Exam 1 cardiac blueprint Flashcards
S & S of AV heart block
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
post op care of pacemaker
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)
education for pacemaker
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
paced rhythm
Pacer spikes are seen:
Preceding the P wave = atrial pacing
Preceding the QRS complex = ventricular pacing
Both = dual chamber pacemaker
Shockable and non-shockable rhythms
Ventricular Tachycardia (VTach):
W/O a pulse: code, CPR, defibrillation
Ventricular Fibrillation (Vfib):
Defibrillation ASAP & Epinephrine
NOT SHOCKABLE = Pulseless Electrical Activity & Asystole
arrhythmia complications
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)
Digoxin
improves contractility
A transthoracic echocardiogram (TTE) MUST be preformed before cardioversion to rule out clots that could be mobilized during shock
Amiodarone
anti-arrhythmic, given to a patient in Vtach if they HAVE a pulse.
Atropine
given as treatment to a patient experiencing sinus bradycardia
Adenosine
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
ECG interpretation
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
P-Wave
beginning of electrical cycle, represents an electrical impulse through the atria, originates in the SA node, occurs before each QRS.
QRS complex
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
ST segment
ventricular R & R
Ventricles recover and begin refilling
Measure from the S to the T, should exist at the baseline
T-wave
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
Normal sinus rhythm
Rate: 60-100
Rhythm: regular
QRS: normal
P-Wave: normal
T-wave: normal
ST segment: normal
Treatment of systole
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!
Vaso-vagal maneuvers
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
electrolytes K+ and Ca+
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)
hyperkalemia
(>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
hypokalemia
(<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
Hypercalcemia
(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
Hypocalcemia
(<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
pt safety cardioversion
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
