13.2 Core Workflows and Decision Points

13.2 Core Workflows and Decision Points

Data collection on the STNA exam is procedural. The questions test whether you follow the exact technique, so learn the steps and the numbers behind each measurement.

Counting pulse and respirations

Locate the radial pulse (thumb side of the wrist) using your fingertips, never your thumb, which has its own pulse. If the beat is regular, count for 30 seconds and multiply by 2. If it is irregular, count for a full 60 seconds. For an apical pulse (over the heart with a stethoscope) always count a full minute.

Right after the pulse, keep your fingers on the wrist and count respirations for 30 seconds times 2 (or 60 seconds if irregular). Do not announce that you are counting breaths - a resident who knows will change their breathing pattern and ruin the reading. One respiration equals one full inhale plus exhale.

Temperature timing rules

Reporting the wrong route or skipping the wait time is a classic trap because it produces a falsely abnormal value.

Blood pressure technique

Use the correct cuff size, position the arm at heart level, and place the cuff about 1 inch above the elbow with the bladder over the brachial artery. Wait if the resident just exercised, smoked, or had caffeine. Record systolic over diastolic (for example 118/76). If unsure of a reading, wait 1-2 minutes before re-inflating.

Intake and output

All I&O is recorded in milliliters (mL). Memorize the conversions: 1 oz = 30 mL and a standard cup or glass = 8 oz = 240 mL. Output includes urine, emesis, and liquid stool; intake includes all fluids and foods that are liquid at room temperature (gelatin, ice cream, broth).

• 8 oz cup fully consumed = 240 mL
• Half of a 6 oz bowl of broth (180 mL total) = 90 mL
• 4 oz juice consumed = 120 mL

Weight and height

Weigh at the same time of day, on the same scale, in similar clothing, with the resident having voided first. A weight change of several pounds in a few days is a red flag to report - it may signal fluid retention.

Worked example

A resident drinks a full 240 mL cup of water, eats half a 120 mL cup of gelatin (60 mL), and voids 300 mL of urine. Recorded intake = 300 mL; recorded output = 300 mL. The exam may ask you to total or to separate intake from output, so keep the columns straight.

What counts as intake and what counts as output

Intake is more than just beverages. Anything that is liquid at room temperature counts toward fluid intake: water, juice, coffee, milk, broth, gelatin, ice cream, popsicles, and the melted portion of ice chips (record about half the volume of ice chips, since ice melts to roughly half its frozen volume). Solid foods are not part of fluid intake. Tube feedings and intravenous fluids are also intake, but a nurse aide records only the oral intake and leaves the rest to the nurse.

Output is everything the body eliminates that can be measured: urine, emesis (vomit), liquid stool, wound drainage, and the contents of drainage devices. You measure urine in a graduated container (often a "hat" placed in the toilet or a urinal/bedpan) rather than estimating. If a resident is incontinent, you cannot measure the exact amount, so you record the episode and describe it instead of inventing a number.

Measuring devices and reading them correctly

When you pour urine into a graduate, set the container on a flat surface and read the volume at eye level at the bottom of the meniscus - the curved surface of the liquid. Reading at an angle or from above gives a falsely high or low value. Always perform hand hygiene and wear gloves when handling output, then discard, clean the equipment, and remove gloves before charting so you do not contaminate the record.

Common technique errors that change the number

• Counting a pulse for only 10 or 15 seconds and multiplying - acceptable shortcuts on the floor sometimes, but the exam expects 30 seconds (regular) or 60 seconds (irregular).
• Letting the resident talk while taking respirations, which changes the rate.
• Taking blood pressure over a sleeve, with the arm dangling, or with a cuff that is too small - each falsely raises the reading.
• Weighing a resident before they void, in heavy clothing, or on a different scale than yesterday, which makes a real trend impossible to see.

Getting the technique right is the difference between data the care team can trust and data that triggers a false alarm or hides a real problem.