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H & Illness 4: A & C illness > week 5 - Cardiac Disorders: Pump Problems > Flashcards

week 5 - Cardiac Disorders: Pump Problems Flashcards

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1
Q

y98f
9
/./Physical assessment/signs of symptoms of AFIB : bonus what does the symptoms depend on?

A

ventricular rate

assess the pt for fatigue, SOB, weakness, dizziness, anxiety, syncope, palpitations, chest discomfort or pain, and hypotension

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2
Q

what is common in AFIB?

A

recurrence of AF , that is why previous conduction issues can be helpful in developing the plan of care

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3
Q

what are we assessing in terms of psychosocial ?

A

1.those with high ventricular rate can feel anxious
2. increase HR, cardiac output decreases which can relate to dyspnea, a contribution to feelings of anxiety
3.Pt with Chronic AF may have anxiety related to anticoagulation meds and potential emboli development

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4
Q

what does AF classified as
give the description for each below
1.Paroxysmal
2.Persistent
3.Long standing persistent
4.Non valvular

A
  1. when the pt experiences an episode within 7 days that converts back to sinus rhythm
    2.experienced as episodes that occur for longer than 7 days
    3.more than 12 months categorized as long standing persistent
    4.absence of mitral valve disease or repair
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5
Q

Analysis: Analyze Cues and Prioritize Hypotheses
what are the priority collaborative problems for most pts with AFIB?

A
  1. potential for embolus formation due to irregular cardiac rhythm
    2.Potential for HF due to altered conduction pattern
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6
Q

planning and implementation : generate solutions and take actions
how are interventions taken ?

A

depend on the severity of the problem and pt’s response

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7
Q

what is often effective for treating AF?

A

Drug therapy

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8
Q

what is expected outcome ?

A

remain free of embolus formation by restoring regular cardiac conduction

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9
Q

what is our intervention for someone who has AFIB ?

A

restore regular blood flow through the atrium when possible
- correcting the rhythym & controlling the rate of the rhythym restore blood flow
- helps prevent embolus formation and increases cardiac output

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10
Q

the loss of coordinated atrial contractions in AFIB can lead to pooling of blood resulting in

A

clotting

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11
Q

IF PE is suspected

A

remain with the pt, monitor for SOB, chest pain, hypotension

initiate rapid response

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12
Q

When a pt has AFIB what else are they in risk for other than emboli?

A

systemic emboli -> particularly embolic stroke , which may cause severe neurologic impairment or death

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13
Q

true or false.PT with AF who have valvular disease are particularly at risk for venous thromboembolism ( VTE ).

bonus : what is usually the report?

A

Report lower extremity pain and swelling

Anticipate ultrasound of vasculature and initiation of systemic anticoagulation

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14
Q

Because of the unpredictable drug response and many food-drug interactions, laboratory test monitoring (e.g., international normalized ratio [INR]) is required when a patient is taking warfarin.

true or false.

A

true

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15
Q

Because of the problems associated with warfarin, direct oral anticoagulants (DOACs) such as dabigatran, rivaroxaban, apixaban, or edoxaban may be given on a long-term basis to prevent strokes associated with nonvalvular AF.

A

yes this is true

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16
Q

Because of the problems associated with warfarin, direct oral anticoagulants (DOACs) such as dabigatran, rivaroxaban, apixaban, or edoxaban may be given on a long-term basis to prevent strokes associated with nonvalvular AF.because these drugs achieve steady state do we still need a laboratory test?

A

no we do not

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17
Q

what are the two main perfusion requirements

A

strong heart ( pump )
patent arteries ( flow )

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18
Q

If they cause issues on how the blood moves and pumps or the actual structure of the heart , what will be the end result?

A

heart failure

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19
Q

which one is on the right side and left side

A

tricuspid valve - is on the right
mitral valve- in on the left

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20
Q

what are the signs and symptoms of right sided heart failure ( think of big )

A

jugular distension
changes in BP ( high or low )
enlarged liver and spleen
weight gain
anorexia
nausea
polyuria at night
dependent edema

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21
Q

left sided heart failure

A

decreased CO
fatigue, weakness confusion, dizziness

angina, tachycardia, weak peripheral pulses

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22
Q

what happens with urinary during left sided heart failure

A

oliguria during ( day ) + nocturia ( night )

cool extremities

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23
Q

pulmonary congestion what are the signs and symptoms ( this is still left sided heart failure )

A

hacking cough ( worse at night )
dyspnea/breathlessness
crackles/wheezes in lungs
frothy pink-tinged sputum
tachypnea , s3/s4 gallop

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24
Q

fluid overload systemically where do we see it first ?

A

we would see this in the neck ( jugular vein ) - would be very full and elevated

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25
Q

where does congestion go a lot to>

A

-congestion goes a lot in the abdomen - such as the feet ( right sided heart failure ) they do not go forward as well
big drop in the cardiac output

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26
Q

true or false. We usually see the sign of both ( heart functions as a unit )

A

true

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27
Q

what are some diagnostics tests to assess heart function?

A

cxr
12 lead EKG
telemetry
blood work ( troponin , lipids, bnp)
echo
exercise/stress test
angiogram/angioplasty

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28
Q

True or false. PT and INR are not accurate predictors of bleeding time when DOACs are used.

A

true

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29
Q

what is the medication for DOAC that is reversal agent ?

A

dabigatran

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29
Q

Although the risk of bleeding with DOACs are lower, what else is important ?

A

it is important ti be aware of the reversal agents for these medications.

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30
Q

what is ventricular fibrillation ?

A

the result of electrical chaos in the ventricles ( life threatening )

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31
Q

Describe the ventricular fibrillation characteristics

A

there is no cardiac output or pulse and therefore no cerebral myocardial, or systemic perfusiojn

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32
Q

true or false. ventricular fibrillation is rapidly fatal if not successfully ended within 3 to 5 minutes

A

true

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33
Q

what could be a first manifestation of CAD

A

Ventricular FIbrilliation

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34
Q

people with ______ are at great risk for VF

A

Myocardial Infraction

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35
Q

what are the things that can cause Ventricular Fibrilliation

A

Hypokalemia
Hypomagnesemia
Drug theraphy
Rapid supra ventricular tachycardia
shock

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36
Q

Surgery or trauma may also cause VF

A

yes this si true

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37
Q

Interprofessional collaborative care for Ventricular Fibrillation

A

emergency care for VF is critical for survival

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38
Q

What does VF typically looks like when it begins ?

A

the pt becomes faint, immediately loses consiousness, becomes pulseless and apneic ( no breathing ) –> no bp/heart sounds are absent

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39
Q

Resp and metabollic acidosis develop and may cause what ?

A

seizsures can occur

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40
Q

within the minutes , the pupils become fixed and dilated and the skin becomes cold and mottled during a VF

A

yes this is true

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41
Q

Death can result without prompt intervention when it comes to VF

A

yes this is true

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42
Q

what is our priority/intervention for a pt who is having VF

A

The priority is to defibrillate the pt immediately according to ACLs protocol

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43
Q

this would be an intervention to a what type of patient ?: If a defibrillator is not readily available, high-quality CPR must be initiated and continued until the defibrillator arrives. An automated external defibrillator (AED) is frequently used because it is simple for both medical and lay personnel.

A

yes this is true

VF pt

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44
Q

Class I is used for what ?

A

drugs that help control abnormal heartbeats

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45
Q

what are class II meds?

A

beta blockers

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46
Q

what are class III meds ?

A

amiodarone
ibutilide

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47
Q

what are class IV meds?

A

calcium channel blockers such as verapamil, and diltiazem

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48
Q

what treats refractory ventricular arhythmias and a specific type of life threatening arrhythmia called torsades de pointes

A

magnesium sulfate

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49
Q

what is Ventricular Asystole :
Also called , and what is it ?

A

ventricular standstill is the complete absence of any ventricular rhythm

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49
Q

does this undergo Ventricular Asystole : No electrical impulses in the ventricles, and therefore no ventricular depolarization
No QRS complex
No contraction
No cardiac output
No perfusion to the rest of the body

A

yes it does

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50
Q

what would we recognize as a nurse when a pt has ventricular asystole

A

has no pulse, respirations, or blood pressure.

The patient is in full cardiac arrest. In some cases, the sinoatrial (SA) node may continue to fire and depolarize the atria, with only P waves seen on the ECG.

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51
Q

does this fall under recognizing cues : when it comes to a pt who has VA :

the sinus impulses do not conduct to the ventricles, and QRS complexes remain absent. In most cases, the entire conduction system is electrically silent, with no P waves seen on the ECG.

A

yuh

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52
Q

Ventricular asystole usually results from ____________, which may be a consequence of advanced heart failure.
It may also be caused by severe _______ and acidosis. If P waves are seen, asystole is likely because of severe ventricular conduction blocks.

A

myocardial hypoxia
hyperkalemia

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53
Q

pump problems causes altered perfusion
what are our intervention?

A

Optimize Cardiac Output
* Monitor vital signs
Assess peripheral circulation
Administer cardiac medication as
indicated
Assess for therapeutic effect of meds

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54
Q

blood pressure/heart rate/ look at the blood work - look at their potassium
always reassess after giving the drugs

A

yes

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55
Q

what are the fantastic four ( HF with EF<40%)

A

ACE/ARNI
Beta blockes
MRAs
SGLT2 is

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56
Q

what is MRAs

A

mineralcorticioid antagonist sprirolactone

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57
Q

maintain blood vessels
potassium is important
salt is a huge deal - the more salt- the more they retain fluid - try to limit salt

A

yup

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58
Q

aside from optimizing their cardiac output what else do we have to do during a pumping problem ?

A

optimize their nutrition and fluid balace
- maintain healthy weight
-eat a well balanced diet
-be aware of how meds affect k
-1.5-2 liters/day ( all fluids )
-limit salt ( 2-3 grams )

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59
Q

weight gain of 5 lbs/week = too much

A

if they have gained 5 pounds within a week, they need to come to the doctor

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60
Q

acitvity level has to be optimized during a pump problem ?

A

yes this si true

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61
Q

what do we do when optimizing activity level ?

A

encourage pt to stay as active as possible
balance activity and rest
increase activity level gradually ( goal to walk 3x week )
teach pt to recongize when t stop activity
cardiac rehabilitation

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62
Q

encourage pt to stay as active as possible
balance activity and rest
increase activity level gradually ( goal to walk 3x week )
teach pt to recongize when t stop activity
cardiac rehabilitation

what could indicate that a pt may have fluid accumulation?

A

coughing

thing limit activities such as coughing, SOB and ischemia

making ur heart work a little too hard

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63
Q

what is going wrong with valvular heart disease?

A

stenosis :
- when valve opening is narrowed, and blood is restricted from moving forward

regurgitation
-when valve fails to close properly results in blood backflow

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64
Q

valvular heart disease causes what ?

A

rheumatic heart disease, infective endocarditis, MI, Ct disease, bicuspid aortic valve, atherosclerosis of aortic valve

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65
Q

rheumatic heart disease is not as often anymore

A

yes this is true

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66
Q

strep throat is always something to be aware of !

A

yes this is true

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67
Q

what happens during MI

A

circulation is interrupted within the valve, someone had an MI valves cannot

suddenly break that is because of ischemia

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68
Q

true or false. some people are born with this , the older we get, the valve becomes calcified what is it ?

A

true, biscupid aortic valve

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69
Q

what are symptoms ( cues ) for valvular heart disease ?

A

all : heart failure ( L-> R ), fatigue, dyspnea an exertion, orthopnea murmur

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70
Q

what are symptoms for valvular heart disease
mitral

A

Afib, hemoptysis ( MS )

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71
Q

mitral is left side
- flow is damage through that flow, we get back up in the left atrium
and when atrium stretches this undergoes for what ?

A

Afib

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72
Q

what undergoes aortic for valvular heart disease for symptoms

A

angina, syncope, paroxysmal nocturnal dyspnea

73
Q

what is rheumatic fever ?

A

is an inflammatory disease that can develop when strep throat or scarlet fever isnt properly treated

73
Q

what can rheumatic fever affect ?

A

it can affect several connective tissues of the body, especially those of the heart, brain, joints, skin

74
Q

what is a rheumatic heart disease ?

A

chronic condition resulting from rheumatic fever that is characterized by scarring and deformity of the heart valves.

75
Q

A 60-year-old female patient with a history of mitral stenosis presents to the emergency department with complaints of hemoptysis, dyspnea, and fatigue. Which pathophysiological mechanism best explains the occurrence of hemoptysis in this patient?
a. Increased left ventricular pressure
b,Pulmonary hypertension and rupture of bronchial veins
c.Right ventricular failure
d.Decreased pulmonary capillary pressure

A

B

76
Q

for infective endocarditis what type of diagnostic tests are we looking at ?

A

cxr
ecg
encho
angiogram

77
Q

what are the two types of echo

A

transthoracic and transesophageal

two types of endocardiogram

78
Q

pump problem : infective endocarditis
what is a valve complication?

A

a microbial infection ( commonly strep or staph) of the heart valves or endocardial surface of the heart

79
Q

pump problem : infective endocarditis
predisposing conditions :

A

rheumatic heart disease, IVDU, recent valve surgery or dental surgery

80
Q

what might you see with infective endocarditis

A

heart failure
arterial embolization ( fragments of vegetation break off )
fever, malaise, chills
cardiac murmur
anorexia/wt loss

81
Q

what do we often see with infective endocarditis ?

A

we get back flow of blood , most often this affects the left side of the heart and can also be seen in the right side

this type of infection can break of

82
Q

what kind of symptoms would you see if a clot is carried to the kidneys?

A

youd look for decrease urine output, creatine, urea, and less urine being produced

sounds like a kidney injury ( intra-renal )

83
Q

where can vegetation travel to?

A

brain
spleen
kidneys
gi tract
extremities
lungs

84
Q

which side of the heart did the clot most likely originate from ?

A

this would go forward this would indicate left

85
Q

exemplar #1: pump problem : valvular heart disease

non surgical interventions :take action

A

1) balance rest/activity
2)oxygen
3)meds to decrease afterload ( ACEi)
4) meds to decrease preload ,BB,diuretics, digoxin,nitrates
5) monitor for AFIB with MV disease ( can decrease cardiac output )
- dysrhythmic drugs and anti-platelet theraphy ( DOAC)

86
Q

disease from the valve, they are going to be tired because cardiac output has been affected, is this true or false?

A

this is true

87
Q

_____ needs to be stayed away from nitro

A

aortic stenosis
yes, drops it quickly

88
Q

is valvular disease ( stenosis/regurgitation )a flow problem or is it a pump problem

A

this is a pump problem

89
Q

true or false. oxygen - especially during pre-op ( we are going to decrease workload in the heart especially if they have stenosis )

A

true

90
Q

what are the non surgical interventions for valvular heart disease ( stenosis/regurgitation)

A

TAVI ( transcatheter aortic valve implanatation )

TAVR ( transcatheter aortic valve replacement )

91
Q

what is this describing : this is good option for people undergoing heart surgery
do not have to cut through the sternum

A

TAVI

92
Q

infective endocarditis
what are the non surgical interventions : take action

A

monitor for signs of heart failure
long term antimicrobials ( route: iv central line, 4-6 weeks )
treat fever ( acetaminophen or ibuprofen )

93
Q

true or false. anticoagulants do not prevent vegetative thrombus ( only used if pt has prosthetic valve ) when it comes to infective endocarditis

A

true

94
Q

use aseptic technique to protect against infection ( is this true amongst infective endocarditis)

A

yes this is true

95
Q

things that break off vegetation ( anticoagulation doesnt help ) unless they need _______ then it is used

A

valve surgery

96
Q

valvular heart disease ( including endocarditis )
surgical repair interventions: take action

open heart surgery (spare the details )

A

always better to repair than replacement
- this is not part of your body , what happens is ur body starts to develop clotting over top ( platelets try to cover )

97
Q

if repair is not an option then what is nxt ?

A

replacement

98
Q

pump problem : valvular heart disease

mechanical valve characteristics

A

last a long time ( synthetic material )
increased risk of thromboembolism ( lifelong anticoagulation )

99
Q

pump problem : valvular heart disease what is biologic valve

A

constructed from bovine, porcine, human & artificial tissue
low thrombogenicity, less durable can calcify

100
Q

true or false. Failure rate increases after 7-10 years for biologic valve ( valvular heart disease )

A

true

101
Q

true or false biologic valve, valvular heart disease require lifelong anticoagulants

A

false, does not require lifelong anticoagulants

102
Q

valvular heart disease
interventions
pre op care

A

patients will have pre op dental exam ( cavities filled )
- anti coagulant stopped 72 prior to surgery
- teaching regarding life long anticoagulation ( mech valve )

103
Q

post op care : valvular heart disease

A

sterile technique for dressing change ( prevent infection )
cardiac monitoring ( watch for arrythmia )
frequent viral signs ( watch for htn, hypotension,hypothermia)

104
Q

what else should we monitor for post op care for valvular heart diseasemonitor fluid/electrolytes ( especially K )

A

monitor for bleeding/cardiac tamponade/decrease LOC

105
Q

true or false. monitor for angina post op valvular heart disease

A

true

106
Q

what is cardiac tamponade

A

bleeding in the heart sac

107
Q

what is this describing : pressure on the heart- it cannot pump, risk of sudden cardiac output ( drop in BP and , then we would suspect either bleeding )

A

cardiac tamponade

108
Q

evaluate outcomes : pt education
pump problems
what undergoes heart failure

A

pt managed illness
education on s/s, when to report,watching ins and outs
daily weights
fluid restriction
low na diet
diet

109
Q

home oxygen for some and help for smokers when it comes to heart failure

A

yes this is true

110
Q

pump problems : valvular disorders
information for EI or post valve sx

A

avoiding people with infection
good oral hygiene
inform hcp about condition
prophylactic abx before procedures ( dental work )

111
Q

is fatigue is normal after surgery ( information for ei or post valve sx )

pump problems : valvular disorders

A

yes this is true

112
Q

Information for EI or Post valve sx
importance of taking meds ( anticoagulants )

A

true

113
Q

pump problem : cardiomyopathies
chronic disease of cardiac muscle
what are the cause

A

cause : alcohol abuse, chemo , infection, sometimes unknown

114
Q

sometimes the cause is unknown when it comes to cardiomyopathies

A

this is called idiopathic cardiomyopathy

115
Q

what can go wrong with cardiomyopathy

A

dilated - hf, dysrhythmias, emboli, scd

116
Q

in terms of angina, syncope in terms of hypertrophic

A

overdeveloped heart muscles impedes blood flow either to the coronary arteries which would produce angina or it can block the movement of blood out of the ventricles and this can cause syncope related to the cardiac output

117
Q

what can go wrong with cardiomyopathy ? ( hypertrophic )

A

hf, dysrhythmias, emboli, angina, syncope, scd

118
Q

why is dysrhythmias happening during dilated

A

due to change in conduction through this abnormal muscle tissue

119
Q

what is restrictive?

A

rare, dont need to know

120
Q

what is the description of dilated

A

the myocardium becomes weak and thinner so it is not able to contract as well

121
Q

what is the description of hypertrophic

A

the heart muscle becomes thicker and stiffer

have less room for the ventricle to fill with blood

122
Q

what is this describing : disease of the heart muscle produces changes that negatively affect the ability of the heat to pump blood

what are the 3 main types of cardiomyopathies

A

cardiomyopathies
1. dilated
2.hypertrophic
3.restrictive

123
Q

cardiomyopathies
diagnostic tests

A

xray
encho
angiography
ekg

124
Q

xray for cardiomyopathies

A

chest xray check the size of the heart ( cardiac )

125
Q

what does echo check ?

A

how thick - ejection fraction ( how its pumping )

126
Q

angiogram ( describe )

A

coronary perfusion, and inject dye to coronary arteries and look for blockages

127
Q

EKG ( what undergoes it )

A

conduction through abnormal heart function can cause dysrthmias can be picked up by this

128
Q

cardiomyopathies :
_________ is an issue with these pts just because of their weakened _______ and so we can always want to be on the lookout for acutely decompensated heart failure

A

heart failure
weakened heart muscle

129
Q

what is largely seen when the left side becomes too weak ?

A

largely seen as pulmonary edema when the left side becomes too weak that blood starts baking up within the pulmonary circulation .

130
Q

largely seen as pulmonary edema when the left side becomes too weak that blood starts baking up within the pulmonary circulation (what happens after this )?

A

starts to leak out and can go into the lungs, we also have a drop in cardiac output

131
Q

what is the worst case scenario when it comes to cardiomyopathies , is acute decompensated heart failure/scd ?

A

Lasix
Morphine
Nitro
Oxygen
Positioning

132
Q

is this true or false in terms of cardiomyopathies : given in IV reduce pul edema
vasodilation and perfusion to coronary arteries
less anxious and dysnic
tripod position to get fluid sitting in the bottom
( have to be careful for hypertrophic for outflow obstruction so this si increasing cycaped ( aortic stenosis ) narrowed outflow —> dropping preload - make it worst the co
defibrilliate the rhythym ( with code cart or aud )

A

true

133
Q

cardiomyopathies :
interventions

A

HF
dysrhythmias
emboli: anti coagulant
scd: may require icd ( internal cardiac defibrillator )
* no digoxin or nitro with hypertrophic CMO

134
Q

emboli: anti coagulant –> interventions, why is this ?

A

largely correlated to the ejection fraction so if its lower ejection fraction, that means less the heart, more stagnant blood is sitting there and they’re likely at increased risk

135
Q

relay heavily on med related to cardiomyopathy ( things that will decrease workload of heart, weight reduction, block reabsorption of sodium and fluid retention )

A

true

136
Q

what is internal cardiac defibrillator ?

A

the dysrthmias or heart of chage in heart uscles
this is a small device implanted sits under the chest wall ( can see a bump ) or if larger person ( kinda hides it the subcutaneous )

137
Q

true or false. The lead is threaded to pull vein into the right atrium and then into the right ventricle and the it sits increasing how the cardiac muscle is conducting electricity if its sensing a dangerous cardiac rhythm this device will do that automatically and it can potentially save a person who has gone into lethal rhythym

A

true

138
Q

why don’t we use digoxin when u have cardiomyopathies

A

digoxin is big oversized muscle and try to squeeze even harder- worsening cardiac muscle with every beats. stops blood flow, the effect is made worst.

139
Q

pump problem : pericarditis
causes :

A

idiopathic, bacterial, viral, autoimmune disease, radiation, post mi

140
Q

what do we recognize during pericarditis

A

recognize during pericarditis
sharp chest pain, radiates to l neck/shoulder/back and increase with respiration

pain worse when lying supine relieved by sitting forward

141
Q

what type of temp would we see in pericarditis

A

increased temp, increased wbcs

142
Q

what is a hallmark sign of pericarditis

A

pericardial friction rub

143
Q

pericarditis : ekg what do we recognize in terms of cue

A

st elevation in all leads

144
Q

what is this describing : two layers of the myocardium rubbing together ( two pieces of leather together surrounding and high pitch)

A

pericardial friction rub

145
Q

pericarditis
what type of diagnostics do we utilize

A

ecg
cxr
echo
ct or mri of the heart
labs : crp, esr, wbc, urea, crea, troponin

146
Q

what could we see with ecg ?
cxr?
echo ?
ct or mri ?

A

might see widespread of st elevation
enlargement of heart
echo tells us how bad it is ( ejection fraction )
detail task of function

147
Q

what can we see with this : * Labs: CRP, ESR, WBC, Urea, Crea, Troponin

A

crp and esr are inflammation
urea and creatinine ( kidney )
uremic pericarditis ( end stage of chronic kidney disease )

148
Q

pericarditis, what are some potential complications ?

A

pericardial effusion
cardiac tamponade

149
Q

recall that pericardial effusion and cardiac tamponade are potential complications of pericarditis, what does this mean ?start off with cardiac tamponade

A

blood coming into the heart if its rstricted starts backing up compensating because of fluid surrounding the heart ( drop is systolic pressure in each inspiration )

150
Q

signs and symptoms of cardiac tamponade as a potential complication of pericarditits

A

increase in jvp
tachycardia/hypotension
muffled heart sounds
pulsus paradoxus ( drop in systolic bp with inspiration

151
Q

what are our interventions for pericardititis

A

correct underlying problem ( treat infection, hemodialysis for uremic cause )

manage pain ( high dose anti inflammatories ( nsaids )- monitor for gi bleeds

152
Q

as our intervention what type of position are we going to put the pt in when we have to take action for pericarditis

A

sit upright and lean forward sightly

153
Q

what do we have to monitor for when they have pericarditis ?

A

monitor for indications of tamponade ( excessive fluid in pericardial sac )

154
Q

true or false. its important for us to watch for pt’s stool colors or trending hemoglobin to check if its dripping down

A

yes this is true when it comes to pericarditis because they could be at risk for gi bleeds to manage pain give them nsaids

155
Q

how does pericardiocentesis work?

A

usually under the ultrasound will insert the needle into the pericardial sac and possibly provide some freezing with the lidocaine and then aspirate the fluid to hopefully decrease the pressure on the heart and improve co

156
Q

what is sinus rhythm, sinus tachycardia, atrial fibrillation

A

sinus rhythym - normal conduction generally generated by SA node

sinus tatchycardia - looks exactly sinus rhythym ( but this is faster )

atrial fibrilliation - not emptying , increase risk of developing clots ( not equally spaced )

157
Q

what is amiodarone?

A

potassium channel blocker

158
Q

what is the mechanism of action of amiodarone ?

A

prolongs the effective refractory period ( erp is time during which cell unable to respond to excitation and to initiate a new action potential )

159
Q

what are additional cardiac effects of amiodarone ?

A

decrease SA automaticity, decrease contractility, decrease AV conduction

160
Q

what are some adverse effects for amiodaronen?

A

increase in arrhythmias, pulmonary toxicity, thyroid toxicity, liver toxicity

161
Q

pacemakers are made up of two basic parts : what are they ?

A

generator ( called battery sometimes ) , and one or more wire called leads

162
Q

true or false. the generator contains the battery, important wiring and the computer that make the pacemaker work properly. The leads are special wires that are attached on one end to the generator and the other end is attached to a spot inside your heart

A

true

163
Q

what is a pace spiker ?

A

indicate when the pacer turns on and paces beats ( tiny beats shows up )

164
Q

cardiac dysrhythmias : VFIB
a. no cerebral myocardial
b. no systemic perfusion
c.no BP, with breaths, no heart sounds, responsive

A

a and b are correct but c is wrong there is no breathing within the pt and unresponsive

165
Q

what is our priority in a vfib pt ?

A

defibrillate pt ( cpr until defib is available )

code blue needed ( would follow acls guidelines )

166
Q

is this true amongst VFIB: what do we do ?
establish wehther they have pulse ( some pt have pulse int ehse situations antiatrerthias adminsiter or cardio version intra shock oto get them into sinus
fib no blood pressure no nothing brain is not being perfused —> alarm will go off if they have monitor
on ward - suddenly loses conciousness ( immediatey take a pulse, and call code blue ) start cpr ( dleiver shock ) into the rhythym

A

yes this is true

167
Q

Hypovolemia

Hypoxemia

Hydrogen ion (acidosis)

Hypo/hyperkalemia

Hypothermia

Tension pneumothorax

Tamponade, cardiac

Toxins

Thrombosis, pulmonary

Thrombosis, coronary

are these reversable causes of VFIB ?

A

yes

168
Q

refer to pre ventricular contraction, ventricular tatchycardia on the slides ( slide 49)

A

yep

169
Q

what is a defibrillation?

A

the passage of DC ( direct current ) electrical shock through the heart depolarizes the cells of the myocardium

170
Q

what is the most effect way to terminate V fib and pulseless VT ?

A

defibrillation

171
Q

true or false shock is delivered as soon as possible following rhythm change ( no time for sedation ) is this true amongst defibrillation?

A

yes this is true

172
Q

where is the electrodes placed ? on defibrilliation?

A

patient’s chest

173
Q

true or false. vital signs are monitored throughout the defibrillation

A

yep

174
Q

what is this describing : involve delivering an electrical current through the heart and depolarizing or resetting the cells of the myocardium.

the shock is delivered through either pads paddles and we place on on paddle on top above the heart an the other below the heart and the current move between the pads or paddles starting at the top and moving down just like a normal electrical beat this is the best way.

A

defibrillation

175
Q

what is this describing : we want to do this as soon as possible because we know that time is muscle and the longer a pt is without perfusion the more damage that can occur to tissue in the body.

A

defibrillation

176
Q

true or false. when the pads are place on the pt try to deliever the current

bonus : why is it important to make sure that no one is touching the bed ?

A

true

its important because they are they could potentially be shocked as well and a shock is very good at getting someone of a dangerous rhythm but it could also put a person into a normal rhythm into a dangerous rhythm by resetting or interrupting the normal electrical flow through the heart.

177
Q

cardiac dysrhythmias : asystole

A

complete absence of any ventricular rhythym.

no electrical impulses in the ventricles, no QRS, no contraction, no CO, and no perfusion to the rest of the body

178
Q

what is the code blue during cardiac dysrhythmias:asystole

A

CPR + epinephrine, no defibrillation warranted

179
Q

In terms of a patient who has AFIB : what undergoes assessment and recognizing cues

A

1.Assess for prior history of AF or other dysrhythmias
2. Assess for history of cardiovascular disease

180
Q

what is common in AFIB?

A

recurrence of AF , this is why previous conduction issues cna be helpdul

H & Illness 4: A & C illness (20 decks)

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