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NUR 425 Complex Care Exam 1 Blueprint 2023.
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NUR 425 Complex Care Exam 1 Blueprint 2023.
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Complex Care Exam 1 BlueprintYou should know the normal values for:
Serum Potassium:
o 3.5-5.0 mEq
PR interval:
o 0.12-0.20 sec
QRS interval:
o < 0.12 sec
Central Venous Pressure (CVP) in adults
o 2-8mmHg
Cardiac Output (CO) in adults
o 4-8L/min
Cardiac Index (CI) in adults
o 2.2-4L/min/m^2
MAP in adults
o 70-105mmHg
Normal vital signs parameters for adults
o BP: 120/80
o HR: 60-100
o RR: 12-20
o Temp: 97.8-99.1F,
o Pulse Ox: 95-100%
Normal INR
o 0.8-1.2 sec
Understand the significance of the following Not required to memorize actual normal ranges
Systemic Vascular Resistance (SVR)
o Resistance to left ventricle
Pulmonary Vascular Resistance (PVR)
o Resistance to right ventricle
Wedge Pressure (PAOP/PAWP)
o Estimates the left atrial pressure by “looking through” the lungs
Stroke Volume
o Amount of blood ejected from left ventricle
o Measure of CONTRACTILITY
o Volume measured in mL
Ejection fraction
o Fraction (percentage) of blood ejected from the left ventricle with each beat
o Measure of CONTRACTILITY
o Left ventricle must squeeze hard enough to get blood out
Serum Lactate
o When pt is unable to perfuse oxygen, aerobic metabolism converts to anaerobic metabolism and
lactate is released.
o Elevated serum lactate indicates significant hypoperfusion
PTT/aPTT
o Partial Thromboplastin Time
o May be prolonged with DIC
, o Measures integrity of the intrinsic system
D-Dimer
o Detects protein that results from clot breakdown
o Indicated that fibrin has been formed and degraded (fibrinolysis)
o Often markedly elevated with DIC
o Unlikely DIC if this test is normal
Fibrinogen
o Clotting factor that typically is low with DIC
The concept of a therapeutic PTT and INR
o PTT:
o INR: While taking Warfarin, it is typically expected that INR (standardized measurement of PT) is
prolonged.
2-3 seconds
You DO NOT need to memorize the coagulation cascade (eg. which factors activate which factors), just a general
understanding of its purpose and what happens if there are more or less clotting factors, if it is slowed down/sped
up, and what triggers the coagulation cascade.
The following medications could be tested on this exam. You should know the medication’s indications, side
effects, and nursing considerations when administering these:
Warfarin (Coumadin) - Anticoagulant
o Interferes with synthesis of clotting factors that use Vitamin K to be synthesized
o Will not affect factors already floating around, will prevent future factors from being made
o Indications:
Venous Thrombosis
Pulmonary Embolism
A-fib
Myocardial Infarction
o Nursing Considerations:
Can cause bleeding
Aspirin and NSAIDs increase risk of bleeding
Therapeutic levels: PT 15.5-35 seconds, INR 2-3
Avoid alcohol
Avoid foods that have a lot of Vitamin K: green vegetables, grains, mayo, canola and
soybean oil
Vitamin K is antidote
o Contraindications:
Vitamin K deficiency
Liver disease
Alcoholism
Pregnancy
Aspirin – Non opioid analgesic, antiplatelet
o Platelet aggregation leading to a decrease in ischemic diseases
o COX inhibitor
o Irreversible 7-10 days
o Indications:
Ischemic strokes and MI prophylaxis
Angina
o Nursing Considerations:
Increases risk for bleeding with warfarin, heparin, clopidogrel
, Monitor LFTs
Increased risk for GI bleeding very high with NSAID, alcohol use
o Contraindications:
Hemorrhagic stroke
PUD
o Caution:
Renal dysfunction
Pregnant women
Smokers
Nasal polyps
Clopidogrel (Plavix) – Antiplatelet
o Inhibits platelet aggregation
o Blocks ADP receptors
o Irreversible 7-10 days
o Indications:
Artherosclerotic events
MI, ACS
CVA, PVD
o Nursing Considerations:
Monitor for signs of bleeding
Monitor CBC and platelet count
Discontinue 5-7 days before surgery
Watch for TTP in first two weeks
Dabigatran (Pradaxa) - Anticoagulant
o Directly inhibits thrombin
o Indications:
CVA prophylaxis
Non-valvular A-fib
o Nursing Considerations:
Do not need INR checks
GI distress
Strict schedule-BID
Antidote: Praxbind
Pt do not need to focus on diet compared to warfarin
Heparin - Anticoagulant
o Prevents clotting by activating antithrombin, thus indirectly inactivating both thrombin and factor
Xa.-- “revs up” antithrombin
o Indications:
Venous thrombi
DVT prophylaxis, current DVT, AMI, DIC
o Nursing Considerations:
Cannot dissolve existing clots, prevents further clot formation
PTT: 1.5-2x control value
Treatment for hemorrhage: Protamine Sulfate
SubQ injections 2 inches from umbilicus
o Adverse Effects:
Bleeding
Heparin Induced Thrombocytopenia
Hypersensitivity
o Contraindications:
Thrombocytopenia
Uncontrollable bleeding
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