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# NCLEX-PN Study Guide

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### NCLEX-PN Study Guide

2. 2. TABLE OF CONTENTSNCLEX TEST RESOURCES................................................................................................................. 4INTRODUCTION TO THIS GUIDE ................................................................................................ 5TESTING AND ANALYSIS................................................................................................................. 7INTRODUCTION TO THE NCLEX................................................................................................... 9THE NCLEX SCORING SCALE........................................................................................................ 10GENERAL STRATEGIES.................................................................................................................... 11 STRATEGY 1: UNDERSTANDING THE INTIMIDATION ........................................................................... 11 STRATEGY 2: FINDING YOUR OPTIMAL PACE ..................................................................................... 13 STRATEGY 3: DON’T BE A PERFECTIONIST .......................................................................................... 15 STRATEGY 4: FACTUALLY CORRECT, BUT ACTUALLY WRONG ............................................................ 16 STRATEGY 5: EXTRANEOUS INFORMATION ......................................................................................... 16 STRATEGY 6: AVOIDING DEFINITES..................................................................................................... 18 STRATEGY 7: USING COMMON SENSE ................................................................................................. 18 STRATEGY 8: INSTINCTS ARE RIGHT ................................................................................................... 19 STRATEGY 9: NO FEAR .......................................................................................................................... 19 STRATEGY 10: DON’T GET THROWN OFF BY NEW INFORMATION .................................................... 20 STRATEGY 11: NARROWING THE SEARCH ........................................................................................... 20 STRATEGY 12: YOU’RE NOT EXPECTED TO BE EINSTEIN .................................................................... 21RESPIRATORY CONDITIONS ....................................................................................................... 21CIRCULATORY SYSTEM................................................................................................................... 35 COURSE OF CIRCULATION...................................................................................................................... 36 THE HEART .............................................................................................................................................. 37 CARDIOVASCULAR CONDITIONS............................................................................................................ 40 ARRHYTHMIAS REVIEW .......................................................................................................................... 53CARDIAC FAILURE REVIEW ......................................................................................................... 55ENDOCRINE REVIEW ....................................................................................................................... 57MICROBIOLOGY REVIEW .............................................................................................................. 68 Copyright © StudyGuideZone.com. All rights reserved. 2
3. 3. CHARACTERISTICS OF BACTERIA TYPES ............................................................................................... 68 IMMUNOGLOBULIN ISOTYPES ................................................................................................................. 74 CYTOKINES REVIEW ............................................................................................................................... 74PHARMACOLOGY ................................................................................................................................ 78MEASUREMENT EQUIVALENTS................................................................................................... 87DRUG DISTRIBUTION...................................................................................................................... 90BIOTRANSFORMATION OF DRUGS .......................................................................................... 93 DRUG ELIMINATION................................................................................................................................ 94GENERAL PHARMACOKINETICS REVIEW............................................................................. 96 PHARMACODYNAMIC TERMS................................................................................................................... 98 AUTONOMIC NERVOUS SYSTEM RECEPTORS........................................................................................ 98SPECIFIC PEDIATRIC CONDITIONS ....................................................................................... 99TUMOR REVIEW ................................................................................................................................ 108GI REVIEW........................................................................................................................................... 110EYE, EAR, AND MOUTH REVIEW .............................................................................................. 118 DISORDERS OF THE EYE ...................................................................................................................... 118 DISORDERS OF THE MOUTH ................................................................................................................ 121 DISORDERS OF THE EAR ...................................................................................................................... 123OBSTETRICS/GYNECOLOGY ...................................................................................................... 125DERMATOLOGY REVIEW .............................................................................................................. 133AXIAL SKELETON ............................................................................................................................. 139APPENDICULAR SKELETON........................................................................................................ 140MUSCULOSKELETAL CONDITIONS ......................................................................................... 146SAMPLE QUESTIONS ...................................................................................................................... 154ANSWER KEY ...................................................................................................................................... 174 Copyright © StudyGuideZone.com. All rights reserved. 3
4. 4. VALUABLE NCLEX RESOURCE LINKS .................................................................................... 181SPECIAL REPORT– QUICK REFERENCE LESION REVIEW ......................................... 182SPECIAL REPORT- HIGH FREQUENCY TERMS.................................................................. 184DEFINITION OF ROOT WORDS ................................................................................................ 190PREFIXES.............................................................................................................................................. 194SUFFIXES.............................................................................................................................................. 196 NCLEX Test ResourcesFree NCLEX Practice Testshttp://www.testprepreview.com/nclex_practice.htmFinancial Aid Factshttp://www.finaidfacts.orgScholarship Helphttp://www.scholarshiphelp.orgStudy Tips and Informationhttp://www.studyguidezone.com/resource_tips.htm Copyright © StudyGuideZone.com. All rights reserved. 4
8. 8. something you can learn from taking a course or reading a book, but itis something you can develop through practice and concentration.The following chapters in this guidebook will lay out the format andstyle of the NCLEX as well as give you sample questions and examplesof the frame of mind you’ll be expected to take. If there is one skillthat you take with you from your preparation for the NCLEX, thisshould be it. Copyright © StudyGuideZone.com. All rights reserved. 8
9. 9. Introduction to the NCLEXThe purpose of the NCLEX is to establish a standard method ofmeasurement for the skills that have been acquired by nursing schoolgraduates. These skills are considered critical to the healthcareprofession. The principle behind the NCLEX is similar to the SAT’s thatare required for application to American colleges. Although these testsare similar experiences in some respects, the NCLEX is a much morechallenging and complex.Fortunately, the NCLEX does not change very dramatically from yearto year. What this means to you, is that it has become possible forquality practice tests to be produced, and if you should take enough ofthese tests, in addition to learning the correct strategies, you will beable to prepare for the test in an effective manner.The NCLEX is not just a multiple-choice test. Fill in the blankquestions and multiple right answer questions have been added to thetest. Although these types of questions are not the majority ofquestions asked on the NCLEX. The main point is that the content hasstayed the same. The nursing principles tested prior to these changesare still the same. The content has remained relatively the same. Ifyou understand the content material of the exam, the type of testingquestion won’t matter. Copyright © StudyGuideZone.com. All rights reserved. 9
11. 11. 10. Remember if you don’t pass, you can retake the exam. General Strategies Strategy 1: Understanding the IntimidationThe test writers will generally choose some material on the exam thatwill be completely foreign to most test takers. You can’t expect all ofthe medical topics to be a topic with which you have a fair amount offamiliarity. If you do happen to come across a high number oftopics/cases that you are extremely familiar with, consider yourselflucky, but don’t plan on that happening.Each case and scenario will be slightly different. Try and understandall of the material, while weeding out the distracter information. Thecases will also frequently be drawn from real world experiences.Therefore, the passage that you will face on the test may almost seemout of context and as though it begins in the middle of a medicalprocess. You won’t have a nice title overhead explaining the generaltopic being covered but will immediately be thrown into the middle of astrange format that you don’t recognize.Getting hit by strange sounding medical topics that you don’trecognize, of which you may only have a small exposure, is justnormal on the NCLEX. Just remember that the questions themselveswill contain all the information necessary to choose a correct answer. Copyright © StudyGuideZone.com. All rights reserved. 11
22. 22. Blood thinners ValvuloplastyARDS- low oxygen levels caused by a build up of fluid in the lungs andinflammation of lung tissue.Causes:Trauma Symptoms:Chemical inhalation Low BPPneumonia Rapid breathingSeptic shock SOBTests: CyanosisABG Chest X-rayCBCCulturesTreatment: Mechanical VentilationEchocardiogram Treat the underlying conditionAuscultationMonitor the Patient for:Pulmonary fibrosisMultiple system organ failureVentilator associated pneumoniaAcidosisRespiratory failureRespiratory Acidosis- Build-up of Carbon Dioxide in the lungs thatcauses acid-base imbalances and the body becomes acidic. Copyright © StudyGuideZone.com. All rights reserved. 22
24. 24. Respiratory Alkalosis: CO2 levels are reduced and pH is high.Causes: Tests:Anxiety ABGFever Chest X-rayHyperventilation Pulmonary function testsSymtpoms: Treatment:Dizziness Paper bag techniqueNumbness Increase carbon dioxide levelsRSV (Respiratory synctial virus) - spread by contact, virus can survivefor various time periods on different surfaces.Symptoms:Fever Treatment:SOB RibvirinCyanosis Ventilator in severe casesWheezing IV fluidsNasal congestion BronchodilatorsCroupy cough Monitor the patient for:Tests: PneumoniaABG Respiratory failureChest X-ray Otitis Media Copyright © StudyGuideZone.com. All rights reserved. 24
25. 25. HyperventilationCauses: KetoacidosisCOPD Aspirin overdosePanic Attacks AnxietyStressApnea: no spontaneous breathing.Causes: Drug overdoseObstructive sleep apnea PrematuritySeizures BronchospasmCardiac Arrhythmias EncephalitisBrain injury ChokingNervous system dysfunctionLung surgeryCauses: EmphysemaCancer PneumothoraxLung abscesses TumorsAtelectasis BronchiectasisPneumonia: viruses the primary cause in young children, bacteria theprimary cause in adults. Bacteria: Streptococcus pneumoniae,Mycoplasma pneumoniaepneumoniae (pneumococcus). Copyright © StudyGuideZone.com. All rights reserved. 25
26. 26. Types of pneumonia: Chest painViral pneumonia Tests:Walking pneumonia Chest X-rayLegionella pneumonia Pulmonary perfusion scanCMV pneumonia CBCAspiration pneumonia Cultures of sputumAtypical pneumonia Presence of cracklesLegionella pneumonia Treatment:Symptoms: Antibiotics if caused by aFever bacterial infectionHeadache Respiratory treatmentsRibvirin SteroidsSOB IV fluidsCough Vaccine treatmentsPulmonary actinomycosis –bacteria infection of the lungs caused by(propionibacteria or actinomyces)Causes: FeverMicroorganisms Tests:Symptoms: CBCPleural effusions Lung biopsyFacial lesions ThoracentesisChest pain CT scanCough BronchoscopyWeight loss Copyright © StudyGuideZone.com. All rights reserved. 26
27. 27. Monitor patient for: MeningitisEmphysema OsteomyelitisAlveolar proteinosis: A build-up of a phospholipid in the lungs werecarbon dioxide and oxygen are transferred.Causes: Tests:May be associated with infection Chest X-rayGenetic disorder 30-50 yrs. Old Presence of crackles CT scanSymptoms: BronchoscopyWeight loss ABG- low O2 levelsFatigue Pulmonary Function testsCoughFever Treatment:SOB Lung transplantation Special lavage of the lungsPulmonary hypertension: elevated BP in the lung arteriesCauses: FatigueMay be genetically linked Chest PainMore predominant in women SOB with activity LE edemaSymptoms: WeaknessFainting Copyright © StudyGuideZone.com. All rights reserved. 27
28. 28. Tests:Pulmonary arteriogram Treatment:Chest X-ray Manage symptomsECG DiureticsPulmonary function tests Calcium channel blockersCT scan Heart/Lung Transplant ifCardiac catheterization necessaryPulmonary arteriovenous fistulas: a congenital defect were lungarteries and veins form improperly, and a fistula is formed creatingpoor oxygenation of blood.Symptoms: CT ScanSOB with activity Pulmonary arteriogramPresence of a murmur Low O2 Saturation levelsCyanosis Elevated RBC’sClubbingParadoxical embolism Treatment: SurgeryTests: EmbolizationPulmonary aspergilloma: fungal infection of the lung cavities causingabscesses.Cause: SOBFungus Aspergillus Chest pain FeverSymptoms: CoughWheezing Copyright © StudyGuideZone.com. All rights reserved. 28
29. 29. Tests: BronchoscopyCT scanSputum culture Treatment:Serum precipitans SurgeryChest X-ray Antifungal medicationsPulmonary edema: most commonly caused by Heart Failure, but maybe due to lung disorders.Symptoms: Tests:Restless behavior Murmurs may be presentAnxiety EchocardiogramWheezing Presence of cracklesPoor speech Low O2 Saturation levelsSOBSweating Treatment:Pale skin DiureticsDrowning sensation Oxygen Treat the underlying causeIdiopathic pulmonary fibrosis: Thickening of lung tissue in the loweraspects of the lungs. Copyright © StudyGuideZone.com. All rights reserved. 29
30. 30. Causes:Response to an inflammatoryagent Tests:Found in people ages 50-70. Pulmonary function testsLinked to smoking Lung biopsy Rule out other connective tissueSymptoms: diseasesCough CT scanSOB Chest X-rayChest painCyanosis Treatment:Clubbing Lung transplantationCyanosis Corticosteroids Anti-inflammatory drugsMonitor the patient for:PolycythemiaPulmonary Htn.Respiratory failureCor pulmonarlePulmonary emboli: Blood clot of the pulmonary vessels or blockagedue to fat droplets, tumors or parasites.Causes: Chest painDVT- most common Decreased BP Skin color changesSymptoms: LE and pelvic painSOB (rapid onset) Sweating Copyright © StudyGuideZone.com. All rights reserved. 30
31. 31. Dizziness Pulmonary perfusion testAnxiety PlethysmographyTachycardia ABGLabored breathing Check O2 saturationCough Treatment: Placement of an IVC filterTests: Administer OxygenDoppler US SurgeryChest X-ray Thrombolytic Therapy if clotPulmonary angiogram detectedMonitor the patient for:ShockPulmonary hypertensionHemorrhagePalpitationsHeart failureTuberculosis- infection caused by Mycobaterium tuberculosis.Causes: FatigueDue to airborne exposure Wheezing Phlegm productionSymptoms:Fever Tests:Chest pain ThoracentesisSOB Sputum culturesWeight Loss Presence of crackles Copyright © StudyGuideZone.com. All rights reserved. 31
32. 32. TB skin test Generally about 6 monthsChest X-ray RifampinBronchoscopy Pyrazinamide IsoniazidTreatment:Cytomegalovirus – can cause lung infections and is a herpes-typevirus.Causes:More common in immunocompromised patientsOften associated with organ transplantationSymptoms: BronchoscopyFeverSOB Treatment:Fatigue Antiviral medicationsLoss of appetite Oxygen therapyCoughJoint pain Monitor the patient for: Kidney dysfunctionTests: InfectionCMV serology tests Decreased WBC levelsABG RelapsesBlood culturesViral pneumonia – inflammation of the lungs caused by viral infection.Causes: Herpes simplex virusRhinovirus Influenza Copyright © StudyGuideZone.com. All rights reserved. 32
33. 33. Adenovirus Tests:Hantavirus BronchoscopyCMV Open Lung biopsyRSV Sputum cultures Viral blood testsSymptoms:Fatigue Treatment:Sore Throats Antiviral medicationsNausea IV fluidsJoint painHeadaches Monitor the patient for:Muscular pain Liver failureCough Heart failureSOB Respiratory failurePneumothorax: a build-up of a gas in the pleural cavities.Types:Traumatic pneumothorax Symptoms:Tension pneumothorax SOBSpontaneous pneumothorax TachycardiaSecondary spontaneous Hypotensionpneumothorax Anxiety Copyright © StudyGuideZone.com. All rights reserved. 33
35. 35. Circulatory SystemFunctionsThe circulatory system serves: (1) to conduct nutrients and oxygen to the tissues; (2) to remove waste materials by transporting nitrogenous compounds to the kidneys and carbon dioxide to the lungs; (3) to transport chemical messengers (hormones) to target organs and modulate and integrate the internal milieu of the body; (4) to transport agents which serve the body in allergic, immune, and infectious responses; (5) to initiate clotting and thereby prevent blood loss; (6) to maintain body temperature; (7) to produce, carry and contain blood; (8) to transfer body reserves, specifically mineral salts, to areas of need.General Components and StructureThe circulatory system consists of the heart, blood vessels, blood andlymphatics. It is a network of tubular structures through which bloodtravels to and from all the parts of the body. In vertebrates this is acompletely closed circuit system, as William Harvey (1628) oncedemonstrated. The heart is a modified, specialized, powerful pumpingblood vessel. Arteries, eventually becoming arterioles, conduct blood Copyright © StudyGuideZone.com. All rights reserved. 35
36. 36. to capillaries (essentially endothelial tubes), and venules, eventuallybecoming veins, return blood from the capillary bed to the heart. Course of CirculationSystemic Route:a. Arterial system. Blood is delivered by the pulmonary veins (twofrom each lung) to the left atrium, passes through the bicuspid (mitral)valve into the left ventricle and then is pumped into the ascendingaorta; backflow here is prevented by the aortic semilunar valves. Theaortic arch toward the right side gives rise to the brachiocephalic(innominate) artery which divides into the right subclavian and rightcommon carotid arteries. Next, arising from the arch is the commoncarotid artery, then the left subclavian artery.The subclavians supply the upper limbs. As the subclavian arteriesleave the axilla (armpit) and enter the arm (brachium), they are calledbrachial arteries. Below the elbow these main trunk lines divide intoulnar and radial arteries, which supply the forearm and eventuallyform a set of arterial arches in the hand which give rise to commonand proper digital arteries. The descending (dorsal) aorta continuesalong the posterior aspect of the thorax giving rise to the segmentalintercostals arteries. After passage “through” (behind) the diaphragmit is called the abdominal aorta.At the pelvic rim the abdominal aorta divides into the right and leftcommon iliac arteries. These divide into the internal iliacs, which Copyright © StudyGuideZone.com. All rights reserved. 36
37. 37. supply the pelvic organs, and the external iliacs, which supply thelower limb.b. Venous system. Veins are frequently multiple and variations arecommon. They return blood originating in the capillaries of peripheraland distal body parts to the heart.Hepatic Portal System: Blood draining the alimentary tract(intestines), pancreas, spleen and gall bladder does not return directlyto the systemic circulation, but is relayed by the hepatic portal systemof veins to and through the liver. In the liver, absorbed foodstuffs andwastes are processed. After processing, the liver returns the blood viahepatic veins to the inferior vena cava and from there to the heart.Pulmonary Circuit: Blood is oxygenated and depleted of metabolicproducts such as carbon dioxide in the lungs.Lymphatic Drainage: A network of lymphatic capillaries permeatesthe body tissues. Lymph is a fluid similar in composition to bloodplasma, and tissue fluids not reabsorbed into blood capillaries aretransported via the lymphatic system eventually to join the venoussystem at the junction of the left internal jugular and subclavian veins. The HeartThe heart is a highly specialized blood vessel which pumps 72 timesper minute and propels about 4,000 gallons (about 15,000 liters) ofblood daily to the tissues. It is composed of: Endocardium (lining coat; epithelium) Copyright © StudyGuideZone.com. All rights reserved. 37
38. 38. Myocardium (middle coat; cardiac muscle) Epicardium (external coat or visceral layer of pericardium; epithelium and mostly connective tissue) Impulse conducting systemCardiac Nerves: Modification of the intrinsic rhythmicity of the heartmuscle is produced by cardiac nerves of the sympathetic andparasympathetic nervous system. Stimulation of the sympatheticsystem increases the rate and force of the heartbeat and dilates thecoronary arteries. Stimulation of the parasympathetic (vagus nerve)reduces the rate and force of the heartbeat and constricts the coronarycirculation. Visceral afferent (sensory) fibers from the heart end almostwholly in the first four segments of the thoracic spinal cord.Cardiac Cycle: Alternating contraction and relaxation is repeatedabout 75 times per minute; the duration of one cycle is about 0.8second. Three phases succeed one another during the cycle: a) atrial systole: 0.1 second, b) ventricular systole: 0.3 second, c) diastole: 0.4 secondThe actual period of rest for each chamber is 0.7 second for the atriaand 0.5 second for the ventricles, so in spite of its activity, the heart isat rest longer than at work.BloodBlood is composed of cells (corpuscles) and a liquid intercellularground substance called plasma. The average blood volume is 5 or 6 Copyright © StudyGuideZone.com. All rights reserved. 38
39. 39. liters (7% of body weight). Plasma constitutes about 55% of bloodvolume, cellular elements about 45%.Plasma: Over 90% of plasma is water; the balance is made up ofplasma proteins and dissolved electrolytes, hormones, antibodies,nutrients, and waste products. Plasma is isotonic (0.85% sodiumchloride). Plasma plays a vital role in respiration, circulation,coagulation, temperature regulation, buffer activities and overall fluidbalance. Copyright © StudyGuideZone.com. All rights reserved. 39
40. 40. Cardiovascular ConditionsCardiogenic Shock: heart is unable to meet the demands of the body.This can be caused by conduction system failure or heart muscledysfunction.Symptoms of Shock:Rapid breathing ABGRapid pulse Chem-7Anxiety Chem-20Nervousness ElectrolytesThready pulse Cardiac EnzymesMottled skin colorProfuse sweating Treatment:Poor capilary refill Amrinone NorepinephrineTests: DobutamineNuclear Scans IV fluidsElectrocardiogram PTCAEchocardiogram Extreme cases-pacemaker, IABPElectrocardiogramAortic insufficiency: Heart valve disease that prevents the aortic valvefrom closing completely. Backflow of blood into the left ventricle.Causes: EndocarditisRheumatic fever Marfan’s syndromeCongenital abnormalities Ankylosing spondylitis Copyright © StudyGuideZone.com. All rights reserved. 40
41. 41. Reiter’s syndrome Auscultation Left heart cathereterizationSymptoms: Aortica angiographyFainting Dopper USWeakness EchocardiogramBounding pulse Treatment:Chest pain on occasion DigoxinSOB DieureticsFatigue Surgical aorta valve repairTests: Monitor patient for:Palpation PEIncreased pulse pressure and Left-sided heart failurediastolic pressure EndocarditisPulmonary edema presentAortic aneurysm: Expansion of the blood vessel wall often identified inthe thoracic region.Causes: Possible back pain may be theHtn only indicatorMarfan’s syndromeSyphilis Tests:Atherosclerosis (most common) AortogramTrauma Chest CT X-raySymptoms: Treatment: Copyright © StudyGuideZone.com. All rights reserved. 41
42. 42. Varies depending on location BleedingStent StrokeCirculatory arrest Graft infectionSurgery Irregular Heartbeats Heart AttackMonitor patient for:Hypovolemic shock: Poor blood volume prevents the heart frompumping enough blood to the body.Causes:TraumaDiarrheaBurnsGI BleedingCardiogenic shock: Enough blood is available, however the heart isunable to move the blood in an effective manner.Symptoms: EchocardiogramAnxiety CT scanWeakness Endoscopy with GI bleedingSweating Swan-Ganz catheterizationRapid pulse Treatment:Confusion Increase fluids via IVClammy skin Avoid Hypothermia EpinephrineTests: NorepinephrineCBC Dobutamine Copyright © StudyGuideZone.com. All rights reserved. 42
44. 44. Myocarditis: inflammation of the heart muscle.Causes: Tests:Bacterial or Viral Infections Chest X-rayPolio, adenovirus, coxsackie Echocardiogramvirus ECG WBC and RBC countSymptoms: Blood culturesLeg edemaSOB Treatment:Viral symptoms DiureticsJoint Pain PacemakerSyncope AntibioticsHeart attack (Pain) SteroidsFeverUnable to lie flat Monitor the patient for:Irregular heart beats Pericarditis CardiomyopathyHeart valve infection: endocarditis (inflammation), probable valvularheart disease. Can be caused by fungi or bacteria.Symptoms: Janeway lesionsWeakness Joint painFeverMurmur Tests:SOB CBCNight sweats ESR Copyright © StudyGuideZone.com. All rights reserved. 44
45. 45. ECG Surgery may be indicatedBlood culturesEnlarged speen Monitor the patient for:Presence of splinter Jaundicehemorrhages Arrhythmias CHFTreatment: GlomerulonephritisIV antibiotics EmboliPericarditis: Inflammation of the pericardium.Causes:Viral- coxsackie, adenovirus, influenza, rubella virusesBacterial (various microorganisms)FungiOften associated with TB, Kidney failure, AIDS, and autoimmunedisorders.SurgerySymptoms: Unable to lie down flatDry coughPleuritis Tests:Fever AuscultationAnxiety MRI scanCrackles CT scanPleural effusion Echocardiogram (key test)LE swelling ESRChest pain Chest x-ray Copyright © StudyGuideZone.com. All rights reserved. 45
46. 46. Blood cultures PericardiectomyCBC Monitor the patient for:Treatment: Constrictive pericarditisNSAIDS A fib.Pericardiocentesis Supraventricular tachycardiaAnalgesics (SVT)Arrhythmias: Irregular heart beats and rhythms disorderTypes: Irregular pulseBradycardiaTachycardia Tests:Ventricular fibrillation Coronary angiographyEctopic heart beat ECGVentricular tachycardia EchocardiogramWolff-Parkinson-white syndrome Holter monitorAtrial fib.Sick sinus syndrome Treatment:Sinus Tachycardia DefibrillationSinus Bradycardia Pacemaker MedicationsSymptoms:SOB Monitor the patient for:Fainting Heart failurePalpitations StrokeDizziness Heart attackChest pain Ischemia Copyright © StudyGuideZone.com. All rights reserved. 46
48. 48. Arteriosclerosis: hardening of the arteries.Causes: IVSUSmoking MRI testHtn Poor ABI (Ankle brachial index)Kidney disease readingCADStroke Treatment: AnalgesicsSymptoms: Vasodilation medicationsClaudication pain Surgery if severeCold feet Ballon surgeryMuscle acheness and pain in the Stent placementlegsHair loss on the legs Monitor the patient for:Numbness in the extremities Arterial emboliWeak distal pulse Ulcers ImpotenceTests: Gas gangreeneDoppler US Infection of the lowerAngiography extremitiesCardiomyopathy- poor hear pumping and weakness of themyocardium.Causes:HtnHeart attacksViral infections Copyright © StudyGuideZone.com. All rights reserved. 48
49. 49. Types:Alcoholic cardiomyopathy- due to alcohol consumptionDilated cardiomyopathy-left ventricle enlargementHypertrophic cardiomyopathy-abnormal growth left ventricleIschemic cardiomyopathy- weakness of the myocardium due to heartattacks.Peripartum cardiomyopathy- found in late pregnancyRestrictive cardiomyopathy-limited filling of the heart due to inabilityto relax heart tissue.Symptoms: Isoenzyme testsChest pain Coronary AngigraphySOB Chest X-rayFatigue MRIAscites AuscultationLE swellingFainting Treatment:Poor Appetite Ace inhibitorsHtn DieureticsPalpitations Blood thinners LVAD – Left Ventricular AssistTests: DeviceECG DigoxinCBC VasodilatorsCongestive Heart Failure: Copyright © StudyGuideZone.com. All rights reserved. 49
50. 50. Class I describes a patient who is not limited with normal physicalactivity by symptoms.Class II occurs when ordinary physical activity results in fatigue,dyspnea, or other symptoms.Class III is characterized by a marked limitation in normal physicalactivity.Class IV is defined by symptoms at rest or with any physical activity.Causes: Symptoms:CAD Skin cold or cyanoticValvular heart disease WheezingCardiomyopathies Mitral valvular deficitsEndocarditis Lower extremity edemaExtracardiac infection Pulsus alternansPulmonary embolus Hypertension Tachypnea Copyright © StudyGuideZone.com. All rights reserved. 50
51. 51. Heart Sounds:S1- tricuspid and mitral valve closeS2- pulmonary and aortic valve closeS3- ventricular filling completeS4-elevated atrial pressure (atrial kick)Wave ReviewST segment: ventricles depolarizedP wave: atrial depolarizationPR segment: AV node conductionQRS complex: ventricular depolarizationU wave: hypokalemia creates a U waveT wave: ventricular repolarizationWave Review Indepth:1. P WAVE - small upward wave; indicates atrial depolarization2. QRS COMPLEX - initial downward deflection followed by largeupright wave followed by small downward wave; represents ventriculardepolarization; masks atrial repolarization; enlarged R portion -enlarged ventricles; enlarged Q portion - probable heart attack.3. T WAVE - dome shaped wave; indicates ventricular repolarization;flat when insufficient oxygen; elevated with increased K levels4. P - R INTERVAL - interval from beginning of P wave to R wave;represents conduction time from initial atrial excitation to initialventricular excitation; good diagnostic tool; normally < 0.2sec. Copyright © StudyGuideZone.com. All rights reserved. 51
52. 52. 5. S-T SEGMENT - time from end of S to beginning to T wave;represents time between end of spreading impulse through ventriclesand ventricular repolarization; elevated with heart attack; depressedwhen insufficient oxygen.6. Q-T INTERVAL - time for singular depolarization and repolarizationof the ventricles. Conduction problems, myocardial damage orcongenital heart defects can prolong this. Copyright © StudyGuideZone.com. All rights reserved. 52
53. 53. Arrhythmias ReviewSupraventricular TachyarrhythmiasAtrial fibrillation – Abnormal QRS rhythm and poor P wave appearance.(>300bpm.)Sinus Tachycardia- Elevated ventricular rhythum/rate.Paroxysmal atrial tachycardia- Abnormal P wave, Normal QRS complexAtrial flutter- Irregular P Wave development. (250-350 bpm.)Paroxysmal supraventricular tachycardia- Elevated bpm (160-250)Multifocal atrial tachycardia- bpm (>105). Various P waveappearances.Ventricular TachyarrhythmiasVentricular Tachycardia- Presence of 3 or greater PVC’s (150-200bpm), possible abrupt onset. Possibly due to an ischemic ventricle.No P waves present.(PVC)- Premature Ventricular Contraction- In many cases no P wavefollowed by a large QRS complex that is premature, followed by acompensatory pause. Copyright © StudyGuideZone.com. All rights reserved. 53
54. 54. Ventricular fibrillation- Completely abnormal ventricular rate andrhythum requiring emergency innervention. No effective cardiacoutput.BradyarrhythmiasAV block (primary, secondary (I,II) TertiaryPrimary- >.02 PR intervalSecondary (Mobitz I) – PR interval IncreaseSecondary (Mobitz II) – PR interval (no change)Tertiary- most severe, No signal between ventricles and atria noted onECG. Probable use of Atrophine indicated. Pacemaker required.Right Bundle Branch Block (RBBB)/Left Bundle Branch Block (LBBB)Sinus Bradycardia- <60 bpm, with presence of a standard P wave. Copyright © StudyGuideZone.com. All rights reserved. 54
55. 55. Cardiac Failure ReviewRight Sided Heart FailureA. Right Upper Quadrant Pain Left Sided Heart FailureB. Right Ventricular heave A. Left Ventricular HeaveC. Tricuspid Murmur B. ConfusionD. Weight gain C. Paroxysmal noturnal dyspneaE. Nausea D. DOEF. Elevated Right Atrial E. Fatiguepressure F. S3 gallopG. Elevated Central Venous G. Cracklespressure H. TachycardiaH. Peripheral edema I. CoughI. Ascites J. Mitral MurmurJ. Anorexia K. DiaphoresisK. Hepatomegaly L. OrthopneaECG Changes with MIT Wave inversionST Segment ElevationAbnormal Q wavesECG Changes with DigitalisInverts T waveQT segment shorter Copyright © StudyGuideZone.com. All rights reserved. 55
56. 56. Depresses ST segmentECG Changes with QuinidineInverts T waveQT segment longerQRS segment longerECG Changes with PotassiumHyperkalemia- Lowers P wave, Increases width of QRS complexHypokalemia- Lowers T wave, causes a U waveECG Changes with CalciumHypercalcemia-Makes a longer QRS segmentHypocalcemia- Increases time of QT interval Copyright © StudyGuideZone.com. All rights reserved. 56
57. 57. Endocrine ReviewHypothyroidism: Poor production of thyroid hormone:Primary- Thyroid cannot meet the demands of the pituitary gland.Secondary- No stimulation of the thyroid by the pituitary gland.Causes: Decreased BP and HRSurgical thyroid removal Chest X-rayIrradiation Elevated liver enzymes,Congenital defects prolactin, and cholesterolHashimoto’s thyroiditis (key) Decreased T4 levels and serum sodium levelsSymptoms: Presence of anemiaConstipation Low temperatureWeight gain Poor reflexesWeaknessFatigue Treatment:Poor taste Increase thyroid hormone levelsHoarse vocal sounds LevothyroxineJoint painMuscle weakness Monitor the patient for:Poor speech Hyperthyroidism symptomsColor changes following treatmentDepression Heart disease MiscarriageTests: Myxedema coma if untreated Copyright © StudyGuideZone.com. All rights reserved. 57
58. 58. Hyperthyroidism: excessive production of thyroid hormone.Causes: Hair lossIodine overdose Elevated BPThyroid hormone overdose FatigueGraves’ disease (key) SweatingTumors affecting thereproductive system Tests: Elevated Systolic pressure notedSymptoms: T3/T4 (free) levels increasedSkin color changes TSH levels reducedWeight lossAnxiety Treatment:Possible goiter Radioactive iodineNausea SurgeryExophthalmos Beta-blockersDiarrhea Antithyroid drugsCongenital adrenal hyperplasia: Excessive production of androgen andlow levels of aldosterone and cortisol. (Geneticially inherited disorder).Different forms of this disorder that affect males and femalesdifferently.Causes: Adrenal gland enzyme deficit causes cortisol and aldosteroneto not be produced. Causing male sex characteristics to be expressedprematurely in boys and found in girls. Copyright © StudyGuideZone.com. All rights reserved. 58
59. 59. Symptoms: Salt levelsBoys: Low levels of cotisolSmall testes development Low levels of aldosteroneEnlarged penis development Increased 17-OH progesteroneStrong musculature appearance Increased 17-ketosteroids inGirls: urineAbnormal hair growthLow toned voice Treatment:Abnormal genitalia Reconstructive surgeryLack of menstruation Hydrocoristone DexamethasoneTests:Primary/Secondary HyperaldosteronismPrimary Hyperaldosteronism: problem within the adrenal glandcausing excessive production of aldosterone.Secondary Hyperaldosteronism: problem found elsewhere causingexcessive production of aldosterone.Causes:Primary: Symptoms:Tumor affecting the adrenal Paralysisgland FatiguePossibly due to HBP Numbness sensationsSecondary: HtnNephrotic syndrome WeaknessHeart failureCirrhosis Tests:Htn Increased urinary aldosterone Copyright © StudyGuideZone.com. All rights reserved. 59
60. 60. Abnormal ECG readings Treatment:Decreased potassium levels Primary: SurgeryDecreased renin levels Secondary: Diet/DrugsCushing’s syndrome: Abnormal production of ACTH which in turncauses elevated cortisol levels.Causes:Corticosteroids prolonged use Tests:Tumors Dexamethasone suppression testSymptoms: Cortisol level checkMuscle weakness MRI- check for tumorsCentral obesity distributionBack pain Treatment:Thirst Surgery to remove tumorSkin color changes Monitor corticosteroid levelsBone and joint painHtn Monitor the patient for:Headaches Kidney stonesFrequent urination HtnMoon face Bone fracturesWeight gain DMAcne InfectionsDiabetic ketoacidosis: increased levels of ketones due to a lack ofglucose. Copyright © StudyGuideZone.com. All rights reserved. 60
61. 61. Causes: Insufficient insulin causing ketone production which end up inthe urine. More common in type I vs. type 2 DM.Symptoms: Increased amylase andLow BP potassium levelsAbdominal pain Ketones in urineHeadaches Check BPRapid breathingLoss of appetite Treatment:Nausea InsulinFruit breath smell IV fluidsMental deficits Monitor the patient for:Tests: Renal failureElevated glucose levels MI ComaT3/T4 ReviewBoth are stimulated by TSH release from the Pituitary glandT4 control basal metabolic rateT4 becomes T3 within cells. (T3) Active form.T3 radioimmunoassay- Check T3 levelsHyperthyroidism- T3 increased, T4 normal- (in many cases)Medications that increase levels of T4:MethadoneOral contraceptivesEstrogen Copyright © StudyGuideZone.com. All rights reserved. 61
62. 62. CloffibrateMedications that decrease levels of T4:LithiumPropranololInterferon alphaAnabolic steroidsMethiamazoleLymphocytic thyroiditis: Hyperthyroidism leading to hypothyroidismand then normal levels.Causes: Lymphocytes permeate the thyroid gland causinghyperthyroidism initially.Symptoms: Lymphocyte concentration notedFatigue with biopsyMenstrual changesWeight loss Treatment:Poor temperature tolerance Varies depending on symptoms.Muscle weakness (Beta blockers may be used.)Hyperthyroidism symptoms Monitor the patient for:Tests: Autoimmune thyroditisT3/T4 increased Hashimoto’s thyroiditisIncreased HR Goiter Stuma lymphomatosoma Copyright © StudyGuideZone.com. All rights reserved. 62
63. 63. Graves’ disease: most commonly linked to hyperthyroidism, and is anautoimmune disease. Exophthalmos may be noted (protrudingeyeballs). Excessive production of thyroid hormones.Symptoms:Elevated appetite Treatment:Anxiety Beta-blockersMenstrual changes SurgeryFatigue PrednisonePoor temperature tolerance Radioactive iodineDiplopiaExophthalmos Monitor the patient for: FatigueTests: CHFElevated HR DepressionIncreased T3/T4 levels Hypothyroidism (over-Serum TSH levels are decreased correction)GoiterType I diabetes (Juvenile onset diabetes)Causes: Poor insulin production from the beta cells of the pancreas.Excessive levels of glucose in the blood stream that cannot be useddue to the lack of insulin. Moreover, the patient continues toexperience hunger, due to the cells not getting the fuel that they need.After 7-10 years the beta cells are completely destroyed in manycases. Copyright © StudyGuideZone.com. All rights reserved. 63
64. 64. Symptoms: Relieve the diabetic ketoacidosisWeight loss symptomsVomiting Foot ulcer preventionNauseaAbdominal pain Monitor for infection:Frequent urination Monitor for hypoglycemiaElevated thirst conditions if type I is over- corrected.Tests: Glucagon may need to beFasting glucose test administered if hypoglycemiaInsulin test conditions are severe.Urine analysis Monitor the patient for ketone build-up if type I untreated.Treatment: Get the eyes checked- once aInsulin year Copyright © StudyGuideZone.com. All rights reserved. 64
65. 65. Type II diabetesThe body does not respond appropriately to the insulin that is present.Insulin resistance is present in Type II diabetes. Results inhyperglycemia.Risk factors for Type II Fasting glucose test.Diabetes:Obesity Treatment:Limited exercise individuals TlazamideRace-Minorities have a higher Glimepiridedistribution Control dietElevated Cholesterol levels Increase exercise levelsHtn Repaglidine/Nateglinide Glycosylated hemoglobinSymptoms: BUN/ECGBlurred vision Frequent blood sugar testingFatigue AcarboseElevated appetite Diabetic Ulcer preventionFrequent urinationThirst Monitor the patient for:Note: A person may have Type NeuropathyII and be symptom free. CAD Increased cholesterolTests: RetinopathyRandom blood glucose test. PVDOral glucose tolerance test Htn Copyright © StudyGuideZone.com. All rights reserved. 65