FON-1000-ONE LINER-GOLDEN LINE-PHC

🌟 General Nursing Principles & Theories

✅ Florence Nightingale is the founder of modern nursing.
✅ Nursing is both an art and a science.
✅ Orem’s theory is based on self-care.
✅ Henderson’s theory has 14 components of basic nursing care.
✅ Roy’s adaptation model focuses on adaptation to environment.
✅ Maslow’s Hierarchy has 5 levels of human needs.

🌡️ Vital Signs

✅ Normal temperature: 98.6°F / 37°C
✅ Normal pulse rate (adult): 60–100 bpm
✅ Normal respiratory rate (adult): 12–20/min
✅ Normal BP (adult): 120/80 mmHg
✅ Apical pulse is taken for 1 full minute in children < 3 years.
✅ Radial artery is the most common site for pulse.
✅ Rectal temperature is the most accurate.

💉 Infection Control & Asepsis

✅ Medical asepsis = clean technique | Surgical asepsis = sterile technique
✅ Hand hygiene is the single most effective method to prevent infection.
✅ Autoclaving is done at 121°C, 15 lbs pressure for 15–20 min.
✅ Standard precautions are used for all patients regardless of diagnosis.

🛏️ Positioning

✅ Fowler’s position: used for respiratory distress
✅ Left lateral position: used for enema administration
✅ Trendelenburg position: used in shock or hypotension
✅ Sims’ position is ideal for rectal examination and enemas

💊 Drug Administration

✅ 10 Rights of Drug Administration ensure safe medication practice.
✅ IM injection angle = 90°, SC = 45°, ID = 10–15°
✅ Dorsogluteal site is avoided due to risk of sciatic nerve injury
✅ Deltoid muscle is preferred for small volume IM injections

🚿 Elimination Needs

✅ Enema is administered in left lateral position
✅ Normal urine output: ~1200–1500 ml/day
✅ 24-hour urine collection begins after discarding the first sample
✅ Bright red blood in stool = lower GI bleeding

🛏️ Bed Making & Patient Hygiene

✅ Mitered corner is used in bed making for neatness
✅ Oral care in unconscious patient = lateral position to prevent aspiration
✅ Back care prevents bedsores (pressure ulcers)

🧠 Communication & Documentation

✅ SBAR: Situation, Background, Assessment, Recommendation
✅ SOAP: Subjective, Objective, Assessment, Plan
✅ Legal records must be accurate, complete & timely
✅ Consent is mandatory for all invasive procedures

⚠️ Safety & Emergency

✅ Restraints need doctor’s order and frequent monitoring
✅ CPR sequence: C-A-B (Compression, Airway, Breathing)
✅ Compression rate for adult CPR = 100–120/min
✅ Shock requires Trendelenburg or flat position + fluid resuscitation

🔍 Quick Recall Key Abbreviations

🩺 ADL – Activities of Daily Living
💊 PRN – As needed
🩸 NPO – Nothing by mouth
📝 TID – Three times a day
🛌 HS – At bedtime
💧 IV – Intravenous
📈 BMR – Basal Metabolic Rate

🩹 Wound Care & Dressings

✅ Wound healing phases: Inflammatory → Proliferative → Maturation
✅ Primary intention healing: edges approximated (e.g., surgical wounds)
✅ Secondary intention healing: wounds left open, heal from bottom up
✅ Serous drainage: clear, watery | Purulent: thick, yellow/green
✅ Surgical asepsis is mandatory for dressing open wounds

💧 Fluid, Electrolyte & IV Therapy

✅ 1 liter = 1000 ml
✅ Isotonic solutions: 0.9% NS, Ringer Lactate – used for hydration
✅ Hypotonic solutions: 0.45% NS – cause cells to swell
✅ Hypertonic solutions: D10W, D5NS – cause cells to shrink
✅ Check IV site every 2 hours for patency and infiltration

🏥 Specimen Collection & Lab Values

✅ Sputum collection is done early morning before food
✅ Stool specimen should be sent to lab within 30 minutes
✅ Blood specimen for culture is collected before starting antibiotics
✅ Random blood sugar (RBS): 70–140 mg/dL
✅ Normal Hb (adult female): 12–15 g/dL | Male: 13–17 g/dL

🧼 Hygiene & Comfort

✅ Perineal care is important in catheterized patients
✅ Back rub increases circulation & relaxation
✅ Bed bath helps reduce infection and promote comfort
✅ Early morning care includes brushing teeth, washing face
✅ Foot care in diabetics must be done cautiously to prevent ulcers

😴 Rest & Sleep

✅ Adults require 6–8 hours of sleep per day
✅ Pain, anxiety, and noise are common factors affecting sleep
✅ Back rub and warm milk promote natural sleep
✅ Melatonin is the natural hormone regulating circadian rhythm

📏 Measurement & Conversions

✅ 1 inch = 2.54 cm
✅ 1 teaspoon = 5 ml | 1 tablespoon = 15 ml
✅ 1 kg = 2.2 pounds
✅ 1 pint = 500 ml (approx.)
✅ 1000 mcg = 1 mg | 1000 mg = 1 g

⏰ Time Management & Prioritization

✅ Life-threatening conditions are always first priority
✅ ABC (Airway, Breathing, Circulation) = initial emergency focus
✅ First nursing action in any emergency = ensure patient safety
✅ Delegate tasks based on qualification, skill, and scope of practice

⚖️ Legal & Ethical Principles

✅ Informed consent must be obtained before any procedure
✅ Negligence = failure to act as a prudent nurse
✅ Battery = unauthorized physical contact
✅ Confidentiality is a core principle of patient rights
✅ Advance directive is a written legal document for end-of-life decisions
✅ Ethics = doing what is morally right | Law = legal obligation

👩‍⚕️ Professionalism in Nursing

✅ Nurse’s primary role is to advocate, care, educate, and support the patient

🧠 Psychological Aspects in Nursing

✅ Empathy is the ability to understand and share another’s feelings
✅ Therapeutic communication involves active listening, silence, and empathy
✅ Non-verbal communication is more powerful than verbal communication
✅ Defense mechanisms are unconscious psychological responses to stress
✅ Regression means reverting to child-like behavior under stress

🩺 Nursing Process (ADPIE)

✅ Assessment is the first step in the nursing process
✅ Diagnosis is a clinical judgment about health problems
✅ Planning includes setting SMART goals (Specific, Measurable…)
✅ Implementation is the action phase of nursing process
✅ Evaluation determines if desired outcomes were achieved

💉 Parenteral Therapy

✅ Z-track method prevents leakage of medication into subcutaneous tissue
✅ Heparin is given subcutaneously in the abdomen – never massage the site
✅ Intradermal injection is used for sensitivity tests like Mantoux test
✅ IV fluids must be checked for clarity, expiry, and leaks before use
✅ Vesicant drugs (e.g., chemotherapy) must be given through central lines

🧬 Genetics & Growth/Development

✅ Down syndrome = Trisomy 21
✅ Growth = quantitative increase | Development = qualitative progress
✅ Cephalocaudal = development from head to toe
✅ Proximodistal = development from center to periphery
✅ Apgar score is assessed at 1 and 5 minutes after birth

🧼 Infection Control (Advanced Concepts)

✅ Nosocomial infections = hospital-acquired infections
✅ Airborne precautions are used for TB, measles, chickenpox
✅ Droplet precautions for influenza, mumps, meningitis
✅ Contact precautions for MRSA, VRE, scabies
✅ N95 mask is essential for airborne infection protection

💊 Pharmacology Essentials

✅ Half-life: time taken to eliminate 50% of a drug
✅ Loading dose: initial high dose to achieve therapeutic level quickly
✅ Trough level: lowest concentration of drug before next dose
✅ Peak level: highest concentration of drug after administration
✅ Narrow therapeutic index drugs (e.g., Digoxin, Lithium) require monitoring

🧍 Mobility & Body Mechanics

✅ Log rolling is used for patients with spinal injuries
✅ Range of motion (ROM) exercises prevent contractures
✅ Gait belt helps in safe ambulation of weak patients
✅ Foot drop is prevented with footboard or splints
✅ Orthopneic position helps in maximum chest expansion

🛏️ Comfort, Pain & End-of-Life Care

✅ Pain is subjective – best assessed by patient’s own rating
✅ PCA (Patient Controlled Analgesia) allows self-dosing of pain meds
✅ Palliative care = improving quality of life in chronic/terminal illness
✅ DNR (Do Not Resuscitate) order must be written and documented
✅ Hospice care is for patients with life expectancy < 6 months

🧪 Nursing Research & Statistics

✅ Hypothesis is a predictive statement to be tested statistically.
✅ Primary data is collected firsthand by the researcher.
✅ Sampling is selecting a portion of the population for study.
✅ Validity = tool measures what it’s supposed to | Reliability = consistency
✅ Pilot study is a small-scale trial of the main study.
✅ Mean is the average, Median is the middle, Mode is most frequent value.
✅ p-value < 0.05 indicates statistically significant result.
✅ Qualitative research uses words, Quantitative uses numbers.
✅ Descriptive research describes what is, not why it is.
✅ Ethical approval from Institutional Ethics Committee is mandatory for human studies.

⚖️ Nursing Ethics & Legal Aspects

✅ Beneficence = doing good | Non-maleficence = do no harm
✅ Autonomy = respect for patient’s decision-making
✅ Veracity = duty to tell the truth | Fidelity = keeping promises
✅ Negligence is a civil wrong | Malpractice is professional negligence
✅ Informed consent must be voluntary, informed, and competent
✅ Battery = unauthorized physical contact | Assault = threat without contact
✅ Advance directives guide care when patient loses decision capacity
✅ False documentation is a legal offense in nursing
✅ Legal age for consent in India = 18 years
✅ HIPAA protects patient’s health information (USA law – relevant for NCLEX)

💊 Advanced Pharmacology

✅ Digoxin toxicity signs: bradycardia, nausea, visual disturbances (yellow vision)
✅ Phenytoin toxicity causes gum hypertrophy, ataxia, confusion
✅ Therapeutic INR range for warfarin = 2.0–3.0
✅ Beta-blockers are contraindicated in asthma and bradycardia
✅ Aminoglycosides (e.g., Gentamicin) can cause ototoxicity and nephrotoxicity
✅ Tetracycline should not be given with milk or antacids
✅ Peak and trough levels are monitored for vancomycin, gentamicin
✅ Insulin is never given orally as it gets destroyed in GI tract
✅ Nitroglycerin patches should be rotated and removed at bedtime
✅ Antidote for morphine overdose = Naloxone (Narcan)

🧠 ICU & Critical Care Nursing

✅ GCS (Glasgow Coma Scale) max score = 15 | Min = 3
✅ MAP (Mean Arterial Pressure) should be > 65 mmHg to ensure perfusion
✅ Ventilator-associated pneumonia (VAP) is a common ICU infection
✅ Central lines increase risk of sepsis – strict asepsis is critical
✅ Inotropes (e.g., dopamine, dobutamine) increase cardiac output
✅ Tachycardia + hypotension = early sign of shock
✅ ABG test assesses acid-base balance and oxygenation
✅ Pulse oximeter cannot detect CO poisoning
✅ RRT (Rapid Response Team) is activated for acute patient deterioration
✅ Code Blue = Cardiac/Respiratory arrest

🛏️ Comfort, Rest & Sleep

✅ Back rubs before sleep promote relaxation and sleep
✅ Sundowning is confusion and agitation in elderly during evening/night
✅ Sleep cycle has NREM (4 stages) and REM – REM = dreaming stage
✅ Noise, light, pain are common causes of sleep disturbances in hospitals
✅ Warm bath or milk is a natural non-pharmacological sleep aid

🌬️ Oxygen Therapy

✅ Nasal cannula delivers 1–6 L/min O₂
✅ Venturi mask gives precise O₂ concentration (ideal for COPD patients)
✅ Oxygen is a drug – requires a doctor’s prescription
✅ Oxygen is combustible – avoid oils, flames, and static electricity
✅ Signs of hypoxia = restlessness, tachycardia, cyanosis

🧹 Hygiene & Personal Care

✅ Daily bathing removes dead cells and microbes
✅ Oral hygiene prevents halitosis and infection
✅ Perineal care is essential in patients with catheters or vaginal discharge
✅ Shaving should be avoided in patients on anticoagulants
✅ Sitz bath is used for perineal soreness, hemorrhoids, postpartum care

🛑 Pressure Injury & Mobility

✅ Braden scale is used to assess risk of pressure ulcer
✅ Stage 1 pressure sore = non-blanchable redness
✅ Stage 4 pressure sore = deep ulcer with bone/tissue exposure
✅ 2-hourly repositioning prevents bedsores
✅ Trochanter roll prevents external rotation of the hip

💧 Fluid Balance & Elimination

✅ Oliguria = urine output <400 ml/day
✅ Anuria = <100 ml/day | Polyuria = >2500 ml/day
✅ Fluid overload causes edema, hypertension, dyspnea
✅ Urine specific gravity: 1.010–1.030 – high = concentrated urine
✅ Dark amber urine indicates dehydration or bilirubin presence

🧼 Medical & Surgical Asepsis

✅ Surgical hand scrub lasts for 2–6 minutes
✅ Sterile to sterile = sterile | Sterile to unsterile = contaminated
✅ Sterile field is always kept at waist level or above
✅ Draping is done from near to far, front to back
✅ Moisture contaminates a sterile field by capillary action

📋 Documentation & Reporting

✅ Legal documents must be dated, timed, and signed
✅ Late entry must be marked with “Late Entry” and actual time
✅ SOAP notes = Subjective, Objective, Assessment, Plan
✅ ISBAR – Identify, Situation, Background, Assessment, Recommendation
✅ Do not use correction fluid or erase in records – draw a line & sign

🧠 Mental Health & Patient Behavior

✅ Therapeutic communication = silence, empathy, clarification
✅ Aggressive patients should be managed with calm, firm approach
✅ Disorientation can be managed with reorientation cues like clocks, calendars
✅ Anxiety increases vital signs and restlessness
✅ Touch can be therapeutic but must be culturally appropriate

📏 Miscellaneous but High-Yield

✅ NANDA = North American Nursing Diagnosis Association
✅ Vital signs are considered the first signs of clinical deterioration
✅ Delegation requires right task, circumstance, person, direction, supervision
✅ Professional boundaries must be maintained in nurse–patient relationship
✅ Nurses are patient advocates – speak up for patient rights
✅ Good documentation = good defense in court
✅ Reflective practice helps nurses improve self-awareness and care quality
✅ Self-care is vital to prevent nurse burnout
✅ Prevention is better than cure = Core nursing philosophy
✅ Nursing is a holistic science – physical, mental, emotional, spiritual care

💉 Drug Administration & Safety

✅ Before giving Digoxin, check apical pulse for 1 full minute
✅ Red biohazard bag = used for infected cotton, gauze, dressing materials
✅ Insulin and heparin require double-check by two nurses
✅ Trough levels are checked immediately before next dose
✅ Drugs with narrow therapeutic index need frequent blood monitoring
✅ Buccal and sublingual routes bypass first-pass metabolism
✅ Transdermal patch provides slow and steady drug release
✅ Eye drops are instilled into conjunctival sac, not directly on cornea
✅ Always wear gloves while applying topical medication
✅ NEVER crush enteric-coated or sustained-release tablets

🏥 Patient Admission, Transfer & Discharge

✅ Orientation to hospital reduces patient anxiety and confusion
✅ Transfer summary must include vital signs, diagnosis, and treatment details
✅ Discharge teaching must be done in patient’s own language
✅ Leaving against medical advice (LAMA) must be documented and signed
✅ Admission kit includes items like bedpan, toiletries, gown, ID band

💭 Critical Thinking & Clinical Judgement

✅ Triage is used to prioritize patients in emergencies
✅ ABC rule is used in emergency and critical care situations
✅ First thing in CPR = check responsiveness and pulse
✅ Signs of clinical deterioration = restlessness, confusion, rapid pulse
✅ Nurse’s intuition often alerts to early patient deterioration

🧑‍⚕️ Professional Conduct & Legal Responsibilities

✅ Negligence = omission or failure to act reasonably
✅ Licensure gives legal right to practice as a registered nurse
✅ Code of Ethics guides nurses in professional behavior
✅ Accountability means accepting responsibility for one’s actions
✅ Tort is a civil wrong committed against a person

🛌 Bed Positioning & Transfers

✅ Supine position = patient lying flat on back
✅ High Fowler’s = 90° upright | used in severe dyspnea
✅ Trendelenburg position = head low, feet high – used in shock
✅ Orthopneic position relieves dyspnea by allowing chest expansion
✅ Draw sheet helps in turning or lifting patients safely

🩸 Specimen Collection & Handling

✅ Midstream urine sample is best for urine culture
✅ Stool for occult blood must be fresh and not mixed with urine
✅ Sputum culture should be done before starting antibiotics
✅ CSF (cerebrospinal fluid) is collected via lumbar puncture
✅ Label every specimen with name, date, time, and test required

🧪 Vital Signs – Deep Concepts

✅ Tachypnea = respiratory rate > 20/min (adult)
✅ Orthostatic hypotension is drop in BP upon standing
✅ Pulse deficit = difference between apical and radial pulse
✅ Cheyne–Stokes breathing = periods of apnea alternating with hyperpnea
✅ Diastolic BP reflects vascular resistance

📋 Miscellaneous Master Points

✅ Bed cradle prevents blanket pressure on wounds or burns
✅ Cold application reduces inflammation and swelling
✅ Hot application promotes vasodilation and muscle relaxation
✅ ROM exercises maintain joint flexibility and circulation
✅ Elastic stockings (TED hose) prevent deep vein thrombosis (DVT)
✅ Incentive spirometry encourages lung expansion and prevents atelectasis
✅ Fall risk is higher in elderly, sedated, or confused patients
✅ Hand-off report is essential for continuity of care during shift change
✅ Environmental safety includes bed low position, call bell, no clutter
✅ Cultural sensitivity improves patient compliance and trust

🛏️ Patient Positioning & Safety

✅ Lateral position reduces the risk of aspiration in unconscious patients
✅ Dorsal recumbent position is used for perineal and vaginal exams
✅ Knee-chest position is ideal for rectal examination and enema administration
✅ Prone position helps with drainage in patients with lung secretions
✅ Fowler’s position reduces risk of aspiration and improves lung expansion

🧼 Infection Control & Isolation Techniques

✅ Chain of infection includes infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host
✅ Standard precautions apply to all patients regardless of infection status
✅ Reverse isolation is used to protect immunocompromised patients
✅ Negative pressure rooms are used for airborne precautions (e.g., TB)
✅ Hand hygiene is required before and after patient contact, and after removing gloves

🧠 Cognitive & Emotional Care

✅ Reality orientation helps reduce confusion in dementia patients
✅ Validation therapy acknowledges the feelings of disoriented patients
✅ Delirium is an acute, reversible condition | Dementia is chronic & progressive
✅ Depression is often underdiagnosed in the elderly
✅ Anxiety can mimic physical illnesses like chest pain or shortness of breath

🧬 Growth & Development

✅ Infancy is the most rapid period of growth
✅ Toilet training is typically achieved by 2–3 years of age
✅ School-age children (6–12 yrs) focus on industry vs inferiority (Erikson)
✅ Adolescents face identity vs role confusion
✅ Erikson’s theory addresses psychosocial development

🧍 Body Mechanics & Ergonomics

✅ Keep back straight and bend knees while lifting patients
✅ Wide base of support increases body stability
✅ Use assistive devices like slide sheets to prevent nurse back injury
✅ Pivot turning reduces strain during patient transfer
✅ Ergonomics reduces workplace-related injuries

💊 Medication Safety & Calculations

✅ Always verify patient ID before drug administration
✅ Three checks of medication: before removing, before preparing, before giving
✅ 6 rights of medication: right patient, drug, dose, route, time, documentation
✅ Pediatric dosages are usually calculated per kg of body weight
✅ Look-alike, sound-alike drugs (LASA) are a major source of medication errors

📏 Monitoring, Assessment, & Vitals

✅ Orthopnea = difficulty breathing when lying flat
✅ Cyanosis = bluish discoloration due to low oxygen saturation
✅ Hypotension = BP less than 90/60 mmHg
✅ Bounding pulse is seen in fever or fluid overload
✅ Thready pulse indicates shock or severe blood loss

🛌 Perioperative & Postoperative Care

✅ NPO status is essential before surgery to prevent aspiration
✅ Informed consent is the responsibility of the doctor, but nurse verifies it
✅ Early ambulation after surgery reduces risk of DVT and pneumonia
✅ First void after catheter removal should be monitored for retention
✅ Post-op vitals should be checked every 15 minutes for the first hour

🧠 Mental Health, Stress, and Coping

✅ Defense mechanisms are unconscious strategies to reduce anxiety
✅ Denial is refusing to accept reality or facts
✅ Displacement involves shifting emotions from real source to safer one
✅ Projection = attributing one’s own feelings to others
✅ Therapeutic touch and active listening help reduce patient anxiety

🛏️ Comfort Devices & Support

✅ Bed cradle prevents sheets from touching burns or ulcers
✅ Air ring relieves pressure from hemorrhoids or postpartum perineal pain
✅ Sandbags help in immobilization and maintaining position
✅ Back rest supports patient in semi-upright position
✅ Footboard prevents foot drop in bed-bound patients

🧹 Aseptic Techniques & Sterile Fields

✅ First step of sterile dressing: wash hands and gather sterile equipment
✅ Sterile items must not be touched with bare hands
✅ Contaminated = touches non-sterile or becomes wet
✅ Sterile field expires if left unattended
✅ Tongs and forceps used in sterile procedures must be pre-sterilized

💉 Injection Sites & Techniques

✅ Vastus lateralis is preferred for IM injections in infants
✅ Deltoid should not receive more than 1 mL of medication
✅ Dorsogluteal site avoided due to risk of sciatic nerve injury
✅ Subcutaneous injections are given at 45° or 90° angle
✅ Intradermal injections form a bleb/wheal under skin

🧴 Hot & Cold Applications

✅ Cold compress reduces swelling, pain, and bleeding
✅ Hot packs relieve muscle stiffness and increase circulation
✅ Hot/cold packs should not be applied for more than 20 minutes at a time
✅ Always assess skin before and after thermal therapy
✅ Contraindications for heat include bleeding, acute injury, inflammation

🩸 Blood Pressure & Circulation

✅ Korotkoff sounds are heard during blood pressure measurement
✅ Cuff too narrow = falsely high BP | too wide = falsely low BP
✅ BP cuff should cover 2/3rd of the arm
✅ Orthostatic hypotension = BP drop of ≥20 mmHg systolic or ≥10 mmHg diastolic on standing
✅ Palpatory method avoids auscultatory gap during BP recording

🧼 Personal Hygiene & Self-Care

✅ Oral care in unconscious patients should be done in side-lying position
✅ Hair care prevents lice, dandruff, and scalp infection
✅ Eye care is done from inner to outer canthus
✅ Foot care in diabetics should avoid soaking and sharp instruments
✅ Perineal care should be done front to back in females to avoid UTI

🧍 Range of Motion & Physical Activity

✅ Passive ROM = performed by nurse or caregiver
✅ Active ROM = done by patient independently
✅ Contracture = permanent tightening of muscles/tendons
✅ Isometric exercises = muscle tensing without movement (e.g., plank)
✅ Ambulation aids (walker, cane) should be sized to patient’s height

⚠️ Risk Assessment & Emergency Basics

✅ High fall risk = history of falls, confusion, weakness, polypharmacy
✅ Restraints require doctor’s order and frequent monitoring
✅ Incident report is NOT part of patient record but used for legal documentation
✅ Seizure precautions include side rails up, padding, airway access
✅ Code Red in hospital usually means fire emergency

🗂️ Records & Reports

✅ Errors in documentation should be corrected with single line and signature

✅ Charting should be clear, concise, factual, and timely

✅ Narrative charting gives descriptive, time-based events

✅ Flow sheets are used for routine tasks like vitals, intake-output

✅ Subjective data = symptoms (e.g., pain), Objective data = signs (e.g., fever)

💉 Medication Administration – Deep Concepts

✅ Schedule H drugs are prescription-only medications in India
✅ Antibiotics should always be taken as per full course to avoid resistance
✅ Sublingual medications should never be swallowed
✅ Insulin vials should be stored in the refrigerator (2°C–8°C)
✅ Heparin injection site should not be massaged after administration

🛏️ Bed Making & Linen Management

✅ Occupied bed is made with patient in the bed
✅ Unoccupied/closed bed is made when no patient is assigned
✅ Fan-folding of linen allows easy transfer or admission
✅ Mackintosh protects bed from soiling and moisture
✅ Soiled linen should be folded inward to avoid cross-contamination

🧠 Neurological Observations

✅ PERRLA – Pupils Equal, Round, Reactive to Light and Accommodation
✅ Glasgow Coma Scale (GCS) ≤ 8 = coma
✅ Decorticate posture = flexion – indicates cerebral cortex damage
✅ Decerebrate posture = extension – indicates brainstem injury
✅ Postictal phase is the recovery period after a seizure

🚻 Elimination Needs – Urinary & Bowel

✅ Crede’s method is used to promote bladder emptying by manual pressure
✅ Catheter care should be done every 8–12 hours
✅ Urine output <30 ml/hour for more than 2 hours must be reported immediately
✅ Suppositories should be inserted past the internal anal sphincter
✅ Oil enema softens hardened feces before digital evacuation

🛡️ Safety Measures & Injury Prevention

✅ Side rails should always be up in ICU or confused patients
✅ Red plug sockets indicate emergency power supply
✅ Sharp objects must be discarded in puncture-proof sharps container
✅ Fall mats or bed alarms help prevent injuries in high-risk patients
✅ Slippery floors and loose wires are common causes of hospital falls

📚 Ethics & Professional Behavior

✅ Ethical dilemma occurs when there is conflict between two moral principles
✅ Accountability = being answerable to your actions and outcomes
✅ Confidentiality means keeping patient information private
✅ Advocacy means speaking up for patient’s rights
✅ Veracity = being truthful and honest in communication

🧍 Rehabilitation & Assistive Devices

✅ Crutches should be placed 6 inches lateral and 6 inches forward
✅ Four-point gait provides maximum support for walking
✅ Cane should be held on the stronger side
✅ Wheelchair footrests should be up during transfer
✅ Walker is used when maximum support and balance are needed

🧪 Vital Signs – Advanced Interpretations

✅ Pulse oximeter may give false readings in nail polish, cold hands, CO poisoning
✅ Axillary temperature is 0.5°C lower than oral
✅ Febrile seizures are common in children under 5 with high fever
✅ Bradycardia = heart rate <60 bpm | Tachycardia = >100 bpm (adult)
✅ Apnea = absence of breathing for more than 20 seconds (infant)

⚕️ Miscellaneous High-Yield

✅ Nursing audit is a method of quality evaluation of nursing care
✅ Sundowning is worsening of confusion in evening (seen in dementia)
✅ Therapeutic nurse-patient relationship has four phases: pre-interaction, orientation, working, and termination
✅ Critical thinking is required for clinical decision-making
✅ Hand-off communication ensures continuity of care between shifts

🗂️ Documentation & Record-Keeping

✅ Flow charts are used for continuous monitoring like vitals and I&O
✅ SOAPIE = Subjective, Objective, Assessment, Plan, Intervention, Evaluation
✅ Electronic health records (EHR) improve accuracy and accessibility
✅ Never document before doing the procedure
✅ Late entries in records must be labeled and timed clearly

💉 Injection Practices & Techniques

✅ Aspirating before IM injection is done to avoid injecting into blood vessels
✅ Deltoid site is ideal for vaccines and low-volume drugs
✅ Intradermal route is used for tuberculin and allergy testing
✅ Z-track method prevents medication leakage and staining
✅ Rotate injection sites to prevent lipodystrophy (especially insulin)

🧪 Specimen Collection Protocols

✅ Early morning sputum is best for detecting TB bacilli
✅ Stool sample for ova and parasites must be sent immediately
✅ 24-hour urine collection starts after discarding the first void
✅ Label specimen containers before leaving the bedside
✅ Blood culture bottles should be filled with aerobic first, anaerobic second

🛌 Preoperative & Postoperative Nursing Care

✅ Consent must be signed before preoperative medication is administered
✅ Skin preparation before surgery reduces risk of infection
✅ Pre-op checklist ensures patient is NPO, consented, and prepared
✅ Airway assessment is the first priority after surgery
✅ Postoperative pain should be assessed using pain scale regularly

💧 Fluid & Electrolyte Balance

✅ Dehydration signs: dry mucosa, decreased skin turgor, oliguria
✅ Hyperkalemia causes muscle cramps and cardiac arrhythmias
✅ Hyponatremia may lead to seizures and confusion
✅ Normal sodium level = 135–145 mEq/L
✅ I&O (Intake and Output) charting is essential in fluid imbalance

📏 Medical Terminology & Abbreviations

✅ PRN = “as needed” | BID = twice daily | TID = three times daily
✅ NPO = nothing by mouth | PO = by mouth
✅ STAT = immediately | HS = at bedtime
✅ OD = once a day | IV = intravenous | IM = intramuscular
✅ I&O = intake and output – key part of fluid monitoring

🧍 Body Mechanics & Ergonomics

✅ Always raise the bed to waist level before providing care
✅ Keep heavy objects close to body when lifting
✅ Bend knees, not back, when reaching low areas
✅ Pivot with feet, not spine, when turning
✅ Mechanical lift or 2-person technique should be used for heavy/immobile patients

🧠 Cognitive & Behavioral Care

✅ Hallucinations = false sensory perceptions (e.g., seeing things not there)
✅ Delusions = false beliefs held despite evidence
✅ Validation therapy supports emotional comfort in dementia patients
✅ Mild confusion in elderly can be the first sign of UTI or dehydration
✅ Reorientation techniques: use of clock, calendar, family photos

⚕️ Health Assessment & Nursing Process

✅ Nursing diagnosis is a clinical judgment about patient response
✅ Primary data comes from the patient directly
✅ Secondary data comes from family, reports, or records
✅ Short-term goals are expected to be achieved within a few hours to days
✅ Nursing evaluation determines if goals were met or need revision

🛡️ Patient Safety & Legal Considerations

✅ Patient identification must be done using 2 identifiers (name + DOB or ID)
✅ Bed brakes must be locked before patient transfer
✅ Restraints should be removed every 2 hours to assess circulation
✅ Consent for treatment can be withdrawn anytime by the patient
✅ Incident reports are non-punitive tools used for system improvement

🔄 Continuity of Care & Communication

✅ Handoff report during shift change ensures continuity and safety
✅ Open-ended questions promote therapeutic communication
✅ Clarification is a therapeutic technique to avoid misunderstanding
✅ Silence can be powerful in emotional or anxious patients
✅ SBAR format standardizes communication: Situation, Background, Assessment, Recommendation

🧠 Neurological Assessment & Consciousness

✅ Glasgow Coma Scale (GCS) evaluates eye, verbal, and motor response
✅ A GCS score of 15 = fully conscious, 3 = deep coma
✅ Pupil reaction to light tests cranial nerve III (oculomotor)
✅ Decorticate posture shows flexion, arms toward core
✅ Decerebrate posture shows extension, arms and legs stiffly extended

💉 Venipuncture & IV Therapy

✅ Common IV site in adults = cephalic or median cubital vein
✅ IV infiltration = swelling, pallor, coolness at the site
✅ Phlebitis signs = redness, warmth, pain, and swelling
✅ Saline flush is used to check patency of IV line
✅ Always label IV tubing with date and time of change

🛏️ Mobility, Transfer & Assistive Devices

✅ Logrolling technique is used for spinal injury patients
✅ Gait belt aids in safe ambulation of weak patients
✅ Walker should be lifted and moved with all legs flat
✅ Cane is held on the stronger side, opposite the weak leg
✅ Two-person lift is used for heavy or dependent patients

📋 Patient Education & Discharge

✅ Teach-back method confirms patient’s understanding of instructions
✅ Discharge summary includes medications, follow-up, and precautions
✅ Patient teaching is part of nursing responsibility
✅ Reinforcement improves patient compliance and retention
✅ Health literacy affects how well the patient follows treatment

🧪 Laboratory Monitoring & Normal Values

✅ Normal Hemoglobin (Hb): Male – 13–17 g/dL, Female – 12–15 g/dL
✅ WBC count: 4,000–11,000 /mm³ – elevated in infections
✅ Platelets: 1.5–4 lakh/mm³ – low = risk of bleeding
✅ Fasting blood sugar: 70–110 mg/dL – high = possible diabetes
✅ Serum creatinine: 0.6–1.3 mg/dL – high = possible kidney dysfunction

🚿 Hygiene & Daily Care

✅ Back care prevents pressure ulcers and promotes circulation
✅ Shaving should be done in direction of hair growth
✅ Mouth care for unconscious patients every 2–4 hours
✅ Bathing promotes hygiene and stimulates blood flow
✅ Foot care must be done carefully in diabetics to avoid ulcers

💊 Drug Administration Responsibilities

✅ Check MAR (Medication Administration Record) before giving meds
✅ Do not administer drugs prepared by someone else
✅ Document immediately after drug is given
✅ Never leave medications unattended at bedside
✅ Look-alike sound-alike (LASA) drugs must be double-checked

🧍 Pain Management & Comfort Measures

✅ Pain is subjective – the patient’s report is the best indicator
✅ Non-pharmacologic methods: repositioning, cold/hot packs, distraction
✅ Analgesics must be given before pain becomes severe
✅ Pain scale (0–10) helps assess intensity and relief
✅ Chronic pain lasts more than 3–6 months

⚖️ Ethical Practice & Legal Documentation

✅ Advance directives guide care if patient becomes unconscious
✅ Negligence is a failure to act as a reasonable nurse would
✅ Battery = touching without consent | Assault = threat to harm
✅ Informed consent is required for all invasive procedures
✅ Confidentiality is maintained even after patient discharge

🧭 Critical Thinking & Decision-Making

✅ Prioritization is based on Maslow’s hierarchy & ABCs (Airway, Breathing, Circulation)
✅ Clinical judgment combines knowledge, experience, and intuition
✅ Delegation must match task to right person, right time, right situation
✅ Nursing process (ADPIE) is the core framework for care
✅ Critical incident reporting helps improve patient safety and systems

💉 Injection, Asepsis, and Drug Safety

✅ Intramuscular injection volume in adults should not exceed 5 mL
✅ Angle of intradermal injection is 10–15° into dermis layer
✅ Aseptic technique = absence of pathogenic microorganisms
✅ Vial rubber stopper must be cleaned with 70% alcohol before use
✅ Ampules must be opened using a dry swab or ampule opener to prevent injury

🧴 Topical & Mucosal Medication Application

✅ Suppositories should be stored in refrigerator to maintain shape
✅ Eye drops are applied in lower conjunctival sac, not cornea
✅ Nasal drops are best instilled in supine position with head tilted back
✅ Ear drops in adults: pull pinna upward & backward
✅ Transdermal patches must be removed before applying a new one

🛏️ Patient Safety & Restraints

✅ Soft restraints are used for non-violent confused patients
✅ Wrist restraints are checked every 15–30 minutes for circulation
✅ Restraints must be tied to the bed frame, not side rails
✅ Remove restraints every 2 hours to assess skin and movement
✅ Physical restraints require a valid doctor’s order with documentation

🧠 Patient Mental Health & Cognitive Care

✅ Reality orientation helps confused patients recognize time, place, person
✅ Acute confusion is often reversible (e.g., UTI, fever)
✅ Validation therapy is used for chronic confusion/dementia
✅ De-escalation techniques are useful for aggressive behavior
✅ Family support and familiarity reduce delirium risk in hospitalized elderly

📋 Patient Rights & Legal Ethics

✅ Right to refuse treatment is a basic patient right
✅ Incompetent patients need a legal guardian or surrogate to give consent
✅ Advance directives include living wills & durable power of attorney
✅ Good Samaritan Law protects healthcare workers offering emergency care
✅ Documentation is a legal defense tool in court cases

💧 Elimination, Catheterization, and Bowel Care

✅ Straight catheterization is for intermittent bladder drainage
✅ Foley catheter balloon is inflated with 10 mL sterile water (commonly)
✅ Remove catheter when no longer clinically indicated
✅ Bowel training programs help regain voluntary bowel control
✅ Bladder irrigation is done to remove clots or debris post-surgery

🧍 Body Mechanics & Rehabilitation Nursing

✅ Tripod position helps in maximal lung expansion in dyspnea
✅ Walker should be at level of the wrist crease when arms hang down
✅ Two-point gait requires partial weight-bearing on both legs
✅ Footboards prevent plantar flexion contractures
✅ Passive ROM is performed when patient is unable to move limb actively

📚 Miscellaneous High-Yield Clinical Nuggets

✅ Orthopnea = difficulty breathing while lying flat
✅ Cyanosis = bluish discoloration due to reduced oxygenation
✅ Chills & shivering occur in the cold stage of fever
✅ Diaphoresis = excessive sweating
✅ Bradycardia = pulse rate less than 60 bpm

🛡️ Risk Reduction & Patient Environment

✅ Call bell should always be kept within patient’s reach
✅ Proper lighting, dry floors, and clutter-free environment prevent falls
✅ Side rails are a form of passive restraint if raised without consent
✅ Bed in lowest position helps prevent injury from falls
✅ Emergency crash cart should be checked daily for completeness

🧠 Thinking Like a Nurse (Judgment & Prioritization)

✅ First priority = life-threatening problems (ABCs)
✅ High fever in child + convulsions = address seizure risk immediately
✅ Post-op patient not passing urine in 6 hours = high priority
✅ Unresponsive patient = check Airway and responsiveness first
✅ Best decision-making tool = combine knowledge, assessment, and evidence

💉 Injection, Parenteral Drugs & Medication Safety

✅ Z-track technique is used in IM injection to prevent leakage and staining of skin.
✅ Intradermal injections are commonly used for Mantoux and allergy tests.
✅ Heparin and insulin are high-alert drugs and require double-checking.
✅ Syringes should not be recapped after use to prevent needle-stick injury.
✅ Gauge 25–27 is used for subcutaneous injections.

🧪 Specimen Collection & Lab Care

✅ Sputum collection is done early morning before eating or drinking.
✅ Urine culture requires midstream clean-catch sample.
✅ Blood sample for blood glucose is typically taken fasting and 2 hours postprandial.
✅ Labeling specimen containers must be done at the bedside before sending to lab.
✅ Stool sample for occult blood must be free from urine and toilet paper.

🛏️ Bed Sores, Mobility & Comfort

✅ Stage 1 pressure ulcer = non-blanchable redness over intact skin.
✅ Repositioning patients every 2 hours helps prevent pressure injuries.
✅ Heel protectors prevent pressure ulcers on bony prominences.
✅ Trochanter roll prevents external rotation of the hip in bed-bound patients.
✅ Pillows and foam wedges are used to offload pressure points.

🧼 Infection Control & Sterile Techniques

✅ Sterile gloving is essential for invasive or aseptic procedures.
✅ Do not turn back on sterile field — it becomes contaminated.
✅ Wound dressing must be done with sterile technique to avoid infection.
✅ Autoclave kills all forms of microbial life including spores.
✅ Handwashing for surgical asepsis = minimum 2–6 minutes scrub.

🧠 Cognitive & Mental Status Monitoring

✅ GCS score of 8 or less indicates a comatose state.
✅ Delirium is acute, sudden onset and usually reversible.
✅ Dementia is chronic and progressive memory loss.
✅ Sundowning is a phenomenon seen in dementia where confusion worsens in the evening.
✅ Orientation questions include name, place, time, and situation.

💊 Pharmacology & Drug Handling

✅ Enteric-coated tablets should never be crushed.
✅ Sublingual tablets should be placed under the tongue and not swallowed.
✅ Look-Alike/Sound-Alike (LASA) drugs increase risk of medication errors.
✅ Medication reconciliation is done during admission, transfer, and discharge.
✅ 10 rights of drug administration form the basis of safe nursing practice.

📋 Documentation & Legal Aspects

✅ Documentation should be clear, accurate, timely, and complete.
✅ Do not erase or white-out any error — use single line and sign.
✅ Electronic health records (EHR) improve accuracy and access to patient information.
✅ Late entries must be clearly marked with the actual time of documentation.
✅ Nurses are legally accountable for all care documented under their name.

🧍 Rehabilitation & Positioning

✅ Logrolling technique is used to move patients with spinal injury.
✅ Orthopneic position is used for patients with dyspnea.
✅ Trendelenburg position is used in hypotension and shock.
✅ Sims’ position is best for enema and rectal exams.
✅ Semi-Fowler’s (30–45°) is preferred for NG tube insertion and feeding.

💧 Elimination & Catheter Care

✅ Straight catheterization is used for single drainage.
✅ Urine output <30 ml/hour indicates possible kidney dysfunction.
✅ Bladder training is a technique used after removing long-term catheters.
✅ Indwelling catheter care includes perineal hygiene and ensuring free drainage.
✅ Constipation prevention includes fiber intake, fluid, and mobility.

💬 Communication & Patient-Centered Care

✅ Effective communication improves patient satisfaction, safety, and outcomes.

✅ Empathy, not sympathy, is key in therapeutic communication.

✅ Silence is an effective therapeutic tool during emotional situations.

✅ Paraphrasing shows the nurse has understood the patient’s feelings.

✅ Closed-ended questions are used in emergencies or for specific data.

💉 Parenteral Therapy & Drug Actions

✅ Infiltration = IV fluid enters surrounding tissue → swelling, pallor, cool skin
✅ Extravasation = leakage of vesicant drug causing tissue necrosis
✅ Phlebitis = inflammation of vein due to IV → redness, warmth, cord-like vein
✅ IV site rotation recommended every 72–96 hours
✅ Intermittent IV medication requires saline flush before and after

🛏️ Posture & Positioning

✅ Dorsal recumbent – used for abdominal exam & female perineal care
✅ Knee-chest position – used in rectal procedures or sigmoidoscopy
✅ Reverse Trendelenburg – used in head trauma or increased ICP
✅ High Fowler’s position – ideal for severe dyspnea, feeding, NG insertion
✅ Side-lying (lateral) – used for oral care in unconscious patient

🧼 Sterilization & Infection Control

✅ Medical asepsis = reduces microorganisms | Surgical asepsis = sterile
✅ Biohazard bag (red) = for infectious waste like blood-soaked dressings
✅ Sharps container = puncture-proof, do not overfill above ¾ level
✅ Donning order: gown → mask → goggles → gloves
✅ Doffing order: gloves → goggles → gown → mask

🧠 Consciousness, Sensory, Neurological Monitoring

✅ Lethargy = drowsy but arousable
✅ Stupor = only arousable with vigorous stimulus
✅ Coma = no motor/verbal response to stimulus
✅ PERRLA test indicates cranial nerve III integrity
✅ Decorticate and decerebrate posturing are signs of serious brain damage

💊 Pharmacology: Side Effects & Cautions

✅ Nephrotoxic drugs: aminoglycosides, NSAIDs, amphotericin B
✅ Ototoxic drugs: gentamicin, furosemide, vancomycin
✅ Tetracyclines should not be given with milk or antacids
✅ Warfarin therapy requires INR monitoring
✅ Digoxin toxicity signs: nausea, halos, bradycardia, confusion

📋 Legal, Ethical & Documentation

✅ Informed consent is invalid if patient is under sedatives or unconscious
✅ Implied consent applies in emergencies when patient can’t respond
✅ Advance directives = legal docs outlining care if patient loses capacity
✅ Verbal orders must be written and signed within 24 hours
✅ SOAPIE charting adds Intervention & Evaluation to SOAP format

🧍 Body Mechanics & Ergonomics

✅ Wide base of support + low center of gravity = maximum stability
✅ Back injury in nurses is commonly caused by poor lifting technique
✅ Mechanical lifts must be used for patients unable to bear weight
✅ Pivot transfers should use gait belts and nonslip footwear
✅ Team lifting prevents musculoskeletal injury in caregivers

💧 Elimination, Catheterization & Bowel Care

✅ Urinary retention = inability to void despite bladder fullness
✅ Overflow incontinence = bladder overdistension with frequent dribbling
✅ Neurogenic bladder results from spinal cord injury
✅ Digital rectal exam checks for fecal impaction
✅ Laxatives overuse can cause electrolyte imbalance

🩺 Therapeutic Communication & Cultural Sensitivity

✅ Empathy = understanding feelings | Sympathy = sharing feelings
✅ Reflecting helps patient explore own thoughts and emotions
✅ Non-judgmental approach builds patient trust
✅ Open-ended questions encourage patient expression
✅ Silence can be therapeutic during grief or shock

⚠️ Miscellaneous & Safety Concepts

✅ Incident reports are completed for falls, errors, unexpected events
✅ Crash cart should be readily available, stocked, and checked daily
✅ Call bell must be within reach at all times
✅ Alarm fatigue can lead to missed critical alerts
✅ RACE protocol for fire = Rescue, Alarm, Contain, Extinguish

💊 Drug Administration & Monitoring

✅ Sublingual route gives rapid absorption due to rich blood supply under tongue
✅ Buccal meds are placed between cheek and gums and not swallowed
✅ Transdermal drugs provide slow, sustained release over hours to days
✅ Topical medications act locally at the site of application
✅ Antipyretics reduce fever by acting on the hypothalamus

🧪 Diagnostic Testing & Lab Responsibilities

✅ Pre-test instructions are essential for accuracy of diagnostic tests
✅ Fasting blood sugar (FBS) requires 8–12 hours fasting
✅ Urinalysis should be examined within 30–60 minutes of collection
✅ ECG/EKG evaluates electrical activity of the heart
✅ ABG test assesses oxygenation and acid-base balance

🧼 Environmental Hygiene & Isolation Techniques

✅ Negative pressure rooms are used for airborne infections (e.g., TB)
✅ Positive pressure rooms protect immunocompromised patients
✅ Double-bagging of waste is done in high-risk infection control
✅ Contact isolation requires gown and gloves before room entry
✅ Droplet transmission spreads through coughing, sneezing, or close contact

🛏️ Physical Examination & Assessment

✅ Skin turgor test is used to assess hydration status
✅ Pallor indicates anemia or poor perfusion
✅ Clubbing is associated with chronic hypoxia (e.g., COPD)
✅ Auscultation of bowel sounds is done before palpation or percussion
✅ Palpate pulse with index and middle fingers, not the thumb

🧠 Cognitive & Emotional Support

✅ Active listening involves undivided attention and feedback
✅ Reality orientation helps reorient patients with confusion or delirium
✅ Validation therapy accepts emotions of dementia patients without contradiction
✅ Stress triggers sympathetic nervous system activation
✅ Mindfulness and breathing exercises reduce anxiety and promote calm

💧 Hydration, Fluids, & Electrolyte Monitoring

✅ 1 liter of fluid = 1000 mL = 1 kg body weight
✅ Fluid volume excess signs: edema, crackles in lungs, weight gain
✅ Dehydration: dry skin, decreased turgor, low urine output
✅ Sodium is the primary extracellular electrolyte regulating water balance
✅ Potassium imbalance affects cardiac rhythm and muscle function

📋 Nursing Process: Planning & Implementation

✅ Nursing interventions are based on SMART goals: Specific, Measurable, Achievable, Realistic, Time-bound
✅ Implementation phase = carrying out planned nursing actions
✅ Prioritization is based on Maslow’s hierarchy and ABCs
✅ Reassessment is done after every nursing intervention
✅ Collaborative interventions involve multidisciplinary input (e.g., physiotherapy)

🧍 Mobility & Rehabilitation Basics

✅ Active ROM is done independently by patient
✅ Passive ROM is performed by caregiver for immobile patients
✅ Early ambulation reduces risk of DVT, constipation, pneumonia
✅ Walker use: move walker → weak leg → strong leg
✅ Wheelchair safety: lock wheels during transfers or bed movement

⚠️ Safety Precautions & Risk Management

✅ R.A.C.E. fire protocol: Rescue, Alarm, Contain, Extinguish/Evacuate
✅ PASS technique (fire extinguisher): Pull, Aim, Squeeze, Sweep
✅ High-fall-risk patients: frequent rounding, non-slip socks, bed alarms
✅ Toxic exposure or spillage must be handled using MSDS guidelines
✅ Unconscious patients should never be left in supine position without supervision

🌈 Culturally Sensitive & Holistic Nursing

✅ Spiritual care supports patient values, beliefs, and hope
✅ Cultural competence = respecting customs, language, dietary practices
✅ Personal beliefs affect patient’s health decisions and compliance
✅ Family-centered care includes supporting caregivers and involving them in care
✅ Holistic nursing = caring for mind, body, emotion, and spirit

💉 Routes & Principles of Drug Administration

✅ Inhalation route allows rapid absorption through alveolar capillaries
✅ Rectal suppositories are useful for vomiting or unconscious patients
✅ Topical corticosteroids should be used in thin layers only
✅ Eye drops should be given 5 minutes apart if multiple are prescribed
✅ Never administer IV potassium as undiluted bolus – it can cause cardiac arrest

🧪 Lab Values & Interpretation

✅ BUN (Blood Urea Nitrogen) reflects kidney function; normal = 7–20 mg/dL
✅ Creatinine is a more specific indicator of renal damage
✅ Hemoglobin (Hb) low → anemia | high → dehydration or polycythemia
✅ Platelets <1.5 lakh = risk of bleeding (thrombocytopenia)
✅ Serum calcium is essential for bones, clotting, muscle contraction

🧼 Infection Prevention & Isolation

✅ Don PPE before entering isolation room, remove before exit
✅ Alcohol-based hand rub is not effective against C. difficile spores
✅ Airborne precautions require N95 respirator and negative pressure room
✅ Hand hygiene is the first and last step of all nursing procedures
✅ Disinfect stethoscope between each patient to avoid cross-contamination

🛏️ Daily Nursing Care & Hygiene

✅ Oral care for unconscious patients is done in side-lying position to prevent aspiration
✅ Shaving a patient on anticoagulants should use electric razor only
✅ Bath water temperature should be around 110°F (43.3°C) to prevent burns
✅ Perineal care reduces risk of urinary tract infections
✅ Complete bed bath is done for totally dependent or unconscious patients

🧠 Mental Health Nursing Essentials

✅ Orientation to reality is priority for patients with acute confusion
✅ Paranoid patients benefit from consistent routine and structured care
✅ Depressed patients often show low energy, sleep disturbance, and loss of interest
✅ Psychosis includes delusions, hallucinations, and disorganized thought
✅ Suicidal ideation must be reported immediately and not ignored

🧍 Mobility, Positioning & Prevention

✅ Anti-embolism stockings (TED hose) reduce venous stasis and DVT risk
✅ Reposition immobile patients every 2 hours to prevent pressure sores
✅ Footboards and high-top sneakers prevent foot drop
✅ Contractures can develop within a few days of immobility
✅ Sliding sheets and draw sheets reduce friction and shear injuries

📋 Communication & Teaching

✅ Therapeutic communication builds trust and supports healing
✅ Closed-ended questions are ideal for collecting specific data
✅ Restating and summarizing clarifies understanding during teaching
✅ Written instructions support long-term retention of health education
✅ Teach-back method ensures that the patient understands correctly

⚠️ Emergency, First Aid & ICU Basics

✅ First priority in unresponsive patient = check airway and breathing
✅ Defibrillation is used in ventricular fibrillation and pulseless VT
✅ Cardiac monitoring must be done for patients on IV electrolytes, digoxin, or diuretics
✅ Code Blue = cardiac or respiratory arrest
✅ Bag-valve mask (Ambu bag) provides manual ventilation support

🌍 Holistic, Family & Cultural Nursing

✅ Cultural sensitivity promotes respectful and safe care
✅ Family-centered care involves the patient and family in decisions
✅ Spiritual care helps patients find meaning and comfort in illness
✅ Alternative therapies like yoga and meditation support mental health
✅ Holistic care sees patient as a whole person, not just a diagnosis

🧾 Legal, Ethical & Professional Conduct

✅ Autonomy = patient’s right to make own healthcare decisions
✅ Non-maleficence = duty to do no harm
✅ Fidelity = keeping promises and commitments to patients
✅ Veracity = obligation to be truthful and honest
✅ Nurses must report all suspected abuse or neglect as part of legal duty

💊 Drug Administration & Patient Safety

✅ Before giving any drug, always check patient’s allergy status
✅ Time-critical medications should be administered within 30 minutes of scheduled time
✅ Medication errors must be reported immediately as per protocol
✅ Look-alike, sound-alike (LASA) drugs are a major source of medication errors
✅ High-alert medications (e.g., insulin, heparin) need double verification

🧠 Cognitive, Behavioral & Neurological Care

✅ Mini-Mental Status Exam (MMSE) screens for cognitive impairment
✅ Delirium is sudden, often reversible; Dementia is gradual and progressive
✅ Restlessness and confusion can be early signs of hypoxia or electrolyte imbalance
✅ Aphasia = difficulty in speaking or understanding language
✅ Apraxia = inability to perform learned movements despite intact motor function

🧍 Mobility Aids & Rehabilitation Devices

✅ Three-point gait is used for partial weight-bearing on one leg
✅ Quad cane provides more support than single-tip cane
✅ Canes should be held on the stronger side, advancing with the weaker leg
✅ Proper wheelchair transfer includes locking wheels and removing footrests
✅ Occupational therapy helps patients regain ADL (Activities of Daily Living) skills

🧼 Wound Care & Dressings

✅ Primary intention = surgical wounds closed by suturing or stapling
✅ Secondary intention = open wounds healing by granulation & contraction
✅ Serosanguinous drainage = pink or pale red, mix of serum and blood
✅ Purulent drainage = thick, yellow, green, or foul-smelling → sign of infection
✅ Moist wound healing promotes faster epithelialization

🛌 Sleep, Comfort & Pain Relief

✅ Non-pharmacological pain relief: music, heat/cold, distraction, guided imagery
✅ Chronic pain persists beyond normal tissue healing time (3–6 months)
✅ Rest and sleep are essential for tissue repair and immunity
✅ Pain threshold = point at which a stimulus is perceived as pain
✅ Pain tolerance = amount of pain a person is willing to endure

🩸 Vital Signs & Thermoregulation

✅ Axillary temperature is least accurate, used when oral/rectal not possible
✅ Tympanic thermometer reflects core body temperature quickly
✅ Hyperthermia = body temperature >38°C due to failed heat regulation
✅ Hypothermia = body temp <35°C → causes bradycardia, confusion
✅ Orthostatic hypotension = BP drop after standing → risk of falls

🧾 Legal Documentation & Accountability

✅ Late entries in nurse’s notes must be marked as “late entry” with correct time
✅ Do not leave blank spaces in nursing documentation
✅ Only chart what you have done, never chart for another nurse
✅ “If it wasn’t documented, it wasn’t done” – Legal documentation rule
✅ Informed consent must include risks, benefits, and alternatives

🧬 Infection Control & Standard Precautions

✅ Standard precautions are used with every patient, every time
✅ Transmission-based precautions include airborne, droplet, contact
✅ Nail polish or artificial nails are discouraged in infection control settings
✅ Cough etiquette is part of respiratory hygiene measures
✅ MRSA and VRE require contact precautions

📋 Assessment, Nursing Process & Reporting

✅ Data collection includes subjective (symptoms) and objective (signs)
✅ Nursing diagnosis describes human response to health problems
✅ Expected outcomes must be patient-centered and measurable
✅ Handoff reports ensure continuity and safety of care
✅ Evaluation phase checks if goals have been met, partially met, or unmet

🌎 Professionalism, Ethics & Cultural Safety

✅ Professional boundaries protect both nurse and patient
✅ Cultural beliefs may affect diet, modesty, pain expression, healing
✅ Confidentiality must be maintained in verbal, written, and electronic formats
✅ Nurses are patient advocates, promoting rights, safety, and informed choices
✅ Ethical principles in nursing = autonomy, beneficence, non-maleficence, fidelity, veracity, and justice

💉 Pharmacology: Safety, Actions, and Side Effects

✅ Tachyphylaxis = rapid loss of response to repeated doses of a drug
✅ Placebo effect = improvement from inert substance due to belief
✅ Antagonist drugs block the action of agonists at receptors
✅ Toxic effect = occurs when drug levels exceed therapeutic range
✅ Polypharmacy = use of multiple drugs, common in elderly

🧠 Neuro, Reflexes & Sensory Assessment

✅ Babinski reflex positive in adults = sign of neurological damage
✅ Romberg test checks for balance and proprioception
✅ PERRLA confirms cranial nerve III (oculomotor) function
✅ Miosis = constricted pupils | Mydriasis = dilated pupils
✅ Glasgow Coma Scale (GCS) ≤8 = coma, max score = 15

🛏️ Patient Care Procedures

✅ NG tube insertion is done in high Fowler’s position
✅ Auscultation of bowel sounds: 5–30 sounds/min = normal
✅ Urine output <30 ml/hour for 2 hours = report to physician
✅ Stool consistency reflects hydration and GI function
✅ After lumbar puncture, patient should lie flat to prevent headache

📋 Records, Reporting & Ethics

✅ Advance directives guide care when patient is incompetent or unconscious
✅ Incident reports are non-punitive tools for system improvement
✅ Malpractice = professional negligence with harm
✅ Whistle-blowing = reporting unsafe/illegal healthcare practices
✅ Ethical dilemma = conflict between two morally right actions

🧴 Skin Integrity & Wound Management

✅ Stage 2 pressure injury = partial-thickness skin loss (blister/abrasion)
✅ Eschar = dead, blackened tissue, often seen in pressure ulcers
✅ Debridement = removal of dead or infected tissue
✅ Hydrocolloid dressings maintain a moist wound environment
✅ Reposition bedbound patients every 2 hours to prevent ulcers

🩸 Blood, Circulation & Monitoring

✅ Capillary refill time >3 seconds = poor peripheral circulation
✅ Pitting edema is graded from +1 to +4
✅ Dorsalis pedis pulse is located on the top of the foot
✅ Cool, pale extremities = sign of vasoconstriction or poor perfusion
✅ Shock = inadequate tissue perfusion causing cellular hypoxia

🧬 Infection, Inflammation & Asepsis

✅ Signs of inflammation: redness, warmth, swelling, pain, loss of function
✅ Nosocomial infection = hospital-acquired infection
✅ Fomite = object that carries infection (e.g., thermometer, linen)
✅ Standard precautions = apply to all patients regardless of diagnosis
✅ Use clean gloves for standard precautions, sterile gloves for surgical asepsis

🌬️ Respiratory Care & Oxygen Therapy

✅ Nasal cannula delivers 1–6 L/min, approx. 24–44% O₂
✅ Venturi mask provides precise O₂ concentration (ideal for COPD)
✅ Oxygen is a drug and requires a doctor’s order
✅ Oxygen safety: keep away from open flame, oils, and static electricity
✅ Pursed-lip breathing improves exhalation in COPD

🧍 Rehabilitation & Activity Management

✅ Activity intolerance = insufficient physical energy for ADLs
✅ DVT prevention includes early ambulation and leg exercises
✅ Range-of-motion (ROM) maintains joint flexibility and circulation
✅ Walker should be level with patient’s wrist crease
✅ Occupational therapy focuses on daily functional activities

🔄 Miscellaneous Must-Know Concepts

✅ 10 Rights of Drug Administration ensure safe medication delivery
✅ Nursing audit = evaluation of nursing care/documentation quality
✅ Triage is used to prioritize emergency patients based on severity
✅ Spiritual distress = impaired ability to find meaning, hope, or peace
✅ Compassion fatigue = emotional exhaustion due to prolonged caregiving stress

🧠 Neurological & Cognitive Care

✅ Level of consciousness is the first indicator of neurological deterioration
✅ Decorticate posture = flexion of arms & legs → cerebral cortex lesion
✅ Decerebrate posture = extension of arms & legs → brainstem lesion
✅ Tinnitus may occur with ototoxic drugs (e.g., gentamicin, aspirin)
✅ Glasgow Coma Scale verbal score 1 = no verbal response

🩸 Circulatory & Hemodynamic Monitoring

✅ MAP (Mean Arterial Pressure) = [(SBP + 2×DBP)/3]; must be >65 mmHg
✅ Peripheral cyanosis = cold, bluish extremities due to poor perfusion
✅ Central cyanosis = bluish lips, tongue → respiratory/cardiac problem
✅ Hypovolemic shock = decreased blood volume → low BP, rapid pulse
✅ Cardiogenic shock = heart pump failure → cold skin, low urine output

🛌 Positioning & Pressure Ulcer Prevention

✅ Trendelenburg position = feet elevated, used in shock
✅ Reverse Trendelenburg = head elevated, used in increased ICP or reflux
✅ Shearing force contributes to deep tissue injury
✅ Stage 3 pressure ulcer = full-thickness skin loss with visible fat
✅ Waffle mattress, air-bed, and heel protectors prevent pressure injuries

💉 Medication, Injection, and IV Care

✅ ID injections are administered in forearm or upper back
✅ IV push meds must be given slowly and diluted if necessary
✅ Medication reconciliation is done at admission, transfer, and discharge
✅ Safe insulin injection site rotation prevents lipohypertrophy
✅ Ampule: break away from self using gauze or alcohol swab

🧴 Skin, Burns & Cold/Heat Therapy

✅ 1st degree burn = only epidermis affected; red and painful
✅ 2nd degree burn = blisters, red, moist, painful
✅ 3rd degree burn = full thickness with white/charred, painless skin
✅ Cold therapy causes vasoconstriction → reduces swelling & pain
✅ Heat therapy causes vasodilation → improves circulation

🧍 Mobility, Rehabilitation & Fall Prevention

✅ Call bell should be within patient’s reach at all times
✅ Non-slip footwear prevents slips and falls in at-risk patients
✅ Gait belt provides support during ambulation
✅ Fall risk increases with polypharmacy, weakness, confusion
✅ Post-fall assessment includes neuro checks, vitals, and documentation

📋 Legal Responsibilities & Documentation

✅ Nurse Practice Act defines scope and standard of nursing practice
✅ Confidentiality must be respected even after patient discharge or death
✅ Incident report is not part of the medical record but is used internally
✅ Fraudulent documentation is a criminal offense in nursing
✅ Nurses are legally accountable for their own acts and omissions

💧 Hydration & Fluid-Electrolyte Balance

✅ 1 kg weight gain = approximately 1 liter fluid retention
✅ Signs of dehydration: dry mucosa, hypotension, tachycardia
✅ Isotonic IV fluids: NS, LR → for fluid resuscitation
✅ Hypertonic fluids: D10W, D5NS → pull fluid from cells into vessels
✅ Potassium must never be given IV push → fatal arrhythmia risk

🌬️ Respiratory Nursing & Airway Management

✅ Cheyne-Stokes breathing = deep breathing with apnea in between
✅ Kussmaul’s breathing = deep, rapid breathing seen in metabolic acidosis
✅ Use incentive spirometer post-op to prevent atelectasis
✅ Suctioning duration should not exceed 10–15 seconds
✅ Oral suction catheter = Yankauer, used for oral secretions

🧠 Mental Health & Therapeutic Care

✅ Empathy helps patients feel understood and supported
✅ Delusion = fixed false belief | Hallucination = false sensory perception
✅ Suicide risk assessment includes plan, means, history, mood
✅ Therapeutic milieu = safe, structured environment that promotes healing
✅ Validation therapy accepts feelings of dementia patients without correcting them

🧠 Neuro-Assessment & Neurological Nursing

✅ Cranial nerve VII (Facial) controls facial expressions and taste (anterior 2/3 tongue)
✅ Cranial nerve X (Vagus) regulates heart rate and digestion
✅ Meningeal signs include Kernig’s and Brudzinski’s signs
✅ Seizure precautions: padded side rails, suction, oxygen setup, low bed
✅ Status epilepticus = seizure lasting >5 minutes or multiple seizures without recovery

🛏️ Bedside Care, Positioning & Comfort

✅ Trendelenburg position increases venous return in hypotension
✅ Fowler’s position aids in lung expansion and feeding
✅ Sims’ position is ideal for rectal suppository or enema
✅ Prone position is used for spinal drainage or post-laminectomy
✅ Logrolling technique protects the spinal column during movement

💉 IV, Injections & Fluid Therapy

✅ Short peripheral IV sites should be changed every 72–96 hours
✅ Heparin flush is used to maintain patency of central venous catheters
✅ Intramuscular injections in adults = deltoid, vastus lateralis, ventrogluteal
✅ Z-track IM method minimizes skin staining and irritation
✅ Crystalloids = clear IV fluids (e.g., NS, Dextrose); Colloids = volume expanders (e.g., albumin)

🧬 Infection, Inflammation & Prevention

✅ Infection chain includes: Agent → Reservoir → Exit → Mode → Entry → Host
✅ Nosocomial infection prevention: hand hygiene, PPE, sterilization
✅ Standard precautions are used with all patients
✅ Contact precautions = gloves and gown (e.g., MRSA, C. diff)
✅ Airborne isolation = negative pressure + N95 mask

🧾 Legal & Ethical Responsibilities

✅ Informed consent requires capacity, information, and voluntariness
✅ Negligence = failure to give expected standard of care
✅ Battery = touching a person without permission
✅ Assault = threat of harm (verbal or gesture)
✅ Autonomy = patient’s right to refuse or choose treatment

🌬️ Respiratory Monitoring & Oxygen Care

✅ SpO₂ < 90% = hypoxemia; notify provider
✅ Oropharyngeal airway is used only in unconscious patients
✅ Endotracheal tubes (ETT) are used for mechanical ventilation
✅ Chest physiotherapy (CPT) loosens secretions in lungs
✅ Postural drainage positions patient so gravity aids mucus clearance

🧍 Fall Risk, Mobility & Assistive Devices

✅ Use gait belt during ambulation in patients with balance issues
✅ Cane height: handle should align with greater trochanter
✅ Walker use: move walker → affected leg → unaffected leg
✅ Post-fall protocol: check vitals, neuro status, and document incident
✅ Call bell and bed in low position help prevent falls

🩸 Vital Signs, Pain & Thermoregulation

✅ Normal adult temperature: 36.5–37.5°C (97.7–99.5°F)
✅ Tympanic thermometer reflects core body temperature
✅ Pain scale (0–10) is used for subjective pain assessment
✅ Fever (pyrexia) = temp > 100.4°F | Hyperpyrexia > 104°F
✅ Pulse pressure = systolic – diastolic | normal = 30–50 mmHg

🧠 Therapeutic Communication & Mental Health

✅ Open-ended questions encourage elaboration and sharing
✅ Restating confirms nurse’s understanding of patient’s words
✅ Silence is useful in grief or emotional situations
✅ Delirium = sudden, temporary confusion | Dementia = gradual, irreversible
✅ Depression in elderly often presents with somatic complaints (e.g., fatigue, insomnia)

📚 Miscellaneous High-Yield Essentials

✅ 10 Rights of medication: patient, drug, dose, route, time, documentation, education, assessment, evaluation, refusal
✅ SBAR tool improves handoff communication between nurses and doctors
✅ SOAP notes: Subjective, Objective, Assessment, Plan
✅ Triage color RED = immediate/emergency | BLACK = expectant
✅ Health promotion includes activities that enhance well-being and prevent disease

💉 Pharmacology: Drug Effects & Administration

✅ Loading dose = initial high dose to reach therapeutic concentration quickly
✅ Trough level = lowest drug concentration before next dose
✅ Adverse drug reaction (ADR) = unexpected, harmful reaction
✅ Half-life = time taken to reduce drug concentration by 50%
✅ Transdermal patches must be rotated and dated upon application

🧠 Neuro & Emergency Nursing

✅ Unilateral pupil dilation = sign of increased intracranial pressure (ICP)
✅ CSF leak after lumbar puncture = headache relieved by lying flat
✅ Stroke FAST tool = Face drooping, Arm weakness, Speech slurred, Time to call
✅ Seizure patient care: do not restrain, protect head, turn to side
✅ Postictal phase = confused, sleepy recovery phase after a seizure

🛌 Comfort, Pain, Sleep & Palliative Care

✅ Breakthrough pain = transient, severe pain despite regular analgesia
✅ Palliative care improves quality of life in chronic or terminal illness
✅ Sleep hygiene includes fixed sleep schedule, avoiding caffeine before bed
✅ Warm bath or back rub can enhance relaxation and sleep
✅ Nonverbal pain cues: grimacing, guarding, moaning

💧 Hydration, Urinary, and Renal Care

✅ Anuria = urine output <100 mL/day
✅ Oliguria = <400 mL/day | Polyuria = >2500 mL/day
✅ Specific gravity of urine: 1.010–1.030 → high = concentrated
✅ 24-hour urine collection: discard first sample, then start timing
✅ Urinary catheter care: keep bag below bladder, secure tubing, daily hygiene

🧼 Asepsis, Waste, and Infection Control

✅ Medical asepsis = reduce microbes | Surgical asepsis = eliminate all microbes
✅ Biohazard bags (red) = used for blood-soaked materials
✅ Yellow bins = anatomical waste (per BMW rules)
✅ Sterile field is contaminated when below waist or turned away from
✅ Clean to dirty is the principle followed during wound cleaning

🧍 Mobility, Fall Risk, and Rehabilitation

✅ High-risk fall patients: elderly, sedated, confused, weak
✅ Braden Scale is used to assess pressure sore risk
✅ Rehabilitation aims to restore functional independence
✅ Passive ROM prevents contractures and improves circulation
✅ Frequent repositioning prevents pressure injuries and respiratory complications

🩺 Vital Signs, Assessment, & Communication

✅ Respiratory rate is the most sensitive indicator of deterioration
✅ Radial pulse is most commonly used | Apical pulse is most accurate
✅ BP cuff too small = falsely high reading | too large = falsely low
✅ Hand-off communication ensures continuity and safety
✅ Closed-loop communication confirms that message was understood and acted upon

📚 Leadership, Ethics & Professional Practice

✅ Accountability = being answerable for own actions and outcomes
✅ Advocacy = acting in the best interest of the patient
✅ Delegation requires assessing right task, right person, right circumstances
✅ Professionalism includes ethics, appearance, reliability, and respect
✅ Time management helps improve nurse efficiency and patient care quality

🌈 Holistic & Culturally Competent Care

✅ Holistic care = treating patient’s mind, body, emotion, and spirit
✅ Spiritual assessment identifies sources of strength, hope, and belief
✅ Culture impacts pain expression, communication, diet, and compliance
✅ Health beliefs influence how patients perceive illness and treatment
✅ Respect and empathy are key to culturally safe nursing practice

🧠 Final Powerful Clinical Pearls

✅ Prioritization uses ABCs (Airway, Breathing, Circulation) and Maslow’s hierarchy
✅ Triage red = life-threatening | Yellow = urgent but not critical
✅ “If it’s not documented, it’s not done” – legal rule in nursing
✅ Nurses are lifelong learners – continuing education ensures safe, evidence-based practice
✅ Compassion is the heart of nursing – combine skill with kindness to heal lives 💖

Published April 20, 2025By mynursingapp

Categorized as FON-SYNOPSIS-PHC, Uncategorised