7.2 Key Clinical Skills Walkthrough

Key Clinical Skills Walkthrough

Quick Answer: Every NNAAP skill opens the same way — knock, introduce yourself, provide privacy, explain, and wash your hands — and closes the same way — call light in reach, bed low and locked, wash hands, report. Between those bookends, each skill has a few make-or-break steps. Learn the bold (critical) steps below for the highest-frequency skills, then rehearse each one out loud until the sequence is automatic.

The skills below are among the most commonly assigned. Each is written as an ordered checklist so you can practice the sequence, because the evaluator scores order as well as technique. Assume the universal indirect-care steps from Section 5.1 wrap around every one.

Hand Washing (always tested)

1. Turn on the water and wet your hands and wrists, keeping hands lower than the elbows.
2. Apply soap and work up a lather.
3. Rub all surfaces — palms, backs, between fingers, and under the nails — for at least 20 seconds using friction.
4. Rinse with fingertips pointing down, not letting your hands or clothing touch the sink.
5. Dry your hands thoroughly with a clean paper towel and discard it.
6. Turn off the faucet using a clean, dry paper towel so you do not re-contaminate your hands.

Donning and Doffing PPE

Personal protective equipment (PPE) goes on and comes off in a fixed order. The rule: gloves go on last and come off first because they are the most contaminated.

Remove the mask by its ties or ear loops, never the contaminated front, and perform hand hygiene immediately after all PPE is off.

Radial Pulse and Respirations

1. Place your first two or three fingertips (never your thumb) over the radial artery at the thumb side of the wrist.
2. Count the pulse for a full 60 seconds; note the rate, rhythm, and force.
3. Without moving your hand or telling the resident, count respirations for a full 60 seconds — one rise and fall of the chest is one breath.
4. Record both values and report anything outside normal (pulse 60-100, respirations 12-20).

Keeping your fingers on the wrist while counting breathing prevents the resident from consciously altering their breaths.

Manual Blood Pressure

1. Position the arm supported at heart level, palm up, and apply the correct-size cuff to the bare upper arm.
2. Place the stethoscope over the brachial artery, inflate, then deflate slowly.
3. Note the systolic (first sound) and diastolic (last sound), reading the gauge at eye level.
4. Record the value; your reading must be within plus or minus 8 mmHg of the evaluator's.

Ambulation With a Gait Belt

1. Explain the walk, apply non-skid footwear, and lock the bed wheels.
2. Apply the gait belt snugly at the waist over clothing, leaving room for two fingers, and grasp it underhand.
3. Help the resident to standing; let them steady themselves before moving.
4. Walk slightly behind and to the resident's weak (affected) side, holding the belt.
5. Watch for dizziness or fatigue; if the resident starts to fall, ease them to the floor protecting the head — never try to hold them up.
6. Return the resident to a safe position, remove the belt, and report how they tolerated the walk.

Passive Range of Motion (one joint, e.g., the shoulder)

1. Explain that you will move the joint for the resident, who should tell you if it hurts.
2. Support the limb above and below the joint (for the shoulder, support the elbow and the wrist).
3. Move the joint slowly and gently through its normal motions (for the shoulder: flexion, extension, abduction, adduction).
4. Perform each motion the ordered number of times (commonly 3-5 repetitions).
5. Stop at the point of pain or resistance — never force a joint past resistance.
6. The goal is to prevent contractures (permanent stiffening); report any new pain or limited motion.

Perineal Care and Catheter Care

1. Provide privacy, wash hands, glove, and drape so only the perineum is exposed.
2. Use warm water and a clean section of the cloth for each stroke.
3. Always wipe front to back (urethra toward rectum) to keep bacteria away from the urinary opening and prevent a urinary tract infection (UTI).
4. For catheter care, clean the catheter from the meatus outward along the tube, never back toward the body.
5. Keep the drainage bag below the bladder and the tubing free of kinks; never rest the bag on the floor.
6. Observe and report cloudy, bloody, or foul-smelling urine.

Measuring Urinary Output

1. Put on gloves and pour urine from the bedpan, urinal, or graduate collection container into a graduate (measuring container).
2. Place the graduate on a flat surface and read at eye level for accuracy.
3. Record the amount in milliliters (mL), also written cc (1 ounce equals 30 mL).
4. Empty, rinse, and store the equipment; remove gloves and wash hands.
5. Report low output or dark, concentrated urine (a sign of dehydration).

Positioning a Resident on the Side (lateral)

1. Lower the head of the bed flat and move the resident to one side of the bed.
2. Cross the resident's far leg over the near leg and turn them toward you onto their side.
3. Support the back with a pillow; place a pillow between the knees to keep the legs aligned.
4. Support the top arm on a pillow and check body alignment (head, spine, hips straight).
5. Confirm comfort, place the call light, and reposition again within 2 hours to prevent pressure injuries.