DECREASED CARDIAC OUTPUT

Decreased Cardiac Output related to systolic dysfunction secondary to impaired Myocardial Oxygenation

Nursing Assessment	Nursing Diagnosis	Goal	Nursing Intervention	Rationale	Evaluation
Subjective Data: Chest tightness/palpitation Productive cough Shortness of breath Diaphoresis Cool, clammy skin Weakness, fatigue & lethargy Swelling of hands & feet Facial puffiness Objective Data: Skin looks pale & edematous Diminished Peripheral Pulses Capillary refill time prolonged Vital signs show increased heart & Respiratory rate & BP decreased Presence of Respiratory crackles Presence of Cardiac Murmurs ECG show dysrhythmias Oxygen saturation decreased ABG Analysis show Respiratory acidosis/Metabolic Acidosis	Decreased Cardiac Output related to systolic dysfunction secondary to impaired Myocardial Oxygenation	Client maintains a normal Cardiac Output with normal vital Signs & Hemodynamic parameters	Assess the vital Signs & hemodynamic parameters like cardiac Output, intra arterial Pressure, Central venous pressure & pulmonary artery pressure continually	To monitor the hemodynamic status of the client & start immediate interventions	Client's cardiac output was increased as evidenced by normal cardiac output & stable dynamic parameters.
			Monitor the ECG & Saturation levels continually	To identify the need for oxygen therapy & provide interventions
			Monitor I/O chart daily	To identify Renal function as decreased cardiac output can impair Renal Perfusion
			Provide Strict bed rest & elevate the head end of the bed	To decrease Myocardial Oxygen demand & improve cardiac contraction
			Administer Oxygen therapy as indicated	To improve oxygenation to the Lungs & improve Myocardial Perfusion
			Administer Digitalis therapy as Prescribed	To improve contractility & increase cardiac Output
			Administer diuretics like thiazide, loop or potassium sparing diuretics as Prescribed	To decrease the fluid Overload & aid in cardiac contractility
			Administer Vasodilators like Nitroglycerine, hydralazine & isosorbide dinitrate as prescribed	To dilate the arteries & veins and reduce afterload thereby Increasing Cardiac Output
			Administer Nesiritide as Prescribed	To cause rapid vasodilation & increased Stroke volume
			Administer antiarrhythmic drugs & positive inotropic agents as Prescribed	To treat cardiac dysrhythmias
			Administer beta-blockers & ACE inhibitors as prescribed	To improve the ejection fraction & increase cardiac Output
			Assess the need for emergency Surgical or Invasive Interventions like IABP & Ventricular Assist devices & prepare the client for the Procedure	To treat the cause and improve Oxygenation & aid in gaseous Exchange

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Anti Hypercholesterolemic Drugs

Drug (Brand — Generic)	Class	Dose	Mechanism	Indications	Contraindications	Common SE	Serious AE	Nurse's Role
Atorvastatin (Lipitor)	Statin (HMG-CoA reductase inhibitor)	10–80 mg PO once daily	↓HMG-CoA reductase → ↓cholesterol synthesis → ↑hepatic LDL receptors → ↓LDL-C	Primary hypercholesterolemia, mixed dyslipidemia, ASCVD risk reduction	Active liver disease, pregnancy, breastfeeding, hypersensitivity	GI upset, headache, myalgias	Myopathy/rhabdomyolysis, hepatotoxicity	Baseline LFTs, CK if muscle symptoms; teach to report muscle pain/weakness or dark urine; avoid grapefruit; ensure contraception
Rosuvastatin (Crestor)	Statin	5–40 mg PO once daily (adjust for renal impairment)	Potent HMG-CoA reductase inhibition → large LDL reductions	Same as atorvastatin	Same as atorvastatin	Same as atorvastatin	Same as atorvastatin	Monitor renal function in elderly and adjust as needed
Simvastatin (Zocor)	Statin	10–40 mg PO once daily (usually evening)	Same as atorvastatin	Same as atorvastatin	Same as atorvastatin	Same as atorvastatin	Same as atorvastatin	More drug-interactions (CYP3A4) — many contraindications with strong CYP3A4 inhibitors
Ezetimibe (Zetia)	Cholesterol absorption inhibitor	10 mg PO once daily	Inhibits NPC1L1 intestinal cholesterol uptake → ↓chylomicron/LDL cholesterol	Add-on to statin if LDL goals not met; statin intolerance strategies	Active liver disease (when combined with statin)	Diarrhea, arthralgia; rare myopathy/hepatitis when combined with statin	Myopathy (when combined with statin)	Monitor LFTs if combined with statin; counsel on adherence and lifestyle
Fenofibrate (Tricor)	Fibrate (PPAR-α agonist)	48–145 mg PO once daily (depending on formulation)	↑lipoprotein lipase activity → ↓TG, ↑HDL	Severe hypertriglyceridemia, mixed dyslipidemia	Severe hepatic or renal disease, gallbladder disease	GI upset, ↑LFTs	Myopathy (especially with statins), gallstones	Monitor LFTs, creatinine; avoid combination with gemfibrozil if on statin
Niacin (Nicotinic acid)	Miscellaneous	IR/ER regimens vary (up to ~2000 mg/day under supervision)	↓VLDL production → ↓TG; ↑HDL.	Low HDL or hypertriglyceridemia (less used now)	Active liver disease, peptic ulcer disease, gout, uncontrolled diabetes.	Flushing, pruritus, GI upset.	Hepatotoxicity, hyperglycemia, gout exacerbation.	Recommend aspirin 30–60 min before to reduce flushing (if not contraindicated); monitor LFTs and glucose.
Cholestyramine (Questran), Colesevelam (Welchol)	Bile Acid Sequestrants	Cholestyramine powder varies 4–16 g/day; colesevelam 3.75 g/day (tablet or powder).	Bind bile acids in gut → ↑conversion of cholesterol to bile acids → ↓LDL.	LDL lowering, adjunct therapy.	Complete biliary obstruction.	Nausea, Constipation, Bloating.	Constipation, bloating, reduced absorption of fat-soluble vitamins and some drugs.	Mix powder well; separate other oral meds by 2–4 hours; encourage fiber/fluids.

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Low Cholesterol Diet (One Week Menu)

Low-Cholesterol Diet Chart

Day	Meal Time	Menu	Calories
Day 1 (~1,520 kcal)	Early Morning (6:30 AM)	Warm lemon water + 5 soaked almonds	40 kcal
	Breakfast (8:00 AM)	2 Idli + sambar + 1 tsp chutney	280 kcal
	Mid-Morning Snack (10:30 AM)	Buttermilk (200 ml) + 1 small banana	100 kcal
	Lunch (1:00 PM)	Brown rice (1 cup) + sambar + beans poriyal + green gram dal + low-fat curd	420 kcal
	Evening Snack (4:30 PM)	Sundal (steamed chana, ½ cup)	120 kcal
	Dinner (7:30 PM)	2 chapati + mixed veg kurma + salad	320 kcal
	Bedtime (9:00 PM)	Warm low-fat milk (150 ml)	100 kcal
Day 2 (~1,560 kcal)	Early Morning	Warm water + 4 walnuts	60 kcal
	Breakfast	Vegetable upma (1 cup)	300 kcal
	Mid-Morning Snack	Papaya slices	50 kcal
	Lunch	Millet rice (1 cup) + rasam + spinach poriyal + tur dal + low-fat curd	420 kcal
	Evening Snack	Roasted green gram (¼ cup)	110 kcal
	Dinner	Pongal (moong dal + rice, minimal oil) + sambar	420 kcal
	Bedtime	Chamomile tea	0 kcal
Day 3 (~1,550 kcal)	Early Morning	Warm water + 5 soaked almonds	40 kcal
	Breakfast	2 dosa (minimal oil) + tomato chutney + sambar	320 kcal
	Mid-Morning Snack	Orange	50 kcal
	Lunch	Red rice (1 cup) + mixed veg sambar + carrot beans poriyal + low-fat curd	430 kcal
	Evening Snack	Sprouted green gram salad	120 kcal
	Dinner	2 chapati + lauki (bottle gourd) curry + salad	320 kcal
	Bedtime	Turmeric milk (low-fat, 150 ml)	100 kcal
Day 4 (~1,540 kcal)	Early Morning	Lemon water + 4 soaked almonds	40 kcal
	Breakfast	Vegetable semiya upma	300 kcal
	Mid-Morning Snack	Guava slices	50 kcal
	Lunch	Brown rice (1 cup) + rasam + cabbage poriyal + green gram dal + low-fat curd	420 kcal
	Evening Snack	Roasted chana (¼ cup)	100 kcal
	Dinner	2 phulkas + mixed veg kurma + cucumber salad	320 kcal
	Bedtime	Herbal tea	0 kcal
Day 5 (~1,560 kcal)	Early Morning	Warm water + 4 walnuts	60 kcal
	Breakfast	2 Idli + sambar + mint chutney	280 kcal
	Mid-Morning Snack	Apple	60 kcal
	Lunch	Millet rice (1 cup) + sambar + beetroot poriyal + tur dal + low-fat curd	420 kcal
	Evening Snack	Sundal (steamed chana, ½ cup)	120 kcal
	Dinner	Pongal (moong dal + rice, minimal oil) + greens poriyal	420 kcal
	Bedtime	Warm low-fat milk (150 ml)	100 kcal
Day 6 (~1,530 kcal)	Early Morning	Lemon water + 5 soaked almonds	40 kcal
	Breakfast	2 dosa (minimal oil) + onion chutney + sambar	320 kcal
	Mid-Morning Snack	Watermelon slices	50 kcal
	Lunch	Red rice (1 cup) + rasam + drumstick poriyal + tur dal + low-fat curd	430 kcal
	Evening Snack	Sprouted moong salad	120 kcal
	Dinner	2 chapati + bottle gourd curry + salad	320 kcal
	Bedtime	Turmeric milk (low-fat)	100 kcal
Day 7 (~1,550 kcal)	Early Morning	Warm water + 4 walnuts	60 kcal
	Breakfast	Vegetable upma	300 kcal
	Mid-Morning Snack	Papaya slices	50 kcal
	Lunch	Millet rice (1 cup) + sambar + beans carrot poriyal + tur dal + low-fat curd	420 kcal
	Evening Snack	Roasted green gram	110 kcal
	Dinner	Pongal + spinach poriyal	420 kcal
	Bedtime	Chamomile tea	0 kcal

Tips for Success

• Use max 2–3 tsp oil/day (rice bran, sunflower, or groundnut oil).
• Use skimmed or toned milk.
• Include at least 4–5 servings of vegetables and 2 servings of fruits daily.
• Avoid adding ghee/butter to rice or dosa.

UPDATED MEDICAL TERMINOLOGY AND ABBREVIATIONS

Updated Medical Terms & Abbreviations

All Specialties Nephrology Cardiology Neurology Pulmonology Gastroenterology Obstetrics Infectious Diseases Psychiatry Dermatology General Laboratory Surgery

Older Term / Abbreviation	Updated / Preferred Term	Specialty	Reason for Change
Chronic Renal Failure (CRF)	Chronic Kidney Disease (CKD)	Nephrology	Stages-based classification; avoids the word "failure".
End-Stage Renal Disease (ESRD)	Kidney Failure (Stage 5 CKD)	Nephrology	More patient-friendly.
Acute Renal Failure (ARF)	Acute Kidney Injury (AKI)	Nephrology	Reflects potential reversibility.
Congestive Heart Failure (CHF)	Heart Failure (HF)	Cardiology	Not all patients present with congestion.
Myocardial Infarction (MI)	Acute Myocardial Infarction (AMI)	Cardiology	Distinguishes from prior MI.
Cerebrovascular Accident (CVA)	Stroke	Neurology	"Accident" is misleading; stroke is direct.
Petit Mal	Absence Seizure	Neurology	Descriptive classification.
Consumption	Tuberculosis (TB)	Pulmonology	Historical term obsolete.
Bronchial Asthma	Asthma	Pulmonology	"Bronchial" is redundant.
Infective Hepatitis	Hepatitis A Virus Infection	Gastroenterology	Etiology-specific terminology.
Miscarriage	Spontaneous Abortion (SAB)	Obstetrics	Medical accuracy.
Toxemia of Pregnancy	Pre-eclampsia	Obstetrics	Describes actual pathophysiology.
Venereal Disease (VD)	Sexually Transmitted Infection (STI)	Infectious	Broader scope beyond diseases.
Manic Depression	Bipolar Disorder	Psychiatry	DSM update.
Leper	Person with Hansen’s Disease	Dermatology	Non-stigmatizing.
Male Nurse	Nurse	General	Gender-neutral.
Blood Sugar	Blood Glucose	Laboratory	More accurate term.
Compound Fracture	Open Fracture	Surgery	Standard orthopedic terminology.

HOSPITAL COLOR CODES

CODE RED

Fire or smoke

CODE BLUE

Medical emergency (e.g., cardiac arrest)

CODE PINK

Infant or child abduction

CODE ORANGE

Hazardous material spill

CODE YELLOW

Disaster or mass casualty

CODE GREEN

Evacuation or combative person

CODE GRAY

Security threat or patient elopement

CODE SILVER

Active shooter or weapon threat

CODE BLACK

Bomb threat

CODE WHITE

Pediatric medical emergency (in some areas)

Expanded Neurological Deficit & Lesion Localization Chart

Expanded Neurological Deficit & Lesion Localization Chart

Neurological Deficit / Named Sign	Likely Lesion Location	Notes / Examples
Hemiplegia / Hemiparesis	Contralateral motor cortex or corticospinal tract above medulla	MCA stroke → opposite side weakness
Quadriplegia	Bilateral cervical spinal cord or brainstem	High cervical injury, brainstem infarct
Paraplegia	Thoracic spinal cord	Trauma, tumor, transverse myelitis
Monoplegia	Cortical motor area or peripheral nerve	Stroke, plexopathy
Foot drop	Common peroneal nerve, L5 root	Peripheral neuropathy, disc prolapse
Wrist drop	Radial nerve	Humeral fracture, lead poisoning
Babinski sign	Corticospinal tract (UMN lesion)	Stroke, MS
Hoffman sign	Corticospinal tract	Cervical myelopathy
Clasp-knife rigidity	UMN lesion	Stroke, spinal cord injury
Cogwheel rigidity	Basal ganglia	Parkinson’s disease
Chorea	Basal ganglia	Huntington’s disease
Hemiballismus	Subthalamic nucleus	Stroke
Loss of touch/pain/temp (one side)	Contralateral parietal lobe or sensory tract	MCA stroke, thalamic lesion
Loss of vibration & proprioception	Dorsal columns	Posterior cord syndrome
Sensory level on trunk	Spinal cord	Transverse myelitis
Glove-and-stocking sensory loss	Peripheral neuropathy	Diabetes
Paresthesia	Peripheral nerve / spinal cord / cortex	Multiple causes
Allodynia	Thalamus / sensory pathway	Post-stroke pain
Romberg sign	Dorsal columns or vestibular system	Positive if unsteady with eyes closed
Lhermitte sign	Cervical spinal cord (dorsal columns)	MS, B12 deficiency
Astereognosis	Contralateral parietal lobe	Cannot identify object by touch
Agraphesthesia	Parietal lobe	Cannot identify numbers traced on skin
Facial weakness (upper+lower)	Ipsilateral facial nerve	Bell’s palsy
Facial weakness (lower only)	Contralateral motor cortex	UMN lesion
Diplopia	CN III, IV, VI or brainstem	Stroke, MS
Ptosis	CN III or sympathetic pathway	Horner’s, CN III palsy
Anisocoria	CN III or sympathetic pathway	Horner’s, CN III palsy
Bitemporal hemianopia	Optic chiasm	Pituitary adenoma
Homonymous hemianopia	Optic tract/radiations/occipital cortex	Stroke, tumor
Internuclear ophthalmoplegia	MLF in brainstem	Multiple sclerosis
Kernig sign	Meningeal irritation	Meningitis
Brudzinski sign	Meningeal irritation	Meningitis
Dysarthria & dysphagia	Medulla / CN IX, X, XII	Lateral medullary syndrome
Loss of corneal reflex	CN V (sensory) or VII (motor)	Brainstem lesion
Loss of gag reflex	CN IX, X	Brainstem lesion
Ataxia	Cerebellum (ipsilateral)	Stroke, tumor
Dysdiadochokinesia	Cerebellar hemisphere	Inability for rapid alternating movements
Intention tremor	Cerebellar hemisphere	MS, stroke
Nystagmus	Cerebellum / vestibular	Vestibular neuritis
Hypotonia	Cerebellum	Acute lesion
Rebound phenomenon	Cerebellum	Failure to stop movement
Titubation	Midline cerebellum	Head tremor
Wide-based gait	Cerebellum	Midline lesion
Aphasia	Dominant hemisphere	Broca’s/Wernicke’s area
Apraxia	Dominant parietal lobe	Cannot perform learned movement
Neglect	Non-dominant parietal lobe	Right parietal stroke → left neglect
Agnosia	Parietal/occipital/temporal cortex	Failure to recognize objects
Alexia without agraphia	Dominant occipital cortex + splenium corpus callosum	Stroke
Gerstmann syndrome	Dominant parietal lobe (angular gyrus)	Agraphia, acalculia, finger agnosia, L-R disorientation
Seizures with focal signs	Cerebral cortex	Epilepsy, tumor
Acute confusion + memory loss	Bilateral hippocampus / diffuse cortex	Hypoxia, encephalitis
Ophthalmoplegia + ataxia + confusion	Midbrain	Wernicke’s encephalopathy

Neurological Signs

Neurological Signs Master Chart

Neurological Sign	Description	Associated Disorder
Lhermitte's Sign	Electric shock sensation on neck flexion	Multiple Sclerosis
Uhthoff's Phenomenon	Symptom worsening with heat	Multiple Sclerosis
Marcus Gunn Pupil	Pupil dilates when light is swung to affected eye	Optic neuritis
Dawson's Fingers	Periventricular demyelinating lesions on MRI	Multiple Sclerosis
Internuclear Ophthalmoplegia	Impaired adduction with nystagmus in opposite eye	MS, brainstem lesions
Charcot's Triad (MS)	Nystagmus, intention tremor, scanning speech	Multiple Sclerosis
Cogwheel Rigidity	Ratchet-like resistance to passive movement	Parkinson's Disease
Lead-pipe Rigidity	Uniform resistance throughout movement	Parkinsonism
Myerson's Sign	Persistent blinking when glabella tapped	Parkinson's Disease
Pill-rolling Tremor	Resting tremor of thumb and forefinger	Parkinson's Disease
Festinating Gait	Short, accelerating steps	Parkinson's Disease
Chorea	Involuntary, irregular, purposeless movements	Huntington's Disease
Hemiballismus	Violent flinging movements of limbs	Subthalamic nucleus lesion
Dystonia	Sustained muscle contractions causing abnormal posture	Primary or secondary dystonias
Athetosis	Slow, writhing movements	Cerebral palsy, basal ganglia lesions
Kernig's Sign	Pain/resistance on knee extension with hip flexed	Meningitis
Brudzinski's Sign	Neck flexion causes hip/knee flexion	Meningitis
Neck Stiffness	Resistance to passive neck flexion	Meningitis
Jolt Accentuation	Headache worsens with horizontal head rotation	Meningitis
Fatigable Ptosis	Eyelid drooping worsens with sustained upgaze	Myasthenia Gravis
Cogan's Lid Twitch	Upper lid overshoots after downgaze	Myasthenia Gravis
Peek Sign	Eyelids slowly separate with sustained closure	Myasthenia Gravis
Ice Pack Test	Improvement in ptosis after ice application	Myasthenia Gravis
Babinski Sign	Upgoing big toe with plantar stimulation	UMN Lesion
Hoffmann's Sign	Flicking middle finger causes thumb flexion	Cervical myelopathy
Clasp-knife Spasticity	Initial resistance followed by sudden release	UMN Lesion
Pronator Drift	Arm pronates and drifts downward	UMN Lesion
Fasciculations	Visible muscle twitches	LMN Lesion, MND
Flaccid Paralysis	Loss of tone and reflexes	LMN Lesion
Atrophy	Muscle wasting	LMN Lesion
Bells Phenomenon	Upward eye roll on eyelid closure attempt	Facial Nerve Palsy
Argyll Robertson Pupil	Pupil accommodates but no light reflex	Neurosyphilis
Relative Afferent Pupillary Defect	Pupil paradoxically dilates with light in affected eye	Optic nerve lesion
Jaw Jerk Reflex	Exaggerated in UMN lesions above pons	Pseudobulbar palsy
Brown-Séquard Syndrome	Hemisection with ipsilateral motor loss	Spinal injury
Clonus	Rhythmic contractions on sudden stretch	Spinal cord lesion
Spinal Shock	Temporary loss of reflexes below lesion	Acute spinal injury
Romberg's Sign	Unsteadiness with eyes closed	Posterior column lesion
Lhermitte's Phenomenon	Electric shock with neck flexion	Cervical cord lesion
Stocking-Glove Loss	Distal sensory loss	Peripheral neuropathy
Allodynia	Pain from non-painful stimuli	Neuropathic pain
Froment's Sign	Thumb IP flexion when gripping paper	Ulnar nerve palsy
Battle's Sign	Mastoid bruising	Basilar skull fracture
Raccoon Eyes	Periorbital ecchymosis	Basilar skull fracture
Gowers' Sign	Climbing up thighs to stand	Duchenne muscular dystrophy
Tinel's Sign	Tingling on tapping nerve	Carpal tunnel syndrome
Phalen's Maneuver	Wrist flexion reproduces symptoms	Carpal tunnel syndrome