Modules 7 & 8 made exam-ready: every listed condition built out with pathophysiology, manifestations, management, nursing priorities, and teaching — plus a quiz.
Built from the ATI Adult Med-Surg eBook (Unit 4) to match your Exam 3 Key Concepts. Each condition follows the same frame: causes/risk → pathophysiology → manifestations → medical management → nursing priorities → teaching. Tap the Quiz tab to test yourself.
🧭 How to use this
The colored boxes chunk each disorder the same way every time, so your eyes know where to look: 🔬 Patho📋 Manifestations💊 Management🚨 Nursing priority🎓 Teaching
🫀 Module 7 — Coronary, Conduction & Hypertension
🎯 Module objectives (deliverables)
Discuss normal and abnormal cardiovascular assessment findings. (CO 1)
Identify diagnostic tests of the cardiovascular system and related nursing implications. (CO 1)
Describe pathophysiology, clinical manifestations, and treatment of coronary vascular disorders. (CO 1, 2, 3, 4)
Use the nursing process as a framework for care of the client with hypertension, angina pectoris, acute coronary syndrome, or who has undergone cardiac revascularization procedures or cardiac surgery. (CO 1, 2, 3, 4)
📋 For all disorders, know:
Causes and risk factors
Pathophysiology
Diagnostic procedures
Clinical manifestations
Medical management
Nursing management & priorities of care
Client teaching / education
❤️ Coronary Artery Disease (CAD)
🔬 Pathophysiology & causes
Atherosclerosis = gradual thickening of the intima/media with plaque buildup → progressive narrowing of the coronary lumen → reduced blood flow & oxygen to the myocardium (ischemia). Modifiable risks: smoking, hypertension, hyperlipidemia, diabetes, obesity, sedentary lifestyle, elevated CRP. Non-modifiable: age, family history, sex assigned at birth.
🎓 Teaching / prevention
Smoking cessation, DASH/low-fat diet, regular exercise to raise HDL, control BP/glucose/lipids, manage stress, statin adherence.
💢 Angina Pectoris
Type
Pattern
Relief
Stable (exertional)
With exercise or emotional stress; predictable
✅ Rest or nitroglycerin
Unstable (preinfarction)
At rest or exertion; ↑ in frequency, severity, duration
⚠️ NOT reliably relieved — emergency
Variant (Prinzmetal)
Coronary artery spasm, often at rest
Calcium channel blockers, nitrates
💊 Medical management
Nitroglycerin (vasodilator), beta-blockers, calcium channel blockers, antiplatelets (aspirin), statins. 12-lead ECG & troponin to rule out MI.
🎓 Nitroglycerin teaching
Sit/lie down first (causes hypotension). Take 1 SL tablet; if pain persists, call 911, may take up to 3 tablets 5 min apart. Store in a dark glass bottle; replace every 6 months; expect a tingling/headache. Never combine with erectile-dysfunction drugs (severe hypotension).
🚨 Acute Coronary Syndrome (ACS) & MI
🔬 Pathophysiology
ACS = acute onset of myocardial ischemia from supply/demand imbalance. Spectrum: unstable angina → NSTEMI → STEMI. Abrupt loss of oxygen → ischemia (reversible) → infarction/necrosis (permanent) if flow isn't restored. Pain unrelieved by rest or nitro and lasting >15 min differentiates MI from angina. Women & older adults may have atypical symptoms (fatigue, indigestion, dyspnea).
📋 Manifestations
Crushing substernal chest pain/pressure radiating to jaw/left arm/back, dyspnea, diaphoresis, nausea, anxiety, sense of doom. Diagnostics: ECG (ST elevation = STEMI), ↑ troponin (most specific; rises 3-4 hr, stays up ~2 wk), CK-MB.
🚨 Immediate management — MONA + reperfusion
Morphine — for pain unrelieved by nitro
Oxygen — only if SpO₂ < 90% or in distress
Nitroglycerin — vasodilation
Aspirin — chewed, 162–325 mg
STEMI = time is muscle: PCI within 90 min (door-to-balloon) or fibrinolytics within 30 min
SA node (pacemaker 60–100/min) → AV node → Bundle of His → right & left bundle branches → Purkinje fibers → ventricular contraction. Depolarization = electrical activation (contraction); repolarization = recovery/reset.
Wave
Represents
P wave
Atrial depolarization
PR interval
Time from atrial depolarization to ventricular (SA→AV delay)
QRS complex
Ventricular depolarization (contraction)
T wave
Ventricular repolarization (recovery)
💡 PQRST memory
The letters run in order through one heartbeat: P-wave first (atria), then the QRS (ventricles fire), then T (ventricles reset).
⚡ Cardiac Arrhythmias (Dysrhythmias)
🔬 Why they matter
Classified by site of origin (SA, atria, AV, ventricle) and effect on rate/rhythm. Life-threatening effects come from decreased cardiac output & poor tissue perfusion. Dysrhythmias are a leading cause of death after acute MI.
Rhythm
Key feature
Priority response
Bradycardia
HR < 60; may cause ↓ output, dizziness
Atropine; pacing if symptomatic
Tachycardia / SVT
Fast rate ↓ filling time
Vagal maneuvers, adenosine; cardioversion if unstable
Atrial fibrillation
Irregularly irregular, no P waves
Rate control + anticoagulation (stroke risk!)
Ventricular tachycardia
Wide QRS, fast; may have/lose pulse
Pulse → cardiovert/antiarrhythmic; no pulse → defibrillate
Ventricular fibrillation
Chaotic, no output — lethal
Defibrillate immediately + CPR
Asystole
Flat line, no electrical activity
CPR + epinephrine (NOT shockable); confirm in 2nd lead
🚨 A-fib = clot = stroke
Blood pools in the fibrillating atria → thrombus → embolic stroke. Clients are anticoagulated (warfarin or a DOAC) based on the CHA₂DS₂-VASc score.
⚡ Cardioversion vs. Defibrillation
🔄 Synchronized Cardioversion
Shock is timed to the R wave (avoids the vulnerable T wave). Used for unstable rhythms WITH a pulse: unstable A-fib, SVT, V-tach with a pulse. Usually sedated & scheduled; hold digoxin beforehand.
⚡ Defibrillation
Unsynchronized immediate shock. Used for V-fib and pulseless V-tach only. "Clear" before discharging; resume CPR immediately after.
🔋 Pacemakers & AICD
💊 What they do
Pacemaker = delivers electrical impulses when the heart's own rate is too slow (e.g., symptomatic bradycardia, heart block). AICD (implantable cardioverter-defibrillator) = senses lethal ventricular arrhythmias and delivers a shock/paces to terminate them.
🎓 Discharge teaching
Check pulse daily; report rate below the set rate
Report dizziness, fainting, or hiccups (may signal lead displacement)
Keep cell phones ~6 inches from the generator; avoid strong magnets/MRI unless cleared
Carry the device ID card; avoid heavy lifting/raising the arm above the shoulder initially
If an AICD fires, you may feel a "kick"; report repeated firings
🩺 Coronary Revascularization
PCI (angioplasty/stent)
Catheter opens the blocked artery, often with a stent. Post-op: monitor the insertion site for bleeding/hematoma, check distal pulses, keep the affected leg straight, monitor for dysrhythmias, give antiplatelets.
BP at or above 130/80 on two+ readings on two+ occasions. Essential (primary) = no known cause (most cases). Secondary = caused by another condition (kidney disease, endocrine disorders, medications) — treat the cause. Prolonged HTN damages heart, brain, eyes, kidneys → left ventricular hypertrophy, stroke, retinopathy, CKD. Often the "silent killer" (few symptoms).
DASH diet, sodium ≤ 2,300 mg/day (ideally 1,500), weight loss, exercise, limit alcohol, no smoking, take meds even when feeling well, rise slowly (orthostatic hypotension), monitor BP at home.
Define the pathophysiology and etiology of cardiac valve disorders, infectious cardiac disorders, and cardiomyopathy. (CO 1)
Describe the nursing care of the adult client with a cardiac valvular disorder, with cardiomyopathy, and with an infectious cardiac disorder. (CO 1, 2, 3, 4)
Use the nursing process as a framework for care of the adult client with heart failure. (CO 1, 2, 3, 4)
📋 For all disorders, know:
Causes and risk factors
Pathophysiology
Diagnostic procedures
Clinical manifestations
Medical management
Nursing management & priorities of care
Client teaching / education
🚪 Valvular Heart Disease
🔬 Patho
Dysfunction of any of the 4 valves reduces the heart's pumping efficiency and stroke volume → remodeling (hypertrophy) → heart failure. Stenosis = narrowed opening impedes forward flow. Regurgitation = incomplete closure lets blood flow backward. Aortic stenosis is most common in older adults (calcification). Tricuspid dysfunction is linked to IV drug use (endocarditis).
Vegetations can break off → stroke (sudden weakness/slurred speech), PE, splenic/limb infarcts. New neuro deficits = emergency.
💪 Cardiomyopathy
Dilated
Ventricle stretches & weakens → poor contractility → heart failure, dysrhythmias, thrombus/embolism. Managed like HF; may need AICD or transplant.
Hypertrophic
Thickened septum can obstruct outflow → risk of sudden cardiac death. Avoid strenuous exertion, dehydration, and Valsalva. Beta-blockers reduce obstruction.
💔 Heart Failure
⬅️ Left-sided = Lungs
Backs up into the lungs: crackles, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, pink frothy sputum, fatigue. ("Left = Lungs.")
➡️ Right-sided = Body
Backs up into the body: peripheral/dependent edema, JVD, hepatomegaly, ascites, weight gain. (Cor pulmonale = right HF from lung disease.)
🔬 Diagnostics
BNP (B-type natriuretic peptide) rises with ventricular stretch/volume overload — supports the diagnosis and trends with severity. Echocardiogram measures ejection fraction.
🚨 Acute pulmonary edema — emergency
Sudden severe dyspnea, pink frothy sputum, anxiety. Priority: sit upright (high-Fowler's, legs dependent) + oxygen. Anticipate LMNOP: Lasix (furosemide), Morphine, Nitrates, Oxygen, Position.
🎓 Self-management teaching
Daily weight — same time, same clothes, after voiding. Report a gain of 2–3 lb in a day or ~5 lb in a week
Low-sodium diet & prescribed fluid restriction
Take meds as prescribed (diuretics, ACE-I/ARB, beta-blocker); don't skip
Report worsening dyspnea, edema, fatigue, or nighttime breathlessness
Balance activity with rest; elevate legs when sitting
🦵 Peripheral Vascular Disorders
🔴 Peripheral ARTERIAL disease (PAD)
Atherosclerosis ↓ arterial flow to the legs. Intermittent claudication (cramping pain with walking, relieved by rest); cool, pale, hairless legs; diminished pulses; thick nails; pain worse with elevation, better dependent. Keep legs dependent; walk to build collaterals; protect feet; no tight stockings.
🔵 Peripheral VENOUS disease
Poor venous return → edema, brown (hemosiderin) discoloration, stasis ulcers near the ankle, aching relieved by elevation. Elevate legs above heart + compression stockings to promote return.
💡 Arterial vs. venous (don't mix them up!)
Arterial → dependent (gravity helps flow down). Venous → elevate + compress (help blood get back up). They are exact opposites.
Never massage the leg (dislodges clot → PE). Maintain rest, elevate the leg, warm compresses, anticoagulation (heparin → warfarin/DOAC). Watch for PE: sudden dyspnea, pleuritic chest pain, tachycardia, hypoxia → emergency.
🎓 Prevention
Early ambulation, leg exercises, sequential compression devices, hydration, prophylactic anticoagulants. Avoid leg crossing & prolonged immobility.
❄️ Raynaud Syndrome
🔬 Patho & teaching
Episodic vasospasm of the fingers/toes triggered by cold or stress → classic color change: white (pallor) → blue (cyanosis) → red (rubor/reperfusion). Teaching: keep warm, wear gloves, avoid cold & nicotine, manage stress; calcium channel blockers may be prescribed.
🎈 Aortic Aneurysm
🔬 Patho & risk
Weakening/outpouching of the arterial wall. Main cause: uncontrolled hypertension + atherosclerosis. Abdominal aortic aneurysm (AAA) most common; may have a pulsatile abdominal mass and bruit. Often asymptomatic until it enlarges or ruptures.
🚨 Rupture/dissection — emergency
Sudden severe tearing back/abdominal pain, hypotension, signs of shock. Do not palpate the mass. Notify provider, prepare for emergent surgical repair. Control BP to reduce wall stress.
🧮 Dosage calculation reminder
Exam 3 includes math. Practice IV drip rates, weight-based infusions (mcg/kg/min), and concentration conversions — there are worked examples in the quiz's Dosage Calc topic.
💪 You've got this
Work each disorder the same way — patho, signs, management, priority, teaching — and the patterns start to repeat. Run the quiz by topic to lock it in.
🎯 Build your quiz
Pick a topic and length. Rationales appear right after you answer.