Assisting with Daily Living Flashcards

A resident with moderate dementia refuses to bathe, becomes agitated when approached with a washcloth, and begins striking out at the CNA. What is the most appropriate immediate action?

Answer: Stop the bath attempt, ensure the resident's safety, and document the refusal and behavior

Forcing a bath on a resident who is refusing and becoming combative violates the resident's rights and can cause physical and psychological harm. The CNA must stop, ensure safety, and document the refusal. A different approach—such as offering choices, using a different time of day, or involving a family member—should be tried later. Restraining, medicating without an order, or forcing cooperation are all inappropriate and potentially abusive.

When assisting a hemiplegic resident to dress, the CNA should put on the shirt by starting with which side, and why?

Answer: The weaker (affected) side first, to minimize painful and difficult manipulation of the impaired limb

The correct technique is 'weak side on first, strong side off first.' Dressing the weaker (affected) limb first reduces the range of motion needed for that limb and prevents overstretching or injury. When undressing, the stronger limb is removed first. This principle applies to all upper-body garments and is essential for residents with hemiplegia, hemiparesis, or joint limitations.

A CNA notices that a resident who normally feeds herself independently has begun holding food in her cheek for several minutes before chewing. Which condition does this behavior most strongly suggest, and what should the CNA do?

Answer: The resident may be experiencing dysphagia or oral motor dysfunction; report the observation to the nurse

Pocketing food (holding it in the cheek without chewing or swallowing) is a classic sign of dysphagia or oral motor dysfunction, which can lead to aspiration and aspiration pneumonia. This change from baseline is a significant clinical observation that must be reported to the nurse immediately. A speech-language pathologist evaluation may be warranted. While depression or food preferences could affect eating behavior, pocketing is specifically associated with swallowing difficulties.

A resident on a fluid restriction of 1,200 mL per day has already consumed 900 mL by 2:00 PM. The resident requests a full 8 oz (240 mL) cup of water. What is the most appropriate action?

Answer: Offer a smaller amount of fluid within the remaining allowance and inform the nurse of the resident's request

The resident has 300 mL remaining for the day (1,200 − 900 = 300 mL). Providing a full 240 mL cup would not exceed the restriction, but the CNA should offer a measured amount, document intake carefully, and notify the nurse so the care team can monitor the remaining allowance. Withholding all fluids is inappropriate and potentially harmful, and the CNA cannot unilaterally decide to override a physician-ordered restriction.

During perineal care for a female resident, the CNA should cleanse in which direction and change the washcloth or wipe with each stroke to prevent which specific complication?

Answer: Front to back, changing the cloth after each stroke, to prevent the introduction of fecal bacteria into the urinary tract

The correct technique is to cleanse front to back (from the urethral meatus toward the anal area) and use a clean area of the cloth or a fresh wipe with each stroke. This prevents fecal organisms—particularly E. coli—from being introduced into the urethra, which is the primary cause of catheter-associated and non-catheter urinary tract infections (UTIs) in female residents. Reusing the same cloth surface or wiping back to front dramatically increases UTI risk.

A CNA is assisting a resident with Parkinson's disease to ambulate. The resident suddenly freezes mid-step in the hallway. Which technique is most effective for helping the resident initiate movement again?

Answer: Cue the resident to step over an imaginary line or a visual cue on the floor, or use rhythmic auditory cues such as counting

Freezing of gait is a common and distressing symptom of Parkinson's disease. Pulling the resident can cause falls or injury. Evidence-based techniques to overcome freezing include visual cues (asking the resident to step over an imaginary line, a crack in the floor, or a laser pointer line), rhythmic auditory cues (counting 'one-two-three-step' or marching to a beat), and tactile cues. These strategies engage alternate motor pathways and can effectively break the freeze without risk of injury.