Essential Definitions and Concepts to Understand

Fundamentals (1–20)

1. ADPIE (Nursing Process)
   A structured approach for RN-level decision-making: Assessment, Diagnosis, Planning, Implementation, and Evaluation.
2. Maslow’s Hierarchy of Needs
   A priority system for human needs: Physiological → Safety → Love/Belonging → Esteem → Self-Actualization.
3. ABCs
   Airway, Breathing, Circulation—critical for addressing life-threatening conditions.
4. Therapeutic Communication
   Effective communication through open-ended questions, reflective listening, and active engagement, while avoiding false reassurance or personal opinions.
5. Informed Consent
   Ensures patients fully understand the procedure’s risks and benefits, and agree voluntarily, while being mentally competent to decide.
6. HIPAA (Confidentiality)
   Safeguarding patient privacy by sharing information only with those directly involved in care.
7. Standard Precautions
   Universal measures like hand hygiene and personal protective equipment (PPE) for all patients, with additional precautions (contact, droplet, airborne) as necessary.
8. Patient Advocacy
   Representing and defending the patient’s rights and best interests.
9. Delegation
   Assigning tasks appropriately using the five rights: task, circumstance, person, direction/communication, and supervision.
10. Documentation Principles
    Ensure care documentation is factual, accurate, complete, current, and organized—serving as the legal record of care provided.
11. SBAR Communication
    A structured communication method for effective handoffs: Situation, Background, Assessment, and Recommendation.
12. Vital Sign Norms
    Standard adult ranges: Heart Rate (60–100), Respiratory Rate (12–20), Blood Pressure (~120/80), Temperature (36.5–37.5°C), Oxygen Saturation (>94%).
13. Body Mechanics
    Techniques for safe lifting, such as using the legs, keeping objects close to the body, and maintaining a wide base of support.
14. Pain Assessment
    Using tools like PQRST (Provokes, Quality, Radiates, Severity, Time) or numeric and facial scales to assess pain levels.
15. Types of Nursing Diagnoses
    Different classifications: Actual, Risk, and Health Promotion, with clear “related to” and “as evidenced by” statements.
16. Incident Reporting
    Accurate documentation of unusual events (e.g., falls, medication errors), but do not note the incident report was filed in the chart.
17. Advance Directives
    Legal documents such as living wills and durable power of attorney for healthcare, outlining patient preferences for end-of-life care.
18. Immobility Risks
    Risks such as pressure ulcers, contractures, DVT, and pneumonia—mitigated by repositioning, range of motion (ROM) exercises, and SCDs.
19. Fire Safety (RACE, PASS)
    RACE: Rescue, Activate alarm, Contain, Extinguish. PASS: Pull, Aim, Squeeze, Sweep—fire extinguisher usage.
20. Infection Control
    Understanding the chain of infection (agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host) and strategies to break any link to prevent spread.

Pharmacology (21–40)

21. 6 Rights of Medication Administration
    Ensure the correct Patient, Drug, Dose, Route, Time, and Documentation (and sometimes Right Reason/Response) are followed.
22. High-Alert Medications
    Drugs like insulin, opioids, anticoagulants, and chemotherapy require extra verification or caution due to their risk of severe consequences.
23. Therapeutic Drug Levels
    Monitoring blood concentrations of certain medications, such as Digoxin (0.5–2 ng/mL), Lithium (0.6–1.2 mEq/L), and Theophylline (10–20 mcg/mL), to ensure effectiveness and avoid toxicity.
24. Trough and Peak
    The trough is the lowest serum level before the next dose, and the peak is the highest level after administration. Crucial for drugs like vancomycin and aminoglycosides.
25. IV Infiltration vs. Extravasation

• Infiltration: Non-vesicant fluids leaking, causing the site to be cool and pale.
• Extravasation: Vesicant fluids leaking, resulting in tissue damage such as pain and blistering.

26. Insulin Types

• Rapid (Lispro): Onset ~15 min, peak ~1 hr
• Short (Regular): Onset ~30 min, peak ~2–3 hr
• Intermediate (NPH): Onset ~1–2 hr, peak ~4–8 hr
• Long (Glargine): Minimal peak, lasts 24+ hr

27. Warfarin vs. Heparin Monitoring

• Warfarin: Monitored by PT/INR (target INR ~2–3)
• Heparin: Monitored by aPTT (1.5–2.5× baseline), with protamine sulfate as the antidote.

28. Opioid Side Effects
    Common effects include respiratory depression, constipation, sedation, nausea, and urinary retention. Naloxone (Narcan) reverses these effects.
29. Beta-Blockers
    Medications ending in -olol, used to reduce HR and BP. Be cautious for bradycardia and wheezing, particularly with nonselective types.
30. ACE Inhibitors
    Medications ending in -pril, which may cause a cough, hyperkalemia, and angioedema. Monitor BP and potassium levels.
31. Diuretics

• Loop (furosemide): Watch for hypokalemia.
• Thiazide (hydrochlorothiazide): Mild diuretic effect, also carries a risk for hypokalemia.
• K-sparing (spironolactone): Risk of hyperkalemia.

32. Antibiotic Classes
    Includes drugs like penicillins (amoxicillin), cephalosporins (ceftriaxone), tetracyclines (doxycycline), macrolides (azithromycin), and fluoroquinolones (ciprofloxacin). Be aware of major side effects and cross-sensitivities.
33. Antipsychotics
    Distinguish between typical and atypical antipsychotics, noting the risks of extrapyramidal symptoms (EPS), tardive dyskinesia, and metabolic syndrome.
34. SSRIs
    Selective serotonin reuptake inhibitors, commonly used to treat depression, carry a risk of serotonin syndrome, especially if combined with MAOIs or other serotonergic drugs.
35. Metered-Dose Inhalers (MDIs)
    Proper technique: Shake, exhale, inhale slowly while pressing the canister, hold breath for 10 seconds, and exhale slowly.
36. Drug Calculations
    Includes calculations for pediatric dosing (mg/kg), IV drip rates, and reconstitution math. Master the method of dimensional analysis.
37. Suffix Clues
    Recognize medication classes by their suffixes:

• -pril (ACE inhibitors)
• -sartan (ARBs)
• -lol (beta-blockers)
• -mycin (antibiotics)
• -azole (antifungals)
• -prazole (proton pump inhibitors)

38. Epinephrine (Adrenaline)
    Used for anaphylaxis and advanced cardiac life support (ACLS). It increases HR and BP, and extravasation can cause tissue damage.
39. Antidotes
    Reversal agents for specific overdoses:

• Naloxone for opioids
• Flumazenil for benzodiazepines
• Acetylcysteine for acetaminophen
• Vitamin K for warfarin
• Protamine sulfate for heparin

40. Polypharmacy
    The use of multiple medications in elderly patients, which increases the risk of drug interactions and adverse effects. This is a common concern in geriatric care.

Medical-Surgical (41–100)

A. Cardiovascular (41–50)

41. Heart Failure (HF)
• Left-sided (pulmonary symptoms) vs. Right-sided (systemic edema). S3 gallop is typical.
• Treatment: diuretics, ACE inhibitors, beta-blockers, low-sodium diet.

42. Coronary Artery Disease
    • Atherosclerosis leading to angina or myocardial infarction (MI).
    • Management: nitrates, beta-blockers, antiplatelets (e.g., aspirin), lifestyle changes.
43. Myocardial Infarction (MI)
    • Elevated troponin I/T, chest pain, potential ECG changes (ST elevation).
    • Immediate measures: MONA-B (Morphine, O2, Nitrates, Aspirin, Beta-blockers).
44. Hypertension
    • Known as the “silent killer.” Can be primary or secondary.
45. Peripheral Artery Disease (PAD)
    • Symptoms include claudication, decreased pulses, cool extremities, ulcers on toes.
    • Management: exercise, antiplatelets, revascularization if necessary.
46. Deep Vein Thrombosis (DVT)
    • Symptoms include calf pain, swelling, and possibly Homan’s sign (controversial).
    • Anticoagulation therapy to prevent pulmonary embolism.
47. Dysrhythmias
    • Conditions such as A-fib, V-tach, PVCs, and heart blocks. Understanding EKG and emergent interventions (e.g., amiodarone, cardioversion).
48. Shock Types
    • Hypovolemic, cardiogenic, and distributive (e.g., septic, anaphylactic). Early recognition is essential.
49. Anemia
    • Types include iron deficiency, pernicious, and hemolytic. Watch hemoglobin/hematocrit (H/H) and RBC indices, monitor for symptoms like fatigue and pallor.
50. Blood Transfusion Basics
    • Confirm crossmatch, use an 18–20G IV, and monitor for transfusion reactions such as fever or flank pain.

B. Respiratory (51–60)

51. Chronic Obstructive Pulmonary Disease (COPD)
• Chronic bronchitis (blue bloater) vs. emphysema (pink puffer).
• Avoid high O2 in some COPD patients due to the risk of CO2 retention.

52. Asthma
    • Reversible airway inflammation with various triggers (e.g., allergens, exercise).
    • Quick-relief medications include short-acting beta-agonists (e.g., albuterol); long-term treatment may include inhaled steroids.
53. Pneumonia
    • Inflammation of alveoli caused by infection. Symptoms include fever, productive cough, and crackles.
    • Management includes antibiotics, fluids, and respiratory support like incentive spirometry.
54. Tuberculosis (TB)
    • Caused by Mycobacterium tuberculosis, transmitted via airborne droplets.
    • Symptoms: night sweats, weight loss, cough. Treatment includes RIPE therapy (Rifampin, Isoniazid, Pyrazinamide, Ethambutol).
55. Pulmonary Embolism (PE)
    • A blood clot obstructing the pulmonary artery. Symptoms include sudden dyspnea, chest pain, and tachycardia.
    • Treatment may include anticoagulants and thrombolytics in severe cases.
56. Arterial Blood Gases (ABGs)
    • Normal values: pH 7.35–7.45, PaCO2 35–45, HCO3 22–26.
    • Interpretation of respiratory vs. metabolic acidosis/alkalosis.
57. Oxygen Delivery Devices
    • Options include nasal cannula (1–6 L/min), simple mask (5–8 L/min), non-rebreather (~60–90% FiO2), and Venturi mask (precise FiO2).
58. Chest Tube Care
    • Maintain water seal, monitor drainage, keep the system below the chest level.
    • If dislodged, apply a sterile occlusive dressing and notify the provider.
59. Incentive Spirometry
    • Promotes deep breathing, reduces the risk of atelectasis post-surgery or in respiratory conditions.
60. Mechanical Ventilation
    • Settings include tidal volume, rate, FiO2, and PEEP. Monitor ABGs, sedation level, and prevent VAP (ventilator-associated pneumonia).

C. Endocrine (61–70)

61. Diabetes Mellitus
• Type 1 vs. Type 2 diabetes, treatment with insulin or oral medications. Monitor for DKA or HHS.

62. Diabetic Ketoacidosis (DKA)
    • Typically occurs in Type 1, marked by hyperglycemia, ketonemia, acidosis, and fruity breath. Treated with IV fluids and insulin drip.
63. Hyperosmolar Hyperglycemic State (HHS)
    • Seen in Type 2, characterized by severe hyperglycemia without ketosis, leading to profound dehydration. Manage with fluids and insulin.
64. Hypoglycemia
    • Blood glucose <70 mg/dL, with symptoms like tremors, sweating, and confusion. Treat with 15g of carbs or IV dextrose if severe.
65. Hypothyroidism
    • Low T3/T4, high TSH. Symptoms include cold intolerance, bradycardia, and weight gain. Managed with levothyroxine.
66. Hyperthyroidism (Graves’ Disease)
    • High T3/T4 and low TSH. Symptoms include heat intolerance, tachycardia, and weight loss. Treated with PTU, methimazole, or radioactive iodine.
67. Cushing’s Syndrome
    • Excess cortisol leading to symptoms like moon face, buffalo hump, hyperglycemia, and hypertension. Often caused by steroids or adrenal hyperfunction.
68. Addison’s Disease
    • Adrenal insufficiency with symptoms like bronze skin, hypotension, hyperkalemia, and hyponatremia. Requires lifelong hormone replacement.
69. Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
    • Excess ADH causing water retention, hyponatremia, and low urine output. Managed with fluid restriction and hypertonic saline.
70. Diabetes Insipidus
    • Deficiency of ADH, leading to polyuria and polydipsia. Managed with desmopressin, and dehydration must be monitored.

D. GI and Nutrition (71–80)

71. Peptic Ulcer Disease
• Caused by H. pylori or NSAIDs. Risk of bleeding and perforation. Treated with PPIs and triple therapy for H. pylori.

72. Gastroesophageal Reflux Disease (GERD)
    • Acid reflux causing heartburn and regurgitation. Managed with lifestyle modifications, PPIs, and H2 blockers.
73. Inflammatory Bowel Disease (IBD)
    • Includes Crohn’s disease and Ulcerative Colitis. Symptoms include diarrhea and malabsorption, with potential surgery required.
74. Pancreatitis
    • Autodigestion of the pancreas leading to severe pain and elevated lipase/amylase. Managed with NPO status, IV fluids, and pain control.
75. Hepatic Cirrhosis
    • Liver scarring resulting in portal hypertension, ascites, and varices. Monitor ammonia levels and avoid hepatotoxic drugs.
76. Cholecystitis
    • Gallbladder inflammation, typically due to gallstones. Symptoms include right upper quadrant pain and a positive Murphy’s sign. Surgery may be needed.
77. Bowel Obstruction
    • Can be mechanical or paralytic ileus. Symptoms include distention, inability to pass stool, and abnormal bowel sounds. Decompression via NG tube or surgery may be required.
78. Enteral vs. Parenteral Nutrition
    • Enteral (via GI tract) for a functioning gut, parenteral (IV TPN) when the GI is non-functional. Monitor for infection and hyperglycemia with TPN.
79. Malnutrition
    • Types include Kwashiorkor (protein deficiency), Marasmus (calorie deficiency), and cachexia. Assess albumin levels and develop an appropriate feeding plan.
80. Bariatric Surgery
    • Used for morbid obesity, but watch for dumping syndrome and nutritional deficiencies post-surgery. Reintroduce food gradually.

E. Renal and GU (81–90)

81. Acute Kidney Injury (AKI)
• Prerenal, intrarenal, and postrenal causes. Symptoms include oliguria, elevated BUN/Cr, and electrolyte imbalances.

82. Chronic Kidney Disease (CKD)
    • Progressive loss of nephron function, requiring dialysis if GFR <15. Monitor for hyperkalemia and fluid overload.
83. Hemodialysis
    • Care for AV fistulas, monitor for hypotension and disequilibrium syndrome.
84. Peritoneal Dialysis
    • Requires sterile technique to prevent peritonitis. Monitor infusion dwell times and outflow.
85. Urinary Tract Infection (UTI)
    • Commonly seen in females with symptoms like burning, frequency, and urgency. Managed with antibiotics and fluids.
86. Pyelonephritis
    • Kidney infection with symptoms such as flank pain, fever, and chills. Treated with IV antibiotics if severe.
87. Benign Prostatic Hyperplasia (BPH)
    • Causes urinary retention, dribbling, and difficulty starting the stream. Treated with medications like tamsulosin or surgery (TURP).
88. Nephrolithiasis (Kidney Stones)
    • Renal colic and hematuria are common. Hydration, pain control, and possibly lithotripsy are necessary treatments.
89. Incontinence Types
    • Stress, urge, overflow, or functional incontinence. Managed with pelvic floor exercises, toileting schedules, and medications.
90. Prostate Cancer
    • Elevated PSA and abnormal digital rectal exam findings. Treatment options include watchful waiting, surgery, radiation, or hormone therapy.

F. Hematology/Oncology (91–100)

91. Anemias
• Includes iron deficiency, pernicious (B12 deficiency), and folate deficiency. Diagnosed by RBC indices like MCV.

92. Leukemia
    • A malignancy of white blood cells, with risks of infection, anemia, and bleeding. Treatment involves chemotherapy or bone marrow transplants.
93. Lymphomas
    • Includes Hodgkin’s and Non-Hodgkin’s lymphoma. Symptoms include painless lymph node enlargement. Treatment includes chemotherapy and radiation.
94. Breast Cancer
    • Risk factors include family history and BRCA genes. Treatment includes mammography, surgical interventions, chemotherapy, or radiation.
95. Lung Cancer
    • Mainly caused by smoking. Symptoms include persistent cough and hemoptysis. Treatments include lobectomy, chemotherapy, and targeted therapy.
96. Colon Cancer
    • Screening via colonoscopy starting at age 45–50. Monitor for changes in bowel habits and occult blood.
97. Prostate Cancer
    • Characterized by elevated PSA and changes in digital rectal exam. Treatment options vary and may include surgery, radiation, or hormone therapy.
98. Chemotherapy Side Effects
    • Includes myelosuppression (neutropenia, anemia, thrombocytopenia), GI upset, alopecia, and mucositis.
99. Radiation Therapy
    • A localized treatment method. Common side effects include skin irritation and fatigue.
100. Palliative vs. Hospice Care
     • Palliative care focuses on symptom management at any disease stage. Hospice care is for end-of-life with a prognosis of less than six months, focusing on comfort.

Pediatrics (111–120)

111. Growth and Development Stages
• Infant, toddler, preschooler, school-aged, adolescent (refer to sections 1-20 in pediatric bridging notes).

112. Pediatric Dosage Calculations
     • Calculations based on mg/kg; be cautious with fluid amounts and double-check high-risk medications.
113. Common Childhood Vaccines
     • DTaP, Polio, MMR, Varicella, Hib, PCV, Rotavirus, Hep B, Hep A.
114. Dehydration in Children
     • Indicators include sunken fontanels, lack of tears, and fewer wet diapers. Start with oral rehydration solutions.
115. RSV (Bronchiolitis)
     • Primary cause of lower respiratory infections in infants. Supportive care is key.
116. Asthma in Kids
     • Identify triggers, use spacers and peak flow meters. Albuterol for managing acute attacks.
117. Otitis Media
     • Ear infection, marked by ear pulling and fever. Antibiotics if it’s bacterial.
118. Croup vs. Epiglottitis
     • Croup: barking cough, stridor. Epiglottitis: drooling, airway emergency.
119. Pediatric GI Issues
     • Classic symptoms of pyloric stenosis, Hirschsprung disease, and intussusception.
120. Signs of Child Abuse
     • Inconsistent accounts, bruises in various healing stages, fear of a caregiver. Mandatory reporting required.

Mental Health (121–130)

121. Therapeutic Communication Techniques
• Techniques like restating, reflecting, clarifying; avoid closed-ended or “why” questions (see sections 4–5 in fundamentals).

122. Depression vs. Bipolar
     • Depression vs. mania/hypomania episodes. (Refer to sections 21–22 for antidepressants, #25 for lithium).
123. Anxiety Disorders
     • Generalized Anxiety Disorder, panic disorder, phobias, OCD. Coping strategies: CBT, relaxation techniques (see section 2 from earlier pitfalls).
124. Schizophrenia
     • Positive and negative symptoms, antipsychotic treatments. Watch for extrapyramidal side effects (review sections 1-10 psychopharmacology notes).
125. Substance Abuse
     • Detoxification, Medication-Assisted Treatment (MAT), relapse prevention strategies (including 12-step programs). Related to section 3 from earlier psych notes.
126. Crisis Intervention
     • Focus on immediate stabilization and short-term coping (refer to section 2 in therapeutic modalities).
127. ECT (Electroconvulsive Therapy)
     • Used for severe depression or mania that doesn’t respond to medication. NPO, short anesthesia, confusion post-procedure.
128. Personality Disorders
     • Examples include borderline and antisocial. Emphasize boundaries and consistent approaches to care.
129. Therapeutic Milieu
     • Structured and safe environment for psychiatric patients (refer to section 3 in therapeutic modalities).
130. Suicide Precautions
     • For high-risk patients: one-on-one observation, remove hazards, ask direct questions about suicidal thoughts (see section 4 from crisis intervention).

Leadership/Delegation (131–140)

131. 5 Rights of Delegation
• Right task, situation, person, communication, and supervision (see section 9 in fundamentals).

132. RN vs. LPN vs. UAP Tasks
     • RNs handle assessments, care planning, evaluations, and education. LPNs focus on stable patients, follow-up assessments, and specific medications. UAPs assist with ADLs and monitor vital signs for stable clients.
133. Chain of Command
     • In case of conflict, escalate to the next level (charge nurse, manager) if immediate resolution isn’t possible.
134. Conflict Resolution
     • Utilize assertive communication, focus on the issue rather than the person, and aim for mutually beneficial solutions.
135. Time Management
     • Prioritize tasks using frameworks like Maslow, ABC, urgent vs. important tasks. Group tasks for efficiency.
136. Change Agent Role
     • RNs may lead quality improvement projects, staff training, and integrate evidence-based practice for change.
137. Ethical Principles
     • Autonomy, beneficence, nonmaleficence, justice, fidelity, veracity (see section 7 from mental health fundamentals).
138. Legal Terms
     • Malpractice (negligence causing harm), informed consent, confidentiality (HIPAA).
139. Incident Reporting
     • Document objective facts, but do not include in the patient’s chart that a report was filed.
140. Horizontal/Lateral Violence
     • Bullying between staff members. Promote a zero-tolerance culture and report issues to management.

Geriatrics (141–146)

137. Aging and Physiological Changes
• Reduced bone density, slower gastrointestinal motility, decreased glomerular filtration rate, and other age-related changes.

138. Falls in Older Adults
     • The most common cause of injury in this group. Fall prevention strategies include using risk assessments, environmental adjustments, and exercise programs.
139. Polypharmacy
     • Taking multiple medications increases the likelihood of adverse drug interactions and reactions. Beer’s Criteria can guide safer medication selections.
140. Dementia vs. Delirium
     • Dementia is a long-term, irreversible condition. Delirium is acute and can often be reversed once the underlying cause is addressed.
141. Arthritis
     • Osteoarthritis is frequently seen in older adults. Treatment focuses on pain management, using assistive devices, and joint protection techniques.
142. Hypertension in Older Adults
     • Isolated systolic hypertension is common. Be vigilant for orthostatic hypotension.
143. Diabetes in Older Adults
     • A1C targets may be more lenient. Watch for signs of hypoglycemia such as confusion and falls.
144. Depression in Older Adults
     • Often goes undiagnosed. Symptoms include loss of interest, appetite changes, and physical complaints that may mask emotional issues.
145. End-of-Life Planning
     • Includes creating living wills, Do Not Resuscitate (DNR) orders, and appointing a durable power of attorney.
146. Elder Abuse
     • Can be physical, emotional, or financial. It is mandatory to report suspected abuse.

End-Of-Life Care (147-156)

147. Palliative Care vs. Hospice Care
• Palliative care is provided for symptom management at any stage of illness, while hospice care is for those with a life expectancy of less than six months, focusing on comfort.

148. Comfort Care Measures
     • Involves pain relief (often opioids), alleviating breathing difficulties (morphine, positioning), mouth care, and providing emotional support.
149. Advance Directives
     • These documents allow patients to express their preferences for end-of-life care.
150. Stages of Grief
     • Denial, anger, bargaining, depression, and acceptance (as per Kubler-Ross’s model).
151. Cultural Sensitivity in End-of-Life Care
     • Different cultures have varying preferences regarding discussions about death. Some prefer indirect language, while others want complete transparency.
152. Hospice Eligibility Criteria
     • For individuals with terminal illnesses who no longer benefit from curative treatments and seek comfort-focused care.
153. Terminal Secretions (Death Rattle)
     • This symptom can occur at the end of life. Positioning for drainage and using anticholinergics (such as scopolamine patches or atropine drops) can help. Reassure families that this is a natural part of the dying process.
154. Spiritual Care
     • Provide chaplaincy or faith-based support for patients who wish it. Encourage life review and participation in legacy-building activities.
155. Family Discussions about Prognosis
     • Clear communication about the patient’s condition and the decision between hospice care and ongoing aggressive treatments. Nurses play a vital role in coordinating and clarifying information.
156. Signs of Imminent Death
     • Include Cheyne-Stokes respiration, mottled skin, low urine output, and unresponsiveness. Comfort measures and a calm environment are key at this stage.

Exam Prep and Concept Recap (157-196)

157. ADN vs. LPN Scope
• RNs handle independent assessments, care planning, delegating tasks, and evaluating care outcomes. These responsibilities are essential when transitioning from LPN to ADN roles.

158. Prioritization Framework
     • Always address ABC (Airway, Breathing, Circulation) first. Then, treat the underlying cause or apply Maslow’s hierarchy of needs when caring for multiple stable patients.
159. Select-All-That-Apply (SATA) Strategy
     • For questions with multiple correct answers: evaluate each option carefully, and only second-guess if uncertain. Trust your initial judgment when sure.
160. Medications with Narrow Therapeutic Index
     • Drugs like digoxin, lithium, warfarin, and phenytoin require close monitoring of levels to prevent toxicity.
161. Early Signs of Sepsis
     • Initial indicators include fever or chills, rapid heart rate, fast breathing, possible low blood pressure, and changes in mental status.
162. Pain Scales
     • Pain assessment tools include Numeric Rating Scale, Wong-Baker Faces, FLACC for infants and non-verbal patients, and CRIES for neonates.
163. Critical Blood Glucose Ranges
     • Hypoglycemia: <70 mg/dL. Hyperglycemia: >200 mg/dL. Immediate intervention is necessary for both extremes.
164. Pre/Post-Operative Education
     • NPO guidelines, the use of incentive spirometry, early ambulation, and recognizing signs of infection post-surgery are key teaching points.
165. Electrolyte Range Norms
     • Sodium (Na+): 135–145, Potassium (K+): 3.5–5.0, Calcium (Ca++): 8.5–10.5, Magnesium (Mg++): 1.7–2.2, Chloride (Cl–): 98–106, Phosphorus: 2.5–4.5.
166. Neurological Assessments
     • Evaluate level of consciousness (LOC), pupil reaction, motor responses, orientation, and use the Glasgow Coma Scale. Watch for subtle changes.
167. Seizure Precautions
     • Ensure side rails are padded, have suction and oxygen nearby, loosen restrictive clothing, and never restrain the patient during a seizure.
168. Burn Classification
     • First-degree burns are superficial, second-degree burns are partial thickness, and third-degree burns are full thickness. Monitor for fluid shifts and infection risks.
169. Glasgow Coma Scale
     • Assess eye opening (1–4), verbal response (1–5), and motor response (1–6). A score of 15 is normal; a score <8 suggests coma.
170. Pressure Ulcer Stages
     • Stage I: Non-blanchable redness with intact skin. Stage II: Partial thickness loss. Stage III: Full thickness loss into subcutaneous tissue. Stage IV: Involves muscle or bone.
171. Respiratory Alkalosis
     • Characterized by low CO2 and high pH, typically caused by hyperventilation due to anxiety or pain. Slowing the breathing rate or administering sedatives may help.
172. Metabolic Acidosis
     • Marked by low bicarbonate (HCO3–) and low pH. Common in conditions like diabetic ketoacidosis (DKA) and renal failure. Kussmaul respirations occur as compensation.
173. Blood Type Compatibility
     • O– is the universal blood donor, while AB+ is the universal recipient. Distinguish between red blood cells (RBCs) and whole blood.
174. Shockable Cardiac Rhythms
     • Includes ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT). Defibrillation as part of Advanced Cardiac Life Support (ACLS) is critical.
175. APGAR Scoring
     • Assesses appearance, pulse, grimace, activity, and respiration at 1 and 5 minutes after birth. A key factor in newborn assessments.
176. Cardiac Enzymes
     • Key enzymes like CK-MB, troponin I/T, and myoglobin are used to diagnose myocardial infarction (MI), with troponin being the most specific marker.
177. Pressure Infuser Use
     • Utilized for rapid infusion of fluids or blood products. Watch for complications like infiltration or extravasation.
178. Pain Management Ladder (WHO)
     • Step 1: Non-opioids, Step 2: Mild opioids plus adjuvants, Step 3: Strong opioids for severe pain.
179. Osteoporosis
     • Diagnosed with a DEXA scan showing a T-score of ≤–2.5. Treatment includes increased calcium and vitamin D, weight-bearing exercise, and bisphosphonates.
180. Organ Donation
     • Respect legal documentation related to organ donation. While nurses can offer support, they should not directly approach patients for consent if a specialized team exists.
181. Subcutaneous Injection Sites
     • Common sites include the outer arm, abdomen, and anterior thigh. Use a 45–90° angle, with the abdomen preferred for insulin.
182. Intramuscular (IM) Injection Sites
     • The deltoid (for small volumes), vastus lateralis, and ventrogluteal (ideal for larger volumes) are typical sites. Z-track technique should be used for irritating medications.
183. Postmortem Care
     • Ensure no autopsy or coroner hold is needed, clean the body, remove tubes as appropriate, and attach identification tags.
184. Foley Catheter Care
     • Perform sterile insertion, maintain the catheter bag below the bladder, ensure daily perineal hygiene, and securely anchor the catheter to the thigh.
185. Central Line Care
     • Follow sterile procedures for dressing changes, check patency, flush with saline or heparin according to protocol, and monitor for infection signs.
186. STEMI vs. NSTEMI
     • STEMI shows ST elevation on EKG, while NSTEMI shows elevated cardiac enzymes but no ST elevation. Both require urgent treatment, but STEMI is more critical and requires catheterization.
187. Informed Refusal
     • Patients have the right to refuse treatment after being fully informed of potential consequences. This must be documented carefully.
188. Risk Management
     • Identify and mitigate potential liability risks, such as the improper use of bed rails on confused patients. Documentation of preventive actions is essential.
189. Therapeutic Levels for Phenytoin
     • Maintain a therapeutic level of 10–20 mcg/mL. Be alert for signs of toxicity, such as gingival hyperplasia, ataxia, and nystagmus.
190. Magnesium Sulfate in Obstetrics
     • Used for seizure prevention in preeclampsia. Watch for signs of toxicity such as diminished deep tendon reflexes (DTRs) and respiratory depression (antidote: calcium gluconate).
191. Wound Healing Stages
     • The inflammatory phase lasts 3–5 days, the proliferative phase lasts from day 5 to 3 weeks, and the remodeling phase may take months.
192. H. pylori Triple Therapy
     • Triple therapy involves a proton pump inhibitor (PPI), clarithromycin, and amoxicillin (or metronidazole if allergic to penicillin).
193. DKA vs. HHS
     • Diabetic ketoacidosis (DKA) involves ketones and acidosis, usually in Type 1 diabetes. Hyperosmolar hyperglycemic state (HHS) presents with extreme hyperglycemia without ketones, common in Type 2 diabetes, and is marked by severe dehydration.
194. Scabies vs. Lice (Pediculosis)
     • Scabies is caused by mite burrows with intense nocturnal itching. Lice (pediculosis) involve visible nits on hair shafts. Both require topical treatments.
195. GCS < 8 = Intubate
     • A Glasgow Coma Scale score of 8 or lower typically indicates the need for airway protection via intubation.
196. Neuroleptic Malignant Syndrome (NMS)
     • A rare, life-threatening reaction to antipsychotic medications, presenting with fever, muscle rigidity, altered mental status, and autonomic instability. Treatment includes dantrolene or bromocriptine.