Home > Articles > Professional Certifications

CNA Certified Nursing Assistant Exam Cram: Promotion of Function and Health of Residents

  • Print
  • + Share This
This chapter focuses on the key principles involved in providing resident care as tested on the CNA Clinical Skills Test . Topics include Personal Care Skills, Restorative Skills, Psychosocial Skills, and Recording and Reporting.
This chapter is from the book

Nearly half of the written exam (WE) contains questions about your nursing skills. This chapter focuses on the key principles involved in providing resident care, organized into the following categories:

  • Personal Care Skills
  • Restorative Skills
  • Psychosocial Skills
  • Recording and Reporting

You must also review all skills as outlined in the performance checklists in Chapter 6, “Clinical Skills Performance Checklists.” Critical steps for safe skills performance often reflect the key principles reviewed here; these critical steps must be met to successfully pass the Clinical Skills Test (CST), which tests your competencies in the following categories.

Personal Care Skills

The focus of this category is a review of direct care you provide residents on a daily basis to promote their health and well-being.

Activities of Daily Living (ADLs)

Assisting residents with activities of daily living (ADLs) is one of your primary responsibilities. The sections that follow describe the skills involved with ADLs.

Hygiene

It is important for residents to feel clean and fresh. Equally important is to keep the residents free from disease due to harmful bacteria that can enter the body through any skin break, which includes mucous membranes that line any body cavity. With aging, the skin produces less oil, which makes it dry, requiring less frequent bathing. This does not mean that a daily partial bath is not needed to freshen the mouth and perineal area (area of the body that includes the male and female genitalia and the anus). Cleanliness also removes body sweat, odors, and other secretions. Morning care (AM care) that includes washing the resident’s face and hands followed by tooth brushing or denture care before eating breakfast helps decrease harmful bacteria, maintain a pleasant appearance, and increase a sense of well-being for the resident. Hygiene care before bedtime, often called HS (hour of sleep) care, accomplishes the same goals and promotes rest and sleep. HS care also might include a back rub or other form of massage to relax the resident.

Bathing

The resident’s bath schedule as determined by the care plan might require a complete bath, shower, or a partial bath. Remember the general goals of skin care when bathing the resident, that is, to remove pathogens and promote comfort. Bathing promotes cleanliness, helps improve circulation by stimulating the muscles, provides exercise for the joints and limbs, and gives you the opportunity to inspect the resident’s skin, mobility, and other signs of health and well-being. It also provides a time for personal interaction with residents that helps increase their self-esteem.

With each type of bath, safety, security, and privacy are key considerations. Allow the resident to participate in all aspects of personal care and grooming to promote self control. Residents have taken care of themselves all of their lives and need to feel they can be independent as much as possible. Independence, decision-making, and self-control are also known as having autonomy. Feeling secure is second only to being safe from harm. Protect residents from accidents while bathing, which includes falls, and from undue exposure due to failure to provide privacy during the bathing procedure. Posting privacy signs, using a privacy curtain, or closing the door, as well as shielding the body while bathing, are all essential steps to ensure privacy.

Skin care involves keen observation of any breaks in the skin or other abnormalities that might indicate injury or disease. Keeping the skin moist but not wet, dry in the axilla (armpits) and perineum, and free from pressure are very important steps to protect the resident. Be sparing with lotions or other emollients for keeping skin supple. Avoid talcs, powders, or other products that can cake within skin folds. Areas, such as the axilla, beneath the breasts, the genitalia, buttocks, and other skin creases, are warm and moist, which can encourage bacterial growth.

A skin break can result in a pressure ulcer (also called a bedsore, or decubitus ulcer) found over any bony part, such as the tailbone (coccyx), hip, back, elbow, breasts, spine, shoulder, or the back or side of the head. The term bedsore is misleading because a pressure ulcer can occur outside of bed by prolonged sitting or any pressure on the skin that decreases the blood supply to that area. Follow the facility’s protocol for care of residents who are high risk, often evaluated according to the Braden scale, a guide used by the licensed nurse for describing the skin’s risk for breakdown. Residents who are immobile (cannot move or walk), have a poor nutrition status, or have trouble healing are considered high risk for pressure ulcers and must be observed closely for any skin breakdown. Pressure ulcers are very painful and difficult to heal, leading to other complications and misery for the resident. The best approach to bedsores is prevention. Additional steps to prevent bedsores are incorporated into personal skills such as positioning and turning the immobile resident, protecting bony prominences from undue pressure, using protective devices and equipment, and keeping the resident dry, comfortable, well nourished, and hydrated as outlined in Chapter 5, “Specialized Care.”

The following are other general principles that apply to bathing and grooming:

  • Use standard precautions for personal care.
  • Keep bathwater temperature at a safe level.
  • Use mild soaps or other cleansers per facility policy, watching for resident allergies to bath products.
  • When cleansing the body, wash from the cleanest area to the dirtiest area.
  • For the complete bed bath, change water, wash cloth, and gloves prior to bathing the lower body and extremities.
  • If assisting the resident to bathe, provide for rest so as not to overly tire the resident.
  • Avoid touching the floor with bath towels, the remote shower spray head, or other bath equipment because the floor is considered contaminated.
  • Disinfect the tub, shower, and other bath articles following the bath or shower.
  • Promptly remove soiled bath linens.
  • Report and record the bath/grooming procedure and the resident’s response.

Oral Care

Residents might need assistance with oral care, which can include brushing the resident’s teeth or denture care. Dentures are false teeth, which might replace all or part of the resident’s own teeth; they are necessary for proper eating, to retain the shape of the face, and to promote a positive self-image. Handle dentures gently by washing and rinsing them in warm (tepid) water to avoid damaging the dentures; store them in a designated container labeled with the resident’s name.

In addition to teeth brushing, keep the mouth moist and free of debris. Dry mucous membranes in the mouth encourage bad breath and skin breakdown along with tooth decay. Depending on the resident’s condition, you might need to provide oral care hourly or every two hours.

Because the comatose resident breathes through the mouth, frequent oral care is needed to help clear secretions and keep the mouth and membranes well hydrated.

Grooming

Grooming includes hair care, shaving, nail care, and eyeglasses and hearing aid care. A resident who is well-groomed feels better and has a more positive outlook and self-esteem. Grooming principles mirror those for ADLs in general regarding standard precautions, providing privacy for the resident, and encouraging the resident to participate in ADLs as much as possible, which includes making choices that will increase satisfaction and compliance with the daily care plan. Remember to dress residents appropriately and comfortably in their own clothing. Consider weather and environmental changes for each resident; make clothing adjustments accordingly to maintain a comfortable body temperature. As some residents might lose body fat, they can become chilled more easily, requiring a light wrap, sweater, or extra bed covering. Always check with the residents to determine their clothing and comfort needs.

Shaving

Shaving residents requires careful technique to avoid accidental nicking of the skin, which can create an entry for pathogens. Residents who have prolonged blood clotting for any reason might be required to shave with an electric razor. Check the resident’s care plan for directions on how to manage his shaving needs.

Nail Care

Like skin care, nail care requires careful cleansing, frequently accomplished when washing the resident’s hands. Keeping nails trimmed and clean can improve appearance while preventing injury or infection transmitted by dirty, unkempt nails. Soaking the resident’s hands and feet in warm water helps loosen debris and eases nail trimming and cuticle care.

Aging can cause the toenails to become thick and difficult to manage. Despite the need to keep nails trimmed, special consideration must be made for residents with diabetes because their toenails must be trimmed very carefully to avoid cuts on the foot that, due to poor circulation or diabetes, might not heal properly. Consult the facility’s policy for nail care required for residents with special conditions such as diabetes. Refer to Chapter 5 for more information on foot care for the diabetic resident.

Hair Care

Clean hair that is neatly combed helps improve the self-image of residents and contributes to their general well-being. Each facility has a policy for hair care, including shampooing. In some facilities, shampooing the hair might require a doctor’s order. Many residents might have their hair washed, set, and combed by a beautician who provides cosmetology services in the long-term care facility. Being sensitive to each resident’s unique grooming needs is the hallmark of effective nursing assistant practice. Consult with the resident and family to learn the best approach for hair care, realizing that not all hair can be managed in the same way by different races or cultures. Please consult with the licensed nurse when deciding the most effective approach.

Nutrition

Food is necessary for life. The fuel needed for adequate life functions comes from calories in food, defined as units of heat measurement. Caloric intake through foods gives the body the energy it needs. Elders, like younger adults, need the same kinds of nutrients, including vitamins and minerals. However, in the long-term care setting, residents must depend on care givers for their nutritional needs. Although the diet of each resident must contain a balance of proteins for cell growth and healing, carbohydrates for ready energy, and fats for fueling the cells, the caloric needs of residents vary according to their activity level and their health status. Nutrition also includes fluid intake to maintain adequate hydration needed for all cellular functions in the body, especially digestion of foods. Fluid intake is required to replace losses through perspiration, respirations, evaporation, and normal elimination. Fluid intake also helps regulate body temperature as well as the moisture in the skin and mucous membrane. Aging can affect the sense of taste, smell, and thirst, which can cause a decrease in solid food and fluid intake. Other factors can affect resident nutrition such as level of awareness, dentition, and the ability to chew properly; cultural considerations (religion, personal preferences, and family traditions); emotional well-being (depression, isolation, frustration, and anger); and the long-term care environment. If the resident’s care plan specifies a special diet, the resident might not be satisfied with the diet and refuse to follow it. This is an example of noncompliance, meaning the resident does not adhere to the diet order. Noncompliance with diet can lead to malnutrition (inadequate consumption or absorption of food) or dehydration, meaning there is not enough fluid in the body that can cause serious problems in all body systems. Edema, opposite of dehydration, occurs when there is too much fluid in the body from excessive fluid intake or from accumulation of fluid in the body tissues. Remember these factors when assisting the resident with meals, fluids, and snacks to help maintain adequate nutritional status. The following guidelines can help achieve this goal:

  • Diet permitting, offer the resident choices in the menu to encourage independence and sense of control.
  • Make mealtime as pleasant an experience as possible. If dining in the room, remove noxious odors, bedpans, urinals, and anything that could negatively affect the resident’s appetite. If eating in the dining room, seat residents together who encourage pleasant social interaction.
  • If dining alone, encourage social interaction with the resident, offering assistance as needed and conversation that helps increase resident satisfaction with the dining experience.
  • Present food as attractively as possible.
  • Keep hot foods hot and cold foods cold.
  • Offer fluids as often as possible according to the diet order.
  • Assist with feeding as needed to encourage adequate nutrition.
  • Be patient with slow eaters and praise progress as needed to help increase motivation.
  • Encourage physical activity to help improve the appetite.
  • Individualize approaches to meals that recognize cultural needs, for example, offering a Kosher diet, involving family or friends to assist with meals or feeding, praying before eating, and so on.
  • If diet permits, encourage family members or friends to bring favorite foods from home or the community that appeal to the resident.

As with other nursing skills, accurately record and report all dietary intake, including fluids. Review the I & O skill in Chapter 6, “Clinical Skills Performance Checklists,” for critical steps regarding charting meal consumption.

Toileting

Aging can affect the nervous system that controls elimination of body wastes like urine and feces (also known as stool or solid waste). The urge or need to void, or urinate (pass urine from the body) or defecate (pass feces from the body) decreases with age, often meaning that the resident is not aware of voiding or defecating until it actually happens. Decreased appetite and thirst, coupled with less food and fluid intake as well as slower digestion of foods, contribute to elimination problems. Infirmity or being unable to get to the toilet in time to avoid accidental soiling of clothing by urine or feces is not only potentially dangerous due to the increased risk of falls but also embarrassing for the resident.

Other factors might interfere with normal elimination, such as certain medications that could cause constipation or diarrhea, inactivity, pelvic muscle weakness due to aging, and nervous disorders. Small, watery leakage of stool could indicate a fecal impaction, a condition in which hard feces is trapped in the large intestine and rectum and cannot be pushed out by the resident. Diarrhea, on the other hand, results when food wastes pass too quickly through the intestine so that water is not reabsorbed adequately. This causes a watery brown liquid to be expelled, which leads to local skin irritation and a dangerous imbalance in the resident’s fluid and electrolyte status. Both conditions require immediate reporting to the licensed nurse as well as prompt intervention to prevent further complications.

Remember the following principles when assisting the resident with toileting:

  • Assisting the resident to void or defecate on a routine, timely basis to maintain normal elimination pattern and avoid accidents
  • Being alert to individual toileting needs and prepare accordingly to help prevent accidents
  • Observing standard precautions when handling urine or stool
  • Using a bedpan, urinal, or bedside commode (portable toilet), and other procedures to maintain a normal elimination schedule
  • Performing careful skin care following voiding or defecating
  • Observing, reporting, and recording excess or decreased output

Chapter 5 reviews guidelines for special care regarding elimination (for example, catheter care, ostomy care, enema procedure, and so on).

Rest, Sleep, and Comfort

Elders need as much sleep as other adults. Their ability to sleep might be influenced by the long-term care environment, especially when newly admitted, their activity level, their general state of health, and their individual habits. Naps or rest periods are essential for health and well-being and should be included in the resident’s care plan. However, excessive napping during the day can interfere with sleep as well as signaling a febrile illness or neurological complication. Residents might also awaken from sleep confused or delirious, meaning a state of agitated confusion. This situation is a sign of decreased oxygen to the brain that leads to the confusion. Report any change in consciousness (the awakened state), awareness or alertness, sleepiness for no obvious reason, and the inability to respond verbally.

Pain or discomfort can also interfere with rest and sleep. Pain might go unreported by the resident whose pain tolerance (ability to carry out activities or rest despite pain) is high or who has lost the ability to perceive pain. Likewise the resident might deny pain but act in other ways that indicate discomfort, which might include loss of appetite, refusal to participate in recreational activities, inability to sleep (insomnia), or withdrawing from social contact. Residents might also be less likely to report pain if they believe they will be labeled as complainers.

Physical signs of pain include increased pulse (tachycardia), increased respirations (tachypnea), difficulty breathing (dyspnea), and high blood pressure (hypertension). Sweating, crying, grunting, moaning, and other indicators of distress can indicate pain as well. The nurse can assess the resident’s pain on a scale of 0–5 (zero meaning no pain to a score of five, which means it hurts enough to cry). The nurse might administer an analgesic, a drug to relieve pain. If the resident receives analgesia, you must assist the nurse in observing the resident’s response to the medication, any dramatic change in the resident’s vital signs after receiving the medication, and the resident’s report of pain relief. Any abnormal reactions (known as ADEs or adverse drug effects) to analgesia can include a sudden drop in blood pressure or respirations, dyspnea (rapid breathing), a rash on the body, and emotional distress. These signs require immediate intervention, so report them immediately to the nurse. Skills related to respiratory distress or cardiac emergencies are discussed in Chapter 5. You can assist the resident to rest more comfortably by changing the resident’s position, offering diversion activities (reading, listening to music, meditation, and so on), providing a massage, and creating a quiet environment.

The following are general principles of care to promote rest and sleep:

  • Maintaining the individual resident’s routine to promote safety and security that encourages rest and sleep
  • Arranging the resident’s environment to decrease noise and confusion
  • Pacing resident activities to arrange for rest periods during the day and an effective sleep schedule
  • Using positioning devices to increase comfort
  • Offering emotional support when the resident is experiencing pain and discomfort
  • Promoting safety by keeping the bed in the lowest position; locking the wheelchair when the resident is sitting; keeping the urinal, bed pan, or bedside commode near the bed; and keeping a night light on for the resident when visiting the restroom during the night
  • Arranging care routines to encourage rest, for example, spacing ADLs, recreational activities, and visiting times
  • + Share This
  • 🔖 Save To Your Account

Pearson IT Certification Promotional Mailings & Special Offers

I would like to receive exclusive offers and hear about products from Pearson IT Certification and its family of brands. I can unsubscribe at any time.

Overview


Pearson Education, Inc., 221 River Street, Hoboken, New Jersey 07030, (Pearson) presents this site to provide information about Pearson IT Certification products and services that can be purchased through this site.

This privacy notice provides an overview of our commitment to privacy and describes how we collect, protect, use and share personal information collected through this site. Please note that other Pearson websites and online products and services have their own separate privacy policies.

Collection and Use of Information


To conduct business and deliver products and services, Pearson collects and uses personal information in several ways in connection with this site, including:

Questions and Inquiries

For inquiries and questions, we collect the inquiry or question, together with name, contact details (email address, phone number and mailing address) and any other additional information voluntarily submitted to us through a Contact Us form or an email. We use this information to address the inquiry and respond to the question.

Online Store

For orders and purchases placed through our online store on this site, we collect order details, name, institution name and address (if applicable), email address, phone number, shipping and billing addresses, credit/debit card information, shipping options and any instructions. We use this information to complete transactions, fulfill orders, communicate with individuals placing orders or visiting the online store, and for related purposes.

Surveys

Pearson may offer opportunities to provide feedback or participate in surveys, including surveys evaluating Pearson products, services or sites. Participation is voluntary. Pearson collects information requested in the survey questions and uses the information to evaluate, support, maintain and improve products, services or sites; develop new products and services; conduct educational research; and for other purposes specified in the survey.

Contests and Drawings

Occasionally, we may sponsor a contest or drawing. Participation is optional. Pearson collects name, contact information and other information specified on the entry form for the contest or drawing to conduct the contest or drawing. Pearson may collect additional personal information from the winners of a contest or drawing in order to award the prize and for tax reporting purposes, as required by law.

Newsletters

If you have elected to receive email newsletters or promotional mailings and special offers but want to unsubscribe, simply email information@informit.com.

Service Announcements

On rare occasions it is necessary to send out a strictly service related announcement. For instance, if our service is temporarily suspended for maintenance we might send users an email. Generally, users may not opt-out of these communications, though they can deactivate their account information. However, these communications are not promotional in nature.

Customer Service

We communicate with users on a regular basis to provide requested services and in regard to issues relating to their account we reply via email or phone in accordance with the users' wishes when a user submits their information through our Contact Us form.

Other Collection and Use of Information


Application and System Logs

Pearson automatically collects log data to help ensure the delivery, availability and security of this site. Log data may include technical information about how a user or visitor connected to this site, such as browser type, type of computer/device, operating system, internet service provider and IP address. We use this information for support purposes and to monitor the health of the site, identify problems, improve service, detect unauthorized access and fraudulent activity, prevent and respond to security incidents and appropriately scale computing resources.

Web Analytics

Pearson may use third party web trend analytical services, including Google Analytics, to collect visitor information, such as IP addresses, browser types, referring pages, pages visited and time spent on a particular site. While these analytical services collect and report information on an anonymous basis, they may use cookies to gather web trend information. The information gathered may enable Pearson (but not the third party web trend services) to link information with application and system log data. Pearson uses this information for system administration and to identify problems, improve service, detect unauthorized access and fraudulent activity, prevent and respond to security incidents, appropriately scale computing resources and otherwise support and deliver this site and its services.

Cookies and Related Technologies

This site uses cookies and similar technologies to personalize content, measure traffic patterns, control security, track use and access of information on this site, and provide interest-based messages and advertising. Users can manage and block the use of cookies through their browser. Disabling or blocking certain cookies may limit the functionality of this site.

Do Not Track

This site currently does not respond to Do Not Track signals.

Security


Pearson uses appropriate physical, administrative and technical security measures to protect personal information from unauthorized access, use and disclosure.

Children


This site is not directed to children under the age of 13.

Marketing


Pearson may send or direct marketing communications to users, provided that

  • Pearson will not use personal information collected or processed as a K-12 school service provider for the purpose of directed or targeted advertising.
  • Such marketing is consistent with applicable law and Pearson's legal obligations.
  • Pearson will not knowingly direct or send marketing communications to an individual who has expressed a preference not to receive marketing.
  • Where required by applicable law, express or implied consent to marketing exists and has not been withdrawn.

Pearson may provide personal information to a third party service provider on a restricted basis to provide marketing solely on behalf of Pearson or an affiliate or customer for whom Pearson is a service provider. Marketing preferences may be changed at any time.

Correcting/Updating Personal Information


If a user's personally identifiable information changes (such as your postal address or email address), we provide a way to correct or update that user's personal data provided to us. This can be done on the Account page. If a user no longer desires our service and desires to delete his or her account, please contact us at customer-service@informit.com and we will process the deletion of a user's account.

Choice/Opt-out


Users can always make an informed choice as to whether they should proceed with certain services offered by Adobe Press. If you choose to remove yourself from our mailing list(s) simply visit the following page and uncheck any communication you no longer want to receive: www.pearsonitcertification.com/u.aspx.

Sale of Personal Information


Pearson does not rent or sell personal information in exchange for any payment of money.

While Pearson does not sell personal information, as defined in Nevada law, Nevada residents may email a request for no sale of their personal information to NevadaDesignatedRequest@pearson.com.

Supplemental Privacy Statement for California Residents


California residents should read our Supplemental privacy statement for California residents in conjunction with this Privacy Notice. The Supplemental privacy statement for California residents explains Pearson's commitment to comply with California law and applies to personal information of California residents collected in connection with this site and the Services.

Sharing and Disclosure


Pearson may disclose personal information, as follows:

  • As required by law.
  • With the consent of the individual (or their parent, if the individual is a minor)
  • In response to a subpoena, court order or legal process, to the extent permitted or required by law
  • To protect the security and safety of individuals, data, assets and systems, consistent with applicable law
  • In connection the sale, joint venture or other transfer of some or all of its company or assets, subject to the provisions of this Privacy Notice
  • To investigate or address actual or suspected fraud or other illegal activities
  • To exercise its legal rights, including enforcement of the Terms of Use for this site or another contract
  • To affiliated Pearson companies and other companies and organizations who perform work for Pearson and are obligated to protect the privacy of personal information consistent with this Privacy Notice
  • To a school, organization, company or government agency, where Pearson collects or processes the personal information in a school setting or on behalf of such organization, company or government agency.

Links


This web site contains links to other sites. Please be aware that we are not responsible for the privacy practices of such other sites. We encourage our users to be aware when they leave our site and to read the privacy statements of each and every web site that collects Personal Information. This privacy statement applies solely to information collected by this web site.

Requests and Contact


Please contact us about this Privacy Notice or if you have any requests or questions relating to the privacy of your personal information.

Changes to this Privacy Notice


We may revise this Privacy Notice through an updated posting. We will identify the effective date of the revision in the posting. Often, updates are made to provide greater clarity or to comply with changes in regulatory requirements. If the updates involve material changes to the collection, protection, use or disclosure of Personal Information, Pearson will provide notice of the change through a conspicuous notice on this site or other appropriate way. Continued use of the site after the effective date of a posted revision evidences acceptance. Please contact us if you have questions or concerns about the Privacy Notice or any objection to any revisions.

Last Update: November 17, 2020