unit 3 Flashcards by britt rank

med to help convert out of afib

amiodarone

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Transcutaneous pacing uses _____ milliamperes than transvenous or epicardial pacing

higher

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normal QRS interval

.04-.12 second

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10 symptoms of decreased cardiac output

LOC change
Chest discomfort
Hypotension
Shortness of breath; respiratory distress
Pulmonary congestion; crackles 
Rapid, slow, or weak pulse
Dizziness
Syncope
Fatigue
Restlessness

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ECG where:

Rate: greater than 150

Rhythm: regular

P-wave: P waves and T waves are fused together

PR interval: indeterminate

QRS: narrow and normal

supraventricular tachycardia

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ECG where:

Rate:100-150 beats/minute

Rhythm:Regular

P-wave:Upright, rounded, smooth, 1 for each QRS complex, all look similar in size and shape

PR interval: 0.12-0.20 seconds

QRS:0.04-0.12 seconds
All QRS complexes look similar in size and shape

Sinus Tachycardia

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2 medications for Anticoagulants

Heparin

Coumadin

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let patient with pacemaker know that these 4 things could be complications

hiccuping
dizziness
fatigue
low radial pulse

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ECG where:

Rate: not discernible.

Rhythm: not discernible.

P-wave: none

PR interval: none

QRS: none

Ventricular Fibrillation

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for treatment of asystole what 2 things would you do

CPR
epinephrine

(dfib will not work)

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ECG where:

Rate: absent.

Rhythm: absent.

P-wave: absent

PR interval: absent

QRS: absent.

Asystole

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for treatment of V tach with NO PULSE and V fib what 3 things would you do

CPR
defibrilator
epinephrine

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Strong Current indicated for Pulseless Rhythms

External Defibrillators

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for treatment of V tach with a pulse

first you would give ____________

if that doesnt work, next you would do _________

amiodarone IVP
lidocane IVP

cardioversion

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3 things before Cardioversion

Obtain consent
Give sedation
Anticoagulants

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4 complications after Acute Myocardial Infarction (AMI)

Dysrhythmias
Sudden death
Heart failure
Cardiogenic shock

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Includes stable angina, unstable angina or acute myocardial infarction

Acute Coronary Syndrome (ACS)

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irregular, QRS wider than normal and no Pwave

PVC

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every big box is ____ of a second on a ECG

.2 seconds

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ST depressed is a sign of

cardiac ischemia

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– obtain a 6-second strip and count the R waves; then multiply by 10

to determine _____

Ventricular Rate

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Coronary artery bypass graft (CABG) surgery

Minimally invasive direct coronary artery bypass (MIDCAB) surgery

Transmyocardial revascularization (TMR)

3 surgical treatments for ___

3 surgical treatments for Acute Myocardial Infarction (AMI)

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Recommended HDL for males >__; for females, > __

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4 causes of Acute Coronary Syndrome (ACS)

Blunt trauma
Emboli
Atherosclerosis
Spasm

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4 medical management for Acute Myocardial Infarction (AMI)

Morphiene (pain & anxiety) Oxygen Nitroglycerin Asprin / clopiderol

the mode for a pace maker is either _____ or _____

demand – only when needed fixed- asynchronous (most patients on demand)

may be too high risk for some patients that are very elderly or have many co-morbidities such as poorly controlled DM or renal disease.

CABG Surgery

Chronic stable angina occurs with exertion, more likely to resolve with______& _______

rest and nitrates.

the ability of the pacemaker to recognize the body’s intrinsic or native electrical activity. It is measured in millivolts

sensitivity

one major problem that can happen from AFIB is

CLOTS

after a CABG Surgery, which 3 things to monitor for

infection bleeding hemodynamic instability.

for decreased cardiac output, the first step would be to use ______ the second step would be to use ____

atropine IVP external pacemaker

normal PR interval

.12 - .20 seconds 3-5 little boxes in length

2 pre cardiac catheterization care

Metformin held | NPO

ST elevation is a sign of

infarction

no consistency in the PR inerval and more P waves than QRS is a good indication of

3rd degree block | av diassociation

ECG where: Rate: matches the underlying rhythm Rhythm: irregular P-wave: not present PR interval: none QRS: greater than 0.12 second (wide)

Premature Ventricular Contractions (PVC)

Percutaneous transluminal coronary angioplasty (PTCA) Intracoronary stenting 2 non surgical treatment for _____

2 non surgical treatment for Acute Myocardial Infarction (AMI)

ECG where: Rate: greater than 100 bpm Rhythm: regular unless capture beats occur and momentarily interrupt P-wave: none PR interval: none QRS: consistent in shape but appear wide and bizarre

Ventricular Tachycardia

Ischemic heart disease, acute myocardial infarction, and conduction system disease are possible causes of _______

third-degree heart block.

ECG where: Rate: 40-60 Rhythm: regular P-wave: more p waves than QRS PR interval: varies QRS: greater than 0.12 second P& Q work seperatly

Third-Degree Block

7 symptoms of Acute Myocardial Infarction (AMI)

Pale and diaphoretic Hypotension Dyspnea/tachypnea ``` Midsternal chest pain Impending doom Nausea and vomiting Dysrhythmias Syncope ```

should you use defibrilation with asystole

no, wont work

6 Post cardiac catheterization care;

Monitor puncture site vs distal CMS frequently Bedrest for 4-6 hours fluids Keep leg extended (straight)

initial dose of adenosine is ___ mg if you need an additional dose you will ____

6mg double dose (12mg)

Hypoxemia, acid-base imbalance, exacerbation of heart failure, ischemic heart disease, cardiomyopathy, hypokalemia, hypomagnesemia, valvular heart disease, genetic abnormalities, and QT prolongation are all possible causes of ______

Ventricular Tachycardia

digitalis toxicity, electrolyte imbalance, lung disease, ischemic heart disease, valvular abnormalities, can also occur in normal hearts may be possible causes of _____

Supraventricular Tachycardia

every small box is ____ of a second on a ECG

.04 seconds

3 medications to treat bradycardia

Atropine Epinephrine Dopamine

Recommended LDL

100

30 horizontal big boxes are ___ seconds in time

6 seconds in time

Delivers electricity to the heart to stimulate depolarization (contraction)

Pacemakers

2 things to remember after internal pacemaker

arm adjacent to the surgical site should not be lifted Incision monitored for infection

chest pain that is Severe, crushing, and squeezing pressure May radiate Unrelieved with nitrates is a sign of

Acute Myocardial Infarction (AMI)

For patients at risk for lethal cardiac rhythms or sudden cardiac death Will recognize lethal rhythm and shock patient if necessary May have pacing capabilities

``` Automatic Implantable Cardioverter Defibrillator (AICD) ```

3 things that help diagnose a Acute Myocardial Infarction (AMI)

Signs and symptoms 12-lead: Elevated serum troponin (ordered every 3-6 hrs #3)

8 nursing intervenions for Acute Myocardial Infarction (AMI)

``` Stay with the patient Apply oxygen EKG monitoring and VS Give SL Nitroglycerin, morphine Targeted history and Focused exam At least 2 IV sites Draw blood for troponin levels CXR ```

prolonged PR interval (>.20) but consistent is an indication of ____

first degree AV block

HR is 150 or higher and you can not distinguish the p & T wave this is a sign of

supraventricular tachycardia | atrial tachycardia

3rd degree block almost always needs to be ______

externally pacemaker

stress, CAD,CHF,COPD, myocarditis, rheumatic heart disease, hypokalemia, hypomagnesemia, acid-base imbalances, and increased catecholamine levels can cause ______

PVCs.

Hyperthyroidism, hypovolemia, heart failure, anemia, exercise, use of stimulants, fever, and sympathetic response to fear or pain and anxiety may cause________

sinus tachycardia.

can be caused by caffiene, alcohol, smoking, aging, MI, Hypoxia, Hypokalemia, hypomagnesium

PVC

Percutaneous Coronary Intervention (PCI) should be performed within __ minutes of arrival to the emergency department, with a target of less than __ minutes (door to balloon time).

90 60

ECG where: Rate: 60-100 beats/minute Rhythm:Regular P-wave:Upright, rounded, smooth,1 for each QRS complex, all look similar in size and shape PR interval: 0.12-0.20 seconds QRS:0.04-0.12 seconds All QRS complexes look similar in size and shape

Normal Sinus Rhythm

the Electrical Output for a pacemaker is

milliamps

ECG where: Rate: greater than 100 Rhythm: irregular P-wave: indeterminate PR interval: indeterminate QRS: generally narrow and normal unless underlying disease present

Atrial Fibrillation

8 signs and symptoms of ``` SVT VTACH VFIB AFIB 1st degree block 3rd degree block ```

``` Chestpain Oxygen low Lethargy Anxiety Palpations Shortness of breath Elevated HR Dizziness ```

Progressive narrowing of coronary arteries by atherosclerosis hardening or arteries

Coronary Artery Disease (CAD)

3 medications for rate control

Amiodarone Beta blockers Calcium channel blockers

Vasovagal response; medications such as digoxin or AV nodal blocking agents, including calcium channel blockers and beta blockers; myocardial infarction; normal physiologic variant in the athlete; disease of the sinus node; increased intracranial pressure; hypoxemia; and hypothermia may cause ________

sinus bradycardia

ECG where: Rate: 60-100 (unless bradycardic) Rhythm: regular P-wave: upright, smooth, and round PR interval: longer than normal (>0.20) QRS:narrow and normal

First Degree Heart Block

the rate for a pacemaker is ____

60-100 usually 60

5 big boxes is ______ seconds

1 second

2 things to make sure of before 12 lead EKG

dry and lying still

representing ventricular depolarization which comes before ventricular contraction

QRS interval

3 types of medications used if patient is afib and HR over 100 to slow down HR as well as _____

calcium channel blocker (diltiazam) beta blocker (metopralol) digoxin anticoagulants (heparin, warfarin)

Depolarizes the cardiac cells so that the sinoatrial node can take over as the primary pacemaker of the heart Indicated for fast rhythms with a pulse

Cardioversion

3 treatments for - 3rd Degree Block – Lethal rhythm

Atropine Epinephrine If meds don’t work → Pace

with supraventricular tachycardia, 3 interventions are __

bear down adenosine (IVP fast/ 6mg) flush after cardioversion

4 medications for Acute Myocardial Infarction (AMI) after MONA

Anticoagulants: Heparin, enoxaparin Fibrinolytic therapy: Alteplase Beta blockers Angiotensin-converting enzyme inhibitors

Ischemic heart disease, valvular heart disease, hyperthyroidism, lung disease, heart failure, and aging may cause ____________

atrial fibrillation.

SVT, VTACH, VFIB, AFIB all have the same signs and symptoms because they are problems of _______

low oxygen

starts at the begining of the P wave ends with the QRS measures the time it takes for the SA node to fire and travel to the AV node.

PR interval

signs of Acute Myocardial Infarction (AMI) are often ______ in women

asymptomatic

Medications after stents include what 3 things

ASA, clopidogrel, anti-hypertensives,

impulse starts at SA node (atrial depolarization) which comes before atrial contraction should be uniform, round smooth and upright.

p wave

are fast heart rates with narrow QRS complexes.

Atrial dysrhythmias

have wide QRS complexes.

Ventricular dysrhythmias

any sinus rhythems are ______

regular rhythem

peaked T waves is usually a sign of

hyperkalemia

Ischemia with myocardial cell death | Imbalance of oxygen supply and demand

Acute Coronary Syndrome (ACS)

ECG where: Rate:Less than 60 beats/minute Rhythm:Regular P-wave:Upright, rounded, smooth,1 for each QRS, all look similar in size and shape PR interval:0.12-0.20 seconds QRS: 0.04-0.12 seconds All QRS complexes look similar in size and shape

Sinus Bradycardia

``` elective procedure client is awake & frequently sedated schnronized with QRS 50- 200 joules consent form EKG monitoir ``` would all indicate the use of _____

cardioversion

up right and one after every QRS represents ventricular repolarization or ventricular relaxation.

T wave

cardiac injury med toxicity electrical imbalances may cause

V fib

6 risk factors for Coronary Artery Disease (CAD)

Smoking Hypertension Inactivity Overweight Cholesterol(High LDL/Low levels of HDL) Diabetes

2 non modifiable risk factors for Coronary Artery Disease (CAD)

age Men > 45 years Women > 55 years family history

``` emergency v-fib/v-tach no cardiac output 200 joules up to 360 client unconscious EKG monitor ``` would all indicate the use of _____

defibrillation

Starts where QRS ends and ends where T wave beings should be flat.

ST segment