unit 3 Flashcards
med to help convert out of afib
amiodarone
Transcutaneous pacing uses _____ milliamperes than transvenous or epicardial pacing
higher
normal QRS interval
.04-.12 second
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
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
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
2 medications for Anticoagulants
Heparin
Coumadin
let patient with pacemaker know that these 4 things could be complications
hiccuping
dizziness
fatigue
low radial pulse
ECG where:
Rate: not discernible.
Rhythm: not discernible.
P-wave: none
PR interval: none
QRS: none
Ventricular Fibrillation
for treatment of asystole what 2 things would you do
CPR
epinephrine
(dfib will not work)
ECG where:
Rate: absent.
Rhythm: absent.
P-wave: absent
PR interval: absent
QRS: absent.
Asystole
for treatment of V tach with NO PULSE and V fib what 3 things would you do
CPR
defibrilator
epinephrine
Strong Current indicated for Pulseless Rhythms
External Defibrillators
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
3 things before Cardioversion
Obtain consent
Give sedation
Anticoagulants
4 complications after Acute Myocardial Infarction (AMI)
Dysrhythmias
Sudden death
Heart failure
Cardiogenic shock
Includes stable angina, unstable angina or acute myocardial infarction
Acute Coronary Syndrome (ACS)
irregular, QRS wider than normal and no Pwave
PVC
every big box is ____ of a second on a ECG
.2 seconds
ST depressed is a sign of
cardiac ischemia
– obtain a 6-second strip and count the R waves; then multiply by 10
to determine _____
HR
Ventricular Rate
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)
Recommended HDL for males >__; for females, > __
40
50
4 causes of Acute Coronary Syndrome (ACS)
Blunt trauma
Emboli
Atherosclerosis
Spasm
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
