Unit 2: Advanced Cardiovascular Concepts Flashcards
What are the nursing interventions for symptomatic bradycardia?
Monitor Vs, administer oxygen, initiate IV therapy, obtain ordered lab work
Unstable patients are treated with:
-Atrpoine 0.5-1mg IV q 3-5 minutes to a max of 3mg
-Temporary Pacing
What are the three types of temporary pacemakers?
- Transcutaneous: through skin, temporary emergency measures
- Transvenous: Through the veins, they float the pacing wire to endocardium
- Epicardial: pacing wires sit on top of the heart
How is a permanent pace maker different from temporary?
The pulse generator is inside the body
Acute Coronary Syndrome Treatment: Fibrinolytics
What is it and who receives this treatment?
This tx opens the artery by dissolving the clot, must be door to needle within 30 minutes
LYTICS LYSE CLOTS
Acute Coronary Syndrome Treatment: Percutaneous Coronary Intervention
This tx displaces the clot by angioplasty.
Used when fibrinolytics fail, a catheter is used to place a small structure called a stent to open up blood vessels in the heart
Acute Coronary Syndrome Treatment: CABG
Coronary Artery Bypass Graft ‘replaces the pipes’. Failed PCI, multi-vessel disease,
Post PCI Nursing Managment
Frequent VS, ECG, Assessment of access site for swelling, pain, bleeding,
Rx: Clopidogrel/ASA ( 2 anti-platelets to avoid occlusion of new stent d/t inflammatory process).
Patient and family education
++heparin used
CABG nursing responsibilities
Assess cardiopulmonary status, vital signs, strict ins and outs, ECG rhythms, LOC
Do prevent complications
Teach Discharge planning
What are CABG Complications in an Unstable patient?
hypovalemia, maldistribution, electrolyte imbalances, arrhythmias, low cardiac output, cardiac tamponade
When caring for a patient with acute chest pain, in what order, would the nurse perform the following interventions?
- Draw serum cardiac markers
- obtain a 12-lead ECG
- 12 lead ECG
2. Draw serum cardiac markers
ECG interpretation: P wave
Atrial depolarization
- are they present?
- Is there one P-wave for every QRS?
- Are the P waves smooth, rounded, and upright?
- Do all P waves have similar shapes?
ECG interpretation: QRS complex
Ventricular depolarization
Should be 0.06-0.10 seconds
1. Measure from beginning of QRS to end of the QRS complex
2. Does the QRS fall within the normal interval of time?
ECG interpretation: T Wave
Ventricular Repolarization
Look to make sure the wave is upright and rounded
How many seconds is each square on an ECG?
0.04 seconds
ECG interpretation: P-R Interval
Indicates AV conduction time.
1. Measure the interval from the beginning of the P wave to the beginning of the QRS complex
2. Does the PR-interval fall within the norm of 0.12-0.20 seconds?
Should be 0.12-0.20 seconds
ECG interpretation: ST Segment
St Segment reprresents the time between ventricular depolarization and repolarization
- Measure from the end of the QRS complex to the beginning of the T wave
- Should be isoelectric-flat
What can an inverted T wave mean?
May be seen with ischemia ad infarct
What are the 6 Atrial Rhythms?
Normal Sinus Rhythm, Sinus Bradycardia, Sinus Tachycardia, SInus Arrhythmia, Atrial fibrillation, atrial flutter
What are the 4 Ventricular Rhythms?
PVC, Vtach, Vfib, Asystole
Normal Sinus Rhythm
Everything is normal, rate 60-100
Sinus bradycardia
Too slow!!
SA node innervates it,
No tx, except consider Atropine or pacing (if very unstable)
Rate
Sinus Tachycardia
Too fast!!
Rate >100, may be compensatory for another problem
Tx is to correct the underlying cause for tachy
This is a normal response to increased workload: high temperature, pain, anxiety, physical activity, could be dehydrated,
Sinus Arrhythmia
Common in kids, normal, only a little irregular
can be related to increased breathing-increased with inspiration and decreased with expiration
Atrial Flutter
Atrial rate: 250-350, flutter waves
Due to elevated atrial pressure, caused by ectopic foci, the flutter waves are increased and the AV nodes only accept every few flutter waves
Treatment is rhythm control, rate control, anticoagulation. Digoxin and Lasix
Has a P WAVE
described by number of flutters before Av response, eg. 3:1 flutter
Atrial Fibrilation
Loss of atrial kick, ventricular response
Treated with cardioversion, rhythm control, rate control, anticoagulants. 48 hr anticoags, Beta blockers, digoxin
Has NO P WAVE
What is cardioversion?
Like defibrillation, we want to put the patient back into total systole,
Form of rhythm control
PVC’s
Premature ventricular contractions.
This causes it to be ‘irregular’ no matter what rhythm it is in- risk for vtach
Can be benign or normal
Seen in older population, low potassium, post- menopausal, COPD, can be normal
Treatment: check K, CA, MG, O2, reduce triggers,
Rx: Beta Blockers, antiarrhythmic
What are the classifications of PVC’s? and what is the treatment?
Trigeminy: Every 3rd beat is a PVC
Bigeminy: Every 3nd beat is a PVC
Unifocal: 1 PVC
Multifocal: multiple, more than one irritable site
Watch K, Mg, Ca and administer antiarrhythmics and beta blockers
Vtach
Can be stable (pulse) or unstable (no pulse)
Check for symptoms!!
Tx: Ablation, Internal cardiac Defib- Advanced coronary life support2
V-fib
Everything will be wrong!
Irregular, chaotic rhythm >400
No cardiac output, pulselessness, put will be unconscious
Treatment- Advanced Coronary Life Support
CRASH CART
Asystole
Prelude to death,
ACLS but NOT a shockable rhythm
