Oklahoma CNA cheat sheet

Objective information is what you see, hear, measure, or smell; subjective information is what the resident reports feeling - record both and quote the resident for pain, nausea, or dizziness.

Hearing loss: face the resident, get to eye level, cut background noise, lower the pitch of your voice instead of shouting, and confirm understanding by asking the resident to repeat the message back.

Hearing aid: check the battery, confirm the device is switched on, and clean and seat the mold before speaking; remove at bedtime per facility policy and store it labeled in its case.

Aphasia: allow extra time, ask one question at a time with yes-or-no answers, use gestures, pictures, or a communication board, and never finish the resident's sentences or pretend to understand.

Vision loss: identify yourself on entry, say what you are about to do before touching, and describe tray items by the clock method (for example, 'potatoes at six o'clock').

Use the resident's preferred name, short plain sentences, and everyday words; avoid medical jargon, and sit at eye level when the resident is seated or in bed.

Common barriers include pain, fear, hearing or vision loss, language differences, noise, and sedation; reduce one barrier at a time and report any sudden change in speech or comprehension.

Report changes to the nurse promptly and factually - time, what you observed, what you did - and do not give opinions, diagnoses, or guesses to the family.

Wash with soap and water for at least 20 seconds when hands are visibly soiled and after care of residents with C. difficile or norovirus; use alcohol-based rub for 20-30 seconds until dry when hands are not visibly soiled.

Perform hand hygiene before and after every resident contact, before donning gloves, immediately after removing gloves, and between dirty and clean tasks on the same resident.

Standard precautions apply to every resident regardless of diagnosis: treat blood, body fluids, secretions, excretions, non-intact skin, and mucous membranes as potentially infectious.

Don PPE in order - gown, mask or respirator, goggles or face shield, gloves; remove in order - gloves, goggles, gown, mask - then perform hand hygiene.

Contact precautions (MRSA, C. difficile, scabies) require gown and gloves and dedicated equipment; droplet precautions (influenza, pertussis) require a mask within about 3 feet; airborne precautions (TB, measles) require an N95 and a negative-pressure room.

Do not share razors, toothbrushes, washcloths, or other personal care items between residents; label each resident's equipment and store it separately.

Blood or body-fluid spill: wear gloves, absorb the spill, clean with detergent, then disinfect with an approved product such as a 1:10 bleach solution according to facility policy.

Handle soiled linen without shaking it or holding it against your body; bag it at the point of use and never place it on the floor or in a chair.

Needlestick or sharps injury: wash the site with soap and water, report to the nurse immediately, and follow the facility's post-exposure evaluation protocol.

Before ambulating: apply non-skid footwear, place a gait belt, lock the bed wheels, clear the path, and get enough help to prevent a fall.

Fall prevention: bed in the lowest position with wheels locked, call light and personal items within reach, night light on, floor free of clutter, and calls answered promptly.

Restraints require a physician's order, the least restrictive device, release and repositioning with circulation checks at least every 2 hours or per order, and are never used for convenience, discipline, or coercion.

Fire response - RACE: Rescue anyone in danger, Alarm, Contain by closing doors, Extinguish or Evacuate; extinguisher use - PASS: Pull the pin, Aim at the base, Squeeze the handle, Sweep side to side.

Seizure: protect the head, do not restrain or place anything in the mouth, time the seizure, note the movements, and turn the resident to the side afterward.

Conscious adult choking: give abdominal thrusts until the object is expelled; if the resident becomes unresponsive, ease them to the floor, call for help, and begin CPR.

Adult CPR: compressions at least 2 inches deep at 100-120 per minute, 30 compressions to 2 breaths, with minimal interruptions until help arrives.

Suspected stroke: note the time the resident was last known to be well, apply FAST (Face, Arms, Speech, Time), call emergency services, and give nothing by mouth.

Burns: cool with running cool water, do not apply ice, butter, or ointments, do not break blisters, and report to the nurse.

Residents have the right to dignity, privacy, respect, and self-determination; provide care with the door or curtain closed and expose only the body part being cared for.

A resident may refuse any treatment, medication, or food; the aide stops, informs the nurse, documents the refusal, and never forces, threatens, or bargains.

Confidentiality: discuss resident information only with the care team, in private - never in hallways, elevators, or with other residents and visitors.

Residents may keep and use personal possessions; label items, secure valuables per policy, and never borrow from or lend money to a resident.

Residents have the right to voice grievances without retaliation, to access their records, to choose activities and schedules, and to receive visitors.

Promote independence: let the resident perform every step they can (washing, dressing, feeding) and assist only with the steps they cannot complete.

Offer choices within safety limits - which shirt, which beverage, when to bathe - because control over daily decisions supports dignity and function.

Residents are free from physical, sexual, verbal, and financial abuse and from neglect; report suspected abuse immediately to the charge nurse and administrator.

Normal adult ranges: oral temperature 97.6-99.6 degrees Fahrenheit, pulse 60-100 beats per minute, respirations 12-20 per minute, blood pressure below 120/80 mmHg, oxygen saturation 95-100 percent.

Count the pulse for 30 seconds and multiply by 2 when the rhythm is regular; count a full minute when irregular; count respirations for a full minute without telling the resident.

Blood pressure cuff sits about 1 inch above the antecubital space with the arm at heart level; avoid an arm with an IV, a dialysis fistula, or on the side of a mastectomy per facility policy.

Axillary temperature reads about 1 degree Fahrenheit lower than oral and rectal about 1 degree higher; report a temperature of 100.4 degrees Fahrenheit (38 degrees Celsius) or above.

Bathing: wash from cleanest to dirtiest - eyes (inner to outer corner) and face first, then trunk and limbs, then perineum last, always front to back.

Bed bath water is about 105 degrees Fahrenheit (40-43 degrees Celsius); change the water when it cools or becomes soiled and keep the resident covered to prevent chilling.

Reposition immobile residents at least every 2 hours, use a 30-degree lateral position and pressure-relieving devices, and never massage reddened bony areas.

Pressure injury staging: stage 1 is intact skin with a red area that does not blanch, stage 2 is partial-thickness skin loss, stages 3 and 4 are full-thickness loss down to fat, muscle, or bone.

Catheter care: keep the drainage bag below bladder level and off the floor, keep tubing unkinked, provide daily perineal hygiene, and report cloudy, bloody, or foul-smelling urine.

Diet orders include NPO (nothing by mouth), clear liquid, full liquid, mechanical soft, and pureed; never give food or fluids not on the ordered diet without nurse approval.

Dysphagia precautions: seat the resident upright at 90 degrees, tuck the chin slightly, offer small bites and one food item at a time, and keep the resident upright 30 minutes after the meal.

Thickened liquids are served at the ordered consistency; do not use a straw unless ordered, because straws increase the risk of aspiration.

Signs of aspiration: coughing, choking, a wet or gurgling voice, pocketing food, tearing eyes, or falling oxygen saturation - stop feeding and report immediately.

Place food on the stronger side of the mouth, check the affected cheek for pocketing after each bite, and allow rest periods during the meal.

Encourage 1500-2000 mL of fluid per day unless the resident is on a restriction; record intake in milliliters and offer fluids between meals and with medications.

Dehydration signs: dark concentrated urine, dry mouth, poor skin turgor, confusion, weight loss, and urine output below 30 mL per hour.

Weigh residents at the same time of day, on the same scale, in similar clothing; report a loss of 5 percent of body weight in one month or 10 percent in six months.

Maslow's hierarchy runs physiological, safety, love and belonging, esteem, self-actualization; physical needs such as oxygen, food, water, and pain relief are met first.

Depression signs include sadness, withdrawal, loss of interest, appetite and sleep changes, and hopelessness lasting two weeks or more; report these to the nurse.

Suicide warning signs include talking about dying, giving away possessions, and sudden calm after a period of depression; report immediately and do not leave the resident alone.

Anxiety: stay with the resident, speak calmly and slowly, reduce noise and stimulation, and use short, direct statements.

Defense mechanisms such as denial, projection, and regression reduce anxiety; do not argue or confront, and report significant changes in behavior to the nurse.

Grief responses include denial, anger, bargaining, depression, and acceptance, but they do not occur in a fixed order or on a set timetable.

Therapeutic communication uses open-ended questions, active listening, silence, and empathy; avoid false reassurance, giving advice, and talking about your own problems.

Report changes in mood, appetite, sleep, or social participation to the nurse; the aide does not diagnose or treat mental health conditions.

Dementia is chronic, progressive, and irreversible; delirium is a sudden change in alertness and thinking, often caused by infection, medication, or dehydration, and is a medical emergency.

Behavior is communication: check for pain, hunger, thirst, constipation, a full bladder, fatigue, noise, or unfamiliar people before assuming the behavior is 'just the dementia.'

Validation: acknowledge the resident's feelings instead of arguing about facts; do not repeatedly correct or reorient a resident who has dementia.

Sundowning is increased confusion and agitation in late afternoon or evening; respond with a calm routine, reduced noise, and fewer activities late in the day.

Wandering: provide a safe area, secure exits per policy, use an identification bracelet, never restrain, and report a missing resident immediately.

Memory support: keep routines consistent, place calendars and clocks, label drawers and doors, and lay out clothing in the order it is put on.

Alzheimer's stages: early - short-term memory loss and repetition; middle - wandering, confusion, needs help with ADLs; late - total care, swallowing problems, little speech.

Give one instruction at a time, allow extra time, and offer simple choices between two options rather than open-ended questions.

Safety: remove throw rugs and clutter, lock up cleaning supplies and medications, supervise smoking, and control water temperature to prevent burns.

Restorative care focuses on maintaining or improving function and independence; the aide follows the care plan and encourages the resident to do what they can.

Passive range of motion is performed by the aide, who supports the limb above and below the joint and moves it through the pain-free range; active range of motion is performed by the resident.

Perform range of motion as ordered, usually 2-3 times per day; stop if the resident reports pain, and never force or bounce a joint.

Contractures are permanent shortening of muscles and tendons; prevention is range of motion, repositioning at least every 2 hours, and use of ordered splints.

Ambulation: apply a gait belt, stand slightly behind and on the resident's weaker side, guard the resident, and have them step with the stronger leg first.

Cane: the resident holds the cane on the stronger side and moves the cane and the weaker leg forward together, then steps forward with the stronger leg.

Walker: the resident moves the walker forward about an arm's length, steps into it with the weaker leg, then brings the stronger leg forward; the handgrips should be at hip level with elbows slightly bent.

Adaptive devices - built-up utensils, plate guards, long-handled sponges, and reachers - let residents perform self-care with less assistance.

Report changes in strength, range of motion, skin condition, or the ability to perform ADLs to the nurse and document what the resident actually did.

Scope of practice: perform only tasks you were trained and checked off to do, follow the care plan and facility policy, and never perform a task that requires an RN or LPN.

Nurse aides may not delegate nursing tasks to other unlicensed workers; only the nurse delegates, and the aide reports to and takes direction from the licensed nurse.

Negligence is failure to provide the care a reasonable, prudent person would provide in the same situation; malpractice is negligence by a professional, and both create legal liability.

Abuse types are physical, sexual, verbal or emotional, financial, involuntary seclusion, and neglect; a nurse aide is a mandated reporter in Oklahoma.

Report suspected abuse or neglect immediately to the charge nurse and administrator and follow Oklahoma State Department of Health and facility reporting requirements; failure to report is itself a violation.

HIPAA protects resident health information; do not discuss residents outside the facility, on social media, or with anyone not involved in their care.

Advance directives - living will, durable power of attorney for health care, and DNR orders - must be followed and kept accessible per policy; the aide does not decide resuscitation status.

Documentation is a legal record: chart only what you did and observed, use objective language, chart promptly, sign and date, and never erase, white out, or chart for another person.

Do not accept gifts, money, or tips from residents, do not witness a resident's will, and do not act as a resident's power of attorney; these create conflicts of interest and legal risk.