Wisconsin CNA cheat sheet

Hearing loss usually affects high-pitched sounds first: face the resident, get their attention, speak at a normal-to-lower pitch, and avoid shouting or covering your mouth.

For a resident with aphasia, use short sentences, yes-or-no questions, gestures, and picture boards; allow extra time and never finish the resident's sentences for them.

With vision loss, announce yourself when entering, say when you are leaving, and describe food positions using the clock-face method (meat at 6 o'clock, potatoes at 3 o'clock).

A resident with a tracheostomy or on a ventilator cannot speak; provide a call light, paper and pen, or a communication board and allow time to respond.

For a confused resident, give one instruction at a time in short simple sentences and reorient gently to person, place, and time.

Report any change in a resident's physical or mental condition to the charge nurse promptly; assessment and clinical judgment are outside the aide's scope.

Active listening includes sitting at eye level, facing the resident, nodding, and restating the message back; it does not include arguing, changing the subject, or false reassurance.

Share resident information only with the care team who needs it; do not discuss residents in hallways, elevators, dining rooms, or on social media.

Hand hygiene is the single most effective way to prevent infection: soap and water for at least 20 seconds, or an alcohol-based rub when hands are not visibly soiled.

Use soap and water, not alcohol rub, when hands are visibly soiled and after contact with a resident who has C. difficile or norovirus, because alcohol does not kill those organisms.

Standard precautions apply to every resident regardless of diagnosis: hand hygiene plus gloves, gown, mask, and eye protection based on the task and expected exposure to blood or body fluids.

Gloves never replace hand hygiene; remove gloves and perform hand hygiene between residents and when moving from a soiled task to a clean task on the same resident.

Order of PPE removal: gloves first, then goggles or face shield, then gown, then mask last by the ties; perform hand hygiene immediately afterward.

Contact precautions (gown and gloves) for MRSA and C. difficile; droplet precautions (mask) for influenza; airborne precautions (N95 respirator, negative-pressure room) for tuberculosis.

Do not share personal items such as razors, toothbrushes, combs, or washcloths; hold soiled linen away from your uniform and never place it on the floor.

When a sterile field is set up, only objects that touch the field must be sterile; never turn away from the field or reach across it.

Fire response is RACE: Rescue anyone in immediate danger, Alarm (activate the alarm), Contain the fire by closing doors, and Extinguish or Evacuate per facility policy.

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

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

Never leave a resident alone in a bathtub, on a shower chair, or on a toilet; remain within arm's reach at all times during bathing and toileting.

Seizure care: protect the head, move hard objects away, loosen tight clothing at the neck, do not restrain or put anything in the mouth, and turn the resident to the side after the seizure ends.

Choking in a conscious adult is treated with abdominal thrusts; if the resident becomes unconscious, lower them to the floor, call for help, and begin emergency response per training.

If a resident falls or is found on the floor, do not move them; check for injury, stay with them, and call for the nurse immediately.

Restraints require a physician's order, are used only after less restrictive options fail, and require release, repositioning, and circulation checks on a scheduled basis (at least every 2 hours for non-violent restraints; every 15 minutes for violent or self-destructive restraints).

Residents have the right to dignity, privacy, respect, freedom from abuse and neglect, and the right to refuse any treatment or care.

When a resident refuses care, honor the refusal without arguing or forcing, document it, and notify the nurse so the reason can be followed up.

Privacy practices: knock before entering, close the door and pull the curtain, keep the resident covered during care, and do not discuss care in public areas.

Residents may receive visitors, send and receive mail unopened, use the telephone in private, and keep personal possessions; the aide must not open or read resident mail.

Offer choices (clothing, food, activity, bath time) to promote independence and self-determination; do not do tasks for the resident that they can do themselves.

Federal and Wisconsin law require immediate reporting of suspected abuse, neglect, or misappropriation of resident property to the charge nurse and administrator; good-faith reporters are protected.

The Wisconsin Board on Aging and Long Term Care Long-Term Care Ombudsman advocates for residents, receives complaints, and helps resolve concerns without retaliation against the resident.

Residents may form and join resident councils and voice grievances without fear of retaliation or interference with care.

Normal adult ranges: oral temperature 97.6–99.6 °F, pulse 60–100 beats per minute, respirations 12–20 per minute, blood pressure under 120/80 mmHg, and oxygen saturation 95% or higher.

Count the radial pulse for 30 seconds and multiply by 2; count a full 60 seconds if the rhythm is irregular, and never use your thumb to feel the pulse.

Blood pressure cuff bladder should wrap around about 40% of the arm circumference; the arm must be supported at heart level, and avoid an arm with an IV, dialysis fistula, or lymphedema.

Wash from cleanest to dirtiest: eyes first (inner to outer corner, separate corner of the cloth for each eye), then face, neck, arms, chest, abdomen, legs, back, and perineum last.

Provide oral care every shift, including denture care; for an unconscious resident, turn the head to the side and use suction to prevent aspiration.

Turn and reposition an immobile resident at least every 2 hours and whenever moisture or discomfort occurs; inspect bony prominences with each turn.

Intake and output conversions: 1 ounce = 30 mL, 1 cup = 240 mL; report urine output of less than 30 mL per hour to the nurse.

Stage 1 pressure injury is intact skin with a localized area of non-blanchable redness over a bony prominence; relieve pressure and report it, and do not massage the reddened area.

Range of motion: move the joint slowly, support the limb above and below, and never force a joint past resistance or to the point of pain.

Sudden behavior changes such as new withdrawal, agitation, or refusal to eat may signal pain, infection, medication effects, or depression; report observations to the nurse.

Signs of depression include persistent sadness, loss of interest, appetite or sleep changes, hopelessness, and withdrawal lasting two weeks or more.

With an angry or agitated resident, stay calm, lower your voice, acknowledge the feeling without arguing, offer simple choices, and ensure the safety of the resident and others.

Any statement about suicide or self-harm must be reported to the nurse immediately; stay with the resident if there is immediate risk and never promise to keep it secret.

Grief is not a fixed sequence of stages; allow the resident to talk, listen without judgment, and do not impose your own religious or personal beliefs.

Encourage social contact, group activities, and hobbies to reduce isolation, but respect a resident's right to decline.

Sexual expression between consenting adults is a resident right; report concerns about coercion, non-consent, or unsafe situations to the nurse.

Dementia is a progressive, irreversible decline in cognition; Alzheimer's disease is the most common cause, with memory loss typically appearing first.

Do not argue with or correct a resident who has dementia; respond to the feeling behind the statement (validation) and redirect to a safe activity.

Approach from the front and at eye level, identify yourself, use the resident's name, and keep one caregiver consistent when possible to reduce fear.

Sundowning is increased confusion or agitation in late afternoon or evening; reduce noise and stimulation, keep routines, use night lights, and limit caffeine.

For wandering, do not restrain; redirect to a safe walking path, provide purposeful activity, monitor exits per facility policy, and report new or increased wandering.

Support memory with a visible clock and calendar, labeled drawers, and a consistent daily routine and environment.

At meals, offer one food item at a time, use finger foods, cue and demonstrate, and check the cheeks for pocketed food after eating.

New agitation in a resident with dementia is often pain, constipation, or infection; report it rather than assuming it is the disease progressing.

Restorative care helps the resident regain or maintain function lost to illness or disuse by encouraging self-care, exercise, and mobility rather than doing tasks for them.

Use a gait belt around the waist for transfers and ambulation; stand on the resident's weaker side and walk slightly behind and to that side.

If a resident's knee buckles during walking, block the weak knee with your own knee and lower the resident safely to a chair or the floor.

Active range of motion is performed by the resident; passive range of motion is performed by the aide when the resident cannot move the joint; stop at the point of pain or resistance.

Apply splints and braces as ordered, check the skin underneath at each shift, and remove them for skin care only as directed by the care plan.

Encourage the resident to hold a cane in the hand opposite the weaker leg and to advance the cane with the weaker leg for a wider base of support.

Bowel and bladder training uses scheduled toileting, adequate fluids, and a prompt response to the call light; report accidents without scolding.

The nurse aide performs only tasks delegated by the licensed nurse that fall within state-approved training and demonstrated competence; the aide does not assess, diagnose, or give medications unless certified as a medication aide.

An aide may and should refuse a task that is unsafe or outside their training, and must report the refusal and the reason to the supervising nurse.

Abuse is intentional harm (physical, verbal, sexual, financial, or involuntary seclusion); neglect is failure to provide needed care; negligence is failure to give the care a reasonable aide would give.

Involuntary seclusion, restraining, or confining a resident without justification can constitute false imprisonment and is a reportable violation.

OBRA requires at least 12 hours of in-service education per year for nurse aides to maintain active certification on the Wisconsin Nurse Aide Registry.

Documentation must be objective, factual, timely, and signed; correct errors with a single line, your initials, and the date rather than erasing or using correction fluid.

Resident health information is protected by HIPAA; share it only on a need-to-know basis with the care team and report any breach.

Do not accept money, gifts, or bequests from residents or families, and do not act as a witness to a resident's will; report any such offer to the supervisor.