Mark K lecture 3

Question 1

Positive inotropy

Answer 1

• Increase cardiac contractile force !
  Ventricles empty more completely !
  Cardiac output improved

Question 2

Positive chronotropy

Answer 2

• Increase rate of impulse formation at SA
  node ! Accelerate heart rate

Question 3

Positive dromotropy

Answer 3

• Increase speed that impulses from SA
  node travel to AV node (increase
  conduction velocity)

Question 4

Negative inotropy

Answer 4

• Weaken/decrease the force of myocardial
  contraction

Question 5

Negative chronotropy

Answer 5

• Decrease rate of impulse formation at the
  SA node ! decelerate heart rate

Question 6

Negative dromotropy

Answer 6

• Decrease speed that impulses from SA node
  travel to AV node (decrease conduction
  velocity)

Question 7

CCBs (Calcium channel blockers) are like

Answer 7

Valium for the heart
* They relax and slows down the heart
* In other words, CCBs have negative inotropic, chronotropic, dromotropic effects on the heart

Question 8

Calcium channel blockers uses

Answer 8

Antihypertensive
AntiAnginal drugs (decreasing oxygen demand)
AntiAtrialArrhythmia

Question 9

Side Effects

Answer 9

Headache and hypotension

Question 10

CCB Name: ends in

Answer 10

“dipine” … Not “pine”
* Also, verapimil, Cardizem (diltiazem)
* Cardizem (diltiazem) is given continuous IV drip

Question 11

What are the parameters to assess before putting a pt on CCBs?

Answer 11

• Assess for BP
• Hold if SBP <100

Question 12

A lack of QRS complexes is

Answer 12

is asystole—a flat line

Question 13

P waves (atrial) in the form of saw tooth wave

Answer 13

atrial flutter

Question 14

Chaotic P wave patterns

Answer 14

atrial fibrillation

Question 15

Chaotic QRS complexes

Answer 15

ventricular fibrillation

Question 16

Bizarre QRS complexes

Answer 16

ventricular tachycardia (v-tach)

Question 17

Periodic wide bizarre QRS complexes

Answer 17

PVCs

Question 18

Lethal arrhythmias are high priority

Answer 18

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

Question 19

Potentially Lethal Cardiac Arrhythmia

Answer 19

V-tach (ventricular tachycardia) is a potentially lethal cardiac rhythm but it has a CO

Question 20

treatment of ventricular arrhythmia

Answer 20

Lidocaine, Amiodarone

Question 21

Supraventricular arrhythmias are

Answer 21

Atrial arrhythmias

Question 22

Treatments of Supraventricular arrhythmias

Answer 22

“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)

Question 23

Beta-blockers treat “A, AA, AAA”

Answer 23

• Antihypertensive
• AntiAnginal drugs (decreasing oxygen demand)
• AntiAtrialArythmia
• Side Effects = Headache and hypotension

Question 24

Treatment of V-fib and Asystole

Answer 24

• Defib for V-fib (Defib = defibrillate = Shock em!)
• Epinephrine and Atropine for Asystole

Question 25

In a pneumothorax, chest tube removes

Answer 25

air

Question 26

In a hemothorax, chest tube removes

Answer 26

blood

Question 27

In a hemopneumo- thorax, chest tube removes

Answer 27

air and blood

Question 28

Where should the chest tube be placed?

Answer 28

* Apical (top) or Basilar (base) * Apical chest tube removes Air * Basilar chest tube removes Blood or fluid (due to gravity)

Question 29

Always assume trauma and surgery is (in regards to sides affected in pneumothorax)

Answer 29

unilateral unless otherwise specified

Question 30

If the water seal of the chest tube breaks

Answer 30

* 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

Question 31

If a chest tube gets pulled out ...

Answer 31

1.Take a gloved hand and cover the opening (first step) 2.Take a sterile Vaseline gauze and tape 3 sides (best step)

Question 32

Chest tube is bubbling ask the 2 following questions

Answer 32

where it is bubbling, and (2) when it is bubbling?

Question 33

Rules for clamping tubes

Answer 33

* 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

Question 34

What congenital heart defects are Trouble?

Answer 34

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

Question 35

TRouBLe

Answer 35

“TRouBLe” congenital heart defect * “TRouBLe” shunts blood Right to Left * “TRouBLe” is Blue (cyanotic) * All “TRouBLe” start with the letter “T”

Question 36

four defects of Tetralogy of Fallot — “PROVe”

Answer 36

* Pulmonary artery stenosis * RVH (right ventricular hypertrophy) * Overriding aorta * VSD (ventricular septal defect)

Question 37

Contact precautions

Answer 37

* 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

Question 38

Droplet precautions

Answer 38

* 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)

Question 39

Airborne precautions “Air MTV”

Answer 39

* MMR * TB * Varicella (chickenpox)

Question 40

PPE (Personal Protective Equipment) * Order to put in on

Answer 40

o Gown o Mask o Goggle o Gloves

Question 41

Order to take it off

Answer 41

o Gloves o Goggle o Gown o Mask