AACN ACNPC-AG flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Positive likelihood ratio

A positive likelihood ratio equals sensitivity divided by (1 minus specificity). Values above 10 substantially increase the probability of disease after a positive test.

Sensitivity and specificity

Sensitivity is the proportion of diseased patients with a positive test; specificity is the proportion of nondiseased patients with a negative test. High sensitivity helps rule out disease.

Anion gap formula

Anion gap equals sodium minus the sum of chloride and bicarbonate. A normal gap is about 8 to 12 mEq/L; an elevated gap with acidosis suggests unmeasured anions such as ketones or lactate.

Corrected calcium formula

Corrected calcium equals measured calcium plus 0.8 times (4.0 minus albumin in g/dL). Ionized calcium is preferred in critical illness because albumin and acid-base status affect total calcium.

Delirium screening features

Delirium is an acute fluctuating disturbance of attention and awareness. The Confusion Assessment Method requires acute onset or fluctuation, inattention, and either disorganized thinking or altered consciousness.

Glasgow Coma Scale airway rule

A Glasgow Coma Scale score of 8 or less indicates severe neurologic impairment and warrants consideration of airway protection. Reassess trends because a falling score may signal herniation or deterioration.

D-dimer pretest probability

D-dimer is most useful to exclude pulmonary embolism in low or intermediate pretest probability patients. High pretest probability warrants imaging rather than reliance on a negative D-dimer.

Worst-case diagnostic strategy

Diagnostic reasoning first considers time-critical and dangerous diagnoses, then uses risk stratification and targeted testing. This approach reduces harm from anchoring on benign explanations.

Septic shock initial bundle

For septic shock, obtain cultures, give broad-spectrum antibiotics within one hour, and administer 30 mL/kg crystalloid for hypotension or lactate of 4 mmol/L or greater.

Hyperkalemia membrane stabilization

Intravenous calcium stabilizes cardiac membranes in hyperkalemia with ECG changes. Insulin with glucose, beta-2 agonists, and diuretics lower potassium; dialysis treats refractory or renal failure cases.

DKA insulin initiation rule

In diabetic ketoacidosis, begin insulin infusion after potassium is at least 3.3 mEq/L. Add dextrose when glucose falls below 200 to 250 mg/dL while continuing insulin to clear ketones.

STEMI reperfusion time

For ST-elevation myocardial infarction, reperfusion is urgent: primary percutaneous coronary intervention is preferred if achievable within 120 minutes; otherwise fibrinolysis is considered within 30 minutes of presentation.

COPD exacerbation NIV

Noninvasive ventilation is indicated for COPD exacerbation with respiratory acidosis, typically pH below 7.35 and elevated PaCO2, when the patient can protect the airway and cooperate.

Upper GI bleed transfusion

For acute upper gastrointestinal bleeding, use restrictive transfusion with hemoglobin threshold below 7 g/dL, or below 8 g/dL in ischemic heart disease, while giving proton pump inhibitor therapy.

Increased intracranial pressure actions

Elevate the head about 30 degrees, avoid hypotension and hypoxia, and use hyperosmolar therapy for increased intracranial pressure. Brief hyperventilation is reserved for impending herniation.

Terminal dyspnea opioid use

Opioids titrated to symptoms relieve refractory dyspnea in terminal illness. Anticipate and treat pain, dyspnea, secretions, and anxiety; discontinue nonbeneficial monitoring and treatments consistent with goals.

Colorectal cancer screening ages

Average-risk colorectal cancer screening begins at age 45 and continues to age 75. Ages 76 to 85 require individualized decisions based on health status and prior screening.

Lung cancer screening criteria

Annual low-dose computed tomography screens adults aged 50 to 80 with at least a 20 pack-year smoking history who currently smoke or quit within 15 years.

Hypertension diagnostic threshold

Hypertension is diagnosed when blood pressure is 130/80 mm Hg or higher on repeated readings. Lifestyle modification and pharmacotherapy reduce cardiovascular risk.

Diabetes screening thresholds

Diabetes screening is recommended for adults aged 35 to 70 with overweight or obesity. Diagnosis uses A1c 6.5% or higher, fasting glucose 126 mg/dL or higher, or oral glucose tolerance test 200 mg/dL or higher.

Adult immunization schedule

Adults need annual influenza vaccination, Tdap every 10 years, and recombinant zoster vaccine at age 50 or older. Pneumococcal vaccination is recommended at age 65 or for younger adults with risk conditions.

Tobacco cessation assist

The five A's are ask, advise, assess, assist, and arrange follow-up. Combine behavioral counseling with varenicline, bupropion, or nicotine replacement unless contraindicated.

Obesity treatment thresholds

Obesity is a body mass index of 30 kg/m2 or higher. Intensive behavioral therapy is first-line; pharmacotherapy may be added, and bariatric surgery is considered at BMI 40 or 35 with comorbidities.

Falls screening older adults

Screen adults aged 65 and older annually for falls. Multifactorial assessment and interventions include exercise, medication review, vision correction, and home safety modification.

Informed consent elements

Valid informed consent requires diagnosis, proposed intervention, risks and benefits, reasonable alternatives, and consequences of refusal. Emergency exceptions apply when immediate treatment is necessary and no surrogate can consent.

Decision-making capacity criteria

Capacity requires the patient to understand relevant information, appreciate consequences, reason about options, and express a choice. Capacity is decision-specific; a diagnosis alone does not determine it.

Surrogate decision-maker hierarchy

When a patient lacks capacity, identify the legally authorized surrogate under state law. Surrogates use substituted judgment, then best interests if the patient's values are unknown.

HIPAA minimum necessary

HIPAA permits treatment, payment, and operations disclosures while requiring minimum necessary information. State law may impose stricter privacy or reporting requirements.

Mandatory reporting duties

Clinicians must report suspected abuse, neglect, and certain communicable diseases according to state law. Duty-to-warn obligations may arise when a patient poses a serious threat to an identifiable person.

Ethics consultation triggers

Seek ethics consultation for value conflicts, uncertain surrogate authority, requests for nonbeneficial treatment, or disagreement about goals of care. Consultation supports, but does not replace, clinical decision-making.

SBAR communication

SBAR structures handoffs as situation, background, assessment, and recommendation. Closed-loop communication confirms that the receiver understands and accepts the plan.

PDSA quality cycle

The Plan-Do-Study-Act cycle tests small changes, measures results, and refines interventions. It supports quality improvement and is distinct from research.