Safety, Emergencies, and Basic Nursing

Safety Is Prevention Plus Fast Response

Prometric's Idaho outline gives safety its own domain and also lists acute situations under basic nursing care. The pattern is consistent: prevent predictable harm, notice changes early, call for help, and report facts without diagnosing.

Fall prevention starts before the resident stands. Check footwear, glasses, hearing aids, clutter, lighting, bed height (lowest locked position), wheelchair brakes, call light placement, and the care-plan transfer method. Use a gait belt (transfer belt) when assigned, applied snugly over clothing with two fingers fitting underneath, never on bare skin or over a colostomy or feeding tube. Stand close, keep a wide base of support, bend your knees, push with your legs, and avoid twisting at the waist.

If a resident begins to fall, do not try to hold them upright; guide a controlled descent, protecting their head, and lower them to the floor or back into a chair, bending your knees as you go. If a resident is found on the floor, stay with them, check responsiveness and obvious injury, call for help, and do not lift them until the nurse assesses them.

Fire, Oxygen, Choking, and Stroke

For fire, remember RACE: Rescue anyone in immediate danger, Activate the alarm, Contain by closing doors and windows, and Extinguish if small and safe or Evacuate as directed. To use an extinguisher, remember PASS: Pull the pin, Aim at the base of the flames, Squeeze the handle, Sweep side to side. Oxygen supports combustion, so keep flames, smoking materials, sparks, electric razors, and petroleum products (such as Vaseline) away from oxygen equipment, and post No Smoking signs.

For choking, decide whether the resident can cough or speak. A partial obstruction (the resident can cough or speak in short phrases) means stay, encourage forceful coughing, and call for help. A complete obstruction (cannot speak, cough, or breathe, possibly clutching the throat) means activate emergency help and follow facility choking procedure (abdominal thrusts for a conscious adult). Never give water to push food down.

For possible stroke, think FAST: Face drooping, Arm weakness, Speech trouble, Time to report immediately. Also report sudden confusion, new trouble walking, new vision changes, the worst headache of one's life, or any sudden change from baseline. These are minutes-matter emergencies; report at once rather than waiting for routine charting.

Vitals, Normal Ranges, I&O, and SBAR Reporting

Basic nursing skills include data collection: temperature, pulse, respirations, blood pressure, oxygen saturation if assigned, pain, weight, and I&O. Memorize the normal adult ranges so you can recognize what to report.

Count respirations without announcing it, ideally right after the pulse while still holding the wrist, because people change breathing when they know it is counted. Count an irregular pulse for a full minute. For I&O, record intake in milliliters, empty output into a graduate, read it at eye level on a flat surface, and report unusual amount, color, odor, blood, sediment, vomiting, or missing output.

Use a concise SBAR report: Situation, Background, Assessment or observation, Recommendation or request. A CNA does not make the nursing assessment but gives exact observations: "At 0915 the resident had new slurred speech, a right facial droop, and could not grip with the right hand." That beats "the resident seems off." Report immediately for chest pain, shortness of breath, unresponsiveness, fall, head injury, uncontrolled bleeding, seizure, choking, sudden confusion, fever with decline, very high or low vitals, oxygen equipment problems, and any suspected abuse or neglect, then document what you did, observed, told, and when.

Body Mechanics, Restraints, and Emergency First Steps

Proper body mechanics protect both resident and CNA. Keep your back straight, bend at the hips and knees, hold the load close to your body, use the large leg and arm muscles rather than your back, pivot your feet instead of twisting your spine, and push or pull rather than lift when possible. Raise the bed to your waist height for care, then return it to the lowest locked position when you finish. When transferring, lock the bed and wheelchair brakes, apply non-skid footwear, and use a gait belt or mechanical lift exactly as the care plan directs.

Restraints are a last resort, used only with a doctor's order and the least restrictive option. They are tied to the bed frame (not the side rail) with a quick-release knot, checked every 30 minutes, and released at least every 2 hours for repositioning, toileting, range of motion, and circulation checks. Never use a restraint for staff convenience or as punishment. Watch for circulation loss, skin breakdown, and strangulation risk. Side rails, when used inappropriately, count as a restraint.

For immediate emergencies, the CNA's universal first steps are: stay calm, stay with the resident, call for help (call light, hallway, or emergency code), and check responsiveness and breathing. For bleeding, apply firm direct pressure with a clean barrier and call for help. For a seizure, do not restrain the resident or put anything in the mouth; protect the head, clear nearby objects, turn them on their side if possible, time the seizure, and report. For a burn, cool a minor burn with cool (not ice) water and report; never apply butter or ointment.

For suspected fainting (syncope), help the resident to a safe lying or sitting position and report. The thread through every emergency is the same Idaho-exam pattern: prevent, recognize, act within scope, summon the nurse, and report exact facts.