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Advanced Med Surg > AdvMS Cardiac and Fundamental Peds > Flashcards

AdvMS Cardiac and Fundamental Peds Flashcards

1
Q

peaked T waves occur in

A

hyperkalemia

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2
Q

PR interval represents

A

time for impulse to travel from SA node to ventricular depolarization. Prolongation indicates delay in AV function.

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3
Q

Normal PRI

A

0.12-0.20 seconds

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4
Q

QRS interval represents

A

time required for ventricular depolarization

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5
Q

normal QRS interval

A

0.04-0.10 sec or < 0.12 sec

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6
Q

RR interval represents

A

regularity of rhythm

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7
Q

EKG small square

A

0.04 sec (1mm)

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8
Q

EKG large square

A

0.2 sec

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9
Q

EKG 5 large squares

A

1 sec

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9
Q

EKG 5 large squares

A

1 sec

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10
Q

QRS interval measured

A

from first downturn of Q until reaches baseline after S (J-point)

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11
Q

ST segment measured

A

from return to baseline after S (J-point) to beginning of T. Should be on isoelectric line, elevation or depression d/t cardiac ischemia/MI

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12
Q

to calculate HR on EKG strips

A

count # or R waves on a 6-second strip (30 large boxes) and multiply by 10
Best for irregular rhythms

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13
Q

regular rhythm, rate 40-60, normal PRI and QRS

A

sinus bradycardia

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14
Q

causes of sinus bradycardia

A

vagal stimulation (vomiting/straining)
MI, IICP, uremia
Dig toxicity, BBs, CCBs

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15
Q

sinus bradycardia treatment

A 
none unless symptomatic
Atropine IVP (to decrease vagal stimulation), withhold meds, PM
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16
Q

regular rhythm
HR 100-160
normal PRI and QRS

A

sinus tachycardia

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17
Q

causes of sinus tachycardia

A

fever, blood loss, anxiety, HF, meds

Do not ignore, treat cause!

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18
Q

p wave is early, abn in size, shape or direction and sometimes hidden in preceding t wave

A

PACs

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19
Q

causes of PACs and tx

A

caffeine, nicotine, alcohol
CHF, MI, hypoxia
emotion, can occur in normal hearts
not treated but watch, can signal future arrythmia

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19
Q

causes of PACs and tx

A

caffeine, nicotine, alcohol
CHF, MI, hypoxia
emotion, can occur in normal hearts
not treated but watch, can signal future arrythmia

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20
Q

atrial rate 250-400, ventricular rate varies with number of impulses that make it through to AV node
Sawtooth wave forms

A

Aflutter

“flutter” waves

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21
Q

causes of Aflutter

A

CHF, MI, CAD, cardiomyopathy, hypoxia, thyrotoxicosis, electolyte imbalance

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22
Q

Aflutter/Afib tx

A

Dig or Verapamil to convert to A fib, which is easier to treat
RFA (ablation), cardioversion, BBs, dofetilide, ibutilide, IV adenosine or amiodorone

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23
Q

grossly irregular rhythm (unless very rapid)
atrial rate unmeasurable (400+), ventricular rate varies with impulses conducted through to AV node. Wavy deflections called f waves, varying rhythm and shapes. PRI unmeasurable, QRS normal

A

Afib

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24
Q

causes of Afib

A

CHF, MI, CAD, after OHS heart is irritated, pericarditis, heart valve disease, hyperthyroid, hypoxia

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25
Q

TEE before cardioversion for afib because

A

check for clots that could be dislodged once sinus rhythm is restored

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25
Q

TEE before cardioversion for afib because

A

check for clots that could be dislodged once sinus rhythm is restored

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26
Q

conplications due to afib

A

increase risk for clots (**CVA), cardiac output is decreased

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27
Q

BIGEMINY

A

every other beat is a PVC

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28
Q

early, wide QRS that differ from the QRSs of the underlying rhythm

A

PVCs

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29
Q

causes of PVCs

A

hypoxia, MI, hypokalemia, hypomagnesia, acidosis, exercise, Dig toxicity, hyperthyroidism, caffeine, CVADs, idiopathic

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30
Q

Regular rhythm, rate 140-250
no visible p waves, hidden in QRS
wide QRS

A

Vtach

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31
Q

causes of Vtach

A

same as PVCs but more dangerous because of the decrease in CO and tendency to develop into Vfib

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32
Q

Vtach tx

A

with pulse: meds (Lidocaine IVP, IV amio)

pulseless: CPR, defib starting at 50j, ICD

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33
Q

chaotic rhythm
rate=0 because no QRS complexes
no p waves, just “fine” or “coarse” deflections

A

Vfib

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34
Q

Vfib treatment

A

CPR, defibrillation

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35
Q

causes of Vfib

A

MI, CHF, CAD, ischemia with increased catecholamine levels (shock)
cardiomyopathy, electrolyte imbalance, etc.

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36
Q

most common cause of sudden cardiac death

A

Vfib

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37
Q

regular rhythm and p waves but prolonged PRI, normal QRS (can be wide sometimes with DIVC)

A

First degree Heart Block

DIVC=delay in ventricle

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38
Q

general causes of heart block

A

MI (can happen initially but then go away)

Dig, BBs, CCBs

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39
Q

treatment of first degree heart block

A

none, but watch for progression of heart block

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40
Q

regular atrial rhythm but irregular ventricular
more p waves than QRS waves
PRI progressively lengthens until a P wave occurs without a QRS, pause follows dropped QRS

A

Second degree heart block Type 1: Wenckebach

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41
Q

regular atrial rhythm, ventricular rate less and will depend on the number of impulses conducted–NO WARNING of a dropped beat, less QRS waves than p waves

A

Second degree heart block type 2:Mobitz II

less common but more serious than Wenchebach

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42
Q

high mortality rate if this is associated with acute MI; pt needs pacemaker and atropine to increase heart rate

A

Second degree heart block type 2:Mobitz II

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43
Q

regular atrial and ventricular rates but they beat independently of each other. No consistent PRI, some p waves hide under QRS (unique to this arrythmia)

A

Third degree Heart block

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44
Q

posterior fontanel closes by

A

2-3 mos

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44
Q

posterior fontanel closes by

A

2-3 mos

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45
Q

anterior fontanel closes by

A

18 mos

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46
Q

vaccines at 2,4,6 mos

A 
Hep B
Hib
Prevnar
RV
IPV
Dtap
at 6 mos add Flu
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47
Q

rooting, palmar grasp, tonic neck (fencer) and Moro (startle) reflexes present

A

birth-4mos

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48
Q

plantar grasp reflex present

A

birth-8mos

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49
Q

Babinski reflex present

A

birth-1yr

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50
Q

rolls front to back by

A

5 mos

51
Q

rolls back to front by

A

6 mos

52
Q

crawls, crude pincer grasp and pulls to stand/stands holding on by

A

9 mos

53
Q

fontanels should be

A

flat.
sunken=dehydration
bulging=IICP

54
Q

uses cup and spoon, stacks two blocks by

A

15 mos

55
Q

starting to walk independently by

A

12 mos

56
Q

sits unsupported by

A

7-8 mos

57
Q

Ibuprofen only if child is

A

6 mos+

58
Q

object permanence by

A

9 mos

59
Q

walks up and down stairs by

A

2 years

60
Q

jumps with both feet, stands on 1 foot by

A

2 1/2 years

61
Q

preoperational thought

A

2-7y
egocentric, only understands own viewpoint
domestic mimicry

62
Q

concrete operations

A

7-11 yrs
logic, sort and classify
take things literally

63
Q

vaccine at 15-18 mos

A

Dtap

64
Q

vaccines at 1 year

A 
MMR
varicella
Prevnar
Hib
HepA  (MVP-HH)
65
Q

1st teeth around

A

6 mos

66
Q

this many teeth by 1 yr

A

6-8

67
Q

cooperative play and pretend play

A

preschooler (3-6)

68
Q

vaccines at 4-6y (school shots)

A

MMR
varicella
IPV
DTap

69
Q

psychosocial stage of preschooler

A

Initiative vs. guilt

need to try new things, develop conscience, advance initiative while respecting others

70
Q

psychosocial stage of school age child

A

industry vs. inferiority

motivated by tasks that increase self-worth, need to develop competence

71
Q

vaccines at 11-12y

A

Tdap
HPV (series of 3)
Menactra

72
Q

vaccine at 16-18

A

Menactra

73
Q

definition and dx FTT

A

inadequate growth due to inability to obtain or use calories

<5th percentile of weight for age

74
Q

preconventional moral dev

A

r/t consequences

no concept of moral behavior

75
Q

conventional moral dev

A

obey rules, be nice, good behavior is what is approved of by the group; conformity and loyalty

76
Q

postconventional moral dev

A

abstract ethical universal principles; correct behavior is defined by individual rights and societal standards

77
Q

triple birth weight by

A

12 mos

78
Q

double birth weight by

A

5-6 mos

78
Q

double birth weight by

A

5-6 mos

79
Q

BMI screening is done ages

A

2 and up

80
Q

obese

A

> 97th percentile for age and gender BMI

81
Q

overweight

A

> 95th percentile for age and gender BMI

82
Q

s/s FTT besides weight

A

developmental delays
apathy, poor hygeine,
**withdrawn behavior
avoid eye contact, minimal smiling, stiff or flaccid

83
Q

most important in tx of FTTq

A

same nurses to do feedings, in a quiet calm environment. face to face contact

84
Q

lead checked at

A

12 and 24 mos

85
Q

acceptable lead level

A

<10

86
Q

to combat Pb retention, feed child a diet high in

A

Fe and Ca

compete with Pb for storage in bones.

87
Q

research validated pain scale for children 4+

A

Faces scale

88
Q

research validated pain scale for ages 3 mos-7yrs for kids that can’t express their pain

A 
FLACC scale
Face
Legs
Activity 
Cry 
Consolability
89
Q

prevent and manage opioid AEs, such as

A

n/v
constipation
pruritis
sedation

90
Q

rear facing car seat is recommended until

A

2 years

91
Q

booster seat recommended until

A

80 lbs. or 4” 9’

92
Q

count RR on infant

A

1 full minute due to irregularity

93
Q

order of VS for infant, child

A 
least invastive to most
RR
pulse
BP
temp
94
Q

tuft of hair or dimple at base of spine could signify

A

spina bifida

95
Q

impetigo

A

superficial skin infection with honey-colored crusts, caused by GABHS or Staph/MRSA

95
Q

impetigo

A

superficial skin infection with honey-colored crusts, caused by GABHS or Staph/MRSA

96
Q

impetigo treatment

A 
mupirocin ointment (Bactroban)
more serious, 1st gen CS
97
Q

resembles a “spider bite” that won’t heal

A

CA-MRSA

98
Q

CA-MRSA Tx

A

TMP-SMZ (Bactrim), clindamycin, doxycycline

98
Q

CA-MRSA Tx

A

TMP-SMZ (Bactrim), clindamycin, doxycycline

99
Q

thrush tx

A

nystantin swish after feeding
boil nipples/pacis
treat bf mom

100
Q

kids often get this from farm animals

A

tinea corporis (ringworm)

101
Q

ringworm appearance on body

A

well-defined circle of red bumps, skin in center of circle normal tone

102
Q

treatment for tinea capitis

A

Griseofulvin PO 3-6 mos

check LFTs q 4-6 mos

103
Q

tinea versicolor tx

A

Selsun Blue (SeS)

104
Q

recurrent varicella viral infection causing lesions on oral mucosa, lips, and eyes

A

Herpes Simplex

105
Q

viral-induced epithelial tumors (HPV)

A

warts

106
Q

benign viral skin infection due to a contagious pox virus; causes dimpled bumps

A

molluscum contagiosum

107
Q

scabies

A

highly contagious infection of skin by itch mite (Sarcoptes scabiei)

108
Q

scabies tx

A

Elimite cream neck to toes 8-12h, then shower

wash bedding

109
Q

no sunscreen until

A

6 mos

110
Q

rose-coored, flaking, self-limiting viral rash with a “herald patch” and symmetric “Christmas tree” pattern

A

Pityriasis Rocea

111
Q

chronic skin disorder of remissions and exacerbations causing silvery scales

A

psoriasis

112
Q

atopic dermatitis

A

excema
chronic superficial inflammation and itching
r/t allergens (often milk)
cheeks–creases of elbows, wrists, and knees
skin cream w/in 3 min of bathing

113
Q

with any CVAD there is increased risk of

A

infection–use good hygiene and practice

114
Q

a CVAD in an IV catheter with the tip in the

A

SVC, near RA

114
Q

a CVAD in an IV catheter with the tip in the

A

SVC, near RA

115
Q

CVAD with a shorter dwell time and increased risk of complications, used in emergent situations, can be inserted at bedside

A

non-tunneled

116
Q

CVAD placed surgically, longer dwell time (indefinite) lower incidence of infection and can be repaired

A

tunneled

117
Q

CVAD with indefinite dwell time, no site care when not in use, 1-2000 punctures; implanted in subq

A

implanted port

118
Q

dwell time of PICC

A

several months to 1 year

119
Q

catheter of CVAD doesn’t go all the way into the SVC

A

midline catheter

120
Q

pt position for removal of CVAD

A

supine, flat
pt-bear down as catheter withdrawn
pressure to site

121
Q

s/s of SVC syndrome

A

periorbital/facial edema

JVD, HA

121
Q

Myoglobin test usefulness

A

Useful in r/o acute MI if absent; Peaks in 12h

122
Q

CK-MB

A

Indicator of acute MI; peaks in 24h

123
Q

Total troponin

A

Begins 3-5h
Peak 24-48 h
Lasts to 21 d

124
Q

Troponin levels

A

Normal: 0- 0.10

Ischemia: 0.5-1.0
MI: 1+

Advanced Med Surg (6 decks)

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