States Exam Prep - Vocabulary Flashcards

ABG interpretation and acid–base balance

• Normal ranges and definitions:
  • PaO2: $70\text{-}100\ \text{mmHg}$; anything < $60\ \text{mmHg}$ results in tissue hypoxia.
  • PaCO2 (PCO2): measurement of carbon dioxide in arterial blood; respiratory component; carbon dioxide acts as an acid (can release H+).
  • HCO3-: bicarbonate content in blood; metabolic component; kidneys regulate; bicarbonate acts as a base (can accept H+).
  • Normal pH range: $7.35\text{-}7.45$
  • pH < $7.35$ = acidosis; pH > $7.45$ = alkalosis.
• Acid–base equation:
  $\mathrm{CO<em>2 + H</em>2O \rightleftharpoons H<em>2CO</em>3 \rightleftharpoons HCO_3^- + H^+}$
• The 4 acid–base disturbances:
  • Respiratory acidosis: buildup of CO2
  • Respiratory alkalosis: loss of CO2
  • Metabolic acidosis: buildup of H^+ or HCO3- deficit (loss of base)
  • Metabolic alkalosis: loss of hydrogen ions or excess HCO3-
• How respiratory acid–base disturbances occur:
  • Respiratory acidosis: not blowing out enough CO2 (acute respiratory failure, COPD, hypoventilation, airway obstruction)
  • Respiratory alkalosis: blowing out too much CO2 (hyperventilation) due to stress, pain, hypoxemia, CNS/metabolic conditions
  • Metabolic acidosis: increased acid production, loss of bicarbonate (e.g., diarrhea), impaired renal excretion
  • Metabolic alkalosis: loss of hydrogen ions (vomiting, diuretics), increased bicarbonate (IV therapy or antacids), Cushings syndrome, hypokalemia
• Compensation techniques for acid–base disturbances:
  • Buffers (immediate)
  • Renal compensation (slower; changes bicarbonate; up to 1 day)
  • Respiratory compensation (fast; minutes; changes CO2)
• Steps when interpreting ABG:
  1. Evaluate oxygenation
  2. Evaluate pH — normal, acidotic, or alkalotic
  3. Evaluate PaCO2 — normal, acidotic, or alkalotic
  4. Evaluate HCO3- — normal, acidotic, or alkalotic
  5. Match PaCO2 or HCO3- with the pH
  6. Assess for compensation
• How to assess for compensation:
  • Has the other value changed (increased or decreased) to match the change in the affected process?
  • Determine the disorder and compensation pattern (examples from notes):
  • Metabolic acidosis: pH low; HCO3- low; PaCO2 may be partially/fully compensatory
  • Metabolic alkalosis: pH high; HCO3- high; PaCO2 may be compensatorily high/low
  • Respiratory acidosis: ↑ PaCO2; a compensatory ↑ HCO3-
  • Respiratory alkalosis: ↓ PaCO2; a compensatory ↓ HCO3-
  • Has the pH returned to normal? (Complete), partially, or uncompensated
• Signs of dehydration, fluid overload and fluid/electrolyte effects (IV therapy context):
  • Hypovolemia (dehydration/volume depletion): postural hypotension, tachycardia, absent JVP at 45°, decreased skin turgor, dry mucosae, supine hypotension, oliguria, organ failure
  • Hypervolemia (fluid overload): hypertension, tachycardia, raised JVP, edema, pleural effusions, pulmonary edema, ascites, organ failure
  • Electrolyte disturbances often accompany fluid shifts: hyponatremia, hypernatremia, hypokalemia, hyperkalemia, hypocalcemia, hypercalcemia
• How potassium fluctuations affect cardiac function:
  • Resting membrane potential changes: hypoK+ makes cells more negative (harder to reach threshold); hyperK+ makes cells less negative (spontaneous depolarizations)
  • Action potential duration: hypoK+ slows; hyperK+ speeds
  • Conduction velocity: hypoK+ slows; hyperK+ can speed then slow; arrhythmias possible
• How sodium fluctuations affect cardiac function:
  • Action potential initiation: hypo reduces excitability; hyper increases excitation/spontaneous APs
  • Conduction velocity: hypo slows conduction/bradycardia; hyper increases/decreases pulses; potential blocks and arrhythmias
  • Osmotic balance effects on perfusion and cardiac workload

Hypertonic, Hypotonic, and Isotonic Solutions; Colloids and Crystalloids

• Hypertonic solutions:
  • Mechanism: Draw water out of cells into extracellular space due to higher solute concentration
  • Effect: Reduces cellular swelling; used in cerebral edema or severe hyponatremia
  • Water redistribution: water moves out of cells causing them to shrink
  • Uses: cerebral edema
  • Examples: $3\%\ NaCl$, protein solutions
• Hypotonic solutions:
  • Mechanism: Water moves into cells from extracellular space due to lower solute concentration
  • Effect: Rehydrates cells; used in dehydration with intracellular fluid deficit
  • Water redistribution: water moves into cells causing them to swell
  • Uses: cellular dehydration (shrunk cells)
  • Examples: $0.45\%\ NaCl$, $0.33\%\ NaCl$
• Isotonic solutions:
  • Mechanism: Distribute evenly between intravascular and interstitial spaces
  • Effect: Expands extracellular volume; used in resuscitation and maintenance
  • Matches plasma concentration
  • Examples: $0.9\%\ NaCl$, Lactated Ringers (Hartmann's), 5% dextrose in water (D5W), 5% dextrose with NaCl
• Colloids:
  • Intravascular volume expansion by large molecules that stay in vessels; draws water into vascular space
  • Used to maintain vascular volume in hypovolemia or low-protein states
• Blood products:
  • Replaces specific blood components (RBCs, plasma proteins, platelets) to restore oxygen-carrying capacity and coagulation factors
• Rules of fluid replacement:
  • Replace blood with blood; replace plasma with colloid
  • Resuscitate with crystalloid and colloid; maintain with D5W or D5W in saline; replace fluid loss with crystalloid (e.g., lactated ringers)
• Signs of IV therapy issues and blood transfusion considerations:
  • Blood transfusion reactions: rash, angioedema, nausea, vomiting, fever/chills, anxiety, dyspnea, abnormal bleeding, urination changes
  • What you need for a transfusion: valid group and screen, prescription, informed consent, patent vascular access, equipment, baseline observations, documentation, two certified staff
  • Nursing responsibilities during transfusion: administer unit one at a time; ensure consent; no other meds/fluids in same line; saline only with other fluids to avoid clumping; two RNs verify orders, patient ID, blood bank info, expiration; monitor vitals; stay with patient for first 15 minutes; stop transfusion if reaction; monitor vitals every 5 minutes
• Complications of IV therapy:
  • Infiltration, cannula slipping into tissue
  • Phlebitis (vessel wall infection) from mechanical, bacterial, chemical causes

IV Therapy – Monitoring, Safety, and Infections

• VIP Score (Visual Infusion Phlebitis) levels and actions:
  • I.V. site healthy: No signs of phlebitis
  • Evolving signs: slight pain near IV site or slight redness
  • Moderate signs: erythema, swelling; pale/erythema near IV site
  • Severe signs: pain along cannula path, erythema, induration, palpable venous cord
  • Extensive signs: pain along cannula path, erythema, induration, palpable venous cord, pyrexia
  • Consider resiting or treatment at various stages; infection prevention with hand hygiene
• Preventing fluid overload and embolism: monitor infusion rates; air embolism risk with loose connections; needle-stick injury precautions

Respiratory health basics; Asthma management

• Asthma (definition and triggers): chronic inflammatory condition causing airway narrowing in response to triggers
• Signs/symptoms of an asthma attack: coughing, wheezing, shortness of breath, chest tightness, cyanosis, increased RR and HR, anxiety/panic, restlessness, decreasing SpO2
• Medications and effects:
  • Anti-inflammatory agents to reduce airway inflammation
  • Bronchodilators to relieve bronchospasm (e.g., Ventolin/short-acting beta-agonists)
• Nursing strategies for asthma management:
  • Maintain oxygen to prevent hypoxia
  • Respiratory support as needed
  • Maintain normal body temperature
  • Maintain fluid, electrolyte, acid–base balance
  • Nutrition support (IV fluids as needed)
  • Administer antibiotics if ordered
  • Continuous observation for complications
  • Reassurance and asthma action plan adherence
• Prevention and diagnostics:
  • Follow asthma action plan; avoid triggers; vaccinations; lifestyle modifications; adherence
  • ABG for oxygen and acid–base balance; spirometry for functional status; chest X-ray to identify overinflation, depressed diaphragm, ribs; sputum analysis to rule out infection

Rheumatic fever and rheumatic heart disease (RHD)

• What is rheumatic fever? A complication of untreated/poorly treated group A streptococcal throat infection; can lead to chronic RHD
• Risk factors:
  • Overcrowded housing; family history; daily sugary drink intake; barriers to healthcare access
• Symptoms:
  • Sore/swollen joints; skin rash; fever; fatigue; other neurological signs (e.g., Sydenham’s chorea)
• Medications used:
  • Antibiotics (e.g., amoxicillin, penicillin, erythromycin) to eradicate infection and prevent recurrence
  • Anti-inflammatory drugs (Aspirin, NSAIDs)
  • Heart failure medications (diuretics/furosemide, beta-blockers/metoprolol, ACE inhibitors/enalapril)
• Complications:
  • RHD: permanent valve damage leading to stenosis or regurgitation; heart failure, arrhythmias
  • Carditis (endocarditis, myocarditis, pericarditis)
  • Sydenham’s chorea; rash; subcutaneous nodules; fever
• Relationship to future risk and complications: recurrence risk, heart failure progression, valve damage

Congestive heart failure (CHF) and kidney disease overview

• CHF basics: insufficient myocardial function causing inadequate tissue perfusion
• Systolic (left-sided) heart failure:
  • Contraction issue; pulmonary edema signs: dyspnea, rales, orthopnea, nocturia, weight gain, fatigue
• Diastolic (right-sided) heart failure:
  • Filling issue; systemic edema signs: enlarged liver, edema in extremities, weight gain, ascites, jugular venous distention, lethargy, irregular HR, nocturia
• Diagnostic tests for CHF:
  • B-type natriuretic peptide (BNP): biomarkers released when ventricles under pressure
  • X-ray: enlarged/overloaded ventricles, dull lung colors, venous congestion
  • Echocardiography, nuclear stress tests, heart catheterization
• Treatments for CHF:
  • Medications: ACE inhibitors, beta blockers, diuretics, anticoagulants, vasodilators, digoxin
  • Labs and lifestyle: low-salt diet, fluid restrictions, vaccinations (flu), smoking/alcohol cessation support, weight monitoring, prevention of readmission through education
• Kidney disease (CKD/AKI) basics:
  • AKI: acute kidney injury; sudden decline in renal function with reduced GFR, oliguria, metabolic waste retention, edema, metabolic acidosis; prerenal, intrarenal, and postrenal causes
  • Prerenal AKI: hypovolemia, hemorrhage, hypotension, burns, cardiac dysfunction, septic shock, renal artery stenosis
  • Intrarenal AKI: acute tubular necrosis, glomerulonephritis, vascular disease, tumors, interstitial nephritis, polycystic disease
  • Postrenal AKI: urinary tract obstruction, ureteral destruction, neurogenic bladder, obstruction
  • CKD: progressive, irreversible nephron destruction; causes include diabetes, hypertension, glomerulonephritis, polycystic kidney disease
  • Symptoms in CKD: azotemia/uremia, hypertension, anemia due to erythropoietin deficiency, bone disease due to vitamin D activation issues
  • Management of CKD: dietary control, EPO supplementation, ACE inhibitors, beta-blockers, glycemic control in diabetics, analgesics

Cancer chemotherapy and related effects

• What is chemotherapy? Use of cytotoxic drugs targeting cell growth and replication
• Common side effects:
  • Fatigue; cytopenias; impaired wound healing; nausea, vomiting, diarrhea; alopecia; sterility; growth depression in children; GI mucosal damage; teratogenicity
• Immune system effects: neutropenia, lymphopenia; infection risk; delayed healing
• Commonly observed infections and precautions: increased infection risk, potential for autoimmune/inflammatory reactions

Surgical care and perioperative planning

• Pre-operative considerations:
  • Checklist; vitals; health history; allergy status; cultural needs; next of kin; emotional status; previous anesthesia problems
  • Risk assessments (VTE, falls, pressure injuries)
  • Nutritional status; last oral intake; pre-medication; jewelry removal; handover to theatre staff; pre-op education
  • VTE prophylaxis, falls prevention, deep breathing/coughing exercises, incentive spirometry, pain management, wound/drain care, bowel prep
• Intraoperative considerations and safety:
  • WHO surgical safety checklist and 10,000 feet patient safety initiative
  • Intraoperative complications: allergic reactions/anaphylaxis, dysrhythmias, hypotension, bleeding, hypothermia, CNS changes, airway complications, trauma to laryngeal nerve, thrombosis risk over time, malignant hyperthermia, N/V, positioning problems
• Post-anesthesia care (PACU):
  • Airway management, ventilation, circulation monitoring; disability (AVPU/GCS); exposure/minimize heat loss; assess injuries, drains
  • Before transfer: warmed, hemodynamically stable, rule out MI/bleeding, monitor wound drainage, position changes
• Priorities after surgery:
  • Establish trust; monitor vitals; manage pain; prevent respiratory complications; GI function; early mobilization; pressure injury prevention; hygiene; fluid balance; VTE prophylaxis

Cardiac ischemia and rhythm disorders

• Myocardial infarction (MI):
  • AKA heart attack; occurs when blood flow in coronary arteries is reduced or stopped; myocardial ischemia and cell necrosis
  • Risk factors: high BP, high cholesterol/triglycerides, diabetes, obesity, smoking, age, family history, stress, illicit drugs, sedentary lifestyle
  • Symptoms: chest pressure/tightness, SOB, sweating, nausea, anxiety, coughing, tachycardia
  • Diagnostic tests: ECG (ST-elevation or non-ST elevation), troponin T, angiography, echocardiogram, stress test
  • Treatment (short-term): MONA (Morphine, Oxygen, Nitroglycerin, Analgesics)
  • Long-term treatments: CABG, angioplasty with stent; medications include aspirin, thrombolytics, antiplatelets, nitroglycerin, beta-blockers, ACE inhibitors, analgesics
  • Complications: recurrent angina/infarct, arrhythmias, valve issues, cardiogenic shock, heart failure, pericarditis, ventricular rupture, death
• Angina:
  • Chest pain due to myocardial oxygen demand exceeding supply
  • Stable angina: predictable; relief with rest or nitroglycerin
  • Unstable angina: unpredictable; may occur at rest; increasing severity/frequency
  • Symptoms: squeezing chest pain; dyspnea; pain may radiate; pallor; diaphoresis
• ECG electrode placements (V1–V6; RA, LA, RL, LL):
  • V1: right sternal edge, 4th intercostal space (ICS)
  • V2: left sternal edge, 4th ICS
  • V3: between V2 and V4
  • V4: mid-clavicular line, 5th ICS
  • V5: between V4 and V6, 5th ICS
  • V6: mid-axillary line, 5th ICS
  • Right arm (RA), Left arm (LA), Right leg (RL), Left leg (LL)
• Common heart rhythms:
  • Normal Sinus Rhythm: regular, 60–100 bpm; P waves before each QRS
  • Sinus Bradycardia: <60 bpm; regular; P waves before each QRS
  • Sinus Tachycardia: >100 bpm; regular; P waves before each QRS
  • Atrial Fibrillation: irregularly irregular; no discernible P waves; variable HR
  • Atrial Flutter: sawtooth flutter waves; typically 250–350 bpm; variable ventricular response
  • Ventricular Tachycardia: 100–250 bpm; regular rhythm; wide QRS

Gastrointestinal: IBS vs IBD; chronic kidney disease and renal emergencies

• IBS (Irritable Bowel Syndrome): functional GI disorder; unknown exact cause; potential gut–brain interaction, stress, hormones, food sensitivities
  • Symptoms: constipation, diarrhea, cramps, flatulence, bloating, mucus in stool
  • Treatments: LOW FODMAP diet; stress management; psychological therapies; symptom relief meds
• IBD (Inflammatory Bowel Disease): chronic inflammatory conditions; Ulcerative Colitis and Crohn’s disease
  • Causes: abnormal immune response; genetic, environmental factors
  • Symptoms: persistent diarrhea, abdominal pain, blood in stool, weight loss, fatigue, reduced appetite
  • Treatments: anti-inflammatory drugs, immune suppressors, antibiotics; surgery in severe cases
  • Key differences:
  • Ulcerative Colitis: blood with mucus; continuous colonic inflammation; inflammation starts in rectum and moves up
  • Crohn’s Disease: can involve any GI tract; patchy inflammation; granulomas possible; skip lesions
• Acute kidney injury (AKI): sudden decline in renal function; symptoms include reduced GFR, oliguria, metabolic waste retention, edema, metabolic acidosis, nausea/vomiting, confusion
• Prerenal AKI causes: hypovolemia, hemorrhage, hypotension, burns, cardiac dysfunction, septic shock, renal artery stenosis
• Intrarenal AKI causes: acute tubular necrosis, glomerulonephritis, vascular disease affecting renal vasculature, tumors, interstitial nephritis, polycystic disease
• Postrenal AKI causes: urinary tract obstruction, ureteral destruction, neurogenic bladder, urinary retention
• Chronic kidney disease (CKD): progressive irreversible nephron destruction; causes include diabetes mellitus, hypertension, glomerulonephritis, polycystic kidney disease
• CKD symptoms due to decreased filtration, blood pressure regulation, erythropoietin production, vitamin D activation: nausea, edema, anemia, bone pain, hypertension
• CKD management: diet (protein restriction, adequate calories, electrolyte management), vitamin D supplementation, erythropoietin, ACE inhibitors, beta blockers, glycemic control, analgesics

Respiratory disease and infectious diseases

• COPD: chronic obstructive pulmonary disease; progressive airway obstruction; risk factors include smoking and long-term exposure to pollutants; alpha-1 antitrypsin deficiency in some cases
  • Symptoms: dyspnea on exertion, chronic cough with phlegm, fatigue, barrel-shaped chest, cyanosis, pursed-lip breathing
  • Diagnostics: spirometry, chest X-ray, CT
  • Management: smoking cessation, avoid irritants, pulmonary rehab, exercise, breathing techniques, vaccinations, oxygen therapy (16 hours/day)
• Tension pneumothorax:
  • Life-threatening air in pleural space; mediastinal shift; risk factors include chest trauma, mechanical ventilation, underlying lung disease, procedures
  • Symptoms: absent breath sounds, cyanosis, dyspnea, hypotension, chest pain, subcutaneous emphysema, tachycardia, tachypnea
  • Diagnostics: clinical exam, chest X-ray; possibly ultrasound
  • Management: monitor vitals, oxygen, high Fowler's position, chest tube prep; reassure patient
  • Complications: cardiac arrest, hypoxia, hypotension, tracheal deviation, JVD
• Pneumonia:
  • Infection in lungs leading to alveolar inflammation; can be bacterial, viral, or fungal; risk factors include age, weakened immunity, chronic conditions, hospitalization, aspiration
  • Symptoms: cough, fever, night sweats, dyspnea, chest pain, fatigue, reduced appetite
  • Diagnostics: chest X-ray, blood cultures, sputum culture, pulse oximetry, CT, bronchoscopy
  • Management: antibiotics, respiratory therapy, hydration; prevent complications (bacteremia, ARDS, pleural effusion)
• Tuberculosis (TB):
  • Contagious bacterial infection; risk factors include exposure, weakened immune system; symptoms include prolonged cough, hemoptysis, chest pain, weight loss, fever, night sweats
  • Diagnostics: Mantoux test, TB blood test, chest X-ray, sputum tests, biopsy, CT/MRI
  • Management: first-line anti-TB drugs (INH, RIF, EMB, PZA); isolation; sputum monitoring; liver function tests; nutrition and education
• Oxygen therapy and oxygen masks:
  • Types of masks and delivery systems; considerations for use and patient safety
  • Nasal cannula: 1–4 L/min; 24–44% O2
  • Simple mask: 5–10 L/min; 35–50% O2
  • Non-rebreather mask: 10–15 L/min; 60–80% O2; high oxygen concentration
  • High Flow Nasal Cannula: 15–60 L/min; 50–92% O2 with humidification
  • Venturi mask: precise FiO2 mixing; can deliver humidity/aerosol therapy
  • CPAP mask: spontaneous breathing with/without artificial airway; risk of pneumothorax
  • Transtracheal oxygen: catheter through tracheal opening; avoids airway drying; not for uncompensated respiratory acidosis
• Oxygen therapy considerations:
  • Elevate head of bed 30–45 degrees (if not contraindicated)
  • Monitor signs of hypoxia; reassess ABGs to justify high-concentration therapy
  • Watch for oxygen toxicity, temperature considerations, pressure injuries from masks

Notifiable diseases; pharmacology basics; pediatric dosing

• Notifiable diseases: diseases required by law to be reported to authorities to enable outbreak control and surveillance; issues include data accuracy, privacy, and cross-border coordination
• Drug calculations and medication administration rights:
  • The five rights: Right patient, Right time, Right dose, Right route, Right drug
  • Formulas:
  • Dosing: $\text{Dose required} / \text{Dose available} \times \text{Number of units}$
  • IV rate: $\frac{\text{Volume to be given (mL)}}{\text{Time (hours)}}$ × (adjusted by drop factor as needed)
  • Drip sets:
  • Macrodrip: 15/20 drops per mL
  • Microdrip: 60 drops per mL
  • IV flow rate formula: $\text{IV amount (mL)} \times \text{giving set factor} / (\text{hours} \times 60)$
• Pediatric dosing and pharmacokinetics:
  • Weight-based dosing: weight-based calculations are required for under-12s; do not round calculations; use liquids when possible
  • Weight-based example: Scenario: a 10 kg child requires a dose of paracetamol at 15 mg/kg. Dose = $10\ \text{kg} \times 15\ \text{mg/kg} = 150\ \text{mg}$
  • Pharmacokinetics:
  • Absorption: gastric pH, emptying time
  • Distribution: higher body water content and lower body fat in children
  • Metabolism: immature liver enzymes in neonates/infants slow drug metabolism
  • Excretion: immature renal function
  • Formulations:
  • Liquids favored for young children; crushing tablets (safe/effective?); flavoring agents
  • Administration:
  • Oral meds via syringes/droppers; injections require appropriate needle size and site

Immunizations and pediatric care in NZ

• Immunization schedule highlights:
  • Rotavirus, Diphtheria, Tetanus, Whooping Cough, Polio, Hepatitis B, Haemophilus influenzae type b at various early ages
  • Pneumococcal and Meningococcal vaccines; Measles/Mumps/Rubella (MMR)
  • HPV vaccine (2 injections for under 14; 3 injections if 15+; spacing differs by age)
  • 11–12 years: Td/Tdap booster; 12 months, 15 months, 4 years milestones noted
• Vital signs in children and infants (examples):
  • Newborn: HR 80–180; RR 30–80; BP ~73/55; T ~36.8°C (axillary)
  • Infants: HR 80–140; RR 20–40; BP ~90/55; T ~36.5–37.5°C
  • Children 6–8 yrs: HR 75–120; RR 15–25; BP ~95/75; T ~37°C
  • Children 10 yrs: HR 75–110; RR 15–25; BP ~102/62; T ~37°C
• NZ health targets for children (highlights):
  • Reducing poverty; faster cancer treatment (95% treated within 31 days of decision to treat)
  • Improved immunization (95% fully immunized by 24 months)
  • ED throughput (admission/discharge/transfer within 6 hours)
  • Shorter wait times for first specialist assessments and elective treatments (95% within 4 months)
• Weight-based dosing reminder for under 12s.

Sepsis and deterioration assessment

• Sepsis definition and stages:
  • Sepsis: infection-triggered dysregulated host response leading to organ dysfunction; can progress to septic shock and multi-organ failure
  • Stage 1: local infection to generalized inflammation
  • Stage 2: organ dysfunction
  • Stage 3: septic shock; severe hypotension and organ failure
• Quick recognition checklist (SPEPIS):
  • S: Shivering or fever
  • P: Pain or general discomfort
  • E: Pallor
  • P: Sleepiness or confusion
  • I: “I feel like I might die” (impending doom)
  • S: Shortness of breath
• Sepsis management sequence:
  • ABCDE approach; blood cultures → antibiotics → lactate → fluids → oxygen → urine output monitoring
• Quick deterioration response (ESBAR/ISBAR):
  • Identification, Situation, Background, Assessment, Recommendation
  • Use ISA-based escalation: EWS (Early Warning Scores) to guide monitoring and escalation
• Signs indicating deterioration (Seven Signs): pyrexia, tachypnea, tachycardia, hypotension, altered level of consciousness, oliguria, and others; red flags prompting escalation

Emergency response and life support

• AED and defibrillation:
  • AED is used for sudden cardiac arrest; steps include: check responsiveness, check breathing, check pulse, call for help, start CPR, turn on AED, attach pads, analyze rhythm, deliver shock, resume CPR following prompts
  • Pad placement: ensure pads are at least 1 inch away from implanted devices
• Deteriorating patient management: lay flat or elevate legs if hypotensive; initiate ECG monitoring; gather and document data; maintain oxygen as needed

Public health, safety, and ethical considerations

• Palliative vs end-of-life care:
  • Palliative care focuses on symptom relief and quality of life; may involve conversations about end-of-life options
  • Euthanasia/assisted dying: discussion of end-of-life decision-making when suffering is unbearable
• Spirituality and loneliness:
  • Nursing considerations for patients who are socially isolated; trauma-informed care; HEART assessment (for pre-pubescent patients) and HEADSSS framework for adolescent psychosocial assessment
• Trauma-informed care and de-escalation:
  • Realize the wider impact of trauma; recognize signs; respond with trauma-informed care across assessment, home and education contexts; de-escalation strategies (active listening, non-defensive communication, empathy, self-regulation)

Obstetrics, pregnancy complications, and maternity care

• Global maternal health considerations:
  • Higher risk in adolescents (10–14); 94% of maternal deaths occur in low- and lower-middle-income countries
  • Skilled care around pregnancy can save lives
• Maternal risk factors and barriers to maternal health in NZ:
  • Alcohol, drugs, smoking, family violence; geographic and cultural barriers; access to care; centralisation of services; health literacy
• Hyperemesis gravidarum:
  • Occurs in 0.3%–0.2% of pregnancies; excessive vomiting leading to dehydration and electrolyte imbalance; management includes antiemetics and IV therapy; hospitalisation if needed
• Bleeding in pregnancy and pregnancy-related complications:
  • Early pregnancy bleeding can be due to implantation, intercourse, infection; more serious causes include ectopic pregnancy, miscarriage types (threatened, imminent, complete, incomplete, missed), anembryonic gestation, molar pregnancy
  • Diagnostic testing: pregnancy tests; ABO/Rh type; ultrasound; hCG levels
  • Rh isoimmunisation: routine Rh typing and antibody screening; RhIG prophylaxis; neonatal risk including hydrops fetalis, anemia, jaundice, edema
  • Late-pregnancy/postpartum bleeding: placenta previa, placental abruption, postpartum hemorrhage (PPH: blood loss ≥ 500 mL; major PPH ≥ 1000 mL)
• Hypertension in pregnancy:
  • Gestational hypertension: new onset after 20 weeks without preeclampsia
  • Preeclampsia: hypertension with proteinuria or end-organ signs; management may include magnesium sulfate, antihypertensives, and delivery
  • Chronic hypertension: persists beyond pregnancy
• Pre-eclampsia management:
  • Low-dose aspirin from the second trimester; antihypertensives; magnesium sulfate during labour; delivery planning; maternal and fetal monitoring
• Preterm labour:
  • Labour before 37 weeks; risk factors include prior preterm birth, multiple gestations, infections, short cervical length, smoking, poor nutrition, stress
• Perinatal mental health:
  • Antepartum and postpartum depression/anxiety; prevalence higher in certain populations; Edinburgh Postnatal Depression Scale as screening tool

Critical care and safety checklists

• Notable critical care tools and concepts:
  • Head injury and trauma: ABCDE approach; airway management; oxygenation and ventilation strategies
  • Hypothermia: definition (< 35°C); nursing care includes gradual warming and monitoring for arrhythmias
  • Deterioration recognition and escalation: EWS, seven signs, ISBAR/ESBAR communication
  • Safety checklists: WHO surgical safety checklist; 10,000 feet safety steps; ensure appropriate documentation and patient safety

Notable practical skills and numbers

• Blood product and IV therapy specifics:
  • Drip rates: macrodrip vs microdrip; volume and time calculations; patient weight adjustments in pediatrics
• Quick references: common relationships between electrolytes and cardiac function; common signs of dehydration vs overload; signs of electrolyte disturbances (e.g., hyponatremia, hypernatremia, hypokalemia, hyperkalemia, hypocalcemia, hypercalcemia)

Summary of key exam-ready points

• ABG interpretation hinges on pH, PaCO2, and HCO3- with compensation patterns (renal vs respiratory)
• Fluid therapy choices depend on tonicity and patient state; crystalloids vs colloids; careful monitoring for overload and reactions
• Cardiac emergencies require rapid assessment (MI, angina), ECG interpretation, and evidence-based initial therapy (MONA; aspirin; nitro; beta-blockers/ACE inhibitors as indicated)
• Pediatric dosing must be weight-based and carefully calculated; understand pharmacokinetics in children; vaccination schedules and pediatric vitals are essential
• Sepsis recognition uses simple signs (SPEPIS) and escalation pathways (EWS, ISBAR)
• Obstetric complications require understanding of preeclampsia, placenta previa/abruption, PPH, and appropriate management strategies to ensure maternal and fetal safety
• Deteriorating patient safety relies on timely recognition, airway/breathing/circulation assessment, and escalation to advanced care when needed
• Trauma-informed and trauma-responsive care emphasizes safety, trust, communication, and psychological supports for patients and families
• Public health concepts (notifiable diseases, outbreak control, vaccination programs) are essential for holistic nursing care and community health planning