Nursing study guide
Emergency + critical care nursing
Recognize instability, organize immediate priorities, support complex devices, and reassess the patient through every transition.
Nursing filter
Assess the patient first, recognize time-sensitive change, prevent harm, and trend the response.
Connect systems
Symptoms, laboratory patterns, medications, nutrition, function, and psychosocial needs interact.
Safety boundary
Use current orders, facility policy, clinical supervision, and emergency pathways.
Triage + rapid assessment
Sort by acuity and resource need, then reassess
Triage is dynamic: appearance, physiology, risk, pain, and change can outweigh the initial complaint.
First look
Scene and staff safety, general appearance, airway, breathing, circulation, disability, exposure, immediate lifesaving needs, and isolation concerns.
Focused history
Symptoms and timing, allergies, medications, history, last intake, events, baseline function, pregnancy possibility, and goals of care as relevant.
Reassessment
Repeat vital signs, mental status, pain, perfusion, respiratory effort, output, response to treatment, and waiting-room or transport status.
Scope boundary
Use the facility’s validated triage system and escalation policy; this guide does not reproduce ESI, ACLS, trauma, stroke, or resuscitation algorithms.
Shock patterns
Recognize impaired tissue perfusion before hypotension becomes profound
Shock types can overlap; trends and response matter more than one isolated number.
| Pattern | Common clues | Nursing priorities |
|---|---|---|
| Hypovolemic / hemorrhagic | Loss history, tachycardia, cool skin, narrow pulse pressure, low output, altered status | Control loss, obtain access/labs, give ordered fluids or blood, warm, and reassess perfusion. |
| Distributive / septic | Suspected infection, vasodilation, fever or hypothermia, altered status, hypotension, organ dysfunction | Activate sepsis pathway, cultures/lactate and antimicrobials/fluids as ordered, monitor response. |
| Cardiogenic | Chest symptoms, congestion, crackles, cool skin, dysrhythmia, low output | Support oxygenation, monitor ECG, avoid reflex fluid loading, and prepare ordered cardiac treatment. |
| Obstructive | Sudden dyspnea or collapse, distended neck veins or asymmetric findings in context | Immediate escalation and preparation for cause-directed intervention. |
| Neurogenic / anaphylactic | Loss of vascular tone after spinal injury; or rapid airway/skin/GI/circulatory allergic findings | Spinal precautions when indicated; activate emergency pathway and give ordered first-line treatment. |
Sepsis + deterioration
Detect, act, reassess, and titrate
Sepsis is a medical emergency; immediately alert the supervising clinician and follow the facility pathway.
Recognize
Possible infection plus new organ dysfunction, confusion, abnormal temperature, tachycardia, hypotension, tachypnea, hypoxemia, low urine output, mottling, or severe discomfort.
Act
Escalate, obtain cultures and other ordered tests without unsafe delay, administer ordered antimicrobials and resuscitation, manage source and oxygenation, and document time-critical care.
Reassess
Mental status, perfusion, pressure, oxygenation, respiratory effort, lactate trend when ordered, urine output, fluid tolerance, and response to vasoactive support.
Rapid response
Use early-warning and rapid-response systems for any acute concern—even when a score or single vital sign is not yet extreme.
Trauma + neurologic safety
Treat life threats while protecting function
Mechanism, anticoagulation, age, pregnancy, intoxication, and comorbidity can change risk.
Trauma priorities
Hemorrhage control, airway with cervical protection when indicated, breathing, perfusion, disability, exposure, temperature, pain, and repeated head-to-toe assessment.
Neurologic trend
Level of consciousness, pupils, speech, motor/sensory change, glucose, seizure, headache, vomiting, anticoagulants, and last known well.
Prevent secondary injury
Avoid hypoxemia, hypotension, fever, glucose extremes, aspiration, pressure injury, and unnecessary stimulation while preparing definitive care.
Respiratory support + ventilation
Treat the patient, not only the monitor or ventilator
A ventilated patient still needs airway, breathing, comfort, communication, mobility, and delirium care.
Assess
Airway position/patency, tube depth and security, breath sounds, chest movement, secretions, SpO2 and waveform, end-tidal data when used, ABGs, synchrony, and hemodynamics.
Alarm response
Assess the patient first, call for help, check connections/tubing/oxygen source, and manually ventilate with the approved backup when necessary and within role.
Prevent harm
Head elevation when appropriate, oral care, suction by indication, cuff/skin checks, aspiration precautions, communication support, sedation review, mobility, and readiness-to-wean collaboration.
Hemodynamics + vasoactive care
Interpret numbers in clinical context and trend
Waveforms, leveling, zeroing, rhythm, position, and device problems can create misleading data.
| Domain | Nursing checks | Safety connection |
|---|---|---|
| Perfusion | Mental status, skin, capillary refill, pulses, urine output, lactate when ordered, organ function | Escalate worsening clinical perfusion even if a target number appears acceptable. |
| Arterial monitoring | Site/perfusion, dressing/tubing, leveling and zeroing, waveform quality, pressure-bag setup, alarm limits | Never give medication through an arterial catheter; protect against blood loss and disconnection. |
| Vasoactive infusions | Dedicated compatible access, concentration, pump and line trace, ordered target, frequent pressure/rhythm/perfusion checks | Titrate only per order/protocol and role; recognize extravasation, dysrhythmia, ischemia, and abrupt interruption. |
| Fluids | Indication, response, lung findings, edema, pressure/perfusion, output, electrolytes, and cumulative balance | More fluid is not automatically better; report intolerance and reassess after each intervention. |
Lines, drains + device safety
Every device needs an indication, assessment, securement, and removal plan
Trace every line from patient to source before access, medication, transport, or handoff.
Central access
Verify indication and lumen purpose, use aseptic access, scrub and allow antiseptic to dry, keep dressing intact, assess infection/occlusion, and review daily necessity.
Drains and tubes
Confirm location/order, patency, securement, output amount/character, suction or gravity setup, insertion site, and changes that require escalation.
Transport
Plan oxygen, battery, medications, pumps, monitors, emergency equipment, staffing, route, destination handoff, and line/device protection before movement.
Pain, sedation, delirium + mobility
Balance comfort and safety with wakefulness, breathing, and recovery
Use validated tools and individual goals rather than sedation by appearance alone.
Assess pain
Use self-report when possible; otherwise use an appropriate behavioral tool and reassess after treatment.
Sedation + awakening
Target the ordered level, identify oversedation or withdrawal, coordinate spontaneous awakening/breathing assessments when eligible, and protect lines and dignity.
Delirium
Use a validated assessment; address hypoxemia, infection, medications, sleep disruption, pain, sensory impairment, immobility, and orientation.
Mobility + family
Use progressive mobility and pressure/injury prevention with team screening; involve family and support people according to patient preference and safety.
Teamwork, delegation + sources
Closed-loop communication protects patients during rapid change
State the concern, relevant trend, action taken, response, and what is needed now.
Handoff
Illness severity, summary, action list, situation awareness/contingency plans, devices, medications, pending results, code status, and opportunity for questions.
Delegate carefully
Stable, predictable tasks may be assigned with exact limits and reporting triggers; RN retains assessment, interpretation, unstable care, titration within authorized role, teaching, and evaluation.
After the event
Reconcile medications/devices, document objectively, communicate with patient/family, debrief, identify safety learning, and support the team.