Activities of Daily Living Study Guide for the CNA

General Information

As a Certified Nursing Assistant (CNA), you play a crucial role in supporting clients with their activities of daily living (ADLs). These tasks not only maintain clients’ physical health but also contribute significantly to their emotional well-being and dignity. From feeding to assisting with ambulation, each action requires a careful, respectful approach to meet each client’s individual needs. This study guide provides a thorough overview of the key ADLs to help you prepare for your CNA responsibilities and ensure the highest standard of care.

Feeding and Nutrition

Proper nutrition and hydration are fundamental to a client’s overall health. CNAs play a pivotal role in ensuring clients receive appropriate nutrition, especially when they need assistance with feeding.

Feeding Assistance

When assisting with feeding, begin by washing your hands to maintain a sterile environment. Check the meal tray against the client’s dietary restrictions and preferences. This is especially important for clients on specific diets, such as those who require food of a particular texture to prevent choking or aspiration.

Assess the client’s needs. Determine the level of assistance required. Some clients may only need help with opening containers or cutting food, while others might need full assistance. Encourage the client to participate as much as possible to promote independence.
Ensure safe feeding. Sit at the client’s eye level, ensuring they are in an upright position to aid swallowing. Offer small, manageable bites and sips, and allow the client to dictate the pace. Always be vigilant for signs of difficulty swallowing or choking. Keep the interaction engaging by informing the client about each type of food being offered and allowing them to make choices about what they want to eat.
Monitor intake. Throughout the meal, monitor the client’s intake and document any refusal to eat or drink. This information is critical for the care team to assess the client’s nutritional status.
Conclude the meal. After feeding, clean the client’s hands and mouth area, reposition them comfortably, and ensure they remain upright for a while to aid digestion and prevent aspiration.

Therapeutic Diets

Understanding therapeutic diets is essential. Some clients may be on a low-sodium diet to manage hypertension, a diabetic diet to regulate blood sugar levels, or a pureed diet if they have difficulty swallowing. Familiarize yourself with each client’s specific dietary needs and the reasons behind them to provide safe and effective care.

Addressing Nutritional Challenges

preventing aspiration—Always position clients upright during and after meals. For those with swallowing difficulties, use thickened liquids and modified food textures as prescribed. Educate clients and their families about safe eating practices to minimize the risk of aspiration.
combating dehydration—Dehydration is a common risk, especially in older adults. Encourage regular fluid intake and monitor for signs of dehydration, such as dry mouth, reduced urine output, and lethargy. For clients with restrictions on oral intake (NPO), ensure they receive adequate hydration through other means as prescribed.
managing malnutrition—Be attentive to the client’s eating habits and appetite. If you notice changes such as weight loss or refusal to eat, report these observations promptly. Providing meals that are both nutritious and appealing can help prevent malnutrition.

Personal Hygiene and Grooming

Maintaining good personal hygiene is vital for client health and dignity. Regular hygiene care prevents infections, promotes comfort, and enhances a client’s sense of well-being.

Bed Baths

For bedridden clients, bed baths are essential. Before beginning, gather all necessary supplies, such as a basin of warm water, soap, washcloths, and a bath blanket. Explain the procedure to the client to alleviate any anxiety. The bath should start with the face and move down the body, covering one area at a time to maintain warmth and privacy. Be mindful of skin conditions, and report any abnormalities, such as redness or sores, to the nursing staff. Thorough drying after the bath is crucial to prevent skin breakdown, especially in areas where moisture can accumulate, such as skin folds.

Perineal Care

Perineal care is sensitive and requires a respectful approach to maintain the client’s dignity. Always clean from front to back to reduce the risk of infection. Pay special attention to clients who are incontinent or postpartum, as they may require more frequent care. Use gentle, thorough cleaning techniques, and be sure to dry the area completely to prevent skin irritation and breakdown.

Oral and Denture Care

Oral hygiene is crucial for preventing infections and maintaining comfort. For clients unable to perform oral care independently, assist with brushing their teeth, be sure to clean all surfaces and the tongue. For those with dentures, remove and clean the dentures with a denture brush and mild cleanser. To maintain their shape, always store dentures in a soaking solution or water when not in use. Monitor the mouth for signs of sores, infections, or discomfort, and report any concerns to the nursing staff.

Assisting with Toileting and Incontinence Care

Helping clients with toileting is an important aspect of maintaining their dignity and hygiene.

Bedpan Use

When assisting with a bedpan, ensure privacy by closing curtains or doors. Explain the procedure and position the client properly to prevent spills. Once the client is finished, clean the perineal area from front to back to reduce the risk of infection. Dispose of the waste appropriately and sanitize the bedpan. Document the client’s output and note any abnormalities, such as changes in color or consistency, which could indicate health issues.

Changing an Adult Diaper

Changing an adult diaper requires sensitivity and adherence to infection control practices. Gather supplies, including a clean diaper, wipes, and barrier cream if necessary. After informing the client and ensuring privacy, carefully remove the soiled diaper and clean the genital and anal areas thoroughly, wiping from front to back. Apply barrier cream to protect the skin if the client is prone to rashes. Secure the clean diaper comfortably and document the change, noting any skin abnormalities.

Catheter Care

Catheter care is essential for preventing urinary tract infections and maintaining client comfort. Clean around the catheter entry site daily and after any bowel movements. For female clients, clean from front to back. For male clients, use a circular motion, and if uncircumcised, retract and replace the foreskin gently during cleaning. Always monitor for signs of infection, such as redness, swelling, or discharge, and report any concerns immediately.

Promoting Comfort and Sleep

A comfortable environment and proper sleep are crucial for the healing and well-being of clients.

Creating a Comfortable Sleeping Environment

Ensure the client’s room is conducive to sleep by maintaining a comfortable temperature, reducing noise and light, and using suitable bedding. The mattress and pillows should provide proper support, and any specialized equipment like positioning aids should be in place to enhance comfort and prevent pressure ulcers.

Establishing a Bedtime Routine

A consistent bedtime routine helps regulate the client’s sleep-wake cycle. Encourage relaxing activities before bed, such as reading or listening to soft music, and avoid disturbances during sleep hours. Address individual needs such as pain management, toileting, or anxiety that may interfere with rest, and communicate any issues to the nursing staff for proper intervention.

Making a Client’s Bed

Proper bed-making is key to client comfort and skin integrity. For an unoccupied bed, use clean, wrinkle-free linens to prevent discomfort and pressure sores. When making an occupied bed, work carefully and gently, ensuring the client’s safety and comfort throughout the process. Use proper body mechanics to avoid strain, and always ensure the client has a clean and comfortable surface to lie on.

Dressing and Ambulation

Assisting clients with dressing and mobility helps maintain their independence and promotes physical and psychological well-being.

Dressing the Client

When dressing a client, especially one with a weak arm, begin by gathering loose-fitting clothing that is easy to put on. Dress the weak arm first to minimize discomfort, and encourage the client to assist as much as possible with the stronger arm. This promotes independence and preserves the client’s dignity. Be patient and gentle throughout the process, and provide privacy by closing doors or using curtains.

Assisting with Ambulation

Ambulation is important for maintaining muscle strength, balance, and circulation. Before assisting, assess the client’s physical condition and any equipment needed, such as a walker or cane. Ensure the environment is free of obstacles, and the client is wearing non-slip shoes. Use a gait belt for support and stand slightly behind and to the client’s side. Encourage independence by allowing the client to set the pace and monitor for signs of fatigue or discomfort. Assist with the proper use of assistive devices, ensuring they are at the correct height and used safely.