How to Measure and Record Apical Pulse

The ability of the heart to pump blood out of the heart towards the body is called the cardiac function. It can be measured by means of listening to the apical pulse, which refers to the pulsation that is located at the apex of the heart. For a person who is healthy, the heart can be located wherein the apex is in the left portion of the chest that points down and towards the left. This is otherwise known as the PMI or the point of maximum impulse.

The evaluation of the apical pulse is the most reliable non-invasive means of assessing the cardiac function. For every pulsation that you will hear, it is the combined two sounds called the S1 and S2.

nurse-aide-instructor-44000444– S1 – it is the sound that can be heard during the closure of the tricuspid and mitral valves at the end of the filling of the ventricles and just prior to the start of systolic contraction

– S2 – it is the sound heard during the closure of the pulmonic and aortic valves at the end of the systolic contraction

To determine the apical pulse, it is vital to make use of anatomical landmarks to correctly place the stethoscope over the apex of the heart because it is in this way that the heart sounds can be heard clearly. The heart rate refers to the number of times that the heart beats over a one-minute period. The stethoscope is the device used in listening to the sound of the apical pulse as it amplifies sounds.

Below are the steps when measuring the apical pulse:

1. Feel the first rib by looking for the clavicle or collarbone. This can be felt on the top of the rib cage. The first rib is the one that can be felt directly below the clavicle. The space in the middle of the two ribs refers to the intercostal space.

2. Count the ribs going down. From the first intercostal space, move the fingers going down the fifth intercostal space by counting the ribs and this space is situated between the fifth and sixth ribs.

3. Draw an imaginary line running from the middle of clavicle on the left side through the nipple and this is referred as the mid-clavicular line. The apical pulse can be felt and heard at the intersection of 5th intercostal space and mid-clavicular line.

4. Use the stethoscope by putting the earpiece on the ears and holding the diaphragm part of the stethoscope. Warm the diaphragm by rubbing it.

5. Position the diaphragm of the stethoscope on the area where the apical pulse is found. Instruct the person to normally breathe. A lub-dub sound can be heard and this is considered to be a single beat.

6. Count the total number of lub-dub that can be heard over one minute period. This will determine the apical pulse rate. A watch with a second-hand is used in counting the apical pulse.

How to Record the apical pulse rate and determine if it falls to the normal range:

– Newborns to three years old: 80-140 beats per minute
– Four to nine years old: 75-120 beats per minute
– Ten to fifteen years old: 50-90 beats per minute
– Adults: 60-100 beats per minute

How to Communicate with a Patient

Learning how to start a conversation and communicate with a patient is an important skill that a certified nursing assistant should learn in order to achieve better interaction with them and provide them with the best care possible.  It is also important as the initial encounter between patient and healthcare worker can be full of tension if the worker is not able to handle the situation properly.  Not knowing or being familiar with a person can make a patient apprehensive and uncooperative and make things hard for the CNA to care for them. If you want to avoid this scenario, it is therefore important to know just how to make the first conversation work.

The first step is that a CNA should introduce himself or herself to the patient in the most comprehensive manner possible in order to remove any apprehension by the patient.  Health care workers are expected to treat their patient with attention and care as they provide direct care to them.  They must make the introduction in a friendly and polite manner and should avoid being overly cheery as the patient does not yet know them.  They must do talk-with-elderly-patienteverything that they can in order to make the patient comfortable and feel as if they are in their own home. An important way to do this is to show respect at all times. If the patient is having a difficult time understanding your instructions, try to speak more slowly and clearly. You can also try using easier words to help them understand.

The caregiver must also be able to provide answers to the questions which are being asked by the patient.  They may have some questions about the facility, the date, or the time and may even be curious about the various services that are being done to them.  It is important for a worker to provide answers to these questions in an honest way, and in the best manner that they can.  This will help to calm the patient down and will also give them some assurance that their concerns are being addressed by the worker.

There will be times when the CNA would have to ask the patient some questions in order to learn about their concerns and needs.  At these times, the worker must ask only simple questions which can be answered with a simple “yes” or “no.”  This will make it easier for the patient to grasp what is being asked instead of complex types of questions.  The worker can also ask the patient to just nod or blink his eyes if the patient cannot communicate orally with them.  If the patient has any concern with his or her doctor or relative that they wish to communicate, write them down and send or tell them to the person concerned.

Being able to communicate well with a patient is an important aspect in the relationship between a patient and a nurse aide.  It will help provide a smoother relationship between them and will make it easier for the health care worker to provide the care and services that the patient needs.  Knowing therefore how to start a conversation with a patient is an important skill that must be mastered by a CNA before starting to work.  It will remove any hardship and miscommunications which may occur in their future employment. photo attribution: docoverachiever

Watch the video on how a health care worker should communicate with a patient:

Helping Patients with Memory Loss and Confusion

One of the most challenging tasks that a CNA may encounter when caring for a patient is helping patients with memory loss and confusion.  There are a lot of instances when people who have experienced serious traumas to the head or are undergoing a disease which impairs their memory. Often patients with dementia are assigned to a health care worker.  In this case, it is important to learn exactly how they shall be treated and how they are to act towards these patients.  These patients need a very caring and understanding person in order to avoid any problems when they are being provided with healthcare services.

The first thing that a CNA must always do is to always knock on the door of the patient’s room and to call out the name of the patient.  This will help eliminate any chances of the patient getting surprised when they enter the room and of being suspicious as well.  The worker must also introduce himself well to the patient in a manner that will be grasped by the patient.  Always have a polite and comforting tone to your voice and have a light and cheery approach when talking to them.

dementia-patientThe next thing to remember is that patients who suffer from memory problems do not have the capacity to process too much information.  Therefore, a nurse aide must be as concise and to the point when asking the patient questions or when stating some instructions to them. The patient may easily get upset or irritated when there is too much information being offered to them at one time.  The worker must therefore try to make it as easy as possible for the patient to grasp what they are saying. Do not talk down to the patient or express your irritation if the patient does not seem to understand or pay attention to what you are saying at times.

If the patient is suffering from poor memory or of total loss of memory, it is important that one be very honest with them. Never try to play along with the patient’s poor recollection or of mistaking you for someone else such as their children or spouse.  Tell them what your real name is or if they are quite confused with the date and the place that they are in, tell them also what the exact date is and where they really are. Assure them that it is the right date and place.

It can be pretty hard to handle a patient who is suffering from this type of condition but the CNA must remember that it is not the patient’s fault.  They must try to be as patient and understanding as they can and must exercise all respect and politeness when answering the patient.  Remember that the patient themselves are having a hard time with their memory and is also frustrated with it. The important thing therefore, when helping patients with memory loss and confusion is to be as patient and as understanding as you can.

Watch the video on how to care for people with dementia: (Part 1)

How to approach patients: (Part 2)

How to distract and redirect from unsafe behaviors: (Part 3)

Stop and assess the situation: (Part 4)

When doing all the right stuff doesn’t work: (Part 5)

http://www.youtube.com/watch?v=0P9KL2J-bgQ

Bathing patients who have dementia: (Part 6)

http://www.youtube.com/watch?v=mnFC1zFHVmI

 

Provide Passive Range of Motion to Elbow and Wrist

Patients have to be provided with passive range of motion exercises to elbow and wrist in order to stimulate blood flow in this area and to avoid any future health problem which may arise in the future.  A CNA must know how to provide this care effectively if he wishes to provide the best healthcare to the patient and in order to avoid injuring or damaging the patient.  Learning how to do this properly is also important for those who are just beginning their careers as a health care worker or to those who will be taking their certification exams.

In providing this care, it is important to take note of several minor details which are considered as important aspects of providing passive motion exercises.  The first thing that has to be done is to knock at the resident’s room and to call out the name of the patient.  After this, introduce yourself to the patient and explain to them why you are there.  Provide the patient with a step-by-step description of how the whole process will be carried out in order to prevent any apprehension or anxiety as to what shall be done next.

passive-range-of-motion-to-armAfter all of these introductions, wash your hands thoroughly and wear the appropriate personal protective equipment for the proper handling of the patient.  Place the patient in a comfortable position and make sure that you have addressed their safety and privacy concerns.  It is important their preferences should also be taken into consideration when doing this process.  Support the patient’s left or right extremity depending on which arm is to be exercised.  Bend and extend their elbows at the joints in order to provide flexion and extension exercises to the patient’s arm.  Ask them if they are feeling any pain or discomfort during the process and make sure that you do not force or overextend the patient’s extremities.

Next, move to the patient’s wrist and slowly bend their wrist downward with their hands facing down and then backwards in order to provide flexion and hyperextension exercises to it.  This type of exercise will help to maintain the patient’s wrist’s flexibility and will also help to determine whether they have a problem in this area or not.  It is important that this process should be done slowly and in a non-forceful manner in order to prevent injuring or damaging the patient’s wrist.

After all of this is done, return the patient to a comfortable position and ask them if they need any other help from you.  Ask them how they are feeling and place their call lights within their reach. Remove your personal protective equipment and then proceed to wash your hands thoroughly.  Tell the patient that the procedure is finished and that you are leaving the room.  It is important to keep the patient informed with the step-by-step procedure of this exercise and should also be asked for their preferences during the whole activity.  Provide them with the independence and the privacy that they need also.

Watch the video on how to provide passive range of motion (ROM) to the elbow and wrist:

Communicating with Hearing Impaired Patients

In communicating with hearing impaired patients and residents, it is important for the CNA to have all the necessary patience to cope with their resident’s weakness.  You have to remember that they are physically impaired so you will have to cope with that situation and learn that it will take some time in order for what you are saying to become clear to them.  It can be a bit hard especially for a new CNA to deal with these situations but if you want to have a more pleasurable experience with your job, then you have to follow these steps.

The first thing to do is to find an entry where you will be easily seen by the patient on the front or on the side.  Never try to enter the room of someone who has a hearing impairment through the back as it can startle them to see you there.  You can also tap them slightly on their shoulders in order to let them know that you are in their room.  The next thing that you have to do is to lessen the amount of noise and other sounds which may be entering the room.  You can do this by lowering the volume of the sound in their room or by closing the door in order to minimize the amount of noise that is coming from the outside.

hearing-impaired-patient-77833

Next, check the patient’s hearing aid and make sure that they are clean.  You can help the patient adjust the volume of their hearing aid as well in order to help them hear well.  Make sure that the volume is set on a desirable level in order to eliminate any irritating noise from coming from the hearing aid.  To communicate with your patient if he does not have a hearing aid, you can employ several steps in order to make you well understood.  For example, you can make use of charades or writing tablets in order to effectively relay what they have to say but you should always encourage your patient to make use of their hearing faculty.

The next thing that you can do is to try to keep a slow pace of speaking in order for the patient to catch up with what you are trying to say.  Sometimes, the patient can try to make sense of what you are saying by reading the shapes that your mouth makes when you speak.  You should also try to be as articulate as possible in order for the patient to get a good grasp of what you would like to say.

After you are done communicating with your patient, try to make them understand that you are leaving but that you would like to continue the conversation next time. Always make sure that their call button is within their reach and that everything that they might need is also close by.  Be as patient as you can when you are communicating with these types of patients and always view it as an exciting part of your job.

Communicating with Patients with Speaking Problems

There are certain steps that you can take in order to carry out the task of communicating with patients with speaking problems more effectively.  This can sometimes be the most challenging part of a CNAs job as oral communication is the best way for the patient to tell how they are feeling and also to convey requests that they may have.  This particular aspect of a CNAs job requires a lot of patience and sensitivity in order to carry this task more effectively.  Depending on the state of your patient’s speaking faculty, you will have an easier or harder job of doing this.

The first thing that you have to do is to knock on the resident’s door and to introduce yourself and explain what your purpose is in visiting their room.  Greet them by their name and wish them well.  After that, try to communicate with your patient as much as you can and keep your sentences as short as you can and to the point.  Make the words more understandable by keeping away from too many technical terms and try to keep it on more familiar wording.  This will help them understand you much easier and they will also be able to answer you more clearly.

holding-hands-with-patient-48939

Ask those using simple questions which are also direct.  Such question can be like, “Are you hungry?” or “Do you want to sleep?” in order to make the resident understand and grasp what you are saying much easier.  You may need to wait patiently in order for the patient to respond and try to grasp what they are saying.  It will require a lot of patience to do this since the patient is having difficulties communicating.  You can make use of certain signals or body actions in order to indicate a simple yes or no answer to what you are saying.

Aside from that, you can also make use of writing in order to communicate with your patient or you can also make use of cards or scrabble tiles in order for them to convey what they wish to say.  You can also teach them how to point out things that they want in order for you to understand them better. You can also make use of pictures in order to help you understand what the resident is trying to say.  Bring any of these items in order to help them communicate.

Lastly, you will have to encourage them to communicate with you by providing them with ample time to respond and by letting them know that you are being attentive to what they are trying to say.  Never show your patient that you are getting mad or impatient due to the slowness of their response.  This will discourage them from ever trying to communicate with you and may create some tension in your relationship as their CNA.  When you are about to leave, let the resident know that clearly and then make sure that everything that they need is within their reach.

How to Apply Anti-Embolism Stockings

When applying anti-embolism stockings, there is a prescribed method of properly dressing them to your patient.  It is an important fact to note that you are putting these stockings on people who have other physical concerns such as a more restricted range of movements, a disability, or pain which they may feel if ever you place the stocking on wrong.  You therefore have to make sure that you are putting them on in the best way possible where you would not be injuring or damaging the patient.  Anti-embolism stockings are an important part of your work as a CNA.

Just like with other procedures, you will have to greet the patient appropriately when you enter their room and you have to introduce yourself also.  This is to minimize any tension that the patient may feel over your appearance and also fear which may arise especially if they do not know you yet.  Explain to the patient why you are there and what particular steps will you take in order to carry out the procedure.  It will be best to describe the procedure first and then talk to the patient about it while you are performing it.

ted-hose-medical-stockingNext, you should first ask your patient or determine for yourself whether they have any allergic reaction to things that contain latex. This is an important factor since the patient will be wearing the stocking for an extended period of time and any allergic reaction to latex will significantly increase their discomfort.  If they do not have any then proceed to the application of the stockings.  Take note of the size of the stockings and the legs of the patient.  Are they compatible with each other or is it too large or small for the patient?  Afterwards, put the patient in a supine position and then proceed to dry the legs of the patient with talcum powder to give them a comfortable time wearing the stockings.

After this, gather the stockings into your hand and then slowly roll them upwards until it reaches the level above the knee.  Place the heels and the toes of the stockings in the correct position and remove any wrinkle which may be found in the stockings.  Make sure that you try to do this in the most comfortable method as possible and avoid pinching the skin of the patient.  Afterwards, ask the patient if he would like to be in another position.

When you have finished applying the stockings, remove your gloves and proceed to wash your hands as recommended.  Applying anti-embolism stockings is an important part of CNA work as it helps to reduce instances of blood pooling and other similar incidents which may affect the overall well being of the patient.  Make sure that you have given them sufficient privacy and rights to independence during the administration of the procedure and that you have taken their requests and needs into consideration.  Taking note of all these factors is an important part not only of your CNA exam but in your future job as well.

Watch the video on how to put TED hose on a patient:

https://www.youtube.com/watch?v=W2LqyAh5GEw

Feeding a Patient

There are several things that should be done appropriately in order to feed a resident who cannot feed themselves.  These steps have to be done correctly to get the most efficient care to the patient as well as prevent any injury or infection that may happen to them.  You will have to do them properly as well, in order to pass the CNA certification examination, and to maintain a good working status in the nursing facility that you are working in.  In short, they are an essential part of the job if you want to keep it.

The first step is to first greet the resident and introduce yourself when you enter the room.  Make sure that you address the resident with their proper name and not with their nickname.  Inform the resident as to why you are there and explain the different steps that will be taken in order to feed them.  This should be done before and while you are feeding them.  Tell or assist the patient to get into a sitting position before feeding them.  Ask them also if they want to wash their hands before they eat using a wet washcloth, a paper towel, or a hand wipe.

hospital-food-being-served-0766After this, sit on a chair in front of the resident in order to feed them.  Ask the resident if they want to use a bib or a napkin in order to protect their clothing from any accidental spillage before feeding them.  Use the appropriate size of spoon for feeding the resident.  Try to let the resident take a sip of liquid at least every two or three spoons of food.  Give them the time to chew their food thoroughly and to swallow it before offering the next spoonful of food.  As the resident is eating, try to engage them in a light conversation in order to lighten their mood and help their appetite.

When the resident is done eating, try to wipe the area around their mouth dry with a clean piece of napkin or towel.  Finish the feeding session by placing any dirty linen on the hamper and placing the trash on the garbage can.  Try to keep the overbed table as clean and dry as possible.  After this, you can proceed to record the amount of intake of the resident on the Food and Fluid Intake Form.  During the process, make sure that you have taken the resident’s requests and preferences as to the feeding.

It is important to make all the necessary standard precautions as well as methods of infection control during the whole process.  Ask the resident if they feel comfortable with the feeding and what other needs do they have.  Make sure that you have taken all the necessary steps to provide the resident with his rights as to privacy and safety during the whole process.  It is important to keep these things in mind in order to provide the best feeding care to a resident who does not have the ability to feed themselves.

Watch the video on how to help feed a resident who can not eat for herself/himself:

http://www.youtube.com/watch?v=TFhbmeS3FZc

Ambulate a Resident Using a Transfer Belt

Learning the correct way to ambulate a resident using a transfer belt can make the task a lot more easier not just for the patient, but for you as well. This skill can be very useful especially if your patient is having some difficulty going from a sitting to a standing position and in walking.  Not everyone is able to handle this task very well especially when they are not very keen observers or are doing the job haphazardly.  This is a very unfortunate yet common practice which can be seen in most nursing assistants who do not take their jobs seriously.

A gait belt or a transfer belt is one that is about two inches wide and has a sufficient diameter to provide enough space for the patient’s waist and for the hands of the nursing assistant to pull them up.  Before doing this procedure, make sure that you have greeted and introduced yourself to the patient.  It is also important that you discuss the procedure to the patient while you are doing each step for him to be ready for any action or change of position that he or she will be doing.

transfer-belt-for-patient-0432The next step is to remove any object which may cause your patient to slip when he or she stands on the bedside.  Put the appropriate footwear also, ones which have a greater traction in order to help avoid any slipping accidents while they are walking.  Lower the bed so that his or her feet will be touching the floor when they sit on the bedside.  This will make it easier not just for them, but also for you to help them stand from their sitting position.

After this, assist your patient to assume a sitting position on the side of the bed.  Allow them a few seconds or even minutes to cope and ask how they are feeling.  It may cause dizziness for some patients during such activity.  If he is feeling fine, begin to put the belt on your patient’s waist.  Make sure that is will not touch any part of the skin on their waist and that there is a two-finger allowance in between.  This is to make sure that the belt will not be too tight and cause restrictions in breathing.

Put the patient’s feet flat on the floor and provide instructions as to the timing when he or she should be starting on stand up.  Being in front of the patient, grasp the two sides of the transfer belt from under the patient’s arms and put one of your feet as a brace for the patient’s leg.  At a signal, begin to pull the transfer belt while holding your hands in an upward position.  As much as possible, tell your patient to do his best to try to stand up to help ease the tension on your back too.  Once the patient is stable on his feet, assist them to walk by getting on the side where they have more difficulty walking and slightly behind him while holding the transfer belt.

Video on the correct procedure for using a gait belt to transfer a patient:

https://www.youtube.com/watch?v=4CBIEmgt_rQ

Indirect Care Skills for Nurse Aides

Learning how to perform indirect care skills for nurse aides well is sometimes considered to be one of the least important priorities for applicants, which is definitely not correct.  Nursing assistant students often tend to ignore this particular aspect of the training and prefer to just go through them as quickly as possible before taking the certification exam.  Since it only involves the easiest tasks to perform, they can well be reviewed just before taking the certification exams.

What these nursing assistant students do not understand however is that these skills are important and performing them well is a vital part of the job.  They are small tasks indeed but without them, you can never give the proper care that your resident will be expecting you to perform.  They involve communication skills, resident rights, safety and comfort, and infection control.  They are skills which will not provide the direct performance of clinical skills but will be an important part and aspect of delivering such skills.

safety-gloves-for-health-care-0223The first is about communication skills.  The important thing that you will need to learn about this skill is the proper way of communicating with a resident.  You need to give them the proper respect that is due to them.  It is important not to offend them by addressing them in an informal or familiar way.  You also need to greet and introduce yourself when you enter their room and explain to them why you are there.  Discuss to them the process that you will be performing so they will not feel violated and for them to understand the process.

The next is about resident rights.  This includes the very significant right to privacy, as well as their rights to choose what is done with their body such as those which are involved in grooming and the type of meal that they will eat.  You also need to respect the resident’s feelings by not calling them names and also, you need to help them establish a sense of independence which is a very important human right.

Safety and comfort are two very important aspects when it comes to providing care.  Making your patients safe should not entail great discomfort to them and that their comfort should not also stand in the way of their safety.  Make sure that before you perform a procedure, your patient is not at risk of falling or injuring himself during the process.  Check if the side rails are up if you will be rolling your patient; that wheelchairs and beds are locked when they need to be locked; or that call lights are within their reach.

The last but not the least is infection control.  This includes all the tasks that you need to do in order to make sure that you will not be spreading sources of infection near your patient or in his or her immediate vicinity.  It involves using gloves, washing your hands, avoiding surfaces which may contaminate you or your patient’s things, and using clean materials for any procedure that will involve direct care with your patient.