Assisting with Passive Range of Motion-Lower Extremities for ARC Testing

Equipment: Bath blanket or sheet

Procedure:

1.) Knock on door and listen for residents response.

2.) Address resident by name and introduce self.

3.) Wash hands.

4.) Explain procedure to resident speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.

5.) Provide for residents privacy during procedure with curtain, screen, or door.

6.) Adjust bed to safe working height (such that residents feet touch the floor when sitting on edge of bed);lock wheels.

7.) Instruct client to inform CNA if experiencing pain during exercise.

8.) Support residents leg at knee and ankle while performing PROM for knee.

9.) Bend the knee to the point of resistance and then return leg to residents normal position (extension/flexion) (REPEAT AT LEAST 3 TIMES)

10.) Support foot and ankle close to the bed while performing PROM for ankle.

11.) Push/pull foot toward head (dorsiflexion), and push/pull foot down, toes point down (plantar flexion) (REPEAT AT LEAST 3 TIMES)

12.) While supporting the limb, move joints gently, slowly, and smoothly through the range of motion to the point of resistance, discontinuing exercise if pain occurs.

13.) Place signaling device within residents reach.

14.) Leave bed in lowest position.  Remove privacy measures.

15.) Wash hands.

16.) Report any changes in resident to nurse.  Document procedure according to facility guidelines.

Assisting with Passive Range of Motion-Upper Extremities for ARC Testing

Equipment: Bath blanket or sheet

Procedure:

1.) Knock on door and listen for residents response.

2.) Wash hands before contact with resident.

3.) Address resident by name and introduce self.

4.) Explain procedure to resident speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.

5.) Provide for residents privacy during procedure with curtain, screen, or door.

6.) Adjust bed to safe working height; lock wheels.

7.) Instruct client to inform CNA if experiencing pain during exercise.

8.) Support residents arm at elbow and wrist while performing range of motion for shoulder.

9.) Raise residents straightened arm from side position forward to above head and return arm to side of body (flexion/extension) (REPEAT AT LEAST 3 TIMES).

10.) Raise arm to side position above head and return arm to side of body (abduction/adduction) (REPEAT AT LEAST 3 TIMES).

11.) While supporting the limb in two places, move joint gently, slowly, and smoothly through the range of motion to the point of resistance, discontinuing exercise if pain occurs.

12.) Place signaling device within residents reach.

13.) Leave bed in lowest position.  Remove privacy measures.

14.) Wash hands.

15.) Report any changes in resident to nurse.  Document procedure according to facility guidelines.

Assisting Resident to Ambulate with Transfer Belt for ARC Testing

Equipment: Non-skid footwear, gait belt, 2 paper towels

Procedure:

1.) Knock on door and listen for residents response.

2.) Address resident by name and introduce self.

3.) Wash hands.

4.) Explain procedure to resident speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.

5.) Provide for residents privacy during procedure with curtain, screen, or door.

6.) Adjust bed to safe working height (such that residents feet touch the floor when sitting on edge of bed);lock wheels.

7.) Before ambulating, put on and properly fasten non-skid footwear. (place towels under feet to protect bed)

8.) Before standing resident, place bed at a safe and appropriate level for the resident.

9.) Stand in front of and facing the resident.

10.) Brace residents lower extremities.

11.) With transfer (gait) belt: Place belt around residents waist and grasp the belt, while assisting resident to stand.

12.) With transfer(gait) belt: Walk slightly behind and to one side of resident for the full distance, while holding onto the belt.

13.) After ambulation, assist resident to a position of comfort and safety in bed and remove transfer belt, if used.

14.) Place signaling device within residents reach.

15.) Leave bed in the lowest position.  Remove privacy measures.

16.) Wash hands.

17.) Report any changes in resident to nurse.  Document procedure according to facility guidelines. 

Putting a Knee-High Elastic Stocking on a Resident for ARC Testing

Equipment: Elastic stockings of correct size

Procedure:

1.) Knock on door and listen for residents response.

2.) Address resident by name and introduce self.

3.) Wash hands.

4.) Explain procedure to resident speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.

5.) Provide for residents privacy during procedure with curtain, screen, or door.

6.) Adjust bed to safe working height; lock wheels.

7.) Turn stocking inside-out at least to heel area.

8.) Gently place foot of stocking over toes, foot, and heel.

9.) Gently pull top of stocking over foot, heel, and leg.

10.) Move residents foot and leg gently and naturally, avoiding force and over-extension of limb and joints throughout procedure.

11.) Make sure stocking is properly placed (heel positioned correctly); it must fit smoothly with no twists or wrinkles.

12.) Place signaling device within residents reach.

13.) Wash hands.

14.) Leave bed in the lowest position. Remove privacy measures.

15.) Report any changes in resident to nurse.  Document procedure according to facility guidelines.

Feeding a Resident Who Cannot Feed Self for ARC Testing

Equipment: Food tray with residents menu card, clothing protector

Procedure:

1.) Knock on door and listen for residents response.

2.) Address resident by name and introduce self.

3.) Wash hands.

4.) Explain procedure to resident speaking slowly, clearly, and directly, maintaining face-to-face contact whenever possible.

5.) BEFORE FEEDING RESIDENT- pick up name card and verify that resident has received the tray prepared for him/her.  Place try where it can be seen by client.

6.) BEFORE FEEDING RESIDENT- ensure resident is in an upright sitting position.

7.) Clean clients hands before feeding.

8.) Assist resident to put on clothing protector.

9.) Sit facing resident.

10.) Offer different types of food, allowing for resident choices.

11.) Offer the food in bite-sized pieces.

12.) Make sure residents mouth is empty before next bite of food or sip of beverage.

13.) Offer beverage to resident throughout meal.

14.) Talk with resident during meal.

15.) Wipe food from residents mouth and hands as necessary and at the end of the meal.  Use a wet washcloth or paper towel at the end of the meal if needed.

16.) Remove clothing protector and dispose in proper container.

17.) Remove food tray.

18.) Place signaling device within residents reach.

19.) Wash hands.

20.) Report any changes in resident to nurse.  Document percentage eaten and amount of liquids consumed according to facility guidelines.

Making an Occupied Bed for ARC Testing

Equipment: Fitted bottom sheet, flat top sheet, blanket, bath blanket, pillow case, barrier

Procedure:

1.) Knock on door and listen for residents response.

2.) Address resident by name and introduce self.

3.) Wash hands.

4.) Explain procedure speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.

5.) Place clean linen on clean surface within easy reach (e.g., bedside stand, over-bed table, or chair)

6.) Provide for residents privacy during procedure with curtain, screen, or door.

7.) Adjust bed to safe working height; lock wheels.

8.) Lower head of bed before moving resident.

9.) Loosen top linen from the end of the bed on working side.

10.) Unfold bath blanket over the top sheet and remove top sheet.

11.) Raise side rail, go to other side.

12.) Loosen bottom soiled linen on working side and move bottom soiled linen toward center of bed.

13.) Place and tuck in clean bottom linen or fitted bottom sheet on working side (if flat sheet is used, tuck in at top and working side), then raise side rail.

14.) Go to other side of bed, lower side rail, then assist resident to turn onto clean bottom sheet.

15.) Remove soiled bottom linen.

16.) Pull and tuck in clean bottom linen, finishing with bottom sheet free of wrinkles.

17.) Cover resident with clean top sheet and blanket.  Remove bath blanket.

18.) Change pillowcase.

19.) Loosen linen over toes to avoid pressure.

20.) Center and anchor clean linen over resident.

21.) Avoid contact between your clothing and soiled linen throughout procedure.

22.) Dispose of soiled linen in soiled linen container.

23.) Place signaling device within residents reach.

24.) Wash hands.

25.) Leave bed in the lowest position.  Remove privacy measure.

26.) Report any changes in resident to nurse.  Document procedure according to facility guidelines.

Providing Catheter Care on Female Resident for ARC Testing

Equipment: Basin with water (105 degrees), soap, thermometer, gloves, incontinent pad, 2 wash cloths, towel, bath blanket, barrier

Procedure:

1.) Knock on door and listen for residents response.

2.) Address resident by name and identify self.

3.) Wash hands.

4.) Explain procedure speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.

5.) Provide for residents privacy during procedure with curtain, screen, or door.

6.) Adjust bed to safe working height;lock wheels.

7.) Test water temperature in basin to determine if it is safe and comfortable before washing and adjust if necessary.

8.) Put on clean gloves before contact with linen and/or resident.

9.) Place towel or pad under residents buttocks before washing.

10.) Cover resident with bath blanket and move top linens to foot of bed.

11.) Expose only area surrounding catheter. (Use towel to cover privates everytime you prepare items to work with)

12.) Apply soap to wet washcloth.

13.) Hold catheter near meatus, without tugging while cleaning at least four inches of catheter nearest meatus, moving in only one direction (i.e., away from meatus) using a clean area of the cloth for each stroke.

14.) Rinse at least four inches of catheter nearest meatus, moving only in one direction (i.e., away from meatus) using a clean area of the cloth for each stroke.

15.) Replace top covers and remove bath blanket.

16.) Dispose of linen in soiled linen container.

17.) Avoid contact between your clothing and soiled linen/pads throughout procedure.

18.) Empty, rinse, and wipe basin and return it to proper storage.

19.) Remove and dispose of gloves per facility policy.

20.) Place signaling device within residents reach.

21.) Wash hands.

22.) Leave bed in the lowest position.  Remove privacy measures.

23.) Report any changes in resident to nurse.  Document procedure according to facility guidelines.

Measuring and Recording Urinary Output for ARC Testing

Equipment: Bedpan with urine, measuring container, gloves, pen, paper

Procedure:

1.) Knock on door and listen for residents response.

2.) Wash hands before contact with resident and introduce self and address resident by name.

3.) Put on clean gloves before handling bedpan.

4.) Pour the contents of the bedpan into measuring container without spilling or splashing any of the urine or touching bedpan to rim of container.

5.) Measure the amount of urine at eye level (on a flat surface).

6.) After measuring urine,empty contents of measuring container into toilet without splashing.

7.) Clean measuring container and pour rinse water into toilet and dry with paper towel.  Clean bedpan and pour rinse water into toilet.

8.) Return bedpan and measuring container to proper storage.

9.) Remove and dispose of gloves into wastebasket.

10.) Wash hands before recording output.

11.) Record contents of container in output column (must be within +/- 25 ml of instructors reading).

12.) Report any changes in resident to nurse.  Document procedure according to facility guidelines.

Weight of Ambulatory Resident for ARC Testing

Equipment: Balanced scales

Procedure:

1.) Knock on door and listen for residents response.

2.) Address resident by name and identify self.

3.) Wash hands.

4.) Explain procedure to resident speaking clearly, slowly, and directly, while maintaining face-to-face contact whenever possible.

5.) Ensure resident has shoes on before walking to scale.

6.) Start with scale balanced at zero before weighing resident.

7.) Determine residents weight.

8.) Assist resident off scale before recording weight, maintaining safety.

9.) Record weight; must be within +/- 2 lbs. of instructors reading.

10.) Place signaling device within residents reach.

11.) Wash hands.

12.) Report any changes in resident to nurse.  Document procedure according to facility guidelines.

Taking and Recording Blood Pressure (Two-Step Procedure) for ARC Testing

Equipment: Sphygmomanometer, stethoscope, alcohol wipes, pen, paper

Procedure:

1.) Knock on door and listen for residents response.

2.) Address resident by name and introduce self.

3.) Wash hands before contact with resident.

4.) Explain procedure to resident speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.

5.) Adjust bed to safe working height (if resident is in bed).

6.) Before using stethoscope, wipe diaphragm and earpieces with alcohol.

7.) Deflate cuff by squeezing it.

8.) Expose residents upper arm and position arm with palm up.

9.) Locate brachial pulse with fingertips. (bend of elbow)

10.) Place blood pressure cuff snugly on residents upper arm, with sensor placed over artery.

11.) Locate radial pulse with fingertips.

12.) Inflate the cuff until you don't feel pulse anymore and take note of the number.  Add 30.

13.) Deflate cuff.

14.) Locate brachial pulse with fingetips.

15.) Place diaphragm over brachial artery. (don't forget to gently tap diaphragm to make sure its on)

16.) Place earpieces of stethoscope in ears. (make sure earpieces are facing away from you when putting them in)

17.) Inflate cuff to estimated number.  No more than 30mm Hg beyond where pulse was last felt.

18.) Deflate cuff slowly,listening for systolic and diastolic pressures.

19.) Remove cuff and squeeze excess air out of it.

20.) Place signaling device within residents reach.

21.) Wash hands.

22.) Record both systolic and diastolic pressures; must be within+/- 8mm Hg of instructors reading.

23.) Leave bed in the lowest position if adjusted earlier.

24.) Report any changes in resident to nurse.  Document procedure according to facility guidelines. 

Counting and Recording Respirations for ARC Testing

Equipment: Watch with second hand

Procedure:

1.) Knock on door and listen for residents response.

2.) Wash hands before contact with resident.

3.) Identify self to resident and address resident by name.

4.) Provide for residents privacy during procedure with curtain, screen, or door.

5.) Count respirations for one full minute.

6.) Place signaling device within residents reach.  Remove any privacy measures.

7.) Wash hands.

8.) Record respiration rate; must be within +/- 2 breaths of instructors reading.

9.) Report any changes in resident to nurse.  Document procedure according to facility guidelines.

Taking and Recording Radial Pulse for ARC Testing

Equipment: Watch with second hand, pen, paper

Procedure: 

1.) Knock on door and listen for residents response.

2.) Wash hands before contact with resident.

3.) Identify self to resident and address resident by name.

4.) Explain procedure to resident, speaking clearly, slowly, and directly, maintaining face to face contact whenever possible.

5.) Provide for residents privacy during procedure with curtain, screen, or door.

6.) Place fingertips on thumb side of residents wrist to locate pulse.

7.) Count beats for one full minute.

8.) Place signaling device within residents reach.  Remove privacy measures.

9.) Wash hands.

10.) Record pulse rate; must be within +/- 4 beats of instructors reading.

11.) Report any changes in resident to nurse.  Document procedure according to facility guidelines.

Taking and Recording Oral Temperature with Glass Thermometer for ARC Testing

Equipment: Glass thermometer, thermometer sheaths, alcohol wipes, gloves, pen, paper

Procedure:

1.) Knock on door and listen for residents response.

2.) Wash hands before contact with resident.

3.) Address resident by name and introduce self.

4.) Explain procedure to resident, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.

5.) Provide for residents privacy during procedure with curtain, screen, or door.

6.) Adjust bed to safe working height if resident is lying in bed; lock wheels.

7.) Put on clean gloves before handling oral thermometer.

8.) Clean thermometer with alcohol wipes (or cool water with soap especially if its an old mercury thermometer)

9.) Hold oral thermometer firmly by stem.  Before inserting oral thermometer in residents mouth, shake oral thermometer down to 96 degrees F or lower.

10.) Place a sheath/protective cover on oral thermometer.

11.) Insert bulb end of oral thermometer into residents mouth, under tongue and to one side.

12.) Tell resident to hold oral thermometer in mouth with lips closed and assist as necessary.

13.) Leave thermometer in place for at least 3 minutes.

14.) Remove sheath/protective cover and dispose of in wastebasket.

15.) Read oral thermometer before cleaning thermometer.

16.) Clean oral thermometer and return to container for used thermometers.

17.) Remove gloves and dispose of in wastebasket.

18.) Place signaling device within residents reach.

19.) Wash hands.

20.) Immediately record oral temperature, date, time, and method used ("O" for oral); must be within +/- 0.2 degrees of instructors reading.

21.) Leave bed in the lowest position if adjusted earlier.  Remove privacy measures.

22.) Report any changes in resident to nurse.  Document procedure according to facility guidelines.

Transferring a Resident from Bed to Wheelchair for ARC Testing

Equipment:  Residents wheelchair (check ID), non-skid footwear, barrier for feet (2 paper towels), gait belt

Procedure:

1.) Knock on door and listen for residents response.

2.) Address resident by name and introduce self.

3.) Wash hands before contact with resident.

4.) Explain procedure to resident speaking clearly, slowly, and directly maintaining face-to-face contact whenever possible.

5.) Provide for residents privacy with curtain, screen, or door.

6.) Before transferring resident, put on non-skid footwear on resident and securely fasten. (with paper towels under feet to protect bed.)

7.) Before transferring place wheelchair next to bed.

8.) Fold up footrests.

9.) Place bed in a safe and appropriate level for the residents sitting height.

10.) Before transferring resident, lock wheels on wheelchair.

11.) Check and/or lock bed wheels.

12.) Support residents back and hips and assist resident to sitting position with feet flat on floor.

13.) With transfer/gait belt: Apply belt, then stand in front of resident, positioning self to ensure safety for yourself and resident during transfer (i.e., knees bent, feet apart, back straight) place belt around residents waist, and grasp belt.

14.) Provide instructions to enable resident to assist in transfer.

15.) Brace residents lower extremities to prevent slipping.  (Their feet together and yours formed in a triangle against them with your knees against theirs.)

16.) Count to 3 (or say other prearranged signal) to alert resident to begin transfer.

17.) On signal, gradually assist resident to stand.

18.) Assist resident to pivot to front of wheelchair with back of residents legs against wheelchair.

19.) Lower resident into wheelchair.

20.) Position resident with hips touching back of wheelchair and remove transfer belt, if used.

21.) Position residents feet on footrests.

22.) Place signaling device within residents reach.  Remove privacy measures.

23.) Wash hands.

24.) Report any changes in resident to nurse.  Document procedure according to facility guidelines.

Turning a Resident (Lateral Position) for ARC Testing

Equipment: 4 pillows or supportive devices

Procedure:

1.) Knock on door and listen for residents response.

2.) Wash hands before contact with resident.

3.) Address resident by name and introduce self.

4.) Explain procedure to resident speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.

5.) Provide for residents privacy with curtain, screen, or door.

6.) Adjust bed to safe working height.  Lock wheels.

7.) Before turning resident, lower head of bed.

8.) Raise side rail on side to which residents body will be turned.

9.) Slowly roll resident onto side toward raised side rail while supporting residents body:

      -Cross residents arm over his chest.  Cross leg nearest you over far leg.

      -Stand with feet about 12 inches apart.  Bend knees.

      -Place one hand on residents shoulder and the other on residents hip nearest you.

      -Gently push resident toward the other side of the bed.  Shift weight from back leg to front              leg.

10.) Place or adjust pillow under residents head for support.

11.) Place supportive device or tightly rolled up pillow behind residents back.

12.) Goto opposite side of bed.  Adjust shoulder so resident is not lying on arm.

13.) Support top arm with body or supportive device.

14.) Place supportive device between legs with top knee flexed (knee and ankle supported).

15.) Cover resident with top linen.

16.) Place signaling device within residents reach.

17.) Leave bed in lowest position. Remove privacy measures.

18.) Wash hands.

19.) Report any changes in resident to nurse.  Document procedure according to facility guidelines.

Providing Perineal Care for the Female Resident for ARC Testing

Equipment: incontinent pad, bath blanket, 2 towels, 4 washcloths, gloves, basin of water (105 degrees), soap, cream for irritation if needed, barrier

Procedure:

1.) Knock on door and listen for residents response.

2.) Address resident by name and introduce self.

3.) Wash hands before contact with resident.

4.) Explain procedure to resident, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.

5.) Provide for residents privacy with curtain, screen, or door.

6.) Adjust bed to safe working height with rails up; lock wheels.

7.) Test water temperature and ensure it is safe and comfortable before washing, and adjust if necessary.

8.) Put on clean gloves before contact with linen, incontinent pad, and/or resident.

9.) Cover resident with bath blanket and move top linens to foot of bed.

10.) Place pad or protective linen under area.

11.) Expose only perineal area.  Wash perineal area with soapy washcloth, moving from front to back, while using a clean area of the washcloth for each stroke.

12.) Rinse perineal area, moving from front to back, while using a clean area of the washcloth for each stroke.

13.) Dry perineal area moving from front to back, using a blotting motion with towel.

14.) Turn resident on side.  Wash, rinse, and dry buttocks and peri-anal area.

15.) Reposition resident.  Replace top covers and remove bath blanket.

16.) Dispose of soiled linen and incontinent pad in proper containers.  Avoid contact between your clothing and soiled linens/pads throughout procedure.

17.) Empty, rinse, and wipe basin and return to proper storage.

18.) Wash hands.

19.) Place signaling device within residents reach.

20.) Leave bed in lowest position. Remove privacy measure.

21.) Report any changes in resident to nurse.  Document procedure according to facility guidelines.

Who is really inside?

When an old lady died in the geriatric ward of a hospital in England, it appeared she had left nothing of value.

The nurse, packing up her possessions, found this poem. The quality so impressed the staff that copies were distributed to all the nurses in the hospital. 

This poem then later appeared in the Christmas edition of "Beacon House News," a magazine of the Northern Ireland Mental Health Association. This was the Lady's bequest for posterity.

 

What do you see nurse, 
What do you see?
What are you thinking 
When you look at me?
A crabbit old woman, 
Not very wise,
Uncertain of habit 
With far away eyes. 

 

Who dribbles her food 
And makes no reply;
Then you say in a loud voice,
"I do wish you'd try."
Who seems not to notice 
The things that you do,
And forever is losing 
A stocking or shoe. 

 

Unresisting or not, 
Lets you do as you will;
With bathing or feeding, 
The long day to fill.
Is that what you're thinking, 
Is that what you see?
Then open your eyes nurse,
You're not looking at me. 

 

I'll tell you who I am, 
As I sit here so still,
As I move at your bidding,
As I eat at your will. 

 

I'm a small child of ten ...
With a father and mother,
And brothers and sisters 
Who love one another. 

 

A girl of sixteen,
With wings on her feet;
Dreaming that soon, 
A lover she'll meet.


A bride soon at twenty ...
My heart gives a leap;
Remembering the vows 
That I promised to keep. 

 

At twenty-five,
I have young of my own,
Who need me to build 
A secure and happy home. 

 

A woman of thirty,
My young now grow fast,
Bound together with ties 
That forever should last. 

 

At forty, my young ones 
Have grown up and gone;
But my man is beside me 
To see I don't mourn. 

 

At fifty, once more ...
Babies play 'round my knees;
Again we know children, 
My loved ones and me. 

 

Dark days are upon me, 
My husband is dead ...
I look at the future, 
I shudder with dread;
For my young are all rearing,
Young of their own,
And I think of the years 
And the love I have known. 

 

I am an old woman now, 
Nature is cruel,
‘Tis her jest to make old age 
Look like a fool.


The body, it crumbles,
Grace and vigor depart,
There is now a stone 
Where I once had a heart. 

 

But inside this old carcass, 
A young girl still dwells,
And now and again 
My battered heart swells.


 

I remember the joys, 
I remember the pain,
And I'm loving and living 
Life over again. 

 

I think of the years ...
All too few, gone too fast,
And accept the stark fact 
That nothing can last. 

 

So open your eyes nurses,
Open and see ...
Not a "Crabbit Old Woman,"
Look closer ... see "Me." 

~ Phyllis McCormack ~ 

Dressing a Resident with an Affected (Weak) Right Arm for ARC Testing

Equipment: Clean clothes of residents choice, non-skid footwear

Procedure:

1.) Knock on door and listen for residents response.

2.) Wash hands before contact with resident.

3.) Identify self to resident and address resident by name.

4.) Explain procedure to resident, speaking clearly, slowly, and directly, maintaining face to face contact whenever possible.

5.) Provide for the residents privacy with curtain, screen, or door.

6.) Ask resident which outfit they would like to wear and dress resident in their outfit of choice.

7.) Remove residents gown without completely exposing resident.

8.) Assist resident to put the affected arm through the correct sleeve of the shirt,sweater, or slip before placing garment on unaffected arm.

9.) Assist resident to put on skirt, pants, or dress.

10.) Apply non-skid footwear.

11.) Put on all items,moving residents body gently and naturally, avoiding force and over-extension of limbs and joints.

12.) Finish with resident dressed appropriately.  (e.g., clothing right side out, zippers/buttons fastened, etc)

13.) Place gown in soiled linen container.

14.) Before leaving resident, place signaling device within residents reach.

15.) Remove privacy measures.

16.) Wash hands.

17.) Report any changes in resident to  nurse.  Document procedure according to facility guidelines.

Examples of Mechanical Lifts

Hoyer Lift

The lift and transfer is the traditional style, portable lift constructed of heavy-duty steel. The easy rolling casters, two locking in the back and four swivel in the front, allows for positioning into various locations.  Patient is placed in the sling and lowered to desired location.

Stand-Assist Lift

Used when resident is seated and needs help standing up.  A sling is attached to hooks on lift after being wrapped around back of resident to give support from behind.

Sling

"No Lift" Booster

Eases back strain by making even heavy residents easier to move toward the headboard. A flat tube of fabric with a slippery interior surface. Position the resident on top of the tube just as on a draw sheet, then slide the top tube layer upwards, using the reinforced edges. No lifting needed. Standard size fits most; 4 or fewer staff members can use bariatric size for residents up to 600 lbs. 

You know you're a nurse if...

• You believe that every patient needs tlc, diazepam,temazepam, and haloperidol. 

• You would like to meet the inventor of the Nurse call buzzer some night in a dark alley. 

• You believe not all patients are annoying, some are unconscious. 

• Your sense of humour gets more warped each year. 

• You can only tell time by the 24 hr clock. 

• Almost everything can seem humorous....eventually. 

• When asked what colour that patients diarrheic was, you show them your 
Shoes. 

• You know the smell of different diarrhea to identify it. 

• Every time you walk you make a jingling noise because of all the 
Scissors and clamps in your pocket.

• You can tell the pharmacist more about the medication they are dispensing than they know. 

• You carry more "spare" meds in your pocket rather than waiting for pharmacy to deliver them. 

• You refuse to watch ER because it is too much like the real thing and it triggers flashbacks. 

• You check the caller id on your day off to see if anyone from the hospital is trying to call and ask you to work. 

• You've been telling stories in a restaurant and made someone at another table throw up. 

• Notice that you are using more 4 letter words than you did before you started nursing. 

• Everytime someone asks you for a pen you can find at least 4 of them on you. 

• You can intubate your friends at parties. 

• You don't get excited about blood unless it's your own. 

• You live by the motto "to be right is only half the battle, to convince the doctor is more difficult" 

• You've basted your thanksgiving turkey with a nasogastric syringe. 


• You've told a confused patient that your name was that of your co-worker and to holler if they need help. 

• Eating microwave popcorn out of a clean bedpan is perfectly normal. 

• Your bladder can expand to the size of a Mack Truck's Radiator Sump. 

• When checking the level of a patient’s orientation you aren't sure of the answer. 

• You find yourself checking out other customers veins in grocery waiting lines. 

• You can sleep soundly at the hospital cafeteria table on your dinner break and not be embarrassed when you wake up. 

• You avoid unhealthy looking shoppers in the mall for fear that they will drop near you and you'll have to do cpr on your day off. 

• You have ever referred to someone's death as a transfer to the "Eternal Care Unit".

• You have ever wanted to hold a seminar entitled "Suicide ... Doing It Right".

• You have ever had a patient look you straight in the eye and say "I have no idea how that got stuck in there".

• You have ever had to leave a patient's room before you begin to laugh uncontrollably.

• You throw a party for a co-worker and use a urinal (clean of course) as a lemon-aid pitcher and use a bed sheet for a tablecloth 

• You believe that the government should require a permit to reproduce.


• You hate to get dressed in "real clothes" because scrubs are what you live in and why can't they make jeans that comfortable. 
• You have ever restrained someone and it was not a sexual experience.
• Your most common assessment question is "what changed tonight to make it an emergency after 6 hours / days / weeks / months / years)?".


• You often stay awake for 24+ hrs at a time when you work nights realize you don't need alcohol or drugs to hallucinate just lack of 
sleep... 

• You pull over in some parking lot after working nights because you are too tired to drive home and wake up to someone knocking on your window thinking you have had a stroke because you are passed out in your car and drooling. 

• Your finger has gone places you never thought possible. 

• You have seen more penises than any prostitute 
• You disbelieve 90% of what you are told and 75% of what you see.
• You've sworn to have "Not For Resuss" tattooed on your chest. 
• You threaten to strangle anyone who even starts to say the "q" word when it is even remotely calm.

The Cute Little Lady in the Pink Sweater by Dawn Maselli, RN

They can take my meal away before I’m done 
They can talk to me like I’m dumb 
They can refer to me as a "Feeder" 
Fluff me up to make me look neater 
They talk about me like I’m not Here 
They address me as "honey" "cutie and "dear". 
But there are things they can’t do to me 
As they insult my dignity 
Oh there are things they can’t do to me 
They can’t take away my memories 
My Roles through this life cement my presence 
With withered mind they call senescence 
I am rich in culture, wisdom and knowledge 
That medical people can’t learn in college 
I am a mother, a sister, a historian, a wife 
I have mastered many roles throughout my life 
I created warm meals in my day 
I wiped my children’s tears away 
I cared for a close knit family 
Who look up to and value me 
And now I master another role 
Dependent patient with golden soul 
If just one of "them" would sit with me 
I’d share with them this history 
And if one would stay awhile 
I’d teach them that I’m still God’s child. 
They are so busy this I know 
I have aged and have gotten slow 
This I must share in written word 
I may not be seen but I will be heard 
They say I’m anxious, noisy and loud 
This life has taught me not to be too proud 
I am too many things to capture in a letter 
I am so much more than the lady in the pink sweater 
If you’ve listened from the start 
I may help you find your heart.

Cleaning Upper and Lower Dentures for ARC Testing

Equipment: Gloves, dentures in labeled denture cup, sink with running water, toothbrush, toothpaste, basin with liner (washcloth or paper towels), barrier

Procedure:

1.) Knock on door and listen for residents response.

2.) Wash hands before beginning procedure.

3.) Put on gloves before handling dentures.

4.) Before handling dentures, protect dentures from possible breakage (e.g., by lining sink/basin with paper towels/washcloth and by filling it with water).

5.) Place dentures in basin.

6.) Rinse denture cup and fill with cool water.

7.) Rinse dentures in cool running water before brushing them.

8.) Apply toothpaste or denture cleanser to toothbrush.

9.) Brush dentures on all surfaces.

10.) Rinse all surfaces of dentures under cool running water.

11.) Place dentures in clean denture cup with cool water (may use solution if desired); return denture cup to proper storage.

12.) Clean and return implements to proper storage.

13.) Maintain clean technique with placement of dentures and toothbrush throughout procedure.

14.) Dispose of sink liner in appropriate container and drain sink.

15.) After completing procedure, remove gloves without contaminating self and dispose of gloves appropriately.

16.) Wash hands.

17.) Report any changes in resident to nurse.  Document procedure according to facility guidelines.

Providing Mouth Care for ARC Testing

Equipment: Gloves, towel, toothpaste, toothbrush (or toothette), cup of water, diluted mouthwash, emesis basin, and barrier

Procedure:

1.) Knock on door and listen for residents response.

2.) Address resident by name and introduce yourself.

3.) Wash hands before contact with resident.

4.) Explain the procedure to the resident speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.

5.) Provide for residents privacy throughout procedure using curtain, screen, or door.

6.) Adjust bed to safe working height, if done in bed; lock wheels.

7.) Before providing mouth care, ensure resident is in a upright sitting position.

8.) Put on clean gloves before providing mouth care.

9.) Place towel across residents chest.

10.) Moisten toothbrush or toothette.

11.) Apply toothpaste to toothbrush or toothette.

12.) Clean entire mouth (including tongue and all surfaces of teeth), using gentle, circular motion. (7 surfaces including tongue)

13.) Assist resident to rinse his or her mouth.

14.) Hold emesis basin to residents chin, encouraging resident to spit out rinse water.

15.) Wipe residents mouth and remove towel.

16.) Dispose of soiled linen in soiled linen container.

17.) Maintain clean technique with placement of toothbrush or toothette throughout procedure.

18.) Clean, rinse, and return implements to proper storage.

19.) Remove and dispose of gloves appropriately.

20.) Reposition head of bed to residents choice and leave bed in lowest position if previously adjusted.

21.) Place signaling device within residents reach.

22.) Removes privacy measures.

23.) Report any changes to nurse.  Document procedure according to facility guidelines.

Providing Foot Care for ARC Testing

Equipment: Basin with water (105 degrees), soap, washcloth, towel, gloves, lotion, bath mat (or bed protector if done in bed), clean socks, non-skid footwear

Procedure:

1.) Knock on door and listen for residents response.

2.) Address resident by name and introduce yourself.

3.) Wash hands before contact with resident.

4.) Explain procedure to resident speaking slowly, clearly, and directly, maintaining face-to-face contact whenever possible.

5.) Provide for the residents privacy during procedure with curtain, screen, or door.

6.) Adjust bed to safe working height (if done in bed); lock wheels.

7.) Test water temperature and ensure it is safe and comfortable before placing residents foot in water; adjust if necessary.

8.) Place basin on bath mat/bed protector.

9.) Put on clean gloves before washing feet.

10.) Completely submerge foot in water for 3-5 minutes.

11.) Remove foot from water; wash entire foot, including between the toes, with soapy washcloth.

12.) Rinse entire foot, including between the toes.

13.) Dry entire foot, including between the toes.

14.) Put lotion in hand and warm the lotion by rubbing hands together.

15.) Massage lotion into entire foot (top and bottom), removing excess (if any) with a towel; do not put lotion between toes.

16.) Assist resident to replace sock and non-skid footwear.

17.) Support foot and ankle properly throughout procedure.

18.) Before leaving resident, place signaling device within residents reach.

19.) Return bed to appropriate level if previously adjusted.  Remove privacy measures.

20.) Empty, rinse, and wipe basin, and return to proper storage.

21.) Dispose of soiled linen in soiled linen container.

22.) Remove gloves and dispose of in wastebasket.

23.) Wash hands.

24.) Report any changes in resident to nurse.  Document procedure according to facility guidelines.

Providing Fingernail Care for ARC Testing

Equipment: Basin with water (105 degrees), orangewood stick, emery board, towel, paper towel, lotion, gloves, bed protector if done in bed

Procedure:

1.)Knock on door and listen for residents response.

2.) Wash hands before contact with resident.

3.) Address the resident by name and introduce self.

4.) Explain procedure to resident, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.

5.) Provide for residents privacy (if desired) during procedure before immersing residents fingers in water, and adjust if necessary.

6.) Test water temperature and ensure it is safe and comfortable before immersing residents fingers in water, and adjust if necessary.

7.) Immerse residents fingers in basin of water which is placed at a comfortable level (3-5 mins)

8.) Dry residents hand, including between fingers.

9.) Put on clean gloves before cleaning under fingernails.

10.) Clean under fingernails with orangewood stick.

11.) Wipe orangewood stick on paper towel after each nail.

12.) Groom nails with file or emery board.

13.) Finish with nails smooth and free of rough edges.

14.) Apply lotion from fingetips to wrist.

15.) Place signaling device within residents reach.

16.) Empty, rinse, and wipe basin, and return to proper storage.

17.) Dispose of soiled linens in soiled linen container, paper towel, orange stick, and file in trash.

18.) Remove and dispose of gloves in trash.

19.) Wash hands.

20.) Report any changes in resident to nurse.  Document procedure according to facility guidelines.

Recording % of Meal Completion

Remember- 30 ccs=1 oz

BREAKFAST:                        %

Entree-                                   40

(Entree=40%  May consist of: meat 20%/eggs 20%

                                                      pancakes 20%/eggs 20%

                                                      eggs only 40%

                                                      pureed egg 50%)

Cereal-                                    20

Milk (8 oz)-                            20

Toast-1 slice-                         10

Juice-                                      10

                                     Total-100%

LUNCH:

Entree-                                  40

Starch-                                   30

(Starch-Consists of bread 10%

rice, potatoes, noodles 20%)

Vegetable-                             10

Dessert-                                 10

Milk (4oz)-                            10

                                    Total-100%

SUPPER:

Entree-                                  40

Starch-                                   20

(Starch-Sandwich 60%)

Soup or Juice-                       10

Salad-                                     10

Dessert-                                 10

Milk (4oz)-                             10

                                      Total-100%

Approaching Death

Common signs of approaching death include:

*blurred and failing vision

*unfocused eyes

*impaired speech

*diminished sense of touch

*loss of movement, muscle tone, and feeling

*rising or below-normal body temperature

*decreasing blood pressure

*weak pulse that is abnormally slow or rapid

*slow, irregular respirations or rapid, shallow respirations, called Cheyne-Stokes respirations

*a "rattling" or "gurgling" sound as the person breathes

*cold, pale skin

*mottling, spotting, or blotching of skin caused by poor circulation

*perspiration

*incontinence (both urine and stool)

*disorientation or confusion

Some guidelines to follow:

-keep room lighting low to reduce glare

-give mouth care often

-keep sheets wrinkle-free

-reposition resident often

-spend time and listen

-do not babble or be especially cheerful or sad

-be professional

High Blood Pressure (Hypertension)

When blood pressure is consistently 140/90 or higher, a person is diagnosed as having hypertension.  If blood pressure is between 120/80 and 139/89 mmHg, it is called prehypertension.

Hypertension is caused by hardening and narrowing of the blood vessels.  It can also result from kidney disease,tumors of the adrenal gland, and pregnancy.  It can form in people of any age.

Individuals may complain of headache, blurred vision, and dizziness in the early stages.

High blood pressure can lead to serious problems such as CVA (stroke), heart attack, kidney diease, or blindness.  Treatment to control this problem is vital.  Residents may take diuretics or medication that lowers cholesterol for a treatment.  Diuretics are drugs that reduce fluid in the body.  Residents may also have a prescribed exercise program or may be on a special low-fat, low-sodium diet.

Cancer

Cancer is a general term used to describe many types of malignant tumors which are clusters of abnormally growing cells.  Benign tumors grow slowly in local areas and are considered non-cancerous.  Malignant tumors grow rapidly and they invade surrounding tissues.

Cancer often appears first in the breast, colon, rectum, uterus, prostate, skin, or lungs.

7 Warning Signs of Cancer

1.) Change in bowel or bladder habits

2.) A sore that does not heal

3.) Unusual bleeding or discharge

4.) Thickening or lump in the breast or elsewhere

5.) Indigestion or difficulty swallowing

6.) Obvious change in a wart or mole

7.) Nagging cough or persistant hoarsness

Modified Bed Bath for ARC Testing

This consists of washing the face, one arm, hand, and underarm.

Equipment: 2 washcloths, 2 towels, bath blanket, gown, basin, water(105 degrees), soap, barrier, lotion, deodorant, and gloves

Always wear gloves!

A-assemble equipment

W-wash hands

I-introduce self

P-provide privacy

E-explain/direct

S-safety

1.) Place barrier over table and place equipment on top.  (Barrier is usually a towel to help protect personal table.)

2.) Adjust bed to safe working height with rails up.

3.) Put rail down nearest you and place bath blanket over bed covers.

4.) Pulls back bed covers underneath the bath blanket.

5.) Remove gown while keeping resident covered.

6.) Beginning with eyes, washes eyes with wet washcloth (no soap), using a different area of the washcloth for each eye, washing inner aspect to outer aspect then proceed to wash face.

7.) Dry off face with towel.

8.)Expose one arm and place towel under arm.

9.) Apply soap to wet washcloth and wash from the hand working your way up the arm in a circular motion and do the underarm last.

10.) Rinse and dry arm the same way.

11.) Rub lotion on hand and arm and dab off any excess.

12.) Apply deodorant.

13.) Put clean gown on resident.

14.) Pull bed covers back up over bath blanket and slide bath blanket out from under.

15.) Lower bed back to lowest position with rails up for safety.  Then put rails down.

16.) Empty rinse and dry basin in bathroom then place it in the dirty supply area.

17.) Dispose of used gown and linen into soiled linen container.  (Always hold linen away from you when carrying it even if it's clean.)

17.) Remove gloves and check your basics.

C-comfort

S-safety

C-call bell

O-observe

R-record/report

E-equipment away

*wash hands 

Examples of Passive Range of Motion Movements (PROM)

Normal Ranges for Adult Vital Signs

Temperature:          *Fahrenheit          *Celsius

Oral-                           97.6-99.6              36.5-37.5

Rectal-                        98.6-100.6           37.0-38.1

Axillary-                     96.6-98.6              36.0-37.0

Pulse: 60-90 beats per minute

Respirations: 12-20 respirations per minute

Blood Pressure:

Normal:

Systolic- 100-119

Diastolic- 60-79

Prehypertension:

Systolic- 120-139

Diastolic- 80-89

High:  140/90 or above

(Prehypertension means that the person does not have high blood pressure now but is likely to have it in the future.)

Some Basic Abbreviations for Nursing Assistants

p-after

COPD-chronic obstructive pulmonary disorder

hypo-low, less than normal

CVA-cerebrovascular accident, stroke

R-respirations

N/A-not applicable

q.i.d., qid-four times a day

FWB-full weight bearing

FF-force fluids

hyper-above normal, too fast, rapid

N.A.-nursing assistant

tx-treatment

q2h-every 2 hours

SDAT-Senile Dementia Alzheimer Type

ASVD-arteriosclerotic vascular disease

NCS-no concentrated sweets

ASHD-arteriosclerotic heart disease

DM-Diabetes Mellitus

IDDM-Insulin Dependent Diabetes Mellitus

DON-director of nursing

G/C, g/c-Geri-chair

hx-history

HOB-head of bed

OOB-out of bed

T.P.R.-temperature, pulse, and respiration

hs-hour of sleep

NIDDM-Non-insulin Dependent Diabetes Mellitus

NAS-no added salt

NKA-no known allergies

BRP-bathroom privileges

NPO-nothing by mouth

CHF-congestive heart failure

CBR-complete bedrest

MRSA-methicillin resistant staph aureus

OBRA-Omnibus Budget Reconciliation Act

fx-fracture

t.i.d., tid-three times a day

S/P-status post

URI-upper respiratory infection

PPE-personal protective equipment

BKA-below the knee amputation

DNR-do not resuscitate

AKA-above the knee amputation

stat-immediately

vs-vital signs

 T.-temperature

q4h-every 4 hours

p.r.n., prn-when necessary

q3h-every 3 hours

q.h., qh-every hour

FR-fluid restriction

LTC-long-term care

I&O-intake and output

b.i.d.-two times a day

BP,B/P-blood pressure

BM-bowel movement

cc-cubic centimeters

amb-ambulatory

ADL-activities of daily living

lb.(s)-pound(s)

NA-sodium

ht-height

h, hr-hour

TB-tuberculosis

wt.-weight

w/c-wheelchair

UTI-urinary tract infection

RN-Registered Nurse

ROM-range of motion

Testable Skills for Prospective Nursing Assistants

Here is a list of all of the testable skills that you may have to perform with one always being "Washing hands" and only 4 randomly selected other skills.

There are a total of 24.

Washing Hands     Modified Bed Bath     Fingernail Care     Foot Care     Mouth care-conscious     Dentures     Dressing with affected side     Bedpan     Peri-Care     Lateral Positioning(Turning a resident)     Transfer from bed to w/c      Oral temperature     Radial Pulse     Respirations     Blood pressure-2 step     Weight of amb resident      Measuring urinary output     Catheter care     Occupied bedmaking     Feeding     Elastic Stockings     Ambulation     Passive range of motion-upper extremities     PROM-lower extremities

ALWAYS REMEMBER TO:

-Gather equipment needed before getting started.

-Greet resident by their name with respect and introduce yourself if you have not met.

-Wash your hands before performing any task as well as after.

-Explain what you are about to do before you do anything and get proper direction.

-Provide privacy.  

-Ensure safety.

-Make sure the resident is comfortable.

-Call bells must always be within residents reach.

-When performing a procedure, take the opportunity to observe any changes in the resident.

-Record what you did as well as anything you may have noticed different.

WASHING HANDS

Equipment: Sink with warm running water, soap, paper towels, trash can

1.) Take one paper towel and place it on counter.  Take off watch and place it on top of towel.

2.) Use another paper towel to turn faucet on and adjust heat.  Dispose of towel.

3.) Rinse hands.

4.) Pump alot of soap.

5.) Rub soap into all surfaces on hands doing each area for 10 seconds. (Don't forget fingernails and wrists!)

6.) Rinse off soap.

7.) Take one towel to shut off faucet.  Dispose of towel.

8.) Grab 2 towels and dry off one hand.  DON'T use towels on the opposite hand.  Dispose of 2 towels.

9.) Grab another 2 towels to dry off opposite hand.  Dispose.

10.) Put watch back on and then either throw towel on counter out or use to open door and then throw out.

You will always get this skill! ^