Cardiac 2 Flashcards
what is a pacemaker
its a device that sends out impulses for the heart to contract which will increase the heart rate with bradycardia
when should a pacemaker cause concern
pacemakers have a minimal heart rate so if it falls below this the device could have issues.
post-op care for ppm
monitor incision site
monitor for electrode displacement (wires move)
immobilise arm closes to site
support gentle movement to prevent frozen shoulder
keep patient from raising arm higher than shoulder
s/s of malfunction of ppm
loss of capture- no contraction after stimuli
failure to sense- fires at inappropriate times
what can cause loss of capture
ppm programmed incorrectly
electrodes dislodged
battery depleted
ppm client education
check pulse daily
ID card or bracelet
avoid electromagnetic fields- No MRI’s and cell phones on opposite ear
who is at risk of pulmonary oedema
patients receiving fast iv fluids
very young and very old
patients with hx of heart or kidney disease
what is pulmonary oedema
fluid backing up into lungs due to heart unable to move volume forward.
this usually occurs at night when patient in bed.
during the day it will become peripheral oedema when upright.
pulmonary edeme s/s
sob
restless/anxious
severe hypoxia
productive cough
treatment pulmonary oedema
high flow o2- keep above 90%
diuretics-increase u/o-40mg bolus 1-2mins to prevent htn and ototoxicity.
nitroglycerin - decrease after load = increases c/o as less resistance forward flow
morphine- vasodilator decrease pre and after load, decreases agitation, helps with sob
nesiritide- vasodilator for veins and arteries + diuretic affect.->short term iv infusion under 48hrs and infusion to be off for 2hrs before draw a BNP level.
positioning- upright, legs down, promotes pooling of blood
what is cardiac tamponade
blood, fluid or exudate has leaked into pericardial sac causing compression of the heart.
cause of cardiac tamponade
motor vehicle accident, right ventricular biopsy, MI, pericarditis, or haemorrhage from CABG
s/s of cardiac tamponade
decreased c/o cvp (central venous pressure) will be increased bp will drop hallmark signs- increased cvp and decreased bp heart sounds muffled neck veins distended narrowed pulse pressure <40 shock- decreased c/o
how do you get narrowed pulse pressure from baseline
example 120/80-> 80 - 120=40
treatment for cardiac tamponade
pericardiocentesis to remove the blood from around the heart
surgery
patient has carotid endarterectomy(CEAL) to enhance perfusion. ho who you know it was a success
increased loc- follows commands
patient has a aortic abdominal aneurysm(AAA) repair, how do you know it was a success
monitor below the waist, warm skin, good perfusion, increased o/p
what are the s/s of arterial occlusion due to atherosclerosis
numbness and pain extremities will be cold no palpable pulse- 5 P's hallmark sign intermittent claudication skin/nails changes ulcerations severe pain at rest
treatment of arterial occlusion
angioplasty(stent inserted) or endarterectomy
remember rule of thumb vein problems and arterial problems
elevate if vein problems
dangle if artery problems
