ANCC AGPCNP-BC cheat sheet

Orthostatic vital signs: measure after 5 minutes supine, then at 1 and 3 minutes of standing; positive when systolic falls at least 20 mm Hg or diastolic falls at least 10 mm Hg.

Comprehensive geriatric assessment covers function (ADLs/IADLs), cognition, mood, falls, continence, nutrition, polypharmacy, sensory deficits, social support, and advance care preferences.

Mini-Cog combines a 3-item recall with clock drawing; a total score of 2 or less out of 5 is a positive dementia screen.

Timed Up and Go longer than 12 seconds, or usual gait speed below 0.8 m/s, flags elevated fall risk and frailty.

Ankle-brachial index of 0.90 or less supports peripheral artery disease; above 1.40 indicates noncompressible calcified vessels.

PHQ-2 score of 3 or more triggers the PHQ-9; AUDIT-C is positive at 4 or more in men and 3 or more in women.

Post-bronchodilator FEV1/FVC below 0.70 defines persistent airflow obstruction consistent with COPD.

Pooled Cohort Equations estimate 10-year ASCVD risk; 7.5 percent or higher prompts statin risk discussion and 20 percent or higher is high risk.

Review the Beers Criteria at every visit for adults 65 and older to flag potentially inappropriate medications.

Confusion Assessment Method is positive with acute onset or fluctuating course plus inattention, plus either disorganized thinking or altered level of consciousness.

Hyponatremia workup sequence: serum osmolality first; if hypotonic, obtain urine osmolality then urine sodium to classify the cause.

Light's criteria call pleural fluid an exudate when protein ratio exceeds 0.5, LDH ratio exceeds 0.6, or fluid LDH exceeds two-thirds the upper normal serum limit.

Serum-ascites albumin gradient of 1.1 g/dL or more indicates portal hypertension-related ascites; lower values suggest malignancy, tuberculosis, or pancreatic disease.

Chronic kidney disease is defined by GFR below 60 mL/min/1.73 m2 or markers of kidney damage persisting more than 3 months, staged by GFR category plus albuminuria category.

Diabetes is confirmed by A1c 6.5 percent or higher, fasting glucose 126 mg/dL or higher, 2-hour OGTT 200 mg/dL or higher, or random glucose 200 mg/dL or higher with symptoms; asymptomatic results need repeat confirmation.

Multiple myeloma is suggested by CRAB features: hyperCalcemia, Renal insufficiency, Anemia, and Bone lesions.

A likelihood ratio above 10 or below 0.1 meaningfully changes pretest to posttest probability; values near 1 are uninformative.

Anemia of inflammation typically shows ferritin above 100 ng/mL with transferrin saturation below 20 percent.

High-intensity statin therapy is atorvastatin 40 to 80 mg or rosuvastatin 20 to 40 mg daily, lowering LDL cholesterol by 50 percent or more.

A1c goal is below 7 percent for most nonfrail adults and below 8 percent when life expectancy is limited or hypoglycemia risk is high.

Blood pressure goal is generally below 130/80 mm Hg, individualized upward in frail older adults with orthostasis, falls, or limited life expectancy.

Adult immunization: recombinant zoster vaccine 2 doses at age 50 or older; PCV20 or PCV21 once at 65 or older (or PCV15 followed by PPSV23); Tdap every 10 years; influenza annually; RSV at 75 or older or 60 to 74 with risk factors.

Screening intervals: colorectal cancer ages 45 to 75 (colonoscopy every 10 years or annual FIT); mammography every 1 to 2 years ages 50 to 74; DXA for women 65 and older and men 70 and older.

Aspirin is not routinely started for primary prevention at age 60 or older because bleeding risk offsets modest cardiovascular benefit.

Anticoagulation for atrial fibrillation is recommended at CHA2DS2-VASc 2 or more in men and 3 or more in women, with a direct oral anticoagulant preferred over warfarin.

Document SMART goals and advance care planning, including code status and health care proxy, as part of every chronic disease plan.

Start low and go slow: begin older adults near half the usual adult dose and titrate gradually because hepatic and renal clearance decline.

Cockcroft-Gault creatinine clearance = [(140 - age) x weight in kg] / (72 x serum creatinine), multiplied by 0.85 for women, and drives renal dose adjustment.

Start basal insulin at 10 units daily or 0.1 to 0.2 units/kg/day, titrating against fasting glucose every 3 days.

Co-prescribe naloxone when opioid dose reaches 50 morphine milligram equivalents daily, when a benzodiazepine is combined, or with prior overdose or substance use disorder.

Tobacco cessation uses the 5 A's (Ask, Advise, Assess, Assist, Arrange) plus pharmacotherapy; varenicline is the most effective single agent.

Motivational interviewing core skills are OARS: open-ended questions, affirmations, reflections, and summaries.

Deprescribe anticholinergic and Beers-listed medications by tapering rather than abrupt discontinuation for benzodiazepines, proton pump inhibitors, and antidepressants.

Prescribe at least 150 minutes weekly of moderate aerobic activity plus resistance training twice weekly and balance training for fall prevention.

Confirm inhaler and spacer technique with teach-back before assuming treatment failure.

Check A1c every 3 months while adjusting therapy or when goals are unmet, then every 6 months once targets are stable.

Recheck TSH 6 to 8 weeks after any levothyroxine dose change because the pituitary-thyroid axis requires that interval to equilibrate.

Recheck lipids 4 to 12 weeks after starting or changing statin therapy to assess response and adherence.

Check INR weekly during warfarin initiation and after dose changes, then every 4 weeks once stable; target INR is 2 to 3 for atrial fibrillation.

Home blood pressure monitoring: 2 readings morning and evening for 7 days with a validated upper-arm cuff, averaging the second week.

Deintensify sulfonylureas or insulin when A1c falls below 7 percent in an older adult, since these agents drive most severe hypoglycemia.

Evaluate statin-associated muscle symptoms clinically; check creatine kinase only when symptoms are significant or rhabdomyolysis is suspected.

Repeat DXA no more often than every 2 years, and rescreen annually for falls, depression, and cognitive change.