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Med Surg 2 > Cardiovascular Therapeutic Management > Flashcards

Cardiovascular Therapeutic Management Flashcards

1
Q

what is the equation for cardiac output

A

heart rate X stroke volume

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2
Q

what is the defintion for heart rate

A

number of beats per minute

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3
Q

what are the factors for stroke volume

A

preload
contractility
afterload

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4
Q

preload defintion

A

how much fluid is in the ventricles
stretching in diastole

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5
Q

what are some things that can influence preload

A

hypovolemia or hypervolemia
regurgitation of cardiac valves
heart failure

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6
Q

contractility defintion

A

contraction of the heart

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7
Q

afterload defintion

A

force the heart has to push against to exit the heart

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8
Q

what are some things that can effect afterload

A

arterial contraction
hypertension

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9
Q

average heart rate

A

70bpm

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10
Q

average stroke volume

A

70mL

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11
Q

average cardiac output

A

4-8L

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12
Q

what are some things that can impact heart rate

A

stress
meds
caffeine

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13
Q

what happens if we increase after load

A

increase cardiac workload

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14
Q

what does frank starling law mean

A

increased preload leads to increase stroke volume which leads to increased cardiac output

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15
Q

intrinsic rate

A

the patients own heart beat

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16
Q

extrinsic rate

A

a rate that is set by an artificial source

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17
Q

capture

A

heart responds to the pace maker stimulation

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18
Q

sense

A

the ability of the pacer to see the intrinsic activity of the heart

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19
Q

trigger

A

an intrinsic event causes a stimuli to be delivered

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20
Q

inhibited

A

an intrinsic event causes the pacer to turn off because some activity is seen

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21
Q

Asynchronous pacing (fixed)

A

set at a fixed rate, a non sensing mode
pacer paces regardless of the intrinsic activity

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22
Q

synchronous pacing

A

pacer delivers a stimuli in response to what it senses

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23
Q

what do we need for atrial pacing

A

intact AV node condition system

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24
Q

why might we do ventricular pacing

A

loss of atrial kick

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25
Q

ventricular pacing will sustain

A

cardiac output

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26
Q

atrial and ventriclar pacing is more like

A

intrinsic pacing

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27
Q

what is the most physiologic pacing mode

A

DDD

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28
Q

what dose DDD do

A

pace both the atria and the ventricle
both of the chambers are sensed
dual response to sensing

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29
Q

why might we do temporary pacemakers

A

ischemia
electrolyte imbalance
myocardial infarction
cardiac surgery
heart surgery
low HR
3rd degree block

30
Q

three types of pacing routes

A

transcutaneous
epicardial
transvenous

31
Q

transcutaneous pacing route

A

outside of the body
large skin electrodes
non invasive

32
Q

epicardial pacing route

A

routine after many cardiac surgeries
right into the heart

33
Q

what side of the body do the atrial wires come out

A

right side of the sternum

34
Q

what side of the body do the ventricular wires come out of

A

left side of sternum

35
Q

transvenous pacing route

A

into the endocardial tissue through a vein or artery

36
Q

what do pacing artifacts mean

A

this is good
it means that the pacemaker is working

37
Q

how might atrial pacing look

A

spike and then P wave

38
Q

how might ventricular pacing look

A

spike and then QRS

39
Q

how might both atrial and ventricular pacing look

A

spike, P wave, spike, QRS

40
Q

what does rate control control

A

how quickly we want the heart to beat

41
Q

what is the output dial

A

how much electrical impulse is giving

42
Q

what is output dial measured in

A

miliamps

43
Q

sensitivity control

A

how much the pace maker is sensing intrinsic

44
Q

what is the sensitivity control measured in

A

millivolts

45
Q

if the pace maker is not sensing what will we do

A

turn down millivolt

46
Q

if we are pacing the patient externally what should we do

A

give pain meds and sedation

47
Q

what happens if we don’t have our millivolts low enough

A

it is not going to see what the patients heart rate is doing

48
Q

what happens if we do not have our milliamps high enough

A

then it is not giving enough of an electrical impulse for the heart to respond

49
Q

how do the QRS look in ventricular pacing

A

wide and bizarre QRS

50
Q

what is the solution for failure to sense

A

increase pacemaker sensitivity
DECREASE MILIVOLTS

51
Q

what is happening in under sensing

A

pacemaker is not seeing the intrinsic activity and sending out impulses when it is not needed

52
Q

what is happening during over sensing

A

the pacemaker is sensing there is a QRS when there isn’t

53
Q

why is over sensing dangerous

A

potential for decreased cardiac output

54
Q

why might failure to sense be dangerous

A

if a spike lands on the T wave and then R on T phenomenon can occur leading to V tach or V fib

55
Q

how might failure to capture look

A

throwing a pacemaker spike but there is no wave that follows

56
Q

why might failure to capture occur

A

low pacemaker battery
electrolyte abnormality

57
Q

how do we fix failure to capture

A

increase pacer output
INCREASE MA OR VOLTS

58
Q

under sensing how to fix

A

increase pacemaker sensitivity or MILIVOLT

59
Q

how to fix over sensing

A

decrease pacemaker sensivitiy

60
Q

what are some education for pacemakers

A

avoid large generator or large magnetic fields

61
Q

the use of what can inhibit pacemaker function

A

electrocautery

62
Q

what is ICD

A

these can shock patients who go into a dangerous rhythm
such as vfib and vtach

63
Q

why might someone get an ICD

A

sudden cardiac arrest
spontaneous and sustained VT
inherited conditions

64
Q

postoperative nursing management for cardiac surgery

A

normalize cardiac output
rewarming but not too quickly
control bleeding
promote early extubation

65
Q

what happens to body temp during bypass

A

lowered to 28-32

66
Q

what is a complication of bypass

A

altered coagulation

67
Q

what could happen with a valve replacement

A

rejection
infection
clot formation

68
Q

what should we watch for with carotid endaretrectomy

A

cranial nerve intact
difficulty swallowing or breathing

69
Q

what CN do we want to assess for with carotid endarterectomy

A

VII (7), X, XI, XII

70
Q

how does an intraaortic balloon pump work

A

in diastole the balloon inflates to promote blood flow to the coronary arteries
in systole the balloon deflates and decreases afterload

71
Q

how do we treat 3rd degree heart block

A

pacemaker

72
Q

what meds decrease preload

A

nitro
morphine
diuretics

Med Surg 2 (29 decks)

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