HOW TO PROVIDE FOR AND RESPOND TO A CLIENT S DAILY LIVING NEEDS INTRODUCTION. Providing for and responding to a client s daily needs is one of the

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1 HOW TO PROVIDE FOR AND RESPOND TO A CLIENT S DAILY LIVING NEEDS INTRODUCTION Providing for and responding to a client s daily needs is one of the most important functions performed by Certified Nursing Assistants (CNAs) and Home Aides. These needs may be simple or they can be complicated; for example, some clients only require a little help with dressing while others cannot do any activities of daily living without your assistance. But every one of your clients will require some help in performing self-care, and you are expected to be able to determine what their daily needs are and to ensure these needs are met. STATEMENT OF PURPOSE This course will provide CNAs and Health Aides with the information they need to make an assessment of a client s daily needs and to help a client with her/his needs in the areas of personal hygiene, eating and nutrition, self-administration of medications, and safety. ASSESSMENT The first step in helping clients with their daily needs is to identify their needs by performing an assessment. A helpful way to do your assessment is to use Maslow s hierarchy of needs. Abraham Maslow was a psychologist and he felt that human needs could be viewed as a continuum from simple to complex. There are basic needs for health and survival, there are more sophisticated cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com 1

2 emotional and psychological needs, and the higher needs such as a need for love and companionship cannot be satisfied if basic needs for food, shelter, and sleep are unfulfilled. Maslow s hierarchy of needs is illustrated in Table 1. It is a useful framework for organizing a client assessment, but it has been changed a bit here; separate categories of self-care and psychological care have been added and several of Maslow s original categories have been removed. Assessments for home care clients and clients in a healthcare facility will differ. It is assumed here the experienced CNA can identify problems specific to age groups, particularly the elderly. Table 1: The Hierarchy of Needs Physiological Needs Self-Care Safety and Security Psychological Needs Social Needs 1. Assessment of physiological needs should begin with measurement of temperature, pulse, respirations, and blood pressure. This assesses the client s physiological stability and identifies any deficits that should be addressed. The next step is a basic assessment of the client s neurological status. Following that, in the order that you decide is best, assess the client s nutritional and fluid status; any problems with cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com 2

3 elimination, and; the adequacy of the client s sleep pattern. You should find out what medical problems the client has, what prescription and (if applicable) over-the-counter medications she/he takes, and what therapies the client is currently receiving. 2. An assessment of self-care should include your evaluation of how well the client can perform these activities of daily living: ambulating, bathing/self-hygiene, dressing, eating, and if applicable, medication self-administration. 3. Assessing client safety and security is closely aligned with the physiological needs. Environmental safety and security are big concerns if the client lives at home or if a hospitalized client is confused and disoriented. If you are providing home care you should find out what emergency resources are available to the client and if he/she knows how to use them. For example, does the client have her/his physician s telephone number close at hand, are the telephone numbers for poison control, the pharmacy, and a close relative easily found? How competent is the patient at taking his/her prescription medications? Can he/she cope with a basic medical emergency? If you are working with a home care client find out what medical problems the client has and how well she/he cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com 3

4 understands them. This last point is especially important if a client has chronic diseases that require self-care, diseases such as diabetes, heart disease, chronic obstructive pulmonary disease (COPD), heart disease, or hypertension. The topic of safety will be discussed in more detail later in the module. 4. The psychological needs assessment would include knowledge of the client s need for emotional support, any chronic psychiatric problems the client has, and what psychological issues the client identifies as important. 5. Social needs vary from person to person. The simplest way to determine a client s social needs is to ask him/her what these needs are. It can be difficult asking personal questions so observing is a better way to start. Does the client seem lonely? Does he/she seem to be satisfied with the current level of social contact? When the client is interacting with others do the interactions seem satisfying? Considering all of this information can make an assessment seem very complicated. But an assessment can be done quickly and efficiently if you remember three points. cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com 4

5 First, the entire assessment does not have to be done at one time. Second, a lot of the information you need can be found in a client s chart. Third, if you re-read those five assessment areas you will see that an experienced CNA can easily evaluate a client s physiological needs, need for safety and security, and the other areas that were mentioned. PROVIDING FOR YOUR CLIENTS SELF-CARE NEEDS In this section it is assumed that you are working in a heath care setting and your client is a 67-year-old man who recently had a cerebrovascular accident (CVA, aka a stroke). Your assessment indicates that your client cannot perform many selfcare activities. He is fully awake and oriented and can speak but he is weak and uncoordinated and cannot walk or stand unassisted. In addition, the stroke has affected his gag reflex and swallowing food and liquids puts him at risk for aspiration. You will have to bath him and perform oral hygiene care; assist with eating; help him with elimination; help him dress, and; within the limits established his physician, assist him with ambulation. PERSONAL HYGIENE NEEDS Personal hygiene should be performed every day and some clients will need attention to personal hygiene and skin care several times during the course of a day. Personal hygiene has many beneficial effects. It cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com 5

6 helps the client relax, it eliminates and prevents body odors, prevents skin breakdown, and stimulates circulation. In addition, being clean and having good personal hygiene also promotes dignity and selfrespect. The personal hygiene needs discussed in this module are bathing, elimination, and oral hygiene. Bathing Assisting a client with bathing is one of the primary responsibilities of CNAs. Many of your clients (and the client discussed in this module) are susceptible to skin breakdown and bathing is a good time for doing a skin assessment. Carefully and systematically inspect at the patient s skin. Normal skin should be intact (no open areas) and there should be no bruises. Look for swelling, especially in the ankles, feet, and hands. The elbows, the back of the head, the heels, the hips, and the area at the base of the spine should be inspected for redness; this is the first sign of a pressure ulcer. This last point is most important in patients who are immobile, but the elderly patient who has thinner skin and is perhaps less active should be have these areas periodically examined, as well. If the patient has diabetes, pay special attention to the ankles, feet and the areas around the toenails. Poor circulation and nerve damage are common complications of diabetes, and diabetic patients can easily cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com 6

7 develop ulcers and infections in their ankles, feet, and nail beds of the toes. If the patient has diabetes and there are any signs of infection in the ankles, feet, or nail beds around the toes notify your supervisor. This client will need a complete bed bath. This is not a complicated procedure but it is better for the client if you do it efficiently. Wash your hands and put on disposable gloves. Identify the client by checking the name band. Protect his privacy: close the door or draw the curtains around the bed. Position the bed so that the client is lying flat, if this is allowed. Some clients patients need to have the head the bed elevated and some cannot tolerate lying flat. Assess each situation individually. Remove the client s clothing and jewelry. Place the jewelry in a safe place. Removing the jewelry will prevent it from catching on the washcloth, which could injure the patient or damage the jewelry. Assess the condition of the client s skin. Pay special attention to areas that are susceptible to pressure ulcers, eg, the heels, elbows, shoulder blades, hips, and buttocks. cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com 7

8 Use warm, not hot water. The best temperature is 115 F, 46.1 C. Use a lower temperature if the client finds 115 /46.1 too warm. Place an absorbent blanket or disposable pads underneath the client. Wash, rinse, and dry the body in sections. Start at the face and head and move down. Washing in sections preserves the client s modesty, helps keep him warm, and keeps the procedure organized. When you have finished one section make sure you cover that area with a dry towel or a section of the bath blanket. Change the water as needed. Once you have finished the bath, comb or brush the patient's hair, return the jewelry, and position the patient comfortably with the call light within reach. Discard the linen, discard the gloves, and document what you have done. Don't forget to include observations about the condition of the patient's skin. Washing the hair does not need to be done every day. Check the client s chart for specific instructions or ask your supervisor how often this should be done. Position an absorbent towel or pads basin underneath the client s head to capture the water and shampoo. cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com 8

9 Wet the hair thoroughly, apply the shampoo, and then rinse it off. Use a small amount of water when rinsing. Dry the hair with a towel. Some people recommend placing cotton in a patient's ears when shampooing the hair. Check with your supervisor before you do this. Shaving can be done every day or when the client wants it to be done. It can be done using an electric razor or a safety razor, but the procedure outlined below assumes that you are using a safety razor. Always check before using a safety razor to shave a client. It might be contraindicated for clients who have certain medical conditions or who take blood thinners. Wash your hands and put on disposable gloves. Identify the client by checking his/her name band. Use warm, not hot water. The specific temperature is not important; simply make sure that the water is comfortable to the touch. Spread a towel across the client's chest and tuck it up under his chin. Moisten his face with a washcloth and water and apply the shaving cream. cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com 9

10 Hold the skin with the fingers of one hand so that it is tight and then move the razor in the same direction that the hair grows. Rinse the razor often. When finished, wash the skin with a washcloth and water. If the client is cut during shaving, make sure you document this fact and tell your supervisor. Trimming fingernails can be done using ordinary care and precautions but trimming toenails should only be done if it is specifically allowed by your health care facility; it is not a routine part of skin care. Cutting the toenails can be hazardous. Patients with diabetes have very poor circulation in their feet. Any cuts can easily get infected and because the patient with diabetes may also have nerve damage in his/her extremities the patient not notice the pain and swelling of an infection. Elimination Because this client cannot walk or stand unassisted he will need assistance with elimination. Urination can be done by helping the client to stand and then holding the urinal for him. If it is safer for him to stay in bed, simply put the urinal in place. In either case, wash your hands and put on disposable gloves before you start. After he has finished ask the client if he had cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com 10

11 any difficulty urinating. Measure and record the amount and check for the presence of blood or an unusual color. If the client needs to defecate he will need to use a bedside commode or a bedpan; the bedside commode is preferable as it is easier for a client to use. Wash your hands and put on disposable gloves. Close the door or pull the bedside curtain around the commode help him out of bed and onto the commode. Give him a call light if he can use it; if he can t simply come back in a few minutes. After he has finished, clean the rectal area and help the client back to bed. Ask him if he experienced any difficulty or pain while defecting. Empty the commode, discard the gloves and wash your hands, and document what any important observations. Using a bedpan is much less comfortable but at times it is necessary. Wash your hands and put on disposable gloves. Ask the client to raise his hips and slide a waterproof bed protector and the bedpan underneath him. If he cannot lift his hips, have him roll to one side (or help him to do so), place the bedpan against his back and buttocks, and then have the client roll back; elevate the head of the bed is possible. Give him a call light if he can use it; if he can t simply come back in a few minutes. Remove the bedpan and clean the rectal area. Ask the cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com 11

12 client if he experienced any difficulty or pain while defecting. Empty the bedpan, discard the gloves and wash your hands, and document what happened. Oral Hygiene This client had a CVA that affected his strength and coordination so he will need someone to perform his oral hygiene. Oral hygiene is very important. Oral health affects our ability to eat, drink, and speak, and to maintain good food and fluid intake. And if oral hygiene is not done the client s mouth may become dry and unpleasant; his lips and tongue may crack and bleed; the client s appetite may be adversely affected, and; his dignity and self-image may suffer. Before performing oral hygiene, always check a client s chart to determine if he/she is allowed to have food or liquids. Some clients have medical conditions that make swallowing food or liquids undesirable or even dangerous. If this is the case you may see the letters NPO somewhere in the client s chart. NPO is an abbreviation for a Latin phrase that means "nothing by mouth." If the client has an NPO order make sure they do not swallow any liquids, mouthwash, or toothpaste when you are providing oral hygiene. You should also familiarize yourself with situations in which clients may be NPO. These are listed in Table 2. cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com 12

13 Table 2: Indications for NPO Pre-operative patients Post-operative patients Bowel obstruction Placement of a PEG tube (Usually) Before certain procedures Clients who are on aspiration precautions Clients who have recently had a stroke Providing oral hygiene is relatively simple and it does not take a long time to complete. Wash your hands and put on disposable gloves. Identify the client by checking his/her name band. Inform the client that you will be helping him perform oral hygiene. Spread a towel across the client's chest in order to keep the patient dry. Offer the client a glass of water or mouthwash/water mix and instruct him to rinse and spit. Put toothpaste on the toothbrush. If the client is able to do so, let him/her do the brushing. If not you will need to do it. After brushing is completed instruct the client to rinse and spit. Offer floss. If the client is unable to use the floss you will need to perform this task. After flossing have the client rinse and spit again. Offer mouthwash if this is allowed. Offer a lip moisturizer if needed. Cleaning Dentures cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com 13

14 Wash your hands and put on disposable gloves. Identify the client by checking his/her name band. Inform the client that you will be cleaning his/her dentures. Remove the client's dentures. Place the dentures in an emesis basin or any type of suitable container that is lined with a paper towel. Carry the dentures to the sink. Place a towel in the sink; if the dentures are dropped, they will not break. Use toothpaste or denture cleaner and clean all of the surfaces of the dentures. Rinse the dentures with cool running water. Fill the denture cup with water, mouthwash, or a denture solution and place the dentures in the client s denture cup. Return the dentures to the client or put them in an appropriate place. EATING AND NUTRITION This client had a CVA that affected his strength, coordination, and gag reflex. Because of those issues he cannot feed himself and he may aspirate. Good food and fluid intake are essential to his recovery but feeding this client presents risks and challenges. Feeding someone is not difficult, but it does require time and planning and there are some important points that you must remember. Begin by washing your hands. The next step is to identify the client by checking his/her name band. Following that, you should check the food tray. There should be some identifying information attached it, cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com 14

15 something that indicates that the correct meal has been delivered to the right client. If the client is in a chair make sure his/her head is supported. If there is a risk for spills place a towel or absorbing protecting pad across the client s chest and under the chin. If the client must stay in bed, elevate the head of the bed as far as is practical and comfortable. The exact angle is not important, but if the client is at risk for aspiration there will often be a protocol for a minimal angle of elevation that should be used during feeding. The key is to keep the client in an upright position. This allows food to travel down into the stomach and prevents food from being aspirated into the lungs. Ask the client what he/she would like to eat first, second, and so on. If the client is unable to view the tray, describe the food. Feed the patient in small portions. Be patient. Someone who needs assistance eating will very often not be able to consume his/her food as quickly as someone who can eat without help. Although you should encourage your clients to eat, never rush the client through a meal. Doing so can cause the client to aspirate the food. Aspiration will be discussed later in this section of the module. Budget time. The client who cannot feed herself/himself will typically eat at a slow pace so you should plan accordingly. cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com 15

16 This will take some practice; just remember that you can't use the amount of time it takes you or unimpaired clients to eat as a reference. Allot enough time so that neither you nor the client are hurried and there is ample time to finish the meal. Use small portions. The client who needs assistance with eating often cannot chew and swallow large pieces of food. Food portions that are too large may be aspirated. Don't be afraid to underestimate what the client can tolerate; it is better to use smaller rather than larger bites to avoid the risk of aspiration. Never leave a client alone with the food tray. This point does not apply to this situation, but if someone is disoriented or confused he/she might aspirate a piece of food. Use utensils. Even if you are wearing gloves, never use your fingers to place a piece of food in a client s mouth. Consider using a spoon instead of a fork, if possible. A spoon is as effective as a fork and using a spoon eliminates the chance that the client could be injured by the points of a fork. This may sound implausible, but a client who is confused and disoriented and especially hungry may bit down hard on a fork or grab the fork and place it forcefully in his/her mouth. cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com 16

17 Make sure there are fluids available and occasionally offer something to drink. Encourage the client to eat as much as possible. An adequate calorie intake and good nutrition are vital for people who are sick. Make sure you document on the client's chart how much of the meal he/she finished and how much fluid was consumed. If the client was unable to finish a substantial portion of the meal, ask why (if he/she can tell you) and make sure your supervisor is informed. Aspiration Aspiration is the medical term for movement of a foreign body or foreign substance into the lungs. In people who are awake and alert and neurologically intact, aspiration is prevented by the gag reflex. The gag reflex is a protective reflex that is initiated when something such as food, liquid, or a foreign body comes in contact with a nerve that is located in the back of throat. When this nerve is stimulated by the foreign body a powerful cough is produced that expels the aspiration hazard. Almost everyone has experienced the gag reflex after eating or drinking something too quickly; it is commonly called something going down the wrong way. Aspiration of food into the lungs can have serious medical consequences such as pneumonia. Many clients who cannot feed themselves are likely to have a weak or absent gag reflex. For cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com 17

18 example, clients who a depressed level of consciousness may have a weak gag reflex and patients who have had a stroke may not have a gag reflex. In either case, aspiration can occur with minimal signs and symptoms or without signs and symptoms so caution is required when feeding these clients. Because aspiration can be difficult to detect, a patient who requires assistance with feeding should be closely observed during meals. Each healthcare facility should have guidelines for aspiration precautions. MEDICATION SELF-ADMINISTRATION Certified Nursing Assistants often provide home care, and many home care clients self-administer their medications. Most clients can learn to self-administer medications effectively and safely if they are properly educated and they have support, but there is potential for harm and mistakes. Helping clients self-administer medications and making sure they know how to do so correctly requires them to: Understand the six rights of medication administration. Have a basic understanding of medication errors. Have a basic understanding of the side effects of the medications he/she is taking. Understand the concept of medication interactions. cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com 18

19 Know what their resources if they need help with medication self-administration. If these points are learned and retained and if clients are periodically evaluated for their knowledge virtually anyone can self-administer medications. A Short Review of Medications What is a medication? A medication is defined as: 1) A substance that is used to cure, diagnose, prevent, or treat a disease; 2) A substance that is intended to enhance mental or physical wellbeing; 3) A substance that has a measurable effect on human physiology or a measurable effect on the signs and symptoms of a disease or illness, and; 4) A substance that can cause side effects, minor or serious. Prescription drugs, over-the-counter drugs, vitamins, and supplements should all be considered medications. This is an important point that your clients should know. Many people consider over-the-counter medications to be safe, but there are multiple ways in which over-thecounter medications can be harmful. Example: Over-the-counter cough and cold relief products often contain a cough suppressant called dextromethorphan and/or a cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com 19

20 decongestant such as phenylephrine or pseudoephedrine. Dextromethorphan should not be used by someone who is taking certain anti-depressants such as Prozac, and phenylephrine and pseudoephedrine should be avoided by people who have cardiac disease or hypertension. The Six Rights of Medication Administration The six rights of medication administration are guidelines that will ensure safe and effective use of medications. These guidelines should be reviewed with clients who self-administer medications. 1. Right drug: The correct medication should be used. If a client is prescribed the diuretic furosemide (Lasix ), he/she should receive furosemide. You should also remember that although a physician may have ordered a medication and the pharmacy correctly filled the prescription that does not mean it is the right drug. For example, a physician or other health care professional could have mistakenly prescribed insulin for a client who is not diabetic. Each bottle of prescription medication should be examined to be sure the right drug was dispensed to the right person. And never take a medication that was not prescribed for you. 2. Right dose: The correct dose should be used, eg, the correct strength and the correct frequency of dosing. The client cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com 20

21 should know that she/he should not take more or less of the medication. Do not stop taking a prescription medication without first consulting with the prescriber. 3. Right route: Medications can be taken orally, by injection, intravenously, intra-nasally, rectally, vaginally, topically, by the otic route, or by the ophthalmic route. Oral medications should be taken orally, subcutaneous medications should be injected subcutaneously and so on. Taking a medication by the wrong route happens more often than you would imagine. 4. Right time: Medication should be taken at the proper time, eg, before or after meals, before going to bed, every 8 hours, every 12 hours. If a dose is missed, check with the prescriber or a pharmacist for instructions. 5. Right client: Prescription labels should be checked to see if the right drug was dispensed to the right person. 6. Right reason: This is similar to the right drug. Is this medication appropriate for this client? Medications are used to cure, diagnose, prevent, or treat a disease, so any drug that is prescribed by a physician is for a specific client need. In order for clients to be sure that they are taking a medication for the right reason they must: 1) know their medical history, and; 2) know what a particular medication is used for. cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com 21

22 Medication Side Effects A side effect is an unwanted and possibly harmful effect caused by a medication. Clients who self-administer medications should know which side effects can commonly occur with these drugs and which are considered serious. This information about these can be obtained by the client s pharmacist or her/his prescriber. More importantly, anyone who self-administers medications must understand the following point. It is not necessary to memorize a list of side effects, but if there are any new signs and symptoms - especially in the first few days of taking a new medication or if a dose has been changed - these might be a medication side effect and the client should call his/her physician. Medication Interactions It is impractical and unrealistic to expect clients to know about specific medication interactions. What they do need to know is that not only their prescription medications but over-the-counter drugs, vitamins, and supplements should all be considered to be medications. Although over-the-counter medications, vitamins, and supplements may seem safe, harmful interactions between these products and prescription medications are not uncommon. Tell your home care clients to check with a physician, pharmacist, or other healthcare provider before taking any new medication. Medication-Food Interactions cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com 22

23 Significant medication-food interactions are uncommon but there are some that are important. People who take warfarin should avoid foods such as kale or spinach that contain a lot of vitamin K. The MAO inhibitor anti-depressants can interact with certain types of cheeses and with liver. Grapefruit juice can significantly interfere with cholesterol-lowering medications such as Lipitor and Mevacor. If alcohol is ingested along with an anti-depressants or a sedative such as Valium, excessive drowsiness can occur. And some medications must be taken with food while others must be taken on an empty stomach. PRACTICAL TIPS FOR SAFE SELF-ADMINISTRATION OF MEDICATIONS Make a list: The client should make a list of his/her medications, including names, dosages, reason for use, the times the medications should be taken, how to take them, and side effects. A health care professional who can verify the information such as a pharmacist, MD, CNA, or RN should check the list to be sure it is accurate. The client should make a copy and keep the information in a safe and easily accessible place. Medication timers: Medications timers are clocks that can be set to ring or alarm at specified times during the day. When the alarm goes off the client will know it is time to take a cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com 23

24 medication. Medication watches that serve the same function are also available. These devices may be useful for some clients. Medication organizers: A medication organizer is a small plastic container that is used to hold tablets and capsules. Medication organizers are very popular and the most commonly used ones are "week-long" organizers. These have seven separate containers that are labeled Monday through Sunday. The client simply places the day's supply of medications in the appropriate part of the container. Medication calendars are another option. The client writes down what he/she needs to take each day and makes a note on the calendar after taking a dose. Medication cards: These are printed cards that contain all the important information about the medications the client is taking. These can be placed in a prominent position where the client can easily access them. Client Resources Professional resources for medication information are the client s physician; the dispensing pharmacist; other healthcare professionals who are caring for the client, and; telephone resources such as poison control centers and nurse help lines that are sponsored by health cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com 24

25 insurance companies. Clients who self-administer medications should have the telephone numbers of all of these at hand. For nonemergency situations clients should call the physician, the pharmacist, or other healthcare professional. If there is an emergency or a medication error has occurred, call the poison control center ( ) or the nurse help line. Poison control or the nurse help line will be able to determine if the situation is emergent and direct the client to the appropriate resource. CLIENT SAFETY Ensuring client safety is done by assessing the environment - the client s home - and the client. A home evaluation looks for obvious and not so obvious hazards, and the client is assessed to determine if there are any physical or psychological conditions that may affect his/her safety. One of the most important aspects of these assessments is the prevention of falls. These assessments are typically done by a home health care nurse, a physical therapist, or an occupational medicine specialist. However, CNAs should be aware of environmental, physical, and psychological factors that put clients at risk. Assessment of the Environment Assessment of the environment should include determining if there are carbon monoxide and smoke detectors, installed and working. Is there cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com 25

26 a fire extinguisher in the house? Does the client have an escape plan in the event of a fire? Does the client have emergency numbers close at hand? Does she/he know who to call if there is an emergency? Specific environmental hazards that increase the risk of a fall include: Bathtub: Bathtub surfaces are very slippery when wet. Is this a risk for your client? Should railings be installed? Cluttered rooms: If there is clutter on the floors such as loose electrical cords, piles of clothing, or newspapers and books this creates a trip and fall risk. Loose rugs. Poor lighting. Stair railings that are not secure. Client factors that increase the risk of falling include: Balance problems. Diminished vision. Health problems such as arthritis or stroke that affect balance, coordination, and strength. Loss of sensation; this is a problem for people who have diabetic neuropathy. Muscle weakness. Poor balance. cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com 26

27 There are many fall assessment tools available. The Centers for Disease Control and Prevention (CDC) publishes the Stay Independent brochure and this can be viewed by using this link: The Stay Independent brochure can be used by clients to assess their environmental and personal risk for falling. The brochure includes a 12 point questionnaire that CNAs can use to determine if the client is a fall risk SUMMARY Providing for and responding to a client s daily needs is one of the most important functions performed by Certified Nursing Assistants (CNAs). Every one of your clients will require some help in performing self-care, and you are expected to be able to determine what their daily needs are and to ensure these needs are met. An assessment of these needs should be done for every client. The process will differ slightly depending on the care situation, but all clients should assessed for their physiological, self-care, safety, psychological, and social needs. cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com cnazone.com 27