CCRN (Adult) cheat sheet

MAP = (SBP + 2 × DBP)/3; septic shock vasopressor goal commonly MAP ≥65 mmHg.

Septic shock: 30 mL/kg crystalloid within 3 hours for hypotension or lactate ≥4 mmol/L; norepinephrine is first-line if MAP remains <65 mmHg despite fluids.

DKA: check potassium before insulin; hold insulin if K+ <3.3 mEq/L; add dextrose when glucose falls below 200–250 mg/dL.

Metabolic acidosis: expected PaCO2 = (1.5 × HCO3) + 8 ± 2; a higher PaCO2 indicates concurrent respiratory acidosis.

ICP >20 mmHg for >5 minutes requires treatment; CPP = MAP − ICP; target CPP commonly 60–70 mmHg in adult traumatic brain injury.

Lung-protective ventilation: tidal volume 6 mL/kg predicted body weight; plateau pressure ≤30 cm H2O.

Hyperkalemia with ECG changes: give IV calcium first, then insulin/dextrose, beta-agonist, and potassium removal.

ICU delirium: CAM-ICU positive; first treat pain, sleep disruption, immobility, and sensory deficits; antipsychotics are not routine.

RBC transfusion threshold: 7 g/dL for stable critically ill adults; 8 g/dL for cardiac surgery or active bleeding.

Four ethical principles: autonomy (patient choice), beneficence (benefit), nonmaleficence (avoid harm), and justice (fairness).

Informed consent elements: capacity, disclosure, understanding, voluntariness, and authorization.

Adult restraint order: maximum 4 hours; violent or self-destructive restraint requires face-to-face evaluation within 1 hour.

Delegation requires right task, circumstance, person, direction/communication, and supervision/evaluation; the RN retains assessment, teaching, and evaluation.

HIPAA: disclose minimum necessary protected health information for treatment, payment, and operations; avoid public-area discussion.

Advance directives: if none exist, follow the state surrogate hierarchy and document goals-of-care conversations.

Organ donation: death is determined by neurologic or circulatory criteria; donation discussions are separated from withdrawal decisions.

Incident reports: objective facts only; the medical record contains clinical facts, not blame or references to the report.

Moral distress: the ethically right action is blocked by barriers; address with ethics consultation, debriefing, and policy change.