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D-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 feedings
continuous feedings

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
Can happen from cardiac disorders like m d t Sinus bradycardia
mi/ drug tocixity-beta blockers, digoxin
26
Sinus bradycardia slow hr leads to
atrial junction ventricular ectopic rythms
27
first line of treaetmtn in sinus bradycardia recommend
placing pt on 02 if symptomatic recommend atropine
28
sinus tachycardia BPM harmless except
Normal rate greater then 100 bpm Usually harmless except in heart disease when it increases oxygen demand
29
what causes sinus tachycardia response seen in
Response to stress or compensation mechanism to increase co in fight/flight also seen in fever
30
external causes like c s d use m tachycardia
caffeine, sleep deprivation, smoking/ nicotine use ,meds
31
s/s sinus tachy
asymtpmatic
32
treatment sinus tachycardia identify assess use what meds
Identify and treat underlying cause, assess/trat pain, use olol to lower hr- beta blocker
33
What ECG looks like in NSR Bradycardia Tachycardia
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
34
Atrial flutter atrail rate of rate rarely seen
Atrial rate of 200-350 bpm Rate is regular Rarely seen In healthy heart
35
Atrial flutter caused by I what disorder c c h c m what med
ischemia, valve disorders, copd, chf, hypertrophy, cardiomypotathy, mi, dig toxiciy
36
Intervention- atrial flutter assess aim treat consider
assess pt, aim to control ventricular rate, treatment depends on symtoms, consider anticoauglation,
37
meds to control ventriclular rate in artial flutter a b c
amiodarone, beta blockers olols, Calcium channel blocker like dilitizem/ digoxin
38
Atrial flutter risk for use
Risk for potential clots- herpain enoxaparin, warfarin,
39
atrial fluter what meds slows look for
Digoxin slows ventrilaur rate Dig toxicity- hypotension, confusion, visual changes
40
What ECG looks like on A flutter
regular rhythm regular p qrs t just has a lot of waves/ lots of p's in between the qrs
41
A fib atrial most
Atrial activity is completely chaotic- Most common arrythmia
42
A fib Casued by I h vd c m c c med
ischemia, hypertrophy, valve disoerds, cardiomypotahy, mi, chf , copd dig toxicity
43
A fib assess what give what aim is what
Assess pt, vitals, give 02 if needed Aim is to control ventricular rate
44
A fib meds a c b d
Amiodarone, ccb, - diltiazem bb, -olols digoxin
45
A fib why use anticoagulation
Anticagulation used because blood is pooling in atria
46
A fib Planned sycnronixed cardioversion same excpet shock
-same as defibrillation except shock is less powerful shock is given with paitents r wave
47
A fib what before procedure rules out
Echoogardigram is used before procedure rule out any clots
48
What A fib looks like on ECG what rhythm what qrs main idefitfies cant get
irregular rythm has a normal qrs but time in between looks scribbly cant get a proper p pr t
49
Supraventricular tachycardia (SVT) what is it
Generic term for any tahcy cardia that occurs above ventricles-a flutter, a tcah
50
Supraventricular tachycardia (SVT) Caused by f s h cd u
fever , stress , hypovolemia, conduction disturbances, unknown
51
Goal treat try what Supraventricular tachycardia (SVT)
Goal is to treat underlying cause- treat with adenosine- but try Valsalva manuever before
52
If s/s of decreased cario output- do what Supraventricular tachycardia (SVT)
do cardioversion to convert back to normal rhythm
53
what drug does what half life give how/hold Supraventricular tachycardia (SVT)
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
Supraventricular tachycardia (SVT) put what on pt
Ecg onpaitent
55
pt feels pt will Supraventricular tachycardia (SVT)
Patient may also feel doom and gloom for a few seconds – pt will flatline for a few seconds
56
What does SVT looks like on ECG very will not
Very narrow- high on tachycardia will have a barely visible p or t wave
57
what area seen in indicates Premature Ventricular Contraction (PVC)
Irritable area with anywhere in the ventricle that causes premature firing Seen in anyone on and off indicates myocardial irritiblity
58
Premature Ventricular Contraction (PVC) on ECG wil have but then that look like what
Will have NSR most of time but them occasional wide and bizarre one wide/ bizzare goes down and looks inverted
59
Frequently caused by I h h med h a seen in Premature Ventricular Contraction (PVC)
ischemia, hypokalemia, hypoglycemia, med toxicity, hypoxemia, acidosis, seen in stress or caffeine use
60
assess assess what labs get what get what remove Premature Ventricular Contraction (PVC)
Assess pt, oxygen, assess k, ca, mg-replete if low, get dig level, get glucose, remove irritants,
61
give what if patent is symptomatic a l p Premature Ventricular Contraction (PVC)
amiodarone lidocaine procanimide
62
Ventricular Arrythmias are what 3 types
Ventricular Tachycardia (V tach) Ventricular Fibrillation (V fib) Asystole
63
ventricle is ventricular rate what is happening Ventricular Tachycardia (VT)
Ventrical is irritated and sends out at a rapid rate V Rate will be 100-250 Atrium and ventricles are beating independeatly
64
Ventricular Tachycardia (VT) qrs pvc
Qrs is wide and bizzare, 3 or more pvc in a row
65
Ventricular Tachycardia (VT) can become leads to
Can become vfib lead to sudden death
66
Ventricular Tachycardia (VT) assess/check to do what
Assess pt and check pulse, to determain course of action and repsosinvess
67
stable vtach- s/s Ventricular Tachycardia (VT)
not experiencing serious s/s- of cardiac output,
68
stable vtach- give establish consider order Ventricular Tachycardia (VT)
give 02 , establish iv, consider antiartymics, order electrolyte like k or mg,
69
stable vtach notify anticipate keep pt
notify pt- anticipate cardioversion- keep pt hooked up to cardiac monitor
70
unstable vtach – s/s Ventricular Tachycardia (VT)
serious s/s of decreased cardiac output
71
unstable vtach – call still administer establish Ventricular Tachycardia (VT)
/ call code/ still have a pulse/ administer 02, establish iv,
72
unstable vtach – prepare for consider what consider order notify Ventricular Tachycardia (VT)
prepare for synronized carioverison consider sedation for that with versate, consider antiarythmic, order electrolyte, notify md
73
pulseless- call what asap start Ventricular Tachycardia (VT)
call a code, dfib asap, start cpr immedialty and follow acls guidelines-
74
pulsless have what meds Ventricular Tachycardia (VT)
have a continuous infusion of whatever drug works- vasopressin, epinephrine, amiodarone
75
what does v tach look like on ECG
Big M's a lot of big m's
76
Torsades de Pointes (TdP) what type of v tach what qt/ qrs
Polymorphic v tach- all over place- stems from different areas Prolonged qt interval- qrs changes shape and will twist around line
77
Torsades de Pointes (TdP) is what if pulseless
life threatening, if pulseless call a code- defribrilate adap and do cpr,
78
Torsades de Pointes (TdP) if not pulseless check notify treat -
check s/s of decreased co, notify physician, treat with meds, -give magnesium sulfate iv, may use lidocaine as well
79
Torsades de Pointes (TdP) rate not call
Rate is rapid, irregular, no definitive parts, not combative with life- call code
80
Damage to cardiac muscle causes this, c acute acure c h Torsades de Pointes (TdP)
- cad, acute coronary syndrome , acute mi, cardiomypothaty, hypoxia
81
Asses pt- for what if truly in fib they will be Torsades de Pointes (TdP)
assess rhythm to make sure rythmm is legit, if truly in vfib they will be pulseless, apnic and unresponsive
82
what is only treatment Torsades de Pointes (TdP)
Dfib is only treatemtns and begin bls
83
what does torsades look like on ECG
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
Asytole what is it what look like-always do what
Flatlined- without contractions Pulsless, always cinfirm asystole in another lead
85
asystole cannot have to do what
Cannot shock because no electrical activity Cpr and give epi
86
5 h's Asystole
Hypoxia ,hypovolemia, hypothermia, hydrogen ions, hypo/per kalemia
87
5 t's Asystole
Tablets, tamponade, tension pnieonthorax, thrombus cariac , thrombus pe
88
Asystole assess call start confirm
Assess pt, call code, start cpr, confirm rythmm for tru asytotle,
89
measurements of the ecg 5 large boxes equals each small box
5 large boxes = 1 second Each small box is 0.04 seconds
90
Six Steps to Interpreting Rhythms determine determine analyze measure measure determine
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
1 Determine heart rate
at a glance – too fast or too slow or appear normal?
92
Determine HR each mark is how ling we look at what count number multiply by
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
2. Determine whether the rhythm is regular or irregular measure with
Calipers Visualize
94
3. Analyze the P waves is there is there
Is there a P for every QRS wave is there a QRS for every P wave
95
4. Measure the PR interval normal from the beginning
Normal = 0.12-0.2 From the beginning of the P to the beginning of the QRS
96
5. Measure the QRS duration from what normal is
From beginning of the Q wave (if present) to the end of the S wave Normal is less than 0.12 seconds.
97
When can you defibrillate x3
pulseless pt pulsless vtach vfib
98
when can you synchronized cardioverison x4
afib a flutter vtach w pulse svt
99
when do you external pacing
severe bradycardia w pulse

D-Third semester (19 decks)

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