PNUR 152 Exam 2 Study Guide: Perfusion, Dysrhythmias, Spinal Cord Injury, Emergency Preparedness, and Interdisciplinary Care

50 high-yield vocabulary flashcards reviewing cardiac perfusion, dysrhythmias, spinal cord injuries, emergency preparedness, bioterrorism classification, and interdisciplinary collaboration for Nursing Exam 2.

Perfusion

The delivery of oxygen-rich blood to tissues and organs.

Cardiac Output

The product of heart rate and stroke volume ($\text{Cardiac output} = \text{HR} \times \text{stroke volume}$); disruptions in rate or rhythm impair this mechanism and decrease tissue perfusion.

Adequate Perfusion Indicators

Clinical findings including normal level of consciousness (LOC), warm, pink, dry skin, capillary refill $< 2\,\text{sec}$, urine output $\ge 30\,\text{mL/hr}$, and normal blood pressure and heart rate.

Impaired Perfusion Indicators

Clinical indicators including altered LOC, dizziness, lightheadedness, confusion, pale, cool, clammy skin, capillary refill $> 2\,\text{sec}$, oliguria/anuria, and tachycardia and/or decreasing blood pressure.

P Wave

The EKG waveform representing atrial depolarization; normally present before each QRS complex in sinus rhythm.

PR Interval

The EKG measurement representing atrial-to-ventricular conduction time, normally lasting $0.12\text{--}0.20\,\text{sec}$.

QRS Complex

The EKG waveform representing ventricular depolarization, with a normal duration of $0.06\text{--}0.10\,\text{sec}$.

T Wave

The EKG waveform representing ventricular repolarization that follows the QRS complex.

QT Interval

The EKG measurement representing total ventricular depolarization and repolarization, with a normal range of $0.32\text{--}0.44\,\text{sec}$ on the source tip sheet.

Normal Sinus Rhythm

A regular cardiac rhythm characterized by a heart rate of $60\text{--}100$, a P wave before every QRS complex, and intervals within standard expected limits.

Sinus Bradycardia

A regular cardiac rhythm with normal P-QRS-T morphology occurring at a rate of $< 60$.

Symptomatic Sinus Bradycardia

Sinus bradycardia presenting with poor perfusion signs (dizziness, lightheadedness, chest pain, SOB, hypotension, cool/clammy skin, confusion, fatigue, altered LOC, decreased UO); managed by supporting oxygenation, holding rate-slowing drugs, and anticipating atropine and/or transcutaneous pacing.

Sinus Tachycardia

A regular rhythm with normal complexes at a rate of $> 100$ (usually $< 150$), representing a compensatory mechanism for underlying triggers such as fever, pain, anxiety, hypovolemia, hypoxia, CHF, MI, or exercise.

Atrial Fibrillation (AF)

A cardiac dysrhythmia where the atria quiver, visible P waves are absent, the baseline is fibrillatory/wavy, the rhythm is irregular, and the QRS is usually narrow.

Rapid Ventricular Response (RVR)

A high ventricular rate of $> 100$ occurring during atrial fibrillation or flutter, further compromising cardiac output and organ perfusion.

Atrial Flutter

A dysrhythmia characterized by flutter waves, an atrial rate of $\sim 250\text{--}350$, and a regular or irregular ventricular rhythm that can rapidly convert to atrial fibrillation.

Clinical Complications of AF and Flutter

The two primary problems caused by atrial fibrillation and atrial flutter: 1) compromised rate and perfusion, and 2) mural clot formation and stroke risk.

Ventricular Tachycardia (VT)

A rapid cardiac rhythm characterized by wide, ventricular-looking QRS complexes that may present either with or without a palpable pulse.

Unstable Ventricular Tachycardia with a Pulse

Ventricular tachycardia with a palpable pulse that presents with poor perfusion (hypotension, hypoxia, cool skin, confusion), requiring emergency synchronized cardioversion.

Pulseless Ventricular Tachycardia

A form of ventricular tachycardia with no palpable pulse; treated as cardiac arrest with immediate high-quality CPR, unsynchronized defibrillation, and epinephrine/amiodarone.

Ventricular Fibrillation (VF)

Chaotic ventricular electrical activity without identifiable QRS complexes or effective cardiac output, resulting in cardiac arrest; treated with immediate CPR and prompt defibrillation.

Asystole

The complete absence of ventricular electrical activity and cardiac output; treated with CPR, epinephrine, and identification of reversible causes, but NEVER defibrillated.

H's and T's

The reversible causes of cardiac arrest: Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo-/hyperkalemia, Hypothermia, Tension pneumothorax, Cardiac tamponade, Cardiac thrombosis, Pulmonary thrombosis, and Toxins/tablets.

Third-Degree Heart Block

Complete AV block where no electrical impulses conduct from atria to ventricles, causing atria and ventricles to beat independently with no consistent P-to-QRS relationship and a slow ventricular rate that compromises cardiac output.

Atropine

An anticholinergic medication administered via rapid IV push at $0.5\,\text{mg}$ every $3\text{--}5\,\text{min}$ up to a maximum of $3\,\text{mg}$ to raise heart rate and cardiac output in symptomatic bradycardia.

Metoprolol

A beta blocker used for rate control in atrial fibrillation, atrial flutter, and SVT; requires assessment for bradycardia and hypotension and may mask symptoms of hypoglycemia.

Epinephrine

An adrenergic medication utilized in cardiac arrest code algorithms for asystole, ventricular fibrillation, and pulseless ventricular tachycardia.

Amiodarone

An antiarrhythmic agent used in ventricular and atrial dysrhythmias; known to cause bradycardia, hypotension, and toxicities involving the lungs, thyroid, and QT interval.

Apixaban

An anticoagulant used to reduce thromboembolic stroke risk in atrial fibrillation and flutter; adverse bleeding signs (such as falling hemoglobin or dark, melenic stool) represent urgent priorities.

Digoxin Toxicity

A toxic drug state manifested by nausea, yellow halos around lights, bradycardia, and hypokalemia, requiring the medication to be held and immediately reported.

Immediate Priorities in Spinal Cord Injury

Maintaining spinal alignment/immobilization without twisting or flexion, securing ABCs (airway/breathing can be impaired by cervical injuries), and conducting frequent neurologic and perfusion assessments.

Neurogenic Shock

A perfusion emergency resulting from loss of sympathetic tone (usually after high spinal cord injury) characterized clinically by hypotension, BRADYCARDIA, and warm, dry skin.

Spinal Shock

A temporary neurologic phenomenon following spinal injury marked by flaccid paralysis and the absence of reflexes, motor function, and sensory function below the level of injury, which gradually resolves as reflexes return.

Autonomic Dysreflexia

An emergency syndrome occurring in patients with spinal cord injuries at or above T6 after spinal shock resolves, characterized by severe hypertension, pounding headache, bradycardia, nasal congestion, and flushing/sweating above the lesion.

Autonomic Dysreflexia Interventions

Emergency nursing actions including sitting the patient upright, loosening tight clothing, checking and eliminating triggers (evaluating bladder distention/kinked catheters first, then bowel impaction/skin irritation), and notifying the provider while closely monitoring BP.

Mitigation Phase

The disaster management phase dedicated to assessing infrastructure, hazards, vulnerabilities, and identifying populations unable to withstand a disaster independently.

Preparedness Phase

The disaster management phase focused on coordinating responding agencies, establishing communication and early warning systems, planning supply allocation, and running operational drills.

Response Phase

The disaster management phase that involves activating the National Incident Management System (NIMS), rapidly assessing the situation, and conducting triage to prioritize care during a surge.

Recovery Phase

The disaster management phase centered on restoring community functioning and services, implementing sanitation and infection controls, and providing psychological stress support.

Disaster Vulnerable Populations

Identified groups needing focused disaster planning: infants/children/older adults, pregnant people, individuals with chronic disease or limited mobility, people experiencing poverty/houselessness, non-dominant language speakers, and incarcerated populations.

Macro Command

Interagency coordination during a disaster involving organizations such as FEMA, CDC, DHS, Red Cross, emergency management, and local public health.

Rapid Span Assessment

An initial disaster evaluation determining the number of people affected, injured, or dead, the status of water, food, and sanitation, and immediate resource needs.

Micro Triage

The field or emergency department process of prioritizing serious versus minor injuries during a disaster surge to allocate scarce medical resources where they can do the most good.

Category A Bioterrorism Agents

Highest-priority biological agents that are easily transmitted, carry high mortality rates, and cause immediate public health crises; includes smallpox, botulism, anthrax, tularemia, viral hemorrhagic fevers/Ebola, and plague.

Category B Bioterrorism Agents

Second-highest priority biological agents that are moderately easy to disseminate, cause high morbidity, and have relatively lower mortality rates; includes typhus fever, ricin toxin, diarrheagenic E. coli, and West Nile virus.

Category C Bioterrorism Agents

Emerging pathogens with the potential for mass dissemination, high morbidity, and high mortality; includes hantavirus, influenza virus, tuberculosis, and rabies virus.

Inhalational Anthrax

A Category A biological infection presenting with fever, chills, myalgias, severe dyspnea, and shock; managed post-exposure with ciprofloxacin or doxycycline.

Botulism

A Category A paralytic condition caused by a neurotoxin; manifestations include blurred vision, slurred speech, progressive symmetric muscle weakness, and difficulty breathing, with airway management as the primary nursing priority.

Smallpox vs. Chickenpox Presentation

Smallpox features deep, non-collapsing lesions in the same stage located primarily on the face, tongue, and distal extremities following high fever; chickenpox features superficial, collapsing vesicles in varying stages located primarily on the trunk.

SBAR

A standardized framework for concise interdisciplinary communication comprising Situation, Background, Assessment, and Recommendation.