CNA Unit 10, 11, and 19 Review

+ Unit 12

Chewing and swallowing may be affected by

• missing teeth, poorly fitting dentures

• loss of muscle control

mouth

digestion begins

Esophagus

• tube from pharynx to stomach

• peristalsis

stomach

• gastric juice

• kills microorganisms w/ acid

• food remains for ap. 3 hrs

ileum (small intestine)

absorption of nutrients and medications

colon (large intestine)

absorption of water and produces feces

peristalsis

food going down the GI track w/ use of enzymes

GI primary functions

• peristalsis

• absorbing nutrients into blood

• extracting solid waste

regular bowel elimination

3x a day to every 3 days

emesis

food going up

belching

gas being released through mouth

flatus

gas being released through anus (farts)

rectum

end of ileum; stores poop

anus

opening

factors that affect resident’s nutrition/hydration status

• less appetite

• lack of motor control

• tiredness

• medication affecting taste and absorption of food

Dysphagia

difficulty swallowing

CNA role in nutrition and fluids

• Respect religious and cultural beliefs

• accommodate food and food habits

• Encourage independent eating

• report and record observations to the nurse

How CNAs job in safe nutrition

• position in High-Fowler’s Position

• hand-wash both resident’s and your own hands

• wear gloves is mouth secretes when eating

• promote independent eating

• sit and feed at eye level

• observe and report management of food

How to Promote safe fluid intake

• monitor fluid intake both at and in between meals

• nurse will provide fluid restriction

Prepping Resident for food intake

• verbal and non-verbal cues

• dress and groom properly

• assist w/ washing hands

• upright posture, head slightly forward and aligned

• High Fowler’s

• clothing protector > bib; language

Recording food intake

• done after meal or snack

• recorded as fraction or %

• follow facility recording policies

Weighing Resident

• weight at same time of day in same clothing

• compare weight to previous weight, report to nurse

Infection control practice

• wash own hands and resident’s hands

• clean surface

• 0 blowing on food

• safe temperature

• wear gloves if secretions

How to promote independent eating

• offer least amount of assistance first, then go up if needed

• verbal and non-verbal cues

• give plate guard, adopted spoon, capped sprout cap, etc. if needed

How to assist feeding resident (if unable to feed themselves)

• sit at eye level

• allow thorough chewing

• identify and cue food

• coughing → stop feeding and provide drink

• vomiting → comfort and request to clean

• mouth weakness → observe retention of food

How to assist nutrition with dysphagia

• High- Fowler’s

• smaller amounts

• allow time to swallow

• Food thickeners (if part of care plan)

Aspiration

food and liquid intake in lungs

Regular diet

2000 cal, 30% cal from fat, 3000 mg of sodium/day

Mechanical soft diet

• Resident with difficulty chewing or swallowing

• easy to chew and swallow

• fruit and veggies finely chopped

• e.g. pasta, bread, tender meats

Pureed Diet

• Resident with difficulty chewing or swallowing

• soft and smooth texture

• e.g. hummus, jam

Liquid diet

• resident preparing for diagnostic test or after surgery, or upset stomach

• clear and full liquids + milk based

• anything that melts in body temp

Low concentrated diet (diabetic diet)

• residents with diabetes

• balanced w/ insulin to avoid hypertension

• Encouraged to eat all meals and snacks provided

• food with simple/natural sugars e.g. fruits, vegetables, fiber

No added salt diet

• resident with kidney disease or fluid retention

• 0 additional salts

• alternative seasoning or salt substitute used

No added fat diet

• resident with difficulty digesting fat/ elevated cholestorol

• removes high fat foods like bacon or butter

• uses alternatives such as skim milk

Low calorie diet

• resident that needs to lose weight or has low energy needs

• low calorie food in small servings

High calorie diet

• resident with high energy needs

• foods with higher calories e.g. milk butter, cream, liquid supplements and shakes

Reason for recording inputs and outputs

• monitors medical treatment

• used by physicians to diagnose medications

Measuring fluid intake

• mL

• measure liquids and any foods that turn into liquid at body temp

• IV and tube feeding are ONLY for nurses to measure

When to record fluid intakes?

• at the end of every meal and snack

• when bedside water is refilled

• total the amount at end of 24 hour period

NPO

Nothing by mouth

How to record fluid output

• measure urine or emesis w/ measuring cup

• record measurement with each urination

• urinary catheter: drainage bag

• if urine is unusual, immediately notify nurse; DONT flush down toilet

• look for skin redness or irritation

How to assist resident with elimination?

• close privacy curtain or door

• understand toileting habits

• stay by their side

• upright position

• check in in at least 10 minutes and assist at 20 min unless directed otherwise

• cover commode bucket when carrying to toilet

consequences of incontinence

• discomfort and embarrassment

• skin breakdown if urine remains in contact with skin; skin must be clean and dry

check and change

checking resident for incontinence regularly if they have history with being unable to control urine

IV infusions

nutrients administered to resident via needle to vein

When observing/caring patient with an IV tube

• protect tube when changing, bed turning, and walking

• observe drips or possible blood backflow

• observe pump

• observe redness or irritation

• don’t connect or disconnect tube; notify nurse instead

Tube feedings

nutrients administered to resident via feeding tube (NBO)

When observing/ caring for patient with feeding tube

• Fowler’s Position

• protect tube from pressure or kinks

• continue to provide oral care

• observe for aspiration or symptoms of nausea or vomiting

CNA’s role for fluid intake in general

• understand nuitrition and hydration goals in care plan

• protect tubes

• keep infusion site dry when bathing

• notify nurse for problems; Don’t try to fix it

Urinary catheters

• alternative urinary elimination instead of toilets or bedpan

• tube inserted through urethra to bladder

• held in place via balloon

• urine flows through tube and into collection bag

• goal is to restore normal bladder function

How to empty drainage bag

• empty every 8 hours/ facility policy

• empty urine into measuring cup

• measure and record output

• dispose in toilet

When observing/caring for resident with urinary cathater

• must be light yellow, clear, and odorless; if not notify nurse immediately

• any redness or irritation

• verbal or nonverbal signs of pain

External cathater

• for males

• wash and dry penis

• roll on, leave 1 in at tip

• apply tape in spiral pattern; not too tight or loose

• reapply daily or when leaking

colostomy

opening in large intestine to expense bowel movement

ileostomy

opening in small intestine to expense bowel movement

ostomy

surgical opening in body strcuture

CNA’s job for a resident who has colostomy

• change colostomy pouch

• empty in toilet (if reusable)

• remove and reapply if leaking (directed by nurse)

• clean and dry stoma

• encourage resident to partake in colostomy care

causes of inconstinence

• disease/injury, e.g. multiple sclerosis, paralysis, etc.

• impaired mobility

• disorientation

Reasons for promoting bladder and bowel continence

• restore dignity and self respect

• prevent other health problems

• restore normal function

Bowel incontinence management

bowel elimination via medication

Voiding assistance program

prompting the need to pee by recognizing bladder fullness

Habit training program

recording resident’s voiding pattern and strengthening a habit

Bladder retraining

regain voiding control

Scheduled voiding

going to toilet at intervals

CNA’s role in toileting assisting program

records progress and info for a development plan