Oregon CNA cheat sheet

Normal adult ranges: oral temperature 97.6-99.6 F (36.5-37.5 C), pulse 60-100 beats per minute, respirations 12-20 per minute, blood pressure below 120/80 mmHg.

Count pulse and respirations for a full 60 seconds; if the radial pulse is irregular, the nurse measures an apical pulse.

Apical pulse is heard at the fifth intercostal space at the left midclavicular line; pulse deficit equals apical rate minus radial rate.

1 ounce = 30 mL and 1 cup = 240 mL; record intake and output in milliliters for the shift in which the fluid was taken in or voided.

Report adult urine output below 30 mL per hour, or no voiding for 6-8 hours.

Orthostatic hypotension is a systolic drop of 20 mmHg or more, or a diastolic drop of 10 mmHg or more, within 3 minutes of standing.

Weigh residents at the same time of day, on the same scale, with the same amount of clothing.

Pain is the fifth vital sign; use a 0-10 numeric scale or the Wong-Baker FACES scale, and treat the resident's self-report as the standard.

Bath water should be 100-105 F (38-41 C); test it with the inner wrist or a thermometer before the resident gets in.

Wash from cleanest to dirtiest: face and eyes, arms, chest, abdomen, legs, back, and perineum last.

Perineal care always moves front to back, from the urethra toward the rectum, to prevent urinary tract infection.

During a bed bath expose only one body part at a time and keep the rest covered for warmth and privacy.

Dress the weak or affected side first; when undressing, remove the strong side first.

Remove dentures at night, clean them, and store them in a labeled cup of cool water; hot water warps the plastic.

For an unconscious resident, turn the head to the side, use suction, and never place fingers or fluids in the mouth.

Encourage independence in ADLs by setting up supplies and allowing extra time so the resident performs as much self-care as possible.

Reality orientation means calmly stating person, place, and time and repeating as needed, rather than arguing about facts.

Validation therapy acknowledges the feeling behind a confused resident's statement instead of correcting the content.

Do not confront delusions or hallucinations; acknowledge the emotion and redirect the resident to a safe activity.

Kubler-Ross grief stages are denial, anger, bargaining, depression, and acceptance; residents do not move through them in a fixed order.

Depression signs to report include withdrawal, appetite loss, sleep changes, tearfulness, and statements of hopelessness.

A new behavior change in a confused resident often signals pain, infection, constipation, or a medication effect and should be reported.

Sit at eye level, face the resident when speaking, and use open-ended questions; hearing and vision loss are common in older adults.

OBRA 1987, the Nursing Home Reform Act, establishes federal residents' rights and the minimum standards for nursing home care.

Residents must be informed of their rights in writing, in a language they understand, and must sign an acknowledgment.

A resident may refuse any treatment, medication, or care task; document the refusal and notify the nurse, and never force care.

Privacy rights cover personal care (curtains and door), unopened mail, telephone calls, and visits from people of the resident's choosing.

The facility must make the resident's clinical record available for inspection within 24 hours of a request.

Residents may manage their own money or voluntarily delegate it, and the facility must account for any funds it holds.

Freedom from physical and chemical restraints is a right; a restraint needs a physician's order, a time limit, and periodic review.

Any suspicion of abuse, neglect, or exploitation must be reported immediately to the administrator and the state agency or ombudsman.

Restraints require a physician's order, must be the least restrictive option, must be released and the resident repositioned at least every 2 hours, and must be removed as soon as possible.

Never use side rails as a restraint; a rail the resident cannot lower independently functions as a restraint.

Fall prevention: bed in the lowest position, wheels locked, call light within reach, non-skid footwear, and a clear pathway.

Highest fall risk comes from sedatives, diuretics, antihypertensives, gait or balance problems, and a history of falling.

Hot water at the resident's tap must not exceed 120 F (49 C) to prevent scalding.

Store cleaning chemicals locked and never in unmarked food or drink containers.

Residents with dysphagia sit upright at about 90 degrees during meals and remain upright for 30 minutes afterward.

Remove environmental hazards such as clutter, cords, spills, and poor lighting, and report broken equipment.

Fire response is RACE: Rescue anyone in danger, Alarm, Contain the fire by closing doors, then Extinguish or Evacuate as directed.

Fire extinguisher use is PASS: Pull the pin, Aim at the base of the fire, Squeeze the handle, Sweep side to side.

Adult CPR is 30 compressions to 2 breaths, at a rate of 100-120 per minute, with a depth of about 2-2.4 inches.

For a choking adult with an ineffective cough, give abdominal thrusts; if the resident becomes unresponsive, lower them to the floor and start CPR.

Seizure care: protect the head, clear nearby objects, do not restrain, place nothing in the mouth, time the seizure, and report events lasting more than 5 minutes.

Stroke screening is FAST: Face droop, Arm weakness, Speech difficulty, Time to call emergency services.

For shock, lay the resident flat, elevate the legs if there is no injury, keep them warm, give nothing by mouth, and get help.

Wash hands with soap and running water for at least 20 seconds; use alcohol-based rub only when hands are not visibly soiled.

Perform hand hygiene before and after every resident contact and immediately after removing gloves.

Standard precautions apply to every resident regardless of diagnosis.

Don PPE in order gown, mask, goggles, gloves; remove in order gloves, goggles, gown, mask; then perform hand hygiene.

Change gloves between residents and between dirty-to-clean tasks, and never wash or reuse disposable gloves.

For C. difficile and norovirus, wash with soap and water because alcohol rub does not kill spores.

After a needlestick or splash, wash the area with soap and water, report immediately, and follow the facility exposure protocol.

Tuberculosis requires airborne precautions: an N95 respirator and a negative-pressure room.