Virginia CNA cheat sheet

CNA scope includes ADLs, bathing, grooming, toileting, feeding, repositioning, vital signs, and reporting; it excludes assessment, diagnosis, prescribing, medication administration, and teaching care plans.

Reporting chain: nurse aide reports to the licensed nurse, who directs care; observations are documented objectively and promptly.

Delegation requires the nurse to assess the resident and the task to be within aide training and facility policy; an aide may refuse an unsafe or out-of-scope task and must report the refusal.

Resident rights include dignity, privacy, choice, confidentiality, access to records, freedom from abuse and unnecessary restraints, and the grievance process.

Virginia nurse aide certification requires state-approved training, competency evaluation, background check, and registry maintenance according to the Virginia Board of Nursing.

HIPAA requires sharing resident information only with care-team members who need to know; public areas and social media are not appropriate for resident information.

The job description and facility policy define permitted tasks; the state nurse practice act governs the legal scope of unlicensed assistive personnel.

Work settings include nursing homes, assisted living, hospitals, home health, and hospice; the basic aide scope remains consistent across settings.

Suspected abuse, neglect, or exploitation must be reported immediately to the licensed nurse and administrator; Virginia Adult Protective Services receives reports for adults as required by law.

Informed consent is obtained by the licensed provider after explaining risks, benefits, and alternatives; an aide may witness a signature only when facility policy permits.

Negligence is failure to meet the standard of care that causes harm; malpractice is professional negligence involving a licensed professional.

Assault is a threat of harm; battery is unauthorized touching; false imprisonment is unlawful confinement or restraint without justification.

Restraint use requires a provider order specifying type and duration, the least restrictive method, circulation and needs checks at least every 15 minutes, and release/repositioning every 2 hours per policy.

Confidentiality follows HIPAA and the minimum-necessary rule; suspected breaches are reported through facility channels.

Advance directives include a living will and durable power of attorney for health care; the aide follows documented resident wishes and reports conflicts.

Ethical conduct includes honesty, privacy, avoiding gifts or financial conflicts, and never taking or posting resident photographs without authorization.

Mandatory reporting includes unexplained injuries, sexual abuse, physical abuse, verbal abuse, neglect, and financial exploitation.

Therapeutic techniques include open-ended questions, restatement, reflection, clarification, silence, and empathy; avoid why questions, false reassurance, arguing, and changing the subject.

For aphasia, use short sentences, yes/no questions, gestures, pictures, and extra time; do not pretend to understand unclear speech.

For hearing loss, face the resident, get attention, speak clearly at normal volume with lower pitch, reduce background noise, and avoid shouting or covering the mouth.

For vision loss, identify yourself, explain before touching, orient the resident to the call light, and keep frequently used items in the same place.

For dementia, use one-step directions, short sentences, validation, redirection, routine, and calm tone.

Use a trained medical interpreter for language barriers; speak directly to the resident, not to the interpreter, and avoid using family for complex medical information.

SBAR handoff means Situation, Background, Assessment, Recommendation; it gives the nurse objective facts and a clear request.

Documentation must be objective, factual, timely, legible, signed, and dated; avoid opinions, blank lines, and alterations that violate facility policy.

Nonverbal communication includes tone, posture, eye contact, and touch; cultural differences affect personal space and acceptable touch.

Hand hygiene is the most important infection control measure; use soap and water for 20 seconds when hands are visibly soiled or after C. difficile, otherwise use alcohol-based rub.

Standard precautions treat all blood and body fluids as infectious; wear gloves for contact and add gown, mask, and eye protection when splash is likely; perform hand hygiene after PPE removal.

PPE donning order is gown, mask, goggles, then gloves; doffing order is gloves, goggles, gown, then mask, followed by hand hygiene.

Transmission-based precautions: contact for MRSA, C. difficile, and scabies; droplet for influenza and pertussis; airborne for tuberculosis, measles, and varicella with an N95 respirator.

Fall prevention includes low bed, locked brakes, call light within reach, non-skid footwear, clear path, frequent toileting offers, and rounding checks.

Fire response uses RACE: Rescue, Alarm, Confine by closing doors, Extinguish or Evacuate; extinguisher use is PASS: Pull, Aim, Squeeze, Sweep.

Adult choking with a forceful cough is encouraged; if the airway is obstructed and the resident is responsive, use abdominal thrusts; if unresponsive, start CPR.

Adult CPR uses 30 compressions to 2 breaths at 100-120 compressions per minute, depth 2 inches, with an AED as soon as available.

Seizure care protects the head, clears nearby objects, does not restrain or place anything in the mouth, times the seizure, turns the resident to the side afterward, and reports immediately.

Bath water is about 105 degrees Fahrenheit (40.5 degrees Celsius); check temperature, provide privacy, wash eyes from inner to outer, and clean perineal area front to back.

Oral care includes brushing teeth, gums, and tongue; remove dentures, clean them with denture cleanser, store them wet in a labeled container, and inspect the mouth for sores.

Dress the affected or weak side first, then the strong side; undress the strong side first to promote independence and safety.

Nail care includes filing and cleaning; do not trim the nails of residents with diabetes or poor circulation unless specifically permitted, and report problems.

Use an electric razor for residents who take anticoagulants or have bleeding risk, following facility policy.

Skin care includes inspecting pressure areas, keeping skin clean and dry, repositioning at least every 2 hours, and reporting redness that does not blanch.

Toileting includes offering the bedpan or toilet every 2 hours, providing privacy, cleaning front to back, and changing wet or soiled clothing promptly.

Bed making avoids shaking linens, places dirty linen in the proper bag, and never places clean or dirty linens on the floor.

Morning and evening care includes mouth care, face and hands, perineal care, back care, and respect for resident preferences and dignity.

Normal adult temperature is about 97-99 degrees Fahrenheit (36.1-37.2 degrees Celsius); routes include oral, rectal, axillary, tympanic, and temporal, with rectal contraindicated in diarrhea, rectal surgery, or bleeding.

Normal adult pulse is 60-100 beats per minute; count 30 seconds and multiply by 2 if regular, but count a full minute if irregular or if medications affect heart rate.

Normal adult respirations are 12-20 per minute; count for a full minute while the resident is unaware and report rate, depth, rhythm, and effort.

Normal adult blood pressure is less than 120/80 mm Hg; use the correct cuff size, support the arm at heart level, and avoid caffeine, smoking, or exercise for 30 minutes before measurement.

Pain is the fifth vital sign; use a 0-10 scale when possible and observe nonverbal signs such as grimacing, guarding, and restlessness.

Pulse oximetry measures oxygen saturation; normal is 95-100%, and readings below 92% or per order are reported.

Intake and output use 1 ounce equals 30 milliliters and 1 cup equals 240 milliliters; record all oral, tube, and IV fluids plus urine, vomitus, and drainage.

Weight is measured at the same time of day, on the same scale, with similar clothing; significant changes are reported.

Orthostatic blood pressure is measured lying, sitting, and standing; a drop with dizziness or fainting is reported.

Therapeutic diets include regular, low sodium, diabetic, renal, pureed, mechanical soft, and thickened-liquid diets; follow the written order and never change consistency independently.

Dysphagia precautions include upright positioning at 90 degrees, chin tuck, small bites, thickened liquids as ordered, checking for pocketing, and keeping suction available if indicated.

Usual fluid intake is about 1500-2000 milliliters per day unless restricted; encourage fluids, offer frequently, and record intake accurately.

Dehydration signs include dry mouth, thirst, dark concentrated urine, decreased output, dizziness, confusion, and poor skin turgor; report promptly.

Constipation prevention includes fiber, fluids, and activity; report no bowel movement for 3 days or per facility policy.

Urinary catheter care keeps the drainage bag below the bladder and off the floor, prevents kinks, cleans the perineum front to back, empties regularly, and reports cloudy, bloody, or foul urine.

Normal urine is clear and pale yellow; report blood, sediment, foul odor, or decreased output.

Aspiration signs include coughing, choking, wet voice, fever, and difficulty breathing; stop feeding and report immediately.

Incontinence care includes changing promptly, cleaning front to back, applying skin barrier as ordered, and providing privacy.

Maslow hierarchy is physiological, safety, love and belonging, esteem, and self-actualization; basic needs and safety come first.

Dementia stages are early, middle, and late; sundowning is increased confusion or agitation in late afternoon or evening.

Validation therapy acknowledges feelings rather than arguing with confused statements; redirection and routine reduce distress.

Behavior is communication; agitation may signal pain, hunger, toileting, fatigue, or overstimulation, so assess triggers and report patterns.

Depression signs include withdrawal, appetite change, sleep change, hopelessness, and loss of interest; report these observations.

Anxiety care includes calm tone, simple explanations, safety, and avoiding argument; report worsening symptoms.

Grief is not linear; allow expression, listen, and report severe or prolonged distress.

For mental illness, show respect, do not argue with delusions, focus on feelings, and report suicidal statements immediately.

Any suicide threat or plan requires immediate reporting to the licensed nurse and emergency evaluation; do not leave the resident alone.

Range-of-motion exercises may be active or passive; support the joint, move slowly, and stop if pain occurs.

Reposition immobile residents at least every 2 hours, use 30-degree lateral positioning, maintain body alignment with pillows, and check skin for non-blanching redness.

Contracture prevention includes range of motion, positioning, splints as ordered, and encouraging independence in activities.

Transfer technique uses a gait belt, locked wheels, non-skid footwear, a wide base, standing on the weak side, and pivoting; never lift by the arms or pull on the resident.

Ambulation checks for dizziness, uses a gait belt and non-skid footwear, and follows the ordered device; a cane is generally used on the strong side.

Walker use moves the walker forward first, then steps into it; the resident should not use the walker to pull up from a chair unless it is designed for that purpose.

Mechanical lift use requires two staff per policy, a checked sling, locked wheels, and clear instructions to the resident.

Fall recovery does not involve lifting the resident alone; call for help, assess for injury, and follow facility policy.

Restorative care encourages independence, uses adaptive equipment as ordered, praises effort, and allows extra time for tasks.