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Adult Critical Care > Test 1 > Flashcards

Test 1 Flashcards

1
Q

What is the difference between ECG and Continuous cardiac monitoring

A

Provides information about cardiac status

  • as it is happening
  • it does not diagnose pump problems(CHF, heart failure, cor pul)
  • Records electrical activity in the heart
  • records dysrhythmias
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2
Q

Dysrhythmias are caused by

A

Hypoxia, Ishemia, Sypathetic stimulation, drugs, Electrolyte imbalance, rate, stretch

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3
Q

1 reason adult cardiac arrest

A

Underlying heart problem

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4
Q

1 reason kids cardiac arrest

A

Resp failure/ Sepsis

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5
Q

Heart blood path

A

Superior Vena Cava, Inlet of the superior vena cava, right atrium, inlet of the inferior vena cava, Coronary sinus, Inferior vena cava, Coronary sinus, Inferior vena cava, Tricuspid valve, Right Ventricle, Interatrial septum, Interventricular Septum, Left atrium, Mitral valve, Left ventricle

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6
Q

During a fib. blood starts

A

elsewhere other than SA node

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7
Q

Heart conduction

A
  1. SA Node
  2. AV node
  3. Bundle of His
  4. Bundle branches
  5. Purkinje fibers
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8
Q

SA Node-

A

Automaticity

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9
Q

AV Node-

A
  • Conduction is delayed at the AV node to allow the ventricles to fill with blood
  • Also limits the rate of ventricular stimulation during excessive atrial firings
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10
Q

Purkinje fibers-

A

Finger like branches that penetrate the cardiac muscle

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11
Q

Properties of cardiac muscle

A
  1. Contractile muscle fibers

2. Auto-rhythmic cells

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12
Q

Contractile muscle fibers

A

Responsible for pumping activity of the heart, Make up bulk of musculature of myocardium

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13
Q

Auto-rhythmic cells

A

Make up 1% of cardiac cells, most found in SA node, cause myocardial fibers to contract, stimulate and create action potential

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14
Q

Four properties of cardiac muscle

A
  1. Automaticity
  2. Excitability
  3. Conductivity
  4. Contractility
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15
Q

Excitability

A

Response to stimulation or irritation, Ischemia and hypoxia cause myocardial cells to become more excitable (irritated)

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16
Q

Conductivity

A

Unique ability of the heart cells to transmit electrical current from cell to cell throughout the entire conductive system

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17
Q

Contractility

A

Is the ability of cardiac muscle fibers to shorten and contract in response to an electrical stimulus

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18
Q

Electrolytes responsible for electricity

A
  1. Potassium (K+)
  2. Sodium (Na+)
  3. Calcium (Ca2+)
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19
Q

Nervous System Role

A

plays important role in the rate of impulse formation, conduction, and contraction strength

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20
Q

Sympathetic stimulation role

A
  • Cause increase in HR
  • Increase in AV conduction
  • Increase in heart contractility
  • increase in excitability
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21
Q

Parasympathetic role

A
  • Decrease in HR
  • Decrease in AV conduction
  • Decrease in contractility
  • Decrease in excitability
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22
Q

Continuous Cardiac Monitor 5 leads

A

White in the clouds over grass (green), with crap in the middle, then smoke (black) over fire (red)

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23
Q

Ectopic beat

A

any heart beat originating outside the SA node

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24
Q

Foci/Focus

A

Where the ectopic beat originates

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25
Q

Dysrhythmias

A

abnormal cardiac conduction, also termed arrhythmia

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26
Q

Escape beat

A

a heart beat that originates outside the sinus node after a period of SA node inactivity

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27
Q

Myocardial ischemia

A

partial or complete obstruction of blood flow, reducing oxygen supply to the heart

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28
Q

angina

A

chest pain associated with reduced coronary blood flow

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29
Q

Stable Angina

A

Persistent reoccurring chest pain that usually occurs with exertion

30
Q

Unstable Angina

A

Unexpected chest pain, usually occurring during rest. Chest pain is usually more intense and lasts for a longer period of time

31
Q

Myocardial infarction

A

death of muscle tissue

32
Q

Atrial kick

A

Responsible for cardiac output (10-30% ventricular filling)

33
Q

Heart block

A

Conduction stopped or insignificantly delayed

34
Q

Automaticity

A

ability of heart to beat on own

35
Q

PVCs

A

Premature ventricular contractions

36
Q

Syncope

A

Fainting (lack of blood flow)

37
Q

STEMI

A

ST elevated myocardial infarction (BAD)

38
Q

Normal rates: SA Node, AV junction, Bundle Branches, Purkinje Network

A

SA- 50-100
AV- 40-60
Bundle-30-40
Purkinji- 30-40

39
Q

Steps to reading ECG

A
  1. HR
  2. Heart rhythm (reg/ irreg) R-R interval
  3. Presence of P wave
  4. Is there a QRS following each P wave
  5. PR interal (is it less than 0.20)
  6. QRS complex (Is it less than 0.12 seconds)
  7. ST segment (baseline)
40
Q

PVC

A

Wide ectopic beat from ventricles

41
Q

ECG systems use the same standard paper and run at the same speed of

A

25mm/sec

42
Q

Each small ECG square=

A

0.04

43
Q

Each large ECG square=

A

0.20, containing 5 small squares

44
Q

1 second on a ECG strip=

A

5 large squares

45
Q

Ventricle rhythm, comparing the R-R ratio with the longest/ shortest… how many seconds to make irregular

A

> 0.12

46
Q

P Wave

A

Represent atrial conduction originated in the SA node, Paces the heart.

  • Less than 2.5 mm in height
  • more than 0.10 seconds in length
47
Q

PR Interval

A

Normal 0.12-0.20 seconds

-Longer= delay in conduction through the AV node (AV block)

48
Q

Complete heart block=

A

third degree heart block

49
Q

QRS Complex

A

-Normal is less than 0.12 seconds long,

Represents ventricular depolarization

50
Q

Rules of QRS

A
  • If the first deflection is downward than it is a Q wave
  • The initial upward deflection is an R wave
  • The first neg. deflection following R is an S wave
  • QS is a negative deflection with no positive deflection at all
  • regardless of missing waves it is still called QRS complex and represents ventricular depolarization
51
Q

T wave

A

reflects ventricular repolarization, inverted T waves suggest ischemia

52
Q

ST segment

A

Normally baseline, A depressed ST segment suggests myocardial ischemia
-an elevated segment suggests myocardial infarction

53
Q

Sinus Dysrhythmias

A

Sinus bradycardia- Regular rhythm, HR < 60bpm,

Sinus tachycardia- Regular rhythm, HR 100-160bpm

54
Q

Supraventricular Tachycardia

A

Ventricular rate: 150-250bpm

  • Regular rhythm
  • P waves may be hard to see
  • Narrow QRS
  • Connect SVT to adenosine as first line drug
  • Cardioversion
55
Q

Cardioversion

A

machine cardioverts on R wave (synchronize)

Resents heart

56
Q

Defibrillation

A

shock whenever

57
Q

Atrial flutter

A

-flutter or saw tooth wave is produced by same ectopic beat (outside SA node)
-Flutter wave replaces P (sinus)wave
-Atria Rate 250-350bpm
Commonly seen in pts with atrial fibrillation

58
Q

Complications of atrial flutter

A

-Diminishes atrial filling: results in minimal atrial assistance in filling the ventricles (10-30% CO)
-Development of thrombi in atrial walls: need for blood thinners
(blood in atrial for too long)

59
Q

Atrial Fibrillation

A
  • The AV node is bombarded with hundreds of ectopic atrial beats at various rates and amplitudes
  • atrial rate: >400 (chaotic and irregular)
  • RHYTHM is regular
60
Q

Treatment options for A. Fib.

A

Reduce the heart rate with cardioversion,
Medication to maintain normal rhythm:amiodarone,
medication to control ventricular rate: calcium channel blockers, beta blockers,
Medication to reduce atrial thrombus: coumadin, Pradaxa, Xarelto, Eliquis,
Cardiac ablaton: burn places in heart

61
Q

A. Fib Symptoms

A 
Racing heartbeat, irregular
Heart palpitations
Dizziness
Sweating
Chest pain or pressure
SOB
Confusion
Fatigue
Reduced ability to exercise
A. Fib may be occasional, persistent, or permantent
FROM POOR CARDIAC OUTPUT
62
Q

Associated causes of A flutter and A fib

A

COPD, CHF, Valvular heart disease, Chronic hypertension, Ischemic heart disease, MI

63
Q

First Degree AV block

A

Normal rate, regular rhythm, one p wave before each QRS,

  • PR prolonged and constant (longer than 0.20)
  • usually no tx needed
64
Q

Second Degree AV block- Wenkebach type 1

A
  • Progressive prolongation of the PR interval until a Pwave is not conducted
  • Patterns repeats itself
  • it occurs when an abnormality in the AV junction delays or blocks conduction of some of the impulses through the AV node
65
Q

Second Degree AV block- Mobitz type II

A

PR intervals: for conducted p waves, P-R intervals is consistent (normal or can have a 1st degree block), muliple p waves not followed by QRS wave

66
Q

Mobitz type II result from

A

serious problem such as MI or ischemia, requires tx to improve cardiac output, pacemaker is indicated

67
Q

3rd degree (complete) AV block

A

Normal everything, but no measurable PR intervals, heart must pace to maintain acceptable cardiac output

68
Q

List one major complication/ risk of having Atrial fib.

A

Thrombi= must be on blood thinners, and emboli= stroke

69
Q

Symptomatic Bradycardia

A

(Need IV access)

  • HR is slow
  • Pt has symptoms
  • Symptoms due to slow HR
70
Q

Bradycardia symptoms

A

Chest discomfort or pain, SOB, decrease LOC, Weakness, fatigue, light headed, dizziness, and presyncope or syncope similar to tachycardia

Adult Critical Care (5 decks)

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