CCRN (Adult) flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

IV alteplase window

IV alteplase may be given within 3 hours of ischemic stroke symptom onset; selected patients may be treated up to 4.5 hours after contraindications are excluded.

MAP formula

MAP = (SBP + 2 × DBP) ÷ 3; a common shock goal is ≥65 mmHg, individualized to perfusion pressure and patient condition.

Cardiogenic shock profile

Cardiogenic shock shows low cardiac index, elevated PCWP, and often elevated SVR; treat with inotropes and cause-specific therapy rather than large fluid boluses.

Septic shock initial fluids

Septic shock: give 30 mL/kg crystalloid within the first 3 hours for hypotension or lactate ≥4 mmol/L, then start norepinephrine if MAP remains <65 mmHg.

Anaphylaxis epinephrine dose

IM epinephrine 0.3–0.5 mg of 1:1000 solution into the anterolateral thigh; repeat every 5–15 minutes as needed; adjuncts never replace epinephrine.

Hyperkalemia ECG changes

Peaked T waves, PR prolongation, widened QRS, and sine-wave pattern occur in hyperkalemia; give IV calcium immediately when ECG changes are present.

DKA insulin initiation

DKA: check potassium before insulin; start IV insulin after potassium is ≥3.3 mEq/L; add dextrose when glucose falls below 200–250 mg/dL.

Metabolic acidosis compensation

Expected PaCO2 in metabolic acidosis = (1.5 × HCO3) + 8 ± 2; a higher PaCO2 suggests concurrent respiratory acidosis.

CPP formula

CPP = MAP − ICP; in adult traumatic brain injury, target CPP commonly 60–70 mmHg and treat ICP >20 mmHg lasting more than 5 minutes.

Plateau pressure threshold

Plateau pressure >30 cm H2O suggests alveolar overdistention; use tidal volume 6 mL/kg predicted body weight and evaluate for causes.

Unfractionated heparin target

Unfractionated heparin infusion: target aPTT 1.5–2.5 times control or per institutional nomogram; monitor platelets for heparin-induced thrombocytopenia.

Restrictive transfusion threshold

Stable critically ill adults: restrictive RBC transfusion threshold is hemoglobin 7 g/dL; use 8 g/dL for cardiac surgery or active bleeding.

BiPAP contraindications

BiPAP provides inspiratory pressure support plus PEEP; avoid in unprotected airway, vomiting, inability to protect airway, or hemodynamic instability.

Postoperative hypotension causes

Postoperative hypotension: assess bleeding, hypovolemia, pump failure, sepsis, and residual anesthetic effects; pain alone rarely causes significant hypotension.

ARDS refractory hypoxemia

ARDS: bilateral infiltrates, refractory hypoxemia, and normal PCWP; use low tidal volume, PEEP, and prone positioning if PaO2/FiO2 <150.

Acute pancreatitis care

Acute pancreatitis: isotonic fluid resuscitation, analgesia, and early enteral nutrition when tolerated; prophylactic antibiotics are not routine.

Upper GI bleed resuscitation

Upper GI bleed with hypotension: resuscitate with crystalloid and blood products, start IV proton-pump inhibitor, and arrange urgent endoscopy after stabilization.

Hepatic encephalopathy lactulose

Hepatic encephalopathy: titrate lactulose to 2–3 soft stools daily; avoid sedatives and evaluate for GI bleeding, infection, and electrolyte disturbances.

ICU delirium first-line

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

Critical illness glucose target

Critically ill adults: start insulin when glucose >150–180 mg/dL and target 140–180 mg/dL; avoid hypoglycemia below 70 mg/dL.

Informed consent elements

Informed consent requires capacity, disclosure of risks, benefits, and alternatives, and voluntary choice; the provider performing the procedure obtains consent; the nurse verifies or witnesses.

Advance directive purpose

Advance directives record patient preferences for future care; when absent, follow state surrogate hierarchy and document goals-of-care discussions.

Organ donation timing

Organ donation is considered after death by neurologic or circulatory criteria; donation discussions should be separate from withdrawal decisions and never a barrier to care.

Delegation to UAP

Delegation to unlicensed assistive personnel requires task within state law, agency policy, and delegate competence; nursing assessment, teaching, and evaluation remain RN responsibilities.

Restraint order limits

Restraint orders in adults are time-limited (usually ≤4 hours); violent restraints require face-to-face evaluation within 1 hour and ongoing monitoring; discontinue promptly.

HIPAA minimum necessary

HIPAA permits minimum necessary protected health information for treatment, payment, and operations; avoid discussing patient details in public areas or with unauthorized persons.

Moral distress

Moral distress occurs when a nurse knows the ethically right action but barriers prevent it; address through ethics consultation, debriefing, and policy change.

Palliative care definition

Palliative care provides symptom relief and goals clarification alongside curative treatment; hospice generally requires a prognosis of 6 months or less.

Culturally congruent care

Culturally congruent care: ask about language, decision-making roles, religious practices, and preferences; use qualified interpreters rather than family for consent discussions.

Incident report use

Incident reports support quality improvement and are not punishment; document objective facts in the medical record and complete the report according to policy.

Patient advocacy

Patient advocacy includes protecting privacy, ensuring informed choice, and voicing concerns; escalate unsafe practice through the chain of command.

Surrogate decision hierarchy

Surrogate decision hierarchy follows state law, commonly spouse, adult child, parent, then sibling; surrogates use substituted judgment based on patient values.