PCCN (Adult) cheat sheet

MAP = (SBP + 2DBP)/3; for most adults, target MAP at least 65 mmHg because values below 60 mmHg threaten organ perfusion.

Cardiac output = heart rate x stroke volume; cardiac index = cardiac output/body surface area, with a normal adult CI of about 2.5-4.0 L/min/m².

Sepsis-3: suspected infection plus an acute SOFA increase of at least 2 points; septic shock adds vasopressor-requiring hypotension and lactate above 2 mmol/L despite fluids.

STEMI: new ST elevation in at least two contiguous leads; posterior MI may show ST depression and tall R waves in V1-V3, so obtain posterior leads.

Ventilator rules: keep plateau pressure at or below 30 cm H2O; driving pressure = plateau pressure minus PEEP; high peak with normal plateau suggests airway resistance.

Hypoglycemia: treat blood glucose below 70 mg/dL with 15-20 g fast carbohydrate if conscious; use IV dextrose or IM glucagon if unconscious.

Hyperkalemia ECG sequence: peaked T waves, PR prolongation, QRS widening, sine wave; give IV calcium first when ECG changes are present.

Ischemic stroke thrombolysis window is generally up to 4.5 hours from last known well; blood pressure must be below 185/110 mmHg before treatment.

AKI criteria: urine output below 0.5 mL/kg/hour for at least 6 hours or creatinine rise of at least 0.3 mg/dL within 48 hours; monitor potassium and volume status.

Informed consent requires capacity, disclosure, comprehension, and voluntariness; the provider obtains consent, while the nurse may witness the signature.

A competent adult may refuse treatment even when refusal risks death; document the refusal, notify the provider, and confirm the patient is informed.

HIPAA requires minimum necessary protected health information; permitted disclosures include treatment, payment, operations, and legally required reporting.

Mandatory reporting includes suspected abuse, neglect, or exploitation under state law and facility policy, regardless of patient wishes.

Delegation rule: the RN retains accountability; delegate only the right task to the right person with clear direction, supervision, and evaluation.

Ethical principles: autonomy respects informed choice; beneficence promotes good; nonmaleficence avoids harm; justice requires fair resource distribution.

Advance directives document wishes or appoint a surrogate; verify code status and ensure comfort care is not automatically withheld by a DNR order.

Chain of command: use it when a provider is unavailable or an order seems unsafe; escalate to charge nurse or supervisor and document the concern.

Documentation: record objective, contemporaneous facts; label late entries with actual entry time and the time care occurred; never alter an existing record.