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COMPLEX > Exam 1 cardiac blueprint > Flashcards

Exam 1 cardiac blueprint Flashcards

1
Q

S & S of AV heart block

A

Chest pain
Oxygen, SpO2 lower
Hypotension
Tachycardia
Lethargy
Anxiety
Palpitations
SOB
Dizziness (syncope)

S & S get progressively worse from 1st degree to 3rd degree heart block

Low O2 leads to these S & S

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2
Q

post op care of pacemaker

A

Post-op:

Immobilize arm
No raising arm above head (2 weeks)
No lifting heavy objects

Infection (monitor incision)
Warm, red, inflamed
No tub baths, creams or powders

Inspect HR and BP (check pulse daily)

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3
Q

education for pacemaker

A

Long-term maintenance:

Approved
Swim and drive after 2 weeks
ID card (pacemaker)
Report S/S of dyspnea, dizzy

Avoid
Contact sports
Constrictive “tight” clothing
MRI
Microwaves
Metal detectors (airport & mall)
MP3 earphones

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4
Q

paced rhythm

A

Pacer spikes are seen:
Preceding the P wave = atrial pacing
Preceding the QRS complex = ventricular pacing
Both = dual chamber pacemaker

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5
Q

Shockable and non-shockable rhythms

A

Ventricular Tachycardia (VTach):
W/O a pulse: code, CPR, defibrillation

Ventricular Fibrillation (Vfib):
Defibrillation ASAP & Epinephrine

NOT SHOCKABLE = Pulseless Electrical Activity & Asystole

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6
Q

arrhythmia complications

A

Underlying heart disease + sudden onset of an arrhythmia = Acute heart failure

Arrhythmia really fast - heart demands more O2 - O2 supply not met - Myocardium suffers from Ischemia (Angina)

Palpitations

May alter cardiac output: signs of hypotension and decreased brain perfusion (dizzy, altered mental status, syncope)

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7
Q

Digoxin

A

improves contractility
A transthoracic echocardiogram (TTE) MUST be preformed before cardioversion to rule out clots that could be mobilized during shock

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8
Q

Amiodarone

A

anti-arrhythmic, given to a patient in Vtach if they HAVE a pulse.

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9
Q

Atropine

A

given as treatment to a patient experiencing sinus bradycardia

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10
Q

Adenosine

A

Provided to a pt experiencing supra-ventricular tachycardia

When delivering…
Consent
MD present
Defib pads on
Triple stop-clock in place
Rapid push followed by rapid saline
Will stop cardiacs conduction (flatline the pt), push hard and fast

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11
Q

ECG interpretation

A

QRS complex: normal is 0.04-0.12 seconds (1-3 small boxes)

PR interval: normal is 0.12-0.20 seconds (3-5 small boxes)

ST segment: normally level with baseline. If higher, possible ST elevation. 12 lead ECG is needed to properly evaluate ST elevation. 2 small boxes higher than baseline = elevated and 2 boxes lower than baseline = depressed.

BPM = # of QRS’s x 10

Rhythm = regular or irregular

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12
Q

P-Wave

A

beginning of electrical cycle, represents an electrical impulse through the atria, originates in the SA node, occurs before each QRS.

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13
Q

QRS complex

A

Ventricular depolarization

What happens to the heart when the ventricles depolarize? Contraction

When ventricles contract, what occurs that can be assessed? Pulse

Should be up right

When the ventricles take longer than normal to re-polarize, a rhythm will have a wide QRS

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14
Q

ST segment

A

ventricular R & R

Ventricles recover and begin refilling

Measure from the S to the T, should exist at the baseline

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15
Q

T-wave

A

ventricular re-polarization

The T-wave represents the end of the electrical conduction

The ventricles are rested and ready to pump again with the next electrical impulse

A smooth, round wave that is upright

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16
Q

Normal sinus rhythm

A

Rate: 60-100
Rhythm: regular
QRS: normal
P-Wave: normal
T-wave: normal
ST segment: normal

17
Q

Treatment of systole

A

CPR and tube the patient (ET-Endotracheal tube)

Deliver ACLS (advanced cardiac - life support drug)

Epinephrine (stimulate a HR, 1 MG IV/10 push every 3-5 M

Vasopressin (squeezes BP to the heart)

Defibrillation will not work

NOT SHOCKABLE - no conduction = nothing to shock!

18
Q

Vaso-vagal maneuvers

A

Vaso-vagal remover occurs when you stimulate the vagal nerve

Slows conduction and interrupts the circuit

Bare down

Carotid massage

Have pt blow threw a straw that is blocked

19
Q

electrolytes K+ and Ca+

A

K+ (3.5-5 mEq/L)
Ca+ (total serum Ca+ = 8.5-10.5 mg/dL and ionized Ca+ = 4.4-5.4 mg/dL)

20
Q

hyperkalemia

A

(>5.0 mEq/L)

ECG changes:
Tall peaked T waves
Prolonged PRI, loss of P waves, ST depression, wide QRS complex
Dysrhythmias: heart block, Vfib, cardiac standstill

Mechanism:
Decreases rate of ventricular depolarization (slows)
Shortens repolarization (accelerates)
Depresses AV conduction

Causes:
Impaired renal excretion
Excess K+ admin
K+ sparing diuretics, ACE inhibitors, ARB drugs
Extensive skeletal muscle destruction

Management:
Stop oral and IV intake of K+
Increase K+ excretion
Force K+ from ECF to ICF
Stabilize cardiac cell membrane

21
Q

hypokalemia

A

(<3.5 mEq/L)

ECG changes:
Flattened T waves, depresses ST, p waves peaked, QRS prolonged
Risk for heart block, Vtach, Vfib

Mechanisms:
Impairs myocardial conduction
Prolongs ventricular re-polarization

Causes:
Increased loss of K+
Increased shift of K+ from ECF to ICF
Dietary K+ deficiency
Renal losses

Management:
Oral or IV K+ replacement
High alert med
Never IV push (give 10 mEq/H-infusion pump)
Dilute K+ sufficiently and admin slow
Monitor for phlebitis

22
Q

Hypercalcemia

A

(ionized Ca++ >5.4 mg/dL or total Ca++ > 10.5 mg/dL)

ECG changes:
Shortened ST segment and QT interval
Ventricular dysrhythmias

Mechanisms:
Strengthens contractility
Shortens ventricular re-polarization

Causes:
Cancer
Hyperparathyroidism
Endocrine disorders
Overdose vitamin A or D

Management:
Low Ca+ diet
Increased weight bearing activity
Increased fluid intake
Hydration with isotonic saline infusion
Bisphosphonates
Calcitonin SQ or IM

23
Q

Hypocalcemia

A

(<4.4 mg/dL (ionized Ca++))

ECG changes:
Prolonged ST segment and QT interval
Vtach

Mechanisms:
Decreased myocardial contractility
Reduces cardiac output
Hypotension
Decreased responsiveness to digitalis

Causes:
Decreased production of parathyroid hormone
Multiple blood transfusions
Alkalosis
Increased Ca+ loss
Low Mg levels

Management:
Treat cause
Ca+ and Vitamin D supplements
IV Ca+ gluconate
Seizure precautions

24
Q

pt safety cardioversion

A

Pre-procedure:
Obtain 12 lead ECG as baseline

Begin ECG monitoring

Perform baseline assessment: VS, o2 stat, and CM associated with dysrhythmias
Withhold food and fluids per hospital protocol

Verify informed consent document signed for non-emergent procedure

Assess electrolyte and cardiac biomarkers

Teach client and caregiver about procedure

25
Q

post-cath management

A

Looking for bleeding and Hematoma

Monitor EKG, VS (+apical pulse)

Neuro status

Site where cath was placed

Keep leg/arm straight for at least 4 H

Palpate for pulses

Auscultate for pericardial friction rub

Report CP & SOB

Cap refill, sensation, color distal to cath site

COMPLEX (23 decks)

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