Exam 2 Med Surg 3 Flashcards
1
Q
Nursing Intervention for ventricular fibrillation
A
- CPR
- Defrbrillate
- Crashcart to bedside
- Administer amiodarone IVP
2
Q
Causes for Sinus Tachycardia
A
inflammation, shock, hypovolemia, fever, PE, HF
3
Q
Repolarization is equal to
A
resting, filling
4
Q
What is the preferred alpha blocker for pheochromocytoma
A
phenoxybenzamine
5
Q
Teaching for Addisons disease
A
- fall prevention
- lifelong replacement therapy
- infection control
- mgmt of glucose with steroidds
6
Q
Causes for Brady Cardia
A
Beta Blockers, hypothyroid, hypothermia, amiodarone, PNS drugs
7
Q
What is a client’s level of consciousness for cardioversion
A
cawak and sedated
8
Q
QRS
A
ventricular depolarization
9
Q
Causes for Sinus dysrthmias
A
digoxin/morphine, autonomic dysfunction, diabetic neuropathy, slower HRs
10
Q
What should you think with an addiosnian crisis
A
severe hypotension and vascular collapse
11
Q
s/sx of hypoparathyroidism
A
parasthesia, muscle cramps,, fatigue, bone pain, insomnia
12
Q
Cardiac Output is low Sx
A
BP low, SOB, LOC, HR high, hypoactive, Dec Urine Output
13
Q
what does exercise do for blood sugar
A
lowers it, need less insulin
14
Q
What could a narrow QRS indicate
A
Sinus, Atrial, Junctional rhythm, PSVT
15
Q
First action for chest pain (MI, Angina)
A
EKG, ST wave will have and issue
16
Q
QRS Interval issues is a disturbance in
A
Bundle Branches, or Ventricles
17
Q
what is the purpose of ventricular defribllation
A
allows the SA node to resume the role of pacemaker in the heart.
18
Q
on EKG strip what does Afib look like
A
no P wave
19
Q
What is Afib
A
fourth of july in your SA node over Right Atrium
Risks: CVA, Mi, PE, DVT
20
Q
ST segment/ Twave
A
ischemia, injury, infarction, electrolyte imbalance
21
Q
Causes for Premature Atrial Complex
A
Infection, anxiety, alcohol, smking Caffeine
22
Q
Tx for Tachycardia
A
beta blockers, antipyretics, analgesics, fluid (dehydrated),
23
Q
Patient prep for EKG
A
no smoking or caffeine 24 hours bnefore, must lie still
24
Q
Pituitary Gland Anterior Lobe
A
Growth Hormone
25
Tx for Brady Cardia
Pacemaker, oxygen, epinephrine (don't give fluids) atropine
26
Atropine
SE- Myocardial Ischemia, antiarrythmic, increase HR
27
Normal range for P wave
0.06 - 0.12 seconds 3 squares
28
How do you treat PSVT
medication, adenosine, verapamil or beta blockers
Carotid Sinus Massage
29
Hypothyroidism and mental status
memory loss/confusion. Keep personal belongings in the same place.
30
How does Parathyroid regulat calcium in the blood
* Reaborption of Ca+ from bone
* Absorption of Calcium in the intestine
* Reasbroption of Calcium from kidneys
* *Decrease excretion of Ca+ in the urine*
31
How does defribllation differ from cardioversion
the sitch on the defibrillator is differemt
32
What are you looking for in the PR Interval
is there a block between conduction systems, less than 4-5 boxes??
33
Adrenal cortex is associated with
* Glucocorticoids- cotisol
* mineralocorticoids- aldosterone
34
Hypo thyroidism
* Myxedema (non-pitting), Hashimoto
* Cold, constipated, dry skin
* Tx: levothyroxine -**take in the morning**
35
3rd Degree AV BBB
twave and p-wave overlap, wide QRS, low HR
36
Post op Thyroidectromy
* Have suction, oxygen, trach available
* monitor repsirations
* Semi Fowler's position
* laryngeal nerve damage
* **hypocalcemia**
* thyroid storm
37
Normal Range for T Wave
0.16 seconds (4 squares)
38
Trigeminy PVC.
PVC after 2 normal QRS
39
Tx for Premature Atrial Complex
Beta Blockers, Reduce caffeine intake
40
Why is Cushings disease at risk for infection
* Decreased macrophage production
* antibodies decreased
41
What do calcium channel blockers?
helps vessel *relax*
42
What is clients level of consciousness with defibrillation
no cardiac output, unconscious, 200-360 joules
43
Treatment for Premature Ventricular Complex
Procainamide, Amiodarone, Lidocaine
44
What does Hyper Growth Hormone look like
Gigantism before puberty, Acromegaly, after puberty. Could be a tumor.
45
What is hypocortex
* Addisons
* hyperkalemia, hyponateriumia, low BP, dark pigment, dark nail
* postural hypotension
* *tx: corticosteroids, salt, aldosterone, IV fluids*
46
Paraoxysmal Supraventricular Tachy
Fast, Narrow QRS,
Regular Rhythm
**QRS & P wave 1:1**
47
What does Hypo ADH look like
* DI, hypopopituitary
* Hypokalemia, hypotension, thirsy
* tx: Vasopressin
48
Afib, No Pwave, & Irregular
300-650 bpm
49
What is the most accurate way to use an EKG to calculate the heart rate of the client with an irregular rate
Count QRS complexes for 1 minute time interval
50
What does parathyroid do?
Increase calcium
51
What three things associated with the adrenal glands?
Salt Sugar Sex
52
Precautions for levothyroixine therapy
* angina, or dysrhythmia (increase oxygen demand)
* prevent of med interactions, reduce dosase
* increase BS, DM)
53
what is a hypophysectomy
removal of pituitary gland
54
Effects of corticosteroid therapy
* hypokalemia
* peptic ulcer
* hypocalcemia
* BP increase
* protein depletion
55
Causes for Afib
necrosis, lung disease, ischemia, valve disease, dec CO,
56
s/sx of hypoparathyrdoid
numbness around the mouth, positive trousseau, tingling hands/feet
57
How to assess a patient w/ goiter
Stand behind them in posterior approach, use both hands on either side of trachea
58
59
assessments post op thyroidectomy
surgical site, trousseau's, chvosteks
60
Why does hyperclygemica lead to neuropathy
* schwann cells (sorbitol.fructose in the nerves, Ischemia in blood vessels
* reduced nerve conduction, dec suply nutrition to nerves
61
What is the mst common cause of cushing's syndrome
benign pituitary *adenoma*
62
each normal beat is followed by an abnormal one
Bigeminy/ Premature Ventricular Complex
63
Immediate tx for graves disease
propanolol, thionamide, glucocorticoids
64
Premature Ventricular Complex
Wide QRS/bizarre
No P wave
65
How does a pacemaker work
provides electrical stimuli to the heart muscle, stimulated to contract. If heart rate drops too *low*
## Footnote
*pacemaker spike before CRS comples*
66
Myxedema occurs..
low thyroid production, abrupt stop in medication, hypothermia, hypotension, hypoglycemia, bradycardia
67
Hypoparathyroid
* tx: calcium gluconate IV, Vit D,
* Cvostek, Trouseaus sign
* DONT DRINK MILK, also contains phosphorus
68
PR Interval is what part of the electro
Bundle of His
69
Defribrillation procedure similarities to Cardioversion
* placement over right sternal border and over apex of the heart--CLEAR perimeter
* require conductive materials to the chest
* operator applies 20-25 lbs pressure
70
How does cardioversion work
synchronized with qrs, 50-200 joules, *synch on*
71
What is the drug of choice for ventricular dysrhythmias
lidocais, suppresses ventricular ectopy
72
Supraventricular Tachycardia
Beardown, Ice pack to the neck
100-300BPM
73
During expiration the HR..
decreases
74
If a client has a complete heart block which intervention is first
administer atropine
75
Normal range for PR Interval
0.12 - 0.20 seconds
76
What is the priority for cardia dysrthythmias
decreased cardiac output
77
What does the PR Interval measure
onset of atrial depolarization to ventricular depolarization
78
what does hypo growth hormone look like?
dwarfism
79
Procainamide
decreases myocardial excitability, slows down conduction velocity
80
Corticosteroid therapy teaching
* Assess for cataracts
* avoid infected persons
* exercise
* protein, calcium potassium diet
* low fat and simple carbohyrdates
81
Causes for Premature Ventricular Complex
old age, anasthesia, electrolyte imbalance, caffeine, alcohol, ischemia
82
What does adenosine do?
slows conduction time through the AV node. coronary artery vaso**dilation**
83
What does RR Interval measure?
ventricular cardiac cycle
84
Anterior Pituitary Gland produce
ACTH, FSH, GH, Prolactin
85
Quadrigeminy
PVC after 3 normal QRS
86
What is not asscoiated with thryoidectomy
dehydration, hyperglycemia
87
Why do we increase fluids for someone with hyperparathyroidsm
risk for renal calculi
88
Premature Atrial Complex
PR Interval is shoerter.
89
In a 6 second strip how is the heart rate determine
the number of QRS complexes x 10
90
What does the medulla do?
release catecholamines- epi & norepi. SNS
91
What is amiodarone
used to treat *ventricular tachycardia* or *ventricular fibrillation*
92
What is a priority for DKA
fluid replacement
93
vtach
94
tx for Afib
Warfarin, Coumadin, Digoxin, Calcium Channel Blockers, Amiodarone
95
Hyper parathyroid
* bone decalcification, renal caclui, constipathy, dysrhthmyia, psych
* tx: calcitonin, fluids, activity, remove
96
PR wave is a disturbance in
AV node, bundle of HIS, bundle branches
97
hypoglycemia s/sxx
shakiness, anxiety, palpitations, coldness, hunger, irritable, confusion, headache
98
What could a wide QRS indicate?
Ventricular Tachycardia
99
What does ADH do?
increase H2O vasopressin
100
which electrolyte imbalance is associated with SIADH
hyponatremia (potassium within normal limits)
101
findings w/ fluid volume deficit
low plasma osmolality, low hematocrit (diluted), low specific gravity, low BUN, low sodium
102
What are the 5 steps for reading and ekg
1. Are there any P waves?
2. Are there any QRS?
3. Measure PR Interval
4. Rate
5. Rhythmn
103
What does the Thyroid do
* decrease Calcium, metabolism
* Increase protein and bone turnover
* Increase response to catecholamines
* Needed for fetal, infant growth
* chief complaint is difficulty swallowing
104
Posterior pituitary gland produce
ADH and oxytocin
105
Pituitary Gland Posterior Lobe
ADH
106
What else does the thyroid gland secrete, what does it do\>
* Calcitonin-
* response to high ca+
* more calcium in blood, *lower blood calcium levels*
107
Electrolytes in repolarization
potassium goes up, sodium goes down
108
Electrolytes in Depolarization
Sodium goes up, potassium goes down (exits intracellular)
109
QT Interval Normal Range
0.32 -0.4 seconds
110
Most common cause of hyperaldosteronism
adrenal adenoma or hyperplasia
111
SA Node rate
60-100 BPM = Pacemaker
112
P wave measures contraction of the
atrium
113
Normal QRS Interval
0.04 - .12 seconds (1-3 squares)
114
Normal Range for Specific Gravity
1.002 - 1.030
115
AV Node Rate
40-60 BPM
116
Whos is the border patrol in the Heart
AV node, blocks the heart rate from going too crazy. Heart is ichemic
117
2nd Degree AV node BBB
Weinkebach, Mobitz II, irregular PR, QRS disappears
118
Hypercortex
* Cushing's Disease
* moonface, buffalo hump
* Hyperglycemia, hypernatremia, hairy face
* tx: Potassium low surgar, exercise. Insulin NO, b/c dec potassium
119
Hyper Thyroidism
* Graves, Thyroid Storm, Goiter
* BP increase, hyperactive bowel, weight loss, bulging eyes
* tx: Blockers, removal, propythioracil, radioiodine
120
What is the first intervention for ventricular tachycardia
assess the client's apical pulse and BP
121
Depolarization is equal to
contraction, blood goes out
122
Each square in EKG represents how many seconds
0.04 seconds
123
What does obtundation mean
greatly reduced level of consciousness
124
Hypermedulla is?
* increased vitals, Pheochromocy**toma**
* tx: Beta blockers, alpha blockers, stress MGMT, removal
125
First Degree AV node BBB
PR interval is longer, Sa-AV node problem
126
During inspiratation the HR..
Increases
127
Signs of Hyperkalemia
* **M**uscle weakness
* **u**rine- oliguria
* **r**espiratory distress
* **d**ecreased cardiac contractility
* **E**KG changes
* **R**eflexes ,hyper/hypo
128
What is hyper ADH
* SIADH
* Specific Gravity will be high
* Low Na+
* CNS disorder
* Tx: Lasix, fluid *restriction*, hypertonic solution
129
s/sx of thyroid storm
fever, tachycardia, hypertensioin, tremors, agitation, vomiting, coma
130
AV block refers to
PR interval
131
T wave measure
ventricular repolarization, relaxtion
132
Diet for hypothyroidism
low calorie low fat
133
What are some causes for atrial flutter
septal defect. PE. Pericarditis, Congenital Heart Disease, Hyperthyroidism
134
What is the pacemaker of the heart?
SA node
135
Normal range for ST segment
0.12 (4 squares)
136
What is defbrillation used for?
emergency, Vfib, Vtach. Synch off
137
Teaching for Addison's Disease
* Medic Alert Bracelet
* avoid strenuous exercise (stress)
* Call physician before dental procedures
* Call for weakness or fatigue
138
Atrial Flutter
250-350 bpm
139
Common in endocrine imbalances?
changes in energy level and fatigue
140
What does TRF (Thryotropin Factor) do?
stimulates release of TSH, and prolactic release, decreases sex hormone (amenorrhea)
141
Patient position after thyroidectomy
semi fowler's with head supported on 2 pillows
142
Which complication post op parathyroidectomy
hypercalcemia
143
* Normal Sinus Rhythm
* Regular Rate
* Heart Rate 70
144
* Normal w/ PACs (2nd & 7th beat)
* irregular rate
* HR 70
145
* Sinus Bradycardia
* Regular Rate
* HR 50
146
* Atrial Fibrillation
* Irregular
* Heart Rate 60
* PRI- n/A
* QRS Interval 0.04 -0.06
147
* Atrial Flutter
* Regular Rate
* QRS 0.06
148
* Supraventricular Tachycardia
* Regular Rate
* HR 180
* QRS- 0.08-.10
149
* Aystole
150
If you can see p waves and rate looks fast, what does that mean
atrial tachycardia
151
Ventricular Fibrillation
152
Normal Sinus Rhthm w/ PVCs & 2 PVCs in a row or couplet
PVC's are wide and bizarre
irregular rate
153
* Ventricular Tachycardia
* HR 160
* Regular Rate
154
* Atrial Pacemaker
* Regular Rate
* PRI 0.20
* QRS 0.09-0.10
* HR 60
155
* Ventricular Pacemaker w/ Failure to capture
* HR 40-50
* Irregular
* QRS \>0.10
