CNA cheat sheet

Scope of practice is limited to skills taught in an approved training program and delegated by a licensed nurse; assessments, care planning, sterile procedures, and medication administration are outside the aide's role.

The aide takes direction only from licensed nursing staff (LPN/RN); orders or requests from physicians, families, or other residents are referred to the charge nurse.

Document only care you personally performed or directly observed, at the time it occurred, in black ink, using objective, measurable terms; record a refusal and who was notified.

Correct an error by drawing one line through it, writing "error," initialing, and dating - never erase, use correction fluid, or leave blank lines in a chart.

Late entry rule: record the actual date and time of writing plus the time the care or observation occurred, and label it as a late entry.

Subjective data are the resident's own words and must be quoted; objective data are what you see, hear, smell, or measure (for example, "skin red and warm").

Any suspicion of abuse, neglect, or misappropriation of resident property must be reported immediately to the charge nurse and administrator; the aide does not investigate or confront the accused.

Residents have the right to a private phone call and to contact the state long-term care ombudsman; contact information must be posted and accessible without asking permission.

If asked to perform a task outside training or scope, decline politely, explain why, and report the request to the supervisor.

Wash hands with soap and water for at least 20 seconds when visibly soiled, after using the toilet, before eating, and after contact with a resident who has Clostridioides difficile; alcohol-based rub is used when hands are not visibly soiled.

Standard precautions apply to every resident regardless of diagnosis: gloves for blood, body fluids, mucous membranes, and non-intact skin; additional PPE per transmission route.

PPE removal order: gloves first, then goggles, then gown, then mask; perform hand hygiene immediately after removing all PPE and avoid touching the face.

Contact precautions (MRSA, C. difficile, scabies) require gloves and gown plus dedicated equipment; droplet precautions (influenza, pertussis) require a mask within about 3 feet; airborne precautions (tuberculosis, measles) require an N95 and a negative-pressure room.

Body mechanics: widen the base of support, bend at the knees, keep the load close to the body, face the direction of movement, and never twist while lifting; use a mechanical lift or a second helper for a dependent resident.

Fall prevention bundle: bed in the lowest position, wheels locked, call light and personal items within reach, non-skid footwear, clear pathways, adequate lighting, and hourly rounding per facility policy.

Fire response is RACE - Rescue anyone in danger, Alarm (pull alarm and call), Contain (close doors), Extinguish or Evacuate; for a small fire use PASS - Pull, Aim, Squeeze, Sweep; never use an elevator during evacuation.

Seizure care: ease the resident to the floor, protect the head, turn to the side, loosen tight clothing, time the seizure, and never restrain the person or place anything in the mouth; report duration and characteristics afterward.

Restraints require a physician's order and the least restrictive device; release, reposition, and check circulation at least every 2 hours, and check the resident every 15 minutes for safety and needs.

Normal adult ranges: oral temperature 97.6–99.6 °F (36.5–37.5 °C), radial pulse 60–100 beats/min, respirations 12–20/min, blood pressure under 120/80 mmHg, oxygen saturation 95% or higher.

Count the radial pulse for 30 seconds and multiply by two if the rhythm is regular; count a full 60 seconds if the rhythm is irregular or the rate is abnormal.

Count respirations for 30 seconds and multiply by two (full minute if abnormal) without telling the resident, so the rate is not consciously altered.

Wait 15–30 minutes after hot or cold food, drink, or smoking before an oral temperature; axillary is least accurate, rectal is most accurate but contraindicated with diarrhea or rectal surgery; avoid a blood pressure cuff on an arm with a mastectomy, dialysis fistula, or IV line.

Blood pressure cuff selection: the bladder should encircle about 40% of the upper arm; a cuff that is too small produces falsely high readings; support the arm at heart level.

Bathing sequence is clean to dirty: face and eyes first (inner to outer canthus), then trunk and arms, then legs and feet, then perineal area - washing front to back on females - with a clean portion of the washcloth for each stroke.

Denture care: remove and rinse dentures after meals, brush gums and palate, store dentures in a labeled cup of water when not in the mouth, and never use hot water on them.

Intake and output are recorded in milliliters: 1 ounce = 30 mL, 1 cup = 240 mL, 1 teaspoon = 5 mL; report urine output under 30 mL per hour, dark or cloudy urine, or output less than intake.

Positioning rules: reposition at least every 2 hours, use a 30-degree lateral tilt, place pillows between the knees and under the arms, and keep heels off the mattress; perform range of motion to the point of resistance and never force a joint.

Resident rights include dignity, privacy, choice, self-determination, refusal of treatment, freedom from abuse and unnecessary restraints, voicing grievances without retaliation, keeping personal possessions, and private communication.

Knock and announce before entering, close the door and draw curtains during care, and expose only the body part being cared for; never discuss a resident in hallways, elevators, or on social media.

Maslow's hierarchy orders needs: physiological (air, food, water, elimination, pain relief) first, then safety, love and belonging, esteem, and self-actualization; unmet lower needs block higher ones.

Therapeutic communication uses open-ended questions, restating, reflecting, silence, and clarification; avoid "why" questions, false reassurance ("don't worry"), changing the subject, and giving personal advice.

Do not argue with a confused resident about facts; acknowledge the feeling behind the statement and gently redirect (validation), which reduces agitation better than correction.

Defense mechanisms such as denial, regression, projection, and displacement are unconscious coping responses to anxiety or loss; anger is often a expression of fear or grief rather than hostility toward the aide.

Grief responses (denial, anger, bargaining, depression, acceptance) may occur in any order, overlap, and repeat; the aide listens without judging or imposing a timeline.

Include family in care conferences and teaching when the resident consents, give visits privacy, and recognize that family guilt, stress, and complaints often reflect caregiver burden.

Restorative care maintains or regains function by prompting and encouraging self-care (self-feeding, washing the face, walking to the bathroom) and providing only the minimum assistance the resident needs.

Range of motion: passive (aide moves the joint), active-assistive (resident moves with help), and active (resident moves alone); perform as ordered, usually at least daily, supporting the joint above and below and stopping at pain or resistance.

Apply a gait belt snugly around the waist over clothing, grasp it with an underhand grip, walk on the resident's weaker side and slightly behind, and remove it when the resident is seated.

Cane is held on the stronger side with the handle at wrist-crease height; a walker is moved forward first, then the weaker leg steps into it, then the stronger leg; weight-bearing status on crutches follows the physician's order exactly.

Contracture prevention: proper body alignment in bed and chair, foot support (footboard or firm shoes), splints and hand rolls as ordered, and repositioning every 2 hours.

The Braden Scale scores six areas - sensory perception, moisture, activity, mobility, nutrition, friction/shear; a lower total score indicates higher pressure-injury risk and triggers more frequent turning.

Stage 1 pressure injury is intact skin with non-blanchable redness over a bony prominence; never massage a reddened area, keep it off the pressure, and report it immediately.

Check skin at every repositioning, especially sacrum, heels, hips, elbows, ears, and occiput; report blanching redness that does not fade, blisters, or open areas at once.

Reportable changes include new confusion or change in level of consciousness, pain unrelieved by the ordered intervention, temperature above 100 °F, pulse or respirations outside normal range, blood in urine or stool, refusal of food or fluids, and any skin breakdown.