Mark K lecture 3 Flashcards
Positive inotropy
- Increase cardiac contractile force !
Ventricles empty more completely !
Cardiac output improved
Positive chronotropy
- Increase rate of impulse formation at SA
node ! Accelerate heart rate
Positive dromotropy
- Increase speed that impulses from SA
node travel to AV node (increase
conduction velocity)
Negative inotropy
- Weaken/decrease the force of myocardial
contraction
Negative chronotropy
- Decrease rate of impulse formation at the
SA node ! decelerate heart rate
Negative dromotropy
- Decrease speed that impulses from SA node
travel to AV node (decrease conduction
velocity)
CCBs (Calcium channel blockers) are like
Valium for the heart
* They relax and slows down the heart
* In other words, CCBs have negative inotropic, chronotropic, dromotropic effects on the heart
Calcium channel blockers uses
Antihypertensive
AntiAnginal drugs (decreasing oxygen demand)
AntiAtrialArrhythmia
Side Effects
Headache and hypotension
CCB Name: ends in
“dipine” … Not “pine”
* Also, verapimil, Cardizem (diltiazem)
* Cardizem (diltiazem) is given continuous IV drip
What are the parameters to assess before putting a pt on CCBs?
- Assess for BP
- Hold if SBP <100
A lack of QRS complexes is
is asystole—a flat line
P waves (atrial) in the form of saw tooth wave
atrial flutter
Chaotic P wave patterns
atrial fibrillation
Chaotic QRS complexes
ventricular fibrillation
Bizarre QRS complexes
ventricular tachycardia (v-tach)
Periodic wide bizarre QRS complexes
PVCs
Lethal arrhythmias are high priority
Asystole and V-fib (ventricular fibrillation)
Both rhythms produce low or no cardiac output (CO), without which there is inadequate or
no brain perfusion. This may lead to confusion and death
Potentially Lethal Cardiac Arrhythmia
V-tach (ventricular tachycardia) is a potentially lethal cardiac rhythm but it has a CO
treatment of ventricular arrhythmia
Lidocaine, Amiodarone
Supraventricular arrhythmias are
Atrial arrhythmias
Treatments of Supraventricular arrhythmias
“ABCDs”
* Adenocard (Adenosine) … Fast IV push (push in less than 8 seconds and 20 mL NS flush
right after) … These pts will go into asystole for about 30 seconds and out of it
* Beta-blockers (end in -olol)
* CCBs
* Digitalis (digoxin), Lanoxin (another digitalis analog)
Beta-blockers treat “A, AA, AAA”
- Antihypertensive
- AntiAnginal drugs (decreasing oxygen demand)
- AntiAtrialArythmia
- Side Effects = Headache and hypotension
Treatment of V-fib and Asystole
- Defib for V-fib (Defib = defibrillate = Shock em!)
- Epinephrine and Atropine for Asystole
In a pneumothorax,
chest tube removes
air
In a hemothorax,
chest tube removes
blood
In a hemopneumo-
thorax, chest tube removes
air and blood
Where should the chest tube be placed?
- Apical (top) or Basilar (base)
- Apical chest tube removes Air
- Basilar chest tube removes
Blood or fluid (due to gravity)
Always assume trauma and surgery is (in regards to sides affected in pneumothorax)
unilateral unless otherwise specified
If the water seal of the chest tube breaks
- Clamp
o Clamping, unclamping, and placing the tube under water must be done in 15 seconds or
less - Cut the tube away
- Submerge (stick) the end of the tube under sterile water
o The most important step - Unclamp the tube if it was initially clamped, (clamping the tube prevent air to get into the
chest but does not allow anything from the chest to get out
If a chest tube gets pulled out …
1.Take a gloved hand and cover the opening (first step)
2.Take a sterile Vaseline gauze and tape 3 sides (best step)
Chest tube is bubbling ask the 2 following questions
where it is bubbling, and (2) when it is bubbling?
Rules for clamping tubes
- Do not clamp a tube for more than 15 seconds without a physician’s order
- Use rubber tooth (will not puncture tubing), double clamps
- Therefore, when the water seal breaks, the nurse has no more than 15 seconds to clamp, cut
the tube, submerge it under sterile water, and then unclamp it
What congenital heart defects are Trouble?
o Tetralogy of Fallot
o Truncus arteriosus
o Transposition of the great vessels
o Tricuspid atresia
o Totally anomalous of pulmonary vasculature (TAPV)
o Except, Left ventricular hypoplastic syndrome
TRouBLe
“TRouBLe” congenital heart defect
* “TRouBLe” shunts blood Right to Left
* “TRouBLe” is Blue (cyanotic)
* All “TRouBLe” start with the letter “T”
four defects of Tetralogy of Fallot — “PROVe”
- Pulmonary artery stenosis
- RVH (right ventricular hypertrophy)
- Overriding aorta
- VSD (ventricular septal defect)
Contact precautions
- Anything enteric (GI, or fecal/oral)
o C. diff., Hepatitis A, E. coli, cholera, dysentery - Staph
- RSV (droplets fall onto object then pt touches object or put it in mouth)
Do not cohort 2 RSV pts unless culture and symptoms say that have the same disease - Herpes
Droplet precautions
- For bugs travelling on large particles through Coughing, Sneezing to less than 3 feet
- Meningitis
- H. influenza b
o Example: epiglottitis (nothing in the throat)
Airborne precautions “Air MTV”
- MMR
- TB
- Varicella (chickenpox)
PPE (Personal Protective Equipment)
* Order to put in on
o Gown
o Mask
o Goggle
o Gloves
Order to take it off
o Gloves
o Goggle
o Gown
o Mask
