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3-Third semester > Skills 3- ng tube and EKG > Flashcards

Skills 3- ng tube and EKG Flashcards

1
Q

uses of ng tube
e f
m a
d
post
long

A

Enteral feedings

Medication administration

Decompression

Post-op placement – bowel rest

long term continuous feedings

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2
Q

Insertion of a NG Tube: Assessment

verify
patient
assess/ and
hh
check
review
assess

A

Verify order

Patient identifiers

Assess patients knowledge and educate as needed

Hand hygiene

Check nare patency

Review medical history

Assess mental status, ability to actively participate in insertion directions

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3
Q

Planning and Implementation ng

explain

hand

position

apply

drape

measure

prepare

insert/tuck

advance

aspirate

fasten

confirm

hand

A

Explain the procedure- be honest and concise

Hand Hygiene

Position High Fowlers

Apply pulse oximeter/Capnography

Drape patients chest

Measure length of tube Tip of nose, xyphoid process to sternum

Prepare fixation dressing

Insert tube, tuck chin once tube has passed nasopharynx

Advance until desired length is reached

Aspirate gastric pH

Fasten tube as appropriate

Confirm with x ray (Facility policy)

Hand hygiene, dispose of equipment, document

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4
Q

never
due to

Things to know…Gastric surgery

A

NEVER withdraw a NG or place a NG on patients with recent gastric surgery

due to possible hemorrhage with suture lines

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5
Q

if
need to

things to know cough/choking

A

If cyanosis is present with coughing and choking NG is in airway

need to withdraw NG during insertion

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6
Q

checked how often

remember

whats needed

things to know ng

A

Placement should be checked every 8 hours or according to protocol

Remember I & O (including when you remove the NG)

Frequent oral hygiene is needed along with nasal hygiene

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7
Q

can place

wait for/look for

things to know ng tube

A

Can place to suction- need to be at low intermittent- nebver continuous

Wait for order to remove- look for passing flatus and tolerating clear liquids

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8
Q

Removing NG

A
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9
Q

complications ng tube

most common
FV
post
if/check

A

MC- aspiration

FVD

post op bleeding

if nausated- assess patency of tube

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10
Q

NG flush

before/after what
how often in ongoing feeding
before/after what

A

Before and after NG feeding

Ongoing feedings
Flush every eight hours (usually with 20-30mls) unless protocol specifies

Before and after enteral medication administration

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11
Q

NG flush

intermittent
continuous

A

Intermittent feedings need to have tube flushed first

Continuous feedings- checking placement usually every shift

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12
Q

how know if absorbed

to check what

ng flush

A

To know if feeding is absorbed you must check residual

To check patency and effectiveness of tube for bowel rest or decompression purposes

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13
Q

Right side of heart
receives
sends

A

receives blood from body

sends to lungs

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14
Q

left side of heart

receives
sends

A

receives 02 rich blood from lungs

sends to body

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15
Q

placement of leads- look at opposites

middle
lowerr right
upper right
lower left
upper left

A

brown in middle

lowerr right- green

upper right-white

lower left -red

upper left- black

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16
Q

lowest number of electrodes

most normal

why a 12 lead

dont do what in a 12 lead

A

Lowest number of electrodes that can be used is 3-

most normal is 5.

12 lead ekg to identify subtle changes – used for diagnostics like in mi

Don’t leave 12 lead on for too long- then go back onto 5

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17
Q

ecg

p
q
r
s
t

A

p- small hump at begging before qrs

q-small down bump in qrs

r- big up in qrs

s- going back to baseline from neg in qrs

t- small hmup after wrs

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18
Q

P wave:

represents

known as

A

represents atrial depolarization

(contraction)

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19
Q

QRS complex:

represents
known as

A

represents ventricular depolarization (

contraction

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20
Q

T wave:

represents
known as

A

represents ventricular repolarization

(relaxation)

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21
Q

Normal sinus rhythm

has
hr between

A

Has a normal p qrs t all within normal limits

Hr between 60-100

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22
Q

BPM

p qrs t

Sinus bradycardia

A

Less then 60 bpm

Normal p qrs t wave just slow

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23
Q

l
d
h
v
s

Decreased hr causes decreased cardiac output-
S/s

Sinus bradycardia

A

lightheaded,

dizziness,

hypotension,

vertigo,

syncopy

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24
Q

non cardiac problems causes

h
increased
h
h
s

Sinus bradycardia

A

hyperkalemia,

increased intercranial pressure,

hypothyroidism,

hypothermia

sleep

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25
Q

Can happen from cardiac disorders like
m
d t

Sinus bradycardia

A

mi/

drug tocixity-beta blockers, digoxin

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26
Q

Sinus bradycardia

slow hr leads to

A

atrial junction

ventricular ectopic rythms

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27
Q

first line of treaetmtn in sinus bradycardia

recommend

A

placing pt on 02 if symptomatic

recommend atropine

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28
Q

sinus tachycardia

BPM
harmless except

A

Normal rate greater then 100 bpm

Usually harmless except in heart disease when it increases oxygen demand

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29
Q

what causes sinus tachycardia

response
seen in

A

Response to stress or compensation mechanism to increase co in fight/flight

also seen in fever

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30
Q

external causes like

c
s d
use
m

tachycardia

A

caffeine,

sleep deprivation,

smoking/ nicotine use

,meds

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31
Q

s/s sinus tachy

A

asymtpmatic

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32
Q

treatment sinus tachycardia

identify
assess
use what meds

A

Identify and treat underlying cause,

assess/trat pain,

use olol to lower hr- beta blocker

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33
Q

What ECG looks like in

NSR
Bradycardia
Tachycardia

A

NSR- has a regular p qrs t

B- has a regular p qrs t just is <60

T- has a regular p qrs t just is >100

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34
Q

Atrial flutter

atrail rate of

rate

rarely seen

A

Atrial rate of 200-350 bpm

Rate is regular

Rarely seen In healthy heart

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35
Q

Atrial flutter

caused by
I
what disorder
c
c
h
c
m
what med

A

ischemia,

valve disorders,

copd,

chf,

hypertrophy,

cardiomypotathy,

mi,

dig toxiciy

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36
Q

Intervention- atrial flutter

assess
aim
treat
consider

A

assess pt,

aim to control ventricular rate,

treatment depends on symtoms,

consider anticoauglation,

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37
Q

meds to control ventriclular rate in artial flutter

a
b
c

A

amiodarone,

beta blockers olols,

Calcium channel blocker like dilitizem/ digoxin

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38
Q

Atrial flutter

risk for
use

A

Risk for potential clots-

herpain enoxaparin, warfarin,

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39
Q

atrial fluter

what meds slows
look for

A

Digoxin slows ventrilaur rate

Dig toxicity- hypotension, confusion, visual changes

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40
Q

What ECG looks like on A flutter

A

regular rhythm

regular p qrs t

just has a lot of waves/ lots of p’s in between the qrs

41
Q

A fib

atrial
most

A

Atrial activity is completely chaotic-

Most common arrythmia

42
Q

A fib Casued by

I
h
vd
c
m
c
c
med

A

ischemia,

hypertrophy,

valve disoerds,

cardiomypotahy,

mi,

chf

, copd

dig toxicity

43
Q

A fib
assess what
give what
aim is what

A

Assess pt, vitals,

give 02 if needed

Aim is to control ventricular rate

44
Q

A fib meds

a
c
b
d

A

Amiodarone,

ccb, - diltiazem

bb, -olols

digoxin

45
Q

A fib why use anticoagulation

A

Anticagulation used because blood is pooling in atria

46
Q

A fib Planned sycnronixed cardioversion

same
excpet
shock

A

-same as defibrillation

except shock is less powerful

shock is given with paitents r wave

47
Q

A fib what before procedure

rules out

A

Echoogardigram is used before procedure

rule out any clots

48
Q

What A fib looks like on ECG

what rhythm

what qrs

main idefitfies

cant get

A

irregular rythm

has a normal qrs

but time in between looks scribbly

cant get a proper p pr t

49
Q

Supraventricular tachycardia (SVT)

what is it

A

Generic term for any tahcy cardia that occurs above ventricles-a flutter, a tcah

50
Q

Supraventricular tachycardia (SVT)

Caused by
f
s
h
cd
u

A

fever

, stress

, hypovolemia,

conduction disturbances,

unknown

51
Q

Goal
treat
try what

Supraventricular tachycardia (SVT)

A

Goal is to treat underlying cause-

treat with adenosine-

but try Valsalva manuever before

52
Q

If s/s of decreased cario output-
do what

Supraventricular tachycardia (SVT)

A

do cardioversion to convert back to normal rhythm

53
Q

what drug
does what
half life
give how/hold

Supraventricular tachycardia (SVT)

A

Adenosine is most common drug-

vasodilation and increasing blood flow up to 400%-

hl of less then 10 seconds-

give very fast and hold patient arm up to give

54
Q

Supraventricular tachycardia (SVT) put what on pt

A

Ecg onpaitent

55
Q

pt feels

pt will

Supraventricular tachycardia (SVT)

A

Patient may also feel doom and gloom for a few seconds

– pt will flatline for a few seconds

56
Q

What does SVT looks like on ECG

very

will not

A

Very narrow- high on tachycardia

will have a barely visible p or t wave

57
Q

what area
seen in
indicates

Premature Ventricular Contraction (PVC)

A

Irritable area with anywhere in the ventricle that causes premature firing

Seen in anyone on and off

indicates myocardial irritiblity

58
Q

Premature Ventricular Contraction (PVC) on ECG

wil have

but then

that look like what

A

Will have NSR most of time

but them occasional wide and bizarre one

wide/ bizzare goes down and looks inverted

59
Q

Frequently caused by
I
h
h
med
h
a
seen in

Premature Ventricular Contraction (PVC)

A

ischemia,

hypokalemia,

hypoglycemia,

med toxicity,

hypoxemia,

acidosis,

seen in stress or caffeine use

60
Q

assess
assess what labs
get what
get what
remove

Premature Ventricular Contraction (PVC)

A

Assess pt, oxygen,

assess k, ca, mg-replete if low,

get dig level,

get glucose,

remove irritants,

61
Q

give what if patent is symptomatic

a
l
p

Premature Ventricular Contraction (PVC)

A

amiodarone

lidocaine

procanimide

62
Q

Ventricular Arrythmias

are what
3 types

A

Ventricular Tachycardia (V tach)

Ventricular Fibrillation (V fib)

Asystole

63
Q

ventricle is

ventricular rate

what is happening

Ventricular Tachycardia (VT)

A

Ventrical is irritated and sends out at a rapid rate

V Rate will be 100-250

Atrium and ventricles are beating independeatly

64
Q

Ventricular Tachycardia (VT)

qrs
pvc

A

Qrs is wide and bizzare,

3 or more pvc in a row

65
Q

Ventricular Tachycardia (VT)

can become
leads to

A

Can become vfib

lead to sudden death

66
Q

Ventricular Tachycardia (VT)

assess/check
to do what

A

Assess pt and check pulse,

to determain course of action and repsosinvess

67
Q

stable vtach- s/s

Ventricular Tachycardia (VT)

A

not experiencing serious s/s- of cardiac output,

68
Q

stable vtach-

give
establish
consider
order

Ventricular Tachycardia (VT)

A

give 02

, establish iv,

consider antiartymics,

order electrolyte like k or mg,

69
Q

stable vtach
notify
anticipate
keep pt

A

notify pt-

anticipate cardioversion-

keep pt hooked up to cardiac monitor

70
Q

unstable vtach – s/s

Ventricular Tachycardia (VT)

A

serious s/s of decreased cardiac output

71
Q

unstable vtach –
call
still
administer
establish

Ventricular Tachycardia (VT)

A

/ call code/

still have a pulse/

administer 02,

establish iv,

72
Q

unstable vtach –
prepare for
consider what
consider
order
notify

Ventricular Tachycardia (VT)

A

prepare for synronized carioverison

consider sedation for that with versate,

consider antiarythmic,

order electrolyte,

notify md

73
Q

pulseless-

call
what asap
start

Ventricular Tachycardia (VT)

A

call a code,

dfib asap,

start cpr immedialty and follow acls guidelines-

74
Q

pulsless
have
what meds

Ventricular Tachycardia (VT)

A

have a continuous infusion of whatever drug works-

vasopressin, epinephrine, amiodarone

75
Q

what does v tach look like on ECG

A

Big M’s

a lot of big m’s

76
Q

Torsades de Pointes (TdP)

what type of v tach

what qt/ qrs

A

Polymorphic v tach- all over place- stems from different areas

Prolonged qt interval- qrs changes shape and will twist around line

77
Q

Torsades de Pointes (TdP)

is what
if pulseless

A

life threatening,

if pulseless call a code-
defribrilate adap and do cpr,

78
Q

Torsades de Pointes (TdP)
if not pulseless

check
notify
treat -

A

check s/s of decreased co,

notify physician,

treat with meds, -give magnesium sulfate iv, may use lidocaine as well

79
Q

Torsades de Pointes (TdP)

rate
not
call

A

Rate is rapid, irregular, no definitive parts,

not combative with life-

call code

80
Q

Damage to cardiac muscle causes this,

c
acute
acure
c
h

Torsades de Pointes (TdP)

A
  • cad,

acute coronary syndrome ,

acute mi,

cardiomypothaty,

hypoxia

81
Q

Asses pt- for what
if truly in fib they will be

Torsades de Pointes (TdP)

A

assess rhythm to make sure rythmm is legit,

if truly in vfib they will be pulseless, apnic and unresponsive

82
Q

what is only treatment

Torsades de Pointes (TdP)

A

Dfib is only treatemtns and begin bls

83
Q

what does torsades look like on ECG

A

looks like vtach but it will go up and down more and look a lot smaller

nut will follow a line, just get smaller and upper

84
Q

Asytole

what is it

what look like-always do what

A

Flatlined- without contractions

Pulsless, always cinfirm asystole in another lead

85
Q

asystole

cannot
have to do what

A

Cannot shock because no electrical activity

Cpr and give epi

86
Q

5 h’s Asystole

A

Hypoxia

,hypovolemia,

hypothermia,

hydrogen ions,

hypo/per kalemia

87
Q

5 t’s Asystole

A

Tablets,

tamponade,

tension pnieonthorax,

thrombus cariac

, thrombus pe

88
Q

Asystole

assess
call
start
confirm

A

Assess pt,

call code,

start cpr,

confirm rythmm for tru asytotle,

89
Q

measurements of the ecg

5 large boxes equals

each small box

A

5 large boxes = 1 second

Each small box is 0.04 seconds

90
Q

Six Steps to Interpreting Rhythms

determine
determine
analyze
measure
measure
determine

A
  1. Determine heart rate
  2. Determine if rate is regular or irregular
  3. Analyze the P wave
  4. Measure the P-R interval
  5. Measure the QRS duration
  6. Determine the rhythm
91
Q

1 Determine heart rate

A

at a glance – too fast or too slow or appear normal?

92
Q

Determine HR

each mark is how ling
we look at what
count number
multiply by

A

Each mark across the top represents 3 secs,

we typically look at 6 seconds,

and count the number of QRS complexes,

and multiply it by 10 and this will give you the rate.

93
Q
  1. Determine whether the rhythm is regular or irregular

measure with

A

Calipers

Visualize

94
Q
  1. Analyze the P waves

is there
is there

A

Is there a P for every QRS wave

is there a QRS for every P wave

95
Q
  1. Measure the PR interval

normal

from the beginning

A

Normal = 0.12-0.2

From the beginning of the P to the beginning of the QRS

96
Q
  1. Measure the QRS duration

from what
normal is

A

From beginning of the Q wave (if present) to the end of the S wave

Normal is less than 0.12 seconds.

97
Q

When can you defibrillate x3

A

pulseless pt

pulsless vtach

vfib

98
Q

when can you synchronized cardioverison x4

A

afib

a flutter

vtach w pulse

svt

99
Q

when do you external pacing

A

severe bradycardia w pulse

3-Third semester (13 decks)

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