Day I Flashcards
1
Q
client presentation that could indicate need for an ECG
A
- Cardiovascular dz
- MI
- Hypoxia
- Acid base imbalances
- Electrolyte disturbances
- Kidney failure, liver, or lung dz
- Pericarditis
- Drug or alcohol use
- Hypovolemia
- Shock
2
Q
ECG: preprocedure
A
- Prepare client for 12 lead if prescribed
- Position client in supine with chest exposed
- Wash client’s skin to remove oils
- Clip hair (do not shave)
3
Q
ECG: intraprocedure
A
- Instruct client to remain still and breathe normally
- Monitor client for manifestations of dysrhythmias: chest pain, dec LOC, SOB, hypoxia
4
Q
ECG: post procedure
A
- Remove leads, print ECG, notify provider
- Apply Holter monitor if client on tele
- Monitor pt
5
Q
dysrhythmias
A
- Dysrhythmias can be life threatening or benign, but if life threatening it is usually related to decreased CO and ineffective tissue perfusion
- Dysrhythmias are a primary cause of death in clients suffering acute MI and other sudden death disorders
6
Q
what is cardioversion?
indications for cardioversion?
A
- delivery of a direct countershock to the heart synchronized to the QRS complex
- Indications:
- Atrial dysrhythmias
- SVT
- V tach with a pulse
- For clients who are symptomatic
7
Q
what is defibrillation?
indications for defibrillation?
A
- delivery of an unsynchronized, direct countershock to the heart
- Stops all electrical activity of the heart, allowing the SA node to take over and re-establish a perfusing rhythm
- Indications:
- V fib
- pulseless v tach
8
Q
cardioversion/defib: preprocedure
A
- Clients with afib of unknown duration must receive adequate anticoags for 4-6 weeks prior to cardioversion therapy to prevent dislodgement of thrombi into bloodstream
- Explain procedure to client, obtain consent
- Administer O2
- Document preprocedure rhythm
- Digoxin held 48 hrs prior to elective cardioversion
9
Q
cardioversion/defib: intraprocedure
A
- Administer sedation as needed
- Ensure proper placement of leads
- Monitor client in a lead that has an upright QRS
- Stand clear of pt
- Cardioversion requires activation of synchronizer button in addition to charging the machine
- Allows shock to sync with underlying rhythm
- Failure to sync can lead to development of lethal arrhythmia, like v fib
- Perform CPR for asystole or other pulseless rhythms
- Defibrillate immediately for v fib
- Administer meds
10
Q
cardioversion/defib: post procedure
A
- Monitor V/S, assess airway, obtain ECG
- Document:
- Postprocedure rhythm
- Number of defibrillation or cardioversion attempts
- Client’s condition, state of consciousness
- Skin condition
11
Q
what are the 2 possible complications of cardioversion?
A
- embolism
- decreased cardiac output and HF
12
Q
explain embolism as a complication of cardioversion
A
- Embolism: can be dislodged by cardioversion
- A PE evidenced by: dyspnea, chest pain, air hunger, dec SaO2
- A CVA evidenced by: dec LOC, slurred speech, muscle weakness/paralysis
- An MI evidenced by: chest pain and ST segment depression or elevation
- Nursing actions: provide therapeutic anticoagulation for clients who have dysrhythmias
13
Q
explain decreased cardiac output and HF as a complication of cardioversion
A
- cardioversion may damage heart tissue and impair heart function
- Nursing actions:
- Monitor the client for signs of:
- Dec CO: hypoTN, syncope, inc HR
- HF: dyspnea, productive cough, edema, venous distention
- Provide meds to increase output (inotropic agents) and to decrease cardiac workload
- Monitor the client for signs of:
14
Q
tx of bradycardia if the client is symptomatic
A
- meds: atropine and isproterenol
- electrical mgmt: pacemaker
15
Q
tx of a fib, supraventricular tachycardia, and ventricular tachycardia with a pulse
A
- meds: amiodarone, adenosine, verapamil (CCB)
- electrical mgmt: cardioversion
16
Q
tx of ventricular tachycardia w/o a pulse or ventricular fibrillation
A
- meds: amiodarone, lidocaine, epinephrine
- electrical mgmt: defibrillation
17
Q
permanent pacemaker
A
- Contains an internal pacing unit
- Indicated for chronic or recurrent dysrhythmias due to sinus or AV node malfunction
- Can be programmed to pace the atrial (A) or ventricular (V) chamber, or both (AV)
18
Q
what are the pacemaker modes available on a permanent pacemaker?
A
- Fixed rate (asynchronous): fires at a constant rate w/o regard for the heart’s electrical activity
-
Demand mode (synchronous): detects the heart’s electrical impulses and fires at a preset rate only if the heart’s intrinsic rate is below a certain level
- Inhibited: pacemaker activity is inhibited/does not fire
- Triggered: pacemaker activity is triggered/fires when intrinsic activity is sensed
- Tachydysrhythmia function: can overpace a tachydysrhythmia and/or deliver an electrical shock
19
Q
potential diagnoses that would be indication for a pacemaker
A
- Symptomatic bradycardia
- Complete heart block
- Sick sinus syndrome
- Sinus arrest
- Asystole
- Atrial tachydysrhythmias
- Ventricular tachydysrhythmias
20
Q
subjective presentation of a client that needs a pacemaker
A
- Dizziness
- Palpitations (racing heart)
- Chest pain or pressure
- Anxiety
- Fatigue
- Nausea
- Breathing difficulties
21
Q
objective presentation of a client that needs a pacemaker
A
- Bradycardia or tachycardia
- Abnormal ECG
- Dyspnea, tachypnea
- Restlessness
- JVD
- Vomiting
- hypoTN
- Diaphoresis
- Dec CO
22
Q
preprocedure considerations for a pacemaker
A
- Nursing actions:
- Assess the client’s knowledge of the procedure and need for pacemaker
- Obtain informed consent
- Prepare client’s skin (clean with soap and water, trim hair)
- Do not shave, rub, or apply alcohol
- Client edu: teach about type of pacemaker
- Temporary pacemaker:
- Explain that wires and pacemaker box will be on the client’s chest
- Wires and box must be kept dry–>can’t shower
- Permanent pacemaker:
- Small incision made with local anesthetic and IV sedation
- May be programmed externally after procedure
- Pacemaker battery will last about 10 yrs
- Temporary pacemaker:
23
Q
postprocedure nursing actions for a pacemaker
A
- Document time and date of insertion, model, settings, rhythm strip, presence of pulse and BP, client response
- Monitor HR and rhythm
- CXR: to check lead placement and monitor for pneumothorax, hemothorax, pleural effusion
- Provide pain meds
- Minimize shoulder movement
- Monitor incision site for bleeding, hematoma formation, or infection
- Assess for hiccups: indicates that the generator is pacing the diaphragm
- Maintain safety
- Assess for thermal burns, dehydration
- Provide client with pacemaker ID card
24
Q
postprocedure client education for a pacemaker
A
- Temporary pacemakers: used only in a controlled facility w/ telemetry for continuous ECG monitoring
- Permanent pacemaker:
- Carry ID card at ALL times
- Prevent wire dislodgement: do not raise arm above shoulder for 1-2 weeks
- Take pulse daily at same time
- Report: dizziness, fainting, fatigue, weakness, chest pain, hiccupping, palpitations, difficulty breathing, weight gain
- If have a pacemaker defibrillator: when device delivers a shock, anyone touching pt will feel electrical impulse
- No contact sports or heavy lifting for 2 mos
- Avoid direct blows or injury to generator site
- Resume sexual activity as desired
- Never place items that generate a magnetic field over the pacemaker (including garage door openers, strong magnets, stereo speakers)
- MRI, heat therapy: contraindicated
- Will set off airport security alarms
25
Q
what are possible complications that occur due to pacemaker insertion?
A
- infection or hematoma at site of insertion
- pneumothorax or hemothorax
- arrhythmias
26
Q
infection or hematoma at pacemaker insertion site: nursing actions
A
- Assess for redness, pain, drainage, swelling
- Administer antibiotics
- Monitor PT, PTT, CBC
27
Q
pneumo/hemothorax as a result of pacemaker insertion: nursing actions
A
- Assess breath sounds, chest mvmt
- Monitor O2 sats
- CXR
28
Q
arrhythmias as a result of pacemaker insertion: nursing actions
A
- related to ventricular irritation from pacemaker electrode
- Monitor ECG and BP
- Administer antiarrhythmics
- Have emergency resuscitation equipment ready
29
Q
pacemaker complications
A
- relate to improper sensing or pacing electrical charge being outside the heart
- Causes: insufficient pacemaker settings, lead wire placement and function, battery function, myocardial damage, electrolyte imbalance
- Can often detect with ECG
