Skills

Question 1

Handwashing (At a real sink, using soap and water)

Answer 1

1. Remove watch, or push it up on forearm, roll up sleeves
2. Turn on water and adjust temperature
   - do not let uniform touch sink
   - use paper towel to turn on water
   - don’t turn on the water too quickly/hard
3. Wet hands and wrists. Apply soap
4. Keep hands lower than elbows. Rub hands together to make a bubbly lather
5. Re-wet hands/wrists and re-apply soap as needed
6. Wash hands, fingers, and wrists for about 15 seconds (not under the water)
7. Rinse hands and wrists (avoid splashing), keep hands lower than elbows
8. Let hands drip, reach for paper towels
9. Dry hands and wrists thoroughly (from fingertips to wrists). Discard towels
10. Use a new clean paper towel to turn off the faucet
11. Discard paper towel

• initial hand wash is 1 minute
• in between residents is 10-15 seconds

Question 2

Put on and remove gown and gloves

Answer 2

1. Wash hands
2. Choose appropriately sized gown and gloves
3. Examine gown and gloves for any damage
4. Put on the gown (With opening in back)
   * put on outside of room
5. Overlap gown to fully cover uniform in the back
6. Tie gown (securely) at the neck then the waist
7. Put on gloves
8. Pull gloves up (over) the gown cuff. (OK to make thumb-hole in gown cuff)
9. Knock; enter, and proceed with “opening procedure”.
10. Perform some form of patient care.
11. Perform “closing procedure”.
12. Remove PPE (at the appropriate time and place), without contaminating yourself.
    * remove inside the room & bottom to top & inside out.
13. Dispose of PPE properly (in the appropriate container and location).
14. Wash hands; exit room.
15. Report and record.

Question 3

Position the resident in a Fowler’s position

Answer 3

1. Perform “opening procedure”.
2. Verbally acknowledge resident’s complaint of “having difficulty breathing”.
3. Adjust HOB to appropriate level as quickly as possible
   
   • 45-90 degrees and automatically put FOB up
4. Re-check patient’s breathing
   
   • check alignment
5. Perform comfort measures (pillows, raising FOB to prevent sliding, etc).
6. Perform “closing procedure”.
7. Report and record (resident’s complaint, what you did to help, and the results of your actions).

Question 4

Position the resident in a side-lying (lateral) position

Answer 4

1. Perform “opening procedure”.
2. Use good body mechanics: raise level of bed, bend knees, spread feet apart.
3. Safely move the supine resident to the side (edge) of bed in 3 segments.
4. Cross resident’s arms over chest or prepare correct arm in “stop-sign” position.
5. Cross ankles or bend the knee of the upper (top) leg
6. Be sure side rail is up on the side resident is turned toward.
7. Place one hand on shoulder, the other on hip, and “log-roll” the resident.
8. Support resident’s back by tucking a pillow, folding lengthwise, behind back.
9. Support resident’s top arm with a pillow in front of chest; use hand roll if needed.
10. Place resident’s top leg slightly forward, with knee bent; support top leg with a pillow.
11. Be sure that the top leg/foot does not rest on (or rub) the lower leg/foot.
    * float heals
12. Stand at FOB to see if resident’s body is properly aligned
13. Resident should not be lying on his/her arm or shoulder.
14. Adjust pillow to cradle/support resident’s head/face comfortably.
15. Perform “closing procedure”.

Question 5

Transfer the resident from bed to chair using a gait (safety) belt

Answer 5

1. Perform “opening procedure”.
2. Place chair or wheelchair near the bed
   
   • place at strong side
3. Remove/fold back wheelchair footrest and lock bed/wheelchair brakes (if used).
4. Raise HOB fully to assist resident to a sitting position
   
   • put shoes and socks on while resident is lying in bed
5. Lower side rail nearest to chair
6. To dangle: place on arm behind the resident’s back and the other arm under the thighs.
7. Encourage resident to assist in turning to a sitting position, placing feet flat on the floor
8. Assist resident with robe and non-skid shoes (may do prior to dangle).
9. Stand in front of resident to apply gait belt snugly around resident’s waist, with room between resident’s body and belt to grasp belt (with two hands) at each side of waist.
10. Place your knee, (furthest from wheelchair), between resident’s knees.
11. Use a secure, underhand (palms-up) grasp to hold belt at each side of resident’s waist.
12. May instruct resident to assist (to stand) by having resident pressing hands on mattresses.
13. On the count of “three”, assist resident to stand up, maintaining palms-up grasp on belt.
14. If belt loosens upon standing, assist resident to sit on the bed for all belt adjustments
15. Turn, taking steps along with the resident, until the resident is right in front of chair
    * “Do you feel the wheelchair at the back of your knees?”
16. Lower resident into chair, then release your 2-handed grasp and remove gait belt. Remove belt carefully, lifting away from resident’s body (to avoid injury from friction).
17. Position wheelchair footrest and provide a lap blanket
18. Perform “closing procedure”

Question 6

Brush the resident’s dentures

Answer 6

1. Perform “opening procedure”
2. Apply gloves.
   
   • remove gloves, sanitize hands, and re-glove as needed
3. Take dirty dentures (already in denture cup) and supplies to sink area.
4. Line bottom of sink with a washcloth or small towel. Turn on water without splash.
5. Place dirty dentures in emesis basin. Clean denture cup and fill with cool water.
6. Apply toothpaste (or denture cleanser) to toothbrush (or denture brush).
7. Brush all areas of dentures (on both sides of each plate) within sink area.
8. Handle dentures carefully by holding/brushing one plate at a time.
9. Rinse dentures under cool, running water.
10. Place dentures back in denture cup that is filled with clean, cool water
    * change gloves
11. Offer mouthwash solution/sponge-tipped swabs, emesis basin for oral hygiene
12. Clean and store equipment. Dispose of linens and trash appropriately.
13. Remove gloves and wash hands.
14. Perform “closing procedure”

Question 7

Give the resident a partial bed-bath (upper body): face-neck-chest-abdomen-arms-hands

Answer 7

1. Perform “opening procedure”
2. Apply gloves
   
   • remove gloves, sanitize hands, and re-glove as needed
3. Drape resident for warmth and privacy with a bath blanket
4. Keep linens dry by placing a towel/waterproof barrier under limbs while washing
5. Gently wash (with soap), rinse and pat-dry entire upper body, starting with face
   
   • may omit soap for face (as desired by resident)
   • wash furthest to nearest:
     furthest eye -> nearest eye; face; furthest ear -> neck -> nearest ear; furthest arm/hand -> chest/abd -> nearest arm/hand
6. Only uncover one area at a time to ensure warmth, dignity, and privacy
7. Leave resident draped and comfortable when bath is completed
8. Clean and store equipment. Dispose of linens and trash appropriately.
9. Remove gloves and wash hands.
10. Perform “closing procedure”

Question 8

Give the resident a partial bed-bath (lower body): hips-legs-feet

Answer 8

1. Perform “opening procedure”
2. Apply gloves
   
   • remove gloves, sanitize hands, and re-glove as needed)
3. Drape resident for warmth and privacy with a bath blanket
4. Keep linens dry by placing a towel-waterproof barrier under limbs while washing
5. Gently wash (with soap), rinse and pat-dry entire lower body, starting with hips.
6. Only uncover one area at a time to ensure warmth, dignity, and privacy.
7. Leave resident draped and comfortable when bath is completed.
8. Clean and store equipment. Dispose of linens and trash appropriately.
9. Remove gloves and wash hands.
10. Perform “closing procedure”

Question 9

Give the resident perineal care (female resident)

Answer 9

1. Perform “opening procedure”
2. Apply gloves
   
   • remove gloves, sanitize hands, and re-glove as needed
3. Gently assist resident into supine position with knees bent and legs apart
4. Place a linen protector under resident’s buttocks
5. Keep resident warm and completely draped with a bath blanket
6. Only uncover perineal area/buttocks area to ensure warmth, dignity, and privacy.
7. Wash (using soap/peri-wash), rinse, and pat dry genital area from front to back (while resident is in supine position)
8. Wash (using soap/peri-wash), rinse, and pat dry rectal area from front to back (while resident is in a side-lying position with side-rail up).
9. Use a different part of the washcloth/mitt for each wipe/stroke
10. Remove gloves, wash, re-glove to assist resident into position of choice
11. Cover resident with sheet (bed linens) and remove bath blanket
12. Wear gloves to clean and store equipment. Dispose of linens and trash appropriately.
13. Remove gloves and wash hands.
14. Perform “closing procedure”

Question 10

Shave the resident

Answer 10

1. Perform “opening procedure”
2. Place barrier for supplies to maintain clean set-up
3. Place clothing protector (towel) to resident’s chest area prior to shave
4. Assess skin for abrasions, moles, and/or direction of hair growth.
5. Check razor for rust, chips, or breaks
6. Soften beard with warm, moist cloth before applying shaving cream.
7. Apply shaving cream to resident’s face
8. Apply gloves before shaving
   
   • remove gloves, sanitize hands, and re-glove as needed
9. Hold skin taut to prevent nicks.
10. Shave face using downward strokes, in direction of hair growth and shave under chin using upward strokes
11. Rinse razor often during procedure to remove hair/excess shaving cream
    * change gloves and change water
12. Wipe/rinse resident’s face of remaining lather after the shave
13. Dry resident’s face.
14. Offer resident a mirror
15. Offer resident choice of aftershave or shaving lotion
16. Remove towel from resident, clean equipment and return to proper area.
17. Dispose of razor in sharps container
    * do not recap
18. Dispose of linens and trash appropriately
19. Remove gloves and wash hands
20. Perform “closing procedure”

Question 11

Clean and trim the resident’s fingerna.

14. ils

Answer 11

1. Perform “opening procedure”
2. Apply gloves
   
   • remove gloves, sanitize hands, and re-glove as needed
3. Soak resident’s hands/fingernails in a basin of warm water. Use soap to clean them.
   
   • soak for about 3 minutes
4. Place towel under resident’s hands for comfort and hygiene
5. Push back cuticles gently with a washcloth
6. Use orange stick to clean under dirty fingernails
   
   • remember a paper towel
7. Change water and rinse resident’s hands
8. Dry resident’s hands thorougly
9. Use clippers to trim fingernails straight across
   
   • say to the resident, “I will file the rough edges later.”
   • if resident is diabetic, skip clipping.
10. Use nail file/emery board to smooth rough and sharp edges
11. Offer lotion and gently massage resident’s hands
    * put on from fingertips up and keep fingers together
12. dispose of linens and trash appropriately
13. Return clippers to facility designated dirty area (or to resident’s personal grooming kit)
14. Remove gloves and wash hands.
15. Perform “closing procedure”.