Heart Failure (HF)
- Types – HFrEF (EF <40%, systolic) vs HFpEF (EF ≥50%, diastolic); Left HF vs Right HF.
- Left HF S&S – Dyspnea, orthopnea, PND, crackles, S3 gallop, pulmonary edema.
- Right HF S&S – JVD, peripheral edema, hepatomegaly, ascites, weight gain.
- Diagnostics – BNP/NT-proBNP (elevated), echo (EF), CXR (cardiomegaly, pulmonary congestion).
- Nursing Interventions – Daily weights (report >2 lb/day gain), fluid/sodium restriction, HOB 30–45°, O₂ therapy, monitor I&O.
- Medications – Loop diuretics, ACE inhibitors/ARBs, beta-blockers, aldosterone antagonists, digoxin (select cases).
Myocardial Infarction (MI)
- STEMI vs NSTEMI – STEMI: complete occlusion, ST elevation, requires emergent PCI (<90 min). NSTEMI: partial occlusion, troponin rise, no ST elevation.
- S&S – Chest pressure/pain radiating to jaw/arm, diaphoresis, nausea, dyspnea, sense of doom. Women may present atypically (fatigue, jaw pain, nausea).
- Diagnostics – Troponin I/T (rises 3–6 hrs, peaks 12–24 hrs), 12-lead ECG, CK-MB.
- MONA – Morphine (pain), Oxygen (if SpO₂ <90%), Nitrates, Aspirin (325 mg chew immediately).
- Nursing Priorities – Establish IV access, 12-lead ECG within 10 min, obtain blood, continuous cardiac monitoring, prepare for cath lab.
Diabetes Mellitus
| Feature | Type 1 DM | Type 2 DM |
|---|---|---|
| Pathophysiology | Autoimmune destruction of beta cells; absolute insulin deficiency | Insulin resistance + progressive beta-cell dysfunction |
| Onset | Usually childhood/young adult; acute | Usually adult; gradual |
| Treatment | Insulin therapy required | Lifestyle, oral agents, insulin if needed |
| DKA Risk | High | Low (HHS more common) |
- DKA – Glucose >250, pH <7.3, bicarbonate <18, anion gap >12, ketones present. Treatment: IV fluids, insulin drip, K⁺ replacement, bicarbonate if pH <7.0.
- HHS – Glucose >600, serum osmolality >320, no significant ketosis. Treat with aggressive IV fluids + insulin.
- Hypoglycemia – BG <70 mg/dL. 15-15 rule: 15 g fast-acting carbs → recheck in 15 min. If unconscious: IV dextrose or glucagon IM.
Stroke
- Ischemic (87%) – Thrombotic or embolic occlusion. Treat with tPA if within 3–4.5 hrs of onset (no hemorrhage on CT).
- Hemorrhagic (13%) – Intracerebral or subarachnoid hemorrhage. No tPA; control BP, prevent rebleeding, surgical evaluation.
- FAST – Face drooping, Arm weakness, Speech difficulty, Time to call 911.
- Nursing Priorities – Airway, neuro checks q1-2h (GCS, pupils, grip, speech), aspiration precautions, fall prevention, DVT prophylaxis.
- Post-tPA – No anticoagulants/antiplatelets for 24 hrs; monitor for reperfusion hemorrhage; frequent neuro checks.
Chronic Obstructive Pulmonary Disease (COPD)
- Pathophysiology – Chronic airway inflammation → airflow limitation (emphysema: alveolar destruction; chronic bronchitis: excessive mucus >3 months/yr × 2 yrs).
- S&S – Chronic cough, dyspnea on exertion, barrel chest, prolonged expiration, wheezing, pursed-lip breathing.
- Oxygen Caution – COPD patients may rely on hypoxic drive; target SpO₂ 88–92%; high-flow O₂ can suppress respiratory drive.
- Medications – SABA (albuterol) for rescue, LABA + LAMA for maintenance, inhaled corticosteroids, mucolytics, systemic steroids for exacerbations.
- Nursing Interventions – Tripod position, pursed-lip breathing, incentive spirometry, smoking cessation counseling, pulmonary rehab.
Sepsis & Septic Shock
- Sepsis – Life-threatening organ dysfunction caused by dysregulated host response to infection. qSOFA: RR ≥22, AMS, SBP ≤100.
- Septic Shock – Sepsis + vasopressor requirement to maintain MAP ≥65 mmHg + serum lactate >2 mmol/L.
- Hour-1 Bundle (Surviving Sepsis) – Measure lactate; blood cultures before antibiotics; broad-spectrum antibiotics within 1 hr; 30 mL/kg IV crystalloid bolus; vasopressors if MAP <65.
- Nursing Priorities – Obtain cultures (2 sets blood cultures); ensure IV access; monitor urine output (>0.5 mL/kg/hr goal); continuous monitoring; reassess frequently.