West Virginia CNA cheat sheet

Communication loop: a sender encodes a message, a receiver decodes it, and feedback confirms whether the message was understood.

For a resident with aphasia: ask one question at a time, use yes/no questions, allow 10-30 seconds for a reply, and supplement with gestures or a picture board.

Hearing loss: stand in the resident's line of vision, get attention with a light touch, lower voice pitch instead of shouting, and reduce background noise.

Vision loss: announce yourself on entering, say when you are leaving, describe care before touching, and keep personal items in the same location each time.

Use the resident's preferred name and title; avoid childish terms such as 'honey' or 'dear' and avoid medical jargon.

Kubler-Ross grief stages in order: denial, anger, bargaining, depression, acceptance.

Dementia: give one-step directions in short sentences; do not argue with delusions or hallucinations, acknowledge the feeling and redirect.

When an interpreter is used, speak directly to the resident rather than the interpreter, and keep sentences short.

Hand hygiene is performed before and after every resident contact, before donning gloves, after glove removal, and between dirty and clean tasks; a soap-and-water scrub lasts 15-20 seconds.

Standard precautions apply to every resident regardless of diagnosis; all blood and body fluids are treated as potentially infectious.

Donning PPE order: gown, mask or respirator, goggles or face shield, gloves.

Removing PPE order: gloves first, then goggles, then gown, then mask, followed by hand hygiene.

Contact precautions (MRSA, C. difficile, scabies) require gown and gloves; droplet precautions (influenza) require a surgical mask; airborne precautions (tuberculosis) require a fit-tested N95.

Alcohol-based hand rub does not destroy C. difficile spores; soap and water handwashing is required.

Sterile field: the outer 1-inch border is not sterile, and ungloved hands never reach over or turn away from the field.

Never recap a used needle; drop sharps directly into a puncture-resistant sharps container.

Do not share razors, toothbrushes, or other personal items; clean shared equipment between residents.

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

Restraints require a physician's order; when in use, check circulation and position at least every 15 minutes and release and rotate at least every 2 hours per policy.

RACE for fire: Rescue anyone in danger, Alarm, Contain the fire by closing doors, Extinguish or Evacuate.

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

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

Adult CPR: compression rate 100-120 per minute with a depth of at least 2 inches; call for help and use an AED as soon as available.

Choking adult with severe airway obstruction: abdominal thrusts; if the resident becomes unresponsive, lower to the floor and begin CPR.

Stroke screening (FAST): Face droop, Arm weakness, Speech change, Time to call emergency services.

Burn first aid: cool running water for 10-20 minutes; never apply ice, butter, or ointment.

OBRA 1987 guarantees dignity, self-determination, privacy, confidentiality, choice, and freedom from abuse and unnecessary restraints.

A resident may refuse any treatment or care; the aide stops, informs the nurse, and documents the refusal without arguing or pressuring.

Care information is shared only with the care team on a need-to-know basis; discussing a resident in a hallway, elevator, or off duty violates confidentiality.

Residents may send and receive unopened mail, make private telephone calls, and receive visitors in a private area.

Residents keep personal possessions; the aide inventories and labels items and reports missing or damaged belongings.

Grievances may be filed without fear of retaliation; aides must not discourage complaints or retaliate for them.

Encourage independence by allowing the resident to perform as much self-care as possible, even when it takes longer.

Suspected abuse or neglect is reported immediately to the nurse or administrator according to facility policy and state law.

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

Radial pulse: count 30 seconds and multiply by two when regular; count a full minute when irregular.

Blood pressure cuff: center the artery marker over the brachial artery and place the lower edge 1 inch above the antecubital space.

Wait 15 minutes after a hot or cold drink or after smoking before an oral temperature; the oral route is unsafe for unconscious, confused, or seizure-prone residents.

Rectal temperature is avoided with diarrhea, rectal surgery, or rectal bleeding.

Perineal care: wash from front to back (urethra toward anus), using a clean area of the cloth for each stroke.

Turn and reposition at least every 2 hours, use a 30-degree lateral tilt, and keep heels floated off the mattress.

Range of motion: move the joint slowly only to the point of resistance; never force past pain.

Use an electric razor for residents on anticoagulants or with bleeding disorders; file rather than cut the nails of a resident with diabetes.

Dysphagia precautions: sit upright at 90 degrees, chin tuck, small bites, alternate bites with thickened liquids, and remain upright at least 30 minutes after eating.

Thickened liquids are given only at the ordered consistency (nectar, honey, pudding); never thin them.

Signs of aspiration: coughing or choking while eating, wet or gurgling voice, teary eyes, and food pocketed in the cheek.

Record intake as a percentage of what was served; report intake of 50% or less and any refusal of two or more consecutive meals.

Typical adult fluid goal is 1,500-2,000 mL per day unless a fluid restriction is ordered.

Dehydration signs: dark concentrated urine, dry mucous membranes, poor skin turgor, confusion, and low urine output.

Report a weight loss of 5% or more in one month or 10% or more in six months.

Never force food or fluids; document refusals and offer alternatives consistent with the resident's choice.

Keep the urinary drainage bag below the level of the bladder and off the floor, keep tubing free of kinks, and never pull on the catheter.

Empty the drainage bag when it is about half to two-thirds full, using a separate container for each resident.

Minimum adequate adult urine output is about 30 mL per hour; report lower output or no urine for 8 hours.

Bladder retraining: offer the bedpan or toilet at scheduled intervals, often every 2 hours, and gradually lengthen the interval.

Bowel retraining uses the gastrocolic reflex: schedule toileting 20-30 minutes after breakfast at the same time each day.

Constipation care within the care plan: increase fluids and fiber and encourage activity.

Incontinence care: change promptly, cleanse and dry the skin, apply a barrier product, and avoid harsh soaps.

For an ostomy, empty the pouch when it is one-third to one-half full and check that the skin barrier is sealed.

Restorative care: encourage the resident to use prescribed devices such as a gait belt, splints, or adaptive utensils and to perform as much self-care as possible.

Maslow's hierarchy from the base: physiological needs, safety, love and belonging, esteem, then self-actualization; lower needs are met first.

Delirium has a sudden onset, fluctuates through the day, and is often reversible (infection, medications, dehydration, pain); dementia is gradual and progressive.

Behavior is communication: check for pain, hunger, thirst, toileting, noise, and fear before addressing the behavior itself.

With hallucinations or delusions, neither argue nor pretend to agree; acknowledge the feeling and redirect to a real activity.

Depression signs to report: withdrawal, appetite change, sleep change, loss of interest, and statements of hopelessness.

Anxiety: stay calm, speak slowly, remain with the resident, and give simple reassurance rather than dismissing the fear.

Residents have the right to private visits and intimate expression that does not harm others.

Encourage social contact, hobbies, and religious practice; isolation increases confusion and functional decline.

Nurse aide scope: assist with activities of daily living and collect data; do not assess, teach, administer medications, perform sterile procedures, or give IV care.

Report changes and abnormal findings to the licensed nurse; the aide does not contact the physician or family directly unless directed.

Six categories of elder abuse: physical, sexual, emotional or verbal, financial, neglect, and involuntary seclusion.

Document objectively: record exactly what was seen and said, in the resident's own words and in quotation marks, without opinion or conclusion.

Informed consent is obtained by the physician or nurse; the aide never pressures a resident to sign.

Never accept money, gifts, or loans from residents or families, never witness a will, and never act as a resident's power of attorney.

Negligence is failure to meet the standard of care; malpractice is negligence by a professional acting in a professional capacity.

Advance directives such as a living will or durable power of attorney for health care express the resident's wishes and must be followed and kept in the record.

False imprisonment (restricting movement without justification), defamation (false statements), and invasion of privacy are legal risks in care.