CNA Gerontological Nursing cheat sheet

Normal aging changes: decreased cardiac output, reduced vital capacity, lower glomerular filtration rate, decreased bone density, thinner skin, slower reaction time.

Presbyopia (lens stiffening) and presbycusis (high-frequency hearing loss) are expected sensory changes, not disease.

Older adults often have atypical illness signs: confusion, falls, incontinence, or appetite loss may be the only presentation of infection.

Decreased thirst sensation and reduced kidney concentrating ability raise dehydration risk even when intake seems adequate.

Skin becomes fragile with reduced elasticity and subcutaneous fat, so tape, friction, and pressure cause injury faster.

Body temperature regulation declines; infection may present without fever, and hypothermia risk rises in cool rooms.

Homeostasis reserve is reduced, so small fluid, electrolyte, or medication shifts cause larger functional changes.

Functional status (ADLs and IADLs) is a better health indicator than chronological age.

For hearing loss: face the person, speak at normal volume but slower, lower pitch, avoid covering the mouth, reduce background noise.

Do not assume hearing loss from confusion; screen by speaking clearly first, then use written words if needed.

Aphasia: allow extra time, use yes/no questions, gestures, and pictures; never finish sentences for the resident.

Use resident-preferred name and title unless invited otherwise; address the resident, not only the companion.

Dementia communication: one instruction at a time, short sentences, validation of feelings, redirect rather than argue.

Interpreters or translated materials are required when the resident is not fluent; family children should not be used as interpreters for consent.

Nonverbal cues (eye contact, tone, touch) carry much meaning; approach from the front at eye level to avoid startling.

Document communication barriers and effective strategies in the care plan so all staff use the same approach.

Provide care in the order the resident prefers when possible; encourage independence and only assist with what the resident cannot do.

Bathing: check water temperature (about 100-105°F/38-40°C), test with wrist or thermometer, and never leave the resident alone in the tub.

Perineal care is always front to back to prevent urinary tract infection; use a new washcloth for each stroke.

Pressure injury risk: reposition at least every 2 hours in bed and every 1 hour in a chair; keep skin clean and dry.

Oral care is needed even for edentulous residents; dentures are cleaned over a basin of water to prevent breakage.

Dressing: dress the affected (weak) side first, undress it last; use adaptive devices to preserve independence.

Toileting schedules and prompt response to call lights reduce incontinence and fall risk.

Report skin redness, blisters, or unrelieved pressure areas; do not massage reddened bony prominences.

Before ambulation: non-skid footwear, clear path, bed at lowest height, brakes locked, gait belt applied.

Standing order is up from the bed: roll to side, dangle legs, sit at edge, stand with support, then walk.

Fall risk factors: sedatives, orthostatic hypotension, urinary urgency, poor vision, clutter, and prior falls.

Do not use bed rails, restraints, or locked doors as fall prevention without a specific ordered and reviewed plan; least restrictive option first.

Assistive devices: cane held on the stronger side; walker should be picked up and placed ahead, then step into it.

Wheelchair safety: lock brakes before transfers, swing footrests away, and back the chair down ramps or curbs.

Orthostatic hypotension: have the resident sit up slowly and dangle before standing, especially after bed rest.

Report any fall immediately even if the resident appears uninjured; internal injury may not be visible.

Offer fluids frequently; older adults may not feel thirst. Typical goal is roughly 1,500-2,000 mL/day unless fluid restriction is ordered.

Signs of dehydration: dry mouth, dark concentrated urine, confusion, poor skin turgor, weight loss, low blood pressure.

Dysphagia: sit upright at least 90 degrees, chin tucked, small bites, and remain upright 30 minutes after eating.

Thickened liquids and mechanical soft diets are ordered by a clinician; never change consistency on your own.

Weigh residents at the same time, same scale, and similar clothing; report unplanned weight loss promptly.

Denture fit, oral pain, and ill-fitting plates reduce intake; check mouth before blaming appetite.

Food safety: check expiration dates, keep hot foods hot and cold foods cold, and follow special diets strictly.

Document percentage of meal eaten and fluid intake accurately; intake records guide nutrition interventions.

The five rights: right resident, right medication, right dose, right route, right time (plus right documentation).

Verify identity using two identifiers, such as name and date of birth, not room number.

Never crush, split, or alter a medication unless the prescriber and pharmacist confirm it is safe.

Observe and report side effects: new confusion, rash, diarrhea, dizziness, or changes in behavior after a new drug.

Do not leave medications at the bedside; stay with the resident until the dose is taken.

Nursing assistants may assist with self-administration only where state law and facility policy allow; they do not administer.

Medication errors must be reported immediately to the nurse; never hide or delay reporting.

Store medications securely and per policy; controlled substances require counting and witnessing.

Depression in older adults may present as pain, insomnia, appetite loss, or irritability rather than sadness.

Warning signs of suicide risk: giving away possessions, hopeless statements, withdrawal; report immediately.

Dementia behaviors are communication; look for unmet needs such as pain, hunger, toileting, or overstimulation.

Validation therapy accepts the resident's feelings and reality; arguing with delusions increases distress.

Provide routine and orientation cues (clocks, calendars, natural light) to reduce confusion and sundowning.

Encourage social contact, activities matched to ability, and independence to support identity and mood.

Delirium is sudden and fluctuating with altered attention; dementia is gradual and progressive. Report sudden change.

Grief and loss are common; listen, allow expression, and report persistent withdrawal or hopelessness.

Resident rights include dignity, privacy, choice, voice, freedom from abuse and restraints, and access to records.

Abuse types: physical, sexual, verbal, emotional, financial, neglect, and involuntary seclusion.

Mandatory reporting: any suspected abuse, neglect, or exploitation must be reported to the nurse and per facility/state rules.

Never accept money, gifts, or bequests from residents; this is a boundary and potential exploitation issue.

Confidentiality applies to all resident information; discuss care only in private and only with those who need to know.

Informed consent must be voluntary and given by a capable resident; the assistant's role is to support choice, not decide.

Restraints require a physician order, least restrictive alternative trial, monitoring, and regular review.

Advance directives and living wills guide care; know where they are kept and honor documented wishes.

Hand hygiene is the single most effective infection control measure; use soap and water or alcohol-based rub per policy.

Standard precautions apply to all residents: gloves, gown, mask, eye protection when splash risk exists.

Wash hands after glove removal; gloves do not replace hand hygiene.

Isolation precautions: follow posted signs, keep door closed as directed, and use dedicated equipment.

Emergency sequence: recognize, call for help, start CPR if trained and permitted, and follow the emergency plan.

Choking: encourage coughing if able; if airway is blocked, use abdominal thrusts or back blows per training.

Falls, burns, and sudden confusion are emergencies; report immediately and document what was observed.

Fire safety: RACE (rescue, alarm, contain, evacuate/extinguish) and know evacuation routes and meeting points.