Cardiovascular Therapy Management

Question 1

For a patient with a ventricular pacemaker, what is seen on the EKG?

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Answer 1

Spike BEFORE each QRS complex

Question 2

What is capture in terms of a pacemaker?

Answer 2

When the heart contracts (responds) after the pacemaker fires

Works for EVERY beat the pacemaker is set for

Question 3

What is sense / sensing in terms of a pacemaker?

Answer 3

Ability of the pacemaker to “see” the intrinsic activity of the heart (the patient’s own heartbeat) to know whether or not it needs to fire

Question 4

What is trigger in terms of a pacemaker?

Answer 4

An intrinsic event causes the pacemaker to fire

Question 5

What is inhibited / inhibition in terms of a pacemaker?

Answer 5

An intrinsic event causes the pacer to be “turned off” and does NOT fire

Question 6

What is the difference in a trigger & inhibited in terms of a pacemaker?

Answer 6

Trigger = intrinsic event causes pacemaker to fire

• Inhibited = intrinsic event does NOT cause pacemaker to fire; pacer is “turned off”

Question 7

What is the difference in asynchronous & synchronous pacing?

Answer 7

Asynchronous pacing – pacemaker is fixed & fires with every beat

Synchronous = “on demand” ; the pacer only fires when it needs to work

Question 8

What is asynchronous pacing?

Answer 8

Pacemaker is fixed (set rate) & fires with ever beat (regardless of the intrinsic activity)

Question 9

What is synchronous pacing?

Answer 9

The pacemaker only fires when it needs to

Question 10

What is seen on an EKG when there is ventricular pacing?

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Answer 10

Spike BEFORE each QRS complex

Question 11

What is seen on an EKG when A-V pacing occurs?

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Answer 11

• Spike BEFORE each P wave
• Spike BEFORE each QRS complex

TWO SPIKES SEEN ON THE EKG (before P wave & QRS complex)

Question 12

What is seen on an EKG when there is ventricular pacing?

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Answer 12

Spike BEFORE a WIDE (bizarre) QRS complex

Spike can go up or down

Question 13

What is seen on an EKG with failure to pace? (pacemaker failure to pace)

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Answer 13

Patient’s rhythm is present, but there are NO pacer spikes (before P waves or QRS complexes)

Question 14

What is seen on an EKG with failure to capture? (failure to capture of a pacemaker)

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Answer 14

Spikes + NO RHYTHM

• pacemaker is firing, but is not causing the heart to contract / do anything

May capture in some places, but not in others

Question 15

What is seen on an EKG in failure to sense? (failure to sense for a pacemaker)

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Answer 15

Pacemaker does not detect electrical activity of the heart causing it to fire randomly

• Spikes are all over the place
• Oversensing AND undersensing

Pacemaker fails to sense true P-waves or true R-waves … can lead to overpacing

Question 16

Patients in what type of rhythm require a pacemaker?

Answer 16

3rd degree heart block

atria & ventricles are contracting independent / separately from one another

Question 17

What are potential complications that can be associated with pacemakers / pacemaker malfunctioning

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Answer 17

• Failure to Pace – pacemaker **doesn’t fire **when it should / is expected to fire
• Failure to Sense – pacing / firing occurs at the wrong time (patient might have a slow rhythm & a bunch of different spikes, but they don’t align correctly)
• Failure to Capture – spikes (firing from pacemaker) are present, but spikes do NOT align with QRS complexes

Question 18

Explain the nursing management for pacemakers

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Answer 18

• avoidance of high voltage electrical generators (avoid exposure to electrical fields like MRIs)
• Monitoring for complications
• Patient education

Question 19

What is a DDD pacemaker?

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Answer 19

DDD = Dual pacemaker (is on demand)

Most physiologic (enhances atrial contribution to ventricular filling)

Physiologic synchronous pacing

Question 20

What is a VV1 pacemaker?

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Answer 20

Ventricular pacing

Question 21

What is a DOO pacemaker?

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Answer 21

Physiologic & Asynchronous pacing (fires every time / every beat)

Physiologic asynchronous pacing

Question 22

What is a VOO pacemaker? (fires every beat / each time)

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Answer 22

Ventricular & Asynchronous pacing

Only ventricles are paced asynchronously (every beat)

Question 23

What is sensitivity of a pacemaker?

Answer 23

Ability of pacemaker to sense the patient’s heart

Question 24

What is the atrioventricular interval control?

Answer 24

Difference between when the atrium fire & when the ventricles fire (usually preset)

Question 25

**Explain the post-operative / nursing management (monitoring) of a patient after a Carotid Endarterectomy** | **KNOW THIS!!!...in red** ## Footnote IN RED

Answer 25

* control BP * **Assess cranial nerves VII** (facial)**, X** (vagus)**, XI** (accessory)**, XII (hypoglossal)** * **Airway Management (difficulty with swallowing or breathing)** * Bleeding

Question 26

**What does an Intraaortic Balloon Pump (IABP) do / what is its job?** | **KNOW THIS!!!...in red** ## Footnote IN RED

Answer 26

** Reduces workload & helps the heart pump more blood** **1.) INFLATES** in **diastole** (relaxation) **= ↑ blood flow** (in coronary arteries) **2.) deflates** in **systole** (contraction) **= ↓ afterload**