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Complex Exam One > Week Three > Flashcards

Week Three Flashcards

1
Q

What does K+ do in the body?

A

conduction velocity
helps to confine pacing activity to the SA node

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2
Q

Potassium value

A

3.5-5

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3
Q

Hyperkalemia (>5) ECG changes

A

tall, peak T wave
PVCs* that lead to VFib, that lead to cardiac standstill
prolonged P waves and PRI
flattened P waves or loss of P wave

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4
Q

Causes Of Hyperkalemia

A

excess K+ admin
K+ sparing diuretics
ACEI
ARB drugs
renal failure
acidosis

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5
Q

What hyperkalemia does to the body

A

decreases rate of ventricular depolarization (slows)
shortens repolarization (accelerates)
depresses AV conduction

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6
Q

Management
of
hyperkalemia

A

D50W and Insulin drip (forces K+ into cells so kidneys can filter out) (fast method)
Calcium Chloride ( temporary)
Kayexalate (cation exchange resin products into GI tract) (permanent)
Hemodialysis or Peritoneal dialysis

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7
Q

Hypokalemia (<3.5) ECG changes

A

PVCs, brady, ventricular tachy, (into VFib)
depressed T waves, inverted T waves, ST depression
U waves
2 and 3 degree heart blocks `

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8
Q

How does Hypokalemia effect the body

A

impairs myocardial conduction
prolongs ventricular repolarization

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9
Q

Causes of Hypokalemia

A

GI losses
renal dysfunction
alkalosis
diuretic therapy with insufficient replacement (LASIX)
chronic steroid therapy

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10
Q

Management of Hypokalemia

A

K+ replacement (10 meq per hour) THAT’S IT
high alert med
NEVER PUSH
monitor for phlebitis

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11
Q

What do you need to fix first hypomagnesium or hypokalemia

A

mag because that’s where K+ binds to

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12
Q

Magnesium values

A

1.3-2.4

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13
Q

Magnesium in the body

A

energy producer
essential for enzyme, protein, lipid, and carbs functions in the body
extracellular level essential for normal cardiac muscle function

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14
Q

Hypermagnesemia (>2.4) ECG Changes

A

rare
PCVs leading to VTach, leading to VFib
tall peak T waves
prolonged P waves and PRI
flattened P waves

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15
Q

Causes of Hypermag

A

renal dysfunction
tumor lysis syndrome (cancer)
overtreatment of low Mag levels

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16
Q

Treatment of Hypermag

A

IV calcium gluconate
Furosemide (Lasix)
hemodialysis

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17
Q

Hypomagnesemia (<1.3) ECG changes

A

prolonged PR and QT
presence of U waves
T wave flattening
widened QRS complex

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18
Q

What happens to the body in hypomag

A

impairs myocardial conduction
prolongs ventricular repolarization

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19
Q

causes of hypomag

A

insufficient intake
alcohol abuse
diuresis/diarrhea/ vomiting
rapid administration of citrated blood products (trauma from surgery)
-citrated binds to mag and pulls it out of the blood

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20
Q

Hypomag can lead to what rhythm?

A

torsades de pointes (sudden death, artery spasms, HTN)

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21
Q

management of hypomag

A

no pulse: 1-2 g in 10 mL D5W over 5-20 min
pulse: 1-2g over 5-60 min

evaluate renal function when administering Mg++

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22
Q

Calcium Levels

A

total: 8.5-10.5
ionized: 4.4-5.4

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23
Q

Functions of Calcium

A

vascular tone
myocardial contractility
cardiac excitability

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24
Q

hypercalcemia ecg changes

A

shortened QT interval
brady
heart block, BBB

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25
Q

what is seen in the body with hypercalcemia

A

strengthens contractility
shortened ventricular repolarization

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26
Q

causes of hypercalcemia

A

bone tumors
hypomagnesemia
endocrine disorders
excessive intake of Vit D or Ca
oral anti-acids

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27
Q

management of hypercalcemia

A

loop diuretics (furosemide 1mg/kg along with NS to maintain body water stability, along with K+ replacement
calcitonin (slower)
biphophonates
hemodialysis

28
Q

hypocalcemia ecg changes

A

variable
brady
VTach
asystole
prolonged QT interval (leads to torsades de pointes)

29
Q

what happens in the body with hypocalcemia

A

decreases myocardial contractility
reduces cardiac output
HoTN
decreases responsiveness to Digitalis

30
Q

causes of hypocalcemia

A

post surgical, blood transfusions
alkalosis
shock
mag imbalances

31
Q

what hypocalcemia what precautions do you put the pt on

A

seizure precautions

32
Q

management of hypocalcemia

A

oral or IV replacement
calcium chloride
calcium gluconate (1-2 hr no push)

33
Q

Pacemakers are?

A

a machine that delivers an electrical current to stimulate depolarization when the normal conduction pathway is damaged (can be temporary or permanent)

34
Q

What would someone need a pacemaker?

A

symptomatic brady
severe asymptomatic brady
AV block
complete block
atrial flutter/AFib with slow ventricular response
sick sinus syndrome
tachy-Brady syndrome

35
Q

sensing is

A

the ability to detect or see the patient’s intrinsic heart rhythm (cardiac depolarization)
if the rate is not where it needs to be it will cause the pacemaker to fire

36
Q

pacing is

A

stimulates the heart to contract via myocardial cell depolarization
maintains primary control of pacing function of the heart
the “firing” action

37
Q

atrial pacing causes what wave

A

p

38
Q

ventricular pacing causes

A

QRS complex

39
Q

Biventricular (dual-chamber) pacing you’ll see what

A

pacer spike followed by P wave then another pacer spike followed by QRS complex

40
Q

Transcutaneous Pacemakers

A

through the skin - pads - only for 24 hours

41
Q

Transvenous Pacemakers

A

through the vein into heart (RA to RV)

42
Q

Epicardial Pacemaker

A

on the outside tissue of the heart (surgeries)

43
Q

rate settings on pacemaker

A

60-80 (dr orders)

44
Q

Output is equal to

A

milliamperes (mA)
how much electrical current is needed to depolarize the heart and capture a rhythm
start small

45
Q

sensitivity is equal to

A

millivolts (mV)
the degree to which the pm is response to electrical activity of heart

46
Q

AV interval control

A

time interval b/w atrial and ventricle pacing stimuli

47
Q

temporary pacemaker care (three types)

A

avoiding shocking things that you don’t want to shock
wear gloves
cover wires
make sure you’re not burning the skin (use gel)
change transcutaneous pads 24 hours
put a new battery in the machine
check for loose connections
monitor for infections (drainage, redness, edema)

48
Q

Permanent Pacemakers Post op care

A

OOB once stable
limit arm and shoulder activity
monitor insertion site for bleeding and infection
patient teaching important
watch for complications (infection, hematoma formation, pneumothorax, atrial or ventricular septum perforation, lead misplacement)

49
Q

Permanent Pacemakers Patient and Caregiver Teaching

A

follow up app for pm function checks
incision care
arm restrictions
avoid direct blows
avoid high output generators
no MRI unless approved
microwaves ok
avoid antitheft devices
air travel
monitor pulse
pacemaker ID and medic alert ID

50
Q

Failure to pace

A

Absence of pacing spikes and return to the underlying rhythm

51
Q

what should you do when there’s a failure pace

A

check connections of pacing wire/extension cable attached to pulse generator
check/change battery
replace generator unit
remove source of electromagnetic interference

52
Q

failure to capture

A

pacemakers spikes not followed by what they should (p or qrs)

53
Q

what to do when there’s a failure to capture

A

increase mA settings until there’s a capture

54
Q

over-sensing

A

absence of pacing spikes
lower sensitivity

55
Q

undersensing

A

pacing spikes that occur after or are unrelated to the intrinsic rate
higher sensitivity setting
replace battery
reposition leads

56
Q

how will you know a pm is working

A

increased cardiac output
increased BP
palpable pulses
improved color, temp, LOC

57
Q

defibrillation

A

unsynchronized shock used to terminate ventricular fibrillation
2 MIN
allows SA node to resume pacemaker role

58
Q

output is in what for defibrillation

A

joules or watts per seconds

59
Q

how many joules do you start with

A

biphasic: 120 - 200
monophasic: 360 (one)

60
Q

steps to defibrillation

A

start CPR while the defibrillator is getting set up
turn on and select energy
make sure sync is turned off (that’s for pacing)
apply gel pads
charge
put paddles on chest and make sure no one is touching the body
deliver charge

61
Q

do you shock a pulse

A

no

62
Q

do you shock asystole

A

no

63
Q

synchronized cardioversion

A

low energy shock that goes with the R rhythm
sync button is on
sedate pt
70-75 joules (not 120)

64
Q

rhythms that may be cardioverted

A

V tach with pulse
unstable SVT
unstable AFib
unstable Aflutter

65
Q

nursing responsibilities for synchronized cardioversion

A

informed consent
NPO 6-12 hours
baseline 12 lead
O2 and BP monitoring
sedation as ordered
check that the cardiovertor is sensing like it should
document ( synchronized cardioversion, rhythm before and after, meds given, joules used, pt tolerance)

66
Q

implantable cardioverter-defibrilator (ICD)

A

lead placed via subclavian vein to endocardium and the generator is placed in the skin (subcutaneously)
25 joules

67
Q

when pt get ICD do they need to take their meds

A

YES teach to still take meds, ICD is last resort

Complex Exam One (3 decks)

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