MED/SURG EXAM #2 Flashcards
What is the purpose of cardiac rehabilitation?
safe activity/restore, but will not undo damage
Patient has a new onset of chest pain, what is the first priority nursing action?
EKG
What type of order will you question if patient has heart failure?
Prescription for fluids in general
Patient has PVCs + you auscultate HR for 1 full minute. What are you listening for?
Listening for irregular heartbeat
Patient has VFIB + pulseless + apneic. What do you do?
Defibrillate/CPR
NOTE: “if VFIB, DEFIB”
Interventions used for heart palpitations + VTACH
Cardioversion
S/Effects of diuretics with heart issues + K
with K –> watch for fatigue, cramps, weak/achy muscles
AFIB manifestations
– Heart is not regular
– No E
– Dizziness
Distinguish between ventricular depolarization + ventricular repolarization
– Ventricular depolarization + activation is represented by the QRS complex
– Ventricular repolarization is expressed as the interval from the beginning of the QRS complex to the end of the T wave (QT interval)
Component of the electrical sequence component
______________
P-wave
PR Interval
QRS Complex
ST Segment
T-wave
P-wave: Firing of the SA node + depolarization of the atria
_____________
PR Interval: delay of the electrical impulse @ the AV node + depolarization of the atrium
_________________
QRS Complex: ventricular depolarization
– Q-wave: 1st negative deflection
– R-wave: 1st positive deflection
– S-wave: 2nd negative (-) deflection
_____________________
ST Segment: the beginning of ventricular repolarization. Should be isoelectric (flat @ baseline)
____________________
T-wave: ventricular repolarization
HYPOkalemia on an EKG vs. HYPERKalemia on EKG
HYPOK+
– Tall p-waves
– Flattened t-wave
– Widened QRS complex
– Prominent j-waves
– ST-segment depression
– a prolonged QT interval
– Premature ventricular contraction
– Ventricular tachycardia
– Torsade de Pointes
_____________
HYPERK+
– Peaked t-waves
A K+ level of 8.0 would commonly be associated with which ECG finding?
T-wave merging w/ QRS
U-wave
Delta wave
Flattening T-wave
T-wave merging w/ QRS
U-wave
Delta wave
Flattening T-wave
ECG Readings for:
HYPOK+
HYPERK+
HYPOCa2+
HYPERCa2+
HYPOK+ –> long QU interval; prominent U-wave
HYPERK+ –> peaked t-waves
HYPOCa2+ –> QT prolongation
HYPERCa2+ –> shortening of the ST segment
HYPOkalemia on EKG/ECG
– Increase of P wave size and duration.
– PR interval prolongation.
– QRS complex widening.
– QT interval prolongation.
– T wave amplitude decrease or inversion (“flattening”).
Causes U waves!
HYPERkalemia on EKG/ECG
– Normal P wave
– PR interval prolongation.
– QRS duration increases with shortened QT intervals.
– Peaked T waves with a narrow base (best seen in precordial leads).
HYPERcalcemia on EKG/ECG
– QRS complex widening.
– QT interval shortens.
HYPOcalcemia on EKG/ECG
– QRS complex narrows.
– QT interval lengthens
HYPERmagnesemia on EKG/ECG
– PR interval prolongation.
– QRS widening.
– Q-T interval increase.
HYPOmagnesemia on EKG/ECG
Moderate depletion:
– QRS widening.
– Peaked T waves.
Severe depletion:
– PR interval prolongation.
– T wave decrease in amplitude.
– Atrial arrhythmia.
– Ventricular arrhythmia.
How should patient be lying 4hrs after cardiac catheterization?
Still, lying flat (up to 6hrs), DO NOT bed surgical leg
Dietary restrictions for heart failure + cardiac patients
– < 1,500mg of Na+
– Less red meat, more fish, fruits, and veggies
– Shredded wheat has less Na+ than yogurt
– Plain rice, pasta, oatmeal
Foods with fat animal vs. non-animal
Animal-based: milk, egg, liver (high in cholesterol)
Non-animal (good fats): avocado, soy, lentils
Herbals that interact with cardiac drugs
Dabigatran = injectable anticoagulant; Tx DVTs + PEs; like Xeralto
How to monitor Dabigatran
anticoagulant + inhibits factors IIa
Thrombin time to test for residual drug. Dilute thrombin time to assess extent of anticoagulation or test for residual drug
Common herbals that interfere w/ blood clotting
– Aloe
– Cranberry
– Garlic: lower BP, prevent age-related CVDs, reduce lipids & body weight control
– Ginkgo
– Meadowsweet
– Turmeric
– Feverfew: used to tx migraine H/A, arthritis, GI d/o, allergies, fever|
can potentiate to cause bleeding
Lab values for Warfarin vs. Coumadin
Warfarin (Coumadin)
– pT =
– INR = 2.0-3.0
Heparin
– PTT
– anti-factor Xa
LMW Heparin
– Anti-factor Xa (if needed)
Symptomatic bradycardia treatment
Atropine sulfate
1st dose: 1mg IV bolus Repeat q3-5 minutes. Max total dosage: 3mg
S/Sx thrombus
Warm, painful, swollen
Cardiac catheterization post-op what to monitor
– Lie flat for 6hrs
– Check for bleeding, pulses
– Legs remain extended (do not bend on surgical side)
Define a heart murmur
Whoosh, turbulent blood flow
Define AFIB manifestations
irregular rhythm
PAD + toenails manifestations
Hard/thick, shiny legs, cold/cool legs with pain @ rest, clubbing
Angina pectoris manifestations + triggers
Less than 15min w/ pain to the L arm, jaw/back = MI
– Triggers: stress, exertion on exercise
Right-side ventricular failure (heart failure)
Ascites = liver problems
Dosage calculations
Order: 1mg/kg/dose + Patient is 185lb
Available: 1mg/84.1kg
185lb/2.2kg = 84.9kg –> 84.1kg
Order: 1600units/hr
Available: 25,000 units in D5W in 500mL
(500mL/25,000units) x (1600units/1hr) = 32mL/hr
Coumadin + Heparin @ same time
Want the INR to increase to stop the Heparin
Furosemide + HCTZ + Metolazone vs. Spironolactone
Furosemide, HCTZ, Metolazone = K-wasting
Spironolactone = K-sparing diuretic = wastes Na+, increase K
Drugs that cause orthostatic hypotension
–Sartans
–Diloxetine
–Furosemide
–Clopidrel = DOES NOT cause this
Interventions for cardiac ECG
– Asystole –> CPR + epinephrine
– VFIB –>
– VTACH = peaks + troughs WITH pulse –> vagal then cardioversion
– Torsades de Pointes = Magnesium
What to look for STEMI vs. NSTEMI
STEMI = “Fireman/Pharrell hat”
NSTEMI = ST-segment depressions and/or T-wave inversions
PAD S/Sx
Cold, intermittent claudication
Cholesterol lab values
Total cholesterol: <200mg/dL
LDL: <100mg/dL
HDL: >60mg/dL
Triglycerides: <150mg/dL
Glucose: 70-100mg/dL
Endocarditis interventions
– PICC/central line needed (especially for chemo patients)
– Antibiotics (ABX)
Chronic venous insufficiency S/Sx + Interventions
PVD
Warm, edema (wet, sappy wounds)
Interventions: rest feet UP, browny color, wear stockings
Propranolol
Dopamine
Propranolol = masks HYPOglycemia
Dopamine = increases BP
