Nursing Clinical Cheatsheet Cheatsheet

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Normal Lab Values Reference

CBC, BMP, LFT, Coags & More

Quick reference for commonly tested laboratory values. Values may vary slightly between laboratories — always reference the facility-specific reference range. Critical values are marked; these require immediate physician notification.

Complete Blood Count (CBC)

Test	Abbreviation	Normal Range	Critical Values	Nursing Action
Hemoglobin	Hb	Men: 13.5-17.5 g/dL; Women: 12-16 g/dL	H below 7 or above 20 g/dL	O2 therapy if low; assess for bleeding/anemia; transfusion if below 7
Hematocrit	Hct	Men: 41-53%; Women: 36-46%	Below 21% or above 60%	Volume replacement if low; phlebotomy if polycythemia
RBC Count	RBC	Men: 4.5-5.9 M/μL; Women: 4.1-5.1 M/μL	Below 2.5 or above 7 M/μL	Assess for anemia or polycythemia; check reticulocyte count
WBC Count	WBC	4,500-11,000/μL	Below 2,000 or above 30,000/μL	Low: infection risk (neutropenic precautions). High: infection, leukemia, inflammation
Platelet Count	PLT	150,000-400,000/μL	Below 50,000 or above 1,000,000/μL	Below 50K: bleeding precautions. Below 20K: strict precautions. Below 10K: platelet transfusion
MCV	MCV	80-100 fL	Below 70 or above 110 fL	Low = microcytic (iron deficiency, thalassemia). High = macrocytic (B12/folate deficiency)
MCHC	MCHC	32-36 g/dL	Below 28 or above 38 g/dL	Low = hypochromic. High = spherocytosis
Neutrophils	ANC	1,500-7,000/μL (40-70%)	Below 500/μL	Severe neutropenia = emergency; strict reverse isolation; no fresh produce
Lymphocytes	LYM	1,000-4,000/μL (20-40%)	Above 10,000/μL	High = viral infection, CLL. Low = HIV, immunosuppression
ESR	ESR	Men: 0-15 mm/hr; Women: 0-20 mm/hr	Above 100 mm/hr	Non-specific inflammation marker; rule out infection, autoimmune, malignancy

Basic Metabolic Panel (BMP)

Test	Normal Range	Critical Values	Clinical Significance
Sodium (Na)	136-145 mEq/L	Below 120 or above 160	Hyponatremia: confusion, seizures. Hypernatremia: dehydration, diabetes insipidus
Potassium (K)	3.5-5.0 mEq/L	Below 2.5 or above 6.5	HYPERKALEMIA IS LIFE-THREATENING — cardiac arrest risk. Check ECG. Hold K-sparing meds.
Chloride (Cl)	98-106 mEq/L	Below 80 or above 120	Elevated with dehydration, metabolic acidosis. Low with vomiting, diuretics
CO2 (Bicarbonate)	22-28 mEq/L	Below 10 or above 45	Low = metabolic acidosis. High = metabolic alkalosis (vomiting, diuretics)
BUN	7-20 mg/dL	Above 100	Elevated: dehydration, renal failure, GI bleed, high protein diet
Creatinine	0.6-1.3 mg/dL	Above 10	Gold standard for kidney function. Elevated: AKI, CKD. Compare with baseline.
Glucose (Fasting)	70-100 mg/dL	Below 40 or above 500	Below 40: hypoglycemia emergency. Above 126 (fasting): diabetes. Above 500: DKA/HHS risk.
Calcium (Ca)	8.5-10.5 mg/dL	Below 6.5 or above 13	Low: tetany, Chvostek/Trousseau signs. High: renal calculi, pancreatitis, confusion

Liver Function Tests (LFT)

Test	Normal Range	Elevated In	Notes
ALT (SGPT)	7-56 U/L	Hepatitis, liver damage, muscle injury	Most specific marker for hepatocellular damage
AST (SGOT)	10-40 U/L	Liver damage, muscle injury, MI, pancreatitis	Also found in heart, muscle, kidney — not liver-specific
Alkaline Phosphatase	44-147 U/L	Biliary obstruction, bone disease, pregnancy	Higher in children and growing adolescents
Total Bilirubin	0.3-1.2 mg/dL	Hemolysis, liver disease, biliary obstruction	Above 2: visible jaundice. Direct vs indirect fractionation needed
Albumin	3.5-5.0 g/dL	Malnutrition, liver disease, nephrotic syndrome, inflammation	Below 2.5: severe — poor surgical wound healing, ascites risk
PT/INR	PT: 11-13.5 sec; INR: 0.8-1.1	PT above 30 or INR above 5	Liver produces clotting factors; elevated PT = impaired liver synthetic function

Cardiac Markers & Lipid Panel

Test	Normal Range	Critical / Clinical Significance
Troponin I	Below 0.04 ng/mL	Above 0.04 = myocardial injury; serial testing q6h for 3 sets; MI rule-in/out
BNP / NT-proBNP	BNP below 100 pg/mL	Above 400: heart failure likely; above 900: severe HF; used for CHF diagnosis and monitoring
CK-MB	0-25 U/L	Elevated in MI (peaks 12-24 hrs); less specific than troponin; useful for reinfarction detection
Total Cholesterol	Below 200 mg/dL	200-239: borderline. Above 240: high risk; statin therapy consideration per ACC/AHA guidelines
LDL Cholesterol	Below 100 mg/dL (optimal)	Above 190: very high risk; target below 70 for established CVD or diabetes
HDL Cholesterol	Above 40 mg/dL (men); above 50 mg/dL (women)	Below 40 (men): increased CVD risk; HDL is protective — higher is better
Triglycerides	Below 150 mg/dL	Above 500: pancreatitis risk; above 200: high risk; fasting sample required

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Potassium (K+) Alert: Hyperkalemia (K above 6.5) is a medical emergency. Check for tall peaked T waves on ECG. Report immediately. Hold potassium supplements, potassium-sparing diuretics, and ACE inhibitors. Prepare for: calcium gluconate IV (stabilize cardiac membrane), insulin + glucose (shift K into cells), Kayexalate (bind GI K+), or dialysis.

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Drug Calculation Formulas

Dosage & Conversions

Accurate drug calculation is a critical nursing competency. Errors in dosage account for 20-30% of all medication errors. Always double-check calculations, verify with a colleague for high-risk medications, and use the 5 Rights: Right patient, Right drug, Right dose, Right route, Right time.

Formula	Equation	Example	Nursing Notes
Basic Dose Calculation	Dose = (Ordered Dose / On-Hand Dose) x Quantity	Ordered: 500mg Amoxicillin. Available: 250mg capsules. Dose = (500/250) x 1 = 2 capsules	Most fundamental formula; master this first
Weight-Based Dosing	Dose (mg) = Weight (kg) x Ordered Dose (mg/kg)	Child weighs 15 kg. Order: Ibuprofen 10 mg/kg. Dose = 15 x 10 = 150 mg	For pediatric dosing. Verify child weight within 24 hrs.
Body Surface Area	BSA (m²) = square root of [(Height cm x Weight kg) / 3600]	Child: 110 cm, 20 kg. BSA = sqrt[(110 x 20) / 3600] = sqrt(0.61) = 0.78 m²	Mosteller formula. Used for chemo, pediatric critical care drugs.
Reconstitution	Concentration = Total Powder (mg) / Diluent Volume (mL)	Add 5 mL to 500 mg vial: Conc = 500/5 = 100 mg/mL	Always verify total volume after adding diluent. Some powder adds to volume.
IV Infusion Rate (mL/hr)	Rate = (Total Volume in mL / Total Time in hours)	1000 mL NS over 8 hours: Rate = 1000/8 = 125 mL/hr	Always program pump; verify drip rate manually as backup.
IV Infusion Rate (gtt/min)	Rate (gtt/min) = (Volume mL x Drop Factor) / Time (min)	1000 mL over 8 hrs, drop factor 20: (1000 x 20) / (8 x 60) = 20000/480 = 41.7 = 42 gtt/min	Macro: 10-20 gtt/mL. Micro: 60 gtt/mL. Round to nearest whole drop.
mg/min to mL/hr	mL/hr = (Dose mg/min x 60 min/hr) / Concentration (mg/mL)	Dopamine 5 mcg/kg/min, 70 kg patient, 400mg in 250mL D5W: (5 x 70 x 60) / (400/250) = 21000/1.6 = 13.125 mL/hr	Critical for vasopressors and high-alert medications.

Common Conversions — Quick Reference

Weight1 kg = 2.2 lb | 1 lb = 0.45 kg | 1 oz = 28.35 g | 1 g = 1000 mg | 1 mg = 1000 mcg

Temperature°C = (°F - 32) x 5/9 | °F = (°C x 9/5) + 32 | Normal: 36.5-37.5°C (97.7-99.5°F)

Length1 inch = 2.54 cm | 1 foot = 30.48 cm | 1 meter = 39.37 inches

Household to Metric2.2 lb = 1 kg | 1 fl oz = 30 mL | 2.5 cm = 1 inch | 1 cup = 8 fl oz = 240 mL

Pediatric Dosing — Special Considerations

Rule	Formula	Example	Use
Clark's Rule	Child Dose = (Weight in lb / 150) x Adult Dose	Child: 44 lb. Adult: 500 mg. Child dose = (44/150) x 500 = 146.7 mg	For children over 2 years; based on weight
Young's Rule	Child Dose = [Age (yr) / (Age + 12)] x Adult Dose	Child: 4 years. Adult: 250 mg. Child dose = [4/(4+12)] x 250 = 62.5 mg	For children 1-12 years; based on age (less accurate)
Fried's Rule	Child Dose = [Age (mo) / 150] x Adult Dose	Infant: 10 months. Adult: 100 mg. Child dose = (10/150) x 100 = 6.67 mg	For infants under 1 year; based on age in months
BSA Method	Child Dose = (Child BSA / 1.73 m²) x Adult Dose	Child BSA = 0.78 m². Adult dose: 200 mg. Child dose = (0.78/1.73) x 200 = 90.2 mg	Most accurate; preferred for chemotherapy and critical drugs

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High-Alert Medications:Insulin, heparin, opioids, chemotherapy, potassium chloride (IV), digoxin, and neuromuscular blocking agents require independent double-check by two nurses. Always verify the 5 Rights. Never abbreviate "units" — write "units" in full (not "U" which can be misread as "0").

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IV Drip Rate Calculator

Infusion Math Made Easy

IV drip rate calculations are among the most tested nursing skills. Whether using manual drip tubing or infusion pumps, the nurse must verify the rate is correct to prevent fluid overload or under-resuscitation.

Scenario	Given	Formula Applied	Calculation	Answer
Macro Drip	1000 mL NS over 8 hrs; drop factor: 20 gtt/mL	(Volume x Drop Factor) / Time (min)	(1000 x 20) / (8 x 60) = 20000/480	42 gtt/min (round up)
Micro Drip	500 mL D5W over 6 hrs; drop factor: 60 gtt/mL	(Volume x Drop Factor) / Time (min)	(500 x 60) / (6 x 60) = 30000/360	83 gtt/min
mL/hr	1500 mL LR over 10 hrs	Volume / Time (hr)	1500 / 10	150 mL/hr
Infusion Time	1000 mL at 125 mL/hr	Volume / Rate (mL/hr)	1000 / 125	8 hours
Fluid Bolus	20 mL/kg bolus; patient 60 kg; over 1 hour	Weight x Volume/kg	60 x 20	1200 mL over 1 hr = 1200 mL/hr

Common Drop Factors

Tubing Type	Drop Factor	Use	Visual Clue
Macro Drip Set	10 gtt/mL	General IV fluids, blood products	Large drops; clear tubing
Macro Drip Set	15 gtt/mL	General IV fluids	Medium-large drops
Macro Drip Set	20 gtt/mL	General IV fluids (most common)	Standard hospital tubing
Micro Drip Set	60 gtt/mL	Pediatric, critical meds, precise control	Very fine drops; pediatric tubing; 60 drops = 1 mL
Blood Administration Set	10-20 gtt/mL	Blood transfusions only	Built-in filter; large-bore; special tubing

Vasopressor Drip Calculation (Dopamine Example)

Standard Mix400 mg Dopamine in 250 mL D5W = 1600 mcg/mL concentration

Order5 mcg/kg/min for 70 kg patient

mcg/min5 x 70 = 350 mcg/min

mL/hr(350 mcg/min x 60 min/hr) / 1600 mcg/mL = 21000/1600 = 13.1 mL/hr

TitrationAlways titrate in small increments (2-5 mcg/kg/min); reassess BP every 5-15 min; use infusion pump

Common IV Solutions & Uses

Solution	Composition	Indication	Precautions
0.9% NaCl (Normal Saline)	154 mEq/L Na, 154 mEq/L Cl; Isotonic	Fluid resuscitation, dehydration, blood product transfusion, medication diluent	Do NOT use for prolonged maintenance (hypernatremia risk); 3L/day max typically
0.45% NaCl (Half Normal)	77 mEq/L Na, 77 mEq/L Cl; Hypotonic	Hypernatremia, DKA fluid phase, maintenance in some protocols	Risk of cellular swelling; monitor for cerebral edema; do not use with increased ICP
Lactated Ringer's (LR)	Na 130, K 4, Ca 3, Cl 109, Lactate 28; Isotonic	Fluid resuscitation (preferred over NS), burns, surgery, DKA	Contains potassium — do not use with hyperkalemia. Do not mix with blood (calcium causes clotting).
D5W (5% Dextrose in Water)	50 g/L dextrose; Hypotonic (becomes isotonic as dextrose metabolizes)	Hypernatremia, NPO maintenance, medication diluent	Provides free water; NOT for volume resuscitation; spreads to ICF; check blood glucose
D5NS	Dextrose 50g/L + Normal Saline; Hypertonic	DKA treatment, hyponatremia, fluid deficit with hypernatremia	Monitor glucose closely; hypertonic — rapid fluid shift

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Pump Setting vs Manual Drip: Always use an infusion pump when available, especially for vasopressors, insulin, heparin, and pediatric infusions. If using manual drip, count drops for 1 full minute and verify rate. Recheck every 30-60 minutes. Gravity drip rates change with patient position, tubing kinks, and IV site swelling.

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Vital Signs Normal Ranges by Age

TPR, BP, SpO2 & Pain

Vital signs are the first indicators of patient deterioration. Knowing age-specific normal ranges and recognizing abnormalities early is a core nursing competency. Assess vital signs at minimum every 4 hours for stable patients and every 1-2 hours for unstable patients.

Age Group	Heart Rate (bpm)	Respiratory Rate (br/min)	Systolic BP (mmHg)	Temperature (°C / °F)	SpO2 (%)
Neonate (0-28 days)	120-160	30-60	60-80	36.5-37.5 / 97.7-99.5	95-100
Infant (1-12 mo)	100-150	25-40	70-100	36.5-37.5 / 97.7-99.5	95-100
Toddler (1-3 yr)	90-130	20-30	80-110	36.5-37.5 / 97.7-99.5	95-100
Preschool (4-5 yr)	80-120	18-25	80-110	36.5-37.5 / 97.7-99.5	95-100
School-Age (6-12 yr)	70-110	18-22	85-120	36.5-37.5 / 97.7-99.5	96-100
Adolescent (13-17 yr)	60-100	12-20	95-130	36.5-37.5 / 97.7-99.5	96-100
Adult (18-64 yr)	60-100	12-20	90-140 (120/80 ideal)	36.5-37.5 / 97.7-99.5	95-100
Elderly (65+ yr)	60-100 (may be lower)	12-20	90-140 (may be higher)	36.0-37.2 / 96.8-99.0 (lower baseline)	93-98

Pain Assessment Scales

Scale	Type	Population	How to Use	Score Interpretation
Numeric Rating Scale (NRS)	0-10 self-report	Adults (verbal, cognitively intact)	Ask: "On a scale of 0-10, what is your pain?" 0 = no pain, 10 = worst imaginable	1-3: Mild. 4-6: Moderate. 7-10: Severe. Treat at 4+ or per facility policy
Wong-Baker FACES	Faces with expressions	Children (3-7 years), cognitively impaired	Show 6 faces from smiling (0) to crying (10); patient points to their pain level	Same numeric interpretation; child-friendly visual representation
FLACC Scale	Behavioral observational	Pre-verbal children (0-7 years), cognitively impaired	Score 0-2 each on: Face, Legs, Activity, Cry, Consolability. Total 0-10	0-3: Mild. 4-6: Moderate. 7-10: Severe
CPOT (Critical-Care)	Behavioral + physiological	Intubated/sedated ICU patients	Score 0-2 each on: Facial expression, Body movements, Muscle tension, Compliance with ventilator	0-2: No/Minimal pain. 3-5: Moderate. 6-8: Severe
MOBID-2	Behavioral + body language	Advanced dementia, non-verbal	Observational: breathing, vocalization, facial expression, body language, protectiveness	Observational; requires training; validated for advanced dementia

Early Warning Signs — NEWS2 / qSOFA

NEWS2 Score 7+Urgent escalation: RR above 25, SpO2 below 92%, systolic BP below 90, HR above 130, temp above 38.3°C, altered consciousness. Call physician immediately.

qSOFA (Sepsis Screen)Any 2 of 3: RR 22+, Altered consciousness, Systolic BP 100 mmHg or below. Positive = high risk of poor outcome; initiate sepsis protocol.

Red Flags — PediatricRR above 60 (infant), HR above 200, SpO2 below 90%, capillary refill above 3 sec, sunken fontanelle, high-pitched cry, lethargy, poor feeding

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SBAR Communication:When reporting to a physician, use SBAR: Situation (what is happening now), Background (relevant history), Assessment (your clinical judgment), Recommendation (what you need). Example: "I am calling about Mrs. Sharma in room 4. She is 68, post-op day 1. Her BP has dropped from 130/80 to 88/54 in the last hour with HR 110. She appears pale and diaphoretic. I suspect bleeding. I recommend a stat Hb, type and cross, and IV fluid bolus."

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SAMPLE & OPQRST History

Patient Assessment Framework

SAMPLE and OPQRST are two standardized frameworks used by nurses and first responders to gather comprehensive patient history quickly and systematically. Mastering these ensures you never miss critical information during assessment.

Letter	Stands For	Questions to Ask	Why It Matters
S	Signs & Symptoms	What are you experiencing? What made you come in today? Any visible signs? (bleeding, swelling, rash, pallor)	Establishes chief complaint; objective signs + subjective symptoms
A	Allergies	Are you allergic to any medications, food, latex, or environmental substances? What reaction do you get?	Prevents anaphylaxis; guides medication choices; document prominently
M	Medications	What medications are you taking? Prescription, OTC, herbal, supplements. Dose? Frequency? Last taken?	Drug interactions, contraindications, adherence assessment; includes birth control
P	Past Medical History	Do you have any chronic conditions? Diabetes, HTN, heart disease, asthma, cancer? Previous surgeries? Hospitalizations?	Provides context for current presentation; reveals underlying conditions
L	Last Meal	When did you last eat or drink? What did you have?	Important for: surgery timing, aspiration risk, blood glucose assessment, food poisoning
E	Events Leading Up	What were you doing when this started? What happened right before? Any trauma, exertion, stress, illness?	Triggers, mechanism of injury, timeline of symptom onset and progression

Letter	Stands For	Questions to Ask	Red Flags to Note
O	Onset	When did the pain/symptom start? Sudden or gradual? What were you doing?	Sudden onset = possible MI, PE, rupture, dissection, hemorrhage
P	Provocation / Palliation	What makes it worse? What makes it better? Position, movement, food, medications, rest?	Pain with exertion = cardiac until proven otherwise. Relief with nitrates = supportive
Q	Quality	How would you describe the pain? Sharp, dull, aching, burning, stabbing, pressure, cramping, colicky?	Chest pressure/squeezing = MI. Tearing pain = dissection. Burning = GERD or neuropathy
R	Region / Radiation	Where exactly is the pain? Does it travel anywhere? Point with one finger.	Radiation to jaw/arm/back = cardiac. Radiation to back = AAA, pancreatitis. Migration = appendicitis
S	Severity	On a scale of 0-10, how bad is it? How does it affect your daily activities?	10/10 + diaphoresis + tachycardia = emergency. Pain score change = treatment efficacy
T	Time	Is the pain constant or intermittent? How long does each episode last? Getting better or worse?	Constant worsening = obstruction, infection, inflammation. Intermittent = colic, spasm, angina

Chest Pain — Rapid Differential Assessment

Cardiac (MI/ACS)Chest pressure/squeezing, radiation to L arm/jaw/back, diaphoresis, SOB, nausea. WORSE with exertion. Better with rest/nitroglycerin.

Pulmonary EmbolismSudden-onset pleuritic chest pain (sharp, worse with deep breath), SOB, tachycardia, hypoxia, recent DVT/surgery/immobility.

Aortic DissectionTearing/ripping pain radiating to back, BP difference between arms, unequal pulses, sudden onset, hypertensive history.

GERD / EsophagealBurning pain, worse after meals/lying down, sour taste, antacid relief, no radiation, no diaphoresis.

PneumothoraxSudden sharp pleuritic pain, absent breath sounds on one side, tracheal deviation (tension), SOB, trauma or spontaneous.

Panic AttackChest tightness, tingling, hyperventilation, sense of doom, normal ECG/troponin, history of anxiety.

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Documentation Tip:Always document the patient's exact words in quotes alongside your clinical interpretation. "Patient states: 'It feels like an elephant sitting on my chest.' Reports pain radiating to left arm. Rated 9/10." This protects you legally and provides accurate handoff communication.

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Cardiac Arrhythmia Quick ID

ECG Rhythm Recognition

Rapid ECG rhythm identification is a lifesaving nursing skill. This section provides a quick-reference guide to the most common arrhythmias: their ECG characteristics, clinical significance, and immediate nursing actions.

Rhythm	Rate	P Wave	PR Interval	QRS Width	Rhythm Regularity	Clinical Significance	Nursing Action
Normal Sinus Rhythm	60-100	Normal (upright, before each QRS)	0.12-0.20 sec	Narrow (<0.12 sec)	Regular	Normal cardiac rhythm	No intervention needed; baseline reference
Sinus Bradycardia	Below 60	Normal, before each QRS	0.12-0.20 sec	Narrow	Regular	Athletes (normal), hypothyroid, beta-blockers, increased ICP, MI	Monitor; atropine if symptomatic (HR below 50 with hypotension/dizziness)
Sinus Tachycardia	Above 100	Normal, before each QRS	0.12-0.20 sec	Narrow	Regular	Fever, pain, anxiety, dehydration, anemia, PE, HF, hyperthyroid	Treat underlying cause; beta-blocker if appropriate; IV fluids if dehydrated
Atrial Fibrillation	Variable (often HR 100-160+)	Absent — irregular fibrillatory baseline	Not measurable	Narrow	Irregularly Irregular	Stroke risk (CHADS2), HF, palpitations; most common sustained arrhythmia	Rate control (metoprolol/diltiazem); anticoagulation (heparin bridge to warfarin/DOAC); assess for emboli
Atrial Flutter	Atrial: 250-350; Ventricular: variable (depends on block)	Sawtooth flutter waves (F waves)	Variable	Narrow	Can be regular (fixed block) or irregular	Similar to A-fib: stroke risk, HF; often 2:1, 3:1, or 4:1 conduction	Rate control; anticoagulation; may need cardioversion; consider cardiology consult
SVT (PSVT)	150-250	Abnormal (may be buried in T wave)	Short or absent	Narrow	Regular	Sudden onset/offset; palpitations, anxiety, dizziness; often in young healthy adults	Vagal maneuvers (Valsalva, carotid massage); if unstable: sync cardioversion; if stable: adenosine 6mg rapid IV push
1st Degree AV Block	60-100 (or underlying rate)	Normal	PROLONGED: above 0.20 sec	Narrow	Regular	Usually benign; caused by beta-blockers, digoxin, aging, ischemic heart disease	Monitor; no treatment typically needed; hold rate-slowing drugs if progressive
2nd Degree Type I (Wenckebach)	Variable (gradually slows)	Normal, PR gradually lengthens	Progressively lengthening until beat dropped	Narrow	Irregular (grouped beating)	Usually benign; caused by increased vagal tone, medications, inferior MI	Monitor; usually self-resolving; hold digoxin/beta-blockers; atropine if symptomatic
2nd Degree Type II (Mobitz II)	Variable (often bradycardic)	Normal (constant PR for conducted beats)	Constant (normal or prolonged)	Narrow (may widen intermittently)	Irregular (unexpected dropped beats)	DANGEROUS — may progress to complete heart block; associated with anterior MI	Prepare for temporary pacing; do NOT give atropine (may worsen); stat cardiology consult
3rd Degree (Complete) AV Block	Atrial: 60-100; Ventricular: 20-40 (escape)	Present but NOT associated with QRS	Variable — no relationship	Wide (junctional or ventricular escape)	Regular (atria and ventricles independent)	EMERGENCY — no atrial-ventricular conduction; pump failure risk; syncope, Adams-Stokes	Temporary pacemaker STAT; atropine drip (may be ineffective); dopamine/epinephrine drip; prepare transvenous pacing
Ventricular Tachycardia (VT)	100-250	Absent	N/A	WIDE (>0.12 sec); bizarre morphology	Regular	LIFE-THREATENING — pulseless = immediate defibrillation; with pulse = cardioversion or amiodarone	Pulseless VT: Defibrillate immediately, CPR. With pulse: Amiodarone 150mg IV over 10 min; synchronized cardioversion
Ventricular Fibrillation (VF)	Chaotic, no discernible waves	Absent	N/A	Chaotic, irregular, no identifiable QRS	Chaotic, irregular	CARDIAC ARREST — no pulse, no BP, no consciousness	DEFIBRILLATE immediately (biphasic 120-200J); CPR between shocks; epinephrine 1mg q3-5min; amiodarone 300mg
PVC (Premature Ventricular Complex)	Underlying rate + premature beats	Absent before PVC	N/A	WIDE (>0.12 sec) with compensatory pause	Irregular (due to premature beats)	Isolated PVCs: usually benign. Frequent or multifocal: may indicate ischemia, hypokalemia, digoxin toxicity	Monitor; correct K+, Mg2+; hold digoxin if toxic; treat underlying cause; lidocaine if frequent/unifocal
Asystole	Flatline (0)	Absent	N/A	Flatline	Flatline	CONFIRMED DEATH RHYTHM — no electrical activity; check leads/pads first to rule out lead disconnect	Confirm true asystole (check in 2 leads). CPR + epinephrine 1mg q3-5min. DO NOT DEFIBRILLATE. Consider H's and T's reversible causes.

H's and T's — Reversible Causes of Cardiac Arrest (PULSE Check)

H: HypovolemiaGive IV fluid bolus; assess for bleeding; blood products if hemorrhage

H: HypoxiaEnsure airway; 100% O2; intubate if needed; check SpO2 and ETCO2

H: Hydrogen ion (acidosis)Sodium bicarbonate 1mEq/kg IV; correct underlying cause; check ABG

H: Hypo/HyperkalemiaTreat per protocol: calcium gluconate, insulin+glucose, bicarbonate, albuterol, Kayexalate

H: HypothermiaActive warming; blanket, warm IV fluids; target temp above 35°C

T: Tension PneumothoraxNeedle decompression (2nd intercostal space, MCL) followed by chest tube

T: Tamponade (Cardiac)Pericardiocentesis; IV fluids; bedside echo if available

T: ToxinsIdentify and reverse: naloxone for opioids, flumazenil for benzos, specific antidotes

T: Thrombosis (PE)Consider fibrinolytics if high suspicion; surgical embolectomy; anticoagulation

T: Thrombosis (MI)PCI or fibrinolytics; aspirin 300mg chewed; heparin; oxygen; nitroglycerin; morphine

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Rule of 300: To estimate heart rate from ECG: count the number of large boxes (0.2 sec each) between two R waves and divide 300 by that number. Example: 4 boxes between R waves = 300/4 = 75 bpm. For fast rhythms, count small boxes (0.04 sec each) and divide 1500 by that number.

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Nursing Care Plans Templates

NANDA, NIC, NOC Framework

Nursing care plans follow the nursing process: Assessment, Diagnosis (NANDA), Planning (outcomes/NOC), Implementation (interventions/NIC), and Evaluation. Below are templates for common nursing diagnoses that appear frequently in exams and clinical practice.

NANDA Diagnosis	Related To	Defining Characteristics	Expected Outcomes (NOC)	Nursing Interventions (NIC)	Evaluation Criteria
Ineffective Airway Clearance	Mucus secretion, bronchospasm, pain, decreased consciousness	Dyspnea, wheezing, productive cough, diminished breath sounds, SpO2 below 94%	Patient maintains patent airway; SpO2 above 95%; lungs clear to auscultation; effective cough	1) Assess respiratory status q2-4h. 2) Position HOB 30-45°. 3) Encourage deep breathing and coughing q2h. 4) Suction PRN. 5) Administer bronchodilators per order. 6) Hydration 2-3L/day (if not contraindicated)	SpO2 maintained above 95%; breath sounds clear; RR 12-20; no dyspnea; effective cough
Acute Pain	Tissue injury, inflammation, surgical incision, trauma	Verbal report of pain (4+ /10), facial grimacing, guarding, restlessness, elevated vital signs	Pain reduced to below 3/10; patient uses non-pharmacological relief methods; restful sleep	1) Assess pain q1-4h using NRS. 2) Administer analgesics per order. 3) Position for comfort. 4) Apply heat/cold as appropriate. 5) Teach relaxation techniques. 6) Evaluate effectiveness q30-60min post-medication	Pain at or below 3/10; vitals within normal limits; patient reports improved comfort; uses coping strategies
Risk for Infection	Compromised skin integrity, invasive lines, immunosuppression, surgery	Risk factors present (NO actual signs of infection yet)	Patient remains free from infection; WBC within normal limits; no fever; wound healing without signs of infection	1) Hand hygiene before/after patient contact. 2) Sterile technique for procedures. 3) Assess IV sites, wounds, incisions daily. 4) Monitor temp q4h. 5) Encourage nutrition and hydration. 6) Isolate if infectious. 7) Monitor WBC trends	Afebrile (below 38°C); WBC 4500-11000; wound clean and healing; no signs of infection at invasive sites
Impaired Gas Exchange	Alveolar-capillary membrane changes, mucus plug, PE, atelectasis	Hypoxemia (SpO2 below 92%), dyspnea, cyanosis, confusion, abnormal ABG	SpO2 maintained above 94%; ABG values within normal limits; no dyspnea at rest; clear lung sounds	1) Administer O2 per order. 2) Monitor SpO2 continuously. 3) Position HOB 30-45° (Fowler's). 4) Encourage deep breathing, incentive spirometry q1-2h. 5) Suction airway PRN. 6) ABG per protocol. 7) Monitor for respiratory fatigue	SpO2 above 94% on prescribed O2; PaO2 above 80 mmHg; PaCO2 35-45 mmHg; no cyanosis; RR 12-20
Fluid Volume Deficit	Vomiting, diarrhea, fever, hemorrhage, NPO status, diuretics	Dry mucous membranes, decreased urine output, tachycardia, hypotension, poor skin turgor, concentrated urine	Urine output above 30 mL/hr; BP stable; HR below 100; skin turgor normal; mucous membranes moist	1) Assess I&O strictly. 2) Weigh daily. 3) Monitor vital signs q2-4h. 4) Administer IV fluids per order. 5) Monitor electrolytes. 6) Assess skin turgor and mucous membranes. 7) Encourage oral fluids when permitted	UOP above 30 mL/hr; BP within 20 mmHg of baseline; HR 60-100; BUN/creatinine ratio normalizing; weight stable

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Care Plan Writing Tips:Nursing diagnoses must be based on assessment data — never write a diagnosis without supporting evidence. Interventions must be specific and actionable ("Turn patient q2h" not "Prevent pressure ulcers"). Goals must be measurable and time-bound ("Patient will ambulate 50 feet by Day 3"). Always individualize — avoid copy-paste care plans.

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AIIMS/PGI High-Yield Topics

Exam-Focused Nursing Topics

These topics are frequently tested in AIIMS, PGI Chandigarh, JIPMER, and other Indian nursing entrance exams. Focus areas are based on analysis of previous years' question papers and expert recommendations.

Subject	High-Yield Topic	Key Points to Remember	Common Question Types
Anatomy	Cranial Nerves	I: Olfactory, II: Optic, III: Oculomotor, IV: Trochlear, V: Trigeminal, VI: Abducens, VII: Facial, VIII: Vestibulocochlear, IX: Glossopharyngeal, X: Vagus, XI: Accessory, XII: Hypoglossal. Mnemonic: "Oh Oh Oh To Touch And Feel Very Good Velvet, AH!"	Which nerve affected by specific lesion? Extraocular eye movement deficits? Bell palsy (CN VII)?
Physiology	GFR & Renal	GFR = 125 mL/min; normal UO = 1-2 mL/kg/hr; nephron types (cortical 85%, juxtamedullary 15%); RAAS system; ADH mechanism; creatinine clearance = (140-age x weight) / (72 x Cr) x 0.85 if female	GFR calculation, renal clearance, ADH effect on urine, aldosterone mechanism
Pharmacology	Antibiotics	Penicillin: cell wall synthesis, PCN allergy. Cephalosporins: cross-reactivity with PCN 1-10%. Aminoglycosides: ototoxicity + nephrotoxicity. Macrolides: QT prolongation. Fluoroquinolones: tendon rupture, cartilage damage	Drug of choice for specific infection; adverse effects; mechanism of action
Medical-Surgical	Heart Failure	Left HF: pulmonary congestion (SOB, orthopnea, crackles, cough). Right HF: systemic congestion (JVD, peripheral edema, hepatomegaly, ascites). NYHA Class I-IV. Treatment: diuretics, ACE-I, beta-blockers, aldosterone antagonists	Differentiate left vs right HF; NYHA classification; medication management
Medical-Surgical	Diabetes Emergencies	DKA: high glucose, anion gap metabolic acidosis (AG above 12), K+ shifts (total body low, serum may be high initially), Kussmaul respirations. HHS: very high glucose (above 600), hyperosmolar, minimal ketosis, severe dehydration	DKA vs HHS differentiation; fluid resuscitation order; insulin dosing; potassium management
Obstetrics	Labor Stages	Stage 1: Dilation (Latent 0-6 cm; Active 6-10 cm). Stage 2: Expulsion (full dilation to delivery). Stage 3: Placental (delivery to placenta delivery). Stage 4: Recovery (first 1-2 hrs postpartum). Bishop Score for induction readiness.	Identify labor stage; Bishop score interpretation; when to notify provider
Pediatrics	IM Vaccination Schedule	Birth: BCG, OPV-0, Hep B-0. 6 wk: OPV-1, IPV-1, Pentavalent-1, Rotavirus-1. 10 wk: OPV-2, IPV-2, Pentavalent-2, Rotavirus-2. 14 wk: OPV-3, IPV-3, Pentavalent-3, Rotavirus-3. 9 mo: Measles-1, Vit A. 16-24 mo: DPT booster, OPV, Measles-2, Vit A.	Which vaccines at which age? Contraindications to vaccination? Cold chain maintenance?
Mental Health	Antipsychotic Side Effects	Extrapyramidal symptoms (EPS): dystonia (acute), akathisia, parkinsonism, tardive dyskinesia (irreversible). NMS: hyperthermia, muscle rigidity, altered consciousness — EMERGENCY. Treatment: benztropine (dystonia), propranolol (akathisia)	Identify EPS type; NMS recognition and management; anticholinergic effects
Community Health	National Health Programs	RNTCP (TB): DOTS strategy. NACP (HIV): free ART. RCH: maternal & child health. NPCDCS: NCD screening. NMQ: midday meal scheme. Poshan Abhiyaan: nutrition. Pulse Polio: OPV. National Iodine Deficiency Disorders program	Program objectives, target population, strategies, key indicators
Fundamentals	Sterilization & Asepsis	Autoclave: 121°C, 15 psi, 15-30 min. Dry heat: 160°C, 2 hrs. Chemical: glutaraldehyde 2%, 10 hrs. Disinfection vs Sterilization: disinfection reduces pathogens; sterilization eliminates ALL microorganisms	Identify correct method for equipment; parameters; storage of sterilized items

Exam Strategy — AIIMS/PGI Pattern Tips

AIIMS PatternSingle best response (multiple choice); 200 questions; 3.5 hrs; +1 correct, -1/3 wrong. Focus: conceptual understanding and clinical application.

PGI PatternMultiple true-false type; 5 options per question, mark true/false for each; no negative marking. Broad coverage required.

High-Yield ResourcesBrunner & Suddarth (Medical-Surgical), Pillitteri (Maternal-Child), Potter & Perry (Fundamentals), Park (Community Health), KPark (Microbiology)

Last Month StrategyPrevious year papers (10+ years); focus on repeatedly tested topics; practice time management; revise short notes daily

Common MistakesOverlooking "most appropriate" vs "first" vs "best" action; not reading full question stem; confusing similar-sounding drugs/conditions

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Mnemonic Collection: Remember these high-yield mnemonics for exams: RAPID for DKA management (Resuscitate, Assess, Potassium, Insulin, Determine cause); MONA for MI initial treatment (Morphine, Oxygen, Nitroglycerin, Aspirin — though current guidelines de-emphasize O2); FAST for stroke (Face drooping, Arm weakness, Speech difficulty, Time to call emergency).

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Test

Abbreviation

Normal Range

Critical Values

Nursing Action

Hemoglobin

Men: 13.5-17.5 g/dL; Women: 12-16 g/dL

H below 7 or above 20 g/dL

O2 therapy if low; assess for bleeding/anemia; transfusion if below 7

Hematocrit

Hct

Men: 41-53%; Women: 36-46%

Below 21% or above 60%

Volume replacement if low; phlebotomy if polycythemia

RBC Count

RBC

Men: 4.5-5.9 M/μL; Women: 4.1-5.1 M/μL

Below 2.5 or above 7 M/μL

Assess for anemia or polycythemia; check reticulocyte count

WBC Count

WBC

4,500-11,000/μL

Below 2,000 or above 30,000/μL

Low: infection risk (neutropenic precautions). High: infection, leukemia, inflammation

Platelet Count

PLT

150,000-400,000/μL

Below 50,000 or above 1,000,000/μL

Below 50K: bleeding precautions. Below 20K: strict precautions. Below 10K: platelet transfusion

MCV

80-100 fL

Below 70 or above 110 fL

Low = microcytic (iron deficiency, thalassemia). High = macrocytic (B12/folate deficiency)

MCHC

32-36 g/dL

Below 28 or above 38 g/dL

Low = hypochromic. High = spherocytosis

Neutrophils

ANC

1,500-7,000/μL (40-70%)

Below 500/μL

Severe neutropenia = emergency; strict reverse isolation; no fresh produce

Lymphocytes

LYM

1,000-4,000/μL (20-40%)

Above 10,000/μL

High = viral infection, CLL. Low = HIV, immunosuppression

ESR

Men: 0-15 mm/hr; Women: 0-20 mm/hr

Above 100 mm/hr

Non-specific inflammation marker; rule out infection, autoimmune, malignancy

Test

Normal Range

Critical Values

Clinical Significance

Sodium (Na)

136-145 mEq/L

Below 120 or above 160

Hyponatremia: confusion, seizures. Hypernatremia: dehydration, diabetes insipidus

Potassium (K)

3.5-5.0 mEq/L

Below 2.5 or above 6.5

HYPERKALEMIA IS LIFE-THREATENING — cardiac arrest risk. Check ECG. Hold K-sparing meds.

Chloride (Cl)

98-106 mEq/L

Below 80 or above 120

Elevated with dehydration, metabolic acidosis. Low with vomiting, diuretics

CO2 (Bicarbonate)

22-28 mEq/L

Below 10 or above 45

Low = metabolic acidosis. High = metabolic alkalosis (vomiting, diuretics)

BUN

7-20 mg/dL

Above 100

Elevated: dehydration, renal failure, GI bleed, high protein diet

Creatinine

0.6-1.3 mg/dL

Above 10

Gold standard for kidney function. Elevated: AKI, CKD. Compare with baseline.

Glucose (Fasting)

70-100 mg/dL

Below 40 or above 500

Below 40: hypoglycemia emergency. Above 126 (fasting): diabetes. Above 500: DKA/HHS risk.

Calcium (Ca)

8.5-10.5 mg/dL

Below 6.5 or above 13

Low: tetany, Chvostek/Trousseau signs. High: renal calculi, pancreatitis, confusion

Test

Normal Range

Elevated In

Notes

ALT (SGPT)

7-56 U/L

Hepatitis, liver damage, muscle injury

Most specific marker for hepatocellular damage

AST (SGOT)

10-40 U/L

Liver damage, muscle injury, MI, pancreatitis

Also found in heart, muscle, kidney — not liver-specific

Alkaline Phosphatase

44-147 U/L

Biliary obstruction, bone disease, pregnancy

Higher in children and growing adolescents

Total Bilirubin

0.3-1.2 mg/dL

Hemolysis, liver disease, biliary obstruction

Above 2: visible jaundice. Direct vs indirect fractionation needed

Albumin

3.5-5.0 g/dL

Malnutrition, liver disease, nephrotic syndrome, inflammation

Below 2.5: severe — poor surgical wound healing, ascites risk

PT/INR

PT: 11-13.5 sec; INR: 0.8-1.1

PT above 30 or INR above 5

Liver produces clotting factors; elevated PT = impaired liver synthetic function

Test

Normal Range

Critical / Clinical Significance

Troponin I

Below 0.04 ng/mL

Above 0.04 = myocardial injury; serial testing q6h for 3 sets; MI rule-in/out

BNP / NT-proBNP

BNP below 100 pg/mL

Above 400: heart failure likely; above 900: severe HF; used for CHF diagnosis and monitoring

CK-MB

0-25 U/L

Elevated in MI (peaks 12-24 hrs); less specific than troponin; useful for reinfarction detection

Total Cholesterol

Below 200 mg/dL

200-239: borderline. Above 240: high risk; statin therapy consideration per ACC/AHA guidelines

LDL Cholesterol

Below 100 mg/dL (optimal)

Above 190: very high risk; target below 70 for established CVD or diabetes

HDL Cholesterol

Above 40 mg/dL (men); above 50 mg/dL (women)

Below 40 (men): increased CVD risk; HDL is protective — higher is better

Triglycerides

Below 150 mg/dL

Above 500: pancreatitis risk; above 200: high risk; fasting sample required

Formula

Equation

Example

Nursing Notes

Basic Dose Calculation

Dose = (Ordered Dose / On-Hand Dose) x Quantity

Ordered: 500mg Amoxicillin. Available: 250mg capsules. Dose = (500/250) x 1 = 2 capsules

Most fundamental formula; master this first

Weight-Based Dosing

Dose (mg) = Weight (kg) x Ordered Dose (mg/kg)

Child weighs 15 kg. Order: Ibuprofen 10 mg/kg. Dose = 15 x 10 = 150 mg

For pediatric dosing. Verify child weight within 24 hrs.

Body Surface Area

BSA (m²) = square root of [(Height cm x Weight kg) / 3600]

Child: 110 cm, 20 kg. BSA = sqrt[(110 x 20) / 3600] = sqrt(0.61) = 0.78 m²

Mosteller formula. Used for chemo, pediatric critical care drugs.

Reconstitution

Concentration = Total Powder (mg) / Diluent Volume (mL)

Add 5 mL to 500 mg vial: Conc = 500/5 = 100 mg/mL

Always verify total volume after adding diluent. Some powder adds to volume.

IV Infusion Rate (mL/hr)

Rate = (Total Volume in mL / Total Time in hours)

1000 mL NS over 8 hours: Rate = 1000/8 = 125 mL/hr

Always program pump; verify drip rate manually as backup.

IV Infusion Rate (gtt/min)

Rate (gtt/min) = (Volume mL x Drop Factor) / Time (min)

1000 mL over 8 hrs, drop factor 20: (1000 x 20) / (8 x 60) = 20000/480 = 41.7 = 42 gtt/min

Macro: 10-20 gtt/mL. Micro: 60 gtt/mL. Round to nearest whole drop.

mg/min to mL/hr

mL/hr = (Dose mg/min x 60 min/hr) / Concentration (mg/mL)

Dopamine 5 mcg/kg/min, 70 kg patient, 400mg in 250mL D5W: (5 x 70 x 60) / (400/250) = 21000/1.6 = 13.125 mL/hr

Critical for vasopressors and high-alert medications.

Rule

Formula

Example

Use

Clark's Rule

Child Dose = (Weight in lb / 150) x Adult Dose

Child: 44 lb. Adult: 500 mg. Child dose = (44/150) x 500 = 146.7 mg

For children over 2 years; based on weight

Young's Rule

Child Dose = [Age (yr) / (Age + 12)] x Adult Dose

Child: 4 years. Adult: 250 mg. Child dose = [4/(4+12)] x 250 = 62.5 mg

For children 1-12 years; based on age (less accurate)

Fried's Rule

Child Dose = [Age (mo) / 150] x Adult Dose

Infant: 10 months. Adult: 100 mg. Child dose = (10/150) x 100 = 6.67 mg

For infants under 1 year; based on age in months

BSA Method

Child Dose = (Child BSA / 1.73 m²) x Adult Dose

Child BSA = 0.78 m². Adult dose: 200 mg. Child dose = (0.78/1.73) x 200 = 90.2 mg

Most accurate; preferred for chemotherapy and critical drugs

Scenario

Given

Formula Applied

Calculation

Answer

Macro Drip

1000 mL NS over 8 hrs; drop factor: 20 gtt/mL

(Volume x Drop Factor) / Time (min)

(1000 x 20) / (8 x 60) = 20000/480

42 gtt/min (round up)

Micro Drip

500 mL D5W over 6 hrs; drop factor: 60 gtt/mL

(Volume x Drop Factor) / Time (min)

(500 x 60) / (6 x 60) = 30000/360

83 gtt/min

mL/hr

1500 mL LR over 10 hrs

Volume / Time (hr)

1500 / 10

150 mL/hr

Infusion Time

1000 mL at 125 mL/hr

Volume / Rate (mL/hr)

1000 / 125

8 hours

Fluid Bolus

20 mL/kg bolus; patient 60 kg; over 1 hour

Weight x Volume/kg

60 x 20

1200 mL over 1 hr = 1200 mL/hr

Tubing Type

Drop Factor

Use

Visual Clue

Macro Drip Set

10 gtt/mL

General IV fluids, blood products

Large drops; clear tubing

Macro Drip Set

15 gtt/mL

General IV fluids

Medium-large drops

Macro Drip Set

20 gtt/mL

General IV fluids (most common)

Standard hospital tubing

Micro Drip Set

60 gtt/mL

Pediatric, critical meds, precise control

Very fine drops; pediatric tubing; 60 drops = 1 mL

Blood Administration Set

10-20 gtt/mL

Blood transfusions only

Built-in filter; large-bore; special tubing

Solution

Composition

Indication

Precautions

0.9% NaCl (Normal Saline)

154 mEq/L Na, 154 mEq/L Cl; Isotonic

Fluid resuscitation, dehydration, blood product transfusion, medication diluent

Do NOT use for prolonged maintenance (hypernatremia risk); 3L/day max typically

0.45% NaCl (Half Normal)

77 mEq/L Na, 77 mEq/L Cl; Hypotonic

Hypernatremia, DKA fluid phase, maintenance in some protocols

Risk of cellular swelling; monitor for cerebral edema; do not use with increased ICP

Lactated Ringer's (LR)

Na 130, K 4, Ca 3, Cl 109, Lactate 28; Isotonic

Fluid resuscitation (preferred over NS), burns, surgery, DKA

Contains potassium — do not use with hyperkalemia. Do not mix with blood (calcium causes clotting).

D5W (5% Dextrose in Water)

50 g/L dextrose; Hypotonic (becomes isotonic as dextrose metabolizes)

Hypernatremia, NPO maintenance, medication diluent

Provides free water; NOT for volume resuscitation; spreads to ICF; check blood glucose

D5NS

Dextrose 50g/L + Normal Saline; Hypertonic

DKA treatment, hyponatremia, fluid deficit with hypernatremia

Monitor glucose closely; hypertonic — rapid fluid shift

Age Group

Heart Rate (bpm)

Respiratory Rate (br/min)

Systolic BP (mmHg)

Temperature (°C / °F)

SpO2 (%)

Neonate (0-28 days)

120-160

30-60

60-80

36.5-37.5 / 97.7-99.5

95-100

Infant (1-12 mo)

100-150

25-40

70-100

36.5-37.5 / 97.7-99.5

95-100

Toddler (1-3 yr)

90-130

20-30

80-110

36.5-37.5 / 97.7-99.5

95-100

Preschool (4-5 yr)

80-120

18-25

80-110

36.5-37.5 / 97.7-99.5

95-100

School-Age (6-12 yr)

70-110

18-22

85-120

36.5-37.5 / 97.7-99.5

96-100

Adolescent (13-17 yr)

60-100

12-20

95-130

36.5-37.5 / 97.7-99.5

96-100

Adult (18-64 yr)

60-100

12-20

90-140 (120/80 ideal)

36.5-37.5 / 97.7-99.5

95-100

Elderly (65+ yr)

60-100 (may be lower)

12-20

90-140 (may be higher)

36.0-37.2 / 96.8-99.0 (lower baseline)

93-98

Scale

Type

Population

How to Use

Score Interpretation

Numeric Rating Scale (NRS)

0-10 self-report

Adults (verbal, cognitively intact)

Ask: "On a scale of 0-10, what is your pain?" 0 = no pain, 10 = worst imaginable

1-3: Mild. 4-6: Moderate. 7-10: Severe. Treat at 4+ or per facility policy

Wong-Baker FACES

Faces with expressions

Children (3-7 years), cognitively impaired

Show 6 faces from smiling (0) to crying (10); patient points to their pain level

Same numeric interpretation; child-friendly visual representation

FLACC Scale

Behavioral observational

Pre-verbal children (0-7 years), cognitively impaired

Score 0-2 each on: Face, Legs, Activity, Cry, Consolability. Total 0-10

0-3: Mild. 4-6: Moderate. 7-10: Severe

CPOT (Critical-Care)

Behavioral + physiological

Intubated/sedated ICU patients

Score 0-2 each on: Facial expression, Body movements, Muscle tension, Compliance with ventilator

0-2: No/Minimal pain. 3-5: Moderate. 6-8: Severe

MOBID-2

Behavioral + body language

Advanced dementia, non-verbal

Observational: breathing, vocalization, facial expression, body language, protectiveness

Observational; requires training; validated for advanced dementia

Letter

Stands For

Questions to Ask

Why It Matters

Signs & Symptoms

What are you experiencing? What made you come in today? Any visible signs? (bleeding, swelling, rash, pallor)

Establishes chief complaint; objective signs + subjective symptoms

Allergies

Are you allergic to any medications, food, latex, or environmental substances? What reaction do you get?

Prevents anaphylaxis; guides medication choices; document prominently

Medications

What medications are you taking? Prescription, OTC, herbal, supplements. Dose? Frequency? Last taken?

Drug interactions, contraindications, adherence assessment; includes birth control

Past Medical History

Do you have any chronic conditions? Diabetes, HTN, heart disease, asthma, cancer? Previous surgeries? Hospitalizations?

Provides context for current presentation; reveals underlying conditions

Last Meal

When did you last eat or drink? What did you have?

Important for: surgery timing, aspiration risk, blood glucose assessment, food poisoning

Events Leading Up

What were you doing when this started? What happened right before? Any trauma, exertion, stress, illness?

Triggers, mechanism of injury, timeline of symptom onset and progression

Letter

Stands For

Questions to Ask

Red Flags to Note

Onset

When did the pain/symptom start? Sudden or gradual? What were you doing?

Sudden onset = possible MI, PE, rupture, dissection, hemorrhage

Provocation / Palliation

What makes it worse? What makes it better? Position, movement, food, medications, rest?

Pain with exertion = cardiac until proven otherwise. Relief with nitrates = supportive

Quality

How would you describe the pain? Sharp, dull, aching, burning, stabbing, pressure, cramping, colicky?

Chest pressure/squeezing = MI. Tearing pain = dissection. Burning = GERD or neuropathy

Region / Radiation

Where exactly is the pain? Does it travel anywhere? Point with one finger.

Radiation to jaw/arm/back = cardiac. Radiation to back = AAA, pancreatitis. Migration = appendicitis

Severity

On a scale of 0-10, how bad is it? How does it affect your daily activities?

10/10 + diaphoresis + tachycardia = emergency. Pain score change = treatment efficacy

Time

Is the pain constant or intermittent? How long does each episode last? Getting better or worse?

Constant worsening = obstruction, infection, inflammation. Intermittent = colic, spasm, angina

Rhythm

Rate

P Wave

PR Interval

QRS Width

Rhythm Regularity

Clinical Significance

Nursing Action

Normal Sinus Rhythm

60-100

Normal (upright, before each QRS)

0.12-0.20 sec

Narrow (<0.12 sec)

Regular

Normal cardiac rhythm

No intervention needed; baseline reference

Sinus Bradycardia

Below 60

Normal, before each QRS

0.12-0.20 sec

Narrow

Regular

Athletes (normal), hypothyroid, beta-blockers, increased ICP, MI

Monitor; atropine if symptomatic (HR below 50 with hypotension/dizziness)

Sinus Tachycardia

Above 100

Normal, before each QRS

0.12-0.20 sec

Narrow

Regular

Fever, pain, anxiety, dehydration, anemia, PE, HF, hyperthyroid

Treat underlying cause; beta-blocker if appropriate; IV fluids if dehydrated

Atrial Fibrillation

Variable (often HR 100-160+)

Absent — irregular fibrillatory baseline

Not measurable

Narrow

Irregularly Irregular

Stroke risk (CHADS2), HF, palpitations; most common sustained arrhythmia

Rate control (metoprolol/diltiazem); anticoagulation (heparin bridge to warfarin/DOAC); assess for emboli

Atrial Flutter

Atrial: 250-350; Ventricular: variable (depends on block)

Sawtooth flutter waves (F waves)

Variable

Narrow

Can be regular (fixed block) or irregular

Similar to A-fib: stroke risk, HF; often 2:1, 3:1, or 4:1 conduction

Rate control; anticoagulation; may need cardioversion; consider cardiology consult

SVT (PSVT)

150-250

Abnormal (may be buried in T wave)

Short or absent

Narrow

Regular

Sudden onset/offset; palpitations, anxiety, dizziness; often in young healthy adults

Vagal maneuvers (Valsalva, carotid massage); if unstable: sync cardioversion; if stable: adenosine 6mg rapid IV push

1st Degree AV Block

60-100 (or underlying rate)

Normal

PROLONGED: above 0.20 sec

Narrow

Regular

Usually benign; caused by beta-blockers, digoxin, aging, ischemic heart disease

Monitor; no treatment typically needed; hold rate-slowing drugs if progressive

2nd Degree Type I (Wenckebach)

Variable (gradually slows)

Normal, PR gradually lengthens

Progressively lengthening until beat dropped

Narrow

Irregular (grouped beating)

Usually benign; caused by increased vagal tone, medications, inferior MI

Monitor; usually self-resolving; hold digoxin/beta-blockers; atropine if symptomatic

2nd Degree Type II (Mobitz II)

Variable (often bradycardic)

Normal (constant PR for conducted beats)

Constant (normal or prolonged)

Narrow (may widen intermittently)

Irregular (unexpected dropped beats)

DANGEROUS — may progress to complete heart block; associated with anterior MI

Prepare for temporary pacing; do NOT give atropine (may worsen); stat cardiology consult

3rd Degree (Complete) AV Block

Atrial: 60-100; Ventricular: 20-40 (escape)

Present but NOT associated with QRS

Variable — no relationship

Wide (junctional or ventricular escape)

Regular (atria and ventricles independent)

EMERGENCY — no atrial-ventricular conduction; pump failure risk; syncope, Adams-Stokes

Temporary pacemaker STAT; atropine drip (may be ineffective); dopamine/epinephrine drip; prepare transvenous pacing

Ventricular Tachycardia (VT)

100-250

Absent

N/A

WIDE (>0.12 sec); bizarre morphology

Regular

LIFE-THREATENING — pulseless = immediate defibrillation; with pulse = cardioversion or amiodarone

Pulseless VT: Defibrillate immediately, CPR. With pulse: Amiodarone 150mg IV over 10 min; synchronized cardioversion

Ventricular Fibrillation (VF)

Chaotic, no discernible waves

Absent

N/A

Chaotic, irregular, no identifiable QRS

Chaotic, irregular

CARDIAC ARREST — no pulse, no BP, no consciousness

DEFIBRILLATE immediately (biphasic 120-200J); CPR between shocks; epinephrine 1mg q3-5min; amiodarone 300mg

PVC (Premature Ventricular Complex)

Underlying rate + premature beats

Absent before PVC

N/A

WIDE (>0.12 sec) with compensatory pause

Irregular (due to premature beats)

Isolated PVCs: usually benign. Frequent or multifocal: may indicate ischemia, hypokalemia, digoxin toxicity

Monitor; correct K+, Mg2+; hold digoxin if toxic; treat underlying cause; lidocaine if frequent/unifocal

Asystole

Flatline (0)

Absent

N/A

Flatline

CONFIRMED DEATH RHYTHM — no electrical activity; check leads/pads first to rule out lead disconnect

Confirm true asystole (check in 2 leads). CPR + epinephrine 1mg q3-5min. DO NOT DEFIBRILLATE. Consider H's and T's reversible causes.

NANDA Diagnosis

Related To

Defining Characteristics

Expected Outcomes (NOC)

Nursing Interventions (NIC)

Evaluation Criteria

Ineffective Airway Clearance

Mucus secretion, bronchospasm, pain, decreased consciousness

Dyspnea, wheezing, productive cough, diminished breath sounds, SpO2 below 94%

Patient maintains patent airway; SpO2 above 95%; lungs clear to auscultation; effective cough

1) Assess respiratory status q2-4h. 2) Position HOB 30-45°. 3) Encourage deep breathing and coughing q2h. 4) Suction PRN. 5) Administer bronchodilators per order. 6) Hydration 2-3L/day (if not contraindicated)

SpO2 maintained above 95%; breath sounds clear; RR 12-20; no dyspnea; effective cough

Acute Pain

Tissue injury, inflammation, surgical incision, trauma

Verbal report of pain (4+ /10), facial grimacing, guarding, restlessness, elevated vital signs

Pain reduced to below 3/10; patient uses non-pharmacological relief methods; restful sleep

1) Assess pain q1-4h using NRS. 2) Administer analgesics per order. 3) Position for comfort. 4) Apply heat/cold as appropriate. 5) Teach relaxation techniques. 6) Evaluate effectiveness q30-60min post-medication

Pain at or below 3/10; vitals within normal limits; patient reports improved comfort; uses coping strategies

Risk for Infection

Compromised skin integrity, invasive lines, immunosuppression, surgery

Risk factors present (NO actual signs of infection yet)

Patient remains free from infection; WBC within normal limits; no fever; wound healing without signs of infection

1) Hand hygiene before/after patient contact. 2) Sterile technique for procedures. 3) Assess IV sites, wounds, incisions daily. 4) Monitor temp q4h. 5) Encourage nutrition and hydration. 6) Isolate if infectious. 7) Monitor WBC trends

Afebrile (below 38°C); WBC 4500-11000; wound clean and healing; no signs of infection at invasive sites

Impaired Gas Exchange

Alveolar-capillary membrane changes, mucus plug, PE, atelectasis

Hypoxemia (SpO2 below 92%), dyspnea, cyanosis, confusion, abnormal ABG

SpO2 maintained above 94%; ABG values within normal limits; no dyspnea at rest; clear lung sounds

1) Administer O2 per order. 2) Monitor SpO2 continuously. 3) Position HOB 30-45° (Fowler's). 4) Encourage deep breathing, incentive spirometry q1-2h. 5) Suction airway PRN. 6) ABG per protocol. 7) Monitor for respiratory fatigue

SpO2 above 94% on prescribed O2; PaO2 above 80 mmHg; PaCO2 35-45 mmHg; no cyanosis; RR 12-20

Fluid Volume Deficit

Vomiting, diarrhea, fever, hemorrhage, NPO status, diuretics

Dry mucous membranes, decreased urine output, tachycardia, hypotension, poor skin turgor, concentrated urine

Urine output above 30 mL/hr; BP stable; HR below 100; skin turgor normal; mucous membranes moist

1) Assess I&O strictly. 2) Weigh daily. 3) Monitor vital signs q2-4h. 4) Administer IV fluids per order. 5) Monitor electrolytes. 6) Assess skin turgor and mucous membranes. 7) Encourage oral fluids when permitted

UOP above 30 mL/hr; BP within 20 mmHg of baseline; HR 60-100; BUN/creatinine ratio normalizing; weight stable

Subject

High-Yield Topic

Key Points to Remember

Common Question Types

Anatomy

Cranial Nerves

I: Olfactory, II: Optic, III: Oculomotor, IV: Trochlear, V: Trigeminal, VI: Abducens, VII: Facial, VIII: Vestibulocochlear, IX: Glossopharyngeal, X: Vagus, XI: Accessory, XII: Hypoglossal. Mnemonic: "Oh Oh Oh To Touch And Feel Very Good Velvet, AH!"

Which nerve affected by specific lesion? Extraocular eye movement deficits? Bell palsy (CN VII)?

Physiology

GFR & Renal

GFR = 125 mL/min; normal UO = 1-2 mL/kg/hr; nephron types (cortical 85%, juxtamedullary 15%); RAAS system; ADH mechanism; creatinine clearance = (140-age x weight) / (72 x Cr) x 0.85 if female

GFR calculation, renal clearance, ADH effect on urine, aldosterone mechanism

Pharmacology

Antibiotics

Penicillin: cell wall synthesis, PCN allergy. Cephalosporins: cross-reactivity with PCN 1-10%. Aminoglycosides: ototoxicity + nephrotoxicity. Macrolides: QT prolongation. Fluoroquinolones: tendon rupture, cartilage damage

Drug of choice for specific infection; adverse effects; mechanism of action

Medical-Surgical

Heart Failure

Left HF: pulmonary congestion (SOB, orthopnea, crackles, cough). Right HF: systemic congestion (JVD, peripheral edema, hepatomegaly, ascites). NYHA Class I-IV. Treatment: diuretics, ACE-I, beta-blockers, aldosterone antagonists

Differentiate left vs right HF; NYHA classification; medication management

Medical-Surgical

Diabetes Emergencies

DKA: high glucose, anion gap metabolic acidosis (AG above 12), K+ shifts (total body low, serum may be high initially), Kussmaul respirations. HHS: very high glucose (above 600), hyperosmolar, minimal ketosis, severe dehydration

DKA vs HHS differentiation; fluid resuscitation order; insulin dosing; potassium management

Obstetrics

Labor Stages

Stage 1: Dilation (Latent 0-6 cm; Active 6-10 cm). Stage 2: Expulsion (full dilation to delivery). Stage 3: Placental (delivery to placenta delivery). Stage 4: Recovery (first 1-2 hrs postpartum). Bishop Score for induction readiness.

Identify labor stage; Bishop score interpretation; when to notify provider

Pediatrics

IM Vaccination Schedule

Birth: BCG, OPV-0, Hep B-0. 6 wk: OPV-1, IPV-1, Pentavalent-1, Rotavirus-1. 10 wk: OPV-2, IPV-2, Pentavalent-2, Rotavirus-2. 14 wk: OPV-3, IPV-3, Pentavalent-3, Rotavirus-3. 9 mo: Measles-1, Vit A. 16-24 mo: DPT booster, OPV, Measles-2, Vit A.

Which vaccines at which age? Contraindications to vaccination? Cold chain maintenance?

Mental Health

Antipsychotic Side Effects

Extrapyramidal symptoms (EPS): dystonia (acute), akathisia, parkinsonism, tardive dyskinesia (irreversible). NMS: hyperthermia, muscle rigidity, altered consciousness — EMERGENCY. Treatment: benztropine (dystonia), propranolol (akathisia)

Identify EPS type; NMS recognition and management; anticholinergic effects

Community Health

National Health Programs

RNTCP (TB): DOTS strategy. NACP (HIV): free ART. RCH: maternal & child health. NPCDCS: NCD screening. NMQ: midday meal scheme. Poshan Abhiyaan: nutrition. Pulse Polio: OPV. National Iodine Deficiency Disorders program

Program objectives, target population, strategies, key indicators

Fundamentals

Sterilization & Asepsis

Autoclave: 121°C, 15 psi, 15-30 min. Dry heat: 160°C, 2 hrs. Chemical: glutaraldehyde 2%, 10 hrs. Disinfection vs Sterilization: disinfection reduces pathogens; sterilization eliminates ALL microorganisms

Identify correct method for equipment; parameters; storage of sterilized items