Washington CNA cheat sheet

Bath water is approximately 105°F (40.5°C); test with the inner wrist and keep the resident covered to prevent chilling.

Wash from cleanest to dirtiest: face and neck first, then arms, chest, abdomen, legs, back, and perineum last; use a different part of the washcloth for each stroke.

Perineal care on a female resident moves front to back (pubis toward rectum) to prevent dragging bacteria toward the urethra.

Dress the affected (weak) side first and undress the affected side last; remove clothing from the strong side first.

Apply a gait belt snugly around the waist over clothing; it is not placed over bare skin, ribs, or a surgical incision, and it is never used to lift a resident who cannot bear weight.

When ambulating, stand on the resident's weaker side and slightly behind, holding the gait belt; the resident never holds the aide's neck or shoulder.

For a resident with dysphagia, seat upright at 90 degrees or as high as tolerated, give small bites, allow time to swallow, and check for pocketed food after the meal.

Oral care for an unconscious resident is done in a side-lying position with suction available and no fluids or fingers placed in the mouth.

Lock bed wheels, lower the bed to a safe working height, and raise the head of the bed before placing a bedpan; a fracture pan is used when hip movement is restricted.

Typical adult ranges: oral temperature 97.6–99.6°F, radial pulse 60–100 beats per minute, respirations 12–20 per minute, blood pressure below 120/80 mmHg, SpO2 95–100%.

Count the radial pulse for 30 seconds and multiply by 2; if the rhythm is irregular, count a full 60 seconds and report the irregularity. Never use the thumb.

Count respirations without telling the resident, since awareness alters the rate; count 30 seconds and double, or a full minute if abnormal.

Blood pressure cuff: bladder width about 40% of arm circumference, lower edge 1 inch above the antecubital space, inflate 30 mmHg above the point where the pulse disappears.

An apical-radial pulse deficit is measured by two staff counting simultaneously for a full minute; the apical rate minus the radial rate is the deficit.

Hand hygiene: soap and water for at least 20 seconds, or alcohol-based rub for at least 15 seconds, before and after resident contact and after glove removal.

Standard precautions apply to every resident; gloves are worn for contact with blood, body fluids, mucous membranes, or broken skin, with gown, mask, and eyewear added if splashing is likely.

Temperature routes rank rectal highest and axillary lowest; axillary readings run roughly 1°F lower than oral, so the route is always documented with the value.

Urine is described by color, clarity, and odor; dark, cloudy, or foul-smelling urine and any output less than 30 mL per hour are reported to the nurse.

Restorative care aims to maintain function and independence, so the resident performs as much self-care as possible with the aide assisting only where needed.

Range of motion types: active (resident moves the joint alone), passive (aide moves the joint), and active-assistive (resident moves with some help).

Never force a joint past resistance or to the point of pain; support the limb above and below the joint being moved.

Cane rule: the cane is held on the strong side and advanced with the weak leg, then the strong leg steps forward.

Walker sequence: move the walker forward a short distance, step the weak leg into it, then bring the strong leg forward.

Contractures are prevented by positioning in body alignment, scheduled range-of-motion exercises, and applying splints or positioning devices exactly as ordered.

Bladder retraining uses scheduled toileting intervals, adequate fluids, praise for success, and a record of incontinent episodes for the nurse to review.

Encourage use of the call light and place items within reach to promote independence and reduce fall risk.

Report any decline in the resident's ability to perform an activity, since a change in function may signal a new medical problem.

Reality orientation uses calm, simple, repeated cues about person, place, and time, supported by clocks, calendars, and labeled belongings.

Validation responds to the feeling behind a dementia resident's statement instead of correcting the facts, then redirects gently to a safe activity.

With hearing impairment, face the resident, reduce background noise, speak clearly at a normal volume, and never shout into the ear.

With aphasia, use short sentences and yes-or-no questions, allow extra time to respond, and do not finish the resident's sentences unless asked.

Resident rights include privacy, dignity, confidentiality, choice, keeping personal belongings, receiving visitors, and refusing care.

Restraints require a provider order and the least restrictive device; monitor at least every 15 minutes and release, reposition, exercise, and check circulation at least every 2 hours.

Agitation or aggression is treated as communication of an unmet need such as pain, fear, hunger, or a full bladder; look for the cause and report it rather than arguing.

Grief stages described by Kubler-Ross are denial, anger, bargaining, depression, and acceptance; they are not sequential and residents may move back and forth.

Defense mechanisms such as denial, regression, and anger are coping responses; accept the feeling without taking it personally and report persistent distress.

The aide performs tasks delegated through the care plan and does not assess, teach, give medications, or perform sterile procedures.

Report all observations to the charge nurse or licensed nurse responsible for the resident; an aide never accepts orders directly from a physician or other provider.

Report immediately: falls, changes in condition, skin breakdown, refusal of care, abnormal vital signs, and complaints of pain.

Documentation is objective and timely, stating what was seen, heard, measured, and done; care that was not performed is never charted as done.

An incident report is completed for any accident or error and given to the charge nurse; the incident report itself is never mentioned in the resident's medical record.

HIPAA: resident information is shared only with staff involved in that resident's care and only in private areas, never in hallways, elevators, or with uninvolved family.

Nursing assistants are mandated reporters; suspected abuse, neglect, or misappropriation of property is reported immediately to the charge nurse and administrator.

The long-term care ombudsman advocates for residents and can be contacted privately by the resident; contact information must be posted where residents can see it.

Work practices that prevent injury: lock bed and wheelchair wheels, keep the bed at a safe working height, and never leave a resident unattended on a toilet or during a transfer.