CNA Practical Skills Process "Script"

CNAPracticalSkillsProcessScript/Blocking
PROCEDURE LISTS FOR TESTABLE SKILLS

The following procedure lists should be used by the instructor to prepare students for the state
manual skills test. Only testable skills are included. While recognizing there are numerous,
acceptable ways to perform these tasks, each of these individual procedures are used for the
manual skills exam to allow a consistent and objective test result. Textbooks should be
consulted for untested skills.

UniversalPreandPostSteps....Page2
Handwashing1...Page3
Pulse,Respirations,andBloodPressure2.....Page4
UndressingandDressingaPersonwhohasLimiteduseofLimbs3....Page6
MakinganUnoccupiedBed(Closed)4....Page8
MakinganOccupiedBed5.....Page10
ApplicationofAntiEmbolicStockings6......Page13
AssistingaPersonw/Eating(AssumethisPersonisinBed)7....Page15
BodyMechanics8......Page17
CleaningDentures9.....Page18
PerinealCare(Female)10....Page20
GivingaBackrub11.....Page23
SidelyingPosition12......Page25
RangeofMotionExercises(ROM)13.........Page27
AmbulationofaPersonUsingaTransferBelt14.....Page29
AssistingaPersonw/anAffectedSideintoaChair/Wheelchair15...Page31
IndwellingCatheterCare16....Page33
GivingaBedBath17........Page36
HelpingaPersontotheCommode18........Page39
HairbrushingandCombing19.....Page42
Charting/Documentation20.........Page43
ExamplesofPositions.......Page44
ExamplesofRangeofMotion......Page47
Key Points to Remember :

Critical Items are bolded and asterisked (*). You cannot miss any critical items during the skill test.
Decontamination of hands immediately before and after gloving is an important infection control
issue.
The persons privacy and safety as well as infection control must be maintained throughout the
entire procedure. These are always critical steps.
You can miss a limited number of items that are not critical. You must know the entire procedure!
1
UniversalPre&PostSteps

Pre-Steps

Knock, Knock. Hello Mr./Mrs.________, my name is ______, I will be your CNA today.
- Knock

Let me just wash my hands before we get started.
- Wash Hands

OK, thank you for waiting. As I said before my name is ______. May I check you wristband real
quick? Thank you. Mr./Mrs.____________
- Identify Patient

I will draw the curtain to give you a little privacy.
- Provide Privacy - If needed

Today we will be doing ____________. Is that OK with you? Alright, lets get started
- Explain the Procedure

Post-Steps

Here is the call-light, feel free to use it if you need anything
- Place Call-Light Within Reach

Are you comfortable Mr./Mrs._________? Good.
- Ensure Comfort

Lets just lower this bed for you
- Lower Bed

And lower the side rails as well.
- Lower Siderail(s) Per Care Plan

Ill tidy up and wash my hands
- Wash Hands

Now Ill write down everything we did together and I will see you again soon Mr./Mrs__________.
Thank you.
- Chart / Document

2
Handwashing
(Must be performed before care is started)

Handwashing Equipment
(2) Paper Towels, or more as needed
Soap
Water

1. Turn on water and adjust temperature.
2. Wet hands and wrists with fingertips pointing downward.
3. Apply soap to hands and wrists, enough to produce a soapy lather.*
4. Rub hands together in a circular motion.
5. Interlace fingers and rub back and forth.
6. Rub back of hands and wrists.
7. Entire process of scrubbing should take at least 20 seconds.*
8. Clean nails by running them over soap lathered palm of opposite hand.
9. Rinse wrists and hands, keeping them pointed down.
10. Dry hands with clean dry paper towel keeping fingertips pointed up.
11. Discard towel.
12. Turn off faucet with a new, clean dry paper towel.*
13. Discard towel without contaminating clean hands.

3
Pulse, Respirations, and Blood Pressure
(All performed as a single skill, therefore only one set of pre- and poststeps are needed)

Required Equipment
Sphygmomanometer (BP Cuff)
Stethoscope
Watch (w/ second hand)
Alcohol Wipes

Checking a Radial Pulse

I will grab a few things that we will need
1. Assemble equipment.

2. Pre- Steps (See page 2 for script and blocking) -
Knock - Knock, Knock. Hello Mr./Mrs.________, my name is ______, I will be your CNA today.
*Wash Hands* - Let me just wash my hands before we get started.
Introduce Self - Thank you for waiting. As I said before my name is ______.
*Identify Person* - May I check you wristband real quick? Thank you. Mr./Mrs.____________
*Explain Procedure* - Today we will be checking your BP, Resp., and Pulse. Is that OK with you? Alright, lets get
started

Lets get you comfortable before we start
3. Place the person in comfortable position with arm well-supported.

Ok, it will take about a minute while I take your pulse
4. Place tips of first two or three fingers (not thumb) over radial artery on thumb side of
the persons wrist.*

5. When pulse is felt, count for 1 minute (or 30 seconds and multiply x 2).*
Pulse must be within 4 beats per minute of the instructor.*

6. Chart / Document Results.

Counting Respirations

Now I will just double check your pulse
1. Do not indicate to the person that you are counting respirations.

2. Observe rise and fall of the persons chest and count respirations in one minute
(or 30 seconds and multiply x 2).*

3. Note rhythm and characteristics of breathing.
Respirations must be within 2 respirations of the instructor.*

4
6. Chart / Document Results.
Pulse, Respirations, and Blood Pressure (Continued)

Measuring Blood Pressure

Time to check your BP, Ill just get this cleaned up real quick.
1. Clean ear pieces and diaphragm of stethoscope with alcohol.

Is that a comfortable position for your arm? Good.
2. Place person in comfortable position with arm well supported.

3. Wrap cuff around arm, position 1-2 inches above elbow.*

4. Center arrow of cuff over brachial artery.*

5. Place stethoscope in ears and place diaphragm over brachial artery site.*

Im gonna squeeze your arm a little bit
6. Pump cuff up.

7. Open valve slowly and release pressure in cuff steadily and gradually.*
(Note: If beat is heard immediately, release all the air and let the arm rest for 30 sec.
Then re-pump to 20 mmHg higher. Again listen for the first and last beat.)
Readings must be within 6 mmHg of the instructor.*

8. Record your findings.

Ok, thanks for loaning me your arm. Ill let you have it back now.
9. Remove the cuff and make the person comfortable.

Thank you for your time, Ill get this all put away
10. Clean and put equipment away.

12. Post-Steps
* Place Call-Light Within Reach * - Here is the call-light, feel free to use it if you need anything
* Ensure Comfort * - Are you comfortable Mr./Mrs._________? Good.
* Lower Bed * - Lets just lower this bed for you
* Lower Siderail(s) Per Care Plan * - And lower the side rails as well.
* Wash Hands * - Ill tidy up and wash my hands
* Chart / Document * - Ill write all this down and thank you for your time Mr./Mrs__________.

5
Undressing/Dressing a Person Who Has Limited
Use of Limbs
Note: Undress strong side first, and Dress affected side first

Required Equipment
Shirt
Pants
Socks
Non-slip Footwear
Privacy Blanket/Bath Blanket

* Provide Privacy * - I will draw the curtain to give you some privacy.
*Explain Procedure* - We will be getting you dressed today. Is that OK with you? Alright, lets get started

Which outfit would you like to wear today? This one or this one? Good choice.
2. Provide clothing or assist with selection.

First things first, lets get you sitting up (if applicable)
3. Assist person to a supine or sitting position.

4. If in supine position, raise side rails or have two caregivers to provide persons safety,
and raise bed to a level for best body mechanics.

Ill get this rail out of the way
5. If used, lower side rail on the side you are working on.

6. If person has affected side, begin undressing on strong side first.*

Well off your shirt on first, lets start with your [strong side] arm
7. Remove persons upper clothing by pulling off one arm sleeve at a time.

Pants next, lets start with your [strong side] arm
8. Remove persons lower clothing by lowering pants to the knees, then pulling off one
pant leg at a time.

9. Place removed clothing properly for laundry or reuse.

10. If person has affected side, begin dressing with affected side first.*

Would you like to change your undergarments as well? Ok.
11. Assist with underclothing as needed.
6

Lets get these undone for you.
12. Undo all fasteners of clothing to be put on.

Well start by getting your pants on.
13. Assist person to put on pants:
Gather one pant leg on affected side. Lift persons leg at ankle and pull pant leg
over persons foot and leg up to the knee.
Repeat for other leg.
Pull pants up legs as far as possible.
Have the person lift buttocks or roll to the side to pull pants up to waist.
Fasten pants as needed.

Well get your shirt on next, lets start with your [affected side] arm
14. Assist the person to put on top (opening at front):
Gather sleeve, grasp persons affected arm at wrist and slide sleeve over arm.*
Have the person roll away from you and tuck garment beneath persons back.
Have the person roll towards you and pull garment out from under them.
Gather next sleeve and place over the persons other arm.
Adjust garment and fasten as needed.

Well get your shirt on next, lets start with your [affected side] arm
15. Assist the person to put on top (pullover):
Place the persons hands in sleeves, starting with affected side.*
Pull garment up arms.
Carefully pull neck opening over the persons head.
Pull garment down over trunk, adjust and fasten.

Last but not least, your shoes.
16. Assist the person to put on footwear:
Carefully pull stockings onto feet.
Put on shoes or slippers.

Ill put these in the hamper for you.
17. Place used clothing in a laundry bag.

18. Post-Steps

7
Making an Unoccupied Bed (Closed)

Required Equipment
Bed Spread
Top-sheet
Bottom/Fitted-sheet
Pillow Case
Chuck (to provide sanitary surface for clean linens)


2. Assemble linen and place it in a clean, convenient location.

3. Raise bed to a level for best body mechanics.

4. Do not shake linens at any time throughout the procedure.*

5. Loosen top linens from foot of bed and place spread in laundry bag or in clean location if
it will be reused.

6. Remove soiled linen.

7. Unfold clean bottom sheet and place on bed so that sheets hem stitching is toward
mattress.

8. Anchor the sheet over mattress corners on the side nearest you.

9. Place cotton turn/lift sheet and bed protector in the middle of the bed, if used.

10. Unfold clean top sheet and place so that the center is in middle of the bed. Open the
sheet but do not tuck it in. The hem stitching should be to the outside and even with the
top of the mattress.

11. (Optional) Place the blanket on the bed so that center crease is in the middle, upper
hem is 6-8 inches from top of bed and open blanket on your side of bed.

12. Place bedspread on top of the blanket in the same manner, making sure it is even and
covers the other linen.

13. Tuck bedspread, blanket, and top sheet together smoothly and tightly at the bottom
bed corner near you and make a mitered corner.

14. Go to the other side and pull the bottom sheet over the corners of the bed.

15. If used, pull turn/lift sheet tight and tuck it in.
8

16. Straighten all top linen from top to bottom and tuck them in at bottom and make a
mitered corner.

17. Turn the top linen down about 6-8 inches at the head of the bed to make room for the
pillow.

Good, everything is nice and wrinkle free.
18. Assure there are no wrinkles.*

19. Change the pillowcase without contaminating it.

20. Place the pillow at head of the bed so that the open end is away from the door and the
seam is toward the head of bed.

21. Place used linen in a laundry bag.

22. Post-Steps

How to Make a Mitered Corner

9
Making an Occupied Bed

Required Equipment
Bed Spread
Top-sheet
Bottom/Fitted-sheet
Pillow Case
Lift Sheet/ Draw Sheet
Privacy Blanket/Bath Blanket
Chuck (to provide sanitary surface for clean linens)

*Explain Procedure* - I will be changing your bed linens today. Is that OK with you? Alright, lets get started

I have everything I need to change your linens.
2. Assemble linen and place it in a clean, convenient location.

Well put up these side tails for your safety while we change your linens.
3. Raise side rails or have two caregivers to provide persons safety.*

Now I will raise your bed up a ways.

Ill need you lower the head of the bed while we change the sheets is that OK? Good.
5. Lower head of bed to make bed as flat as the person can tolerate.


7. Do not shake linens at any time throughout the procedure.*

I will just set aside the spread for later.
8. Loosen top linens from foot of bed and place spread in laundry bag or in clean location if
it will be reused.

I will make sure you stay covered while we do this with this bath blanket, OK? Good.
9. Provide privacy with top sheet or bath blanket and position the person on his/her side
facing away from you and toward raised side rail or second caregiver.*

Are your head and neck comfortable like this? Ok.
10. Place pillow for comfort.

I am going to loosen the bottom sheet and tuck them underneath you now.
10
11. Loosen the bottom linens, roll soiled linens toward the person and tuck under them.

Now I am going to tuck the new sheet underneath you as well.
12. Place clean bottom sheet on mattress so that stitching is away from the person, pull
nearest corners into place and tuck remaining sheet under person. Smooth any
wrinkles.

I will do your lift sheet next. (if used)
13. If used, place the cotton turn/lift sheet on the middle portion of the bed, tuck under the
person and smooth any wrinkles.

Time to switch sides.
14. Raise side rail. Go to other side of bed and lower side rail, or trade places with other
caregiver.* (Note: In a facility, the other caregiver would typically perform the rest of
the steps.)

Now I am going to help you gently roll towards me. Thank you.
15. Assist the person to roll toward the opposite side of the bed.

Are your head and neck comfortable like this? Ok.
16. Adjust pillow for comfort and provide privacy.

I will just put this in the hamper
17. Remove bottom linen and place in laundry bag.

And I will get this bottom sheet nice and smooth. Good, no wrinkles.
18. Pull clean bottom sheet toward you, pull corners into place and smooth any wrinkles.

Ill make sure that this lift sheet is tucked in properly for you.
19. Pull turn/lift sheet toward you and tuck under mattress.

Good, no wrinkles. That should be nice and comfortable for you.
20. Smooth any wrinkles.

Lets have you slowly roll onto your back and get this pillow comfy for you too. Is that OK? Good.
21. Position the person in supine position in the middle of the bed and adjust pillow.

Now for the top sheet.
22. Unfold clean top sheet without shaking it and place it on top of the used sheet so that
the center is in middle of the bed, but do not tuck in.

Let me check that the stitching is on the right side, good, and its even, perfect!
23. The hem stitching should be to the outside and even with the top of the mattress
without covering the persons face.

Would you kindly hold this, thank you. or Ill just tuck this under your shoulders for a moment.
24. Have the person hold top sheet or tuck it under the persons shoulders.

11
Ill move this privacy blanket now for you.
25. Remove privacy cover without exposing the person.*

And now I will put the spread back on.
26. Place bedspread evenly on bed and unfold to cover the person, the other linen, and is
even on both sides of the bed.

How high would you like the covers? There? Ok, Ill fold down the rest
27. Avoid covering the face and pull the top linen up to the shoulder/chin (as the person
desires) then fold the excess back down, making a smooth cuff.

I will tuck the last of that in with a nice mitered corner to make it neat.
28. Tuck top linens together at the bottom of the bed and make a mitered corner.

caregiver.*

Are these nice and smooth for you? Good.
30. Smooth the top linens over the person.

Ill tuck in the last corner now.
31. Tuck top linens together at the bottom of the bed and make a mitered corner.

Can your feet move comfortably? Good.
32. Assure the linens are loose enough so that the persons feet have room to move.

33. Assure there are no wrinkles.*

Pardon me, I need to borrow your pillow for just a moment so I can change the case. Thank you.
34. Change the pillowcase without shaking or contaminating it.

Now it has a nice clean case to match your sheets. Let me get that so the opening is away from the
door. Is that comfortable? Excellent.
35. Place the pillow at head of the bed so that the open end is away from the door and the
seam is toward the head of bed.

Ill get this into the hamper real quick.
36. Clean and put equipment away. Place used linen in a laundry bag.

37. Post-Steps
12
Application of Anti-embolic Stockings

Required Equipment
(2) Anti-Embolic Stockings

1. Obtain stockings.

*Explain Procedure* - Today will help you put on your stockings. Is that OK with you? Alright, lets get started

Ill start by raising your bed up a bit.

I will just lower this side rail for a moment so I can reach you.

Ill help you to roll on your back so that we can put your stockings on.
5. Have the person lying supine in bed.

Which leg would you like me to start with. Left or Right? Ok.
6. Expose only the leg used for placement of the stocking.*

Ill just turn this inside out so that we can get it on easily.
7. Grasp stockings from top and turn inside out to the ankle or bunch with right side out.

Onto the foot.
8. Slide stockings over toes, foot and heel.

Let me just check the hem and the heel.
9. Ensure the stocking is seam side out and the heel is positioned correctly.

Up the rest of the leg.
10. Re-grasp remaining portion of stocking and pull stocking up to knee or thigh, depending
on the length of the stocking.

Nice and gently.
11. Release stockings gently; do not snap.

13
12. Ensure stockings are smooth and wrinkle free.*

13. Post-Steps

Applying Anti-Embolic Stockings

14
Assisting a Person with Eating (Assume person is in bed)
Note: Begin with a drink and end with a drink when assisting with a meal.

Required Equipment
Food Tray w/ Drink
Gloves
Clothing Protector or Napkin
Moist Towelette & Paper Towel or
(2) Washcloths (Moist & Dry)

*Explain Procedure* - Today I will be helping you with your meal. Is that OK with you? Alright, lets get started

Before we get started lets just make sure this is the right meal. Good.
2. Before delivery, check tray with dietary card to make sure meal is correct.*

Ill help you upright.
3. Assure the person is in a safe, comfortable sitting position.

Lets wash your hands before we begin.
4. Assist the person with hand hygiene.

5. Place tray on table in front of the person.

Would you like a napkin to cover your chest. Good, here you go.
6. Offer napkin or clothing protector per care plan/facility policy, to go across the persons
chest.

7. Open containers and prepare food. Avoid touching food with fingers unless gloves are
worn.

This is a delicious meal we have for you today. There is [this], [this], and [this] to drink.
8. Inform the person about food on tray.

What would you like to start with? or Which would you like next?
9. Serve food as required/requested by the person.

Is the food temperature OK? Not to hot/cold? Good.
10. Make eating as pleasant as possible by:
Checking with the person about food temperature.
Serving small amounts from tip of spoon.
Offering straws for fluids.
Alternating solids and liquids.
15
Not rushing.
Communicating.

11. Observe the person for signs of choking.*
If choking, respond:*
Stop offering food or fluid.*
Ask if they are OK.* - Are you OK?
Encourage hard coughing.* - Keep coughing to help clear your throat. Thats good.
Offer sips of fluid when airway is clear.* Are you ready for some water? Here you go.
Report choking to the nurse.* Im glad you are feeling better let me notify the nurse real quick. I will be right
back.

Would you like another bite?
12. Encourage food intake but do not force.

OK, let me tidy you up before I take the tray away, did you enjoy your meal?
13. Be sure the persons mouth is clear of food and face is clean during and after feeding.

Ill just get this clothing protector/napkin out of the way for you.
14. Remove clothing protector, if used, and assist the person with hand hygiene.

Ill chart this real quick.
15. Record intake of fluid and percent of meal eaten.*

And I will drop these off in the hamper.
16. Clean and put equipment away. Place used linen/towels in a laundry bag.

17. Post-Steps

16
Body Mechanics

1. Assess weight of load and need for assistive device.

2. Demonstrate proper body alignment, including:*
Wide base of support, feet shoulder width apart.*
Back straight do not bend at the waist.*

3. Position body close to and facing object to be moved.

4. Bend from hips and knees, keeping back in alignment.*

5. Use large muscles (gluteal, shoulders, upper arms and thighs) to lift the object.

6. Use both hands and arms to lift, move, or carry heavy items.

7. Carry item close to body.*

8. Do not lift object higher than chest level.

9. Move feet and turn the whole body when changing direction (NO TWISTING).*

10. Work with smooth movements, no jerky or sudden moves.

11. Set objects on edge of table and push to center.

17
Cleaning Dentures

Required Equipment
Dentures
Denture Cup
Gloves
Chuck
Emesis Basin
Foam Tipped Oral Swabs
Washcloth (or Paper Towels)
Denture Brush
Towel
Cup of Water


*Explain Procedure* - Today I will be helping to cleaning your dentures and gums. Is that OK with you? Good.

Ill help you sit up first thing.
3. Assure the person is in a safe, comfortable sitting position.

Pardon me, if I could put this towel on your chest, thank you.
4. Spread towel across the persons chest.

Ill just clean up my hands and put on gloves real quick.
5. Decontaminate hands and put on gloves.*

Would you kindly remove your dentures for me. Would you like assistance? Thank you.
6. Ask the person to remove his/her dentures. Assist if needed.

I will just put them in here so they are safe.
7. Place dentures in a safe sanitary container.

I am going to take your dentures to the sink to wash them. I will be right back.
8. Transport them to the sink.

9. Line bottom of sink with wash cloth/paper towel. (To avoid dropping and breaking dentures)

Lets rinse them off.
10. Rinse each denture under cool running water.

Is this the cleaner you prefer? Good.
11. Use toothpaste or denture cleanser to clean the dentures.

18
And get them nice and clean for you.
12. With dentures in your hand, brush all surfaces until they are clean.*

I will rinse them off one last time.
13. Rinse dentures thoroughly under cool running water.*

And lets keep these safe for after your oral care.
14. Place dentures in a clean denture cup, labeled with the persons name and filled with
cool water.

Lets cover them up.
15. Cover the cup to transport back to the person.

Now we will do your oral care. Is that OK? Good.
16. Assist the person with oral hygiene. Provide oral hygiene by:
Cleaning upper and lower gums using moistened foam-tipped applicator.
Would you kindly open your mouth for me so that I may clean your gums? Thank you.
Offering the person a cup of water to rinse mouth.
Here some water, please take a sip to rinse your mouth.
Providing emesis basin or disposable cup to use for spitting.
This basin/cup is for you to spit into, here you go. Thank you.

Here are your dentures back, would you like some assistance putting them back in? OK, here.
17. Have the person replace the dentures in his/her mouth, if desired. If not, store in
persons nightstand or sink countertop. Dentures must be in water or in a denture
soaking solution.

Lets wipe your mouth real quick to finish up.
18. Leave the area around the persons mouth clean and dry when care is completed.

Now I will just get rid of these gloves and clean my hands.
19. Remove gloves and decontaminate hands.*

Last but not least I will get all this put away.

21. Post-Steps

19
Perineal Care-Female
Note: Some facilities may use pre-moistened cloths or special solutions. Use as directed.

Required Equipment
Chuck or Towel (Barrier to Lay Supplies on)
Bath Blanket
Bath Basin
(4) Washcloths
Soap
(2) Towels (1 for during care 1 for drying)
Gloves


*Explain Procedure* - I will be helping with your Peri-Care today. Is that OK with you? Alright, lets get started

First things first, lets raise the side rails.

And I will raise up your bed a bit.

Now I will get this side rail down so that I can reach you.

Ill just clean up my hands and put on gloves real quick.

Now I will help you gently onto your back and cover you with a bath blanket so you are comfortable.
OK? Good.
7. Assist the person to a supine position and cover the person with bath blanket/sheet.

Ill just untuck these linens real quick.
8. Pull top linens to foot of bed without exposing the person.

9. Position the person on her back.

Im going to place this pad/towel under your buttocks, OK?
10. Place waterproof pad or towel under her buttocks.

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I will keep you as covered as I can so you are comfortable. Is this alright? Good.
11. Drape the person so as to provide privacy. Uncover just enough of the perineal area
to provide care.*

Im going to wash you now, is the temperature of the water OK? Good.
12. May use peri wipes, peri wash or soap and water. If using soap and water fill the wash
basin with water, making sure the temperature is comfortable.

13. Separate labia with thumb and forefinger, with moist soaped washcloth, gently wash
down one side of the labia, from front to back (urinary meatus to vagina), change to
clean area of wash cloth and wash down other side of the labia.*

14. Repeat until clean in the same manner.

15. Rinse and pat dry in the same manner if using soap and water.

16. Wash pubic and groin area.

17. Rinse and pat dry if using soap and water.

Lets move your legs down now so we can turn you to your side next. Thank you.
18. Help lower persons legs.

OK, lets have you roll slowly toward that side rail.
19. While maintaining privacy turn the person onto her side; facing away from you
(toward a raised side rail or the other caregiver).*

Im going to wash your buttocks next, let me know if the water temperature is still OK. Good.
20. Wash buttocks. Rinse and pat dry if using soap and water.

21. Clean the rectal area from front to back (vagina to anus). Change to clean area of
wash cloth with each stroke.*

22. Rinse and pat dry the rectal area in the same manner, if using soap and water.

Lets have you roll back and I will remove this pad/towel.
23. Remove waterproof pad/towel.

Now I will just get rid of these gloves and clean my hands.

Ill place this pad underneath you now.
25. Place incontinent pad per care plan.

Are you comfortable in the position you are in? Good.
26. Return person to position of comfort.

Ill move the linens back for you now and get this out of your way.
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27. Replace linens and remove drape while maintaining privacy.*

Ill tidy this up and get these into the hamper for you.

29. Post-Steps

22
Giving a Backrub

Required Equipment
Lotion


*Explain Procedure* - I will be giving you a back rub today. Is that OK with you? Alright, lets get started




OK, lets have you roll slowly toward that side rail so you are comfortable on your side.
6. Position the person in side-lying or prone position, towards raised side rail or the other
caregiver.

Ill just uncover your back and buttocks, and I will keep the rest of you covered. OK?
7. Expose the back and buttocks, keeping the rest of the body covered.*

Before we start let me check your skin to make sure everything is OK. Good, everything looks fine.
8. During the care, observe the persons skin for any redness, rash, sores or cuts. Do not
massage over open area. Report any redness, rash, sores or cuts to the nurse.

I will get the lotion nice and warm for you.
9. Warm a small amount of lotion in your hands.

10. Begin at the base of the spine; rub up the center of the back to the neck with firm
pressure.

11. Using long soothing strokes move around the shoulders and down the sides of the back.

12. Rub down over the buttocks and circle back to starting point.

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13. Repeat this motion 4 times.

14. Continue with firm upward and downward strokes rubbing with smaller circular motions
over entire back, shoulders, shoulders blades, hips and coccyx.

15. Repeat this motion 4 times.

16. Complete back rub with up and down motions over the entire back.

All done, I will cover you back up now.
17. Straighten bed linen.

Ill tidy this up and get these into the hamper for you.

19. Post-Steps

24
Side-lying Position
See diagram on page 45 for reference.

Required Equipment
(3) Pillows
Bath Blanket (For Privacy)
Barrier (Chuck or towel to place pillows on)


*Explain Procedure* - Today I will be helping you into a comfortable side-lying position. Is that OK with you?
Good.




Next lets lower the head of the bed
6. Lower head of bed.

Lets have you move towards the edge of the bed towards me.
7. Assist the person to move to the edge of the bed closest to you.

And onto your side.
8. Turn the person onto side (facing side rail or the other caregiver).

Well tuck this pillow behind your back for support.
9. Place support pillow behind persons back and tuck underneath.

Ill just raise this side tail and switch sides.
caregiver.

Lets get this pillow comfortable under your head.
25
11. Position pillow to support head and neck in level position.

Lets make sure there isnt too much pressure on your shoulder.
12. Adjust lower shoulder to prevent direct body pressure upon it.*

Now well straighten your lower leg.
13. Straighten lower leg.

Lets bend your upper leg and put this pillow underneath it for support. Ok? Good.
14. Flex upper leg and place in front of lower leg on pillow or pillows to prevent contact
with lower leg. Support leg level from hip to foot.*

Lets bend your lower arm and get it in a comfortable position.
15. Position lower arm with elbow flexed and palm up, or with elbow straight and arm
alongside of body.

Now lets put this pillow under your upper arm for support.
16. Support upper arm with pillow, in front of body.*

17. Post-Steps

26
Range of Motion Exercises (ROM)
*Explain Procedure* - Today I will help you with your ROM exercises. Is that OK with you? Alright, lets get started


I will help you into position so you will be lying comfortably on your back.
3. Place person in a supine position in the middle of the bed.*

Now that we have you well centered in the bed are you comfortable enough for us to start? Good.
4. Assure person is in the middle of the bed to provide for their safety.*

Well work slow and gently and give your joints support as they are being exercised.
5. Move each joint slowly, always supporting the part being exercised. Never go beyond
the persons joint resistance.*

We only need to uncover what we are working with so you will have some privacy.
6. Cover person to maintain their privacy throughout procedure, exposing only the area
being worked on.*

Lets start with your shoulders up and down.
7. Shoulder Flexion and Extension Holding the persons wrist and elbow, raise the arm
straight in front and overhead, then bring arm down to side-repeat 3 times.

Now lets work with your shoulders side to side.
8. Shoulder Abduction and Adduction Holding the persons wrist and elbow, move
straight arm away from the side of the body then back to the side-repeat 3 times.

Now well work your elbows up and down.
9. Elbow Flexion and Extension Holding the persons wrist and elbow alongside the
body, bend elbow so hand touches shoulder, straighten the arm-repeat 3 times.

Now we will twist your forearms abit to flex them.
10. Forearm Supination and Pronation With arm alongside body, bend elbow to 90
degrees. Turn forearm so palm faces head of bed, then so palm faces foot of bed-repeat
3 times.

And wrists up and down.
11. Wrist Flexion and Extension hold the persons wrist and hand, bend the persons hand
up and down at the wrist- repeat 3 times.

27
Wrists side to side now.
12. Ulnar and Radial Deviation - bend the persons hand at wrist from side to side-repeat 3
times.

Lets move on to your legs. Keeping your knee straight we will raise it a few times.
13. Straight Leg Raises Supporting the lower calf and back of knee, keep knee straight and
raise leg off bed, then return to bed-repeat 3 times.

Now legs out and back.
14. Hip Abduction and Adduction Supporting leg at ankle and knee, with knee pointing up,
draw leg out to side, then back to touch other legrepeat 3 times.

Now well bring your knee towards you and back down again.
15. Hip/Knee Flexion and Extension Supporting leg at foot/heel and calf bend knee to o
chest and then straighten leg back onto bed-repeat 3 times.

Down to your ankles now. Toes pointing up to your head and then back down again.
16. Ankle Dorsiflexion and Plantar Flexion Supporting heel, bend foot so that toes point to
head then down towards foot of bed-repeat 3 times.

Now flexing side to side.
17. Foot Supination and Pronation Turn sole of foot inward, then sole of foot outward-
repeat 3 times.

Now lets take care of your other side.
18. Repeat on other side as directed by care plan.

Now that we are done Ill cover you up so you are comfortable.
19. Cover the person with top linens.

20. Post-Steps

28
Ambulation of a Person Using a Transfer Belt

Required Equipment
Gait Belt Non-Slip Footwear (verify)


*Explain Procedure* - Today I will help you walk to __________. Is that OK with you? Alright, lets get started

We will be walking ________, down to the _________ and back.
3. Know the distance to be walked.

Lets double check that the wheels are locked.
4. Assure bed wheels are locked.

Ill help you now to sit on the edge of the bed.
5. Assist the person to a sitting position on the edge of the bed.

You are already dressed, lets just check that you have some non-slip foot wear. Good.
6. Assure the person is wearing non slip footwear and appropriate clothing.*

Ill help you into your gait-belt.
7. With person seated, apply gait belt snugly around persons waist.*

Well place your feet so you will be stable
8. Position the persons feet shoulder width apart, flat on the floor with slightly bent
knees.

Now if you will place your hands on the bed and get ready to push.
9. Have the person prepare to push up by placing their hands on the bed.

On three well go up together. One, two, three.
10. Using good body mechanics, grasp gait belt with both hands, equal distance apart, and
assist the person to stand.*

Ok. I will be right here to support you the whole way.
11. Position self slightly behind and to the persons side, holding the belt at the side and
back.*

12. Allow the person to begin walking. Ambulate in step with him/her.
29

Dont forget to stand up straight.
13. Cue the person to use good posture, looking ahead and to walk without shuffling.

How are we doing? OK? Good.
14. Monitor the persons tolerance.
Would you like to get back into bed or sit now? OK.
15. Assist the person to a comfortable position when ambulation is completed.

Lets get this belt off for you.
16. Remove gait belt.

Now Ill go put everything away.
17. Put equipment away.

18. Post-Steps

30
Assisting a Person with an Affected Side into a
Wheelchair/Chair

Required Equipment
Gait Belt
Wheelchair
Non-Slip Footwear (verify)


Lets just check that the wheelchair is good to use.
2. Assure wheelchair is in good repair.

*Explain Procedure* - Today I will be helping you into your wheelchair. Is that OK with you? Alright, lets get
started

Ill move these foot pedals out of the way.
4. Place foot pedals in up position and to the side, or remove from wheelchair.



7. With the person seated, apply gait belt snugly around the persons waist.*

I will move the wheelchair into position.
8. Position wheelchair/chair near and parallel, or slightly angled, to the bed on persons
strongest side.*

And I will lock the wheels so it doesnt roll away on us.
9. Lock the wheelchair brakes.*

10. Position the persons feet shoulder width apart, flat on the floor with slightly bent
knees.

31
11. Have the person prepare to push up by placing their hands on the bed.

assist the person to stand.*

Now that we are stable lets turn.

13. When balanced, adjust your footing and assist the person to pivot (ball of foot remains
stationery) until aligned with the wheelchair/ chair.

Reach back and grab the arm of the chair for me.
14. Have the person reach back and grasp the arm of the chair.

Now we will lower down, slow and steady.
15. Assist the person to slowly lower self to a comfortable sitting position.

Good, I will move these foot pedal back into position.
16. Replace foot pedals on wheel chair if the person requests and unlock wheelchair brakes.

Lets get this belt off for you.
17. Remove gait belt.

18. Post-Steps

32
Indwelling Catheter Care
Note: Some facilities may use pre-moistened cloths or special solutions. Use as directed.

Required Equipment
Bath Blanket
Bath Basin
(4) Washcloths
Soap
Gloves


*Explain Procedure* - Today will be helping you with your catheter care. Is that OK with you? Alright, lets get
started




I will go ahead and clean my hand and put on some gloves.

Lets have you lay on your back now and I will cover you with a blanket for some privacy.
7. Assist the person to a supine position and cover the person with bath blanket/sheet.

Lets move these linens out of the way.
8. Pull top linens to foot of bed without exposing the person.

Im going to place a pad under your buttocks now, OK? Good.
9. Place waterproof pad or towel under her buttocks.

I will keep you draped as much as I can so that you have plenty of privacy.
10. Drape the person so as to provide privacy. Uncover just enough of the perineal area
to provide care.*
33

Is the water temperature comfortable? Let me know if it is too hot or cold.
11. May use peri wipes, peri wash or soap and water. If using soap and water fill the wash
basin with water, making sure the temperature is comfortable.

12. Separate labia with thumb and forefinger, with moist soaped washcloth, gently wash
down one side of the labia, from front to back (urinary meatus to vagina), change to
clean area of wash cloth and wash down other side of the labia.*

13. Repeat until clean in the same manner.

I will rinse and dry now.
14. Rinse and pat dry in the same manner if using soap and water.

And I will wash around the tubing.
15. Anchoring catheter between two fingers, wash from meatus down catheter tubing
four inches, with clean part of washcloth. Rinse with clear water in the same manner
you washed.*

16. Wash pubic and groin area.

Lets dry this area.
17. Rinse and pat dry if using soap and water.

Well lower your legs down now.
18. Help lower persons legs.

And lets make sure that your tubing is secure.
19. Assure catheter tubing is secured to upper thigh by appropriate means, positioned for
drainage and attached to the bed frame.

I will help you turn onto your side now.
20. While maintaining privacy turn the person onto her side; facing away from you
(toward a raised side rail or the other caregiver).*

Let me know if the water is too hot or cold.
21. Wash buttocks. Rinse and pat dry if using soap and water.

22. Clean the rectal area from front to back (vagina to anus). Change to clean area of
wash cloth with each stroke.*

All done, lets dry you off.
23. Rinse and pat dry the rectal area in the same manner, if using soap and water.

Im going to remove that pad now.
24. Remove waterproof pad/towel.

And get rid of these glove then clean my hands.
34

Here is a new pad for you, lets get that in place.
26. Place incontinent pad per care plan.

Lets get you comfortable now, what position would you like to be in? OK, lets do that.
27. Return person to position of comfort.

Ill put the linens back now and remove the drape/cloth for you.
28. Replace linens and remove drape while maintaining privacy.*

Ill put everything away and get these into the hamper.

30. Post-Steps

35

Giving a Bed Bath
Notes:
May use disposable washcloths.
Sequence of washing is not important as long as eyes are cleaned first and perineum is
cleaned last.
During testing you will be expected to deliver a partial bath which includes washing face,
ears, neck, chest, one arm, hand, and axilla area.

Required Equipment
Bath Blanket
Bath Basin
(4) Washcloths
Soap
Gloves
+ Peri-Care Supplies (See pages 20 to 22)

1. Assemble equipment (water should be appropriate temperature).

started

I will fill up this basin with some water first thing.
3. Fill basin with warm water if not bathing with disposable washcloths. Change water if it
becomes cool.

Lets move these side rails up to keep you safe while we do your bed bath.

I will just raise your bed up a bit.

Are you comfortable? Good.
6. Adjust the bed to a comfortable position.

7. Lower side rail on the side you are working on.

I will move these out of the way for now and I will give you this blanket/cloth for some privacy.
8. Remove bedspread and place bath blanket over top sheet.
36

Lets move this sheet out of the way.
9. Remove top sheet from under the bath blanket without uncovering the person.*

Well take your gown off now.
10. Remove the persons gown.

And put this towel on your chest.
11. Place a towel over the persons chest.

I will clean my hands now and get some gloves on
12. Decontaminate hands. If person or care provider has any open skin areas don gloves
according to standard precautions.

Lets start with cleaning your eyes.
13. Wash the eyes (no soap) from the nose toward the ear, using a different area of the
washcloth for each stroke.*

And get the rest of your face ears and neck now.
14. Wash and rinse the face, ears, and neck. (Do not use soap on face area unless
requested).

I will go ahead and pat that dry for you.
15. Pat all areas dry.

16. Leaving the towel on the chest, reach under the towel and fold the bath blanket to the
waist.

I will move down and wash your chest and stomach now.
17. Lifting the towel one part at a time, wash, rinse and pat dry the chest (observe under
persons breasts for redness).

18. Wash the abdomen and navel, rinse and pat dry.

Lets cover you back up.
19. Cover the chest and abdomen with bath blanket and remove the towel from the chest
without exposing the person.*

And wash your arm now.
20. Place a towel lengthwise under the arm nearest you. Wash, rinse and pat dry the hand,
arm, axilla and shoulder.

Lets turn on your side, towards the bed rail, so we can wash your back.
21. Turn the person on their side, facing away from you and towards the raised side rail or
the other caregiver.

Well get your back clean now.
22. Place a towel on the bed against their back and wash, rinse and pat dry the back and
37
back of the neck.

Time to roll onto your back again.
23. Reposition the person on their back.

And now your leg.
24. Place bath towel lengthwise under leg nearest you and wash, rinse and pat dry leg and
foot.

Ill raise the side rail now and switch sides.
25. Raise the side rail or trade places with other care giver.*

Ill change this out for some fresh water.
26. Rinse bath basin and refill with clean water.

Lets lower this rail and we can get your other side.
27. Go to other side of bed and lower side rail, or trade places with other care giver.

28. Repeat steps 19 and 23.

29. Provide perineal care. (See pages 20 to 22)

Ill get rid of these gloves now and clean my hands.
30. If gloves were used, remove gloves and decontaminate hands.*

Lets get you dressed again.
31. Assist the person to dress and groom.

Now that we dont need it anymore I will get this cover out of your way.
32. Replace linen and remove drape while maintaining privacy.*

Ill put all of this away and get these into the hamper.

34. Post-Steps

38

Helping a Person to the Commode

Required Equipment
(3 Pairs) Gloves
Gait Belt
Commode
Bath/ Privacy Blanket
Toilet Paper
Moist Towelette & Paper Towel or
(2) Washcloths (Moist & Dry)


started

I will go ahead and make sure the bed wheels are locked.
3. Assure bed wheels are locked.

And move the commode into position.
4. Position commode within easy reach.



7. With the person seated, apply gait belt snugly around the persons waist.*

And I will lock the wheels so it doesnt roll away on us.
8. Position commode near and parallel, or slightly angled, to the bed. Lock wheels of
commode.

9. Position the persons feet shoulder width apart, flat on floor with slightly bent knees.

I will clean my hands now and get some gloves on
10. Decontaminate hands and put on gloves.

39
11. Have the person prepare to push up with their hands by placing them on the bed.

assist person to stand.*

Now that we are stable lets turn.
13. When balanced, adjust your footing and assist the person to pivot (ball of foot remains
stationery) until aligned with the commode.

Reach back and grab the arm of the chair for me.
14. Have the person reach back and grasp the arm of the commode.

I will move this clothing out of the way for you before you sit down.
15. Move clothing out of the way (pull down pants).

Now we will lower down, slow and steady.
16. Have the person lower self slowly to comfortable seated position.

Here is a blanket for some privacy and to keep you warm.
17. Assure warmth with robe or blanket.

The toilet paper is right here for you.
18. Place toilet tissue within reach.

Here is the call light, I will give you some privacy, call me when you are done.
19. Place call light within reach. Ask the person to call when ready or if assistance is
needed.*

20. Remove gloves and decontaminate hands.

21. Leave room if the persons condition allows.

Thank you for calling me. Lets get you back to your bed/chair.
22. When person signals, return promptly to assist.

I will clean my hands now and get some gloves on.

Lets wash your hands.
24. Assist the person with hand hygiene.

I will wipe for you now if thats OK.
25. Provide perineal/anal care (clean from urinary meatus to anus).*

40
26. Make sure the person is safe, then remove gloves and decontaminate hands.*

Lets have you stand up and get your clothing back on for you.
27. Reposition clothing.

Now lets walk back to bed.
28. Assist the person to the bed.

Well take off your shoes and belt.
29. Remove footwear and transfer belt.

I will clean my hands now and get some gloves on.

I will take this away for you.
31. Cover and remove container from commode.

32. Empty it into the toilet, note contents and measure output per care plan.

33. Clean/disinfect container per policy.

34. Replace container in commode.

35. Clean commode.


Now Ill put all of this away.
37. Return commode and other supplies to appropriate area.

38. Post-Steps

41

Hair Brushing/Combing

Required Equipment
Brush or Comb

*Explain Procedure* - Today I will help you with your style your hair.. Is that OK with you? Alright, lets get started

2. Assemble the persons brush or comb.

Lets get you sitting comfortably upright for this.
3. Assist the person to sitting or Fowlers position. (see diagram on page 44)

Ill gently work these snarls out for you.
4. If hair is tangled, separate small lock of hair and grasp it firmly with one hand to prevent
pulling on scalp. Begin brushing or combing from bottom of lock toward scalp as tangles
are removed.

5. After tangles are out, or if hair is not tangled, brush or comb from scalp to hair ends.

6. If hair is kinky or curly, a pic style comb may be used to gently comb hair.

How do you like your hair done. Ok, we can do that.
7. Arrange hair in style preferred by the person.

All done. I will get this put away.

9. Post-Steps

42

Charting
1. Use black/blue ink in all charting.*

2. Mark vital signs in appropriate space.*

3. If required mark intake and output in % and cc or ml.*

4. Initial all skills you performed.*

5. Chart that you informed the nurse if you noticed any areas of concern or change in the
persons condition and what those areas were. Be specific.

6. If error occurs, use one line to cross out and then initial the change.

7. Initial, sign the bottom of the form with your full first name, last name, title (NA), and
date.*

8. Use electronic documentation per facility policy.

43
Examples of Positions

Supine Position
1. The resident should be placed lying on their
back, with their face up, their arms to the side
and legs slightly apart from one another.

2. Place pillows in order to support the back and
neck of the patient.

______________________________________________________
Fowlers Position

1. The head of the bed should
be raised by 30 or 90 degrees, based
on whether you want a low Fowlers
or a high Fowlers position.

2. Unless there is prohibition, raise
the knee gatch in order to allow the
patient to feel comfort and not slide
off.

3. Make sure the arms are supported
for comfort.

44
Lateral Side-Lying Position

1. Lock the wheels after
raising the opposite side rail.

2. The resident should be
moved to your nearest side
of the bed.

3. The distant arm should be
flexed to the head, whereas
the nearest should be placed
on the chest.

4. The closer leg should be crossed at the ankle with the other one.

5. One hand should be placed on the shoulder, whereas the other on the nearest hip of the resident.

6. The resident has to be turned away from you on the side.

7. Make use of a positioning device, such as a pillow.

8. The residents arm and shoulder should be adjusted to avoid any pressure.

9. The bed and side rail should be lowered by orders.

______________________________________________________

Sims Position
1. Lock the wheels after raising the
opposite side rail.

2. The resident should be moved to
your nearest side of the bed.

3. The undermost arm should be
placed with the back of the patient.
This is the only difference between
side-lying and Sims position.

45
4. The closer leg should be crossed at the ankle with the other one.

5. One hand should be placed on the shoulder, whereas the other on the nearest hip of the resident.

6. The resident has to be turned away from you on the side.

7. Make use of a positioning device, such as a pillow.

8. The residents arm and shoulder should be adjusted to avoid any pressure.

9. The bed and side rail should be lowered by orders.

______________________________________________________

Prone Position

1. The resident should be positioned
lying on their abdomen and with their
head to the side. The hands should be
straight or flexed to the head.

2. The bed has to be as flat as
possible.

46
Examples of Range of Motion Exercises

A - Flexion: The bending of a joint.

B - Extension: A movement opposite
to flexion in which a joint is in a
straight position.

C - Rotation: Pivoting a body part
around its axis, as in shaking the head.

D - Abduction: A movement of a limb
away from the median plane of the
body; the fingers are abducted by
spreading them apart.

E - Adduction: Moving toward the
midline of the body or to the central
axis of a limb.

F - Circumduction: A combination of
movements that cause a body part to
move in a circular fashion.

G - Supination: Extension of the
forearm to bring the palm of the hand
upward.

H - Pronation: Movement of the
forearm in the extended position that
brings the palm of the hand to a
downward position.

I - Inversion: Movement of the ankle to turn the sole of the foot medially.

J - Eversion: Movement of the sole of the foot laterally.
47

CNA Practical Skills Process "Script"

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PROCEDURE LISTS FOR TESTABLE SKILLS

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PROCEDURE LISTS FOR TESTABLE SKILLS

Key Points to Remember :

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CNA Practical Skills Process "Script"

CNA Practical Skills Process "Script"