A Certified Nursing Assistant (CNA) should be familiar with many basic nursing skills. This study guide covers the basics of infection control, technical procedures, and patient safety.
In every healthcare setting, knowing how to prevent the spread of infection is crucial to keep outbreaks to a minimum and to prevent getting sick yourself. Hand washing is the single most important thing you can do to prevent the spread of infection. Hand washing should be performed before and after providing direct patient care, after going to the bathroom, before eating, and whenever your hands are visibly soiled. Use plenty of friction when you wash, and scrub your hands, wrists, and the area under the nails for at least 15 seconds. Many facilities also allow the use of a waterless hand antiseptic, such as Avagard, if your hands are not visibly soiled. Always wear gloves if you expect to come into contact with mucous membranes, blood, or other infectious substances. Remove the gloves immediately after caring for the patient.
Technical procedures such as obtaining vital signs, providing mouth and nail care, and helping a patient dress are all part of the everyday job of the CNA—and also something you will likely be asked to demonstrate on the clinical skills portion of the test. Before beginning any procedure, greet the patient and explain what it is you intend to do. Always allow the patient as much privacy as possible and ensure you stay with them throughout the procedure to prevent injury. Vital signs may be taken a number of ways depending on the facility where you work. Know the difference between—as well as the techniques of obtaining—oral, rectal, axillary, and tympanic temperatures, and which findings need to be reported for each type. Blood pressures may be taken manually or with a machine depending on the facility, but for either method a normal reading is usually around 120/80 or slightly less. Many vitals machines come equipped with a “pulse ox” that tells how much oxygen is in the patient’s blood and gives his current pulse rate. A normal pulse rate is between 60 and 100 beats per minute. Anything higher or lower than this range could be indicative of a problem and should be reported to the nurse assigned to your patient. When providing nail care, soak the nails in comfortably warm water for 10–20 minutes. Dry and trim them straight across with nail clippers. For those who may have problems with hands or feet, such as diabetics, check for special orders before performing nail care. When assisting patients with toothbrushing, allow them as much independence as possible while still maintaining their safety. If you are caring for dentures, transport them in a cup or basin, and fill the sink with water or pad it with a washcloth while cleaning to prevent accidental breakage. When dressing a patient, have all their fresh clothing ready to go before removing their soiled clothing to prevent prolonged periods of nakedness. Allow patients to choose their clothes, if possible, and allow them as much independence as safety permits. If one side of their body is weak or paralyzed due to stroke, ensure the affected arm/leg is supported while you assist them in dressing.
Knowing how to keep both yourself and your patient safe is critical to providing safe care and to passing your CNA exam. Be familiar with the personal protective equipment available in your facility such as masks, gloves, eye shields, and gowns, and know when it is appropriate to wear each. Be careful when changing patient sheets because they are a common location for discarded needles, especially in the hospital setting. Change sheets that are soiled immediately, and fold the soiled portion inward and away from your body. Dispose of the linen in an appropriate plastic bag, and put it in the designated soiled linen area to prevent it from becoming a fall hazard for yourself or the patient.
Falls are the most common accident for patients. They can have devastating consequences, especially for older patients. To help prevent a fall, put back equipment and supplies in their proper location, clean up any spills, and always ensure that patients have glasses, ambulation devices, and a call light nearby so they can get quick assistance. When safety is compromised and a patient is injured, report to the nurse on duty or a supervisor.