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critical care > test 3 > Flashcards

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
Q

sinus tachy

A

100-150

causes- hyperthyroidism, hypovolemia, heart failure, anemia, stimulants, fever, sympathetic responses

assess for symptoms of low cardiac output

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25
Q

sinus bradycardia

A

less than 60 bpm

causes- vagal, drugs, ischemia, diseases of the nodes, ICP, hypoxemia, and athletes (normal)

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26
Q

what causes atrial dysrhythmias

A

increased automaticity in the atrium

causes- stress, electrolyte imbalance, hypoxia, atrial injury, digitalis toxicity, hypothermia, hyperthyroidism, alcohol, pericarditis

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27
Q

premature atrial contraction

A

early beats initiated by atrium
noncompensatory pause

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28
Q

Afib

A

erratic impulse formation in atria

no discernible P wave

irreg vent rate

high risk for emboli

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29
Q

A flutter

A

sawtooth patterns

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30
Q

supraventricular tachycardia

A

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

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31
Q

ventricular dysrhythmias

A

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

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32
Q

ventricular Tachycardia

A

rapid life threatening, rate can be 150-250. ACLS will most likely be needed

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33
Q

torsades de pointws

A

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

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34
Q

V fib

A

Life threatening. Immediate treatment needed

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35
Q

asystole

A

flat line

check leads and pt

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36
Q

pulseless elecrtical activity

A

has rhythm but no pulse. Caused By Hs and Ts. Must treat cause

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37
Q

AV blocks

A

block of conduction from atria to ventricles

4 types- first degree, second (morbitz type 1 and 2), third degree (complete)

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38
Q

Cardiac pacemakers

A

deliver an electrical current to stimulate depolarization

can pace atrium, ventricle or both

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39
Q

method of pacing: cardiac pacemaker

A

transcutaneous- emergency
transvenous
epicardial

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40
Q

what to know when taking care of pt w pacemaker

A

rate
mode
electrical output (mA)
sensitivity
sense-pace indicator
AV interval

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41
Q

automaticity

A

the ability of certain cardiac cells to spontaneously generate electrical impulses, leading to heart contractions without external stimulation.

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42
Q

when do codes occur

A

cardiac arrest
resp arrest
life threatening dysthymia’s causing loss of consciousness

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43
Q

when to call a rapid

A

change in pt conditions such as:
HR, BP
RR, o2 sat
mental status
Urinary output
lab values

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44
Q

what do rapid response teams decrease

A

cardiac arrest
critical care length of stay
incidence of acute illness

they do not reduce mortality rate

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45
Q

types of nurses in a code

A

primary nurse- knows patient
secondary- gives meds, get equipment
teritary- records events
nurse supervisor- traffic control, secures ICU bed if needed

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46
Q

equipment needed for code

A

crash cart
backboard
monitor/defibrilator, pacemaker
bag valve mask device
airway supplies/suction
meds
IV supplies
NG tube
BP cuff

47
Q

sequence of events: BLS

A

Advanced directives
airway open
breathing
circulation- compressions

48
Q

technique to open airway

A

head tilt/chin lift

49
Q

rate of air ml/min for ACLS

A

15 mL/min

50
Q

ACLS

A

advanced cardiac life support
additional certification

uses early defibrillation and AED

51
Q

what meds can be delivered through endotracheal tube (ETT) if needed

A

lidocaine
epinephrine
vasopressin

52
Q

treatment of V-fib and pulseless V tach

A

ABCD, initiate CPR

shock-CPR-shock-CPR

consider antidysrthymic drugs. Amiodarone is drug of choice

ensure IV access

53
Q

pulseless electrical activity (PEA)

A

Rhythm without pulse

airway, o2, intubate, IV access

treat cause

med= epinephrine

ABCD with circulation

54
Q

causes of pulseless electrical activity

A

hypoxia
hypovolemia
hypothermia
H+ ions (acidosis)
hypokalemia or hyperkalemia

tablets (OD)
Tamponade
tension pneumothorax
thrombosis (coronary or pulmonary)

55
Q

treatment of asystole

A

ABCD with CPR

Airway, o2, intubate, IV access

confirm with multiple leads

treat cause

pacemaker

epinephrine

56
Q

treatment of symptomatic bradycardia

A

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
Q

unstable tachycardia

A

ABCD

airway, o2, IV access
sedation
cardioversion

58
Q

cardioversion

A

electric current, much lower joules then defib. (60 joules)

synchronized delivery on R wave.

used for symptomatic tachycardia.

59
Q

defibrillation

A

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
Q

transcutaneous cardiac pacing

A

for symptomatic bradycardia

sedation and analgesics may be needed

61
Q

Meds may be used in code

A

o2
epinephrine
vasopressin
atropine
amiodarone
lidocaine
adenosine
magnesiun
dopamine

62
Q

what o2 percent to give during arrest

A

100%

63
Q

epinephrine

A

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
Q

Vasopressin

A

vasoconstriction

may be as effective as epinephrine

65
Q

atropine

A

for symptomatic brady.
Given IV push, can be given through ETT.

decreases vagal tone= increases HR

66
Q

Amiodarone

A

for VT and VF

reduces membrane excitability

can be given IV/IO in cardiac arrest

67
Q

lidocaine

A

antidysrhythmic

surpasses ventricular ectopy

can be IV/IO/ETT

68
Q

adenosine

A

for SVT

slows conduction through AV node

rapid IV push

69
Q

magnesium

A

used for refractory VF, torsades de pointes.

only if known deficiency of Mg

70
Q

sodium bicarb

A

treatment of metabolic acidosis

71
Q

Dopamine

A

for symptomatic hypotension

vasoconstrictor- increases bp

continuous drip

72
Q

documentation of arrest

A

Write everything- order of events, med (doses, time, etc), time when things are done, vitals, Pt responses, team members present

73
Q

postresusication goals

A

optimize cardiopulmonary function
transport to critical care unit
determine cause of arrest

74
Q

post CPR interventions

A

12 lead ECG
neuro exams
arterial line
indwelling Cath for hourly output
monitor BG

75
Q

interventions if pt comatose after CPR

A

Head CT, EEG

76
Q

Therapeutic hypothermia

A

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
Q

complications of ther hypothermia

A

bleeding
infection
metabolic and electrolyte disturbances
hyperglycemia

78
Q

hemodynamic monitoring studies the relationship of:

A

blood flow
o2 delivery
tissue perfusion
heart rate

79
Q

goal of hemodynamic monitoring

A

assess the patient and provide therapies to optimize o2 delivery and tissue perfusion

80
Q

cardiac output

A

volume of blood ejected from heart/min

heart rate + stroke volume= cardiac output

81
Q

normal Cardiac output

A

4-8 L/min

low = body doesn’t have enough blood/fluid.
high= vise versa

82
Q

ejection fraction

A

fraction of blood ejected with each beat

83
Q

normal ejection fraction

A

60-70%

low in HF pts. may be around 20%

84
Q

contractility

A

force of ventricular contraction.
how well the heart is pumping

digoxin is a med that can help this

85
Q

systemic vascular resistance

A

peripheral vascular resistance. diameter of blood vessels.

86
Q

what is arterial BP

A

cardiac output + SVR

87
Q

afterload

A

pressure or resistance against flow

it is related to lumen size and viscosity

88
Q

preload

A

degree of muscle fiber stretch before systole- volume of blood in ventricle prior to contraction

increased stretch= increased volume

89
Q

vasodilators

A

nitroglycerin, hydralazine

90
Q

vasoconstrictors

A

vasopressin, epinephrine, atropine

91
Q

noninvasive hemodynamic monitoring modalities

A

BP cuff
jugular venous pressure
serum lactate levels

92
Q

invasive hemodynamic monitoring modalities

A

arterial BP
pulmonary artery BP
right arterial pressure

93
Q

components of invasive hemodynamic monitoring system

A

invasive catheter
noncompliant pressure tubing
transducer and stepcocks
flush system
bedside monitor

94
Q

arterial pressure monitor indications and complications

A

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
Q

Central venous pressure (CVP)

A

Catheter in superior or inferior vena cava. triple lumen.

96
Q

normal value or right arterial pressure (RAP) and central venous pressure (CVP)

A

2-6 mm Hg

low= not enough pressure
high= too much pressure

97
Q

nursing interventions RAP/CVP

A

zero it
PT position 0-60 degrees
monitor for comp- puncture, dysrhythmias, pneumothorax, infection

98
Q

what does RAP/CVP assess

A

RV preload or right vent end diastolic pressure

direct measurement of pressure in right atrium

99
Q

pulmonary artery pressure

A

normal level is 8-12

created by Dr Swan and Ganz

100
Q

insertion of pulmonary artery cath

A

proper position of pt- tredelenburg position, towel roll between shoulder blades

Monitor waveforms

confirm placement with chest x-ray, check for puncture

101
Q

norepinephrine like drugs

A

epinephrine, norepinephrine, vasopressin, atropine

102
Q

acetylcholine like drugs

A

nitroglycerin, beta blockers, hydralazine

103
Q

coronary artery disease

A

progressive narrowing of arteries due to atherosclerosis

diagnosed by cardiac enzymes, EKG

management- aspirin, lower lipids

104
Q

angina

A

3 types
chest pain/discomfort caused by imbalance in myocardial o2 supply and demand

decrease pain, find out cause.

105
Q

MI

A

ischemia with myocardial cell death

106
Q

STEMI vs NSTEMI

A

ST elevation vs no ST elevation

107
Q

MI s/s

A

chest pain
pale and diaphoretic
dyspnea
syncope
n/v
dysrhythmias
shoulder blade/arm pain
flu like symptoms

108
Q

diagnosis of MI

A

12 lead EKG
elevated troponin, elevated CK-MB

109
Q

Complication of MI

A

dysrhythmias
HF
Rupture
pericarditis
cardiogenic

110
Q

complications of CABG

A

dysthymias
impaired contractility
MI
pericardial temponade
resp insufficiency
pain
emboli
death

111
Q

post CABG management

A

assess for adequate cardiac output
airway management- vent
circulation

112
Q

goal of HF treatment

A

improve pump function
remove fluid
reduce cardiac workload/o2 damage
improve gas exchange

113
Q

flash pulmonary edema

A

HF complication

pink frothy sputum
hypoxemia
dyspnea
cyanosis

lassix needs to be given immediately

114
Q

4 types of aortic aneurysm

A

flase
fusiform
saccular
dissecting

115
Q

aortic dissection

A

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

critical care (4 decks)

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