Nebraska CNA cheat sheet

Face the resident at eye level, reduce background noise, and maintain eye contact when speaking; this improves comprehension for residents with hearing loss or confusion.

Hearing loss: speak clearly in a lower pitch at normal volume, keep your face visible so lips can be read, and never shout into the ear.

Aphasia: ask yes-or-no questions, use gestures and picture boards, allow extra time, and never rush or finish the resident's sentences.

Vision loss: announce yourself on entering, state your name and role, describe care before touching, and keep personal items in consistent locations.

Unresponsive resident: assume hearing is intact and explain each task before performing it.

Use the resident's preferred name; avoid elderspeak (honey, sweetie, good girl) and medical jargon.

Report to the nurse using objective observations (what was seen, heard, or measured) rather than opinions or guesses about a diagnosis.

At hand-off, report what care was completed, what is due, and any change in the resident's condition.

OBRA 1987 (Nursing Home Reform Act) guarantees residents dignity, privacy, self-determination, choice, and freedom from abuse and unnecessary restraint.

A resident may refuse any care or treatment; notify the nurse, document the refusal, and never coerce, threaten, or bribe.

Knock and announce before entering, close the door or curtain, and expose only the body area being cared for.

Protect confidentiality: discuss care only with the care team, never in hallways, elevators, or on social media.

Residents retain the right to visitors, mail, telephone calls, personal possessions, and access to their own records.

Restraints require a physician's order, must be the least restrictive option, and are released with repositioning at least every 2 hours; never used for punishment or staff convenience.

Promote independence by letting residents perform the ADLs they can do and providing setup and adaptive devices instead of doing tasks for them.

Residents may file grievances without fear of retaliation; staff assist with the process and never discourage it.

Falls: bed in lowest position, wheels locked, call light within reach, non-skid footwear, and a clear path to the bathroom.

Fire: RACE - Rescue, Alarm, Contain, Extinguish or Evacuate. Extinguisher use: PASS - Pull, Aim, Squeeze, Sweep.

Adult CPR: 30 compressions to 2 breaths, rate 100-120 per minute, depth at least 2 inches, allowing full chest recoil.

Conscious choking adult: abdominal thrusts; if the resident becomes unconscious, activate emergency response and begin CPR.

Seizure: protect the head, clear dangerous objects, do not restrain or put anything in the mouth, time the seizure, and turn the resident on the side afterward.

Burns: cool with running water for 10-20 minutes; never apply ice, butter, or ointment.

Wheelchair: lock brakes before transfer, use a gait belt, back into elevators, and never leave a resident unattended where they could roll.

Complete an incident report for any injury or error; record facts only, never blame or opinion, and note that it is not part of the medical record.

Chain of infection: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host; breaking any link prevents transmission.

Wash hands with soap and water at least 20 seconds, or use alcohol-based rub, before and after every resident contact and after removing gloves.

Standard precautions apply to every resident: wear gloves for contact with blood, body fluids, mucous membranes, and non-intact skin.

Don PPE in order: gown, mask, goggles, gloves. Remove in reverse order: gloves, goggles, gown, mask, then perform hand hygiene.

Contact precautions: gown and gloves with dedicated equipment. Droplet: mask within about 3 feet. Airborne: N95 respirator and negative-pressure room.

Do not recap needles; drop them directly into a puncture-resistant sharps container and report any exposure immediately.

Sterile field: keep it above waist level, do not reach over it, and do not turn away from it.

Soiled linen: hold away from the body, do not shake it, and bag it in the resident's room.

Adult normal ranges: temperature 97.6-99.6 F orally, pulse 60-100 beats per minute, respirations 12-20 per minute, SpO2 95-100%.

Radial pulse: place two fingers on the thumb side of the wrist; count 30 seconds and multiply by 2 if regular, a full minute if irregular.

Respirations: count for one full minute without telling the resident, because awareness of being watched alters the rate.

Blood pressure: cuff bladder covers about 80% of arm circumference, arm supported at heart level, deflate 2-3 mm Hg per second.

Oral temperature: wait 15 minutes after hot or cold drinks or smoking; axillary is least accurate and rectal is most accurate.

Intake and output: 1 ounce equals 30 mL and 1 cup equals 240 mL; record all fluids taken in and all output measured.

Weight: use the same scale at the same time of day, with bladder empty and shoes off.

Orthostatic hypotension: measure blood pressure and pulse with the resident lying, then sitting, then standing; a drop with dizziness is reported to the nurse.

Bath water: about 105 F, tested on the inner wrist; wash from cleanest to dirtiest areas and clean the perineum last.

Perineal care: wash front to back, using a clean portion of the cloth for each stroke.

Reposition immobile residents at least every 2 hours, inspect the skin at each turn, and keep heels off the mattress.

Pressure injury staging: stage 1 non-blanchable redness; stage 2 partial-thickness loss; stage 3 full-thickness loss; stage 4 extends to bone, tendon, or muscle.

Oral care: brush teeth at least twice daily; remove dentures at night and clean them over a sink lined with a towel.

Dressing: put the garment on the weak or affected side first; when undressing, remove it from the strong side first.

Foot care: an aide does not cut the nails of a resident with diabetes or poor circulation; report redness, breaks, or sores.

Toileting: offer the toilet on a scheduled basis, answer call lights promptly, and provide privacy.

Maslow's hierarchy from bottom to top: physiological, safety, love and belonging, esteem, self-actualization; lower unmet needs take priority.

Depression indicators: withdrawal, sad or flat affect, poor appetite, weight loss, sleep change, loss of interest; report these to the nurse.

Anxiety: stay calm, listen, give short simple explanations, and do not argue with the resident's feelings.

Grief stages (not strictly sequential): denial, anger, bargaining, depression, acceptance.

New confusion or agitation can signal pain, infection such as a UTI, constipation, or a medication effect; report it rather than labeling it behavior.

Any statement suggesting self-harm or suicide is taken seriously, reported immediately, and the resident is not left alone.

Encourage social contact through group activities, meals with others, and family involvement as written in the care plan.

Reality orientation (clocks, calendars, names) helps residents with mild confusion; validation of feelings works better in late dementia.

Dementia is chronic, progressive, and usually irreversible; delirium is acute, fluctuating, often reversible, and is a medical emergency.

Communicate with one-step instructions, short sentences, a calm tone, and extra time; never argue with or correct the resident's reality.

Wandering: provide supervision, safe walking areas, an identification bracelet, and secured exits; do not restrain or lock the resident in a room.

Sundowning is increased confusion in late afternoon or evening; reduce noise and stimulation, keep lights on, and maintain a calm routine.

Alzheimer's progression: early memory loss, middle-stage wandering and ADL loss, late-stage total dependence and swallowing difficulty.

Agitation: look for a trigger such as pain, hunger, need to toilet, noise, or fatigue before responding with redirection.

Remove or lock up hazards: medications, cleaning supplies, car keys, and stove controls; keep pathways clear.

Repetitive questions: respond calmly each time, redirect to an activity, and avoid saying 'you already asked me that.'

Restorative care goal: maintain or restore function, promote independence, and slow decline.

Active range of motion is performed by the resident; passive range of motion is performed by the aide moving each joint slowly without forcing.

Stop exercise for pain, dizziness, shortness of breath, or a change in vital signs, and report it to the nurse.

Gait belt: placed around the waist over clothing and fastened snugly; walk on the resident's weaker side and slightly behind.

A cane is used on the strong side and moved forward with the weak leg; a walker is lifted and moved forward before the resident steps.

Contracture prevention: frequent repositioning, splints as ordered, range of motion, and never pulling on a weak or paralyzed arm.

Check the skin under splints and braces before and after use, and report redness or breakdown.

Restorative dining: seat the resident upright, encourage self-feeding, provide adaptive utensils, and record the amount and type of assistance given.

OBRA 1987 sets federal nursing home standards; the state Nurse Practice Act and facility policy define the nurse aide's scope of practice.

An aide performs only tasks they are trained for and that a licensed nurse has delegated; never assess, administer medications, or perform sterile procedures unless state law permits.

Negligence is failure to meet the standard of care; malpractice is negligence by a professional; both require a duty, a breach, and resulting harm.

Abuse types: physical, sexual, emotional or verbal, financial, and neglect; involuntary seclusion is also a form of abuse.

Suspected abuse or neglect must be reported immediately to the charge nurse or administrator and the state hotline; failure to report is a crime.

HIPAA: share only the minimum necessary information with the care team, and never post resident information or photos online.

Advance directives include living wills, durable power of attorney for health care, and DNR orders; follow the resident's documented wishes.

False imprisonment is unlawfully confining a resident, such as locking them in a room or applying restraints without justification.