Physical Care Skills
64%of exam
Psychosocial Care Skills
10%of exam
Emotional NeedsDementia CareEnd-of-LifeSpiritual/Cultural
Role of the Nurse Aide
26%of exam
Quick Facts
- Exam
- Georgia CNA (NNAAP)
- Written Qs
- 60 scored
- Skills
- 5 random
- Pass
- 70% + all skills
- Registry
- Alliant / DCH
- Format
- 90 min + skills
Fire Response: RACE
Rescue, Alarm, Confine, Extinguish
R: rescue peopleA: pull alarmC: close doorsE: extinguish
Sterile vs Clean
Sterile
- No microorganisms
- Surgical technique
- Catheter insertion
Clean
- Reduces microbes
- Hand washing
- Routine ADL care
Germ-free vs reduced
Isolation Precaution Picker
- TB or measles→Airborne(N95 mask)
- Flu, pertussis→Droplet(Surgical mask)
- MRSA, C. diff→Contact(Gown, gloves)
- C. diff cleanup→Soap + water(Spores resist gel)
- Any body fluid→Standard(Always baseline)
- Bloody procedure→Add goggles(Splash risk)
Vital Sign Ranges
- Oral temp
- 97.6-99.6 F
- Pulse
- 60-100 bpm
- Respirations
- 12-20 breaths
- Blood pressure
- Below 120/80
- SpO2
- 95-100%
- Pain
- Resident-reported 0-10
Extinguisher: PASS
Pull, Aim, Squeeze, Sweep
P: pull pinA: aim baseS: squeeze handleS: sweep side-to-side
Sign vs Symptom
Sign
- Objective, observed
- Rash, fever
- You measure it
Symptom
- Subjective, felt
- Pain, nausea
- Resident reports
Seen vs felt
Care Step Picker
- Before any care→Wash hands(Then introduce)
- Dressing weak side→Weak first(Undress strong first)
- Perineal care→Front to back(Prevent UTI)
- Transfer→Lock wheels(Strong side leads)
- Feeding→Sit upright(Prevent aspiration)
- After care→Call light reach(Bed lowered)
Report These Thresholds
- Temp
- Above 100.4 FFever
- Pulse low
- Below 60Brady
- Pulse high
- Above 100Tachy
- BP high
- 130/80 or more
- SpO2
- Below 90%
- Resp
- Below 12 or 20+
Emergency: ABCs
Airway, Breathing, Circulation
A: open airwayB: check breathingC: check pulse
Bradycardia vs Tachycardia
Bradycardia
- Pulse below 60
- Slow heart rate
- Report to nurse
Tachycardia
- Pulse above 100
- Fast heart rate
- Report to nurse
Slow vs fast
Infection Control
- Hand washing
- Best infection control
- Scrub time
- 20 seconds minimum
- Standard precautions
- All body fluids
- Faucet
- Off with towel
- Sharps
- Never recap needles
- Linen
- Hold away from body
PPE Donning
Gown, mask, goggles, gloves on
Gown firstMask/respiratorGogglesGloves last
Active vs Passive ROM
Active
- Resident moves
- Self-performed
- More independence
Passive
- Aide moves joint
- Resident cannot
- Support the limb
Self vs aide-moved
PPE + Isolation
- Don order
- Gown, mask, goggles, gloves
- Doff order
- Gloves, goggles, gown, mask
- Airborne
- TB, measles, varicellaN95
- Droplet
- Flu, pertussis, mumps
- Contact
- MRSA, C. diff
- C. diff
- Soap, not sanitizer
Fall + Restraint Safety
- Bed
- Lowest position locked
- Call light
- Within reach
- Spills
- Clean up immediately
- Restraint
- Last resort, MD order
- Restraint check
- Every 30 minutes
- Release
- Every 2 hours
Fire + Emergency
- RACE
- Rescue, Alarm, Confine, Extinguish
- PASS
- Pull, Aim, Squeeze, Sweep
- Oxygen
- No flames, no smoking
- Choking
- Abdominal thrusts
- Seizure
- Protect head, side-lying
- Fall
- Stay, call nurse
Body Mechanics + Transfers
- Lift
- Bend knees, not back
- Base
- Feet shoulder-width apart
- Load
- Hold close to body
- Turn
- Pivot, never twist
- Gait belt
- Snug at waist
- Transfer
- Toward strong side
Resident Positions
- Fowler's
- Head up 45-60
- Semi-Fowler's
- Head up 30-45
- Supine
- Flat on back
- Prone
- Flat on stomach
- Lateral
- Lying on side
- Sims'
- Left side, knee bent
Skin + Pressure Injury
- Reposition
- At least every 2h
- Bony sites
- Heels, sacrum, hips
- First sign
- Red, non-blanching skin
- Keep skin
- Clean and dry
- Pad
- Pillows between knees
- Massage
- Never on red area
ADL Care Steps
- Dressing
- Weak side first
- Undressing
- Strong side first
- Perineal care
- Front to back
- Bath water
- About 105 F
- Oral care
- Unconscious side-lying
- Nails
- No diabetic toenails
ROM + Restorative
- ROM goal
- Prevent contractures
- Active
- Resident does it
- Passive
- Aide moves joint
- Pain
- Stop at resistance
- Restorative
- Promote independence
- Support
- Above and below joint
Intake + Output
- I&O
- Fluids in and out
- Measure
- In mL or cc
- 1 oz
- Equals 30 mL
- Catheter bag
- Below bladder level
- Dehydration
- Dark, concentrated urine
- Edema
- Swelling, report it
Delirium vs Dementia
Delirium
- Sudden onset
- Often reversible
- Report at once
Dementia
- Gradual onset
- Progressive, chronic
- Long-term decline
Sudden vs gradual
End-of-Life + Psychosocial
- Hospice
- Comfort, not cure
- Hearing
- Last sense to go
- Postmortem
- Care with dignity
- Sundowning
- Confusion late day
- Validation
- Enter their reality
- Reminiscence
- Recall past life
Abuse vs Neglect
Abuse
- Intentional harm
- Hitting, threats
- Deliberate act
Neglect
- Failure to provide
- Missed care
- Often omission
Action vs omission
When to Report Picker
- Abnormal vital sign→Tell nurse(Right away)
- Skin change→Tell nurse(Document)
- Resident fall→Stay, call nurse(Incident report)
- Suspected abuse→Report to supervisor(Mandatory)
- Supervisor is abuser→Report to DCH(Skip chain)
- Beyond scope→Notify nurse(Do not act)
Abuse + Neglect Types
- Physical
- Hitting, rough handling
- Verbal
- Threats, yelling, insults
- Sexual
- Unwanted sexual contact
- Financial
- Misuse of money
- Neglect
- Failure to provide care
- Involuntary seclusion
- Confining a resident
Residents' Rights
- Privacy
- Knock, curtain, drape
- Dignity
- Respect at all times
- Refuse
- Right to decline care
- Unopened, private
- Grievance
- Complain without fear
- Ombudsman
- Resident advocate
Communication
- Open question
- Encourages full answer
- Hearing aid
- Face, speak clearly
- Aphasia
- Use picture board
- Active listening
- Eye contact, attend
- Report
- Objective, factual changes
- HIPAA
- Protect private information
Common Traps
Objective vs subjective
Signs are observed ≠ Symptoms are reported
Weak vs strong side
Dress weak first ≠ Undress strong first
Don vs doff PPE
Gloves on last ≠ Gloves off first
Active vs passive ROM
Active resident moves ≠ Passive aide moves
Abuse vs neglect
Abuse is intentional ≠ Neglect is omission
Gel vs soap
C. diff needs soap ≠ Gel spares spores
Last Minute
- 1.Pulse normal 60-100 bpm
- 2.Respirations normal 12-20
- 3.Oral temp 97.6-99.6 F
- 4.BP normal below 120/80
- 5.Hand washing scrub 20 seconds
- 6.Reposition at least every 2h
- 7.Dress weak side first
- 8.Perineal care front to back
- 9.Gloves on last, off first
- 10.Report abuse to supervisor first
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