Common Chronic Conditions & Observation

The CNA Role: Observe, Record, Report

Around 39% of the Connecticut written exam is Basic Nursing Skills, and a large share of that is observation. The CNA does not diagnose, interpret lab values, or change treatment — that exceeds your scope of practice. Your job is to observe, record, and report changes so the nurse and physician can act.

Two terms appear constantly on the exam:

• Objective data (signs) — what you can measure or see: a temperature of 101.4 F, a pulse of 110, a reddened heel, vomit in the bed.
• Subjective data (symptoms) — what the resident tells you: "My chest feels tight," "I feel dizzy," "I'm nauseous."

Report both, but remember that an objective, measured value is the most accurate thing you can hand the nurse.

Normal Adult Vital-Sign Ranges (memorize these)

A value outside these ranges is a change of condition to report. If you cannot recognize "abnormal," you cannot report it — which is exactly what the test is checking.

What and When to Report

Report promptly to the nurse anything new, sudden, or different: a fall, chest pain, trouble breathing, a temperature of 100.4 F or higher, a blood pressure far outside the resident's normal, sudden confusion, refusal to eat or drink, blood in urine or stool, a new skin breakdown, or any complaint of pain. "I'll mention it later" is almost always the wrong exam answer — changes are reported when you notice them.

Stroke (CVA) and Cardiovascular Conditions

A stroke (cerebrovascular accident, or CVA) is a sudden interruption of blood flow to the brain. It is a true emergency where minutes matter. Use the BE-FAST memory aid to recognize warning signs and call the nurse immediately:

1. Balance — sudden loss of balance or coordination
2. Eyes — sudden vision changes in one or both eyes
3. Face — facial drooping on one side
4. Arm — weakness or numbness, often on one side
5. Speech — slurred or garbled speech, confusion
6. Time — note the time symptoms started and report at once

Residents who survived a stroke often have hemiplegia (one-sided weakness). Remember the dressing rule: weak (affected) side first when dressing, strong side first when undressing.

Congestive heart failure (CHF) residents may show shortness of breath, swelling (edema) in the ankles and feet, sudden weight gain, and fatigue. Report new or worsening edema and any sudden weight gain promptly — a gain of 2-3 pounds overnight can mean fluid is building up and the nurse needs to know right away. Daily weights and elevating the legs when ordered are common CNA tasks for these residents.

Diabetes and Diabetic Emergencies

Diabetes mellitus is a chronic condition of high blood sugar (hyperglycemia) caused by problems with the hormone insulin. CNAs must recognize two opposite emergencies:

• Hypoglycemia (low blood sugar) — rapid onset: shakiness, sweating, pallor, confusion, irritability, hunger. This is the more urgent emergency. Report immediately.
• Hyperglycemia (high blood sugar) — slower onset: excessive thirst, frequent urination, fruity-smelling breath, drowsiness.

Key safety rules tested on the exam:

1. Never trim or cut a diabetic resident's toenails — reduced circulation and sensation mean a small nick can become a serious infection. File only if allowed, and refer cutting to the nurse or podiatrist.
2. Inspect a diabetic resident's feet daily for cuts, redness, blisters, and report findings.
3. Report any change in how much a diabetic resident eats, since meals are matched to insulin.
4. Keep diabetic feet clean and dry, and ensure shoes and socks fit well to prevent pressure injuries.

A worked scenario the exam loves: a diabetic resident skips most of breakfast and an hour later becomes sweaty and confused. The CNA recognizes possible hypoglycemia and reports to the nurse at once — the CNA does not give insulin and does not simply wait for lunch.

Respiratory Conditions: COPD

COPD (chronic obstructive pulmonary disease) includes chronic bronchitis and emphysema; residents have trouble breathing, especially on exertion. Helpful CNA measures: position the resident upright (high-Fowler's) to ease breathing, encourage rest between activities, and ensure prescribed oxygen is flowing.

A worked scenario: a resident with end-stage COPD says she feels suffocated and panicky. The correct action is to stay with her, call for the nurse, position her upright, ensure oxygen is on if ordered, and use calm reassurance — never leave her alone and never adjust the oxygen liter flow yourself, which is outside CNA scope.

Common Observation Traps on the Exam

• Choosing to "wait and see" or "document it for the next shift" instead of reporting an abnormal vital sign or new symptom now.
• Interpreting or diagnosing ("The resident is having a heart attack") instead of reporting the objective findings to the nurse.
• Adjusting oxygen, giving food/juice without an order during a suspected low-sugar event before the nurse is notified, or trimming diabetic toenails.
• Reporting only what the resident said and omitting the measured vital sign, or vice versa — the nurse needs both.