Maryland CNA cheat sheet

Hand hygiene: soap and water for at least 20 seconds; alcohol-based rub is acceptable only when hands are not visibly soiled, and soap and water is required after C. difficile or norovirus contact.

Normal adult values to compare against: oral temperature 97.6-99.6 degrees F, radial pulse 60-100 beats/min, respirations 12-20/min, blood pressure under 120/80 mmHg.

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

Pressure injury rule: stage 1 is intact skin with non-blanchable erythema; never massage a reddened bony prominence, and reposition immobile residents at least every 2 hours.

Fluid math: 1 kilogram of body weight equals about 1 liter of fluid; record intake and output in mL and report urine output under 30 mL/hour for 2 or more hours.

Passive range of motion stops at the first sign of resistance or pain; support the joint above and below and never force a joint.

Bowel rule: no stool for 3 days, abdominal distention, or liquid stool leaking around a blockage suggests impaction - report it and do not give an enema without an order.

Transfer rule: lock bed and wheelchair wheels, lower the bed, apply a gait belt, and position yourself on the resident's weaker side before moving.

Maslow order: physiological needs are met before safety, love and belonging, esteem, and self-actualization - food, fluids, oxygen, and pain relief come first.

Kubler-Ross order: denial, anger, bargaining, depression, acceptance; residents may cycle back and forth between stages rather than moving straight through.

Mild confusion: use reality orientation (state date, place, person; use clocks and calendars). Dementia-related confusion: use validation and redirection and do not argue with the resident's reality.

Restraint rule: a physical restraint requires a physician's order, must be the least restrictive device, and must be released with circulation and skin checks at least every 15 minutes.

Refusal rule: a resident may refuse care or food; do not force it, document exactly what was refused, and notify the nurse.

New-onset confusion is a medical symptom, not normal aging: common causes include urinary tract infection, dehydration, hypoxia, constipation, and medication changes.

Hearing impairment: get the resident's attention first, face the person, speak clearly at normal volume, and do not shout.

Depression versus normal aging: withdrawal, appetite change, sleep change, and loss of interest lasting more than 2 weeks are reported, not dismissed as part of aging.

Scope: a CNA carries out delegated tasks (bathing, feeding, vital signs, ambulation) and does not assess, diagnose, or administer medication unless specifically certified to do so.

Chain of command: CNA to licensed nurse (RN/LPN) to charge nurse to physician; changes in condition go to the licensed nurse first.

Report immediately, not at end of shift: chest pain, dyspnea, fall, loss of consciousness, new bleeding, new skin breakdown, abnormal vital signs.

Documentation must be objective, factual, timed, dated, signed, and in black ink; an error gets a single line through it with initials - never white-out.

A late entry is labeled 'late entry' and carries the date and time it is actually written; entries are never back-dated.

HIPAA: resident information is shared only with the care team; no discussion in hallways, elevators, or with friends and family.

OBRA training minimums: at least 75 hours of state-approved training including 16 hours of supervised clinical practice, plus 12 hours of in-service education per year.

Abuse, neglect, and misappropriation of property must be reported immediately; substantiated findings are placed on the state nurse aide registry by the Board of Nursing.

Every skill begins and ends with hand hygiene and with explaining the procedure to the resident before touching them.

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

Apical pulse: fifth intercostal space at the left midclavicular line, diaphragm of the stethoscope, counted for a full 60 seconds.

Blood pressure cuff: bare upper arm, bladder width about 40% of arm circumference, lower edge 1 inch above the antecubital crease, arm supported at heart level.

Bed bath order: eyes (inner to outer, separate corner of cloth per eye), face, neck, arms, chest, abdomen, legs, back, perineum last.

Dentures: line the sink or fill it with water, hold with gauze, brush with denture cleanser, and store in a labeled cup with water when not in the mouth.

Indwelling catheter: clean front to back, keep the bag below bladder level, keep tubing free of kinks and loops, and never let the bag touch the floor.

Feeding: head of bed at 90 degrees or the highest angle tolerated, small bites, time to chew and swallow, and the resident stays upright 30 minutes after the meal.