Adult Health II (Med-Surg II) Nursing Bundle
Condensed Exam Notes + Clinical Care Maps
Condensed exam study guides for Adult Health II (Med-Surg II) nursing, plus two graded concept care maps
from clinical practice.
Includes:
- AH2 Exam 1 Review
- AH2 Exam 2 Review
- AH2 Exam 3 + Final Review
- 2 Clinical Care Maps on Small Bowel Obstruction and Post-Panniculectomy Hypovolemia & Infection
**Bolded content reflects material emphasized and tested at a top 10 U.S. BSN program.**
Perfect for exam prep, clinical documentation examples, and NCLEX review.
Page 1
,Lecture 1: ECG Rhythm Strip Interpretation
Cardiac physiology
● Systole is the simultaneous contraction of ventricles ejecting blood
● Diastole is ventricular relaxation / when ventricles passively fill from atria- this number
should be lower
● Normal HR is 60-100 bpm
● Stroke volume is the volume of blood pumped out of ventricles in one contraction
○ Normal is 60-130 ml
● Cardiac output is the amount of blood pumped by the left ventricle in one minute
○ SV x HR
○ Normal is 4-8 L/min
● Preload is the volume and stretch of ventricular muscle at the end of diastole
○ How much does it have to stretch to fill with blood before being pumped out?
● Afterload is the amount of pressure in systemic circulation which the left ventricle must
work against during diastole (clinically measure by systolic blood pressure)
○ Example: you can’t just walk through a gate, you have to put pressure to actually
open the door
Cardiac Electrical Conduction
● This is what an ECG measures!
● The SA node is the pacemaker of the heart; intrinsic rate 60-100
○ Like the ignition of the car, starts the heart engine
● The internodal pathways are 4 paths that conduct from SA to AV
● The AV node is the gatekeeper with a slight delay; intrinsic rate 40-60
○ Picks up from SA node if SA node doesn’t do its job
○ Acts like a speed bump
○ Contributes to lower HR
● The Bundle of His divides into right and left bundle branches
● The Purkinje fibers conduct through the ventricles; intrinsic rate 20-40
○ Second speed bump/detour if AV node doesn’t do its job
○ Contributes to even lower HR
● Automaticity: allows the heart tissue to initiate an impulse
● Rhythmicity: allows impulses to form at regular intervals w/o an outside stimulus
○ lub/dub lub/dub at regular intervals
● Conductivity: once an impulse is initiated, allows it to travel through myocardium
● Contractility: ability of cardiac cells to shorten and contract
● Excitability: ability to respond to an outside stimulus
○ Example: gunshot wound > heart picks up and goes faster/responds
ECG Lead Placement
● White on right
● Clouds above grass
, ● Smoke above fire
● Brown in the middle
Interpreting an ECG Rhythm Strip
● The P wave is the SA node impulse and atrial depolarization
● The PR interval represents delay at the AV node
● The QRS complex is when the Bundle of His and Purkinje fibers impulse and
ventricular depolarization
● The ST segment is the end of ventricular depolarization and beginning of repolarization
● The T wave is ventricular repolarization (rest)
● The Isoelectric line is the normal flatline between beats (baseline)
Interpreting and Measuring an ECG Strip
● Normal measurements
○ PR interval is 0.12 - 0.2 seconds
○ QRS wave is 0.04 - 0.1 seconds
○ QT interval is 0.36 - 0.44 seconds
● Eight step method
○ Regular or irregular? Any ectopic beats?
○ What is the rate?
○ Is the P wave upright? Rounded? Present before each QRS?
○ Measure PR interval
○ Measure QRS complex
○ Examine ST segment and T wave- upright? Rounded? Inverted?
■ Should come back to isoelectric line
○ Measure QT interval
○ Interpret the rhythm!
Different dysrhythmias and blocks on ECG: separate sheet
Lecture 2: Acute Cardiovascular Conditions
Heart Failure Review: Clinical Manifestations
● Impaired forward flow
○ Decreased blood to the brain
■ Vertigo, syncope, confusion, anxiety
○ Decreased blood to the heart
■ Hypotension, palpitations, angina
■ Tachycardia- trying to compensate for less volume w/ more force
○ Decreased blood to kidneys
■ Decreased urine output
○ Decreased blood to GI
■ Ileus or abdominal distention
, ○ Decreased blood to skin
■ Pale, cyanosis
○ Fatigue, activity intolerance, impaired oxygen exchange
■ Decreased O2 sat
● Increase in backward flow
○ Back up to left atrium and lungs
■ Pulmonary congestion and dyspnea, orthopnea, rales and crackles,
dyspnea on exertion, cough
○ Back up to inferior vena cava
■ Pedal edema, edema in dependent areas, hepatomegaly, weight
gain, ascites, nausea, anorexia
○ Back up to superior vena cava
■ JVD
Acute Decompensated Heart Failure
● Sudden onset of left ventricular heart failure
○ Exacerbation of chronic heart failure
○ Result of an acute event
● Manifests as acute pulmonary edema
○ Accumulation of fluid in interstitial spaces and alveoli
● Can lead to acute respiratory failure and death
Pulmonary edema pathophysiology and assessment
● Can develop slowly or very quickly
○ Flash pulmonary edema- sudden
● Ventricle cannot handle the volume overload
● Blood volume and pressure build in left atrium
○ Rapid increase in atrial pressure leads to increase in pulmonary venous pressure
leads to forcing of fluid out of pulmonary capillaries
■ Lungs start to drown!
■ Fluid in alveoli mixes with air causing PINK FROTHY SPUTUM
■ Impairs gas exchange and leads to hypoxemia
● Decreased O2 sat and cyanosis
● Increasing restlessness and anxiety
● Sudden onset of SOB, feeling of suffocation, noisy breathing patterns, coughing,
decreased O2 sat, cyanosis
● Immediate diagnostic assessment
○ Place on cardiac monitor
○ Labs: ABG, chemistry
○ CMP, chest xray
Acute decompensated HF assessment and interventions
● Neuro: confusion, dilated pupils
Condensed Exam Notes + Clinical Care Maps
Condensed exam study guides for Adult Health II (Med-Surg II) nursing, plus two graded concept care maps
from clinical practice.
Includes:
- AH2 Exam 1 Review
- AH2 Exam 2 Review
- AH2 Exam 3 + Final Review
- 2 Clinical Care Maps on Small Bowel Obstruction and Post-Panniculectomy Hypovolemia & Infection
**Bolded content reflects material emphasized and tested at a top 10 U.S. BSN program.**
Perfect for exam prep, clinical documentation examples, and NCLEX review.
Page 1
,Lecture 1: ECG Rhythm Strip Interpretation
Cardiac physiology
● Systole is the simultaneous contraction of ventricles ejecting blood
● Diastole is ventricular relaxation / when ventricles passively fill from atria- this number
should be lower
● Normal HR is 60-100 bpm
● Stroke volume is the volume of blood pumped out of ventricles in one contraction
○ Normal is 60-130 ml
● Cardiac output is the amount of blood pumped by the left ventricle in one minute
○ SV x HR
○ Normal is 4-8 L/min
● Preload is the volume and stretch of ventricular muscle at the end of diastole
○ How much does it have to stretch to fill with blood before being pumped out?
● Afterload is the amount of pressure in systemic circulation which the left ventricle must
work against during diastole (clinically measure by systolic blood pressure)
○ Example: you can’t just walk through a gate, you have to put pressure to actually
open the door
Cardiac Electrical Conduction
● This is what an ECG measures!
● The SA node is the pacemaker of the heart; intrinsic rate 60-100
○ Like the ignition of the car, starts the heart engine
● The internodal pathways are 4 paths that conduct from SA to AV
● The AV node is the gatekeeper with a slight delay; intrinsic rate 40-60
○ Picks up from SA node if SA node doesn’t do its job
○ Acts like a speed bump
○ Contributes to lower HR
● The Bundle of His divides into right and left bundle branches
● The Purkinje fibers conduct through the ventricles; intrinsic rate 20-40
○ Second speed bump/detour if AV node doesn’t do its job
○ Contributes to even lower HR
● Automaticity: allows the heart tissue to initiate an impulse
● Rhythmicity: allows impulses to form at regular intervals w/o an outside stimulus
○ lub/dub lub/dub at regular intervals
● Conductivity: once an impulse is initiated, allows it to travel through myocardium
● Contractility: ability of cardiac cells to shorten and contract
● Excitability: ability to respond to an outside stimulus
○ Example: gunshot wound > heart picks up and goes faster/responds
ECG Lead Placement
● White on right
● Clouds above grass
, ● Smoke above fire
● Brown in the middle
Interpreting an ECG Rhythm Strip
● The P wave is the SA node impulse and atrial depolarization
● The PR interval represents delay at the AV node
● The QRS complex is when the Bundle of His and Purkinje fibers impulse and
ventricular depolarization
● The ST segment is the end of ventricular depolarization and beginning of repolarization
● The T wave is ventricular repolarization (rest)
● The Isoelectric line is the normal flatline between beats (baseline)
Interpreting and Measuring an ECG Strip
● Normal measurements
○ PR interval is 0.12 - 0.2 seconds
○ QRS wave is 0.04 - 0.1 seconds
○ QT interval is 0.36 - 0.44 seconds
● Eight step method
○ Regular or irregular? Any ectopic beats?
○ What is the rate?
○ Is the P wave upright? Rounded? Present before each QRS?
○ Measure PR interval
○ Measure QRS complex
○ Examine ST segment and T wave- upright? Rounded? Inverted?
■ Should come back to isoelectric line
○ Measure QT interval
○ Interpret the rhythm!
Different dysrhythmias and blocks on ECG: separate sheet
Lecture 2: Acute Cardiovascular Conditions
Heart Failure Review: Clinical Manifestations
● Impaired forward flow
○ Decreased blood to the brain
■ Vertigo, syncope, confusion, anxiety
○ Decreased blood to the heart
■ Hypotension, palpitations, angina
■ Tachycardia- trying to compensate for less volume w/ more force
○ Decreased blood to kidneys
■ Decreased urine output
○ Decreased blood to GI
■ Ileus or abdominal distention
, ○ Decreased blood to skin
■ Pale, cyanosis
○ Fatigue, activity intolerance, impaired oxygen exchange
■ Decreased O2 sat
● Increase in backward flow
○ Back up to left atrium and lungs
■ Pulmonary congestion and dyspnea, orthopnea, rales and crackles,
dyspnea on exertion, cough
○ Back up to inferior vena cava
■ Pedal edema, edema in dependent areas, hepatomegaly, weight
gain, ascites, nausea, anorexia
○ Back up to superior vena cava
■ JVD
Acute Decompensated Heart Failure
● Sudden onset of left ventricular heart failure
○ Exacerbation of chronic heart failure
○ Result of an acute event
● Manifests as acute pulmonary edema
○ Accumulation of fluid in interstitial spaces and alveoli
● Can lead to acute respiratory failure and death
Pulmonary edema pathophysiology and assessment
● Can develop slowly or very quickly
○ Flash pulmonary edema- sudden
● Ventricle cannot handle the volume overload
● Blood volume and pressure build in left atrium
○ Rapid increase in atrial pressure leads to increase in pulmonary venous pressure
leads to forcing of fluid out of pulmonary capillaries
■ Lungs start to drown!
■ Fluid in alveoli mixes with air causing PINK FROTHY SPUTUM
■ Impairs gas exchange and leads to hypoxemia
● Decreased O2 sat and cyanosis
● Increasing restlessness and anxiety
● Sudden onset of SOB, feeling of suffocation, noisy breathing patterns, coughing,
decreased O2 sat, cyanosis
● Immediate diagnostic assessment
○ Place on cardiac monitor
○ Labs: ABG, chemistry
○ CMP, chest xray
Acute decompensated HF assessment and interventions
● Neuro: confusion, dilated pupils
