11pm - sleep

5am to 6:45 am – wake up, clean, exercise, bathe, coffee

16 hrs (30 mins lunch + 30 mins dinner)
7 am – prepare what to study
7:30 begin

CARDIOVASCULAR/RESPIRATORY
7 hrs MORNING SESSION 7 hrs AFTERNOON SESSION
SUNDAY  A  A
 B  B
 C  C
 D  D
 E  E
 F  F
 G  G
MONDAY  A  A
 B  B
 C  C
 D  D
 E  E
 F  F
 G  G
TUESDAY  A  A
 B  B
 C  C
 D  D
 E  E
 F  F
 G  G

WEDNESDAY  Finish all Kaplan videos  A

  B
 C  C
 D  D
 E  E
 F  F
 G  G

THURSDAY  Read Uworld  A

 Review Pre-test Rationale  B
  C
 D  D
 E  E
 F  F
 G
G

FRIDAY  A  Take post test

 B  B
 C  C
 D  D
 E  E
 F  F
 G  G

SATURDAY  SWHA Diagnostic exam review  SWHA Diagnostic exam retake

 B  B
 C  C
 D  D
 E  E
 F  F
 G  G

Cues Notes

••Note key points. ••Record notes here during class or while

reading.
••Phrase notes as questions.
••Use meaningful abbreviations and symbols.
••Write questions within twenty-four hours after
class. ••Leave space to add additional information.

Summary

••Record main ideas and major points.

••Write during review sessions.

Kaplan Videos Peripheral Vascular Disease

What are 2 types of Peripheral Vascular Aterial & Venous PVD

Disease?

Assessment relevant to Arterial PVD: Pallor when legs raised up

dependent feet rubor (red)
ulcers/gangrene
intermittent claudication
impaired sensation
↓peripheral pulses
What are usual causes of Arterial PVD: Reynaud’s disease, arteriosclerosis, Buerger’s
disease

What are care given to Arterial PVD? Monitor peripheral pulses

Good foot care
Stop smoking
Regular exercise
Avoid crossing legs
What type of medications usually given to Vasodilators, anticoagulants, antiplatelets
Arterial PVD?

Assessment relevant to Venous PVD: Cool, brown skin

Edema
Ulcers w/pain
Normal or ↓ pulses

What are usual causes of Venous PVD: Varicose veins

Thrombophlebitis

What are care given to Venous PVD? Monitor peripheral pulses

Elastic stockings/Intermittent pneumatic
compression device
TED hose
Elevate legs
Warm moist packs
Bed rest 4-7 days
Avoid extreme temps

What medication given to Venous PVD? Anticoagulants

Summary
Kaplan Videos Congenital Heart Anomalies

What are general effects of Congenital Heart Increase workload of heart results into
Anomalies? hypertrophy and tachycardia
Pulmonary HTN w/↑vascular resistance &
dyspnea
Inadequate cardiac output
Tachypnea
Respiratory insufficiency
Exercise intolerance
Growth failure
Abn. Shunting of blood that causes
polycythemia, cyanosis, cerebral changes,
clubbing
Squatting to help w/respiratory distress

What are the 2 types of Congenital Heart Acyanotic and Cyanotic

Anomalies?
Normal color/Normal CNS fxn
Enumerate assessment found on Acyanotic Possible exercise intolerance
Congenital Heart Anomalies? Small stature
Failure to thrive
Heart murmur
↑frequency of respiratory infxns

What are the 6 types of Acynotic Congenital Ventricular septal defect (VSD)
Heard Anomalies? V A P – C P A Atrial septal defect (ASD)
Patent ductus arteriosus (PDA)
Coarctation of the aorta
Pulmonic stenosis
Aortic stenosis

What is Ventricular septal defect (VSD)? Opening between the right & Left ventricle

What heart sound will you hear? Loud, harsh murmur

Will it close? If yes, what age? Yes. Sometimes by 3 y.o

If not, what will be done? Surgery might be needed

What is Atrial septal defect (ASD)? Opening between the left and right atria
Will closure be done immediately? If No. Later in childhood.
no, when?
What is Patent ductus arteriosus (PDA)? Failure of the fetal structure to close
What is the usual treatment? Medications & surgery.

What is Coarctation of the aorta? Narrowing of the aorta

What is the usual treatment? Surgery

What is Pulmonic stenosis? Narrowing of pulmonary artery.

What is the usual treatment? Surgery

What is Aortic stenosis? Narrowing of the aortic valve.

What is the usual treatment? Surgery

What differentiates Cyanotic from Cyanotic types showed ↓pulmonary blood

Acyanotic? flow

Enumerate usual assessment found: Cyanosis since birth

Clubbing of fingers
Seizures/fainting/confusion
Marked exercise intolerance
Difficulty in eating resulting weight loss
Small stature
Failure to thrive
Characteristic MURMUR
Frequent severe respiratory infections

Why is their difficulty in eating? Because it’s difficult for babies to eat and
breathe at the same time

What are the 4 types of Cyanotic Congenital Tetralogy of Fallot

Heard Anomalies? Transposition of great vessels
Truncus arteriosis
Total anomalous venous return

VSD
What are the 4 abnormalities in Tetralogy of Pulmonic stenosis
Fallot? Overriding aorta
Right ventricular hypertrophy

Pulmonary artery leaves from the left

What is Transposition of great vessels? ventricle and the aorta leaves from the right
ventricle

Surgery
What is the usual treatment?
Failed embryonic division of the pulmonary
artery and the aorta. A single vessel overrides
What is Truncus arteriosis? both ventricles.

Absence of direct communication between

What is Total anomalous venous return? pulmonary veins & left atrium.
Surgery
What is the usual treatment?
Tachycardia
What are the client’s common Polycythemia (↑Hgb in the blood)
compensatory mechanism? Posturing – Squatting, knee chest position
(to help w/dyspnea)

How to prevent Congenital Heard Starts w/optimum maternal nutrition

Anomalies? Prenatal care
Avoid alcohol & drugs during pregnancy
Monitor v/s & heart rhythms
Change feeding pattern – small amounts of
feeding every 2 hrs.
Feed small volumes @ frequent intervals
Enlarge nipple hole – so that they don’t have
to suck so hard & tire themselves out
↓ sodium
↑ potassium
What are the medications given?
Digoxin
Iron
Diuretics
Potassium

Summary

Kaplan Videos Antihypertensives

Identify the suffixes used for the ff:

Angiotensin-Converting Enzyme (ACE)

Inhibitors -pril
(3) Example:
Captopril
Enalapril
Ramipril
MOA:
Blocks ACE in lungs.
Stops them from converting angiotensin I
into angiotensin II, which is a powerful
vasoconstrictor.
It causes drop in BP & sodium & fluid loss
Indication:
HTN
CHF
Common side effects:
Orthostatic hypotension
Myocardial infarction
GI irritation/peptic ulcer
Persistent, dry, nonproductive cough
Nursing consideration in providing
patient care: Give 1 h ac or 2 h pc or on an empty stomach
to increase absorption
Change position slowly (orthostatic
hypotension)
Dangle first before getting up of bed
Report swelling of the face
Small frequent meals
Frequent mouth care
Beta-Adrenergic Blockers (β – blockers)
-olol
(3) Example: Metoprolol
Atenolol
Nadolol
Propranolol
Which of these is the one used for stage
fright or anxiety and can cause Propranolol
bronchospasm? Also called a nonselective
beta blocker.

MOA:
Blocks beta-adrenergic receptors in the heart
which will ↓excitability of the heart,
↓cardiac workload & O2 consumption
How does it reduce BP?
↓CNS stimulation
Indication:
HTN
Angina
Supra-ventricular tachycardia
Prevent recurrent MI
Heart failure
Usually, it’s used with what meds?
Diuretics
Common side effects:
Acute severe heart failure
Cardiac dysrhythmias
Impotence
Bronchospasm – Propranolol
Gastric Pain
Nursing consideration in providing
patient care: Take with meals
Do not discontinue abruptly
Taper doses over 2 weeks
Monitor glucose levels frequently
What happens to client’s w/DM taking β
– blockers? It masks signs of hypoglycemia – sweating &
How to intervene? tachycardia
Monitor glucose levels frequently
Calcium Channel Blockers
-dipine
(3) Example:
Nifedipine
Amlodipine
Verapamil
MOA:
Inhibits movement of calcium across cell
membranes of arterial and cardiac muscle
cells that results to a slow impulse
conduction, dilation of coronary arteries,
↓cardiac workload and energy consumption
thus ↓BP
Indication:
Angina
Hypertension
Interstitial cystitis
Common side effects:
Peripheral edema
Dysrhythmias
AV block
Impotence
Dizziness
Headache
Nervousness
Nursing consideration in providing
patient care: Monitor v/s
Contraindicated in Heart block
Call HCP if BP <90/60
Monitor signs of heart failure
No grapefruit juice especially w/ Verapamil
Angiotensin II Receptor Blockers (ARBs)
-sartan
(3) Example:
Candesartan
Losartan
Eprosartan
MOA:
Blocks action of Angiotensin II thus promotes
vasodilation that lowers BP
Indication:
HTN
Heart failure
Diabetic neuropathy
Stroke prevention
MI
Common side effects:
Angioedema
Renal failure
Orthostatic hypotension
Nursing consideration in providing
patient care: Change position slowly
Monitor for edema
Notify HCO if edema occurs
Alpha 1 Adrenergic Blockers
-zosin
(2) Example:
Doxazosin
Prazosin
MOA:
Selective blockage of alpha-1 receptors in the
peripheral blood vessels
Indication:
HTN
BPH
Reynaud’s disease
Common side effects:
Reflex tachycardia
Orthostatic hypotension
Impotence
Nasal congestion
What is reflex tachycardia?
If BP ↓, the heart beats faster in an attempt
to raise it.
When does this usually happens?
Happens in response to a decrease in blood
volume (through dehydration or bleeding), or
an unexpected change in blood flow
Nursing consideration in providing
patient care: Administer first dose @ bedtime to manage
hypotension
Monitor BUN, creatinine, weight & edema
Change position slowly
Centrally Acting Alpha-Adrenergic
Example:
Methyldopa
Clonidine
MOA:
Stimulates alpha receptors in medulla to
↓sympathetic action in the heart thus ↓rate
& force of contraction & ↓cardiac output.
Indication:
HTN
Common side effects:
Sedation
Orthostatic hypotension
CHF
Nursing consideration in providing
patient care: Should not discontinue abruptly
Monitor fluid retention
Change position slowly
Direct-Acting Vasodilators
Example:
Hydralazine
Minoxidil
MOA:
Relaxes smooth muscle of the blood vessels
Indication: thus lowering peripheral resistance
HTN
Common side effects:
Sedation
Orthostatic hypotension
CHF
Nursing consideration in providing
patient care: Should not discontinue abruptly
Monitor fluid retention
Change position slowly

7 classifications of Antihypertensives: Safety is a concern: Orthostatic hypotension

ACE inhibitors
Β – blockers
Calcium channel blockers
Angiotensin II Receptor Blockers (ARBS)
Alpha 1 Adrenergic blockers
Centrally Acting Alpha-Adrenergic
Direct-Acting Vasodilators

Uworld Cardio Peripheral Vascular Disease

What are 2 types of Peripheral Vascular Arterial & Venous PVD

Disease?

Assessment relevant to Arterial PVD: Pallor when legs raised up

dependent feet rubor (red)
ulcers/gangrene
intermittent claudication
impaired sensation
↓peripheral pulses

What are usual causes of Arterial PVD: Reynaud’s disease, arteriosclerosis, Buerger’s
disease

What are care given to Arterial PVD? Monitor peripheral pulses

Good foot care
Stop smoking
Regular exercise
Avoid crossing legs
What type of medications usually given to Vasodilators, anticoagulants, antiplatelets
Arterial PVD?

Assessment relevant to Venous PVD: Cool, brown skin

Edema
Ulcers w/pain
Normal or ↓ pulses

What are usual causes of Venous PVD: Varicose veins

Thrombophlebitis

What are care given to Venous PVD? Monitor peripheral pulses

Elastic stockings/Intermittent pneumatic
compression device
TED hose
Elevate legs
Warm moist packs
Bed rest 4-7 days
Avoid extreme temps

What medication given to Venous PVD? Anticoagulants

Summary