Need to Know Facts for Nursing Students
ASSESSMENTS: What will your patient look/sound like if they have…
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Airway problem?
Breathing problem?
Circulation problem?
VITAL SIGNS:
Vital sign
Blood pressure
Normal range
90-120 (systolic)
60-90 (diastolic)
temperature
97.6-98.6 (oral),
98.6-99.6 (rectal)
96.6-97.6 (axillary)
respiratory
12 –20 breaths per minute
Heart rate/ pulse
60-100 beats per minute
SpO2/ Pulse ox/ O2 sat
90-100%
If 100% on oxygen reduce it.
American Heart Association Blood Pressure Ranges
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DIGNOSTIC STUDIES:
Lab
Normal Range
Complete Blood Count (CBC)
WBC
5 – 10 × 109/L
Plts
150 – 400 × 109/L
RBC
Female: 4.2 to 5.4 million cells/mcL
Male: 4.7 to 6.1 million cells/mcL
Hgb
Female: 12 – 16 g/dL
Male: 14 – 18 g/dL
Female: 37 – 47 %
Male: 42 – 52 %
Hct
Differential
Neutrophils
(segs + bands)
55 – 75 %
Segs
55 – 70 %
Bands
0–8%
ANC
> 1,500
(absolute neutrophil
count)
Eosinophils
1–4 %
Metabolic Panel (BMP/CMP)
Na+
136 – 145 mEq/L
K+
3.5 – 5 mEq/L
Ca+
9 – 10.5 mg/dL
Mg+
1.3 – 2.1 mEq/L
Glucose
AST/SGOT
Fasting1: 70 – 100 mg/dL
Diabetic < 130 mg/dL
90 min after eating: 100 – 140 mg/dL
Diabetic < 180
0 – 35 U/L
ALT/SGPT
4 – 36 U/L
Abnormal Findings
↑ = inflammation or infection
↓ = decreased ability to fight infection
↓ = less material to create clot > bleed easier
↑ = could indicate cancer
# of RBCs in serum
↓ = anemia (body is not making/destroying RBCs) or
bleeding
Part of RBC that carries O2 to all cells in body
↓ = ↓ oxygenation to cells (fatigue, dyspnea)
% of blood volume that contains RBCs
↓ = ↓ % volume of RBCs in blood
Bodies primary defense against bacterial infection or
physiologic stress
↑ = acute bacterial infection
↓ = virus/depleted immune system
Mature neutrophils
↑ = acute bacterial infection
Immature neutrophils
↑ = acute bacterial infection
↓ = immune system unable to fight infection
ANC = (% neutrophils + % bands) x WBC
100
↑ = Allergic reaction, parasites
Fluid balance2
↓ = swelling of cells > CNS problems3
Fluid balance, muscle, and nerve function2
↓ = Heart arrhythmia, muscle cramps, fatigue3
↑ = Heart arrhythmia/palpitations, muscle weakness,
diarrhea3
Bone strength, muscle and nerve function2
↓ = tetany (+Trousseau, + Chvostek), numbness3
↑ = emotional lability, confusion3
Muscle and nerve function, blood sugar and BP
regulation2
↓ = tetany, personality change3
↑ = respiratory depression, hypotension, cardiac
arrest (torsades)3
*If ↓Mg AND ↓K+ GIVE Mg FIRST*
↑ = diabetes1, stress, steroids
↑ = inflammation/damage to liver > ↓ liver function
(may see jaundice, lethargy)
↑ = inflammation/damage to liver > ↓ liver function
(may see jaundice, lethargy)
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Lab
Normal Range
Metabolic Panel (BMP/CMP) Continued…
Alk Phos
30 – 120 U/L
BUN
10 – 20 mg/dL
Creatinine
Female: 0.5 – 1.1 mg/dL
Male: 0.6 – 1.2 mg/dL
3.5 – 5 g/dL
Albumin
GFR
Special
Hgb A1C1
100 dL/min
CK
Female: 30-135 U/L
Male: 55-170 U/L
Coagulation (times)
PTT (aPTT) (heparin)
PT (warfarin)
INR (warfarin)
< 5.6%
30 – 40 sec
11 – 12.5 sec
1
D-Dimer
< 250 mcg/mL
Cardiac Enzymes
CK-MB
< 4% - 6% of total CK
Troponin
-Troponin I (more
specific for MI)
-Troponin T (less
specific for MI)
< 0.03 mcg/L
Abnormal Findings
Found in liver and bone
↑ = liver damage/disease (blocked bile duct) OR
bone breakdown
↑ = either kidneys are not functioning properly, OR
increase in protein catabolism (fever, sepsis, stress)
↑ = ↓ kidney function
↓ = decreased nutritional status or ↓ liver function
↓ = edema r/t low oncotic pressure
↓ = decreased renal filtration (damage to kidneys)
Avg blood sugar for the past 2-3 months
↑ = Diabetes1
↑ = breakdown of muscle > muscle damage
↑ = longer it takes to form clot > bleed easier
↑ = longer it takes to form clot > bleed easier
↑ = longer it takes to form clot > bleed easier
ratio = patient PT time
normal PT time
Released when blood clot is dissolved/dissolving
↑ = lots of small clots or a big clot is being dissolved
↑ = breakdown of cardiac muscle > cardiac muscle
damage
↑ = breakdown of cardiac muscle > cardiac muscle
damage specific to infarction
< 0.1 mcg/L
BNP (brain
< 100 pg/mL
natriuretic peptide)
Inflammatory Indicators
ESR
< 20 mm/hr
CRP
< 1.0 mg/dL
Procalcitonin
Urinalysis
Sp. Gravity
< 0.15 ng/mL
Protein
Glucose
Leukocytes
Nitrites
Negative
Negative
1.01 – 1.02
Negative
↑ = ↑ stretch of heart muscle > heart not effectively
pumping blood out into body (heart failure)
↑ = inflammatory response
Made by the liver in response to acute inflammation
↑ = acute inflammation
↑ = bacterial infections or tissue injury
↑ = concentrated urine > dehydration
↓ = diluted urine
Present = kidneys are inflamed/damaged
Present = ↑ serum glucose levels or kidney damage
↑ = inflammation or infection
Present = Bacterial UTI (neg nitrites does not mean
they do not have UTI. Only some bacteria create
nitrites)
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IV FLUID
Type
Description
Isotonic
• Replaces losses without altering intravascular electrolyte concentrations
• Only IV Fluid used as a bolus
• Increases intravascular volume
Normal Saline (NS)
0.9% NaCl in water
Lactated Ringer’s (LR)
0.9% NaCl, K+, Ca++, Lactate (buffer)
D5W*
5% Dextrose in water
D5 ¼ NS*
Use/Misc
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Helpful for Na+ replacement
Often seen with surgery
Physiologically hypotonic
Isotonic in the bag*
5% Dextrose, 0.22% NaCL
Hypertonic
• IVF that contains more than an isotonic solution
• Moves fluid from intracellular space to extracellular space (monitor for fluid volume overload)
D5NS
5% Dextrose, 0.9% NaCl
D5 ½NS
5% Dextrose, 0.45% NaCl
D5LR
5% Dextrose, LR (0.9% NaCl, K+,
Ca++, Lactate)
Hypotonic
• IVF that contains less than an isotonic solution
• Moves fluid from extracellular space to intracellular space (monitor for cerebral edema)
• Must infuse very slowly
½ NS
0.45% NaCl in water
*Considered isotonic but not used as bolus
RULES OF MATH:
1. Rounding to the nearest…
a. Whole number = 1
b. Tenths = 0.1
c. Hundredths = 0.01
2. NO trailing zeros (2.6 not 2.60)
3. ALWAYS put a zero before a decimal (0.3 not .3)
4. Gtts/min is ALWAYS a whole number (you can’t
give a fraction of a drop)
5. Insulin units is always a whole number (don’t
round up)
6. IVF (mL/hr) rate is ALWAYS a whole number
7. ALWAYS use commas! (1,000,000 not 1000000) or
your answer will be considered incorrect.
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ORGAN/STYSTEM:
Organ/System Function
Liver
• Bile production and stores in gallbladder
• Excretion of bilirubin, cholesterol, hormones and drugs
• Metabolizes fats, proteins, carbohydrates
• Stores glycogen (helps to balance glucose levels) , vitamins, iron
• Makes albumin, clotting factors
• Detoxifies blood
• Makes immune factors and removes bacteria from blood
• Converts ammonia (dangerous) into urea (excreted in urine)
Gall bladder
• Stores and excretes bile (when needed by small intestine)
o Bile helps digest fats
Pancreas
• Makes insulin – promotes glucose entry into cells
• Makes glucagon – promotes the breakdown of glycogen to glucose in the liver
• Makes amylase – helps digest carbohydrates
• Makes lipase – helps digest fats
Kidneys
• Fluid & Electrolyte balance
• Acid/Base balance
• Excretion of wastes/toxins
• Help regulate BP
• Stimulation of RBC production
• Produce active form of Vit D
Spleen
• Removes old/abnormal/damaged RBCs
o Recycles the iron for use in making new RBCs
o Metabolizes the hgb > bilirubin > excreted by liver
• Plays a role in immunity
o Stores WBC to fight infection
o Filters out bacteria and viruses
• Stores platelets
Lymphatic
• Removes fluid from body tissues into the blood
System
• Contains lymphocytes to fight infection
• Lymph vessels drain into lymph nodes
o Lymph nodes trap or destroy anything harmful that the body does not need
o Lymph nodes contain lymphocytes which attack and break down bacteria, viruses,
damaged cells or cancer cells
o The lymph fluid carries the waste products and destroyed bacteria back into the
bloodstream > excreted by liver or kidneys
Renin• Stimulated in response to ↓ in BP
Angiotensin
• Stimulates production of Angiotensin II
System (RAS)
o ↑ ADH secretion > kidneys keep H2O
o ↑ Aldosterone secretion > kidneys keep H2O and Na+, excrete K+
o Vasoconstriction
PHARMACOLOGIC THERAPY:
Adrenergic – means “working on epi or nor epi”, part of the autonomic nervous system
Agonist – a substance that acts like another substance = stimulates an action
Antagonist – blocks an action
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Anticholinergics – blocks acetylcholine in the CNS & PNS
a. Keeping it from binding to nerve cells = inhibiting parasympathetic nerve impulses in the:
a. GI tract (constipation)
b. Lungs (↓ mucous production, bronchodilation)
c. GU tract (urinary retention)
b. To help control salivation, digestion, urination and mucous production.
MEDICATIONS:
Generic name
Prefix/suffix Function
Anti-coagulants
• Stop prior to surgery/procedures
Warfarin
• ↑ time it takes to form clot > ↑ bleeding
• MOA - Inhibits Vit K (liver needs to form factors)
• Antidote – Vit K
• Labs – PT, INR
• Long half-life = approx. 40 hrs (1eek to reach
therapeutic level)
Heparin
• ↑ time it takes to form clot > ↑ bleeding
• MOA - Binds activated factors
• Antidote – protamine sulfate
• Labs – PTT, aPTT
• Short half-life = 60 – 90 min (works quickly)
Enoxaparin
• ↑ time it takes to form clot > ↑ bleeding
• Low molecular weight heparin
• Antidote – protamine sulfate
• Labs – none
Apixaban, Rivaroxaban
-xaban
• ↑ time it takes to form clot > ↑ bleeding
• MOA – Direct factor Xa inhibitor
• Antidote – none
• Labs – none
Aspirin
• MOA – prevents plts from sticking together
• Give if suspect MI
• Can cause GI bleeding, tinnitus
Anti-Infectives:
Antibiotics
• Kill or prevent reproduction of bacteria
• ↑ risk of opportunistic infections
Anti-viral
-vir
• ↓ virus ability to get into cell
• ↓ virus ability to reproduce
• ↓ time patient has virus/↓ symptom severity
Anti-Inflammatories:
NSAIDs
• Inhibit COX-1 & COX-2 (↓ prostaglandins)
Ibuprofen, Ketorolac
- ↓ Renal perfusion
- ↓ Plt aggregation
- ↓ inflammation
• ↑ risk for GI bleeding
Steroids
• Stop/suppress inflammatory response
Prednisone, prednisolone,
• ↑ Glucose, ↑ GI acid secretions, ↑ BP, ↑ bone
Methylprednisolone
breakdown
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Anti-Hypertensive Meds:
• Do not give if HR < 50 bpm or SBP < 100 mmHg
ACE Inhibitors
-pril
ARBs (Angiotensin receptor
blockers)
-sartan
Beta Blockers
Cardio Selective:
- Metoprolol
- Atenolol
- Esmolol
Non-selective:
- Propranolol
- Nadolol
-lol
MOA – inhibits production of Angiotensin II
o Vasodilation
o ↓ intravascular fluid volume
• Labs – K+ (can cause ↑ K+ levels)
• Can cause irritating cough
• MOA – inhibits action of Angiotensin II
o Vasodilation
o ↓ intravascular fluid volume
• Labs – K+ (can cause ↑ K+ levels)
Given in acute stages of MI
• MOA – block Beta1 only
o ↓ HR, ↓ contractility, ↓ renin secretion
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Alpha & Beta Blockers:
- Carvedilol
- Labetalol
Diuretics: Monitor BP
Safety: Fall precautions, Orthostatic
Hypotension
- Loop (furosemide)
- K+ sparing (spironolactone)
- Thiazide
(hydrochlorothiazide)
Heart Failure Meds: Daily weights
Cardiac Glycosides (Digoxin)
GI Meds
PPI (proton-pump inhibitors)
H2 Blockers
Antacids (Tums, Milk of Magnesia)
Prokinetic (metoclopramide)
Anti-Nausea/Emetic
- Ondansetron
- Phenergan
- Compazine
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MOA – block all Beta Cells
o ↓ HR, ↓ contractility, ↓ renin secretion
Bronchoconstriction (contraindicated in asthma, COPD,
etc.)
Hypo/Hyperglycemia (inhibits glucose release, blocks
pancreatic beta cells)
Non-selective traits
Vasodilation
↓ intravascular fluid volume
MOA – ↑ urination
Labs – Na+, K+, Creatinine
• can cause ↓ K+ levels, ↑ Glucose, Ototoxicity
• can cause ↑ K+ levels (inhibit aldosterone)
• can cause ↓ K+ levels, ↑ Glucose
• CAUTION: Allergy to sulfonamide Abx
-prazole
-tidine
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MOA – ↑ contractility of heart, ↓ HR
Labs – K+ (do not give if ↓K+ > Dig toxicity)
S/S of Toxicity: HR < 60 bpm, fatigue, weak, nausea,
visual changes (halos)
o Antidote – Digoxin Immune Fab
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MOA – stops ALL acid production in stomach
Used with antibiotic to treat H. Pylori
Should only use for 1 month
MOA – decreases acid production in stomach
MOA – neutralize acid already in the stomach
MOA – increases gastric emptying
Can cause extrapyramidal movements
MOA
- Stops signal to brain to induce vomiting
- Blocks histamine receptors in stomach
- Blocks dopamine receptors in brain
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Diabetic Meds: Monitor glucose levels
Insulin
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Metformin
Incretin mimetics (exenatide,
dulaglutide, liraglutide, albiglutide)
-tide
Sulfonylureas (glipizide, glyburide,
glimepiride)
Glucagon
-ide
Narcotics: Monitor: RR, BP, LOC; Fall Precautions
Opioids:
Heroin, Oxycodone, Hydrocodone,
Opium, Hydromorphone, Morphine,
Fentanyl, Tramadol, Methadone
Benzodiazepam:
-pam
Lorazepam, Midazolam, Diazepam,
-lam
Alprazolam, Clonazepam
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Type I Diabetes
MOA – supplements bodies inability to produce insulin
MOA
- ↑ glucose uptake and use by muscles
- ↑ insulin receptor sensitivity
- ↓ glucose absorption of intestines
- ↓ glucose production by the liver
First line treatment for Type II diabetes
STOP 24 hrs before GETTING CONTRAST
MOA
- ↑ release of insulin
- ↓ release of glucagon
- Delays gastric emptying
SQ injection
↑ release of insulin
CAUTION: Sulfonamide allergy
↑ glucose release by liver (ADMIN for HYPOGLYCEMIA)
SQ, IM, IV – turn pt before admin (prevent aspiration)
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Antidotes – Naloxone (may give multiple doses as it
wears off)
Long acting forms ↓ risk of abuse
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Antidote - Flumazenil
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RESPIRATORY MEDICATIONS:
Category
β-adrenergic
agonist
Mechanism of Action
Relaxes the muscles of the small airways
→widening the airway.
Anti-cholinergic
Relaxes smooth muscle → bronchodilation of
large airways (bronchi), and ↓ mucous
production.
Increases watery secretions→ thinning mucous
Breaks up the sputum → dissolving mucous
Decrease inflammation
Expectorants
Mucolytic
Corticosteroids
Antitussives
Mast cell
stabilizers
Leukotriene
receptor agonist
Suppress cough
Inhibits hypersensitivity reaction → inhibits
histamine release from mast cells
Inhibits leukotrienes → produced by
the immune system
Leukotrienes promote: bronchoconstriction,
inflammation, capillary permeability, and
mucus secretion
Examples
Short acting: Albuterol, Levalbuterol, racemic
epi
Long acting: salmeterol
Short acting: Atrovent (Ipratropium bromide)
Long acting: Spiriva (tiotropium)
Guaifenesin
Mucomyst (acetylcysteine)
Inhaled: Pulmicort (budesonide), Flovent
(fluticasone propionate), QVAR
(beclomethasone)
PO/IV: Solu-medrol (methylprednisolone),
Prelone/Orapred (prednisolone), prednisone
Delsym (dextromethorphan)
NasalCrom (Cromoglicic acid), Xolair
( Omalizumab)
Singulair (Montelukast)
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INSULIN COMPARISON CHART:
Insulin Name
Lispro (Humalog)
Aspart (Novolog)
Glulisine (Apidra)
Afrezza (inhaled insulin)
Regular
(Novolin R or Humulin R)
Isophane suspension (NPH)
(Novolin N or Humulin N)
Glargine (Lantus)
Detemir (Levemir)
Humulin 70/30
(isophane/regular)
Novolin 70/30
(isophane/aspart or regular)
Novolog Mx 70/30
(aspart protamine/aspart)
Humalog Mix 75/25
(lispro protamine/lispro)
When does it start
working?
(onset)
15-30 min
When will the effect be
the greatest?
(peak)
Rapid Acting
Black box warning: acute
bronchospasm in pts
w/chronic lung disease
Short Acting
30-60 min
Intermediate Acting
1-2 hrs
70 min
15-30 min
15-30 min
Long Acting
Combinations
How long will it lower
blood glucose?
(duration)
1-2 hrs
3-5 hrs
1-5 hrs
6-10 hrs
6-14 hrs
16-24 hrs
none
Up to 24 hrs
1st: 1-2 hrs
2nd: 6-14 hrs
16-24 hrs
1st: 1-2 hrs
2nd: 4-8 hrs
16-24 hrs
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MEDICATION ERROR PREVETION:
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NEEDLE SIZE/SITE
Parenteral
Route
Intradermal
Subcutaneous
Syringe Selection
1-mL tuberculin
syringe
½-3 mL
Needle Diameter and Needle Angle
Needle length
25-27 gauge, ½ - 5/8 inch 5-15 degrees
25-27 gauge, 3/8-5/8 inch
(up to 1 inch for an obese
patient)
45 to 90
degrees
Subcutaneous Insulin syringe U-100, Pre-attached to insulin
Insulin
U-50, or U-30
syringe: 25-31 gauge, 5/16
to ½ inch
45 to 90
degrees
Intramuscular
Adults: 1-5 mL
18-25 gauge, 5/8 to 1 ½
(IM)
depending on site and
inch
muscle mass
Oil based solutions: 18-20
gauge
90 degrees
Site Selection
Inner forearm, upper arm and
across the scapula
Abdomen, lateral aspects of the
upper arm and thigh, scapular are
of the back, and
upper ventrodorsal gluteal area
Abdomen, lateral aspects of the
upper arm and thigh, scapular are
of the back, and
upper ventrodorsal gluteal area
Ventrogluteal, vastus lateralis, and
deltoid.
ATI and Yoost, B. L., & Crawford, L. R. (2020). Fundamentals of Nursing: Active learning for collaborative practice (2nd ed.). Elsevier.
Resources:
1. American Diabetes Association. https://www.diabetes.org/a1c/diagnosis
2. National Institutes of Health. Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/list-all/
3. Merck Manual: Professional Version. https://www.merckmanuals.com/professional
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