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CNA Notes Example: Mastering the Art of Charting for Certified Nursing Assistants
Are you a Certified Nursing Assistant (CNA) looking to improve your charting skills? Accurate and thorough documentation is crucial for providing quality patient care and avoiding potential legal issues. This comprehensive guide provides practical examples of CNA notes, demonstrating best practices for clear, concise, and effective charting. We'll cover various scenarios and provide tips to help you become a charting pro. This isn't just a collection of examples; we'll dissect why these examples are effective and what makes them stand out. Let's dive into the world of CNA note-taking excellence!
Understanding the Importance of Accurate CNA Notes
Before we jump into examples, let's reiterate the significance of meticulous charting. Your notes are a legal record of a patient's condition and the care you provided. They are used by nurses, doctors, and other healthcare professionals to make informed decisions about patient care. Inaccurate or incomplete notes can lead to:
Medication errors: If you don't document a medication refusal accurately, it could lead to the patient receiving the wrong dosage.
Treatment delays: Incomplete notes might delay necessary interventions.
Legal repercussions: Poorly documented care can lead to malpractice lawsuits.
Inconsistent care: Without accurate notes, other healthcare providers may not understand the patient's needs and preferences.
Therefore, mastering the art of CNA note-taking is not just a job requirement; it's a crucial component of safe and effective patient care.
CNA Notes Example: Vital Signs and Observations
Let's start with a common scenario: recording vital signs.
Example 1:
Date: 2024-10-27
Time: 08:00 AM
Patient: John Doe, Room 312
Vital Signs: BP: 120/80 mmHg, HR: 72 bpm, RR: 16 breaths/min, Temp: 98.6°F (oral)
Observations: Patient awake, alert, and oriented x3. Skin warm and dry. No complaints of pain. Good appetite at breakfast.
Why this example is effective: It's concise, includes all necessary information (date, time, patient details), and uses objective language.
CNA Notes Example: Assisting with Activities of Daily Living (ADLs)
Next, let's consider charting assistance with ADLs.
Example 2:
Date: 2024-10-27
Time: 10:00 AM
Patient: Jane Smith, Room 205
Activity: Assisted patient with morning hygiene, including oral care, washing face and hands, and toileting. Patient required minimal assistance.
Observations: Patient reported feeling slightly weak but otherwise in good spirits.
Why this is effective: It clearly documents the assistance provided and the patient's condition.
CNA Notes Example: Incident Reporting
Charting incidents is crucial for patient safety.
Example 3:
Date: 2024-10-27
Time: 14:30 PM
Patient: Robert Jones, Room 110
Incident: Patient experienced a fall while attempting to ambulate to the bathroom without assistance. Patient reported slight dizziness prior to the fall.
Actions Taken: Immediately assessed patient for injuries. No obvious injuries noted. Notified nurse. Patient repositioned to bed.
Observations: Patient is now resting comfortably.
Why this example is strong: It's detailed, objective, and outlines the actions taken.
CNA Notes Example: Medication Administration (With Nurse Verification)
Important Note: CNAs do not typically administer medications. This example illustrates how to chart when a nurse administers medication, and you observe.
Example 4:
Date: 2024-10-27
Time: 16:00 PM
Patient: Mary Brown, Room 401
Medication: Observed Nurse administer 1 tablet of Acetaminophen 500mg, as ordered.
Observation: Patient tolerated medication well.
Why this is effective: Clearly shows who administered the medication and the patient's response.
Tips for Effective CNA Note-Taking
Use objective language: Avoid subjective terms like "seemed tired." Instead, use observable facts like "patient slept for 2 hours."
Be specific: Instead of "patient had a bad day," write "patient expressed frustration with limited mobility and pain in right knee."
Maintain chronological order: Document events in the order they occurred.
Use proper abbreviations: Only use approved abbreviations.
Chart immediately after care: This ensures accuracy and prevents forgetting details.
Follow your facility's guidelines: Different facilities may have specific charting requirements.
Conclusion
Accurate and detailed CNA notes are essential for providing safe and effective patient care. By following the examples and tips provided in this guide, you can significantly improve your charting skills and contribute to a safer healthcare environment. Remember, clear communication through accurate documentation is paramount in healthcare.
FAQs
1. What happens if I make a mistake in my CNA notes? Follow your facility's policy for correcting errors. Generally, you should draw a single line through the mistake, initial and date the correction, and write the correct information.
2. Can I use shorthand or abbreviations in my CNA notes? Only use abbreviations that are approved by your facility. Unclear abbreviations can lead to misunderstandings and errors.
3. What if I witness something that's not directly related to my patient care? Report it to your supervisor immediately. This could be anything from a safety hazard to a colleague's inappropriate behavior.
4. How often should I document patient observations? Document relevant observations at least every shift, more frequently if there are significant changes in the patient's condition.
5. What kind of training is available to help improve CNA charting skills? Many facilities offer in-service training on documentation and charting best practices. Check with your supervisor or human resources department.
cna notes example: CNA Certified Nursing Assistant Exam Cram Linda Whitenton, Marty Walker, 2009-10-19 CNA Certified Nursing Assistant Exam Cram Linda Whitenton Marty Walker Succeed with topical reviews, practice exams, and preparation tools · Covers exactly what you need to know to score higher on your CNA exam · More than 150 sample test questions help you gain confidence and decide when you’re ready to take the actual exam · Simplifies key nursing assistant concepts and techniques for easy learning · Includes popular Cram Sheet tearcard to help you remember key concepts and do extra last-minute studying · Exam Alerts identify important information found on the exam Written by Leading Experts! Score Higher on the CNA Exam! The CD features an adaptive test engine, giving you an effective tool to assess your readiness for the CNA exam. Key features include · Detailed explanations of correct and incorrect answers · Multiple test modes · Random questions and order of answers · Coverage of all CNA topic categories |
cna notes example: Nursing Assistant Care Susan Alvare, 2005 Over 6,000 instructors shared their ideas for the perfect nursing assistant textbook. Nursing Assistant Care is exactly what you asked for: a full-color, up-to-date, affordable book that meets and exceeds federal and state requirements. Specifically, it contains: beautifully illustrated and clearly photographed chapters organized around learning objectives and written at a low reading level creative methods to teach care and observations, promoting independence, and essential information on preventing abuse and neglect chapter-ending material which develops critical thinking and tests the chapter illnesses and common conditions in one chapter, organized by body system an entire chapter on confusion, dementia, and Alzheimer?s disease up-to-date CPR and emergency care sections a full chapter on mental health and mental illness information on developmental disabilities personal care skills housed within one chapter, as are nursing skills separate chapters for bowel and urinary elimination |
cna notes example: Charting Made Incredibly Easy , 1998 Now nurses can chart the Incredibly Easy! way with this remarkable reference. They'll find easy-to-follow directions for charting thoroughly and accurately in all clinical situations. And they'll learn to improve speed and efficiency, reduce legal risks, and meet requirements for licensing, accreditation, and reimbursement. Contents include charting basics: understanding charting, the nursing process, plans of care, and charting systems; charting in contemporary health care: acute care, home health care, longterm care, and rehabilitation; and special topics: enhancing charting, avoiding legal pitfalls, and documenting procedures. |
cna notes example: Mosby's Nursing Drug Cards E-Book Kathleen Jo Gutierrez, Patricia A. Nutz, Joseph A. Albanese, 2018-03-01 Get a head-start to becoming a pharmacology expert! Mosby's Nursing Drug Cards, 24th Edition is the ideal, pocket-sized drug information reference with over 400 sturdy cards containing guidelines for 700+ generic and 600 brand-name drugs. Each card lists the most up-to-date nursing information, including descriptions, use(s), mechanism(s), pharmacokinetics, side/adverse effects, contraindications/precautions, interactions, dosing, and nursing management priorities. Best of all, these pre-made drug cards come ready-to-go for use in the classroom or during clinicals! Tall Man lettering of over 700 generic and 600 brand-name drugs provides one-stop access to the information most needed for clinical practice. High-alert drugs and Black Box Warnings point out these need-to-know medications. Portable 4x6-inch cards are smaller than most drug cards and fit easily into a pocket. Alphabetic organization helps you find information quickly. Consistent format features a drug’s generic name, pronunciation, category, pregnancy category, brand name, dosage forms, use, action, pharmacokinetics, side/adverse effects, contraindications, interactions, dosage, and nursing management priorities. Nursing management priorities follow a nursing process format: assess, diagnose, implement, and evaluate. Comprehensive index contains generic and trade names, drug classes and combination products. Critical Thinking fill-in-the-blank card may be used on any drug to prompt students to think about the drug category, action, patient teaching, and more. Drug interaction information includes subheadings for drug, food, and laboratory interactions. Drug pronunciations are listed for each generic drug and drug category. Common conversion formulas are found on the inside lid of the box. Dosage calculation formulas are listed in the appendix. NEW! 20 additional drugs and drug categories have been added to this edition to reflect the most recent FDA-approved drugs. NEW! 100 new drug facts offer the latest information on dosage forms, new brand names, contraindications, side effects, actions, drug interactions, uses, and nursing management priorities. NEW! Condensed category cards feature essential information to help you find what you need fast! NEW! Separate coverage of the top 200 commonly used drugs gives you quick access to medications you may reference the most. |
cna notes example: Realities of Canadian Nursing Carol McDonald, Marjorie McIntyre, 2017-12-12 In Realities of Canadian Nursing, influential scholars throughout Canada give voice to the unheard concerns of nurses and go to great lengths to ensure the text offers readers more than an update on current and pressing professional, legal, ethical, political, social, economic, and environmental issues in nursing and healthcare. In chapter 1 of the text, authors Carol McDonald PhD, RN and Marjorie McIntyre RN, PhD offer a Framework for Analysis, which gives students and educators a shared and organized format through which to identify, analyze, and strategize about solving the issues. Students will be inspired to influence professional associations, collective bargaining units, government, and workplace and participate in political action. In this edition, the authors will retain the content and features that have made this text the mostly widely used issues and trends book in the Canada, while adding new coverage of Canada’s Truth and Reconciliation Commission (TRC) and the subsequent Calls to Action. Student and Instructor resources on thePoint will help prepare students for the NCLEX and help faculty save time as well as integrate their course resources with their required text. |
cna notes example: Nursing Practice Standards Canadian Nurses' Association, College and Association of Registered Nurses of Alberta, Alberta Association of Registered Nurses, 2008 The Canadian Nurses Association's Code of Ethics for Registered Nurses is a statement of the ethical values of nurses' commitments to persons with health-care needs and persons receiving care. |
cna notes example: Covering ABS Tomme R. Young, 2009 The most difficult and least addressed ABS implementation issue is that of coverage. On the one hand, the CBD's ABS provisions appear to give every country full rights over all genetic resources found in the country, even if the exact subspecies or variety is also found in other countries. On the other hand, however, even within a single country, each biome may be separately regulated, and each community or landowner may be given the right to control access to and receive benefits for the genetic resources of every specimen taken from their land or sold by them. This book analyzes the basic concept of ABS, examining the overall mechanisms that could be used to make the system work internationally. |
cna notes example: Single Cell Analysis Miodrag Gužvić, 2024-02-10 This volume explores the latest advancements and techniques used to study cell analysis, their capabilities, and the type of results that can be obtained. The chapters in this book cover topics such as FACS; fluorescence microscopy; organic spectroscopy such as MALDI; inorganic spectroscopy such as ICP-MS; and sequencing. Written in the highly successful Methods in Molecular Biology series format, chapters include introductions to their respective topics, lists of the necessary materials and reagents, step-by-step, readily reproducible laboratory protocols, and tips on troubleshooting and avoiding known pitfalls. Cutting-edge and practical, Single Cell Analysis: Methods and Protocols is a valuable tool for any researcher interested in learning more about this important and developing field. |
cna notes example: Code of Ethics for Nurses with Interpretive Statements American Nurses Association, 2001 Pamphlet is a succinct statement of the ethical obligations and duties of individuals who enter the nursing profession, the profession's nonnegotiable ethical standard, and an expression of nursing's own understanding of its commitment to society. Provides a framework for nurses to use in ethical analysis and decision-making. |
cna notes example: Toward 2020 Michael Villeneuve, Jane MacDonald, Canadian Nurses' Association, 2006 |
cna notes example: CNA Study Guide 2020-2021 Newstone Cna Test Prep Team, 2019-10-28 How is this guide different from others? It includes 4 Practice tests with detailed answer explanations. |
cna notes example: The Nursing Assistant' 2005 Ed.2005 Edition , |
cna notes example: Canadian Fundamentals of Nursing Patricia Ann Potter, Janet C. Kerr, Anne Griffin Perry, Marilynn J. Wood, 2009 With the market-leading nursing fundamentals text in Canada, you can be assured that students will develop a firm educational foundation that will help them to succeed. Written in a clear manner and organized logically, this book will teach students all of the principles, concepts and skills necessary for them to thrive, both academically and professionally. A trusted favourite for Canadian faculty and students, the new Fourth Canadian Edition offers the most complete teaching and learning package available. A companion CD and Evolve website included with the book ensure that students have the most up-to-date and practical tools at their fingertips, and provide instructors with a host of resources to assist in their lesson planning, development and delivery. The new Fourth Canadian Edition of this nursing classic is the most current and comprehensive text available. . Nursing skills include steps and rationales to illustrate how and why a skill is performed . Critical thinking models illustrate how to provide the best care for clients . Nursing care plans include sections on Assessment, Planning, Interventions and Evaluation . Client teaching boxes emphasize key points for patient education . Boxes on older adults, culture and primary health care highlight key principles and aspects of nursing care . Evidence-informed practice guidelines provide examples of recent guidelines for Canadian nursing practice . Research highlights provide abstracts of current nursing research studies and explain the implications for daily practice . Companion CD includes student learning activities, Butterfield's Fluids and Electrolytes Tutorial, and more . Companion Evolve website includes review questions, interactive exercises, and more . Completely revised and updated to reflect current Canadian nursing practice . New chapter on Surviving Cancer . New chapter on Nursing Informatics . 3 new Canadian section editors . An all-new Canadian editorial advisory board . Over 55 contributors from across the country . Emphasis on the Media Resources that accompany each chapter help to detail the comprehensive electronic resources available for that specific topic . Addition of new Nursing Story boxes that describe real-life scenarios . Increased emphasis on nurse and client safety, including Safety Alerts embedded throughout the text that highlight safe practices and techniques . New appendix on laboratory values |
cna notes example: Charting Made Incredibly Easy! Lippincott Williams & Wilkins, 2009-05 A charting reference that's authoritative and enjoyable. Helps you document patient care with incredible skill and confidence. |
cna notes example: Notes on Grief Chimamanda Ngozi Adichie, 2021-05-11 From the internationally acclaimed, bestselling author of We Should All Be Feminists and Americanah, a profound reckoning with loss, written in the wake of her father’s death. During the brutal summer of 2020, Chimamanda Ngozi Adichie’s beloved father, a celebrated professor at the University of Nigeria and an irreplaceable figure in a close-knit family, succumbed unexpectedly to complications of kidney failure. Notes on Grief is Adichie’s tribute to him, and a moving meditation on loss. Here Adichie offers a candid snapshot of the shock, loneliness, and disillusionment that followed the news of her father’s death. Her family, unable to be together except for on video calls, struggles to go through the rites of mourning amid a global crisis of unimaginable scale. As Adichie wrestles with his passing, she recalls with vivid, poignant detail who her father was: a remarkable survivor of the Biafran war, a man of kindness and charm, and a fierce supporter of his youngest daughter. Here is a uniquely personal, profound work of remembrance and hope by one of today’s luminaries—a book to bring us together in a time when we need it most. |
cna notes example: Chart Smart , 2011 Chart Smart: the A-to-Z Guide to Better Nursing Documentation tells nurses exactly what to document in virtually every type of situation they may encounter on the job, no matter where they practice--hospital, medical office, outpatient, rehabilitation facility, long-term care facility, or home. This portable handbook has nearly 300 entries that cover documentation required for common diseases, major emergencies, complex procedures, and difficult situations involving patients, families, other health care team members, and supervisors. In addition to patient care, this book also covers documenta |
cna notes example: Labor Notes , 1998 |
cna notes example: The Making of National Money Eric Helleiner, 2018-07-05 Why should each country have its own exclusive currency? Eric Helleiner offers a fascinating and unique perspective on this question in his accessible history of the origins of national money. Our contemporary understandings of national currency are, Helleiner shows, surprisingly recent. Based on standardized technologies of production and extraction, territorially exclusive national currencies emerged for the first time only during the nineteenth century. This major change involved a narrow definition of legal tender and the exclusion of tokens of value issued outside the national territory. Territorial currencies rapidly became bound up with the rise of national markets, and money reflected basic questions of national identity and self-presentation: In what way should money be managed to serve national goals? Whose pictures should go on the banknotes? Helleiner draws out the potent implications of this largely unknown history for today's context. Territorial currencies face challenges from many monetary innovations—the creation of the euro, dollarization, the spread of local currencies, and the prospect of privately issued electronic currencies. While these challenges are dramatic, the author argues that their significance should not be overstated. Even in their short historical life, territorial currencies have never been as dominant as conventional wisdom suggests. The future of this kind of currency, Helleiner contends, depends on political struggles across the globe, struggles that echo those at the birth of national money. |
cna notes example: Yoder-Wise's Leading and Managing in Canadian Nursing - E-Book Nancy Walton, Janice Waddell, 2024-06-13 Prepare for licensure and your transition to nursing practice! Organized around the issues in today's constantly changing health care environment Yoder-Wise's Leading and Managing in Canadian Nursing, 3rd Edition offers an innovative approach to leading and managing by merging theory, research, and practical application. This cutting-edge text is intuitively organized around the issues that are central to the success of Canadian nurses including cultural diversity, resource management, advocacy, patient safety, delegation, and communication. In addition, it provides just the right amount of information to equip you with the tools you need to master leadership and management — all to help prepare you for clinical practice! - UPDATED! Comprehensive inclusion of the latest Canadian statistics, research, references, resources, and more! - NEW! Updated art programme reflects Canada's diverse workforce and patient demographic. - NEW! Streamlined content ensures an appropriate level of content and depth of information and facilitates learning of theory and complex concepts. - UNIQUE! Chapter on nursing leadership in Indigenous health explains the leadership role and is integrated into relevant topics throughout the text. - UNIQUE! Chapter authored by an undergraduate student and an early career alumnus helps you build your leadership skills within your academic program. - UNIQUE! Each chapter opens with A Challenge, where practising nurse leaders/managers offer their real-world views of a concern related in the chapter, encouraging you to think about how you would handle the situation. - UNIQUE! A Solution closes each chapter with an effective method to handle the real-life situation presented in A Challenge and demonstrates the ins and outs of problem-solving in practice. - NEW! End-of-chapter Thinking it Through Case Studies provide questions to stimulate critical thinking in applying concepts discussed in the chapter. - Examples of real-life practice cases help you examine and apply theoretical concepts. - Helpful pedagogical elements include chapter objectives, glossary terms, exercises, Research Perspectives, Literature Perspectives, Theory boxes, chapter checklists, tips, and references. - Innovative content and presentation merge theory, research, and professional practice in key leadership and management areas. - Inviting and well-structured full-colour design enhances learning by providing quick reference to important information and visually reinforcing key concepts. |
cna notes example: CNA Certified Nursing Assistant Exam Cram Linda Whitenton, Marty Walker, 2017 Includes access to companion website with practice tests, other study materials, and additional bonus content. |
cna notes example: Certified Nursing Assistant Recruitment and Retention Pilot Project Final Report , 2000 |
cna notes example: The Civil Wars in U.S. Labor Steve Early, 2011-03-15 “Should be required reading for all workers’ rights advocates.” —Bernie Sanders Between 2008 and 2010, the progressive wing of the US labor movement tore itself apart in a series of internecine struggles. More than $140 million was expended, by all sides, on organizing conflicts that tarnished union reputations and undermined the campaign for real health care and labor law reform. Campus and community allies, along with many rank-and-file union members, were left angered and dismayed. In this incisive book, labor journalist Steve Early draws on scores of interviews and on his own union organizing experience to explain why and how these labor civil wars occurred. He examines the bitter disputes about union structure, membership rights, organizing strategy, and contract standards that enveloped SEIU, UNITE HERE, the California Nurses Association, and independent organizations like the Federación de Maestros de Puerto Rico and the new National Union of Healthcare Workers in California. Along the way, we meet rank-and-file activists, local union officers, national leaders, and concerned friends of labor who were drawn into the fray, as Early considers the quest to stem the tide of the labor movement’s long decline. |
cna notes example: Psychiatric and Mental Health Nursing for Canadian Practice Wendy Austin, Mary Ann Boyd, 2010-01-01 Rev. ed. of: Psychiatric nursing for Canadian practice / Wendy Austin, Mary Ann Boyd. |
cna notes example: Microsoft Project 2016 Step by Step Carl Chatfield, Timothy Johnson, 2016-04-08 The quick way to learn Microsoft Project 2016! This is learning made easy. Get more done quickly with Project 2016. Jump in wherever you need answers–brisk lessons and colorful screenshots show you exactly what to do, step by step. Quickly start a new plan, build task lists, and assign resources Share your plan and track your progress Capture and fine-tune work and cost details Use Gantt charts and other views and reports to visualize project schedules Share resources across multiple plans and consolidate projects Master project management best practices while you learn Project Look up just the tasks and lessons you need |
cna notes example: The Future of Nursing Institute of Medicine, Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine, 2011-02-08 The Future of Nursing explores how nurses' roles, responsibilities, and education should change significantly to meet the increased demand for care that will be created by health care reform and to advance improvements in America's increasingly complex health system. At more than 3 million in number, nurses make up the single largest segment of the health care work force. They also spend the greatest amount of time in delivering patient care as a profession. Nurses therefore have valuable insights and unique abilities to contribute as partners with other health care professionals in improving the quality and safety of care as envisioned in the Affordable Care Act (ACA) enacted this year. Nurses should be fully engaged with other health professionals and assume leadership roles in redesigning care in the United States. To ensure its members are well-prepared, the profession should institute residency training for nurses, increase the percentage of nurses who attain a bachelor's degree to 80 percent by 2020, and double the number who pursue doctorates. Furthermore, regulatory and institutional obstacles-including limits on nurses' scope of practice-should be removed so that the health system can reap the full benefit of nurses' training, skills, and knowledge in patient care. In this book, the Institute of Medicine makes recommendations for an action-oriented blueprint for the future of nursing. |
cna notes example: Acute Stroke Nursing Jane Williams, Lin Perry, Caroline Watkins, 2013-05-07 Stroke is a medical emergency that requires immediate medical attention. With active and efficient nursing management in the initial hours after stroke onset and throughout subsequent care, effective recovery and rehabilitation is increased. Acute Stroke Nursing provides an evidence-based, practical text facilitating the provision of optimal stroke care during the primary prevention, acute and continuing care phases. This timely and comprehensive text is structured to follow the acute stroke pathway experienced by patients. It explores the causes, symptoms and effects of stroke, and provides guidance on issues such as nutrition, continence, positioning, mobility and carer support. The text also considers rehabilitation, discharge planning, palliative care and the role of the nurse within the multi-professional team. Acute Stroke Nursing is the definitive reference on acute stroke for all nurses and healthcare professionals wishing to extend their knowledge of stroke nursing. Evidence-based and practical in style, with case studies and practice examples throughout Edited and authored by recognised stroke nursing experts, clinicians and leaders in the field of nursing practice, research and education The first text to explore stroke management from UK and international perspectives, and with a nursing focus |
cna notes example: The Federal Reporter , 1988 |
cna notes example: Providing Legal Services by Members of the Judge Advocate Generals' Corps United States. Congress. Senate. Committee on Armed Services. Subcommittee on Personnel, 2012 |
cna notes example: The Let My People Go Handbook Raleigh Sadler, Hannah Grundmann, 2022-01-18 The Let My People Go handbook is a practical guide to equip churches to love their most vulnerable neighbors. The name, Let My People Go, recalls the words of Moses as he spoke to those who had enslaved his people. Moses called for holistic freedom, freedom from physical and spiritual bondage. It's the authors' prayer that this guide would help you and your church take up this mantle of liberty in your community. Human trafficking is the exploitation of vulnerability for commercial gain. Lmpg wants to empower your church to fight human trafficking by loving those most vulnerable around. In this curriculum, you will be given the tools to address the vulnerabilities in your church and outside of your church in a way that is congregational & collaborative with the gospel As its motive. |
cna notes example: United States Reports United States. Supreme Court, 1990 |
cna notes example: Hartman's Nursing Assistant Care: Long-Term Care Susan Alvare Hedman, Jetta Lee Fuzy, Suzanne A. Rymer, 2014-01-01 A comprehensive nursing assistant training textbook which includes information on long-term care, multiple chapters on home health care, and material on subacute and acute care. In addition it includes in-depth information on resident and client rights with sidebars that teach ways to promote independence and prevent abuse and neglect; a discussion of culture change; infection prevention; anatomy and physiology with an emphasis on normal changes of aging; updated nutrition information on MyPyramid, special diets, and feeding techniques; current information on legal issues, such as HIPAA and the Patient Self-Determination Act; 7 chapters on home health care, including information on medications, safety, infection prevention, mothers & newborns, and meal planning and preparation; a chapter containing subacute and acute care information, including pre- and post-operative care, as well as mechanical ventilation, chest tubes, and artificial airways. |
cna notes example: Statistical Methods for Learning Curves and Cost Analysis Matthew S. Goldberg, Anduin Touw, 2003 operations research and management science |
cna notes example: Providing Legal Services by Members of the Judge Advocate Generals' Corps, S. Hrg. 112-217, July 20, 2011, 112-1 Hearing, * , 2012 |
cna notes example: Nursing Interventions Classification (NIC) Gloria M. Bulechek, PhD, RN, FAAN, Howard K. Butcher, Joanne M. McCloskey Dochterman, PhD, RN, FAAN, Cheryl Wagner, 2012-11-01 Covering the full range of nursing interventions, Nursing Interventions Classification (NIC), 6th Edition provides a research-based clinical tool to help in selecting appropriate interventions. It standardizes and defines the knowledge base for nursing practice while effectively communicating the nature of nursing. More than 550 nursing interventions are provided - including 23 NEW labels. As the only comprehensive taxonomy of nursing-sensitive interventions available, this book is ideal for practicing nurses, nursing students, nursing administrators, and faculty seeking to enhance nursing curricula and improve nursing care. More than 550 research-based nursing intervention labels with nearly 13,000 specific activities Definition, list of activities, publication facts line, and background readings provided for each intervention. NIC Interventions Linked to 2012-2014 NANDA-I Diagnoses promotes clinical decision-making. New! Two-color design provides easy readability. 554 research-based nursing intervention labels with nearly 13,000 specific activities. NEW! 23 additional interventions include: Central Venous Access Device Management, Commendation, Healing Touch, Dementia Management: Wandering, Life Skills Enhancement, Diet Staging: Weight Loss Surgery, Stem Cell Infusion and many more. NEW! 133 revised interventions are provided for 49 specialties, including five new specialty core interventions. NEW! Updated list of estimated time and educational level has been expanded to cover every intervention included in the text. |
cna notes example: Nursing Assisting Diana Dugan, 2023-03 The 6th edition of this comprehensive nursing assistant training textbook is organized by body system, which gives students a context for learning. Here is important information about the latest edition:?Chapters are organized around body systems (structure and function, normal changes of aging, and common diseases and related care are grouped together).?Chapter review sections contain multiple choice questions, along with short answer questions.?The concept of person-centered care is reinforced throughout the book. ?This edition contains new information about the following diseases and disorders: COVID-19, migraines and cluster headaches, more types of cancers, respiratory syncytial virus (RSV), metabolic syndrome, varicose veins, and seasonal affective disorder (SAD), as well as expanded and reorganized mental health disorder coverage.?We added additional electronic documentation guidelines. ?We included new information on topics including testing (albumin/protein, CT calcium score, point-of-care testing [POCT], and continuous glucose monitoring [CGM] systems); medical devices (stents, Holter monitors, nebulizers); and patient care/treatments (cochlear implants, targeted therapy, and information from the International Dysphagia Diet Standardisation Institute (IDDSI) on thickened liquids and texture modified foods).. ?There is a hardback version of this book. |
cna notes example: Being a Nursing Assistant Francie Wolgin, 2005 Now in its ninth edition, this market-leading book continues to prepare the nation's finest nursing assistants in the deliver safe, effective care in acute, sub-acute, long-term care, and home heath settings by maintaining the time-tested hallmark features students and instructors love while staying current in the dynamic, ever-changing world of healthcare. To enrich learning, enhance critical thinking skills and improve client care, the guidelines and clearly illustrated procedures that illustrate the how of what nursing assistants need to do, now include clearly written rationales that help them to understand the why behind their patient care actions. NEW - Guidelines and Procedures-including Waterless Hand Hygiene and Applying a Condom Catheter. NEW! Rationales for all procedures that help students to understand the why behind their patient care actions. NEW! Topics such as SARS precautions and care of patients with Alzheimer's disease. NEW! Charting examples in each procedure that reinforce the importance of documentation. NEW! Tear-Out English-Spanish Clinical Pocket Reference that provides translations of commonly encountered words and phrases to aide in client care. Expanded coverage of infection control and patient restraints. FREE Companion Website provides chapter-specific online resources for both students and instructors including certification review multiple choice questions, case studies, matching exercises, weblinks, a Syllabus Manager, an audio glossary and more. FREE Student CD-ROM provides certification review multiple choice questions and an audio glossary. Nursing assistants in acute, sub-acute, long-term care, and home heath settings as well as those studying to enter into the field. |
cna notes example: Pearson's Nursing Assistant Today Francie Wolgin, Julie French, Kate Smith, 2012 For nursing assistant courses in any venue or institution, including high schools, community colleges, technical schools, nursing centers, and hospitals. PEARSON'S NURSING ASSISTANT TODAY brings together all the skills, knowledge, and practical insights today's nursing assistants need to succeed in any care environment. Written for students with widely diverse learning needs and reading proficiencies, it is designed for easy understanding and quick reference. It presents 152 step-by-step procedures, ranging from the absolute basics to advanced procedures for use at the instructor's discretion. All procedures reflect 2010 AHA guidelines for CPR and ECC, modern care technologies, and Medicare OBRA requirements. Each procedure is explained with rationales, preparation, steps, follow-up, a charting example, and in many cases, full-color illustrations. This text's pedagogical features include chapter learning objectives, On the Job scenarios, Nursing Assistant in Action critical thinking features, exercises, sample exams, and more. |
cna notes example: The Nursing Audit Helen W. Dunn, Elizabeth M. Morgan, 1968 |
cna notes example: PROP - Articulated Nursing Assistant Custom E-Book Anthem, 2014-04-06 PROP - Articulated Nursing Assistant Custom E-Book |
cna notes example: End-to-End QoS Network Design Tim Szigeti, Christina Hattingh, Robert Barton, Kenneth Briley Jr., 2013-11-21 End-to-End QoS Network Design Quality of Service for Rich-Media & Cloud Networks Second Edition New best practices, technical strategies, and proven designs for maximizing QoS in complex networks This authoritative guide to deploying, managing, and optimizing QoS with Cisco technologies has been thoroughly revamped to reflect the newest applications, best practices, hardware, software, and tools for modern networks. This new edition focuses on complex traffic mixes with increased usage of mobile devices, wireless network access, advanced communications, and video. It reflects the growing heterogeneity of video traffic, including passive streaming video, interactive video, and immersive videoconferences. It also addresses shifting bandwidth constraints and congestion points; improved hardware, software, and tools; and emerging QoS applications in network security. The authors first introduce QoS technologies in high-to-mid-level technical detail, including protocols, tools, and relevant standards. They examine new QoS demands and requirements, identify reasons to reevaluate current QoS designs, and present new strategic design recommendations. Next, drawing on extensive experience, they offer deep technical detail on campus wired and wireless QoS design; next-generation wiring closets; QoS design for data centers, Internet edge, WAN edge, and branches; QoS for IPsec VPNs, and more. Tim Szigeti, CCIE No. 9794 is a Senior Technical Leader in the Cisco System Design Unit. He has specialized in QoS for the past 15 years and authored Cisco TelePresence Fundamentals. Robert Barton, CCIE No. 6660 (R&S and Security), CCDE No. 2013::6 is a Senior Systems Engineer in the Cisco Canada Public Sector Operation. A registered Professional Engineer (P. Eng), he has 15 years of IT experience and is primarily focused on wireless and security architectures. Christina Hattingh spent 13 years as Senior Member of Technical Staff in Unified Communications (UC) in Cisco’s Services Routing Technology Group (SRTG). There, she spoke at Cisco conferences, trained sales staff and partners, authored books, and advised customers. Kenneth Briley, Jr., CCIE No. 9754, is a Technical Lead in the Cisco Network Operating Systems Technology Group. With more than a decade of QoS design/implementation experience, he is currently focused on converging wired and wireless QoS. n Master a proven, step-by-step best-practice approach to successful QoS deployment n Implement Cisco-validated designs related to new and emerging applications n Apply best practices for classification, marking, policing, shaping, markdown, and congestion management/avoidance n Leverage the new Cisco Application Visibility and Control feature-set to perform deep-packet inspection to recognize more than 1000 different applications n Use Medianet architecture elements specific to QoS configuration, monitoring, and control n Optimize QoS in rich-media campus networks using the Cisco Catalyst 3750, Catalyst 4500, and Catalyst 6500 n Design wireless networks to support voice and video using a Cisco centralized or converged access WLAN n Achieve zero packet loss in GE/10GE/40GE/100GE data center networks n Implement QoS virtual access data center designs with the Cisco Nexus 1000V n Optimize QoS at the enterprise customer edge n Achieve extraordinary levels of QoS in service provider edge networks n Utilize new industry standards and QoS technologies, including IETF RFC 4594, IEEE 802.1Q-2005, HQF, and NBAR2 This book is part of the Networking Technology Series from Cisco Press®, which offers networking professionals valuable information for constructing efficient networks, understanding new technologies, and building successful careers. |
Cna Notes Example (book) - netsec.csuci.edu
examples of CNA notes, demonstrating best practices for clear, concise, and effective charting. We'll cover various …
MEDICAL RECORD DOCUMENTATION AND LEGA…
Identify three things that a CNA may document about his/her patients. Identify the proper way to document a note …
Certified Nursing Assistant (CNA)
Certified Nursing Assistant (CNA) – an individual who has completed a state approved course and has successfully …
CNA/PERSONAL CARE AIDES NOTES & TIME SHEET - High …
CNA/PERSONAL CARE AIDES NOTES & TIME SHEET Email: info@highqualitycareinc.com Web: …
Module 10: Vital Signs - CA-HWI
Vital signs refer to the temperature, pulse, respirations, and blood pressure. Pain, previously considered the 5th vital …
REPORTING & DOCUMENTING CLIENT CARE - Sanzie Health …
For example, some health care organizations use a twelve hour clock, noting whether it’s AM or PM. Others a …
Nursing Assistant Clinical Skills Checklist and Competency Ev…
Please refer to WAC 246-841-400 for standards of practice and competencies for nursing assistants. Nursing …
Easy to Understand Notes for Future Nursing Assistants
These notes will assist you to gain the knowledge you need to prepare you for your Florida State Exam.
SAMPLE NARRATIVE FEEDBACK : CLINICAL PERFORMANCE
differential diagnoses for each of the patients on the schedule the night before and make notes on your patients that are organized just like a case presentation. Sometimes you are hesitant …
Skin Monitoring: Comprehensive CNA Shower Review
Skin Monitoring: Comprehensive CNA Shower Review Visual Assessment 1. Bruising 2. Skin tears 3. Rashes 4. Swelling 5. Dryness 6. Soft heels 7. Lesions 8. Decubitus 9. Blisters 10. …
Module 8: Resident Care Skills - CA-HWI
Module 8: Patient Care Skills California Community Colleges Chancellor’s Office Nurse Assistant Model Curriculum - Revised December 2018 Page 3 of 119
Hourly Rounding Log - Daily
Daily Hourly Rounding® Log – Sample Note: All patients in this unit are visited hourly by the nursing staff between 6:00 a.m. and 10 p.m., and every two hours between 10 p.m. and 6:00 …
In-Services for Long-Term Care
of a new job, for example, usually requires talking to strangers, figuring out unfamiliar routines and tasks, and getting around in a strange building. Encourage the learners to tell you how they …
WANDERING AND ELOPEMENT - Advanced Health Care
for example, loud conversations in the background, noise of kitchen utensils, or a loud TV. ... CNA Training Advisor (ISSN: 1545-7028 [print]; 1937-7487 [online]) is published monthly by HCPro, …
Standards of Care Examples - LeadingAge New York
CNA Considerations: 1. Resident will perform self care with ADLs at the level on the CNA care plan. If the resident shows a change in the ADL function the nurse and rehabilitation staff will …
NURSING ASSISTANT PROGRAM STUDENT HANDBOOK
MARICOPA COMMUNITY COLLEGES NURSING ASSISTANT PROGRAM STUDENT HANDBOOK e 7 iii. 75-83% = C iv. 68-74% = D v. 67% or below = F 4) Students will receive …
ANA/CNA Manual - Oregon.gov
ANA/CNA Manual, version 3 333333 5 The assessment tabs do not need to be completed in the order they appear in the tool and manual. In some cases, the assessor may find it productive …
CNA e-Tool Version 3.0 Technical Tips - HUD.gov
In the Legacy CNA e-Tool (Version 2.4 and before) only 2,000 total characters per topic in the Excel Assessment Tool was allowed. With Version 3.0 the total character limit for each …
CNA Charting (for CNAs) - American Data
CNA Charting (for CNAs) Open the CNA Access screen 1. Log into ECS as a user with access to the CNA Access screen. 2. Once your Access screen begins to load, you will either be …
CERTIFIED NURSING ASSISTANT: COMPETENCY SKILLS …
7/19 CNA Competency Skills Evaluation Page 1 of 7 CERTIFIED NURSING ASSISTANT: COMPETENCY SKILLS EVALUATION Initial Competency Annual Competency Instructions: …
7 examples of patient-specific homebound …
Apr 14, 2014 · in explaining the need for home health services and to agency clinicians for use in skilled visit notes. The narratives ... Example #1: Patient is homebound due to inability to …
CNA TRAINING PROGRAM RESOURCE PACKET 2016
Rev. 7/20/2016 Maryland Board of Nursing CNA Training Programs CURRICULUM INVENTORY Regulation 07: Training Program Section A: The training program shall provide a minimum of …
Module 1 The Nurse Aide I - NCDHHS
Content Notes (S-3) Infection Prevention • Ways to control and prevent the spread of infection (S-4) Infection ... • Example – an infected finger (when a finger becomes infected, it may be red, …
Documentation: Writing Nutrition-Related CAAs
6/2/2016 3 ANFP Annual Conference & Expo | Indianapolis, IN | 2016 MDS 3.0 – Basic and Quick Review 5 By law, all residents in Medicare and/or Medicaid-certified
Clinical Skills Test Checklist - Prometric
describe how the skill is being tested. For example, if you test on the feeding skill, you will feed a resident positioned in a chair. Remember, you are still responsible for knowing how to feed …
Personal Care, Hygiene, and Grooming - CMHCM
Feb 24, 2009 · For example, one individual might like to bathe at night, while another likes to shower in the morning. Having choices about personal care also involves letting the individual …
Nutrition Care Process: Case Study A Examples of Charting …
as narrative and SOAP notes. The example below illustrates how the assessment/monitoring and ... Sign/symptoms) statement, and nutrition intervention terminologies can be incorporated into …
Infection Control and Prevention - HHS.gov
• Example: Ebola . 2. Indirect contact • Coughing, sneezing, talking, picking up left behind germs • Example: Smallpox . 3. Vector-borne • Insect carriers – mosquitos, fleas, lice or ticks • …
Worksheet: Checking on ADLs and IADLs - Better Health …
about. You can also jot down some notes about your specific concerns relating to each. Be sure to write down the date when you do this, along with your name. For more information, see: …
Providing Excellent Customer Service - AAPACN
Because the nurse and CNA ignored the visitor, what could happen to the resident? The resident could fall and have an injury such as a broken hip, injury to the brain, or bruises. The nurse …
Emulex® OneCommand® CNA Manager for VMware vCenter …
Emulex® OneCommand® CNA Manager for VMware vCenter for OneConnect® Adapters Release Notes Purpose and Contact Information These release notes describe the …
Change in Condition: When to report to the - ADL Data Systems
Nov 17, 2014 · ©2011 lorida Atlantic University, all rights reserved. Ve r sion 4.0 Tool Symptom or Sign Immediate Non-Immediate Back, injuries and complaints
Cna Notes Example (Download Only) - offsite.creighton.edu
Cna Notes Example Newstone Cna Test Prep Team. Cna Notes Example CNA Life Is Beautiful A. Jourmey,2021-03-03 Lined Notebook For Daily Thoughts Work or Reflection Pop Art Bright …
Cna Notes Example - 45.79.9.118
Cna Notes Example Cindi Brassington,Cheri Goretti CNA Study Guide 2020-2021 Newstone Cna Test Prep Team,2019-10-28 How is this guide different from others? It includes 4 Practice …
STATE OF ARKANSAS LONG TERM CARE FACILITY …
a CNA delivers care outside of the defined Standards of Practice, whether it is on the CNA’s own initiative or at the direction of a licensed nurse, the CNA may have violated the Arkansas Adult …
Module 15: Observation and Charting - CA-HWI
E. Example of Patient care summary/care plan C. A. Written test ; B. Class participation ; Module 15: Observation and Charting California Community Colleges Chancellor’s Office Nurse …
RESOURCES for INSTRUCTORS - Nurse Aide Testing
CNA Virtual Job Interview. To help student prepare for when they go looking for their first CNA job. This is a Google spreadsheet of virtual activities covering many topics, scroll through it …
Documentation for Certified Nursing Assistants - Amazon …
Page 10 CNA.EliteCME.com Documentation for Certified Nursing Assistants 2 Contact Hours Learning objectives Identify and explain the functions of documentation. List requirements for …
Counselor Spotlight: Responding to a Subpoena - HPSO
CNA AND HPSO COUNSELOR SPOTLIGHT: Responding to a Subpoena 1 Counselor Spotlight: Responding to a Subpoena Healthcare Providers Service Organization ... insisted on having …
CHAPTER Preventing Pressure Ulcers and Assisting With …
CHAPTER 19 Preventing Pressure Ulcers and Assisting With Wound Care 433 receive government funding is the health care team’s ability to prevent residents from getting pressure …
Writing High-Quality Evaluations of Student Performance: …
• Keep personal notes while working with the student of what you have observed and feedback you have discussed, to use whe n writing your summary evaluation. • Complete your written …
Cna Notes Example
Cna Notes Example Nurse Publishing CNA Life Is Beautiful A. Jourmey,2021-03-03 Lined Notebook For Daily Thoughts, Work, or Reflection. Pop Art Bright Style CNA Notebook, …
ACTIVITIES OF DAILY LIVING (ADL) DECLINE
Yes No 9. Other health conditions and components that may influence ADL function: a. Adverse drug reaction b. Total number of medications > 3
Client Care Log Sample - AIHC
Role: RN LPN CNA HHA Companion Week Ending Date: Pursuant to Regulations by the Agency for Health Care Administration, it is mandatory that Care Provider document any changes in …
Care Area Assessments and Care Planning Chapter 4 RAI …
6/1/19 1 Care Area Assessments and Care Planning Chapter 4 RAI Manual Judy Wilhide Brandt, RN, BA, RAC-MT, QCP, CPC, DNS-CT judy@judywilhide.com 909-800-9124
CNA Report Sheet - Carepatron
Additional notes CNA signature. Date and time. Title: Carepatron Created Date: 20240822074110Z ...
Texas Curriculum for Nurse Aides in Long-Term Care Facilities
Notes to Instructor: Discuss how today’s nurse aide came about, how they are essential to the health care team and how it can be an entry point to a nursing profession. The first 16 hours of …
Addendum: Capital Needs Assessment Process - Rural …
If the CNA is funded by the property’s reserve account, a minimum of two bids is required if the CNA service contract amount is estimated to exceed $5,000 as specified in HB-2-3560, …
Patient Transfers and Body Mechanics
surface to another. One example of a lateral transfer is a transfer from bed to stretcher. There are many types of aids available to make the process of a manual lateral transfer easier. A sliding …
Project Firstline: CNA Toolkit Implementation Guide
California focuses on providing IPC training for Certified Nursing Assistants (CNA). CNA are an integral part of resident care and play a critical role in ensuring safety for their residents and …
How to Use C-Code Functions in CANape - Vector Informatik …
DemoDll.cna CANape configuration file demodll.dll Sample file with auxiliary functions Subfolder Panels Several CANape panels for starting a sample script, e.g. Panel1.xvp, ... When you …
Data Analysis with QCA and CNA for Health Researchers
CNA Coincidence Analysis. QCA and CNA are configurational comparative methods of causal data analysis that investigate implicational (Boolean) hypotheses of the type: X = 1 is …
Documenting The Care You Provide: ADL Accuracy - HubSpot
CNA Role in Documentation When the patient functions below their capability for a prolonged period of time, functional losses may become permanent Documentation may help to qualify …
Emulex OneCommand CNA Manager Application for VMware …
Emulex OneCommand CNA Manager Application for VMware vCenter for OneConnect Adapters Release Notes 2 OCM-VM-OCA-RN1122-100-31CS If the adapter in use is currently running …
Your ULTIMATE Head To Toe Assessment Transcript Cheat …
g¯Ê¼;W1S#7 S ;" p ;S¯;S¯ ; ÀÀ ÀÀ© ªÆ;S¼pªÀ|¼ ¹Æ **Shine your penlight to take a look at their cheeks, gums, tongue, and throat.
Vital Signs Cheat Sheet - JHF
Vital Signs Cheat Sheet. Temperature. Blood Pressure. Systolic Pressure. Contraction of the maximum left ventricle
Removal of a Midline/PICC Catheter
Removal of a Midline/PICC Catheter Page 1 of 4 CarePro Health Services Phone 800-755-6997 Revised: 07/24/20
Nutrition Basics and Patient Feeding Ceu - cnaZone
procedures a CNA will need to follow when feeding a patient. Patients who cannot feed themselves are at risk of aspirating food into the lungs, and the CNA who observes …