Semester 3
Neuro, renal, GI, and critical care — the semester that humbles.
Med-Surg II stacks the systems on top of each other and asks you to manage a whole patient. Expect multi-system stems: a septic renal patient with a neuro change and a potassium of 6.2. This is the semester that turns students into nurses.
One of the highest-yield neuro topics and full of counterintuitive answers.
Memory trick
HOB 30°, head midline (no neck flexion — it blocks venous drainage), quiet room, cluster care, avoid suctioning >10 sec, avoid Valsalva, treat fever, mannitol or hypertonic saline. Never suction through the nose with a basilar skull fracture.
Midline head, calm room, no straining. Treat them like a hangover in a library.
The treatment for one kills the other.
Memory trick
CT without contrast FIRST, always — you must rule out bleed before tPA. tPA window: 3–4.5 hours from last known well. Hemorrhagic: control BP, no anticoagulants, neuro checks. Left brain stroke = right side weak + aphasia. Right brain = left side weak + neglect and impulsivity.
Right brain stroke patients think they're fine and try to walk. They are not fine.
Sepsis bundles show up on every exam and in every job you'll ever have.
Memory trick
Hour-1 bundle: lactate, blood cultures BEFORE antibiotics, broad-spectrum antibiotics, 30 mL/kg crystalloid for hypotension or lactate ≥4, vasopressors (norepinephrine first) if MAP <65 after fluids.
Cultures before antibiotics. Otherwise you're growing nothing and guessing forever.
Renal is where fluid, electrolytes, and meds collide.
Memory trick
Prerenal = perfusion problem (dehydration, shock) → fix volume. Intrarenal = damage (contrast, aminoglycosides, ATN). Postrenal = obstruction (BPH, stones). Dialysis pre-assessment: weight, BP, K⁺; hold antihypertensives and dialyzable meds. Thrill and bruit means the fistula works.
No cuff, no stick, no IV in that arm. Protect the fistula with your life.
Fast identification changes the intervention.
Memory trick
Upper GI = hematemesis, coffee-ground emesis, melena (black tarry). Lower GI = bright red blood per rectum. Both: assess ABCs, large-bore IVs ×2, type and cross, monitor H&H and orthostatics.
Test writers describe the stage without naming it.
Memory trick
Compensatory: normal-ish BP, tachycardia, cool skin, anxiety, ↓urine output. Progressive: BP falls, lactate rises, mottling, altered LOC. Irreversible: organ failure. The tachycardia comes before the hypotension — always.
A 'normal' BP with a heart rate of 128 is not a stable patient. It's a compensating one.
Calculation plus priority, all in one question type.
Memory trick
Parkland formula: 4 mL × kg × %TBSA; half in the first 8 hours from time of injury, remainder over 16 hours. Priority is always airway first with facial burns or singed nasal hair.
Autonomic dysreflexia is a true emergency that students blow past.
Memory trick
Injury at T6 or above + pounding headache + severe hypertension + flushing above the injury + bradycardia = autonomic dysreflexia. Sit the patient UP first, then find and remove the trigger (usually a full bladder or impacted stool).
Sit them up before you do anything else. Gravity is your first drug here.
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Nursing Fundamentals
Semester 1
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Pharmacology
Semester 2
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Med-Surg I
Semester 2
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Pediatrics
Semester 3
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OB / Labor & Delivery
Semester 4
