Montana CNA cheat sheet

OBRA (1987) resident rights include dignity, privacy, self-determination, choice, freedom from abuse and neglect, and the right to voice grievances without retaliation.

Nurse aides perform only tasks taught in the approved training program and delegated by a licensed nurse; assessment, care planning, sterile technique, and initial teaching are outside aide scope.

Suspected abuse, neglect, mistreatment, or misappropriation of property is reported immediately to the charge nurse; the aide documents objectively and does not investigate.

Escalation order: charge nurse → director of nursing → administrator → state survey agency or long-term care ombudsman.

A competent resident may refuse care; the aide stops, informs the nurse, documents the refusal, and offers the care again later - force is never used.

HIPAA limits discussion of resident information to care-team members who need it; hallway, elevator, and off-duty conversations are violations.

Aides never accept money, gifts, or bequests from residents and never act as a witness to a will or as a resident's power of attorney.

Residents have the right to see their records, be informed of changes in condition, participate in care planning, and receive visitors of their choosing.

Knocking and announcing before entering, closing doors and curtains, and covering the resident during care are required privacy practices.

Alcohol-based rub is used when hands are not visibly soiled; soap and water for 20 seconds is required when soiled and after care of residents with C. difficile, whose spores resist alcohol.

Standard precautions apply to every resident: gloves for blood, body fluids, mucous membranes, and non-intact skin; gown, mask, and eye protection when splashing is likely.

Contact precautions (MRSA, VRE, scabies, C. difficile): gown and gloves, dedicated equipment, hand hygiene on entry and exit. Droplet (influenza): surgical mask. Airborne (TB, measles): N95 respirator and negative-pressure room.

Never recap, bend, or break a used needle; place sharps immediately in a puncture-resistant, closable, labeled container at the point of use.

Fall prevention set: bed in lowest position and locked, call light and needed items within reach, non-skid footwear, adequate lighting, and prompt response to call lights.

Restraints require a provider order and care-plan review, must be the least restrictive device, and are released, repositioned, and toileted at least every 2 hours with circulation and skin checks.

RACE = Rescue, Alarm, Contain (close doors), Extinguish/Evacuate; PASS = Pull, Aim, Squeeze, Sweep for an extinguisher; elevators are never used during a fire.

Seizure care: protect the head, move hazards away, do not restrain or place anything in the mouth, time the seizure, and report duration and characteristics.

Oxygen safety: no smoking, flames, or petroleum-based products near the resident; avoid wool and synthetic fabrics that generate static.

Reposition an immobile resident at least every 2 hours; inspect bony prominences (sacrum, heels, hips, elbows, ears) at each turn.

Use the 30-degree lateral position with pillows between the knees; avoid direct pressure over the greater trochanter.

Perform passive range of motion slowly and only to the point of resistance; never force a joint, and report new pain, swelling, or heat.

Ambulate with a gait belt at the waist, standing on the resident's weaker side slightly behind, and pivot toward the stronger side.

Offer fluids throughout the day - roughly 1,500–2,000 mL daily unless restricted - and record intake and output; dehydration presents as confusion, dry mucous membranes, and dark urine.

Feeding safety: sit the resident upright about 90 degrees, give small bites, allow chewing and swallowing time, follow diet texture and thickened-liquid orders, and report coughing, pocketing, or a wet voice.

Restorative care: let residents perform all self-care they can do safely, provide setup and cueing, and use adaptive devices as ordered.

Bowel and bladder retraining: scheduled toileting, adequate fluids and fiber, privacy, and activity; indwelling catheters are avoided when possible to prevent infection.

Bath water is about 105°F (40.5°C), tested on the inner wrist; wash eyes inner to outer with plain water, then wash from cleanest to dirtiest area, changing water as it cools or soils.

Perineal care: gloves, privacy, front to back, a fresh part of the washcloth for each stroke; never wash back to front, which reduces urinary tract infection risk.

Dentures: remove at night, clean with a denture brush over a water-filled basin, store in a labeled container, and never use hot water because it warps them.

Oral care at least twice daily and after meals; for an unconscious resident, turn the head to the side, use suction if available, and do not use toothpaste.

Dressing: put clothing on the weak or affected side first and remove it last; undress the strong side first.

Nails: file straight across for residents with diabetes or poor circulation; never clip without an order; report redness, swelling, or skin breaks between toes.

Typical adult vital signs: temperature 97–99°F (36.1–37.2°C), pulse 60–100/min, respirations 12–20/min, blood pressure about 120/80 mmHg, SpO2 95% or higher; report values outside the resident's baseline.

Skin care: keep skin clean and dry, moisturize dry areas, do not massage reddened bony areas, and report any new redness, blister, or open area immediately.

Elastic stockings are applied before the resident gets out of bed in the morning and checked each shift for wrinkles, skin color, warmth, and swelling.

Dementia care: validate feelings, redirect rather than argue or correct, use one-step instructions, keep routines familiar, and reduce noise and crowds.

Sundowning: increase daytime light and activity, limit late caffeine and long naps, maintain a calm evening routine, and use gentle redirection.

Aphasia after stroke: speak slowly with short sentences, use gestures and pictures, allow time to respond, and never finish sentences or exclude the resident from conversation.

Hypoglycemia signs (shakiness, sweating, hunger, confusion, irritability) are reported immediately; give fast-acting carbohydrate only if the care plan or nurse directs.

COPD: position upright, encourage pursed-lip breathing, and never increase oxygen flow above the ordered rate.

End-of-life care priorities: pain control, mouth care, repositioning and skin protection, quiet presence, and honoring cultural or religious practices; food and fluids are not forced.

Depression indicators - withdrawal, loss of appetite, sleep changes, tearfulness, statements of hopelessness - are reported to the nurse rather than kept as a confidence.

Parkinson's disease: rigidity, pill-rolling tremor, slow movement, and masked face; allow extra time, encourage exercise as ordered, and offer small frequent meals.

Hand hygiene sequence: wet hands, apply soap, rub palms, backs, between fingers, thumbs, and wrists for at least 20 seconds, rinse, dry with a paper towel, and use the towel to turn off the faucet.

Radial pulse: count for a full 60 seconds with two fingers, noting rate, rhythm, and strength; report irregular or out-of-range rates to the nurse.

Respirations: count for a full minute without announcing it (keep fingers on the wrist as if still counting pulse), noting depth and character.

Blood pressure: resident seated, arm supported at heart level, cuff bladder 1 inch above the antecubital space and about 80% of arm circumference; inflate about 30 mmHg above the point the pulse disappears.

Weight: same scale, same time of day, same amount of clothing, recorded to the nearest pound or 0.1 kg; report a gain or loss of 2–3 lb in a day or 5 lb in a week.

Sterile field: keep it above waist level and in view; items below the waist, out of sight, or wetted by moisture are contaminated.

Transfer sequence: lock wheels, lower the bed, apply the gait belt, position the resident's feet flat, ask the resident to push and stand on a count, and pivot toward the stronger side.

Specimen collection: label the container at the bedside, use clean-catch midstream technique for urine, and deliver to the lab promptly or refrigerate 24-hour collections.