The Resident Who Wants to Wash Her Own Face
Mrs. Alvarez, 78, had a stroke four weeks ago and has left-sided weakness and a contracted left hand. She is on a 7:00 a.m. schedule with three other residents who must be up, washed, and dressed before breakfast at 7:45. This morning she tells you, "I want to wash my own face and brush my own teeth." Her right hand works well; her left hand cannot hold a washcloth. She is wearing a soft foam splint on the left hand that the nurse applied yesterday. Breakfast trays arrive in 25 minutes, she has not yet been toileted, and two residents on your assignment are still in bed.
1. It is 7:20 and you still have two other residents to get up. What do you do about Mrs. Alvarez's request to wash her own face, and why?
Read the worked answer
Let her do it. Washing her face and brushing her teeth are ADLs she can still perform with her strong right hand, and protecting that independence is part of the care plan and her rights as a resident.
- Set her up: warm water, soap, washcloth, toothbrush and paste, emesis basin, all on her right side within reach. Put the washcloth in her right hand.
- Do only the parts she cannot: her left arm and hand (never force the contracted hand open), her back, and perineal care. Then step back and let her finish at her own pace.
- Do not take over to save time. Finishing for her is faster for you and worse for her: it teaches helplessness and ignores her right to make choices about her own care. Do not tell her she is too slow.
- If 7:45 is at risk, tell the nurse or charge nurse that the schedule needs adjusting or that you need help. Never rush a resident or skip toileting to stay on time.
2. Before you dress her, what must you check and report about the splint and her left arm?
Read the worked answer
The splint was applied by the nurse, so it stays on and stays as it is unless the nurse or therapist says otherwise. A CNA does not remove, loosen, or reposition it.
Check and report:
- Skin under and around the splint: redness (especially over bony points), pallor, warmth, swelling, blisters, drainage, or odor.
- The hand: color, temperature, swelling, capillary refill, and whether she reports numbness, tingling, or pain - signs the splint is too tight.
- The splint itself: soiled, wet, or broken, which requires the nurse to change it.
- New pain when you move her arm.
Report findings to the nurse before dressing and document what you saw and to whom you reported. When dressing, put the sleeve on the weak (left) side first and ease it over the splint rather than pulling the contracted hand through.
3. Mrs. Alvarez now says she needs to use the bathroom right away, and breakfast is about to arrive. What do you do?
Read the worked answer
Take her now. Do not ask her to wait until after breakfast and do not tell her she should have gone earlier - continence and dignity are not negotiable against a tray schedule.
- Assist her to the toilet before dressing if her brief is soiled, or after if she is dry; either way she goes before the meal.
- She has left-sided weakness: stand on her weak (left) side, apply the gait belt, and let her use her right hand on the grab bar.
- Give privacy but stay within hearing; do not leave her alone and unattended if she is a fall risk.
- Watch for dizziness or straining; report constipation or pain.
- Assist with hand hygiene afterward and record urine and bowel output.
- If this pushes breakfast late, that is a staffing/schedule problem to report, not a reason to hurry her.