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Nursing > U4 Cardiac > Flashcards

U4 Cardiac Flashcards

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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
Q

Premature Atrial Complexes (PAC)

A

Fires an impulse before next sinus impulse is due

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26
Q

Causes of PAC

A 
Stress
Fatigue
Anxiety
Infection
Caffeine
Epi, amphetamines, Dig
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27
Q

S/S PAC

A

Often no symptoms

Treat underlying cause

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28
Q

Supraventricular Tachycardia (SVT)

A

Rapid stimulation of atria–150-280 BPM
Narrow QRS
Usually caused by PAC

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29
Q

Paroxysmal Supraventricular Tachycardia

A

Starts & ends quickly

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30
Q

S/S SVT

A 
Palpitations
Chest pain
Fatigue
SOB
Nervousness
Hypotension
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31
Q

SVT tx

A

Adenosine 5 mg
If ineffective, 12 mg IV push
Expect a short period of asystole

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32
Q

Risk factors for atrial fibrilation

A 
Age
Hypertension
Previous ischemic stroke/TIA
Heart failure
Diabetes mellitus
Obesity
Alcohol excess (holiday heart)
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33
Q

S/S atrial fibrilation

A 
Fatiuge 
Dizziness
Palpitations
Weakness
Anxiety
SOB
Hypotension
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34
Q

Atrial fibrillation tx

A 
Cardizem (calcium channel blocker)
Amiodarone
Beta blockers
Digoxin
Anticoagulants
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35
Q

Atrial flutter

A

Atrial rate 250-350 BPM

Saw-toothed P-waves

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36
Q

Causes of atrial flutter

A

MI
Rheumatic heart disease
CHF
Ischemia

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37
Q

Atrial flutter tx–slow heart rate

A

Calcium channel blockers
Beta-blockers
Digoxin

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38
Q

Atrial flutter tx–convert rhythm

A

Amiodarone
Propafenone
Sotolol
Felacainide

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39
Q

Causes of premature ventricular complexes (PVC)

A 
MI, chronic heart failure, anemia
Hypokalemia
Hypomagnesemia
Caffeine/alcohol
Infection
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40
Q

Unifocal PVC

A

All PVCs look alike

Identical shapes

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41
Q

Multifocal PVC

A

PVCs originate from different places in ventricles

More dangerous than unifocal

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42
Q

Bigeminy

A

Every 2nd beat is a PVC

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43
Q

Absolute refractory period

A

Beginning of Q to middle of T

Heart will stop it

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44
Q

Relative refractory period

A

End of T wave

Heart will let it in

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45
Q

R on T phenomena

A

PVC come in during T wave

46
Q

Ventricular tachycardia

A

3 or more PVCs in a row

Wide QRS, no P

47
Q

Interventions

V-tach with pulse

A

Assess to see if pt is stable

48
Q

Interventions

V-tach with pulse & stable

A

Call Rapid Response
Amiodarone 150mg piggyback
Slow-loading infusion–360 mg over 8 hrs
Maintenance infusion–540 mg over 18 hrs

49
Q

Interventions

V-tach without pulse

A

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
Q

Causes of v-tach

A

CAD
Hypokalemia
Hypomagnesemia
Heart failure

51
Q

Interventions

V-tach with pulse & unstable

A

Cardioversion

52
Q

Ventricular fibrilation

A

No cardiac output
No pulse, no breathing, no BP
No blood perfusion

53
Q

Causes of v-fib

A 
MI
Hypokalemia
Hypomagnesemia
Hemorrhage
Rapid SVT
Shock
54
Q

V-fib tx

A

Defibrillate

CPR until defibrillator arrives

55
Q

Causes of cardiac arrest

A 
Hypovolemia
Hypoxia
Hydrogen ions (acidosis)
Hypo/hyperkalemia
Hypothermia
Tension pneumothorax
Tamponade, cardiac
Toxins
Thrombosis
Trauma
56
Q

Cardioversion

A

Elective procedure
Synchronized with QRS
50-200 Joules
Consent form

57
Q

Defibrillation

A

Emergency
No synchronization
200-360 Joules

58
Q

1st degree AV block

A

PR interval >.20 sec

59
Q

Causes of 1st degree AV block

A 
Infarction
Ischemic heart disease
Dig toxicity
Electrolyte imbalance
Acute rheumatic fever
60
Q

2nd degree AV block Type I (Wenckebach)

A

Progressive delay after each P wave until a skipped beat

61
Q

Causes of Wenckebach AV block

A 
Infarction
Ischemic heart disease
Dig toxicity
Electrolyte imbalance
Acute rheumatic fever
62
Q

2nd degree AV block Type II

A

PR intervals are normal
Skipped beat
QRS sometimes >.12 sec

63
Q

3rd degree AV blpcl

A

Independent beating of atria & ventricles

P-waves & QRS are constant but at different rates

64
Q

Causes of 3rd degree heart block

A 
Infarction
Ischemic heart disease
Dig toxicity
Electrolyte imbalances
Acute rheumatic fever
65
Q

Class I Antiarythmics

A

Membrane-stabilizing agents

Decrease automaticity

66
Q

Type IA Antiarrythmics

A

Treat/prevent SVT, PVC, & tachydysrhythmias

Pronestyl

67
Q

Type IB Antiarrythmics

A

Treat/prevent PVC, v-tach, & v-fib

Lidocaine, Mexitil

68
Q

Type IC Antiarrythmics

A

Treat/prevent recurrent PVCs, v-tach, & v-fib

69
Q

Class II Antiarrythmics

A

Control dysrhythmias associated with beta-adrenergic stimulation
Decrease heart rate
Treat/prevent SVT, PVCs, & tachydysrhythmias
Inderol

70
Q

Class III Antiarrhythmics

A

Lengthen absolute refractory period & prolong repolarization
Treat/prevent PVCs, v-tach, & v-fib
Amiodarone

71
Q

Class IV Antiarrhythmics

A

Depresses automaticity of atrial & AV node
Depresses heart rate
Treat SVT, a-fib, & a-flutter
Calcium channel blockers

72
Q

Lanoxin

A

Controls the rate of a-fib

73
Q

Atropine

A

Treats bradydysrhythmias

0.5 mg IV up to 3 mg

74
Q

Adenosine

A

Slows AV node conduction to interrupt re-entry pathways
5 mg
If ineffective, 12 mg IV push

75
Q

Mg Sulfate

A

Given for refractory v-tach or v-fib

Torsade de pointes

76
Q

Epinephrine

A

1st line drug for cardiac arrest

77
Q

Vasopressin

A

Used in place of 1st or 2nd epi dose

78
Q

Dopamine drip

A

Beta-adrenergic

Increases myocardial contractility & cardiac output

79
Q

Dobutamine drip

A

Alpha-adrenergic

Improve cardiac output

80
Q

Norepinephrine drip

A

Alpha-adrenergic effects

Increase perfusion pressure

81
Q

Sodium bicarb

A

Used w/ pts in cardiac arrest from hypokalemia

82
Q

Isuprel drip

A

Increase heart rate in transplant pts

83
Q

Midline catheter

A

3-8 in long
Median antecubital vein
Lasts 1-4 wks

84
Q

PICC line

A

18-29 in
Antecubital fossa vein
Resides in superior vena cava
Anything can be infused

85
Q

PICC line complications

A

Central line infection
Phlebitis & thrombophlebitis
Arterial puncture

86
Q

PICC line pt teaching

A

No limitations on ADLs
Avoid excessive physical activity & heavy lifting
Flush w/ 5 mL heparin daily
Always use 10 mL syringe

87
Q

Non-tunneled central catheter

A

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
Q

Non-tunneled central catheter insertion

A

Trendelenburg position

When removing, measure length to make sure it’s intact

89
Q

Tunneled central catheters

A

Portion of catheter lies in subcutaneous tunnel
Rough material cough w/ antibiotics inside to prevent infection
Long-term use

90
Q

Bard powerport

A

3 palpable bumps on septum
Triangular-shaped port
Noncoring needle is used

91
Q

Nursing Safety–catheters

A

Assess patency before each use
Any resistance–stop procedure
Aspirate for blood return before flushing
Use small syringe for drawing blood samples

92
Q

Changing administration sets

A

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
Q

Pneumothorax

A

Puncture of lung by introducer or insertion of diret subclavian approach
Dyspnea & tachycardia

94
Q

Hemothorax

A

Puncture or transection of the subclavian vein or artery

Dyspnea & tachycardia

95
Q

Chylothorax

A

Transection of the thoracic duct on the left side

Dyspnea & tachycardia

96
Q

Hydrothorax

A

Transection of the subclavian & placement of catheter into thoracic cavity
Dyspnea & tachycardia

97
Q

Air embolism

A 
Air in central venous system 
Chest pain
Dyspnea
Tachycardia
Dizziness
Clamp catheter; L lateral trendelenburg's
98
Q

Arterial puncture

A

Accessed artery instead of vein
Pulsating bright red blood from introducer needle
Remove immediately

99
Q

Malpositioned catheter

A

Catheter passed into jugular vein, R atrium, or axygos vein

Pain in ears, neck, or back

100
Q

Catheter migration

A

Movement of catheter tip into another vein
Causes–coughing, vomiting, heavy lifting
S/S–hearing running stream or gurgling
Stop all infusions

101
Q

Causes of central-line related blood infections

A

Lack of sterile field during insertion
Inadequate skin antisepsis
Inadequate hand hygiene
Long dwell time

102
Q

TPN risks

A

Fluid imbalance
Extreme hyperosmolarity (fluid shift)
Increased blood sugar
Fluid overload

103
Q

TPN interventions

A

Daily weights
Accurate I&O
Monitor glucose & electrolytes–hyperglycemia; hypercalcemia

104
Q

Fat emulsions–fat overload syndrome

A

Fever
Increased triglycerides
Clotting problems
Organ failure

105
Q

Hemodialysis catheter

A

Large lumens to accommodate hemodialysis procedure

Don’t use catheter for infusion of other fluids/drugs

106
Q

Subcutaneous infusions

A

Used for palliative care for pts who can’t tolerate oral meds, IM injections too painful, &/or IV not available

107
Q

Hypodermoclysis

A

Slow infuse isotonic fluids into subcut tissue

Max fluid rate 80mL/hr

108
Q

Intraosseous

A

When vascular access can’t be obtained

Used in emergencies

109
Q

Intraosseous complications

A

Improper needle placement with infiltration
Osteomyelitis
Compartment syndrome

110
Q

Intraspinal infusion

A

Local anesthetic administered epidurally to block pain impulses
Dr administers 1st dose of medication

111
Q

Intrathecal infusion

A

Treat cancers that cross blood-brain barrier & involve CNS

Used to treat spasticity of neurologic diseases–cerebral palsy, traumatic & anoxic brain injuries

112
Q

Epidural infusion complications

A 
Check if pt can move legs
Infection
CSF leak
Catheter occlusion
Local infection
Meningitis

Nursing (9 decks)

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