CHPNA cheat sheet
CHPNA · Keep the key ideas within reach.
The Hospice and Palliative Care Team and the Role of the Nursing Assistant
Hospice eligibility generally requires a physician-certified prognosis of 6 months or less if the disease follows its expected course; certification is reviewed at each benefit period.
The hospice interdisciplinary team (IDT) typically includes the physician, nurse, social worker, chaplain, therapies, and nursing assistant; the IDT meets at least every 14 days to review care plans.
The nursing assistant provides personal care, mobility, nutrition assistance, and observation within the plan of care, and reports changes to the supervising nurse rather than making clinical decisions.
Palliative care can begin at diagnosis alongside curative treatment; hospice requires the patient to forgo curative treatment for the terminal diagnosis.
The Medicare hospice benefit is organized in benefit periods: two 90-day periods followed by an unlimited number of 60-day periods.
Scope of practice for nursing assistants is set by state law and the individual care plan; tasks outside training or plan must be declined and reported.
The four levels of hospice care are routine home care, continuous care, inpatient respite, and general inpatient care.
Bereavement support for the family continues for at least a year after death under the Medicare hospice benefit.
Patient and Family-Centered Care, Communication, and Cultural Competence
Patient and family-centered care treats the patient and family as partners; the patient defines who counts as family.
Open-ended questions invite fuller responses; closed questions confirm specific facts.
The patient's stated goals and values take priority over staff preferences when care options conflict.
Cultural competence includes assessing language needs; use a qualified medical interpreter, not a family child, for consent and care discussions.
Health literacy affects understanding; plain language and teach-back (ask the patient to restate) verify comprehension.
Active listening includes reflecting, paraphrasing, and clarifying before responding.
Confidentiality applies to all patient information; share only with those the patient authorizes or who are directly involved in care.
Nonverbal cues (tone, posture, eye contact, touch) carry meaning and may differ by culture; ask before assuming preference.
Personal Care and Activities of Daily Living
Provide perineal care front to back to reduce urinary tract infection risk.
When bathing, wash from cleanest to dirtiest areas and keep water temperature comfortably warm, testing it first.
Oral care is provided at least twice daily and after meals; dentures are removed, cleaned, and stored in labeled containers.
Dressing generally follows the rule: dress the affected (weak) side first and undress it last.
Skin assessment during bathing looks for redness, breakdown, moisture, and rashes; report new findings to the nurse.
Nail care is avoided or referred for patients with diabetes or circulatory problems per agency policy.
Provide privacy by closing doors and curtains and exposing only the body part being cared for.
Encourage independence in ADLs; assist only the portions the patient cannot complete safely.
Nutrition and Hydration
Offer small, frequent meals and preferred foods; appetite often declines naturally near end of life.
Patients with dysphagia need thickened liquids and upright positioning per speech therapy orders.
Signs of aspiration include coughing, choking, or a wet voice during or after eating; stop feeding and report.
Position the patient upright (about 90 degrees) during meals and for 30 minutes afterward to reduce aspiration risk.
Anorexia and reduced intake at end of life are expected; artificial nutrition and hydration may not improve comfort and are a family decision with the team.
Good mouth care (moistening lips, swabbing the mouth) relieves thirst when fluid intake is limited.
Monitor and report weight loss, dry mucous membranes, poor skin turgor, and decreased urine output as signs of dehydration.
Follow prescribed diets and fluid restrictions exactly; do not add salt or restricted items.
Mobility, Positioning, and Skin Integrity
Reposition immobile patients at least every 2 hours to reduce pressure injury risk.
Pressure injuries most commonly form over bony prominences: sacrum, heels, hips, shoulders, elbows, and occiput.
Use the 30-degree lateral (side-lying) position and avoid positioning directly on the trochanter when possible.
Keep heels off the mattress with pillows or devices to prevent heel pressure injuries.
Stage pressure injuries from 1 (non-blanchable redness) to 4 (full-thickness tissue loss); unstageable and deep tissue injuries are classified separately.
When transferring, keep the patient's feet under them, use gait belt and proper body mechanics, and bend at the knees, not the waist.
Nutrition and moisture management support skin healing; report incontinence and moisture to the nurse.
Encourage mobility within tolerance; immobility increases risk of pressure injury, constipation, and pneumonia.
Comfort and Pain and Symptom Management
Use a validated pain scale appropriate to the patient: numeric (0-10), faces, or behavioral scales for patients who cannot self-report.
Pain assessment includes location, quality, intensity, timing, and aggravating/relieving factors.
Nonpharmacologic comfort measures include repositioning, heat/cold per order, massage, distraction, and relaxation.
Report unrelieved pain or new symptoms to the nurse promptly; do not wait for the next scheduled visit.
Opioid side effects to monitor include constipation, sedation, and respiratory depression; constipation is expected and managed preventively.
Dyspnea comfort measures include upright positioning, fan or cool air, and relaxation; report new or worsening breathing difficulty.
Other symptoms to observe and report include nausea, vomiting, constipation, diarrhea, agitation, and itching.
Document comfort interventions and the patient's response per agency policy.
Psychosocial, Spiritual, and Emotional Support
Common emotional responses near end of life include fear, anger, denial, bargaining, and depression; all are valid and not to be corrected.
Active listening and presence are core supportive interventions; silence can be therapeutic.
Refer spiritual questions and rituals to the chaplain or the patient's own faith leader; do not impose personal beliefs.
Support the patient's hope and goals; hope often shifts from cure to comfort and meaningful time.
Signs of complicated grief or depression (persistent hopelessness, withdrawal) should be reported to the social worker or nurse.
Respect cultural and religious rituals around dying, food, and body care; ask about preferences.
Include family caregivers in emotional support and recognize caregiver burden.
Confidentiality and dignity apply to emotional disclosures; do not discuss patient information in public areas.
Care in the Final Hours and After-Death Care
Signs of approaching death include decreased intake, increased sleep, cool mottled extremities, irregular breathing, and terminal secretions.
Terminal (death) rattle is caused by secretions pooling; repositioning and per orders may help; it is generally not distressing to the patient.
Hearing is often thought to persist near death; speak to the patient with respect and avoid negative comments at the bedside.
Provide mouth care, eye care, and gentle repositioning for comfort; stop routine tasks that cause discomfort.
At death, verify absence of respirations and heartbeat, note the time, and notify the supervising nurse and agency per policy.
Post-mortem care includes positioning the body, closing eyes and mouth, and respecting religious and cultural practices and family wishes.
Notify the family and support their grief; allow privacy and time with the body as the family wishes.
Do not remove tubes or devices unless agency policy or the nurse directs; follow post-mortem care protocol.
Safety, Infection Prevention, and Emergency Response
Standard precautions apply to all patients: hand hygiene and gloves for contact with blood, body fluids, and non-intact skin.
Perform hand hygiene before and after patient contact and after glove removal; alcohol-based rub is preferred when hands are not visibly soiled.
Clean hands with soap and water when visibly soiled or after caring for a patient with C. difficile (alcohol does not kill spores).
Follow transmission-based precautions (contact, droplet, airborne) as posted; do not enter without required PPE.
Prevent falls: keep call light in reach, bed in low position, brakes locked, and clear pathways; assess and report fall risk.
In a fire, follow RACE: Rescue, Alarm, Contain, Extinguish/Evacuate.
For a choking patient who cannot speak or cough, activate emergency response and begin abdominal thrusts if trained and permitted by policy.
Report unsafe conditions, needlesticks, and exposures immediately per agency policy.
Documentation, Ethical and Legal Issues, and Self-Care
Document objectively: record what was observed and done, not opinions or judgments.
Documentation is contemporaneous; record care at the time it is given and never pre-chart.
Never alter or falsify a record; correct errors per policy with a single line, initials, and date, not by erasing.
Advance directives (living will, durable power of attorney for health care) express the patient's wishes; the nursing assistant supports and honors them.
Report suspected abuse, neglect, or exploitation immediately per state law and agency policy.
Patient rights include privacy, dignity, informed consent, and refusal of care; a competent patient may refuse any care.
Self-care for the nursing assistant includes recognizing burnout, compassion fatigue, and grief, and using available support and debriefing.
Set boundaries and seek help for personal distress; impaired practice endangers patients and must be addressed.
Care in the Final Hours and After-Death Care
Signs of approaching death include decreased intake, increased sleep, cool mottled extremities, irregular breathing, and terminal secretions.
Terminal (death) rattle is caused by secretions pooling; repositioning and per orders may help; it is generally not distressing to the patient.
Hearing is often thought to persist near death; speak to the patient with respect and avoid negative comments at the bedside.
Provide mouth care, eye care, and gentle repositioning for comfort; stop routine tasks that cause discomfort.
At death, verify absence of respirations and heartbeat, note the time, and notify the supervising nurse and agency per policy.
Post-mortem care includes positioning the body, closing eyes and mouth, and respecting religious and cultural practices and family wishes.
Notify the family and support their grief; allow privacy and time with the body as the family wishes.
Do not remove tubes or devices unless agency policy or the nurse directs; follow post-mortem care protocol.