The CPCT may be required to work in a patient's home and function as a home health aide. In the home health setting, some of the duties of the CPCT include:

• Assisting with ADLs

• Assisting with patient ambulation

• Performing housekeeping duties

• Transporting patients to doctor or other appointments

• Offering companionship

• Training family members to care for the individual

• Measuring vital signs

• Changing linens

• Emptying bedpans

The CPCT must always remember that they are working in a patient's home and must be respectful of the patient, the patient's family, and the patient's belongings.

Perform Hospice/Palliative Aide Care Services

Hospice care is designed to allow the patient to die in the comfort of their home. Typically, the patient's family and a hospice nurse are present in the home. It is a privilege for health care providers to be in a patient's home, and the CPCT must always remember to be compassionate, respectful, and comforting with the patient, family members, and other members of the health care team. The CPCT is a part of a comprehensive team that

cares for the patient and family. The team is comprised of a physician, a registered nurse, a home health aide, social workers, a spiritual caregiver, counselors, bereavement services, nutritionists, and volunteers. The role of the CPCT includes many of the same functions as the home health aide listed above.

Observe for and Report Edema

Edema is the inappropriate accumulation of fluid in body tissue. The CPCT can assess for edema by gently pressing on the patient's legs and determining if the pressure creates a "pit." The CPCT should immediately report findings of edema to the patient's nurse. Edema can also be observed in all of the dependent areas of the body. Dependent areas include the arms and legs, the back of the shoulders, sacrum, buttocks, and thighs.

Observe and Report Patient Pain Using a Pain Scale

As part of the vital signs assessment, the CPCT should assess the patient for pain. Several different tools are available to assist patients and health care providers in determining the intensity of the patient's pain. The Numeric Rating Scale is one of the most common tools used to determine the level of pain in adults. The patient is shown the scale and asked to associate a number with the intensity of their pain.

The Wong-Baker FACES Pain Rating Scale is another scale used to determine pain intensity in children. Similar to the numeric rating scale, the patient is shown the FACES scale and asked to point to the face that best represents the way he or she feels.

Monitor and Record Vital Signs

Blood pressure (manually)

Blood pressure can be measured manually using a stethoscope and a blood pressure cuff. The blood pressure cuff is typically placed on the patient's left upper arm, an inch or two above the crease "o' f the elbow. The patient should sit comfortably with the left arm placed at the level of the heart. Next, locate the radial pulse and inflate the cuff until the pulse is no longer detected. The cuff is then inflated an additional 10 to 20 millimeters of mercury (mm Hg). Place the stethoscope over the left brachial artery and slowly release the pressure in the blood pressure cuff. The first sound heard through the stethoscope as the pressure is being released is the systolic (top number) pressure. Continue to listen over the brachial artery and release pressure in the cuff. Record the pressure on the blood pressure cuff the

moment no more sound is heard through the stethoscope. This is the diastolic (bottom number) pressure.  An important point to remember is that blood pressure cuffs come in different sizes. It iscritical to use the correct blood pressure cuff on each patient. Using a cuff that is too large

or too small will cause errors in blood pressure measurement. Refer to the manufacturer's instructions for determining the proper cuff size for each patient.

Blood pressure (electronically)

The CPCT will often use an electronic blood pressure monitor to measure the patient's blood pressure. Electronic blood pressure devices typically measure the patient's heart rate at the same time, providing both results simultaneously. The electronic blood pressure devices are reliable and efficient. The CPCT should measure the patient's blood pressure manually if the electronic device measures an abnormal blood pressure, or if the patient

has an irregular heart rate.

Pulse (manually)

The CPCT can measure the patient's pulse rate by palpating the area over an artery. The most commonly used sites for measuring the pulse rate are the radial, brachial, and carotid arteries. The radial site is located on the thumb side of the back of the wrist. The brachial site is located on the inside of the elbow closest to the body. The carotid site is located in the neck to the right and left of the windpipe at the level of the Adam's apple. The CPCT should locate the pulse site, count the number of pulses felt during a 30 second time interval, and then multiply the result by 2 to calculate the patient's heart rate. The normal adult pulse rate ranges between 60 and 100 beats per minute. If the pulse feels irregular, the CPCT should measure the pulse rate for a full 60 seconds and report the findings to the nurse. Report pulse rates outside the normal range to the nursing staff immediately.

Pulse (electronically)

The CPCT will often use an electronic vitals monitor to measure the pulse rate. The device usually measures the heart rate in conjunction with the blood pressure or oximeter.

Apical pulse

The apical pulse can be felt over the left chest in the area of the fifth intercostal space at the mid-clavicular line. The CPCT should measure the pulse rate at the apical site if the heart rate is irregular. The CPCT can palpate the pulse or use a stethoscope to listen to the heart and measure the rate over a full 60-second time interval.

Apical-radial deficit

The apical-radial deficit, or pulse deficit, is the difference between the apical and radial pulse rate. This measurement requires two health care workers to simultaneously measure the pulse at the apical site and at the radial site. If the difference between the two measurements exceeds 8 to 10 beats per minute, the finding should be reported to the nursing staff.

Respirations (manually)

The CPCT can measure the patient's respiratory rate using a variety of techniques. These include watching the movement of the patient's chest, placing the palm of the hand on the patient's back, or listening to respirations with a stethoscope. The CPCT should count the number of respirations during a 15-second interval then multiply by 4 to calculate the respiratory rate. Also, the CPCT should note the depth of respirations (shallow, deep) and the rhythm of respirations (regular, irregular).

Pulse oximetry

Pulse oximetry is a noninvasive method of measuring the oxygen saturation of hemoglobin. Typically, the pulse oximetry probe is placed on one of the patient's fingers. Alternatively, the probe can be placed on a toe or earlobe. The device uses infrared light to measure oxygen saturation and the test is painless. Certain conditions may cause false oximetry readings such as cold fingers, edema, nail polish, acrylic nails, and certain toxic exposures such as carbon monoxide. The normal oxygen saturation range is 94 to 100%. Certain diseases such as COPD may alter the normal oxygen saturation range. The CPCT should report any abnormal oxygen saturation results to the nursing staff immediately.