Certified Nursing Assistant (CNA) Exam Self-Care, Independence, and Restorative Care Summary

Restorative care helps residents keep or regain abilities. Encourage the resident to do what she can, give extra time, and help only with what she cannot do.

Wrong choices

• Deciding for the resident which tasks she will do: She has the right to take part in decisions about her care.
• Doing all care for the resident to save time: Doing everything for her makes her weaker and more dependent.
• Rushing the resident so she finishes quickly: Rushing makes tasks harder and can cause falls.

Move each joint only as far as it goes comfortably. If the resident reports pain, stop and report it to the nurse. Never force a joint.

Wrong choices

• Push the joint a little further to stretch it: Forcing a joint past the point of pain can cause injury.
• Ignore it, since exercise always hurts: Pain is a warning sign and must be reported.
• Finish the exercise faster: Moving faster does not reduce injury and can make it worse.

In passive range of motion, the aide moves the resident's joints. Move slowly and gently, support the limb above and below the joint, repeat each movement as the care plan says, and stop if there is pain.

Wrong choices

• Past the point of resistance to stretch the muscle: Forcing past resistance can cause injury.
• Only on the strong side of the body: Range of motion is especially important for weak or unused joints.
• Quickly, so the joint loosens up: Fast movements can injure muscles and joints.

Hold a cane on the strong side, the side opposite the weak leg. With a weak left leg, the cane goes in the right hand. The cane and the weak leg move forward together, so the cane shares the weight the weak leg cannot carry.

Wrong choices

• Either hand, switching every few steps: Switching hands is unsafe; the cane stays on the strong side.
• The left hand: The cane is held on the strong side, opposite the weak leg.
• Both hands: Holding the cane with both hands is unsteady and blocks normal walking.

Doing tasks the resident can do herself takes away independence, even if it saves time. Giving time, keeping items in reach, and praising effort all help residents stay as independent as possible.

Wrong choices

• Praising the resident's effort and progress: Praise encourages the resident to keep trying.
• Allowing extra time for the resident to do self-care: Extra time lets the resident do more alone.
• Placing needed items within the resident's reach: Items within reach let the resident do things alone.

With a standard walker, the resident lifts and moves the walker a short distance forward, sets all legs down, and then steps into it, usually with the weak leg first. The walker is always on the floor when it carries weight.

Wrong choices

• Step forward first, then pull the walker up to the body: The walker must be set down first so it can support the resident's weight.
• Carry the walker while walking: A walker that is lifted gives no support.
• Push the walker far ahead with each step: Reaching too far forward can cause a fall.

Adaptive (assistive) devices like built-up utensils, plate guards, and long-handled reachers help residents do tasks themselves. A thick handle is easier to grip for people with arthritis or weak hands.

Wrong choices

• To keep food from going into the airway: Thickened liquids and posture help swallowing; a thick handle does not.
• To make the spoon hold more food: A bigger handle does not change how much the spoon holds.
• Because only blind residents can use it: Built-up utensils are for weak hands, not blindness.

Bladder training helps the resident regain control by toileting at regular times as the care plan says, giving enough privacy and time, and encouraging fluids unless restricted. Accidents are handled kindly, never with scolding.

Wrong choices

• Scold the resident after an accident: Scolding is abusive and harms the resident's dignity.
• Limit the resident's fluids all day: Too little fluid causes dehydration and concentrated urine that irritates the bladder.
• Put on a brief and change it once a shift: This does not train the bladder and is not a bladder training program.

The skin on the residual limb (stump) is under pressure all day. Check it for redness, blisters, or sores and report changes. Keep it clean and dry, and follow the care plan for cleaning and storing the prosthesis.

Wrong choices

• Stand the prosthesis in the shower to clean it: A prosthesis should be cleaned as directed, not soaked.
• Apply heavy lotion inside the socket: Lotion inside the socket can make the limb slip and the skin break down.
• Leave the residual limb wet after washing it: Moist skin is more likely to break down.