5.4 Common Conditions & Care Needs

High-Yield Skill: Transfer Bed-to-Wheelchair with a Gait Belt

Safe transfers protect both resident and aide and appear constantly with mobility-impaired conditions like stroke and arthritis. The Minnesota gait-belt transfer (verified order):

1. Hand hygiene, then explain the procedure and provide privacy.
2. Assist with non-skid footwear BEFORE standing.
3. Adjust bed height so the resident's feet are flat on the floor when sitting on the edge.
4. Lock the bed brakes AND the wheelchair brakes BEFORE assisting to stand — both are critical safety steps.
5. Bring the resident to a sitting position, then apply and tighten the gait belt at the waist; check tightness by slipping fingers underneath.
6. Stand facing the resident, grasp the gait belt on both sides with an upward grasp, and bring them to standing.
7. Pivot so the back of the resident's legs touch the wheelchair, then lower in a controlled manner.
8. Position hips to the back of the seat, remove the gait belt, place the call light within reach, and perform hand hygiene.

Trap: Forgetting to lock either set of brakes or skipping the non-skid shoes is a critical-step failure — the wheelchair can roll out from under the resident.

High-Yield Skills: Range of Motion and Perineal Care

Range of motion (knee/ankle or shoulder): position the resident supine, support the joint above and below, and move gently, slowly, and smoothly through each motion (knee flexion/extension, ankle dorsiflexion/plantar flexion; shoulder flexion/extension and abduction/adduction) at least 3 times. The candidate must ask at least once whether there is any discomfort or pain and stop at the point of resistance — moving to pain is a critical error.

Perineal care for a female (a mandatory task): after hand hygiene, privacy, gloves, and a barrier pad, wash the genital area from front to back, using a clean portion of the washcloth for each stroke; rinse and pat dry the same front-to-back direction. Then turn the resident and wash the rectal area front to back.

Why front to back? It moves microorganisms away from the urethra and prevents urinary tract infection — a fact the knowledge test loves. Using one dirty cloth surface for multiple strokes spreads bacteria and fails the skill.

For catheter care, clean from the insertion site outward (away from the body) down the tubing, never scrubbing back toward the meatus. Keep the drainage bag below the level of the bladder so urine never flows back, and keep the bag off the floor. When you empty a urinary drainage bag, wear gloves, avoid touching the drain spout to the graduate, and after measuring, record the output within 25 mL of the observer's reading.

A shared theme across these skills is infection control through technique: clean-to-dirty direction, a fresh cloth surface per stroke, and a closed drainage system. The skill also rewards dignity — exposing only the area being washed and keeping the resident covered.

Diabetes, Stroke, and the Conditions Behind the Skills

Diabetes mellitus means the body cannot control blood glucose. Two opposite emergencies:

Both are reported to the nurse immediately; a CNA never gives insulin and offers food/fluid only if the care plan directs.

A stroke (cerebrovascular accident, CVA) often causes one-sided weakness (hemiplegia), speech trouble (aphasia), and swallowing trouble (dysphagia). The CNA approaches from and places items on the strong side, dresses the weak side first, watches for choking at meals and follows thickened-liquid orders, and supports ROM and communication. Recognize FAST: Face drooping, Arm weakness, Speech difficulty, Time to report at once. These conditions are why the transfer, ROM, and feeding skills above matter on the job.

Heart, Lung, and Joint Conditions

Congestive heart failure (CHF): the heart cannot pump effectively and fluid backs up. The CNA reports shortness of breath (worse lying flat), edema of the ankles/feet/legs, and sudden weight gain — which is why daily weights and accurate I&O matter. Sitting the resident upright eases breathing.

Chronic obstructive pulmonary disease (COPD): exhaling is hard; residents breathe best sitting upright and leaning slightly forward (orthopneic/tripod position). Oxygen safety: oxygen feeds fire, so post No Smoking signs and keep flames away; the CNA checks tubing and skin behind the ears/nose and that the device is on, but never changes the prescribed liter flow.

Arthritis: joint pain, stiffness, and swelling (osteoarthritis is wear-and-tear; rheumatoid arthritis is inflammatory and often symmetric). The CNA:

• Allows extra time; never rushes a resident in pain.
• Encourages gentle activity and prescribed ROM, stopping at the point of pain.
• Applies heat or cold only as ordered.
• Uses adaptive equipment to support independence.
• Reports increased pain, swelling, or reduced movement to the nurse.

Care of the Impaired is 6 of the 70 knowledge questions and Disease Process is 4, so these conditions are well represented. The unifying exam principle across every condition is the same: the CNA observes specific signs, supports comfort and independence, stays inside scope (no insulin, no oxygen-flow changes, no diagnosing), and reports changes promptly to the nurse. Match the sign to the report — fruity breath and thirst to high blood sugar, sudden one-sided droop to a possible stroke, new ankle swelling and weight gain to heart failure — and you will answer these scenario items correctly.