Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CCN > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

atrial flutter is usually associated with

A

underlying CAD, rheumatic, or other heart diseases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what happens in atrial flutter

A

ectopic focus in the atria fires at 250-350 bpm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what node is the gatekeeper

A

AV node

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q
A

atrial flutter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

diff between cause of afib and a flutter

A

a fib can happen in healthy people

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what happens in afib

A

ectopic focus in the atria stimulates chaotic impulses at 350-500bpm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

afib vs aflutter ventricular rate

A

afib - irregular
aflutter - regular ventricular rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

p waves in atrial flutter

A

NO P waves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q
A

afib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

goal for atrial arrhythmias

A

get back to 60-100 NSR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is affected by ventricular rate

A

hemodynamic effects like BP and O2 and perfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what greatly affects cardiac output in atrial arrhythmias

A

loss of atrial kick and ventricular fililng time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

3 medications for controlling atrial rate

A

Ca channel blockers
Beta blockers
digoxin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

if patient has afib but is hypotensive what med to use

A

amiodarone because it doesnt affect BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

digoxin use / moa / problem

A

heart failure
controls HR and strengthens contractility
takes 2-3 days to go into effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

med for thrombus formation

A

heparin IV then oral warfarin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

cardioversion vs defib 2

A

cardioversion =
lower energy
SYNCHRONIZED

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

when is cardioversion used

A

afib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

warfarin onset/antidote

A

2-4 days (so start is when starting heparin)/vitamin K

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

apixaban onset of action

A

1-4 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

if patient has renal insufficiency but needs warfarin what to order

A

labs - BMP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

warfarin MOA

A

inhibits clotting factors that depend on vitamin K

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

cause of hypovolemic shock

A

decreased circulating volume from - hemorrhage, dehydration, GI or urinary losses, burns, pancreatitis, surgery, trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

cardiogenic shock is result of

A

the heart’s inability to deliver adequate circulation to the tissues due to cardiac pump failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

distributive shock cause

A

Vasodilation and redistribution of blood volume.

Due to sepsis, spinal cord injury, and anaphylaxis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

obstructive shock cause

A

Occurs from impairment of cardiac ventricular filling or impairment of ventricular emptying.

Causes include cardiac tamponade, tension pneumothorax, and massive pulmonary embolism.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

common s.s of ALL shock 10

A

Hypotension
high RR
high HR (except neurogenic)
Altered LOC
Hypoxia
Increased serum lactase because of low Oxygen switching to anaerobic
Metabolic acidosis
Decreased urine ouput
Pale and cool extremities
Dec bowel sounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

priority nursing diagnosis no matter the type of shock

A

ineffective tissue perfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

s/s of hypovolemic shock

A

hypotension,
orthostatic hypotension,
tachycardia,
delayed capillary refill,
dry mucous membranes,
poor skin turgor,
thirst,
weight loss,
oliguria,
concentrated urine,
altered mental status.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

cardiac output values in hypovolemic shock

A

reduced map, cvp, pawp, preload, stroke volume, cardiac output but elevated SVR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

labs for hypovolemic shock

A

hypernatremia >145

inc hct in dehydration
low hct/hbg if bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

priority for hypovolemic shock

A

identification and correction of the source of blood loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

goal of blood and fluid admin in hypovolemic shock

A

restore tissue perfusion and oxygen transport

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

recommended MAP for restoration for shock

A

> 65

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

electrolyte complications of hypovolemic shock 2

A

hypocalcemia
hyperkalemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

6 nursing actions for hypovolemic shock

A

identification and correction of source of blood loss.

Application of pressure and preparation for surgery.

Establish and maintain large, functioning IV access.

Monitor fluid resuscitation parameters – MAP > 65, urine output > 0.5-1 mL/kg/hour, decreasing lactate level.

Monitor for respiratory compromise and pulmonary congestion.

Monitor for complications of renal insufficiency/failure and cerebral ischemia. (change in LOC)

Maintain patient safety – patients are at a high risk for falls.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

types of distributive shock

A

neurogenic and anaphylaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

cause of neurogenic shock

A

Occurs when a spinal cord injury to the cervical and upper thoracic spinal cord causes a temporary interruption in the sympathetic innervation leaving parasympathetic innervation unopposed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

s/s of neurogenic shock 5

A

parasympathetic!!

immediate loss of autonomic and motor reflexes below the level of injury.

vasodilation

redistribution of blood volume

WARM DRY SKIN

BRADYCARDIA

HYPOTENSION

LOW HR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

hemodynamic findings for neurogenic shock

A

decreased MAP, CVP/RAP, and PAWP,
reduced preload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

goal of tx for neurogenic shock

A

to restore adequate tissue perfusion by correcting vasodilation and bradycardia using fluid, meds(atropine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

5 priorities for patient in neurogenic shock

A

spine immobilization THEN airway and ventilation

monitor vitals

give atropine for bradycardia

IV fluids and vasopressors for hypotension

assess skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

dopamine
MOA
admin
SE 2
monitor

A

acts on beta 1, beta 2 and dopaminergic adrenergic receptors to increase cardiac contractility and afterload(increases Bp in high doses due to vasoconstriction).

given through CL

tachycardia (good for neurogenic shock), dysrthyth.

MAP- if not 65, increase dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Norepinephrine
MOA
admin
monitor

A

potent alpha-adrenergic agonist. Vasoconstrictive, increases MAP with LITTLE CHANGE IN HR or cardiac output

CL

monitor urine output and kidney function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

phenylephrine
moa
admin
assessment prior
SE

A

alpha receptor drug leading to vasoconstriction without an increase in heart rate. but increases BP, cardiac output and SVR

infusion pump CL

assess HR, BP, RR, O2

bradycardia, dec pulses, temp and paresthesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

anaphylactic results in 5

A

vasodilation, bronchoconstriction, GI contractions, dec blood volume and smooth muscle contraction,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

s/s of anaphylaxis

A

wheezing,
dyspnea,
flushing,
uticaria,
nausea/vomiting,
diarrhea,
abdominal cramps,
palpitations,
dizziness,
hypotension,
tachycardia,
syncope,
anxiety,
feeling of impending doom.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

priority of nursing care for ana 5

A

maintain airway
O2
monitor BP and HR
Epi without delay
antihistamines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

epi moa

A

bronchodilation and vasoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

obstructive shock cause

A

impaired ventricular emptying due to pulmonary embolus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

s/s of obstructive shock due to PE

A

hypotension,
tachycardia,
chest pain
O2 <92
resp alkalosis
elevated d- dimer
oliguria
altered LOC

52
Q

hemodynamic findings of obstructive shock

A

inc HR, CVP, PAWP, SVR
dec BP, CO

53
Q

sign of tension pneumothorax

A

tracheal deviation

54
Q

cardiac tamponaude tx

A

periocardiocentesis to remove fluid

55
Q

tension pneumothorax tx

A

large needle or chest tube insertionq

56
Q

pulmonary embolus tx

A

thrombolytic therapy/surgery

57
Q

what to do after pericardiocentesis

A

they will have chest tube so make sure output is flowing good

58
Q

8 nursing actions for obstructive shock

A

assist with the pericardiocentesis or chest tube insertion.

Maintain patient safety

Continuously monitor HR, BP, RR, and pulse oximetry.

Administer oxygen as ordered.

Promote patient comfort and provide reassurance.

Perform baseline neurologic assessment

administer thrombolytics without delay for pulmonary embolus,

monitor for signs and symptoms of bleeding and coagulation lab values.

59
Q
A

1st degree heart block - prolonged and constant PR

look for drug toxicity because some meds can cause heart block

60
Q
A

2nd degree block- wenchebach

progressive lengthenning of PR until QRS id dropped caused by drug toxicity, heart disease, myocarditis, acute rheumatic fever

treat with atropine if asymptomatic

61
Q
A

2nd degree mobitz

CONSTANT PR interval

caused by drug toxicity, acute MI, vascular disease

treat with pacemaker

62
Q

counting atrial rate

A

p waves

63
Q
A

3rd degree block
complete AV dissociation
atrial rate > ventricular rate
caused by acute MI, drug toxicity

treat with pacemaker and maybe epi

64
Q

temp pacemaker

A

used in emergency situations,
after open-heart surgery,
acute anterior/inferior MI with heart block

65
Q

transvenous pacemaker

A

antecubital or central vein threaded to heart

66
Q

epicardial pacemaker

A

after heart surgery , wires out of sternal incision connected to generator

67
Q

transcutaneous pacemaker

A

through the skin with pads – least effective so used outside hospital or initially in ED until they can get another option

68
Q

permenant pacemaker

A

used in patients with acquired 2nd or 3rd degree heart block, bundle branch block, cardiomyopathy, heart failure, tachydysrhythmias, SA node dysfunction. Can be combined with an ICD (implantable cardioverter-defibrillator).

69
Q

nursing actions for pacemaker 5

A

ECG assessment

Assessment of the insertion site for bleeding/swelling/hematoma formation

Assess and address pain

Provide education/information
For temporary pacemakers,

adjust settings as needed

70
Q

failure to sense

A

pacemaker set to 70, you see 82 and spikes - inc sensitivity

71
Q

failure to capture

A

only see spikes- increase energy delivered

72
Q

over sensing due to

A

coughing and pacemaker firing- dec sensitivity

73
Q

failure to fire

A

change battery

74
Q

8 education for pacemakers

A

Check pulse
Notify hcp of bleeding and infection at insertion site usually happening at day 3
Can shower after 48 hours
Avoid heavy lifting and lifting arm for a month
Report Feeling shocks
No electronics or cell phones in pocket
Avoid metal detectors
Medical alert bracelet

75
Q

swan ganz/thermodilution catheter is used to

A

monitor preload (CVP/RAP, PAWP), afterload (SVR) and cardiac output.
and to to obtain cardiac output/index values (svo2) by thermodilution

76
Q

describe thermodilution

A

(cold NSS injected and catheter reads the time/temperature as the NSS moves through the heart to provide values).

77
Q

benefits of swan ganz catheter 4

A

monitors pressures, preload, give fluids, check CO

78
Q

pulm wedge pressure is

A

tells us preload for L side of the heart

79
Q

right ventricular pressure wave

A

spikes(contractions)

80
Q

pulmonary artery pressure wave

A

systole and diastole and continuous numerical readings

81
Q

pulmonary artery wedge pressure wave

A

inflate balloon here , wave dampens and it gives you number for pressure - then deflate baloon - if you see dampened wave and are not in PAWP notify hcp!!

82
Q

arterial line used for

A

continous BP monitoring and to draw blood

83
Q

swan ganz catheter consideration

A

leveled at phlebostatic aixs when patient is in supine position

84
Q

arterial catheter consideration

A

perform allens test prior to insertion in radial artery, and perform NV assessment of extremetities q shift

85
Q

general care for hemodynamic monitoring devices 9

A

aseptic
prime and flush with NSS/heparin
remove air bubbles
inflate pressure to 300
prevent kinks
monitor insertion site
connnect to transducer
zero system
perform square wave test

86
Q

4 steps to allens test

A

Compress the radial artery, then

Compress the ulnar artery and have the patient open and close their fist.

Release the ulnar compression and observe for blood return to the hand.

If ulnar compression is released and blood does not return to the hand, the radial artery should not be used for arterial line insertion.

87
Q

preload

A

volume of blood in the heart (specifically the left ventricle) at the end of diastole.

88
Q

afterload

A

force the right ventricle must generate to eject blood into the pulmonary vasculature and the left ventricle must generate to eject blood into the aorta (left ventricular resistance is systemic vascular resistance).

89
Q

cardiac output

A

volume of blood pumped by the heart in 1 minute.

90
Q

cardiac index

A

cardiac output adjusted for BSA.

91
Q

svo2

A

% of O2 bound to Hgb returning to the right side of the heart after the tissues have extracted what they need.

92
Q

2 measures of preload

A

CVP and PAWP

93
Q

CVP

A

reflects preload of the right side of the heart, normal 2-6 mmHg

94
Q

PAWP

A

reflects preload of the left side of the heart, normal 5-12 mmHg

95
Q

when is preload increased and decreased

A

Increased in fluid overload, CHF, pulmonary edema and cardiogenic shock

Decreased in hypovolemic shock

96
Q

measure of afterload

A

SVR - normal 800-1200 Dynes

97
Q

when is SVR increased and decreased

A

SVR may be increased initially in hypovolemic and septic shock as a compensatory mechanism, but then decreases

SVR remains increased in cardiogenic shock as a compensatory mechanism and due to circulating catecholamines

As SVR increases, cardiac output decreases

98
Q

cardiac output

A

Determined by Stroke Volume (SV) X Heart Rate (HR)

Normal 4-8 L/min

99
Q

when is cardiac ouput decreased

A

shock

100
Q

cardiac index

A

divided by BSA (body surface area) of the patient and is a more precise measurement of the pumping action of the heart. Normal 2.2-4 L/min

101
Q

MAP

A

Normal MAP is 70-105 mmHg, a minimum of 60 mmHg is needed to maintain perfusion to vital organs, and a MAP of 65 mmHg is usually the goal when vasopressors are administered.

102
Q

SVO2

A

Normal is 65-75%. Readings can help determine if the patient’s cardiac output and oxygen delivery are high enough to meet the patient’s needs.

103
Q

scvo2 and factors that affect it

A

levels are higher (3-11% higher) because they are not true ‘mixed’ samples.

cardiac output, hemoglobin levels, arterial oxygen saturation, oxygen demand.

104
Q

acute decompensated HF characterized by

A

development of dyspnea associated with rapid fluid accumulation in the alveolar and interstitial spaces of the lungs

105
Q

R ventricular filling causes

A

peripheral and organ edema

106
Q

L ventricular filling in HF causes

A

fluid to build up in the lungs and

107
Q

What lab study is particularly helpful in assessing heart failure? What are normal values and what other factors can affect this test?

A
108
Q

underlying cause of ADHF

A

either diastolic in nature (failure of the ventricle to relax and fill) or systolic in nature (failure of the ventricle to stretch and contract effectively).

109
Q

s/s of ADHF

A

same as cardiogenic shock except not always hypotension

110
Q

leading cause of mortaility among complications of ACS is

A

cardiogenic shock

111
Q

most common cause of cardiogenic shock

A

left ventricular failure following a MI

112
Q

s/s of cardiogenic shock

A

restlessness,
anxiety,
agitation.
Cyanosis,
pallor,
cool/clammy skin,
decreased capillary refill.
Tachypnea,
pulmonary congestion.
Decreased cardiac output (< 2.0 L/min) and cardiac index,

decreased BP < 90 mm Hg,

increased pulmonary artery wedge pressure (PAWP) > 18 mm Hg.

ABG with metabolic acidosis and hypoxia.

Serum lactate level > 4 mmol/L.

Reduced mixed venous oxygen saturation.

Decreased urine output,

Na/H2O retention.

Decreased bowel sounds/peristalsis.

113
Q

4 ways to improve cardiac output

A

Controlling heart rate
Decreasing preload
Decreasing afterload
Improving contractility

114
Q

how to control HR in cardiogenic shock

A

digoxin, calcium channel blockers, beta adrenergic blockers

115
Q

how to control dec preload and afterload in cardiogenic shock

A

nitroglycerin, nitroprusside, morphine and diuretics, and sodium restriction

116
Q

how to improve contractility in cardiogenic shock

A

inotropic medications: dopamine, dobutamine, digoxin, milrinone

117
Q

when are ACE and arbs used

A

when pt is recovering from HF and has reduced ejection fraction

118
Q

Nesiritide
use
moa
SE 5

A

for HF

inhibits ADH production and vasodilates which results in inc urine output, dec PAWP, dec preload and dec dyspnea

hypotension, arryhthm, circulatory collpase, electrolyte imbalance, renal insufficiency

119
Q

IABP (intra-aortic balloon pump)

A

improves cardiac output - counter-pulsation device, increases blood flow to the coronary arteries and decreases afterload

120
Q

impella

A

designed to propel blood to decrease the work of the heart

121
Q

ventricular assist device

A

takes over work of the ventricle to allow time for rest and healing, or as a bridge-to-transplant

122
Q

How does the nurse know if the mechanical intervention to improve cardiac output is effective?

What assessment findings would indicate improvement?

What assessment findings would indicate a complication?

A
  1. urine output, dec swelling, skin color, improved SOB and O2 stat, less crackles, improved LOC, not tachycardic

complications: pale skin/cyanosis/cool and clammy, bleeding, loss of pulses distal to device, altered labs

123
Q

nursing responsibilities for mechanical devices in cardiogenic shock 7

A

evaluating arterial pressure values and tracings (balloon inflates at the start of diastole and deflates before onset of systole).

Monitor for alarms indicating a leak or loss of augmentation.

Monitor for blood in the extender tubing.

keeping the head of the bed < 30 degrees and avoiding hip flexion.

Monitor urine output hourly.

Assess for complications – limb ischemia, bleeding, infection, and thrombocytopenia (patients are anticoagulated using heparin infusion).

Monitor hemodynamic status continuously.

124
Q

stroke volume

A

The volume of blood pumped out of the left ventricle of the heart during each systolic cardiac contraction.

125
Q

what affects stroke volume 7

A

reduced or increased preload
decreased contractility
decreased filling time
heart size
fitness level
gender
contraction duration

126
Q

normal CO value

A

4-8

CCN (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions