EUC-ENFER cheat sheet

Four ethical principles: autonomy (right to decide), beneficence (do good), non-maleficence (avoid harm), justice (fair distribution of resources).

Informed consent requires capacity, disclosure of risks/benefits/alternatives, comprehension, and voluntariness; it can be withdrawn at any time by a competent patient.

Patient autonomy overrides family preference in competent adults; for minors, assess Gillick-type competence and legal age thresholds for consent.

Confidentiality may be breached only when legally mandated (notifiable disease, court order) or to prevent serious imminent harm (public-interest disclosure).

Negligence requires four elements: duty of care, breach of duty, causation, and demonstrable harm.

Documentation is a legal record: record objectively, contemporaneously, sign and date, avoid alterations; late entries are labelled as such.

Advance directives and living wills guide care when capacity is lost; a valid refusal of treatment must be respected.

Professional regulation covers scope of practice, mandatory reporting of impaired colleagues, and duty of candour after adverse events.

Restraint use requires a lawful basis, least-restrictive alternative, time-limited authorization, monitoring, and documentation.

Normal adult vitals: temperature 36.1-37.2 C, pulse 60-100/min, respirations 12-20/min, BP <120/80 mmHg, SpO2 94-100% on room air.

ABCDE primary assessment order: Airway, Breathing, Circulation, Disability (neuro), Exposure; reassess after every intervention.

Pain assessment tools: numeric rating scale (0-10) for adults, Wong-Baker FACES for children, PAINAD or Abbey for dementia patients.

Aseptic non-touch technique: key parts and key sites must not be touched; clean gloves do not replace hand hygiene.

Pressure injury staging follows NPUAP/EPUAP categories 1-4 plus unstageable and deep tissue injury; Braden score guides prevention.

Fluid balance: record intake/output, daily weight, and assess for edema, jugular venous distension, and mucous membranes.

Falls risk tools (Morse, Hendrich) trigger environmental measures: bed low, call bell in reach, non-slip footwear, hourly rounding.

Neurological observation: GCS (eye 4, verbal 5, motor 6), pupil size and reactivity, limb power; escalate a drop of 2 or more points.

Heart failure: assess for dyspnea, orthopnea, bibasilar crackles, JVD, peripheral edema; manage with diuretics, fluid/salt restriction, daily weights.

COPD: target SpO2 88-92% in at-risk CO2 retainers; assess for pursed-lip breathing, accessory muscle use, and sputum changes.

Post-operative care: early mobilization, incentive spirometry, pain control, wound assessment, and DVT prophylaxis reduce complications.

Diabetes: hypoglycemia (<3.9 mmol/L or <70 mg/dL) is treated with 15-20 g fast-acting carbohydrate and recheck in 15 minutes.

Acute kidney injury: monitor urine output (<0.5 mL/kg/h), creatinine rise, potassium; avoid nephrotoxins and adjust drug doses.

Stroke: use FAST (Face, Arms, Speech, Time); thrombolysis window typically up to 4.5 hours from symptom onset.

Oncology: neutropenic sepsis is a medical emergency; fever ≥38 C in neutropenia requires urgent cultures and antibiotics.

Ostomy and wound care: assess stoma color (pink-red is healthy), output, and peristomal skin; dark or black stoma requires urgent review.

Pregnancy: estimated date of delivery via Naegele's rule - first day of last menstrual period minus 3 months plus 7 days.

Fetal monitoring: baseline heart rate 110-160/min; late decelerations suggest uteroplacental insufficiency, variable decelerations suggest cord compression.

Postpartum hemorrhage: most common cause is uterine atony; manage with uterine massage, oxytocin, and escalation.

Preeclampsia: hypertension after 20 weeks plus proteinuria or organ dysfunction; magnesium sulfate prevents seizures, monitor for toxicity.

Normal labor stages: first (latent and active), second (delivery), third (placenta), fourth (first hour postpartum).

Newborn APGAR at 1 and 5 minutes: Appearance, Pulse, Grimace, Activity, Respiration (0-10).

Breastfeeding: colostrum in first days, skin-to-skin contact, rooming-in, and on-demand feeding support lactation.

Contraception counselling: combined hormonal methods are contraindicated in migraine with aura, smoking over 35, and history of VTE.

Pediatric vitals vary with age: infants have higher heart and respiratory rates and lower blood pressure than older children.

Weight-based dosing in children uses mg/kg; verify dose against a pediatric reference and maximum adult dose.

Fluid maintenance in children uses the Holliday-Segar rule: 100 mL/kg for first 10 kg, 50 mL/kg for next 10 kg, 20 mL/kg thereafter.

Dehydration assessment: sunken fontanelle, reduced skin turgor, dry mucous membranes, reduced urine output, lethargy.

Febrile children: antipyretics address discomfort, not the fever itself; avoid aspirin due to Reye syndrome risk.

Developmental milestones: head control around 3-4 months, sitting by 6-8 months, walking by 12-18 months.

Adolescent mental health: screen for depression, self-harm, and substance use; confidentiality must be balanced with safeguarding.

Pediatric pain: use age-appropriate tools and non-pharmacological methods (distraction, sucrose in neonates, comfort positioning).

Risk assessment for suicide: direct, calm questioning about ideation, plan, means, and intent; remove access to means and escalate.

Therapeutic communication: use open questions, reflection, and silence; avoid false reassurance, advice-giving, and judgmental responses.

Mental state examination components: appearance, behavior, speech, mood/affect, thought, perception, cognition, insight.

Acute agitation: use de-escalation first; if restraint or rapid tranquilization is used, follow local policy and monitor physical health.

Neuroleptic malignant syndrome: fever, rigidity, autonomic instability, raised CK - stop antipsychotic and seek urgent medical review.

Serotonin syndrome: clonus, hyperreflexia, agitation, hyperthermia after serotonergic drugs - stop the agent and manage supportively.

Eating disorders: monitor electrolytes, weight, and cardiac status; refeeding syndrome risk requires cautious nutritional reintroduction.

Safeguarding: document risks, share information appropriately, and follow local mental health legislation for detention and treatment.

Primary survey ABCDE with rapid intervention; secondary survey includes history (SAMPLE) and head-to-toe examination.

Anaphylaxis: intramuscular adrenaline 0.5 mg (1:1000) into the anterolateral thigh for adults, repeat after 5 minutes if needed.

Sepsis: use a screening tool; start antibiotics within 1 hour of recognition and take cultures before antibiotics when possible.

Shock types: hypovolemic, cardiogenic, distributive (septic, anaphylactic, neurogenic), obstructive (tamponade, tension pneumothorax).

Perioperative: verify patient identity, procedure, site, consent, allergies, and NPO status against the WHO surgical safety checklist.

Malignant hyperthermia: triggered by volatile anesthetics and succinylcholine; treat with dantrolene and aggressive cooling.

Airway: use a stepwise approach (positioning, adjuncts, supraglottic device, intubation); confirm placement with capnography.

Post-anesthesia care: monitor airway, breathing, circulation, temperature, pain, nausea, and surgical site; use Aldrete scoring for discharge readiness.

The 'rights' of medication administration: right patient, drug, dose, route, time, documentation; many services add reason and response.

High-alert medications (insulin, heparin, opioids, potassium) require independent double checks and clear labelling.

Pharmacokinetics: absorption, distribution, metabolism (often hepatic), excretion (often renal); half-life guides dosing intervals.

Therapeutic index: narrow-index drugs (digoxin, warfarin, lithium, phenytoin) need therapeutic drug monitoring.

Adverse drug reactions: distinguish type A (dose-related, predictable) from type B (idiosyncratic, unpredictable).

Anticoagulants: monitor INR for warfarin, APTT for unfractionated heparin, anti-Xa for LMWH in selected patients; know reversal agents.

Opioid safety: assess sedation and respiratory rate; naloxone reverses opioid toxicity; co-prescribe laxatives for constipation.

Medication reconciliation at admission, transfer, and discharge reduces errors; document allergies and reactions clearly.

WHO 5 moments for hand hygiene: before patient contact, before aseptic task, after body fluid exposure risk, after patient contact, after contact with surroundings.

Standard precautions apply to all patients; transmission-based precautions (contact, droplet, airborne) apply to specific pathogens.

Airborne precautions require a fit-tested FFP3/N95 respirator and negative-pressure room (e.g., tuberculosis, measles, varicella).

Droplet precautions apply to influenza, pertussis, and meningococcal disease; use a surgical mask and eye protection.

Contact precautions apply to MRSA, C. difficile, and carbapenemase-producing organisms; use gloves and gown and dedicate equipment.

C. difficile: soap and water handwashing is preferred over alcohol gel because spores are not killed by alcohol.

Sterile technique: maintain sterile field, avoid reaching over, and consider any contact with non-sterile surfaces as contamination.

Sharps safety: never recap needles; dispose immediately in a sharps container; report needlestick injuries per local policy.

Antimicrobial stewardship: prescribe only when indicated, use the correct dose, route, and duration, and review daily.

Evidence hierarchy: systematic reviews and meta-analyses of RCTs rank highest; expert opinion ranks lowest.

PICO framework: Population, Intervention, Comparison, Outcome - used to frame a searchable clinical question.

Validity: internal validity concerns whether the study measures what it claims; external validity concerns generalizability.

Sensitivity is the ability to detect true positives; specificity is the ability to detect true negatives.

Positive predictive value depends on prevalence, not just sensitivity and specificity.

Levels of measurement: nominal, ordinal, interval, ratio - determine which statistical tests are appropriate.

Quality improvement uses PDSA cycles (Plan-Do-Study-Act) and measures structure, process, and outcome.

Critical appraisal checks for bias, confounding, sample size, and whether conclusions follow from the data.

Normal adult vitals: temperature 36.1-37.2 C, pulse 60-100/min, respirations 12-20/min, BP <120/80 mmHg, SpO2 94-100% on room air.

ABCDE primary assessment: Airway, Breathing, Circulation, Disability (neuro), Exposure; reassess after every intervention.

Pain assessment: numeric rating scale (0-10) for adults, Wong-Baker FACES for children, PAINAD for dementia patients.

Aseptic non-touch technique: key parts and key sites must not be touched; clean gloves do not replace hand hygiene.

Pressure injury staging follows NPUAP/EPUAP categories 1-4 plus unstageable and deep tissue injury; Braden score guides prevention.

Fluid balance: record intake and output, daily weight, and assess for edema, jugular venous distension, and mucous membranes.

Falls risk tools (Morse, Hendrich) trigger environmental measures: bed low, call bell in reach, non-slip footwear, hourly rounding.

Neurological observation: GCS (eye 4, verbal 5, motor 6), pupil size and reactivity, limb power; escalate a drop of 2 or more points.

Heart failure: assess for dyspnea, orthopnea, bibasilar crackles, JVD, peripheral edema; manage with diuretics, fluid and salt restriction, daily weights.

COPD: target SpO2 88-92% in at-risk CO2 retainers; assess for pursed-lip breathing, accessory muscle use, and sputum changes.

Post-operative care: early mobilization, incentive spirometry, pain control, wound assessment, and DVT prophylaxis reduce complications.

Diabetes: hypoglycemia (<3.9 mmol/L or <70 mg/dL) is treated with 15-20 g fast-acting carbohydrate and recheck in 15 minutes.

Acute kidney injury: monitor urine output (<0.5 mL/kg/h) and creatinine rise; avoid nephrotoxins and adjust drug doses.

Stroke: use FAST (Face, Arms, Speech, Time); thrombolysis window typically up to 4.5 hours from symptom onset.

Oncology: neutropenic sepsis is a medical emergency; fever ≥38 C in neutropenia requires urgent cultures and antibiotics.

Ostomy care: assess stoma color (pink-red is healthy), output, and peristomal skin; dark or black stoma requires urgent review.

Estimated date of delivery via Naegele's rule: first day of last menstrual period minus 3 months plus 7 days.

Fetal monitoring: baseline heart rate 110-160/min; late decelerations suggest uteroplacental insufficiency, variable decelerations suggest cord compression.

Postpartum hemorrhage: most common cause is uterine atony; manage with uterine massage, oxytocin, and escalation.

Preeclampsia: hypertension after 20 weeks plus proteinuria or organ dysfunction; magnesium sulfate prevents seizures, monitor for toxicity.

Stages of labor: first (latent and active), second (delivery), third (placenta), fourth (first hour postpartum).

Newborn APGAR at 1 and 5 minutes: Appearance, Pulse, Grimace, Activity, Respiration (0-10).

Breastfeeding: colostrum in first days, skin-to-skin contact, rooming-in, and on-demand feeding support lactation.

Contraception counselling: combined hormonal methods are contraindicated in migraine with aura, smoking over 35, and history of VTE.

Pediatric vitals vary with age: infants have higher heart and respiratory rates and lower blood pressure than older children.

Weight-based dosing in children uses mg/kg; verify against a pediatric reference and maximum adult dose.

Fluid maintenance in children uses Holliday-Segar: 100 mL/kg for first 10 kg, 50 mL/kg for next 10 kg, 20 mL/kg thereafter.

Dehydration assessment: sunken fontanelle, reduced skin turgor, dry mucous membranes, reduced urine output, lethargy.

Febrile children: antipyretics address discomfort, not the fever itself; avoid aspirin due to Reye syndrome risk.

Developmental milestones: head control around 3-4 months, sitting by 6-8 months, walking by 12-18 months.

Adolescent mental health: screen for depression, self-harm, and substance use; confidentiality must be balanced with safeguarding.

Pediatric pain: use age-appropriate tools and non-pharmacological methods (distraction, sucrose in neonates, comfort positioning).

Suicide risk assessment: ask directly and calmly about ideation, plan, means, and intent; remove access to means and escalate.

Therapeutic communication: use open questions, reflection, and silence; avoid false reassurance, advice-giving, and judgmental responses.

Mental state examination components: appearance, behavior, speech, mood and affect, thought, perception, cognition, insight.

Acute agitation: use de-escalation first; if restraint or rapid tranquilization is used, follow local policy and monitor physical health.

Neuroleptic malignant syndrome: fever, rigidity, autonomic instability, raised CK - stop antipsychotic and seek urgent medical review.

Serotonin syndrome: clonus, hyperreflexia, agitation, hyperthermia after serotonergic drugs - stop the agent and manage supportively.

Eating disorders: monitor electrolytes, weight, and cardiac status; refeeding syndrome risk requires cautious nutritional reintroduction.

Safeguarding: document risks, share information appropriately, and follow local mental health legislation for detention and treatment.

Primary survey ABCDE with rapid intervention; secondary survey includes history (SAMPLE) and head-to-toe examination.

Anaphylaxis: intramuscular adrenaline 0.5 mg (1:1000) into the anterolateral thigh for adults, repeat after 5 minutes if needed.

Sepsis: use a screening tool; start antibiotics within 1 hour of recognition and take cultures before antibiotics when possible.

Shock types: hypovolemic, cardiogenic, distributive (septic, anaphylactic, neurogenic), obstructive (tamponade, tension pneumothorax).

Perioperative: verify identity, procedure, site, consent, allergies, and NPO status against the WHO surgical safety checklist.

Malignant hyperthermia: triggered by volatile anesthetics and succinylcholine; treat with dantrolene and aggressive cooling.

Airway: stepwise approach (positioning, adjuncts, supraglottic device, intubation); confirm placement with capnography.

Post-anesthesia care: monitor airway, breathing, circulation, temperature, pain, nausea, and surgical site; use Aldrete scoring for discharge readiness.

Rights of medication administration: right patient, drug, dose, route, time, documentation; many services add reason and response.

High-alert medications (insulin, heparin, opioids, potassium) require independent double checks and clear labelling.

Pharmacokinetics: absorption, distribution, metabolism (often hepatic), excretion (often renal); half-life guides dosing intervals.

Therapeutic index: narrow-index drugs (digoxin, warfarin, lithium, phenytoin) need therapeutic drug monitoring.

Adverse drug reactions: type A is dose-related and predictable; type B is idiosyncratic and unpredictable.

Anticoagulants: monitor INR for warfarin, APTT for unfractionated heparin, anti-Xa for LMWH in selected patients; know reversal agents.

Opioid safety: assess sedation and respiratory rate; naloxone reverses opioid toxicity; co-prescribe laxatives for constipation.

Medication reconciliation at admission, transfer, and discharge reduces errors; document allergies and reactions clearly.

WHO 5 moments for hand hygiene: before patient contact, before aseptic task, after body fluid exposure risk, after patient contact, after contact with surroundings.

Standard precautions apply to all patients; transmission-based precautions (contact, droplet, airborne) apply to specific pathogens.

Airborne precautions require a fit-tested FFP3/N95 respirator and negative-pressure room (e.g., tuberculosis, measles, varicella).

Droplet precautions apply to influenza, pertussis, and meningococcal disease; use a surgical mask and eye protection.

Contact precautions apply to MRSA, C. difficile, and carbapenemase-producing organisms; use gloves and gown and dedicate equipment.

C. difficile: soap and water handwashing is preferred over alcohol gel because spores are not killed by alcohol.

Sterile technique: maintain the sterile field, avoid reaching over, and consider any contact with non-sterile surfaces as contamination.

Sharps safety: never recap needles; dispose immediately in a sharps container; report needlestick injuries per local policy.

Antimicrobial stewardship: prescribe only when indicated, use the correct dose, route, and duration, and review daily.

Evidence hierarchy: systematic reviews and meta-analyses of RCTs rank highest; expert opinion ranks lowest.

PICO framework: Population, Intervention, Comparison, Outcome - used to frame a searchable clinical question.

Validity: internal validity concerns whether the study measures what it claims; external validity concerns generalizability.

Sensitivity is the ability to detect true positives; specificity is the ability to detect true negatives.

Positive predictive value depends on prevalence, not just sensitivity and specificity.

Levels of measurement: nominal, ordinal, interval, ratio - determine which statistical tests are appropriate.

Quality improvement uses PDSA cycles (Plan-Do-Study-Act) and measures structure, process, and outcome.

Critical appraisal checks for bias, confounding, sample size, and whether conclusions follow from the data.