exam 4 cont Flashcards
60-100
sa node
40-60
av node
20-40
perkingje fibers
.12-.20 (>.20 = AV block)
pr
.04- .10
qrs
st depression
ischemia
st elevation
mi
if what is prolonged it can cause dysrhythmias
qt interval
analyzing strip what do you ask
o Rate- fast or slow?
o Rhythm- regular or irregular? (obtain fastest with counting QRS for 6 sec x 10)
o P waves- one before every QRS?
o QRS complex- do they look the same? Follow P wave?
sinus brady
atropine ; hr is <60
tachycardia
IV Adenosine or Lopressor (Metoprolol)
PSVT tx
vagal down first then IV adenocard, Cardizem, Digoxin, Amiodarone, Adenosine
a fib meds to slow the rate
Cardizem (Diltiazem), Metoprolol, Digoxin, Amiodarone, Synchronized Cardioversion,
a fib meds to anticoagulate
warfarin and heparin
pt: 11-14
ptt: 25-35
inr: 0.8-1.2
digoxin toxicity
n/v and halos
pulseless v tach
cpr and defibrillation ; unstable
pulse v tach
amiodarone ; stable
no cardiac out put
ventricular fib
tx for v fib
CPR, Defibrillation (d/t no pulse), ACLS Protocol, Amiodarone, Epi
important with heart failure
bnp
Represents the time to pass from the SA node through the atria & AV node to the ventricles.
pr interval
pr greater than .20 means
communication is no longer between SA node and AV node
5x5 on ekg is
.20 seconds
pr intervals should be how big on ekg
5 boxes. anymore than that=prolonged pr interval
analyzing the strips what 4 questions do you want to ask yourself
rate: fast or slow; count T wave
regular or irregular
p wave before QRS
do every QRS look the same and have a P wave before?
rate of 100 to 150
sinus tachy; normal rhythm just really fast
albuterol, dehydration, exercise, hypovolemic shock, fever, hyperthyroidism
sinus tachy
questions to ask every patient
dizzy/lightheadedness, LOC impaired, low bp, dyspnea, chest pain, hypotension
tx for sinus tachy
tx the cause. vasovagal response, iv adenosine or metoprolol but give a CCB instead
1 intervention for sinus tach
find the cause and fix the cause
150-250 hr
PSVT
Paroxysmal
means it starts and stops spontaneously
premature atrial contractions so p waves are abnormal
PSVT
Causes: caffeine, stress, stimulants, dig toxicity, CAD
PSVT
tx for PSVT
vagal response, adenosine, cardizem, digoxin, amiodarone
SLOW HR
when giving adenosine to PSVT pt what do you need to do
give it in a proximal IV because the half life is only 10 seconds; 18 gauge is better because the med will go in faster. RAPID IV PUSH FOLLOWED BY FLUSH
what do you do for a premature atrial contraction- PAC
wear a holter monitor
for healthy heart- no big deal
pt w underlying issue- should go see doc
tx:ccb
ventricular rate is 60-180
a fib
a fib- atrial is quivering
its not pushing all the blood through so blood sits and clots there then when the blood does move through it pushes the clot out to the rest of the body
why does a fib affect hr
ventricles are trying to keep up w the atria
tx for a fib
slow the rate and treat the clotting risks
anticoagulant for a fib
warfarin- takes 2-3 days to become therapeutic; pt goes home on this. INR
heparin- starts quick. people dont go home on this- ptt
tx for a fib
cardizem, digoxin, metoprolol, amiodarone, synchronize cardioversion ; cardioversion can be done with meds or with pads
a flutter
a little more of a contraction than a fib; less risk for blood clots
normal slow rhythm
sinus brady
meds that cause sinus brady
betablockers and ccb
crackles and fluid volume overload
think HEART FAILURE
med for sinus brady
atropine and oxygen
prolonged pr interval
1st degree heart block
how to treat first degree
usually no treatment but monitor for new changes; usually a precursor for dysrhythmia
Complete AV Heart Block Atrial and ventricular rhythms regular, but independent of each other
third degree heart block
third degree heart blocks will progress to
asystole
tx for third degree
transcutaneous pacemaker until transvenous pacemaker can be inserted. Atropine, epinephrine, dopamine.
post op for permanent pace makers
Don’t lift arm above head
Antibiotic therapy
Monitoring of rhythm
Pacemaker function checked frequently
premature ventricular contraction
like the pac but in the ventricles; QRS depression
not a problem in a healthy heart but if they happen more frequently or together then this is a problem
pvc
stable v tach
they have a pulse
unstable v tach
no pulse
v tach and no pulse
cpr and shock patient; epi /amiodarone
v tach and pulse
amiodarone and lidocaine
shockable rhythms
v tach no pulse and v fib
asystole
epi and cpr
will never have a pulse because there are no contractions
v fib ; shock/epi/cpr
drug of choice for ventricular dysrhythmias
amiodarone
how is amiodarone give
pulse- iv drip
no pulse- iv push
what to do for v fib
cpr, amiodarone, defibrillation, epi
pea
pulseless electrical activity
electrical shock
v tach and v fib
people who survive sudden cardiac death or dysrhythmias get
automatic implantable cardioverter defibrillator
Area that is causing dysrhythmias is burned
ablation
digoxin toxicity
potassium level
prolonged pr interval is what
an AV block
chronic heart failure weight gain
> 3-5lb in a week, >3lb in 2 days, or >2lb in a day
intervention for endocarditis
get blood cultures quickly
triggers for dvt
venous stasis, endothelial damage, hypercoaguability
immobility, obesity, long surgery, prolonged bed rest, varicose veins, heart failure, stroke
venous stasis
abdominal and pelvic surgery, trauma, indwelling catheter, iv meds, iv drug abuse, prior dvt, fractures of hip, leg, or pelvis
endothelial damage
pregnancy, estrogen therapy, oral contraceptives, cancer, inherited coagulopathies, antithrombin, polycythemia, dehydration
hypercoagulability
complications of dvt
pe; bleeding from thrombolytic therapy
what causes rheumatic fever
strep infections
intermittent claudication- pain triggered by exercise and relieved with rest, & thin shiny skin
PAD
5 p’s in pad
Pain, Pallor, Pulselessness, Paresthesia, Paralysis
intervention for aortic dissection
blood pressure control to prevent tear from getting worse
