NUR 240 Exam 1 Study Guide Cardiac Concepts and Care 2026

Nur 240 exam 1 Ethical Issues ● Withholding/Withdrawing treatment ● Medical futility: Nothing can be done medically to cure/treat an illness anymore ● Moral distress Rapid Response team Patient Triggers - Altered mental status - HR greater than 140 bpm - RR greater 22 OR LESS THAN 8 - Systolic BP 180 OR less than 90 - Chest pain unrelieved with Nitro - Threatened loss of airway - Seizure Interfacility transport: one unit to another; charge nurse Intrahospital transport: one hospital to another→ physician makes 1st call End of life and Palliative Palliative care core principles: - Symptom management: pain, dyspnea, anxiety/ agitation, depression, delirium, N/V - Advanced care planning, family centered care, emotional, psychological, social and spiritual care, facilitating communication, awareness of ethical issues, caring for the caregiver End of life sedation ● Symptoms are intractable (hard to deal with); pt is experiencing unbearable and unmanageable pain ● Multidisciplinary approach has exhausted all tx ● Goals of end of life sedation ○ Level of obtundation, relieve suffering, without hastening death Advanced directives ● Living will and POA ● A designated person authorized to make decisions ○ Health care proxy, surrogate decision maker, health care agent DNR Orders: NEEDS explicit orders→ if none CPR is performed Communication and end of life care: ● Establish tx goals and priorities: ○ Proper setting, assess pt and family knowledge, explore hopes and expectations of pt and family, set realistic goals, be empathetic, make a plan, revise goals as appropriate Types of loss ● Necessary loss: anticipated; positive; loss that is replaced with something different or better. EX:child leaves home to go to college, ● Actual loss: Losing a person, job, or a house ● Perceived loss: hasn't happened yet→ think it's gonna happen ● Maturational or developmental loss: through life cycle ● Situational loss: natural disaster; unpredictable life event Grief reactions ● Normal grief ● Anticipatory grief ● Complicated grief: unresolved or chronic ● Disenfranchised grief: miscarriages Preload Afterload Preload → CVP, PCWP - Volume of blood in the ventricle at the end of the diastole. - “Stretch” Causes of Elevated Preload → Ventricular Dysfunction, Valvular Defects, Cardiac Tamponade Elevated Preload→ Orthopnea, Dyspnea, Cough, Crackles - Preload Reduction Medications→ Diuretics, Vasodilators (ACE Nitrates) Causes of Decreased Preload→ Hypovolemia, Hemorrhage, Third Spacing, Diuresis, Vasodilation - To Increase Preload→ Volume Administration, Patient Positioning (mod. trendel) Afterload→ SVR, PVR (~MAP, BP) Pressure that the ventricle pumps against to eject blood during systole. Most impacted by vascular resistance. Causes of Elevated Afterload → Vasoconstriction, HTN, Aortic Impedance, Catecholamine release, Hypovolemia, Pain, Hypoxia, Hypothermia Afterload Reduction Therapy→ Vasodilators (Nitroprusside, CCBs, ACE-Inhibitors, ARBs) **monitor blood pressure** Causes of Reduced Afterload→ Vasodilation (decreased SVR), Inadequate aortic valve, Inflammation, Hyperthermia - To Increase Afterload→ Fluid Resuscitation, Vasopressor/Adrenergic Agonist Therapy (NE/Levophed, Phenylephrine, Dopamine, Vasopressin) Low Contractility→ Cool, pale skin, decreased urine output, ALOC, weak pulses, tachy, Low CO/CI/EF - Interventions to Increase Contractility→ Positive Inotropic Agents (Dobutamine, Dopamine, Digoxin) - Interventions to Decrease Contractility→ Negative Inotropic Agents (Beta-Blockers, CCBs) Ejection Fraction→, Normal is 50-70% - Low level = Indicates HF