Pathophysiology in NCLEX® - Physiological Integrity for Nursing RN

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

Aortic Regurgitation

Diastolic Murmur

Immediate High-pitched

Blowing Murmur

Wide Pulse Pressure

Water Hammer Pulse

Head Bobbing

Pulsating Nail Bed

Can Cause Austin Flint Murmur

1 min

Tricuspid Regurgitation

Holosystolic

Blowing Murmur

Radiates to Right Sternal Border

Enhanced by Inspiration

1 min

Mitral Stenosis

Murmur Follows Opening Snap

Late Diastolic Murmur

Enhanced by Expiration

Low-Pitched Rumbling

Dilation of Left Atrium (LA)

Recurrent Attacks of Rheumatic Fever

2 mins

Mitral Regurgitation

Holosystolic

Blowing Murmur

Loudest at Apex

Radiates toward Axilla

Louder by Squatting

Hand Grip

Expiration

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

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

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

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

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 Flutter

Variable

Regular or Irregular

Saw Tooth, Multiple Before Every QRS

Non-measurable

< 0.12 seconds

2 mins

ECG: Atrial Fibrillation

Variable Rate

Irregular Rhythm

No P Wave

No PR Interval

QRS < 0.12 Seconds

1 min

Torsades de Pointes

Polymorphic Ventricular Tachycardia

Prolonged QT Interval

QRS Twist Around Isoelectric Line

Congenital

Antibiotics

Antiarrhythmics

Antipsychotics

Antidepressants

Electrolyte Deficiencies

Ventricular Fibrillation

Stable: Magnesium Sulfate

Unstable: Defibrillation

3 mins

MET Levels

Metabolic Equivalent

MET Levels 1.0-1.4

Bedrest

MET Levels 1.4-2.0

Sitting Up in Chair

MET Levels 2.0-3.0

Seated Warm Shower

MET Levels 3.0-3.5

Standing Warm Shower

MET Levels 3.5-4.0

Golfing

MET Levels 4.0-10

High-Impact Aerobics

Cardiac Rehabilitation

3 mins

Phases of Cardiac Rehabilitation

MET Levels

Acute Phase

Assessment

Education

Discharge

Goals

Outpatient Phase

Reinforcing Phase 1

Ergonomic Approach

Community Based

Acute Care

Long-Term Acute Care

Skilled Nursing Facilities (SNF)

Independent Living

5 mins

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

Blood Pressure Classification (JNC 7)

Normal

Systolic (<120)

Diastolic (< 80)

Prehypertension

Systolic +20 (120-139)

Diastolic +10 (80-89)

Stage 1 Hypertension

Systolic +20 (140-159)

Diastolic +10 (90-99)

Stage 2 Hypertension

Systolic + > 20 (160)

Diastolic + > 10 (100)

Hypertensive Crisis

Systolic > 180

Diastolic > 110

4 mins

Blood Pressure Classification (ACC/AHA 2017)

Normal

Systolic Less than 120

Diastolic Less than 80

Elevated

Systolic +10 (120-129)

Diastolic Less than 80

Stage 1 Hypertension

Systolic +10 (130-139)

Diastolic +10 (80-89)

Stage 2 Hypertension

Systolic +40 (140-179)

Diastolic +30 (90-119)

Hypertensive Crisis

Systolic greater than or equal to 180

Diastolic greater than or equal to 120

5 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

Hypertension Medications

Diuretics

ACE Inhibitors

Angiotensin Receptor Blockers (ARBs)

Beta Blockers

Dihydropyridine Calcium Channel Blockers

2 mins

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

Peripheral Artery Disease (PAD)

Atherosclerosis

Intermittent Claudication

Pain with Exercise

Paresthesias

Arterial Ulcers

Critical Limb Ischemia

Amputation

Ankle-Brachial Index (ABI)

2 mins

Arterial Ulcer Assessment

Absent or Decreased Pulses

Intermittent Claudication

Sharp Pain

Dependent Rubor

Well Defined Edges

Over Bony Areas

Smooth, Shiny Skin

Toes, Heels, Lateral Lower Legs

Cool

2 mins

Arterial Ulcer Interventions

Saline Dressing

Structured Exercise Programs

Fibrinolytics

Antiplatelet Medication

No Caffeine, Nicotine

Surgery

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

Superficial Thrombophlebitis

IV Catheter Irritation

Erythema

Cord-like Vein

Edema

Remove IV Catheter

Elevate

Warm Compress

Rotate Sites Q3 Days

Aseptic Technique

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

Thoracic Aortic Aneurysm

Elderly Men

Above the Diaphragm

Usually Asymptomatic

Hypertension

Smoking

Connective Tissue Disorders

Vasculitis

Chest X-Ray

Chest CT Angiography

Manage Risk Factors

Surgery if Rupture or Dissection

Observation if Asymptomatic

4 mins

Arterial vs. Venous Insufficiency Interventions

Arterial Insufficiency

Venous Insufficiency

Aerobic Exercise

Strength Training

Soft Tissue Mobilization

Lifestyle Modifications

Vascular Surgery

Compression Therapy

Lower Extremity/Calf Exercises

Manual Therapy

Skin Care

Lifestyle Modifications

3 mins

Angiodysplasia

Tortuous Dilation of Vessels

Fragile Blood Vessels

Right-Sided Colon

Hematochezia

Painless

Endoscopy

Angiography

Von Willebrand Disease

Aortic Stenosis

Elderly

Chronic Renal Failure

Supportive

Surgery

2 mins

Cognitive Abilities Assessment

Collecting/Organizing Objective Information

Mini-Mental State Examination (MMSE)

Montreal Cognitive Assessment Test (MoCA)

Mini-Cog

2 mins

Cerebellar Assessment

Observe Rapid Alternating Movements (RAM)

Touch Thumb to Each Finger

Finger-Nose-Finger Test

Heel-to-Shin Test

Observe Gait

2 mins

Skull, Scalp and Hair Assessment

Inspect Size, Shape and Contour

Inspect and Palpate Areas for Tenderness or Lesions

Inspect for Tenderness, Lesions or Rashes

Inspect for Dandruff

Inspect for Lice or Nits

Inspect Quality and General Appearance of Hair

Observe Hair Distribution

2 mins

Head, Face and Neck Assessment

Inspect Size and Shape of Skull

Palpate Temporal Artery

Observe Facial Expression

Inspect Facial Structures and Symmetry

Look for Symmetry

Check Range of Motion

Inspect Lymph Nodes and Thyroid Gland

Confirm Trachea is Midline

2 mins

Eye Assessment

Eye and Eyebrow Symmetry

Eyeball Alignment

Examine Cornea and Lens for Cloudiness

Iris and Pupil Shape and Size

Pupillary Light Reflex and Accommodation

P.E.R.R.L.A

2 mins

Visual Perceptual Hierarchy

Oculomotor Control

Visual Fields

Visual Acuity

Visual Attention

Visual Scanning

Pattern Recognition

Visual Memory

Visual Cognition

Adaptation Through Vision

A Child Makes Parents See Appropriately

3 mins

Nose Assessment

Inspect for Deformity or Asymmetry

Inspect for Inflammation and Skin Lesions

Check for Nasal Obstruction

Inspect Nasal Mucosa

Note Discharge, Bleeding or Foreign Body

Palpate the Sinus Areas

2 mins

Ear Assessment

Inspect Position and Symmetry

Inspect for Lesions, Drainage, Nodules or Redness

Inspect Opening of Ear Canal

Insert Speculum

Position Scope

View Structures

Light Reflect

Whisper Test

Weber’s Test

Rinne Test

4 mins

Throat and Mouth Assessment

Inspect for Color, Asymmetry and Swelling

Inspect Lips, Teeth, Gums and Oral Mucosa

Assess Tongue

Examine Pharynx with Tongue Depressor

2 mins

Skin Assessment

Observe for Abnormal Skin Pigmentation

Inspect for Cyanosis

Observe Skin for Pallor

Observe for Jaundice

Inspect for Erythema

Check the Temperature

Inspect for Diaphoresis or Dehydration

Imprint Thumb Firmly for 3 to 4 Seconds

Note the Characteristics

Palpate Lesion

4 mins

Nail Assessment

View Index Finger at its Profile

Look at Consistency

Observe Color

Check Capillary Refill

2 mins

Gastrointestinal System Assessment

Inspect Mouth, Jaw, Teeth, Gums and Oral Mucosa

Inspect Tongue

Palpate Areas for Tenderness/Lesions

Inspect Abdominal Quadrants

Auscultate

Percuss

Palpate

Light Palpation

Deep Palpation

Check for Rebound Tenderness and Ascites

Inspect Perianal Area

Palpate Rectum with Gloved Index Finger

6 mins

Abdomen Assessment

4 Quadrants

Contour, Shape, Symmetry

Umbilicus

Bowel Stethoscope

Vascular Sounds

Percuss 4 Quadrants

Tympany or Dullness

Light Palpation

Deep Palpation

Rebound Tenderness

5 mins

Reflexes Assessment

Hyperactive

Hypoactive

Biceps

Triceps

Brachioradialis

Patellar (Quadriceps)

Achilles Tendon

Plantar Reflex (Babinski Sign)

3 mins

ROM Assessment

Active ROM (AROM)

Active Assisted ROM (AAROM)

Passive ROM (PROM)

Neck Flexion, Extension and Rotation

Shoulder Flexion, Extension and Rotation

Elbow Flexion and Extension

Fingers and Wrist Flexion and Extension

Hip and Knee Flexion

Hip Abduction and Rotation

Ankle Rotation

Toe Flexion and Extension

Lumbar Rotation and Spine Inspection

4 mins

Cardiac and Circulation Assessment

Inspect General Appearance

Inspect Chest

Note Location of Apical Impulse

Percuss Chest Wall

Auscultate Heart Sounds: S1, S2, S3, S4

Auscultate for Pericardial Friction Rub and Murmurs

Assess Skin, Fingernails and Toenails

Check Carotid Artery and Jugular Vein

Palpate Skin for Temperature, Texture, Turgor

Check Capillary Refill Time

Palpate Arterial Pulses Bilaterally

5 mins

Male Urinary System Assessment

Past Medical History

Medications

Urination Pattern

Inspection

Palpation

Auscultation

Percussion

Intake and Output

Characteristic of Urine

2 mins

Male Reproductive System Assessment

Inspect the Penis and Urethral Meatus

Inspect the Scrotum, Testicles and Pubic Hair

Inspect the Inguinal and Femur

Palpate the Entire Penile Shaft

Palpate Both Testicles

Palpate Epididymides and Both Spermatic Cords

Palpate for Direct or Indirect Inguinal Hernia and Femoral Hernia

Palpate Prostate Gland

3 mins

Female Reproductive System Assessment

Past Genitourinary and Gynecological History

Current and Past Medication Use

Urine Collection and Characteristics

Inspect External Genitalia

Palpate External Genitalia

Inspect Internal Genitalia Using Lubricated Speculum

Examine Vaginal Wall for Color, Texture, and Integrity

Examine Cervix for Color, Position, Size, Shape, Mucosal Integrity and Discharge

Palpate Internal Genitalia

Note Abnormal Findings

4 mins

Airway and Lungs Assessment

Examine Back of Chest

Determine Respiratory Rate for 1 Minute

Assess for Abnormalities with Uneven Movement or Use of Accessory Muscles

Inspect Skin, Nails and Mucous Membrane

Palpate for Crepitus, Tenderness, Alignment, Masses or Retraction

Palpate for Tactile Fremitus

Check Chest-Wall Symmetry and Expansion

Note Resonance, Hyperresonance, Dullness and Tympany

Use Diaphragm of Stethoscope to Listen to Full Inspiration and Full Expiration

Ask Patient to Breathe Through Mouth

Normal Breath Sounds

Abnormal Breath Sounds

5 mins

Strength Assessment

Assess Patient Appearance for Abnormalities

Observe ROM of Upper and Lower Extremities

Hand Grips

Dorsiflexion and Plantarflexion

Hip and Knee Flexion Against Resistance

Manual Muscle Test (MMT) Grading System

2 mins

Female Urinary System Assessment

Past Medical History

Urination Pattern

Medications

Urine Collection

Inspect Areas Over Kidney and Bladder

Percuss Kidneys

Palpate Kidneys and Bladder

Note Abnormal Findings

Intake and Output

Characteristic of Urine

2 mins

Cranial Nerves I and II Assessments

Cranial Nerve I - Olfactory Nerve

Use Familiar Attainable Smells

Note Any Sense of Smell Asymmetry

Cranial Nerve II - Optic Nerve

Test Visual Fields

2 mins

Cranial Nerves III, IV and VI Assessments

Cranial Nerve III - Oculomotor Nerve

Cranial Nerve IV - Trochlear Nerve

Cranial Nerve VI - Abducens Nerve

Assess Extraocular Movements, P.E.R.R.L.A

Note Any Nystagmus

2 mins

Cranial Nerves V and VII Assessments

Cranial Nerve V - Trigeminal Nerve

Assess Temporal and Masseter Muscles

Assess Light Touch Sensation

Cranial Nerve VII - Facial Nerve

Note Mobility and Facial Symmetry

2 mins

Cranial Nerves VIII, IX and X Assessments

Cranial Nerve VIII - Acoustic (Vestibulocochlear) Nerve

Test Hearing to Normal Conversation

Whisper Test

Cranial Nerve IX - Glossopharyngeal Nerve

Cranial Nerve X - Vegus Nerve

Depress the Tongue and Say “Ahh”

Touch the Posterior Pharyngeal

2 mins

Cranial Nerves XI and XII Assessments

Cranial Nerves XI - Spinal Accessory Nerve

Examine Sternocleidomastoid Muscles

Examine Trapezius Muscles

Cranial Nerve XII - Hypoglossal Nerve

Inspect the Tongue

Note Lingual Speech

2 mins

Shoulder Exam

Skin

Shape

Humeral Head

Acromioclavicular Joint

Rotator Cuff

Clavicle

Spine of Scapula

Flexion

Extension

Abduction

Adduction

Internal Rotation

External Rotation

3 mins

Low Back Assessment

Inspection

Movement

Palpation

Flexion and Extension

Rotation

Lateral Bend

Hyperextension

Straight Leg Raise Test

4 mins

Knee Assessment

Inspection

Palpation

Check Range of Motion

Assess Strength

Neurovascular Assessment

Ballottement and Effusion

Ligament Integrity

Meniscal Integrity

4 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

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

Cardiac Catheterization

Fluttering Sensation

Contrast Media

NPO 6-12 Hours

Bed Rest

Assess Circulation

Assess for Bleeding

Monitor Vital Signs

2 mins

Evolution of Myocardial Infarction and Complications

Arrhythmia

Fibrinous Pericarditis

Papillary Muscle Rupture

Interventricular Septum Rupture

Ventricular Pseudoaneurysm

Ventricular Free Wall Rupture

True Ventricular Aneurysm

Dressler Syndrome

Left Ventricular Failure

2 mins

Infarction Types

Red Infarct

Venous Occlusion

Organ with Multiple Blood Supplies

Liver

Intestine

Testes

Reperfusion Injury

White Infarct

Arterial Occlusion

Organ with Single Blood Supplies

Heart

Kidney

Spleen

2 mins

Types of Heart Failure

Left Sided

Pulmonary Congestion

Right Sided

Peripheral Edema

High Output

Unable to Meet Metabolic Needs

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

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 Causes

Idiopathic

Infection

Trauma

Cardiac

Myocardial Infarction

Autoimmune Diseases

Uremia

Tumor

Radiation

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

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

Types of Shock

Hypovolemic

Depleted Volume

Cardiogenic

Pump Failure

Obstructive

Indirect Pump Failure

Distributive

Lost Vascular Tone

Neurogenic

Anaphylactic

Septic

2 mins

Sepsis Assessment

Systemic Infectious Process

Fever

Hypotension

Change in LOC

Increased WBC

Shift to the Left

Tachycardia

Tachypnea

Hyperglycemia

Edema

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

Respiratory Anatomy

Nasal Cavity

Hair Filters

Mucus Filters and Moistens

Capillaries Warm

Pharynx (Throat)

Larynx (Voice Box)

Cilia Expel Mucus and Dust

Trachea

Bronchi

Alveoli

2 mins

Alveolar Gas Exchange

Pulmonary Artery Blood is O2-Poor, CO2-Rich

Two-Cell Thick Air-Blood Barrier

CO2 Diffuses Into Air

O2 Diffuses Into Blood

Gases Equilibrate

Pulmonary Vein is O2-Rich, CO2-Poor

Thermoregulation

2 mins

Hypoxia (Early Symptoms)

Diaphoresis

Restlessness

Tachypnea

Dyspnea on Exertion

Tachycardia

Hypertension

Arrhythmias

Decreased Urine Output

Unexplained Fatigue

1 min

Hypoxia (Late Symptoms)

Cyanosis

Cool, Clammy Skin

Use of Accessory Muscles

Retractions

Hypotension

Arrhythmias

2 mins

Tracheostomy Care

Inner Cannula Removed and Cleaned

Clean Q8 Hours Around Stoma

One Finger Under Ties

Speak with Deflated Cuff

Can Eat with Tube in Place

Keep Replacement Tube Nearby

Immediately Replace if Dislodged

Physician Does First Tube Change

2 mins

Lung Sounds - Wheezes

Throughout Lung

High Pitched

Musical

Air Moving through Narrowed Airways

38 secs

Lung Sounds - Crackles

Lower Lobes

Fine/Coarse

Fine: Twisting Hair through Fingers

Coarse: Velcro

Collapsed Small Airways and Alveoli "Popping Open"

1 min

Lung Sounds - Rhonchi

Trachea and Bronchi

Low Pitched Rumbling

Gurgling

Narrowed Airway

Secretions or Bronchospasm

49 secs

Lung Sounds - Pleural Friction Rub

Anterior Lateral Lung

Dry, Rubbing, or Squeaking

Rubbing a Balloon with Finger

Inflamed Pleura

50 secs

Oxygen Delivery Methods

Nasal Cannula

Simple Face Mask

Non-Rebreather Mask

Venturi-Mask

Oxygen In Use Sign

No Electrical Sparks

Six Feet Away from Open Flames

Dry Nasal and Upper Airway Mucosa

Skin Irritation

Home Education

1 min

Restrictive vs. Obstructive Lung Diseases

Restrictive Lung Disease

Decreased Lung Volume

FEV1/FVC Ratio Normal to Increased

Obstructive Lung Disease

Increased Lung Volume

Decreased FEV1/FVC Ratio

2 mins

COPD Overview (Chronic Obstructive Pulmonary Disease Overview)

Inhaled Toxins

Smoking

AAT Deficiency

Emphysema

Chronic Bronchitis

Asthma

Spirometry

Slow Progression

2 mins

Asthma Assessment

Triggers (Cold air, Dander, Dust, Infection, Mold, Pollen, Smoke)

Shortness of Breath (SOB)

Tachypnea and Tachycardia

Wheezing

Diaphoresis

Accessory Muscles

Decreased Pulmonary Function Tests

2 mins

Asthma Implementation and Education

Oxygen

Corticosteroids

Ipratropium (Anticholinergic)

Albuterol

Inhaler/nebulizer

Pulse Oximetry

Pursed Lip Breathing

Carry Inhaler

Rinse Mouth after Inhaler

Identify Trigger (Cold Air, Dander, Dust, Infection, Mold, Pollen, Smoke)

2 mins

Chronic Bronchitis Assessment

Chronic Productive Cough

> 3 Months for 2 Years

Increased Mucus Production

Dyspnea

Cyanosis

Wheezes

Right Side Heart Failure

Jugular Venous Distention (JVD)

Peripheral Edema

2 mins

Chronic Bronchitis Interventions

Tripod Position

Humidified Oxygen

Pursed Lip Breathing

Increase Fluid Intake

ABGs

Early Detection of Exacerbation

Lowest O₂ Therapy

Assisted Ventilation

Increased Infection Risk

2 mins

Emphysema

Hyperinflation and Loss of Elasticity

Pursed Lip Breathing

Barrel Chest

Dyspnea on Exertion

Clubbing

Depression and Anxiety

Thin Appearance

CO2 Retention

Low Concentration of O2

High Fowler's Position

High Calorie, High Protein Diet

2 mins

Pneumonia Assessment

Older Adult

Immunocompromised

Long Term Care

Shortness of Breath (SOB)

Hypoxemia

Cough and Sputum Production

Wheezing or Crackles

Fever

Pleuritic Pain

Chest X-ray

2 mins

Pneumonia Intervention

Humidified Oxygen

Deep Breathing Exercises

Position of Comfort

Increase Fluid Intake

Manage Fever

Antibiotics

Mucolytics

Expectorants

Pneumococcal Vaccine

Sepsis

Acute Respiratory Failure (ARF)

Prevention Education

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

Tuberculosis Assessment

Airborne Droplet

3 Week Productive Cough

Night Sweats

Chest Pain

Fever

Weight Loss

Fatigue

Chest X-Ray

Blood Tests

Mantoux Skin Test

3 Positive Sputum Tests

1 min

Pulmonary Embolism Assessment

Shortness of Breath (SOB)

Pleuritic Chest Pain

Tachypnea

Hemoptysis

Hypoxemia

Sudden Death

52 secs

Tuberculosis Intervention

Airborne Isolation

Combination Drug Therapy (RIPE)

6-12 Months

DOT

BCG Vaccination

Medication Education

3 Negative Sputum Specimens

Infection Control

2 mins

Respiratory Acidosis Assessment

Decreased pH < 7.35

Increased PaCO2 > 45

Reduced Respirations

Anxiety

Change in LOC

Tachycardia

Cyanosis

Increased Electrolytes

ECG Changes

Muscle Weakness

Hyporeflexia

2 mins

Cystic Fibrosis Assessment

Thickened Mucus

Recurrent Pulmonary Infections

Pulmonary Congestion

Pancreatic Insufficiency

Steatorrhea

Fat-Soluble Vitamin Deficiencies

Salty Taste to Skin

Meconium Ileus

Delayed Growth and Poor Weight Gain

2 mins

Respiratory Acidosis Interventions

Improve Respiration

Bronchodilators

Respiratory Stimulants

Drug Antagonists

Oxygen

Assisted Ventilation

Prevent Complications

1 min

Cystic Fibrosis Interventions

Bronchodilators

N-Acetylcysteine (Mucolytics)

Inhaled Hypertonic Saline

Early Antibiotics

Dornase Alfa (Mucolytic Agent)

Postural Drainage with Percussion

Fat Soluble Vitamin Supplements

Pancreatic Enzymes with Every Meal

High Protein, High Calorie Diet

Added Dietary Salt

Glucose Monitoring

2 mins

Respiratory Alkalosis Assessment

Increased pH > 7.45

Decreased PaCO2 < 35 mmHg

Hyperventilation

Brainstem Stimulation

Head Injury

Shock

Lightheadedness

Tingling Lips or Fingers

Trousseau's

Chvostek's Sign

Anxiety

2 mins

Pneumothorax

Air Enters Pleural Space

Sudden Dyspnea

Absent or Restricted Movement on Affected Side

Decreased or Absent Breath Sounds on Affected Side

Chest Pain

Tracheal Deviation

Vital Sign Changes

Crepitus

High Fowler's Position With Oxygen

Prepare For Chest Tube Placement

Educate High Risk Patients

2 mins

Respiratory Alkalosis Interventions

Treat Underlying Cause

Decrease Tidal Volume and/or Respiratory Rate

Give Adequate Pain Control and Sedation

Sedatives

Antidepressants

Compensatory Drop in Serum Bicarbonate

Calming Breathing Exercises

Correct CO2 Slowly

2 mins

Croup (Laryngotracheobronchitis)

Parainfluenza Virus

3 Months to 3 Years

Nighttime

Barking Seal Cough

Inspiratory Stridor

Cool Humidified Air

Dexamethasone

Racemic Epinephrine

2 mins

Obstructive Sleep Apnea (OSA)

Narrowed or Obstructed Air Passage

Apnea

Loud Snoring

Startle Response

Daytime Drowsiness

Positional Therapy

Oral Appliance

Continuous Positive Airway Pressure (CPAP)

Surgery

Weight Loss

3 mins

Lung Cancer Assessment

2nd Most Common Cancer

Chronic Cough

Hoarseness

Abnormal Breath Sounds

Hemoptysis

Chest Pain

Anorexia or Weight Loss

Symptoms Appear Late in Disease

2 mins

Adenocarcinoma of the Lung

Most Common Lung Cancer

Most Common in Nonsmokers

Peripheral Location

KRAS, EGFR, and ALK Mutations

Glandular Pattern

Often Stains with Mucin

Presents with Hemoptysis

Clubbing

Surgical Resection

Chemotherapy and Radiation

2 mins

Small Cell (Oat Cell) Carcinoma

Aggressively Malignant

Strong Correlation with Smoking

Central Location

Amplification of Myc Oncogenes

Narrowing of Bronchial Airways

Cushing's Syndrome

Ectopic ACTH

Syndrome Of Inappropriate Antidiuretic Hormone (SIADH)

Lambert-Eaton Syndrome

Kulchitsky Cells

Neuron-Specific Enolase Positive

Chromogranin A Positive

Chemotherapy and Radiation

3 mins

Squamous Cell Carcinoma of the Lung

Strong Correlation with Smoking

More Common in Men

Central Location

Cavitating Lesion Extending to Hilum

PTHrP Causes Hypercalcemia

Keratin Pearls

Intercellular Bridges

Surgical Resection (if Early Stage)

Chemotherapy and Radiation (if Later Stage)

2 mins

Atypical Pneumonia

Diffuse Patchy Inflammation

Interstitial Pattern

"Walking Pneumonia"

Mycoplasma pneumoniae

Chlamydia pneumoniae

Legionella pneumophila

Adenovirus

Respiratory Syncytial Virus (RSV)

Cytomegalovirus (CMV)

Influenza

Dry Cough

Macrolides

2 mins

Acute Respiratory Distress Syndrome (ARDS) Assessment

Damaged Alveolar-Capillary Membrane

Restlessness

Dyspnea

Refractory Hypoxemia

Decreased PaO2

Diffuse Pulmonary Infiltrates

Atelectasis

Pulmonary Hypertension

2 mins

Acute Respiratory Distress Syndrome (ARDS) Interventions

Closely Monitor Patient

ABG's (Arterial Blood Gases)

Oxygen

Assess for O2 Toxicity

Mechanical Ventilation

PEEP

Assess for Pneumothorax

Permissive Hypercapnia

High Mortality Rate

2 mins

Neonatal Respiratory Distress Syndrome

Fetal Lung Immaturity

Lack of Surfactant

Respiratory Distress

Nasal Flaring

Retractions

Grunting

Surfactant

Oxygen

Mechanical Ventilation

Total Parenteral Nutrition (TPN)

2 mins

Alpha 1 Antitrypsin Deficiency

Decreased Alpha Anti Trypsin

Increased Elastase Activity

Decreased Elastic Tissue

Misfolded Protein Aggregates

PAS+ Globules

Panacinar Emphysema

Dyspnea

Cirrhosis

Hepatocellular Carcinoma

2 mins

Idiopathic Pulmonary Fibrosis

Interstitial Restrictive Lung Disease

Age over 50 years, Males, Tobacco

Dyspnea and Cough

Fatigue

Crackles

Digital Clubbing

Bronchiectasis

Honeycomb Pattern

Restrictive Pattern

Respiratory Failure

Right Heart Failure

Oxygen

Antifibrotic Medications

Lung Transplant

5 mins

Beta-2 Agonists

Short-term Treatment

Terbutaline

Asthma

Tocolysis

Albuterol

Asthma

Long-term Treatment

Salmeterol

Asthma

Chronic Obstructive Pulmonary Disease (COPD)

3 mins

Albuterol (Proventil)

Short-Acting Beta-2 Agonist

Bronchospasm

Asthma

Angina

Tachycardia

Tremor

1 min

Cromolyn (Mast Cell Stabilizers)

Mast Cell Stabilizer

Asthma Prophylaxis

Bronchial Inflammation

Allergic Rhinitis

Cough

Bronchospasm

Fixed Schedule Administration

2 mins

Theophylline (Theo-24)

Bronchial Smooth Muscle Relaxation

Asthma

Insomnia

Restlessness

Arrhythmias

Seizures

Narrow Therapeutic Range

Monitor Plasma Levels

1 min

Montelukast (Singulair)

Leukotriene Receptor Blocker

Allergic Rhinitis

Asthma Prophylaxis

Exercise Induced Bronchospasm

Fatigue

Headache

Mood Changes

Suicidal Thoughts

Increased Risk of Churg Strauss

2 mins

Terbutaline (Brethine)

Beta-2 Agonists

Asthma

Tocolytic

Hypotension

Tremor

Tachycardia

Pulmonary Edema

Hyperglycemia

2 mins

Second Generation Antihistamines

Allergies

Lipophobic

Histamine H1 Receptor Antagonist

Azelastine + Fluticasone (Dymista)

Intranasal Spray

Cetirizine (Zyrtec)

Loratadine (Claritin)

Fexofenadine (Allegra)

Fewer Anticholinergic Effects

Fewer CNS Effects

2 mins

First Generation Antihistamines

Histamine H1 Receptor Antagonist

Allergies

Nausea and Vomiting

Motion Sickness

Anaphylaxis

Diphenhydramine (Benadryl)

Promethazine (Phenergan)

Chlorpheniramine

Sedation

Anticholinergic Effects

2 mins

Stages of Asthma Treatments

Short-acting Inhaled Beta-Agonist

Low-Dose Inhaled Corticosteroid

Montelukast (Leukotriene Receptor Antagonist)

Low to Medium-dose Inhaled Corticosteroid

Zileuton

High-Dose Inhaled Corticosteroid

Systemic Corticosteroids

Omalizumab (Allergies)

2 mins

Hypothalamus

Anterior Pituitary Stimulated Through the Hypophyseal Portal

GHRH

GnRH

TRH

PIF

CRF Released During Stress

Posterior Pituitary Stimulated Through Neural Control

3 mins

Anterior Pituitary

Hypothalamic Control

FLAT PeG Mnemonic

Follicle-Stimulating Hormone (FSH)

Lutenizing Hormone (LH)

Adrenocorticotropic Hormone (ACTH)

Thyroid-Stimulating Hormone (TSH)

Prolactin (PRL)

Growth Hormone (GH)

2 mins

Posterior Pituitary

Neuroendocrine Reflex Stimulation (By Hypothalamus)

Vasopressin

Increased Water Retention (In Kidneys)

Oxytocin

Increased Uterine Contraction

Mammary Glands Contraction

2 mins

Thyroid Gland

TSH Stimulates T3 and T4 Release

Metabolism Regulation

Blood Calcium Sensor

Calcitonin Release

Blood Calcium Decreases

Bone Building

2 mins

Parathyroid Gland

Blood Calcium Sensor

Parathyroid Hormone

Bone Resorption

Blood Calcium Increases

Vitamin D Activation

Calcium Absorption From The Small Intestine

1 min

Adrenal Gland (Basic)

Adrenal Cortex

RAAS Stimulates Aldosterone

CRF (CRH) acts on Anterior Pituitary Gland to Release ACTH

Cortisol Released

Androgens Released

Adrenal Medulla

Epinephrine & Norepinephrine

2 mins

Adrenal Gland (Advanced)

Adrenal Cortex

Zona Glomerulosa

Aldosterone

Zona Fasciculata

Cortisol

Zona Reticularis

Androgens

Adrenal Medulla

Chromaffin Cells

Epinephrine & Norepinephrine

2 mins

Peptide Hormones

Fast-Acting and Short-Lived

Bind To Cell Membrane Receptors

Stimulate Secondary Messengers

Amino Acid-Derived

Insulin

Parathyroid Hormone (PTH)

Vasopressin

Oxytocin

2 mins

Steroid Hormones

Nuclear Membrane

Long-Lived and Slow-Acting

Cholesterol-Derived

Intracellular Receptors

DNA Transcription

Testosterone

Aldosterone

Estrogen

Cortisol

2 mins

Pancreas

Acinar Cells Release Digestive Enzymes

Ductal Epithelial Cells Release Bicarbonate

Islets of Langerhans

Beta Cells Release Insulin

Alpha Cells Release Glucagon

Delta Cells Release Somatostatin

Somatostatin Inhibits Alpha and Beta Cells

3 mins

Addison's Disease Assessment

Deficiency of Cortisol and Aldosterone

Irritability

Hyperkalemia

Muscle Weakness

Skin Hyperpigmentation

Hyponatremia

Hypotension

Hypoglycemia

Addisonian Crisis

2 mins

Testes

FSH Stimulates Sertoli Cells

Inhibin B Release

LH Stimulates Leydig Cells

Leydig Cells Secrete Testosterone

Testosterone Causes Male Development

2 mins

Addison's Disease Intervention

Hydrocortisone

2/3 Dose in Morning

1/3 Dose in Late Afternoon

Fludrocortisone

Androgen Replacement Therapy

Salt Additives

Increase Dosage During Stress and Infection

Medic Alert Bracelet

Lifelong Hormone Therapy

2 mins

Syndrome Of Inappropriate Antidiuretic Hormone (SIADH)

Hypersecretion of ADH

Increased Sensitivity to ADH

Serum Hypoosmolality

Coma and Seizure

Dilutional Hyponatremia

Cramps and Tremors

Euvolemia

Change in LOC

2 mins

Addisonian Crisis

Severe Symptoms

Shock

High-Dose Hydrocortisone

Large Volumes of IV Fluid

Insulin with Dextrose

Kayexalate

Loop or Thiazide Diuretics

2 mins

Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Pharmacologic Interventions

Diuretics

Hypertonic IV Fluids

Demeclocycline

Tolvaptan and Conivaptan

1 min

Pheochromocytoma

Adrenal Medulla Tumor

Increased Catecholamines

Episodic Hypertension

Diaphoresis

Abdominal or Chest Pain

Surgery

Antihypertensives

Phenoxybenzamine

Metyrosine (Demser)

Do Not Palpate Abdomen

3 mins

Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Nonpharmacologic Interventions

Monitor Serum and Urine Osmolality

IandOs with Daily Weights

Restrict Fluid Intake

Monitor Cardiovascular and Neurological Status

Seizure Precautions

2 mins

Primary Hyperaldosteronism

Increased Aldosterone Secretion

Adrenal Adenoma

Bilateral Adrenal Hyperplasia

Hypertension

Hypokalemic Metabolic Alkalosis

No Significant Edema

Increased Aldosterone

Decreased Renin

Abdominal CT Scan

Aldosterone Antagonists

Surgery

3 mins

Sheehan's Syndrome

Postpartum Pituitary Gland Necrosis

Agalactorrhea

Amenorrhea

Secondary Hypothyroidism with Cold Intolerance

1 min

Peripheral Precocious Puberty

Secondary Sex Characteristics before 8 Years (Girls) or 9 Years (Boys)

Breast Development (Girls) or Testicular Enlargement (Boys)

GnRH Independent

Congenital Adrenal Hyperplasia

Exogenous Sex Steroids

Granulosa Cell Tumor

Non-Germ Cell Tumor

GnRH Stimulation Test

No Increase in LH

Bone Age

Hormone Levels

Treating Underlying Disorders

3 mins

Central Diabetes Insipidus

ADH Deficiency

Increased Serum and Urine Osmolality

Mental Illness

Brain Injuries

Desmopressin

1 min

Dawn Phenomenon

Increased Hormone Production

Hyperglycemia Upon Awakening

Long-Acting Evening Insulin

Change Administration Times

Insulin Pump

Closely Monitor Glucose Levels

Between 2-6AM

Limit Carbohydrates Before Bedtime

2 mins

Hypothyroidism Assessment

Weight Gain - Edema

Lethargy

Cold Intolerance

Bradycardia

Hypertension

Brittle Nails and Dry Skin

Constipation

Goiter

Prolonged Menses

Slowed Thinking

Decreased Free T4

Increased TSH

2 mins

Diabetes Assessment

Juvenile Onset

Absent Insulin Production

Ketosis Prone

Adult Onset

Insulin Resistance

Obesity

Onset During Pregnancy

Glucose Intolerance

Retinopathy

Peripheral Vascular Disease

Nephropathy

Neuropathy

2 mins

Hypothyroidism Intervention

Levothyroxine (Synthroid)

Liothyronine (Cytomel)

Myxedema Coma

Lifelong Replacement Hormone

Monitor Vital Signs

Fluids and Fiber

Low Calorie, Low Fat Diet

Medication Education

No Switching Brands

2 mins

Diabetes Interventions

Early Diagnosis

Insulin

Oral Hypoglycemics

Glucose Monitoring

Routine Exercise

Diabetic Diet

Monitor for Complications

Insulin Therapy

Diabetic Ketoacidosis (DKA)

2 mins

Hyperthyroidism Assessment

Heat Intolerance

Exophthalmos

Warm, Moist Skin and Silky Hair

Tremors

Goiter

Diarrhea

Weight Loss

Tachycardia

Hypertension

Amenorrhea

Decreased TSH with Elevated Free T4

Radioactive Iodine Uptake (RAIU)

2 mins

Diabetes Education

Self-Monitoring (Blood Glucose)

SubQ Injection Technique

Lifestyle Changes

Symptoms of Hyperglycemia and Hypoglycemia

Sick Day Care

Foot Care

Exercise Therapy

Medication

1 min

Hyperthyroidism Interventions

Propylthiouracil (PTU)

Methimazole (Tapazole)

Iodine

Beta Blockers

Radioiodine Ablation

Thyroidectomy

Thyrotoxicosis

Post-Surgery Hypocalcemia

2 mins

Diabetes Insipidus Assessment

Polyuria

Nocturia

Low Specific Gravity (USG)

Polydipsia

Dehydration

Hypotension

Tachycardia

Confusion

2 mins

Graves' Disease Characteristics

Women 20-40 years old

Anti-TSH Receptor Antibodies

Ophthalmopathy

Exophthalmos

Hyperthyroidism

Goiter

Pretibial Myxedema

1 min

Metabolic Syndrome

Dyslipidemia

Central Obesity

Insulin Resistance

Hypertension

Increased C-Reactive Protein (CRP)

Increased Fibrinogen

Increased Risk Cardiovascular Disease

1 min

Graves' Disease Labs and Treatment

Decreased TSH

Increased T3

Increased T4

Radioactive Iodine Uptake (RAIU)

Beta blocker

Methimazole

Radioiodine Ablation

1 min

Acromegaly Assessment

Excess Growth Hormone (GH)

Protruding Jaw

Large Lips and Nose

Hearing Loss

Enlargement of Hands and Feet

Vision Changes and Headache

Joint Pain

Peripheral Neuropathy

Hyperglycemia

2 mins

Hashimoto's Thyroiditis

Hypothyroidism with Bouts of Hyperthyroidism

Enlarged, Nontender Thyroid

Autoimmune

Anti-Thyroid Peroxidase (TPO)

Anti-Thyroglobulin

Hurthle Cells

Lymphoid Follicles

HLA-DR5 and HLA-DR3

Increased Risk Of Non-Hodgkin Lymphoma

2 mins

Hypocalcemia Causes

Hypoalbuminemia

Hypomagnesemia (Less Common Hypermagnesemia)

Hypovitaminosis D

Hypoparathyroidism

Medications

Hyperphosphatemia

Malnutrition

Acute Pancreatitis

Alkalosis

Sepsis

Chronic Kidney Disease

2 mins

Riedel Thyroiditis

Autoimmune

IgG4

Fibrous Invasion of Thyroid

Very Firm on Palpation

Nontender

Slowly Enlarging Mass

Invades Local Structures

Hypothyroidism

Fibrous Tissue

Eosinophilic Infiltrate

Prednisone

Tamoxifen

Surgery

2 mins

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

Hypoparathyroidism

Hypocalcemia

Lethargy

Tetany

Arrhythmias

Decreased Calcium and Increased Phosphorus

IV Calcium Chloride

Rebreather Mask

Lifelong Medications

Oral Calcium Supplements with Vitamin D

2 mins

Hypocalcemia Treatments

Treat Underlying Disorder

IV Calcium Gluconate

Cardioprotective

Calcium Carbonate

Calcium Citrate

Vitamin D Supplements

Treat Hypomagnesemia

2 mins

Primary Hyperparathyroidism

Hypercalcemia

Kidney Stones

Osteoporosis

Arrhythmias

Increased Calcium and Decreased Phosphorus

Prevent Injury

Medication Education

Surgery

1 min

Hypercalcemia Causes

Two CHIMPANZEES Acronym

Thyroid Disorders

Calcium Supplements

Hyperparathyroidism

Iatrogenic (Drugs, immobility)

Milk-Alkali Syndrome

Paget's Disease of Bone

Acromegaly or Addison's Disease

Neoplasms

Zollinger-Ellison Syndrome

Excessive Vitamin A

Excessive Vitamin D

Sarcoidosis

2 mins

Cushing's Syndrome Assessment

Increased Cortisol Levels

Truncal Obesity

Purple Abdominal Striae

Buffalo Hump

Decreased Bone Density

Moon Face

Thinning Skin

Hyperglycemia

Hypertension

Long Term Glucocorticoid Use

Immunosuppression

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

Hypercalcemia Treatments

Treat Underlying Disorder

Hydration

Dialysis

Calcium Restriction

Bisphosphonates

Calcitonin

Cinacalcet

Glucocorticosteroids

Denosumab

2 mins

Parkinson's Disease Assessment

Decreased Dopamine

Older Adult

Cogwheel Rigidity

Bradykinesia

Shuffling Gait

Resting Tremor

Pill-Rolling

Mask-Like Face

Cognitive Decline

2 mins

Parkinson's Disease Interventions

Levodopa/Carbidopa (Sinemet)

Entacapone (Comtan)

Selegiline (Eldepryl)

Amantadine (Symmetrel)

Bromocriptine (Parlodel)

Benztropine (Cogentin)

Allow Extra Time

Ensure Patient Safety

Surgery As Last Resort

2 mins

5 A's of Alzheimer's Disease

Agnosia

Anomia

Aphasia

Apraxia

Amnesia

1 min

Alzheimer's Disease Assessment (Early Symptoms)

Advanced Age

Poor Judgment and Decision-Making

Difficulty Having a Conversation

Inability to Manage a Budget

Losing Track of the Date or Season

Misplacing Things

1 min

Alzheimer's Disease Assessment (Late Symptoms)

Memory Impairment

Wandering Behavior

Confabulation

Perseveration

Lack of Abstract Thinking

Severe Cognitive Decline

1 min

Alzheimer's Disease Interventions

PET Scan and CT

Mini-Mental State Examination

Drug Therapy

Safe Environment

Moderate Exercise

Behavioral Modification

Assistance with Functional Independence

Assistance and Support for Caregiver

2 mins

Huntington's Disease Assessment and Interventions

Decreased GABA

Appears around Age 40

Slow Cognitive Decline

Choreiform Movements

Non Repetitive Jerks

Neuroleptics

Tetrabenazine

Genetic Counseling

Stages of Disease

High Calorie Diet

2 mins

Multiple Sclerosis Assessment

Nerve Fiber Demyelination

Motor Issues

Cerebellar Signs

Fatigue

Paresthesias

Spasticity

Urinary Incontinence

Optic Neuritis

Women Between 20-50 Years Old

Relapse and Remission of Symptoms

2 mins

Multiple Sclerosis Interventions

Corticosteroids

Interferon Beta

Dimethyl Fumarate (Tecfidera)

Fingolimod (Gilenya)

Mitoxantrone (Novantrone)

Natalizumab (Tysabri)

Increase Exercise

Identify Triggers

2 mins

Down Syndrome

Trisomy 21

Meiotic Nondisjunction

Intellectual Disability (Mental Retardation)

Single palmar crease

Flat Facies

Duodenal Atresia

Hirschsprung's Disease

Septum Primum Type ASD

Endocardial Cushion Defects

Prominent Epicanthal Folds

Increased Risk of Acute Lymphoblastic Leukemia

Alzheimer's Disease

3 mins

Guillain-Barre Syndrome Assessment

Ascending Paralysis

Muscle Weakness

Paresthesias (Pins and Needles)

Diplopia

Difficulty Speaking

Dysphagia

Labile Blood Pressure

Loss of Bowel and Bladder Control

Aggressive Airway Management

2 mins

Myasthenia Gravis Assessment

Weakness with Muscle Use

Diplopia

Ptosis

Dysphagia

Difficulty Speaking

Fatigue

Cholinergic Crisis

Overmedicated

Myasthenic Crisis

Not Enough Medication

Respiratory Muscle Paralysis

2 mins

Amyotrophic Lateral Sclerosis (ALS)

Progressive Muscle Weakness

Systemic Muscle Wasting

Fasciculations

Spasticity

Fatigue

Riluzole (Rilutek)

Stretching

Little to No Cognitive Decline

Respiratory Support

Palliative Care

2 mins

Sciatica

Compression or Damage to Sciatic Nerve

Herniated Disc

Shooting Pain

Lower Back Down to Thigh

Anti-Inflammatories

Steroid Injections

IDET (Intradiscal Electrothermoplasty)

Straight-leg Raising Test

2 mins

Autonomic Dysreflexia

Injury Above T6

Paroxysmal Hypertension

Bradycardia

Diaphoresis

Flushing Above Lesion

Piloerection

Nasal Congestion

Headache

Elevate Head of Bed

Remove Noxious Stimuli

2 mins

Essential Tremor

Most Common Tremor in Adults

Positive Family History

Bilateral Upper Extremities

Worse with Physical and Psychological Stress

Better with Rest and Alcohol

Beta Blockers

Primidone

1 min

Cranial Nerve Pathologies

Horner Syndrome

Trigeminal Neuralgia

Bell's Palsy

Brain or Brainstem Lesion

Microvascular Cranial Nerve Palsy

Glossopharyngeal Neuralgia

Multiple Sclerosis

Arnold Chiari Malformation

Amyotrophic Lateral Sclerosis (ALS)

Guillain Barre’ Syndrome

Parkinson's Disease

3 mins

Types of Seizures

Tonic-Clonic

Tonic

Clonic

Absence (Petit Mal)

Myoclonic

Atonic

Partial (Focal) Seizure

Focal Aware (Formerly Called Simple Partial)

Focal Impaired Awareness (Formerly Called Complex Partial)

3 mins

Seizure Interventions

Maintain Airway

Side-lying Position

Support Head

Move to Floor

Benzodiazepines

Never Restrain

No Objects in Mouth

Document Details

2 mins

Seizure Precautions

Reduce Environmental Stimuli

Identify Triggers

Aura

Pad Side Rails

Bed Lowest Position

Oxygen and Suction Available

Monitor Therapeutic Drug Levels

2 mins

Types of Head Injuries

Open Head Injury

Linear Fracture

Comminuted Fracture

Depressed Fracture

Open Fracture

Basilar Skull Fracture

Closed Head Injury

Coup and Contrecoup

Brain Contusion

Concussion

2 mins

Traumatic Brain Injury Assessment

Change in LOC

Personality Changes

Amnesia

Increased Intracranial Pressure

Diplopia

Posturing

Basilar Skull Fracture

Halo or Ring Sign

Intracranial Bleeding

2 mins

Increased Intracranial Pressure (ICP) Assessment

Change in LOC

Headache

Cushings Triad

Irregular Respirations

Widening Pulse Pressure

Bradycardia

Projectile Vomiting

Abnormal Pupils

Papilledema

Posturing

2 mins

Increased Intracranial Pressure (ICP) Interventions

Elevate Head Of Bed

Foley Catheter

Mannitol (Osmitrol)

High Dose Barbiturates

Passive Hyperventilation

Dexamethasone (Neoplasm or Infection)

Neuro Assessment

Maintain Normal Temperature

Avoid Activities That Increase ICP

Intracranial Monitoring System

2 mins

Types of Strokes

Transient Ischemic Attack (TIA)

Reversible Ischemic Neurologic Deficit (RIND)

Ischemic

Thrombotic

Atherosclerosis

Embolic

Atrial Fibrillation

Hemorrhagic

Severe Hypertension

3 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

Left Hemisphere Stroke Assessment

Opposite Side Weakness (Hemiplegia)

Side to Side Discrimination

Aphasia

Agraphia

Slow Performance

Aware of Deficits

Anxiety

Depression

2 mins

Hydrocephalus

Increased CSF in Ventricles of Brain

Signs of Increased ICP

High Pitched Cry

Irritability

Opisthotonus

Increased Head Circumference

Bulging Fontanel

Setting Sun Sign

Seizure Precautions

Elevate HOB

CSF Shunt

2 mins

Lesions of the Brain and Presentations

Frontal Lobe

Parietal Lobe

Temporal Lobe

Occipital Lobe

Brainstem

Cerebellum

Epidural Hematoma

Subdural Hematoma

Contusion/ Parenchymal Hemorrhage

Intraventricular Hematoma

Subarachnoid Hemorrhage

Diffuse Axonal Injury

3 mins

Concussion

Brain Trauma

Neurometabolic Cascade

Visual Disturbances

Cognitive Dysfunction

Sleep Disturbances

Emotional Instability

Sport Concussion Assessment Tool 5th Edition (SCAT5)

Diagnostic Imaging

Physical and Cognitive Rest

Monitored Exercise

Vestibular Rehabilitation

Second Impact Syndrome

4 mins

Aphasia Post Stroke

Cerebrovascular Accident

Broca’s Aphasia

Wernicke’s Aphasia

Global Aphasia

Conduction Aphasia

Verbal Apraxia

Dysarthria

Cerebral Angiography

Computed Tomography

Magnetic Resonance Imaging (MRI)

Simple Short Sentences

Visual and Tactile Cues

Speech Therapy

4 mins

Rancho Los Amigos Levels of Cognitive Functioning Scale

Level I - No Response

Level II - Generalized Response

Level III - Localized Response

Level IV - Confused/Agitated

Level V - Confused, Inappropriate Non-Agitated

Level VI - Confused, Appropriate

Level VII - Automatic, Appropriate

Level VIII - Purposeful, Appropriate with Stand-by Assistance

Level IX - Purposeful, Appropriate with Stand-by Assistance on Request

Level X - Modified Purposeful, Appropriate

No General Localizes Aggresively Inappropriate Apples Automatically on Purpose

4 mins

Meningitis Assessment

Nausea and Vomiting

Fever

Nuchal Rigidity

Severe Headache

Purpura

Seizures

Photophobia

Opisthotonus Position

High-Pitched Cry

Bulging Fontanel

2 mins

Meningitis Interventions

IV Antibiotics

Dexamethasone

Analgesics

Antipyretics

Closely Monitor for Increased ICP

Bed Rest

Preventative Vaccinations

Droplet-Airborne Precautions

2 mins

Herpes Zoster (Shingles)

Varicella-Zoster Virus

Linear, Unilateral Rash Along a Dermatome

Pruritus

Postherpetic Neuralgia

Acyclovir

Analgesics

Gabapentin

Contagious Vesicles

Shingrix

3 mins

Primary Angle-Closure Glaucoma (PACG - Acute)

Rapid Increase in IOP

Rapid Onset

Pain

Blurred Vision

Halos Around Lights

Nausea and Vomiting

IOP over 30 mm Hg

Drug Therapy

Surgery

1 min

Primary Open-Angle Glaucoma (POAG - Chronic)

Flow of Aqueous Humor Slowed

Slow Onset

No Pain

Tunnel Vision

IOP 22-32mm Hg

Drug Therapy

1 min

Age-Related Macular Degeneration (AMD)

Dry (nonexudative)

Wet (exudative)

Scotomas

Blurred, Darkened Vision

Loss of Central Vision

Distortion of Vision

Drug Therapy

Surgery

Low-vision Assistive Devices

2 mins

Detached Retina

Flashes of Light

Floaters

Curtain Like Shadow

Eye Patch

Bed Rest

Surgical Emergency

No Vigorous Activity

2 mins

Cataract

Age-related

No Pain

Cloudy Opaque Lens

Decreased Visual Acuity

Occurs Gradually

Surgery

1 min

Nystagmus

Vestibulo-Ocular Reflex (VOR) Dysfunction

Vestibular Injury

Concussion

Upbeating or Horizontal Beating Eyes

Oscillopsia

HINTS (Head Impulse-Nystagmus-Test of Skew)

History Examination

INFARCT (Impulse Normal Fast-phase Alternating Refixation on Cover Test)

Visual Acuity Test

Brandt-Daroff Maneuver

Epley Maneuver

Baclofen

Congenital vs Acquired

4 mins

Internal Eye Abnormalities

Nuclear Cataract

Cortical Cataract

Papilledema

Optic Atrophy

Excessive Cup-Disc Ratio

Macular Degeneration

Scotomas

Increased Ocular Pressure

Retinal Detachment

Optic Tract Lesions

Arteriovenous Crossing

Attenuated Arteries

Diabetic Retinopathy

4 mins

External Eye Abnormalities

Strabismus

Exophthalmos

Ptosis

Ectropion

Entropion

Blepharitis

Dacryocystitis

Hordeolum (Stye)

Chalazion

Anisocoria

Mydriasis

Miosis

Pterygium

Hyphema

Hypopyon

4 mins

Age-Related Dizziness

Presbystasis

Visual Decline

Somatosensory Dysfunction

Vestibular Dysfunction

Muscular Atrophy

Increased Loss of Balance

Vertigo

Vestibular Rehabilitation

Strength Training

3 mins

Common Eye Disorders

Conjunctivitis

Refractive Errors

Presbyopia

Cataract

Glaucoma

Uveitis

Age-Related Macular Degeneration

Diabetic Retinopathy

Retinal Detachment

Leukocoria

Cranial Nerve Palsies

4 mins

Retinoblastoma

Loss of Heterozygosity

Chromosome 13

Children

Leukocoria

Strabismus

Vision Loss

Osteosarcoma

Genetic Testing

Cryotherapy

Photocoagulation

Chemotherapy or Radiation

Surgery

3 mins

Otitis Media Assessment

Red or Bulging Tympanic Membrane

Ear Pain

Pulling at Ear

Fever

Upper Respiratory Infection

More Common in Young Children

Eustachian Tube Narrower

Conductive Hearing Loss

Smoking Increases Risk

2 mins

Otitis Media Interventions

Antipyretics

Analgesics

Antibiotics

Irrigation

Position on Affected Side

Myringotomy

Tympanostomy Tube

2 mins

Meniere's Disease

Excess Endolymph

Tinnitus

One-sided Sensorineural Hearing Loss

Vertigo

Nausea and Vomiting

Meclizine (Antivert)

Low Salt Diet

Surgery

2 mins

Labyrinthitis/Vestibular Neuritis

Inner Ear Infection

Postural & Gait Instability

Vertigo

Nystagmus

Increased Fall Risk

Dizziness

Nausea and Vomiting

Medication

Vestibulo-Ocular Reflex (VOR)

Postural Control & Balance Training

Gait Training

Habituation Exercise

3 mins

Vestibular Disorders

Unilateral Vestibular Hypofunction

Vestibular Neuritis

Labyrinthitis

Vestibular Schwannoma (Acoustic Neuroma)

Bilateral Vestibular Hypofunction

Benign Paroxysmal Positional Vertigo

Meniere's Disease

Perilymphatic Fistula

Vertebrobasilar Insufficiency

Traumatic Head Injury

Vestibular Migraine

Brainstem & Cerebellar Conditions

3 mins

Brachial Plexus Roots

C5 through T1

Long Thoracic Nerve

Dorsal Scapular Nerve

43 secs

Brachial Plexus Trunks

Superior Trunk

Suprascapular Nerve

Middle Trunk

Inferior Trunk

1 min

Brachial Plexus Divisions

Anterior (Division)

Posterior (Division)

27 secs

Brachial Plexus Cords

Lateral Cord

Lateral Pectoral Nerve

Posterior Cord

Upper Subscapular Nerve

Thoracodorsal Nerve

Lower Subscapular Nerve

Medial Cord

Medial Pectoral Nerve

Medial Cutaneous Nerve of Arm and Forearm

1 min

Brachial Plexus Branches

Musculocutaneous Nerve

Axillary Nerve

Radial Nerve

Median Nerve

Ulnar Nerve

56 secs

Gastroesophageal Reflux Disease (GERD) Assessment

Relaxed Lower Esophageal Sphincter

Dyspepsia (Indigestion)

Belching

Nighttime Coughing

Dysphagia

Epigastric Pain

Regurgitation

Heartburn (Pyrosis)

Globus

2 mins

Barrett's Esophagus

Metaplasia in Lower Esophagus

Columnar Epithelium

Gastroesophageal Reflux Disease (GERD)

Esophagitis

Esophageal Ulcers

Increased Risk of Esophageal Adenocarcinoma

1 min

Mallory-Weiss

Bleeding From Tears in Mucosa

Forceful Vomiting

Alcoholism

Eating Disorders (Bulimia)

Painful Hematemesis

Endoscopy

Observation

2 mins

Boerhaave Syndrome

Esophageal Rupture

Increased Esophageal Pressure while Vomiting

Lower 1/3 of Esophagus

Chest Pain

Odynophagia

Subcutaneous Emphysema

Shock

Surgical Emergency

2 mins

Tracheoesophageal Fistula (TEF)

Esophageal Atresia

Ends in Blind Pouch

Coughing

Choking

Cyanosis

Drooling

NPO

Surgical Emergency

Aspiration Pneumonia

2 mins

Esophageal Adenocarcinoma Characteristics and Presentation

Most Common Esophageal Cancer in USA

Lower 1/3 of Esophagus

Gastroesophageal Reflux Disease (GERD)

Barrett's Esophagus

Achalasia

Obesity

Smoking

Weight Loss

Progressive Dysphagia

Anemia

2 mins

Dysphagia

Neurological Disorders

Muscular Disorders

Structural Abnormalities

Gastroesophageal Reflux Disease (GERD)

Inflammatory Conditions

Difficulty Swallowing

Choking or Coughing

Regurgitation

Clinical History and Physical Examination

Fiberoptic Endoscopic Evaluation of Swallowing (FEES)

Videofluoroscopy (Modified Barium Swallow Study - MBSS)

Treat Underlying Cause

Therapy

Dietary Modifications

Medications

Surgery

3 mins

Sialolithiasis

Stone Formation

Ducts of Major Salivary Glands

Recurrent Periprandial Pain

Swelling

Trouble Swallowing

Dehydration

Smoking Tobacco

Trauma

NSAIDs

Stimulation of Salivary Flow

Antibiotics

Surgery

2 mins

Peptic Ulcer Disease Interventions

Combination Drug Therapy

Two Antibiotics

Proton Pump Inhibitor (PPI)

Decrease Acid Secretion

Avoid NSAIDs

Diet and Lifestyle Changes

1 min

Peptic Ulcer Disease Assessment

Helicobacter Pylori

NSAIDs

Increased Stomach Acid

Abdominal Pain

Heartburn (Pyrosis)

Melena

Weight Changes

GI Distress

Most Commonly in Duodenum

Duodenal: Pain Relieved by Eating

Gastric: Pain Caused by Eating

2 mins

Gastroenteritis

Viruses

Bacteria

Food Intolerances

Flu-Like Symptoms

GI Distress

Bloody Stool

Oral Rehydration

Self-Limiting

Prevention

2 mins

Hypertrophic Pyloric Stenosis (HPS) Assessment

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