Nutrition, Hydration, Elimination, and Skin Integrity

Feeding is a safety skill

Nutrition assistance is not only placing food in a resident's mouth. Before meals, perform hand hygiene, check the resident's identity, confirm the correct tray and diet, position the resident upright, apply dentures, glasses, or hearing aids if used, and make sure adaptive equipment is available. Keep the call light within reach and protect clothing with a napkin or clothing protector according to preference and policy.

The CNA should encourage independence. Open containers, cut food if allowed, cue the resident, and allow enough time. Sit at eye level when feeding, offer small bites, alternate solids and liquids as tolerated, and do not rush. Respect dislikes and cultural or religious food preferences. If a resident refuses food, report and document the amount eaten rather than arguing or hiding the refusal.

Hydration and swallowing risks

Hydration prevents constipation, urinary problems, confusion, skin breakdown, and weakness. Offer fluids allowed by the care plan and record intake accurately. Some residents have fluid restrictions, so the CNA should not encourage extra fluids without checking the plan. Other residents require thickened liquids because thin liquids increase aspiration risk. Never change liquid consistency because the resident dislikes it.

Swallowing problems require immediate attention. Watch for coughing, a wet-sounding voice, drooling, shortness of breath, food left in the cheeks, repeated throat clearing, watery eyes during eating, or refusal because swallowing hurts. Stop feeding if the resident shows signs of aspiration risk and report to the nurse. Do not put more food in the mouth to see if the problem continues.

Elimination and dignity

Toileting is personal care with a high dignity burden. Answer call lights promptly, provide privacy, use safe transfer technique, and never shame a resident for incontinence. For bedpans and urinals, position the resident safely and comfortably, provide toilet tissue and hand hygiene, and check skin after incontinence. Record bowel movements, urine output, and unusual findings according to policy.

Report dark, cloudy, bloody, foul-smelling, or very low urine output; burning or pain with urination; new incontinence; constipation; diarrhea; black tarry stool; bright red blood; vomiting; abdominal pain; or sudden change in bowel pattern. With an indwelling catheter, keep the drainage bag below bladder level, off the floor, and free of kinks. Do not disconnect tubing or raise the bag above the bladder.

Skin integrity connects everything

Pressure injuries are more likely when residents are immobile, poorly nourished, dehydrated, incontinent, or have reduced sensation. The CNA helps by repositioning according to the care plan, keeping skin clean and dry, smoothing wrinkles, using pressure-relief devices as directed, encouraging nutrition and fluids within orders, and reporting early skin changes. A reddened area that does not blanch, an open blister, drainage, warmth, swelling, or pain over a bony area must be reported.

Common bony risk points include heels, ankles, knees, hips, coccyx, elbows, shoulders, ears, and the back of the head. Do not massage reddened bony areas; massage can damage tissue. Do not apply powders, creams, dressings, or heat unless directed by the nurse or care plan. The CNA role is prevention, observation, routine hygiene, accurate documentation, and timely reporting.

Exam filter

Choose answers that keep the resident upright for meals, follow diet orders, measure intake and output, provide privacy, keep catheter drainage flowing downward, clean incontinence promptly, and report skin or elimination changes. Reject choices that force-feed, ignore choking, change diets independently, leave residents wet, or treat pressure injuries without nurse direction.