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Saunders Comprehensive Review For The NCLEX-PN Examination, 8 Ed. | Practical Nurse (LPN) School Study Aid

Cardiac Cycle - Systole

AV Node

AV Node Conducts Signal to Bundle of His

Bundle of His Signals Purkinje Fibers to Contract Ventricles

Tricuspid Valve Closes

Pulmonary Valve Opens

Mitral Valve Closes

Aortic Valve Opens

2 mins

Cardiac Cycle - Diastole

Aortic Valve Closes

Pulmonary Valve Closes

Ventricles Relax

Mitral Valve Opens

Tricuspid Valve Opens

Ventricles Fill

Sinoatrial (SA) Node Fires

Atrial Contraction

3 mins

Vital Signs - Adult

Temperature (96.8-100.4 Degrees F) (36-38 Degrees C)

Rectal

Tympanic

Oral

Axillary

Temporal

Respiration (12-20)

Oxygen Saturation (95%-100%)

Pulse (60-100)

Blood Pressure (<120/80)

Pain

2 mins

Low Blood Pressure Response

Posterior Pituitary Releases Vasopressin

Vasoconstriction

Adrenal Cortex Releases Aldosterone

Increased Na+ and H2O Reabsorption

1 min

High Blood Pressure Response

Atria Release Atrial Natriuretic Peptide

Vasodilation

Antagonizes Aldosterone

Na+ and Water Excreted

1 min

Troponin Lab Values

Troponin T (cTnT)

< 0.1 ng/mL Normal

Troponin I (cTnI)

< 0.5 ng/mL Normal

> 2.3 ng/mL Myocardial Injury

2 mins

Cardiac Enzyme Evaluation: Creatine Kinase CK-MB

Skeletal or Cardiac Muscle Injury

Onset: 4-8 Hours

Peak: 12-24 Hours

Return to Normal: 2-3 Days

1 min

Cardiac Enzyme Evaluation: Myoglobin

Skeletal or Cardiac Muscle Injury

Onset: 1 - 4 Hours

Peak: 12 Hours

Return to Normal: 24 Hours

Elevation After 24 Hours: Reinfarction

2 mins

Red Blood Cell Count (RBC) Lab Values

Women: 3.5-5.5 million cells/ MuL

Men: 4.3-5.9 million cells/ MuL

1 min

WBC Differential Lab Value

White Blood Cells (WBC)

5-10 (5,000-10,000)

Neutrophils (50%-70%)

Bands (2%-5%)

Segs (50%-70%)

Lymphocytes (20%-40%)

Monocytes (4%-8%)

Eosinophils (2%-4%)

Basophils (0.5%-1.5%)

2 mins

Hematocrit (Hct) Lab Values

Women: 36% - 46%

Men: 41% - 53%

1 min

Hemoglobin (Hgb) Lab Values

Men: 13 - 17 g/dL

Women: 12 - 16 g/dL

47 secs

Clotting Overview

Endothelial Cells are Damaged

Platelets Respond to Exposed Collagen and Stick

Platelets Release Recruiting Factors

More Platelets are Attracted

Soluble Fibrinogen Turns to Insoluble Fibrin

Fibrin Seals the Clot

Clot Dissolves

Liver Produces Clotting Factors

2 mins

Cholesterol Lab Values

LDL (Low Density Cholesterol)

< 100 mg/dL

HDL (High Density Cholesterol)

> 40 mg/dL Males

> 50 mg/dL Females

Total Cholesterol

< 200 mg/dL

1 min

Triglycerides Lab Value

< 150 mg/dL

51 secs

Potassium (K+) Lab Value

3.5 to 5.0 mEq/L

20 secs

Hypokalemia

< 3.5 mEq/L

Muscle Weakness

Arrhythmia

U Wave

Ileus

Hyporeflexia

IV K+ Infusion at 5-10 mEq/hr

Give Orally with Food

Monitor Respiratory Status

3 mins

Hyperkalemia

> 5.0 mEq/L K+

Abdominal Cramps

Muscle Weakness

Diarrhea

Arrhythmia

Tall, Peaked T Waves

IV Calcium

Infusion of Glucose and Insulin

Loop or Thiazide Diuretics

Kayexalate

Dialysis

Prevention Education

2 mins

Sodium (Na+) Lab Value

135-145 mEq/L

24 secs

Hyponatremia

< 135 mEq Na+

Nausea and Vomiting

Decreased LOC

Confusion / Lethargy

Seizures

Assess Airway

Reduce Diuretic Dosage

Mannitol (Osmitrol)

Fluid Restriction

Hypertonic Solution (3% or 5% NaCl)

2 mins

Hypernatremia

> 145 mEq/L Na+

Change in LOC

Extreme Thirst

Orthostatic Hypotension

Dry Flushed Skin

Muscle Twitching

Seizures

Treat and Prevent Dehydration

Hypotonic Solutions (0.225% or 0.45% NaCl)

Sodium Restriction

Diuretics

2 mins

Calcium (Ca2+) Lab Value

8.5 to 10.5 mg/dL

26 secs

Hypocalcemia

Muscle Spasms

< 8.5 mg/dL Ca2+

Decreased Bone Density

Tetany

Chvostek's Sign

Trousseau's Sign

Increased DTR

ECG Changes

QT Prolongation

Oral and IV Replacement of Ca2+

Seizure Precautions

2 mins

Hypercalcemia

> 10.5 mg/dL Ca²⁺

Pathologic Fractures

Lethargy

Hypercoagulation

Constipation

ECG Changes

QT Shortening

No Calcium Intake

Chelating Drugs

Calcitonin

Bisphosphonates

Loop Diuretics instead of Thiazide Diuretics

Increased Risk for Renal Calculi

Increase Fluids

3 mins

Magnesium (Mg2+) Lab Value

1.5 to 2.5 mEq/L

28 secs

Hypomagnesemia

Confusion

Increased Deep Tendon Reflexes (DTRs)

Neuromuscular Irritability

Seizures

Muscle Cramps

Tremors

Insomnia

Tachycardia

Magnesium Sulfate

Foods High in Magnesium

1 min

Hypermagnesemia

Flushing

Lethargy

Muscle Weakness

Decreased Deep Tendon Reflexes (DTRs)

Decreased Respirations

Bradycardia

Hypotension

Dialysis

IV Calcium Gluconate

Diuretics

Avoid Antacids and Laxatives containing Mg²⁺

2 mins

BUN (Blood Urea Nitrogen) Lab Values

10-20 mg/dL

40 secs

Blood Glucose Lab Value

70-100 mg/dL

25 secs

Magnetic Resonance Imaging (MRI)

Internal Body Images

Detects Variations of Soft Tissues

No Metal Objects

No Pacemakers

Contrast is Non-Iodine

Safe During Pregnancy

Long Procedure

Antianxiety Medications

2 mins

Cardiac Catheterization

Fluttering Sensation

Contrast Media

NPO 6-12 Hours

Bed Rest

Assess Circulation

Assess for Bleeding

Monitor Vital Signs

2 mins

Stable Angina

Chest Pain with Exertion

Relieved within 15 Minutes

ST Depression

Nitroglycerin

Up to 3 Doses q 5 Minutes

Rest

Antiplatelet Medication

CABG

Angioplasty

2 mins

Unstable Angina

Chest Pain with Rest or Exertion

Limits ADLs

> 15 Minutes

Less Likely Relieved by Nitroglycerin

ST Depression

Fatigue

Acute Coronary Syndrome (ACS) Treatment

Emergency Treatment

2 mins

Coronary Artery Bypass Grafting (CABG)

ST-Segment Elevation Myocardial Infarction (STEMI)

Cardiovascular Disease (CAD)

Uncontrolled Angina

Internal Mammary Artery

Saphenous (Leg) Vein

Transient Limb Edema

Closely Monitor Patients

Venous Thromboembolism (VTE) Prophylaxis

Incentive Spirometer

2 mins

Parts of an ECG

P Wave

Atrial Depolarization

QRS Complex

Ventricular Depolarization

T Wave

Ventricular Repolarization

2 mins

ECG Interpretation

Rate

Rhythm

P Waves

Upright, Rounded, Before Every QRS

PR Interval (< 0.20 seconds)

Normal QRS (< 0.12 seconds)

2 mins

ECG: Sinus Bradycardia

< 60 bpm

Regular

Present, Upright, Every QRS

< 0.20 seconds

< 0.12 seconds

Atropine

1 min

ECG: Sinus Tachycardia

> 100 bpm

Regular

Present, Upright, Every QRS

< 0.20 seconds

< 0.12 seconds

Treat Underlying Cause

2 mins

ECG: Atrial Fibrillation

Variable Rate

Irregular Rhythm

No P Wave

No PR Interval

QRS < 0.12 Seconds

1 min

ECG: Atrial Flutter

Variable

Regular or Irregular

Saw Tooth, Multiple Before Every QRS

Non-measurable

< 0.12 seconds

2 mins

Cardiopulmonary Resuscitation (CPR) for Adults

Scan Scene

Activate Emergency Response System

Check For Breathing (Max 10 Seconds)

Open Airway

Compressions: 2 Inches Deep (100-120 Compressions/Min)

Airway: Ensure Airway is Still Open

Breathing: Administer 2 Rescue Breaths

Repeat C-A-B Sequence (30:2) Until Help Arrives

3 mins

Atrioventricular Block Types

First Degree

PR Interval > 200ms

No Treatment Needed

Second Degree

Mobitz I (Wenckebach)

Progressive PR Interval Lengthening with Nonconducted QRS Complex

Mobitz II

Constant PR Interval with Nonconducted QRS Complex

Third Degree

Atrioventricular Dissociation

3 mins

Types of Heart Failure

Left Sided

Pulmonary Congestion

Right Sided

Peripheral Edema

High Output

Unable to Meet Metabolic Needs

1 min

Heart Failure Interventions

Echocardiogram

Invasive Hemodynamic Monitoring

High Fowler's Position

Oxygen

Advanced Airway

Diuretics

Beta Blockers

Angiotensin II Receptor Blockers (ARBs)

ACE Inhibitors

Digoxin (Lanoxin)

Pacemaker

2 mins

Right Heart Failure Assessment

Jugular Venous Distention (JVD)

Peripheral Edema

Hepatosplenomegaly

Nocturia

Weight Gain

Ascites

Fatigue

1 min

Left Heart Failure Assessment

Pulmonary Congestion

Pink Frothy Sputum

Wheezing or Crackles

Dyspnea with Exertion

Cough

Fatigue

Tachycardia

Weak Peripheral Pulse

S3, S4 Heart Sounds

1 min

Myocardial Infarction Diagnosis

12 Lead ECG

ST Elevation

Q Wave

T Wave Inversion

Troponin T and I

CK-MB

Early ECG

Cardiac Stress Test

2 mins

Myocardial Infarction Assessment

Substernal Chest Pain

Crushing or Dull Sensation

Arm, Jaw, and Neck

> 20 Minutes

Unrelieved by Nitro

Palpitations

Diaphoresis

Fear of Impending Doom

Nausea and Vomiting

Shortness of Breath

Monitor for Arrhythmias

2 mins

Myocardial Infarction Interventions

Morphine

Oxygen

Nitrates

Aspirin

Thrombolytics (tPA)

Cardiac Catheterization

Stent Placement

Angioplasty

Coronary Artery Bypass Grafting (CABG)

Decrease Modifiable Risk Factors

Resuming Activity (Physical, Sexual)

2 mins

Acute Pericarditis Assessment

Pericardial Sac Inflammation

Sharp Chest Pain

Increased with Inspiration

Pain Decreased by Leaning Forward

Pericardial Friction Rub

Diffuse ST-Elevation

T Wave Inversion

Fever

May Be Asymptomatic

Cardiac Tamponade

2 mins

Acute Pericarditis Interventions

Treat Underlying Disorder

Antibiotics

Colchicine + NSAIDs

Corticosteroids

Place Patient Upright with Head of Bed at 45°

Pericardiocentesis

Pericardial Window

2 mins

Endocarditis Assessment

Infection of Inner Layer and Valves

Fever

Fatigue

New or Changed Murmurs

Roth's Spots

Splinter Hemorrhages

Janeway Lesions

Osler's Nodes

Heart Failure

Embolization

2 mins

Endocarditis Interventions

IV Antibiotics

4-6 Weeks

Anticoagulants

Good Hygiene

Closely Monitor

Antibiotic Prophylaxis

Dental Procedures

Invasive Procedures

1 min

Hypertrophic Cardiomyopathy Signs, Symptoms and Treatment

Sudden Death Of Young Athlete

Heart Failure

Angina

Arrhythmias

Syncope

Harsh Systolic Ejection Murmur

S4 Heart Sound

Beta Blocker

Non-dihydropyridine Calcium Channel Blocker

2 mins

Venous Thromboembolism (DVT) Assessment

Venous Wall Inflammation caused by Thrombus

Tenderness

Edema

Warmth

Asymmetry

Could be Asymptomatic

Monitor for Pulmonary Embolism

58 secs

Venous Thromboembolism (DVT) Interventions

Anticoagulants

Prevention Education

Frequent Ambulation

Leg Exercises

Compression Stockings or SCD's

Avoid Nicotine and Oral Contraceptives

Surgery

1 min

Superficial Thrombophlebitis

IV Catheter Irritation

Erythema

Cord-like Vein

Edema

Remove IV Catheter

Elevate

Warm Compress

Rotate Sites Q3 Days

Aseptic Technique

2 mins

Pulmonary Embolism Assessment

Shortness of Breath (SOB)

Pleuritic Chest Pain

Tachypnea

Hemoptysis

Hypoxemia

Sudden Death

52 secs

Pulmonary Embolism Causes

FAT BAT Mnemonic

Fat

Air

Deep Vein Thrombosis (DVT)

Bacteria

Amniotic Fluid

Tumor

Hypercoagulable

Central Venous Lines

Immobilized

1 min

Chronic Venous Insufficiency (Venous Stasis Ulcer) Assessment

Venous Stasis Ulcer

Uneven Edges

Dull Persistent Pain

Medial Malleolus

Necrotic

Normal Pulses

Lower Leg Edema

Bronze-Brown Pigmentation

Warm

Pruritus

2 mins

Chronic Venous Insufficiency (Venous Stasis Ulcer) Interventions

Frequently Elevate Legs

Avoid Standing/Sitting for Long Periods of Time

Elastic Compression Stockings

Bilayer Artificial Skin

Daflon

Wound Dressings

Proper Foot and Leg Care

2 mins

Varicose Veins Assessment

Increased Venous Pressure

Incompetent Valves

Telangiectasias

Small Reticular Veins

Dilated and Tortuous Veins

1 min

Varicose Veins Interventions

Laser Therapy

Sclerotherapy

Removal of Saphenous Vein

Avoid Prolonged Standing

Elastic Compression Stockings

2 mins

Peripheral Artery Disease (PAD)

Atherosclerosis

Intermittent Claudication

Pain with Exercise

Paresthesias

Arterial Ulcers

Critical Limb Ischemia

Amputation

Ankle-Brachial Index (ABI)

2 mins

Abdominal Aortic Aneurysm (AAA) Assessment

Atherosclerosis

Bruit

Pulsation in Abdomen

Abdominal or Lower Back Pain

Tearing Pain

Ultrasound

Rupture

Shock

Surgical Repair

1 min

Hypertension Assessment

Essential Hypertension

Secondary Hypertension

Headache

Vision Changes

Nosebleed (Epistaxis)

Chest Pain

Syncope (Fainting)

Average 2 Sets, 2 Minutes Apart

After 2 or More Visits (within 1-4 weeks)

Take BP Both Arms

Common in African Americans

2 mins

Hypertension Intervention

Weight Reduction and Exercise

Diet Changes

Relaxation Techniques

Smoking Cessation

Medications

Encourage Self Monitoring

1 min

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