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Health Care Participant Nursing: N1220 > Cardiovascular System (Exam Two) > Flashcards

Cardiovascular System (Exam Two) Flashcards

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1
Q

What is an electrocardiogram (EKG)?

A

Recording of the electrical activity of the heart from various views

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2
Q

What are the benefits of an electrocardiogram (EKG)?

A
  • Fast
  • Easy
  • Painless
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3
Q

What are the two types of electrocardiogram (EKG)?

A
  • 12-lead-EKG
  • 18-lead-EKG
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4
Q

What is the cardiac conduction pathway? What affects these electrical impulses?

A
  • Electrical impulses used to generate the heartbeat
  • Affected by electrolytes (i.e. sodium, potassium, calcium, magnesium)
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5
Q

What is the purpose of the cardiac conduction pathway?

A

Stimulate the mechanical cells of the heart to contract and perfuse the body

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6
Q

It is vital for electrolytes to be in appropriate range for which cardiac system to run effectively?

A

Cardiac Electrical System/Cardiac Conduction Pathway

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7
Q

Name the parts of the Cardiac Conduction Pathway in order.

A
  1. Sinoatrial (SA) Node (in wall of right atrium) –>
  2. Interatrial Bundles –>
  3. Left and Right Atria begin to contract –>
  4. Internodal Bundles –>
  5. Atrioventricular (AV) Node –>
  6. Bundle of His –>
  7. Purkinje Fibers
  8. Right and Left Ventricles begin to contract
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8
Q

Where is the Sinoatrial Node (SA) located?

A

In the wall of the right Atrium

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9
Q

The rate of the Sinoatrial Node (SA) is dictated by what?

A

The needs of the body

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10
Q

Which part of the Cardiac Conduction Pathway is known as the “pacemaker” of the heart?

A

Sinoatrial (SA) Node

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11
Q

If the Sinoatrial Node fails, which part of the Cardiac Conduction Pathway will initiate a heartbeat? What is the rate?

A
  • Atrioventricular (AV) Node
  • Rate of 40 to 60 beats per minute
  • The body is able to function regularly at this rate
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12
Q

If the Sinoatrial (SA) Node and Atrioventricular (AV) Node fails, which part of the Cardiac Conduction Pathway will initiate a heartbeat? What is the rate?

A
  • Bundle of His (right and left)
  • Rate of 20-40 beats per minute
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13
Q

What is the cardiac cycle? What does it consist of?

A
  • Period from the beginning of one heartbeat to the beginning of the next
  • Depolarization and repolarization
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14
Q

What is depolarization?

A

Period of contraction

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15
Q

What is repolarization?

A

Period of rest

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16
Q

The smallest box on an EKG represents how many millimeters/seconds?

A

1mm = 0.04 seconds

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17
Q

The largest box on an EKG represents how many millimeters/seconds?

A

5mm = 0.20 seconds

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18
Q

Within one normal cardiac cycle, there is what?

A
  • P wave
  • QRS complex
  • T wave
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19
Q

Which wave is first in the cardiac cycle?

HINT: PQRST

A

P wave

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20
Q

What does a P wave indicate?

A
  • The SA node is firing
  • Atrial depolarization
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21
Q

What are the normal characteristics of a P wave?

HINT: Think of a hill

A
  • Rounded, upright
  • Occur regularly
  • Should be 1 P wave for every 1 QRS complex
  • Symmetrical throughout EKG
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22
Q

What is the PR interval? What does it identify?

A
  • The amount of time it takes for an impulse to travel from the SA node to the AV node
  • Can identify if an electrical delay is present
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23
Q

When do you start and finish measuring for a PR interval on an EKG?

A
  • Begin at the peak of the P wave
  • End at the trough of the QRS interval (before Q starts going in downward position)
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24
Q

What is the normal measurement for the PR interval?

HINT: P”R” = “Respiratory Rate”

A

0.12 - 0.20 seconds

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25
Q

If the PR interval is >20 seconds, what does this indicate?

A

Electrical delay through the AV node

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26
Q

Which wave occurs in the middle of the cardiac cycle?

HINT: PQRST

A

QRS complex

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27
Q

What does a QRS complex represent?

A

Ventricular depolarization and atrial repolarization

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28
Q

When do you start and finish measuring for a QRS complex and QRS interval on an EKG?

A
  • Begin at the trough of the Q
  • End where the S trough returns back to the isoelectric line
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29
Q

What does the QRS interval indicate?

A
  • The amount of time it takes for electrical impulse to travel from the AV node through the ventricle
  • Occurs rapidly
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30
Q

What is the normal measurement for the QRS interval?

A

0.06 - 0.10 seconds

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31
Q

If the QRS interval is >0.10 seconds, what does this indicate?

A

Bundle branch block (block in ventricles)

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32
Q

Which wave occurs last in the cardiac cycle? HINT: PQRST

A

T wave

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33
Q

What does a T wave represent?

A

Repolarization of the ventricles

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34
Q

What are the normal characteristics of a T wave?

A
  • Upright, rounded
  • Above the isometric line
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35
Q

The time from depolarization of the ventricles to repolarization of the ventricles is known as what?

A

ST segment

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36
Q

When will the nurse check the ST segment?

A

When a patient complains of chest pain

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37
Q

List the steps to analyze an EKG?

A
  1. Check regularity of the rhythm (i.e. regular, irregular, regularly irregular, irregularly irregular)
  2. Check heart rate
  3. Check characteristics of P wave
  4. Check consistency of PR interval (0.12 - 0.20)
  5. Check consistency of QRS interval (0.06 -0.10)
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38
Q

How do you determine the regularity of the rhythm on an EKG?

A

R-to-R Spacing

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39
Q

What are the characteristics of a normal sinus rhythm?

A
  • Regular rhythm
  • Regular heart rate
  • Rounded, upright P wave
  • P wave and QRS interval ratio is 1:1
  • PR interval is 0.12 - 0.20
  • QRS interval is 0.06 - 0.10
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40
Q

How should the nurse intervene if the patient presents with a normal sinus rhythm?

A
  • DO NOTHING!
  • Intervention is not needed for this patient
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41
Q

What is an arrhythmia?

A
  • Abnormal heart rhythm
  • Also called a dysrhythmia
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42
Q

Arrhythmias can result in what?

A
  • Increased heart rate
  • Decreased heart rate
  • Early beats
  • Late beats
  • Atrial fibrillation
  • Ventricular fibrillation
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43
Q

What are rhythms that arise from the SA node called?

A

Sinus rhythm (i.e. normal sinus rhythm, sinus bradycardia, sinus tachycardia)

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44
Q

What is sinus bradycardia?

A

Sinus rhythm with a heart rate of <60 bpm

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45
Q

What are the causes of sinus bradycardia?

A
  • Athletic individuals
  • Medications
  • Electrolyte imbalance
  • MI
  • Hypothyroidism
  • Sleep apnea
  • Problems with SA node
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46
Q

What are the signs and symptoms of sinus bradycardia?

A
  • Asymptomatic
  • Hypotension
  • Diminished pulse
  • Fatigue
  • Dizziness
  • Syncope
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47
Q

What is the first-defense treatment for a patient with symptomatic sinus bradycardia?

A

IV Atropine

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48
Q

Describe the characteristics of sinus bradycardia on an EKG?

A
  • Slowed rhythm
  • Slowed heart rate
  • Rounded, upright P wave
  • P wave and QRS interval ratio is 1:1
  • R-to-R Spacing is father apart
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49
Q

What is sinus tachycardia?

A

Sinus rhythm with a heart rate of >100 bpm

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50
Q

What are the causes of sinus tachycardia?

A
  • Shock
  • Medications
  • Dehydration
  • Infection
  • Anxiety
  • Electrolyte imbalance
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51
Q

What are the signs and symptoms of sinus tachycardia?

A
  • Asymptomatic
  • Angina
  • Syncope
  • Dizziness
  • Palpitations
  • SOB
  • Anxiety
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52
Q

What medications can be used to treat sinus tachycardia?

A
  • Beta Blockers
  • Calcium Channel Blockers
  • Adenosine
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53
Q

Describe the characteristics of sinus tachycardia on an EKG?

A
  • Rapid rhythm
  • Rapid heart rate
  • Rounded, upright P wave
  • P wave and QRS interval ratio is 1:1
  • R-to-R Spacing is closer together
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54
Q

What is occurring during an atrial arrhythmia?

A
  • The atria is initiating impulses faster than the SA node
  • Usually faster than 100 bpm
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55
Q

Which wave is associated is with atrial arrhythmias?

A

P wave

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56
Q

What is the most common form of arrhythmia?

A

Premature Atrial Contraction (PAC)

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57
Q

What causes a premature atrial contraction (PAC)? HINT: “Early” beat

A
  • Premature discharge of the electrical impulse in the atria
  • Occurs prematurely/earlier than the normal beat should have occured
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58
Q

What characteristics will a P wave present with in a premature atrial contraction (PAC) on an EKG?

A
  • Flatter
  • Peaked
  • Notched
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59
Q

In a premature atrial contraction (PAC), will the P wave always be followed by a QRS complex

A
  • No, a QRS complex will not always follow the P wave
  • P wave may occur outside of the cardiac cycle or in the T wave
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60
Q

What are the causes of a premature atrial contraction (PAC)?

A
  • Hypoxia
  • Smoking cigarettes
  • Heart failure
  • Electrolyte imbalances
  • Caffeine
  • Alcohol
  • Medications
  • Fatigue
  • Stress
  • Anxiety
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61
Q

What are the signs and symptoms of a premature atrial contraction (PAC)?

A
  • Asymptomatic
  • Palpitations
  • Dizziness
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62
Q

What are the treatment options for premature atrial contraction (PAC)?

A
  • Often no treatment
  • Lifestyle changes (i.e. stop smoking)
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63
Q

What is happening with electrical impulses during atrial fibrillation?

A
  • Electrical impulses initiated randomly from ectopic sites
  • Atria over rides the SA node as the pacemaker
  • Atrial rate chaotic and rapid = atria quiver
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64
Q

Why is the ventricular rate usually regular with atrial fibrillation?

A
  • The AV node blocks most of the ectopic/random impulses sent by the atria
  • Ventricular rate then has the ability to be regular (between 60-100 bpm)
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65
Q

What type of action is occurring within the atria during atrial fibrillation?

A
  • The atria is quivering/fibrillating due to the rapid & chaotic rate from ectopic impulses
  • Due to the quivering/fibrillating, the atria cannot complete the diastole and systole phases completely
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66
Q

What type of rhythm is atrial fibrillation?

A

Irregularly irregular

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67
Q

What happens with blood flow in the atria during atrial fibrillation?

A
  • Blood remains in the atrial chambers because it is unable to empty out (due to quivering)
  • Blood stasis within the atria results in increased risk for developing a thrombus
  • Increased risk for developing a stroke
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68
Q

What percentage of stroke patients have an underlying atrial fibrillation rhythm?

A

15% to 20%

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69
Q

What is persistent atrial fibrillation?

A

Patient is constantly in atrial fibrillation

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70
Q

What is paroxysmal atrial fibrillation?

A

Patient is going in and out of atrial fibrillation

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71
Q

What is atrial fibrillation RVR? What is the priority nursing concern with atrial fibrillation RVR?

A
  • Atrial fibrillation with a heart rate >100
  • Priority: control the heart rate
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72
Q

What are the signs and symptoms of atrial fibrillation RVR?

A
  • Hypotension
  • Dizziness
  • Pulse deficit
  • Chest pain
  • Palpitations
  • Fatigue
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73
Q

List the risk factors for developing atrial fibrillation?

A
  • Older age (65 y/o or greater at increased risk)
  • Smoker
  • Heart disease
  • Heart failure
  • Hypertension
  • Hyperthyroidism
  • MI
  • Cardiac surgery
  • Medications
  • COPD
  • Unknown
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74
Q

What medications should be used to combat atrial fibrillation?

A

*Anticoagulants

  • Beta Blocker
  • Calcium Channel Blocker
  • Digoxin
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75
Q

Which “anticoagulant” is not an approved medication to use for atrial fibrillation?

A

Aspirin

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76
Q

What are the treatment options for atrial fibrillation?

A
  • Cardioversion
  • Cardiac ablation
  • Surgery (i.e. maze procedure)
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77
Q

What must the patient be on prior to having a cardioversion? For how long?

A
  • Anticoagulant
  • 4 to 6 weeks prior to procedure
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78
Q

What characteristics will atrial fibrillation present with on an EKG?

A
  • Wavy pattern (atria quivering)
  • No P wave
  • Irregular rhythm
  • Irregular heart rate
  • PR interval cannot be determined
  • QRS interval is present and normal
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79
Q

What is atrial flutter?

A

Atria are contracting appropriately at an exceedingly rapid rate of 250 - 350 beats per minute

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80
Q

What type of rhythm is atrial flutter?

A

Regularly irregular

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81
Q

In atrial flutter, the rapid P waves on an EKG are called what?

A

F waves

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82
Q

What are the causes of atrial flutter?

A
  • CHF
  • MI
  • Valve disorders
  • Hypertension
  • Post-CABG
  • COPD
  • Rheumatic/ischemic heart disease
  • Pulmonary embolism
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83
Q

What are the signs and symptoms of atrial flutter?

A
  • Palpitations
  • Angina
  • Dyspnea
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84
Q

What are the treatment options for atrial flutter?

A
  • Medications (i.e. Calcium Channel Blocker, Beta Blocker, Digoxin)
  • Cardioversion
  • Cardiac ablation
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85
Q

What characteristics will atrial flutter present with on an EKG?

A
  • Identical “sawtooth” like pattern
  • Sawtooth F wave and QRS complex ratio is 4:1
  • Regular rhythm
  • Irregular heart rate
  • PR interval cannot be determined
  • QRS interval is present and normal
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86
Q

What are ventricular arrhythmias?

A
  • Abnormal heart beat that originates in the ventricles
  • Causes heart to beat too fast
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87
Q

What are premature ventricular contractions (PVCs)?

A
  • Extra abnormal heartbeat that originates in the ventricle(s)
  • Ventricles fire prematurely before the SA node causing a wide QRS interval
  • Very common
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88
Q

What are the signs and symptoms of premature ventricular contractions (PVCs)

A

-Increased awareness of heartbeat (i.e. flip-flop, pounding, fluttering, jumping, skipping beats, missing beats

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89
Q

What characteristics will premature ventricular contractions (PVCs) present with on an EKG?

A
  • Regular rhythm
  • Rapid heart rate
  • No P wave present on PVC beat
  • QRS interval appears widened
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90
Q

What are the risk factors for premature ventricular contractions (PVCs)?

A
  • Caffeine
  • Tobacco
  • Alcohol
  • Exercise
  • Hypertension
  • Anxiety
  • Underlying heart disease
91
Q

What are the treatment options for patients with premature ventricular contractions (PVCs)?

A
  • Lifestyle modifications
  • Medications (i.e. Beat Blocker, Calcium Channel Blocker, Amiodorone)
  • Cardiac ablation
92
Q

What are unifocal premature ventricular contractions (PVCs)?

A
  • Initiate from the same irritated area in the ventricle
  • Will look the same on an EKG
93
Q

What are multifocal premature ventricular contractions (PVCs)?

A
  • Initiate from different irritated area in the ventricle
  • Will look different on an EKG
94
Q

Premature ventricular contractions (PVCs) that occur every other beat are referred to as what?

A

Bigemeny PVC

95
Q

Premature ventricular contractions (PVCs) that occur every third beat are referred to as what?

A

Trigemeny PVC

96
Q

Three or more premature ventricular contractions (PVCs) in a row is considered what?

A

Ventricular Tachycardia

97
Q

What is ventricular tachycardia?

A
  • Rapid heart beat that originates in the ventricles (150-250 beats per minute)
  • Ventricles become the pacemaker of the heart instead of the AV node
98
Q

What are the causes of ventricular tachycardia?

A
  • MI
  • Hypokalemia
  • Respiratory acidosis
  • Myocardial irritability
99
Q

What are the signs and symptoms of ventricular tachycardia?

A
  • Asymptomatic
  • Dyspnea
  • Lightheadedness
  • Angina
  • Feeling of fast heart rate
100
Q

What type of rhythm is ventricular tachycardia?

A

Regular

101
Q

What are the treatment options for ventricular tachycardia if the patient DOES have a pulse?

A
  • Medications (i.e. Beta Blocker, Lidocaine, Adenosine)
  • Cardioversion
  • ICD
  • Cardiac ablation
102
Q

What are the treatment options for ventricular tachycardia if the patient DOES NOT have a pulse?

A

1) CPR
2) Defibrillation
3) Medications

103
Q

The seriousness of ventricular tachycardia depends on what?

A

Duration

104
Q

Ventricular tachycardia will _____ cardiac output.

A

Increase

105
Q

What is the rhythm that commonly precedes ventricular fibrillation?

A

Ventricular tachycardia

106
Q

What is the nursing priority for a patient who is experiencing ventricular tachycardia?

A

Determine whether they are stable or unstable

107
Q

What characteristics will ventricular tachycardia present with on an EKG?

A
  • High, wide, and rapid QRS intervals (>0.10)
  • No P wave
  • Rapid heart rate
  • Regular rhythm
108
Q

What is ventricular fibrillation? Will ventricular fibrillation be stable or unstable?

A
  • Life-threatening, EMERGENCY!
  • Ventricular activity is chaotic with no discernible waves
  • Ventricles quiver and heart is unable to pump blood to the rest of the body
  • Patient will have no pulse and will ALWAYS be unstable
109
Q

Which arrhythmia is considered the most serious?

A

Ventricular fibrillation

110
Q

Ventricular fibrillation will _____ cardiac output?

A

Decrease

111
Q

What are the causes of ventricular fibrillation?

A
  • Hyperkalemia
  • Hypomagnesemia
  • CAD
  • MI
  • Electrocution
112
Q

What is the nursing priority for a patient who is in ventricular fibrillation? HINT: VFIB = DFIB

A

Defibrillation

*Should also begin CPR on the patient

113
Q

What medications will you administer to a patient who is in ventricular fibrillation?

A
  • Epinephrine
  • Amiodarone
  • Lidocaine
114
Q

What type of rhythm is ventricular fibrillation?

A

Highly irregular

115
Q

What characteristics will ventricular fibrillation present with on an EKG?

A

-Inconsistent wavy line

116
Q

What is asystole?

A
  • Not a true rhythm
  • State of no electrical cardiac activity
117
Q

What is the nursing priority for a patient in asystole?

A

CPR

118
Q

Asystole is usually preceded by which rhythm?

A

Ventricular fibrillation

119
Q

Can you defibrillate a patient who is in asystole?

A

No!

120
Q

What are the causes of asystole?

A
  • Hyperkalemia
  • Ventricular fibrillation
  • Massive MI
  • Shock
121
Q

What characteristics will asystole present with on an EKG?

A

Flat line

122
Q

What is the rhythm below?

A

Normal Sinus Rhythm

123
Q

What is the rhythm below?

A

Ventricular Fibrillation

124
Q

What is the rhythm below?

A

Premature Ventricular Contractions (PVCs)

125
Q

What is the rhythm below?

A

Asystole

126
Q

What is the rhythm below?

A

Sinus Tachycardia

127
Q

What is the rhythm below?

A

Premature Atrial Contraction (PAC)

128
Q

What is the rhythm below?

A

Sinus Bradycardia

129
Q

What is the rhythm below?

A

Atrial Fibrillation

130
Q

What is the rhythm below?

A

Ventricular Tachycardia

131
Q

What is the rhythm below?

A

Atrial Flutter

132
Q

What is cardiovascular disease?

A

Disease of the heart or the blood vessels

133
Q

What is arteriosclerosis?

A
  • Thickening, loss of elasticity, and calcification of arterial walls
  • Part of the aging process
134
Q

What is atherosclerosis? Where does it occur?

A
  • Formation of plaque within arterial walls
  • Occurs in the lumen (space inside the artery)
  • Can be prevented
135
Q

What is the leading cause of disability and death in the United States?

A

Cardiovascular disease

136
Q

Where can atherosclerosis be found? How is atherosclerosis classified?

A
  • Found in any of the arteries
  • Classified by location
137
Q

What are common locations of atherosclerosis?

A
  • Coronary arteries
  • Arteries of legs
  • Renal arteries
  • Carotid arteries
138
Q

If atherosclerosis is present in one artery, it is likely…

A

Present in other arteries

139
Q

What is an early indication of atherosclerosis?

A

Fatty streak (plaque)

140
Q

What are the non-modifiable risk factors for atherosclerosis?

A
  • Age
  • Gender
  • Ethnicity
  • Genetics
141
Q

Who is most at risk for atherosclerosis?

A

African american males

142
Q

What are modifiable risk factors for atherosclerosis?

A
  • Physical inactivity/sedentary lifestyle
  • Obesity
  • Diabetes
  • Alcohol/tobacco use
  • Stress
  • Elevated cholesterol
  • Hypertenstion
143
Q

What does tobacco cause?

A
  • Vasoconstriction
  • Decreases HDL’s
144
Q

Coronary artery disease is assocaited with a cholesterol level greater than what?

A

>200

145
Q

What are the normal HDL levels in men and women?

A
  • Men: >40
  • Women: >50
146
Q

What is a normal LDL level?

A

<100

-The lower the better

147
Q

Triglyceride levels should be less than what?

A

<150

148
Q

What is a stress test?

A
  • Shows how the heart works during physcial activity
  • Usually done on treadmill or bike
  • Patient monitored by EKG
149
Q

What is a cardiac catheterization?

A
  • Procedure done to visualize anatomy of the heart using contrast dye
  • Inserted through femoral artery in groin or radial artery in wrist
150
Q

What is the nursing role in regards to a cardiac catheterization?

A
  • Assess for allergies
  • Obtain consent
  • Monitor vitals, entry site, and pulses
151
Q

What are the therapeutic measures for atherosclerosis?

A
  • Diet
  • Smoking cessation
  • Exercise
  • Medications
152
Q

What foods are part of the heart-healthy diet?

A
  • Fruits and vegetables
  • Avoid trans fat
  • Reduce saturated fat
  • Reduce sugar and sodium
153
Q

What are the most common lipid lowering medication?

A

Statins

154
Q

What medications fall under the drug class of Statins?

A
  • Atorvastatin
  • Pravastatin
  • Simvastatin
  • Rosuvastatin
155
Q

What labs should be monitored when giving a statin?

A
  • Liver function tests
  • Lipid panel
156
Q

What time of day should statins be taken?

A

Evening or night

157
Q

Fibrates are used to do what?

A

Reduce triglycerides

158
Q

What medications fall under the drug class of fibrates?

A
  • Fenofibrate
  • Gemofibrozil
159
Q

Bile Acid Sequestrants are use for what?

A

Increase conversion of cholesterol to bile acids

160
Q

Statins are used to do what?

A

Reduce cholesterol synthesis

161
Q

What drug class decreases cholesterol absorption?

A

Cholesterol Absorption Inhibitors

162
Q

What medication falls under the drug class of Cholesterol Absorption Inhibitors?

A

Ezetimibe

163
Q

What is Niacin? What does it do?

A
  • Water soluable B vitamin
  • Lowers LDL and triglyceride levels by interfering with synthesis
  • Increases HDL
164
Q

Patients taking Niacin may experience what?

A

Patients may experience severe flushing

165
Q

What is coronary artery disease?

A

Form of atherosclerosis that affects coronary arteries

166
Q

What causes coronary artery disease?

A

Atherosclerosis

167
Q

Coronary artery diease can cause what?

A
  • Angina
  • MI
  • Death
168
Q

What is angina?

A

-Chest pain due to ischemia

169
Q

What is stable angina?

A
  • Patient can predict when angina will occur
  • Decrease with rest
  • Usually only lasts a few minutes
170
Q

What is unstable angina?

A
  • Unpredictable in frequency
  • Occurs when patient is at rest or sleeping
  • Not relieved by medication or rest
  • EMERGENCY!
171
Q

What are the signs and symptoms of angina?

A
  • Discomfort
  • Burning
  • Fullness or pressure
  • Pain may radiate
  • Heaviness in arms
  • Women may have atypical symtoms (i.e. SOB, fatigue)
172
Q

How long to episodes of angina last?

A

5 to 15 minutes

173
Q

What is the first line treatment for angina?

A

Nitroglycerin

174
Q

How does nitroglycerin work?

A

Dilates arteries and reduces workload of heart

175
Q

What is the onset and duration for nitroglycerin? How often can a patient take nitroglycerin?

A
  • Onset: 1-2 minutes
  • Duration: 30-40 minutes
  • Take 1 every 5 minutes x3
176
Q

What are the side effects of nitroglycerin?

A
  • Hypotension
  • Headache
177
Q

What patient education should be provided in regards to nitroglycerin?

A
  • Sit down while taking medication
  • Can drastically drop blood pressure
  • Can repeat dose every five minutes up to three times
  • If chest pain does not ease, call 911!
178
Q

What other medications can be used to treat angina?

A
  • Calcium Channel Blockers
  • Anti-ischemic agents
  • Nitrates
179
Q

What medication should you avoid taking with nitrates?

A

Erectile dysfunction medications

180
Q

What is acute coronary syndrome?

A

-Includes unstable angina and MI

181
Q

Acute coronary syndrome is most commonly caused by what?

A

Formation of an occlusive thrombus on the coronary plaque

182
Q

What is the most common cause of an MI?

A

Thrombus formation

183
Q

The area of the heart affected by an MI depends on what?

A

Coronary artery that is affected

184
Q

What is a STEMI myocardial infarction?

A
  • Most serious
  • Affects full thickness of the heart
  • Will see ST elevatin on EKG

-

185
Q

What is a NSTEMI myocardial infarction?

A
  • Less serious
  • Blockage is usually partial
186
Q

In a myocardial infarction, the area affected will be _____ from the clot.

A

Distal or below

187
Q

What are the signs and symptoms of a myocardial infarction?

A
  • Chest pain
  • Vague symptoms
  • Dyspnea
  • Syncope
  • N/V
  • Fatigue
  • SOB
  • Decreased BP
  • Elevated HR
  • Cool clammy skin, gray skin
188
Q

What are the common diagnostic tests for myocardial infarction?

A
  • Troponin
  • Myoglobin and creatine kinase
  • EKG
  • Magnesium
  • Potassium
189
Q

What is a normal troponin level?

A

<0.04

190
Q

When do troponin levels peak?

A

12 hours

191
Q

Describe drug therapy for MI.

HINT: MONA

A
  • Morphine
  • Oxygen
  • Nitro
  • Aspirin
192
Q

What are common treatment options for myocardian infarction?

A
  • Cardiac catheterization with intervention
  • Coronary Artery Bypass Graft (CABG)
193
Q

List common medications used post myocardial infarction?

A
  • Beta Blockers
  • ACE Inhibitor
  • Statin
  • Antiplatelet
  • Vasodilators
194
Q

Anytime a stint is placed in a patient, what kind of medication must they be on?

A

-Antiplatelet

195
Q

What is peripheral arterial disease?

A
  • Narrowing of the arteries that leads to occlusion or obstruction
  • Usually occurs in lower extremeties
196
Q

What is the most common cause of peripheral artery disease?

A

Atherosclerosis

197
Q

What are the signs and symptoms of peripheral artery disease?

A

*Intermittent claudication (pain in calves that approves with rest)

  • Paresthesia
  • Thin, shiny, taut skin
  • Loss of hair on lower legs
  • Pain at rest
  • Decreased sensation
  • Pallor of extremeties when elevated, reddened when in dependent position
198
Q

What symptoms most commonly causes patients to seek treatment with peripheral artery disease?

A

Intermittent caludication

199
Q
A
200
Q

What are the most serious complications of peripheral artery disease? What can these result in?

A
  • Tissue necrosis
  • Arterial ulcers
  • Result in amputation
201
Q

What is an ankle-brachial index (ABI)? What is the normal range of an ABI?

A
  • Done using a hand-held doppler
  • Normal range is 1
  • Lower the range, more severe disease is present
202
Q

What is the first diagnostic test usually completed for a patient with peripheral artery disease?

A

Arterial ultrasound

203
Q

What is an aneurysm?

A

A buldging, ballooning, or dilation at weakend point of arterial wall

204
Q

An aorta greater than _____ is considered an aneurysm.

A

>3cm

205
Q

Aortic aneurysms may involve:

A
  • Aortic arch
  • Thoracic aorta
  • Abdominal aorta
206
Q

What are the risk factors for aortic aneurysms?

A
  • Age >65
  • Male gender
  • Smoking
  • Hypertension
207
Q

What is a fusiform aneurysm?

A

Dilation of entire circumference

208
Q

What is a saccular aneurysm?

A

Bulges on one side of arterial wall

209
Q

What is a dissecting aneurysm?

A

Cavity is formed from tear in artery wall

210
Q

What is the most common symptom of a thoracic aortic aneurysm?

A

Deep chest pain that radiates across back

211
Q

What are the signs and symptoms of an AAA?

A
  • Asymptomatic
  • Pulsatile mass
  • Bruit
  • Back/flank pain
  • Abdominal pain
  • Feeling of fullness
212
Q

AAA are often an _____ finding.

A

Incedential

213
Q

Small aneurysms, or those less than 4cm, will require how often of a follow up?

A

6 to 12 months

214
Q

What are the treatment options for aneurysms?

A
  • Lifestyle changes
  • Control BP!
  • Surgery
  • Endovascular aneurysm repair (EVAR)
215
Q

What is an Endovascular Aneurysm Repair (EVAR)?

A
  • Catheter threaded through femoral artery
  • Stent and graft place to support aneurysm
  • Decrease size of aneurysm over time
216
Q

If a patient has a loss of pulse post surgery, what should the nurse do?

A
  • Notify the physician!
  • Something has occluded
217
Q

What are the signs and symptoms of a ruptured aneurysm in the retroperitoneal space?

A
  • Sudden, severe back pain
  • Cool, clammy skin
  • Bleeding may be tamponaded by surrounding structures
218
Q

What are the signs and symptoms of a ruptured aneurysm in the thoracic or abdominal cavity?

A
  • Massive hemorrhage!
  • Decreased LOC
  • Patients usually do not make it to the hospital
219
Q

What should the nurse monitor in a patient with an aortic aneurysm?

A
  • Indication of rupture
  • Diaphoresis
  • Pallor
  • Weakness
  • Tachycardia
  • Hypotension
  • LOC changes
  • Pulsating abdominal mass
  • Abdominal, back, groin, periumbilical pain
220
Q

What can cause an aortic dissection?

A

Anything that puts pressure on the aortic wall

221
Q
A
222
Q

What are the signs and symptoms of aortic dissection?

A
  • Pain, sharp or tearing in chest
  • Weak or absent pulses
  • Decreased LOC
  • Dizziness
  • Fatigue
  • SOB
223
Q

What are the complications of an aortic dissection?

A
  • Cardiac tamponade
  • Rupture of aorta
  • Occlusion of arterial supply to organs (spinal cord, renal, abdominal)

Health Care Participant Nursing: N1220 (5 decks)

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