Electricity

Question 1

Atrial Fibrillation Drug Treatment

Goal is to control the rate and prevent clots

Answer 1

Beta blockers, Calcium Channel Blockers, Amiodarone, Digoxin, Heparin, Warfarin, Enoxaparin, and Pradaxa

Question 2

Bleeding precautions

Answer 2

-use an electric shaver
-soft toothbrush & do not floss
-no dental work without consulting w/ provider
-do not take aspirin or aspirin containing products
-wear shoes/slippers with a sole
-no contact sports
-if bumped, apply ice for 1 hr
-avoid anal intercourse
-avoid bending over at the waist

Question 3

Elective procedure
Client is awake and sedated
Synced w/ QRS
50-200 joules
Consent form needed
EKG monitor

Answer 3

Cardioversion- used in pts who have a fast rhythm (ex: AFib w/RVR) that is causing problems with perfusion

Question 4

Emergency
VFib/VTach
No cardiac output
Begin with 200 joules & up to 360 joules
Client unconscious
EKG monitor

Answer 4

Defibrillation

Question 5

Pacing modes

Answer 5

Synchronous demand, atrioventricular, and universal atrioventricular

Question 6

The heart is stimulated to beat when the client’s pulse rate falls below a set value or rate (usually between 60 and 72 bpm); if client’s pulse rate falls below the set value, the pacemaker initiates a heartbeat. The pacemaker senses the normal heart-beat and the following conduction. If a normal cardiac beat is initiated and conducted, the pacemaker does not initiate an impulse.

What pacing mode?

Answer 6

Synchronous demand

Question 7

The ventricle is sensed, and the atrium is paced. If the ventricle does not depolarize, then it is also paced.

What pacing mode?

Answer 7

Atrioventricular

Question 8

Both the atrial and ventricular circuits sense and pace in the respective chambers. This most closely resembles the normal conduction system.

What pacing mode?

Answer 8

Universal atrioventricular

Question 9

Spike will show anywhere, but where it should be.

What pacemaker malfunction?

Answer 9

Failure to sense

Question 10

Spike will be regular and will show up, but no complex after the spike will show.

What pacemaker malfunction?

Answer 10

Failure to capture

No complex after the spike

Question 11

No spikes at all when you should see them.

What pacemaker malfunction?

Answer 11

Failure to pace

No spikes

Question 12

Pacemaker perceives electrical current from sources other than the heart.

What pacemaker malfunction?

Answer 12

Oversensing

Question 13

Permanent Pacemaker Patient Education

Answer 13

-carry pacemaker identification
-take pulse for 1 minute at the same time each day
-do not apply pressure over your generator
-certain tests (ex: MRI) could damage pacemaker
-do not operate electrical appliances directly over pacemaker, can cause malfunctions
-safe to operate microwave unless it does not have proper shielding
-if you feel symptoms when near any device, move 5 to 10 feet away & check pulse

Question 14

What is an implantable cardioverter defibrillator used to treat?

Answer 14

Used in patients to treat life threatening rhythms

Question 15

Beta Blockers

Answer 15

Watch HR & BP

Question 16

Calcium channel blockers

Answer 16

usually a drip
watch HR & BP

Question 17

Amiodarone

Answer 17

watch BP

Question 18

Digoxin

Answer 18

Given to patients with HF & Afib
HOLD FOR HR<60

Question 19

Heparin

Answer 19

o Fast acting, short half-life (1-2 hours), IV- you can control it better
o PTT or Heparin Xa monitoring
o Monitor for bleeding and HIT (Platelets <100 or >50% drop)
o antidote: Protamine Sulfate

Question 20

Warfarin

Answer 20

o 3-5 days to take effect, PO
o PTT/INR monitoring
o Monitor for bleeding, avoid foods high in Vitamin K
o antidote: Vitamin K

Question 21

Enoxaparin (Low Molecular Weight Heparin)

Answer 21

o Predictable dose response, so no PTT monitoring needed
o Monitor for Bleeding & HIT (Platelets <100 or >50% drop)
o antidote: Protamine Sulfate

Question 22

Pradaxa

Answer 22

o Novel oral anticoagulant (NOAC)
o Antidote: Idarucizumab