Think Like A Nurse

Brooke Wallace
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Guided by 20-year experienced ICU nurse Brooke Wallace and powered by AI — here's your study buddy from the classroom to the bedside. Think Like A Nurse is your go-to podcast for nursing students, NCLEX test-takers, and new graduate nurses who want to survive nursing school, thrive in clinicals, and step confidently into practice. Powered by AI and real-world nursing experience, each episode features conversational insights based on common questions and challenges faced by student and new graduate nurses. The discussions are designed to feel like listening in on a supportive study session — connecting evidence-based strategies, encouragement, and clinical wisdom in a relatable way. Whether you're tackling pharmacology, preparing for clinicals, or learning to manage your first 12-hour shift, this podcast helps you grow in confidence, knowledge, and resilience — from student nurse to strong nurse. Inspired by the most common FAQs from nursing students and new grads, this podcast answers the real questions future nurses are asking: How do I survive pharmacology? How do I talk to patients with confidence? What should I expect on my first 12-hour shift? Created by seasoned ICU nurse Brooke Wallace, RN, BSN, CCRN, CPTC, each episode delivers practical study tips, NCLEX prep strategies, and real-world clinical pearls alongside honest conversations about the challenges of nursing school and early practice.

  1. Diabetic Emergencies: Mastering DKA and HHS Crisis Management

    NOV 23

    Diabetic Emergencies: Mastering DKA and HHS Crisis Management

    Check out ThinkLikeANurse.org COMPREHENSIVE NOTES Core Difference: DKA vs HHS DKA (Type 1 diabetic, absolute insulin deficiency)No insulin → body burns fat → ketones formed → metabolic acidosis Deep, rapid Kussmaul respirations Total body potassium depleted though serum may appear high State of starvation + dehydration HHS (Type 2 diabetic, relative insulin deficiency) Some insulin remains → prevents ketones → no significant acidosis Extreme hyperglycemia (often 600–1200+) Severe dehydration + high serum osmolality Slow onset, often in older adults Diagnostic Markers DKA Diagnostic TriadHyperglycemia > 250 Metabolic acidosis pH Bicarb Anion gap elevated Ketones moderate to large (blood or urine) HHS Diagnostic Markers Extreme hyperglycemia > 600 (often > 1000) Serum osmolality > 320 Minimal or no ketones, pH > 7.3 DKA Treatment Priorities (FIK Sequence)This is a major NCLEX priority sequence. F – Fluids first Severe dehydration: 4–6 liters lost Start aggressive normal saline About 1 liter in the first hour Goal: restore perfusion and blood pressure quickly I – Insulin second Only after fluids have begun Regular insulin IV bolus → insulin infusion Critical NCLEX rule: Check potassium FIRST K – Potassium last Insulin drives potassium into cells → serum potassium drops fast If potassium Begin potassium replacement once potassium When glucose reaches 200–250 Switch to D5 ½ NS Purpose: prevent hypoglycemia while continuing insulin to clear ketones and acidosis HHS Treatment PrioritiesFluids (most critical)Fluid loss often 9–12 liters More aggressive initial resuscitation than DKA Start 0.9% normal saline, often 1–2 liters in the first hour Slow, careful insulinLower dose: ~0.05–0.1 units/kg/hr Begin only after fluid resuscitation Target glucose drop: 50–70 per hour Purpose: prevent cerebral edema, caused by rapid osmotic shifts Prevent thrombosis (HHS-specific)Hyperosmolar blood → massive thrombosis risk Early low molecular weight heparin unless contraindicated Fluid transition Switch fluids when glucose reaches 250–300 Use 0.45% sodium chloride High-Yield Scenarios Scenario 1: DKA with potassium 3.0Priority: Start normal saline Hold insulin Immediate aggressive potassium replacement Once potassium rises above 3.3 → start insulin infusion NCLEX trap: Giving insulin first. Scenario 2: HHS elderly patient, glucose 1250, osmolality 400 Priority: Aggressive normal saline Insert Foley catheter for hourly urine output Start LMWH for clot prevention Delay insulin until hydration improves Then start low-dose insulin infusion slowly Prevention and Patient Education Who is high risk for DKA?Type 1 diabetics Young adults Those experiencing diabetes burnout Patients omitting insulin doses Any illness that increases metabolic demand Discharge teaching essentials Sick-day rules: Never skip insulin Check blood glucose 4–10 times/day Check ketones when glucose > 250 Evolving Role of TechnologyContinuous glucose monitors (e.g., Eversense 365) Automated insulin delivery systems Omnipod 5 iLet / Twist system These systems significantly reduce DKA admissions (40–60%) Nurses increasingly become educators and system managers rather than crisis responders Need to reach out? Send an email to Brooke at ThinkLikeaNursePodcast@gmail.com

    15 min
  2. SIADH vs DI: Clear, Simple, & Finally Understandable

    NOV 22

    SIADH vs DI: Clear, Simple, & Finally Understandable

    Check out thinklikeanurse.org Comprehensive Notes Core ConceptBoth conditions revolve around one hormone: ADH, the body’s water-saving signal. SIADH: Too much ADH → body holds water (soaked inside) DI: Not enough ADH or kidneys ignore ADH → body loses water (dry inside) The blood and urine move in opposite directions in each disorder. SIADH — “Soaked Inside, All Diluted” What HappensADH is high → kidneys save water Blood becomes diluted Urine becomes concentrated Classic Causes Small cell lung cancer (ectopic ADH) Head trauma Pituitary surgery SSRIs Carbamazepine, vincristine Severe pneumonia, meningitis Severe pain or nausea Hallmark Labs Low sodium Low serum osmo High urine specific gravity High urine osmo Typical Patient Picture Confusion, headache, lethargy Weight gain (one kilogram equals one liter held) High blood pressure Puffy face or eyes Not thirsty Very low urine output, dark concentrated urine Priority Interventions Strict fluid restriction Daily weights Neuro checks every few hours Seizure precautions (especially when sodium drops below one twenty) Critical Medication Hypertonic saline (three percent) for seizures or very low sodium Must use a central line Must correct sodium slowly (no more than eight to twelve points in twenty-four hours) Major Warning Correcting sodium too fast risks central pontine myelinolysis, an irreversible brainstem injury. Never Do Never give hypotonic fluids Never give normal saline Never increase free water Diabetes Insipidus — “Dry Inside, All High” What HappensLittle or no ADH signal Kidneys dump water Blood becomes concentrated Urine becomes extremely dilute Two Types Central DI Pituitary does not make ADH Causes: head trauma, brain tumors, pituitary surgery Nephrogenic DI Kidneys ignore ADH Causes: lithium, some antibiotics, chronic high calcium Hallmark Labs High sodium High serum osmo Very low urine osmo Very low specific gravity Typical Patient Picture Intense thirst Clear water-like urine Ten to twenty liters of urine per day Rapid weight loss Tachycardia, low blood pressure Signs of hypovolemic shock Priority Interventions Aggressive fluid replacement (D5W or free water) Hourly intake and output Daily weights Watch closely for shock Stopping the Water Loss Central DI: Give desmopressin (DDAVP) Nephrogenic DI: Stop lithium or offending drug Give a thiazide diuretic (paradox: triggers earlier sodium and water reabsorption) Major Warning Never fluid restrict DI — causes immediate circulatory collapse. SIADH vs DI: The Instant EN-KLEX Pattern Think Like a Nurse Bow-Tie PatternLow sodium + high urine osmo → SIADH Action: fluid restrict Safety: neuro checks, seizure precautions High sodium + low urine osmo → DI Action: free water, D5W, desmopressin Safety: hourly intake and output, watch for shock Bedside PearlIf a post-pituitary surgery patient suddenly puts out large amounts of clear urine and their sodium is rising past one forty-five: → Stop what you’re doing and call the provider immediately. This is a DI crisis until proven otherwise. Need to reach out? Send an email to Brooke at ThinkLikeaNursePodcast@gmail.com

    15 min
  3. Respiratory Emergencies: ARDS, Pulmonary Edema & Tension Pneumothorax

    NOV 22

    Respiratory Emergencies: ARDS, Pulmonary Edema & Tension Pneumothorax

    This episode breaks down three of the most dangerous respiratory emergencies nurses face: ARDS, cardiogenic pulmonary edema, and tension pneumothorax. Using clear bedside cues and rapid-action frameworks, you learn how to spot these crises early, understand the physiology driving them, and take the immediate steps that prevent collapse. From pink frothy sputum to tracheal deviation to refractory hypoxia, this conversation turns complex pathology into a simple action plan rooted in airway-first priorities, lung-protective strategies, and critical “never delay” rules. By the end, you’ll know exactly how to differentiate a mechanical problem, a cardiac overload problem, and an inflammatory lung problem—and what to do the moment each one appears. Need to reach out? Send an email to Brooke at ThinkLikeaNursePodcast@gmail.com

    15 min
  4. Electrolyte Emergencies: Lifesaving Moves Every Nurse Must Know for NCLEX

    NOV 22

    Electrolyte Emergencies: Lifesaving Moves Every Nurse Must Know for NCLEX

    Check out thinklikeanurse.org for more #Comprehensive Notes ##I. Overview Focus: 6 electrolytes + 4 acid–base disorders Goal: Know one classic sign + one lifesaving intervention for each NCLEX weight: High (8–16 questions across categories) Foundational rule: Always assess volume status first — dry vs overloaded guides almost every intervention II. SodiumA. HyponatremiaClassic sign: seizures (especially when levels plunge) Why: water shifts into brain → swelling → seizure risk Lifesaving action: 3% hypertonic saline, rapid bolus for active seizure Additional pearls: Chronic hyponatremia (e.g., “tea and toast” elderly patient): correct slowly to prevent osmotic demyelination syndrome Limit correction to 6–8 points in 24 hours once stable B. HypernatremiaClassic sign: intense thirst + confusion Why: brain cells shrink from dehydration Lifesaving action: give free water (D5W IV, oral, or tube) Rule: correct slowly to prevent cerebral edema III. PotassiumA. HypokalemiaClassic sign: U-waves on ECG Lifesaving action: potassium replacement Safety rules: Never exceed 10–20 per hour through a peripheral line Oral preferred Replace magnesium first—low magnesium prevents potassium correction B. HyperkalemiaThe most urgent electrolyte emergency Classic sign: tall peaked T-waves → wide QRS → sine-wave → cardiac arrest Three-step lifesaver sequence: Stabilize: calcium gluconate protects myocardium Shift: insulin + dextrose (or high-dose albuterol) moves potassium into cells Remove: kayexalate, loop diuretics, or dialysis IV. Calcium & MagnesiumA. HypocalcemiaClassic signs: Chvostek sign (facial twitch with cheek tap) Trousseau sign (carpal spasm with BP cuff) Lifesaving action: slow IV calcium gluconate Risk of fast push: bradycardia, severe hypotension B. HypermagnesemiaOften renal failure or magnesium infusions Classic signs: Profound hypotension Loss of deep tendon reflexes (areflexia) Lifesaving action: Stop magnesium Give calcium gluconate to counteract cardiac depression V. Acid–Base DisordersInterpretation Rule:pH + bicarbonate same direction → metabolic pH + CO₂ opposite directions → respiratory Clinical principle:Treat the patient before the number Volume status affects everything. A. Respiratory AcidosisCause: CO₂ retention from hypoventilation (opioids, COPD flare) Signs: sleepiness, poor arousal Lifesaving action: improve ventilation — stimulate, bilevel support, or intubate B. Respiratory AlkalosisCause: hyperventilation (pain, anxiety, early sepsis, PE) Signs: tingling around mouth and fingers, lightheaded Lifesaving action: treat cause — calm anxiety, treat PE, manage pain C. Metabolic AcidosisClassic sign: Kussmaul respirations (deep, rapid breathing) DKA clue: fruity acetone breath Mnemonic for causes: MUDPILES Methanol Uremia DKA Propylene glycol Iron Lactic acidosis Ethylene glycol Salicylates Lifesaving action: treat underlying cause DKA → insulin Lactic acidosis → fix shock Give bicarbonate only when pH D. Metabolic AlkalosisCause: loss of stomach acid (vomiting, NG suction) Often causes: secondary low potassium Lifesaving action: normal saline + potassium Chloride allows kidneys to excrete excess bicarbonate Potassium replaces losses Consider acetazolamide in severe cases. VI. Practice Scenarios (High-Yield NCLEX Style)1. Vomiting × 3 dayspH high + bicarbonate high → metabolic alkalosis Interventions: normal saline + potassium; consider acetazolamide 2. Severe DKApH extremely low + bicarbonate low → metabolic acidosis First action: start regular insulin infusion 3. Chronic COPDpH low + CO₂ high + bicarbonate high → partially compensated respiratory acidosis Need to reach out? Send an email to Brooke at ThinkLikeaNursePodcast@gmail.com

    13 min
  5. Shock, Sepsis & SIRS: Early Clues, Fast Actions & Bedside Nursing Pearls

    NOV 21

    Shock, Sepsis & SIRS: Early Clues, Fast Actions & Bedside Nursing Pearls

    Visit thinklikeanurse.org Comprehensive Episode Notes1. What Shock Really IsCore definition: inadequate tissue perfusion, leading to anaerobic metabolism, rising acid, cellular hypoxia, and eventual organ failure. All shock types follow the same three-stage progression: Stage 1: Compensated – tachycardia, tachypnea, cool pale skin, anxiety, decreased urine output; BP may still look normal. Stage 2: Decompensated – severe tachycardia, severe tachypnea, drop in BP, narrowed pulse pressure, mental status changes, oliguria/anuria, metabolic acidosis. Stage 3: Irreversible – refractory hypotension, multiorgan failure, disseminated intravascular coagulation, poor response to pressors or fluids. 2. The Big Three Shock CategoriesA. Hypovolemic Shock — “The Empty Tank”Causes: bleeding, trauma, burns, dehydration, massive fluid shifts (DKA, vomiting, diarrhea). Key assessment: Pale, cool, clammy Flat neck veins Thready pulses Low urine output Lab clues: Low hemoglobin/hematocrit (bleeding) High hemoglobin/hematocrit (hemoconcentration from dehydration) BUN-to-creatinine ratio over 20:1 → prerenal dehydration Priority actions: Two large-bore IVs, rapid fluid resuscitation Blood products if bleeding Keep patient warm; control source of fluid loss B. Cardiogenic Shock — “The Broken Pump”Causes: massive heart attack, myocarditis, pulmonary embolism, cardiac tamponade. Key assessment: Cold + wet Jugular vein distention Crackles, pulmonary edema, pink frothy sputum New S3 heart sound Advanced hemodynamics: High wedge pressure Low cardiac index Priority actions: Avoid aggressive fluids Reduce afterload Start inotropes (dobutamine, milrinone) Pressors if needed (norepinephrine is first-line) Immediate cardiology intervention (cath lab, mechanical support) C. Distributive Shock — “The Leaky Pipes”Includes: Septic Anaphylactic Neurogenic Adrenal crisis Early septic shock often looks warm: Warm, flushed skin Bounding pulses Wide pulse pressure High cardiac output, low vascular resistance Neurogenic shock exception: Warm, dry Bradycardic Caused by spinal cord injury above T6 3. SIRS vs. Sepsis-3SIRS (old criteria): too sensitive, not specific; triggered by many non-infectious conditions. Sepsis-3 definition: Life-threatening organ dysfunction caused by a dysregulated response to infection. SOFA ScoreICU tool measuring organ failure across six systems. QS-SOFA Bedside ScreenSuspected infection + 2 of 3: Respiratory rate 22 or higher Altered mentation Systolic pressure 100 or less → Activate sepsis pathway immediately. 4. Defining Septic ShockSepsis PLUS: Vasopressors needed to maintain a MAP of 65 Lactate level over 2 despite adequate fluid resuscitation → Mortality increases dramatically. 5. Universal Nursing Actions for ShockAirway, breathing, circulation first High-flow oxygen Two large-bore IVs immediately Goal-directed fluids Urine output target: 0.5–1 per hour → early marker of organ perfusion Serial lactates For sepsis: Blood cultures before antibiotics if no delay Broad-spectrum antibiotics within 60 minutes Pressors through central line when possible Maintain warmth; initiate stress-ulcer and DVT prevention 6. 5-Minute Bedside Differentiation TriadHypovolemic: Cold + flat veins Cardiogenic: Cold + wet lungs Distributive (early septic): Hot + flushed Neurogenic: Warm + bradycardic Master these patterns → fast, accurate recognition. Need to reach out? Send an email to Brooke at ThinkLikeaNursePodcast@gmail.com

    13 min
  6. 18 Pharmacology Red Flags With 1 Simple & Clear Action for each

    NOV 21

    18 Pharmacology Red Flags With 1 Simple & Clear Action for each

    Check out www.thinklikeanurse.org 1. Opioids – Respiratory DepressionRed Flag: Respiratory rate below 8–10 Action: Stop the infusion immediately, administer naloxone, monitor closely for re-sedation. 2. Heparin – HIT (Heparin-Induced Thrombocytopenia)Red Flag: Platelets below 100,000 Action: Stop heparin immediately, notify provider, avoid antiplatelets. 3. Warfarin – Excessive AnticoagulationRed Flag: INR above 3.5–4 or any active bleeding Action: Hold the dose, give vitamin K (planned) or FFP (active bleed). 4. Digoxin – ToxicityRed Flag: Yellow/green halos, heart rate below 60, significant nausea Action: Hold digoxin, draw serum level before considering antidote. 5. Potassium Chloride – IV DangerRed Flag: Severe burning, rhythm changes, undiluted infusion Action: Stop the infusion instantly. 6. Vancomycin – Red Man SyndromeRed Flag: Intense flushing and rash during infusion Action: Slow the infusion, pre-treat with diphenhydramine for future doses. 7. Phenytoin – Purple Glove SyndromeRed Flag: Purple, swollen, painful IV site Action: Stop the infusion, use slow rate and inline filter for prevention. 8. ACE Inhibitors – AngioedemaRed Flag: Rapid swelling of lips, tongue, or face Action: Stop the drug immediately, never restart ACE inhibitors. 9. Aminoglycosides – OtotoxicityRed Flag: New tinnitus or hearing loss Action: Stop the medication, check peak and trough levels. 10. Lithium – Toxicity From DehydrationRed Flag: Coarse tremor, confusion, severe nausea Action: Hold the dose, check level, increase fluids. 11. Serotonin Syndrome – SSRI/SNRI EmergencyRed Flag: High fever, agitation, rigidity, hyperreflexia Action: Stop the medication immediately, initiate cooling and supportive care. 12. NSAIDs/Aspirin in Children – Reye SyndromeRed Flag: Child with viral illness taking NSAIDs/aspirin Action: Stop immediately, switch to acetaminophen. 13. Metformin – Contrast Dye Risk / Lactic AcidosisRed Flag: Upcoming contrast study or muscle pain/drowsiness Action: Hold 48 hours before and after contrast. 14. Magnesium Sulfate – OB ToxicityRed Flags: Respiratory rate below 12, absent DTRs, low urine output Action: Stop magnesium, give calcium. 15. Beta Blockers – BradycardiaRed Flag: Heart rate below 50–60 with symptoms Action: Hold dose, notify provider; glucagon for severe overdose. 16. Antiplatelets (Clopidogrel/Ticagrelor) – Surgical BleedingRed Flag: Scheduled surgery within 3–5 days Action: Hold medication pre-op (5 days for clopidogrel, 3–5 for ticagrelor). 17. Amiodarone – Pulmonary ToxicityRed Flag: Persistent dry cough, new shortness of breath, abnormal chest image Action: Stop amiodarone, start steroids. 18. Chemotherapy Vesicants – ExtravasationRed Flag: Burning, swelling, pain at IV site Action: Stop the infusion Do NOT remove the IV Aspirate the drug Remove needle Apply cold (or heat for vinca alkaloids) Give antidote Need to reach out? Send an email to Brooke at ThinkLikeaNursePodcast@gmail.com

    15 min
  7. Dirty Sixty Breakdown: NCLEX Pharmacology Red-Flags & Priority Actions

    NOV 21

    Dirty Sixty Breakdown: NCLEX Pharmacology Red-Flags & Priority Actions

    Visit thinklikeanurse.org EPISODE NOTES 1. Why Pharmacology Is the GatekeeperLargest and most feared NCLEX subsection. Students may face 20–50+ pharm questions in a row. Scoring under 58% on pharm practice drops first-time pass chance to ~30%. NCLEX repeatedly tests the same 15–20 high-danger scenarios, not broad memorization. 2. The Strategy Shift: From Memorizing Everything → Knowing the Life-Threatening Red FlagsStop memorizing hundreds of drugs. Master the 60–70 prototypes (“Dirty 60”) and the red-flag dangers they carry. NCLEX focuses on: Immediate safety threats Priority nursing actions Reversal agents Toxicity signs Safe administration rules 3. The High-Yield Antidotes (Guaranteed Questions)You will see 1–3 antidote questions on the NCLEX. High-Alert Drug Antidote Heparin Protamine sulfate Warfarin Vitamin K; FFP if actively bleeding Opioids Naloxone Benzodiazepines Flumazenil Acetaminophen Acetylcysteine Digoxin DigiBind Magnesium sulfate toxicity Calcium gluconate Beta-blocker overdose Glucagon 4. The “Dirty 60” Prototype DrugsPain / AnticoagulantsOpioids: morphine, hydromorphone, fentanyl Anticoagulants: heparin, enoxaparin, warfarin, one DOAC (apixaban) Endocrine / DiabetesInsulins: regular, NPH, lispro, glargine Metformin Cardiac / Rhythm / BP ControlDigoxin Amiodarone Adenosine Dopamine Nitroglycerin Metoprolol ACE inhibitors (lisinopril, enalapril) ARBs (losartan) Hydralazine NeurologicalPhenytoin Valproic acid Levetiracetam Magnesium sulfate (OB + seizure) AntibioticsVancomycin Gentamicin Tobramycin Ceftriaxone PsychLithium Major antipsychotics MiscellaneousAcetaminophen Potassium chloride Albuterol Levothyroxine 5. The Most Common NCLEX Red-Flag Scenarios & Priority ActionsOpioids → Respiratory Rate Below 8–10Action: Stop infusion immediately Give naloxone Stay with patient Heparin → HIT (Heparin-Induced Thrombocytopenia)Red flag: platelets Action: Stop heparin Label as allergic Notify provider Never give aspirin ACE Inhibitors → AngioedemaAirway emergency Action: Stop ACE inhibitor for life Never restart any drug in the class Vancomycin → Red Man SyndromeFlushing during infusion Action: Slow rate to 90–120 minutes Pre-treat with antihistamine Not a true allergy Aminoglycosides → OtotoxicityRinging, hearing loss Action: Stop drug Notify provider Check peak/trough levels Digoxin ToxicityRed flags: Yellow/green halos HR Severe N/V Action: Holds dose, check dig level, notify provider Metformin Danger SituationsRed flags: Any imaging with IV contrast Muscle pain + drowsiness → lactic acidosis Action: Hold 48 hours before & after contrast Monitor kidneys Magnesium Toxicity (OB)Red flags: Respiratory depression Loss of reflexes Action: Give calcium gluconate 6. Calculations & IV Rules (Deadly NCLEX Traps)Two formulas you must know:Dose calculations: Desired ÷ Have × Vehicle IV drip rate: Total Volume ÷ Time in minutes × Drop factor 50 calculation problems daily builds automaticity.7. IV Push Safety Rules the NCLEX LovesNever IV push undiluted potassium chloride (instant cardiac arrest) Fentanyl/morphine: push over 4–5 minutes Adenosine: must be pushed in 6 seconds, followed by rapid flush Blood transfusion: Two nurses verify Stay with patient for first 15 minutes 8. The 8-Week Pharmacology Mastery PlanWeeks 1–2: Content OnlyMemorize Dirty 60 Memorize antidote list Use Anki/Quizlet No practice questions yet Weeks 3–4: Math Weeks50 dosage calcs per day Build accuracy + speed Weeks 5–6: Question Immersion100 pharm questions per day Read every rationale Week 7: ConsolidationWatch Simple Nursing, Mark Klimek Only focus on high-yield drug classes Week 8: Final PrepMixed blocks Track pharm separately Goal: 65%+ (UWorld 70–80%) Three cheat sheets to print:Dirty 60 Antidote chart IV push rates + insulin peaks 9. Final Thought: Lithium ToxicityWhy push fluids? Because lithium is excreted entirely through the kidneys. Hydration increases clearance and prevents worsening toxicity. Need to reach out? Send an email to Brooke at ThinkLikeaNursePodcast@gmail.com

    13 min
  8. Shock, Sodium, Potassium & pH: The High-Stakes NCLEX Breakdown

    NOV 21

    Shock, Sodium, Potassium & pH: The High-Stakes NCLEX Breakdown

    Check out thinklikeanurse.org Comprehensive Episode Notes I. The “Critical Triangle” for NCLEXFluids, electrolytes, and acid–base interpretation form the foundation of the NCLEX physiological adaptation category. Accounts for ~11–17% of exam questions. Mastery requires recognizing patterns, sequences, and priorities. II. Fluid Volume: Absolute Loss vs DehydrationA. Absolute Volume LossFluid physically leaves the vascular space. Causes: trauma bleeding, burn plasma loss, third spacing. Third spacing = fluid shifts out of vessels into unusable spaces (e.g., pancreatitis abdomen). Treatment: volume replacement. B. Pure DehydrationLoss of free water > sodium. Hallmark: high sodium (hypernatremia). Seen in elderly, confused, poor intake. Treatment: free water replacement, not saline. III. Burn Management & The Parkland FormulaEquation: 4 mL × weight × % TBSA burns (2nd & 3rd degree). Half must be given in the first 8 hours (critical due to peak capillary leak). Preferred fluid: LR (unless potassium is high). LR contraindicated in crush injuries or pre-existing hyperkalemia → switch to normal saline. Large volumes of normal saline risk hyperchloremic metabolic acidosis. IV. Fluid Overload: Early vs Late SignsEarlyBounding pulses. Widened pulse pressure. LateCrackles. JVD. Dyspnea. Early detection prevents progression to pulmonary edema or cardiogenic complications. V. Hemodynamics & Shock DifferentiationA. Hypovolemic vs Cardiogenic ShockBoth show: Low cardiac output. High SVR. Difference: Filling pressures low in hypovolemia (tank is empty). Filling pressures high in cardiogenic (pump fails; backup into lungs). B. Early Warm Septic ShockBreaks the usual rules: Low SVR from vasodilation. High cardiac output as compensation. High mixed venous oxygen (SVO2) because tissues cannot extract oxygen. Profile: High CO + Low SVR + High SVO2 = Early sepsis. VI. Potassium: The Most Lethal ElectrolyteEmergency sequence (memorize the order):Protect the heart: IV calcium gluconate. Shift potassium into cells: Regular insulin + D50, or high-dose albuterol. Remove potassium: Binders or dialysis. Critical pearlIf potassium won’t correct → check magnesium first. Low magnesium prevents potassium retention. VII. Sodium: Emergencies & Rate of CorrectionA. Low SodiumAcute symptomatic (seizing): give 3% hypertonic saline quickly. Chronic low sodium: NEVER increase more than 8–12 per 24 hours. Risk: osmotic demyelination syndrome (ODS). B. High SodiumReplace free water slowly. Do not correct faster than ½ per hour. Risk: cerebral edema. VIII. Calcium & MagnesiumLow calcium causes neuromuscular irritability: Chvostek’s sign. Trousseau’s sign. QT prolongation. Give IV calcium gluconate slowly (10–20 minutes) to prevent bradycardia. IX. Acid–Base Interpretation (NCLEX Method)Step-by-step sequencepH (acidosis, alkalosis, or compensated). CO₂ = respiratory component (moves opposite pH). Bicarbonate = metabolic component (moves with pH). Apply ROME mnemonic: Respiratory = Opposite. Metabolic = Equal. X. Metabolic AcidosisA. Normal Gap AcidosisCauses = HARD P S (focus on): D – Diarrhea (loss of bicarbonate). S – Saline overload → hyperchloremic acidosis. B. High Gap Acidosis (MUDPILES)Focus on: D – DKA (ketone acids). L – Lactic acidosis (shock, sepsis). XI. Metabolic AlkalosisMnemonic CLU → focus on U = Upper GI losses. Vomiting, NG suction = loss of hydrochloric acid. Treatment requires: Normal saline (volume). Chloride (to exchange for bicarbonate). XII. Compensation: Winter’s FormulaExpected CO₂ ≈ 1.5 × bicarbonate + 8 (±2). Use to detect mixed disorders. Example: If expected CO₂ is 21–25 but actual is 15 → metabolic acidosis with respiratory alkalosis. XIII. Priority Actions (ABCs First)Stabilize airway/breathing before calling the provider. Emergency actions: Anaphylaxis → epinephrine IM. Tension pneumothorax → immediate needle decompression. Post-op day 2–3 SOB → assume pulmonary embolism. Red man syndrome → stop infusion, antihistamine, restart slowly. HIT → stop heparin, switch to direct thrombin inhibitor. XIV. DKA & PotassiumHigh or normal potassium on arrival is misleading. Total body potassium is low. As soon as insulin is given → potassium drops fast. Anticipate and replace aggressively. XV. Mixed Disorder Example: Aspirin ToxicityStimulates respiratory center → respiratory alkalosis. Produces organic acids → high gap metabolic acidosis. Check out thinklikeanurse.org Need to reach out? Send an email to Brooke at ThinkLikeaNursePodcast@gmail.com

    16 min
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About

Guided by 20-year experienced ICU nurse Brooke Wallace and powered by AI — here's your study buddy from the classroom to the bedside. Think Like A Nurse is your go-to podcast for nursing students, NCLEX test-takers, and new graduate nurses who want to survive nursing school, thrive in clinicals, and step confidently into practice. Powered by AI and real-world nursing experience, each episode features conversational insights based on common questions and challenges faced by student and new graduate nurses. The discussions are designed to feel like listening in on a supportive study session — connecting evidence-based strategies, encouragement, and clinical wisdom in a relatable way. Whether you're tackling pharmacology, preparing for clinicals, or learning to manage your first 12-hour shift, this podcast helps you grow in confidence, knowledge, and resilience — from student nurse to strong nurse. Inspired by the most common FAQs from nursing students and new grads, this podcast answers the real questions future nurses are asking: How do I survive pharmacology? How do I talk to patients with confidence? What should I expect on my first 12-hour shift? Created by seasoned ICU nurse Brooke Wallace, RN, BSN, CCRN, CPTC, each episode delivers practical study tips, NCLEX prep strategies, and real-world clinical pearls alongside honest conversations about the challenges of nursing school and early practice.

Information

  • Creator
    Brooke Wallace
  • Years Active
    2023 - 2025
  • Episodes
    43
  • Rating
    Clean
  • Copyright
    © 2025- Present
  • Show Website
    Think Like A Nurse