14.2 Mandatory First Tasks: Bedpan, Catheter Care, Drainage Bag, Perineal Care, and Hand Washing

Mandatory First Tasks: Bedpan, Catheter Care, Drainage Bag, Perineal Care, and Hand Washing

In the Wyoming skill test, Task 1 is the cornerstone of the examination. While your remaining two or three tasks are drawn at random from the published skill task listing, Task 1 is always assigned from a pool of exactly four tasks centred on elimination, intimate personal care and fluid measurement.

Most significantly, Task 1 carries the embedded soap-and-water hand washing sequence. You may not simulate hand hygiene or substitute alcohol foam here. You walk to the sink and physically perform medical asepsis while the RN Test Observer records each step. A single missed key step in Task 1 — under-timing the lather, contaminating clean hands on the faucet, misreading output beyond tolerance — fails that task, and failing any assigned task fails the skill test.

+-----------------------------------------------------------------------------------+
|                THE FOUR MANDATORY TASKS (ONE WILL BE YOUR TASK 1)                 |
+-----------------------------------------------------------------------------------+
|  1. Assist Resident with the use of a Bedpan with Hand Washing      [LIVE ACTOR]  |
|  2. Catheter Care for a Female with Hand Washing                    [MANIKIN]     |
|  3. Don PPE (gown + gloves), Empty a Urinary Drainage Bag,                        |
|     Measure and Record Urine Output, Doff PPE with Hand Washing     [LIVE ACTOR]  |
|  4. Perineal Care for a Female with Hand Washing                    [MANIKIN]     |
+-----------------------------------------------------------------------------------+
|  Every one of them ends with the same embedded soap-and-water hand washing.       |
+-----------------------------------------------------------------------------------+

Only two Wyoming tasks are demonstrated on a manikin — catheter care for a female and perineal care for a female. Everything else is performed on a live resident actor, and you must treat the manikin with the same dignity, gentle handling and privacy draping you would give a person.

---

Task 1: Perineal Care for a Female with Hand Washing (Manikin)

Perineal care cleanses the external genitalia and the anal area. Because the perineum sits between the urinary meatus and the rectum, meticulous front-to-back technique prevents enteric organisms such as Escherichia coli from migrating into the urethra — the dominant cause of healthcare-associated urinary tract infections.

+-----------------------------------------------------------------------------------+
|             FEMALE PERINEAL CLEANSING SEQUENCE (FRONT TO BACK)                    |
+-----------------------------------------------------------------------------------+
|  WASH (soapy washcloth)              then    RINSE (clean washcloth, water)       |
|   1. One side of the labia                    4. One side of the labia            |
|   2. Other side of the labia                  5. Other side of the labia          |
|   3. Vaginal area, front to back              6. Vaginal area, front to back      |
|                                                                                   |
|  Then PAT DRY, turn the resident onto their side away from you, and:              |
|   7. Wash from vagina to rectal area          8. Rinse rectal area front to back  |
|                                                                                   |
|  *RULE: A CLEAN PORTION of the washcloth for EVERY stroke, ALWAYS front to back.  |
|  *RULE: Water and a soapy washcloth only - NO peri-wash and NO no-rinse soap.     |
+-----------------------------------------------------------------------------------+

Step Sequence

1. Hand hygiene: cover all surfaces of the hands with sanitizer and rub until completely dry.
2. Explain the procedure to the resident and provide for privacy.
3. Fill a basin with comfortably warm water.
4. Raise the bed height and put on gloves.
5. Turn the resident or raise the hips and place a waterproof pad under the buttocks.
6. Expose the perineal area only.
7. Separate the labia. It helps to verbalize what you are doing as you demonstrate it.
8. Use water and a soapy washcloth — peri-wash and no-rinse soap are not allowed.
9. Clean one side of the labia front to back; use a clean portion of the cloth and clean the other side front to back; use another clean portion for the vaginal area front to back.
10. Repeat the identical three-stroke pattern to rinse with a clean washcloth, then pat dry.
11. Assist the resident onto their side away from you, toward the centre of the bed. The RN Test Observer may help hold the manikin on its side, but only after you have turned it.
12. Wash from vagina to rectal area with a clean soapy washcloth, use a clean portion with any stroke, then rinse the rectal area front to back and pat dry.
13. Safely remove the waterproof pad, position the resident on their back, place soiled linen in the designated hamper, and empty, rinse, dry and return the equipment.
14. Remove gloves, turning them inside out, and dispose of them in a trash container.
15. Lower the bed and place the call light within easy reach.
16. Maintain respectful, courteous interaction throughout, then proceed to the embedded hand washing sequence.

---

Task 2: Catheter Care for a Female with Hand Washing (Manikin)

An indwelling catheter is a direct highway from the perineum into the bladder. Catheter-associated urinary tract infection is one of the most common and most preventable healthcare-associated infections, and the two mechanisms this task defends against are organisms tracking up the outside of the tube and traction injury to the urethra.

+-----------------------------------------------------------------------------------+
|                   CATHETER CARE DIRECTIONAL RULE (FEMALE)                         |
+-----------------------------------------------------------------------------------+
|                                                                                   |
|      [URETHRA]======================== drainage tube =====> [to drainage bag]     |
|          ^                                                                        |
|          |   Hold the catheter HERE, where it exits the urethra, with one hand    |
|          |                                                                        |
|          +--- ALL strokes move AWAY from the urethra, at least 3-4 inches         |
|               down the tube, a CLEAN PORTION of cloth for EVERY stroke,           |
|               at least TWO strokes to wash and TWO to rinse.                      |
|                                                                                   |
|  *NEVER wipe back toward the meatus. *NEVER let the tube be tugged or pulled.     |
+-----------------------------------------------------------------------------------+

Step Sequence

1. Hand hygiene with sanitizer, rubbed until completely dry.
2. Explain the procedure and provide for privacy.
3. Fill a basin with comfortably warm water and put on gloves.
4. Expose the area surrounding the catheter, exposing only the lower half of the resident's body.
5. Hold the catheter where it exits the urethra with one hand — and keep holding it. This single act is what prevents traction on the balloon and the bladder neck.
6. While holding the catheter, clean at least 3 to 4 inches down the drainage tube, using at least two strokes, only away from the urethra, with a clean portion of the washcloth for each stroke.
7. While still holding the catheter, rinse at least 3 to 4 inches down the tube using the same away-from-the-urethra strokes and a clean portion of cloth for each.
8. Pat dry.
9. Do not allow the tube to be tugged or pulled at any time during the procedure.
10. Replace the top cover over the resident, place soiled linen in the designated laundry, and empty, rinse, dry and return the equipment.
11. Remove gloves inside out and dispose of them, then place the call light within easy reach.
12. Maintain respectful, courteous interaction, then perform the embedded hand washing sequence.

[!CAUTION] The two most common failures on this task are letting go of the catheter to reach for a fresh washcloth — which permits traction — and reversing a stroke back toward the meatus, which sweeps perineal flora directly to the urethral opening. Plan your washcloth folds before you touch the catheter so that one hand never has to leave the tube.

---

Task 3: Assist Resident with the use of a Bedpan with Hand Washing

This task evaluates elimination dignity, positioning, privacy and cross-contamination control. It is worth reading the official step list closely, because it differs from what many national CNA textbooks describe.

[!IMPORTANT] The Wyoming bedpan task contains no measurement step. There is no graduate, no meniscus reading and no recorded volume — and therefore no tolerance to hit. The RN Test Observer pours liquid (simulated urine) into the bedpan while you hold it, and you empty, rinse and return the equipment. If you have practised this task from an out-of-state checklist that includes measuring output, you have practised the wrong task.

Step Sequence

1. Hand hygiene with sanitizer, rubbed until completely dry.
2. Explain the procedure and provide for privacy.
3. Put on gloves.
4. Position the resident on the bedpan or fracture pan correctly — the pan is not upside down and is centred.
5. Raise the head of the bed to a comfortable level. (The handbook says "a comfortable level," not a specific angle; sitting upright is what makes elimination physiologically possible and prevents sacral shear.)
6. Leave tissue within reach of the resident.
7. Leave the call light or signaling device within reach of the resident.
8. Move to an area of the room that provides privacy for the resident.
9. Return when the RN Test Observer indicates.
10. Lower the head of the bed.
11. Gently remove the bedpan or fracture pan. You hold the pan while the RN Test Observer pours the simulated urine in.
12. Empty the equipment into the designated toilet or commode, rinse it and empty the rinse water into the toilet or commode, then return the equipment to storage.
13. Wash or assist the resident in washing and drying their hands with soap and water. A wet, soapy washcloth is acceptable. This step is easy to forget and is part of the task.
14. Place soiled linen in the designated laundry hamper.
15. Remove gloves inside out and dispose of them.
16. Place the call light within easy reach, maintain respectful interaction, and perform the embedded hand washing sequence.

Choosing the Pan

+-----------------------------------------------------------------------------------+
|                         BEDPAN SELECTION AND ALIGNMENT                            |
+-----------------------------------------------------------------------------------+
| STANDARD BEDPAN                                 FRACTURE (ORTHOPEDIC) PAN         |
|   Deep, with a wide curved rim under the          Shallow with a low flat end;    |
|   buttocks and the narrow end toward the          the LOW END goes under the      |
|   feet.                                           buttocks, handle toward feet.   |
|   Use for residents who can raise the hips.       Use for hip fracture, spinal    |
|                                                   surgery, severe arthritis, or   |
|                                                   limited hip flexion.            |
+-----------------------------------------------------------------------------------+

---

Task 4: Don PPE, Empty a Urinary Drainage Bag, Measure and Record Output, Doff PPE

This is the only mandatory task that combines PPE sequencing, closed-system asepsis and a scored measurement. It is also the only one of the four with a published numeric tolerance.

Donning Sequence

1. Hand hygiene with sanitizer, rubbed until completely dry.
2. Unfold the gown and face the back opening.
3. Place arms through each sleeve.
4. Secure the neck opening.
5. Secure the gown at the waist, making sure the back flaps cover your clothing as completely as possible.
6. Put on gloves, with the cuffs of the gloves overlapping the cuffs of the gown.

Emptying and Measuring

1. Explain the procedure and provide for privacy.
2. Place a barrier on the floor under the drainage bag, then place the graduate on that barrier.
3. Open the drain and let the urine flow into the graduate until the bag is completely empty.
4. Avoid touching the graduate with the tip of the tubing. Contact between the drain spout and the graduate rim contaminates the closed system.
5. Close the drain.
6. Wipe the drain with an alcohol wipe AFTER emptying the drainage bag. The word AFTER is capitalised in the handbook, which means this step is genuinely order-dependent — wiping before you empty earns nothing.
7. Place the graduate on a level, flat surface.
8. With the graduate at eye level, measure the output. Read the bottom of the meniscus with your line of sight horizontal to the fluid; reading from above inflates the value.
9. Empty the graduate into the designated toilet or commode, rinse the equipment, emptying the rinse water into the toilet or commode, and return the equipment to storage.
10. Record the output in mL on the previously signed recording form.

[!IMPORTANT] THE ONE PUBLISHED TOLERANCE ON A MANDATORY TASK: the candidate's recorded measurement must be within 25 mL of the RN Test Observer's measurement. Nothing tighter is required, and no other mandatory task is measured at all.

Doffing Sequence

1. Place the call light within easy reach and maintain respectful interaction.
2. Remove gloves BEFORE removing the gown — another capitalised, order-dependent step — or, with gloves still on, pull or pop the gown off by pulling on the front of the gown.
3. Remove gloves by turning them inside out and folding one inside the other, or pull the gown from the neck, always keeping gloved hands on the outside (contaminated) portion of the gown.
4. Do not touch the outside of the gloves with your bare hand at any time, or work the gown down the arms from the neck and roll it inside out as it is removed.
5. Dispose of the gloves and gown in the appropriate container, then perform the embedded hand washing sequence.

---

The Embedded Soap-and-Water Hand Washing Sequence

Every mandatory task ends here, and the handbook scores it as a numbered list of discrete steps rather than as a general impression of technique.

+-----------------------------------------------------------------------------------+
|            THE WYOMING EMBEDDED HAND WASHING STEPS, IN ORDER                      |
+-----------------------------------------------------------------------------------+
|   1. Turn on the water.                                                           |
|   2. Wet hands and wrists thoroughly.                                             |
|   3. Apply soap to hands.                                                         |
|   4. Rub hands together using friction with soap.                                 |
|   5. Scrub/wash hands together for AT LEAST TWENTY (20) SECONDS with soap.        |
|   6. Scrub/wash with INTERLACED FINGERS POINTING DOWNWARD with soap.              |
|   7. Wash all surfaces of your hands with soap.                                   |
|   8. Wash WRISTS with soap.                                                       |
|   9. Clean fingernails by rubbing fingertips against the palm of the              |
|      opposite hand.                                                               |
|  10. Rinse fingers, hands and wrists thoroughly under running water with          |
|      FINGERS POINTED DOWNWARD.                                                    |
|  11. Dry hands with a clean paper towel(s).                                       |
|  12. Discard paper towel(s) in a trash container as used.                         |
|  13. Turn off the faucet with a CLEAN, DRY paper towel and discard it.            |
|  14. DO NOT RECONTAMINATE HANDS at any time during the procedure.                 |
+-----------------------------------------------------------------------------------+

The Four Ways Candidates Lose This Sequence

1. Under-timing the friction. Twenty seconds is longer than it feels. Candidates counting silently routinely stop at 15 to 18 seconds. Sing "Happy Birthday" twice at a deliberate pace, or count "one-Mississippi" to twenty-five for margin.
2. Forgetting the wrists and the fingernails. These are separate scored steps, not part of "washing your hands." Wash the wrists explicitly and rub your fingertips against the opposite palm where the observer can see it.
3. Fingers not pointing downward. Both the lather step and the rinse step specify downward-pointing fingers so that contaminated water runs off the fingertips into the basin rather than back onto clean forearms.
4. Recontaminating at the end. The handbook gives two explicit examples: touching the sides of the sink during the procedure, and crumpling up the paper towel used to turn off the faucet with both hands before discarding it. Turn the faucet off with a fresh, dry towel held in one hand and drop it straight into the trash.