California CNA cheat sheet

Normal adult oral temperature is about 97.6-99.6 degrees F (36.5-37.5 C); rectal and tympanic readings run about 0.5-1 degree higher, axillary about 0.5-1 degree lower.

Pulse: if the rhythm is regular, count for 30 seconds and multiply by two; if irregular, count a full 60 seconds. Adult resting range is 60-100 beats per minute.

Respirations: count without telling the resident; one rise and fall equals one breath. Adult normal is 12-20 per minute; count a full minute if irregular.

Blood pressure: cuff on bare upper arm at heart level, bladder covering about 80 percent of arm circumference. Report systolic below 90 or above 160, diastolic above 100, or any reading far from the resident's baseline.

1 ounce equals 30 mL and an 8-ounce cup holds 240 mL. Record intake as oral fluids, tube feedings, and IV fluids; record output as urine, emesis, and drainage, all in mL.

Range of motion: move a joint only to the point of resistance or pain; never force it. Stop and report pain, jerking, or a sudden loss of motion.

Specimens: collect in a clean container, label with the resident's name, date, and time, and send promptly. Collect midstream clean-catch urine after cleansing the area.

Weigh residents on the same scale, at the same time of day, in the same amount of clothing; report unplanned weight gain or loss.

Report immediately: change in level of consciousness, new or worsening pain, skin color change, pulse or respirations outside the normal range, and any vital sign markedly different from the resident's usual reading.

Expose only the body part being washed and keep the rest covered. Wash the eyes from the inner canthus outward, using a clean portion of the cloth for each eye.

Perineal care is always front to back, using a clean part of the cloth for each stroke; for an uncircumcised resident, retract the foreskin to wash and replace it afterward.

Dentures: handle them over a sink lined with a towel or filled with water to prevent breakage; store them in a labeled cup covered with water; brush gums and tongue daily even if the resident is edentulous.

Nail care: soak to soften, then cut straight across and file edges. Do not trim the nails of residents with diabetes or poor circulation - refer to the nurse or podiatrist.

Shaving: use an electric razor unless the resident requests and can safely use a safety razor; lather the skin and shave in the direction of hair growth.

Turn and reposition residents who cannot move independently at least every two hours, more often if skin is fragile or the care plan specifies; check the skin at every turn.

Report any reddened area over a bony prominence that does not blanch when pressed - this is an early pressure injury.

Dress the weak or affected side first and undress that side last.

Oral care for an unconscious resident: turn the head to the side, use only a small amount of water, and never place fingers inside the mouth.

Provide privacy for every care task: knock, announce yourself, close the door and curtain, and drape the resident.

Core rights: dignity, privacy, confidentiality, personal choice, freedom from abuse and unnecessary restraints, access to one's own records, participation in care planning, and the right to voice grievances without retaliation.

A resident may refuse any care, treatment, or medication. Do not force or coax; accept the refusal, document it, and report it to the nurse.

Restraints require a physician's order, must be the least restrictive option, and must be released with repositioning and circulation checks at least every two hours.

Residents keep the right to manage their own money and possessions; the CNA safeguards belongings and never borrows or handles funds without following facility procedure.

Knock and announce before entering, close curtains and doors for care, and never discuss one resident's information with another resident or with uninvolved family.

Residents may file grievances without fear of retaliation; the CNA forwards complaints to the charge nurse, administrator, or long-term care ombudsman.

Any suspicion of abuse, neglect, or exploitation must be reported immediately to the charge nurse and administrator. CNAs are mandated reporters under California law, which also requires reporting to the state.

Residents must be informed of and allowed to take part in their care plan, including changes in condition, roommate selection, schedules, and activities.

Fire response is RACE: Rescue anyone in danger, Alarm by pulling the station, Contain the fire by closing doors, then Extinguish or Evacuate as directed.

Extinguisher use is PASS: Pull the pin, Aim at the base of the fire, Squeeze the handle, Sweep side to side.

Never use elevators during a fire. Evacuate horizontally to another zone on the same floor first, then vertically if directed.

Fall prevention: bed in the lowest position and locked, call light within reach, non-skid footwear, clear path, adequate lighting, and call lights answered promptly.

Conscious choking adult: abdominal thrusts. If the resident becomes unconscious, call for help and begin CPR per facility protocol.

Seizure: ease the resident to the floor, protect the head, do not restrain and put nothing in the mouth; after the seizure turn the resident to the side, check breathing, and report.

Oxygen safety: post a no-smoking sign, remove petroleum-based products, keep open flames and heat sources away, and check that electrical cords are not frayed.

Shock: pale, cool, clammy skin, rapid weak pulse, restlessness, shallow breathing, falling blood pressure. Lay the resident flat, elevate the legs, keep warm, and call the nurse.

After any accident, complete an incident report with objective facts and document the resident's condition and the care given in the medical record; do not file a copy of the incident report in the chart.

Wash hands with soap and water for at least 20 seconds; use alcohol-based rub only when hands are not visibly soiled. Perform hand hygiene before and after every resident contact and after glove removal.

Gloves never replace hand hygiene. Wear gloves for contact with blood, body fluids, non-intact skin, and mucous membranes.

Don PPE in this order: gown, mask, goggles, gloves. Remove in this order: gloves, goggles, gown, mask last - then perform hand hygiene.

Standard precautions apply to every resident regardless of diagnosis, because all blood and body fluids are treated as potentially infectious.

Sharps: never recap, bend, or break a needle by hand. Drop it directly into the sharps container at the point of use and never overfill the container.

Spill cleanup: wear gloves, absorb with disposable towels, clean with detergent, then disinfect with an EPA-registered disinfectant such as a 1:10 bleach solution; bag waste per policy.

For C. difficile and norovirus, wash with soap and water - alcohol rub does not kill spores.

Transmission-based precautions: follow the door sign, use dedicated equipment, keep the door closed for airborne precautions, and transport the resident only when necessary with a mask.

Keep a sterile field above waist level, never reach across it, and consider anything below waist level or wet to be contaminated.

Dysphagia precautions: seat the resident upright at about 90 degrees, offer small bites, check the mouth for pocketed food, keep them upright at least 30 minutes after eating, and serve only the prescribed thickened liquids - never thin them.

Signs of aspiration during a meal: coughing, choking, a wet or gurgly voice, watery eyes, or food held in the cheek. Stop feeding, keep the resident upright, and report.

NPO means nothing by mouth - no food, fluids, ice chips, or oral medications unless specifically ordered.

Intake and output: record all oral fluids, tube feedings, and IV fluids, plus urine, emesis, and drainage, in milliliters (1 oz = 30 mL).

A typical adult needs about 1500-2000 mL of fluid daily unless a restriction is ordered; offer fluids between meals and with medications.

Dehydration signs: dry mouth, thirst, dark concentrated urine, poor skin turgor, confusion, and dizziness - report and offer fluids.

Common diets: regular, mechanical soft, pureed, low-sodium, renal, consistent-carbohydrate (diabetic), and thickened liquids; some residents also need calorie counts.

Feed at the resident's own pace, sit at eye level, offer choices, allow rest periods, and never feed a resident who is lying flat.

Report meal intake below 50 percent, refusal of meals, or an unplanned weight change to the nurse.

Behavior is communication: check for pain, hunger, needing the toilet, fatigue, noise, or fear before labeling a behavior as a problem.

Dementia care: do not argue, correct, or quiz the resident. Validate the feeling, redirect to a safe topic or activity, and use short, simple sentences.

Sundowning is increased confusion and agitation in the late afternoon or evening; reduce noise and activity, keep routines predictable, and offer calm reassurance.

Encourage independence in ADLs - allow extra time and let the resident perform the parts of care they can still do.

Depression signs: withdrawal, appetite change, sleep disturbance, crying, hopeless statements, or talk of dying. Report immediately, and treat any suicidal statement as an emergency.

Grief and loss: listen, allow the resident to express feelings, and do not minimize the loss; report persistent sadness or refusal to eat.

Residents have the right to practice their own religion, to have spiritual needs met, and to privacy for intimate relationships - knock and give privacy.

Try restraint-free approaches first: distraction, music, activity, positioning, and reassurance, then report to the nurse if the behavior continues.

Hearing loss: face the resident, get their attention first, lower the pitch of your voice rather than shouting, reduce background noise, and use written notes if needed.

Aphasia: use short sentences and yes-or-no questions, allow extra time, use gestures and pictures, and do not finish the resident's sentences unless asked.

Speak directly to the resident rather than only to family members, and use an adult tone - baby talk and elderspeak are demeaning.

Assume an unconscious or comatose resident can hear; explain each care task before doing it.

Active listening: face the resident at eye level, make eye contact, nod, and paraphrase what you heard.

Document objectively: record what you saw, heard, or measured (for example, 'ate 50 percent of lunch') rather than opinions or judgments.

Use a qualified interpreter for medical information, not a family member or another resident; speak to the resident and keep sentences short.

If a resident is angry, stay calm, acknowledge the feeling, do not argue, ensure safety, and get the nurse if the behavior threatens harm.

Report changes in condition to the nurse promptly and chart care after it is given, accurately and on time.