Nursing Qualification Level Assessment (Kazakhstan) cheat sheet

Nursing process has five cyclic stages: assessment, diagnosis, planning, implementation, evaluation; evaluation findings feed back into reassessment.

Ethical principles: autonomy (patient's right to decide), beneficence (act for benefit), non-maleficence (do no harm), justice (equitable care), veracity (truthfulness), confidentiality.

Informed consent requires capacity, disclosure of risks/benefits/alternatives, comprehension, and voluntariness; document who obtained consent and when.

Confidentiality may be breached only when legally mandated: notifiable infectious disease, suspected violence or abuse, court order.

Professional boundaries: refuse gifts of substantial value, avoid dual relationships, never accept a power of attorney for a patient under your care.

Patient identification uses two identifiers (full name plus date of birth); never use room or bed number as an identifier.

Hand hygiene moments per WHO: before patient contact, before aseptic task, after body fluid exposure, after patient contact, after contact with patient surroundings.

Nursing documentation is a legal record: record factually, in real time, with time, signature, and designation; never erase or backdate entries.

Spaulding classification: critical items (enter sterile tissue, e.g. surgical instruments) require sterilization; semicritical (contact mucous membranes, e.g. endoscopes) require high-level disinfection; noncritical (intact skin) require low-level disinfection.

Sterilization methods: steam autoclave 121 °C at 1 atm for 15–20 min or 134 °C for 3–4 min; dry heat 160 °C for 120 min; ethylene oxide for heat-sensitive items; plasma (hydrogen peroxide) for heat-sensitive instruments.

Sterile packs are stored at 18–22 °C, relative humidity 35–70%, and remain sterile for the shelf life stated by the manufacturer; any wet, torn, or opened pack is non-sterile.

High-level disinfectants: glutaraldehyde 2% (10–20 min), ortho-phthalaldehyde; low-level: alcohols 60–70%, chlorhexidine, quaternary ammonium compounds.

Hand hygiene with soap and water is required when hands are visibly soiled or after contact with spore-forming organisms (C. difficile); alcohol-based rub is preferred for routine decontamination.

Standard precautions apply to all patients: gloves for body fluid contact, gown if splashing likely, mask and eye protection within 1 m for aerosol-generating procedures.

Medical waste classes: Class A - non-hazardous; Class B - infectious; Class C - extremely hazardous (sharps, pathological); Class D - toxic/chemical; Class E - radioactive. Sharps go into puncture-resistant yellow containers.

Needlestick injury: wash with soap and water, do not squeeze, apply antiseptic, report immediately, and start HIV post-exposure prophylaxis within 2 hours (maximum 72 hours).

Normal adult ranges: temperature 36.0–37.0 °C (axillary 36.2–36.9 °C), pulse 60–80/min, respiration 14–18/min, systolic BP 100–139 mmHg, diastolic 60–89 mmHg.

Blood pressure cuff width should be about 40% of arm circumference; cuff too narrow overestimates BP, too wide underestimates it.

Tachycardia >100/min, bradycardia <60/min; tachypnea >20/min, bradypnea <12/min; fever ≥37.5 °C, hyperpyrexia ≥41 °C.

Pulse quality: rhythm (regular/irregular), filling (full/thread), tension; count 60 s if irregular or on admission.

Pain assessed with numeric rating scale 0–10 for adults, Wong-Baker faces for children, behavioral scale (e.g., PAINAD) for dementia patients.

Level of consciousness: Glasgow Coma Scale 3–15 (eye 1–4, verbal 1–5, motor 1–6); score ≤8 indicates need for airway protection.

Pulse oximetry: SpO2 95–100% normal; <90% requires action; readings unreliable with poor perfusion, nail polish, or motion.

Orthostatic hypotension: drop of ≥20 mmHg systolic or ≥10 mmHg diastolic within 3 minutes of standing; measure BP supine, then after 1 and 3 minutes standing.

Ten rights of medication administration: right patient, drug, dose, route, time, documentation, reason, to refuse, assessment, education.

Enteral route is preferred when possible; oral medications generally given 30 min before meals or 2 h after, unless drug-specific (e.g., levothyroxine 30 min before breakfast).

Intramuscular injection sites: deltoid (up to 1 mL), ventrogluteal (up to 3 mL, safest for adults), vastus lateralis (infants and children).

Subcutaneous injection angle 45° for thin patients or 90° for normal pinch; insulin sites rotate systematically and never aspirate.

Intravenous push rate for most drugs ≤1 mL per 10 s; never give potassium chloride undiluted by IV push - it is fatal.

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

Antibiotic timing: obtain cultures before the first dose; monitor for anaphylaxis within 30 min of first parenteral dose.

Antidotes: naloxone for opioids, flumazenil for benzodiazepines, N-acetylcysteine for paracetamol, protamine sulfate for heparin, vitamin K for warfarin, atropine for organophosphate and bradycardia.

Heart failure: daily weight (gain >2 kg in 3 days or >1 kg overnight is significant), fluid restriction, sodium restriction, monitor for orthopnea and basal crackles.

Diabetes: target HbA1c <7% for most adults, fasting glucose 4.4–7.2 mmol/L; hypoglycemia <3.9 mmol/L treated with 15–20 g fast carbohydrate and recheck after 15 min.

Asthma/COPD: oxygen target SpO2 94–98% for most, 88–92% for COPD with CO2 retention risk; assess inhaler technique at every visit.

Hypertension: lifestyle modification plus medication; adherence support and home BP monitoring; target <140/90 mmHg generally, lower in selected patients.

Geriatric syndromes: delirium (acute, fluctuating, reversible), dementia (chronic, progressive), depression; assess with CAM, MMSE/MoCA, and geriatric depression scale.

Falls prevention: Morse Fall Scale, remove restraints, bed in lowest position, non-slip footwear, night lighting, toileting schedule.

Pressure injury risk: Braden Scale ≤18 indicates risk; reposition every 2 h, use pressure-redistributing surfaces, keep skin clean and moisturized.

Polypharmacy in older adults: review medications with Beers criteria, avoid benzodiazepines and anticholinergics when possible, reconcile at every transition of care.

Preoperative fasting: clear fluids 2 h, breast milk 4 h, light meal 6 h before anesthesia; no routine bowel preparation for most surgeries.

Preoperative checklist includes consent, allergy review, NPO status, site marking, removal of jewelry/dentures, and VTE prophylaxis.

Postoperative monitoring: airway, breathing, circulation, level of consciousness, pain, urine output, drain output, wound, temperature.

Postoperative complications timeline: hemorrhage and shock in first 24 h, atelectasis and pneumonia 1–3 days, wound infection 3–7 days, dehiscence 5–10 days, VTE 5–10 days.

Wound healing phases: hemostasis (minutes–hours), inflammation (1–4 days), proliferation (4–21 days), maturation (up to 2 years).

Wound assessment uses TIME: Tissue non-viable, Infection/inflammation, Moisture imbalance, Edge of wound not advancing; document size, depth, exudate, and periwound skin.

Drainage types: serous (clear), sanguineous (bloody), serosanguineous (pink), purulent (yellow-green, infected); report sudden changes or >100 mL/h.

Surgical site infection prevention: prophylactic antibiotic within 60 min before incision, normothermia, glycemic control, chlorhexidine skin prep, sterile technique.

Pregnancy duration: 40 weeks from last menstrual period; trimesters: 1–13, 14–27, 28–40 weeks.

Antenatal visits per WHO: at least 8 contacts; minimum tests include hemoglobin, blood group and Rh, HIV, syphilis, hepatitis B, glucose tolerance at 24–28 weeks.

Labor stages: first (latent 0–6 cm, active 6–10 cm), second (full dilatation to delivery), third (delivery of placenta, up to 30 min), fourth (first 2 h postpartum).

Postpartum hemorrhage: blood loss >500 mL after vaginal birth or >1000 mL after cesarean; first-line uterotonic is oxytocin 10 IU IM; uterine massage and bladder emptying.

Newborn Apgar at 1 and 5 minutes: Appearance, Pulse, Grimace, Activity, Respiration, each 0–2; score 7–10 normal, 4–6 moderate depression, 0–3 severe.

Newborn routine care: skin-to-skin contact, delayed cord clamping 1–3 min, exclusive breastfeeding within the first hour, vitamin K 1 mg IM, hepatitis B vaccine in first 24 h.

Pediatric weight: 1–6 months ~ birth weight + 600 g/month; 7–12 months ~ +500 g/month; formula for 1–10 years: weight (kg) = 2 × age (years) + 8.

Pediatric fluid maintenance (Holliday–Segar): 100 mL/kg for first 10 kg, 50 mL/kg for next 10 kg, 20 mL/kg for each kg above 20.

Adult basic life support: check responsiveness and breathing ≤10 s, call for help, start compressions at 100–120/min, depth 5–6 cm, full recoil, minimize interruptions <10 s.

Compression-to-ventilation ratio 30:2 for single or two rescuers in adults; 15:2 for two-rescuer child/infant; use AED as soon as available.

Adult advanced life support: shockable rhythms (VF/pulseless VT) - defibrillate immediately, then CPR 2 min, adrenaline 1 mg IV every 3–5 min, amiodarone 300 mg after third shock.

Non-shockable rhythms (asystole/PEA): CPR, adrenaline 1 mg every 3–5 min, treat reversible causes (4 H: hypoxia, hypovolemia, hypo/hyperkalemia, hypothermia; 4 T: thrombosis, tamponade, tension pneumothorax, toxins).

Anaphylaxis: adrenaline 0.5 mg IM (1:1000) in the anterolateral thigh, repeat every 5 min as needed; oxygen, IV fluids, positioning supine with legs elevated.

Stroke: use FAST (Face, Arms, Speech, Time); thrombolysis window up to 4.5 h, thrombectomy up to 24 h in selected patients; check glucose immediately.

Hypoglycemia in an unconscious patient: 20–50 mL of 40% glucose IV or 1 mg glucagon IM if no IV access.

Triage in mass casualty: START - immediate (red), delayed (yellow), minor (green), deceased/expectant (black); treat only life-threatening conditions at each level.

The Code of the Republic of Kazakhstan on Public Health and the Healthcare System (No. 360-VI, 7 July 2020) is the core healthcare law; it governs citizens' rights, licensing, and sanitary-epidemiological welfare.

Medical care in the guaranteed volume of free medical care (ГОБМП) is provided to citizens and residents at state expense; the package is defined annually by the Government.

Sanitary-epidemiological requirements are set by the Sanitary Rules and Norms (СанПиН) of the Republic of Kazakhstan and enforced by the Sanitary-Epidemiological Service.

Mandatory vaccination schedule (ККВ) includes BCG and hepatitis B at birth, DTP, polio, MMR, and others; refusals are recorded and may restrict access to certain settings during outbreaks.

Medical secrecy is protected by law; disclosure without consent is permitted only for notifiable diseases, threat to public health, or by legal request.

Informed voluntary consent is documented before any medical intervention; emergency care is provided without consent when the patient's life is at risk.

Healthcare workers must be vaccinated against hepatitis B and undergo periodic medical examinations; tuberculosis screening is mandatory for healthcare staff.

Medical errors and adverse events must be reported through the internal quality system; patients have the right to compensation for harm caused by medical care.

Primary health care in Kazakhstan is delivered through polyclinics and rural outpatient clinics, with a district physician (участковый врач) responsible for a defined population.

Screening programs include cervical cancer (Pap smear from age 30 every 3 years), breast cancer (mammography from age 40 every 2 years), colorectal cancer (FIT from age 50), and hypertension screening.

Vaccination schedule follows the national immunization calendar; cold chain requires +2 to +8 °C storage with temperature monitoring twice daily.

Risk factor counseling: smoking cessation (5A's: Ask, Advise, Assess, Assist, Arrange), alcohol brief intervention, physical activity ≥150 min/week moderate intensity.

Noncommunicable disease prevention targets: BMI 18.5–24.9, waist circumference <94 cm men, <80 cm women, blood pressure <140/90, no tobacco.

Breastfeeding promotion: exclusive breastfeeding to 6 months, complementary feeding from 6 months, continued breastfeeding to 2 years.

Health education materials must be culturally and linguistically appropriate; use teach-back to confirm understanding.

Community screening for tuberculosis uses fluorography and sputum testing; contacts of TB patients are followed for 12 months.

Medical record entries must include date, time, signature, and printed name; corrections are made by single-line strike-through with initials and date, never by erasure.

Nursing documentation standards: objective data, interventions, patient response, and communication with the physician; use approved abbreviations.

Patient safety goals: correct identification, effective communication (read-back for verbal orders), safe medication use, safe surgery (sign-in, time-out, sign-out), infection prevention, falls and pressure injury prevention.

Incident reporting is non-punitive and confidential; near-misses should be reported as well as adverse events.

Quality indicators include hospital-acquired infection rate, fall rate, medication error rate, pressure injury rate, patient satisfaction, and readmission rate.

Handover uses structured tools (SBAR: Situation, Background, Assessment, Recommendation) to reduce communication errors.

Verbal and telephone orders must be read back to the prescriber and documented within the timeframe set by the facility.

Patient rights include access to their medical record, the right to a second opinion, and the right to complain to the healthcare authority.

Continuing professional development: nurses in Kazakhstan participate in continuing education and periodic certification; document credits and training.

Scope of practice: perform only procedures for which you are trained and authorized; delegated tasks remain the nurse's responsibility to perform safely.

Emergency preparedness: know the evacuation plan, fire extinguisher locations, and the code system of your facility.

Infection control breach reporting: report exposures and needlestick injuries immediately to the occupational health service; document in the exposure register.

Patient education: assess health literacy, use plain language, and confirm understanding via teach-back.

Team communication: escalate deteriorating patients using early warning scores and SBAR; document escalation and response.

Cultural competence: respect language, religious, and family preferences; use interpreters when needed.

Professional self-care: recognize burnout, fatigue, and impairment; report impairment in colleagues through the appropriate channel.

Therapeutic communication techniques: open-ended questions, reflection, clarification, silence, summarizing; avoid false reassurance, advice-giving, and why-questions.

Breaking bad news: use SPIKES (Setting, Perception, Invitation, Knowledge, Empathy, Strategy and summary).

Conflict resolution: address behavior, not personality; use 'I' statements; escalate to the charge nurse or ethics committee when needed.

Consent for minors: in Kazakhstan, parents or legal guardians consent; adolescents' assent should be sought according to capacity.

End-of-life care: respect advance directives where recognized, provide pain relief, involve family, and document discussions.

Whistleblowing: report unsafe practice through internal channels first; protect patient safety over institutional loyalty.

Documentation of refusal: document the patient's decision, capacity assessment, information given, and notification of the physician.

Confidentiality in teaching: anonymize patient data in case discussions and social media; never post identifiable patient information.

High-alert medications require independent double-check: insulin, heparin, opioids, concentrated electrolytes, chemotherapy, and neuromuscular blockers.

Insulin: use only insulin syringes; U-100 concentration; never abbreviate 'units' as 'U'; store unopened vials at 2–8 °C, in-use at room temperature up to 28 days.

Heparin: monitor aPTT; antidote protamine sulfate; watch for heparin-induced thrombocytopenia (platelets drop >50%).

Opioids: monitor respiratory rate, sedation, and pain score; naloxone for overdose; bowel regimen for constipation prophylaxis.

Warfarin: monitor INR; target 2–3 for most indications; antidote vitamin K; many drug and food interactions.

Chemotherapy: use closed-system transfer devices, double gloves, and a spill kit; pregnant nurses should not handle cytotoxic drugs.

Look-alike/sound-alike drugs: use tall-man lettering and separate storage; verify indication before administration.

Adverse drug reaction reporting: document in the medical record and report to the pharmacovigilance service.

Preeclampsia: BP ≥140/90 after 20 weeks plus proteinuria or organ dysfunction; severe features include BP ≥160/110, headache, visual changes, RUQ pain; treatment magnesium sulfate and delivery.

Magnesium sulfate toxicity: monitor respiratory rate ≥12/min, deep tendon reflexes, and urine output ≥30 mL/h; antidote calcium gluconate 10%.

Ectopic pregnancy: triad of amenorrhea, abdominal pain, and vaginal bleeding; suspect with positive hCG and empty uterus; risk of rupture and shock.

Shoulder dystocia: McRoberts maneuver, suprapubic pressure, episiotomy if needed; document time and maneuvers.

Neonatal resuscitation: warm, dry, stimulate; if HR <100 or apnea, positive pressure ventilation; chest compressions if HR <60 after effective ventilation.

Newborn jaundice: assess bilirubin level; phototherapy for significant hyperbilirubinemia; monitor for kernicterus risk.

Pediatric dehydration: assess capillary refill, mucous membranes, skin turgor, and urine output; ORS 50–100 mL/kg over 3–4 h for some dehydration.

Child abuse recognition: inconsistent history, unexplained injuries, delayed presentation; report per mandatory reporting law.

Adrenaline (epinephrine): cardiac arrest 1 mg IV/IO every 3–5 min of 1:10,000; anaphylaxis 0.5 mg IM of 1:1000.

Atropine: 0.5–1 mg IV for symptomatic bradycardia, repeat every 3–5 min, maximum 3 mg.

Amiodarone: 300 mg IV bolus for refractory VF/VT, then 150 mg; maintenance infusion 900 mg/24 h.

Dopamine and noradrenaline: vasopressors requiring central line when possible; monitor for extravasation (phentolamine antidote).

Dose calculation: dose (mg) = ordered dose (mg/kg) × weight (kg); volume (mL) = dose (mg) / concentration (mg/mL).

Drip rate: drops/min = (volume mL × drop factor gtt/mL) / time min; infusion pump rate mL/h = volume / time h.

Pediatric dose checks: always verify weight in kg, use a length-based tape if weight unknown, and double-check calculations.

Emergency trolley: check daily, seal intact, document expiry dates, and restock immediately after use.

Hand hygiene sinks must be equipped with soap, disposable towels, and alcohol rub at point of care; compliance is audited monthly.

Cleaning schedule: current cleaning with detergent, terminal cleaning after discharge, and disinfection of high-touch surfaces at least twice daily in high-risk areas.

Sterilization control: physical (temperature, pressure, time), chemical indicators on each pack, and biological indicators (Geobacillus stearothermophilus for steam) weekly and per load for implants.

Autoclave load documentation includes load number, contents, cycle parameters, and biological indicator result; retain records per regulation.

Isolation precautions: contact for MRSA, VRE, C. difficile; droplet for influenza, pertussis; airborne for tuberculosis, measles, varicella; use N95 respirator for airborne.

Outbreak investigation: identify cases, define case definition, line list, isolate, and notify the sanitary service within the required timeframe.

Sharps containers filled to no more than 3/4, closed, and stored in a designated area before removal.

Healthcare waste removal requires a contract with a licensed operator; manifests are retained for the period set by SanPiN.

PDSA cycle: Plan, Do, Study, Act; use small tests of change before system-wide implementation.

Root cause analysis (RCA) for sentinel events: multidisciplinary team, timeline, contributing factors, and action plan with owners and deadlines.

Failure mode and effects analysis (FMEA) proactively identifies risks by severity × occurrence × detection.

Clinical guidelines should be evidence-graded; adapt to local context and audit adherence.

Audit cycle: define standard, measure practice, compare, implement change, re-audit.

Patient experience surveys and complaints are quality data; respond and close the loop with the patient.

Benchmarking against national indicators supports priority setting; share results transparently with staff.

Education and simulation improve teamwork and reduce errors; evaluate with pre/post knowledge and skills checks.

Patients have the right to receive information about their diagnosis and treatment in accessible form, and to refuse treatment.

Medical workers must maintain confidentiality, provide emergency care, and report notifiable diseases and suspected abuse.

Informed consent is documented in the medical record; for minors, consent is given by legal representatives.

Licensing of medical activity is mandatory; practice outside a license or scope is an administrative or criminal offense.

Medical examination (forensic) is conducted by order of law enforcement or court; nurses must preserve evidence and chain of custody.

Patient complaints are filed with the healthcare organization, the healthcare authority, or the court; response timelines are set by law.

Professional liability insurance is available; adverse events may lead to civil, administrative, or criminal liability.

Mandatory reporting of infectious diseases occurs within the timeframe set by sanitary rules; failure to report is an offense.

Exclusive breastfeeding to 6 months, complementary feeding from 6 months with continued breastfeeding to 2 years.

Growth monitoring uses WHO growth standards; plot weight, length/height, and head circumference at each visit.

Warning signs in infants: poor feeding, lethargy, fever, rapid breathing, jaundice, and dehydration; refer urgently.

Immunization schedule begins at birth with BCG and hepatitis B; follow the national calendar and document in the immunization record.

Developmental milestones: social smile 6 weeks, head control 3 months, sitting 6 months, walking 12 months, words 12–18 months.

Vitamin D supplementation 400 IU/day for breastfed infants; iron-rich foods from 6 months.

Prevention of sudden infant death: supine sleep, firm surface, no soft bedding, smoke-free environment.

ORS and zinc for diarrhea: zinc 10–20 mg/day for 10–14 days reduces duration and recurrence.

Comprehensive geriatric assessment covers function (ADL/IADL), cognition, mood, nutrition, falls, continence, and social support.

Delirium prevention: orient the patient, maintain hydration and sleep, mobilize early, avoid unnecessary catheters and restraints.

Medication review: use Beers criteria to identify potentially inappropriate medications in older adults.

Fall risk interventions: Morse Fall Scale, bed alarm, non-slip footwear, vision correction, and medication review.

Pressure injury prevention: Braden Scale, repositioning every 2 h, nutrition support, moisture management.

Chronic disease self-management: action plans for COPD and heart failure, symptom diaries, and vaccination (influenza, pneumococcal).

Advance care planning: discuss goals of care, document preferences, and involve family with the patient's consent.

Elder abuse: screen for unexplained injuries, fear, and financial exploitation; report per mandatory reporting law.

WHO surgical safety checklist: sign-in before induction, time-out before incision, sign-out before the patient leaves the operating room.

Anesthesia types: general, regional (spinal, epidural, nerve block), and local; monitor airway, ventilation, circulation, and temperature.

Malignant hyperthermia: triggered by volatile anesthetics and succinylcholine; signs include rising temperature, muscle rigidity, tachycardia; treat with dantrolene.

Post-anesthesia care unit monitoring: airway patency, oxygen saturation, level of consciousness, pain, temperature, and urine output.

Spinal anesthesia complications: hypotension, bradycardia, post-dural puncture headache; position supine and hydrate.

Surgical counts: instruments, sponges, and sharps counted before, during, and after surgery; discrepancies require imaging before closure.

Positioning: protect pressure points, eyes, and nerves; avoid hyperextension and shearing.

Postoperative nausea and vomiting: risk factors include female sex, non-smoking, history of PONV; prophylaxis with ondansetron and dexamethasone.

Hand hygiene before and after every newborn contact; use alcohol rub or soap and water.

Umbilical cord care: keep clean and dry; apply chlorhexidine in high neonatal mortality settings per national guidance.

Prevention of neonatal sepsis: clean delivery, sterile cord cutting, early breastfeeding, and avoiding unnecessary invasive procedures.

Group B streptococcus prophylaxis: intrapartum antibiotics for colonized women or risk factors.

Postpartum endometritis: fever, uterine tenderness, foul lochia; treat with broad-spectrum antibiotics.

Mastitis: breast pain, redness, fever; continue breastfeeding and treat with antibiotics.

Infection control in the delivery room: separate clean and dirty areas, sterile instruments, and proper waste segregation.

Neonatal skin care: avoid harsh soaps, use emollients, and prevent hypothermia and skin breakdown.

Triage categories: red (immediate), yellow (delayed), green (minor), black (deceased or expectant).

Primary survey: airway with cervical spine control, breathing, circulation, disability, exposure (ABCDE).

Secondary survey: head-to-toe examination, history (AMPLE: allergies, medications, past illness, last meal, events).

Mass casualty: establish incident command, triage area, treatment area, and transport area; communicate with dispatch.

Burns: rule of nines for adults; parkland formula 4 mL × weight × %TBSA for 24 h, half in first 8 h.

Hypothermia: passive and active rewarming; avoid rough handling; monitor cardiac rhythm.

Toxic exposure: decontaminate before entry; use personal protective equipment; remove contaminated clothing.

Documentation during disasters: use triage tags and a patient tracking log; record time and interventions.

Electronic health record (EHR) entries are time-stamped and auditable; never share passwords.

Use standardized nursing terminology (NANDA, NIC, NOC) to support data aggregation.

Clinical decision support alerts should be reviewed and acted on; document override reasons.

Data privacy: access only the records needed for care; unauthorized access is a disciplinary offense.

Bar-code medication administration reduces errors; scan patient and medication, verify, then administer.

Downtime procedures: use paper forms, document the time of downtime, and back-enter data after restoration.

Handover in the EHR should follow SBAR; avoid copy-paste errors by verifying each entry.

Security: log off workstations, lock screens, and report phishing or suspicious emails.

Oxygen delivery devices: nasal cannula 1–6 L/min (24–44%), simple mask 5–10 L/min (40–60%), non-rebreather 10–15 L/min (80–95%), Venturi mask precise FiO2.

Oxygen is a drug: document flow rate, device, SpO2, and response; humidify for high flows.

Airway suctioning: pre-oxygenate, limit suction to 10–15 s, use sterile technique for tracheal suction.

Nebulizer therapy: use a mouthpiece when possible, sit upright, rinse mouth after inhaled corticosteroids.

Pulse oximetry limitations: poor perfusion, motion, nail polish, and carbon monoxide poisoning.

Signs of respiratory distress: accessory muscle use, nasal flaring, tripod position, altered mental status.

Chest physiotherapy and incentive spirometry: teach after surgery to prevent atelectasis.

Smoking cessation counseling is part of every respiratory care plan.

ECG basics: P wave, QRS, T wave; PR interval 0.12–0.20 s; QRS <0.12 s; QT interval varies with heart rate.

Life-threatening arrhythmias: ventricular fibrillation, pulseless VT, asystole, and PEA require immediate CPR and defibrillation when shockable.

Heart failure monitoring: daily weight, intake/output, edema, lung sounds, and BNP.

Anticoagulation: monitor INR for warfarin, aPTT for heparin; educate on bleeding precautions.

Chest pain: obtain 12-lead ECG within 10 minutes, give aspirin 300 mg chewed, and monitor for complications.

Hypertension crisis: BP >180/120 with organ damage; treat in a monitored setting with IV antihypertensives.

Peripheral vascular assessment: pulses, color, temperature, capillary refill, and sensation.

Patient education: medication adherence, low-salt diet, exercise, and recognition of warning signs.

Normal fluid balance: intake and output 2000–2500 mL/day; urine output ≥0.5 mL/kg/h.

Dehydration signs: thirst, dry mucous membranes, decreased skin turgor, oliguria, tachycardia.

Hyperkalemia: peaked T waves, muscle weakness; treat with calcium gluconate, insulin and glucose, and dialysis if severe.

Hyponatremia: confusion, seizures; correct slowly to avoid osmotic demyelination.

Chronic kidney disease: monitor creatinine, eGFR, potassium, phosphate, and hemoglobin; restrict sodium, potassium, and phosphate as needed.

Dialysis access care: avoid BP measurement and venipuncture on the fistula arm; check thrill and bruit.

Urinary catheter care: closed drainage, bag below bladder, daily review of need, and remove as soon as possible.

Nephrotoxic drugs: NSAIDs, aminoglycosides, and contrast; monitor renal function.

Nutrition screening within 24 h of admission; use MUST or NRS-2002; refer to dietitian if at risk.

Protein needs for wound healing: 1.2–1.5 g/kg/day; energy 30–35 kcal/kg/day.

Micronutrients for healing: vitamin C, zinc, and vitamin A; supplement only when deficient.

Pressure injury nutrition: high-protein, high-calorie diet; consider oral nutritional supplements.

Enteral feeding: elevate head of bed 30–45°, check residual per policy, and flush the tube.

Parenteral nutrition: dedicated line, monitor glucose and electrolytes, and prevent infection.

Dysphagia: use texture-modified diet and thickened fluids; refer to speech therapy.

Patient education: hydration, balanced diet, and food safety.

Catheter-associated urinary tract infection: avoid unnecessary catheters, use closed drainage, and remove early.

Central line-associated bloodstream infection: bundle with hand hygiene, maximal barrier precautions, chlorhexidine skin prep, and daily review.

Ventilator-associated pneumonia: elevate head of bed 30–45°, daily sedation interruption, oral care, and avoid unnecessary circuit changes.

Surgical site infection: prophylactic antibiotics within 60 min, normothermia, glucose control, and sterile technique.

Clostridioides difficile: contact precautions, soap and water hand hygiene, and avoid unnecessary antibiotics.

Multidrug-resistant organisms: screen high-risk patients, isolate, and use contact precautions.

Hand hygiene compliance is the single most effective measure; audit and provide feedback.

Environmental cleaning: use approved disinfectants, follow contact time, and audit high-touch surfaces.

Postpartum hemorrhage: uterine massage, oxytocin 10 IU IM, tranexamic acid 1 g IV, and IV fluids.

Eclampsia: magnesium sulfate loading dose 4–6 g IV over 20 min, then 1–2 g/h; monitor for toxicity.

Prolapsed cord: knee-chest or Trendelenburg position, avoid cord compression, and prepare for immediate delivery.

Shoulder dystocia: McRoberts maneuver and suprapubic pressure; document maneuvers and time.

Neonatal resuscitation: warm, dry, stimulate; positive pressure ventilation if HR <100 or apnea; compressions if HR <60.

Newborn hypoglycemia: screen at-risk infants; treat with feeding or IV glucose if <2.6 mmol/L.

Preterm care: kangaroo mother care, thermoregulation, and infection prevention.

Referral: stabilize the mother and newborn before transfer; communicate with the receiving facility.

Reflective practice: describe the event, analyze feelings and knowledge, evaluate, and plan changes.

Continuing education: maintain a portfolio of certificates, skills, and reflections.

Clinical supervision: seek feedback, set learning goals, and review progress.

Evidence-based practice: formulate a PICO question, search, appraise, and apply evidence.

Mentoring: support new nurses with structured orientation and competency checks.

Stress management: recognize burnout, use debriefing after critical events, and access support services.

Ethical decision-making: identify the dilemma, gather facts, consider options, and consult the ethics committee.

Career development: explore specialties, certifications, and leadership pathways.