Comprehensive System-by-System Review for Nursing Excellence

Study Guide Overview

This comprehensive guide focuses on assessment, prioritization, intervention, and patient education across all major body systems. Master high-yield NCLEX concepts with evidence-based nursing practices and critical thinking strategies.

???? CARDIOVASCULAR SYSTEM

Myocardial Infarction (MI)

Signs & Symptoms:

 Crushing chest pain radiating to left arm, jaw, or back  Nausea, vomiting, diaphoresis

 Shortness of breath, anxiety

  Women: Atypical symptoms (fatigue, back pain, indigestion)

  Elderly: May present with confusion, weakness

MONA Protocol (Immediate Management):

 M - Morphine (pain relief)

 O - Oxygen (maintain SpO2 >90%)

  N - Nitrates (sublingual nitroglycerin)

 A - Aspirin (chewed, 325mg unless contraindicated)

Additional Interventions:

  12-lead ECG within 10 minutes

 Cardiac enzymes (troponin, CK-MB)  Beta-blockers, ACE inhibitors

  Prepare for percutaneous coronary intervention (PCI)

Heart Failure (HF)

Left-Sided Heart Failure:

  Pulmonary manifestations: Dyspnea, orthopnea, paroxysmal nocturnal dyspnea

  Crackles (rales), pink frothy sputum

 Restlessness, confusion (due to decreased CO)  S3 gallop heart sound

Right-Sided Heart Failure:

 Systemic manifestations: Peripheral edema (ankles, sacrum)  Jugular vein distention (JVD)

 Hepatomegaly, ascites

 Weight gain >2-3 pounds in 24 hours

Key Nursing Interventions:

 Daily weights at same time, same scale  Strict intake and output monitoring

 Fluid restrictions (usually 2L/day)  Low-sodium diet (<2g/day)

 Position in high-Fowler's for breathing  Monitor for medication compliance

Hypertension (HTN)

Patient Education Priorities:

 DASH diet: Low sodium (<2300mg/day), high potassium  Regular aerobic exercise (30 min, 5 days/week)

 Weight management (BMI 18.5-24.9)  Limit alcohol intake

 Smoking cessation

 Stress management techniques

  Medication adherence: Never stop abruptly

???? RESPIRATORY SYSTEM

COPD vs Asthma Comparison

COPD Management

  Bronchodilators: Short-acting (albuterol) and long-acting

  Oxygen therapy: Low-flow (1-3L/min) to avoid CO2 retention

  Pulmonary rehabilitation: Exercise training, education

 Flu and pneumonia vaccines

Asthma Management

  Peak flow monitoring: Personal best comparison

 Controller medications: Inhaled corticosteroids  Rescue medications: Short-acting beta-agonists  Trigger avoidance: Environmental control

  Action plan: Written instructions for exacerbations

Pneumonia

Assessment Findings:

 Fever, chills, productive cough

 Pleuritic chest pain (sharp, worse with breathing)  Decreased or bronchial breath sounds

 Crackles, dullness to percussion

  Elderly: Confusion may be primary symptom

Nursing Priorities:

1. Airway clearance: Positioning, coughing, deep breathing
2. Oxygenation: Monitor SpO2, supplemental O2 as needed
3. Infection control: Isolation precautions if indicated
4. Hydration: Adequate fluids to thin secretions
5. Antibiotic therapy: Culture before first dose

???? NEUROLOGICAL SYSTEM

Stroke Assessment: FAST Protocol

F - Face: Facial drooping (ask to smile) A - Arms: Arm weakness (raise both arms) S - Speech: Speech difficulty (repeat simple phrase) T - Time: Time to call 911 (note onset time)

Ischemic vs Hemorrhagic Stroke

Ischemic Stroke (85% of strokes):

 Thrombotic or embolic occlusion

 Treatment: tPA within 3-4.5 hours if eligible  Aspirin 24 hours after tPA

 Monitor for bleeding complications

Hemorrhagic Stroke (15% of strokes):

 Intracerebral or subarachnoid hemorrhage

  Treatment: Control blood pressure, prevent rebleeding

 Contraindications: No anticoagulants, no tPA  Surgical intervention may be needed

Increased Intracranial Pressure (ICP)

Cushing's Triad (Late Signs):

1. Hypertension with widening pulse pressure
2. Bradycardia
3. Irregular respirations (Cheyne-Stokes)

Early Warning Signs:

 Decreased level of consciousness (most sensitive indicator)  Pupil changes (unequal, sluggish, non-reactive)

 Severe headache, projectile vomiting  Motor weakness, posturing

Nursing Interventions:

 Elevate head of bed 30 degrees

  Maintain head in midline position

  Avoid activities that increase ICP (Valsalva, hip flexion)

 Monitor neurological status hourly

  Administer osmotic diuretics as ordered (mannitol)

Seizure Management

During Seizure:

 Safety first: Protect from injury, lower to ground

 Time the seizure: Note duration and characteristics

 Do NOT: Restrain, put objects in mouth, give oral medications  Turn to side to prevent aspiration

 Suction airway if needed

Post-Seizure (Postictal Phase):

 Maintain airway, monitor respirations

 Reorient patient (confusion is common)  Document seizure activity in detail

 Check for injuries

 Administer anticonvulsants as ordered

⚡ ENDOCRINE SYSTEM

Diabetes Mellitus Management

Type 1 vs Type 2 Comparison:

  Type 1: Autoimmune, insulin-dependent, usually <30 years

  Type 2: Insulin resistance, often preventable, usually >40 years

Blood Glucose Targets:

 Preprandial: 80-130 mg/dL

  Postprandial: <180 mg/dL (2 hours after meal)

 Bedtime: 100-140 mg/dL

 HbA1c: <7% for most adults

Diabetic Emergencies

Diabetic Ketoacidosis (DKA):

 Population: Primarily Type 1 diabetics

  Pathophysiology: Lack of insulin → ketosis → acidosis

  Signs: Fruity breath odor, Kussmaul respirations, dehydration

  Labs: Glucose >250 mg/dL, pH <7.3, positive ketones

  Treatment: IV fluids, insulin drip, electrolyte replacement

Hyperosmolar Hyperglycemic State (HHS):

 Population: Primarily Type 2 diabetics

  Pathophysiology: Severe dehydration, no ketosis

  Signs: Altered mental status, extreme dehydration

  Labs: Glucose >600 mg/dL, osmolality >320, no significant ketones

  Treatment: Aggressive fluid replacement, insulin, electrolytes

Hypoglycemia Management

Mild Hypoglycemia (BG 54-70 mg/dL):

 Conscious patient: 15g fast-acting carbohydrates  Recheck glucose in 15 minutes

  Repeat treatment if still low

  Follow with protein/complex carb snack

Severe Hypoglycemia (BG <54 mg/dL):

  Unconscious/unable to swallow: Glucagon 1mg IM/SubQ

IV access available: D50W 25g IV push

  Monitor closely, may need repeated doses

Thyroid Disorders

Hyperthyroidism (Thyroid Storm):

  Signs: Hyperthermia, tachycardia, hypertension, altered mental status

 Treatment: Antithyroid medications, beta-blockers, corticosteroids

  Nursing: Cool environment, cardiac monitoring, frequent vitals

Hypothyroidism (Myxedema Coma):

  Signs: Hypothermia, bradycardia, decreased mental status

  Treatment: IV levothyroxine, corticosteroids, supportive care

  Nursing: Warm environment, passive rewarming, respiratory support

???? GASTROINTESTINAL & HEPATIC SYSTEM

Peptic Ulcer Disease (PUD)

Risk Factors:

H. pylori infection (most common cause)  NSAIDs, corticosteroids

 Smoking, alcohol use

  Stress, spicy foods (exacerbating factors)

Complications:

1. Bleeding: Melena, hematemesis, coffee-ground emesis
2. Perforation: Sudden severe pain, rigid abdomen, rebound tenderness
3. Obstruction: Vomiting, abdominal distention, early satiety

Treatment:

H. pylori eradication: Triple therapy (PPI + 2 antibiotics)

  Proton pump inhibitors: Omeprazole, pantoprazole

  Lifestyle modifications: Avoid NSAIDs, alcohol, smoking

Inflammatory Bowel Disease

Crohn's Disease vs Ulcerative Colitis:

Liver Disease

Cirrhosis Assessment:

 Jaundice: Yellow discoloration of skin, sclera

  Portal hypertension: Ascites, splenomegaly, varices

  Hepatic encephalopathy: Confusion, asterixis (flapping tremor)

  Bleeding tendencies: Easy bruising, prolonged bleeding

Hepatic Encephalopathy Stages:

1. Stage 1: Mild confusion, mood changes
2. Stage 2: Drowsiness, inappropriate behavior
3. Stage 3: Stuporous, marked confusion
4. Stage 4: Comatose, minimal response

Management:

  Lactulose: Reduces ammonia levels (goal 2-3 soft stools/day)

  Protein restriction: 0.8-1.0 g/kg/day initially

 Avoid sedatives: Increased sensitivity

  Monitor ammonia levels: Normal <50 mcg/dL

???? RENAL & URINARY SYSTEM

Acute Kidney Injury (AKI)

Phases of AKI:

1. Onset Phase: Hours to days, kidney function begins to decline
2. Oliguric Phase: <400 mL urine/24 hours (most dangerous phase)
3. Diuretic Phase: Increased urine output (3-5 L/day possible)
4. Recovery Phase: Weeks to months, gradual return to baseline

Causes (Pre/Intra/Post-renal):

  Pre-renal: Dehydration, hemorrhage, heart failure

  Intra-renal: Nephrotoxins, contrast dye, rhabdomyolysis

  Post-renal: Obstruction (stones, enlarged prostate, tumors)

Chronic Kidney Disease (CKD)

Stages Based on GFR:

 Stage 1: GFR >90 (normal with kidney damage)

 Stage 2: GFR 60-89 (mild decrease)

  Stage 3: GFR 30-59 (moderate decrease)

 Stage 4: GFR 15-29 (severe decrease)

 Stage 5: GFR <15 (kidney failure - dialysis needed)

Management:

  Blood pressure control: ACE inhibitors preferred