Iowa CNA cheat sheet

Nurse aides provide basic direct care under the supervision of a licensed nurse and do not diagnose, assess, or perform tasks outside state-approved training and facility policy.

Chain of command: nurse aide → charge nurse or licensed nurse → director of nursing → administrator; concerns are reported through this line.

The individualized care plan directs care; the aide follows it and reports needed changes to the licensed nurse rather than changing the plan independently.

Observation and reporting are core aide duties: report changes in condition, skin, appetite, behavior, pain, elimination, and vital signs promptly.

A nurse aide may not delegate nursing tasks to another unlicensed worker; delegation comes from a licensed nurse.

Unfinished assigned care and handoff information are communicated to the licensed nurse or next caregiver at the end of the shift.

Job description and facility policy define permitted tasks; the aide requests clarification when a task is unfamiliar or outside training.

Team membership requires respectful communication with nursing, therapy, dietary, social services, housekeeping, and other staff.

Negligence is failure to meet the standard of care, causing harm; abuse is intentional mistreatment; neglect is failure to provide needed care.

Abuse, neglect, exploitation, and misappropriation of property must be reported immediately to the charge nurse and per facility policy; nurse aides are mandated reporters.

Assault is a threat of harm; battery is unauthorized physical contact; both are legal violations and must be reported.

Confidentiality is required by law and facility policy; resident information is shared only with the care team and only as needed for care.

Informed consent is obtained by the licensed provider; the nurse aide does not obtain consent or pressure a resident to sign.

Advance directives state a resident's treatment wishes; the aide follows the care plan and reports questions to the licensed nurse.

Restraints require a provider order and follow least-restrictive rules; the aide never applies a restraint without an order and policy authorization.

Incident reports document unexpected events objectively; record facts, not blame or opinions, and follow facility policy for the medical record.

Resident rights include dignity, privacy, confidentiality, choice, self-determination, and freedom from abuse and neglect.

A competent resident may refuse care or treatment; the aide respects the decision, reports the refusal, and does not force care.

Residents may receive and send mail, use the telephone, have visitors, and keep personal belongings according to facility policy.

Residents have the right to voice grievances without retaliation; the aide listens and reports the complaint through proper channels.

Residents participate in care planning and have the right to know the names and roles of caregivers.

Residents have the right to privacy during care, including draping, closing doors or curtains, and keeping health information confidential.

Residents have the right to be free from unnecessary restraints and unnecessary medications; the aide reports concerns.

Residents may organize and join resident councils and have access to records as permitted by law and facility policy.

Active listening uses eye contact, nods, and clarifying questions; it avoids interrupting and shows the resident is heard.

Open-ended questions invite fuller answers, such as 'How are you feeling?' and are useful when learning about a resident's needs.

Introduce yourself by name and role, use the resident's preferred name, and explain care before beginning.

Speak clearly at normal volume, face the resident, reduce background noise, and avoid medical jargon.

For a resident with aphasia, allow extra time, use yes-or-no questions, gestures, and pictures, and do not finish the resident's sentences.

For hearing loss, get attention, face the person in good light, speak clearly, and use written notes if needed; shouting may distort speech.

Use a trained interpreter when language barriers exist; do not rely on a family member unless facility policy and the resident agree.

Report changes in speech, hearing, vision, memory, or mood to the licensed nurse because these can signal a change in condition.

In conflict, stay calm, avoid arguing, acknowledge feelings, and report the situation to the licensed nurse.

Hand hygiene: soap and water for at least 20 seconds or alcohol-based rub when hands are not visibly soiled; perform before and after resident contact and after removing gloves.

Standard precautions apply to all residents and include hand hygiene, gloves, gown, mask, eye protection, and safe handling of body fluids and sharps.

Donning PPE order: gown, mask or respirator, goggles or face shield, then gloves; doffing order: gloves, goggles or face shield, gown, then mask.

Transmission-based precautions add contact, droplet, or airborne measures; follow posted signs and facility instructions for each type.

Clean technique reduces microbes; sterile technique prevents all microbes and requires not touching the sterile field or allowing it to become wet.

Do not shake dirty linen; hold it away from the uniform and place it in the designated container.

Sharps go immediately into a puncture-resistant container; never recap by hand or force a sharp into an overflowing container.

Blood or body fluid exposure requires washing the area, reporting immediately, and following facility post-exposure policy.

Isolation care uses dedicated equipment when required and follows visitor and transport policies.

Fall prevention: bed low and locked, call light within reach, floor clear, non-skid footwear, and prompt response to calls.

Report dizziness, new weakness, unsteady gait, vision changes, and falls immediately, even when the resident appears unhurt.

Restraints require a provider order, least-restrictive choice, release and circulation checks, and documentation per facility policy.

RACE: Rescue anyone in immediate danger, Alarm activate, Confine fire by closing doors, Evacuate or Extinguish if safe.

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

For choking with ineffective coughing or unable to breathe, activate emergency help and follow trained abdominal thrust or CPR procedures.

For a seizure: lower the resident to the floor, protect the head, clear dangerous objects, loosen tight clothing, do not restrain or put anything in the mouth, and time the event.

Emergency preparedness includes knowing exit routes, emergency numbers, call-light use, and the facility disaster plan.

Incident reports are completed after falls, injuries, medication errors, or other unexpected events; document objective facts.

Normal adult oral temperature is about 97.0–99.0°F; rectal readings are about 0.5–1°F higher and axillary readings about 0.5–1°F lower.

Normal adult resting pulse is 60–100 beats per minute; count 30 seconds and multiply by 2 when regular, or count a full minute when irregular.

Normal adult respirations are 12–20 breaths per minute; count for a full minute and observe depth, rhythm, and effort without telling the resident.

Normal adult blood pressure is less than 120/80 mm Hg; use the correct cuff size and support the arm at heart level.

Pulse oximetry on room air is typically 95–100%; report readings below the resident's normal range or per facility policy.

Pain is what the resident reports; use the facility pain scale, ask about location and severity, and report unrelieved pain.

Weigh residents at the same time of day, on the same scale, with similar clothing; report significant gain or loss.

Report vital signs outside the resident's usual range, sudden changes, or any value triggering facility emergency policy.

Oral temperatures are avoided for confused, uncooperative, or mouth-breathing residents; rectal temperatures are avoided with diarrhea or rectal surgery.

Bathing: provide privacy, check water temperature, use non-skid protection, and expose only the body part being washed.

Perineal care is performed front to back with a clean washcloth area for each stroke to reduce urinary tract infection risk.

Denture care: remove dentures, brush gums and tongue, clean dentures over a basin or towel, and store them in a labeled cup with water; avoid hot water.

Do not cut the nails of residents with diabetes or poor circulation unless facility policy permits; report nail problems.

When dressing a resident with a weak side, put clothing on the weak side first and remove it from the strong side first.

Bed making avoids shaking linen and holding dirty linen against the uniform; clean linen is kept away from the floor and dirty surfaces.

Inspect skin during care and report redness that does not blanch, warmth, swelling, tears, or rash.

Provide toileting assistance promptly, give privacy, and perform perineal care after elimination as needed.

Shower safety includes checking water temperature, using a shower chair as ordered, and staying within reach of the resident.

Aspiration precautions: sit the resident upright at about 90 degrees, offer small bites, allow time to chew and swallow, and stop if coughing, choking, or a wet voice occurs.

For dysphagia, follow the ordered diet texture and liquid thickness; straws may increase aspiration risk unless specifically allowed.

Feed at the resident's pace, encourage independence, and alternate food and fluids as tolerated; do not feed an unconscious resident.

Intake and output: record all liquids and melting foods in milliliters; 1 ounce equals 30 mL and 1 cup equals 240 mL.

Dehydration signs include dry mouth, dark urine, decreased urine output, thirst, confusion, and poor skin turgor.

Fluid restrictions require exact measurement and reporting; the aide does not increase or restrict fluids without an order.

Follow the tray card for diet type, such as regular, mechanical soft, pureed, low-sodium, diabetic, or renal, and report wrong trays.

Report poor intake, weight loss, swallowing problems, denture pain, or refusal to eat to the licensed nurse.

Mealtime positioning, oral care, and a calm environment support safe eating and hydration.

Range of motion: move each joint gently through available motion, support the limb, never force, and stop if the resident reports pain.

Positioning: align the body, support limbs with pillows, and reposition bedbound residents at least every two hours to prevent pressure injury.

Ambulation: use a gait belt as ordered, non-skid footwear, a clear path, and stand slightly behind and to the weaker side unless the care plan directs otherwise.

Transfers: lock bed and wheelchair wheels, raise the bed to a safe height, and move the resident toward the stronger side unless the care plan directs otherwise.

A cane is typically held on the stronger side; a walker is advanced before stepping into it, following therapy instructions.

Contracture prevention includes range of motion, proper positioning, and splints or devices only as ordered.

Restorative care encourages the resident to do as much self-care as possible, allowing extra time and praising effort.

Report changes in strength, balance, joint motion, skin condition, or ability to walk to the licensed nurse.

Prevent falls during mobility by clearing clutter, wearing non-skid shoes, and keeping the call light within reach.

Dementia is progressive cognitive decline affecting memory, judgment, language, and function; behavior is often a form of communication.

Validation acknowledges the resident's feelings and reality instead of arguing with confused statements; redirection and distraction can then be used.

Maintain routine, calm lighting, low noise, and simple one-step instructions to reduce confusion and agitation.

Wandering requires a safe environment, identification, supervision, and reporting; restraints are not a substitute for supervision.

Sundowning is increased confusion or agitation in late afternoon or evening; reduce stimulation and identify triggers such as hunger, pain, or fatigue.

Depression signs include sadness, withdrawal, poor appetite, sleep changes, and loss of interest; report these to the licensed nurse.

Social services address discharge planning, counseling, financial concerns, abuse, and community resources; the aide reports identified needs.

For mental illness, respect dignity, avoid judgment, set calm limits, and report changes in behavior or safety risk.

For cognitive impairment, break tasks into small steps, use cues and gestures, and allow time for the resident to respond.