Unit 1 Exam Review: Oxygenation, Perfusion, Clotting — Comprehensive Bullet Notes

Discharge Teaching and Medication Interactions

• Focus of unit review areas: oxygenation, perfusion, and clotting; include diagnostic tests, post-procedure care, and focused assessments in acute med/surg contexts.

• Nitrostat discharge teaching:

  • Do not take nitroglycerin with erectile dysfunction (ED) medications due to the risk of an unsafe drop in blood pressure.

  • Nitro can also cause orthostatic hypotension; monitor for lightheadedness or dizziness with position changes.

• Post-cardiac catheterization considerations:

  • Access via the femoral artery requires careful assessment afterward for bleeding, hematoma, distal pulses, color, and temperature of the affected limb.

  • Discharge teaching should cover activity restrictions, recognizing signs of bleeding or ischemia, and when to seek care.

Assessment Rules and Decision Making

• Key rule: Stop → Assess → Decide. If something isn’t right, pause, assess the patient, then make a clinical decision.

• Focused assessments depend on the presenting issue (e.g., coronary artery disease/heart attack). Identify the specific area to assess rather than broad checks.

• When questions ask for the greatest importance or priority, choose the option that represents the highest risk or most immediate threat to the patient (the “priority” item), recognizing that many answers may be correct but one is most critical.

• Angioplasty prep example: the most important action is to ensure the patient understands the test, assess pulses, and communicate; a key specific action is to withhold anticoagulants/blood thinners prior to the procedure to prevent excessive bleeding or hemorrhage.

• Acute MI care reminders: know the medications to administer (MONA) and be familiar with common arrhythmias and their treatments.

MONA and Acute MI Medications

• MONA mnemonic for acute myocardial infarction management:

  • M: Morphine

  • O: Oxygen

  • N: Nitroglycerin (sublingual)

  • A: Aspirin

• Note: In this review, there is emphasis on the sequence and the role of each therapy in stabilizing a patient with MI.

Arrhythmias and Rhythm Management

• Common rhythms discussed:

  • Atrial fibrillation and atrial flutter (rapid atrial rhythms): know medical treatments and possibilities for cardioversion.

  • Complete heart block: treatment of choice typically involves pacing support (pacemaker).

  • Ventricular rhythms (e.g., ventricular tachycardia, ventricular fibrillation): these are dangerous; immediate defibrillation is used for ventricular fibrillation/pulseless VT in emergent settings; cardioversion is used in controlled settings for certain rhythms.

  • Sinus bradycardia and sinus tachycardia: considered normal rhythms when appropriate; not necessarily pathologic by itself.

• Key distinctions:

  • Defibrillation: emergent, unsynchronized shock to treat life-threatening arrhythmias.

  • Cardioversion: synchronized shock in a controlled setting to restore normal rhythm.

Virchow’s Triad and Clotting Risk

• Virchow’s triad describes the factors that predispose to thrombosis:

  • Hypercoagulability

  • Stasis

  • Endothelial injury

• These factors were linked back to oxygenation/therapy and critical care contexts discussed earlier in Unit 1.

Diagnostic Tests for Oxygenation and Respiratory Function

• Arterial blood gas (ABG): a key diagnostic test for assessing ventilation and acid-base status.

  • Drawn from the radial artery.

  • ABG provides information on pH, PaCO2, and HCO3−, helping identify respiratory vs metabolic components.

  • The body’s compensatory responses to acid-base disturbances include adjusting the respiratory rate to blow off CO2 and thereby influence pH toward normal.

• Other procedures discussed:

  • Thoracentesis

  • Bronchoscopy

Post-Procedure Care and Considerations

• Bronchoscopy:

  • Watch for gag reflex return; assess airway protection after procedure.

• Thoracentesis:

  • Position the patient on the unaffected side after the procedure.

• Tracheostomy care and airway patency:

  • Airway patency is critical after tracheostomy insertion due to high mucus production.

  • Have a dilator readily available at the bedside in case of dislodgement to maintain airway patency.

  • Be familiar with complications: aspiration, infection, mucus plugs, laryngeal nerve injury.

Chest Tubes, Water Seal Drainage, and Nursing Assessments

• Chest tubes are used for pneumothorax or hemothorax to drain air, blood, and secretions from the pleural space.

• Water seal drainage system:

  • Monitor the water column for expected behavior: does it bubble? does it rise and fall with respiration (tidal movement)?

  • Some systems can be connected to suction.

• Ongoing assessment:

  • Inspect the skin around the insertion site and assess for subcutaneous emphysema.

  • Monitor respiratory rate and cardiac status.

  • Inspect how the chest tube is secured (stitches) and ensure tubing and canister are intact and functioning.

Pulmonary Embolism, Pneumothorax, and Chest Injury Complications

• Pulmonary embolism (PE):

  • Often originates from a deep vein thrombosis (DVT) typically in the calf.

  • Red flags include calf pain and swelling (DVT signs) followed by chest pain and dyspnea if PE occurs.

  • Immediate management: administer oxygen via face mask and call for help if PE is suspected with chest symptoms and hypoxia.

• Pneumothorax and related conditions:

  • Pneumothorax, hemothorax, and tension pneumothorax are potential thoracic emergencies.

  • Rib fractures can contribute to these conditions.

• Flail chest:

  • A specific chest wall injury pattern that requires careful assessment and management.

Shock, Perfusion, and Hemodynamics

• Early (initial) stages of shock:

  • Tachycardia (rapid pulse)

  • Slightly elevated temperature

  • Tachypnea (rapid breathing)

  • Elevated white blood cell count (WBC)

• Decompensation stage features:

  • Microemboli formation is possible.

  • Prophylactic heparin may be used to prevent clot formation.

  • Vital sign changes occur; peripheral pulses diminish; skin color changes toward cyanosis; urine output decreases due to reduced renal perfusion.

  • Target urine output: at least

  • Note: The transcript states urine output goal of 30 mL/hour (
    $30 ext{ mL/hour}$) as an indicator of adequate kidney perfusion.

• Irreversible stage of shock: multisystem organ failure occurs.

Acute Respiratory Distress Syndrome (ARDS) and Related Risk Factors

• ARDS is a critical condition with several risk factors and common etiologies:

  • Drug overdose

  • Dysphagia with aspiration of secretions or fluids

  • Recent coronary artery bypass graft (CABG)

  • Near-drowning incidents

  • Sepsis is a very common cause of ARDS

• Understanding who is at risk helps in early recognition and management strategies.

Exam Context and Final Notes

• The unit review emphasizes a total of $45$ questions on this exam.

• This material covers Unit 1 concepts across oxygenation, perfusion, and clotting, with a focus on practical nursing care, diagnostic testing, procedures, and clinical decision-making in acute care settings.

Quick Reference Cheat Sheet

• Important patient safety rule: Stop → Assess → Decide

• MONA order and purpose

• Distinguish defibrillation (emergent) vs cardioversion (controlled)

• Virchow’s triad components

• Post-procedure care specifics for bronchoscopy, thoracentesis, and tracheostomy

• Chest tube assessment: water seal behavior, potential suction, watch for subcutaneous emphysema

• Early shock signs: tachycardia, tachypnea, slight fever, leukocytosis; monitor urine output (≥ 30 mL/hour)

• ARDS risk factors and sepsis linkage