CCB, C-tube & CHD Flashcards
CCB are like Valium for the heart
If in shock give CCB
If tachycardia give CCB
Shock No
Tachycardia Yes
CCB have a (negative / positive) inotropic, chronotropic, dromotropic effect
CCB have a negative inotropic, chronotropic, dromotropic
Negative inotrophic:
Negative chronotrophy:
Negative dromotrophy:
decrease speed that impulses from SA node travel to AV node (decrease conduction velocity)
weaken the myocardial contraction
decrease rate of impulse formation at SA node -> decelerate HR
Negative inotrophic: weaken the myocardial contraction
Negative chronotrophy: decrease rate of impulse formation at SA node -> decelerate HR
Negative dromotrophy: decrease speed that impulses from SA node travel to AV node (decrease conduction velocity)
What do CCB treat
A, AA, AAA
A: Antihypertensive-> Lower BP
AA: AntiAnginal - relax heart, works by decreasing oxygen demand
AAA: AntiAtrialArythmia: treats atrial-flutter / Fibrillation, premature atrial contraction, atrial bigeminy, SVT
Side effects of CCB
H.H.
Headaches - vasodilation
Hypotension- it relaxes BV
-Dipine is the ending of CCB
There are 2 more you have to remember by name
Verapamil (isoptin)
Cardizem (diltiazem) - can be given with an IV drip
Monitor BP before giving CCB
hold when
If SBP <100
If SBP <100 when Cardizem (diltiazem) is given with drip, titrate the rate of the IV depending on how low the SBP is
Rhythm Strips Must Know by Sight
Normal Sinus Rhythm
Evenly spaces
Rhythm Strips Must Know by Sight
Vfib
Chaotic squiggly line
Rhythm Strips Must Know by Sight
V Tach
1970s wallpaper border
Pattern
Rhythm Strips Must Know by Sight
Asystole
Flat line
Asystole occurs when the heart’s electrical system fails, causing the heart to stop pumping. It can be a fatal arrhythmia
if it occurs in relation to a severe underlying illness
QRS wave will always be (Arterial / Ventricular)
Ventricular
“P” wave will always be about (Arterial/ Ventricular)
Arterial
Unless it’s a Lack of P wave then it’s ventricular
Lack of a QRS line is called
Asystole
Described as “SawTooth” is always…
Flutter
Chaotic is always the word to describe
Fibrillation
“Bizarre” is always the way the will describe
Tachycardia
More than 6 PVC in 1 minute
More than 6 PVC in a row
PVC Falls on T wave of pervious beat
What is the priority level
Moderate
If its only PVC wave, then it is a low level
PVCs, or premature ventricular contractions, are extra heartbeats
They are a common type of irregular heartbeat (arrhythmia)
Premature ventricular contractions (PVCs) are
extra heartbeats begin Ventricles
Disrupt the regular heart rhythm, fluttering / Skipped beat
Is PVC after MI a major concern
No, it is a good sign.
It means they are reprofusing
Asystole & Vfib both share (no /low / high) Cardiac output
What can happen to a patient with these conditions
No cardiac output
Leathal within 8 minutes
VTACH has this level of seriousness
Potentially fatal
For Vtach problems this medicine
amiodarone
Lidocaine (in the Past)
Artial/ Supra ventricular
Use these types of medications
A,B,C,D
Adenocard (Push <8sec) - (can go into Asystole for 30 sec)
Beta Blockers (lol) - (Same as CCB)
slow heart down
SE: Head / Hypotension
CCB:
Digitalis ( Lanoxin / Digox)
What do you use for V fib
Defibrillator
What do you use to correct Asystole
Epinephrine/ Atropine
In this order
Purpose of a chest tube
Reestablish NEGATIVE pressure in pleural space
Chest tube
In a pneumothorax a chest tube removes air to reestablish (negative / positive) pressure
Negative
In hemothorax a chest tube is inserted to remove blood reestablishing a (negative/ positive) pressure
Negative
What do you report to DR with a Hemochest tube
Chest tube is not draining
What do you report to a DR about a pneumothorax chest tube
Chest tube is not bubbling
Chest tube drained 800mL in first 10 hours
IT NEEDS TO BUBBLE
Apical chest tubes remove (air / blood)
Basilar chest tubes remove (air / blood)
Apical Air
Basilar Blood
How many chest tubes and where for unilateral pneumo/hemothorax
2
Apical pneumo
Basilar hemo
How many chest tubes and where for bilateral pneumo
2
Apical Left & Right
How many chest tubes and where for post opp chest surgery
2
Apical & Basilar on same side as surgery
Always assume chest Trauma or Surgery is ( Unilateral / Bilateral) unless otherwise noted
Unilateral
How many chest tubes would you need and where would you place them on a post op, right pneumonectomy
None
pneumonectomy / lung removal
Closed chest drainage devices
Pleural Vac, PneumaVac, Emmerson
What do you do if it gets knocked over?
Set back up & have them take deep breaths
If Pneumavac device breaks
What is the first thing you do
What is the best thing you do
- Clamp it
- Cut tube away from broken device
- Stick tube under sterile water
- Unclamp it
What is the best thing you do: Stick tube under sterile water
Always assume that it is a perfect world and everything and everyone is available in NCLEX situations
True or False
True
Tip
Understand the difference between;
What would you do first
&
What is best
I understand
What is the first thing you do if a chest tube gets removed
What is the best thing
1st. Cover hole with gloved hand
Best cover with Vaseline gauze
Chest tube bubbling
Where & When
Water seal & Interment bubbling
Water seal & Continous bubbling
Suction Control Chamber & Interment bubbling
Suction Control Chamber & Continous bubbling
Water seal & Interment: Good
Water seal & Continous: Bad
Leak in the system. Put tape over it
Suction Control Chamber & Interment: Bad. Suction not high enough- Turn suction up
Suction Control Chamber & Continous: Good its susposed to be Continous bubbling
Analogy
Straight catheter is to a fully catheter
As a
thoracentesis is to _____
chest tube
Straight catheter (Temp) is to a fully catheter (Permanent)
thoracentesis (temp) is to a chest tube(permanent)
What’s the longest you can clamp a tube without a Dr’s orders
15 seconds
Use these types of clamps
Rubber tipped Double Clamps
Congenital heart defects are always a problem
True or false
False
It’s either a big problem or No problem
There is no in between
CHD
Trouble defects shunt blood in the heart how (Right to left) or (Left to Right)
Which direction do No Trouble heart defects shunt blood
Right to left
Think Trouble
R –> L
No Trouble (Left to Right)
CHD
T
R
o
u
B
L
e
T All Trouble CHD Start with T
R Right to Left heart shunt is trouble
o
u
B Blue Cyanosis
L
e
All congenital heart defects CHD will have 2 things
Murmurs & ECG done
4 defects of Tetralogy of Fallot
Ventricular septal defect
Pulmonary
stenosis
Overriding aorta
Right ventricular hypertrophy
Valentines day
Pick someone
Out a
Red heart
Or
Varied
Pictures
Of a
Ranch
Infectious disease and transmission based precautions
Contact precautions is for anything
Enteric
C Dif
Hep A
Cheloria
Disentary
&
STAPH infections
RSV (Droplet Spread but on CONTACT PRECAUTIONS)
Herpies
Contact precautions
Private room (preferred or required)
Preferred. A private room is preferable
Contact precautions
PPE
Gloves & Gown & disposable supplies/ dedicated equipment
Droplet precautions
Disease
Meningitis
H-Flu (epiglottis)
Droplet precautions
Private room (required/ preferred)
PPE
Preffered (Select Private Room on NCLEX)
Masks, Paitent wears mask when leaving room, dedicated equipment/ disposable ppe
Airborne precautions
Disease
MMR
TB
Varicella (Chix Pox)
Airborne PPE
Private room
Mask, Special Filter Maks (TB), Mask when leaving room, Negative Pressure
TB is spread droplet but uses airborne precautions.
PPE Doffing
PPE Donning
Gloves, Goggles, Gown, Mask
Alphabetical
Gown, Mask, Googels, Gloves
Reverse Alphabetical but Masks Second
You Must use leading zeros before a decmil point.
Cannot use trailing zeros ever
True or False
True
(Left / Right) atrium
The upper chamber of the heart that receives Oxygen-Rich blood from the lungs through the pulmonary veins
(Left / Right) ventricle
The lower chamber of the heart that receives oxygen-rich blood from the left atrium through the mitral valve and pumps it to the aorta
Left side = Oxygen Rich
Verapamil (isoptin)
Cardizem (diltiazem)
This class of medication
CCB
Suffix Usually = dipine
