ATI Med Surg Proctored Exam Study Guide

0) Test‑Taking Strategy for ATI (Fast Wins) ●​ ABCs + Safety first → Airway → Breathing → Circulation → Safety (falls, suicide, bleeding, sepsis). Unstable beats stable; new admission beats chronic stable. ●​ Maslow: Physiologic > Safety > Love/Belonging > Esteem > Self‑actualization. In med‑surg, physiologic almost always wins. ●​ Acute > Chronic; Unstable > Stable; Systemic > Local; No treatment > Post‑treatment. ●​ Delegation: ○​ RN only: assessment (initial), teaching, evaluation, judgment, unstable, IV push, blood, care plans. ○​ LPN: stable patients, routine meds, sterile skills (wound care, foley insertion), reinforce teaching. ○​ UAP/CNA: ADLs, hygiene, stable VS, I&O, transfers, specimen collection (non‑sterile), CPR. ●​ SATA: Treat each option as true/false; look for global correctness; avoid all‑or‑none thinking; include safety/priority items. ●​ If two answers say the same thing, both are likely wrong. Prefer the broader/more safety‑focused action. ●​ “Best initial action” ≠ “Definitive treatment.” (e.g., chest pain → apply O2 if hypoxic, get ECG, chew aspirin, not immediate thrombolytics.) ●​ Recheck what is actually being asked (first, most important, initial, priority, teaching success/failure) before selecting. 1) Safety & Infection Control Isolation Precautions (who needs what) ●​ Standard: all patients; hand hygiene. ●​ Contact: MRSA, VRE, C. difficile (soap & water), RSV (contact + droplet in many facilities), scabies. Gown + gloves, dedicated equipment. ●​ Droplet: influenza, meningitis (N. meningitidis), pertussis, mumps, rubella, diphtheria (pharyngeal). Surgical mask within 3–6 ft. ●​ Airborne: TB, measles (rubeola), varicella, disseminated zoster. N95/respirator, negative pressure room. ●​ Donning: Gown → Mask/Resp → Goggles/Face shield → Gloves. Doffing: Gloves → Goggles → Gown → Mask. ●​ Sterile field: keep above waist, 1‑inch border not sterile, do not reach over, open flap away first. Restraints ●​ Use last resort; try alternatives first. Need provider order & time‑limited; assess/document skin, pulses, toileting, fluids q2h; two‑finger fit; quick‑release knots. Fire Safety ●​ RACE: Rescue → Alarm → Contain → Extinguish. PASS: Pull → Aim → Squeeze → Sweep. Falls ●​ Bed low, brakes on, call light in reach, non‑skid footwear, frequent toileting, signage, side rails x2 only unless ordered. 2) Fluids, Electrolytes, and ABGs Key Normal Ranges (know cold) Test Normal Na⁺ 135–145 mEq/L K⁺ 3.5–5.0 mEq/L Cl⁻ 98–106 mEq/L HCO₃⁻ 22–26 mEq/L Ca²⁺ (total) 8.6–10.2 mg/dL Mg²⁺ 1.7–2.2 mg/dL Phos 2.5–4.5 mg/dL BUN 7–20 mg/dL Creatinine 0.6–1.3 mg/dL Glucose (fasting) 70–99 mg/dL WBC 4,000–11,000/µL Hgb 12–16 g/dL (F) ; 13.5–17.5 (M) Hct 36–46% (F) ; 41–53% (M) Platelets 150–400 K/µL INR 0.8–1.2 (therapeutic warfarin 2–3; valve 2.5–3.5) aPTT ~30–40 s (therapeutic 1.5–2.5×) Troponin I <0.04 ng/mL BNP <100 pg/mL ABGs pH 7.35–7.45; PaCO₂ 35–45; HCO₃⁻ 22–26; PaO₂ 80–100 Electrolyte Patterns & Priorities ●​ K⁺: low → dysrhythmias, muscle weakness; high → peaked T waves, widened QRS → telemetry + insulin/dextrose, calcium gluconate, kayexalate per order. ●​ Ca²⁺: low → tetany, Trousseau/Chvostek, laryngeal spasm; high → stones/bones/thrones/psych overtones. ●​ Mg²⁺: high (e.g., in preeclampsia Rx) → depressed DTRs, resp depression → antidote calcium gluconate. ●​ Na⁺: hypo → seizures, confusion; hyper → thirst, neuro changes. Correct slowly. ABG Interpretation (3‑step) 1.​ ●​ ●​ ●​ pH acid/alk; 2) CO₂ respiratory; 3) HCO₃ metabolic; then compensation. Resp acidosis: hypoventilation (COPD, opioid OD). Support ventilation. Resp alkalosis: hyperventilation (anxiety, pain). Calm breathing. Metabolic acidosis: DKA, diarrhea, renal failure, lactic acidosis. Treat cause, give bicarb if severe. ●​ Metabolic alkalosis: vomiting, NG suction, diuretics. Replace volume/Cl⁻. IV Therapy Complications ●​ Infiltration: cool, pallor, swelling → stop, elevate, warm compress. ●​ Extravasation (vesicant): pain, blistering → stop, antidote per policy, cold/warm per drug, notify provider. ●​ Phlebitis: warmth, red streak → stop, warm compress, new site. ●​ Air embolism: chest pain, dyspnea → Trendelenburg left side, O₂, notify. ●​ Fluid overload: crackles, edema, HTN → slow/stop, O₂, diuretics. Nutrition Support ●​ TPN: central line, filter, dedicated line, daily weights, glucose q6h, never stop abruptly (→ rebound hypoglycemia); if bag empty → hang D10 until new bag. ●​ Enteral: HOB ≥30–45°, verify placement, check residuals per policy, flush before/after meds, pause feeds for levothyroxine/phenytoin. 3) Hematology & Transfusion Blood Transfusion (packed RBCs) 1.​ 2.​ 3.​ 4.​ Verify order & consent; type/cross; IV 18–20G; NS only; baseline VS. Two‑RN verification at bedside (right patient/product/exp date). Start slowly; stay first 15 min; VS q15–30 min; must complete within 4 hours. Reaction? Stop blood, keep NS, save tubing, notify provider/bank, VS, urine sample. Reactions ●​ Acute hemolytic (ABO mismatch): fever, chills, low back pain, hypotension, hemoglobinuria → Stop immediately. ●​ Febrile non‑hemolytic: fever/chills; leukocyte antibodies → antipyretics. ●​ Allergic: urticaria/itching → antihistamine; anaphylaxis (wheezing, hypotension) → Epi IM, airway. ●​ TACO (overload): dyspnea, HTN, crackles → slow/stop, diuretics, O₂. ●​ TRALI: acute hypoxemia, non‑cardiogenic edema → stop, O₂, ventilatory support. Anticoag Targets ●​ Heparin: aPTT 1.5–2.5× control; protamine antidote. ●​ Warfarin: INR 2–3 (valve 2.5–3.5); Vitamin K antidote; consistent vitamin K diet. 4) Cardiovascular Chest Pain (Suspected ACS) ●​ Priority: Aspirin chew (if not contraindicated), O₂ if SpO₂ < 90–92%, Nitro (if SBP > 90, no PDE‑5 in 24–48 h), ECG, troponins, IV access. Morphine if pain persists. Heart Failure ●​ Left: pulmonary (crackles, orthopnea, pink frothy sputum). ●​ Right: systemic (JVD, edema, ascites, hepatomegaly). ●​ Tx: diuretics, ACE/ARB, beta‑blocker, fluid/Na⁺ restrict, daily weights (report >2 lb/day or >5 lb/week), elevate HOB. Hypertensive Crisis ●​ Severe HA, blurry vision, epistaxis; lower BP gradually with IV meds; neuro checks. Peripheral Vascular ●​ PAD: intermittent claudication, dependent rubor, cool, hair loss, weak pulses → dependent positioning (legs down), avoid heat/cold, no crossing legs. ●​ PVD: edema, warm, brown pigmentation, normal pulses → elevate legs. DVT/PE ●​ DVT: calf pain, swelling; no massage, early ambulation, anticoags. ●​ PE: sudden dyspnea, pleuritic pain, tachycardia, hemoptysis → O₂, HOB up, call provider, anticoag/thrombolysis per order. Post Cardiac Catheterization ●​ Flat (femoral) with leg straight, check site/retroperitoneal bleed (back pain, hypotension), pulses, color/temp, fluids to flush dye, hold metformin per policy. Basic Rhythm Pearls ●​ ●​ ●​ ●​ Afib RVR: diltiazem, beta‑blocker; anticoag. SVT: vagal, adenosine rapid IV push. VT with pulse: amiodarone; pulseless VT/VF: defibrillate + CPR. Symptomatic brady: atropine, pacing. 5) Respiratory Oxygen Devices ●​ NC 1–6 L (24–44%); Simple mask 6–10 L (35–60%); Non‑rebreather 10–15 L (up to ~95%); Venturi (precise FiO₂). COPD ●​ Chronic CO₂ retention; target SpO₂ 88–92%; pursed‑lip breathing, small frequent meals, high‑calorie, avoid high O₂. Asthma (Acute) ●​ SABA (albuterol) first, ipratropium, systemic steroids; watch for silent chest (ominous). Peak flow zones. Pneumonia ●​ Productive cough, fever, crackles; vaccinate, incentive spirometry, early ambulation, antibiotics. TB ●​ Airborne isolation; N95, negative pressure; meds: RIPE (Rifampin → orange fluids; Isoniazid → hepatotoxic, neuropathy give B6; Pyrazinamide; Ethambutol → optic neuritis). Adherence critical. ARDS ●​ Refractory hypoxemia; high PEEP, prone positioning. Chest Tubes ●​ Water seal: tidaling with breaths = normal; continuous bubbling = air leak. ●​ Suction chamber: gentle bubbling is OK. ●​ Diconnected: place end in sterile water to create seal; dislodged from chest: cover with occlusive 3‑sided dressing. Tracheostomy/Suctioning ●​ HOB ≥30°, sterile technique, preoxygenate, 10–15 sec passes, allow rest; keep obturator & spare trach at bedside. Ventilator Alarms ●​ High pressure: kink, secretions, biting, bronchospasm → check tubing, suction. ●​ Low pressure: disconnection, cuff leak → reconnect, check cuffs. 6) Neurologic Stroke (CVA) ●​ Ischemic vs Hemorrhagic. tPA window typically ≤4.5 h from onset (no active bleed/recent surgery). ●​ NPO until swallow eval; aspiration precautions; BP parameters per type. ●​ Prevention: Afib anticoag, manage HTN, DM, lipids. Increased ICP ●​ HA, vomiting, ↓LOC, pupil changes, Cushing triad (HTN, brady, irregular respirations). HOB 30°, neutral neck, avoid hip flexion, no suctioning/clustered care, stool softeners. Seizure Care ●​ Protect airway, side‑lying, loosen clothing, do not restrain or insert objects; time seizure; postictal safety. Status → benzodiazepines. Meningitis ●​ Droplet precautions; nuchal rigidity, photophobia; ↓stimuli; seizure precautions; antibiotics promptly. Spinal Cord Injury ●​ Autonomic dysreflexia (T6+): severe HTN, headache, flushing, bradycardia → Sit up, remove noxious stimuli (bladder, bowel), notify. 7) Endocrine Diabetes ●​ Hypoglycemia: sweating, tremor, confusion → 15 g rapid carbs → recheck in 15; if unconscious → glucagon IM. ●​ DKA (T1DM): hyperglycemia, ketones, Kussmaul, fruity breath; fluids first, insulin drip, replace K⁺. ●​ HHS (T2DM): very high glucose, no ketosis, neuro changes; aggressive fluids, insulin. ●​ Sick day: never stop insulin, monitor q4h, hydrate, check ketones. ●​ Insulin times (approx): Rapid lispro/aspart (onset 15 min, peak 1–3 h); Regular (30–60 min; peak 2–4 h); NPH (1–2 h; peak 6–14 h); Glargine (no peak). Thyroid ●​ Hyperthyroid/Graves: weight loss, heat intolerance, tachycardia; risk thyroid storm (fever, HTN, tachyarrhythmia) → beta‑blockers, PTU/methimazole, iodine, cooling. ●​ Post‑thyroidectomy: monitor airway, hemorrhage, hypocalcemia (tingling, tetany) → keep calcium gluconate. ●​ Hypothyroid: cold intolerance, weight gain, brady; myxedema coma → airway, IV levothyroxine, warming. Adrenal ●​ Addison: hypotension, hyperpigmentation, hyponatremia, hyperkalemia; crisis → IV hydrocortisone, fluids. Stress dose steroids. ●​ Cushing: hyperglycemia, truncal obesity, purple striae, osteoporosis, hypokalemia. SIADH vs DI ●​ SIADH: water retention, hyponatremia, low urine output; treat fluid restriction, hypertonic saline if severe, demeclocycline. ●​ DI: polyuria, polydipsia, hypernatremia; treat desmopressin, fluids. 8) GI & Hepatic/Pancreas Upper GI ●​ GERD: PPI/H₂ blockers, small meals, avoid late eating, elevate HOB, avoid caffeine, chocolate, alcohol, mint. ●​ PUD: epigastric pain; H. pylori → triple therapy; avoid NSAIDs; monitor for perforation (rigid board‑like abdomen, sudden severe pain). Hepatic ●​ Cirrhosis: ascites (measure girth), jaundice, spider angiomas, coagulopathy; encephalopathy (↑ammonia) → lactulose to 2–3 soft stools/day; bleeding varices (octreotide, banding). No acetaminophen excess, careful meds. ●​ Hepatitis: rest, nutrition, avoid alcohol; transmission education per type. Pancreatitis ●​ Severe LUQ pain to back, N/V; ↑amylase/lipase; NPO, NG suction, IV fluids, analgesia; no alcohol, low‑fat diet; watch hypocalcemia. Gallbladder (Cholecystitis) ●​ RUQ pain radiating to right shoulder, fever, Murphy sign; NPO, antibiotics, possible cholecystectomy; low‑fat diet. Lower GI ●​ Appendicitis: RLQ (McBurney), rebound tenderness; NPO, no heat, prepare surgery. ●​ Diverticulitis (acute): LLQ pain, fever; NPO, IV fluids/abx; avoid enemas/laxatives; once resolved → high‑fiber diet. ●​ IBD: ○​ Crohn: patchy, entire GI, fistulas, weight loss; ○​ UC: continuous colon, bloody diarrhea. ○​ Tx: steroids, 5‑ASA, immunosuppressants; low‑residue during flares. ●​ Bowel obstruction: high‑pitched then absent sounds, distention, vomiting; NPO, NG to LIS, fluids, correct electrolytes, surgery if strangulated. Tubes & Ostomies ●​ NG Salem sump: blue pigtail to air; verify placement, maintain LIS per order. ●​ Enteral meds: stop feeds, flush, meds separately, flush. ●​ Ostomy: stoma pink/moist; skin barrier; empty when 1/3–1/2 full; avoid gas‑forming foods initially. 9) Renal & Urinary ●​ AKI: pre‑renal (hypoperfusion), intra‑renal (ATN), post‑renal (obstruction). Manage cause, fluids vs diuretics, monitor K⁺. ●​ CKD: fluid overload, anemia (↓EPO), hyperphosphatemia, hypocalcemia; renal diet (low Na/K/Phos, fluid restrict), phosphate binders with meals. ●​ Dialysis: assess AV fistula thrill/bruit; no BP/IV/venipuncture on fistula arm; hold dialyzable meds before session as ordered. ●​ UTI: dysuria, urgency; in older adults → confusion; increase fluids, complete antibiotics (e.g., nitrofurantoin with food; may turn urine brown), wipe front‑to‑back. ●​ Nephrolithiasis: flank pain, hematuria; strain urine, hydrate, manage pain; lithotripsy teaching (bruising, hematuria expected). 10) Musculoskeletal & Ortho ●​ Fractures: immobilize, neurovascular checks (5 P’s); fat embolism (triad: hypoxemia, neuro changes, petechiae) → O₂, high‑flow, notify. ●​ Casts: handle with palms while drying, keep dry, no objects inside; report hot spots, foul odor. ●​ Traction: weights free‑hanging, alignment, pin care (sterile), skin checks. ●​ Compartment syndrome: severe unrelieved pain, pallor, paresthesia, pulselessness, paralysis → notify, keep limb at heart level (not elevated), remove constriction, prepare fasciotomy. ●​ Hip replacement: posterior approach → avoid hip flexion >90°, adduction (no crossing legs), internal rotation; use abductor pillow; DVT/PE prophylaxis. ●​ Osteoporosis: calcium/vit D, weight‑bearing exercise, bisphosphonates (alendronate: upright 30 min, empty stomach, full glass water). ●​ Gout: avoid purines (organ meats, sardines), hydrate; allopurinol for prevention (stop if rash), colchicine/NSAIDs for acute. 11) Integumentary & Burns Pressure Injury Staging ●​ I non‑blanchable erythema; II partial thickness; III full thickness adipose visible; IV muscle/bone visible; Unstageable eschar/slough; DTI purple/maroon intact skin. Burns ●​ Rule of nines (adult): Head 9%, each arm 9%, anterior trunk 18%, posterior trunk 18%, each leg 18%, perineum 1%. ●​ Parkland: 4 mL × kg × %TBSA (LR). Give ½ in first 8 h from time of injury, rest over 16 h. ●​ Priorities: Airway (inhalation injury), O₂, large‑bore IVs, fluid resuscitation, keep warm, tetanus, pain control. No ice. ●​ Electrical: risk arrhythmias/rhabdo → cardiac monitor, maintain urine output. 12) Immune, Sepsis & Hypersensitivity ●​ Sepsis: fever or hypothermia, tachycardia, tachypnea, hypotension, ↑lactate, altered mentation. Bundle: blood cultures → broad abx → 30 mL/kg crystalloid → vasopressors if needed; monitor MAP ≥65. ●​ Anaphylaxis: urticaria, wheeze, hypotension → Epinephrine IM 1:1000, airway/O₂, fluids, antihistamines, steroids. ●​ HIV/AIDS: standard precautions; opportunistic infections education, adherence. 13) Perioperative Care ●​ Pre‑op: informed consent (competent, voluntary; RN witnesses signature), NPO, allergies (latex/iodine/shellfish), remove prosthetics/jewelry, pre‑op checklist. ●​ Post‑op: airway, breath sounds, VS, surgical site, drains, urine output ≥30 mL/hr; prevent atelectasis (IS, ambulation), DVT (SCDs), paralytic ileus (early ambulation). ●​ Evisceration: cover with sterile saline‑moistened gauze, knees bent, call surgeon, NPO. 14) Pain, Palliative & Misc ●​ Pain scales: choose appropriate tool; reassess after intervention. ●​ Opioids: resp depression, sedation, constipation (give stool softeners), N/V, itching; naloxone PRN. ●​ PCA: patient only presses; educate family. 15) Diagnostic & Therapeutic Levels Test Notes Cardiac markers Troponin rises 3–4 h, peaks 10–24 h BNP Heart failure severity LFTs AST/ALT ↑ in hepatitis; bilirubin ↑ in obstruction Pancreas Amylase/lipase ↑ in pancreatitis UA leukocyte esterase/nitrites in UTI Digoxin 0.8–2.0 ng/mL; hold if HR <60; toxicity: N/V, vision halos; risk ↑ with hypokalemia Lithium 0.6–1.2 mEq/L; toxicity: GI upset → neuro; maintain fluids/Na⁺ 16) High‑Yield Medications (alerts & teaching) Cardiac ●​ ACE inhibitors (‑pril): cough, hyperkalemia, angioedema (emergency), avoid in pregnancy. ●​ ARBs (‑sartan): alternative to ACE cough. ●​ Beta‑blockers (‑lol): brady, bronchospasm (avoid non‑selective in asthma), mask hypoglycemia. ●​ CCBs (diltiazem, verapamil, amlodipine): edema, constipation (verapamil), brady. ●​ Nitrates: HA, hypotension; no PDE‑5. ●​ Diuretics: ○​ Loop (furosemide): hypokalemia, ototoxicity (high dose/rapid IV). ○​ Thiazide: hyponatremia, hypokalemia, hyperglycemia. ○​ K‑sparing (spironolactone): hyperkalemia, gynecomastia. ●​ Antiplatelets: aspirin, clopidogrel—bleeding precautions. Respiratory ●​ Albuterol: tremor, tachycardia. ●​ Ipratropium: dry mouth. ●​ Inhaled steroids: rinse mouth (oral candidiasis). Endocrine ●​ Levothyroxine: take morning, empty stomach, lifelong; ↑HR warning. ●​ Steroids: hyperglycemia, infection risk, GI ulcer; taper. ●​ Antithyroid (methimazole/PTU): agranulocytosis (report fever/sore throat), hepatotoxicity. GI ●​ ●​ ●​ ●​ PPIs (omeprazole): ↑fracture risk long term; C. diff risk. H₂ blockers (famotidine). Lactulose: lowers ammonia; titrate to 2–3 soft stools/day. Pancrelipase: take with meals. Neuro/Pain ●​ Opioids: see above; naloxone available. ●​ Antiepileptics (phenytoin): gingival hyperplasia, narrow index. Anti‑infectives ●​ ●​ ●​ ●​ ●​ ●​ Vancomycin: trough levels, Red Man if infused fast; nephro/ototoxic. Aminoglycosides (gentamicin): oto/nephrotoxic; trough. Tetracyclines: no dairy/antacids/iron; photosensitivity; not for kids/pregnancy. Fluoroquinolones: tendon rupture risk; avoid with antacids. Sulfonamides: allergy (sulfa), photosensitivity, crystalluria—hydrate. Nitrofurantoin: take with food, may brown urine; avoid in severe renal impairment; report pulmonary symptoms. ●​ TB drugs: see Respiratory. Antidotes & Emergencies ●​ Opioids → naloxone; Benzo → flumazenil (use cautiously); Warfarin → vitamin K; Heparin → protamine; Acetaminophen → N‑acetylcysteine; HyperK⁺ → calcium gluconate, insulin/dextrose, albuterol, diuretics, resins; Mg toxicity → calcium gluconate. 17) Geriatric Considerations ●​ Delirium: acute, fluctuating, reversible; r/o infection, drugs, electrolytes. ●​ Dementia: chronic, progressive. ●​ Falls: vision, orthostasis, polypharmacy; simplify regimens, assistive devices. 18) Prioritization & Delegation (Applied) ●​ RN: new onset chest pain, new neuro deficits, post‑op day 0 unstable, fresh trach, titrating drips, teaching new diagnoses. ●​ LPN: stable COPD with routine nebs, stable post‑op day 2 wound care, reinforce teaching. ●​ UAP: chronic stable requiring bathing, feeding (no dysphagia), I&O, ambulation with safety. 19) Rapid Reference Sheets Isolation Quick List ●​ Contact: C. diff, MRSA/VRE, RSV. ●​ Droplet: Flu, meningitis, mumps, rubella, pertussis. ●​ Airborne: TB, measles, varicella/disseminated zoster. Insulin Timing (approx) ●​ ●​ ●​ ●​ Rapid (lispro/aspart): onset 15 min, peak 1–3 h, duration 3–5 h. Regular: onset 30–60 min, peak 2–4 h, duration 5–8 h. NPH: onset 1–2 h, peak 6–14 h, duration 16–24 h. Glargine/detemir: no peak, 24 h. Chest Tube Troubleshooting ●​ Continuous bubbling water seal = air leak → check connections/dressing. ●​ No tidaling = lung re‑expanded or obstruction. ●​ If system tips: set upright; if breaks: place tube in sterile water. Trach Emergency ●​ If decannulates <7 days: call for help, insert obturator, attempt to replace same size or smaller; if not, maintain airway with bag‑valve‑mask over stoma/mouth per policy. Anticoag Parameters ●​ Heparin aPTT goal 1.5–2.5×; Warfarin INR 2–3 (valve 2.5–3.5). ABG Cheats ●​ pH↓ + CO₂↑ = resp acidosis; pH↓ + HCO₃↓ = met acidosis; pH↑ + CO₂↓ = resp alkalosis; pH↑ + HCO₃↑ = met alkalosis. 20) Exam‑Eve Cram Plan (6–8 hours total) 1) First pass (2–3 h): Skim sections 1–9; speak out loud why each priority matters. 2) Drill tables (1 h): Labs, ABGs, insulin, isolation, antidotes. 3) Procedures (1 h): Transfusion steps, chest tube, trach suction, NG/enteral, evisceration response. 4) High‑risk meds (1 h): Anticoags, insulin, steroids, thyroid, antibiotics red‑flags. 5) Practice 25–50 mixed items (45–60 min): Use ABCs/unstable first logic, mark misses, revisit weak topics. 6) Wind‑down (30 min): Eat, hydrate, pack ID/snacks, light review of mnemonics. Sleep 7–8 h if possible. Test‑day: Arrive early; manage time (flag & move); read stem twice; pick safe answer; trust first instinct if evidence‑based. ✅ Final Self‑Check (say them out loud) ●​ ●​ ●​ ●​ ●​ ●​ ●​ ●​ ●​ ●​ Parkland formula & timing? 4 mL × kg × %TBSA; ½ in first 8 h. Chest tube: continuous bubbling where = air leak (water seal). DKA vs HHS differences & first therapy? Fluids first. Addison vs Cushing key labs? (Na/K/Glu) SIADH vs DI water/Na patterns? PAD vs PVD positioning? tPA window & swallow eval NPO. Transfusion first action with reaction? Stop blood, keep NS. COPD O₂ goal? 88–92%. Compartment syndrome position? At heart level, notify. You’ve got this. Breathe, prioritize safety, and let the frameworks do the heavy lifting. 💪🩺