Nursing Nerds

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

5 areas to remember: APETM

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

IMPORTANT ELECTROLYTE VALUES TO KNOW FOR YOUR NCLEX:

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

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 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.

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.

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.

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.