Physical Care Skills
35%of exam
ADLsBathing + GroomingFeedingEliminationTransfers + ROM
Basic Nursing + Safety
25%of exam
MA Role + Regulations
20%of exam
MGL 19AAbuse ReportingMA NARScopeMOLST
Psychosocial Care
12%of exam
DementiaRightsDignityGriefEnd of Life
Communication + Records
8%of exam
Quick Facts
- Exam
- MA NA Competency Eval
- Provider
- D&S / Headmaster
- Knowledge
- 60 MCQs, 60 min
- Pass
- 76% knowledge
- Skills
- 5 skills, all pass
- Training
- 75 hours min
- Fees
- $40 / $50 / $70
- Attempts
- 4 written / 3 skills
Dress + Transfer
Weak arm in, strong side leads
Dress: weak firstUndress: strong firstTransfer: strong sideSupport weak
Dressing vs Undressing
Dressing
- Weak arm first
- Support joint
- Affected side
Undressing
- Strong arm first
- Leave weak last
- Gentle
Weak in, strong out
Skill Safety First
- Start any skill→Wash hands(Always scored)
- Before care→Knock + identify
- Privacy→Curtain + drape
- Transfer→Lock wheels, gait belt
- Done with care→Lower bed, call light
- End of skill→Wash hands again
ADLs + Personal Care
- Bathing
- Cleanest to dirtiest
- Perineal care
- Front to back
- Oral care
- Even if NPO
- Dressing
- Weak arm first
- Undressing
- Strong arm first
- Nail care
- No diabetic clipping
- Shaving
- Razor with grain
- Denture care
- Line sink, water
Transfers + Mobility
- Gait belt
- Around waist
- Transfer side
- Toward strong side
- Body mechanics
- Bend knees
- ROM
- Never past pain
- Mechanical lift
- Two staff
- Logroll
- Spine aligned
- Fowler's
- Head elevated
- Dangle
- Before standing
Fire RACE
Rescue, Alarm, Contain, Extinguish
R: rescue peopleA: pull alarmC: close doorsE: extinguish small
C. diff vs Sanitizer
C. diff
- Spore forming
- Soap + water
- Friction
Sanitizer
- Fast routine
- No visible soil
- Not for spores
Spores need soap
Emergency Response
- Fire→RACE then PASS(Rescue first)
- Resident choking→Abdominal thrusts
- Active seizure→Protect head(No restraint)
- Resident fell→Do not move, call nurse
- Suspected stroke→Note time, alert nurse
- Spill hazard→Stay, clean, signage
Vital Sign Normals
- Temp oral
- 97.6-99.6 F
- Pulse adult
- 60-100 bpm
- Respirations
- 12-20 per min
- BP normal
- Under 120/80
- Hypertension
- 140/90 or higherReport
- O2 sat
- 95-100% normal
- Apical pulse
- Full minute count
- Pain
- 5th vital sign
Extinguisher PASS
Pull, Aim, Squeeze, Sweep
P: pull pinA: aim baseS: squeeze handleS: sweep side
Infection Control
- Hand hygiene
- Best preventionKey
- Standard precautions
- Treat all blood
- Don order
- Gown then gloves
- Doff order
- Gloves off first
- C. diff
- Soap, not sanitizer
- Airborne
- TB, N95 mask
- Droplet
- Flu, surgical mask
- Sharps
- No recapping
Safety + Emergencies
- RACE
- Rescue, alarm, contain, extinguish
- PASS
- Pull, aim, squeeze, sweep
- Falls
- Call light reach
- Choking
- Abdominal thrusts
- Seizure
- Protect, do not restrain
- Restraints
- Last resort, order
- Bed position
- Lowest, locked
- Oxygen sign
- No open flame
MA Abuse Lines
Elder 922, Facility 462, Disabled 426
EPS: 922-2275DPH: 462-5540DPPC: 426-9009Plus tell supervisor
MOLST vs Health Care Proxy
MOLST
- Medical order
- CNA follows it
- CPR + treatment
Proxy
- Names a person
- MGL 201D
- Future decisions
Order vs decision-maker
MA Reporting Picker
- Elder 60+ abused→EPS (800) 922-2275(Oral now)
- Abuse in LTC→DPH (800) 462-5540(24/7)
- Disabled adult 18-59→DPPC (800) 426-9009
- Any suspicion→Tell supervisor(Also)
- Written follow-up→Within 48 hours
- Resident states abuse→Believe + report
MA Laws + Regs
- MGL 19A s.15
- Elder abuse reportingMA
- MGL 111 s.72G
- Facility abuse reporting
- 105 CMR 150
- LTC facility standards
- 105 CMR 155
- Abuse + registry rules
- 105 CMR 156
- Nurse aide training
- MGL 201D
- Health Care Proxy
- MA NAR
- MA Nurse Aide Registry
- OBRA 1987
- Federal aide standards
EPS vs DPH Hotline
EPS 922-2275
- Elder 60+
- Community + home
- MGL 19A
DPH 462-5540
- LTC facility
- Resident abuse
- MGL 72G
Where abuse happened
MA Reporting Lines
- Elder 60+
- EPS (800) 922-2275Hotline
- EPS timing
- Oral now, written 48h
- LTC facility
- DPH (800) 462-5540
- Disabled 18-59
- DPPC (800) 426-9009
- First step
- Tell supervisor too
- Reasonable cause
- No proof needed
- Mandated reporter
- CNA must report
- Failure to report
- Violates state law
CNA vs Nurse Tasks
CNA
- ADLs + vitals
- Reposition
- Report changes
Nurse
- Meds + IVs
- Sterile care
- Assessments
Care vs clinical
Scope + Role
- Within scope
- ADLs, vitals, hygiene
- Out of scope
- No meds, no IVs
- Sterile tasks
- Nurse only
- Delegation
- Nurse stays accountable
- Report changes
- Tell the nurse
- MA NAR contact
- (617) 753-8144
- Renewal
- 8 paid hours / 2 yrs
- Renewal cost
- Free, no CE
Objective vs Subjective
Objective
- You measure
- Vital signs
- Visible signs
Subjective
- Resident reports
- Pain, nausea
- Their words
Seen vs stated
Communication + Records
- Objective
- Measured, observed
- Subjective
- Resident states
- SBAR
- Situation, background, assess, recommend
- Chart rule
- Not done, not done
- Error fix
- Line out, initial
- HIPAA
- Need to know
- Aphasia
- Allow extra time
- Hard of hearing
- Face, low pitch
Common Traps
MOLST vs proxy
MOLST is an order ≠ Proxy names a person
Where to report
EPS for elders ≠ DPH for facilities
C. diff hand care
Use soap + water ≠ Sanitizer fails spores
Dressing direction
Weak arm dressed first ≠ Strong arm undressed first
Scope of practice
CNA does ADLs ≠ Nurse gives meds
Charting honesty
Chart only done care ≠ Never pre-chart
Last Minute
- 1.Knowledge: 60 MCQs, 60 minutes
- 2.Pass mark: 76% knowledge test
- 3.Skills: pass all 5 demonstrated
- 4.Provider: D&S Diversified (Headmaster)
- 5.Training: 75 hours before testing
- 6.Attempts: 4 written, 3 skills
- 7.Elder 60+ abuse: EPS (800) 922-2275
- 8.LTC facility abuse: DPH (800) 462-5540
- 9.MOLST = order; Proxy = decider
- 10.Renew: 8 paid hours / 2yr
- 11.Always wash hands first and last
- 12.Transfer toward the strong side
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