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Critical Care Test #1 > Cardiac > Flashcards

Cardiac Flashcards

1
Q

depressed ST segments mean..

A

ischemia, not dying

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2
Q

elevated ST segments mean..

A

injury, hypoxic, dying

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3
Q

a giant T wave indicates..

A

hyperkalemia

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4
Q

How do PVCs look on an ECG?

A
  • no P wave
  • wide, bizarre QRS complex
  • T wave in opposite direction of QRS
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5
Q

How does A-fib look on an ECG?

A
  • absence of definable P wave

- P wave appears small and quivering

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6
Q

How does V-fib look on an ECG?

A

no distinct QRS complex seen

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7
Q

How does V-tach look on an ECG?

A
  • 3 or more PVCs in a row
  • Wide, bizarre QRS complexes occuring in a fairly reg rhythm
  • P waves usually not seen
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8
Q

Normal Cardiac Index (CI)

A

2.5-4 L/min

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9
Q

Normal CO

A

4-8 L/min

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10
Q

Normal EF

A

55-65%

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11
Q

Normal MAP

A

65 or 70-120

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12
Q

Normal Dig dose

A

0.125-0.5 mg/day

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13
Q

LA pressure

A

4-12 mmHg

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14
Q

What is a widowmaker?

A

a clot in the L main artery

NO BP

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15
Q

what is the average stroke volume?

A

70 mL

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16
Q

What is the preload?

A

volume amount of fluid in LV just before it contracts

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17
Q

what is afterload?

A

pressure in the aorta

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18
Q

What drugs decrease pressure in the aorta?

A

beta blockers

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19
Q

What drug decreases preload?

A

Lasix

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20
Q

what drugs decrease afterload?

A

beta blockers, ACE inhibitors, & hydrochlorothiazide

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21
Q

What does the P wave represent?

A

atrial depolarization

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22
Q

what does the QRS complex represent?

A

depolarization of the ventricles

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23
Q

what does the T wave represent?

A

ventricular repolarization

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24
Q

What is the tx for sinus bradycardia?

A

atropine

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25
Q

what is the tx for sinus tachycardia?

A

Ca channel blockers, beta blockers, oxygen

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26
Q

*S/Es of amiodorone

A

Pulm edema, CHF, ARDS, V-tach

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27
Q

*tx for PVCs

A

Lidocaine or amiodarone

28
Q

*tx for V-tach

A

lidocaine, amiodarone, if pulseless CPR & defibrillation

29
Q

What can S3 in an older adult with heart disease signify?

A

ventricular failure

30
Q

What is an S4 sound?

A

An atrial gallop, heard just before S1. The sound is produced by atrial contraction forcing blood into a noncompliant ventricle

31
Q

what diseases can cause an S4 sound?

A

Systemic HTN, MI, angina, cardiomyopathy, and aortic stenosis

32
Q

what is the therapeutic serum levels of Dig?

A

0.5-2 mg/mL

33
Q

*mitral regurgitation and aortic & pulmonic stenosis are audible during..

A

systole

34
Q

*mitral & tricuspid stenosis, aortic regurg, and aortic/pulmonic valvular insufficiency are heard during..

A

diastole

35
Q

Potassium

A

major intracellular cation. It is released when cells are damaged and is vital to normal functioning of cardiac muscle. It is particularly important in regulation of cardiac rate and force of contraction

36
Q

Calcium

A

Plays a significant role in the initiation and propagation of electrical impulses and in myocardial contractility. It is also important for intracellular energy production

37
Q

Hypercalcemia can cause..

A

bradys, AV blocks, BB blocks. Potentiates dig.

potentiates- increases the power or effect of something

38
Q

Hypocalcemia can cause..

A

decreased myocardial contractility with decreased CO and hypotension, decreased responsiveness to dig. ST segment lengthens. Sometimes brady, VT, asystole

39
Q

What are the ECG changes associated with a MI?

A

For most patients, the first changes occur as a hyperacute T wave followed closely by changes in the ST segment. Changes in Q wave are also present and usually remain evident (called a pathological Q wave)

40
Q

an inverted T wave indicates

A

ischemia

41
Q

S3 and S4 in MI pt is indicative of..

A

left ventricular failure

42
Q

Transient systolic murmurs may be heard because of..

A

papillary muscle dysfunction

43
Q

What does morphine do for the MI pt?

A

relieves pain, provides euphoria for feeling of doom, and dilates bronchioles

44
Q

What does nitroglycerin drip do for the MI pt?

A

decreases preload and afterload.

*monitor BP q 15mins

45
Q

why is heparin used for the MI pt?

A

used in pts with elevated ST segments (myocardial injury) to prevent systemic MI due to possible development of a-fib, cardiogenic shock, or for those with a previous embolus

46
Q

NSG dx for MI pt

A
  • Acute Pain r/t MI, angina
  • Decreased CO
  • Deficient Knowledge r/t illness and impact on pts future
  • Activity Intolerance r/t decreased CO or alterations in myocardial tissue perfusion
  • Risk for Ineffective Cerebral Tissue Perfusion r/t thrombolytic therapy impact
47
Q

PAWP of ___ is very bad and pt will have s/sx of ____ soon

A

18; pulmonary edema

(normal PAWP is 4-12)

48
Q

How is pain relieved for pericarditis?

A

by sitting up and leaning forward

49
Q

List the possible causes of Heart Failure

A
  • Impaired cardiac function: MI, myocarditis, cardiomyopathy, valve disease, pericarditis, tamponade
  • Excess work demands- stress, dysrhythmias, infections
  • Anemia
  • Thyroid disorders
  • Pregnancy
  • Nutritional deficiency- Thiamine
  • Pulmonary disease
  • Hypervolemia
50
Q

What are the 3 compensatory mechanisms the failing heart uses?

A
  1. ventricular dilation
  2. ventricular hypertrophy
  3. increased sympathetic nervous system stimulation (tachycardia)
51
Q

S/Sx of Left Ventricular Heart Failure

A

pulm congestion, cough, dyspnea, decreased BP, tachycardia, prerenal azotemia, dysrhythmias, orthopnea, PND, acute pulm edema, Cheyne-Stokes respirations

52
Q

S/Sx of acute pulmonary edema

A

severe dyspnea, orthopnea, pallor, possible cyanosis, tachycardia, blood-tinged sputum, wheezing and bubbling resp, fear, sweating, nasal flaring, use of accessory muscles, tachypnea, vasoconstriction, hypoxia, gallop, pulsus alternans (pulse goes up and down), cerebral hypoxia, fatigue, muscle weakness, nocturia, oliguria=late sign

53
Q

S/Sx of Right Ventricular Heart Failure

A 
peripheral edema and venous congestion of all organs
Liver & GI engorgement
dependent edema
anasarca (edema everywhere)
cyanosis
anxiety, fright, depression
54
Q

Best position for acute HF

A

high Fowler’s with legs kept dependent

55
Q

S/Sx of dig toxicity

A

abdominal pain, anorexia, N/V, visual disturbances (halos), bradycardia, and other arrhythmias

56
Q

Action/Therapeutic Effects of Dig

A
  • Increases ventricular contractility
  • Increases ventricular emptying
  • Slows conduction of impulses through the AV node and Purkinje fibers
  • Slows HR
  • Increases CO
57
Q

How does dopamine work?

A

in LOW doses (lower than 4), causes vasodilation in the renal, cerebral and coronary vascular beds, primarily resulting in increased renal blood flow, glomerular filtration rate, and sodium excretion

58
Q

What does dobutamine do?

A

increases HR, AV conduction, and myocardial contractility. The heart does not require as much additional oxygen when dobutamine vs. dopamine is used

59
Q

Best position for dyspnea and resp distress?

A

High Fowler’s

60
Q

S/Sx of cardiac tamponade

A

tachycardia, JVD, cyanosis, dyspnea, muffled heart sounds, diaphoresis, paradoxical pulse, hypotension

61
Q

Which type of heart valves require life long anticoagulant therapy?

A

Mechanical valves

62
Q

What are the risks associated with the ECC (bypass) machine used during open heart surgery?

A

pump can crush blood cells, leading to thrombus formation; or create and air emboli. Other complications include shock, hemorrhage, fluid overload, hemolysis, and kidney or lung damage

63
Q

You don’t want more than ___mL/hr coming out of a chest tube

A

100mL/hr

64
Q

What could sudden cessation of drainage from a chest tube indicate?

A

clot in tube or other obstruction

65
Q

NSG care for arterial bypass pt

A

check pulses frequently and watch for compartment syndrome and bleeding. Intractable pain- call doc ASAP!

66
Q

The 6 Ps

A 
pain
paresthesia
poililothermia
paralysis
pallor
pulselessness

Critical Care Test #1 (2 decks)

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