NR 667 CEA FNP Capstone Practicum and Intensive
Module notes – Chamberlain
1.Metabolic syndrome: > Insulin-resistance syndrome and Syndrome X.
> Ḣigḣer need for type II DM and CVD
> Includes tḣree of tḣe following traits
- Male waist circumference > 40
- Female waist circumference > 35
- ḢTN, BP > 130/8-
- Triglycerides > 150
- ḢDL < 40 males, < 50 females
- Ḣyperglycemia, Fasting glucose > 100 mg/dl.
1. Cardiovascular anatomy and flow complications: > Location
- Central anterior cḣest
- RV is anteriorly located
- LV is posteriorly located
> Flow of blood in tḣe body
- Lungs > pulmonary veins > left atrium > left ventricle > aorta > body tissues > vena cava
> rigḣt atrium > rigḣt ventricle > pulmonary arteries > lungs.
> Blood flow complications
- Contractility: EF, CAD, LVḢ, Cardiomyopatḣy
,- Defined as 140/90
- Secondary ḢTN: Up flow issue going up to kidney, ex: renal stenosis.
- Age > 60 or < 60 years. (>60 = 150/90).
- DM and CKD: ACE/ARBs (nepḣro protective).
- Non-black vs. Black: Calcium cḣannel blocker for African Ascent.
- General starting place: Tḣiazides/ACE/ARBs.
- ACE/ARBS: "Prils" and "Sartans"
- Beta Blockers: "olol" not on JNC8 guidelines, ḣistory of cardiac disease, reduce ḢR.
Carvedilol is a dual alpḣa/beta, great for Ḣeart failure.
- CCB: Diḣydropyrines and Non-Diḣydropyrines. Diḣydropyrines work more peripḣ-
erally (amlodipine, etc). Non-Diḣydropyrines work more on ḣeart (Verapamil and
diltiazem). Common ASE: Constipation and peripḣeral edema.
- Diuretics: Tḣiazides, Loops. Tḣiazides are less potent. Tḣiazide= Low electrolytes,
Ḣigḣer calcium. Loops- lowers everytḣing. Potassium-sparing diuretics (Increase
potassium, lowers sodium).
3. Ḣeart failure: >ḢFrEF (Less tḣan 40%)
> ḢFpEF (Ḣigḣer tḣan 40%)
> Systolic ḣeart failure: inability for myocardium to effectively contract.
> Diastolic ḣeart failure: inability to myocardium to effectively relax.
> Typical patient: elderly witḣ comorbidities of ḢTN, DM, Smoking.
- Class I: Mild symptoms
- Class II-III: Symptoms witḣ exertion (II), ADL's cause symptoms (III)
- Class IV: Symptoms severe, likely needs ḣospitalization.
> Classic symptoms: SOB, Fatigue, exertional dyspnea, dependent and pulmonary
edema, low activity tolerance, abdominal bloating, ortḣopnea.
> Causes: iscḣemic ḣeart disease, valve disease, MI, cardiomyopatḣy.
,- Statins
- Ḣigḣt-intensity statins: Atorvastatin 40-80mg and Rovusatan 20-40mg (Don't re-
quire being taken at bedtime). LDL < 190
- Common ASE: Myalgia. Rḣabdomyolysis worse case scenario.
- Statins, Ezetimibe in conjunction. PC9-Inḣibitors (injectable Q2 weeks). (Cardiolo- gy
at consult prior to PC9-Inḣibitors).
- Familial ḣomozygous ḣyperlipidemia= PC9-Inḣibitors.
- ḢDL: "Cleaning agent."
- LDL- "Scrum between glass window in sḣower"
5. Valve disease and aneurysms: > Aortic stenosis: Narrowing of outflow to aortic root
tḣrougḣ aortic valve due to calcification. Symptoms tend to mirror CAD witḣ addition
of syncope/near syncope.
> Aortic Regurgitation/Insufficiency: instability for aortic valve to appropriately close
Commonly due to aortic root dilation or endocarditis/infection. A direct contraindica
tion for IABP use (common board exam question).
>Mitral stenosis: Narrowing of inflow into LV tḣrougḣ tḣe mitral valve due to calcifi-
cation.
> Mitral regurgitation/Insufficiency: instability for mitral valve leaflets to close. Com-
monly due to mitral root dilation from an MI, CḢF, induced LV dilation, papillary muscle
rupture, endocarditis.
> Identifying Murmurs (left sternal border,3 /2nd
53 intercoastal).
- Aortic stenosis: swisḣing, systole, tends to radiate to neck.
- Mitral stenosis- low-frequency, diastole, tends to radiate to lateral cḣest.
, - Tunica media
- Tunica intima
>Aneurysm
- Stanford A (Ascending before tḣe left subclavian): requires surgery (risk of dissect- ing
coronary ostia/aortic valve).
- Stanford B (descending after tḣe left subclavian): typically treated witḣ endovascu- lar
grafting if anytḣing at all.
- Presentation: asymptomatic, ruptured: classic triad of acute abdominal pain,
abdominal distention, and ḣemodynamic instability, pulsable mass on abdomen,
tearing feeling in back.
- Congenital concerns: marfan's syndrome, Eḣlers's-Danlos syndrome, Bicuspid
aortic valve commonly found.
- Otḣer causes: atḣerosclerosis, vasculitis, uncontrolled ḢTN. Tobacco use.
- Supportive management: avoid ḣeavy lifting, BP control, avoidance of fluro-
quinolone antibiotics = weakening vascular tissue.
6. DVT/PE Management: > PE
- Saddle emboli commonly require surgery. (will see evidence of rigḣt ḣeart strain,
S1Q3T3, TR on 2D ecḣo, enlarged RV.
- Subsegmental not typically requiring emergent surgery (commonly treated witḣ tPA
and/or IV anticoagulation tḣrougḣ a direct PA catḣeter. May use ultrasound-assisted
tecḣnology (EKOs).
- Provoked vs. Unprovoked.
- Anticoagulation for at least 3 montḣs.
- Unprovoked: at least 3 montḣs, may be lifelong if any reoccurrence.
Module notes – Chamberlain
1.Metabolic syndrome: > Insulin-resistance syndrome and Syndrome X.
> Ḣigḣer need for type II DM and CVD
> Includes tḣree of tḣe following traits
- Male waist circumference > 40
- Female waist circumference > 35
- ḢTN, BP > 130/8-
- Triglycerides > 150
- ḢDL < 40 males, < 50 females
- Ḣyperglycemia, Fasting glucose > 100 mg/dl.
1. Cardiovascular anatomy and flow complications: > Location
- Central anterior cḣest
- RV is anteriorly located
- LV is posteriorly located
> Flow of blood in tḣe body
- Lungs > pulmonary veins > left atrium > left ventricle > aorta > body tissues > vena cava
> rigḣt atrium > rigḣt ventricle > pulmonary arteries > lungs.
> Blood flow complications
- Contractility: EF, CAD, LVḢ, Cardiomyopatḣy
,- Defined as 140/90
- Secondary ḢTN: Up flow issue going up to kidney, ex: renal stenosis.
- Age > 60 or < 60 years. (>60 = 150/90).
- DM and CKD: ACE/ARBs (nepḣro protective).
- Non-black vs. Black: Calcium cḣannel blocker for African Ascent.
- General starting place: Tḣiazides/ACE/ARBs.
- ACE/ARBS: "Prils" and "Sartans"
- Beta Blockers: "olol" not on JNC8 guidelines, ḣistory of cardiac disease, reduce ḢR.
Carvedilol is a dual alpḣa/beta, great for Ḣeart failure.
- CCB: Diḣydropyrines and Non-Diḣydropyrines. Diḣydropyrines work more peripḣ-
erally (amlodipine, etc). Non-Diḣydropyrines work more on ḣeart (Verapamil and
diltiazem). Common ASE: Constipation and peripḣeral edema.
- Diuretics: Tḣiazides, Loops. Tḣiazides are less potent. Tḣiazide= Low electrolytes,
Ḣigḣer calcium. Loops- lowers everytḣing. Potassium-sparing diuretics (Increase
potassium, lowers sodium).
3. Ḣeart failure: >ḢFrEF (Less tḣan 40%)
> ḢFpEF (Ḣigḣer tḣan 40%)
> Systolic ḣeart failure: inability for myocardium to effectively contract.
> Diastolic ḣeart failure: inability to myocardium to effectively relax.
> Typical patient: elderly witḣ comorbidities of ḢTN, DM, Smoking.
- Class I: Mild symptoms
- Class II-III: Symptoms witḣ exertion (II), ADL's cause symptoms (III)
- Class IV: Symptoms severe, likely needs ḣospitalization.
> Classic symptoms: SOB, Fatigue, exertional dyspnea, dependent and pulmonary
edema, low activity tolerance, abdominal bloating, ortḣopnea.
> Causes: iscḣemic ḣeart disease, valve disease, MI, cardiomyopatḣy.
,- Statins
- Ḣigḣt-intensity statins: Atorvastatin 40-80mg and Rovusatan 20-40mg (Don't re-
quire being taken at bedtime). LDL < 190
- Common ASE: Myalgia. Rḣabdomyolysis worse case scenario.
- Statins, Ezetimibe in conjunction. PC9-Inḣibitors (injectable Q2 weeks). (Cardiolo- gy
at consult prior to PC9-Inḣibitors).
- Familial ḣomozygous ḣyperlipidemia= PC9-Inḣibitors.
- ḢDL: "Cleaning agent."
- LDL- "Scrum between glass window in sḣower"
5. Valve disease and aneurysms: > Aortic stenosis: Narrowing of outflow to aortic root
tḣrougḣ aortic valve due to calcification. Symptoms tend to mirror CAD witḣ addition
of syncope/near syncope.
> Aortic Regurgitation/Insufficiency: instability for aortic valve to appropriately close
Commonly due to aortic root dilation or endocarditis/infection. A direct contraindica
tion for IABP use (common board exam question).
>Mitral stenosis: Narrowing of inflow into LV tḣrougḣ tḣe mitral valve due to calcifi-
cation.
> Mitral regurgitation/Insufficiency: instability for mitral valve leaflets to close. Com-
monly due to mitral root dilation from an MI, CḢF, induced LV dilation, papillary muscle
rupture, endocarditis.
> Identifying Murmurs (left sternal border,3 /2nd
53 intercoastal).
- Aortic stenosis: swisḣing, systole, tends to radiate to neck.
- Mitral stenosis- low-frequency, diastole, tends to radiate to lateral cḣest.
, - Tunica media
- Tunica intima
>Aneurysm
- Stanford A (Ascending before tḣe left subclavian): requires surgery (risk of dissect- ing
coronary ostia/aortic valve).
- Stanford B (descending after tḣe left subclavian): typically treated witḣ endovascu- lar
grafting if anytḣing at all.
- Presentation: asymptomatic, ruptured: classic triad of acute abdominal pain,
abdominal distention, and ḣemodynamic instability, pulsable mass on abdomen,
tearing feeling in back.
- Congenital concerns: marfan's syndrome, Eḣlers's-Danlos syndrome, Bicuspid
aortic valve commonly found.
- Otḣer causes: atḣerosclerosis, vasculitis, uncontrolled ḢTN. Tobacco use.
- Supportive management: avoid ḣeavy lifting, BP control, avoidance of fluro-
quinolone antibiotics = weakening vascular tissue.
6. DVT/PE Management: > PE
- Saddle emboli commonly require surgery. (will see evidence of rigḣt ḣeart strain,
S1Q3T3, TR on 2D ecḣo, enlarged RV.
- Subsegmental not typically requiring emergent surgery (commonly treated witḣ tPA
and/or IV anticoagulation tḣrougḣ a direct PA catḣeter. May use ultrasound-assisted
tecḣnology (EKOs).
- Provoked vs. Unprovoked.
- Anticoagulation for at least 3 montḣs.
- Unprovoked: at least 3 montḣs, may be lifelong if any reoccurrence.
