Adult Health and Cardiovascular Nursing Review

Vital Signs and Clinical Reference Values

  • Blood Pressure (BP): 120/80 mmHg120/80\,mmHg

  • Heart Rate (HR): 60−100 bpm60 - 100\,bpm

  • SPO2: 95−100%95 - 100\% or 88−92%88 - 92\% for patients with COPD.

  • Temperature: 36.5−37.5 ∘C36.5 - 37.5\,^{\circ}C

  • Respiratory Rate: 12−20 rpm12 - 20\,rpm

  • Optimal Blood Pressure: < 120 / < 80

  • Normal Blood Pressure: < 130 / < 90

  • High Normal Blood Pressure: 120−139/85−90120-139 / 85-90

  • Hypertension: > 140 / > 90

Cardiovascular Anatomy and Physiology

  • Blood Pressure Regulation Factors: Includes blood volume, overall compliance, cardiac output, and peripheral resistance.

  • Nervous System Control:

    • Parasympathetic: Releases acetylcholine to slow the heart.

    • Sympathetic: Releases catecholamines, epinephrine (adrenaline), and norepinephrine (noradrenaline) to increase heart rate.

  • The Renin-Angiotensin-Aldosterone System (RAAS): This system increases blood pressure through a seven-step sequence:

    1. Blood pressure drops.

    2. The Sympathetic nervous system is stimulated.

    3. Kidney cells release Renin.

    4. Renin activates angiotensinogen produced by the liver.

    5. This creates Angiotensin 1.

    6. Angiotensin-converting-enzyme (ACE), found on the surface of the lungs and kidneys, converts Angiotensin 1 into Angiotensin 2.

    7. Angiotensin 2 constricts vessels and increases blood volume.

  • Cardiac Output Regulation: Defined as the amount of blood ejected by each ventricle in 1 minute. It is regulated by:

    • Heart Rate: Influenced by sympathetic stimulation (↑\uparrow), drugs (↑\uparrow), and parasympathetic/ACE activity.

    • Stroke Volume: Influenced by preload (venous return, blood volume, atrial contraction), afterload (hypertension, vasoconstriction), and contractility.

  • Electrical Impulses (PQRST):

    • P: Atrial depolarisation; the impulse is then delayed at the AV node.

    • QRS: Ventricle depolarisation.

    • T: Ventricle repolarisation.

Cardiovascular Pathophysiology and Disorders

  • Ischemia and Angina:

    • Ischemia: Occurs when there is an imbalance of oxygen supply and demand. Decreasing supply factors include atherosclerosis, anaemia, and low coronary blood flow (aortic valve incompetence, hypotension). Increasing demand factors include stress, physical work, tachycardia, hypertension, and thyrotoxicosis.

    • Stable Angina: Pain only occurs on exertion; typically lasts 5−155-15 minutes and is relieved by rest or Glyceryl trinitrate.

    • Unstable Angina: Can occur at any time, including at rest. May last longer than 10 minutes and might not be fully relieved by meds; higher risk for a heart attack.

  • Congestive Heart Failure (CHF): Defined as insufficient cardiac output to maintain metabolic needs.

    • Metaphor: Think of the heart as a water bottle. If you cannot squeeze the bottle with enough force, water will not come out the top (Systolic failure). If the water is not full enough when the bottle is squeezed, not all the water comes out (Diastolic failure).

    • Systolic Failure: A contraction issue.

    • Diastolic Failure: A filling issue.

    • Left Sided HF: Fluid backs up into the lungs (Drowning symptoms: Dyspnoea, rales, orthopnoea, weakness, nagging cough, weight gain).

    • Right Sided HF: Fluid backs up into the body (Swelling symptoms: Enlarged liver, oedema in hands and legs, weight gain, large neck vein, lethargy, irregular HR).

    • Diagnostics: B-type Natriuretic peptide (biomarkers), X-ray (hypertrophied ventricles, duller lung colour), Echo, Nuclear stress test.

  • Myocardial Infarction (MI): Occurs when blood flow stops in coronary arteries, damaging heart muscle due to plaque buildup.

    • Symptoms: Chest tightness, shortness of breath, nausea, sweating, and upper back/jaw pain.

    • Diagnosis: ECG (Hyperacute T waves, ST elevation, negative T waves, pathologic Q waves). Blood test for Troponin T (released after heart muscle injury).

  • Aortic Dissection: A tear in the aorta (Type A near heart, Type B going down). Risks include uncontrolled hypertension and atherosclerosis. Complications include stroke, kidney failure, and internal bleeding death.

  • Deep Vein Thrombosis (DVT): Clot formation in a deep vein. Causes include Virchow's Triad: stasis (immobilisation, AFib), hypercoagulability (cancer, birth control, sepsis), and endothelial damage (IV drug use, surgery).

  • Shock:

    • Obstructive Shock: Physical blockage (Pulmonary embolism, cardiac tamponade, hemothorax).

    • Cardiogenic Shock: Damage to the heart muscle or rhythm issues.

    • Distributive Shock: Loss of blood vessel tone (Anaphylaxis, Septic, Neurogenic).

    • Hypovolemic Shock: Depletion of intravascular volume (>15\% loss to show symptoms). Features rapid/weak pulse, BP around 70/56 mmHg70/56\,mmHg, and decreased urine output. Use the modified Trendelenburg position for treatment.

  • Iron Deficiency Anemia: Low iron leads to low haemoglobin. Symptoms include microcytic and hypochromic RBCs. Treatment includes iron supplements (avoid milk/antacids; take with juice) and iron-rich foods (red meat, spinach).

Respiratory Assessment and Conditions

  • Asthma Pathophysiology: Three stages: (1) Bronchoconstriction/smooth muscle reaction, (2) Inflammation/thickening of the mucosa, and (3) Increased mucus production and swelling. Triggers can be inflammatory (allergens, infections) or irritants (temp changes, stress).

  • COPD and Emphysema: Loss of lung elasticity and narrowed passages due to irritant exposure. Characterized by barrel-shaped chest, cyanosis, and pursed-lip breathing. Risk factor: alpha 1 antitrypsin deficiency.

  • Pneumonia: Infection in alveoli (fluid/pus buildup). Can be Hospital-acquired, Community-acquired, or Aspiration-based.

  • Pulmonary Embolism: Thrombus in the pulmonary artery. Notable symptom: feeling of impending doom and blood-tinged sputum.

  • Pneumothorax and Haemothorax: Air (Pneumo) or blood (Haemo) in the pleural cavity causing lung collapse. Priority: cover opening with three-sided semi-occlusive dressing.

  • Flail Chest: Rib segment breaks and detaches from the chest wall due to trauma. Symptoms include uneven rising/falling of the chest.

Neurological Stewardship

  • Strokes:

    • Ischemic: Blockage from embolism or thrombosis. Treated with TPA (must be given within 3 hours; CT must be negative for blood; BP < 185/110).

    • Haemorrhagic: Rupture causing bleeding/swelling.

    • TIA: Transient blockage; symptoms resolve but serve as a warning.

  • Glasgow Coma Scale (GCS): Used to assess sedation, responsiveness, and consciousness.

  • Nursing During Loss of Consciousness:

    • Maintain patent airways (lateral/semi-prone position, suctioning).

    • Protect the patient (padded side rails, orient client to day/date).

    • Manage urinary retention via palpation or catheterization.

  • Cerebral Palsy (CP): Umbrella term for brain damage effects. Types include Spastic (Quadriplegia, Diplegia, Hemiplegia), Dyskinetic (Dystonia, athetosis), and Ataxic (tremors).

  • Seizures: Abnormal electrical activity.

    • Generalised: Whole brain (6 types including Grand Mal).

    • Focal: Part of the brain (starts in one area; can become bilateral).

    • Action: Do not hold down, do not put items in mouth. Call 111 if > 5 minutes.

  • Meningitis: Inflammation of the meninges. Viral is usually mild; Bacterial is medical emergency treated with IV antibiotics. Symptoms in babies: high-pitched cry, floppiness, and rash.

  • Guillain-Barre Syndrome: Autoimmune attack on peripheral nerve myelin sheath. Features acute inflammatory demyelinating polyneuropathy (symptoms migrate upward from extremities).

  • Multiple Sclerosis (MS): Destruction of myelin forming scar tissue (sclerosis). Types include Relapsing-remitting and Primary Progressive. High prevalence in cooler climates.

Gastrointestinal and Renal Health

  • Stool Indicators:

    • Small, dry: Constipation.

    • Light grey/clay: Biliary obstruction.

    • Mucus: Ulcerative colitis.

    • Black/tarry: Upper GI bleed.

    • Bright red (Melena): Lower GI bleed.

  • Peptic Ulcers: Mucosa destruction; often caused by H. pylori or NSAIDs. Treatments include "H. pylori eradication" (antibiotics) and acid reduction.

  • Paralytic Ileus: Lack of movement in intestines causing blockage. Often post-surgical due to opioids (morphine).

  • Renal Tests:

    • Serum Creatinine: Early sign if > 1.2 (women) or > 1.4 (men).

    • GFR: Normal > 90. Kidney failure risk if < 60; dialysis likely if < 15.

    • BUN: Normal 7−207-20.

  • Acute Renal Failure (ARF): Three phases: (1) Oliguric (reduced output/waste build-up), (2) Diuretic (increased GFR but risk of necrotic cells), (3) Recovery (normal urine 1−2 L/Day1-2\,L/Day).

Diabetes Mellitus

  • Type 1: T-cells attack B-cells in the islets of Langerhans. Symptoms: Polyuria, Polydipsia, and Polyphagia. Can lead to DKA (toxic ketone buildup causing metabolic acidosis and fruity/nail polish breath).

  • Type 2: Resistance to insulin or insufficient production. Signs: Vaginal thrush, numbness in limbs, and blurred vision.

  • Hypoglycaemia: "Sweaty, cold, and clammy… give me some candy."

  • Hyperglycaemia: "Hot and dry… sugar high."

  • HbA1c Threshold: Greater than 55 mmol/L55\,mmol/L suggests diabetes.

Acid-Base Balance Reference Data

  • Sodium: 135−145 mmol/L135-145\,mmol/L

  • Potassium: 3.5−5 mmol/L3.5-5\,mmol/L

  • Chloride: 95−105 mmol/L95-105\,mmol/L

  • pH: 7.35−7.457.35-7.45

  • PaO2: 75−100 mmHg75-100\,mmHg

  • PaCO2: 35−45 mmHg35-45\,mmHg

  • HCO3: 22−26 mmol/L22-26\,mmol/L

  • Metabolic Acidosis: pH < 7.35 and HCO3 < 22. Potential causes: Diarrhoea, Ketoacidosis.

  • Respiratory Acidosis: pH < 7.35 and PaCO2 > 45. Potential causes: Airway obstruction, narcotic overdose, GA.

Integumentary and Wound Care

  • Wound Healing Phases: (1) Haemostasis, (2) Inflammatory, (3) Proliferative, (4) Remodelling.

  • Pressure Injury Staging:

    • Stage 1: Red, does not blanch, skin intact.

    • Stage 2: Partial loss of dermis; blister formation.

    • Stage 3: Full loss of skin; subq (fatty tissue) visible.

    • Stage 4: Exposed bone, muscle, and tendon.

    • Unstageable: Covered by slough or eschar.

  • Burn Classifications:

    • Superficial: Epidermis only; red with no blisters.

    • Partial Thickness: Blisters, pink base.

    • Full Thickness: White/waxy/charred; no sensation/capillary refill.

    • Treatment: Room temp tap water for at least 20 minutes (within 3 hours of burn). Never use ice.

Pharmacology and Medication Classes

  • Antibiotics: Bactericidal (-cidial) kills by preventing cell wall formation; Bacteriostatic (-static) stops multiplication.

  • Opioids: Bind to Mu/Kappa receptors. Use Naloxone (antagonist) to reverse. Side effects: respiratory depression and constipation.

  • Diuretics:

    • Loop (Frusemide): Works on ascending loop of Henle; inhibits Na-K-Cl cotransporter.

    • Thiazide: Works on distal convoluted tubule; used for hypertension.

    • Potassium-sparing (Amiloride): Works on distal tubule/collecting duct; monitor for hyperkalaemia.

  • ACE Inhibitors (-prils): Inhibits ACE from converting Angiotensin 1 to 2. Monitor for dry cough and angioedema.

  • Beta-blockers (-lol): Blocks Beta 1 receptors. Do not give in asthma/COPD due to Beta 2 blocking (bronchoconstriction).

  • Digoxin: Positive inotropic (stronger) and negative chronotropic (slower). HR must be > 60\,bpm. Toxic level > 2.4\,ng/mL.

  • Insulin Pharmacokinetics:

    • Ultra-short acting: Onset 15 min15\,min, Peak 1 hr1\,hr, Duration 3 hrs3\,hrs.

    • Short acting: Onset 30 min30\,min, Peak 2 hrs2\,hrs, Duration 8 hrs8\,hrs.

    • Intermediate: Onset 2 hrs2\,hrs, Peak 8 hrs8\,hrs, Duration 16 hrs16\,hrs.

    • Long acting: Onset 2 hrs2\,hrs, no peak, Duration 24 hrs24\,hrs.

Mental Health and Legality

  • The Mental Health Act 1992:

    • S111: RN power to detain for 6 hours for urgent assessment.

    • S29: Community treatment order.

    • S30: Inpatient treatment order.

    • Delusion vs Hallucination: A delusion is a fixed false belief (mailbox is a boyfriend); an hallucination is a sensory perception not shared by others (mailbox is shouting).

  • Antipsychotics:

    • Typical (1st Gen): Treat positive symptoms; risk of EPSEs (treated with Benztropine).

    • Atypical (2nd Gen): Treat negative symptoms; Clozapine requires weekly blood tests for 18 weeks to monitor for agranulocytosis.

  • Serotonin Syndrome: Overload of serotonin. Symptoms include muscle spasms, hyperreflexia, and hyperthermia. Treat with Benzodiazepines and serotonin blockers (cyproheptadine).

  • Enduring Power of Attorney (EPA): Authorises an attorney to make decisions only if the person becomes mentally incapable. Attorney cannot refuse life-saving treatment or consent to ECT/brain surgery.

  • The Treaty of Waitangi (1840) Principles: The Three P's—Participation, Protection, and Partnership.

  • Nursing Council Roles: Issue practicing certificates, set competencies, discipline nurses, and protect the public. Bound by HPCAA (2003).

Maternity and Pediatrics

  • Pregnancy Signs: Goodells Sign (softening of cervix); Chadwick's Sign (bluish colour of vagina/vulva).

  • Pre-Eclampsia: Hypertension after 20 weeks with proteinuria. Patho: spiral arteries in the uterus fail to widen, leading to ischemic placenta and toxic endothelial damage.

  • The Apgar Score: Appearance, Pulse, Grimace, Activity, and Respiration (Each rated 0−20-2).

  • Infant Reflexes: Moro (first month peak), Rooting (cheek stroke), Babinski (abnormal if toes dorsiflex after infancy—indicates CNS lesion).

  • Congenital Defects:

    • Coarctation of the Aorta (CoA): Narrowing causing high BP in upper body and low BP/absent pulses in lower extremities.

    • Transposition of Great Arteries (TGA): Aorta and Pulmonary artery switched. Results in "Blue Babies" as no oxygenated blood reaches the body. Treat with Prostaglandin E to keep ductus arteriosus open until surgery.

  • Developmental Stages (Erikson): Trust v Mistrust (Infant), Autonomy v Shame (Toddler), Initiative v Guilt (Pre-schooler), Industry v Inferiority (School-age), Identity v Confusion (Adolescent).