ASN Exam 4 Study Guide

(PLEASE READ THE ATI SECTIONS, LAB WORKSHEETS, AND LECTURE CONTENT) This
study guide is just meant to briefly cover what I believe would be on the test.
If you have any additions you would like me to make, or have any questions, please message me at
vannanquan.nguyen@mga.edu or in the GroupMe (Junior Nguyen)

Dosage Calc (Units to Remember)/I&O

1 ounce (oz) = 30 mL | 1 gram (g) = 1000 milligram (mg) = 1,000,000 microgram (mcg)
1 teaspoon (t) = 5 mL | 3 t = 1 Teaspoon (T) | 2.2 pounds (lbs) = 1 kilogram (kg) 1
cc = 1 mL
Jello and ice cream is included with I&O. Pudding, yogurt, or custard are not. Ice chips are halved, so if
ice chips is 8oz, for input, you would record 4oz instead. Also remember that IV amount counts for input.
Insensible loss – Water loss from skin and lungs. This is not calculated, just good to know about its
existence. Typically it’s a loss of 600mL daily. If output is greater than input – Risk for Dehydration
If input is greater than output – Risk for Volume Fluid Overload
ALWAYS RECORD IN mLs. Remember to convert from 1oz to 30 mL.
For output, if there’s bladder irrigation, subtract the amount used to irrigate from the total amount in
foley bag/collection method to get urine output amount. Remember output can also include emesis
Mobility/Immobility & Safety
Mobility is another way to say motion/movement. Immobility is inability to reposition or move self
(could lead to complications like pressure injury which is why turning every 2 hours is so essential)
Tendons – muscle to bone
Ligaments – bone to bone
Cartilage – reduces friction between bones
Synovial joints – allow for flexibility and movement of bones
Functions of Skeletal Muscle – Movement, Posture, Positioning, and Body heat (shivering)
Functions of Skeletal System – Support, Protect (internal organs), Produce (RBCs, WBCs, platelets, and
macrophages from bone marrow), Storage (calcium, phosphorus, magnesium, iron, and lipids), and
Movement
Neurological System – Composed of Central Nervous System (brain and spinal cord) and Peripheral
Nervous System (the thousands of nerves that interface with spinal cord that run throughout rest of body).
The nerves are encasing in connective tissue and communicate with muscles and sensory receptors via
neurotransmitters.
Muscle movement is under a person’s conscious control, but brain coordinates the action. Propioception
or kinesthesia is where sensory information sent to receptors is sent back and forth to the brain, creating a
sense of self-awareness and body position that enables the body to coordinate, balance and fine-tune
body’s position and movement.
Body mechanics – combined effort of the musculoskeletal and nervous systems to maintain posture,
alignment, and balance in daily life. Describes how you use your body to sit, stand, lift, carry, bend, or lie
around. Incorrect and unsafe movement can place abnormal stress on spine, resulting in injury or
degeneration from the wear and tear. Key principles are body alignment, balance, and body movements
Body alignment – Positioning of body parts while performing activities. Optimal posture supports spine,
muscles, and joints. When handling clients or lifting objects, keep back straight, the chin level, and
tighten abdominal muscles
Center of gravity is central point of weight, just below umbilicus when standing straight up. Center of
gravity shifts with positioning, typically you want CoG lower or as close to base as possible to improve
stability and balance. Creating a wide base by spreading the feet shoulder-width apart and flexing
the knees improves stability and balance.
Body Movements – Reaching, bending, and twisting motions risk muscle strain/injury. Keep client or
object as close to nurse’s body as possible. Face to face with patient when transferring, pivot feet in
direction of movement instead of twisting spine. Bend knees and not back, when picking up objects from
lower level
Proper Body Mechanics
Stand or move as close to the object as possible.
Keep the abdominal muscles contracted (tightened) and the lower back in its normal position. Maintain
the head upright with shoulders raised up.
Bow the hips slightly and squat.
Do not twist the torso. Always pivot or side-step.
Push up from the knees and use that momentum to lift the object.
Nursing specific Body mechanics – Locking bed and raising bed to avoid bending back. Also crossing pt’s
arm across chests in order to reduce friction. Use drawsheet, and spread feet apart to improve balance, flex
hips and knees, using two people for lifts.
Ergonomics - study of body mechanics in relation to the demand and design of the work environment,
along with the equipment used. It focuses on designing, adjusting, and arranging items so that people can
work safely and efficiently. Examples of ergonomics in Healthcare Setting: Modifiable workstations
and chairs, Keyboards with wrist supports, Adjustable IV stands and poles, Height-adjustable beds,
Twoperson lifts/transfers, Client transfer devices, Shower chairs, Toilet seat risers, Side-opening garbage
and linen containers, Elimination of uneven floor surfaces
Mobility – capacity to move about without restrictions. Mobility typically results in better outcomes than
simply bedrest.
Effects of Decreased Mobility
Bones are constantly remodeling – they breakdown and then are subsequently replaced throughout one’s
life. That means that prolonged immobility reducing the mechanical load and stress on bones contribute
to a loss of mass, density, and strength, this is called Disuse osteoporosis. This demineralization in fragile
bones can result in fragility fractures – fractures that occur following stress that would not typically
result in a break. Assist client with weight-bearing activities to help with disuse osteoporosis.
Muscles can undergo a similar process. Atrophy – becoming smaller and weaker, typically from disuse.
Occurs from prolonged bed rest and limb immobilization. More noticeable in older adult populations.
Sarcopenia – loss of lean muscle caused by immobility. Typically occurs in the lower extremities due to
the constant work done there to keep the body upright. This is why clients experience weakness in legs
after a few days of bedrest. Have client participate in self-care activities to promote muscle usage. Also
include dangling, sitting, and standing to build strength.
Joint contractures are abnormal fixations of the joints that occur as a result of changes to muscles and
connective tissue. The flexor muscles are naturally stronger than extensor muscles. In clients with
continued muscle disuse, atrophy occurs and leads to an imbalance between the opposing muscles. The
stronger flexor muscles pull and place a joint in a bent, nonfunctional position. This can occur in as few
as 4 days of bed rest. Have pt perform ADLs to promote flexion and extension. Move joint every 8
hours, use splints if prescribed on contracted joints, inspect position and posture for proper body
alignment every 2 hours.
Foot drop – is another type of joint contracture, the inability to perform dorsiflexion. It results from nerve
entrapment and shortening of the calf muscles and Achilles tendon in the lower leg. Ambulation prevents
this, notify HCP if foot drop is noted, and apply splints if it is present when prescribed.
Cardiovascular Deconditioning - Atrophy of the heart muscle that results in a decreased amount of blood
being ejected from the heart during contraction. After 24 hours of bed rest, body fluids that pool in lower
extremities is redistributed to head, abdomen, and chest areas. This imbalance is fixed via hormones, but it
results in decreased circulating blood volume.
Orthostatic hypotension - a decrease in blood pressure and a sensation of dizziness that occurs when a
client sits or stands up. Resulting from long periods of immobility, it can increase risk for client falls. A
decrease in systolic blood pressure of 20 mm Hg or more or a decrease in diastolic blood pressure of 10
mm Hg or more within 3 minutes of changing to a sitting or standing position indicates Orthostatic
hypotension. Interventions that can be done include: elevate head of bed, assist pt from lying to sitting to
standing, change positions slowly, and apply antiembolism stockings to decrease venous pooling in
lower extremities.
Properly fitting on an antiembolism stocking involves measuring pt’s calf circumference and leg length.
Also making sure that their toes are covered/not exposed. Smoothen and straighten, no wrinkles present.
Knee-high stockings are two inches below back of knee. Thigh-high stockings are two inches below
buttocks. Assess client’s comfort and circulation after 30 mins.
Deep Vein Thrombosis - a thrombus or blood clot develops in one or more of the deep veins, typically in
the arms, pelvis, thighs, or lower legs. Immobile pts have greater risk. DVTs can result in the following:
Pulmonary Embolism - An obstruction of blood flow in a pulmonary artery due to the movement of
blood clot from an extremity to the lungs. Cerebrovascular Attack (CVA or Stroke) - Death of brain
cells due to a blood clot or the rupture of a blood level within the brain. Myocardial Infarction (MI or
heart attack) - A condition in which arterial blood flow to the heart muscle is blocked resulting in death
of cardiac muscle cells. Ambulation and sequential compression devices prevent DVTs. Also, leg
exercises like flexing ankle and circling foot around, antiembolism stockings, fluid intake, and
anticoagulant meds.
SCDs should be taken off if there is an indication of an DVT present.
Atelectasis – Partial or complete collapse of lungs, including airways and small sections of lung tissue,
resultant from shallow breathing, typically from supine positioning (laying down) which impairs ribcages
ability to freely expand and puts pressure on diaphragm. Incentive spirometer, deep breathing and cough
exercises, elevating head of pt bed, turning every 2 hours
Pneumonia – Infection in limited mobility pts related to shallow breathing, thickened mucus, and
decreased ability to cough. Prone position can help promote secretion drainage. Elevate head of bed.
Increased fluid intake. Oxygen therapy as prescribed. Deep coughing, coughing, and turning
Malnutrition – absorption of protein from GI tract into the blood is decreased, leading to risk for
malnutrition for pts on bedrest due to slowed muscle activity/peristalsis. Select high-protein,
nutrientdense foods with the pt’s preferences. Consult dietitian.
Constipation – 16 times more likely to occur in pt on bedrest compared to active pt. Can result from
hardened stool or decreased urge to defecate. If it becomes chronic, fecal impaction (hardened fecal mass
causing a blockage) can occur. Increase fluid intake, high-fiber diet, and pt’s mobility to help treat.
Evaluate pt for N&V or abdominal pain
Gastroesophageal reflux - A backflow of gastric fluids into the esophagus that can result in irritation of
the tissue, pressure is put on the lower esophageal sphincter here. Occurs when lying flat. Heartburn can
be an indication of this. Elevate head of bed after meals to counteract reflux.
Urinary retention - A condition in which the bladder does not completely empty with urination, occurs
when lying flat. Gravity causes abdominal organs to exert pressure on bladder, enhancing sensation of
urge to void, but when supine, this is not present. Encourage fluid intake to fill bladder and encourage
urge to void, assist client to toilet/commode to promote emptying, and remind pt to urinate in
upright position.
Incomplete drainage of the kidneys and urinary retention can lead to the formation of renal calculi –
kidney stones, that can lead to UTI and overdistention of bladder, damaging bladder lining. Frequent
voiding of urine can help prevent. Pt should turn in bed and maintain perineal cleanliness.
Pressure Injuries can occur from Immobility: Stage 1: Redness, Stage 2: Broken skin, but no fat present
(blisters also count as stage 2), Stage 3, fat present, Stage 4: Muscle/Bone present. Prevent with high-
protein meals and shakes (like Ensure). Turn every 2 hrs, pillows & cushions, assistive devices,
moisturize dry skin, keep skin free of moisture from incontinence, wound drainage, or perspiration.
Decreased mobility leads to increased dependence on others, loss of privacy, and inability to participate in
work/hobbies. This could result in negative impact to self-concept – beliefs one holds regarding their
qualities and attributes formed through experiences. Social isolation can occur as well. Encourage
interaction with family, staff, friends, or other clients to counteract isolation. To counteract
depression, encourage pt expressing their feelings, communicate support and empathy to client, and
report mental health concerns to provider.
Assessment of Mobility
Activity Intolerance - Inadequate amount of physical or psychological energy to undergo or complete a
necessary activity, related to prolonged bed rest, decrease in mobility, balance difficulties, or weakness
due to an illness or hospitalization. A tool for evaluating activity tolerance from the client’s perspective is
the Borg Rating of Perceived Exertion (RPE) scale, allowing clients to gauge, subjectively, their level
of exertion during activities. 6, indicating a state of resting or sitting that is effortless. 20 indicates
maximum effort is required. Clients should be sitting at between 12-14, a somewhat hard to strong effort.
ADLs (Activities of Daily Living) – dressing, bathing, toileting, and feeding oneself. Toilet seat risers can
assist with these.
Kyphosis, an outward curvature of the thoracic area of the spine, most commonly occurs in older adult
females due to weakening and breakage of the vertebra. This posture change can impact a client’s ability
to ambulate and rise from a seated position.
Mobility Assessment (Done with the Mobility Assessment Tool/MAT) – assesses how well a client
moves, including what equipment is needed for them to maximize mobility potential. Assessment
includes the following: Normal mobility status, ability to sit/stand/walk, Use/need for assistance, Degree
of mobility/immobility, Skin condition, and Presence of manifestations during activity. Begins at Level 1
and ends at Level 4. 1 is Maximum Assist pt, and 4 is No assist.
A pt who CANNOT sit at the side of the bed and hold position is MAXIMUM ASSIST. (Mechanical
lifts/slide boards)
If pt can sit at side of bed, it’s Moderate Assist (Mechanical sit to stand lifts)
Minimal Assist if pt can rise up from seated position with an assistive device. (gait belt)
No Assist it pt can MARCH in place
Gross Motor Skills - The use of large muscle groups to perform whole body movements.
Changes in Older Adult Pts that can affect mobility: Increase spine curvature can result in forward
leaning/stooped posture resulting in unsteady ambulation. Poor balance r/t nervous system dysfunction
can cause unsteadiness/decreased ability to right oneself. Joint stiffness r/t cartilage loss can result in
slower steps with a wider stance. Loss of muscle mass means increased fatigue with ambulation. Lower
visual acuity can result in hesitant ambulation and risk for trips/falls.
Dangling - The act of having a client sit on the edge of the bed for a few minutes before moving to a
standing position. Done to counteract orthostatic hypotension.
Gait belt – used for Minimal Assist pts to help them ambulate and can be used in conjunction with other
assistive devices. Placed on top of clothes around waistline, adjusted for incisions and drains by moving
belt slightly. Make sure fingers can fit under belt
Assistive Devices – Cane (Make sure it’s same length as great trochanter, held with side opposite of
injured leg, elbow bent 15-30 degrees while gripping cane, keep cane on same level as weaker leg when
climbing stairs, advance with cane, then good leg, then bad leg parallel to cane), Crutches (Bear weight
on good leg, then advance crutches. After planting crutches, swing body forward even to crutches, make
sure there is 2-3 fingers length between armpits and crutches, hand grips should be even with hips, and
elbows 15-30 angle bent when gripping), Walker – provide greatest support (Advance walker first, then
affected leg, then unaffected leg, when holding walker 15 degree angle in arm), Gait belt (Used to walk pt
who are fall risk)
Crutches require a substantial amount of upper arm strength and are best used by younger clients.
Ensure the client understands that the bodyweight should be supported by the hands on the grips,
not in the axilla. Bearing weight on the top of the crutches can lead to nerve damage that causes
numbness and tingling in the arms.

In general, for walking with an assistive device – Device first, then weak side, then strong side. CLIENT
MUST BE ABLE TO SIT BY SELF UNASSISTED in order to use Assistive Device
Slide Board - allows the lateral transfer of a client without imposing the physical exertion of lifting on the
staff member
Pivot Disc - is used for sitting or standing transfers for clients who are cooperative and have
weightbearing capabilities. This tool is used for clients who can stand but have difficulty moving their
feet.
Mechanical Sit-to-Stand Lift/Mechanical Lift – helping pt go from sitting to standing position for the 1st
one and to transfer an immobile pt for the 2nd one.
ROM Passive or Active helps joint function and flexibility, improves posture, reduces stiffness, and lowers
risk of injury.
Health promotion: all adults should engage in moderate-intensity aerobic activities for at least 150 min per
week (30 min per day, 5 days per week). Aerobic activities like ballroom dancing, water aerobics,
swimming laps, brisk walking (2.5 miles), hiking, and slow bike riding at 10 miles per hour.
Resistance bands are good for muscle-strengthening and improve balance.
____________
Alarm fatigue, or sensory overload from the noise pollution created in part by the numerous distress alerts
and nuisance alarms, which then affects client safety and increases the risk for negative client outcomes.
Culture of Safety - Have nurses spend 70% of their time at the bedside performing direct client care,
Strengthen management through leadership development programs, Implement a rapid response team for
the facility’s medical–surgical units, and create frameworks for standardized communication
Joint Commission’s National Patient Safety goal – teachings on how to prevent surgical-site infections,
to prevent Hospital-Acquired Infections (HAIs)
Currently, nurses spend less than 2 hours of 12-hour shift by client bedside. If more time is spent at
bedside, less HAIs, Falls, and Medication Errors would occur.
Strategies to improve Patient Safety/Satisfaction – Hourly Rounding (a nurse checking on pt every hour
for toileting, positioning, pain management, safety check on siderails and bed positioning, and call light
proximity), Leadership Development, Rapid Response Team (RRT), Utilize a Standardized
Communication Tool
5Ps of Hourly Rounding – Pain, Potty, Position, Possessions, Pump Handoff
communication is done at pt bedside.
Leadership Development – Strong management skills and strategies, Team performance building
strategies, Ability to hire staff, willingness to uplift/praise staff when needed, coach staff when they lack a
skill/behavior, and the ability to conduct performance evaluations of staff members. Rapid Response
Team (RRT) – Dedicated interdisciplinary team who brings critical care knowledge/skills to pt’s bedside.
Comprised of ICU Nurse, Respiratory Therapist, and Critical Care Provider. Priority alert received when
pt not doing well/client’s condition changes suddenly. RRT gathers at the client’s bedside to rescue the
client from a potentially life-threatening event after receiving alert.
RRT decrease cardiac events (cardiac arrest) resulting in reduced mortality.
Conditions that warrant RTT callout: Sudden VS change, Low oxygen sat despite efforts to oxygenate,
Chest pain despite nitroglycerine administration, Seizure, Medical professional has deep concern about
client’s condition, or Sudden variation in mental status.
Standardized Communication Tool: ISBARR – Used to make report or handoff to other medical
professionals to convey relevant client specific information. Identity, Situation, Background,
Assessment, Recommendations, Read Back.
Identity – Introduce self and where you’re calling from
Situation – Client name & age, admitting diagnosis, chief complaint/urgent need for RRT to be called
Background – Medical history, including currents meds & advanced directives
Assessment – General client impression & significant findings r/t assessment, diagnostic tests, lab work,
and Vital Signs
Recommendations – Treatment provide and client response to said treatment
Read Back – Read back message or prescription from provider, allowing for clarification to prevent
miscommunication.
ISBARR is concise and focused, helping reduce med errors.
____________
Unexpected events
Near Miss – potential error/event/circumstance that could have caused harm, but was caught & avoided
Patient Safety Event – Unexpected event/circumstance that occurred without injury to patient.
Adverse Event – Situation/event that caused unexpected harm to client
Sentinel Event – Critical, unexpected adverse event that caused severe physical/psychological harm to pt,
including death/dismemberment, permanent injury, or severe temporary injury.
Occurrence reporting – ALL client safety/care events or concerns must be immediately reported to the
nurse leader or another manager according to facility procedures/policy. After leadership and provider are
notified and client is safe, then occurrence/incident report should be made. This report is intended to
provide hospital, administration, and staff with an opportunity to investigate the issues that led up to the
unexpected event to help prevent future unexpected incidents. These reports typically come from frontline
staff members (nurses, pharmacists, physicians), but management can make these as well. NEVER
MENTION OCCURRENCE REPORT IN CLIENT’S HOSPITAL CHART, these reports are
internally handled by the facility. Can be used for legal purposes.
Unexpected events that can be documented in an occurrence report – Accident/injury (fall),
unexpected vaccine reaction, unexpected drug reaction, wrong vaccine/drug given to client, Incorrect
administration of drug/vaccine, property damage/lost items, exposure to blood, body fluid, or other
infectious material on skin, eyes, or mucous membranes, and atypical behaviors, actions, or events that go
against facility policy/procedures.
Time-out - a pause in all personnel activities within the operating or procedure room—take place before
each surgery, ensuring right patient, right procedure, and right site.
______________
Patient Falls – Main Safety Risk for older adults. 1 in 3 older adults each year experience a fall. Every
20 mins, the fall is fatal. Nurses should routinely conduct fall risk assessments with clients and provide
education to reduce chances of fall-related injuries. Fall is defined as “unplanned descent to the floor with
or without injury.” Every 11s in the US, a fall occurs and every 19 min, it’s fatal. In the hospital setting
between 700,000 and 1,000,000 clients fall each year, costing hospitals $19.2 billion and extending
hospital stays for clients by 7 days on average.
Hospital Fall Precautions – Non-skid footwear, Bed locked in lowest position, Bed wheels locked,
Brakes on wheelchairs, Clutter-free environment, Adequate lighting, Call light and belongings in pt’s
reach, fall prevention education, orientation to room and call light system, hourly rounding, timely
answering of call lights (This one and hourly rounding have positive correlation with reduction in falls and
patient satisfaction), bed/chair alarms, yellow armband.
TWO MOST IMPORTANT INTERVENTIONS TO PREVENT FALLS – Fall risk assessment & Pt
education
NUMBER ONE INDICATOR OF POTENTIAL FALL RISK IS HISTORY OF PREVIOUS FALLS
If pt is taking antidepressant, make sure they sit up and stand up slowly at bedside for a couple of
minutes before heading to use restroom. Antidepressants can cause orthostatic hypotension. If a fall
occurs, FIRST PRIORITY is assessing what happened, determine if any injuries occurred, THEN
you can document and correct cause.
Two major factors that cause falls – Intrinsic factors (aging process and physical illness) and Extrinsic
factors (environmental factors).
Home Safety Bathroom Precautions – Grip bars by toilet, shower, or bathtub. Waterproof
bathmat/nonslip strips to base of tub and shower floor. Waterproof chair/seat in shower. Rubber-backed
bathmats to prevent sliding on bathroom floor. Raised toilet. Step-free shower/tub entryway. Electric
Razor (ESPECIALLY if on anticoagulant medication). Reduce water temp to 49 C/120 F to prevent
scalding. Install GCFIS (shuts off electricity to protect client from electrocution if touching outlet with wet
hand or body part). Remove all toxic cleaning supplies from bathroom or put in locked cabinet. Home
Safety Bedroom Precautions – Lower bed/mattress in case of rolling out of bed. Hospital bed for clients
with mobility difficulty. Install floor mat alarm, motion sensor alarm, or audio/video alarm for alerting
family/caregivers if client has mobility or cognitive issues and are trying to get out of bed unassisted.
Home Safety Kitchen Precautions – Place commonly used items in reach without a stepstool. If you
must use stepstool, make sure it has rubber gripped on bottom to prevent slippage. Stove with auto shutoff
function. Install GCFIS. Toxic cleaning supplies in locked cabinet. Turn pot handles to face back of stove
to avoid accidental burns.
Other safety precautions: Ramps instead of stairs. Nonslip socks. Ambulatory Assistive Device If
client has ataxia and is being discharged home, ensure that all scatter rugs are removed from home.
Most important intervention for falls is PREVENTION. Minimize intrinsic/extrinsic factors
Inspect heater if it’s making you dizzy, DO NOT WARM UP CAR IN GARAGE DUE TO CARBON
MONOXIDE POISONING
General Home Safety Precautions – Bright lighting/motion sensor lighting for cataract or similar pts.
Traditional doorknobs replaced with door handles for ease of use. Pets and their food bowls are trip
hazards, keep away if able. Eliminate swivel/wheel chairs. Remove loose rugs/secure electrical cords to
edge of floors. Paint walls one color to create greater reflection of light. Daily pill dispenser used, keep out
of reach of children. Chair lift to assist with sitting or standing pt down in chair. Handrail installation.
Replace/remove uneven flooring/pavement. Mark edges of stairs/areas with change in flooring with bright
colored tape. Cordless window coverings to avoid strangulation of children (or if too cost-prohibitive,
store cords away). Keep emergency numbers in phone (Poison control, local police, fire department)
Home Safety Fire Precautions – Fire and Carbon Monoxide Detectors on every floor/outside each
sleeping quarter. Test alarms monthly and change battery every 6 months. Place fire extinguishers on
every floor, especially basement, kitchen, and garage. Maintain passable pathway to exit. Identify two exit
points from each room of house and purchase rescue ladder for multilevel homes. Practice escape plan
twice a year, one being done at night, and make sure to select central gathering area outside of home. Do
not overcrowd electrical outlet. Only one appliance per plug (fridge, dryer, etc.). Unplug small appliances
(like toasters) when not in use. Cover available outlets if children are in home. Replace broken/exposed
electrical cords. Keep flammable items 3 feet minimum away from space heaters. Inspect fireplace
chimney annually and only use dried/seasonal wood to reduce risk of fires.
Social services can assist with electricity if electricity turned off in a client’s home. Usual temperature
comfort range is 65-75 Degrees Fahrenheit.
Hypothermia is when body core temp is 95 Degrees F or less.
Remove gloves after empty urinary catheter, then remove eye protection, then hand hygiene.
Pt’s surgical site is written on in order to distinguish correct surgical site.
Used needles go in red needle container
A pt who states when how many days they need to take the antibiotic for is the appropriate answer when
asking if they understand the directions
Children in late infancy/toddlerhood are at risk for injury owing to growing ability to explore and oral
activity.
School-age children should wear a bicycle helmet because bike-related deaths and injuries are a major
risk factor during this time.
Adolescents need teachings on drugs and alcohol for safety due to risk-taking behavior
Safety teachings for older adults would something like “Can you hear the tornado sirens in your area?”
due to presbycusis (aged-related hearing loss)
Diversionary tactics like asking a pt to fold washcloths could be an alternative to restraints Falls
= Wet floors
Patient-inherent accidents = pinching finger in doors
Procedure-related accidents = Failure to use lift
Equipment-related accidents = Improperly functioning alarm, sequential compression devices High
risk for falls armband placed on pts admitted for falls. Lock beds and chairs in place when
transferring pt from bed to chair
Most errors occur during the medication process in Ordering and Administrating Benadryl
increases risk for falls, same as being 60 years old.
Pts pulling on IVs or urinary catheters when confused would have the Nursing Diagnosis of “Risk for
Injury”
Never induce vomiting if accidental poisoning occurs
Check pt pulse if they’re unconscious and nonbreathing to determine if they need CPR
If you are helping ambulate pt and an alarm sounds, ask another nurse to check alarm
Pts should take water pill in morning to reduce number of bathroom trips at night, which is the time falls
are most frequent
CODE RED = FIRE
R.A.C.E. – Rescue, Alarm, Contain (close doors/windows), Extinguish
P.A.S.S. – Pull, Aim, Squeeze (aim at base of fire), Sweep
Active Shooter Safety – 3 PRIORITY ACTIONS in order of priority – RUN, HIDE, OR FIGHT.
CODE SILVER = ACTIVE SHOOTER
_______________
When to use Restraints – Client exhibits unnecessary/unwanted movement that is unsafe. Client attempts
to remove needed medical items (feeding tubes, IV catheters, indwelling urinary catheters, breathing
devices, drains, or bandages.) Safety/Security precaution before or during a procedure. Aggressive or
Combative client. Client is danger to self or others. Other alternatives have exhausted and delayed
application of restraint could potentially cause significant injury/damage.
Restraint Alternatives – Engaging socially with client. Offering diversional activities. De-escalate
situation. Place client in room near nurses’ station. Encourage family member presence at bedside. Have
sitter at bedside. Use bed/chair alarms. Keep IV tubing, catheters, or other medical devices out of pt view.
Remind pt to not pull on medical device/get out of bed.
Restraint Assessment/Safety – Quick tie release knot, never tie to bed rail. Assess restraint site often to
monitor circulation and ROM. Discontinued or Revised restraint as soon as clinically possible and when
client is safe (EX. Restraint applied when pt pulled at IV line. If IV line is discontinued, can take off
restraint immediately afterwards). Reevaluated need for mechanical restraint every 24 hours by provider.
Never use for cruelty, corrective action, revenge, staff convenience, or staff shortage. Only use as last
resort.
Remove restraints every 2 hours to assess limbs and skin. Can put 2 fingers between restraint and pt’s
ankle/wrist. Make sure they are never attached to side rail.
LOOK UP RESTRAINTS ON LAB SECTION AND ATI MODULES
Pre Seizure Safety Precautions – Suction equipment set up at bedside. O2 set up at bedside. Check
baseline VS, including O2 Sat. Establish two IV sites. Ensure siderails are padded to prevent injury during
seizure activity. Remove potentially constrictive clothing/jewelry. Ask client if they feel an aura (sensation
that the seizure is about to happen) and to notify if they feel it. Remove dentures during aura if possible
Safety during a seizure – Call for immediate assistance (RRT), suction as needed to maintain airway.
Assist pt into side-lying position, protect pt head from injury, place folded towel, jacket, or pillow under
pt’s head. Remove furniture/objects that may pose danger to seizing client. DO NOT HOLD DOWN
CLIENT, CAN CAUSE INJURY. Loosen restrictive/tight clothes around neck. DO NOT LEAVE
CLIENT, reassure any family members/visitors who are present. Monitor for start time/when it was found,
duration, and activity occurring when seizure started, if known. Provide O2 is sats are low. Assess VS,
skin color and temp (Does pt look pale, cyanotic, or clammy?). Provide verbal assurance that assistance is
on the way. Obtain blood glucose level at bedside, follow provider’s prescription to replace glucose.
If seizure starts in chair, assist pt down to floor. After seizure activity, make sure to lay pt on side and let
them rest if they’re exhausted. DO NOT PLACE ANYTHING INSIDE MOUTH DURING
TONICCLONIC SEIZURE, can cause broken teeth or injury to lips/tongue.
Prevention of Work-related injuries – Work-related Musculoskeletal disorders (MSDs) are common
among nurses. 25,000 recorded instances in 2018, 6000 of which were back injuries (healthcare workers
have highest incidence of this injury). Direct correlation between back pain incidence/injury and tasks
performed by nursing personnel. Standing for too long, turning, repositioning, and moving clients in bed,
transferring clients in/out of bed/chair can all cause these MSDs. Also assisting clients with ADLs.
Needlestick Injury Prevention Tips: Empty sharps container when less than ¾ full. Report any needlestick
injuries to Nursing Supervisor. Engage Needle Safety Device immediately after withdrawing needle from
pt. NEVER recap a needle after med administration.

Basic Pharmacology
Drugs only have one generic drug name, but can have multiple brand/trade names. Despite the
difference in names, these drugs have the same chemical composition and same effects. Generic drugs are
generally less expensive. Generic names are not capitalized.
IV drugs have immediate and complete onset. Subq shots can be rapid if highly water soluble and pt has
good circulatory flow, or slow if poorly water soluble and/or circulatory blood flow is slow or impaired.
It’s variable. Topical/transdermal drugs are applied to skin, eyes, ears, nose, rectum, vagina, or lungs.
They deliver a constant amount of the drug over an extended period of time, have slower onset of action,
and longer duration of action compared to oral/parenteral.
______
Pharmacokinetics – Absorption (How will it get in? Orally, Parenteral, etc.), Distribution (Where will it
go? Transporters), Metabolism (How is it broken down? Liver), Excretion (How does it leave body?)
Absorption – Oral drugs are absorbed in gut wall then enter portal vein, then liver, then body’s
circulation (Typically amount ingested is less than amount that ends up inside of body’s circulation due to
First-pass effect that occurs in liver). Bio-availability is the amount of the oral drug available after
passing through the liver. Parenteral absorb through veins directly, muscle indirectly, or subcutaneous
tissue indirectly. They then enter the blood, THEN pass through the liver. This bypasses the First-pass
effect. Metabolism of drugs typically take place in liver.
Distribution – Movement of drug by circulatory system to intended site of action. Drugs enter blood after
being absorbed by intestinal wall in case of oral medication, Alveoli in lungs via inhalation drug, or via
direct/indirect methods like IV/IM/Subq. Areas of the body with rich blood supply like liver, kidneys, and
heart receive the highest amount of drug. Areas that do not have a rich blood supply like bones, or an area
with a natural barrier like brain’s blood brain barrier, will not receive much of the drug.
Metabolism – Change of drug into a more/less potent form, a more soluble form, or an inactive form of
the drug. The liver is responsible for most drug metabolism that occurs in the body. These changes are
called biotransformation when the drug structure is chemically altered by metabolism. This new altered
drug is called a metabolite, which is a byproduct of metabolism.
Excretion – Elimination of a drug or its metabolites through various parts of the body. Kidneys eliminate
many drugs in the blood plasma through urine. Kidneys can also allow for some of the drug to reabsorb
back into the blood/body. Gastrointestinal excretion via feces for oral drugs that absorbed via intestinal
tract. Skin (sweat) for transdermal drugs. Lungs via exhalation for inhaled drugs.
______
IV drugs have immediate and complete onset. Subq shots can be rapid if highly water soluble and pt has
good circulatory flow, or slow if poorly water soluble and/or circulatory blood flow is slow or impaired.
It’s variable. Topical/transdermal drugs are applied to skin, eyes, ears, nose, rectum, vagina, or lungs.
They deliver a constant amount of the drug over an extended period of time, have slower onset of action,
and longer duration of action compared to oral/parenteral.
Half-Life – The amount of time it takes for half the amount of a taken drug to have been excreted by the
body. Short half-life drugs are taken several times a day. Long half-life drugs are taken only once a day.
Decreased in liver or kidney function can impact the level of drugs in the body, affecting half-life.
Example: Insulin aspart (rapid-acting insulin) has an onset of 15 minutes and a peak time of as soon as 30
mins. Should you give insulin 30 minutes after the last dose? NO, the drug is at its current peak, if you
inject now, you risk hypoglycemia. Check patient’s blood sugar levels instead, to make sure the drug is
working.

General Insulin info - Monitor glucose level and A1C level (determining long-term treatment
effectiveness and adherence). 70-120 glucose is regular levels. Teach pt to watch for signs of DKA:
nausea, thirst, polyuria, dry mouth, drowsiness, Kussmauls (deep rapid respirations)
Insulin lispro/aspart – (Rapid Acting Insulin) – Onset 15mins, peak 30m-2.5hrs, duration 3-6hrs. Give
with NPH 15 mins before meal.
Regular Insulin – (Short Acting Insulin) – Onset 30m–1hr, peak 1-5 hrs, duration 6-10 hrs. Given before
meal, injected subq for basal glycemic control, and given via IV in emergencies.
NPH Insulin – (Intermediate Acting Insulin) – Onset 1-2 hrs, peak 6-14 hrs, duration 16-24 hrs. Given 12
times daily. Has delayed action, less effective for mealtime glucose increases.
Insulin glargine – (Long Acting Insulin) – Onset 70m, no peak/peakless, duration 18-24hrs. Given once
daily, typically at the same time. Risk of hypoglycemia due to steady effect with no peak. Meant to
provide basal glucose control.
Insulin detemir – (Long Acting Insulin) – Slow onset, peaks 12-24hrs, duration varies w/ dosage
DO NOT MIX LONG ACTING INSULIN WITH OTHER INSULINS
Only lispro, aspart, and regular can be mixed with NPH.
Cloudy Clear (injecting air), Clear Cloudy (pulling out insulin)

Onset, Peak, and Duration – How long it takes for drug to demonstrate a therapeutic response. Peak
effect is amount of time it takes for drug to demonstrate full therapeutic effect. Drug duration of action
is the length of time the drug’s therapeutic effect lasts, without additional dose.
Peak is when the drug is at its highest level in the body while trough is when it’s at its lowest level. You
determine them by taking blood samples from client throughout the day. The variation in client’s blood
levels determine if you’re maintaining therapeutic level throughout the day. Therapeutic index is between
peak and trough. Can stay at peak if excretion is impaired. Kidney impairment.

An antibiotic must maintain at a constant therapeutic level in blood in order to exert maximum therapeutic
effect.
_______
Pharmacodynamics – Biological changes that occur in the body as a result of taking a drug.
Therapeutic effects are the intended drug effects. Adverse drug reactions are unintended drug effects.
The effects from drugs occur secondary to changes in how cells function, changes in cellular environment,
or changes in action of body’s enzymes.
Changes in cellular function precipitate a greater/lesser response than what typically occurs.
Agonists are drugs that bind with and activates receptors. They precipitate a greater than typical
response.
Antagonists are drugs that exert their effect in a competitive or noncompetitive manner. Antagonists
that compete WITH agonists for receptor sites are considered competitive antagonists. Antagonists that
block an agonist’s access for receptor sites are considered noncompetitive antagonists. In high doses,
noncompetitive antagonists can completely block an agonist’s typical response. Competitive antagonists
given in high doses rarely completely block the typical response, but it can decrease the typical response,
resulting in a weakened response.
Partial agonists exist. They are competitive antagonists because they take over the receptor sites the
agonists would have bonded to, and they have less efficacy than if the agonists were in the sites instead.
Partially effective, or looking for a reduced action.
Changes in the cellular environment occur when the drug interferes with the structure of a cell or critical
processes, like cell walls or the cell replication process. Penicillin inhibits cell wall synthesis resulting in
certain bacteria’s destruction and death. Sulfa-type antibiotics inhibit the replication of certain types of
bacteria by preventing folic acid from helping to make DNA to RNA.
Selective Drug Action – Drug reacts with specific receptor sites to produce desired effects. Receptor
exists for all molecules that synchronize the body’s physiologic activities, including neurotransmitters and
hormones. Selective drugs target fewer receptors resulting in a more limited effect. Drugs that affect
multiple receptors allow for widespread bodily reactions.
_________
Essential Drug Information – What is the med for (therapeutic use), its onset, peak, duration, and
halflife, precautions/contraindications, food/drug interactions, pregnancy/breast feeding effects, age, and
other health concerns.
Drug Endings and their Classification
-caine – Local Anesthetic
-cillin - Antibiotics
-dine – H2 Blockers (anti-ulcers)
-done – Opioid Analgesics
-ide – Oral Hypoglycemics
-lam – Anti-Anxiety agents -micin/mycin
– Antibiotics
-mide - Diuretics
-nium – Neuromuscular Blocking Agents
-olol – Beta Blockers
-oxacin - Antibiotics
-pam – Anti-Anxiety Agents
-pine – Calcium Channel Blockers
-pril - ACE Inhibitors
-sone - Steroids
-statin - Antihyperlipidemics
-vir - Antivirals
-zide - Diuretics
PLEASE REFER TO POWERPOINT SLIDE FOR REMEMBERING DRUGS AND THEIR
EFFECTS
_________
FDA Drug Risk Classification – Controlled substance/Pregnancy categories
A – Controlled studies in humans show no risk to fetus
B – No controlled studies have been conducted in humans; animal studies show no risk to fetus
C – No controlled studies have been conducted in animals or humans
D – Evidence of human risk to fetus exists; however, benefits may outweigh risks in certain situations E –
Controlled studies in both animals and humans demonstrate fetal abnormalities; the risk in pregnant
women outweighs any possible benefit
Drugs can have multiple therapeutic uses. Diphenhydramine (Benadryl) treats allergies, is an antiemetic, a
hypnotic/sleep aid, and can assist with treating Parkison’s disease due to anticholinergic effects.
Adverse Drug reactions (ADR) – nontherapeutic unintended drug effects that occur at therapeutic dose.
Range from predictable/well-known to unpredictable. From annoying but tolerable to life-threatening.
Client should contain Healthcare Provider if adverse effects occur. They can be potentially lifethreatening.
Diphenhydramine (Benadryl)’s adverse effects include dry mouth and drowsiness.
Most severe form of ADR is allergic reaction. Ranges from itching, rashes, or hives to life-threatening
anaphylactic shock. If initial reaction to allergic drug is mild, next exposure incident can have increased
sensitivity to drug and may lead to a more severe reaction.
Anaphylactic Shock is an exaggerated response of body’s immune system to a drug. Precipitates massive
release of histamines and other chemical mediators into body. Symptoms of Anaphylactic Shock that can
occur almost immediately after exposure include: swollen eyes, face (angioedema), mouth, and throat;
difficulty breathing; wheezing; tachycardia, and hypotension.
If a pt is coming to the ER with suspected anaphylactic shock, do the following: Initiate oxygen therapy to
support respiratory function, Administer epinephrine to increase BP, Administer diphenhydramine to stop
histamine release, and Establish/maintain open airway to ensure oxygenation. Maintaining airway and
oxygen therapy is initial focus.
_________
Drug Tolerance, Cumulative Effect, and Toxicity – Must monitor for during course of drug therapy.
Tolerance is body’s decreased response to drug over a period of time. To maintain therapeutic effect,
providers must increase dosage. Pharmacodynamic tolerance – tolerance r/t long-term use of opioid
analgesics.
Drug sensitivity, or cumulative drug effect, may occur in clients secondary to metabolic changes
(impaired hepatic and renal function, poor excretion of drugs). Body cannot metabolize and excrete drug
in time for another dose administration. Assess clinical signs and monitor lab results to avoid Adverse
Drug Reactions.
Drug toxicity – Drug received in excessive dosage, leading to negative physiologic effects.
Providers should prescribe lowest effective dose to achieve therapeutic effects to avoid toxicity. Toxicity
can occur when impaired excretion of drug results in build up if drug dose is given while still in
circulation. Periodic lab tests are essential in monitoring serum drug levels.
DRUG TOXICITY CAN CAUSE IRREVERSIBLE POTENTIALLY LIFE-THREATENING
DAMAGE. Vancomycin/Vancocin can damage CN VIII (Vestibulocochlear) resulting in reduced
hearing/deafness. Acetaminophen/Tylenol can cause temporary/permanent liver damage that can
result in liver failure.
Glomerular filtration, passive tubular reabsorption, or active tubular secretion, which are the three
mechanisms by which drugs are excreted renally.
Drugs that cause Nephrotoxicity (Kidney toxicity) – acetaminophen, acyclovir, aminoglycosides,
amphotericin B, combination of acetaminophen, aspirin or other salicylates, ciprofloxacin, cisplatin,
methotrexate, NSAIDs, rifampin, sulfonamides, tetracyclines (EXCEPT doxycycline & minocycline),
vancomycin
Drugs that cause Hepatotoxicity (Liver toxicity) – ACE inhibitors, acetaminophen, alcohol, iron
overdose, erythromycins, estrogens, fluconazole, isoniazid, itraconazole, ketoconazole, NSAIDs,
phenothiazines, phenytoin, rifampin, sulfamethoxazole and trimethoprim, sulfonamides
Drugs that cause Ototoxicity (Ear toxicity) – aminoglycosides, bumetanide, cisplatin, erythromycin,
ethacrynic acid, furosemide, hydroxychloroquine, NSAIDs, salicylates, vancomycin
__________
Precautions and Contraindications
Take care with drugs that can cause potential ADRs in certain populations or when taken with other
drugs/foods. Only take when necessary/benefits outweigh the risks.
Take care in clients with chronic/multiple medical conditions. A stroke pt requires anticoagulant therapy,
but if patient also has peptic ulcer disease, it will require additional assessment/lab monitoring to prevent
gastric bleeding.
CONTRAINDICATIONS ARE NOT SUGGESTIONS. Do they can result in serious or lifethreatening
ADRs, only in extremely unusual circumstances can contraindicated drugs be taken together.
________
Drug-Drug and Drug-Food Interactions

Drug-Drug Interaction – When one drug changes the way another drug affects the body. Additive if they
both have the same effect, resulting in a 1+1 = 2 effect (Example is giving two CNS depressants, like
opioids and alcohol, could result at risk for fatal CNS depression. Synergistic occurs when the
effectiveness of a drug becomes GREATER when given with another drug, resulting in a 1+1 = Greater
than 2 effect. Aspirin + Warfarin. Warfarin intensifies when given with Aspirin, resulting in potential
severe bleeding. Antagonistic occurs when the effect of one drug is decreased or block by another drug.
Results in a 1+1 = less than 2 effect. Asthma drug to open airway + cardiovascular drug that restricts
airways. This results in less effectiveness of the asthma drug.
These interactions can radically change action of drug in body.
Grapefruit juice decreases enzymatic metabolism of certain drugs, increasing drug potency and causing
risk for toxicity.
Wine/processed meats that contain tyramine can cause hypertensive crisis
Milk’s calcium binds to tetracycline, reducing absorption and thus therapeutic effect
Dark green vegetables like avocados or spinach that are high in vitamin K counteract warfarin. High-
protein meals decrease absorption of levodopa. Can cause symptoms of Parkinson’s to abruptly
increase. _______
Medication Error Prevention – Assessment, Planning, Implementation, Evaluation (ADPIE) Antacids
are antagonistic to tetracycline. They reduce tetracycline’s efficacy.
HCP/PCP prescribe drug dosages to children based on: Body surface area, age, weight, and the drug’s
properties. These are all necessary to avoid toxicity, overdose, or undertreatment.
When recommending drugs for a post-partum client, consider the following: Newborn’s weight, how
much breast milk they consume daily, whether the benefits to client outweigh the risks to the newborn,
and the drug’s properties Neonates – younger than 1 month
Infants – 1 month to 1 year
Children – 1 year to 12 years
An older client may be at risk for drug overdose r/t reduced hepatic blood flow that occurs due to aging.
When teaching client about insulin injection, demonstration of an injection is the best method for
evaluating effective learning.
DO NOT CRUSH OR CHEW ENTERIC COATED TABLETS. They absorb in small intenstine.
When doing drug teachings and discharge planning, make sure to do them AS SOON AS POSSIBLE. Pt
must be willing to learn, but do it at earliest convenience.
Paradoxical effects are the opposite of the intended or desired effect of a drug, such as a drug intended to
aid with sedation causing increased excitability in certain clients.
The indications section in a drug handbook provides information on conditions and diseases for which the
drug is used.
Extended-release tablet is best for clients who have difficulty remembering to take drugs.
Extendedrelease tablets are taken less frequently, promoting adherence to adhered dosage.
Factors that can DECREASE ability to learn: Impaired cognitive level, Language barrier, Discomfort, and
Unreadiness to learn
Teratogenic drugs can cause birth defects. Clients who are pregnant should not take these drugs.
Infection Prevention & Control/Sterile Field
Chain of Infection – Sequence of factors needed for infection to occur: Infectious agent (bacteria, fungi,
virus, parasite, prion), Reservoir (the habitat of the infectious agent, a location where it can live, grow, and
reproduce itself or replicate), Portal of Exit (Means by which the infectious agent can leave the reservoir),
Mode of transmission (contact, droplet, or airborne), Portal of Entry (a body orifice that provides a place
for the infectious agent to replicate/toxin to act in), Susceptible Host (Required for the infectious agent to
take hold and become a reservoir for infection) Reservoirs can be: Healthcare workers, Clients, Furniture,
or Equipment
Virulent - how efficient an infectious agent is at making people ill, even infecting healthy individuals if
strong enough.
Direct contact – microbes move directly from one person to another (like with HIV), typically when
coming in contact with a client’s blood
Indirect contact – spread via contaminated objected, like uncleaned equipment.
Droplet transmission – infectious droplets from a client travel through the air and come in contact with
the mucosa of a host
Airborne transmission - Occurs when small particulates move into the airspace of another person.
Vehicle Transmission – transmission from contaminated items to multiple persons, like water/food.
Vector-borne transmission – sources like rats/mosquitoes that carry the microbes from one location to
another to infect people.
C. diff and MRSA are contact precaution
Pneumonia, Pertussis, Influenza, Strep, meningitis, RSV are droplet precaution.
TB, chickenpox (varicella), Measles (rubeola), COVID are airborne precaution.
Compound Fracture is a high risk for infection, even more so than an AIDs patient. This is because
unbroken skin is body’s primary physical defense to infection.
Skin reduces water loss, protects against abrasion/microbes, and provides permeable barrier against
environment.
Skin contains Langerhans cells – sense and kill pathogens found on skin trying to enter body. Stratum
corneum (lipid layer) being intact is key to preventing water loss and helping body fight infection.
Mucous membranes secrete mucus to stop invaders.
Tears, sweat, and white blood cells (WBCs) aid in removing waste from the body. The respiratory tract
contains cilia (short hair-like structures) that help prevent particulates from entering the body. Likewise,
coughing helps remove materials. The GI tract secretes acids and enzymes that can destroy or neutralize
some foreign invaders. Even the natural flora of the gastrointestinal (GI) tract (which can be destroyed by
antibiotics) helps limit the transmission and overgrowth of some bacteria. The genitourinary (GU) tract
in males (i.e., the urethra) is typically longer than the female GU tract, which results in fewer bacteria
moving into the bladder and kidneys in male clients compared to female clients.
The vagina has a natural pH that also inhibits bacterial growth.
Nonspecific Immunity – neutrophils and macrophages, both WBCs, both eat and destroy microbes, as
their role as macrophages. These release during inflammatory response
Specific Immunity - antibodies (also called immunoglobulins) and lymphocytes. Antibodies bind to
infectious agents and activate the white blood cells and complement to destroy the infectious agent.
Inflammatory Response – body’s natural defense that activates when body is injured, foreign substances
are present, or when an infectious agent attacks. The following occurs in order during the inflammatory
response: Bacteria enters wound. Histamine, Kinins, and Prostaglandins arrive at site. Plasma from
blood enters site. Phagocytosis occurs. Pus forms.
1. Recognition of harmful stimuli by pattern receptors (located on the surface of cells)
2. Activation of the inflammatory pathway
3. Release of inflammatory markers
4. Recruitment of inflammatory cells
Antihistamines like Diphenhydramine control allergic responses, swelling, and itching by blocking
histamine to prevent swelling.
GERD is an example of a chronic disorder where the acid reflux in the esophagus erodes the tissue,
causing inflammation constantly.
Stages of Infection – Incubation, Prodromal, Acute Illness, Period of Decline, Period of Convalescence
Types of Infection – Local (confined to one area of the body) or Systemic (Starts as local then transmits
into bloodstream, infecting entire body system)

Expected WBC count is 5,000 to 10,000 per cubic milliliter (mm3). IF ELEVATED, NOTIFY
PHYSICIAN.

Expected Range
Neutrophils (55-70%) – First responder to injury, acting as a phagocyte.
Lymphocytes (20-40%) – Fights chronic bacterial infections or acute viruses. T cells (killer cells, T4
helper cells, suppressor cells) and B cells
Monocytes (2-8%) – Phagocytes that clean up tissue damage, produce interferon, and enhance immune
response.
Eosinophils (1-4%) – Active in allergic reactions and parasitic infections, performs phagocytosis, and
fights inflammation/infection. Number decreases as allergic reaction diminishes.
Basophils/mast cells (0.5-1%) – Release histamine, serotonin, and heparin.
C-REACTIVE PROTEIN IS AN INDICATOR OF GENERALIZED INFLAMMATION.
____________________
Hand Hygiene - scrubbing vigorously for a minimum of 15 to 20 seconds creates friction which helps
to remove germs and micro-organisms. Water moves from wrist to hands to adhere to least contaminated
to most contaminated area. Soap and water when visibly soiled, otherwise alcohol rub.
HANDWASHING IS PRIORITY when it comes to infection prevention when doing client care.
Bed Baths – Either complete (nurse gives bath to pt in bed) or partial bed bath (client does part of bed
bath themselves)
____________________
Medical Asepsis (clean technique) - Clean technique practices that reduces the presence of diseasecausing
micro-organisms on surfaces.
Not using any dressing material that you’re unsure what its sterility is important for maintaining asepsis.
Surgical Asepsis (sterile technique) – Sterile techniques ensuring sterility of items that will come in
contact with client.
To perform surgical asepsis, prior to cleansing the hands, first remove all rings, watches, and bracelets.
Apply chlorhexidine and ethanol solution to skin and let it dry on skin. No artificial nails, keep fingernails
less than 0.25 inches, and remove CHIPPED nail polish
Sterilization – All microbes, including bacterial spores, are eradicated. Steam into dry heat into ethylene
oxide into a sealed container.
Sterile Fields - Created to assure that the smallest number of microorganisms possible are present; used
for procedures where surgical asepsis is indicated. Prepped as close as possible time-wise to when the
procedure is being performed.
Position on flat surface, 12-18 inches from any walls/potentially contaminated objects. No tears/holes in
packaging. Outer 1-inch border is unsterile/contaminated.
Open the package in the following sequence: Peel first flap AWAY from nurse’s body, Peel sides back one
at a time, then Peel flap closest to nurse’s body.
Any sterile supplies that are placed on the field should first be checked to confirm that they are still sterile,
which can be determined based on whether the enclosed sterile indicator has changed color.
When adding sterile items, open packaging according to instructions then drop into sterile field from 1015
cms above field. When sterile solution to sterile field, place cap upside down in nonsterile field when
taking cap off and hold the container with the label side facing palm of hand, then pour from 10-15cm
above field. DO NOT REPLACE SOLUTION BOTTLE IN STERILE FIELD.
Dinsinfection – almost all microbes are eradicated, but not all. In high level disinfection, only spores
remain. In low level disinfection, spores, fungi, and viruses may still remain.
___________
PPE DONNING ORDER – HAND HYGIENE – GOWN – MASK – GOGGLES/FACESHIELD
GLOVES
PPE REMOVAL/DOFFING ORDER – GLOVES – GOGGLES/FACESHIELD – GOWN – MASK –
HAND HYGIENE.
Sections of PPE considered CLEAN – Ties on gown, back of gown, Inside of Gloves, and Goggle Straps
___________
Standard Precaution – Used on all clients, whether or not it is known that they have an infectious agent.
Contact Precaution – Gown and Gloves at minimum. Drainage from wounds and fecal matter would be
of concern. Vancomycin-resistant Enterococcus (VRE), MRSA, Clostridium difficile (C. diff), Staph
noroviruses, other intestinal tract pathogens, and respiratory syncytial virus (RSV) are contact precaution.
If splashing is involved, include a face shield. Tracheostomy would require protective eye wear.
Make sure to wash hand with soap and water afterwards on handling C. diff
Always remove PPE inside client’s room (EXCEPT for N95 mask on airborne precaution) before
leaving pt room. Always don PPE before entering pt’s room.
Droplet Precaution – Surgical mask required. Influenza, Adenovirus, SARS-CoV1, rhinovirus (common
cold), and Mycoplasma pneumoniae.
When transferring client out of room, only face mask is needed.
Airborne Precaution – Private room, fitted N95 respirator, negative pressure room (airborne infection
isolation room - AIIR). COVID, TB. Keep door closed on these rooms. Air exchange happens 6-12/hr
Protective Isolation – Used on immunocompromised pts (like someone who had an allogenic
hematopoietic stem cell transplant need to be protectively isolated for 100 days after transplant). No plants
allowed in facility, and positive pressure keeps airflow from entering into room.
____________
Health care-associated infections (HAIs) – infections acquired at health care facility (hospital, nursing
home, ambulatory care facility. 4 major categories: Central line-associated bloodstream infection
(CLABSIs), Catheter-associated urinary tract infections (CAUTIs), Surgical-sites infections (SSIs),
and Ventilator-assisted pneumonias (VAPs)
Infection Control Bundles – guidelines for practice that are bundled together to prevent HAIs. Hand
hygiene, aseptic technique, appropriate site (avoid femoral site on obese/overweight pts), clean site with
alcohol. Bathe client daily with chlorhexidine preparation. Change gauze every 2 days and semipermeable
dressing every 7 days. Change tubing for propofol infusion every 6-12 hours, fat emulsions/blood
products every 24 hours, and every other fusion change tubing every 4-7 days.
Multidrug-Resistant Organisms (MDROs) - Bacteria that are resistant to one or more classes of existing
antimicrobials. (MRSA, VRE, VRSA, VISA, ESBL, MDRSP)
Enhanced Barrier Precautions – New CDC guidelines from 2019 for nursing homes to reduce MDRO
transmission. Hand hygiene, gowns & gloves, contact precautions. Use these when bathing/showering,
hygiene care, dressing/linen change, toileting, wound care, transferring, or caring for pt devices.
Taking off gloves: Grasp opposite gloved hand at cuff, peel off glove and hold removed glove in palm of
hand, use bare fingers UNDER cuff of other glove, peel glove off to contain first glove in second glove,
throw away in pt’s room, finally, hand hygiene
Closed Glove - hands are kept inside the sterile gown until gloves are donned.
Open Glove technique - gloves are touched directly with the hands.
Gloves cover the wrist portion of a gown when they are worn together.
Gowns – Can only be used once then discarded before leaving client room.
Sterile gowning and independent gowning – Put the gown on with sterile technique and doing it by
yourself. Gowns are considered sterile only from just above the cuff to 2 inches above the elbows.
The axilla is not considered sterile, and neither is the back of the gown.as
If nurse has open and weeping lesions on hands, gloves will not be sufficient when providing direct client
care.
Meningitis is droplet precaution, so respiratory isolation is needed.
When acquiring throat culture: Swab back of pharyngeal wall, place swab in sterile container, use clean
gloves, and ensure culture medium goes to lab within 30 mins of obtaining sample.
Informatics/Documentation
Informatics – use of information and technology to communicate, manage knowledge, mitigate errors,
and support decision making.
Simulation – component of clinical education to prep nurses to safely function in complex and diverse
health care system, enabling them to utilize clinical decision-making and nursing skills outside of typical
hospital setting. This allows them to make errors without causing harm.
Clinical decision-making – iterative process using nursing knowledge to assess a client situation,
identifying priority concern, and using evidence-based interventions to implement care.
Clinical information system - Computer systems that allow for instant retrieval of client information
either directly or from data networks. (Scanning armbands, med barcodes, documenting vital signs,
I&Os, allergies, etc)
Information technology - Technology and physical devices used to create and store information,
including electronic health records.
Electronic Health Records (EHR) - Systemic, digitized documentation system used to improve medical
records. A computerized, real-time form of a client's paper chart that can be shared between members of
the interprofessional team.
Clinical pathways – care maps or integrated care pathways, they’re a standardized method of health care
delivery for a specific group of clients through the use of practices based on evidence-based guidelines.
Quality Improvement - A systematic process of analyzing care practices to maintain the highest levels of
client care and outcomes.
Health Insurance Portability and Accountability Act (HIPAA) - HIPAA is a federal law enacted to
safeguard clients’ medical health information when it is being accessed or shared electronically without
the clients’ consent or knowledge.
Protected Health Information (PHI) - any information held by a covered entity for healthcare that can
be linked to an individual.
Breach Notification Rule – Mandatorily reporting to clients of a breach of unsecured PHI. Notified via
mail ASAP, but at least within 60 days.
Security Rule – Establishes safeguards for electronic PHI (like a personal code).
Privacy Rule – Establishes standards under which PHI in any form could be used and disclosed
Enforcement Rule - compliance and investigations, the administration of financial penalties for violations
of HIPAA rules, and procedures for the investigation of these violations. Office for Civil Rights (OCR)
check for compliance with Privacy and Security Rules and dole out penalties with the Department of
Justice to noncompliant entities.
Telehealth – use of telecommunication technologies to facilitate client to provider communication. Your
face has to be seen during this or else it’s not Telehealth, but a phone call, computer is used for
videoconferencing.
EHR Meaningful Use – Ensure privacy and security, Improve population health, Improve safety and
quality, Engage patients and families, and Coordinates Care
Medication errors are comparable to chronic lower respiratory disease (3rd leading cause of mortality).
Health literacy, the ability to read, write, and understand health-related information, has a significant
impact on client outcomes.
Low literacy levels are associated with Decreased use of preventative services. Examples and printed
material can promote understanding. _____________
Problem-oriented Medical Records –
SOAP (Subjective Data, Objective Data, Assessment, Plan)
PIE (Problem, Intervention, Evaluation)
_____________
FACT – Factual, Accurate, Complete, Timely