02.12 Myocardial Infarction- Inferior Wall for CCRN Review
Nursing Points General Inferior Wall MI (Myocardial Infarction) Supplied by R coronary artery Complications Sinus node Heart rate bradycardia Lightheaded, ringing in ears -> lie flat with legs up -> brings blood to atria (releases natriuretic hormone and increases HR) AV node Atria-ventricle ‘disconnection’ Complete heart block 3rd degree heart block (multiple p waves for […]
02.13 Myocardial Infarction – Anterior Septal Wall for CCRN Review
Nursing Points General Anterior Septal Wall MI (Myocardial Infarction) Supplied by Left anterior descending Complications Bundle of his Mobitz 2 (constant PR interval) Tx-> pacemaker Bundle branches Right bundle branch block (BBB) Tx-> pacemaker Ventricular septum Ventricular septal defect Tx-> surgery
02.14 Shock Stages for CCRN Review
Nursing Points General Shock Stages Compensatory stage Body attempts to restore homeostatis Cardiac output decreased Sympathetic Nervous System -> releases adrenaline -> causes vessels to constrict systemically Result Improved cardiac output Improved blood pressure Progressive stage Vessels dilate systemically -> low blood pressure & decreased cardiac output
02.15 Hypovolemic Shock for CCRN Review
Nursing Points General Hypovolemic Shock Compensatory symptoms Anxiety and irritability Increased heart rate (HR) Decreased pallor Less output Progressive symptoms Lethargic Low BP Low PCWP Treatment IV fluids (increase circulatory volume) Crystalloids NS (Normale Saline) Lactated Ringers Colloids
02.16 Cardiogenic Shock for CCRN Review
Nursing Points General Cardiogenic Shock Cause MI CHF Arrhythmia Cardiac tamponade Papillary muscle rupture Assessment Confusion Increased respirations Increased HR Venous distention Low BP Decreased urine output Low PCWP Treatment -> Intra-aortic balloon pump (IABP) Deflate during systole Inflate during diastole Purpose Decrease afterload and heart’s demand for oxygen Increase perfusion of heart and cardiac […]
02.17 Septic Shock for CCRN Review
Nursing Points General Septic Shock Caused by bacteria (usually gram -) At-risk Elders Severe burn Alcohol and drug abusers Surgery Immunosuppressed Long hospitalizations Patho Bacteria releases endotoxin -> many harmful substances released causes vasodilation (pool blood in capillary bed) First stage Confusion (due to endotoxin) Increased cardiac output (due to endotoxin) Increased RR (due to […]
03.01 Syndrome of Inappropriate Antidiuretic hormone (SIADH) for CCRN Review
Nursing Points General SIADH (Syndrome of Inappropriate Antidiuretic Hormone) Elevated ADH (Antidiuretic Hormone) Antidiuretic hormone (ADH) make kidneys retain fluid Decreased sodium levels due to dilution Decreased osmolarity (normal 275-295) due to dilution Quick formula = sodium level x 2 Decreased urine output Causes (that increase ADH) Oat cell carcinoma -> tumor in lung apices […]
03.02 Diabetes Insipidus for CCRN Review
Nursing Points General Diabetes Insipidus Nephrogenic ADH (Antidiuretic Hormone) present Kidneys not responsive Cause -> increased calcium level Central Absence of ADH (Antidiuretic Hormone) Kidneys release all water -> increased diluted urine output (specific gravity 1.001-1.005) Increased sodium Increased osmolarity Cause Issues with head Medications (Dilantin, Lithium) Complication -> hypovolemia -> shock Treatment ADH (Pitressin) […]
03.03 Hypoglycemia for CCRN Review
Nursing Points General Hypoglycemia Cardiac symptoms Caused by adrenaline released by adrenal medulla -> cause liver to convert glycogen into glucose (to bring blood sugar up) High HR Palpitations Diaphoretic Irritable and restless CNS symptoms Why? No glycogen available (ex: alcohol) Beta-blockers (no adrenaline -> no cardio signs) Brain cells die Confusion Lethargic Slurred speech […]
03.04 DKA vs HHNK for CCRN Review
Nursing Points General DKA (Diabetic Ketoacidosis) vs HHNK (Hyperglycemic Hyperosmolar Non-Ketotic Coma) Diabetic ketoacidosis Blood sugar 400-900 Dehydrated No insulin Fat is broken down for energy -> ketones released -> acidosis -> kussmaul breathing When in acidosis, should have elevated K+ Normally -> K+ increased 0.6 for every drop in PH of 0.1 Acid moves […]