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.