CNA

Principles of Dressing

Dressing in their own clothes promotes independence, self-esteem, and a sense of normal life. Let the resident choose clothing whenever possible, make sure clothing suits the weather and the day's activity, and check the fit, because tight clothing can cause skin breakdown.

When a resident has one weak or affected side (for example after a stroke), dress the weak side first and undress it last. Putting the weak arm or leg in first lets the stronger limb do the harder work of reaching into the second sleeve or leg, and removing the strong side first leaves slack for the weak side to come out gently.

Task	Steps
Puttingonagownorshirt	Gatherthesleeveontheaffectedside slideitontotheaffectedarmfirst bringthegarmentaround , ,
	theback guidetheunaffectedarmintoitssleeve andfastentheclosures , , .
Removingagownorshirt	Unfastentheclosures removethegarmentfromtheunaffectedarmfirst andslideitoffthe , ,
	affectedarmlast .
Puttingonpantsinbed	Slidethepantsoverthefeet(weaklegfirst)andupthelegs Havetheresidentraisethehips orroll . ,
	sidetoside topullthemoverthehips , .
Puttingonpantsinachair	Havetheresidentleanforward slidethepantsoverthefeet(weaklegfirst) helptheresiden1t , , standwithassistanceifneeded andpullthepantsup , .

Grooming

Grooming includes hair styling, applying makeup, and attending to the resident's personal appearance preferences. Respect cultural and personal preferences, and assist only as needed so the resident stays as independent as possible.

Basic Nutrition Concepts

The six classes of nutrients are carbohydrates, proteins, fats, vitamins, minerals, and water. Each serves specific functions in the body.

Nutrient	Function	SourcesandNotes
Carbohydrates	Primaryenergysource	Grains fruits vegetables andsugars Complex , , , .
		carbohydratesprovidesustainedenergyandfiber .
Proteins	Buildandrepairtissues;essentialforwoundhealing	Meat fish poultry eggs dairy legumes andnuts , , , , , ,
	andimmunefunction
Fats	Concentratedenergy;insulatethebody protect ,	Chooseunsaturatedfatsoversaturatedandtrans
	organs andhelpabsorbvitamins ,	fats
Vitamins	Regulatebodyprocesses	Water-soluble vitamins (B -complex C) must be ,
		consumed daily; fat-soluble vitamins (A D E K) are , , ,
		storedinthebody
Minerals	Supportbonehealth fluidbalance andcellfunction , ,	Calcium iron sodium potassium andothers , , , ,
Water	Essentialforeverybodyfunction	Adults need about 2 ,000–2 ,500 mL daily; needs
		increasewithfever vomiting diarrhea andwound , , ,
		drainage

Therapeutic Diets

Diet	DescriptionandUse
Regular	Norestrictions;balancednutrition
Clearliquid	Water broth gelatin clearjuices andtea Usedbeforesurgeryordiagnostictests , , , , .
Fullliquid	Allclearliquidsplusmilk creamsoups pudding andicecream Atransitiondiet , , , .
Mechanicalsoft Pureed Thickenedliquids Lowsodium	Groundorchoppedfoodsforresidentswithchewingdifficulties Foodsblendedtoasmoothconsistencyforseveredysphagia Liquidsthickenedtonectar honey orpuddingconsistencyfordysphagia , , Restrictssodiumforhypertension heartfailure andkidneydisease , ,	1

Diet	DescriptionandUse
Diabetic(carbohydratecontrolled)	Consistentcarbohydrateintaketomanagebloodsugar
Renal	Restrictsprotein sodium potassium andphosphorusforkidneydisease , , ,
Lowfat/lowcholesterol	Limitsfatintakeforcardiovasculardisease
Highprotein	Increasedproteinforwoundhealing burns andmalnutrition , ,

Assisting with Meals

Check the diet order and the resident's identification before serving any tray. Offer oral hygiene and hand washing before meals, and position the resident upright at 60–90 degrees. Check food temperature, cut food into bite-sized pieces, open containers and packages, and place the tray within reach. For a resident with impaired vision, describe where each food is located using the face of a clock.

Situation	WhattoDo
Feedingadependentresident	Sitateyelevel Offersmallbites allowenoughtimetochewandswallow andalternatesolidsand . , ,
	liquids Watchforsignsofaspiration andrecordthepercentageofthemealeaten . , .
Dysphagiaprecautions	Dysphagiaisdifficultyswallowing Signsincludecoughing choking awetorgurglyvoice . , , ,
	pocketingfoodinthecheeks drooling andrepeatedpneumonia Followthespeechtherapist's , , .
	recommendations seattheresidentuprightat90degrees usethickenedliquidsasordered give , , ,
	small bites make sure each bite is swallowed before the next and keep the resident upright for 30– , ,
	60minutesaftereating .

Measuring and Recording Intake

Record all fluids consumed in milliliters (mL). Foods that are liquid at room temperature, such as gelatin, ice cream, and popsicles, count as fluid intake. Record intake at the intervals your facility requires and report inadequate intake promptly.

Item	Volume
Cup	240mL
Cartonofmilk	240mL
Bowlofsoup	180mL
Juiceglass	120mL
Gelatin	120mL
Icecream	120mL
Popsicle	90mL

One fluid ounce equals 30 mL, so an 8-ounce cup is 240 mL. On intake and output questions, add each column separately and check your arithmetic twice before choosing an answer.

Alternative Feeding Methods

Method	CNAResponsibilities
Nasogastric(NG)tube	Passesthroughthenoseintothestomach Thenurseverifiesplacementbeforefeeding Keep . .
	theheadofthebedelevatedduringandafterfeedings .
Gastrostomy tube (G -tube)	Surgicallyplacedthroughtheabdominalwallintothestomach Keeptheinsertionsiteclean .
	anddry andreportleakage redness ordrainage , , , .
Totalparenteralnutrition(TPN)	Nutrientsdeliveredintravenously CNAsdonotadministerTPNbutobserveforandreport .
	complications .

Hydration

Adequate fluid intake is critical for every body function. Unless fluids are restricted, offer fluids frequently, provide preferred beverages when possible, and record all intake accurately.