How to Diagnose Acute Respiratory Distress Syndrome

Before going into details on how to efficiently diagnose acute respiratory distress syndrome (ARDS), we’ll have a quick overview and some signs and symptoms.


Acute respiratory distress syndrome (ARDS) develops due to the building up of fluids inside the alveoli or the microscopic, elastic sacs of air inside the lungs. This build-up of fluid will prevent or make it difficult for the lungs to be filled in with air, resulting in limited oxygen reaching the bloodstream. Decreased oxygen in the body compromises the entire system from working properly.


ARDS usually happens to people who are severely ill or those who have experienced critical injuries. As for those who already have ARDS, most of them do not survive, and the risk of mortality increases with the illness’ severity and age. As for those who do survive, they either have irreversible lung damage or will recover completely.

Signs and Symptoms

The manifestations of ARDS change with intensity, and will significantly depend on the illness’ severity and cause; not to mention the presence of an underlying lung or heart disease. Some of the common signs and symptoms of ARDS are:

  • Shortness of breath (SOB)
  • Decreased blood pressure
  • Extreme fatigue
  • Confusion
  • Rapid and labored breathing


How do we diagnose ARDS? How does one say that the client needs to be taken to the ICU as soon as possible? Here are the main criteria to accurately diagnose ARDS in a client:

  1. Erroneous breathing

One of the main criteria for diagnosing ARDS is the inconsistency in breathing patterns since the lungs are primarily affected.

  1. Oxygen saturation (SaO2)

If a post-operative client’s oxygen saturation has been steadily below 90% Sa02, it is one of the main indicators for ARDS.

  1. Partial pressure of oxygen (PaO2)

The doctor will also order out an ABG test to see how much PaO2 or oxygen is going back to the pulmonary artery. If the result is anything less than 60%, that’s another criterion for ARDS.

  1. Power of hydrogen (pH)

If the pH result is less than 7.30, this means that the blood’s acidity is high and will immediately affect the lungs.

To summarize, here are the things that healthcare practitioners should watch out for when trying to diagnose ARDS:

  • SaO2 – less than 90%
  • PaO2 – less than 60%
  • pH – less than 7.3


Aside from distressed breathing, if the results show the indicators mentioned above, all it means is that the lungs are filling up with carbon di-acid or carbon dioxide, which makes it hard for the client to breathe.

While oxygen is not going inside the lungs and to the rest of the body, carbon dioxide is building up. Therefore, it is expected that carbon dioxide can go as high as 50mEq/L. This will cause the blood to become very acidic.

So, now that we are well aware of how acute respiratory distress syndrome is diagnosed, we will now proceed to the stages based on the severity of the illness; all this and more in our next article.

For more topics related to nursing, drop by Simple Nursing’s website and YouTube channel.

Cardiac Output: Stroke Volume, Preload, & Afterload Pt 5, with Mike Linares, is here once again to turn complicated, frustrating lectures into effortless, piece-of-cake study systems.

Right now, we will be discussing the following:

  1. Cardiac output (CO)
  2. Stroke volume (SV)
  3. Preload
  4. Afterload

Before we go into specifics, let’s first have a quick overview of how the heart functions regarding blood flow regulation.

Heart Regulation of Blood Flow

An average person has about five liters of blood that needs to be circulated throughout the body; therefore, as a pumping organ, if your heart cannot pump the required blood to the rest of the body, what happens? The body gets sick, gets impaired, or eventually dies.

The heart pumps blood throughout the body. Blood carries oxygen and plasma that helps infiltrate the veins and arteries, sustaining blood pressure, thereby sustaining life.

  • Insufficient blood flow = decreased oxygen distribution = tissue death

Think of it as putting a tourniquet around your finger, cutting the blood supply. Immediately, the finger starts to get pale, cold, and cyanotic. Technically, that’s what happens to all parts of the body if blood flow and oxygen are cut off.

Now that you have a better understanding of blood flow regulation by the heart, we go to our main topic.

Cardiac Output

Cardiac output is the amount of blood that’s ejected from the left ventricle, into the aorta of your heart, then out to the rest of the body in one minute.

                        Heart rate x Stroke volume = Cardiac output (one minute)

Stroke Volume

Stroke volume is the amount of blood in one clean pump. How is this seen or applied in the clinical setting?

A client with cardiac failure or congestive heart failure has increased pressure being backed up from the rest of the body because of high blood pressure, so left ventricle struggles to pump out blood to relieve pressure inside the heart. For this reason, stroke volume is decreased because the left ventricle is unable to pump blood efficiently.

Backing up of traffic (too much blood) causes the left ventricle to swell or inflate because it’s trying its hardest to push blood out, going against the resistance of high blood pressure.

  • Decreased stroke volume = compromised cardiac output = left ventricular hypertrophy

How Left Ventricle Hyperinflation is Measured

To determine left ventricular hyperinflation, the lab test of choice is the Brain Natriuretic Peptides (BNP).

When the cardiac output no longer sustains oxygen in the peripheral veins, the brain sends signals to the left ventricle.  Brain natriuretic peptides are compensatory mechanisms of the brain, communicating to the left ventricle, calling out its hyperinflation, and informing it that there is decreased oxygen level inside the body.

There’s a vasomotor center in the brainstem that controls blood pressure, the RAAS system of your kidneys, and the BNP. So BNP is basically telling the left ventricle, “Hey, we need you to take the pressure off.”

  • Normal BNP = less than 100

BNP as high as 300 or more is usually a sign of congestive heart failure (CHF).

Now, when the cardiac output is not meeting the required amount of blood in a minute, and the stroke volume is having a hard time getting pressure off from the heart because of too much resistance, that’s where preload and afterload come in.


Preload is, in simplest terms, the stretching of ventricles. So ventricles tend to stretch (fill with blood) and squeeze (push out blood). If there is too much pressure filling the ventricles, they tend to extend to the point of not having a proper contraction.

  • Too much stretch = unable to squeeze properly


Afterload is the degree of pressure inside the aorta to push or eject blood. Afterload is just a fancy word for the pressure required for the left ventricle to force blood out of the body. So, afterload is just the effort of the ventricle to squeeze. In cases of congestive heart failure (CHF) or hypertension, you have a back-up of pressure on the left ventricle causing it to stretch at great lengths causing a bigger preload and a struggling afterload.

How are increased preload and afterload managed in a hospital setting?

Clients with acute myocardial infarction (MI) are given nitroglycerin and morphine to bring down preload and afterload.

  • Nitroglycerin = relaxes smooth muscle to allow vasodilation
  • Morphine = a central nervous system (CNS) opioid analgesic that relaxes the heart

Hopefully, this was able to help you have a better grasp at one of the trickiest subjects of nursing.

For more useful tips and information, visit On this site, you can check out our Patho Bible – The Top 70 Diagnoses that are commonly seen in a clinical setting.

Thanks for dropping by!

Key Terms for NCLEX® Delegation and Management Questions

Recent NCLEX® topics are primarily focused on delegation, prioritization and leadership. Among those that were mentioned, delegation type questions are going to be a huge part of nursing schools.

Fortunately, Mike is here to provide the gist and the important keywords that you have to watch out for every time you encounter delegation and management questions on your comprehensive exams, especially on your NCLEX®.

The PACET Method

When dealing with client and task delegations, there are five things that you cannot entrust to other people and that is broken down into the acronym, PACET (pronounced as “paket”). As a registered nurse, you cannot delegate the nursing process which is also known in other schools as SOAPIE, ADPIE, or DAR. Mike simplifies this as PACET.

P for Planning

If you are an RN, one of your main tasks is to plan and collaborate for client goals; thus you cannot delegate planning to an LPN or a CNA. This is because it is expected of you, as a registered nurse, to take on full responsibility of your client and you cannot share that responsibility with other healthcare teams.

A for Assessment

Secondary assessments can be delegated; however, you cannot pass primary assessments to anybody. That said, can you pick which is the right answer to the question below?

Q: Which of the following clients would you delegate?

  1. A post-op client who just came out from the operating room
  2. New admissions
  3. Three-day-old chest pain

When picking the right answer, you always have to remember that nurses do the first assessment. Now, among the three situations given above, which do you think needs first assessment?

Answer: The client who just came out of the operating room is unstable and needs initial assessment which is also termed as vigilant assessment. On the other hand, nurses are required to gather more information from new admissions. Therefore, both post-op (A) and new admissions (B) are NOT to be delegated.

So now, you’re left with the post-operative client who’s already been in the hospital for a couple of days and is considered stable. So the answer for the question above is “C”.

C for Collaboration

Collaboration is for working with other members of the healthcare team to achieve client goals. Some of the collaborations inside the hospital are wound consult, social services, dietary services, and if the client needs a respiratory therapist. Only the RN does this kind of collaboration, not the LVNs.

E for Evaluation

LPNs and CNAs can take note of the pain scale and vital signs but are not allowed to evaluate because it’s specifically the RN’s role – to think critically and evaluate efficiently. Therefore, the nurse should evaluate:

  • Care plans
  • Client goals
  • Vital signs
  • Pain scale

T for Teaching

Primary education or client teaching cannot be delegated. LVNs can reinforce education but they are not responsible for providing exemplary client education to decrease complications that might occur after discharge.

During the exam

Keep in mind, during your NCLEX®, that if you see any of the PACET keywords the multiple choice questions, it’s automatically the correct answer under the topic of delegation. Once again, those that you should not delegate and are your primary responsibilities are:

  • Planning
  • Assessment
  • Collaboration
  • Evaluation
  • Teaching

As registered nurses, you have to assume obligation and accountability for the five keywords mentioned above. Furthermore, being keen on identifying if it’s primary or secondary evaluation can help you quickly point out the right answer to your NCLEX®.

Don’t forget PACET.

For more information and other easy-to-understand nursing lectures and videos, visit our website at

See you in the next video!

Ace Your NCLEX® and Exit Exam in 3 Outrageously Simple Steps

Hello, we are back to give you the simplest, most uncomplicated way possible to get you through your exams, whether it’s the HESI or ATI or even your NCLEX.

Comprehensive exams are something that student look forward to but wish would never happen. It’s probably one of the most stressful times in a nursing student’s life. And more often than not, they make it difficult for everyone. And for that reason, we at will provide what you need to do and what you should not do when taking your exams.

Test preparation

Doomsday is right around the corner and you feel like there’s still so much to comprehend, memorize, and remember. Universities or colleges usually allow students to prepare for at least seven to 14 days. HESI or ATI week is one of the most stressful periods of students’ lives that they even experience physical manifestations like ulcer, anxiety, panic attack, and insomnia.

Preparation for comprehensive exams feels like dumping a lot of information in your brain all at once and remembering nothing at all. But fear not, Mike is here to help make things simpler and far less complicated. This game plan in facing your exams has been proven effective by over 40,000 students and counting.

Step 1: Focus on the top three most difficult subjects of the semester.

Passing nursing exams is not rocket science. You need to create a plan that works for you which is effective enough to get you from point A to point B. Studying all the materials given at school is not enough. Initially, you need to create a strategic plan to conquer the most frustrating parts of studying.

So, the basic goal here is to select which subjects are giving you the hardest time and underneath that, prioritize the topics that you find most difficult to comprehend. Know where to focus your time and effort. Instead of focusing on what you have already mastered by heart, concentrate on the areas that are crippling your mind.

To give you a solid example:

Your HESI or ATI is coming up, and you’ve realized that on all the areas that are covered by the exams, the subjects that are giving you a hard time, namely:

  • Medical-surgical
  • Pharmacology
  • Pediatrics
  • OB
  • Psychiatric

Note: Usually, community health questions do not show up on the exams or have a significant effect on the test questions.

So, among the provided list of subjects, which of the three are giving you a hard time? As for Mike, his Waterloos are medical-surgical, OB, and psychiatric nursing. So, the next thing that you should do is to identify which top three topics about medical-surgical, OB, and psychiatric nursing stress you the most. Mike has identified his topics like this:

  • Medical-surgical – Heart, Lungs, Brain
  • OB – Labor, Mom assessment, Prenatal
  • Psychiatric – Pharmacology, Two (2) types of personality disorders

That’s basically the top three hardest topics of your top three hardest subjects which you should be focusing on. But that’s not all. You should also identify underneath the top three topics, the sub-topics that you struggle with the most. For example, what lessons about the heart do you find most difficult? Write it down.

Now, because there usually are more than three areas that we struggle with for our sub-topics, that’s the time that we head on out to our step two.

Step 2: Create a plan.

Now that you know where your focus should be, the next thing that you should do is to make the plan and implement it in an organized manner. In creating the plan, you have to do a couple of things:

  1. Print out a calendar. Take note that HESI or ATI exams give at least two weeks of preparation. However, if you are in an accelerated program, you probably just have seven days to take it all in. That’s not sufficient at all. Now, to give you a better picture, if you are given two weeks to study, you will do so in four to six days in a week which means, in 14 days, you will have 8 to 12 rigorous study periods.
  2. Pinpoint important dates. In order to implement the study days, you should point out the date when you would start studying, as well as the date of the exam.
  3. Cross out your calendar. Get a red pen or marker then diagonally cross each day out. The diagonal line is the division between your morning (AM) and afternoon (PM) study sessions. The division of AM and PM is to save your brain from fatigue. Rigorous study hours, usually consisting of up to eight hours in a day is not helpful at all. This is because the exhausted brain will normally zone out what you’ve studied in between and just remember what you’ve learned at the beginning and the end.
  4. Break up the days. It is advisable that there should only be three hours of studying done in the morning. As for the PM study session, that will be tackled on step 3.

Now, you’re wondering, “Why is it just 3 hours in the morning? And why does it have to be in the morning?” Mornings are the best time of the day to be active and productive. The brain has replenished itself from a well-rested sleep, making it fruitful that it can accommodate complex questions.

Furthermore, the reason why you should only study for three hours in the morning is because in a span of three hours, you’ll be able to answer and rationalize 60 of the most difficult questions about the complicated sub-topics that you have previously identified. Here’s how:

  1. Break down your three hours.
  2. For every hour, you have 20 minutes to answer 20 questions, then 40 minutes to rationalize. You will also be doing this in your second and third hour.

This technique works effectively for anyone especially for those slow, anxious test-takers. For those who have text anxiety, Mike suggests the following effective methods:

  1. Stress yourself out within the 20 minutes of taking the 20 questions.
  2. Listen to loud, distracting music that you hate.
  3. Hope on one foot.

Distraction within those 20 minutes is recommended because it will take you out of your comfort zone and make you immune to other forms of distraction during the test day. You might think that’s nonsense but it actually works for most people because it lessens the anxiety and increases focus.

What to do in the remaining 40 minutes? Aside from rationalizing, you should note down the topics that you’ve missed. These are the topics that you’ve missed within those 20 minutes.

Not only have you accomplished 60 test questions in three hours, you’ve also accumulated and outlined 60 specific topics you are having problems with. This technique saves you a lot of time than scouring through all your nursing books and jotting down the topics that you don’t know.

Step 3: Summarize and memorize content efficiently.

Now, we go to your PM study session. Study time here should not be more than four hours. Come to think about it, AM and PM sessions combined, you have a total of seven hours study time. Not bad.

By now, your anxiety must be getting the best of you. Don’t worry, you have we have a plan. And this plan is going to take you from A to B. One of the main reasons why students fail, aside from not studying efficiently, is because they did not stick with their plans. Whether it’s a HESI, or an ATI, or NCLEX, for as long as you have a plan and don’t divert from it, you’ll be okay.

So, step 3 is about condensing information you absolutely have no idea whatsoever. There are a couple of options that you can do to review these certain topics – go back to the same boring nursing books and climb that steep hill all by yourself or get condensed videos of those topics. You’ve probably seen some of these videos containing summarized topics like the Liver Song and ABGs. There are about 900 videos available at that you can rely on to carry you through these tough 14 days of your life.

Even better if you avail of one our membership plans. Mike has managed to condense three comprehensive NCLEX study guides and other nursing materials. With, you don’t have to figure out which topics you need to focus on because Mike’s done that for you. Aside from that, Mike has arranged keywords and acronyms inside those videos to make it easier for you to understand.

During your PM study session, use the list of topics you’ve gathered in the morning from the test questions then search the website database for keywords. There are about 300 videos available in YouTube for free! But that’s just the tip of the iceberg or 30% of the overall topics that we can provide; 70% of those videos are locked in our membership vault.

So here’s what you have to do with the list of questions you’ve missed in your AM session:

  1. Match the questions or topics to the video content available on YouTube or in our membership plan vault.
  2. Using a regular computer paper, make a four-square outline.
  3. In each of the box, write down the topics that you’re having difficulties with like for example:
    1. First box – Heart
    2. Second box – Lungs
    3. Third box – Brain
    4. Fourth box – Other
  4. These boxes are useful when watching our videos by getting the key information that you might be struggling with and writing it down the specific box.

For example:

If you are taking Neurology exam and you are struggling with multiple sclerosis, or Guillain-Barre Syndrome, or ALS, in Mike’s videos, there are a few key things that he touches on wherein he strongly points out that it is significant to know those points because they usually come out in the tests.

  1. Write those key points, the only need-to-know information, inside the boxes which you can think of as a filing cabinet.

Track your progress

So imagine that it’s been seven days. In a span of seven days, what have you accomplished?

  1. 240 to 360 questions. Inefficient instructors will tell you that you should finish test questions of not less than 400. This is not beneficial to you in any way. Your mind will reach its limit even before you get to the 100th Mike’s words: 60 questions per day and that’s it.
  2. Up to 360 topics are uncovered and understood with qualifying keywords on your piece of paper.
  3. That piece of paper can be brought anywhere and everywhere. Do not be chained to your books.

Don’t miss out on the good stuff

This three-step technique is really everything you need to make it through whatever exams you have. If you’re wondering if this applies for your finals, there is actually an entire course on that at which will absolutely blow your mind. The success stories that we have will inspire you. If they can do it, so can you.

We highly recommend that you become a member especially for those who are struggling with HESI, ATI or NCLEX. All you need to do is drop by and ace that test!

Cholinergic and Anticholinergic Pharmacology Made Easy

Today, we’ll be focusing our attention on anticholinergic bronchodilators.

In the simplest sense, you anticholinergic bronchodilators are your drugs that have the capacity to turn off the system in your body that causes the fight and flight reaction.

To explain further…

Sympathetic versus Parasympathetic

So, there are two systems involved – the sympathetic nervous system and the parasympathetic nervous system. How do you distinguish one from the other?

  • Sympathetic nervous system (SNS) – fight and flight
  • Parasympathetic nervous system (PNS) – rest and digest

When trying to differentiate one from the other, there are a couple of questions that you need to ask:

  1. Where is the blood going?
  2. Is it headed towards your fight and flight organs or towards your digest and rest organs?
  3. What are your fight and flight organs?
  4. What are your digest and rest organs?

Your fight and flight organs are:

  1. Heart
  2. Lungs
  3. Brain

Your digest and rest organs are:

  1. Gastrointestinal (GI) Tract
  2. Kidneys
  3. Muscles
  4. Other organs

The teeter-totter figure

To make your memorization easier, imagine a teeter-totter.

On the left side, is your sympathetic nervous system (SNS), and on the right side is your parasympathetic nervous system (PNS) or the parasympathomimetics nervous system. Below your SNS, write down the organs responsible for the fight and flight reaction which is your heart, lungs, and brain. Then below the PNS, write down the organs responsible for the digest and rest reaction.

Anticholinergic versus Cholinergic

After identifying what your SNS and PNS are, we now have to relate them to your cholinergic and anticholinergic drugs.

How does one distinguish anticholinergic from cholinergic drugs?

Sympathomimetic reactions (fight and flight) – Anticholinergic drugs

The mechanism of anticholinergic drugs is to direct blood to your heart, lungs, and brain by inhibiting the parasympathetic nervous system. When the signal going to the PNS is blocked or disrupted, the involuntary functions like mucus secretion, salivation, urination, and digestion is decreased significantly.

Examples: Atropine, Epinephrine

Parasympathetic nervous system (rest and digest) – Cholinergic drugs

On the other hand, cholinergic drugs are basically the opposite of the SNS. Because with cholinergic drugs, there is an increase in involuntary functions which basically means that there is saliva production, urination, and mucus secretion.

An instructor of Mike’s once shared a very useful tip when remembering cholinergic and anticholinergic drugs. Just remember the 3 S’s:

  • See
  • Spit
  • Shit (excrete)

Simply put it this way:

Anticholinergics – can’t see, can’t spit, can’t shit

Cholinergics – can see, can spit, can shit

Easy enough?

Cholinergic agents allow you to see due to the production of fluid that moisturizes the eyes and you can salivate because of the production of mucus. You can also urinate and defecate.

Anticholinergic agents decrease all the activities mentioned above. Instead, you will increase the client’s heart rate and perfusion to the lungs and brain.

So just remember…

Administering drugs with SNS and PNS effects will directly influence where the blood will be heavily distributed for the sake of treating a number of conditions. If you turn one off, the other is turned on. Don’t forget the teeter-totter figure. 

Arterial Blood Gases Uncomplicated Study Guide – Part 4

One of the most difficult, confusing topics in your nursing fundamentals would be determining whether your client is alkalotic or acidotic.

To help you create a more functional method of expertly distinguishing your respiratory and metabolic acidosis and alkalosis, has created the marching band suit especially for you.

What is the marching band suit?

The marching band suit is an ABG figure with three rows and six buttons (three buttons on each end of the row).

On the left side, label each button as A-B-A and on the right side, label each button as B-A-B. The As stand for acidosis and the Bs stand for base or alkalosis. As for the three rows, label each row as pH, lungs, and kidneys.

Now, let’s put in the normal values so that it would look something like:

pH                    7.35     A —————— B       7.45

Lungs               35        B —————— A       45

Kidneys            22        A —————— B       26

So, once you have this kind of figure drawn and labeled out, you are now ready to interpret your scenarios.

Important: The pH above is going to act as your key to interpreting your ABGs.

Now, let’s proceed with the different scenarios.

How does your marching band figure works?

If you are given an NCLEX® question that indicates a pH of 7.25, that would automatically mean that it’s acid. Now, you just need to match that acid with the A (acid) in your lungs (respiratory acidosis) and with the A (acid) in your kidneys (metabolic acidosis). You can match either of the two in different scenarios.

Technically, you will be matching your pH which is your key, to the figures of the lungs and the kidneys to pinpoint the ABGs effectively.

To further explain, here are some scenarios.

Scenario #1

A client who failed to take her benzodiazepine and just experienced a traumatic event, like a car accident, came in hyperventilating and is becoming very anxious. How are you going to interpret this?

Tips for answering:

  1. When a person is hyperventilating, they tend to make the sound of a dog that’s breathing fast like, “Alk, alk, alk, alk.”
  2. pH level – more than 7.45.
  3. Lungs – breathing off the carbon dioxide (Mike calls it carbon diacid to help with memorization); retain base inside your lungs, making the base below 35.
  4. Kidneys (aim for homeostasis) – compensate since the body is alkalotic, would make the body a bit acidic.

Answer: Respiratory alkalosis

Scenario #2

A client with respiratory depression who’s manifesting improper breathing pattern like slow or labored breathing which technically means that there is more carbon dioxide in the lungs.

Tips for answering:

  1. When a person has respiratory depression, you have to remind yourself of someone who’s sleeping soundly  in their sleep, snoring while breathing slowly and making a hissing sound like, “Hiss, hiss.” Like that of a snake. You can remember this as, “hiss-cidosis or acidosis.” The respiratory rate is expected to be less than 12 to 20.
  2. pH level – less than 7.35
  3. Lungs – acid is more than 45
  4. Kidneys – would compensate and make the body alkalotic.

Answer: Respiratory acidosis

Scenario #3

A vomiting client.

Tips for answering:

  1. When vomiting, a client will go, “Ulk! Ulk-alosis.” This means that the body is giving out all the acid from the stomach; thus, increasing its alkaline level.
  2. pH level – more than 7.45 (for confirmatory purposes)
  3. Kidneys – more than 26

Answer: Metabolic alkalosis

Scenario #4

A client who has been experiencing two days of severe diarrhea.

Tips for answering:

  1. When a client has diarrhea, alkaline from the GI tract, intestines and colon goes out. Alkaline, for your information, enables proper food digestion and the breaking down of enzymes. Diarrhea gets rid of your base; thus, increasing the acid level.
  2. pH level – less than 7.35
  3. Kidneys – less than 22

Answer: Metabolic acidosis

A quick refresher


If the client is hyperventilating (alk, alk, alk-alosis), that client has respiratory alkalosis. On the other hand, if the client is hypoventilating (hiss, hiss, hiss-cidosis), that client has respiratory acidosis.


If the client is vomiting (ulk, ulk, ulk-alosis), that client has metabolic alkalosis. On the other hand, if the client has diarrhea, that client has metabolic acidosis.

So, that’s your ABG interpretation for you, guys. Hopefully, that helped clarify all your questions.

For more useful and free nursing content, drop by at You can also catch up on the ABG topics we’ve previously discussed.


Identifying Isotonic, Hypertonic, & Hypotonic Solutions Pt 2

Hello guys.

Mike’s back for part 2 of your IV solutions namely: isotonic, hypertonic, and hypotonic. At, we turn your frown upside down by filtering all those unnecessary details and focusing on the ones that matter… the ones that will definitely show up on your exams.

A brief recap

In part 1, we’ve discussed how to easily identify your intravenous solutions. You can do it by remembering the following:

  1. Hypotonic fluids are hippotonic cells because all the fluid goes into the cell causing it to swell.
  2. Hypertonic fluids are for skinny cells because the fluid goes out of the cell, making it skinny. When people are hyper, they become skinny.
  3. Isotonic fluids are isoperfect cells, like “I’m so perfect.” This means that there’s no osmosis or shifting is happening with the cell.

Now that we were able to refresh your memory, the next thing that you have to keep in mind is how to pinpoint an IV solution once you have spotted one.

IV Solution Numbers

Mike got this wrong on his test and because of his frustration, he committed himself to finding a simpler way to remember these IV solutions. Mind you, it will come out of your test and when it does, it will be very difficult if you didn’t know how to find your way around it.

There are a couple of different types of IV solutions created based on how they’re used. Sometimes, remembering all these numbers can be quite overwhelming because they are confusing. How do you do it?

  1. Hypotonic – all the fluid rushes into the cell. What do hypotonic solutions consist of?
  • ½ Normal Saline (0.45%)
  • ¼ Normal Saline (0.225%)
  • 1/3 Normal Saline (0.33%)

Remember: Anything above 0.30% Normal Saline is considered as a hypotonic solution.

  1. Hypertonic – all the fluid rushes out of the cell. What do hypertonic solutions consist of?
  • 3% Normal Saline
  • 5% Normal Saline
  • D10W
  • D5W

Remember: Numbers that don’t go beyond 30% are considered as hypertonic solutions. People who are hyper are skinny, therefore, their numbers are limited to a single digit and can go as far as double digits but not over 30%. Those solutions that have Ws labeled on them is a hypertonic solution.

  1. Isotonic – isoperfect, nothing is happening inside and outside the cell. Osmosis is not present.
  • Normal Saline
  • NS 0.09
  • Sodium Chloride (NaCl)

Remember: Blood has the same consistency as isotonic solutions. Therefore, during post-op surgeries, Lactated Ringer’s solution is given.

One for the books

Nursing tests love inserting questions about isotonic solutions primarily because it is one of the most commonly used solutions in a hospital setting. They will keep on adding those questions in your exams until you get it right because isotonic solutions are integral in healthcare.

A scenario that usually gets placed in exams is the one wherein a client is hypovolemic, having low blood volume inside the body. What solution should you use? So first, you need to consider these:

  1. Hypovolemic clients require fluid within the intravascular space
  2. Hypovolemic clients require fluid to fill their veins
  3. Fluid is not necessary inside the cells
  4. Fluids do not come out from the cells
  5. You need something just right

Answer: Isotonic. Because you just want things to be perfect (isoperfect).

Memorize this by heart. And hopefully, when you encounter IV solution questions in your exams, you can efficiently identify what specific solution to use.

You can check out other lectures on a wide variety of nursing topics on our website, and at our YouTube channel.

Until next time!

Foolproof Techniques to Easily Memorize Respiratory Drugs

Imagine having your very own technique for memorizing all the respiratory drugs. At, we’ve put out our drug cards and made easier for you to remember one of the most complicated sets of medications in your nursing career.

Mike has stated that you just have to remember two categories when dealing with respiratory drugs – your BAM category and your SLM (pronounced as “slam”) category.

Easy, right?

Once you’ve memorized these acronyms by heart, you’ll never go wrong with the identification and administration of respiratory drugs.

Let’s get into it.

BAM: The Bronchodilator Team

Some of the most popular bronchodilators are albuterol, methylxanthines, and anticholinergic agents.

  • B stands for beta2-agonist. These are medications ending in “-terol.” One good example is albuterol (Solu-Medrol).
  • represents the anticholinergic agents that end in “-pium.” These drugs decrease mucus production in the bronchioles. An effective way to remember this kind of drug is the thought that, if you can’t pee with them, it’s anticholinergic.
  • is for methylxanthines which are drugs ending in “-phylline.” These drugs cause a sympathomimetic response that essentially increases heart rate and expands the lungs, making you breathe better. Caffeine has a similar effect. Theophylline is a typical example.

SLM: The Anti-Inflammatory Team

Anti-inflammatory drugs cause the smooth muscles and the major pathways (bronchi and bronchioles) of the lungs to relax.

  • S stands for steroids; corticosteroids ending in “-sone.” Prednisone falls under this group.

Word of caution: do not discontinue this drug abruptly. Naturally, the human body produces steroids. Consumption of corticosteroids for a period of time will make the body think that it no longer needs to secrete steroids. So the adrenal glands will eventually shut down its normal production of corticosteroids. Sudden cessation of intake will result in withdrawal symptoms, which is why it is advisable to taper off corticosteroids to allow the adrenal gland to gradually regenerate and resume regular steroid production that the body needs.

  • L is for “-leukast.” Leukotrienes, the blood cells that cause prostaglandin production leading to inflammation, are stabilized by this drug. Once leukotrienes are controlled, the bronchi and the bronchioles will start to relax. Singulair (montelukast sodium) is a leukotriene receptor antagonist.

Tip: Remember leukotrienes in singulair by memorizing, “Luke likes to sing.”

  • M stands for mast cells stabilizers, much like Cromolyn. As the name implies, this type of drug stabilizes mast cells. What is the main function of mast cells? They dilate the blood vessels which causes blood to rush into the smooth muscle.

What would happen if there is a mass of blood within the lining of the smooth muscles of the bronchi and bronchioles? There will be the presence of puffiness and inflammation. Cromolyn acts on reducing the swelling through stabilization of the mast cells.

Tip: To help you remember this, just think about “mast of crom” which is basically people who drive with massive chrome rims. I hope you get the point.

So don’t forget, for your respiratory drugs, all you need to keep in mind are: BAM and SLM.


Identifying Isotonic, Hypertonic, & Hypotonic Solutions Pt 1

Let’s face it, intravenous (IV) solutions, are burdensome to remember.  It’s confusing! It gets even more complicated if it shows up during your examination. How are you going to differentiate one fluid from another? If you are not familiar with the concepts of each IV solution, chances are, you’ll flunk your exam.

If only there’s just an easier way to remember the indications and mechanism of action for all three, it’ll definitely save you from hours of tedious memorization.

Fortunately, at, Mike has formulated the easiest, most amusing way to correctly identify your hypotonic, isotonic, and hypertonic solutions.

Mike’s fun study tip

When memorizing something that can be a bit confounding, it would be so much easier to connect the complicated physiology to an image that’s closely related to it.

Here’s how…

Hypotonic is for Hippo

In cases of dehydration or medication treatments, the hypotonic solution is the IV solution of choice. This is because hypotonic solutions contain fewer electrolytes and sodium. Oftentimes used if there is decreased solute level outside the cell and the goal is to shift that back inside through osmosis in order to put everything back to normal.

Now, to be able to remember that, think of hypotonic fluids as a hippo. Got it? Hypo to hippo. Why? When fluid goes into your cell, it causes the cell to become full and swollen, like a hippo.

Uses: Hyperosmolar hyperglycemia, diabetic ketoacidosis (DKA)

Hypertonic is for Skinny

On the other hand, hypertonic solutions are used when solutes are increased extracellularly. Osmosis causes water to run from inside out. If this happens, the cell will shrink.

With hypertonic solutions, the first thing that you have to think of is what would happen to someone who is hyper? They have a lot of energy that makes them do activities like running around, keeping them fit and skinny. Hypertonic solutions cause the cell to become skinny because of the fluid that escapes from it.  As Mike puts it, hypertonic is to running and running is to skinny.

Uses: Most likely given to counter the effects of fluid overload or pulmonary edema

Isotonic is for I-so-perfect

Intravascularly, isotonic solutions don’t cause osmotic shifting from the cell to the vascular spaces. There is an equal concentration of cellular conditions.

This can be remembered by simply putting it this way – isotonic is Isoperfect. And being perfect means you don’t have to change anything, you are not required to gain or lose, everything is perfect – Isoperfect.

Uses: Dehydration, surgery

As a recap, here are the things that you need to keep in mind:

  1. Hypo is to hippo. Hippo is to swollen cells.
  2. Hyper is to Skinny. Skinny is to emaciated cells.
  3. Isotonic is to Isoperfect. Isoperfect is to no exchange of fluids required.

By remembering these, you are now able to get the questions related to IV solutions in your next nursing exam. Hopefully, this was able help clear concepts that seem jumbled up for you.

Visit for more nursing videos and to get your Pathophysiology Bible.

Improve IM Injection Skills to Ace Clinical Demonstration

At, we simplify those complicated lessons and demonstrations for you. Today, Mike will be walking you through the proper way of performing an intramuscular (IM) injection to increase your knowledge and skills and pass that clinical demonstration in flying colors.

Let’s begin.

Intramuscular (IM) injection is a method used in the healthcare setting to deliver different kinds of medicines deeply into the muscles. This technique will allow better absorption of the medication into the bloodstream.

IM Sites

When giving an IM injection, there are four main sites namely:

Deltoid muscle – the site preferred for vaccination
Dorsogluteal (buttocks) – no longer recommended due to potential sciatic nerve injury
Dorsal-ventral (side of the hip) or also known as the ventrogluteal muscle – considered as the safest site for children and adults
Vastus lateralis (thigh) – when the other sites are not available due to trauma or other factors, this site is used

Fundamentally, your books will provide instructions on how to administer intramuscularly, saying it should not be more than one or two milliliters in the shoulder; with the legs, it should not be more than 2.5 milliliters. However, there are times when you can actually give 4 milliliters in a person’s leg.

The administration of the drug will entirely depend on the size of your client.

Now here’s a scenario: The doctor ordered 2.5 milligrams of any drug like, Rocephin. How are you going to administer that and what is the proper way to do so?

To answer that, here are the steps in drawing the drug:

1. Do the necessary precaution like washing your hands and gathering the supplies you need.
2. Check if the drug is the right drug; following the five rights of medication administration.
3. Calculate the right dosage.
4. Using the syringe, draw up 2.5 mg of air. Draw the plunger back to fill the syringe with the appropriate dose of air. This is done to regulate pressure inside the vial, making it easier to draw medication.
5. Remove needle cap, insert the needle into the vial, then use the plunger to push all that air inside the vial. Remember not to touch the inside of the syringe for sterility purposes.
6. Turn the syringe and vial upside down, making sure that you have a firm grasp.
7. Draw the appropriate medication dose.
8. Get rid of the air and the bubbles out of your syringe through tapping then depressing.
9. Label your drug. So that if by accident, you dropped the syringe on the floor, whoever will see it will know what kind of drug the syringe contains.
10. Take out the syringe you used for taking the medication and replace it with the appropriate insertion catheter.

Note: The size of the syringe will depend on the size of the client you’re going to administer the drug to. For the arm and leg sites, a 23-gauge syringe which is commonly used for IM injections. That would be an inch to an inch and a half, same with the buttocks.

Administering the drug

Once you’ve prepared your drug and it’s good for administration, you have to follow these steps:

1. Assuming the catheter is already attached to the syringe, the next thing that you would do is to do another round of tapping and depressing the syringe to make sure that no air will be inserted into your client. Make your drug “bleed” to completely get rid of the air from the inside.
2. Identify the appropriate landmark then swab the site with alcohol from the inside out.
3. Use the Z-track method by pulling the skin top. This technique prevents drug leakage from the muscles to the subcutaneous tissues.
4. Hold the syringe like a dart, aiming at the site, then sticking the needle in at a 90-degree angle. Make sure that you don’t push the plunger yet.
5. Once the needle is in, use your index finger and thumb to hold the middle of the syringe for stabilization, then carefully, pull the plunger back a bit to check if blood is present. This method is called aspiration.

Note: If you see a tinge of blood, it means that you have hit a blood vessel. This would call for a repeat of the process with a new syringe and injection site. But this rarely happens.

6. Assuming that there is no blood and everything went out smoothly, the next thing that you have to do is to administer the medication, pushing the plunger slowly.
7. As soon as you’ve administered all of the medication inside the syringe, with the needle from the site then immediately discard into a sharps container.
8. Apply a bit of pressure on the injection site, massaging for effective absorption. Put bandage to get rid of the slight bleeding.

Getting it right

Everything is about mechanics. And with proper practice, you’ll be able to do IM injections smoothly on your next clinical examination. How can you do that? Use an orange. Do the steps at least 10 times before the demonstration. By practicing, you will be able to perform IM injections smoothly. Studies say that during your best days, your dexterity will be about 60% accurate. Make the most out of it and get a hold of your nerves and adrenaline rush through practice.