4.2 Oral Care and Dressing

Oral Care Basics

Mouth care keeps the resident comfortable, prevents infection, and supports appetite and dignity, so it is a frequent NNAAP skill. Provide oral care at least twice a day and after meals. The basic steps for a conscious resident:

• Put on gloves, raise the head of the bed so the resident sits upright, and place a towel across the chest.
• Brush all tooth surfaces and the tongue with a soft toothbrush.
• Let the resident rinse and spit into an emesis basin, then clean the lips.
• For a resident with natural teeth, include flossing as allowed.

Report bleeding gums, sores, loose teeth, or a coated tongue to the nurse.

Oral Care for the Unconscious Resident

The most safety-critical version of this skill is mouth care for a resident who is unconscious or cannot swallow. Because the resident cannot protect the airway, the single most important step is positioning: turn the resident's head to one side in the lateral (side-lying) position so secretions and rinse fluid drain out of the mouth instead of into the lungs. This is the key step that prevents aspiration (inhaling fluid into the airway, which can cause pneumonia).

Use only a small amount of fluid and a moistened swab or padded tongue blade — never pour water into the mouth and never use a large cup. Clean gently, keep an emesis basin and towel at the cheek, and stop if the resident shows any sign of distress.

Denture Care

For residents with dentures, handle them carefully over a basin of water or a padded surface so a dropped denture does not break. Clean them with a denture brush and cool or lukewarm water (hot water can warp them), rinse, and store them in a labeled denture cup filled with cool water or denture solution when not worn, so they stay moist and are not lost. Never wrap dentures in a tissue or napkin, the leading way they get thrown away. Always report cracked or ill-fitting dentures.

Dressing and Undressing: The Weak-Side Rule

The single most-tested dressing fact on the Georgia CNA exam is the weak-side-first rule: dress the weak (affected) side first and undress the strong (unaffected) side first. Putting the garment on the impaired arm or leg first means you are not forcing a stiff, painful, or paralyzed limb through a sleeve or pant leg, because there is the most slack at the start. When undressing, removing the strong side first lets the resident assist and leaves the weak limb (which needs the most maneuvering) until last, when the garment is loosest. Think of it as "affected goes in first, comes out last."

Dressing a Resident Who Has an IV

An intravenous (IV) line adds one twist to the weak-side rule, and CNAs are tested on it. When removing a gown, slip the gown off the arm without the IV first, then slide the gown down the IV arm, over the tubing, and over the IV bag last — never disconnect or clamp the line, and keep the bag higher than the site if possible.

When putting on a gown, do it in reverse: thread the gown sleeve over the IV bag and tubing first, rehang the bag, then ease the resident's IV arm and the free arm into the gown. If the gown has snap sleeves, use them. If you ever feel resistance at the IV site or the alarm sounds, stop and call the nurse.

Grooming with Dignity

Dressing and grooming are deeply personal, so always promote independence and protect dignity. Let the resident choose what to wear and do as much as they safely can. Provide privacy, keep the resident covered while you work, use clothing that fits and is appropriate for the weather and activity, and never rush. Encouraging self-care with clothing fasteners, buttons, or an adaptive device is also restorative care — it preserves the resident's remaining abilities.

Example: A resident has right-side weakness from a stroke and an IV in the left (strong) arm. To put a fresh gown on, the aide first slides the sleeve over the IV bag and tubing on the left, rehangs the bag, eases the left IV arm through, then dresses the weak right arm. To take a gown off, the aide would remove the right (weak, non-IV) consideration last — but because the IV is on the strong arm, the aide removes the free arm first and handles the IV arm last. The guiding principles combine: protect the IV and keep the affected side in first, out last.