GNA 10 cheat sheet

Normal adult vital sign ranges: oral temperature 97.6-99.6°F (36.5-37.5°C); pulse 60-100 beats/min; respirations 12-20 breaths/min; blood pressure less than 120/80 mmHg; oxygen saturation 95-100%.

Count respirations for a full 60 seconds; count pulse for 60 seconds when irregular, otherwise 30 seconds and multiply by 2.

Blood pressure cuff width should be about 40% of arm circumference; a cuff that is too small yields falsely high readings.

When taking an oral temperature, wait 15-30 minutes after the resident smokes, eats, or drinks hot or cold fluids.

Intake and output are recorded in milliliters; 1 ounce equals 30 mL, 1 cup equals 240 mL, and 1 teaspoon equals 5 mL.

Hand hygiene with soap and water for at least 20 seconds is required when hands are visibly soiled or after caring for a resident with C. difficile; alcohol-based rub is used otherwise.

Standard precautions apply to all residents: gloves for contact with blood, body fluids, mucous membranes, or non-intact skin; change gloves between tasks and after contact with contaminated material.

When measuring weight, use the same scale, same time of day, and similar clothing each time; report a gain or loss of 3-5 pounds in a week or 5% of body weight in a month.

Provide privacy by closing the door, pulling the curtain, and exposing only the body part being washed.

Wash from cleanest to dirtiest: face and neck first, then arms and trunk, then legs, and lastly the perineal area.

Use warm, not hot, water and check temperature with the inner wrist before bathing a resident.

When dressing a resident with a weak side, put the garment on the weak arm first and remove it from the strong arm first.

Oral care for an unconscious resident: turn the head to the side, use a toothbrush or swab, do not use toothpaste, and suction as needed.

Denture care: remove dentures with a washcloth or gauze to prevent slipping, clean over a basin of water or a towel, and store in a labeled cup when not in the mouth.

Nail care for residents with diabetes or poor circulation is performed only by a nurse or podiatrist; never cut corns or calluses.

Offer the bedpan or urinal at least every 2 hours and before meals and sleep; answer call lights promptly to prevent incontinence and falls.

Restorative care focuses on maintaining or improving function lost through illness or injury, not on curing disease.

Encourage the resident to do as much self-care as possible; provide assistive devices such as a reacher, long-handled sponge, or adaptive utensils.

Range-of-motion exercises are performed to the point of resistance, never beyond, and never on a joint that is swollen or painful without a nurse's direction.

When transferring a resident, use a gait belt, keep the resident's feet flat, and bend at the knees while keeping the back straight.

Ambulation: walk on the resident's weaker side, slightly behind, with a hand on the gait belt.

Positioning for a resident in bed: change position at least every 2 hours; use pillows to keep body parts in alignment and prevent pressure on bony prominences.

A cane is held on the stronger side and moved forward with the weaker leg; a walker is picked up and placed forward, then the resident steps into it.

Report to the nurse any change in the resident's ability to perform ADLs, such as new weakness or refusal to participate in therapy.

Depression signs in older adults include persistent sadness, loss of interest, changes in appetite or sleep, and statements of hopelessness; report these to the nurse.

Do not argue with a resident who has delusions or hallucinations; acknowledge the feeling and redirect to a safe topic or activity.

Anxiety may present as restlessness, pacing, sweating, or rapid breathing; stay with the resident and use calm, short sentences.

Suicidal statements or gestures are always taken seriously and reported immediately to the nurse and social worker.

Residents with substance use disorders may need referral to social services; report signs of withdrawal such as tremors, sweating, and agitation.

Encourage social interaction through group activities, but respect a resident's right to decline.

When a resident is grieving, listen without judgment and allow expressions of sadness; do not tell the resident to 'cheer up'.

Confusion that comes on suddenly (within hours or days) may be delirium from infection, dehydration, or medication and requires immediate nurse notification.

For a resident with dementia, approach from the front, make eye contact, state your name, and use short, simple sentences.

Use validation rather than correction: if the resident says a deceased spouse is coming, respond to the feeling rather than arguing about reality.

Maintain a consistent routine and place familiar objects in the same location to reduce confusion.

Use redirection for unsafe behavior: offer a snack, a walk, or another activity instead of saying 'no'.

Wandering is a safety risk; ensure the resident wears identification, keep the environment safe, and report wandering patterns to the nurse.

Sundowning is increased confusion in late afternoon or evening; reduce noise and lighting changes, and provide calm activities before dusk.

When assisting with eating, sit at eye level, give one food item at a time, and allow enough time; check for pocketing of food.

Never restrain a resident or lock doors to prevent wandering without a physician's order and family consent; report the need to the nurse.

Use active listening: face the speaker, maintain eye contact, nod, and repeat back the message to confirm understanding.

When speaking with a hearing-impaired resident, face them, speak clearly and slowly, lower the pitch of your voice, and avoid shouting.

Use open-ended questions to encourage expression and closed questions to obtain specific facts.

Avoid medical jargon; use simple, everyday words and explain procedures before performing them.

Give the resident time to respond; do not finish sentences or interrupt.

Report changes in condition using SBAR: Situation, Background, Assessment, Recommendation.

When a resident expresses a concern, acknowledge it and follow up; do not promise things you cannot deliver.

Cultural differences affect communication: ask about preferences for touch, eye contact, and family involvement.

Residents have the right to be informed of and participate in their care plan, to refuse treatment, and to be free from abuse and neglect.

Confidentiality: do not discuss a resident's information in public areas or with other residents; share only with the care team.

Residents have the right to privacy during care, visits, mail, and telephone calls.

Residents may keep and use personal possessions and manage their own money unless a legal guardian is appointed.

Residents have the right to voice grievances without fear of retaliation; report complaints to the nurse or administrator.

Encourage independence by allowing residents to make choices, such as what to wear or when to get up, whenever safe.

Residents have the right to refuse food, medication, or care; document the refusal and notify the nurse.

Mandatory reporting: any suspected abuse, neglect, or exploitation must be reported immediately to the nurse and administration.

Fire safety: RACE - Rescue anyone in immediate danger, Activate the alarm, Contain the fire by closing doors, Extinguish or Evacuate.

Use a fire extinguisher with PASS: Pull the pin, Aim at the base of the fire, Squeeze the handle, Sweep from side to side.

Fall prevention: keep the bed in the lowest position, wheels locked, call light within reach, and floor free of clutter.

Never leave a resident unattended in a bathtub or on a toilet; stay within arm's reach.

Choking: for a conscious adult, give abdominal thrusts (Heimlich maneuver); for an unconscious resident, lower to the floor and begin CPR.

When a resident falls, do not move them until you assess for injury; call for the nurse immediately and stay with the resident.

Oxygen safety: post 'No Smoking' signs, keep oxygen away from heat and open flames, and do not use petroleum-based products on the face or nose.

Seizure precautions: lower the resident to the floor, protect the head, do not restrain or put anything in the mouth, and time the seizure.