12.2 Core Workflows and Decision Points
Key Takeaways
- Positioning is a frontline STNA intervention: high Fowler's for breathing trouble, pressure-relief turns every 2 hours, never massage a possible DVT.
- For low blood sugar, give a fast-acting sugar source only if the resident is awake and able to swallow, then notify the nurse.
- Stroke is time-critical: use FAST (Face, Arms, Speech, Time) and report instantly — minutes determine whether brain tissue is saved.
- Skin checks during care are one of the most valuable observations an aide makes; a non-blanchable red spot is the earliest pressure-injury warning.
12.2 Core Workflows and Decision Points
Each disease has a predictable bedside workflow: you notice a trigger, take a safe immediate action inside your scope, and report the right details. Memorize the action and the report for each condition.
Breathing trouble (COPD and CHF)
When a resident is short of breath, position is your most powerful tool. Place the resident in high Fowler's position (sitting upright at about 90 degrees), which lets the lungs expand fully. Stay calm, loosen tight clothing, and encourage pursed-lip breathing for COPD residents (inhale through the nose, exhale slowly through pursed lips). Never lay a breathless resident flat — it worsens the work of breathing. Then notify the nurse.
The universal workflow
Every condition in this chapter runs through the same three-part loop, which is worth memorizing because the exam rewards it again and again. Trigger: you notice a sign during routine care. Action: you take the safe, in-scope step that protects the resident — usually positioning, relieving pressure, keeping the airway clear, or keeping the resident still. Report: you tell the licensed nurse the objective facts and document them. If a question ever leaves you unsure, defaulting to "protect from immediate harm, then report" is the most defensible path.
Notice what is not in the loop: diagnosing, medicating, restricting fluids, or treating. Those belong to the nurse and the care plan.
Diabetes: high vs. low sugar
| Problem | Onset | Key signs | STNA action |
|---|---|---|---|
| Hypoglycemia (low sugar) | Sudden | Shaky, sweaty, pale, confused, irritable | If awake and able to swallow, give fast sugar (juice, glucose); notify nurse |
| Hyperglycemia (high sugar) | Gradual | Thirsty, frequent urination, fruity breath, drowsy | Report to nurse; do NOT give sugar |
The memory aid is that low is dangerous fast. Never put food or fluid in the mouth of a resident who is unresponsive or cannot swallow — that risks choking. Report and let the nurse manage it.
Stroke: FAST and time
A stroke is an emergency where minutes of delay equal lost brain tissue. Use the FAST screen: Face drooping, Arm weakness, Speech slurred, Time to call for help. If you see any of these, report to the nurse immediately and note the time the symptoms started — that time directly affects which treatments are still possible.
Pressure-injury prevention
Pressure injuries form when blood flow to skin over a bony prominence is cut off by unrelieved pressure. Your routine prevents most of them:
- Reposition bedbound residents at least every 2 hours (chairbound about every hour or per care plan).
- Keep skin clean and dry; change wet or soiled linens promptly.
- Use pillows to keep bony areas (heels, hips, sacrum, elbows) from pressing on the bed.
- During every bath and change, look at the skin and report any redness, especially redness that does not turn white when you press it (non-blanchable).
DVT: the one you never rub
A deep vein thrombosis is a clot, usually in a calf, that shows up as a leg that is suddenly warm, red, swollen, and painful. The critical rule: never massage or rub the area and do not exercise the limb. Pressure could dislodge the clot, which can travel to the lungs (a pulmonary embolism) and become fatal. Keep the resident still and report immediately.
Pressure-injury stages (recognize, do not assign)
Nurses assign the stage; you only need to recognize that damage is present so you report it. Knowing the stages helps you describe what you see accurately:
| Stage | What you see |
|---|---|
| Stage 1 | Intact skin, non-blanchable redness over a bony area |
| Stage 2 | Partial-thickness loss — a shallow open sore or blister |
| Stage 3 | Full-thickness loss; fat may be visible |
| Stage 4 | Deep loss exposing muscle, tendon, or bone |
| Deep tissue injury | Intact skin that is purple or maroon |
| Unstageable | Base hidden by slough or eschar (dead tissue) |
This staging system comes from the National Pressure Injury Advisory Panel (formerly NPUAP). Your takeaway: any of these findings gets reported, and prevention — turning, padding, keeping skin clean and dry — is your responsibility on every shift.
Cardiac and choking emergencies
Two emergencies overlap with this domain and follow the same report-fast rule. Chest pain with sweating, nausea, or arm/jaw pain can signal a heart attack: keep the resident calm and still, do not let them walk, and get the nurse immediately. Choking (clutching the throat, unable to speak or cough) in a conscious resident calls for abdominal thrusts if you are trained and the airway is fully blocked. In both cases, the worst answer is to delay or to handle it alone when help is available.
Worked example
During a bed bath you find a quarter-sized red mark over the resident's tailbone. You press it and the redness stays. This is a likely Stage 1 pressure injury. You do not stage it or apply a dressing — instead you reposition the resident off that area, keep the skin dry, and report the non-blanchable redness to the nurse so the care plan can be updated.
A resident with diabetes becomes shaky, sweaty, and confused but is awake and able to swallow. What is the STNA's best immediate action?
An STNA notices a resident's left calf is warm, red, swollen, and painful. What should the aide avoid doing?