Basic Nursing Skills and Clinical Care
Collecting data, not diagnosing
Basic nursing skills center on accurate measurement, safe technique, and timely reporting. A CNA should know how to take temperature by oral, tympanic, axillary, and temporal routes; count pulse for 30 seconds and multiply by two when regular, but count a full minute when irregular; count respirations for a full minute when abnormal and avoid telling the resident you are counting; measure blood pressure with the cuff at heart level and the correct size; and obtain pulse oximetry with a clean site and no nail polish if possible. Also know intake and output, weight, specimen collection, range-of-motion exercises, positioning, catheter care, and oxygen safety.
The scope trap is doing more than reporting. Do not interpret a rhythm, adjust oxygen, or decide a reading is unimportant. Report new or worsening pain, shortness of breath, chest pain, a temperature above the facility parameter, a pulse outside 60–100, respirations outside 12–20, or a blood pressure change. Orthostatic vital signs are a common question: measure lying, then sitting, then standing, and report a drop of 20 mm Hg systolic or 10 mm Hg diastolic with dizziness.
A second trap is technique. Inflate the cuff 20–30 mm Hg above the estimated systolic, deflate slowly, and wait before repeating. Use standard precautions and hand hygiene before and after every contact. Document what you measured, when, and what you reported-never chart a value you did not obtain.
Worked example: a resident's lying BP is 118/72; on standing it is 92/58 and she says she feels dizzy. Do not simply record it. Help her sit or lie down, stay with her, and report the symptomatic drop to the nurse.