I85PREP
⌘ K
Alaska CNA study materials
Alaska CNA study resources

The Bed Alarm at 0210

Alaska CNA · Put your knowledge to work in context.

All case studies

The Bed Alarm at 0210

Mrs. K, 84, has moderate dementia and lives on your 28-bed unit. She walks with a walker and has fallen twice in the past 30 days; her care plan includes a bed-exit alarm, hourly rounding, and a scheduled toileting program at 0200. It is 0210. You are the only aide on the hall, responsible for 14 residents. Her alarm sounds. You find her standing at the side of the bed, gripping the walker, urine running down her leg, saying 'I have to go, I have to go.' A pitcher of water has spilled beside the bed and the floor is wet under her feet. The nearest help is a nurse two halls away, and the unit phone is at the nursing station.

1. In the first 60 seconds, what do you do and in what order? Explain why the order matters.

Read the worked answer

Order of actions

  1. Close the distance and stabilize - step beside her, put a hand on the gait belt (not her arm, not her clothing), and block the direction of travel. Do not grab, pull, or try to lift her.
  2. Get her off the wet floor - guide her to sit on the edge of the bed or onto the commode, whichever is closer and dry. Never walk her through the puddle; her walker tips on wet vinyl.
  3. Summon help - use the bed's call light or call out down the hall. Do not leave her standing or sitting alone to go find the nurse.
  4. Check for injury - ask about pain, look at hips, knees, elbows, head; note whether she is bearing weight normally.

Why the order: the highest-probability harm in this moment is a fall caused by you, not by her. A startled aide who grabs a standing 84-year-old with a walker can take them both down. Preventing the fall and the wet-floor slip comes before the alarm, the puddle, and the paperwork - the alarm already did its job.

2. She needs to toilet right now and there is no one to assist. How do you manage the toileting, and what must you not do?

Read the worked answer

Do

  • Place the bedside commode on dry floor next to her, use the gait belt, and assist her to sit. Stay with her, keep the door or curtain partly open, and keep the call light within reach.
  • Give her privacy of sound, not of person - talk her through it calmly, and do not rush her.
  • If she cannot be safely transferred alone, sit her on the commode beside the bed and use the call light for a second set of hands. A commode at the bedside is always safer than a solo walk down a wet hall.

Do not

  • Do not put her back in bed and tell her to use the brief.
  • Do not leave her alone on the toilet with the door shut.
  • Do not apply any restraint or lap belt, and do not tip the walker or chair to keep her in place.
  • Do not skip the scheduled 0200 toileting tomorrow 'because she was asleep.'

Reasoning: the unmet need to urinate is usually the reason a resident with dementia gets up - the behavior is not random. Meeting the need is the fall-prevention intervention. Restraints require an order, are not a fall precaution, and typically increase injury when the resident climbs over them. Charting 'redirected' hides the real pattern; charting 'awake, incontinent of urine, toileted on commode, no injury' gives the nurse and therapy something to act on.

3. The puddle, and then the end of shift. What do you do about the water and what goes in your report?

Read the worked answer

The water

  • Once she is seated safely, absorb what you can with towels within reach while keeping her in sight. Do not walk away to the janitor's closet leaving her alone.
  • Ask the nurse, when she arrives, to bring a mop and wet-floor sign; finish the cleanup and dry the floor completely before either of you leaves the room.
  • Then sweep the room for the other fall hazards: walker tips, footwear, glasses, hearing aids, call light cord, the water pitcher placed within reach of the bed.

The report (to the nurse before you leave the unit)

  • Time the alarm sounded, what you found on arrival, that the floor was wet.
  • No injury; incontinent of urine; toileted on the commode; able to bear weight.
  • Floor cleaned; pitcher relocated.
  • A request: increased rounding or a 0100/0200 toileting check, and a nurse reassessment of her fall risk.

Reasoning: this is a near-miss that happened because a scheduled intervention (0200 toileting) did not occur. Reporting only 'alarm sounded, resident safe' hides the cause and guarantees a repeat. Write what happened and what you did, in objective, time-stamped terms - not 'resident was confused and difficult.'