NCT cheat sheet

The NCT (Nursing Care Technician / patient care technician) role covers direct basic nursing care under a licensed nurse's delegation: bathing, mobility, vital signs, intake/output, specimen collection, and observation reporting.

Delegation rule: the licensed nurse retains accountability for the task; the technician accepts only tasks within training, policy, and legal scope, and may refuse or clarify any assignment felt unsafe.

The five rights of delegation - right task, right circumstance, right person, right direction/communication, right supervision/evaluation - frame every assignment decision.

Tasks never delegated to unlicensed personnel include initial assessment, care planning, evaluation of outcomes, and teaching requiring nursing judgment.

Chain of command: report concerns to the delegating nurse first, then charge nurse, then unit manager; document the concern and the response.

Standard precautions apply to all patients regardless of diagnosis: hand hygiene, gloves, gown, mask, eye protection based on anticipated exposure.

Hand hygiene is the single most effective infection-control action; use soap and water when hands are visibly soiled or after C. difficile exposure, alcohol rub otherwise.

Scope boundaries are set by state nurse practice acts, facility policy, and job description; when the three conflict, follow the most restrictive applicable rule.

Fall precautions: bed in lowest position, brakes locked, call light within reach, non-skid footwear, hourly rounding, and bed/chair alarms when ordered.

Restraint use requires a provider order, the least restrictive device, scheduled release and circulation checks, and never tying to side rails.

Never-events reporting: falls with injury, medication errors, pressure injuries, and wrong-site events are reported through the facility incident system, not the medical record narrative.

Safe patient handling uses gait belts, mechanical lifts, and teamwork; keep the load close and avoid twisting to protect the caregiver's spine.

Oxygen safety: post 'no smoking' signs, keep oxygen at least 5-10 feet from open flame, avoid petroleum-based products on the face or nares.

Pressure injury prevention: reposition at least every 2 hours, keep skin clean and dry, offload heels, use support surfaces, and inspect skin at each turn.

Isolation categories: contact (gown/gloves, e.g., MRSA, C. difficile), droplet (mask within 3-6 feet, e.g., influenza), airborne (N95 plus negative-pressure room, e.g., tuberculosis, measles).

Sharps safety: never recap a needle by hand; activate the safety device and drop the used sharp directly into the puncture-resistant container at point of use.

Normal adult ranges: temperature 36.5-37.5 C (97.7-99.5 F); pulse 60-100 beats/min; respirations 12-20/min; blood pressure under 120/80 mmHg; SpO2 95-100% on room air.

Count respirations for a full 60 seconds without telling the patient, since awareness alters rate and depth; note rate, rhythm, and effort.

Pulse deficit equals apical rate minus radial rate, measured simultaneously by two caregivers for a full minute; it signals ineffective cardiac output.

Orthostatic hypotension: measure blood pressure and pulse supine, then after standing 1 and 3 minutes; a drop of 20 mmHg systolic or 10 mmHg diastolic is significant.

Blood pressure cuff width should be about 40% of arm circumference; a cuff too small falsely raises the reading, too large falsely lowers it.

Temperature routes differ: oral and axillary read lower, rectal reads higher by roughly 0.5 C; wait 15-30 minutes after hot or cold drinks for oral readings.

Pain is the fifth vital sign: use a 0-10 numeric scale for adults, Wong-Baker faces for children, and PAINAD or similar for nonverbal or dementia patients.

Report vital signs immediately when they cross defined thresholds or deviate from the patient's baseline, and document the time, value, site, and who was notified.

Provide perineal care front to back to prevent urinary tract infection; use a new washcloth for each stroke and rinse thoroughly.

Oral care reduces ventilator-associated pneumonia; brush teeth and gums at least twice daily and provide denture care with a labeled cup.

Log-roll technique keeps the spine aligned: place a pillow between the knees, cross the arms over the chest, and move the patient as one unit with enough helpers.

Range-of-motion exercises prevent contractures; move joints slowly to the point of resistance, never past pain, and stop for new or sharp pain.

Dangling at the bedside before ambulation reduces orthostatic risk: sit on the edge, feet flat, for 1-2 minutes while checking for dizziness.

Intake and output: record all oral fluids, IV fluids, tube feedings, emesis, urine, stool liquid, and drains; 1 mL of urine weighs about 1 gram, and 30 mL/hour urine output is the usual minimum adult benchmark.

Aspiration precautions: elevate the head of bed 30-45 degrees during and 30 minutes after meals, place food on the stronger side of the mouth, and observe for coughing or pocketing.

Fluid balance signs: report weight gain over 1 kg/day, new edema, crackles, or a urine output below 30 mL/hour for two consecutive hours.

Clean-catch midstream urine: cleanse front to back, void a small amount, collect the midstream portion into a sterile container, and label at the bedside.

Blood glucose monitoring: clean the finger with alcohol and let it dry, use the side of the fingertip, wipe the first drop if policy requires, and never share lancets.

Venipuncture order of draw for capillary/venous tubes follows color-coded additive sequence to avoid cross-contamination; follow facility policy and label tubes before leaving the bedside.

Stool specimen for occult blood avoids contamination with urine or toilet paper; collect from several areas of the stool and deliver promptly.

Sputum collection is best in the early morning; have the patient rinse the mouth, then cough deeply from the lungs, not the throat.

Point-of-care testing requires quality control checks per policy, correct patient identification by two identifiers, and immediate documentation of results.

Specimen labeling requires two patient identifiers and the collector's initials; mislabeled specimens are rejected and must be recollected.

Universal precautions apply to all specimens; transport in a sealed biohazard bag and never recap needles after blood draws.

Documentation rule: if it was not charted, it was not done; record objective findings, interventions, patient responses, and notifications with time stamps.

Use objective language: write 'patient grimaced and rated pain 8/10' rather than 'patient was in terrible pain.'

HIPAA: share protected health information only on a need-to-know basis; do not discuss patients in elevators, hallways, or on social media.

Hand-off communication uses SBAR: Situation, Background, Assessment, Recommendation - concise and structured.

Therapeutic communication uses open-ended questions, reflection, and silence; avoid false reassurance, 'why' questions, and giving medical advice.

When a patient refuses care, respect autonomy, inform the nurse, document the refusal verbatim, and never force or threaten.

Incident reports are factual, objective, and filed separately from the medical record; never mention the incident report in the chart.

Patient identification uses two identifiers - name and date of birth or medical record number - never the room number.

Recognize cardiac arrest: unresponsive, no normal breathing, no pulse within 10 seconds; start compressions at 100-120/min, depth 5-6 cm (2-2.4 in), full recoil.

Activate the emergency response system and retrieve the AED early; apply pads, clear the patient before shock, and resume compressions immediately after.

Choking adult with effective cough: encourage coughing; with ineffective cough, give abdominal thrusts; for an obese or pregnant patient use chest thrusts.

Seizure care: protect the head, turn to the side, loosen restrictive clothing, time the event, and never insert anything into the mouth.

Hypoglycemia signs - shakiness, sweating, confusion, irritability - require immediate glucose check and nurse notification; if conscious, give 15 g fast-acting carbohydrate per protocol.

Early warning signs to escalate: respiratory rate above 28 or below 8, SpO2 below 90%, systolic BP below 90, new confusion, or urine output below 30 mL/hour.

Fall found on floor: do not move the patient until assessed for injury; check responsiveness, pain, and head injury, then notify the nurse and document.

Emergency equipment checks: verify crash cart seal, AED battery and pads, and oxygen supply each shift per policy.

Informed consent is obtained by the provider, not the technician; the technician may witness the signature and confirm the patient understands the procedure being consented to.

Patient rights include privacy, dignity, refusal of treatment, access to records, and an interpreter when needed; the technician supports these without judgment.

Mandatory reporting: suspected abuse, neglect, or exploitation of children, older adults, or dependent adults must be reported per state law and facility policy.

Advance directives and do-not-resuscitate orders must be verified and followed; if the order is unclear, stop and ask the nurse before acting.

Confidentiality continues after death and after employment ends; discussing identifiable patients outside authorized channels violates HIPAA.

Negligence elements: duty, breach, causation, and damages; following policy and documenting accurately are the technician's best protection.

Restraints and seclusion are regulated by CMS; use only with an order, monitor circulation and skin every 15 minutes, and release at least every 2 hours.

Ethical principles in practice: autonomy (respect choice), beneficence (do good), nonmaleficence (do no harm), justice (fair treatment), and veracity (truthfulness).