Exam 2 semester 2

What is defibrillation and when is it used?

An unsynchronized electrical shock used for life-threatening rhythms such as ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT). Resume CPR immediately after the shock.

Heart Failure

The heart cannot pump enough blood to meet the body’s needs.

• Monitor daily weight, I&O, lung sounds, edema, and oxygenation.

Left sided heart failure

• crackles, dyspnea, orthopnea, pulmonary edema

Right sided heart failure

• JVD, peripheral edema, weight gain

Angina

Chest discomfort/pain caused by temporary decreased blood flow and oxygen to the myocardium (ischemia). It may feel like pressure, squeezing, or heaviness and may radiate to the arm, shoulder, neck, or jaw.

Pericarditis

inflammation of the pericardium causing sharp chest pain that worsens with inspiration or lying flat and improves when sitting up and leaning forward. A pericardial friction rub may be heard.

Cardiac Labs

Troponin is the most important marker for myocardial injury/MI. BNP can increase with heart failure. Also monitor electrolytes, especially potassium and magnesium, because abnormalities can cause dysrhythmias.

What is the difference between stable and unstable angina?

Stable angina usually occurs predictably with activity/stress and improves with rest or nitroglycerin. Unstable angina can occur at rest, is new/worsening, and may not improve with rest or nitroglycerin—treat it as an emergency/acute coronary syndrome.

Diltiazem

A calcium channel blocker used for hypertension, angina, and certain dysrhythmias. It slows heart rate and decreases BP. Check BP and pulse and watch for bradycardia and hypotension

Raynaud Disease

Episodic vasospasm of the fingers/toes, often triggered by cold or stress. Digits may become white → blue → red. Keep extremities warm and avoid smoking/nicotine and excessive cold exposure.

Argatroban

An IV direct thrombin inhibitor/anticoagulant, commonly used when a patient has or is at risk for heparin-induced thrombocytopenia (HIT). Monitor for bleeding and aPTT.

Myocardial Infarction (MI)

Prolonged myocardial ischemia causes heart muscle death. Symptoms may include severe chest pressure, radiation to the arm/jaw/back, diaphoresis, nausea, dyspnea, and anxiety. Elevated troponin supports myocardial injury. Rapid treatment is essential.

Digoxin

Digoxin increases cardiac contractility and slows heart rate. Check the apical pulse for 1 full minute before administration and follow ordered hold parameters. Watch for toxicity such as nausea, vomiting, bradycardia, dysrhythmias, confusion, and visual changes. Low potassium increases toxicity risk.

Hypertension

Chronic high BP damages blood vessels and organs and increases the risk of MI, stroke, heart failure, and kidney disease. It is often called a silent condition because patients may have no symptoms.

Antihypertensive Medications

Take medications consistently, monitor BP as instructed, and change positions slowly to prevent orthostatic hypotension. Do not abruptly stop certain antihypertensives unless directed by the provider.

Heart Disease

Stop smoking, control BP/cholesterol/diabetes, exercise as tolerated, maintain a healthy weight, manage stress, and eat a heart-healthy diet low in excessive saturated fat, trans fat, and sodium.

Congestive Heart Failure

Take medications as prescribed, follow sodium/fluid recommendations, and weigh daily at the same time using the same scale. Report rapid weight gain, increasing edema, or worsening shortness of breath according to the provider’s instructions.

Aspirin

Aspirin inhibits platelet aggregation, helping prevent blood clots. Monitor for bleeding and GI irritation. Aspirin may be used during suspected ACS/MI when appropriate and not contraindicated.

Bradycardia

An adult heart rate below 60 bpm. It becomes especially concerning when it causes poor perfusion, such as hypotension, altered mental status, chest discomfort, or signs of shock.

Coronary Artery Disease (CAD)

Atherosclerotic plaque buildup narrows coronary arteries, reducing blood flow to the myocardium. Can cause angina, acute coronary syndrome, and MI.

Electrical Cardioversion

Delivers a synchronized shock timed with the R wave and is used for certain unstable tachydysrhythmias when a pulse is present. If the patient is conscious and time permits, sedation is usually needed.

Acute Pericarditis

Cardiac tamponade, where fluid compresses the heart and prevents adequate filling. Warning signs include hypotension, JVD, muffled heart sounds, tachycardia, and worsening clinical status.

Anemia

A reduction in the blood’s oxygen-carrying capacity, often associated with decreased hemoglobin. Common findings include fatigue, weakness, pallor, dyspnea, dizziness, and tachycardia.

Aplastic Anemia

Bone marrow failure causes decreased production of RBCs, WBCs, and platelets (pancytopenia), leading to anemia, infection risk, and bleeding risk.

Hypovolemia

Decreased circulating blood volume can cause tachycardia, hypotension, weak pulses, decreased urine output, cool skin, thirst, and altered mental status.

Hypovolemic Anemia

Blood loss decreases circulating volume and RBCs, potentially causing tachycardia, hypotension, pallor, weakness, decreased oxygen delivery, and shock. Control bleeding and restore circulation as ordered.

Sickle Cell Anemia

Sickled RBCs obstruct blood flow and cause severe pain and tissue ischemia. Priorities commonly include hydration, pain control, oxygen when indicated, and treating the underlying trigger. Avoid dehydration and extreme temperatures.

Polycythemia Vera

A myeloproliferative disorder causing excessive blood cell production, especially RBCs. Increased blood viscosity raises the risk of thrombosis. Phlebotomy is a common treatment.

Cardiomyopathy

Disease of the heart muscle that can impair the heart’s ability to pump effectively and may lead to heart failure, dysrhythmias, or sudden cardiac death. Types include dilated, hypertrophic, and restrictive.

Iron Supplementation

May cause dark stools, constipation, nausea, and GI upset. Vitamin C can improve absorption. Avoid taking iron at the same time as substances that significantly decrease absorption when instructed, and keep iron safely away from children.

Iron Deficiency Anemia

Fatigue, weakness, pallor, dyspnea, dizziness, and typically microcytic, hypochromic RBCs. Low ferritin commonly supports iron deficiency.

Neutropenic Precautions

Prevent infection. Perform strict hand hygiene, avoid sick visitors/exposures, monitor temperature closely, and follow facility precautions regarding foods, flowers/plants, and protective measures. Fever can be an emergency in severe neutropenia.

Thrombocytopenia

Low platelets increase bleeding risk. Monitor for petechiae, bruising, hematuria, melena, and other bleeding. Avoid unnecessary invasive procedures and medications that increase bleeding risk unless prescribed.

Idiopathic/Immune Thrombocytopenia (ITP)

An immune disorder in which platelets are destroyed, causing thrombocytopenia and increased bleeding risk. Findings can include petechiae, purpura, bruising, and mucosal bleeding.

NSAIDs

NSAIDs can cause GI irritation/ulcers and bleeding, kidney injury, and fluid retention. They can increase bleeding risk, so use caution in patients with platelet or coagulation problems.

Hemophilia

An inherited clotting-factor deficiency causing prolonged bleeding, especially into joints and muscles. Hemophilia A involves factor VIII deficiency; hemophilia B involves factor IX deficiency. Treatment includes replacing the deficient factor.

Bone Marrow Transplant

Prevent infection and monitor for complications, including graft-versus-host disease (GVHD) in allogeneic transplants. Protective precautions may be necessary during severe immunosuppression

Hodgkin Lymphoma

Reed-Sternberg cells are characteristic. Patients commonly develop painless enlarged lymph nodes and may have fever, night sweats, and unexplained weight loss (B symptoms).

Disseminated Intravascular Coagulation (DIC)

Abnormal widespread clotting consumes platelets and clotting factors, which can then cause severe bleeding and organ damage. Treatment focuses on the underlying cause and supportive management.

What findings are associated with multiple myeloma?

A cancer of plasma cells that can cause bone pain/lesions, fractures, anemia, kidney problems, recurrent infections, and hypercalcemia.

Assessment for a Blood or Lymphatic Disorder

Look for pallor, fatigue, bleeding/bruising, petechiae, infection/fever, enlarged lymph nodes, weight loss, night sweats, and abnormal CBC findings.

Splenectomy

Increased risk for serious infection, especially from encapsulated bacteria. Vaccinations and prompt evaluation of fever or infection symptoms are especially important.

Blood Typing

Blood must be carefully matched to prevent a potentially life-threatening hemolytic transfusion reaction. O negative RBCs are commonly considered universal donor RBCs, while AB positive patients can generally receive RBCs of any ABO/Rh type.

Chemotherapy Education

Monitor for infection, bleeding, fatigue, nausea/vomiting, and mouth sores. Practice good hand hygiene and oral care, maintain nutrition/hydration as tolerated, and report fever promptly.

Bone Marrow Aspiration

 A needle removes liquid bone marrow for examination, commonly from the posterior iliac crest. Local anesthetic is used, but the patient may feel pressure or brief sharp pain during aspiration. Afterward, apply pressure and monitor the site for bleeding and infection.