Cardiac (Alexanders brainscape) Flashcards
describe why lifting your arms is contraindicated in post-op pts who has a permanent pacemaker implanted
pts who get a permanent pacemaker should be educated to not lift their arms for a period of time post operatively because the lead wires that rest on the heart have not had time to stabilize and could easily be displaced
explain why a pt with a pacemaker should report new onset of fatigue and weakness
pacemaker malfunction causes bradycardia and a drop in cardiac output. this can cause hypoxia, with classic manifestations of weakness, fatigue, and dizziness.
explain why defibrillation takes priority over any intervention when a pt is in ventricular fibrillation
the greatest risk to the pt is death from a lack of cardiac output. Vfib is a lethal rhythm in which the ventricles are in a quivering pattern and there is no atrial activity. defibrillation is essential to resolve Vfib promptly and convert the rhythm to restore cardiac output. the nurse should follow defibrillation with cardiopulmonary resuscitation and repeated defibrillation if necessary, to convert the Vfib into a sustainable rhythm.
describe the appearance of ventricular tachycardia
rate: fast
rhythm: regular
p wave: no
QRS: wide and bizarre
t wave: no
explain the difference between Vtach with a pulse and pulseless Vtach
vtach with a pulse is typically intermittent and the pt should be observed and treated for symptoms. pulseless vtach is a shockable rhythm and defibrillation is the priority action.
when interpreting an ECG strip for a pt with a pacemaker, describe what you should be able to see if the pacemaker is functioning properly
Atrial pacing will show pacer spikes before each P wave
Ventricular pacing will show pacer spikes before each QRS complex
describe why pulmonary embolism is a high risk complication of atrial fibrillation
altered atrial contractions can cause blood pooling and thrombus formation. the pt is at risk for developing a pulmonary embolism or embolic stroke. the client should monitor and repost immediately manifestations, such as SOB or neurological changes.
Dosage: Run Heparin at 1,500u per hour
Heparin is delivered from pharmacy in 25,000u mixed in 500ml
How many ml/hr will you set the pump for?
30 mL/H
state the arrhythmias that are shockable and describe why defibrillation is the priority action
Vfib and pulseless Vtach
Both of these are incompatible with life because there is virtually no cardiac output due to the left ventricle not squeezing efficiently
describe the characteristics of atrial fibrillation
in Afib there are multiple foci of electrical stimulation in the atria which makes the isometric line of the ECG appear squiggly and without a visible P wave. the QRS complex is present because occasional beats are fully conducted.
describe why amiodarone is the treatment of choice for a pt who converts into ventricular tachycardia but has a pulse
Vtach with a pulse is not defibrillated nor is CPR started. pacing is not indicated. the rhythm will be treated with antiarrhythmics
describe vagal maneuvers and why you would use them
vagal maneuvers refer to actions that stimulate the vagus nerve and cause the heart rate to slow down. things like baring down and carotid stimulation are considered vagal maneuvers and are used for pts with stable supraventricular tachycardia (SVT)
describe the priority nursing action for a pt in asystole and why
a pt in asystole should be given high-quality CPR as a priority. defibrillation is not indicated for asystole because there is no electrical activity
describe what titration of a medication means
titrating medications is the process of adjusting doses to maximize the benefit of medications w/o adverse effects. orders for titration are written to meet parameters of lab results and should be adjusted according to orders
state proper delivery of adenosine for tachycardia arrhythmias
adenosine must be delivered in a controlled environment such as an ICU setting where advanced cardiac life support resources are readily available
describe the rationale for using IV amiodarone
amiodarone is used as an antiarrhythmic for maintenance of normal rhythms
describe the mechanism of action for adenosine and what it is used for
adenosine slows the conduction through the AV and SA nodes, thereby disrupting erratic cardiac electrical activity. it is used in the treatment of SVT that is unresponsive to other methods of conversion. adenosine must be administered with consent from the pt, a physician at the bedside, and defibrillation pads in place
describe the mechanism of action for atropine and what it is used for
atropine increases the sympathetic nervous system drive and depresses the parasympathetic drive thereby increasing the heart rate. atropine can be used to treat symptomatic bradycardia.
describe the relationship between electrolytes and the appearance of ECG rhythms
potassium - helps maintain normal muscle function. too high = peaked/tented T waves and too low = flattened/depressed T waves
calcium - impacts contractility and excitability. too high = short ST segment and QT interval, ventricular arrhythmias and too low = prolonged ST and QT, Vtach
explain nursing interventions involved in post cath care
pt who have recently has a femoral approach for a heart cath should remain in a supine position with legs extended for at least the first 3 H, then HOB 30 degrees for the remaining time (up to 6 H). direct pressure should be held to the site for at least the first 30 M. nurses should assess the site for bleeding. pulses distal to the insertion site should be checked along with circulation assessment.
indicate the common signs and symptoms of a STEMI
chest pain w/ or w/o radiation to the arm, dyspnea, nausea, diaphoresis, ST segment elevation, elevated troponin, change in vital signs
describe the interventions used for supraventricular tachycardia
least invasive intervention is the use of vasovagal maneuvers. for persistent SVT, it is appropriate to use adenosine
what specific assessment must be done before administering digoxin and why?
digoxin decreases the heart rate, so the nurse should count the apical pulse for at least 1 M before administering. the nurse should hold the medication and notify the provider if the pts heart rate is below 60/M or if a change in heart rhythm is detected.
