CARDIAC – MED-SURG SYSTEMS SURVIVAL NOTES
(Adult Health / Med-Surg – Exam/NCLEX Focused)
1. Big-Picture Cardiac Overview
• The heart’s job = pump blood forward to meet the body’s oxygen and nutrient needs.
• Cardiac problems usually fall into:
o Pump problems – heart failure, cardiogenic shock.
o Plumbing problems – CAD, MI, clots.
o Electrical problems – dysrhythmias (AFib, VT, VF, blocks).
o Structural problems – valve disorders, cardiomyopathy.
• High-yield priorities:
o Perfusion (brain, kidneys, heart).
o Fluid balance (overload vs dehydration).
o Rhythm & conduction (risk for sudden death).
o Oxygenation (lungs + circulation).
2. Heart Failure (HF)
2.1 Must-Know Overview
• Heart failure = the heart can’t pump enough blood to meet the body’s needs.
• Often caused by MI, long-standing HTN, valve disease, cardiomyopathy.
• Two main sides:
o Left-sided HF → lungs (congestion, SOB).
o Right-sided HF → body (edema, JVD, ascites).
• Key problems: ↓ cardiac output, fluid overload, poor perfusion.
2.2 Left vs Right HF (Quick Compare)
Feature Left-Sided HF (L = Lungs) Right-Sided HF (R = Rest of body)
Main issue Blood backs into lungs Blood backs into systemic venous circulation
Key s/s Dyspnea, orthopnea, crackles, cough, fatigue Peripheral edema, JVD, ascites, hepatomegaly
Red flag Pink frothy sputum (pulmonary edema – emergency) Rapid weight gain, worsening edema
2.3 Assessment – Classic Findings
Left-sided HF:
• Dyspnea on exertion, orthopnea (needs extra pillows).
• Crackles, possible wheezes.
• Cough, pink frothy sputum (late, emergency).
• Fatigue, weakness, confusion, restlessness.
• S3 heart sound, tachycardia.
Right-sided HF:
• Edema in legs, ankles, sacrum.
• JVD, abdominal distension, ascites.
• Hepatomegaly, RUQ discomfort.
• Weight gain, anorexia, nausea.
, Red Flags (call provider immediately):
• Sudden weight gain >2–3 lb in 1 day or >5 lb/week.
• New or worsening SOB at rest.
• Pink frothy sputum, crackles spreading up lungs.
• Chest pain, confusion, decreased urine output.
2.4 Diagnostics & Labs
• BNP ↑ (correlates with severity of HF).
• Chest X-ray: cardiomegaly, pulmonary congestion.
• Echocardiogram: ↓ ejection fraction (EF).
• Electrolytes: Na, K, BUN/Cr (diuretics, ACEIs affect them).
• EKG: may show ischemia, MI, dysrhythmias.
2.5 Nursing Interventions (Priority)
• Position High-Fowler’s; give O₂ as ordered.
• Monitor:
o Vital signs, especially BP, HR, O₂ sat.
o Lung sounds and work of breathing.
o I&O, daily weights, edema.
• Fluid & Na restriction as ordered.
• Cluster care, rest periods to ↓ O₂ demand.
• Educate:
o Daily weights, low-sodium diet.
o Medication adherence.
o When to call provider (rapid weight gain, increased SOB, swelling, chest pain).
2.6 Patient Teaching – “MAWDS” (Common HF Mnemonic)
• Medications – take as prescribed, don’t skip.
• Activity – balance rest and activity, stop if SOB or chest pain.
• Weight – daily weights, report rapid gains.
• Diet – low sodium, fluid limits if ordered.
• Symptoms – report swelling, SOB, chest pain, confusion, decreased urination.
3. Coronary Artery Disease (CAD) & Angina
3.1 Overview
• CAD = narrowed coronary arteries from atherosclerosis → ↓ blood flow to heart muscle.
• Angina = chest pain due to temporary ischemia (not full-blown cell death yet).
• Risk factors:
o Non-modifiable: age, male sex, family hx, ethnicity.
o Modifiable: smoking, HTN, high cholesterol, DM, obesity, sedentary lifestyle, high stress.
3.2 Types of Angina
• Stable angina
(Adult Health / Med-Surg – Exam/NCLEX Focused)
1. Big-Picture Cardiac Overview
• The heart’s job = pump blood forward to meet the body’s oxygen and nutrient needs.
• Cardiac problems usually fall into:
o Pump problems – heart failure, cardiogenic shock.
o Plumbing problems – CAD, MI, clots.
o Electrical problems – dysrhythmias (AFib, VT, VF, blocks).
o Structural problems – valve disorders, cardiomyopathy.
• High-yield priorities:
o Perfusion (brain, kidneys, heart).
o Fluid balance (overload vs dehydration).
o Rhythm & conduction (risk for sudden death).
o Oxygenation (lungs + circulation).
2. Heart Failure (HF)
2.1 Must-Know Overview
• Heart failure = the heart can’t pump enough blood to meet the body’s needs.
• Often caused by MI, long-standing HTN, valve disease, cardiomyopathy.
• Two main sides:
o Left-sided HF → lungs (congestion, SOB).
o Right-sided HF → body (edema, JVD, ascites).
• Key problems: ↓ cardiac output, fluid overload, poor perfusion.
2.2 Left vs Right HF (Quick Compare)
Feature Left-Sided HF (L = Lungs) Right-Sided HF (R = Rest of body)
Main issue Blood backs into lungs Blood backs into systemic venous circulation
Key s/s Dyspnea, orthopnea, crackles, cough, fatigue Peripheral edema, JVD, ascites, hepatomegaly
Red flag Pink frothy sputum (pulmonary edema – emergency) Rapid weight gain, worsening edema
2.3 Assessment – Classic Findings
Left-sided HF:
• Dyspnea on exertion, orthopnea (needs extra pillows).
• Crackles, possible wheezes.
• Cough, pink frothy sputum (late, emergency).
• Fatigue, weakness, confusion, restlessness.
• S3 heart sound, tachycardia.
Right-sided HF:
• Edema in legs, ankles, sacrum.
• JVD, abdominal distension, ascites.
• Hepatomegaly, RUQ discomfort.
• Weight gain, anorexia, nausea.
, Red Flags (call provider immediately):
• Sudden weight gain >2–3 lb in 1 day or >5 lb/week.
• New or worsening SOB at rest.
• Pink frothy sputum, crackles spreading up lungs.
• Chest pain, confusion, decreased urine output.
2.4 Diagnostics & Labs
• BNP ↑ (correlates with severity of HF).
• Chest X-ray: cardiomegaly, pulmonary congestion.
• Echocardiogram: ↓ ejection fraction (EF).
• Electrolytes: Na, K, BUN/Cr (diuretics, ACEIs affect them).
• EKG: may show ischemia, MI, dysrhythmias.
2.5 Nursing Interventions (Priority)
• Position High-Fowler’s; give O₂ as ordered.
• Monitor:
o Vital signs, especially BP, HR, O₂ sat.
o Lung sounds and work of breathing.
o I&O, daily weights, edema.
• Fluid & Na restriction as ordered.
• Cluster care, rest periods to ↓ O₂ demand.
• Educate:
o Daily weights, low-sodium diet.
o Medication adherence.
o When to call provider (rapid weight gain, increased SOB, swelling, chest pain).
2.6 Patient Teaching – “MAWDS” (Common HF Mnemonic)
• Medications – take as prescribed, don’t skip.
• Activity – balance rest and activity, stop if SOB or chest pain.
• Weight – daily weights, report rapid gains.
• Diet – low sodium, fluid limits if ordered.
• Symptoms – report swelling, SOB, chest pain, confusion, decreased urination.
3. Coronary Artery Disease (CAD) & Angina
3.1 Overview
• CAD = narrowed coronary arteries from atherosclerosis → ↓ blood flow to heart muscle.
• Angina = chest pain due to temporary ischemia (not full-blown cell death yet).
• Risk factors:
o Non-modifiable: age, male sex, family hx, ethnicity.
o Modifiable: smoking, HTN, high cholesterol, DM, obesity, sedentary lifestyle, high stress.
3.2 Types of Angina
• Stable angina
