- Standard Precautions
- Treat ALL blood and body fluids of EVERY resident as potentially infectious.
- NNAAP
- National Nurse Aide Assessment Program; NCSBN's nurse aide exam, administered by Credentia/Pearson VUE; the dominant national CNA exam.
- Two parts of the CNA exam
- Written (or Oral) Knowledge test AND a hands-on Skills Evaluation; must pass BOTH.
- Written exam — total questions
- 70 multiple-choice items.
- Written exam — scored vs pretest
- 60 scored + 10 unscored pretest items.
- Written exam — time limit
- 2 hours (120 minutes).
- Oral exam format
- 60 multiple-choice + 10 reading-comprehension (word recognition) items; 2 hours.
- Skills Evaluation — number of skills
- 5 skills total.
- Skills Evaluation — time limit
- 30 minutes (5-minute warning at 25 minutes).
- Skill always tested first
- Hand Hygiene (Handwashing).
- Skills Evaluation — always includes
- 1 measurement skill + handwashing + 3 random skills.
- Skills Evaluation — pass criteria
- Must pass 5 out of 5 skills.
- Critical Element Step
- A bolded step on the checklist; missing it = automatic fail of that skill.
- Measurement skills
- Blood pressure, radial pulse, respirations, urinary output, weight.
- OBRA '87
- Omnibus Budget Reconciliation Act of 1987; federal law requiring nurse aide training + competency testing + state registry.
- Federal minimum training hours
- 75 clock hours (including at least 16 hours of supervised practical/clinical training).
- Months before certification required
- A nurse aide cannot work more than 4 months in a certified facility without passing the competency evaluation.
- Nurse Aide Registry
- State list of CNAs who passed the competency evaluation; required to work.
- Certification renewal
- Generally every 2 years with evidence of paid nursing-related work.
- CNA testing vendors
- Credentia (NNAAP, most states) and Prometric (some states).
- Skills evaluation tolerance
- A measurement value must fall within the official tolerance of the evaluator's reading, or the skill fails.
- Verbalizing on the skills test
- Only LATER handwashing may be verbalized; every other step of every other skill must be physically performed.
- Attempts allowed
- Most states allow 3 attempts within a set window (often ~2 years) before retraining is required.
- NATCEP
- Nurse Aide Training and Competency Evaluation Program — the state-approved course (75+ hours) required before testing.
- Clinical training minimum
- At least 16 of the 75 federal training hours must be supervised practical (clinical) training before direct resident contact.
- Four main vital signs
- Temperature, Pulse, Respirations, Blood Pressure (plus pain, SpO2).
- Normal adult oral temperature
- 96–99°F (35.8–37.3°C).
- Normal axillary temperature
- 94.6–97.3°F (34.8–36.3°C); lowest reading route.
- Normal rectal temperature
- 98.2–100.7°F (36.8–38.2°C); most accurate, highest reading.
- Normal tympanic temperature
- 96.9–100.2°F (36.1–37.9°C).
- Normal temporal temperature
- 95.3–98°F (35.2–36.7°C).
- Fever / report temperature
- Report temperature greater than 100.4°F (38°C).
- Normal adult pulse (heart rate)
- 60–100 beats per minute.
- Report pulse if
- Less than 60 (bradycardia) or greater than 100 (tachycardia).
- Radial pulse site
- Thumb side of the wrist; count for 1 full minute.
- Apical pulse
- Heart pulse heard with stethoscope at the apex; counted for 1 full minute.
- Normal adult respirations
- 10–20 breaths per minute (some refs 12–20).
- Report respirations if
- Less than 10 or greater than 20.
- Counting respirations tip
- Count without telling the resident (so they breathe naturally); 1 full breath = inhale + exhale.
- Normal blood pressure
- Systolic 91–129 / diastolic 61–89 mmHg.
- Hypertension
- Systolic ≥130 OR diastolic ≥90 mmHg.
- Systolic
- Top number; pressure when the heart contracts.
- Diastolic
- Bottom number; pressure when the heart rests.
- Hypotension
- Abnormally low blood pressure.
- Orthostatic hypotension
- BP drop on standing; dizziness/fall risk.
- Normal SpO2 (oxygen saturation)
- 95–100%; report below 90% (supplemental reference).
- Pulse oximeter
- Device measuring oxygen saturation, usually on a fingertip.
- Pain scale
- Usually 0–10 (0 = no pain, 10 = worst); report pain to the nurse.
- BP cuff placement
- Snug, 1 inch above the elbow, bladder over the brachial artery; arm at heart level.
- Single most important infection-control measure
- Hand hygiene (handwashing).
- Handwashing lather time
- At least 20 seconds with friction.
- Handwashing hand position
- Keep fingertips DOWN and hands LOWER than elbows.
- Handwashing faucet
- Turn off with a clean paper towel (or knee/foot control); never with bare hands.
- Handwashing sink rule
- Never touch the inside of the sink.
- When to wash hands
- Before and after every resident contact, before/after gloves, after toileting, before food.
- PPE
- Personal Protective Equipment: gown, mask, goggles/face shield, gloves.
- PPE donning (putting on) order
- Gown → Mask → Goggles → Gloves.
- PPE removal (doffing) order
- Gloves → Goggles → Gown → Mask (gloves first because dirtiest).
- Clean vs dirty
- Always work from cleanest area to dirtiest.
- Contact precautions
- For organisms spread by touch (e.g., MRSA, C. diff); gown + gloves.
- Droplet precautions
- For organisms in respiratory droplets (e.g., flu); mask.
- Airborne precautions
- For tiny airborne particles (e.g., TB); N95 respirator + negative-pressure room.
- Nosocomial / HAI
- Healthcare-associated infection (acquired in the facility).
- Medical asepsis
- Clean technique to reduce spread of microbes.
- Sterile (surgical asepsis)
- Free of all microbes; outside the CNA scope.
- Biohazard / sharps disposal
- Contaminated items into labeled biohazard/sharps containers.
- Chain of infection
- Agent → reservoir → portal of exit → mode of transmission → portal of entry → susceptible host.
- Body mechanics
- Bend the knees (not the back), wide base of support, lift with legs, hold load close, never twist.
- Lifting rule
- Never lift alone if unsafe; use a gait/transfer belt or get help/mechanical lift.
- Transfer/gait belt
- Belt around the resident's waist over clothing to assist standing/transfer/ambulation.
- Fall prevention
- Call light in reach, bed in LOW position, non-skid footwear, clear pathways, lock wheels.
- Call light/signaling device
- Always place within the resident's reach before leaving.
- Bed position when leaving
- Lowest position, wheels locked.
- Cane placement
- Hold cane on the STRONG (unaffected) side.
- Choking response
- Abdominal thrusts (Heimlich maneuver) for a conscious choking adult.
- Fire safety — RACE
- Rescue, Alarm, Confine, Extinguish.
- Fire extinguisher — PASS
- Pull, Aim, Squeeze, Sweep.
- Restraint
- Any device limiting movement; last resort, requires a doctor's order, never for staff convenience.
- Restraint monitoring
- Check frequently (commonly q15–30 min) and release/reposition (commonly q2h).
- Scald prevention
- Test water temperature; protect residents with reduced sensation.
- Oxygen safety
- No smoking/open flames near oxygen.
- Objective data (signs)
- Measurable/observable (e.g., BP 150/95, redness).
- Subjective data (symptoms)
- What the resident reports (e.g., "I feel dizzy").
- CNA's core duty
- Observe, record, and REPORT changes to the nurse.
- Report immediately
- Sudden change in condition, abnormal vitals, chest pain, difficulty breathing, fall, skin breakdown, bleeding.
- CNA scope — charting
- Document only care actually performed; never chart ahead or what wasn't done.
- CNA does NOT
- Diagnose, assess (nursing assessment), prescribe, or give medications (unless a certified med aide).
- Intake and output (I&O)
- Tracking all fluids in and out; recorded in mL/cc.
- Pressure injury (bedsore) signs
- Redness over bony areas, broken skin; report and reposition q2h.
- Handwashing critical steps
- 20+ seconds of friction, fingertips down/hands below elbows, paper towel to turn off faucet, never touch the inside of the sink.
- C. difficile precautions
- Contact precautions PLUS soap-and-water handwashing — alcohol gel does NOT kill C. diff spores.
- TB, measles, chickenpox precautions
- Airborne precautions — N95 respirator and a negative-pressure room.
- Influenza precautions
- Droplet precautions — a surgical mask.
- Reposition immobile resident
- At least every 2 hours to prevent pressure injuries (bedsores).
- Bony prominences
- Sacrum, hips, heels, and elbows — common pressure-injury sites to inspect.
- Counting respirations
- Count for a full minute without telling the resident; one rise + fall = one breath.
- Counting a pulse
- Count the radial or apical pulse for a full minute; note rate, rhythm, and force.
- Rectal vs axillary temperature
- Rectal reads highest and is most accurate; axillary (armpit) reads lowest and is least accurate.
- Heimlich maneuver
- Abdominal thrusts for a CONSCIOUS choking adult who cannot speak, cough, or breathe.
- If a resident can cough or speak while choking
- Encourage coughing — do not interfere.
- ADLs
- Activities of Daily Living: bathing, dressing, grooming, toileting, eating, mobility/transferring.
- Dressing rule (weak/affected arm)
- Dress the weak/affected side FIRST; undress the strong side first.
- Feeding position
- Sit resident upright at 90° (Fowler's) to prevent aspiration/choking.
- Dysphagia
- Difficulty swallowing; use thickened liquids, small bites, allow time, sit upright.
- Aspiration
- Inhaling food/fluid into the lungs; major choking/pneumonia risk during feeding.
- Feeding pace
- Feed slowly, offer small amounts, alternate food and liquids, let resident chew/swallow.
- NPO
- Nothing by mouth (Latin nil per os).
- Perineal care direction (female)
- Always wipe front to back (clean to dirty) to prevent UTI.
- Mouth care for unconscious resident
- Turn head to the side to prevent aspiration.
- Denture care
- Line sink with towel + water to prevent breakage; use cool/tepid water; store in cool water.
- Bathing water temperature
- Comfortably warm (about 105°F / 40.5°C); always test before use; check for skin breakdown.
- Eye care during bath
- Wash eye from inner canthus to outer canthus; use clean area of cloth for each eye.
- Bed bath wash order
- Clean to dirty; face first, perineal area last.
- Incontinence
- Inability to control bladder or bowel; provide prompt peri-care to protect skin.
- Elimination dignity
- Provide privacy, knock, cover resident, allow time.
- Output recording
- Measure urine at eye level on a flat surface; record in mL/cc.
- Rest/sleep/comfort
- Reduce noise/light, position comfortably, manage pain reports to nurse.
- Safe bath water temperature
- About 105°F (40.5°C); always test it before bathing to prevent scalds.
- Position after a meal
- Keep the resident upright for 30–60 minutes after eating to prevent aspiration.
- Eye care during a bath
- Wipe from the inner corner to the outer corner, using a clean part of the cloth for each eye.
- Catheter drainage bag
- Keep it below the level of the bladder, off the floor, with no kinks in the tubing.
- Diabetic nail care
- CNAs do NOT cut the nails of diabetic residents — report the need to the nurse.
- Denture water temperature
- Use cool or tepid water (hot water warps dentures); line the sink to prevent breakage.
- Foot care and lotion
- Dry thoroughly between the toes; apply lotion everywhere EXCEPT between the toes.
- Restorative care
- Helping residents regain/maintain function and independence to their ability.
- Promote independence
- Let residents do what they can themselves; assist, don't take over.
- Range of motion (ROM)
- Moving joints through their full movement to prevent stiffness/contractures.
- Active ROM (AROM)
- Resident performs the movements themselves.
- Passive ROM (PROM)
- CNA moves the joint for the resident.
- ROM rule
- Support the joint above and below; move slowly to the point of resistance, NOT pain; never force.
- Contracture
- Permanent shortening/tightening of a muscle/joint from disuse; prevented by ROM.
- Atrophy
- Muscle wasting from disuse.
- Ambulation
- Walking; assist with gait belt and proper footwear.
- Assistive devices
- Cane, walker, gait belt, wheelchair; promote safe mobility.
- Prosthesis
- Artificial body part (e.g., limb); care for skin and device.
- Orthotic / orthosis
- Brace/splint supporting a body part.
- Bowel and bladder training
- Scheduled toileting to restore continence.
- Abduction / adduction
- Move away from / toward the midline of the body.
- Flexion / extension
- Bending / straightening a joint.
- Active vs passive ROM
- Active ROM = the resident moves themselves (preferred); passive ROM = the CNA moves the joint.
- ROM repetitions
- Repeat each movement the number of times in the care plan (commonly ~3–5); exercise both sides.
- Walker use
- Move the walker forward, then step into it; all four tips on the ground before stepping; never on stairs.
- If a resident starts to fall
- Ease them to the floor while protecting the head — do not try to hold them upright.
- Walking with a resident
- Use a gait belt and walk slightly behind and to the weaker side, ready to support.
- Maslow's hierarchy of needs
- Physiological → Safety → Love/Belonging → Esteem → Self-actualization.
- Physiological needs (Maslow)
- Most basic: food, water, oxygen, elimination, sleep — met first.
- Defense mechanism
- Unconscious way of coping with stress (denial, projection, regression, rationalization, displacement).
- Denial
- Refusing to accept reality.
- Regression
- Reverting to earlier/childlike behavior under stress.
- Five stages of grief (Kübler-Ross)
- Denial, Anger, Bargaining, Depression, Acceptance.
- Hospice care
- Comfort/palliative care for the terminally ill (focus on quality, not cure).
- Palliative care
- Care focused on comfort and symptom relief.
- Signs of approaching death
- Decreased responsiveness, irregular/slowed breathing, cool/mottled skin, loss of bladder/bowel control.
- Postmortem care
- Care of the body after death with dignity and respect.
- Dementia
- Progressive loss of cognitive function (memory, reasoning).
- Alzheimer's disease
- Most common type of dementia.
- Sundowning
- Increased confusion/agitation in the late afternoon/evening.
- Wandering
- Aimless walking; ensure safety, do not restrain.
- Managing agitation
- Stay calm, reassure, redirect, avoid arguing, reduce stimulation.
- Self-esteem support
- Encourage choices, independence, grooming, and dignity.
- Sundowning management
- Increase evening light, reduce noise/clutter, limit caffeine, keep evenings calm.
- Approaching a dementia resident
- Approach from the front at eye level, identify yourself, smile, and use a calm low voice.
- Suicide or self-harm statement
- Report to the nurse IMMEDIATELY — never keep it confidential or handle it alone.
- Cheyne-Stokes respirations
- Cycles of fast and slow breathing with pauses, a sign that death is approaching.
- Last sense lost when dying
- Hearing is believed to be the last sense lost — keep speaking gently and reassuringly.
- Validation vs reorientation
- With a firmly confused resident, validate feelings and redirect — do not argue or reorient.
- Cultural competence
- Respecting each resident's beliefs, values, and practices.
- Dietary restrictions
- Honor religious/cultural diets (kosher, halal, vegetarian).
- Spiritual support
- Arrange clergy/services per resident's wishes; provide privacy; do not impose your beliefs.
- Personal space/eye contact
- Vary by culture; observe and respect resident preferences.
- Modesty
- Provide privacy and gender-appropriate care per resident's cultural/religious needs.
- Religious items
- Handle rosaries, prayer beads, and holy books with care and respect; never discard or move them.
- Kosher / halal diets
- Honor religious diets per the care plan; never serve a forbidden food.
- Consensual intimacy between residents
- Provide privacy and leave; it is a privacy matter, not a behavior to report or stop.
- Verbal communication
- Spoken/written words.
- Nonverbal communication
- Body language, facial expression, tone, touch, gestures.
- Therapeutic communication
- Supportive techniques: active listening, open-ended questions, silence, clarifying.
- Open-ended question
- Cannot be answered with yes/no; encourages the resident to share.
- Communicating with hearing impairment
- Face the resident, speak clearly at normal/slightly lower pitch, reduce background noise.
- Communicating with vision impairment
- Announce your presence, describe surroundings, explain before touching.
- Aphasia
- Loss of ability to speak/understand language; use yes/no questions, allow time, communication boards.
- Communicating with dementia
- Simple short instructions, calm tone, approach from the front, redirect, validate.
- Reporting vs recording
- Reporting = telling the nurse verbally; Recording = documenting in the chart.
- Active listening
- Face the resident, sit at eye level, give full attention, allow silence, and reflect what you heard.
- Elderspeak
- Talking down or baby talk to an older adult; a communication barrier to avoid.
- False reassurance
- Saying 'you'll be fine' dismisses feelings; a barrier to therapeutic communication.
- Charting rule
- Document objectively and factually, AFTER care is given — never chart ahead or what you didn't do.
- Residents' Rights source
- Federal Nursing Home Reform Act / OBRA '87 (42 CFR 483).
- Right to privacy & confidentiality
- Personal and medical information is protected.
- Right to make personal choices
- Choose schedule, clothing, activities, food when possible.
- Right to voice grievances
- Complain without fear of retaliation.
- Right to be free from abuse/neglect
- Protected from physical, verbal, sexual, financial abuse and neglect.
- Right to be free from restraints
- No unnecessary physical/chemical restraints.
- Right to dignity & respect
- Treated with dignity; privacy during care.
- Right to refuse treatment
- Resident may refuse care.
- Right to manage finances / keep possessions
- Security of personal money and belongings.
- Right to participate in groups
- Resident and family councils.
- HIPAA
- Law protecting private health information (PHI); share only on need-to-know basis.
- Involuntary seclusion
- Separating a resident against their will; a form of abuse.
- Right to refuse care
- A competent resident may refuse any care or treatment; report the refusal to the nurse, never force it.
- Privacy during care
- Knock and wait, close doors/curtains, drape the resident, and expose only the area being cared for.
- Misappropriation of property
- The official term for stealing or misusing a resident's belongings — a form of abuse.
- Reporting suspected abuse
- Report a SUSPICION immediately to the nurse; you do not need proof and do not investigate yourself.
- Resident finances
- Residents have the right to manage their own money or designate someone, with access to records.
- Abuse
- Intentional infliction of harm (physical, verbal/psychological, sexual, financial).
- Neglect
- Failure to provide needed care/services.
- Mandated reporter
- CNAs MUST report suspected abuse/neglect immediately to the nurse/supervisor.
- Negligence
- Failure to provide the expected standard of care, causing harm.
- Malpractice
- Negligence by a professional.
- Assault
- Threatening to touch/harm someone without consent.
- Battery
- Touching someone without their consent.
- False imprisonment
- Restraining or confining a resident improperly.
- Defamation
- Harming reputation by false statements (libel = written, slander = spoken).
- Invasion of privacy
- Exposing a resident or sharing their information improperly.
- Informed consent
- Resident agrees to care after understanding it.
- Advance directive
- Legal document stating care wishes (living will, DPOA for health care).
- DNR / DNAR
- Do Not Resuscitate order; no CPR.
- Living will
- Document stating wishes for end-of-life treatment.
- Durable power of attorney for health care
- Person authorized to make health decisions if resident cannot.
- Restraint order
- Requires a physician's order; never for convenience or punishment; least-restrictive.
- Ethics
- Standards of right conduct (honesty, accountability, respect).
- Accountability
- Taking responsibility for one's actions.
- Restraint requirements
- Requires a physician's order, is a last resort and least restrictive, never for convenience or punishment.
- Slander vs libel
- Defamation: slander is spoken, libel is written.
- Falsifying records
- Never falsify documentation or chart care you did not perform — it is fraud and unethical.
- Chain of command
- CNA → LPN/LVN → RN → physician/DON.
- CNA supervision
- CNAs work UNDER a licensed nurse (RN or LPN/LVN).
- Scope of practice
- The tasks a CNA is legally permitted and trained to perform.
- Delegation
- A nurse assigns a task; CNA accepts only if within scope, trained, and safe — may refuse unsafe/out-of-scope tasks.
- The nursing process
- Assessment, Diagnosis, Planning, Implementation, Evaluation (CNAs assist with implementation and report data only).
- Care plan
- Individualized plan of care; the CNA must follow it.
- Interdisciplinary team
- RN/LPN, physician, PT, OT, SLP, dietitian, social worker, activities staff.
- PT (physical therapist)
- Restores mobility/strength.
- OT (occupational therapist)
- Helps with ADLs/daily function.
- SLP (speech-language pathologist)
- Treats speech/swallowing problems.
- Dietitian
- Plans nutrition and special diets.
- Incident report
- Documentation of an accident/unusual event (e.g., a fall).
- Professionalism
- Punctuality, reliability, appearance, ethics, teamwork, respect.
- DON
- Director of Nursing.
- MDS
- Minimum Data Set; standardized resident assessment in nursing homes.
- ADPIE
- The nursing process: Assessment, Diagnosis, Planning, Implementation, Evaluation — only the nurse assesses, diagnoses, plans, evaluates.
- Occupational therapist (OT)
- Restores ADL skills (dressing, eating, grooming) and fine motor function.
- Physical therapist (PT)
- Restores mobility, strength, balance, gait, and transfers.
- Speech-language pathologist (SLP)
- Treats speech, language, communication, and swallowing (dysphagia) problems.
- Social worker (MSW)
- Addresses emotional, social, financial, and discharge-planning needs.
- Five Rights of Delegation
- Right task, right circumstance, right person, right direction/communication, right supervision.
- After a resident falls
- Keep the resident safe, do NOT move them if injury is suspected, and report to the nurse immediately.