Nursing Nerds

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Pulse Oximetry

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Charts and Figures: Inhale, Exhale

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thenursingblog: Charts and Figures: Inhale, Exhale

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Preload is the stretch. The amount of volume being returned to the right side of the heart from systemic circulation.

Afterload is the squeeze. The amount of resistance the left side of the heart has to overcome in order to eject blood. 

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Location of heart sounds.

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NCLEX Tip: On NCLEX, heart sounds can appear in a multiple-choice format question or a hot spot question.

5 areas to remember: APETM

Here’s another illustration by Nursing Education Consultants, Inc. (2007):

Mnemonics (input by various people)   - APE To Man   - All People Enjoy Time Magazine   - All Physicians Earn Too Much   - All Patients Enjoy Taking Meds   - All Pigs Eat Too Much

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Blood Pressure =  Cardiac output x Systemic Vascular Resistance

When BP is low, here are some drugs you can administer. 

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Electrolyte imbalance: normal lab values.

IMPORTANT ELECTROLYTE VALUES TO KNOW FOR YOUR NCLEX:

Remember: NCLEX will never give you a value that is too close to the normal value.

For example: NCLEX will not give you a sodium level of 134 and ask you to definitely say the patient has hyponatremia. The value will more likely be 130 or less.

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Fluid Management

From Zerwekh J, Claborn J, Gaglione T: Mosby’s fluid and electrolyte memory notecards: visual, mnemonic, and memory aids for nurses, ed 2, St. Louis, 2010, Mosby.

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Stroke - series

Much of the brain is supplied blood by the internal carotid arteries.

The internal carotid arteries branch at the base of the brain in an area called the circle of Willis.

A blood clot (thrombus) may form in the body, break-off, and travel to the brain through a carotid artery and the circle of Willis.

The blood clot may block the passage of blood through a brain artery, depriving nearby tissue of oxygen and nutrients. The result is a stroke.

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Systolic & Diastolic Blood Pressure

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another great mnemonic for OB is VEAL CHOP

The trick to this mnemonic is writing it so each letter is associated with the one beneath it, like so:

Variable decelerations are associated with cord compression. (V and C)

Early decelerations are associated with head compression. This is generally a benign event. (E and H)

Accelerations are associated with oxygenation – which explains why they’re generally a good prognostic factor. (A and O)

Late accelerations are associated with placental insufficiency. (L and P)

Variable decelerations are the most common of the decelerations but also the most complex. The exact shape of the deceleration is determined by whether the uterine artery or vein is occluded first – but the important thing to remember is that it’s caused by compression of the umbilical cord. Unlike early and late decelerations, variable decelerations are not gradual. This works to your advantage, as their relative abruptness makes them easy to pick out in a monitoring strip.

The “early” in “early deceleration” refers to the lowest point of the deceleration occurring at the same time as the peak of the contraction. They are a result of increased vagal tone secondary to head compression and are generally benign when they occur during the 1st or 2nd stage of labor – but they can be a sign of cephalopelvic disproportion if they persist.

The “Late” in “Late decelerations” refers to the lowest point of the deceleration occurring after the peak of the contraction. Maternal contractions constrict the placental blood supply, thereby limiting the fetus’ blood supply to what’s already stored in the placental reserve. In the case of uteroplacental insufficiency, this lack of oxygen results in a deceleration which occurs as a result of (i.e. after) the contraction.

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Maternity/Postpartum/Labor/Deliver Nursing

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Alzheimer’s Disease:

Stage 1: no impairment - normal function.

Stage 2: very mild cognitive decline - which may appear to be normal age-related changes.

Stage 3: mild cognitive decline - losing or misplacing objects; short-term memory loss; difficulty remembering words or names; difficulty in work or social situations.

Stage 4: moderate cognitive decline - personality changes; withdrawal; obvious memory loss; difficulty performing tasks requiring planning or organizing; difficulty with complex cognition such as math.

Stage 5: moderately severe cognitive decline - inability to remember important details; disorientation to time and place.

Stage 6: severe cognitive decline - loss of awareness of events or surroundings; significant personality changes such as hallucinations, delusions, compulsive behavior; assistance required with ADLs; incontinence.

Stage 7: very severe cognitive decline - loss of ability to respond to environment; unrecognizable speech; incontinence; decreased mobility; death frequently related to infection or choking.

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Prolonged Ischemia will lead to necrosis and myocardial infarction.

Pathophysiology

Plaque ruptures and initiates the events of an MI. Myocardial cells become ischemic within 10 seconds of coronary occlusion. Cells experience a shortage of oxygen (hypoxia). After the myocardium is deprived of its glucose necessary for aerobic metabolism, anaerobic processes to take over, and a build up of lactic acid ensues. The cells cannot fully polarize. If this build up continues an MI occurs. The build up of scar tissue from the necrotic heart can lead to ventricular remodeling which changes the shape and function of the heart muscle itself.

Focused Assessment & Management

Classic symptom during a cardiac even is PAIN.

Nurse must be able to differentiate MI from anger for other pain.

MI is SEVERE crushing chest pain a squeezing sensation radiating down the left arm or up to the jaw

The Pain lasts for more than 20 minutes and not relieved by rest or nitro.

A associated symptoms: deepens, nausea/vomiting, diaphoresis, palpitations, feelings of impending doom P precipitating factors: exertion: exposure to cold; following meals; movement; relieved by rest, nitro, or positional changes Q quality: heaviness; tightness; pressure; sharp; stabbing; burning R region, radiation, risk factors: radiates to arm, jaw, back, below diaphragm, region is substernal left lateral right chest, risk factors: HTN, diabetes, obesity, dyslipidemia, smoking S severity: pain scale of 0-10 T timing: onset of duration, nocturnal, consistant or intermittent.

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ECG & Electrolytes

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CARDIAC COMPLICATIONS ARE PRIORITY!

Treatment is high dose aspirin, but watch out for Reyes Syndrome. Aspirin reduces fever and has an anti-flammatory effect.

(side note: aspirin is recommended for kawasai’s disease, rheumatic fever and rheumatoid arthritis)

What is a priority nursing diagnosis for a child in the late stage of Kawasaki disease?


A. Alterations in skin integrity.

B. High risk for altered tissue perfusion, cardiac morbidity.

C. Risk for imbalanced body temperature, hyperthermia.

D. High risk for fluid volume deficit.