Tennessee CNA cheat sheet

Normal adult resting respiratory rate is 12 to 20 breaths per minute; count for a full 60 seconds while keeping fingers on the wrist as if still counting the pulse.

Typical adult temperature ranges: oral 97.6 to 99.6 degrees F; rectal readings run about 1 degree higher and axillary readings about 1 degree lower than oral.

Hand hygiene is the single most effective way to prevent infection spread: soap and water for at least 20 seconds, or alcohol-based rub when hands are not visibly soiled.

Standard precautions apply to every resident regardless of diagnosis; gloves are required for blood, body fluids, secretions, excretions, non-intact skin, and mucous membranes.

Order for donning PPE is gown, mask, goggles or face shield, then gloves; removal reverses the order with gloves first, and hand hygiene follows removal.

Blood pressure cuff bladder should cover about two-thirds of the upper arm; inflate to 30 mmHg above the point where the radial pulse disappears.

Pulse deficit equals the apical rate minus the radial rate counted simultaneously for one full minute; a deficit indicates the heart is not pumping effectively.

Sterile field rule: any item below waist level, out of direct view, or touched by clothing is contaminated, and a field you turn away from is considered contaminated.

Bed bath sequence goes from cleanest to dirtiest: face and neck first, then arms, chest, abdomen, legs, back, with perineal care always last.

Perineal care is performed front to back, moving from the urethral opening toward the rectum, to prevent urinary tract infection.

Bath water is about 105 degrees F, or comfortably warm to the inner wrist, and is checked with a thermometer before the resident enters or is washed.

Immobile residents are turned and repositioned at least every 2 hours, day and night, with the skin inspected at each turn for redness that does not blanch.

When dressing, put the garment on the weak or affected side first and remove it from the strong side first.

Oral care for an unconscious resident: turn the head to the side, use suction, use no water, and inspect the mouth for food or foreign objects.

Dentures are cleaned over a basin filled with water or lined with a washcloth, and stored in a labeled cup of water when not in the mouth.

Range of motion is done slowly within the resident's comfort limits; a joint is never forced and the movement stops if pain is reported.

Nail trimming is not performed by the nursing assistant on residents with diabetes or peripheral vascular disease; the need is reported to the nurse.

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

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

A restraint requires a current physician's order, must be the least restrictive option, is released and checked at least every 15 minutes, and is never tied to side rails.

Fall prevention bundle: bed in lowest position, brakes locked, call light within reach, non-skid footwear, adequate lighting, and clear pathways.

During a seizure: protect the head, do not restrain, place nothing in the mouth, time the seizure, and turn the resident to the side afterward.

For an adult choking with a strong cough, encourage coughing; for a complete obstruction with a conscious adult, use abdominal thrusts.

Before a wheelchair-to-bed transfer: lock the brakes, swing away the footrests, and position the chair at a 45-degree angle to the bed.

Burn first aid is cool running water for at least 20 minutes; ice and ointments are never applied.

Restorative approach: set up supplies and cue the resident to perform as much self-care as safely possible, using ordered adaptive devices.

Active listening includes facing the resident, maintaining eye contact, nodding, and restating the message to confirm understanding.

With a hearing-impaired resident: face them, get their attention, reduce background noise, speak clearly and slowly, and lower voice pitch rather than shouting.

With a resident who has aphasia: allow extra time, ask short yes-or-no questions, and use gestures or picture boards; never pretend to understand.

Any message or telephone order received is repeated back to the speaker in your own words, and written down when possible, to verify accuracy.

Report objective observations (what is seen, heard, measured) rather than interpretive labels about the resident's mood or character.

Resident information is not discussed in hallways, elevators, or dining rooms; it is shared only with staff directly involved in that resident's care.

The charge nurse is the nursing assistant's supervisor; assessment, teaching, and medication administration are outside the nursing assistant's scope and are reported, not performed.

Changes in condition are reported immediately, including new confusion, refusal of food or fluids, skin breakdown, and complaints of pain.

Resident rights include being informed, participating in care planning, refusing treatment, privacy, confidentiality, dignity, freedom from abuse and neglect, and voicing grievances without retaliation.

Before entering a resident's room: knock, announce yourself, and wait for permission; close doors and curtains and expose only the area being cared for.

A resident may refuse any care; the refusal is honored, documented, and reported to the nurse, and care is never forced or threatened.

Any suspicion of abuse, neglect, or misappropriation of resident property must be reported immediately to the charge nurse and to the state hotline as required by law.

Restraints may never be used for convenience, discipline, or coercion, and only under a physician's order with consent-related protections.

Independence is promoted by offering choices (which clothing, when to bathe) and allowing the resident to complete as much self-care as is safe.

Residents may keep personal possessions, receive visitors, and set their own schedule for waking, eating, and activities.

Gifts or money from residents and families are not accepted, resident mail is not opened, and resident funds are never handled by the nursing assistant.

Alzheimer's disease is irreversible and progressive; delirium is an acute, often reversible change caused by illness, medication, or dehydration, and is always reported.

Sundowning is increased confusion and agitation in late afternoon or evening; reduce noise and crowds, keep lighting bright, maintain routines, and limit caffeine.

For a resident with dementia who is confused, do not argue or correct; acknowledge the feeling, reassure, and redirect to a safe activity.

Approach an agitated resident from the front at eye level with a calm, low voice, and avoid sudden touch or standing over the resident.

For a wandering resident: do not restrain or scold; redirect gently, walk with them, offer a distraction, and check that exits and stairwells are secured.

New signs of depression (withdrawal, poor appetite, sleep change, hopelessness) are reported to the nurse; any talk of self-harm is an emergency requiring constant supervision.

Reality orientation with gentle cues (date, place, time) suits mild confusion, while joining the resident's reality suits moderate to severe dementia.

With delusions or hallucinations, do not argue about whether the experience is real; acknowledge the emotion and redirect the conversation.