Comprehensive Study Notes (Exam Prep)

Angina and Cardiomyopathy

• Exam 1 Review: focus on cardiovascular conditions and emergency management.
• Angina (chest pain): ask detailed history to differentiate types and guide treatment.
• Angina types:
  • Stable: predictable & constant pain
  • Unstable: pain that doesn’t go away with rest; can lead to a heart attack
• Drugs of choice to treat angina:
  • Nitroglycerin: vasodilator; side effect: hypotension
• Oxygen therapy: initiated at the time of heart issue
• Nurse’s duty: obtain a detailed history to differentiate angina type
• Cardiomyopathy: disease of the heart muscle; anything that affects heart function causes decreased cardiac output (CO)
• Types of cardiomyopathies:
  • Dilated cardiomyopathy: (the most common) significant dilation of ventricles without simultaneous hypertrophic and systolic dysfunction
  • Hypertrophic cardiomyopathy: (common in athletes) genetic; leads to increased heart muscle size and mass
• Sodium/fluid status: always consider sodium and fluid overload in cardiomyopathy management
• Deep vein thrombosis (DVT): immobile patients are at high risk (bedridden, post-surgical, etc.); DVT can travel to cause a pulmonary embolism (PE)
• DVT treatment: heparin and warfarin
• DVT labs: INR therapeutic levels on warfarin: $2.0-3.0$; normal therapeutic range: $2.0-3.5$
• Thrombophlebitis: does not always require hospitalization; rest and compression stockings are typical management
• Dysrhythmia (arrhythmia): focus on EKG results
  • P-wave: represents the electrical impulse of the atria (upper chambers)
  • QRS complex: represents the depolarization of the ventricles (lower chambers)
  • T-wave: represents ventricular repolarization (return to electrical rest)
• Pulmonary embolism (PE): obstruction of the pulmonary artery or branches by a thrombus originating in the venous system or the right heart
• Clinical manifestations of PE: chest pain, shortness of breath (dyspnea)
• Manage PE: administer O₂; conduct a full assessment
• Dysrhythmias and device therapy:
  • Implantable cardioverter defibrillator (ICD): detects and terminates life-threatening tachycardia or fibrillation, especially ventricular in origin
• Acute Coronary Syndrome (ACS): emergent condition with acute onset of myocardial ischemia leading to myocardial death
• Labs/diagnostics for MI: EKG (ECG), Troponin, Creatine Kinase (CK), Myoglobin
• Stents: patients with stents placed are at risk for bleeding
• Nursing management for valvuloplasty/valve replacement: admitted for $24-48\,\text{hours}$; aim to improve cardiac output

Deep Vein Thrombosis (DVT), Pulmonary Embolism (PE), and Thromboembolic Conditions

• DVT risk factors: immobility (bedrest), recent surgery, prolonged travel, etc.
• PE pathophysiology: venous thrombus travels to and obstructs pulmonary circulation
• DVT management specifics:
  • Anticoagulation with heparin and warfarin
  • INR targets: $2.0-3.0$ while on warfarin; therapeutic range often given as $2.0-3.5$ in some protocols
• Thrombophlebitis management (as per notes): rest; wear compression stockings; outpatient approach if uncomplicated

Respiratory and Cardiac Rhythm Disturbances

• Respiratory acidosis: clinical disorder (definition truncated in transcript; generally due to hypoventilation and CO₂ retention) – note normal values below
• Normal arterial blood gas values (as listed):
  • pH: $[7.35, 7.45]$
  • PCO₂: $35-45\ \text{mmHg}$
  • PO₂: >80\ \text{mmHg}
  • HCO₃⁻: $22-26\ \text{mEq/L}$
  • SaO₂: >94\%
• Pneumothorax: air in pleural space due to breach of pleura; pleural pressure becomes positive relative to atmosphere
• Types of pneumothorax:
  • Simple (spontaneous): air enters pleural space through rupture of a bleb or bronchopleural fistula; can occur in a healthy person without trauma
  • Traumatic: air enters pleural space from a lung laceration or chest wall wound
  • Tension: air drawn into pleural space from lung injury or chest wall opening; causes lung collapse and mediastinal shift
• Clinical manifestations of pneumothorax: sudden chest pain; reduced chest expansion; diminished or absent breath sounds; chest percussion may be normal or hyperresonant depending on size
• Tension pneumothorax findings: tracheal shift away from affected side; decreased chest expansion; absent/diminished breath sounds; hyperresonant percussion on affected side
• SARS: signs and symptoms include non-productive cough, sore throat, fatigue, muscle aches, congestion, nausea

Metabolic Disorders and Acid-Base Balance

• Metabolic acidosis: low pH due to increased hydrogen ion concentration and low plasma bicarbonate concentration
• High anion gap metabolic acidosis: occurs with excessive acid accumulation; common etiologies include lactic acidosis, salicylate (acetylsalicylic acid) poisoning, renal failure, methanol, ethylene glycol, propylene glycol toxicity, diabetic ketoacidosis (DKA), and starvation ketoacidosis
• Mechanism in high anion gap acidosis: hydrogen ions are buffered by bicarbonate, causing a fall in plasma bicarbonate and eventual depletion
• Metabolic alkalosis: often caused by severe vomiting or gastric suctioning
• Nursing responsibilities for metabolic acidosis: correct underlying acid-base disorder; restore normal fluid volume (e.g., with saline, NaCl)

Diabetes Emergencies: DKA and Hyperosmolar Hyperglycemic State (HHS)

• Diabetic Ketoacidosis (DKA): caused by absence or severe deficiency of insulin
  • Blood glucose levels: $250-800\ \text{mg/dL}$
  • Hallmarks: fruity breath and Kussmaul respirations
  • Major concern: potassium (affecting the heart); monitor blood glucose vigilantly
  • Three main clinical features:
  • Hyperglycemia
  • Dehydration and electrolyte losses
  • Acidosis
• Hyperosmolar Hyperglycemic State (HHS): usually in type 2 diabetes; relative insulin deficiency with illness increasing insulin demand
  • Clinical manifestations: hypotension; profound dehydration (dry mucous membranes, poor skin turgor); tachycardia; variable neurologic signs (altered consciousness, seizures, hemiparesis)
  • Treatment: aggressive fluid replacement; correction of electrolyte imbalances; insulin therapy

Viral Hepatitis

• Hepatitis A (Hep A): hygiene; prevention and treatment primarily via vaccine
• Hepatitis B (Hep B): transmitted primarily through blood; prevention via safe sex practices and avoidance of high-risk behaviors; hygiene considerations
• Hepatitis C (Hep C): transmitted by blood transfusion and sexual contact; treatment includes Protease Inhibitor therapies for $8-12\ \text{weeks}$ of oral therapy

Summary of Nursing Considerations and Interventions

• Always assess for risk factors (immobility, recent procedures, chest pain characteristics, dyspnea, signs of electrolyte imbalance)
• Recognize emergency presentations (ACS, PE, tension pneumothorax, DKA/HHS) and initiate appropriate monitoring and therapy per protocol
• Monitor for bleeding risks after stent placement or valve interventions; monitor anticoagulation parameters (INR) and adjust therapy accordingly
• Prioritize airway, breathing, circulation assessments; provide supplemental oxygen as indicated; ensure prompt diagnostic testing (ECG, troponin, CK, myoglobin, ABGs, imaging as needed)
• Collaborate with interdisciplinary teams to manage electrolyte disturbances, acid-base disorders, and fluid status
• Educate patients on disease processes, treatment plans, and the importance of adherence to medications and follow-up care