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70 Diseases Condtions Nclex Cheat Sheet 2

Medical-Surgical Nursing (Miami Dade College)

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Contents
Before You Get Started 6

Pharmacology Table 8

List of Medical Diseases/Conditions 10

Atrial fibrillation (A Fib) 10
Pneumonia 10
Diverticular disease 11
Crohn’s disease 11
Irritable bowel syndrome 12
COPD 12
Acute Pancreatitis 13
Cushing’s disease 13
Addision’s disease 14
Diabetes mellitus 14
Diabetes insipidus 15
Heart failure 15
Urinary tract infection 15
Asthma 16
Coronary artery disease 16
Cerebrovascular Accident (CVA) 16
Kidney disease 17
Hepatic encephalopathy 17
Hypertension 17
Hypothyroidism 18
Hyperthyroidism 18
Sickle cell anemia 18

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Abdominal Aneurysm 19
Renal failure 19
Pernicious Anemia 19
Liver Cirrhosis 20
Myasthenia gravis 21

Nursing Procedures You Must Know 22

Chest Tube 22
Blood Transfusion 22
Thoracentesis 22
Urinary Catheter Insertion 23
Nasogastric/Tube Feeding 23
Paracentesis 23

Contact Precautions 24
Droplet precautions 24
Airborne Precautions 24
Fluid & Electrolyte Balance 25
Hyponatremia 25
Hypernatremia 25
Hypokalemia 25
Hyperkalemia 26
Hypomagnesemia 26
Hypermagnesemia 26
Hypocalcemia 26
Hypercalcemia 27

IV Fluids 28
Isotonic solutions 28

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Rules 30
Rule of Nines 30

MONA 31
MONA 31
RICE 32

ABGs 33

Key Nurse Role Differences 34

Physical Restraints 34
Chemical restraint 34
Seclusion 35
Advance Directives 35

Developmental Stages of Transition 36

Trust Versus Mistrust (Birth to About 18 Months) 36
Autonomy Versus Shame and Doubt (About 18 Months to About 3 Years) 36
Initiative Versus Guilt (About 3 Years to About 5 Years) 36
Industry Versus Inferiority (About 5 Years to About 13 Years) 37
Identity Versus Role Confusion (About 13 Years to About 21 Years) 37
Intimacy Versus Isolation (About 21 Years to About 40 Years) 37
Generativity Versus Stagnation (About 40 Years to About 60 Years) 37
Integrity Versus Despair (About 60 Years to Death) 37

Maternal Nursing 38
Age of Gestation (AOG) 38
Nagele’s Rule 38
McDonald’s Method 38
Bartholomew’s Rule 39
Prolapsed Cord 39
Premature Rupture of Membranes PROM 39
Shoulder Dystocia 39

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Induction of Labor 39

Mental Health 40
Bipolar Disorder 40
Schizophrenia 40
Delirium 40
Dementia 40

Psychotropic Medications 41

Therapeutic Communication 43
Therapeutic Communication 43

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Before You Get Started

Hey there so before you dive right into the cheat sheet, just want to tell you what
it’s going to be covering and give you a few pointers on how to study.

First is I created a pharmacology table. I listed all the suffices of every medication
as well as their rationale and common side effects. What I want you to do is
continue studying in detail all the most common drugs that you’ve been taught
will be on the NCLEX exam but also memorize these suffices so that way you know
which rationale and side effects to associate them with. The NCLEX is not going to
test you on the most common drugs, it’s going to test you on the least common
drugs so unless you can memorize every single medication with their rationale
and side effects, I suggest at least knowing all the suffices.

Next thing is I’ll be covering all the most common tested illnesses, diseases and
conditions. The exam is not going to ask you questions such as, “What is
Pneumonia?” It’s going to ask you to APPLY what you know about these conditions
in typical nursing scenarios. So don’t just memorize the signs and symptoms,
understand them well enough to know how it is managed in the clinical setting.

Additional things we will go over:

 Nursing Procedures You Must Know

 Standard Precautions and More

 Fluid & Electrolyte Balance

 IV Fluids

 Rules (Nursing Wise)

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 ABGs

 Key Nurse Role Differences

 Restraints

 Developmental Stages of Transition

 Maternal Nursing

 Mental Health

 Therapeutic Communication

Let’s Get Started!

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Pharmacology Table
Origin Example Rationale Common Side Effects

Thrombol ytic- Severe bleeding &

Ase pain Streptase
dissolves clots abdominal
Antifungal-treat fungal
Azole Miconazole Rash burning
infections
Nausea orthostatic
Caine Lidocaine Anesthetic
hypotension
Treat bacterial
Cef / Ceph Cephalos porin Rash stomach cramps
infections
Treat bacterial Nausea/vomiting
Cillin Penicillin
infections diarrhea
Treats bacterial
Floxacin Fluoroquinolone Nausea anaphylaxiss
infections
Toxicity in pregnancy
Cycline Tetracycline Antibiotic
discolors teeth
Treats bacterial/s kin
Dazole Nitroimidazole Skin irritation dryness
infections
Low blood pressure &
Dipine Nifidepine (CCBs) Dilates arteries
edema
Reduces acid in
Prazole Pantaprzole (PPIs) Headache & diarrhea
stomach
Increase bleeding
Profen Ibuprofren (NSAID) Decrease inflammation
stomach upset
Increase hair growth,
Pheny toin Dilantin Prevents seizures
stomach pain
Treat bacterial
Mycin / Micin Gentamicin Ototoxicity flank pain
infections

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Origin Example Rationale Common Side Effects

Lowers HR, SOB in

Olol Beta blocker Lowers BP
respiratory pts
Increased blood sugar,
Cort Cortisone Anti-inflammatory
edema
Arin Warfarin Prevent blood clots Bleeding, bruises
Treat high blood Nonproductive cough,
Pril ACE inhibitor
pressure dizziness
Angioedema
Sartan Cozaar (ARBs) treat high BP
hyperkalemia
Statin Simvastatin (C10AA) Lowers cholesterol level Headache weakness
Increased urination
Removes water from
Semide Loop diuretic hyponatremia,
body
hypokalemia
Removes water from Increased urination
Thiazide Thiazide diuretic
body hypokalemia
Removes water from Increased urination
Actone Potassium sparing
body hyperkalemia
Setron Ondansetron(5-HT) Prevents nausea Diarrhea, fatigue
Relieve breathing Irregular heartbeat
Terol Salmeterol-(B2)
problems headache
Nausea/vomiting
Vir Acyclovir Treat viral infections
diarrhea
Zepam /
Lorazepam Treats anxiety/ seizures Confusion sleepiness
Zolam

CCBs= Calcium channel blockers PPIs= Proton Pump Inhibitors

ARBs= Angiotensin II receptor antagonist C10AA= HMG-CoA reductase inhibitor

5-HT= Serotonin receptor antagonist

B2= Beta agonist

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List of Medical
Diseases/Conditions
Atrial fibrillation (A Fib)

 Irregular heartbeat (arrhythmia) often, but not always, resulting in a fast

heart beat (greater than 100 bpm) at rest. Atrial fibrillation increases the
risk of stroke so patients with this condition typically are placed on
anticoagulants. Ex: Warfarin. Important things to monitor in these
patients are INR levels, heart rate and changes in circulation.

Precautions: Standard

Pneumonia

 Pneumonia is an acute inflammation of the lungs caused by a bacterial,

viral, mycoplasmal, fungal, protozoal, or mycobacterial infection.

Types of Pneumonia:

Health care-associated pneumonia- Affects patients who are not hospitalized but
who have close contact with the health care system, such as those who reside in
long-term care facilities or who have regular hemodialysis.

Community-acquired pneumonia- Occurs in the community setting or within the first

48 hours of admission to a health care facility because of community exposure.

Aspiration pneumonia- Can occur in a community or health care facility setting

and results from inhalation of foreign matter, such as vomitus or food particles,
into the bronchi (most common in older patients, patients with a decreased level

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of consciousness, and those receiving nasogastric tube feedings); microaspiration,

or aspiration of microbiologic organisms.

Nursing Interventions: include encouraging coughing and deep breathing.

Administer antibiotic therapy as ordered.

Precautions: Contact (May be placed on Droplet if patient is positive for specific

bacterial strains in sputum.

Diverticular disease

 Diverticulosis is a chronic condition of multiple diverticula formation that

develops most commonly in middle age. It is typically discovered during
routine colonoscopy screening, is often asymptomatic, and does not
usually require treatment. Diverticulitis is an inflammatory complication
of diverticulosis. It causes signs and symptoms that can have serious
consequences. Most uncomplicated diverticulitis patients with mild
symptoms are treated with antibiotics and a clear liquid diet.

Nursing interventions: includes monitoring for strict intake and output and
administering antibiotics.

Precautions: Standard

Crohn’s disease

 Crohn’s disease is an inflammatory disorder affecting mostly the distal

ileum and colon. Crohn disease results in the malabsorption of water and
nutrients, which may lead to fluid and electrolyte imbalances. Anemia
often results, secondary to poor dietary intake and/or absorption of
vitamins and nutrients.

Nursing Interventions: include monitoring intake and output and laboratory values.

Precautions: Standard

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Irritable bowel syndrome

 IBS is a disorder that produces chronic, uncontrolled inflammation of the

intestinal mucosa, which can affect any part of the gastrointestinal (GI)
tract, causing edema, ulceration, bleeding, and profound fluid and
electrolyte losses. Patients experience abdominal cramping, pain with
diarrhea, nausea, dehydration, weight loss, cachexia, and anemia. Patients
may experience an average of 5 to 10 diarrhea stools each day that also
contain mucus leading to anemia, hypovolemia, and malnutrition. Anemia
is related to active bleeding and poor intake and/or absorption of
nutrients.

Nursing interventions: includes monitoring hemoglobin levels and intake and output.

Precautions: Standard

COPD

 COPD is a lung disease characterized by progressive airflow limitation

resulting from small-airway disease and parenchymal destruction. Major
risk factors include exposure to smoke (including tobacco, cooking fires,
and fuel), occupational dust, or fumes. Oxygen should be titrated to
improve hypoxemia, with an arterial oxygen saturation (SaO2) goal of
88% to 92% in patients without complications. The first intervention
usually involves increasing the dose or frequency of a currently
prescribed, short-acting inhaled bronchodilator, such as the beta 2-
agonist albuterol (Ventolin HFA).

Nursing interventions: include auscultating lung sounds and monitoring for

shortness of breath.

Precautions: Standard

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Acute Pancreatitis

 Acute pancreatitis is a sudden inflammation that lasts for a short time. It

may range from mild discomfort to a severe, life-threatening illness. The
most common symptom is abdominal pain.

Nursing Interventions: involve placing patient as NPO to inhibit pancreatic

stimulation and secretion of pancreatic enzymes, administration of parenteral
nutrition and insertion of nasogastric tube to suction and relieve nausea and
vomiting, decrease painful abdominal distention and paralytic ileus and remove
hydrochloric acid so that it does not stimulate the pancreas.

Precautions: Standard

Cushing’s disease

 Cushing disease is marked by the formation of a pituitary microadenoma

(a tumor less than 10 mm in size). This benign, basophilic (highly
granulated) tumor produces adrenocorticotropic hormone (ACTH) and is
composed of corticotrophin cells, which cause hyperplasia of the adrenal
glands and result in an excess secretion of cortisol.

Nursing Interventions: Strictly monitor your patient's intake and output and obtain
daily weights. Your patient is at risk for transient diabetes insipidus post-
procedure. Observe for large volumes of dilute urine output; if this occurs, your
patient may become hypotensive and go into shock. Persistent headaches
unrelieved by mild analgesics may indicate an increase in ICP. Monitor your
patient's neurologic status for changes in level of consciousness and pupillary
response because this may indicate neurologic complications.

Precautions: Standard (These patients are also immunocompromised so they may

also be on neutropenic precautions (reverse isolation).

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Addision’s disease

 Primary adrenal cortical insufficiency is a relatively rare disorder also

known as Addison disease.

Nursing Intervention: Follow the "5 S's" for management:

1. Salt replacement

2. Sugar (dextrose) replacement

3. Steroid replacement

4. Support of physiologic functions.

5. Search for and treat any identified cause.

Precautions: Standard

Diabetes mellitus

 Diabetes mellitus (DM) is a chronic disease characterized by insufficient

production of insulin in the pancreas or when the body cannot effectively
use the insulin it produces.

Type 1 is a lack of insulin production. Type 2 is the body’s ineffective use of insulin.

Nursing Interventions: Administer regular insulin by intermittent or by continuous

IV method. Observe for signs of hypoglycemia: changes in LOC, cold and clammy
skin, rapid pulse, hunger, irritability, anxiety, headache, lightheadedness, shakiness.

Precautions: Standard

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Diabetes insipidus

 Diabetes insipidus (DI) is a condition which causes frequent urination. The

reduction in production or release of ADH results in a fluid and electrolyte
imbalance caused by increased urinary output.

Nursing Interventions: Monitor laboratory values and intake and output

Dietary measures: limiting sodium intake to less than 3 g per day help to reduce
urine output. Fluid replacement: hypotonic saline is administered intravenously.

Precautions: Standard

Heart failure

 The heart's inability to pump enough blood to meet the body's oxygen
and nutrient demands. Diuretics play a major role in CHF treatment.
Diuretics act within the kidney to promote increased urination.

Nursing Interventions: Monitor the patient's pulse rate and BP and check for
postural hypotension due to dehydration. Monitor the number of patients use at
night to facilitate breathing.

Precautions: Standard

Urinary tract infection

 Urinary tract infection is a common kidney infection due to a lack of

proper hygiene and indwelling catheters. Pyelonephritis is particular type
of urinary tract infection (UTI) in which the renal tissue becomes inflamed
due to the prolonged presence of a pathogen.

Nursing Interventions: Administer oral and IV antibiotics, and monitor for signs of
infection, such as burning, fever and especially confusion in the elderly.

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Precautions: Standard (Depending on the microbiology report, patient may also

be placed on contact precautions)

Asthma

 Asthma is a chronic inflammatory disorder of the airway characterized by

airway hyper responsiveness, mucus hypersecretion, and reversible
airflow limitation.

Nursing Interventions: includes assessing and supporting the patient's airway,

breathing, and circulation and monitoring his clinical status and vital signs.
Administer systemic corticosteroids as prescribed. Prednisone, methylprednisolone,
prednisolone, hydrocortisone, and dexamethasone are commonly prescribed and
should be administered for 3 to 10 days.

Precautions: Standard

Coronary artery disease

 Characterized by the accumulation of plaque within coronary arteries,

which progressively enlarge, thicken and calcify.

Nursing Interventions: Monitor for signs of chest pain and administer antianginal
medications. Monitor blood pressure, heart rate and prep patient for surgery.

Precautions: Standard

Cerebrovascular Accident (CVA)

 The sudden impairment of cerebral circulation in one or more of the blood

vessels supplying the brain which causes hemorrhage from a tear in the
vessel wall or impairs the cerebral circulation by a partial or complete
occlusion of the vessel lumen with transient or permanent effects.

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Nursing Interventions: Closely monitor patient’s neurological status and functional

level in comparison to their baseline. Monitor vital signs and changes in blood
pressure.

Precautions: Standard

Kidney disease

 Kidney disease is also marked by end stage renal disease which is a

permanent loss of function of the kidneys. Patients typically excrete little
or no urine and are unable to properly fill out excess electrolytes in their
blood.

Nursing Interventions: Closely monitor patient’s electrolyte values especially

potassium, sodium, BUN and creatinine. Monitor blood pressure and administer
medications.

Precautions: Standard

Hepatic encephalopathy

 A loss of brain function that occurs when the liver is unable to remove
toxins from the blood.

Nursing Interventions: Monitor ammonia levels and monitor level of consciousness.

Precautions: Standard

Hypertension

 Characterized by abnormal blood pressure readings, and controlled with

diet and medications.

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Nursing Interventions: Monitor blood pressure frequently. Many patients are

typically asymptomatic. Administer blood pressure medications. Educate. Monitor
for signs and symptoms of stroke.

Precautions: Standard

Hypothyroidism

 A condition where the thyroid gland does not produce enough thyroid
hormone.

Nursing Interventions: Monitor labs for FreeT3, T4 and TSH levels. Administer oral
medication such as Synthroid. Everything slows down so you’ll see weight gain,
fatigue, and constipation symptoms in the body.

Precautions: Standard

Hyperthyroidism

 A condition caused by an overproduction of the thyroid hormone.

Nursing Interventions: Monitor labs for FreeT3, T4 and TSH levels. Administer oral
medication such as Tapazole. Everything speeds up so monitor for tachycardia,
diarrhea and complications of grave’s disease.

Precautions: Standard

Sickle cell anemia

 A condition in which there are not enough healthy red blood cells to carry
oxygen because the cells are “sickle” in shape.

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Nursing Interventions: Pain control management is very essential with these

patients, as well as administering oxygen. Many of these patients require blood
transfusions on a regular basis.

Precautions: Standard

Abdominal Aneurysm

 An abdominal aortic aneurysm is an enlarged area in the lower part of the

aorta, the major blood vessel that supplies blood to the body.

Nursing Interventions: Monitor for signs of rupture and notify MD immediately.

Prep patient for surgery. NPO for at least 8 hours, obtain consent.

Precautions: Standard

Renal failure

 A condition in which the kidneys fail to adequately filter waste toxins out
of the body. Acute kidney failure is reversible and oftentimes occurs
suddenly.

Nursing Interventions: Monitor kidney function tests (BUN, Creatine) and monitor
output.

Precautions: Standard

Pernicious Anemia

 When the body does not produce enough intrinsic factor, and fails to
absorb vitamin B12, it is known as pernicious anemia. Some stomach
conditions, or procedures that are carried out on the stomach, can stop
it absorbing enough vitamin B12. For example, a gastrectomy (the

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removal of part of the stomach) increases the risk of developing vitamin

B12 deficiency anemia.

Nursing Interventions: Monitoring blood count levels and administering B12

injections.

Precautions: Standard

Liver Cirrhosis

 Cirrhosis is a chronic disease characterized by replacement of normal liver

tissue with diffuse fibrosis that disrupts the structure and function of the
liver.

The three classifications of Cirrhosis:

Alcoholic cirrhosis -scar tissue characteristically surrounds the portal areas. This is
the most prevalent type that is caused by long history of chronic alcoholism

Postnecrotic cirrhosis- consists of broad bands of scar tissue and results from
previous acute viral hepatitis or drug-induced massive hepatic necrosis.

Biliary cirrhosis- consists of scarring of the liver around the bile ducts. This type of
cirrhosis usually results from chronic biliary obstruction and infection (cholangitis).
It is much less common than the other two classifications of cirrhosis.

Nursing Interventions: administer vitamins, fluid/electrolyte replacement and

monitor for ascites.

Precautions: Standard

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Myasthenia gravis

 Myasthenia gravis is a chronic autoimmune neuromuscular disease

characterized by varying degrees of weakness of the skeletal (voluntary)
muscles of the body. Methods of treatment include medication, surgery,
plasmapheresis, and I.V. immunoglobulin (IVIg) Corticosteroids, such as
prednisone, and immunosuppressing agents, help to improve muscle
strength by suppressing abnormal antibody production.

Nursing Interventions: Monitor for changes in breathing and functional levels;

administer corticosteroids.

Precautions: Standard (May be placed on neutropenic precautions (reverse isolation)

due to being immunocompromised).

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Nursing Procedures You

Must Know
Chest Tube

 Closed chest drainage - observe for leaks, maintain, measure output,

assess and document respiratory status, assess dressing. Do not clamp
the chest tube during transport or ambulation unless specifically ordered
by the doctor. Clamping the chest tube in patients with an air leak
increases the chance for pneumothorax. Note the pattern of the bubbling.
If it fluctuates with respirations (i.e. occurs on exhalation in a patient
breathing spontaneously), the most likely source is the lung. Water seal -
Check the fluid level in the water seal and adjust to 2 cm.

Nursing Interventions: Monitor for signs of leaks, kinks, bleeding at the dressing
site, and changes in the patient’s respirations.

Blood Transfusion

 Blood products: Administer blood with normal saline bag. Check,

administer, and document blood product administration. Monitor patient
during administration. Follow policy/procedure to use if a transfusion
reaction occurs.

Thoracentesis

 Thoracentesis is a procedure in which a needle is inserted through the

back of the chest wall into the pleural space (a space that exists between
the two lungs and the interior chest wall) to remove fluid or air.

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Nursing Interventions: Check for consent and verify procedure. Monitor closely for
blood pressure, breathing, and coughing. Monitor site for signs of bleeding

Urinary Catheter Insertion

 Procedure should be done only using aseptic technique. Explain procedure

to patient. Use hand hygiene. Monitor for signs of infection. Monitor urine
color, odor or signs of sediments.

Nasogastric/Tube Feeding

Care of the patient with nasogastric tube - check for placement and patency,
maintain suction, check bowel sounds, perform nasal care, and document. Tube
feeding- check for placement, administer feedings, check (usually every four
hours) and record residual.

Paracentesis

 A procedure to take out an excess of fluid that has collected in the

abdomen (peritoneal fluid) also known as ascites. Ascites may be caused
by infection, inflammation, an injury, or other conditions, such as cirrhosis
or cancer. The fluid is taken out using a long, thin needle put through the
abdomen. The fluid is sent to a lab and studied to find the cause of the
fluid buildup.

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Contact Precautions
Perform hand hygiene before touching patient and prior to wearing gloves.

Wear gloves when touching the patient and the patient’s immediate environment
or belongings. Wear a gown if substantial contact with the patient or their
environment is likely to occur.

Perform hand hygiene after removal of PPE; note: use soap and water when hands
are visibly soiled (e.g., blood, body fluids), or after caring for patients with known
or suspected infectious diarrhea (e.g., Clostridium difficile, norovirus).

Droplet precautions

 Respiratory viruses (e.g., influenza, parainfluenza virus, adenovirus,

respiratory syncytial virus, human metapneumovirus), Bordetella or
pertussis). Place the patient in an exam room with a closed door as soon
as possible. PPE use includes wearing a facemask, such as a procedure or
surgical mask, for close contact with the patient; the facemask should be
donned upon entering room. If substantial spraying of respiratory fluids
is anticipated, gloves and gown as well as goggles (or face shield in place
of goggles) should be worn. Instruct patient to wear a facemask when
exiting the exam room, avoid coming into close contact with other
patients, and practice respiratory hygiene and cough etiquette.

Airborne Precautions

 Apply to patients known or suspected to be infected with a pathogen that

can be transmitted by airborne route; these include, but are not limited
to: Tuberculosis, Measles, Chickenpox, localized (in immunocompromised

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patient) or disseminated herpes zoster (until lesions are crusted over)

(You must know these). Place the patient immediately in an airborne
infection isolation room (negative pressure).

PPE use includes wearing a fit-tested N-95 or higher level disposable respirator,
when caring for the patient the respirator should be placed on prior to room entry
and removed after exiting room.

Fluid & Electrolyte Balance

To function normally, the body must keep fluid levels from varying too much in
the areas of the body that contain fluid (called compartments). The three main
compartments are: fluid within cells, fluid in the space around cells and blood.

Hyponatremia

 Occurs when the body contains too little sodium for the amount of fluid
it contains. A low sodium level has many causes, including consumption
of too many fluids, kidney failure, heart failure, cirrhosis, and use of
diuretics.

Hypernatremia

 Occurs when the body contains too little water for the amount of sodium.
Hypernatremia involves dehydration, which can have many causes,
including not drinking enough fluids, diarrhea, kidney dysfunction, and
diuretics.

Hypokalemia

 A low potassium level. Can make muscles feel weak, cramp, twitch, or
even become paralyzed and abnormal heart rhythms may develop.

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Usually, eating foods rich in potassium or taking potassium supplements

by mouth is all that is needed.

Hyperkalemia

 The level of potassium in blood is too high. The most common cause of
mild hyperkalemia is the use of drugs that decrease blood flow to the
kidneys or prevent the kidneys from excreting normal amounts of
potassium.

Hypomagnesemia

 The level of magnesium in blood is too low. Although blood contains very
little magnesium, some is still necessary for normal nerve and muscle
function and for development of bone and teeth. Hypomagnesemia is
also associated with the cause for the rhythm torsades de pointes.
Conditions can be improved quickly with the treatment of IV magnesium.

Hypermagnesemia

 The level of magnesium in blood is too high.

Bone contains most of the magnesium in the body. Very little circulates in the
blood. Hypermagnesemia may cause weakness, low blood pressure, and impaired
breathing.

Hypocalcemia

 Most commonly results when too much calcium is lost in urine or when
not enough calcium is moved from bones into the blood. For your
patients that have had a thyroidectomy surgical procedure, it is
important to closely monitor their calcium levels for hypocalcemia.

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Abnormally low levels of calcium can cause symptoms like confusion,

muscle cramps and tingling.

Hypercalcemia

 The level of calcium in blood is too high. A high calcium level may result
from a problem with the parathyroid glands, as well as from diet, cancer,
or disorders affecting bone. If the calcium level is very high or if symptoms
of brain dysfunction or muscle weakness appear, fluids and diuretics are
given intravenously as long as kidney function is normal. Drugs such as
calcitonin and corticosteroids can be used to treat hypercalcemia.

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IV Fluids
Isotonic solutions

 A solution is isotonic when the concentration of dissolved particles is

similar to that of plasma. The types of isotonic solutions are 0.9% sodium
chloride (0.9% NaCl), lactated Ringer's solution, 5% dextrose in water
(D5W), and Ringer's solution.

A solution of 0.9% sodium chloride is simply salt water. It should be used

cautiously in certain patients, such as those with cardiac or renal disease, because
of the risk for fluid volume overload.

Lactated Ringer's (LR) is the most physiologically adaptable fluid because its
electrolyte content is most closely related to the composition of the body's blood
serum and plasma. Because of this, LR is another choice for first-line fluid
resuscitation for certain patients, such as those with burn injuries. LR is used to
replace GI tract fluid losses, fistula drainage, and fluid losses due to burns and
trauma. It's also given to patients experiencing acute blood loss or hypovolemia
due to third-space fluid shifts.

D5W is basically a sugar water solution that provides some calories, but it doesn't
replace electrolytes. However, it's appropriate to treat hypernatremia because it
dilutes the extra sodium in extracellular fluid.

Hypotonic solutions have a lower concentration, or tonicity, of solutes (electrolytes).

The infusion of hypotonic crystalloid solutions lowers the serum osmolality within the
vascular space, causing fluid to shift from the intravascular space to both the
intracellular and interstitial spaces. Types of hypotonic fluids include 0.45% sodium

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chloride (0.45% NaCl), 0.33% sodium chloride, 0.2% sodium chloride, and 2.5%
dextrose in water.

Hypertonic solutions contain a higher concentration of sodium and chloride than

what is normally contained in plasma. These examples include 3% sodium chloride
(3% NaCl), and 5% sodium chloride (5% NaCl). These solutions are highly
hypertonic and should be used only in critical situations to treat hyponatremia.
Give them slowly and cautiously to avoid intravascular fluid volume overload and
pulmonary edema.

Blood products Use an 18-gauge or larger needle to infuse colloids. Monitor the
patient for signs and symptoms of hypervolemia, including increased BP, dyspnea,
crackles in the lungs, JVD, edema, and bounding pulse. Closely monitor intake and
output. Colloid solutions can interfere with platelet function and increase bleeding
times, so monitor the patient's coagulation indexes.

Key Reminder

Frequently assess the patient's response to I.V. therapy, monitoring for

signs and symptoms of hypervolemia, such as hypertension, bounding
pulse, pulmonary crackles, shortness of breath, peripheral edema, jugular
venous distention (JVD), and extra heart sounds, such as S3. Monitor
intake and output, hematocrit, and hemoglobin. Elevate the head of bed
to 35 to 45 degrees, unless contraindicated.

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Rules
Rule of Nines

The rule of nines assesses the percentage of burn and is used to help guide
treatment decisions, including fluid resuscitation, and becomes part of the
guidelines to determine transfer to a burn unit. You can estimate the body surface
area on an adult that has been burned by using multiples of 9.

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MONA
MONA

Mona is an acronym used to help remember the initial treatment for acute
coronary syndrome. MONA stands for morphine, oxygen, nitroglycerin and
aspirin. It is important to understand that the acronym represents the steps in
treatment, but not necessarily the order in which they are administered.

The ‘M’ in MONA stands for morphine. Morphine is administered to patients with
acute coronary syndrome to decrease pain when pain is not resolved with
nitroglycerin.

The “O” in MONA stands for oxygen administration. When blood flow is decreased
to the heart in acute coronary syndrome, a portion of the heart is deprived of
oxygen. Supplemental oxygen may be administered as part of the initial treatment
for acute coronary syndrome in order to improve oxygenation of the ischemic
heart tissue.

The “N” in MONA stands for nitroglycerin. Another medication used as part of the
initial treatment for acute coronary syndrome is nitroglycerin. Nitroglycerin is used
to decrease chest pain and may be administered as soon as pain starts. It causes
arterial and venous dilatation, which decreases the workload of the heart and
reduces myocardial oxygen demand. Nitroglycerin may be administered in
sublingual tablets at a dose of 0.3 mg to 0.4 mg every five minutes, for up to three
doses every five minutes.

The “A” in MONA stands for aspirin. Aspirin is also part of the initial treatment for
acute coronary syndrome. Aspirin is used to prevent further clot formation by

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decreasing platelet aggregation. If possible, the aspirin should be chewed to allow

for faster absorption.

RICE

These four interventions are prescribed for early treatment of acute soft tissue
injuries, such as a: sprain, strain or bone injury.

The acronym R.I.C.E. stands for:

Rest

Ice

Compression

Elevation

Rest: Reduce or stop using the injured area for 48 hours.

Ice: Put an ice pack on the injured area for 20 minutes at a time, 4 to 8 times per
day. Use a cold pack, ice bag, or a plastic bag filled with crushed ice that has been
wrapped in a towel.

Compression: Compression of an injured ankle, knee, or wrist may help reduce

the swelling. These include bandages such as elastic wraps, special boots, air casts
and splints.

Elevation: Keep the injured area elevated above the level of the heart. Use a pillow
to help elevate an injured limb.

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ABGs
Normal Values and Acceptable Ranges of the ABG Elements

ABG Element Normal Value Range

pH 7.4 7.35 to 7.45
Pa02 90mmHg 80 to 100 mmHg
Sa02 95% 93 to 100%
PaC02 40mmHg 35 to 45 mmHg
HC03 24mEq/L 22 to 26mEq/L

Acidosis (acidemia) occurs when pH drops below 7.35

Alkalosis (alkalemia) occurs when the pH rises above 7.45

A respiratory problem is determined if the PaC02 is less than 35mmHg (alkalosis)

or greater than 45 mmHg (acidosis)

A metabolic problem is when the HC03 is less than 22mEq/L (acidosis) or greater
than 26mEq/L (alkalosis).

Compensated- the pH level is normalized (within the normal range)

Uncompensated- the pH level is abnormal and either the PaCO2 is

abnormal or the HCO3 is abnormal

Partially Compensated- the pH level is abnormal, the PaCO2 is abnormal,

and the HCO3 is abnormal

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Key Nurse Role Differences

CNA- Handles your patient’s hygiene needs, ADLs, toileting, monitoring patient safety
and linen changes. They can also walk your patient if there is a physician order.

LVN- Similar role as RN but cannot push or give any intravenous medications. Also
is responsible for nursing interventions but not nursing assessment.

RN- Provides nursing assessments applies the nursing process and can give
intravenous medications/fluids.

*It’s important to understand the differences between each role because

you will be tested on this.

Physical Restraints

Three general categories of restraints exist— physical restraint, chemical restraint,

and seclusion

Physical restraint, the most frequently used type, is a specific intervention or device
that prevents the patient from moving freely or restricts normal access to the
patient’s own body. Physical restraint may involve: applying a wrist, ankle, or waist
restraint.

Chemical restraint

Chemical restraint involves the use of a drug to restrict a patient’s movement or

behavior, where the drug or dosage used isn’t an approved standard of treatment
for the patient’s condition. For example, a provider may order Haldol or Ativan in

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a high dosage for a postsurgical patient who won’t go to sleep. (If the drug is the
standard treatment for the patient’s condition, such as an antipsychotic for a
patient with psychosis or a benzodiazepine for a patient with alcohol-withdrawal
delirium, then this is not considered a chemical restraint.) Many healthcare
facilities prohibit the use of medications for chemical restraint.

Seclusion

With seclusion, a patient is held in a room involuntarily and prevented from

leaving. Many emergency departments and psychiatric units have a seclusion
room. Typically, medical-surgical units do not have a seclusion room. Seclusion is
used only for patients who are behaving violently. Use of a physical restraint
together with seclusion for a patient who’s behaving in a violent or self-destructive
manner requires continuous nursing monitoring.

Advance Directives

The Advance Directive is a written document by a competent person, regarding

their health care preference. An Advance Directive may include a living will and/or
a durable power of attorney for health care. A living will is a written directive
regarding the course, continuation, or discontinuation of medical treatment in the
event that a person becomes incompetent.

A durable power of attorney for health care is a written designation to authorize

one or more person(s) to make health care decisions in the event of a person
becoming incompetent to make their own decisions.

Informed consent is the legal obligation to provide full disclosure to a patient

regarding potential risks and outcomes of tests and treatments. The obligation is
operative in the development of the Advance Directive because the corollary is
the right not to consent to treatment.

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Developmental Stages of
Transition
Trust Versus Mistrust (Birth to About 18 Months)

The infant is taking the world in through with their mouth, eyes, ears, and sense
of touch. A baby whose mother is able to anticipate and respond to its needs in a
consistent and timely manner despite its oral aggression will eventually learn to
tolerate the inevitable moments of frustration and deprivation.

Autonomy Versus Shame and Doubt (About 18 Months to

About 3 Years)

This oral-sensory stage of infancy, marked by the potential development of basic

trust aiming toward the achievement of a sense of hope. Here, the child will
develop an appropriate sense of autonomy, otherwise doubt and shame will
undermine free will (also known as the terrible twos stage).

Initiative Versus Guilt (About 3 Years to About 5 Years)

Here, the child’s task is to develop a sense of initiative as opposed to further shame
or guilt. The lasting achievement of this stage is a sense of purpose. The child's
increasing mastery of locomotor and language skills expands its participation in the
outside world and stimulates omnipotent fantasies of wider exploration and conquest

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Industry Versus Inferiority (About 5 Years to About 13 Years)

Here the child is in the school-age, so- called stage of latency. He tries to master
the crisis of industry versus inferiority aiming toward the development of a sense
of competence.

Identity Versus Role Confusion (About 13 Years to

About 21 Years)

At puberty, the fifth stage, the task of adolescence is to navigate their “identity
crisis” as each individual struggles with a degree of “identity confusion”.

Intimacy Versus Isolation (About 21 Years to About 40 Years)

Young adulthood, at the stage of genitality or sixth stage, is marked by the crisis
of intimacy versus isolation, out of which may come the achievement of a capacity
for love (they are learning who they are).

Generativity Versus Stagnation (About 40 Years to About

60 Years)

Care is the virtue that corresponds to this stage. This failure of generativity can
lead to profound personal stagnation, covered by a variety of escapisms, such as
alcohol and drug abuse, and sexual and other infidelities. Mid-life crisis may also
occurduring this stage.

Integrity Versus Despair (About 60 Years to Death)

The individual in possession of the virtue of wisdom and a sense of integrity has
room to tolerate the proximity of death and to achieve.

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Maternal Nursing
The antepartum or pre-natal period starts when the woman’s pregnancy is
diagnosed and ends just before the baby is delivered.

The following are the goals of antepartum care: To evaluate the health status of
the mother and the fetus, estimate the gestational age, identify the patient at risk
for complications, anticipate problems before they occur and prevent them if
possible, and promote patient education and communication.

Age of Gestation (AOG)

Should be estimated to calculate the exact date of delivery and the estimated
weight and height of the fetus. The following are some estimates of AOG methods:

Nagele’s Rule

Naegele's rule - rule for calculating an expected delivery date; subtract three months
from the first day of the last menstrual period and add seven days to that date.

McDonald’s Method

Fundal height, or McDonald’s Method, is a measure of the size of the uterus to

assess fetal growth and development. It is measured from the top of the pubic
bone to the top of the uterus in centimeters and it should match the baby’s
gestational age.

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Bartholomew’s Rule

This method estimates the age of gestation relative to the height of the fundus of
the uterus above the symphysis pubis.

Prolapsed Cord

A prolapsed cord is the descent of the umbilical cord into the vagina ahead of the
fetal thereby presenting part with resulting compression of the cord between the
presenting part and the maternal pelvis.

Premature Rupture of Membranes PROM

Is the rupture of chorion and amnion before the onset of labor. The gestational
age of the fetus and estimates of viability affect management.

Shoulder Dystocia

In shoulder dystocia, the anterior shoulder of the baby is unable to pass under the
maternal pubic arch.

Induction of Labor

Oxytocin-induced labor must be done with careful, ongoing monitoring; oxytocin

is a powerful drug. Hyperstimulation of the uterus may results in titanic
contractions prolonged to more than 90 seconds, which could cause fetal
compromise due to impaired uteroplacental perfusion, abruption placentae,
laceration of the cervix, uterine rupture, or neonatal trauma.

Important Tip: Know what kind of signs or symptoms to pay attention to that
would warn you to stop the oxytocin.

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Mental Health
Bipolar Disorder

Bipolar disease is classified as bipolar I (sustained mania with depressive episodes)

or bipolar II (at least one major depression episode with at least one hypomanic
episode). People with bipolar disorder experience unusually intense emotional
states that occur in distinct periods called "mood episodes".

Schizophrenia

A mental disorder where patients do not think clearly, or act normally in social
situations and cannot differentiate between reality and fantasy and do not have
normal emotional responses. Schizophrenia is characterized by having two or
more symptoms a significant portion of the time over a period of one month.
Symptoms may include: delusions, hallucinations, disorganized speech,
disorganized behavior, and negative symptoms (loss of pleasure, flat affect, poor
grooming, poor social skills, and social withdrawal).

Delirium

Is an acute state of confusion that usually affects older adults following surgery or
a serious illness. A longer length of stay can oftentimes be associated with an
increase in mortality. Providing as much normalcy for these patients is essential.
Examples of this may include maintaining a sleep/wake cycle pattern, reality
orientation and maintaining a safe environment.

Dementia

Is a chronic state of confusion typically seen by elderly patients over time. Interventions
may include providing meaningful stimuli, maintaining a safe environment, and
avoiding stressful situations.

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Psychotropic Medications
A psychotropic medication is a term for psychiatric medicines that alter chemical
levels in the brain which impact mood and behavior.

Atypical antipsychotics- Used to treat the symptoms of schizophrenia and bipolar

disorder. Drug examples may include Risperidal, Seroquel, and Zyprexa.

Anti-Manic & Mood Stabilizing Drugs- Mood stabilizers are medicines that treat
and prevent highs (manic or hypomanic episodes) and lows (depressive episodes).
Examples may include Lithium, Lamictal and Tegretol.

Tricyclic Antidepressants- These medications work by inhibiting the reuptake of

norepinephrine and serotonin by pre-synaptic neurons into the central nervous
system. Examples may include Anfranil and Elavil.

Selective Serotonin Reuptake Inhibitors (SSRI) are currently the most common
type of anti-depressants prescribed for depression. Examples include Prozac, Paxil,
Celexa, and Zoloft.

MAOIs- Medications that are also used to treat depression that inhibit monamine
oxidase. Because of the role that MAOs play in the inactivation of
neurotransmitters in the brain, MAO dysfunction (too much or too little MAO
activity) is thought to be responsible for a number of psychiatric and neurological
disorders such as depression and schizophrenia. Examples of these drugs include
Marplan, Nardil, and Parnate.

Serotonin Norepinephrine Reuptake Inhibitors (SSRIs) work by preventing the

body from filtering excess serotonin and norepinephrine. SSRIs have the power to
significantly improve mood, outlook, and behavior in people with depression.
Examples include Effexor, Pristiq and Cymbalta.

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Important Thing to Remember: Most antidepressant medications typically take

within 2 weeks to begin working in patients and 6 to 8 weeks before they feel the
full effect of the medication.

Benzodiazepines- This is a class of agents that work in the central nervous system
to act selectively on the gamma-aminobutyric acid-A (GABA-A) receptors in the
brain. Some examples may include Ativan, Klonopin, Valium, and Xanax.

Typical Antipsychotics- Used to reduce anxiety and agitation that often happen in
schizophrenia. They can also reduce problems with thinking or remembering
(cognitive impairment) and reduce or control delusions and hallucinations
(psychosis). Example may include Haldol.

Important Thing to Remember: Most common dangerous side effect of Haldol is

QT prolongation.

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Therapeutic Communication
Therapeutic Communication

Therapeutic relationships are goal- oriented and directed at learning and growth
promotion.

Requirements for Therapeutic Relationship are Rapport, Empathy, Trust, Respect,

and Genuineness (RETRG).

Therapeutic Communication Techniques Using Silence - allows client to take control

of the discussion, if he or she so desires.

Accepting - conveys positive regard.

Giving recognition – acknowledging, indicating awareness.

Offering self - making oneself available.

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