CNA

California
Module 8
Nursing Assistant Certification

Patient Care Skill

© August Learning Solutions, 2019

CNA
California
Section 8A
Nursing Assistant Certification

Bathing
and Medicinal Baths

© August Learning Solutions, 2019

CNA Routine Bathing
California
Nursing Assistant Certification

• The nursing assistant is responsible for:

– Routine cares in the morning and evening
– Shower, tub bath, or complete bed bath on regular basis
– Peri-care and changing incontinence garment as needed
– Cleaning up the resident if food or drink is spilled

– *Adapt bathing techniques to meet the needs and desires of the

resident*

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA Routine Bathing
California
Nursing Assistant Certification

• Scheduled showers or tub baths:

– One to two times each week in home health, assisted living,
and LTC
– As-needed basis in hospitals
– Replaces either the AM or PM partial bath on that day

© August Learning Solutions, 2019

CNA Routine Bathing
California
Nursing Assistant Certification

• While bathing resident:

– Check for red, open, or excoriated areas
– Pay special attention to skin folds, the peri-area if resident is
incontinent, and pressure areas
– Take measures to prevent spread of rashes to other areas of
the body
– Offer lotion and back massage, unless contraindicated

© August Learning Solutions, 2019

CNA Distressed Bathing
California
Nursing Assistant Certification

• Reasons for refusing bath:

– Pain
– Embarrassment
– Feeling ill or tired
– Cold
– Dementia
– Cognitive disabilities

© August Learning Solutions, 2019

CNA Distressed Bathing
California
Nursing Assistant Certification

• Interventions to ease bathing:

– Work at a pace comfortable for the resident
– Ask for assistance as needed
– Engage resident in conversation
– Offer comfort items for resident to hold
– Keep resident covered and warm
– Always ensure privacy

© August Learning Solutions, 2019

CNA Distressed Bathing
California
Nursing Assistant Certification

• Alternatives to traditional tub bath or shower:

– Complete bed bath
– Wash hair in sink or bed
– Change sequence of bathing to accommodate resident’s needs
– Use rinseless products, unless contraindicated

© August Learning Solutions, 2019

CNA Distressed Bathing
California
Nursing Assistant Certification

• Ways to ease distressed bathing:

– Stop the bath and cover resident
– Return resident to his room
– Finish bath after he has quieted
– Update nurse on incident
– Discuss future bathing options with nurse

© August Learning Solutions, 2019

CNA Rinseless Systems
California

ADVANTAGES PRODUCT TYPES

Nursing Assistant Certification

– No soap residue – Peri-cleansers

– Gentle on skin – Pre-moistened cloths
– Fast and efficient – Spray cleansers
– As effective as soap and water – Disposable shower caps
– Can reduce resident distress

© August Learning Solutions, 2019

CNA Peri-Care
California
Nursing Assistant Certification

• When performing peri-care:

– Act and speak in a professional manner
– Discourage rude jokes or remarks made by resident
– Wash from clean to dirty areas
– Avoid overexposure of resident
– Check skin for breakdown

© August Learning Solutions, 2019

CNA Peri-Care
California
Nursing Assistant Certification

• Peri-care for a female resident:

– Open labia with nondominant hand
– With soapy washcloth, start at top of labia and wash downward
toward anus
– Start at urethra and work toward outer aspect
– Wash front to back at least three times
– Wash until area is clean
– Use clean part of washcloth with each wipe
– Rinse with new washcloth, following the same steps
– Pat area dry

© August Learning Solutions, 2019

CNA Peri-Care
California
Nursing Assistant Certification

• Peri-care for a male resident:

– If resident is uncircumcised, pull foreskin back to clean head of
penis
– Wash, starting at tip of penis and moving downward to base
– Continue until penis is cleansed, using new part of washcloth with
each wipe
– Rinse in same manner, then pat dry
– Gently pull foreskin back in place
– If unable to retract foreskin, immediately inform nurse

© August Learning Solutions, 2019

CNA Peri-Care
California

• To complete peri-care:
Nursing Assistant Certification

– Have resident roll onto his or her side

– Wash buttocks with soapy washcloth
– Then wash anal area from front to back
– Use adult wipes before cleaning if feces is present
– Use clean part of washcloth with each wipe
– Wash until area is clean
– Rinse in same manner
– Gently pat buttocks and anal area dry

© August Learning Solutions, 2019

CNA Peri-Care
California
Nursing Assistant Certification

• After performing peri-care:

– Place dirty washcloths and towels on incontinence pad or
directly into linen bag
– Apply barrier cream as directed
– Place clean incontinence pad under resident
– Remember to document bowel movements at end of shift

© August Learning Solutions, 2019

CNA Bed Baths
California
Nursing Assistant Certification

• Preparing for bed bath:

– May adapt steps to resident’s needs
– Assemble supplies
– Use barrier to prepare space for supplies
– Assist resident with toileting before starting
– Fill basin with warm water
– Verify comfort of water for resident

© August Learning Solutions, 2019

CNA Bed Baths
California

• During bed bath:

Nursing Assistant Certification

– Encourage independence
– Follow infection control principles
– Avoid overexposure
– Ensure resident comfort
– Inspect skin for changes
– Protect bed linens from becoming wet
– Change water when cool, soapy, or dirty
– May use rinseless products to save time, unless contraindicated

© August Learning Solutions, 2019

CNA Bed Baths
California

• Partial bed bath:

Nursing Assistant Certification

– Completed upon rising and before resident goes to bed

– May be completed in bed or while resident is sitting on toilet

• Complete in the following order:

– Face, beginning with the eyes
– Hands
– Under breasts
– Abdominal folds
– Axillae (underarms)
– Perineal area

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA Bed Baths
California

• Perform complete bed bath in the following order:

Nursing Assistant Certification

– Face and neck

– Arms and hands
– Chest, breasts, and abdomen
– Axillae (underarms)
– Back
– Hips and legs
– Feet
– Perineal area

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA Bed Baths
California

• After bathing and grooming:

Nursing Assistant Certification

– Tidy room and put away supplies

– Empty wash water into toilet
– Rinse and dry basin
– Remove linen bag and trash bag from room

© August Learning Solutions, 2019

CNA Shower and Tub Baths
California
Nursing Assistant Certification

• Showers:
– Verify if resident’s hair is to be washed
– Ensure resident safety when getting in and out of shower
– Typically work from head to feet
– Peri-care may need to be completed at bedside
– Disinfect shower chair or bench after use

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA Shower and Tub Baths
California
Nursing Assistant Certification

• Providing comfort during shower:

– Pad shower chair
– Provide support for resident’s legs while in chair
– Use heat lamps if available
– Keep resident warm and covered
– Regulate water temperature during process

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA Shower and Tub Baths
California
Nursing Assistant Certification

• Whirlpool tub bath:

– Can provide comfort to sore muscles and joints
– Only use if relaxing to resident
– Ask resident if she wants hair washed in tub
– Ensure comfort of water
– Peri-care may need to be done at bedside
– Disinfect tub after use

© August Learning Solutions, 2019

CNA Shower and Tub Baths
California
Nursing Assistant Certification

• Types of medicinal baths:

– Epsom salts
– Pine or tar products
– Oatmeal or bran
– Sitz bath

– *Follow directives from nurse and in the care plan*

© August Learning Solutions, 2019

CNA
California
Section 8B
Nursing Assistant Certification

Dressing

© August Learning Solutions, 2019

CNA Dressing
California
Nursing Assistant Certification

• Assisting with dressing:

– Allow resident to choose clothes
– Provide at least two clothing options
– Choose matching outfit for resident if he is unable
– Ensure clothes are clean
– Check whether family or facility does resident’s laundry

© August Learning Solutions, 2019

CNA Dressing
California
Nursing Assistant Certification

• Assisting a resident with one-sided weakness:

– Support affected limb while dressing
– Place affected arm in sleeve first when putting on shirt
– Take shirt off from unaffected side first when removing
– If resident has an IV, take care not to disturb; ensure there is
no pulling or tugging

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA Dressing
California
Nursing Assistant Certification

• Assisting a resident with anti-embolism stockings:

– Commonly referred to as TED hose
– Worn to decrease risk of blood clot formation in the legs or to
decrease edema in legs and feet
– Knee-high or thigh-high styles
– Worn as ordered by physician: around the clock or during day only
– Ensure stockings are wrinkle-free once on resident
– Must be washed by hand

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA Vision and Hearing
California
Nursing Assistant Certification

• Eyeglasses care:
– Clean with eyeglass solution or warm water; dry with soft
cloth
– Ensure nosepieces are intact
– Check behind resident’s ears and bridge of nose for redness
and irritation
– Verify resident’s comfort after eyeglasses are on
– Place in safe place when not being worn

© August Learning Solutions, 2019

CNA Vision and Hearing
California

• Hearing aid care:

Nursing Assistant Certification

– Custom fit to the individual

– Make sure hearing aid is in correct ear
– Check battery before each use
– Ensure aid is clean and kept dry
– Clean with alcohol wipe or tissue
– Ask resident if volume is adequate
– May need to be cleaned with supplied brush and cleaning tools
– Store in appropriate container at night
– Keep battery compartment open when not in use

© August Learning Solutions, 2019

CNA
California
Section 8C
Nursing Assistant Certification

Oral Hygiene

© August Learning Solutions, 2019

CNA Oral Care
California
Nursing Assistant Certification

• Inadequate oral care can lead to:

– Poor overall health
– Decreased self-esteem
– Tooth decay and loss
– Poor nutritional intake
– Pain
– Embarrassment
– Increased risk of choking

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA Oral Care
California

• Assisting a resident with his own teeth:

Nursing Assistant Certification

– Brush at least twice daily

– Clean all surfaces of teeth and mouth
– Hold toothbrush at 45-degree angle for outside of teeth
– Use tip of brush for inside surfaces
– Brush tongue with back-to-front motion
– Use mouthwash before or after brushing, if appropriate for resident
– Stop brushing if bleeding occurs and update nurse
– Use oral swabs for residents unable to swish and spit

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA Oral Care
California

• Denture care:
Nursing Assistant Certification

– Ask resident to remove dentures; assist if necessary

– Remove bottom plate first
– Slide index finger to back of gum line
– Use hooked finger to remove plate
– Place removed plate in denture cup or emesis basin
– Rinse mouth with mouthwash or water
– Place barrier in sink to prevent breakage
– Brush all surfaces using toothpaste and denture brush

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA Oral Care
California
Nursing Assistant Certification

• Denture care:
– Place clean denture in resident’s mouth or in clean denture
cup
– Use denture adhesive or lip balm, if resident wishes
– Cover stored dentures with water or solution
– Denture cup and lid should be labeled with resident’s name or
room
– Check resident’s mouth daily

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA Oral Care
California

REPORT TO THE NURSE

Nursing Assistant Certification

Sores in the mouth Ill-fitting dentures

Cracked or bleeding lips White patches in the mouth

Complaints of pain Sweet- or foul-smelling breath

Missing dentures or partials Damaged or missing teeth

Refusal of oral care Bleeding in the mouth

© August Learning Solutions, 2019

CNA
California
Section 8D
Nursing Assistant Certification

Hair Care, Hair Shampoo,

Medicinal Shampoo, Nail Care,
and Shaving

© August Learning Solutions, 2019

CNA Hair Care
California
Nursing Assistant Certification

• Hair care:
– Cover resident’s eyes with washcloth while shampooing
– Use cup, pitcher, or available shower head to wash hair during tub
bath
– Hair can be washed while resident is in bed using a trough or
rinseless system
– Style hair as resident desires
– Use of facility’s beauty shop may be an option
– Use medicinal OTC shampoo as indicated on care plan

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA Nail and Foot Care
California

• Nail care:
Nursing Assistant Certification

– Done on bath day and as needed

– Soak and wash hands in basin or with soapy washcloth
– Use wedged end of orange stick to clean underneath nail
– Trim each nail as needed along natural curve
– Do not trim nails of diabetic residents
– Use emery board or file to smooth rough edges
– File in one direction only
– Approach resident with cognitive disabilities during quiet time to
prevent injury

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA Nail and Foot Care
California

• Foot care:
Nursing Assistant Certification

– Performed on bath day and as needed

– Can be relaxing activity for resident
– Wash, rinse, and dry feet in basin if not a scheduled bath day
– Trim toenails and apply lotion as needed
– Do not put lotion between toes
– Toenails may need to be trimmed by nurse or podiatrist
– Monitor skin closely

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA Nail and Foot Care
California

REPORT TO THE NURSE

Nursing Assistant Certification

Broken or cracked skin Pink or reddened heels

Cracked, split, or bleeding nails Rashes

Pressure areas on the feet Skin problems between toes

Bruises or evident trauma Nails that are too thick to cut

© August Learning Solutions, 2019

CNA Shaving
California
Nursing Assistant Certification

• Assisting with shaving:

– Use electric razor if resident is on anticoagulants
– Replace disposable razors often
– Use water and shaving cream (or soap) with disposable razors
– Shave in direction of hair growth when using a flathead or
disposable razor
– Shave in circular motion if razor has circular heads
– Do not use razor if damaged, rusty, or dull

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA Shaving
California
Nursing Assistant Certification

• Assisting with shaving:

– May need to pull skin taut
– Rinse soap or cream from skin after shaving
– Place pressure on nicks that bleed
– Report any bleeding to the nurse
– Offer aftershave or lotion after shaving
– Clean razor as needed

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA
California
Section 8E
Nursing Assistant Certification

Prosthetic Devices

© August Learning Solutions, 2019

CNA The Resident With a Prosthesis
California

• Prosthesis:
Nursing Assistant Certification

– Artificial limb or body part

– May be necessary due to disease, damage, trauma, or birth defect
– Custom-made to fit each individual

• Types of prostheses:
– Arms and legs
– Breasts—Total or partial
– Prosthetic eyes—Nonfunctioning, acrylic, and concave

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA The Resident With a Prosthesis
California

• Skin care:
Nursing Assistant Certification

– Clean skin with mild soap and water daily; rinse and dry
thoroughly
– Do not soak residual limb
– Do not apply lotions or creams, unless ordered by doctor
– Check skin at least twice daily—before putting prosthesis on and
after taking it off
– Report red, swollen, blistered, or excoriated areas to nurse
– Do not use prosthesis until irritated skin is healed

© August Learning Solutions, 2019

CNA The Resident With a Prosthesis
California
Nursing Assistant Certification

• Skin damage may occur if:

– Fit is not precise
– Resident experiences fluctuations in weight or fluid volume
– Sock or gel cushion shifts or becomes wrinkled
– Resident heals slowly or has fragile skin

© August Learning Solutions, 2019

CNA The Resident With a Prosthesis
California

• Care of prosthesis:
Nursing Assistant Certification

– Clean socket of limb prosthesis daily with mild soap and water
– Ensure socket is completely dry before use
– Report any damage to prosthesis promptly

• Care of sock/gel insert:

– Wash with soap and water daily
– Ensure it is completely dry before use
– Fit should be snug but not tight
– Should be free of wrinkles

© August Learning Solutions, 2019

CNA
California
Section 8F
Nursing Assistant Certification

Skin Care Including

Prevention of Decubitus Ulcers

© August Learning Solutions, 2019

CNA The Importance of Healthy Skin
California
Nursing Assistant Certification

• Prevention of skin breakdown helps:

– Maintain resident health
– Prevent pain
– Reduce rate of infections
– Limit healthcare costs

© August Learning Solutions, 2019

CNA Types of Skin Breakdown
California
Nursing Assistant Certification

• Rashes:
– Often caused by skin-on-skin contact
– May be result of germs or overgrowth of yeast
– Always wear gloves when bathing resident
– Take measures to prevent spread of rash
– Easiest type of skin breakdown to prevent and heal

© August Learning Solutions, 2019

CNA Types of Skin Breakdown
California
Nursing Assistant Certification

• Shearing: occurs when resident slides down in bed

• Friction: occurs during movement of one layer of skin
against another or against a surface

• Prevention:
– Limit time spent in bed with head of bed elevated
– Position resident with head of bed less than 30 degrees

© August Learning Solutions, 2019

CNA Types of Skin Breakdown
California
Nursing Assistant Certification

• Pressure injuries:
– Occur when there is constant, unrelieved pressure on bony
prominence
– Cause physical and emotional pain
– Can lead to infection or death
– Preventable
– Costly to heal
– Also known as decubitus ulcers, pressure ulcers, or bed sores

© August Learning Solutions, 2019

CNA Stages of Pressure Injuries
California

• Stage I:
Nursing Assistant Certification

– Skin is intact, is reddened or discolored, and does not blanch

– May be warm and edematous
– Resident may complain of pain or itching at site

© August Learning Solutions, 2019

CNA Stages of Pressure Injuries
California

• Stage II:
Nursing Assistant Certification

– Skin is open
– Epidermis and possibly dermis are involved
– Appears as shallow crater
– May have blister covering the area
– Can be very painful

© August Learning Solutions, 2019

CNA Stages of Pressure Injuries
California

• Stage III:
Nursing Assistant Certification

– Epidermis, dermis, and subcutaneous tissue are involved

– Eschar or tunneling may be present
– Appears as deep crater
– Can be very painful

© August Learning Solutions, 2019

CNA Stages of Pressure Injuries
California

• Stage IV:
Nursing Assistant Certification

– Epidermis, dermis, subcutaneous tissue, and supporting

structures are involved
– Eschar may be present
– Takes months to heal
– Can lead to scarring, deformity, or loss of function to affected
area

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA Stages of Pressure Injuries
California
Nursing Assistant Certification

• The nursing assistant’s responsibilities include:

– Follow care plan regarding skin care
– Monitor resident’s skin closely
– Report skin changes to nurse promptly
– Ensure resident is not on affected areas
– Apply topical creams to intact skin as directed by nurse

© August Learning Solutions, 2019

 Risk Factors for Developing Pressure
CNA Injuries
California
Nursing Assistant Certification

Immobility Incontinence

Altered level of consciousness Poor nutrition

Inability to perceive pain High microclimate

© August Learning Solutions, 2019

 Risk Factors for Developing Pressure
CNA Injuries
California
Nursing Assistant Certification

• Immobility:
– May be result of medical conditions, paralysis, or obesity
– Example: multiple sclerosis

• Inability to perceive pain:

– Residents who are comatose, confused, or have certain diseases
may not have pain sensation or are unable to react to that sensation
– Examples: diabetes, dementia

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

 Risk Factors for Developing Pressure
CNA Injuries
California

• Incontinence:
Nursing Assistant Certification

– Leads to maceration
– Increases possibility of damage to skin
– Changes skin’s pH
– Enzymes in feces break down skin

• High microclimate:
– Close environment in which heat and humidity levels are localized
– May be caused by resident remaining in bed or sitting in wheelchair for
long periods of time
– May also be result of fever

© August Learning Solutions, 2019

 Interventions for Preventing Skin
CNA Breakdown
California
Nursing Assistant Certification

• Inspection and cleanliness:

– Inspect skin at least twice daily
– Check skin folds at place of origin
– Ensure skin is washed, rinsed, and dried thoroughly
– Use soft cloths or powder to reduce skin-on-skin contact

© August Learning Solutions, 2019

 Interventions for Preventing Skin
CNA Breakdown
California
Nursing Assistant Certification

• Repositioning and turning:

– Turn residents in bed every 2 hours
– Reposition residents in wheelchair every hour
– Use pillows to keep pressure off bony prominences
– Use positioning devices when moving residents
– Encourage independent residents to move

© August Learning Solutions, 2019

 Interventions for Preventing Skin
CNA Breakdown
California

• Pressure-relieving devices:
Nursing Assistant Certification

– Specialty beds
– Alternating air mattress toppers
– Specialty mattresses
– Alternating pressure pads for wheelchair
– Specialized boots

• Positioning devices:
– Bed or wedge pillows
– Rolled bed or bath blankets

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

 Interventions for Preventing Skin
CNA Breakdown
California
Nursing Assistant Certification

• Incontinence care:
– Complete at least every 2 hours
– Use mild cleanser or peri-care product
– Pat area dry
– Apply barrier cream to intact skin
– Encourage resident to use toilet, if she is able
– Product types used include liners, briefs, and barrier creams

© August Learning Solutions, 2019

 Interventions for Preventing Skin
CNA Breakdown
California
Nursing Assistant Certification

• Nutrition and hydration:

– Encourage protein intake
– Offer extra fluids at least once a shift
– Keep fluids accessible to resident, unless contraindicated
– Encourage snacks such as ice cream, sherbet, or popsicles
– Watch for signs of dehydration

© August Learning Solutions, 2019

 Interventions for Preventing Skin
CNA Breakdown
California
Nursing Assistant Certification

• Reducing the microclimate:

– Reposition residents frequently
– Report and address fevers promptly
– Ensure resident is not heavily covered while in bed
– Use low-air-loss mattresses for those at risk of skin
breakdown

© August Learning Solutions, 2019

CNA Preventing Friction and Shearing Injuries
California
Nursing Assistant Certification

• Friction/shearing prevention device:

– Used when moving a resident upward in bed
– Can limit or eliminate shearing force with movement
– Can help prevent back injuries to staff
– Follow manufacturer’s directions
– Maintain infection control

© August Learning Solutions, 2019

CNA
California
Section 8G
Nursing Assistant Certification

Elimination Needs

© August Learning Solutions, 2019

CNA Urinary Elimination via Catheter
California
Nursing Assistant Certification

1. Urine is formed in the kidneys and travels through ureters to the bladder,
where it is stored
2. When bladder is full, nerves send signal to brain, and sphincters open
3. Urine then flows via urethra out of body

• Urinary retention:
– The inability to empty the bladder
– Can result in damage to bladder or rupture

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA Bowel Elimination
California

• Laxatives:
Nursing Assistant Certification

– Oral medication typically given after 3 days of no bowel movement

• Suppositories:
– Wax cone inserted into rectum after 4 days of no bowel movement

• Enemas:
– Injection of fluid into rectum after 5 days of no bowel movement

© August Learning Solutions, 2019

CNA Incontinence
California

• Resident care:
Nursing Assistant Certification

– Toilet client or change incontinence garment every 2 hours

– Cleanse the perineal area with adult wipes
– Apply barrier cream to intact skin
– Monitor skin integrity closely
– Allow client to sit on toilet and attempt to void if she is able
– Remain with client during toileting if she is at risk of falls
– Promptly remove soiled incontinence garments from room

© August Learning Solutions, 2019

 • Incontinence
CNA
California – Inability to control urination
or bowel movements
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA Urostomy
California
Nursing Assistant Certification

• Artificial opening in abdominal wall through which urine drains to outside

of body
• Required when bladder no longer functions due to damage or disease
• Urine is collected in bag outside of body
• Empty bag when 1/3 to 1/2 full and at end of shift
• Measure and record urinary output

© August Learning Solutions, 2019

CNA Ostomies
California

• Segment of bowel is drawn to outside of body in abdominal area

Nursing Assistant Certification

• Stool is diverted through stoma and empties into collection bag

– Colostomy—made from large intestine
– Ileostomy—made from small intestine

• Resident care:
– Empty and clean ostomy bag
– Clean stoma and surrounding area when emptying bag
– Change ostomy appliance according to facility protocol
– Chart bowel movements

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA Devices Used for Elimination
California
Nursing Assistant Certification

– Bedpans—traditional and fracture

– Commodes—can be placed at bedside for resident
– Urinals—only ones for males are commonplace
– Commode hats—placed under seat of toilet or commode; can
be used to measure output or specimen collection

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA
California
Nursing Assistant Certification

© August Learning Solutions, 2019

CNA Digestive Tract Bleeding
California

• Occult blood:
Nursing Assistant Certification

– Stool looks black and tarry

– Sticky or pasty and may smell foul
– Result of bleeding in upper part of digestive tract
• Frank blood:
– Red, obvious blood
– Result of bleeding in lower part of digestive tract
– May be due to hemorrhoids

• *Update nurse with any sign of bleeding; do not flush the toilet*

© August Learning Solutions, 2019

CNA
California
Section 8H
Nursing Assistant Certification

Bowel and Bladder Retraining

© August Learning Solutions, 2019

CNA Bowel and Bladder Retraining
California
Nursing Assistant Certification

• Bowel and bladder training:

– Initiated by the nurse and resident’s healthcare provider
– Nursing assistant reinforces education done by nurse
– Important to provide emotional support
– Document according to facility protocol

© August Learning Solutions, 2019

CNA
California
Section 8I
Nursing Assistant Certification

Weighing and Measuring

the Patient

© August Learning Solutions, 2019

CNA Height and Weight
California

• Height:
Nursing Assistant Certification

– Measured periodically throughout lifespan

– Obtained using standing scale, stadiometer, or tape measure
– May need to obtain while resident is in bed

• Weight:
– Should be measured at least once a week
– Weight typically taken daily in hospital setting
– Obtained using upright scale, wheelchair scale, mechanical lift, or
bed scale

© August Learning Solutions, 2019

[Link]

© August Learning Solutions, 2019