The CNA Study Guide – Promoting and Maintaining Function of Patients and Residents
Section 1 – Promoting and Maintaining Function of Patients and Residents
Feeding Patients and Residents
At times, a nursing aid will need to provide feeding assistants to patients who are not able to eat on their own or require assistance. Prior to beginning the feeding process, it is important to double check and make sure the patient is receiving the correct food. Many patients will have dietary requirements that need to be followed. Not providing the correct meal may lead to health problems either immediately or later.
It remains crucial for a nursing air to know the dietary requirements, restrictions, and status of a patient. These requirements need to be followed. Additionally, there are times where a patient may have a medical procedure or surgery scheduled which prevents consuming food during an established window of time prior. The nurse needs to know the patient is NPO (nothing by mouth). Should the patient consume food prior to surgery the procedure may need to be canceled or postponed. Letting a patient consume food that is not allowed puts the patient at risk and may be considered negligence.
If a patient has trouble swallowing (dysphasia), they are at a greater risk for choking (aspiration). Whenever assisting a patient who suffers from this it is imperative to ensure all liquids are thickened prior to feeding. Also, the patient needs to be seated upright and not fed while lying down. Feeding should also take place slowly and they need to be checked routinely to make sure they finish swallowing after each bite prior to moving on to the next bite. Following the conclusion of their meal, a patient needs to remain sitting for a minimum of 30 minutes after eating to allow proper digestion and prevent anything from coming back up.
If a patient is visually impaired they likely will also need help with their food. However, there are many patients who are able to overcome their lack of vision over time by following what is known as the “clock method.” This is where the nursing assistant describes each portion of the pate using a clock. If there is a piece of turkey located at the top of the plate, the nursing assistant will tell the patient they have turkey at 12 o’clock. If they have potatoes at the bottom of the plate the nursing assistant will tell them they have potatoes at 4 o’clock. This way, a patient who is able to swallow without assistance and can pick up utensils may remain as independent as possible.
Patients and residents need to enjoy their meal times, no matter what kind of medical issue or disability they might have. It is up to the nursing assistant to help make sure the food looks good and is served at the correct temperature. From here, the nursing aid also needs to work with the patient in order to help promote the highest level of independent eating possible.
It is important for patients to remain hygienic. This will reduce the potential for sickness spreading while improving circulation and boost a patient’s ability to relax. The patient’s overall level of mobility will play a big role in whether or not they are able to bathe themselves or if they need assistance. If a patient is fully mobile and they do not pose a risk of falling down will be able to take a shower or tub bath on their own (or at least with very little help). There are times where a patient may need a partial bath, which occurs if only part of the body needs to be washed. The partial bath can be given in a bathtub, shower (with the patient sitting on a shower chair) or in another location designed for partial baths. Different healthcare facilities may have different requirements when it comes to partial baths.
If a patient is not able to leave their bed on their own they will need to take a bed bath. In many cases, a patient does not need a full bath every single day. In order to maintain the necessary level of hygiene though a patient does need to have at least two perineal cleanings a day. During a bath, the patient’s skin needs to be completely inspected in order to make sure there is no irritations, tears or redness. If there are skin blemishes the nursing assistant needs to inform the nurse on staff.
When helping a patient bath, it is important to start cleaning the areas of the body that remain the cleanest and work in the most soiled areas. This way, germs, dirt and other bodily fluids are not spread to other areas of the body during the wash. During these kinds of baths, the face should always receive initial cleaning and the perineal area needs to be the final area of the body cleaned.
During a bath, the basin water and cloths used can be changed whenever necessary. If the bath needs to be stopped for any reason, the patient needs to first be dried off and covered. This prevents a chill and exposure. When the bath can resume the covers can be removed.
After the conclusion of a bath, it is necessary to fully dry out the skin. This is especially important in areas where moisture may remain, such as in the armpits, between fingers and toes, in folds of skin and under breasts. Not drying out these areas may result in chaffing and skin tears. Typically it is not necessary to apply lotions or powders, as long as the areas are dried completely.
Catheter and Perineal Care
It is necessary to provide initial perineal care in the morning and prior to going to bed. For some, additional care may be needed throughout the day. If a patient has a bowel or bladder incontinence, or if they are suffering from diarrhea or have trouble moving on their own in order to make it to the restroom, additional perineal care will likely be necessary.
It is crucial that when providing perineal care for a female patient that the genitals are washed from front to the back. This prevents any kind of infections that might lead to a urinary tract infection. When cleaning a male who is not circumcised, the foreskin needs to be gently pulled back in order to completely wash the head of the penis. As this is a personal cleaning experience, it is important to provide as much privacy as possible.
If a patient has a catheter, the perineal cleaning is no different than that of other patients, although it is very important to not pull on the catheter (pulling will cause discomfort). The exposed area o the catheter needs to be cleaned with a washcloth. During the cleaning, the end nearest the patient needs to be cleaned first and then clean the area moving away. During the cleaning process, it is necessary to avoid crimping or tangling any areas of the catheter. The nursing assistant also needs to make sure the tubing remains secured to the patient as this will prevent any kind of dislodging during movement. The collection bag of the catheter must remain under the bladder; otherwise, the runoff will push back against the body and potentially lead to a UTI.
It is important for a patient to be washed and dried completely. Lotion should not be used often. Some healthcare facilities may not allow the use of lotion. Lotion and powders may collect in folds of the skin and cause damage. Whenever washing and dressing a patient, the skin needs to be examined for any signs of irritation, redness or abrasions. Any changes in the skin should be reported.
Using the Restroom
If a patient needs help using the bathroom the nursing assistant must offer toileting services in the morning and prior to going to bed, in addition, to help during the day. If a resident uses a false bladder or bowel, it is important to stick to the bladder or bowl program of the facility.
Nails and Feet Care
Nails on a patient need to remain clean and trimmed. Looking over finger and toenails should occur daily and any signs of infections or fungal development need to be reported. There are some healthcare facilities that do not allow patients to trim their own nails, so understanding facility requirements are important. Patients who suffer from diabetes are at a greater risk of infection so any cut needs to be treated quickly.
Dressing and Undressing Care
Some patients will need help both dressing and removing their clothes. When help is required the nursing assistant should help the patient remain as independent as possible. They need to ask the patient what they want to wear and promote independent thought and choices.
When dressing a patient, inspecting the skin is important and any changes in the skin should be reported to the lead nurse on staff. An entire outfit should be picked out prior to dressing so the patient does not remain exposed for long periods of time. Dirty clothes should be collected for cleaning. When a patient is weaker with one side (such as paralysis) that area should be undressed last and it should be clothed first. This way, the patient can help their best while dressing and the nursing assistant can help the rest of the way.
In most cases, when a patient does require help for dressing they will work directly with an occupational therapist or a physical therapist. These professionals will help educate the patient for specific care techniques in order to improve their physical wellbeing. The nursing assistant needs to then help reinforce these techniques as this will help the patient develop proper habits while remaining independent.
Patients who are not able to brush or clean their own teeth need to be assisted. Oral care includes daily inspections. Any redness, bleeding, swelling, cracks, sores or discolorations need to be reported (as do any odd odors or damaged teeth). Oral care needs to take place both in the morning and prior to going to bed. Additional care can be offered following meals. If a patient is intubated they will need additional care as the oral mucosa is dying. The healthcare facility will provide information as to when oral care needs to be performed.
When dentures are used, the false teeth need to be removed carefully and placed in a denture cup right away. If the patient is unconscious, the patient needs to be sat upright (whenever possible) and their head turned to the side. Their mouth can be opened with gentle pressure placed on the chin. It is important for a nursing aid to never place their hand inside of a patient’s mouth but instead uses swabs to clean the teeth and gums. Lip moisturizer can be applied to the lips when needed.
If a patient has dentures and it needs to be moved, the dentures must remain in a denture cup. When cleaning the dentures, the false teeth should be positioned onto a washcloth in a sink basin in order to avoid dropping the teeth. Brushing the teeth under tepid water and then the teeth should be placed back into the patient’s mouth (or placed back into the denture cup). Dentures should not be washed in hot water as this can damage it.
Providing grooming services, such as shaving and hair care also falls under personal care for the patient. The nursing assistant needs to provide aid when needed.
Shaving will include shaving a patient’s face, under their arms and their legs. Now, this may depend on the particular healthcare facility’s specifications. Some patients are at a higher risk for bleeding (especially if they have diabetes). For these patients, it is important to provide extra delicate care in order to avoid cuts. Electric razors are always desirable over exposed blades whenever possible.
Hair care will include everything from washing a patient’s hair to helping them style it. It is important to also inspect the hair and the scalp and look for possible dryness, lesions or redness. If any of this is discovered it should be reported to the staff nurse right away.