Lesson 4: Residents Care. Restorative Skills

Residents Care questions make up nearly half of the CNA exam so it’s important to become extremely familiar with the content of this section as well as the personal care skills and psychosocial sections on this site.

In this section, we will focus on restorative skills. These duties performed by CNAs assist residents in retaining the skills they need to function day to day and regain their independence.

Self Care and Independence

As a CNA one of your most critical roles in residents’ care is to assist them in improving their own ability to care for themselves and develop independence in their day to day activities.

In truth, this is also a legal issue as the Omnibus Budget and Reconciliation Act of 1987 (also known as OBRA) was implemented by the administration of President Ronald Reagan. This legislation was designed to ensure that caregivers in nursing homes would not just maintain the health of residents, but assist them in reaching their highest degree of function using all available resources.

As a CNA, it’s important to keep in mind that your role is more than maintenance, you need to provide motivation and support for those you care for.

More information on OBRA:

Mobility and Immobility

Mobility is necessary for a patient to perform different activities. If mobility is affected, the patient may not be able to function properly or perform activities of daily living. It can result in mental and emotional disturbances such as frustration or depression in the patient. The patient may even start losing self-esteem. There can be physical changes such as body deformities which can result in further complications.

The CNAs can assist such patients by helping with different exercises that can maintain muscle condition and function. Such exercises are prescribed by a physical therapist and are called range of motion (ROM) exercises. Some patients may need assistance when performing exercises. On the other hand, some patients can perform the full joint movement without any assistance.

Other than ROM, the patients can be encouraged to perform routine exercises and mobilization as prescribed. This will promote circulation and prevent complications.

The other way of assisting immobile patients is by using assistive devices. For instance, a mechanical lift is used to lift a patient safely. Special attention should be paid to positioning devices to ensure that the patient is correctly positioned while lifting or transferring to another bed. If the patient’s body parts are not correctly positioned, there is a risk of injury or accident.

Immobilization increases the risk of skin breakdown and sores. To avoid this, the patient should be repositioned every two hours. This will avoid pressure on bony prominences and avoid friction and skin breakdown. Pressure-relieving mattresses can also be used to avoid pressure sores.

Health Maintenance and Restoration

Taking the patient’s vital signs and measuring health, weight as well as documenting them accurately are some of the important duties of the CNA. These duties ensure health maintenance and restoration of the patient.

Proper documentation of vital signs and weight measurements is crucial as it indicates the overall health condition of a patient. Vital signs indicate if the patient’s temperature, blood pressure, heart rate are normal. Factors such as age, gender, food intake, activity levels, medication can impact the patient’s vital signs. Therefore, any abnormal rise or fall in the vital signs, as well as the patient’s weight, should be immediately reported, so that they receive prompt care.

Changes in weight should be immediately reported as they could indicate obesity, malnutrition, fluid retention or any other illness. A change in the height could also indicate a problem in the musculoskeletal system. It should also be noted that a change in one vital sign such as temperature is likely to affect other vital signs. For instance, a patient with a fever is likely to have an increased pulse rate. Proper documentation of these changes will help the physician determine the right plan of care for the patient.

The CNA should use the following guidelines when measuring the vital signs, height, and weight of the patient:

  • Explain to the patient what you are going to do, before taking the measurements.
  • Ensure that the patient has not consumed any hot liquid at the time of taking the temperature. This can indicate a wrong recording. The best practice is to wait for at least 15 minutes before taking the measurements.
  • Ensure that the patient’s weight is recorded according to the facility protocols. For instance, the weight measurements can be affected by articles, shoes, and clothing on the patient’s body.

Taking Vital Signs

One of the most important duties of a CNA is to record the patient’s vital signs. Any dramatic change in the vital signs can indicate an abnormality, and the patient may require prompt treatment. The four important vital signs that the CNA has to record are temperature, blood pressure, pulse, and respiration. Let’s look at the guidelines for recording each of these vital signs:

Recording Temperature

Recording temperature is easier, as the CNA has to use a thermometer. However, the CNA should ensure that the temperature is recorded accurately and that the patient is not exposed to any pathogens on the thermometer. Temperature can be recorded orally, rectally or even by ear. The CNA should use the facility protocols and the proper method to ensure accurate recording. Normal body temperatures are 98 to 99 degrees Fahrenheit. Any dramatic increase or decrease in the temperature should be promptly reported.

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Recording Blood Pressure

A dramatic change in blood pressure can indicate an emergency. So, it should be recorded accurately, so that the physician can prescribe appropriate treatment. A sphygmomanometer or a blood pressure gauge is used to take the patient’s blood pressure. The CNA records the systolic and the diastolic pressure of the patient using the device. Systolic is the pressure in the arteries that occurs during heartbeats. Diastolic is the pressure that occurs between heartbeats. Systolic pressure is indicated by the higher number and diastolic by the lower number.

Recording Pulse

The pulse rate indicates the number of times the heart beats per minute. The CNAs use their fingers to measure the patient’s pulse rate. The CNA places two fingers on the patient’s radial artery on the wrist and counts the number of pulses that occur in 15 seconds. That number is multiplied by 4. The number that is obtained is the patient’s pulse rate. In a normal person, a healthy pulse rate is 60-100 beats per minute.

Recording Respirations

The respiration rate is the number of breaths a patient takes per minute. The CNA counts the number of times the chest rises in 15 seconds and then multiplies that number by 4. The number obtained is the respiration rate of the patient. The CNA should also pay close attention to any breathing difficulties when recording the respiration rate, and report immediately to the supervisor if any abnormality is noticed.

Continue to Lesson 5: Residents Care: Psychological Care