AACN ACNPC-AG cheat sheet

Assess airway, breathing, and circulation before history; SpO2 below 90%, systolic blood pressure below 90 mm Hg, or altered mentation mandates immediate stabilization.

Positive likelihood ratio = sensitivity / (1 - specificity); values above 10 markedly raise post-test probability and values below 0.1 markedly lower it.

Diagnostic reasoning prioritizes time-critical and dangerous diagnoses before common benign ones, using risk stratification and targeted testing to avoid anchoring bias.

Glasgow Coma Scale score of 8 or less signals severe impairment and prompts consideration of airway protection; a falling score suggests deterioration.

Delirium screen: acute onset or fluctuation, inattention, and either disorganized thinking or altered consciousness; use CAM-ICU for mechanically ventilated patients.

Anion gap = Na - (Cl + HCO3); normal is 8-12 mEq/L; elevated gap metabolic acidosis suggests ketones, lactate, uremia, or toxins.

Corrected calcium = measured calcium + 0.8 x (4.0 - albumin g/dL); ionized calcium is preferred in critical illness because total calcium is albumin-dependent.

For suspected pulmonary embolism, D-dimer is most useful in low or intermediate pretest probability; high pretest probability warrants imaging rather than D-dimer alone.

Sepsis: suspected infection plus SOFA increase of 2 or more; septic shock requires vasopressors for MAP at least 65 mm Hg and lactate above 2 mmol/L despite fluids.

Septic shock bundle: cultures before antibiotics, broad-spectrum antibiotics within 1 hour, and 30 mL/kg crystalloid for hypotension or lactate 4 mmol/L or higher.

Acute coronary syndrome: obtain ECG within 10 minutes, give aspirin 162-325 mg chewed, and measure troponin; STEMI requires urgent reperfusion.

Hyperkalemia with ECG changes: IV calcium stabilizes membranes; insulin with glucose, beta-2 agonist, and diuretics lower potassium; dialysis for refractory or renal failure.

DKA: begin insulin infusion only after potassium is at least 3.3 mEq/L; add dextrose when glucose is 200-250 mg/dL while continuing insulin until ketones clear.

COPD exacerbation with pH below 7.35 and hypercapnia: noninvasive ventilation reduces intubation risk when the patient can protect the airway and cooperate.

Upper GI bleed: restrictive transfusion at hemoglobin below 7 g/dL, or below 8 g/dL with ischemic heart disease; give proton pump inhibitor for suspected upper bleeding.

Increased ICP: elevate head about 30 degrees, avoid hypoxia and hypotension, use mannitol or hypertonic saline; brief hyperventilation only for impending herniation.

Terminal illness: titrate opioids for pain or dyspnea, anticipate secretions and anxiety, and withdraw nonbeneficial monitoring and treatments consistent with goals.

Colorectal cancer screening: average risk starts at age 45 and continues to 75; ages 76-85 require individualized decisions based on health and prior screening.

Lung cancer screening: annual low-dose CT for ages 50-80 with at least 20 pack-years and current smoking or quit within 15 years.

Hypertension: diagnose at 130/80 mm Hg or higher on repeated readings; treatment includes lifestyle change and pharmacotherapy based on risk.

Diabetes screening: adults 35-70 with overweight or obesity; A1c 6.5% or higher, fasting glucose 126 mg/dL or higher, or 2-hour OGTT 200 mg/dL or higher.

Immunizations: influenza annually; Tdap every 10 years; recombinant zoster at age 50 or older; pneumococcal at age 65 or younger with risk conditions.

Tobacco cessation: five A's (ask, advise, assess, assist, arrange); combine counseling with varenicline, bupropion, or nicotine replacement unless contraindicated.

Obesity: BMI 30 kg/m2 or higher; intensive behavioral therapy first-line; pharmacotherapy may be added; bariatric surgery at BMI 40 or 35 with comorbidity.

Falls: screen adults 65 and older annually; multifactorial assessment includes exercise, medication review, vision, orthostatic blood pressure, and home safety.

Informed consent: diagnosis, nature and purpose of intervention, risks and benefits, alternatives, and consequences of refusal; emergency exception when immediate treatment is needed.

Decision-making capacity: patient understands, appreciates, reasons, and expresses a choice; capacity is decision-specific and not determined by diagnosis alone.

Surrogate hierarchy: follow state law; surrogate uses substituted judgment first, then best interests when patient values are unknown.

HIPAA: minimum necessary applies to treatment, payment, and operations; state law may require stricter privacy or specific mandatory reporting.

Mandatory reporting: suspected abuse or neglect and specified communicable diseases per state law; duty to warn may apply for serious threat to an identifiable person.

Ethics consultation: value conflict, uncertain surrogate authority, nonbeneficial treatment requests, or goals-of-care disagreement; consultation advises but does not replace clinical judgment.

SBAR: situation, background, assessment, recommendation; closed-loop communication confirms receipt and understanding of the plan.

PDSA cycle: plan, do, study, act; tests small changes with measurement and refinement; quality improvement differs from research and does not require IRB review unless human-subjects research.