Wyoming CNA cheat sheet

OBRA 1987 guarantees residents the right to be informed of and to participate in their own care plan, and to refuse any treatment or medication.

The right to privacy covers curtains and doors during care, confidentiality of records under HIPAA, and private telephone calls and mail.

Residents must be free of physical and chemical restraints used for convenience or discipline; any restraint requires a physician's order, the least restrictive option, and frequent monitoring.

Grievances may be filed without fear of retaliation; residents may contact the state long-term care ombudsman.

Independence rule: the CNA lets the resident do every part of an ADL the resident can do safely and assists only with the parts that cannot be done.

Residents choose their own schedule, clothing, activities, and possessions, and must be given a locked space for personal funds on request.

Suspected abuse, neglect, or misappropriation of property is reported immediately to the charge nurse and per Wyoming law; failure to report is itself a violation.

A refused task is documented factually and reported to the nurse; care is never forced and refusal is never punished.

RACE: Rescue anyone in immediate danger, Alarm, Contain the fire by closing doors, Extinguish or Evacuate. Elevators are never used during a fire.

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

Adult CPR: 30 compressions to 2 breaths, 100-120 compressions per minute, depth of at least 2 inches, with full chest recoil between compressions.

Fall-prevention setup: bed in lowest position, wheels locked, call light within reach, non-skid footwear, clear path, personal items within reach.

Seizure: ease the resident to the floor, protect the head, put nothing in the mouth, do not restrain, time the event, turn to the side afterward, and report a seizure lasting over 5 minutes as an emergency.

Choking: encourage coughing while air is still moving; if the airway is blocked in a conscious adult, give abdominal thrusts and call for help.

Restraint monitoring: check circulation, skin, and comfort every 15 minutes; release, reposition, and offer fluids and toileting every 2 hours.

Suspected fracture, head injury, or spinal injury after a fall: do not move the resident, stay with the resident, and summon the nurse.

An incident report is completed for every fall, error, or injury, states facts only, and is not filed in the medical record.

Chain of infection: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host. Hand hygiene breaks the transmission link most often.

Wash with soap and water for at least 20 seconds when hands are visibly soiled, before eating, after toileting, and after caring for a resident with C. difficile.

Alcohol-based hand rub is used for routine decontamination when hands are not visibly soiled; it does not remove C. difficile spores.

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

PPE donning order: gown, mask, goggles, gloves. Removal order: gloves, goggles, gown, mask, then hand hygiene.

Contact precautions require gown and gloves; droplet precautions require a mask; airborne precautions require a fit-tested N95 and a negative-pressure room.

Sharps go into rigid puncture-resistant containers at the point of use; needles are never recapped, bent, or broken by hand.

Blood spills are cleaned with an EPA-registered disinfectant or 1:10 bleach; soiled linen is bagged at the bedside and never held against the body or set on the floor.

Needlestick or body-fluid exposure: wash with soap and water, report immediately, and follow the facility post-exposure protocol.

Bath water is about 105°F (40.5°C); test with a thermometer or the inner wrist, and never leave a resident unattended in the tub or shower.

Wash eyes from the inner canthus outward with a clean corner of the cloth; wash the perineum front to back with one stroke per cloth.

Provide privacy by closing the door or curtain, draping the resident, exposing only the body part being washed, and keeping the resident warm.

Oral care at least twice daily; remove dentures, clean over a towel-lined or water-filled sink, and store them in a labeled cup of water, never hot water.

Nail care: cut straight across. Do not cut the nails of a resident with diabetes or peripheral vascular disease unless the nurse authorizes it.

Use an electric razor for residents on anticoagulants or with bleeding disorders, and shave in the direction of hair growth.

A back massage of 3-5 minutes with lotion promotes circulation and comfort; avoid reddened, broken, or painful skin.

Report skin changes immediately: redness that does not blanch, pallor, cyanosis, bruising, tears, or moisture between skin folds.

Normal adult ranges: oral temperature 97.6-99.6°F (36.5-37.5°C), pulse 60-100 beats/min, respirations 12-20/min, blood pressure under 120/80 mmHg, SpO2 95-100%.

Count respirations without telling the resident, keeping fingers on the wrist as if still counting the pulse; count 30 seconds and double, or a full minute if irregular.

Radial pulse is counted with two fingertips for 30 seconds and doubled; an apical pulse is counted with a stethoscope at the fifth intercostal space for a full minute.

Wait 15 minutes after hot or cold drinks or smoking before an oral temperature; rectal temperatures are avoided with diarrhea or rectal surgery.

BP cuff bladder width is about 40% of arm circumference; the arm is supported at heart level, and BP is not taken on an arm with an IV, dialysis fistula, or on the mastectomy side.

Pulse deficit = apical rate minus radial rate, reflecting beats that do not produce a peripheral pulse.

Weight is measured at the same time of day, on the same scale, with similar clothing; a rapid gain or loss is reported.

Any vital sign outside the normal range is reported to the nurse immediately and documented with time, site, and route.

Usual adult fluid need is about 1500-2000 mL per day unless a restriction is ordered; intake and output are recorded in milliliters.

Dysphagia feeding: sit upright at 90 degrees, chin tucked, small bites, full chewing time, liquids thickened per order, and check the cheek for pocketing.

Aspiration signs during or after a meal: coughing, choking, wet or gurgling voice, tearing eyes, dyspnea, and later fever. Stop feeding and report.

NPO means nothing by mouth, including ice chips and sips of water; provide mouth care and keep the call light within reach.

Document the percent of food eaten (25%, 50%, 75%, 100%) and the amount of fluid taken.

Report urine output under 30 mL per hour, total output under 300 mL in 8 hours, or no bowel movement in 3 days.

Therapeutic diets include low-sodium, diabetic, low-fat, mechanical soft, pureed, and liquid diets; a CNA never adds or substitutes food items on a restricted diet.

Mealtime setup: glasses and dentures in place, containers opened, food positions described in clock terms for visually impaired residents, and the resident seated upright.

Offer toileting every 2 hours, before and after meals, and at bedtime; a consistent schedule is the basis of bladder and bowel retraining.

Bedpan: warm with water, raise the head of the bed, place the wider end under the buttocks, provide privacy, and stay nearby.

A fracture pan is used for residents with hip or pelvic restrictions; a urinal is used for male residents who can stand or sit safely.

Normal urine is clear to pale yellow; report cloudy, dark, blood-tinged, sediment-filled, or foul-smelling urine.

Incontinence care: cleanse front to back, change promptly, and apply a moisture barrier to protect the skin.

Catheter care: keep the bag below bladder level and off the floor, avoid kinks and loops, and provide daily perineal care.

Constipation prevention: fluids, fiber, and activity; report abdominal pain, distention, or no stool for 3 days.

Clean-catch midstream specimen: cleanse, void a small amount, collect the middle portion in a labeled container, note the time, and deliver promptly.

Reposition an immobile resident at least every 2 hours, using a 30-degree lateral tilt or pillows, and inspect the skin at each turn.

Body mechanics: feet shoulder-width apart, bend the knees not the back, keep the load close, tighten the abdominal muscles, and never twist while lifting.

Use a gait belt around the waist; never lift a resident by the underarms or by holding the arms.

Before a transfer: lock bed and wheelchair wheels, cross the resident's arms, place the wheelchair on the resident's strong side, and pivot toward the strong side.

When ambulating, stand on the resident's weak side and slightly behind, hold the gait belt, take short steps, and allow rest periods.

Log-rolling keeps the spine aligned for residents on spinal precautions; pillows support the back and are placed between the knees.

Restorative care: encourage the resident to perform as much self-care as possible and provide adaptive devices such as plate guards, long-handled sponges, and built-up utensils.

Orthostatic hypotension prevention: have the resident dangle the feet and rise slowly while watching for dizziness or pallor.

Speak at eye level, use the resident's preferred name, keep sentences short, and avoid medical jargon.

Aphasia: allow extra time, ask yes-or-no questions, use gestures or pictures, and never finish the resident's sentences.

Hearing loss: face the resident in good light, get attention first, lower the pitch of the voice rather than shouting, and reduce background noise.

HIPAA: resident information is shared only with the care team and only as needed; it is never discussed in hallways, elevators, or with visitors.

Documentation is objective and factual: record what was seen, said, and done, with measurements and times, never opinions or guesses.

Chart only care you personally gave, and chart it after it is done; use black ink, sign with name and title, and never use white-out.

Report a change in condition to the nurse promptly and document the time and content of that report.

Use a qualified interpreter for residents with limited English; family members, especially children, are not used to interpret medical information.

Dementia: validate the feeling and redirect to a pleasant activity rather than arguing about a confused statement.

Behavior is communication; check for pain, hunger, thirst, full bladder, constipation, noise, temperature, and fatigue before assuming behavior is random.

Offer simple choices between two options to preserve autonomy and reduce agitation.

Do not argue with delusions or hallucinations; acknowledge the feeling, reassure, and distract.

Wandering: ensure safety, do not restrain, alert the nurse, provide structured activity, and check whether the resident is seeking a bathroom or an exit.

Signs of depression such as withdrawal, poor appetite, sleep changes, and loss of interest are reported to the nurse and not dismissed as normal aging.

Any statement about self-harm or suicide is taken seriously: stay with the resident, notify the nurse immediately, and remove dangerous items.

Encourage social contact, activities, and family involvement, and respect the resident's religious and cultural practices.