T2: Imaging & Devices Flashcards
Routinely obtained to determine the size, silhouette, and position of the heart
Chest X-Ray
Chest X-rays:
In acutely ill patients, a simple _______ can be obtained at the bedside
anteroposterior (AP)
What can be seen on a chest X-Ray (4)
-Cardiac enlargement
-Pulmonary congestion
-Cardiac Calcification
-Placement of central venous catheters (CVC), endotracheal tubes, and hemodynamic monitoring devices
most definitive but most invasive test in the diagnosis of heart disease
Cardiac catheterization
Uncommon, but serious complications that may follow coronary arteriography: (7)
Myocardial infarction (MI)
Stroke
Arterial bleeding
Thromboembolism
Lethal dysrhythmias
Arterial dissection
Death
Indications for cardiac catheterization
-confirm suspected heart disorders
-determine the location and extend the disease process
-assess stage/severity of condition
-determine best therapeutic option
-evaluate effects of medical or invasive treatment
Nursing actions pre-cardiac catheterization (7)
-Teach pt about procedure
-Obtain consent
-Pre-procedure exams
-Solids and non-clear liquids held 6 hours before procedure
-Clear liquids held 2 hours before procedure
-Prepare surgical site with antiseptic
-Obtain vitals
Cardiac catheterization:
right side Cath through ___(1_____
left side Cath through ___(3)____
right side: femoral artery
left side: femoral, brachial, or radial artery
Pre-Heart Cath tests (4)
-Chest X-Ray
-CBC
-Coagulation studies
-12 lead ECG
Nursing Actions: Post Heart Cath
-HOB at 30 degrees
-Bedrest 2-6 hours with surgical limb remaining straight
-Monitor vital signs
-Assess site for blood drainage or hematoma
Routine part of every cardiovascular evaluation and is one of the most valuable diagnostic tests
Electrocardiography
Various forms of ECG: (5)
-Resting
-Continuous ambulatory (holter)
-Exercise (stress test)
-Signal-averaged
-30-day event monitoring
Resting ECG provides information about: (6)
-Cardiac dysrhythmias
-Myocardial ischemia
-Site and extend of MI
-Cardiac hypertrophy
-Electrolyte imbalances
-Effectiveness of cardiac drugs
assesses cardiovascular response to an increased workload
Stress test
Nurse actions: stress test (8)
-inform pt
-attach 12 leads
-light meal 2 hours before
-comfortable outfit
-monitor vitals and note baseline BP
-check med history
-prep for resuscitation
-set treadmill to 1-10 mph w/ gradual incline
On cardiac stress test, patient continues to exercise until one of the following occurs: (4)
-Predetermined HR is reached and maintained
-Signs and symptoms appear
-Significant ST-segment depression or T-wave inversion occurs
-20 minute protocol is completed
Nursing actions: post stress test
-monitor VS
-No hot showers for 1-2 hours after
-telemetry observation
noninvasive, risk free test that uses ultrasound waves to assess cardiac structure and mobility, particularly of the valves
echocardiography
Echocardiography is used to help assess and diagnosis: (6)
-Cardiomyopathy
-valvular disorders
-pericardial effusion
-left ventricular function
-ventricular aneurysms
-cardiac tumors
nursing action: echocardiography
-no special prep
-pt lies down on left side with HOB elevated 15-20 degrees
-takes 30-60 minutes to complete
test used when patients cannot tolerate exercise; slightly more aggressive form due to the use of pharmacological induction of stress
pharmacologic stress echocardiogram
Pharmacologic stress echocardiograms use what medications that do what (2)
-Dobutamine increases the heart’s contractibility
-Dipyridamole is a coronary artery dilator
Nursing actions: pharmacologic stress echocardiogram
-NPO 3-6 hours before
-IV access is present before procedure
-Monitor BP and pulse continuously throughout procedure
Nursing actions: post pharmacologic stress ECG
vital signs monitored until BP returns to baseline and pulse rate slows to less than 100 bpm
examining cardiac structure and function with an ultrasound transducer placed immediately behind the heart in the esophagus or stomach
Transesophageal ECG
Transducer used in trasnesophagela ECG provides detailed views of ______ cardiac structures such as:
-posterior
-left atrium, mitral valve, and aortic arch
generates & transmits electrical impulses which stimulates contractions of the atria and then the ventricels
cardiac conduction system
Steps in the heart’s conduction system:
(Send a big bounding pulse)
-SA node
-AV node
-Bundle of HIs
-Bundle branches
-Purkinje Fibers
Primary pacemaker of the heart; creates electrical impulses of 60-100 bpm
SinoAtrial (SA) node
Secondary pacemaker of the heart “backup pacemaker”; SA node malfunctions, the AV node takes over at a rate of 40-60 bpm
AtrioVentricular (AV) node
If the SA and AV nodes fail, the Purkinje fibers can fire at a rate of ________-
30-40 bpm
ECG: atrial contraction (depolarization)
P wave
movement of electrical activity from atria to ventricles
PR segment
Ventricle contraction (depolarization)
QRS complex
Time between ventricular depolarization & repolarization
ST segment
Ventricle relaxing (depolarization)
T wave
Ventricles relaxing and filling
TP interbal
ECG: 60-100 bpm
normal sinus
ECG: >100 bpm
sinus tachycardia
ECG: < 60 bpm
Sinus Bradycardia
Electronic apparatus used to initiate heartbeat when the SA node is seriously damaged and unable to act correctly
pacemaker
Types of pacemakers (4)
-Internal/implantable
-External
-Temporary
-Permanent
Major methods of cardiac pacing (2)
Rate responsiveness pacemaker
Demand pacemaker
pacemaker allows faster pacing rates to meet increased bodily demand
rate responsiveness pacemaker
electrode wire inserted percutaneously and threaded though to the ventricle; battery pack is implanted under skin
Demand pacemaker
Technical problems associated with cardiac pacing (5)
-Dislodgment and migration of endocardial leads
-Wire breakage
-Cracking of insulation surrounding wires
-Infection of sites surrounding either pacing wires or pulse generator
-Battery exhaustion
Pacemaker batteries can last ______. A computer monitors ____________ of the pacemaker. It could be a ___, _____, or ____chamber pacemaker
-5-10 years
-electrical activity and tailor function
-single, double, or triple chamber
Pacemaker functions when heart rate goes below set rate
Demand pacemaker
Pacemaker that stimulates ventricles at preset constant rate
fixed rate pacemaker
pacemaker used in emergency situations
Temporary pacemaker
Pacemaker is placed within right ventricle or right atrium and ventricle, and generator is implanted under skin below clavicle or in abdominal wall
permanent pacemaker
synchronized countercheck that may be performed to restore normal conduction in a hospitalized patient with -onset AF; can also be ordered for stable AF that is resistant to medical therapy
Cardioversion
Synchronized cardioversion is used to treat both:
-hemodynamically unstable ventricular
-supraventricular rhythms
nursing care before cardioversion includes: (8)
-informed consent
-Diazepam or Midazolam IV
-Voltage 25-360 watts/s
-digoxin withhold 48 hours prior to procedure
-synchronizer turned on, check at the R wave
-Oxygen discontinued
-Assess airway latency
-assess vital signs every 15 mins for first hour, then every 30 mins for 2 hours
Nursing care after cardioversion includes: (8)
-maintaining a patent airway
-administer oxygen
-assessing vital sings and the level of consciousness
-administering antidysrhythmic drug therapy
-monitoring for dysrhythmias
-assessing for chest burns from electrodes
-Providing emotional support
-documenting the results of cardioversion
used in the treatment of v-fib; device sends an electrical pulse to the heart to restore a normal heartbeat (preventing/correcting uneven heartbeats
defibrillation
Defibrillation completely __________ the myocardial cells so SA node can be pacemaker
depolarizes
indicated for patients who have experienced one or more episodes of spontaneous sustained ventricular tachycardia (VT), or ventricular fibrillation (VF) not caused by a myocardial infarction (MI)
Implantable cardioverter defibrillator
continuously monitor the heart and apply a defibrillator shock to bring the pt back to NSR if it identifies that the pt has a shockable dysrhythmia
Implantable cardioverter defibrillator
ICDs are indicated for patients who have experienced one or more episodes of ____ or _____ not caused by myocardial infarction (MI)
-ventricular tachycardia
-ventricular fibrillation
