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Nursing Care Plan (NCP) for Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)

Nursing Care Plan (NCP) for Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)

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Study Tools For Nursing Care Plan (NCP) for Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)

HHNS Pathochart (Cheatsheet)
DKA vs HHNS (Cheatsheet)
Treatment for DKA and HHNS (Image)
Care Plan Example_Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS) (Cheatsheet)
Blank Nursing Care Plan_CS (Cheatsheet)
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Outline

Lesson Objective for Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)

  • Define HHNS:
    • Understand the pathophysiology and clinical manifestations of Hyperosmolar Hyperglycemic Nonketotic Syndrome.
  • Identify Risk Factors:
    • Recognize the risk factors that may predispose individuals to HHNS, such as uncontrolled diabetes mellitus, dehydration, and infection.
  • Understand Complications:
    • Comprehend the potential complications associated with HHNS, including neurological deficits, electrolyte imbalances, and organ dysfunction.
  • Master Nursing Assessment:
    • Develop proficiency in conducting a comprehensive nursing assessment for patients with HHNS, focusing on signs and symptoms, fluid balance, neurological status, and laboratory values.
  • Implement Evidence-Based Interventions:
    • Acquire knowledge of evidence-based nursing interventions to manage HHNS, including fluid replacement, insulin therapy, and addressing underlying causes.

Pathophysiology of Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)

  • Severe Hyperglycemia:
    • HHNS is characterized by extremely high blood glucose levels, often exceeding 600 mg/dL. This results from insulin deficiency, insulin resistance, or a combination of both.
  • Insulin Deficiency:
    • Unlike diabetic ketoacidosis (DKA), HHNS is not primarily associated with ketone formation. Instead, there is a significant deficiency of insulin, preventing glucose from entering cells for energy utilization.
  • Osmotic Diuresis and Dehydration:
    • Elevated blood glucose levels lead to osmotic diuresis, causing excessive urination and fluid loss. Dehydration ensues, contributing to the hypovolemic state seen in HHNS.
  • Hyperosmolarity and Neurological Impairment:
    • The increased concentration of glucose in the blood leads to hyperosmolarity, affecting the osmotic balance in the central nervous system. This can result in neurological symptoms, such as altered mental status, seizures, and coma.
  • Electrolyte Imbalances:
    • As fluid is lost through diuresis, electrolyte imbalances, particularly sodium and potassium, can occur. These imbalances contribute to further complications, including cardiovascular dysfunction and neurological disturbances.

Etiology of Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)

  • Poorly Controlled Diabetes:
    • The primary cause of HHNS is uncontrolled diabetes mellitus, particularly in individuals with type 2 diabetes. Insufficient insulin action or production results in persistent hyperglycemia.
  • Insulin Resistance:
    • Individuals with insulin resistance, where the body’s cells do not respond effectively to insulin, are at an increased risk of developing HHNS. This contributes to the inability of glucose to enter cells.
  • Infection or Illness:
    • Concurrent infections or other illnesses can exacerbate insulin resistance and trigger the onset of HHNS. Infections may increase the body’s demand for insulin, leading to a relative deficiency.
  • Medication Non-Adherence:
    • Failure to adhere to prescribed diabetes medications, including insulin, can contribute to poor glycemic control, increasing the risk of developing HHNS.
  • Underlying Medical Conditions:
    • Conditions such as cardiovascular disease, stroke, or renal dysfunction can complicate the course of diabetes and contribute to the development of HHNS. These comorbidities may impact insulin utilization and exacerbate hyperglycemia.

Desired Outcome for Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)

 

  • Normalization of Blood Glucose Levels:
    • The primary goal is to achieve and maintain blood glucose levels within the target range, typically between 80-130 mg/dL before meals and less than 180 mg/dL two hours after meals.
  • Restoration of Fluid and Electrolyte Balance:
    • Adequate hydration and correction of electrolyte imbalances, including sodium and potassium, are essential for restoring physiological balance and preventing complications such as dehydration or electrolyte abnormalities.
  • Resolution of Symptoms:
    • Alleviation of symptoms associated with HHNS, such as excessive thirst, dehydration, confusion, and weakness, indicating improvement in the patient’s overall condition.
  • Prevention of Complications:
    • Prevention and management of complications related to HHNS, including cardiovascular events, renal impairment, and neurological issues. Timely intervention and ongoing monitoring are crucial.
  • Patient Education and Empowerment:
    • Empowering the patient with knowledge about diabetes management, including medication adherence, lifestyle modifications, and recognizing early signs of complications. This contributes to long-term glycemic control and reduces the risk of recurrent HHNS episodes.

Subjective Data:

  • Extreme thirst 
  • Drowsiness
  • Confusion 
  • Loss of vision 
  • Weakness on one side of the body 
  • Hallucinations

Objective Data:

  • Blood glucose level >600 mg/dL
  • Dry mucous membranes 
  • Warm, dry skin that does not sweat 
  • High fever

Nursing Assessment for Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)

  • Vital Signs:
    • Monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, frequently to identify signs of cardiovascular compromise and dehydration.
  • Neurological Assessment:
    • Conduct a thorough neurological assessment, including mental status, level of consciousness, and neurological signs, to detect any alterations related to hyperosmolarity and dehydration.
  • Fluid Status:
    • Assess fluid balance by monitoring intake and output, including urine output, to identify signs of dehydration or fluid overload.
  • Blood Glucose Levels:
    • Continuously monitor blood glucose levels to assess the effectiveness of insulin therapy and guide adjustments to maintain glucose within the target range.
  • Renal Function:
    • Evaluate renal function through assessments of urine output, renal labs (e.g., creatinine, blood urea nitrogen), and signs of acute kidney injury.
  • Electrolyte Levels:
    • Regularly check electrolyte levels, especially sodium and potassium, to identify and address imbalances promptly.
  • Cardiovascular Status:
    • Assess cardiovascular status by monitoring for signs of hypovolemia or volume overload, such as changes in heart rate, blood pressure, and presence of edema.
  • Patient History:
    • Gather a detailed patient history, including previous episodes of HHNS, diabetes management, medications, and compliance, to identify potential contributing factors and tailor the care plan.
  • Collaboration with Healthcare Team:
    • Collaborate with the healthcare team, including endocrinologists and dietitians, to ensure a comprehensive assessment and implement a coordinated care plan.

Implementation for Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)

  • Fluid Replacement:
    • Administer intravenous (IV) fluids as prescribed to correct dehydration and restore intravascular volume. Use isotonic solutions initially and adjust based on ongoing assessments.
  • Insulin Administration:
    • Administer insulin therapy as prescribed to lower blood glucose levels. Continuous insulin infusion may be necessary, and adjustments should be made based on frequent blood glucose monitoring.
  • Electrolyte Replacement:
    • Replace electrolytes, particularly potassium, as prescribed to correct any imbalances. Monitor electrolyte levels closely and adjust replacement therapy accordingly.
  • Monitoring and Documentation:
    • Continuously monitor vital signs, blood glucose levels, urine output, and electrolyte levels. Document the patient’s response to interventions and any changes in the clinical status.
  • Collaboration with Interdisciplinary Team:
    • Collaborate with the healthcare team, including physicians, pharmacists, dietitians, and other specialists, to coordinate care, address specific patient needs, and facilitate a comprehensive approach to treatment.

Nursing Interventions and Rationales

 

Nursing Intervention (ADPIE) Rationale
Monitor blood glucose levels The hallmark of HHNS is extremely elevated blood glucose levels >600 mg/dL
Encourage optimal hydration and administer IV fluids (Normal Saline) to maintain fluid balance. Excessive urination can cause dehydration. Encourage oral fluids as tolerated and administer IV fluids to re-establish tissue perfusion and maintain electrolyte balance.
Insulin (Regular) infusion to reduce blood glucose level. Monitor for hypokalemia. Monitor blood glucose levels and serum potassium. As insulin is administered, potassium is lost. Initiate potassium supplementation as necessary.
Frequently assess level of consciousness and mentation The brain is an insulin-dependent tissue. With elevated glucose levels, there is not enough insulin to normalize and the patient becomes confused, dizzy and may have changes in level of consciousness. Patients often experience drowsiness.
Monitor for hyperthermia and treat with antipyretics (fever reducers), cool compresses and cooled IV fluids Thermoregulation is impaired as urine production decreases; sweating decreases and electrolytes become imbalanced.
Monitor vitals for hypotension and tachycardia Most likely related to dehydration and hypovolemia. Patient is at risk for hypovolemic shock.
Educate patient on disorder  Always important to educate patient throughout and give them resources they can use when at home 

Evaluation for Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)

 

  • Resolution of Hyperglycemia:
    • Evaluate the effectiveness of insulin therapy in lowering blood glucose levels. Monitor trends in blood glucose levels to ensure they are within the target range.
  • Restoration of Fluid Balance:
    • Assess the patient’s hydration status by monitoring vital signs, urine output, and laboratory values. Evaluate whether intravenous fluid replacement has successfully corrected dehydration.
  • Normalization of Electrolytes:
    • Review laboratory results to determine if electrolyte replacement has successfully corrected any imbalances. Pay particular attention to potassium levels and ensure they are within the desired range.
  • Clinical Improvement:
    • Evaluate the overall clinical status of the patient, considering factors such as mental status, responsiveness, and signs of improvement in symptoms associated with HHNS.
  • Patient Education and Follow-up:
    • Assess the patient’s understanding of the condition, its management, and the importance of ongoing diabetes care. Provide any necessary education and ensure appropriate follow-up care and monitoring.

References

https://hhma.org/healthadvisor/ac-diabeteshhns-dx/

https://my.clevelandclinic.org/health/diseases/21147-hyperosmolar-hyperglycemic-syndrome

https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/diagnosis-treatment/drc-20351199

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Transcript

Hi everyone. Today, we’re going to be putting together a nursing care plan for hyperosmolar hyperglycemic, nonketotic syndrome, or HHNS. So let’s get started. First, we’re going to go over pathophysiology. So HHNS occurs in type two diabetes. When the body is unable to excrete excess sugar in the blood, the blood becomes very concentrated or hyperosmolar, but does not produce ketones. Nursing considerations: you want to monitor vital signs, glucose levels, level of consciousness, signs of hypoglycemia after treatment with IV fluids and medication. Desired outcome: you’re going to maintain blood glucose levels within target range for the patient, obtain optimal hydration and fluid balance. 

So we’re going to go ahead and get into the care plan. We’re going to be going in, and we’re going to be writing in some of the subjective data and some of the objective data. So what are you going to see with the patient, or what will they tell you? One of the main things you’re going to notice is extreme thirst. And one of the hallmarks is going to be a blood glucose level that’s going to be greater than 600 milligrams per deciliter (mg/dL). They will also have a high fever. Other things you may notice are that they complain of drowsiness, confusion, any loss of vision, weakness on one side of the body, possible hallucinations, dry mucous membranes, warm dry skin that does not sweat and, and that high fever. 

So one of the nursing interventions, we’re going to start, we’re going to make sure we’re monitoring their blood glucose levels. Hallmark of HHNS is the blood glucose levels. That’s greater than 600. So we want to make sure we’re monitoring for that. Another intervention we’re going to do is encourage optimal hydration and administer IV fluids, such as normal saline to maintain fluid balance. So we want to give IV fluids as excess urination can cause dehydration. So encouraging those oral fluids as tolerated and administering IV fluids can help reestablish the tissue perfusion and maintain electrolyte balance. Another invention we’re going to be doing is giving insulin to reduce that blood glucose level; you want to monitor for hypoglycemia. So we’re going to monitor the glucose levels and the serum potassium levels – as insulin is administered, potassium is lost. So you want to initiate potassium supplement as necessary. Another intervention that we’re going to be doing is to make sure that we are monitoring level of consciousness. The brain is an insulin dependent tissue; with elevated glucose levels, there’s not enough insulin to normalize and the patient becomes confused or dizzy, or has changes in their level of consciousness. So patients often experience drowsiness. Another intervention that we want to do is to monitor for hyperthermia. 

Thermoregulation is impaired as urine production decreases and sweating decreases. So you want to be sure you’re treating with antipyretics and/or giving cool compresses to help bring that down. We’re going to monitor vital signs because they can be hypotensive. And you’ll notice they’ll have tachycardia. So high heart rate it’s most likely related to dehydration, and they are at risk for hypovolemic shock. And, as always, we want to educate; we want to make sure we’re educating them as far as managing their glucose levels at home and giving them any sort of resources that they can use once they are at home. 

All right, we’re going to get into the key points here. So pathophysiology and etiology. This occurs in type two diabetes. When the body is unable to excrete excess sugar in the blood, the blood becomes very concentrated, but does not produce ketones. Most are caused by the common cold or a bacterial infection. Some subjective and objective data: what you’re going to see with the patient is they are going to say they have extreme thirst and dehydration from excess urination, drowsiness, and confusion. The blood glucose will be greater than 600 – that is the hallmark for this condition. Warm, dry skin that does not sweat and high fever. We’re going to monitor this patient. We’re going to monitor vital signs, looking for hypotension, tachycardia, fever, glucose levels, LOCs, and hyperthermia Administer medications; we’re going to administer IV fluids such as isotonic solutions to keep them hydrated, regular insulin, and antipyretics. And there you have that care plan. 

You guys did awesome. We love you guys. Go out, be your best self and, as always, happy nursing.

 

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Medical-Surgical Nursing Study Plan

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Study Plan Lessons

1st Degree AV Heart Block
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2nd Degree AV Heart Block Type 2 (Mobitz II)
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Causes of Pancreatitis Nursing Mnemonic (BAD HITS)
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Chronic Renal (Kidney) Module Intro
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Cirrhosis Case Study (45 min)
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Day in the Life of a Med-surg Nurse
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Diabetes Insipidus Nursing Mnemonic (DDD)
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Diabetes Mellitus Case Study (45 min)
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Dysrhythmias Labs
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Endocarditis Case Study (45 min)
Endoscopy & EGD
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Enteral & Parenteral Nutrition (Diet, TPN)
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Epoetin (Epogen) Nursing Considerations
Epoetin Alfa
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Erythromycin (Erythrocin) Nursing Considerations
Essential NCLEX Meds by Class
Evaluation of Irregular Moles Nursing Mnemonic (ABCDE)
Fentanyl (Duragesic) Nursing Considerations
Ferrous Sulfate (Iron) Nursing Considerations
Fibrin Degradation Products (FDP) Lab Values
Fibrinogen Lab Values
Fibromyalgia
Fluid Volume Overload
Fractures
Free T4 (Thyroxine) Lab Values
Fundamentals Course Introduction
Gabapentin (Neurontin) Nursing Considerations
Gastritis
Gastrointestinal (GI) Bleed Concept Map
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General Assessment (Physical assessment)
Genitourinary (GU) Assessment
Genitourinary Course Introduction
GERD (Gastroesophageal Reflux Disease)
GERD causes Nursing Mnemonic (Reflux Is Probably Mean)
Glaucoma
Glipizide (Glucotrol) Nursing Considerations
Global Symptoms for Brain Tumors Nursing Mnemonic (HAS)
Glucagon (GlucaGen) Nursing Considerations
Gout Case Study (45 min)
Hb (Hepatitis) Vaccine
Head/Neck Assessment
Health Assessment Course Introduction
Hearing Loss
Heart (Cardiac) and Great Vessels Assessment
Heart (Cardiac) Failure Module Intro
Heart (Cardiac) Failure Therapeutic Management
Heart (Cardiac) Sound Locations and Auscultation
Heart Failure – Live Tutoring Archive
Heart Failure – Right Sided Nursing Mnemonic (HEAD)
Heart Failure 2 – Live Tutoring Archive
Heart Failure Case Study (45 min)
Heart Failure-Left-Sided Nursing Mnemonic (CHOP)
Heart Failure-Origin Nursing Mnemonic (Left – Lung|Right – Rest)
Hematology Module Intro
Hematology/Oncology/Immunology Course Introduction
Hemodialysis (Renal Dialysis)
Hemorrhagic Stroke Risk Factors Nursing Mnemonic (HATS)
Heparin (Hep-Lock) Nursing Considerations
Hepatitis B Virus (HBV) Lab Values
Hiatal Hernia
Hiatal Hernia Symptoms Nursing Mnemonic (Her Belly Really Hurts Following Dinner)
High Pressure Vent Alarms Nursing Mnemonic (Kings Eat Big Cakes)
Histamine 1 Receptor Blockers
Histamine 2 Receptor Blockers
HMG-CoA Reductase Inhibitors (Statins)
Hydralazine
Hygiene
Hypercalcemia – Signs and Symptoms Nursing Mnemonic (GROANS, MOANS, BONES, STONES, OVERTONES)
Hyperglycaemic Hyperosmolar Non-ketotic syndrome (HHNS)
Hypernatremia – Signs and Symptoms 2 Nursing Mnemonic (FRIED)
Hypernatremia – Signs and Symptoms 2 Nursing Mnemonic (SWINE)
Hypernatremia – Signs and Symptoms 3 Nursing Mnemonic (SALT)
Hypertension – Nursing care Nursing Mnemonic (DIURETIC)
Hypertension (HTN) Concept Map
Hypertension- Complications Nursing Mnemonic (The 4 C’s)
Hypertensive Crisis Case Study (45 min)
Hyperthermia (Thermoregulation)
Hyperthyroidism Case Study (75 min)
Hypertonic Solutions (IV solutions)
Hypocalcemia – Definition, Signs and Symptoms Nursing Mnemonic (CATS)
Hypoglycemia
Hypoglycemia – Signs and Symptoms Nursing Mnemonic (TIRED)
Hypoglycemia Management Nursing Mnemonic (Cool and Clammy – Give ‘Em Candy)
Hypoglycemia symptoms Nursing Mnemonic (DIRE)
Hypokalemia – Signs and Symptoms Nursing Mnemonic (6 L’s)
Hyponatremia- Definition, Signs and Symptoms Nursing Mnemonic (SALT LOSS)
Hypoparathyroidism
Hypothermia (Thermoregulation)
Hypotonic Solutions (IV solutions)
Hypoxia – Signs and Symptoms Nursing Mnemonic (RAT BED)
ICU Nurse Report to OR (Operating)Team
Immunology Module Intro
Impulse Transmission
Inflammatory Bowel Disease Case Study (45 min)
Informed Consent
Inserting a Foley (Urinary Catheter) – Male
Inserting an NG (Nasogastric) Tube
Insulin
Insulin – Intermediate Acting (NPH) Nursing Considerations
Insulin – Long Acting (Lantus) Nursing Considerations
Insulin – Mixtures (70/30)
Insulin – Rapid Acting (Novolog, Humalog) Nursing Considerations
Insulin – Short Acting (Regular) Nursing Considerations
Insulin Mnemonic (Ready, Set, Inject, Love)
Intake and Output (I&O)
Integumentary (Skin) Course Introduction
Integumentary (Skin) Important Points
Integumentary (Skin) Module Intro
Interventional Radiology
Interventions for Aphasia Nursing Mnemonic (PROP)
Intracranial Pressure ICP
Intraoperative (Intraop) Complications
Intraoperative Nursing Priorities
Intraoperative Positioning
Intrarenal Causes of Acute Kidney Injury Nursing Mnemonic (TONIC)
Intro to Health Assessment
Introduction to Health Assessment
Intubation in the OR
Iodine Nursing Considerations
Ionized Calcium Lab Values
Iron (Fe) Lab Values
Ischemic (CVA) Stroke Labs
Isoniazid (Niazid) Nursing Considerations
IV Complications (infiltration, phlebitis, hematoma, extravasation, air embolism)
Kidney Cancer
Lactate Dehydrogenase (LDH) Lab Values
Lactic Acid
Leukemia
Leukemia – Signs and Symptoms Nursing Mnemonic (ANT)
Leukemia Case Study (60 min)
Levels of consciousness Nursing Mnemonic (Never Carry Dirty Socks Or Smelly Clothes)
Levofloxacin (Levaquin) Nursing Considerations
Levothyroxine (Synthroid)
Lidocaine (Xylocaine) Nursing Considerations
Lidocaine Toxicity – Signs and Symptoms Nursing Mnemonic (SAMS)
Linen Change
Lipase Lab Values
Lisinopril (Prinivil) Nursing Considerations
Live Bedside Report Medsurg (Medical surgical)
Liver Cancer
Liver/Gallbladder Module Intro
Local Anesthesia
Loperamide (Imodium) Nursing Considerations
Losartan (Cozaar) Nursing Considerations
Low Pressure Vent Alarms Nursing Mnemonic (Cake Everyday)
Lower Gastrointestinal (GI) Module Intro
Lung Cancer
Lung Diseases Module Intro
Lymphatic Assessment
Lymphoma
Lymphoma – Signs and Symptoms Nursing Mnemonic (NURSE For Pete’s Sake)
Macular Degeneration
Magnetic Resonance Imaging (MRI)
Malignant Hyperthermia
Mammogram
Management of Glomerulonephritis Nursing Mnemonic (Please Help Deliver Diuretics)
Management of Lyme Disease Nursing Mnemonic (BAR)
Management of Pressure Ulcers (Pressure Injuries) Nursing Mnemonic (SKIN)
Mechanical Aids
Medication Classess for IBD Nursing Mnemonic (Sometimes I Can’t Answer)
Medications for Pancreatitis Nursing Mnemonic (Please Make Tummy Better)
Medications to Prevent Seizures Nursing Mnemonic (Pretty Little Liars Forever)
Melanoma
Meniere’s Disease
Meperidine (Demerol) Nursing Considerations
Meropenem (Merrem) Nursing Considerations
Metabolic & Endocrine Module Intro
Metabolic Acidosis (interpretation and nursing diagnosis)
Metabolic/Endocrine Course Introduction
Metformin (Glucophage) Nursing Considerations
Methylprednisolone (Solu-Medrol) Nursing Considerations
Metoclopramide (Reglan) Nursing Considerations
Metoprolol (Toprol XL) Nursing Considerations
Metronidazole (Flagyl) Nursing Considerations
MI Surgical Intervention
Migraines
Miscellaneous Nerve Disorders
Mobility & Assistive Devices
Moderate Sedation
Montelukast (Singulair) Nursing Considerations
Morphine (MS Contin) Nursing Considerations
Multiple Myeloma
Multiple Sclerosis Symptoms Nursing Mnemonic (DEMYELINATION)
Murmur locations Nursing Mnemonic (hARD ASS MRS. MSD)
Musculoskeletal Assessment
Musculoskeletal Course Introduction
Musculoskeletal Module Intro
Myocardial Infarction (MI) Case Study (45 min)
Myocardial Infarction Nursing Mnemonic (MONATAS)
Naproxen (Aleve) Nursing Considerations
Nasal Disorders
Neostigmine (Prostigmin) Nursing Considerations
Nephrotic Syndrome Case Study (Peds) (45 min)
Neuro A&P Module Intro
Neuro Anatomy
Neuro Assessment Module Intro
Neuro Course Introduction
Neuro Disorders Module Intro
Neuro Trauma Module Intro
Neurological Fractures
NG (Nasogastric)Tube Management
Nitro Compounds
Nitroglycerin (Nitrostat) Nursing Considerations
Nitroprusside (Nitropress) Nursing Considerations
Norepinephrine (Levophed) Nursing Considerations
NRSNG Live | So You Want to be a Surgical Nurse?
Nuclear Medicine
Nursing Care and Pathophysiology for Acquired Immune Deficiency Syndrome (AIDS)
Nursing Care and Pathophysiology for Anaphylaxis
Nursing Care and Pathophysiology for Anemia
Nursing Care and Pathophysiology for Aortic Aneurysm
Nursing Care and Pathophysiology for Appendicitis
Nursing Care and Pathophysiology for Arterial Disorders
Nursing Care and Pathophysiology for Asthma
Nursing Care and Pathophysiology for Cardiogenic Shock
Nursing Care and Pathophysiology for Cardiomyopathy
Nursing Care and Pathophysiology for Chlamydia (STI)
Nursing Care and Pathophysiology for Cholecystitis
Nursing Care and Pathophysiology for Cirrhosis (Liver Disease, Hepatic encephalopathy, Portal Hypertension, Esophageal Varices)
Nursing Care and Pathophysiology for Compartment Syndrome
Nursing Care and Pathophysiology for Crohn’s Disease
Nursing Care and Pathophysiology for Cushings Syndrome
Nursing Care and Pathophysiology for Diabetes Insipidus (DI)
Nursing Care and Pathophysiology for Disseminated Intravascular Coagulation (DIC)
Nursing Care and Pathophysiology for Distributive Shock
Nursing Care and Pathophysiology for Diverticulosis – Diverticulitis
Nursing Care and Pathophysiology for Endometriosis
Nursing Care and Pathophysiology for Epididymitis
Nursing Care and Pathophysiology for Gonorrhea (STI)
Nursing Care and Pathophysiology for Gout
Nursing Care and Pathophysiology for Hashimoto’s Thyroiditis
Nursing Care and Pathophysiology for Heart Failure (CHF)
Nursing Care and Pathophysiology for Hemorrhagic Stroke (CVA)
Nursing Care and Pathophysiology for Hemorrhoids
Nursing Care and Pathophysiology for Hepatitis (Liver Disease)
Nursing Care and Pathophysiology for Herpes Simplex (HSV, STI)
Nursing Care and Pathophysiology for Herpes Zoster – Shingles
Nursing Care and Pathophysiology for Human Papilloma Virus (HPV STI)
Nursing Care and Pathophysiology for Hyperparathyroidism
Nursing Care and Pathophysiology for Hyperthyroidism
Nursing Care and Pathophysiology for Hypothyroidism
Nursing Care and Pathophysiology for Hypovolemic Shock
Nursing Care and Pathophysiology for Inflammatory Bowel Disease (IBD)
Nursing Care and Pathophysiology for Influenza (Flu)
Nursing Care and Pathophysiology for Ischemic Stroke (CVA)
Nursing Care and Pathophysiology for Lyme Disease
Nursing Care and Pathophysiology for Male Infertility
Nursing Care and Pathophysiology for Meningitis
Nursing Care and Pathophysiology for Menopause
Nursing Care and Pathophysiology for Multiple Sclerosis (MS)
Nursing Care and Pathophysiology for Myasthenia Gravis
Nursing Care and Pathophysiology for Osteomyelitis
Nursing Care and Pathophysiology for Pancreatitis
Nursing Care and Pathophysiology for Parkinsons
Nursing Care and Pathophysiology for Pelvic Inflammatory Disease (PID)
Nursing Care and Pathophysiology for Peptic Ulcer Disease (PUD)
Nursing Care and Pathophysiology for Pneumothorax & Hemothorax
Nursing Care and Pathophysiology for Polycystic Ovarian Syndrome (PCOS)
Nursing Care and Pathophysiology for Psoriasis
Nursing Care and Pathophysiology for Pulmonary Edema
Nursing Care and Pathophysiology for Pulmonary Embolism
Nursing Care and Pathophysiology for Rhabdomyolysis
Nursing Care and Pathophysiology for Rheumatoid Arthritis (RA)
Nursing Care and Pathophysiology for Scleroderma
Nursing Care and Pathophysiology for Seizure
Nursing Care and Pathophysiology for Sepsis
Nursing Care and Pathophysiology for SIADH (Syndrome of Inappropriate antidiuretic Hormone Secretion)
Nursing Care and Pathophysiology for Sickle Cell Anemia
Nursing Care and Pathophysiology for SIRS & MODS
Nursing Care and Pathophysiology for Syphilis (STI)
Nursing Care and Pathophysiology for Testicular Torsion
Nursing Care and Pathophysiology for Thrombophlebitis (clot)
Nursing Care and Pathophysiology for Tuberculosis (TB)
Nursing Care and Pathophysiology for Ulcerative Colitis(UC)
Nursing Care and Pathophysiology for Valve Disorders
Nursing Care and Pathophysiology of Acute Kidney (Renal) Injury (AKI)
Nursing Care and Pathophysiology of Acute Respiratory Distress Syndrome (ARDS)
Nursing Care and Pathophysiology of Angina
Nursing Care and Pathophysiology of BPH (Benign Prostatic Hyperplasia)
Nursing Care and Pathophysiology of Chronic Kidney (Renal) Disease (CKD)
Nursing Care and Pathophysiology of COPD (Chronic Obstructive Pulmonary Disease)
Nursing Care and Pathophysiology of Coronary Artery Disease (CAD)
Nursing Care and Pathophysiology of Diabetes Mellitus (DM)
Nursing Care and Pathophysiology of Diabetic Ketoacidosis (DKA)
Nursing Care and Pathophysiology of Endocarditis and Pericarditis
Nursing Care and Pathophysiology of Glomerulonephritis
Nursing Care and Pathophysiology of Hypertension (HTN)
Nursing Care and Pathophysiology of Myocardial Infarction (MI)
Nursing Care and Pathophysiology of Myocarditis
Nursing Care and Pathophysiology of Nephrotic Syndrome
Nursing Care and Pathophysiology of Osteoarthritis (OA)
Nursing Care and Pathophysiology of Osteoporosis
Nursing Care and Pathophysiology of Pneumonia
Nursing Care and Pathophysiology of Renal Calculi (Kidney Stones)
Nursing Care and Pathophysiology of Urinary Tract Infection (UTI)
Nursing Care Plan (NCP) & Interventions for Increased Intracranial Pressure (ICP)
Nursing Care Plan (NCP) for Abdominal Pain
Nursing Care Plan (NCP) for Acquired Immune Deficiency Syndrome (AIDS)
Nursing Care Plan (NCP) for Activity Intolerance
Nursing Care Plan (NCP) for Acute Bronchitis
Nursing Care Plan (NCP) for Acute Kidney Injury
Nursing Care Plan (NCP) for Acute Pain
Nursing Care Plan (NCP) for Acute Respiratory Distress Syndrome
Nursing Care Plan (NCP) for Addison’s Disease (Primary Adrenal Insufficiency)
Nursing Care Plan (NCP) for Anaphylaxis
Nursing Care Plan (NCP) for Anemia
Nursing Care Plan (NCP) for Angina
Nursing Care Plan (NCP) for Aortic Aneurysm
Nursing Care Plan (NCP) for Arterial Disorders
Nursing Care Plan (NCP) for Aspiration
Nursing Care Plan (NCP) for Asthma / Childhood Asthma
Nursing Care Plan (NCP) for Atrial Fibrillation (AFib)
Nursing Care Plan (NCP) for Bell’s Palsy
Nursing Care Plan (NCP) for Benign Prostatic Hyperplasia (BPH)
Nursing Care Plan (NCP) for Bladder Cancer
Nursing Care Plan (NCP) for Blunt Chest Trauma
Nursing Care Plan (NCP) for Bone Cancer (Osteosarcoma, Chondrosarcoma, and Ewing Sarcoma)
Nursing Care Plan (NCP) for Bowel Obstruction
Nursing Care Plan (NCP) for Brain Tumors
Nursing Care Plan (NCP) for Breast Cancer
Nursing Care Plan (NCP) for Bronchoscopy (Procedure)
Nursing Care Plan (NCP) for Cardiogenic Shock
Nursing Care Plan (NCP) for Cardiomyopathy
Nursing Care Plan (NCP) for Cellulitis
Nursing Care Plan (NCP) for Cervical Cancer
Nursing Care Plan (NCP) for Cholecystitis
Nursing Care Plan (NCP) for Chronic Kidney Disease
Nursing Care Plan (NCP) for Chronic Obstructive Pulmonary Disease (COPD)
Nursing Care Plan (NCP) for Colorectal Cancer (Colon Cancer)
Nursing Care Plan (NCP) for Congestive Heart Failure (CHF)
Nursing Care Plan (NCP) for Cushing’s Disease
Nursing Care Plan (NCP) for Dementia
Nursing Care Plan (NCP) for Diabetes
Nursing Care Plan (NCP) for Diabetes Insipidus
Nursing Care Plan (NCP) for Diabetic Ketoacidosis (DKA)
Nursing Care Plan (NCP) for Disseminated Intravascular Coagulation (DIC)
Nursing Care Plan (NCP) for Diverticulosis / Diverticulitis
Nursing Care Plan (NCP) for Emphysema
Nursing Care Plan (NCP) for Encephalopathy
Nursing Care Plan (NCP) for Endocarditis
Nursing Care Plan (NCP) for Enuresis / Bedwetting
Nursing Care Plan (NCP) for Epididymitis
Nursing Care Plan (NCP) for Gastroesophageal Reflux Disease (GERD)
Nursing Care Plan (NCP) for GI (Gastrointestinal) Bleed
Nursing Care Plan (NCP) for Glaucoma
Nursing Care Plan (NCP) for Glomerulonephritis
Nursing Care Plan (NCP) for Gout / Gouty Arthritis
Nursing Care Plan (NCP) for Guillain-Barre
Nursing Care Plan (NCP) for Hashimoto’s Thyroiditis
Nursing Care Plan (NCP) for Heart Valve Disorders
Nursing Care Plan (NCP) for Hepatitis
Nursing Care Plan (NCP) for Herpes Zoster – Shingles
Nursing Care Plan (NCP) for Hydrocephalus
Nursing Care Plan (NCP) for Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)
Nursing Care Plan (NCP) for Hyperparathyroidism
Nursing Care Plan (NCP) for Hyperthermia (Thermoregulation)
Nursing Care Plan (NCP) for Hyperthyroidism
Nursing Care Plan (NCP) for Hypoglycemia
Nursing Care Plan (NCP) for Hypoparathyroidism
Nursing Care Plan (NCP) for Hypothyroidism
Nursing Care Plan (NCP) for Hypovolemic Shock
Nursing Care Plan (NCP) for Impetigo
Nursing Care Plan (NCP) for Inflammatory Bowel Disease (Ulcerative Colitis / Crohn’s Disease)
Nursing Care Plan (NCP) for Kidney Cancer
Nursing Care Plan (NCP) for Leukemia
Nursing Care Plan (NCP) for Lung Cancer
Nursing Care Plan (NCP) for Lyme Disease
Nursing Care Plan (NCP) for Lymphoma (Hodgkin’s, Non-Hodgkin’s)
Nursing Care Plan (NCP) for Meniere’s Disease
Nursing Care Plan (NCP) for Multiple Sclerosis (MS)
Nursing Care Plan (NCP) for Mumps
Nursing Care Plan (NCP) for Myasthenia Gravis (MG)
Nursing Care Plan (NCP) for Myocardial Infarction (MI)
Nursing Care Plan (NCP) for Nephrotic Syndrome
Nursing Care Plan (NCP) for Neutropenia
Nursing Care Plan (NCP) for Nutrition Imbalance
Nursing Care Plan (NCP) for Osteoarthritis (OA), Degenerative Joint Disease
Nursing Care Plan (NCP) for Osteoporosis
Nursing Care Plan (NCP) for Ovarian Cancer
Nursing Care Plan (NCP) for Pancreatitis
Nursing Care Plan (NCP) for Parkinson’s Disease
Nursing Care Plan (NCP) for Peptic Ulcer Disease (PUD)
Nursing Care Plan (NCP) for Pericarditis
Nursing Care Plan (NCP) for Pneumonia
Nursing Care Plan (NCP) for Pneumothorax/Hemothorax
Nursing Care Plan (NCP) for Polycystic Ovarian Syndrome (PCOS)
Nursing Care Plan (NCP) for Pressure Ulcer / Decubitus Ulcer (Pressure Injury)
Nursing Care Plan (NCP) for Prostate Cancer
Nursing Care Plan (NCP) for Psoriasis
Nursing Care Plan (NCP) for Pulmonary Embolism
Nursing Care Plan (NCP) for Renal Calculi
Nursing Care Plan (NCP) for Respiratory Failure
Nursing Care Plan (NCP) for Restrictive Lung Diseases
Nursing Care Plan (NCP) for Rhabdomyolysis
Nursing Care Plan (NCP) for Rheumatoid Arthritis (RA)
Nursing Care Plan (NCP) for Risk for Fall
Nursing Care Plan (NCP) for Rubeola – Measles
Nursing Care Plan (NCP) for Seizures
Nursing Care Plan (NCP) for Sepsis
Nursing Care Plan (NCP) for Skin cancer – Melanoma, Basal Cell Carcinoma, Squamous Cell Carcinoma
Nursing Care Plan (NCP) for Skull Fractures
Nursing Care Plan (NCP) for Spinal Cord Injury
Nursing Care Plan (NCP) for Stomach Cancer (Gastric Cancer)
Nursing Care Plan (NCP) for Stroke (CVA)
Nursing Care Plan (NCP) for Syncope (Fainting)
Nursing Care Plan (NCP) for Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Nursing Care Plan (NCP) for Systemic Lupus Erythematosus (SLE)
Nursing Care Plan (NCP) for Testicular Cancer
Nursing Care Plan (NCP) for Thoracentesis (Procedure)
Nursing Care Plan (NCP) for Thrombocytopenia
Nursing Care Plan (NCP) for Thrombophlebitis / Deep Vein Thrombosis (DVT)
Nursing Care Plan (NCP) for Thyroid Cancer
Nursing Care Plan (NCP) for Tuberculosis
Nursing Care Plan (NCP) for Urinary Tract Infection (UTI)
Nursing Care Plan (NCP) for West Nile Virus
Nursing Care Plan for (NCP) Trigeminal Neuralgia
Nursing Care Plan for Amputation
Nursing Care Plan for Chlamydia (STI)
Nursing Care Plan for Cirrhosis (Liver)
Nursing Care Plan for Compartment Syndrome
Nursing Care Plan for Coronary Artery Disease (CAD)
Nursing Care Plan for Distributive Shock
Nursing Care Plan for Endometriosis
Nursing Care Plan for Fibromyalgia
Nursing Care Plan for Fractures
Nursing Care Plan for Gastritis
Nursing Care Plan for Gonorrhea (STI)
Nursing Care Plan for Hemorrhoids
Nursing Care Plan for Herpes Simplex (HSV, STI)
Nursing Care Plan for Hiatal Hernia
Nursing Care Plan for Liver Cancer
Nursing Care Plan for Macular Degeneration
Nursing Care Plan for Myocarditis
Nursing Care Plan for Nasal Disorders
Nursing Care Plan for Osteomyelitis
Nursing Care Plan for Pelvic Inflammatory Disease (PID)
Nursing Care Plan for Pulmonary Edema
Nursing Care Plan for Restrictive Lung Diseases (Pulmonary Fibrosis, Neuromuscular Disorders)
Nursing Care Plan for Scleroderma
Nursing Care Plan for Syphilis (STI)
Nursing Care Plan for Testicular Torsion
Nursing Case Study for Acute Kidney Injury
Nursing Case Study for Breast Cancer
Nursing Case Study for Cardiogenic Shock
Nursing Case Study for Colon Cancer
Nursing Case Study for Diabetic Foot Ulcer
Nursing Case Study for Hepatitis
Nursing Case Study for Pneumonia
Nursing Case Study for Rheumatic Heart Disease
Nursing Case Study for Rheumatoid Arthritis
Nursing Case Study for Type 1 Diabetes
Nursing Skills Course Introduction
Nutrition (Diet) in Disease
Nutrition-related Diseases
Omeprazole (Prilosec) Nursing Considerations
Oncology Important Points
Oncology Module Intro
Oncology nurse
Ondansetron (Zofran) Nursing Considerations
Opioids
Osteosarcoma
Ovarian Cancer
Oxygen Delivery Module Intro
Pacemakers
Pain and Nonpharmacological Comfort Measures
Pain Assessment Questions Nursing Mnemonic (OPQRST)
Pain Assessments for Certified Perioperative Nurse (CNOR)
Pantoprazole (Protonix) Nursing Considerations
Parasympatholytics (Anticholinergics) Nursing Considerations
Patient Positioning
Patients with Communication Difficulties
Pentobarbital (Nembutal) Nursing Considerations
Peptic Ulcer Disease Case Study (60 min)
Performing Cardiac (Heart) Monitoring
Perioperative Nursing Course Introduction
Perioperative Nursing Roles
Peripheral Vascular Assessment
Peritoneal Dialysis (PD)
Phenazopyridine (Pyridium) Nursing Considerations
Phenobarbital (Luminal) Nursing Considerations
Phosphorus (PO4) Blood Test Lab Values
Pituitary Adenoma
Plant Alkaloids Topoisomerase and Mitotic Inhibitors
Pneumonia Concept Map
Pneumonia Labs
Pneumonia Risk Factors Nursing Mnemonic (VENTS)
Pneumothorax Signs and Symptoms Nursing Mnemonic (P-THORAX)
Positioning
Post-Anesthesia Recovery
Postoperative (Postop) Complications
PPE Donning & Doffing
Premature Atrial Contraction (PAC)
Premature Ventricular Contraction (PVC)
Preoperative (Preop) Education
Preoperative (Preop) Nursing Priorities
Preoperative (Preop)Assessment
Pressure Line Management
Pressure Ulcers/Pressure injuries (Braden scale)
Procalcitonin (PCT) Lab Values
Propofol (Diprivan) Nursing Considerations
Propranolol (Inderal) Nursing Considerations
Propylthiouracil (PTU) Nursing Considerations
Prostate Cancer
Prostate Nursing Mnemonic (FUN)
Prostate Specific Antigen (PSA) Lab Values
Protein in Urine Lab Values
Proton Pump Inhibitors
Pulmonary edema treatment Nursing Mnemonic (MAD DOG)
Pupil Reactions Nursing Mnemonic (PERRLA)
Radiation Cancer Treatment
Ranitidine (Zantac) Nursing Considerations
Reactivation of Herpes Zoster Nursing Mnemonic (FICA)
Reasons for a Bronchoscopy Nursing Mnemonic (Please Assess His Weird Bronchoscopy Results)
Reasons for Chest Tube Nursing Mnemonic (Don’t Ever Fail)
Red Cell Distribution Width (RDW) Lab Values
Renal (Kidney) Failure Labs
Respiratory A&P Module Intro
Respiratory Alkalosis
Respiratory Course Introduction
Respiratory Infections Module Intro
Respiratory Procedures Module Intro
Respiratory Trauma Module Intro
Restrictive Lung Disease Causes Nursing Mnemonic (PAINT)
Restrictive Lung Diseases (Pulmonary Fibrosis, Neuromuscular Disorders)
Rheumatoid Arthritis Assessment Nursing Mnemonic (RHEUMATOID)
Rifampin (Rifadin) Nursing Considerations
Risk Factors for Cholelithiasis Nursing Mnemonic (5-F’s)
Risk Factors for Osteoporosis Nursing Mnemonic (ACCESS)
Routine Neuro Assessments
Science of Nutrition
Scleroderma Symptoms Nursing Mnemonic (CREST)
Sedatives-Hypnotics
Sedatives-Hypnotics
Seizure Assessment
Seizure Causes (Epilepsy, Generalized)
Seizure Causes Nursing Mnemonic (VITAMIN)
Seizure Therapeutic Management
Seizures Case Study (45 min)
Seizures Module Intro
Sepsis Concept Map
Sepsis Labs
Septic Shock (Sepsis) Case Study (45 min)
Shock
Shock – Signs and symptoms Nursing Mnemonic (TV SPARC CUBE)
Shock Module Intro
Signs of Osteoarthritis Nursing Mnemonic (OSTEO)
Sinus Bradycardia
Sinus Tachycardia
Skin Cancer
Specialty Diets (Nutrition)
Spinal Cord Injury
Spinal Cord Injury Case Study (60 min)
Spinal Precautions & Log Rolling
Sprains and Strains – Nursing Care Nursing Mnemonic (RICE)
Stages of Hepatitis Nursing Mnemonic (PIP)
Sterile Field
Sterile Gloves
Stoke Assessments Nursing Mnemonic (FAST)
Stomach Cancer (Gastric Cancer)
Strabismus
Streptokinase (Streptase) Nursing Considerations
Stroke (CVA) Module Intro
Stroke Assessment (CVA)
Stroke Case Study (45 min)
Stroke Concept Map
Stroke Nursing Care (CVA)
Stroke Therapeutic Management (CVA)
Sucralfate (Carafate) Nursing Considerations
Supraventricular Tachycardia (SVT)
Surgical Incisions & Drain Sites
Surgical Prep
Sympatholytics (Alpha & Beta Blockers)
Symptoms of Hyperthyroidism Nursing Mnemonic (SWEATING)
Symptoms of Hypothyroidism Nursing Mnemonic (MOM’S SO TIRED)
Symptoms of Nephrotic Syndrome Nursing Mnemonic (NAPHROTIC)
Symptoms of Wernicke’s Encephalopathy Nursing Mnemonic (COAT)
Systemic Lupus Erythematosus (SLE)
TB Drugs Nursing Mnemonic (RIPE)
Tension and Cluster Headaches
Testicular Cancer
Tetracycline (Panmycin) Nursing Considerations
The 5-Minute Assessment (Physical assessment)
The Medical Team
Thoracentesis
Thrombin Inhibitors
Thrombocytopenia
Thrombolytics
Thyroid Cancer
Thyroid Stimulating Hormone (TSH) Lab Values
Thyroxine (T4) Lab Values
To Clot or Not To Clot – Anticoagulants! – Live Tutoring Archive
Total Iron Binding Capacity (TIBC) Lab Values
Toxicity Sepsis- Signs and Symptoms Nursing Mnemonic (The 6 T’s)
Trach Care
Trach Suctioning
Traction – Nursing Care Nursing Mnemonic (TRACTION)
Trauma – Assessment (Emergency) Nursing Mnemonic (ABCDEFGHI)
Triiodothyronine (T3) Lab Values
Trimethoprim-Sulfamethoxazole (Bactrim) Nursing Considerations
Troponin I (cTNL) Lab Values
Tuberculosis (TB) Case Study (60 min)
Types of Anemia Nursing Mnemonic (Always Introduce Special Patients)
Types of Hemorrhoids Nursing Mnemonic (Pie)
Ulcerative Colitis – Assessment Nursing Mnemonic (MADE 10)
Ultrasound
Understanding Blood Pressure Meds! – Live Tutoring Archive
Upper Gastrointestinal (GI) Module Intro
Urinary Elimination
Urinary Tract Infection Case Study (45 min)
Urine Culture and Sensitivity Lab Values
Using Aseptic Technique
Vancomycin (Vancocin) Nursing Considerations
Varicocele
Vascular Disease – Deep Vein Thrombosis Nursing Mnemonic (HIS Leg Might Fall off)
Vascular disease – Raynaud’s symptoms Nursing Mnemonic (COLD HAND)
Vasopressin
Vasopressin (Pitressin) Nursing Considerations
Venous Disorders (Chronic venous insufficiency, Deep venous thrombosis/DVT)
Vent Alarms
Ventilator Settings
Ventricular Fibrillation (V Fib)
Ventricular Tachycardia (V-tach)
Vessels & Fluid
Vitamin D Lab Values
Warfarin (Coumadin) Nursing Considerations
Who Needs Dialysis Nursing Mnemonic (AEIOU)
Wound Care – Assessment
Wound Care – Dressing Change
Wound Care – Selecting a Dressing
Wound Care – Wound Drains
Seizure Documentation Nursing Mnemonic (TDOC)