Nat Skills

Front 1

Opening Procedure

Back 1

1. wash hands and gather all supplies*
2. knock on door, pause for a response then enter the room
3. greet the resident
4. introduce self with name, title "Hi, my name is Evangeline. I'm your nurse assistant for today"
5. ask the resident for permission to check their ID band
6. Greet the pt. by name "Nice to meet you Mr/Mrs. .."
7. Explain procedure and ask permission to perform skill
8. Provide Privacy
9. Follow safety precautions (lock, bed breaks, lower/raise bed, and lock wheelchair if you need to)

Front 2

During Procedure

Back 2

1. be confident
2. do not recite "skill steps" to the skill evaluator . Demonstrate the skills
3. use good interpersonal skills (conversation, interaction, give clear directions)
4. always be professional when interacting with residents
5. maintain face to face contact with the resident
6. You must actually use good body mechanics while performing skills
7. demonstrate safety (yours, residents', and equipment safety)
8. be safe and gentle when moving the patient's body
9. check alignment by standing at FOB from head to toe
10. check for comfort by adjusting pillows, etc. always ask the resident if they are comfortable
11. demonstrate good infection control measures
12. you must include ALL "6 principles of care"

Front 3

Closing Procedure

Back 3

1. re-verify that your resident is positioned comfortably and is correctly aligned
2. be sure resident's bed is in the lowest position
3. make sure bed rails are up
4. place and secure call light within reach of the resident's hands "Mr./Mrs.. feel free to let us know if you need anything"
5. place over bed table within reach
6. open privacy curtains
7. say goodbye and that you will be back every 2 hours
8. wash hands
9. record and report

Front 4

steps for handwashing

Back 4

1. remove watch/push/roll up sleeves
2. turn on water with clean paper towel
3. wet hands and wrists and apply soap (if bar soap, rinse it first)
4. work up a good lather with friction
5. wash wrists for 10 sec.
6. wash palms and back of hands
7. wash between fingers
8 wash nails against palms of hands
9. rinse hands and wrists, keeping hands pointed downward and not touching each other!
10. use "ring out" hands motion from wrists to finger tips to remove excess water
11. use clean paper towel to dry wrists and hands i direction from fingertips toward wrists (DRY OVER SINK)
12. use clean paper towel to turn off faucet

Front 5

steps for putting on and removing PPE (PINK CARD)

Back 5

remember to : put ON OUTSIDE of room and take OFF INSIDE of room

Putting on: 1. put on gown with opening in back by tying at the neck and waist COVERING ALL YOUR CLOTHING. 2. put on gloves and pull up over the gown cuffs

Taking off : 1. using two right hand fingers make a cuff of hte glove on the left hand and pull glove down toward the fingers. do not remove all the way.
2. using left hand thumb and index finger pinch and pull of right hand glove just below underside of cuff and while pulling off work into a ball
3. place balled up right hand glove into palm of left hand glove and pull of left hand glove by grabbing inside portion of glove that was exposed with first move
3. throw away in the trash container
4. untie gown at neck and waist
5. pull off one gown sleeve by slipping your fingers under the cuff and pulling the sleeve just over your fingertips
6. grasp the other sleeve with the covered hand and pull it off completely
7. grasp the inside of the first shoulder of the gown with your uncovered hand and remove the gown
8. fold outer contaminated surfaces inward away from you and roll the gown up
9. throw away in the linen or trash container
10 WASH HANDS!

Front 6

supplies for taking blood pressure

Back 6

blood pressure cuff
stethoscope
alcohol preps
paper and pen

Front 7

NEVER put a BP cuff on an arm if :

Back 7

resident has:

a cast
IV
had a mastectomy
or has a weak arm due to stroke

Front 8

how to take BP (PINK CARD)

Back 8

1. Intro
2. position cuff
3. clean earpieces and diaphragm of stethoscope using 2 alcohol wipes
4. find brachial pulse
5. place diaphragm over brachial pulse
6. quickly inflate cuff (the whole procedure should last for about a minute)
7. let air out of cuff slowly
8. 1st sound is the systolic and last is diastolic REMEMBER THIS NUMBER
9. record "ok Mr./Mrs. your BP is ..."
10. Closing procedure

if reading not noted, wait 1 minute and take again. NEVER try more than twice on one arm

Front 9

counting Respirations (PINK CARD)

Back 9

NEVER TELL RESIDENT RESPIRATIONS ARE BEING COUNTED. INSTEAD SAY VITALS SIGNS ARE BEING TAKEN. eg: pretend you are taking Pulse.

Bring pen and paper

1. INTRO. wash hands for every procedure*
2. count resp. by watching the rise and fall of the resident's chest for 1 minute
3. record
4. closing

Front 10

Counting Radial Pulse (PINK CARD)

Back 10

Bring pen and paper

1. Intro
2. make sure resident is comfortable (for more accurate reading. Ask if they are comfortable or tell them to relax)
3. place 3 fingers over pulse
4. count number of beats for 1 full minute
5. record
6. closing procedure

Front 11

Supplies for assisting a resident with Bedpan

Back 11

bedpan
basin
2 disposable blue pads
4 sets of gloves
1 large towel
2 washcloths
toilet tissue roll
soap and soap dish
powder
trash and laundry bag
table cloth*

Front 12

Things to remember when assisting a pt. with a bedpan

Back 12

NEVER PUT A BED PAN ON THE TABLE!

NEVER leave resident on bedpan alone for longer than 5 minutes. Don't forget to give them call light

Front 13

How to assist a resident with a bedpan

Back 13

1. Intro
2. powder the rim of the bed pan and place on blue pad on the chair covered (with other blue pad)
3. check for open sores or new markings on the skin
4. lower side rails
5. rails down
6. fold linens out of the way
7. turn pt. on side and have them grab the rail
8. place large towel under the resident
9. assist pt. onto bedpan - flat at top, skinny at bottom
10. assist on turning them back over
11. cover pt.
12. remove gloves and put on trash so that
13. you can raise rails
14. raise the head of the bed in a sitting position (90 - high fowler's) ask about their breathing
15. place toilet tissue on the table within the residents reach
and the CALL LIGHT. let them know you will be back in 5 min. and to use the call light if they need assistance
16. Verbalize when washing hands OUT and coming back IN (x2)
17 knock. after resident signals
18. state that hands are washed
19 fill basin with water and check temperature
20 put on gloves
21 offer wet soapy washcloth to clean hands and put in laundry
22. give 2nd washcloth to dry hands and put in laundry bag
23. take gloves off
24. lower the head of the bed
25. lower side rail
26. put on gloves
27 turn resident on side
28. hold bedpan securely while removing it - keep bed pan on bed and check for blood in the urine.
29. wipe resident twice, FRONT TO BACK, with toilet paper
30. place used toilet paper in the bedpan
31. cover bedpan and set aside on chair lined with disposable pad
32. pat down resident with towel and place towel in laundry bag
33. take gloves off
34. place resident back on their back.
35. raise side rail
36. cover resident
37. put on gloves
38. empty (in the toilet), wash, rinse, and dry the bedpan first*
39. clean up the rest
40 take gloves off
41. closing procedures

Front 14

Measuring the weight of the resident using an upright scale

Back 14

Supplies: Scale, paper towel, paper and pen

**Determine if the resident can stand alone without help
** Resident should always wear robe and slippers or shoes without heels
** keep one hand behind resident's back while walking for safety
** make certain resident is able to stand on scale

1. Intro -- place the table next to the scale with pen and paper
2. walk the resident to the scale
3. place paper towel on the platform of scale
4. balance scale (at zero)
5. assist resident to remove robe and step up onto scale facing the platform
6. adjust markers to appropriate notches on both bars until scale balances
7. add figures from both bars to get total weight
8. record weight (make sure the table is next to the scale)
9 assist resident off the scale to the SIDE, re-robe and take her back to the room
10. Closing Procedures

Front 15

Measuring the height of the resident `

Back 15

Supplies: Scale, paper towel, paper and pen

**Determine if the resident can stand alone without help
** Resident should always wear robe and slippers or shoes without heels
** keep one hand behind resident's back while walking for safety
** make certain resident is able to stand on scale

1. Intro -- place the table next to the scale with pen and paper
2. walk resident to the scale
3. place paper towel on platform of scale
4. help resident onto scale facing away from measuring rod (assist from either side, making sure you protect from falling)
5. raise measuring rod and ask resident to stand up as straight as possible
6. lower measuring rod until it touches the top of resident's head
7. record height and write down in inches
8. lower measuring rod (safety measures)
9. help resident step off to the SIDE of the scale and take him/her back to the room
10. closing procedures

Front 16

Making an occupied bed Supplies

Back 16

top sheet (no gloves needed)
bottom sheet (no gloves needed)
table cover*
drawsheet
bath blanket (no gloves needed)
blanket (fold and place on the bed side table with table cover)
pillowcase
laundry bag

Front 17

Things to remember when making an occupied bed

Back 17

DO NOT SHAKE LINENS
Check bed for personal items
Soft side of seam and no tags towards resident's body
Hold dirty linens away from you
No linens on floor
Make one side of bed at a time
Use proper body mechanics
Bed at proper height as necessary

Front 18

Steps in Making an occupied bed (YELLOW CARD - positioning, transferring, restorative care, and bed making)

Back 18

1. Intro
2. remove and fold reusable blanket and place on table
3. keep top sheet on resident
4. put clean bath blanket on top of top sheet
5. start on the FAR side of the bed.
6. have resident roll to the other side and grab the rail
7. position pillow under resident's head for comfort and ask if they are comfortable
8 side rail down
9. check bed for personal items
10. loosen fitted sheet and roll up dirty bottom sheet and draw sheet toward the resident and tuck firmly against the resident's back.
11. put clean bottom sheet and unfold with the center fold in the center of the bed. smooth out and towards resident's back
12. put draw sheet on middle one-third of mattress and tuck in the side you are on, making smooth as possible
13. flatten the new bottom sheet and draw sheet and have resident roll over linens TOWARDS YOU. say "you're going to feel a little bump later on when I turn you over"
14.side rail up
15 go to opposite side of bed
16 side rail down
17. check under pillow and under rolled lines for personal items
18 roll and take off dirty bottom sheet and draw sheet and put them at the FOB or in laundry bag and HOLD AWAY FROM YOU.
19 pull clean bottom sheet toward you and tuck in at top and bottom of bed
20. tighten draw sheet by tucking in on side
21 assist resident to move to center of the bed and assure proper alignment
22. position pillow
23 side rail up
24 put clean top sheet on top of clean bath blanket - ONE SIDE AT A TIME
25 have resident hold clean top sheet while you remove the bath blanket and the dirty top sheet and place both in laundry bag
26. remove pillow from under resident's head
27 remove dirty pillow case and place in laundry bag
28 replace dirty pillow case with new ones and put under pt's head
29 put blanket back over the top sheet and tuck in top sheet and blanket with mitered corners - DO NOT TUCK IN SIDES. Corners only!
30 fold hem of top sheet down over blanket and spread.
31 make a toe pleat at FOB (3-4 inches across the FOB)
32. closing procedures

-Remember: Roll, Remove, Replace, Tuck

Front 19

Assisting in a Fowler's Position (YELLOW CARD)

Back 19

Supplies: 4 Pillows, table cover

*use a hand roll only if the resident has L/R sided weakness
*Remember :FRAPPP (flatten bed, remove all pillows, alignment, position, place pillow, and put call light)

1. Intro
2. Lower head and FOB to make flat
3. remove pillows (place on table with table cover)
4. make sure resident is in the center of the bed (check at the FOB)
5. raise the HOB 30/45 degrees (assess breathing - "How's your breather Mr./Mrs...)
6. lower side rails
7. put a pillow behind the resident's head for comfort (just to top of shoulders and open end of case facing the wall)*
8. put a pillow under forearm and wrist, keeping wrist higher than elbow (open end of case facing the wall at the HOB)
9. raise side rail
10. move to the other side and lower the side rail
11. put a pillow under forearm and wrist
12. put a pillow as foot support at the FOB (folded) so feet can rest on top of it as well as up against it.
13. raise the side rails
14. *raise FOB just enough to prevent pt. for sliding down in bed **
15 stand at the FOB and check for proper alignment. Ask if they are comfortable in that position.
16. cover the resident
17. closing procedures

Front 20

Assisting in a side-lying Position (YELLOW CARD)

Back 20

Supplies: 4 pillows, table cover
*FRAPPP (flatten, remove all pillows, alignment, positioning, place pillows, put call light)
*BHLA - back, head, leg and arm pillows)

1. Intro "I'm going to put you in a side-lying position)
2. make sure HOB and FOB are flat
3. remove head pillow
4. side rail down
5. explain to resident that you need to move them, starting with feet, and ask if they can assist you on count of 3.
6. pull legs over to side of the bed towards you (ankles & behind the knees)
7. pull middle over to the side (back of knees & waist)
8. pull upper body (waist & neck)
9. ask if they can cross their arms. cross their ankles toward the direction you are turning them. (*WATCH OUT FOR L/R sided weakness from stroke!* -start on the weak side *** so if you turn them over, they're on their strong side and their weak side is higher).
10. make sure that when you turn them they are off the tailbone but not quite on the hip. (to avoid sores on bony prominence. count to 3 and have them grab the rail
11. support their back with a pillow folded lengthwise and push in to keep them in proper position
12. place a pillow under the head
13. place a pillow in between legs and place it forward so that it does not rest on bottom leg (*make sure their knees are not touching! and open end of case toward the pt's body)
13. place a pillow under top arm (arm should be on hip or in front of resident) -- open side toward the pt's armpit and make sure elbow is level with arm and that fingers are not pointing down for better circulation)
14. side rails up
15. side rails down the other side
16. pull out shoulder and hip (so that there is less pressure on those prominence). ask if they are comfortable.
17. side rails up
18. stand at the FOB and check alignment
19. cover the resident
20 closing procedures

Front 21

Assisting in a Fowler's Position (YELLOW CARD)

Back 21

Supplies: 4 Pillows, table cover

*use a hand roll only if the resident has L/R sided weakness
*Remember :FRAPPP (flatten bed, remove all pillows, alignment, position, place pillow, and put call light)

1. Intro
2. Lower head and FOB to make flat
3. remove pillows (place on table with table cover)
4. make sure resident is in the center of the bed (check at the FOB)
5. raise the HOB 30/45 degrees (assess breathing - "How's your breather Mr./Mrs...)
6. lower side rails
7. put a pillow behind the resident's head for comfort (just to top of shoulders and open end of case facing the wall)*
8. put a pillow under forearm and wrist, keeping wrist higher than elbow (open end of case facing the wall at the HOB)
9. raise side rail
10. move to the other side and lower the side rail
11. put a pillow under forearm and wrist
12. put a pillow as foot support at the FOB (folded) so feet can rest on top of it as well as up against it.
13. raise the side rails
14. *raise FOB just enough to prevent pt. for sliding down in bed **
15 stand at the FOB and check for proper alignment. Ask if they are comfortable in that position.
16. cover the resident
17. closing procedures

Front 22

Assisting in a side-lying Position (YELLOW CARD)

Back 22

Supplies: 4 pillows, table cover
*FRAPPP (flatten, remove all pillows, alignment, positioning, place pillows, put call light)
*follow BHLA when placing pillows- back, head, leg and arm pillows)

1. Intro "I'm going to put you in a side-lying position)
2. make sure HOB and FOB are flat
3. remove head pillow
4. side rail down
5. explain to resident that you need to move them, starting with feet, and ask if they can assist you on count of 3.
6. pull legs over to side of the bed towards you (ankles & behind the knees)
7. pull middle over to the side (back of knees & waist)
8. pull upper body (waist & neck)
9. ask if they can cross their arms. cross their ankles toward the direction you are turning them. (*WATCH OUT FOR L/R sided weakness from stroke!* -start on the weak side *** so if you turn them over, they're on their strong side and their weak side is higher).
10. make sure that when you turn them they are off the tailbone but not quite on the hip. (to avoid sores on bony prominence. count to 3 and have them grab the rail
11. support their back with a pillow folded lengthwise and push in to keep them in proper position
12. place a pillow under the head
13. place a pillow in between legs and place it forward so that it does not rest on bottom leg (*make sure their knees are not touching! and open end of case toward the pt's body)
13. place a pillow under top arm (arm should be on hip or in front of resident) -- open side toward the pt's armpit and make sure elbow is level with arm and that fingers are not pointing down for better circulation)
14. side rails up
15. side rails down the other side
16. pull out shoulder and hip (so that there is less pressure on those bony prominence). ask if they are comfortable.
17. side rails up
18. stand at the FOB and check alignment
19. cover the resident
20 closing procedures

Front 23

Moving the resident from Bed to Chair with Safety Belt ( YELLOW CARD)

Back 23

Supplies: safety belt, wheelchair, non-skid shoes, and robe or gown

*Make sure bed brakes are locked
*Use proper body mechanics when lifting the resident
*Make sure it is OK to use safety belt on resident
*if possible, raise/lower the bed so that it is the same height as the wheelchair
(*move pt. first to the side of the bed so you don't bend to much if you have to lower the bed.** (Safety))

1. Intro "I came here to help you get on your wheelchair"
2. place wheelchair at slight angle next to resident's bed
3. remove wheelchair footrests
4. lock wheelchair breaks
5. raise HOB so that resident is sitting up, and ask if their breathing is OK (Fowler's 90)
6. lower side rail on bed side where chair is
7 lift and move resident's legs so they are dangling over the side of the bed
8. Hold resident around shoulders and pull to a sitting position on side of the bed
9. ask resident if they're dizzy
10. help resident put on shoes ad clothing - make sure their feet are touching the ground. if not, ask if they can move forward towards the edge of the bed
11. apply safety belt around resident's waist. make snug so no more than 2 fingers fit in between the belt and resident
12. grasp safety belt on back sides of resident's waist and have resident hold around your shoulders
13. place your knee between residents legs. Flex your knees, and other leg at the back for support. DO NOT BEND FORWARD.
14. get as close as possible in a "hugging position". and on rocking count of 3, raise the resident to a standing position. Ask if they are dizzy
15. turn your body with resident until resident is right in front of the wheelchair (3 slow steps)
16. ask if they are feeling dizzy, and if they can feel their wheelchair against the back of their legs
17. on count of 3 lower the resident into the chair. ask again if they're dizzy
18 remove safety belt
19 place footrest under resident's feet
20. closing procedures

*if the pt. is short, make sure the bed is at it's lowest so that their feet touch the ground.

Front 24

When is it not OK to use safety belt on a resident?

Back 24

when resident has/had a:

colostomy, heart problems, recent abdominal/chest/back surgery, or respiratory problems) ASK!

Front 25

Supplies for brushing the resident's dentures

Back 25

tissues to remove dentures
2 emesis basins
denture cup
denture toothbrush
toothpaste
mouthwash solution
1 cup
4 pairs of gloves
2 towels
1 laundry and trash bag
1 table cover

Front 26

Brushing the resident's dentures (BLUE CARD - Personal Care0

Back 26

*When setting up supplies to demo skill, use one side of table as your "Sink"

1. Intro -"Hi Mr./Mrs....I'm here to clean your dentures, would that be ok?"
2. raise the bed, ask about breathing (high Fowler's)
3. side rail down
4. put on gloves
5. towel on chest
6. Verbalize " Mr./Mrs. ...first I'm going to remove your top dentures, is that ok?" Remove top denture with tissue, pulling down and out, and place in emesis basin
7. verbalize "now I'm going to remove the bottom dentures" remove with tissue and place in emesis basin
8. remove gloves
9 side rail up "Mr/Mrs....I'll be right back. I'm just going to clean your dentures at the sink. Here's your call light, let me know if you need anything"
10. go to "sink" and place towel on the sink to protect dentures*
11. gloves on
12. turn water on, check temperature and verbalize that the water is cool. rinse denture cup, and then fill with cool water.
13. wet toothbrush over sink, apply toothpaste and brush top dentures (be very thorough with brushing. do not miss a spot), rinse and then place in denture cup
14. brush bottom dentures the same way you brushed the top dentures, and place in denture cup
15. put lid on denture cup.
16. remove gloves and *write: Name and Room #
17. verbalize that you washed your hands before re-entering the room. let the resident know you have returned. "Hello, Mr/Mrs....I'm back with your clean dentures. Can I assist you in putting it back on?"
18. side rails down
19. gloves on
20. put 50/50 solution of water and mouth wash in a cup and offer to the resident. hold the emesis basin to spit the solution out.
21. remove towel and dab mouth and put down in laundry bag.
22. remove gloves
23. offer dentures back to resident "Mr./Mrs....Can you put the dentures on by yourself or would you like me to put it in for you?"
24. side rails up
25. put on gloves
26. clean up (emesis basin first)
27. remove gloves
29. lower the bed. Ask if they want to stay up or if they want to lay back down.
30. Closing procedures

Front 27

supplies you need for unconscious resident's mouth care

Back 27

2 towels
6 toothettes
1 emesis basin
1 cup
mouthwash
5 pairs of gloves
chapstick
laundry bag and trash bag
table cover

Front 28

Mouthcare for the Unconscious Resident (BLUE CARD - with dummy)

Back 28

**ALWAYS COMMUNICATE WITH AN UNCONSCIOUS PATIENT**

*clean: LUT, RUT, LLT, RLT, ROM, and Tongue.

1. Intro
2. raise bed, asses breathing, verbally "It looks like you're not having problems breathing while I'm raising the bed Mr./Mrs. That's very good" ??
3. Side rail down
4. put on gloves
5. place 1st towel next to head/shoulder
6. place 2nd towel on chest
7. turn head toward you and tilt down
8. inspect mouth and tongue
9. place emesis basin under the chin. make sure it's secure
10. make 50/50 solution of water and mouthwash

*MAKE SURE YOU LET THE PT. KNOW WHAT YOU ARE GOING TO DO. VERBALIZE step 11-16.

11. swish #1 toothette in cup of 50/50 solution. tap off excess solution and clean left upper teeth (front to back, up and out, place toothette in trash
12. Swish #2 toothette follow previous step and clean right upper teeth (front to back, up and out. trash)
13. Swish #3 toothette, follow previous step and clean left lower teeth
14. Swish #4 toothette, clean right lower teeth
15. Swish #5 toothette, clean the roof of the mouth
16 Swish # 6 toothette, clean the tongue.
17. remove emesis basin carefully
18. dab face with chest towel and remove both towels to laundry
19. remove gloves
20 put on new gloves to apply chapstix
20. verbalize to pt. and apply chapstix
21. gloves off
22. position head back in place
23. side rail up
24. lower bed
25. use remaining gloves to clean up
26 clean up emesis basin first. and put away stuff
27. closing procedures. place call light on their hand even if they're unconscious)

Front 29

Supplies for back rub

Back 29

lotion
1 towel
a bath blanket
2 pairs of gloves
1 laundry and trash bag
table cover

Front 30

Giving Resident a Back Rub (BLUE CARD)

Back 30

1. Intro
2. side rail down
3 glove on.
4. roll the blanket at the FOB
5. put bath blanket over resident and ask them to hold while you pull sheet to bottom of the bed
6. turn resident to side and try to keep covered as much as possible (Dignity). make sure only their back is exposed.
7. put towel down behind resident's back
8. warm lotion in hands with friction.
9. rub up on sides back and then down in the middle in big circle motions. DO 5 times*
10. Dry the back off of excess lotion with towel and remove to laundry
11. gloves off
12. turn resident back over
13. pull up sheet and ask resident to hold while you pull bath blanket from under sheet to bottom of the bed and remove
14. put side rail up
15. gloves on to clean up.
16. closing procedures - "Thank you for letting me assist you with your back rub. Here's your call light, I'll be back in 2 hours"

Front 31

Supplies for giving a partial upper body bed bath

Back 31

Basin
Gown
Bath Blanket
Soap and Soap Dish
2 towels
2 washcloths
4 pairs of gloves
1 laundry and trash bag
table cover
lotion (optional)

Front 32

Giving a resident an upper body bed bath

Back 32

*Read the card for paralysis. Do not turn on the paralyzed side*

1. Intro "Mr. Mrs. ... I'm going to give you an upper body bed bath for your face, shoulder, arms, chest and abdomen. is that ok?
2. get water. check the temperature
3. side rail down
4. remove blanket to the FOB
5. place bath blanket over sheet (OK to reach over**)
6. ask resident to hold the bath blanket while you pull the sheet down to the FOB.
7. remove gown from under bath blanket *Start with arm farther away from you*
8. put gloves on
9. place 1st towel over chest area
10. place 2nd towel under shoulder and arm. ask pt. if they can assist you on raising their arm
11. mit washcloth #1, wet and wipe eyes. NO SOAP!!*. back and front of the mit (far side eye first)
12. rinse off, remit using the same washcloth, and ask pt. if he wants soap on face
13. making a heart shape - wipe off face (far side first using front side of the mit...and the back side of the mit on the other half of face)
14. rinse off. remit and wash from ear, behind ear down to neck (farther side first)
15. place washcloth in laundry
16. gloves off
17. expose arm
18. gloves on
19. mit washcloth #2, wet and soap and wash around the shoulder going to armpit
20. rinse off. remit. and wash arm, forearm, and then hand x2 each (front and back of arm, forearm, and hand). Place basin on top of disposable blue pad. and wash hands on the basin.
21. put washcloth over basin edge. NEVER LEAVE WASHCLOTH IN THE BASIN
22. cover and dry arm with the towel (leave covered)
23. pull bed bath blanket to waist from under chest towel (same gloves)
24. expose chest side to clean
25. mit, wet washcloth from edge of basin, soap and wash in a 1-2-3 motion, chest, under breast (lift with back of your hand), and abdomen)
26. place mit in laundry
27. cover chest back up with towel
28. change gloves*
29. put on gown on over towel (far side first. ask pt. to assist you by lifting their arm)
30. remove chest towel to laundry
31. remove 2nd towel to laundry
32. pull up sheet over bath blanket
33. ask resident to hold sheet while you pull off bath blanket from under sheet
34. place bath blanket in laundry
35. cover resident with blanket
36. remove gloves
37. side rail up
38. gloves on for clean up

Front 33

Supplies for partial lower body bed bath

Back 33

basin
bath blanket
disposable blue pads (goes underneath the basin when you wash the foot)
soap and soap dish
1 towel
1 washcloth
4 pairs of gloves
1 laundry and trash bag
table cover
lotion (optional)

Front 34

Giving a Partial lower body bed bath (BLUE CARD)

Back 34

*Hips first, leg, then feet
*If proctor want to see a FULL lower body bath, start on the farther side.

1. Intro "Mr/Mrs. Smith I'm going to assist you with you bed bath for your hips, legs, and feet. Is that OK?"
2. get water ready and test temp.
3. side rail down
4. remove bed blanket to FOB
5. put on bath blanket over sheet (you can reach over*)
6. ask resident to hold the bath blanket while you pull the sheet to the FOB.
7. gloves on.
8. expose leg only.
9. place towel under leg, from hip to the foot. ask the resident if they can assist you in lifting their leg up.
10. mit washcloth, wet, soap around the hip to thigh, and down to leg x2 using back and front of mit (front and back of quads, then shin part/anterior and lateral/calves)
11. put washcloth on the edge of the basin
12. place disposable cloth under the foot. ask the pt. to assist
13. place foot in basin on top of disposable pad
14. wash foot and put washcloth in laundry
15. remove basin. and disposable cloth to trash
16. dry leg and foot with towel (and leave it covered while you prep lotion)
17. remove gloves and put on new ones
18. rub and apply lotion and remove excess with towel. place towel in laundry and remove gloves
19. pull up sheet over bath blanket
20. ask resident to hold sheet while you pull bath blanket from under sheet
21. place bath blanket in laundry
22. cover resident with blanket
23. put side rail up
24. put on gloves to clean up

*for full lower bath = change the water in between each leg, and double your supplies. so DO NOT ASK THE PROCTOR*

25. closing procedure "thank you for allowing me to assist you with your bed bath for your hips, legs, and feet. Here's your call light, I'll be back in two hours to check up on you."

Front 35

Supplies for Peri Care

Back 35

NO POWDER FOR BEDPAN

Basin
bath blanket
bedpan
2 blue pads
soap and soap dish
2 towels
3 washcloths
4 pairs of gloves
1 laundry and trash bags
table cover

Front 36

Female Perineal Care (BLUE CARD)

Back 36

NEVER PUT BED PAN ON TABLE*

1. Intro "Mr./Mrs.... I came here to assist you with cleaning your perineal area. Is that OK?"
2. start on the opposite side (next to the wall) bring the supplies with you. side rail down.
3. place bath blanket over sheet in a diamond shape. seam up. DO NOT lean over. finish one side at a time. ask the pt. to hold the bath blanket and pull out the sheet only the side that's covered by the bath blanket.
4. side rail up. walk to the other side (with the supplies) and lower side rail
5. fix 2nd side of bath blanket. Ask the pt. to keep holding the bath blanket while you pull the rest of the sheet down to the FOB from underneath.
6. gloves on.
7. turn the resident to the side (keeping them covered)
8. expose rear
9. place disposable blue pads on the pt's back
10. roll resident onto the bed pan (no powder) ask if the bed pan is secure and if they are comfortable.
11. ask the resident to bend the leg you are working on atm and wrap bath blanket around the ankle of that leg.
12 REMOVE GLOVES
13 rails up.
14. walk to the other side. lower rails, bend leg and wrap ankle and anchor under foot.
15. rails up.
16 fill basin with water and check temp.
17 rails down and move table closer to you.
18. PUT ON NEW GLOVES.
19. communicate to the resident that you are going to raise the blanket to clean her perineal area.
20. mit washcloth, wet and soap
21. expsose the vagina. spread labia majora. wipe the farther side or the labia majora (left) first with one side of the towel and wipe the right side with the other side of the towel. ALWAYS wipe front to back.
22. cover the patient.
23. place wash cloth in the laundry
24 mit. 2nd wash clost, wet and soap
25. expose. spread labia minora. start with left side using one side of the mit, and then the right side using the other clean side of the mit.
26. place in the laundry
27. dab dry with large towel and put in the laundry
28 cover the pt.
29. change gloves **
30. "Ms. smith you can lower your legs now" Turn the pt. and ask if they could grab the rail on the count of 3.
31. hold the bed pan while turning. DO NOT place bed pan on the table!* place the bed pan on the blue pad near the trash bag.
32. leave the blue pad that was on the bed.
33. mit 3rd washcloth, wet and soap
34. wipe anal area twice, front to back using different sides of the mit.
35. place washcloth in the laundry
36. gently dab dry with 2nd large towel and put in laundry
37. throw away disposable blue pad
38. gloves off
39. turn resident over on the count of three
40. pull sheet up over resident and remove bath blanket.
41. rails up
42 gloves on for clean up
43. closing procedure. "Thank you for allowing me to assist you with your perineal care. Here's your call light. I will check on you in two hours but if you need anything, please let me know"

Front 37

supplies for shaving

Back 37

large basin
emesis basin
after shave
razor
shaving cream
soap and soap dish
1 large towel
2 washcloths
4 pairs of gloves
hand mirror
sharps container
1 laundry and trash bag
a table cover

Front 38

Assisting with Shaving (BLUE CARD)

Back 38

1. Intro "Hi, Mr...I'm here to assist you with your shaving. Is that ok?"
2. Get water in large and emesis basin**. check temp.
3. lower side rail.
4. raise the HOB and bring supplies near you
5. Gloves on
6. place towel on the chest of the resident.
7. check the skin**
8. ask resident if they want to keep their mustache.
9. mit washcloth, wet and soap
10. clean face and put in the laundry
11. apply shaving cream to palm of hand (not directly to the residents face)
12. change gloves **
13. push skin up and shave down 1 side of the face in 3 moves (father side first. ASK the pt. to turn their head towards you). Rinse the razor in emesis basin.
14. push skin up and shave down on the other side of the face with 3 moves. rinse razor in emesis basin
15. shave down the chin and place razor in Sharps container
16. mit. 2nd washcloth. wet and wipe off excess of shaving cream and place in laundry
17. dab face dry with towel
18 ask if they want aftershave
19. offer mirror
20. remove gloves.
21. side rail up
22. lower HOB.
23. gloves back on for clean up
24. closing procedure "thank you for allowing me to assist you with your shaving. I'll be back in two hours Mr.....Here's your call light, if you need anything, please let me know."

Front 39

supplies for cleaning and trimming the resident's fingernails

Back 39

basin
soap and soap dish
2 large towels
1 washcloth
2 pairs of gloves
nail clippers
orange stick
emery board or file
lotion
1 laundry and trash bag

Front 40

Cleaning and Trimming the Resident's Fingernails (BLUE CARD)

Back 40

*SIDE RAILS ARE UP FOR THIS SKILL
*Verbalize that you asked the charge nurse if nail care is permitted or if the patient is diabetic. Check card.

1. Intro "Mr./Mrs. I'm here to assist you with cleaning and trimming your fingernails. Is that ok?"
2. raise the bed to high fowler's. ask about breathing
3. fill basin with water and test
4. gloves on
5. move table in front of pt. make sure it's the right height...place the resident's hands in the basin with water..with lrg. towel in front of it.
6. mit washcloth, we and soap. wash hands and push back their cuticles with the corner of washcloth. place in laundry after use.
7. use orange stick (slanted side) to clean underneath the nails
8. remove the pt's hand from the basin and place the pt's hand on the towel. pat dry and leave hands covered with the same towel.
9. refill basin with water and test the temp
10 put hands back in the basin and remove towel and put in laundry
11. remove the basin and put the the side of the table.
12. lay hands on clean towel (2nd). let the pt's hands dry and leave it covered.
13. *if pt. is not diabetic, cut each nail with 1 straight cut across
14. file each nail
15. warm lotion up
16 rub hands with lotion. (still the same first glove)
17. wipe off excess lotion with towel
18 gloves off. move the table away from the front of the pt.
19 gloves on for clean up.
20. closing "thank you for allowing me to assist you with cleaning and trimming your nails Mr./Mrs..." "I'll check up on you every two hours.. so here's your call light, let me know if you need anything"

Front 41

Assisting a resident with dressing and undressing (BLUE CARD)

Back 41

*Dignity skill.
*Resident WILL have L/R side weakness** must check card. and check for Hand Rolls
*NO GLOVES?
* can dress w/o walking around to the other side of the bed.

1. Intro "Hello Mr/Mrs. I'm here to assist you with putting on a new gown. Is that ok?"
2. make sure the bed is flat. lower HOB and FOB.
3. rails down.
4. fold blanket to the FOB. place bath blanket over sheet
5. ask pt. to hold bath blanket while you roll sheet to the FOB
6. REMOVE gown from the STRONG side first to weak (under bath blanket) while asking if they can assist you.
7. DRESS from WEAK to strong. while asking if they can assist you by using their strong arm.
8. sheet back up and remove bath blanket
9. side rails up.
10. closing procedures "thank you for letting me assist you with putting on a new gown"

Front 42

Assisting resident to Eat (BLUE CARD)

Back 42

* Check card!**
*watch out for hand rolls
*feed them on their strong side if stroke pt.

1. Intro "I'm here to assist you with your B/L/or D meal. Is that ok?"
2. bring head to high fowler's while assessing breathing
3. rails down
4. towel across chest
5 set up/uncover food before giving tray to pt.
6 check food temp. verbalize.
7 offer salt if non NAS. "Mr. smith I cannot give you the salt because you're still in an NAS diet, but what I can do is get you Mrs. Dash or put pepper on your food for added flavor?"
8. tell them what they're having and if they want you to cut it up for them. "Are these pieces too big or do you want me to cut your meat, pizza, etc smaller so it's easier to swallow?"
9. caution them with hot liquids.
10. ask if they can feed themselves or if they want you to assist them with feeding
11. offer everything on the tray.
12. ask if they finished.
13. "You did pretty good Mr./Mrs...."
14. Rails up.
15. Closing -- Explain that you have to leave the bed up for 10/15 min. (if pt. is reg), and 30 min. (if stroke pt). Call light.

Front 43

What do we record after feeding a pt. who had stroke?

Back 43

% meal intake

fluid intake

if they refused the food

and if they had difficulty swallowing the food

Front 44

Performing Passive Upper body ROM. (Shoulder, Elbow, Wrist, and Fingers - YELLOW CARD)

Back 44

No supplies needed
*Key is communication and safety**

1. Intro. Make sure the pt. is able to perform exercises
2. Adjust the bed to a safe and comfortable working height
3. Lower the side rail on the side you will be working on
4. Instruct the resident to inform you if any pain or discomfort is experienced during the exercises.
5. Safely and gently exercise the resident's shoulder, elbow, wrist, and fingers, supporting and moving each joint gently and naturally (w/o force to limbs or joints)
6. exercise each joint in as many patterns as you can ?*
7. examples of pattern: flexion, extension, abduction, adduction, rotation
8. exercise each joint at least 3 times each.
9. ask the resident during the exercises if they are having any pain.
10. closing procedures

Front 45

Performing Passive Lower Body ROOM. (Hip, Knee, Ankle, Toes - YELLOW CARD)

Back 45

No supplies needed.
*the key is communication and safety

1. Intro
2. Adjust the bed at comfortable working height
3. lower the side rail on the side you will be working on
4. instruct the resident to inform you of any pain or discomfort during the exercise
5. safely and gently exercise the resident's hip, knee, ankles, and toes, supporting and moving each joint gently and naturally (do not force)
6. exercise each joint in as many patterns as you can
7. examples are flexion, extension, abduction, adduction, and rotation.
8. exercise each joint at least 3 times each
9. ask the resident if they are in pain
10. closing procedures

Front 46

Assisting the Resident in Walking Using a Gait Belt

Back 46

Supplies: non-skid shoes, safety belt, gown

1. Intro
2. apply resident's non-skid shoes (verbalize)
3. place the safety belt snugly around the resident's waist with no more than 2-3 fingers b/w the safety belt and the resident's body.
4. ask the resident if they are dizzy before and after standing the resident
5. hold the belt on the sides, with an upward grasp, to support the resident when standing
6. instruct the resident to stand on the count of three
7. maintain an upward grasp while walking the resident
8. stand slightly behind and to the side of the resident when walking
9. ask the resident if they are dizzy, tired, in pain, or SOB while walking
10. return the resident back to bed
11. hold the belt on both sides, with an upward grasp, when seating the resident on the bed.
12. remove belt by carefully lifting it away from the resident's body (to avoid friction)
13. closing procedures