Your FREE CCRN Flashcards 2026 – 250+ Cards

2–6 mmHg — a measure of right-heart preload and volume status.

6–12 mmHg — reflects left atrial pressure and left-ventricular preload.

4–8 L/min — the volume of blood pumped per minute.

2.5–4.0 L/min/m² — cardiac output indexed to body surface area.

800–1,200 dynes·sec·cm⁻⁵ — the left-ventricular afterload.

70–105 mmHg; the usual resuscitation goal is a MAP ≥ 65.

MAP ≈ (systolic + 2 × diastolic) ÷ 3 — diastole is weighted because the heart spends more time in it.

60–80% (central venous ScvO2 ≥ 70%) — low SvO2 means tissues are extracting more oxygen.

Low preload (low CVP/PCWP), low cardiac output, high SVR.

High preload (high PCWP), low cardiac output, high SVR — pump failure.

Low SVR; cardiac output high early then low late; warm skin early.

Low cardiac output with a high/variable preload and high SVR; relieve the obstruction.

Distributive shock (septic, neurogenic, anaphylactic) — the others compensate with a high SVR.

The stretch on the ventricle at end-diastole (its filling); estimated by CVP (right) and PCWP (left).

The resistance the ventricle pumps against; for the left heart it is largely the SVR.

Unstable angina, NSTEMI, and STEMI.

Primary PCI within 90 minutes, or fibrinolysis if timely PCI is unavailable.

Aspirin, oxygen if hypoxic, nitroglycerin for ischemic pain, and an anticoagulant; get a 12-lead and troponin.

An RV infarct is preload-dependent — nitrates drop preload and can cause severe hypotension; give fluids instead.

A cardiac-specific biomarker that rises with myocardial injury; serial troponins help diagnose MI.

An inotrope (dobutamine or milrinone) to raise contractility/output, careful unloading, and mechanical support (IABP/VAD) — not more fluids.

A β1 inotrope that raises cardiac output and lowers SVR; used in cardiogenic shock and low-output heart failure.

A phosphodiesterase-3 inhibitor (inodilator): raises contractility and vasodilates; renally cleared, can cause hypotension.

Pulmonary edema, dyspnea, crackles, elevated JVD, and a high filling (wedge) pressure.

Hypotension + jugular venous distension + muffled heart sounds = cardiac tamponade.

A fall in systolic BP > 10 mmHg on inspiration; a sign of cardiac tamponade.

Pericardiocentesis (or surgical drainage) to relieve the compression.

Synchronized cardioversion.

Immediate defibrillation (unsynchronized), CPR, epinephrine, and amiodarone.

Atropine first; then transcutaneous pacing, dopamine, or epinephrine if it persists.

Torsades de pointes (polymorphic VT); treat torsades with IV magnesium.

An accessory conduction pathway (delta wave) that can cause dangerous tachycardias; avoid AV-nodal blockers in WPW with atrial fibrillation.

Control the rate (beta-blocker or calcium-channel blocker) and anticoagulate per stroke risk; cardiovert if unstable.

Lower heart rate with a beta-blocker FIRST, then a vasodilator, to reduce aortic wall shear.

Severely high BP WITH acute target-organ damage (stroke, MI, dissection, pulmonary edema, encephalopathy).

Lower the MAP by no more than ~25% in the first hour to avoid hypoperfusing the brain, heart, and kidneys.

A balanced vasodilator for hypertensive emergency/dissection; prolonged high doses risk cyanide/thiocyanate toxicity, especially in renal failure.

Inflates in diastole (improves coronary perfusion) and deflates in systole (reduces afterload) — used in cardiogenic shock.

Low-voltage QRS with electrical alternans (the heart swinging in fluid).

A large myocardial infarction (left-ventricular pump failure).

JVD, peripheral edema, hepatomegaly, and ascites (systemic congestion).

Pulmonary congestion — crackles, dyspnea, orthopnea, and a high wedge pressure.

B-type natriuretic peptide rises with ventricular stretch; a high BNP supports heart failure.

Monitor the access site for bleeding/hematoma, check distal pulses, keep the leg straight (femoral), and assess for contrast nephropathy.

Pleuritic chest pain relieved by sitting forward, a friction rub, and diffuse ST elevation.

Vegetations on valves that can embolize; suspect with fever, a new murmur, and risk factors (IV drug use, prosthetic valves).

No relationship between P waves and QRS; treat unstable patients with pacing.

Sudden severe pain and hemorrhagic shock — a surgical emergency.

Sudden pulmonary edema and a new murmur after MI (papillary muscle rupture); needs urgent surgery.

Watch for bleeding/tamponade (sudden drop in chest-tube output with hypotension), dysrhythmias, and hemodynamic instability.

Low dose dopaminergic, moderate β1 (↑ CO), high α (↑ SVR); arrhythmogenic and used less now.

A pure α1 agonist that raises SVR/BP; can cause reflex bradycardia.

7.35–7.45 — below is acidosis, above is alkalosis.

35–45 mmHg — the respiratory (ventilation) component.

22–26 mEq/L — the metabolic component.

80–100 mmHg on room air.

Read the pH: < 7.35 acidosis, > 7.45 alkalosis.

CO2 moves OPPOSITE to pH = respiratory; HCO3 moves the SAME direction as pH = metabolic.

Respiratory Opposite, Metabolic Equal — keeps ABG directions straight.

Hypoventilation (sedation, COPD, neuromuscular weakness) → ↑ PaCO2, ↓ pH.

Hyperventilation (anxiety, pain, early sepsis) → ↓ PaCO2, ↑ pH.

Added acid or lost bicarbonate (DKA, lactic acidosis/shock, renal failure, diarrhea) → ↓ HCO3, ↓ pH.

Vomiting, NG suction, or diuretics → ↑ HCO3, ↑ pH.

Na − (Cl + HCO3); normal 8–12. A high gap = added acid (MUDPILES).

Causes of high-anion-gap metabolic acidosis: Methanol, Uremia, DKA, Propylene glycol, Iron/INH, Lactic acidosis, Ethylene glycol, Salicylates.

Partial: both values abnormal, pH still off. Full: both abnormal, pH back in the normal range.

Lungs compensate within minutes; kidneys take hours to days.

Acute, non-cardiogenic pulmonary edema with bilateral infiltrates and refractory hypoxemia.

PaO2/FiO2 ≤ 300 mild, ≤ 200 moderate, ≤ 100 severe.

ARDS has a NORMAL wedge pressure (non-cardiogenic); cardiogenic edema has a HIGH wedge.

Low tidal volume (~6 mL/kg ideal body weight), plateau pressure < 30 cmH2O, PEEP, and permissive hypercapnia.

Improves oxygenation and survival in moderate-to-severe ARDS; named in the CCRN test plan.

Positive end-expiratory pressure holds alveoli open at end-expiration to improve oxygenation and recruit lung.

Obstruction — kink, secretions, biting, bronchospasm, or a developing pneumothorax.

A disconnection or a leak in the circuit.

Displacement of the tube, Obstruction, Pneumothorax, Equipment failure — disconnect and bag while troubleshooting.

Incomplete exhalation in obstructive disease that traps air; can cause hypotension and barotrauma.

HOB 30–45°, daily sedation interruption and spontaneous breathing trials, oral care, and DVT/stress-ulcer prophylaxis.

Absent breath sounds, hyperresonance, hypotension, JVD, and late tracheal deviation away from the side.

Immediate needle decompression, then a chest tube.

Obstructive shock with acute RV strain — sudden hypoxia and hypotension; treat with anticoagulation ± thrombolysis/embolectomy.

A 'silent chest' and a rising/normalizing PaCO2 (fatigue) signal impending respiratory failure.

Carbon monoxide gives a falsely normal SpO2; treat with high-flow 100% oxygen (or hyperbaric).

Type 1 = hypoxemic (low PaO2); Type 2 = hypercapnic (high PaCO2, ventilation failure).

Confirms ET tube placement and monitors ventilation and CPR quality (a sudden rise can indicate ROSC).

Suggests a kink, clot, or re-expanded lung; assess the tube and patient.

Indicates an air leak in the system or patient.

Hypoxemia = low oxygen in the blood; hypoxia = inadequate oxygen at the tissues.

Reduced venous return/cardiac output and barotrauma (e.g., pneumothorax).

Early diffuse alveolar damage with protein-rich edema and hyaline membranes → refractory hypoxemia.

A spontaneous breathing trial with adequate oxygenation, stable hemodynamics, and an acceptable rapid-shallow-breathing index.

Right-heart strain and failure; avoid hypoxia and acidosis, which worsen pulmonary vasoconstriction.

≥ 3 adjacent ribs each broken in 2+ places → paradoxical movement and an underlying pulmonary contusion.

A three-sided occlusive dressing, then a chest tube.

Pus in the pleural space, usually from pneumonia; requires drainage and antibiotics.

Non-invasive support for COPD exacerbation and cardiogenic pulmonary edema to avoid intubation.

Selective pulmonary vasodilators used as rescue for refractory hypoxemia/pulmonary hypertension.

Refractory respiratory or cardiac failure not responding to conventional support — a high-acuity CCRN intervention.

Glucose > 250, pH < 7.3, ketones present, and a high-anion-gap metabolic acidosis.

Glucose often > 600, minimal/no ketosis, very high osmolality, profound dehydration.

Fluids FIRST, then an insulin infusion, with close potassium replacement.

Insulin drives K+ into cells, so a normal or low K+ can crash dangerously — replace before/with insulin.

When the glucose falls to ~200, add dextrose to fluids to avoid hypoglycemia and cerebral edema.

Excess ADH → water retention, dilutional hyponatremia, concentrated urine; managed with fluid restriction.

ADH deficiency → large volumes of dilute urine and hypernatremia; the opposite of SIADH.

Hypotension refractory to fluids and pressors; treat with stress-dose corticosteroids.

Severe hyperthyroidism — fever, tachyarrhythmia, agitation; treat with beta-blocker, antithyroid drugs, and supportive care.

Disseminated intravascular coagulation — clotting consumes platelets/factors → simultaneous thrombosis and bleeding; treat the cause.

Heparin-induced thrombocytopenia — immune reaction dropping platelets with paradoxical clotting; STOP all heparin, use a non-heparin anticoagulant.

Transfusion-related acute lung injury — hypotension + non-cardiogenic edema within ~6 h; does NOT improve with diuresis.

Transfusion-associated circulatory overload — hypertension + volume overload; DOES improve with diuresis.

TRALI trends hypotensive (lung injury); TACO trends hypertensive (too much volume).

Fever, flank pain, dark urine, hypotension (often ABO mismatch); STOP the transfusion immediately and support.

Massive cell breakdown → high potassium, phosphate, and uric acid, low calcium; treat with hydration, allopurinol/rasburicase.

Peptic ulcers and esophageal varices; resuscitate with blood, correct coagulopathy, and arrange endoscopy.

Blood products, octreotide, endoscopic banding, and balloon tamponade if needed.

Lactulose (and rifaximin) to reduce ammonia; the patient may be confused or comatose.

Severe epigastric pain with elevated lipase/amylase; supportive care, fluids, and pain control; watch for SIRS/necrosis.

A tense distended abdomen with rising airway pressures and falling urine output; measure bladder pressure; may need decompression.

Prerenal (hypoperfusion), intrinsic (ATN, nephrotoxins, sepsis), and postrenal (obstruction).

CRRT provides slow continuous dialysis tolerated by hemodynamically unstable patients; HD is faster but less tolerated.

IV calcium (gluconate/chloride) to stabilize the cardiac membrane — it does NOT lower the K+.

Regular insulin with dextrose, plus a nebulized beta-agonist (albuterol).

Dialysis, a potassium binder, or a loop diuretic (if making urine).

Peaked T waves → widening QRS → sine wave → arrest.

Flattened T waves, U waves, and ST depression; risk of arrhythmia.

Chvostek's and Trousseau's signs, tetany, prolonged QT; common with citrate (massive transfusion).

Correct slowly — too-rapid correction risks osmotic demyelination (central pontine myelinolysis).

Pain out of proportion, crepitus, rapid systemic toxicity; a surgical emergency.

Repositioning, support surfaces, skin/nutrition care; the critically ill are high-risk from immobility and poor perfusion.

Leakage of a vesicant (e.g., norepinephrine) into tissue causing necrosis; stop the infusion and follow the antidote protocol.

PPIs or H2 blockers reduce GI bleeding risk in high-risk ICU patients.

SIADH = concentrated urine with hyponatremia; DI = dilute urine with hypernatremia.

Encephalopathy, coagulopathy, cerebral edema, and hypoglycemia.

Citrate in stored blood binds calcium → hypocalcemia; replace calcium during massive transfusion.

Pancreaticoduodenectomy; monitor for bleeding, fistula, and glucose changes post-op.

The most common intrinsic AKI in the ICU — from ischemia or nephrotoxins; often recovers with supportive care.

Acidosis, Electrolytes (refractory hyperkalemia), Intoxication, Overload (fluid), Uremia.

Rising risk as platelets fall; spontaneous bleeding risk is high below ~10–20 ×10⁹/L.

Protect the immunocompromised patient from infection; fever in neutropenia is an emergency (give antibiotics fast).

High phosphate binds calcium, lowering it — seen in renal failure and tumor lysis.

Hold short-acting/prandial insulin while NPO but continue basal needs and monitor glucose to avoid DKA.

Pain out of proportion to the exam plus lactic acidosis — a surgical emergency.

5–15 mmHg; the goal is to keep it < ~20–22.

CPP = MAP − ICP; the net pressure perfusing the brain.

HOB 30° with head midline, normothermia, normocapnia, avoid hypoxia/hypotension, minimize stimulation; hypertonic saline or mannitol for spikes.

Hypertension with a WIDENING pulse pressure, bradycardia, and irregular respirations — a LATE sign of high ICP.

Damage AFTER the initial insult from hypoxia, hypotension, edema, or rising ICP — preventable by nursing care.

Thrombolysis within the window after a CT rules out hemorrhage, ± mechanical thrombectomy for a large-vessel occlusion.

Blood-pressure control and reversal of anticoagulation; neurosurgical evaluation.

Distributive shock after a high spinal cord injury — hypotension WITH bradycardia and warm, dry skin.

Neurogenic shock has BRADYcardia; hypovolemic shock has tachycardia.

A hypertensive crisis in cord injuries at/above T6 triggered by a stimulus below the lesion (often a full bladder); sit up and remove the trigger.

Irreversible loss of all brain AND brainstem function; confirmed by coma, absent brainstem reflexes, and a positive apnea test.

A seizure > 5 min or repeated seizures without recovery; first-line treatment is a benzodiazepine, then an antiepileptic.

Pain (out of proportion / on passive stretch — earliest), Paresthesia, Pallor, Pulselessness, Paralysis, Poikilothermia.

Pain out of proportion and pain on passive stretch; pulselessness and paralysis are LATE.

Emergent fasciotomy; do NOT elevate above the heart or apply ice; remove constricting dressings.

Muscle breakdown releasing myoglobin (elevated CK, dark urine) that threatens the kidneys; treat with aggressive IV fluids.

Hypoxia, confusion, and a petechial rash 24–72 h after a long-bone/pelvic fracture.

Acute, fluctuating disturbance of attention/awareness — hyperactive, hypoactive (often missed), or mixed.

The CAM-ICU (Confusion Assessment Method for the ICU).

Assess/treat pain, Both spontaneous awakening and breathing trials, Choice of sedation, Delirium monitoring, Early mobility, Family engagement.

Benzodiazepines (and excessive sedation) — minimize them and treat reversible causes.

New/worsened physical, cognitive, or mental-health impairment after critical illness; reduced by light sedation and early mobility.

Eye (1–4) + Verbal (1–5) + Motor (1–6); total 3–15; ≤ 8 = secure the airway.

3 (no eye, verbal, or motor response) — there is no score of 0.

Spinal shock = temporary loss of all reflexes/function below the injury (neurologic); neurogenic shock = hypotension with bradycardia (hemodynamic).

Ascending paralysis that can reach the respiratory muscles — monitor vital capacity and prepare for ventilation.

Both cause weakness; myasthenic improves with edrophonium/anticholinesterase, cholinergic worsens (from excess medication).

Ensure safety: remove means, provide one-to-one observation, and consult mental-health/psychiatry.

Tremor, agitation, autonomic instability, and seizures/DTs; treat with benzodiazepines and monitor with CIWA.

Identify and treat the cause (hypoxia, pain, delirium); use non-pharmacologic measures first, restraints only as a last resort.

Both lower ICP osmotically; mannitol is a diuretic (watch volume/electrolytes), hypertonic saline raises serum sodium.

Both cause hyponatremia after brain injury; CSW is volume-depleted (treat with salt/fluids), SIADH is euvolemic (fluid-restrict).

Decorticate = flexion (arms to the core), decerebrate = extension; decerebrate indicates a deeper, worse injury.

Historically hypertension, hypervolemia, hemodilution for cerebral vasospasm after SAH; current practice emphasizes euvolemia and induced hypertension.

Protect the airway, do not restrain or put anything in the mouth, time the seizure, and pad/lower the patient.

Injuries above C3–C5 can paralyze the diaphragm → respiratory failure needing ventilation.

Suction briefly and pre-oxygenate — suctioning and coughing transiently spike ICP.

Least restrictive, time-limited, with an order and frequent reassessment; a last resort after non-pharmacologic measures.

Agitation, hyperthermia, clonus, and autonomic instability from serotonergic drugs; supportive care ± cyproheptadine.

Rigidity, hyperthermia, and altered mental status from antipsychotics; stop the drug and provide supportive care/dantrolene.

The quiet, withdrawn form is the most common and most often MISSED — screen routinely with CAM-ICU.

Life-threatening organ dysfunction from a dysregulated host response to infection.

Sepsis with persistent hypotension needing vasopressors to keep MAP ≥ 65 PLUS a lactate > 2 despite fluids.

Systemic inflammatory response syndrome — abnormal temperature, heart rate, respiratory rate, and WBC; may be infectious or not.

Multiple organ dysfunction syndrome — progressive failure of ≥ 2 organ systems; the leading cause of ICU death.

Measure lactate, draw cultures BEFORE antibiotics, give broad-spectrum antibiotics, begin 30 mL/kg crystalloid, and start vasopressors to MAP ≥ 65.

Draw blood cultures BEFORE giving antibiotics — but do not delay antibiotics beyond the first hour.

Norepinephrine; add vasopressin when norepinephrine alone is not enough.

An α1 ≫ β1 vasopressor that raises SVR and MAP; extravasation causes tissue necrosis.

Anaphylaxis (first-line), cardiac arrest, and refractory shock; α and β effects are dose-dependent.

A non-adrenergic V1 vasoconstrictor (fixed ~0.03 units/min) added to norepinephrine in septic shock.

A rising lactate reflects tissue hypoperfusion; clearance is a resuscitation goal in sepsis.

Hypovolemic, cardiogenic, distributive (septic/neurogenic/anaphylactic), and obstructive.

Septic → norepinephrine; cardiogenic → dobutamine; anaphylactic → epinephrine; hypertensive emergency → nitroprusside.

Ventricular fibrillation and pulseless ventricular tachycardia → defibrillate + epinephrine + amiodarone.

PEA and asystole → CPR + epinephrine every 3–5 min; NO defibrillation; treat the H's and T's.

Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo-/Hyperkalemia, Hypothermia.

Tension pneumothorax, Tamponade, Toxins, Thrombosis (pulmonary or coronary).

1 mg IV/IO every 3–5 minutes during CPR.

Optimize oxygenation/ventilation and hemodynamics, identify the cause, and provide targeted temperature management.

Controlled cooling/temperature control after cardiac arrest to protect the brain.

Naloxone.

N-acetylcysteine (NAC).

Flumazenil (used cautiously — can precipitate seizures).

Digoxin-specific antibody fragments (DigiFab).

Sodium bicarbonate for a widened QRS and arrhythmia.

A hypermetabolic crisis from anesthetics — rigidity, rising EtCO2, hyperthermia; treat with dantrolene.

The airway: intubate early for inhalation injury (facial burns, singed hairs, soot, hoarseness, stridor).

Parkland formula: 4 mL lactated Ringer's × kg × %TBSA, half in the first 8 hours; titrate to urine output.

Hemolysis, Elevated Liver enzymes, Low Platelets — a severe preeclampsia variant; definitive treatment is delivery.

Magnesium sulfate to prevent/treat seizures, blood-pressure control, and delivery.

Hand hygiene, CLABSI/CAUTI bundles, the VAP bundle, and appropriate isolation precautions.

Intramuscular epinephrine, plus airway support, fluids, antihistamines, and steroids.

Hypoxia and ARDS; monitor and support oxygenation even if the patient initially looks well.

Altered mentation, respiratory rate ≥ 22, and systolic BP ≤ 100 — a quick bedside flag for sepsis risk.

A falling lactate with resuscitation indicates improving perfusion.

30 mL/kg of balanced crystalloid for hypotension or a lactate ≥ 4 mmol/L.

Intramuscular epinephrine 0.3–0.5 mg in the lateral thigh, repeated as needed.

Septic, neurogenic, and anaphylactic — all share a LOW SVR.

Push hard (≥ 2 inches) and fast (100–120/min), allow full recoil, minimize interruptions.

Given for refractory VF/pulseless VT after defibrillation and epinephrine.

High-flow 100% oxygen; hyperbaric oxygen for severe poisoning.

Hydroxocobalamin (and/or the cyanide antidote kit).

Circumferential full-thickness burns causing compartment-like compromise of a limb or the chest.

Rapid cooling and supportive care; differentiate from neuroleptic malignant/serotonin syndrome and malignant hyperthermia.

Painful vaginal bleeding, a rigid/tender uterus, and fetal distress — an obstetric emergency.

After ~20 weeks, left lateral tilt or manual uterine displacement to relieve aortocaval compression.

Patient outcomes are best when the nurse's competencies match the patient's characteristics and needs.

Clinical judgment, advocacy/moral agency, caring practices, collaboration, systems thinking, response to diversity, clinical inquiry, facilitation of learning.

80% Clinical Judgment / 20% Professional Caring & Ethical Practice.

Working on the patient's behalf and acting as a moral agent to identify and resolve ethical and clinical concerns.

Activities (vigilance, engagement, responsiveness) that create a compassionate, therapeutic environment to promote comfort and prevent suffering.

Working with patients, families, and the interdisciplinary team toward optimal, realistic goals.

Using knowledge and tools to manage environmental and system resources across the care continuum.

Recognizing and incorporating differences (cultural, spiritual, gender, age, values) into patient-centered care.

Questioning and evaluating practice and creating change through evidence-based practice and research utilization.

Teaching patients, families, staff, and the community, formally and informally.

Autonomy, beneficence, non-maleficence, and justice.

The patient's right to make their own informed decisions about their care.

Beneficence = act in the patient's best interest; non-maleficence = do no harm.

Disclosure, understanding, voluntariness, and competence; the nurse witnesses and verifies, the provider obtains it.

A document stating a patient's wishes for care if they cannot decide; honor it and identify the lawful surrogate.

The legally designated surrogate's authority takes precedence over other family members' wishes.

Situation, Background, Assessment, Recommendation — a structured handoff/communication tool.

A non-punitive approach to error reporting that focuses on system improvement rather than individual blame.

Palliative care = comfort/symptom care at any disease stage alongside treatment; hospice = comfort care at end of life.

Knowing the right action but being constrained from taking it; recognize and address it to prevent burnout.

A resource for resolving complex ethical conflicts (e.g., goals-of-care disputes) at the bedside.

Including the family in communication, decision-making, and (where appropriate) presence during procedures/resuscitation.

Support the family and follow protocol; the organ procurement organization, not the bedside nurse, approaches the family about donation.

Speaking up when planned care conflicts with the patient's documented wishes or is unsafe.

Integrating the best research evidence with clinical expertise and patient values to guide care.

Active listening, open-ended questions, and empathy that build trust and elicit the patient's concerns.

Arranging an interpreter and respecting cultural/religious practices in the plan of care.

A patient/surrogate decision honored with comfort-focused care; the nurse ensures symptom management and family support.

Do-Not-Resuscitate — withholds CPR; it does not mean withholding other care unless specified.

Brain death = irreversible loss of all brain function (legally dead); PVS = wakefulness without awareness.

Shared, goal-directed planning across the team to align care and prevent errors.

Escalating a safety concern up the hierarchy until it is addressed.

Drugs (insulin, heparin, vasoactives, opioids) requiring extra safeguards like independent double-checks.

Plan-Do-Study-Act cycles to test and implement practice changes.

A person legally designated to make medical decisions when the patient cannot.

Treat pain, dyspnea, and agitation aggressively for comfort; the goal shifts to quality, not cure.