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NRSG 421 > Week 6 - CVS and Rhythm interpretation > Flashcards

Week 6 - CVS and Rhythm interpretation Flashcards

1
Q

how is cardiac output calculated?

A

SV (stroke volume) X heart rate

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2
Q

what is the normal CO in a healthy adult at rest?

A

4-8L/ min

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3
Q

increased venous return, ventricle filling and stretching, leads to greater contraction and stroke volume. What is this referring to?

A
  • preload
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4
Q

what can indicate decreased cardiac output?

A
  • narrowed pulse pressure (BP 90/65)
  • bradycardia (HR regular at 52/ min)
  • tachycardia (HR irregular at 180/min)
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5
Q

what does decreased CO mean for the body?

A

bodies demands not being met

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6
Q

what is the range for normal pulse pressure?

A

40-60 mmHg

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7
Q

what is the range for narrow pulse pressure? What does it indicate?

A

<40 mmHg
- HF

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8
Q

what is the range for wide pulse pressure? What does it indicate?

A
  • > 60 mmHg
  • A. Fib
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9
Q

what does low MAP indicate?

A
  • blood loss through sepsis, stroke or bleed
  • HF once ejection fraction is low
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10
Q

what does a high MAP indicate? why?

A

HF due to high pressure in the arteries

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11
Q

describe frank starlings law

A

increased stretch = increased contraction

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12
Q

what causes widening pulse pressure?

A
  • aortic regurgitaiton
  • aortic sclerosis
  • severe anemia
  • arteriosclerosis
  • hyperthyroidism
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13
Q

why does anemia cause widening pulse pressure?

A

reduced blood viscosity

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14
Q

why does arteriosclerosis cause widening pulse pressure?

A

less compliant arteries

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15
Q

why does hyperthyroidism cause widening pulse pressure?

A

increased systolic pressure

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16
Q

what are the different ways you can measure cardiac output (CO)?

A
  • doppler ultrasound
  • fick’ method
  • thermodilution method
  • arterial pulse contour analysis
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17
Q

what is preload?

A
  • volume of blood being returned to the heart
  • heart stretches
  • end diastolic
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18
Q

what is afterload?

A
  • pressure or resistance the heart has to overcome to eject blood
  • heart squeezes
  • systolic
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19
Q

describe cariogenic shock

A
  • life threatening
  • heart unable to pump enough blood to rest of body
  • filling issue
  • heart cannot contract properly
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20
Q

what happens as a result of cariogenic shock?

A

acute hypo perfusion and hypoxia of tissue and organs

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21
Q

if someone is in hypovolemic shock how does preload affect stroke volume?

A
  • increase with fluid
  • SNS activation
  • give vasopressors to increase blood return
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22
Q

if someone is fluid overloaded how does preload affect stroke volume?

A
  • to much pressure in tubes need to get rid of some of the water
  • do this with diuretics and vasodilation
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23
Q

how is after load affected in the right and left side of the heart in regards to vascular resistance? How do you treat it?

A

right
- pulmonary vascular resistance
affects right atrium

left
- systemic vascular resistance
- affects left atrium

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24
Q

how do you decrease after load?

A

vasodilators

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25
how do you increase after load ?
give vasopressors
26
what are conditions that increase vascular resistance for after load?
- pulmonary HTN - valve problems - aortic stenosis
27
heart failure that leads to decreased CO and bodies inability to perfuse tissues. This is referring to what?
shock
28
what are signs and symptoms of left sided HF?
- dyspnea - crackles on auscultation
29
what med is best for a client with heart failure, crackles, pitting edema and needing O2 therapy?
furosemide
30
what medications are used to treat heart failure and fluid overload?
- midodrine - furosemide - amiodarone - captopril
31
what is midodrine?
- vasopressor
32
what does midodrine treat?
- orthostatic hypotension - supine HTN - urinary pruritis - paresthesia
33
what is furosemide?
loop diuretic
34
how does furosemide work?
- blocks Na and K reabsorption - increases fluid elimination - eliminates urine even if blood flow to kidney's is diminished
35
what are things we need to watch for when giving someone furosemide?
- serum K levels - S/S of hypokalemia - hypotension - syncope
36
What is amiodarone?
potassium channel blocker
37
what does amiodarone treat?
- atrial fibrillation - bradycardia - hypotension - thyroid dysfunction - liver toxicity - hypokalemia - hypomagnesium - SOB
38
what is captopril?
ACE inhibitor "pril"
39
what does captopril treat?
- reduce after load that was affected by RAAS - hypokalemia - renal function
40
if someone is taking digoxin and they have A. fib what medication do we need to be careful with? Why
- lasix - potassium can increase the risk of digoxin toxicity
41
what could chest pain indicate in a patient with A. Fib?
- MI - ischemia
42
what is the most accurate way to get a pulse?
auscultate heart
43
what is atrial fibrillation?
- irregular rhythm and pulse deficit - atria are fluttering
44
how can you tell someone has A.Fib during your assessment?
listen to heart and feel pulse at the same time, there will be a difference
45
what is the goal for a pt with A. fib?
assess rhythm and rate control
46
if someone has A. Fib, what do you want to assess for?
- FAST VAN - CHADS
47
what does CHADs stand for?
C - congestive heart failure H - hypertension A - age > 75 yrs D - diabetes S - prior stoke/ TIA
48
what are some risk factors for A. Fib?
- HTN - CAD - valve disease - obesity - DM - alcohol - hyperthyroid - smoking - genetics
49
How do you treat atrial Fibrillation from short to long term interventions in the order of priority
- antiarrhythmics - cardio version - beta blockers - anticoagulants - ablation - pacemaker
50
how do you know if someone has persistent or permanent Atrial fibrillation?
- s/s come and go then Ca builds up and there's scarring - leads to persistent Af - if lasts > 12 months is permanent A. Fib
51
if a patient just had a pulmonary ablation, what do we want to assess after procedure?
- bleeding - pedal pulses - reports chest pain 2/10 - apply pressure prn - supine with HOB < 30 - keep extremities straight
52
if a pt just had a pulmonary ablation, and we are assessing them after the procedure why are we concerned if they have chest pain?
at high risk of cardiac damage or ischemia
53
what are S/S of atrial fibrillation ?
- proximal events - irregular HR <100/min - fluttering - weakness - light headed
54
what can cause SOB in someone with A. Fib?
fluid build up in lungs due to increased irregular rate with exertion
55
what are red flags to watch out for with A. Fib?
- HR >110 - chest pain - SOB - anxiety
56
what is the number 1 thing we want to watch out for in pt's with A. Fib?
chest pain
57
what is the ejection fraction for someone with heart failure?
< 40% (55-65%)
58
what is the ejection fraction for someone with preserved heart failure?
40-50%
59
what medication groups do we want to give patients with heart failure?
- ACE inhibitors - ARBS - beta blockers
60
what does S3 indicate?
- reduced left ventricular ejection - class sign of left ventricular failure
61
when does S4 indicate? What can it result in?
- with reduced compliance of left ventricle - impairs diastolic filling
62
What are worsening signs and symptoms of heart failure?
- crackles - decreased O2 - elevated BNP - low Ejection fraction <50% - edema
63
why is BNP elevated in heart failure?
response to increased intraventricular volume and stretch
64
What do you use to diagnose someone with A. Fib?
- ECG - halter monitor
65
what do you use to diagnose someone with heart failure?
- BNP - ECHO - risk factors
66
what do you use to diagnose someone with fluid overload?
- crackles in lungs - labs - Chest X-Ray
67
when diagnosing someone with A. Fib what would their ECG look like?
- no P wave - irregular R wave intervals
68
when diagnosing someone with heart failure what would their ECHO look like?
- low ejection fraction - enlarged ventricle - altered structure
69
when diagnosing someone with fluid overload what would their labs look like?
- low or normal Na - low Hct - low K - low bun
70
what do inotropic agents do?
increases the force of contraction
71
what do chronotropic agents do what?
increase or decrease heart rate
72
what are some risk factors for hypertension?
- black ethnics - frequent stress - smoking 1 pack of cigarettes/ day - type 2 diabetes
73
what are the signs of hypertension crisis?
- BP 210/ 110 - tachycardia - RR 20 - SpO2 normal
74
what do we want to assess for HTN crisis?
- LOC - Systolic > 180 and or diastolic > 120 - N/V - confusion - seizures
75
what can hypertension crisis cause?
- end organ damage - hemorrhagic stroke - AKI - HF - papilledema
76
how do you treat hypertension crisis?
- IV nitrates - IV antihypertensives - monitor BP - telemetry - urine output
77
describe automaticity
ability of cardiac pacemaker cells to spontaneously initiate an electrical impulse
78
what is automaticity usually done by?
- SA node/ pacemaker
79
describe excitability
ability of cardiac cells to respond to an electrical impulse generate by pacemaker cells of other stimuli
80
when does depolarization occur?
occurs when the cells become electrically excited
81
when does repolarization occur?
occurs when cells return to the resting state
82
what cations are we mostly worried about when it comes to the heart?
- sodium - potassium
83
what happens to cations during deloparization?
sodium rushed into the cells
84
what happens to cations during reloparization?
- potassium leaves cells slower than sodium came in - calcium enters at the beginning or repolarization when potassium is had way out
85
describe conductivity
ability of the cardiac cells to transmit the electrical impulse to adjacent cardiac cells
86
describe contractility
ability of the cardiac cells to shorten in response to electrical stimulation - mechanical event
87
what electrolyte is primarily responsible for contraction?
calcium
88
is it possible to have contraction without depolarization?
no
89
explain the normal cardiac conduction system beginning with the sinus node and ending with the purkinje fibers
- starts in SA node - then sent to AV node - then goes through bundle branches/ purkinje fibers into ventricles
90
what is the pacemaker of the heart?
SA node
91
what is the gatekeeper of the heart? why is it called this?
- AV node - only electrical pathways between the Atari and ventricles
92
what does the P wave represent?
atrial depolarization
93
what does the QRS complex represent?
ventricles depolarizing
94
what does the T wave represent?
ventricles repolarizing
95
what should the P wave look like ?
- round - upright - before QRS
96
what does the PR interval reflect?
depolarization of right and left atria - impulse delay through the AV node/ AV junction
97
what does the ST segment represent?
early repolarization of the ventricles
98
What are the 7 steps of interpreting an ECG rhythm strip?
- determine HR - determine heart rhythm - examine P waves - examine P to QRS ratio - measure the QRS complex - interpret the rhythm/ pt response
99
what do you do if someone is in V. Fib?
- check for pulse - no pulse - call code blue - start chest compressions - ACLS protocol
100
what do you do if someone is in V. Tach?
- check for pulse - if pulse present > electrical or chemical cardio version - no pulse present > begin CPR and follow ACLS protocol
101
How do you know if someone is in controlled A. Fib?
< 100 HR
102
how do you know if someone is in uncontrolled A. Fib?
> 100 HR
103
practice interpreting rhythm strips prof made on word document. Know how to identify: - sinus rhythm - sinus bradycardia - sinus tachycardia -controlled/ uncontrolled A. Fib - ventricular tachycardia - ventricular fibrillation - Asystole
104
what are the interventions for A. Fib/ A-flutter? what does each do?
anticoagulant - prevents clots beta blocker - control rate cardioversion - stops impulses to help SA node take over again digoxin - slows down HR

NRSG 421 (6 decks)

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