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Role Transition > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

P wave is
QRS is
T wave is
PR interval (time)
QRS
Rate of AV node
Re-entry rhythms

A
  • atrial depo
  • ventricular depo
  • ventricular repo
  • .12- .20
  • .04 - .12
  • 40 to 60
  • A-fib & A flutter
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2
Q

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

A
  • systolic < 90, diaphoresis, change in LOC, SOB, dizziness
  • monitor patient or give med
  • cardioversion
  • Defib
  • pacing & atropine
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3
Q

Sinus tachy causes
Atrial flutter causes / treatment
A fib is & med
Heparin guidelines
Coumadin/warfarin guidelines

A
  • 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
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4
Q

3 PVCs in a row
Bigeminy
Trigeminy
Quadrigeminy
Multi focal
Nursing intervention
PVC on T wave

A
  • 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
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5
Q

V tach if stable
If unstable
No pulse
V fib
Stable pt in SVT

Torsades is due to
Pt at risk

A
  • rapid adenosine
  • cardiovert
  • Defib & cpr
  • immediate Defib
  • vagal maneuvers first
  • hypomagnesemia
  • alcoholics, malnourished, homeless
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6
Q

1st degree AV block
2nd degree type 1
2nd degree type 2
3rd degree
Which is unstable & what do you do

A
  • 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
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7
Q

Synchronous / demand pacing
Asynchronous/ fixed
Pacing atrium
Pacing ventricle
2 spikes
Pacemaker education

A
  • 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
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8
Q

Holter monitor is
Angiogram is
Cardiac cath pre-test
Post-test
Echocardiogram is used

A
  • 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
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9
Q

Exercise stress test is
Pre test
During
Post test
Cardiac enzymes

A

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

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10
Q

DVT signs
Prevent
Nurse interventions
Virchows triad
Phlebitis / intervention

A
  • 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
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11
Q

Venous insufficiency caused by
Manifestations / interventions
Varicose veins / treatment

A
  • 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
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12
Q

Peripheral arterial disease common cause
Manifestations
Interventions

A
  • 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
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13
Q

Raynaud’s disease is
Manifestations
Interventions
Buergers disease signs

A
  • 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
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14
Q

Thoracic aortic aneurysm
Abdominal aortic aneurysm
Rupturing aneurysm
Prevention of rupturing aneurysm
Resection post op interventions

A
  • 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
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15
Q

Pericarditis is & can lead to
Assessment
Cardiac tamponade Becks triad & treatment
Infective endocarditis risk factors
Assessment
Osler node
Janeway lesion

A
  • 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
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16
Q

Dilated cardiomyopathy
Hypertrophic
Restrictive
Assessment
Treatment

A
  • 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
17
Q

Coronary artery disease is
Manifestations
Treatment
Meds
Prinzmetals angina

A
  • 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
18
Q

MI risk factors
Symptoms
EKG changes
Diagnostics
Med

A
  • 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
19
Q

Congestive heart failure
Progression
Interventions

A
  • 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)
20
Q

Diagnosis of high BP
Unstable BP
1st like treatment
Risk factors
Diuretics
ARBs
ACE

A
  • 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”
21
Q

Best way to assess fluid status
1 cup of ice is
Na range
K+
Mg

A
  • daily weights ; 1L of fluid = 1Kg weight
  • 1/2 cup of fluid = 120ml
  • 135-145
  • 3.5-5.0
  • 1.5-2.5
22
Q

Adrenal glands
ADH
High osmolality during
Low osmolality during
Ace inhibitor side effect
RAAS system does

A
  • 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
23
Q

Edema is known as
3 main mechanisms of edema
What causes decrease in oncotic pressure

A
  • Anasarca
  • increased capillary hydrostatic pressure, decreased capillary oncotic pressure, lymph node obstruction
  • albumin & cirrhosis
24
Q

Isotonic solutions
Hypotonic
Hypertonic
Hypotonic effect on cells
Hypertonic effect

A
  • 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)
25
Q

Isotonic dehydration causes
Hypertonic dehydration
Hypotonic dehydration

A
  • 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
26
Q

Fluid volume deficit signs
Treatment
Orthostatic vital signs
Fluid volume excess treatment
Loop diuretics
Thiazides
Potassium sparing

A
  • 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
27
Q

Hyponatremia causes
Signs & symptoms
Interventions
Lithium interaction

A
  • increased excretion, inadequate intake
  • tachycardia, decreased muscle contraction, decreased specific gravity, N/V/D
  • high sodium diet, hypertonic solution,
  • can lead to lithium toxicity
28
Q

Hypernatremia causes
Signs & symptoms
Interventions

A
  • 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
29
Q

Hypokalemia causes
Signs & symptoms
Potassium IV

Interventions for hyperkalemia

A
  • 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
30
Q

Calcium levels
Signs of hypocalcemia
Interventions
Signs of hypercalcemia
Interventions

A
  • 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
31
Q

Too much magnesium causes

A
  • sedation, lethargy, drowsiness, decreased DTRs, muscle weakness
32
Q

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

A
  • 7.35 acidic - 7.45 alkalotic
  • 35 alkalotic - 45 acidic
  • 22 acidic - 26 alkalotic
  • mixed acidosis
  • it is uncompensated
  • fully compensated
  • partially compensated
33
Q

The lungs
Kidneys
Renal regulation when PH decreases
When PH increases

A
  • 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
34
Q

Causes of respiratory acidosis
Interventions
Causes of respiratory alkalosis
Intervention

A
  • 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)
35
Q

What to give in acidosis
What to give in alkalosis

A
  • give lactate containing solution
  • give chloride containing solution

Role Transition (3 decks)

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