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NSG > Cardio #3 > Flashcards

Cardio #3 Flashcards

1
Q

What is an electrocardiogram

A

A recording of the electrical activity of the heart from various views

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2
Q

Quick, fast, painless test that shows cardiac electrical activity in a moment of time

A

electrocardiogram

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3
Q

Most common leads for electrocardiogram

A

12-lead EKG

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4
Q

18-lead-EKG and 15 leads-

A

dependent where work

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5
Q

An __ is usually performed as soon as the patient presents to the emergency department or complains of chest pain

A

EKG

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6
Q

Can also be performed if the patient has acute cardiac complaints or arrhythmia noted on the cardiac monitor

A

EKG

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7
Q

Place electrodes on the chest & extremities

A

EKG

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8
Q

Connect wires to electrodes

A

EKG

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9
Q

Electrical impulses will be transmitted to the ___ machine

A

EKG

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10
Q

Instruct patient to uncross arms & legs, lay as still as possible

A

EKG

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11
Q

The EKG machine will pick up “artifact” if there is movement

A

EKG

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12
Q

Once an appropriate image is noted on the EKG screen, press “capture”

A

EKG

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13
Q

Electrical impulses appear as waves on the graph paper

A

EKG

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14
Q

Remove wires and electrodes from chest

A

EKG

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15
Q

Similar to telemonitor. Legs on ankles and arms

A

EKG

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16
Q

EKG placement

A

White on the right. Snow on grass
Dirt in the middle
Fire over smoke

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17
Q

EKG V1

A

4th intercoastal space to the right of the sternum

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18
Q

EKG V2

A

4th intercoastal space to the left of the sternum

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19
Q

EKG V3

A

Directly between leads V2 and V4

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20
Q

EKG V4

A

5th intercoastal space at the midclavicular line

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21
Q

EKG V5

A

Level with V4 at left anterior axillary line

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22
Q

EKG V6

A

Level with V5 at left midaxillary line (directly under the midpoint of the armpit)

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23
Q

Leg leads on ankle not hips

A

EKG

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24
Q

12 or 18 lead print

A

EKG

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25
Q

Different views on the heart, most normal lead is 2. Look at lead 2!

A

EKG

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26
Q

Every rhythm on the test will be lead 2.
6 second strips,

A

multiple choice and fill in the blank

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27
Q

Can use abbreviations,

A

A-fib, V-fib

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28
Q

Electrical impulses generates heartbeat

A

Cardiac Conduction System

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29
Q

Electrical impulses are affected by electrolytes:

A

Sodium, potassium, magnesium, calcium

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30
Q

SA node –

A

60-100 bpm

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31
Q

Interatrial bundles

A

Internodal bundles

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32
Q

AV node –

A

40-60 bpm

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33
Q

Bundle of His (right and left) –

A

20-40bpm, if it has to take over it wont be effective

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34
Q

Purkinje

A

fibers

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35
Q

If the SA node fails the

A

AV node takes over

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36
Q

If AV nodes fails-

A

Bundle of his takes over

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37
Q

The period from the beginning of one heartbeat to the beginning of the next

A

Cardiac Cycle

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38
Q

Depolarization

A

(Systole)= Contraction

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39
Q

Repolarization

A

(Diastole)= Rest

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40
Q

EKG: Each 1 mm (small) horizontal box corresponds to __ second,

A

0.04

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41
Q

EKG: with heavier lines forming larger boxes that include five small boxes and hence represent ___ sec intervals.

A

0.20

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42
Q

The ____ is straight line on paper where no positive or negative deflections

A

isoelectric line

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43
Q

Wave forms Printed on grid like paper- can maximize on computer

A

EKG

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44
Q

base line of the electrical activity, expect all wave forms to go back down

A

Isoelectric line-

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45
Q

P-waves and QRS

A

positively deflective

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46
Q

Negative deflection=

A

problem

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47
Q

Within normal cardiac cycle, there is a

A

P wave, QRS complex, and a T wave

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48
Q

not common unless potassium is off, we do not look for ___

A

U waves

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49
Q

Indicative of the SA node firing

A

P-wave

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50
Q

Indicates atrial depolarization
Should be rounded

A

P-wave

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51
Q

Are they present?

A

P-wave

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52
Q

Do they occur regularly?- is there a ____ for every QRS rhythm

A

P-wave

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53
Q

Do they look alike? Are they rounded and upright? Should be roundish and similar

A

P-wave

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54
Q

First positive deflection
Atria are depolarizing (contracting)

A

P-wave

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55
Q

Time it takes for impulse to travel from SA to AV node

A

PR-Interval

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56
Q

Identifies electrical delay

A

PR-Interval

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57
Q

Should be 0.12 – 0.20 seconds (3-5 horizontal squares)

A

PR-Interval

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58
Q

For “R” think “Respirations” (normal 12-20, put decimal before each number)

A

PR-Interval

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59
Q

Measured from beginning of increase of P to beginning of QRS complex

A

PR-Interval

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60
Q

If prolonged= taking longer for the SA node to go to the AV

A

PR-Interval

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61
Q

First degree AV block- PR interval is longer

A

PR-Interval

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62
Q

___ come after the P wave

A

QRS

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63
Q

Represents ventricular depolarization and atrial repolarization

A

QRS

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64
Q

Tall and skinny

A

QRS

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65
Q

It they are fat we have a problem

A

QRS

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66
Q

Minorly deflect, go up and then go down

A

QRS

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67
Q

Represents time it takes for electrical impulse to travel from AV node rapidly through ventricles

A

QRS

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68
Q

should measure 0.06-0.10 (1.5-2.5 little boxes)

A

QRS Interval

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69
Q

Measure from the beginning of Q to the end of S wave

A

QRS Interval

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70
Q

Count number of squares from end of PR interval to end of S wave

A

QRS Interval

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71
Q

The wider it is the ventricles aren’t contracting as forcefully as they should be

A

QRS Interval

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72
Q

If bigger than 2.5 boxes= concern

A

QRS Interval

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73
Q

If wider= ventricles are having problems, over excited and firing to early

A

QRS Interval

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74
Q

Time from completion of contraction to recovery

A

ST Segment

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75
Q

Starts at the end of QRS complex, ends at beginning of T wave

A

ST Segment

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76
Q

Checked for patients with chest pain

A

ST Segment

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77
Q

Don’t measure segment

A

ST

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78
Q

Make sure it goes back to isoelectric line to determine MI, current or past Ischemia indication

A

ST segment

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79
Q

Stemi-

A

ST elevated myocardial infarction

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80
Q

Check troponin to check MI

A

ST segment

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81
Q

When the ST is elevated =

A

MI happening right now

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82
Q

ST depression or depression or T wave inversion-

A

MI/ischemia

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83
Q

The ___ follows the QRS complex

A

T wave

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84
Q

Represents repolarization (resting state) of the ventricles and atria

A

T wave

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85
Q

Rounded, medium-sized, upward deflection

A

T wave

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86
Q

Don’t worry about the __ wave

A

U

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87
Q

Should be positive
Don’t have to measure ___

A

T wave

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88
Q

Steps to analyze EKG

A

Regularity of the rhythm
HR
P-waves
PR-interval
QRS-interval

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89
Q

Is the rhythm regular or irregular?

A

Regularity of the rhythm

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90
Q

Marching out? (Equal distance)

A

Regularity of the rhythm

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91
Q

Regularly irregular or irregularly irregular?

A

Regularity of the rhythm

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92
Q

What is the rate? 60-100

A

HR

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93
Q

Is there a P wave for every QRS?

A

P Waves

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94
Q

Are the P waves upright and rounded?

A

P Waves

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95
Q

Do they look the same?

A

P Waves

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96
Q

Is PR interval normal and constant? 0.12-0.20 seconds?

A

PR Interval

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97
Q

Is there a QRS complex for each P wave?

A

QRS Interval

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98
Q

Is the QRS interval 0.06-0.1 seconds?

A

QRS Interval

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99
Q

Left to right

A

EKG

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100
Q

How to quick count heart rate

A

In between the black lines at the top is 15 boxes which equals 3 seconds.
A sheet is 6 seconds

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101
Q

Heart rate second method

A

6 seconds = 30 big boxes
Count number of complexes in 6 sec strip x =10

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102
Q

Calculating HR

A

300 divided by the of big boxes between the R waves (QRS) or 1500 divided by the number of small boxes between the R waves

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103
Q

Sinus rhythm? Regularity of the rhythm

A

Regular (March out)

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104
Q

Sinus rhythm? Heart rate

A

60-100 bpm (means SA node firing)

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105
Q

Sinus rhythm? P Waves

A

P wave present, rounded and upright
P wave for every QRS complex

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106
Q

Sinus rhythm? PR Interval

A

0.12-0.20 seconds (3-5 boxes)

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107
Q

Sinus rhythm? QRS Interval

A

QRS interval less than or equal to 0.1 seconds.

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108
Q

Also called dysrhythmia

A

Arrhythmias

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109
Q

An abnormal rhythm of the heart

A

Arrhythmias

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110
Q

Arrhythmias can result in increased or decreased

A

HR, early or late beats, or atrial or ventricular fibrillation

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111
Q

Rhythms arising from SA node referred to as

A

sinus rhythms

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112
Q

Normal Sinus Rhythm, can abbreviate

A

Sinus tachycardia
Sinus bradycardia

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113
Q

Sinus Bradycardia Regularity of the rhythm

A

Regular

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114
Q

Sinus Bradycardia Heart rate

A

< 60 bpm

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115
Q

Sinus Bradycardia P Waves

A

P wave present, rounded and upright
P wave for every QRS complex

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116
Q

Sinus Bradycardia PR Interval

A

0.12-0.20 seconds

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117
Q

Sinus Bradycardia QRS Interval

A

QRS interval less than or equal to 0.1 seconds.

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118
Q

Sinus Bradycardia only abnormality

A

<60 HR

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119
Q

Sinus Bradycardia: Causes

A

Medications, Electrolyte imbalances, MI, Hypothyroidism, Hypothermia, Sleep apnea, SA node problems

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120
Q

SB Causes: Medications

A

Beta Blockers, Ca Channel Blockers, Digoxin

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121
Q

SB Causes: Electrolyte imbalances

A

Potassium, Magnesium, Sodium and calcium

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122
Q

SB Causes: MI, Hypothyroidism,

A

Hypothermia, Sleep apnea

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123
Q

SB Causes: Problems with SA node

A

sick sinus syndrome- put pacemaker in to fix

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124
Q

Past MI can stay in a bradycardia,

A

ischemia=myocardial infarction

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125
Q

Sinus Bradycardia: Symptoms

A

Hypotension, Diminished pulses, Fatigue, Syncope (fainting)

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126
Q

Athletes and older people can have

A

Sinus Bradycardia

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127
Q

Sinus Bradycardia: Treatment Asymptomatic

A

no treatment

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128
Q

Sinus Bradycardia: Treatment Symptomatic

A

Atropine IV, Dopamine IV, Transcutaneous pacing and Pacemaker

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129
Q

Atropine IV

A

Anticholinergic/Antispasmodic

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130
Q

Dopamine IV

A

Inotropic

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131
Q

Transcutaneous pacing

A

Temporary pacing
Deliver pulses of electric current through patient’s chest

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132
Q

Pacemaker

A

generates electrical pulses delivered by electrodes to one or more of the chambers of the heart, the upper atria or lower ventricles.

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133
Q

Sinus Tachycardia Regularity of the rhythm

A

Regular

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134
Q

Sinus Tachycardia Heart rate

A

> 100 bpm

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135
Q

Sinus Tachycardia P Waves

A

P wave present, rounded and upright
P wave for every QRS complex

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136
Q

Sinus Tachycardia PR Interval

A

0.12-0.20 seconds

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137
Q

Sinus Tachycardia QRS Interval

A

QRS interval less than or equal to 0.1 seconds.

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138
Q

Sinus Tachycardia only abnormality

A

HR >100

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139
Q

Sinus Tachycardia: Causes

A

Physical activity, Hemorrhage, Shock, Medications, Dehydration, Infection, Anxiety, Electrolyte imbalances

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140
Q

Sinus Tachycardia Cause Physical

A

activity

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141
Q

Sinus Tachycardia Cause Hemorrhage

A

Initial response as compensation

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142
Q

Sinus Tachycardia Cause Shock

A

Compensation mechanism

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143
Q

Sinus Tachycardia Cause Medications

A

Inhaled corticosteroids, SABAs, LABAs, pseudoephedrine, phenylephrine, levothyroxine (Inhalers)

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144
Q

Sinus Tachycardia Cause Dehydration

A

Compensation

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145
Q

Sinus Tachycardia Cause Infection and

A

Anxiety

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146
Q

Sinus Tachycardia Cause Electrolyte imbalances

A

Potassium, magnesium, sodium, calcium

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147
Q

Common Sinus Tachycardia: Symptoms

A

Angina, Dyspnea, Syncope, Dizziness, Anxiety, Palpations

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148
Q

Could be asymptomatic but symptoms are more common in

A

Sinus Tachycardia

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149
Q

Sometimes- sweating, diaphoresis

A

Sinus Tachycardia

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150
Q

Sinus Tachycardia: treatment

A

Correct the cause and Medications

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151
Q

Sinus Tachycardia: treatment Medications

A

Beta Blockers
Calcium Channel Blockers
Adenosine

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152
Q

Decrease SNS response

A

Beta Blockers

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153
Q

___ bind to beta-adrenoceptors and thereby block the binding of norepinephrine and epinephrine to these receptors

A

Beta Blockers

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154
Q

When these bind blood vessels constrict, HR, BP, CO, and force of contraction increase

A

Epinephrine and Norepinephrine

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155
Q

Heart has both β1and β2adrenoceptors, although the predominant receptor type is ___

A

β1

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156
Q

Β1 adrenoreceptors found in the heart and also found in the

A

kidneys

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157
Q

β2adrenoceptors are found in the smooth muscle like the

A

lungs and blood vessels

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158
Q

In the kidneys, activation of adrenoreceptors causes release of

A

renin into the blood

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159
Q

Blocks epinephrine and norepinephrine

A

Beta Blockers

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160
Q

We want cardiac selective beta blockers if

A

lung problems are present

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161
Q

Reduce cardiac output thus decrease blood pressure

A

Beta Blockers

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162
Q

Cause decrease in HR and contractility

A

Beta Blockers

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163
Q

Decrease myocardial oxygen requirements

A

Beta Blockers

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164
Q

Have many uses such as hypertension, angina, myocardial infarction, arrhythmias and heart failure

A

Beta Blockers

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165
Q

Cardio-selective beta blockers

A

bind specifically to beta-1 receptors (heart kidneys)

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166
Q

Cardio-selective beta blockers: MANBABE

A

M etoprolol (lopressor) or Metoprolol ER (Toprol XL)
A tenolol (Tenormin)
N ebivolol
B isoprolol
A cebutotol
B etaxolol
E smolol

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167
Q

Non-cardio selective beta blockers (do not specifically target beta-1 receptors):

A

Propranolol
Nadolol
Labetalol- combo alp/beta
Carvedilol- combo alp/beta
Sotalol

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168
Q

Beta Blockers Nsg Considerations

A

Check HR and BP prior to administration
Monitor for bronchospasm/SOB
Education- rise slowly (can cause orthostatic hypotension), do not stop abruptly
African Americans not as sensitive to BB

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169
Q

Beta Blockers HR and BP

A

Less than 60 hold
Systolic is less than 100

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170
Q

African Americans not as sensitive to BB

A

Increase Dosages

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171
Q

Calcium channel blockerswork toblock the L-type calcium channelsin the: Vascular smooth muscle cells:

A

coronary arteries and peripheral arteries

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172
Q

Calcium channel blockerswork toblock the L-type calcium channelsin the: Cardiac myocytes:

A

cells that control the strength of the heart’s contractions

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173
Q

Calcium channel blockerswork toblock the L-type calcium channelsin the: Cardiac nodal tissue:

A

cells that are responsible for theelectrical conduction of the heart

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174
Q

Causes vasodilation (decreased BP) and decreased HR

A

CCBs

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175
Q

Have anti-anginal effects
Can be used for arrhythmias

A

CCBs

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176
Q

Causes vasodilation

A

CCBs

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177
Q

Can be used with tachycardia with angina = vasodilation causes less angina

A

CCBs

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178
Q

Calcium Channel Blockers Medications

A

Diltiazem (Cardizem)
Verapamil (Calan SR)
Amlodipine (Norvasc)
Clevidipine (Cleviprex)
Nifedipine (Procardia)
Hydralazine (Apresoline)

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179
Q

Calcium Channel Blockers Nsg considerations: Check

A

HR and BP

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180
Q

Calcium Channel Blockers Nsg considerations: Assess for

A

angina

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181
Q

Calcium Channel Blockers Nsg considerations: Monitor digoxin levels and signs of toxicity

A

Vision changes, N/V, diarrhea, confusion, arrhythmias, loss of appetite (anorexia)

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182
Q

Calcium Channel Blockers Nsg considerations: Side effects can include

A

headaches and flushing

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183
Q

Calcium Channel Blockers Nsg considerations: Edema is common side effect with

A

Amlodipine

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184
Q

Any BP medication can cause

A

Orthostatic (Postural) Hypotension

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185
Q

Antiarrhythmic

A

Adenosine

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186
Q

Restores NSR by interrupting re-entrant pathways in the AV node

A

Adenosine

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187
Q

Slows conduction time through the AV node

A

Adenosine

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188
Q

Produces coronary artery vasodilation

A

Adenosine

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189
Q

Need telemonitor

A

Adenosine

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190
Q

Use cautiously in patients with asthma
May cause bronchospasms

A

Adenosine

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191
Q

Adenosine Monitor

A

HR
EKG
BP
Respiratory status

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192
Q

Adenosine Educate

A

Change positions slowly for at least 24 hrs

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193
Q

Emergent drug- IV

A

Adenosine

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194
Q

Atria initiate impulses faster than SA node
P wave looks different

A

Atrial Arrhythmias

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195
Q

Usually faster than 100bpm

A

Atrial Arrhythmias

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196
Q

Atrial Arrhythmias types

A

Premature Atrial Contractions (PAC)
Atrial Flutter (A-flutter)
Atrial Fibrillation (A-fib)

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197
Q

Not from SA node but from interatrial bundle
More p waves than QRS

A

Atrial Arrhythmias

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198
Q

Most common arrhythmia

A

Premature Atrial Contraction (PAC)

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199
Q

Premature electrical impulse in atrium- think “early” beat

A

Premature Atrial Contraction (PAC)

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200
Q

First determine underlying rhythm

A

Premature Atrial Contraction (PAC)

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201
Q

P wave morphology is different than other P waves

A

Premature Atrial Contraction (PAC)

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202
Q

Look at distance between R waves

A

Premature Atrial Contraction (PAC)

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203
Q

Atria contracting too soon, most common, early beat

A

Premature Atrial Contraction (PAC)

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204
Q

Know if it is a PAC

A

Premature Atrial Contraction (PAC)

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205
Q

Picture does not march out(even)

A

Premature Atrial Contraction (PAC)

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206
Q

Premature Atrial Contraction (PAC) only abnormal is

A

P-wave

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207
Q

Premature Atrial Contraction (PAC): Causes

A

Hypoxia, Cigarette Smoking, HF, Electrolyte imbalances, Caffeine, Alcohol, Meds, Fatigue, Anxiety, Stress

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208
Q

Premature Atrial Contraction (PAC): Causes, Electrolyte imbalances

A

Sodium, Calcium, Potassium, Magnesium

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209
Q

Premature Atrial Contraction (PAC): Causes, Caffeine

A

Coffee, soda, energy drinks

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210
Q

Premature Atrial Contraction (PAC): Causes, Meds

A

Asthma medications

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211
Q

Premature Atrial Contraction (PAC): Symptoms

A

Palpitations
Dizziness, lightheadedness, syncope more severe

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212
Q

Premature Atrial Contraction (PAC): Tx

A

Asymptomatic- No treatment
Symptomatic- Beta blockers, CCBs
Figure out cause
SA node firing to quick

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213
Q

Premature Atrial Contraction (PAC) abnormaility

A

Early P wave- Does not march out
P waves look abnormal

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214
Q

Electrical impulses initiated randomly from ectopic sites= atria quiver

A

Atrial Fibrillation

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215
Q

Stroke risk is increased due to stasis of blood

A

Atrial Fibrillation

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216
Q

Can be persistent or paroxysmal(sudden and uncontrolled)

A

Atrial Fibrillation

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217
Q

Afib Rapid Ventricular Rate (unstable Afib)

A

HR greater than 100

218
Q

Still have p waves

A

Atrial Fibrillation

219
Q

Multi-atrial firings with interatrial bundle, does not actually contract

A

Atrial Fibrillation

220
Q

Stasis, clotting, aspirin=81mg chewable

A

Atrial Fibrillation

221
Q

Stroke risk elevated

A

Atrial Fibrillation

222
Q

HR could be normal

A

Atrial Fibrillation

223
Q

A-fib(stuttering) with rapid ventricular rate=

A

ventricles are beating raiding, HR greater than 100-150 = ICU

224
Q

Atrial Fibrillation Regularity of the rhythm

A

Irregularly Irregular

225
Q

Atrial Fibrillation Heart rate

A

Atrial rate of 350-600
Ventricular rate much slower
A-fib with RVR = ventricular rate >100

226
Q

Atrial Fibrillation P Waves

A

No P waves
Wavy pattern on EKG

227
Q

Atrial Fibrillation PR Interval

A

Unable to determine

228
Q

Atrial Fibrillation QRS Interval

A

QRS interval less than or equal to 0.1 seconds.

229
Q

Atrial Fibrillation (A-Fib) abnormality

A

Does not march out
Atrial HR- 350-600 or 100-200
Multiple P-waves
Cannot determine PR-interval

230
Q

Atrial Fibrillation: Causes

A

Age, Heart Disease, Hyperthyroidism, Sleep apnea, Cardiac surgery, Medications, Unknown

231
Q

Atrial Fibrillation: Causes, Age

A

Risk increases after age 65

232
Q

Atrial Fibrillation: Causes, Heart disease

A

HF, HTN, MI, valvular disease

233
Q

Atrial Fibrillation: Causes, Medications

A

Cardiac stimulants: digoxin, increase SNS activity

234
Q

Atrial Fibrillation: Causes, Electrolytes

A

Potassium, Calcium, Magnesium, Sodium

235
Q

Atrial Fibrillation: S/sx

A

Hypotension, dizziness, pulse deficit (Hard to palpate), Chest pain (NO O2), palpations, fatigue

236
Q

Radial pluse can be different than atrial= notify physican

A

Atrial Fibrillation

237
Q

Atrial Fibrillation: Treatments

A

Anticoagulants, Rate and rhythm control, Cardioversion, Cardiac ablasion, Surgery

238
Q

Atrial Fibrillation: Treatments, Anticoagulants

A

Warfarin
Eliquis
Xarelto
Lovenox and heparin (Hospital)
Plavix and Asprin (Home)

239
Q

Warfarin Antidote

A

Vitamin K

240
Q

Therapeutic range for INR (Warfarin)

A

2-3

241
Q

Lovenox and Heparin Antidote

A

Protamine sulfate

242
Q

Plavix antidote

A

NONE

243
Q

Aspirin Antidote

A

Sodium bicarbonate

244
Q

Eliquis (Apixaban) and Xarelo Antidote

A

Andexanet alfa (Andexxa)

245
Q

Atrial Fibrillation: Treatments, Rate and rhythm control= slow and control the heart

A

Beta Blockers
Ca Channel Blockers
Digoxin

246
Q

Atrial Fibrillation: Treatments, Cardioversion-

A

shock the pt. 150 volts, could put in worse rhythm, not an option for a pt that already has a clot
Anticoagulation prior

247
Q

Atrial Fibrillation: Treatments, Cardiac ablation-

A

cauterizing, chemically or physically. procedure requiring informed consent, cutting off electrical impulse from the area

248
Q

Atrial Fibrillation: Treatments, Surgery

A

Maze procedure- reroute the electrical activity, rare, serious a-fib and rvr, last resort

249
Q

Aflutter is less likely to turn into __

A

A-fib

250
Q

Digoxin: increase CO

A

Strengthens ventricular contraction

251
Q

Digoxin: Slows ventricular rate

A

Decreases conduction through the SA and AV node

252
Q

Digoxin: Therapeutic range

A

0.5 – 2 ng/mL

253
Q

Digoxin: S/SX

A

vision changes, N/V, diarrhea, confusion, arrhythmias, decreased appetite

254
Q

Digoxin: Monitor Potassium levels

A

Hypokalemia increases toxicity risk

255
Q

Digoxin: Monitor Calcium levels

A

Hypercalcemia increases toxicity risk

256
Q

Digoxin: Monitor Magnesium levels

A

Hypomagnesemia increases toxicity risk

257
Q

Digoxin: Nsg implications

A

Monitor apical pulse for 1 full min before administration
Hold if HR < 60 bpm
Monitor ECG during IV administration and 6hr after each dose

258
Q

Coordinated electrical activity in the atria

A

Atrial Flutter

259
Q

Not every impulse goes to ventricles

A

Atrial Flutter

260
Q

Fire forms the interatrial bundle, fire consistently

A

Atrial Flutter

261
Q

Can see 3-5 p waves

A

Atrial Flutter

262
Q

Atria contracting each time and then ventricles contract, can worry about preload in ventricle

A

Atrial Flutter

263
Q

HF, cannot pump effectively

A

Atrial Flutter

264
Q

Atrial Flutter: Regularity of the rhythm

A

Atrial rhythm regular,
ventricular rhythm regular or irregular depending on AV conduction impulses

265
Q

Atrial Flutter: Heart rate

A

Atrial rate 250-350 bpm
Ventricular rate depends on underlying rhythm

266
Q

Atrial Flutter: P Waves

A

Rapid coordinated P waves
Sawtooth pattern

267
Q

Atrial Flutter: PR Interval

A

Unable to determine= too many

268
Q

Atrial Flutter:

A

QRS interval less than or equal to 0.1 seconds.

269
Q

Atrial Flutter abnormality

A

Regularity of the rhythm
HR
P-waves
PR interval

270
Q

Atrial Flutter: Causes

A

CHF, MI, Valve disorders, HTN, Rheumatic or ischemic heart disease, PE, COPD, Post-CABG

271
Q

Atrial Flutter: Causes

A

Chronic=asymptomatic
Paroxysmal=palpitations
Angina=decrease in O2
Dyspnea

272
Q

Atrial Flutter Tx

A

Same as Atrial Fibrillation

273
Q

Abnormal beats originating in ventricles

A

Ventricular Arrhythmias

274
Q

Often cause heart to beat too fast

A

Ventricular Arrhythmias

275
Q

Types of Ventricular Arrhythmias

A

Premature Ventricular Contractions (PVCs)
Ventricular tachycardia(V-Tec)
Ventricular fibrillation(V-fib)

276
Q

Very common

A

Premature Ventricular Contractions (PVCs)

277
Q

Extra abnormal heartbeat of the ventricle

A

Premature Ventricular Contractions (PVCs)

278
Q

Ventricles fire prematurely before the SA node causing wide QRS

A

Premature Ventricular Contractions (PVCs)

279
Q

2nd most common dysrhythmias

A

Premature Ventricular Contractions (PVCs)

280
Q

Ventricular fire prematurely before atria

A

Premature Ventricular Contractions (PVCs)

281
Q

Wide QRS problem in the ventricles

A

Premature Ventricular Contractions (PVCs)

282
Q

Bundle of his or purkinje fibers, fire too early

A

Premature Ventricular Contractions (PVCs)

283
Q

Can have every other beat or every 3rd beat

A

Premature Ventricular Contractions (PVCs)

284
Q

Premature Ventricular Contractions (PVCs) risk factors

A

Caffeine, Tobacco, Alcohol, Exercise, Hypertension, Anxiety, Stimulant use, Underlying heart disease

285
Q

Premature Ventricular Contractions (PVCs) risk factors, Stimulant use

A
  • speed, methamphetamines
286
Q

Premature Ventricular Contractions (PVCs) risk factors, Underlying heart disease

A

congenital heart disease, coronary artery disease, heart attack, heart failure and a weakened heart muscle (cardiomyopathy)

287
Q

Premature Ventricular Contractions (PVCs) S/Sx

A

“Flip-Flops”- skipped beats
Skipped beats
Missed beat
Cyanosis, headache, anemia
If 1 PVC may not notice

288
Q

Premature Ventricular Contractions (PVCs) Tx

A

Lifestyle changes- energy drinks, Tobacco, Alcohol, Stimulant
Beta Blockers
Calcium Channel Blockers
Amiodarone- common drug for PVC
Cardiac Ablation

289
Q

Premature Ventricular Contractions (PVCs) types

A

Unifocal, Multifocal, Bigeminy, Trigeminy, Couplet, Run/V-Tach

290
Q

Premature Ventricular Contractions (PVCs) Unifocal

A

Come from the same irritable ventricular area
look the same

291
Q

Premature Ventricular Contractions (PVCs) Multifocal

A

Originate from several different irritable areas in the ventricle
do not look the same

292
Q

Premature Ventricular Contractions (PVCs) Bigeminy- normal, PVC

A

Every other beat is a PVC

293
Q

Premature Ventricular Contractions (PVCs) Trigeminy- normal, normal, PVC

A

Every third beat is a PVC

294
Q

Premature Ventricular Contractions (PVCs) Quadgeminy- normal, normal, normal, PVC

A

Every fourth beat is PVC

295
Q

Premature Ventricular Contractions (PVCs) Couplet- some normals

A

2 PVCs back to back in a row, likely to get 3 or 4

296
Q

Premature Ventricular Contractions (PVCs) Run/Vtach

A

3 or more PVCs in a row (FATAL)

297
Q

When naming the rhythm when PVC and not saying specific type =

A

list if its a PVC

298
Q

Originates in the ventricles

A

Ventricular Tachycardia (VTACH)

299
Q

3 or more Premature Ventricular Contractions (PVCs)

A

Ventricular Tachycardia (VTACH)

300
Q

Ventricles become the pacemaker instead of SA node

A

Ventricular Tachycardia (VTACH)

301
Q

Ventricular Tachycardia (VTACH) Regularity of the rhythm

A

Regular

302
Q

Ventricular Tachycardia (VTACH) Heart rate

A

150-250 bpm

303
Q

Ventricular Tachycardia (VTACH) P Waves

A

Absent

304
Q

Ventricular Tachycardia (VTACH) PR Interval

A

Unable to determine

305
Q

Ventricular Tachycardia (VTACH) QRS interval

A

> 0.1 seconds
Bizarre appearance
wide

306
Q

PVC fatal if they turn into

A

V-tech

307
Q

Lethal rhythms, shockable –

A

V-tech, V-fib

308
Q

Tombstone rhythm

A

Ventricular Tachycardia (VTACH)

309
Q

Vtach: common causes

A

Mi, Cardiomyopathy, Hypokalemia, Respiratory acidosis, Myocardial irritability, Drugs, Medications

310
Q

Vtach: s/sx

A

Dyspnea, Lightheaded, Angina, Feeling of fast HR, Pulselessness
T-tach, awake and talking, may turn unconscious

311
Q

Vtach: treatment with pulse

A

Meds, Synchronized cardioversion, ICD(not best practice), Ablation

312
Q

Vtach: treatment with pulse, Meds

A

Lidocaine
Adenosine-stop electrical activity to restart rhythm
Beta Blockers- slow hrt down, lobatolol IV
Amiodarone- antidysrhythmic
Diltiazem- CCB- blood flow to the heart

313
Q

treatment with no pulse

A

CPR (call for help)
Defibrillation
Meds
AED- synchronize, follows the beat where the P wave should be
ACLS protocol- meds-not pulse

314
Q

Vtach: treatment with no pulse, Meds

A

Epinephrine
Lidocaine
Amiodarone

315
Q

Tombstone-

A

V-tach

316
Q

Cardio aversion-

A

low shock

317
Q

Defibrillation-

A

high shock

318
Q

Vagal down- act like bowel movement until meds into the room
Wide QRS
V-tach leads to V-fib untreated
Deterioration of the heart, V-fib

A

Vtach

319
Q

Mrs. Parker,age 76, is admitted to the long-term care unit where you are working. She has been transferred from the hospital after treatment for a recent myocardial infarction and several episodes of ventricular tachycardia (VT). At 1600 hours, you find her unresponsive, with no palpable pulses and shallow respirations. Vital signs are blood pressure 80/40 mm Hg, apical pulse 150 bpm, and respiratory rate 6 breaths per minute.
Is this patient hemodynamically stable?

A

No

320
Q

Why are there no palpable pulses?

A

Blood is being rerouted to vital organs

321
Q

What is happening to the heart when VT is occurring?

A

Ventricles constantly contraction

322
Q

What action should you take?

A

Call 911, bring crash cart, cpr when losing pulse completely

323
Q

Ventricular activity is chaotic, ventricles quiver

A

Ventricular Fibrillation (V-Fib)

324
Q

No discernible waves

A

Ventricular Fibrillation (V-Fib)

325
Q

No Pulse, will not be responsive

A

Ventricular Fibrillation (V-Fib)

326
Q

ACT FAST

A

Ventricular Fibrillation (V-Fib)

327
Q

If you see VFIB=DFIB
Always defibrillate these patients

A

Ventricular Fibrillation (V-Fib)

328
Q

Start with CPR, epinephrine, and Amiodarone or Lidocaine may be given

A

Ventricular Fibrillation (V-Fib)

329
Q

Ventricular Fibrillation (V-Fib) Causes

A

V-tach, Hyperkalemia, hypomagnesemia, CAD, MI, electrocution

330
Q

ACLS protocol meds

A

Ventricular Fibrillation (V-Fib)

331
Q

Ventricular Fibrillation (V-Fib) Regularity of the rhythm

A

Irregularly irregular

332
Q

Ventricular Fibrillation (V-Fib) Heart rate

A

Unmeasurable

333
Q

Ventricular Fibrillation (V-Fib) P Waves

A

Absent

334
Q

Ventricular Fibrillation (V-Fib) PR Interval

A

Unable to determine

335
Q

Ventricular Fibrillation (V-Fib) QRS Interval

A

None

336
Q

QRS are small
V-Fib= death
Cannot shock systole

A

Ventricular Fibrillation

337
Q

Absence of electrical activity

A

Asystole

338
Q

VF usually precedes asystole= sudden cardiac death

A

Asystole

339
Q

Unconscious and unresponsive
Hard to bring back

A

Asystole

340
Q

Start CPR immediately

A

Asystole

341
Q

Asystole causes

A

Hyperkalemia
V-fib
Massive MI
Shock

342
Q

hardening of wall and loss of elasticity

A

Arteriosclerosis

343
Q

Arteriosclerosis Patho

A

thickening, loss of elasticity, and calcification of arterial walls
Part of aging process

344
Q

Plaque

A

Arteriosclerosis

345
Q

Atherosclerosis Patho

A

formation of plaque within arterial wall
Injury to endothelial cells
Lipids, platelets, and clotting factors accumulate
Scar tissue

346
Q

Atherosclerosis: Growth of smooth muscle cells which secrete:

A

Collagen and fibrous proteins

347
Q

Formation of atheroma’s (plaques of lipid material)

A

Athersclerosis

348
Q

Thickening of the inner wall and the central wall of the artery

A

Arteriosclerosis

349
Q

A fatty streak forms on the lining of the artery- known as plaque

A

Atherosclerosis

350
Q

Plaque has jagged edges that allow blood cells and other materials to adhere to wall

A

Atherosclerosis

351
Q

Fibrous cap forms- Can tear or rupture and a blood clot forms which can block artery

A

Atherosclerosis

352
Q

Vessel can also become narrowed from plaque buildup

A

Atherosclerosis

353
Q

Injury to endothelial wall
Clotting and obstruction risk
Perfusion risk

A

Atherosclerosis

354
Q

Development of Plaque

A

Atherosclerosis

355
Q

Atherosclerosis: Non-modifiable Risk Factors

A

Age-Men after 50, women after menopause
Gender- Men
Ethnicity- African Americans
Genetics- Family hx. of hyperlipidemia

356
Q

Atherosclerosis: Modifiable Risk Factors

A

Physical Inactivity
Obesity
Diabetes Mellitus type 2
Alcohol use
Sedentary lifestyle
Stress
Elevated cholesterol
Hypertension
Nicotine Use

357
Q

Atherosclerosis: Diagnosis:

A

Lipid profile, C-reactive protein, Blood glucose levels, Stress Test, Cardiac Catheterization

358
Q

Atherosclerosis: Diagnosis: Labs- Lipid Profile

A

Total Cholesterol, Triglycerides, LDL, HDL

359
Q

Range: <200mg/dL
>200 associated with CAD
Measurement of HDL, LDL, and VLDL

A

Total Cholesterol

360
Q

Range: <150mg/dL
Critical value > 400mg/dL
>150 mg/dL at risk

A

Triglycerides

361
Q

Range: <130mg/dL
contains both cholesterol and trigs and may deposit cholesterol directly onto walls of arteries

A

LDL

362
Q

Range: >45mg/dL-men; >55mg/dL-women
Carry LDL to liver to be broken down and excreted

A

HDL

363
Q

Atherosclerosis: Diagnosis: Labs- C-Reactive protein

A

1.0-3.0mg/L
>3.0 mg/L Indicates low-grade inflammation

364
Q

Atherosclerosis: Diagnosis: Labs- Blood Glucose levels

A

elevated levels can increase the risk for atherosclerosis

365
Q

Shows how heart works during physical activity

A

Atherosclerosis: Diagnosis: Stress Test

366
Q

Can be on a treadmill/bike

A

Atherosclerosis: Diagnosis: Stress Test

367
Q

If patient unable to exercise adenosine or another vasodilator used to open up vessels

A

Atherosclerosis: Diagnosis: Stress Test

368
Q

Nuclear stress test- not common

A

Atherosclerosis: Diagnosis: Stress Test

369
Q

Small amounts of radioisotopes given IV

A

Atherosclerosis: Diagnosis: Stress Test

370
Q

Photos taken and compared

A

Atherosclerosis: Diagnosis: Stress Test

371
Q

Handles increase activity and O2 demand

A

Atherosclerosis: Diagnosis: Stress Test

372
Q

Procedure done to visualize anatomy of heart

A

Atherosclerosis: Diagnosis: Cardiac Catheterization

373
Q

Thin catheter inserted

A

Atherosclerosis: Diagnosis: Cardiac Catheterization

374
Q

Fluoroscopy used to produce real-time images

A

Atherosclerosis: Diagnosis: Cardiac Catheterization

375
Q

Contrast dye can be injected

A

Atherosclerosis: Diagnosis: Cardiac Catheterization

376
Q

Cardiac Catheterization Nsg implications

A

Assess for allergies prior
Obtain consent
When patient returns from cath check labs
Keep on bedrest
assess vitals
entry site- bleeding, dressing
6 Ps
Activity restriction, cannot climb more than 2 flights of stairs for minimum for 3 weeks, unable to engage in sexual activity

377
Q

24-48 hours minimum= 48-72 hrs before cardiac cath- metformin, nephrotoxic
Groin or wrist
insert stent to inflate balloon

A

Cardiac Catheterization

378
Q

Atherosclerosis: Therapeutic Measures

A

Diet- Heart-healthy diet. DASH diet
Smoking Cessation
Exercise
Low-dose aspirin 81 mg chewable
Medications
Assess vitals, continuous q15 blood pressure on monitor

379
Q

Atherosclerosis: Therapeutic Measures, Diet- Heart-healthy diet. DASH diet

A

Fruits and veggies, avoid trans fats, reduce saturated fats, reducing sugar and sodium (nothing fried, coconut oil)

380
Q

Atherosclerosis: Therapeutic Measures, Exercise

A

Increases HDL and can lower insulin resistance, can lead to development of collateral circulation.
30 mins a day most days can be intervals

381
Q

Atherosclerosis: Therapeutic Measures, Medications

A

Often needed to reduce lipid levels, can take up to 4-6 weeks.

382
Q

Atherosclerosis: Drug Therapy

A

Statins, Fibrates, Bile Acid Sequestrants, Cholesterol Absorption Inhibitor, Niacin

383
Q

Reduce cholesterol synthesis (4-6 weeks), rhabdomyolysis. #1 medication for atherosclerosis

A

Statins

384
Q

Atorvastatin (Lipitor)
Pravastatin (Pravachol)
Simvastatin (Zocor)
Rosuvastatin (Crestor)

A

Statins

385
Q

Reduce triglycerides

A

Fibrates

386
Q

Fenofibrate (TriCor)
Gemfibrozil (Lopid)

A

Fibrates

387
Q

Increase conversion of cholesterol to bile acids, if statins aren’t fully working

A

Bile Acid Sequestrants

388
Q

Cholestyramine (Questran)
Colesevelam (WelChol)
Colestipol (Colestid)

A

Bile Acid Sequestrants

389
Q

Inhibits Cholesterol Absorption

A

Cholesterol Absorption Inhibitor

390
Q

Ezetimibe (Zetia)

A

Cholesterol Absorption Inhibitor

391
Q

Prevents conversion of fats into VLDLs

A

Niacin:

392
Q

Caused by atherosclerosis

A

Coronary Artery Disease (CAD)

393
Q

Plaque buildup in the walls of coronary arteries causing blockage

A

Coronary Artery Disease (CAD)

394
Q

Progressive disease

A

Coronary Artery Disease (CAD)

395
Q

Coronary Artery Disease (CAD) risk factors

A

Same as atherosclerosis

396
Q

Coronary Artery Disease (CAD) can cause

A

Age- Men over 50
Woman after menopause
Angina- ischemia or decreased O2 supply
MI
Death

397
Q

Angina is chest pain due to ischemia

A

CAD: S/SX: Angina

398
Q

Narrowed blood vessels unable to dilate

A

CAD: S/SX: Angina

399
Q

Carry less blood/oxygen for heart muscle

A

CAD: S/SX: Angina

400
Q

Types of angina

A

Stable, Unstable, Variant or Vasospastic (Prinzmetal) and Microvascular

401
Q

Occurs in pattern familiar to patient, only lasts a few minutes. Goes away with rest/Nitro. Pattern familiar. Less than 10 mins.

A

Stable Angina

402
Q

Increases unpredictably in frequency, occurs at rest, during sleep. Not relieved by meds or rest
Should be treated as emergency, can lead to MI
Can last longer than 10 mins

A

Unstable Angina

403
Q

Caused by coronary artery spasms. Pattern is cyclical, lasts longer than stable. In cycles, can treat with nitro

A

Variant or Vasospastic angina (Prinzmetal angina)

404
Q

Spasms in walls of tiniest arteries. Pain may be more severe. Brings to knees right away, very painful

A

Microvascular angina

405
Q

Tight pressure, crushing=

A

angina

406
Q

Discomfort, burning, fullness, pressure, squeezing

A

CAD: S/SX: Angina

407
Q

Pain may radiate down arms, to neck and scapula

A

CAD: S/SX: Angina

408
Q

Heaviness in arms

A

CAD: S/SX: Angina

409
Q

Women may have atypical symptoms: SOB, fatigue, nausea

A

CAD: S/SX: Angina

410
Q

Lasts 5-15 minutes

A

CAD: S/SX: Angina

411
Q

Nitroglycerin- direct vasodilator Tx

A

Angina

412
Q

Nitroglycerin

A

CAD: S/SX: Angina: Treatment

413
Q

Dilates arteries thereby reducing workload of heart

A

Nitroglycerin

414
Q

Sublingual
Acts in 1-2 minutes
Last 30-40 min.

A

Nitroglycerin

415
Q

1 dose Q5min x 3

A

Nitroglycerin

416
Q

Nitroglycerin Side effects:

A

Hypotension, headache (rush of blood to heart and brain)

417
Q

Assess pain and BP because it dilates

A

Nitroglycerin

418
Q

Educate pts to assess bp and keep nitro on them or close

A

Nitroglycerin

419
Q

Kept in cool, dry, dark, area because of photosensitivity keep in pockets

A

Nitroglycerin

420
Q

Under 100 systolic and 40 diastolic

A

Nitroglycerin

421
Q

IV or Patch
Remove patch to give sublingual

A

Nitroglycerin

422
Q

12 hrs is cut off-

A

Nitroglycerin

423
Q

CAD: Angina: Medications/treatment

A

CCBs, Anti-ischemic agents, Nitrates

424
Q

Amlodipine- most common
Felodipine

A

Calcium channel blockers- vasodilates, check BP and HR

425
Q

Ranexa

A

Anti-ischemic agent

426
Q

Isosorbide mononitrate
Nitro
Avoid erectile dysfunction meds- causes vasodilation ask if Viagra (tidalifil) or Sialis

A

Nitrates

427
Q

Includes unstable angina and MI

A

Acute Coronary Syndrome (ACS)

428
Q

Caused by sequence of inflammatory processes

A

Acute Coronary Syndrome (ACS)

429
Q

80% caused by Thrombus or clot formation leading to reduced blood flow (Unstable angina)

A

Acute Coronary Syndrome (ACS)

430
Q

Partial or complete occlusion of coronary artery (MI)

A

Acute Coronary Syndrome (ACS)

431
Q

NSTEMI (not ST elevation still myocardial infarction) or STEMI (ST elevated myocardial infarction)

A

Acute Coronary Syndrome (ACS)

432
Q

Caused by CAD or atherosclerosis

A

Acute Coronary Syndrome (ACS)

433
Q

12 lead EKGs- which coronary artery is effected, fireman’s hat,

A

nitro, get physician

434
Q

Chest pain-
New
Worse
Sudden
Occurs at rest, while asleep, with little exertion
Lasts longer than stable angina (over 10 mins)
Not relieved by medicine

A

Unstable Angina

435
Q

Usually caused by atherosclerosis, which can rupture leading to blood clot

A

Unstable Angina

436
Q

Should be treated as an emergency, can lead to MI
Should be coming to ED

A

Unstable Angina

437
Q

Results in death of heart muscle

A

Myocardial Infarction

438
Q

80-90% of time caused by thrombus formation

A

Myocardial Infarction

439
Q

Ischemic injury happens over hours before complete necrosis takes place

A

Myocardial Infarction

440
Q

Area of heart affected depends on coronary artery affected

A

Myocardial Infarction

441
Q

STEMI- Most serious, affects full thickness of heart

A

Myocardial Infarction

442
Q

NSTEMI- Less serious, blockage is usually partial

A

Myocardial Infarction

443
Q

Time is muscle!!!=act quickly. 4 hours time frame from start of symptoms

A

Myocardial Infarction

444
Q

Scar tissue may form in the damaged area

A

Myocardial Infarction

445
Q

Can give TPA for stroke and MI also (not common)
To break up thrombus
CTA- to see type of stroke

A

Myocardial Infarction

446
Q

Typical Myocardial infarction S/Sx:

A

Heaviness, pressure, tightness, burning, constriction, or crushing pain- “elephant sitting on my chest”
Substernal or retrosternal, may radiate
Fatigue
Weakness
SOB
Anxiety
SNS is activated
Low BP
Elevated HR
Diaphoresis caused by anxiety
Cool, Clammy, gray skin
Nausea/vomiting

447
Q

Myocardial Infarction/Heart attack symptoms in men

A

N/V, Jaw, neck, and back pain, Squeezing chest pressure or pain, SOB

448
Q

Myocardial Infarction/Heart attack symptoms in women

A

N/V, Jaw, neck, and back pain, chest pain but not always, pain or pressure in the lower chest or upper abdomen, SOB, fainting, indigestion, extreme fatigue

449
Q

Low Bp
Elevated HR
N/V typical in women

A

Myocardial Infarction

450
Q

Denial common
Wait to seek care (no tPA)

A

Myocardial Infarction: Treatment

451
Q

“Time is muscle”
Call 911
Do not drive self or ride with others
Reperfusion time critical

A

Myocardial Infarction: Treatment

452
Q

Chew one uncoated adult aspirin (324mg= adult aspirin)
If in LTC chew enteric coated

A

Myocardial Infarction: Treatment

453
Q

STEMI TX
Educate on nitro and angina
May have atherosclerosis or CAD and not know they had a MI

A

Myocardial Infarction: Treatment

454
Q

Diagnostic Tests for MI

A

Troponin, Myoglobin and creatine kinase, EKG, Magnesium and Potassium

455
Q

Troponin

A

The more damage the higher number will be

456
Q

Myoglobin and creatine kinase

A

(CK)-MB- not as sensitive as troponin

457
Q

EKG-

A

Look at ST segment

458
Q

Magnesium and Potassium

A

NOT AS CRITICAL

459
Q

ST elevation

A

MI

460
Q

ST depression

A

Ischemia

461
Q

STEMI (HAPPENING NOW) AND

A

NSTEMI (COULD HAVE HAPPENED) = ISCHEMIA

462
Q

Myocardial Infarction: emergency Drug Therapy

A

IV nitro, Antiplatelet Therapy, Systemic anticoagulation, pain management, thrombolytic

463
Q

Reduces pain
vasodilates which improves blood flow

A

IV nitro-

464
Q

Reduce platelets from forming clots

A

Antiplatelet therapy-

465
Q

IV Heparin (PROTAMINE SULFATE=ANT)

A

Systemic anticoagulation-

466
Q

Usually IV Morphine
Decreases preload and afterload
Decreases BP and HR

A

Pain management-

467
Q

Used to dissolve blood clot
STEMI
O2 if O2 is less than 92%

A

Thrombolytic-

468
Q

MI- MONA TASS

A

M orphine
O xygen
N itroglycerin
A spirin
T hrombolytics
A nticoagulants
S tool softeners
S edatives

469
Q

Myocardial Infarction: Treatment Cardiac catheterization

A

Balloon angioplasty
Percutaneous coronary intervention (PCI)- can pull out clot

470
Q

Coronary Artery Bypass Graft (CABG)

A

Myocardial Infarction: Treatment

471
Q

Post operative concerns-

A

perfusion, clots, HR, BP, sites for bleeding, below sites for 6 P’s

472
Q

Myocardial Infarction: Post Medications

A

Beta Blockers, ACE inhibitors, (2nd line), Statins, Antiplatelet, Vasodialators

473
Q

If MI for the rest of their life. Decrease HR, BP, prevent release of renin, reduce preload and afterload. Decrease O2 demand

A

Beta Blockers

474
Q

Metoprolol (heart specific)
Carvedilol, or propranolol asthma or COPD should not be on it

A

Beta Blockers

475
Q

Lowers BP, reduces workload on heart (hypotension, cough)

A

ACE inhibitor (2nd line)-

476
Q

Lisinopril, Ramipril

A

ACE inhibitor (2nd line)-

477
Q

Lowers cholesterol

A

Statin-

478
Q

Crestor, Lipitor

A

Statin-

479
Q

Reduce preload and afterload, reduce oxyIsosorbide mononitrate
en consumption of myocardium

A

Vasodilators-

480
Q

Isosorbide mononitrate

A

Vasodilators-

481
Q

MI is also called

A

acute coronary syndrome

482
Q

Narrowing of arteries that leads to occlusion or obstruction

A

Peripheral Arterial Disease (PAD)

483
Q

Strongly related to other CVD (likely to have PAD)

A

Peripheral Arterial Disease (PAD)

484
Q

Usually in lower extremities

A

Peripheral Arterial Disease (PAD)

485
Q

Reduces blood supply
Leads to ischemia distal to obstruction

A

Peripheral Arterial Disease (PAD)

486
Q

Can have one or multiple occlusions

A

Peripheral Arterial Disease (PAD)

487
Q

PAD: Risk factors

A

Smoking, Hyperlipidemia, Hypertension, Diabetes Mellitis, Elevated BMI, Family history of athersclerosis, Age, Ethnicity-African americans

488
Q

PAD: S/SX

A

Intermittent Claudication- Pain in calves with activity (causes PT to seek TX)
Paresthesia
Thin, shiny, and taut skin (Rubor)
Loss of hair on the lower legs
Diminished (is okay if they have PAD) or absent pedal, popliteal, or femoral pulses
Pallor of extremity when elevated, reddish-purple when dependent
Cool skin
Thickened toenails
Dry, flaky, scaly skin
Decreased sensation
Pain at rest (Severe PAD)

489
Q

Atrophy of the skin and underlying muscles (blood and O2 supply inadequate= weak)

A

PAD: Complications

490
Q

Delayed healing (blood supply)

A

PAD: Complications

491
Q

Wound infection (gangrene, can lead to amputations’)

A

PAD: Complications

492
Q

Tissue necrosis (caused by gangrene or no blood supply, occlusion, leads to amputations)

A

PAD: Complications

493
Q

Arterial ulcers (difficult to heal, different than PVD ulcers)

A

PAD: Complications

494
Q

Amputation

A

PAD: Complications

495
Q

Jagged edge not perfect shape, hard to heal bc of

A

blood supply

496
Q

On ankles but can be anywhere in lower extremities-

A

PAD

497
Q

PAD: Diagnostic Studies

A

Ankle-brachial index (ABI), Arterial ultrasound, CT or MRI, Angiography

498
Q

Ankle-brachial index (ABI)

A

trying to find pulse
Done using a hand-held Doppler
Take systolic of leg and divide by systolic of arm

499
Q

Angiography-

A

important, scan of the vessels, uses. Push fluids, allergies, metformin
PVI

500
Q

No compression socks for

A

PAD

501
Q

= balloon-like bulge in vessel

A

Aneurysm

502
Q

Aortic aneurysms may involve the

A

aortic arch,
thoracic aorta
abdominal aorta. (AAA)

503
Q

Aorta >3cm is considered

A

aneurysm

504
Q

Outpouching of the wall of the artery

A

aneurysm

505
Q

Aortic Aneurysms: Risk Factors

A

Age, Male, Smoking, HTN, Atherosclerosis, Family history, High cholesterol, Elevated BMI

506
Q

Can lead to rupture- HTN control

A

aortic aneurysm

507
Q

Types of Aneurysms

A

Saccular, Fusiform, and Dissecting

508
Q

Bulges on one side of arterial wall

A

Saccular

509
Q

dilation of entire circumference

A

Fusiform

510
Q

Cavity is formed from tear in artery wall

A

Dissecting- not a true aneurism *

511
Q

Aortic Aneurysm: S/Sx, Thoracic aortic aneurysms

A

Often asx, SOB, CP, pain that radiates to back
SOB, Chest pain if its bigger, radiates

512
Q

Aortic Aneurysm: S/Sx, Abdominal Aorta Aneurysm (AAA)

A

Often asx, Pulsatile mass-no touching, Bruit (bowel sounds- swishing sounds), Back or flank pain, Abdominal pain, feeling of fullness

513
Q

Hoarseness pushing against the vocal area
dysphagia

A

Aortic Aneurysm: S/Sx

514
Q

Aneurysms: Diagnostic Tests

A

Abdominal Ultrasound
CT
MRI
Aortography

515
Q

Aortogram or Arteriogram

A

Definitive test for aneurisms – golden standard

516
Q

Aneurysms: Treatment Lifestyle changes-

A

stop smoking, dash diet, increase cardiac activity (little)

517
Q

Aneurysms: Treatment Surgery- super asymptomatic or large enough

A

Dilated aorta section is removed, graft sutured in place

518
Q

Aneurysms: Treatment Endovascular aneurysm repair (EVAR)

A

Minimally invasive
Catheter threaded through femoral artery, stent and graft placed to support aneurysm

519
Q

Bigger than 3 cm but they wait about 5 cm to intervene

A

Aneurysms

520
Q

Monitor 6 P’s (bilaterally), BP. Every 30 mins to an hour every 4 hours to assess

A

Aneurysms

521
Q

Notify physical and anesthesiologist if no pulse

A

Aneurysms

522
Q

Aortic dissection- tear of the inner lining of the wall and blood flowing in between

A

Aortic Aneurysm: Complications

523
Q

Rupture—serious complication

A

Aortic Aneurysm: Complications

524
Q

into retroperitoneal space: if it ruptures

A

into retroperitoneal space: if it ruptures

525
Q

into thoracic or abdominal cavity:

A

Massive hemorrhage
Usually don’t make it to the hospital
Medical emergency

526
Q

Do not palpate if seeing a pulsating mass

A

Aneurysm

527
Q

Monitor for indications of rupture

A

Cool, Clammy skin. Diaphoresis
Pallor
Weakness
Tachycardia
Hypotension
Abdominal, back, groin, or periumbilical pain
Changes in level of consciousness
Pulsating abdominal mass

527
Q

Sudden severe pain, sharp
Weakened or absent pulse
Decrease of LOC depend son how much it dissects

A

Aortic Dissection

528
Q

Geriatric- more likely to present with hypotension and vague symptoms

A

Aortic Dissection

529
Q

Thoracic- tamponade (hypotension, muffled heart sounds

A

Aortic Dissection

530
Q

Aortic Dissection: Patho

A

Tear occurs
Blood “tracks” between inner and middle layer
Inner and middle layers separate (dissect)
Systolic pulsation ↑ pressure on damaged area
Further ↑ dissection
May occlude major branches of aorta

531
Q

Aortic Dissection: S/Sx

A

Pain, Cardiovascular, Neurologic, Respiratory, Geriatric presentation

532
Q

sudden, severe
Something is sharp or tearing in chest

A

Pain

533
Q

weakened or absent pulses

A

Cardiovascular

534
Q

decreased LOC
dizziness
syncope

A

Neurologic

535
Q

dyspnea

A

Respiratory

536
Q

More likely to present with hypotension and vague symptoms.

A

Geriatric presentation

537
Q

Aortic Dissection: Complications

A

Cardiac tamponade, Rupture of Aorta, Occlusion of arterial supply to organs

538
Q

Life-threatening
Blood escapes from dissection into pericardial sac
Hypotension, muffled heart sounds , narrowed pulse pressure

A

Cardiac tamponade

539
Q

Hemorrhage, can lead to death
Can hemorrhage into mediastinal, pleural, or abdominal cavity, retroperitoneal space

A

Rupture of Aorta

540
Q

(spinal cord, renal, abdominal)

A

Occlusion of arterial supply to organs

541
Q

Systolic should be <160 when having an ___
Heart feels like it had to compensate- control hypertension

A

aneurysm

NSG (13 decks)

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