Texas CNA cheat sheet

Scope of practice: the nurse aide performs only tasks delegated by the licensed nurse and taught in the training program; sterile procedures, IV medication, care planning, and the initial resident assessment are outside the role.

The aide reports changes in condition to the charge nurse immediately and never accepts a medical order from a physician, family member, or visitor.

Suspected abuse, neglect, or exploitation is reported immediately to the charge nurse and to the state agency; Texas nurse aides are mandatory reporters.

Documentation is objective, factual, and timely: record what was observed, done, or reported; sign and date each entry; never chart for another caregiver or chart care not yet given.

Resident information is confidential and shared only with the care team; discussing a resident in hallways, elevators, or with other residents violates HIPAA and residents' rights.

A resident may refuse any care; the refusal is documented and reported to the nurse rather than argued with or forced.

Federal OBRA 1987 sets the minimum standard of 75 hours of nurse aide training plus a competency evaluation for certification.

Texas certification renews every two years and requires 24 hours of in-service education during each two-year renewal period.

Gifts, loans, and money from residents are never accepted, and a nurse aide never witnesses a resident's will or handles resident funds.

RACE fire sequence: Rescue anyone in immediate danger, Alarm, Contain the fire by closing doors, then Extinguish or Evacuate per policy.

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

Fall prevention bundle: bed low with wheels locked, call light within reach, non-skid footwear on, clear path to the bathroom, and call lights answered promptly.

Restraints require a physician's order and the least restrictive device; the resident is released, repositioned, offered toileting and fluids, and checked for circulation at least every 2 hours.

An incident report is completed for any error or injury, records objective facts only, is not filed in the medical record, and never assigns blame or admits fault.

A resident is never left unattended in a bathtub, on a toilet, or on a bed with side rails down when the resident is a fall risk.

Back a wheelchair down ramps and curbs, lock the brakes before every transfer, and swing footrests away rather than using them as a step.

Chemical and oxygen safety: supplies locked and labeled, never transferred into unlabeled containers, no smoking or petroleum products near oxygen, tanks secured upright.

Heavy residents are moved with a mechanical lift or a two-person assist; the aide bends the knees, keeps the load close, and never twists while lifting.

Bedbound and chairbound residents are repositioned at least every 2 hours, and skin at pressure points is inspected with every turn.

Range of motion is performed slowly with the limb supported; a joint is never forced past the point of resistance or pain.

Common pressure injury sites: sacrum and tailbone, heels, hips, elbows, shoulders, ears, and any skin under a device or tubing.

A gait belt is fastened snugly over clothing around the waist; the aide stands on the resident's weaker side and slightly behind.

Offer fluids frequently toward 1,500-2,000 mL per day unless a fluid restriction is ordered, and record the intake.

Contracture prevention combines range of motion, proper body alignment, ordered splints, and encouragement of self-care.

Residents are encouraged to do as much of their own ADL care as possible; completing every task for the resident accelerates function loss.

These findings are reported to the nurse: no bowel movement in 3 days, urine output under 30 mL per hour, blood in stool or urine.

Poor appetite, weight loss, and coughing or choking with swallowing are reported promptly because they signal malnutrition and aspiration risk.

Normal adult ranges: oral temperature 97.6-99.6 degrees Fahrenheit, pulse 60-100 beats per minute, respirations 12-20 per minute, blood pressure about 120/80.

Report a temperature of 101 degrees Fahrenheit or higher, pulse under 60 or over 100, respirations under 12 or over 20, or a systolic change of 20 mmHg or more.

Bath sequence: wash the face first, then the front of the body, the back, and the perineal area last; change washcloth and water as needed.

Perineal care always moves front to back, using a clean portion of the cloth for each stroke.

Dentures are removed at night, brushed, stored in a labeled cup of water, and the mouth is inspected and rinsed.

Intake counts all oral, tube, and IV fluids; output counts urine, emesis, and drainage; urine output under 30 mL per hour is reported.

Clean-catch urine specimen: cleanse front to back, collect the midstream in a sterile container, and label it at the bedside.

An unconscious resident receives oral care with a swab and no fluids and is given nothing by mouth.

Soiled linen is held away from the uniform, never placed on the floor, and never shaken in the air.

Report immediately: chest pain, sudden shortness of breath, one-sided weakness, facial droop, slurred speech, loss of consciousness, bleeding, or cyanosis.

FAST stroke screen: Face droop, Arm drift, Speech change, Time to call for emergency help and the charge nurse.

Hypoglycemia signs are shakiness, sweating, confusion, hunger, irritability, and a rapid pulse; report before giving anything by mouth unless the care plan directs otherwise.

Seizure care: protect the head, clear dangerous objects away, do not restrain or put anything in the mouth, time the seizure, turn the resident on the side afterward.

The catheter drainage bag stays below bladder level and off the floor; cloudy, foul-smelling, or bloody urine is reported.

During a tube feeding and for at least 30 minutes afterward the head of the bed stays elevated 30-45 degrees to reduce aspiration risk.

Signs that death is near include mottling, cool skin, irregular breathing with pauses, decreased intake and urine output, and restlessness.

Hospice comfort care consists of mouth care, repositioning, gentle range of motion, and quiet presence; food and fluids are never forced.

Residents with COPD use pursed-lip breathing and the tripod position; oxygen flow rate is set by the nurse or physician and is never changed by the aide.