NSG223 HESI Final Exam Study Guide Graded A 2025

01.03.02 Atrial Flutter & PAC Etiology and pathophysiology and identify subjective and objective assessment data associated with a diagnosis of Premature Atrial Complex, Atrial Fibrillation and Flutter. Atrial flutter & PAC • Irregular pulse • Fatigue • SOB • C/O goes down • Dyspnea on exertion Rate – 250-400 beats/ min Saw tooth appearance Causes • HF • Tricuspid or mitral valve disease • PE • Cor pulmonale • Inferior wall MI • Carditis • Digoxin toxicity 01.03.04 Identify key pharmacological concepts related to the management of Sinus Node and Atrial Dysrhythmias Atrial flutter – treatment Atrial flutter – treatment • Stable o CCB – diltiazem, verapamil o BB – propranolol ▪ SE: decrease work load of heart, decrease BP, decrease HR, dizzy o antiarrhythmic/antidysrhythmic – amiodarone, procainamide o Anticoagulation – heparin (if someone come in now - immediate, warfarin (takes a few days for therapeutic), enoxaparin • Unstable – ventricular rate of 150bpm initiate cardioversion S/S • Chest pain • SOB • Low BP Medical management • Vagal maneuvers • Trial administration of adenosine – block and slow conduction through AV node lOMoAR cPSD| 2 terminates tachycardia • Adenosine o IV, rapid administration & 20 cc saline flush & elevation of arm with IV line to promote circulation MOD 2 CV Disorders pt. 1 02.01.01 Angina – POC Describe the etiology, pathophysiology and assessment data, and non-pharmacological medical management of angina pectoris Angina – FIRST STEP • Give oxygen 02.01.02 Anginal Pain Discuss the nursing process as it relates to care of the patient with angina pectoris Anginal pain • Cardiac pain due to decreased blood flow • Primary goal to restore oxygen to the heart 02.01.03 Unstable Angina – Nitroglycerin (NTG) ACS – Unrelieved chest pain Identify key pharmacological concepts related to the management of angina pectoris. 02.03.01 Chest Pain Algorithm (map) Etiology, pathophysiology and identify subjective and objective assessment data associated with a diagnosis of acute coronary syndrome (ACS) 02.03.02 Chest pain ACS algorithm (map) Describe the non-pharmacological medical management of acute coronary syndrome (ACS). lOMoAR cPSD| 3 02.03.03 Acute MI Activity CAD Action MI - POC Unstable angina – POC Discuss the nursing process as it relates to care of the patient with acute coronary syndrome (ACS) CAD – action • Elevate HOB @ 30 degress • Laying flat and 90 degrees put stress on heart • No caffeine • Oxygen & nitroglycerin 02.03.04 Acute MI (AMI) Identify key pharmacological concepts related to the use of management of acute coronary syndrome (ACS) MOD 3 CV Disorders pt. 2 03.01.01 Mitral valve prolapse – 2D ECHO Valve surgery activity Describe the pathophysiology, subjective and objective assessment data and the medical and nursing management of the patient with a valvular disorder. Mitral valve prolapse – what to get • Could be asymptomatic (could have fatigue & SOB) • Do an echocardiogram Valve surgery – activity • 03.02.01 Cardiomyopathy – HA onset Describe the pathophysiology, subjective and objective assessment data and medical and nursing management of the patient with cardiomyopathy. Cardiomyopathy – HA onset • Clinical manifestations – similar to CHF o Extra heart sounds o Cough lOMoAR cPSD| 4 o Orthopnea o Chest pain o Nausea • Treatment o Anticoagulation o Diuretics • Risk factors o Pregnancy o Alcohol • Interventions o Sit with legs hanging down – pulls water down 03.03.03 Pericarditis pain Describe the pathophysiology subjective and objective assessment data and medical and nursing of the patient with pericarditis Pericarditis pain • NSAIDS – ok to use • Pain worst with breating IN • Fever, SOB • Bedrest till pain is gone • Hear a friction rub, creaky • Sitting forward can relief pain (tripod or orthopneic position) MOD 4 Respiratory System 04.01.01 PE – 1 st action Describe the etiology, pathophysiology, and subjective and objective assessment data associated with a diagnosis of Pulmonary Embolism PE – FIRST ACTION • Nasal Oxygen 04.01.04 PE – Heparin Identify key pharmacological concepts related to the management of pulmonary embolism. 04.03.02 PE – ABG’s & Hypoxia Describe Respiratory Failure in terms of pathophysiology, identify subjective and objective assessment data also describe the assessment and diagnostic findings aligning with the medical and nursing management including non-pharmacological interventions lOMoAR cPSD| 5 PE – ABG & Hypoxia • Will get respiratory acidosis 04.02.01 Describe the etiology, pathophysiology, and subjective and objective assessment data ARDS S/S associated with a diagnosis of Acute Respiratory Distress Syndrome ARDS – symptoms • Hypoxia even when 100% oxygen is given (room air at 21%) • Decreased lung compliance – loss of elasticity • Dyspnea • Edema • Bilateral pulmonary edema (non-cardiac) • Dense pulmonary infiltrates on XRAY • Fluid in lungs • Low BP • HR & RR high • Low O2 • Can have increased temp • Dysrhythmias • Working very hard to breathe, cyanosis, external muscle, use • Hear crackles 04.02.01 & 04.02.02 Describe the etiology, pathophysiology, and subjective and objective assessment data associated with a diagnosis of Acute Respiratory Distress Syndrome. Pneumonia – Frothy Sputum Discuss the medical and nursing management including non-pharmacological interventions for a patient with Acute Respiratory Distress Syndrome (ARDS) ARDS – Priority Lab 04.02.03 ARDS – COPD Discuss the nursing process as it relates to care of the patient with Acute Respiratory Distress Syndrome (ARDS) MOD 5 Acid-Base Balance lOMoAR cPSD| 6 05.01.03 Differentiate between Acute and Chronic Respiratory Acidosis (Carbonic Acid Excess) in terms of pathophysiology, subjective and objective assessment data and medical management. Respiratory Acidosis Respiratory Acidosis • High CO2 level related to low RR • Causes o Shallow beathing or not breathing (HYPOVENTILATING) o Surgery & anesthesia lowering RR o Narcotic use – causing lethargy and depressed RR o Muscular dystrophy o Multiple sclerosis o Myasthenia gravis • Chronic cause o OSA o COPD • Treatment o Improving ventilation/ breathing o Cardiac arrest intubate & Ventilate o Asthma bronchodilators o Pneumonia/ARDS antibiotics o Hydration o Pulmonary hygiene/toileting TCDB, IS o Semi fowelers position 05.01.05 Describe Mixed Acid–Base Disorders in terms of pathophysiology, subjective and objective assessment data and medical management. Normal ABG values Normal pH = (Acidic) 7.35 – 7.45 (alkalotic) Normal CO2 = (Acid) 45– 35 (Alkalosis) 45 acidic 35 alkalosis Normal HCO3 = (Acidic) 22 – 26 (alkalotic) Mixed imbalances • Only mixed imbalance you can’t have is resp. acidosis & resp. alkalosis – b/c you can’t be hypoventilating and hyperventilating at the same time CO2 respiratory • 45 = acidic • 35 = alkalosis Interpretation • First word – respiratory or metabolic determined by which buffer (CO2 or HCO3) ABGs – within normal limits (WNL) lOMoAR cPSD| 7 • Second word whatever the ph is Compensations • Uncompensated o HCO3 or CO2 is normal • Partially compensated o Nothing is normal • Fully compensated o PH is normal o HCO3 and CO2 are opposite MOD 6 GI System 06.02.01 Define the etiology, pathophysiology and identify subjective and objective assessment data associated with a diagnosis of Acute Pancreatitis AST level • 10-40 U/mL (0.34-0.68 U/L) ALT level • 8-40 U/mL (0.14-0.68 U/) Pancreatitis – electrolytes • HYPOCALcemia • HYPERglycemia Pancreatitis – Lipase Pancreatitis – Amylase Pancreatitis – Electrolytes 06.02.02 Discuss the medical management of acute pancreatitis including non-pharmacological ACUTE interventions of acute pancreatitis ACUTE pancreatitis – treatments • Opioids IV or PCA – hydromorphone (dilauded), morphine, fentanyl if pain not controlled, call doctor • Strict NPO • NG tube and hook to suction • Bed rest – to decrease metabloic rate, semifowlers OK • Tube feedings – TPN o Check blood sugar Q6 hrs • Avoid heavy meals and alcohol after recovery • Diet: high protein, low fat • Incentive spirometer