Med Surge chapters 24, 25, and 26 Flashcards by Leila Matos

Sinoatrial (SA) node

75 to 100 beats per minute

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Atrioventricular (AV) node

40 to 60 beats per minute

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Bundle of His

a continuation of the AV node

carries electrical signals from the AV node to the bundle branches.

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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)

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Cardiac Cycle

One heartbeat

Electrical representation of contraction and relaxation of atria/ventricles

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Electrocardiogram (ECG)

Shows cardiac electrical activity.

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Isoelectric Line

Baseline
Seen with no electrical activity
Straight line produced

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P wave

First wave

Represents atrial depolarization

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P R interval

Beginning of P wave to beginning of Q R S complex

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QRS complex

Follows P wave
Q wave first negative (downward) deflection
R wave first positive (upward) deflection
S wave second negative deflection

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Q,R,S waves are not…

present every time.

this represents ventricular depolarization

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T wave

Ventricular repolarization

Follows Q R S complex

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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

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U wave

Rare
Indicates hypokalemia
After T wave

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what is an Arrhythmia?

disturbance in the rhythm and conduction

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Sinus Bradycardia

s/s and treatment

fatigue or fainting
None if asymptomatic
treatment:
Oxygen, atropine, dopamine or epinephrine, pacing

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sinus tachycardia

s/s and treatment

Angina or dyspnea (Older adults are more sensitive)
Therapeutic interventions
Medications
Adenosine, beta blocker, calcium channel blocker

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Atrial Arrhythmia

Premature atrial contractions (P A C’s)
Atrial flutter
Atrial fibrillation

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Premature Atrial Contractions therapeutic interventions

Treat cause

Beta blocker

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Atrial Flutter Signs and symptoms

if the ventricular rate normal
None
if a rapid ventricular rate is present then
Palpitations, angina, dyspnea

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therapeutic interventions for atrial flutter

Cardioversion for rapid ventricular rate
Rapid atrial pacing
Calcium channel blocker
Beta blocker
Catheter ablation

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Atrial Fibrillation

Signs and symptoms

Palpitations

Faint radial pulse

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Atrial Fibrillation therapeutic interventions

Synchronized cardioversion if unstable
Medications
Beta blocker
Calcium channel blocker
Digoxin
Anticoagulation
Ablation (after anticoagulation)
Surgical maze procedure

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causes of Third-Degree Atrioventricular Block

Coronary heart disease
Myocardial infarction
Digoxin
Aging

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symptoms of Third-Degree Atrioventricular Block

Dizziness
Syncope
Fatigue
Shortness of breath
Chest pain
Hypotension
Diminished or absent peripheral pulses

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Third-Degree Atrioventricular Block Therapeutic interventions

Medical emergency
Supportive care to treat symptoms
Atropine considered
Temporary pacemaker
Permanent pacemaker possibly for lifetime

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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

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Premature Ventricular Contractions

s/s

Palpitations

Fatigue, dizziness, severe arrhythmias

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Premature Ventricular Contractions Therapeutic interventions

Antiarrhythmics
Amiodarone I V
Beta blocker
Lidocaine

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Ventricular Tachycardia

s/s

Dyspnea
Palpitations
Lightheadedness
Angina 
Cardiac arrest

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Ventricular Tachycardia

Therapeutic interventions

If pulseless V T
C P R, defibrillation, epinephrine, amiodarone, lidocaine
If stable
Antiarrhythmics

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Ventricular Fibrillation

Signs and symptoms

Unconscious
No heart sounds, peripheral pulses, blood pressure
Respiratory arrest
Cyanosis
Pupil dilation

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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

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asystole signs and symptoms

Unconscious
No heart sounds, peripheral pulses, blood pressure
Respiratory arrest
Cyanosis
Pupil dilation

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asystole therapeutic regimen

CPR 
ACLS protocols 
Endotracheal intubation with oxygen
Epinephrine
Treat cause

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Cardiac Pacemakers

Generate an electrical impulse
Traditional types
External and temporary
Internal and permanent

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Cardiac Pacemaker Problems

Failure to sense
Failure to pace
Failure to capture

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Nursing Care for Pacemakers

Monitor ECG.
Monitor apical pulse.
Monitor for symptoms.

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Patient Pacemaker Education

Incision care
Activity restrictions
Symptoms or infection signs to report
Pacemaker I D card
Periodic pacemaker checks

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Defibrillation

Electrical shock to reset lethal ventricular arrhythmias

Must announce “clear” for safety

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Synchronized Cardioversion

Used in arrhythmias if R wave present
Sedation used
Low energy: 25 to 50 joules

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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…?

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

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Med Surge chapters 24, 25, and 26 Flashcards

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