South Carolina CNA cheat sheet

Hand hygiene: wash with soap and water for at least 20 seconds when hands are visibly soiled or after caring for a resident with C. difficile or norovirus; an alcohol-based rub is acceptable for routine cleaning of hands that are not visibly soiled.

Adult baseline vital signs: oral temperature 97.6-99.6 degrees F (36.5-37.5 C), pulse 60-100 beats per minute, respirations 12-20 per minute, blood pressure below 120/80 mmHg, oxygen saturation 95-100%.

Count respirations for 30 seconds and multiply by 2 without telling the resident you are counting; count an irregular pulse for a full 60 seconds.

Turn and reposition a resident who cannot move independently at least every 2 hours, keeping the body in alignment and supporting dependent limbs to prevent pressure injury.

Range of motion: active means the resident moves the joint; passive means the aide moves it. Move only to the point of resistance, never force, bounce, or cause pain, and stop and report if the resident reports pain.

Intake and output conversions: 1 fluid ounce = 30 mL, 1 cup (8 oz) = 240 mL, 1 teaspoon = 5 mL, 1 tablespoon = 15 mL; record intake as the percentage of the meal actually eaten.

Positioning angles: Fowler's 45-60 degrees, high-Fowler's 60-90 degrees, semi-Fowler's about 30 degrees; Sims' is left side-lying with the right knee drawn up; Trendelenburg places the head lower than the feet.

Personal protective equipment order: gown, then mask, then goggles or face shield, then gloves last. Remove gloves first, then goggles, then gown, then mask by the ties only; perform hand hygiene immediately after.

Reportable thresholds: urine output below 30 mL per hour, no voiding for 6-8 hours, output less than intake, a new irregular pulse, respirations outside 12-20, or a temperature at or above 100 degrees F.

Kubler-Ross grief stages: denial, anger, bargaining, depression, acceptance. The stages are not strictly sequential, and residents may move back and forth or never reach acceptance.

Maslow's hierarchy is met from the bottom up: physiological needs, safety, love and belonging, esteem, then self-actualization. Hunger, pain, or a full bladder must be relieved before higher needs can be addressed.

Aphasia: use short sentences, ask one question at a time, offer yes-or-no choices, use gestures or pictures, and allow extra response time. Do not finish the resident's sentences or pretend to understand.

Hearing loss: get the resident's attention and face them before speaking, lower the pitch of the voice, avoid shouting, reduce background noise, and use written notes if speech is not understood.

Dementia: redirect rather than correct. Do not argue with delusions or hallucinations; acknowledge the feeling, maintain a consistent routine, and use validation of the emotion being expressed.

Behavior is communication: new aggression, crying, or withdrawal usually signals pain, hunger, constipation, a full bladder, fear, or overstimulation. Look for and report the cause rather than only managing the behavior.

Restraints: only with a physician's order for a specific medical symptom, using the least restrictive device, with release, repositioning, and circulation checks at ordered intervals. Never use a restraint for convenience, punishment, or staff shortage.

Resident rights include refusing care, privacy during care and visits, confidential mail and telephone calls, choosing visitors, keeping personal possessions, and filing a grievance without retaliation.

Defense mechanisms such as denial, regression, projection, rationalization, displacement, and compensation are unconscious ways of handling stress; acknowledge the feeling instead of challenging the mechanism.

Scope of practice: perform only skills taught in the state-approved nurse aide program and delegated by a licensed nurse. Do not administer medications, insert tubes, perform sterile procedures, or make nursing assessments.

Chain of command: the nurse aide reports to the charge nurse or LPN, who reports to the RN, who reports to the physician. Report changes in condition immediately, not at the end of the shift.

Documentation: objective, factual, timely, chronological, in black ink, signed with name and title. Chart what you observed or performed, not opinions, guesses, or what another caregiver did.

Correcting a chart error: draw a single line through the error so it remains readable, write "error," and add initials and date. Never erase, scribble out, or use correction fluid.

Abuse categories under OBRA: physical, sexual, verbal or emotional, financial exploitation, neglect, involuntary seclusion, and misappropriation of property. Nurse aides are mandatory reporters and must report suspicion immediately, without needing proof.

HIPAA confidentiality: share resident information only with the care team. Do not discuss residents in hallways, elevators, on social media, or off duty, and do not open personal mail without consent.

OBRA 1987 set federal nursing home standards and resident rights, including dignity, self-determination, privacy, freedom from unnecessary restraints, and access to the state long-term care ombudsman.

Advance directives such as a living will or durable power of attorney for health care must be asked about at admission under the Patient Self-Determination Act, documented, and honored by the care team.

Delegation: the nurse delegates tasks, not accountability. If asked to perform a task outside your training or unsafe for the resident, refuse politely, explain why, and report the request to the nurse.