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Meg Surg 155-02 > Week 7 Study Guide > Flashcards

Week 7 Study Guide Flashcards

1
Q

General Assessment: Tachycardia/Bradycardia

A

-Tachycardia is normal with exertion and exercise but abnormal at rest
-Could indicate weak heart muscle, pain, fever, inadequate fluid volume

-Bradycardia at rest can be normal in those with good physical condition.
- Can also indicate low CO, be aware of dizziness, SOB, chest pain

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2
Q

General Assessment: Blood pressure

A
  • Reflection of the pressures generated during cardiac cycle.
    *Postural hypotension can be indicative of poor CO or decreased blood volume
  • Influencing factors: amount of blood ejected during systole or CO, resistance to flow in the peripheral vessels, or peripheral vascular resistance
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3
Q

General Assessment: Poor Peripheral Perfusion

A

Can be noted by pallor (light) or cyanosis (blueish grey) and capillary refill

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4
Q

General Assessment: Edema

A
  • Can indicate a heart problem when it is noted bilaterally (affecting two sides).
  • Can be a sign of cardiac or liver issues.
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5
Q

General Assessment: Gender- related concerns

A
  • For awhile it was considered difficult, time consuming, and not worth it to research/investigate problems equally for men and women
  • Research was based off of men and then assumed to be the same for women.
  • Heart attack: Men S&S= crushing chest pain, radiation down left arm and back. Women S&S= indigestion, jaw pain, fatigue, SOB
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6
Q

General Assessment: Age-related Changes

A
  • Stenosis, stiffening of arterial walls, and fibrotic changes of heart chambers can result in hypertension
  • Atherosclerosis (buildup of fats and cholesterol on artery wall) plagues, narrowing of arterial walls can increase the risk of stroke and MI.
  • Heart diseases is #1 cause of death in older adults.
  • Physical deconditioning can result in atrophy of left ventricle, decreased elasticity of the aorta, rigidity of the valves
  • Common cardiovascular age-related changes: hypertension, coronary artery disease, congestive heart failure, aFib.
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7
Q

Labs: Brain Natriuretic Peptide (BPN)

A
  • Less than 100 pg/mL
  • measures degree of stretch in the ventricles- indicates heart failure
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8
Q

Labs: Cardiac Panel

A
  • Contains CK (creatine kinase), CKMB (creatine kinase myocardial bands 0-3 ng/mL), *TROPONIN (< 0.4 ng/mL) (order from least specific to most specific for heart damage, opposite for speed)
  • Troponin is specific to heart damage.
  • “Serial cardiac panels”: several in a row to determine trends. Usually drawn q4 hrs.
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9
Q

Procedure: Stress Testing

A
  • Evaluating the heart function during increased workload
  • No eating or drinking for 4 hours before procedure, no smoking, no caffeine.
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10
Q

Procedure: Angiography & Catheterization

A
  • Advancing catheter through the radial or femoral artery to the heart to directly visualization the vessels of the heart and remove any blockages.
  • Risks: Infection & bleeding, clot formation, dysrhythmias
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11
Q

Procedure: Pacemaker Placement

A
  • Surgically implanted device under the skin, near the collarbone to generate electrical signals for the heart
  • After surgery: Avoid lifting L arm above shoulder level, keep arm in sling as ordered, no lifting > 5 lbs, monitor for infection, avoid magnetic fields (heavy duty electrical equipment, radio towers), take pulse at least once daily. Usually inserted to treat low heart rate.
  • Other considerations: medical-alert bracelet and carry pacemaker information card, report pulses < pacemaker set rate, report and cardiac issues to primary care provider (PCP)
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12
Q

Cardioversion

A
  • Used to electrically correct arrhythmias
  • Synchronized shock at peak of R wave of QRS complex.
  • Patient is awake and aware: shocking is painful. Treat with with anxiolytics, sedatives, or pain meds prior if possible.
  • Pads placed anterior/posterior on clean, dry, hair-free skin
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13
Q

Defibrillation

A
  • Unsynchronized shock that resets a non-perfusing rhythm and brings back a stable, perfusing rhythm
  • Used on pulseless patients (cardiac arrest)
  • Pads placed on anterior/posterior on clean,, dry, hair-free skin
  • Steps in defibrillation: turn on machine, place the paddles/pads select energy level, ALL CLEAR, deliver shock
  • AED is similar, choose energy, announces on its own all clear, delivers shock automatically
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14
Q

Transcutaneous Pacing

A
  • Using the same pads of our defibrillator machines to provide external pacemaking triggers to a patients heart
  • Typically used for symptomatic bradycardia and heart blocks
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15
Q

Telemetry

A
  • Constant monitoring of rhythm with a 5-lead EKG monitor.
  • Provides rate and rhythm information, but not detailed electrical and conduction information like a 12-lead EKG
  • Nurse delegates to a tele tech (CNA with training)
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16
Q

EKG

A
  • 12-lead snapshot of the heart. A quick picture of the electrical conduction of the entire heart from multiple ‘angles’
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17
Q

EKG Interpretation: Normal Sinus Rhythm

A
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18
Q

Pulseless Electrical Activity

A
  • Electrical system working fine at the moment, but the heart isn’t responding to it
  • Potential causes: hypoxia, hypovolemia, altered potassium levels, Tamponade, MI
  • Cardiac arrest, no pulse> CPR, Epinephrine, treat underlying cause
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19
Q

Asystole “Flatline”

A
  • Flat line of electrical activity (no electrical activity)
  • Can we defibrillate this rhythm? No.
  • Provide CPR
20
Q

Sinus Bradycardia

A
  • NSR that is slower than 60 BPM
  • Asymptomatic= monitor but it can be normal in athletes & sleep
  • Symptomatic= give atropine, transcutaneous pacing, or place a pacemaker
21
Q

Sinus Tachycardia

A
  • NSR that is faster than 100 BPM
  • Treat underlying causes: infection, caffeine, exercise, anxiety, certain drugs, fever
  • Beta blockers or calcium channel blockers can be given to reduce the rate
22
Q

Premature Atrial Contractions (PACs)

A
  • Non-life-threatening out-of-rhythm beat when the atria cause a full contraction. After PAC, normal conduction returns
  • Causes: stimulant ingestion (caffeine, illegal drugs), CAD, Hypoxia
  • Treatment:
23
Q

Atrial Fibrillation

A
  • No P-waves, atria just quivering, fibrillation
  • AV node gets chaotic signals, transmits some of them down the line to ventricles. Less than 100 bpm (controlled A-fib.), Greater than 100 bpm (noncontrolled a-fib).
  • Causes: age, cardiomyopathy, pericarditis, valve disease, obesity, diabetes, CAD
  • Complications: clot formation & loss of atrial kick (reduces pts. cardiac output)
  • ## Treatment: Controlled <100 bpm= rhythm control with medications or cardioversion. Uncontrolled >100 bpm= first control rate, then rhythm control
24
Q

Atrial Flutter (Aflutter)

A
  • Not driven by SA node= no P wave. Flutter waves (F waves) with sawtooth pattern waves between QRS complexes
  • More symptoms than Afib: hypotension, dizziness, lightheadedness, fainting, feeling palpitations
  • Treatment, same as Afib: rate control, rhythm control with meds or cardioversion
25
Q

Supraventricular Tachycardia (SVT)

A
  • Rapid heart rhythm, narrow QRS complex (150-250 bpm)
  • Can be symptomatic or asymptomatic
  • Symptoms: hypotension, dizziness, fainting, palpations, anxiety- heart disease/failure, a lot of caffeine/alcohol, lung disease
  • Treatment: slow down HR with vasovagal maneuvers, administer Adenosine, cardioversion
    *Adenosine= FUN, fast push medication that causes a brief period of asystole (flat line 3-4 sec.) before recapture and slowed HR. Ensure a transcutaneous pacemaker, a DR. and code card is on hand.
26
Q

Vasovagal Maneuvers

A
  1. Sit/ lie down
  2. Take a deep breath and hold it
  3. Pinch nose shut
  4. Close your mouth
  5. Bear down hard as if trying to pass a BM
27
Q

Premature Ventricular Contractions (PVCs)

A
  • Wide, weird-looking QRS complexes that fire randomly from within the ventricles themselves
    -Like PACs, a brief pause at the end allows normal electrical conduction to happen after
    -Only concerning when frequent or semi-rhythmic -> bigeminy, trigeminy, couplets
    -After 3 PVCs in a row, we are V-tach
    -Causes: typically stimulant usage, electrolyte issues, hypoxia, MI, HTN
    -Treatment: fix underlying causes and potentially use anti-arrhythmic
28
Q

Ventricular Tachycardia (Vtach, VT)

A
  • Wide, weird-looking QRS complexes, all the time
  • Potential causes: altered potassium
  • CHECK A PULSE FIRST
29
Q

Ventricular Fibrillation (V-fib, VF)

A
  • Pure chaos, non-perfusing (no blood moving), LETHAL
  • Potential causes: altered potassium levels, toxins,
30
Q

1st Degree Heart Block

A
  • NSR with a long PR interval (time between P wave and QRS complex)
  • Caused by a delay in conduction in the AV node
31
Q

2nd Degree Heart Block

A
  • ## NSR with an increasing PR interval until a beat drops (longer, longer, longer, drop)
32
Q

2nd Degree Type 2 Heart Block

A
  • NSR with a regular/normal PR interval until a random beat drops.
33
Q

3rd Degree Heart Block (complete heart block)

A
  • No communication between atria and ventricles- completely
34
Q

Medication: Atropine

A
  • When to use:
    -What the do:
  • Way they work:
35
Q

Dysrhythmia Synmptoms

A
  • VS changes = drop related to cardiac output decreases
  • LoC changes
  • Chest pain
36
Q
  1. S3 Ventricular Gallop
  2. S4 Atrial Gallop
A
    • Ventricular dysfunction when heard in adults
    • Gallop-like sounds
    • Early diastole
    • Decreased ventricular compliance
    • Gallop like sounds
    • Late diastole after atrial systole
37
Q
  1. Systolic Murmur
  2. Diastolic Murmur
A
    • Valvular disease such as aortic stenosis
    • Turbulent flow heard
    • Systole between S1 and S2
    • Valvular disease such as aortic or pulmonic
      regurgitation
    • Turbulent flow heard
    • Diastole after S2
38
Q
  1. Click
  2. Friction Rub
A
    • Mitral valve stenosis
    • High-pitched sound
    • Early diastole
    • Pericarditis
    • Harsh, scratching sound
    • Anywhere during the cardiac cycle
39
Q

1.Systole (Contraction)=

2.Diastole (Relaxation) =

3.Stroke Volume=

4.Contractility=

A

1-the squeeze that moves the blood out of the ventricles. “Pumping part of the pump”.

2-Allows blood to fill up the ventricles. Myocardial tissue perfusion happens.

3-amount of blood ejected from ventricles with each contraction of heat

4- the force of the ‘squeeze’ that the heart produces

40
Q
  1. Preload=
  2. Afterload=
A

1- amount of blood in the ventricles at the end of diastole
*Increased in: hypervolemia, regurgitation of cardiac valves, heart failure

2- Resistance that the left ventricle must overcome to circulate blood (push it OUT).
*Increased in: Hypertension and cardiac output, vasoconstriction

41
Q

Heart Electric Pathway

A

SA Node -> atrial myocardium causing contraction (inter-nodal pathway) -> AV Node (impulse is delayed) -> Bundle of His -> Branches into the R and L (branches even further), branches -> Purkinje fibers of each ventricle -> ventricle contraction

42
Q

Inherent Rates of the Conduction System

A
  • Sinoatrial node (SA node) = 60-100 bpm [default]
  • Atrioventricular node (AV node) = 40-60 bpm [AV takes over when SA isn’t working]
    Ventricular pacemaker cells = 20-40 bpm
    Purkinje fibers = 20 bpm
43
Q

EKG Basics and their Associations

P Wave

QRS Complex

T Wave

A
  • P Wave: ATRIAL DEPOLARIZATION produced by the SA node through atria. Atria contract milliseconds after depolarization.
  • QRS Complex: VENTRICULAR DEPOLARIZATION. Ventricular contraction occurs after QRS complex in the ST segment.
  • T Wave: VENTRICULAR REPOLARIZATION. Atrial repolarization occurs during ventricular contraction.
44
Q

Cardiac Output = HR x SV

A
  • SV effected by Preload: Increased preload increases stroke volume. Too full decreases the contraction which decreases CO.
  • SV effected by Afterload: Hypertension is implicated by increased afterload which decreases stroke volume.
  • SV affected by Contractility: Contraction can increase with stimulation or calcium release. Decrease from hypoxia or acidosis. Increase contractility can increase SV
45
Q

RAAS (Renin - Angiotensin - Aldosterone System)

A
  • Activated by low blood pressure noted by baroreceptors
  • RAAS increases blood pressure by causing vasoconstriction, telling the kidneys to increase sodium reabsorption
46
Q

Cardiac Monitoring

A
  • EKG, telemetry, cardioversion/defibrillation units
  • Skin must be clean, dry, and hair-free for good conduction

Meg Surg 155-02 (5 decks)

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