Protecting the skin is one of the most vital roles of a CNA. To prevent pressure injuries, you must:
- Follow the repositioning plan strictly.
- Avoid dragging residents across sheets, which causes friction and shear.
- Observe for redness, swelling, or sores and report them promptly.
Oral Care and Grooming
Oral hygiene should be provided according to the resident's care plan. A common mistake to avoid involves dentures: always store them in a labeled denture container; never wrap them in tissues, as they are easily discarded by accident.
Dressing Protocols
When assisting a resident who has a weak side (due to a stroke or injury), follow this specific sequence:
- Dressing: Put clothing on the weak side first.
- Undressing: Take clothing off the strong side first.
Nutrition, Hydration, and Elimination
A resident's nutritional status is a key indicator of their overall health. You must strictly adhere to prescribed diet textures (such as pureed or mechanical soft) and fluid consistencies.
Feeding and Hydration Safety
When feeding a resident, ensure they are positioned upright to prevent choking. Offer small bites, allow plenty of time to chew, and stop immediately if you notice coughing, choking, or a "wet/gurgly" voice.
Monitor for signs of dehydration, which include:
- Dry mouth
- Dark urine
- Dizziness
- New or increased confusion.
Elimination and I&O
You may be assigned to record Intake and Output (I&O). This involves measuring and documenting all fluids consumed and all urine output. Always report blood in stool or urine, painful urination, or sudden changes in bowel/bladder habits to the nurse.
Mobility, Vital Signs, and Safety
Safe Movement and Body Mechanics
To protect yourself and the resident, always use proper body mechanics: maintain a wide base of support, bend at the hips and knees (not the waist), and avoid twisting your torso.
- Gait Belts: Use these only if you have been trained, and remember: a gait belt is for stability during transfers, never for lifting a resident.
- Restorative Care: Encourage residents to use their strength through approved range-of-motion activities to maintain independence.
Vital Signs
You are responsible for monitoring temperature, pulse, respirations, blood pressure, and oxygen saturation. When measuring blood pressure, ensure you use the correct cuff size. Always report any readings that fall outside of the facility's normal parameters to the nurse immediately.
Fall Prevention and Response
Falls are a major risk in healthcare settings. To prevent them, keep pathways clear, ensure lighting is adequate, and keep the call light within the resident's reach.
If a resident falls:
- Do not move the resident unless they are in immediate danger.
- Stay with them and call for the nurse or emergency help immediately.
- Observe their responsiveness and breathing while waiting for help.
Communication and Mental Health
Overcoming Communication Barriers
Effective communication requires adjusting your approach based on the resident's needs:
- Vision Loss: Identify yourself immediately and describe the room and any objects before touching them.
- Hearing Loss: Face the resident directly, reduce background noise, and speak clearly at a natural pace (do not shout).
- Confusion: Use short, simple statements and one instruction at a time.
Dementia and Person-Centered Care
Dementia affects memory, judgment, and orientation. Use person-centered care by maintaining familiar routines and offering limited choices to prevent overwhelm.
Critical Observation: If a resident experiences sudden confusion, do not assume it is part of their dementia. Sudden changes often signal an acute illness or infection and must be reported to the nurse immediately.
When managing behaviors, avoid arguing about a resident's mistaken beliefs. Instead, use gentle redirection and focus on their comfort and safety.
Final Study Checklist
As you prepare for your exam, ask yourself if you can:
