NNC NLEN BSc cheat sheet

The nursing process is a five-step cyclic framework: assessment, diagnosis, planning, implementation, and evaluation (ADPIE); evaluation findings loop back into reassessment.

Subjective data are what the patient reports (pain rating, nausea); objective data are measurable findings (vital signs, wound appearance, lab values).

Maslow's hierarchy orders needs from physiological (airway, breathing, circulation) upward through safety, love/belonging, esteem, and self-actualization; physiologic needs take priority.

Normal adult resting vital-sign ranges: temperature 36.5-37.5 C, pulse 60-100/min, respirations 12-20/min, blood pressure <120/80 mmHg, SpO2 95-100% on room air.

Standard precautions apply to all patients: hand hygiene, gloves for contact with blood/body fluids, gown and eye protection when splash risk exists.

Transmission-based precautions: contact (MRSA, C. difficile, scabies), droplet (influenza, pertussis, meningococcal meningitis), airborne (tuberculosis, measles, varicella).

Pressure injury staging runs from stage 1 (non-blanchable erythema, intact skin) through stage 4 (full-thickness loss exposing fascia, muscle, or bone); unstageable injury is obscured by slough or eschar.

The six rights of medication administration are right patient, drug, dose, route, time, and documentation; many facilities add right reason and right to refuse.

Blood flows through the heart in the sequence: right atrium, tricuspid valve, right ventricle, pulmonary valve, pulmonary artery, lungs, pulmonary veins, left atrium, mitral valve, left ventricle, aortic valve, aorta.

Normal cardiac output equals heart rate multiplied by stroke volume, roughly 4-8 L/min in adults; mean arterial pressure approximates (systolic + 2 x diastolic)/3.

The nephron's functional units filter about 125 mL/min (GFR); the proximal tubule reabsorbs most filtered sodium, water, and glucose, while the loop of Henle builds the medullary concentration gradient.

Normal arterial blood gas values: pH 7.35-7.45, PaCO2 35-45 mmHg, HCO3 22-26 mEq/L, PaO2 80-100 mmHg; respiratory disorders alter PaCO2 first, metabolic disorders alter HCO3.

Inflammation's cardinal signs are redness, heat, swelling, pain, and loss of function, driven by vasodilation, increased capillary permeability, and leukocyte migration.

Starling forces govern capillary exchange: hydrostatic pressure pushes fluid out, oncotic pressure pulls fluid in; low albumin lowers oncotic pressure and causes edema.

The renin-angiotensin-aldosterone system raises blood pressure: renin converts angiotensinogen to angiotensin I, ACE converts it to angiotensin II, which vasoconstricts and triggers aldosterone release.

Wound healing phases are hemostasis, inflammatory (days 1-4), proliferative (granulation, days 4-21), and maturation/remodeling (up to a year or more).

Pharmacokinetics covers absorption, distribution, metabolism (chiefly hepatic CYP enzymes), and excretion (chiefly renal); half-life determines dosing interval and steady-state timing (about 4-5 half-lives).

First-pass metabolism reduces oral bioavailability because portal circulation carries drug to the liver before systemic circulation; sublingual and IV routes bypass it.

Narrow therapeutic index drugs (digoxin 0.5-2.0 ng/mL, warfarin INR 2-3, lithium 0.6-1.2 mEq/L, phenytoin 10-20 mcg/mL) require serum level monitoring.

Antidote pairs: opioid to naloxone, benzodiazepine to flumazenil, warfarin to vitamin K (phytonadione), heparin to protamine sulfate, acetaminophen to acetylcysteine, iron to deferoxamine.

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

Adverse drug reactions are categorized as predictable (type A, dose-related, e.g., bleeding with anticoagulants) or unpredictable (type B, idiosyncratic or allergic).

Heparin monitoring uses aPTT or anti-Xa; low-molecular-weight heparin and fondaparinux generally need no routine aPTT monitoring but require renal function and platelet checks.

The Beers criteria identify potentially inappropriate medications in older adults, including benzodiazepines, anticholinergics, and long-acting sulfonylureas.

Acute coronary syndrome care: MONA-B (morphine, oxygen only if hypoxemic, nitroglycerin, aspirin, beta-blocker); ST-elevation myocardial infarction triggers reperfusion with PCI within 90 minutes of first medical contact.

Heart failure exacerbation signs: dyspnea, orthopnea, paroxysmal nocturnal dyspnea, bibasilar crackles, S3 gallop, jugular venous distention, dependent edema, weight gain >2-3 lb/day.

Chronic obstructive pulmonary disease patients rely on hypoxic drive; target SpO2 88-92% and use pursed-lip breathing and tripod position to reduce air trapping.

Diabetic ketoacidosis presents with hyperglycemia >250 mg/dL, pH <7.30, bicarbonate <18 mEq/L, ketonemia, anion gap >10, and Kussmaul respirations; treat with isotonic fluids, insulin infusion, and potassium replacement.

Stroke: alteplase window is up to 4.5 hours from last known well; contraindications include recent surgery, active bleeding, and uncontrolled hypertension >185/110 mmHg.

Postoperative complications to monitor: atelectasis and pneumonia (early ambulation, incentive spirometry), deep vein thrombosis (sequential compression devices, early mobilization), paralytic ileus (return of bowel sounds).

Chronic kidney disease stages use GFR: stage 1 >90, stage 2 60-89, stage 3 30-59, stage 4 15-29, stage 5 <15 mL/min/1.73 m2; dialysis typically begins near stage 5 with symptoms.

Burn rule of nines: each arm 9%, each leg 18%, anterior trunk 18%, posterior trunk 18%, head 9%, perineum 1%; Parkland formula gives 4 mL x kg x %TBSA lactated Ringer's in 24 hours, half in the first 8 hours.

Estimated date of delivery uses Naegele's rule: first day of last menstrual period minus 3 months plus 7 days (plus 1 year).

Normal fetal heart rate is 110-160 beats/min; categories are baseline, variability (moderate 6-25/min is reassuring), accelerations, and decelerations.

Variable decelerations signal umbilical cord compression (reposition, especially left lateral, and consider amnioinfusion); late decelerations signal uteroplacental insufficiency (turn off oxytocin, reposition, give oxygen and IV fluids).

First stage of labor runs from onset of regular contractions to full 10 cm dilation; second stage is full dilation to birth; third stage is birth to placental delivery; fourth stage is the first 1-2 hours postpartum.

Postpartum hemorrhage is blood loss >1000 mL after cesarean or >500 mL after vaginal birth; uterine atony is the most common cause, managed with fundal massage and uterotonics (oxytocin, methylergonovine, carboprost, misoprostol).

Preeclampsia is new hypertension after 20 weeks with proteinuria or end-organ dysfunction; magnesium sulfate prevents seizures, with calcium gluconate as the antidote for toxicity.

Newborn Apgar scores at 1 and 5 minutes assess appearance, pulse, grimace, activity, and respiration, each 0-2, for a maximum of 10.

Rh incompatibility: Rho(D) immune globulin is given to Rh-negative mothers at about 28 weeks and within 72 hours of delivery of an Rh-positive infant.

Pediatric vital signs vary with age: newborns breathe 30-60/min and have heart rates of 100-160/min; rates decline progressively toward adult values by adolescence.

Pediatric weight-based dosing uses mg/kg, and safe dose ranges must be verified against the recommended range per dose and per day before administration.

Dehydration in children is assessed by weight loss percentage, capillary refill, mucous membranes, tears, fontanel status, and urine output (target 1-2 mL/kg/hr).

Pyloric stenosis presents at 3-6 weeks with projectile nonbilious vomiting and an olive-shaped epigastric mass; metabolic consequence is hypochloremic, hypokalemic metabolic alkalosis.

Intussusception presents with colicky pain, drawing up of legs, and currant-jelly stools; air or barium enema is both diagnostic and often therapeutic.

Kawasaki disease criteria include fever >5 days plus conjunctivitis, oral mucosal changes, rash, extremity changes, and cervical lymphadenopathy; risk is coronary artery aneurysm, treated with IVIG and aspirin.

Epiglottitis and croup differ: epiglottitis has drooling, tripod posture, and muffled voice and requires no throat inspection; croup has a barking cough and inspiratory stridor.

Infant developmental milestones: sits unsupported around 6-8 months, crawls and pulls to stand around 9 months, walks independently around 12-15 months.

Therapeutic communication techniques include open-ended questions, reflection, restating, clarification, and silence; non-therapeutic techniques include false reassurance, giving advice, and changing the subject.

Suicide risk assessment evaluates ideation, plan, intent, means, and protective factors; highest acute risk often follows a recent attempt, a sudden calm after agitation, or access to lethal means.

Serotonin syndrome features include agitation, hyperthermia, clonus, hyperreflexia, and diaphoresis; neuroleptic malignant syndrome features rigidity, high fever, autonomic instability, and elevated creatine kinase.

Extrapyramidal symptoms from antipsychotics include acute dystonia (treat with benztropine or diphenhydramine), akathisia, parkinsonism, and tardive dyskinesia.

Lithium therapeutic range is 0.6-1.2 mEq/L; toxicity signs include coarse tremor, vomiting, diarrhea, ataxia, and confusion, aggravated by dehydration and NSAIDs.

Alcohol withdrawal timeline: tremor and anxiety at 6-12 hours, hallucinations at 12-24 hours, withdrawal seizures at 24-48 hours, and delirium tremens at 48-96 hours; benzodiazepines are first-line.

Anorexia nervosa features low body weight, intense fear of weight gain, and body image distortion; refeeding syndrome risks hypophosphatemia, hypokalemia, and hypomagnesemia.

Defense mechanisms include denial, projection, rationalization, displacement, sublimation, and regression; identifying the mechanism guides non-confrontational nursing response.

Levels of prevention: primary (immunization, seat belts, fluoridation), secondary (screening, mammography, Pap smear), tertiary (rehabilitation, chronic disease management).

Incidence counts new cases over a period; prevalence counts all existing cases at a point in time; prevalence rises with longer disease duration.

Epidemiologic measures: attack rate = new cases / population at risk; case fatality rate = deaths from disease / diagnosed cases; relative risk compares incidence in exposed versus unexposed.

Herd immunity thresholds depend on transmissibility; measles requires about 95% coverage, while polio needs roughly 80-85% to interrupt transmission.

Reportable disease surveillance uses notifiable condition lists that vary by jurisdiction; mandated reporters must report suspected abuse, neglect, and specified communicable diseases.

The epidemiologic triangle consists of agent, host, and environment; the web of causation adds multiple interacting factors for chronic and multifactorial disease.

Screening test properties: sensitivity detects true positives (few false negatives), specificity detects true negatives (few false positives), and predictive value depends on disease prevalence.

Community assessment models include windshields surveys, key informant interviews, and the community-as-partner model, which emphasizes community core, subsystems, and lines of resistance.

Ethical principles: autonomy (self-determination), beneficence (do good), nonmaleficence (do no harm), justice (fair distribution), veracity (truthfulness), and fidelity (keeping promises).

Informed consent requires capacity, disclosure of risks and benefits, comprehension, and voluntariness; the provider obtains consent, and the nurse witnesses and verifies understanding.

A living will or advance directive states treatment preferences; durable power of attorney for health care designates a surrogate decision-maker; do-not-resuscitate orders require provider authorization.

Delegation follows the five rights: right task, circumstance, person, direction/communication, and supervision; the nurse retains accountability for outcomes.

Conflict management styles include avoiding, accommodating, competing, compromising, and collaborating; collaboration is preferred for patient safety issues.

Transformational leadership inspires through idealized influence, inspirational motivation, intellectual stimulation, and individualized consideration.

Just culture distinguishes human error (console), at-risk behavior (coach), and reckless behavior (punish); it encourages error reporting without blame.

Nurse practice acts define scope of practice by state; the nurse must follow the more restrictive of law, facility policy, or professional standard.

The evidence hierarchy ranks systematic reviews and meta-analyses of randomized controlled trials highest, then RCTs, cohort studies, case-control studies, case series, and expert opinion.

PICO frames a clinical question: population, intervention, comparison, and outcome; PICo substitutes a qualitative phenomenon of interest for intervention and comparison.

Validity types: internal validity concerns causal inference, external validity concerns generalizability, and reliability concerns consistency of repeated measurement.

Sensitivity and specificity, positive and negative predictive values, and likelihood ratios interpret diagnostic test accuracy; a 95% confidence interval excluding the null indicates statistical significance.

Levels of measurement: nominal (categories), ordinal (ranked), interval (equal intervals, no true zero), ratio (true zero); parametric tests require interval or ratio data.

Qualitative designs include phenomenology (lived experience), grounded theory (theory generation), ethnography (culture), and case study; rigor uses credibility, transferability, dependability, and confirmability.

EBP steps are ask, acquire, appraise, apply, and assess; implementation considers patient preferences, clinical expertise, and best available evidence.

Nursing informatics standards include HL7 for message exchange, FHIR for application programming interfaces, SNOMED CT and LOINC for terminology, and HIPAA for protected health information privacy.