GPNC(C) cheat sheet

Autonomy: the patient's right to self-determination, including refusal of treatment, even when the nurse disagrees with the choice.

Beneficence requires acting in the patient's interest; nonmaleficence requires avoiding harm - the two are weighed together when interventions carry risk.

Fidelity is keeping promises and commitments; veracity is truthfulness. Both are breached by misleading a patient about prognosis.

Justice governs fair allocation of scarce resources; it is the ethical basis for triage and organ-allocation decisions.

Informed consent elements: capacity, voluntariness, disclosure of risks/benefits/alternatives, and comprehension. The provider who performs the procedure obtains consent; the nurse witnesses and verifies understanding.

Nurse Practice Acts are state law defining scope of practice; they vary by state, so an action legal in one state may be outside scope in another.

Delegation to unlicensed assistive personnel follows the five rights: right task, circumstance, person, direction/communication, and supervision. Assessment, teaching, and evaluation remain the RN's responsibility.

A patient may revoke an advance directive at any time, including when they still have capacity; a durable power of attorney for health care activates when the patient loses capacity.

Mandatory reporting duties typically include suspected abuse of children, older adults, or dependent adults, and certain communicable diseases; reporting is required even if the nurse believes it breaches confidentiality.

The Joint Commission's Universal Protocol for invasive procedures has three parts: preprocedure verification, site marking, and a time-out immediately before the procedure.

Fall risk scales (for example Morse or Hendrich II) score specific factors; interventions are matched to score - bed low and locked, call light within reach, nonskid footwear, and hourly rounding.

The chain of infection has six links: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host. Hand hygiene breaks the most common link.

RCA (root cause analysis) is retrospective and systems-focused, used after a sentinel event; FMEA (failure mode and effects analysis) is prospective and used before a process is implemented.

PDSA (Plan-Do-Study-Act) is a rapid-cycle improvement model; the 'Study' phase compares predicted with actual results before adopting or adapting the change.

High-alert medications (insulin, heparin, opioids, concentrated electrolytes) require independent double-checks, standardized concentrations, and distinct labeling.

Speak-up culture and just culture distinguish human error (console), at-risk behavior (coach), and reckless behavior (remediate or discipline); punitive response to error suppresses reporting.

National Patient Safety Goals emphasize identifying patients with two identifiers, improving staff communication, safe medication use, infection prevention, and reducing harm from falls and pressure injuries.

ABCDE primary survey order: Airway, Breathing, Circulation, Disability (neuro), Exposure. Life threats are corrected before a full history is taken.

Glasgow Coma Scale ranges 3-15, scoring eye (1-4), verbal (1-5), and motor (1-6); a score of 8 or less indicates need to assess airway protection.

Vital sign red flags: systolic BP <90 mmHg, heart rate >120 or <50, respiratory rate >30 or <8, temperature >38.3 C or <36 C, SpO2 <90% on room air.

Orthostatic hypotension: a drop of at least 20 mmHg systolic or 10 mmHg diastolic within 3 minutes of standing, or symptoms on standing.

Murmurs are graded I-VI; a thrill (palpable vibration) is associated with grade IV or higher.

SAMPLE history: Symptoms, Allergies, Medications, Past medical history, Last meal, Events leading to presentation.

Pulse deficits, unequal blood pressures between arms, or a pulsus paradoxus >10 mmHg suggest vascular or pericardial pathology.

The clinical reasoning cycle: consider the patient situation, collect cues, process information, identify problems, establish goals, take action, evaluate outcomes, and reflect.

Therapeutic index = toxic dose / therapeutic dose; a low index (digoxin, warfarin, lithium, gentamicin) requires serum level monitoring.

First-order kinetics: a constant fraction of drug is eliminated per unit time, so half-life is constant. Zero-order (phenytoin, ethanol, high-dose aspirin) eliminates a constant amount per time and can accumulate unpredictably.

Steady state is reached after roughly 4-5 half-lives; a loading dose reaches therapeutic levels faster without waiting for steady state.

The six rights: right patient, drug, dose, route, time, and documentation - plus right reason and right to refuse.

Antidotes: naloxone for opioids, flumazenil for benzodiazepines, acetylcysteine for acetaminophen, protamine sulfate for heparin, vitamin K (phytonadione) for warfarin, and digoxin immune Fab for digoxin toxicity.

Heparin monitoring uses aPTT or anti-Xa; warfarin monitoring uses INR, with a typical target of 2-3 for most indications.

Parenteral medication checks: verify compatibility, flush lines, and confirm central versus peripheral route before administration; vesicants require patency verification.

High-alert insulin: use an independent double-check, verify the type of insulin, and never abbreviate 'units' or use a trailing zero (write 5 units, not 5.0).

Heart failure: daily weight is the most sensitive indicator of fluid status; a gain of 2-3 lb in 24 hours or 5 lb in a week warrants provider notification.

COPD: target SpO2 is typically 88-92% because excessive oxygen can worsen hypercapnia in chronic retainers; the hypoxic drive is a secondary concern, and titration to the ordered range is the rule.

Acute kidney injury is classified as prerenal (hypoperfusion), intrinsic (tubular damage), or postrenal (obstruction); a BUN-to-creatinine ratio >20:1 suggests prerenal cause.

Hyperkalemia ECG progression: peaked T waves, prolonged PR, widened QRS, sine wave. Calcium gluconate stabilizes the myocardium first, then insulin/dextrose shifts potassium intracellularly.

Diabetic ketoacidosis management priorities: isotonic fluids first, then insulin infusion, with potassium replacement once K+ is below 5.2 mEq/L and urine output is adequate.

Postoperative care: early ambulation and incentive spirometry reduce atelectasis and VTE; a sudden drop in hemoglobin with tachycardia may indicate hemorrhage.

Cirrhosis complications include ascites, varices, hepatic encephalopathy, and spontaneous bacterial peritonitis; lactulose titrates to 2-3 soft stools per day.

Stroke: thrombolytic window is typically up to 4.5 hours from last known well; permissive hypertension is maintained after ischemic stroke unless thrombolytics are given.

Fetal heart rate baseline is 110-160 bpm. Late decelerations (mirror uterine contractions) suggest uteroplacental insufficiency; variable decelerations suggest cord compression; early decelerations are benign head compression.

Postpartum hemorrhage is most often caused by uterine atony; the first action is fundal massage with firm bimanual pressure while oxytocin is administered.

Magnesium sulfate for preeclampsia: monitor respiratory rate (>=12/min), deep tendon reflexes, and urine output (>=30 mL/hr); calcium gluconate is the antidote for toxicity.

APGAR scores are assigned at 1 and 5 minutes for Appearance, Pulse, Grimace, Activity, and Respiration, each 0-2; it does not guide resuscitation.

Newborn transitional findings: physiologic jaundice appears after 24 hours; jaundice within 24 hours is pathologic and requires evaluation.

Pediatric weight-based dosing uses mg/kg; verify pediatric doses against a reliable reference and never exceed adult maximums.

Dehydration in children: 1-2 mL/kg/hr of urine output is expected; sunken fontanelle, decreased tears, and delayed capillary refill indicate moderate to severe dehydration.

Infant milestones: head control by about 4 months, sitting with support by 6 months, sitting unsupported by 8 months, and walking by 12-15 months.

Serotonin syndrome triad: mental status change, autonomic instability, and neuromuscular hyperactivity (clonus, hyperreflexia); it is a medical emergency.

Neuroleptic malignant syndrome: rigidity, hyperthermia, altered mental status, and autonomic instability; stop the antipsychotic, and dantrolene or bromocriptine may be used.

Lithium therapeutic range is typically 0.6-1.2 mEq/L; toxicity signs include tremor, ataxia, vomiting, and confusion, and dehydration and NSAIDs increase risk.

Therapeutic communication techniques include open-ended questions, reflection, restating, and silence; avoid false reassurance, giving advice, and why-questions.

Suicide risk assessment screens for ideation, plan, intent, means, and protective factors; a patient with a plan and access to means requires immediate safety interventions.

Alcohol withdrawal: monitor for tremor, diaphoresis, and seizures; benzodiazepines are first-line, and thiamine is given before glucose to prevent Wernicke encephalopathy.

Anorexia nervosa has the highest mortality of psychiatric disorders; refeeding syndrome risk requires monitoring of phosphate, potassium, and magnesium.

Ethical-legal: a patient with capacity may refuse psychiatric treatment; involuntary hold criteria are danger to self, danger to others, or grave disability, per state law.

Shock is inadequate tissue perfusion; early signs include tachycardia, narrowed pulse pressure, and cool extremities. Late signs include hypotension and altered mental status.

Sepsis bundle elements: measure lactate, obtain blood cultures before antibiotics, give broad-spectrum antibiotics, and administer 30 mL/kg crystalloid for hypotension or lactate >=4 mmol/L.

Ventilator alarms: high peak pressure suggests obstruction, secretions, or decreased compliance; low pressure suggests a leak or disconnection.

ACLS: for ventricular fibrillation or pulseless VT, defibrillate immediately, then resume CPR for 2 minutes before rhythm recheck; for asystole and PEA, give epinephrine and high-quality CPR.

CPR quality: compression rate 100-120/min, depth at least 2 inches (5 cm) in adults, full recoil, and minimize interruptions to less than 10 seconds.

Massive transfusion protocol ratio is often 1:1:1 of packed red blood cells, plasma, and platelets; monitor for hypocalcemia and hypothermia.

Increased intracranial pressure: elevate head of bed 30 degrees, keep head midline, avoid hip flexion, and maintain normocapnia; hyperventilation is reserved for impending herniation.

Anaphylaxis: epinephrine IM in the anterolateral thigh is first-line; antihistamines and corticosteroids are adjuncts, not initial treatment.

Standard precautions apply to all patients regardless of diagnosis; they include hand hygiene, gloves, gown, mask, eye protection, and safe sharps handling.

Transmission-based precautions: contact (MRSA, C. difficile, scabies), droplet (influenza, pertussis, meningococcus), and airborne (tuberculosis, measles, varicella).

Hand hygiene: alcohol-based rub is preferred for non-soiled hands; soap and water is required when hands are visibly soiled and for C. difficile and norovirus because alcohol does not kill spores.

PPE sequence for donning: gown, mask or respirator, goggles or face shield, then gloves. Doffing order reverses it, with gloves removed first.

N95 respirator requires a fit check each use and annual fit testing; airborne isolation rooms require negative pressure and at least 6 air exchanges per hour.

Surgical site infection prevention: administer prophylactic antibiotics within 60 minutes before incision, maintain normothermia and normoglycemia, and remove hair with clippers rather than razors.

Central line-associated bloodstream infection prevention bundle: hand hygiene, maximal barrier precautions, chlorhexidine skin antisepsis, optimal site selection, and daily review of line necessity.

Postexposure management: for HIV exposure, start postexposure prophylaxis as soon as possible, ideally within hours and no later than 72 hours; for hepatitis B, status of immunity determines need for immunoglobulin and vaccine.