Unit 2: Advanced Cardiovascular Concepts

Question 1

What are the nursing interventions for symptomatic bradycardia?

Answer 1

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

Question 2

What are the three types of temporary pacemakers?

Answer 2

1. Transcutaneous: through skin, temporary emergency measures
2. Transvenous: Through the veins, they float the pacing wire to endocardium
3. Epicardial: pacing wires sit on top of the heart

Question 3

How is a permanent pace maker different from temporary?

Answer 3

The pulse generator is inside the body

Question 4

Acute Coronary Syndrome Treatment: Fibrinolytics

What is it and who receives this treatment?

Answer 4

This tx opens the artery by dissolving the clot, must be door to needle within 30 minutes
LYTICS LYSE CLOTS

Question 5

Acute Coronary Syndrome Treatment: Percutaneous Coronary Intervention

Answer 5

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

Question 6

Acute Coronary Syndrome Treatment: CABG

Answer 6

Coronary Artery Bypass Graft ‘replaces the pipes’. Failed PCI, multi-vessel disease,

Question 7

Post PCI Nursing Managment

Answer 7

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

Question 8

CABG nursing responsibilities

Answer 8

Assess cardiopulmonary status, vital signs, strict ins and outs, ECG rhythms, LOC
Do prevent complications
Teach Discharge planning

Question 9

What are CABG Complications in an Unstable patient?

Answer 9

hypovalemia, maldistribution, electrolyte imbalances, arrhythmias, low cardiac output, cardiac tamponade

Question 10

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

Answer 10

1. 12 lead ECG

2. Draw serum cardiac markers

Question 11

ECG interpretation: P wave

Answer 11

Atrial depolarization

1. are they present?
2. Is there one P-wave for every QRS?
3. Are the P waves smooth, rounded, and upright?
4. Do all P waves have similar shapes?

Question 12

ECG interpretation: QRS complex

Answer 12

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?

Question 13

ECG interpretation: T Wave

Answer 13

Ventricular Repolarization

Look to make sure the wave is upright and rounded

Question 14

How many seconds is each square on an ECG?

Answer 14

0.04 seconds

Question 15

ECG interpretation: P-R Interval

Answer 15

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

Question 16

ECG interpretation: ST Segment

Answer 16

St Segment reprresents the time between ventricular depolarization and repolarization

1. Measure from the end of the QRS complex to the beginning of the T wave
2. Should be isoelectric-flat

Question 17

What can an inverted T wave mean?

Answer 17

May be seen with ischemia ad infarct

Question 18

What are the 6 Atrial Rhythms?

Answer 18

Normal Sinus Rhythm, Sinus Bradycardia, Sinus Tachycardia, SInus Arrhythmia, Atrial fibrillation, atrial flutter

Question 19

What are the 4 Ventricular Rhythms?

Answer 19

PVC, Vtach, Vfib, Asystole

Question 20

Normal Sinus Rhythm

Answer 20

Everything is normal, rate 60-100

Question 21

Sinus bradycardia

Answer 21

Too slow!!
SA node innervates it,
No tx, except consider Atropine or pacing (if very unstable)
Rate

Question 22

Sinus Tachycardia

Answer 22

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,

Question 23

Sinus Arrhythmia

Answer 23

Common in kids, normal, only a little irregular

can be related to increased breathing-increased with inspiration and decreased with expiration

Question 24

Atrial Flutter

Answer 24

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

Question 25

Atrial Fibrilation

Answer 25

Loss of atrial kick, ventricular response
Treated with cardioversion, rhythm control, rate control, anticoagulants. 48 hr anticoags, Beta blockers, digoxin
Has NO P WAVE

Question 26

What is cardioversion?

Answer 26

Like defibrillation, we want to put the patient back into total systole,
Form of rhythm control

Question 27

PVC’s

Answer 27

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

Question 28

What are the classifications of PVC’s? and what is the treatment?

Answer 28

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

Question 29

Vtach

Answer 29

Can be stable (pulse) or unstable (no pulse)
Check for symptoms!!
Tx: Ablation, Internal cardiac Defib- Advanced coronary life support2

Question 30

V-fib

Answer 30

Everything will be wrong!
Irregular, chaotic rhythm >400
No cardiac output, pulselessness, put will be unconscious
Treatment- Advanced Coronary Life Support
CRASH CART

Question 31

Asystole

Answer 31

Prelude to death,

ACLS but NOT a shockable rhythm