w3 Flashcards
HF is an issue with
_________ = amount of resistance/pressure LV has to overcome to pump blood out of heart
Increased afterload is harder on heart
_________ = too fast/slow for a long period of time
__________ = amount of blood comes into heart during diastole (filling)
Increases blood volume = increases preload
___________= myocardial cells ability to contract
HF is an issue with
- afterload = amount of resistance/pressure LV has to overcome to pump blood out of heart
Increased afterload is harder on heart - heart rate = too fast/slow for a long period of time
- preload = amount of blood comes into heart during diastole (filling)
Increases blood volume = increases preload - myocardial contractility = myocardial cells ability to contract
- cause = ventricular repolarization/relaxation
- unexpected = peaked
- T wave
3 main s/s of PAD
- _________
- ________
- issues r/t _______:
(- Hair loss
- Dry, scaly, dusky, pale or mottled skin
- Thick toenails
- Skin cool to the touch
- Prolonged cap refill
- Decreased/weak pedal pulse
- Dependent rubor - skin of the lower extremities turns a reddish color when the legs are in a dependent position (dangling down).
- Muscle atrophy)
intermittent claudication
arterial ulcers
issues r/t lack of arterial perfusion
saw tooth =
quiver =
A flutter
A fibrillation
Spironolactone (potassium sparing diuretic)
class: mineralocorticoid receptor antagonist
- used with chronic HF
- is it being used as a diuretic?
- is it being used for suppression of sodium/water retention to help with offloading the LV?
- watch for hyp__kalemia and worsening__________
- Not being used as a diuretic
- Being used for suppression of sodium/water retention to help with offloading the LV
- watch for hyperkalemia and worsening renal failure
- cause = SA node triggers atrial depolarization/contraction
- P wave
- cause = SA node triggers atrial depolarization/contraction
drugs for rhythm control, rate control, or drugs to prevent clots?
metoprolol =
diltiazem, verapamil =
Amiodarone and dofetilide =
Warfarin =
Which is Calcium channel blockers and Beta adrenergic blockers?
metoprolol = Beta adrenergic blockers, rate control,
diltiazem, verapamil = Calcium channel blockers, rate control,
Amiodarone and dofetilide = for rhythm control,
Warfarin = drugs to prevent clots
A fib/A flutter Treatment
- treatment goals =
- ________ control
- _______ control
- Prevent _______
- drugs for rate control – IV route initially
- ______________
- ______________
- drugs for rhythm control – IV route initially
- ______________
- ______________
- drugs to prevent clots
- ______________
rate or rhythm priority?
- Ventricular rate control (lower HR)
- Rhythm control
- Prevent embolic stroke
- drugs for rate control – priority, IV route initially
- Beta adrenergic blockers – metoprolol
- Calcium channel blockers – diltiazem, verapamil
- drugs for rhythm control – IV route initially
- Amiodarone and dofetilide
- drugs to prevent clots
- Warfarin
rate
Tachydysrhythmias can cause –
good or bad?
- initially, may __crease CO and BP
- eventually, if sustained or increased, ventricular filling will __crease = __creased CO and BP
- _________ diastole = shortens coronary perfusion time = angina
- workload on heart ___creases = myocardial oxygen demand increases
good:
- initially, may increase CO and BP
bad:
- eventually, if sustained or increased, ventricular filling will decrease = decreased CO and BP
bad
- shortened diastole = shortens coronary perfusion time = angina
bad
- workload on heart increases = myocardial oxygen demand increases
A fib/A flutter Treatment
- if hemodynamically unstable (VS are not ok) =
- Synchronized cardioversion/cardiovert/life pack = synchronized circuit delivers a countershock on the R wave of the QRS complex which gives you back your atrial kick
tele vs 12 lead EKG
1- Continuous observation of HR and rhythm (nurse can be at bedside or at nurses station)
2- monitoring only
3- can be diagnostic
4- unidimensional view
5- snapshot in time
6- routine or STAT
7- multidimensional view
8- done by EKG tech at bedside
9- nurse doesn’t interpret
1- T
2- T
3- 12 lead EKG
4- T
5- 12 lead EKG
6- 12 lead EKG
7- 12 lead EKG
8- 12 lead EKG
9- 12 lead EKG
s/s
- asymptomatic
- may be found during routine physical exam
- pulsatile mass in periumbilical area
- bruit present in abdomen
- back pain
Abdominal aortic aneurysm
Raynaud’s phenomenon: Nursing care
- primary focus = patient _______
- ________ clothing
- Gloves with _____ items
- Avoid temp _________
- Immersing hands in ______ water may decrease vasospasm
- Avoid _______ – cold, emotional upset, tobacco, caffeine
- drug therapy - _______ blockers
- 1st line
- used to lower BP?
- Used to treat _______ in peripheral vessels
Nursing care
- primary focus = patient teaching
- Layered clothing
- Gloves with cold items
- Avoid temp extremes
- Immersing hands in warm water may decrease vasospasm
- Avoid triggers – cold, emotional upset, tobacco, caffeine
- drug therapy - SR calcium channel blockers
- 1st line
- Not used to lower BP
- Used to treat vasospasm in peripheral vessels
Some patients may be able to tolerate a HR outside of 60-100 if their ___ remains adequate
How do we know – they will be asymptomatic or symptomatic
Asymptomatic -
- _______ + _______ = asymptomatic = they can tolerate abnormal HR
Symptomatic -
- ________ + ________ = symptomatic = they can’t tolerate abnormal HR
- may lead to
- Myocardial ischemia/infarct
- Dysrhythmias
- Hypotension or HTN?
- HF
Asymptomatic -
- Bradycardia/tachycardia + BP remain adequate = asymptomatic = they can tolerate abnormal HR
Symptomatic -
- Bradycardia/tachycardia + BP doesn’t remain adequate = symptomatic = they can’t tolerate abnormal HR
- may lead to
- Myocardial ischemia/infarct
- Dysrhythmias
- Hypotension
- HF
cardiovert and defibrillation:
- _________ = synchronized circuit delivers a countershock on the R wave of the QRS complex which gives you back your atrial kick
- ___________ = (synchronized switch is turned on)
- if switch is turned on pt must have _________
- turning the synch switch on means it will fire when?
- If the lifepack is not synched and fires at wrong time = trigger
- For defibrillation
- (synchronized switch is turned _______)
- Pt does or doesn’t have QRS complex/R wave? - when the switch is off = does not synch up with pts QRS and will fire ________
- Synchronized cardioversion/cardiovert/life pack
- synchronized cardioversion/cardiovert
- R wave/QRS complex
- This will synch up with pts QRS and fire at the appropriate time
- If the lifepack is not synched and fires at wrong time = trigger life threatening dysrhythmias
- For defibrillation (synchronized switch is turned off) – Pt doesn’t have QRS complex/R wave (ex: Vfib or VTACH)
- This does not synch up with pts QRS and will fire as soon as the button is pressed
which dysrhythmia
- originates in ectopic focus anywhere above bifurcation of bundle of His, anywhere in atria
- run of repeated premature beats, that starts and stops abruptly
- usually initiated by a PAC
- rate is > 100 bpm
PSVT
Paroxysmal supraventricular tachycardia
- originates in ectopic focus anywhere above bifurcation of bundle of His, anywhere in atria (supraventricular)
- run or repeated premature beats, that starts and stops abruptly (paroxysmal)
- start of P wave to start of QRS complex
- expected 0.12 – 0.20 seconds
PR interval
Afib
Explanation of different rates
- atrial rate > 400 bpm
- ventricular rate up to 100-175 bpm
- ___ node is gate keeper helping to slow >400 bpm down, so only some of the atrial pulses are conducted though the ___ node
- all the little quivers are the _______ firing that didn’t get through to the AV node (called ___ waves)
- the ___________ is the ectopic firing that did get through the AV node
Explanation of different rates -
- atrial rate > 400 bpm
- ventricular rate up to 100-175 bpm
- AV node is gate keeper helping to slow >400 bpm down, so only some of the atrial pulses are conducted though the AV node
- all the little quivers are the ectopic sites firing that didn’t get through to the AV node (called f waves)
- the QRS complex is the ectopic firing that did get through the AV node
Causes of ______
- can occur with any underlying heart disease
- electrolyte imbalance
- hypoxia
- cardiac surgery
A fib
You can live with A fib?
You can live with Vfib?
yes - You can live with A fib, bc what really matters is ventricular rate
Ex: if patient is A fib with HR 90, he can live with this b/c ventricle rate is under control (not ideal, but possible)
no - can’t live with vfib
Venous thromboembolism VTE
Patho:
- 3 things occur
______
______
______
- as a result
________
Venous thromboembolism VTE
Patho
- 3 things occur
- Venous stasis
- Endothelial tissue damage
- Blood thickens (hypercoagulability)
- as a result
- Thrombus forms
Start of QRS complex to end of T wave
- QT interval
Causes of ______
- benign (common)
- electrolyte imbalance
- stress
- cardiac stimulants – caffeine
- atrial pathology (any disease or abnormality that affects the atria of the heart, includes: A fib, A flutter)
PAC
- cause = AV node triggers ventricular depolarization/contraction
- atrial repolarization/relaxation occurs here, can’t see it on EKG
- expected = “skinny or narrow”
- QRS complex (R wave)
Digoxin –
- 2nd line drug – b/c of ________ risk
- negative chronotrope or positive inotrope? = slows HR
-negative chronotrope or positive inotrope? = increases contractility - hyp__kalemia can cause:
- digitoxicity
- cardiac dysfunction
- serious dysrhythmias
- levels should be 0.5-2
- s/s of digitoxicity
- bradycardia or tachycardia?
- 3 head things
- 1 GI thing
- 1 eye thing
- take ________ for full minute before giving
- HOLD IF ________
- monitor cardiac _______
- antidote = _______ IV
- pt education – take own ______ at home
Digoxin –
- 2nd line drug – b/c of dysrhythmia risk
- negative chronotrope = slows HR
- positive inotrope = increases contractility
- hypokalemia can cause
- digitoxicity
- cardiac dysfunction
- serious dysrhythmias
- levels should be 0.5-2
- s/s of digitoxicity
- bradycardia
- h/s
- dizzy
- confusion
- nausea
- visual disturbances
- take apical pulse for full minute before giving
- HOLD IF pulse < 60
- monitor cardiac rhythm
- antidote = digibind IV
- pt education – take own pulse at home
s/s _______ HF
- fatigue
- increased peripheral venous pressure
- JVD
- hepatomegaly – liver enlarged
- splenomegaly – enlarged spleen
- ascites
- vascular congestion in GI tract – anorexia, nausea
- peripheral edema
- scrotal edema
right
life pack/ cardioversion/ defibrillator
T/F
- Make sure people are “clear” before discharging device – not even touching bed
- If pt becomes pulseless (they lost their QRS complex) = Turn off synchronizer switch and perform defibrillation
T - Make sure people are “clear” before discharging device – not even touching bed
T - If pt becomes pulseless (they lost their QRS complex) = Turn off synchronizer switch and perform defibrillation
a long PR interval implies there is something wrong with
- if it is longer it implies there is something wrong with the conduction between atria and ventricle
b/c its inbetween the start of P wave to start of QRS complex = atrial contraction and ventricle contraction
bradycardia treatment
check for symptomatic or asymptomatic
- asymptomatic = _________
- symptomatic =
1. Atropine - 1st line
- Route IV
- Vagolytic – ______ vagus nerve, will ___crease HR
- 1 mg q 3-5 mins, 3 mg max
2. Transcutaneous pacing of heart (temp) - 2nd line – if atropine didn’t work and pt is still brady and symptomatic
3. pacemaker (permanent) - indicated if it continues
- pacemaker fires when SA nodes aren’t doing their job
- check for symptomatic or asymptomatic
- asymptomatic = monitor
- symptomatic =
- Atropine
- 1st line
- Route IV
- Vagolytic – blocks vagus nerve, will increase HR
- 1 mg q 3-5 mins, 3 mg max
- Transcutaneous pacing of heart (temp)
- 2nd line – if atropine didn’t work and pt is still brady and symptomatic
- pacemaker (permanent)
- indicated if it continues
- pacemaker fires when SA nodes aren’t doing their job
EKG strip
- shows markings for measuring amplitude and duration of waveforms
- smallest box = 0.04 seconds
- bigger box = 0.20 seconds
- strips = __ seconds
6
____________
- Normal cardiac rhythm, seen in young healthy people
- d/t changes in intrathoracic pressure w/ breathing
- everything is normal except, R to R interval is not regular
Sinus arrhythmia
Peripheral artery disease vs venous disease
9. ulcer tissue
_____– black eschar or pale pink granulation
_____ – yellow slough or dark red/ruddy granulation
- pain
_____ – intermittent claudication (with walking) or rest pain (constant). Ulcer may/may not be painful
_____– dull ache or heaviness in calf or thigh. Ulcer often painful - nails
_____ – thick or normal
_____ – thick and brittle - skin color
_____ – bronze/brown pigmentation, varicose veins
_____– dependent rubor (dark purple when legs hang), elevation pallor
- ulcer tissue
PAD – black eschar or pale pink granulation
Venous disease – yellow slough or dark red/ruddy granulation - pain
PAD – intermittent claudication (with walking) or rest pain (constant). Ulcer may/may not be painful
Venous disease – dull ache or heaviness in calf or thigh. Ulcer often painful - nails
Venous disease – thick or normal
PAD – thick and brittle - skin color
Venous disease – bronze/brown pigmentation, varicose veins
PAD – dependent rubor (dark purple when legs hang), elevation pallor
VTACH
CO =
Vfib
CO =
very decreased
NONE
Treatment tachycardia
1. treat the cause
- If FVD = __________
- If in pain = __________
- If febrile = ________
- If panic attack/anxiety = ____________
2. give beta adrenergic blockers – _______ HR and ________ myocardial oxygen consumption
Treatment
- treat the cause
- If FVD = fluid volume replacement
- If in pain = give analgesic
- If febrile = give anti-pyretic
- If panic attack/anxiety = give benzo/anxiolytic
- beta adrenergic blockers – reduce HR and myocardial oxygen consumption
Chronic venous insufficiency (CVI)
Collaborative care
- ___________ worn daily
- avoid ___________ for long times
- leg position that promotes venous return, reduces swelling?
- daily ________ – venous circulation
- good foot and leg care
- high ______, high ________ diet – r/t skin healing
Collaborative care
- compression (stockings or SCUDS) worn daily
- avoid standing/sitting for long times
- elevate legs above heart – promotes venous return, reduces swelling
- daily walking – venous circulation
- good foot and leg care
- high calorie, high protein diet – r/t skin healing
PVC subtypes
-_______ = every other QRS complex is a PVC
- ________ = every third QRS complex is a PVC
- _________ = every forth QRS complex is a PVC
- _________= all PVCs are either above the isoelectric line or below the isoelectric line (all coming from same place)
- _________= PVCs are both above and below the isoelectric line (coming from different places)
PVC subtypes
- bigamy = every other QRS complex is a PVC
- trigeminy = every third QRS complex is a PVC
- quadrigeminy = every forth QRS complex is a PVC
- unifocal = all PVCs are either above the isoelectric line or below the isoelectric line (all coming from same place)
- multifocal = PVCs are both above and below the isoelectric line (coming from different places)
s/s
- UNILATERAL leg edema = indicates its r/t ______ not ________
- pain
- tenderness with palpation
- dilated superficial veins
- sense of fullness in thigh or calf
- parasthesia
- warm skin and erythema
- temp > 100.4 = r/t inflammation
most serious complication = ______
VTE s/s
- UNILATERAL leg edema = indicates its r/t blood clot not venous insufficiency
- pain
- tenderness with palpation
- dilated superficial veins
- sense of fullness in thigh or calf
- parasthesia
- warm skin and erythema
- temp > 100.4 = r/t inflammation
most serious complication = PE
Collaborative therapy: acute or chronic HF
- treat underlying cause
- O2 therapy NC – helps relieve dyspnea/fatigue
- rest/activity period – conserve energy/minimize O2 demands
- daily weights
- sodium restricted diet – so they don’t retain more water
- drug therapy
- ACE inhibitors and ARBs
- Beta blockers – carvedilol
- - diuretics – loop, potassium sparing, thiazide, osmotic
- Nitrates
- Cardiac glycosides – digoxin
- left ventricular assist device LVAD
- heart transplant
chornic
VTE Risk factors: r/t Venous stasis, Endothelial tissue damage, or hypercoagulability?
- caustic or hypertonic IV drugs
- fractured pelvis, hip, leg
- IV drug abuse
- trauma
Risk factors: endothelial damage
Peripheral artery disease (PAD)
Risk factors
- atherosclerosis
- tobacco
- DM
- hyperlipidemia
- uncontrolled HTN
- familial
- ___creased CRP – non specific indicator of inflammation
which one is the main one?
- atherosclerosis!!
increased
Peripheral artery disease vs venous disease
5. hair
________ – hair could be present or absent
________ – no hair on legs, feet, toes (r/t poor perfusion)
- ulcer location
________ - medial malleolus (bony bump on the inner ankle)
________ – tips of toes, foot, or lateral malleolus (bony bump on the outer ankle) - ulcer margin
________ – rounded, smooth, Punched-out appearance (edges are well-defined, sharp, resembling a hole punched in the skin)
________ – irregular shaped - ulcer drainage
________ – minimal amounts
________ – moderate to large amounts
- hair
Venous disease – hair could be present or absent
PAD – no hair on legs, feet, toes (r/t poor perfusion) - ulcer location
Venous disease - medial malleolus (bony bump on the inner ankle)
PAD – tips of toes, foot, or lateral malleolus (bony bump on the outer ankle) - ulcer margin
PAD – rounded, smooth, Punched-out appearance (edges are well-defined, sharp, resembling a hole punched in the skin)
Venous disease – irregular shaped - ulcer drainage
PAD – minimal amounts
Venous disease – moderate to large amounts
________ rhythm
- Normal cardiac rhythm
- Sinus nodes fire 60-100 bpm
- Follows normal conduction pattern
- R to R interval is regular
Normal sinus
Causes of bradycardia -
T/F
- excessive vagal stimulation by parasympathomimetic
- Carotid sinus massage
- Vomiting/gagging
- Valsalva maneuvers
- Eyeball pressure
- Administration of parasympathomimetic drugs
- digoxin toxicity
- Hypokalemia – slows depolarization
- MI
- excessive vagal stimulation by parasympathomimetic
- Carotid sinus massage
- Vomiting/gagging
- Valsalva maneuvers
- Eyeball pressure
- Administration of parasympathomimetic drugs
- digoxin toxicity
X - Hyperkalemia – slows depolarization - MI
Ventricular or atrial dysrhythmias are
Life threathening?
Ventricular dysrhythmias
PVC, VTACH, VFIB
Peripheral artery disease vs venous disease
1.peripheral pulses
______ – present
_____ – decreases or absent
- cap refill
_____ – slow >3 secs
_____ – brisk <3 secs - ABI Ankle-Brachial Index - compares the BP in your ankle and arm.
_____ – >0.90 (good)
_____ – <0.90 (bad) - edema
_____ – none (unless leg is constantly in dependent position (dangling)
_____ – lower leg edema
1.peripheral pulses
Venous disease – present
PAD – decreases or absent
- cap refill
PAD – slow >3 secs
Venous disease – brisk <3 secs - ABI Ankle-Brachial Index - compares the BP in your ankle and arm.
Venous disease – >0.90 (good) no arterial obstruction = ankle pressure is typically normal
PAD – <0.90 (bad) narrowed arteries reduces blood flow to the legs = lower ankle pressures compared to the arm - edema
PAD – none (unless leg is constantly in dependent position (dangling)
Venous disease – lower leg edema
