If you are studying to become a CNA you’ll want to pay extra close attention to this Residents Care section as well as the two others, restorative skills and psychosocial skills. These areas are particularly important because they make up nearly half of the questions on the CNA exam, so building up a comfort level with these items is critical.
In this section, we focus on personal care, which CNAs will need to be well versed in to assist patients with their daily routines.
- Oral Care
- Manicures and Pedicures
- Hair Care
- Using the Toilet
- Rest & Comfort
Encouraging personal hygiene in residents, and bathing critically ill patients are important duties of nursing assistants. Bathing patients in intensive care unit is especially important as the patients are at a greater risk for infection if harmful microorganisms are not removed from the body. Bathing also relaxes the muscles and tissues, improves blood circulation and makes the residents feel good.
When bathing patients, the nursing assistants have to follow these guidelines:
Ensure safety: There is a possibility of various accidents during bathing, so the nursing assistants should ensure the safety of the environment. For instance, wet and slippery floors are likely to cause falls. Such accidents can be avoided by providing assistive devices to patients such as walkers. Notice for any signs of weakness, dizziness that can cause falls. Use lukewarm water and mild soap, when bathing the elderly patients.
Other than accidents, there may be scratches or skin breaks that need to be prevented when bathing residents. Skin breaks can become an entry point for disease-causing microorganisms. Drying the body parts with a towel is also important as microorganisms thrive in wet and warm areas such as armpits and buttocks.
Ensure privacy: Ensure that curtains are used when undressing and bathing the patient.
Note any skin conditions: Redness or blisters on the patient’s skin should immediately be reported to the supervisor so that the patient receives prompt treatment. Some patients with disabilities may have bed sores or pressure sores that occur when the patient is confined to the bed for a long time. Bedsores are likely to be found in elderly patients on areas such as the hips, elbows, spine or shoulders.
As bedsores are painful and do not heal easily, it is important to treat them properly and in time. The best approach is to ensure that the patients do not develop bedsores. For that purpose, the nursing assistants can take the following actions:
- Turn the patients at regular intervals, so pressure is not prolonged on one particular bony area
- Re-position patients to make them comfortable
- Use protective devices such as pressure relief cushions
- Provide proper diet
Nursing assistants need to provide oral care to intensive care patients who are unconscious or unable to eat, drink or clean their mouth without assistance. Proper oral care helps prevent infections and other oral problems. Oral care management involves using appropriate oral care equipment and providing proper oral care periodically. For instance, materials such as pediatric toothbrushes, sponge-stick, oral aspiration tools, tongue depressor, and sterilized water are used to keep the patient’s mouth clean, hydrated and free from microorganisms.
Oral care procedures are different for the conscious and the unconscious patient. For the conscious patient, the nursing assistant should perform the following actions:
- Inform the patient about oral care so that the patient can assist in the care process.
- Perform hand hygiene and wear gloves. Raise the patient’s head and cover the chest with a towel.
- Use a pediatric toothbrush and a small amount of toothpaste to clean the patient’s teeth, gums and tongue.
- When brushing, note any signs of bleeding or infection in the patient’s mouth. If any lesions or abscesses are seen, report immediately to the supervisor so that appropriate treatment can be provided.
- After brushing, help the patient take small amounts of water into the mouth to remove the toothpaste.
- Place the patient back onto the bed.
If the patient is using dentures, ensure that these false teeth are also brushed and cleaned properly with warm water. Dentures should be rinsed and placed in a container stating the patient’s name, to prevent loss or damage.
For the unconscious patient or the patient associated with a mechanic ventilator, the nursing assistant uses a tongue depressor so that the mouth is clearly visible for cleansing and moisturizing. Next, a pediatric toothbrush is used to brush the teeth and gums. The patient’s head is turned to one side so that saliva and toothpaste are not aspirated. After brushing, the nursing assistant has to suction the remaining toothpaste as the patient cannot clean himself. Once the patient’s mouth is cleaned properly, the nursing assistant places him/her back on the bed in a comfortable position.
To avoid bad breath, and the growth of bacteria in the mouth, tooth brushing should be done at least twice daily.
Shaving hair is one of the important activities for a patient to look well-groomed. However, intensive care patients or patients with other disabilities may need assistance with such activities. Also, some patients may not be able to skillfully shave which may result in accidental cuts. Apart from pain and bleeding, such cuts also act as an entry point for the disease-causing microorganisms to enter the body. Therefore, shaving patients becomes one of the important tasks for the nursing assistant. To avoid accidents, the nursing assistant should use proper equipment for shaving.
The nursing assistant should perform the following actions when shaving patients:
- Apply a thin layer of shaving cream or a towel soaked in lukewarm water to areas that are to be shaved. Using a warm towel softens the skins and makes it easier to shave.
- Use an electric razor for shaving, as manual razors increase the risk for cuts and bleeding.
- Stretch the skin if required and shave in the direction where the hair grows.
- After shaving, wash the patient’s face and pat it dry with a towel.
Manicures and Pedicures
One of the important duties of a CNA is to provide manicure and pedicure care to a patient. Some patients are too weak to perform activities of daily living and may need the assistance of a CNA. Nail care is important to prevent the spread of infections that may occur due to scratching. The patients’ nail beds are also likely to have microorganisms that may enter the body if there is breakage in the skin due to scratching.
The CNA should be adequately trained to perform nail care on a patient. The nursing assistant should use the following guidelines while providing manicure and pedicure to a patient:
- Ensure to have suitable sterile materials for nail care such as warm water, soap, nail cutter, lotion, towel, and orange stick.
- Perform hand hygiene and put on your gloves.
- Ensure that the patient is comfortably situated before beginning nail care.
- To sterilize the patient’s fingers and toes, soak them in warm soapy water.
- Take the hands/feet from the water and use the orange stick to gently clean the nails. Next, clip one nail at a time.
- Look for any signs of fungal growth or inflammation in the nail beds. If there are any signs of infection, report immediately to the supervisor.
- Once cleaned and clipped, use a towel to wipe the patient’s fingers/toes.
- The rough or sharp areas of the nails are then filed, for smoothness.
- Apply hand/feet lotion as required.
- Ensure to correctly dispose of all soiled material, linen or wash-cloth used for manicure and pedicure. Perform hand hygiene.
Providing nail care to a diabetic patient is critical as a small nick can result in a serious infection. It is usually performed by a doctor or a nail care specialist. In a diabetic patient, the body tissues do not repair naturally, so a minor scratch on the skin can cause an infection. An orange stick is also not ideally used for a diabetic patient as it increases the risk for nail fungus. The cuticles should not be clipped, but gently pushed back. Clipping the nails too short may also cause irritation and is therefore avoided. In case there are ulcers on the skin, pedicures and manicures are not recommended until the ulcers heal completely.
Assisting patients with hair care is one of the duties of a CNA. Patients with weak motor movements or other disabilities may find it difficult to comb, wash or oil their hair. It becomes imperative for the CNA to assist such patients and make their hair clean and healthy.
However, there are no standard procedures for providing hair care to a patient. It is one of the grooming activities that can keep the patient healthy both physically and emotionally, and improve their self-esteem.
Before performing hair care, the CNA should inform the patient that he or she is going to brush or comb the patient’s hair. Talking to the patient’s family members to understand the patient’s preferences is another way to make the patient comfortable. For instance, some patients may prefer a cosmetician to do their hair, and their decision should be considered.
When providing hair care, the CNA should take the following actions:
- Put on the gloves and gather all the required supplies for hair care such as comb, oil or other hair care products.
- Enquire how the patient would like his hair done.
- Even when you are brushing the hair, talk to the patient to know how the patient is feeling or is experiencing any pain.
- Use gentle movements when combing towards the scalp.
- Observe the patient’s facial expressions for any signs of pain.
As a CNA, you need to ensure that a resident gets proper nutrition, is properly hydrated and eats a balanced diet.
Encouraging the patient to eat a balanced diet, containing the right amounts of protein, carbohydrates, fats, minerals, and vitamins will positively impact the health and wellness of a patient. At the same time, ensuring that the patient consumes the right amount of water each day will keep the patient’s body hydrated, replace fluid loss, aid digestion and help maintain the body temperature.
CNAs should ensure that the patient eats a diet which contains the following nutrients:
- Carbohydrates: Grains, fruits, vegetables, sugars
- Fats: Butter, oils, meat, milk, nuts
- Proteins: Meat, fish, cheese, beans
- Calcium: Dairy products, broccoli, kale
- Iron: Beef, chicken, nuts
- Vitamins: milk, eggs, liver, cereals, sweet potatoes, kale
The nursing assistant should ensure that there is a balance between the calories consumed by the patient and the calories expended. This will help maintain a proper body weight.
The dietary requirements of each patient are different, and the CNA should ensure that the patient is consuming the prescribed diet. For instance, a soft diet should have everything that has a soft and smooth texture. A low sodium diet should have very low amounts of salt. As a rule, the CNA should check the patient’s chart before giving them food.
CNAs should also note any dietary changes in elderly patients. In elderly patients, aging affects the sense of smell, thirst, and taste leading to a decrease in appetite. This may further lead to malnourishment and body malfunction if their bodies do not get the daily calorie requirement. The CNA should encourage the patient to eat as much as possible. It is also a good strategy to feed the patient in small portions. Another strategy is to add healthy and prescribed supplements, seasonings to food that will encourage the patient to eat well. Adding the patient’s favorite food to the meal, if not forbidden by the physician, will also increase the patient’s appetite.
Using the Toilet
Assisting patients with toileting is one of the responsibilities of the nursing assistant. Helping the patient use the toilet successfully also helps the patient maintain self-respect. It also helps to avoid any accidents such as falls in elderly patients, who experience weakness, blood pressure changes, or are prone to accidents such as falls.
When assisting with toileting, the primary responsibility of the CNA is to be present with the patient for balance and support. The CNA should walk the patient to the bathroom, clean them, and be aware of their toileting needs. Sometimes, some patients experience age-related incontinence, or in some cases, medications or too little water intake can cause constipation. In such cases, it becomes important for the CNA to monitor the patient’s toileting routine, and also monitor their food and fluid intake.
While assisting with toileting, the CNA should also note any problem associated with defecation such as watery stools, diarrhea, or signs of dehydration. Any problem should be promptly noted to the supervisor so that immediate treatment or dietary changes can be prescribed for the patient.
Some elderly patients have inconsistent toileting routines, while others become unaware or forget to go to the bathroom. They may also defecate on themselves, or on the floor, due to decreased control in eliminating wastes. Such incidents can be embarrassing and also cause accidents such as falls. In order to prevent such incidents the CNA should take the following actions:
- Keep a record of the patient’s fluid and food intake.
- Keep a note of the medications prescribed to the patient.
- Clean up the area immediately in case the patient defecates or urinates.
- Ensure that all members of the healthcare team are aware of the toileting routines of the patient.
CNAs should also have proper procedures of how to use the bedpan and urinal in order to maintain sanitation. Gloves should be worn when handling any waste such as feces or urine. Proper hygienic practices should also be followed after assisting the patient.
Rest and Comfort
Rest and sleep are important for a patient to restore the energies of the body, keep him mentally relaxed, free from worry, and physically calm. Lack of proper sleep can cause fatigue, increase blood pressure, impair the ability to think clearly and make the patient susceptible to infections.
Most of the time, chronic pain and discomfort due to conditions such as osteoarthritis, osteoporosis, amputation, surgery, cancer, or other disabilities, may affect the patient’s sleep patterns. Other factors that affect sleep can include unfamiliar beds, roommates, wrinkled linens, or bright lights in the room.
In such cases, it is the CNA’s responsibility to promote the patient’s sleep by increasing patient comfort and managing their pain.
The CNA should take the following actions to manage the patient’s pain. Relief from pain will immediately increase patient comfort.
- The first step is to recognize the symptoms of pain and discomfort in the patient. This includes observing the verbal and nonverbal expressions of pain such as moaning, wincing, restlessness, or rubbing body parts.
- Report any signs of pain immediately to the supervisor so prompt actions can be taken for pain relief.
- Ensure that the patient is taking any prescribed pain relief medications as indicated.
- Apply heat and cold to affected body parts and as prescribed as they are effective strategies for pain relief.
- Provide back rubs for stress relief. Repositioning the patient is another strategy to increase patient comfort.
The CNA should perform the following actions to promote rest and sleep in the patient:
- Be aware of the patient’s bedtime and waking time. Try and maintain this routine every day.
- Ensure that the patient’s bladders/bowels are empty, to reduce discomfort related to these areas.
- Engage the patient in exercise or physical activity during the day and reduce napping times.
- Educate the patient on the importance of sleep and techniques to promote sleep.
- Ensure there are no distractions at night, such as bright lights, loud noises, etc, so that the patient sleeps peacefully.
Ensure that the sleeping environment is restful and neither too hot nor cold.