Nursing Bundle

THE COMPLETE




Nu r s i n g
Sch oo l
BUNDLE

BROUGHT TO YOU BY Nurse
in the making

, TABLE OF CONTENTS
Head To Toe Assessment...................................................................4
Dosage Calculation.........................................................................6
Lab Value Cheat Sheet...................................................................18
Lab Value Memory Tricks................................................................19
Blood Types................................................................................20
Fundamentals..............................................................................21
Pharmacology: Suffixes, Prefixes, & Antidotes...................................... 41
Mental Health Disorders............................................................... 49
Mental Health Pharmacology.......................................................... 59
Mother Baby.............................................................................. 65
Pediatric Milestones..................................................................... 82
Med-Surg
Renal / Urinary System.......................................................... 87
Cardiac System.....................................................................97
Endocrine System................................................................ 118
Respiratory Disorders........................................................... 128
Hematology Disorders........................................................... 133
Gastrointestinal Disorders..................................................... 136
Neurological Disorders..........................................................140
Burns............................................................................... 145
ABG’s............................................................................... 149
Templates & Planners.................................................................. 153
Note from Kristine..................................................................... 172

, HEAD-TO-TOE ASSESSMENT
Introduction Orientation "Normal" Vital Signs
INSPECT • Knock • What is your name?
PULSE: 60-100 bpm
• Introduce yourself • Do you know where you are?
PALPATE • Wash hands
BLOOD PRESSURE:120/80 mmHg
• Do you know what month it is?
PERCUSS • Provide privacy • Who is the current U.S. president? O2 SATURATION: 95-100%
• Verify patient ID and DOB • What are you doing here? TEMPERATURE: 97.8-99.1° F
AUSCULTATE • Explain what you are doing • A&O X4 = Oriented to Person, RESPIRATIONS: 12-20 breaths per min
(using non-medical language) Place, Time, and Situation


Head & Face Neck, Chest (Lungs) & Heart
HEAD NECK
• Inspect head/scalp/hair • Inspect and palpate
• Palpate head/scalp/hair • Palpate carotid pulse
• Check skin turgor (under clavicle)
FACE
• Inspect POSTERIOR CHEST
• Check for symmetry • Inspect
• To assess Cranial Nerve 7, check the following: • Auscultate lung sounds in posterior and lateral chest
– Raise eyebrows – Note any crackles or diminished breath sounds
– Smile
– Frown ANTERIOR CHEST
– Show teeth • Inspect:
– Puff out cheeks – Use of accessory muscles
– Tightly close eyes
– AP to transverse diameter
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• Inspects external eye structures • Palpate: symmetric expansion
• Inspect color of conjunctiva and sclera • Auscultate lung sounds – anterior
and lateral
• PERRLA – Note any crackles or diminished breath sounds
– Pupils Equal, Round, Reactive to Light,
& Accommodation HEART
• Auscultate heart sounds (A, P, E, T, M)
with diaphragm and bell
– Note any murmurs, whooshing, bruits,
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, Peripherals Spine
PERIPHERALS ELBOWS • Have the patient stand up (if able)
Upper extremities • Inspect, palpate, and assess • Inspect the skin on the back
• Inspect and palpate. • Inspect: spinal curvature
• Note any texture, lesions, temperature,
HANDS AND FINGERS (cervical/thoracic/lumbar)
moisture, tenderness, & swelling Ř ,QVSHFWKDQGVŵQJHUVQDLOV • Palpate spine
• Palpate radial pulses bilaterally Ř 3DOSDWHKDQGVDQGŵQJHUMRLQWV • Note any lesions, lumps,
(+1, +2, +3, +4) • Check muscle strength of hands bilaterally or abnormalities
– Does each hand grip evenly?
SHOULDER
+1 = Diminished +3 =Full
• Inspect, palpate, and assess +2 =”Normal” +4 =Bounding, strong


Lower Extremities (hips, knees, ankles) Abdomen
LOWER EXTREMITIES • Inspect:
– Skin color
• Inspect:
– Contour
– Overall skin coloration
– Lesions – Scars
– Hair distribution – Aortic pulsations
– Varicosities • Auscultate bowel sounds:
– Edema all 4 quadrants (start in RLQ and go clockwise)
• Palpate: Check for edema (pitting or non-pitting) • Light palpation: all 4 quadrants
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ABSENT: Must listen for at least 5 minutes to chart
absent bowel sounds
HIPS
• Inspect and palpate HYPOACTIVE: One bowel sound every 3-5 minutes

NORMOACTIVE: Gurgles 5-30 time per minute
KNEES
HYPERACTIVE: Can sometimes be heard without a
• Inspect and palpate
stethoscope constant bowFl sounds,
> 30 sounds per minute
ANKLES
• Inspect and palpate
• Post tibial pulse (+1, +2, +3, +4) OVERALL
• Dorsal pedis pulse bilaterally (+1, +2, +3, +4) • Positions and drapes patient appropriately
during exam (gave patient privacy)
– Check strength bilaterally
• Gave patient feedback/instructions
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• Exhibits professional manner during exam,
treated patient with respect and dignity
• Organized: exam followed a logical sequence
(order of exam “made sense”)