Missouri CNA cheat sheet

The nursing assistant performs tasks delegated by a licensed nurse; the registered nurse or licensed practical nurse retains responsibility for assessment, care planning, and evaluation.

Report changes to the licensed nurse and do not change the care plan or perform sterile procedures, IV therapy, or initial teaching unless state law and facility policy authorize it.

Typical adult resting values are respirations 12 to 20 per minute, pulse 60 to 100 per minute, and oral temperature about 36.5 to 37.5 degrees Celsius (97.7 to 99.5 degrees Fahrenheit); report deviations per policy.

Pain is often treated as the fifth vital sign; ask the resident to rate pain from 0 to 10 and report location, quality, timing, and relief measures.

Measure intake and output in milliliters; 1 ounce equals 30 milliliters, and record oral, tube, IV, urine, vomitus, and drainage as ordered.

Weigh the resident at the same time, on the same scale, and in similar clothing; document in pounds or kilograms according to facility policy.

Follow the chain of command: nursing assistant to charge nurse to director of nursing, using facility policy for unresolved concerns.

Basic nursing skills include bed bath, oral care, grooming, bed making, positioning, ambulation, and specimen collection when delegated.

Never perform a task outside training or delegation; ask for clarification and document objective observations only.

Fall prevention includes keeping the call light, phone, water, and needed items within reach; bed low, brakes locked, non-skid footwear, and adequate lighting.

Restraint use requires a physician order, informed consent per policy, the least restrictive device, frequent monitoring, release, and documentation; never tie restraints to side rails.

Fire response RACE means Rescue anyone in immediate danger, Alarm or activate the system, Contain fire by closing doors, and Extinguish or Evacuate if safe.

Fire extinguisher PASS means Pull the pin, Aim at the base of the fire, Squeeze the handle, and Sweep side to side.

For a seizure, protect the resident from injury, do not restrain or place anything in the mouth, time the seizure, turn the resident to the side afterward, and call the nurse.

For choking in a conscious adult, encourage coughing; if coughing is ineffective, call for help and begin abdominal thrusts or CPR according to training and facility protocol.

For suspected stroke, note the time last known well and report facial droop, arm weakness, or speech difficulty immediately.

Oxygen safety includes no-smoking signs, avoiding petroleum products, keeping oxygen away from flames and heat, and securing tubing.

Complete an incident report per policy for falls, injuries, medication errors, or near misses; report facts and do not blame or alter the medical record.

Perform hand hygiene before and after resident contact, after removing gloves, after body fluid exposure, and between dirty and clean tasks; use soap and water for C. difficile or visibly soiled hands.

Standard precautions apply to all residents and treat blood, body fluids, secretions, excretions, non-intact skin, and mucous membranes as potentially infectious.

Use gloves for contact with body fluids, a gown for splash risk, and a mask with eye protection when splashes are likely; remove gloves before leaving the room and perform hand hygiene.

Transmission-based precautions include contact precautions with gown and gloves, droplet precautions with a mask, and airborne precautions with an N95 respirator and negative-pressure room per policy.

Clean less soiled areas first, then disinfect high-touch surfaces and shared equipment between residents according to facility policy.

Do not recap, bend, or break used needles; dispose of them immediately in a puncture-resistant sharps container.

For bloodborne pathogen exposure, wash the area, report immediately, and follow facility policy for post-exposure evaluation.

Catheter care includes keeping the drainage bag below the bladder and off the floor, preventing kinks, cleaning the perineal area front to back, and maintaining a closed system.

Do not share personal care items, and keep soiled linen away from the uniform and place it in the designated bag.

Residents have the right to dignity, privacy, confidentiality, choice, and freedom from abuse, neglect, exploitation, and restraint.

A resident may refuse care or treatment; notify the nurse, document the refusal, and offer alternatives without arguing.

Protect privacy during care by knocking, identifying yourself, closing curtains or doors, and exposing only the body part being cared for.

Share resident information only with the care team on a need-to-know basis and do not discuss it in public areas.

Report suspected abuse, neglect, or exploitation immediately to the charge nurse and, in Missouri, to the Adult Abuse and Neglect Hotline at 1-800-392-0210.

Encourage independence by allowing the resident to do what they can, offering choices, and providing assistive devices rather than doing tasks for them.

A resident can file a grievance or contact the ombudsman without retaliation; provide contact information according to facility policy.

Do not accept gifts or money from residents or borrow from them; avoid personal relationships that exploit the power imbalance.

Restraints and seclusion may not be used for convenience, discipline, or coercion; follow order and monitoring rules.

Use the resident's preferred name, introduce yourself, and explain care before beginning.

For hearing loss, face the resident, speak clearly and slowly, reduce background noise, and use written notes or an interpreter; do not shout.

For aphasia, allow extra time, use yes-or-no questions, gestures, and pictures, and do not finish sentences unless asked.

Report subjective statements in the resident's own words and objective observations without guessing or interpreting.

SBAR means Situation, Background, Assessment, and Recommendation; use it for concise handoff and change reports.

Use a qualified medical interpreter, not family members, for consent or complex care according to policy.

Therapeutic communication includes open-ended questions, active listening, silence, reflection, and empathy; avoid why questions that sound accusatory.

For cognitive impairment, use short sentences, one-step directions, a calm tone, and validation rather than correction.

Do not discuss residents in elevators, dining rooms, or on social media.

During bathing, gather supplies, provide privacy, test water temperature, wash eyes from inner to outer, clean the perineal area front to back, and dry skin folds.

Provide oral care at least twice daily; remove dentures, clean them over a sink, use denture cleaner, and store them in a labeled cup.

Prevent pressure injuries by repositioning at least every 2 hours, keeping skin clean and dry, inspecting bony areas, using pressure-relieving devices, and reporting redness.

Encourage dressing choice; dress the affected or weaker side first and undress the stronger side first while respecting modesty.

Offer toileting regularly, answer call lights promptly, assist with perineal hygiene front to back, and document bowel and bladder patterns.

Do not cut the nails of a resident with diabetes or circulation problems unless allowed; report abnormalities.

Comb and shampoo hair according to preference, and report rash, skin breakdown, bruising, or other changes.

Use clean linen, avoid shaking linen, keep soiled linen off the floor, and never place dirty linen on clean surfaces.

For perineal care, wear gloves, wash front to back, use a separate washcloth for the perineal area, and dry thoroughly.

For dysphagia, sit the resident upright at 90 degrees, use a chin tuck if taught, give small bites, allow time, and check the mouth for pocketing.

Use prescribed thickened liquids at the ordered consistency; do not thin them, and report coughing, choking, a wet voice, or pocketing.

Follow orders for diabetic, low-sodium, renal, mechanical soft, pureed, or NPO diets; do not add salt or sugar without approval.

Offer fluids frequently, record intake accurately, and report dark urine, dry mouth, poor skin turgor, or weight loss.

Feed in a dignified manner, do not rush, alternate fluids and solids, and stop if choking or fatigue occurs.

Measure all liquids in milliliters; 1 cup equals 240 milliliters and 1 ounce equals 30 milliliters, including IV fluids, tube feedings, urine, emesis, and drainage.

Check expiration dates, keep hot foods hot and cold foods cold, and follow facility policy for reheating.

Coughing, choking, cyanosis, difficulty breathing, or fever after eating may indicate aspiration; stop feeding and report immediately.

Encourage independence with adaptive utensils and allow food choices when permitted.

Perform range of motion only as ordered; move each joint slowly to the point of resistance, never force a joint, and stop if pain occurs.

Before ambulation, apply a gait belt, check non-skid shoes, clear the path, stand on the weaker side, and follow weight-bearing orders.

A cane is held on the stronger side; the resident moves the cane with the weaker leg, then steps with the stronger leg, per therapy instructions.

For a walker, the resident lifts or rolls it forward and then steps into it while staying upright and using the gait belt as needed.

Wheelchair safety includes locking brakes before transfer, raising footrests, using a transfer belt, and keeping feet on footrests during transport.

Use proper body mechanics during transfers: keep the resident close, bend the knees, and avoid lifting with the back.

Position for body alignment, support limbs with pillows, avoid pressure on bony prominences, and change position regularly.

Prevent contractures with active range of motion, ordered splints, proper positioning, and early mobility.

Report new weakness, swelling, pain, or inability to bear weight before mobilizing the resident.

Depression warning signs include sadness, withdrawal, poor appetite, sleep changes, and hopelessness; report them to the nurse.

For anxiety, stay calm, use simple explanations, reduce stimulation, offer presence, and report escalating distress.

For grief, allow expression, listen, avoid clichés, maintain routines, and refer to social services or chaplaincy according to preference.

Take all suicide statements seriously, stay with the resident, notify the nurse immediately, and remove means if safe per policy.

Report tremors, sweating, agitation, hallucinations, or seizures immediately because they may indicate substance withdrawal.

Use empathy, active listening, nonjudgmental language, and respect for cultural and spiritual needs.

Social services can help with finances, advance directives, discharge planning, and community resources through referral.

Behavior changes may signal pain, infection, constipation, or environmental stress; report and document possible triggers.

Dementia is progressive cognitive decline; delirium is an acute, fluctuating change often caused by illness, medications, or infection, so report sudden changes.

Approach from the front, use the resident's name, speak in short sentences, give one step at a time, allow time, and avoid arguing with delusions.

For wandering, redirect to a safe activity, secure the environment, report elopement risk, and use alarms according to policy.

For sundowning, increase lighting, reduce noise, maintain routine, limit late naps, and plan calm activities in late afternoon.

Use validation by acknowledging the feeling behind a behavior rather than correcting facts, and redirect gently if the resident is unsafe.

Remove clutter, lock hazardous items, supervise smoking, prevent falls, and monitor for choking and medication errors.

Keep a consistent schedule, label items, use calendars or clocks, and encourage familiar tasks to support memory.

Watch for grimacing, guarding, restlessness, vocalization, or refusal as possible pain signs and report them for treatment per order.

Do not use restraints for wandering or confusion unless ordered and monitored under strict rules.