Colorado CNA cheat sheet

Normal adult ranges: oral temperature 97.6-99.6 °F, pulse 60-100 beats/min, respirations 12-20 breaths/min, blood pressure 90/60 to 120/80 mmHg.

Count the pulse for a full 60 seconds; count respirations for 60 seconds without announcing it, because awareness of being watched alters the rate.

An axillary temperature reads about 1 °F lower than an oral temperature; a rectal temperature reads about 1 °F higher.

The blood pressure cuff bladder should cover about two-thirds of the upper arm; inflate to roughly 30 mmHg above the point where the pulse disappears.

Conversions: 1 oz = 30 mL, 1 cup = 240 mL, 1 kg = 2.2 lb, 1 inch = 2.54 cm.

Hand hygiene: soap and water for at least 20 seconds, or alcohol-based rub when hands are not visibly soiled and the resident does not have C. difficile.

Report immediately: temperature 101 °F or higher, pulse under 60 or over 100, respirations under 12 or over 20, systolic pressure under 90 or over 160, chest pain, shortness of breath, or a change in consciousness.

A resident who is unconscious or has trouble swallowing is kept NPO, positioned on the side, with suction equipment at hand.

Weigh at the same time of day, on the same scale, in the same amount of clothing, and record in the unit the facility uses.

Bath water is 100-105 °F and is tested on the inner wrist or forearm before the resident enters.

Wash the eyes from the inner to the outer canthus, using a different part of the washcloth for each eye to avoid spreading infection.

Wash the perineum from front to back (urethra toward rectum) and use a clean area of the cloth for each stroke.

Clean dentures over a towel-lined basin and store them in a labeled cup covered with water; hot water warps dentures and cracks them.

Do not cut the nails of a resident with diabetes or circulatory problems; report nail care to the nurse.

Use an electric razor for residents on anticoagulants or with a bleeding disorder.

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

For an unconscious resident, give mouth care every 2 hours with a toothbrush and suction, with the head turned to the side.

Expose only the body part being washed and keep the rest of the body covered with a bath blanket.

Physical needs (air, food, fluid, elimination, pain relief) are met before psychosocial needs are addressed.

Do not argue with or confirm a delusion or hallucination; acknowledge the feeling behind it and redirect to a real activity.

Any statement of suicidal or self-harm intent is an emergency: stay with the resident and notify the nurse immediately.

Depression signs lasting more than 2 weeks - sadness, appetite change, sleep change, withdrawal, hopeless statements - are reported to the nurse.

For anxiety: reduce stimulation, speak calmly and slowly, stay with the resident, and use short sentences.

Grief is individual and not linear; denial, anger, bargaining, depression, and acceptance may occur in any order and can recur.

Confidentiality: resident information is shared only with staff who need it to provide care, never with other residents or visitors.

Offering choices about clothing, activities, and schedule supports autonomy and self-esteem.

Alzheimer's disease is progressive and irreversible; short-term memory loss appears first, while long-term memory may remain intact longer.

Approach from the front at eye level, state your name and the resident's name, and speak slowly using short sentences with one instruction at a time.

Validation means accepting the resident's reality; do not correct or argue about inaccurate statements.

Sundowning is increased confusion and agitation in late afternoon or evening; bright even lighting, reduced noise, and quiet activity lessen it.

Wandering is managed by redirecting and providing safe walking, never by restraint or by locking the resident in a room.

New or sudden behavior change is reported as a possible sign of pain, constipation, urinary tract infection, dehydration, or a medication effect.

Consistent routines and an unchanged environment reduce confusion and agitation.

In late-stage disease a resident may not recognize family members and requires total assistance with all activities of daily living.

Never leave a cognitively impaired resident alone in a bathroom, with hot liquids, or unsupervised near an exit.

Range of motion: move each joint only to the point of resistance, never force it, and stop if the resident reports pain.

Active ROM is performed by the resident; passive ROM is performed by the caregiver, who supports the joint above and below.

Use a gait belt for transfers and ambulation, stand on the resident's weaker side, and grip the belt with an underhand hold.

A cane is held on the stronger side and moved forward at the same time as the weaker leg.

With a walker, the resident moves the walker forward first, then steps into it, and never lifts it while stepping.

Splints and braces are applied as ordered, skin is checked before and after application, and the ordered wearing schedule is followed.

Reposition a resident every 2 hours in bed and about every hour in a chair, checking the skin at each turn.

Encourage self-care by giving only the assistance the resident cannot perform, which maintains strength and function.

Bladder and bowel training uses scheduled toileting, adequate fluids, and a prompt response to call lights.

The federal Nursing Home Reform Act (OBRA 1987) established residents' rights; Colorado enforces them through CDPHE surveys and the long-term care ombudsman.

Residents have the right to be informed of and participate in the care plan, and the right to refuse treatment, medication, or a care task.

Right to privacy and dignity: knock before entering, close doors and curtains, and keep records confidential.

Residents may voice grievances to staff, the administrator, the state survey agency, or the ombudsman without fear of retaliation.

Physical and chemical restraints imposed for discipline or convenience are prohibited; a restraint requires a physician's order for a documented medical symptom.

Residents may manage their own personal funds or name a representative, and must receive a written accounting of the money.

Right to communicate freely: send and receive unopened mail, use a telephone, and receive visitors of their choosing.

Residents may keep personal clothing and possessions and use personal items within facility rules.

Suspected abuse or neglect - physical, sexual, verbal, financial, or neglect - is reported immediately to the nurse or administrator and to the proper authorities.