General Knowledge

1. Role and Responsibilities of a CNA

Key Concepts:

• Definition: CNAs provide basic care to patients under the supervision of RNs or LPNs in settings like hospitals, nursing homes, or home care.

• Primary Duties:

  • Assist with activities of daily living (ADLs): bathing, dressing, grooming, toileting, eating, and mobility.

  • Measure and record vital signs (temperature, pulse, respiration, blood pressure).

  • Report changes in patient condition (e.g., pain, confusion, skin changes).

  • Maintain a clean and safe environment (e.g., change linens, tidy rooms).

• Scope of Practice:

  • CNAs cannot administer medications, perform invasive procedures, or diagnose conditions.

  • Always report abnormal findings to a nurse immediately.

• Patient Rights:

  • Right to privacy, dignity, and confidentiality (per HIPAA).

  • Right to refuse care or treatment.

  • Right to be free from abuse, neglect, or restraints (unless medically ordered).

• Ethical Principles:

  • Treat all patients with respect, regardless of background or behavior.

  • Maintain professional boundaries (e.g., avoid personal relationships with patients).

  • Report unethical behavior or unsafe conditions.

Common Knowledge:

• Understand the chain of command: Report to the supervising nurse, not directly to a doctor.

• Know the importance of accurate documentation (e.g., ADLs, intake/output).

• Be aware of cultural sensitivity (e.g., respect dietary or religious preferences).

2. Infection Control

Key Concepts:

• Hand Hygiene:

  • Wash hands before/after patient contact, after touching contaminated surfaces, and before/after gloves.

  • Use soap and water for 20 seconds or alcohol-based sanitizer (if hands are not visibly soiled).

• Standard Precautions:

  • Assume all blood, bodily fluids, and mucous membranes are infectious.

  • Use gloves for contact with fluids, gowns for splashes, and masks for respiratory droplets.

• Transmission-Based Precautions:

  • Contact: For infections like MRSA or C. difficile (gloves, gown).

  • Droplet: For infections like influenza or meningitis (mask within 3 feet).

  • Airborne: For infections like TB or measles (N95 respirator, negative pressure room).

• Cleaning and Disinfection:

  • Clean reusable equipment (e.g., stethoscopes) with alcohol wipes.

  • Dispose of single-use items in biohazard bins.

• Personal Protective Equipment (PPE):

  • Donning: Hand hygiene, gown, mask, gloves.

  • Doffing: Gloves, gown, mask, hand hygiene.

Common Knowledge:

• Know the difference between clean, sterile, and contaminated items.

• Understand how infections spread (e.g., direct contact, droplets, fomites).

• Recognize signs of infection (e.g., fever, redness, swelling).

3. Safety and Emergency Procedures

Key Concepts:

• Fall Prevention:

  • Keep beds in the lowest position with locked wheels.

  • Ensure call lights are within reach.

  • Use non-slip shoes and clear walkways.

• Emergency Response:

  • Choking: Recognize signs (clutching throat, inability to speak) and perform Heimlich maneuver (if trained).

  • Heart Attack: Symptoms include chest pain, shortness of breath, sweating. Call for help immediately.

  • Stroke: Use FAST (Face drooping, Arm weakness, Speech difficulty, Time to call 911).

  • Seizures: Protect the patient from injury, do not restrain or insert objects in mouth.

• Fire Safety:

  • Follow RACE: Rescue, Alarm, Contain, Extinguish/Evacuate.

  • Use PASS for fire extinguishers: Pull, Aim, Squeeze, Sweep.

• Restraints:

  • Use only with a doctor’s order.

  • Check circulation every 15–30 minutes.

  • Explore alternatives (e.g., bed alarms, distraction).

Common Knowledge:

• Know how to use a gait belt for safe transfers.

• Understand the importance of side rails for high-risk patients.

• Be familiar with facility evacuation plans.

4. Vital Signs and Observations

Key Concepts:

• Normal Ranges:

  • Temperature: 97.8°F–99°F (36.6°C–37.2°C).

  • Pulse: 60–100 beats/min (radial or carotid).

  • Respiration: 12–20 breaths/min.

  • Blood Pressure: ~120/80 mmHg (systolic: 90–120, diastolic: 60–80).

  • Oxygen Saturation: 95–100% (via pulse oximeter).

• Measurement Techniques:

  • Temperature: Oral (most common), rectal (most accurate), axillary, tympanic.

  • Pulse: Count for 30 seconds and multiply by 2; note rhythm and strength.

  • Respiration: Count chest rise/fall for 30 seconds without alerting the patient.

  • Blood Pressure: Use manual cuff or automatic monitor; ensure arm is at heart level.

• Abnormal Findings:

  • Report fever (>100.4°F), tachycardia (>100 bpm), bradycardia (<60 bpm), irregular respirations, or blood pressure outside normal ranges.

Common Knowledge:

• Know factors affecting vital signs (e.g., exercise increases pulse, fever raises temperature).

• Understand when to retake a reading (e.g., if blood pressure seems unusually high).

• Recognize symptoms requiring immediate reporting (e.g., cyanosis, dyspnea).

5. Personal Care and ADLs

Key Concepts:

• Bathing:

  • Bed bath for bedbound patients; partial bath for specific areas.

  • Maintain privacy, use warm water, dry thoroughly to prevent skin breakdown.

• Oral Care:

  • Brush teeth or clean dentures; use swabs for unconscious patients.

  • Check for mouth sores or dryness.

• Perineal Care:

  • Clean from front to back to prevent infection, especially for females.

  • Use gloves and change water if soiled.

• Dressing:

  • Dress the weaker side first (e.g., stroke-affected arm).

  • Ensure clothing is comfortable and appropriate.

• Toileting:

  • Assist with bedpans, urinals, or commodes.

  • Promote independence while ensuring safety.

• Mobility:

  • Use gait belts for transfers; encourage range of motion (ROM) exercises.

  • Reposition every 2 hours to prevent pressure ulcers.

Common Knowledge:

• Know how to prevent skin breakdown (e.g., keep skin dry, use pillows for positioning).

• Understand the importance of observing skin for redness or sores.

• Be familiar with assistive devices (e.g., walkers, wheelchairs).

6. Communication and Interpersonal Skills

Key Concepts:

• Effective Communication:

  • Use clear, simple language and verify understanding.

  • Practice active listening (nod, maintain eye contact, paraphrase).

  • Adapt for sensory impairments (e.g., speak loudly for hearing loss, use writing for speech issues).

• Cultural Competence:

  • Respect cultural, religious, and personal preferences (e.g., modesty, dietary restrictions).

  • Avoid assumptions based on background.

• Documentation:

  • Record observations objectively (e.g., “Patient ate 50% of meal” not “Patient didn’t like food”).

  • Use correct abbreviations (e.g., ADL, NPO, PRN).

• Teamwork:

  • Report promptly to nurses about changes in condition.

  • Collaborate respectfully with coworkers.

Common Knowledge:

• Know how to handle difficult patients (e.g., stay calm, don’t argue).

• Understand nonverbal cues (e.g., grimacing may indicate pain).

• Be familiar with communication barriers (e.g., dementia, language differences).

7. Care for Specific Populations

Key Concepts:

• Elderly Patients:

  • Address age-related changes (e.g., thinner skin, hearing loss, slower mobility).

  • Promote independence while ensuring safety.

• Patients with Dementia:

  • Use simple instructions and a calm tone.

  • Manage sundowning (increased confusion in the evening) with reassurance.

  • Avoid sudden changes in routine.

• Patients with Disabilities:

  • Adapt care to physical or cognitive limitations (e.g., use assistive devices).

  • Communicate at eye level for wheelchair users.

• End-of-Life Care:

  • Provide comfort (e.g., repositioning, mouth care).

  • Respect cultural/religious practices (e.g., prayer, family presence).

  • Offer emotional support to patient and family.

Common Knowledge:

• Know stages of grief (denial, anger, bargaining, depression, acceptance).

• Understand common dementia behaviors (e.g., wandering, agitation).

• Be aware of adaptive equipment (e.g., hearing aids, prosthetic limbs).

8. Medical Terminology and Common Conditions

Key Concepts:

• Terminology:

  • Hypertension: High blood pressure (>140/90 mmHg).

  • Dyspnea: Difficulty breathing.

  • Edema: Swelling from fluid buildup.

  • Cyanosis: Bluish skin from low oxygen.

• Abbreviations:

  • ADL: Activities of Daily Living.

  • NPO: Nothing by mouth.

  • PRN: As needed.

  • ROM: Range of motion.

  • BID: Twice daily.

• Common Conditions:

  • Diabetes: Monitor for hypoglycemia (sweating, shakiness) or hyperglycemia (thirst, fatigue). Assist with foot care.

  • Heart Disease: Watch for chest pain, shortness of breath. Limit exertion.

  • Stroke: Recognize FAST symptoms; assist with mobility on affected side.

  • COPD: Assist with oxygen therapy; monitor for dyspnea.

  • Arthritis: Avoid forcing joints; assist with ROM exercises.

Common Knowledge:

• Know CNA interventions for each condition (e.g., elevate legs for edema).

• Understand the importance of reporting symptoms promptly.

• Be familiar with medical equipment (e.g., oxygen tanks, glucose meters).

9. Nutrition and Hydration

Key Concepts:

• Assisting with Feeding:

  • Position patient upright (60–90 degrees).

  • Check for swallowing difficulties (e.g., coughing, gurgling).

  • Record percentage of meal consumed.

• Special Diets:

  • Low-Sodium: For heart disease or hypertension.

  • Diabetic: Balanced carbs, avoid sugary foods.

  • Pureed: For swallowing issues.

  • NPO: No food or drink (e.g., before surgery).

• Intake and Output (I&O):

  • Measure fluids consumed (e.g., water, juice) and output (e.g., urine, vomit).

  • Report significant changes (e.g., low urine output).

Common Knowledge:

• Know signs of dehydration (e.g., dry mouth, dark urine).

• Understand aspiration risks and prevention (e.g., small bites, upright position).

• Be familiar with measuring tools (e.g., graduated cylinders for I&O).