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Nursing: A Concept-Based Approach to Learning, Volume 1, 3rd Ed.
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Perfusion

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Nursing: A Concept-Based Approach to Learning, Volume 1, 3rd Ed. | Registered Nurse (RN) School Study Aid

Perfusion
73 Picmonics to Learn | 2 hrs 8 mins
Cardiac Cycle - Systole
Characteristics
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
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2 mins
Cardiac Cycle - Diastole
Characteristics
Aortic Valve Closes
Pulmonary Valve Closes
Ventricles Relax
Mitral Valve Opens
Tricuspid Valve Opens
Ventricles Fill
Sinoatrial (SA) Node Fires
Atrial Contraction
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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
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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
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2 mins
Disseminated Intravascular Coagulation (DIC) Assessment
Mechanism
Improper Initiation of Clotting Cascade
Signs and Symptoms
Systemic Bleeding
Petechiae, Purpura, Ecchymosis
Change in LOC
Increased PT and PTT
Cyanosis
Increased Fibrin Degradation Products (FDP)
Decreased Platelets and Fibrinogen
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2 mins
Disseminated Intravascular Coagulation (DIC) Interventions
Complications
Risk for Shock
Renal Failure
Interventions
Treat Underlying Cause
Manage Bleeding
Maintain Fluid and Hemodynamic Balance
Transfusion
Oxygenation
Heparin Drip
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2 mins
Hypertension Assessment
Mechanism
Essential Hypertension
Secondary Hypertension
Assessment
Headache
Vision Changes
Nosebleed (Epistaxis)
Chest Pain
Syncope (Fainting)
Diagnosis
Average 2 Sets, 2 Minutes Apart
After 2 or More Visits (within 1-4 weeks)
Nursing Considerations
Take BP Both Arms
Common in African Americans
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2 mins
Hypertension Intervention
Lifestyle Modifications
Weight Reduction and Exercise
Diet Changes
Relaxation Techniques
Smoking Cessation
Medications
Encourage Self Monitoring
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1 min
Supine Hypotension (Vena Cava Syndrome)
Mechanism
Compression of the Vena Cava and Descending Aorta
Signs and Symptoms
Hypotension
Dizziness
Tachycardia
Decreased Renal Perfusion
Decreased Uteroplacental Perfusion
Intervention
Side-lying Position
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2 mins
Parts of an ECG
PQRST
P Wave
Atrial Depolarization
QRS Complex
Ventricular Depolarization
T Wave
Ventricular Repolarization
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2 mins
ECG Interpretation
Rate
Rhythm
P Waves
Upright, Rounded, Before Every QRS
PR Interval (< 0.20 seconds)
Normal QRS (< 0.12 seconds)
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2 mins
Statins
Rhabdomyolysis
Hepatotoxicity
HMG-CoA reductase inhibitors
Decrease LDL
Decrease Triglycerides
Increase HDL
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2 mins
Atorvastatin (Lipitor)
Characteristics
-statin Suffix
Mechanism
HMG-CoA Reductase Inhibitors
Indications
High Cholesterol
Side Effects
Hepatotoxicity
Rash
Rhabdomyolysis
Myopathy
Considerations
Monitor Liver Enzymes
Administer at Bedtime
Avoid Grapefruit
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2 mins
Hypertension Medications
Diuretics
ACE Inhibitors
Angiotensin Receptor Blockers (ARBs)
Beta Blockers
Dihydropyridine Calcium Channel Blockers
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2 mins
Loop Diuretics
Mechanism of Action
Thick Ascending Limb of Loop of Henle
Inhibits Na+-K+-2Cl-
Sulfa Drug
Drug Names
Furosemide
Lasix
Side Effects
Ototoxicity from Rapid Injection
Gout
Dehydration
Hypocalcemia
Hypokalemia
Orthostatic Hypotension
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2 mins
Spironolactone (Aldactone)
Mechanisms
Inhibition of Aldosterone
Potassium Retention
Indications
Hypertension
Edema
Heart Failure
Side Effects
Hyperkalemia
Endocrine Effects
Consideration
Avoid Potassium Supplements
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2 mins
Angiotensin-Converting Enzyme (ACE) Inhibitors
"-pril" Suffix
Mechanism of Action
Block Renin Angiotensin-Aldosterone System (RAAS)
Indications
Hypertension
Heart Failure
Side Effects
Dry Non-productive Cough
Hypotension
Dizziness
Possible Hyperkalemia
Angioedema
Nursing Considerations
Slowly Change Position
Do Not Stop Abruptly
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2 mins
Hydralazine (Apresoline)
Indications
Severe Hypertension
CHF
Reduced Afterload
Pregnancy
Mechanism of Action
Vasodilates Arterioles
Side Effects
Drug-induced Lupus
Reflex Tachycardia
Hypotension
Considerations
Combined with Diuretic and Beta Blocker
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1 min
Nitroprusside
Mechanism of Action
Direct Release of NO
Increase cGMP
Short Half-Life
Indications
Malignant Hypertension
Side Effect
Cyanide Toxicity
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1 min
Calcium Channel Blockers (Verapamil and Diltiazem)
Mechanism of Action
Slows AV Conduction
Indications
Angina Pectoris
Arrhythmias
Essential Hypertension
Side Effects
Bradycardia
Hypotension
Constipation
Peripheral Edema
Gingival Hyperplasia
Nursing Consideration
Medication Education
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2 mins
Digoxin (Lanoxin)
Mechanism of Action
Increases Inotropy
Indications
Heart Failure
Atrial Fibrillation
Side Effects
Bradycardia
Fatigue
Contraindications
Heart Block
Nursing Considerations
Heart Rate Below 60
Hypokalemia
Monitor for Toxicity and Visual Changes
Digibind
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2 mins
Digoxin Toxicity Treatment
Activated Charcoal
Slowly Normalize K+
Digibind (Anti-Digoxin Fab)
Magnesium Sulfate
Lidocaine
Cardiac Pacing
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2 mins
Alteplase
Mechanism
Tissue Plasminogen Activator
Indications
Thrombosis
Side Effects
Bleeding
Contraindications
Intracranial Hemorrhage
Internal Hemorrhaging
Considerations
Minimize Bleeding
Monitor for Shock
Antidote
Aminocaproic Acid
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2 mins
Fetal Circulation
Placenta
Umbilical Vein
Ductus Venosus
Right Atrium
Foramen Ovale
Left Atrium
Aorta
Right Ventricle
Ductus Arteriosus
Umbilical Arteries
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2 mins
Hypertrophic Cardiomyopathy Mechanisms
Pathophysiology
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
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2 mins
Hypertrophic Cardiomyopathy Signs, Symptoms and Treatment
Signs and Symptoms
Sudden Death Of Young Athlete
Heart Failure
Angina
Arrhythmias
Syncope
Harsh Systolic Ejection Murmur
S4 Heart Sound
Treatment
Beta Blocker
Non-dihydropyridine Calcium Channel Blocker
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2 mins
Types of Heart Failure
Left Sided
Pulmonary Congestion
Right Sided
Peripheral Edema
High Output
Unable to Meet Metabolic Needs
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1 min
Patent Ductus Arteriosus
Continuous
Machine like murmur
Often Due to Congenital Rubella
Prematurity
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1 min
Tetralogy of Fallot
Blue Baby Syndrome (Cyanosis)
Crying or Feeding
PROVe
Pulmonary Stenosis
Right Ventricular Hypertrophy
Overriding Aorta
Ventricular Septal Defect (VSD)
Diagnosis and Treatment
Boot-Shaped Heart
Squatting for Tet Spells
Surgery
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2 mins
Aortic Stenosis
Characteristics
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
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2 mins
Stable Angina
Assessment
Chest Pain with Exertion
Relieved within 15 Minutes
ST Depression
Interventions
Nitroglycerin
Up to 3 Doses q 5 Minutes
Rest
Antiplatelet Medication
CABG
Angioplasty
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2 mins
Unstable Angina
Assessment
Chest Pain with Rest or Exertion
Limits ADLs
> 15 Minutes
Less Likely Relieved by Nitroglycerin
ST Depression
Fatigue
Considerations
Acute Coronary Syndrome (ACS) Treatment
Emergency Treatment
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2 mins
Myocardial Infarction Assessment
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
Considerations
Monitor for Arrhythmias
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2 mins
Myocardial Infarction Diagnosis
Diagnosis
12 Lead ECG
ST Elevation
Q Wave
T Wave Inversion
Troponin T and I
CK-MB
Considerations
Early ECG
Cardiac Stress Test
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2 mins
Myocardial Infarction Interventions
MONA
Morphine
Oxygen
Nitrates
Aspirin
Thrombolytics (tPA)
Invasive Procedures
Cardiac Catheterization
Stent Placement
Angioplasty
Coronary Artery Bypass Grafting (CABG)
Considerations
Decrease Modifiable Risk Factors
Resuming Activity (Physical, Sexual)
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2 mins
Cardiac Enzyme Evaluation: Creatine Kinase CK-MB
Measures
Skeletal or Cardiac Muscle Injury
Time Ranges
Onset: 4-8 Hours
Peak: 12-24 Hours
Return to Normal: 2-3 Days
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1 min
Cardiac Enzyme Evaluation: Troponin
Measures
Cardiac Muscle Injury
Time Ranges
Detection in Blood: 4 Hours
Peak: 24 - 36 Hours
Return to Normal: 5 - 14 Days
Considerations
Most Specific for Cardiac Muscle
Treat Aggressively
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2 mins
Cardiac Enzyme Evaluation: Myoglobin
Measures
Skeletal or Cardiac Muscle Injury
Time Ranges
Onset: 1 - 4 Hours
Peak: 12 Hours
Return to Normal: 24 Hours
Considerations
Elevation After 24 Hours: Reinfarction
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2 mins
Aspirin (Acetylsalicylic Acid)
Mechanism
Inhibits Platelet Aggregation
NSAID
Indications
Thrombotic Event Prevention
General Pain
Inflammatory Conditions
Fever
Side Effects
Pancytopenia
GI Ulcers
Bleeding
Considerations
Withhold Before Surgery 7-10 Days
Reye's Syndrome
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2 mins
Clopidogrel (Plavix)
Mechanism
ADP Receptor Antagonist
Prevent Platelet Aggregation
Indications
Acute Coronary Syndrome (ACS)
Prevention of Thrombotic Events
Side Effects
Bleeding
Thrombotic Thrombocytopenic Purpura (TTP)
Pancytopenia
Abdominal Pain
Considerations
Withhold Before Surgery
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2 mins
Coronary Artery Bypass Grafting (CABG)
Indications
ST-Segment Elevation Myocardial Infarction (STEMI)
Cardiovascular Disease (CAD)
Uncontrolled Angina
Considerations
Internal Mammary Artery
Saphenous (Leg) Vein
Transient Limb Edema
Closely Monitor Patients
Venous Thromboembolism (VTE) Prophylaxis
Incentive Spirometer
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2 mins
Venous Thromboembolism (DVT) Assessment
Mechanism
Venous Wall Inflammation caused by Thrombus
Assessment
Tenderness
Edema
Warmth
Asymmetry
Considerations
Could be Asymptomatic
Monitor for Pulmonary Embolism
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58 secs
Venous Thromboembolism (DVT) Interventions
Anticoagulants
Prevention Education
Frequent Ambulation
Leg Exercises
Compression Stockings or SCD's
Avoid Nicotine and Oral Contraceptives
Surgery
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1 min
Heparin (Unfractionated)
Mechanism of Action
Suppresses Coagulation
Indications
Deep Vein Thrombosis (DVT)
Pulmonary Embolism
Side Effects
Hemorrhage
Heparin-Induced Thrombocytopenia (HIT)
Considerations
Monitor aPTT
Preferred (Safe) During Pregnancy
Antidote
Protamine Sulfate
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2 mins
Heparin Induced Thrombocytopenia (HIT)
Pathophysiology
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
Symptoms
Thrombocytopenia
Diagnosis
Serotonin Release Assay (SRA)
Treatment
Stop Heparin, Start Direct Thrombin Inhibitor
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2 mins
Warfarin (Coumadin)
Mechanism of Action
Inhibits Clotting Factors
Indications
Atrial Fibrillation
Venous Thrombosis
Pulmonary Embolism
Assessment
PT/INR Levels
Observe for Bleeding
Contraindications
Pregnancy
Nursing Considerations
Vitamin K and Fresh Frozen Plasma
Prolonged Therapeutic Onset
Maintain Same Diet
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2 mins
Warfarin Antidotes
Antidotes
Vitamin K
Fresh Frozen Plasma
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59 secs
INR Lab Value
0.8-1.2 Normal Range
Warfarin
2.0-3.0
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1 min
PT/PTT Lab Values
Prothrombin Time (PT)
10-14 seconds
Activated Partial Thromboplastin Time (PTT or aPTT)
25-35 seconds
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1 min
Right Heart Failure Assessment
Jugular Venous Distention (JVD)
Peripheral Edema
Hepatosplenomegaly
Nocturia
Weight Gain
Ascites
Fatigue
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1 min
Left Heart Failure Assessment
Pulmonary Assessment
Pulmonary Congestion
Pink Frothy Sputum
Wheezing or Crackles
Dyspnea with Exertion
Cough
Systemic Assessment
Fatigue
Tachycardia
Weak Peripheral Pulse
S3, S4 Heart Sounds
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1 min
Heart Failure Interventions
Diagnostic Tests
Echocardiogram
Invasive Hemodynamic Monitoring
Improve Gas Exchange
High Fowler's Position
Oxygen
Advanced Airway
Drugs and Devices
Diuretics
Beta Blockers
Angiotensin II Receptor Blockers (ARBs)
ACE Inhibitors
Digoxin (Lanoxin)
Pacemaker
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2 mins
Cardiac Tamponade
Mechanism
Fluid in the Pericardial Sac
Pericarditis
Decreased Cardiac Output
Signs/Symptoms
Beck's Triad
Hypotension
Jugular Venous Distention (JVD)
Distant Heart Sounds
Pulsus Paradoxus
Electrical Alternans
Treatment
Pericardiocentesis
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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
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2 mins
Preeclampsia Assessment
After 20 Weeks of Pregnancy
Mild
Hypertension > 140/90
Proteinuria or End-Organ Dysfunction
Severe
Hypertension > 160/110
Progressive Renal Insufficiency
Vision Changes
HELLP Syndrome
Pulmonary Edema
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2 mins
Severe Preeclampsia
Mechanism of Action
Vasospasm and Decreased Organ Perfusion
Intravascular Coagulation
Increased Permeability and Capillary Leakage
Signs and Symptoms
Hypertension
Proteinuria or End-Organ Dysfunction
HELLP Syndrome
Hepatic Dysfunction and Hemolysis
Elevated Liver Enzymes
Low Platelet Counts
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3 mins
Eclampsia
Mechanism of Action
Increased Central Nervous System Irritability
Signs and Symptoms
Hyperreflexia
Positive Ankle Clonus
Headaches
Visual Disturbances
Epigastric or RUQ Pain
Seizures
Coma
Considerations
Don't Leave Bedside
Magnesium Sulfate
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2 mins
ECG: Sinus Bradycardia
Rate
< 60 bpm
Rhythm
Regular
P Wave
Present, Upright, Every QRS
PR Interval
< 0.20 seconds
QRS Interval
< 0.12 seconds
Treatment
Atropine
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1 min
ECG: Sinus Tachycardia
Rate
> 100 bpm
Rhythm
Regular
P Wave
Present, Upright, Every QRS
PR Interval
< 0.20 seconds
QRS Interval
< 0.12 seconds
Treatment
Treat Underlying Cause
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2 mins
ECG: Atrial Fibrillation
Rate
Variable Rate
Rhythm
Irregular Rhythm
P Wave
No P Wave
PR Interval
No PR Interval
QRS Interval
QRS < 0.12 Seconds
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1 min
ECG: Atrial Flutter
Rate
Variable
Rhythm
Regular or Irregular
P Wave
Saw Tooth, Multiple Before Every QRS
PR Interval
Non-measurable
QRS Interval
< 0.12 seconds
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2 mins
Lidocaine
Mechanism
Blocks Na+ Channels
Indications
Ventricular Arrhythmia
Anesthetic
Side Effects
Paresthesias
Seizures
Respiratory Depression
Drowsiness
Consideration
Anesthetic Effects Extended with Epinephrine
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1 min
Phenytoin (Dilantin)
Mechanism
Blocks Na+ Channels
Indications
Tonic-clonic Seizures
Side Effects
Ataxia
Nystagmus
Sedation
Gingival Hyperplasia
Purple Glove Syndrome
Hirsutism
Rash
Anemia
Considerations
Individualized Dosing
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2 mins
Cardiopulmonary Resuscitation (CPR) for Adults
Steps Before CPR
Scan Scene
Activate Emergency Response System
Check For Breathing (Max 10 Seconds)
Open Airway
Compressions, Airway, Breathing (CAB)
Compressions: 2 Inches Deep (100-120 Compressions/Min)
Airway: Ensure Airway is Still Open
Breathing: Administer 2 Rescue Breaths
Considerations
Repeat C-A-B Sequence (30:2) Until Help Arrives
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3 mins
Peripheral Artery Disease (PAD)
Mechanism
Atherosclerosis
Assessment
Intermittent Claudication
Pain with Exercise
Paresthesias
Arterial Ulcers
Critical Limb Ischemia
Amputation
Consideration
Ankle-Brachial Index (ABI)
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2 mins
Pulmonary Embolism Causes
Causes
FAT BAT Mnemonic
Fat
Air
Deep Vein Thrombosis (DVT)
Bacteria
Amniotic Fluid
Tumor
Risk Factors
Hypercoagulable
Central Venous Lines
Immobilized
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1 min
Pulmonary Embolism Assessment
Assessment
Shortness of Breath (SOB)
Pleuritic Chest Pain
Tachypnea
Hemoptysis
Hypoxemia
Considerations
Sudden Death
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52 secs
Types of Shock
Hypovolemic
Depleted Volume
Cardiogenic
Pump Failure
Obstructive
Indirect Pump Failure
Distributive
Lost Vascular Tone
Neurogenic
Anaphylactic
Septic
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2 mins
Severe Sepsis and Septic Shock Assessment
Microthrombi
DIC
Decreased Oxygen Saturation
Decreased WBC
Oliguria
High Output Heart Failure
Multiple Organ Failure
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2 mins
Ephedrine
Mechanism of Action
Alpha Agonist
Beta Agonist
Indications
Rhinitis
Hypotension
Urinary Incontinence
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35 secs
Types of Strokes
Warning Signs
Transient Ischemic Attack (TIA)
Reversible Ischemic Neurologic Deficit (RIND)
Types
Ischemic
Thrombotic
Atherosclerosis
Embolic
Atrial Fibrillation
Hemorrhagic
Severe Hypertension
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3 mins
Left Hemisphere Stroke Assessment
Opposite Side Weakness (Hemiplegia)
Side to Side Discrimination
Aphasia
Agraphia
Slow Performance
Aware of Deficits
Anxiety
Depression
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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
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2 mins

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