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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

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

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

1 min

Coagulation Cascade Overview

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

2 mins

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

2 mins

Disseminated Intravascular Coagulation (DIC) Interventions

Risk for Shock

Renal Failure

Treat Underlying Cause

Manage Bleeding

Maintain Fluid and Hemodynamic Balance

Transfusion

Oxygenation

Heparin Drip

2 mins

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

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

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

Statins

Rhabdomyolysis

Hepatotoxicity

HMG-CoA reductase inhibitors

Decrease LDL

Decrease Triglycerides

Increase HDL

2 mins

Atorvastatin (Lipitor)

-statin Suffix

HMG-CoA Reductase Inhibitors

High Cholesterol

Hepatotoxicity

Rash

Rhabdomyolysis

Myopathy

Monitor Liver Enzymes

Administer at Bedtime

Avoid Grapefruit

2 mins

Hypertension Medications

Diuretics

ACE Inhibitors

Angiotensin Receptor Blockers (ARBs)

Beta Blockers

Dihydropyridine Calcium Channel Blockers

2 mins

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

2 mins

Spironolactone (Aldactone)

Inhibition of Aldosterone

Potassium Retention

Hypertension

Edema

Heart Failure

Hyperkalemia

Endocrine Effects

Avoid Potassium Supplements

2 mins

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

2 mins

Hydralazine (Apresoline)

Severe Hypertension

CHF

Reduced Afterload

Pregnancy

Vasodilates Arterioles

Drug-induced Lupus

Reflex Tachycardia

Hypotension

Combined with Diuretic and Beta Blocker

1 min

Nitroprusside

Direct Release of NO

Increase cGMP

Short Half-Life

Malignant Hypertension

Cyanide Toxicity

1 min

Calcium Channel Blockers (Verapamil and Diltiazem)

Slows AV Conduction

Angina Pectoris

Arrhythmias

Essential Hypertension

Bradycardia

Hypotension

Constipation

Peripheral Edema

Gingival Hyperplasia

Medication Education

2 mins

Digoxin (Lanoxin)

Increases Inotropy

Heart Failure

Atrial Fibrillation

Bradycardia

Fatigue

Heart Block

Heart Rate Below 60

Hypokalemia

Monitor for Toxicity and Visual Changes

Digibind

2 mins

Digoxin Toxicity Treatment

Activated Charcoal

Slowly Normalize K+

Digibind (Anti-Digoxin Fab)

Magnesium Sulfate

Lidocaine

Cardiac Pacing

2 mins

Alteplase

Tissue Plasminogen Activator

Thrombosis

Bleeding

Intracranial Hemorrhage

Internal Hemorrhaging

Minimize Bleeding

Monitor for Shock

Aminocaproic Acid

2 mins

Fetal Circulation

Placenta

Umbilical Vein

Ductus Venosus

Right Atrium

Foramen Ovale

Left Atrium

Aorta

Right Ventricle

Ductus Arteriosus

Umbilical Arteries

2 mins

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

2 mins

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

Types of Heart Failure

Left Sided

Pulmonary Congestion

Right Sided

Peripheral Edema

High Output

Unable to Meet Metabolic Needs

1 min

Patent Ductus Arteriosus

Continuous

Machine like murmur

Often Due to Congenital Rubella

Prematurity

1 min

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

2 mins

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

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

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 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 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

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: 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

2 mins

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

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

2 mins

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

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

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

Heparin (Unfractionated)

Suppresses Coagulation

Deep Vein Thrombosis (DVT)

Pulmonary Embolism

Hemorrhage

Heparin-Induced Thrombocytopenia (HIT)

Monitor aPTT

Preferred (Safe) During Pregnancy

Protamine Sulfate

2 mins

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

2 mins

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

2 mins

Warfarin Antidotes

Vitamin K

Fresh Frozen Plasma

59 secs

INR Lab Value

0.8-1.2 Normal Range

Warfarin

2.0-3.0

1 min

PT/PTT Lab Values

Prothrombin Time (PT)

10-14 seconds

Activated Partial Thromboplastin Time (PTT or aPTT)

25-35 seconds

1 min

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

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

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

1 min

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

2 mins

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

2 mins

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

3 mins

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

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

Lidocaine

Blocks Na+ Channels

Ventricular Arrhythmia

Anesthetic

Paresthesias

Seizures

Respiratory Depression

Drowsiness

Anesthetic Effects Extended with Epinephrine

1 min

Phenytoin (Dilantin)

Blocks Na+ Channels

Tonic-clonic Seizures

Ataxia

Nystagmus

Sedation

Gingival Hyperplasia

Purple Glove Syndrome

Hirsutism

Rash

Anemia

Individualized Dosing

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

Peripheral Artery Disease (PAD)

Atherosclerosis

Intermittent Claudication

Pain with Exercise

Paresthesias

Arterial Ulcers

Critical Limb Ischemia

Amputation

Ankle-Brachial Index (ABI)

2 mins

Pulmonary Embolism Causes

FAT BAT Mnemonic

Fat

Air

Deep Vein Thrombosis (DVT)

Bacteria

Amniotic Fluid

Tumor

Hypercoagulable

Central Venous Lines

Immobilized

1 min

Pulmonary Embolism Assessment

Shortness of Breath (SOB)

Pleuritic Chest Pain

Tachypnea

Hemoptysis

Hypoxemia

Sudden Death

52 secs

Types of Shock

Hypovolemic

Depleted Volume

Cardiogenic

Pump Failure

Obstructive

Indirect Pump Failure

Distributive

Lost Vascular Tone

Neurogenic

Anaphylactic

Septic

2 mins

Severe Sepsis and Septic Shock Assessment

Microthrombi

DIC

Decreased Oxygen Saturation

Decreased WBC

Oliguria

High Output Heart Failure

Multiple Organ Failure

2 mins

Ephedrine

Alpha Agonist

Beta Agonist

Rhinitis

Hypotension

Urinary Incontinence

35 secs

Types of Strokes

Transient Ischemic Attack (TIA)

Reversible Ischemic Neurologic Deficit (RIND)

Ischemic

Thrombotic

Atherosclerosis

Embolic

Atrial Fibrillation

Hemorrhagic

Severe Hypertension

3 mins

Left Hemisphere Stroke Assessment

Opposite Side Weakness (Hemiplegia)

Side to Side Discrimination

Aphasia

Agraphia

Slow Performance

Aware of Deficits

Anxiety

Depression

2 mins

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

2 mins

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