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In the United States, certified nurse assistants (CNAs) provide personal care to residents or patients under the supervision of a registered nurse (RN) or licensed practical nurse (LPN); see Nurse: Types of nurses (and non-nurses).
The requirements for certification vary from state to state.
Among the requirements for becoming a state-certified nurse assistant is the mastery of a set of basic skills. These skills are needed to care for patients in both long-term-care facilities and in home settings. The descriptions below refer mostly to the care of elderly patients, but most of them would apply to any nursing assistant situation.
Hand washing
Proper hand washing is an important part of nurse assisting. It is the first step in preventing the spread of germs. Hand washing must be performed before and after doing anything involving contact with a patient. Hands that do not appear soiled can still spread disease.
Ambulation
Ambulation assistance is a set of techniques for helping patients to walk. One example is the use of a gait belt or transfer belt for patients who cannot stand on their own. The gait belt is put around the patient's waist and enables the assistant to lift the patient safely without straining his or her back. It can be used to help patients get in and out of bed, get up from a chair, or enter a walker.
Walkers help the elderly get exercise. Many elderly patients cannot walk on their own due to osteoporosis or other conditions. Exercise promotes movement, helps with circulation, helps the patient heal faster, be in better health, and ultimately have a longer, happier life.
Applying antiembolic stocking
An antiembolic stocking is a device that is used on patients under observation for or at risk for circulation problems. It is a high sock which applies extra pressure on the legs to prevent blood clots. It may also have a hole on the top or bottom of the foot for comfort, and easy access to the feet, so that the nurse assistant doesn't need to remove the sock every two hours to check circulation.
Bedpan use and output measurement
A bedpan is a device that is placed under patients who are unable to get up and use a bedside toilet or go to the restroom. It is used to catch all of the urination and bowel movement. The patient must be properly wiped and cleansed after elimination to prevent infection. The volume of urine must be measured and recorded. If a bowel movement has taken place, that should be noted along with any significant characteristics of the stool.
Denture/mouth care
Denture/mouth care is very important in providing proper hygiene for patients. Teeth must be cleaned in the morning and after each meal. This will help prevent tooth decay or gum conditions that could lead to tooth loss. Clean teeth are healthy teeth.
Dressing
For the dependent patients dressing is not an easy task. In fact it is very difficult and needs to be done properly. The best way to ensure that it is done right is to remember that you dress the weak side first so that the patient can help with their strong side, and to undress the stronge side first so they can help you undress the weak side as much as possible.
Feeding
Patients must not be overassisted in feeding or they may stop helping themselves. Assistance should be confined to those parts of the task they cannot accomplish for themselves. For example, a patient who cannot load a spoon but is capable of conveying it to his mouth should be assisted only in loading the spoon. He should convey it to his mouth himself, even if it would be faster for the assistant to do this for him.
Hair care
Providing hair care will help patients feel good about themselves. Long-term-care facilities may have a salon where residents can have their hair done once a week just as they would at home. Hair must be maintained every day as well. Hair should be brushed from roots to ends, and care should be taken to avoid irritating the patient's scalp.
Bedmaking
Bedmaking as practiced by a nurse assistant is a skilled task that must be performed precisely. The bed must be wrinkle-free to prevent bedsores, which not only cause discomfort to the patient but can cause serious health problems. Bedmaking should be learned both when the bed is occupied by a patient as well as when unoccupied.
Nail care
Nail care with may not be as important as feeding but nevertheless must be done. Bacteria get in the nail bed and can cause serious infections in elderly patients. It is helpful to soak nails for at least five minutes to help loosen dirt and germs that are lodged in nail beds.
Bedbath
Due to lack of staff and the cost of water, patients may only get a bath once or twice a week; on other days, patients get bedbaths. This involves cleaning the underarms, body and peri- areas.
Serving fresh water
Fresh ice water should be offered frequently to promote hydration. It is important to encourage drinking, because it is not unusual for elderly patients to be unaware of thirst and thus be easily subject to dehydration.
Positioning
Positioning refers to a set of techniques for changing the position of a bedridden person in order to avoid health problems such as bedsores. Many states required that bedridden persons be checked and repositioned at intervals of two hours or less.
Range-of-motion exercises
If not exercised, joints gradually lose their range of motion. Nurse assistants must be able to assist patients in performing a series of range-of-motion exercises that flex the joints of their arms, wrists, legs, fingers, hips, and feet. This aids circulation, prevents arthritis and stiffness, and speeds recovery from such conditions as strokes, seizures, and falls.
Vital signs
Vital signs—temperature, respiration, blood pressure, and pulse—must be taken and recorded at least once a day. Increasing temperature can indicate disease; increasing blood pressure may require medical treatment and special diets; and irregular pulse can indicate heart problems. If a patient's vital signs have changed significantly within a short period of time, a double check for accuracy may be warranted. Unusual findings should be brought to the attention of a supervising nurse or doctor.
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