Kansas CNA cheat sheet

OBRA (1987) federal law sets resident rights; the facility must give a written statement of rights at admission and post them where residents can see them.

A resident may refuse any treatment, medication, or food; the CNA stops, informs the nurse, and documents the refusal - refusal is never overridden by staff.

Physical or chemical restraints require a physician order, documented medical need for safety, the least restrictive option, and periodic release; they are never used for discipline, convenience, or staffing.

Privacy rule: knock and wait for permission, close doors and curtains, drape the resident, and keep medical information confidential except with the care team.

Residents may file grievances with staff, the state survey agency, or the Long-Term Care Ombudsman; retaliation against a resident or family member who complains is prohibited.

Resident funds over $50 must be kept in an interest-bearing account separate from facility money, and the resident must receive a written record of transactions.

Access to records: on request the facility must let the resident inspect their own clinical record (generally within 24 hours) and provide copies as permitted.

Independence rule: if a resident can perform part of a task, let them do that part and supply adaptive equipment; do only the portion the resident cannot do.

Suspected abuse, neglect, or misappropriation must be reported immediately to the charge nurse/administrator and, in Kansas, to KDADS and law enforcement; CNAs are mandatory reporters.

Fire: R.A.C.E. = Rescue, Alarm, Contain (close doors), Extinguish/Evacuate; PASS = Pull, Aim, Squeeze, Sweep for an extinguisher.

Fall prevention checklist: bed low and locked, call light and personal items within reach, non-skid footwear, clear path, adequate lighting.

Seizure: protect the head, turn the resident to the side, loosen clothing at the neck, time the seizure; do not restrain or put anything in the mouth. Report a seizure lasting over 5 minutes or a second seizure.

Choking in a conscious adult: encourage coughing; if ineffective, call for help and give abdominal thrusts. If the resident becomes unresponsive, start CPR and call a code.

Suspected fracture or head injury after a fall: do not move the resident, keep them still and warm, stay with them, and call the nurse immediately.

Stroke: FAST - Face droop, Arm drift, Speech change, Time symptoms began; report immediately and record the time of onset.

Wheelchair safety: lock the brakes before any transfer, move footrests out of the way, and never attempt stairs or an escalator; get a second helper for ramps.

Oxygen safety: post no-smoking signs, keep flame and petroleum products away, avoid wool and synthetic fabrics that spark, and secure cylinders upright.

Unresponsive resident: check responsiveness and breathing, call for help/code, and begin CPR with compressions 100–120 per minute at least 2 inches deep for an adult.

Hand hygiene is the single most effective way to prevent infection: soap and water for at least 20 seconds, or an alcohol-based rub when hands are not visibly soiled.

Use soap and water rather than alcohol rub after caring for a resident with C. difficile, after contact with body fluids, and whenever hands are visibly dirty.

Standard precautions apply to every resident regardless of diagnosis: gloves for blood, body fluids, mucous membranes, and non-intact skin; gown if a splash is likely.

Donning order: gown, mask/respirator, goggles or face shield, then gloves. Doffing order: gloves, goggles, gown, mask; hand hygiene afterward.

Contact precautions (MRSA, C. difficile, scabies, draining wounds): gown and gloves for room entry, dedicated equipment, private room or cohorting.

Droplet precautions (influenza, pertussis, strep): surgical mask within about 3–6 feet. Airborne precautions (TB, measles, varicella): N95, negative-pressure room, closed door.

Blood spill: wear gloves, absorb the spill, clean with detergent and water, then disinfect with a facility-approved disinfectant (or 1:10 bleach); bag waste per policy.

Sharps: never recap, bend, or break a needle by hand; drop it immediately into a puncture-resistant sharps container.

Do not share razors, toothbrushes, washcloths, or other personal items; hold soiled linen away from your body and never place it on the floor.

Perineal care: wash front to back with a fresh part of the cloth each stroke, rinse, and dry completely; perform perineal care last in the bath.

Bath water: approximately 100–105 degrees Fahrenheit; test with a thermometer and the resident's hand; never leave a resident alone in a tub.

Dressing: put clothing on the weak/affected side first and remove it from the weak side last; encourage the resident to do as much as possible.

Dentures: remove with a washcloth or denture cup, clean over a basin lined with a washcloth, and store in a labeled cup of cool water; hot water warps them.

Nail and foot care: soak to soften, dry between the toes; do not cut the nails of residents with diabetes or poor circulation - report instead.

Shaving: use an electric razor unless the resident's own razor and nurse approval allow otherwise; never use a blade on a resident taking blood thinners.

Turning and positioning: reposition at least every 2 hours, keep heels off the mattress, and maintain body alignment with pillows.

Transfers with a gait belt: apply the belt snug over clothing, place hands on the belt (not the resident's arms), and pivot on the count of three.

Range of motion: support the joint, move slowly to the point of resistance, and stop if the resident reports pain; never force a joint.

Adult resting ranges: oral temperature 97–99 degrees F, pulse 60–100 bpm, respirations 12–20/min, blood pressure under 120/80, oxygen saturation 95–100%.

Report promptly: pulse under 60 or over 100, respirations under 12 or over 20, oral temperature 101 degrees F or higher, systolic BP under 90 or over 180, oxygen saturation below 90%.

Pulse: place two fingers over the radial artery, never the thumb; count 30 seconds and double, or count a full minute if the rhythm is irregular.

Respirations: count for a full minute while still holding the wrist, so the resident does not consciously change their breathing.

Blood pressure: cuff one inch above the antecubital space, bladder centered over the artery, arm supported at heart level; deflate 2–3 mmHg per second.

Intake and output: 1 ounce = 30 mL; measure at eye level; report urine output under 30 mL per hour or a sudden change in output.

Report abnormal urine or stool: cloudy, foul-smelling, or bloody urine; black tarry or clay-colored stool; diarrhea, or no bowel movement for several days.

Weight: same scale, same time of day (typically morning, after voiding, before breakfast), same clothing; report a gain or loss of 3–5 lb in a week.

Specimens: collect a clean-catch midstream urine, label with name, date, and time, and send to the lab promptly or refrigerate per policy.

Speak at eye level, face the resident, use their preferred name, and introduce yourself and what you are going to do before touching them.

Hearing loss: stand in good light, get attention first, speak clearly at a slightly lower pitch, do not shout or cover your mouth, and check the hearing aid first.

Aphasia: use short questions with yes/no answers, allow long pauses, use gestures and picture boards, and do not finish sentences or correct words.

Confidentiality: discuss resident information only with the care team and only where others cannot overhear; never on social media or in public areas.

Report objectively: state what you saw or heard, e.g., 'Resident ate half of lunch and refused fluids,' not conclusions like 'Resident was difficult.'

Documentation rules: chart only care you actually gave, at the time you gave it, in black ink; for an error, draw a single line, write 'error,' initial, and date.

Plain language: replace jargon (NPO, PRN, edema) with everyday words, and confirm understanding by asking the resident to repeat the information back.

Use a qualified interpreter for residents with limited English; do not use a family member for consent or sensitive information.

Maslow order: physiological needs (air, food, fluids, elimination, pain relief) come before safety, belonging, esteem, and self-actualization.

Depression indicators: withdrawal, appetite or weight change, sleep change, crying, loss of interest, hopeless statements - report them rather than attributing them to aging.

Any statement about suicide or self-harm is taken seriously: stay with the resident, remove harmful objects, and notify the nurse immediately.

Anxiety or agitation: reduce noise and lights, use a calm voice and short sentences, stay with the resident, and offer simple choices.

Behavior is communication: check for pain, hunger, thirst, constipation, urinary retention, loneliness, or overstimulation before assuming a behavioral problem.

Encourage social, religious, and recreational activity, and respect the resident's right to decline, to privacy, and to choose how to spend their time.

Kubler-Ross grief stages (denial, anger, bargaining, depression, acceptance) are not linear; a resident may move back and forth or never reach acceptance.

Refer needs beyond CNA scope - finances, discharge planning, family conflict, mood changes - to the social worker or charge nurse.

Delirium vs dementia: delirium is a sudden change with fluctuating attention, often from infection (UTI), dehydration, pain, or medication; report it as urgent.

Alzheimer's progression: early - memory loss and repetition; middle - help with ADLs, wandering, personality change; late - total care, swallowing and speech loss.

Do not argue, quiz, or correct: use validation, respond to the feeling, and redirect to a safe activity rather than insisting on reality.

Give one instruction at a time with short sentences, yes/no questions, and gestures; allow extra time for the resident to process and respond.

Sundowning: confusion worsens in late afternoon and evening; bright light during the day, a quiet evening routine, limited caffeine, and fewer naps help.

Wandering: provide safe walking activity, an ID bracelet, and a secured unit per policy; never use restraints, and report new exit-seeking behavior.

A new behavior change (agitation, refusal, crying) should trigger a search for physical causes - pain, constipation, urinary tract infection, hunger, or a medication change.

Keep routines and caregivers consistent, label drawers and belongings, and use familiar objects to reduce agitation and errors.

Home safety for dementia: lock away medications and cleaning products, lower the water heater setting, supervise smoking and cooking, and remove weapons.