Eating/Hygiene/Shower
Ms. S prefers to feed herself as much as she is capable. During all meals, after eating three-fourths of the meal by herself, Ms. S usually becomes extremely fatigued and requests assistance from the CNA to feed her the remainder of the meal.
03, Partial/moderate assistance
A CNA instructs Mr. D in the use of adaptive equipment to facilitate lower body dressing. He requires a helper to retrieve his clothing from the closet. Mr. D uses his adaptive equipment to assist in threading his legs into his pants. Because of balance issues, Mr. D needs the helper to steady him when standing to manage pulling on or pulling down his pants/undergarments. Mr. D also needs some assistance to put on and take off his socks and shoes.
04, Supervision or touching assistance.
Mr. A suffered multiple vertebral fractures. He requires assistance from a CNA to get from a sitting position to lying flat on the bed. The CNA supports his trunk and lifts both legs to assist Mr. A from sitting at the side of the bed to lying flat on the bed. Mr. A assists himself a small amount by raising one leg onto the bed and then bending both knees while transitioning into a lying position.
02, Substantial/maximal assistance
Mr. U uses a transfer board for chair/bed-to-chair transfers. The CNA places the transfer board under his buttock. Mr. U then attempts to scoot from the bed onto the transfer board. Mr. U has reduced sensation in his hands and limited upper body strength, but assists with the transfer. The CNA assists him in side scooting by lifting his trunk in a rocking motion across the transfer board and into the wheelchair.
02, Substantial/maximal assistance
True and false? A rock N Go and a Geri chair are considered wheel chairs and should be coded as such?
False
Mr. W is edentulous (without teeth) and his dentures no longer fit his gums. In the morning and evening, Mr. W begins to brush his upper gums after the helper applies toothpaste onto his toothbrush. He brushes his upper gums, but cannot finish due to fatigue. The CNA completes the activity of oral hygiene by brushing his back upper gums and his lower gums.
02, Substantial/maximal assistance
Mrs. Z wears a bra and a sweatshirt most days while in the SNF. She requires assistance from a certified nursing assistant to initiate the threading of her arms into her bra. Mrs. Z completes the placement of the bra over her chest. The helper hooks the bra clasps. Mrs. Z pulls the sweatshirt over her arms, head, and trunk. When undressing, Mrs. Z removes the sweatshirt, with the helper assisting her with one sleeve. Mrs. Z slides the bra off, once it has been unclasped by the help
03, Partial/moderate assistance
Mrs. G suffered a traumatic brain injury three months prior to admission. She requires the CNA to steady her movements from sitting on the side of the bed to lying flat on the bed. Mrs. G requires steadying (touching) assistance throughout the completion of this activity.
04, Supervision or touching assistance
Walk 50 feet with two turns: Mrs. U has an above-the-knee amputation, severe rheumatoid arthritis, and uses a prosthesis. Mrs. U is assisted to stand and, after walking 10 feet, requires progressively more help as she nears the 50-foot mark. Mrs. U is unsteady and typically loses her balance when turning, requiring significant support to remain upright. The therapist provides significant trunk support for about 30 to 35 feet.
02, Substantial/maximal assistance
True or false? Residents should be allowed to perform activities as independently as possible, as long as they are safe.
True
Mrs. J uses a bedside commode. The CNA provides steadying (touching) assistance as Mrs. J pulls down her pants and underwear before sitting down on the toilet. When Mrs. J is finished voiding or having a bowel movement, the CNA provides steadying assistance as Mrs. J wipes her perineal area and pulls up her pants and underwear without assistance.
04, Supervision or touching assistance
Mr. K sustained a spinal cord injury that has affected both movement and strength in both upper extremities. He places his left hand into one-third of his left sleeve of his shirt with much time and effort and is unable to continue with the activity. A certified nursing assistant then completes the remaining upper body dressing for Mr. K
02, Substantial/maximal assistance.
Mr. B pushes up on the bed to attempt to get himself from a lying to a seated position as the occupational therapist provides much of the lifting assistance necessary for him to sit upright. The occupational therapist provides additional lifting assistance as Mr. B scoots himself to the edge of the bed and lowers his feet to the floor
02, Substantial/maximal assistance
Mrs. Y is anxious about getting up to use the bathroom. She asks the CNA to stay with her in the bathroom as she gets on and off the toilet. The CNA stays with her, as requested, and provides verbal encouragement and instructions (cues) to Mrs. Y.
04, Supervision or touching assistance
Compression stocking/Ted hoses are consider lower body dressing or footwear?
Compression stockings (considered footwear because of dressing don/doff over foot).
The dietary aide opens all of Mr. S’s cartons and containers on his food tray before leaving the room. There are no safety concerns regarding Mr. S’s ability to eat. Mr. S eats the food himself, bringing the food to his mouth using appropriate utensils and swallowing the food safely
05, Setup or clean-up assistance
Mrs. M has severe rheumatoid arthritis and multiple fractures and sprains due to a fall. She has been issued a knee brace, to be worn during the day. Mrs. M threads her legs into her garments, and pulls up and down her clothing to and from just below her hips. Only a little assistance from a helper is needed to pull up her garments over her hips. Mrs. M requires the helper to fasten her knee brace because of grasp and fine motor weakness.
03, Partial/moderate assistance.
Mrs. P is recovering from Guillain-Barre Syndrome with residual lower body weakness. The CNA steadies Mrs. P’s trunk as she gets to a fully upright sitting position on the bed and lifts each leg toward the edge of the bed. Mrs. P then scoots toward the edge of the bed and places both feet flat on the floor. Mrs. P completes most of the effort to get from lying to sitting on the side of the bed.
03, Partial/moderate assistance
Mrs. T has an unsteady gait due to balance impairment. Mrs. T walks the length of the hallway using her quad cane in her right hand. The physical therapist supports her trunk, helping her to maintain her balance while ambulating. The therapist provides less than half of the effort to walk the 160-foot distance.
:03, Partial/moderate assistance
Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.
02 Substantial/maximal
Resident requests the use of a bedpan when voiding or having bowel movements and requires two CNAs to pull down his pants and underwear and mobilize him onto and off the bedpan. Mr. J is unable to complete any of his perineal/perianal hygiene. Both certified nursing assistants help Mr. J pull up his underwear and pants.
01, Dependent
Mr. M wears an ankle-foot orthosis that he puts on his foot and ankle after he puts on his socks but before he puts on his shoes. He always places his AFO, socks, and shoes within easy reach of his bed. While sitting on the bed, he needs to bend over to put on and take off his AFO, socks, and shoes, and he occasionally loses his sitting balance, requiring staff to place their hands on him to maintain his balance while performing this task.
04, Supervision or touching assistance.
CNA helps resident turn onto their right side by instructing them to bend their right leg and roll onto their right side. The CNA then instructs them how to position their limbs to return to a lying on their back and then to repeat a similar process for rolling onto their left side and then return to lying on their back. Resident is able to return to lying on their back from their right side.
04, supervision or touch assist
Mr. B is currently unable to stand when getting out of bed. He transfers from his bed into a wheelchair with assistance. The activity of sit to stand is not attempted due to his medical condition
Coding: 88, Not attempted due to medical condition or safety concerns
True or false? When charting toilet hygiene with a resident with a catheter- toileting hygiene includes perineal hygiene to the indwelling catheter site, but not management of the equipment.
True