Safety, Emergencies, and Basic Nursing
Key Takeaways
- Falls, fire, choking, stroke signs, bleeding, burns, respiratory distress, and sudden confusion require immediate safety action and prompt reporting.
- For a fall or suspected injury, stay with the resident, call for help, assess responsiveness, and do not lift until the nurse evaluates the resident.
- Vital signs and I&O are data collection, not diagnosis; record exact measurements and report values outside baseline or facility parameters.
- CNAs protect residents by using body mechanics, gait belts, oxygen safety, call lights, low locked beds, and clear SBAR-style reporting.
Safety Is Prevention Plus Fast Response
Prometric's Idaho outline gives safety its own domain and also lists acute situations under basic nursing care. For CNA practice, 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, wheelchair brakes, call light placement, and the care plan transfer method. Use a gait belt when assigned, stand close, keep a wide base, bend your knees, and avoid twisting. If a resident begins to fall, guide a controlled descent rather than trying to pull them upright. 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 Extinguish only if safe or Evacuate as directed. PASS is for extinguisher use: Pull, Aim, Squeeze, Sweep. Oxygen increases fire risk, so keep flames, smoking materials, sparks, and petroleum products away from oxygen equipment.
For choking, decide whether the resident can cough or speak. If they can cough forcefully, stay with them and call for help while encouraging coughing. If they cannot speak, cough, or breathe, activate emergency help and follow facility choking procedure. Do not 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, severe headache, or a sudden change from baseline.
Vitals, I&O, and Reporting
Basic nursing skills include data collection. CNAs commonly measure temperature, pulse, respirations, blood pressure, oxygen saturation if assigned, pain reports, weight, intake, output, and bowel or bladder patterns. Count respirations without announcing it when possible because people can change their breathing if they know it is being counted. Count an irregular pulse for a full minute and report irregularity.
I&O must be exact enough to guide care. Record intake in milliliters, empty output containers into a graduate when appropriate, read the measurement at eye level, and report unusual amounts, color, odor, blood, sediment, vomiting, diarrhea, or missing output. A resident on fluid restriction needs coordinated tracking across the whole shift, not guesswork.
What Makes a Report Useful
Use a concise SBAR style: Situation, Background, Assessment or observations, Recommendation or request. A CNA does not make the nursing assessment, but can give exact observations: at 0915 resident had new slurred speech, right facial droop, and could not grip with the right hand. That is more useful than resident seems off.
Report immediately for chest pain, shortness of breath, unresponsiveness, new weakness, fall, head injury, uncontrolled bleeding, seizure, choking, sudden confusion, fever with decline, very low or high vital signs, oxygen equipment problems, and any suspected abuse or neglect. Document what you did, what you observed, who you told, and when.
A resident who normally walks with a walker is found sitting on the floor beside the bed. They say their hip hurts. What should the CNA do first?
Which observations should be reported immediately rather than saved for routine charting?
Select all that apply
A resident begins coughing during lunch but can speak in short phrases. What is the best CNA response?