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Atrial Flutter

Atrial Flutter

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Brad Bass
ASN,RN
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Included In This Lesson

Study Tools
Outline
Transcript
Additional Lessons

Study Tools For Atrial Flutter

Atrial Flutter (Image)
10 Common EKG Heart Rhythms (Cheatsheet)
EKG Chart (Cheatsheet)
Heart Rhythms Signs and Symptoms (Cheatsheet)
Heart Rhythm Identification (Cheatsheet)
Atrial Fibrillation Cheatsheet (Cheatsheet)
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Outline

Overview of Atrial Flutter

  1. Atrial flutter
    1. Irritable cells produce additional electrical impulse in atria
      1. Causes atria to flutter at a fast rate
        1. 250-300 bpm
      2. AV node blocks most of the electrical impulses from reaching the ventricles
        1. Atria contract faster than ventricles

Nursing Points for Atrial Flutter

General

  1. Characteristics of Atrial flutter
    1. Rhythm
      1. Irregular
      2. Regular at times
    2. Rate
      1. Atrial rate
        1. 250-300 bpm
        2. Sawtooth
      2. Ventricular rate
        1. 60-100 bpm
        2. >100 bpm
    3. P:QRS ratio
      1. Variable
        1. 4:1 or 5:1
    4. PR interval
      1. Not measurable
    5. QRS complex
      1. 0.06-0.12 seconds
        1. Varies depending on ventricular rate
  2. Nursing Interventions
    1. Acute or chronic
    2. Assess for s/s of stroke
      1. Blood pooling in atria
        1. Increased risk for clots

Assessment

  1. Patient Presentation
    1. Palpitations
    2. Chest pain
    3. Lightheaded/Syncope
  2. Acute or Chronic
  3. Atrial and ventricular rates
  4. Decreased Cardiac Output
    1. Syncope
    2. Hypotension
  5. PT/INR
    1. If taking Coumadin

Therapeutic Management for Atrial Flutter

  1. Medications
    1. Antiarrhythmics
    2. Beta Blockers
    3. Calcium Channel Blockers
    4. Anticoagulants
  2. Cardioversion
    1. Synchronized
  3. Ablations

Nursing Concepts

  1. EKG Rhythms
  2. Perfusion
  3. Clotting

Patient Education

  1. Do not miss a dose of on anticoagulants
    1. Check PT/INR
  2. Check radial pulse
    1. Report if >100
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Transcript

Hey guys, my name is Brad, and welcome to nursing.com. And in today’s video, what we’re going to be doing is we’re going to be discussing atrial flutter, also known as a-flutter. I think it’s going to be important to discuss some of the physiology behind a-flutter, as well as some signs and symptoms the patient may experience, how we may treat a patient experiencing a-flutter, and most importantly, for this course, how to identify it on an EKG exam. Let’s dive in. 

So in atrial flutter, this is causing the atria to beat rapidly in unison, right? So atrial flutter, before I continue, is very, very similar to a-fib. We’re going to see that from the signs and symptoms the patient expresses to how we treat them to also the physiology.  Make sure you go check out our course on atrial fibrillation as well, to help bring better clarity to the concept of a-flutter. 

But essentially what we’re seeing is, instead of a normal physiological homeostatic electrical conduction system where we originate at this SA node in our electrical conduction, goes down to the AV node and all the way down to the Purkinje fibers. Instead we have SA node dysfunction, where our sinus rhythms, where our normal electrical impulse originates, we actually have a dysfunctional SA node. And so, as a result, what’s going to happen is instead of our electrical impulses originating in that SA node, going down to the AV node, our electrical impulses actually come from these atrial tissues themselves, which causes a very rapid cyclical, like a firing of electrical impulses that rapidly go around and around inside of that atrial tissue, pretty much producing an atrial rate of approximately 300 beats per minute. Again, remember that that AV node here actually acts as a filter, filtering out a lot of those electrical impulses, because we don’t want 300 beats per minute to actually reach these ventricles. Because if our ventricles were beating at 300 beats per minute, that’s not conducive or compatible with life. So the AV node acts as a filter filtering out those 300 beats per minute down to approximately 150 beats per minute that we’re going to see ventricularly.. 

Now, the way that I like to think about this, and one of the ways in which this is actually different from a A-fib is that it is in unison. It is a coordinated, although very rapid, atrial firing occurring in a coordinated manner. And so the way that I like to think about this is a flock of birds, right? Ignore my drawing. I know it’s amazing. We’re an artist over here. I like to think about a flock of birds, right? A-flutter, birds flying in this “A” pattern, right? And their wings all fluttering together. And you can imagine a flock of birds flying together. They’re all doing so in unison, this is different from a-fib, which is rapid and uncontrolled. This is actually a controlled, although rapid beating of the atrium. 

So again, a lot of the causes and other things that we’re going to see in a-flutter are very similar to a-fib, right? The older you are, the more weak that the conduction system gets. But ischemia, right, lack of perfusion to the heart itself is actually going to end up resulting in these electrical abnormalities, such as a-flutter. 

Now regarding assessment findings. Of course, if our atria are rapidly beating at a rate of 300 beats per minute, palpitations are absolutely going to occur, right? A patient’s heart is just going to be beating away. This is going to cause things such as anxiety, patients feeling anxious, patients feeling like they can’t catch their breath. We have an impaired electrical conduction system, therefore we have an impaired contraction system. Remember the electrical impulses actually cause the contraction, right? If our electrical conduction system is impaired, so is our contraction. And patients could experience shortness of breath. And if that LV is impaired and unable to pump blood out of the heart, as effectively as it normally would, our blood pressure is going to drop as well, which can end up resulting in syncope. 

Now, again, a lot of the therapeutic managements that we’re going to see in a-flutter are very, very similar to what we’re going to see in AFib, right? Again, either physical or mechanical cardioversion. And remember what this is, is essentially we have an incredibly rapid, rapidly firing atria. We need to stop that and restore normal electrical conductivity. We can do that either through physical means such as cardioversion, where we actually place the defibrillation pads connected to a defibrillating machine, normally used in a code, but instead we reduce the amount of power that we hit the patient’s chest with, so to speak, in an attempt to mechanically convert a patient back to a normal rhythm. And chemically, we could use antiarrhythmic medications, such as amiodarone.  Rhythm stabilizers to stabilize this erratic rhythm. Negative chronotropes, again, chronotropes being medications that affect heart rate, negative meaning that it decreases your heart rate. A-flutter, incredibly rapid, rapidly firing heart. We want to decrease that heart rate.  And anticoagulation.  Again, this is something that’s very similar to a-fib, and I didn’t mention it in our initial slide here for a-flutter. But remember if we have this cyclical firing of electrical impulses throughout the atrial tissue at approximately 300 beats per minute, what is happening is these atria are quivering, right? Our atria are quivering instead of contracting right now. Why is that important? As these atria quiver, blood just sits there and that atria stagnant, not moving, not being ejected properly. And as blood sits here, stagnated, that causes clots to form within these atria. And should this clot travel down to a ventricle and then be ejected out of the body, we’re talking about a clot now traveling throughout the body, possibly hitting the brain, causing a stroke, the lungs causing a PE or the heart causing an MI. So anticoagulation adherence is definitely going to be important in a-flutter. 

Now regarding the six step method used to solve for a-flutter, what are we going to see in an EKG strip whenever we see a-flutter? Now, heart rate, we’ll recall atrially, we’re going to see approximately 300 beats per minute and ventricular rate. Regularity. Now, one of the differentiators between AFib and A-flutter is in AFib. we’re seeing an uncontrolled, uncoordinated cyclical firing of electrical impulses within that atrial tissue. Instead in a-flutter, remember we have those birds, that flock of birds in “A” flutter beating away in unison. But normally what we will see here is indeed R to R regularity that we’ll usually check out. 

P to QRS interval. Again, same with a-fib, there are no distinguishable P waves. We just really won’t be able to see that in a-flutter. Instead, the key massive thing that you’re going to use to differentiate a-flutter from anything else is this “saw-tooth” like pattern. You’re going to see what appears to be a “saw-tooth” like pattern. We’ll see that better in our next slide whenever we actually take a look at an example question. But you can almost see that “saw-tooth” morphology on an EKG strip and know without looking at any of the other six steps that what we’re dealing with is a-flutter. That’s how clinically important and differentiating that morphology is.

PR interval. Because there is no distinguishable P wave, you will not be able to see a PR interval length. And QRS length, remembering that the normal was 0.06 to 0.12 seconds. This is indeed what we’re going to see with a-flutter. Let’s go ahead and dive into an example question and close this out. 

So taking a look at a practice question and using the six step method that we use to solve for EKG, the sixth being the solve, let’s actually take a look and implement this. Okay. Now let’s take a look at the heart rate here. Again. What we have is a six second strip. So let’s count each individual QRS complex and multiply by ten. 1, 2, 3, 4, 5, 6, 7, 8.  So we have eight times 10 giving us a heart rate of 80 (8 X 10 = 80) right? Now, 80 beats per minute. I’ve already said that typically what we would see, ventricularly is a heart rate of 150 beats per minute. We can see here, this is actually an example, where that does not always meet the bill, right? But again, this massive differentiator that you can see right from the strip is this “saw-tooth” like pattern, right? All throughout this actual “saw-tooth” appearance, morphology, of this rhythm, you can almost see that and immediately know that what we have is a-flutter. 

The second thing’s going to be that R to R our interval. Again, we’re basically looking at the measurements between, our distances between, our R to R intervals. Again, not always going to be the same. You can see this is a little bit shorter. This is longer. Not always going to be regular, but usually is going to be regular. So in this instance, another instance in this example where we are in a-flutter, but we’re not regular, right? It doesn’t always fit the bill, but morphology is so important. 

So again, P to QRS ratio, is there one P for every QRS? No. Because we cannot see the P wave. Instead, we are positive for this “saw-tooth” morphology. 

Now our PR interval. We cannot see a P wave. So cannot measure a PR interval. 

And regarding our QRS length, we would actually measure the individual lines in between our QRS complex. So we would say we would go, 1, 2 small boxes 0.04 times two equals 0.08 seconds (0.04 X 2 = 0.08). And this is indeed a normal QRS length. 

So to summarize some of our key points associated with a-flutter, remember in a-flutter, the atria are beating rapidly, but they’re beating rapidly in unison. Try and remember the flock of birds fluttering together in unison. As far as the heart rate is concerned, we’re going to see that atrial rate of approximately 300 beats per minute being filtered out by that AV node. Remember this regularity with the R to R interval. Usually we will see a regular R to R interval because those birds are fluttering in unison, right? But not always the case as we saw with our example. Again, you’re not gonna be able to see a PR interval length, nor are you going to be able to see any P waves at all associated with QRS complexes because the atria are beating too rapidly for those P waves to even be identifiable. And with the QRS complex length, this will still remain normal. 

If you need a little additional clarity regarding a-flutter, make sure that you also check out our lesson on a-fib as these two rhythms are very similar to one another. Guys, go out there and be your best selves today. And as always, happy nursing.

 

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Nursing Care Plan (NCP) for Cellulitis
Nursing Care Plan (NCP) for Cardiomyopathy
Nursing Care Plan (NCP) for Cardiogenic Shock
Nursing Care Plan (NCP) for Bowel Obstruction
Nursing Care Plan (NCP) for Blunt Chest Trauma
Nursing Care Plan (NCP) for Benign Prostatic Hyperplasia (BPH)
Nursing Care Plan (NCP) for Bell’s Palsy
Nursing Care Plan (NCP) for Atrial Fibrillation (AFib)
Nursing Care Plan (NCP) for Asthma / Childhood Asthma
Nursing Care Plan (NCP) for Aspiration
Nursing Care Plan (NCP) for Angina
Nursing Care Plan (NCP) for Anemia
Nursing Care Plan (NCP) for Anaphylaxis
Nursing Care Plan (NCP) for Addison’s Disease (Primary Adrenal Insufficiency)
Nursing Care Plan (NCP) for Acute Respiratory Distress Syndrome
Nursing Care Plan (NCP) for Acute Pain
Nursing Care Plan (NCP) for Acute Kidney Injury
Nursing Care Plan (NCP) for Acute Bronchitis
Nursing Care Plan (NCP) for Activity Intolerance
Nursing Care Plan (NCP) for Acquired Immune Deficiency Syndrome (AIDS)
Nursing Care Plan (NCP) for Abdominal Pain
Nursing Care Plan (NCP) & Interventions for Increased Intracranial Pressure (ICP)
Nursing Care and Pathophysiology of Urinary Tract Infection (UTI)
Nursing Care and Pathophysiology of Pneumonia
Nursing Care and Pathophysiology of Osteoporosis
Nursing Care and Pathophysiology of Osteoarthritis (OA)
Nursing Care and Pathophysiology of Nephrotic Syndrome
Nursing Care and Pathophysiology of Myocarditis
Nursing Care and Pathophysiology of Myocardial Infarction (MI)
Nursing Care and Pathophysiology of Hypertension (HTN)
Nursing Care and Pathophysiology of Glomerulonephritis
Nursing Care and Pathophysiology of Diabetic Ketoacidosis (DKA)
Nursing Care and Pathophysiology of Diabetes Mellitus (DM)
Nursing Care and Pathophysiology of Coronary Artery Disease (CAD)
Nursing Care and Pathophysiology of COPD (Chronic Obstructive Pulmonary Disease)
Nursing Care and Pathophysiology of Chronic Kidney (Renal) Disease (CKD)
Nursing Care and Pathophysiology of BPH (Benign Prostatic Hyperplasia)
Nursing Care and Pathophysiology of Angina
Nursing Care and Pathophysiology of Acute Respiratory Distress Syndrome (ARDS)
Nursing Care and Pathophysiology of Acute Kidney (Renal) Injury (AKI)
Nursing Care and Pathophysiology for Valve Disorders
Nursing Care and Pathophysiology for Ulcerative Colitis(UC)
Nursing Care and Pathophysiology for Tuberculosis (TB)
Nursing Care and Pathophysiology for Thrombophlebitis (clot)
Nursing Care and Pathophysiology for Syphilis (STI)
Nursing Care and Pathophysiology for SIRS & MODS
Nursing Care and Pathophysiology for Sickle Cell Anemia
Nursing Care and Pathophysiology for SIADH (Syndrome of Inappropriate antidiuretic Hormone Secretion)
Nursing Care and Pathophysiology for Sepsis
Nursing Care and Pathophysiology for Rheumatoid Arthritis (RA)
Nursing Care and Pathophysiology for Pulmonary Embolism
Nursing Care and Pathophysiology for Pulmonary Edema
Nursing Care and Pathophysiology for Psoriasis
Nursing Care and Pathophysiology for Polycystic Ovarian Syndrome (PCOS)
Nursing Care and Pathophysiology for Pneumothorax & Hemothorax
Nursing Care and Pathophysiology for Parkinsons
Nursing Care and Pathophysiology for Pancreatitis
Nursing Care and Pathophysiology for Myasthenia Gravis
Nursing Care and Pathophysiology for Multiple Sclerosis (MS)
Nursing Care and Pathophysiology for Meningitis
Nursing Care and Pathophysiology for Ischemic Stroke (CVA)
Nursing Care and Pathophysiology for Influenza (Flu)
Nursing Care and Pathophysiology for Inflammatory Bowel Disease (IBD)
Nursing Care and Pathophysiology for Hypovolemic Shock
Nursing Care and Pathophysiology for Hypothyroidism
Nursing Care and Pathophysiology for Hyperparathyroidism
Nursing Care and Pathophysiology for Human Papilloma Virus (HPV STI)
Nursing Care and Pathophysiology for Herpes Zoster – Shingles
Nursing Care and Pathophysiology for Hepatitis (Liver Disease)
Nursing Care and Pathophysiology for Hemorrhagic Stroke (CVA)
Nursing Care and Pathophysiology for Heart Failure (CHF)
Nursing Care and Pathophysiology for Hashimoto’s Thyroiditis
Nursing Care and Pathophysiology for Diverticulosis – Diverticulitis
Nursing Care and Pathophysiology for Distributive Shock
Nursing Care and Pathophysiology for Disseminated Intravascular Coagulation (DIC)
Nursing Care and Pathophysiology for Diabetes Insipidus (DI)
Nursing Care and Pathophysiology for Cushings Syndrome
Nursing Care and Pathophysiology for Crohn’s Disease
Nursing Care and Pathophysiology for Cirrhosis (Liver Disease, Hepatic encephalopathy, Portal Hypertension, Esophageal Varices)
Nursing Care and Pathophysiology for Compartment Syndrome
Nursing Care and Pathophysiology for Cardiogenic Shock
Nursing Care and Pathophysiology for Asthma
Nursing Care and Pathophysiology for Arterial Disorders
Nursing Care and Pathophysiology for Aortic Aneurysm
Nursing Care and Pathophysiology for Anemia
Nursing Care and Pathophysiology for Anaphylaxis
Nursing Care and Pathophysiology for Acquired Immune Deficiency Syndrome (AIDS)
Nuclear Medicine
Norepinephrine (Levophed) Nursing Considerations
Noncardiac Pulmonary Edema for Certified Emergency Nursing (CEN)
Nitroprusside (Nitropress) Nursing Considerations
Nitroglycerin (Nitrostat) Nursing Considerations
Nitro Compounds
NG (Nasogastric)Tube Management
Neurological Fractures
Neurological Disorders (Multiple Sclerosis, Myasthenia Gravis, Guillain-Barré Syndrome) for Certified Emergency Nursing (CEN)
Neurogenic Shock for Certified Emergency Nursing (CEN)
Neostigmine (Prostigmin) Nursing Considerations
Naproxen (Aleve) Nursing Considerations
Myocardial Infarction Nursing Mnemonic (MONATAS)
Myocardial Infarction (MI) Case Study (45 min)
Musculoskeletal Course Introduction
Musculoskeletal Assessment
Murmur locations Nursing Mnemonic (hARD ASS MRS. MSD)
Multiple Sclerosis Symptoms Nursing Mnemonic (DEMYELINATION)
Morphine (MS Contin) Nursing Considerations
Moderate Sedation
Mobility & Assistive Devices
Miscellaneous Nerve Disorders
Minimally-Invasive Thoracic Surgery (VATS) for Progressive Care Certified Nurse (PCCN)
Migraines
MI Surgical Intervention
Metronidazole (Flagyl) Nursing Considerations
Metoprolol (Toprol XL) Nursing Considerations
Metoclopramide (Reglan) Nursing Considerations
Methylprednisolone (Solu-Medrol) Nursing Considerations
Metformin (Glucophage) Nursing Considerations
Metabolic/Endocrine Course Introduction
Metabolic Acidosis (interpretation and nursing diagnosis)
Metabolic & Endocrine Module Intro
Meropenem (Merrem) Nursing Considerations
Meperidine (Demerol) Nursing Considerations
Meningitis for Certified Emergency Nursing (CEN)
Meniere’s Disease
Medication Classess for IBD Nursing Mnemonic (Sometimes I Can’t Answer)
Mechanical Aids
Management of Pressure Ulcers (Pressure Injuries) Nursing Mnemonic (SKIN)
Malignant Hyperthermia (MH) Nursing Interventions for Certified Perioperative Nurse (CNOR)
Malignant Hyperthermia
Magnetic Resonance Imaging (MRI)
Macular Degeneration
Lymphoma – Signs and Symptoms Nursing Mnemonic (NURSE For Pete’s Sake)
Lymphoma
Lymphatic Assessment
Lung Diseases Module Intro
Lower Gastrointestinal (GI) Module Intro
Low Pressure Vent Alarms Nursing Mnemonic (Cake Everyday)
Losartan (Cozaar) Nursing Considerations
Loperamide (Imodium) Nursing Considerations
Local Anesthetic Systemic Toxicity (LAST) Nursing Interventions for Certified Perioperative Nurse (CNOR)
Local Anesthesia
Liver/Gallbladder Module Intro
Live Bedside Report Medsurg (Medical surgical)
Lisinopril (Prinivil) Nursing Considerations
Lipase Lab Values
Linen Change
Lidocaine Toxicity – Signs and Symptoms Nursing Mnemonic (SAMS)
Lidocaine (Xylocaine) Nursing Considerations
Levothyroxine (Synthroid)
Levofloxacin (Levaquin) Nursing Considerations
Levels of consciousness Nursing Mnemonic (Never Carry Dirty Socks Or Smelly Clothes)
Lactic Acid
Lactate Dehydrogenase (LDH) Lab Values
Lacerations for Certified Emergency Nursing (CEN)
IV Complications (infiltration, phlebitis, hematoma, extravasation, air embolism)
Isoniazid (Niazid) Nursing Considerations
Ischemic Bowel for Progressive Care Certified Nurse (PCCN)
Ischemic (CVA) Stroke Labs
Iron (Fe) Lab Values
Ionized Calcium Lab Values
Iodine Nursing Considerations
Intubation in the OR
Introduction to Health Assessment
Intro to Health Assessment
Intrarenal Causes of Acute Kidney Injury Nursing Mnemonic (TONIC)
Intraoperative Positioning
Intraoperative Nursing Priorities
Intraoperative (Intraop) Complications
Intracranial Pressure ICP
Interventions for Aphasia Nursing Mnemonic (PROP)
Interdisciplinary Team Participation for Certified Perioperative Nurse (CNOR)
Interdisciplinary Team Member Functions for Certified Perioperative Nurse (CNOR)
Interdisciplinary Healthcare Team Collaboration for Certified Perioperative Nurse (CNOR)
Integumentary (Skin) Important Points
Integumentary (Skin) Module Intro
Integumentary (Skin) Course Introduction
Intake and Output (I&O)
Insulin Mnemonic (Ready, Set, Inject, Love)
Insulin – Short Acting (Regular) Nursing Considerations
Insulin – Rapid Acting (Novolog, Humalog) Nursing Considerations
Insulin – Mixtures (70/30)
Insulin – Long Acting (Lantus) Nursing Considerations
Insulin – Intermediate Acting (NPH) Nursing Considerations
Insulin
Inserting an NG (Nasogastric) Tube
Inserting a Foley (Urinary Catheter) – Male
Informed Consent
Influenza for Certified Emergency Nursing (CEN)
Inflammatory Bowel Disease Case Study (45 min)
Infectious Diseases: Influenza for Progressive Care Certified Nurse (PCCN)
Individualized Physical Assessments for Certified Perioperative Nurse (CNOR)
Increased Intraocular Pressure for Certified Emergency Nursing (CEN)
Impulse Transmission
Implant Verification and Availability for Certified Perioperative Nurse (CNOR)
Implant Records and Tracking for Certified Perioperative Nurse (CNOR)
Implant Preparation for Certified Perioperative Nurse (CNOR)
Impaired or Disruptive Behavior Reporting (Interdisciplinary Healthcare Team) for Certified Perioperative Nurse (CNOR)
Immunology Module Intro
Immunocompromise (HIV and AIDS, Oncology and Chemotherapy, Transplant Patient) for Certified Emergency Nursing (CEN)
Hypoxia – Signs and Symptoms Nursing Mnemonic (RAT BED)
Hypovolemic and Distributive Shock for Certified Emergency Nursing (CEN)
Hypotonic Solutions (IV solutions)
Hypothermia (Thermoregulation)
Hypoparathyroidism
Hyponatremia- Definition, Signs and Symptoms Nursing Mnemonic (SALT LOSS)
Hypokalemia – Signs and Symptoms Nursing Mnemonic (6 L’s)
Hypoglycemia symptoms Nursing Mnemonic (DIRE)
Hypoglycemia Management Nursing Mnemonic (Cool and Clammy – Give ‘Em Candy)
Hypoglycemia for Progressive Care Certified Nurse (PCCN)
Hypoglycemia – Signs and Symptoms Nursing Mnemonic (TIRED)
Hypoglycemia
Hypocalcemia – Definition, Signs and Symptoms Nursing Mnemonic (CATS)
Hypertonic Solutions (IV solutions)
Hyperthyroidism Case Study (75 min)
Hyperthermia (Thermoregulation)
Hypertensive Crisis Case Study (45 min)
Hypertension- Complications Nursing Mnemonic (The 4 C’s)
Hypertension (Uncontrolled) and Hypertensive Crisis for Progressive Care Certified Nurse (PCCN)
Hypertension (HTN) Concept Map
Hypertension – Nursing care Nursing Mnemonic (DIURETIC)
Hypernatremia – Signs and Symptoms 3 Nursing Mnemonic (SALT)
Hypernatremia – Signs and Symptoms 2 Nursing Mnemonic (SWINE)
Hypernatremia – Signs and Symptoms 2 Nursing Mnemonic (FRIED)
Hyperglycemia for Progressive Care Certified Nurse (PCCN)
Hyperglycaemic Hyperosmolar Non-ketotic syndrome (HHNS)
Hypercalcemia – Signs and Symptoms Nursing Mnemonic (GROANS, MOANS, BONES, STONES, OVERTONES)
Hygiene
Hydralazine
HMG-CoA Reductase Inhibitors (Statins)
Histamine 2 Receptor Blockers
Histamine 1 Receptor Blockers
High Pressure Vent Alarms Nursing Mnemonic (Kings Eat Big Cakes)
Hepatitis for Certified Emergency Nursing (CEN)
Hepatitis B Virus (HBV) Lab Values
Hepatic Disorders (Cirrhosis, Hepatitis, Portal Hypertension) for Progressive Care Certified Nurse (PCCN)
Heparin (Hep-Lock) Nursing Considerations
Hemorrhagic Stroke Risk Factors Nursing Mnemonic (HATS)
Hemorrhagic Fevers for Certified Emergency Nursing (CEN)
Hemorrhage Nursing Interventions for Certified Perioperative Nurse (CNOR)
Hemodialysis (Renal Dialysis)
Hematology/Oncology/Immunology Course Introduction
Hematology Module Intro
Hematologic Disorders for Certified Emergency Nursing (CEN)
Heart Failure-Left-Sided Nursing Mnemonic (CHOP)
Heart Failure-Origin Nursing Mnemonic (Left – Lung|Right – Rest)
Heat Temperature-related Emergencies for Certified Emergency Nursing (CEN)
Heart Failure for Certified Emergency Nursing (CEN)
Heart Failure Case Study (45 min)
Heart Failure 2 – Live Tutoring Archive
Heart Failure (Acute Exacerbations, Chronic) for Progressive Care Certified Nurse (PCCN)
Heart (Cardiac) Sound Locations and Auscultation
Heart (Cardiac) Failure Therapeutic Management
Heart (Cardiac) Failure Module Intro
Heart (Cardiac) and Great Vessels Assessment
Healthcare-Acquired Infections: Surgical Site Infections (SSI) for Progressive Care Certified Nurse (PCCN)
Hearing Loss
Healthcare-Acquired Infections: Catheter-Associated Bloodstream Infections (CAUTI) for Progressive Care Certified Nurse (PCCN)
Healthcare Team Member Supervision and Education for Certified Perioperative Nurse (CNOR)
Health Assessment Course Introduction
Head/Neck Assessment
Hb (Hepatitis) Vaccine
Hazardous Material Handling and Disposition (Chemo, Radioactive) for Certified Perioperative Nurse (CNOR)
Hand Hygiene Guideline Adherence for Certified Perioperative Nurse (CNOR)
Glucagon (GlucaGen) Nursing Considerations
Glipizide (Glucotrol) Nursing Considerations
Glaucoma
GI Infections (C. difficile) for Progressive Care Certified Nurse (PCCN)
GI Bleed (Upper, Lower) for Progressive Care Certified Nurse (PCCN)
GERD causes Nursing Mnemonic (Reflux Is Probably Mean)
GERD (Gastroesophageal Reflux Disease)
Genitourinary Infections for Certified Emergency Nursing (CEN)
Genitourinary Course Introduction
Genitourinary Trauma for Certified Emergency Nursing (CEN)
Genitourinary (GU) Assessment
General Assessment (Physical assessment)
General Anesthesia
Gastrointestinal (GI) Bleed Concept Map
Gastritis
Gabapentin (Neurontin) Nursing Considerations
Fundamentals Course Introduction
Functional Issues (Immobility, Falls, Gait Disorders) for Progressive Care Certified Nurse (PCCN)
Functional GI Disorders (Obstruction, Ileus, Diabetic Gastroparesis, Gastroesophageal Reflux, Irritable Bowel Syndrome) for Progressive Care Certified Nurse (PCCN)
Free T4 (Thyroxine) Lab Values
Fluid Volume Overload
Fibromyalgia
Fibrinogen Lab Values
Fibrin Degradation Products (FDP) Lab Values
Ferrous Sulfate (Iron) Nursing Considerations
Fentanyl (Duragesic) Nursing Considerations
Explant Preparation (Final Disposition) for Certified Perioperative Nurse (CNOR)
Ethical and Professional Standards for Certified Perioperative Nurse (CNOR)
Essential NCLEX Meds by Class
Esophageal Varices for Certified Emergency Nursing (CEN)
Erythromycin (Erythrocin) Nursing Considerations
Erythrocyte Sedimentation Rate (ESR) Lab Values
Equipment Utilization (Manufacturers Recommendations) for Certified Perioperative Nurse (CNOR)
Epoetin Alfa
Epoetin (Epogen) Nursing Considerations
Epinephrine (EpiPen) Nursing Considerations
Environmental Stewardship (Waste Minimization) for Certified Perioperative Nurse (CNOR)
Environmental Factor Control for Certified Perioperative Nurse (CNOR)
Environmental Cleaning (Spills, Room Turnover, Terminal Cleaning) for Certified Perioperative Nurse (CNOR)
Envenomation Emergencies for Certified Emergency Nursing (CEN)
Enteral & Parenteral Nutrition (Diet, TPN)
Enoxaparin (Lovenox) Nursing Considerations
Endoscopy & EGD
End-Stage Renal Disease (ESRD) for Progressive Care Certified Nurse (PCCN)
Encephalopathy (Hypoxic-ischemic, Metabolic, Infectious, Hepatic) for Progressive Care Certified Nurse (PCCN)
Encephalopathies
Enalapril (Vasotec) Nursing Considerations
Emergency Situation Identification for Certified Perioperative Nurse (CNOR)
EENT Medications
EENT Course Introduction
Echocardiogram (Cardiac Echo)
Dysrhythmias Labs
Dysrhythmias for Certified Emergency Nursing (CEN)
Drugs that Cause SJS Nursing Mnemonic (I C NASA)
Dopamine (Inotropin) Nursing Considerations
Dobutamine (Dobutrex) Nursing Considerations
DKA Treatment Nursing Mnemonic (KING UFC)
Diverticulitis for Certified Emergency Nursing (CEN)
Diverticulitis Complications Nursing Mnemonic (Please Fix His Abscess SOon)
Disseminated Intravascular Coagulation Case Study (60 min)
Disease Specific Medications
Discharge Planning for Certified Emergency Nursing (CEN)
Discharge (DC) Teaching After Surgery
Different Dressings
Diltiazem (Cardizem) Nursing Considerations
Dialysis & Other Renal Points
Diagnostic Criteria for Lupus Nursing Mnemonic (SOAP BRAIN MD)
Diabetic Ketoacidosis for Progressive Care Certified Nurse (PCCN)
Diabetic Ketoacidosis (DKA) Case Study (45 min)
Diabetes Mellitus Type 1- Signs & Symptoms Nursing Mnemonic (The 3 P’s)
Diabetes Mellitus for Progressive Care Certified Nurse (PCCN)
Diabetes Mellitus & Those Dang Blood Sugars! – Live Tutoring Archive
Diabetes Mellitus Case Study (45 min)
Diabetes Mellitus (DM) Module Intro
Diabetes Management
Diabetes Insipidus Nursing Mnemonic (DDD)
Diabetes Insipidus Case Study (60 min)
Dementia and Alzheimers
Delegation and Personnel Management for Certified Perioperative Nurse (CNOR)
Decrease ICP Nursing Mnemonic (Craniums Excite Me)
Day in the Life of a Med-surg Nurse
D-Dimer (DDI) Lab Values
Cyclosporine (Sandimmune) Nursing Considerations
Cyclic Citrullinated Peptide (CCP) Lab Values
Cushings Assessment Nursing Mnemonic (STRESSED)
Cushing’s Syndrome Case Study (60 min)
Cultures
CT & MR Angiography
Crohn’s Morphology and Symptoms Nursing Mnemonic (CHRISTMAS)
Critical Thinking to Facilitate Patient Care for Certified Perioperative Nurse (CNOR)
Creatinine Clearance Lab Values
Creatine Phosphokinase (CPK) Lab Values
Cranial Nerve Mnemonic 02 Nursing Mnemonic (Oh Oh Oh To Touch And Feel Very Good Velvet AH!)
Cortisone (Cortone) Nursing Considerations
Cortisol Lab Vales
Coronavirus (COVID-19) Nursing Care and General Information
Coronary Circulation
Coronary Artery Disease Concept Map
Coronary Arteries – Location Nursing Mnemonic (I have a RIGHT to CAMP if you LEFT off the AC)
Cor Pulmonale – Signs & Symptoms Nursing Mnemonic (Please Read His Text)
COPD management Nursing Mnemonic (COPD)
COPD Exacerbation for Progressive Care Certified Nurse (PCCN)
COPD Concept Map
COPD (Chronic Obstructive Pulmonary Disease) Labs
Congestive Heart Failure Concept Map
Confirming Patient Identity (Patient Identifiers) for Certified Perioperative Nurse (CNOR)
Confirmation of Correct Procedure (Operative Site, Side, Site Marking) for Certified Perioperative Nurse (CNOR)
Complications of Thoracentesis Nursing Mnemonic (Patients Sometimes Bleed Internally)
Complications of Immobility
Compartment Syndrome for Certified Emergency Nursing (CEN)
Communication of Patient Outcomes (Continuum of Care) for Certified Perioperative Nurse (CNOR)
Common Signs of Parkinson’s Nursing Mnemonic (SMART)
Comfort Provisions (Behavioral Response to Procedure) for Certified Perioperative Nurse (CNOR)
Colonoscopy
Cold Temperature-related Emergencies for Certified Emergency Nursing (CEN)
Coagulopathies, Medication-Induced (Coumadin, Platelet Inhibitors, Heparin, HIT) for Progressive Care Certified Nurse (PCCN)
Coagulation Studies (PT, PTT, INR)
Clopidogrel (Plavix) Nursing Considerations
Cirrhosis Complications Nursing Mnemonic (Please Bring Happy Energy)
Cirrhosis for Certified Emergency Nursing (CEN)
Cirrhosis Case Study (45 min)
Circulatory Checks (5 P’s) Nursing Mnemonic (The 5 P’s)
Chronic Obstructive Pulmonary Disease (COPD) for Certified Emergency Nursing (CEN)
Chronic Renal (Kidney) Module Intro
Chronic Kidney Disease (CKD) Case Study (45 min)
CHF Treatment Nursing Mnemonic (UNLOAD FAST)
Chest Tube Management Case Study (60 min)
Chest Tube Management
Chest Tube Management
Chest Tube Assessment Nursing Mnemonic (Two AA’s)
Cerebral Perfusion Pressure CPP
Cerebral Perfusion Pressure Case Study (60 min)
Cephalexin (Keflex) Nursing Considerations
Central Line Dressing Change
Celecoxib (Celebrex) Nursing Considerations
Causes of Dyspnea Nursing Mnemonic (The 6 P’s)
Causes of Pancreatitis Nursing Mnemonic (BAD HITS)
Causes of Anaphylaxis Nursing Mnemonic (Many Boys Love Food)
Cataracts
Cardiovascular Disorders (CVD) Module Intro
Cardiovascular Angiography
Cardiogenic Shock For PCCN for Progressive Care Certified Nurse (PCCN)
Cardiogenic Shock and Obstructive Shock for Certified Emergency Nursing (CEN)
Cardiac/Vascular Catheterization (Diagnostic, Interventional) for Progressive Care Certified Nurse (PCCN)
Cardiac Valves Blood Flow Nursing Mnemonic (Toilet Paper my Ass)
Cardiac Tamponade for Progressive Care Certified Nurse (PCCN)
Cardiac Surgery (Post-ICU Care) for Progressive Care Certified Nurse (PCCN)
Cardiac Stress Test
Cardiac Labs – What and When to Use Them 2 – Live Tutoring Archive
Cardiac Labs – What and When to Use Them – Live Tutoring Archive
Cardiac Course Introduction
Cardiac Arrest Nursing Interventions for Certified Perioperative Nurse (CNOR)
Cardiac Anatomy
Cardiac A&P Module Intro
Cardiac (Heart) Enzymes
Carbon Dioxide (Co2) Lab Values
Carbidopa-Levodopa (Sinemet) Nursing Considerations
Captopril (Capoten) Nursing Considerations
Canes Nursing Mnemonic (COAL)
Calcium Channel Blockers
Calcium Carbonate (Tums) Nursing Considerations
Calcium Acetate (PhosLo) Nursing Considerations
C. Difficile for Certified Emergency Nursing (CEN)
C-Reactive Protein (CRP) Lab Values
Burns for Certified Emergency Nursing (CEN)
Burn Injuries
Brain Natriuretic Peptide (BNP) Lab Values
Brain Death v. Comatose
BPH Symptoms Nursing Mnemonic (FUN WISE)
Bowel Perforation for Certified Emergency Nursing (CEN)
Bowel Obstruction Concept Map
Body Mechanics (Utilization) for Certified Perioperative Nurse (CNOR)
Blunt Chest Trauma
Blood Salvage Transfusion Anticipation for Certified Perioperative Nurse (CNOR)
Blood Flow Through The Heart
Bleeding Precautions Nursing Mnemonic (RANDI)
Bleeding for Certified Emergency Nursing (CEN)
Bleeding Complications (Minor) Nursing Mnemonic (BEEP)
Bismuth Subsalicylate (Pepto-Bismol) Nursing Considerations
Biopsy
Biohazard Material Handling and Disposition (Blood, Microbiology, Creutzfeldt-Jakob Disease) for Certified Perioperative Nurse (CNOR)
Beta Hydroxy (BHB) Lab Values
Benztropine (Cogentin) Nursing Considerations
Bed Bath
Barriers to Health Assessment
Barrier Material Selection (Procedure-Specific) for Certified Perioperative Nurse (CNOR)
Bariatric: IV Insertion
Bariatric Surgeries
Barbiturates
Bacterial Endocarditis – Symptoms Nursing Mnemonic (Be Joan Of Arc)
Azithromycin (Zithromax) Nursing Considerations
AV Blocks Dysrhythmias for Progressive Care Certified Nurse (PCCN)
Atrial Flutter
Atrial Fibrillation (A Fib)
Atrial Dysrhythmias for Progressive Care Certified Nurse (PCCN)
Atorvastatin (Lipitor) Nursing Considerations
Atenolol (Tenormin) Nursing Considerations
Asthma for Certified Emergency Nursing (CEN)
Asthma (Severe) for Progressive Care Certified Nurse (PCCN)
Assessment of Guillain-Barre Syndrome Nursing Mnemonic (GBS=PAID)
Assessment for Myasthenic Crisis Nursing Mnemonic (BRISH)
ASA (Aspirin) Nursing Considerations
Artificial Airways
ARDS causes Nursing Mnemonic (GUT PASS)
ARDS Case Study (60 min)
Aortic Stenosis Symptoms Nursing Mnemonic (SAD)
Aortic Aneurysm – Thoracic signs Nursing Mnemonic (PEE BADS)
Aortic Aneurysm – Management Nursing Mnemonic (CRAM)
Antinuclear Antibody Lab Values
Antineoplastics
Antimetabolites
Antidiabetic Agents
Anticonvulsants
Anti-Platelet Aggregate
Anti-Infective – Antitubercular
Anti-Infective – Tetracyclines
Anti-Infective – Sulfonamides
Anti-Infective – Glycopeptide
Anti-Infective – Carbapenems
Anti Tumor Antibiotics
Anion Gap Acidosis 1 Nursing Mnemonic (KULT)
Anion Gap Acidosis 2 Nursing Mnemonic (MUDPILES)
Anion Gap
Angiotensin Receptor Blockers
Aneurysm and Dissection for Certified Emergency Nursing (CEN)
Anesthetic Agents
Anesthetic Agents
Aneurysm (Dissecting, Repair) for Progressive Care Certified Nurse (PCCN)
Anesthesia Management Assistance for Certified Perioperative Nurse (CNOR)
Anemia for Progressive Care Certified Nurse (PCCN)
Amputation for Certified Emergency Nursing (CEN)
Anaphylaxis Nursing Interventions for Certified Perioperative Nurse (CNOR)
Amputation Concept Map
Amputation
Amlodipine (Norvasc) Nursing Considerations
Amitriptyline (Elavil) Nursing Considerations
Altered Mental Status Nursing Mnemonic (AEIOU TIPS)
Alteplase (tPA, Activase) Nursing Considerations
Altered Mental Status- Delirium and Dementia for Progressive Care Certified Nurse (PCCN)
Alkylating Agents
Alkaline Phosphatase (ALK PHOS) Lab Values
Alendronate (Fosamax) Nursing Considerations
Alanine Aminotransferase (ALT) Lab Values
Airway Suctioning
AIDS Case Study (45 min)
Age and Culturally Appropriate Health Assessment Techniques for Certified Perioperative Nurse (CNOR)
Advanced Directive and DNR Status Confirmation for Certified Perioperative Nurse (CNOR)
Advance Directives
Adrenal Gland Hormones Nursing Mnemonic (The 3 S’s)
Adrenal and Thyroid Disorder Emergencies for Certified Emergency Nursing (CEN)
Admissions, Discharges, and Transfers
Adjunct Neuro Assessments
Addisons Disease
Addisons Assessment Nursing Mnemonic (STEROID)
Acute Respiratory Distress Syndrome (ARDS) for Progressive Care Certified Nurse (PCCN)
Acute Renal (Kidney) Module Intro
Acute Kidney Injury Case Study (60 min)
Acute Inflammatory Disease (Myocarditis, Endocarditis, Pericarditis) for Progressive Care Certified Nurse (PCCN)
Acute Coronary Syndromes (MI-ST and Non ST, Unstable Angina) for Progressive Care Certified Nurse (PCCN)
Acute Abdomen for Certified Emergency Nursing (CEN)
ACE (angiotensin-converting enzyme) Inhibitors
Accountability and Assistance for Personal Limitations for Certified Perioperative Nurse (CNOR)
Absolute Reticulocyte Count (ARC) Lab Values
Absolute Neutrophil Count (ANC) Lab Values
3rd Degree AV Heart Block (Complete Heart Block)
2nd Degree AV Heart Block Type 2 (Mobitz II)
2nd Degree AV Heart Block Type 1 (Mobitz I, Wenckebach)
1st Degree AV Heart Block
10.04 Pulmonary Question Review for CCRN Review
07.10 Neurologic Review questions for CCRN Review
07.09 Meningitis for CCRN Review
06.05 Wide Complex Tachycardia for CCRN Review
06.04 Differentiating Ectopy and Aberrancy for CCRN Review
05.05 GI Practice Questions for CCRN Review
05.02 Liver Overview and Disease for CCRN Review
05.01 Pancreatitis and Large Bowel Obstruction for CCRN Review
03.04 DKA vs HHNK for CCRN Review
03.05 Endocrine Practice Questions for CCRN Review
03.03 Hypoglycemia for CCRN Review
03.02 Diabetes Insipidus for CCRN Review
03.01 Syndrome of Inappropriate Antidiuretic hormone (SIADH) for CCRN Review
02.18 Cardiovascular Practice Questions for CCRN Review
02.17 Septic Shock for CCRN Review
02.16 Cardiogenic Shock for CCRN Review
02.15 Hypovolemic Shock for CCRN Review
02.14 Shock Stages for CCRN Review
02.13 Myocardial Infarction – Anterior Septal Wall for CCRN Review
02.02 Cardiomyopathy for CCRN Review
02.06 Heart Murmurs for CCRN Review
02.08 Cardiac Catheterization & Acute Coronary Syndrome for CCRN Review
02.12 Myocardial Infarction- Inferior Wall for CCRN Review