NURS 432 EXAM 1 BLUE PRINT
BARRY UNIVERSITY
, NUR 432
EXAM 1 Study Blueprint
• Carotid stenosis and treatment
o Atherosclerosis can cause plaque build up in any artery, not just the coronary
arteries
o Plaques and narrowing can decrease blood supply to the brain resulting in
ischemic strokes
o Treatment = carotid endarterectomy and balloon angioplasty/stent
• Carotid endarterectomy care and complications
o Involves making an incision into the carotid artery and scraping out the plaque
build-up
o Restores blood flow to the brain
o Complications = stroke during the procedure if a piece of plaque breaks off and
massive hemorrhage
o Check pulses hourly post-op
o Towel between neck to keep pressure off injury site and check for tracheal
swelling, gag reflex, hematoma, SOB, swelling
o Check pulses hourly post-op
o Performed to open the artery by removing atherosclerotic plaque. This procedure
is performed when the carotid artery is blocked or when the client is experiencing
TIAs.
▪ Assess for increased headache, neck swelling, and hoarseness of the
throat.
o In patients with carotid stenosis, carotid endarterectomy may be performed to
prevent a stroke. Carotid endarterectomy is a surgical procedure in which
atherosclerotic plaque that has accumulated inside the carotid artery is surgically
removed
• Pericarditis – symptoms/assessments, complications
o Inflammation of the outer later of the heart referred to as the visceral (inner of the
outer) or parietal (outer of the outer) pericardium
o Causes = infection, dresslers syndrome (autoimmune reaction after an MI), renal
failure, defect in pericardium, space-occupying tumor, cardiac surgery/injury
(very common for post CABG or open heart)
o Quality of pain = sharp stabbing worsens with inspiration. Sitting forward causes
relief
o How to relieve pain = sitting up and leaning forward, NSAIDS, treat the
underlying cause if possible
o S/S = pericardial friction rub, precordial chest pain or left shoulder pain, dyspnea
and fever (if bacterial)
▪ Pericardial friction rub is best heard with the diaphragm at the lower left
sternal border. To differentiate from pleural rub ask the patient to hold
, their breath. Will be audible while holding their breath as opposed to
pleural rub.
▪ Precordial chest pain is worse when lying down, coughing, swallowing,
deep breathing and relieved by sitting forward with forearms on legs.
o Dx = elevated WBC, EKG (low voltage QRS, ST elevation in most leads – can be
mistaken for MI), CXR normal unless effusion develops, echocardiogram is
abnormal if effusion is present
o Tx = treat cause, decrease inflammation (NSAIDs, if NSAIDs are ineffective use
steroids) and appropriate anti-infective agent (determined by blood culture
▪ NSAIDs = salicylates or indomethacin (Indocin)
• May cause GI irritation or ulcers. Must be taken with food
• Should relieve pain within 48 hours
o Commonly follows a respiratory infection.
o Can be due to a myocardial infarction.
o Can be due to acute exacerbation of a systemic connective tissue disease.
o Findings include chest pressure/pain aggravated by breathing (mainly inspiration),
coughing, and swallowing; pericardial friction rub auscultated at left lower sternal
border; shortness of breath; and relief of pain when sitting and leaning forward.
• Cardiac tamponade symptoms
o This is a complication of pericarditis that causes a rapid accumulation of fluid in
the pericardium. Inflammation leads to serous exudate which can build up within
the pericardial sack. Eventually the fluid compresses the heart and it is unable to
beat effectively. The heart becomes compressed and is unable to fill or contract
o S/S = low voltage EKG, heart sounds are distant/muffled, JVD, low cardiac
output, hypotension, narrow pulse pressure (ex. 80/65), tachycardia tachypnea,
pulsus paradoxus (>10 mmHg of SBP with expiration minus SBP with deep
inhalation)
▪ Becks triad = JVD, distant heart sounds, and hypotension/narrow pulse
pressure
▪ May lead to pulseless electrical activity
o Tx = Small ones can be treated with diuretics but often may need a
pericardiocentesis
▪ If untreated, will lead to pulseless electrical activity
o Can be seen with an echo
o Notify the provider immediately.
o Administer IV fluids to combat hypotension.
o Obtain a chest x-ray or echocardiogram to confirm diagnosis.
o Prepare the client for pericardiocentesis. (Verify informed consent. Gather
materials. Administer medications as appropriate.)
o Monitor hemodynamic pressures.
o Monitor heart rhythm. Changes indicate improper positioning of the needle.
o Monitor for reoccurrence of manifestations
BARRY UNIVERSITY
, NUR 432
EXAM 1 Study Blueprint
• Carotid stenosis and treatment
o Atherosclerosis can cause plaque build up in any artery, not just the coronary
arteries
o Plaques and narrowing can decrease blood supply to the brain resulting in
ischemic strokes
o Treatment = carotid endarterectomy and balloon angioplasty/stent
• Carotid endarterectomy care and complications
o Involves making an incision into the carotid artery and scraping out the plaque
build-up
o Restores blood flow to the brain
o Complications = stroke during the procedure if a piece of plaque breaks off and
massive hemorrhage
o Check pulses hourly post-op
o Towel between neck to keep pressure off injury site and check for tracheal
swelling, gag reflex, hematoma, SOB, swelling
o Check pulses hourly post-op
o Performed to open the artery by removing atherosclerotic plaque. This procedure
is performed when the carotid artery is blocked or when the client is experiencing
TIAs.
▪ Assess for increased headache, neck swelling, and hoarseness of the
throat.
o In patients with carotid stenosis, carotid endarterectomy may be performed to
prevent a stroke. Carotid endarterectomy is a surgical procedure in which
atherosclerotic plaque that has accumulated inside the carotid artery is surgically
removed
• Pericarditis – symptoms/assessments, complications
o Inflammation of the outer later of the heart referred to as the visceral (inner of the
outer) or parietal (outer of the outer) pericardium
o Causes = infection, dresslers syndrome (autoimmune reaction after an MI), renal
failure, defect in pericardium, space-occupying tumor, cardiac surgery/injury
(very common for post CABG or open heart)
o Quality of pain = sharp stabbing worsens with inspiration. Sitting forward causes
relief
o How to relieve pain = sitting up and leaning forward, NSAIDS, treat the
underlying cause if possible
o S/S = pericardial friction rub, precordial chest pain or left shoulder pain, dyspnea
and fever (if bacterial)
▪ Pericardial friction rub is best heard with the diaphragm at the lower left
sternal border. To differentiate from pleural rub ask the patient to hold
, their breath. Will be audible while holding their breath as opposed to
pleural rub.
▪ Precordial chest pain is worse when lying down, coughing, swallowing,
deep breathing and relieved by sitting forward with forearms on legs.
o Dx = elevated WBC, EKG (low voltage QRS, ST elevation in most leads – can be
mistaken for MI), CXR normal unless effusion develops, echocardiogram is
abnormal if effusion is present
o Tx = treat cause, decrease inflammation (NSAIDs, if NSAIDs are ineffective use
steroids) and appropriate anti-infective agent (determined by blood culture
▪ NSAIDs = salicylates or indomethacin (Indocin)
• May cause GI irritation or ulcers. Must be taken with food
• Should relieve pain within 48 hours
o Commonly follows a respiratory infection.
o Can be due to a myocardial infarction.
o Can be due to acute exacerbation of a systemic connective tissue disease.
o Findings include chest pressure/pain aggravated by breathing (mainly inspiration),
coughing, and swallowing; pericardial friction rub auscultated at left lower sternal
border; shortness of breath; and relief of pain when sitting and leaning forward.
• Cardiac tamponade symptoms
o This is a complication of pericarditis that causes a rapid accumulation of fluid in
the pericardium. Inflammation leads to serous exudate which can build up within
the pericardial sack. Eventually the fluid compresses the heart and it is unable to
beat effectively. The heart becomes compressed and is unable to fill or contract
o S/S = low voltage EKG, heart sounds are distant/muffled, JVD, low cardiac
output, hypotension, narrow pulse pressure (ex. 80/65), tachycardia tachypnea,
pulsus paradoxus (>10 mmHg of SBP with expiration minus SBP with deep
inhalation)
▪ Becks triad = JVD, distant heart sounds, and hypotension/narrow pulse
pressure
▪ May lead to pulseless electrical activity
o Tx = Small ones can be treated with diuretics but often may need a
pericardiocentesis
▪ If untreated, will lead to pulseless electrical activity
o Can be seen with an echo
o Notify the provider immediately.
o Administer IV fluids to combat hypotension.
o Obtain a chest x-ray or echocardiogram to confirm diagnosis.
o Prepare the client for pericardiocentesis. (Verify informed consent. Gather
materials. Administer medications as appropriate.)
o Monitor hemodynamic pressures.
o Monitor heart rhythm. Changes indicate improper positioning of the needle.
o Monitor for reoccurrence of manifestations
