Alabama CNA cheat sheet

Normal adult ranges: oral temperature 97.6-99.6 degrees F, pulse 60-100 beats per minute, respirations 12-20 per minute, blood pressure below 120/80 mmHg, oxygen saturation 95% or higher.

Pulse and respiration rule: count 30 seconds and multiply by 2 when regular; count a full 60 seconds when irregular. Never tell the resident you are counting respirations.

Hand hygiene: soap and friction for at least 20 seconds, cleaning between fingers and under nails; perform before and after every resident contact and after glove removal.

Blood pressure technique: cuff width about 40% of arm circumference; inflate 30 mmHg above the point the radial pulse disappears, then deflate slowly at 2-3 mmHg per second.

Pressure injury staging: stage 1 = intact skin with non-blanchable erythema; stage 2 = partial-thickness loss; stage 3 = full-thickness loss; stage 4 = extends to fascia, muscle, or bone; unstageable = covered by slough or eschar.

Reposition at least every 2 hours, lift rather than drag using a draw sheet, keep heels floated off the mattress, and keep bony prominences off pressure points.

Restraint rule: only with a physician order and only after less restrictive measures fail; release and reposition every 2 hours, check circulation at least every 15 minutes, never tie to side rails.

Urinary catheter rule: drainage bag below bladder level and off the floor, tubing free of kinks, empty at least every 8 hours, perineal care daily and after each bowel movement.

Fluid conversion: 1 ounce = 30 mL, a standard 8-ounce cup = 240 mL; record all intake and output in milliliters on the flow sheet.

Maslow order: physiological needs, then safety, love and belonging, esteem, self-actualization; an unmet lower-level need such as pain or hunger is addressed before higher-level needs.

Erikson's older-adult task is integrity versus despair; the outcome depends on accepting one's life, and listening to life review supports it.

Kubler-Ross stages: denial, anger, bargaining, depression, acceptance; they are not sequential and a resident may move back and forth among them.

Depression is not normal aging: low mood, loss of interest, appetite or sleep change, and hopelessness lasting 2 weeks or more are reported to the nurse.

Any statement of intent to harm self or others is an emergency: stay with the resident, do not promise secrecy, and notify the charge nurse immediately.

Defense mechanisms to recognize include denial, regression, projection, rationalization, and displacement; accept the mechanism and address the feeling instead of arguing with the content.

Anger escalation rule: stay calm, lower your voice, keep an exit path, acknowledge the feeling, offer simple choices; leave and report if threats or violence occur.

Intimacy rule: consenting adults keep the right to privacy; knock, close the door or curtain, avoid judgmental comments, and report any sign of coercion or inability to consent.

Behavior change first step: check pain, hunger, thirst, toileting, constipation, fatigue, noise, or a break in routine before labeling the behavior as psychiatric.

Delirium versus dementia: delirium is sudden, fluctuating, and often reversible (infection, dehydration, medication, pain); dementia is gradual, progressive, and irreversible.

Alzheimer's disease is the most common cause of dementia, about 60-80% of cases; vascular dementia is the second most common.

Dementia stages: mild (memory lapses, ADLs intact), moderate (wandering, behavior changes, ADL assistance), severe (total care, dysphagia, incontinence, minimal speech).

Validation versus reality orientation: use validation (accept the feeling, do not correct facts) in moderate-to-late dementia; use gentle reality orientation only for mild confusion or delirium.

Sundowning rule: late-day confusion is reduced by consistent routines, daytime light exposure, quiet evenings, limited caffeine, and avoiding late naps.

Wandering is never managed with restraints; use identification bracelets, alarmed exits, safe walking paths, and supervised activity, and check for bathroom or exit-seeking needs.

Communication rule: one idea per sentence, yes-or-no questions, eye level facing the resident, at least 30 seconds to respond, never argue about factual errors.

Behavior is communication: look for pain, constipation, urinary retention, hunger, fatigue, or overstimulation first, then follow the care plan before asking for medication.

Environment safety: lock medications and cleaning supplies, supervise smoking, set the water heater at 120 degrees F or lower, and remove throw rugs and clutter.

Restorative rule: the resident does as much as possible; give the least assistance that is safe instead of completing the task for them.

Range of motion: active = resident moves the joint; passive = aide moves the joint; perform each motion 3-5 times as ordered, slowly, stopping at pain or resistance.

Contracture prevention: daily range of motion, alignment with pillows, splints or hand rolls as ordered, and repositioning at least every 2 hours.

Ambulation rule: gait belt around the waist over clothing, stand on the resident's weaker side and slightly behind, and never let the resident hold your neck or clothing.

Cane rule: cane in the stronger hand; advance the cane and weaker leg together, then step through with the stronger leg.

Walker rule: lift and place the walker about one arm's length ahead, step into it, keep the back straight; a walker is not used to pull up from a chair.

Positioning angles: semi-Fowler's = 30-45 degrees, Fowler's = 45-60 degrees, high Fowler's = 60-90 degrees; upright sitting is required for eating and eases shortness of breath.

Bowel and bladder training: scheduled toileting based on the resident's usual pattern, adequate fluid and fiber, prompt response to the call light, and recorded continence patterns.

Splint and brace check: apply exactly as ordered, remove for skin care per the care plan, and inspect the skin beneath for redness, swelling, or pressure each shift.

OBRA 1987 (Nursing Home Reform Act) sets federal nursing home standards covering resident rights, individualized care planning, and survey inspections; aides are bound by these rights.

Resident rights include dignity, privacy, confidentiality, choice, freedom from abuse and unnecessary restraint, refusal of treatment, voicing grievances, and receiving visitors.

Abuse types: physical, sexual, verbal or emotional, financial, neglect, and involuntary seclusion; suspected abuse is reported immediately to the charge nurse and per Alabama law to state authorities.

Documentation rule: objective, factual, timely entries in black ink, signed and dated; correct errors with a single line and initials, never erase or use white-out.

Incident reports are completed factually for the facility record; do not chart that an incident report was filed and do not assign blame in the entry.

Chain of command: charge nurse, then RN supervisor, director of nursing, and administrator; a concern unresolved at one level moves up to the next.

HIPAA rule: disclose protected health information only to the care team on a need-to-know basis; no discussion in hallways, elevators, or on social media.

Informed consent is obtained by the licensed provider, not the aide; advance directives such as a living will or health care proxy must be honored, and a competent resident may refuse treatment.

Communication rule: address the resident directly, use open-ended questions, avoid medical jargon, and use a qualified interpreter when a language barrier exists.