Calcium Channel Blockers Flashcards
Channel Blockers are like_____ for your _____.
Valium
Heart
Who do you give a calcium channel blockers?
Tachycardia pt.
Tachyarrhythmia
Heart attack ….. etc
Give you only when you want the heart to REST!
Channel Blockers are also known as?
- Negative Inotropes
- Negative Dromotropes
- 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!
When do we use Calcium Channel Blockers? and how do we TX.? Think: A, AA, AAA
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.
What are the 2 side affects of Calcium Channel blockers?
Think H and H
- Headache
- Hypotension
Note: Always pick headache on a SATA question.
Name Calcium Channel Blockers
- Anything ending in DIPINE!!!
“ Your dippin in the calcium channel” - Verapamil
- Cardizem (given by continious IV drip)
What must the nurse do before giving a calcium channel blocker?
What and when must you hold a calcium channel blocker?
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.
What are the 4 Cardiac Rhythm strips you must know by sight?
- Sinus Rhythm
- P-wave, QRS, T-wave
- Equal distance b/w P-waves
- Doesn’t matter if upset down
- Ventricular Fibrillation (v-fib)
- no pattern
- CHAOTIC (CF), squiggly line.
- V-tach
- sharp peaks / jags pattern,
- Bizarre (BT)
- Asystole __________ flatline.
What are 10 rules you must know when reading rhythm
strips?
- QRSTD Polarization = ventricular (rule out atrial).
- P. WAVE = Atrial (rule out ventricular)
- A lack of QRS = ASYSTOLE
- Flutter is always described as saw tooth.
“ I saw the teeth and my heart did flutter” - Chaotic = Fibrillation
- Bizarre = Tachycardia
- Periodic = PVC
- 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.
- Salvo of PVC = a group of PVC is short run of vtach.
- PVC pts. are low priority unless they fall under these 3 circumstances then they increase to moderate:
- More than 6 PVC in a minute
- More than 6 PVC in a Row
- 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,
Name the HIGH PRIORITY Lethal arrhythmia’s.
- Asystole
- V-fib
- 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!
How do we treat Cardiac Artial/Ventricular Arrhythmia’s?
- PVC and V-TACH for ventrical use lidacane or Ameoderone.
- 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.
I.V. Push: When you dont ______, go ______, except for ______.
Know
Slow
Adencard then you slam it in less than 8 seconds.
So for, Calcium Channel Blockers “ Dipines” and Beta Blockers “lol” Atrial tx includes?
A - Anti-hypotensive AA- Anti-angina AAA- Anti Atrial Arrithmias ADENA, BETA, CALCIUM, DIG Side effects: Headache * Hypotension
Whats the TX. for PVC and Vtach?
Lidacane/ Ameoderone
Whats the TX. for Vfib?
” For V-Fib you D-Fib” - You Shock em!
Whats the TX. for ASYSTOLE?
- Epinephrine
- Atropine
Atropine S T O L Epinephrine Reverse order to remember what to give first.
How do TX. Atrial FIB or Atrial Flutter?
ADENA, BETA, CALCIUM, DIG
What is the purpose of a chest tube?
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.
When you get a chest tube question look at the reason the chest tube was placed for example: Pneumthorax, Hemothorax and Pneumohemothorax. Explain each.
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: If you have a pt. with chest tubes in for Hemothorax what would you report to the DOC?
- Chest tube not bubbling
- Chest tube drained 800ml in first 10 hrs
- Chest tube is not draining
- Chest tube is intermittently bubbling
Note: Ask what would you expect from a hemo? removal of blood aka - drainage
- Chest tube is not draining
Pick this answer b/c its not doing what its suppose to be doing.
Question: If you have a pt. with chest tubes in for Pneumothorax what would you report to the DOC?
- Chest tube not bubbling
- Chest tube drained 800ml in first 10 hrs
- Chest tube is not draining
- Chest tube is intermittently bubbling
Note: Ask what would you expect from a Pneumothorax ?
- Chest tube not bubbling
- 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.
What are the 2 locations of chest tubes? What do they do?
- Apical - chest tube is up high, removes air.
- Basilar - chest tube is at bottom of lung, removes blood.
A=Apical-Air (rises)
B=Basilar-blood (sinks)
Question:
1. If your Apical is draining 200ml per hour is this good or bad?
- If your Basilar is draining 200ml per hour is this good or bad?
- Bad
2. Good
Question:
- your apical tube is not bubbling good/bad?
- your basilar tube is not bubbling good/bad?
- Bad
2. Good
How many chest tubes and where would you place them for a uni lateral pheumohemothorax?
2 tubes
1 x apical
1 x basilar
How many chest tubes and where would you place them for a Bilateral Pneumothorax?
2 tubes
2x Apical one on either side
How many chest tubes and where would you place them for post op surgery?
2 tubes because you are to assume that its unilateral unless specified 1 apical or bilateral
How many chest tubes would you need for a post -op pneumoectomy?
0 because its removing the lung therefore there is no need to re-establish the pleural space.
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?
1) Set it back up and have pt. take some deep breaths.
2) This is not a medical emergency - Do NOT call DOC.
What do you do if the water seal device breaks?
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 "
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?
Pick submerge b/c it sloves the problem.
if its an order question “first” pick clamp.
“BEST” questions are the answers you pick when you can only pick _____? “FIRST” questions you can______?
one
> one
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?
- a) place back board
b) begin chest compressions - Begin chest compressions
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?
FIRST = Take gloved hand and cover the hole BEST= Cover with vaseline gauze
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
- Where is it bubbling?
2. When is it bubbling?
What does it mean if there is continuous bubbling in the water seal?
It means there is a leak in the system therefore need to tape it until it stops leaking ( in LPN scope)
Is intermittent bubbling in the suction control chamber good or bad?
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.
If something is sealed i.e. water chamber, should you have a continuous bubble?
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!
If a water seal bubbling:
Intermittent =?
Continuous =?
Intermittent =Good
Continuous = Bad
If suction control chamber is bubbling:
Intermittent =?
Continuous =?
Intermittent = BAD means suction is low Continuous = Good
How long are you able to clamp a chest tube for without a Doctors order? What kind of clamps are used?
15 secs.
rubber tipped double clamps x 2, so you don’t puncture tubing.
Congenital Heart Defects: Every congenital heart defect is either ________ or _____ _________.
Trouble or not trouble.
So it either causes a big problem or no problem at all.
Describe Congenital Heart Defects using the TRouBLe acronym.
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
Which Congenital Heart Defects have murmurs?
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.
Describe the 4 defects of Tetratology of Fallot the “VarieD PictureS Of A RancH acronym.
- Ventricular Defect
- Pulmonary Stenosis
- Over riding Aorta
- Right Hypotrophy
Infectious Disease and Transmission Based Precautions:
What are the 4 Transmission Based Precautions?
- Standard Universal
- Contact
- Droplet
- Airborne
Describe Contact Precautions
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
Describe Droplet Precautions
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
Describe Airborne Precautions
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.
In what order do you DON/ DOFF PPE?
DON: Gown Mask Googles Gloves
DOFF: Gloves Googles Gown Mask
