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
________ = Amount of blood ejected from LV
___________= amount of blood in the ventricle prior to ejection
SV
———- =
end diastolic volume
Stroke volume
End diastolic volume/preload
Ejection fraction
bradycardia s/s
- symptomatic, asymptomatic, or both?
tachycardia s/s
- symptomatic, asymptomatic, or both?
- may be asymptomatic with HR < 60
- may be symptomatic ***
- may be asymptomatic with HR >100
- may be symptomatic ***
waves in order (3)
1st -________
2nd - PR interval
3rd - ________
4th - ST segment
5th - _________
6th - QT interval
7th - isoelectric flat line
P wave
QRS complex/R wave
T wave
VTE Risk factors: r/t Venous stasis, Endothelial tissue damage, or hypercoagulability?
- older age
- bed rest or prolonged immobility
- HF
- fractured hip or leg
- long trip w/o adequate exercise
- obesity
- pregnancy
- varicose veins
Risk factors: venous stasis
ABI
Ex:
left brachial systolic pressure = 130 mm
left ankle systolic pressure = 110 mm
right brachial systolic pressure = 125 mm
right ankle systolic pressure = 75 mm
right ABI = _____/______ = 0.84
left ABI = ______/______ = 0.58
0.9-1.3 = Normal ABI
< 0.9 = occlusive atrial disease (0.4 – 0.9 is often associated w/ claudication)
< 0.4 = non-healing ulcerations, ischemic rest pain
This person has ___________ in ______ extremity(s), and the _____ leg is probably worse off than the______ leg
left ABI = 110/130 = 0.84
right ABI = 75/130 = 0.58
This person has occlusive arterial disease in both extremities, and the left leg is probably worse off than the right leg
Collaborative therapy for acute or chronic HF?
- treat underlying cause
- hourly vitals and UO
- continuous EKG and pulse ox
- monitor ABG results
- position in high fowlers with feet:
horizontal?
elevated?
dangling at bedside?
- O2 by ______ or ______
- daily weights
- hemodynamic monitoring
- drug therapy goal
-__crease intravascular volume
-__creases afterload
-__crease anxiety
-__creases LV function - drug therapy meds
-diuretics
-vasodilators
-morphine – decrease ____load and ______load
-positive inotropes (increase _________) – digoxin
Collaborative therapy
- treat underlying cause
- hourly vitals and UO
- continuous EKG and pulse ox
- monitor ABG results
- position in high fowlers with feet
horizontal
or
dangling at bedside – decreases venous return/preload
- O2 by mask or bipap
- daily weights
- hemodynamic monitoring
- drug therapy goal
- decrease intravascular volume
- decreases afterload
- decrease anxiety
- increases LV function
- drug therapy meds
- diuretics
- vasodilators
- morphine – decrease preload and afterload
- positive inotropes (increase contractility) – digoxin
PAC treatment
- benign =
- if atrial pathology (any disease or abnormality that affects the atria of the heart, includes: A fib, A flutter) is the cause =
treatment
- benign = no treatment
- if atrial pathology is the cause = same treatment as A fib
acute or chronic HF?
1.______
- dx in outpatient setting
- marked by periods of acute and/or slowly worsening cardiac function
- may be caused by damage from other cardiac events/disease
2. _______
- dx in inpatient setting
- worsening chronic health failure s/s requiring urgent therapy
- life threatening condition
- s/s – SOA d/t excess fluid caused by cardiac overload
chronic
acute
Treatment if a-fib >48 hours
(not an emergency) = planned ___________
- ___________ therapy before cardioversion for 3-4 weeks AND after cardioversion for 3-4 weeks = want to make sure you don’t have _____
- ______ may be performed before cardioversion = way to check and make sure _________
if cardioversion if emergent = low molecular weight heparin or heparin _______
Treatment if a-fib >48 hours
- anticoagulation therapy (warfarin/coumadin) before cardioversion for 3-4 weeks AND after cardioversion for 3-4 weeks = want to make sure you don’t have any clots leading to a stroke
- TEE may be performed before cardioversion = make sure no clots in atrium
- if cardioversion if emergent = low molecular weight heparin or heparin drip
- End of QRS complex/R wave to start of T wave
- expected = equal to isoelectric line
- ST segment
HF diagnosis
- hx
- physical exam
- EKG =
- BNP and ProBNP =
- CXR =
- echocardiogram =
- hx
- physical exam
- EKG
- reduced EF will have significant EKG abnormalities
- BNP and ProBNP
- helps distinguish HF from other sources of dyspnea
- pts with dysnea and HF have BNP >400
- CXR
- cardiomegaly
- pleural effusions
- echocardiogram
- EF
- episodic
- vasospastic
- autoimmune
- disorder of small cutaneous arteries (often fingers and toes)
- may occur in isolation or with other autoimmune diseases – SLE, RA
Raynaud’s phenomenon
_______ nerve = part of parasympathetic nervous system (PNS), causes rest and digest
______________ = substances/conditions that stimulate the vagus nerve, thus the PNS, thus rest and digest
vagal
parasympathomimetic
AAA post op care
- ICU after surgery
- monitor for:
- _______ patency
- maintain adequate _____ (too low = poor perfusion, too high = can blow graft)
- CV status – r/t ____ risk
- infection
- GI status – ________ risk
- peripheral perfusion – especially _____ to entrance site
- renal perfusion – hourly ______
- provide discharge teaching
AAA post op care
- ICU after surgery
- monitor for:
- graft patency
- maintain adequate BP (too low = poor perfusion, too high = can blow graft)
- CV status – MI risk
- infection
- GI status – paralytic ileus risk
- peripheral perfusion – especially distal to entrance site
- renal perfusion – hourly u.o.
- provide discharge teaching
***Key features of sustained tachy/brady dysrhythmias
HR outside of 60-100 range
- ______ = r/t poor coronary perfusion
- _____, ______, ______ = r/t poor brain perfusion
- ______ and _______ = r/t poor brain perfusion and low BP
- pulse _____ = r/t poor peripheral perfusion
- SOA
- tachypnea or bradypnea?
- ________ = r/t left HF
- _________ (can’t breathe when lying down)
- ________ heart sounds (gallop)
- ____ = r/t right HF
- weakness, fatigue
- pale, cool skin, diaphoresis
- n/v
- ____creases urine output = r/t poor kidney perfusion
- _______ cap refill = r/t poor peripheral perfusion
- hyp__tension = r/t low CO
Only tachydysrhythmias
- palpitations
***Key features of sustained tachy/brady dysrhythmias
HR outside of 60-100 range
- angina = r/t poor coronary perfusion
- restlessness (think hypoxia), anxiety, confusion = r/t poor brain perfusion
- dizziness and syncope = r/t poor brain perfusion and low BP
- pulse deficit (when we check radial and apical pulse at same time, apical is higher than radial) = r/t poor peripheral perfusion
- SOA, tachypnea
- pulmonary crackles = r/t left HF
- orthopnea (can’t breathe when lying down)
- S3 or S4 heart sounds (gallop)
- JVD = r/t right HF
- weakness, fatigue
- pale, cool skin, diaphoresis
- n/v
- decreases urine output = r/t poor kidney perfusion
- delayed cap refill = r/t poor peripheral perfusion
- hypotension = r/t low CO
Only tachy
- palpitations
PAD s/s
intermittent claudication
- Location of pain correlates with site of ________
- Pain with ________ r/t peripheral artery occlusion when ________, no pain when _________
arterial ulcers (most ulcers are venous)
- Distal digits (toes)
- Bony prominences
- Deep lesions
- _________ (edges are well-defined, sharp, resembling a hole punched in the skin)
- Little to no ________
- lack of arterial perfusion leads to
- Hair _______
- Dry, scaly, dusky, pale or mottled ______
- Thick _______
- Skin_____ to the touch
- ________ cap refill
- _________ pedal pulse
- ____________- skin of the lower extremities turns a reddish color when the legs are in a dependent position (dangling down).
- Muscle _________
intermittent claudication
- Location of pain correlates with site of occlusion
- Pain with walking r/t peripheral artery occlusion when walking, no pain at rest
arterial ulcers (most ulcers are venous)
- Distal digits (toes)
- Bony prominences
- Deep lesions
- Punched out (edges are well-defined, sharp, resembling a hole punched in the skin)
- Little to no exudate
- lack of arterial perfusion leads to
- 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
normal electrical pattern in order
1st - P wave =
2nd - PR interval =
3rd - QRS complex / R wave =
4th - ST segment =
5th - T wave =
6th - QT interval =
7th - isoelectric flat line =
atrial contraction
measure of P wave start to QRS complex start
ventricular contraction (atrial relaxation)
measure of End of QRS complex/R wave to start of T wave
ventricular relaxation
measure of Start of QRS complex to end of T wave
Absence of electrical activity in cardiac cells
- ectopic pacemaker (group of cells in the heart, other than the SA node, that spontaneously generates electrical impulses) in atrium fires before SA node fires
- isolated premature atrial beat
- one time early discharge of an ectopic beat outside of the SA node
- we know this by looking at R to R interval, and can see one early beat that is out of the pattern, that is a ____
PAC
Premature atrial contraction
Nursing care: Synchronized cardioversion/cardiovert/lifepack
T/F
- airway
- oxygen
- vitals and LOC
- Monitor dysrhythmias
- emotional support
- document results of cardioversion
- airway
- oxygen
- vitals and LOC
- Monitor dysrhythmias
- emotional support
- document results of cardioversion
Treatment PSVT
Paroxysmal supraventricular tachycardia
- _____ maneuvers – trigger _______ response/_NS, brings pt out of PSVT
Ex: ________ maneuver – most effective, hold breath 10-15 secs, should see JVD, then resume breathing
Ex: Coughing
Ex: Carotid sinus massage – HCP only - diving reflex/_____ water submersion
- If that doesn’t work
med = atropine or adenosine?
- IV push followed with rapid ________ (may use stop cock)
- Warn pt may see _______ on rhythm strip
- Onset is 10-40 _____
- Duration – 1-2 _____
- very _____ half life - if that doesn’t work and pt becomes hemodynamically unstable
- cardioversion or defibrillation?
- synchronized switch on or off?
- vagal maneuvers – trigger vagal response/PNS, brings pt out of PSVT
- Valsalva maneuver – most effective, hold breath 10-15 secs, should see JVD, then resume breathing
- Coughing
- Carotid sinus massage – HCP only
- diving reflex/cold water submersion
If that doesn’t work
- adenosine
- IV push followed with rapid NS flush (may use stop cock)
- Warn pt may see pause on rhythm strip – flat line
- Onset is 10-40 secs
- Duration – 1-2 mins
- very short half life
if that doesn’t work and pt becomes hemodynamically unstable
- cardioversion, synchronized switch on
EF = ____-____% normal
<___% = HF
EF = 55-70% normal
<40% = HF
2 leads/electrodes are next to each other anatomically =
ST elevation in 2 contiguous leads =
Contiguous leads
pt is having/had a STEMI
Treatment for VTACH
1. depends on if the pt has ________ or _______
- ACLS
- anti-___________ drug – beta blocker, calcium channel blockers, amiodarone
- electrolyte replacement
s/s
- will be __________ very quickly unless converts back to other rhythm
- depends on pulse (perfusion) or pulseless (no perfusion)
- ACLS
- anti-dysrhytmic drug – beta blocker, calcium channel blockers, amiodarone
- electrolyte replacement
s/s
- will be symptomatic very quickly unless converts back to other rhythm
s/s PSVT Paroxysmal supraventricular tachycardia
- depends on
- __________
- How _______ the ventricular rate is
(if it’s too high ____ is reduced)
- depends on
- How long it lasts
- How fast the ventricular rate is (tachycardia), if it’s too high CO is reduced
VTACH
Ventricular tachycardia
- 3 or more______ together
- ectopic focus within the ventricles takes controls and fires ________
- no _______ contractions occurring
- ______ ______ cardiac output
- rate _____-____ bpm,
- regular or irregular?
- p wave?
- PR interval?
VTACH
Ventricular tachycardia
- 3 or more PVCs together
- ectopic focus within the ventricles takes controls and fires repeatedly
- no atrial contractions occurring
- very decreased cardiac output
- rate 150-200 bpm,
regular
- no p wave,
PR interval not measurable
s/s _______ HF
- pulmonary congestion/edema
- cough
- crackles, rhonchi, wheeze
- blood tinged sputum
- tachypnea
- restlessness, confusion
- Orthopnea – SOA when lying flat
- tripod position
- tachycardia
- exertional dyspnea
- fatigue
- cyanosis
- late sign = paroxysmal nocturnal dyspnea - sudden SOA that awakens a person from sleep
left
- SA node fires < 60 bpm
- may be a normal rhythm in athletes and during sleep
- SA node fires >100 bpm
Sinus bradycardia
Sinus tachycardia
PAD treatment
Post op nursing care
- frequent _________ assessment
- when to notify HCP
- Dramatic increase in ______
- Loss of pulses_______ to site (doppler)
- Extremity _______ or _______ (color)
- Change in any other _______ status
- avoid ___________ position – impedes arterial flow
- early __________
- foot care
Post op nursing care
- frequent peripheral vascular system assessment (PVS)
- when to notify HCP
- Dramatic increase in pain
- Loss of pulses distal to site (doppler)
- Extremity pallor or cyanosis
- Change in any other PVS status
- avoid knee flexed position – impedes arterial flow
- early ambulation
- foot care
Causes of _____
- if it’s isolated – may be benign
- stimulants
- electrolyte imbalance
- Hypoxia
- fever
- exercise
- emotional stress
- CVD
PVC
HR < 60
HR > 100
Bradydysrhythmias
Tachydysrhythmias
Atrial flutter
- Atrial ______dysrhythmia
- identified by
recurring or single?
irregular or regular?
“________” shaped flutter waves
- originates from a _______ ectopic focus, reentry impulse is repetitive and cyclic
- R to R interval can be regular or irregular
- atrial rate may be >_____ bpm
- ventricular rate slower
- atria is not _______, atria is ________
Atrial flutter
- Atrial tachydysrhythmia identified by
recurring,
regular,
saw tooth shaped flutter waves
- originates from a single ectopic focus, reentry impulse is repetitive and cyclic
- R to R interval can be regular or irregular
- atrial rate may be >250 bpm
- ventricular rate slower
- atria is not contracting/kicks (p wave), atria is fluttering (f wave)
Bradydysrhythmias could cause -
which is good/bad?
- ________ myocardial oxygenation demand
- ________ diastole (extended period of relaxation and filling of the heart’s chambers, particularly the ventricles)
- if HR is too slow = ___crease in coronary perfusion
good
- reduced myocardial oxygenation demand
good
- prolonged diastole (extended period of relaxation and filling of the heart’s chambers, particularly the ventricles) = improve myocardial perfusion
The bad:
- if HR is too slow = decrease in coronary perfusion = angina
Causes of ________
- can occur with any underlying heart condition
- electrolyte imbalance
A flutter
A fib/A flutter Treatment: if hemodynamically stable (VS are ok), but symptomatic***
- ___________ and ______ with either IV calcium channel blockers, beta blockers, digitalis, amiodarone
- “Bolus and start a drip” may be ordered = bolus med to get to therapeutic level and then put the med on a drip to keep it at that level
- Slow ventricular rate and control rhythm
Cardioversion vs defibrillation
1- elective procedure
2- emergency
3- call a code
-4 pt awake and often sedated
5- synchronized with QRS (switch turned on)
-6 pulselessness – vfib, VTACH
7- no cardiac output
8- 200-360 joules
9- 50-200 joules
10- consent form
11- pt unconscious
12- EKG monitor
13- not synchronized with QRS (switch turned off)
1 c
2 d
3 d
4 c
5 c
6 d
7 d
8 d
9 c
10 c
11d
12 both
13 d
with PACs
When to contact HCP
___
___
why?
When to contact HCP
- new PACs
- increasing PACs
why? could indicate pt is about to convert to A fib
Chronic venous insufficiency (CVI)
s/s
- _______ skin
- ________color
- edema
- eczema with itching
- ulcer location medial malleolus – ______ ankle
- _________ positon makes pain worse
- w/out treatment ulcer gets deeper and wider and increases risk of _______
s/s
- leathery skin
- brownish/brawny color
- edema
- eczema with itching
- ulcer location medial malleolus – inside ankle
- dependent positon (leg dangle) makes pain worse
- w/out treatment ulcer gets deeper and wider and increases risk of infection
Peripheral artery disease vs venous disease
13. Skin texture
____– thick, hard/indurated
____ – thin, shiny, taut
- skin temp
____ – cool temperature gradient down the leg (toes are cool)
____ – warm, no temperature gradient - dermatitis
____ – rare
____ – frequent - pruritus
____ – frequent
____ – rare
- Skin texture
Venous disease – thick, hard/indurated
PAD – thin, shiny, taut - skin temp
PAD – cool temperature gradient down the leg (toes are cool)
Venous disease – warm, no temperature gradient - dermatitis
PAD – rare
Venous disease – frequent - pruritus
Venous disease – frequent
PAD – rare
left ventricular assist device LVAD
T/F
- treatment for acute or chronic HF?
- used as a bridge to transplant or if no surgery is planned (destination therapy)
- must take BP manually with doppler
- LVAD machines are in continuous flow so BP can’t be read
- heart tones S1/S2 can still be heard
- if pt is unresponsive – make sure pump is turned on or off? then start CPR
- education
- chronic
T - used as a bridge to transplant or if no surgery is planned (destination therapy)
T- must take BP manually with doppler
T - LVAD machines are in continuous flow so BP can’t be read
F - heart tones S1/S2 cant be heard – just a humming sound of LVAD - if pt is unresponsive – make sure pump is turned off, then start CPR
- education
PVC Treatment
1. treat the cause
2. drugs
- beta blockers
- lidocaine
- amiodarone or atropine?
PVC Treatment
1. treat the cause
2. drugs
- beta blockers
- lidocaine
- amiodarone
- irregular waveforms of varying shapes and sizes
- ventricles are quivering
- no effective contractions = NO cardiac output
Ventricular fibrillation
If A fib/A flutter treatment doesn’t work
- long term ________ required
- drug of choice - ________
- Have to monitor ____ regularly
- Antidote – ________
- alternatives – dabigatran, apixaban, rivaroxaban, eboxaban
- Don’t require ________
- More _________
- dosing?
- Contraindicated with __________
- antidote -
If A fib/A flutter treatment doesn’t work
- long term anti coagulation required
- drug of choice - warfarin/coumadin
- Have to monitor INR regularly
- Antidote – vitamin K
- alternatives – dabigatran, apixaban, rivaroxaban, eboxaban
- Don’t require routine lab testing
- More expensive
- May have to takes >once per day
- Contraindicated with renal dysfunction
- No antidote
- Elevated ST seg. + elevated troponin =
- Not elevated ST seg. + elevated troponin =
- Not elevated ST seg. + not elevated troponin + chest pain =
STEMI
NSTEMI
stable or unstable angina
does this cause bradycardia or tachycardia?
- excessive vagal stimulation by parasympathomimetic
- vagal inhibition (restraining)
- physical activity
- low BP
- anxiety
- Hyperkalemia – slows depolarization
- pain
- digoxin toxicity
- stress
- Carotid sinus massage
- Vomiting/gagging
- anemia
- hypoxia
- Valsalva maneuvers
- Eyeball pressure
- Administration of parasympathomimetic drugs
- dehydrated/ hypovolemia/ low SV
- MI
- HF
- fever
- excessive vagal stimulation by parasympathomimetic = B
- vagal inhibition (restraining) = T
- physical activity =T
- low BP = T
- anxiety =T
- Hyperkalemia – slows depolarization = B
- pain =T
- digoxin toxicity =B
- stress=T
- Carotid sinus massage =B (vagal stimulation)
- Vomiting/gagging = B (vagal stimulation)
- anemia = T r/t lack of RBC to oxygenate
- hypoxia =T
- Valsalva maneuvers =B (vagal stimulation)
- Eyeball pressure =B (vagal stimulation)
- Administration of parasympathomimetic drugs =B (vagal stimulation)
- dehydrate/hypovolemia/low SV = low BP = T
- MI = low BP = T or B
- HF = low BP = T
- fever=T
Causes of _______
- overexertion
- emotional stress
- stimulants
- digitalis toxicity
- various forms of heart disease
PSVT Paroxysmal supraventricular tachycardia
non waves (segments, intervals, measures) in order
1st - P wave
2nd ________
3rd - QRS complex / R wave
4th - ________
5th - T wave
6th - _______
7th - isoelectric flat line
- PR interval
ST segment
QT interval
Raynaud’s phenomenon
s/s
- _______ changes in fingers and toes d/t ____________
- lasts _____-______
- cold or hot?
- numbness
- when perfusion returns – (4)
- event is triggered by - (4)
Diagnosis
- based on symptoms for __ years
s/s
- color changes (red, white, blue) in fingers and toes d/t vasospasms
- lasts mins – hours
- cold
- numbness
- when perfusion returns – throbbing, aching, tingling, swelling
- event is triggered by cold, emotional upset, tobacco, caffeine
Diagnosis
- based on symptoms for 2 years
Stroke/emboli risk and A fib
A flutter
fibrillating/quivering atria (not a properly ______ atria) =
________ of blood =
_____ formation =
risk for _______ =
risk for _______
fibrillating/quivering atria (not a properly contracting atria) = pooling of blood = clot formation = risk for embolus = risk for stroke
- graphic tracing of electrical impulses produced by heart
- waveforms represent activity of charged ions across membranes of myocardial cell
EKG
Ankle brachial index ABI
- Right ABI formula = ________ pressure in ________ /
_________ pressure in ________ - Left ABI formula = ________ pressure in ________ /
_________ pressure in ________ - 0.9-1.3 = _______
- < 0.9 = _________
- < 0.4 = _________
non-healing ulcerations
ischemic rest pain
occlusive atrial disease
Normal ABI
often associated w/ claudication
- Right ABI formula = highest pressure in right foot /
Highest pressure out of BOTH arms - Left ABI formula = highest pressure in left foot /
Highest pressure out of both arms - 0.9-1.3 = Normal ABI
- < 0.9 = occlusive atrial disease (0.4 – 0.9 is often associated w/ claudication)
- < 0.4 = non-healing ulcerations, ischemic rest pain
PAD diagnostic tests
- ______________
- can determine degree of blood flow
- ______________
- screening tool
- uses hand held doppler on all 4 extremities, gel, BP cuff
PAD diagnostic tests
- doppler ultrasound
- can determine degree of blood flow
- Ankle brachial index ABI
- screening tool
- uses hand held doppler on all 4 extremities, gel, BP cuff
- 3 or more PVCs together
- ectopic focus within the ventricles takes controls and fires repeatedly
- no atrial contractions occurring
- very decreased cardiac output
- rate 150-200 bpm, regular
- no p wave, PR interval not measurable
VTACH
Ventricular tachycardia
When to contact HCP
- isolated?
- if new PVC?
- increasing frequency PVCs?
why?
- if new PVC or
increasing frequency PVCs
could be turning into VTACH
drugs for rhythm control (anti-dysrhythmic), Slows ventricular rate
(Vagolytic) blocks vagus nerve, will increase HR
antiarrhythmic drug used to convert paroxysmal supraventricular tachycardia (PSVT) to normal sinus rhythm.
all the a drugs - atropine, Amiodarone, adenosine
drugs for rhythm control (anti-dysrhythmic), - Slow ventricular rate - Amiodarone and dofetilide
atropine - - Vagolytic – blocks vagus nerve, will increase HR
adenosine - antiarrhythmic drug used to convert paroxysmal supraventricular tachycardia (PSVT) to normal sinus rhythm.
_______ sided HF
- blood backs up in _____ atrium and pulmonary veins
______ sided HF
- blood backs up into the ____ atrium and venous circulation
left sided HF
- blood backs up in left atrium and pulmonary veins
- think LHF think lungs
right sided HF
- blood backs up into the right atrium and venous circulation
- think RHF think body
VTE nursing care
- early/aggressive _______ or _____ q 2 hours
- _______ and _______ of feet, hips, knees q 2-4 hours while awake = mimics __________
- anti__________ therapy
- pt teaching to minimize risk factors
- inferior vena cava interruption _______ – “greenfield _______”
- Uses stainless steel filter to prevent ______
- as blood travels up the vena cava, clots are trapped in the filter, preventing them from reaching lungs
nursing care
- early/aggressive mobilization or turn q 2 hours
- flexion and extension of feet, hips, knees q 2-4 hours while awake – mimics skeletal muscle pump
- anticoagulation therapy
- pt teaching to minimize risks
- inferior vena cava interruption filters – “greenfield filter”
- Usus stainless steel filter to prevent PE
- as blood travels up the vena cava, clots are trapped in the filter, preventing them from reaching lungs
CVI
Compression therapy – Promotes venous return back to heart
- recommended if pt currently has VTE?
static vs dynamic
_________ = compression hosiery
- Graded compression from distal to proximal
- Prescriptions by HCP specializing in vascular disease
- Measure in morning
- TED hose – can impede flow if put on incorrectly
________ = intermittent pneumatic compression pumps/sleeves
- SCUDs
Compression therapy – Promotes venous return back to heart
- not recommended to pt currently has VTE
static vs dynamic
- static = compression hosiery
- Graded compression from distal to proximal
- Prescriptions by HCP specializing in vascular disease
- Measure in morning
- TED hose – can impede flow if put on incorrectly
- dynamic = intermittent pneumatic compression pumps/sleeves
- SCUDs
Permanent localized out-pouching of vessel wall in abdominal aorta
- aorta undergoes very high pressure so it is a susceptible place to get ________
Abdominal aortic aneurysm
A fib/A flutter Treatment: non-pharm therapy/surgical
- Catheter _________ – radiofrequency or cryothermal therapy
- Invasive or noninvasive?
- Destroys irritable _____ causing the dysrhythmias
- Must undergo ____ studies and mapping procedure to locate the focus - ______ procedure
- Surgical or catheter procedure?
- Creates numerous atrial incisions to disrupt dysrhythmias, only one path from SA node to AV node
- Catheter abliation – radiofrequency or cryothermal therapy
- Invasive
- Destroys irritable focus causing the dysrhythmias
- Must undergo EP studies and mapping procedure to locate the focus
- Maze procedure
- Surgical procedure
- Creates numerous atrial incisions to disrupt dysrhythmias, only one path from SA node to AV node
Abdominal aortic aneurysm
Complications
- _______
Collaborative care
- early _________ – know familial tendency
- goal = prevent _________
- if AAA is small (<4 cm)
- surgery or Watchful waiting?
- Reduce ________
- Reduce ______
- Monitor ______ annually - surgical therapy – elective vs emergency
- Prefer ________
- If ________ – mortality very high
- Open aneurysm repair (OAR)
- Open surgical repair = pt comes back w/ large abdominal incision or dressing over artery entrance site?
- Surgery procedure involves – artery clamped and sew synthetic graft
- endovascular aneurysm repair (EVAR)
- open surgery or performed inside the vessel?
- pt comes back with abdominal incision or dressing over artery entrance site?
- Less or more invasive?
- Similar post op care to cardiac cath – lay flat, don’t bend effected extremity, etc.
which procedure has better morbidity/mortality rates?
Complications
- rupture
Collaborative care
- early detection – know familial tendency
- goal = prevent rupture
- if AAA is small (<4 cm)
- Watchful waiting
- Reduce risk factors (CV risk factors)
- Reduce BP
- Monitor size annually
- surgical therapy – elective vs emergency
- Prefer elective
- If rupture – mortality very high
- Open aneurysm repair (OAR)
- Open surgical repair = pt comes back w/ large abdominal incision
- Surgery procedure involves – artery clamped and sew synthetic graft
- endovascular aneurysm repair (EVAR)
- Not open surgery, performed inside the vessel =
- pt doesn’t come back with abdominal incision, pt comes back with dressing over artery entrance site
- Less invasive
- Similar post op care to cardiac cath – lay flat, don’t bend effected extremity, etc.
- Both procedures have similar morbidity/mortality rates
PAD:Collaborative care
1.modify _______
2.drug therapy
- Statins
- Anti____________
- Anti__________
- Cilostazol – inhibits _________ and increases vaso__________ (1st line drug for __________ if modifying risk factors alone isn’t effective)
- 3.________ exercises
- Walk until pain starts, stop/rest until pain goes away, repeat
- Purpose – increase ________ circulation
- 4.proper foot care
- 5.angioplasty/stenting – minimally invasive
- 6.intervention radiology ________-based procedures
- Alternative to _________
- In cath lab
- Similar to angiography/specialized catheter inserted via femoral artery:
- PTA - Percutaneous transluminal angioplasty (balloon)
- Stents (balloon)
- Atherectomy – plaque removal
- Cryoplasty – PTA + cold therapy
- 7.________ surgery
- 8.amputation
1.modify risk factors
- atherosclerosis
- tobacco
- DM ?
- hyperlipidemia
- uncontrolled HTN
X- familial
- ___creased CRP – non specific indicator of inflammation
- 2.drug therapy
- Statins
- Antihypertensives
- Antiplatelets – ASA
- Cilostazol – inhibits platelet aggregation and increases vasodilation (1st line drug for intermittent claudication if modifying risk factors alone isn’t effective)
- 3.walking exercises
- Walk until pain starts, stop/rest until pain goes away, repeat
- Purpose – increase collateral circulation
- 4.proper foot care
- 5.angioplasty/stenting – minimally invasive
- 6.intervention radiology catheter-based procedures
- Alternative to open surgery
- In cath lab
- Similar to angiography/specialized catheter inserted via femoral artery:
- PTA - Percutaneous transluminal angioplasty (balloon)
- Stents (balloon)
- Atherectomy – plaque removal
- Cryoplasty – PTA + cold therapy
- 7.bypass surgery
- 8.amputation
A fib and A flutter s/s
- depends on
- _________ rate
- how long _______ has been present
- _____ status
- typically, s/s of tachydysrhythmia ***
s/s
- depends on
- ventricular rate
- how long rhythm has been present
- CV status
- typically, s/s of tachydysrhythmia ***
PAD treatment
Types of bypass surgery
- name is based on _______ and _________
- Ex: femoral popliteal bypass “fem-pop bypass”
- Femoral occlusion
- Graft in femoral artery and popliteal artery, bypassing the occlusion
Types of bypass surgery
- name is based on where blockage is and what they are bypassing
- Ex: femoral popliteal bypass “fem-pop bypass”
- Femoral occlusion
- Graft in femoral artery and popliteal artery, bypassing the occlusion
Cor pulmonale
- type of _____HF
- caused by _________
- enlargement of ______ side of heart
Cor pulmonale
- type of RHF
- caused by pulmonary HTN
- enlargement of right side of heart
VTE Risk factors: r/t Venous stasis, Endothelial tissue damage, or hypercoagulability?
- dehydration
- malnutrition
- high altitudes
- oral contraceptives
- pregnancy
- cancer
- tobacco
Risk factors: hypercoagulability of blood
Vfib
Treatment
- CPR
- ACLS
- defibrillation
synch switch turned on or off?
Treatment
- CPR
- ACLS
- defibrillation (synch switch turned off, no QRS)
Atrial fibrillation
- described as “________”
- most common dysrhythmia
- total disorganization of atrial electrical activity d/t ________ ectopic foci firing all at the same time
- this causes loss of effective __________
- atrial isn’t _______, atrial is ___________
- SA is being taken over and is no longer the ________of the heart
- atrial rate > ____ bpm
- ventricular rate up to ____-____ bpm
- R to R intervals are “________ _________”
- prevalence ___creases with age
Atrial fibrillation
“quiver”
- most common dysrhythmia
- total disorganization of atrial electrical activity d/t multiple ectopic foci firing all at the same time = loss of effective atrial contraction/kick (p wave)
- atrial isn’t contracting, atrial is quivering
- SA is being taken over and is no longer the pacemaker of the heart
- atrial rate > 400 bpm
- ventricular rate up to 100-175 bpm
- R to R intervals are irregularly irregular (irregular and erratic)
- prevalence increases with age
Causes of _______
- MI
- CAD
- electrolyte imbalance
- HF
- drug toxicities
VTACH
