CJE HELP

1. Clinical Judgment & Prioritization

• Recognize cues

• Analyze cues

• Prioritize hypotheses

• Generate solutions

• Take action

• Evaluate outcomes

• ABCs

• Acute vs chronic

• Stable vs unstable

• Actual vs potential problem

• Expected vs unexpected finding

• First action

• Priority patient

• When to assess first

• When to intervene first

• Reassessment after intervention

• Nursing process: ADPIE

2. Safety

• Fall risk

• Fall prevention

• Bed safety

• Side rails

• Call light placement

• Nonskid footwear

• Clutter/environmental hazards

• Home safety

• Bathroom safety

• Older-adult safety

• Medication-related fall risk

• Orthostatic hypotension precautions

• Seizure precautions

• Aspiration precautions

• Suicide/self-harm safety basics

• Fire safety

• RACE

• PASS

• Oxygen safety

• Electrical safety

3. Restraints

• Least restrictive intervention

• Alternatives before restraints

• Indications

• Provider order

• Proper application

• Quick-release knot

• Tie to bed frame

• Neurovascular checks

• Skin checks

• ROM

• Toileting

• Hydration/nutrition

• Reassessment

• Restraints vs side rails

• Never use for staff convenience/punishment

4. Infection Control

• Chain of infection

• Hand hygiene

• Standard precautions

• Contact precautions

• Droplet precautions

• Airborne precautions

• Protective precautions basics

• PPE selection

• Donning PPE

• Doffing PPE

• Clean vs sterile technique

• Isolation room setup

• Dedicated equipment

• Transporting isolated patients

• Specimen handling

• Needlestick prevention

• Sharps disposal

5. Common Isolation Diseases

Contact

• C. difficile

• MRSA

• VRE

• Scabies

• Draining wounds

• RSV basics

Droplet

• Influenza

• Pertussis

• Meningococcal meningitis

• Mumps

• Rubella

Airborne

• Tuberculosis

• Measles

• Varicella

• Disseminated herpes zoster

6. Surgical Asepsis / Sterile Technique

• Sterile field setup

• 1-inch contaminated border

• Sterile touches sterile

• Below waist = contaminated

• Out of sight = contaminated

• Moisture/strike-through

• Opening sterile packages

• Pouring sterile solution

• Not reaching over field

• What to do if sterility is questioned

• Sterile gloves

7. Vital Signs

• Temperature

• Pulse

• Respirations

• Blood pressure

• Oxygen saturation

• Pain as assessment data

• Normal vs abnormal trends

• Tachycardia

• Bradycardia

• Tachypnea

• Bradypnea

• Hypotension

• Hypertension

• Fever

• Hypothermia

• Orthostatic hypotension

• When to recheck a vital sign

• What findings require immediate action

8. Physical Assessment Basics

• General survey

• LOC/orientation

• Skin assessment

• Respiratory assessment

• Cardiovascular assessment

• Neuro checks

• Peripheral pulses

• Cap refill

• Edema

• Bowel sounds

• Urine output

• Pain assessment

• System-specific abnormal findings

• Comparing findings to baseline

9. Mobility

• Safe ambulation

• Transfers

• Gait belt

• Bed-to-chair transfer

• Dangling

• Body mechanics

• ROM

• Positioning

• Turning/repositioning

• Weight-bearing status

• Fall prevention during mobility

10. Assistive Devices

Cane

• Strong side

• Cane → weak leg → strong leg

Walker

• Walker → weak leg → strong leg

Crutches

• Proper fit

• Weight on hands, not axillae

• Basic gait patterns

• Stairs: up with good, down with bad

11. Immobility Complications

Respiratory

• Atelectasis

• Pneumonia

• Secretion retention

Cardiovascular

• Venous stasis

• DVT

• Orthostatic hypotension

Musculoskeletal

• Muscle atrophy

• Weakness

• Contractures

• Foot drop

GI

• Constipation

GU

• Urinary stasis

• UTI

• Stones

Skin

• Pressure injuries

12. Pressure Injuries

• Risk factors

• Prevention

• Repositioning

• Moisture control

• Nutrition

• Off-loading heels

• Stage 1

• Stage 2

• Stage 3

• Stage 4

• Unstageable

• Deep tissue pressure injury

• Braden scale basics

13. Skin Integrity & Wounds

• Wound assessment

• Size/depth

• Drainage

• Odor

• Surrounding skin

• Serous

• Sanguineous

• Serosanguineous

• Purulent

• Signs of infection

• Wound healing basics

• Dehiscence

• Evisceration

• Dressing principles

14. Hygiene

• Bathing

• Oral care

• Denture care

• Perineal care

• Hair/nail care basics

• Skin protection

• Hygiene for unconscious patient

• Aspiration prevention during oral care

• Promoting independence with ADLs

15. Nutrition

• Balanced nutrition basics

• Malnutrition

• Protein needs

• Calorie needs

• Older adult nutrition

• Nutrition screening

• Feeding assistance

• Cultural food preferences

• Therapeutic diets basics

• NPO

• Enteral nutrition basics

• Oral hydration

16. Dysphagia & Aspiration

• Risk factors

• Coughing with meals

• Wet/gurgly voice

• Pocketing food

• Choking

• Drooling

• Upright positioning

• Small bites/sips

• Thickened liquids if prescribed

• NPO if swallowing unsafe

• Speech-language pathology referral

• Aspiration pneumonia risk

17. Fluids

Fluid Volume Deficit

• Dehydration

• Dry mucous membranes

• Tachycardia

• Hypotension

• Orthostasis

• Decreased UO

• Concentrated urine

• Confusion

• Weight loss

Fluid Volume Excess

• Edema

• Crackles

• Dyspnea

• JVD

• Weight gain

• Hypertension

• Bounding pulses

Monitoring

• I&O

• Daily weights

• 1 kg ≈ 1 L fluid

• Urine output

18. Electrolytes

Sodium

• Neuro effects

• Confusion

• Seizures with severe abnormalities

Potassium

• Cardiac rhythm risk

• Weakness

• Hyperkalemia vs hypokalemia basics

Calcium

• Neuromuscular effects

• Tetany basics

• Weakness basics

Magnesium

• Neuromuscular/cardiac basics

19. Acid-Base Basics

• Respiratory acidosis

• Respiratory alkalosis

• Metabolic acidosis

• Metabolic alkalosis

• Basic cause recognition

• Compensation concept

• Link to vomiting, diarrhea, hypoventilation, hyperventilation

20. Oxygenation

• Early hypoxia

• Restlessness

• Anxiety

• Tachycardia

• Tachypnea

• Confusion

• Late hypoxia

• Cyanosis

• Decreased LOC

• Positioning

• HOB elevation

• Oxygen administration basics

• Pulse oximetry limitations

21. Oxygen Devices

• Nasal cannula basics

• Simple mask basics

• Venturi basics

• Nonrebreather basics

• Humidification basics

• Oxygen safety

22. Incentive Spirometry / Pulmonary Hygiene

• Proper technique

• Slow deep inhalation

• Breath hold

• Coughing/deep breathing

• Splinting incision

• Repositioning

• Early ambulation

• Atelectasis prevention

23. Pain

• Pain assessment

• PQRST

• Acute pain

• Chronic pain

• Nociceptive pain

• Somatic pain

• Visceral pain

• Neuropathic pain

• Referred pain

• Patient self-report

• Pain in older adults

• Nonverbal pain cues

• Reassessment after intervention

24. Nonpharmacologic Comfort

• Repositioning

• Heat/cold

• Massage when appropriate

• Guided imagery

• Relaxation

• Music

• Distraction

• Quiet environment

• Splinting

• Therapeutic touch basics

25. Sleep & Rest

• Sleep hygiene

• Cluster care

• Reduce noise/light

• Pain control

• Reduce interruptions

• Bedtime routine

• Factors that disturb sleep

• Hospital-related sleep disruption

26. Medication Administration

• Medication rights

• Two patient identifiers

• Allergy checks

• Medication reconciliation

• Pre-administration assessment

• Safe dose verification

• Route

• Timing

• Documentation

• Evaluation

• Refusal

• PRN medications

• Holding medications

• Medication errors

27. Routes of Medication Administration

• PO

• Sublingual

• Buccal

• Enteral tube

• Topical

• Transdermal

• Ophthalmic

• Otic

• Inhaled

• Subcutaneous

• IM

• IV basics

28. High-Alert Medications

• Insulin

• Anticoagulants

• Opioids

• Extra verification

• Bleeding precautions

• Hypoglycemia precautions

• Respiratory depression

29. Opioid Safety

• Sedation

• Respiratory depression

• RR assessment

• LOC

• BP

• SpO₂

• Naloxone basics

• Constipation

• Nausea

• Fall risk

• Do not give if unsafe

• Reassessment

30. Diabetes / Glucose Regulation

• Hypoglycemia

• Hyperglycemia

• Signs/symptoms

• Glucose monitoring

• Fast-acting carbohydrates

• Glucagon

• IV dextrose

• Insulin timing

• Rapid acting

• Regular insulin

• NPH

• Glargine

• Mixing insulin basics

• Sick-day basics

• Foot care basics

31. Dosage Calculation

• Tablets/capsules

• Liquid medications

• mL/hr

• Units/hr basics

• Weight-based basics

• Dimensional analysis

• Rounding rules

• Safe dose checks

32. Elimination — Urinary

• Normal urine

• Urinary retention

• Incontinence

• UTI basics

• Catheter care

• CAUTI prevention

• Straight catheterization basics

• Foley indications

• Post-op retention

• Urinary specimen collection

• Bladder training

• Urine output

33. Elimination — Bowel

• Constipation

• Diarrhea

• Fecal impaction

• Bowel sounds

• Stool characteristics

• Enemas basics

• Bowel training

• Opioid constipation

• Fiber/fluids/activity

• Ostomy basics

34. Hemodynamics / Perfusion

• Cardiac output

• HR × stroke volume

• Preload basics

• Perfusion

• Hypovolemia

• Shock basics

• Tachycardia as compensation

• Hypotension

• Cool clammy skin

• Weak pulses

• Decreased urine output

• Altered LOC

35. Shock / Hemorrhage

• Early shock

• Late shock

• Bleeding assessment

• Tachycardia

• Restlessness

• Hypotension

• Weak pulses

• Cool skin

• Low UO

• Emergency response priorities

36. DVT / PE

DVT

• Unilateral swelling

• Warmth

• Redness

• Tenderness

• Risk factors

• Prevention

• Do not massage

PE

• Sudden dyspnea

• Chest pain

• Tachycardia

• Hypoxemia

• Anxiety

• Emergency response

37. Peripheral Vascular Disease

• Arterial vs venous basics

• Perfusion assessment

• Pulses

• Color

• Temperature

• Edema

• Positioning basics

• Skin protection

38. Heart Failure

• Fluid overload

• Crackles

• Dyspnea

• Orthopnea

• Edema

• JVD

• Daily weights

• Sodium/fluid concepts

• Monitoring response to therapy

39. Hypertension

• Risk factors

• Often asymptomatic

• Medication adherence

• Lifestyle teaching

• Orthostatic effects of treatment

• Severe HTN with symptoms = concern

40. Asthma

• Bronchoconstriction

• Wheezing

• Dyspnea

• Rescue vs controller basics

• Inhaler teaching

• Respiratory distress cues

41. Upper Respiratory Infection

• Infection prevention

• Hydration

• Rest

• Respiratory assessment

• When symptoms suggest deterioration

42. Meningitis

• Droplet precautions initially as appropriate

• Neuro changes

• Fever

• Nuchal rigidity

• Photophobia

• Seizure risk

• Rapid deterioration

43. Chronic Kidney Disease

• Fluid overload

• Electrolytes

• Potassium risk

• I&O

• Daily weights

• Medication considerations

• Renal function labs basics

44. Traumatic Brain Injury

• LOC

• Pupils

• Motor response

• Speech

• Headache

• Vomiting

• Seizures

• Neuro deterioration

• ICP signs

• Cushing triad

45. Neurovascular Assessment

• 6 Ps

• Pain

• Pallor

• Pulselessness

• Paresthesia

• Paralysis

• Poikilothermia

• Cap refill

• Pulses

• Compartment syndrome

• Pain with passive stretch

• Pulselessness as late sign

46. Musculoskeletal Basics

• Osteoarthritis

• ROM

• Mobility

• Joint protection

• Pain control

• Assistive devices

• Cast basics

• Neurovascular checks

47. Perioperative Care

Pre-op

• Consent

• NPO

• Allergies

• Baseline assessment

• Teaching

Post-op

• ABCs

• Airway

• Bleeding

• Pain

• Wound

• Urine output

• IS

• DVT prevention

• Early ambulation

• Complications

48. Post-op Complications

• Atelectasis

• Pneumonia

• DVT

• PE

• Hemorrhage

• Infection

• Urinary retention

• Constipation

• Dehiscence

• Evisceration

49. Seizures

• Protect patient

• Side-lying

• Protect head

• Time seizure

• Do not restrain

• Nothing in mouth

• Postictal airway/neuro assessment

50. Emergency Care Basics

• ABCs

• Rapid assessment

• Hypoglycemia

• Respiratory distress

• Shock

• Hemorrhage

• Seizure

• Falls

• Acute neuro change

• Medical emergency escalation

51. Therapeutic Communication

• Open-ended questions

• Silence

• Reflection

• Restating

• Clarification

• Focusing

• Exploring

• Offering self

• Empathy

• Avoid false reassurance

• Avoid “why”

• Avoid advice

• Avoid changing subject

• Avoid minimizing

52. Sensory Alterations

Vision

• Identify yourself

• Describe environment

• Keep items consistent

• Clock-face meal setup

• Explain before touching

• Offer elbow when guiding

Hearing

• Face patient

• Reduce background noise

• Speak clearly

• Lower pitch

• Don't shout

• Hearing aids

• Written communication

53. Culture, Religion & Spiritual Care

• Ask, don't assume

• Respect preferences

• Dietary practices

• Modesty

• Prayer/spiritual practices

• Family roles

• Interpreter use

• Cultural humility

54. Stress, Coping & Crisis

• Normal stress response

• Coping mechanisms

• Crisis intervention

• Safety

• Active listening

• Support systems

• Referral when needed

55. Grief & Loss

• Normal grief

• Anticipatory grief

• Individual variation

• Supportive communication

• Avoid rushing grief

• End-of-life support

56. End-of-Life Care

• Comfort

• Dignity

• Pain management

• Family support

• Advance directives

• DNR

• Oral care

• Positioning

• Postmortem care

• Cultural/religious practices

57. Sexual Health

• Nonjudgmental assessment

• Privacy

• Consent

• Safe-sex education

• Contraception basics

• Sexual function concerns

• Inclusive communication

58. STIs

• Prevention

• Screening

• Condom teaching

• Partner notification concepts

• Treatment adherence

• Avoiding reinfection

• Patient education

59. Delegation

• RN vs LPN vs UAP

• Stable vs unstable

• Routine vs complex

• Assessment

• Teaching

• Evaluation

• Five rights of delegation

• Supervision

• Accountability

60. Collaboration & Referrals

• PT

• OT

• SLP

• Dietitian

• Social worker

• Case manager

• Pharmacist

• Respiratory therapist

• Chaplain

• Provider

• When each referral is appropriate

61. Prioritization

• ABC

• Maslow

• Acute vs chronic

• Stable vs unstable

• Expected vs unexpected

• Safety

• Actual vs potential

• Least restrictive

• Least invasive

• Time-sensitive treatment

• Post-op priorities

• New neuro changes

• New respiratory changes

62. Patient Education

• Readiness to learn

• Pain/fatigue first

• Health literacy

• Language needs

• Interpreter

• Teach-back

• Return demonstration

• Short teaching sessions

• Written materials

• Evaluation of learning

63. Advocacy

• Respect patient wishes

• Protect safety

• Support refusal

• Clarify information

• Escalate concerns

• Prevent coercion

• Speak up for vulnerable patient

64. Accountability

• Own your actions

• Follow standards

• Report errors

• Follow through on delegation

• Evaluate delegated care

• Maintain competence

• Seek help when outside scope

65. Ethics

• Autonomy

• Beneficence

• Nonmaleficence

• Justice

• Fidelity

• Veracity

66. Legal Responsibilities

• Negligence

• Malpractice basics

• Assault

• Battery

• False imprisonment

• Privacy

• Confidentiality

• Scope of practice

• Duty to report

• Safe documentation

67. Informed Consent

• Provider explains procedure

• Risks

• Benefits

• Alternatives

• Nurse witnesses

• Voluntary consent

• Capacity

• Stop and notify provider if patient has questions

68. Advance Directives

• Living will

• Healthcare proxy

• Durable POA

• DNR

• Patient retains decision-making while capable

• Surrogate decision-making

69. Patient Rights

• Privacy

• Confidentiality

• Refusal

• Information

• Participation in care

• Access to interpreter

• Respect

• Safe care

• Advance directives

70. Confidentiality / HIPAA

• Minimum necessary

• No hallway/elevator talk

• No casual chart access

• Family does not automatically get information

• Secure documents

• Protect screens

• Dispose of PHI appropriately

• Social media restrictions

• Photos/videos

71. Informatics

• Password security

• Log off

• No shared credentials

• Appropriate chart access

• Secure messaging

• EHR documentation

• Correcting errors properly

• Protect electronic PHI

• Technology used safely

72. Documentation

• Objective

• Accurate

• Timely

• Complete

• Quote patient when useful

• No judgmental language

• Document responses

• Document notification

• Correct errors appropriately

• Never falsify

73. Incident / Variance Reports

• Complete after unusual event/error

• Not part of medical record

• Do not chart “incident report completed”

• Chart facts and patient response

• Used for quality improvement

74. Quality Improvement

• Identify system problems

• Reduce errors

• Improve outcomes

• Incident trends

• Root cause concepts

• Process improvement

• Patient safety culture

75. Evidence-Based Practice

• Best current evidence

• Clinical expertise

• Patient preferences

• Following evidence-based protocols

• Questioning outdated practices

• Basic research vs quality improvement distinction

76. Teamwork

• SBAR

• Closed-loop communication

• CUS

• Chain of command

• Clarifying unsafe orders

• Interprofessional communication

• Handoff safety

77. Continuity of Care

• Admission

• Transfer

• Discharge

• Handoff

• Medication reconciliation

• Home-care needs

• Equipment

• Follow-up appointments

• Community resources

• Patient understanding before discharge

78. Health Promotion

• Prevention

• Exercise

• Nutrition

• Smoking cessation

• Alcohol/substance counseling

• Sleep

• Vaccination basics

• Screening basics

• Self-care

• Risk reduction

79. Screening & Physical Assessment

• BP screening

• Glucose screening basics

• Cancer screening concepts

• Fall risk assessment

• Nutrition screening

• Skin assessment

• Functional assessment

• Health history

80. High-Risk Behaviors

• Smoking

• Alcohol

• Drug use

• Unsafe sex

• Poor nutrition

• Sedentary lifestyle

• Nonadherence

• Injury risk

• Nonjudgmental counseling