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The Nursing Process
ADPIE
Assessment
Diagnosis
Planning
Implementation
Evaluation
2 mins
Respiratory Acidosis Assessment
Assessment
Decreased pH < 7.35
Increased PaCO2 > 45
Reduced Respirations
Anxiety
Change in LOC
Tachycardia
Cyanosis
Increased Electrolytes
ECG Changes
Muscle Weakness
Hyporeflexia
2 mins
Standard Precautions
Hand Hygiene
Wash In / Wash Out
Alcohol-Based Hand Rub
Hand Washing
Personal Protective Equipment (PPE)
Gown
Face Mask
Goggles/Face Shield
Gloves
Donning and Removing PPE
Discard Sharps in Puncture-Resistant Container
Cough Etiquette
2 mins
APGAR Score
1 and 5 Minutes
Appearance
Pulse
Grimace
Activity and Muscle Tone
Respiration
Total Scores
Gentle Stimulation
Oxygen
2 mins
Patient Position Overview
Position Techniques
Trochanter Roll
Trapeze Bar
Ankle-Foot Orthotic (AFO) Devices
Positions
Fowlers Position
Supine Position
Trendelenburg
Side-Lying Position
Prone Position
Sims' Position
Nursing Considerations
Reposition q2 Hours/Prevent Skin Breakdown
Confirm Body Alignment
2 mins
Beta Blockers
"-olol" suffix
Mechanism
Decreases Heart Rate and Contractility
Decreases Peripheral Vascular Resistance
Decreases Renin Release
Indications
Hypertension
Heart Failure
Angina Pectoris
Contraindications
Asthma and Heart Block Patients
Nursing Considerations
Assess Blood Pressure and Heart Rate
Masking Signs of Hypoglycemia
Do Not Stop Abruptly
2 mins
Digoxin (Lanoxin)
Mechanism of Action
Increases Inotropy
Indications
Heart Failure
Atrial Fibrillation
Side Effects
Bradycardia
Fatigue
Contraindications
Heart Block
Nursing Considerations
Heart Rate Below 60
Hypokalemia
Monitor for Toxicity and Visual Changes
Digibind
2 mins
Hydrochlorothiazide HCTZ
Mechanism of Action
Inhibits Reabsorption NaCl and H2O
Indications
Edema
Mild to Moderate Hypertension
Side Effects
Hypokalemia
Hyponatremia
Dehydration
Hyperglycemia
Gout
Contraindications
Sulfa Allergy
Pregnancy and Breastfeeding
1 min
Hyperkalemia
Assessment
> 5.0 mEq/L K+
Abdominal Cramps
Muscle Weakness
Diarrhea
Arrhythmia
Tall, Peaked T Waves
Interventions
IV Calcium
Infusion of Glucose and Insulin
Loop or Thiazide Diuretics
Kayexalate
Dialysis
Prevention Education
2 mins
Fluoxetine (Prozac)
Mechanism of Action
Inhibits Reuptake of Serotonin
Indications
Depression
Side Effects
Sexual Dysfunction
CNS Stimulation
Weight Changes
Serotonin Syndrome
Contraindications
No MAO-Is
No Anticoagulants / Antiplatelets
Considerations
Suicide Risk
Delayed Onset of Action
2 mins
Vancomycin
Mechanism of Action
Inhibits Bacterial Cell Wall Synthesis
Indications
Serious Gram-Positive Infections
Side Effects
Nephrotoxicity
Ototoxicity
Red Man Syndrome
Thrombophlebitis
Nursing Considerations
Culture Samples First
Infuse IV Over 60 Minutes
Take Around the Clock
2 mins
Hyperthyroidism Assessment
Assessment
Heat Intolerance
Exophthalmos
Warm, Moist Skin and Silky Hair
Tremors
Goiter
Diarrhea
Weight Loss
Tachycardia
Hypertension
Amenorrhea
Diagnosis
Decreased TSH with Elevated Free T4
Radioactive Iodine Uptake (RAIU)
2 mins
Diabetes Assessment
Assessment Type 1
Juvenile Onset
Absent Insulin Production
Ketosis Prone
Assessment Type 2
Adult Onset
Insulin Resistance
Obesity
Gestational Diabetes
Onset During Pregnancy
Glucose Intolerance
Complications
Retinopathy
Peripheral Vascular Disease
Nephropathy
Neuropathy
2 mins
Hypercalcemia
Assessment
> 10.5 mg/dL Ca2+
Pathologic Fractures
Lethargy
Hypercoagulation
Constipation
ECG Changes
QT Shortening
Interventions
No Calcium Intake
Chelating Drugs
Calcitonin
Bisphosphonates
Loop Diuretics instead of Thiazide Diuretics
Considerations
Increased Risk for Renal Calculi
Increase Fluids
3 mins
Left Heart Failure Assessment
Pulmonary Assessment
Pulmonary Congestion
Pink Frothy Sputum
Wheezing or Crackles
Dyspnea with Exertion
Cough
Systemic Assessment
Fatigue
Tachycardia
Weak Peripheral Pulse
S3, S4 Heart Sounds
1 min
Heart Failure Interventions
Diagnostic Tests
Echocardiogram
Invasive Hemodynamic Monitoring
Improve Gas Exchange
High Fowler's Position
Oxygen
Advanced Airway
Drugs and Devices
Diuretics
Beta Blockers
Angiotensin II Receptor Blockers (ARBs)
ACE Inhibitors
Digoxin (Lanoxin)
Pacemaker
2 mins
Fluoroquinolones
End in "-floxacin"
Mechanism of Action
Bactericidal
Indications
Variety of Infections
Side Effects
GI Distress
Photosensitivity
Achilles Tendon Rupture
Contraindications
Pregnancy
Children
Myasthenia Gravis
Considerations
Avoid Milk Products or Antacids
Slow IV Infusion
2 mins
Aminoglycoside Overview
End in "-mycin"
GNATS
Gentamicin
Neomycin
Amikacin
Tobramycin
Streptomycin
Mechanism of Action
Bactericidal
Indications
Severe Gram Negative Infections
Bowel Surgery Prep
1 min
Aminoglycoside Side Effects
Side Effects
Ototoxicity
Nephrotoxicity
Respiratory Paralysis
Contraindications
Pregnancy
Considerations
Peak and Trough
Never Mix with Penicillin in Same IV
2 mins
Atropine
Mechanism of Action
Muscarinic Antagonist
Indications
Bradycardia
Increased Exocrine Secretions
Smooth Muscle Spasms
Side Effects
Tachycardia
Dry Mouth
Urinary Retention
2 mins
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