We perform many acts of hygiene during the day, almost without thinking about taking shower or brushing our teeth. For some residents the certified nurses’ aid might have to remember and assist with hygiene. Residents function at different levels, and should be encouraged to do as much as they can for themselves, so find out how much the resident is able to do before assisting. Some residents might just need a gentle reminder, while some might have to have procedures done entirely for them, and you are likely to see everything in between.
Tooth Brushing: Many residents will have dentures, which should be brushed with a special denture brush and denture cream or paste. Regular toothbrushes and toothpaste should not be used, because they will scratch the dentures. Dentures should be soaked overnight in denture cleaning and disinfecting solution (not mouthwash), and replaced in the morning.
Residents’ natural teeth need brushing and flossing too, and they should be cared for just as you would clean your own teeth. If the resident is able to get out of bed, he or she can use a sink. If not, then bring a toothbrush, toothpaste, emesis basin, towel, and glass of water. If the resident is unable to brush his or her own teeth, wash your hands and explain what you are going to do. Put a dab of toothpaste onto the brush and proceed to scrub and floss each tooth. Allow the resident to rinse with the water and spit it into the emesis basin. If mouthwash is used, follow the directions on the label for mixing with water.
Additional Reading: CNA Skill: Cleans upper or lower denture
Showers: Shower chairs are a good idea for even the healthiest of residents, to prevent falls. Wash your hands, explain what you are going to do, and help the resident into the shower chair. When you wash his or her face, ask the resident to hold his or her head back for rinsing so that soap and water do not flow into the person’s face. Put soap onto a washcloth and gently rub the skin, rinsing as you go to keep the soap from drying the skin. Ask the resident to wash his or her own genitalia. If this is not possible, wash the genitalia according to the earlier description on bed baths.
Additional Reading: CNA Skill:Gives modified bed bath (face & one arm, hand & underarm)
Shampooing the hair: Be sure there is an order to shampoo the resident’s hair before doing so. If the resident is unable to get out of bed, fold a bed blanket to make a trough and cover it with a plastic bag. Place your trough onto the bed with a bucket directly beneath it on the floor. Wash your hands and explain what you are going to do. Wet the resident’s hair and shampoo it, then carefully pour water over it so that the water flows onto your trough and down into the bucket. If this is done carefully, not a drop of water should fall onto the sheets. Wrap the resident’s head in a towel and dry it.
Meals: Residents with poor coordination or weak muscles will have some spills. If your resident eats in bed, place a towel onto his or her chest to catch spills, or onto the mattress if the resident is unable to sit up. Soiled sheets or clothing should be changed as soon as possible after meals.
Additional Reading: CNA SKill: Feeds client who cannot feed self
Incontinence: If you find that your resident has soiled the bed, change the sheets immediately. Urine will break down the skin, and residents tend to have thin, fragile skin. If the resident has dressings, notify the nurse. It is important that dressings be clean and dry.
Q. What oral care do you provide for patients as part of your duties as a certified nursing assistant?
A. As a nursing assistant, you will assist patients with oral care if they need help. This includes brushing a patient’s teeth and cleaning gums. There are some patients for whom you will need to clean their dentures and their gums. Oral care is a vital part of the health of patients.
Explanation: Good oral care for patients can help to prevent irritation and infections of the gums and other oral areas. When you provide oral care, you should pay careful attention to a person’s mouth to see if they have any sign of infections or sores. Any signs of a problem should be reported to your supervisor.
Q. What should a nursing assistant do if a patient soils their clothes and bed?
A. A nursing assistant should clean up a patient who has soiled their clothing. In some cases, a bed bath might be necessary. The diaper or undergarments and clothing should be changed. Linen from the bed should be removed and changed if it has become soiled. Make certain all laundry is replaced in the proper receptacle for soiled clothing.
Explanation: Every patient deserves dignity and should be cleaned and changed as fast as possible when they have become soiled. Soiled clothing and linen must be removed to prevent infection and other illnesses transferred in bodily fluids. If a patient has dressings or sores, the soiled items should be reported to the person whom is responding for their dressing or wound care, so that dressings can be changed to prevent infection.
Q. What is Perineal Care?
A. When a nursing assistant carefully cleans the rectal and genital areas of a patient, this is referred to as perineal care. This care can be provided when giving a patient a bath or shower.
Explanation: Perineal care should be provided one time at a minimum for all patients. If a patient is having problems with incontinence, it will be necessary to provide this care more than once each day. The care is intended to help reduce the risk of irritation and infection in those areas. You will be trained to provide perineal care for individuals who do not have catheters as well as those who do.
This is a collaborative effort and is thus a work in progress. Parts of this study guide are constantly being updated and improved upon.