Specialized Care

As a CNA you may have to work with patients with serious physical and mental issues. You will need specialized care skills to work with these types of patients. We’ll walk through a high level overview of the types of physical and psychological problems that require specialized CNA skills.

Psychological Problems

Issues that affect one’s thinking and behavior can have a significant impact on a patient’s health and wellbeing. As a CNA, you’ll need to be able to recognize these conditions that post a danger to your patients. 

  • Confusion. Patients can become confused for a variety of reasons ranging from hypoxia (a lack of oxygen) to Sundowner’s Syndrome to cultural barriers. For their safety, it’s important that CNAs help orient them by reminding them of who they are, where they are, and the current date and time. If residents are confused, you can also assist them by removing any hazards that might harm them during their confusion.
  • Aggression. Aggression can come hand in hand with confusion. CNAs need to know how to recognize the signs of building anger and how to diffuse or manage situations with aggressive patients. If you are able to leave, that is preferable. If not, maintain your calm and do not return any hostilities. Speak in a calm, clear voice and try to talk them down while paying close attention to what they are saying to you so you can acknowledge what is driving their aggression. You may need to get special training for learning how to restrain especially combative patients.
  • Dementia. The progressive loss of mental abilities from Alzheimer’s and dementia can lead to a number of potential problems for patients and CNAs. These patients can lose the ability to remember things, make rational judgments, maintain their orientation, and socialize. Along with the loss of ability comes a range of emotions from anger, to depression to suspicion. Dementia can ultimately lead to complete immobility. CNAs must provide special care for these patients to protect them from accidents and injuries, help maintain their routines, and provide emotional support.
  • Depression. Some common symptoms of depression in patients include extreme sleep habits (too much or too little), poor hygiene, changes in appetite and body weight, extreme sadness, and social withdrawal. Many older people begin experiencing this with loss of physical abilities, independence, or the advancement of chronic health problems. CNAs can help provide care for depressed patients by encouraging them to discuss their feelings, being a good listener, encouraging and helping with personal care, motivating them to stay active, removing items that could lead to self-harm, and offering realistic reassurances for their condition.
  • Terminal illness. When a patient knows they are facing death there are many issues that come into play. End of life issues may be decided by legally binding documents, or it may fall on relatives to make these difficult decisions. As a healthcare worker, it’s important to follow the orders set forth in any legally binding documents, such as a do not resuscitate (DNR) order. Terminally ill patients need holistic care, covering needs ranging from pain management, emotional support, nutrition, personal care, and assistance with activities of daily living when possible. Perhaps most importantly, you’ll need to customize care to the patient’s needs. Terminally ill patients need rest but monitor their behaviors and conditions carefully to help keep them comfortable and safe.

Physical Problems

Over the course of time chronic conditions and injuries can take their toll on the main systems that help keep us alive and functioning. We’ll review some of the more common chronic physical issues that patients encounter.

  • Vision. It’s not uncommon to work with people with visual impairments from conditions like glaucoma, cataracts or complications from diabetes. When working with these patients there are tasks you can do to help ensure their safety and comfort. This includes maintaining adequate lighting, keeping eyeglasses and magnifying glasses clean and well maintained, always announcing yourself when entering their room, avoiding clutter in their surroundings, and in some cases assisting them with eating.
  • Hearing. For patients who have issues with hearing there are many things you can do to improve your communication with them. Turn off anything causing background noise, speak clearly and at a steady pace in a low tone, use short statements, use visual aids when necessary like notepads or whiteboards, ensure hearing aids are properly cleaned and maintained, and confirm the patient’s understanding by having them repeat back to you.
  • Speech. Some patients may have trouble speaking due to complications from a stroke, Alzheimer’s or other medical conditions. While it can be difficult to communicate with a patient with a speech impairment, you must remember to be patient with them. They can still understand you, and they may get frustrated as well. When possible, use assistive devices and encourage them to use their other senses or abilities to communicate their needs.
  • Respiratory. Patients may have short term or long term respiratory issues. Long term issues may be a chronic disease like COPD or emphysema. Many of these patients will receive oxygen therapy and you will need to maintain a safe environment as oxygen is highly flammable. Short term respiratory issues can be caused by allergies, medical conditions, or even choking. To avoid acute or short term respiratory issues, pay attention to patients receiving oxygen therapy – note the ease of their respirations, skin color, and alertness. If you see something that is out of the ordinary, report it immediately. When a resident is choking you may need to perform the Heimlich maneuver.
  • Cardiovascular. Heart disease, hypertension, and circulatory issues are among the most common killers in the United States. Heart disease occurs when circulation is blocked by diseased arteries which leads to a whole host of other serious health issues. Hypertension, or high blood pressure, can lead to strokes and damage organs. Circulatory issues like blood clots can also cause pain, swelling, discomfort, and strokes. As a CNA, accurate reporting of pulse rates and rhythms, noting abnormalities, and carefully following dietary restrictions and care plans is critical for these patients.
  • Paralysis. People who have lost the ability to move all or part of their bodies may struggle to perform typical activities of daily living. This can be caused by any number of injuries or diseases. With the inability to move comes a greater risk for pneumonia, pressure ulcers, incontinence, and difficulty swallowing. CNAs need to work with these patients to encourage independence and self-care whenever possible and help promote a positive, reassuring environment.
  • Digestion and elimination. Diseases and injuries that impact digestion and elimination can have serious consequences. Conditions such as pancreatitis, hepatitis, or gall bladder disease can lead to everything from jaundice to death. To ensure proper nutrition and elimination, patients will be fitted with an IV to receive medication and nutrition. As a CNA, you won’t be dealing with the IV, but as you clean the resident or change their gown you will need to be careful not to dislodge the IV and you’ll need to report any signs of infection or issues with the IV.  
  • Digestive and urinary tract cancers. Some patients who are recovering from cancers of the bladder or kidneys may require total parenteral nutrition tube in their nose in the short term or a gastronomy tube in their stomach for longer recoveries. In some instances, these patients will not be able to receive food or fluids by mouth which will require oral care from a CNA every two hours to protect the skin and the mucous membrane. For patients who can no longer eliminate urine or stool, they may require an ostomy that diverts urine and feces. This is a dramatic change for patients, so providing emotional support can be critical for these patients as they get used to this new process. 
  • Chronic disease. CNAs will sometimes have to deal with patients dealing with chronic illnesses like kidney disease. Oftentimes, these diseases come with a long list of complications that can escalate quickly. With these patients, it’s important to observe and report changes in the patient’s vital signs, pain tolerance, diet, behavior, and any other notable issues like unusual urine or stool.
  • Diabetes. It’s been estimated that 10.5% of the United States population has diabetes. Diabetes is a disease that causes the pancreas to create insufficient insulin for the body to turn sugars and starches into energy. This creates dangerous imbalances in the body unless insulin is supplemented to maintain balance. Diabetes, even when treated can lead to an array of serious health issues including blindness, cardiovascular disease, and kidney failure. CNAs will need to help patients stick to their diets and be aware of signs of both low and high blood sugar (hypoglycemia and hyperglycemia, respectively) to help maintain the health of diabetic patients.  
  • HIV and AIDS. Patients who have been diagnosed with HIV and AIDS are at a higher risk of other serious illnesses due to a compromised immune system. While there are treatments for HIV and AIDS, they can be taxing. CNAs can help these patients by being empathetic and providing emotional support and a non-judgmental person to discuss their concerns.