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reversing
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Reverse Percentages
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Reverse Engineering
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NMBDs + Reversals
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Reversible reactions
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NMB Reversal
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Reversing Entries
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Reversible Reactions
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What is Reverse Osmosis?
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Reciprocals & Reversive Sentences
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Pressure and Reversible Reactions
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Reverse Inference in Neuroimaging
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Reverse Proxy Overview
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Car Backing/Reversing
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Reverse Engineering Recap
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9.1 reversible reactions
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knee imaging referral
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Vocabulary blackmail=chantage ditch= abandonner/ nom fossé iffy=douteux incertain mischievous espiègle croquette cuivre =copper stérilet =IUD pristine =immaculé crow's feet =pattes d'oie vanguard =avant garde conduct= conduite mener steadfast=inebranlable grim=sombre sinistre dread= redouter effroi loath = répugne loathsome= repugnant/detesable/odieux befitting = digne lenient=indulgent clement oursin= sea urchin /ursine (tch) pimp= proxénète watering can =arrosoir bulletproof vest = gilet pare-balle frolicking= gambadant urinary infection = uti/infection urinaire blandness= fadeur insipidité spool= bobine afore=avnt ogle= reluquer/mater skidded= dérapé/ glisser slack= mou lache slope=pent /versant irk= irriter agacer extol= exalter prôner jabber= jacasser tidal wave = ras demaree tsunami deadlock=stalemate can opener = ouvre boite mire= boue automaton= automate selflessness=altruisme ringlets= boucles anglaises snuggle =se blottir caye=île îlot dodgy=douteux mane=criniere une louche= a ladle loucher=squint disembled = faire semblant baffled= stupéfait funnel= entonnoir clog/unclog= bouche débouche bulky = encombrant, imposant to beam= diffusee:a line of light that shines from a brightobject: disruptive = perturbateur spades= piques jacks(card)= valets aces= as clubs= trèfles diamonds= carreaux brash adj= effronté, impétueux to wail= pleurnicher, gemir enhanced = rehaussé, augmenter an oar =une rame to mow= tondre to row= ramer a nightstand = table de nuit to gloat= se vanter, jubiler cuckhold= cocu daunting = intimidant tattle= rapporter, denoncer stiffen (up)= se raidir, rigide the slops= les pistes filthy=sale crasseux bliss= bonheur, felicité hence = donc/par consequent ivy= lierre a gauze= une compresse snot= morve dew= rosée coax= amadouer convaincre ripples= ondulations adamant assets=biens/ capital to go berserk= devenir fou furieux shiner folksy= folklorique swoon wince=grimace cave=grotte wobble smug bosom threshold= entree pas de la porte gallow stern token escale stop over liquider voc cheva =sell ect renes got fed up= en avoir marre splurged doused = arrose asperge blithe insouciant squashed écrase crouching accroupi swaying balancement licence = bachelor degree propriétaire d'appartement crinière toboggan hive= ruche dam= barrage glider= planeur tame= apprivoiser step-ladder= escabeau ladder= echelle whiskers= moustache (de chat) willow=saule, osier to slaughter= massacrer ablaze= embrasé to be doomed= être condamné destiny= doom hoax= canular handcuff= menottes raven= corbeau bail on= laisser tomber lean on= s'appuyer sur/ compter sur pull over= s'arrêter/ se garer suspicion=soupçon shawty= belle fille calleux= calloused clearing= clairière a track= une piste, une voie intruder= un intrus coudre= sew tricoter= knit unhinged = déséquilibré / dérangé unfortunate= malheureux/ regrettable asset= atout kick in = faire effet tire= pneu shovel= pelle wrap up=conclure/terminer leek= poireau rewind= rembobiner the seam= veine de mine appealing= attrayant/attirant/séduisant slender= mince catch up= rattraper/rejoindre/discuter kidney= rein pine cone= pomme de pin a stain=une tache cauliflower= chou fleur cabbage= chou a rope= une corde a monk= un moine shield= bouclier a pattern= un motif the lark= l'alouette a barn= une grange a homestead= une propriété to hoist= hisser a pebble= un galet,petit caillou moisten= humidifier dash off= detaller, filer the flu= la grippe to sneeze= éternuer dizzy= avoir la tete qui tourne moldy= moisi zucchini = courgette eggplant= aubergine traffic jam= embouteillage staircase= escalier feather= plume 🪶 a strap= sangle, bretelles to budge= céder, changer d'avis assert= affirmer the nerve= le culot fence= barrière cloture peeve= bete noire pastry= patisserie pastry chef/cook= pâtissier water lilies = nénuphar mesmerize= hypnotiser/ envouter slightly= légèrement recollection=memory an awaiting= une attente to hop=sauter, monter fetch=récupérer, aller chercher hatred= haine displease smug= prétentieux to brag= se venter spokesperson= porte parole oat= avoine cunning= astucieux, rusé sly= sournois odd number= impair even number= paire crutches= bequilles come out of the blue= sort de nulle part vulture= vautour crumb= miettes steam=vapeur lice= poux beat up:battre frapper band-aid : pansement a gag= un baillon clay= argile a saw= une scie doormat= paillasson bridesmaid= demoiselle d'honneur corkscrew= tire bouchon dodge= esquiver diamond= losange the fee= les frais enroll= s'inscrire dimple= fossette mellow= moelleux frame= cadre strike= grève flawless= impeccable casket= coffin slur= insulte greed= cupidity rug= tapis without further ado= sans plus attendre earmuffs= caches oreilles beanie= bonnet tripod= trépieds watercolor=aquarelle mat flaw=défaut drench= tremper smother= étouffer, asphyxier to bask= se prélasser assignment= devoir/tache/mission start from scratch= partie de rien oatmeal= flocons d'avoine shuffle= melanger (des cartes) choke up= gorge nouée lust= luxure shatter= brisé slumber= sommeil chummy= copain-copain bankruptcy= faillite bankrupt= en faillite/ ruinée railroad= chemin de fer inquieries= enquetes, investigations, questions the sod= la tourbe grasshopper= sauterelle sleigh= traineau tonsils= amygdales surly= hargneux harvest = récolte yearn= désirer a tramp= un clochard dowry= dot lowkey= discret(kinda)≠highkey seldom=rarement puzzled= perplexe feat= exploit tough-looking= costaud neglect= négligence/ négliger a channel= un détroit crosswalk= passage piéton matted= emmêlés a sore= une plaie scavenger= charognard a fan= ventilateur short-tempered= colérique embroider= broder dump= une décharge heap=tas leaflet= brochure tract flyer dusk=crepuscule boast= brag blow up=exploser premises= locaux feud= querelle creed= croyance whip= fouetter shrine = sanctuaire oak=chêne oath=serment blood test, blood sample = prise de sang wrought = forgé overthrow=renverser to flash= clignoter a turn signal = un clignotant ghastly = épouvantable horrible affreux sweatpants= joggers hankerchief= mouchoir dreadful= terrible épouvantable atonement= expiation, redemption popy= coquelicot turtleneck = col roulé safety pins= épingles à nourrice soak= imbiber, faire tremper floss= fil dentaire scum= ecume, racaille, ordure make-believe= imaginaire mousy= timide, terne bouds-> boundaries= barrières, frontières dumplings adamant a fuss brat punk weary thread gasp midget(offensive)= dwarf escapism = evasion forlorn = desespéré, abandonné, triste binoculars= jumellles amphitheater, lecture theater =amphi midwife=sage femme neckline= décolleté low-neck t-shirt= un t-shirt décolleté prise= a plug interrupteur = a switch robinet = a tap ardoise= slat s'adoucir=to soften crainte= awe apprehension= trepidation fearfulness =peur crainte meticulously sacoche = satchel cavalier = a horse rider gaze glare look etc une ouverture = an opening, an aperture stetoscope = stetoscope rapière= rapier forsake= abandonner makeover = relooking keep it up= maintenir, continuer (comme ça) a ray= une raie repasser = ironing fer à repasser= iron cloths ironing board= planche à repasser flashlight= lampe torche stroller= poussette can you give me a lift= can you give me a ride agrafeuse= stapler trombone(music) = trombone trombone= paper clip cardboard = carton backbeat= contretemps winding= enroulement, sinueux, tortueux bouillotte= heating pad sopalin = paper towel braindead= abrutis, demeuré gant de toilette= washcloth lave vaisselle= dishwasher machine à laver= washing machine loofah = fleur de douche smirk= sourire en coin, narquois a grin= un large sourire a wry smile=sourire ironique a beam smile= un sourire rayonnant torchon = a rag turd= 💩 riddle= énigme, devinette bonds=lien ≠ bounds= limites prowess= prouesse ordeal= épreuve, calvaire undergo= subir, être soumis edgy= nerveux, avant-gardiste audacieux footage= séquence, image, video roll your eyes prison cell= cellule crever qqchose= poke something hasard = chance poke an eye out= crever un oeil slip knot= noeud coulant valuable = précieux, objet précieux coton swab= coton-tige heater,radiator = radiateur boiler= chaudière glimpse= apperçu mainstream= grand public rois mage= three wise men paille = straw hay= foin creche = Christmas crib la messe = mass appetizer= apéritif USB key( or flash) clé usb lame= nul inn= auberge the laundry= la lessive laundry detergent = lessive test tube= tube à essai fur= fourrure shingles=herpes= herpès tiles= carrelage tile roof/shingle= tuiles pipes= pipes/tuyaux wellness= bien être palate= palais(bouche) wisdom teeth= dents de sagesse to be set appart calvitie= hair loss machine gun saucer = soucoupe enable drain to file= limer bump= une bosse strips= rayures scratches = rayures griffes= claw howl= hurler to rear= se cabrer to bolt= se ruer abhorred= abhorré, détester bespeak= temoigner de anguish= angoisse unearthly= unnatural uncanny = étrange, troublant begone= va t en scarcely = a peine, rarement to sport= wear (proudly) annihilation= anéantissement spurn= rejeter misdeed= méfait fiend= demon bliss= bonheur, beatitude bestowed= accorder, donner, conférer maw= gueule animal deck= pont terrasse= terrace ordonnance= prescription raccrocher= hang up≠ pick up= décroché fuguer = run away warehouse= entrepôt talon= heel 🤦‍♀️ foie=liver baver, bave= drool run off= ruissellement, fuite cleavage= décolleté public transport figurine= figurine tie (up)= attach flow= ecouler/ment,flux hem= ourlet shackles lumberjack= bucheron salopette = overall to mend= raccommoder, réparer grated(to grate)=râpés, râper a grater= une râpe heckling= chahut, interpellation a mop= une serpillière out of whack= détraqué, hors de contrôle, chamboulé=doesnt work normally wracked= ravagé, déchiré to follow suit= faire de même, emboiter le pas take over= prendre le contrôle gear= engrenage ⚙️ boiler = chaudière foolhardy= téméraire meddlesome= indiscrète shimmer= scintiller, briller glimmer= lueur, étincelle trout= truite le hoquet= hiccups groundhog= marmot= marmotte a mole= une taupe squeaky= grinçant squeaky clean= irreproachable, blanc comme neige, clean turmoil flip-flops= claquettes tongs 🩴 calf= mollet/ veau harvest= recolter collect sort out= trier play pretend= jouer a faire semblant cumbersome= bulky = encombrant païens= pagans ferrets= furets drowsy load upload flashy platypus =ornithorynque egerie first off= firstly loathsome stick out your tongue = tirer la langue 😛 butchery= boucherie pharmacy chemist chimiste bookstore= librairie red trail = piste rouge stoop= se baisser/ perron restraint= restriction/ contrainte vb= restrain windowpane= vitre/ carreau pane= vitre windpipe = trachea (trekia) huffing= souffler/ sniffer/ raler spew= cracher, degueler graft= greffe/er slot= fente spill the beans = cracher le morceau snog= rouler une pelle courbatures= muscle soreness écœurant= cloying cul sec= bottoms up/ down in one cul de sac= dead end receipt= reçu/ facture short attention span = faible capacité d'attention wreckage= epave/ debris gut= intestin boyaux bladder=vessie plump= repulpant, charnu dodu yawn 🥱 pue= pus cloques = blisters cataplasme= cataplasm to gag= relent, reflexe vomitif plaster= le plâtre cast= un platre (jambe cassée ) tampon/ner = stamp (to stamp) timbre= stamp sauvegarder = save, safeguard, back up etre pressé= be in a rush/hurry lianes = liana sangsues = leeches litchi= lychee deed= acte (ex de propriété) chocolate milk= chocolat au lait off my face insure un coffre caveman = homme de cromagnon too little to late salt shaker tap dance = claquette subtle (sutle) a demonstration= manif sole=semelle attic= grenier l taky= ringard, vulgaire a peak= un coup d'oeil whacked = frappe ou épuisé deeds=actes blast=explosion
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Events/Ideas that Changed the World Notes Day 1 What is a dictatorship? Origins: Dictatura, ancient Roman term, wasn’t originally negative, it was just a title, Caesar went by it. What it meant was that the republican senate in rome determined there was a threat to the social order, they would elect a dictator. We need to give someone total power for six months to protect the country from whatever threat. They would choose two guys, and then choose a dictator from them. That dictator would establish order, then step down. The dictator was given extralegal powers, they couldn’t change laws, but they didn’t have to, because they could do whatever they wanted for six months. It did work for awhile, but what happens if someone decides not to leave? Caesar was elected dictator, but never left, until he was murdered. After that, they started to rethink the whole system. Tyrant and Despot also used to be neutral terms. They were just court titles. It was a term for someone that had power in a local area, but gained that power in an unusual way, usually through buying it. Later, they become synonymous with illegitimate rule. Day 2 Notes Dictatorship wasn’t originally considered a negative term. You were called a Despot, which was also a neutral term. Hobbes was a believer in dictatorship, using the countries around them as evidence that they needed a monarch; they couldn’t do whatever they wanted, although they basically could, because removing them was near impossible. The logic with electing a dictator temporarily was that they assumed the public would turn against them once it was time to leave, and they would fold under public pressure. Once Caesar came in, he pretended the emergency was still going on, and he swayed the public vote in favour of him. In the 18th/19th century, tyranny and despotism started to be synonymous with power being exercised illegitimately. French Revolution, revolutionary dictatorship to achieve the social equality you need. We will force you to be free. Napoleon makes himself dictator of France, temporarily, and then makes himself emperor of France. Switch definition of what public support means, such as making nonaggress the enemy. Karl Marx wanted to overthrow the capitalist system by overthrowing the dictatorship. Vladimir Lenin took power of Russia in 1917 through a violent revolution against a long standing monarchy. They openly refer to themselves as dictators at first, saying that they need to eliminate enemies, or it will allow the enemies to come back. Post WW1: positive use of dictatorship declines, even in the Soviet Union. Mussolini seized power in 1922, establishing a Fascist state. Dictatorship starts to become a negative term. Mussolini used the term Totalitarianism, he adopted the term as positive. He wanted to neutralize the masses to preserve power and social order. Day 3 Notes Cult of Personality Non necessary element of dictatorships. Legitimize the leader. Legitimize an ideology by identifying it with said leader. Establish the leader as both above normal human concerns and as the fatherly protector of the people. Manipulation of mass media. They establish the leader as above normal human concerns, but also the fatherly protector of the people. Triumph of the Will, 1935 documentary, an account of the Nazi party. It’s an example of propaganda from the nazi party. Day 4 Notes Italy was divided into various city states, kingdoms, and other empires, for centuries. Italy was mostly unified as one country by 1861. The pope was basically the head of the country at this point. They especially welded power over Rome. The vast majority of Italians then and now are Catholics. They didn’t believe the people were ready to govern themselves, or vote, they believed in a monarchy, just not a dictatorship. The Ethiopian Army destroyed the Italians in their war, which destroyed the narrative that the black people needed help to be governed, given that they destroyed the Italians. A narrative develops that the liberals were at fault for Italy losing, creating a desire for a new leader. Enter Mussolini, he was a militant socialist advocating violence (propaganda of the deed). Was arrested many times, he was influenced by Nietzsche, Filppo Marinetti. He believed violence was useful and necessary, that it purified people. Ironically, he referred to the military a lot, yet was arrested for avoiding being drafted. He said he would only fight for the working class, not the country. WW1 breaks out, he did serve there. He started a newspaper during this time, and Italy entered the war in 1915, turning on allies Germany, and joining France, Britain, and Russia. Originally, he didn’t support Italy entering the war, but eventually decided he agreed with it. He was a socialist, and socialists didn’t support capitalist centered wars, Mussolini disagreed and expected that they would finally get all the territory Italy deserves back. He’s kicked out of the socialist party for these beliefs. In his newspaper, he starts promoting pro-intervention views. He denounces socialism entirely, and says he was kicked out for promoting violence. Day 5 Notes Fascism in a couple words is fighting in action, that’s what it’s about. It’s difficult to turn into a government. The Fascists originally didn't get as many votes as the National Fascist Party in Italy. Speech in October, march on Rome, if Fascists were not given power, they would take it by force. Day 6 Notes Mussolini's goal was to reestablish the Roman Empire, and wants to go back to a Roman Empire. It’s about obliterating earlier society, replacing corrupt liberal democracy. Mussolini's party murdered a political opponent, named Giacomo Matteotti, who was a socialist and a vocal opposition. He went missing in June, found dead in August. Vatican City, which is the smallest country in the world, smaller than the university. Italy and Mussolini recognized the Pope as a sovereign of an independent nation, which is now Vatican City, it will now be a separate country from Italy, the Pope will control it. Italy will live there, if the Pope agrees to stay out of Italian politics, and be neutral on international affairs unless asked, and all bishops in Italy have to pledge loyalty to the Fascist movement. Italy also paid this new country a big sum of money, they also agreed to teach Catholicism in schools, along with Fascists. This was viewed at the time as a win for Mussolini. Most Catholics saw it as a decent win for the church as well. Mussolini gained popularity as a result. Mussolini is even painted alongside Jesus in some churches in Italy. The Pacificiation of Libya, has since been labelled a genocide. It was meant to crush local resistance to Italian ruling. They used mustard gas on civilians and rebels. Innocent LIbyan citizens died during this. They eventually arrested the resistance leader. By the end of it, the Italians labelled Libya as pacified. Italy still deals with this in today's politics, with the fallout of committing this act to Libya. It seems like there might have been a racial motivation for it. The racial motivation was viewed as Mussolini simply seeing Italians as better than everyone else, Libyans were inferior to Italians, and in their deserved territory. One of the major problems with dictatorships is that you can never get the truth, nobody is going to tell you if there is a problem, out of fear for their lives. He didn’t know how popular Fascism was, and there wasn’t a reliable way to find out. He tries to do things to earn the popular vote, like war, like conquering things. Ethiopia was very symbolic, they had lost to Ethiopia in a previous war, that embarrassed them. So, he decides to get some getback. Mussolini has to be careful, their army can’t take Britain or France, so he has to take Ethiopia without provoking the Europeans, so he bluffs. He lies and says that his troops were attacked by Ethiopian troops, unprovoked. He threatened force to measure the reactions of the other count Day 7 Notes Mussolini was concerned about the lack of enthusiasm about fascism in Italy, He even created an encyclopedia of Fascism. Now that Mussolini has indicated they have relatively similar views with Germany, they form an alliance, there is economic dependence on each other, this is not a popular move, as Italians don’t like Germany. In 1939, they signed the Pact of Steel, this is a military agreement, they agree to attack anyone that attacks them. They continued to invade other countries, for no real reason, it was cheered, but now we were seeing the natural end of Fascism. How can you stick with an ideology that is centered around violence, if you’ve won, what do you do then? Mussolini introduced racially motivated laws called the Defense of the Race in 1938, which was very similar to the laws introduced by the Nazis. It frustrated Italians that he was just doing what Hitler was doing, it’s possible he was trying to center out specific people to explain why things aren’t perfect yet, to distract from his incompetent leadership. In 1940, Italy declared war on Britain and France. Mussolini didn't join the war early on. Poland is getting destroyed by Germany, but on the Western front, it’s quiet for a while. Mussolini changes that, by swooping in to take advantage of Hitlers chaos, who quickly destroys most of Western Europe. Hitler now owns France, Mussolini thinks things look good for Hitler. So, he declares war. His justification was that the Italians were trapped, they needed living space. Sounds very similar to Hitler there. It works, at first. Mussolini tries to expand his African empire. The Italian army was not ready for this, even his war commanders who supported him told him they would lose the war. Mussolini ignored them, insisting Fascism would always win. They start to lose the war, they don’t have the military capable of doing this. It embarrassed Mussolini greatly. His only idea is to continue to expand, but that doesn’t work either. By 1943, the Italians collapsed, and Germany had to come save them. The problem is that Germany is now fighting wars on several fronts, and that proves too much. Hitler is now really angry with Mussolini that he had to come save him. The Allies were counting on Southern Italy not being as supportive of Mussolini, so they invaded there, and the Southern Italians didn’t fight the Allies, simply because they didn’t like Mussolini. That year, Mussolini was voted out by his own Fascist Grand Council as leader. They voted him out on the basis that he was no longer promoting true Fascism, most of the council were his relatives, they still voted him out. Mainland Italy is invaded, and they surrender. This leads to a civil war. Germany is still fighting the Allies in Italy, plus Northern Italy still believes in Fascism, while Southern Italy no longer does. Hitler, while angry with Mussolini, still believes he could be useful, so he decides to liberate him from a castletop prison. THey break in with a helicopter and hand gliders, they kill all the guards, and they get Mussolini. Hitler installed Mussolini as a puppet leader of the Italian Social Republic. Hitler sees him as a useful figurehead so they can claim that Italy is still independent. The Italian Social Republic is not a well run country, and is nothing but revenge plots, Mussolini gets his son in law who voted him out, and executes him in front of his daughter. That’s what Mussolini does for the last years of his life, is take revenge. Day 8 Notes Mussolini was captured in 1945, he and numerous other Fascists were executed right after being captured. Adolf Hitler The Habsburg family led Germany for many years, they controlled various German states. Around when Hitler was born, some of the other German states were controlled by other people, eventually they were unified, the differences were religious in nature. Germany is eventually unified, Austria is left out of the proceedings. In 1867, the conflict was settled, the Hungarians took over the nation, although the other nation states were not happy about this. Hitler was born into a dysfunctional family, his parents died at a young age. Hitler had two siblings, but five siblings died as infants. He was born sick, but he survived. His mother did not work. Even Hitlers name is confusing, his father was born out of wedlock, and the gossip is that Hitler might've actually been jewish. We don’t know who his grandfather was. His step siblings ditched the abuse after their parents died, so he has to raise his sister. He did not get into the Academy of Graphic Arts. He then just works odd jobs in Vienna, sells some paintings, he’s living off the little bit that his father left him, he is often homeless. Vienna is home to many different ideologies. He’s attracted to Pan Germanism, Volkisch nationalism, and antisemitism. Pan Germanism is that the Germans needed all the German states to give them living space so that they could thrive. He sees the Hasbergs as a problem. He hated Catholicism. He blamed them for Austria being left out, and he begins to identify with Germany a lot more than Austria, despite not yet being a German citizen. Day 9 Notes Hitler existed in the military in 1914, he initially refused to serve, but eventually changed his mind. He was blinded by gas in 1918. As he was recovering from this, Germany surrendered. He did have to get special permission, as he was not a citizen. Losing this war, much like with Italy, was a shock to German nationalism. He never drank, and stopped eating meat. He fights a lot, and wins awards for bravery. He really starts to internalize social Darwinism. They believed that the European countries that were winning wars was because nature had determined they were the strongest. The destiny of Germany was to win, but they didn't, they lost. The media was telling the citizens that they had been winning, so it was a shock that they lost. The king, a monarch, abdicates, so monarchy is now gone too. A myth that Germany was stabbed in the back by internal traitors starts, communists, jews, socialists, that’s why Germany lost the war. Hitler becomes a regular in what’s known as beer hall politics. Nobody knows what to do with a lot of the vets that survived the war. So, one thing they do is hire them as military intelligence, as with Hitler. They decide they need to stop political violence. Hitler gets hired to spy on a party, called the German Worker’s Party, but it’s actually a far right party, they call themselves that so they can appeal to the working class. Their goal is to get rid of the Jews so that they can fix capitalism. Hitler joins it, to spy on it. While doing it though, he looks around, and likes some of their ideas, but it’s not extreme enough, they need more. So, Hitler starts speaking on the events, and stops spying on them. Within a couple of years, he is the leader of the group, and they rebrand themselves as the Nazi party. The Nazis are far more willing to commit violence, and are more far right than other groups of that time. He believes it’s about saving not just Germany, but the world. Ernst Rohm led the Storm Troopers. His job was to beat up political rivals, and Hitler eventually got his eye. This political violence works, it scares people into voting for the Nazis. Hitler is also able to say that he is separated from the violence because someone else runs the violent part of things. Hitler is able to stop the violence, he is able to stop Rohm. Day 10 Notes The people in charge of Hitlers trial were Nazi sympathizers, and gave Hitler and Nazis light sentences, while also allowing him to speak at his trial, which gave him ample time to gain fame, it made national news. Hitler is convicted anyway, for five years, but only serves nine months, in a min security prison, and is allowed visitors, where he converts most of the prison to his worldview, and also writes Mein Kempf. Hitler now learns that he can’t use force to win the government, he needs to win them over. Paul von Hindenburg uses the emergency act to be a dictator temporarily after the depression, but uses it several times. He does not believe in democracy. His plan is to stop the left from forming a party and organizing. There are about five elections in 1931, because the left keeps getting elected, but the emergency act is being used to overrule it, though it annoys the German population. However, it was being used as an example of the fact that democracy doesn’t work. The Nazis continued to grow, there were several elections in 1932, where the Nazis got 37 % of the popular vote, the largest single party. This is one of the worst points of depression. After less than a year, Hitler became dictator. Franz von Papen convinced Hindenburg to appoint Hitle chancellor in 1933. Their popularity starts to decline, the only way to get around that is for Hindenburg to hire Hitler, they count on him being a peasant that will be too stupid to do much. Papen will be co chancellor, to watch things, we’ll be able to control him. A fire happened in 1933, historians still don’t know who started it, but it was blamed on a communist conspiracy at the time. The Nazis use this to get more power, they pass the Enabling Act, which gives Hitler a dictatorship. A couple of months later, all non Nazi political parties were removed. In 1934, Hindenburg died, he didn't replace him, he just merged his position with his own, so he gained more power. A significant amount of violence and intimidation happens in his early years. The Night of the Long Knives happens during this time, that is when Hitler killed rivals of the Nazi party, sending out goons later known as the SS, and brutally hundreds of people he believes are challenging him for power. He killed Rohm for being gay, though he had known this since he had met him. In 1939, they opened their first concentration camp. From the first party, it’s usually enemies of the Nazis, communists, the left, starts to include more Jews as it goes. This is justified by saying these people are threats to the government. Day 11 Notes You had to get a racial card, if you had more than 3 jewish relatives, you would not be considered a german citizen. If it was less than that, you would temporarily be a German citizen. This would get restricted even more as time goes on. These regulations consider who you can marry, who can drive cars, everything is regulated. Property is taken away from Jews. If you were gay, or religious, you would be regulated. They also sterilized thousands of people as well. THey gas brought 500 000 people in three years. Hundreds of jews were shot in public merely for being Jews, then the Germans blamed them for property damage, justification for restricting the jews even more. He took Germany out of the League of Nations. That’s what Nazis do, they create conditions that then they can point to and say see, you need us, we need war, it’s being forced upon us. Hitler invades Czechia, but claims he only wants the part that has mostly german speaking people, people on the Allies side don’t believe him, others say that they don’t want to fight a war. So they hammer out an agreement to give him this land, guess who they get to negotiate? Mussolini. Hitler then immediately betrays everybody, takes the land he was given, but then also invades the rest of Czechia. So Hitler is told, if he does anything else, they will go to war. Hitler then invades Poland, Britain and France soon declare war, and WW2 begins. The West is pretty quiet at this time, a different story in the East. We’re at war, even with the total destruction of Poland, the Allies do nothing, they seem to be holding out hope that maybe things can be resolved. The Germans through the 40s took Denmark, Norway, Sweden, Netherlands, France, Belgium. France was one of the strongest empires in the world at the time, and they fell in six weeks, now the Nazis have a monopoly. The Allies are losing by a lot at this point. Nobody seems to be able to stand up to Germany, Hitler is the most powerful man in the world. Some of this was revenge for WW1. Hitler has more power than anybody on earth pretty much, and portrays himself as a Messiah, but he’s not actually very good at this, it’s mostly the military taking advantage. Hitler starts to believe his own hype, and believes that he’s infallible. He starts to execute military leaders that contradict him, creating a bunch of yes-men. Hitler even allowed the Allies to escape at one point when they had him on the run because of a decision made by Hitler. This is causing the empire to crack. Hitler decided in 1941 to invade the Soviet Union. His racial version of the world centers around this, and he’s convinced that they have enough to stop the Russians. They bet it all on one giant hit on the SU, really fast, it’ll take them all out, and then they will own Russia. This was briefly successful at first, but then it’s not. The top reason is that Russia is really big, and it’s cold, the Soviets don’t just collapse, 27 million Soviets die in this war. However, they don’t fold, they retreat, burn everything so the Nazis can’t get supplies, but unlike Hitler, Stalin goes the other direction, he listens to military leaders. Htiler is doubling down on making his own decisions. To the point all the decisions are made by Hitler, which leads to inaction in several areas, they stretch out the Germans supplies and people, and then winter hits. The Germans weren’t prepared for the cold, and they slowed down significantly. The Soviets then join the Allies. So the Soviets get supplies from the Allies, and it helps them as the Germans are now isolated in Russia. America then entered the war in 1941. Japan attacks the States, and so the States have to enter the war, they are a powerhouse. They help the Allies, but the States also give supplies to the Russians against the Nazis. All of a sudden, the advantage in the war has moved to the allies. Day 12 Notes In just two days in 1941, the Nazis shot 33 thousand Jews, in another two day span, 28 thousand, in a couple weeks, 70 thousand. However, the Nazis realize that they are using too much resources, and it comes to light that some of the soldiers are showing signs of guilt, and that needs to be minimized, so they need to come up with a better way. Hitler had permission to come up with a plan, so they went back to what they had been doing to disabled: gas them. They determine they will build extermination camps, the whole point being to kill as many people as possible. They did this by putting gas in showers. It’s estimated roughly 1.1 million people that were deported into Germany were killed. The Germans couldn’t function, they were terribly disorganized. D Day, the Allies decided to attack the Nazis where they were at their strongest. They believed that they had reallocated so many resources to the Eastern front, that the area was weak enough in the West that the Allies could break through, while it was difficult, they were correct. Hitler refused to believe that the Allies could break through the West, so even though he was warned, he ignored the warnings. From this point, everyone knows the Nazis will lose eventually. In 1944, there was an assanation attempt on Hitler. A group of military elites and citizens were banded together to try and kill Hitler, a pretty diverse group of people that had different motivations for why they wanted Hitler dead. Some for moral reasons, for most of them, were afraid of what Hitler was going to do to the country, thinking he was a madman. If they got rid of them, they could surrender and get peace. Some had been active members in getting rid of Jews, they agreed with his mindset, but believe he specifically is a madman. Their plan involves a meeting that is approaching for military leaders, one of them was going to bring two bombs, and place them next to Hitler, who would blow up. They would then claim someone inside of the Nazi government had killed him, they would arrest everybody, and establish a new government. One of the bombs doesn’t work, he can only arm one. He places it next to Hitler, someone by chance moves it a little bit, and when it explodes, it explodes a table. Anyone involved, and their families, are executed. Several thousand are killed in the next few days, as he believes the hype that he’s a god even more. Hitler then orders the Battle of the Bulge, against advice, and it fails. He believed he could hit the Allies once, and they would get defeated, which of course doesn’t happen. The Western front has collapsed. The Red Army has pushed the Nazis back to Poland. They keep getting to the areas quicker and quicker, for the first time, the Russians find the concentration camps, and share the information with the world, they didn’t know this. Some believe the Russians even made it up. Hitler keeps demanding more deaths, starves thousands in the Netherlands, orders half a million deaths in Hungary, and he starts realizing that the walls are closing in on him. He’s about to lose. The Allies had debated whether they should invade Berlin, in 45, they decided that they needed to kill him, otherwise the war would never end, so they decided to go all out on Berlin, which they did. They destroy Berlin. Hitler lived the rest of his days in an underground bunker, Hitler had said that if he died, he would take the Germans with him. So, Hitler stayed in Berlin. Day 13 Notes Germany is slowly encircled, Hitler is all powerful, but he has no counter strategy. Berlin is under attack, and Hitler refuses all concessions. he then commits suicide, with a will and a last dictate left behind him. Germany surrenders a week after he dies. He appointed a heir to his dictatorship, and Hitler also married his girlfriend a few hours before they both commited suicide. The war still is going on, because Japan does not surrender. Hitler did try to make a deal to get away from the Allies, they of course refused. Joseph Stalin Under the Tsarist government, the Russian Empire was one of the major powers of Europe for centuries. The majority of the country were serfs. The dictator of the nation was called a Tsar, this idea was taken from what Caesar was called. Serfs were not technically considered slaves, though they had a similar role to one. They had no personhood, and were legally considered property. They were technically considered people, they had some rights, but very few. They were peasants, tied to the land forever. They owed their allegiance to the local princes, usually a rich family in the area that reported to the tsar. Almost none of the population went to high school, especially peasants. Stalin was a peasant, but he did go to hs for about a year. Most of the population was completely illiterate. Things started to change in the 19th century, new ideas started to come into Europe, and Alexander the second freed the serfs, technically, with a lot of qualifications. Stalin was raised poor, but in the school he was able to attend, he thrived. He rather suddenly converted to socialism in 1896. He became a professional revolutionary, one that got arrested frequently. Once he converts to socialism, he is kicked out of the seminary he was a part of, and eventually joins a Socialist Party. Day 14 Notes Stalin was arrested for trying to organize a strike in a factory in Georgia. Marxism is a pretty complicated set of ideas. Marxists believe history has a beginning, middle, and end, these stages are defined by the economic stages of the time. Marxists believe these are the laws of history, these ideas are widely criticized, especially for the idea history is predictable, it’s scientific. History will evolve until we reach the final class conflict, the ones that own the means of production, and then everyone else. Marxist believe work is essential to who we are as people, class consciousness is when people are tricked into believing that they have to work and not knowing that work should define who they are. Religion dulls the senses and makes you easier to control. The Su was a little bit different from the Nazis in that they claimed that they accidentally persecuted the Jews, not for their race specifically. Whereas the Jews were specifically targeted and that was made obvious by the Nazis. First, a Social Democratic Workers Party was started, in 1898. Russia needed to develop to be ready for revolution. Then, three years later, the Socialist Revolutionary Party was started, they needed land reform. It was labelled at the time as a party split, as the Social Democratic party was split on how to handle the situation. Russia lost the Russo-Japan war just four years later, Russia lost. This is a disaster, for obvious reasons, but it was also an embarrassment. There’s also racism involved, how could Russia lose to a non-European country? It signaled to many that Russia was collapsing. Workers started going on strike, over 100,000 workers, a couple of years later, which grinds the country's production to a halt. Then a bread march led to a czar's house, demanding food, the Russian soldiers came out, killing hundreds and wounding thousands. The czar started to break, allowing a very restricted vote, which temporarily kept people at bay. However, he reverted those policies a couple of years later. The socialist parties, all of them, pulled out of working with the czar entirely. This emboldened radicals, including Stalin. In 1912, Stalin was part of the two parties officially splitting. He was arrested for sedition in 1913, and this time, the authorities sentenced him to exile in the Arctic, this is his first real punishment. He’s stuck there when WW1 breaks out a year later. His party publicly advocates for Russia to lose the war, because that party believes it’s the inevitable result of capitalism, so if you destroy them, it would lead to communism being enforced. So, the party sabotages their own country. Russia, for more than one reason, handles the war really poorly. The Tsar says that they are getting involved to protect the Slavs peoples, which was a race. They lost the Battle of Tannenberg to the Germans badly. In 1917, the Tsar was overthrown, the family had run Russia for three centuries, but Russia is getting dominated by Germany. In his place, a provisional government takes over, there is no vote. So, a coalition of the two parties and several others are all formed to form a government in Russia. At the same time, in the major cities, groups called Soviets, or a Workers Council, are rising, and organizing the cities. They become strong locations of authority that counters the provisional government. Day 15 Notes The new party promised peace immediately, and delivered, this made them popular. They promised war would end. They threw the only real election in Russian history at this time. They lost the election really badly. They believe the election was tainted somehow. After this party signs a peace treaty with Germany, it pulls them out of the war, but they seize a significant amount of land. Giving up the land was not popular. Russia then breaks into a civil war, with three sides, the communist, the red side, very well organized. The whites, they are a loose grouping of anti communists. The greens were really effective, they were the socialist revolutionaries, the reds are afraid of the greens, they are powerful, but the whites kill them because they don’t like communists, then the reads finished them off. Russia becomes a Communist state, with Stalin being a background member of the party. They hold farce elections at this point, where there are several communist from the same party to choose from, but you pick the same party no matter what. Stalin was named General Secretary by Lenin in 1922. He parlays this position to gain further power. The leadership of the party notices that Stalin is growing more power. Vlad Lenin releases a document on his death called the Testament where he warns his party of the threat Stalin presents. He asked the party to think of a way to get rid of Stalin. His testament is debated, but Stalin stays in power. Against the wishes of Lenin and his widow, they embalm his body to hold it for display to the party. Stalin survives the vote, and decides he can outmanuever everybody. He does this by continuing a cycle of forming alliances, breaking them with another alliance, breaking that one, and so on. Stalin is part of a trio that is leading the Socialist party. They align themselves against Trotsky's ideas of permanent revolution to save the world. He was outed by the trio. The trio's idea is to let the Western powers weaken themselves, it’s inevitable with a capitalist system, in the meantime, make sure socialism is strong here in Russia first. By outing Trotsky, Stalin gains even more power and influence. Stalin then betrays his two partners of the trio right after. Stalin changes his mind on whether some members of his party, including his partners, aren’t really spies, or not dedicated enough, to what is now known as Marxism-Lenism. He fosters distrust in those members of the party. Despite it being counterintuitive, Stalin makes friends with the capitalists of the party, and uses that alliance to vote out the two members of the trio, even having them killed and/or expelled from the country. He’s now the only one left from the last era, and the undisputed leader. Day 16 Notes Stalin plans now to abolish private property. Everything is owned by the state. This is being done to provide food to other cities, and the SU starts building industrial cities. Stalin is building, or rearming Russia. They had gone through a lot, and he was getting fresh war material. They are planning on going to war with the capitalist countries eventually. They call it the five year plan. Stalin blames most of the problems on peasants who had been successful during this dark time for Russia. A key part of this period was to remove the peasants as a problem, by murdering them all. So, there are mass killings of anybody that identifies with that system. Stalin, by 1929, was a full dictator, he got rid of all challengers. It’s widely debated on whether this actually worked, within a decade, they had collectivised almost everything. Production, however, went down. This caused a massive famine that spread across the whole US, leading to millions of deaths. It’s debated over whether Stalin targeted specific people groups with the famine. Stalin's wife kills herself because of her husband being responsible for this. Stalin blames the failures of the system on the industrial production people in charge, killing them. Stalin also imprisoned millions of people in labour camps. One of the consequences of purging the people is that Stalin can make the people more dependent on him, so he appoints puppet leaders. They introduced a new Constitution in 1936, however, it made little change. All of the culture was still very traditional, criminalizing abortion, limiting divorce rights. This was called the Depression. Stalin knew SU was not ready for a WW in the 30’s. He attempted to ally with the Western powers, but that didn’t work, he tried again with Germany, but that also didn’t work. Enter the Spanish Civil War. Stalin thinks that if he waits for the capitalist countries to go to war, he can wait and then come in and wipe them all out. The Nazis offered the SU good terms for an alliance. However, they didn’ count on the Nazis trying to promote racial conquest. SU fought Finland in the Winter War in 1939, the SU didn't start off very well, despite outnumbering the Fins. The Fins start off well because they have a good strategy. Stalin actually took Finland to defend against Germany, even though they were allies. Eventually, SU overwhelmed Finland. Day 17 Notes Nazis invaded the USSR in 1941. Early disaster for the SU, German forces are halted outside of Moscow. Stalin goes into hiding, for weeks on end after the Nazis invade. Both sides wipe out whole populations, with nobody being safe. Stalin rallies, as he creates more positions for himself to fill. The difference between Stalin and Hitler was charisma, with the exception being a famous speech in 1941 to motivate his soldiers. Women fight in the Soviet Union, unique for those times. The Germans make it all the way to Moscow, then are stopped. In the West of the Soviet Union, it’s a blood bath, and the Final Solution begins. Everybody is wiped out. When territory would be invaded, you would have to decide whether you would ally with the Nazis or with the Soviet Union. The SU refuses to retreat from Moscow, and it works. stalin from this point starts to delegate and not just do all of it himself. He allows the military experts to do what they do. Gregory Zhukov leads the military effort against the Nazis and turns the tables. They also get a significant amount of money, before America gets in the war, they don’t want to get involved in the war. The Soviets, unlike the Allies, are willing to sacrifice their people to win. Stalin starts to relent on things like religion, as well as delegating. However, Stalin, due to believed disloyality, orders his daughter in law arrested and murdered, killed his brother in law, and their wife, and Stalin's son was captured as a POW, and he allowed his son to die. From this, Stalin became a world leader in the big state. They were willing to ally with the Soviets despite disagreeing with him because of the threat the Nazis faced. The Soviets held the Nazis off long enough that the other countries realized the threat the Nazis faced, and they acted. Poland is stuck between Germany and Russia. So, they are sacrificed. Stalin goes to the Allies, and says that he needs help, he’s been fighting the Nazis by himself. He believes the Allies should attack the West so weaken Germany, which eventually happens and he is correct. This adds to Stalin's credibility. Because they are capitalists, Stalin believes that the Allies will negotiate with Hitler as soon as they can sell out the Soviets. So, he pushed the Red Army to aggressively pursue Hither, the Allies were also racing there for a different reason, they didn’t want to give a lot of the land to the Russians. Stalin encouraged his soldiers to rape Germans, and to kill as many citizens as possible. It didn't matter if they were Nazis or not. They also start to liberate concentration camps. The war ends, the Soviets are now a superpower. The reason for the Cold War starting is heavily debated, who started it? Was it Americans, or Russians? Could it have been stopped? The Soviet Union was scared of being invaded again, given recent history. However, the SU are now more powerful than after WW1, they are now in the Security Council and the United Nations. Stalin says that he wants Poland to be free, but friendly to the SU. That’s not what happens. The elections that do happen are not free or fair. Stalin does not trust former allies. In 1947, the United States agreed to the Marshall Plan, this is a generous infusion of American dollars, billions, into Europe, to help it recover from the war, with almost no strings attached. Stalin doesn’t trust it. He’s suspicious of those that participated in the war coming back to the Soviet Union, he worries his people have been Westernized. Stalin is angry at the donations, he believes Communism is being destroyed. He refuses the marshall plan, and forces various countries in the East to refuse it too. He threatens invasion. Day 18 Notes The Marshall Plan was made in part to stop eastern countries from becoming communist. The tensions in the Cold war ramp up. The Soviets stop food from going into Berlin if it’s not given to them by the West. The West ignored the demands, flew over the blockade that the Soviets had set up, and delivered food. The Soviets are still somewhat in a position of weakness, not as strong as the US, so they back down. Stalin is at his most powerful, but is more suspicious than ever. He was scared of the different military leaders, as some of them were executed. He believes some of his people that had been in the war had been exposed to the western version of living. He starts having his own family members executed, his daughter escapes, and actually advocates against him Stalin's anti-semitism became stronger during this time as well. Stalin died in March 1953, they had not attended a meeting, so had been scared that he would kill them, so it took several days for anyone to realize he was dead. He had tens of millions of people killed during his reign, de stalinization began almost immediately, although the dictatorship was maintained for decades. Mao Zedong Qing Dynasty Was a Manchu family, a small minority within the massive country of China. However, they are the royal family. This was not well received by most of the country, since Manchus were considered outsiders. Most of China are peasants, Mao comes from a royal family, but his father had been a peasant, and had worked his way up to being a successful farmer, where he hired people. He was rural, but being a land owner at the time was a big deal in China. Mao is outspoken and rebellious, that doesn’t fit into society. His mother is a devout Buddhist, and is illiterate. She had bound her feet for most of her life, which was a tradition that deformed the feet of those that did it. Mao wants to be more than the farmer that his dad is. Day 19 Notes Sino Japanese war is a war that the Japanese won soundly over the Chinese, where the Chinese called it the Century of Darkness. The Chinese were unable to protect land, and were unable to modernize their military. This is when America gets involved, takes over Spain, and wages war against the Filipino population. This was seen as a good step towards China, America has interest in China for economic possibilities. However, America is late in the game, compared to the European powers. They try to negotiate, this doesn’t go well, the negotiation, rather unconvincingly saying that they should negotiate together against the Chinese, without taking them, but we’re not taking them over, just control the whole economy. The Chinese Revolution is next, moderate reforms at first, such as local elected assemblies. Don’t have much power, but the idea is you can give them a place to vent anger. Dr. Sun Yat sen founded the Revolutionary Alliance, he believed in nationalism. He founded a political party as well. Dedicated to overthrowing the monarchy. The Qing dynasty was overthrown, though Mao is not a part of the Revolution. Shikai names himself emperor, and only lasts three days. China started to enter world politics, called Warlordism. China is disintegrated into regional warlords and competing authorities. Remnants of Shikais Beiyang government. Sun Yat-sen returned from exile to the south, re-established the Guomindang, and tried to organize a rival power. May 4th Movement, student led protest against Treaty of Versailles. Left wing radicalism gained in popularity. The treaty was an agreement they had to get stuff back that had been taken from them from Germany, however, it was given to Japan. It was around here when Mao started reading Marx, anything he can get translated. So, the Chinese Communist Party came into play in 1921. To this day, they rule the government in China. Mao was converted to Communism in two years, and was a founding participant. He organizes labour and students. He is concerned about the anti-nationalism parts of it however. Is looked at as a voice of the people because he was well educated while also being a peasant at the same time. It was Guomindang and the CCP worked together to oust the Beiyang government and the warlords. Chiang Kai shek Sun Yat sen died in 1925, succeeded by Kai shek. He was a military leader in the Guomindang, leader of the right wing faction of the party. Keep the United Front, but only for convenience. Mao began to theorize more about the centrality of the peasantry for the achievement of true Chinese Communism. Mobilization of mass peasantry, radical transformation from spontaneous mass action. Day 20 Notes In 1926-28, warlordism was broken, Chiang established a government in Nanjing. Started to purge Communists and leftists in 26. Mao was unsure at this point about supporting the United Front, but stayed the course. The People would decide the revolution, not the United Front. So, the White Terror starts in 1927, Chiang betrays the Communists, slaughtering thousands. Mao and roughly 1000 communists organize the Chinese Red army. Shiang is trying to wipe out the Communist party in one fell swoop. Mao leads his faction to killing thousands of political opponents. Chiang becomes obsessed with wiping out communists, they lose a whole region of China under his rule, and they are forced to negotiate with the Japanese. Only Mao's stronghold was left, and they had to abandon it. So, what do they do? Why don’t we just leave, and walk somewhere else? We need to pick a time period where Chiang is busy, then we can try and escape. The Long March 1934-35, a 6000 mile walk, 18 mountain ranges. Roughly 70,000 people died, one of the reasons for that is that soldiers were following them, any mistakes, they die. Mao consolidated support by acting against Soviet advice. Portrayed the March as moving against Japanese imperialism. Guomindang was weak in face of foreign influence. They can’t fully wipe them out though. There are only 20,000 communists left, yet they are able to rebuild. Mao almost dies on the march. Japan invaded 1937, resulting in GMD-CCP United Front, CCP and Mao proved to be more capable at reaching out to the peasantry, crushing internal opposition and enforcing ruthless discipline centred in Mao's interpretations of Marxism. Red Army forces were often on the frontlines against Japan. Shiang is forced to constantly give concessions to the Japanese, he can’t do anything else, CCP calls him a cronie, he complains that it’s only because he has to deal with the Communists. Shiang is now told he can’t work with the Japanese anymore, they just signed a deal with the Nazis and Fascist Italy. They get tired of Shiang, so his own military kidnaps him. Shiang concedes, and says they will focus on Japan as well now. Day 21 Notes Another new wife for Mao, named Jiang Qing. For WW2, Guonmindang and CCP forces forced a stalemate on Japan. The Red Army cultivated grassroots support in occupied China. Guomindang is not in occupied China and continues in corruption and even sometimes its anti CCP actions. Mao Zedong Thought: Became the official ideology of the CCP, Rectification Movement, and self criticism to save people from error. Mao used the fact that Sheng needed help to take over. One of the reasons Japan lost is due to the violence they were inflicting, they were unable to gain allies. Part of it too is Shiang tries to force people into joining his army, his government is also super corrupt. IN this period, the SU is dealing with something else, which helps Mao. Japan and Germany had terrible communication with each other, in part because Hitler didn’t want to communicate with them, because he thought they were lesser. For Pearl Harbour, for example, Germany didn’t advise Japan on that. China was viewed as the fourth of the big three, and was underestimated. Not consulted on the plan to bomb Japan by the Allies, the Allies also didn’t trust Sheng's government. They didn’t understand the GMD CCP hatred, didn’t understand the appeal of the CCp in China, and didn’t see China as an issue in the postwar era. Mao agreed to American backed negotiations for a coalition government. Mao and Sheng are actively trying to backstab each other at this time. The United Nations were formed in October 1945, General Assembly, one nation, one vote, where most of the big stuff happens. Security Council: 5 permanent, 6 rotating members, China was one of the 5 permanent members, Chiang's Republic of China would hold this seat until 1971. Another Civil War breaks out between CCP and GMD forces. Mao ordered strategic retreat into the countryside and abandonment, which had been going on for almost 40 years at this point. Mao knew the longer the war went, it would be worse for GMD. GMD corruption, reliance on conscription, reliance on foreign money. They rely on the people's support, and have far more discipline. They outsmart Shiang's army. CCP now occupied Beijing, Nanjing, and Shanghai. Chiang fled to Taiwan, with men, civilians, and money. They are still the Republic of China. Mao declared the People's Republic of China, there are now technically two Chinas. Day 22 Notes Korean War Communist North Korea invaded Western allied South Korea, prompting a United Nations backed, US led force. Mao was pressured into involvement by North Korean weakness and US strength. China lost 500k troops, stood against the USs, who now was committed to permanently protect Taiwan. The economy was militarized. Eventually, China gets pulled in, North Korea gets pretty far, but the US forces push the North Koreans back. The US forces were told not to cross a border line so as to not provoke the Chinese, the men didn’t listen, and the Chinese entered the war. War ends in a stalemate, with little to no territory changing hands. Mao commits to building a massive bomb, and announces a five year plan. To collectivize agriculture to support the military and industrialization. Thousands were executed in a two year span. America decides that Taiwan needs to be defended, which sends a massive fleet to protect them from China, the forces are still there. Taiwan at this time was run by Shiang's government. China and Taiwan are often still considered the same, much to the chagrin of people from Taiwan. They launch the Hundred Flowers Campaign. The Chinese people are too afraid to criticize Mao because he was in power, so he’s willing to criticize himself, then they are willing to criticize him. He encourages this feedback. A few months later, he kills them all. He was trying to make the enemies of the people clear. It led to the greatest famine in human history, killing at least 34 million people. Any suffering was covered up. Mao fails to take responsibility for this famine. Mao is so determined to prove himself right he exports grain to the Soviet Union to impress them, leading to more deaths. The alternative to Stalin's communism is Mao's, which isn’t anything better. Maos has a book on how to fight imperialists, which enables people around the world to model themselves after Mao. Soviets don’t like this. The two of them finally realize that the two countries need to learn how to live together, Mao looks down upon the Soviets for backing off of Stalin's approach. Mao also believes they are trying to isolate China. They broke diplomatic relations in 1961, that was the case for about 25 years, almost going to war multiple times. Mao retreated from the public eye, and focused on developing a cult of personality. He realizes that his rule has been a disaster, but he needs a scapegoat. So, he allows two other people to clean up the mess, to enact some reforms to help the people recover. They were similar to Stalin, allowed some private property, didn't take their food, etc. He allows this so that he can blame them later for China being poorly run. A key part of this cult of personality is the little red book. It’s been printed hundreds of millions of times, it’s actually known as Quotations of Mao, literally just quotes of wisdom from Mao that spread his cult of personality. In 1964, China tested its first bomb. This changes how the West sees China, gaining them respect out of fear. Day 23 Notes Mao is being convinced that the Revolution is being corrupted from within. Starting in 1966, Chinese society was purified of bourgeois intellectualism. Empowered youth to murder authority figures. Mao thought the SU had lost its way and condemned Stalin's legacy, he believed the Communist Party didn’t care about the Revolution anymore, just staying in power. He didn’t want this to happen in China. The Chinese had really struggled, but Mao blaming himself wasn’t an option, so he advertised that the Revolution was being corrupted. May 16th, Mao announced that some people in authority were capitalists, he said that they would try to seize power. Striking fear among the people by bringing up the Soviet Union as an example. The Gang of Four stands out in Mao's camp as being especially violent and aggressive, one of them being Mao's wife, despite not having a great relationship. Young people should attack their parents, professors, and unleash a tidal wave. There was no significant challenge to him at this time. China is now in social and economic chaos. Mao disbanded the Red Guards, ordered them to be labour for peasants. The People's Liberation Army is now tasked with protecting the Revolution. In the 70’s, Mao was almost dead. He continues to purge the parties. He is concerned with what will happen when he dies. SU and China are still bickering about who the Communist Party truly is. Mao then decides to meet with the West, specifically Richard Nixon. Nixon is a strong capitalist, why is he meeting with Mao in China? The talks aren’t extensive, more symbolic, but there are some trade talks, and it ends up increasing trade between the two of them. China opens its markets up to the world eventually. He likely had Parkinsons, maybe ALS. Addicted to drugs, poor hearing, likely was blind. Multiple heart attacks as well. Died in 1976. Day 25 Notes Idi Amin is our African dictator. Uganda is divided significantly regionally, tribally, ethnically. Buganda was viewed by the British as civilized by Africans. The Bugandans were propped up by the British as sort of being trusted and capable. The Northerners were viewed as backwards and primitive. It was claimed they had no government, which wasn’t true, though it wasn’t very capable. They were called Muslims, maybe even Arabic, however, they were good fighters, it was all based on racist assumptions. Britain used these divisions to their advantage by convincing the population that they will need to oversee them. Idi Amin was a Muslim convert, his father was a police officer and in the King's Army Rifles, and his mother was a traditional healer, or witch according to the British. The British claimed they wanted to remove slavery, they just changed it to indebted servitude, which they viewed as the same thing by raising taxes to such an extent that most would have to do it. Idi was one of many that joined the military to avoid this. He enlisted in 1946, and gained a reputation as an effective soldier. He is very violent, and helps quash Black African resistance to British rule in Uganda. Through the 50’s, he helped quash the Mau Mau uprising in Kenya. He was seen as a stooge of the British, this was because he was a part of the British forces that took down African resistance, he betrayed his people. Critics of that would say that assuming that is racist in and of itself, he may not have identified with black people necessarily, he was also following orders. British forces viewed Amin as an ideal candidate if armed forces were to be Africanized, although that is not the plan that they favour. Gets to a point where he is one of two black supervisors. Amin rose quickly, Ugandan independence came in 1962 under PM Milton Obote. Amin was very important during this time under Obote, he helped to calm down mutinies and present grievances to Obote, who made concessions. He was seen as defending Ugandan rights, while also proving himself to the British. There are significant revolts during this time, where the Africans recognize and believe that the British are still running the show. Amin uses the fact he is one of them to appeal to them. Amin takes demands from the people to Obote, which show to be reasonable. It doesn’t last, but helps to prove Amin. Obote, worried for his powers, goes on the offensive, suspending the constitution. Amin is appointed head of the armed forces. He is united Uganda, whether anyone likes it or not. This created a rift between Amin and Obotoe after a while. They negotiated with the British during the Cold War, threatening to not help them if they didn't give in. Amin is promoted to commander of the army during this time as well. Amin knows at this point Obotoe will try to kill him, but nonetheless Obotoe gets convinced to go to an important meeting in Singapore. Amin overthrows his government while Obotoe is at the meeting. Amin is named temporary leader. Immediately, Amin purges the military, which is the only thing he seems to know how to do. He relies on an army from his hometown, which he gives special privileges to. Obote allied forces attacked Uganda in 1972 of people that didn't like Amin. Repression increases significantly during this time. Amin orders the expulsion of all Asians, he calls himself the Black Hitler. Thousands of people have to leave during this time. The West condemns this, but most Ugandans support it. But it devastated the Ugandan economy. Day 28 Notes The Vietnam war went poorly for the States because they weren’t willing to sacrifice their own people. Bombs were dropped on Cambodia, an innocent party, in 1973, by the Americans. It kills a lot of Vietnamese, but the Vietnamese don’t care about losing people, eventually, they realize the Americans won’t keep killing citizens like that. They reach a treaty, but the treaty is quickly broken. So the Democratic Republic of Kampuchea takes over. They are unknowns, they were not known as the people that had taken over Cambodia. In fact, the citizens think they defeated the Americans, and the war was going to stop. They had been in the rural areas through most of this area. Within weeks, the Kampuchea over evacuated everyone in the cities, everyone was an enemy of the people that needed to be eradicated or removed. Leads to significant deaths as the Kampuchea starts to purge, if they aren’t helpful to the revolution, they are killed. Sick people, old people, children. They abolish money, and all forms of religion. Money is no longer worth anything. Poi Pot is the general secretary of the Democratic party, but no one knows he’s the leader, as he lies in the background. The head of state tries to rein them in, ends up getting kidnapped and becomes a puppet leader. To the detriment of the Cambodian people, they continue to rule for years. Collectivize agriculture to gather money, even though they had gotten rid of money. They would be able to stand on their own against their enemies, primarily Vietnam. They wanted the country to be self-sufficient. Pot was very convinced it only didn’t work because people didn’t try hard enough, so he executed people as his system didn’t work. Pot arrests all the people he’s been allied with for years. Pot also abolishes education, turning high school into an interrogation complex, which is now a genocide museum. One example is over 5000 people were in the place, only 6 survived. The people from April 17th were turned into slaves, many of which died. They went to war with Vietnam in 1977. A series of border raids are carried out by the Cambodians, which in response leads to attacks. He resented Vietnam for believing that they didn’ t respect Cambodia. Su supported Vietnam, China supported Cambodia, became a proxy war between two communist nations, and supported by communist parents. It doesn’t go well with Cambodia, who had killed all of the people that could have served in the army. When Vietnam is able to liberate prisoners, Pot kills the soldiers, this method obviously has consequences. Most of the fighting takes place in Cambodia. In 1978, Vietnam invaded Cambodia fully, which they won easily and quickly. Vietnam then creates their own Communist government. They kick out Poi Pot. They publicize Poi Pot's crimes. Vietnam gives the government the same name as the previous one, basically a puppet government for Vietnam. Poi Pot and some others are able to flee to Thailand. By 1980, everyone knows what Poi Pot did, in less than four years, they had killed about 25% of the Cambodian population. However, because of Vietnam's reputation, Thailand agrees to protect Poi Pot and his people, in exchange for China not funding Vietnam. So, China sends supplies and pays for Poi Pot, and so does America, they reject the new government in Cambodia because they lost in Vietnam. America supports Poi Pot being protected and funded by Thailand and China. Pot carries out raids in Cambodia from Thailand trying to retake it. Also means they keep their seats in the United Nations for 14 years after his crimes were made public. The justification made by the US is that Pot isn’t running the party anymore, which he claims, but he’s lying. In the mid 90’s, Cambodia had an election under the supervision of the UN, which didn't last very long. This ends all the international support for Poi Pot. In 1997, he ordered the murder of his closest ally and their family. Finally, his party has enough, and they consider Poi Pot a traitor, Pot dies while on trial by heart attack. Some repetition from previous tests. Need to know authors' last names and who they wrote about. Will focus on major events, themes, people, and organizations. Won’t be testing on specific dates or stats. Guest lectures can be included. Most questions will be about a specific dictator, although some might be on themes. What were the themes or the focus of specific readings? List of Authors of Readings + Subheadings Non-Specific Dictators: Dictatorship: Modern Tyranny Between Leviathan and Behemoth by Jan C Behrends Benito Mussolini: Mussolini by Peter Neville Chapters 2,5,6,9 Sub Headings: Chapter 2: The Achievement of Power The Genesis Fascism The Red Two Years The Death of Liberal Italy The Taking of Power The March on Rome Fascism: revolution or counter-revolution? Mussolini and Parliament The Fascist Grand Council The Voluntary Militia for National Security The 1924 Elections Chapter 5: Italian society under Mussolini, 1931–39 Winning Over Italy's Youth Women Under Fascism The Media Corporativism and the Great Depression The Dopolavoro Opposition in Fascist Italy Anti-Semitism Was there a Fascist consensus? Chapter 6: The Ethiopian War, 1935–36 The end of the old diplomacy, 1932–35 The Austrian crisis Fascism in Africa The Ethiopian Question The invasion of Ethiopia’ The Hoare–Laval Pact The consequences of the war Chapter 9: The last phase, 1943–45 The foundation of the Italian Social Republic A dictator's twilight The Congress of Verona The last days Conclusion Mussolini in retrospect Adolf Hitler Hitler by Ian Kershaw Eva Braun: Life With Hitler by Heike Gortenmaker War and Genocide: A Concise History of the Holocaust by Doris Bergen Kershaw Chapter 1: Power of the Idea No subheadings Braun Chapter 9: Isolation of War The Outbreak of War The Berghof of Fuhrer Headquarters The Beginning of the End Bergen Death Throes and Killing Frenzies Attacks on the Nazi Regime The Soviet Advance Allied Bombing and Conditions in Germany D Day - Allied Invasion from the West The Plot of 20 July, 1944 The Volkssturm The Warsaw Uprising Germany's Allies and the Jews of Hungary Auschwitz and the end of war The Death Marches Final Collapse Joseph Stalin Popular Opinion in Stalin’s Russia: Terror, Propaganda, and Dissent, 1934- 1941 by Sarah Davis Stalin by Hiroaki Kuromiya Davis Chapter 9: The leader cult in official discourse The evolution of the cult The cult as official culture Chapter 10: Affirmative representations of the leader and the leader cult The leader as benefactor The traditional defender of the people The Charismatic Leader Kuromiya Chapter 7: Twilight of the god Victory Cold War Death Also, supposed to read Conclusion ig Mao Zedong From Urban Radical to Rural Revolutionary: Mao from the 1920s to 1937 by Brantly Womack War, Cosmopolitanism, and Authority: Mao from 1937-1956 by Han J
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NUR 204: EXAM 1 COMPLETE STUDY GUIDE SECTION 1: CANCER PATHOPHYSIOLOGY & EPIDEMIOLOGY Cellular Characteristics • Cancer is uncontrolled cell growth caused by genetic damage. • Apoptosis: The body's natural ability to destroy abnormal or cancerous cells. Malignant cells fail to undergo apoptosis. • Angiogenesis: Malignant cells can create their own blood supply for nourishment, making them very difficult to eliminate. • Progression to Malignancy: Hyperplasia (rapid increase in normal cells) → Dysplasia (abnormal cells) → Carcinoma in situ (localized cancerous cells) → Malignancy. Tumor Types & Staging • Primary vs. Secondary: The primary tumor is where the cancer originated. Secondary tumors are the sites of metastasis (e.g., lung cancer that spreads to the liver means the liver contains secondary tumors). • TNM Staging System: o T = Tumor size. o N = Lymph Node involvement. o M = Metastasis (Spread). • Number Staging (0-4): Stage 0 (In situ, abnormal cells haven't spread) to Stage IV (Distant metastasis, spread to distant body parts). Risk Factors & Prevention (Live Lecture Focus) • Modifiable vs. Non-modifiable: Age, genetics (BRCA mutations), and gender are non-modifiable. Smoking, alcohol, obesity, and sedentary lifestyle are modifiable. • Environmental Factors: o Physical: UV light (tanning beds), radiation. o Chemical: Tobacco, alcohol, workplace pesticides/cleaners. o Biological: Viral infections (HPV causes cervical cancer, Hep B/C causes liver cancer), poor diet. • Nurse's Role in Community Screenings: Skin cancer screenings are highly effective for community health fairs because they are non-invasive. Screening Guidelines • Breast: Mammograms starting at age 40 (earlier if high risk). • Colorectal: Colonoscopy every 10 years starting at age 45. • Prostate: PSA blood screening at age 50. • Tumor Markers: PSA (Prostate) and BRCA1/BRCA2 (Breast). SECTION 2: IMPACT OF CANCER & NURSING CARE Physiological Impacts • Pain: Very common, affecting up to 80% of advanced cancer patients. • Infection/Neutropenia: Dangerously low white blood cells. Live Lecture Note: Any spike in temperature (even a low-grade fever like 100.4°F) is a massive red flag for impending sepsis and must be addressed immediately. • GI Issues: Nausea, vomiting, and mucositis (painful mouth inflammation). For mucositis: avoid spicy/acidic foods and use lidocaine rinses. Cognitive & Psychosocial Impacts • Delirium (HIGH YIELD): Acute, sudden confusion. Live Lecture Note: Delirium is reversible. The nurse must treat the underlying cause. Interventions include reorienting the patient, clustering care, avoiding interruptions, and simulating day/night to regulate circadian rhythms (lights on during the day, off at night). • Financial & Psychosocial: Cancer treatments are grueling and expensive, leading to lost employment and depression. Nurses should facilitate early referrals to social workers and case managers. Nursing Safety & Medication Administration • Extravasation Safety: Vesicant chemotherapy drugs can severely damage tissue if they leak outside the vein. Live Lecture Note: If chemo is given via a peripheral IV, the nurse MUST check for blood return every single hour to prevent extravasation. If extravasation occurs: stop the infusion immediately. • Chemotherapy PPE: The nurse must wear proper PPE (e.g., double gloves, chemo gown, face protection) and dispose of chemo materials in designated hazardous waste bins (e.g., yellow bins). • Neutropenic Precautions (Reverse Isolation): Protecting the highly vulnerable patient from the nurse/visitors. Includes strict hand hygiene, no sick visitors, and avoiding crowds. SECTION 3: ONCOLOGIC EMERGENCIES • Spinal Cord Compression: Early signs include back pain, muscle weakness, loss of sensation, and bowel/bladder incontinence. • Brain Metastasis/Increased ICP: Personality changes, seizures, altered speech/balance. • Hypercalcemia: Confusion, severe muscle weakness, arrhythmias, and ECG changes. • Superior Vena Cava (SVC) Syndrome: Tumor compresses the SVC causing facial/neck edema and dyspnea. • Tumor Lysis Syndrome (TLS): Rapid cell death causes severe electrolyte imbalances (hyperkalemia, hyperuricemia). • SIADH: Tumor triggers excessive antidiuretic hormone (ADH), leading to massive water retention, dilutional hyponatremia, and confusion. SECTION 4: SELECTED CANCERS Lymphedema What is it? A frequent cancer treatment complication where fluid builds up in an extremity (typically on one side), causing severe swelling. • Signs & Symptoms: Swelling, a feeling of heaviness, decreased range of motion, and tightness in the skin. • Common complication of: Breast cancer treatments, specifically resulting from lymph node dissection/removal, radiation therapy, or chemotherapy. • Nursing Priorities & Treatment: o Elevate the affected arm above heart level. o Use compression sleeves as prescribed. o Encourage range-of-motion exercises to prevent stiffness. o ABSOLUTE SAFETY RULE: NO blood pressures, NO IVs, and NO blood draws on the affected arm. • Breast Cancer: o Live Lecture Note: Ductal breast cancer is the most common type (originating in the milk ducts). o Signs: Hard mass, nipple retraction, "orange peel" skin (peau d'orange). o Hormone Receptors: If the tumor is estrogen-receptor positive, treatment must avoid estrogen as it will feed the tumor. o Lymphedema Care: Swelling in the arm due to lymph node removal. Rule: No blood pressures, IVs, or blood draws on the affected arm. Elevate the arm and use compression. • Lung Cancer: o Live Lecture Note: Often asymptomatic in the early stages, leading to late diagnosis. o Signs: Chronic cough, hemoptysis (rust-colored/bloody sputum), dyspnea. High risk for brain metastasis. • Colorectal Cancer: o Live Lecture Note: A hallmark sign is "ribbon-like" or pencil-thin stool, caused by a tumor pressing in the rectum and narrowing the passageway. Other signs: rectal bleeding, changes in bowel habits, anemia. • Pancreatic Cancer (HIGH MORTALITY): o Live Lecture Note: High mortality because early symptoms are incredibly vague; usually caught too late. o Whipple Procedure: Surgery that removes the head of the pancreas but leaves a portion behind so the patient retains some insulin secretion. Nursing Priority: You must strictly monitor for manifestations of diabetes (hypo/hyperglycemia) because pancreatic function is deeply impaired. • Skin Cancer: o Types: Basal cell (slow-growing, sun-exposed areas), Squamous cell (more serious), Melanoma (most deadly, highly metastatic). o Melanoma ABCDEs: Asymmetry, Border irregularity, Color variation, Diameter >6mm, Evolving. • Brain Tumors: o Live Lecture Note: Primary brain tumors are typically benign. Malignant brain tumors have usually metastasized from somewhere else. SECTION 5: INFLAMMATION & IMMUNITY BASICS • Acute vs. Chronic Inflammation: Acute is short-term and protective (redness, heat, swelling, pain). Chronic is prolonged, causing tissue damage. Exam Tip: Chronic inflammation heavily increases the risk for cardiovascular disease. • Infection vs. Inflammation: Inflammation does not always mean infection (e.g., sprains, allergies). Systemic infection signs include fever, tachycardia, and confusion. Rule: Always draw a blood culture before starting antibiotics. SECTION 6: AUTOIMMUNE & INFLAMMATORY DISORDERS Detailed Osteoarthritis (OA) (Live Lecture Focus) • Pathophysiology: OA is a degenerative joint disease causing progressive cartilage breakdown. It is characterized by the friction of "bone on bone" as cartilage degenerates, which leads to the formation of bone spurs and bone cysts (fluid-filled cavities). • Key Distinction: There is NO systemic inflammation; OA is localized to the affected joints. • Risk Factors: Natural wear and tear of aging, trauma, joint overuse (e.g., repetitive work or sports), obesity, genetics, and a sedentary lifestyle. • Complications: Because OA causes a lack of mobility and a sedentary lifestyle, patients are at a highly increased risk for cardiovascular disease, diabetes, and obesity. Patients over 65 should also be screened for iron overload (hemochromatosis), which can accelerate the progression of OA. Patients are also at high risk for depression and anxiety due to loss of independence and chronic pain. • Signs & Symptoms: Joint pain, stiffness, crepitus (cracking of the joints), muscle atrophy, and limited range of motion. • Treatment: o Non-surgical first: Physical therapy, exercise (specifically swimming/water exercises to take pressure off the joints), and weight loss. o Medications: Acetaminophen (monitor for liver toxicity), NSAIDs like ibuprofen/naproxen (monitor for kidney toxicity), and cortisone injections into the joint. o Surgical: Joint replacement (e.g., hip or knee). Nursing Priority: Ambulate the patient right away after surgery to prevent complications. Detailed Rheumatoid Arthritis (RA) (Live Lecture Focus) • Pathophysiology: A chronic autoimmune disease where the body's immune system mistakenly attacks the synovial tissue and fluid in the joints. • Risk Factors: Increased age (highest onset in the 60s), genetics, females (especially those who have never given birth), obesity, smoking, and high stress. o Trigger mechanism: Someone with a genetic susceptibility who experiences an external trigger (like an infection or trauma) can kickstart the autoimmune reaction. • Signs & Symptoms: Symmetric joint swelling and pain (usually in the hands and feet), morning stiffness lasting longer than 1 hour, fever, malaise, and weakness. Patients experience flare-ups (severe symptoms) and remissions (no symptoms). • Rheumatoid Nodules: The most common visible manifestation of RA. These are detachable, movable subcutaneous knots or swellings of varying sizes, typically found in the fingers/hands. • Diagnostics: Elevated ESR and C-reactive protein (CRP) indicate inflammation. Positive Rheumatoid Factor (RF) and ANA (anti-nuclear antibody) blood tests. • Medications & Safety: o Treated with DMARDs (Disease-Modifying Antirheumatic Drugs). o Priority: DMARDs suppress the immune system, putting the patient at a severe risk for infection. o Hydroxychloroquine teaching: Long-term use can cause retinal damage and glaucoma leading to blindness; patients MUST see an optometrist regularly for eye exams. Systemic Lupus Erythematosus (SLE): • Multisystem autoimmune disease attacking self-tissues. • Symptoms: Butterfly rash on the face, photosensitivity, joint pain. • Complications: Cardiovascular disease (pericarditis) and kidney failure (lupus nephritis). • Triggers: Teach patients to avoid UV light/sun exposure, severe stress, exhaustion, and infections to prevent flare-ups. Peritonitis (LIFE THREATENING): • Inflammation of the peritoneum (abdomen). • Symptoms: Rigid, board-like abdomen, rebound tenderness. • Complication: Septic shock and death. SECTION 7: HIV / AIDS & HYPERSENSITIVITY HIV/AIDS: • A retrovirus that specifically targets and destroys CD4 T-cells. • Transmission Phase: The virus is most highly infectious during the initial phase when the viral load is the highest. • Opportunistic Infections: When CD4 drops < 200 (AIDS), the patient is at extreme risk for deadly infections like Tuberculosis, Pneumocystis pneumonia (PCP), and Kaposi sarcoma. • PrEP (Pre-Exposure Prophylaxis): Reduces risk of contracting HIV but does NOT replace safe sex practices (condoms). Risk Factors & At-Risk Populations: o Individuals with multiple sexual partners without protection, and those who share IV drug needles. o Substance use (drugs/alcohol) is a major risk factor because it lowers inhibitions, leading to unprotected sex. o Incarcerated populations or those in closed settings (due to sharing needles, self-tattooing, and sexual violence). o Pregnant or lactating women (due to the risk of perinatal transmission). Phases of HIV Progression: 1. Acute Infection Phase: Occurs 2 to 4 weeks after exposure. The risk of transmission is at its absolute highest because the viral load in the blood is massive. Patients exhibit flu-like symptoms (fever, malaise, fatigue). 2. Chronic Infection Phase: Patients are often asymptomatic, meaning they may not even realize they are infected. They can still transmit the virus if their viral load is high enough. This stage can last for a decade or longer. 3. AIDS: If left untreated, HIV progresses to AIDS. Diagnosis is confirmed when the CD4 T-cell count falls below 200. Immune system damage is severe, creating a very high risk for fatality and opportunistic infections (such as Tuberculosis, Kaposi sarcoma, and fungal infections). • PrEP vs. PEP (Crucial Difference): o PrEP (Pre-Exposure Prophylaxis): Medication taken prophylactically to prevent the transmission of HIV to an HIV-negative person. It does NOT replace safe sex practices (condoms must still be used). o PEP (Post-Exposure Prophylaxis): Medication taken after accidental exposure (e.g., a broken condom, a needle stick injury, or sexual assault). It MUST be taken within 72 hours of exposure to be effective. It is taken daily for 28 days and is not meant for regular, ongoing use. Anaphylaxis: • Severe allergic reaction triggering massive histamine release. • Patho: Causes increased capillary permeability, where blood vessels leak fluid into the tissues, leading to profound hypotension and airway edema. • Priority Treatment: Epinephrine IM. • High-Risk Factor: Patients taking Beta-blockers or Alpha-adrenergic blockers are at a high risk of death because these medications reduce the effectiveness of epinephrine, preventing the reversal of the shock. SECTION 8: INFECTIONS & SAFETY PROTOCOLS Meningitis (SAFETY RULE): • Diagnosed via Lumbar Puncture (testing CSF). • Live Lecture Safety Rule: If the patient shows signs of Increased Intracranial Pressure (ICP) (like severe headache, altered mental status), a CT scan of the head MUST be performed BEFORE a lumbar puncture. Performing a lumbar puncture when ICP is high can cause fatal brain herniation. • Risk Groups: College dorm students, unvaccinated individuals. Lumbar Puncture (Live Lecture Safety Rules) • Purpose: To draw out and test the cerebrospinal fluid (CSF) specifically to screen for and confirm a diagnosis of meningitis. • Position: The patient should be laying on their side with their knees pulled to their chest (fetal position) to help open up the spinal column for needle insertion. • Contraindication & Safety Priority: A lumbar puncture is completely contraindicated if the patient has Increased Intracranial Pressure (ICP). o Rule: A CT scan of the head MUST be performed BEFORE a lumbar puncture to rule out increased ICP. Performing a lumbar puncture on a patient with increased ICP can cause fatal brain herniation Sinusitis: • Inflammation of the sinuses causing facial pressure ("like you got punched in the face"), congestion, and post-nasal drip. • Live Lecture Rule: Treat with hydration, nasal irrigation, and steam. AVOID over-the-counter antihistamines and decongestants because they cause rebound inflammation (making symptoms worse when they wear off). Influenza: • FACTS Mnemonic: Fever, Aches, Chills, Tiredness, Sudden onset. High risk for secondary pneumonia in older adults and pregnant women. SECTION 9: MEDICATIONS HIGHLIGHTED IN LIVE LECTURE 1 Your instructor specifically highlighted these medications and their nursing implications during the recorded lectures: 1. Analgesics & Anti-inflammatories • Opioids (Cancer Pain): A major side effect is delayed gastric emptying and severe constipation. Intervention: Administer stool softeners, encourage hydration and mobility. Monitor for decreased respirations and drowsiness (which creates a fall risk). • Acetaminophen (Tylenol): Used for mild OA pain. Warning: Hepatotoxic (toxic to the liver) if too much is given. • Ibuprofen/Naproxen (NSAIDs): Used for OA/RA inflammation. Warning: Nephrotoxic (toxic to the kidneys) and can cause GI bleeding. • Corticosteroids (Cortisone): Can be injected directly into joints for OA inflammation. 2. Neurological & Emergency Medications • Mannitol: An osmotic diuretic used specifically to lower elevated Intracranial Pressure (ICP) in patients with brain tumors. • Phenytoin & Levetiracetam (Keppra): Anti-epileptic medications used to prevent seizures in patients with brain metastasis/tumors. • Epinephrine: The absolute first-line priority treatment for anaphylaxis. Works to constrict blood vessels and open the airway. • Hydroxychloroquine (DMARD): Used for RA and Lupus. Warning: Can cause retinal toxicity. Patients require regular eye exams (every 6 months) and must use photosensitivity precautions. SECTION 10: SAMPLE QUESTIONS & ANSWERS Q1: The client’s cancer is staged as T1, N2, M1 according to the TNM classification system. How would the nurse interpret this staging? A. One tumor that is nonresponsive to treatment with distant metastasis B. Leukemia indicated that is confined to the bone marrow C. A 2-cm tumor with one regional lymph node involved and no distant metastasis D. Small tumor with extension into two lymph nodes and one site of distant metastasis Answer: D. Rationale: T = small primary tumor, N = extension to regional lymph nodes, M = distant metastasis has occurred. Q2: The nurse is assessing an older client at a checkup visit. Which reported change would alert the nurse to the possibility of colon cancer? A. Pencil-thin stool B. Erectile dysfunction C. Reduced urine stream D. Persistent pain in the lower back and legs Answer: A. Rationale: Tumors growing in the colon/rectum compress the passageway, resulting in ribbon-like or pencil-thin stool. Q3: A nurse is performing a cancer screening assessment on several clients. Which of the following findings is a possible manifestation of cancer? (Select all that apply) A. Temperature 36° C (96.8° F) B. Sore that does not heal C. Difficulty swallowing D. Blood in the urine E. Rhinitis Answer: B, C, D. Rationale: Using the CAUTION mnemonic, signs include sores that do not heal, difficulty swallowing, and unusual bleeding/discharge. Q4: A nurse is caring for a client who has breast cancer. The client asks why the treatment plan contains a combination therapy of three different medications. Which of the following responses should the nurse make? (Select all that apply) A. “Combination chemotherapy decreases the risk of medication resistance.” B. “Combination chemotherapy attacks cancer cells at different stages of cell growth.” C. “Combination chemotherapy increases production of platelets.” D. “Combination chemotherapy stimulates the immune system.” Answer: A, B. Rationale: Using multiple chemo drugs reduces drug resistance and attacks the cell at various phases of the cell cycle. Q5: A nurse is caring for a burn client whose calculated 24-hour intravenous fluid requirements are determined to be 5000 mL. What is the total volume (mL) that the nurse should infuse after the first 8 hours of fluid resuscitation has infused? Answer: 2500 mL. Rationale: Standard burn fluid resuscitation protocols require half (50%) of the 24-hour total to be administered in the first 8 hours following the burn injury. Q6: The nurse is caring for a client who has a systemic infection. What is the best method to prevent infection transmission? A. Obtaining an immunization B. Implementing proper hand hygiene C. Wearing gloves D. Managing the client’s fever Answer: B. Rationale: Strict hand hygiene remains the most effective method for preventing the transmission of infectious organisms. Q7: The nurse is assessing a client with systemic lupus erythematosus (SLE). Which of the following laboratory findings should the nurse anticipate? (Select all that apply) A. Positive ANA titer B. Increased hemoglobin C. Pancytopenia D. Urine positive for protein and RBCs Answer: A, C, D. Rationale: SLE causes an autoimmune response (Positive ANA), bone marrow suppression (pancytopenia), and lupus nephritis, which damages the kidneys causing protein and blood to spill into the urine. Q8: A nurse is providing teaching to a client who is to receive a vaccination following a deep puncture wound to the foot. Which information would the nurse include? A. “You will need to receive this vaccination annually.” B. “Your passive immunity will be boosted by receiving this shot.” C. “I am administering this vaccination to help protect you against tetanus.” D. “This immunization requires three separate injections several weeks apart.” Answer: C. Rationale: Tetanus vaccination is indicated for deep puncture wounds. Q9: A nurse is assessing a client who is being treated with interferon alfa-2b for malignant melanoma. The nurse should identify that which of the following findings are adverse effects of this medication? (Select all that apply) A. Tinnitus B. Muscle aches C. Peripheral neuropathy D. Bone loss E. Depression Answer: B, C, E. Rationale: Interferon therapy causes significant flu-like symptoms (muscle aches, chills), peripheral neuropathy, and mood changes including severe depression. Q10: A nurse is reviewing the medical record of a client. Which of the following findings are risk factors for ovarian cancer? (Select all that apply) A. Previous history of endometriosis B. Family history of colon cancer C. First pregnancy at age 24 D. First period at age 14 E. Use of oral contraceptives for 10 years Answer: A, B. Rationale: Endometriosis and a family history of associated cancers (like colon or breast BRCA mutations) increase the risk for ovarian cancer. (Pregnancy and oral contraceptive use typically decrease the risk). Q11: The nurse is caring for a client whose white blood cell count is 6000/mm3. Which differential value would the nurse discuss with the health care provider? A. Eosinophils 700/mm3 (Reference range: 50–400/mm3) B. Monocytes 500/mm3 (Reference range: 100–800/mm3) C
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Objectives come from your Unit 3 sheet  and the content/examples come from the PowerPoints . ⸻ UNIT 3 COMPLETE STUDY GUIDE (Based strictly on your slides + objectives) ⸻ CHAPTER 11 — CONTROLLING MICROBIAL GROWTH Difference Between Antisepsis, Disinfection, Sanitization, Sterilization, Degerming, Decontamination Sterilization Complete destruction of all microbial life including viruses and endospores. Examples from slides: • Surgical instruments • Syringes • Packaged foods Endospores must be destroyed for something to be considered sterile.  ⸻ Disinfection Destroys most vegetative pathogens on nonliving surfaces. Examples: • Disinfecting medical equipment • Hospital surfaces ⸻ Antisepsis Use of antimicrobial chemicals on living tissue. Examples: • Skin prep before surgery • Cleaning wounds ⸻ Degerming Mechanical removal of microbes by scrubbing. Example: • Handwashing ⸻ Sanitization Reduces microbial numbers to public health safe levels. Examples: • Cleaning food preparation surfaces • Restaurant sanitation ⸻ Decontamination General removal of microbes from objects or surfaces. Example: • Cleaning contaminated hospital equipment ⸻ Difference Between Static and Cidal Cidal Kills microbes. Example Bactericidal antibiotics. ⸻ Static Stops growth but does not kill. Example Bacteriostatic antibiotics. ⸻ Variables That Influence Effectiveness of Antimicrobial Methods 1. Population size Large populations require more time to kill. 2. Nature of microbes Some microbes are more resistant. Example: Bacterial endospores. 3. Temperature Higher temperature increases killing. 4. Concentration of agent 5. Contact time 6. Organic matter present Example: Blood or mucus interfering with disinfectants. 7. Mode of action of agent 8. Biofilms Biofilms protect microbes from antimicrobials.  ⸻ Most Resistant vs Least Resistant Microbes Most resistant: Bacterial endospores Reason: Thick protective layers. ⸻ Less resistant: • Mycobacteria • Gram-negative bacteria • Gram-positive bacteria • Fungi • Viruses Endospores are the target of sterilization methods.  ⸻ Mechanisms of Antimicrobial Agents Agents work by damaging: Cell wall Example Detergents and alcohol disrupt cell wall. ⸻ Cell membrane Effects • Loss of permeability • Leakage of molecules ⸻ Proteins Agents denature proteins. Examples • Heat • Alcohol • Strong acids ⸻ DNA and RNA Example Radiation damaging DNA. ⸻ Practical Concerns When Choosing Control Method Consider: • Does item require sterilization or disinfection? • Can item tolerate heat, pressure, radiation, chemicals? • Cost effectiveness • Safety • Ability of agent to penetrate surfaces.  ⸻ PHYSICAL AND MECHANICAL METHODS ⸻ Pasteurization vs Sterilization Pasteurization: Reduces microbial numbers but does not sterilize. Used for: Milk and beverages. Sterilization: Destroys all microbes including endospores. ⸻ Boiling Kills many pathogens but may not destroy endospores. ⸻ Autoclaving Uses steam under pressure. Conditions from slides: 121°C 15 minutes 15 psi Mechanism: Denatures proteins and disrupts metabolism.  ⸻ Most Rigorous Heat Method Incineration (dry heat) Burns microbes completely. ⸻ Ionizing Radiation vs UV Radiation Ionizing radiation Examples: Gamma rays X-rays Effect: Destroys DNA and proteins. Highly penetrating. ⸻ UV radiation Example: Germicidal lamps. Mechanism: Forms pyrimidine dimers (thymine dimers). Effect: DNA replication blocked.  ⸻ Filtration Removes microbes from liquids or air. Examples: • Water purification • Milk filtration • Air filtration systems • HEPA filters • N95 masks HEPA filters remove 99.97% of particles.  ⸻ Osmotic Pressure High salt or sugar removes water from microbes. Examples: Salt: Cured meats Sugar: Jams and jellies Causes plasmolysis and prevents growth.  ⸻ Cold and Drying Cold: Slows microbial metabolism but rarely kills microbes. Drying (desiccation): Removes water necessary for microbial metabolism. Example: Freeze drying (lyophilization).  ⸻ CHEMICAL METHODS ⸻ Characteristics of Good Chemical Antimicrobials • Rapid action • Effective at low concentrations • Broad spectrum • Stable • Non-toxic to tissues • Affordable • Effective in presence of organic matter  ⸻ Major Chemical Agents ⸻ Halogens Examples: • Chlorine • Iodine Common example: Household bleach (sodium hypochlorite) Mechanism: Oxidizes cellular molecules and damages enzymes.  ⸻ Phenols Mechanism: Disrupt cell membranes and denature proteins. Examples: Phenolic disinfectants. ⸻ Alcohols Examples: • Ethanol • Isopropanol Mechanism: Denature proteins and disrupt membranes. Common use: Hand sanitizers. ⸻ Quats Quaternary ammonium compounds. Mechanism: Disrupt membranes. Example: Lysol wipes ⸻ Peroxides Example: Hydrogen peroxide. Mechanism: Forms reactive oxygen molecules that damage cells. ⸻ Detergents / Surfactants Mechanism: Break down lipid membranes. Examples: Soap and cleaning detergents.  ⸻ CHAPTER 12 — ANTIBIOTICS ⸻ Alexander Fleming Discovered penicillin in 1928 from the fungus Penicillium.  ⸻ Characteristics of a Good Antimicrobial Drug • Selective toxicity • High therapeutic index • Targets unique microbial structures • Effective against pathogen • Minimal harm to microbiota  ⸻ Selective Toxicity Ability of a drug to kill microbes without harming host cells. Example: Penicillin targets bacterial cell walls, which human cells lack. ⸻ Susceptibility Tests ⸻ Kirby-Bauer Disc diffusion test. Antibiotic discs placed on bacterial culture. Zone of inhibition measured. Results: Sensitive Resistant  ⸻ MIC Minimum inhibitory concentration. Smallest drug concentration preventing visible growth. ⸻ MBC Minimum bactericidal concentration. Smallest concentration that kills bacteria. ⸻ Therapeutic Index TI = toxic dose / therapeutic dose Example from slides: TI of 10 safer than TI of 1.1.  ⸻ Antibiotic Mechanisms ⸻ Cell Wall Inhibitors Example: Penicillin Mechanism: Prevents cross-linking of NAM-NAG peptidoglycan. Cell bursts due to osmotic pressure. Other examples: • Methicillin • Cephalosporins  ⸻ Cell Membrane Disruption Examples: • Polymyxin • Daptomycin • Colistin Mechanism: Creates pores causing leakage.  ⸻ Protein Synthesis Inhibitors Example: Tetracycline Mechanism: Blocks 30S ribosomal subunit. Other examples: • Erythromycin • Azithromycin • Chloramphenicol  ⸻ DNA / RNA Inhibitors Example: Fluoroquinolones Examples: • Ciprofloxacin • Levofloxacin Mechanism: Inhibit DNA gyrase. ⸻ Metabolic Pathway Inhibitors Example: Sulfa drugs Block folic acid synthesis. Example drug: Bactrim.  ⸻ Drugs for Eukaryotic Pathogens ⸻ Antifungals Examples: • Fluconazole • Amphotericin B • Azoles Target ergosterol in fungal membranes. ⸻ Antiprotozoal Drugs Examples: • Metronidazole • Chloroquine ⸻ Antihelminthic Drugs Examples: • Pyrantel • Mebendazole • Ivermectin  ⸻ Antiviral Drugs Targets: • Viral attachment • Viral transcription/translation • Viral assembly or release Examples: Acyclovir Blocks viral DNA replication. Tamiflu Prevents influenza virus release.  ⸻ HIV Drugs Target steps in HIV replication: 1 Reverse transcriptase 2 Integrase 3 Protease 4 Viral attachment Combination therapy prevents resistance. ⸻ Antibiotic Resistance ⸻ How Resistance Develops • Mutation • Natural selection • Overuse of antibiotics ⸻ Mechanisms of Resistance • Drug-destroying enzymes • Efflux pumps • Target modification • Reduced permeability  ⸻ CHAPTER 13 — MICROBIOTA ⸻ Normal Microbiota Microorganisms living on body surfaces without causing disease. Examples from slides: Skin: Staphylococcus epidermidis Gut: Escherichia coli Breast milk microbes: • Bifidobacterium • Lactobacillus • Streptococcus • Clostridium  ⸻ Benefits of Microbiota • Produce vitamins • Digest food • Stimulate immune system • Produce neurotransmitters • Prevent pathogen colonization  ⸻ Dysbiosis Imbalance in microbiota. Associated diseases: • Diabetes • Obesity • Cancer • Asthma • Allergies • Heart disease  ⸻ Microbiota Development Microbiota develop: 1 During birth 2 Through breast milk 3 Environmental exposure Stable microbiome forms by age 3. ⸻ Probiotics vs Prebiotics Probiotics: Live microbes that improve microbiota. Example: Yogurt. ⸻ Prebiotics: Food that feeds beneficial microbes. Examples: • Garlic • Onions • Asparagus • Agave • Artichokes  ⸻ Fecal Microbiota Transplant Transfer of microbiota from healthy donor. Used for: Clostridioides difficile infections Success rate: 70–90%.  ⸻ Virulence Factors Examples: Adhesion structures: Capsules, fimbriae Exoenzymes: Hyaluronidase Coagulase Biofilms increase resistance.  ⸻ Toxins ⸻ Exotoxins Secreted protein toxins. Examples: • Cytotoxins • Neurotoxins • Enterotoxins ⸻ Endotoxins Found in gram-negative bacteria. Example: LPS containing lipid A. Effects: • Fever • Inflammation • Shock  ⸻ CHAPTER 14 — EPIDEMIOLOGY ⸻ Epidemiology Study of disease frequency, distribution, and control in populations.  ⸻ Epidemiological Terms Index case: First identified patient. Incidence: Number of new cases. Prevalence: Total existing cases. Mortality rate: Deaths in a population. Case fatality rate: Deaths among infected individuals.  ⸻ Disease Occurrence Sporadic: Random cases. Endemic: Constant presence. Outbreak: Localized increase. Epidemic: Large regional increase. Pandemic: Worldwide epidemic.  ⸻ Healthcare-Associated Infections (HAIs) Common examples: • CAUTI Catheter-associated urinary tract infection • CLABSI Central line bloodstream infection • Surgical site infections • Ventilator associated infections  ⸻ Causes of HAIs • Low patient immunity • Antibiotic resistant organisms • Invasive procedures • Healthcare worker transmission Example: Healthcare workers moving between patients.  ⸻ Prevention of HAIs • Medical asepsis • Surgical asepsis • Universal precautions • Infection control officers Examples: • Needlestick precautions • Surface decontamination • Barrier protection  ⸻ If you want, I can also give you the 20–30 questions your professor is MOST likely to put on the exam from these slides. Micro professors tend to repeat the same exact conceptual questions every semester, and your slides have some really obvious ones.
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NURS 348 — EXAM 4 STUDY GUIDE Hypertension Definition & Overview • Persistent elevation of BP ≥130/80 mmHg (systolic at/greater than 130 OR diastolic at/greater than 80) on at least 2 separate visits, 2+ weeks apart. • Primary (Essential): No identifiable cause, most common (90–95% of cases). • Secondary: Caused by another condition or adverse effects of medications. Etiology/Pathophysiology • ↑ Peripheral resistance and/or ↑ cardiac output → ↑ blood pressure → When blood vessels get narrower (increased resistance) or the heart pumps more forcefully (increased output), pressure inside the vessels rises “like squeezing a hose while water is running” → Over time, this high pressure damages the vessel walls and heart muscle, increasing the risk for atherosclerosis, heart attack (myocardial infarction), and stroke. • ↑ Increased peripheral resistance (arteriolar constriction) → ↑ afterload → left ventricular hypertrophy → heart failure → The heart pushes against more resistance (afterload), making the heart muscle thicker (hypertrophy). Over time, it becomes weaker and can lead to heart failure. • Kidneys retain sodium and water → ↑ circulating volume → The kidneys hold onto extra salt and water, adding more fluid to the blood. More fluid means higher pressure—like overfilling a water balloon. • Activation of renin–angiotensin–aldosterone system (RAAS) = vasoconstriction + fluid retention. RAAS is like the “blood pressure booster” → When this system turns on, blood vessels tighten and the kidneys save even more salt and water, both of which raise blood pressure. Risk Factors: • Primary: family history, ↑ sodium intake, Obesity (BMI >25), African-American ethnicity, smoking, hyperlipidemia, diabetes mellitus, and stress. • Secondary: kidney disease, Cushing’s, pregnancy, pheochromocytoma, medic (steroids, OCPs). Clinical Manifestations (S/S) • Often asymptomatic (“silent killer”)!!! • Headache, dizziness, fainting, vision changes • Retinal damage on exam (cotton wool spots, papilledema). • Note: if blood pressure reading is elevated then take in both arms; pt legs uncrossed, and arms above heart; correct cuff Diagnostics (Dx)/Labs • Multiple BP readings (both arms, sitting and standing) • ECG → Left-Ventricular hypertrophy. evaluates cardiac function. • Labs → ↑ BUN/creatinine (kidney disease), lipids, glucose, cortisol (Cushing’s) Nursing Care / Nursing Interventions • Monitor pt BP regularly and accurately, check both arms/correct cuff • Put on DASH diet (Dietary Approach to Stop Hypertension) Medications • ⭐️Diuretics (first-line): excess fluids, they need to remove; increase urine • Thiazides (hydrochlorothiazide) inhibits water & sodium reabsorption and increases potassium excretion • Side effects/SE: hypokalemia; monitor potassium(K⁺) levels • Loop (furosemide) decreases sodium reabsorption & increase potassium excretion– SE: hypokalemia; monitor potassium(K⁺) levels • Potassium-sparing (spironolactone) – SE: hyperkalemia; monitor potassium levels. EKG: peaked T waves • Also watch out for muscle weakness, irregular, pulse, and dehydration. • ⭐️Calcium channel blockers (verapamil, amlodipine, and diltiazem) Calcium channel blockers relax and widen blood vessels by preventing calcium from entering muscle cells, leading to lower blood pressure (vasodilation) • SE: constipation; take fiber for verapamil, and all can ↓HR • Avoid grapefruit juice ➡️ toxicity, hypotensive effects Calcium= contract • ⭐️ACE inhibitors (lisinopril, enalapril): prevents angiotensin II → vasodilation • SE: - hypotension; monitor BP and pulse HR -hyperkalemia; monitor potassium levels -erectile dysfunction -⭐️cough linked to angioedema (swollen tissue under the skin around lips, tongue, and glottis); report swelling & discontinue med • ⭐️ARBs (valsartan, losartan): for ACE-intolerant pts from cough/hyperkalemia. ARBs lower blood pressure by blocking angiotensin II from binding to its receptors, preventing vasoconstriction, and reducing fluid retention. • SE: angioedema, heart failure, hyperkalemia • Change position, slowly, report, angioedema, edema, and avoid foods that are high in potassium (bananas, potatoes, apricots, spinach, beans); monitor potassium levels • Aldosterone-receptor antagonists (eplerenone, spironolactone): blocks aldosterone action. • SE: kidney damage, hypertriglyceridemia, hyponatremia, and hyperkalemia; monitor kidney function, triglycerides, sodium, and potassium levels • Avoid Grapefruit juice and St. John’s wort, salt substitutes, and potassium rich foods • ⭐️Beta blockers (metoprolol, atenolol): blocks beta receptors (adrenaline/epinephrine) ➡️reduces heart rate, cardiac output, and blood pressure ↓HR, ↓CO; use cautiously in diabetics • SE: -⭐️erectile dysfunction, -Fatigue, weakness, depression -hypoglycemia • Monitor heart rate (hold if HR is less than 60) and do not suddenly stop taking med (cause rebound hypertension); and don’t give to pts with asthma, airway disease (cause bronchospasms) • Central Alpha-2 agonists (clonidine): calm the nerves that raise blood pressure, letting blood vessels, relax, and BP go down, ↓SNS tone • SE: sedation, orthostatic, hypotension, and sexual dysfunction/impotence • Monitor BP and pulse • Alpha-adrenergic blockers (prazosin, doxazosin): vasodilator= relaxed BP; give at night to avoid first-dose hypotension. Start with low dose. • SE: postural hypotension; make sure patient rises slowly and caution. • Monitor BP 2 hrs after initiation Complications • Hypertensive Crisis: usually when patients do not follow the medication regimen • BP >180/120 → organ damage (encephalopathy, renal failure) • S/S: severe headache, dizziness, blurred vision, confusion, epistaxis • Treat: IV antihypertensives (nitroprusside, nicardipine, labetalol); the goal is to lower BP gradually by 20-25% in first hour. Not less than 140/90. Monitor BP every 5-15 mins Patient Education • Adhere to medication regimen, don’t abruptly stop even when you feel better • Change positions slowly • Encourage DASH diet (low sodium, high fruits/veggies, low-fat dairy) ex: grilled salmon, brown rice, steamed broccoli, and low-fat milk • Avoid high-sodium foods. Consume less than 2.3 g/day • Monitor BP at home • Report signs or symptoms of electrolyte imbalances • Encourage Weight loss, exercise 3x weekly • Encourage Smoking cessation • Encourage Limit alcohol (≤2/day men, ≤1/day women) • Manage stress • Report persistent cough or swelling (ACE inhibitor red flag) Peripheral Venous Disorders(PVD) Patho: problems with veins where Deoxygenated blood can't get back to the heart Oxygenated blood pools in the extremities. The valves are preventing backflow. • Venous Thromboembolism (VTE): blood clot that starts in a vein. -Two types: deep vein thrombosis (DVT) and pulmonary embolism (PE) • Venous insufficiency: Improper functioning of the veins. Veins aren’t able to push back blood to the heart which results in swelling, venous stasis ulcers, or cellulitis. Blood can go down into the veins just fine but cannot come back up. a. VTE ex: Deep Vein Thrombosis (DVT) Pathophysiology • Thrombus (Blood clot) forms in deep veins (usually in legs) → can embolize (travel and block vessel) its way to lungs (PE). • Caused by Virchow’s triad: venous/blood flow stasis, endothelial injury, hypercoagulability. Risk Factors • Surgery (hip, knee, prostate) • Immobility • Heart failure • Pregnancy • Family hx • Oral contraceptives or hormone therapy • Cancer • COVID-19 (elevated D-dimer) • Central venous catheters Clinical Manifestations • Note that clients can be asymptomatic • Calf/groin pain (dull/achy), tenderness, warmth, edema • Unilateral swelling • Shallow, irregular shaped wounds • Too much blood, brown/yellow discoloration • Sudden SOB and sharp chest pain → suspect PE • Positioning: “Elevate Veins”, position up in “V” shape, above heart. Worsens: if dangling, sitting/dangling for long periods of time. Diagnostics • ⭐️Venous duplex ultrasonography = gold standard; it’s an ultrasound of Leg to see blood clot/blood flow through the vessel. • ⭐️D-dimer ↑ = clot breakdown evidence • Venogram/MRI if ultrasound inconclusive Nursing Interventions • Bed rest until anticoagulation started • Elevate leg slightly above heart (no knee gatch). Positioning: “EleVate Veins”, think V as veins are up, to keep the veins open. • Warm compresses • DO NOT massage leg • Compression stockings (after swelling ↓) • Encourage early ambulation when safe • SCDS Medications/Procedures (Anticoagulants) stops blood from clotting, another nurse must be with you • Unfractionated heparin (given IV): prevents clots and growth of existing clot; monitor platelets, and aPTT (how long it takes blood to clot) (1.5–2× normal). Must be given in facility. MUST MONITOR CLOSELY • Antidote: protamine sulfate • Low-molecular-weight heparin (Lovenox/enoxaparin): given SubQ, weight-based, prevention and treatment of DVT, given twice daily, can be used in home setting. Don’t need labs. Monitor for bleeding, and take bleeding precautions (Electric razor, soft toothbrush, environment safety) • Warfarin (Coumadin): oral, inhibits vitamin K clotting factors overlaps; combined with heparin 3–4 days until INR 2–3 (takes awhile to kick in; therapeutic affect) • Antidote: vitamin K • Avoid high vitamin K foods (green leafy veggies) • Monitor PT (range: 11-13.5 secs), INR (must know range: 2–3) • Factor Xa inhibitors (fondaparinux; SubQ) (rivaroxaban, apixaban; oral): Prevents development of Thromboses; transitional medication; initial labs are PT and PTT; not routinely • Direct thrombin inhibitors (dabigatran): directly prevents growth of thrombus Formation, given sub Q ; initiate initial lab values only for PT and APTT. • Antidote: idarucizumab • Thrombolytics (tPA): for massive DVT/PE, directly infused into clot, start within 24hrs- 5 days of clot formation; monitor for bleeding, neuro status, dizziness, headache. Take bleeding precautions, pt must use electric razor and, brush teeth with a soft toothbrush. • Inferior vena cava filter: prevents embolus from reaching lungs (PE), inserted in femoral vein; catches blood clot. Used when pt is unresponsive to other treatments. Monitor: bleeding, hematoma, infection, PE (dyspnea, chest pain, tachycardia). Nursing actions: assess circulation and encourage leg exercises/ambulation early, have patient not sit for too long Anticoagulant Therapy Nurse’s Role • Verify labs,;Double-check with another RN for IV heparin, Assess for bleeding (bruises, gums, stools) and Monitor vitals, mental status (signs of intracranial bleed) Reversal Agents • Heparin → protamine sulfate • Warfarin → vitamin K • Dabigatran → idarucizumab Patient Education • Avoid contact sports • Soft toothbrush, electric razor • Avoid sudden diet changes (vitamin K) Complications (anticoagulants) • ⭐️Pulmonary embolism: sudden dyspnea, chest pain, SOB, anxiety, tachypnea → emergency; sit, patient in high Fowlers, and administer oxygen and anticoagulants • ⭐️Ulcer formation(venous): often formed over the medial malleolus, chronic, hard to heal, can reoccur. Can lead to amputation/death. Neuropathic patients might not feel this. Nursing care: Dressing is left 3–7 days; wound vacuums, diet: high in zinc, protein, iron, and vitamins A and C, debride necrotic tissue so wound can heel. Patient Education(Anticoagulants) • Bleeding precautions (soft toothbrush, electric razor) • Report bruising or black stools • Avoid prolonged sitting/crossing legs • Wear compression stockings b. Venous insufficiency Pathophysiology • Valves and legs are damaged due to prolong venous HTN Our previous blood clot Risk factors: • Sitting/standing in one position for a long period of time • Obesity • Pregnancy • Thrombophlebitis Clinical manifestations: • Status dermatitis(brown discoloration along ankles) • Edema • Stasis ulcers around ankles Labs/DX • D-dimer ↑ = clot breakdown evidence, detects clot Nursing interventions: Elevate legs to increase venous return (20 mins, 4-5/day), position: legs above heart, “Elevate Veins”, Apply stockings, and monitor for cellulitis Patient education: avoid sitting/standing still for too long, change positions often, avoid crossing legs, tight clothing. Apply stockings before getting out of bed in the morning Peripheral Arterial Disease (PAD) : affects blood vessels that carry blood away from the heart; artery carries blood away from heart but has difficulty going down to extremities. Pathophysiology • Atherosclerosis in lower extremities → decreased blood flow to tissues. Risk Factors • Smoking, DM, hypertension, hyperlipidemia, obesity, age, sedentary lifestyle. Clinical Manifestations • Intermittent claudication: leg pain with exercise, relieved by rest; not enough oxygen makes the tissue suffer = pain; ischemia • Pain(sharp) that is only relieved when resting in dependent position • Cool, pale, cyanotic skin • Loss of hair on legs, thick toenails • Weak/absent pedal pulses; dorsalis pedis; Doppler(verify), +1 • Numbness, burning at night • No blood and no edema due to an adequate blood flow • Note: think “A” in PAD as Antarctica, where it’s cold! For cold, pale skin! Diagnostics • ⭐️ABI < 0.9 = PAD; ankle pressure compared to break your pressure; expected finding is 0.9–1.3; less than is PAD • ⭐️Arteriography for visualization of occlusion/decreased arterial flow with contrast injection on a x-ray. Monitor for bleeding, hemorrhage, marked, pedal pulses • Doppler studies → decreased flow in DM patients • ⭐️Exercise tolerance testing → decreased pressure in lower limbs, read the workload of the heart/circulation, and clarification during exercise. May use treadmill or meds (dipyridamole, adenosine). Finding of a BP/pulse waveform = arterial disease. Monitor vitals before, during, and after. Stop test if chest pain or symptoms are severe. Nursing Interventions • Encourage graded exercise until pain, rest, repeat • Avoid elevating legs above heart (impairs flow) • Avoid cold, caffeine, nicotine, tight clothing • Keep extremities warm (no heating pad), they can’t feel • Foot care: inspect daily, no bare feet, toenails straight Medications • Antiplatelets: (aspirin, clopidogrel) reduces blood viscosity and increases blood flow and extremities. Monitor: bleeding, abdominal pain, black, tarry stools. • Statins: (atorvastatin, simvastatin). Relieved manifestations like intermittent claudication. • Pentoxifylline: improves RBC flexibility (claudication). Monitor for bleeding, abdominal pain, black tarry stools. Procedures • Angioplasty (balloon/stent). Opens and helps, maintain the patency of the vessel, however, laser vaporizes atherosclerosis plaque. Monitor for bleeding, vital signs, pulses, cap Refill. As patients rest limbs are straight for 2-6 hrs before ambulation. Anticoagulant/Antiplatelet therapy given 1-3 months after. • Atherectomy rotation, device removes, arterial plaque. Monitor for bleeding and distal pulses. rest limbs are straight for 2-6 hrs. Anticoagulant/Antiplatelet therapy given 1-3 months after. • Arterial revascularization bypass surgery • Used for clients at risk for losing a limb, severe claudication, or limb pain at rest. It reroutes the circulation around the arterial occlusion. • Post-op: ⭐️ maintain adequate circulation in repaired artery, mark pedal/dorsalis pulses(compare both), monitor color/temp, pain, cap refill, blood pressure (HTN= risk for bleeding; Hypotension=clot risk). • Complications: for these notify provider first -graft occlusion: acute blockage of bypass graft within 24 hr(absent pulse, cold foot, increased pain) -compartment syndrome: tissue pressure restricting blood flow; causing ischemia (numbness, tingling, edema, worsening/passive pain) -infection: infection of site (warm, tenderness, elevated, WBC, purulent drainage, use sterile technique) Patient Education • Walk until pain → rest → walk more • Stop smoking • Avoid crossing legs • Diet low in cholesterol and fat Postoperative Care – Peripheral Bypass/Revascularization Priorities • Assess extremity: color, temperature, cap refill, sensation, pulses q15min ×1hr • Mark pedal pulses before surgery • Maintain adequate BP (avoid hypo or hypertension) • Do not flex hip/knee excessively • Encourage ambulation when ordered • Report sudden pain, loss of pulse, pale/cool extremity = graft occlusion Complications • Graft occlusion, Compartment syndrome, Wound infection Arterial vs. Venous Ulcers Feature Arterial Ulcer Venous Ulcer Location Toes, feet, lateral ankle Medial ankle Appearance Pale, dry, round “punched out”, no drainage Irregular, leaky/moist, brown discoloration Pain Severe, worse with elevation Achy, relieved with elevation Skin Cool, shiny Warm, thickened Treatment Improve arterial flow Compression therapy, elevate legs Valvular Heart Disease OVERVIEW Overview • Stenosis = narrowed opening/thickening and hardening • Regurgitation = backflow of blood • Causes: rheumatic fever, degenerative calcification, endocarditis Diagnostics • Chest X-ray → chamber enlargement • ⭐️ECG → hypertrophy • Echo → valve dysfunction • TEE → direct view of valves ⭐️ Medications overview • Diuretics [furosemide, hydrochlorothiazide, spironolactone]: reduce pulmonary congestion, by removing excessive extracellular fluid. Monitor: hypokalemia, eats foods high in potassium, and administer furosemide IV slowly over 1 – 2 minutes. • Afterload–reducing agents [Beta-blockers (-lol); calcium channel blockers (-dipine); ACE inhibitors (-pril); angiotensin–receptor blockers (-artan); vasodilators (hydralazine]): control heart rate, by lessening resistance to contraction. Monitor: hypotension. • Inotropic agents (digoxin): increases contractility, improves cardiac output. Hold medication if pulse rate (abnormal) is less than 60/min or greater than 100/min. Take medication same time every day, avoid combining with antacids (2hrs). Monitor: toxicity such as weakness, confusion, visual changes, low appetite. • Anticoagulants: reduces risk of thrombus. Monitor: stroke, PT, INR, bleeding/bruising. Procedures • Valvuloplasty (balloon dilation) • Valve replacement • Mechanical = lifelong anticoagulants • Tissue = replace every 7–10 years Patient Education • Prophylactic antibiotics before dental procedures • Good oral hygiene • Daily weights • Sodium restriction • Avoid caffeine/alcohol • Report HF signs (weight gain, edema, SOB) • Avoid alcohol, epinephrine, and ephedrine= can cause dysrhythmias THE 4 VALVULAR DISORDERS Mitral Stenosis Etiology/Pathophysiology: Narrowed mitral valve obstructs blood flow from left atrium (LA) → left ventricle (LV), increasing LA pressure and pulmonary congestion → right-sided heart failure. Often caused by rheumatic fever. Clinical Manifestations: Dyspnea on exertion, orthopnea, pitting edema, fatigue, palpitations, hemoptysis, apical diastolic murmur. Risk Factors: Rheumatic heart disease, aging, congenital malformations. Labs/Diagnostics: Echocardiogram (valve narrowing, pressure gradient), ECG (A-fib), chest X-ray (LA enlargement). Medications/Management: • Diuretics [furosemide, hydrochlorothiazide, spironolactone]: reduce pulmonary congestion, by removing excessive extracellular fluid. Monitor: hypokalemia, eats foods high in potassium, and administer furosemide IV slowly over 1 – 2 minutes. • Afterload–reducing agents [Beta-blockers (-lol); calcium channel blockers (-dipine): control heart rate, by lessening resistance to contraction. Monitor: hypotension. • Anticoagulants: reduces risk of thrombus; prevent emboli from A-fib. Monitor: stroke, PT, INR, bleeding/bruising. • Surgical: Balloon valvuloplasty or valve replacement. NCLEX Tip: Rheumatic fever is the most common cause. Mitral Insufficiency Etiology/Pathophysiology: Incomplete closure of mitral valve causes blood to leak back into LA during systole → LV dilation and hypertrophy. Clinical Manifestations: Fatigue, dyspnea, orthopnea, palpitations, holosystolic murmur at apex, pitting edema, S3 sounds Risk Factors: Mitral valve prolapse, rheumatic disease, MI, endocarditis. Labs/Diagnostics: Echocardiogram (regurgitant volume), ECG (A-fib), BNP (HF indicator). Medications/Management: • Beta-blockers (-lol); ACE inhibitors (-pril); ARBS/angiotensin–receptor blockers (-artan): reduce afterload /control heart rate, by lessening resistance to contraction. Monitor: hypotension. • Diuretics [furosemide, hydrochlorothiazide, spironolactone]: manage fluid overload. Monitor: hypokalemia, eats foods high in potassium, and administer furosemide IV slowly over 1 – 2 minutes. • Anticoagulants if A-fib present; reduces risk of thrombus; prevent emboli from A-fib. Monitor: stroke, PT, INR, bleeding/bruising. • Surgery for severe cases. NCLEX Tip: Afterload reduction decreases regurgitant flow. Aortic Stenosis Etiology/Pathophysiology: Narrowed aortic valve → obstructed LV outflow → ↑ LV pressure → hypertrophy → ↓ cardiac output. Clinical Manifestations: Triad: angina, syncope, dyspnea (heart failure); systolic murmur radiating to carotids. Risk Factors: Aging (calcification), congenital bicuspid valve, rheumatic fever. Labs/Diagnostics: Echocardiogram (valve area), ECG (LV hypertrophy), cardiac cath (pressure gradient). Medications/Management: • Avoid nitrates/vasodilators (can cause hypotension). • Use beta-blockers (-lol) cautiously. reduce afterload /control heart rate, by lessening resistance to contraction. Monitor: hypotension. • Surgical aortic valve replacement (definitive). NCLEX Tip: Do not aggressively lower preload; maintain perfusion. Aortic Insufficiency Etiology/Pathophysiology: Incomplete closure of aortic valve → backflow of blood into LV → volume overload → dilation and LV hypertrophy. Clinical Manifestations: Dyspnea, palpitations, fatigue, bounding (“water hammer”) pulse, wide pulse pressure, diastolic murmur. Risk Factors: Rheumatic fever, endocarditis, Marfan syndrome, trauma. Labs/Diagnostics: Echocardiogram (backflow volume), ECG (LV enlargement), chest X-ray (cardiomegaly). Medications/Management: • Calcium channel blockers (-dipine); ACE inhibitors (-pril); vasodilators (hydralazine]): reduce afterload /control heart rate, by lessening resistance to contraction. Monitor: hypotension. • Diuretics for volume management. • Surgical valve replacement when severe. NCLEX Tip: Bounding pulse and wide pulse pressure are hallmark findings. General Nursing & Exam Focus • Best diagnostic test: Echocardiogram (for all). • Monitor for A-fib in mitral disorders. • Valve replacement (mechanical): Lifelong anticoagulation. • Daily weights & fluid balance: Detect early HF. • Positioning: High-Fowler’s for dyspnea, low-sodium diet. Inflammatory Heart Disorders (Endocarditis, Pericarditis, Myocarditis, Rheumatic Carditis) Risk Factors • IV drug use, valve replacement, streptococcal infection, immunosuppression, lower socioeconomic status Pericarditis: inflammation of the pericardium (sac around heart) -RF: heart attack, lupus, rheumatoid arthriti -Clinical manifestations: Chest pain (relieved when leaning forward), coughing, Pericardial friction rub, fever, dysrhythmias, and SOB -Labs/DX: • High WBCs, EKG showing ST or T spiking, echocardiogram (inflamed heart) -Nursing care/Intervention: address pain/inflammation, and monitor for cardiac tamponade, position, patient upright, leaning forward, and monitor ECG - Medications: NSAIDs, corticosteroids, anti antibiotics for bacterial • Ibuprofen/NSAIDs for inflammation (pericarditis). Avoid if patient has peptic ulcer, monitor for G.I. bleeding, platelets, liver/kidney function. Must be taken with food, avoid alcohol. • Corticosteroids (prednisone) for autoimmune causes (pericarditis/myocarditis). Low-dose first, take with food, and patient must not stop abruptly. Monitor BP, glucose, electrolytes, wounds, infection, sudden weight gain. -Complication: cardiac tamponade → muffled heart sounds, paradoxical pulse, JVD, hypotension (Beck’s triad) Myocarditis: inflammation of the myocardium (heart muscle itself) -RF: viral (covid, Coxsackie), fungal, or bacterial infection; autoimmune disorder -Clinical Manifestations: Tachycardia, chest pain, murmur, friction rub, dysrhythmias, peripheral swelling, cardiomegaly. -Labs/Dx: ECG, echocardiogram, high troponin, CK – MB, ESR in CRP for inflammation/injury -Nursing Care/interventions: monitor for heart failure, and dysrhythmia’s, provide rest and activity restriction -Medication: • Amphotericin B for fungal infection (myocarditis/endocarditis). Monitor liver/kidney function for a G.I. upset. • Corticosteroids (prednisone) for autoimmune causes (pericarditis/myocarditis). Low-dose first, take with food, and patient must not stop abruptly. Monitor BP, glucose, electrolytes, wounds, infection, sudden weight gain. Endocarditis: bacterial infection that leaves inflammation of the endocardium (inner layer of the heart); bacterial or fungal Infection of endocardial tissues that leads to necrosis and embolization of growth -RF: congenital/valvular heart disease, prosthetic valve, IV drug use -Clinical Manifestations: janeway lesions, Fever, murmur, petechiae, splinter hemorrhages (red streaks under nail beds), Osler’s nodes -labs/dx: positive blood culture, echocardiogram -nursing interventions/care: administer IV antibiotics, antipyretics for fever, and anticoagulants, patient should use soft toothbrush, and prophylactic antibiotics before dental/invasive procedures -medication: • Penicillin for infection (rheumatic fever/endocarditis). Monitor for allergic reaction, kidney function/electrolytes. • Amphotericin B for fungal infection (myocarditis/endocarditis). Monitor liver/kidney function for a G.I. upset. Rheumatic Carditis/heart disease: infection of endocardium due to complication of rheumatic fever; GABHS triggers, rheumatic fever leading to inflammatory lesions in the heart -RF: children, Follows untreated strep infection -Clinical Manifestations: tachycardia, Fever, rash(trunk/extremities), joint pain, murmur, chest pain, muscle spasms, friction rub -Labs/Dx: throat culture (strep infection), positive ASO titer, echocardiogram -Nursing care/Interventions: administering antibiotics to stop strep infection, and promote rest, monitor for heart failure, and encourage life on prophylactic antibiotics. -Medications: antibiotics, valve replacement/repair • Penicillin for infection (rheumatic fever/endocarditis). Monitor for allergic reaction, kidney function/electrolytes. Nursing Interventions (Overview for Inflammatory disorders) • Monitor for tamponade & HF • Administer antibiotics (penicillin) • Pain relief (NSAIDs for pericarditis) • Bed rest • Emotional support • Auscultate heart sounds; murmur or friction rub • Collab with cardiologist and physical therapists Procedures (Overview for Inflammatory disorders) • Pericardiocentesis for fluid removal, then sent to laboratory; monitor for recurrence of cardiac tamponade. ( pericarditis.) • Valve surgery if damaged Complications (Overview for Inflammatory disorders) • Cardiac tamponade: medical emergency resulted from fluid accumulation in pericardial sac. S/S: dyspnea, dizziness, tightness in chest, restlessness. Administer IV fluids, notify the provider, obtain chest, x-ray or ECG Cardiac Diagnostics & Vascular Access (Ch. 28) Transesophageal Echocardiography (TEE) Provides clear heart images via probe in the esophagus to detect valve disease, thrombi, or heart failure. NPO 4–6 hr, monitor VS, ECG, and sedation; check gag reflex before eating post-procedure; keep HOB 45°. Stress Testing (Exercise or Pharmacologic) Assesses heart’s response to stress for angina, HF, MI, or dysrhythmia. NPO 2–4 hr, avoid caffeine/tobacco, wear comfortable clothes; stop test for chest pain, SOB, dizziness. Post: monitor ECG & BP until stable. Coronary Angiography (Cardiac Catheterization) Identifies coronary artery blockages using contrast dye via femoral, radial, or brachial artery. NPO 4–6 hr, assess renal function, allergies (iodine/shellfish), and hold metformin 48 hr before/after. Post: monitor VS and site for bleeding, hematoma, or thrombosis, keep limb straight, maintain bedrest. Complications: cardiac tamponade (↓BP, JVD, muffled heart sounds), embolism, hematoma, AKI—notify provider. Teach: report chest pain, bleeding, SOB, avoid lifting >10 lb, and take antiplatelets as prescribed if stent placed. Vascular Access Devices (VADs) Provide reliable central access for fluids, meds, TPN, or blood. Verify tip placement via x-ray before use. PICC: up to 12 mo use, insert in basilic/cephalic vein → SVC; no BP/venipuncture in that arm, keep dressing dry. Tunneled Catheter: long-term use, subcutaneous tunnel prevents infection; no dressing once healed. Implanted Port: long-term chemo access; access with Huber needle, flush with heparin after use. Complications: • Phlebitis: redness, pain, warmth—maintain sterile technique. • Occlusion: flush gently with 10 mL syringe; never force. • Mechanical issues: swelling or pain at port site = dislodgement → notify provider
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