Handwashing

Materials required - Soap

Length of procedure - 1 Minute

Step 1. Wet hands & apply soap

Step 2. Work up lather, cleansing front and back of hands, wrists, between fingers, around cuticles.

Step 3.  Provide cleansing friction for AT LEAST 20 seconds.

Step 4. Rinse hands while holding fingers below level of wrists.

Step 5. Pat hands dry with paper towel, dispose.

Step 6. Turn off water with paper towel, dispose.

Warnings -  Do not use flicking motion with fingers, do not touch sides of sink with hands, do not dry hands with towel used to turn off sink.

Unoccupied Bedmaking

Materials required* - Pillowcase, Fitted (Bottom) Sheet, Flat (Top) Sheet, Mattress Pad, Incontinence Pad, Drawsheet, Bedspread, Dirty Linnen Bag

Length of Procedure - 5 Minutes

Step 1. Wash Hands

Step 2. Place linnens on clean surface

Step 3. Adjust bed to comfortable height

Step 4. Remove soiled linnen from bed, rolling away from you, Place in linnen bag.

Step 5. Secure mattress pad with absorbant side up. (if applicable)

Step 6. Place fitted sheet on mattress and secure.

Step 7. Place drawsheet over fitted sheet and secure, leaving wrinkle free.

Step 8. Place incontinence pad (If applicable)

Step 9. Allign top sheet near head of the bed, and spread over bed.

Step 10. Place bedspread over top sheet, and miter the bottom corners.

Step 11. Replace pillowcase.

Step 13. Fold linnens at top of bed down about three inches and place pillow at head of bed, with open end of pillowcase facing away from the door.

Step 14. Lower bed, wash hands, take care of linnen cart.

Bedpan

Materials required - Bedpan, Towel & washcloth, Gloves, Soap & Water, Incontinence Pad, Toilet Paper.

Length of Procedure - 5 minutes

Step 1. Pre-Procedures

Step 2. Apply Gloves, assist resident to wash hands

Step 3. Adjust bedding and clothes, place incontinence pad under buttocks and over sheets

Step 4. Position bedpan under resident by either

A) Asking resident to flex their knees and raise their hips

B) Turning the resident onto their side, placing the bedpan near their buttocks, and rolling them onto bedpan.

Step 5. Check on position of bedpan, making sure positioning is correct.

Step 6. Replace linnen over resident and raise head of bed into a low fowlers position (15° - 30°)

Step 7. Place call light and toilet tissue within reach and instruct resident to call your you when finished.

Step 8. Step behind privacy curtain and wait for resident to finish.

Step 9. Lower head of bed, and remove bedpan without spillage (cover with towel).

Step 10. Provide for perineal cleaning

Step 11. Observe contents, and record if neccesary.

Step 12. Empty contents of bedpan into toilet, then rinse, dry, and store bedpan where it belongs (Bottom shelf / Drawer of bedside cabinet).

Step 13. Remove gloves, wash hands, assist resident to wash hands, tidy the work area.

Step 14. Post-Procedures.

Blood Pressure

Materials Required - Alcohol Wipe, Stethoscope, Paper & Pen, Blood Pressure Cuff (Sphygmomanometer)

Length of Procedure - < 1 Minute

Step 1. Pre-Procedures

Step 2. Wash hands, clean earpeices and diaphragm of stethoscope with wipe.

Step 3. Expose anticubital area, and wrap cuff snugly about one inch above elbow.

Step 4. Position resident arm with palm up and elbow at heart level, feel for pulse, and place diaphragm of stethoscope over artery.

Step 5. Close air pump on cuff, and inflate cuff to about 150mm or pulse is no longer heard.

Step 6. Deflate slowly and steadily, listening for the first sound (systolic), and the last sound (diastolic).

Step 7. Open valve to release remaining air. If you need to repeat (from a misreading or unable to hear the pulse) wait at least 30 seconds before trying again.

Step 8. Record measurements, and remove the cuff, and store it.

Step 9. Post-procedures.

Catheter Care

Materials Required - Soap & water, Bath blanket, Incontinence Pad, Gloves, Basin, Towel & washcloths (4).

Length of Procedure - ~10 Minutes

Step 1. Pre-procedures

Step 2. Wash hands & apply gloves

Step 3. Cover resident with bath blanket, fold linnens to foot of bed

Step 4. Place incontinent pad on bed to protect bedding

Step 5. Position resident on back with legs seperated and knees flexed

Step 6. Fill basin with warm water at a safe and comfortable temperature (Or ask "is this water warm enough for you?")

Step 7. For a male, gently draw back the foreskin and cleanse around the catheter insertion site and up the tube four inches with clean soapy washcloth, changing the position on the washcloth with each stroke. For a female, seperate the labia and clean around the insertion side and up the tube about four inches with a soapy washcloth.

Step 8. Change washcloths, and rinse the catheter insertion site and down the catheter tube four inches, changins sides with each stroke.

Step 9. Provide perineal care using seperate washcloths.

Step 10. Pat dry entire perineal area and catheter. Leave catheter tube coiled on the bed without kinks or coil hanging over side of bed. Remove incontinent pad, and take care of equipment.

Step 11. Post Procedures

Occupied Bedmaking

Materials required- Bedspread, Draw sheet, Fitted sheet, Top sheet, Incontinent pad, Pillowcase, Linnen bag

Length of Procedure- ~10 min

Step 1. Pre procedures

Step 2. Wash hands

Step 3. Lower head of bed (if raised), remove bedspread, loosen top sheet at foot of bed, and remove pillow

Step 4. Assist resiednt to side of bed, facing away from you, and loosen linnens on your side of mattress

Step 5. Roll linnens away from you, and tuck under resident. Place fitted sheet on your side of mattress and tuck in, rolling the excess under the roll of dirty linnens. Repeat with draw sheet and incontinent pad

Step 6. Assist resident in rolling over linnens, and onto the clean linnens.

Step 7. Finish rolling up dirty linnens, and place them in linnen bag. Unroll clean linnens, and secure them to mattress without wrinkles.

Step 8. Place resident back on middle of mattress, and replace dirty top sheet with new sheet, avoiding unneccesary exposure. Secure linnens at foot of mattress (miter corners), leaving room for feet movement. Keep sides untucked, replace pillowcase, and place pillow back under head.

Step 9. Post procedures

Dressing

Materials required - Residents Clothing (Undergarments, top clothing, and socks, or just a hospital gown)

Length of procedure - ~ 5 minutes

Step 1. Pre-procedures / Wash hands

Step 2. Offer resident choice/prefrence for clothing as appropriate

Step 3. Remove soiled garments, draping resident to avoid exposure. If resident is weaker on one side, then while undressing, remove clothing from the strong side first.

Step 4. Assist resident in dressing by gathering up sleeve to ease pulling over the affected arm/leg.

Step 5. Move residents extremeties gently, and without over-extention or force. When resident is fully clothed, adjust cloting as needed for comfort and apperance.

Step 6. Place dirty clothes in hamper.

Step 7. Post-procedures / Wash hands

Hints - When dressing and undressing, always follow the order of strong-weak-weak-strong. Undress strong side of body first, and dress it last. This promotes resident to assist with dressing. Always give resident choice when it comes to picking out garments for the day.

Feeding

Materials required - Food tray (with utensils), clothing protector, pen & paper.

Length of Procedure - Varied

Step 1. Pre-procedures / Wash hands & offer resident to do the same

Step 2. Check resident ID and make sure food tray if correct, Put on clothing protector, raise bed and the head of bed (60° minimum) and have resident in proper allignment.

Step 3. Adjust overbed table and place open food trey on table. Offer a drink before offering food to moisten mouth.

Step 4. Sit to mantain eye level, and only use a spoon to feed. Only fill the spoon 1/3 full, and offer a drink between every three bites. Check to see if resident has swallowed before offering another bite of food.

Step 5. When resident is full, offer one final drink to wash the food down. Clean the residents face with the clothing protector, and tidy the work area at end of task. Also, accurately record the food intake on the Food Acceptance Record.

Step 6. Assist resident to clean face / hands, Post procedures /  Wash hands

Tips - Observe the resident while feeding. A cough or over salivating could mean there is an obstruction or they are eating too fast. While feeding a resident, always have a conversation. It not only comforts the resident, it can increase their appetite and put them in a better mood. While feeding, ask them what they want to eat. If they ask for dessert first, give it to them. They have the right to choice.

Hair & Nail Care

Materials required - Brush, Mirror, Comb, Towel, Hair Accessories, Laundry bag, Basin, Nail Clippers, Soap, Orange Stick, Washcloth, Emery Board, Bath blanket

Length of Procedure - >5 Minutes

Step 1. Pre-procedure / Wash hands

Step 2. Assist resident to get out of bed, and into a chair. Position bed table over their lap, and place a barrier over it. Fill basin with warm water to residents liking, and place on top of the barrier. Have resident place finders into warm water for at least 5 minutes.

Step 3. While fingers are soaking, Place a towel over the residents shoulders, and remove any glasses or accessories. Gently comb the residents hair, starting at the bottom and working your way up to the scalp, without causing discomfort or pain in the resident. Style the hair to the residents preference. Show their reflection in the mirror, and ask if that is acceptable. Take care of the towel, and brushing accessories. Change gloves.

  Step 4. Take residents hands out of the water basin, and wash the nails with a washcloth, while gently pushing back the cuticles. When finished, take the orange stick, and clean the residue from under the fingernails with the flat end. When done, dry the residents hands, and ask if they would like their nails clipped. If they accept, make the nails flat with no jagged edges. After trimming the nails, or if they did not want their nails trimmed, ask is they would like you to smooth their nails with an emery board. If they allow you to, then use the emery board gently, and only making upward potions, not down towards the finger.

Step 5. Clean the residents hands, and apply lotion to yours. Rub your hands to warm the lotion, and massage their hands. When finished, wipe off all excess lotion, and dry their hands.

Step 6. Post procedures / Wash hands

Tips - Always chat with the resident, they appreciate the company. When brushing the hair, be careful of knots. They can be a real pain, and hassle to clean up without causing discomfort.

Height & Weight

Materials required - Scale, Paper towel, Pen & paper

Length of procedure - ~ 1 minute

Step 1. Pre-procedures / Wash hands

Step 2. Make sure scale is zero balanced. Place the paper towel on the scale to act as a barrier. Assist resident onto scale, and make sure they are steady. When steady, read the scale and record the weight.

Step 3. Whils still on the scale, raise the measurment bar, and rest it gently atop the residents head. Measure the height, and record it.

Step 4. Assist resident off scale and dispose of barrier. Step 5. Post procedure / Wash hands.

Tips - When reading the height, make sure to get the measurements in Inches and not Centimeters. While making sure resident is steady during weighing, make sure they are not leaning or holding supports.

Measure and Record contents of urinary drainage bag

Materials required - Alcohol Swab, Paper towel, Graduated container

Length of Procedure - ~1 minute

Step 1. Pre-procedures, wash hands, apply gloves

Step 2. Place paper towel on ground as barrier. Unclasp the tubing of drainage bag, and drain the urine into the graduated container without touching the container with the tubing.

Step 3. When empty, wipe the drain of the tubing with an alcohol wipe, reclasp the tubing, and tuck drain into protective pocket. Leave the bag secured to unmoveable part of bed, not allowing it to touch the floor.

Step 4. Take graduated container to bathroom, and set on a level surface, on top of another barrier. Get down to eye level to read urine ammount.

Step 5. Remove gloves, and wash hands. Record the measurement, empty the container and rinse it before storing it.

Step 6. Post-procedures, wash hands

Tips - Your measurement must be within 50 cc's of the CSO's reading, so you don't have much room for error. Always be sure to wash your hands after contact with any resident.

Change of Position with Backrub

Materials required - Pillows or repositioning devices, Hand Rolls*, Lotion, Towel

Length of Procedure - ~2 minutes

*Hand rolls are only required if resident has hand contracture. If hand rolls are needed, be sure to clean out inside of hand before placing them.

Step 1. Pre-procedures / Wash hands

Step 2. Lock wheels and fold linnens to end of bed. Adjust bed to comfort level and assist resident to move towards edge of bed.

Step 3. Cross the residents ankles, pull their shoulder out from under them, then assist them in rolling iback onto the center of the bed.

Step 4. Have observer hold the resident in place while you give backrub. place towel against the residents back, and apply lotion to your hands. Rub hands to warm lotion, and rub residents back with circular motion, moving up. Do this three times.

Step 5. Use towel to rub off all excess lotion off skin. Place a pillow behind residents back to maintain position.

Step 6. Allign legs with knees slightly bent to alleviate hip and back strain. Position a pillow between legs, making sure that the bony prominences at the knees and ankles are apart.

Step 7. Adjust residents shoulder that they are lying on to alleviate any pressure. Make sure a pillow is under their head, and supporting neck and head.

Step 8. Place pillow under the residents arm to promote comfort If handrolls are needed, place the roll in residents hand after cleaning, with the thumb straightened out to avoid thumb contracture.

Step 9. Post-procedures / Wash hands

Mouth Care - Brushing Teeth

Materials Required - Floss, Toothpaste, Lip Balm, Diluted Mouthwash, Toothbrush, Towels, Emesis Basin, Gloves

Length of Procedure - ~5 Minutes

Step 1. Pre-procedures / Wash hands / Apply Gloves

Step 2. If resident is in a bed, raise the head of the bed to a minimum of 45°. Place a towel across the chest of the resident, and an emesis basin under the residents chin. Moisten the toothbrush and apply toothpaste.

Step 3 (Minimal Assistance). Allow resident to brush teeth / clean inside of mouth if permited. Give them some diluted mouthwash or water to rinse their mouth, and offer oppertunity to spit in emesis basin as needed. Dry around residents mouth, and offer floss. Repeat mouthwash offer, and offer lip balm.

Step 3 (Total assistance). Brush residents teeth using short strokes, cleaning two or three teeth at a time. Also brush the entire surface of the residents mouth, and if they have no teeth then gently brush gums. If resident is able to, offer mouthwash and emesis basin to spit into. Dry the residents mouth, and apply lip balm.

Step 4. Post-procedures / Wash hands

Tips - If they don't want to use floss or mouthwash, don't force it on them. They have the right to choose.

Mouth Care - Dentures

Materials Required - Dentures, Toothpaste (or Denture Cleaner), Diluted Mouthwash, Denture Cup, Towels, Toothbrush, Gloves, Emesis Basin, Pen & Paper

Length of Procedure - ~5 Minutes

Step 1. Pre-procedures / Wash Hands / Apply Gloves

Step 2. Obtain Dentures. If possible, have resident remove them and give them to you. If you must take them out, always take the upper dentures first, using up and down to break the vacuum. Place dentures in emesis basin.

Step 3. Take emesis basin to sink. Cover the bottom of the sink in paper towels and fill sink with cool water, to prevent damage from dropping. Apply toothpaste to brush, and scrub dentures thuroughly over sink.

Step 4. Rinse dentures in cool water (NOT the water already in sink), and place in denture cup. Rinse out the emesis basin, and take them back to the resident.

Step 5. Place towel across residents chest, and perform mouth care on resident as condition permits. Use toothbrush/toothette/swab to massage gums, freshen mouth, and remove food particles from gum pockets.

Step 6. Offer resident mouthwash and emesis basin. If this is during the day, then offer the resident the dentures back and, if needed, place them in the residents mouth yourself, inserting the bottom dentures first. Dry residents mouth.

Step 7. Post-procedures / Wash hands

Tips - Use soft, circular motions when massaging residents gums.

Partial Bed Bath

Materials Required - Bath Blanket, Towel, Incontinent Pad, Washcloths (4), Wash Basin, Deoderant, Soap, Water, Lotion, Gloves, Hospital Gown

Length of Procedure - 5 - 10 minutes

Step 1. Pre-procedures / Wash Hands / Apply Gloves / Check Temp.

Step 2. Will basin with water that is acceptable to resident. Drape resident with bath blanket, avoiding unnecessary exposure.

Step 3. Place the towel under the residents head, wet a washcloth (don't use soap), and clean around residents eyes and face. When cleaning the eyes, wipe from the inside out, changing sides of the washcloth with every new stroke. When finished, pat face dry with towel.

Step 4. Remove residents gown, being careful to avoid exposure. Place towel under residents neck, and apply a little soap directly to a seperate washcloth. Dip the soapy washcloth in water, and wash the neck. Use the wet washcloth to rinse the neck, and then pat dry with the towel or bath blanket. 

Step 5. Change water if cold. Expose residents far arm, and place the towel underneath the arm and hand. Wash residents hand with soapy washcloth, and rinse with wet one before patting hand dry. Wash residents far arm and axillae with soapy washcloth, and then rinse with wet cloth. Pat arm dry, and remove towel from under far arm.

Step 6. Repeat previous step for near hand and arm. Re-cover the residents arm, and expose their chest. Place the towel lengthwise along the residents chest. Clean the chest, using the soapy washcloth first, then rinsing with the wet one. Pat dry with towel, and ask or assist the resident to turn on their side.

Step 7. Place the towel under the residents back, and wash the residents back with the soapy washcloth, then rinsing with the wet cloth. Finally, pat dry with the towel.

Step 8. Apply lotion in hands, and rub until warm. Provide a backrub, starting from the base of the spine and working towards the neck three times, using circular motions and gentle strokes. Pat dry any excess lotion with the towel, and assist the resident back in supine position.

Step 9. Replace residents gown while avoiding exposure, and remove bath blanket.

Step 10. Post-procedures / Wash hands

Tips - Be gentle when moving resident, and always support the joints when moving them.

Perineal Care - Female

Materials required - Washcloths, Bath Blanket, Soap, Disposable Bag, Bath Towel, Gloves, Wash Basin, Paper Towels

Length of Procedure - ~10 minutes

Step 1. Pre-procedures / Wash Hands / Apply Gloves

Step 2. Remove soiled linnen from bed. Cover resident with bath blanket, and replace incontinent pad underneath resident before begining procedure. Cover residents legs with the bath towel.

Step 3. Fill the wash basin with water from 105° and 109° (Or to residents comfort level). Place basin on top of a level surface with a paper towel barrier. Place washcloths in basin to soak. Assist resident to flex her knees, and spread her legs if possible. If not, just keep her legs straight, and spread them far apart as possible without discomfort.

Step 4. Fold bath blanket as to expose perineal area only. Apply soap to one of the washcloths, and seperate the labia with your fingers. Pass over the urinary meatus with the first stroke of the washcloth, and change the spot of the washcloth with each washing stroke, wiping from front to back with each stroke. When cleaning the perineum, follow the order of middle-side-side. Rinse entire area with a new washcloth, working in the smae order. Pat area dry with a towel when completed.

Step 5. If water in basin is getting cold or soapy, then empty and refill. Position resident of her side for cleansing of buttocks and rectal area. Cleanse, rinse, and dry rectal area using the same procedure as the paraneum, but use the order of side-side-middle. Remove gloves.

Step 6. Post-procedure / Wash hands / Dispose of Bag

Tips - Observe and take notice of any abnormal redness, discharge, or complaints of pain.

Pulse and Respirations

Materials required - Watch (With second hand), Pen & Paper

Length of Procedure - 2 minutes

Step 1. Pre-procedures / Wash Hands

Step 2. Support residents arm, and locate radial artery

Step 3. Count pulsations for 60 seconds with the watch. Note the regularity and strength of beat (throbbing, weak, ect.)

Step 4. Record pulse rate, and watch residents respirations (without informing them of seperate procedure).

Step 5.  Observe residents respiration for 60 seconds, noting the depth and rythym of respirations (Shallow, deep, ect). Record respirations.

Step 6. Post-procedures / Wash Hands

Tips - To pass this section, you must have recorded the residents pulse to within four beats of the instructor. When coundting respirations, try your best to not let the resident know. If they do know, they try and controll their respirations, thus changing your tally.

Range of Motion (Upper & Lower)

Materials required - Bath Blanket

Length of procedure - ~3 minutes each

Step 1. Pre-procedures / Wash hands

Step 2. elevate bed, and position resident in supine position.

Step 3. (Upper ROM)

Lift the residents arm, supporting the joints, and assist them to abduct, adduct, flex, extend, and rotate the shoulder. Repeat each procedure three times, or until resident complains of pain / discomfort. Next, flex and extend the elbow. Followed by flexing, extending, and rotating the wrist, and finally, abducting, adducting, flexing, extending, and rotating each finger.

Step 4. (Lower ROM)

Abduct, adduct, flex, and extend the hip. By flexing and extending the hip, you are also doing the same to the knee. After that, flex extend and rotate the ankle, and finally, Abduct, adduct, flex, extend, and rotate each toe.

Step 5. Post-procedures / Wash Hands

Tips - BE GENTLE! Remember that older residents are weak, and their joints may not move that much. Even so, just a little movement is beneficial to them. Support each joint while performing ROM exercises, and keep asking the resident if they feel any pain. Just be aware of the residents facial expression.

Transfer from Bed to Wheelhair

Materials required - Wheelchair, Bath Blanket, Gait Belt, Cushions, Support devices, Non-skid footware

Length of procedure - ~3 minutes

Step 1. Pre-procedures / Wash Hands

Step 2. Place wheelchair in position first. Make sure that wheels are locked, leg rests are off, and that resident is wearing non-skid footware.

Step 3. Provide support to assist resident to sitting position on side of bed. Apply the gait belt, and make sure that it is not too loose or tight, and keep flaps of skin above the belt.

Step 4. Ensure that the residents feet are on the floor. Make sure everything in in position, and stand in front of the resident. Brace the residents legs with yours, and reach around resident, under their arms, to grab gait belt from behind. Alert resident that you are going to help them up at the count of 'three'. Mantain proper body mechanics and assist resident to stand up. Complete the transfer as a pivot, and make sure to place them in the wheelchair gently. If resident is out of position, then reposition them until their hips are in the back of the seat, and replace the footrests. Remove the gait belt, unlock the wheelchair wheels.

Step 5. Post-procedure / Wash Hands

Tips -Stay gentle, and don't push the resident to do something they don't want to do. If they are feeling light headed, then let them stay in position for a few minutes.

Pre-Procedures

The 5 steps to ALWAYS do before begining a skill. Failure to do so can result in an automatic failing grade, and/or removal from the program. For the certification test, you must perform these skills before every section of your test.

Step 1. Knock, and introduce yourself.

Step 2. Verify residents identity, and explain the procedure.*

Step 3. Have equipment prepared

Step 4. Wash hands

Step 5. Provide privacy**

*Verify residents identity by looking at their care card.

**Provide privacy for resident by closing bedroom door, and closing the privacy curtain.

Post-Procedures

The 5 steps to ALWAYS do after finishing a skill. Failure to do so can result in an automatic failing grade, and/or removal from the program. For the certification test, you must perform these skills after every section of your test.

Step 1. Resident Prefrences*

Step 2. Ensure residents comfort level

Step 3. Ensure residents safety

Step 4. Take care of equipment

Step 5. Remove privacy measures

*e.g. "Would you like some water? Where would you like it at?"