Unit 3 Flashcards
antiarrhythmic drug which means it helps to get the heart back to a normal rhythm. specifically used to tx SVT.
adenosine
What kind of monitoring is needed for Adenosine?
ECG, HR, BP, perfusions
What should you have ready when giving adenosine?
the crash cart
Avoid what when taking adenosine?
methylxathines
What to know about the IV when giving adenosine?
Large bore IV’s
as proximal as possible to the body
What dpes adenosine do to the AV node?
restarts it!
its the pace maker of the heart
Promotes the movement of calcium
Causes vascular relaxation
Used for the suppression and prevention of SVT arrythmias
CAlcium channel blockers
Diet for calcium channel blockers
lean meats, no fried foods, low sodium,
If pt is already taking nitrates for angina pain can they continue taking thier nitrates?
yes if angina does not change.
Calcium channel blockers cannot be what?
crushed, chewed, or split when SR capsules.
Why should pts on antabuse avoid expectorant syrup
it contains alcohol
FLuid intake for pt’s taking pt’s taking an expectorant
1500-2000 mL per day
IV contrast dye is used to find what?
if there is a blockage in the brain or the heart
Withold what medication when giving IV contrast dye to diabetics and for how long?
antidiabetics, 48 hrs
If pt is getting IV contrast dye testing done what allergy would alarm you?
seafood; fish
Medication given for angina pain; a vasodialator; a nitrate
nitroglycerin
If a pt is taking ED medications need to be told what when taking nitro?
not to take their ED medications with their nitrates
If pt is taking nitro and angina pain does not subside after 5 min
call the provider
What VS is important to monitor when taking nitro?
BP
If a pt taking nitro SL and complains of fizzing or burning what do you tell them?
it is normal
Electrolyte replacement, can burn blood vessels, monitor potassium, and HR
IV potassium
How should IV potassium be given?
SLOWLY and with a dilutant
If pt is prescribed potassium via pill but cannot swallow should you crush it?
NO
Can a potassium pill be melted in water?
yes
People taking certain BP medications that are potassium sparring because if they are using a
salt subsitute
What labs should be drawn before and during IV potassium therapy?
Kidney function- BUN Creatinine, and serum potassium
A statin that helps lower cholesterol; keeps blockages from forming and allows blockages to break up slowly
Simvastatin
What kind of labs need to be drawn before and during Simvastatin therapy?
Liver function
Cholesterol levels
If muscle pain occurs when taking simvastatin what labs should be drawn?
CPK or CK
used to help prevent a pt from having a vagel response during a bowel movement who are having cardiac issues
Stool softeners
a blood thinner that helps PREVENT clots or helps a clot dissolve on its own SLOWLY
warfarin/coumadin
What labs are you closly monitoring for pt’s taking warfarin or coumadin?
PTNINR
warfarin antidote
Vitamin K
Vitamin D foods
Canned salmon, sardines, tuna Cereals Fish Fish liver oils Non fat dry milk
surgical removal of emoblus or thrombus to restore blood flow and oxygenation to the tissue distal to the occlusion. If not tx can lead to ischemia and necrosis. This is an emergency surgery.
embolectomy and thrombectomy
a surgery that involves the use of either autographs such as the pts own saphenous vein, or synthetic graft material. The graft is anastomosed to the artery proximal to the occlusion and tunneled past the occlusion. There, the distal end of the graft is anastomed to the artery. The graft is assessed for patency and infection
vascular bypasses and grafts
Arteriosclerotic plaques are dissected from the lining of the arterial wall and removed in a procedure called an
endarterectomy
Earmy S/S of ARDS
nasal flaring Head bobbing Anxiety Lethargy Decreased rate of resposiveness Retractions Wheezing and stridor Use of accessory muscles Increased use of energy and effort needed to breathe Feeding problems and refusal to eat Tachypnea hypernea Hypoxia
Late S/S of ARDS
Poor perfusion Bradycardia Decreased air movement and diminished braeth sounds Expiratory grunting Apnea
Classis S/S of MI
Crushing vice like chest pain with radiation to arm shoulder neck jaw or back
Atypical MI S/S
adsence of chest pain fatigue cramping in the chest anxiety feeling of impending doom falling
Common S/S of MI in women
epigastric of abdominal pain chest discomfort, pressure, burning Arm shoudler neck jaw or back pain discomfort/pain between shoulder blades Shob fatigue indegestion or gas pain nausea or vomiting
minimally invasive technique that are used to open up plaque-blocked arteries.
angioplasty
these are placed inside a artery to keep them open
stents
_________ are used to generate an electrical impulse when there is a problem with the heart’s conduction system. Permanent pacemakers are used for symptomatic bradycardia and third-degree AV block (complete dissociation between atrial and ventricular activity). Pacemakers can be temporary (epicardial, transcutaneous, transvenous) or permanent. When a patient is in a paced rhythm, a small spike (vertical line) is seen on the ECG at the start of the paced beat. This spike is the electrical stimulus. It can precede the P wave, QRS complex, or both depending on what is being paced. Patients may have 100% paced beats, a mixture of their own beats and paced beats, or 100% their own beats. Pacemakers should not fire during a patients’ own beat.
cardiac pacemaker
Issues with cardiac pacemakers
Failure to sense a patient’s own beat
Failure to pace because of a malfunction of the pulse generator
Failure to capture, which is the heart’s lack of depolarization
What to report when you have a pace maker
Any change in heart rhythm, reports of chest pain, or changes in vital signs are reported immediately. The patient may have outpatient surgery or remain in the hospital overnight.
a _______________________ is placed into the chest of a patient who experiences life-threatening arrhythmias or is at risk for sudden cardiac death.
implantable cardioverter defibulator
low sodium diet
baked or broiled poultry canned pumpkin cooked turnips egg yolk fresh vegetables fruit grits (not instant) honey jams and jellies lean meats low-calorie mayonnaise macaroons potatoes puffed wheat and rice red kidney and lima beans sherbet unsalted nuts whiskey
PT/coumadin/warfarin
10-13 sec
APTT/Heparin
25-35
INR levels for no anticoag tx
0.9-1.1
INR for pts recieving tx for clots
2.5-3.5
If pt is allergic to _______ they cannot have IV contrast dye
shellfish
How long before IV contrast dye should metformin be stopped and how long after
2 weeks before and 48 hrs after
the following are S/S of what?
dyspnea, fatigue, and fluid volume overload, tachycardia, jugular vein distension while sitting or standing, congestion- wheezing, crackles, decreased o2 sat., SOB, fatigue, weight gain, chest tightness, chest pain.
Heart failure
LDL is
bad cholesterol
HDL is
Good cholesterol
LDL desired level
less than 100
HDL desired level
more than 60
desired triglycerides
less than 150 mg
LDL health risk level
more than 159
HDL health risk level
less than 40
Triglycerides health risk level
more than 199
___________ is precipitated by exertion or stress. Relieved by rest or nitroglycerin. Manifestations last less than 15 min. Not associated with nausea, epigastric distress, dyspnea, anxiety or diaphoresis
stable angina
___________ Can occur without cause, often in the morning after rest. Relieved only by opioids. Manifestations last more than 30 min. Associated with nausea, epigastric distress, dyspnea, anxiety and diaphoresis.
MI
The following are S/S of what??
Tachycardia Tachypnea Wheezing Hypotension Cyanosis Oliguria Altered mental status Can have urticaria, pruritus, angioedema, laryngeal edema, severe bronchospasm. If conscious, can be extremely apprehensive.
anaphylactic shock
____________________ Occurs when the heart fails as a pump and decreases cardiac output. It requires immediate treatment to prevent death
cardiogenic shock
The following are S/S of what?
Sudden numbness or weakness of face, arm, or leg, especially on one side of the body. Sudden confusion or trouble speaking or understanding. Sudden trouble seeing in one or both eyes. Sudden trouble walking, dizziness, loss of balance, or coordination. Sudden severe headache with no known cause.
CVA
a women is presenting with the following:
hallucinations, chest pain, hiccups, palpitations, SOB, facial pain.
what do you suspect the dx is?
CVA
S/S of CVA in women
hallucinations, chest pain, hiccups, palpitations, SOB, facial pain.
S/S of CVA
Sudden numbness or weakness of face, arm, or leg, especially on one side of the body. Sudden confusion or trouble speaking or understanding. Sudden trouble seeing in one or both eyes. Sudden trouble walking, dizziness, loss of balance, or coordination. Sudden severe headache with no known cause.
S/S of anaphylactic shock
Tachycardia Tachypnea Wheezing Hypotension Cyanosis Oliguria Altered mental status Can have urticaria, pruritus, angioedema, laryngeal edema, severe bronchospasm. If conscious, can be extremely apprehensive.
cause of chest pain
ischemia resulting from a reduction in coronary artery blood flow and oxygen delivery to the heart muscle.
Early manifestations of CF
wheezing, rhonchi, dry, nonproductive cough.
S/S of increased involvement of CF
dyspnea, paroxysmal cough, obstructive emphysema and atelectasis on chest x-ray
S/S of advanced involvement of CF
cyanosis, barrel-shaped chest, clubbing of fingers and toes, multiple episodes of bronchitis or bronchopneumonia.
What diet should be used to help improve cardiac health
DASH diet for HTN (low sodium, high potassium, high calcium), decreasing sodium intake, high fiber, limit caffeine
Cranial nerve 1
olfactory smell
cranial nerve 2
visual activity, visual feilds
cranial nerve 3
eye movement
cranial nerve 4
trochlear, verticle eye movement
cranial nerve 5
light touch sensation to the face. Jaw opening chlenching chewing
Cranial nerve 6
abducens; lateral movement of eyes
cranial nerve 7
facial taste (salty/sweet), saliva, facial movements
Cranial nerve 8
auditory hearing and balance
cranial nerve 9
glossopharyngeal; taste (sour/bitter) on posterior third or tongue. Swallowing, speech, sounds, gag reflex
cranial nerve 10
vagus; gag reflex, swallowing, speech quality
Cranial nerve 11
spinal accessory; turning head, shrugging shoulders
Canial nerve 12
hypoglossal tongue movement.
cranial nerve that controls olfactory smell
cranial nerve 1
cranial nerve that controls visual activity, visual feilds
cranial nerve 2
cranial nerve that controls eye movement
cranial nerve 3
cranial nerve that controls verticle eye movement
cranial nerve 4
cranial nerve that controls light touch sensation to the face. Jaw opening chlenching chewing
cranial nerve 5
cranial nerve that controls lateral movement of eyes
cranial nerve 6
cranial nerve that controls taste (salty/sweet), saliva, facial movements
cranial nerve 7
cranial nerve that controls auditory hearing and balance
cranial nerve 8
cranial nerve that controls taste (sour/bitter) on posterior third or tongue. Swallowing, speech, sounds, gag reflex
cranial nerve 9
cranial nerve that controls gag reflex, swallowing, speech quality
cranial nerve 10
cranial nerve that controls turning head, shrugging shoulders
cranial nerve 11
cranial nerve that controls tongue movement.
cranial nerve 12
Type of angina that occurs with moderate exertion in a pattern that is familiar to the patient. The pain is predictable and only lasts a few hours. Can be relieved by resting and using NTG
stable angina
the kind of angina that increases unpredictable in frequency or that occurs with less exertion, at rest or during sleep. Is not relieved by rest or medication. Blood clots that form in response to injury to the artery from athersclerosis cause a reduction in blood flow leading to unstable angina. This is a serious condition that can lead to MI
unstable angina
this type of angina is caused by coronary artery spasms and is serious. The pattern of occurrence is often cyclical, with the pain happening about the same time each day. The pain lasts longer than stable angina. Can occur with exercise or at rest often occurs at night.
Variant or vasospastic angina
this kind of angina spasms in the walls of the tiniest arteries of the heart reduce coronary blood flow and result in microvascular angina. Compared with other types of aninal pain this pain may be more severe and last longer
microvascular angina
node at the junction of the superior vena cava and right atrium, regarded as the starting point of the heartbeat.
Sinoatrial Node
SA node
node that is located in lower right atrium; receives an impulse from the sinoatrial node and relaus it to the ventricles
avioventricular node
AV node
the contraction of the atria
atrial systole
the period of relaxation of the two ventricles
ventricular diastole
a bundle of fibers from the impulse-conducting system of the heart originates in the AV node
the bundle of his
the contraction of the two ventricles
ventricular systole
an arrythmia that Originates in the SA node. Regular rhythm, less than 60 HR. P waves are rounded upright, precede each QRS complex alike. Can decrease BP, cause resp distress, diminished or absent peripheral pulses, fatigue, or syncope can occur. Happens in well conditioned athletes bc their hearts work so efficiently. Usually an under lying cause and once tx it goes away
sinus brady
an arrythmia with Reguar rhythm, HR 101-180. Causes incluse physical activity, hemorrhage shock, medications such as epinephrine, atropine, or nitrates, dehydration, fever, MI, electrolyte imbalance, fear, anxiety. Tachy cardia occurs as a compensatory mechanism for hypoxia to help produce cardiac output to deliver oxygen to tissues. Can cause angina, dyspnea, syncope, or tachypnea. Older adults become symptomatic more rapidly than younger pts. Pt’s with I may not tolerate a rapid HR
sinus tachy
an arrythmia that has An early beat. Premature beat interrupts underlying rhythm where it occurs. HR depends on the underlying rhythm; if NSR 60-100 bpm. Usually not serious. Often no tx is required other than correcting the cause.
premature atrial contrctions
an arrythmia Atrial rhythm regular; ventricular rhythm regular or irregular depending on consistency of AV conduction of impulses. HR: ventricular rate varies. Can be caused by rheumatic or ischemic heart disease, CHF, HTN, pericarditis, PE, and postoperative coronary artery bypass surgery. Can also be caused my medications..
atrial flutter
Irregularly Irregular rhythm; HR: atrial rate not measurable; ventricular rate under 100 BPM is controlled response greater than 100 bpm is rapid ventricular response. “extremely rapid and chaotic” AF increases with age (65 and above) esp in those w/ heart disease. Can be caused by cardiac surgery, HF, HTN, heart valve disease, MI, MI, hyperthyroidism, emphysema, sleep apnea, and some meds. Most pts can feel the irregular rhythm they describe it as palpitation, racing heart, or a heart skipping a beat. Can cause shob, dizziness, chest discomfort, faint radial pulse. Can cause left sided HF
A fib
AV block, SA node impulses are blocked and do not reach the ventricles to stimulate them to contract. Can be caused by cardiac ischemia or infarction, hyperkaemia, infection, antiarrythmic medications or digoxin toxicity. Can cause dizziness, chest pain, fatigue, dyspnea, severe chest pain, hypotension or syncope. This is a medica emergency. Oxygen needs to be given. If caused by toxicity it will resolve after toxicity is resolved.
THird degre
CBH
an arrythmia caused by caffine, alcohol, anxiety, hypokalemia, cardiomyopathy, ischemia, and MI. Usually interrupts rhythym. This can lead to dizziness, fatuige, or more arrythmias Pt may describe this as skipped beat or palpitations. Only require tx if more than 6 per min.
premature ventricular arrythmias
The occurrence of three or more PVC’s ina row. Usually a regular rhythm my have some irregularity 150-250 ventricular bpm; slow VT is below 150 bpm. Pt is aware of a sudde onsetof rapid HR. Pt may experience dyspnea, palpitations, and light-headedness. Angina commonly occurs. Seriousness of VT is determined by duration of the arrythmia..Can cause pulseless or not breathing…You better know you are supposed to do CPR.
v tach
The ventricle “quivers”. If rhythm is not corrected immediately death occurs. Can be caused by hyperkalemia, hypomagnesemia, electrocution, CAD, MI, placement of intracardiac catheters, and cardiac pacing wires. Rhythm is described as chaotic and extremely irregular. HR not measurable. Pt’s experiencing VF lose consciousness immediately. There are no heart sounds, peripheral pulses, or blood pressure readings. These are all indicative of circularoty collapse. Respiratory arrest, cyanosis, and pupil dialation occur. IMMEDIATE defibrillation is require CPR until defibrillator is available. Intubation may be required.
v fib
The silent heart or the absence of electrical activity in the heart. THIS IS CARDIAC ARREST. Can be caused by hyperkalemia, VF, loss of majority of functional cardiac muscle due to MI. VF usually precedes asystole. VF must be reversed immediately to help prevent asystole. No HR, no pulse, no RR, no BP, no. CPR REQUIRED Intubation helps with RR???
asystole
