Nursing: A Concept-Based Approach to Learning, Volume 1, 3rd Ed. | Registered Nurse (RN) 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
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
Coronary Arteries
- Aortic Root
- Right Coronary Artery (RCA)
- Right (Acute) Marginal Artery
- Posterior Descending Artery (PDA)
- Left Coronary Artery (LCA)
- Left Anterior Descending (LAD) Artery
- Circumflex Artery
- Left Marginal Artery
Coagulation Cascade
- Secondary Hemostasis
- Intrinsic Pathway
- Partial Thromboplastin Time (PTT)
- Heparin
- Extrinsic Pathway
- Prothrombin Time (PT)
- Warfarin
- Common Pathway
- Thrombin
- Convert Fibrinogen to Fibrin
- Stabilizes the Platelet Plug
Disseminated Intravascular Coagulation (DIC) Assessment
- Improper Initiation of Clotting Cascade
- Systemic Bleeding
- Petechiae, Purpura, Ecchymosis
- Change in LOC
- Increased PT and PTT
- Cyanosis
- Increased Fibrin Degradation Products (FDP)
- Decreased Platelets and Fibrinogen
Disseminated Intravascular Coagulation (DIC) Interventions
- Risk for Shock
- Renal Failure
- Treat Underlying Cause
- Manage Bleeding
- Maintain Fluid and Hemodynamic Balance
- Transfusion
- Oxygenation
- Heparin Drip
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
Hypertension Intervention
- Weight Reduction and Exercise
- Diet Changes
- Relaxation Techniques
- Smoking Cessation
- Medications
- Encourage Self Monitoring
Supine Hypotension (Vena Cava Syndrome)
- Compression of the Vena Cava and Descending Aorta
- Hypotension
- Dizziness
- Tachycardia
- Decreased Renal Perfusion
- Decreased Uteroplacental Perfusion
- Side-lying Position
Parts of an ECG
- P Wave
- Atrial Depolarization
- QRS Complex
- Ventricular Depolarization
- T Wave
- Ventricular Repolarization
ECG Interpretation
- Rate
- Rhythm
- P Waves
- Upright, Rounded, Before Every QRS
- PR Interval (< 0.20 seconds)
- Normal QRS (< 0.12 seconds)
Statins
- Rhabdomyolysis
- Hepatotoxicity
- HMG-CoA reductase inhibitors
- Decrease LDL
- Decrease Triglycerides
- Increase HDL
Atorvastatin (Lipitor)
- -statin Suffix
- HMG-CoA Reductase Inhibitors
- High Cholesterol
- Hepatotoxicity
- Rash
- Rhabdomyolysis
- Myopathy
- Monitor Liver Enzymes
- Administer at Bedtime
- Avoid Grapefruit
Hypertension Medications
- Diuretics
- ACE Inhibitors
- Angiotensin Receptor Blockers (ARBs)
- Beta Blockers
- Dihydropyridine Calcium Channel Blockers
Loop Diuretics
- Thick Ascending Limb of Loop of Henle
- Inhibits Na+-K+-2Cl-
- Sulfa Drug
- Furosemide
- Lasix
- Ototoxicity from Rapid Injection
- Gout
- Dehydration
- Hypocalcemia
- Hypokalemia
- Orthostatic Hypotension
Spironolactone (Aldactone)
- Inhibition of Aldosterone
- Potassium Retention
- Hypertension
- Edema
- Heart Failure
- Hyperkalemia
- Endocrine Effects
- Avoid Potassium Supplements
Angiotensin-Converting Enzyme (ACE) Inhibitors
- "-pril" Suffix
- Block Renin Angiotensin-Aldosterone System (RAAS)
- Hypertension
- Heart Failure
- Dry Non-productive Cough
- Hypotension
- Dizziness
- Possible Hyperkalemia
- Angioedema
- Slowly Change Position
- Do Not Stop Abruptly
Hydralazine (Apresoline)
- Severe Hypertension
- CHF
- Reduced Afterload
- Pregnancy
- Vasodilates Arterioles
- Drug-induced Lupus
- Reflex Tachycardia
- Hypotension
- Combined with Diuretic and Beta Blocker
Nitroprusside
- Direct Release of NO
- Increase cGMP
- Short Half-Life
- Malignant Hypertension
- Cyanide Toxicity
Calcium Channel Blockers (Verapamil and Diltiazem)
- Slows AV Conduction
- Angina Pectoris
- Arrhythmias
- Essential Hypertension
- Bradycardia
- Hypotension
- Constipation
- Peripheral Edema
- Gingival Hyperplasia
- Medication Education
Digoxin (Lanoxin)
- Increases Inotropy
- Heart Failure
- Atrial Fibrillation
- Bradycardia
- Fatigue
- Heart Block
- Heart Rate Below 60
- Hypokalemia
- Monitor for Toxicity and Visual Changes
- Digibind
Digoxin Toxicity Treatment
- Activated Charcoal
- Slowly Normalize K+
- Digibind (Anti-Digoxin Fab)
- Magnesium Sulfate
- Lidocaine
- Cardiac Pacing
Alteplase
- Tissue Plasminogen Activator
- Thrombosis
- Bleeding
- Intracranial Hemorrhage
- Internal Hemorrhaging
- Minimize Bleeding
- Monitor for Shock
- Aminocaproic Acid
Fetal Circulation
- Placenta
- Umbilical Vein
- Ductus Venosus
- Right Atrium
- Foramen Ovale
- Left Atrium
- Aorta
- Right Ventricle
- Ductus Arteriosus
- Umbilical Arteries
Hypertrophic Cardiomyopathy Mechanisms
- 2/3 Autosomal-Dominant
- 1/3 Sporadic Type
- Mutation in Gene for Sarcomere Protein
- Cardiac Myosin Binding Protein C
- Asymmetric Septal Hypertrophy
- Outflow Tract Obstruction
- Diastolic Dysfunction
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
Types of Heart Failure
- Left Sided
- Pulmonary Congestion
- Right Sided
- Peripheral Edema
- High Output
- Unable to Meet Metabolic Needs
Patent Ductus Arteriosus
- Continuous
- Machine like murmur
- Often Due to Congenital Rubella
- Prematurity
Tetralogy of Fallot
- Blue Baby Syndrome (Cyanosis)
- Crying or Feeding
- Pulmonary Stenosis
- Right Ventricular Hypertrophy
- Overriding Aorta
- Ventricular Septal Defect (VSD)
- Boot-Shaped Heart
- Squatting for Tet Spells
- Surgery
Aortic Stenosis
- Age-related Calcifications
- Bicuspid Aortic Valve
- Crescendo-decrescendo Murmur
- Systolic Murmur
- Ejection Murmur
- Ejection Click
- Radiates to Carotids and Apex
- Pulsus Parvus et Tardus
- Syncope
- Helmet Cells
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
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
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
Myocardial Infarction Diagnosis
- 12 Lead ECG
- ST Elevation
- Q Wave
- T Wave Inversion
- Troponin T and I
- CK-MB
- Early ECG
- Cardiac Stress Test
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)
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
Cardiac Enzyme Evaluation: Troponin
- Cardiac Muscle Injury
- Detection in Blood: 4 Hours
- Peak: 24 - 36 Hours
- Return to Normal: 5 - 14 Days
- Most Specific for Cardiac Muscle
- Treat Aggressively
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
Aspirin (Acetylsalicylic Acid)
- Inhibits Platelet Aggregation
- NSAID
- Thrombotic Event Prevention
- General Pain
- Inflammatory Conditions
- Fever
- Pancytopenia
- GI Ulcers
- Bleeding
- Withhold Before Surgery 7-10 Days
- Reye's Syndrome
Clopidogrel (Plavix)
- ADP Receptor Antagonist
- Prevent Platelet Aggregation
- Acute Coronary Syndrome (ACS)
- Prevention of Thrombotic Events
- Bleeding
- Thrombotic Thrombocytopenic Purpura (TTP)
- Pancytopenia
- Abdominal Pain
- Withhold Before Surgery
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
Venous Thromboembolism (DVT) Assessment
- Venous Wall Inflammation caused by Thrombus
- Tenderness
- Edema
- Warmth
- Asymmetry
- Could be Asymptomatic
- Monitor for Pulmonary Embolism
Venous Thromboembolism (DVT) Interventions
- Anticoagulants
- Prevention Education
- Frequent Ambulation
- Leg Exercises
- Compression Stockings or SCD's
- Avoid Nicotine and Oral Contraceptives
- Surgery
Heparin (Unfractionated)
- Suppresses Coagulation
- Deep Vein Thrombosis (DVT)
- Pulmonary Embolism
- Hemorrhage
- Heparin-Induced Thrombocytopenia (HIT)
- Monitor aPTT
- Preferred (Safe) During Pregnancy
- Protamine Sulfate
Heparin Induced Thrombocytopenia (HIT)
- 5-10 Days After Heparin Exposure
- Heparin-Platelet Factor 4 Complex
- Autoantibodies Form Against Complex
- Heparin-Platelet Factor 4-Antibody Complex Binds Platelets
- Platelet Aggregation
- Procoagulant Release
- Thrombocytopenia
- Serotonin Release Assay (SRA)
- Stop Heparin, Start Direct Thrombin Inhibitor
Warfarin (Coumadin)
- Inhibits Clotting Factors
- Atrial Fibrillation
- Venous Thrombosis
- Pulmonary Embolism
- PT/INR Levels
- Observe for Bleeding
- Pregnancy
- Vitamin K and Fresh Frozen Plasma
- Prolonged Therapeutic Onset
- Maintain Same Diet
Warfarin Antidotes
- Vitamin K
- Fresh Frozen Plasma
INR Lab Value
- 0.8-1.2 Normal Range
- Warfarin
- 2.0-3.0
PT/PTT Lab Values
- Prothrombin Time (PT)
- 10-14 seconds
- Activated Partial Thromboplastin Time (PTT or aPTT)
- 25-35 seconds
Right Heart Failure Assessment
- Jugular Venous Distention (JVD)
- Peripheral Edema
- Hepatosplenomegaly
- Nocturia
- Weight Gain
- Ascites
- Fatigue
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
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
Cardiac Tamponade
- Fluid in the Pericardial Sac
- Pericarditis
- Decreased Cardiac Output
- Beck's Triad
- Hypotension
- Jugular Venous Distention (JVD)
- Distant Heart Sounds
- Pulsus Paradoxus
- Electrical Alternans
- Pericardiocentesis
Primary Hypertension Risk Factors
- Excessive Alcohol Consumption
- High Sodium Diet
- Dyslipidemia
- Obesity
- People of African Descent
- Advanced Age
- Vitamin D Deficiency
- Reduced Nephron Number
- Diabetes
- Lack of Physical Activity
Preeclampsia Assessment
- After 20 Weeks of Pregnancy
- Hypertension > 140/90
- Proteinuria or End-Organ Dysfunction
- Hypertension > 160/110
- Progressive Renal Insufficiency
- Vision Changes
- HELLP Syndrome
- Pulmonary Edema
Severe Preeclampsia
- Vasospasm and Decreased Organ Perfusion
- Intravascular Coagulation
- Increased Permeability and Capillary Leakage
- Hypertension
- Proteinuria or End-Organ Dysfunction
- Hepatic Dysfunction and Hemolysis
- Elevated Liver Enzymes
- Low Platelet Counts
Eclampsia
- Increased Central Nervous System Irritability
- Hyperreflexia
- Positive Ankle Clonus
- Headaches
- Visual Disturbances
- Epigastric or RUQ Pain
- Seizures
- Coma
- Don't Leave Bedside
- Magnesium Sulfate
ECG: Sinus Bradycardia
- < 60 bpm
- Regular
- Present, Upright, Every QRS
- < 0.20 seconds
- < 0.12 seconds
- Atropine
ECG: Sinus Tachycardia
- > 100 bpm
- Regular
- Present, Upright, Every QRS
- < 0.20 seconds
- < 0.12 seconds
- Treat Underlying Cause
ECG: Atrial Fibrillation
- Variable Rate
- Irregular Rhythm
- No P Wave
- No PR Interval
- QRS < 0.12 Seconds
ECG: Atrial Flutter
- Variable
- Regular or Irregular
- Saw Tooth, Multiple Before Every QRS
- Non-measurable
- < 0.12 seconds
Lidocaine
- Blocks Na+ Channels
- Ventricular Arrhythmia
- Anesthetic
- Paresthesias
- Seizures
- Respiratory Depression
- Drowsiness
- Anesthetic Effects Extended with Epinephrine
Phenytoin (Dilantin)
- Blocks Na+ Channels
- Tonic-clonic Seizures
- Ataxia
- Nystagmus
- Sedation
- Gingival Hyperplasia
- Purple Glove Syndrome
- Hirsutism
- Rash
- Anemia
- Individualized Dosing
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
Peripheral Artery Disease (PAD)
- Atherosclerosis
- Intermittent Claudication
- Pain with Exercise
- Paresthesias
- Arterial Ulcers
- Critical Limb Ischemia
- Amputation
- Ankle-Brachial Index (ABI)
Pulmonary Embolism Causes
- FAT BAT Mnemonic
- Fat
- Air
- Deep Vein Thrombosis (DVT)
- Bacteria
- Amniotic Fluid
- Tumor
- Hypercoagulable
- Central Venous Lines
- Immobilized
Pulmonary Embolism Assessment
- Shortness of Breath (SOB)
- Pleuritic Chest Pain
- Tachypnea
- Hemoptysis
- Hypoxemia
- Sudden Death
Types of Shock
- Hypovolemic
- Depleted Volume
- Cardiogenic
- Pump Failure
- Obstructive
- Indirect Pump Failure
- Distributive
- Lost Vascular Tone
- Neurogenic
- Anaphylactic
- Septic
Severe Sepsis and Septic Shock Assessment
- Microthrombi
- DIC
- Decreased Oxygen Saturation
- Decreased WBC
- Oliguria
- High Output Heart Failure
- Multiple Organ Failure
Ephedrine
- Alpha Agonist
- Beta Agonist
- Rhinitis
- Hypotension
- Urinary Incontinence
Types of Strokes
- Transient Ischemic Attack (TIA)
- Reversible Ischemic Neurologic Deficit (RIND)
- Ischemic
- Thrombotic
- Atherosclerosis
- Embolic
- Atrial Fibrillation
- Hemorrhagic
- Severe Hypertension
Left Hemisphere Stroke Assessment
- Opposite Side Weakness (Hemiplegia)
- Side to Side Discrimination
- Aphasia
- Agraphia
- Slow Performance
- Aware of Deficits
- Anxiety
- Depression
Right Hemisphere Stroke Assessment
- Opposite Side Weakness (Hemiplegia)
- Poor Proprioception
- Disoriented to Person, Place, Time
- Can't Recognize Faces (Prosopagnosia)
- Loss of Judgement and Awareness
- Impulsiveness
- Personality Changes
- Tonal Hearing Loss