Mod 1 cardiac Flashcards
Arterial catheters
provide pressure readings
BP
saline flush bags pressured to 300 mmHg
central venous pressure
placed in internal jugular or subclavian or femoral vein
indicates right atria pressure and estimate of R ventricular filing pressure (preload)
normal CVP
8- 12 mm hg
Swanz-Ganz catheter or PA catheter
placed in internal jugular or subclavian or measures pulmonary artery
normal systolic is 15-30
diastolic 4-12
normal PR interval
0.10-0.20 or < 5 small boxes
QRS interval
0.06 to 0.10 seconds
1 small box equals
0.04 secs
1 large box equals
0.20 secs
5 large box
1 second
depolarization
contraction
repolarization
relaxation
P-wave
atrial depolarization
SA node sending out impulse
QRS
ventricular depolarization
T-wave
ventricular repolarization
Sinus bradycardia Tx
atropine 0.5mg IVP
pacemaker
Sinus tachycardia causes “TACHY HEARTS”
Temperature
Aerobics
Cardiac disease
Hyperthyroidism
Yelp (pain)
Hemorrhage or hypovolemic shock
Emotional stress/fear
Anemia
Respiratoy conditions
Therapeutics (atropine, albuterol, dopamine, epinephrine)
Simulants
Sinus tachycardia tx
BB
CCB
pain meds
antipyretic
Premature atrial contractions (PACs)
pacemaker cell close to SA node fired too early has pause at end
PVC tx
dependant on cause
eliminate cause
atrial flutter
no P-waves has F-waves
QRS complex < 0.12 secs
Dobutamine nursing considerations
continous cardiac montioring
weight for dosage calculatino
baseline v/s
monitor i&O
monior potassium
monitor drug range (40-190)
Dobutamine s/e
tachycardia
pain at injection site
Dobutamine indications
heart failure
cardiogenic shock
Nitroglycerin nursing considerations
take off at night and then reapply in morning
contraindicated in taking erectile dysfunction meds
take tylenol for headache
keep in amber glass
do no chew crush or swallow SL tabs
Nitroglycerin S/E
FLUSHED
Flushing
Lightheadedness
Upset stomach
Syncope
Hypotension/Headache
Effectiveness/tolerance decreases
dizziness
Amiodarone teaching
take in divided doses if upset stomach
avoid grapefruit juice
use sunscreen no tanning beds
stays in body for a long time so side effects may remain even after if stopped
Amiodarone s/e
AMIODARONE
Abnormal thyroid function
Muscle weakness
Interstitial lung disease
Optic neuropathy
Discoloration of skin (blue skin)
Ataxia
Reduction of HR
Occular corneal microdeposits
Nausea/vomiting/constipation
Enzyme fluctuations of the liver
Beta blocker teaching
Hold if SBP <90 HR <60
take medication with food
monitor for bradycardia & hypotension
can mask hypoglycemia (anxiety, shakiness, palpitations except for sweating & hunger)
dont stop quickly, reduce over 2 weeks
Beta blocker S/E
BAD FISH
Bradycardia/bronchospasm
AV block/arrhythmias contrindications
dizziness/depression
fatigue
impotence
s/s of hypoglycemia masked
hypotension
ACE inhibitor side effects
TOP CARD
teratogenic
orthostatic hypotension
potassium increase
cough
angiodema
renal impairment
dizziness
Premature ventricular contractions
impulse starts in ventricles
no p=wave
QRS wide > or equal to 0.12 or 3 smal boxes
PVC tx
based on s/sx correct cause
ventricular tachycardia with pulse
pt maintaining BP and pulse with or without s/sx
Vtach tx
antiarrhythmic meds
elctrolyte replacement
cardioversion
Pulseless Vtach tx
CPR and defib
Ventricular fibrillation
chaotic impulses w/i ventricles prevents blood flow stopping cardiac output causing death
Vfib tx
CPR and defib
1st degree heart block
PR interval > 0.20 secs
2nd degree AV block type 1
not all atrial impulses form AV node get to ventricles
more p-waves than QRS complexes
PR interval gets longer until QRS drops
3rd degree AV block
complete heart block
R-R regular
P-P regular
MI management
Oxygen, nitroglycerin, aspirin, pain meds
labs for MI
troponin
CK
CKMB
ECG gold standard
echo
stress test
Cardiogenic shock
heart muscles can’t adequately contract, causing decrease CO
Cardiogenic shock s/sx
CP
thready reapid pulse
diaphoresis
narrow pulse pressure
n/v
JVD
tachycardia
hypotension
dyspnea
Cardiogenic shock management
meds to increase BP &CO
intra-aortic ballon pump
LVAD or RVAD
ECMO
Cardiogenic shock nursing care
v/s
neuro assessment
labs
o2 therapy
adminster meds
fluid replacement
Cardiac tamponade
sudden accumulation of fluid in pericardial sac
Cardiac tamponade causes
knife/gun wounds
ventricle rupture
anticoagulants
viral infections
pericarditis
TB
Cardiac tamponade s/sx
dyspnea
tachycardia
tachypnea
pallor
cold extremities
Cardiac tamponade management
pericardiocentesis
thoracotomy
inotropic meds
Cardiac tamponade nursing care
ABCs
fluid resuscitation
O2 therapy
administer meds
assess drainage site
DIC
overactivation of clotting mechanisms leading to enhanced bleeding
DIC s/sx
hematuria
epistaxis
petechiae
ecchymoses
DIC labs
d-dimer
platelets
PTT
INR
DIC management
PRBC, FFP
Heparin
Pulm artery catheter (PAC)
DIC nursing care
monitor for bleeding
no razor or electric razor
give meds
02 therapy
Norepinephrine
vasoconstrictor increase HR, BP and contractility
Norepinephrine s/e
tissue necrosis at IV site; infuse through central line
myocardial ischemia
reflex bradycaria
Dopamine
vasoconstriction to increase BP and H R
Positive inotropes
dopamine
dobutamine
digoxin
Negative inotropes
Beta blockers
CCB
Negative chronotropes
digoxin
BB
CCB
Positive chronotropic
atropine
dopamine
epinephrine
dobutamine
Adenosine
slow conduction in AV node
Adenosine indications
contraindications
s/e
indications: SVT
contraindications; 2/3 AV block
s/e : flushing
hypo BP and HR
tingling numbness
Clonindine
antihypertensive
clonidine contraindications
active liver disease
active use of MAOI
pregnancy
clonidine s/e
HTN DRUG
HTN DRUG
Headache
Tired
Not able to poop
Dizziness/dry mouth
Rash
Unable to sleep
GI upset
clonidine teaching
avoid abrupt d/c to avoid rebound htn
avoid driving when drowsy
avoid alcohol
if using patch apply to hairless area
clopidogrel (plavix)
antiplatelet
clopidogrel (plavix) contraindications
intracranial hemorrhage
peptic ulcer
pregnancy
hepatic impairment
statins
inhibit cholesterol synthesis
statin s/e
CHAMG
CHAMG
Cpk increase
Hepatotoxicity/headache
Avoid in pregnancy
Myalgia/myopathy
GI upset
statin teaching
monitor LFT
avoid grapefuit
take in evening/bedtime
Nitroglycerin teaching
take ER tabs with water on empty stomach
dose meds to have 10-12 hr nitrate free period to decrease tolerance
avoid alcohol use
take 7 hrs apart for IR isosorbibe formulation
max dose 3 q15 mins
rise slowly dont take if SBP is <90
Inotropes
dopamine
dobutamine
epinephrine
vasopressin
isoproterenol
norepinephrine
Antiarrhythmics
potassium chanel blockers
BB
CCB
sodium channel blockers
digoxin
vasodilators
nitrates
nitroprusside sodium (Nipride)
ACEs
Vasoconstrictors
Dopamine
Epinephrine
Norepinephrine
Phenylephrine
Vasopressin
what do vasoconstrictors do?
increase HR, BP
increase contractility
what do vasodilators do?
increase HR, and decrease BP
no effect on contractility
what do inotropes do?
increase HR and contractility
decrease BP
afib tx
rate control w/ digoxin BB, CCB
anti-arrhythmic meds
cardiac ablation
cardioversion
Sinus brady causes
SLOW RATES
Sick sinus syndrome
Low thyroid hormone
Older adults
Weak and damage heart muscle
Raised ICP
Athlete
Toxicity of BB CCB, digoxin
Electrolyte imbalances
Stimulation of vagal response
