North Dakota CNA cheat sheet

Hand hygiene: scrub with soap and water for at least 20 seconds when hands are visibly soiled; use alcohol-based rub when they are not.

Vital sign baselines: normal adult resting pulse is 60-100 beats per minute and respirations are 12-20 breaths per minute; count respirations for a full minute without announcing it.

Oral temperature is taken only on residents who are alert and can close their lips; use axillary, tympanic, or rectal routes as ordered for confused, unresponsive, or coughing residents.

1 fluid ounce = 30 mL; record all intake (oral, IV, tube feeding) and all output (urine, emesis, wound drainage) on the intake and output sheet.

Reposition an immobile resident at least every 2 hours and inspect skin each time; report any reddened area that does not fade when pressed.

Range of motion: support the joint above and below, move slowly to the point of resistance, and stop at pain - never force a joint.

Perineal care is given front to back using a clean part of the cloth for each stroke, and the perineal area is washed last during a bath.

Transfer rule: feet shoulder-width apart, bend at the knees and hips, keep the resident close to your body, and never twist; use a gait belt unless contraindicated.

Aspiration precautions at meals: seat the resident upright near 90 degrees, offer small bites, place food on the unaffected side after a stroke, and stay with anyone who has trouble swallowing.

Maslow's order is physiological, safety, love and belonging, esteem, self-actualization; unmet lower needs such as pain, hunger, or a full bladder take priority over higher ones.

Kubler-Ross stages are denial, anger, bargaining, depression, and acceptance; they are not sequential and may repeat, and anger should not be taken personally.

Dementia behavior rule: validate the feeling behind the statement, then redirect; do not argue about facts or try to reorient a resident with advanced dementia.

Behavior is communication: new agitation, withdrawal, or crying often signals pain, fear, constipation, or infection, so report it rather than respond with discipline.

Depression warning signs include sad or flat affect, appetite and sleep changes, loss of interest in grooming, and statements of hopelessness; any talk of self-harm is reported immediately.

Sundowning is confusion and agitation that peak in late afternoon or evening; reduce noise, turn on lights, and keep evening routines familiar and calm.

Therapeutic communication uses open-ended questions, restating, reflecting, and silence; avoid 'why' questions, false reassurance, and giving personal advice.

Privacy and dignity: knock and announce yourself, close curtains and doors, keep the resident covered, and discuss care only with the care team.

Defense mechanisms such as denial, rationalization, projection, and regression are unconscious coping; acknowledge the feeling and do not confront the mechanism itself.

Scope of practice: aides provide personal care, mobility, feeding, vital signs, and intake and output; aides do not give medications, insert tubes, perform sterile dressing changes, or give medical advice.

Chain of command: report to the licensed nurse supervising your care (RN or LPN) and report changes in condition immediately, not at the end of the shift.

The RN develops the care plan; follow it exactly and report when a resident's needs or preferences no longer match it.

OBRA 1987 requires nurse aide training and competency evaluation and established residents' rights: dignity, privacy, choice, refusal of care, visitors, and freedom from restraints.

Abuse categories are physical, sexual, emotional or verbal, financial, neglect, and involuntary seclusion; aides are mandated reporters and must report any suspicion immediately.

Charting: record objective facts with date, time, and signature; correct errors with a single line, the word 'error,' and your initials - never erase, scribble, or use white-out.

Incident reports are completed per facility policy for unusual events; never mention the incident report in the resident's progress notes.

HIPAA: share resident information only with the care team and only as needed; do not discuss residents in hallways, elevators, or while off duty.

A resident who is alert and oriented may refuse any care; accept the refusal without forcing, document it, and inform the nurse. An aide may also decline a task outside their training.