Lessons · Nursing · Quick reference
Nursing quick reference
36 topics, one line each, in the order Hone teaches them.
Hone is a place to practise a career, one idea a day. This sheet is the whole Nursing track at a glance: every idea it covers, in the order they are taught, one line each. It is a map rather than a lesson. Read opens the full explanation of an idea; Practise gives you a question on it. Both are free, and reading needs no account at all.
From a unit conversion to a safe medication pass · Units
the metric ladder: g, mg, mcg, L, mLGrams, milligrams and micrograms sit a thousand apart, and so do litres and millilitres: 1 g = 1000 mg, 1 mg = 1000 mcg, 1 L = 1000 mL. Going down a rung multiplies by a thousand; going up divides. Read: The metric ladder: every rung is a thousand · Practise the metric ladder: g, mg, mcg, L, mL
kilograms from poundsOne kilogram is 2.2 pounds. Pounds to kilograms is a division by 2.2; kilograms to pounds is a multiplication. Read: Kilograms from pounds: divide by 2.2 · Practise kilograms from pounds
hours, minutes and the 24-hour clockOne hour is 60 minutes. Pumps and orders speak in hours; drips, piggybacks and boluses speak in minutes; and the clock on the chart runs from 0000 to 2359 with no am or pm. Read: Hours, minutes and the 24-hour clock · Practise hours, minutes and the 24-hour clock
reading a label: strength per volumeA label states a strength as an amount of drug in an amount of liquid, or in one tablet: 125 mg per 5 mL means every 5 mL holds 125 mg, so every 1 mL holds 25 mg. Read: Reading a label: how much drug in how much liquid · Practise reading a label: strength per volume
rounding as the problem statesThe answer is rounded the way the order or the unit's rule says: drops to a whole drop, millilitres to a tenth, or to a hundredth below 1 mL, tablets to a half only when the tablet is scored. Carry the decimals through the arithmetic and round once, at the end. Read: Round as the problem states, and only at the end · Practise rounding as the problem states
From a unit conversion to a safe medication pass · Dose calculation
desired over have, times quantityThe dose to give is what the order wants, divided by what one tablet or one measured volume holds, times that volume: D / H × Q. The units on D and H must be the same so they cancel. Read: Desired over have, times quantity · Practise desired over have, times quantity
tablets from an orderTablets = ordered dose ÷ dose per tablet, with both in the same unit. A half tablet is allowed only when the tablet is scored and the problem says so. Read: Tablets from an order · Practise tablets from an order
a liquid dose in mLThe volume to draw up or pour is the ordered amount divided by the label's strength per millilitre, or D / H × Q with the label's own volume as Q. Read: A liquid dose: how much of the bottle · Practise a liquid dose in mL
weight-based doses, mg/kgA weight-based order gives an amount per kilogram; multiply it by the patient's weight in kilograms for the dose. If the order is per day, divide by the number of doses in the day. Read: Weight-based dosing: the order is per kilogram · Practise weight-based doses, mg/kg
a daily dose split across the dayA total per day is shared among the doses; the schedule's interval tells you how many there are: every 8 hours is 24 / 8 = 3 doses. Read: A daily dose split across the day · Practise a daily dose split across the day
does the answer make sense by sizeBefore anything is given, ask whether the amount looks like a dose: usually one or two tablets, a few millilitres, a rate a pump can run. Fifteen tablets or 0.02 mL means an arithmetic slip, most often a unit that did not match. Read: Does the answer make sense by size · Practise does the answer make sense by size
From a unit conversion to a safe medication pass · IV rates
mL per hour from volume and timePump rate = total volume ÷ time in hours. If the time is in minutes, divide it by 60 first. Read: mL per hour: the number the pump wants · Practise mL per hour from volume and time
drops per minutegtt/min = mL/h × drop factor (gtt/mL) ÷ 60. The drop factor is printed on the tubing package. Round to a whole drop, because you cannot count half a drop. Read: Drops per minute: when there is no pump · Practise drops per minute
how long an infusion takesTime = volume ÷ rate. With the rate in mL/h the answer is in hours; the decimal part times 60 is the minutes. Read: How long the bag will take · Practise how long an infusion takes
a piggyback over thirty minutesA secondary bag runs over minutes, not hours, and the pump still wants mL/h: rate = volume ÷ (minutes ÷ 60), or volume × 60 ÷ minutes. A 30-minute bag runs at twice its volume per hour. Read: A piggyback: a small bag over a short time · Practise a piggyback over thirty minutes
mcg/kg/min to mL/hA weight-based drip: the ordered mcg/kg/min times the kilograms gives mcg/min; times 60 gives mcg/h; and dividing by the bag's concentration in mcg/mL gives mL/h. Every figure comes from the order, the weight and the bag label. Read: mcg/kg/min to mL/h: the long chain, one link at a time · Practise mcg/kg/min to mL/h
a bolus over a short timeA bolus is a volume over a short stated time; the pump rate is volume × 60 ÷ minutes. A weight-based bolus is mL per kg times the kilograms, and then the same line. Read: A bolus: a set volume, fast · Practise a bolus over a short time
From a unit conversion to a safe medication pass · Fluids and intake
intake and output over a shiftEverything that goes in is added up in millilitres, everything that comes out is added up in millilitres, and the two totals are written at the end of the shift. Read: Intake and output: two columns, one total each · Practise intake and output over a shift
percent solutions: g per 100 mLA solution labelled a percent holds that many grams of solute in every 100 mL: 0.9 percent is 0.9 g per 100 mL, so the grams in a bag are the percent times the volume divided by 100. Read: A percent solution is grams in every 100 mL · Practise percent solutions: g per 100 mL
diluting a solution: C1V1 = C2V2The amount of drug does not change when you add liquid, so the strength you start with times the volume you take equals the strength you want times the volume you end with: C1 × V1 = C2 × V2. Read: Diluting a solution: C1V1 = C2V2 · Practise diluting a solution: C1V1 = C2V2
maintenance fluids by the 4-2-1 ruleThe rule, as the problem gives it: 4 mL/kg/h for the first 10 kg of weight, 2 mL/kg/h for the next 10 kg, and 1 mL/kg/h for every kilogram above 20; add the three pieces for the hourly rate. Read: Maintenance fluids by the 4-2-1 rule the problem states · Practise maintenance fluids by the 4-2-1 rule
net fluid balanceNet fluid balance is total intake minus total output over the period being counted. A positive number means more went in than came out; a negative number means the other way. Read: Net balance: what came in, less what went out · Practise net fluid balance
From a unit conversion to a safe medication pass · The fundamentals in order
hand hygiene, in orderWet, soap, rub every surface for at least twenty seconds, rinse with the fingers pointing down, dry with a paper towel, and turn the tap off with that towel. Read: Hand hygiene: the order, and the twenty seconds · Practise hand hygiene, in order
the rights of medication administrationBefore a medication leaves your hand: the right patient, the right drug, the right dose, the right route, the right time, and then the right documentation, written after it is given. Read: The rights of medication administration, in order · Practise the rights of medication administration
two patient identifiersA patient is identified by two pieces of information that belong to the person, such as full name and date of birth, checked against the band and the record; a room number or a bed is not one of them. Read: Two identifiers, and what does not count as one · Practise two patient identifiers
vital signs: the order, and the ranges givenTemperature, pulse, respirations, blood pressure, then oxygen saturation and pain. Counting for part of a minute and multiplying up is part of taking them: 15 seconds times 4, or 30 seconds times 2, gives the rate per minute. Read: Vital signs: the order they are taken, and the arithmetic in them · Practise vital signs: the order, and the ranges given
a sterile field, and what breaks itA sterile field counts as sterile only at or above waist level, in sight, and dry; the outer border of the drape is not sterile, and anything that leaves your view or touches something unsterile has broken it. Read: A sterile field, and the ordinary things that break it · Practise a sterile field, and what breaks it
a lift transfer, in orderExplain the move, lock the wheels, position the sling under the patient, attach every strap and check each one, raise just clear of the surface and stop, move, lower, then remove the sling. Read: A lift transfer, in the order that keeps everyone upright · Practise a lift transfer, in order
isolation precautions: PPE on and offPutting it on: gown, mask, eye protection, gloves. Taking it off: gloves first, then eye protection, then gown, then mask, with hand hygiene at the end and any time the hands become contaminated. Read: Protective equipment: on in one order, off in another · Practise isolation precautions: PPE on and off
SBAR handoffSituation, what is happening now; Background, what brought the patient here; Assessment, what you observed, with the figures; Recommendation, what you are asking for. Read: SBAR: four boxes, in order, in under a minute · Practise SBAR handoff
From a unit conversion to a safe medication pass · On the shift
a med pass, end to endRead the record, clean your hands, prepare one patient's medications while checking the label against the record, identify the patient with two identifiers at the bedside, give it, watch it taken, and document immediately. Read: A med pass, end to end · Practise a med pass, end to end
a change in vitals: what firstGo and look at the patient, confirm the measurement by repeating it yourself with the right equipment and technique, then report it with SBAR and document what you found and what you did. Read: A set of vitals has changed: what comes first · Practise a change in vitals: what first
documentation: what and whenWrite what you observed and what you did, after you did it, with the time it happened and your signature; correct an error with a single line through it, the correction beside it, your initials and the date, never by erasing or writing over. Read: Documentation: what, when, and how a mistake is corrected · Practise documentation: what and when
after a medication errorCheck the patient first, tell the nurse in charge and then the prescriber, document in the record exactly what was given and when, complete the incident report the organisation requires, and keep monitoring as instructed. Read: After a medication error: the order of the next few minutes · Practise after a medication error
prioritising by ABCWhen more than one patient needs you, the rule as given is airway first, then breathing, then circulation, and everything else after those three; among calls of the same kind, the one that is changing fastest goes first. Read: Prioritising by the ABC rule, as it is stated · Practise prioritising by ABC
reading a MAR lineA line on the record gives the drug, the dose, the route, the frequency and the times; the frequency tells you how many doses are in a day, and the box beside each time is signed as that dose is given. Read: Reading a line on the medication record · Practise reading a MAR line