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Adult Nursing - 225 > Study Guide > Flashcards

Study Guide Flashcards

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1
Q

Medications to slow the heart down? Non medications that slow down the heart?

A
  • Amiodarone, Lidocaine, digoxin, cardizem

- Vaso maneuver

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2
Q

What are the typical causes when PVC is frequent and sustained? Treatment

A
  • ventricular irritability due to hypoxia
  • heart disease
  • drug toxicities
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3
Q

Progressive Stage Medical Management:

A

-Depends on type of shock and cause
-Based on degree of decompensation
-Some interventions are common to all:
Appropriate IV fluids
Prevent complications
Close, continuous monitoring

-Medications to restore perfusion:
Support pumping action of heart (inotropics-dobutamine)
Vasoconstrictors (dopamine, norepi)
Perfusion through dialation (Sodium nitroprusside)
Support resp system-ABGs
Hemodynamic monitoring-CVP, Art line, PCW

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4
Q

Examples of Thrombolytic therapy?

A
  • TPA, Alteplase, Tenecteplase TNK,
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5
Q

PVC may be a warning for the impending onset of ….?

A
  • impending onset of, or precipitate V-tach or V-fib
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6
Q

Treatment of Cardiac Tamponade?

A

-Pericardiocentesis - removes fluid

Pericardial window - involves removing a portion of the pericardium to permit excessive pericardial fluid to drain into the pleural space.

-Pericardiectomy

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7
Q

What is Capillary leak syndrome?

A

Response of capillaries to the presence of body chemicals that enlarge capillary pores and allow fluid to shift from the capillaries into the interstitial tissues.

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8
Q

Progressive Stage (intermediate) of SHOCK:

A

MAP falls more than 20 mm Hg from baseline

Compensation functioning, no longer adequate
Vital organs develop hypoxia
Less vital ischemia
Life-threatening emergency-critical rescue!
Immediate interventions are needed.
Vital organs can only tolerate so long
Survival depends on age and overall health

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9
Q

Treatment of stable Atrial Fibrillation vs treatment of unstable atrial fibrillation?

A
  • Medications: Antidysrhythmics (Amiodarone, procainamide, lidocaine), beta blockers, calcium channel blockers, procainamide, digoxin)
  • Cardioversion “.”
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10
Q

What is ANGINA PECTORIS?

A
  • Temporary imbalance /b/ the coronary arteries ability to supply oxygen and the cardiac muscles demand for oxygen. “strangling of the chest”
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11
Q

Describe VARIANT Angina?

A

Variant - chest pain or discomfort resulting from coronary artery spasm and typically occurs after rest. EKG = ST changes but no changes in troponin or CK levels b/c no tissue has be damaged yet. * begins to block oxygen flow to the tissues

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12
Q

What does endocarditis/pericardit sound like?

A

Washing machine sound

  • S3 or S4
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13
Q

What is the Atrial rate? and

Ventricular rate?

A

Atrial >300/min

Ventricular > 100/min

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14
Q

Signs and Symptoms of CARDIOGENIC SHOCK?

A
  • Everything is going to decrease (perfusion, BP, CO)
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15
Q

Initial (early) stage of SHOCK?

A
  • Difficult to detect!
  • Baseline MAP decreased by less than 10 mm Hg
  • Heart and respiratory rate increased from the baseline or a slight increase in diastolic blood pressure
  • Adaptive responses of vascular constriction and increased heart rate
  • Compensatory mechanisms effective
  • Overall metabolism still aerobic
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16
Q

What is the normal EJECTION FRACTION? What does the EF measure?

A
  • 50-70%

- Contractility

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17
Q

Pathophysiology of SHOCK:

A 
-Cells forced to produce energy with anaerobic (w/o 02) metabolism
This causes:
Low yield of energy and ATP
Produces lactic acid (why we draw lactic acids)
Acidotic cell environment
Membrane more permeable
Electrolytes and fluid seep in and out
Na-K pump fails
Cell structures damaged
Cell death

3 major components:

  • Volume
  • Pump
  • Vasculature

Must respond to feedback systems: (3 compensatory responses)

  • Neural (sympathetic vs parasympathetic, baroreceptors/epi/norepi)
  • Chemical( RAAS and kidneys that are trying to make adjustments in order to maintain adequate blood volume and flow )
  • Hormonal (aldosterone NA/water retention in order to maintain blood volume and increase blood volume to increase CO)

When one fails, the others compensate

Eventually no longer able to compensate

Tissues are then not perfused adequately

Shock occurs

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18
Q

How does a PVC appear on the EKG? What is the rate?

and Rhythm?

A
  • seen as early ventricular complexes followed by a pause
  • QRS wide (greater than 0.12 sec ), bizarre appearance (uniform or multiform)
Rate = variable; 
Rhythm=  atrial regular, ventricular irregular;
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19
Q

What is obstructive shock?

A

caused by problems that impair the ability of the normal heart to pump effectively. The heart itself remains normal but conditions outside the heart prevent either adequate filling or adequate contraction of heart muscle

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20
Q

What is the atrial/ ventricular rhythm for a person in Atrial Fibrillation?

A

Irregular

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21
Q

Refractory (Irreversible) Stage of SHOCK:

A

Rapid loss of consciousness, nonpalpable pulse, cold, dusky extremities; slow, shallow respirations; unmeasurable oxygen saturation

MODS can occur here or as separate syndrome

Therapy ineffective, death imminent

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22
Q

What speeds up the heart? Medications? Non medications that increase heart rate?

A

Atropine
Epinephrine
Inotropic - Dobutamine

  • Caffeine - stimulants
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23
Q

Medications for shock?

A

Insulin
Steroids
Antibiotics
Vasopressors

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24
Q

Manifestations of sepsis/septic shock:

A

Early symptoms of sepsis:

  • fever usually higher than 101˚F (38˚C)
  • low body temperature (hypothermia)
  • fast heart rate
  • rapid breathing, or more than 20 breaths per minute

Severe sepsis:

  • noticeably lower amounts of urine
  • acute confusion
  • dizziness
  • severe problems breathing
  • bluish discoloration of the digits or lips (cyanosis)
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25
Q

Formula for Drip factor

A

Volume (mL)/ Time (min) x Drop Factor (gtts/mL) = Y (Flow Rate in gtts/min

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26
Q

Signs and Symptoms of Atrial Fibrillation?

A
  • irregular rapid heart rate
  • lower blood pressure
  • ortho-hypotension
  • low 02 stat
  • anxious
  • change in level of consciousness
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27
Q

What is ATRIAL FIBRILLATION? Rhythm? P waves?

A

Occurs when the atria beat chaotically and irregularly — out of coordination with the two lower chambers (the ventricles) of the heart

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28
Q

Progressive stage manifestations:

A
  • Laboratory data: Low blood pH, rising lactic acid, hyperkalemia
  • Cardiac: Rapid, weak pulse, Hypotension, Pallor, cool, moist skin, anuria
  • Pulmonary: Cyanosis, Hypoxemia
  • Neuro: Decreased cerebral perfusion, Mental status deteriorates, Feeling of doom
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29
Q

What does MAP stand for? What MAP value is necessary to maintain perfusion of major body organs, such as the kidneys and brain. What happens when the map is decreased?

A
  • Mean Arterial Pressure
  • 60 to 70 mm Hg
  • When map is below 60 the heart hurts
30
Q

Distributive Shock? What are the two causes of Distributive Shock? What are the difference between the two causes?

A

occurs when blood volume is not lost from the body but is distributed to the interstitial tissues where it cannot perfuse organs.

Causes- Loss of sympathetic tone, blood vessel dilation, pooling of blood in venous and capillary beds, and increased capillary leak.

-neural-induced and chemical-induced

31
Q

For pt with ENDOCARDITIS, what are some Ports of entry of Infective Agents?

A
  • Oral cavity
  • Skin rash
  • Lesion/abscess
  • Infection
  • Surgery or invasive procedure
32
Q

When do you do CARDIOVERSION (synchronized) ? What test should you do before cardioversion on a pt with AFIB, AFLUTTER?

A
  • VTACH with pulse
  • Unstable AFIB or AFLUTTER
  • electively for stable tachydysrhythmias
  • Trans Esophageal Echocardiogram - (TEE) - check to see if there are any clots that can be dislodged
33
Q

What percent of cardiac output is Atrial Kick is responsible for? What are the manifestations when Atrial Kick is lost?

A
  • 25 - 30% of CO
  • When Atrial Kick is lost Manifestations Hypotension, shortness of breath, chest pain, increase pulse rate (to make up for cardiac output)
34
Q

What populations are known for having silent MI’s? Why?

A
  • Diabetics
  • Women
  • Elderly
35
Q

Antidote for COUMADIN ? Antidote for Heparin?

A 
Coumadin = vitamin K
Heparin = Protamine Sulfate
36
Q

Manifestations of Cardiac Tamponade?

A

Cardiac tamponade findings:

  • JVD
  • Paradoxical pulse
  • Decreased CO
  • Muffled heart sounds
  • Circulatory collapse
  • Hypotension

-

37
Q

Right sided heart failure

A
  • Characterized by insufficient force of cardiac contraction and/or inadequate filling of the heart with blood.

Symptoms:
Peripheral edema, JVD, weight gain, ascites, hepatomegaly, S3 gallop on auscultation

38
Q

What is the treatment and goal time of treatment?

A
  • cath lab in 90 mins or less
39
Q

Time frame of giving thrombolytics post MI? How are they administered?

A
  • Within first 6 hrs of cardiac event

- Given during cardiac catheterization but they can be given via IV

40
Q

3 Common origins of distributive shock?

A
  1. Anaphylaxis
  2. Sepsis
  3. Capillary leak syndrom
41
Q

What is the result of a NSTEMI ? EKG appearance?

A
  • Myocardial ischemia due to coronary vasospasm, spontaneous dissection, and sluggish blood flow due to narrowing of the
  • ST depression or T wave Inversion
42
Q

What do the P waves look like in AFIB?

A
  • Wavy with no prominent P wave
43
Q

What does MONA stand for? What position should a pt with a potential MI sit in?

A
  • Morphine, O2, Nitro, Aspirin
  • Morphine sulfate - vasodilates coronary arteries, relaxes/decreases anxiety. ease pain, increases oxygenation, lowers BP, decreases demand of 02
  • O2 - body is deprived
  • Nitro - vasodilator (sublingual, spray, IV) - should bring more 02 to the heart. I
  • Aspirin - antiplatelet
  • Position of comfort; semi-fowlers
44
Q

What valve problems sound like a washing machine?

A

Stenosis

45
Q

what are the stages of SHOCK?

A 
Initial stage (early shock)
Nonprogressive stage (compensatory stage)
Progressive stage (intermediate stage)
Refractory stage (irreversible stage)
46
Q

Nonprogressive (compensatory) Stage of SHOCK?

A
  • BP stays WDL
  • MAP falls 10 t0 15 mm/hg below baseline
  • Kidney, baroreceptors, and hormonal adaptive mechanisms activated.
  • Stimulates sympathetic NS
  • Kidneys sense decreased MAP
  • Renin/angiotensin system activated
  • Pituitary kicks in with ADH
  • Tissue hypoxia in nonvital organs.
  • Acidosis and hyperkalemia.
  • Stopping conditions that started shock and supportive interventions can prevent shock from progressing
  • Can have no permanent damage
  • Best time to intervene

Still have some clinical signs that indicate poor organ perfusion:

Anxiety, restlessness, thirst
Resp: increased resp rate, decrease in O2 sat
Cardiac: tachycardia, falling systolic pressure, rising diastolic pressure, narrow pulse pressure, cool extremities, decreased UO

47
Q

Manifestations of Atrial Fibrillation?

A
  • No P waves
  • irregular rhythm
  • Decreased cardiac output (loss of 25-30% CO)
48
Q

When AFIB is prolonged > 48 hours the patient will be at risk for ______?

A

Mural Thrombi (Formation of a thrombus in contact with the endocardial lining of a cardiac chambe)

49
Q

Nonprogressive (compensatory) interventions:

A
  • ID cause: Correct underlying disorder
  • Compare changes to baseline
  • Support by: Help maintain BP and adequate perfusion
  • Vasoconstrictors, inotropic, enhance CO
  • Fluid replacement: Crystalloids, colloids, blood products
  • Medication
  • Oxygen
  • Monitor tissue perfusion, vitals
  • Patient safety
  • Reduce anxiety for pt and family
50
Q

_________ is lost when the SA Node is not the chief dominant pacemaker in the heart (afib, aflutter)

A

Atrial Kick

51
Q

What are PREMATURE VENTRICULAR CONTRACTIONS?

A
  • Results from increased irritability of ventricular cells

- lower chambers of the heart contract before they should. When this happens, your heartbeat becomes out of sync.

52
Q

Disease states that affect Afterload? Drugs used to improve?

A

Disease states that increase resistance makes it harder for the heart to pump blood

  • Hypertension
  • Aortic stenosis
  • Increased blood viscosity

**Antihypertensives - Beta Blockers, Vasodilators

53
Q

Who is at high risk for Endocarditis?

A
  • IV drug abusers
    • Valve replacement recipients
    • People who have had systemic infections
    • People with structural cardiac defects
54
Q

Pacemaker/ICD EDUCATION:

A
  • Report skin irritation at pacemaker site, report fever,
  • Don’t apply pressure over your generator. Avoid tight clothing
  • Follow activity restrictions
  • Avoid external electrical fields
  • Record daily pulse (1min) at the same time every day. (or if they patient is having symptoms of P/M failure)
  • Teach patient S/S of pacemaker failure
  • Report hiccups, weight gain, difficulty breathing, dizziness, fainting, chest pain.
55
Q

PT or INR tests for?

A

coumadin and warfarin

56
Q

what is Hemodynamic monitoring?

A

Invasive system used in critical care areas to provide quantitative information about vascular capacity, blood volume, pump effectiveness, and tissue perfusion

types:
Pulmonary artery catheter
Invasive arterial catheter and monitoring
Pulmonary capillary wedge pressures

57
Q

Medications for Valvular disease?

A
  • ACE inhibitor - blood pressure
  • Digoxin- decrease contractility
  • Beta Blockers - protects the heart
  • Antibiotics
  • Anticoagulant
  • Diuretics
  • Vasodialators
58
Q

Atrial Fibrillation is almost always associated with _____________ and _______.

A
  • Heart disease

- COPD

59
Q

What is the Ejection Fraction? What is it measuring?

A
  • Percent of the blood ejected from the heart during systole
60
Q

Treatment of PVC ?

A
  • Treatment = antidysrhythmics if symptomatic (amiodarone, lidocaine, procainamide, B-blockers)
61
Q

What drugs are aimed at decreasing preload?

A

Vasodilators, Diuretics

62
Q

What does Digoxin do?

A
  • increases vagal tone, slowing AV nodal conduction.
63
Q

Interventions for sepsis/septic shock:

A
  • Correct the cause!
  • Use of sepsis resuscitation bundle within 6 hours
  • Oxygen therapy
  • IV therapy: Normal saline (NS) or Lactated Ringers (LR)
  • Drug therapy: Vasoconstrictors: Dopamine, Epinepherine etc.
  • Agents to enhance contractility and perfusion/CO
  • Blood replacement therapy
  • Identify those at risk, early detection!
64
Q

Factors that influence MAP?l. For the stable patient with sustained VT, administer oxygen and confirm the rhythm via a 12-lead ECG. Amiodarone (Cordarone), lidocaine, or magnesium sulfate may be given.lo999mom

A
  1. Total blood volume
  2. Cardiac output
  3. Size o9:of the vascular bed
65
Q

What is the most common cause of obstructive shock?

A

Cardiac tamponade

66
Q

Patients with a an EF less than __% are a candidate for an Implantable cardioverter defibrillator? What must the EF be to diagnose heart failure?

A
  • 33%

- 40%

67
Q

Sepsis/septic shock lab values

A

lactate levels, BC before antibiotics, WBC, clotting factors with DIC

68
Q

Hypovolemic Shock

A

pH, Lactic Acid, Hematocrit, Hemoglobin, Potassium

69
Q

Cause of Mitral Valve Regurgitaion

A

Aging, infective endocarditis, rheumatic heart disease

70
Q

What is the goal of crisis intervention

A

-to help survivors return to their previous lifestyle as quickly as possible.

**Crisis Intervention. The focus of the initial interview and follow-up with the client who has been sexually assaulted is on the rape incident alone. Problems identified but unassociated with the rape are not dealt with at this time.

71
Q

Signs of Physical Abuse to a child:

A
  • Has unexplained burns, bites, bruises, broken bones, or black eyes
  • Has fading bruises or other marks noticeable after an absence from school
  • Seems frightened of the parents and protests or cries when it is time to go home
  • Shrinks at the approach of adults
  • Reports injury by a parent or another adult caregiver
  • Abuses animals or pets
72
Q

Signs that a parent or adult caregiver are abusing a child?

A
  • Offers conflicting, unconvincing, or no explanation for the child’s injury
  • Describes the child as “evil,” or in some other very negative way
  • Uses harsh physical discipline with the child
  • Has a history of abuse as a child
  • Has a history of abusing animals or pets

Adult Nursing - 225 (9 decks)

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