Exam One Key Points Flashcards
What leads look at the heart from the Right inferior portion?
Lead I, III, aVF
I- look form the right shoulder to the left shoulder
II- connects the lead on the right to the chest
III- connect the lead on the left shoulder to chest looking at the right ventricle
avf( unipolar)
These leads look primarily at the left ventricle/Anterior portion of the heart
V2, V3, V4
What are the 4 key factors for transmission of electrical impulses
Automaticity, Excitability, Conductivity, and Contractility
can you have an electrical conduction without mechanical ventilation?
Can you have mechanical contraction without electrical conduction?
Yes.
NO.
Electrical activity always precedes mechanical contraction
What is the Gold Standard for ECG recording?
5 lead ECG
How do we calculate the rate on a ECG strip ? PR interval? QRS complex? QT interval
P waves x 10 or
R wave x 10
PR interval= tiny square x 0.04 (0.06-0.10s)
QRS = small square from beginning to end of QRS x 0.04
QT = beginning of QRS complex to end of T wave x 0.04
What is occurring if a pt has 3 pvc in a row
Ventricular Tachycardia
Interpret the pacing code: AVI
The pace is located in the atrial, sensing in the ventricle, and Inhibits (does nothing as long as the HR falls within a set number
what is describes the HR falling below the set number and the pacemaker not responding
Failure to pace. The nurse must report!
This occurs if a pacing spike is not followed by a mechanical contraction
Failure to capture
Pacing spike should always be followed by a complex . Can be caused by electrolyte imbalance and hypoxia
A new nurse is caring for a patient with a new intra-arterial blood pressure monitor upon admission to the cardiac unit what with the first action the nurse must take? Can the new nurse inflate or remove the catheter, can she administer meds through the catheter?
The nurse needs to assess the insertion site FIRST. No gauze at the insertion site to visualize and palpate to ensure no hematoma (firm and palpable), assess distal extremities of the catheter. The nurse can remove the catheter if ordered NOT inflate. The nurse will NEVER administer meds into the arterial line!
What are the normal values for hemo dynamic monitoring?
CVP, CO, PAP, MAP, PAOP
CVP= 2-6 CO= 4-8 PAP= 15-30/10-15 MAP=90-100 PAOP= 4-12
What 4 things are cardiac output influenced by?
HR (speed), Preload (volume), Afterload (resistance), and contractility
What is important nursing consideration after placement of CVP monitor . What will the nurse do if a pt is experiencing an air embolus following CVP monitor placement
Chest x-ray must be performed. The nurse will place the patient in Left lateral trendelenburg in an attempt to trap the air.
The nurse is caring for a patient with an intra-aortic ballon pump and notices blood in the tubing. what is the priority action for the nurse.
The nurse needs to STOP the pumping and Call the MD. The patient needs to be places in a left lateral trendelenburg position. The bleeding in the tubing indicates balloon perforation
While caring for a patient on acardiac floor the nurse notices the pateint HR is 54 and has a bp of 96/64, cool clammy skin, and changes in their mental status. What atrial dysrhythmia is the patient experiencing and what will the nurse need to administer
The patient is experiencing bradycardia. Since the patient is symptomatic the nurse will administer ATROPINE 0.5mg IV to increase the HR other interventions include oxygen, transcutaneous pacing, dopamine and epinepherine. If the patient was asymptomatic the nurse would leave the patient alone!!
What are the top 2 priorities for a patient in a-fib
1.) control the rate
-Amioderone, bb, ccb, tikosyn
2.) prevent embolus
-eliquis, preadaxa, etc
Synchronized cardioversion will NOT be performed if clots are present
The nurse notices this rhythm on the monitior
^^^^^^^^^^^^^^^ (shark tooth). what is the rhythm and what will the nurse do?
The patient is in V-tach (ventricular tachycardia). The nurse will check the carotid pulse, if no pulse is present the nurse will START CPR then defibrillate to save the life. If the patient has a pulse the nurse will administer the antidysrhythmic amioderone and perform a synchronized cardioversion
The nurse finds the patient with this rhythm on the monitor ____________ (flat line) the patient has no pulse or perfusion. what is priority
The nurse can only perform CPR administer EPI and antidysrhythmics
NOT SHOCKING WITH ASYSTOLE
A patient that has chest pain with moderate to prolonged exertion relieved with rest and/or nitroglycerine most likely has what condition?
This patient likely has chronic stable angina
This patient has chest pain that occurs at exertion and rest with severe activity limitation. What does the patient have and can this patient with this condition control it with nitro
This patient has unstable angina pectoris which is NOT relieved by Nitro.
This patient has ST elevation in two leads on ECG and cardiac enzymes present, what is the patient experiencing.
STEMI- ST elevation myocardial infarction. A rupture of plaque with thrombus formation at site of rupture causing 100% occlusion of coronary artery
For a patient admitted with complaints of chest discomfort what should be obtained within 10 min of patient presentation?
A 12 LEAD ECG should be obtained within 10min
After obtaining a 12 lead ECG the patient has changes in leads V1 and V2 what location is the complication? What are the other areas assess for complication
This patient has changes in the septal location= leads v1,v2, s/s of left sided Hf Other areas include: Anterior: V3,V4 = left Hf Lateral: V5,6,avL,1 = Left HF Inferior: II, III, avf = right HF
A patient with chest pain and a suspected clot must be receive PCI intervention within what time frame? What is priority following PCI, what are signs of reocclusion?
90 MIN !! Door to balloon time = 90 min!!
The first priority is to monitor the insertion site for ANY bleeding. Signs of reocclusion include chest pain and ST elevation
While caring for a patient following a CABG with a chest tube drain you noitce drainage of 180mL in the first hr. What will the nurse need to do?
The nurse will need to notify the physician! Report if drainage >150ml in 1 hr. The nurse may need to autotransfuse blood back or give blood production.
What is Beck’s Triad? What could these signs indicate
Distant heart tones, decreased arterial blood pressure, and distended jugular veins. This could indicate cardiac tamponade
What are interventions for acute decompensated HF?
Unload Fast: Upright position (high fowlers-legs down) Nitrates (reduce preload) Lasix (reduce preload) Oxygen ACE inhibitors (reduce afterload) Digoxin (increase contractility) Fluids Afterload (decrease) Sodium Restriction Tests
What is the first symptom of mitral valve stenosis?
Pulmonary congestion and right sided HF. With the valve complication think back flow. With mitral valve complication it goes to the lungs. With aortic valve complication is affects the LV
A patient enters with ER with a pulsating abdominal mass then has sudden severe pain in the back of lower abdomen. What is the patient experiencing and what will the nurse need to do?
The patient has an abdominal aortic aneurysm rupture and will need emergency surgery. Following surgery the nurse will need to monitor for s/s of bleeding, covert signs of bleeding include complaints about back pain, the pt will also need to keep the legs straight and assess for changes in the pulses, cool extremities, sever pain.
What patient are at risk of infective endocarditis? What is a key manifestation?
Patient with recent dental procedures, patient with skin rashes, lesions, abscesses, surgery or invasive procedures, IV drug uses, valve replacement, systemic infections or structural cardiac defects. A key manifestation is petechiae on the mucous membranes, palate, conjunctive, and skin above the clavicles.
A patient with positive blood culture, new regurgitant murmur, and evidence of endocardial involvement on echocardiogram has what?
Infective endocarditis! Please No Endocarditis Positive BC New murmur Endocardial involvement on echo
How much protein can a patient with chronic kidney disease have? acute kidney injury?
The patient can have up to 60g/day if the patient is receiving dialysis. A patient with acute kidney injury can have 40g/day, carbohydrates are encouraged
This type on acute kidney injury is caused by an insult before the blood reaches the kidney, is this reversible? What are the other 2 types?
This is prerenal and is cause by hypoperfusion, sever blood loss, renal artery stenosis or thromboemboli and is reversible.
The other 2 types include
intrarenal- cause by toxic insults at the site of the nephrons which injure the glomeruli and tubules.
Postrenal-occurs below the kidney dies to a disruption of flow or obstruction and include things such as kidney stones, prostatic disease, and neurogenic (paralysis).
