NLN NACE Adult Health cheat sheet

Primary prevention targets risk factors before disease occurs: immunization, seat-belt use, tobacco avoidance, diet and exercise counseling.

Secondary prevention is screening for early, asymptomatic disease: mammography, colonoscopy, Pap smear, blood pressure and lipid checks, HbA1c.

Tertiary prevention limits disability and complications after disease is established: cardiac rehab, insulin self-management teaching, wound care, support groups.

Adult BP categories: normal <120/<80; elevated 120-129/<80; stage 1 130-139 or 80-89; stage 2 >=140 or >=90 mm Hg.

Recommended aerobic activity for adults: at least 150 min/week moderate intensity or 75 min/week vigorous, plus muscle strengthening twice weekly.

Colorectal cancer screening begins at age 45 for average-risk adults; cervical screening starts at 21; mammography typically begins at 40-50 by guideline.

Tetanus-diphtheria booster every 10 years; influenza annually; pneumococcal and shingles vaccination schedules are age- and risk-based.

Health belief model: behavior change depends on perceived susceptibility, severity, benefits, barriers, and cues to action; self-efficacy drives maintenance.

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

Airborne precautions: N95 respirator, negative-pressure room, door closed - used for tuberculosis, measles, and varicella.

Droplet precautions: surgical mask within 3-6 feet - used for influenza, pertussis, mumps, rubella, and meningococcal disease.

Contact precautions: gown and gloves, dedicated equipment - used for MRSA, VRE, C. difficile, and scabies; C. difficile also requires soap-and-water handwashing because alcohol gel does not kill spores.

Five moments of hand hygiene: before patient contact, before aseptic task, after body-fluid exposure risk, after patient contact, after touching patient surroundings.

Surgical asepsis: sterile field edges are unsterile; items below waist or out of view are contaminated; never turn away from or reach over a sterile field.

Fall risk interventions: bed low and locked, call light within reach, non-skid footwear, hourly rounding, bed alarm; use least-restrictive restraint only with an order.

Needlestick injury: wash with soap and water, report immediately, and start post-exposure evaluation; HIV PEP is most effective when begun within hours.

Turn and reposition immobile patients at least every 2 hours; stage pressure injuries result from unrelieved pressure over bony prominences.

Braden Scale subscales: sensory perception, moisture, activity, mobility, nutrition, friction/shear; lower total score = higher risk.

Pain assessment: use 0-10 numeric rating in adults, Wong-Baker FACES in children; reassess after IV opioid in 15-30 min, after oral analgesic in 1 hour.

Nonpharmacologic comfort measures: repositioning, heat/cold, massage, relaxation breathing, distraction, music, and splinting during coughing.

Sleep hygiene teaching: consistent schedule, limit caffeine and screens before bed, cool dark room, and avoid long daytime naps.

Constipation prevention: adequate fluid, dietary fiber, and mobility; encourage toileting after meals to use the gastrocolic reflex.

Oral care for dependent patients: brush teeth and moisten mucosa at least twice daily; dentures removed and cleaned; inspect for stomatitis.

Heat application causes vasodilation and is avoided over acute inflammation, bleeding, or impaired sensation; cold causes vasoconstriction and reduces edema.

Six rights: right medication, dose, route, time, patient, and documentation; verify with two identifiers and scan when available.

IV push rate limits and compatibility must be checked; never give a drug that is incompatible in the same line without flushing between.

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

Digoxin: hold and notify for apical pulse <60/min in adults; therapeutic level 0.5-2 ng/mL; early toxicity signs include nausea, visual halos, confusion.

Heparin (unfractionated): monitor aPTT; antidote protamine sulfate. Warfarin: monitor INR; antidote vitamin K. Opioids: antidote naloxone.

Insulin onset: rapid-acting (lispro/aspart) 10-15 min, peak 1-2 h; regular 30 min, peak 2-3 h; NPH peak 4-12 h; glargine has no peak.

Potassium chloride is never given IV push; infuse diluted at a controlled rate and verify renal function and urine output.

Parenteral therapy: check IV site for phlebitis and infiltration; isotonic fluids (0.9% NaCl, LR) expand extracellular volume; hypotonic fluids shift water into cells.

Normal adult labs: pH 7.35-7.45, PaCO2 35-45 mm Hg, HCO3 22-26 mEq/L, Na 135-145, K 3.5-5.0, glucose 70-100 mg/dL fasting.

Respiratory acidosis: low pH with high PaCO2; respiratory alkalosis: high pH with low PaCO2; metabolic acidosis: low pH with low HCO3; metabolic alkalosis: high pH with high HCO3.

Early signs of increased intracranial pressure: change in level of consciousness, headache, vomiting, unequal pupils; late sign is a Cushing response (bradycardia, hypertension, irregular respirations).

Postoperative priority: airway, breathing, circulation, then pain, wound, and mobility; atelectasis and pneumonia are common pulmonary complications.

DVT prevention: early ambulation, sequential compression devices, and anticoagulation; assess for unilateral calf pain, swelling, warmth.

Hypoglycemia symptoms (<70 mg/dL): diaphoresis, tremor, tachycardia, confusion; give 15 g fast carbohydrate and recheck in 15 minutes.

Dehydration signs: poor skin turgor, dry mucous membranes, oliguria, concentrated urine, tachycardia, orthostatic hypotension.

Sepsis screening: suspect when infection plus two or more SIRS criteria (temperature, heart rate, respiratory rate, WBC); act within the first hour for cultures and antibiotics.

Heart failure: left-sided causes pulmonary congestion (dyspnea, crackles, orthopnea); right-sided causes systemic congestion (edema, JVD, hepatomegaly).

Myocardial infarction: MONA is outdated; priority is aspirin, nitroglycerin (if not hypotensive), oxygen only if hypoxic, and reperfusion within 90 minutes for STEMI.

Asthma exacerbation: give short-acting beta-agonist, corticosteroids, and oxygen; assess peak flow; silent chest is a late, ominous sign.

COPD: target SpO2 88-92%; pursed-lip breathing and tripod position reduce air trapping; avoid high-flow oxygen that worsens CO2 retention.

Acute kidney injury: monitor urine output (oliguria <0.5 mL/kg/h), creatinine, potassium, and fluid balance; avoid nephrotoxins.

Diabetic ketoacidosis: hyperglycemia, ketones, anion-gap metabolic acidosis, Kussmaul respirations; treat with isotonic fluids, insulin infusion, and potassium replacement.

Stroke: activate stroke protocol; thrombolytic window is generally within 3-4.5 hours of symptom onset; do not give anything by mouth until swallowing is assessed.

Burn injury: use the rule of nines for extent; Parkland formula 4 mL/kg/%TBSA for 24 h, half in first 8 hours; airway edema may require early intubation.

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

Kubler-Ross stages: denial, anger, bargaining, depression, acceptance; stages are not linear and may recur.

Anxiety interventions: stay with the patient, reduce stimuli, use short clear sentences, and teach relaxation and grounding techniques.

Depression screening: PHQ-2 then PHQ-9; ask directly about suicidal ideation and plan; never leave a high-risk patient alone.

Delirium differs from dementia: acute onset, fluctuating course, inattention, often reversible; dementia is chronic and progressive.

Grief and loss: anticipatory grief before death; complicated grief persists beyond expected time and impairs function.

Substance withdrawal: alcohol and benzodiazepine withdrawal can be life-threatening (seizures, delirium tremens); monitor vital signs and use benzodiazepines per protocol.

Ethical principles: autonomy (patient choice), beneficence (do good), nonmaleficence (do no harm), justice (fairness), veracity (truthfulness).

Five rights of delegation: right task, circumstance, person, direction/communication, and supervision; RN retains accountability.

Tasks delegable to unlicensed assistive personnel: vital signs on stable patients, hygiene, ambulation, intake/output; not assessment, teaching, or evaluation.

SBAR handoff: Situation, Background, Assessment, Recommendation; use for change-of-shift and rapid response calls.

Advance directives: living will specifies treatments; durable power of attorney for health care names a surrogate decision-maker.

Chain of command: notify charge nurse, then nursing supervisor, then physician or administrator when patient safety is threatened.

Triage: use ABCs plus emergent, urgent, nonurgent classification; mass casualty uses color tags (red immediate, yellow delayed, green minor, black expectant).

Informed consent: the provider explains risks and alternatives; the nurse witnesses and verifies understanding, not the disclosure itself.

Incident reports: document facts objectively in the record and complete a separate incident report; never reference the report in the chart.

Assessment is the first step and includes subjective (interview) and objective (observation, exam, labs) data; do not skip before intervening.

Nursing diagnosis uses NANDA-I format: problem, etiology (related to), and defining characteristics (as evidenced by).

Prioritize using Maslow and ABCs: airway, breathing, circulation first, then safety, then psychosocial needs.

Expected outcomes must be patient-centered, measurable, time-bound, and realistic.

Evaluation compares actual outcomes with expected outcomes; if unmet, revise the plan rather than repeating ineffective interventions.

Clinical judgment model (NCSBN): recognize cues, analyze cues, prioritize hypotheses, generate solutions, take action, and evaluate outcomes.

Critical thinking traps: anchoring on the first cue, confirmation bias, and premature closure; recheck data when findings conflict.

Documentation: chart objective findings, interventions, and the patient response; late entries labeled as such; use quotes for patient statements.

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

Airborne precautions: N95 respirator, negative-pressure room, door closed - used for tuberculosis, measles, and varicella.

Droplet precautions: surgical mask within 3-6 feet - used for influenza, pertussis, mumps, rubella, and meningococcal disease.

Contact precautions: gown and gloves, dedicated equipment - used for MRSA, VRE, C. difficile, and scabies; C. difficile also requires soap-and-water handwashing because alcohol gel does not kill spores.

Five moments of hand hygiene: before patient contact, before aseptic task, after body-fluid exposure risk, after patient contact, after touching patient surroundings.

Surgical asepsis: sterile field edges are unsterile; items below waist or out of view are contaminated; never turn away from or reach over a sterile field.

Fall risk interventions: bed low and locked, call light within reach, non-skid footwear, hourly rounding, bed alarm; use least-restrictive restraint only with an order.

Needlestick injury: wash with soap and water, report immediately, and start post-exposure evaluation; HIV PEP is most effective when begun within hours.