Minnesota CNA cheat sheet

Federal OBRA law and Minnesota facility rules guarantee residents dignity, privacy, self-determination, and freedom from abuse, neglect, and exploitation.

A resident with decision-making capacity may refuse any care task; the refusal is documented, the offer may be repeated later, and the nurse is notified - force is never used.

Restraints of any kind require a physician order, must treat a medical symptom, are time-limited, and may never be used for staff convenience or discipline.

Residents may voice grievances, contact advocates, send and receive mail, use the telephone, and receive visitors without retaliation.

Care information is shared only with the care team; discussing a resident's condition with others without consent is a confidentiality breach.

Suspected abuse, neglect, or exploitation must be reported immediately to the charge nurse and administrator; nursing assistants are mandated reporters.

Residents choose their own sleep, meal, and activity schedules unless a medical contraindication is documented, so choices are offered during care.

Personal funds and belongings are protected; staff never borrow from, hold, or spend a resident's money outside facility procedure.

Independence is preserved by allowing the resident to perform any part of a task they can do, with the nursing assistant assisting only the rest.

Effective communication requires facing the resident at eye level, speaking in a normal tone, and minimizing background noise.

Aphasia after stroke is managed with short yes-or-no questions, gestures, pictures, and extra response time; pretending to understand is unsafe.

For hearing loss: lower the pitch of the voice, speak clearly, ensure the hearing aid is on and the battery works, and avoid shouting.

For vision loss: identify yourself on entering, announce each action before it happens, and keep personal items in consistent locations.

Dementia-related confusion is handled with one-step directions, reassurance, and redirection rather than argument or correction.

Language barriers require a qualified interpreter; using an untrained family member for medical information risks errors.

New slurred speech, word-finding difficulty, or a sudden change in responsiveness is treated as a possible neurologic emergency and reported at once.

Non-verbal residents communicate through facial expression, body language, guarding, and vocalization, which are documented as reported observations.

Plain, everyday words replace medical jargon when speaking with residents and families.

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

A resident who is weak or unsteady is never left alone on a bedpan, toilet, shower chair, or in the tub.

RACE = Rescue, Alarm, Contain (close doors), Extinguish or Evacuate; PASS = Pull, Aim, Squeeze, Sweep for a fire extinguisher.

Adult CPR: compressions 100–120 per minute, at least 2 inches deep, with a 30:2 compression-to-ventilation ratio.

A resident who has fallen and may be injured is kept still, covered, and monitored while help is summoned; moving them can worsen injury.

During a seizure: protect the head, clear hazards, place nothing in the mouth, time the event, and turn the resident to the side afterward.

Wheelchair and bed wheels are locked and the bed is at a safe height before any transfer; a gait belt is used for residents with weakness.

Environmental hazards to remove or report include spills, frayed cords, loose rugs, clutter, and unlocked wheels.

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

Soap and water is required after contact with C. difficile or norovirus because alcohol does not destroy spores.

Standard precautions apply to every resident: gloves are worn for contact with blood, body fluids, mucous membranes, and non-intact skin.

Donning order is gown, mask, goggles, then gloves; removal order is gloves, goggles, gown, then mask, with hand hygiene afterward.

Gloves are changed between residents and between dirty and clean tasks; gloves never substitute for hand washing.

Contact precautions use gown and gloves plus dedicated equipment; droplet precautions use a mask and a private or same-illness roommate; airborne precautions use a fit-tested N95.

Soiled linen is bagged at the point of use without shaking and held away from the body.

Shared equipment such as stethoscopes, BP cuffs, and thermometers is disinfected between residents per facility policy.

A bloodborne pathogen exposure is washed immediately, reported at once, and followed by post-exposure evaluation.

Privacy during care means closing the door or curtain and exposing only the body part being washed, with the rest draped.

Bathing proceeds from clean to dirty: face, upper body, lower body, back, with the perineal area washed last.

Bath water is comfortably warm - approximately 105°F (40.5°C) - and is tested on the inner wrist before the resident enters.

Oral care is provided at least twice daily; dentures are removed at night and cleaned over a sink lined with a washcloth or filled with water.

An unresponsive resident receives mouth care with a moistened sponge swab and head turned to the side; toothpaste and poured liquids are avoided.

Nails of residents with diabetes or poor circulation are not cut by nursing assistants; the nurse or podiatrist is notified.

Female perineal care is performed front to back with a separate washcloth to reduce urinary tract infection risk.

Skin is inspected at every bath for redness, bruising, rash, and open areas, especially over bony prominences; non-blanching redness is reported.

Typical adult ranges: oral temperature 97.6–99.6°F, pulse 60–100 beats/min, respirations 12–20/min, SpO2 95–100%.

A regular radial pulse is counted for 30 seconds and doubled; an irregular pulse is counted for a full 60 seconds and the rhythm noted.

Respirations are counted for 30 seconds and doubled (or a full minute if abnormal), ideally without telling the resident, noting depth and character.

An oral temperature is delayed 15–30 minutes after eating, drinking hot or cold liquids, smoking, or chewing gum.

Blood pressure cuff bladder should encircle about 80% of the upper arm; the arm rests at heart level and is supported.

Pulse deficit is the difference between apical and radial rates counted simultaneously by two staff.

Weights are taken at the same time of day on the same scale with similar clothing and recorded in the facility's unit.

Report immediately: temperature 100.4°F or higher, pulse below 60 or above 100, respirations below 12 or above 20, SpO2 below 92%, or BP outside ordered parameters.

Rectal temperature is avoided with diarrhea, rectal surgery, or low platelet/neutrophil counts.

Therapeutic diets - low sodium, diabetic, mechanical soft, thickened liquids - require a physician order; food not on the diet is never given.

Aspiration precautions: sit upright near 90 degrees for meals and 30 minutes after, offer small bites, and stop feeding at the first cough or wet voice.

Signs of dysphagia include coughing or choking while eating, pocketing food, drooling, and a gurgly voice after swallowing.

Thickened liquids are served at the ordered nectar or honey consistency and are never thinned with water or melting ice.

A typical adult needs roughly 1500–2000 mL of fluid daily unless a restriction is ordered; intake and output are recorded per policy.

Independence at meals is supported by opening containers, cutting food, and positioning, with the resident self-feeding whenever able.

Dehydration indicators are dark concentrated urine, dry mouth, poor skin turgor, confusion, and decreased urine output.

Scheduled toileting (habit training) and prompt response to call lights reduce incontinence episodes and skin breakdown.

A bedpan is warmed and dried, placed with the wide end toward the head, and the head of the bed raised if the resident's condition allows.

A weak or unsteady resident is never left alone on a bedpan or toilet.

Report no bowel movement for 3 days, hard dry stool, diarrhea, abdominal discomfort, or blood in stool or urine.

Urinary drainage bags stay below bladder level and off the floor, with tubing unkinked, to prevent backflow and infection.

The catheter bag is emptied when half to two-thirds full, and the amount, color, and odor are recorded.

Bowel regularity is supported with ordered fluids and fiber, mobility, privacy, and a normal upright position.

Incontinence care is provided promptly with front-to-back cleansing and thorough drying to prevent infection and skin damage.

Output is described by color, consistency, amount, and odor, and abnormal findings are reported to the nurse.

Immobile residents are repositioned at least every 2 hours, and more often when skin is reddened or the care plan specifies.

A gait belt is applied snugly around the waist over clothing and used for transfers and ambulation of residents with weakness.

Body mechanics: feet shoulder-width, knees bent, load close to the body, no twisting; a mechanical lift is used when the resident cannot bear weight.

Before a transfer, wheels are locked, the bed is at a safe height, and the resident is moved toward the stronger side.

During a standing transfer the assistant braces the resident's knee and pivots; lifting under the arms can injure the resident's shoulders.

Semi-Fowler's position is 30–45 degrees of head elevation; high Fowler's is 60–90 degrees, used for breathing difficulty and feeding.

Contractures are prevented by supporting limbs in alignment with pillows and keeping heels off the mattress.

When ambulating, the assistant stands on the resident's weak side and slightly behind, holding the gait belt.

If a resident starts to fall during a transfer, the assistant guides them down to the nearest surface while protecting the head rather than trying to catch them.