lOMoAR cPSD| 47061011
1
NUR 445 Exam 1 Comprehensive Study Guide
Nur 445: Study Guide for Exam 1
Intro to Complex Care Cardiovascular Respiratory
Interdisciplinary Team Medications Ventilator management
Ethical considerations Cardiomyopathy Ventilator weaning
Prioritization Flash pulmonary edema Pulmonary embolism
Medications End stage heart failure Acute respiratory failure
Pain STEMI / NON-STEMI Rapid sequence intubation
Sedation Cardiac Cath Lab ARDS
Delirium CABG Pneumothorax
Hemodynamics Common Chest tubes
rhythm/treatments
ABGs
STUDY GUIDE SNAPSHOT
• Communication and Collaboration o SBAR (Situation, Background, Assessment,
Recommendation) o Steps and examples
• Interdisciplinary Teams o Roles & responsibilities, importance of teamwork &
communication o Delegation to UAP = follow 5 rights of delegation (no
delegating nursing process)
o Scope of practice, monitoring & follow-up
• Ethical and Legal Considerations o Ethical dilemmas, med errors, legal
implications, & support (educate & report)
• Clinical Prioritization and Decision Making o Prioritization of Critical Conditions
(ABCs) o MI, Angina, Tamponade, SOB, ABGs, PE, Pneumothorax, Flash
pulmonary edema
• Pharmacology (Indications, Contraindications, Mechanism of Action,
Side Effects) o Sedatives & Analgesics
Dexmedetomidine hydrochloride vs. Propofol
Propofol adverse effects: what labs should be monitored?
Lipid panel o Vasoactive & Emergency
Meds Norepinephrine = hypotension
Atropine = bradycardia (1 mg q3-5 mins x 3 doses)
Epinephrine = cardiac arrest (1 mg q3-5 mins)
Vasopressin (alternative for Epi) o Sedatives & Paralytics
Lorazepam (anxiolytic) What med can this replace?
.
, lOMoAR cPSD| 47061011
2
Morphine (opioid analgesic and venous dilator)
Vecuronium (paralytic used in RSI)
Succinylcholine (paralytic used in RSI)
• Richmond Agitation Sedation Scale (RASS) o Purpose and scoring, titrating
meds based on scale
• Delirium o CAM-ICU
o Delirium - causes & preventative measures | assessment & management
• Hemodynamics & Monitoring o Central Venous Pressure (CVP) and Cardiogenic
Shock
Measurement & interpretation
• Low = hypovolemia or vasodilation
• High = right HF, tension pneumo, tamponade, pulmonary HTN
Indicated meds and/or fluids
• Low = IV fluids (0.9% sodium chloride) or vasopressors
• High = Inotropes, Vasodilators, treat cause (chest tube, etc)
ScvO2 = venous O2 sat = how body uses O2
Normal = sufficient O2 to meet metabolic demands o Arterial Line
Management
Insertion, maintenance, & troubleshooting
• Allen test
• Assessment
• Phlebostatic Axis
Do NOT administer meds in an art line!
Recognizing abnormal findings
• Overdamped/Underdamped wave forms
• Severe pain, swelling, redness, bleeding,
delayed cap refill • Cardiovascular Meds & Interventions o
Nitroglycerin
Indications, contraindications, and mechanism of action o Diltiazem for
AF with RVR
Contraindications & administration guidelines
o Amiodarone o Heparin Therapy
Monitor labs: Hct, Platelets, APTT
Adverse reactions & management
• Heparin-Induced Thrombocytopenia (HIT)
• Argatroban
• Cardiomyopathy Management (Dilated cardiomyopathy most common) o
Contraindicated meds = vasodilators o Anticoagulants & indications
Cardiomyopathy can cause dysrhythmias = clots = stroke
• Heart Failure Meds o Adverse effects of diuretics
.
, lOMoAR cPSD| 47061011
3
Potassium wasting vs potassium sparing o Spironolactone in
end-stage HF
Complications of noncompliance with diuretics
Edema, pulmonary edema, electrolyte imbalances
• Interventional Cardiology o Ablation for A-fib in the cardiac cath lab
Post-procedure care
Normal expectations = free of arrythmia/symptoms!
o Intra-Aortic Balloon Pump (IABP)
Indications and operation? Inflate during diastole! Helps heart!
• Differentiating MI from angina (Please review chart in detailed review below) o
Stable angina = predictable & alleviated with rest o Unstable = unpredictable,
NOT relieved by rest, relieved by NTG!
o MI = Heart attack! Pain not relieved by NTG! Red flag
NSTEMI
• Partial occlusion, elevated trop, no significant ST elevation
STEMI
• Complete occlusion, elevated trop, ST elevations
• Cardiac catheterization o Medications to be held?
IV Contrast is used! Think of renal function & DM meds!
o Post-coronary angiography care o Discharge Education and Home Care o Ablation
for A-fib Post-procedure education
Normal expectations = free of arrythmia/symptoms! o Intra-Aortic
Balloon Pump (IABP)
Indications & operation? Helps heart! Inflate during diastole!
o Pacemaker placement care and assessment
Carry pacemaker card, avoid magnets
Assess LOC
• CABG
o Post-procedure education
No bending at the waist, heavy lifting, or lifting arms above head!
• ACLS Cardiac Rhythm Management o All patients: Tele monitor, Defib pads,
Remove jewelry, NPO,
Proper position o STEMI (ST-Elevation Myocardial Infarction) = tombstones!
ONAM (Oxygen, Nitroglycerin, Aspirin, Morphine) Notify cath lab
.
, lOMoAR cPSD| 47061011
4
Reperfusion therapy to prevent worsening ischemia/injury!
Dietary modifications –DASH diet! Low sodium, no saturated/trans fats
o Atrial Fibrillation with Rapid Ventricular Response (A-Fib RVR) & Atrial Flutter
Stable?
• Diltiazem (or other CCB, BB Unstable?
• Synchronized Cardioversion (need to be anticoagulated asap)
o Supraventricular Tachycardia (SVT)
Stable?
• Vagal Adenosine (6mg, 12mg) Synchronized Cardioversion
Unstable?
• Synchronized Cardioversion
o Ventricular Tachycardia with a Pulse
Synchronized Cardioversion o Pulseless Ventricular Tachycardia (pVT) &
Ventricular Fibrillation (VF or V-Fib) DEFIBRILLATE!!!
CPR & EPI
Amiodarone 1st dose = 300mg, 2nd dose = 150mg o Asystole & Pulseless
Electrical Activity (PEA)
NO SHOCK!!!
CPR & EPI o
Bradycardia & Blocks Monitor if asymptomatic
Atropine if symptomatic sinus brady, 1st degree, or 2nd degree Type I
• 1 mg q3-5mins x 3 doses Max dose = 3mg
• Atropine contraindicated in 2nd degree Type II & 3rd degree blocks
Pace
• For 2nd degree Mobitz Type II & 3rd degree OR no response to Atropine
• Respiratory Care o Acute Respiratory Failure
S/Sx of worsening condition requiring MD notification
Confusion, anxiety, worsening dyspnea, lethargy
o Trauma
Blunt chest trauma
• Flail Chest = paradoxical chest movement o Pneumothorax
Diminished/Absent unilateral breath sounds
o Tension Pneumothorax
Tracheal deviation & tamponade
Excessive air in pleural space cannot escape!
Tamponade
• Beck’s Triad o Muffled heart sounds
o JVD
o Hypotension
o Know the immediate interventions for all of these conditions!
• Mechanical Ventilation Management o Pressure ALARMS: High vs. Low (Use HOLD
mnemonic!)
By performance
1
NUR 445 Exam 1 Comprehensive Study Guide
Nur 445: Study Guide for Exam 1
Intro to Complex Care Cardiovascular Respiratory
Interdisciplinary Team Medications Ventilator management
Ethical considerations Cardiomyopathy Ventilator weaning
Prioritization Flash pulmonary edema Pulmonary embolism
Medications End stage heart failure Acute respiratory failure
Pain STEMI / NON-STEMI Rapid sequence intubation
Sedation Cardiac Cath Lab ARDS
Delirium CABG Pneumothorax
Hemodynamics Common Chest tubes
rhythm/treatments
ABGs
STUDY GUIDE SNAPSHOT
• Communication and Collaboration o SBAR (Situation, Background, Assessment,
Recommendation) o Steps and examples
• Interdisciplinary Teams o Roles & responsibilities, importance of teamwork &
communication o Delegation to UAP = follow 5 rights of delegation (no
delegating nursing process)
o Scope of practice, monitoring & follow-up
• Ethical and Legal Considerations o Ethical dilemmas, med errors, legal
implications, & support (educate & report)
• Clinical Prioritization and Decision Making o Prioritization of Critical Conditions
(ABCs) o MI, Angina, Tamponade, SOB, ABGs, PE, Pneumothorax, Flash
pulmonary edema
• Pharmacology (Indications, Contraindications, Mechanism of Action,
Side Effects) o Sedatives & Analgesics
Dexmedetomidine hydrochloride vs. Propofol
Propofol adverse effects: what labs should be monitored?
Lipid panel o Vasoactive & Emergency
Meds Norepinephrine = hypotension
Atropine = bradycardia (1 mg q3-5 mins x 3 doses)
Epinephrine = cardiac arrest (1 mg q3-5 mins)
Vasopressin (alternative for Epi) o Sedatives & Paralytics
Lorazepam (anxiolytic) What med can this replace?
.
, lOMoAR cPSD| 47061011
2
Morphine (opioid analgesic and venous dilator)
Vecuronium (paralytic used in RSI)
Succinylcholine (paralytic used in RSI)
• Richmond Agitation Sedation Scale (RASS) o Purpose and scoring, titrating
meds based on scale
• Delirium o CAM-ICU
o Delirium - causes & preventative measures | assessment & management
• Hemodynamics & Monitoring o Central Venous Pressure (CVP) and Cardiogenic
Shock
Measurement & interpretation
• Low = hypovolemia or vasodilation
• High = right HF, tension pneumo, tamponade, pulmonary HTN
Indicated meds and/or fluids
• Low = IV fluids (0.9% sodium chloride) or vasopressors
• High = Inotropes, Vasodilators, treat cause (chest tube, etc)
ScvO2 = venous O2 sat = how body uses O2
Normal = sufficient O2 to meet metabolic demands o Arterial Line
Management
Insertion, maintenance, & troubleshooting
• Allen test
• Assessment
• Phlebostatic Axis
Do NOT administer meds in an art line!
Recognizing abnormal findings
• Overdamped/Underdamped wave forms
• Severe pain, swelling, redness, bleeding,
delayed cap refill • Cardiovascular Meds & Interventions o
Nitroglycerin
Indications, contraindications, and mechanism of action o Diltiazem for
AF with RVR
Contraindications & administration guidelines
o Amiodarone o Heparin Therapy
Monitor labs: Hct, Platelets, APTT
Adverse reactions & management
• Heparin-Induced Thrombocytopenia (HIT)
• Argatroban
• Cardiomyopathy Management (Dilated cardiomyopathy most common) o
Contraindicated meds = vasodilators o Anticoagulants & indications
Cardiomyopathy can cause dysrhythmias = clots = stroke
• Heart Failure Meds o Adverse effects of diuretics
.
, lOMoAR cPSD| 47061011
3
Potassium wasting vs potassium sparing o Spironolactone in
end-stage HF
Complications of noncompliance with diuretics
Edema, pulmonary edema, electrolyte imbalances
• Interventional Cardiology o Ablation for A-fib in the cardiac cath lab
Post-procedure care
Normal expectations = free of arrythmia/symptoms!
o Intra-Aortic Balloon Pump (IABP)
Indications and operation? Inflate during diastole! Helps heart!
• Differentiating MI from angina (Please review chart in detailed review below) o
Stable angina = predictable & alleviated with rest o Unstable = unpredictable,
NOT relieved by rest, relieved by NTG!
o MI = Heart attack! Pain not relieved by NTG! Red flag
NSTEMI
• Partial occlusion, elevated trop, no significant ST elevation
STEMI
• Complete occlusion, elevated trop, ST elevations
• Cardiac catheterization o Medications to be held?
IV Contrast is used! Think of renal function & DM meds!
o Post-coronary angiography care o Discharge Education and Home Care o Ablation
for A-fib Post-procedure education
Normal expectations = free of arrythmia/symptoms! o Intra-Aortic
Balloon Pump (IABP)
Indications & operation? Helps heart! Inflate during diastole!
o Pacemaker placement care and assessment
Carry pacemaker card, avoid magnets
Assess LOC
• CABG
o Post-procedure education
No bending at the waist, heavy lifting, or lifting arms above head!
• ACLS Cardiac Rhythm Management o All patients: Tele monitor, Defib pads,
Remove jewelry, NPO,
Proper position o STEMI (ST-Elevation Myocardial Infarction) = tombstones!
ONAM (Oxygen, Nitroglycerin, Aspirin, Morphine) Notify cath lab
.
, lOMoAR cPSD| 47061011
4
Reperfusion therapy to prevent worsening ischemia/injury!
Dietary modifications –DASH diet! Low sodium, no saturated/trans fats
o Atrial Fibrillation with Rapid Ventricular Response (A-Fib RVR) & Atrial Flutter
Stable?
• Diltiazem (or other CCB, BB Unstable?
• Synchronized Cardioversion (need to be anticoagulated asap)
o Supraventricular Tachycardia (SVT)
Stable?
• Vagal Adenosine (6mg, 12mg) Synchronized Cardioversion
Unstable?
• Synchronized Cardioversion
o Ventricular Tachycardia with a Pulse
Synchronized Cardioversion o Pulseless Ventricular Tachycardia (pVT) &
Ventricular Fibrillation (VF or V-Fib) DEFIBRILLATE!!!
CPR & EPI
Amiodarone 1st dose = 300mg, 2nd dose = 150mg o Asystole & Pulseless
Electrical Activity (PEA)
NO SHOCK!!!
CPR & EPI o
Bradycardia & Blocks Monitor if asymptomatic
Atropine if symptomatic sinus brady, 1st degree, or 2nd degree Type I
• 1 mg q3-5mins x 3 doses Max dose = 3mg
• Atropine contraindicated in 2nd degree Type II & 3rd degree blocks
Pace
• For 2nd degree Mobitz Type II & 3rd degree OR no response to Atropine
• Respiratory Care o Acute Respiratory Failure
S/Sx of worsening condition requiring MD notification
Confusion, anxiety, worsening dyspnea, lethargy
o Trauma
Blunt chest trauma
• Flail Chest = paradoxical chest movement o Pneumothorax
Diminished/Absent unilateral breath sounds
o Tension Pneumothorax
Tracheal deviation & tamponade
Excessive air in pleural space cannot escape!
Tamponade
• Beck’s Triad o Muffled heart sounds
o JVD
o Hypotension
o Know the immediate interventions for all of these conditions!
• Mechanical Ventilation Management o Pressure ALARMS: High vs. Low (Use HOLD
mnemonic!)
By performance
