North Carolina CNA cheat sheet

Bed bath sequence: wash the face and neck first, then arms, chest, abdomen, legs, back, and perineal area last; change washcloths and water as needed.

Dressing rule: apply clothing to the affected or weak side first; remove clothing from the unaffected side first.

NPO means nothing by mouth, including water, ice chips, and oral medications; record and report any accidental intake.

Oral care for an unresponsive resident: turn the resident to the side, use suction as trained, and never place fingers in the mouth.

Pressure injury prevention: reposition at least every 2 hours, keep skin clean and dry, and inspect heels, sacrum, hips, and other bony prominences.

Female perineal care: wipe front to back and use a clean area of the washcloth for each stroke to reduce bacterial spread.

Shower or tub safety: check water temperature before the resident enters and never leave the resident unattended in the tub or shower.

Toileting care: answer call lights promptly, provide privacy, and report changes in urine or stool color, odor, or frequency.

Range of motion: support the joint above and below, move slowly, stop if the resident reports pain, and never force a joint.

Fall prevention setup: bed low and wheels locked, call light within reach, non-skid footwear, clear path, and needed items within reach.

Restraint use requires a physician order, the least restrictive device, regular circulation checks, release, repositioning, and documentation per policy.

Never use side rails as restraints; full side rails require an order and must follow facility restraint policy.

Fire response uses RACE: Rescue anyone in danger, Alarm, Contain the fire by closing doors, and Extinguish or Evacuate per policy.

Oxygen safety: post no-smoking signs, keep tanks upright and secure, avoid open flames, and avoid petroleum-based products near oxygen.

Transfer rule: lock wheelchair wheels, raise footrests, use a gait belt as trained, keep the resident close, and pivot rather than twist.

Spill response: clean the spill immediately, place a wet floor sign, and warn others until the floor is dry.

Incident reports document objective facts about what happened, when, and who was notified; they do not assign blame.

Hand hygiene is required before and after resident contact, after glove removal, after body-fluid contact, and before handling clean equipment.

Use soap and water rather than alcohol rub when hands are visibly soiled and for residents with Clostridioides difficile infection per policy.

Standard precautions apply to all residents: gloves for blood or body fluids, and gown, mask, or eye protection when splashes are likely.

PPE donning order: gown, mask, goggles or face shield, then gloves; removal order: gloves, goggles, gown, then mask, followed by hand hygiene.

Blood spill disinfection typically uses a 1:10 bleach solution or an approved facility disinfectant while wearing gloves.

Unresponsive resident: call for help, check breathing and pulse, and begin CPR or use the AED according to training and facility protocol.

Conscious adult choking: give abdominal thrusts; if the resident becomes unresponsive, call for help and start CPR.

Seizure care: protect the head, move objects away, loosen tight clothing, do not restrain or place anything in the mouth, and time the seizure.

Report signs of hypoglycemia such as sweating, shakiness, confusion, or irritability immediately to the nurse.

Adult resting pulse is about 60 to 100 beats per minute; count for 30 seconds and multiply by 2, or count a full minute if irregular.

Adult resting respirations are about 12 to 20 breaths per minute; count without telling the resident so breathing remains natural.

Blood pressure: cuff on the bare upper arm at heart level, correct cuff size, deflate slowly, and record systolic over diastolic.

Oral temperature is about 98.6 degrees Fahrenheit; rectal readings are slightly higher and axillary readings slightly lower.

Pulse oximetry estimates oxygen saturation; place the sensor on a warm, nail-free finger and report readings below 90 percent or per protocol.

Intake and output: 1 ounce equals 30 milliliters and 1 standard cup equals 240 milliliters; record all liquids and output as ordered.

Weight measurement: use the same scale, same time of day, and similar clothing, and record the result accurately.

Pain is often called the fifth vital sign; use the facility pain scale and report unrelieved or new pain to the nurse.

Specimen collection: use the correct container, wear gloves, label at the bedside per policy, and send promptly.

Introduce yourself, use the resident's preferred name, and explain care before beginning.

Hearing impairment: face the resident, reduce background noise, speak clearly in a lower-pitched voice, and avoid shouting.

Aphasia: allow extra time, use yes-or-no questions and gestures, and do not finish the resident's sentences.

Report objective observations such as redness, grimacing, or measured output rather than opinions or guesses.

Confidentiality: discuss resident information only with the care team that needs it and never in hallways, elevators, or social media.

Active listening includes eye contact, clarifying questions, and allowing the resident to finish speaking without interruption.

Cognitive impairment: use one-step directions, a consistent routine, and redirection rather than argument.

Conflict de-escalation: stay calm, listen, maintain safety, and involve the nurse or supervisor when needed.

CNA scope includes assigned ADLs, vital signs, observations, and reporting changes; it does not include sterile procedures or independent care planning.

Follow nurse delegation and facility policy; ask for clarification before performing an unclear or unsafe assignment.

Report resident changes to the charge nurse or licensed nurse promptly and follow the facility chain of command.

Document care accurately and promptly after completion, using objective facts, correct times, and the resident's own words for complaints.

Never chart care before it is given and never alter another person's documentation.

Maintain professional boundaries: do not accept money or gifts, share personal contact information, or form personal relationships with residents.

Promote independence by encouraging residents to perform the parts of care they can safely do themselves.

Maintain certification and complete required continuing education according to North Carolina requirements.

Resident rights include dignity, privacy, informed consent, refusal of treatment, visitors, personal belongings, and filing grievances without retaliation.

A competent resident may refuse care; the aide respects the refusal, documents it objectively, and reports it to the nurse.

Suspected abuse, neglect, or exploitation must be reported immediately to the nurse or administrator and to the required state agency.

Restraints may be used only with an order, for a documented safety need, and never for discipline, convenience, or coercion.

Confidentiality follows HIPAA and facility policy; share only the minimum information needed for care.

Advance directives such as a DNR or living will must be honored according to facility policy and state law.

False imprisonment includes confining a resident, locking doors, or preventing free movement without legal justification.

Assist residents with grievances and complaints without showing anger, retaliation, or discouragement.