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N232 > Module 4: part 5 - A Fib > Flashcards

Module 4: part 5 - A Fib Flashcards

1
Q

What are arrhythmias?

A

Abn electrical conduction in the heart

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2
Q

What do arrhythmias effect?

A

The normal HR and cardiac rhythm

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3
Q

What conditions are associated w arrhythmias

A

CAD, MI, HTN, valve dysfx, digoxin toxicity, low K+, CHF, CVA, pulmonary disease etc

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4
Q

At what rate do we begin to be concerned about abn HR?

A

less than 50 or greater than 100

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5
Q

What rate is the normal sinus rhythm?

A

~ 75 bpm

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6
Q

What is the HR during A Fib?

A

~ 150-300 bpm

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7
Q

Risk factors for developing A Fib?

There are a LOT, just know at least 5

A
  • Advanced age with valvular heart disease (mitral/tricuspid)
  • HTN
  • Inflammatory or infiltrative disease
  • CAD
  • Congenital disorder
  • HF
  • Diabetes
  • Obesity
  • Hyperthyroidism
  • Pulmonary Hypertension
  • Embolism
  • Obstructive sleep apnea (OSA)
  • Moderate to heavy ETOH
  • Following open heart Sx
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8
Q

What is the A Fib triad?

A
  • Racing heart/fluttering/palpitations
  • SOB
  • Feeling lightheaded
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9
Q

Other S+S of A Fib:

A
  • Irregular pulse
  • Dizzy
  • Weakness
  • Fainting
  • Decreased BP if not compensating
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10
Q

Which organ systems should you keep an eye on if pt has A Fib?

A

Hepatic and renal

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11
Q

Which ‘lytes should you keep and eye on if your pt has A Fib?

A

K, Na, Ca

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12
Q

Why is there an inc risk for thrombosis in pts w AFib?

A

Because if the atria are not pump properly, the blood can pool and form a clot

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13
Q

Dx tools for AFib?

A
  • ECG

- Holter monitor

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14
Q

What is a Holter monitor?

A

Records heart activity for 24 hours

a portable ECG

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15
Q

What lab test should you run for Dx AFib?

A
  • Platelets
  • PTT
  • PT-INR
  • Digoxin level
  • Electrolyte
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16
Q

How does defibrillation help w AFib?

A

It extinguishes all electrical activity, allowing the normal sinus rhythm to restart and take over again

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17
Q

How does cardioversion help w AFib?

A

Restores normal sinus rhythm by sending electrical shocks to the heart through electrodes placed on the chest

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18
Q

What is the difference between defibrillation and cardioversion?

A
  • Cardioversion is a shock that is synchronized to the QRS complex
  • Defibrillation is a shock delivered randomly
19
Q

Why should cardioversion be done within the first 48 hours of onset of AFib?

A

Because there is a high risk for clotting after 48 hours and cardioversion started after 48 hours runs a high risk of dislodging the possible clots

20
Q

What s the Maze procedure and how does this help restore a normal sinus rhythm?

A

Using surgical ablation, this is the creation of lines of scar tissue that block the abnormal impulses causing AFib. No AFib = normal sinus rhythm

21
Q

3 drug classes you should give during AFib?

A

1) Beta-blockers
- eg metoprolol
2) Anti-arrhythmics
- eg Digoxin, Amiodarone
3) Anticoags
- Warfarin, Heparin, Apixban, Dalteparin

22
Q

What is the effect of anti-arrhythmic drugs?

A
  • Alter electrophysiological properties of the heart

- Slows the progression or conduction of electrical activity.

23
Q

5 reasons why a pt may be on anticoags?

A
  • Immobility (post surgical)
  • Hx DVT/pulmonary embolus
  • Dysrhythmias (AFib)
  • Mechanical heart valve
  • Post MI or CVA
24
Q

T or F:

Anticoags dec clotting time to prevent thrombi from forming or growing larger

A

F, they inc clotting time to do this

25
Q

What route(s) is/are Heparin given?

A

IV or subQ

26
Q

What is the half-life of Hep?

A

90 min

27
Q

What is thrombocytopenia, and what kind of effect does Hep have on it?

A

Thrombocytopenia is a low platelet count, Hep increases the risk of this

28
Q

What is the antidote to Hep?

A

Protamine sulfate

29
Q

How are LMWHs different from Heparin?

A

They provide a more stable response and their duration is 2-4 times longer than Hep, usually just one subQ injection daily, and a decreased risk for thrombocytopenia

30
Q

what route(s) is/are Warfarin given?

A

Only PO

31
Q

How long does Warf take to reach a therapeutic level?

A

3-5 days

32
Q

What is the half life of Warf?

A

1-3 days

33
Q

What lab(s) should you be monitoring for Warf?

A

PT-INR (Because this is for extrinsic pathway)

34
Q

What is the antidote for Warf?

A

Vit K

35
Q

What do anti-platelat drugs interfere with?

A

Platelet aggregation

36
Q

Common Anti-platelets?

A
  • ASA

- Clopidogrel

37
Q

How long can anticoag effects of ASA last after a dose?

A

Up to a week

38
Q

How long can anticoag effects of Clopid last after a dose?

A

Up to 5 days

39
Q

Who is Clopid usually reserved for?

A

Pts who cannot tolerate ASA

40
Q

After what sort of incident is Clopid given?

A

After recent MI or CVA

41
Q

What organ systems should you be monitoring is you pt is on anticoags?

A

Hepatic and renal

42
Q

What is the most important thing to monitor for when you pt is on anticoags?

A

Bleeding

eg hematuria, epistaxis, bloody stools, bruising

43
Q

What is a consideration regarding IM injections when you pt is on anticoags?

A

Try to avoid/limit them

N232 (9 decks)

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