CMSA cheat sheet

Normal adult resting values: oral temperature 36.5-37.5 C (97.7-99.5 F); pulse 60-100 beats/min; respirations 12-20 breaths/min; blood pressure under 120/80 mmHg.

Body mass index = weight in kilograms divided by height in meters squared (kg/m^2); overweight is 25-29.9, obesity is 30 or higher.

Intake and output are recorded in milliliters; 1 ounce equals 30 mL, 1 cup equals 240 mL, and 1 kilogram of body weight equals about 1 liter of fluid.

The 5 rights of medication and procedure safety: right patient, right drug or procedure, right dose, right route, right time; documentation is the sixth check.

Positioning rules: supine is flat on the back; Fowler is 45-60 degrees head elevation; semi-Fowler is 15-30 degrees; Trendelenburg is head down; Sims is left lateral with the right knee drawn up.

Standard precautions apply to all patients regardless of diagnosis; hand hygiene is performed before and after every patient contact and after glove removal.

Ambulation assistance: stand on the patient's weaker side, apply a gait belt around the waist, and keep the patient's feet behind the walker's rear legs.

Range of motion terms: flexion decreases the joint angle, extension increases it, abduction moves away from midline, adduction moves toward midline, rotation turns on an axis.

Medical asepsis reduces organisms and applies to routine care; surgical asepsis eliminates all microorganisms and applies to invasive procedures, sterile dressing changes, and catheter insertion.

The chain of infection has six links: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host; breaking any link prevents transmission.

Hand hygiene duration: at least 20 seconds with soap and water; alcohol-based rub is used when hands are not visibly soiled and is not effective against C. difficile spores.

Sterile field rules: sterile items contact only sterile items; the field edge is 1 inch (2.5 cm) wide and is considered contaminated; never turn the back on a sterile field.

Personal protective equipment order: gown first, then mask or respirator, then goggles, then gloves; removal reverses the order with gloves removed last.

Needlestick protocol: wash the site with soap and water, report immediately, and follow post-exposure testing; do not squeeze or scrub the puncture.

Transmission-based precautions: contact for MRSA and C. difficile, droplet for influenza and pertussis, airborne with N95 for tuberculosis, measles, and varicella.

Fire safety uses RACE: Rescue, Alarm, Contain, Extinguish or Evacuate; the PASS technique operates an extinguisher: Pull, Aim, Squeeze, Sweep.

Pulse sites in order of ease: radial, brachial, carotid, temporal, femoral, popliteal, posterior tibial, dorsalis pedis; the apical pulse is counted at the heart apex for a full minute.

Pulse quality is graded 0 absent, 1+ weak and thready, 2+ normal, 3+ bounding; an irregular radial pulse requires an apical count.

Blood pressure cuff width should be about 40 percent of arm circumference; a cuff that is too small falsely raises the reading.

Korotkoff sounds: phase I is the first clear tapping sound (systolic), phase V is the disappearance of sound (diastolic).

Orthostatic hypotension is a drop of 20 mmHg systolic or 10 mmHg diastolic within 3 minutes of standing; measure lying, sitting, and standing.

Pain is the fifth vital sign; the 0-10 numeric scale suits adults, the Wong-Baker faces scale suits children, and the PAINAD scale suits nonverbal patients.

Pulse oximetry below 90 percent is abnormal; cold fingers, dark nail polish, and poor perfusion can produce false low readings.

Respiratory assessment: normal adult rate 12-20 per minute, regular rhythm, unlabored; count for 30 seconds and multiply by two if regular, or a full minute if irregular.

The parenteral routes and typical needle gauges: intradermal 25-27 gauge, subcutaneous 25-27 gauge, intramuscular 20-23 gauge, intravenous 18-22 gauge.

Injection angles: intradermal 5-15 degrees, subcutaneous 45-90 degrees, intramuscular 90 degrees; the deltoid holds up to 1 mL, the ventrogluteal up to 3 mL.

The six rights are patient, drug, dose, route, time, and documentation; verify the label against the order at least three times.

Common abbreviations: qd means daily, bid twice daily, tid three times daily, qid four times daily, prn as needed, ac before meals, pc after meals, hs at bedtime.

Dosage formula: desired dose divided by available dose, multiplied by the quantity on hand, gives the amount to administer.

Controlled substances require a witness for wasting, a double lock, and an exact count at shift change; discrepancies are reported immediately.

Anaphylaxis signs include hives, wheezing, throat tightness, and hypotension; epinephrine is the first-line drug and is given intramuscularly.

Insulin types by onset: rapid-acting 15 minutes, short-acting 30 minutes, intermediate 1-2 hours, long-acting 1-2 hours with no peak; only regular insulin may be given intravenously.

Venipuncture order of draw for tubes: blood cultures, light blue citrate, serum red or gold, green heparin, lavender EDTA, gray oxalate or fluoride.

Fasting requirements: lipid panel and fasting glucose need 8-12 hours without food; water and usual medications are permitted unless ordered otherwise.

Hemoglobin A1c reflects average glucose over about 2-3 months and does not require fasting; a value of 6.5 percent or higher supports a diabetes diagnosis.

Complete blood count reference ranges: hemoglobin 12-16 g/dL for women and 14-18 g/dL for men; platelets 150,000-450,000 per microliter.

Capillary puncture: warm the site, use the side of the fingertip, wipe away the first drop, and avoid the thumb and index finger.

Urinalysis: specific gravity 1.005-1.030, pH 4.6-8.0; nitrite and leukocyte esterase positivity suggests urinary tract infection.

Electrolyte values: sodium 135-145, potassium 3.5-5.0, chloride 98-107, and bicarbonate 22-29 mEq/L.

Timed specimens: a 24-hour urine collection discards the first void, keeps all urine after it, and is stored cold; a midstream clean-catch is used for urine culture.

Surgical hand scrub and sterile gowning precede gloving; the closed gloving method is used for the first pair, open gloving for subsequent pairs.

Instrument categories: cutting (scalpel, scissors), grasping (forceps, clamps), retracting (retractors), and suturing (needle holders).

Suture sizing: the first number is the gauge and the second is the length; 3-0 is thicker than 5-0; absorbable sutures include Vicryl and chromic gut.

Anesthesia types: local numbs a small area, regional blocks a region such as a limb, general produces unconsciousness, and moderate sedation keeps the patient responsive.

Counts are performed for sponges, sharps, and instruments at three points: before the incision, before closure, and at skin closure; a discrepancy halts closure.

Surgical wound classification: clean, clean-contaminated, contaminated, and dirty; prophylactic antibiotics are given within 60 minutes before incision.

Postoperative priorities follow the ABCs: airway, breathing, circulation; then monitor for hemorrhage, infection, and deep vein thrombosis.

Malignant hyperthermia presents with rising temperature, muscle rigidity, and tachycardia; dantrolene is the specific treatment.

The medical record is a legal document; entries are made in permanent ink, dated, timed, signed with credentials, and never altered with correction fluid.

Corrections are made with a single line through the error, the initials and date, and the correct information written beside it; the original remains legible.

SOAP note format: Subjective (patient report), Objective (measurable findings), Assessment (impression or diagnosis), Plan (treatment and follow-up).

Scheduling rules: new patients receive longer appointments than established patients; urgent cases are triaged and offered the earliest opening.

Health Insurance Portability and Accountability Act permits disclosure for treatment, payment, and operations; other disclosures need written authorization.

Release of information requires a signed authorization naming the recipient, the specific information, the purpose, and an expiration date.

Appointment reminders reduce no-shows; a missed appointment is documented in the record according to office policy.

Electronic health record safeguards include unique user logins, automatic logoff, audit trails, and role-based access.

Scope of practice defines tasks permitted by licensure and state law; performing outside it exposes the worker to discipline and liability.

Informed consent requires capacity, disclosure of risks and alternatives, voluntariness, and the patient's signature; the provider obtains consent, not the assistant.

Negligence requires four elements: duty, breach of duty, causation, and damages; all four must be proven.

Battery is unauthorized touching; assault is a threat of touching; false imprisonment is unjustified restraint or detention.

Mandatory reporting covers suspected child abuse, elder abuse, and certain communicable diseases; reporting is required regardless of confidentiality.

Advance directives include living wills and durable power of attorney for health care; they take effect when the patient loses decision-making capacity.

Advance beneficiary notice informs a patient in advance that a service may not be covered and that the patient may be billed.

Ethical principles: autonomy respects patient choice, beneficence promotes good, nonmaleficence avoids harm, justice ensures fairness, and confidentiality protects private information.

Therapeutic communication techniques include open-ended questions, reflection, restating, clarification, and silence; closed questions gather specific facts.

Blocking behaviors to avoid: false reassurance, giving advice, changing the subject, and asking why questions that imply judgment.

Teach-back confirms understanding: the patient explains or demonstrates the skill in their own words; a nod is not confirmation.

Health literacy affects comprehension; plain-language materials should target a sixth-grade reading level and avoid unexplained jargon.

Interpreters are used for limited-English-proficiency patients; family members, especially children, are not appropriate interpreters for clinical discussions.

Hearing-impaired patients are entitled to qualified sign language interpreters or auxiliary aids under the Americans with Disabilities Act.

Grief stages described by Kubler-Ross are denial, anger, bargaining, depression, and acceptance; they are not strictly sequential.

Documentation of education includes the topic, the method, the patient's response, and the need for reinforcement.

Informed consent discussion elements: diagnosis, nature of the procedure, risks, benefits, alternatives, and the right to refuse.

Patient education domains: medication purpose and side effects, wound care, diet, activity restrictions, and when to seek emergency care.

Motivational interviewing uses open questions, affirmation, reflective listening, and summarizing to strengthen a patient's own change talk.

Nonverbal communication includes eye contact, posture, and personal space; the intimate zone is under 18 inches and is reserved for care.

Conflict de-escalation: lower the voice, acknowledge feelings, offer choices, and maintain a safe distance and exit route.

Cultural competence includes using trained interpreters, respecting dietary and religious practices, and avoiding assumptions about health beliefs.

Written instructions should use large print, bullet points, and a teach-back check; follow-up calls reinforce adherence.

Barriers to learning include pain, anxiety, fatigue, hearing or vision loss, and low literacy; address barriers before teaching.

Pediatric teaching targets the caregiver and uses play, simple words, and praise; the child's developmental stage guides the approach.

Older adults may need larger print, slower speech, and repetition; hearing loss often affects high frequencies first.

Cognitive impairment requires short sessions, one instruction at a time, and family involvement with consent.

Anxiety reduces retention; teach in short sessions and provide written reinforcement.

Interpreters should be medically qualified; ad hoc interpreters risk errors and breach confidentiality.

Health literacy screening uses plain-language questions and avoids shame; a sixth-grade reading level is a common target.

Documentation of teaching includes content, method, response, and follow-up plan.

Patient portals and secure messaging extend education but require identity verification and privacy safeguards.

Education documentation includes the topic, the method, the patient's response, and any need for reinforcement.

Follow-up planning includes appointment reminders, written instructions, and a contact number for questions.

Teach-back is the preferred method to confirm understanding; the patient explains or demonstrates the skill.

Plain-language materials target a sixth-grade reading level and avoid unexplained jargon.

Interpreters are required for limited-English-proficiency patients; family members, especially children, are not appropriate for clinical discussions.

Hearing-impaired patients are entitled to qualified sign language interpreters or auxiliary aids under the Americans with Disabilities Act.

Barriers to learning include pain, anxiety, fatigue, hearing or vision loss, and low literacy; address them before teaching.

Confidentiality applies to all communication, including phone calls, portals, and messages left with others.