New Weakness and a Toileting Request
Mrs. L is 82, has Alzheimer's disease, and normally walks 15 feet to the bathroom with a walker and one aide. This morning she is restless, repeats 'I need to go now,' and tries to stand before you can put on the gait belt. You notice her right hand grip is weaker than yesterday, her speech is slightly slurred, and she is unsteady when she bears weight. Her BP is 150/88, pulse 96, temp 98.6°F, respirations 20. She has had only 200 mL of urine since midnight. The call light is within reach, but no coworker is nearby.
1. What is your first priority in the next 60 seconds, and what will you do? Explain why.
Read the worked answer
Priority: keep her from falling and get help for a possible sudden neurologic change.
- Do not let her stand or try to walk her alone. Guide her back to the bed or chair, staying at her side and using the gait belt if she is already up.
- Use the call light or call out for help; do not leave her alone in the room.
- Note the time you first saw the right-hand weakness and slurred speech. New one-sided weakness plus speech change is an emergency until proven otherwise.
- Keep her NPO until the nurse assesses her; do not give food or fluids.
- Reassure her and keep the bed low, brakes locked, and call light in reach.
Reasoning: A CNA cannot diagnose stroke, but a new unequal grip, slurred speech, and unsteadiness are a change from baseline that requires immediate nurse evaluation. Safety and urgent reporting come before completing the toileting task.
2. What will you report to the nurse, and how will you frame the report?
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Report using SBAR and state that this is a change from yesterday.
- Situation: Mrs. L is trying to get up alone and needs to toilet; she has new right-hand weakness, slurred speech, and unsteady standing.
- Background: Alzheimer's disease; usually walks 15 feet with a walker and one aide; vitals BP 150/88, pulse 96, temp 98.6°F, respirations 20; only 200 mL urine since midnight.
- Assessment: She is restless and attempting to stand; symptoms began this morning; I kept her from walking and stayed with her.
- Recommendation: Please come assess her now and tell me whether she can use a bedpan or commode and whether a second staff member is needed.
Do not say 'she had a stroke.' Report what you see, when it started, and what you did. Ask for immediate evaluation.
3. How will you help her toilet safely while waiting for the nurse?
Read the worked answer
Do not walk her to the bathroom while she has new weakness and unsteadiness.
- Stay with her and keep her in bed or a chair with the call light in reach.
- Offer a bedpan or urinal, or a commode at the bedside only if the nurse approves and a second staff member can assist safely.
- Provide privacy, but remain nearby because she is restless and may try to get up.
- If she refuses the bedpan, check on her frequently and tell the nurse; do not leave her unattended on the toilet.
- Document the toileting assistance, her refusal or acceptance, and any incontinence.
Reasoning: The safer choice is a toileting method that does not require her to bear weight and walk until the nurse evaluates the new weakness.