Illinois CNA cheat sheet

Normal adult ranges: pulse 60–100 beats per minute, respirations 12–20 per minute, oral temperature about 97.6–99.6 °F (36.5–37.5 °C).

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

Count respirations for 30 seconds and multiply by 2 when the rhythm is regular; count a full 60 seconds when the rhythm is irregular.

Pulse deficit = apical rate minus radial rate; two staff count at the same time for one full minute.

An apical pulse is heard at the fifth intercostal space at the left midclavicular line and is counted for one full minute.

Intake and output are recorded in milliliters: 1 ounce = 30 mL and 1 cc = 1 mL.

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

A blood pressure of 140/90 mmHg or higher, or any sudden change in vital signs, is reported to the nurse.

Rectal temperatures are avoided in residents who have had rectal surgery or who have diarrhea.

Wash from cleanest to dirtiest: face and neck first, perineal area last, using a clean part of the washcloth for each area.

Perineal care always moves front to back, from the urethra toward the rectum, to keep bowel bacteria out of the urinary tract.

Dress the weak or affected side first; when undressing, remove clothing from the unaffected side first.

An electric razor is used for residents taking anticoagulants or with shaky hands; a blade razor is used only when the resident normally shaves that way and is not on blood thinners.

Clean dentures over a washcloth-lined basin or a basin of water; store them in a labeled container when they are out of the mouth.

Soak nails before filing, file in one direction, and do not clip the nails of residents with diabetes or poor circulation without nurse approval.

Reposition an immobile resident at least every 2 hours and keep heels and other bony prominences off the mattress.

Report any reddened skin area that does not blanch when pressed, and keep the skin clean and dry.

Any statement of hopelessness, self-harm, or suicide is reported to the nurse immediately; the CNA never promises to keep it secret.

Depression indicators include persistent sadness, appetite change, sleep change, withdrawal from activities, and loss of interest; the CNA reports these rather than diagnosing them.

Validate feelings instead of arguing: accept the emotion expressed even when the stated fact is wrong and no harm is involved.

Reality orientation uses calm, repeated statements of person, place, time, and situation, supported by calendars and clocks.

Reminiscence uses photos, music, and familiar objects to prompt positive memories and conversation.

Common defense mechanisms include denial, regression, projection, and rationalization; recognize them without confronting the resident.

Active listening: face the resident at eye level, do not interrupt, restate what was said, and allow silence for processing.

When a resident is angry, stay calm, acknowledge the feeling, give space as safety allows, and never argue or use physical force.

OBRA 1987, the Nursing Home Reform Act, is the federal law that established residents' rights in nursing facilities.

Residents are free from physical, verbal, sexual, and mental abuse, corporal punishment, and involuntary seclusion.

Knock and wait for an answer before entering; close doors and curtains during care; keep resident information confidential.

A resident may refuse any treatment or care; the CNA stops, notifies the nurse, and documents the refusal.

Physical and chemical restraints require a physician's order, must treat a medical symptom, and are never used for discipline or staff convenience.

Residents may voice grievances without fear of retaliation, and the facility must investigate and respond.

Suspected abuse or neglect is reported to the supervisor immediately; Illinois also receives reports through the IDPH Nursing Home Complaint Hotline, 1-800-252-4343.

Residents have the right to privacy in care and in communication, including mail, telephone calls, and visitors.

Alzheimer's disease is the most common cause of dementia; it is progressive, irreversible, and not a normal part of aging.

Early stage: short-term memory loss, repeated questions, misplacing items; middle stage: wandering, agitation, need for ADL assistance; late stage: loss of speech, swallowing difficulty, incontinence.

Use short, simple sentences with one question or direction at a time, and allow extra time for a response.

Do not argue with or correct a false belief; redirect the conversation or the activity instead.

Sundowning is increased confusion and agitation in the late afternoon or evening; reduce noise and stimulation and keep routines consistent.

For wandering: provide safe walking, secure exits, identification, and purposeful activity; restraints are not a treatment for wandering.

Supervise cognitively impaired residents closely in the bathroom and shower and during meals, because judgment and swallowing safety are reduced.

Procedural memory (how to perform familiar tasks) is often preserved longer than factual memory; demonstrate and guide rather than take over.

Range of motion is performed in the direction the joint naturally moves; never force a joint past resistance or to the point of pain.

Passive ROM means staff move the joint; active ROM means the resident moves it; active-assistive ROM means the resident moves it with some help.

Support the body part above and below the joint during ROM and during transfers.

Check the skin under splints, braces, and prostheses each time they are applied or removed, and report redness or breakdown.

Provide setup and cues, then let the resident do as much self-care as possible; independence is the goal of restorative care.

Apply a gait belt snugly over clothing with room for two fingers, and walk on the resident's weaker side.

Contractures are prevented by body alignment in bed, daily range of motion, and ordered footboards or splints.

When a resident begins to fall, do not try to catch or hold the person up; lower the resident gently to the floor while protecting the head.

Hand hygiene is the single most effective way to prevent infection; wash with soap and water for at least 20 seconds.

Use alcohol-based hand rub when hands are not visibly soiled; use soap and water when hands are soiled and after caring for a resident with C. difficile.

Wash hands before and after every resident contact, after removing gloves, and after touching contaminated equipment.

Donning order: gown, mask, goggles, gloves. Doffing order: gloves, goggles, gown, mask, then hand hygiene.

Standard precautions apply to every resident regardless of diagnosis; all blood and body fluids are treated as potentially infectious.

Gloves do not replace hand washing and are changed between tasks and between residents.

Contact precautions (MRSA, C. difficile, scabies) require gown and gloves; add a mask and eye protection when splashing is likely.

Never recap, bend, or break a needle; place it directly into the sharps container and report any exposure at once.

Clean from clean areas to dirty areas, and disinfect shared equipment between residents.

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

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

Oxygen safety: no smoking or open flames nearby, no petroleum-based products on the face or hands, cylinders stored upright and secured.

Conscious adult choking: abdominal thrusts above the navel; if the resident becomes unresponsive, lower to the floor and start CPR.

Seizure: do not restrain and put nothing in the mouth; protect the head, time the seizure, and turn the resident to the side afterward.

Fall prevention: bed in the lowest position, call light within reach, pathways clear, non-skid footwear, and prompt answering of call lights.

Incident reports record facts objectively; the CNA does not admit fault or blame others and follows facility policy on where the report is filed.

Chest pain: stop the activity, place the resident in a comfortable resting position, notify the nurse immediately, and stay with the resident.

Never leave a resident unattended in a bathtub, on a toilet, or on a commode.