Role of the Nursing Assistant
23%of exam
Role & ScopeResident RightsAbuse ReportingNH Regulations
Safety
7%of exam
Body MechanicsFalls PreventionRestraint RulesWanderguard Alarms
Human Needs & Development
10%of exam
Psychosocial NeedsCultural NeedsAging ChangesCognitive Changes
Basic Nursing Skills
30%of exam
Personal Care / ADLs
30%of exam
ADL SequenceTransfers & ROMNutrition CareEnd of Life Care
Quick Facts
- Credential name
- NH LNA, not CNA
- Written exam
- 60 questions, 90 minutes
- Written pass score
- 70% correct required
- Skills exam
- 4 skills demonstrated live
- Skills pass rule
- 100% of critical steps
- Exam fee
- $105 testing fee
- Training required
- 100 hours, NH-approved program
- Approved test agencies
- Excel Testing, community colleges
- License renewal cycle
- Every 2 years
- CE for renewal
- 24 hours plus 200 work hrs
LNA vs CNA Terminology
New Hampshire LNA
- State licenses aide
- Governed by RSA 326-B
- Renews every 2 years
Most other states
- State certifies aide
- Federal OBRA baseline only
- Renewal timelines vary
Licensed vs certified wording
Reporting Escalation Ladder
- Routine observation→Document in the chart
- Abnormal vital sign→Report to nurse promptly
- Suspected abuse→Report immediately, it's mandatory
- Resident refuses care→Respect it, notify nurse
Nurse Aide Role & Scope
- Reporting
- Follow chain of command
- Delegation
- Nurse assigns nursing tasks
- Scope limit
- No meds, no assessment
- Care plan
- Follow the nurse's plan
- HIPAA
- Keep information confidential
- Documentation
- Objective, factual, and timely
Resident Rights (OBRA)
- Right to refuse
- Care cannot be forced
- Right to privacy
- Knock, use curtain, cover
- Right to grievance
- File complaints without retaliation
- Freedom from abuse
- Zero tolerance, always report
- Right to property
- Belongings must be protected
- Self-determination
- Resident chooses own schedule
Abuse Types & Reporting
- Physical abuse
- Intentional bodily harm caused
- Neglect
- Failing to provide needed care
- Financial exploitation
- Misuse of resident funds
- Mandatory reporter
- Must report suspected abuse
- Unexplained bruising
- Report to nurse immediately
New Hampshire Regulations
- RSA 326-B
- NH Nurse Practice Act
- LNA
- NH's term for CNA
- License cycle
- Renews every two years
- Renewal requirement
- 24 CE + 200 work hrs
- MNA add-on
- Extra 80-hour medication course
Restraint vs Safety Alternative
Restraint
- Requires physician's order
- Used as last resort
Alternative device
- Wanderguard alarms, cushions
- Tried before restraints always
Order required vs not
Restraint Use Decision Logic
- Resident wandering→Try wanderguard alarm first
- Family requests restraint→Requires physician's order
- Restraint in use→Check every 2 hours
- Alternative works→Use alternative, not restraint
- Restraint applied→Document reason and schedule
Body Mechanics & Injury Prevention
- Base of support
- Feet shoulder-width apart
- Lift technique
- Bend knees, not back
- Load position
- Keep object close to body
- Twisting
- Never twist while lifting
- Push vs pull
- Push loads, don't pull
Falls & Restraint Rules
- Call light
- Always keep within reach
- Bed position
- Keep low and locked
- Restraint order
- Requires a physician's order
- Restraint check
- Release and check every 2 hours
- Wanderguard
- Alarm for elopement risk
Dementia vs Delirium Onset
Dementia
- Gradual, progressive onset
- Generally irreversible condition
Delirium
- Sudden, rapid onset
- Often reversible cause
Onset speed tells difference
Aging & Cognitive Changes
- Normal aging
- Slower, but not confused
- Dementia
- Progressive, irreversible memory loss
- Delirium
- Sudden onset, often reversible
- Sundowning
- Evening confusion increases
- Depression signs
- Withdrawal and appetite loss
Emergency Priority Order
Check Airway, then Breathing, then Circulation first
A: Airway openB: Breathing presentC: Circulation checked
Standard vs Transmission Precautions
Standard precautions
- Used on every resident
- Hand hygiene, gloves always
Transmission-based precautions
- Added for known infection
- Contact, droplet, or airborne
Baseline vs disease-specific
PPE Donning and Doffing Order
- Entering room→Don gown first(Before mask)
- After gown on→Don mask next
- After mask on→Don goggles third
- Last item donned→Gloves go last
- Leaving room→Remove gloves first(Most contaminated)
- After gloves off→Remove goggles next
- After goggles off→Remove gown next
- Last item removed→Remove mask last(Then wash hands)
Vital Sign Ranges (Adult)
- Temperature
- 97.8-99.1°F oral average
- Pulse
- 60-100 beats per minute
- Respirations
- 12-20 breaths per minute
- Blood pressure
- Below 120/80 is normal
- Pulse oximetry
- 95-100% oxygen saturation normal
- Report threshold
- Oxygen saturation below 90%
PPE Donning and Doffing
Don gown, mask, goggles, gloves; remove in reverse order
Don: gown firstDon: gloves lastDoff: gloves firstDoff: mask last
Subjective vs Objective Data
Subjective data
- Resident's own words
- Cannot be directly measured
Objective data
- Aide's direct observation
- Measurable and factual
Reported vs observed data
Emergency Response Priorities
- Resident is choking→Give abdominal thrusts(Call for help)
- Chest pain reported→Call nurse immediately
- Witnessed a fall→Do not move resident
- Signs of stroke→Note time, call nurse
- Resident unresponsive→Call for help first
Infection Control & PPE
- PPE donning order
- Gown, mask, goggles, gloves
- PPE doffing order
- Gloves, goggles, gown, mask
- Hand hygiene
- Before and after every contact
- Standard precautions
- Used with every resident
- Contact precautions
- Gown and gloves required
- Airborne precautions
- N95 respirator mask required
Observation & Reporting
- Objective data
- What the aide observes
- Subjective data
- What the resident states
- Urgent report
- Chest pain, bleeding, falls
- I&O tracking
- Record all intake, output
- Incident report
- Document any unusual event
Perineal Care Direction
Always clean perineal area front to back, never reverse
Front: urethra areaBack: anal areaPrevents UTI risk
Active ROM vs Passive ROM
Active ROM
- Resident moves independently
- Builds strength and mobility
Passive ROM
- Aide moves the resident
- Prevents joint contractures
Who performs the movement
ADL & Hygiene Sequence
- Bed bath order
- Face first, perineal last
- Perineal care
- Always clean front to back
- Oral care position
- Side-lying if unconscious
- Denture storage
- Cool water, labeled container
- Diabetic nail care
- Refer to nurse or podiatrist
- Dressing hemiplegia
- Weak side dressed first
Dressing Hemiplegia Rule
Dress the weak side first, undress the strong side first
Dress: weak side firstUndress: strong side first
Transfers, Ambulation & ROM
- Gait belt
- Snug fit at waist
- Wheelchair lock
- Always lock before transfer
- Active ROM
- Resident moves independently
- Passive ROM
- Aide moves for resident
- Ambulation aid
- Walk beside the weak side
Nutrition, Elimination & End of Life
- Fluid restriction
- Report if resident exceeds
- Aspiration risk
- Keep upright while feeding
- Bowel training
- Use regular scheduled toileting
- Catheter bag
- Keep below bladder level
- Post-mortem care
- Handle the body with dignity
Common Traps
LNA Name ≠ Lesser Credential
Same national scope of practice ≠ NH licenses instead of certifies
Restraint ≠ First Response Option
Alternatives always tried first ≠ Physician's order required always
Objective ≠ Subjective Reporting
Objective is aide's observation ≠ Subjective is resident's statement
Dementia ≠ Delirium Timeline
Dementia develops gradually always ≠ Delirium develops suddenly, often reversible
Active ROM ≠ Passive ROM
Active means resident moves ≠ Passive means aide moves
Standard ≠ Transmission Precautions
Standard used on everyone ≠ Transmission added for infections
Reporting ≠ Diagnosing Role
Aides report observations only ≠ Nurses diagnose and treat
Last Minute
- 1.Written: 60 questions, 90 minutes
- 2.Written passing score: 70%
- 3.Skills: 4 tasks demonstrated
- 4.Skills require 100% critical steps
- 5.NH uses LNA, not CNA
- 6.Perineal care: front to back
- 7.PPE doffing: gloves removed first
- 8.Restraints need physician's order
- 9.Dress weak side first
- 10.Renewal: 24 CE + 200 work hrs
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