Michigan CNA cheat sheet

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

Axillary temperatures read about 1°F lower than oral; rectal readings run about 1°F higher and are avoided with diarrhea, rectal surgery, or an agitated resident.

Count a radial pulse for 30 seconds and multiply by 2; count a full 60 seconds when the rhythm is irregular. Report a rate below 60 or above 100.

Count respirations for 30 seconds and multiply by 2 without telling the resident, because awareness changes the rate and depth.

Blood pressure technique: cuff bladder about 1 inch above the antecubital space, arm supported at heart level, deflate at 2–3 mmHg per second.

Volume conversions: 1 ounce = 30 mL, 1 cup = 240 mL, 1 teaspoon = 5 mL, 1 tablespoon = 15 mL.

Weigh residents at the same time of day, on the same scale, in similar clothing; 1 kilogram = 2.2 pounds.

Pain is whatever the resident says it is; use a 0–10 scale or the Wong-Baker FACES scale for residents who cannot give a number, and report pain that is unrelieved.

Label specimens at the bedside in the resident's presence, wear gloves, and send them to the laboratory promptly.

Bath water is 100–105°F; test it with a thermometer or on your inner wrist before the resident enters the tub or shower.

Wash in clean-to-dirty order: face, then trunk, arms, and legs, with the perineum last; change water when it becomes cool or soiled.

Perineal care goes front to back, using a separate part of the washcloth for each stroke; rinse, pat dry, and report redness, odor, or discharge.

Dress the weak or affected side first, then the strong side; when undressing, remove the strong side first.

Dentures are removed with gauze for grip, brushed over a basin lined with a towel, and stored in a labeled cup of cool water - never hot water.

Provide oral care at least twice daily and after meals, including for residents who are NPO or unconscious.

Use an electric razor for residents on blood thinners or who are confused; use disposable razors only as facility policy allows.

Inspect skin over pressure points at every bath and report redness that does not blanch when pressed with a finger.

Keep the resident covered and expose only the area being washed; close the door and pull the privacy curtain.

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

Alcohol-based rub does not kill C. difficile spores; use soap and water for residents with C. diff.

Standard precautions apply to every resident regardless of diagnosis or known infection status.

Don PPE in the order gown, mask, goggles, gloves; remove in the order gloves, goggles, gown, mask, then perform hand hygiene.

Contact precautions (MRSA, C. diff, scabies) require gown and gloves; droplet (influenza, pertussis) requires a surgical mask; airborne (TB, measles, disseminated shingles) requires an N95 and a negative-pressure room.

Do not wear artificial nails or rings; keep natural nails short and clean.

Never share razors, toothbrushes, or other personal items; clean shared equipment between residents.

Hold soiled linen away from your uniform, never place it on the floor, and bag it at the point of use without shaking it.

Blood spill: wear gloves, absorb the spill, wash with soap and water, then disinfect with a 1:10 bleach solution or approved disinfectant per policy.

Fall prevention bundle: bed in the lowest position, brakes locked, call light within reach, non-skid footwear, clear path, and adequate lighting.

Restraints require a physician's order and the least restrictive device, secured with a quick-release knot never tied to side rails; check circulation every 15 minutes and release and reposition every 2 hours.

Adult CPR: 30 compressions to 2 breaths, 100–120 compressions per minute, depth at least 2 inches, allowing full chest recoil.

Choking adult: deliver abdominal thrusts; if the person becomes unconscious, lower them to the floor, activate emergency response, and begin CPR.

Fire response RACE: Rescue, Alarm, Contain, Extinguish or Evacuate. Extinguisher PASS: Pull, Aim, Squeeze, Sweep.

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

Burn care: cool with running water for 10–20 minutes; do not apply ice or ointments.

Oxygen safety: no smoking, no petroleum-based products, no wool or synthetic fabrics nearby, and cylinders secured upright.

Severe bleeding: apply direct pressure with gloved hands and call for help immediately.

Fluid equivalents: 1 ounce = 30 mL, 1 cup = 240 mL, 1 teaspoon = 5 mL, 1 tablespoon = 15 mL.

Clear liquid diet includes water, broth, gelatin, and clear juice; full liquid adds milk, ice cream, and strained cereals; pureed and mechanical soft diets change texture only.

Dysphagia warning signs during meals: coughing, choking, pocketing food, drooling, or a wet gurgly voice - stop feeding and report.

Feed with the resident upright at about 90 degrees, small bites, alternating food with fluids, and keep them upright 30–45 minutes afterward.

Thickened liquids are ordered at nectar, honey, or pudding consistency; never thin them or substitute a different consistency.

Dehydration signs: dark concentrated urine, dry mucous membranes, poor skin turgor, confusion, and urine output below 30 mL per hour.

Fluid restriction: measure and record all fluids including ice chips (count half their volume) and spread the allowance across the shift.

Older adults have reduced thirst and taste; offer fluids every 1–2 hours rather than waiting for a request.

Passive ROM means the aide moves the joint while the resident relaxes; active ROM means the resident moves it; active-assist means both work together.

Move each joint 3–5 times, at least twice daily per the care plan, supporting the body above and below the joint.

Stop at the point of resistance or pain, never force a joint, and report swelling, redness, or crepitus.

Reposition at least every 2 hours, use pillows and bolsters to maintain alignment, and keep heels off the mattress.

Apply a gait belt to any resident who needs assistance; stand on the weaker side and slightly behind, holding the belt throughout ambulation.

A cane is held on the strong side and moves forward with the weak leg; a walker is advanced first, then the resident steps into it.

Encourage residents to perform the parts of care they can do themselves, and give praise for attempts.

Contracture prevention combines normal body alignment, daily ROM, ordered splints, and frequent position changes.

Maslow's hierarchy from the base upward: physical needs, safety, love and belonging, esteem, self-actualization.

Kübler-Ross stages of grief are denial, anger, bargaining, depression, and acceptance, and they do not always occur in that order.

Depression indicators: withdrawal, appetite or sleep change, loss of interest, and hopeless statements - report them to the nurse.

Any statement of self-harm or suicide is taken seriously: stay with the resident and report immediately.

Dementia care uses a calm voice, short sentences, one instruction at a time, and a consistent routine; redirect rather than argue with delusions.

Behavior is communication - check first for pain, hunger, thirst, need to toilet, fatigue, or overstimulation.

Anxiety: remain with the resident, speak slowly, and reduce noise and stimulation.

Respect religious, cultural, and sexual expression, and report unmet psychosocial needs to the charge nurse.

OBRA Residents' Bill of Rights guarantees dignity, privacy, choice, self-determination, freedom from abuse and unnecessary restraints, access to records, and grievance without retaliation.

A resident may refuse any care; report the refusal and the reason without forcing, threatening, or bargaining.

Suspecting abuse, neglect, or misappropriation triggers mandatory reporting immediately to the charge nurse or administrator and to the state hotline.

Abuse categories include physical, sexual, emotional or verbal, financial, neglect, and involuntary seclusion.

Confidentiality: discuss resident information only with the care team, never in hallways, elevators, or with unauthorized visitors.

Knock and wait before entering; close the door and curtains and drape so only the area being cared for is exposed.

Personal possessions belong to the resident; label and protect them and never remove items without permission.

Honor advance directives and know the resident's code status before an emergency arises.

The state long-term care ombudsman program contact information must be posted and available to residents.

Speak face-to-face at eye level, use a normal volume, and reduce background noise before starting a conversation.

Hearing loss: get attention first, face the person, speak clearly and slowly, and do not shout or cover your mouth.

Aphasia: allow extra time, use yes-or-no questions, gestures, and picture boards, and never pretend to understand.

Vision loss: identify yourself on entering, announce before touching, and use the clock method to describe food placement on a tray.

Ask open-ended questions instead of yes-or-no questions, and acknowledge feelings before giving information.

Use a trained interpreter for residents with limited English; avoid using family members for sensitive information.

Document objectively: record what you saw and heard, quote the resident's own words, and avoid opinions or conclusions.

Nonverbal cues such as facial expression, posture, and tone carry much of the message; watch the resident's as well as your own.

CNA scope includes ADLs, vital signs, intake and output, ambulation, positioning, specimen collection, and safety; it excludes assessment, teaching, diagnosis, medication administration, and sterile procedures.

Report any change in condition to the charge nurse promptly; the licensed nurse assesses and decides on the response.

SBAR - Situation, Background, Assessment, Recommendation - is the standard structure for handoffs and change-in-condition reports.

Document at the time care is given, sign each entry, and include your title; care that is not documented is treated as not done.

The care plan directs all care; report when it is not working or when the resident's needs have changed.

Incident reports are factual and objective, completed promptly, with facility policy determining charting and disclosure.

Never accept a task you are not trained to perform; ask for help and use the chain of command.

Do not leave a resident on a bedpan or toilet unattended for long periods; check on them frequently.