Exam 1 Flashcards
P wave is
QRS is
T wave is
PR interval (time)
QRS
Rate of AV node
Re-entry rhythms
- atrial depo
- ventricular depo
- ventricular repo
- .12- .20
- .04 - .12
- 40 to 60
- A-fib & A flutter
What symptoms indicate an unstable patient
If patient is stable
If unstable a fib, a flutter, SVT
V-fib & pulseless v tach
3rd degree block & symptomatic Brady
- systolic < 90, diaphoresis, change in LOC, SOB, dizziness
- monitor patient or give med
- cardioversion
- Defib
- pacing & atropine
Sinus tachy causes
Atrial flutter causes / treatment
A fib is & med
Heparin guidelines
Coumadin/warfarin guidelines
- drugs, pain, fever, infection, exercise, nervous
- COPD, hypoxia, cardiac disease / CCBs (cardizem) & cardioversion
- most common arrhythmia ; anticoagulants
- monitor aPTT (1.5-2x 30-40 secs) ; antidote is protamine sulfate
- monitor PT/ INR (INR lvl 2.5-3.5) ; vitamin K is antidote
3 PVCs in a row
Bigeminy
Trigeminy
Quadrigeminy
Multi focal
Nursing intervention
PVC on T wave
- considered a run of V tach
- 1 normal QRS, 1 PVC
- 2 normal, 1 PVC
- 3 normal, 1 PVC
- doesn’t follow a pattern
- check patient, notify physician & place on telemetry
- can lead to V tach
V tach if stable
If unstable
No pulse
V fib
Stable pt in SVT
Torsades is due to
Pt at risk
- rapid adenosine
- cardiovert
- Defib & cpr
- immediate Defib
- vagal maneuvers first
- hypomagnesemia
- alcoholics, malnourished, homeless
1st degree AV block
2nd degree type 1
2nd degree type 2
3rd degree
Which is unstable & what do you do
- PR interval >.20 sec
- PR progressively longer followed by missed beat
- constant prolonged PR followed by missed beat
- no relationship between P&R
- 2nd type 2 & 3rd ; pacing
Synchronous / demand pacing
Asynchronous/ fixed
Pacing atrium
Pacing ventricle
2 spikes
Pacemaker education
- sync with heart, takes over when needed or heart drops pace (not a spike on every P)
- pacing spike at every P
- spike infront of P wave
- spike infront of QRS
- pacing of both atria & ventricle
- check HR daily, report fever, redness, swelling, drainage
Holter monitor is
Angiogram is
Cardiac cath pre-test
Post-test
Echocardiogram is used
- Continous EKG, records anytime symptoms occurr & is used to identify arrhythmias
- gold standard test to diagnose CAD
- check for dye allergies, stop Metformin 24hr prior & 48hr after, check renal fxn (Cr, BUN, GFR)
- must lay flat w extended legs 4-6 hrs, apply pressure if bleeding & check pulses
- used to look at heart valves & determine ejection fraction
Exercise stress test is
Pre test
During
Post test
Cardiac enzymes
Study of the heart to evaluate for CAD
- eat a light meal, no caffeine or smoking 24hr prior
- stop procedure if symptomatic or arrhythmias
- patient stays 2hrs, avoid hot bath due to vasodilation
- Troponin (best for MI) , CK-MB indicates cardiac damage, myoglobin for muscle degradation
DVT signs
Prevent
Nurse interventions
Virchows triad
Phlebitis / intervention
- unilateral swelling, erythema, pain (main cause of PE)
- SCDs, heparin SQ, early ambulation
- never put pillow behind knee
- hypercoagulability (pregnancy, birth control, dehydration)
Vascular damage , circulatory stasis - Red warm area & swelling due to IV / apply warm compress
Venous insufficiency caused by
Manifestations / interventions
Varicose veins / treatment
- blood stasis in legs due to vein valve dysfunction
- stasis dermatitis, wet ulcer / elevate legs & use stockings
- distended tortuous veins that are superficial / sclerotherapy & vein stripping
Peripheral arterial disease common cause
Manifestations
Interventions
- atherosclerosis
- cool extremities, decreased pulses, intermittent claudication, loss of hair on extremities, scaly skin, thick toenails
- vasodilators, want temperature (80 degrees in home), avoid cold weather & tobacco use
Raynaud’s disease is
Manifestations
Interventions
Buergers disease signs
- vasospasm of arteries in upper & lower extremities
- blanching on extremity, numbness, tingling, cold to touch
- use gloves, keep extremities warm, vasodilators, CCBs
- pain in digits, diminished pulses, ulceration
Thoracic aortic aneurysm
Abdominal aortic aneurysm
Rupturing aneurysm
Prevention of rupturing aneurysm
Resection post op interventions
- pain ex teen ding to neck, shoulders, lower back, abdomen
- pulsating mass in abdomen above umbilicus, bruit, abdominal or lower back pain
- back pain, abdominal pain, hypotension, tachycardia, decreased peripheral pulses
- good blood pressure control
- don’t lift anything heavy 5-10lbs for up to a year
Pericarditis is & can lead to
Assessment
Cardiac tamponade Becks triad & treatment
Infective endocarditis risk factors
Assessment
Osler node
Janeway lesion
- inflammation of pericardium , can lead to cardiac tamponade
- friction rub heard at apex, pain worse with deep breathing, ST elevation in all 12 leads
- JVD, muffled heart sounds, hypotension & pericardiocentesis
- IV drug use, valve replacement
- blood cultures (2 different times 15min apart & before antibiotics) , oslers nodes & janeway lesions
- painful red raised lesion on hands & feet
- non-tender macules on palms & soles, not painful
Dilated cardiomyopathy
Hypertrophic
Restrictive
Assessment
Treatment
- most common, heart ejects less than 40% of blood in LV & can lead to HF
- obstruction in LV outflow
- impaired filling of LV during diastole
- activity intolerance, chest pain, dysrhythmias
- diuretics, anti dysrhythmics, vasodilators
Coronary artery disease is
Manifestations
Treatment
Meds
Prinzmetals angina
- narrowing or obstruction of artery mostly due to atherosclerosis
- chest pain, palpitations, dyspnea, excessive fatigue
- percutaneous coronary angioplasty (PTCA ; stent placement)
- nitrates (5 min apart), if patient gets headache, give Tylenol DONT stop nitro
- due to vasospasm
MI risk factors
Symptoms
EKG changes
Diagnostics
Med
- atherosclerosis, physical inactivity
- diaphoretic, hypotensive, dizziness, fatigue
- ST elevated (infarction) , ST depression (ischemia)
- 12 lead EKG in 10 min, angioplasty within 90min, troponin (most important lab; elevated - NSTEMI)
- thrombolytics started within 30 minutes
Congestive heart failure
Progression
Interventions
- left sided (lungs) , right sided (rest of body)
- left sided failure leads to right sided HF
- Elevate HOB, oxygen, diuretics, vasodilator (decrease afterload) , low sodium diet, fluid restriction, ACE inhibitors, digoxin (cardiac fxn), reduce anxiety (morphine)
Diagnosis of high BP
Unstable BP
1st like treatment
Risk factors
Diuretics
ARBs
ACE
- reading of > 140/90 2 different times
- <90 systolic
- diuretics, ACE inhibitors, ARBs
- aging, family history, African American, obesity, smoking
- furosemide (loop diuretic), hydrochlorothiazide (thiazide), spironolactone (K+ sparing)
- “-sartan”
- “-prils”
Best way to assess fluid status
1 cup of ice is
Na range
K+
Mg
- daily weights ; 1L of fluid = 1Kg weight
- 1/2 cup of fluid = 120ml
- 135-145
- 3.5-5.0
- 1.5-2.5
Adrenal glands
ADH
High osmolality during
Low osmolality during
Ace inhibitor side effect
RAAS system does
- secrete aldosterone (retain Na & water & eliminate K+)
- increased water retention ; secreted during dehydration or high osmolality (270-290 normal range)
- fluid deficit
- fluid overload
- cough, must report to provider to change med
- causes vasoconstriction & releases aldosterone to increase blood volume & BP
Edema is known as
3 main mechanisms of edema
What causes decrease in oncotic pressure
- Anasarca
- increased capillary hydrostatic pressure, decreased capillary oncotic pressure, lymph node obstruction
- albumin & cirrhosis
Isotonic solutions
Hypotonic
Hypertonic
Hypotonic effect on cells
Hypertonic effect
- NS 0.9%, LR, D5W (turns hypotonic)
- NS 0.33%
- NS 3%, D5LR
- pushes free water into cells (lysis)
- pulls water out of cells (shrinkage)
Isotonic dehydration causes
Hypertonic dehydration
Hypotonic dehydration
- inadequate intake of fluids, excessive loss of fluids
- excessive perspiration, hyperventilation, ketoacidosis, diabetes insipidus, prolong fevers, diarrhea
- chronic illness, renal failure, chronic malnutrition, excessive fluid replacement
Fluid volume deficit signs
Treatment
Orthostatic vital signs
Fluid volume excess treatment
Loop diuretics
Thiazides
Potassium sparing
- weak thready pulse, decreased urine output, high specific gravity (1.010-1.020), thirst, poor turgor
- replace fluids, monitor output, daily weights
- laying down, sitting, standing ; >20/10 & increased HR is a positive
- diuretics, restrict fluids, low sodium diet
- furosemide: eliminates all electrolytes
- thiazides: doesn’t eliminate calcium
- Spironolactone: holds potassium
Hyponatremia causes
Signs & symptoms
Interventions
Lithium interaction
- increased excretion, inadequate intake
- tachycardia, decreased muscle contraction, decreased specific gravity, N/V/D
- high sodium diet, hypertonic solution,
- can lead to lithium toxicity
Hypernatremia causes
Signs & symptoms
Interventions
- Cushing’s, corticosteroids, excessive sodium intake, NPO, fever, water loss
- altered mental status, muscle twitching, increased specific gravity, dry skin
- hypotonic solution, decrease sodium intake
Hypokalemia causes
Signs & symptoms
Potassium IV
Interventions for hyperkalemia
- diuretics & corticosteroids, V/D, water intoxication, alkalosis, renal disease
- ST depression, flat T wave, big U wave, muscle weakness, arrhythmias
- NEVER IV push, max infusion 10meq/hr, stop infusion if phlebitis occurs
- kayexalate (must have bowel movement to remove K+), glucose D50 & regular insulin, calcium gluconate & sodium bicarbonate
Calcium levels
Signs of hypocalcemia
Interventions
Signs of hypercalcemia
Interventions
- 8.5-10.5
- chvosteks (twitching facial nerve), Trousseas (spasm of forearm w BP), prolonged ST & QT interval
- give calcium gluconate or calcium supplements, seizure precautions
- short ST, wide T wave, bounding pulse, constipation
- discontinue thiazide since it holds calcium, give phosphorus, calcitonin, NSAIDs, aspirin
Too much magnesium causes
- sedation, lethargy, drowsiness, decreased DTRs, muscle weakness
PH range & acidic vs alkalotic
PCO2
HCO3
If both values are acidic
If on value is normal & PH is off
If PH is normal & both values are off
If both values are off & PH is off
- 7.35 acidic - 7.45 alkalotic
- 35 alkalotic - 45 acidic
- 22 acidic - 26 alkalotic
- mixed acidosis
- it is uncompensated
- fully compensated
- partially compensated
The lungs
Kidneys
Renal regulation when PH decreases
When PH increases
- control elimination of CO2
- eliminate H+ ; reabsorb & generate HCO-
- H+ ions are excreted & bocarb ions are formed & retained
- H+ ions are retained & bicarb ions are excreted
Causes of respiratory acidosis
Interventions
Causes of respiratory alkalosis
Intervention
- Respiratory depression, airway obstruction, lung disease
- give oxygen, hydrate, resp. Treatment, deep breathing
- tissue hypoxia (pneumonia, pulmonary edema, anemia), resp stimulation (anxiety, fever, pain)
- appropriate breathing pattern (brown paper bag)
What to give in acidosis
What to give in alkalosis
- give lactate containing solution
- give chloride containing solution
