Maine CNA cheat sheet

Hand hygiene: wash with soap and water for at least 20 seconds; use an alcohol-based rub only when hands are not visibly soiled; wash before and after every resident contact and after removing gloves.

Normal adult vital signs: oral temperature 97.6–99.6°F, pulse 60–100 beats per minute, respirations 12–20 per minute, blood pressure below 120/80 mmHg, oxygen saturation 95% or higher.

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

Count respirations for 30 seconds and double the number, or a full minute if abnormal; one breath equals one inhalation plus one exhalation; count without telling the resident.

Volume conversions: 1 ounce = 30 mL, 1 cup = 240 mL, 1 teaspoon = 5 mL, 1 tablespoon = 15 mL; record intake and output in milliliters.

Reposition an immobile resident at least every 2 hours, inspect the skin at every turn, and avoid dragging the resident to prevent friction and shear injury.

Body mechanics: feet shoulder-width apart, knees bent, back straight, resident held close; never twist while lifting; use a gait belt for transfers unless contraindicated.

Range of motion: move each joint slowly to the point of resistance, never force a joint or cause pain, and stop and report if the resident reports pain.

Maslow's hierarchy in order: oxygen, food, and fluids; safety and security; love and belonging; self-esteem; self-actualization - lower-level needs are met first.

Kübler-Ross stages: denial, anger, bargaining, depression, acceptance; the sequence is not fixed and a resident may revisit stages.

Reality orientation for mild confusion: calm voice, short sentences, one question at a time, repeat as needed, and state person, place, and time.

Hearing loss: face the resident, reduce background noise, speak at a lower pitch with normal-to-loud volume, and use gestures; never shout into the ear or cover your mouth.

Aphasia: allow extra time, use yes/no questions and picture boards, do not correct or finish the resident's speech, and never discuss the resident as if they were absent.

Behavior is communication: agitation may signal pain, hunger, thirst, a full bladder, constipation, noise, temperature extremes, or fear - check unmet physical needs first.

Defense mechanisms include denial, regression, projection, rationalization, and displacement; regression (thumb-sucking, bedwetting) is common during illness and is not to be scolded.

Privacy and dignity: knock, wait for permission, close the door and curtains, drape with a bath blanket, and expose only the area being cared for.

Cultural and spiritual care: ask about diet, hygiene, prayer, and family involvement; honor requests or report them to the nurse rather than substituting personal preference.

Scope of practice: the aide performs delegated, taught tasks only; assessment, teaching, diagnosis, medication administration, sterile procedures, and IV care belong to the licensed nurse.

Delegation: the nurse keeps accountability for the task; the aide may refuse any assignment outside training or that is unsafe and must report the reason.

Chain of command: aide → charge nurse/LPN/RN → nurse manager → director of nursing → administrator; changes in resident condition go to the licensed nurse first.

Charting standards: objective, factual, complete, timely, in the aide's own words, in black ink, signed with name and title; chart only care you personally gave.

Error correction in the record: single line through the entry, write 'error' and initials, then chart correctly; no erasing, correction fluid, or obliterating marks.

Incident reports: complete for any fall, error, injury, or near miss; document the facts in the record without referencing the incident report and never assign blame.

Verbal reporting: changes in condition, refusals of care, abnormal vital signs, and skin breakdown are reported to the nurse immediately, not held until the end of the shift.

Confidentiality and HIPAA: discuss resident information only with the care team and never in public areas, at home, or on social media.

Federal OBRA requirements: at least 75 hours of state-approved training, a passing written and skills competency evaluation, and at least 12 hours of in-service education per year.

RACE: Rescue, Alarm, Contain by closing doors, Extinguish or Evacuate; know the evacuation route and meeting place for your unit.

PASS: Pull the pin, Aim at the base of the fire, Squeeze the handle, Sweep side to side, keeping an exit behind you.

Fall prevention: bed low with wheels locked, side rails per policy, call light in reach, non-skid footwear, clear pathways, adequate lighting, and prompt answering of call lights.

Restraints require a physician's order and consent per policy, are used only after less restrictive measures fail, are never for punishment or convenience, and are never tied to side rails.

Restraint monitoring: check at least every 15 minutes for circulation, skin, and breathing; release, reposition, exercise, offer fluids, and toilet at least every 2 hours.

Abuse categories: physical, sexual, verbal/emotional, financial exploitation, neglect, and involuntary seclusion; suspicion is reported immediately to the nurse and the state agency.

Informed consent: the physician or nurse explains the procedure and risks; the aide may witness a signature but never explains the procedure or pressures the resident to sign.

Chain of infection: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host; hand hygiene and PPE break the transmission link.

OBRA resident rights: privacy, dignity, information, choice, voicing grievances, keeping personal possessions, and contacting the ombudsman without interference.