Exam 1 (C&P) Flashcards
Small square on EKG
0.04 seconds
Large box on EKG
0.20 seconds
5 Large boxes on EKG
1 second
QRS Complex Duration
0.04 - 0.12 seconds (1 - 3 small boxes)
PR Interval on EKG
0.12 - 0.20 seconds (3 - 5 small boxes)
If ST segment is elevated on EKG
Possible code STEMI –> rule out heart attack
Sinus Arrhythmia
Check pt for symptoms
-normal in children
Causes: Sinus Bradycardia
Beta Blockers
Calcium Channel Blockers (Digoxin)
Treatment: Sinus Bradycardia
Atropine
Causes: Sinus Tachycardia
Fever
Stress
Pain
Anxiety
Treatment: Sinus Tachycardia
Vagal maneuver
Beta Blockers
Calcium Channel Blockers
Carotid massage
Causes: A-Fib
Cardiac Surgery
Pulmonary Hypertension
Hyperthyroidism
Symptoms: A-Fib and A-Flutter
Chest pain Hypoxia Hypotension Lethargy SOB Anxiety palpitations dizziness
Treatment: A-Fib and A-Flutter
anticoagulants (they are at HIGH RISK) Beta Blocker Cardiac Ablation Digoxin ElectroCardioeversion
Causes: A-Flutter
COPD Pulmonary hypertension valve disease excess thyroid hormone CABG or CHD repair
Impending Acute Heart Failure
Underlying heart disease + sudden onset of arrhythmia
In Supraventricular Arrhythmias, the QRS complex is _____, due to _____ excitation of the ventricles.
1) narrow
2) rapid
In Ventricular Arrhythmias the QRS complex is ______, due to _____ excitation of the ventricles.
1) wide
2) slower
Supraventricular Tachycardia
Rate: 150-250 bpm
Rhythm: regular
P-waves are buried in previous T waves
QRS: narrow
Causes: Supraventricular Tachycardia
stimulants (caffeine)
sepsis
stress
alcohol
Treatment: Supraventricular Tachycardia
Vaso Vagal maneuver
adenosine (w/ MD, rapid push + rapid flush)
Ablation
Cardioversion
Ventricular Tachycardia
Rate: > 250 bpm
rhythm: regular
No P wave
QRS: wide and even
Causes: Ventricular tachycardia
stimulants (caffeine, meth, cocaine) Med toxicity (digoxin) Low Mg2+ Low K+ cardiac injury
Treatment: Ventricular tachycardia
w/ pulse: amiodarone, cardioeversion
w/out pulse: CODE –> CPR and defibrillation
Ventricular Fibrillation
Rate: not measurable Rhythm: irregular No p wave QRS: no contraction, only quivering monomorphic or polymorphic
Causes: V-Fib
cardiac Injury Med toxicity (digoxin) Electrical disturbance (electrolytes, acid/base, electrical shock)
symptoms: V-Fib
loss of consciousness
Treatment V-Fib
defibrillation
Epinephrine
ST Elevated Myocardial Infarction (STEMI)
ST segment elevated because something is causing it to remain contracted
Causes: STEMI
Low O2 from CAD
High Potassium
Treatment: STEMI
reperfusion
cath lab - angioplasty
Possible CABG
1st degree AV Block
longer PR interval
2nd degree AV block type 1
progressively longer PR intervals until it drops a QRS complex
2nd Degree AV block type 2
No warning sign or PR change, but some QRS complexes are dropped
3rd Degree AV block
random loss of QRS and P waves
Treatment: Asystole
1) CPR + ET tube
2) Deliver ACL drugs
3) Epi every 3- 5 minutes
4) Vasopressin
Atrial PAcing
pacing spikes precede the P wave
Ventricular pasing
Pacer spikes precede the QRS complex
Dual Chamber Pacemakes
Pacer spikes precede both P and QRS
Pacemaker: Post Op
Immobilize arm
Infection precautions
Inspect HR and BP
Pacemaker: AVOID
2 C's: contact sports constrictive clothing 4 M's: MRI Microwaves Metal detectors MP3 earphones
The 6 H’s
Hypoxia Hypovolemia Hypothermia H+ ions (acidosis) Hypo/Hyperkalemia
The 6 T’s
Tablets (overdose) Tamponade (cardiac) Tension pneumothorax Thrombosis (coronary) Thrombosis (pulmonary)
Pulseless Electrical Activity (PEA)
Electrical activity appears but there is no pulse
Treatment for PEA when pt is unresponsive
CPR O2 Start IV (if not already there) Push EPI Treat H's and T's
Artifact
distortion of ECG tracing by electrical activity that is non-cardiac in origin
troubleshooting artifact
Assess client first
identify problem
check electrodes
ensure electrical equipment is grounded properly
Causes: Hypoxemic Respiratory Failure
V/Q mismatch - COPD, asthma Shunt Diffusion Limitation Alveolar Hypoventilation Neuromuscular disease
Causes: Hypercapnic Respiratory Failure
Airways and alveoli abnormalities
CNS abnormalities
Chest wall abnormalities
Neuromuscular conditions
Early signs of Acute Respiratory Failure
Mental Status change tachycardia tachypnea mild hypertension anxiety
Complications of ARDS
Infection Barotrauma Volutrauma Stress Ulcers Renal Failure DIC Multi-Organ dysfunction syndrome
Causes: Low-Pressure Ventilator Alarm
Extubation
Disconnection of tubes
Deflated cuff
Causes: High Pressure Ventilator Alarm
Pulmonary Edema Biting the tube Kink in tube Secretions Coughing
The primary cause of Respiratory Acidosis is _____.
Hypoventilation
The primary cause of Respiratory Alkalosis is _____.
Hyperventilation
Casuse: Metabolic Alkalosis
Vomiting
NG suction
Cause: Metabolic Acidosis
Diarrhea
Renal Failure
DKA
Causes: ARDS
#1: Sepsis vaping near drowning pancreatitis severe burns
The three early signs of HYPOXEMIA are _____, _____, and _____.
restlessness
anxiety
confusion
Symptoms of ARDS:
#1: refractory hypoxemia substernal and intercostal retractions SOB cyanosis hemodynamic instability (hypotension, tachycardia, arrhythmia)
Primary Survey is done for trauma and emergencies. What is included in the survey?
Airway Breathing Circulation Deficit Exposure
A secondary survey once the patient is admitted includes…
History Head-to-toe exam Chest X-Ray CBC ECG and Cardiac Enzymes
Primary intervention for rib fractures…
Pain control to prevent hypoventilation
-NSAIDs and opioids
Supplies to have at bedside for ventilated patients
Intubation kit ambu bag oxygen crash cart suction
Treatment for Torsades De Pointes
- Magnesium Sulfate
- Electrical Pacing
Drugs used for 2nd and 3rd degree AV Block
Beta Blockers Calcium Channel Blockers Digoxin ... Atropine Dopamine Epinephrine
Main treatment for 3rd degree AV block
Pacemaker
Shockable waveforms are _____ and _____.
Pulseless Ventricular Tachycardia (V-tach) Ventricular Fibrillation (V-fib)
Cardiac Output
Blood pumped by the heart in 1 minute
- SV x HR
- 4 8 L/min
Systemic Vascular Resistance (SVR)
Measure of afterload resistance
-(MAP-CVP) / CO
700 - 1500
1st line treatment for hyper/hypotension
Fluid management
Alpha receptors effect ____ ____ & _____.
Smooth muscle vasoconstriction & relaxation
Beta receptors affect _____ & _____.
Inotropy (strengthening and weakening of the heart) & chronotropy (heart rate)
Endocarditis
infection of inner layer of the heart
-forms vegetations on the valves specifically mitral and aortic
Risk factors: Endocardtis
- prosthetic valves
- hemodialysis
- IV drug abuse
Endocarditis diagnostics
Hx Labs: cultures, CBC, ESR, C-reactive Echocardiography Chest X-ray ECG
Pericarditis
inflammation of the outer lining of the heart w/ possible fluid accumulation (pericardial effusion)
Complications: pericarditis
Pericardial effusion
Cardiac Tamponade
Hiccups
Hoarseness
Diagnostics: Pericarditis
12-lead ECG Echocardiogram CT MRI Chest x-Ray Labs: CBC, CRP, ESR, troponins Cultures
Treatment: Cardiomyopathies
treat underlying cause Control Heart Failure Medications VAD PAcing ICD transplant
Nursing care for heart transplant patient:
- monitor chest tube drainage
- monitor cardiac rate and rhythm
- monitor cardiac output, pulmonary artery pressures, and CVP
