One of the main functions of CNA Patients depend on CNA for all aspects

of personal care Need to be sensitive to patient needs

and respect right to privacy Hygiene includes bathing, back

care,perineal care, oral hygiene, hair care, nail care and shaving

Promotes good hygiene habits Provides comfort Stimulates circulation Provides an excellent opportunity to

develop a good caring relationship with the patient

Complete bed bath—the CNA bathes all parts of the patient’s body and provides oral hygiene, back care, nail care and perineal care

Partial bed bath—only parts of the body are bathed

Tub bath or shower

Care of the mouth and teeth Should be administered at least 3 times

a day Proper oral hygiene prevents dental

caries, stimulates the appetite, prevents halitosis, and provides comfort

Routine oral hygiene—regular, everyday brushing and flossing

Denture care—cleaning of dentures or artificial teeth (Extreme care should be taken not to damage dentures)

Special oral hygiene—provided for the unconscious or semiconscious patient

An important aspect of personal care Patients confined to bed often have

tangles and knots in their hair Braiding long hair helps prevent tangles

and knots Brushing hair stimulates the scalp and

helps prevent scalp problems (it is important to observe the condition of the hair and scalp)

Often neglected area of personal care Nails harbor dirt which can lead to

disease and infection Do not cut nails unless you have been

instructed to do so NEVER clip toenails Learn the agency policy on nail care

Regular or electric razors may be used Will always use an electric razor on a

patient who is on anticoagulants Correct technique must be used to

avoid injury

Unless contraindicated, a back rub is given as part of the bath

It should be done every 8 hours if a patient is confined to bed

Good back rub takes 4-7 minutes Stimulates circulation Prevents pressure ulcers Leads to relaxation and comfort

Most patients prefer to wear their own gown, pajamas or clothing

If the patient has a weak or injured arm or has an IV the gown must be positioned with care

Sleeve is removed from the uninjured or untreated arm first

Sleeve of clean gown is placed on the affected arm first

Most residents in long term care wear their own clothing

It is important to help the resident as needed to choose and dress in appropriate clothing

If the resident is paralyzed always put the clothing on the affected side first and remove it from the affected side last

Used to limit movement Two kinds of restraints—chemical and physical Chemical restraints are medications that

affect patient behavior , ex-tranquilizers, sedatives

Physical restraints are protective devices that limit patient movement and are used only to protect themselves or others and when all other measures have failed

Restraints can be applied only under the order of a physician

Order must state the type of restraint, the reason for its use, the length of time it can be used, and where or when it can be used

Least restrictive device is always used first

A restraint applied unnecessarily can be considered false imprisonment

A health care worker should NEVER apply a restraint without proper authorization

Irrational or confused patients Skin conditions (to keep patient from

scratching ) Paralysis or limited muscular

coordination

Usually found on wheelchairs Used to prevent a patient from falling

out of the device Should not be applied too tightly as it

could interfere with breathing or circulation

Wrapped around an arm or leg to limit movement

Straps are then attached to the bed or stretcher

At least two fingers should be slipped between the restraint and the skin to assure it is not too tight

Used to prevent a patient from sitting up, rolling, getting out of bed or falling out of a wheelchair

Come in different sized Must be applied so that they do not

interfere with breathing or circulation

Use only when all other means of obtaining patient cooperation has failed

Restraints should be as unnoticeable to the patient as possible

Patients should be allowed as much freedom of movement as possible without danger of injury

Patient should always be informed of why restraint is being used

Circulation below a limb restraint should be checked every 15-30 min

Signs of poor circulation: paleness, cyanosis, cold skin, edema, weak or absent pulse, poor return of pink color after nail beds are blanched, patient c/o pain, numbness, or tingling

If any signs of poor circulation restraint should be removed immediately and supervisor informed

ALL restraints MUST be removed every 2 hours for at least 10 minutes

Patient should be repositioned, ROM exercises, and skin care to skin under restraint

Restraints should be removed as soon as there is adequate supervision or as soon as the danger of self-injury has passed

Physical and mental frustration—loss of freedom imposed by restraints can cause disorientation, depression, hostility, agitation or withdrawal

Impaired circulation Pressure ulcers Loss of muscle tone, stiffness, discomfort Respiratory or breathing problems

Each facility has it own rules and policies

It is your responsibility to know the rules in the facility that you work in