Skills

1. Knock before entering the room. Identify and greet resident. Explain procedure. Perform hand hygiene. Provide for privacy.
2. *Resident's skin is protected from tearing/shearing throughout the skill.
3. Fill the wash basin with warm water or obtain wipes (may verbalize)
4. *Raise side rails. Raise bed to the best level for good body mechanics.
5. Lower the side rail nearest you. Position the resident in supine position, drape with a bath blanket and remove top linen.
6. *Put on disposable gloves
7. Place a waterproof pad under the buttocks.
8. *Remove wet/soiled brief. Place wet/soiled brief into plastic bag and tie.
9. *Provide perineal care if necessary. (May verbalize, perineal care tested on a separate skill)
10. *Remove and discard gloves. Raise the side rail. Perform hand hygiene.
11. *Lower the rail on the side of the bed you are working. Put on disposable gloves.
12. Roll resident away from you. Tuck and center the brief against the resident's buttocks with tabs away from skin.
13. Roll resident towards you, and unfold the brief through to the other side and remove water proof pad. 
14. Return resident to supine position. Place front panel over abdomen. 
15. Fasten bottom tape tabs angling upward, then fasten top tape tabs to brief.
16. *Remove and discard gloves. Perform hand hygiene.
17. Cover the resident with the top linen and remove bath blanket.
18. *Raise the side rail nearest you. Lower bed. Lower side rails. Attach signal light within resident's reach.
19. Discard plastic tied bad/disposable supplies. (May verbalize)
20. Perform hand hygiene and report & record observations.

* Denotes Critical Step

1. Knock before entering the room. Identify and greet resident. Explain procedure. Perform hand hygiene. Provide for privacy.
2. *Raise bed rails. Raise bed to best level for good body mechanics. 
3. Lower side rail on the side you are working. Place in supine position.
4. Expose the leg while providing for privacy.
5. Turn the stocking inside out down to the heel.
6. Slip the foot of the stocking over the toes, foot, and heel. 
7. Grasp the stocking top. Slip it over the foot and heel. Pull it up the leg. The stocking turns right side out as it is pulled up. The stocking is even and snug. 
8. Remove twists, creases, or wrinkles.
9. *Raise the side rail. 
10. Go to the other side and lower the side rail.
11. Repeat steps 5 through 8 for the other leg. (may verbalize this step)
12. *Raise side rail. Lower bed. Lower side rail. Attach signal light within resident's reach.
13. Perform hand hygiene and report & record observations.

* Denotes Critical Step

1. Knock before entering the room. Identify and greet resident. Explain procedure. Perform hand hygiene. Provide for privacy.
2. *Raise bed rails. Raise bed to best level for good body mechanics.
3. Lower side rail on resident's weak side. Place in supine position.
4. Cover resident with bath blanket. Fanfold linens to food of bed without exposing resident.
5. Raise resident's head and shoulders or turn onto side away from nurse aide.
6. Unfasten buttons, snaps, zippers, or ties in back of garment.
7. Bring sides of garment to the resident's sides, or if in side-lying position, tuck far side under resident and fold near side onto chest. 
8. Place resident in supine position.
9. Slide garment off shoulder on resident's strong side. Remove garment from the arm. Repeat for weak side. 
10. Put on garments that open in the front: slide garment onto arm and shoulder of weak side. 
11. Raise head and shoulders. Bring side of garment around the back. Lower resident to supine position.
12. Slide garment onto the arm and shoulder of the strong arm.
13. Fasten buttons, snaps, zippers, or ties.
14. Put on pants or slacks. Slide pants over feet and up the legs.  
15. Turn onto the strong side and pull pants over buttocks and hip of weak side. 
16. Turn resident to the weak side and pull pants over buttocks and hip of strong side. 
17. Place resident in supine position and fasten buttons, snaps, zippers, ties, and/or belt buckle.
18. Remove bath blanket.
19. Put socks and shoes or slippers on resident.
20. *Raise side rail. Lower bed. Lower side rail. Attach signal light within resident's reach. 
21. Perform hand hygiene and report & record observations.

* Denotes Critical Step

1. Knock before entering the room. Identify and greet resident. Explain procedure. Perform hand hygiene. Provide for privacy.
2. Fill bath basin 2/3 full of warm water.
3. *Raise bed rails. Raise the bed to best level for good body mechanics.
4. Lower bed rail and position resident in supine position.
5. Cover the resident with a bath blanket and remove top linens. 
6. Place towel across resident's chest. Remove the gown without exposing the resident.
7. Make mitten of washcloth and wet with water; squeeze out excess. 
8. Wash eyes first. Start at inner corner and work out. Use different area of mitten for each eye.
9. Wash, rinse, and dry the face.
10. Wash, rinse, and dry the ears and then neck.
11. Expose arm farthest from the side. Place bath towel under arm up to axilla.
12. Place basin of water on bed and immerse resident's hand in water and wash. Remove the basin and dry hand well.
13. Wash, rinse, and dry the shoulders, axillae and arms. 
14. Repeat steps 11, 12, & 13, using nearest arm. (May verbalize this step)
15. Place towel across chest and fold bath blanket to waist.
16. Wash, rinse, and dry chest while lifting towel.
17. Fold bath blanket to public area, keep chest covered with towel.
18. Wash, rinse and dry abdomen. Remove the town and cover with bath blanket. 
19. *Raise the side rail before leaving the bedside. Change bath water in basin. 
20. Lower bed rail.
21. Expose the far leg; flex leg and place bath towel lengthwise under the leg up to the buttocks.
22. Place basin on towel and put foot into it. Support leg at knee joint with hand. 
23. Wash and rinse leg and foot.
24. Remove basic of water and dry leg, foot, and between toes.
25. Repeat steps 21 - 24 for near leg. (May verbalize this step)
26. *Raise the side rail before leaving the bedside. Change bath water in basin. 
27. Lower bed rail and assist resident to turn on side with back facing the aide.
28. Fold the bath blanket over resident's side to expose back and buttocks; place towel parallel to resident's back. 
29. Wash, rinse, and dry back and buttocks.
30. Give back rub and remove towel and turn resident onto back. 
31. *Raise the bedrail before leaving the bedside. Change the water for perineal care.
32. Lower bed rail.
33. *Put on disposable gloves. Wash, rinse, and dry the perineum. (May verbalize, perineal care tested on separate skill). Remove and discard gloves. Perform hand hygiene.
34. *Raise the bedrail before leaving the bedside. 
35. Lower bed rail on side nearest you. Apply lotion and deodorant.
36. Without exposing the resident, dress him/her in a clean gown.
37. *Raise the bed rails. Lower bed. Lower bed rails. Attach signal light within resident's reach. 
38. Perform hand hygiene and report & record observations.

* Denotes Critical Step

1. Knock before entering the room. Identify and greet resident. Explain procedure. Perform hand hygiene. Provide for privacy.
2. Cover the resident with a bath blanket and remove top linens.
3. Fill the washbasin 2/3 full with warm water.
4. Place the basin on the over-bed table.
5. Raise the head of the bed so resident can bathe comfortably. 
6. Help the resident remove the gown or pajamas.
7. Position the over-bed table so the resident can easily reach the basin and supplies.
8. Ask resident to wash easy-to-reach body parts. Explain that you will wash the back and those areas that cannot be reached.
9. *Attach signal light within resident's reach.
10. Return to resident's room when signal light is on. Perform hand hygiene. (May verbalize)
11. Change the bath water.
12. *Raise the side rails. Raise the bed to the best level for good body mechanics. Lower side rail nearest you.
13. Assist resident to wash areas that could not be reached. (may verbalize, including the use of gloves if needed)
14. Apply deodorant and lotion.
15. help resident put on clean clothes, a gown, or pajamas.
16. *Raise side rail. Lower bed. Lower side rail. Attach signal light within resident's reach. 
17. Empty, clean, and store the supplies appropriately. 
18. Perform hand hygiene and report & record observations.

* Denotes Critical Step

1. Knock before entering the room. Identify and greet resident. Explain procedure. Perform hand hygiene. Provide for privacy.
2. *Raise bed rails. Raise bed to best level for good body mechanics.
3. Lower side rail nearest you.
4. Wear gloves if linens are soiled. (May verbalize)
5. Loosen the top bedding at foot of bed. Remove spread and/or blanket.
6. Place bath blanket over top sheet. Remove top sheet without exposing resident.
7. Keep pillow under resident's head and turn resident to side of bed not being made. 
8. Loosena bottom bedding; free bottom linen and roll each piece separately to the resident's back. 
9. Place bottom fitted sheet lengthwise on the mattress. Face hem stitching downward.
10. Tuck the corner of the fitted sheet over the head and foot of the mattress; tuck the sheet under the mattress from the head to the foot.
11. Place draw sheet on the middle of mattress; roll 1/2 to resident's back and tuck in excess material.
12. *Raise side rail of bed.
13. Go to opposite side of bed; lower bed side rail.
14. Move resident to clean side of bed and then place pillow under the resident's head. 
15. Pull through all bottom linen. Roll, remove and discard soiled linen in laundry hamper or bag. Hold soiled linen away from own uniform.
16. Pull clean bottom sheet toward the edge of the bed. Tuck the corner of the fitted sheet over the head and foot of the mattress; tuck the sheet under the mattress from the head to the foot. 
17. Pull the draw sheet toward the side of the bed and remove all wrinkles. Pull the draw sheet tightly towards you and tuck excess under the mattress. 
18. Assist resident to center of bed. Adjust pillows for comfort. 
19. Place top sheet over bath blanket with the hem stitching facing upward; ask resident to hold or tuck under resident's shoulders. Remove bath blanket. Replace blanket/spread.
20. Tuck sheet, blanket, and bedspread at foot of bed under mattress and miter corners on each side, make a toe pleat allowing for movement of resident's feet. 
21. Change pillowcase and place pillow under resident's head. 
22. *Raise side rail. Lower bed. Lower side rail. Attach signal light within resident's reach.
23. Perform hand hygiene and report & record observations.

* Denotes Critical Step

1. Knock before entering the room. Identify and greet resident. Explain procedure. Perform hand hygiene. Provide for privacy.
2. *Raise bed to best level for good body mechanics. 
3. Remove linens from bed, rolling lien away from you so that the surface that touched the resident is inside the roll. 
4. Place the bottom sheet on the mattress. Face hem stitching downward.
5. Tuck corner of the fitted sheet over the head and the foot of the mattress. Make sure the sheet is tight and smooth. Tuck the sheet under the mattress from the head to the foot. 
6. Place the draw sheet on the middle of the mattress. 
7. Open the draw sheet and fanfold to the other side of the bed. 
8. Tuck draw sheet and go to other side of the bed. 
9. Pull the bottom sheet tightly to smooth out wrinkles. Tuck corner of the fitted sheet over the head and the foot of the mattress. Tuck the sheet under the mattress from the head to the foot. 
10. Pull the draw sheet tightly and tuck in the sheet.
11. Place the top sheet on the bed. unfold it lengthwise. Place the center crease in the middle. Place the sheet evenly with the top of the mattress. Open the sheet and fanfold the extra toward the other side. Face hem stitching upward. 
12. Place the bedspread on the bed with the upper hem even with the top of the mattress. Open and fanfold extra to the other side. 
13. Make sure the bedspread facing the door is even and covers all the top linens. 
14. Tuck in the linens together at the foot of the bed. Make a mitered corner. 
15. Put pillowcase on pillow and place on bed with open end away from the door. 
16. *Lower bed. Attach signal light within resident's reach. 
17. Perform hand hygiene and report & record observations. 

* Denotes Critical Step

1. Knock before entering the room. Identify and greet resident. Explain procedure. Perform hand hygiene. Provide for privacy.
2. Fill bath basin 2/3 full of warm water. 
3. *Raise side rails. Raise bed to the best level for good body mechanics.
4. Lower side rail nearest you, place resident in supine position, and drape resident. Fanfold linens to foot of bed. 
5. *Put on disposable gloves.
6. Place bed protector on bed under buttocks.
7. Expose perineal area. (May verbalize, perineal care tested on separate skill)
8. Separate the labia of the female or retract the foreskin (uncircumcised male) and check for any crusts, abnormal drainage, or secretions.
9. *Gently wash around the opening of the urethra with soap and water.
10. *Holding the catheter near the meatus, clean the catheter from the meatus down the catheter about 4 inches, using soap, water, and a clean washcloth. Clean downward away from the meatus with one stroke. Repeat as needed with a clean area on the washcloth each time. Rinse and path dry.
11. Secure catheter properly. Coil and secure tubing to the bed. 
12. Remove the bed protector.
13. *Remove and discard the gloves.
14. Cover resident and remove bath blanket. 
15. Make sure the resident is comfortable.
16. *Raise side rail. Lower bed. Lower side rail. Attach signal light within resident's reach.
17. Perform hand hygiene and report & record observations. 

* Denotes Critical Step

1. Ask the victim if they are choking.
2. *Ask the victim if they can cough or speak.
3. *Stand behind the victim.
4. *Wrap your arms around the victim's waist.
5. *Make a fist with one hand. Place the thumb side fo the fist against the abdomen. The fist is the middle above the navel and well below the end of the sternum.
6. *Grasp your fist with your other hand.
7. *Press your fist and hand into the victim's abdomen with a quick, upward thrust. 
8. *Repeat the abdominal thrust until the object has been expelled or the victim loses consciousness.

* Denotes Critical Step

1. Knock before entering the room. Identify and greet resident. Explain procedure. Perform hand hygiene. Provide for privacy.
2. Raise the head of the bed. Position the resident for oral hygiene. Place towel over the resident's chest. 
3. *Put on disposable gloves. 
4. Ask the resident to remove dentures or remove resident's dentures using gauze if the resident cannot do so.
5. Grasp the upper denture with the thumb and index finger of one hand. Move the denture up and down slightly to break the seal. Gently remove the denture and place in kidney/emesis basin or denture cup.
6. Remove the lower denture by grasping it with your thumb and index finger. Turn it slightly, and lift it out of the mouth. Place the denture in kidney/emesis basin or denture cup. 
7. Line the sink with a towel and fill with water. 
8. Take dentures and equipment to the sink and rinse each denture under warm running water. Return to denture cup. 
9. *Apply denture cleaner to the brush and brush and rinse dentures. Place in denture cup. Fill it with cool water. 
10. Clean kidney/emesis basin. Bring basin and denture cup to bedside. 
11. Clean the person's gums and tongue. Use toothpaste and the toothbrush (or sponge swabs).
12. Ask the resident to rinse their mouth with mouthwash or other noted solutions. Hold the kidney/emesis basin under the resident's chin. 
13. Ask resident to insert dentures. Insert dentures if the resident cannot. 
14. Grasp the upper denture with thumb and index finger. Raise the upper lip with the other hand and insert denture. use index fingers to press gently on upper denture to make sure that it is secure. 
15. Grasp the lower denture securely with thumb and index finger. Pull down slightly on the lower lip and insert the denture. 
16. Put denture cup in the top drawer of the bedside stand. 
17. *Remove and discard gloves.
18. **Attach signal light within resident's reach. 
19. Perform hand hygiene and report & record observations

* Denotes Critical Step

1. Remove your watch and all jewelry. Roll up uniform sleeves. 
2. Perform hand hygiene (May verbalize).
3. Hold a clean gown out in front of the body. let it unfold. Do not shake the gown. 
4. Put hands and arms through the sleeves. Make sure the gown covers from the neck to the knees. It must cover the arms to the end of the wrists. Tie the strings at the back of the neck. 
5. *overlap the back of the gown, covering the back of the uniform snugly. (If the gown does not cover the back, the use of a second gown may be verbalized to ensure protection.)
6. Tie the waist strings. Tie them at the back or the side. Do not tie them in front. 
7. *Put on disposable gloves with gloves extended to cover the gown cuffs. Provide care.
8. *Remove gloves: grasp a glove just below the cuff. Grasp it on the outside. Pull the glove down over your hand so it is inside out. 
9. Hold the removed glove with your other hand. 
10. *Reach inside the other glove. Use the first two fingers of the ungloved hand. 
11. Pull the glove down (inside out) over your hand and the other glove. 
12. Discard the gloves.
13. Untie the neck and waist strings. Pull the gown down from each shoulder toward the same hand. 
14. *Turn the gown inside out as it is removed. Hold the gown at the inside shoulder seams and bring your hands together. 
15. *Hold and roll up the gown away from you. Keep inside out. 
16. Discard the gown. 
17. Perform hand hygiene. (May verbalize)

*Denotes Critical Step

1. Knock before entering the room. Identify and greet resident. Explain procedure. Perform hand hygiene. Provide for privacy.
2. Position the over-bed table in front of the seated resident. It should be low and close to the resident. 
3. Fill the kidney basin with warm water. 
4. Place the kidney basin on the over-bed table on top of paper towels. 
5. Put the resident's fingers into the basin. Position the arms so that they are comfortable. 
6. Let the fingernails soak for 5 to 10 minutes (may verbalize without waiting). Re-warm the water as needed. 
7. Clean under the fingernails with the orange stick. 
8. Remove the kidney basin. Dry fingers thoroughly. 
9. Clip fingernails straight across with nail clippers. 
10. Shape nails with an emery board or nail file. 
11. Push cuticles back with a washcloth or orange stick. 
12. Clean and return equipment and supplies to their proper places. Discard disposable supplies. 
13. *Attach signal light within resident's reach. 
14. Perform hand hygiene and report & record observations.

*Denotes Critical Step

1. Knock before entering the room. Identify and greet resident. Explain procedure. Perform hand hygiene. Provide for privacy.
2. Fill the wash basin with warm water.
3. *Raise side rails. Raise bed to the best level for good body mechanics.
4. Lower side rail nearest you. Position the resident on her back,d rape with a bath blanket and remove top linen. 
5. *Put on disposable gloves.
6. Place a waterproof pad under buttocks. 
7. Assist the resident to flex knees and spread legs, if able. Otherwise, help the resident to spread legs as much as possible with knees straight. 
8. Wet the washcloths. Squeeze out excess water from washcloth. Make a mitted washcloth. Apply soap. 
9. *Separate the labia. Clean downward from front to back with one stroke. 
10. Repeat steps 8 & 9 until the area is clean. Use a clean part of the washcloth for each stroke. Use more than one washcloth if needed. 
11. *Rinse the perineum with a clean washcloth. Separate the labia. Stroke downward from front to back. 
12. Pat the area dry with the towel. 
13. Assist the resident to lower the legs and turn onto the side, away from you.
14. *Wash from the vagina to the anus with one stroke. Repeat as necessary until clean with a clean area of the washcloth. Rinse and pat dry. 
15. Remove waterproof pad. 
16. *Remove and discard the gloves. 
17. Cover the resident with top linen and remove the bath blanket. 
18. *Raise side rail. Lower bed. Lower side rail. Attach signal light within resident's reach. 
19. Perform hand hygiene and report & record observations.

*Denotes Critical Step

1. Knock before entering the room. Identify and greet resident. Explain procedure. Perform hand hygiene. Provide for privacy.
2. Fill the wash basin with warm water.
3. *Raise side rails. Raise bed to the best level for good body mechanics.
4. Lower the side rail nearest you. Position the resident on his back, drape with a bath blanket and remove top linen. 
5. *Put on disposable gloves. 
6. Place a waterproof pad under buttocks. 
7. Wet the washcloths. Squeeze out excess water from washcloth. Make a mitted washcloth. Apply soap. 
8. Grasp the penis. Retract the foreskin if the person is uncircumcised. 
9. Clean the tip. Use a circular motion. Start at the urethra, and work outward. Repeat as needed. Use a clean part of the washcloth each time. 
10. Rinse the area with another washcloth. 
11. Return the foreskin to its natural position. 
12. Clean the shaft of the penis. Use firm downward strokes away from the urinary meatus. Rinse the area.
13. Help the person flex his knees and spread his legs. Or help him spread his legs as much as possible with knees straight. 
14. Clean the scrotum. Rinse well. Observe for redness and irritation in the skin folds. 
15. Pat the penis and scrotum dry. 
16. Help him lower his legs, cover him, and turn him onto his side away from you. Fold the bath blanket back between his legs. 
17. Wash, rinse, and pat dry the anal area. Wash from the scrotum to the anus with one stoke. Repeat as necessary until clean with a clean area of the washcloth. 
18. Remove the waterproof pad. 
19. *Remove and discard gloves. 
20. Cover the resident with top linen and remove bath blanket.
21. *Raise side rail. Lower bed. Lower side rail. Attach signal light within resident's reach. 
22. Perform hand hygiene and report & record observations.

*Denotes critical Step

1. Knock before entering the room. Identify and greet resident. Explain procedure. Perform hand hygiene. Provide for privacy.
2. *Raise side rails. Raise bed to the best level for good body mechanics. 
3. Lower the side rail nearest you. Position the resident in supine position. 
4. *Put on disposable gloves.
5. Turn the resident onto their side away from you and correctly place the waterproof pad under the resident's buttocks. 
6. Push the bedpan down and toward the resident. 
7. Hold the bedpan securely. Turn the resident onto their back. Center the bedpan under the resident. Remove gloves. 
8. Raise the head of the bed so the resident is in a sitting position. 
9. *Place the signal light within resident's reach. Raise side rail. Lower bed. Lower side rail. 
10. Place the toilet tissue & disposable wipes/washcloth within reach of the resident. Ask the resident to signal when through or when assistance is needed. 
11. Perform hand hygiene. Leave the room and close door. (May verbalize)
12. Return with the resident signals. (May verbalize)
13. *Perform hand hygiene. Put on disposable gloves. 
14. *Raise side rails. Raise the bed to the best level for good body mechanics. Lower the side rail nearest you and head of the bed. 
15. Remove the bedpan carefully and cover with bedpan cover or towel. 
16. *Clean the perineal area from front to back with toilet tissue. Provide perineal care (may verbalize perineal care) if necessary. Cover the bedpan. Remove waterproof pad and discard. Remove gloves and discard. 
17. *Raise side rail. Lower the bed. Lower side rails. Perform hand hygiene. Attach signal light. Put on disposable gloves and carry bedpan to bathroom. 
18. Measure urine if the resident is on intake and output. Empty, clean, rinse bedpan and store bedpan. Remove gloves. Perform hand hygiene. 
19. Report & record observations. 

*Denotes Critical Step

1. Knock before entering the room. Identify and greet resident. Explain procedure. Perform hand hygiene. Provide for privacy.
2. Position the resident seated/reclining.
3. Find the resident's radial pulse by placing your middle two or three fingers on palm side of resident's wrist on thumb side, next to bone. 
4. Count for 30 seconds, time 2 if regular. Count for 1 minute if irregular. 
5. Continue to hold the resident's wrist and begin counting when you see the chest rise; count respiration for 30 seconds, time 2 if regular. Count for 1 minute if irregular. 
6. *Recount respiration if unsure. Record respiration on paper. Recorded respiration must be within 5 of that obtained by the evaluator. 
7. *Record pulse. Recorded pulse must be within 5 pulse counts of that obtained by the evaluator. 
8. With the resident seated/reclining, place the entire lower arm on a flat surface. 
9. Expose the arm as much as possible. Squeeze cuff to expel any remaining air and turn the valve clockwise on the bulb to close it. 
10. Wrap cuff snugly around the upper arm - at least one inch above the elbow. 
11. Clean earpieces and diaphragm of the stethoscope with alcohol sponge. 
12. Locate the brachial artery at the inner aspect of the elbow. 
13. Place the earpieces of the stethoscope in your ears. 
14. Place the diaphragm of the stethoscope over the brachial artery. 
    inflate the cuff. 
15. Loosen valve and deflate the cuff slowly, noting the systolic and diastolic reading. 
16. Deflate the cuff completely and remove from the resident's arm. 
17. Record blood pressure on paper. 
18. *Recorded reading must be within 4 mm systolic and 4 mm diastolic of that obtained by the evaluator. 
19. Perform hand hygiene and record & report observations to the nurse. 

*Denotes Critical Step

This procedure begins in supine position

1. Knock before entering the room. Identify and greet resident. Explain procedure. Perform hand hygiene. Provide for privacy.
2. *Raise the head of the bed to a 45-60 degree angle. 
3. Keep the spine straight. 
4. Support the head with a pillow. 
5. Support the arms with pillows. 
6. *Attach signal light within the resident's reach. 
7. Perform hand hygiene and report & record observations. 

*Denotes Critical Step

This procedure begins in supine position

1. Knock before entering the room. Identify and greet resident. Explain procedure. Perform hand hygiene. Provide for privacy.
2. *Raise bed rails. Raise the bed to best level for good body mechanics.
3. Lower rail on side where you are working.
4. Place a pillow under the resident's head and neck. 
5. Roll resident to side away from you.
6. Place upper leg in front of the lower leg. 
7. Support the upper leg and thigh with pillows. 
8. Place a pillow against the resident's back. 
9. Place a small pillow under the upper hand and arm. 
10. *Raise side rail. Lower bed. Lower side rail. Attach signal light within resident's reach. 
11. Perform hand hygiene and report & record observations. 

*Denotes Critical Step

This procedure beings in lateral position.

1. Knock before entering the room. Identify and greet resident. Explain procedure. Perform hand hygiene. Provide for privacy.
2. *Raise bed rails. Raise the bed to best level for good body mechanics. 
3. Lower rail on side where you are working. 
4. Place a pillow under the resident's head and shoulders.
5. Roll resident into supine position. 
6. Position arms comfortably at each side. 
7. *Raise side rail. Lower bed. Lower side rail. Attach signal light within resident's reach. 
8. Perform hand hygiene and report & record observations. 

*Denotes Critical Step

1. Knock before entering the room. Identify and greet resident. Explain procedure. Perform hand hygiene. Provide for privacy.
2. *Raise bed rails. Raise the bed to best level for good body mechanics. 
3. Lower the bed rail nearest you. 
4. *Put on disposable gloves. Position the resident in the side lying position, facing you. Turn resident's head well to the side. 
5. Place the towel under the resident's face. Place kidney/emesis basis under the chin. 
6. Clean the chewing and inner surfaces of the teeth using appropriate supplies. 
7. Swab the roof of the mouth, inside of the cheeks, and the lips using appropriate supplies. 
8. Swab the tongue using appropriate supplies.
9. Moisten a clean sponge swab with water, and swab the mouth to rinse. 
10. Apply moisturizer to the resident's lips. 
11. *Remove and discard the gloves. 
12. Reposition the resident. 
13. *Raise side rail. Lower bed. Lower side rail. Attach signal light within resident's reach. 
14. Perform hand hygiene and report & record observations. 

* Denotes Critical Step

1. Knock before entering the room. Identify and greet resident. Explain procedure. Perform hand hygiene. Provide for privacy.
2. *Raise bed rail. Raise the bed to the best level for good body mechanics. 
3. Lower the side rail. 
4. Position the resident supine and in good alignment. 
5. Support the resident's wrist with one hand and the elbow with the other. 
6. Flexion: bend the arm so that the same side shoulder is touched. 
7. Extension:P straighten the arm. 
8. Repeat flexion and extension 5 to 6 times. 
9. *Raise the side rail. 
10. Got to the other side and lower the side rail. 
11. Repeat steps for exercising the elbow. (May verbalize this step)
12. Make sure the resident is comfortable. 
13. *Raise side rail. Lower bed. Lower side rail. Attach signal light within resident's reach. 
14. Perform hand hygiene and report & record observations. 

*Denotes Critical Step

1. Knock before entering the room. Identify and greet resident. Explain procedure. Perform hand hygiene. Provide for privacy.
2. *Raise side rails. Raise the bed to the best level for good body mechanics. 
3. Lower the side rail of the side you are working. 
   position the resident supine and in good alignment. 
4. Support he resident's wrist with one hand and the elbow with the other. 
5. Flexion: raise the arm straight in front and over the bed. 
6. Extension: bring the arm down to the side.
7. Abduction: move the straight arm away from the side of the body
8. Adduction: move the straight arm to the side of the body. 
9. Internal Rotation: bend the elbow. Place it at the same level as the shoulder. Move the forearm down toward the body. 
   External Rotation: move the forearm toward the head. 
10. Repeat flexion, extension, abduction, adduction, and internal and external rotation 5 to 6 times. 
11. *Raise the side rail. 
12. Go to the other side and lower the side rail. 
13. Repeat steps for exercising the other shoulder. (May verbalize)
14. Make sure the resident is comfortable. 
15. *Raise side rail. Lower bed. Lower side rails. Attach signal light within resident's reach. 
16. Perform hand hygiene and report & record observations. 

*Denotes Critical Step

1. Knock before entering the room. Identify and greet resident. Explain procedure. Perform hand hygiene. Provide for privacy.
2. *Raise side rails. Raise the bed to the best level for good body mechanics. 
3. Lower the side rail of the side you are working. 
4. position the resident supine and in good alignment. 
5. Support he resident's wrist with both of your hands. 
6. Flexion: bend the hand down.
7. Extension: straighten the hand. 
8. Hyperextension: bend the hand back.
9. Radial flexion: turn the hand toward the thumb. 
10. Ulnar flexion: turn the hand toward the little finger.
11. Repeat flexion, extension, hyperextension, and radial and ulnar flexion 5 to 6 times. 
12. *Raise the side rail.
13. Go to the other side and lower the side rail. 
14. Repeat steps for exercising the wrist. (May verbalize this step)
15. Make sure the resident is comfortable. 
16. *Raise side rail. Lower bed. Lower side rails. Attach signal light within resident's reach. 
17. Perform hand hygiene and report & record observations. 

*Denotes Critical Step

1. Knock before entering the room. Identify and greet resident. Explain procedure. Perform hand hygiene. Provide for privacy.
2. *Raise side rails. Raise the bed to the best level for good body mechanics. 
3.  Lower the side rail on the side you are working. 
4. Position the resident supine and in good alignment. Cover resident with a bath blanket and remove top linens. 
5. Place one hand under the resident's knee and the other hand under the ankle to support the leg. 
6. Flexion: raise the leg. 
7. Extension: straighten the leg.
8. Abduction: move the leg away from the body. 
9. Adduction: move the leg toward the other leg. 
10. Internal rotation: turn the leg inward.
11. External rotation: turn the leg outward. 
12. Repeat flexion, extension, abduction, adduction, and inward and outward rotation 5 to 6 times. 
13. Cover the resident.
14. *Raise the side rail. 
15. Go to the other side and lower the side rail.
16. Repeat steps for exercising the hip (May verbalize)
17. Make sure the resident is comfortable. 
18. Cover the resident with top linens. Remove the bath blanket. 
19. *Raise side rail. Lower bed. Lower side rails. Attach signal light within resident's reach. 
20. Perform hand hygiene and report & record observations. 

*Denotes Critical Step

1. Knock before entering the room. Identify and greet resident. Explain procedure. Perform hand hygiene. Provide for privacy.
2. *Raise the bed rails. Raise the bed to the best level for good body mechanics. 
3. Fill the wash basin with warm water. 
4. Place wash basin and needed supplies on the over-bed table. 
5. Lower the side rail on the side you are working. 
6. *Put on disposable gloves. 
7. Place the resident in Fowler's with the over-bed table in front of resident. Place a bath towel over the resident's chest and shoulders. Place resident's dentures in mouth if applicable. 
8. Wash the resident's face. Do not dry. Wet the washcloth and wring it out. 
9. Apply the wet washcloth to resident's face to soften skin/beard for a few minutes (May verbalize amount of time)
10. Apply shaving cream.
11. Hold the skin taut with one hand. 
12. Shave in the direction of hair growth with long strokes on the larger areas fo the face. Use shorter strokes around the chin and lips. 
13. Rinse shaving cream off of razor often. 
14. Wash off any remaining shaving cream. Pat face dry with a towel. 
15. *Verbalize observing for nicks, cuts, bleeding, and irritation. Apply direct pressure if observed. 
16. App.ly after shave and lotion unless nicks or cuts are observed. (May verbalize)
17. *Remove towel. Remove and discard gloves. 
18. *Raise side rail. Lower bed. Lower side rails. Attach signal light within resident's reach. 
19. Clean and return equipment and supplies to their proper place. Clean the over-bed table. 
20. Dispose of safety razor in the sharps container. (May verbalize)
21. Wash hands and report & record observations. 

*Denotes Critical Step

1. Knock before entering the room. Identify and greet resident. Explain procedure. Perform hand hygiene. Provide for privacy.
2. Place chair parallel to or at a 45-degree angle to bed. 
3. *Lock the wheels fo the wheelchair. 
4. Remove the resident's feet from the foot rests. Remove or life foot rests out of the way. Remove lap blanket. 
5. *Adjust bed to lowest position, lock bed wheels, and raise head of bed to Fowler's or sitting position. 
6. Fanfold top linens to the foot of the bed. 
7. Observe resident is wearing non-skid footwear. Stand in front of the resident. Apply transfer belt. 
8. Ask the resident to hold onto the armrests and learn forward. Grasp he transfer belt at each site. 
9. Position your feet and legs to provide stabilizing for the resident and prevent the resident from falling or sliding. 
10. Ask the resident to push down on the armrests on the count of three. Pull resident into a standing position as you straighten your knees. 
11. Support the resident in the standing position.
12. Turn the resident so they can reach the edge of the mattress. The back of the resident's legs should touch the mattress. 
13. Continue to turn the resident until they can reach the mattress with both hands. 
14. Lower the resident onto the bed as you bed your hips and knees. The resident assists by leaning forward and bending the elbows and knees. 
15. Remove the transfer belt and footwear. 
16. Assist the resident to lie down. 
17. *Attach signal light within the resident's reach. 
18. Perform hand hygiene and report & record observations. 

*Denotes Critical Step

1. Knock before entering the room. Identify and greet resident. Explain procedure. Perform hand hygiene. Provide for privacy.
2. Place chair parallel to or at a 45-degree angle to bed. 
3. Cover chair with bath blanket or protective pad. 
4. *Lock the wheels of the wheelchair. 
5. Remove or lift foot rests out of the way. 
6. *Adjust the bed to lowest position, lock bed wheels, and raise head of bed (Fowler's position).
7. Fanfold top linens to the foot of the bed. 
8. Put shoes on the resident and apply transfer belt. 
9. *Turn resident as a unit from Fowler's to dangling position. 
10. Stand in front of resident. 
11. Grasp the transfer belt at each side. 
12. Position your feet and legs to provide stability for the resident and prevent the resident from falling or sliding. 
13. On the count of three, pull resident into a standing position as you straighten your knees. 
14. Support the resident in the standing position. 
15. Turn to lower the resident into the wheelchair as you bend your hips and knees. Position feet on footrests. 
16. Remove transfer belt. Cover the resident with bath blanket or lap robe. 
17. Unlock the wheels of the wheelchair. 
18. *Attach signal light within the resident's reach. 
19. Perform hand hygiene and report & record observations. 

*Denotes Critical Step

1. Remove watch and bracelets or push up 4 to 5 inches above hand. Remove all rings except a smooth wedding band.
2. Stand away from sink so clothes do not touch the sink. 
3. Turn on the faucet and adjust the water to a warm, comfortable temperature. 
4. Wet hands thoroughly, including three to four inches above wrists. 
5. Hold hands with wrists lower than elbows during hand washing procedure. 
6. Apply a generous amount of soap to hands. 
7. Rub palms together to work up a good lather for at least 15 seconds. 
8. Steps 9-12 should last at least 20 seconds. Wash using friction and rotating motion. 
9. Wash the palms and back of hands. 
10. Wash fingers and between fingers. 
11. Wash wrists and lower arms. 
12. Clean well under fingernails by rubbing fingers against palms. Use nail file or orange stick to clean under fingernails. 
13. Rinse well from arms to hands. 
14. With a clean dry paper towel or towels, pat dry starting at fingertips working to wrist. Discard towel(s). 
15. Repeat step on wet hand with clean dry towel(s). Discard towel(s).
16. *Turn off faucet with clean, dry paper towel and discard in wastebasket. 

*Denotes Critical Step