Poor

Normal Values

9% and up

Electrolytes
Potassium:
Sodium
Calcium:

Magnesium
Chloride
Bicarbonate
Serum Osmolality
Phosphate
Phosporus

3.
5 - 5.1 mEq/L
13
5 -145 mEq/L
4.
5 - 5.2 mEq/L or
8.
6 - 10 mg/dL
1.
6 - 2.6 mEq/L
98 -107 mEq/L
22 - 29 mEq/L
285-290 mOsm/kg H2O
1.7-2.6 mEq/L
2.
5 - 4.5 mg/dL

Gastro-Intestinal Serum Studies

3.
Albumin
4 - 5 g/dL
6.
Protein
0 - 8.0 g/dL
4.
Alkaline
5 - 13 u/dL
Phosphatase
ALT
AST
1
Ammonia
5 - 45 ug/dL
2
Amylase
5 - 151 IV/L
1
Lipase
0 - 140 U/L
BUA
M 4.5 to 8 mg/dL
F 2.5 to 6.3 mg/dL
Total Bilirubin
< 1.5 mg/dL
Direct Bilirubin
0 - 0.3 mg/dL
0.
Indirect Bilirubin
1 1 mg/dL

Glucose
FBS
CBG (monitoring)
OGTT
Baseline
30 mins
60 mins
90 mins
120 mins
Glucose 2 hr post-prandial
HbA1c (Glycosylated)
Good Control
Fair

70 -110 mg/dL
60 - 110 mg/dL
70 - 110 mg/dL
11
0
- 170 mg/dL
12
0
- 170 mg/dL
10
0
-140 mg/dL
70 -120 mg/dL
< 140mg/dL
7.5
< %
7.6 - 8.9%

Insulin
Type of
Insulin
Regular
(Humulin R)
Intermediate
Acting

Onset

Peak

Duration

-1 hr

2-4 hr

6-8 hr

2hr

6-12hr

18-26hr

(NPH,
Humulin N)
Long Acting
Ultralente,
Humulin U)
Combination
Humulin
70/30

4hr

8-20hr

24-36hr

hr

2-12hr

24hr

Lipids
Cholesterol
LDL
HDL
Triglycerides

140 199 mg/dL

< 130 mg/dL
30 to 70 mg/dL
< 200 mg/dL

Coagulation Studies
PT
M: 9.6-11.8 s
F: 9.5 - 11.3 s
PT - 10-13sec x 2
INR
2-3
Clotting Time
8 - 15 mins
Bleeding Time
1-9 mins
Platelet Count
150,000 - 400,00 u/L
aPTT
APTT - 25-35sec x 3
1.5 - 2.5 x (therapeutic)
Fibrinogen
M: 180 - 340 mg/dL
F: 190 - 420 mg/dL
ESR
30-40 mm/hr
Mild inflammation
40-70 mm/hr
Moderate inflammation
70-150 mm/hr
Severe inflammation
Hemoglobin
Hematocrit

Blood Gases
pH
pCO2
pO2
HCO3

O2 Sat %

M- 42-52%
F - 37-47%

7.35 - 7.45
35 - 45
80 - 100
22-28
95-98%

Pressures
Tonometry
(IOP)
ICP
CVP
Stomach Capacity
Newborn
1-week-old
2-3-week-old
1-month-old

8-21mm Hg
1-10mmHg
4-11cm H2O or
3-7 mmHg
10 to 20 mL
30 to 60 mL
75 to 100 mL
90 to 150 mL

Obstructive VS Restrictive

Obstructive
Inc
Inc
Inc
Dec
Inc
Dec

TLC
FRC
RV
VLC
PaCO2
FEV1

Restrictive
Dec
Dec
Dec
Dec
Dec
Normal

AC=CC Barrel Chest

Intelligence Quotient:
<70
Mild mental retardation
<50
Moderate mental retardation
<35
Severe mental retardation
<20
Imbecile/Idiot

Immunizations
2

Low Pressure Alarm

Patient disconnection,
Circuit leaks, Airway leaks,
Chest tube leaks

High Pressure Alarm

Patient coughing,
Secretions or mucus in
the
airway, Patient biting tube,
Airway problems,
Reduced
lung compliance,
Increased
airway resistance, Patient
fighting the ventilator,
Accumulation of water in
the
circuit, Kinking in the
circuit,
Problems with inspiratory
or
expiratory valves

Diabetic, Arterial, Venous

Diabetic
Pain

None

Location

Plantar
Aspect,

Temp
Color

Arterial
Painful, Inc
w/
Elevation
Dista
l
Lateral
Leg,
Toes,

Heel,
Metatarsals

Phalanges

Inc
Red

Dec
Pale Base

Newborn Measurements
HC
30-35cm
CC
31-33cm
AC
50-55cm
HC=CC - 2y/o

Venou
s
Dec
w/
Elevation
Medial
aspect
of
Lowe
r
Leg
and Ankle,
Malleolus
area
Inc
Red/Purple

DTP
OPV
Hepa B

x
x
x

x
x
x

HiB
MMR
Varicella
Td

12

15
x
x

4-6
y/o

10y

x
x or
x or

x
x

Allergy Vaccine Contraindications

EGGS
INFLUENZA , MMR
NEOMYCI
N
VARICELLA,IPV,MMR
YEAST
HEPA-B
GELATIN

VARICELLA

Newborn

RR
30-60

HR
120-160

1-4 y/o

20-40

80-140

BP
60systolic or
80/40
90/60-99/65

5-12 y/o

15-25

70-115

100/56 - 110/60

Adult

12-20

60-100

90/60 - 140/90

Glasgow Coma Scale

I. EYE MOVEMENT (4)
4
Spontaneous
To
3
speech
2
To pain
1
No response

II. MOTOR RESPONSE (6)

6
Obeys Commands
5
Localizes pain
4
Withdraws to pain
3
Flexing (Decorticate)
2
Extension (Decebrate)
1
No response

x
x

III. VERBAL RESPONSE (5)

5
Oriented
4
Confused
3
Inappropriate words
2
1

Incomprehensible sounds
No response

RULE OF
NINES
Head
Arms
Torso
Legs & Thighs
Perineum

9
18
36
36
1

Parkland-Baxter
= 4mL x kg x %TBSA
1/2 = given 1st 8 hrs
Renal Function
GFR
SG
Crea
BUN
BUN:Crea Ratio
albumin
Urine Culture
Urine Output
Oliguria
Anuria

125mL/min
1.010 - 1.030
0.6-1.3 mg/dL
8-25mg/dL
15 : 1
3.2 - 4.5 g/dL
>/= 100,000 (Positive Culture)
30-50mL/hr
< 400cc in 24 hr
<100 in 24hr

Therapeutic Levels
Medication
Acetaminophen (Tylenol)
Acetylcysteine
Carbamazepine (Tegretol)
Cycloserine
Digoxin (Lanoxin)
Digitoxin (Crystodigin)
Gentamycin (Garamycin)
Lidocaine (Xylocaine)
Lithium (Lithobid)
Magnesium So4
Phenytoin (Dilantin)
Phenobarbital (Luminal)
Procainamide (Pronestyl)
Propranolol (Inderal)
Salicylate (Aspirin)
Theophylline (Aminophylline)
Vancomycin
Things to prepare :
Hemodialysis
SengstakenBlakemore
Tube
CTT
Acetylcysteine
overdose
Laryngospasm
Tracheostomy
Skeletal pinning
Sterile water /NSS
bottle
tongue depressor and
flashlight

URINE
Clear
cloudy
smoke
y
foamy

normal
UTI
AGN
nephrotic syndrome

Pain Ladder (010)

1-3

Mild

4-7
8-10

Moderate
Severe

(Acetaminophen)
Non-narcotic
PNS
Narcotic (Morphine)- CNS
Non-narcotic + Narcotic

Bence Jones Protein

Auer Rods
Reed Sternberg cells
EBV
ANA test
Rheumathoid factor
(RF)
Bone Scan/Gallium
Scan
Bone Densitometry
Diskogram

Paget's dse
Rheumatoid Arthritis
Osteoarthritis

Levels
5 to 20 ug/mL
5
to 20 ug/mL
3
to 14 ug/mL
25 to 35g/mL
0.
5 to 2 ng/mL
15 to 25 ng/mL
5 to 10 ug/mL
1.5 to 5 ug/mL
0.5 to 1.3 mEq/L
4
to 8 mg/dL
10 to 20 ug/mL
10 to 30 ug/mL
4
to 10 ug/mL
50 to 100 ng/mL
100 to 250 ug/mL
10 to 20 ug/mL
30 to 40 ug/mL

Bulldog clips
Scissors
Rubber-tipped hemostat
Suction Apparatus
Tracheotomy
Set
Obturator
Wire cutter
if the chest tube bottle
breaks
tonsillectomy
Multiple
Myeloma
AML
Hodgkin's lymphoma
infectious mononucleosis
SLE
Rheumatoid Arthritis
Bone Cancer
osteoporosis
HNP
bowing of
legs
wrist drop or foot drop
heberden'
bouchard's
& s
nodule

STANDARD
AIRBORNE

CONTACT

Universal
Prec
PTB,
Varicella
Measles

MRSA
(vancomycin),
CDAD
(vancomycin),
RSV(Ribavirin
)

Gloves,
Goggles,
Gown, Mask
HEPA filter mask, N45
Negative
pressure
room
6-12 exchanges/ hr,
Private Door Closed
GGG(gown
,
goggles,
gloves)
3 feet
away

DROPLET

Herpes
simplex
Impetigo
Respiratory
infections,
Meningitis,
Pneumonia,
Legionnella,

3 feet away,
Private room
Mask

Scarlet Fever
Pertussis
Strep.
Pharyngitis
ENTERIC

NEUTROPENIC

GIT , Hepa A,
Salmonella,
Typhoid,
Cholera

Oral-fecal route
Gloves and gown
Leukemia, Organ
transplant, Sickle cell
dse, HIV, AIDS
Immunocompromised
,
undergoing
chemotherapy,
Radiation therapy,
Steroid therapy,
Burns
No fresh fruits, fish,
meat, stagnant water,
no yoghurt,
buttermilk,
Strict handwashing,
private room, no
dental boxes,
no populated area
No immunization
with
Attenuated vaccines

Prioritization
AIRWAY

BREATHING
CIRCULATION
OXYGEN
FLUIDS

NUTRITION

Bronchiolitis
,
Apnea, Burns, Chest
Croup, Cystic fibrosis, DM, DKA
Seizure Multipl
Asthma, ,
e
sclerosis
Myasthenia
gravis
Flail
chest
CHF,
Edema,Thromboplebitis
Angina,
Shock
Abortion
,
Addisons
disease,
Clostridiu
Norwalk virus, m
defficile
Sickl cell
Anemia, e
,
DI, Giardiasis
Hemorrhage, Renal colic
Salmonellosis,
SIADH
Anorexia,Bulimia Cancer, esophagus

SAFETY

,
Cleft palate, Diverticulitis,
TB
Agoraphobia, ADHD,
Autism,
Battered wife, Menieres
disease
Cataract, Cerebral palsy, CVA,
Depression, Seizure,
Hemophilia,
Hepatic coma, Fracture,
Hypertension,
Hypothyroidism, Hyperthryroidism,
Increase ICP, Leukemia,
Mania,
Meningitis, Osteoporosis,
Parkinsons
disease, Poisoining, PIH,
Suicide,
Spinal cord injury, Wilms
tumor,

MOBILITY
ELIMINATION

(all musculoskeletal cases)

Arthritis
Autonomic dysreflexia, BPH, UTI

PHOTOSENSITIVITY DRUGS
Antipsychotic

PHENOTHIAZINE derivatives
(Haldol,
Thorazine,
Risperdal)

Stelazine,

Antihyperlipidemi
c
Simvastatin/Atorvastatin
agents/
Sulfa Drugs
Quinolones
Tetracyclines
Herbal

Trimethoprim-Bactrim,
Sulfa
Levofloxacin,
Ciprofloxacin
(Doxycycline)
St. John's Wort

RED-ORANGE URINE

Hyper
K

Hypo
K

Rifampicin, Azulfidine,
Pyridium

Causes

S & Sx

Cellular Shift,
Trauma,

BradycardiaBr
adypnea;N &

Burns, Sepsis

Flat P waves

Metabolic
Acidosis,
Respiratory

V; diarrhea;
Intestinal
Colic,
Irritability;
Muscle

Acidosis, renal
Insufficiency,
Potassium
sparers

weakness,
Numbness,
Flaccid
Paralysis

PR lntervals

Cushing's
Syndrome ,
Colitis,
Laxative
Abuse,
Anorexia,
Alcoholism,

ECG
Findings
Tall Peaked
T waves

Widened
QRS
Prolonged

Thready,
rapid,
weak pulse;

Inverted
T waves

faint heart
sounds;
Hypotension,
skeletal

ST seg
Depression
U waves
Heart block

NGT, GI
surgery,
Vomiting,
Diarrhea,

muscle
weakness;
shallow
respirations;

Thiazide
Diuretics,
stress,
Alkalotic states

malaise;
apathy;
lethargy; loss
of orientation;
dec reflexes
anorexia,
vomiting,

Hyper
Na

Steroid intake
Renal failure

weight loss,
Ileus
Dry, Flaky skin
& mucous

Hyperaldostero mem, thirst

nism
edema

Hypo
Na

Diaphoresis or
GI suctioning,
Adrenal
insufficiency

Low UO
High SG
N & V,
abdominal
cramps;
weight
loss; cold,
clammy skin;
decreased
skin
turgor;
fingerprinting
over the
sternum;
shrunken
tongue;
apprehension;
headache;
convulsions;
confusion;
weakness;
fatigue;
Postural
hypotension;

Hyper
Ca

HyperparaThyroidism,

rapid, thready
pulse
Hypoactive
Bowel sounds

Excess Vit. D
osteoporosis
and
osteomalacia

N & V,
anorexia,
constipation,
headache,

Shortened
ST segment
Widened T
wave

confusion,
lethargy,
stupor,
decreased
muscle tone,
deep bone
and/or flank
pain
Hypo

Prolonged Bed

Painful tonic

Prolonged

Ca

Rest, Vit D
Deficiency

muscle
spasms,

QT interval
Prolonged

Hypopara-

fatigue,
laryngospasm
,
Trousseau's
Chvostek's

ST interval

thyroidism
Acute
Pancreatitis,
Diarrhea,
steroid therapy
Hyper
Mg

Renal
insufficiency,
dehydration,

signs,
convulsions,
dyspnea
Drowsiness,S
e
dation,
Lethargy,
Somnolence
Muscle
Weakness
N&V

Hypo

Low intake of

paresthesias
Dec RR, DTRS
Paresthesias,

Mg

magnesium in
diet, prolonged

confusion,
hallucinations,

diarrhea,
massive
diuresis,

convulsions,
ataxia,
tremors,

Peritonitis, Edema
Ileostomy, Colostomy
NGT

Hyper
P04

Fluid
Volume
Overload

Renal
insufficiency

CHF
Dec Kidney Fxn.
Liver Dse.

Tumor Lysis
Syndrome
Hypoparathoro
i
dism
Hypo

Malnutrition,

PO4

Starvation
Alcoholism, Al-

Isotoni
c

Mg (antacids)

LR
D5W
NS

Altered LOC
Vein Distention
Cough, Dyspnea,
Rales
Inc RR, HR, CVP

Hypotonic
0.45 NS

Hypertonic
D10W

1/2 NS

D5 NS
D5 1/2 NS

D5 0.5 NaCl
D5 1/4 NS
Fluid
Volume
Deficit

Respiratory
Alkalosis

Cause
Vomitting, Diarrhea,
Hemorrhage,
Tachypnea
Inc UO, Kidney dse.
Insufficient IVF
replacement
Diuretics
Draining Fistulas,
Hyperventilation,
mechanical
overventilation,
encephalitis

S & Sx
Increased = RR,
HR, Hct, SG
Decreased = CVP,
Wt., UO, BP
Anorexia, Wt. loss
Inc RR & Depth
Headache,
Lightheadedness
,
Vertigo
Mental Status
Changes
Paresthesias
Dry Mouth
Low K, Low Ca

Metabolic
Acidosis

Metabolic
Alkalosis

Ileostomy, Hyperpnea
w/ Kussmaul's

Tetany,
Convulsions
Headache, N&V
Fruity Breath

DKA, Uremia,
starvation, Diarrhea,
Severe infections,
Renal Tubular
Acidosis

CNS depression
Drowsiness,
Convulsions,

Severe Vomiting, NGT

suctioning

N &V, diarrhea,
Paresthesia,

Excessive Antacids,
NaHCO3,
Diuretics,
Biliary Drainage

Tetany,
RR & HR

Tremors
K, Ca

Respiratory
Acidosis

Cause
COPD, Barbiturate or
Sedative Overdose,

S & Sx
Headache,
weakness, visual

Acute Airway
disturbances, ,
Obstruction, Weakness confusion,
of Respiratory muscles drowsiness,
coma
Inc. RR & HR

Dietary Restrictions
KOSHER
Jewish, no mixture of meat and dairy
HALAL
Islam, No pork
VEGAN
vegetable diet - Buddhism
R. CATHOLIC No Meat on Good Fri & Ash Wed
JEHOVAHS
No Blood or Blood Products
WITNESS
Herbal Medications
St. John's
Antidepressant, photosensitive (C/I in
Wort
SULFA drugs)
Garlic
Antihypertensive, (avoid Aspirin)
Ginseng
Anti stress, (C/I in Coumadin)
Antioxidant, (C/I risk for calculioxalates)
immune stimulant (6-8 weeks only) (C/I in
SANDIMMUNE)
Licorice
cough and cold
Ginger root
antinausea, (C/I in Coumadin)
Ginkgo
Improves Circulation; (C/I in
anticoagulant, headache side effect check PT)
Ma Huang
Bronchodilator, Stimulant (Ephedra)
Valerian
For Insomnia
Black Cohosh For Menopause
Kava kava
For stress and anxiety relief
Green tea
Echinacea

RN

Least stable, unstable, central catheters

(hickman, broviac), admission, discharge,
health teachings, patient for transfer, blood