CNA Study Guide

📜 Scope of Practice

• CNAs assist with ADLs (Activities of Daily Living): bathing, dressing, grooming, eating, toileting, ambulating.
• CNAs observe and report changes in resident condition to the nurse — they do NOT diagnose or prescribe.
• Never perform tasks outside your scope — examples include administering medications, inserting catheters, or changing sterile wound dressings (these belong to licensed nurses).
• Delegated tasks: A nurse may delegate tasks to a CNA only if the task is within the CNA's training, it is appropriate for the resident, and the nurse is available for supervision.
• Refusal of inappropriate tasks: You have the right and duty to refuse tasks outside your scope.

⚖️ Legal & Ethical Concepts

🏛️ Residents' Rights (OBRA Guaranteed)

🚨 Abuse: Types, Signs & Reporting

🌟 Professional Behavior Standards

• Confidentiality: Never discuss residents in hallways, elevators, or public spaces. Never post on social media.
• Professionalism: Arrive on time, maintain proper appearance, call if absent.
• Ethics: Treat all residents equally regardless of diagnosis, culture, religion, or behavior.
• Boundaries: Do not accept gifts, do not develop personal relationships with residents outside of work.
• Self-care: Report your own illness to the nurse and stay home if contagious.

🗣️ Types of Communication

📋 Observation vs. Inference

🔠 SBAR Communication Tool

• S
  Situation: State what is happening now. "Mrs. Jones is complaining of chest pain."
• B
  Background: Relevant history. "She has a history of hypertension, last BP 130/82."
• A
  Assessment: What you think is happening. "She appears pale and is diaphoretic."
• R
  Recommendation: What you need. "I believe she needs to be seen immediately."

📄 Documentation Rules

• Use blue or black ink for handwritten records (no pencil).
• Never erase or use white-out — draw a single line through errors and initial.
• Sign every entry with your name and title (e.g., Jane Doe, CNA).
• Record the date and time of every entry.
• Document immediately after care is given — never in advance.
• If you forget an entry, add a late entry with current date/time and note it's late.
• Military time is commonly used: 1:00 PM = 1300, midnight = 2400 or 0000.
• Medical records are legal documents — falsification is a crime.

💡 Communication with Special Populations

🔥 Fire Safety: RACE & PASS

🚶 Fall Prevention

• Always keep the bed in the lowest position when care is not being given.
• Ensure call light is within reach at all times.
• Keep pathways clear of clutter, cords, and spills.
• Use non-slip footwear — no socks alone on hard floors.
• Respond to call lights promptly — don't let residents try to get up alone.
• Use gait belts for transfers and ambulation with unsteady residents.
• Lock wheelchair and bed wheels before all transfers.
• Know each resident's fall risk level and follow the care plan.
• If a resident falls: stay calm, do not move them, call for the nurse immediately, stay with the resident.

🪢 Restraints

• Restraints require a written physician order and informed consent.
• The goal is always to reduce or eliminate restraint use (restraint-free care is the standard).
• Check restrained residents every 15–30 minutes per policy.
• Release and reposition restrained residents at least every 2 hours.
• Offer toileting, exercise, hydration during each release.
• Apply restraints with the quick-release knot and ensure you can fit two fingers between the restraint and the resident.
• Document all restraint applications, checks, releases, and the resident's response.
• Consider alternatives first: call lights, bed alarms, frequent monitoring, low beds, floor mats.

💪 Body Mechanics

• Keep your back straight and bend at the hips and knees (not the waist).
• Keep the load close to your body at all times.
• Use a wide base of support — feet shoulder-width apart.
• Avoid twisting your spine — pivot your whole body with your feet.
• Push or pull rather than lift whenever possible.
• Use mechanical lifts and assistive devices when available and indicated.
• Ask for help for heavy or difficult transfers — never try alone if unsafe.
• Keep your center of gravity low during lifts.

🆘 Emergency Situations

🌡️ Environmental Safety Checklist

• Check water temperature before bathing — should be 105–110°F (use thermometer or inner wrist test).
• Keep spills cleaned up immediately — wet floor signs must be placed.
• Ensure adequate lighting in all areas, especially at night.
• Oxygen is flammable — no smoking, open flames, or petroleum products near oxygen equipment.
• Report broken or malfunctioning equipment immediately — take it out of service.
• Store chemicals and cleaning agents in locked, labeled areas — never in food/medication areas.

🔗 Chain of Infection

🙌 Hand Hygiene — The Most Important Skill

🥼 Personal Protective Equipment (PPE)

🏥 Transmission-Based Precautions

🦠 Common Healthcare-Associated Infections (HAIs)

🗑️ Medical Asepsis & Waste Disposal

• Clean technique: Reducing the number of microorganisms — used in most routine care.
• Sterile technique: Eliminating ALL microorganisms — used for invasive procedures (catheter insertion, wound packing).
• Sharps (needles, lancets) go directly into a puncture-resistant sharps container — never recap with two hands.
• Contaminated linen goes in a linen bag, not on the floor — handle away from your body.
• Biohazardous waste (blood, fluids) goes in red biohazard bags.
• Never overfill sharps containers — fill to 3/4 capacity then seal.

🛁 Bathing

🦷 Oral Care

• Provide oral care at least twice daily and after meals.
• For residents with dentures: remove, clean over a sink lined with a towel (prevents breakage), store in labeled container with water when not in use.
• For unconscious residents: use foam swabs with oral rinse; position on side to prevent aspiration; suction if available.
• Inspect mouth for sores, bleeding, white patches, or unusual odor — report findings.
• Encourage residents to brush their own teeth to maintain function.

👗 Dressing & Grooming

• Let residents choose their clothing — respects autonomy and dignity.
• For residents with weakness on one side: dress the weak/affected side FIRST; undress the weak side LAST ("strong side last, weak side first for removing").
• Provide grooming items: comb, brush, deodorant, makeup if desired — these support self-image and dignity.
• Shave with an electric razor for residents on blood thinners (anticoagulants) or with diabetes.
• Nail care: report long nails; CNAs typically file nails — check facility policy for cutting nails in diabetic residents (usually nurse performs).

🚽 Elimination (Bowel & Bladder)

🔄 Positioning & Pressure Injury Prevention

🦽 Transfers & Ambulation

• Always check the care plan for transfer status: independent, supervised, minimal assist, total assist, mechanical lift.
• Use a gait belt for standing, pivoting, and ambulation — positioned at the waist, not over incisions or tubes.
• Lock all wheels on bed, wheelchair, and shower chair before any transfer.
• Bring wheelchair or chair as close to the resident as possible and at an angle toward the stronger side.
• Position resident at edge of bed with feet flat on floor before standing (dangle).
• Use a mechanical (Hoyer) lift for total-dependent residents — always requires two staff.
• Encourage weight-bearing unless contraindicated — promotes bone density and strength.

🌡️ Vital Signs: Normal Ranges & Techniques

🍽️ Nutrition & Hydration

• Dysphagia (swallowing difficulty): Follow thickened liquid/texture-modified diet orders exactly. Check care plan. Watch for coughing, choking, or changes in voice after eating.
• Aspiration risk: Always feed residents sitting upright (HOB 45–90°). Keep upright 30–45 minutes after eating. Turn head toward stronger side for stroke patients.
• NPO (Nil Per Os): Nothing by mouth — do not give food, water, or medications orally. Post sign on door.
• Intake & Output (I&O): Document all fluids consumed (mL) and all output (urine, drainage, emesis). 1 oz = 30 mL.
• Normal daily fluid intake: approximately 1,500–2,000 mL/day.
• Dehydration signs: dry mouth, dark urine, confusion, sunken eyes, decreased skin turgor.
• Overhydration signs: edema (swelling), shortness of breath, rapid weight gain.
• Weigh residents at the same time each day, on the same scale, in similar clothing.

🧠 Care of Cognitively Impaired Residents

🌿 End-of-Life & Palliative Care

• Hospice care focuses on comfort, not cure — provided when a terminal diagnosis with ≤6 months prognosis.
• Palliative care focuses on symptom relief and quality of life at any stage of serious illness.
• Signs of approaching death: Cheyne-Stokes breathing (irregular pattern), mottling (bluish skin), decreased urine output, cool extremities, decreased consciousness, death rattle.
• Provide comfort care: mouth swabs, positioning, pain management support, peaceful environment.
• Support the family — allow visiting, provide privacy, explain what is happening.
• Maintain dignity until death — speak to the resident as if they can hear you (hearing may persist).
• After death: follow facility policy for post-mortem care. Treat the body with respect. Document time of death.
• Know the Kübler-Ross grief stages: Denial → Anger → Bargaining → Depression → Acceptance.

🧘 Mental & Psychosocial Health

🔬 Specimen Collection

• Urine (Midstream Clean-Catch): Clean perineal area, have resident begin urinating, then catch specimen mid-stream in sterile container.
• Stool specimen: Collect small amount with wooden tongue depressor, place in container — avoid toilet water contamination.
• Sputum specimen: First thing in morning, have resident cough deeply and spit into container (not saliva).
• Label all specimens with: resident's full name, date, time, and type of specimen. Deliver to lab promptly or refrigerate.
• Wear gloves for all specimen collection. Wash hands before and after.