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newSchoolWorks.com › VoTechWorks › Health & Personal Services › Nursing Assistant (CNA) › CNA Capstone: Integrated Patient Care Simulation and Professional Defense › Lesson 2
HLT-CNA36-07 · Lesson 2 · 24 clock hours · lab

Integrated Patient Care Simulation — Full Caseload Execution

Objective. Students perform all six assigned patient care tasks on a mannequin or peer in a controlled simulation environment, meeting each step of the state CNA skills checklist, while completing all required documentation in real time.

⚠ Pending professional review

This lesson, its worked examples and its practice questions has not yet been verified by a licensed clinician in the field or by a certification or approval body. It is a study draft and may contain errors. Do not use it to make decisions about any patient or medication. Always follow your instructor, your supervising professional, and current official references and regulations.

VoTechWorks program approval and accreditation are still in progress. Credentials are issued only by the certifying bodies named in each program, after their own exams.

What This Lab Asks of You

The integrated simulation rotation is the closest experience you will have to a real nursing-home or hospital shift before you sit your state CNA skills examination and begin licensed practice. You will care for an assigned "patient" — a mannequin or peer acting as a resident — through six core tasks, respond to an unannounced safety event, and write all required documentation before you leave the lab. Every action you take is scored against the official state CNA skills checklist. This lesson explains what to expect and how to perform at your best.

The Six Core Care Tasks

1. Hand Hygiene and PPE Donning/Doffing

Wash hands or use alcohol-based hand rub at every entry and exit point in the care sequence. Don gloves before contact with body fluids or mucous membranes; remove and discard them without contaminating your hands. The order matters: don PPE before patient contact, doff PPE after care is complete, and perform hand hygiene immediately after doffing. Skipping hand hygiene is a critical safety failure on the checklist.

2. Vital Signs Measurement and Recording

Measure and record temperature (oral or temporal), radial pulse (count for a full 60 seconds or per your program protocol), respirations (count for 30–60 seconds while appearing to count the pulse so breathing remains natural), blood pressure (auscultatory or aneroid method), and pain using the facility's approved pain scale. Record numbers legibly on the ADL flow sheet the moment you finish each measurement — memory errors are real, even over short intervals. Report any value outside the normal ranges you have learned to the nurse promptly.

3. Partial Bed Bath and Peri-Care

Maintain the resident's privacy with a bath blanket at all times; expose only the area being washed. Change washcloth or rinse thoroughly between body areas. For peri-care, clean from front to back for female residents. Check skin for redness, open areas, or unusual odor and report findings. Maintain water temperature that is comfortable and safe — test it before applying to skin.

4. Ambulation with Gait Belt

Apply the gait belt snugly over clothing at the waist — you should be able to slip flat fingers under it, but no more. Position yourself to the resident's weaker or affected side. Use an underhand grasp on the belt. Ensure the call light is within reach before you begin. If the resident reports dizziness or pain, stop immediately, lower the resident to the nearest safe surface, and call for the nurse. Never leave a resident mid-ambulation without support.

5. Repositioning and Pressure-Injury Prevention

Reposition bedridden residents at least every two hours or per the care plan. Use proper body mechanics: keep your back straight, bend at the knees, keep the load close to your body, and ask for a second person when the resident is unable to assist. After repositioning, ensure bony prominences (heels, sacrum, hips, elbows) are relieved of direct pressure. Place a call light within reach before you step away.

6. Intake and Output Measurement and Recording

Measure fluid intake in milliliters using a calibrated graduate. Read the measurement at eye level to avoid parallax error. Record the time, type, and amount of each fluid on the ADL flow sheet immediately. Urine output is measured the same way. Never estimate; if you spill a container, note what happened and what could be measured, then report to the nurse.

Responding to the Safety Scenario

Halfway through your rotation, your instructor will open a sealed envelope revealing one of three unannounced scenarios: a resident reporting chest pain, a simulated fall, or a choking episode. Your job is not to treat these conditions — it is to recognize them, act within your scope of practice, and get the nurse to the bedside without delay.

Verbalizing your actions out loud as you perform them shows the instructor that your decision-making is sound, not just your technique.

Documentation: Complete It Before You Leave

Three documents are due at the end of every rotation:

1. ADL flow sheet — all vital signs, bath, ambulation, repositioning turns, and I&O entries filled in with no blank required fields.

2. Incident report — a factual, objective account of the safety event: what you observed, what time, what you did, and who you notified. Do not include opinions or diagnoses.

3. Hand-off communication log — written in objective language (what you measured, what you saw, what the resident said verbatim in quotation marks). Avoid unapproved abbreviations; when in doubt, spell it out.

Incomplete documentation is not a minor issue. On the state exam and in practice, undocumented care is considered care that did not happen. Reviewers check for blank fields, subjective language, and unapproved shorthand.

Passing This Lab

You must score 80% or higher on the skills checklist for each of the six tasks. All critical safety steps — hand hygiene, gait belt application, and call-light placement — must be done without any prompting from the instructor. An unsafe or incorrect safety-scenario response requires a full repeat rotation before you advance. Use every session as a real shift: the habits you form now follow you into licensure and employment.

Key terms10

ADL flow sheetA standardized paper or electronic form used to document a resident's activities of daily living, vital signs, intake and output, and care provided during each shift.
Gait beltA sturdy canvas or nylon belt fastened around a resident's waist and grasped by the nursing assistant to provide safe support during ambulation or transfers.
Intake and output (I&O)The measurement and recording, in milliliters, of all fluids a resident takes in (oral, tube, IV) and all fluids the resident excretes (urine, emesis, wound drainage) over a defined period.
Peri-carePerineal care — cleansing of the genital and rectal area — performed to prevent infection and maintain skin integrity, always progressing from cleanest to least-clean area.
Pressure injuryLocalized damage to skin and underlying tissue, usually over a bony prominence, caused by sustained pressure, shear, or friction; formerly called a pressure ulcer or bedsore.
Scope of practiceThe tasks and responsibilities a CNA is legally permitted to perform under state law and facility policy; CNAs may not diagnose, prescribe, or perform tasks assigned to licensed nurses.
Critical safety stepAny checklist item whose omission could directly harm the resident; on the state skills exam these steps must be performed correctly to pass, regardless of the overall score.
Incident reportAn objective written record of an unexpected event — such as a fall, injury, or sudden change in condition — completed immediately after the event and submitted per facility protocol; it is not placed in the resident's medical record.
Hand-off communicationThe structured transfer of accurate resident information from one caregiver to the next, using objective, factual language to ensure continuity of safe care.
PPE (Personal Protective Equipment)Barriers such as gloves, mask, gown, and eye protection worn to protect the caregiver and resident from transmission of infectious material; donned before patient contact and doffed carefully after.

Worked examples4

1. A resident drank 6 oz of juice, 4 oz of milk, and 240 mL of water at breakfast. What is the total intake in milliliters to record on the ADL flow sheet? (1 oz = 30 mL)
  1. Convert juice: 6 oz × 30 mL/oz = 180 mL
  2. Convert milk: 4 oz × 30 mL/oz = 120 mL
  3. Water is already in mL: 240 mL
  4. Add all three amounts: 180 + 120 + 240 = 540 mL
Answer: Total intake to record: 540 mL
2. You empty a urinary drainage bag and read the graduate at eye level. The bottom of the meniscus rests on the 375 mL line. Earlier in the shift, 150 mL had already been recorded. The care plan asks you to record only the new output since the last entry. What do you document?
  1. Total urine measured in graduate this emptying: 375 mL
  2. Amount already recorded from the previous emptying: 150 mL
  3. New output since last entry: 375 − 150 = 225 mL
  4. Record 225 mL on the ADL flow sheet with the current time
Answer: Document 225 mL of urine output for this entry.
3. You count a resident's radial pulse for 30 seconds and tally 18 beats. What is the rate to record in beats per minute, and is this value within a normal adult resting range?
  1. Multiply the 30-second count by 2 to convert to beats per minute: 18 × 2 = 36 bpm
  2. Normal adult resting heart rate is generally 60–100 bpm
  3. 36 bpm is below the normal range (bradycardia territory)
  4. Record 36 bpm and report the finding to the nurse immediately
Answer: Record 36 bpm; this is outside the normal range — report to the nurse before continuing care.
4. During a blood pressure reading you hear the first Korotkoff sound (tapping) at 128 mmHg on the aneroid gauge and the sounds disappear at 82 mmHg. What blood pressure do you record?
  1. The first clear tapping sound heard during deflation is the systolic pressure: 128 mmHg
  2. The point at which sounds disappear (last sound) is the diastolic pressure: 82 mmHg
  3. Record the blood pressure as systolic over diastolic
Answer: Record 128/82 mmHg.

The math in this lesson1

Learners convert oz to mL for 540 mL intake and subtract a prior 150 mL entry from 375 mL output.
N-Q.1
Brush up in the math halls at newSchoolWorks.com:
In class: Each student independently runs a timed simulation rotation (approximately 90 minutes per student across multiple sessions) covering: hand hygiene and PPE donning/doffing, vital signs measurement and recording (temperature, pulse, respirations, blood pressure, and pain scale), partial bed bath and peri-care with privacy and dignity maintained, ambulation with gait belt, repositioning and pressure-injury prevention, and accurate intake/output measurement and recording on the ADL flow sheet—instructor uses the official state skills checklist to score each step as pass or needs-repeat · Midway through each student's simulation, the instructor introduces one unannounced safety scenario from a sealed envelope (options: resident reports chest pain, a simulated fall occurs, a choking episode begins); student must verbalize and demonstrate the correct response—recognizing scope-of-practice limits, calling for the nurse, initiating first aid—before simulation continues · After each rotation, student immediately completes paper documentation: ADL flow sheet entries, a brief incident report for the safety event, and a communication log entry written as a nurse hand-off note using objective language; instructor reviews documentation before student leaves the lab session
Materials: Adult training mannequin, gait belt, blood pressure cuff and stethoscope, thermometer (oral or temporal), pulse oximeter, watch with second hand, disposable gloves and mask, bed linens, bath basin and washcloths, graduate (measuring cup) for I&O, official state CNA skills checklist (one per student per rotation), ADL flow sheet, blank incident report form, communication log template, sealed safety-scenario envelopes
Check: Pass requires: score of 80% or higher on the official state CNA skills checklist for each of the six care tasks (all critical safety steps—hand hygiene, gait belt use, call-light placement—must be performed without prompting); documentation completed with no blank required fields and no unapproved abbreviations; incorrect or unsafe responses to the safety scenario require an immediate repeat rotation before the student advances

Practice check8

Answer each question, then check it. Nothing is recorded; this is your own practice.

Safety and Infection Control
1. During the simulation, a student applies the gait belt but the instructor notices it is placed over the resident's hospital gown and is loose enough to slip off the hip. What is the correct action?
Resident Care
2. A student is performing peri-care on a female mannequin. Which technique is correct?
Safety and Emergency Procedures
3. Midway through a simulation rotation, the sealed scenario envelope reveals that the resident is reporting chest pain. Which response is within the CNA's scope of practice?
Communication and Documentation
4. After the simulation rotation, a student writes on the incident report: "The resident seemed confused and was probably going to fall." The instructor returns the form for revision. Why?
Clinical Measurement
5. A student counts respirations for 30 seconds and tallies 8 breaths. What rate in breaths per minute should be recorded, and what action is required?
Communication and Documentation
6. Which of the following entries on an ADL flow sheet would an instructor flag as using an unapproved abbreviation that should be spelled out?
Safety and Infection Control
7. A student is repositioning a bariatric (heavier) mannequin representing a resident who cannot assist. The student attempts the turn alone. What is the safest action?
Communication and Documentation
8. After measuring a resident's blood pressure, a student records it on the communication log as 'BP high today.' Why is this entry unacceptable for a hand-off note?
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