New Hampshire LNA cheat sheet

Hand hygiene is performed before and after every resident contact; wearing gloves does not replace handwashing.

Wash from cleanest to dirtiest during bathing: face and neck first, then trunk and limbs, perineal area last.

Check bath water temperature with the inner wrist or a thermometer, keep it at or below about 105 degrees F (40.5 degrees C), and ask the resident before immersing.

Pulse: count the radial pulse for 30 seconds and multiply by 2; if the rhythm is irregular, count a full 60 seconds.

Respirations: count for 30 seconds and multiply by 2 without announcing it; the normal adult range is 12 to 20 breaths per minute.

Intake and output are measured in milliliters; 1 ounce equals 30 mL. Report urine output under 30 mL per hour for two consecutive hours.

Range of motion is performed slowly and stopped at resistance or pain; joints are never forced past their natural limit.

Dress the weak or affected side first and undress that side last; change position at least every 2 hours in bed or chair.

NPO means nothing by mouth; verify NPO status before offering any food, fluid, or ice chips.

Before any transfer: lock wheelchair and bed wheels, lower the bed, raise the head of the bed, and apply a gait belt.

Standard fall-prevention checks: bed in lowest position, wheels locked, call light within reach, non-skid footwear.

Never leave a resident alone in a bathtub, on a toilet, or on a shower chair.

Fire response is RACE (Rescue, Alarm, Contain, Extinguish or Evacuate); extinguisher use is PASS (Pull, Aim, Squeeze, Sweep).

Oxygen safety: no smoking or open flame near the resident, no petroleum-based products on skin or lips, tanks stored upright and secured.

Seizure care: protect the head, do not restrain, place nothing in the mouth, time the event, turn the resident to the side afterward, and report.

Restraints require a physician's order, must be the least restrictive option, and must be released with repositioning at least every 2 hours.

Report every fall, injury, medication error, or near-miss to the nurse immediately; complete an incident report per policy but do not chart blame.

Clean spills immediately and post a wet-floor sign; hot water at the tap should not exceed 110 degrees F (43 degrees C).

Standard precautions apply to all residents regardless of diagnosis; treat all blood, body fluids, and non-intact skin as potentially infectious.

Handwashing with soap and water for at least 20 seconds is required for C. difficile and norovirus; alcohol sanitizer does not kill their spores.

Don PPE in order: gown, mask or respirator, goggles or face shield, gloves. Remove in order: gloves, goggles, gown, mask.

Never wear the same gloves from one resident to another or move from a dirty task to a clean task while gloved.

Transmission-based precautions: contact (gown and gloves) for MRSA, VRE, and C. difficile; droplet (mask) for influenza; airborne (N95, negative-pressure room) for tuberculosis, measles, and varicella.

Never recap, bend, or break a used needle; drop it directly into the sharps container at the point of use.

Adult CPR: compressions 100 to 120 per minute, at least 2 inches deep, 30 compressions to 2 breaths for a single rescuer, with full chest recoil.

Stroke signs: sudden facial droop, arm drift, or slurred speech; note the time symptoms began and call 911 immediately.

Blood or body fluid exposure: wash the area with soap and water, flush eyes or mucous membranes, and report immediately for post-exposure evaluation.

Residents may refuse care; document the refusal, notify the nurse, and never force, threaten, or bargain.

HIPAA: share resident information only with staff involved in that resident's care on a need-to-know basis; never in hallways, elevators, or online.

OBRA rights include dignity, privacy, choice, freedom from abuse and neglect, visitation, and the right to voice grievances without retaliation.

Suspected abuse, neglect, or exploitation must be reported immediately to the charge nurse or administrator and to the state agency; this is a legal duty.

Accept no gifts, cash, loans, or bequests from residents or families; report any offer to the supervisor.

Knock, identify yourself, and state what you are about to do before entering; use the resident's preferred name.

With aphasia, ask yes-or-no questions and allow time; with hearing loss, face the resident, speak slowly, lower pitch, and do not shout.

Honor a current DNR or DNI order: do not begin CPR, call the nurse, and stay with the resident.

Documentation is objective and timely: record measurements and observed behavior rather than opinions or conclusions.

In Alzheimer's disease, short-term memory loss typically appears first, followed by decline in language, judgment, and self-care.

Never argue with a delusion or hallucination; acknowledge the feeling behind it and redirect to a safe, familiar activity.

Validation therapy accepts the resident's reality and responds to the emotion behind the statement rather than correcting the facts.

Sundowning is worsening confusion and agitation in late afternoon or evening; reduce noise, brighten lighting, and keep routines stable.

Delirium has sudden onset, fluctuating attention, and a physical cause such as infection, medication, dehydration, or pain; report it immediately.

For dementia, give one short instruction at a time, use a calm tone, maintain eye contact, and allow time to respond.

Wandering: redirect, offer safe walking, and monitor exits; do not restrain the resident or lock them in a room.

Any statement about suicide or self-harm is taken seriously: stay with the resident, remove hazards, and notify the nurse immediately.

Signs of depression such as withdrawal, appetite or sleep change, and hopelessness are reported to the nurse, not dismissed as normal aging.