Vermont CNA (LNA) cheat sheet

LNA scope covers ADLs, vital signs, intake and output, ambulation, transfers, and observation; assessment, care planning, and medication administration belong to licensed nurses.

The care plan is written by the RN and directs what the aide does; if an assignment conflicts with the care plan, clarify with the charge nurse before acting.

Reporting chain: the aide reports to the charge nurse or team leader, who reports to the RN and the director of nursing.

A task outside the aide's training or the state's scope is declined and reported, not attempted.

Vermont LNA certification requires completing an approved training program and passing a competency evaluation; renewal follows Vermont Board of Nursing continuing education rules.

Confidentiality: resident information is shared only with the care team and only as needed for care.

Aide documentation goes on flow sheets and ADL records; progress notes and assessments are written by licensed nurses.

Accepting money, gifts, or a bequest from a resident is prohibited and is treated as exploitation.

Introduce yourself by name and role, and use the resident's preferred name.

Face the resident, speak at a normal volume, and reduce background noise before speaking.

Hearing loss: lower the pitch of your voice rather than shouting, and confirm hearing aids are in place, turned on, and clean.

Aphasia: one question at a time, long pauses, yes/no questions, gestures, and picture boards; do not finish the resident's sentences.

Vision loss: identify yourself on entering, describe what you are about to do, and use clock-face directions (for example, 'food at 3 o'clock').

Cognitively impaired residents respond best to short sentences, one-step directions, and a calm tone.

Report objective findings (measured, seen, heard, smelled) separately from the resident's subjective statements.

Use a qualified interpreter, not a family member, when the resident and aide do not share a language.

Hand hygiene with soap and water for at least 20 seconds, or an alcohol-based rub when hands are not visibly soiled.

Gloves are worn for contact with blood, body fluids, mucous membranes, and non-intact skin; hand hygiene follows glove removal.

C. difficile and norovirus require soap-and-water handwashing because alcohol does not remove spores.

Fire response: RACE - Rescue, Alarm, Contain by closing doors, Extinguish or Evacuate.

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

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

Falls: bed in low position, call light within reach, non-skid footwear, and clear pathways.

Needlestick or splash: wash with soap and water, flush mucous membranes, and report immediately for exposure follow-up.

Residents have the right to dignity, privacy, confidentiality, choice, and to voice grievances without retaliation.

A resident may refuse care; the aide stops, notifies the nurse, and documents the refusal.

Knock and wait for permission before entering; close curtains and doors during personal care.

Report suspected abuse, neglect, or misappropriation of property immediately to the charge nurse and administrator; Vermont law also requires a report to the state.

Physical restraints require a prescriber's order, must be the least restrictive option, and are never used for convenience or discipline.

Advance directives and DNR orders are followed as written in the chart; confirm with the nurse if the status is unclear.

Residents may keep and use personal possessions, receive mail, have visitors, and use the telephone in private.

Accepting gifts or money, or being named in a resident's will, is prohibited.

Bed bath water: about 105 °F (40.6 °C); test with a thermometer or on the inner wrist.

Perineal care: front to back, wash the anal area last, and use a clean portion of the cloth for each stroke.

Dressing: apply clothing to the weak or affected side first; remove it from the strong side first.

Eye care: clean from the inner canthus to the outer canthus, using a different area of the cloth for each eye.

Dentures: remove over a basin lined with a towel, brush with denture cleaner, and store in a labeled cup of water.

Foot and nail care: aides do not cut the nails of residents with diabetes or poor circulation; report to the nurse.

Shaving: use an electric razor for residents on anticoagulants or with a bleeding risk.

Provide mouth care at least every two hours for unconscious or NPO residents.

Dysphagia precautions: upright at 90°, small bites, chin tuck if ordered, thickened liquids per order, and remain upright 30 minutes after meals.

Aspiration signs include coughing or choking while eating, a wet voice, cyanosis, and new fever.

1 ounce = 30 mL; record the percentage of each meal eaten and all fluid intake.

Report urine output below 30 mL per hour, or intake far below the ordered fluid goal.

Weigh the resident at the same time of day, on the same scale, with the same clothing.

Dehydration signs: dry mucous membranes, dark concentrated urine, decreased output, and new confusion.

NPO means nothing by mouth, including ice chips and sips of water, unless the nurse orders otherwise.

Encourage independence with adaptive utensils, and honor cultural and religious food preferences.

Keep the catheter drainage bag below bladder level and off the floor; empty it at least every 8 hours or when two-thirds full.

Perform catheter care daily and after each bowel movement; keep tubing free of kinks and tension.

Report no bowel movement for three days, diarrhea, blood or mucus in stool, or abdominal distension.

Bedpan use: warm the pan, raise the head of the bed to a safe position, provide privacy, and stay nearby.

Bladder training: offer the toilet or bedpan on a scheduled interval rather than waiting for a request.

Change wet or soiled briefs promptly and apply a barrier cream if ordered to protect the skin.

When collecting a stool specimen, avoid contamination with urine or toilet water and send it promptly.

Constipation prevention includes adequate fluids, fiber, and activity within the care plan.

Reposition at least every two hours and document each position change.

Fowler's position is 45–60°; high Fowler's is 90°; Sims' is a semi-prone side-lying position.

Logroll residents with spinal precautions, keeping the head, trunk, and hips aligned.

Before a transfer: lock the wheels, lower the bed, apply a gait belt, and clear the path.

Stand on the resident's weaker side and pivot toward the stronger side; never pull the resident up by the arms or armpits.

Mechanical lifts require two staff, a sling check, and never leaving the resident suspended.

Dangle the resident at the edge of the bed before standing if orthostatic hypotension is a concern.

Use pillows and wedges to maintain body alignment and relieve pressure over bony prominences.

Passive ROM is performed by the aide; active ROM is performed by the resident.

Support the joint above and below the area being moved, move slowly to the point of resistance, and never force a joint past pain.

Stop ROM and report pain, swelling, redness, or a sudden loss of motion.

Perform ROM as often as the care plan specifies, commonly two to three times daily.

Contracture prevention combines positioning, alignment, and regular ROM.

Splints and braces are applied on schedule; check the skin underneath each time.

Restorative goals are set by therapy and the nurse; the aide follows the plan and encourages self-care.

Normal adult ranges: oral temperature 97.6–99.6 °F, pulse 60–100 beats/min, respirations 12–20/min, SpO2 95–100%.

Count respirations for 30 seconds and multiply by two, or a full minute if irregular; one rise and fall equals one respiration.

Count a regular radial pulse for 30 seconds and multiply by two; count an irregular pulse for a full minute.

Blood pressure: cuff 1 inch above the antecubital space, arm supported at heart level, deflate 2–3 mmHg per second.

Report temperature ≥ 100.4 °F, pulse < 60 or > 100, respirations < 12 or > 20, and SpO2 < 95%.

Report systolic BP ≥ 140 or ≤ 90 mmHg, or diastolic BP ≥ 90 or ≤ 60 mmHg.

Axillary temperatures read about 1 °F lower than oral; rectal readings run about 1 °F higher.

Report a weight change of 2–3 pounds in a day or 5 pounds in a week.