Med Surge chapters 24, 25, and 26 Flashcards
Sinoatrial (SA) node
75 to 100 beats per minute
Atrioventricular (AV) node
40 to 60 beats per minute
Bundle of His
a continuation of the AV node
carries electrical signals from the AV node to the bundle branches.
Purkinje fibers
a diffuse network of conducting strands .
spread the wave of depolarization through the ventricles
purkinje fibers can act as the pacemaker with a rate between 20 and 40 beats/min (when SA and AV nodes fail)
Cardiac Cycle
One heartbeat
Electrical representation of contraction and relaxation of atria/ventricles
Electrocardiogram (ECG)
Shows cardiac electrical activity.
Isoelectric Line
Baseline
Seen with no electrical activity
Straight line produced
P wave
First wave
Represents atrial depolarization
P R interval
Beginning of P wave to beginning of Q R S complex
QRS complex
Follows P wave
Q wave first negative (downward) deflection
R wave first positive (upward) deflection
S wave second negative deflection
Q,R,S waves are not…
present every time.
this represents ventricular depolarization
T wave
Ventricular repolarization
Follows Q R S complex
Q to T interval
Beginning of Q wave to end of T wave
Varies based on gender, heart rate, age
Prolonged or shortened Q T interval can lead to ventricular arrhythmias
U wave
Rare
Indicates hypokalemia
After T wave
what is an Arrhythmia?
disturbance in the rhythm and conduction
Sinus Bradycardia
s/s and treatment
fatigue or fainting
None if asymptomatic
treatment:
Oxygen, atropine, dopamine or epinephrine, pacing
sinus tachycardia
s/s and treatment
Angina or dyspnea (Older adults are more sensitive)
Therapeutic interventions
Medications
Adenosine, beta blocker, calcium channel blocker
Atrial Arrhythmia
Premature atrial contractions (P A C’s)
Atrial flutter
Atrial fibrillation
Premature Atrial Contractions therapeutic interventions
Treat cause
Beta blocker
Atrial Flutter Signs and symptoms
if the ventricular rate normal
None
if a rapid ventricular rate is present then
Palpitations, angina, dyspnea
therapeutic interventions for atrial flutter
Cardioversion for rapid ventricular rate Rapid atrial pacing Calcium channel blocker Beta blocker Catheter ablation
Atrial Fibrillation
Signs and symptoms
Palpitations
Faint radial pulse
Atrial Fibrillation therapeutic interventions
Synchronized cardioversion if unstable Medications Beta blocker Calcium channel blocker Digoxin Anticoagulation Ablation (after anticoagulation) Surgical maze procedure
causes of Third-Degree Atrioventricular Block
Coronary heart disease
Myocardial infarction
Digoxin
Aging
symptoms of Third-Degree Atrioventricular Block
Dizziness Syncope Fatigue Shortness of breath Chest pain Hypotension Diminished or absent peripheral pulses
Third-Degree Atrioventricular Block Therapeutic interventions
Medical emergency Supportive care to treat symptoms Atropine considered Temporary pacemaker Permanent pacemaker possibly for lifetime
Ventricular Arrhythmias
abnormal heart rhythms that make the lower chambers of your heart twitch instead of pump.
ex. Premature ventricular contractions (P V C’s), Ventricular tachycardia , and Ventricular fibrillation
Premature Ventricular Contractions
s/s
Palpitations
Fatigue, dizziness, severe arrhythmias
Premature Ventricular Contractions Therapeutic interventions
Antiarrhythmics
Amiodarone I V
Beta blocker
Lidocaine
Ventricular Tachycardia
s/s
Dyspnea Palpitations Lightheadedness Angina Cardiac arrest
Ventricular Tachycardia
Therapeutic interventions
If pulseless V T
C P R, defibrillation, epinephrine, amiodarone, lidocaine
If stable
Antiarrhythmics
Ventricular Fibrillation
Signs and symptoms
Unconscious No heart sounds, peripheral pulses, blood pressure Respiratory arrest Cyanosis Pupil dilation
Ventricular Fibrillation
Therapeutic interventions
Advanced cardiac life support (A C L S) protocols Immediate defibrillation C P R Epinephrine, amiodarone, or lidocaine Endotracheal intubation and oxygen
asystole signs and symptoms
Unconscious No heart sounds, peripheral pulses, blood pressure Respiratory arrest Cyanosis Pupil dilation
asystole therapeutic regimen
CPR ACLS protocols Endotracheal intubation with oxygen Epinephrine Treat cause
Cardiac Pacemakers
Generate an electrical impulse
Traditional types
External and temporary
Internal and permanent
Cardiac Pacemaker Problems
Failure to sense
Failure to pace
Failure to capture
Nursing Care for Pacemakers
Monitor ECG.
Monitor apical pulse.
Monitor for symptoms.
Patient Pacemaker Education
Incision care Activity restrictions Symptoms or infection signs to report Pacemaker I D card Periodic pacemaker checks
Defibrillation
Electrical shock to reset lethal ventricular arrhythmias
Must announce “clear” for safety
Synchronized Cardioversion
Used in arrhythmias if R wave present
Sedation used
Low energy: 25 to 50 joules
Automatic External Defibrillator
Automatically analyzes rhythms
Automatically delivers or prompts operator to deliver electrical shock if shockable rhythm (V-Fib or V T) detected
Nursing Diagnoses for Arrhythmias
Decreased Cardiac Output
Anxiety
On the ECG paper, one small square is equal to how many seconds of time?
- 0.02 seconds
- 0.04 seconds
- 0.20 seconds
- 0.40 seconds
Correct Answer: 2
causes of Angina Pectoris
atherosclerosis, blood clots, and poor blood flow
place the Cardiac conduction system in order
- atrioventricular node
- bundle of his
- internodal tracts
- purkinje fibers
- sinoatrial node
- sinoatrial node
- internodal tracts
- atrioventricular node
- bundle of his
- purkinje fibers
sinus bradycardia
low heart rate may be normal for people who are athletes
treatment will be necessary if client is symptomatic
-hold a medication
-oxygen
-atropine sulfate
-pacemaker
Notify The RN
atrial fibrillation
multiple rapid impulses from many foci depolarize in the atria at a rate of 350 to 600 times per minute. The atria quiver which can lead to thrombi.
no definitive wave can be observed-only fibrillatory waves before each QRS
sinus tachycardia
atrial and ventricular rates are 100 to 180 beats/min
Notify the RN
atrial fibrillation treatment
oxygen anticoagulants cardiac medications possible cardioversion Notify the RN
premature ventricular contractions
early ventricular complexes result from increased irritability of the ventricles.
PVC’s frequently occur in repetitive patterns such as bigeminy, trigemini, and quadrigeminy.
Notify the RN
bigeminy
irregular heartbeat that is characterized by an extra heartbeat that comes too early
trigeminy
three-beat tightening
the extra contractions happen sooner then the next usual heartbeat
quadrigeminy
every fourth beat is a premature ventricular contraction
Ventricular tachycardia
this occurs because of a repetitive firing of an irritable ventricular ectopic focus at a rate of 140 to 250 beats/min or more and can lead to cardiac arrest.
Notify the RN
VT(ventricular dysrhythmia) and a stable client
no signs or symptoms of decreased cardiac output and a pulse.
treatment will be oxygen and antidysrhythmics .
females who smoke and take birth control are at a higher risk for a…?
MI
VT(ventricular dysrhythmia) in a unstable client
pulse and signs and symptoms of decreased cardiac output
oxygen
antidysrhythmic
possible synchronized cardioversion
Raynaud’s
the vasospasm of the arterioles and arteries of the upper and lower extremities. such as…
blanching of the extremity
reddened tissue
numbness, tingling, and numbness
peripheral arterial disease (PAD)
a chronic disorder in which partial or total arterial occlusion deprives the lower extremities of oxygen and nutrients
Buerger’s disease
occlusive disease of the median and small arteries and veins.
(the distal upper and lower limbs are affected most commonly )
atherosclerosis in layman terms
formation of plaque in the arteries
how do you use sublingual nitro
Place the tablet under the tongue or between the cheek and gum, and let it dissolve. Do not eat, drink, smoke, or use chewing tobacco while a tablet is dissolving.
controlling blood cholesterol with diet
two thirds of the body’s cholesterol is produced by the liver and intestines. Most, but not all, people produce less cholesterol or increase it secretion in response to high levels of dietary cholesterol.
aneurism therapeutic measures
smoking cessation
gentle exercise
blood pressure (to prevent arterial wall rupture)
beta clockers (to slow AAA enlargement)
a pt has had a vascular surgery. When a neuro vascular check is done the extremity is cool to the touch and dusty in color. What should you do?
notify the physician
if the legs are brown PVD put them up
myocardial infarction older adults
if pain is not present sudden SOB, restlessness, or fainting
reperfusion therapies such as angioplasty and bypass surgery is proven to be beneficial for older adults
normal troponin level
<0.04
nursing process of pt experiencing a MI
thorough hx is obtained continuous cardiac monitoring serial ECG's laboratory values controlling the pain reduces anxiety (which reduces the physiologic effects pain has) screen for depression afterward
patient education sexual activity during recovery to cardiac disorders
sexual counseling should be offered.
if the pt has angina NTG can be taken prophylactically before sexual activity. After a MI a pt can resume sex 1-2 months or when they can climb two flights of stairs with no symptoms( and approved by HCP).
referral to a sexuality counselor
dissecting aneurism
created when blood separates the layers of the artery wall forming a cavity between them
sudden back or flank pain are classic symptoms of a…?
abdominal aortic aneurism
needs to be reported immediately because it can rupture
venous insufficiency and pathophysiology
damaged or aging valves within the veins interfere with blood return to the heart, causing pooling of blood in the lower extremities.
(chronic venous insufficiency can lead to venous stasis ulcers)
main treatment of buergers disease
no smoking
electrical impulse that originates from the SA node
the p wave
pt has a pacemaker placed what should you do?
take radial pulse for 1 minute
caffeine
D-fib
common cause of a PVC is
caffeine
smoking and digoxin puts a pt at risk for
PAC’s
premature atrial contractions
what is the pattern of A flutter
saw tooth
ST depression indicates cardiac ischemia
need to alert HCP
calcium,
sodium,
potassium,
magnesium
potassium is 3.5 to 5
increase in potassium can cause
ventricular fibrillation
normal sinus rhythm
PQRST intervals
60 to 100 bpm
acute heart failure s/s
anxiety/restlessness, clammy, cold skin, coughing, crackles, and wheezes
left sided heart failure
aortic stenosis- increased volume to pump from restricted blood outflow
cardiomyopathy- increased workload from impaired contractility
hypertension- resistance increased from elevated pressure
chronic heart failure summary
s/s- ascites, dependent peripheral edema, and fatigue
tests- arterial blood gas (ABG’s)
complications- cardiogenic shock
symptoms of digoxin toxicity
abdominal pain, anorexia, nausea, vomiting, visual changes, and bradycardia
digoxin
same time every day
take pulse before taking medication
if below 60 bpm hold and contact HCP
bedside commode ensures
patient safety puts less strain on the heart and it maintains bedrest order
bnp high level indicates
heart failure
pink frothy sputum is an indicator of
pulmonary edema
Contact Healthcare Provider
what should you instruct a patient taking captopril?
monitor BUN
Electrolytes
medications used for HF
ACE inhibitors- first-line therapy to decrease afterload to prevent hypertension.
angiotensin 2- block angiotensin 2 receptor to reduce extracellular fluid and cause vasodilation.
angiotensin receptor nephrilysin inhibitors- reduce blood volume
data collection with CHF
respiratory- lung disease cardiovascular-cardiac disease hx fluid retention-daily sodium intake GI- appetite present? nausea? Urinary- decrease in daytime urine output?
nursing care plans for post op cardiac transplant surgery
turn every 2 hours monitor electrolytes monitor arterial blood gases(ABG's) monitor i&o's listen to lung sounds- note any characteristics of sputum
foods high in potassium
banana’s, potatoes, citrus fruit, cooked spinach
criteria for a heart donor
no hypertension diabetes absent of malignant diseases no active infections no significant cardiac disease
Raynaud’s and buergers nursing interventions
monitor pulses
administer vasodilators
reinforce instructions to the client to wear warm in cold weather
advise the client to avoid injuries to fingers and hands
dissecting aortic aneurysm
created when blood separates the layers of the artery wall forming a cavity between them.
right-sided heart failure
atrial septal defect- left atrial blood flow into right atrium increases right ventricular volume to pump.
pulmonary hypertension- resistance increased from elevated pressure
pulmonary valve stenosis- increased volume to pump from restricted right ventricular blood outflow
Buerger’s data collection
intermittent claudication
ischemic pain occurring in the digits while at rest
aching pain that is more severe at night
