nursing fundamentals rn study buddy

nursing fundamentals
basic Abbreviations
nursing process
client safety & risk factors
priorities of answering questions
maslows hierarchy of needs
ethics
infection control & PPE isolation
I.v. with types and issues
patient positions
19 t
lab values otal
electrolytes page
s
 abbreviations rn study buddy
general things I&D - incision and drainage
I&O - Intake and output
a.c. before meals CPR - Cardiopulmonary resuscitation Isol - Isolation
ADL - Activities of daily living DC or d/c - Discontinue IV - Intravenous
ama - against medical advice DX - Diagnosis NPO - Nothing by mouth
Amb - Ambulatory, able to walk ECG - Electrocardiogram PO - By mouth
abx - antibiotics EEG - Electroencephalogram PT - Patient / physical therapy
aeb - as evidenced by FBS - Fasting blood sugar or prothrombin time
Amt - Amount Fx - Fracture r/o - rule out
ams - altered mental status GI - Gastrointestinal ROM - Range of motion
Cath - Catheter Gtt - Glucose tolerance test SOB - Shortness of breath
CBC - Complete blood count Gyn - Gynecology Stat - immediately
C/C - chief Complaint HOB - Head of bed TPR - Temperature, pulse,
CVA - Cerebrovascular accident or stroke ICU - Intensive care unit respiration
U/A - Urinalysis
VS - Vital signs

titles times
APRN - Advanced practice registered nurse a.c. before meal q - every time frame
CNA - Certified nursing assistant p.c. post meal q15 min = every 15 min
CNM - Certified nurse-midwife qhs - at bedtime
CRNA - Certified registered nurse sid - once a day qd = once a day
anesthetist bid - 2 a day qh = every hour
DNP - Doctor of nursing practice tid - 3 a day prn = as needed
LPN - Licensed professional nurse or qid - 4 a day
license practical nurse
administration routes
LVN - Licensed vocational nurse
(ways to give medication) more stuff
NA - Nursing aid or nursing assistant po - mouth loc - level of consciousness
NP - Nurse practitioner pr - rectum nka - no known allergies
PRN - Pro re nata (per diem nurse) sl- sublingual (under tongue) nkda - no known drug allergies
RN - Registered nurse ogt/ngt - given per a tube
pt - physical therapy ID - intradermal
ot - occupational therapy im - intramuscular - by needle
md - medical doctor i.v. - intravenous
ivpb - iv piggy back
sc/sq - subcutaneously
 abbreviations rn study buddy
head body systems
heart / blood
heent - head / ears /eyes/ nose / throat
abg = arterial blood gas
cns = central nervous system
bp - blood pressure
pns = peripheral nervous system
cabg - coronary artery bypass graft
adh = anti diuretic hormone
cad - coronary artery disease
icp - inter cranial pressure
chf - congestive heart failure
iicp - increased icp
co - cardiac output
csf - cerebrospinal fluid
cvp - central venous pressure
hgb - hemoglobin
hr - heart rate
lungs = respiratory htn - hypertension
rr - respiratory rate mi - myocardial infarction
tv - tidal volume rbc - red blood cell
rll - right lower lobe svr - systemic vascular resistance
rul - right upper lobe wbc - white blood cell
lll - left lower lobe
lul - left upper lobe
o2 = oxygen
o2 delivery devices
nc - nasal canula
nrb - non rebreather
bvm - bag valve mask

stomach = gi
bm - bowel movement
kidney / bladder = gi
dm - diabetes mellitus
aki - acute kidney injury
tpn - total parental nutrition
bun - blood urea nitrogen
Tubes
cki - chronic kidney injury
ng tube - nasogastric (tube)
gfr - glomerular filtration rate
og tube - oral gastric (tube)
uti - urinary tract infection
 nursing process rn study buddy

A d p i e
assess diagnose plan implement evaluate

always do this first

and is always happening

you are conducting a head to take a pause and think

once you have the now that you have a is the plan working?
toe assessment and gathering through what actions
basic information you plan, start to put the plan go back to assess
information. will benefit the client
can now make a into action. and make make a new
most and what they need.
reasonable determination take it step by step. plan if it is not,
if a question ask you what don't just jump into action
of the issue. -if the plan is working
to do first, the answer is almost then keep going with it.
always going to be asses. -prioritize
-no matter how far you are in -.needs to be measurable -
your degree - you always assess client will do x by end of shift
first. client will show increased spo2 within
1 hour.

client basics 1st step of assessment information source

-name subjective: from the client my stomach hurts
-age objective: from the RN (not an opinion)
alert and oriented it can be confirmed - patient guards stomach - shows sign
vitals of pain during exam.
major issues.
safety concerns.

*pro tip*
practice your head to toe assessment the same way everytime!
-the more you change or jump around the more you will end up missing during the exam!
 client safety & risk factors rn study buddy
client safety * lets think about risk factors and how we can mitigate / prevent harm to our client.
falls seizures pressure ulcers
risks risks *2nd most common medical lawsuit*
old, medications, poor eyesight medications, history of seizures, risks
frequent restroom trips, cognitive impairment brain / head injury low food intake, old, immobile, incontinent ,
and a history of falls interventions low sensory perception, shear / friction from
interventions have bvm and suction at bedside moving / sliding patient
understand risk, educate client bvm = bag valve mask and is to interventions
move patient slow / have proper equipment assist in providing oxygen rotate client position q2 hrs
and / or people to help never put anything in clients mouth skin assessment
use bed alarms* clear dangerous objects from the area encourage food intake
keep bed in low position roll the client on their side - prevents use a slide sheet to protect client
never have all 4 siderails of the bed up - chocking / breathing on vomit frequent checks on incontinence
this counts as imprisonment / restraint loosen restrictive clothing
use fall matts on sides of bed
answer call lights promptly q2hour
have proper lighting. reposition

fire safety - r.a.c.e. fire safety p.a.s.s.

r: rescue client p: pull pin extinguisher types
a: alarm a: aim at base of fire a; combustible
c: contain / confine s: squeeze the handle b: liquids / gas fire
e: extinguish s: sweep side to side c: electrical

carseats
smoking
rear facing until 2 years
2nd hand smoke can delay growth and cause health issues
5 point safety harness
can develop respiratory infections in kids
have inspected by trained staff
can worsen asthma attacks
poison and swallowing -------------------- educate ----------------
kids or developmentally smoking outside of house
delayed - keep small objects smoking cessation
or hazard material out of reach don't smoke in cars

suffocation
bags
carbon monoxide
never alone around water
cannot be seen, smelled, or tasted
back to sleep
by product of machines operating
nothing extra in crib
fires should be unobstructed - fireplace
slats in crib are less than
install detectors / check batteries yearly
around 2 inches - wider can trap the infant
 priorities of care rn study buddy
airway ???when do you use this???

A
priority questions will almost always
when assessing the airway
you are looking for obstruction or present with the same key words!
making sure the airway is open.
ha t s ho uld th e n ur se do first?
w
a t is the prior ity inte rvention?
breathing w h

b
tant step?
is the person breathing in and out -
what is the most impor
and is the amount of breathing sufficient
device flow o2 delivered
nasal canula - nc 1 l/min 24%
circulation 2 l/min 28%

c
assess if the heart pumping?
3 l/min 36%
how - do you have pulses?
does their skin have color or oxygen delivery mask / venturi 2-4 l/min 24%
do they look very pale. 4-6 l/min 28%
simple mask 8-10 l/min 34%

s
4-10 l/min 10-12 l/min 40%
safety
identify any risk to safety 12-15 l/min 60%
can the client fall, can they trip, drown, aspirate
non re-breather mask 15 l/min 80%
dont use with less than 10l / min

maslow's maslow should always come to mind with priority questions.

hierarchy of human needs
needs must be met in order from the bottom up.
f ulf
s e l f nt
illm

self acualization seeking out self improvement, growing emotionally,

e

physically, mentally.

self esteem respect from others, status, freedom, recognition

ph y s
iolo
g
ical

love and belonging friends, family, love, personal connections

safety and security security / safety, employment, health, home / place to live
su r v
ival

physiological needs a,b,c's, food, water, shelter, sleep clothes

nursing ethics & restraints rn study buddy
justice

A autonomy
being able to make ones own decisions j treat everybody the same
-even when you have mean clients

n non-maleficence
do no harm v veracity
telling the truth

fidelity

b beneficence
being able to make ones own decisions f keeping a promise
if you say " ill get you water"
make sure you get that water
**you are the patient advocate - always do whats right for the patient**

hippa consent torts

patient has the right to have all health a client must officially give
intentional
care information protected. consent for a procedure. assault - verbal threat i will hit you
RN can only give out information to If they are unable to do so
verified then the health care proxy battery - hitting - wrong medication
recipients. must give the consent.
cannot take pictures consent is in clients native false imprisonment - restraining without a physicians
cannot share on social media language and is given dangers order
don't discus with people not providing care and alternatives.
don't discuss in public areas provider obtains consent - the
non - intentional
stop other people from discussing. rn verifiers it. negligence - forgetting to setting the bed alarm - we
report to supervisor if you overhear hippa Rn also verifies the client is did not mean for them to get hurt
violations. not impaired and is legally
able to give consent. malpractice: performing a procedure wrong -

directives if the client has more

questions, then make the
providing incorrect medication.

living will - clients wishes if they are not able to

make decisions.
provider explains them
again... it is never the nurses
responsibility..
incident report
durable power of attorney - a person who makes Never put in the patients record!!!!!!
decisions for the client. if a question ask - putting the information in the client record is
dnr - do not resuscitate always wrong.. always. -it is a internal report for process
improvement. [ n record = lawsuit... ]

ting suspected abuse - child - elder

report it no matter what - authorities will what does go in the client record = what occurred. example: rn

or follow up and investigate found client on floor, conducted assessment, taken for ct scan.

rep sex trafficking = report

state - communicable diseases
it is simple and straight forward, if you did not witness the fall
then dont say the client fell.
 ppe & isolation rn study buddy

/ on
ppe dof
f /off
stages of infection
incubation
chain of infection
host
causing agent
reservoir
don
prodromal portal of portal
gloves
hand hygiene
illness entry mode of of exit
gown goggles convalescence transmission

mask mask modes of transmission

contact
types of pathogens
bacteria
goggles gown direct - person to person
indirect - object to person
viruses
fungi
gloves hand hygiene fecal/ oral - contaminated food
droplet - cough, sneeze, talk
prions
parasites
airborne - sneezing, coughing.
transmission based precautions
airborne droplet
notes: always wear gloves!!
m measels
s septic / scarlet fever
strep pharyngitis always do hand hygiene

t tuberculosis
p pertussis / pneumonia /
parvovirus airborne:
v varicella

i influenza
private room
n95, gloves, gown goggles
contact
negative pressure room
m multi drug resistant
d diptheria
contact: gloves, gown

r respiratory infections
e epiglottitis
private or same illness room
C.diff

s skin infections droplet: (gown, mask, googles)

r rubella
private or same infection in room
w wound infections surgical mask

e enteric (c- diff)

m mumps / meningitis
meningeal pneumonia most tested
1. meningitis

e eye infections)
an adenovirus 2. pertussis
3. influenza
delegate and supervise rn study buddy
 intra-venous fluid IV rn study buddy
symptoms treatment

iso air embolism same as blood clot

pain at location
heart attack
prevent more air entering
head up -reduce chance to
enter the brain
stroke notify treatment team (DR)
air blocks flow of blood

swelling stop IV
I.V. fluid stays in the veins
cool temperature at area remove iv
Iit has a equall solute to fluid ratio so the
infiltration painful apply a compress
fluid stays in the vessels and does not cause fluid leaks into surrounding tissue tissue damage
a fluid shift of any kind.

hypo hematoma bruising at the site

assess if iv still works
-if not remove it.
hard / swollen lump
blood clot in tissue apply pressure to stop bleed
(most likely to happen
after removing the iv)

I.V. fluid moves from veins to cells remove the iv

streaking discoloration of
it has low solutes and alot of fluid -
this fluid follows the higher solutes in the cells,
phlebitis notify physician
veins that can be seen through start new iv in a different
vein inflammation the skin. vein
so thats where it moves.
(swelling / irritation) warmth , painful, reddened warm compress

hyper assess vitals

systemic change in loc

temp: hot or cold <96 >100
needs antibiotics
can de-compensate fast and
change in vitals may end up in the ICU
infection appear very sick
infection can quickly infect
all major organs
I.V. fluid moves from cells to veins to cells
it has high solutes to fluid ratio, it pulls fluid from the cells
into the vessels, this increases blood pressure or intra vascular
volume.
I.V. rn study buddy
assistive devices & ergonomics rn study buddy
canes crutches walkers
used on the strong side
correct fit. hand grips align with grips on the walker when dangled.
measure - greater trochanter to the floor
1.5 inches or 3 fingers below axilla (when arms are hanging, the hands rest naturally on the
can moves forward 6-10 inches.
(armpit) if axilla rest on crutches it grips of the walker.)
can cause nerve damage. - rolling walkers - assess if you client is actually safe
- elbows flexed when using. using one, usually safe if only minor decline in normal
strength.
client wears nonslip shoes
inspect rubber grips prior to use

steps for walking with crutches

steps for walking with a Cane.
1.strong leg bears weight -
1.cane moves crutches and weak leg move steps for walking with a walker.
2. weak leg moves to the cane 2. crutches bear weight - strong leg moves
3. strong leg moves past cane. think 3 then 1 1.walker moves -12 inches / 1 foot
-----------repeat ------------ 3 =(2 crutches + weak leg) 2. weak leg moves to the walker
4. cane moves 6-10 inches past strong leg 1 = strong leg 3. strong leg moves to weak leg
5. weak leg moves up to the cane -----------repeat ------------ -----------repeat ------------
6. strong leg moves up again. 3 move =(2 crutches + weak leg) 4. walker moves 12inches ahead
---------------------------------------------- 1 moves = strong leg 5. weak leg moves up to the walker
this is test only... very few elderly will
6. strong leg moves up even with weak leg
do this, its slow. (try it.. it helps remember ----------------------------------------------
the steps for testing. you dont need a cane this is test only... very few elderly will
just stand up and do it! it helps..) do this, its slow. (try it.. it helps remember
the steps for testing. you dont need a cane
just stand up and do it! it helps..)

stairs
going up = feet first
down = crutches first www 3 different types of walks s
oooo
oow
nt s ty l e
slo o v eme
4-point 3-point er m 2-point
f ast
everything moves independently 3 point = 2 moving parts 2 point = 2 moving parts
4 point = 4 individual moving parts 2 crutches = 1 2 crutches = 1
1 strong leg = 1 2 legs = 1
1st crutch moves
1st foot moves crutches move together 1st point = 1st leg and 1st crutch
2nd crutch moves strong leg followst 2nd point = 2nd leg and 2nd crutch
2nd foot moves
the weak leg bears no weight
even the weak leg bears some weight
hence why you have 3 points
patient positioning rn study buddy
prone supine

trendelenburg (tilt head down) reverse- trendelenburg

semi -fowler 45* fowler 90*

side lying lithotomy

lab values rn study buddy
 electrolytes rn study buddy
sodium and potassium have inverse relationships, this means if one is high then the other will be low.
135-145 meq example: sodium is at 150 meq then potassium should be on the low end or below 3.5 - 5.0 its normal.
Na+ is the sign for sodium 135-145 mEq/L (Normal Range) Level of measure circulating in the blood
Sodium’s role: Regulates H2O inside of the cell (H2O follows sodium)

hypo-natrimia sodium - na hyper-natrimia

signs and symptoms signs and symptoms

S: Stupor / Coma F: Flushed skin / Fever

A: Anorexia, Nausea & Vomiting R: Restless, Irritable, confused, anxious
L: Lethargy I: Increased blood pressure / fluid retention
T: Tendon reflexes Decreased E: Edema
L: Limp Muscles (weakness) D: Dry mouth/ decreased urine output
O: Orthostatic hypotension
S: Seizures/ headache
S: Stomach Cramping

causes causes
*Decrease in serum sodium *Increase in serum sodium
Hypervolemic Hyponatremia = Increase fluid / decreased sodium Hypervolemic Hypernatremia = Increase fluid / Increased sodium
*Cirrhosis / Heart Failure / nephrotic syndrome Iatrogenic = (From medical treatment) primary Hyperaldosteronism
Hypovolemic Hyponatremia = Decreased fluid and Sodium *Renal loss, Hypovolemic Hypernatremia = Decreased fluid and increased Sodium
Extrarenal loss Renal loss, Extrarenal loss
Euvolemic hyponatremia = Normal fluid, decreased sodium *SIADH / Euvolemic hypernatremia = Normal fluid, Increased sodium Diabetes
Polydipsia / Adrenal insufficiency / Hypothyroidism Insipidus (low ADH) Hypodipsia

interventions interventions

ABC’s Monitor for changes in vitals, Restrict Sodium intake

Hypovolemic: I.V. Solution (3% Saline) Patient safety = monitor for Confusion
Hypervolemic: Restrict fluids, consider diuretics Isotonic Fluid / Hypotonic Fluid 0.9NaCL / 0.45%NS (Slow to
SIADH: Restrict fluids / Antidiuretic antagonist avoid Edema) Educate on diet

increase intake diet decrease intake

Bacon / Canned foods / Processed / preservative foods / Cheese / Table salt

 electrolytes rn study buddy
sodium and potassium have inverse relationships, this means if one is high then the other will be low.
3.5-5 meq example: sodium is at 150 meq then potassium should be on the low end or below 3.5 - 5.0 its normal.
K+ is the sign for Potassium 3.5-5 mEq/L (Normal Range) Level of measure circulating in the blood
Potassium role: Nerve Impulse and Muscle contraction
potassium is abundant in the body and is mainly inside of the cells / not the vascular space

hypo-kalemia potassium - k hyper-kalemia

signs and symptoms signs and symptoms
(Think Slow and Low) M: Muscle Weakness
Weak pulse U: Urine production / low or absent
Confusion D R: Respiratory failure / Muscle weakness
ecreased bowel sounds D: Decreased Cardiac Contractility
Shallow and decreased breath sounds E: Early Signs / Muscle twitch / cramps
Weak muscle contractions R: Rhythm changes / Peak T-Wave Long PR interval / Wide QRS / Peak T wave.
Decreased DTR response

causes causes
*Decrease in serum potassium *Increase in serum potassium
Increased K+ Excretion: Decreased K+ Excretion:
Renal loss: Diuretics, Hyperaldosteronism Renal failure / Volume Depletion
Aldosterone
Decreased K+ Intake (also: ACE inhibitors, Adrenal Insufficiency, Aldosterone antagonist.)
intravascular to Intracellular Shift: Increased K+ Intake (Oral / I.V.)
(moves out of the blood to inside the cells) Intracellular to intravascular Shift:
High Insulin Low Insulin / Trauma / Beta Blockers / Acidosis
Beta Antagonist
Alkalosis
interventions interventions
Cardiac monitor Monitor:
Cardiac Monitor Monitor:
HR / Resp / Gi motility /
HR / Resp / Gi motility /
Renal Labs (K+, Bun 10-20, Creatinine 0.6-1.2)
Renal Labs (K+, Bun 10-20, Creatinine 0.6-1.2)
I.V. Infusion K+
Magnesium (I.V. Infusion) (Replacing Mg decreases wasting of K+)
med administration
Hold Meds that waste K+
oral intake of K / Lasix /Hypertonic Solutions / Insulin
May be able to use potassium sparing
Sodium polystyrene sulfonate -
Hold Digoxin
*insulin acts as a transport to move K+ into cells - temporary

increase intake diet decrease intake

Potatoes/ Oranges / Tomatoes / Avocados/ Strawberries / Spinach / Fish / Mushrooms / Mush Melons
 electrolytes rn study buddy
Mg: has a similar relationship with Ca2+ and K+ (Low Mg = Low Ca2+ and low K+)
1.3-2.1 meq
Mg is the sign for Magnesium 1.5-2.5 mg/dL (Normal Range) Level of measure circulating in the blood (higher concentrations in cells and ICF)
Magnesium’s role: Skeletal muscle contraction, carbohydrate metabolism, coagulation

hypo-magnasemia magnesium - mg hyper-magnasemia

signs and symptoms signs and symptoms
**Calcium and potassium imbalances Reduced membrane excitability
Cardio: Dysrhythmias (long QT, A fib, V fib, Cardiac: ** Cardiac Arrest** (High risk)
premature contraction) / hypertrophic Bradycardia, peripheral vasodilation, Prolonged PR interval, Wide QRS
left ventricle.
Muscular: Nerve excitability, CNS: depressed, Drowsy, and lethargic, Muscular: Decreased DTR or
hyperreflexia, **Numbness and tingling, absent
**Seizures GI: decreased motility,
constipation Respiratory: secondary muscle weakness can lead to failure

causes causes
*Decrease in serum Magnesium ** *Increase in serum Magnesium Increased intake **

Low absorption or high excretion by the kidneys (Loop /thiazide Drugs: Antacids and laxatives
diuretics) IV Magnesium replacement
(Drugs) Absorption/ Crohns/ Celiac /Malnutrition Ethanol ingestion Kidney disease

interventions interventions

Restore normal calcium levels **Correct the underlying issue**

Discontinue diuretics Discontinue any Mg supplements I.V. NS or LR
Magnesium I.V. (Severe cases) loop diuretics (If kidneys are not compromised)
Assess DTR hourly (At least) Calcium may reverse cardiac effects of hypermagnesemia

increase intake diet decrease intake

Avocados, Green leafy vegetables, peanut butter, pork, Oranges

 electrolytes rn study buddy
Calcium and Phosphate have an opposing relationship (Low Ca2+ = High P)
8.5-10.5 meq
Ca2+ is the sign for Calcium 8.5-10.5 mg/dL (Normal Range) Level of measure circulating in the blood Calcium’s role: Bone Formation, Clotting, Nerve
transmission

hypo-calcemia calcium - ca hyper-calcemia

signs and symptoms signs and symptoms
Confusion, Paresthesia beginning in hands and feet, GI: Constipation / decreased motility
(face is a late sign – Chvostek sign/ tap on facial nerve) Poor perfusion: Blood clots form easy
(trousseaus sign – palmar flexion when BP cuff is inflated) ECG: Short QT interval/ long ST/ Flat T
Hyperreflexia, Muscle: Severe Weakness / hyporeflexia
*Cardiac Changes -

causes causes
*Decrease in serum Calcium *Increase in serum Calcium
C Chronic Kidney Issues (End Stage) Elevated Parathyroid-ism (Causes the release of calcium from bone)
A Absorption issues / Chrons -Celiac Elevated Vitamin D - increases absorption
L lactose intolerant Increased Ca2+ Intake
C Calcium affecting med / Mag - diuretic Bone Breakdown: secondary to illness
I inadequate Vitamin D Decreased Excretion: Lithium/ diuretics
U underperforming Parathyroid Gland
M Mobility limited

interventions interventions

*Restore normal calcium levels* Stop Calcium supplements/ diet

Vitamin D / 10% Calcium Gluconate I.V. / Oral calcium supplements Switch thiazide to loop diuretic
*Patient safety* Fractures / falls / reduce environment stimuli / I.V. NS or Lactated to increase excretion
do not pull patient – use a sheet or transfer board. Encourage Calcium reabsorption inhibitors -
calcium diet increase Discontinue Phosphorus Phosphorus / calcitonin/ biphosphate
**Cardiac Monitoring** QT and T wave

increase intake diet decrease intake

*Dairy*, sardines, Dark leafy greens, fortified Foods,

electrolytes rn study buddy