Cardiac Flashcards
What is heart disease?
A condition that affects the heart vessels, valves, and muscles
What is cardiovascular disease?
A condition that affects the heart plus the rest of the cardiovascular system?
How do cardiac glycosides affect the heart?
Increases contractility
Vasopressors
Increase blood pressure
Nitrates
Relieve pain/angina
Antilipids
Decrease cholesterol levels
Diuretics
Reduce fluid volume
Teds
Thromboembolic Deterrent Stocking applied prophylactically to prevent DVT
SVDs
Sequential Compression Device applied prophylactically to prevent DVT
Duplex Ultrasound
Non invasive test to assess how blood moves through arteries and veins (doppler + ultrasound)
Stress test
Physiological response of heart when stressed as in during exercise. Looking for causes of chest pain, irregular heart rhythm, etc.
What is MOLST? Who does MOLST have to be signed by?
Medical Order of Life Sustaining Treatment. Must be signed by physician
RRT
Rapid response team
Causes of ventricular dysrhythmia
Ectopic foci in walls of ventricles
What is the intrinsic ventricular rate?
20-40
Is a PVC (premature ventricular contraction) a medical emergency?
No, many people have occasional PVCs from stress or too much coffee
Is a PVC (premature ventricular contraction) beat?
Yes, not continuous so it is a beat not rhythm
What pulse point is the best place to count V tach?
Too fast to count
What are treatment options for V tach?
CPR/defibrillation, antiarryhtmic medication, implantable device
Signs and symptoms of CHF
SOB, fatigue, weakness, BLE edema, weight gain, tachycardia, dysrhythmia, persistent cough/wheezing
Hallmark symptom of Arrhythmia
fluttering in chest
Signs and symptoms of stroke
numbness, difficulty with balance, speech & understanding, blurred
vision, facial drooping, difficulty swallowing
Signs and symptoms of myocardial infarction
chest pain, numbness/pain in left arm, jaw, back
Signs and symptoms of cardiac arrest
Can occur without warning
Signs and symptoms of HTN
headache, fatigue, vision problems, chest pain, dyspnea, dysrhythmia
What do Cardiac glycosides do?
Increase cardiac contractility;
decrease heart rate
T/F Peripheral intravascular devices can be inserted by nurses and techs
True!
Are peripheral intravascular device used for short term or long term
For the short term
Which one is placed at the beside? Triple Lumen Central Line or Hickman
Triple Lumen Central Line
Which one is placed in the OR? Triple Lumen Central Line or Hickman
Hickman
This device is placed into the internal jugular but there is a risk of pneumothorax or air embolism
Triple Lumen Central Line
Which is the advantage of using a triple lumen central line during medication administration?
Multiple lumens for meds to stay on schedule if not compatible
What is an Angiography/Angiogram used for?
Use of radiopaque dye to
outline vessels looking for
blockage or narrowing
What does PEA stand for in a cardiac emergency?
Pulseless electrical activity.
What is happening in the heart during pulseless electrical activity (PEA)?
Electrical activity is present, but there is no contraction of the heart muscle.
What are the consequences of PEA?
No cardiac output means no tissue perfusion and ultimately, death if untreated.
A patient is in PEA. What should your immediate priority be?
Start CPR and identify/treat reversible causes (e.g., hypoxia, hypovolemia, acidosis, tension pneumothorax, etc.).
What is happening to the heart during asystole? What are the consequences of asystole?
No electrical activity of the heart. Immediate loss of oxygen supply to brain, heart, and tissue
What is a Holter monitor used for?
It records the activity of the heart over an extended period, usually 1-3 days.
A patient is prescribed a Holter monitor. What instructions should they follow?
Continue normal daily activities, avoid getting the device wet, and document any symptoms experienced.
What is the purpose of a pacemaker?
It replaces the natural pacemaker of the heart to regulate heart rhythm.
What conditions may require a pacemaker?
Bradycardia, tachycardia, heart damage from an MI, and congestive heart failure (CHF).
A patient with symptomatic bradycardia is unresponsive to medications. What intervention might be needed?
A pacemaker to regulate heart rate.
How does a pacemaker help in cases of CHF?
It improves heart function by coordinating heartbeats, especially in cases of electrical conduction abnormalities.
What do patients often describe an ICD shock as feeling like?
Being kicked in the chest.
What is the primary purpose of an Implantable Cardiac Defibrillator (ICD)?
To treat ventricular tachycardia and ventricular fibrillation by delivering a shock to restore normal rhythm.
A patient with a history of ventricular fibrillation receives an ICD. What should they be educated about regarding the shock?
The shock can be strong, and if someone is touching them at the time, they may feel a mild shock as well.
What should be monitored in a patient with an ICD?
Battery life, device functionality, and any recurrent arrhythmias that may indicate the need for further medical evaluation.
What are the capabilities of an AED?
Can diagnose life threatening cardiac
arrhythmias and deliver an electrical shock as needed
Where is a Mediport typically placed (hospital department)?
Operating room
Where does a Mediport terminate in the body?
In the superior vena cava near the entrance to the right atrium.
What is a key feature of a Mediport that allows repeated access?
It has a self-sealing port
Is a Mediport used for short-term or long-term access?
Long-term access.
A patient with cancer requires long-term IV chemotherapy. What central access device may be used?
Mediport
A nurse is preparing to access a patient’s Mediport. What type of needle should they use?
Huber needle
Why is a Huber needle preferred for accessing a Mediport?
It is a non-coring needle, which prevents damage to the self-sealing port.
Where does a PICC line terminate?
In the subclavian vein or superior vena cava.
Is a PICC line used for short-term or long-term access?
Long-term access.
What is a key characteristic of a PICC line compared to other central lines?
It has a small diameter and is inserted peripherally, usually in the upper arm
A patient requires long-term IV antibiotics at home. What type of catheter might they receive?
A PICC line
Why do we use telemetry?
To continuously monitor the heart
How do we memorize the color of lead placements?
Smoke over fire
Clouds over grass
Chocolate is good for the heart
How is a PTCA (Percutaneous Transluminal Coronary Angioplasty) procedure performed?
used to tx CAD
A catheter is placed through an IV in the neck, arm, or groin, and the balloon tip is inflated to compress a blockage in the coronary artery.
What is the purpose of inflating the balloon during PTCA?
To compress the blockage in the coronary artery and improve blood flow.
What does PTCA stand for?
Percutaneous Transluminal Coronary Angioplasty
A patient undergoes PTCA for a coronary artery blockage. What might be used to ensure the artery stays open?
A stent may be placed following balloon angioplasty.
How is a coronary artery stent placed?
It is placed using a balloon catheter during a procedure like PTCA.
What happens once a coronary artery stent is placed?
The stent locks in the open position to help maintain blood flow through the artery
A patient has undergone coronary artery stent placement. What key complication should be watched for in the post-procedure period?
Dysrhythmias, which can occur due to irritation or changes in electrical conduction after the procedure.
What is the nursing action for the insertion site after angiography or PTCA?
Maintain pressure dressing and immobilize the limb for approximately 6 hours to prevent bleeding and promote healing.
What should be monitored for within 6 hours after angiography or PTCA?
Urination to ensure kidney function is not compromised, especially with contrast dye.
After a patient returns from angiography or PTCA, what should be checked immediately?
Peripheral pulses, vital signs (VS), Pain, bleeding, or hematoma formation at the insertion site.
What should be administered to a patient after angiography or PTCA to help prevent complications?
Fluids to help flush the contrast dye and support kidney function.
What is the purpose of a Coronary Artery Bypass Graft (CABG)?
To bypass a blocked or damaged vessel in the heart using another healthy vessel.
What types of vessels are commonly used in CABG?
Greater saphenous vein
LIMA (Left Internal Mammary Artery)
LAD (Left Anterior Descending) artery
A patient undergoes CABG. What vessel might be used to bypass a blocked artery in the heart?
The greater saphenous vein, LIMA, or LAD artery may be used, depending on the location and type of blockage.
Who typically inserts a PIV?
A nurse or tech
Is a PIV used for short-term or long-term access?
Short term
A patient needs IV access for a few days for antibiotics. What type of device is most appropriate?
PIV
Where can a Triple Lumen Central Line be placed (location in hospital)?
Bedside
Where is a Triple Lumen Central Line typically inserted?
It is typically placed into the internal jugular vein.
What are the risks associated with a Triple Lumen Central Line insertion?
Pneumothorax or air embolism
Where is a Hickman catheter placed (location in hospital)?
Operating room
Where does a Hickman catheter terminate in the body?
It terminates in the superior vena cava near the entrance to the right atrium.
What is a distinguishing feature of the Hickman catheter?
It involves tunneling under the skin for secure placement
Is a Hickman catheter used for short-term or long-term access?
Long term access
Your patient has gone into ventricular tachycardia. As the nurse, what is the most optimal location to palpate a pulse?
So, what do you do to solve the ventricular dysrrhythmia
There is no palpable pulse.
So what do you do?
You Dfib the Vfib (get the AED for defibrillation & perform CPR).
After that, you use an ICD (implantable cardioverter defibrillator) which will dfib the vfib automatically inside the body.
Your patient has gone into asystole. As the nurse, what is the next best action?
Perform CPR!
What do you use to flush a Hickman?
Saline
Sodium Chloride
Morphine
Heparin
Dextrose in water
Flush with saline or heparin
Where are the (6) leads for an EKG placed?
V1: 4th ICS right of sternum
V2: 4th ICS left of sternum
V3: placed between 2 &4 not on bone
V4: 5th ICS midclavicular
V5: placed between 4&6 not on bone
V6: 5th ICS midaxillary
Why is a Cardiac catheter used?
To assess blood flow
How is a coronary artery stent placed?
Placed with balloon catheter, locks open to keep vessel open
What should we be looking for post cardiac catheterization?
Monitor VS be on lookout for dysrhythmia after placement
Assess for bleeding at insertion site
Check peripheral pulses
Immobilize limb 6hr and maintain pressure dressing
Monitor I &O (urinate within 6 hrs)
Administer fluids
The doctor has ordered a cardiac stress test for one of your patients. What are the steps in a cardiac stress test?
Take VS at rest to get a baseline.
Patient walks on a treadmill and VS are recorded every 3 minutes as treadmill intensity increases.
Patient exercises until they reach or near maximum HR.
Gradually cool down.
What does an echocardiogram visualize?
Can visualize how the heart is pumping and valves work through ultrasound (detects structural abnormalities)
What is a PVC? Is this a rhythm?
premature ventricular contraction
A beat not a rhythm
