4.3 Grooming: Hair, Shaving, Nails, and Feet

Grooming: Hair, Shaving, Nails, and Feet

Quick Answer: CNA grooming covers hair care and shampoo, shaving (use an electric razor for diabetics — safety razors risk cuts that won't heal), fingernail filing, and foot care. The podiatry restriction is absolute: a CNA does NOT trim the toenails of a diabetic resident or any resident with diabetes, poor circulation, or anticoagulant therapy. That task belongs to a licensed nurse or podiatrist.

Grooming is not cosmetic — it is infection control, skin assessment, and dignity. Poor grooming leads to matted hair, pressure points from long nails, infected ingrown toenails, and serious diabetic foot complications. OBRA requires that residents be groomed to look and feel their best.

Hair Care and Shampoo

• Brush or comb daily — short strokes from the scalp outward. For tangled hair, start at the ends and work upward to avoid pulling. A resident's hair should be styled as the resident prefers.
• Shampoo per the care plan — typically once or twice a week, more often if the resident requests. Use shampoo, not bar soap, which leaves a dull film and dries the scalp.
• For a resident in bed, use a shampoo basin (a disposable trough that fits under the neck) and a waterproof pad. Check water temperature on your wrist before beginning. Protect the eyes and ears from water.
• Inspect the scalp during shampoo for redness, scaling, lice (pediculosis — tiny white eggs or nits attached to the hair shaft), or open sores. Report any findings to the licensed nurse.

Shaving — Electric vs. Safety Razor

Diabetic Shaving Precaution

Diabetes causes poor wound healing and reduced sensation (neuropathy). A small nick from a safety razor can become a non-healing ulcer, and the resident may not feel the cut until infection sets in. The CNA must use an electric razor on any resident with diabetes unless the care plan specifically directs otherwise. This is not optional — it is a safety standard tested on the Indiana written exam.

General Shaving Rules

1. Check the care plan for shaving method and allergies before starting.
2. Warm the skin with a warm, wet towel to soften hair and open pores.
3. Shave in the direction of hair growth — against the grain causes ingrown hairs and nicks.
4. For female residents, shave legs and underarms only if requested and ordered in the care plan.
5. Never share a razor between residents — bloodborne pathogen risk.
6. Do not use an electric razor near oxygen — the motor can ignite a spark. Confirm oxygen is off or remove the resident from the oxygen area first.
7. Dispose of used safety razor blades in a sharps container, never in the trash.

Fingernail Care

Fingernails are filed and cleaned as part of daily grooming. The CNA may:

• File nails with an emery board, shaping them straight across and gently rounding the tips.
• Clean under the nails with an orange stick or the pointed end of a nail file.
• Apply hand lotion to prevent cracking.

The CNA may trim fingernails only if the care plan allows it and the resident does not have diabetes, poor circulation, or bleeding risk. When in doubt, file only — do not cut.

Foot Care

Foot care is critical in long-term care. Residents with diabetes are at high risk for foot ulcers, infection, and amputation. The CNA's role in foot care is:

1. Wash feet as part of the bed bath or shower.
2. Dry thoroughly, especially between the toes. Moisture between the toes promotes fungal infection (athlete's foot) and skin breakdown.
3. Inspect feet daily for redness, blisters, cuts, calluses, corns, color changes (pale or blue), or temperature changes (cold feet suggest poor circulation). Report any findings to the licensed nurse immediately.
4. Apply lotion to the top and bottom of the feet — never between the toes, where moisture macerates the skin and promotes fungal growth.
5. Put on clean socks and shoes or slippers with a firm, non-slip sole.

Podiatry Restrictions — What a CNA Does NOT Do

Indiana's 410 IAC 16.2 Standard 14 restricts invasive procedures, and foot care has a hard line:

Trap to remember: A CNA does NOT trim the toenails of a diabetic resident — ever. This is one of the most frequently tested restrictions on the Indiana CNA exam. The correct answer is to file (if allowed by the care plan) and report the request to the licensed nurse; trimming belongs to the licensed nurse or podiatrist. Performing this task as a CNA is a scope-of-practice violation under 410 IAC 16.2 Standard 14 and may be reported as resident neglect.

Reporting Abnormalities

Report to the licensed nurse immediately if you observe any of the following during grooming:

• Redness, swelling, warmth, or break in the skin on the feet (early signs of infection or ulcer)
• Black or darkened areas on toes or heels (possible gangrene or ischemia)
• Ingrown toenails, corns, or calluses
• Scalp redness, scaling, lice, or open sores
• Bleeding during shaving that does not stop with pressure
• Any skin tear or bruising of unknown origin