Activities of Daily Living Study Guide for the CNA

General Information

The Certified Nursing Assistant (CNA) has many roles. One of the most important roles is to assist clients with activities of daily living (often referred to as ADLs). ADLs are simple activities that most of us do every day—feeding, toileting, bathing, and ambulating, among others—but for many clients, these activities may present a unique challenge. The nursing assistant is responsible for knowing the best way to assist the clients with these tasks so they are done attentively, efficiently, and safely.

Feeding

Many clients may need help with opening food packages or getting settled with their meals, and sometimes clients are unable to feed themselves at all. To assist a client at mealtime, here are some important guidelines:

• Wash your hands before you begin feeding.

• Sit at eye level and protect the client’s clothing.

• Use a spoon to deliver bites and ensure the client has completely chewed and swallowed the first mouthful before offering another.

• Offer fluid after every three to four bites of food.

• Try to interact with the client while feeding him to make mealtime a more personal, interactive experience.

• Encourage the client to complete their meal, but do not force them to eat if they refuse or become too full.

• If the client has problems with the meal or refuses it outright, inform the nurse in charge.

Mobility and Toileting

Clients who have limited mobility may need to use a bedside commode or bedpan to go to the bathroom. When assisting in this capacity, these are important things to remember:

• If the client uses a commode, ensure that it is locked and as close to the client as possible to minimize fall risks.

• Have items you may need, such as toilet paper, close by before you help the client to transfer.

• Allow for privacy, if possible, but leave the client alone only if it is safe to do so.

• If the client needs a bed or fracture pan, place a protective pad under the client to protect their bed linens. If able, have the client roll to one side, place the pan under his buttocks, and raise the head of the bed up so the client is in a more natural “seated” position. When the client is finished, lower the head of the bed, remove the bedpan, and cleanse and dry the perineal area.

• No matter how you are assisting the client to toilet, never compromise safety and keep the client’s dignity and privacy in mind at all times.

Immobility and Hygiene

Immobile clients are often given daily bed baths to keep them clean. Several brands of bathing wipes and waterless shampoos, which your facility may use for cleansing immobile clients, are available, but many places still rely on regular soap and water. To give a partial bed bath:

• Ensure that the water is at a comfortable temperature.

• Expose only the area of the client you are cleaning, and dry it immediately after with a clean towel.

• Wash the face only with a wet washcloth. Using only the clean part of the washcloth for each eye, wipe eyes from the inner to the outer canthus.

• Wash the rest of the body using a small amount of soap on the washcloth. Turn the client on his side to wash his back and the back of his extremities.

• When finished, apply warm lotion to the skin and offer fresh clothes and a gown.

• Always be on the lookout for signs of skin breakdown as you bathe your client and report any suspicious findings to the nurse immediately.

Assisting with Ambulation

Different clients need different levels of ambulation assistance. A gait-transfer belt is a common assistive device to help safely move clients from one spot to another. To use the belt:

• Fasten the belt securely around the client’s waist and stand directly in front of the client with your legs slightly apart.

• Hold the gait belt with both of your hands, and help the client to a standing position so his feet are positioned in between yours.

• When the client is steady, move one of your hands to the side of the gait belt and another to the back. Walk with the client while holding the belt in this position, either at his side or slightly behind him.

• If the client begins to fall, do not attempt to prevent the fall or catch him with your hands. Instead, bend your knees and slowly lower the client to the floor, protecting the head from injury and allowing the client to rest his body against your leg. Call for assistance and stay with the client; do not attempt to move him as this may cause further injury.

Range of Motion Exercises

Another type of ambulation CNAs frequently assist with is range of motion exercises. To perform range of motion exercises:

• The client should be lying comfortably supine, that is, flat on his back.

• Begin by smoothly rotating each shoulder, and then moving it toward and away from the client’s body—adducting and abducting.

• Support the wrist and elbow, and flex and extend the lower arms.

• Rotate the wrists and flex and extend each hand, finger, and thumb.

• Next, support the foot and ankle and flex each leg by bending the knees.

• Adduct, abduct, and rotate the legs at the hip.

• Support the foot at the instep and rotate, flex, and extend each foot at the ankle, and then flex and extend the toes.

• Never force or tug on any extremity that seems stiff or does not want to move.

• Report any unusual findings to the client’s nurse immediately.