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CNA · 8 Essential Terms
CNA vital-sign skills and textbook adult ranges: radial pulse, respirations, cuff size, limbs to avoid, pain reports, apical pulse, when to call the nurse, and oxygen saturation.
These are licensure study notes, not orders for patient care. Follow your program, your facility policy, and the current test plan.
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The pulse felt at the thumb-side wrist. It is counted for a full minute when it is irregular. Textbook adult resting rates are often given as 60 to 100 beats per minute.
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The pulse felt at the thumb-side wrist. It is counted for a full minute when it is irregular. Textbook adult resting rates are often given as 60 to 100 beats per minute.
Mnemonic. Count a full minute when the beat is uneven. Report a rate outside the range you were taught.
Exam trap. The trap is counting for 15 seconds and multiplying when the rhythm is irregular, which multiplies the mistake. Use your fingers, not your thumb, so you do not count yourself.
One respiration is a rise and a fall of the chest. Textbook adult rates are often 12 to 20 per minute. Count them without telling the resident, because people change their breathing when they know.
Mnemonic. Count breaths while the resident thinks you are still on the pulse.
Exam trap. The trap is announcing that you are counting breaths, or counting only the inhalations of a resident who is talking. Report fast, slow, or labored breathing rather than deciding the cause.
The cuff is the right width for the arm, placed on a bare arm at heart level, with the resident seated and still. A too-narrow cuff reads high. A too-wide cuff reads low.
Mnemonic. The wrong cuff gives the wrong number. Bare arm, heart level, correct size.
Exam trap. The trap is a cuff over a thick sleeve, or a reading taken while the resident is talking and holding the arm up. If you do not hear it, wait and try again rather than pumping endlessly on a sore arm.
Blood pressure and sometimes venipuncture are avoided on an arm with a dialysis fistula, an IV, a mastectomy or lymph-node surgery on that side, or an injury. Use the other arm and report if neither arm is allowed.
Mnemonic. If the arm has a fistula, an IV, or a mastectomy history, do not put the cuff there.
Exam trap. The trap is using the arm that is easiest to reach when the care plan has it marked. A fistula can be damaged. Ask the nurse which arm is safe if the plan is unclear.
Pain is what the resident says it is. The aide asks, records the resident's words and the number on the scale the facility uses, and tells the nurse. The aide does not decide the resident is exaggerating.
Mnemonic. Record the resident's pain in the resident's words, and tell the nurse.
Exam trap. The trap is waiting to report because the resident was comfortable an hour ago, or offering a personal pain medicine from home. Report the new or worsening pain. Do not give medication.
The heart rate heard with a stethoscope at the apex of the heart, counted for a full minute. It is used when the radial pulse is irregular or when the nurse asks for an apical rate.
Mnemonic. If the wrist is irregular, listen at the chest for a full minute.
Exam trap. The trap is a 30-second apical count, or a radial count substituted because the stethoscope was down the hall. Report a difference between apical and radial rates if your program teaches a pulse deficit.
Vital signs outside the range the nurse gave you, or a significant change from the resident's usual numbers, are reported promptly. You report; you do not diagnose.
Mnemonic. A number outside the range, or a number that changed, gets to the nurse now.
Exam trap. The trap is writing a blood pressure of 180 over 110 on the sheet and going to lunch, or rechecking until you get a normal number and recording only the normal one. Record what you measured and report it.
The percent of hemoglobin carrying oxygen, read by a pulse oximeter on a warm, still finger. Textbook items often say to report a reading under the facility limit, commonly under 95 percent, unless the nurse has set a different target.
Mnemonic. A cold finger or dark polish gives a bad reading. Report a low number; do not change the oxygen.
Exam trap. The trap is turning oxygen up because the number looks low. Oxygen is a nurse or provider decision. A resident with chronic lung disease may have a target that is different from the usual one. Report the number and how the resident looks.