Nursing

Cheat Sheets
76 Cheat Sheets for
Nursing Students

NRSNG
Jon Haws RN
Sandra Haws RD
 Table of contents

Introduction
Cardiac
Blood Pressure Values
R v L Heart Failure
Types of Cardiomyopathy
12 Lead MI Locations
Angina
Heart Blocks
Cardiac Auscultation
Chest Pain Identification
H’s and T’s of Acls
Coronary Circulation
Types of Aneurysms
Fundamentals
Patient Mobility
Chest Tube Care
Pathophysiology Concept Map
Head to Toe Assessment
Pressure Ulcers
Types of Lines
Medical Spanish
Therapeutic Diets
IV Sites and Considerations
Patient Safety
Colostomy Care
Abdominal Pain
Ulcerative Colitis Vs. Crohn’s Disease
Chronic Kidney Disease Symptoms
Types of Viral Hepatitis
Hematologic/Oncology/Immunology
Types of Anemia
Integumentary
Burn Staging
Skin Cancer
Skin Lesions
Labs
Lab Value Skeletons
Lab Value for Clinical
Blood Compatibility Chart
Abg Rome Flowchart
Cardiac Biomarkers
IV Colors and Gauges
Abg Analysis
Fluids and Electrolytes
Endocrine/Metabolic
Endocrine Study Guide Chart
Addison’s Vs. Cushing’s
Hyper Vs. Hypothyroidism
Musculoskeletal
Fracture Management
Mental Health
Stroke Symptoms by Location
Neuro Dysfunction by Pupil Assessment
Routine Neuro Assessments
Ob
Newborn Assessment
Labor
Clinical Assistant – Brain Sheet
Pediatric Burn Chart
Erikson’s Stages of Psychosocial Development
Congenital Heart Defects
Pharmacology
Crystalloid IV Solutions
Drug Card
Nervous System Pharmacology
Dopamine Vs Dobutamine
 Beta Blockers
Common ICU Drips
Medication Antidotes
Insulin Cheat Sheet
Common Antihypertensive Drugs
Antidepressant Cheat Sheet
Immunization Schedule
Antibiotic Cheat Sheet
Answering Pharmacology Questions
Therapeutic Drug Levels
Antidysrrhythmic Meds and Action Potential Chart
Respiratory
Hierarchy of O2 Delivery Systems
Lung Sounds
Gas Exchange
Asthma Medications
Artificial Airways Decision Tree
Ventilator Alarms
Chest Tube Management
 Introduction

My journey into nursing was a long one, but I have found it to be a truly rewarding career
that allows me to make a difference and have ample family time. I am confident that you
will achieve your goals. The fact that you are seeing additional resources to improve your
understanding speaks volumes to your dedication.

This book is intended to provide you with a quick reference to some of the most needed
and most used information for nursing students.

This is not a complete guide to nursing but a simple, compact, and quick reference to
some of the most important information.

Happy Nursing!

Jon Haws RN

For colored images of Cheat Sheets for Nurses download

the Kindle version of the book, which is available at no
additional cost with each physical purchase of the book.
10 Common Ekg Heart Rhythms

Normal Sinus Rhythm

Sinus Bradycardia

Sinus Tachycardia

Atrial Fibrillation

Atrial Flutter

Supraventricular
Tachycardia

Premature Atrial
Contraction

Premature Ventricular
Contraction

Ventricular Tachycardia

Ventricular Fibrillation

[NRSNG Academy Lesson: EKG Waveforms]

 Hemodynamic Values
Methods To Elevate Parameter Methods To Decrease Parameter

Cardiac Output Blood Pressure

CO=HR*SV (4-8L/min) CO*SVR

Heart Rate Cardiac Output

X
60-100 bpm CO=HR*SV (4-8L/min)

Treat cause, parasympatholytic

(Atropine), sympathomimetic
(Epinephrine), pacemaker

Treat cause, antidysrhythmics,

Vagal electrical therapy

Preload Afterload
Contractility
PAOP, CVP SVR

Fluids, blood Cardiac glycosides,

Vasopressors
Sympathomimetics

Venous vasodilators,
Beta blockers, Ca Arterial vasodilators,
diuretics ace inhibitors,
channel blockers ACE inhibitors ARBs,
ARBs
IABP

Key Hemodynamic Values (With Equations)

Cardiac Output (CO) HR x SV 4-8 L/min
Cardiac Index (CI) CO/BSA 2.5-4 L/min/m2
Central Venous Pressure (CVP) 2-6 mmHg
Mean Arterial Pressure (MAP) SBP+(2xDBP)/3 70-100 mmHg
Stroke Volume (SV) EDV - ESV 60-120 ml/beat
Stroke Volume Index (SVI) SV/BSA 30-65 ml/m2/beat
Pulmonary Artery Occlusion Pressure (PAOP) 8-12 mmHg
Systemic Vascular Resistance (SVR) [MAP-RAP) x 80]/CI 800-1400 dynes/sec/cm-5
Central Venous Oxygen Saturation (ScvO2) 65-85%
Oxygen Delivery (DO2) CO x CaO2 x 10 900-1100 ml/min

[NRSNG Academy Lesson: Preload and Afterload]

 Blood Pressure Values
BLOOD PRESSURE VALUES
New 2017 AHA guidelines have eliminated pre-hypertensionand lowered the
threshold for the diagnosis of hypertension to allow for earlier intervention.
Blood pressure categories in the new guideline are:
Normal: Less than 120/80 mm Hg;

Elevated: Systolic between 120-129 and diastolic less than 80;

Stage 1: Systolic between 130-139 or diastolic between 80-89;

Stage 2: Systolic at least 140 or diastolic at least 90 mm Hg;

Hypertensive crisis: Systolicover 180 and/or diastolic over 120,with patients

needing prompt changes in medication if there are no
other indications of problems, or immediate
hospitalization if there are signs of organ damage.

CATEGORY Systolic mm Hg Diastolic mm Hg

Normal <120 <80

Elevated 120-129 <80

Stage 1 130-139 80-89

Stage 2 >140 >90

Hypertensive
>180 >120
Crisis

SOURCE:
http://www.acc.org/latest-in-cardiology/articles/2017/11/08/11/47/mon-5pm-bp-guideline-aha-2017

[NRSNG Academy Lesson: Hypertension]

[NRSNG Academy Lesson: Hypertension]
R v L Heart Failure

[NRSNG Academy Lesson: Heart Failure]

Types of Cardiomyopathy

[NRSNG Academy Lesson: Cardiomyopathy]

12 Lead MI Locations

[NRSNG Academy Lesson: Myocardial Infarction]

 Angina
ANGINA
Chest pain resulting from inadequate blood flow to heart muscle. Most common cause is
coronary artery disease (CAD). Other causes include anemia, heart failure, abnormal rhythms.

STABLE UNSTABLE VARIANT

ONSET Exertion/Stress Rest/Exertion/Stress Typically at Rest

PREDICTABLE Predictable Unpredictable Unpredictable

DURATION <5 min Up to 30 min Varies

RESOLUTION Rest or Nitro May Resolve with Nitro May Resolve with Nitro

ASSESSMENT DIAGNOSIS INTERVENTIONS

Pain EKG PAIN: provide rest and administer nitro as prescribed

Dyspnea Stress Test O2: provide supplemental oxygen to the patient

Pallor Cardiac Biomarkers 12 LEAD EKG: obtain 12 lead ekg

Sweating Cardiac Cath REST: maintain bed rest to reduce O2 demands

Tachycardia ASSESS: assess vital signs and pain

Syncope

HTN

[NRSNG Academy Lesson: Angina]

[NRSNG Academy Lesson: Angina]

 Heart Blocks
HEART BLOCKS
FAILURE OF THE HEART’S NATURAL PACEMAKER DUE TO OBSTRUCTION
(“BLOCK”) IN THE ELECTRICAL CONDUCTION SYSTEM OF THE HEART.

Relationship of P waves to QRSs

All P waves are No P waves are

Some P waves are
followed by a followed by
not followed by QRSs
QRS but PR is >0.20 (associated with)
QRSs (i.e.,
AV dissociation)

First-Degree Progressive Every other PR interval of

AV block lengthening of P wave is not conducted P wave
PR until a conducted (2:1) is consistent
P is not
followed by
a QRS, then
repeated

QRS QRS is Only one More than QRS QRS is

< 0.12 0.12 or > P wave in one P wave < 0.12 0.12 or >
a row is not in a row
conducted is not
conducted

Second- Second- Second- Second- High Complete Complete

degree degree degree degree grade heart block heart block
AV block, AV block, AV block, AV block, AV block with with
Type I Type I Type II Type II junctional ventricular
escape escape
rhythm rhythm

1° 2° Type I 2° Type II 3°
Benign but Block at AV node, Block at Bundle of Ventricular
can progress usually transient, His, occurs with asystole in absence
Significance does not usually anterior MI, often of escape beat
progress progresses to
complete block

Observation, Close monitoring, Atropine, Pacemaker,

d/c digitalis use d/c digitalis use, transcutaneous atropine, monitor
Treatment treat if patient or transvenous for hypoperfusion
is symptomatic pacemaker

[NRSNG Academy Lesson: 1st Degree AV Heart Block]

[NRSNG Academy Lesson: 1st Degree AV Heart Block]
Cardiac Auscultation

[NRSNG Academy Lesson: Heart Sounds]

 Chest Pain Identification
CHEST PAIN IDENTIFICATION

CAUSE PROVOCATION QUALITY REGION SEVERITY TIMING SIGNS/SYMPTOMS TREATMENT

- Ex - Heavy - Substernal - Mild to - Gradual or - Tachycardia - Rest

pressure severe sudden
- Stress - Radia onset - Dyspnea - Oxygen
- Tightness to jaw,
- Cold arms, - <5 min but - N/V - Nitro
- Dull ache neck, may last
ANGINA - Smoking - Diaphoresis - Calcium
abdomen up to Channel
15min - Anxiety Blocker
- ST-T wave
changes

- Stress - Similar to - Substernal - No - Sudden - Tachycardia - MONA

angina onset
- Lifestyle - Radia - Dyspnea - Fibrinol
symptoms
change - Pressure to jaw, - >30min up or
to severe - N/V percutaneous
on chest arms, neck, to 2 hours
abdomen - Diaphoresis coronary
- Clinched interven
ACUTE MI fist over - Anxiety
chest
- Impending doom
- T wave inversion,
ST eleva
- S4

- Venous - Sharp - Substernal - Mild to - Sudden - Tachycardia - Narco

stasis or lateral severe onset
- Shoo - Tachypnea - High
chest
- Hyperco Fowler’s
- Deep minutes to - Dyspnea
agulability - Radiates to
PULMONARY hours - Chest
- Worsened shoulder - Anxiety Splin
EMBOLISM - Vascular
with and neck
injury - Hemoptysis - Thrombol
inspira
- Fever

- Chest - Sharp - Lateral - Mild to - Sudden - Tachypnea - Narco

trauma tearing chest with severe onset
- Tachycardia - Chest tube
radia to
- Excessive - Exacer
shoulder, hours to - JVD
l bated by
arms, back days
volume or breathing - Anxiety
PEEP with
PNEUMOTHORAX mechanical - Diminished
ven a breath sounds

- Bleb - Tracheal
devia
- Hyperresonance
- Dyspnea

[NRSNG Academy Lesson: Angina]

[NRSNG Academy Lesson: Angina]

 H’s and T’s of Acls
H’S AND T’S OF ACLS
A mnemonic used to aid in remembering the possible causes of cardiac arrest. A variety of disease
processes can lead to a cardiac arrest; however, they usually boil down to one or more of the "Hs and Ts".

H’s of ACLS T’s of ACLS

Causes Signs Treatment Causes Signs Treatment

Hypovolemia HR Fluid administration Toxins Prolonged QT Antidote Based on

Narrow QRS Fluid challenge overdose
Blood loss
Tamponade HR Pericardiocentesis
Hypoxia HR Patent airway (Cardiac) Narrow QRS Thoracotomy
Cyanosis Ventilate JVD
Muffled heart

Hydrogen ABG (Low pH) Sodium bicarbonate Tension HR Decompression

Ion (Acidosis) Low amplitude QRS Ventilate Pneumothorax Narrow QRS Chest tube
Unequal breaths
Tracheal deviation
Ventilate (metabolic)
Flat T waves with U
Hyper/Hypokalemia Sodium bicarbonate
wave (hypo) or
(respiratory) Thrombosis EKG alteration Embolectomy
Peaked
Calcium Gluconate (coronary or Chest pain Fibrinolytics
T waves with wide
Insulin and D50 pulmonary) Narrow QRS Anticoagulants
QRS (hyper)
Albuterol SOB Angioplasty
Stent
Hypothermia Hypothermia Warming measures CABG

H’s
Hypovolemia: A lack of circulating body fluids, principally blood volume. This is usually (though not exclusively) caused
by some form of bleeding, anaphylaxis, or pregnancy with gravid uterus.
Hypoxia: A lack of oxygen delivery to the heart, brain and other vital organs. Rapid assessment of airway patency and
respiratory effort must be performed.
Hydrogen Ion: An abnormal pH in the body as a result of lactic acidosis which occurs in prolonged hypoxia and in
severe infection, diabetic ketoacidosis, renal failure causing uremia, or ingestion of toxic agents or overdose of
pharmacological agents.
Hyper/Hypokalemia: Both excess and inadequate potassium can be life-threatening.
Hypothermia: A low core body temperature, defined clinically as a temperature of less than 35 degrees Celsius
(95 degrees Fahrenheit).

T’s
Toxins: Toxin ingestion is one of the most common causes of cardiac arrest. Prolonged QT is a common sign.
Tamponade: Blood or other fluids building up in the pericardium can put pressure on the heart so that it is not able to
beat
Tension Pneumothorax: The build-up of air into one of the pleural cavities, which causes a mediastinal shift. When this
happens, the great vessels (particularly the superior vena cava) become kinked, which limits blood return to the heart
Thrombosis: Hemodynamically significant pulmonary emboli are generally massive and typically fatal.

Text from Wikipedia.org used on CC license

[NRSNG Academy Lesson: Ventricular Tachycardia]

[NRSNG Academy Lesson: Ventricular Tachycardia]

Coronary Circulation

[NRSNG Academy Lesson: Coronary Circulation]

 Types of Aneurysms
TYPES OF ANEURYSMS
An Aneurysm is an outpouching of the vessel wall due to weakened vessel muscle
layers. This is usually caused by hypertension. Blood flow becomes turbulent at the
sit of the aneurysm, putting it at high risk for rupture.

By Nichole Weaver, © NRSNG, LLC.

FUSIFORM SACCULAR DISSECTING FALSE

Fusiform Saccular Dissection occurs False aneurysms

aneurysms aneurysms pouch when the inner appear on scans,
surround the full out from one side layer of the but are actually a
circumference of of the vessel. vessel is torn blood clot
the vessel. This is Also called “Berry away. Blood flows formed outside
common in the Aneurysms”. between vessel the vessel. Blood
Abdominal Aorta. layers instead of flow is not
forward. impeded.

[NRSNG Academy Lesson: Aortic Aneurysm]

 Patient Mobility
PATIENT MOBILITY
GENERAL HOME SAFETY GUIDELINES
•
•
• Use nonslip mats, grab bars, and raised toilet seats

CRUTCHES
Standing up: scoot to front of chair, hold both crutches in hand of injured side, push
up on good foot.
Stairs:
Up Down
• Unaffected/strong leg first • Affected/weak leg and
• Affected/weak leg and crutches first
crutches second • Unaffected/strong leg second

WALKERS
ng

How to ambulate Types

• Push forward about 6” (or whatever is •

• Advance weak leg, then strong leg walker

• •
advance the walker and weak leg able to push the walker
together at once, then move the forward
stronger leg forward

CANES
• Use on STRONG SIDE
• Elbow should be flexed slightly
• Tip of nearest point of the cane should be about 6” in front of and 6” to the side
of that strong leg
How to ambulate Types
• • Straight or regular
• Advance the cane about 1 foot forward (or • Tripod
• Quad
• Move the WEAK SIDE while the cane and

• Then move the strong leg ahead, while

the weaker leg is supported by the cane
•
Sources: American Academy of Orthopaedic Surgeons. How to Use C rutches, Canes, and Walkers-OrthoInfo - AAOS.
.org/topic.cfm?topic=a00181

[NRSNG Academy Lesson: Fall and Injury Prevention]

Chest Tube Care

[NRSNG Academy Lesson: Chest Tube Management]

 Pathophysiology Concept Map
PATHOPHYSIOLOGY CONCEPT MAP

Risk Factors Sign And Symptoms Potential

Complications

DISEASE PROCESS
Pathophysiology (Definition / etiology chronicity and prognosis)

Medical intervention, Labs and diagnostic studies Nursing Diagnosis Nursing Interventions
Head to Toe Assessment

[NRSNG Academy Lesson: Head to Toe Nursing Assessment]

 Pressure Ulcers

[NRSNG Academy Lesson: Complications of Immobility]

 Types of Lines

[NRSNG Academy Lesson: Preparing an IV Infusion]

 Medical Spanish
MEDICAL SPANISH

BASIC ASSESSMENT ESSENTIAL WORDS

My name is _______ . I am your nurse. Me llamo _______. S oy su enferme ra (o). Please Por favor

What is your nam e? ¿Cómo se llam a? Thank you Gracias

How are you feeling? ¿Cómo se sie nte? Never Nunca

Date Fecha
What is the d ate? ¿A qué fecha e stamos?
Sign ature Firma
Where are you? ¿Dónde e stá usted?
Good- bye Adiós
How old are you? ¿Cuá ntos añ os tiene?
Where Donde
Where do you live? ¿Dónde vive usted?

Are you having pai n? Where? ¿Tiene do lor? Dond e?

PHYSICAL ASSESSMENT
Do you have_________? ¿Tiene usted ________?
MEALTIMES
Have you ever had______? Ha tenido alguna vez ________?
Brea kfast Desayuno
Itching Picazón

Lunch Almuer zo
Sores Llagas

Dinner Cena
Edema/swelling Edema/hinchazón

Pain Dolor

ESSENTIAL ITEMS Chest pain Dolor de pecho

Nausea Náuseas
Blank et Manta

Vomiting Vómitos
Brush Cepillo

Gown Bata

Lotion Loción
POSITIONING
Pillow Almohada
Lean backward Recuéstese
Shampoo Champú
Lean forward Inclínese hacia adelante
Shaving cream Crema de afeitar
Lie down Acuéstese

Sheet Sábana
Sit down Siéntese

Soap Jabón
Stand up Póngase de pie

Towel Toalla
 MEDICAL SPANISH

ANATOMY
Skin Piel

Chest Pecho

Lungs Pulmones

Eyes Ojos

Heart Corazón

Kidneys Riñones

Pulse Pulso

Arm Brazo

Leg Pierna

BASIC NURSING PROCEDURES

I'm going to take your ________. Voy a medirle _______.

Vital signs Los signos vitales

Blood pressure La presión sanguínea

Pulse El pulso

Temperature La temperatura

I'm going to take a blood sample. Voy a tomarle una muestra de sangre.

Can you provide a urine specimen? ¿Puede darnos un espécimen de orina?

DIAGNOSTIC TESTS
Biopsy Biopsia

Blood test Análisis de la sangre

Blood culture Cultivo de la sangre

CT scan Tomografía computarizada

Ultrasound Ultrasonido

X-ray Radiografía
 Therapeutic Diets
THERAPEUTIC DIETS

NAME CONSIDERATIONS

NPO Nothing by mouth

(nil per os)

CLEAR transparent to light and liquid at body temperature water fruit juice

LIQUID broth hard candy gelatin popsicles coffee tea

FULL clear and opaque liquid foods at body temperature

ice cream sherbet breakfast drinks
all clear liquid items
fat free & 1% milk pudding
LIQUID thin hot cereals (cream of wheat)

PUREED foods that require no chewing all full liquid items mashed potatoes
DIET
MECHANICAL foods that require less chewing chopped, ground, & pureed foods
DIET tender fruits and vegetables tender meats

LOW RESIDUE/ limit fiber intake to 10g a day white rice

LOW FIBER white bread refined cereals and pastas

HIGH RESIDUE/ high fiber intake 20-35g a day whole-grain products

HIGH FIBER fruits and vegetables

CONSISTENT
CARB limited starches, juice, fruit, milk, and sugars control carbohydrate intake
(diabetic diet)

CARDIAC restrict fat and sodium intake

SODIUM- limit sodium intake to set amount (4 g, 3g , 2g , 1g , 500mg)

RESTRICTED avoid canned, frozen, boxed, smoked, salted foods

[NRSNG Academy Lesson: Nutrition]

IV Sites and Considerations

[NRSNG Academy Lesson: Preparing an IV Infusion]

 Patient Safety
PATIENT SAFETY

FIRE SAFETY RESTRAINT SAFETY

RACE PASS
R: Rescue patients in danger P: Pull the fire extinguisher pin Use the least restrictive method possible

A: Activate the fire alarm A: Aim at the base of the fire Order for restraints needs to be renewed within set time frame

C: Confine the fire S: Squeeze the handle Never ordered PRN

E: Extinguish the fire S: Sweep extinguisher from side Assess skin integrity, neurovascular, and circulatory status every 30m
to side
Remove restraint every 2 hours to check pressure areas

FALL SAFETY STANDARD PRECAUTIONS CONTACT PRECAUTIONS

Asses for risk factors Hand hygiene before and after every patient contact DISEASES PROTECTION
Bed in low and locked position Use PPE when risk of body fluid exposure Norovirus Private room

Use and dispose of sharps safely Rotavirus Gown and gloves when
Bed alarm as needed
in patient room
Clean all shared patient equipment Clostridium difficile
1:1 monitoring
Hand hygiene on exit,
Draining wounds Soap and water for C. Diff
Use of aseptic technique
MDROs
Dispose of all waste and linen safely

AIRBORNE PRECAUTIONS DROPLET PRECAUTIONS

DISEASES PROTECTION DISEASES PROTECTION
Measles Single negative pressure room Influenza Pneumonia Private room

Chickenpox 6-12 air exchanges per hour Meningitis Sepsis Surgical mask within 3 feet of
patient
TB Wear respirator or mask Mumps Pertussis Patient must wear a mask when
leaving room
Mask must be worn by client when Rubella
leaving room
 Colostomy Care

[NRSNG Academy Lesson: Diverticulosis – Diverticulitis]

 Abdominal Pain
ABDOMINAL PAIN

9 Regions of the Abdomen

Gallstones Heartburn Dyspepsia

Cholecystitis Indigestion Gastritis
Stomach ulcer Hiatal hernia Stomach ulcer
Duodenal ulcer Epigastric hernia Pancreatitis
Hepatits Stomach ulcer
Duodenal ulcer
Hepatitis

Kidney stones Umbilical hernia Kidney stones

Kidney infection Early appendicitis Kidney infection
IBD Stomach ulcer IBD
Constipation IBD Constipation
Pancreatitis

Appendicitis Bladder infection Constipation

Inguinal Hernia Prostatitis IBD
IBD Diverticulitis Pelvic pain
Pelvic Pain IBD Inguinal hernia
Constipation Inguinal hernia
Pelvic pain

CRITICAL POINT:
When assessing the abdomen the correct assessment order is:

Inspect, Auscultate, Percuss, Palpate

Ulcerative Colitis Vs. Crohn’s
Disease

[NRSNG Academy Lesson: Inflammatory Bowel Disease]

Chronic Kidney Disease Symptoms
CHRONIC KIDNEY DISEASE SYMPTOMS

By Nichole Weaver, © NRSNG, LLC.

Chronic Kidney Disease involves symptoms associated with LOSS of normal kidney functions such as:

Excretion of waste products

Production of urine

Electrolyte balance

Acid-base balance

Fluid volume regulation

Erythropoietin - creation of RBCs

[NRSNG Academy Lesson: Chronic Kidney Disease]

[NRSNG Academy Lesson: Chronic Kidney Disease]

 Types of Viral Hepatitis
TYPES OF VIRAL HEPATITIS

VIRAL TYPE TRANSMISSION PREVENTION

Hand Hygiene
Hepatitis A Virus
Fecal - Oral Safe Food Handling
(HAV)**
Vaccine

Safe Sex Practices

Handwashing
Hepatitis B Virus Needle Safety
Blood - Body Fluids
(HBV)** Blood Screening
Vaccine

Handwashing
Hepatitis C Virus Needle Safety
Blood
(HCV)** Blood Screening

Hepatitis D Virus
Blood - Body Fluids Same as HBV
(HDV)

Hepatitis E Virus Fecal - Oral Same as HAV

(HEV)

[NRSNG Academy Lesson: Hepatitis]

[NRSNG Academy Lesson: Hepatitis]

 Types of Anemia
TYPES OF ANEMIA
Anemia involves a decreased oxygen carrying capacity of the blood due to a
change in the amount, size, or shape of the red blood cell or the amount of
hemoglobin available for binding oxygen to the cell.

COLOR SIZE SHAPE

Anemia of Blood Loss

Normochromic Normocytic Normal
Hemorrhage

Aplastic Anemia
Leukemia Normochromic Normocytic Normal
Medications

Iron-Deficiency Anemia
Poor iron intake Hypochromic Normocytic Normal
Chronic blood loss

Pernicious Anemia
Normochromic Macrocytic Enlarged
Poor Vitamin B12 intake

Sickle Cell Anemia

Genetics Normochromic Microcytic Abnormal
Triggers (cold, infection)

[NRSNG Academy Lesson: Anemia]

[NRSNG Academy Lesson: Anemia]

 Burn Staging
BURN STAGING

First Degree Second Degree Third Degree Fourth Degree

Reddened, Partial Full thickness, Muscle and/or
painful, intact Thickness, often painless, bone exposed.
skin broken skin, white/black Common in
pain, pink/red, eschar electrical
blisters burns

By The original uploader was
Snickerdo at English Wikipedia -
Transferred from en.wikipedia to
Commons., CC BY-SA 3.0,
https://commons.wikimedia.org/w/in
dex.php?curid=3358773
By Clifford Sheckter, Arhana
Chattopadhyay, John Paro and Yvonne
Karanas - Direct source. Full paper., CC
BY 4.0,
https://commons.wikimedia.org/w/in
dex.php?curid=68491398
By goga312. Original uploader was
Goga312 at ru.wikipedia - Transferred
from ru.wikipedia(Original text :
собственная работа), CC BY-SA 3.0,
https://commons.wikimedia.org/w/in
dex.php?curid=7771672

[NRSNG Academy Lesson: Burn Injuries]

[NRSNG Academy Lesson: Burn Injuries]

Skin Cancer

[NRSNG Academy Lesson: Skin Cancer]

 Skin Lesions
SKIN LESIONS

Macule and Patch

A macule is a flat area of hyperpigmentation, usually < 10mm.
A Patch is a larger macule (usually > 10mm).

By Madhero88 - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=14546457

Papule and Plaque

A papule is a well-defined raised area with no visible fluid,
usually < 10 mm.
A plaque is a large papule or group of them, usually > 10 mm,
or a large raised plateau-like lesion
By Madhero88 - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=14546485

Nodules
A nodule is similar to a papule - raised area with no fluid - but
is much deeper in the dermis than a papule.

By Madhero88 - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=14546471

Vesicles and Bulla

A vesicle is a small, well-defined raised area filled with fluid,
usually <10mm.
A Bulla is a large vesicle, usually >10mm.
Both are also known as blisters.
By Madhero88 - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=14546567

Fissures, Erosions, and Ulcers

A fissure is a crack in the skin that is usually narrow but deep.
Erosions involve full loss of the epidermis in a defined area.
Ulcers involve loss of the epidermis and some or all of the dermis.
By Madhero88 - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=14546561

[NRSNG Academy Lesson: Integumentary Important Points]

[NRSNG Academy Lesson: Integumentary Important Points]

 Lab Value Skeletons
LAB VALUE SKELETONS

Complete Blood Count (CBC) Liver Enzymes

T. Bili
Hgb D. Bili
WBC PLT AST ALT
Hct
ALK Phos

Arterial Blood Gas (ABG)

pH PaCO2 PaO2 HCO3 BE

Basic Metabolic Panel (BMP or CHEM-7) and CHEM-10

Ca
Na Cl BUN
Glu
Mg Phos
K HCO3 Cr

Bleeding
Times
Liver Profile

Ca TP AST LDH PT PTT

Bili
PO4 Alb ALT ALP
INR

[NRSNG Academy Lesson: Shorthand Lab Values]

[NRSNG Academy Lesson: Shorthand Lab Values]

Lab Value for Clinical

[NRSNG Academy Lesson: Lab Panels]

 Blood Compatibility Chart
BLOOD COMPATIBILITY CHART
DONOR BLOOD TYPE

O- O+ B- B+ A- A+ AB- AB+

AB+
PATIENT BLOOD TYPE

AB-

A+

A-

B+

B-

O+

O-

[NRSNG Academy Lesson: Sickle Cell Anemia]

[NRSNG Academy Lesson: Sickle Cell Anemia]

 Abg Rome Flowchart
ABG ROME FLOWCHART

pH

LOW HIGH

Acidosis Alkalosis

HIGH LOW LOW HIGH

PaCO2 HCO3 PaCO2 HCO3

Respiratory Metabolic Respiratory Metabolic

Acidosis Acidosis Alkalosis Alkalosis

[NRSNG Academy Lesson: ABG Labs]

[NRSNG Academy Lesson: ABG Labs]

 Cardiac Biomarkers
CARDIAC BIOMARKERS
5-70 ng/mL
MYOGLOBIN

Rise 1-4 hours

Peak 6-12 hours

Return 1-2 days

<2.40 ng/mL
CK-MB

Rise 6-10 hours

Peak 12-24 hours

Return 2-3 days

TROPONIN I

<0.035 ng/mL

Rise 4-6 hours

Peak 18 hours

Return 1-2 weeks

88-230 U/L
LDH1

Rise 8-12 hours

Peak 72 hours

Return 1-2 weeks

[NRSNG Academy Lesson: Dysrhythmias]

[NRSNG Academy Lesson: Dysrhythmias]

 IV Colors and Gauges
IV THERAPY
IV COLORS AND GAUGES
COLOR

14G 16G 18G 20G 22G 24G

FLOW RATE LENGTH SIZE
(mm)

45 45 32 32 25 19
(ml/min)

240 180 90 60 36 20
USES

Trauma Rapid Blood Routine Routine Small Veins Peds

Rapid Blood Surgery Blood Blood Peds
Surgery Surgery Routine

Important Points:
Check facility protocols. In general blood should not be given in a
catheter <20G. Keep in mind the a smaller gauge # means a larger
IV catheter. Most adult patients will need an 18G or 20G. Always
consider what fluids the patient will be receiving before determining
size.

[NRSNG Academy Lesson: Preparing an IV Infusion]

[NRSNG Academy Lesson: Preparing an IV Infusion]

 Abg Analysis
ABG ANALYSIS

Normal ABG Values

pH 7.35-7.45

PaCO 2 35-45 mmHg

HCO3- 22-26 mEq/L

PaO2 80-100 mmHg

DISORDER CAUSES ASSESSMENT FINDINGS TREATMENTS

Respiratory Acidosis Hypoventilation -Bradycardia -Increase RR
pH < 7.35; PaCO2 > 45 -CNS depression -Hypotension -Reposition patient
-Pulmonary edema -Confusion -Maintain patent airway
-Respiratory arrest -Somnolence -Mechanical ventilation
-Airway obstruction - Rate
- Vt

Respiratory Alkalosis Hyperventilation -Tachycardia -Decrease RR

pH > 7.45; PaCO2 < 35 -Excessive -Palpitations -Administer sedatives
-Anxiety -Rebreather mask
mechanical ventilation
-Seizures -Mechanical ventilation
-Anxiety - RR
-Fever -Perspiration/
- Sedation
-Pneumothorax diaphoresis
- Vt

Metabolic Acidosis Acid Gain -Nausea/vomiting -Improve oxygenation

pH < 7.35; HCO3 < 22 -Shock -Malaise -Treat Cause
-Ketoacidosis -Tachypnea -DKA
-Renal failure -Hypotension -Diarrhea
Bicarbonate loss -Confusion -Renal failure
-Diarrhea
-Bile drainage

Metabolic Alkalosis Acid Loss - Nausea/vomiting/ -Administer buffer

pH > 7.45; HCO3 > 26 -Vomiting diarrhea -Treat cause
-Potassium loss
(diuretic use) -Confusion
-Hyperaldosteronism -Seizures
- Cushing's -Tetany
- Steroids
- Bicarbonate
gain

[NRSNG Academy Lesson: ABG Labs]

[NRSNG Academy Lesson: ABG Labs]

Fluids and Electrolytes

[NRSNG Academy Lesson: Potassium – K]

 Endocrine Study Guide Chart
ENDOCRINE STUDY GUIDE CHART

UNDER PRODUCTION OVER PRODUCTION

HORMONE GLAND SYNDROME SYNDROME

GH Anterio r Pituitary Acromega ly

ADH Posterio r Pituitary Diabetes Insipidus SIADH

T3,T4 Thyroid Myxedema Coma Graves

PTH Parathyroid Hypopa

Hyperparathyroid
rathyroid Hyperpa
Hypoparathyroid
rathyroid

Cortisol Adrenal Addisons Cushings

Insulin Panc reas Diabetes Mellitus

[NRSNG Academy Lesson: Addisons Disease]

NRSNG.com - “Tools and Confidence to Succeed in Nursing School.” ©2018

NRSNG, LLC - Reproduction Strictly Prohibited Disclaimer information at
NRSNG.com

[NRSNG Academy Lesson: Addisons Disease]

Addison’s Vs. Cushing’s

[NRSNG Academy Lesson: Addisons Disease]

 Hyper Vs. Hypothyroidism
HYPER VS. HYPOTHYROIDISM

Body System Hypothyroidism Hyperthyroidism

Hypometabolic Hypermetabolic
Metabolic Hypoglycemia Temperature
Cold intolerance Heat Intolerance
Weight gain / Edema Weight Loss

Bradycardia Tachycardia
Cardiovascular Hypotension Hypertension
Anemia Palpitations

Lethargy / Fatigue Hyperactive reflexes

Neurological Weakness Hand tremor
Muscle aches Emotional instability
Paresthesias Agitation

Dry skin
Integumentary Fine, thin hair
Loss of body hair

Constipation Exophthalmos
Other
Goiter Goiter

T3, T4 T3, T4
Hormone Levels Free T4 Free T4
TSH TSH

[NRSNG Academy Lesson: Hyperthyroidism]

[NRSNG Academy Lesson: Hyperthyroidism]
 Fracture Management
FRACTURE MANAGEMENT

Strain - excessive stretching of muscle

Sprain - excessive stretching of ligament

TREATMENT
RICE - Rest, Ice, Compression, Elevation

TYPES OF FRACTURES

By OpenStax College - Anatomy & Physiology, Connexions Website.

http://cnx.org/content/col11496/1.6/, Sep 7, 2015., CC BY 4.0, | https://commons.wikimedia.org/w/index.php?curid=30127535

TRACTION
Buck’s Traction - force applied to splint
Skeletal Traction pin through bone to hold weight
Force in opposite direction Traction weights:
Realign & immobilize fracture Hang freely
Do not remove without order
Support weight when moving patient

MONITOR FOR COMPLICATIONS

Fat Embolism Compartment Syndrome

[NRSNG Academy Lesson: Fractures]

[NRSNG Academy Lesson: Fractures]

Stroke Symptoms by Location

[NRSNG Academy Lesson: Assessment]

Neuro Dysfunction by
Pupil Assessment

[NRSNG Academy Lesson: Routine Neuro Assessments]

 Routine Neuro Assessments
ROUTINE NEURO ASSESSMENTS

Pupils Equal, Round, and Reactive to Light and Accommodation

(PERRLA) + Size in mm

LEVELS OF CONSCIOUSNESS
Normal A&O x 4, Alert

Confused A&O x <3, unable to answer

Delirious Confused and agitated

Somnolent Excessively sleepy or drowsy

Obtunded Awake, but slow or no response to surroundings

Stuporous Sleep-like, no spontaneous activity, withdraws to pain

Coma NO response to stimuli, unable to arouse

GLASGOW COMA SCALE

SCORE 1 2 3 4 5 6
Open
Eyes No opening Open to pain Open to voice
spontaneously
- -

Incomprehensible Inappropriate
Verbal No response
sounds words
Disoriented Oriented -

Abnormal Abnormal Withdraws Localizes Follows

Motor No response Extension Flexion to Pain to Pain Commands

MUSCLE STRENGTH
SCORE ABILITY
0 No muscle contraction

1 Muscle twitch

2 Movement without gravity

3 Movement against gravity

4 Movement against resistance

5 Full Strength

[NRSNG Academy Lesson: Routine Neuro Assessments]

[NRSNG Academy Lesson: Routine Neuro Assessments]

Newborn Assessment

[NRSNG Academy Lesson: Initial Care of the Newborn]


First Stage
Effacement and
dilation of cervix
Three stages - latent, active,
and transition
Mother is talkative and
eager in latent phase,
becoming tired, restless,
anxious as labor intensifies
and contractions become
stronger
Vertex Positions
ROA (right occipitoanterior)
LOA (left occipitoanterior)
ROP (right occipitoposterior)
LOP (left occipitoposterior)
ROT (right occipitotransverse)
LOT (left occipitotransverse )
V VARIABLE DECELERATION
E EARLY DECELERATION
A ACCELERATION
L LATE ACCELERATION
[NRSNG[NRSNG
Academy
Labor
LABOR
STAGES OF LABOR
Second Stage Third Stage Fourth Stage
Expulsion of fetus Separation of placenta Physical recovery
1-4 hr after expulsion
Pushing stage Expulsion of placenta
of placenta
Mother has intense Mother is relieved after Mother is tired, but is eager
concentration on pushing birth of newborn; mother to become acquainted with
with contractions; may fall is usually very tired her newborn
asleep between contractions
FETAL POSITIONS
Face Positions Breech Positions Other
RMA (right mentoanterior) LSA (left sacroanterior) Brow
LMA (left mentoanterior) LSP (left sacroposterior) Shoulder
RMP (right mentoposterior)
FETAL MONITORING
VEAL – CHOP
C CORD COMPRESSION
H HEAD COMPRESSION
O OKAY!
P PLACENTAL INSUFFICIENCY
AcademyLesson: Mechanisms
Lesson: Mechanisms of Labor] of Labor]
 Clinical Assistant – Brain Sheet
CLINICAL ASSISTANT - BRAIN SHEET

Date: Patient Initials:

Floor: Room Number:

Reason for hospitalization:

Focused Ass ess me nt:

Assess me nt Notes:

Consultations/ Tests:

Patient Med ications:

Name Reason Considera ons Time

[NRSNG Academy Lesson: Documentation]

[NRSNG Academy Lesson: Documentation]
 CLINICAL ASSISTANT - BRAIN SHEET
Normal L ab Values
Na 135-148 WBC 3.6-9.2 Platelet 140-400 “Nurses Dispense
K 3.5-5.3 RBC male 4.39-5.58 Albumin 3.5-5.0
Cl 100-112 RBC female 3.70-5.14 Ca 8.3-10.3 Comfort, Compassion,
CO2 23-29 Hgb male 13.7-17.3 PT 10.4-12.2 and Caring Without
BUN 5.0 - 25.0 Hgb female 12-15.5 aPTT 24-33
Creat 0.5 - 1.7 Hct male 39-49 INR 2.0-3.0 Even a Prescription.”
pH 7.35-7.45 Hct female 35-46 Billirubin 0.0-1.0 Val Saintsbury

Patient Vitals Intake & Output

Time Time Time
Pulse Pulse Pulse
Pulse Ox Pulse Ox Pulse Ox
Respirations Respirations Respirations
BP BP BP
Temp Temp Temp
Pain Pain Pain
IV Site Assess me nt/Fluid/Rate
Time Time Time
Pulse Pulse Pulse
Pulse Ox Pulse Ox Pulse Ox
Respirations Respirations Respirations
BP BP BP
Temp Temp Temp
Pain Pain Pain

Tasks/ Notes Calculations

Things to Research/I mpr ove

[NRSNG Academy Lesson: Documentation]

 Pediatric Burn Chart
PEDIATRIC BURN CHART

BASED ON LUND BROWDER CHART

A A

1 1
2 2 2
13 13
2
1 1 1
1 1 1/4 1 1/4
1 1/4
1 1/4
1 2 2

B B B B
AREA BIRTH AGE 1 YR AGE 5 YR
A: 1/2 of Head 9 1/2 8 1/2 6 1/2
C C B: 1/2 of Thigh 2 3/4 C C 3 1/4 4
C: 1/2 of Leg 2 1/2 2 1/2 2 3/4
1 1
1 3/4 1 3/4

A A

1 1

2 13 2 2 13
2

1 1/2 1 1/2 1 1/2

1 1/2
2 1/2 2 1/2
1 1 1/4
1 1/4 1 1/4
B B B B

1 1/4
AREA AGE 10 YR AGE 15 YR ADULT
C C A: 1/2 of Head 5 1/2 C C 4 1/2 3 1/2
B: 1/2 of Thigh 4 1/2 4 1/2 4 3/4
1 3/4 1 3/4 C: 1/2 of Leg 1 3/4 1 3/4
3 3 1/4 3 1/2

NRSNG.com - “Tools and Confidence to Succeed in Nursing School.” ©2018

[NRSNG Academy Lesson: Burn Injuries]
NRSNG, LLC - Reproduction Strictly Prohibited Disclaimer information at
NRSNG.com

[NRSNG Academy Lesson: Burn Injuries]

 Erikson’s Stages of Psychosocial
ERIKSON’S STAGES
Development
OF PSYCHOSOCIAL DEVELOPMENT

AGE STAGES CHARACTERISTICS

Development of trust based on

Infancy (birth to 18 months) Trust vs Mistrust
caregivers

Development of sense of
Early childhood (18 mo - 3yr) Autonomy vs Shame and Doubt personal control

Development of sense of
Preschool (3-5yr) Initiative vs Guilt purpose and directive

Development of pride in accom -

School age (6-11yr) Industry vs Inferiority plishments

Exploration of independence and

Adolescence (12-18yr) Identity vs Role Confusion development of self

Development of personal
Early adulthood (18-40yr) Intimacy vs Isolation relationships and love

Fulfilling goals and building

Adulthood (40-65yr) Generativity vs Stagnation career and family

Looking back on life with accep -

Older adult (65yr-death) Integrity vs Despair
tance

[NRSNG Academy Lesson: Theories of Growth and Development]

[NRSNG Academy Lesson: Theories of Growth and Development]

 Congenital Heart Defects
CONGENITAL HEART DEFECTS

CYANOSIS

NO YES

Vascularity Vascularity Vascularity Vascularity

Increased Normal Increased Decreased
• Aortic Stenosis • Transposition of the
• Pulmonic Stenosis Great Arteries (TGA)
L Atrium • Coarctation of the Aorta • Truncus Arteriosus Cardiac
Enlarged • TAPVC Enlargement
• Tricuspid Atresia
• Tingle Ventricle

YES NO
• Atrial Septal Defect
YES NO

• Ebstein’s Anomaly • Tetralogy

• Pulmonic Atresia of Fallot
• Tricuspid Atresia
Aorta
Enlarged

YES NO
• Patent Ductus • Ventricular Septal Defect
Arteriosus (PDA)

[NRSNG
NRSNG.com Academy
- “Tools andLesson: Congenital
Confidence Heart in
to Succeed Defects]
Nursing School.” ©2018
NRSNG, LLC - Reproduction Strictly Prohibited Disclaimer information at
NRSNG.com

[NRSNG Academy Lesson: Congenital Heart Defects]

 Crystalloid IV Solutions
CRYSTALLOID IV SOLUTIONS
Osmolality
IVF Content Tonicity Uses
(mOsm/L)
- 50 g/L glucose - treat hypernatremia, replace water loss
D5W - 170 Kcals/L Isotonic 252 - free water (helps renal excretion of solutes)
- no electrolytes - used to administer medications

- 100 g/L glucose

D10W - 340 Kcals/L Hypertonic 505 - free water only
- no electrolytes

- maintenance solution, but doesn’t

replace other daily electrolytes
- 0.45% saline
- free water and NaCl
½NS - 77 mMol/L of Na+ and Cl - Hypotonic 154
- replace hypotonic fluid loss
- no electrolytes - can cause IVF overload if
infused too rapidly

- used for postoperative fluids

- increase IVF and replace ECF
fluid losses
- 0.9% saline - NaCl in higher concentration
NS Isotonic 308 then blood levels
- 154 mMol/L of Na+ and Cl -
- no free water
- no calories
- can cause IVF overload
- only solution that can be
administered with blood products

- administer cautiously, slowly

- 3.0% saline treatment for symptomatic
3%NS Hypertonic 1026 hyponatremia
- 513 mMol/L of Na+ and Cl-
- cerebral edema

- 0.225% saline
- Provides NaCl and free water
- 50 g/L glucose
D5-¼NS Isotonic 330 - treatment of hypernatremia
- 170 kcals/L
- 38.5 mMol/L of Na+ and Cl - - replace hypotonic fluid loss

- maintenance solution, but doesn’t

- 0.45% saline replace other daily electrolytes
- 50 g/L glucose - free water and NaCl
D5-½NS - 170 kcals/L Hypertonic 406 - replace hypotonic fluid loss
- 77 mMol/L of Na+ and Cl - - can cause IVF overload if infused
too rapidly

- increase IVF and replace ECF

- 0.9% saline fluid losses
- used for postoperative fluids
- 50 g/L glucose
D5-NS Hypertonic 560 - NaCl in higher concentration
- 170 kcals/L then blood levels
- 154 mMol/L of Na+ and Cl - - no free water
- can cause IVF overload

[NRSNG Academy Lesson: Preparing an IV Infusion]

[NRSNG Academy Lesson: Preparing an IV Infusion]

 Drug Card
DRUG CARD

Generic Name Trade Name

Pharmacologic Class: ___________________________________________Therapeutic Class: ____________________________________________ _

Action: _______________________________________________________________________________________________________________________ _

Reason Given (Disease States): ________________________________________________________________________________________________ _

Nursing Process
Pre-Administration Assessment: Post Administration Evaluation: Nursing Considerations:

Other:________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

[NRSNG Academy Lesson: Essential NCLEX Meds by Class]

[NRSNG Academy Lesson: Essential NCLEX Meds by Class]

 Nervous System Pharmacology
NERVOUS SYSTEM PHARMACOLOGY

Nervous System

CNS PNS

Spinal Motor Sensory

Brain
Cord Neurons Neurons

Autonomic Somatic
Nervous System Nervous System

Sympathetic Parasympathetic
Nervous System Nervous System
(Adrenergic) (Cholinergic)
“Fight or Flight” “Rest and Digest”
Primarily Norepinephrine (Adrenaline) Primarily ACh
Alpha Receptors: vessels Muscarinic Receptors
Beta1-Receptors: heart Nicotinic Receptors
Beta2-Receptors: bronchial/vascular
smooth muscle
Dopaminergic: renal/mesenteric artery

MED CLASSES/EXAMPLE MEDS

ADRENERGIC AGONIST (SYMPATHOMIMETIC):
Mimics the effects of the SNS. (dobutamine,
dopamine, epinephrine, norepinephrine,
phenylephrine, albuterol, isoproterenol,
salmeterol).
CHOLINERGIC AGONISTS
(PARASYMPATHOMIMETIC): Mimic the effects
of the PNS. (donepezil, bethanechol,
pyridostigmine).

ADRENERGIC BLOCKING AGENTS ANTICHOLINERGIC AGENTS

(SYMPATHOLYTIC): Block the effects of the SNS. (PARASYMPATHOLYTIC): Block the effects
(beta-blockers, amiodarone, tamsulosin, doxazosin, of the PNS. (atropine, scopolamin, ipratropium,
phentola mine). trospium).

[NRSNG Academy Lesson: Autonomic Nervous System]

[NRSNG Academy Lesson: Autonomic Nervous System]

 Dopamine Vs Dobutamine
DOPAMINE VS DOBUTAMINE

DOPAMINE DOBUTAMINE
Vasopressor Inotrope Only
Action

Alpha 1 effects leading to Primarily exhibits Beta 1 effects

to aid in increasing CO
Effects Beta 1 effects leading to an
increase in HR at lower doses.
Increased perfusion to the
kidneys at <5 mcg/kg/min.

Effective to ↑ BP in distributive Generally given to ↑ CO. Used

shocks (septic, anaphylactic) as
Usage it will contribute to ↑ SVR
through vasoconstriction
in HF and Cardiogenic shock.
Drug of choice for ↑ CO as it does not
cause ↑ HR at lower doses leading to
less myocardial oxygen demand

Drug CO MAP PAOP SVR HR

**Dobutamine ↑ ↑ ↓ ↓ same or ↑
Dopamine ↑ ↑ ↑ ↑ ↑

↑ SVR ↓ CO
Phenylephrine

Vasopressin

Norepinephrine

Epinephrine

Dopamine

Dobutamine

↓ SVR ↑ CO

Check us out on YouTube View Jon's Books on Amazon.com

Find our Podcast on iTunes and Stitcher: Search "NRSNG"

[NRSNG Academy Lesson: Cardiogenic Shock]

[NRSNG Academy Lesson: Cardiogenic Shock]

 Beta Blockers
BETA BLOCKERS

Sympathetic Nervous System - "Fight or Flight"

o SNS stim ulates recep tors throug hout the body to create "fight or flight response"
o Recep tors
Alpha - ves sels
Beta 1 - Hea rt
Beta 2 - Lungs

Beta 1 Receptors
o When stim ulated by SNS they cause:
Increase Cardiac Output
Increase HR in SA node (Chronotropic effect)
Increase atrial contractility (Inotropic effect)
Increase conduction and autom aticity of AV node
Increase conduction and autom aticity of ventricles
Goal of Beta Blocker Therapy

o Goal is to block stim ulation of B1 receptors in heart = HR

Common B - Blockers

o Metoprolol
o Esm olol
o Propranolol

Side Effects of B -Blockers

o Bradycardia
o Blood Pres sure
o Bronchoconstriction
o Blood sug ar abnorm alities

[NRSNG Academy Lesson: Disease Specific Medications]

Common ICU Drips

[NRSNG Academy Lesson: Vasopressin]

 Medication Antidotes
MEDICATION ANTIDOTES

Med ication Antidote

Acetam inophen acetylcysteine, mucomyst
Anticholinesterase atropine, pralidoxine
Anticholinergics physos tigmine
Benzodiazepines Romazicon (flumaze nil)
Beta -Blockers glucago n, epinephrine
Ca Channel Blockers Ca Chloride, glucag on
Coumadin phy tonadione, vitam in K
Digo xin Digibind
Dopam ine Rigitine
Heroin Narcan (naloxone)
Heparin protamine sulfate
Iron d eferoxamine
Malignant Hyperthermia dantrolene
Methotrexate leucovorin calcium
Narcotics Narcan (nalxone)
Potassium Insulin, Bicarb, albut erol, Kayexa late
Tricyclic Antide pressants physos tigimine, Bicarb

[NRSNG Academy Lesson: 6 Rights of Medication Administration]

[NRSNG Academy Lesson: 6 Rights of Medication Administration]

 Insulin Cheat Sheet
INSULIN CHEAT SHEET
TYPE BRAND NAME GENERIC NAME ONSET PEAK DURATION
NovoLog Insulin aspart 15m 30-90m 3-5h
Rapid-Acting Apidra Insulin glulisine 15m 30-90m 3-5h
Humalog Insulin lispro 15m 30-90m 3-5h
Humulin R Regular 30-60m 2-4h 5-8h
Short-Acting
Novolin R Regular 30-60m 2-4h 5-8h

Intermediate Humulin N NPH 1-3h 8h 12-16h

Acting Novolin N NPH 1-3h 8h 12-16h
Humulin 70/30 70%NPH and 30% Reg 30-60m varies 10-16h
Pre- Mixed NPH
Novolin 70/30 70%NPH and 30% Reg 30-60m varies 10-16h
w/ Reg ular
Humulin 50/50 50%NPH and 50% Reg 30-60m varies 10-16h

MIXING INSULIN

REGULAR REGULAR
NPH

NPH

1) Withdraw enough air equal to the total amount of insulin.

2) Inject the air into the NPH without touching the insulin.
3) Inject remaining air into the regular insulin then withdraw
the regular dosage.
4) Withdraw the NPH dosage.

[NRSNG Academy Lesson: Diabetes Management]

[NRSNG Academy Lesson: Diabetes Management]

Common Antihypertensive Drugs

[NRSNG Academy Lesson: ACE Inhibitors]

Antidepressant Cheat Sheet

[NRSNG Academy Lesson: Antidepressants]

 Immunization Schedule
IMMUNIZATION SCHEDULE

BABY (months) CHILD (years)

BIRTH 1 2 4 6 12 15 18 19-23 2-3 4-6

HepB HepB HepB

RV RV RV

TDaP TDaP TDaP TDaP TDaP

Hib Hib Hib Hib

PCV PCV PCV PCV

IPV IPV IPV IPV

Anual Influenza (Yearly)

MMR MMR

Varicella Varicella

HepA (2-Dose series)

[NRSNG Academy Lesson: Rubeola – Measles]

[NRSNG Academy Lesson: Rubeola – Measles]

 Antibiotic Cheat Sheet
ANTIBIOTIC CHEAT SHEET
ANTIBIOTIC MOA
Inhibition of
Inhibition of Disruption of cell
cell wall synthesis
nucleic acid synthesis membrane function

Inhibition of Block pathways and

protein synthesis Cell wall Cell inhibit metabolism
membrane
DNA

Ribosome Folic acid

How and Where Various Antibiotics Work

Gram Negative Gram Positive

Outer membrane

Lipoproteins

Peptidoglycan

Periplasmic
space
Cutoplasmic
membrane

Lipopolysaccharides Porin Protein

Gram + Gram + and -

Penicillins Tetracyclines Sulfonamides
(Amoxicillin) (tetracycline, doxycycline) (TMP-SMZ)
Gram + (Strep, Syphillis) Broad spectrum (Gram +/-, atypicals) UTIs
Disrupts synth of peptidoglycan Inhibit protein synth Inhibit DNA synth

Macrolides Cephalosporins Carbapenems

(azythromycin, erythromycin) Disrupts synth of peptidoglycan (meropenem)
Gram + (URI’s, Strep, Staph) 1st gen: Gram + (Keflex) Broad spectrum
Inhibits protein synth 2nd gen: Gram - > Gram + (Cefzil) Disrupts synth of peptidoglycan
3rd gen: Gram - > Gram + Pseudomonas (cefdinir)
Lincosamides (clindamycin) 4th gen: Pseudomonas (Cefepime)
Step, Staph 5th gen: MRSA (Ceftobiprole)
Inhibit protein synth
Fluoroquinolones Metronidazole
(Ciprofloxacin, Levofloxacin) (Flagyl)
Gram - Broad spectrum Anaerobes, protozoa
Inhibit DNA synth Disrupts DNA
Aminoglycosides
(streptomycin, tobramycin, gentamicin)
Gram - Psuedomonas - TB
Inhibit protein synth

[NRSNG Academy Lesson: Penicillin and Cephlosporins]

[NRSNG Academy Lesson: Penicillin and Cephlosporins]

 Answering Pharmacology
Questions QUESTIONS
ANSWERING PHARMACOLOGY

12 Points to Answering Pharmacology Questions

1. Patient Safety
The NCLEX®is concerned about if you will be a SAFE nurse. Always think about what
option will lead to your patient being safe. You can automatically exclude options that
will put your patient in harm.

2. Focus on Side Effects

Learn the top 3 side effects with major medication classes. If you know the class and the
major side effects associated with that class you greatly increase your chances of
answering correctly.

3. ABCs
Airway, Breathing, Circulation. The ABCswill never go away. Focus on the nursing
process and the ABCswith each and every question including side effects.

4. Prefixes and Suffixes

Learn the most common prefixes and suffixes. This will cut down your total study time
tremendously.

5. Look for Patient Clues

Does the question provide information about the patients original diagnosis? Use
general clues in the question about the patients, their history, and their condition. These
clues will guide you to the medications they will be taking.

6. General Patient Reaction

Look for clues in the patients reactions. For example if the patient reports dizziness, this
is a clue that you should assess blood pressure. Use your assessment skills to answer
pharmacology questions.

7. Generic
Only generic names will be used on the actual NCLEX®. Although these names can be a
bit harder to pronounce, they will provide clues (prefix/suffix) into the type of
medication it is which will guide you in choosing the correct answer.

8. Random, Random, Random

Regardless of how much you study . . . you will get that insanely random medication
that no one has ever heard of. In this case just take a deep breath, relax, and use your
nursing judgment, critical thinking, and think Patient Safety.

[NRSNG Academy Lesson: 12 Points to Answering Pharmacology Questions]

[NRSNG Academy Lesson: 12 Points to Answering Pharmacology Questions]

 Answering
ANSWERING Pharmacology
PHARMACOLOGY QUESTIONS

Questions
9. Medical Diagnosis
Does the question identify a medical diagnosis? If you have a working medical
diagnosis, use your knowledge to determine what signs and symptoms the
patient will have, what medications they will require to manage those symptoms,
and what are the main side effects of those medications.

10. Freebies
If you are already familiar with the medication . . . simply use your knowledge,
the nursing process, and critical thinking to answer the question.

11. Med Classes

Learn to recognize common side effects with major medication classes and the
appropriate nursing intervention for each of these side effects.

12. Why is the Medication Given?

Why is the medication being given. Try to identify a relationship between the
medication and the patients diagnosis. If you have the underlying diagnosis you can
generally identify what medication will be given for that condition.

[NRSNG Academy Lesson: 12 Points to Answering Pharmacology Questions]

[NRSNG Academy Lesson: 12 Points to Answering Pharmacology Questions]

Therapeutic Drug LEVELS
THERAPEUTIC DRUG Levels

DRUG THERAPEUTIC LEVEL

Digoxin 0.8-2 ng/mL

Lithium 0.8-1.2 mEq/L

Theophylline 10-20 mcg/mL

Phenytoin 10-20 mcg/L

OTHERS

Vancomycin Trough 10-20 mcg/L

Salicylate 150-300 mg/L

Carbamazepine 5-12 mcg/L

Gentamicin 5-10 mcg/mL

Phenobarbital 10-40 mcg/mL

Procainamide 4-10 mcg/mL

Amitriptyline 120-150 ng/mL

[NRSNG Academy Lesson: Therapeutic Drug Levels]

[NRSNG Academy Lesson: Therapeutic Drug Levels]

 ANTIDYSRRHYTHMIC MEDS AND ACTION
Antidysrrhythmic Meds and Action
POTENTIAL CHART
Potential Chart
Antiarrhythmic Agents

K+/Cl- OUT Ca2+ IN

Class IV
Ca Channel Blocker
Verapamil
Diltiazem

1 2
K+ OUT

Class III

Na+ IN 0 Class II
3
K Channel Blocker
Amiodarone
Sotalol
Class I Beta Blocker
Na Channel Blocker
Propranolol
1a: Procainamide Metoprolol
1b: Lidocaine
1c: Proprafenone

4 4

This chart represents the cardiac action potential (first image) with the electrical conduction of the heart EKG.
The EKG is representative of what is occuring during each phase of the cardiac action potential.
Along the cardiac action potential you will see what is occuring with the ions.
Below the ion activity you will note what antiarrhythmic medications will have an effect during that phase of
the action potential.

[NRSNG Academy Lesson: Calcium Channel Blockers]

[NRSNG Academy Lesson: Calcium Channel Blockers]

Hierarchy of O2 Delivery Systems
HIERARCHY OF O2 DELIVERY SYSTEMS

METHOD
Nasal Cannula
1 lpm = 24% 4 lpm = 36% Terms to Know:
2 lpm = 28% 5 lpm = 40%
3 lpm = 32% 6 lpm = 44%
Pressure support:
Preset inspiratory support level. When the pt initiates
Simple Face Mask
a breath, this positive pressure flows to assist the pts
5 lpm = 40% 7 lpm = 50-55% spontaneous breaths.
6 lpm = 45-50% 8 lpm = 55-60% 2

PEEP (positive end-expiatory pressure):

Non-rebreather Mask Maintenance of pressure above atmospheric at end
6 lpm = 60% 9 lpm = 90% expiration.
7 lpm = 70% 10 lpm = close to 100%
8 lpm = 80% Auto-PEEP:
Trapping of gas in the lung caused by insufficient
Venturi Mask expiatory time (breath stacking). Increases risk of
4 lpm = 24-28% barotrauma.
8 lpm = 35-40%
12 lpm = 50% PIP (peak inspiratory pressure):
Airway pressure at the peak of inspiration.
Trach Collar
21-70% at 10L Tidal Volume (Vt):
The volume of air expired with each breath
T-Piece
21-100% with flow rate at 2.5 times minute ventilation Respiratory Rate (f):
The number of breaths per minute, may be greater
CPAP than preset frequency, but not less.
Positive airway pressure during spontaneous breaths
Minute ventilation (Ve):
Vt X f; volume of air expired per minute.
Bi-PAP
Positive pressure during spontaneous breaths and
PaCO2 (35-45 mm Hg):
preset pressure to be maintained during expiration
Amount of CO2 dissolved in arterial blood. Partial
pressure of arterial CO2.
SIMV
Preset Vt and f. Circuit remains open between SaO2 (95-100%):
mandatory breaths so pt can take additional breaths. Percentage of oxygenated hemoglobin in arterial
Ventilator doesn’t cycle during spontaneous breaths blood. Indirectly measured via SpO2 (pulse ox).
so Vt varies. Mandatory breaths synchronized so they
do not occur during spontaneous breaths.
PaO2 (80-100 mm Hg):
Amount of oxygen dissolved in blood plasma.
Bi-PAP
Preset Vt and f and inspiratory effort required to assist
spontaneous breaths. Delivers control breaths. Cycles
additionally if pt inspiratory effort is adequate.
Same Vt delivered for spontaneous breaths.

[NRSNG Academy Lesson: Hierarchy of O2 Delivery]

[NRSNG Academy Lesson: Hierarchy of O2 Delivery]

Lung Sounds

[NRSNG Academy Lesson: Lung Sounds]

 Gas Exchange
GAS EXCHANGE

By helix84 (en:Image:Alveoli.jpg) [GFDL (http://www.gnu.org/copyleft/fdl.html), CC-BY-SA-3.0

(http://creativecommons.org/licenses/by-sa/3.0/) or CC BY 2.5 (http://creativecommons.org/licenses/by/2.5)], via Wikimedia Commons

Gas exchange occurs in the alveoli - the functional unit of the lungs.
Deoxygenated blood enters the capillaries surrounding the alveoli, O2 enters the
bloodstream and CO2 exits into the alveoli to be exhaled.

Causes of Poor Gas Exchange Priority Interventions

Atelectasis Re-inflate alveoli
Hyper or Hypoventilation Treat cause to restore normal
Poor Airflow (airway swelling or breathing pattern
bronchoconstriction) Give meds to open airways
Pulmonary Edema Diuretics to decrease fluid in lungs
Pulmonary Embolism Thrombolytic or Thrombectomy
Vasoconstriction Vasodilators
Low blood volume Replace lost blood volume

[NRSNG Academy Lesson: Gas Exchange]

[NRSNG Academy Lesson: Gas Exchange]
Asthma Medications

[NRSNG Academy Lesson: Asthma]

 Artificial Airways Decision Tree
ARTIFICIAL AIRWAYS DECISION TREE

Use this decision tree to determine which of the four artificial airways
is most appropriate for your patient’s situation.

Conscious

Clears own Can’t clear own

secretions secretions

Apply oxygen Effective respiratory Ineffective

as needed effort respiratory effort

Nasopharyngeal Requires ventilation

Airway + Suction Endotracheal Tube

Unconscious

Respiratory effort,
No respiratory effort
unprotected airway

If head tilt, chin lift or No contraindication Tracheal obstruction

jaw thrust ineffective to intubation or damage

Oropharyngeal Airway
Endotracheal Tube Tracheotomy
+ Bag/Valve/Mask

[NRSNG Academy Lesson: Artificial Airways]

Ventilator Alarms

[NRSNG Academy Lesson: Vent Alarms]

 Chest Tube Management
CHEST TUBE MANAGEMENT
INDICATIONS FOR A CHEST TUBE:
Drain fluid, blood, or air
Pleural effusion
Hemothorax
Pneumothorax
Establish negative pressure
Facilitate lung expansion

By British Columbia Institute of Technology (BCIT). Download this book

for free at http://open.bccampus.ca -
https://opentextbc.ca/clinicalskills/chapter/10-7-chest-drainage-syst
ems/, CC BY-SA 4.0,
https://commons.wikimedia.org/w/index.php?curid=66770951

PRIORITY NURSING ASSESSMENTS (TWO AA’S)

Tidaling - fluid should fluctuate with respirations
Water seal - there should be sufficient water in the water seal chamber
Output - color, character, and quantity of output - measured hourly at first, then every 4-8 hours
per policy
Air leak - continuous bubbling in the water seal chamber indicates an air leak - this should be
troubleshooted immediately

Ability to breathe - always assess the patient’s lung sounds and respiratory effort
SpO2 - is the patient oxygenating?

SAFETY CONSIDERATIONS
Avoid dependent loops
Never strip or clamp tubing
Ensure collection chamber stays upright
Assess insertion site & dressing for bleeding or drainage
Accidental removal - cover with 3-sided occlusive dressing

[NRSNG Academy Lesson: Chest Tube Management]

[NRSNG Academy Lesson: Chest Tube Management]

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