Common Chronic Conditions & Observation

The CNA's Role: Observe and Report

The CNA is the staff member who spends the most time with residents, so you are the facility's "eyes and ears." Your job is to observe and report — never to diagnose, never to treat, and never to tell a resident their diagnosis. A change from the resident's baseline (their usual normal) is what you watch for and report to the nurse.

Objective data is information you can measure or see — a temperature of 101.4°F, a blood pressure of 168/96, a 2-cm reddened area on the heel, vomit in the bed. Subjective data is what the resident tells you that you cannot measure — "my chest feels tight," "I feel dizzy," "I'm nauseous." Chart both factually; put the resident's exact words in quotation marks.

Report changes promptly, not at the end of your shift. Use clear, factual language and, in Massachusetts facilities, the SBAR framework when handing off to the nurse: Situation (what is happening now), Background (relevant history), Assessment (what you observe), and Recommendation/request (what you think is needed). For example: "Mr. Lopez (S) who has CHF (B) has new swelling in both ankles and gained weight (A) — can you assess him? (R)" Good observation plus a clear report is how the care team catches problems early.

Normal Adult Vital Sign Ranges (Observation Anchors)

Diabetes Mellitus

Diabetes mellitus is a chronic disease in which the body cannot properly use glucose (sugar). The CNA does not give insulin, but you observe intake, skin, and behavior.

• Hypoglycemia (low blood sugar) is an emergency: shaky, sweaty, pale, dizzy, confused, irritable, or sudden hunger. Report immediately — it can progress to unconsciousness.
• Hyperglycemia (high blood sugar) develops more slowly: extreme thirst, frequent urination, fruity breath, drowsiness. Report it.
• Inspect the feet daily for cuts, blisters, redness, or sores; diabetics heal slowly and have reduced sensation, so a small break in the skin can become a serious wound.
• Serve meals on time and report exactly how much the resident ate.

Heart Disease and Hypertension

Hypertension (high blood pressure) and congestive heart failure (CHF) are common in elders. Watch for and report edema (swelling, often in ankles and feet), sudden weight gain, shortness of breath, and chest pain. Chest pain or pressure, especially with sweating, nausea, or pain radiating to the arm or jaw, is a possible myocardial infarction (heart attack) — report it immediately and stay with the resident.

Respiratory Disease (COPD)

COPD (chronic obstructive pulmonary disease) includes chronic bronchitis and emphysema; residents have trouble breathing and tire easily. Help them into an upright or orthopneic (leaning-forward) position to ease breathing, encourage rest between activities, and report any change in breathing, color (bluish lips = cyanosis), or increased coughing. Never raise oxygen flow yourself — oxygen is a treatment, and changing the rate requires a nurse's order.

Stroke (CVA) and Recognizing Emergencies

A stroke (cerebrovascular accident, CVA) is a sudden loss of blood flow to the brain. Use BE FAST to recognize the warning signs:

1. Balance – sudden loss of balance or coordination
2. Eyes – sudden vision changes
3. Face – facial drooping on one side
4. Arms – arm weakness or drift on one side
5. Speech – slurred or confused speech
6. Time – time to call for help immediately

Residents recovering from a stroke may have hemiplegia (one-sided paralysis), dysphagia (difficulty swallowing — a choking/aspiration risk), and communication loss (aphasia). When transferring or dressing, support the weak side; dress the weak arm first and undress it last.

Arthritis and Mobility Conditions

Arthritis causes joint pain and stiffness. Allow extra time, perform care gently during pain-free periods, support painful joints, and encourage prescribed range-of-motion (ROM) exercises to keep joints mobile. Never force a joint past the point of resistance or pain.

Pressure Injury and Skin Observation

Residents with chronic illness, limited mobility, or poor nutrition are at high risk for pressure injuries (pressure ulcers/bedsores). The earliest warning sign is a reddened area over a bony prominence — the sacrum (tailbone), heels, hips, elbows, and the back of the head — that does not fade when you press it (non-blanching redness). Report this immediately and reposition the resident off that area. Prevention is a CNA's frontline duty: turn and reposition at least every 2 hours, keep skin clean and dry, smooth out wrinkled linens, and never massage a reddened bony area, which can worsen damage.

Inspect the skin every time you bathe or reposition the resident.

Dehydration and Nutrition Warning Signs

Elders feel thirst less and are prone to dehydration. Watch for dry lips and tongue, dark or strong-smelling urine, low urine output, sunken eyes, confusion, and dizziness. Offer fluids frequently, record intake and output accurately, and report poor intake. For residents at risk of aspiration (such as after a stroke), position upright at 90 degrees for meals, follow any thickened-liquid or pureed-diet order, and report coughing or choking during meals at once.

Common Reporting Traps

• Waiting until the next shift to mention a fall, a refusal to eat, or new confusion — all require prompt reporting.
• Charting opinions ("the resident seems fine") instead of measurable facts.
• Adjusting oxygen, repositioning a device, or "reassuring" a resident with chest pain instead of reporting at once. When unsure whether something is reportable, report it.