Certified Nurse Assistant – Comprehensive Study Notes

Activities of Daily Living (ADL’s)

• Bathing / Personal hygiene
• Dressing / Grooming
• Eating / Feeding self
• Toileting (bladder & bowel management)
• Transferring (bed ⇄ chair / ambulation)
• Continence maintenance
• Functional mobility / Walking

Stages of Grief (Kübler-Ross)

• Denial
• Anger
• Bargaining
• Depression
• Acceptance
• Progression is NOT always linear; patients may move back-and-forth between stages.

Basic Body Positions (―7 most-tested―)

• Supine
• Prone
• Lateral (side-lying)
• Sims’ (left-lateral with right knee flexed)
• Fowler’s (45–60°)
• Semi-Fowler’s (30–45°)
• Trendelenburg (head-down, feet-up)
• Others you may hear: Lithotomy, High-Fowler’s, Orthopneic.

Seizures – Four Common Causes

• Epilepsy / Genetic disorders
• High fever (febrile)
• Head trauma / Stroke / Brain tumor
• Metabolic abnormalities (e.g., \text{hypoglycemia}, electrolyte imbalance)
• Also: Drug or ETOH withdrawal, infections (meningitis), toxins.

Chain of Infection (6 links)

1. Infectious Agent

2. Reservoir

3. Portal of Exit

4. Mode of Transmission

5. Portal of Entry

6. Susceptible Host
   • Breaking ANY link stops transmission (hand hygiene, PPE, isolation, etc.).

Lifespan Development – 9 Stages

Maslow’s Hierarchy of Needs

1. Physiologic – e.g., food, O_2, sleep.

2. Safety & Security – locked brakes on wheelchair.

3. Love / Belonging – roommate, family visits.

4. Self-Esteem – letting resident choose clothes.

5. Self-Actualization – attending college course online.

Safety Check of Bath Water

• \le 105^\circF (≈ 40.5^\circC).
• Diabetics & pts with neuropathy cannot feel heat → high burn risk, esp. feet.
• test first and then have client verify.

Diabetic Diet Focus

• Control carbohydrates (simple sugars & starches)
• Moderate fat & protein
• Consistent meal timing
• Monitor \text{CHO}\;\leftrightarrow\;\text{Insulin} balance.

Draw Sheet – 2 Purposes

• Re-position / lift pt without shearing skin
• Protect linens & reduce caregiver strain.

Communication – 3 Components

• Sender
• Message
• Receiver

Standard Precautions

• Used with ALL patients, ALL body fluids (except sweat) → assume every body fluid is potentially infectious.

Open-Ended Question Example

• • “How are you feeling about today’s therapy session?”

• questions with multiple answers.(broad)

Positive Body Language / Tone

• Body:
• Eye contact
• Genuine smile
• Nodding / leaning forward
• Tone: Warm, calm, confident pitch.

Complications of Immobility (≥2 / System)

• Cardiovascular – \uparrow thrombus risk; orthostatic hypotension.
• Respiratory – atelectasis; pneumonia.
• Musculoskeletal – contractures; osteoporosis.
• Integumentary – pressure ulcers; skin tears.
• Gastrointestinal – constipation; paralytic ileus.
• Urinary – UTI; renal calculi.
• Nervous – sensory deprivation; foot-drop.
• Psychosocial – depression; anxiety.

Charting Rules (5)

• Use black ink, write legibly.
• Date & time every entry \;(\text{military time}).
• Objective, fact-based; quote pts directly.
• No blank lines; draw single line through errors, write “mistaken entry,” initial.
• Sign: First initial, last name, CNA.

Opportunistic Infections & AIDS Complications

• PCP (P. jirovecii) pneumonia, Kaposi’s sarcoma, TB, candidiasis, CMV retinitis.
• Opportunistic = disease caused by organisms that rarely cause illness in a healthy immune system.

Oxygen Therapy – CNA Scope

• May: Apply/remind nasal cannula, report skin irritation, ensure tank secure.
• May NOT: Adjust flow rate, initiate new order, discontinue, turn off and on.

Resident’s Rights (OBRA ‑ 1987)

• Dignity, privacy, confidentiality, free choice, refuse tx, manage , voice grievances, remain free of abuse/restraints, access to visitors, participate in activities, transfer/discharge protections, access to information, personal possessions, quality care of resident.

Nursing Process (ADPIE)

• Assessment → Diagnosis → Planning → Implementation → Evaluation.
• CNA collects observations (A) & carries out delegated interventions (I); RNs handle Dx & Planning.

Sexually-Transmitted Diseases

• Bacterial (treatable w/ antibiotics): Chlamydia, Gonorrhea, Syphilis, Chancroid.
• Parasitic: Trichomoniasis, Pubic lice.
• Viral (no cure): HIV, HSV, HPV, Hepatitis B/C.

Medical Specialties

• Diabetes Mellitus → Endocrinologist
• Heart Disease → Cardiologist
• Elderly Patients → Geriatrician / Gerontologist
• Stroke / Brain Injury → Neurologist

Common Abbreviations (sample)

Metric / Household Conversions

• 1\;\text{kg}=2.2\;\text{lb}
• 1\;\text{oz}=30\;\text{ml}=30\;\text{cc}
• 110\;\text{cc}=110\;\text{ml}
• 82\;\text{lb}\approx37.3\;\text{kg}
• 80\;\text{kg}\approx176\;\text{lb}
• 82\;\text{kg}\approx180.4\;\text{lb}
• 1\;\text{L}=1000\;\text{ml}=1.06\;\text{qt}
• 1\;\text{in}=2.54\;\text{cm}
• Fluid weight: 2\;\text{c}=16\;\text{oz}\approx1\;\text{lb}.

24-Hour → 12-Hour Time Samples

• 1230 → 12:30 PM
• 0926 → 9:26 AM
• 1950 → 7:50 PM
• 2126 → 9:26 PM
• 1430 → 2:30 PM
• 0030 → 12:30 AM

Critical Skill Elements (Selected Procedures)

• Hand-washing – 20 sec, friction incl. wrists, fingers down.
• Zero scale before weighing; shoes ON for state exam.
• Unconscious mouth care: sponge swabs + side-lying or HOB 30°.
• Dressing w/ affected arm: undress unaffected first; dress affected first.
• Pre-procedure: Knock, identify, explain, hand hygiene, privacy.
• Transfer to wheelchair: lock chair, gait belt, brace legs, count to 3, back legs feel chair.
• Ambulation: stand to pt’s weak side-back, grasp belt, critical = use gait belt.
• Dentures: line sink w/ towel, lukewarm water, brush & store in labeled cup.
• ROM-shoulder x3 reps: flex/ext, abd/add, internal/external rotation – stop if pain.
• Measuring urine: gloves after raising graduate, eye-level reading, record in cc/ml before glove removal.
• Bedpan: HOB 30° on placement, 60–90° during use; critical = hand hygiene + privacy.
• Blood Pressure: arm at heart level, palpate brachial, inflate 30 mmHg above last pulse.
• TED hose: inside-out to heel, smooth—no wrinkles.
• Occupied bed: far rail ↑, pt rolled, clean over dirty, do NOT shake linen.
• Foot care: check water w/ wrist, support ankle, dry between toes, lotion except between toes.
• Feeding: HOB ≥75°, small bites ½-teaspoon, sit facing pt, record % eaten & I&O.
• Modified bed bath: face, hands, axilla, peri-area; change mitt each area, gown removed after face.

Vital Sign Limits to Report

• T > 100.4^\circF or < 97^\circF oral.

• P <60 or >100 bpm.
• R <12 or >24 rpm.
• BP <90/60 (hypo) or >140/90 mmHg.(hyper)

Organizational Chart

• Visual diagram of authority & responsibility levels; clarifies “chain of command.”

Race vs. Culture vs. Ethnicity

• Race – biological traits (skin, hair, genetics).
• Culture – shared beliefs, customs, behaviors.
• Ethnicity – social group w/ common nationality or traditions.

Tympanic Temperature

• Use clean probe cover, pull ear back & up (adult), insert gently, press, read in 1–3 sec.

Gas Exchange

• inhalation, exhaltion

Shower Shampoo

• Verify water temp, apply shield, wet hair back-to-front, shampoo, rinse, towel-dry—prevent water in eyes/ears.

Dressing with IV

• Remove gown from unaffected arm, slide over IV bag/line, then affected arm; reverse when dressing.

Depression – Signs/Symptoms

• Persistent sadness, loss of interest, appetite/weight change, insomnia, hopelessness, suicidal thoughts.

Testicular Self-Exam

• Monthly in warm shower; roll each testicle between thumb & fingers; report lumps, swelling, pain.

Hypoglycemia vs. Hyperglycemia (Common Symptom = Headache)

• Hypo: sweaty, shaky, irritable, \le70\;mg/dL.
• Hyper: polyuria, polydipsia, fruity breath, \ge180\;mg/dL.

Title 22 vs. OBRA & CEU

• Title 22 (CA) – state regulations for LTC; OBRA ’87 – federal law (NATCEP, residents’ rights).
• CEUs: CA CNAs = 48 hrs/2 yrs (≥12 hrs/yr). 50% may be online.

Ombudsman

• Gov’t-appointed advocate who investigates & resolves LTC resident complaints.

Abbreviations for Review

VS, BP, ICU, ADL, Q2H, O_2$$, CVA, etc. – know full wording & purpose.

Key Vocabulary

• Self-care deficit – inability to perform ADLs.
• Fomite – inanimate object transmitting pathogens.
• Body language – posture, gestures, facial expression (e.g., arms open).
• Ergonomics – adapting work to worker to reduce injury.
• Annual – occurring yearly.
• Atelectasis – lung/alveolar collapse.
• Rales – crackling lung sounds from fluid.
• Hypochondriac – abdominal region OR person preoccupied with illness.
• Catastrophic reaction – extreme response to minor stimulus (common in dementia).
• Sleep: REM (dreaming, rapid eye) vs. NREM (restorative stages 1–4).
• Pressure Ulcer Stages:
• I – non-blanchable erythema
• II – partial-thickness, blister
• III – full-thickness, subcutaneous fat visible
• IV – muscle/bone exposed, slough/eschar.