NUR 242 Exam 4 Notes
Medical/Surgical Nursing Concepts
(Galen College of Nursing)
100% Guarantee Pass
CONTENTS
Exam 4 Medsurg Nur-242
Anything Highlighted in Yellow = on test
Galen College Miami Campus Professor: E. Milhomme
Chapters 30, 31,32, 33 38, 39, 40, 41, 42, 43, 44, 45, 46, 47
,Chapter 30: assessment of cardiovascular system: page 611-634
-Heart pumps about 60mL of blood, or 5L/min
-Cardiac output= heart rate x stroke volume
S1/ LUB=mitral and tricuspid valves (atrioventricular valve); S2/DUB= aortic and
pulmonic (semilunar valves) Heart rate= # of times ventricles contract/ min
NORMAL =60-100beats/min
Normal oxygen saturation= 90% - 100%
Normal BP= 130/80; ( 90/60 hypotension)
Drugs that increase HR= epinephrine/ norepinephrine; Drugs that Decrease HR= beta blockers
BP=is the force of blood exerted against vessel walls.
Systolic BP= amount of pressure generated CONTRACTION by LEFT ventricle
Diastolic BP=
amount of force against arterial wall during RELAXTION
(valve fills w/blood) Risk factors of cardiovascular disease=smoking,
inactivity, obesity (BMI more than 30);
Disease that influences cardiovascular status- DM, renal disease, anemia, high bp, stroke, bleeding disorders,
Page 619
pulmonary disease, thrombophlebitis Women present non specific cardiovascular symptoms- fatigue,
malaise, anxiety,, SOB
Page 620 THOUROUGHLY EVALUATE THE NATURE AND CHARACTERISTICS OF CHEST PAIN. BECAUSE PAIN
RESULTING FROM MYOCARDIAL ISCHEMIA IS LIFE THREATENING AND CAN LEAD TO SERIOUS COMPLICATIONS;
ITS CAUSE SHOULD BE CONSIDERED ICHEMIC ( REDUCED OR OBSTRUCTED BLOOD FLOW TO MYCOCARDIUM.)
UNTIL PROVEN OTHERWISE. WHEN ASSESSING SYMTOMS ASK PATIENT IF THEY HAVE “DISCOMFORT,
HEAVINESS, PRESSURE, AND OR INDIGESTION.” IT IS IMPORTANT TO NOTE THAT CHEST PAIN CAN OCCUR IN
ANY SETTING. PROPER ASSESSMENT OF PAIN CAN DECREASE THE POTENITAL FOR SERIOUS COMPLICATIONS
-Cardiac ischemia nursing action- 12 lead EKG, assess for neuro changes or sign of stroke
Women don’t usually feel chest pain. usually feel discomfort or indigestion, abd fullness, chronic fatigue, dyspnea
(TRIAD), inability to catch breath; sensation of aching, choking, strangling, tingling, squeezing, constricting, or
viselike, severe neuropathy
Page 620 Palpitations- fluttering feeling/ unpleasant feeling in chest caused by irregular HR.
Palpitation causes= paroxysmal supraventricular tachycardia, premature contractions, sinus tachycardia, anxiety
stress,
Page 621 fatigue, insomnia, hyperthyroidism, caffeine, nicotine, alcohol
Syncope= brief loss of consciousness decreased profusion to brain caused by decreased perfusion to the
brain
Page 622 Physical assessment: late sign of right sided heart failure = ascites, jaundice, anasarca; best areas to
assess nailbed, mucous membranes and conjunctiva mucosa ABNORMAL- Pulse: 1 weak/ thready or
bounding Temp: cool, moist color: pale, gray, blue, (cyanosis), Rubor (arterial
insufficiency); Sensation: paresthesia, numbness, pain; Other clubbing fingernails= chronic o2 deprivation,
peripheral edema,
Page 623 Orthostatic postural hypotension= decrease in BP of more than 20mm hg of systolic pressure or more
than 10mm hg of diastolic pressure AND 10% increase in HR
Page 624 bruits= swishing sound from turbulent blood flowing narrow atherosclerotic arteries 50% or more if
blocked 90% or more bruit cant be heard ; use bell of stethoscope on carotid artery while patient holds breath
S3= ventricular galloping ABNORMAL in 35 years or older BUT NORMAL IN 35 AND YOUNGER
, Page 626 Labs to know Troponin (acute MI or necrosis, HDL men: more than 45; HDL women: more than 55 LDL
less than 130 ( bad cholesterol) total cholesterol less than 200, triglycerides: men 40-60 women 35-135; Aptt, PT,
INR
angiography= invasive dx procedure; fluoroscopy and contrast
Page 626: Indications for cardiac Catheterizations = confirms suspected heart disorders; determine location and
extent of disease; to assess stable/ severe angina unresponsive to medical management; uncontrolled heart failure,
ventricular dysthymia's, MI, papillary muscle dysfunction, ventricular aneurysm, septal perforation. Determine best
therapeutic options- stents, grafts angioplasty, valve replacement's, and evaluate effects of invasive treatments.
Pre Cardiac Cath- Assess, Review indication, teach expected sensation (palpitations, hot flashes, desire to cough)
contrast ; CONSENT; clear fluids 2hrs before; hold meds diuretics, warfarin anticoagulants; chest hair clipped;
Intra Cardiac Cath- supine on xray table, report chest pain; right side of heart 1st ; then left side 2nd
Page 630 IF PATIENT EXPERIENCES SYMPTOMS OF CARDIAC ISCHEMIA SUCH AS CHEST PAIN;
DYSTHRYSTHMIAS, BLEEDING, HEMATOMA FORMATION , OR A DRAMATIC CHANGE IN PERIPHERAL PULSES IN
AFFECTED EXTREMITY, CONTACT THE RAPID RESPONSE OR PROVIDER IMMEDIATELY TO PROVIDE PROMPT
INTERVENTION. REMAIN W/ PATIENT AND OBTAINA 12 LEAD ECG FOR PATIENTS EXPERIENCING CHEST PAIN OR
DYSRTHMIAS. FOR BLEEDING AND HEMATOMA FORMATION, HOLD STEADY, FIRM PRESSURE TO ACCESS SITE
UNTIL RAPID RESPONSE. NEURO CHANGES INDICATION OF POSSIBLE STROKE, SUCH AS VISUAL DISTURBANCES,
SLURRED SPEECH, SWALLOWING DIFFICULTY, AND EXTREMITY WEAKNESS, SHOULD ALSO BE REPORTED
IMMEDIATELY
Page 630 Stress Test aka exercise tolerance test= requires consent; pre stress test: plenty of rest night before;
may eat meal 2 hours before; AVOID: smoking, drinking alcohol, caffeine beverages on day of test Withold day of:
cardiac drugs: beta blockers, calcium channel blockers; APPAREL: Comfortable , loose clothing, rubber soled ,
supportive shoes ALERT DR IF during test: chest pain, dizzy, SOB, irregular HR, Emergency Supplies needed close
by: defibrillator, cardiac rx; Modes of exercise: pedaling bicycle ergometer; walking on treadmill; Monitor BP and
ECG
Medical/Surgical Nursing Concepts
(Galen College of Nursing)
100% Guarantee Pass
CONTENTS
Exam 4 Medsurg Nur-242
Anything Highlighted in Yellow = on test
Galen College Miami Campus Professor: E. Milhomme
Chapters 30, 31,32, 33 38, 39, 40, 41, 42, 43, 44, 45, 46, 47
,Chapter 30: assessment of cardiovascular system: page 611-634
-Heart pumps about 60mL of blood, or 5L/min
-Cardiac output= heart rate x stroke volume
S1/ LUB=mitral and tricuspid valves (atrioventricular valve); S2/DUB= aortic and
pulmonic (semilunar valves) Heart rate= # of times ventricles contract/ min
NORMAL =60-100beats/min
Normal oxygen saturation= 90% - 100%
Normal BP= 130/80; ( 90/60 hypotension)
Drugs that increase HR= epinephrine/ norepinephrine; Drugs that Decrease HR= beta blockers
BP=is the force of blood exerted against vessel walls.
Systolic BP= amount of pressure generated CONTRACTION by LEFT ventricle
Diastolic BP=
amount of force against arterial wall during RELAXTION
(valve fills w/blood) Risk factors of cardiovascular disease=smoking,
inactivity, obesity (BMI more than 30);
Disease that influences cardiovascular status- DM, renal disease, anemia, high bp, stroke, bleeding disorders,
Page 619
pulmonary disease, thrombophlebitis Women present non specific cardiovascular symptoms- fatigue,
malaise, anxiety,, SOB
Page 620 THOUROUGHLY EVALUATE THE NATURE AND CHARACTERISTICS OF CHEST PAIN. BECAUSE PAIN
RESULTING FROM MYOCARDIAL ISCHEMIA IS LIFE THREATENING AND CAN LEAD TO SERIOUS COMPLICATIONS;
ITS CAUSE SHOULD BE CONSIDERED ICHEMIC ( REDUCED OR OBSTRUCTED BLOOD FLOW TO MYCOCARDIUM.)
UNTIL PROVEN OTHERWISE. WHEN ASSESSING SYMTOMS ASK PATIENT IF THEY HAVE “DISCOMFORT,
HEAVINESS, PRESSURE, AND OR INDIGESTION.” IT IS IMPORTANT TO NOTE THAT CHEST PAIN CAN OCCUR IN
ANY SETTING. PROPER ASSESSMENT OF PAIN CAN DECREASE THE POTENITAL FOR SERIOUS COMPLICATIONS
-Cardiac ischemia nursing action- 12 lead EKG, assess for neuro changes or sign of stroke
Women don’t usually feel chest pain. usually feel discomfort or indigestion, abd fullness, chronic fatigue, dyspnea
(TRIAD), inability to catch breath; sensation of aching, choking, strangling, tingling, squeezing, constricting, or
viselike, severe neuropathy
Page 620 Palpitations- fluttering feeling/ unpleasant feeling in chest caused by irregular HR.
Palpitation causes= paroxysmal supraventricular tachycardia, premature contractions, sinus tachycardia, anxiety
stress,
Page 621 fatigue, insomnia, hyperthyroidism, caffeine, nicotine, alcohol
Syncope= brief loss of consciousness decreased profusion to brain caused by decreased perfusion to the
brain
Page 622 Physical assessment: late sign of right sided heart failure = ascites, jaundice, anasarca; best areas to
assess nailbed, mucous membranes and conjunctiva mucosa ABNORMAL- Pulse: 1 weak/ thready or
bounding Temp: cool, moist color: pale, gray, blue, (cyanosis), Rubor (arterial
insufficiency); Sensation: paresthesia, numbness, pain; Other clubbing fingernails= chronic o2 deprivation,
peripheral edema,
Page 623 Orthostatic postural hypotension= decrease in BP of more than 20mm hg of systolic pressure or more
than 10mm hg of diastolic pressure AND 10% increase in HR
Page 624 bruits= swishing sound from turbulent blood flowing narrow atherosclerotic arteries 50% or more if
blocked 90% or more bruit cant be heard ; use bell of stethoscope on carotid artery while patient holds breath
S3= ventricular galloping ABNORMAL in 35 years or older BUT NORMAL IN 35 AND YOUNGER
, Page 626 Labs to know Troponin (acute MI or necrosis, HDL men: more than 45; HDL women: more than 55 LDL
less than 130 ( bad cholesterol) total cholesterol less than 200, triglycerides: men 40-60 women 35-135; Aptt, PT,
INR
angiography= invasive dx procedure; fluoroscopy and contrast
Page 626: Indications for cardiac Catheterizations = confirms suspected heart disorders; determine location and
extent of disease; to assess stable/ severe angina unresponsive to medical management; uncontrolled heart failure,
ventricular dysthymia's, MI, papillary muscle dysfunction, ventricular aneurysm, septal perforation. Determine best
therapeutic options- stents, grafts angioplasty, valve replacement's, and evaluate effects of invasive treatments.
Pre Cardiac Cath- Assess, Review indication, teach expected sensation (palpitations, hot flashes, desire to cough)
contrast ; CONSENT; clear fluids 2hrs before; hold meds diuretics, warfarin anticoagulants; chest hair clipped;
Intra Cardiac Cath- supine on xray table, report chest pain; right side of heart 1st ; then left side 2nd
Page 630 IF PATIENT EXPERIENCES SYMPTOMS OF CARDIAC ISCHEMIA SUCH AS CHEST PAIN;
DYSTHRYSTHMIAS, BLEEDING, HEMATOMA FORMATION , OR A DRAMATIC CHANGE IN PERIPHERAL PULSES IN
AFFECTED EXTREMITY, CONTACT THE RAPID RESPONSE OR PROVIDER IMMEDIATELY TO PROVIDE PROMPT
INTERVENTION. REMAIN W/ PATIENT AND OBTAINA 12 LEAD ECG FOR PATIENTS EXPERIENCING CHEST PAIN OR
DYSRTHMIAS. FOR BLEEDING AND HEMATOMA FORMATION, HOLD STEADY, FIRM PRESSURE TO ACCESS SITE
UNTIL RAPID RESPONSE. NEURO CHANGES INDICATION OF POSSIBLE STROKE, SUCH AS VISUAL DISTURBANCES,
SLURRED SPEECH, SWALLOWING DIFFICULTY, AND EXTREMITY WEAKNESS, SHOULD ALSO BE REPORTED
IMMEDIATELY
Page 630 Stress Test aka exercise tolerance test= requires consent; pre stress test: plenty of rest night before;
may eat meal 2 hours before; AVOID: smoking, drinking alcohol, caffeine beverages on day of test Withold day of:
cardiac drugs: beta blockers, calcium channel blockers; APPAREL: Comfortable , loose clothing, rubber soled ,
supportive shoes ALERT DR IF during test: chest pain, dizzy, SOB, irregular HR, Emergency Supplies needed close
by: defibrillator, cardiac rx; Modes of exercise: pedaling bicycle ergometer; walking on treadmill; Monitor BP and
ECG
