Nursing Cheat Sheets 76 Cheat Sheets for Nursing Students NRSNG Jon Haws RN Sandra Haws RD Copyright © 2018 by NRSNG, LLC All rights reserved. No part of this book may be used or reproduced in any manner whatsoever without the express written permission of the copyright holder except in the case of brief quotations embodied in critical articles and reviews. NCLEX®, NCLEX®-RN® are registered trademarks of the National Council of State Boards of Nursing, INC. and hold no affiliation or support of this product nor affiliation with NRSNG, LLC or the author. All photos are original photos taken or created by the author or rights purchased at Fotolia.com. All rights to appear in this book have been secured. NRSNG and NRSNG Academy are registered trademarks of NRSNG, LLC. 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Table of contents Introduction Cardiac Blood Pressure Values R v L Heart Failure Types of Cardiomyopathy 12 Lead MI Locations Angina Heart Blocks Cardiac Auscultation Chest Pain Identification H’s and T’s of ACLS Coronary Circulation Types of Aneurysms Fundamentals Patient Mobility Chest Tube Care Pathophysiology Concept Map Head to Toe Assessment Pressure Ulcers Types of Lines Medical Spanish Therapeutic Diets IV Sites and Considerations Patient Safety Colostomy Care Abdominal Pain Ulcerative Colitis Vs. Crohn’s Disease Chronic Kidney Disease Symptoms Types of Viral Hepatitis Hematologic/Oncology/Immunology Types of Anemia Integumentary Burn Staging Skin Cancer Skin Lesions Labs Lab Value Skeletons Lab Value for Clinical Blood Compatibility Chart ABG Rome Flowchart Cardiac Biomarkers IV Colors and Gauges ABG Analysis Fluids and Electrolytes Endocrine/Metabolic Endocrine Study Guide Chart Addison’s Vs. Cushing’s Hyper Vs. Hypothyroidism Musculoskeletal Fracture Management Mental Health Stroke Symptoms by Location Neuro Dysfunction by Pupil Assessment Routine Neuro Assessments Ob Newborn Assessment Labor Clinical Assistant – Brain Sheet Pediatric Burn Chart Erikson’s Stages of Psychosocial Development Congenital Heart Defects Pharmacology Crystalloid IV Solutions Drug Card Nervous System Pharmacology Dopamine Vs Dobutamine Beta Blockers Common ICU Drips Medication Antidotes Insulin Cheat Sheet Common Antihypertensive Drugs Antidepressant Cheat Sheet Immunization Schedule Antibiotic Cheat Sheet Answering Pharmacology Questions Therapeutic Drug Levels Antidysrrhythmic Meds and Action Potential Chart Respiratory Hierarchy of O2 Delivery Systems Lung Sounds Gas Exchange Asthma Medications Artificial Airways Decision Tree Ventilator Alarms Chest Tube Management Introduction My journey into nursing was a long one, but I have found it to be a truly rewarding career that allows me to make a difference and have ample family time. I am confident that you will achieve your goals. The fact that you are seeing additional resources to improve your understanding speaks volumes to your dedication. This book is intended to provide you with a quick reference to some of the most needed and most used information for nursing students. This is not a complete guide to nursing but a simple, compact, and quick reference to some of the most important information. Happy Nursing! Jon Haws RN For colored images of Cheat Sheets for Nurses download the Kindle version of the book, which is available at no additional cost with each physical purchase of the book. 10 Common Ekg Heart Rhythms Normal Sinus Rhythm Sinus Bradycardia Sinus Tachycardia Atrial Fibrillation Atrial Flutter Supraventricular Tachycardia Premature Atrial Contraction Premature Ventricular Contraction Ventricular Tachycardia Ventricular Fibrillation [NRSNG Academy Lesson: EKG Waveforms] Hemodynamic Values Methods To Elevate Parameter Methods To Decrease Parameter Cardiac Output Blood Pressure CO=HR*SV (4-8L/min) CO*SVR Heart Rate X 60-100 bpm Cardiac Output CO=HR*SV (4-8L/min) Treat cause, parasympatholytic (Atropine), sympathomimetic (Epinephrine), pacemaker Treat cause, antidysrhythmics, Vagal electrical therapy Preload Contractility PAOP, CVP Cardiac glycosides, Sympathomimetics Fluids, blood Venous vasodilators, diuretics ace inhibitors, ARBs Beta blockers, Ca channel blockers Afterload SVR Vasopressors Arterial vasodilators, ACE inhibitors ARBs, IABP Key Hemodynamic Values (With Equations) Cardiac Output (CO) HR x SV 4-8 L/min Cardiac Index (CI) CO/BSA 2.5-4 L/min/m2 Central Venous Pressure (CVP) 2-6 mmHg Mean Arterial Pressure (MAP) SBP+(2xDBP)/3 70-100 mmHg Stroke Volume (SV) EDV - ESV 60-120 ml/beat Stroke Volume Index (SVI) SV/BSA 30-65 ml/m2/beat Pulmonary Artery Occlusion Pressure (PAOP) Systemic Vascular Resistance (SVR) 8-12 mmHg [MAP-RAP) x 80]/CI Central Venous Oxygen Saturation (ScvO2) Oxygen Delivery (DO2) 800-1400 dynes/sec/cm-5 65-85% CO x CaO2 x 10 [NRSNG Academy Lesson: Preload and Afterload] 900-1100 ml/min Blood Pressure Values BLOOD PRESSURE VALUES New 2017 AHA guidelines have eliminated pre-hypertensionand lowered the threshold for the diagnosis of hypertension to allow for earlier intervention. Blood pressure categories in the new guideline are: Normal: Less than 120/80 mm Hg; Elevated: Systolic between 120-12 and diastolic less than 80; Stage 1: Systolic between 130-13 or diastolic between 80-8 ; Stage 2: Systolic at least 140 or diastolic at least 0 mm Hg; Hypertensive crisis Systolicover 180 and/or diastolic over 120,with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage. CATEGORY Systolic mm Hg Normal Diastolic mm Hg <120 <80 Elevated 120-129 <80 Stage 1 130-139 80-89 Stage 2 >140 >90 Hypertensive Crisis >180 >120 SOURCE: http //www.acc.org/latest-in-cardiology/articles/201 /11/08/11/4 /mon-5pm-bp-guideline-aha-201 [NRSNG Academy Lesson: Hypertension] [NRSNG Academy Lesson: Hypertension] R v L Heart Failure [NRSNG Academy Lesson: Heart Failure] Types of Cardiomyopathy [NRSNG Academy Lesson: Cardiomyopathy] 12 Lead MI Locations [NRSNG Academy Lesson: Myocardial Infarction] Angina ANGINA Chest pain resulting from inadequate blood flow to heart muscle. Most common cause is coronary artery disease (CAD). Other causes include anemia, heart failure, abnormal rhythms. STABLE UNSTABLE VARIANT ONSET Exertion/Stress Rest/Exertion/Stress Typically at Rest PREDICTABLE Predictable Unpredictable Unpredictable Up to 30 min Varies May Resolve with Nitro May Resolve with Nitro DURATION RESOLUTION 5 min Rest or Nitro ASSESSMENT DIAGNOSIS Pain EKG Dyspnea Stress Test Pallor Cardiac Biomarkers Sweating Cardiac Cath Tachycardia INTERVENTIONS PAIN provide rest and administer nitro as prescribed O2 provide supplemental oxygen to the patient 12 LEAD EKG obtain 12 lead ekg REST maintain bed rest to reduce O2 demands ASSESS assess vital signs and pain Syncope HTN [NRSNG Academy Lesson: Angina] [NRSNG Academy Lesson: Angina] Heart Blocks HEART BLOCKS FAILURE OF THE HEART’S NATURAL PACEMAKER DUE TO OBSTRUCTION (“BLOCK”) IN THE ELECTRICAL CONDUCTION SYSTEM OF THE HEART. Relationship of P waves to QRSs All P waves are followed by a QRS but PR is >0.20 First-Degree AV block Progressive lengthening of PR until a P is not followed by a QRS, then repeated Seconddegree AV block, Type I Every other P wave is not conducted (2:1) PR interval of conducted P wave is consistent QRS < 0.12 QRS is 0.12 or > Only one P wave in a row is not conducted More than one P wave in a row is not conducted QRS < 0.12 Seconddegree AV block, Type I Seconddegree AV block, Type II Seconddegree AV block, Type II High grade AV block Complete heart block with junctional escape rhythm 1° Benign but can progress Significance Treatment No P waves are followed by (associated with) QRSs (i.e., AV dissociation) Some P waves are not followed by QRSs Observation, d/c digitalis use 2° Type I 2° Type II QRS is 0.12 or > Complete heart block with ventricular escape rhythm 3° Block at AV node, Block at Bundle of usually transient, His, occurs with does not usually anterior MI, often progress progresses to complete block Ventricular asystole in absence of escape beat Close monitoring, d/c digitalis use, treat if patient is symptomatic Pacemaker, atropine, monitor for hypoperfusion Atropine, transcutaneous or transvenous pacemaker [NRSNG Academy Lesson: 1st Degree AV Heart Block] [NRSNG Academy Lesson: 1st Degree AV Heart Block] Cardiac Auscultation [NRSNG Academy Lesson: Heart Sounds] Chest Pain Identification CHEST PAIN IDENTIFICATION CAUSE PROVOCATION - Ex - Stress - Cold ANGINA - Smoking QUALITY - Heavy pressure - Tightness - Dull ache REGION - Substernal - Radia to jaw, arms, neck, abdomen SEVERITY - Mild to severe TIMING - Gradual or sudden onset - <5 min but may last up to 15min SIGNS/SYMPTOMS - Tachycardia TREATMENT - Rest - Dyspnea - Oxygen - N/V - Nitro - Diaphoresis - Calcium Channel Blocker - Anxiety - ST-T wave changes - Stress - Lifestyle change - Similar to angina - Pressure on chest - Clinched fist over chest ACUTE MI - Substernal - Radia to jaw, arms, neck, abdomen - No symptoms to severe - Sudden onset - >30min up to 2 hours - Tachycardia - MONA - Dyspnea - Fibrinol or percutaneous coronary interven - N/V - Diaphoresis - Anxiety - Impending doom - T wave inversion, ST eleva - S4 - Venous stasis PULMONARY EMBOLISM - Hyperco agulability - Vascular injury - Sharp - Shoo - Deep - Worsened with inspira - Substernal or lateral chest - Mild to severe - Sudden onset minutes to hours - Radiates to shoulder and neck - Tachycardia - Narco - Tachypnea - High Fowler’s - Dyspnea - Anxiety - Chest Splin - Hemoptysis - Thrombol - Fever - Chest trauma - Excessive l volume or PEEP with PNEUMOTHORAX mechanical ven a - Sharp tearing - Exacer bated by breathing - Lateral chest with to radia shoulder, arms, back - Mild to severe - Sudden onset hours to days - Tachypnea - Narco - Tachycardia - Chest tube - JVD - Anxiety - Diminished breath sounds - Tracheal devia - Bleb - Hyperresonance - Dyspnea [NRSNG Academy Lesson: Angina] [NRSNG Academy Lesson: Angina] H’s and T’s of ACLs H’S AND T’S OF ACLS A mnemonic used to aid in remembering the possible causes of cardiac arrest. A variety of disease processes can lead to a cardiac arrest; however, they usually boil down to one or more of the "Hs and Ts". H’s of ACLS Causes Signs T’s of ACLS Treatment Hypovolemia HR Narrow QRS Blood loss Fluid administration Fluid challenge Hypoxia HR Cyanosis Patent airway Ventilate Hydrogen Ion (Acidosis) Hyper/Hypokalemia Hypothermia ABG (Low pH) Low amplitude QRS Sodium bicarbonate Ventilate Flat T waves with U wave (hypo) or Peaked T waves with wide QRS (hyper) Ventilate (metabolic) Sodium bicarbonate (respiratory) Calcium Gluconate Insulin and D50 Albuterol Hypothermia Warming measures Causes Toxins Signs Prolonged QT Treatment Antidote Based on overdose Tamponade (Cardiac) HR Narrow QRS JVD Mu ed heart Pericardiocentesis Thoracotomy Tension Pneumothorax HR Narrow QRS Unequal breaths Tracheal deviation Decompression Chest tube Thrombosis (coronary or pulmonary) EKG alteration Chest pain Narrow QRS SOB Embolectomy Fibrinolytics Anticoagulants Angioplasty Stent CABG H’s Hypovolemia: A lack of circulating body fluids, principally blood volume. This is usually (though not exclusively) caused by some form of bleeding, anaphylaxis, or pregnancy with gravid uterus. Hypoxia: A lack of oxygen delivery to the heart, brain and other vital organs. Rapid assessment of airway patency and respiratory effort must be performed. Hydrogen Ion: An abnormal pH in the body as a result of lactic acidosis which occurs in prolonged hypoxia and in severe infection, diabetic ketoacidosis, renal failure causing uremia, or ingestion of toxic agents or overdose of pharmacological agents. Hyper/Hypokalemia: Both excess and inadequate potassium can be life-threatening. Hypothermia: A low core body temperature, defined clinically as a temperature of less than 35 degrees Celsius (95 degrees Fahrenheit). T’s Toxins: Toxin ingestion is one of the most common causes of cardiac arrest. Prolonged QT is a common sign. Tamponade: Blood or other fluids building up in the pericardium can put pressure on the heart so that it is not able to beat Tension Pneumothorax: The build-up of air into one of the pleural cavities, which causes a mediastinal shift. When this happens, the great vessels (particularly the superior vena cava) become kinked, which limits blood return to the heart Thrombosis: Hemodynamically significant pulmonary emboli are generally massive and typically fatal. Text from Wikipedia.org used on CC license [NRSNG Academy Lesson: Ventricular Tachycardia] [NRSNG Academy Lesson: Ventricular Tachycardia] Coronary Circulation [NRSNG Academy Lesson: Coronary Circulation] Types of Aneurysms TYPES OF ANEURYSMS An Aneurysm is an outpouching of the vessel wall due to weakened vessel muscle layers. This is usually caused by hypertension. Blood ow becomes turbulent at the sit of the aneurysm, pu ng it at high risk for rupture. By Nichole Weaver, © NRSNG, LLC. FUSIFORM SACCULAR DISSECTING FALSE Fusiform aneurysms surround the full circumference of the vessel. This is common in the Abdominal Aorta. Saccular aneurysms pouch out from one side of the vessel. Also called “Berry Aneurysms”. Dissection occurs when the inner layer of the vessel is torn away. Blood ows between vessel layers instead of forward. False aneurysms appear on scans, but are actually a blood clot formed outside the vessel. Blood ow is not impeded. [NRSNG Academy Lesson: Aortic Aneurysm] Patient Mobility PATIENT MOBILITY GENERAL HOME SAFETY GUIDELINES Use nonslip mats, grab bars, and raised toilet seats CRUTCHES Standing up: scoot to front of chair, hold both crutches in hand of injured side, push up on good foot. Stairs: Up Down Unaffected/strong leg first Affected/weak leg and crutches second Affected/weak leg and crutches first Unaffected/strong leg second WALKERS ng How to ambulate Types Push forward about 6” (or whatever is Advance weak leg, then strong leg walker advance the walker and weak leg together at once, then move the stronger leg forward able to push the walker forward CANES Use on STRONG SIDE Elbow should be flexed slightly Tip of nearest point of the cane should be about 6” in front of and 6” to the side of that strong leg How to ambulate Advance the cane about 1 foot forward (or Types Straight or regular Tripod Quad Move the WEAK SIDE while the cane and Then move the strong leg ahead, while the weaker leg is supported by the cane Sources American Academy of Orthopaedic Surgeons. How to Use C rutches, Canes, and Walkers-OrthoInfo - AAOS. .org/topic.cfm topic=a00181 [NRSNG Academy Lesson: Fall and Injury Prevention] Chest Tube Care [NRSNG Academy Lesson: Chest Tube Management] Pathophysiology Concept Map PATHOPHYSIOLOGY CONCEPT MAP Risk Factors Sign And Symptoms Potential Complications DISEASE PROCESS Pathophysiology (Definition / etiology chronicity and prognosis) Medical intervention, Labs and diagnostic studies Nursing Diagnosis Nursing Interventions Head to Toe Assessment [NRSNG Academy Lesson: Head to Toe Nursing Assessment] Pressure Ulcers [NRSNG Academy Lesson: Complications of Immobility] Types of Lines [NRSNG Academy Lesson: Preparing an IV Infusion] Medical spanish MEDICAL SPANISH BASIC ASSESSMENT ESSENTIAL WORDS My name is _______ . I am your nurse. Me llamo _______. S oy su enferme ra (o). Please Por favor What is your nam e? ¿Cómo se llam a? Thank you Gracias How are you feeling? ¿Cómo se sie nte? Never Nunca Date Fecha Sign ature Firma Good- bye Adiós Where Donde What is the d ate? ¿A qué fecha e stamos? Where are you? ¿Dónde e stá usted? How old are you? ¿Cuá ntos añ os tiene? Where do you live? ¿Dónde vive usted? Are you having pai n? Where? ¿Tiene do lor? Dond e? PHYSICAL ASSESSMENT MEALTIMES Brea kfast Desayuno Lunch Almuer zo Dinner Cena ESSENTIAL ITEMS Blank et Manta Brush Cepillo Gown Bata Lotion Loción Pillow Almohada Shampoo Champú Shaving cream Crema de afeitar Sheet Sábana Soap Jabón Towel Toalla Do you have_________? ¿Tiene usted ________? Have you ever had______? Ha tenido alguna vez ________? Itching Picazón Sores Llagas Edema/swelling Edema/hinchazón Pain Dolor Chest pain Dolor de pecho Nausea Náuseas Vomiting Vómitos POSITIONING Lean backward Recuéstese Lean forward Inclínese hacia adelante Lie down Acuéstese Sit down Siéntese Stand up Póngase de pie MEDICAL SPANISH ANATOMY Skin Piel Chest Pecho Lungs Pulmones Eyes Ojos Heart Corazón Kidneys Riñones Pulse Pulso Arm Brazo Leg Pierna BASIC NURSING PROCEDURES I'm going to take your ________. Voy a medirle _______. Vital signs Los signos vitales Blood pressure La presión sanguínea Pulse El pulso Temperature La temperatura I'm going to take a blood sample. Voy a tomarle una muestra de sangre. Can you provide a urine specimen? ¿Puede darnos un espécimen de orina? DIAGNOSTIC TESTS Biopsy Biopsia Blood test Análisis de la sangre Blood culture Cultivo de la sangre CT scan Tomogra a computarizada Ultrasound Ultrasonido X-ray Radiogra a Therapeutic Diets THERAPEUTIC DIETS NAME CONSIDERATIONS NPO Nothing by mouth (nil per os) CLEAR LIQUID FULL LIQUID PUREED DIET transparent to light and liquid at body temperature broth hard candy gelatin popsicles water coffee fruit juice tea clear and opaque liquid foods at body temperature all clear liquid items ice cream sherbet breakfast drinks fat free & 1% milk pudding thin hot cereals (cream of wheat) foods that require no chewing all full liquid items mashed potatoes MECHANICAL foods that require less chewing tender fruits and vegetables chopped, ground, & pureed foods tender meats LOW RESIDUE/ LOW FIBER limit fiber intake to 10g a day white rice HIGH RESIDUE/ HIGH FIBER high fiber intake 20-35g a day fruits and vegetables CONSISTENT CARB limited starches, juice, fruit, milk, and sugars CARDIAC restrict fat and sodium intake SODIUMRESTRICTED limit sodium intake to set amount (4 DIET white bread refined cereals and pastas whole-grain products control carbohydrate intake (diabetic diet) g, 3g , 2g , 1g , 500mg) avoid canned, frozen, boxed, smoked, salted foods [NRSNG Academy Lesson: Nutrition] IV Sites and Considerations [NRSNG Academy Lesson: Preparing an IV Infusion] Patient Safety PATIENT SAFETY FIRE SAFETY RACE RESTRAINT SAFETY PASS R: Rescue patients in danger P: Pull the fire extinguisher pin Use the least restrictive method possible A: Activate the fire alarm A: Aim at the base of the fire Order for restraints needs to be renewed within set time frame C: Confine the fire S: Squeeze the handle Never ordered PRN E Extinguish the fire S: Sweep extinguisher from side to side Assess skin integrity, neurovascular, and circulatory status every 30m Remove restraint every 2 hours to check pressure areas FALL SAFETY STANDARD PRECAUTIONS CONTACT PRECAUTIONS Asses for risk factors Hand hygiene before and after every patient contact DISEASES PROTECTION Bed in low and locked position Use PPE when risk of body fluid exposure Norovirus Private room Bed alarm as needed Use and dispose of sharps safely Rotavirus 1:1 monitoring Clostridium difficile Gown and gloves when in patient room Clean all shared patient equipment Draining wounds Use of aseptic technique MDROs Dispose of all waste and linen safely AIRBORNE PRECAUTIONS DISEASES PROTECTION Hand hygiene on exit, Soap and water for C. Diff DROPLET PRECAUTIONS DISEASES PROTECTION Measles Single negative pressure room Influenza Pneumonia Private room Chickenpox 6-12 air exchanges per hour Meningitis Sepsis Surgical mask within 3 feet of patient TB Wear respirator or mask Mumps Pertussis Mask must be worn by client when leaving room Rubella Patient must wear a mask when leaving room Colostomy Care [NRSNG Academy Lesson: Diverticulosis – Diverticulitis] Abdominal Pain ABDOMINAL PAIN 9 Regions of the Abdomen Gallstones Cholecystitis Stomach ulcer Duodenal ulcer Hepatits Heartburn Indi estion Hiatal hernia Epigastric hernia Stomach ulcer Duodenal ulcer Hepatitis Dyspepsia astritis Stomach ulcer Pancreatitis Kidney stones Kidney infection IBD Consti ation Umbilical hernia Early a endicitis Stomach ulcer IBD Pancreatitis Kidney stones Kidney infection IBD Consti ation A endicitis Inguinal Hernia IBD Pelvic Pain Consti ation Bladder infection Prostatitis Diverticulitis IBD Inguinal hernia Pelvic pain Consti ation IBD Pelvic pain Inguinal hernia CRITICAL POINT: When assessing the abdomen the correct assessment order is: Inspect, Auscultate, Percuss, Palpate Ulcerative Colitis Vs. Crohn’s Disease [NRSNG Academy Lesson: Inflammatory Bowel Disease] Chronic kidney Disease symptoms CHRONIC KIDNEY DISEASE SYMPTOMS By Nichole Weaver, © NRSNG, LLC. Chronic Kidney Disease involves symptoms associated with LOSS of normal kidney unctions such as Excretion of waste products Production of urine Electrolyte balance Acid-base balance Fluid volume regulation Erythropoietin - creation of RBCs [NRSNG Academy Lesson: Chronic Kidney Disease] [NRSNG Academy Lesson: Chronic Kidney Disease] Types of Viral Hepatitis TYPES OF VIRAL HEPATITIS VIRAL TYPE TRANSMISSION PREVENTION Hepatitis A Virus (HAV)** Fecal - Oral Hand Hygiene Safe Food Handling Vaccine Safe Sex Practices Handwashing Needle Safety Blood Screening Vaccine Hepatitis B Virus (HBV)** Blood - Body Fluids Hepatitis C Virus (HCV)** Blood Hepatitis D Virus (HDV) Blood - Body Fluids Same as HBV Fecal - Oral Same as HAV Hepatitis E Virus (HEV) [NRSNG Academy Lesson Hepatitis] [NRSNG Academy Lesson: Hepatitis] Handwashing Needle Safety Blood Screening Types of Anemia TYPES OF ANEMIA Anemia involves a decreased oxygen carrying capacity of the blood due to a change in the amount, size, or shape of the red blood cell or the amount of hemoglobin available for binding oxygen to the cell. Anemia of Blood Loss Hemorrhage COLOR SIZE SHAPE Normochromic Normocytic Normal Normochromic Normocytic Normal Hypochromic Normocytic Normal Normochromic Macrocytic Enlarged Normochromic Microcytic Abnormal A lastic Anemia Leukemia Medications Iron-De ciency Anemia Poor iron intake Chronic blood loss Pernicious Anemia Poor Vitamin B12 intake Sickle Cell Anemia Genetics Triggers (cold, infection) [NRSNG Academy Lesson: Anemia] [NRSNG Academy Lesson: Anemia] Burn staging BURN STAGING First Degree Second Degree Reddened, painful, intact skin Partial Thickness, broken skin, pain, pink/red, blisters By The original uploader was Snickerdo at English Wikipedia Transferred from en.wikipedia to Commons., CC BY-SA 3.0, h ps //commons.wikimedia.org/w/in dex.php?curid=3358773 Third Degree Fourth Degree Full thickness, often painless, white/black eschar Muscle and/or bone exposed. Common in electrical burns By Cli ord Sheckter, Arhana Cha opadhyay, John Paro and Yvonne Karanas - Direct source. Full paper., CC BY 4.0, h ps //commons.wikimedia.org/w/in dex.php?curid=68491398 By goga312. Original uploader was Goga312 at ru.wikipedia - Transferred from ru.wikipedia(Original te t ), CC BY-SA 3.0, h ps //commons.wikimedia.org/w/in dex.php?curid=7771672 [NRSNG Academy Lesson: Burn Injuries] [NRSNG Academy Lesson: Burn Injuries] skin Cancer [NRSNG Academy Lesson: Skin Cancer] skin Lesions SKIN LESIONS Macule and Patch A macule is a at area of hyperpigmentation, usually < 10mm. A Patch is a larger macule (usually > 10mm). By Madhero88 - Own work, CC BY-SA , h ps //commons.wikimedia.org/w/index.php?curid=14546457 Papule and Plaque A papule is a well-de ned raised area with no visible ui , usually < 10 mm. A plaque is a large papule or group of them, usually > 10 mm, or a large raised plateau-like lesion By Madhero88 - Own work, CC BY-SA , h ps //commons.wikimedia.org/w/index.php?curid=14546485 Nodules A nodule is similar to a papule - raised area with no uid - but is much deeper in the dermis than a papule. By Madhero88 - Own work, CC BY-SA , h ps //commons.wikimedia.org/w/index.php?curid=14546471 Vesicles and Bulla A vesicle is a small, well-de ned raised area lled with uid, usually <10mm. A Bulla is a large vesicle, usually >10mm. Both are also known as blisters. By Madhero88 - Own work, CC BY-SA , h ps //commons.wikimedia.org/w/index.php?curid=14546567 Fissures, Erosions, and Ulcers A ssure is a crack in the skin that is usually narrow but deep. Erosions involve full loss of the epidermis in a de ned area. Ulcers involve loss of the epidermis and some or all of the dermis. By Madhero88 - Own work, CC BY-SA , h ps //commons.wikimedia.org/w/index.php?curid=14546561 [NRSNG Academy Lesson: Integumentary Important Points] [NRSNG Academy Lesson: Integumentary Important Points] Lab Value skeletons LAB VALUE SKELETONS Complete Blood Count (CBC) Liver Enzymes Hgb T. Bili D. Bili WBC PLT Hct AST ALT ALK Phos Arterial Blood Gas (ABG) pH PaCO2 PaO2 HCO3 BE Basic Metabolic Panel (BMP or CHEM-7) and CHEM-10 Na Cl K HCO3 BUN Ca Glu Mg Cr Phos Bleeding Times Liver Profile Ca TP AST LDH PO4 Alb ALT ALP Bili PT [NRSNG Academy Lesson: Shorthand Lab Values] [NRSNG Academy Lesson: Shorthand Lab Values] PTT INR Lab Value for Clinical [NRSNG Academy Lesson: Lab Panels] Blood Compatibility Chart BLOOD COMPATIBILITY CHART DONOR BLOOD TYPE O- O+ B- B+ A- A+ AB- PATIENT BLOOD TYPE AB+ ABA+ AB+ BO+ O- [NRSNG Academy Lesson: Sickle Cell Anemia] [NRSNG Academy Lesson: Sickle Cell Anemia] AB+ ABg Rome Flowchart ABG ROME FLOWCHART pH HIGH LOW Alkalosis Acidosis HIGH PaCO2 Respiratory Acidosis LOW HCO3 LOW PaCO2 HIGH HCO3 Metabolic Acidosis Respiratory Alkalosis Metabolic Alkalosis [NRSNG Academy Lesson: ABG Labs] [NRSNG Academy Lesson: ABG Labs] Cardiac Biomarkers MYOGLOBIN CARDIAC BIOMARKERS 5-70 ng/mL Rise Peak Return 1-4 hours 6-12 hours 1-2 days TROPONIN I CK-MB <2.40 ng/mL Rise 6-10 hours 12-24 hours Peak 2-3 days Return <0.035 ng/mL Rise Peak 4-6 hours 18 hours Return 1-2 weeks LDH1 88-230 U/L Rise 8-12 hours 72 hours Peak 1-2 weeks Return [NRSNG Academy Lesson: Dysrhythmias] [NRSNG Academy Lesson: Dysrhythmias] IV Colors and gauges IV THERAPY USES FLOW RATE LENGTH SIZE (mm) (ml/min) COLOR IV COLORS AND GAUGES 14G 16G 18G 20G 22G 24G 45 45 32 32 25 19 240 180 90 60 36 20 Trauma Rapid Blood Surgery Rapid Blood Surgery Routine Blood Surgery Routine Blood Small Veins Peds Routine Peds Important Points: Check facility protocols. In general blood should not be given in a catheter <20G. Keep in mind the a smaller gauge # means a larger IV catheter. Most adult patients will need an 18G or 20G. Always consider what fluids the patient will be receiving before determining size. [NRSNG Academy Lesson: Preparing an IV Infusion] [NRSNG Academy Lesson: Preparing an IV Infusion] ABg Analysis ABG ANALYSIS Normal ABG Values pH DISORDER 7.35-7.45 PaCO 2 35-45 mmHg HCO3- 22-26 mEq/L PaO2 80-100 mmHg CAUSES ASSESSMENT FINDINGS TREATMENTS Respiratory Acidosis pH < 7.35; PaCO2 > 45 Hypoventilation -CNS depression -Pulmonary edema -Respiratory arrest -Airway obstruction -Bradycardia -Hypotension -Confusion -Somnolence -Increase RR -Reposition patient -Maintain patent airway -Mechanical ventilation - Rate - Vt Respiratory Alkalosis pH > 7.45; PaCO2 < 35 Hyperventilation -Excessive mechanical ventilation -Anxiety -Fever -Pneumothorax -Tachycardia -Palpitations -Anxiety -Seizures -Perspiration/ diaphoresis -Decrease RR -Administer sedatives -Rebreather mask -Mechanical ventilation - RR - Sedation - Vt Metabolic Acidosis pH < 7.35; HCO3 < 22 Acid Gain -Shock -Ketoacidosis -Renal failure Bicarbonate loss -Diarrhea -Bile drainage -Nausea/vomiting -Malaise -Tachypnea -Hypotension -Confusion -Improve oxygenation -Treat Cause -DKA -Diarrhea -Renal failure Metabolic Alkalosis pH > 7.45; HCO3 > 26 Acid Loss -Vomiting -Potassium loss (diuretic use) -Hyperaldosteronism - Cushing's - Steroids - Bicarbonate gain - Nausea/vomiting/ diarrhea -Confusion -Seizures -Tetany -Administer buffer -Treat cause [NRSNG Academy Lesson: ABG Labs] [NRSNG Academy Lesson: ABG Labs] Fluids and Electrolytes [NRSNG Academy Lesson: Potassium – K] Endocrine study guide Chart ENDOCRINE STUDY GUIDE CHART UNDER PRODUCTION SYNDROME OVER PRODUCTION SYNDROME HORMONE GLAND GH Anterio r Pituitary ADH Posterio r Pituitary Diabetes Insipidus SIADH T3,T4 Thyroid Myxedema Coma Graves PTH Parathyroid Hypopa Hyperparathyroid rathyroid Hyperpa Hypoparathyroid rathyroid Cortisol Adrenal Addisons Cushings Insulin Panc reas Diabetes Mellitus Acromega ly [NRSNG Academy Lesson: Addisons Disease] NRSNG.com - “Tools and Confidence to Succeed in Nursing School.” ©2018 NRSNG, LLC - Reproduction Strictly Prohibited Disclaimer information at NRSNG.com [NRSNG Academy Lesson: Addisons Disease] Addison’s Vs. Cushing’s [NRSNG Academy Lesson: Addisons Disease] Hyper Vs. Hypothyroidism HYPER VS. HYPOTHYROIDISM Body System Hypothyroidism Metabolic Hypometabolic Hypoglycemia Cold intolerance Weight gain / Edema Hypermetabolic Temperature Heat Intolerance Weight Loss Bradycardia Hypotension Anemia Tachycardia Hypertension Palpitations Neurological Lethargy / Fatigue Weakness Muscle aches Paresthesias Hyperactive reflexes Hand tremor Emotional instability Agitation Integumentary Dry skin Loss of body hair Fine, thin hair Constipation Goiter Exophthalmos Goiter Cardiovascular Other Hyperthyroidism T3, T4 Hormone Levels T3, T4 Free T4 Free T4 TSH TSH [NRSNG Academy Lesson: Hyperthyroidism] [NRSNG Academy Lesson: Hyperthyroidism] Fracture Management FRACTURE MANAGEMENT Strain excessive stretching of muscle Sprain excessive stretching of ligament TREATMENT ICE Rest, Ice, Compression, Elevation TYPES OF FRACTURES By OpenStax College - Anatomy & Physiology, Connexions Website. h p //cnx.org/content/col11496/1.6/, Sep 7, 2015., CC BY 4.0, | h ps //commons.wikimedia.org/w/index.php?curid=30127535 TRACTION Buck’s Traction Skeletal Traction force applied to splint pin through bone to hold weight Force in opposite direction Realign & immobilize fracture Traction weights: Hang freely Do not remove without order Support weight when moving patient MONITOR FOR COMPLICATIONS Fat Embolism Compartment Syndrome [NRSNG Academy Lesson: Fractures] [NRSNG Academy Lesson: Fractures] Stroke Symptoms by Location [NRSNG Academy Lesson: Assessment] Neuro Dysfunction by Pupil Assessment [NRSNG Academy Lesson: Routine Neuro Assessments] Routine Neuro Assessments ROUTINE NEURO ASSESSMENTS Pupils Equal, Round, and Reactive to Light and Accommodation (PERRLA) + Size in mm LEVELS OF CONSCIOUSNESS Normal A&O x 4, Alert Confused A&O x <3, unable to answer Delirious Confused and agitated Somnolent Excessively sleepy or drowsy Obtunded Awake, but slow or no response to surroundings Stuporous Sleep-like, no spontaneous activity, withdraws to pain Coma SCORE NO response to stimuli, unable to arouse GLASGOW COMA SCALE 2 4 3 1 5 6 - - Eyes No opening Open to pain Open to voice Open spontaneously Verbal No response Incomprehensible sounds Inappropriate words Disoriented Oriented - Motor No response Abnormal Extension Abnormal Flexion Withdraws to Pain Localizes to Pain Follows Commands MUSCLE STRENGTH SCORE ABILITY 0 No muscle contraction 1 Muscle twitch 2 Movement without gravity 3 Movement against gravity 4 Movement against resistance 5 Full Strength [NRSNG Academy Lesson: Routine Neuro Assessments] [NRSNG Academy Lesson: Routine Neuro Assessments] Newborn Assessment [NRSNG Academy Lesson: Initial Care of the Newborn] Labor LABOR STAGES OF LABOR First Stage Second Stage acement an ilation of cervi pulsion of fetus ree sta es latent, active, an transition Mot er is tal ative an ea er in latent p ase, becomin tire , restless, an ious as labor intensi es an contractions become stron er Pus in sta e Third Stage eparation of placenta pulsion of placenta Mot er as intense concentration on pus in it contractions may fall asleep bet een contractions Mot er is relieve after birt of ne born mot er is usually very tire Fourth Stage P ysical recovery r after e pulsion of placenta Mot er is tire , but is ea er to become ac uainte it er ne born FETAL POSITIONS Verte Positions ROA (right occipitoanterior) O left occipitoanterior ROP ri t occipitoposterior ace Positions RMA (right mentoanterior) M left mentoanterior RMP ri reech Positions left sacroanterior P left sacroposterior Other Brow Shoulder t mentoposterior OP left occipitoposterior ROT (right occipitotransverse) O left occipitotransverse ) FETAL MONITORING VEAL – CHOP V E A L VARIABLE DECELERATION EARLY DECELERATION ACCELERATION LATE ACCELERATION C H O P CORD COMPRESSION HEAD COMPRESSION OKAY! PLACENTAL INSUFFICIENCY [NRSNG[NRSNG Academy Mechanisms AcademyLesson: Lesson: Mechanisms of Labor] of Labor] Clinical Assistant – Brain sheet CLINICAL ASSISTANT - BRAIN SHEET Date: Patient Initials Floor: Room Number: Reason for hospitalization: Focused Ass ess me nt: Assess me nt Notes: Consultations/ Tests: Name Patient Med ications: Reason Considera ons [NRSNG Academy Lesson: Documentation] [NRSNG Academy Lesson: Documentation] Time CLINICAL ASSISTANT - BRAIN SHEET Normal L ab Values Na K Cl CO2 BUN Creat pH 135-148 3.5-5.3 100-112 23-29 5.0 - 25.0 0.5 - 1.7 7.35-7.45 WBC RBC male RBC female Hgb male Hgb female Hct male Hct female 3.6-9.2 4.39-5.58 3.70-5.14 13.7-17.3 12-15.5 39-49 35-46 Platelet Albumin Ca PT aPTT INR Billirubin Time Pulse Pulse Ox Respirations BP Temp Pain Patient Vitals Time Pulse Pulse Ox Respirations BP Temp Pain Time Pulse Pulse Ox Respirations BP Temp Pain Time Pulse Pulse Ox Respirations BP Temp Pain Time Pulse Pulse Ox Respirations BP Temp Pain Time Pulse Pulse Ox Respirations BP Temp Pain 140-400 3.5-5.0 8.3-10.3 10.4-12.2 24-33 2.0-3.0 0.0-1.0 “Nurses Dispense Comfort, Compassion, and Caring Without Even a Prescription.” Val Saintsbury Intake & Output IV Site Assess me nt/Fluid/Rate Tasks/ Notes Calculations Things to Research/I mpr ove [NRSNG Academy Lesson: Documentation] Pediatric Burn Chart PEDIATRIC BURN CHART BASED ON LUND BROWDER CHART A A 1 1 2 13 2 2 1 1 1/4 1 1/4 1 1 1/4 1 1/4 2 1 B B C C BIRTH A: 1/2 of Head 9 1/2 B: 1/2 of Thigh 2 3/4 C: 1/2 of Leg 2 1/2 C C 1 3/4 1 1 1 1/4 2 1/2 2 1/2 B B 6 1/2 3 1/4 4 2 1/2 2 3/4 AGE 15 YR ADULT 4 1/2 3 1/2 4 1/2 4 3/4 3 1/4 3 1/2 2 1 1/2 1 1/4 AGE 5 YR 8 1/2 13 2 2 AGE 1 YR 1 3/4 1 1 1/2 B B A 1 1/2 1 1/4 2 B A 13 2 AREA 1 1 2 13 1 1 1 1/2 B 1 1/4 C 1 3/4 C 1 3/4 AREA AGE 10 YR A: 1/2 of Head 5 1/2 B: 1/2 of Thigh 4 1/2 C: 1/2 of Leg 3 C 1 3/4 C 1 3/4 NRSNG.com - “Tools and Confidence to Succeed in Nursing School.” ©2018 [NRSNG Academy Lesson: Burn Injuries] NRSNG, LLC - Reproduction Strictly Prohibited Disclaimer information at NRSNG.com [NRSNG Academy Lesson: Burn Injuries] Erikson’s stages of Psychosocial ERIKSON’S STAGES Development OF PSYCHOSOCIAL DEVELOPMENT AGE STAGES CHARACTERISTICS Infancy (birth to 18 months) Trust vs Mistrust Development of trust based on caregivers Early childhood (18 mo - 3yr) Autonomy vs Shame and Doubt Development of sense of personal control Preschool (3-5yr) Initiative vs Guilt Development of sense of purpose and directive School age (6-11yr) Industry vs Inferiority Development of pride in accom plishments Adolescence (12-18yr) Identity vs Role Confusion Exploration of independence and development of self Early adulthood (18-40yr) Intimacy vs Isolation Development of personal relationships and love Adulthood (40-65yr) Generativity vs Stagnation Fulfilling goals and building career and family Older adult (65yr-death) Integrity vs Despair Looking back on life with accep tance [NRSNG Academy Lesson: Theories of Growth and Development] [NRSNG Academy Lesson: Theories of Growth and Development] Congenital Heart Defects CONGENITAL HEART DEFECTS CYANOSIS NO Vascularity Increased Vascularity Normal Aortic Stenosis Pulmonic Stenosis oarctation of the Aorta L Atrium Enlarged YES YES efect Transposition of the reat Arteries (T A) Truncus Arteriosus TAPV Tricuspid Atresia Tingle Ventricle Cardiac Enlargement YES Ebstein’s Anomaly Pulmonic Atresia Tricuspid Atresia Aorta Enlarged Patent uctus Arteriosus (P A) Vascularity Decreased NO Atrial Septal YES Vascularity Increased NO Tetralogy of allot NO Ventricular Septal efect NRSNG.com [NRSNG - “Tools Academy andLesson: Confidence Congenital to Succeed Heart in Defects] Nursing School.” ©2018 NRSNG, LLC - Reproduction Strictly Prohibited Disclaimer information at NRSNG.com [NRSNG Academy Lesson: Congenital Heart Defects] Crystalloid IV Solutions CRYSTALLOID IV SOLUTIONS IVF Content Tonicity Osmolality (mOsm/L) Uses D5W - 50 g/L glucose - 170 Kcals/L - no electrolytes Isotonic 252 - treat hypernatremia, replace water loss - free water (helps renal excretion of solutes) - used to administer medications D10W - 100 g/L glucose - 340 Kcals/L - no electrolytes Hypertonic 505 - free water only 154 - maintenance solution, but doesn’t replace other daily electrolytes - free water and NaCl - replace hypotonic fluid loss - can cause IVF overload if infused too rapidly Isotonic 308 - used for postoperative fluids - increase IVF and replace ECF fluid losses - NaCl in higher concentration then blood levels - no free water - can cause IVF overload - only solution that can be administered with blood products Hypertonic 1026 - 0.45% saline ½NS - 77 mMol/L of Na+ and Cl - no electrolytes Hypotonic - - 0.9% saline NS - 154 mMol/L of Na+ and Cl - no calories - 3.0% saline 3%NS D5-¼NS - 513 mMol/L of Na+ and Cl- - cerebral edema - 0.225% saline - 50 g/L glucose - Provides NaCl and free water - 170 kcals/L - 38.5 mMol/L of Na+ and Cl Isotonic 330 - maintenance solution, but doesn’t replace other daily electrolytes - free water and NaCl - 50 g/L glucose Hypertonic - 170 kcals/L - 77 mMol/L of Na+ and Cl 406 - 50 g/L glucose Hypertonic - 170 kcals/L - 154 mMol/L of Na+ and Cl - - replace hypotonic fluid loss - can cause IVF overload if infused too rapidly - - 0.9% saline D5-NS - treatment of hypernatremia - replace hypotonic fluid loss - - 0.45% saline D5-½NS - administer cautiously, slowly treatment for symptomatic hyponatremia 560 - increase IVF and replace ECF fluid losses - used for postoperative fluids - NaCl in higher concentration then blood levels - no free water - can cause IVF overload [NRSNG Academy Lesson: Preparing an IV Infusion] [NRSNG Academy Lesson: Preparing an IV Infusion] Drug Card DRUG CARD Generic Name Pharmacologic Class Trade Name Therapeutic Class _ Action _ Reason Given (Disease States) _ Nursing Process Pre-Administration Assessment Post Administration Evaluation Nursing Considerations Other ______________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________ [NRSNG Academy Lesson Essential NCLEX Meds by Class] [NRSNG Academy Lesson: Essential NCLEX Meds by Class] Nervous system Pharmacology NERVOUS SYSTEM PHARMACOLOGY Nervous System CNS Brain PNS Spinal Cord Motor Neurons Autonomic Nervous System Sympathetic Nervous System (Adrenergic) “Fight or Flight” Primarily Norepinephrine (Adrenaline) Alpha Receptors: vessels Beta1-Receptors: heart Beta2-Receptors: bronchial/vascular smooth muscle Dopaminergic: renal/mesenteric artery Sensory Neurons Somatic Nervous System Parasympathetic Nervous System (Cholinergic) “Rest and Digest” Primarily ACh Muscarinic Receptors Nicotinic Receptors MED CLASSES/EXAMPLE MEDS ADRENERGIC AGONIST (SYMPATHOMIMETIC): Mimics the effects of the SNS. (dobutamine, dopamine, epinephrine, norepinephrine, phenylephrine, albuterol, isoproterenol, salmeterol). CHOLINERGIC AGONISTS (PARASYMPATHOMIMETIC): Mimic the effects of the PNS. (donepezil, bethanechol, pyridostigmine). ADRENERGIC BLOCKING AGENTS (SYMPATHOLYTIC): Block the effects of the SNS. (beta-blockers, amiodarone, tamsulosin, doxazosin, phentola mine). ANTICHOLINERGIC AGENTS (PARASYMPATHOLYTIC): Block the effects of the PNS. (atropine, scopolamin, ipratropium, trospium). [NRSNG Academy Lesson: Autonomic Nervous System] [NRSNG Academy Lesson: Autonomic Nervous System] Dopamine Vs Dobutamine DOPAMINE VS DOBUTAMINE DOPAMINE DOBUTAMINE Vasopressor Inotrope Only Alpha 1 effects leading to Primarily exhibits Beta 1 effects to aid in increasing CO Action ects Beta 1 effects leading to an increase in HR at lower doses. Increased perfusion to the kidneys at 5 mcg/kg/min. Effective to BP in distributive shocks (septic, anaphylactic) as it will contribute to SVR through vasoconstriction Usage Drug CO **Dobutamine Dopamine MAP SVR Phenylephrine PAOP Generally given to CO. Used in HF and Cardiogenic shock. Drug of choice for CO as it does not cause HR at lower doses leading to less myocardial oxygen demand SVR HR same or CO Vasopressin Norepinephrine Epinephrine Dopamine Dobutamine SVR Check us out on YouTube CO View Jon's Books on Amazon.com Find our Podcast on iTunes and Stitcher: Search "NRSNG" [NRSNG Academy Lesson: Cardiogenic Shock] [NRSNG Academy Lesson: Cardiogenic Shock] Beta Blockers BETA BLOCKERS Sympathetic Nervous System - ight or light o SNS stim ulates recep tors throug hout the body to create "fight or flight response" o Recep tors Alpha - ves sels Beta 1 - Hea rt Beta 2 - Lungs eta Receptors o When stim ulated by SNS they cause: Increase Cardiac Output Increase HR in SA node (Chronotropic effect) Increase atrial contractility (Inotropic effect) Increase conduction and autom aticity of AV node Increase conduction and autom aticity of ventricles oal of eta loc er Therapy o Goal is to block stim ulation of B1 receptors in heart = HR ommon - loc ers o Metoprolol o Esm olol o Propranolol Side ects of - loc ers o Bradycardia o Blood Pres sure o Bronchoconstriction o Blood sug ar abnorm alities [NRSNG Academy Lesson: Disease Specific Medications] Common ICU Drips [NRSNG Academy Lesson: Vasopressin] Medication Antidotes MEDICATION ANTIDOTES Med ication Acetam inophen Anticholinesterase Anticholinergics Benzodiazepines Beta -Blockers Ca Channel Blockers Coumadin Digo xin Dopam ine Heroin Heparin Iron Malignant Hyperthermia Methotrexate Narcotics Potassium Tricyclic Antide pressants Antidote acetylcysteine, mucomyst atropine, pralidoxine physos tigmine Romazicon (flumaze nil) glucago n, epinephrine Ca Chloride, glucag on phy tonadione, vitam in K Digibind Rigitine Narcan (naloxone) protamine sulfate d eferoxamine dantrolene leucovorin calcium Narcan (nalxone) Insulin, Bicarb, albut erol, Kayexa late physos tigimine, Bicarb [NRSNG Academy Lesson: 6 Rights of Medication Administration] [NRSNG Academy Lesson: 6 Rights of Medication Administration] Insulin Cheat sheet INSULIN CHEAT SHEET Intermediate Acting Pre- Mixed NPH w/ Reg ular ONSET PEAK DURATION 15m 30-90m 3-5h Apidra Insulin glulisine 15m 30-90m 3-5h Humalog Insulin lispro 15m 30-90m 3-5h Humulin R Regular 30-60m 2-4h 5-8h Novolin R Regular 30-60m 2-4h 5-8h Humulin N NPH 1-3h 8h 12-16h Novolin N NPH 1-3h 8h 12-16h Humulin 70/30 70%NPH and 30% Reg 30-60m varies 10-16h Novolin 70/30 70%NPH and 30% Reg 30-60m varies 10-16h Humulin 50/50 50%NPH and 50% Reg 30-60m varies 10-16h MIXING INSULIN REGULAR Short-Acting GENERIC NAME Insulin aspart REGULAR Rapid-Acting BRAND NAME NovoLog NPH TYPE NPH 1) Withdraw enough air equal to the total amount of insulin. 2) Inject the air into the NPH without touching the insulin. 3) Inject remaining air into the regular insulin then withdraw the regular dosage. 4) Withdraw the NPH dosage. [NRSNG Academy Lesson: Diabetes Management] [NRSNG Academy Lesson: Diabetes Management] Common Antihypertensive Drugs [NRSNG Academy Lesson: ACE Inhibitors] Antidepressant Cheat Sheet [NRSNG Academy Lesson: Antidepressants] Immunization Schedule IMMUNIZATION SCHEDULE BABY (months) BIRTH HepB 1 CHILD (years) 2 4 6 HepB 12 15 18 19-23 2-3 4-6 HepB RV RV RV TDaP TDaP TDaP Hib Hib Hib Hib PCV PCV PCV PCV IPV IPV TDaP TDaP IPV IPV Anual In uen a (Yearly) MMR MMR Varicella Varicella HepA (2 ose series) [NRSNG Academy Lesson: Rubeola – Measles] [NRSNG Academy Lesson: Rubeola – Measles] Antibiotic Cheat Sheet ANTIBIOTIC CHEAT SHEET ANTIBIOTIC MOA In ibition of nucleic aci synthesis In ibition of protein synthesis In ibition of cell wall synthesis Disruption of cell membrane function ell wall loc pathways an in ibit metabolism ell membrane NA olic acid Ribosome ow and here Various Antibiotics ram Negative or ram Positive uter membrane ipoproteins Peptidoglycan Periplasmic space utoplasmic membrane ipopolysaccharides Porin Protein Gram + and - Gram + Penicillins (Amoxicillin) Gram + (Strep, Syphillis) Disrupts synth of peptidoglycan Tetracyclines (tetracycline, doxycycline) Broad spectrum (Gram +/-, atypicals) Inhibit protein synth Sulfonamides (TMP-SMZ) UTIs Inhibit DNA synth Macrolides (azythromycin, erythromycin) Gram + (URI’s, Strep, Staph) Inhibits protein synth Cephalosporins Disrupts synth of peptidoglycan 1st gen Gram + (Keflex) 2nd gen Gram - Gram + (Cefzil) 3rd gen Gram - Gram + Pseudomonas (cefdinir) 4th gen Pseudomonas (Cefepime) 5th gen MRSA (Ceftobiprole) Carbapenems (meropenem) Broad spectrum Disrupts synth of peptidoglycan Fluoroquinolones (Ci ro o acin e o o acin) Broad spectrum Inhibit DNA synth Metronidazole (Flagyl) Anaerobes, protozoa Disrupts DNA Lincosamides (clindamycin) Step, Staph Inhibit protein synth Gram Aminoglycosides (streptomycin, tobramycin, gentamicin) Gram - Psuedomonas - TB Inhibit protein synth [NRSNG Academy Lesson Penicillin and Cephlosporins] [NRSNG Academy Lesson: Penicillin and Cephlosporins] Answering Pharmacology Questions QUESTIONS ANSWERING PHARMACOLOGY 12 Points to Answering Pharmacology Questions 1. Patient Safety The NCLEX®is concerned about if you will be a SAFE nurse. Always think about what option will lead to your patient being safe. You can automatically exclude options that will put your patient in harm. 2. Focus on Side ects Learn the top 3 side effects with major medication classes. If you know the class and the major side effects associated with that class you greatly increase your chances of answering correctly. 3. ABCs Airway, Breathing, Circulation. The ABCswill never go away. Focus on the nursing process and the ABCswith each and every question including side effects. 4. Prefi es and Su es Learn the most common prefixes and suffixes. This will cut down your total study time tremendously. 5. Look for Patient Clues Does the question provide information about the patients original diagnosis? Use general clues in the question about the patients, their history, and their condition. These clues will guide you to the medications they will be taking. 6. General Patient Reaction Look for clues in the patients reactions. For example if the patient reports dizziness, this is a clue that you should assess blood pressure. Use your assessment skills to answer pharmacology questions. 7. Generic Only generic names will be used on the actual NCLEX®. Although these names can be a bit harder to pronounce, they will provide clues (prefix/suffix) into the type of medication it is which will guide you in choosing the correct answer. 8. Random, Random, Random Regardless of how much you study . . . you will get that insanely random medication that no one has ever heard of. In this case just take a deep breath, relax, and use your nursing judgment, critical thinking, and think Patient Safety. [NRSNG Academy Lesson: 12 Points to Answering Pharmacology Questions] [NRSNG Academy Lesson: 12 Points to Answering Pharmacology Questions] ANSWERING PHARMACOLOGY QUESTIONS Answering Pharmacology Questions 9. Medical Diagnosis Does the question identify a medical diagnosis If you have a working medical diagnosis, use your knowledge to determine what signs and symptoms the patient will have, what medications they will require to manage those symptoms, and what are the main side effects of those medications. 10. Freebies If you are already familiar with the medication . . . simply use your knowledge, the nursing process, and critical thinking to answer the question. 11. Med Classes Learn to recognize common side effects with major medication classes and the appropriate nursing intervention for each of these side effects. 12. Why is the Medication Given? Why is the medication being given. Try to identify a relationship between the medication and the patients diagnosis. If you have the underlying diagnosis you can generally identify what medication will be given for that condition. [NRSNG Academy Lesson: 12 Points to Answering Pharmacology Questions] [NRSNG Academy Lesson: 12 Points to Answering Pharmacology Questions] Therapeutic Drug LEVELS Levels THERAPEUTIC DRUG DRUG THERAPEUTIC LEVEL Digoxin 0.8-2 ng/mL Lithium 0.8-1.2 mEq/L Theophylline 10-20 mcg/mL Phenytoin 10-20 mcg/L OTHERS Vancomycin Trough 10-20 mcg/L Salicylate 150-300 mg/L Carbamazepine 5-12 mcg/L Gentamicin 5-10 mcg/mL Phenobarbital 10-40 mcg/mL Procainamide 4-10 mcg/mL Amitriptyline 120-150 ng/mL [NRSNG Academy Lesson: Therapeutic Drug Levels] [NRSNG Academy Lesson: Therapeutic Drug Levels] ANTIDYSRRHYTHMIC MEDS AND ACTION Antidysrrhythmic Meds and Action POTENTIAL CHART Antiarrhythmic AChart ents Potential K Cl Ca I Class IV Ca Channel Blocker Verapamil Diltiazem 1 2 K 0 a I Class I Class II Beta Blocker Na Channel Blocker 1a: Procainamide 1b: Lidocaine 1c: Proprafenone 3 Class III K Channel Blocker Amiodarone Sotalol Propranolol Metoprolol 4 4 This chart represents the cardiac action potential (first image) with the electrical conduction of the heart EKG. The EKG is representative of what is occuring during each phase of the cardiac action potential. Along the cardiac action potential you will see what is occuring with the ions. Below the ion activity you will note what antiarrhythmic medications will have an effect during that phase of the action potential. [NRSNG Academy Lesson: Calcium Channel Blockers] [NRSNG Academy Lesson: Calcium Channel Blockers] Hierarchy of O2 Delivery systems HIERARCHY OF O2 DELIVERY SYSTEMS METHOD Nasal Cannula 1 lpm = 24% 2 lpm = 28% 3 lpm = 32% 4 lpm = 36% 5 lpm = 40% 6 lpm = 44% Simple Face Mask 5 lpm = 40% 6 lpm = 45-50% 7 lpm = 50-55% 8 lpm = 55-60% Non-rebreather Mask 6 lpm = 60% 7 lpm = 70% 8 lpm = 80% 9 lpm = 90% 10 lpm = close to 100 Terms to Know: Pressure support: Preset inspiratory support level. When the pt initiates a breath, this positive pressure flows to assist the pts spontaneous breaths. 2 PEEP ( ositive end-expiatory pressure): Maintenance of pressure above atmospheric at end expiration. Auto-PEEP: Trapping of gas in the lung caused by insufficient expiatory time (breath stacking). Increases risk of barotrauma. Venturi Mask 4 lpm = 24-28% 8 lpm = 35-40% 12 lpm = 50% PIP (peak inspiratory pressure): Airway pressure at the peak of inspiration. Trach Collar 21- 0 at 10L Tidal Volume (Vt): The volume of air expired with each breath T-Piece 21-100 with flow rate at 2.5 times minute ventilation CPAP Positive airway pressure during spontaneous breaths Bi-PAP Positive pressure during spontaneous breaths and preset pressure to be maintained during expiration SIMV Preset Vt and f. Circuit remains open between mandatory breaths so pt can take additional breaths. Ventilator doesn’t cycle during spontaneous breaths so Vt varies. Mandatory breaths synchronized so they do not occur during spontaneous breaths. Respiratory Rate (f): The number of breaths per minute, may be greater than preset frequency, but not less. Minute ventilation (Ve): Vt X f; volume of air expired per minute. PaCO2 (35-45 mm Hg): Amount of CO2 dissolved in arterial blood. Partial pressure of arterial CO2. SaO2 (95-100%): Percentage of oxygenated hemoglobin in arterial blood. Indirectly measured via SpO2 (pulse ox). PaO2 (80-100 mm Hg): Amount of oxygen dissolved in blood plasma. Bi-PAP Preset Vt and f and inspiratory effort required to assist spontaneous breaths. Delivers control breaths. Cycles additionally if pt inspiratory effort is adequate. Same Vt delivered for spontaneous breaths. [NRSNG Academy Lesson Hierarchy of O2 Delivery] [NRSNG Academy Lesson: Hierarchy of O2 Delivery] Lung sounds [NRSNG Academy Lesson: Lung Sounds] gas Exchange GAS EXCHANGE By helix84 (en:Image:Alveoli.jpg) [GFDL (h p //www.gnu.org/copyleft/fdl.html), CC-BY-SA-3.0 (h p //creativecommons.org/licenses/by-sa/3.0/) or CC BY 2.5 (h p //creativecommons.org/licenses/by/2.5)], via Wikimedia Commons Gas exchange occurs in the alveoli t e functional unit of the lungs. Deoxygenated blood enters the capillaries surrounding the alveoli, O2 enters the bloodstream and CO2 exits into the alveoli to be exhaled. Causes of Poor Gas Exchange Priority Interventions Atelectasis Re-in ate alveoli Hyper or Hypoventilation Treat cause to restore normal Poor Air ow (airway swelling or breathing pa ern bronchoconstriction) Give meds to open airways Pulmonary Edema Diuretics to decrease uid in lungs Pulmonary Embolism Thrombolytic or Thrombectomy Vasoconstriction Vasodilators Low blood volume Replace lost blood volume [NRSNG Academy Lesson: Gas Exchange] [NRSNG Academy Lesson: Gas Exchange] Asthma Medications [NRSNG Academy Lesson: Asthma] Artificial Airways Decision Tree ARTIFICIAL AIRWAYS DECISION TREE Use this decision tree to determine which of the four arti cial airways is most appropriate for your patient’s situation Conscious Clears own secretions Apply oxygen as needed Can’t clear own secretions E ective respiratory e ort Ine ective respiratory e ort Nasopharyngeal Airway + Suction Requires ventilation Endotracheal Tube Unconscious Respiratory e ort, unprotected airway No respiratory e ort If head tilt, chin lift or jaw thrust ine ective No contraindication to intubation Tracheal obstruction or damage Oropharyngeal Airway + Bag/Valve/Mask Endotracheal Tube Tracheotomy [NRSNG Academy Lesson: Artificial Airways] Ventilator Alarms [NRSNG Academy Lesson: Vent Alarms] Chest Tube Management CHEST TUBE MANAGEMENT INDICATIONS FOR A CHEST TUBE: Drain uid, blood, or air Pleural e on Hemothorax Pneumothorax Establish negative pressure Facilitate lung e pansion By British Columbia Institute of Technology (BCIT). Download t is book for free at h p //open.bccampus.ca h ps //opente tbc.ca/clinicalskills/chapter/10-7-chest drainage-syst ems/, CC BY-SA 4.0, h ps //commons.wikimedia.org/w/index.p p?curid=66770951 PRIORITY NURSING ASSESSMENTS (TWO AA’S) Tidaling - uid should uctuate with respirations Water seal - there should be su ient water in the water seal chamber Output - color, character, and quanti y of output - measured hourly at rst, then every 4-8 hours per policy Air leak - conti ous bubbling in the water seal chamber indicates an air leak - this should be troubleshooted immediately Ability to breathe - always assess the patient’s lung sounds and respiratory e ort SpO is the patient oxygenati g? SAFETY CONSIDERATIONS Avoid dependent loops Never strip or clamp tubing Ensure collection chamber stays upri ht Assess insertion site & dressing for bleeding or drainage Accidental removal - cover wit sided occlusive dressing [NRSNG Academy Lesson: Chest Tube Management] [NRSNG Academy Lesson: Chest Tube Management] Notes 82 Notes 83 Notes 84 Notes 85 Notes 86 Notes 87 Notes 88 Notes 89 Notes 90