Priority Nursing Assessment Ergonomics: Keep the client close to
your body and use your legs, not your
frameworks
back, to lift. [1]
ABC Framework: Always prioritize
Airway, Breathing, and Circulation
issues first.
Maslow’s Hierarchy: Address
physiological needs (pain, fluid volume) 🧪 Vital Signs & Lab Values
before safety or psychological needs. Sodium (Na+): 135 to 145 mEq/L
Safety First: Identify immediate injury (critical for fluid balance and
risks like fall hazards or incorrect neurological function).
isolation precautions. Potassium (K+): 3.5 to 5.0 mEq/L
(critical for cardiac rhythm stability).
WBC Count: 5,000 to 10,000/mm³
(elevated levels indicate acute
🧼 Infection Control & Isolation Precautions infection).
Hypotension: Lower the head of the
Standard Precautions: Use hand bed to promote venous return to vital
hygiene and gloves for all bodily fluids. organs.
Airborne Precautions: Private
negative-pressure room, N95 respirator
(Measles, Varicella, Tuberculosis).
Droplet Precautions: Surgical mask
within 3 feet of client (Influenza, Contents
Pertussis, Meningitis).
No table of contents entries found.
Contact Precautions: Gown and
gloves, dedicated equipment (C. diff, 🧪 Next Generation NCLEX
MRSA, VRE).
Surgical Asepsis: Keep sterile objects (NGN) Strategy
above waist level and within a 1-inch Recognize Cues: Identify abnormal
sterile border. [1] assessment findings, such as changing
vital signs or lab trends.
Analyze Cues: Link findings to potential
complications like hemorrhage, sepsis,
or fluid overload.
💊 Medication Administration Prioritize Hypotheses: Determine
& Patient Safety which client issue is the most urgent
threat to life.
Six Rights: Right client, right Take Action: Select the most
medication, right dose, right route, right appropriate nursing intervention,
time, right documentation. prioritizing non-invasive actions first.
Client Identification: Always verify
identity using two unique identifiers (full
name, date of birth).
Adverse Effects: Stop infusions
immediately if a client shows signs of an
allergic reaction.
Medication Reconciliation: Compare
home medication lists with new provider
orders during admission and discharge.
[1, 2]
🛏️ Mobility & Skin Integrity
Pressure Injury Prevention: Turn
immobile clients every 2 hours and keep
head of bed below 30 degrees.
Friction Reduction: Use a draw sheet
or friction-reducing device when
repositioning clients in bed.
your body and use your legs, not your
frameworks
back, to lift. [1]
ABC Framework: Always prioritize
Airway, Breathing, and Circulation
issues first.
Maslow’s Hierarchy: Address
physiological needs (pain, fluid volume) 🧪 Vital Signs & Lab Values
before safety or psychological needs. Sodium (Na+): 135 to 145 mEq/L
Safety First: Identify immediate injury (critical for fluid balance and
risks like fall hazards or incorrect neurological function).
isolation precautions. Potassium (K+): 3.5 to 5.0 mEq/L
(critical for cardiac rhythm stability).
WBC Count: 5,000 to 10,000/mm³
(elevated levels indicate acute
🧼 Infection Control & Isolation Precautions infection).
Hypotension: Lower the head of the
Standard Precautions: Use hand bed to promote venous return to vital
hygiene and gloves for all bodily fluids. organs.
Airborne Precautions: Private
negative-pressure room, N95 respirator
(Measles, Varicella, Tuberculosis).
Droplet Precautions: Surgical mask
within 3 feet of client (Influenza, Contents
Pertussis, Meningitis).
No table of contents entries found.
Contact Precautions: Gown and
gloves, dedicated equipment (C. diff, 🧪 Next Generation NCLEX
MRSA, VRE).
Surgical Asepsis: Keep sterile objects (NGN) Strategy
above waist level and within a 1-inch Recognize Cues: Identify abnormal
sterile border. [1] assessment findings, such as changing
vital signs or lab trends.
Analyze Cues: Link findings to potential
complications like hemorrhage, sepsis,
or fluid overload.
💊 Medication Administration Prioritize Hypotheses: Determine
& Patient Safety which client issue is the most urgent
threat to life.
Six Rights: Right client, right Take Action: Select the most
medication, right dose, right route, right appropriate nursing intervention,
time, right documentation. prioritizing non-invasive actions first.
Client Identification: Always verify
identity using two unique identifiers (full
name, date of birth).
Adverse Effects: Stop infusions
immediately if a client shows signs of an
allergic reaction.
Medication Reconciliation: Compare
home medication lists with new provider
orders during admission and discharge.
[1, 2]
🛏️ Mobility & Skin Integrity
Pressure Injury Prevention: Turn
immobile clients every 2 hours and keep
head of bed below 30 degrees.
Friction Reduction: Use a draw sheet
or friction-reducing device when
repositioning clients in bed.
