Massachusetts CNA cheat sheet

Normal adult resting vital signs: oral temperature 36.5-37.5 C (97.6-99.6 F); pulse 60-100 beats/min; respirations 12-20/min; blood pressure below 120/80 mmHg (130/80 mmHg or higher is hypertension).

Count respirations for a full 60 seconds without announcing it, since awareness alters the rate; count the radial pulse for 30 seconds and multiply by 2, or for a full minute when the rhythm is irregular.

Apical pulse is heard at the fifth intercostal space at the left midclavicular line and counted for a full minute; it is taken before digoxin and when a radial pulse is irregular or faint.

Blood pressure cuff bladder length should wrap about 80% of the arm circumference (width about 40%); inflate to roughly 30 mmHg above the point where the radial pulse disappears, then deflate slowly.

Orthostatic hypotension check: measure blood pressure and pulse with the resident lying, then sitting, then standing 1-3 minutes apart; report a drop of 20 mmHg systolic or 10 mmHg diastolic, or symptoms of dizziness.

Intake/output is recorded in milliliters: 1 ounce = 30 mL and 1 cup = 240 mL; report hourly urine output below 30 mL/hr or 24-hour output below 500 mL to the nurse.

Temperature routes differ: axillary readings run about 0.5 C (1 F) lower than oral, rectal about 0.5 C higher; wait 15-30 minutes after hot or cold drinks before taking an oral temperature.

Pulse oximetry (SpO2) is normally 95-100%; report a reading below 90%, or a drop of 3-5% from the resident's baseline, along with any shortness of breath.

Pain is treated as the fifth vital sign: use a 0-10 numeric scale, or the Wong-Baker FACES scale for residents who cannot report a number, and record location, quality, and timing.

Provide oral care at least twice daily and after meals; remove dentures at night, clean them with a denture brush, and store them in a labeled, covered cup of water.

Bath water should be 100-105 F (about 38-41 C) and tested with the inner wrist; keep the room warm and drape the resident so only the area being washed is exposed.

During a bed bath, wash the cleanest areas first and the perineal area last; wipe each eye from the inner canthus (nose side) toward the outer canthus.

Perineal care always moves front to back, from the urethra toward the rectum, using a separate washcloth for the perineal area to reduce urinary tract infection risk.

Reposition an immobile resident at least every 2 hours using a 30-degree lateral tilt, and keep the head of the bed at or below 30 degrees unless medically contraindicated.

When dressing a resident with one-sided weakness, put the garment on the affected side first, then the unaffected side; when undressing, remove the unaffected side first.

Do not cut the nails of residents with diabetes or peripheral vascular disease; provide nail care by filing only, and report the need for trimming to the nurse.

Use an electric razor for residents who take anticoagulants or have a bleeding disorder; hold the skin taut and shave in the direction of hair growth.

Offer the bedpan, urinal, or toileting assistance at scheduled intervals (before meals, at bedtime, and on a prompted voiding schedule) rather than waiting for a request.

Hand hygiene: soap and running water for 15-20 seconds, or alcohol-based hand rub for 20-30 seconds; use soap and water after caring for a resident with C. difficile or norovirus and whenever hands are visibly soiled.

Standard precautions apply to every resident regardless of diagnosis; gloves do not replace hand hygiene, and gloves are changed between tasks and between residents.

Donning PPE order: gown, mask or respirator, goggles or face shield, then gloves. Doffing order: gloves, goggles/face shield, gown, then mask or respirator (handled last by the ties or straps).

Fall prevention bundle: bed in the lowest position with brakes locked, call light and personal items within reach, night light on, non-skid footwear, and a clear path to the bathroom.

Fire response uses R.A.C.E.: Rescue anyone in danger, Alarm/activate the alarm, Contain the fire by closing doors, Extinguish or Evacuate per the facility plan. Extinguisher use is P.A.S.S.: Pull, Aim, Squeeze, Sweep.

Adult CPR: compressions at least 2 inches (5 cm) deep at 100-120 per minute, ratio of 30 compressions to 2 breaths, and apply an AED as soon as it is available.

Restraints require a physician's order, the least restrictive device, and monitoring at least every 15 minutes with release and repositioning at least every 2 hours; restraints are never used for convenience, discipline, or staffing shortages.

Sharps are never recapped by hand; place them immediately in a puncture-resistant sharps container, and report any needlestick or body-fluid exposure to the nurse right away.

Airborne precautions (tuberculosis, measles, varicella) require an N95 respirator and a negative-pressure room; droplet precautions (influenza, pertussis) require a mask and, when possible, a private room.

Use active listening: face the resident at eye level, reduce background noise, give full attention, and paraphrase back what you heard to confirm understanding.

For a resident with aphasia, ask yes/no questions, use picture or word boards, allow extra time to respond, and never finish sentences or speak about the resident as if they are absent.

For hearing impairment, get the resident's attention first, face them while speaking, speak clearly at normal volume, and avoid shouting or exaggerating lip movements, which distort speech.

Speak in short, one-step sentences for residents with cognitive impairment; validate feelings and redirect rather than arguing about facts that cannot be changed.

Report objective observations to the nurse (what you see, hear, or measure, such as 'skin is red and warm' or 'ate 25% of lunch'), not opinions, guesses, or diagnoses.

Use SBAR for handoffs: Situation, Background, Assessment, Recommendation, stated in that order and kept brief and specific.

Use a qualified medical interpreter, not a family member or another resident, for consent, discharge teaching, or sensitive information; speak directly to the resident, not to the interpreter.

Share resident information only with care team members who need it to provide care; never discuss residents in hallways, elevators, or public areas, and never post about them online.

Federal law (OBRA 1987 Residents' Bill of Rights) guarantees the right to be informed, to choose, to voice grievances without retaliation, to privacy and dignity, to be free from abuse and unnecessary restraint, and to access records.

A competent resident may refuse any care or treatment; accept the refusal without argument, notify the nurse, document what was refused, and offer acceptable alternatives.

Nursing assistants are mandated reporters: suspected abuse, neglect, or financial exploitation must be reported immediately to the charge nurse and per state law, and the aide must not investigate it personally.

Valid informed consent requires that the resident or legally authorized representative understand the nature of the treatment, its risks, benefits, and alternatives, and consent freely without pressure.

Protect privacy by knocking and waiting before entering, closing the door or curtain, and exposing only the body part being cared for; HIPAA and facility policy protect health information.

Promote independence by allowing residents to perform as much self-care as they can, even if it takes longer, and by supplying adaptive equipment such as grab bars, long-handled sponges, or button hooks.

The long-term care ombudsman is an independent advocate for residents; the contact number must be posted where residents can see it, and the facility may not interfere with a resident contacting the ombudsman.

Do not borrow, accept gifts of money from, or handle a resident's personal funds outside established facility procedure; resident belongings must be safeguarded and inventoried.