ANCC AGCNS-BC cheat sheet

Sepsis-3: sepsis = suspected infection plus an acute increase in SOFA score of at least 2 points; septic shock = vasopressors needed to keep MAP at least 65 mm Hg plus lactate above 2 mmol/L despite adequate fluids.

ARDS Berlin criteria: onset within 1 week, bilateral opacities, PaO2/FiO2 300 or less with PEEP at least 5 cm H2O, and respiratory failure not fully explained by cardiac failure or fluid overload.

KDIGO AKI: creatinine rise of at least 0.3 mg/dL within 48 hours, at least 1.5 times baseline within 7 days, or urine output below 0.5 mL/kg/h for 6 hours.

DKA: glucose above 250 mg/dL, pH below 7.30, bicarbonate below 18 mEq/L, anion gap acidosis, and ketones; give isotonic fluids, start insulin after potassium is above 3.3 mEq/L, and add dextrose when glucose is 200-250 mg/dL.

STEMI reperfusion goal: door-to-balloon time 90 minutes or less; give chewable aspirin 162-325 mg unless contraindicated and avoid NSAIDs.

CAM-ICU positive delirium: acute onset or fluctuating course plus inattention, and either disorganized thinking or altered level of consciousness.

Ventilator bundle: head of bed 30-45 degrees, daily sedation interruption and spontaneous breathing trial, peptic ulcer prophylaxis, DVT prophylaxis, and oral care.

Pressure injury staging: stage 1 = nonblanchable erythema; stage 2 = partial-thickness dermal loss; stage 3 = full-thickness loss into subcutaneous fat; stage 4 = exposure of bone, tendon, or muscle; unstageable = slough or eschar obscures depth.

Beers criteria: avoid benzodiazepines, anticholinergics, first-generation antihistamines, and long-acting sulfonylureas in older adults because of falls, delirium, and hypoglycemia risk.

PICO: Patient/Population, Intervention, Comparison, Outcome; the question type determines whether the best design is an RCT, cohort study, or qualitative study.

Evidence hierarchy high to low: systematic review or meta-analysis of RCTs, randomized controlled trial, cohort study, case-control study, cross-sectional study, case report, expert opinion.

Sensitivity = TP/(TP+FN); specificity = TN/(TN+FP); a highly sensitive test is useful for ruling out disease when the result is negative.

Positive predictive value = TP/(TP+FP) and rises as disease prevalence rises; negative predictive value falls as prevalence rises.

Relative risk = incidence in exposed / incidence in unexposed; odds ratio = (a/c)/(b/d) for a 2x2 table.

Absolute risk reduction = control event rate minus treatment event rate; NNT = 1/ARR; NNH = 1/ARI.

Randomization reduces selection bias; blinding reduces performance and detection bias; intention-to-treat analysis reduces attrition bias.

Type I error is a false positive (alpha, usually 0.05); type II error is a false negative (beta); power = 1 - beta, conventionally 0.80.

IRB approval and informed consent are required for human-subjects research unless the study meets exempt criteria; prisoners, children, and cognitively impaired adults need additional protections.

USPSTF grades: A and B = offer or provide; C = offer selectively based on professional judgment; D = discourage; I = insufficient evidence.

Adults 65 and older: PCV20 alone or PCV15 followed by PPSV23 at least 1 year later; annual influenza vaccine; RSV vaccine at 75 or older, or 60-74 with risk factors.

Recombinant zoster vaccine: 2 doses 2-6 months apart for adults 50 and older and immunocompromised adults 19 and older.

Tdap or Td booster every 10 years; one dose of Tdap during each pregnancy at 27-36 weeks gestation.

Cancer screening: colorectal 45-75; breast mammography 40-74; cervical 21-65 with cytology every 3 years or HPV testing every 5 years.

Diabetes screening: all adults 35 and older or with risk factors; A1c at least 6.5%, fasting glucose at least 126 mg/dL, or 2-hour OGTT at least 200 mg/dL confirms diabetes.

Hypertension: ACC/AHA defines at least 130/80 mm Hg; stage 1 is 130-139/80-89 and stage 2 is at least 140/90.

Smoking cessation: Ask, Advise, Assess, Assist, Arrange; varenicline and combination nicotine replacement have the strongest evidence.

Teach-back and plain-language materials at a 5th-6th grade reading level are health-literacy universal precautions; confirm understanding by having the patient explain back.

CNS practice has three spheres: direct patient and family care, nurses and nursing practice, and organization and system.

APRN Consensus Model: graduate degree, national certification in a population focus, and state licensure; title and scope are set by the state nurse practice act.

Prescriptive authority, including controlled substances, varies by state; CNSs must know state collaborative agreement and DEA requirements.

ANA Code of Ethics principles: autonomy, beneficence, nonmaleficence, and justice; the code guides professional conduct and patient advocacy.

NACNS is the national professional organization for CNSs; specialty organizations set population-specific certification and practice standards.

Certification maintenance typically requires continuing education units and practice hours; requirements differ by certifying body.

Precepting and mentoring support role transition; the CNS preceptor evaluates competencies such as clinical judgment, collaboration, and systems thinking.

Interprofessional collaboration improves outcomes; the CNS facilitates team communication, conflict resolution, and role clarity.

Donabedian model: structure (resources, staffing, policies), process (care delivery), and outcome (patient results).

IHI Model for Improvement asks: What are we trying to accomplish? How will we know that a change is an improvement? What changes will result in improvement?

PDSA: Plan a test, Do it on a small scale, Study the results, Act to adopt, adapt, or abandon.

RCA is retrospective after a sentinel event; FMEA is prospective and scores severity, occurrence, and detectability.

Control charts: special-cause variation is signaled by a point outside limits, 7 consecutive points on one side of the mean, or a trend; common-cause variation is inherent to the process.

Benchmarking compares performance with internal or external standards; variance analysis compares actual budget to expected and classifies favorable or unfavorable.

Kotter's 8 steps include creating urgency and forming a coalition; Lewin's model is unfreeze-change-refreeze.

Just culture separates human error from at-risk and reckless behavior; it supports nonpunitive reporting while maintaining accountability.

Nursing-sensitive indicators include falls, pressure injuries, CAUTI, CLABSI, and HCAHPS communication scores.