ANCC MedSurg-BC cheat sheet

Normal arterial blood gas: pH 7.35–7.45, PaCO2 35–45 mmHg, HCO3 22–26 mEq/L, PaO2 80–100 mmHg.

Anion gap = Na − (Cl + HCO3); normal 8–12 mEq/L; a gap >12 indicates anion-gap metabolic acidosis (lactate, ketones, uremia, toxins).

Winter formula: expected PaCO2 = (1.5 × HCO3) + 8 ± 2; a measured PaCO2 outside this range indicates a second acid–base disorder.

SIRS = two or more of: temperature >38 °C or <36 °C, HR >90, RR >20 or PaCO2 <32, WBC >12,000 or <4,000, or >10% bands.

Glasgow Coma Scale ranges 3–15 (eye 1–4, verbal 1–5, motor 1–6); a score of 8 or less indicates severe impairment requiring airway protection consideration.

Serum reference ranges: Na 135–145 mEq/L, K 3.5–5.0 mEq/L, total Ca 8.6–10.2 mg/dL, Mg 1.3–2.1 mg/dL, creatinine 0.6–1.2 mg/dL, BUN 7–20 mg/dL.

Diabetes diagnostic thresholds: fasting glucose ≥126 mg/dL, 2-hour OGTT ≥200 mg/dL, random glucose ≥200 mg/dL with symptoms, or HbA1c ≥6.5%.

Serum-ascites albumin gradient ≥1.1 g/dL indicates portal hypertension; <1.1 g/dL suggests peritoneal carcinomatosis, tuberculosis, or pancreatic ascites.

Corrected sodium = measured Na + 1.6 mEq/L for each 100 mg/dL of glucose above 100 mg/dL.

Diabetic ketoacidosis: IV regular insulin 0.1 units/kg/hour; hold insulin if potassium <3.3 mEq/L; add dextrose when glucose falls below 200–250 mg/dL.

Hyperkalemia with ECG changes: IV calcium gluconate first to stabilize the myocardium, then insulin with glucose, albuterol, sodium bicarbonate, and dialysis as needed.

Unfractionated heparin: aPTT target 1.5–2.5 times control; a platelet drop >50% suggests heparin-induced thrombocytopenia - stop heparin and switch to argatroban.

Warfarin: INR target 2.0–3.0 for most indications and 2.5–3.5 for mechanical mitral valves; vitamin K and prothrombin complex concentrate reverse major bleeding.

Parkland formula: 4 mL lactated Ringer × kg × %TBSA over 24 hours, with half given in the first 8 hours after the burn.

One unit of packed red blood cells raises hemoglobin about 1 g/dL and hematocrit about 3%; transfuse with 0.9% sodium chloride only, never with lactated Ringer or dextrose solutions.

Sepsis: obtain lactate and cultures, give broad-spectrum antibiotics within 1 hour for septic shock and within 3 hours for possible sepsis without shock, and 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L.

Ventilator-associated pneumonia bundle: head of bed 30–45 degrees, daily sedation interruption and spontaneous breathing trial, oral care, cuff pressure 20–30 cm H2O, plus DVT and stress ulcer prophylaxis.

Pressure injury staging: stage 1 nonblanchable erythema, stage 2 partial-thickness dermal loss, stage 3 full-thickness with fat visible, stage 4 fascia/bone/tendon exposed, unstageable when eschar obscures the bed.

Reassess pain approximately 30 minutes after IV analgesia and 60 minutes after oral analgesia, documenting score, relief, and adverse effects.

During IV insulin infusion, check blood glucose hourly and titrate to a target of 140–180 mg/dL for most critically ill adults.

Check aPTT 6 hours after starting heparin or changing the rate; check INR daily during warfarin initiation, then every 2–3 days once stable.

Transfusion monitoring: vital signs at baseline, at 15 minutes, and per policy; stop the transfusion for fever rise ≥1 °C, chills, dyspnea, back pain, or hemoglobinuria.

Compartment pressure >30 mmHg or within 30 mmHg of diastolic pressure, with pain on passive stretch, indicates compartment syndrome requiring urgent fasciotomy.

Urine output ≥0.5 mL/kg/hour (about 30 mL/hour in a 60 kg adult) indicates adequate perfusion; output <0.5 mL/kg/hour for 2 hours signals hypoperfusion.

Oxygen saturation target is 88–92% for patients with COPD at risk of CO2 retention and 92–96% for most other medical-surgical adults.

Braden score <12 predicts high pressure injury risk; the score is reassessed each shift and after any change in condition.

The state Nurse Practice Act defines scope of practice, licensure requirements, and disciplinary authority; it is the governing legal standard for nursing practice.

Informed consent: the provider performing the procedure discloses risks, benefits, and alternatives; the nurse witnesses the signature and verifies voluntariness and comprehension.

Five rights of delegation: right task, right circumstance, right person, right direction and communication, and right supervision and evaluation.

SBAR handoff structure: Situation, Background, Assessment, Recommendation - a standardized format that reduces omissions during transitions of care.

Serious reportable events include wrong-site surgery, retained foreign body, hemolytic transfusion reaction from blood type error, and stage 3 or 4 hospital-acquired pressure injury.

Mandatory reporting covers suspected child, elder, and dependent adult abuse or neglect, specified communicable diseases, and impaired colleagues as defined by state law.

Core ethical principles: autonomy, beneficence, nonmaleficence, justice, fidelity, and veracity.

A time-out immediately before a procedure verifies patient identity, procedure, site, consent, allergies, and implants aloud with the full team present.

Evidence hierarchy from strongest to weakest: systematic reviews and meta-analyses of randomized trials, randomized trials, cohort studies, case-control studies, expert opinion.