Nursing Assistant Skills

• A transfer belt should be placed over the resident's clothing.
• When transferring a resident from a bed to a wheelchair, the wheelchair should be placed on the stronger side.
• Eating is an example of an activity of daily living (ADL).
• If a resident starts to fall, widen stance and bring the resident's body close.
• To promote respect, dignity, and privacy, encourage the resident to do as much as possible for themselves.
• When the skin first begins to break down, it turns pale, white, red, or purple.
• Restricted mobility increases the risk of pressure ulcers.
• Pressure ulcers can lead to life-threatening infections.
• The tailbone (sacrum) is at a higher risk of skin breakdown.
• Immobile residents should be repositioned at least every two hours.
• A bed cradle keeps the covers from resting on a resident's legs and feet.
• The perineum should be washed every day.
• Mechanical lifts prevent injury.
• When bathing a resident, ensure the room is warm enough before beginning.
• When cleaning the perineal area, work from front to back.
• NAs should check residents' skin each time they are repositioned.
• Nail care should be provided when the nails are dirty.
• Promote independence and dignity by honoring the resident's preferences.
• An NA must always wear gloves when shaving a resident.
• Nursing assistants should cut residents' hair when it gets long and when residents request it.
• Refer to a resident's weakened side as the "involved side".
• If a resident has weakness on one side, start with the weaker side when dressing.
• Oral care should be done at least twice a day.
• Clean dentures should be returned to the resident or stored in a denture cup.
• To prevent aspiration during oral care of unconscious residents, use as little liquid as possible.
• Dangling means sitting up with legs over the side of the bed.
• Bedbound residents should be repositioned at least every two hours.
• Residents in wheelchairs should be repositioned at least every hour.
• A resident lying on either their left or right side is in the lateral position.
• A resident with head and shoulders elevated in a semi-sitting position (45 to 60 degrees) is in Fowler's position.
• A resident lying on their stomach with arms at their sides is in the prone position.
• A resident lying on their left side with the upper knee flexed and raised toward the chest is in Fowler's position.
• Promoting independence is part of how NAs care for residents.
• Styling one's hair is part of grooming oneself.
• Perineal care is NOT care of the fingernails and toenails.
• It is NOT best for the NA to make decisions about when and where procedures will be done.
• Having care explained before it is performed is a resident's legal right.
• The NA should knock and wait for permission to enter the room.
• Personal care provides the NA with an opportunity to observe a resident's mental state.
• If the resident appears tired during a procedure, the NA should NOT encourage him to keep going if the procedure is more efficient.
• Before leaving a resident's room, the NA should NOT leave the bed in its highest position.
• The call light should NOT always be left where the NA can easily reach it when she returns to the room.
• The bottom sheet on residents bed must be kept tight and free from wrinkles.
• Cloth-covered items that keep the hand or fingers in a normal natural position are Handrolls.
• Shearing is a problem that can result from pulling a resident across that sheet when transferring him.
• Skin should be kept clean and dry.
• A bed cradle keeps covers from resting on the legs and feet.
• Plastic prevents air from circulating, causing the skin to sweat.
• Immobile residents should be repositioned at a minimum of every two hours.
• Red skin should not be massaged.

Common Positions and Injuries:

• Lateral position can cause pressure injuries.
• Prone position pressure injuries can affect the cheek, collar bone, breast, buttock, genitals, knees, and toes.
• Supine position pressure injuries can affect the back of the head, shoulder blades, elbows, abdomen, sacrum, between the legs, and heels.

Stage One Pressure Injuries:

• Skin is intact but may appear red.
• The affected area may be warmer than the surrounding skin.
• Areas of the body where bone is close to the skin are at higher risk for skin breakdown.
• Residents seated in wheelchairs DO need to be re positioned.
• The NA should NOT massage any red areas he notices.
• Proper nutrition helps keep the skin healthy.
• When transferring or positioning residents, the NA should NOT pull them slowly across the sheets to make the job easier.
• Another name for pressure injuries is decubitus ulcers.
• Common sites for pressure injuries are NOT the chest, nose, and hands.
• An orthosis is a type of device that helps support and align a limb.
• Bony prominences are areas of the body where the bone lies close to the skin.
• A draw sheet is used to help residents that cannot help with turning or moving in bed, preventing skin damage from shearing.
• A footboard is placed against the feet to keep them properly aligned and to prevent foot drop.
• Handrolls keeps fingers in a natural position.
• An orthotic device helps support and align a limb and improve its functioning.
• Pressure points are areas of the body that bears much of its weight.
• Trochanter rolls are rolled towels used to keep the hips and legs from turning outward.
• A partial bath includes washing a resident's genitals.
• A washcloth and water should be used to wash the resident's face when giving a bed bath.
• The resident is best able to choose a comfortable water temperature.
• Water for shampooing a resident's hair should NOT be higher than 105 F.
• The resident's perineum should be washed once a day.
• Shampoo products should be used when giving a shower or tub bath.
• Gloves should be changed during a bed bath before washing the perineal area.

Benefits of Regular Grooming:

• Enhances appearance and confidence
• Improves feelings of cleanliness and overall well-being
• Affects how one feels about others and themselves

Electrical Razors Caution:

• Do NOT use around water, risk of electrocution
• Do NOT use around oxygen, risk of explosion
• Clean clothes are the best type of clothing for residents to wear during the day.

Dressing Residents with Weakness:

• Undress and place clothes on the weaker side first
• Dress the stronger side first

Oral Care:

• Perform before and after meals
• Report any infections, irritation, swollen tongue, raised areas, flaky white spots, dry/bleeding lips, loose/chipped/decayed teeth, or bad breath.
• Aspiration is inhalation of food/fluid into lungs, turning them on their sides can help.
• A fracture pan is used for voiding for residents who cannot raise their hips.
• Men usually use a urinal for urination when they cannot get out of bed.
• Residents who can get out of bed but cannot walk to the bathroom may use a portable commode.
• Another name for portable commode is bedside commode.
• When handling body wastes, wear gloves.
• Report color, odor, and amount of urine and stool to identify medical problems.

Positions

• Fowler's: semi-sitting body position with head and shoulders elevated 45 to 60 degrees
• Lateral: on side with both hands in front
• Prone: stomach
• Supine: on spine
• Sims: on side on arm behind the back
• Residents who spend a lot of time in bed or wheelchairs need to be re-positioned because they are at risk of skin breakdown and pressure injuries.
• The weaker side on body is called involved sides.
• A draw sheet is used to re-position residents without causing shearing.
• Logrolling is moving a resident as a unit without disturbing alignment.
• Dangling is a way to help residents regain balance before standing up.
• When working with residents in wheelchairs, check the resident alignment in the chair after a transfer is complete.
• A sling may be used to transfer residents unable to bear weight.
• Mechanical or hydraulic lifts help prevent injury to the nursing assistant and the resident.
• When applying a transfer belt, place it over the resident clothing and around the waist.
• If a resident starts to fall during the transfer, bend knees and lower the resident to the floor.
• Elderly have more safety concerns due to dementia, confusion, illness, disability, and diminished senses.
• Prevention is the key to safety in facilities.
• Older adults and those with loss of sensation are at greatest risk of burns.
• Scalds are burns caused by hot liquids.
• A serious burn can occur with a liquid temperature of 140F in 5 seconds or less.
• Check the temperature of hot water with a water thermometer.
• Immediately report an appliance with a frayed cord or that looks unsafe.

Hot Liquids

• When serving hot liquids to residents, pour hot drink away from the resident.
• If a NA doesn't identify a resident before mealtimes or care, it can cause death or serious problems.
• A Material Safety Data Sheet (MSDS) includes chemical ingredients and dangers.
• Employers must have a MSDS for every chemical used.
• Restraints restrict voluntary movement or behavior.

Restraints

• Raised side rails on a bed are an example of physical restraint.
• Medication used to control behavior is a chemical restraint.
• Restraints are restricted because they were abused by caregivers.
• A restraint can be used when a doctor has ordered the use.
• Restraint-free means restraints are never used for any reason.

Alternatives

• Restraint alternatives are any interventions used in place of a restraint.
• Prevent falls by keeping walkways clear of clutter.
• Diabetes can cause a lack of sensation.
• Pour hot drinks away from residents when serving hot liquids.
• Identify a resident before helping with feeding.
• Place a resident in an upright position when eating.
• Oxygen is a dangerous fire hazard.
• NAs should not allow open flames around oxygen equipment.
• A material safety data sheet contains a description of emergency response actions.
• Putting both side rails up on the bed is an example of physically restraining a resident.
• Restraints can be applied only with a doctor's order.
• A serious problem associated with restraint use is pressure ulcers.

Restraint Usage

• People tend to respond better to restraint alternatives.
• Giving the resident a repetitive task is a restraint alternative.
• Check on a resident every 15 minutes if a restraint is applied.

Body Mechanics

• Fulcrum and lever are terms that apply to body mechanics.
• Body mechanics help save energy and prevent injury.
• Bend the knees when helping a resident sit up, stand up, or walk.
• Stand with legs shoulder-width apart to use proper body mechanics.
• RACE is an acronym for a safety rule, meaning: Remove residents, Activate alarm or call 911, Contain fire, Extinguish.

Test on nursing assistant skills, focusing on resident care. Questions cover repositioning, bathing, perineal care, nail care, transferring and positioning residents. Also includes ADLs and fall prevention.