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Nursing Care Plan (NCP) for Neutropenia

Nursing Care Plan (NCP) for Neutropenia

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Outline

Lesson Objectives for Neutropenia

  • Understanding Neutropenia:
    • Define neutropenia as a condition characterized by an abnormally low level of neutrophils, a type of white blood cell crucial for immune function. Understand the role of neutrophils in protecting the body from infections.
  • Causes and Risk Factors:
    • Explore the various causes of neutropenia, including chemotherapy, certain medications, infections, and underlying medical conditions. Identify risk factors that may predispose individuals to develop neutropenia.
  • Clinical Manifestations:
    • Recognize the clinical manifestations of neutropenia, such as increased susceptibility to infections, fever, and potential complications. Understand the importance of early detection and management to prevent severe infections.
  • Diagnostic Approaches:
    • Familiarize with diagnostic approaches for neutropenia, including complete blood count (CBC) with differential, bone marrow aspiration, and assessing the underlying cause through medical history and physical examination.
  • Management and Nursing Interventions:
    • Learn about the management of neutropenia, including pharmacological interventions such as granulocyte colony-stimulating factors (G-CSF), infection prevention strategies, and patient education. Understand the role of nursing interventions in supporting individuals with neutropenia.

Pathophysiology of Neutropenia

  • Impaired Neutrophil Production:
    • Neutropenia often results from a disruption in the production of neutrophils, which are critical for innate immune responses. Impaired production can occur in the bone marrow due to various factors.
  • Increased Destruction of Neutrophils:
    • Accelerated destruction of neutrophils may occur, leading to a decrease in circulating neutrophil levels. Conditions such as autoimmune disorders or medications can contribute to the destruction of these white blood cells.
  • Altered Distribution and Sequestration:
    • Neutrophils may be redistributed or sequestered in organs and tissues, making them less available in the bloodstream. This altered distribution can impact the body’s ability to mount an effective immune response.
  • Bone Marrow Suppression:
    • Conditions that suppress bone marrow function, such as chemotherapy or radiation therapy, can result in neutropenia. The bone marrow, responsible for producing blood cells, may be adversely affected, leading to a reduced neutrophil count.
  • Increased Utilization in Infections:
    • During infections, there is an increased demand for neutrophils at the site of infection. This heightened utilization, coupled with a compromised production or increased destruction, can contribute to neutropenia.

Etiology of Neutropenia

 

  • Chemotherapy and Radiation Therapy:
    • Treatment modalities like chemotherapy and radiation can suppress bone marrow function, leading to a decrease in neutrophil production and subsequent neutropenia.
  • Medications:
    • Certain medications, such as immunosuppressants, antibiotics (e.g., trimethoprim-sulfamethoxazole), and antithyroid drugs, can cause neutropenia as a side effect.
  • Infections:
    • Severe infections, particularly those involving the bone marrow or directly affecting neutrophils, can lead to increased destruction and utilization, contributing to neutropenia.
  • Autoimmune Disorders:
    • Autoimmune disorders, including rheumatoid arthritis and lupus, can result in the destruction of neutrophils by the body’s immune system, contributing to neutropenia.
  • Congenital Disorders:
    • Certain congenital disorders, such as cyclic neutropenia or Kostmann syndrome, can lead to chronic neutropenia due to genetic abnormalities affecting neutrophil production.

Desired Outcome for Neutropenia

  • Maintained Neutrophil Levels:
    • Achieve and maintain an adequate neutrophil count within the normal range to support the body’s ability to defend against infections and prevent complications.
  • Prevention of Infections:
    • Minimize the occurrence of infections by implementing infection prevention strategies, promoting aseptic techniques, and educating the patient on measures to reduce the risk of exposure to pathogens.
  • Resolution of Underlying Cause:
    • Identify and address the underlying cause of neutropenia to prevent recurrent episodes. Collaborate with the healthcare team to manage contributing factors such as medications or underlying medical conditions.
  • Patient Education and Empowerment:
    • Educate the patient on the importance of adherence to prescribed medications, infection prevention measures, and early recognition of signs and symptoms of infection. Empower the patient to actively participate in their care.
  • Improved Quality of Life:
    • Enhance the patient’s overall quality of life by managing neutropenia effectively, minimizing the impact of infections, and providing emotional support. Encourage the patient to engage in normal daily activities while maintaining precautions.

Neutropenia Nursing Care Plan

 

Subjective Data:

**Neutropenia itself will typically not elicit symptoms, but its cause or subsequent infections may, which differ. Many patients are unaware until the lab is drawn and the diagnosis is made.

Objective Data:

absolute neutrophil count < 1500 cells/mm3

Nursing Assessment for Neutropenia

 

  • Complete Blood Count (CBC):
    • Monitor the patient’s CBC with differential regularly to assess neutrophil levels. Document any fluctuations or trends, and report abnormal results promptly.
  • Signs and Symptoms of Infection:
    • Assess for signs and symptoms of infection, such as fever, chills, increased heart rate, and changes in mental status. Promptly investigate and initiate appropriate interventions if infection is suspected.
  • Medication History:
    • Obtain a detailed medication history, including current medications and any recent changes. Identify medications known to cause neutropenia and collaborate with the healthcare team for potential adjustments.
  • Recent Infections or Illnesses:
    • Inquire about recent infections, illnesses, or hospitalizations, as these factors can contribute to neutropenia. Understanding the patient’s medical history aids in determining the underlying cause.
  • Bone Marrow Aspiration:
    • If indicated, assess the results of bone marrow aspiration to determine the cause of neutropenia and guide treatment decisions. Collaborate with the healthcare team for interpretation and planning.
  • Education and Understanding:
    • Assess the patient’s understanding of neutropenia, its causes, and the importance of adherence to prescribed medications. Identify any misconceptions or concerns that require clarification.
  • Psychosocial Assessment:
    • Evaluate the patient’s psychosocial well-being and coping mechanisms. Neutropenia and its management may impact the patient emotionally, so providing emotional support and addressing concerns is crucial.
  • Infection Prevention Practices:
    • Assess the patient’s adherence to infection prevention practices, including hand hygiene, avoiding crowds, and maintaining a clean environment. Provide education and reinforcement of these practices as needed.

 

Implementation for Neutropenia

 

  • Pharmacological Interventions:
    • Administer prescribed medications, such as granulocyte colony-stimulating factors (G-CSF), as directed to stimulate neutrophil production and prevent severe neutropenia. Monitor for potential side effects and report any adverse reactions.
  • Infection Prevention Measures:
    • Educate the patient on infection prevention strategies, including meticulous hand hygiene, avoiding crowds, and maintaining a clean living environment. Emphasize the importance of promptly reporting any signs of infection.
  • Regular Monitoring and Assessments:
    • Conduct regular monitoring of the patient’s complete blood count (CBC) with differential to assess neutrophil levels. Promptly report any significant changes to the healthcare team for further evaluation and adjustments to the care plan.
  • Patient Education and Empowerment:
    • Provide comprehensive education to the patient regarding their condition, including the underlying causes, medications, and self-care measures. Empower the patient to actively participate in managing their health and recognizing potential complications.
  • Collaboration with Healthcare Team:
    • Collaborate with the healthcare team, including physicians, hematologists, and infectious disease specialists, to address the underlying cause of neutropenia. Participate in interdisciplinary discussions to tailor the care plan to the patient’s specific needs.

Nursing Interventions and Rationales

 

  • Prevent infection

 

  • Patients with neutropenia are at an increased risk for infection already and will have a decreased ability to be able to fight infection appropriately, therefore it’s essential to prevent this by avoiding unnecessary lines/drains/tubes, appropriate care and cleaning, and discontinuing lines as soon as they are no longer medically indicated.

 

  • Promote oral care

 

  • The mouth is a place that can get infected easily, especially if a patient is on antibiotics, which destroys some of the good bacteria there. It’s ideal if someone who is about to endure treatment that may cause neutropenia (like chemo) can get a dental exam prior. Brushing and flossing regularly is essential.

 

  • Promote hygiene

 

  • Proper hygiene reduces the risk for infection, which is our main concern with neutropenia.

 

  • Prevent skin breakdown

 

  • Skin is an essential aspect of our body that prevents infection. Therefore, if it is compromised, it can be quite a problem for a patient with neutropenia. Prevent ulcers and breakdown, as they may not be able to heal properly and prevent healing and recovery.

 

  • Promote nutrition and ensure food is prepared and stored appropriately

 

  • Food that is not stored or prepared properly could cause infection. Listeria is a food-borne illness that could be quite detrimental to a neutropenic patient.

 

  • Educate on signs and symptoms of infection

 

  • Patients must know when to alert their healthcare team when/if signs and symptoms of infection present themselves when they are neutropenic, as

 

  • **A note about “neutropenic precautions” or “protective isolation” or “reverse isolation”

 

  • Years ago, the standard in practice for patients with neutropenia was to put the patient on isolation, however evidence does not support this practice. Please see the quote below: “Evidence does not support the use of reverse isolation in hospitals…the use of reverse isolation procedures should be discouraged as they are unlikely to be of benefit, and commonly cause anxiety and confusion for patients, families, and healthcare workers” Sheshadri and Baumann 2008.Essentially, what puts the neutropenic patient at greatest risk for infection is their own body, so putting on gowns and masks doesn’t reduce that risk. It does increase cost and makes the patient feel isolated, straining their mental health unnecessarily.

Evaluation for Neutropenia

 

  • Neutrophil Levels:
    • Regularly evaluate neutrophil levels through CBC with differential. Assess whether neutrophil counts remain within the target range or if adjustments to the treatment plan are necessary.
  • Incidence of Infections:
    • Monitor the patient for the occurrence of infections. Evaluate the frequency and severity of infections, if any, and assess the effectiveness of infection prevention measures in reducing the risk.
  • Medication Adherence:
    • Assess the patient’s adherence to prescribed medications, including G-CSF or other medications aimed at managing neutropenia. Evaluate whether the patient is consistently taking medications as directed.
  • Patient Education:
    • Measure the patient’s understanding of neutropenia, its causes, and the importance of infection prevention measures. Evaluate the patient’s ability to recognize early signs of infection and report them promptly.
  • Quality of Life:
    • Evaluate the impact of neutropenia management on the patient’s overall quality of life. Consider factors such as emotional well-being, ability to engage in daily activities, and any reported improvements or challenges.

References

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Transcript

Hey guys, let’s take a look at the care plan for neutropenia. In this lesson, we’ll briefly take a look at the pathophysiology and etiology of neutropenia. We’re also going to take a look at additional things like subjective and objective data, as well as nursing interventions and rationales for each. 

 

So neutropenia is an abnormally low count of neutrophils, which is a type of white blood cell. Neutrophils are made in the bone marrow, so anything that inhibits or disrupts this process can result in neutropenia. Neutropenia can also occur if neutrophils are destroyed, for instance, by a medication. It can be congenital or can be acquired. Congenital neutropenia can result from conditions like Kostmann’s syndrome or myelokathexis. Acquired neutropenia can result from nutritional deficiencies, infections like Hep A,B,C, HIV, and others, by medications, chemotherapy, leukemia, alcohol use disorder, and even more things. The desired outcome is to restore the neutrophil count, prevent additional destruction, and prevent infection. 

 

Let’s take a look at some of the subjective and objective data that your patient with neutropenia may present with. Remember, subjective data are going to be things that are based on your patient’s opinions or feelings, and actually with neutropenia, it typically will not elicit symptoms. They might have symptoms from the actual cause of the neutropenia or subsequent infections. Many patients are unaware until labs are drawn and the diagnosis is made. 

 

Objective data consists of an absolute neutrophil count of less than 1500 cells. 

 

Let’s take a look at some of the nursing interventions, which are important in caring for a patient with neutropenia. 

 

Preventing infection is key. Patients with neutropenia are at an increased risk for infection already and have a decreased ability to fight infection. With this in mind, it’s important to avoid any unnecessary lines, drains, tubes, and maintain appropriate care in cleaning, and discontinue lines as soon as they are no longer medically indicated. Promoting oral care is also critical as the mouth is a place that can get infected easily, especially if the patient is on antibiotics, which destroys the good bacteria. It is a great idea for any patient who is about to begin a treatment like chemo, which may cause neutropenia, to get a dental exam prior. Brushing and flossing daily is essential. Although it sounds very basic, promoting hygiene is super important as proper hygiene reduces the risk of infection, and this is our main concern with neutropenia patients. 

 

Also, as you know, skin is super important in preventing infection therefore, if it is compromised, it can be a huge problem for a patient with neutropenia. So, prevention of ulcers and skin breakdowns is key as these patients may not be able to heal properly. 

 

Nutrition, this is another important nursing intervention because food that is not stored or prepared properly could cause infection. Listeria, for example, is a foodborne illness that could be detrimental to a neutropenic patient. In case you were wondering, there is no evidence that a neutropenic diet benefits a patient with neutropenia. It is said that just following safe food handling guidelines set by the FDA is enough. Educate the patient on signs and symptoms of infection, and when to alert the healthcare team. 

 

One final note guys, years ago, the standard was to put these patients in isolation, also known as neutropenic precautions, protective isolation, or reverse isolation. However, evidence now does not support this, and states that what actually puts neutropenic patients at risk are their own bodies. So, putting masks and gowns on does not reduce this risk. It simply increases costs, creates feelings of isolation, and places strain on the mental health of the patients. 

 

Okay, guys, here is a look at the care plan for neutropenia. That’s it for this lesson. We love you guys. Now, go out and be your best self today and as always, happy nursing!

 

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Nursing Care Plan (NCP) for Hepatitis
Nursing Care Plan (NCP) for Heart Valve Disorders
Nursing Care Plan (NCP) for Hashimoto’s Thyroiditis
Nursing Care Plan (NCP) for Guillain-Barre
Nursing Care Plan (NCP) for Glomerulonephritis
Nursing Care Plan (NCP) for Glaucoma
Nursing Care Plan (NCP) for GI (Gastrointestinal) Bleed
Nursing Care Plan (NCP) for Gastroesophageal Reflux Disease (GERD)
Nursing Care Plan (NCP) for Enuresis / Bedwetting
Nursing Care Plan (NCP) for Encephalopathy
Nursing Care Plan (NCP) for Emphysema
Nursing Care Plan (NCP) for Diverticulosis / Diverticulitis
Nursing Care Plan (NCP) for Disseminated Intravascular Coagulation (DIC)
Nursing Care Plan (NCP) for Diabetic Ketoacidosis (DKA)
Nursing Care Plan (NCP) for Diabetes Insipidus
Nursing Care Plan (NCP) for Diabetes
Nursing Care Plan (NCP) for Dementia
Nursing Care Plan (NCP) for Cushing’s Disease
Nursing Care Plan (NCP) for Congestive Heart Failure (CHF)
Nursing Care Plan (NCP) for Chronic Obstructive Pulmonary Disease (COPD)
Nursing Care Plan (NCP) for Chronic Kidney Disease
Nursing Care Plan (NCP) for Cellulitis
Nursing Care Plan (NCP) for Cardiomyopathy
Nursing Care Plan (NCP) for Cardiogenic Shock
Nursing Care Plan (NCP) for Bowel Obstruction
Nursing Care Plan (NCP) for Blunt Chest Trauma
Nursing Care Plan (NCP) for Benign Prostatic Hyperplasia (BPH)
Nursing Care Plan (NCP) for Bell’s Palsy
Nursing Care Plan (NCP) for Atrial Fibrillation (AFib)
Nursing Care Plan (NCP) for Asthma / Childhood Asthma
Nursing Care Plan (NCP) for Aspiration
Nursing Care Plan (NCP) for Angina
Nursing Care Plan (NCP) for Anemia
Nursing Care Plan (NCP) for Anaphylaxis
Nursing Care Plan (NCP) for Addison’s Disease (Primary Adrenal Insufficiency)
Nursing Care Plan (NCP) for Acute Respiratory Distress Syndrome
Nursing Care Plan (NCP) for Acute Pain
Nursing Care Plan (NCP) for Acute Kidney Injury
Nursing Care Plan (NCP) for Acute Bronchitis
Nursing Care Plan (NCP) for Activity Intolerance
Nursing Care Plan (NCP) for Acquired Immune Deficiency Syndrome (AIDS)
Nursing Care Plan (NCP) for Abdominal Pain
Nursing Care Plan (NCP) & Interventions for Increased Intracranial Pressure (ICP)
Nursing Care and Pathophysiology of Urinary Tract Infection (UTI)
Nursing Care and Pathophysiology of Pneumonia
Nursing Care and Pathophysiology of Osteoporosis
Nursing Care and Pathophysiology of Osteoarthritis (OA)
Nursing Care and Pathophysiology of Nephrotic Syndrome
Nursing Care and Pathophysiology of Myocarditis
Nursing Care and Pathophysiology of Myocardial Infarction (MI)
Nursing Care and Pathophysiology of Hypertension (HTN)
Nursing Care and Pathophysiology of Glomerulonephritis
Nursing Care and Pathophysiology of Diabetic Ketoacidosis (DKA)
Nursing Care and Pathophysiology of Diabetes Mellitus (DM)
Nursing Care and Pathophysiology of Coronary Artery Disease (CAD)
Nursing Care and Pathophysiology of COPD (Chronic Obstructive Pulmonary Disease)
Nursing Care and Pathophysiology of Chronic Kidney (Renal) Disease (CKD)
Nursing Care and Pathophysiology of BPH (Benign Prostatic Hyperplasia)
Nursing Care and Pathophysiology of Angina
Nursing Care and Pathophysiology of Acute Respiratory Distress Syndrome (ARDS)
Nursing Care and Pathophysiology of Acute Kidney (Renal) Injury (AKI)
Nursing Care and Pathophysiology for Valve Disorders
Nursing Care and Pathophysiology for Ulcerative Colitis(UC)
Nursing Care and Pathophysiology for Tuberculosis (TB)
Nursing Care and Pathophysiology for Thrombophlebitis (clot)
Nursing Care and Pathophysiology for Syphilis (STI)
Nursing Care and Pathophysiology for SIRS & MODS
Nursing Care and Pathophysiology for Sickle Cell Anemia
Nursing Care and Pathophysiology for SIADH (Syndrome of Inappropriate antidiuretic Hormone Secretion)
Nursing Care and Pathophysiology for Sepsis
Nursing Care and Pathophysiology for Rheumatoid Arthritis (RA)
Nursing Care and Pathophysiology for Pulmonary Embolism
Nursing Care and Pathophysiology for Pulmonary Edema
Nursing Care and Pathophysiology for Psoriasis
Nursing Care and Pathophysiology for Polycystic Ovarian Syndrome (PCOS)
Nursing Care and Pathophysiology for Pneumothorax & Hemothorax
Nursing Care and Pathophysiology for Parkinsons
Nursing Care and Pathophysiology for Pancreatitis
Nursing Care and Pathophysiology for Myasthenia Gravis
Nursing Care and Pathophysiology for Multiple Sclerosis (MS)
Nursing Care and Pathophysiology for Meningitis
Nursing Care and Pathophysiology for Ischemic Stroke (CVA)
Nursing Care and Pathophysiology for Influenza (Flu)
Nursing Care and Pathophysiology for Inflammatory Bowel Disease (IBD)
Nursing Care and Pathophysiology for Hypovolemic Shock
Nursing Care and Pathophysiology for Hypothyroidism
Nursing Care and Pathophysiology for Hyperparathyroidism
Nursing Care and Pathophysiology for Human Papilloma Virus (HPV STI)
Nursing Care and Pathophysiology for Herpes Zoster – Shingles
Nursing Care and Pathophysiology for Hepatitis (Liver Disease)
Nursing Care and Pathophysiology for Hemorrhagic Stroke (CVA)
Nursing Care and Pathophysiology for Heart Failure (CHF)
Nursing Care and Pathophysiology for Hashimoto’s Thyroiditis
Nursing Care and Pathophysiology for Diverticulosis – Diverticulitis
Nursing Care and Pathophysiology for Distributive Shock
Nursing Care and Pathophysiology for Disseminated Intravascular Coagulation (DIC)
Nursing Care and Pathophysiology for Diabetes Insipidus (DI)
Nursing Care and Pathophysiology for Cushings Syndrome
Nursing Care and Pathophysiology for Crohn’s Disease
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 Cardiogenic Shock
Nursing Care and Pathophysiology for Asthma
Nursing Care and Pathophysiology for Arterial Disorders
Nursing Care and Pathophysiology for Aortic Aneurysm
Nursing Care and Pathophysiology for Anemia
Nursing Care and Pathophysiology for Anaphylaxis
Nursing Care and Pathophysiology for Acquired Immune Deficiency Syndrome (AIDS)
Nuclear Medicine
Norepinephrine (Levophed) Nursing Considerations
Noncardiac Pulmonary Edema for Certified Emergency Nursing (CEN)
Nitroprusside (Nitropress) Nursing Considerations
Nitroglycerin (Nitrostat) Nursing Considerations
Nitro Compounds
NG (Nasogastric)Tube Management
Neurological Fractures
Neurological Disorders (Multiple Sclerosis, Myasthenia Gravis, Guillain-Barré Syndrome) for Certified Emergency Nursing (CEN)
Neurogenic Shock for Certified Emergency Nursing (CEN)
Neostigmine (Prostigmin) Nursing Considerations
Naproxen (Aleve) Nursing Considerations
Myocardial Infarction Nursing Mnemonic (MONATAS)
Myocardial Infarction (MI) Case Study (45 min)
Musculoskeletal Course Introduction
Musculoskeletal Assessment
Murmur locations Nursing Mnemonic (hARD ASS MRS. MSD)
Multiple Sclerosis Symptoms Nursing Mnemonic (DEMYELINATION)
Morphine (MS Contin) Nursing Considerations
Moderate Sedation
Mobility & Assistive Devices
Miscellaneous Nerve Disorders
Minimally-Invasive Thoracic Surgery (VATS) for Progressive Care Certified Nurse (PCCN)
Migraines
MI Surgical Intervention
Metronidazole (Flagyl) Nursing Considerations
Metoprolol (Toprol XL) Nursing Considerations
Metoclopramide (Reglan) Nursing Considerations
Methylprednisolone (Solu-Medrol) Nursing Considerations
Metformin (Glucophage) Nursing Considerations
Metabolic/Endocrine Course Introduction
Metabolic Acidosis (interpretation and nursing diagnosis)
Metabolic & Endocrine Module Intro
Meropenem (Merrem) Nursing Considerations
Meperidine (Demerol) Nursing Considerations
Meningitis for Certified Emergency Nursing (CEN)
Meniere’s Disease
Medication Classess for IBD Nursing Mnemonic (Sometimes I Can’t Answer)
Mechanical Aids
Management of Pressure Ulcers (Pressure Injuries) Nursing Mnemonic (SKIN)
Malignant Hyperthermia (MH) Nursing Interventions for Certified Perioperative Nurse (CNOR)
Malignant Hyperthermia
Magnetic Resonance Imaging (MRI)
Macular Degeneration
Lymphoma – Signs and Symptoms Nursing Mnemonic (NURSE For Pete’s Sake)
Lymphoma
Lymphatic Assessment
Lung Diseases Module Intro
Lower Gastrointestinal (GI) Module Intro
Low Pressure Vent Alarms Nursing Mnemonic (Cake Everyday)
Losartan (Cozaar) Nursing Considerations
Loperamide (Imodium) Nursing Considerations
Local Anesthetic Systemic Toxicity (LAST) Nursing Interventions for Certified Perioperative Nurse (CNOR)
Local Anesthesia
Liver/Gallbladder Module Intro
Live Bedside Report Medsurg (Medical surgical)
Lisinopril (Prinivil) Nursing Considerations
Lipase Lab Values
Linen Change
Lidocaine Toxicity – Signs and Symptoms Nursing Mnemonic (SAMS)
Lidocaine (Xylocaine) Nursing Considerations
Levothyroxine (Synthroid)
Levofloxacin (Levaquin) Nursing Considerations
Levels of consciousness Nursing Mnemonic (Never Carry Dirty Socks Or Smelly Clothes)
Lactic Acid
Lactate Dehydrogenase (LDH) Lab Values
Lacerations for Certified Emergency Nursing (CEN)
IV Complications (infiltration, phlebitis, hematoma, extravasation, air embolism)
Isoniazid (Niazid) Nursing Considerations
Ischemic Bowel for Progressive Care Certified Nurse (PCCN)
Ischemic (CVA) Stroke Labs
Iron (Fe) Lab Values
Ionized Calcium Lab Values
Iodine Nursing Considerations
Intubation in the OR
Introduction to Health Assessment
Intro to Health Assessment
Intrarenal Causes of Acute Kidney Injury Nursing Mnemonic (TONIC)
Intraoperative Positioning
Intraoperative Nursing Priorities
Intraoperative (Intraop) Complications
Intracranial Pressure ICP
Interventions for Aphasia Nursing Mnemonic (PROP)
Interdisciplinary Team Participation for Certified Perioperative Nurse (CNOR)
Interdisciplinary Team Member Functions for Certified Perioperative Nurse (CNOR)
Interdisciplinary Healthcare Team Collaboration for Certified Perioperative Nurse (CNOR)
Integumentary (Skin) Important Points
Integumentary (Skin) Module Intro
Integumentary (Skin) Course Introduction
Intake and Output (I&O)
Insulin Mnemonic (Ready, Set, Inject, Love)
Insulin – Short Acting (Regular) Nursing Considerations
Insulin – Rapid Acting (Novolog, Humalog) Nursing Considerations
Insulin – Mixtures (70/30)
Insulin – Long Acting (Lantus) Nursing Considerations
Insulin – Intermediate Acting (NPH) Nursing Considerations
Insulin
Inserting an NG (Nasogastric) Tube
Inserting a Foley (Urinary Catheter) – Male
Informed Consent
Influenza for Certified Emergency Nursing (CEN)
Inflammatory Bowel Disease Case Study (45 min)
Infectious Diseases: Influenza for Progressive Care Certified Nurse (PCCN)
Individualized Physical Assessments for Certified Perioperative Nurse (CNOR)
Increased Intraocular Pressure for Certified Emergency Nursing (CEN)
Impulse Transmission
Implant Verification and Availability for Certified Perioperative Nurse (CNOR)
Implant Records and Tracking for Certified Perioperative Nurse (CNOR)
Implant Preparation for Certified Perioperative Nurse (CNOR)
Impaired or Disruptive Behavior Reporting (Interdisciplinary Healthcare Team) for Certified Perioperative Nurse (CNOR)
Immunology Module Intro
Immunocompromise (HIV and AIDS, Oncology and Chemotherapy, Transplant Patient) for Certified Emergency Nursing (CEN)
Hypoxia – Signs and Symptoms Nursing Mnemonic (RAT BED)
Hypovolemic and Distributive Shock for Certified Emergency Nursing (CEN)
Hypotonic Solutions (IV solutions)
Hypothermia (Thermoregulation)
Hypoparathyroidism
Hyponatremia- Definition, Signs and Symptoms Nursing Mnemonic (SALT LOSS)
Hypokalemia – Signs and Symptoms Nursing Mnemonic (6 L’s)
Hypoglycemia symptoms Nursing Mnemonic (DIRE)
Hypoglycemia Management Nursing Mnemonic (Cool and Clammy – Give ‘Em Candy)
Hypoglycemia for Progressive Care Certified Nurse (PCCN)
Hypoglycemia – Signs and Symptoms Nursing Mnemonic (TIRED)
Hypoglycemia
Hypocalcemia – Definition, Signs and Symptoms Nursing Mnemonic (CATS)
Hypertonic Solutions (IV solutions)
Hyperthyroidism Case Study (75 min)
Hyperthermia (Thermoregulation)
Hypertensive Crisis Case Study (45 min)
Hypertension- Complications Nursing Mnemonic (The 4 C’s)
Hypertension (Uncontrolled) and Hypertensive Crisis for Progressive Care Certified Nurse (PCCN)
Hypertension (HTN) Concept Map
Hypertension – Nursing care Nursing Mnemonic (DIURETIC)
Hypernatremia – Signs and Symptoms 3 Nursing Mnemonic (SALT)
Hypernatremia – Signs and Symptoms 2 Nursing Mnemonic (SWINE)
Hypernatremia – Signs and Symptoms 2 Nursing Mnemonic (FRIED)
Hyperglycemia for Progressive Care Certified Nurse (PCCN)
Hyperglycaemic Hyperosmolar Non-ketotic syndrome (HHNS)
Hypercalcemia – Signs and Symptoms Nursing Mnemonic (GROANS, MOANS, BONES, STONES, OVERTONES)
Hygiene
Hydralazine
HMG-CoA Reductase Inhibitors (Statins)
Histamine 2 Receptor Blockers
Histamine 1 Receptor Blockers
High Pressure Vent Alarms Nursing Mnemonic (Kings Eat Big Cakes)
Hepatitis for Certified Emergency Nursing (CEN)
Hepatitis B Virus (HBV) Lab Values
Hepatic Disorders (Cirrhosis, Hepatitis, Portal Hypertension) for Progressive Care Certified Nurse (PCCN)
Heparin (Hep-Lock) Nursing Considerations
Hemorrhagic Stroke Risk Factors Nursing Mnemonic (HATS)
Hemorrhagic Fevers for Certified Emergency Nursing (CEN)
Hemorrhage Nursing Interventions for Certified Perioperative Nurse (CNOR)
Hemodialysis (Renal Dialysis)
Hematology/Oncology/Immunology Course Introduction
Hematology Module Intro
Hematologic Disorders for Certified Emergency Nursing (CEN)
Heart Failure-Left-Sided Nursing Mnemonic (CHOP)
Heart Failure-Origin Nursing Mnemonic (Left – Lung|Right – Rest)
Heat Temperature-related Emergencies for Certified Emergency Nursing (CEN)
Heart Failure for Certified Emergency Nursing (CEN)
Heart Failure Case Study (45 min)
Heart Failure 2 – Live Tutoring Archive
Heart Failure (Acute Exacerbations, Chronic) for Progressive Care Certified Nurse (PCCN)
Heart (Cardiac) Sound Locations and Auscultation
Heart (Cardiac) Failure Therapeutic Management
Heart (Cardiac) Failure Module Intro
Heart (Cardiac) and Great Vessels Assessment
Healthcare-Acquired Infections: Surgical Site Infections (SSI) for Progressive Care Certified Nurse (PCCN)
Hearing Loss
Healthcare-Acquired Infections: Catheter-Associated Bloodstream Infections (CAUTI) for Progressive Care Certified Nurse (PCCN)
Healthcare Team Member Supervision and Education for Certified Perioperative Nurse (CNOR)
Health Assessment Course Introduction
Head/Neck Assessment
Hb (Hepatitis) Vaccine
Hazardous Material Handling and Disposition (Chemo, Radioactive) for Certified Perioperative Nurse (CNOR)
Hand Hygiene Guideline Adherence for Certified Perioperative Nurse (CNOR)
Glucagon (GlucaGen) Nursing Considerations
Glipizide (Glucotrol) Nursing Considerations
Glaucoma
GI Infections (C. difficile) for Progressive Care Certified Nurse (PCCN)
GI Bleed (Upper, Lower) for Progressive Care Certified Nurse (PCCN)
GERD causes Nursing Mnemonic (Reflux Is Probably Mean)
GERD (Gastroesophageal Reflux Disease)
Genitourinary Infections for Certified Emergency Nursing (CEN)
Genitourinary Course Introduction
Genitourinary Trauma for Certified Emergency Nursing (CEN)
Genitourinary (GU) Assessment
General Assessment (Physical assessment)
General Anesthesia
Gastrointestinal (GI) Bleed Concept Map
Gastritis
Gabapentin (Neurontin) Nursing Considerations
Fundamentals Course Introduction
Functional Issues (Immobility, Falls, Gait Disorders) for Progressive Care Certified Nurse (PCCN)
Functional GI Disorders (Obstruction, Ileus, Diabetic Gastroparesis, Gastroesophageal Reflux, Irritable Bowel Syndrome) for Progressive Care Certified Nurse (PCCN)
Free T4 (Thyroxine) Lab Values
Fluid Volume Overload
Fibromyalgia
Fibrinogen Lab Values
Fibrin Degradation Products (FDP) Lab Values
Ferrous Sulfate (Iron) Nursing Considerations
Fentanyl (Duragesic) Nursing Considerations
Explant Preparation (Final Disposition) for Certified Perioperative Nurse (CNOR)
Ethical and Professional Standards for Certified Perioperative Nurse (CNOR)
Essential NCLEX Meds by Class
Esophageal Varices for Certified Emergency Nursing (CEN)
Erythromycin (Erythrocin) Nursing Considerations
Erythrocyte Sedimentation Rate (ESR) Lab Values
Equipment Utilization (Manufacturers Recommendations) for Certified Perioperative Nurse (CNOR)
Epoetin Alfa
Epoetin (Epogen) Nursing Considerations
Epinephrine (EpiPen) Nursing Considerations
Environmental Stewardship (Waste Minimization) for Certified Perioperative Nurse (CNOR)
Environmental Factor Control for Certified Perioperative Nurse (CNOR)
Environmental Cleaning (Spills, Room Turnover, Terminal Cleaning) for Certified Perioperative Nurse (CNOR)
Envenomation Emergencies for Certified Emergency Nursing (CEN)
Enteral & Parenteral Nutrition (Diet, TPN)
Enoxaparin (Lovenox) Nursing Considerations
Endoscopy & EGD
End-Stage Renal Disease (ESRD) for Progressive Care Certified Nurse (PCCN)
Encephalopathy (Hypoxic-ischemic, Metabolic, Infectious, Hepatic) for Progressive Care Certified Nurse (PCCN)
Encephalopathies
Enalapril (Vasotec) Nursing Considerations
Emergency Situation Identification for Certified Perioperative Nurse (CNOR)
EENT Medications
EENT Course Introduction
Echocardiogram (Cardiac Echo)
Dysrhythmias Labs
Dysrhythmias for Certified Emergency Nursing (CEN)
Drugs that Cause SJS Nursing Mnemonic (I C NASA)
Dopamine (Inotropin) Nursing Considerations
Dobutamine (Dobutrex) Nursing Considerations
DKA Treatment Nursing Mnemonic (KING UFC)
Diverticulitis for Certified Emergency Nursing (CEN)
Diverticulitis Complications Nursing Mnemonic (Please Fix His Abscess SOon)
Disseminated Intravascular Coagulation Case Study (60 min)
Disease Specific Medications
Discharge Planning for Certified Emergency Nursing (CEN)
Discharge (DC) Teaching After Surgery
Different Dressings
Diltiazem (Cardizem) Nursing Considerations
Dialysis & Other Renal Points
Diagnostic Criteria for Lupus Nursing Mnemonic (SOAP BRAIN MD)
Diabetic Ketoacidosis for Progressive Care Certified Nurse (PCCN)
Diabetic Ketoacidosis (DKA) Case Study (45 min)
Diabetes Mellitus Type 1- Signs & Symptoms Nursing Mnemonic (The 3 P’s)
Diabetes Mellitus for Progressive Care Certified Nurse (PCCN)
Diabetes Mellitus & Those Dang Blood Sugars! – Live Tutoring Archive
Diabetes Mellitus Case Study (45 min)
Diabetes Mellitus (DM) Module Intro
Diabetes Management
Diabetes Insipidus Nursing Mnemonic (DDD)
Diabetes Insipidus Case Study (60 min)
Dementia and Alzheimers
Delegation and Personnel Management for Certified Perioperative Nurse (CNOR)
Decrease ICP Nursing Mnemonic (Craniums Excite Me)
Day in the Life of a Med-surg Nurse
D-Dimer (DDI) Lab Values
Cyclosporine (Sandimmune) Nursing Considerations
Cyclic Citrullinated Peptide (CCP) Lab Values
Cushings Assessment Nursing Mnemonic (STRESSED)
Cushing’s Syndrome Case Study (60 min)
Cultures
CT & MR Angiography
Crohn’s Morphology and Symptoms Nursing Mnemonic (CHRISTMAS)
Critical Thinking to Facilitate Patient Care for Certified Perioperative Nurse (CNOR)
Creatinine Clearance Lab Values
Creatine Phosphokinase (CPK) Lab Values
Cranial Nerve Mnemonic 02 Nursing Mnemonic (Oh Oh Oh To Touch And Feel Very Good Velvet AH!)
Cortisone (Cortone) Nursing Considerations
Cortisol Lab Vales
Coronavirus (COVID-19) Nursing Care and General Information
Coronary Circulation
Coronary Artery Disease Concept Map
Coronary Arteries – Location Nursing Mnemonic (I have a RIGHT to CAMP if you LEFT off the AC)
Cor Pulmonale – Signs & Symptoms Nursing Mnemonic (Please Read His Text)
COPD management Nursing Mnemonic (COPD)
COPD Exacerbation for Progressive Care Certified Nurse (PCCN)
COPD Concept Map
COPD (Chronic Obstructive Pulmonary Disease) Labs
Congestive Heart Failure Concept Map
Confirming Patient Identity (Patient Identifiers) for Certified Perioperative Nurse (CNOR)
Confirmation of Correct Procedure (Operative Site, Side, Site Marking) for Certified Perioperative Nurse (CNOR)
Complications of Thoracentesis Nursing Mnemonic (Patients Sometimes Bleed Internally)
Complications of Immobility
Compartment Syndrome for Certified Emergency Nursing (CEN)
Communication of Patient Outcomes (Continuum of Care) for Certified Perioperative Nurse (CNOR)
Common Signs of Parkinson’s Nursing Mnemonic (SMART)
Comfort Provisions (Behavioral Response to Procedure) for Certified Perioperative Nurse (CNOR)
Colonoscopy
Cold Temperature-related Emergencies for Certified Emergency Nursing (CEN)
Coagulopathies, Medication-Induced (Coumadin, Platelet Inhibitors, Heparin, HIT) for Progressive Care Certified Nurse (PCCN)
Coagulation Studies (PT, PTT, INR)
Clopidogrel (Plavix) Nursing Considerations
Cirrhosis Complications Nursing Mnemonic (Please Bring Happy Energy)
Cirrhosis for Certified Emergency Nursing (CEN)
Cirrhosis Case Study (45 min)
Circulatory Checks (5 P’s) Nursing Mnemonic (The 5 P’s)
Chronic Obstructive Pulmonary Disease (COPD) for Certified Emergency Nursing (CEN)
Chronic Renal (Kidney) Module Intro
Chronic Kidney Disease (CKD) Case Study (45 min)
CHF Treatment Nursing Mnemonic (UNLOAD FAST)
Chest Tube Management Case Study (60 min)
Chest Tube Management
Chest Tube Management
Chest Tube Assessment Nursing Mnemonic (Two AA’s)
Cerebral Perfusion Pressure CPP
Cerebral Perfusion Pressure Case Study (60 min)
Cephalexin (Keflex) Nursing Considerations
Central Line Dressing Change
Celecoxib (Celebrex) Nursing Considerations
Causes of Dyspnea Nursing Mnemonic (The 6 P’s)
Causes of Pancreatitis Nursing Mnemonic (BAD HITS)
Causes of Anaphylaxis Nursing Mnemonic (Many Boys Love Food)
Cataracts
Cardiovascular Disorders (CVD) Module Intro
Cardiovascular Angiography
Cardiogenic Shock For PCCN for Progressive Care Certified Nurse (PCCN)
Cardiogenic Shock and Obstructive Shock for Certified Emergency Nursing (CEN)
Cardiac/Vascular Catheterization (Diagnostic, Interventional) for Progressive Care Certified Nurse (PCCN)
Cardiac Valves Blood Flow Nursing Mnemonic (Toilet Paper my Ass)
Cardiac Tamponade for Progressive Care Certified Nurse (PCCN)
Cardiac Surgery (Post-ICU Care) for Progressive Care Certified Nurse (PCCN)
Cardiac Stress Test
Cardiac Labs – What and When to Use Them 2 – Live Tutoring Archive
Cardiac Labs – What and When to Use Them – Live Tutoring Archive
Cardiac Course Introduction
Cardiac Arrest Nursing Interventions for Certified Perioperative Nurse (CNOR)
Cardiac Anatomy
Cardiac A&P Module Intro
Cardiac (Heart) Enzymes
Carbon Dioxide (Co2) Lab Values
Carbidopa-Levodopa (Sinemet) Nursing Considerations
Captopril (Capoten) Nursing Considerations
Canes Nursing Mnemonic (COAL)
Calcium Channel Blockers
Calcium Carbonate (Tums) Nursing Considerations
Calcium Acetate (PhosLo) Nursing Considerations
C. Difficile for Certified Emergency Nursing (CEN)
C-Reactive Protein (CRP) Lab Values
Burns for Certified Emergency Nursing (CEN)
Burn Injuries
Brain Natriuretic Peptide (BNP) Lab Values
Brain Death v. Comatose
BPH Symptoms Nursing Mnemonic (FUN WISE)
Bowel Perforation for Certified Emergency Nursing (CEN)
Bowel Obstruction Concept Map
Body Mechanics (Utilization) for Certified Perioperative Nurse (CNOR)
Blunt Chest Trauma
Blood Salvage Transfusion Anticipation for Certified Perioperative Nurse (CNOR)
Blood Flow Through The Heart
Bleeding Precautions Nursing Mnemonic (RANDI)
Bleeding for Certified Emergency Nursing (CEN)
Bleeding Complications (Minor) Nursing Mnemonic (BEEP)
Bismuth Subsalicylate (Pepto-Bismol) Nursing Considerations
Biopsy
Biohazard Material Handling and Disposition (Blood, Microbiology, Creutzfeldt-Jakob Disease) for Certified Perioperative Nurse (CNOR)
Beta Hydroxy (BHB) Lab Values
Benztropine (Cogentin) Nursing Considerations
Bed Bath
Barriers to Health Assessment
Barrier Material Selection (Procedure-Specific) for Certified Perioperative Nurse (CNOR)
Bariatric: IV Insertion
Bariatric Surgeries
Barbiturates
Bacterial Endocarditis – Symptoms Nursing Mnemonic (Be Joan Of Arc)
Azithromycin (Zithromax) Nursing Considerations
AV Blocks Dysrhythmias for Progressive Care Certified Nurse (PCCN)
Atrial Flutter
Atrial Fibrillation (A Fib)
Atrial Dysrhythmias for Progressive Care Certified Nurse (PCCN)
Atorvastatin (Lipitor) Nursing Considerations
Atenolol (Tenormin) Nursing Considerations
Asthma for Certified Emergency Nursing (CEN)
Asthma (Severe) for Progressive Care Certified Nurse (PCCN)
Assessment of Guillain-Barre Syndrome Nursing Mnemonic (GBS=PAID)
Assessment for Myasthenic Crisis Nursing Mnemonic (BRISH)
ASA (Aspirin) Nursing Considerations
Artificial Airways
ARDS causes Nursing Mnemonic (GUT PASS)
ARDS Case Study (60 min)
Aortic Stenosis Symptoms Nursing Mnemonic (SAD)
Aortic Aneurysm – Thoracic signs Nursing Mnemonic (PEE BADS)
Aortic Aneurysm – Management Nursing Mnemonic (CRAM)
Antinuclear Antibody Lab Values
Antineoplastics
Antimetabolites
Antidiabetic Agents
Anticonvulsants
Anti-Platelet Aggregate
Anti-Infective – Antitubercular
Anti-Infective – Tetracyclines
Anti-Infective – Sulfonamides
Anti-Infective – Glycopeptide
Anti-Infective – Carbapenems
Anti Tumor Antibiotics
Anion Gap Acidosis 1 Nursing Mnemonic (KULT)
Anion Gap Acidosis 2 Nursing Mnemonic (MUDPILES)
Anion Gap
Angiotensin Receptor Blockers
Aneurysm and Dissection for Certified Emergency Nursing (CEN)
Anesthetic Agents
Anesthetic Agents
Aneurysm (Dissecting, Repair) for Progressive Care Certified Nurse (PCCN)
Anesthesia Management Assistance for Certified Perioperative Nurse (CNOR)
Anemia for Progressive Care Certified Nurse (PCCN)
Amputation for Certified Emergency Nursing (CEN)
Anaphylaxis Nursing Interventions for Certified Perioperative Nurse (CNOR)
Amputation Concept Map
Amputation
Amlodipine (Norvasc) Nursing Considerations
Amitriptyline (Elavil) Nursing Considerations
Altered Mental Status Nursing Mnemonic (AEIOU TIPS)
Alteplase (tPA, Activase) Nursing Considerations
Altered Mental Status- Delirium and Dementia for Progressive Care Certified Nurse (PCCN)
Alkylating Agents
Alkaline Phosphatase (ALK PHOS) Lab Values
Alendronate (Fosamax) Nursing Considerations
Alanine Aminotransferase (ALT) Lab Values
Airway Suctioning
AIDS Case Study (45 min)
Age and Culturally Appropriate Health Assessment Techniques for Certified Perioperative Nurse (CNOR)
Advanced Directive and DNR Status Confirmation for Certified Perioperative Nurse (CNOR)
Advance Directives
Adrenal Gland Hormones Nursing Mnemonic (The 3 S’s)
Adrenal and Thyroid Disorder Emergencies for Certified Emergency Nursing (CEN)
Admissions, Discharges, and Transfers
Adjunct Neuro Assessments
Addisons Disease
Addisons Assessment Nursing Mnemonic (STEROID)
Acute Respiratory Distress Syndrome (ARDS) for Progressive Care Certified Nurse (PCCN)
Acute Renal (Kidney) Module Intro
Acute Kidney Injury Case Study (60 min)
Acute Inflammatory Disease (Myocarditis, Endocarditis, Pericarditis) for Progressive Care Certified Nurse (PCCN)
Acute Coronary Syndromes (MI-ST and Non ST, Unstable Angina) for Progressive Care Certified Nurse (PCCN)
Acute Abdomen for Certified Emergency Nursing (CEN)
ACE (angiotensin-converting enzyme) Inhibitors
Accountability and Assistance for Personal Limitations for Certified Perioperative Nurse (CNOR)
Absolute Reticulocyte Count (ARC) Lab Values
Absolute Neutrophil Count (ANC) Lab Values
3rd Degree AV Heart Block (Complete Heart Block)
2nd Degree AV Heart Block Type 2 (Mobitz II)
2nd Degree AV Heart Block Type 1 (Mobitz I, Wenckebach)
1st Degree AV Heart Block
10.04 Pulmonary Question Review for CCRN Review
07.10 Neurologic Review questions for CCRN Review
07.09 Meningitis for CCRN Review
06.05 Wide Complex Tachycardia for CCRN Review
06.04 Differentiating Ectopy and Aberrancy for CCRN Review
05.05 GI Practice Questions for CCRN Review
05.02 Liver Overview and Disease for CCRN Review
05.01 Pancreatitis and Large Bowel Obstruction for CCRN Review
03.04 DKA vs HHNK for CCRN Review
03.05 Endocrine Practice Questions for CCRN Review
03.03 Hypoglycemia for CCRN Review
03.02 Diabetes Insipidus for CCRN Review
03.01 Syndrome of Inappropriate Antidiuretic hormone (SIADH) for CCRN Review
02.18 Cardiovascular Practice Questions for CCRN Review
02.17 Septic Shock for CCRN Review
02.16 Cardiogenic Shock for CCRN Review
02.15 Hypovolemic Shock for CCRN Review
02.14 Shock Stages for CCRN Review
02.13 Myocardial Infarction – Anterior Septal Wall for CCRN Review
02.02 Cardiomyopathy for CCRN Review
02.06 Heart Murmurs for CCRN Review
02.08 Cardiac Catheterization & Acute Coronary Syndrome for CCRN Review
02.12 Myocardial Infarction- Inferior Wall for CCRN Review