Utah CNA cheat sheet

OBRA (Nursing Home Reform Act, 1987) establishes federal residents' rights for Medicare/Medicaid-certified nursing homes; each resident receives a written statement of those rights at admission.

Rights include dignity, privacy, confidentiality, choice of activities and roommate, keeping personal possessions, and voicing grievances without retaliation.

A resident may refuse any care or treatment; the CNA stops the task, documents the refusal objectively, and informs the nurse.

Physical or chemical restraints require a physician's order for a specific medical symptom, must be the least restrictive option, and are never used for convenience, discipline, or staffing.

Suspected abuse, neglect, or exploitation is reported immediately to the charge nurse or administrator and, under Utah law, to Adult Protective Services; CNAs are mandated reporters.

HIPAA: resident health information is shared only with those directly involved in care; it is never discussed in hallways, elevators, or public areas.

CNAs do not handle resident money, accept gifts, or witness wills; finances and personal property belong to the resident and are protected by the facility.

The long-term care ombudsman investigates complaints on behalf of residents, and contact information must be posted where residents can see it.

Advance directives (living will, durable power of attorney for health care, DNR order) are addressed at admission, and the CNA follows the resident's documented wishes.

RACE for fire: Rescue anyone in danger, Alarm (pull the alarm), Contain the fire by closing doors, then Extinguish or Evacuate as directed; elevators are never used during a fire.

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

Fall prevention: bed in lowest position with wheels locked, call light and personal items within reach, non-skid footwear, clear pathways, adequate lighting.

An incident report is completed for every fall or unusual event, records facts only without blame or opinion, and is filed per policy rather than copied into the medical record.

Seizure care: protect the head, do not restrain, put nothing in the mouth, time the seizure and note body parts involved, then turn the resident to the side and report.

Choking in a conscious adult: abdominal thrusts; if the resident becomes unconscious, lower to the floor, call for help, and begin CPR.

Body mechanics: feet shoulder-width apart, bend the knees, keep the load close to the body, avoid twisting, and use a mechanical lift or ask for help with heavy residents.

Oxygen safety: no smoking, open flames, or sparks nearby; no petroleum-based products on the face; check the prescribed flow rate.

Bath water is tested before use and mixed with running water; facility hot water is kept at or below 120 degrees F to prevent scalding.

Every message has a verbal and a nonverbal component; tone of voice, facial expression, and posture carry much of the meaning.

Speak face to face at eye level, use a normal tone, short sentences, and plain words; avoid medical jargon with residents and families.

Hearing loss: get attention first, face the resident, lower voice pitch, reduce background noise, do not shout or cover the mouth, and use written notes if needed.

Aphasia: allow extra time, ask yes/no or simple questions, accept gestures or a picture board, and do not finish the resident's sentences.

Vision loss: identify yourself on entering, announce care before touching, and use the clock method to describe food placement on the tray.

Confusion or dementia: short sentences, one-step directions, a calm tone, and redirection rather than argument.

Report objective information to the nurse: what was seen, heard, measured, or smelled, including time and amount; avoid guesses about motives or feelings.

Common barriers to communication include hearing or vision loss, language differences, pain, fear, sedation, and speech disorders; the CNA adjusts technique to the barrier.

Chain of infection links: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host; breaking any link stops spread.

Hand hygiene is the single most effective way to prevent infection; wash with soap and water for at least 20 seconds.

Use soap and water instead of alcohol rub when hands are visibly soiled and after care of a resident with C. difficile or norovirus, because alcohol does not kill those spores.

Perform hand hygiene before and after every resident contact and after removing gloves; gloves never substitute for handwashing.

Standard precautions apply to every resident regardless of diagnosis: gloves for blood, body fluids, mucous membranes, and non-intact skin.

Contact precautions use gown and gloves plus dedicated equipment; droplet precautions use a surgical mask; airborne precautions use an N95 respirator and a negative-pressure room with the door closed.

Do not wear gloves outside the resident's room or touch shared surfaces with soiled gloves; remove gloves and perform hand hygiene before leaving.

Sharps go directly into a puncture-resistant, closable container; never recap, bend, or break a needle.

Any needlestick or splash to eyes or mouth is washed immediately, reported at once, and managed under the facility exposure control plan.

Bathing: a partial bath daily and a complete bath per facility policy (commonly twice weekly); wash the eyes from inner to outer corner using a clean area of the cloth for each eye.

Perineal care: wash front to back with a separate washcloth for each stroke, rinse and dry thoroughly; with a catheter, clean around the meatus and keep the bag below bladder level.

Dress the affected or weaker side first and undress that side last.

Reposition an immobile resident at least every 2 hours, inspect the skin at each turn, and report redness that does not blanch.

Dentures: handle over a towel-lined sink or water-filled basin, use cool water and denture cleanser, and store in a labeled cup.

Never cut the nails of a resident with diabetes or poor circulation; report toenail problems to the nurse.

Oral care for an unconscious resident: side-lying position, no fluids, suction available, and only a small amount of solution.

When making an occupied bed, keep the resident safe per policy, never shake linen, and never place linen on the floor.

Provide privacy by closing the door and curtain and draping the resident during personal care.

Normal adult values: oral temperature 97.6-99.6 degrees F, pulse 60-100 beats per minute, respirations 12-20 per minute, blood pressure below 120/80, oxygen saturation 95% or higher.

Count respirations for a full minute without telling the resident; count an irregular pulse for a full minute.

Rectal temperature is the most accurate and axillary the least accurate; choose another route if the resident has an oral lesion or is on oxygen.

Intake and output are recorded in milliliters; 1 ounce equals 30 mL.

Passive range of motion means the CNA moves the joint, stopping at resistance or pain; never force a joint, and report new pain or swelling.

Use a gait belt for ambulation and transfers, stand on the resident's weaker side, and lock wheelchair wheels before any transfer.

Keep urinary drainage bags below the level of the bladder and off the floor to prevent backflow and infection.

TED hose are applied in the morning before the resident gets out of bed; check the skin and remove for care as ordered.

Restorative care: encourage self-care, provide adaptive devices, assist with prescribed exercises, and document exactly what the resident did.

Common diets include regular, mechanical soft, pureed, clear liquid, full liquid, no concentrated sweets, low sodium, low fat/low cholesterol, and renal.

Dysphagia precautions: sit upright at 90 degrees, give small bites of one texture at a time, use a chin tuck if ordered, check for pocketing, and remain upright 30 minutes after eating.

Stop feeding and report immediately if the resident coughs, chokes, has a wet or gurgling voice, or shows difficulty breathing.

Fluid needs are roughly 1500-2000 mL per day unless a fluid restriction is ordered; record intake and encourage fluids within the order.

Dehydration signs include thirst, dry mouth, dark concentrated urine, low urine output, poor skin turgor, and new confusion; report these findings.

Feed at eye level, allow adequate time, alternate bites of food with fluids, and never force or rush a resident.

Record food intake as a percentage of the meal eaten and report significant weight change to the nurse.

Respect cultural, religious, and personal food preferences; adaptive utensils and proper positioning support independent eating.

Aspiration can lead to aspiration pneumonia; watch for fever, cough, and crackles after meals.

Maslow's hierarchy: physical needs (air, food, water, shelter) precede safety, love and belonging, esteem, and self-actualization.

Kubler-Ross grief stages are denial, anger, bargaining, depression, and acceptance; they are not strictly sequential and not everyone experiences all of them.

Dementia is a progressive loss of memory and function; Alzheimer's disease is the most common cause, and abilities are lost in reverse order of development.

Reality orientation uses clocks, calendars, and clear statements; validation therapy accepts the resident's feelings and reality without arguing.

Sundowning is late-day confusion and agitation; reduce noise and stimulation and keep routines and lighting consistent.

Never argue with a delusion or hallucination; acknowledge the feeling behind it and redirect to a safe activity.

Wandering: provide safe walking space, identification per policy, and door alarms; never restrain or lock the resident in.

Depression signs include appetite loss, sleep changes, withdrawal, tearfulness, and hopelessness; any talk of suicide is reported immediately.

At death, respect religious and cultural beliefs, provide privacy, and do not remove belongings without family permission or per facility policy.