Table of Contents:

1. Stevens-Johnson 3. Cellulitis
Syndrome (SJS) 4. Skin Cancer
2. Shingles (Herpes Zoster) 5. Frostbite

Acute & Concerning Skin Conditions

1. Stevens-Johnson Syndrome (SJS)

y Interventions
FIGURE 1. STEVENS-JOHNSON SYNDROME

Priority = discontinue the trigger medication.
y Administer IV fluids for dehydration.

Manage wounds similarly to burns to prevent
infection (sterile care) and promote healing
(moist dressings) (see BURNS CHEAT SHEET).
y Monitor for respiratory complications if oral
mucosa is affected.
y Administer analgesics.

2. Shingles (Herpes Zoster)

FIGURE 2. SHINGLES

Stevens-Johnson syndrome: A life-threatening skin

reaction to medications  Widespread destruction and
detachment of <30% of skin and mucous membranes
(classified as toxic epidermal necrolysis [TEN] if ≥30% of

Integumentary
body is affected)
y Common causative medications include (3 A’s):
y Antibiotics (sulfa drugs like sulfamethoxazole-
trimethoprim)
y Anticonvulsants (lamotrigine)
y Allopurinol Shingles: Reactivation of latent varicella-zoster virus
y Findings (chickenpox)  Painful, vesicular rash in a linear
y Flu-like symptoms (early) pattern along a dermatome (FIGURE 2).
y Rash: Widespread erythema  Painful blistering y Findings
and peeling (FIGURE 1) y Pain, burning, and itching
y Painful lesions in the eyes and mouth y Rash: Unilateral vesicles on erythematous
base  Crusting

 Stevens-Johnson Syndrome (SJS): The priority for managing SJS is to discontinue the trigger
medication immediately. Apply moist dressings to promote healing and administer IV fluids to
prevent dehydration.

© Bootcamp.com 4
2. Shingles (Herpes Zoster), Continued 4. Skin Cancer
y Interventions

Initiate contact and airborne isolation FIGURE 4. SKIN LESIONS
precautions until lesions crust.
y Administer analgesics (NSAIDs, acetaminophen) or
nerve pain medications (gabapentin).

Administer antiviral medications (acyclovir,
valacyclovir) toseverity and pain.
y Skin care
y Keep lesions clean and dry.
y Avoid scratching to prevent infection.
y Apply calamine lotion.

Recommend zoster vaccine for individuals
≥50 years to prevent recurrence.

3. Cellulitis
Cellulitis: Acute bacterial
infection of skin and FIGURE 3. CELLULITIS
subcutaneous tissue
(commonly by Strep or Skin cancer: Skin malignancy caused primarily by sun
Staph, including MRSA) exposure (FIGURE 4)
(FIGURE 3). y Basal cell carcinoma (BCC): Lesion with pearly, rolled
y Findings borders and a central crater; slow-growing
y Erythema, warmth, y Squamous cell carcinoma (SCC): Firm, red lesion with
swelling, pain at a central crust
the site
Melanoma: Irregular, multicolored, highly metastatic
y Fever, chills y Actinic keratoses: Premalignant lesions with
y Interventions irregularly shaped, rough, scaly patches
y Administer oral or IV y Risk factors
antibiotics (cefazolin,
UV exposure: Sun, tanning beds, outdoor

Integumentary
amoxicillin). occupation

Elevate the affected y Fair skin or hair (blonde, red)
limb toswelling
ABCDEs of melanomas (FIGURE 5):
and improve y A: Asymmetry
circulation. y B: Border irregularity (ragged edges)

Apply warm, moist compresses to promote y C: Color variation (blue, red, white)
drainage andpain. y D: Diameter >6 mm (¼ in) (size of pencil eraser)
y Keep site clean. y E: Evolving appearance

Mark borders of redness using a marker to
monitor for spread.
y Monitor for complications like sepsis.

 Shingles: For clients with shingles, initiate contact  Skin cancer: Teach clients to limit UV exposure
and airborne precautions until lesions crust. (apply sunscreen, wear protective clothing, avoid
Recommend zoster vaccine for individuals ≥50 tanning beds) and perform regular skin checks.
years to prevent recurrence. Assess lesions with the ABCDE mnemonic
(Asymmetry, Border irregularity, Color variation,
 Cellulitis: For clients with cellulitis, elevate the
Diameter >6 mm [¼ in], Evolving appearance).
limb to reduce swelling and apply warm, moist
compresses to promote drainage and reduce pain.
Mark borders to monitor spread.

© Bootcamp.com 2
4. Skin Cancer, Continued 5. Frostbite
y Interventions
y Teach client to prevent and monitor. FIGURE 6. FROSTBITE

Avoid midday sun exposure (from
10 a.m.-2 p.m.).

Avoid tanning beds.

Wear protective clothing (hats, sunglasses).

Apply sunscreen to unprotected areas
and reapply frequently (every 2 hr, after
sweating or swimming).

Perform monthly skin checks and report any
“ABCDE” findings.
y Assist with biopsy of any suspicious lesions (e.g.,
new or changing moles).
y Assist with removal.
y Cryotherapy: Freezing lesions to destroy
abnormal cells.
y Surgical excision, such as Mohs surgery,
where skin is removed in microscopic layers.
y Chemotherapy, radiation
y Topical treatments, like fluorouracil or
imiquimod creams, treat actinic keratoses. Frostbite: Freezing of skin and underlying tissues from
prolonged cold exposure  Tissue damage (FIGURE 6)
FIGURE 5. ABCD OF MELANOMA y Findings
y Cold, pale skin
y Tingling, numbness
y Blisters and blackened tissue (necrosis)
when severe
y Interventions
y Remove clothing and jewelry that can constrict

Integumentary
the extremity.
y Rewarm client and assess for hypothermia.

Thaw the frozen part using a warm water bath.

Do not attempt to rewarm the affected area
using massage or dry heat, which can further
damage tissues.
y Administer analgesics (rewarming is painful).
y Elevate the extremity after thawing to
reduce edema.

Avoid friction and weight (rubbing, heavy
blankets) to prevent further tissue damage.
y Administer tetanus vaccine for prophylaxis for
tetanus-prone wounds.
y Monitor for complications (gangrene, infection,
compartment syndrome).

 Frostbite: Clients with frostbite should rewarm the affected area using a warm water bath.
Avoid massage, which can cause further tissue damage.

© Bootcamp.com 3
  The priority in managing SJS is to _____ the  For clients with cellulitis, _____ the limb to
trigger medication immediately. Apply _____ reduce swelling and apply _____ compresses
dressings to promote healing and administer to promote drainage. Monitor the spread of
_____ to prevent dehydration. infection by _____.

 To manage shingles, initiate _____ and ______  What are three ways to limit UV exposure?
precautions until lesions crust. Recommend the What is the ABCDE mnemonic for lesion
zoster vaccine for clients ≥ ____ years to prevent assessment?
recurrence.
 Clients with frostbite should rewarm the
affected area using _____ (massage or a warm
water bath?).

clothing, no tanning beds; ABCDE: Asymmetry, Border irregularity, Color variation, Diameter >6mm (¼ in), Evolving appearance. 5. warm water bath
Answers: 1. discontinue; moist, IV fluids 2. airborne and contact precautions; 50 3. elevate, warm; marking the borders 4. Use sunscreen, wear protective

Integumentary
References:

American Academy of Dermatology. (n.d.). How to apply sunscreen. Tyerman, J., Cobbett, S., Harding, M. M., Kwong, J., Roberts, D.,
American Academy of Dermatology Association. Retrieved Hagler, D., Reinisch, C. (Eds.). (2023). Lewis’s medical-
February 2, 2025, from https://www.aad.org/public/ surgical nursing in Canada: Assessment and management
everyday-care/sun-protection/shade-clothing-sunscreen/ of clinical problems (5th ed.).
how-to-apply-sunscreen.

Berman, A. B., Snyder, S. J., & Frandsen, G. (2021). Kozier & Erb’s Attributions:
fundamentals of nursing: Concepts, process, and practice
y ABCD of Melanoma: Modified from: https://picryl.com/media/
(11th ed.). Pearson. melanoma-red-and-brown-lesion-2-d650a6, https://picryl.com/media/
Callahan, B., Hand, M., & Steele, N. (Eds.). (2023). Nursing: A melanoma-with-diameter-change-794617, https://timelessmoon.
getarchive.net/amp/media/asymmetrical-melanoma-601464, and
concept-based approach to learning (4th ed., Vol 1).
https://picryl.com/media/melanoma-with-color-differences-b4bfc5
Ignatavicius, D., Heimgartner, N., & Rebar, C. (Eds.). (2024).
y Cellulitis: Pshawnoah, CC BY-SA 3.0, via Wikimedia Commons
Medical-surgical nursing: Concepts for clinical judgment
and collaborative care (11th ed.). Elsevier. y Shingles: Fisle, CC BY-SA 3.0, via Wikimedia Commons

Jarvis, C., & Eckhardt, A. (Eds.). (2020). Physical examination & y SJS: Jay2Base, CC BY-SA 4.0, via Wikimedia Commons and
health assessment (8th ed.). Elsevier. Jay2Base, CC BY-SA 4.0, via Wikimedia Commons

McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2019). y Skin Lesions: Modified from Future FamDoc, CC BY-SA 4.0 via
Pathophysiology: The biologic basis for disease in adults Wikimedia Commons and BruceBlaus, CC BY-SA 4.0, Public domain,
and children (8th ed.). Elsevier. via Wikimedia Commons
© Bootcamp.com 4
 Table of Contents:
1. Acute Kidney Injury 3. Renal Replacement Therapies
2. Chronic Kidney Disease

Acute Kidney Injury & Chronic Kidney Disease

1. Acute Kidney Injury
Acute kidney injury (AKI) is an
FIGURE 1. AKI CAUSES
abrupt loss of kidney function.
y Typically reversible if treated
before permanent damage occurs
AKI causes:
y Categorized as prerenal,
intrarenal, or postrenal, and the
cause determines the treatment
(FIGURE 1)
y Prerenal:intravascular

Renal/Urinary
circulation (dehydration,
shock) renal perfusion
y Intrarenal: Direct damage
to the kidneys (acute tubular
necrosis from nephrotoxins
like IV contrast or antibiotics)
y Postrenal: Urinary obstruction
 Urine backs up into the
kidneys  Renal damage
AKI typically progresses in phases:
Initial  Oliguric  Diuretic  Recovery
Assessment findings

BUN and creatinine
y Urine output varies by phase
(TABLE 1).
y Oliguric phase: Fluid and
electrolyte retention
y Diuretic phase: Fluid and
electrolyte wasting
TABLE 1. AKI KEY FINDINGS

Metabolic acidosis
AKI care focuses on: Oliguric Diuretic
1. Maintaining electrolyte and
fluid balance y urine output y urine output
2. Preventing infection (<400 mL/day) (3–6 L/day)
3. Promoting healing and preventing permanent y Signs of fluid overload y Signs of dehydration
renal damage (edema, crackles) (dry mucous membranes)
y Hyperkalemia y Hypokalemia

© Bootcamp.com 6
1. Acute Kidney Injury, Continued
1. Maintain electrolyte and fluid balance:
� TABLE 2. HYPERKALEMIA MEDICATIONS AT A GLANCE
yMonitor BUN and creatinine levels to assess
renal function. Medication Considerations
y Monitor potassium and sodium levels to identify
imbalances.
Polystyrene sulfonate
Do not administer to
y Closely monitor urine output.
(Kayexalate) clients withbowel
y Measure daily weights at the same time on the
function (constipation,
same scale each day. Binds to potassium in the
bowel sounds) due

Place client on cardiac monitor to assess for GI tract and facilitates
to the risk of intestinal
dysrhythmias from potassium imbalances (FIGURE 2). excretion through stool
necrosis.
y Peaked T waves indicate hyperkalemia.
y Closely monitor
y Flat or inverted T waves indicate
electrolyte levels.
hypokalemia.
y Administer medications to treat hyperkalemia
Loop diuretics y Can cause
(see TABLE 2).
(e.g., furosemide) hypokalemia: Monitor
potassium levels.
Excrete excess fluid and
FIGURE 2. ECG EFFECTS OF POTASSIUM IMBALANCES
Ototoxicity:
potassium through urine
Administer IV

Renal/Urinary
furosemide slowly
over 1-2 min.

IV calcium gluconate
Give IV very slowly to

prevent dysrhythmias.
Reduces the risk of
dysrhythmias caused by
hyperkalemia

IV 50% dextrose and y Dextrose is given

insulin concurrently to
prevent hypoglycemia.
Insulin shifts potassium
back into cells.

Dialysis may be needed to correct persistent

hyperkalemia.

� Hyperkalemia: Monitor clients with AKI and CKD for ECG changes caused by potassium imbalances.
Peaked T waves indicate hyperkalemia. Treatment for hyperkalemia includes polystyrene sulfonate
(Kayexalate), IV insulin with dextrose, or dialysis.

© Bootcamp.com 2
1. Acute Kidney Injury, Continued Assessment findings
2. Prevent infection: Damaged nephrons filtration  Waste buildup 
Infection prevention is a high priority for clients with Systemic effects (TABLE 3)
AKI due to immune suppression.
y Use strict aseptic technique when providing care. TABLE 3. CKD ASSESSMENT FINDINGS
y Provide frequent skin and oral care.

Monitor closely for signs of infection (low-grade Pathophysiology Assessment Findings
fever, tachycardia).

Clients with AKI may not experience high urine output y Oliguria  Anuria
fever with infection. y Fluid overload (edema)
3. Promote healing and prevent permanent
renal damage: excretion of y Hyperkalemia

Avoid administration of nephrotoxic medications electrolytes and y Hypernatremia
(IV contrast, vancomycin). hydrogen y Hyperphosphatemia

protein intake tothe workload of the kidneys y Hypermagnesemia
(the kidneys are responsible for excreting protein y Metabolic acidosis
byproducts).
y Anticipate continuous renal replacement vitamin D y Hypocalcemia
therapy (CRRT) or hemodialysis if less invasive activation by kidneys y Bone disease

Renal/Urinary
interventions fail (see RENAL REPLACEMENT THERAPIES).
production of
Anemia
2. Chronic Kidney Disease erythropoietin

Chronic kidney disease (CKD) is a progressive,

urea excretion Uremic syndrome:
irreversible loss of kidney function over months or years
y Nausea, vomiting
and is classified into stages (FIGURE 3).
y Fatigue
y Skin itching (uremic
FIGURE 3. CKD STAGES
pruritus)

CKD is irreversible and may require dialysis or kidney

transplantation. Nursing care for CKD focuses on:
1. Managing fluid and electrolytes
2. Preventing cardiovascular disease (CVD)
3. Implementing dietary modifications
4. Managing bone disease and anemia
1. Manage fluid and electrolytes:
y Monitor BUN, creatinine, and electrolyte levels.

Implement cardiac monitoring:
y Peaked T waves indicate hyperkalemia.
y Administer medications to treat hyperkalemia
(TABLE 2).
y Teach clients to avoid over-the-counter
medications because they can contain electrolytes.
CKD is caused by conditions that causerenal
y Antacids and laxatives contain magnesium.
perfusion or nephron damage, such as:
y Acetaminophen and NSAIDs contain sodium.

Diabetes
y Administer sodium bicarbonate to treat
y Polycystic kidney disease (PKD)
metabolic acidosis.
y Uncontrolled HTN
y AKI

© Bootcamp.com 3
2. Chronic Kidney Disease, Continued
y Measure daily weights at the same time on the 4. Manage bone disease and anemia:
same scale each day. y Administer oral phosphate binders (e.g.,

Monitor for signs of fluid overload like edema sevelamer, calcium acetate) with meals to
and crackles. phosphorus levels.

Teach clients to report sudden weight gain, y Administer calcium and vitamin D supplements
dyspnea, or edema. to support bone health.
y Restrict fluid intake (for late stages and clients y Monitor hemoglobin and hematocrit levels due to
on dialysis). the risk of anemia.
y Avoid administering large volumes of IV fluids. y Administer medications to treat anemia, such as:
y Administer loop diuretics (furosemide) to remove y Erythropoietin (EPO) injections
excess fluid and potassium. y Iron supplements
y Avoid potassium-sparing diuretics y Blood transfusions
(e.g., spironolactone).
2. Prevent cardiovascular disease (CVD): 3. Renal Replacement Therapies
Clients with CKD are at risk for CVD from arterial Dialysis and kidney transplant are indicated when
stiffness, hypertension, and atherosclerosis. dietary and pharmacological interventions are insufficient
y Monitor BP due to therisk of hypertension. to maintain fluid and electrolyte balance.
y Administer antihypertensive medications y Dialysis removes excess fluid, waste, and toxins
from the blood when the kidneys cannot. Types of

Renal/Urinary
as prescribed.
y sodium intake. dialysis include:
y Monitor lipid levels (cholesterol, triglycerides) due y Hemodialysis
to the risk of atherosclerosis. y Peritoneal dialysis
y Continuous renal replacement therapy (CRRT)
3. Implement dietary modifications:
Hemodialysis (HD)

Implement a low-protein diet.
y HD requires surgical creation of an AV fistula or

Exception: Encourage high-protein diets for
graft for access, where blood is filtered through a
clients on peritoneal dialysis due to albumin
machine intermittently (e.g., three times weekly) and
loss into the dialysate.
returned to the body (FIGURE 4).
y Avoid foods high in:
y When caring for a client with an AV fistula or graft:
y Potassium (salt substitutes)

Assess the site for patency.
y Sodium (canned goods, processed deli meats)
y Feel for a thrill (vibration).
y Phosphorus (meat, eggs, dairy)
y Listen for a bruit (whooshing sound).
y See FLUID & ELECTROLYTE IMBALANCES
y Check distal pulses and capillary refill in the
CHEAT SHEET.
arm with the AV fistula or graft.

Do not measure BP or perform venipuncture
(IV insertion, blood draw) in an arm with an AV
fistula or graft.
y Monitor site for infection or thrombosis
(redness, absence of thrill or bruit).
y Teach clients to avoid placing pressure on
AV graft or fistula (carrying heavy objects that
compress fistula or graft).

 Fluid overload: Monitor clients with AKI and CKD for  Fistula and graft care: Assess for patency by feeling
signs of fluid overload, such as sudden weight gain, for a thrill and listening for a bruit. Do not measure
crackles, and edema. BP or perform venipuncture in the affected arm.

 CKD dietary modifications: Clients with CKD should

follow a low-protein diet (unless on peritoneal dialysis).

© Bootcamp.com 4
3. Renal Replacement Therapies, Continued
y Monitor for complications during and after Peritoneal dialysis (PD)
hemodialysis: y Dialysate is infused into the peritoneal cavity via a
y Hypotension: Monitor BP closely. surgically implanted catheter, where it collects waste
y Interventions:dialysis rate, administer via osmosis and is then drained (FIGURE 5).
IV fluids y When caring for a client receiving PD:
y Air embolism: Air enters dialysis tubing y Wear sterile gloves when accessing the
through leaks or improper handling, reaching dialysis catheter.
the bloodstream and blocking blood flow. y Warm the dialysate fluid before infusing using a
y Interventions: Monitor client for dyspnea, warmer; cold fluiddiscomfort.
chest pain, or confusion.
Assess for cloudy peritoneal fluid, abdominal
y Disequilibrium syndrome: Rapid fluid pain, or fever, which indicates peritonitis (infection).
removal can cause nausea, headache, y Encourage a high-protein diet to replace protein
or confusion. lost in dialysate fluid.
y Interventions:dialysis rate y Monitor for respiratory distress caused by
y Bleeding: Heparin is used during dialysis to dialysate pressing against the diaphragm.
prevent clotting of the filter, which can y Closely monitor intake and output of dialysate
cause bleeding. fluid to assess for retained fluid.
y Interventions: Monitor for bleeding; have Continuous renal replacement therapy (CRRT)
antidote available: Protamine sulfate. y CRRT uses a hemodialysis machine to filter blood

Renal/Urinary
continuously instead of intermittently.
FIGURE 4. AV FISTULA y Only used for critically ill clients who cannot
tolerate larger fluid shifts (e.g., hypotensive)

FIGURE 5. PERITONEAL DIALYSIS

 Peritonitis: When performing peritoneal dialysis, monitor for cloudy peritoneal fluid, which indicates infection.

© Bootcamp.com 5
  Clients with AKI and CKD are at risk for potassium  Clients with CKD should follow a _____-protein
imbalances. Monitor ECG for peaked _____, which diet (high or low?) unless on peritoneal dialysis.
indicates hyperkalemia. Hyperkalemia treatment
includes polystyrene sulfonate (Kayexalate), IV  To assess for patency in a fistula or graft, feel for
insulin with ___, or dialysis. a _____ and listen for a _____. What procedures
should be avoided in the arm with a fistula
 Clients with AKI and CKD should be monitored for or graft?
signs of fluid volume _____ (deficit or overload?),
such as sudden weight _____, crackles, and _____.  What sign of infection should the nurse monitor
for when performing peritoneal dialysis?

Answers: 1. T-waves; dextrose, 2. overload, gain, edema, 3. low, 4. thrill, bruit; BP measurement, VAD insertion, blood draws, 5. Cloudy peritoneal fluid

Renal/Urinary
References: Attributions:
Callahan, B., Hand, M., & Steele, N. (Eds.). (2023). Nursing: A concept- y AKI Causes: Created with BioRender.com
based approach to learning (4th ed., Vol 1). Pearson.
y ECG Effects of Potassium Imbalances: Created with
Harding, M. M., Kwong, J., Hagler, D., & Reinisch, C. (Eds.). BioRender.com
(2023). Lewis’s medical-surgical nursing: Assessment and
y AV Fistula: Mksusana, CC BY-SA 4.0, via Wikimedia Commons
management of clinical problems (12th ed.). Elsevier.
y Peritoneal Dialysis: Modified from BruceBlaus, CC BY 3.0, via
Ignatavicius, D., Heimgartner, N., & Rebar, C. (Eds.). (2024).
Wikimedia Commons with BioRender.com
Medical-surgical nursing: Concepts for clinical judgment
and collaborative care (11th ed.). Elsevier.

Tyerman, J., Cobbett, S., Harding, M. M., Kwong, J., Roberts, D.,
Hagler, D., Reinisch, C. (Eds.). (2023). Lewis’s medical-
surgical nursing in Canada: Assessment and management
of clinical problems (5th ed.). Elsevier.

© Bootcamp.com 6
 Table of Contents:
1. Anemia
2. Leukemia

Anemia & Leukemia

1. Anemia
Anemia is a condition characterized by low RBCs,
hemoglobin, and/or hematocrit oxygen-carrying TABLE 1. ANEMIA AT A GLANCE
capacity of the blood  Inadequate O₂ delivery
to tissues. Type Causes & Risks
Anemia can result fromin RBC production,in RBC
destruction, or chronic blood loss (GI bleeding) (TABLE 1). Iron- y Chronic blood loss
y RBC formation depends on dietary intake of iron, deficiency y Poor iron intake or absorption
vitamin B12, and folic acid. Without adequate intake, anemia y iron demand (pregnancy)
RBC production. y Children drinking large volumes of
cow’s milk instead of iron-fortified
Assessment findings
foods
y Symptoms ofO2 delivery include:

Hematologic/Oncologic
y Fatigue, weakness

Pallor B12- y Diet in animal protein (vegan,
y Tachycardia, dyspnea on exertion deficiency vegetarian)
y Findings associated with underlying cause include: anemia y Deficient intrinsic factor needed for

Iron deficiency: Pica (craving non-food items B12 absorption (pernicious anemia)
like clay or laundry detergent)
Gastric bypass surgery (removes
y B12 deficiency: Neurologic symptoms parietal cells, which produce intrinsic
(numbness and tingling in hands and feet) and factor)
glossitis (smooth, beefy-red tongue) (FIGURE 1)
y Aplastic anemia: Petechiae and bleeding from
pancytopenia Folic acid y Poor diet, alcoholism
y Hemolytic anemia: Jaundice from RBC deficiency
folate demand (pregnancy)
breakdown anemia

FIGURE 1. GLOSSITIS Sickle cell y Genetic disorder causing RBC

anemia sickling

Aplastic y Bone marrow failure (caused by

anemia radiation, autoimmune disease)
RBCs, WBCs, and platelets
(pancytopenia)

Hemolytic y RBC destruction caused by

anemia autoimmune reaction (e.g., to blood
transfusion or medications)

© Bootcamp.com 5
1. Anemia, Continued
Nursing interventions y Folic acid deficiency
For all anemia types: y Encourage foods that are high in folic acid.

Identify and treat the underlying cause (TABLE 1). y Fortified cereals
y Monitor H&H: Anticipate possible transfusion. y Green leafy veggies
y Monitor for symptoms of hypoxia (tachycardia, y Liver
fatigue, pallor). y Citrus (orange juice)
y Alternate rest and activity to manage fatigue. y Nuts
y Encourageiron-, B12-, and folate-rich foods. y Supplement folic acid.

Clients who are pregnant should take
Disease-specific interventions supplemental folic acid (prenatal vitamins) to
y Iron deficiency prevent neural tube defects.

Assess for GI bleeding. y Sickle cell
y Encourage a diet rich in iron. y Correct precipitating cause ofsickling (give IV
y Red meat, liver, eggs fluids, supplemental oxygen).
y Green leafy vegetables y Manage pain caused by ischemia.
y Beans, fortified cereals y Teach client to avoid triggers (infection,

Administer ferrous sulfate as prescribed and dehydration).
teach client to: y See SICKLE CELL DISEASE CHEAT SHEET.
y Take between meals and with vitamin C y Aplastic anemia
(orange juice) to improve absorption. y Anticipate bone marrow biopsy for diagnosis.

Hematologic/Oncologic
y Do not take with milk or antacids, which y Clients with pancytopenia are at risk for infection
impair absorption. and bleeding. Implement neutropenic and
y Liquid ferrous sulfate can stain teeth: bleeding precautions as needed (TABLE 3 &
Administer by placing a straw or dropper TABLE 4).
toward the back of the mouth, then wipe y Administer immunosuppressants and bone
teeth afterward. marrow stimulants (epoetin alfa) as prescribed
y Black stools and constipation are expected toRBC destruction andRBC production.
side effects. y Prepare client for possible bone marrow
y Encourage fluids and stool softeners for transplant.
constipation. y Hemolytic anemia
y B12 deficiency y Treat the underlying cause (discontinue
y Encourage foods rich in B12. medication).
y Red meat, fish y Administer immunosuppressants
y Eggs (corticosteroids) as prescribed to suppress
y Dairy autoimmune RBC destruction.
y Teach client to take B12 supplements as
prescribed.

Teach clients undergoing gastric bypass surgery
that lifelong B12 injections may be necessary
due to surgical removal of parietal cells, which
produce intrinsic factor necessary for B12
absorption.

 Supplemental iron: Teach client that iron  Pernicious anemia: Teach clients who have
supplements should be taken between meals and had gastric bypass surgery that lifelong
with vitamin C (orange juice). Do not take with milk B12 injections may be necessary.
or antacids, which impair absorption. Black stools
and constipation are expected side effects.

© Bootcamp.com 2
2. Leukemia
Leukemia is a blood and bone marrow cancer that
TABLE 2. TYPES OF LEUKEMIA
causes the uncontrolled production of immature WBCs.
Immature WBCs “overcrowd” the bone marrow,
Type Characteristics & Mnemonic
reducing the production of RBCs + healthy WBCs +
platelets  Pancytopenia (anemia + neutropenia +
Acute Most common in children
thrombocytopenia) risk for infection and bleeding
lymphocytic
(FIGURE 2). “All Little Lads”
leukemia (ALL)
Leukemia types
y Leukemia is classified based on disease progression
Acute myeloid Rapid progression, poor
(acute vs. chronic) and affected cell type (lymphoid vs.
leukemia (AML) prognosis (often fatal)
myeloid) (TABLE 2).
y Lymphoid vs. myeloid: “A Mean Leukemia”
y Lymphoid leukemias: Affect lymphoid stem cells,
which produce B and T lymphocytes Chronic Older adults, slow
y Myeloid leukemias: Affect myeloid stem cells, lymphocytic progression
which produce RBCs, platelets, and all other leukemia (CLL) “Comes Late in Life”
WBCs (neutrophils, monocytes)
Chronic myeloid Caused by mutated
FIGURE 2: LEUKEMIA PATHOPHYSIOLOGY leukemia (CML) Philadelphia chromosome

Hematologic/Oncologic
“Chromosome Mutation in
Leukemia”

Nursing interventions
y Assist with bone marrow aspiration and biopsy for
diagnosis (see FIGURE 3).
y After the procedure, apply a pressure dressing to
the puncture site to prevent bleeding.
y Monitor for and report signs of bleeding
or infection.
y Monitor CBC for platelet, hemoglobin, and
WBC levels.
y Prevent infection
y Place client on neutropenic precautions (TABLE 3).
y Follow strict hand hygiene.
y Wear a mask when providing care.
Assessment findings
y Teach client to avoid crowds and sick contacts.
Leukemia symptoms primarily result from pancytopenia y Frequently assess for infection (fever).
(healthy WBCs, RBCs, and platelets). y Notify HCP of low-grade fever; a

Recurrent infections frommature WBCs temperatureof even 1.0℉ (0.5℃) above

Anemia (fatigue, pallor, tachycardia) baseline can indicate a life-threatening

Bruising, petechiae, epistaxis from infection in neutropenic clients.
thrombocytopenia y Administer antibiotics and antifungals as
y Weight loss prescribed.
y Enlarged lymph nodes, spleen, liver (splenomegaly,
Initiate bleeding precautions (TABLE 4).
hepatomegaly) y Alternate activity and rest to help with fatigue.
y Bone pain
y Bone marrow biopsy reveals immature WBCs
(blast cells)

© Bootcamp.com 3
2. Leukemia, Continued
Interventions for chemotherapy and transplant
FIGURE 3. BONE MARROW ASPIRATION WITH BIOPSY
y Provide chemotherapy care.
y Administer antiemetics (ondansetron) to help with
GI side effects.
y Perform oral care after each meal and at bedtime
to help with mucositis.
y Recommend oral rinses and soft-bristled
toothbrushes.
y Avoid overly hot, cold, spicy, or rough foods
that can irritate oral mucosa.
y Monitor CBC for platelet, hemoglobin, and WBC
levels.
y Clients are at highest risk for infection during
the nadir, or lowest neutrophil level, which
usually occurs a week after chemotherapy or
radiation treatment.
y Assist with hematopoietic stem cell transplant
(HSCT) if applicable.

In HSCT, high-dose chemotherapy is given to kill

TABLE 3. NEUTROPENIC PRECAUTIONS all cells in the bone marrow. Then, donor stem

Hematologic/Oncologic
cells are administered to repopulate the bone
y Place client in a private room. marrow, enabling healthy blood cell production
y Do not enter room if you are not feeling well. and potentially curing the disease.
y Perform hand hygiene before entering the room. y Monitor for graft-versus-host disease (GVHD) in
y Use dedicated equipment (stethoscope) and HSCT recipients: Donor T cells identify the recipient’s
disinfect after use. tissues as “foreign” and attack the skin, liver, and
y No fresh flowers or raw foods (fruits, GI tract.
vegetables, eggs, shellfish).
Monitor for skin rash, liver dysfunction, and
diarrhea, which indicate GVHD.

TABLE 4. BLEEDING PRECAUTIONS

y Avoid invasive procedures (IM injections,

enemas).
y Avoid forceful nose-blowing.
y Avoid aspirin.
y Use a soft bristle toothbrush and electric
razor.
y Notify HCP of unusual bleeding (petechiae,
bleeding from gums, blood in stool).

 Leukemia: Clients with leukemia are at  Bleeding precautions: When caring for clients with
increased risk for infection. Teach client to thrombocytopenia, avoid invasive procedures like
avoid raw foods, fresh flowers, crowds, and IM injections and enemas. Teach clients to avoid
sick contacts. aspirin and forceful nose-blowing and to use a
soft-bristle toothbrush and electric razor.
 Neutropenia: For clients with neutropenia,
a low-grade fever (temperature increases
of even of 1.0℉ or 0.5℃) can indicate life-
threatening infection.

© Bootcamp.com 4
  Iron supplements should be taken between _____  For clients that are neutropenic, notify HCP of
and with vitamin _____. Do not take with _____ or _____, which can indicate a life-threatening
_____, which impair absorption. Teach client that infection.
expected side effects include constipation and
_____ stools.  What interventions for bleeding precautions are
indicated for clients with thrombocytopenia?
 Teach clients who have had gastric bypass
surgery that lifelong _____ may be necessary.

 Teach clients with leukemia to avoid crowds, sick

contacts, _____ foods, and fresh _____.

forceful nose blowing; use a soft bristle toothbrush and electric razor.
Answers: 1. meals, C; milk, antacids; black 2. B12 injections 3. raw, flowers 4. increase in temperature 5. Avoid invasive procedures, aspirin, and

Hematologic/Oncologic
References:

Harding, M. M., Kwong, J., Hagler, D., & Reinisch, C. (Eds.). Tyerman, J., Cobbett, S., Harding, M. M., Kwong, J., Roberts, D.,
(2023). Lewis’s medical-surgical nursing: Assessment and Hagler, D., Reinisch, C. (Eds.). (2023). Lewis’s medical-
management of clinical problems (12th ed.). Elsevier. surgical nursing in Canada: Assessment and management
Ignatavicius, D., Heimgartner, N., & Rebar, C. (Eds.). (2024). of clinical problems (5th ed.). Elsevier.
Medical-surgical nursing: Concepts for clinical judgment
and collaborative care (11th ed.). Elsevier. Attributions:

Lowdermilk, D., Cashion, M. C., Alden, K. R., Olshansky, E.F., & y Glossitits: Jihoon Kim, Moon-Jong Kim &amp; Hong-Seop
Perry, S. (2023). Maternity and women’s health care (13th Kho, CC BY 4.0, via Wikimedia Commons
ed.). Elsevier. y Leukemia Pathophysiology: Created with BioRender.com
McKinney, E., Mau, K., Murray, S., James, S., Nelson, K., Ashwill, y Bone Marrow Biopsy: Cancer Research UK, CC BY 4.0, via
J., & Caroll, J. (2022). Maternal-child nursing (6th ed.). Wikimedia Commons
Elsevier.
© Bootcamp.com 5
 Table of Contents:
1. Osteoarthritis & 4. Gout
Rheumatoid Arthritis 5. Osteoporosis
2. Osteoarthritis
3. Rheumatoid Arthritis

Arthritis & Osteoporosis

1. Osteoarthritis & Rheumatoid Arthritis
TABLE 1. OSTEOARTHRITIS VS. RHEUMATOID ARTHRITIS
Rheumatoid arthritis (RA) and osteoarthritis (OA) are
chronic joint disorders with distinct pathophysiologies
(TABLE 1). Condition Osteoarthritis Rheumatoid
y Nursing care for arthritis focuses on pain Arthritis
management, joint protection, and promoting
mobility and independence. Cause Joint Autoimmune
degeneration disease 
2. Osteoarthritis from repetitive Attacks joints
stress + Causes
Osteoarthritis (OA) = degenerative joint disease causing
systemic
cartilage breakdown (FIGURE 1).
inflammation

FIGURE 1. OSTEOARTHRITIS PATHOPHYSIOLOGY Pain Pattern Worse with Better with

activity, better activity, worse
with rest with prolonged
rest

Musculoskeletal
Morning Lasts <30 min Lasts >1 hour
Stiffness

Joints Affected Asymmetrical; Symmetrical,

often large small joints
weight-bearing (fingers, wrists)
joints (knees,
hips)

Systemic None Fatigue,

Findings anorexia,
weight loss, and
inflammatory
markers (ESR,
Risk factors CRP)
y Aging

Obesity (joint stress) Nursing interventions
y Joint injuries, repetitive joint stress (from y Encourage weight loss to take excess pressure off
occupations like farming, construction, sports) of joints.
Assessment findings y Teach client about joint protection and pain

Joint pain and stiffness primarily affecting the hips, management strategies (TABLE 2).
knees, and hands y If chronic pain persists, prepare for possible
y Pain worse with activity, better with rest arthroplasty (joint replacement surgery).
y  joint mobility
y Crepitus (grating joint sensation from loose
cartilage particles)
y Heberden and Bouchard nodes (FIGURE 2)
© Bootcamp.com 5
2. Osteoarthritis, Continued 3. Rheumatoid Arthritis
Rheumatoid arthritis (RA) = chronic autoimmune
FIGURE 2. HEBERDEN AND BOUCHARD NODES disorder causing systemic joint inflammation.
Assessment findings
y Joint pain and swelling primarily affecting the hands
and wrists

Pain worse with prolonged rest, better
with activity
y Prolonged morning stiffness (>1 hr);joint
inflammation after prolonged rest

Fatigue, anorexia, weight loss
y Boutonniere and swan-neck deformities (FIGURE 3)

FIGURE 3. SWAN-NECK DEFORMITY

TABLE 2. CLIENT TEACHING FOR OA & RA

Pain management Diagnostic studies

Musculoskeletal
y Rest and immobilize joints when in pain. y Arthroscopy with synovial fluid aspiration: Cloudy
y Apply cold for swelling and heat for pain and fluid withWBCs
stiffness (hot packs, paraffin dips). y Labs
y Take analgesics (NSAIDs) and corticosteroids as y Rheumatoid factor (RF) positive
prescribed toinflammation. y ESR and CRP (inflammatory markers)
Joint protection Nursing interventions

Encourage low-impact exercises (walking, y Pain management
swimming, Tai Chi). y Administer DMARDs (methotrexate) and
y Use assistive devices for ADLs like canes, self- biologics (etanercept, infliximab) to suppress
fastening closures (e.g., Velcro), an electric can immune response.
opener, and a long-handled hairbrush. y Monitor and report signs of infection (sore

Avoid prolonged standing, heavy lifting, and throat, fever).
repetitive motions (knitting, typing). y Must test negative for TB before starting
y Use large joints rather than small joints for tasks treatment with biologics.
(press water from a sponge instead of wringing it).

 OA vs. RA: Osteoarthritis (OA) pain worsens  OA management: Encourage weight loss and
with activity and improves with rest, while low-impact exercises such as walking and
rheumatoid arthritis (RA) pain improves with swimming. Promote joint protection strategies
activity and worsens with prolonged rest. Unlike such as avoiding prolonged standing, heavy
OA, RA causes systemic symptoms such as lifting, and repetitive motions.
fatigue and weight loss.

© Bootcamp.com 2
3. Rheumatoid Arthritis, Continued Nursing interventions
y Fatigue management
Teach client to limit alcohol and avoid high-purine
y Encourage rest during flares. foods like shellfish (shrimp), red meat, and organ

Teach client to conserve energy by prioritizing meat (liver).
tasks early in the day and sitting during tasks y Excess purine intake serum uric acid.
(preparing food). y Encourage weight loss in obese clients.
y Preventing contractures y Promote hydration torisk for purine renal calculi
y Encourage ROM exercises. (kidney stones).

Splint joints. y Administer allopurinol touric acid production for

Sleep with a small, flat pillow under the head; do prevention of gout flares.
not place pillows under the knees. y Administer colchicine, NSAIDs, or corticosteroids to
y Client teaching and support treat acute flares.

Provide pain management and joint protection
teaching (TABLE 2). 5. Osteoporosis
y Provide emotional support for altered body Osteoporosis = porous, fragile bones from excess bone
image and coping with chronic illness. resorption (FIGURE 5).
y If chronic pain persists, prepare for possible
synovectomy (removal of the joint lining) or
FIGURE 5. OSTEOPOROSIS PATHOPHYSIOLOGY
arthroplasty (joint replacement surgery).

4. Gout
Gout (“gouty arthritis”) = painful flares of inflammatory
arthritis from uric acid crystal deposits in the joints.
Assessment findings

Musculoskeletal

Sudden, severe joint pain and swelling primarily
affecting the toes (FIGURE 4)
y serum uric acid levels

FIGURE 4. GOUT

Risk factors
y Aging
y White or Asian ethnicity

Females with low estrogen (postmenopausal, post-
hysterectomy with oophorectomy)

Long-term corticosteroid use
y Hyperparathyroidism (see THYROID & PARATHYROID
DISORDERS CHEAT SHEET)
y Inadequate calcium or vitamin D intake
y Smoking, excess alcohol intake

 RA management: Clients with RA should  Gout: Teach client to limit alcohol and avoid high-
conserve energy by sitting during tasks and purine foods like shellfish (shrimp), red meat, and
prevent contractures by splinting joints and organ meat (liver).
sleeping with a small, flat pillow under the head;
do not place pillows under the knees.

© Bootcamp.com 3
5. Osteoporosis, Continued
Assessment findings (FIGURE 6) Nursing interventions
y Height loss y Promote bone health.
y Back pain
Instruct client to choose weight-bearing forms
y Kyphosis (forward curvature of the spine) of exercise, which improve bone density (e.g.,

Pathologic fractures (hip, wrist, spine) walking instead of swimming, which does not
require weight-bearing).

Encourage foods rich in calcium (dairy, green
FIGURE 6. OSTEOPOROSIS FINDINGS leafy vegetables) and vitamin D (salmon, eggs);
administer dietary supplements as needed.
y Recommend a safe amount of sun exposure to
vitamin D production.
y Teach the importance of smoking cessation and
caffeine and alcohol intake.
y Administer bisphosphonates (alendronate) to
slow bone resorption.

Can cause esophagitis: Take
bisphosphonates with a full glass of water
and remain upright for 30 min after taking.
y Encourage regular bone mineral density testing
(dual-energy X-ray absorptiometry [DEXA] scan).
y Prevent falls and fractures.

Use assistive devices and modify home
environment (remove throw rugs, use non-slip
shower mats).

Musculoskeletal
y Avoid high-impact activities thatfracture risk
(running, horseback riding).

 Osteoporosis teaching: Instruct client to choose weight-bearing forms of exercise (e.g., walking
instead of swimming). Encourage foods rich in calcium (dairy, green leafy vegetables) and vitamin D
(salmon, eggs).

© Bootcamp.com 4
  Osteoarthritis (OA) pain improves with activity,  A client with gout should avoid foods high
while rheumatoid arthritis (RA) pain worsens with in _____. What are some examples of these
activity (True or False?). What systemic findings foods?
are associated with RA?
 Clients with osteoporosis should engage in
 To manage OA, encourage weight _____ and low- _____ (what form of?) exercise and eat a
impact exercises such as _____ and _____. Avoid diet rich in _____ and _____. Swimming is a
prolonged standing and _____ motions. weight-bearing exercise (True or False?).

 A client with RA should conserve energy by

_____ during tasks and prevent contractures
by _____ joints and sleeping with a small, flat
pillow under the _____; do not place pillows
under the _____.

training and walking are weight-bearing exercises.

3. sitting, splinting, head, knees 4. purines; Shellfish (shrimp), red meat, and organ meat (liver) 5. weight-bearing, calcium, vitamin D; False: Weight
Answers: 1. False: OA pain worsens with activity and RA pain improves with activity; Fatigue, weight loss 2. loss, walking, swimming; repetitive

Musculoskeletal
References:

Callahan, B., Hand, M., & Steele, N. (Eds.). (2023). Nursing: A Rogers, J. (2023). McCance & Huether’s pathophysiology (9th ed.).
concept-based approach to learning (4th ed., Vol 1). Elsevier.
Pearson.
Tyerman, J., Cobbett, S., Harding, M. M., Kwong, J., Roberts, D.,
Harding, M. M., Kwong, J., Hagler, D., & Reinisch, C. (Eds.). Hagler, D., Reinisch, C. (Eds.). (2023). Lewis’s medical-
(2023). Lewis’s medical-surgical nursing: Assessment and surgical nursing in Canada: Assessment and management
management of clinical problems (12th ed.). Elsevier. of clinical problems (5th ed.). Elsevier.

Ignatavicius, D., Heimgartner, N., & Rebar, C. (Eds.). (2024).

Attributions:
Medical-surgical nursing: Concepts for clinical judgment
and collaborative care (11th ed.). Elsevier. y Swan Neck: User:Phoenix119, CC BY-SA 3.0, via Wikimedia
Commons
Pagana, K. D., Pagana, T. J., & Pagana, T. N. (2021). Mosby’s
diagnostic and laboratory test reference (15th ed.). Elsevier. y Osteoporosis Pathophysiology: Created with Biorender.com

y Osteoporosis Findings: Created with Biorender.com

© Bootcamp.com 5
 Table of Contents:
1. Atherosclerotic 3. Coronary Artery Disease
Cardiovascular Disease 4. Acute Coronary Syndrome
2. Risk Assessment & Reduction 5. Cardiac Catheterization

Atherosclerosis, CAD, & ACS

1. Atherosclerotic Cardiovascular Disease

Cardiovascular
Atherosclerotic cardiovascular disease
(ASCVD) refers to vascular disease FIGURE 1: CORONARY ATHEROSCLEROSIS
caused by atherosclerosis, including
coronary artery disease (CAD), peripheral
artery disease, and cerebrovascular
disease (see STROKE & VASCULAR
DISORDERS CHEAT SHEETS).
y In ASCVD, fatty deposits (plaques)
gradually build up in arteries 
Arterial narrowing + endothelial
(vessel) dysfunction blood flow
to the myocardium (see FIGURE 1).
y Chronic inflammation from
factors like smoking and diabetes
contributes to endothelial
dysfunction.
y risk for life-threatening ischemic
events (myocardial infarction (MI),
stroke).

2. Risk Assessment & Reduction

Risk factors

Modifiable risk factors that cause endothelial
damage include: TABLE 1. LIPOPROTEINS
y Smoking
y Hypertension Laboratory Value ToCAD Risk
y High cholesterol (LDL,HDL)
y Diabetes, obesity, sedentary lifestyle
y Lipid panel “Lousy” cholesterol
Low-density lipoprotein (LDL)
y Measures total cholesterol, triglycerides, and should be Lowered.
lipids to assess CAD risk (TABLE 1)
y High cholesterol levels =CAD risk.

Client must be fasting for a lipid panel.
“Healthy” cholesterol
High-density lipoprotein (HDL)
should be High.

© Bootcamp.com 7
2. Risk Assessment & Reduction, Continued
Client teaching

Torisk for MI and stroke, instruct TABLE 2: LIPID-LOWERING MEDICATIONS
clients with ASCVD to implement heart-
healthy lifestyle modifications, such as Drugs & Mechanism Nursing Considerations
those recommended by the American Statins
Can cause rhabdomyolysis: Monitor for muscle
Heart Association’s “Life’s Simple 7”: (atorvastatin, pain.
1. Stop smoking. simvastatin) y Hepatotoxic: Monitor liver function tests

Cardiovascular
2. Eat a healthy diet, including fruits, (AST, ALT).
cholesterol synthesis
vegetables, whole grains, fish, and
lean meats. Fibrates
risk of rhabdomyolysis when combined
y saturated fat, trans fats, and (fenofibrate, with statins
cholesterol (red meat, full- gemfibrozil) y risk of bleeding in clients taking warfarin
fat dairy, fried foods); choose y risk of hypoglycemia in clients taking
healthy fats instead (nuts, triglycerides
antidiabetic medications
avocados). HDL
y Avoid fried foods; eat grilled, Bile acid y Can cause GI upset
baked, or broiled foods sequestrants y Interfere with absorption of some
instead. (cholestyramine) medications (digoxin, β-blockers, fat-
y Eat fatty fish twice weekly soluble vitamins): Take 1 hr before other
Bind bile acids
(salmon, albacore tuna). medications.
tocholesterol
y complex carbohydrates
and fiber (whole grains, fruits, Ezetimibe y Avoid use in clients with liver problems.
vegetables).
y Avoid high-sodium foods cholesterol
(packaged foods). absorption in the
y alcohol intake (≤1 drink/day intestines
for women, ≤2 drinks/day HDL
for men). PCSK9 Inhibitors y Can cause injection site reactions
3. Be active for ≥30 min on most (alirocumab,
days (start with short periods and evolocumab)
graduallyto reach 150 min/week).
4. Lose weight if needed. LDL levels
5. Manage BP with antihypertensives ATP-citrate lyase y Monitor uric acid levels due to risk
as prescribed. inhibitor for gout.
6. Control cholesterol with lipid- (bempedoic acid)
lowering medications as prescribed
(TABLE 2). LDL levels
7. Reduce blood sugar with a healthy
diet and antidiabetic medications as Niacin
Can cause flushing: Take with aspirin
prescribed. (vitamin B3) toside effects.
triglyceride and
LDL levels
HDL

 ASCVD modifiable risk factors: Reduce ASCVD risks by following the “simple 7”: Stop smoking, eat a
healthy diet, be active, lose weight, manage BP, control cholesterol, and reduce blood sugar.

© Bootcamp.com 2
3. Coronary Artery Disease (CAD)
Coronary artery disease (CAD): Plaque buildup 
Stop test if client develops chest pain, dyspnea,
Narrowing of coronary arteries oxygen supply to dizziness, or ECG changes (ST changes).
the heart (FIGURE 1) Medications
y CAD causes angina (chest pain) and can progress to
acute coronary syndrome (myocardial infarction [MI]). Medications for CSA aim to relieve angina and treat
underlying risk factors.
Progression: y Administer medications as prescribed to treat
1. Chronic stable angina (CSA): Chest pain with

Cardiovascular
underlying risk factors (ACE inhibitors or beta-
exertion that is relieved by rest or nitroglycerin blockers for HTN, statins for hyperlipidemia).
2. Unstable angina (UA): Chest pain at rest, usually
Clients should avoid all non-aspirin NSAIDs
unrelieved by nitroglycerin (medical emergency) (ibuprofen, naproxen), which can cause coronary
y Vasospastic (Prinzmetal) angina: Chest pain due thrombosis.
to coronary artery vasospasm y Calcium channel blockers (amlodipine) relax
3. Myocardial infarction (MI): Chest pain caused vascular smooth muscle, improving coronary blood
by acute coronary occlusion  Ischemia  Can supply andoxygen demand.
progress to infarction and necrosis (see ACUTE
For acute relief and angina prophylaxis, nitrates
CORONARY SYNDROME). (nitroglycerin [NTG]) dilate blood vessels 
Cardiac stress testing myocardial oxygen demand and improve oxygen
y Cardiac stress testing is performed to detect and supply (see TABLE 3).
evaluate the severity of CAD. y Tablets and sprays: Take with the onset of
y If a stress test is positive for ischemia, a cardiac chest pain or prophylactically before activity for
catheterization may be required to visualize the a maximum of three doses.
coronary arteries (see CARDIAC CATHETERIZATION). y Long-acting: Remove transdermal patch after
y During a stress test, the client’s ECG and vital signs 12 hr to prevent tolerance (12 hr on, 12 hr off).
are assessed for signs of ischemia while the heart is y Caregivers should wear gloves when handling
stressed (e.g., with exercise). NTG ointment or transdermal patches to
y Types prevent contact with the medication.
y Exercise stress test: Client walks on a treadmill.
y Pharmacologic stress test: Medications
TABLE 3: CLIENT TEACHING FOR NITROGLYCERIN (NTG)
(dobutamine, adenosine) simulate exercise for
non-ambulatory clients.
y When chest pain occurs, sit down and take one
y Nursing considerations
dose; if there is no relief after 5 min, call 911 and
y Pre-test instructions for the day of the test
take a 2nd dose. If needed, take a 3rd dose 5 min

Avoid caffeine and nicotine.
later. Do not exceed three doses.

Hold beta-blockers, which can produce
y Headache, dizziness, and flushing are expected
false results.
effects.
y Wear comfortable clothing and shoes.
y Do not take erectile dysfunction medications
y During test
(sildenafil) within 24 hr of NTG  Severe
y Test is complete once client has reached
hypotension.
their exercise tolerance level or predicted
y Store in the original bottle in a cool, dark place.
maximum HR (calculated by subtracting
y Carry at all times; replace every 6 months.
client age from 220).

 Cardiac stress testing: Clients undergoing  NTG and statins: Teach client to store NTG in original
cardiac stress testing should avoid caffeine, bottle and replace every 6 months. Instruct clients to sit
nicotine, and beta-blockers on the day of the down before taking and not take erectile dysfunction
test. Stop the test if client develops chest pain, medications within 24 hours of NTG. Teach clients to take
dyspnea, dizziness, or ECG changes. a dose every 5 minutes for a maximum of three doses.
Clients taking statins should have liver function tests and
report signs of rhabdomyolysis, like muscle pain.
© Bootcamp.com 3
4. Acute Coronary Syndrome (ACS)
y ACS: Rupture of an
atherosclerotic plaque in a FIGURE 2: TYPES OF ACUTE CORONARY SYNDROME (ACS)
coronary artery  Triggers
thrombus formation 
Obstructs blood flow to the
myocardium (FIGURE 1)
y Includes UA, MI (NSTEMI,

Cardiovascular
STEMI)
Types (FIGURE 2)
y UA: New or worsening chest
pain that does not resolve with
rest or nitroglycerin
y NSTEMI: Partial blockage (MI)
 Elevated troponin but no
ST elevation
y STEMI: Complete coronary
artery blockage (MI) 
Elevated troponin and ST
segment (FIGURE 2)
Assessment findings

Classic signs
y Severe, crushing chest pain (radiates to jaw, left  3. Administer MONA-B medications tocoronary
arm, back) perfusion andangina.
y Shortness of breath y Morphine (only if NTG is ineffective): Reduces
y Diaphoresis (cold, clammy skin) pain and vasodilates, improving blood flow to
y Nausea, vomiting heart heart’s oxygen demands

Note: Clients who are female, older adults, or y Oxygen: To keep oxygen saturation ≥90%
who have diabetes may have atypical symptoms
Nitroglycerin (first-line): Vasodilates coronary
(fatigue, indigestion, dyspnea) without chest pain. arteries toperfusion and relieve chest pain
y Aspirin: Stops clot formation (chew non-enteric
Emergency interventions for acute coronary syndrome: coated aspirin)
1. Position client upright to improve oxygenation. y Beta-blockers:cardiac workload, prevent
2. Assess vital signs, ECG, and troponin levels. arrhythmias
y ECG assesses cardiac rhythm and for
ST changes.

STEMI: ST elevation = immediate cardiac
catheterization that MUST be started ≤90 min
(see CARDIAC CATHETERIZATION) (FIGURE 3).
y NSTEMI and UA: ST depression or T-wave
inversion (indicates ischemia)
y Troponin: Serum cardiac marker confirming
cardiac injury;in MI (NSTEMI and STEMI)

Draw serially over several hours since levels
may not rise immediately.

 Signs of ACS: Classic signs of ACS include severe, crushing chest pain that can radiate to the jaw, arm,
or back; shortness of breath; diaphoresis; nausea; and vomiting. Clients who are female, older adults, or
have diabetes can have atypical symptoms (fatigue, indigestion, dyspnea) without chest pain. Immediate
intervention includes obtaining an ECG and drawing troponin levels.

© Bootcamp.com 4
4. Acute Coronary Syndrome (ACS), Continued
4. Prepare for procedures as indicated.
y STEMI FIGURE 3: ST ELEVATION

Prepare for emergent cardiac
catheterization within 90 min
(see CARDIAC CATHETERIZATION).
y Clients with stenosis in
multiple coronary arteries may

Cardiovascular
require coronary artery bypass
grafting (CABG).
y NSTEMI/UA
y Continue MONA-B
medications, continuous
cardiac monitoring, and
drawing serial troponins.
y Treatment depends on risk
level and may include IV
heparin, antiplatelets, and/
or evaluation with cardiac stress test or

TABLE 4: POST-MI TEACHING
angiography.
Post-MI interventions y Notify HCP for chest pain unrelieved with NTG or
y Maintain continuous cardiac monitoring. other signs of MI.
y Frequently assess vital signs and for presence of y Graduallyactivity as tolerated.
chest pain. y Sexual activity can be resumed when moderate
y If client underwent cardiac catheterization, monitor for activity is achieved without chest pain or SOB
hemorrhage (hypotension, decreased pedal pulses) (walking up a flight of stairs).
or hematoma at the puncture site (see CARDIAC y Monitor blood pressure and glucose levels if
CATHETERIZATION). applicable.
y Notify HCP for signs of complications, including: y Take medications as prescribed and report
y Re-occlusion (thrombosis) of the coronary artery concerning side effects (e.g., muscle pain
stent (new angina or ST-segment changes) with statins).
y Ventricular dysrhythmias (VTach, VFib) y Continue dual antiplatelet therapy (aspirin and
y Heart failure or cardiogenic shock (dyspnea, clopidogrel) for ≥1 year as prescribed to prevent
hypotension) thrombosis; notify HCP for any unusual bleeding
y Provide post-MI discharge education (TABLE 4) and (nosebleeds, blood in stool).
medication teaching.
y Clients are usually discharged after MI with new
prescriptions to manage BP, heart rate, and fluid
balance, requiring medication teaching.
y Clients will require dual antiplatelet therapy
(aspirin and clopidogrel) to prevent clot
formation that could block narrow arteries (see
ANTICOAGULANTS & ANTIPLATELETS CHEAT SHEET).

© Bootcamp.com 5
6. Cardiac Catheterization
Cardiac catheterization: Invasive
FIGURE 4: CARDIAC CATHETERIZATION
procedure that uses contrast dye and
X-ray to visualize coronary artery
blockages and/or place a coronary artery
stent (percutaneous coronary intervention)
(FIGURE 4)
A catheter is threaded through a large

Cardiovascular
artery (usually the femoral artery), through
the aorta, and to the client’s coronary
arteries for visualization and stenting.
Interventions
y Pre-procedure

Assess for allergy to contrast dye
or shellfish.
y Keep NPO for 6-8 hr before
scheduled angiography.

Hold metformin for 48 hr before
contrast if applicable to prevent
kidney damage.
y Teach clients they might feel flushing after dye
administration.
y Post-procedure

Place client on continuous cardiac monitoring to
detect complications (re-occlusion, MI).

Maintain bedrest with the affected extremity
straight for 6-8 hr if femoral approach is used.

Monitor puncture site (femoral or radial artery)
for hematoma and bleeding.
y Assess peripheral pulses, color, temperature,
and sensation of extremity.
y Administer IV fluids to flush out IV contrast.
y Monitor urine output.
y Provide post-MI teaching if applicable (TABLE 4).

 Cardiac catheterization: After a client undergoes cardiac catheterization via a femoral approach, keep
the client on bed rest with the extremity straight for 6-8 hours. Monitor puncture site for hematoma and
bleeding and monitor perfusion status of the lower extremities.

© Bootcamp.com 6
  What seven lifestyle changes should the nurse  Symptoms of ACS include severe, crushing chest
teach the client to reduce risk for ASCVD? pain that can radiate to _____ (what sites?). All
clients with ACS have chest pain (True or False?).
 Clients undergoing cardiac stress testing should Which two diagnostic studies take priority when a
avoid _____ (what three things?) on the day of the client has signs of ACS?
test. Stop test if the client develops _____ pain,

Cardiovascular
_____, _____, or _____ changes.  After a client undergoes cardiac catheterization,
initiate bedrest with the extremity _____ for
 Clients prescribed NTG should store it in the _____-____ hours. Monitor puncture site for _____
_____ bottle and replace every _____ months. and _____ and monitor _____ status of lower
Instruct clients to _____ before taking and extremities.
avoid use with _____ medications. What is the
recommended dosing of NTG to teach clients?
For clients taking statins, monitor _____ tests
and teach clients to report _____, indicating
rhabdomyolysis.

troponin 5. straight, 6-8; hematoma, bleeding, perfusion/neurovascular status

three; liver function, muscle pain 4. radiates to the jaw, arm, or back; False: Some clients only have dyspnea, diaphoresis, nausea/vomiting; ECG and
beta-blockers; chest, dyspnea, dizziness, or ECG changes 3. original, 6 months; sit down, erectile dysfunction; Take a dose every 5 min for a total of
Answers: 1.Stop smoking, eat a healthy diet, be active, lose weight, manage BP, control cholesterol, and reduce blood sugar. 2. caffeine, nicotine,

References:

American Heart Association. (2018, December). Detailed overview: Lilley, L. L., Collins, S. R., & Snyder, J. S. (Eds.). (2023). Pharmacology
Workplace health solutions with Life’s Simple 7 journey. and the nursing process (10th ed.). Elsevier.
Astle, B., Duggleby, W., Potter, P. A., Stockert, Perry, A. G., & Hall, Reinisch, C. (Eds.). (2023). Lewis’s medical-surgical nursing in Canada:
A. M. (2024). Potter and Perry’s Canadian fundamentals of Assessment and management of clinical problems (5th ed.).
nursing (7th ed.). Elsevier. Elsevier.
Berman, A. B., Snyder, S. J., & Frandsen, G. (2021). Kozier & Erb’s Sealock, K., & Seneviratne, C. (Eds.). (2025). Lilley’s pharmacology for
fundamentals of nursing: Concepts, process, and practice Canadian health care practice (5th ed.). Elsevier.
(11th ed.). Pearson.
Tyerman, J., Cobbett, S., Harding, M. M., Kwong, J., Roberts, D.,
Burchum, J. R. & Rosenthal, L. D. (2025). Lehne’s pharmacology for Hagler, D., Reinisch, C. (Eds.). (2023). Lewis’s medical-surgical
nursing care (12th ed.). Elsevier. nursing in Canada: Assessment and management of clinical
Callahan, B., Hand, M., & Steele, N. (Eds.). (2023). Nursing: A concept- problems (5th ed.). Elsevier.
based approach to learning (4th ed., Vol 1). Pearson. Urden, L. D., Stacy, K. M., & Lough, M. E. (2022). Critical care nursing:
Harding, M. M., Kwong, J., Hagler, D., & Reinisch, C. (Eds.). Diagnosis and management (9th ed.). Elsevier.
(2023). Lewis’s medical-surgical nursing: Assessment and Vallaerand, A.H. & Sanoski, C.A. (2023). Davis’s drug guide for nurses
management of clinical problems (12th ed.). Elsevier. (18th ed.). F. A. Davis.
Hockenberry, M., Duffy, E.A., & Gibbs, K. (2024). Wong’s nursing care Attributions:
of infants and children (12th ed.). Elsevier.
y Coronary Atherosclerosis: Created with BioRender.com
Ignatavicius, D., Heimgartner, N., & Rebar, C. (Eds.). (2024). Medical-
surgical nursing: Concepts for clinical judgment and y STEMI: Created with BioRender.com
collaborative care (11th ed.). Elsevier. y Cardiac Catheterization: Created with BioRender.com
© Bootcamp.com 7
 Table of Contents:
1. Prostate Physiology & Screening 3. BPH Medications
2. Benign Prostatic Hyperplasia 4. Prostate Cancer

BPH & Prostate Cancer

1. Prostate Physiology & Screening 2. Benign Prostatic Hyperplasia (BPH)

The prostate gland is a male reproductive organ that BPH: Noncancerous, gradual enlargement of the
produces seminal fluid to support sperm health. prostate gland that typically occurs with age (FIGURE 2)
y As men age, the prostate may become enlarged
(benign prostatic hyperplasia) or develop abnormal FIGURE 2. BENIGN PROSTATIC HYPERPLASIA (BPH)
growths (prostate cancer).
Prostate cancer screening

Screening typically begins at age 50.
y May begin earlier (age 40-45) for men atrisk
(black ethnicity, family history of prostate cancer)

Screening tools include:

Renal/Urinary
y Prostate-specific antigen (PSA): A protein
made by the prostate, measured through a blood
test to assess prostate health

Elevated PSA levels are not specific for
prostate cancer; they can indicate BPH,
prostate cancer, or prostatitis.
y Digital rectal exam (DRE): Palpation of prostate
size, shape, and for presence of nodules (FIGURE 1)
Assessment findings
The enlarged prostate slows and blocks urinary flow,
FIGURE 1. DIGITAL RECTAL EXAM (DRE)
causing lower urinary tract symptoms (LUTS), including:
y Weak urinary stream
y Hesitancy (difficulty starting stream)
y Urinary frequency, urgency
y Nocturia (frequent nighttime urination)
Complications
y Acute urinary retention: Enlarged prostate blocks
urine flow.
y UTI: Incomplete bladder emptying can cause
infection.

� Prostate screening: Screening includes PSA blood tests and DRE to assess the prostate manually.
Screening begins at age 50, or earlier (40–45) for high-risk individuals (black ethnicity, family history of
prostate cancer).

© Bootcamp.com 4
2. Benign Prostatic Hyperplasia (BPH), Continued
Interventions

Assess for bladder distension, which indicates FIGURE 3. CONTINUOUS BLADDER IRRIGATION (CBI)
acute urinary retention, a medical emergency.
y If client develops acute urinary retention,
emergently insert a urinary catheter to
drain urine.
y Recurrent urinary retention is treated with
prostate resection.

Provide client education for symptom management.
y Consume 2-3 L/day of fluid.
y Limit fluid intake near bedtime tonocturia.
y Follow a voiding schedule (void every 2-3 hr) to
prevent stasis.
y Avoid bladder irritants (alcohol, caffeine, spicy
foods) (See URINARY TRACT INFECTIONS CHEAT SHEET
for more information).
y Avoid decongestants (pseudoephedrine) and
TABLE 1. CONTINUOUS BLADDER IRRIGATION (CBI)
anticholinergics (diphenhydramine) because they
can worsen urinary retention.

Renal/Urinary
Description Nursing Interventions
y Administer medications as prescribed to dilate the
urethra and reduce prostate size (TABLE 2).
y Anticipate transurethral resection of the prostate CBI uses a 3-way urinary
Adjust the irrigation flow
(TURP) procedure (removal of prostate tissue) for catheter to continuously rate to maintain light
severe symptoms. flush the bladder with pink or colorless urine
y Postoperatively, manage continuous bladder sterile irrigation solution output.
irrigation (CBI) to prevent urinary obstruction to prevent clotting and
Report bright red blood,
(FIGURE 3 & TABLE 1). urinary obstruction. which can indicate active
y Provide TURP discharge teaching. bleeding.
y Avoid straining and strenuous activity for y Assess for urinary
6 weeks. obstruction (output,
y Perform Kegel exercises to help manage severe pain).
incontinence.
Monitor for TURP
y Report signs of bladder infection (fever, syndrome, which is
malodorous urine). hyponatremia from
systemic absorption
of bladder irrigation
fluid (report confusion,
hypertension, vomiting).
y Keep leg straight if
catheter traction is
secured in place.

 BPH management: Teach clients to drink  Continuous bladder irrigation: Adjust the flow
2-3 L/day of fluid, limit fluid intake near bedtime, rate of CBI to maintain light pink or colorless
and avoid medications like decongestants and urine and report bright red blood. Monitor for
anticholinergics, which can worsen symptoms. TURP syndrome (dilutional hyponatremia) that
causes confusion, vomiting, and hypertension.

© Bootcamp.com 2
3. BPH Medications 4. Prostate Cancer
The goal of medication management for BPH is to Prostate cancer: Malignant growth in the prostate gland
improve urination and reduce LUTS symptoms. y Often detected through screening (PSA levels or DRE)
Risk factors

TABLE 2. BPH MEDICATIONS AT A GLANCE
Older age
y Black ethnicity
Medications Considerations y Family history of prostate cancer
y High-fat diet (red meat, full-fat dairy)
Alpha-blockers: Relax
Take initial dose at Assessment findings
smooth muscle to bedtime torisk of y Often asymptomatic in early stages
improve urine flow first-dose syncope. y Nodules or irregularities palpated on DRE (see FIGURE 1)
tamsulosin
Change positions y Advanced stages
slowly to prevent y Weight loss
alfuzosin
orthostatic y Hematuria
hypotension. y Bone pain from metastasis (lower back, hips)
y LUTS (See BENIGN PROSTATIC HYPERPLASIA:
5α-reductase y May cause erectile Assessment Findings)
inhibitors: Reduce dysfunction and
Interventions
prostate size over time libido
y Advise clients with a family history of prostate

Pregnant women

Renal/Urinary
finasteride cancer that prostate screenings may need to be
should avoid handling
dutasteride performed earlier (age 40-45).
the medication, as it
y Prepare clients for radiation or hormonal therapy
can harm a male fetus.
(antiandrogen medications).
y Change positions
y Teach clients taking hormone therapy about
slowly to prevent
therisk for gynecomastia,libido, and
orthostatic
osteoporosis.
hypotension.
y Depending on the stage, prostatectomy (surgical
removal of all or part of the prostate) may be necessary.
y Monitor urine output postoperatively; report
signs of urinary obstruction or bright red bleeding.

Provide discharge teaching.
y Avoid straining and strenuous activity for
6 weeks.
y Perform Kegel exercises to manage
incontinence.
y Perform home catheter care if discharged
home with a urinary catheter (keep urinary bag
lower than bladder, clean urinary meatus daily)
y Report signs of bladder infection (bladder
spasms, fever).
y Provide psychosocial support for sexual
side effects (erectile dysfunction, retrograde
ejaculation).

 BPH medication safety: Teach clients taking  Prostatectomy postoperative care: Teach
alpha-blockers (tamsulosin) to slowly change clients to avoid straining and strenuous activity
positions to prevent orthostatic hypotension. for 6 weeks and perform Kegel exercises for
Teach clients taking 5α-reductase inhibitors incontinence.
(finasteride) that pregnant women should avoid
handling the medication.

© Bootcamp.com 3
  What are the two primary methods used for  Clients taking alpha-blockers should slowly
prostate cancer screening? What factors classify change positions to prevent _____. Teach clients
individuals as high-risk, requiring prostate taking 5-alpha reductase inhibitors that _____
screening before age 50? should avoid handling the medication.

 Clients with BPH should drink _____ L/day of fluid,  After prostate surgery, clients should avoid
limit fluid intake near _____, and avoid medications straining and _____ for 6 weeks and perform
such as _____ and anticholinergics to prevent _____ exercises to help with incontinence.
worsening symptoms.

 Adjust continuous bladder irrigation to maintain

_____ urine and report _____ blood. What are three
findings that indicate TURP syndrome?

Confusion, vomiting, hypertension 4. orthostatic hypotension; pregnant women 5. strenuous exercise, Kegel
Answers: 1. PSA blood test, DRE; Black ethnicity, family history of prostate cancer 2. 2-3, bedtime, decongestants 3. light pink, bright red;

Renal/Urinary

References:

Callahan, B., Hand, M., & Steele, N. (Eds.). (2023). Nursing: A concept- Ignatavicius, D., Heimgartner, N., & Rebar, C. (Eds.). (2024). Medical-
based approach to learning (4th ed., Vol 1). Pearson. surgical nursing: Concepts for clinical judgment and
collaborative care (11th ed.). Elsevier.
Harding, M. M., Kwong, J., Hagler, D., & Reinisch, C. (Eds.).
(2023). Lewis’s medical-surgical nursing: Assessment and Tyerman, J., Cobbett, S., Harding, M. M., Kwong, J., Roberts, D.,
management of clinical problems (12th ed.). Elsevier. Hagler, D., Reinisch, C. (Eds.). (2023). Lewis’s medical-surgical
nursing in Canada: Assessment and management of clinical
problems (5th ed.). Elsevier.

© Bootcamp.com 4
 Table of Contents:
1. Brain Injuries & Intracranial Pressure 4. Craniotomy
2. Increased Intracranial Pressure 5. Ventriculostomy
3. Traumatic Brain Injury & Hematoma

Brain Injuries & Increased ICP

1. Brain Injuries & Intracranial Pressure 2. Increased Intracranial Pressure

Brain injuries can be traumatic or non-traumatic Causes
(stroke, infection) and causeintracranial pressure (ICP). Anything thatbrain tissue, blood, or CSF without
y Traumatic brain injuries (TBIs) result from head compensatoryin the other components, such as:
trauma, such as falls or blunt force injuries, and can y TBI, hematomas
cause bleeding in or around the brain (hematoma). y Stroke
y ICP can lead to seizures, coma, and death.

Neurologic
y Hydrocephalus
y In severe cases, a craniotomy may be required to y Brain tumors
relieve pressure and drain blood. y Meningitis
y A ventriculostomy can be placed to measure ICP y See related CHEAT SHEETS for more information.
and drain excess CSF.
Assessment findings
ICP regulation
y The ICP, or pressure within the skull, remains stable If ICP is too high, cerebral perfusion, and CSF flow
by balancing volumes of brain tissue, blood, and can become obstructed, increasing the risk for brain
cerebral spinal fluid (CSF) (TABLE 1). herniation. Recognizing signs ofICP is critical for
y If one component(blood volume from preventing permanent brain damage (TABLE 2).
hemorrhage), another mustto maintain normal ICP.
y Failure to compensate ICP TABLE 2. EARLY VS. LATE SIGNS OF INCREASED ICP
y Normal ICP: 5-15 mmHg

Increased ICP: >20 mmHg = emergency Early signs Late signs

TABLE 1. ICP REGULATION
LOC (earliest,
Cushing Triad:

most sensitive Widening
indicator) pulse pressure,

Restlessness, bradycardia, irregular
confusion respirations (Cheyne-
y Headache Stokes)
y Vomiting y Fixed, dilated pupils
y Vision changes y Decorticate or
(blurred, diplopia) decerebrate posturing
(see FIGURE 1)

Infants might have a high-pitched cry and bulging

fontanels (see NEURAL TUBE DEFECTS & HYDROCEPHALUS
CHEAT SHEET for more info).

 Increased ICP: The earliest and most

sensitive sign of increasing ICP is a
decreased LOC.

© Bootcamp.com 6
2. Increased Intracranial Pressure, Continued

Reduce stimulation.
FIGURE 1. POSTURING y Minimize coughing, sneezing, and straining
(Valsalva maneuver).
y Administer stool softeners to
prevent straining.
y Limit suctioning.
y Avoid performing multiple procedures
simultaneously (clustering care), which
canagitation and ICP.
y environmental stimuli (minimize noise, dim
lights, limit visitors).
y Prevent hypoxia, hypercapnia, and
hypotension, which furthercerebral
oxygenation and perfusion.

Neurologic

If intubated, hyperoxygenate with 100%
oxygen before and after suctioning.
y Administer IV fluids for adequate cerebral
perfusion as prescribed.
y Maintain normothermia (shivering ICP).
y Administer osmotic diuretics (mannitol) and
hypertonic saline tocerebral edema by
drawing excess fluid from the brain into the
intravascular space.
Interventions 2. Monitor neurological status:
Care for a client withICP from any cause focuses on: y Perform frequent neurological assessments to
1. Managing ICP monitor for worsening condition.
2. Monitoring neurological status y Assess LOC using GCS (TABLE 3).
3. Preventing injury y 15 = alert
y ≤8 = coma, requires intubation (“Less
1. Manage ICP:
than 8 = intubate”)
y Prepare client for CT scan or MRI to identify the y Report changes in GCS to HCP.
cause and guide treatment. y Assess pupils for size and reaction to light

Position the client’s head to promote venous and notify HCP of any changes.
drainage. y Assess for motor loss or dysfunction
y HOB at 30 degrees (paralysis, posturing).
y Avoid Trendelenburg position.
Monitor for Cushing triad, which indicates life-
y Keep head midline. thre atening brainstem herniation.
y Avoid extreme neck flexion. y Widening pulse pressure (difference between
y Avoid hip flexion. systolic and diastolic BP)
y Bradycardia
y Irregular respirations (Cheyne-Stokes)
y Monitor ICP with ventriculostomy if present
(see VENTRICULOSTOMY).

 Positioning: Position a client with increased ICP  Avoid ICP spikes: Teach the client with increased ICP
with the HOB 30 degrees and head midline. Avoid to avoid straining and coughing. Limit suctioning
Trendelenberg position and hip or neck flexion. and avoid performing multiple procedures
simultaneously. Decrease environmental stimuli
(minimize noise, dim lights, limit visitors).

© Bootcamp.com 2
2. Increased Intracranial Pressure, Continued 3. Traumatic Brain Injury & Hematoma
3. Prevent injury: Pathophysiology
y There is anrisk for injury in clients withICP y A TBI is a disruption in brain function from injury
due to confusion, agitation, inability to protect the to the scalp, skull, or brain (falls, motor
airway, and risk for seizures. vehicle collisions).

Monitor for changes in respirations like snoring, y TBIs can lead to hematomas, whichICP and
which can indicate airway obstruction. worsen neurological outcomes.
y Anticipate mechanical ventilation for y Severity ranges from mild (concussion) to
Glasgow coma scale (GCS) score ≤8. severe (death).
y Implement seizure precautions (padded Types of TBIs
bed rails). y Concussion (mild TBI): Sudden temporary disruption
y Administer anticonvulsant medications as of brain function that causes headache and confusion
prescribed (phenytoin). y Contusion: Bruising of brain tissue, often causing
y Administer short-acting sedatives (propofol) as localized deficits depending on the affected

Neurologic
needed for agitation, which canICP. brain region
y Sedating medications may need to be y Hematoma: Collection of blood in the skull
temporarily stopped or held for accurate y Skull fracture: Break in the skull
assessment of LOC.
Types of hematomas
y Apply restraints if indicated (to prevent pulling
on tubes). Hematomas are classified based on location within the
skull (FIGURE 2).
y Epidural hematoma (surgical emergency): Bleeding
TABLE 3. GLASGOW COMA SCALE
above the dura mater
y Usually an arterial bleed, rapid deterioration
Response Score

Classic sign: Loss of consciousness  Lucid
period (period of alertness)  Rapid decline
Eye Opening 4. Spontaneous

Requires immediate craniotomy to evacuate the
(4 points) 3. To voice
hematoma and lower ICP
2. To pain
y Subdural hematoma: Bleeding below the dura and
1. None
arachnoid mater
y Usually a venous bleed, slower onset
Verbal 5. Oriented y Can be chronic or go undetected
Response 4. Disoriented
(5 points) 3. Inappropriate words
2. Incomprehensible FIGURE 2. EPIDURAL AND SUBDURAL HEMATOMA
1. None

Motor 6. Obeys commands

Response 5. Localizes to pain
(6 points) 4. Flexes away from pain
3. Decorticate posture
2. Decerebrate posture
1. None

Total score: 3-15

Scores ≤8 usually indicate coma and require
mechanical ventilation.

© Bootcamp.com 3
3. Traumatic Brain Injury & Hematoma, Continued
Interventions 3. Monitor for CSF leaks:
Following a head injury, care focuses on: y CSF leaks occur when the dura tears from a
1. Assessing the TBI skull fracture or surgery. This open connection to
2. Managing ICP the brainrisk for meningitis.
3. Monitoring for CSF leaks y Loosely apply a sterile dressing to the nose
or ear to collect drainage and monitor for
1. Assess the TBI:
CSF leakage.
y After a head injury, a neck injury may also be
Assess for fluid leaking from the nose and ears
present; place the client in a cervical collar and (rhinorrhea, otorrhea) and notify HCP if present.
do not remove it until cervical spine injury is ruled y Positive glucose: Test any fluid leaking from
out (clear X-ray, movement and sensation intact). the nose or ear for the presence of glucose
y Prepare client for a CT scan. (CSF contains glucose).

Monitor for signs of skull fracture, including: y “Halo” sign: Collect fluid on gauze and

Battle sign or raccoon eyes, which indicate

Neurologic
observe; a yellow ring around the blood
basilar skull fracture (fracture at base of indicates CSF (FIGURE 3).
skull) (FIGURE 3) y If a CSF leak is present, this creates an open
y CSF leaks: Fluid leaking from nose or ears connection to the brainrisk for meningitis.
(see 3. MONITOR FOR CSF LEAKS)
Do not suction the nose or place NG tube.
y Prepare client for emergency craniotomy
Teach client to avoid sneezing or
toICP if necessary (see CRANIOTOMY). blowing nose.
y For clients with mild TBI (concussion), frequently
Do not clean the ear if drainage occurs.
monitor LOC, pupil size, and for early signs of
increased ICP (see TABLE 2).

TABLE 4. POSTCONCUSSION TEACHING
y Clients with mild TBI are often discharged
home with a caregiver and given instructions
for monitoring (TABLE 4). y Do not leave the client alone.
y Headaches and cognitive impairment that y Notify HCP immediately for seizures, worsening
persist for one month after injury may indicate headache, persistent nausea/vomiting, vision/
postconcussion syndrome, which can limit motor/sensory changes, behavior changes, or
ability to perform ADLs. increasing drowsiness.
y Avoid sedatives like alcohol, opioids, and muscle
2. Manage ICP: relaxants.
y Assess for signs ofICP (LOC, headache, y Take acetaminophen for headache, as it does
vomiting, pupil changes) (TABLE 2). notbleeding risk or cause sedation.
y Monitor LOC using GCS. y Avoid strenuous activity and contact sports as
y Provide interventions toICP (see INCREASED directed.
INTRACRANIAL PRESSURE). y Gradually return to activity when permitted.
y HOB at 30 degrees to promote venous
drainage
y Limit environmental stimuli.

Avoid activities thatICP (straining,
coughing).
y Implement seizure precautions if needed.

 Cushing triad: Cushing triad is a life-threatening  CSF leak: Test any drainage from the ears or nose
late sign of increased ICP. It is characterized for the presence of glucose. A halo sign around
by widening pulse pressure, bradycardia, and blood on a dressing indicates CSF (a yellow ring of
irregular respirations. CSF forms around the blood).

© Bootcamp.com 4
3. Traumatic Brain Injury & Hematoma, Continued 5. Ventriculostomy
y Ventriculostomy: A catheter placed in the ventricle to
FIGURE 3. BASILAR SKULL FRACTURE measure ICP and drain excess CSF (FIGURE 4)
y ICP waveform monitoring helps detect pressure
fluctuations.
y Nursing interventions
y Ensure the transducer is level with the tragus of
the ear.
y Relevel every time the client is repositioned.
y Maintain a sterile dressing to prevent infection.
y Monitor for CSF leakage, infection, or catheter
displacement.

FIGURE 4. VENTRICULOSTOMY

Neurologic
4. Craniotomy
A craniotomy is the surgical removal of hematomas,
tumors, or clots from the brain; a bone flap may be
temporarily removed to relieve pressure.
Postoperative nursing interventions
Post-craniotomy, the primary focus is monitoring for
and preventing complications likeICP, bleeding, fluid
imbalances, CSF leaks, and DVTs.
y Elevate HOB 30 degrees.

Avoid lying on the operative side to
preventpressure, whichblood flow to the brain.
y Perform frequent neurological checks to
detectICP (LOC, pupils, motor response).
y Monitor for and report complications, including:

CSF leaks (halo sign, positive glucose)
y Seizures
y Hemorrhage (bleeding at surgical site, signs
ofICP)
y Infection (fever, stiff neck, headache)
y Administer medications as prescribed.
y Anticonvulsants torisk for seizures
y Antiemetics to prevent post-op vomiting that
couldICP
y Analgesics, like short-acting opioids (morphine,
fentanyl)

Avoid over-sedation, which can mask neuro
changes on exam.
y Corticosteroids toinflammation
y DVT prophylaxis (anticoagulants)
y Maintain ventriculostomy to monitor ICP if present
(see VENTRICULOSTOMY).

© Bootcamp.com 5
  What is the earliest sign of increasing ICP?  What are the three signs of the Cushing triad?

 A client with increased ICP should be positioned  Drainage from the ears or nose should be tested
with the HOB _____ degrees and head _____. for the presence of _____, which indicates CSF.
What positions should be avoided for a client with What is the halo sign?
increased ICP?

 Clients with increased ICP should avoid _____ and

_____ (what actions?). Nurses should perform
suctioning _____ (routinely or only as needed?).
The nurse should perform multiple procedures
simultaneously (True or False?). How can
environmental stimuli be decreased?

Neurologic
yellow ring forms around blood, indicating CSF.
lights, and limit visitors. 4. Widening pulse pressure, bradycardia, irregular respirations 5. glucose; Blood collects in the center of the gauze, and a
Answers: 1. Decreased LOC 2. 30, midline; Trendelenberg, hip and neck flexion 3. straining, coughing; only as needed; False; Minimize noise, dim

References:

Callahan, B., Hand, M., & Steele, N. (Eds.). (2023). Nursing: A concept- Ignatavicius, D., Heimgartner, N., & Rebar, C. (Eds.). (2024). Medical-
based approach to learning (4th ed., Vol 1). Pearson. surgical nursing: Concepts for clinical judgment and
Harding, M. M., Kwong, J., Hagler, D., & Reinisch, C. (Eds.). collaborative care (11th ed.). Elsevier.
(2023). Lewis’s medical-surgical nursing: Assessment and Tyerman, J., Cobbett, S., Harding, M. M., Kwong, J., Roberts, D.,
management of clinical problems (12th ed.). Elsevier. Hagler, D., Reinisch, C. (Eds.). (2023). Lewis’s medical-surgical
Hockenberry, M., Duffy, E.A., & Gibbs, K. (2024). Wong’s nursing care nursing in Canada: Assessment and management of clinical
of infants and children (12th ed.). Elsevier. problems. (5th ed.). Elsevier.

Urden, L. D., Stacy, K. M., & Lough, M. E. (2022). Critical care nursing:
Diagnosis and management (9th ed.). Elsevier.
© Bootcamp.com 6
 Table of Contents:
1. Pathophysiology 4. Rehabilitative Phase
2. Emergent Phase 5. Carbon Monoxide Poisoning
3. Acute Phase 6. Electrical & Chemical Burns

Burns & Inhalation Injury

1. Pathophysiology
A burn injury is skin damage caused by heat, chemicals, Management depends on burn severity:
electricity, or radiation.
Minor burns (1st degree) can be treated at home by
soaking in cool water (no ice) to stop the burning.
Burn severity is determined by:

Staging the depth of damage (TABLE 1)
Major burns cause systemic complications from
extensive tissue damage and typically require transfer

Total body surface area (TBSA) burned, calculated
to a burn center (e.g., large TBSA burned or burns to
using the rule of 9s (TABLE 2):
face, joints, hands, or feet).
y 36% torso
y 18% each leg Pathophysiology
y 9% each arm y Major burn injury  Extensive tissue damage 
y 9% head Release of vasoactive mediators  capillary
y 1% genitalia permeability (capillary leak)  Fluid shifts out of
intravascular space into surrounding tissues  Edema
and hypovolemia  organ perfusion

TABLE 1. BURN STAGING TABLE 2. RULE OF 9S

Degree Depth Appearance Example

Superficial y Dry
1st (Epidermis) y Pink to red
degree y Mild swelling

Integumentary
and pain

Superficial
Moist, weeping, blisters

Partial y Pink to red
Thickness y Severe pain
(Dermis)
2nd
degree
Deep Partial y Waxy and dry with
Thickness blisters that rupture easily
(Deep Dermis) y White to red
y Severe pain
y Each % shown = total area
Full Thickness y Dry and elastic of front + back (except groin).
3rd & 4th (Hypodermis) y Waxy white to black
y Example: 9% for front of leg
degree
No pain (from damaged
+ 9% for back of leg = 18%
nerve endings)

 Total body surface area (TBSA) burned is calculated using the rule of 9s: 36% torso, 18% each leg, 9% each
arm, 9% head, and 1% genitalia.

© Bootcamp.com 5
1. Pathophysiology, Continued y Burns to face or neck area
y Cell death and rupture  Widespread release of y Tight eschar on the chest or abdomen can
potassium and lactic acid from cells, which causes: also restrict respirations.

potassium (risk for arrhythmias) Interventions:
y Metabolic acidosis (lactic acidosis)
Administer 100% oxygen via face mask.
y Sodium and water shift out of the vascular space 
Raise the HOB.
intravascular volume and concentrates the blood,
Anticipate intubation:
which causes: y Intubation may be performed prophylactically
y pulse andBP to keep the airway open as edema develops.
y sodium levels
2. Maintain circulation and perfusion:
y hemoglobin and hematocrit
y Burns destroy the protective skin layer that serves as a Following airway management, the #1 priority during
barrier to pathogens and heat loss, increasing risk for: the emergent phase = IV fluid resuscitation.

Infection y Insert two large bore VADs or prepare for central
y Hypothermia line insertion.
Burn care occurs in three phases:
Administer isotonic fluids such as lactated
y Emergent (resuscitative) phase: Ringer’s solution or normal saline to restore
y From time of injury until capillary leak stops fluid in the intravascular space.
(usually within 24-48 hr) y Calculate the IV fluid volume for the first 24 hr
y Acute (wound-healing) phase: using the Parkland formula.
y From time capillary leak stops until burns
are healed or covered with grafts (during the
following weeks to months) TABLE 3. PARKLAND FORMULA
y Rehabilitative (restorative) phase:
y From time of wound healing until client achieves
highest level of function (weeks to years)

2. Emergent Phase
Emergent (resuscitative) phase priorities include:
1. Protecting the airway

Integumentary
2. Maintaining circulation and perfusion
3. Preventing hypothermia and infection
4. Relieving pain
1. Protect the airway:
It is a priority to assess for inhalation injury on all
Example: 100 kg client with 20% TBSA burned
clients with burn injuries.
1. 4 mL x 20% x 100 kg = 8,000 mL during the
Heat and inhaled smoke  Airway edema first 24 hr
Findings: 2. Give one half (4,000 mL) in the first 8 hr.
y Soot around nose or mouth 3. Give the remaining half (4,000 mL) in the next

Soot-tinged sputum 16 hr.

Hoarse voice

Singed nasal hair

 Singed nasal hair and hoarse voice indicate  In the emergent phase, giving isotonic IV fluids
inhalation injury. Administer 100% oxygen via is the priority intervention to treat hypovolemia.
face mask and anticipate intubation. Perfusion is adequate if the client has a urine
output ≥30 mL/hr, pulse <120, and SBP ≥90.

© Bootcamp.com 2
2. Emergent Phase, Continued 1. Prevent infection:
y Evaluate effectiveness of IV fluid resuscitation.
#1 priority during the acute phase = infection
The most reliable indicators of adequate prevention.
perfusion in burn injuries are: y Keep burns covered with clean dressings.

Urine output ≥30 mL/hr
Initiate protective isolation:
y Pulse <120/min y Perform strict hand hygiene.
y SBP ≥90 mmHg y Wear PPE (gown, masks, shoe covers) to
FIGURE 1. FASCIOTOMY prevent contamination of burns.
y Insert urinary catheter to
monitor urine output closely. y Monitor for infection:
y Excessive drainage
Extremity perfusion: y Odor
y Elevate burned extremities y Erythema of wound edges
to reduce edema (unless y Wound or graft care (TABLE 4) focuses on:
fractures are present). y Promoting adherence and preventing graft
y Circumferential burns on detachment
extremities  “Tourniquet” y Monitoring for signs of infection and rejection
effect  Compartment
syndrome (limb ischemia) 2. Maintain fluid balance:
y Prepare for
Monitor hourly urine output and daily weights.
escharotomy or y Administer prescribed IV fluids.
fasciotomy: Cutting
Monitor for fluid volume overload:
through burned tissue y Crackles
or fascia relieves y Shortness of breath
pressure and restores perfusion. y Worsening edema

3. Prevent hypothermia and infection:

y Warm the room and provide warm blankets. TABLE 4. BURN WOUND & GRAFT CARE
y Remove non-adhered clothes.
y If clothes are adhered to burn, cut clothes off Treatment Interventions
around the burn.

Cover burns with clean, dry cloths. Topical
Assess client for sulfa
antimicrobials allergy before applying

Integumentary
4. Relieve pain:
y Administer IV opioids to reduce pain. (silver nitrate, burn creams; most

Clients with major burn injuries cannot absorb sulfadiazine) contain sulfa.
medications by the IM, SQ, and PO routes
due to impaired tissue perfusion. Instead, give Debridement y Administer analgesics
medications via IV only. Removal of before debridement.
y Exception: Tetanus vaccine must be given IM. necrotic tissue to y Apply topical antimicrobials
promote healing to reduce infection risk.
3. Acute Phase
Acute (wound healing) phase priorities include: Skin graft y Monitor for graft infection
1. Preventing infection or rejection (odor, dusky
Autograft:
2. Maintaining fluid balance appearance).
Client’s skin
3. Maintaining adequate nutrition y Immobilize and elevate
4. Managing pain Allograft: site to prevent graft
Donor skin detachment.
y Apply bandages to
promote graft adherence.

 Do not administer PO, IM, or SQ medications to burn clients. Administer medications via IV only.

© Bootcamp.com 3
3. Acute Phase, Continued 5. Carbon Monoxide Poisoning
3. Maintain adequate nutrition: Pathophysiology
y Clients with burns have very high calorie and y Carbon monoxide binds to hemoglobin more
protein needs to support tissue repair. strongly than oxygen  Oxygen is “knocked off” of

Implement a high-calorie, high-protein diet as hemoglobin  Less oxygen delivered to tissues 
soon as bowel sounds are present. Hypoxia
y Insert NG tube for enteral nutrition if PO intake y Pulse oximeter cannot distinguish between oxygen
is insufficient to meet calorie needs. and carbon monoxide  Clients with carbon
y Monitor calorie counts and daily weights. monoxide poisoning have a false normal pulse
y Monitor for absent or hypoactive bowel oximetry reading.
sounds, which could indicate gastric ileus
Findings:
caused bygastric perfusion.
y Cherry-red, flushed skin
4. Manage pain: y Headache
y Administer IV opioid analgesics. y Dizziness

Premedicate the client with analgesics before

Interventions:
wound care or physical therapy.
y Administer 100% oxygen via face mask, even
with normal pulse oximetry reading.
4. Rehabilitative Phase
y High concentrations of oxygen are needed
Rehabilitative (resuscitative) phase priorities include: to displace carbon monoxide from
1. Preventing scars hemoglobin.
2. Increasing functional capacity
3. Providing emotional support 6. Electrical & Chemical Burns
1. Prevent scars: Electrical burns
y Apply water-based lotion to keep skin Electrical burns can appear small on the surface but
moisturized and reduce itching. cause extensive internal damage as electricity travels
y Apply pressure bandages to healed burns to through tissues and organs, resulting in:
minimize scarring. y Violent muscle contractions that can cause spinal
y Cover wounds when outside and avoid direct injuries
sunlight to the area. If sunlight exposure is y Electrical changes in the heart that can cause
unavoidable, apply sunscreen.

Integumentary
arrhythmias
2. Increase functional capacity: Interventions:
y Burns involving face, hands, feet, joints, or
Immobilize cervical spine to stabilize potential
genitalia require extensive rehabilitation. spinal injuries.
y Apply splints to maintain joint positioning and
Place client on ECG monitor to identify arrhythmias.
prevent contractures. y Anticipate transfer to a burn center.
y Participate in physical therapy and range-
Chemical burns
of-motion exercises to improve mobility and
Chemical burns occur when corrosive substances (drain
prevent contractures. cleaner, ammonia) come into contact with the skin or eyes.
3. Provide emotional support: Interventions:

Use therapeutic communication to discuss
#1 priority if the client is stable = brush off
client’s concerns regarding changes in body chemicals and remove contaminated clothing.
image and functional status. y Flush skin or eyes with water.
y Provide information on community resources like
burn support groups.
y Coordinate referrals to psychiatric and mental
health services as needed.

 #1 priority for carbon monoxide poisoning is 100% oxygen via face mask, even if pulse oximetry is normal.

© Bootcamp.com 4
  Using the rule of 9s, a client with a burn to the  Which medication routes should be avoided
entire torso and head has a burned TBSA of for clients with burns?
____%.
 What is the priority intervention for a client with
 Inhalation injury should be suspected for a carbon monoxide poisoning who has a pulse
client with a _______voice. The nurse should oximetry reading of 100%?
immediately administer ___________.

 After ensuring a patent airway, the priority

intervention for a client with major burns is
__________.

Answers: 1. 45 2. hoarse, 100% oxygen 3. IV fluid resuscitation 4. PO, intramuscular, and subcutaneous 5. Administer oxygen

Integumentary
References: Attributions:

Callahan, B., Hand, M., & Steele, N. (Eds.). (2023). Nursing: A y Staging Table: Modified from: Wikimedia Commons
concept-based approach to learning (4th ed., Vol 1). y Rule of 9s: Created with BioRender.com
Pearson. y Parkland Formula: Created with BioRender.com
y Fasciotomy: Wikimedia Commons
Harding, M. M., Kwong, J., Hagler, D., & Reinisch, C. (Eds.).
(2023). Lewis’s medical-surgical nursing: Assessment and
management of clinical problems (12th ed.). Elsevier.

Ignatavicius, D., Heimgartner, N., & Rebar, C. (Eds.). (2024).

Medical-surgical nursing: Concepts for clinical judgment
and collaborative care (11th ed.). Elsevier.

Tyerman, J., Cobbett, S., Harding, M. M., Kwong, J., Roberts, D.,
Hagler, D., Reinisch, C. (Eds.). (2023). Lewis’s medical-
surgical nursing in Canada: Assessment and management
of clinical problems. (5th ed.). Elsevier.
© Bootcamp.com 5
 Table of Contents:
1. Pathophysiology & Warning Signs 4. Chemotherapy
2. Biopsy & Diagnosis 5. Radiation
3. Pain & Psychosocial Support 6. Oncological Emergencies

Cancer

1. Pathophysiology & Warning Signs

TABLE 1. RISK FACTORS & SCREENING FOR MAJOR CANCERS
Cancer = uncontrolled growth of
abnormal cells.
Average Screening Age
y Cancer can develop in any tissue, Cancer Risk Factors
(Varies)
including soft tissues (tumors) or blood
and bone marrow (leukemia), and can
Breast BRCA mutations, Mammograms starting at
spread to other parts of the body.
longer cumulative age 40-50
y Key nursing interventions include
estrogen exposure
screening at-risk clients and teaching
(early menarche, late
clients about risk reduction.
menopause, nulliparity)
General causes and risk factors
y Advancing age Lung Smoking, asbestos CT scan for high-risk
y Genetics (BRCA1/BRCA2 mutations)

Hematologic/Oncologic
exposure individuals (heavy smokers)

Environmental exposures (smoking,
UV light) Colorectal Family history, age Colonoscopy starting at age
y Some medications >50, inflammatory 45; fecal occult blood test
(immunosuppressants) bowel disease, diet high annually starting at age 45-50
y Chronic inflammation (ulcerative colitis) in red meat
y Viruses (HPV for cervical cancer,
Epstein-Barr virus for lymphoma) Prostate Age >65, Black PSA levels, and digital rectal
y Additional risk factors and screening ethnicity, family history exams starting at age 40-50
protocols vary by specific cancer
(TABLE 1). See related CHEAT SHEETS for more information.
Warning signs

Teach clients to report concerning signs of cancer 2. Biopsy & Diagnosis
(CAUTION):
When cancer is suspected, a biopsy (tissue sample) and
y Change in bowel or bladder habits
imaging are performed for diagnosis and staging.
y A sore that does not heal
y CT, MRI, and PET scans are performed for staging
y Unusual bleeding or discharge
and detecting metastases.
y Thickening or lump in breast or elsewhere
y Stages:
y Indigestion or difficulty swallowing
y Stage 0: Carcinoma in situ (in one place)
y Obvious change in a wart or mole
y Stage I-II: Localized or early regional spread
y Nagging cough or hoarseness
y Stage III: Extensive regional spread
y Stage IV: Metastatic cancer (distant spread,
often liver or bone)

 Cancer warning signs: Teach clients to monitor for warning signs of cancer, such as CAUTION, Change
in bowel habits, A sore that does not heal, Unusual bleeding or discharge, Thickening or lump in breast or
elsewhere, Indigestion or dysphagia, Obvious change in wart or mole, Nagging cough or hoarseness.

© Bootcamp.com 4
3. Pain & Psychosocial Support y Monitor for infection (leukocytosis).
Pain
Clients with low-grade fevers or any signs of
y Cancer can cause extreme chronic pain. infection should immediately notify the HCP.

Manage pain with NSAIDs, opioids, and
Implement neutropenic precautions if
adjuvant medications (corticosteroids) necessary (TABLE 2).
as prescribed. y Monitor for anemia (RBC count).
y Administer analgesics on a regular schedule
Administer erythropoietin as prescribed to
(around the clock) with additional doses for stimulate RBC production.
breakthrough pain (see ANALGESICS y Encourage rest to combat fatigue.
CHEAT SHEET). y Monitor platelet counts for thrombocytopenia.
y Encourage nonpharmacological pain y Avoid invasive procedures (IM injections,
management (meditation, music). enemas) and forceful nose blowing that

Clients choosing palliative care can undergo could damage tissues.
chemotherapy, radiation, and surgery to help y Avoid aspirin.
symptoms.
Use a soft bristle toothbrush and
electric razor.
Psychosocial Support

Notify HCP of signs of bleeding (petechiae).
y Refer client to support groups.
y Administer antiemetics (ondansetron) to help
y Discuss expectations of treatments.
with GI side effects.
y Actively listen to client concerns (chemotherapy side
y Assist clients with peripheral neuropathy to
effects, infertility, end-of-life).
prevent falls.

Hematologic/Oncologic
y Perform oral care after each meal and at bedtime
4. Chemotherapy
to help with mucositis.
Chemotherapy is a mainstay of cancer treatment y Recommend oral rinses and soft-bristled
and may also be combined with radiation or toothbrushes.
surgical therapies. y Avoid overly hot, cold, spicy, or rough food
y Chemotherapy: Systemic medications that kill that can injure tissues.
rapidly dividing cancer cells but also affect healthy y Use appropriate PPE when handling
cells, especially in the bone marrow, GI tract, and chemotherapy drugs and the bodily fluids of
mucous membranes clients receiving treatment.
y Common adverse effects of chemo: y Chemotherapy can be absorbed through skin

Bone marrow suppression  Neutropenia, or mucous membranes during preparation.
anemia, and thrombocytopenia (WBC, y Bodily fluids and excretions may contain
hemoglobin, andplatelets) chemotherapy residues, requiring
y Gastrointestinal: Nausea, vomiting, diarrhea, careful handling.
mucositis (inflammation of mucous membranes
of the GI tract) TABLE 2. NEUTROPENIC PRECAUTIONS
y Hair loss (alopecia)
y Peripheral neuropathy
y Place client in a private room.
y Nursing interventions:
y Do not enter if you are not feeling well.
y Use central lines or implanted ports to
y Perform hand hygiene before entering the room.
administer chemotherapy drugs, which are
y Use dedicated equipment (stethoscope).
vesicants, to prevent extravasation (vesicant
y Disinfect all equipment.
leaks into surrounding tissues  tissue necrosis).
y Avoid raw foods (fruits, vegetables, eggs,
shellfish).

 Chemotherapy adverse effects: The nurse should monitor the client’s WBC and hemoglobin levels
and temperature to detect infection and bone marrow suppression. Clients with neutropenia should
report low-grade fevers to the HCP.

© Bootcamp.com 2
5. Radiation Therapy
Radiation therapy: Localized treatment

TABLE 3. INTERNAL RADIATION SAFETY (BRACHYTHERAPY)
destroys cancer cells by damaging
their DNA.
y Types: Time y Cluster care.
y External beam radiation: Targets y Wear a film badge (dosimeter) to monitor exposure
specific body areas (never share badge).
y Brachytherapy: Radioactive y Limit each visitor’s time (e.g., 30 min/day).
seeds are implanted directly into
the tumor (client is considered Distance y Stay at the foot of bed as much as possible.
radioactive). y Visitors should keep as much distance as possible
y Common side effects: (e.g., 6 ft [2 m]).
y Fatigue

Localized skin changes Shielding y Wear lead aprons.
(redness, peeling) y Position a lead shield in front of the implant to
y Local tissue effects (esophagitis in protect caregivers and visitors.
neck/chest radiation) y Keep client’s door closed.
y Nursing interventions:
If implant is dislodged, do not pick up with bare
y Teach clients to avoid irritating or hands (use lead gloves or long forceps).
injuring sensitive skin.

Use mild soaps. 6. Oncological Emergencies

Hematologic/Oncologic

Avoid scented lotions and soaps.
Oncological emergencies are life-threatening

Wear loose clothing.
complications of cancer or cancer treatments.
y Avoid friction (gently pat skin dry, wash with
y Tumor lysis syndrome: Chemotherapy causes rapid
their hands instead of a washcloth).
destruction of tumor cells  Release of cellular

Avoid sun exposure to the irradiated area
contents  Metabolic imbalances
during and after treatment.
y Symptoms:potassium, uric acid, and
y Encourage rest and hydration to help with fatigue.
phosphate; andcalcium

To minimize radiation exposure when caring
y Nursing actions:
for clients receiving brachytherapy, follow the

Administer IV fluids and diuretics to correct
principles of time, distance, and shielding
electrolyte imbalances.
(TABLE 3).

Administer allopurinol touric acid.
y Caregivers who are pregnant should not
y Hypercalcemia of malignancy: Due to bone resorption
care for these clients.
from bone cancers or PTH-secreting tumors
y Do not allow children or pregnant women
y Symptoms: Nausea, muscle weakness, polyuria
to visit.
y Nursing actions:

Administer IV fluids and diuretics to
calcium loss through urination.

Administer bisphosphonates to inhibit
bone resorption.

 Radiation skin care: Teach clients receiving radiation  Tumor lysis syndrome: For clients receiving
to protect irradiated skin by using mild soap, chemotherapy, monitor electrolytes to
avoiding scented lotions, avoiding sun exposure, detect tumor lysis syndrome (hyperkalemia,
and wearing loose clothing. hyperuricemia, hyperphosphatemia, and
hypocalcemia). If tumor lysis syndrome occurs,
 Brachytherapy safety: When caring for clients
correct electrolyte imbalances with IV fluids and
with internal radiation (brachytherapy) follow the
diuretics and administer allopurinol to decrease
principles of time (cluster care), distance (stay
uric acid.
at foot of the bed), and shielding (lead apron) to
minimize exposure.
© Bootcamp.com 3
6. Oncological Emergencies, Continued
y Superior vena cava (SVC) syndrome: Tumor in the y Syndrome of inappropriate antidiuretic hormone
neck/chest obstructs the SVC (SIADH): Tumors and chemotherapy can cause
y Symptoms: Upper body edema, including facial production of antidiuretic hormone (ADH), leading to
swelling, periorbital edema, distended neck and water retention and dilutional hyponatremia.
chest veins y Symptoms: Weakness, personality changes,
y Nursing actions: Anticipate chemotherapy seizures, and coma
and radiation. y Nursing actions: Implement fluid restriction,
y Spinal cord compression: Tumor in epidural space monitor sodium levels, and administer sodium
or around spinal cord supplementation.
y Symptoms: Severe, persistent back pain; motor
weakness; sensory deficits
y Nursing actions: Prepare client for radiation or
possible surgery.

Hematologic/Oncologic
 Teach clients to report warning signs of cancer  What principles should be followed to minimize
including CAUTION: C_____, A_____, U_____, radiation exposure when caring for clients
T_____, I_____, O_____, N_____. receiving internal radiation (brachytherapy)?

 To detect complications of chemotherapy, such as  Which electrolyte imbalances are present in

infection and bone marrow suppression, the nurse tumor lysis syndrome? To correct electrolyte
should monitor the client’s _____ and _____ levels, imbalances, administer _____ fluids and _____,
and _____ (vital sign?). Clients with neutropenia and decrease uric acid by administering _____.
should report _____ fevers to the HCP.

 Teach clients receiving radiation to protect irradiated

skin by using _____ soap, avoiding _____ lotions,
avoiding _____ exposure, and wearing ____
clothing.
3. mild, scented, sun, loose 4. Time, distance, and shielding 5. Hyperkalemia, hyperuricemia, hyperphosphatemia, and hypocalcemia; IV, diuretics, allopurinol
Indigestion or difficulty swallowing, Obvious change in a wart or mole, Nagging cough or hoarseness 2. WBC, hemoglobin, temperature; low-grade
Answers: 1. Change in bowel or bladder habits, A sore that does not heal, Unusual bleeding or discharge, Thickening or lump in breast or elsewhere,

References:

Burchum, J.R., & Rosenthal, L.D. (2019). Lehne’s pharmacology for McKinney, E., Mau, K., Murray, S., James, S., Nelson, K., Ashwill,
nursing care (10th Edition). Elsevier Health Sciences (US). J., & Caroll, J. (2022). Maternal-child nursing (6th ed.).
Callahan, B., Hand, M., & Steele, N. (Eds.). (2023). Nursing: A Elsevier.
concept-based approach to learning (4th ed., Vol 1). Rogers, J. (2023). McCance & Huether’s pathophysiology (9th ed.).
Pearson. Elsevier.
Ignatavicius, D., Heimgartner, N., & Rebar, C. (Eds.). (2024). Tyerman, J., Cobbett, S., Harding, M. M., Kwong, J., Roberts, D.,
Medical-surgical nursing: Concepts for clinical judgment Hagler, D., Reinisch, C. (Eds.). (2023). Lewis’s medical-
and collaborative care (11th ed.). Elsevier. surgical nursing in Canada: Assessment and management
Lowdermilk, D., Cashion, M. C., Alden, K. R., Olshansky, E.F., & of clinical problems (5th ed.). Elsevier.
Perry, S. (2023). Maternity and women’s health care (13th
ed.). Elsevier.
© Bootcamp.com 4
 Table of Contents:
1. Cholecystitis 2. Pancreatitis

Cholecystitis & Pancreatitis

1. Cholecystitis
Interventions:
FIGURE 1. CHOLECYSTITIS
y Prepare client for abdominal ultrasound to
diagnose cholecystitis.
y If stable, symptoms are managed with supportive
care (IV fluids, antiemetics, analgesics).
y If the client is unstable or if supportive care fails, a
cholecystectomy may be required.

Gastrointestinal
Cholecystitis care focuses on:
1. Managing pain
2. Supporting hydration and nutrition
3. Monitoring for peritonitis and shock
4. Preparing for cholecystectomy or other
procedures as needed

Cholecystitis is acute or chronic gallbladder 1. Manage pain:

inflammation:
Implement NPO status during acute episodes
y Gallstones (cholelithiasis) obstruct bile duct  (eating stimulates the gallbladder).
Bile backs up  Gallbladder becomes distended y Administer IV analgesics.
and inflamed y Administer antispasmodics (anticholinergics [e.g.,
dicyclomine]).
Risk factors:
2. Support hydration and nutrition:

High-fat diet
y 3 “F’s”: y Administer IV fluids.
y Administer antiemetics (e.g., ondansetron).
y Female
y Insert NG tube for severe nausea and vomiting.
y Fat (obesity)
y For clients with chronic cholecystitis, provide
y Forty (age >40)
dietary teaching:
Assessment findings:
Eat high-fiber, low-fat foods.

RUQ pain that radiates to the right shoulder
Eat small, frequent meals instead of large meals.

Pain triggered by high-fat meals (fat stimulates
3. Monitor for peritonitis and shock:
gallbladder contraction)
y Indigestion, nausea, and vomiting y An inflamed gallbladder can rupture, releasing
y Murphy sign (pain when palpating RUQ during bacteria that irritate the peritoneal lining, causing
inhalation) peritonitis and shock.
y Steatorrhea (undigested fat in stool)
Monitor for peritonitis (FIGURE 2):
y Fever andWBC
Rigid, “board-like” abdomen
y Abdominal guarding
y Rebound tenderness

Monitor for shock (HR,BP).

© Bootcamp.com 5
1. Cholecystitis, Continued

FIGURE 2. PERITONITIS FIGURE 3. LAPAROSCOPIC CHOLECYSTECTOMY

4. Prepare for cholecystectomy or other procedures

as needed:

Gastrointestinal
y Nursing considerations following laparoscopic
cholecystectomy (gallbladder removal) (FIGURE 3): 2. Pancreatitis

Ambulate as soon as possible to promote Pancreatitis is acute or chronic inflammation of
gas reabsorption and reduce shoulder pain the pancreas:
associated with trapped laparoscopy gas. y Pancreatic enzymes are prematurely activated
y Encourage deep breathing exercises to prevent inside the pancreas  Enzymes destroy pancreatic
atelectasis and pneumonia. tissue (autodigestion)  Pancreatic inflammation
y Monitor output from T-tube (if present); report
Risk factors are related to pancreatic injury from:
purulent drainage to HCP.
y Laparoscopic cholecystectomy discharge y Cholelithiasis
teaching: y Chronic alcohol use

ERCP procedure

Resume normal activities, including work,
within 1 week postoperatively. Assessment findings:
y Gradually add fat back into the diet as
Severe LUQ or epigastric pain that radiates to
tolerated. the back
y Can shower 1 day postoperatively y Nausea and vomiting
y Report signs of infection (purulent drainage, y Abdominal bruising (FIGURE 5):
erythema).
Cullen sign: Gray-blue discoloration to the
y If cholecystectomy is not indicated, client may periumbilical area
undergo gallstone removal via lithotripsy or
Grey-Turner sign: Gray-blue discoloration to the
endoscopic retrograde cholangiopancreatography flank area
(ERCP).
Elevated pancreatic enzymes:
y ERCP: Endoscopy to visualize the bile duct and/or
y serum amylase
remove gallstones:
y serum lipase (in acute pancreatitis)

Maintain NPO status 8 hours before ERCP and
keep NPO until gag reflex returns.
y Monitor for signs of perforation (abdominal
rigidity and tenderness).

 Cholecystitis causes RUQ pain radiating to the  Following a cholecystectomy, early ambulation
right shoulder, while pancreatitis causes LUQ reduces shoulder pain caused by retained
pain radiating to the back. laparoscopic gas.

© Bootcamp.com 52
2. Pancreatitis, Continued
2. Prevent and treat dehydration:
FIGURE 4. PANCREATITIS
y Administer antiemetics to reduce nausea and
vomiting.
y Administer IV fluids.
3. Monitor for and treat complications:

Pancreatitis can cause several systemic
complications related to widespread damage by
pancreatic enzymes (FIGURE 6).
y Report signs of pancreatitis complications to
the HCP:

Peritonitis and shock (see FIGURE 2):

Rigid, “board-like” abdomen
y Abdominal guarding
FIGURE 5. CULLEN SIGN & GREY-TURNER SIGN y Rebound tenderness

Gastrointestinal
y High fever
y HR, BP

Acute respiratory distress syndrome:
y Dyspnea, tachypnea

Hypoxemia
y Crackles, wheezing
y Hyperglycemia:
y Administer insulin as needed.
Interventions:
Hypocalcemia:
y Chvostek sign: Cheek twitches when tapped
Pancreatitis care focuses on supportive care:
(FIGURE 7)
1.Managing pain
y Trousseau sign: Carpopedal spasm when
2.Preventing and treating dehydration
BP cuff inflates (FIGURE 7)
3.Monitoring for and treating complications
y Administer IV calcium gluconate.
4.Preventing exacerbations and
chronic pancreatitis
FIGURE 6. PANCREATITIS COMPLICATIONS
1. Manage pain:
y Limit further GI stimulation:

Implement NPO status.
y Insert NG tube for decompression.
y Administer proton pump
inhibitors (pantoprazole) or H2-
receptor antagonists (famotidine).
y Place client in side-lying position with
knees bent (fetal position) to relieve
pressure on the abdomen.
y Administer IV opioid analgesics
for pain.

 For cholecystitis and pancreatitis, implement NPO status to prevent worsening of the condition.

© Bootcamp.com 53
2. Pancreatitis, Continued

FIGURE 7. SIGNS OF HYPOCALCEMIA

4. Prevent exacerbations and chronic pancreatitis:

Gastrointestinal
y Avoid alcohol and nicotine.
y Eat small meals that are high in calories.
y Take prescribed pancreatic enzymes with meals
for chronic pancreatitis.

 Peritonitis is a life-threatening complication of  Immediately report life-threatening pancreatitis

cholecystitis or pancreatitis. Immediately report complications to the HCP, including ARDS
abdominal rigidity or rebound tenderness to and hypocalcemia.
the HCP.

© Bootcamp.com 54
  Cholecystitis causes pain to the _______ that  Peritonitis is a life-threatening complication
radiates to the _________; pancreatitis causes of pancreatitis or cholecystitis that causes
pain to the _________ that radiates to the abdominal ________ and rebound _________.
__________.
 The nurse should monitor a client with
 What intervention helps reduce shoulder pain pancreatitis for signs of _______ (what
following a cholecystectomy? respiratory complication?) and ______ (what
electrolyte imbalance?)
 With cholecystitis and pancreatitis, implementing
________ status is a priority to prevent worsening
the condition.

Answers: 1. RUQ, right shoulder, LUQ, back 2. Early ambulation 3. NPO 4. rigidity, tenderness 5. ARDS, hypocalcemia

Gastrointestinal
References: Attributions:
Callahan, B., Hand, M., & Steele, N. (Eds.). (2023). Nursing: A Cholecystitis: Created with BioRender.com
concept-based approach to learning (4th ed., Vol 1).
Peritonitis: Created with BioRender.com
Pearson.
Pancreatitis: Created with BioRender.com
Harding, M. M., Kwong, J., Hagler, D., & Reinisch, C. (Eds.).
(2023). Lewis’s medical-surgical nursing: Assessment and Pancreatitis Complications: Created with BioRender.com
management of clinical problems (12th ed.). Elsevier. Grey-Turner and Cullen Sign: Modified from Herbert L. Fred,
Ignatavicius, D., Heimgartner, N., & Rebar, C. (Eds.). (2024). MD and Hendrik A. van Dijk, CC BY 2.0, via Wikimedia
Medical-surgical nursing: Concepts for clinical judgment Commons
and collaborative care (11th ed.). Elsevier. Signs of Hypocalcemia: Modified from Tmdswan, CC BY-SA 4.0,
Tyerman, J., Cobbett, S., Harding, M. M., Kwong, J., Roberts, D., via Wikimedia Commons
Hagler, D., Reinisch, C. (Eds.). (2023). Lewis’s medical-
surgical nursing in Canada: Assessment and management
of clinical problems (5th ed.). Elsevier.

Van Leeuwen, A. M. & Bladh, M. L. (2021). Davis’s comprehensive

manual of laboratory and diagnostic tests with nursing
implications (9th ed.). F. A. Davis.

© Bootcamp.com 55