Hawaii CNA cheat sheet

Normal adult vital signs: oral temperature 97.6–99.6°F, pulse 60–100 beats/min, respirations 12–20 breaths/min, blood pressure below 120/80 mmHg, and SpO2 95–100%.

Count respirations for 30 seconds and multiply by two when the rhythm is regular; count for a full minute when the rhythm is irregular.

Perform hand hygiene before and after every resident contact, after removing gloves, and whenever hands are visibly soiled; use soap and water for visible soil.

Measure intake and output in milliliters: 1 ounce = 30 mL, 1 cup = 240 mL, and 1 teaspoon = 5 mL.

Use sterile technique for indwelling catheter care, dressing changes, and suctioning; use clean technique for routine bed baths.

Keep the bed in the lowest position with wheels locked and the call light within reach before leaving the resident.

Report to the nurse a temperature above 100°F, pulse below 60 or above 100, respirations below 12 or above 20, or systolic blood pressure below 90.

When taking a blood pressure, the cuff bladder should encircle about 40% of the upper arm circumference and the arm should be supported at heart level.

Bed bath water should be about 105°F (40.5°C); test it against your inner wrist before use.

Provide perineal care from front to back on female residents to prevent urinary tract infection.

Dress a resident with one-sided weakness by putting the affected arm or leg into the garment first; undress the affected side last.

For an unconscious resident, perform oral care with the head turned to the side and suction available; do not put fluids in the mouth.

Remove dentures, clean them with a soft brush over a basin of water, and store them in a labeled cup of water when not in the mouth.

Do not cut the toenails of a resident with diabetes or poor circulation; file them and report problems to the nurse.

Feed a resident with dysphagia while sitting upright at about 90 degrees, offering small bites and checking that each bite is swallowed.

Inspect the skin, especially over bony prominences, during bathing and report redness, breaks, or bruises.

Maslow's hierarchy from bottom to top: physiological needs, safety, love and belonging, esteem, self-actualization.

Use open-ended questions, restating, reflecting, and silence to encourage residents to express feelings.

Avoid asking 'why' questions, which can feel accusatory, and avoid false reassurance such as saying 'You will be fine.'

Kubler-Ross stages of grief: denial, anger, bargaining, depression, acceptance; residents may move back and forth among stages.

Signs of depression include persistent sadness, withdrawal, loss of appetite, sleep changes, and statements of hopelessness; report them.

Defense mechanisms include denial (refusing to accept reality), projection (attributing one's feelings to others), and regression (returning to earlier behavior).

Anxiety may appear as restlessness, pacing, sweating, or repeated questions; reduce stimulation and stay calm.

Respect cultural, religious, and personal preferences, and allow residents to make choices whenever possible.

Alzheimer's disease is the most common cause of dementia and is irreversible and progressive.

Approach a cognitively impaired resident from the front at eye level, use a calm voice, short sentences, and one instruction at a time.

Do not argue with or correct a resident's inaccurate statements; redirect attention or validate the feeling instead.

Sundowning is late-afternoon or evening restlessness and confusion; reduce noise and activity and keep evening routines calm.

For wandering, provide a safe environment, supervision, and identification; restraints are not an appropriate substitute for supervision.

Answer repetitive questions calmly each time, then redirect to another activity; do not test the resident's memory.

Keep routines consistent and use memory aids such as calendars, clocks, and labeled drawers.

Remove tripping hazards, lock away medications and cleaning products, and supervise smoking or stove use.

Perform range-of-motion exercises 2 to 3 times daily with 3 to 5 repetitions per joint, unless the care plan states otherwise.

Stop a range-of-motion exercise if the resident reports pain or if the joint meets resistance; never force a joint.

A cane is held on the resident's stronger side and moved forward with the weaker leg.

With a walker, the resident lifts and moves the walker forward first, then steps into it.

Use a gait belt around the resident's waist for transfers and ambulation assistance, and pivot toward the resident's stronger side.

Reposition an immobile resident at least every 2 hours and support the extremities in proper body alignment.

Restorative care aims to maintain function and independence; encourage residents to do as much self-care as possible.

Check skin, circulation, and fit of splints or prosthetics and report redness, swelling, or pain.

Resident rights are protected by the federal Nursing Home Reform Act (OBRA) of 1987 and apply regardless of payment source.

Report suspected abuse, neglect, or exploitation immediately to the nurse or administrator; CNAs are mandatory reporters.

Restraints require a physician's order for a specific condition, must be the least restrictive option, and must be released, with repositioning, at least every 2 hours.

A resident may refuse treatment or care; document the refusal and inform the nurse, and explain the consequences without pressure.

Keep resident information confidential under HIPAA; discuss care only with the care team and only when needed.

Residents have the right to privacy, dignity, respect, visitors, mail, telephone access, and freedom from abuse and neglect.

Residents may form a resident council, file grievances, and voice concerns without fear of retaliation.

Residents have the right to be informed of changes in condition, care, or room assignment and to participate in their own care planning.