NSG 4100: unit 5,6,7 | 2026 update

3. Incorporate leadership skills required to provide and continuously improve the delivery of safe, patient-
centered quality healthcare to patients experiencing complex, perfusion health problems. (CSLO 3)
4. Integrate best practices and current evidence when using clinical reasoning to care for patients experiencing
complex, perfusion health problems. (CSLO 4)
5. Integrate how information systems and technology can be used to communicate, manage knowledge,
mitigate error, and support decision making to care for patients experiencing complex, perfusion health
problems. (CSLO 5)
6. Evaluate how effective communication and collaboration skills to improve patient satisfaction and health
outcomes when caring for patients experiencing complex, perfusion health problems. (CSLO 6)

Theory Topics
Detailed Content Outline
Complex Perfusion Problems (Part I)
o Hemodynamic Monitoring
 Continuous assessment of the cardiovascular system to diagnose & manage complex medical conditions
 Use by direct pressure monitoring systems
 Types
 Central Venous Pressure- measurement of the vena cava or right atrium and reflects the filling
pressure of the right ventricle (preload). Normal CVP is 2-6 mm Hg.
 CVP > 6 mm Hg indicates an elevated right ventricular preload.
 CVP < 2 mm Hg indicates reduced right ventricular preload. CVP catheter can also be used for
infusing IVF, administering IV medications, and drawing blood specimens.
 Pulmonary Artery Pressure- used to assess the left ventricular function, diagnosing the
etiology of shock, and evaluating the patient’s response to medical interventions. Can measure
right atrial, pulmonary artery systolic/diastolic, and pulmonary artery wedge pressures.
 Intra-arterial blood pressure monitoring- used to obtain direct and continuous BP
measurements in critically ill patients who have severe hypertension or hypotension. They also
can be used for frequent ABG measurements and blood samples.
 Nursing Interventions and Assessment
 Hand hygiene
 Dressing Change
 Catheter site- assess regularly-visually when changing the dressing or by palpation through an
intact dressing. Remove dressing for a thorough assessment if the patient has:
 Tenderness at the insertion site
 Fever
 Other signs of local or bloodstream infections.
 Keep all components of the pressure monitoring system sterile.
 Replace transducers, tubing, continuous-flush device, and flush solution every 96 hours or
per policy
 Do not infuse dextrose through the monitoring system.
 Bathing
 Do not submerge the catheter site in water
 Showering is permitted if the catheter and related tubing are placed in an impermeable
cover.
 Patient education- ask patient to report any new discomforts from the catheter site.
 Nursing Diagnosis
 Risk for Infection
 Cardiac Dysrhythmias
 Cardiac rhythm abnormality affecting impulse generation or conduction.
 Indicate an underlying pathophysiologic disorder and can impair normal cardiac output
 Sinus Tachycardia
NSG 4100
Department of Curriculum & Instruction 3/11/2026

,  P Wave: Normal and Consistent Shape, always in front of QRS
 PR Interval: 0.12-0.20 seconds
 Medical
 Depends on Cause
 Emergency Transcutaneous Pacing
 Medications
 Adrenergic Receptor (Epinephrine)
 Anticholinergic (Atropine)
 Diagnosis
 EKG
 Nursing Diagnosis
 Risk for complications of decreased cardiac output
 Atrial Fibrillation
 Pathophysiology/Pathogenesis
 Atrial depolarizations are blocked at the AV Node, with a few reaching the ventricles and
initiating ventricular contractions. Causes the atria to quiver rather than contract forcefully.
 Completely disorganized and irregular atrial rhythm accompanied by an irregular ventricular
rhythm of variable rate.
 Etiology
 Age
 Hypertension
 Diabetes
 Obesity
 Heart Failure
 Clinical Manifestations
 Risk for formation of Thrombi
 Cerebrovascular Stroke
 Heart Failure-
 increasing cardiac workload.
 Nursing Treatment/Interventions
 History and Physical
 Stroke Risk Assessment
 Monitor Lab (Coags and H/H) Keep INR 2.0 and 3.0
 Electrical Cardioversion- Anticipate TEE performed to evaluate for atrial thrombi before
cardioversion.
 Interpretation/Characteristics
 Rate: Atrial rate is 300 to 600 bpm, Ventricular Rate is 120 to 200 bpm
 Rhythm: Irregular
 QRS Shape: Usually normal, but may be abnormal
 P Wave: No discernible P waves, irregular, and shape are referred as fibrillatory waves
 PR Interval: Cannot measure
 Sign and Symptoms
 Some patients are asymptomatic
 Palpitations
 Heart Failure
 Shortness of Breath
 Hypotension
 Dyspnea on Exertion
 Fatigue
 Medical Treatment
 Prevent Emboli events

NSG 4100
Department of Curriculum & Instruction 3/11/2026

,  Vagal Maneuvers
 Nursing Diagnosis
 Risk for complications of arrhythmias
 Asystole
 Pathophysiology/Pathogenesis
 Also known as Sinus Arrest.
 The absence of impulse initiation in the heart results in electrical asystole.
 Results in zero cardiac output
 Etiology
 MI
 Electrical Shock
 Electrolyte Disturbances
 Acidosis
 Parasympathetic Activity
 Diagnosis
 EKG
 Nursing Interventions
 High Quality CPR
 Identifying underlying and contributing factors
 Identify Hs and Ts
 Hypoxia
 Hypovolemia
 Hydrogen Ion
 Hypo/Hyperglycemia
 Hypo/ Hyperkalemia
 Hyperthermia
 Trauma
 Toxins
 Tamponade
 Tension Pneumothorax
 Thrombus
 IV initiation
 Prepare for intubation
 Rapid cardiac rhythm analysis and Defibrillation as soon as it is available
 Interpretation/Characteristics
 No Rate
 No Rhythm
 Signs and Symptoms
 No heartbeat
 No palpable pulse
 No respirations
 Medical Management
 Intubation
 Medications
 Adrenergic agonist (Epinephrine)
 Nursing Diagnosis
 Ineffective Peripheral Tissue Perfusion
 Risk for Decreased Cardiac Tissue Perfusion
 Ventricular Tachycardia (V tach)
 Pathophysiology/Pathogenesis
 Three or more consecutive ventricular complexes at a rate greater than 100 beats per min.

NSG 4100
Department of Curriculum & Instruction 3/11/2026