test 3 Flashcards

1
Q

what is cardiac cycle caused by

A

electrical (caused by automaticity) (1st)
mechanical (muscular) (2nd)

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2
Q

2 phases of electrical activity

A

depolarization= active (contract)= systole
repolarization= resting =diastole

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3
Q

two mechanical responses

A

systole
diastole

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4
Q

systole

A

contraction

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5
Q

diastole

A

resting or filling phase

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6
Q

sino atrial node (SA)

A

rate of 60-100 bpm

depolarization begins
atrial contraction

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7
Q

AV node

A

40-60 bpm

delays impulse to ventricles; allows for filling
backup pacemaker for SA node

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8
Q

Bundle of His

A

20-40 bpm

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9
Q

electrical conduction pathway

A
  1. SA node
  2. AV node
  3. Bundle of His
  4. Bundle Branches (L and R)
  5. Purkinje fibers
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10
Q

what consist of Autonomic Nervous System

A

sympathetic nervous system

parasympathetic nervous system

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11
Q

parasympathetic nervous system

A

acetylcholine

decreased HR, decreased contractility, vasodilation

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11
Q

sympathetic nervous system

A

epinephrine and norepinephrine

increased HR, increased contractility, vasoconstriction

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12
Q

difference between 15 lead and 12 lead

A

12 lead is only on the front where 15 has 3 on the back

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13
Q

cardiac monitoring

A

continuous monitoring via 3 lead or 5 lead

skin prep, lead placement and appropriate lead selection are very important

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14
Q

ECG graph paper

A

vertical= measures amplitude
horizontal= measures time

1 box is 0.04 secs

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15
Q

P wave

A

atrial depolarization

normally indicates firing of SA node
shouldn’t exceed 3 boxes high

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16
Q

PR interval

A

Atrial depolarization/delay in AV node

beginning of P wave to beginning of QRS complex

should be anywhere from .12 to .20 secs
shorter interval- impulse from AV junction
Longer interval= first degree AV block

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17
Q

QRS complex

A

ventricular depolarization

0.06 to 0.10 secs

if wide its a slowed conduction

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18
Q

ST segment

A

look for depression or elevation.

elevation- MI
depression- ischemia, reciprocal changes, digoxin

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19
Q

QT interval

A

beginning of QRS complex to end of T wave

0.32 to 0.50 secs

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20
Q

U wave

A

not normally seen

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21
Q

PP intervals (atrial)

A

is regular when distance between PP intervals is equal

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22
Q

RR intervals (ventricles)

A

is regular when distance between RR intervals is equal

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23
Q

normal sinus rhythm

A

60-100 bpm

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24
sinus tachy
100-150 causes- hyperthyroidism, hypovolemia, heart failure, anemia, stimulants, fever, sympathetic responses assess for symptoms of low cardiac output
25
sinus bradycardia
less than 60 bpm causes- vagal, drugs, ischemia, diseases of the nodes, ICP, hypoxemia, and athletes (normal)
26
what causes atrial dysrhythmias
increased automaticity in the atrium causes- stress, electrolyte imbalance, hypoxia, atrial injury, digitalis toxicity, hypothermia, hyperthyroidism, alcohol, pericarditis
27
premature atrial contraction
early beats initiated by atrium noncompensatory pause
28
Afib
erratic impulse formation in atria no discernible P wave irreg vent rate high risk for emboli
29
A flutter
sawtooth patterns
30
supraventricular tachycardia
rate 150/160-250 regular rate, P waves may or may not be present PR interval 0.12-0.20 QRS 0.10 secs or less
31
ventricular dysrhythmias
impulses initiated from lower portion of the heart depolarization occurs leading to abnormally wide QRS complex ectopic and escape beats common causes- MI, low K or Mg, hypoxia, acid-base imbalances
32
ventricular Tachycardia
rapid life threatening, rate can be 150-250. ACLS will most likely be needed
33
torsades de pointws
Med emergency. Caused by prolonged QT interval and is often caused by Mag deficiency. Treated as pulseless Vtach characterized by the presence of both positive and negative complexes that move above and below the isoelectric line. This lethal dysrhythmia
34
V fib
Life threatening. Immediate treatment needed
35
asystole
flat line check leads and pt
36
pulseless elecrtical activity
has rhythm but no pulse. Caused By Hs and Ts. Must treat cause
37
AV blocks
block of conduction from atria to ventricles 4 types- first degree, second (morbitz type 1 and 2), third degree (complete)
38
Cardiac pacemakers
deliver an electrical current to stimulate depolarization can pace atrium, ventricle or both
39
method of pacing: cardiac pacemaker
transcutaneous- emergency transvenous epicardial
40
what to know when taking care of pt w pacemaker
rate mode electrical output (mA) sensitivity sense-pace indicator AV interval
41
automaticity
the ability of certain cardiac cells to spontaneously generate electrical impulses, leading to heart contractions without external stimulation.
42
when do codes occur
cardiac arrest resp arrest life threatening dysthymia's causing loss of consciousness
43
when to call a rapid
change in pt conditions such as: HR, BP RR, o2 sat mental status Urinary output lab values
44
what do rapid response teams decrease
cardiac arrest critical care length of stay incidence of acute illness they do not reduce mortality rate
45
types of nurses in a code
primary nurse- knows patient secondary- gives meds, get equipment teritary- records events nurse supervisor- traffic control, secures ICU bed if needed
46
equipment needed for code
crash cart backboard monitor/defibrilator, pacemaker bag valve mask device airway supplies/suction meds IV supplies NG tube BP cuff
47
sequence of events: BLS
Advanced directives airway open breathing circulation- compressions
48
technique to open airway
head tilt/chin lift
49
rate of air ml/min for ACLS
15 mL/min
50
ACLS
advanced cardiac life support additional certification uses early defibrillation and AED
51
what meds can be delivered through endotracheal tube (ETT) if needed
lidocaine epinephrine vasopressin
52
treatment of V-fib and pulseless V tach
ABCD, initiate CPR shock-CPR-shock-CPR consider antidysrthymic drugs. Amiodarone is drug of choice ensure IV access
53
pulseless electrical activity (PEA)
Rhythm without pulse airway, o2, intubate, IV access treat cause med= epinephrine ABCD with circulation
54
causes of pulseless electrical activity
hypoxia hypovolemia hypothermia H+ ions (acidosis) hypokalemia or hyperkalemia tablets (OD) Tamponade tension pneumothorax thrombosis (coronary or pulmonary)
55
treatment of asystole
ABCD with CPR Airway, o2, intubate, IV access confirm with multiple leads treat cause pacemaker epinephrine
56
treatment of symptomatic bradycardia
ABCD with car airway, o2, IV access atropine if conscious. could also use epinephrine or dopamine transcutaneous pacing (very painful. only used if emergency) NO lidocaine
57
unstable tachycardia
ABCD airway, o2, IV access sedation cardioversion
58
cardioversion
electric current, much lower joules then defib. (60 joules) synchronized delivery on R wave. used for symptomatic tachycardia.
59
defibrillation
primary treatment for V Fib and pulseless V tach. Used when there is no pulse electric current- 200-360 joules completely depolarizes the heart. allows for resumption of the rhythm. everything must be clear before shock may cause skin burns (ensure good contact with skin) continue CPR after and reassess
60
transcutaneous cardiac pacing
for symptomatic bradycardia sedation and analgesics may be needed
61
Meds may be used in code
o2 epinephrine vasopressin atropine amiodarone lidocaine adenosine magnesiun dopamine
62
what o2 percent to give during arrest
100%
63
epinephrine
potent vasoconstrictor typically given 1mg IV push but can also be given intraosseous or ETT. continuous infusion may also be done used in V fib, Pulseless V tach, asystole, PEA
64
Vasopressin
vasoconstriction may be as effective as epinephrine
65
atropine
for symptomatic brady. Given IV push, can be given through ETT. decreases vagal tone= increases HR
66
Amiodarone
for VT and VF reduces membrane excitability can be given IV/IO in cardiac arrest
67
lidocaine
antidysrhythmic surpasses ventricular ectopy can be IV/IO/ETT
68
adenosine
for SVT slows conduction through AV node rapid IV push
69
magnesium
used for refractory VF, torsades de pointes. only if known deficiency of Mg
70
sodium bicarb
treatment of metabolic acidosis
71
Dopamine
for symptomatic hypotension vasoconstrictor- increases bp continuous drip
72
documentation of arrest
Write everything- order of events, med (doses, time, etc), time when things are done, vitals, Pt responses, team members present
73
postresusication goals
optimize cardiopulmonary function transport to critical care unit determine cause of arrest
74
post CPR interventions
12 lead ECG neuro exams arterial line indwelling Cath for hourly output monitor BG
75
interventions if pt comatose after CPR
Head CT, EEG
76
Therapeutic hypothermia
For fever from brain injury increases the level of neurological damage post CPR lower body temp is associated with better recovery. Must have continous EEG. Use bladder Cath to monitor temp control shivering with IV sedatives, analgesics, neuromuscular blockade meds REWARM slowly after 24 hours
77
complications of ther hypothermia
bleeding infection metabolic and electrolyte disturbances hyperglycemia
78
hemodynamic monitoring studies the relationship of:
blood flow o2 delivery tissue perfusion heart rate
79
goal of hemodynamic monitoring
assess the patient and provide therapies to optimize o2 delivery and tissue perfusion
80
cardiac output
volume of blood ejected from heart/min heart rate + stroke volume= cardiac output
81
normal Cardiac output
4-8 L/min low = body doesn't have enough blood/fluid. high= vise versa
82
ejection fraction
fraction of blood ejected with each beat
83
normal ejection fraction
60-70% low in HF pts. may be around 20%
84
contractility
force of ventricular contraction. how well the heart is pumping digoxin is a med that can help this
85
systemic vascular resistance
peripheral vascular resistance. diameter of blood vessels.
86
what is arterial BP
cardiac output + SVR
87
afterload
pressure or resistance against flow it is related to lumen size and viscosity
88
preload
degree of muscle fiber stretch before systole- volume of blood in ventricle prior to contraction increased stretch= increased volume
89
vasodilators
nitroglycerin, hydralazine
90
vasoconstrictors
vasopressin, epinephrine, atropine
91
noninvasive hemodynamic monitoring modalities
BP cuff jugular venous pressure serum lactate levels
92
invasive hemodynamic monitoring modalities
arterial BP pulmonary artery BP right arterial pressure
93
components of invasive hemodynamic monitoring system
invasive catheter noncompliant pressure tubing transducer and stepcocks flush system bedside monitor
94
arterial pressure monitor indications and complications
treat hemodynamic instability assess efficacy of vasoactive meds obtain frequent blood samples complications: could fall out and cause person to bleed to death, infection. hold pressure for 15 mins when out.
95
Central venous pressure (CVP)
Catheter in superior or inferior vena cava. triple lumen.
96
normal value or right arterial pressure (RAP) and central venous pressure (CVP)
2-6 mm Hg low= not enough pressure high= too much pressure
97
nursing interventions RAP/CVP
zero it PT position 0-60 degrees monitor for comp- puncture, dysrhythmias, pneumothorax, infection
98
what does RAP/CVP assess
RV preload or right vent end diastolic pressure direct measurement of pressure in right atrium
99
pulmonary artery pressure
normal level is 8-12 created by Dr Swan and Ganz
100
insertion of pulmonary artery cath
proper position of pt- tredelenburg position, towel roll between shoulder blades Monitor waveforms confirm placement with chest x-ray, check for puncture
101
norepinephrine like drugs
epinephrine, norepinephrine, vasopressin, atropine
102
acetylcholine like drugs
nitroglycerin, beta blockers, hydralazine
103
coronary artery disease
progressive narrowing of arteries due to atherosclerosis diagnosed by cardiac enzymes, EKG management- aspirin, lower lipids
104
angina
3 types chest pain/discomfort caused by imbalance in myocardial o2 supply and demand decrease pain, find out cause.
105
MI
ischemia with myocardial cell death
106
STEMI vs NSTEMI
ST elevation vs no ST elevation
107
MI s/s
chest pain pale and diaphoretic dyspnea syncope n/v dysrhythmias shoulder blade/arm pain flu like symptoms
108
diagnosis of MI
12 lead EKG elevated troponin, elevated CK-MB
109
Complication of MI
dysrhythmias HF Rupture pericarditis cardiogenic
110
complications of CABG
dysthymias impaired contractility MI pericardial temponade resp insufficiency pain emboli death
111
post CABG management
assess for adequate cardiac output airway management- vent circulation
112
goal of HF treatment
improve pump function remove fluid reduce cardiac workload/o2 damage improve gas exchange
113
flash pulmonary edema
HF complication pink frothy sputum hypoxemia dyspnea cyanosis lassix needs to be given immediately
114
4 types of aortic aneurysm
flase fusiform saccular dissecting
115
aortic dissection
tear of inner layer of aorta s/s- sudden sharp, severe chest pain usually by the time it presents its too late management- surgical intervention, control BP