CNA Nursing Assistant Certification Review

CNA California Nursing Assistant Certification

Module 8: Patient Care Skills

  • August Learning Solutions, 2019

Section 8A: Bathing and Medicinal Baths
Routine Bathing

  • Responsibilities of the Nursing Assistant:
      - Conduct routine cares during morning and evening
      - Provide shower, tub bath, or complete bed bath regularly
      - Perform peri-care and change incontinence garments as needed
      - Clean resident if food or drink is spilled
      - Adapt bathing techniques to meet resident's needs and desires.

  • Scheduled Showers/Tub Baths:
      - Occur one to two times weekly in home health, assisted living, and long-term care (LTC).
      - As needed in hospitals, replacing either the AM or PM partial bath on that day.

  • While Bathing the Resident:
      - Check for red, open, or excoriated areas.
      - Pay attention to skin folds, peri-area (if incontinent), and pressure areas.
      - Take measures to prevent the spread of rashes.
      - Offer lotion and back massage unless contraindicated.

Distressed Bathing

  • Reasons for Refusing a Bath:
      - Pain
      - Embarrassment
      - Feeling ill or tired
      - Cold
      - Dementia
      - Cognitive disabilities

  • Interventions to Ease Bathing:
      - Work at a comfortable pace for the resident.
      - Ask for assistance as needed.
      - Engage resident in conversation.
      - Offer comfort items for the resident to hold.
      - Keep resident covered and warm.
      - Always ensure privacy.

  • Alternatives to Traditional Tub Bath or Shower:
      - Complete bed bath.
      - Wash hair in sink or bed.
      - Change sequence of bathing to accommodate resident’s needs.
      - Use rinseless products, unless contraindicated.

  • Ways to Ease Distressed Bathing:
      - Stop the bath and cover the resident.
      - Return resident to room to finish bath after they have quieted.
      - Update the nurse on the incident.
      - Discuss future bathing options with the nurse.

Rinseless Systems

  • Advantages:
      - No soap residue.
      - Gentle on skin.
      - Fast and efficient.
      - As effective as soap and water.
      - Can reduce resident distress.

  • Product Types:
      - Peri-cleansers.
      - Pre-moistened cloths.
      - Spray cleansers.
      - Disposable shower caps.

Section 8B: Dressing
Assisting with Dressing

  • Allow resident to choose clothes; provide at least two options.

  • Choose a matching outfit if resident is unable.

  • Ensure clothes are clean and check laundry situation with family or facility.

Assisting a Resident with One-Sided Weakness:

  • Support the affected limb while dressing.

  • Place affected arm in the sleeve first for shirts.

  • Take shirt off from the unaffected side first.

  • Be cautious of IV lines to prevent pulling or tugging.

Assisting a Resident with Anti-Embolism Stockings:

  • Commonly referred to as TED hose:
      - Worn to decrease risk of blood clot formation and reduce edema in legs.
      - Available in knee-high or thigh-high styles based on physician's orders.
      - Ensure stockings are wrinkle-free after application and wash by hand.

Section 8C: Oral Hygiene
Importance of Oral Care

  • Inadequate oral care can lead to:
      - Poor overall health.
      - Decreased self-esteem.
      - Tooth decay and loss.
      - Poor nutritional intake.
      - Pain and embarrassment.
      - Increased risk of choking.

Assisting with Oral Hygiene:

  • Brush teeth at least twice daily and clean all surfaces of teeth.

  • Hold toothbrush at a 45-degree angle for the outside of teeth.

  • Use the tip of the brush for the inside surfaces and brush the tongue back to front.

  • Use mouthwash before or after brushing if appropriate for the resident.

  • If bleeding occurs, stop brushing and update the nurse.

  • Use oral swabs for non-compliant residents.

Denture Care:

  • Ask resident to remove dentures, providing assistance if necessary.

  • Remove bottom plate first, sliding the index finger to the back of the gum line.

  • Brush all surfaces with toothpaste and denture brush.

  • Place clean denture in the resident’s mouth or in a clean denture cup.

  • Label denture cup and lid with the resident’s name or room.

Signs to Report to the Nurse:

  • Sores in the mouth, ill-fitting dentures, complaints of pain, and bleeding.

  • Monitor for cracked or bleeding lips, sweet or foul-smelling breath.

Section 8D: Hair Care, Nail Care, and Shaving
Hair Care:

  • Cover resident’s eyes with a washcloth while shampooing.

  • Use a cup, pitcher, or available shower head to wash hair.

  • Hair can be washed from bed using a rinseless system.

  • Style hair as desired and consider facility’s beauty shop options.

Nail and Foot Care:

  • Nail care should be performed on bath day and as needed.

  • Soak and wash with a soapy washcloth.

  • Use wedged end of an orange stick to clean underneath the nail.

  • Do not trim nails of diabetic residents.

  • Trim toenails as needed and apply lotion, avoiding application between toes.

  • Report broken, cracked, or damaged nails and skin problems to the nurse.

Shaving:

  • Use an electric razor for residents on anticoagulants, and disposable razors should be replaced frequently.

  • Shave in the direction of hair growth with flathead razors and circular motion with circular-head razors.

  • Clean skin after shaving, apply aftershave or lotion, and report any bleeding.

Section 8E: Prosthetic Devices
Understanding Prosthesis:

  • Definition: Artificial limb or body part, necessary due to disease, trauma, damage, or birth defect.

  • Types of prostheses include:
      - Limb prostheses (arms and legs).
      - Breast prostheses (total or partial).
      - Prosthetic eyes (nonfunctioning, acrylic, and concave).

Skin Care with Prosthetics:

  • Clean skin daily with mild soap and water, rinse and dry thoroughly.

  • Do not soak a residual limb; lotions or creams should only be applied when directed by a physician.

  • Check skin condition before and after prosthesis use, reporting any irritation to the nurse.

Complications due to Improper Fit:

  • Can lead to skin damage from improper fit, weight fluctuations, or wrinkled cushions.

  • Regular cleaning of the prosthesis socket and accessories is essential for proper hygiene.

Section 8F: Skin Care Including Prevention of Decubitus Ulcers
Importance of Healthy Skin:

  • Preventing skin breakdown helps maintain resident health, reduce pain, limit infections, and lower healthcare costs.

Types of Skin Breakdown:

  • Rashes: Often due to skin-on-skin contact, requiring care to prevent spread.

  • Shearing: Caused by sliding in bed; can lead to damage.

  • Friction: Occurs from skin movement against surfaces; requires measures to reduce contact.

  • Pressure Injuries: Constant pressure results in ulcers; very painful and preventable.

Stages of Pressure Injuries:

  1. Stage I: Intact skin, reddened but does not blanch.

  2. Stage II: Open skin, may appear as a shallow crater.

  3. Stage III: Involves deep tissue, eschar or tunneling may be present.

  4. Stage IV: Severely damaged, involving deep tissues and structures; takes months to heal and can lead to significant complications.

Responsibilities of Nursing Assistants:

  • Monitor skin closely, report changes, and apply topical creams as directed. Follow the care plan for skin integrity.

Section 8G: Elimination Needs
Urinary Elimination via Catheter:

  1. Urine is formed in kidneys, travels through ureters to bladder.

  2. Nerves signal brain when bladder is full; sphincters open, allowing urine to flow via urethra.

  3. Urinary retention: inability to completely empty the bladder, risking damage or rupture.

Bowel Elimination:

  • Medications: Laxatives (after 3 days without bowel movement), suppositories (after 4 days), enemas (after 5 days).

Incontinence Management:

  • Change incontinence garments every 2 hours and maintain cleanliness. Monitor skin integrity and assist in toileting as needed.

Urostomy Care:

  • Care for the stoma where urine drains outside; clean and empty collection bag routine and record output.

Section 8H: Bowel and Bladder Retraining
Training Protocol:

  • Initiated by healthcare providers; nursing assistant provides support.

  • Emotional support is crucial, and proper documentation is required.

Section 81: Weighing and Measuring the Patient
Height and Weight Measurement:

  • Height: Measured periodically, utilizing appropriate tools based on patient capabilities.

  • Weight: Ideal to measure weekly or daily in certain settings; various scales utilized based on patient mobility issues.

Note: All assessment information should be documented according to facility protocols. Ensure patient safety and comfort throughout all processes conducted in nursing assistance.