Calcium Channel Blockers

Question 1

Channel Blockers are like_____ for your _____.

Answer 1

Valium

Heart

Question 2

Who do you give a calcium channel blockers?

Answer 2

Tachycardia pt.
Tachyarrhythmia
Heart attack ….. etc

Give you only when you want the heart to REST!

Question 3

Channel Blockers are also known as?

Answer 3

1. Negative Inotropes
2. Negative Dromotropes
3. Negative Cronotropes
   These are cardiac depressants that relax your heart and calm it down.

Positive Inotropes
Positive Dromotropes
Positive Cronotropes
These are cardiac stimulators that speed up your heart!

Question 4

When do we use Calcium Channel Blockers? and how do we TX.? Think: A, AA, AAA

Answer 4

A = Anti Hypertensives = relaxed heart vessels therefore decreases blood pressure.

AA = Anti Angina Drugs = relaxes heart therefore decreased O2 demand. The worst thing that can happen to a pt. with angina is to speed up their heart.

AAA=Anti Atrial Arrhythmia = Tx. all problems in atria and supra(above) ventricular tachycardia.

Therefore, Calcium Channel blockers tx. all Atrial probems.

Question 5

What are the 2 side affects of Calcium Channel blockers?

Think H and H

Answer 5

1. Headache
2. Hypotension

Note: Always pick headache on a SATA question.

Question 6

Name Calcium Channel Blockers

Answer 6

1. Anything ending in DIPINE!!!
   “ Your dippin in the calcium channel”
2. Verapamil
3. Cardizem (given by continious IV drip)

Question 7

What must the nurse do before giving a calcium channel blocker?

What and when must you hold a calcium channel blocker?

Answer 7

Check BP because Hypotension is a side effect.

HOLD the Calcium Channel Blocker if systolic is < 100.
i.e. 98/52, if on I.V. then titrate (slow it down) drip so, it slows down and systolic stays above 100.

Question 8

What are the 4 Cardiac Rhythm strips you must know by sight?

Answer 8

1. Sinus Rhythm
   
   • P-wave, QRS, T-wave
   • Equal distance b/w P-waves
   • Doesn’t matter if upset down
2. Ventricular Fibrillation (v-fib)
   
   • no pattern
   • CHAOTIC (CF), squiggly line.
3. V-tach
   
   • sharp peaks / jags pattern,
   • Bizarre (BT)
4. Asystole __________ flatline.

Question 9

What are 10 rules you must know when reading rhythm

strips?

Answer 9

1. QRSTD Polarization = ventricular (rule out atrial).
2. P. WAVE = Atrial (rule out ventricular)
3. A lack of QRS = ASYSTOLE
4. Flutter is always described as saw tooth.
   “ I saw the teeth and my heart did flutter”
5. Chaotic = Fibrillation
6. Bizarre = Tachycardia
7. Periodic = PVC
8. High Priority: > 6 PVC’s in a minute, or in a row, or if the PVC falls on the t-wave of the previous beat.
9. Salvo of PVC = a group of PVC is short run of vtach.
10. PVC pts. are low priority unless they fall under these 3 circumstances then they increase to moderate:
    
    1. More than 6 PVC in a minute
    2. More than 6 PVC in a Row
    3. If PVC falls on the T-wave of previous beat
       Aka: R on T Phenomena, then elevate priority of PVC pt to moderate. So, PCV Pt. never reach high priority. After an M.I. it is good to see PVC because it means they are re-perfusing.

Note: Dont call DOC re: PVC’s unless you want to loss your monitor,

Question 10

Name the HIGH PRIORITY Lethal arrhythmia’s.

Answer 10

1. Asystole
2. V-fib
3. Vtach-is potentially life threatening only difference is that the pt. has a cardiac output (pulse)

Asystole and vfib have no cardiac output therefore zero perfusion = DEAD in 8 minutes!

Question 11

How do we treat Cardiac Artial/Ventricular Arrhythmia’s?

Answer 11

1. PVC and V-TACH for ventrical use lidacane or Ameoderone.
2. Artial Arrithmias (ABCD)
   A) ADENOCARD (ADENOCINE) push in less than 8 seconds. Pt. my go into asystole for 30 sec.

B) BETA BLOCKERS “LOL” negative ino, chromo, dromo-tropes. So, like valium for heart. Therefore tx. = A, AA, AAA, and side effects = H and H - hypotension and headache.

C) Calcium Channel Blocker - negative ino, chromo, dromo-tropes. So, like valium for heart. Therefore tx. = A, AA, AAA, and side effects = H and H - hypotension and headache. Differerence: better for pt. with asthma

D) Digitalious, Digoxin, Lanoxin - all the same.

Question 12

I.V. Push: When you dont ______, go ______, except for ______.

Answer 12

Know
Slow
Adencard then you slam it in less than 8 seconds.

Question 13

So for, Calcium Channel Blockers “ Dipines” and Beta Blockers “lol” Atrial tx includes?

Answer 13

A - Anti-hypotensive
 AA- Anti-angina
 AAA- Anti  Atrial Arrithmias
 ADENA, BETA, CALCIUM, DIG
Side effects: Headache * Hypotension

Question 14

Whats the TX. for PVC and Vtach?

Answer 14

Lidacane/ Ameoderone

Question 15

Whats the TX. for Vfib?

Answer 15

” For V-Fib you D-Fib” - You Shock em!

Question 16

Whats the TX. for ASYSTOLE?

Answer 16

1. Epinephrine
2. Atropine

Atropine
S
T
O
L
Epinephrine
  Reverse order to remember what to give first.

Question 17

How do TX. Atrial FIB or Atrial Flutter?

Answer 17

ADENA, BETA, CALCIUM, DIG

Question 18

What is the purpose of a chest tube?

Answer 18

To re-establish negative pressure in the pleural space. So, lung expands when chest wall moves. The plural space is a space NEGATIVE - GOOD! makes things stick together therefore good air exchange allows breathing in/out.

Question 19

When you get a chest tube question look at the reason the chest tube was placed for example: Pneumthorax, Hemothorax and Pneumohemothorax. Explain each.

Answer 19

Pneumothorax - Pneumo (Air), chest tube removes air. In Pneumothorax positive air is placed therefore a chest tube is inserted to establish negative air.

Hemothorax - Hemo (blood), chest tube removes blood, which creates positive pressure. Therefore chest tube is placed to remove and re-establish negative pressure.

Pneumohemothorax - Pneumohemo ( Air and Blood), Chest tube removes air and blood, therefore chest tube is placed to re establish negative pressure

Question 20

Question: If you have a pt. with chest tubes in for Hemothorax what would you report to the DOC?

1. Chest tube not bubbling
2. Chest tube drained 800ml in first 10 hrs
3. Chest tube is not draining
4. Chest tube is intermittently bubbling

Note: Ask what would you expect from a hemo? removal of blood aka - drainage

Answer 20

3. Chest tube is not draining

Pick this answer b/c its not doing what its suppose to be doing.

Question 21

Question: If you have a pt. with chest tubes in for Pneumothorax what would you report to the DOC?

1. Chest tube not bubbling
2. Chest tube drained 800ml in first 10 hrs
3. Chest tube is not draining
4. Chest tube is intermittently bubbling

Note: Ask what would you expect from a Pneumothorax ?

Answer 21

1. Chest tube not bubbling
2. Chest tube drained 800ml in first 10 hrs

Either of thee answers are right because they are not doing what they are suppose to be doing.

Note: to get chest tube questions right you must pay particular attention to the disease the chest tube is tx.

Question 22

What are the 2 locations of chest tubes? What do they do?

Answer 22

1. Apical - chest tube is up high, removes air.
2. Basilar - chest tube is at bottom of lung, removes blood.

A=Apical-Air (rises)
B=Basilar-blood (sinks)

Question 23

Question:
1. If your Apical is draining 200ml per hour is this good or bad?

2. If your Basilar is draining 200ml per hour is this good or bad?

Answer 23

1. Bad

2. Good

Question 24

Question:

1. your apical tube is not bubbling good/bad?
2. your basilar tube is not bubbling good/bad?

Answer 24

1. Bad

2. Good

Question 25

How many chest tubes and where would you place them for a uni lateral pheumohemothorax?

Answer 25

2 tubes 1 x apical 1 x basilar

Question 26

How many chest tubes and where would you place them for a Bilateral Pneumothorax?

Answer 26

2 tubes | 2x Apical one on either side

Question 27

How many chest tubes and where would you place them for post op surgery?

Answer 27

2 tubes because you are to assume that its unilateral unless specified 1 apical or bilateral

Question 28

How many chest tubes would you need for a post -op pneumoectomy?

Answer 28

0 because its removing the lung therefore there is no need to re-establish the pleural space.

Question 29

For CLOSED CHEST DRAINAGE devices i.e. pleural vac, pneumovac, emmerson plastic containers. 1) What do you do if you knock one of these over? 2) Is this a medical emergency?

Answer 29

1) Set it back up and have pt. take some deep breaths. | 2) This is not a medical emergency - Do NOT call DOC.

Question 30

What do you do if the water seal device breaks?

Answer 30

1) CLAMP IT - to prevent positive pressure from getting into the pleural space. 2) CUT IT - away from broken device b/c its no good anymore. Stick into sterile water. 3) SUBMERGE in unsterile water. 4) UNCLAMP - because you have re: established water seal. " CLAMP, CUT, SUBMERGE, UNCLAMP "

Question 31

Remember that a "BEST" question is different from a "First" question! If the question is asking you to pick "BEST" thing to do if the water seal device breaks. Do you " CLAMP, CUT, SUBMERGE, UNCLAMP " what should you pick?

Answer 31

Pick submerge b/c it sloves the problem. if its an order question "first" pick clamp.

Question 32

"BEST" questions are the answers you pick when you can only pick _____? "FIRST" questions you can______?

Answer 32

one | > one

Question 33

Best and First question example: You notice a pt. have a V-FIB on the monitor. 1. What do you do "FIRST"? a) place back board or b) begin chest compressions? 2. What is the " BEST"thing to do? a) place back board or b) begin chest compressions?

Answer 33

1. a) place back board b) begin chest compressions 2. Begin chest compressions

Question 34

What's the "FIRST" thing you do if a chest tube gets pulled out? What's the "BEST" thing you do if a chest tube gets pulled out?

Answer 34

``` FIRST = Take gloved hand and cover the hole BEST= Cover with vaseline gauze ```

Question 35

For Bubbling Chest Tubes questions what 2 things should you ask? i.e. Bubbling, Bubbling, Bubbling..... Ask: Where? Water seal When? Intermittent = GOOD, Continuous = BAD

Answer 35

1. Where is it bubbling? | 2. When is it bubbling?

Question 36

What does it mean if there is continuous bubbling in the water seal?

Answer 36

It means there is a leak in the system therefore need to tape it until it stops leaking ( in LPN scope)

Question 37

Is intermittent bubbling in the suction control chamber good or bad?

Answer 37

BAD! because if you are only getting intermittent suctioning in the suction control chamber it means that the suction is low therefore you must turn up the dial on the wall until bubbles start bubbling continuously.

Question 38

If something is sealed i.e. water chamber, should you have a continuous bubble?

Answer 38

NO! it means its leaking. i.e. 2 L bottle of pop on the shelf bubbling, would you buy it? No because it means the seal is broken. Therefore in a chest tube if the water seal is broken = BAD!

Question 39

If a water seal bubbling: Intermittent =? Continuous =?

Answer 39

Intermittent =Good | Continuous = Bad

Question 40

If suction control chamber is bubbling: Intermittent =? Continuous =?

Answer 40

``` Intermittent = BAD means suction is low Continuous = Good ```

Question 41

How long are you able to clamp a chest tube for without a Doctors order? What kind of clamps are used?

Answer 41

15 secs. | rubber tipped double clamps x 2, so you don't puncture tubing.

Question 42

Congenital Heart Defects: Every congenital heart defect is either ________ or _____ _________.

Answer 42

Trouble or not trouble. | So it either causes a big problem or no problem at all.

Question 43

Describe Congenital Heart Defects using the TRouBLe acronym.

Answer 43

T- All heart defects that are TROUBLE begin with "T" RIGHT- All trouble defects blood stunts from RIGHT to LEFT o u BLUE- Pt, will be cyanotic with trouble defects LEFT- Acyanotic defects blood shunts from LEFT-RIGHT e

Question 44

Which Congenital Heart Defects have murmurs?

Answer 44

All pt. with Congenital Heart Defects will have a murmur because of the shunting of the blood. Therefore all pt with Congenital Heart Defects will have a Echocardiogram.

Question 45

Describe the 4 defects of Tetratology of Fallot the "VarieD PictureS Of A RancH acronym.

Answer 45

1. Ventricular Defect 2. Pulmonary Stenosis 3. Over riding Aorta 4. Right Hypotrophy

Question 46

Infectious Disease and Transmission Based Precautions: | What are the 4 Transmission Based Precautions?

Answer 46

1. Standard Universal 2. Contact 3. Droplet 4. Airborne

Question 47

Describe Contact Precautions

Answer 47

Contact precautions are for anything interic therefore anything from the intestines - fecal/oral - c-diff, Hep A(nus), cholera, discentary, staph infections, Herpes, RSV-Babies get this) put on contact even through its transmitted thru droplet. These are all contact isolation. Contact Isolation includes: - Private Rm is preferred - Can be put into the same rm cohort, if culture positive - Gown, Handwashing - Disposable Supplies- paper plates, cups, utensils - Dedicated toys/equipment - No Negative Air flow

Question 48

Describe Droplet Precautions

Answer 48

``` Droplet Precautions include bugs that travel 3 ft on large particles due to sneezing and coughing = MENIGITIS, H-Flu- (Haemophilus influenzae-causes Epiglottitis). Droplet Precaution Isolation includes: -Private Rm is preferred -Can be put into the same rm cohort -Mask, gloves -Pt. wears mask when leaving Rm. - Dedicated toys/equipment -TB & RSV cautioned as droplet ```

Question 49

Describe Airborne Precautions

Answer 49

``` Airborne Precautions include measles, mumps, rebella, TB and varicella chicken pox. Airborne Precautions Isolation includes: - Private rm -Mask gloves -Handwashing -Special filter mask for TB -Pt. wears mask when leaving Rm. -Negative air flow - Disposable & dedicated supplies not mandatory -TB is droplet as well. ```

Question 50

In what order do you DON/ DOFF PPE?

Answer 50

``` DON: Gown Mask Googles Gloves ``` ``` DOFF: Gloves Googles Gown Mask ```