Delaware CNA cheat sheet

Normal adult ranges: pulse 60-100 beats/min, respirations 12-20 breaths/min, oral temperature 36.5-37.5 °C (97.6-99.6 °F), SpO2 95-100%.

Count respirations for a full 60 seconds while the resident believes you are still holding the pulse; one rise and fall of the chest equals one breath.

Rectal temperatures read about 0.5-1 °F (0.3-0.6 °C) higher than oral readings; axillary readings run about 1 °F lower than oral.

Intake/output conversion: 1 ounce = 30 mL, 1 cup (8 oz) = 240 mL, 1 teaspoon = 5 mL; record all oral fluids and all urine, vomitus, and drainage in milliliters.

Measure an apical pulse with a stethoscope at the fifth intercostal space, left midclavicular line, counting a full minute; a full-minute count is also required when the radial rhythm is irregular.

Thresholds to report immediately: systolic change of 20 mmHg or more from baseline, pulse under 60 or over 100 at rest, respirations under 12 or over 20, temperature above 101 °F (38.3 °C), SpO2 below 92%.

Urine output of less than 30 mL per hour for two consecutive hours is reported to the licensed nurse.

Range-of-motion exercises are carried only to the point of resistance, never beyond it; stop the exercise if the resident reports pain.

The blanching test: a reddened area over a bony prominence that stays red after your finger is removed is reported as a possible pressure injury.

Turn and reposition an immobile resident at least every 2 hours, more often if skin is already at risk, and record each position on the turning schedule.

Bathe from cleanest to dirtiest: face, neck, arms, chest, abdomen, legs, back, and perineal area last, using a fresh area of the washcloth for each stroke.

Perineal care always moves front to back (urethra toward rectum) so bacteria from the bowel are not carried to the urinary opening.

Bath water should be no hotter than 105 °F (about 40.5 °C); test it on your inner wrist before it touches the resident.

Dress the weak or affected side first and undress that side last when a resident has had a stroke or has one-sided weakness.

Do not trim the toenails of a resident with diabetes or poor circulation; report the need to the licensed nurse.

NPO means nothing by mouth; the resident still receives mouth care and lip care, and the call light stays within reach.

Brush dentures over a sink lined with a towel or partly filled with water so they will not break if dropped, and store them in a labeled cup.

Semi-sitting (Fowler's) position raises the head of the bed 45-60 degrees and is used for eating and for residents with breathing difficulty.

RACE order for fire: Rescue anyone in danger, pull the Alarm, Contain fire by closing doors, then Extinguish or Evacuate.

PASS for an extinguisher: Pull the pin, Aim at the base of the fire, Squeeze the handle, Sweep side to side.

Water never goes on an electrical or grease fire; electrical fires require a Class C (or ABC) extinguisher.

Fall prevention bundle: bed in lowest position, wheels locked, call light within reach, non-skid footwear, adequate lighting, clear pathways.

A restraint requires a physician's order and the least restrictive device; it is released and the resident checked at least every 15 minutes, and it is never tied to side rails.

Seizure: protect the head, move objects away, loosen tight clothing, restrain nothing and place nothing in the mouth, then turn the resident to the side when the seizure ends.

Adult CPR by a single rescuer uses 30 compressions to 2 breaths, compressing at least 2 inches deep at 100-120 compressions per minute.

Oxygen safety: post no-smoking signs, keep oxygen away from open flame, avoid petroleum-based products, and store cylinders upright and secured.

An incident report is completed for any accident, error, or injury using objective facts only; the report is not filed in the medical record.

Knock before entering, identify yourself by name and role, and address the resident by the name the resident prefers.

Answer call lights promptly; if there will be a delay, tell the resident how long it will be rather than leaving the light unanswered.

With a hearing-impaired resident, face them at eye level, lower the pitch of your voice, cut background noise, and never shout into the ear.

For a resident with aphasia, ask yes/no questions, allow extra time to respond, and do not finish sentences for them.

Do not argue with a confused resident about facts; redirect to a safe topic or activity instead of correcting the resident's reality.

Report observations objectively: "Mr. J. ate 25% of lunch and said his stomach hurt," not "Mr. J. was difficult today."

For medical information with a resident who speaks another language, use a qualified interpreter or the facility language line, not a family member.

Protect privacy: close doors and curtains during care, and share health information only with members of the care team (HIPAA).

Perform only tasks that are within the nursing assistant's legal scope and have been delegated by the licensed nurse; medication administration, sterile procedures, and resident teaching fall outside that scope.

Report changes in condition to the licensed nurse in charge, not to another nursing assistant.

If it is not documented, it is treated as not done; record care immediately after giving it and never chart care in advance.

Never chart another person's work and never alter a record; correct an error with a single line, the date, time, and your initials.

Suspected abuse, neglect, or misappropriation of property is reported immediately to the nurse in charge and the administrator; the nursing assistant is a mandatory reporter.

Resident rights include refusing care, privacy, freedom from unnecessary restraints, and voicing grievances without retaliation.

When a resident refuses care, honor the refusal, do not threaten or force, document it, and notify the licensed nurse.

Accept only assignments you are competent to perform, and request training or supervision when a task is unfamiliar.