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Nursing > U4 Cardiac > Flashcards

U4 Cardiac Flashcards

1
Q

Causes of cardiac dysrhythmias

A

Electrolyte imbalance
Problems with oxygenation
Drug toxicity
CAD

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2
Q

Automaticity

A

Ability to generate an electrical impulse

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3
Q

Excitability

A

Ability of heart cells to respond to electrical impulse

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4
Q

Conductivity

A

Ability to send an electrical signal between cell membranes

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5
Q

Contractility

A

Ability of atrial & ventricular muscle to shorten fibers in response to electrical stimulation

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6
Q

Sinoatrial node

A

Primary pacemaker
Located upper right atrium
60-100 BPM

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7
Q

AV node

A

Secondary pacemaker
Located lower right atrium
40-60 BPM

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8
Q

Purkinje fibers

A

3rd pacemaker
Located at ends of bundle branches
20-40 BPM

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9
Q

P wave

A

Atrial depolarization (contraction)

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10
Q

PR interval

A

Time needed for atrial depolarization & impulses to travel through the heart

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11
Q

QRS complex

A

Ventricular depolarization (contraction)

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12
Q

T wave

A

Ventricular repolarization (relaxation)

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13
Q

QT interval

A

Time needed for ventricular depolarization & repolarization

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14
Q

Normal PR

A

.12-.20 sec

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15
Q

Normal QRS

A

0.06-0.10 sec

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16
Q

Normal QT interval

A

Should be <1/2 of R-R interval

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17
Q

Long QT

A

Can lead to Torsades des pointes

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18
Q

Causes of sinus bradycardia

A 
Excessive tone on SA node
Beta blockers (olols)
Calcium channel blockers (verapamil, dilitaxem, nifedipine)
Dig toxicity
Sick sinus syndrome
MI
Hypothyroidism
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19
Q

HR <30-46/min

A

Causes hypotension
Decreased cardiac output
Decreased oxygen perfusion

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20
Q

S/S sinus bradycardia

A 
Dizziness
SOB
Chest pain
Hypotension
Shock
CHF
MI
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21
Q

Treatment of sinus bradycardia

A

Atropine–0.5 mg IV up to 3 mg
Oxygen
Monitor for tachycardia after atropine

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22
Q

Causes of sinus tachycardia

A 
Increased stimulation from exercise
Anxiety
Pain 
Fever
Anemia
Hypoxemia
Hyperthyroidism
Caffeine
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23
Q

S/S sinus tachycardia

A

Usually asymptomatic

If symptomatic, treat the cause (pain, fever)

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24
Q

Assessment sinus tachycardia

A 
Decreased BP
Decreased O2 sat
Weakness
SOB
Restlessness
Decreased urine output
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25
Premature Atrial Complexes (PAC)
Fires an impulse before next sinus impulse is due
26
Causes of PAC
``` Stress Fatigue Anxiety Infection Caffeine Epi, amphetamines, Dig ```
27
S/S PAC
Often no symptoms | Treat underlying cause
28
Supraventricular Tachycardia (SVT)
Rapid stimulation of atria--150-280 BPM Narrow QRS Usually caused by PAC
29
Paroxysmal Supraventricular Tachycardia
Starts & ends quickly
30
S/S SVT
``` Palpitations Chest pain Fatigue SOB Nervousness Hypotension ```
31
SVT tx
Adenosine 5 mg If ineffective, 12 mg IV push Expect a short period of asystole
32
Risk factors for atrial fibrilation
``` Age Hypertension Previous ischemic stroke/TIA Heart failure Diabetes mellitus Obesity Alcohol excess (holiday heart) ```
33
S/S atrial fibrilation
``` Fatiuge Dizziness Palpitations Weakness Anxiety SOB Hypotension ```
34
Atrial fibrillation tx
``` Cardizem (calcium channel blocker) Amiodarone Beta blockers Digoxin Anticoagulants ```
35
Atrial flutter
Atrial rate 250-350 BPM | Saw-toothed P-waves
36
Causes of atrial flutter
MI Rheumatic heart disease CHF Ischemia
37
Atrial flutter tx--slow heart rate
Calcium channel blockers Beta-blockers Digoxin
38
Atrial flutter tx--convert rhythm
Amiodarone Propafenone Sotolol Felacainide
39
Causes of premature ventricular complexes (PVC)
``` MI, chronic heart failure, anemia Hypokalemia Hypomagnesemia Caffeine/alcohol Infection ```
40
Unifocal PVC
All PVCs look alike | Identical shapes
41
Multifocal PVC
PVCs originate from different places in ventricles | More dangerous than unifocal
42
Bigeminy
Every 2nd beat is a PVC
43
Absolute refractory period
Beginning of Q to middle of T | Heart will stop it
44
Relative refractory period
End of T wave | Heart will let it in
45
R on T phenomena
PVC come in during T wave
46
Ventricular tachycardia
3 or more PVCs in a row | Wide QRS, no P
47
Interventions | V-tach with pulse
Assess to see if pt is stable
48
Interventions | V-tach with pulse & stable
Call Rapid Response Amiodarone 150mg piggyback Slow-loading infusion--360 mg over 8 hrs Maintenance infusion--540 mg over 18 hrs
49
Interventions | V-tach without pulse
Call Code Start CPR Epinephrine 1:10,000--1mg IV repeat every 3-5 min Vasopressin 40 units IV (replace 1st or 2nd dose epi) Amiodarone 300 mg IV; 2nd dose 150 mg IV push
50
Causes of v-tach
CAD Hypokalemia Hypomagnesemia Heart failure
51
Interventions | V-tach with pulse & unstable
Cardioversion
52
Ventricular fibrilation
No cardiac output No pulse, no breathing, no BP No blood perfusion
53
Causes of v-fib
``` MI Hypokalemia Hypomagnesemia Hemorrhage Rapid SVT Shock ```
54
V-fib tx
Defibrillate | CPR until defibrillator arrives
55
Causes of cardiac arrest
``` Hypovolemia Hypoxia Hydrogen ions (acidosis) Hypo/hyperkalemia Hypothermia Tension pneumothorax Tamponade, cardiac Toxins Thrombosis Trauma ```
56
Cardioversion
Elective procedure Synchronized with QRS 50-200 Joules Consent form
57
Defibrillation
Emergency No synchronization 200-360 Joules
58
1st degree AV block
PR interval >.20 sec
59
Causes of 1st degree AV block
``` Infarction Ischemic heart disease Dig toxicity Electrolyte imbalance Acute rheumatic fever ```
60
2nd degree AV block Type I (Wenckebach)
Progressive delay after each P wave until a skipped beat
61
Causes of Wenckebach AV block
``` Infarction Ischemic heart disease Dig toxicity Electrolyte imbalance Acute rheumatic fever ```
62
2nd degree AV block Type II
PR intervals are normal Skipped beat QRS sometimes >.12 sec
63
3rd degree AV blpcl
Independent beating of atria & ventricles | P-waves & QRS are constant but at different rates
64
Causes of 3rd degree heart block
``` Infarction Ischemic heart disease Dig toxicity Electrolyte imbalances Acute rheumatic fever ```
65
Class I Antiarythmics
Membrane-stabilizing agents | Decrease automaticity
66
Type IA Antiarrythmics
Treat/prevent SVT, PVC, & tachydysrhythmias | Pronestyl
67
Type IB Antiarrythmics
Treat/prevent PVC, v-tach, & v-fib | Lidocaine, Mexitil
68
Type IC Antiarrythmics
Treat/prevent recurrent PVCs, v-tach, & v-fib
69
Class II Antiarrythmics
Control dysrhythmias associated with beta-adrenergic stimulation Decrease heart rate Treat/prevent SVT, PVCs, & tachydysrhythmias Inderol
70
Class III Antiarrhythmics
Lengthen absolute refractory period & prolong repolarization Treat/prevent PVCs, v-tach, & v-fib Amiodarone
71
Class IV Antiarrhythmics
Depresses automaticity of atrial & AV node Depresses heart rate Treat SVT, a-fib, & a-flutter Calcium channel blockers
72
Lanoxin
Controls the rate of a-fib
73
Atropine
Treats bradydysrhythmias | 0.5 mg IV up to 3 mg
74
Adenosine
Slows AV node conduction to interrupt re-entry pathways 5 mg If ineffective, 12 mg IV push
75
Mg Sulfate
Given for refractory v-tach or v-fib | Torsade de pointes
76
Epinephrine
1st line drug for cardiac arrest
77
Vasopressin
Used in place of 1st or 2nd epi dose
78
Dopamine drip
Beta-adrenergic | Increases myocardial contractility & cardiac output
79
Dobutamine drip
Alpha-adrenergic | Improve cardiac output
80
Norepinephrine drip
Alpha-adrenergic effects | Increase perfusion pressure
81
Sodium bicarb
Used w/ pts in cardiac arrest from hypokalemia
82
Isuprel drip
Increase heart rate in transplant pts
83
Midline catheter
3-8 in long Median antecubital vein Lasts 1-4 wks
84
PICC line
18-29 in Antecubital fossa vein Resides in superior vena cava Anything can be infused
85
PICC line complications
Central line infection Phlebitis & thrombophlebitis Arterial puncture
86
PICC line pt teaching
No limitations on ADLs Avoid excessive physical activity & heavy lifting Flush w/ 5 mL heparin daily Always use 10 mL syringe
87
Non-tunneled central catheter
Subclavian vein in chest or jugular vein in neck Rate of infection high 7-10 in Resides in superior vena cava Short-term use Flush ports not in use every shift w/ heparin or saline
88
Non-tunneled central catheter insertion
Trendelenburg position | When removing, measure length to make sure it's intact
89
Tunneled central catheters
Portion of catheter lies in subcutaneous tunnel Rough material cough w/ antibiotics inside to prevent infection Long-term use
90
Bard powerport
3 palpable bumps on septum Triangular-shaped port Noncoring needle is used
91
Nursing Safety--catheters
Assess patency before each use Any resistance--stop procedure Aspirate for blood return before flushing Use small syringe for drawing blood samples
92
Changing administration sets
Clamp tubing Lay pt flat Valsava maneuver Time change to expiratory cycle if pt breathing spontaneously Time change to inspiratory cycle if pt is mechanically ventilated
93
Pneumothorax
Puncture of lung by introducer or insertion of diret subclavian approach Dyspnea & tachycardia
94
Hemothorax
Puncture or transection of the subclavian vein or artery | Dyspnea & tachycardia
95
Chylothorax
Transection of the thoracic duct on the left side | Dyspnea & tachycardia
96
Hydrothorax
Transection of the subclavian & placement of catheter into thoracic cavity Dyspnea & tachycardia
97
Air embolism
``` Air in central venous system Chest pain Dyspnea Tachycardia Dizziness Clamp catheter; L lateral trendelenburg's ```
98
Arterial puncture
Accessed artery instead of vein Pulsating bright red blood from introducer needle Remove immediately
99
Malpositioned catheter
Catheter passed into jugular vein, R atrium, or axygos vein | Pain in ears, neck, or back
100
Catheter migration
Movement of catheter tip into another vein Causes--coughing, vomiting, heavy lifting S/S--hearing running stream or gurgling Stop all infusions
101
Causes of central-line related blood infections
Lack of sterile field during insertion Inadequate skin antisepsis Inadequate hand hygiene Long dwell time
102
TPN risks
Fluid imbalance Extreme hyperosmolarity (fluid shift) Increased blood sugar Fluid overload
103
TPN interventions
Daily weights Accurate I&O Monitor glucose & electrolytes--hyperglycemia; hypercalcemia
104
Fat emulsions--fat overload syndrome
Fever Increased triglycerides Clotting problems Organ failure
105
Hemodialysis catheter
Large lumens to accommodate hemodialysis procedure | Don't use catheter for infusion of other fluids/drugs
106
Subcutaneous infusions
Used for palliative care for pts who can't tolerate oral meds, IM injections too painful, &/or IV not available
107
Hypodermoclysis
Slow infuse isotonic fluids into subcut tissue | Max fluid rate 80mL/hr
108
Intraosseous
When vascular access can't be obtained | Used in emergencies
109
Intraosseous complications
Improper needle placement with infiltration Osteomyelitis Compartment syndrome
110
Intraspinal infusion
Local anesthetic administered epidurally to block pain impulses Dr administers 1st dose of medication
111
Intrathecal infusion
Treat cancers that cross blood-brain barrier & involve CNS | Used to treat spasticity of neurologic diseases--cerebral palsy, traumatic & anoxic brain injuries
112
Epidural infusion complications
``` Check if pt can move legs Infection CSF leak Catheter occlusion Local infection Meningitis ```

Nursing (9 decks)

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