- First-line drug for type 2 diabetes
- Metformin (biguanide); reduces hepatic glucose output and improves insulin sensitivity. Hold for eGFR <30 and around iodinated contrast.
- Stage 1 hypertension (ACC/AHA)
- Systolic 130–139 mmHg OR diastolic 80–89 mmHg, on the average of ≥2 readings on ≥2 occasions.
- A1c diagnostic threshold for diabetes
- A1c ≥6.5% (confirmed). Prediabetes is 5.7–6.4%.
- Asthma controller cornerstone
- Inhaled corticosteroid (ICS); a short-acting beta-agonist (SABA) is the rescue medication.
- Centor criteria
- Score for strep pharyngitis: fever, tonsillar exudate, tender anterior cervical nodes, absence of cough (age-adjusted). Guides testing/treatment.
- Nursing process — step 1
- Assessment: systematic collection of subjective and objective data (history, physical exam, screening, diagnostics).
- Subjective vs objective data
- Subjective = what the patient reports (symptoms, history). Objective = measurable/observable findings (vital signs, exam, labs).
- OLDCARTS
- Symptom history mnemonic: Onset, Location, Duration, Character, Aggravating, Relieving, Timing, Severity.
- Aortic stenosis murmur
- Harsh crescendo-decrescendo systolic murmur at the right upper sternal border (2nd intercostal space), radiating to the carotids.
- Mitral regurgitation murmur
- Holosystolic (pansystolic) blowing murmur at the apex, radiating to the left axilla.
- Aortic regurgitation murmur
- High-pitched, blowing, decrescendo diastolic murmur at the left sternal border, heard best leaning forward.
- Mitral stenosis murmur
- Low-pitched diastolic rumble at the apex with an opening snap, best heard in the left lateral decubitus position.
- S3 heart sound
- Early diastolic 'ventricular gallop'; suggests volume overload/heart failure in adults (can be normal in children and young adults).
- S4 heart sound
- Late diastolic 'atrial gallop'; reflects a stiff, noncompliant ventricle (e.g., LVH, hypertension, ischemia).
- Crackles (rales)
- Discontinuous popping lung sounds; suggest fluid in the alveoli (heart failure, pneumonia, pulmonary fibrosis).
- Wheezes
- Continuous high-pitched musical sounds from narrowed airways; classic in asthma and COPD.
- Rhonchi
- Low-pitched continuous sounds from secretions in larger airways; often clear with coughing.
- Stridor
- High-pitched inspiratory sound indicating upper-airway obstruction (croup, epiglottitis, foreign body) — an emergency.
- Egophony
- 'E' to 'A' change on auscultation; sign of lung consolidation (e.g., pneumonia).
- Murphy's sign
- Inspiratory arrest on RUQ palpation; suggests acute cholecystitis.
- McBurney's point tenderness
- Tenderness 1/3 of the way from the ASIS to the umbilicus; suggests appendicitis.
- Rovsing's sign
- RLQ pain elicited by palpating the LLQ; suggests appendicitis.
- Homans' sign
- Calf pain on dorsiflexion; historically associated with DVT but unreliable — use Wells criteria and ultrasound instead.
- Korotkoff sounds
- Sounds heard during BP measurement; phase I onset = systolic, phase V disappearance = diastolic pressure.
- Orthostatic hypotension
- Drop of ≥20 mmHg systolic or ≥10 mmHg diastolic within 3 minutes of standing; assess for volume depletion or autonomic dysfunction.
- Ankle-brachial index (ABI)
- Ankle SBP ÷ arm SBP; <0.90 indicates peripheral arterial disease; >1.40 suggests noncompressible (calcified) vessels.
- Normal adult respiratory rate
- 12–20 breaths per minute.
- Normal adult heart rate
- 60–100 beats per minute.
- Social smile (milestone)
- Appears around 2 months of age.
- Sits without support (milestone)
- Around 6 months of age.
- Pulls to stand (milestone)
- Around 9 months of age.
- Walks independently (milestone)
- Around 12 months (range 9–15 months).
- Two-word phrases (milestone)
- Around 24 months; vocabulary ~50 words.
- Anterior fontanelle closure
- Closes between 12 and 18 months of age.
- Posterior fontanelle closure
- Closes by about 2 months of age.
- Tanner staging
- Sexual maturity rating (stages 1–5) describing pubertal development of breasts, genitalia, and pubic hair.
- Failure to thrive (FTT)
- Weight (or weight-for-length) persistently below the 5th percentile or crossing ≥2 major percentile lines downward; evaluate organic vs nonorganic causes.
- Plotting growth
- Use CDC growth charts (2–20 yr) and WHO charts (0–2 yr) to track weight, length/height, and head circumference over time.
- BMI percentile (children)
- Overweight = 85th–94th percentile; obesity = ≥95th percentile for age and sex.
- Red reflex
- Screen all newborns/infants; an abnormal or absent red reflex may indicate cataract, retinoblastoma, or glaucoma — refer urgently.
- Ortolani and Barlow maneuvers
- Newborn hip exam screening for developmental dysplasia of the hip (DDH).
- Geriatric assessment essentials
- Function (ADLs/IADLs), cognition, mood, falls, polypharmacy, sensory deficits, nutrition, and social support.
- Get Up and Go test
- Timed Up and Go: ≥12 seconds suggests increased fall risk in older adults.
- Mini-Cog
- Brief cognitive screen: 3-item recall plus clock draw; quick screen for dementia.
- ADLs
- Activities of daily living: bathing, dressing, toileting, transferring, continence, feeding.
- IADLs
- Instrumental ADLs: shopping, cooking, managing finances, medications, transportation, housekeeping, using the phone.
- USPSTF Grade A/B
- Recommendation grades indicating high/moderate certainty of net benefit; services that should be offered/provided (covered without cost-sharing under the ACA).
- USPSTF Grade D
- Recommendation against the service (no net benefit or harms outweigh benefits).
- Colorectal cancer screening start age
- Begin at age 45 for average-risk adults (USPSTF); options include colonoscopy q10y or annual FIT.
- Mammography screening (USPSTF 2024)
- Biennial screening mammography for women ages 40–74.
- Cervical cancer screening
- Ages 21–29: Pap cytology every 3 years. Ages 30–65: Pap q3y, HPV testing q5y, or co-testing q5y.
- Lung cancer screening
- Annual low-dose CT for adults 50–80 with a 20 pack-year history who currently smoke or quit within 15 years.
- AAA screening
- One-time ultrasound for men ages 65–75 who have ever smoked.
- Osteoporosis screening
- DEXA bone density for women ≥65 (and younger postmenopausal women at increased risk).
- Depression screening
- USPSTF recommends screening all adults, including pregnant/postpartum women; PHQ-9 is commonly used.
- HIV screening
- Screen all persons aged 15–65 at least once; screen all pregnant women.
- Newborn screening
- State-mandated heel-stick panel (e.g., PKU, congenital hypothyroidism, sickle cell, CF), plus hearing and critical congenital heart disease (pulse oximetry) screening.
- Lead screening (peds)
- Risk-based or universal blood lead screening at 12 and 24 months per local guidance.
- Prenatal first-visit labs
- Blood type/Rh and antibody screen, CBC, rubella, hepatitis B, HIV, syphilis (RPR/VDRL), urine culture, and Pap if due.
- Fundal height
- After ~20 weeks, fundal height in cm approximately equals gestational age in weeks (±2 cm).
- Cullen's sign / Grey Turner's sign
- Periumbilical (Cullen) or flank (Grey Turner) ecchymosis; suggest retroperitoneal/hemorrhagic pancreatitis.
- Diabetic foot exam
- Annual comprehensive exam including 10-g monofilament testing for protective sensation (peripheral neuropathy).
- Cranial nerve quick check
- CN II–XII assessment; e.g., facial droop sparing the forehead suggests a central (UMN) lesion vs peripheral Bell's palsy involving the whole side.
- Elevated blood pressure (ACC/AHA)
- Systolic 120–129 AND diastolic <80 mmHg.
- Stage 2 hypertension (ACC/AHA)
- Systolic ≥140 OR diastolic ≥90 mmHg.
- Hypertensive crisis
- BP >180/120 mmHg. 'Urgency' = no target-organ damage; 'emergency' = acute target-organ damage requiring rapid, controlled lowering.
- Normal blood pressure (ACC/AHA)
- Systolic <120 AND diastolic <80 mmHg.
- Fasting plasma glucose for diabetes
- FPG ≥126 mg/dL (no caloric intake ≥8 h), confirmed.
- OGTT diagnostic value
- 2-hour plasma glucose ≥200 mg/dL during a 75-g oral glucose tolerance test diagnoses diabetes.
- Random glucose diagnosis
- Random plasma glucose ≥200 mg/dL with classic hyperglycemia symptoms (polyuria, polydipsia, weight loss) diagnoses diabetes.
- Prediabetes criteria
- A1c 5.7–6.4%, FPG 100–125 mg/dL (impaired fasting glucose), or 2-h OGTT 140–199 mg/dL (impaired glucose tolerance).
- Type 1 vs type 2 diabetes
- Type 1 = autoimmune beta-cell destruction, insulin-dependent, often younger, prone to DKA. Type 2 = insulin resistance + relative deficiency, often adult/obese.
- Anion gap
- Na − (Cl + HCO3); normal 8–12. Elevated gap metabolic acidosis: MUDPILES (e.g., DKA, lactic acidosis, toxins).
- Hypothyroidism labs
- Elevated TSH with low free T4 (primary hypothyroidism). Subclinical = high TSH with normal free T4.
- Hyperthyroidism labs
- Low (suppressed) TSH with elevated free T4 and/or T3.
- Iron deficiency anemia
- Microcytic (low MCV), low ferritin, low serum iron, high TIBC. Most common anemia worldwide.
- B12/folate deficiency anemia
- Macrocytic (high MCV) megaloblastic anemia; B12 deficiency may add neurologic deficits.
- Anemia of chronic disease
- Normocytic (sometimes microcytic), normal/high ferritin, low TIBC.
- Reticulocyte count interpretation
- High retic = appropriate marrow response (blood loss/hemolysis). Low retic = production problem (deficiency, marrow failure).
- Urinalysis: nitrites and leukocyte esterase
- Positive nitrites (gram-negative bacteria) and leukocyte esterase support urinary tract infection.
- Microalbuminuria
- Urine albumin-to-creatinine ratio 30–300 mg/g; early marker of diabetic/hypertensive nephropathy.
- eGFR and CKD staging
- CKD staged G1–G5 by eGFR; G3a = 45–59, G3b = 30–44, G4 = 15–29, G5 <15 mL/min/1.73 m². Albuminuria (A1–A3) further stratifies risk.
- BNP / NT-proBNP
- Elevated natriuretic peptides support heart failure; useful to rule out HF when low in dyspneic patients.
- Troponin
- Cardiac-specific marker; elevation indicates myocardial injury (e.g., acute coronary syndrome).
- D-dimer use
- Sensitive but nonspecific; a negative D-dimer in a low-probability patient helps rule out PE/DVT.
- Wells criteria
- Clinical probability score for DVT/PE to guide D-dimer vs imaging decisions.
- Spirometry for asthma
- Obstructive pattern (reduced FEV1/FVC) with ≥12% and ≥200 mL improvement in FEV1 after bronchodilator (reversibility).
- Spirometry for COPD
- Post-bronchodilator FEV1/FVC <0.70 confirms persistent airflow limitation (not fully reversible).
- Strep pharyngitis testing
- Rapid antigen detection test; in children a negative rapid test is backed up by throat culture.
- Mononucleosis
- EBV; fatigue, posterior cervical lymphadenopathy, splenomegaly; positive monospot (heterophile antibody); avoid contact sports.
- CURB-65
- Pneumonia severity score: Confusion, Urea >19 mg/dL, RR ≥30, BP <90/60, age ≥65; guides outpatient vs inpatient care.
- Community-acquired pneumonia diagnosis
- Cough, fever, dyspnea with focal exam findings and an infiltrate on chest x-ray.
- Acute otitis media diagnosis
- Bulging tympanic membrane with impaired mobility plus signs of acute inflammation/middle-ear effusion.
- Bacterial vs viral sinusitis
- Suspect bacterial if symptoms persist ≥10 days, are severe (≥3–4 days fever ≥39°C/purulence), or worsen after initial improvement ('double sickening').
- UTI vs pyelonephritis
- Cystitis = dysuria/frequency/urgency without systemic signs. Pyelonephritis adds fever, flank pain, and CVA tenderness.
- Major depressive disorder (SIG E CAPS)
- ≥5 symptoms ≥2 weeks including depressed mood or anhedonia: Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicidality.
- GAD diagnosis
- Excessive worry more days than not for ≥6 months plus ≥3 physical symptoms; GAD-7 screens.
- Diagnostic criteria for metabolic syndrome
- ≥3 of: waist circumference (central obesity), triglycerides ≥150, HDL low, BP ≥130/85, fasting glucose ≥100.
- Gout diagnosis
- Acute monoarthritis (classically first MTP joint); definitive = negative birefringent needle-shaped monosodium urate crystals on synovial fluid.
- Differential diagnosis
- A prioritized list of possible conditions explaining the findings; refine with history, exam, and targeted testing.
- Pretest probability
- Likelihood of disease before testing; combined with sensitivity/specificity to interpret results (Bayesian reasoning).
- Sensitivity vs specificity
- Sensitivity = true-positive rate (rule OUT when negative, SnNout). Specificity = true-negative rate (rule IN when positive, SpPin).
- Positive predictive value
- Probability that a positive test reflects true disease; rises with higher disease prevalence.
- Likelihood ratio
- How much a test result changes the odds of disease; LR >10 strongly rules in, LR <0.1 strongly rules out.
- Shingles (herpes zoster)
- Painful unilateral vesicular rash in a dermatomal distribution; antivirals within 72 h reduce postherpetic neuralgia.
- Cellulitis vs abscess
- Cellulitis = spreading erythema, warmth, tenderness without fluctuance. Abscess = fluctuant, walled-off collection needing incision and drainage.
- Tinea infections
- Dermatophyte; annular scaly plaques with central clearing; KOH prep shows hyphae; topical antifungals (oral for scalp/nails).
- Contact dermatitis
- Pruritic, erythematous, sometimes vesicular eruption in the pattern of allergen/irritant exposure.
- Hyperkalemia ECG changes
- Peaked T waves → widened QRS → loss of P waves → sine wave; an emergency requiring stabilization with calcium.
- Hyponatremia symptoms
- Headache, nausea, confusion, lethargy, and (severe) seizures; correct slowly to avoid osmotic demyelination.
- TSH as the screening test
- TSH is the most sensitive first-line screen for thyroid dysfunction; reflex to free T4 if abnormal.
- Lipid panel interpretation
- Assess LDL, HDL, triglycerides, total cholesterol; combine with 10-year ASCVD risk to guide statin therapy.
- HbA1c reflects
- Average glycemia over the prior ~2–3 months; unreliable with hemoglobinopathies, anemia, or recent transfusion.
- Antihypertensive first-line classes
- Thiazide diuretic, ACE inhibitor, ARB, or calcium channel blocker (CCB) for most adults.
- HTN first-line in diabetes/CKD
- ACE inhibitor or ARB (renal protection, especially with albuminuria) — do not combine ACEi + ARB.
- HTN first-line in Black adults (no CKD)
- Thiazide diuretic or calcium channel blocker is preferred initial therapy.
- ACE inhibitor cough
- Dry cough from bradykinin accumulation; switch to an ARB, which does not cause cough.
- ACEi/ARB monitoring
- Check potassium and serum creatinine within 1–2 weeks of starting or dose increase; expect a small Cr rise (≤30% acceptable).
- ACEi/ARB in pregnancy
- Contraindicated (teratogenic — fetal renal and skeletal injury). Use labetalol, nifedipine, or methyldopa instead.
- Thiazide diuretic adverse effects
- Hypokalemia, hyponatremia, hyperglycemia, hyperuricemia (gout), and hypercalcemia.
- Beta-blocker indications
- Not first-line for uncomplicated HTN; preferred with compelling indications (post-MI, heart failure, certain arrhythmias).
- BP treatment goal
- Generally <130/80 mmHg for most adults per ACC/AHA, individualized by risk and tolerance.
- A1c goal
- Generally <7% for most nonpregnant adults; individualize (looser for limited life expectancy/hypoglycemia risk).
- Metformin cautions
- Hold for eGFR <30 (avoid initiating <45) and around iodinated contrast; risk of lactic acidosis; GI side effects and B12 deficiency.
- SGLT2 inhibitors
- Preferred add-on with heart failure, CKD, or ASCVD; cardiorenal benefit; watch for genital infections, euglycemic DKA, volume depletion.
- GLP-1 receptor agonists
- Preferred with ASCVD/obesity; promote weight loss and lower CV risk; GI side effects; avoid with personal/family history of medullary thyroid cancer or MEN2.
- Insulin basics
- Basal (long-acting) controls fasting glucose; bolus (rapid-acting) covers meals; hypoglycemia is the key adverse effect.
- Statin intensity
- High-intensity (atorvastatin 40–80, rosuvastatin 20–40) lowers LDL ≥50%; moderate-intensity lowers LDL 30–49%.
- Statin indications (ACC/AHA)
- Clinical ASCVD; LDL ≥190; diabetes age 40–75; or elevated 10-year ASCVD risk after risk discussion.
- Statin monitoring
- Baseline lipid panel and ALT; recheck lipids 4–12 weeks after starting; counsel on myalgia/rhabdomyolysis.
- Asthma stepwise therapy
- Step up with persistent symptoms; ICS (± LABA) is controller; reassess control and step down when stable.
- Asthma SABA-only caution
- SABA monotherapy is no longer recommended for persistent asthma; even mild asthma benefits from ICS-containing therapy.
- COPD pharmacotherapy
- Long-acting bronchodilators (LAMA/LABA); add ICS for frequent exacerbations/eosinophilia; smoking cessation is the most important intervention.
- Levothyroxine for hypothyroidism
- Replace with levothyroxine (T4); take on an empty stomach; recheck TSH in 6–8 weeks after dose changes.
- Strep pharyngitis treatment
- Penicillin V or amoxicillin first-line; cephalexin/azithromycin/clindamycin for penicillin allergy.
- Uncomplicated cystitis treatment
- Nitrofurantoin, TMP-SMX, or fosfomycin first-line (per local resistance).
- Nitrofurantoin cautions
- Avoid with eGFR <30 (ineffective) and in pyelonephritis (doesn't reach tissue); avoid near term in pregnancy.
- Acute otitis media treatment
- High-dose amoxicillin first-line; amoxicillin-clavulanate if recent antibiotics/treatment failure; observation option in select older children.
- Community-acquired pneumonia (outpatient)
- Healthy adult: amoxicillin or doxycycline (or a macrolide where resistance is low); comorbidities: respiratory fluoroquinolone or beta-lactam + macrolide.
- Acute sinusitis treatment
- Most are viral — supportive care; if bacterial, amoxicillin-clavulanate first-line.
- Folic acid in pregnancy
- 400–800 mcg daily for all women of childbearing potential to prevent neural tube defects; higher doses for prior NTD-affected pregnancy.
- Contraception — combined hormonal
- Estrogen + progestin; contraindicated with migraine with aura, age ≥35 + smoking, history of VTE, or uncontrolled hypertension.
- LARC
- Long-acting reversible contraception (IUDs, implant) — most effective reversible methods; first-line for most including adolescents.
- Emergency contraception
- Levonorgestrel (within 72 h), ulipristal acetate (within 120 h), or a copper IUD (most effective, up to 5 days).
- Iron deficiency anemia treatment
- Oral ferrous sulfate with vitamin C; identify and treat the source of blood loss.
- GERD management
- Lifestyle changes plus a proton pump inhibitor; evaluate for alarm features (dysphagia, weight loss, bleeding, anemia).
- Acute gout treatment
- NSAIDs, colchicine, or corticosteroids for the flare; do not start/stop urate-lowering therapy during an acute attack.
- Allopurinol
- Xanthine oxidase inhibitor for chronic urate lowering; target uric acid <6 mg/dL; titrate gradually.
- Antibiotic stewardship
- Use the narrowest effective agent for the shortest effective duration; avoid antibiotics for viral illness to limit resistance.
- Smoking cessation pharmacotherapy
- Nicotine replacement, varenicline, or bupropion combined with counseling improves quit rates.
- Adult immunizations — influenza
- Annual inactivated influenza vaccine for everyone ≥6 months.
- Tdap/Td schedule
- Tdap once (substituting for a Td), then Td or Tdap booster every 10 years; Tdap in each pregnancy (27–36 weeks).
- Pneumococcal vaccine (adults)
- Recommended for adults ≥65 and younger adults with risk conditions (PCV15/PCV20 ± PPSV23 per current ACIP guidance).
- Shingles vaccine
- Recombinant zoster vaccine (RZV), 2 doses, for adults ≥50.
- HPV vaccine
- Routine at ages 11–12 (can start at 9); catch-up through age 26; shared decision-making 27–45.
- Infant immunization schedule (2-month visit)
- DTaP, IPV, Hib, PCV, rotavirus, and hepatitis B (per ACIP schedule).
- MMR and varicella timing
- First doses at 12–15 months; second doses at 4–6 years.
- Live vaccine contraindications
- Avoid live vaccines (MMR, varicella, LAIV) in pregnancy and significant immunocompromise.
- Hepatitis B birth dose
- Give the first hepatitis B vaccine dose within 24 hours of birth.
- Anticoagulation for atrial fibrillation
- Use CHA2DS2-VASc to decide; anticoagulate (DOAC preferred over warfarin for most) when score warrants.
- Warfarin monitoring
- Monitor INR; target 2–3 for most indications; many food (vitamin K) and drug interactions.
- Opioid prescribing safety
- Use lowest effective dose/duration, screen risk, check the PDMP, and offer naloxone; nonopioid options first for most acute pain.
- Beers Criteria
- AGS list of potentially inappropriate medications in older adults (e.g., benzodiazepines, anticholinergics, long-acting sulfonylureas) — raise fall and delirium risk.
- Start low, go slow
- Geriatric prescribing principle: begin medications at low doses and titrate slowly due to altered pharmacokinetics and polypharmacy risk.
- SMART goals
- Patient-centered goals that are Specific, Measurable, Achievable, Relevant, and Time-bound.
- Shared decision-making
- Collaborative process where clinician and patient weigh options, evidence, and patient values to choose a plan.
- Teach-back method
- Ask the patient to restate instructions in their own words to confirm understanding and improve adherence.
- Chemoprophylaxis examples
- Aspirin (selected ASCVD prevention), tamoxifen/raloxifene (high breast-cancer risk), statins, PrEP for HIV prevention.
- Nursing process — implementation
- Carrying out the plan: prescribing/treatments, education, counseling, referrals, and coordinating care.
- Hypertension lifestyle (DASH)
- DASH diet, sodium reduction (<1500–2300 mg/day), weight loss, physical activity, limited alcohol — each lowers BP measurably.
- Resistant hypertension
- BP above goal on 3 drugs (including a diuretic) at optimal doses; add an aldosterone antagonist (spironolactone) and evaluate for secondary causes.
- Secondary hypertension clues
- Young age, abrupt onset, resistant HTN, hypokalemia (hyperaldosteronism), or episodic symptoms (pheochromocytoma) prompt workup.
- Diabetes self-management education
- Teach glucose monitoring, hypoglycemia recognition/treatment, foot care, sick-day rules, and carbohydrate awareness.
- Hypoglycemia treatment
- Rule of 15: 15 g fast carbohydrate, recheck in 15 minutes, repeat if still <70 mg/dL; glucagon if unable to take orally.
- Diabetic complication monitoring
- Annual dilated eye exam, urine albumin-to-creatinine ratio, comprehensive foot exam, and lipid panel.
- DKA recognition
- Hyperglycemia, anion-gap metabolic acidosis, ketones, dehydration; refer/admit for IV fluids, insulin, and electrolyte correction.
- Asthma action plan
- Written green/yellow/red zone plan based on symptoms and peak flow to guide self-management and escalation.
- Asthma exacerbation management
- Oxygen, repeated SABA (± ipratropium), systemic corticosteroids; assess response and need for higher care.
- COPD exacerbation management
- Short-acting bronchodilators, systemic steroids, antibiotics if increased purulence/volume; oxygen targeting 88–92% saturation.
- Heart failure management
- Guideline-directed therapy: ARNI/ACEi/ARB, beta-blocker, MRA, and SGLT2 inhibitor for HFrEF; diuretics for congestion; sodium/fluid counseling.
- Chronic kidney disease management
- BP and glucose control, ACEi/ARB for albuminuria, SGLT2 inhibitor, avoid nephrotoxins, adjust drug doses, and refer to nephrology in advanced stages.
- Hypothyroidism follow-up
- After starting/adjusting levothyroxine, recheck TSH in 6–8 weeks and titrate to target.
- Anemia workup implementation
- Order CBC with indices, reticulocyte count, iron studies, B12/folate; treat the underlying cause.
- Acute coronary syndrome — initial
- MONA-B context: aspirin, nitroglycerin, oxygen if hypoxic, and emergent transfer; obtain ECG within 10 minutes of presentation.
- Stroke recognition (BE-FAST)
- Balance, Eyes, Face, Arm, Speech, Time — activate emergency response; time-sensitive thrombolysis/thrombectomy window.
- Anaphylaxis treatment
- Intramuscular epinephrine (anterolateral thigh) is first-line; supine positioning, oxygen, IV fluids; antihistamines/steroids are adjuncts.
- Otitis media — pain control
- Acetaminophen or ibuprofen for analgesia regardless of antibiotic decision.
- Conjunctivitis management
- Most viral/allergic — supportive care; bacterial gets topical antibiotics; refer for vision loss, severe pain, or contact-lens-related keratitis.
- Low back pain (acute)
- Reassurance, stay active, NSAIDs/acetaminophen; imaging only with red flags (neuro deficit, cancer, infection, cauda equina).
- Cauda equina syndrome
- Red-flag emergency: saddle anesthesia, urinary retention/incontinence, bilateral leg weakness — urgent imaging and surgery.
- Migraine management
- Abortive triptans/NSAIDs; prophylaxis (e.g., beta-blockers, topiramate, CGRP antagonists) when frequent; lifestyle/trigger counseling.
- Depression treatment
- SSRIs first-line plus psychotherapy; reassess in 1–2 weeks for safety and 4–6 weeks for response; all antidepressants carry the <25 suicidality warning.
- Hypertension in pregnancy
- Treat with labetalol, nifedipine, or methyldopa; evaluate for preeclampsia (BP ≥140/90 after 20 weeks with proteinuria/end-organ signs).
- Preeclampsia red flags
- Severe headache, visual changes, RUQ pain, BP ≥160/110 — urgent evaluation; magnesium sulfate for seizure prophylaxis.
- Well-child visit components
- Growth/development surveillance, immunizations, anticipatory guidance, screening (vision, hearing, lead, autism), and safety counseling.
- Autism screening
- M-CHAT-R/F at 18 and 24 months; refer for early intervention if positive.
- Adolescent confidentiality (HEEADSSS)
- Psychosocial interview (Home, Education, Eating, Activities, Drugs, Sexuality, Suicide, Safety) conducted confidentially when appropriate.
- Acute pharyngitis education
- Complete the full antibiotic course for strep; return-to-school after 12–24 h of antibiotics and afebrile.
- UTI prevention counseling
- Adequate hydration, postcoital voiding; consider prophylaxis for recurrent UTIs; vaginal estrogen for postmenopausal women.
- Obesity management
- Comprehensive lifestyle intervention; pharmacotherapy (e.g., GLP-1 agonists) for BMI ≥30 or ≥27 with comorbidity; bariatric surgery for severe obesity.
- Hyperlipidemia lifestyle
- Heart-healthy diet, physical activity, weight management, and smoking cessation alongside statin therapy.
- Tobacco cessation (5 A's)
- Ask, Advise, Assess, Assist, Arrange — the brief intervention framework at every visit.
- Motivational interviewing
- Patient-centered counseling using OARS (open questions, affirmations, reflective listening, summaries) to strengthen motivation for change.
- Alcohol screening
- Use AUDIT-C or single-item screen; brief intervention and referral to treatment (SBIRT) for risky use.
- Immunization documentation
- Record vaccine, dose, date, site, lot number, and provide the Vaccine Information Statement (VIS).
- HIV PrEP
- Daily emtricitabine/tenofovir for high-risk individuals; baseline and periodic HIV, renal, and STI testing.
- STI treatment — gonorrhea
- Ceftriaxone IM; treat for chlamydia co-infection if not excluded; partner treatment and reporting.
- STI treatment — chlamydia
- Doxycycline (preferred) or azithromycin; partner therapy; retest in 3 months.
- Mandatory reporting
- Report suspected child abuse, elder abuse, and certain communicable diseases per state law.
- Scope of practice
- Defined by state nurse practice acts; NP authority ranges from full to reduced to restricted practice.
- Full practice authority
- State licensure allows NPs to evaluate, diagnose, order/interpret tests, and prescribe independently under the board of nursing.
- Reduced/restricted practice
- State law limits ≥1 element of NP practice and may require a collaborative or supervisory agreement with a physician.
- Prescriptive authority & DEA
- NPs prescribe per state authority; a DEA registration is required to prescribe controlled substances.
- Controlled substance schedules
- Schedule II (high abuse, no refills) through V; opioids and stimulants are commonly Schedule II.
- Informed consent
- Process requiring capacity, disclosure of risks/benefits/alternatives, understanding, and voluntariness — not merely a signature.
- Capacity vs competency
- Capacity is a clinical, decision-specific judgment a clinician makes; competency is a global legal determination only a court makes.
- HIPAA Privacy Rule
- Protects PHI while permitting use for treatment, payment, and operations; disclose only the minimum necessary.
- HIPAA exceptions
- Disclosure allowed for mandatory reporting, serious threats to safety, public health, and court orders.
- Four bioethical principles
- Autonomy, beneficence, nonmaleficence, and justice.
- Advance directives
- Living will and durable power of attorney for healthcare document patient wishes and surrogate decision-makers.
- Delegation principles
- Delegate the right task to the right person with the right direction and supervision; the NP retains accountability.
- Care coordination
- Organizing patient care across providers and settings to improve outcomes and reduce fragmentation/duplication.
- Referral criteria
- Refer when the condition exceeds scope, requires specialized testing/procedures, or fails to respond to appropriate management.
- Cultural humility
- Lifelong self-reflection and respect for patients' cultural beliefs; use a professional interpreter (never a family member) for language barriers.
- Social determinants of health
- Conditions where people live, work, and age (income, housing, education, food access) that strongly shape health outcomes.
- Health literacy
- A patient's ability to obtain and understand health information; use plain language and teach-back to improve outcomes.
- Sick-day management (diabetes)
- Continue insulin, monitor glucose/ketones frequently, stay hydrated, and seek care for persistent vomiting or high ketones.
- Wound care basics
- Clean, assess for infection, moisture balance, and tetanus status; refer chronic/nonhealing wounds.
- Tetanus prophylaxis
- For dirty wounds: Tdap/Td if last dose >5 years; add tetanus immune globulin if unvaccinated/uncertain.
- Hypertension medication adherence
- Simplify regimens (once-daily, combination pills), address cost and side effects, and use home BP monitoring.
- Polypharmacy management
- Perform medication reconciliation, deprescribe when appropriate, and screen with Beers/STOPP criteria in older adults.
- Falls prevention
- Review medications, vision, gait/balance, home hazards, and vitamin D; recommend strength/balance exercise.
- Pressure injury prevention
- Reposition regularly, manage moisture, optimize nutrition, and use support surfaces in at-risk patients.
- Pain management approach
- Assess with a validated scale; use the analgesic ladder, multimodal/nonopioid strategies, and function-based goals.
- Palliative vs hospice care
- Palliative care = symptom-focused care at any stage alongside curative treatment; hospice = comfort care when prognosis is ≤6 months.
- Telehealth practice
- Verify licensure for the patient's location, ensure privacy/consent, and document as for in-person care.
- Quality improvement (PDSA)
- Plan-Do-Study-Act cycle: test small changes, measure results, and refine to improve care processes.
- Evidence-based practice
- Integrating best research evidence with clinical expertise and patient values to guide decisions.
- Levels of evidence
- Systematic reviews/meta-analyses of RCTs rank highest; expert opinion lowest.
- Sentinel event
- An unexpected occurrence involving death or serious harm; triggers root-cause analysis and reporting.
- Just culture
- A safety culture balancing accountability and learning — focuses on system errors rather than individual blame.
- Medication reconciliation
- Compare a patient's medication orders to all medications they are taking at every transition of care to prevent errors.
- Anticipatory guidance
- Age-appropriate counseling on safety, nutrition, development, and behavior at well visits.
- Car seat guidance
- Rear-facing as long as possible (at least to age 2), then forward-facing with harness, then booster per height/weight.
- Safe sleep (infants)
- Back to sleep, firm flat surface, no soft bedding, room-share without bed-share to reduce SIDS risk.
- Fluoride and dental health
- Fluoride varnish for young children; establish a dental home by age 1.
- Iron supplementation (infants)
- Breastfed infants generally need iron supplementation starting around 4 months until iron-rich foods are introduced.
- Postpartum depression
- Screen with the Edinburgh Postnatal Depression Scale; treat with therapy and/or SSRIs; ensure safety.
- Menopause management
- Lifestyle measures; hormone therapy for moderate-severe vasomotor symptoms in appropriate candidates (weigh CV/breast risks).
- Asthma trigger control
- Identify and reduce triggers (allergens, smoke, exercise, infections) as part of comprehensive management.
- COPD nonpharmacologic care
- Smoking cessation, pulmonary rehab, vaccinations, and oxygen therapy for chronic hypoxemia (improves survival).
- Statin-associated muscle symptoms
- Assess CK if severe; consider dose reduction, switching statins, or alternate-day dosing; rule out rhabdomyolysis.
- Acute diarrhea management
- Oral rehydration and supportive care; antibiotics only for specific bacterial/parasitic causes; avoid antimotility agents in bloody diarrhea.
- Constipation management
- Increase fiber/fluids/activity; osmotic laxatives first-line; evaluate alarm features and secondary causes.
- Allergic rhinitis treatment
- Intranasal corticosteroids are most effective; antihistamines and allergen avoidance as adjuncts.
- Nursing process — evaluation
- Determining whether outcomes/goals were met; revise assessment, diagnosis, or plan as needed (the cycle continues).
- Hypertension follow-up
- Recheck BP and adjust therapy monthly until controlled, then every 3–6 months; reinforce adherence and lifestyle.
- Diabetes A1c monitoring
- Check A1c every 3 months until at goal and stable, then at least twice yearly.
- Statin response check
- Recheck lipid panel 4–12 weeks after initiation/dose change, then every 3–12 months.
- Levothyroxine titration
- Recheck TSH 6–8 weeks after each dose change; adjust to keep TSH in the target range.
- Antidepressant follow-up
- Reassess in 1–2 weeks for safety/side effects and at 4–6 weeks for response; full effect may take 6–8 weeks.
- Warfarin INR follow-up
- Monitor INR frequently after initiation/dose change, then at least every 4 weeks when stable.
- Asthma control assessment
- Use symptom frequency, rescue-inhaler use, nighttime awakenings, and (optionally) the ACT/peak flow to gauge control and step therapy.
- CKD monitoring frequency
- Monitor eGFR and urine albumin-to-creatinine ratio at a frequency based on CKD stage and risk.
- Outcome evaluation
- Compare results to the goals set during planning; document whether goals were met, partially met, or unmet.
- When to step down asthma therapy
- Consider stepping down after ≥3 months of well-controlled asthma to find the lowest effective controller dose.
- Treatment failure response
- Reassess diagnosis, adherence, dosing, and barriers before escalating therapy or referring.
- Medication adherence assessment
- Ask nonjudgmentally, review refill data, and address barriers (cost, side effects, complexity, beliefs).
- Re-evaluating the differential
- If the patient doesn't respond as expected, broaden or revisit the differential diagnosis.
- Surveillance vs screening
- Screening detects disease in asymptomatic people; surveillance monitors a known condition for change/progression.
- Goal attainment scaling
- Method to measure progress toward individualized patient goals over time.
- Follow-up after ED/hospital
- Transitional-care visit within ~7 days reduces readmissions; reconcile medications and reinforce the plan.
- Documentation of evaluation
- Record outcomes, patient response, plan modifications, and the next follow-up interval.
- PHQ-9 to track depression
- Repeat the PHQ-9 to monitor treatment response; a ≥50% score reduction suggests adequate response.
- Reassessing pain
- Re-evaluate pain after intervention using the same scale and assess functional improvement, not just the number.
- Blood pressure goal not met
- If BP remains above goal, verify technique/adherence, intensify lifestyle, and add or up-titrate medication.
- Glycemic target not met
- Intensify therapy (add agent/insulin), reinforce education, and address adherence and lifestyle barriers.
- Vaccine response/titers
- Check titers when documentation is unavailable or response is uncertain (e.g., hepatitis B in healthcare workers).
- Evaluating screening results
- Communicate results, arrange appropriate follow-up for abnormal findings, and document recall intervals.
- Abnormal Pap follow-up
- Manage per ASCCP risk-based guidelines — repeat testing, colposcopy, or treatment depending on cytology/HPV results.
- Positive depression screen follow-up
- Conduct a full diagnostic assessment, evaluate suicide risk, and initiate or refer for treatment.
- Microalbuminuria trend
- Rising urine albumin-to-creatinine ratio signals progressing nephropathy; intensify ACEi/ARB and risk-factor control.
- Therapeutic drug monitoring
- Check levels for narrow-index drugs (lithium, warfarin/INR, digoxin, certain antiepileptics) to ensure efficacy and avoid toxicity.
- Evaluating patient education
- Confirm understanding with teach-back and assess whether behavior change/self-management goals were achieved.
- Re-screening intervals
- Define the next screening based on results and guidelines (e.g., normal colonoscopy → 10 years; normal co-test → 5 years).
- Reassessment after antibiotic course
- Evaluate symptom resolution; persistent or worsening symptoms prompt reassessment for resistance, complications, or wrong diagnosis.
- Monitoring for medication side effects
- Schedule labs/visits to detect adverse effects (e.g., potassium with ACEi, LFTs with certain drugs).
- HbA1c discordance
- If A1c and glucose logs disagree, suspect a hemoglobin variant, anemia, or measurement issue and use alternative markers.
- Care plan revision
- Modify diagnoses, goals, or interventions based on evaluation findings — the nursing process is cyclical.
- Patient-reported outcomes
- Use validated questionnaires to capture symptoms, function, and quality of life from the patient's perspective.
- Evaluating fall-prevention plan
- Reassess fall risk and home safety periodically; adjust interventions after any new fall.
- Chronic disease registry
- Population-health tool to track and recall patients due for monitoring or overdue for goals.
- Closing the referral loop
- Confirm the consult occurred, review recommendations, and integrate them into the care plan.
- Evaluating immunization status
- Review the record at each visit and administer due/overdue vaccines (every visit is an opportunity).
- Reassessing function in elders
- Periodically re-evaluate ADLs/IADLs, cognition, and mobility to detect decline early.
- Treatment de-escalation
- Once control is sustained, consider reducing therapy to the lowest effective regimen and monitor for relapse.
- Quality metric evaluation
- Track measures (BP control, A1c <7%, screening rates) to assess and improve practice performance.
- Evaluating anticoagulation
- Reassess bleeding/clotting risk over time (e.g., HAS-BLED, CHA2DS2-VASc) and adjust therapy accordingly.
- Recheck after dose titration
- Re-evaluate efficacy and tolerability at an appropriate interval after each medication change.
- Documentation as evaluation tool
- Accurate, timely documentation supports continuity, legal protection, and outcome evaluation.
- Outcome not met — root causes
- Consider adherence, diagnosis accuracy, dosing, comorbidity, and social barriers before concluding treatment failure.
