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Complex Exam One > Week Three > Flashcards

Week Three Flashcards

(67 cards)

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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
what is seen in the body with hypercalcemia
strengthens contractility shortened ventricular repolarization
26
causes of hypercalcemia
bone tumors hypomagnesemia endocrine disorders excessive intake of Vit D or Ca oral anti-acids
27
management of hypercalcemia
loop diuretics (furosemide 1mg/kg along with NS to maintain body water stability, along with K+ replacement calcitonin (slower) biphophonates hemodialysis
28
hypocalcemia ecg changes
variable brady VTach asystole prolonged QT interval (leads to torsades de pointes)
29
what happens in the body with hypocalcemia
decreases myocardial contractility reduces cardiac output HoTN decreases responsiveness to Digitalis
30
causes of hypocalcemia
post surgical, blood transfusions alkalosis shock mag imbalances
31
what hypocalcemia what precautions do you put the pt on
seizure precautions
32
management of hypocalcemia
oral or IV replacement calcium chloride calcium gluconate (1-2 hr no push)
33
Pacemakers are?
a machine that delivers an electrical current to stimulate depolarization when the normal conduction pathway is damaged (can be temporary or permanent)
34
What would someone need a pacemaker?
symptomatic brady severe asymptomatic brady AV block complete block atrial flutter/AFib with slow ventricular response sick sinus syndrome tachy-Brady syndrome
35
sensing is
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
pacing is
stimulates the heart to contract via myocardial cell depolarization maintains primary control of pacing function of the heart the "firing" action
37
atrial pacing causes what wave
p
38
ventricular pacing causes
QRS complex
39
Biventricular (dual-chamber) pacing you'll see what
pacer spike followed by P wave then another pacer spike followed by QRS complex
40
Transcutaneous Pacemakers
through the skin - pads - only for 24 hours
41
Transvenous Pacemakers
through the vein into heart (RA to RV)
42
Epicardial Pacemaker
on the outside tissue of the heart (surgeries)
43
rate settings on pacemaker
60-80 (dr orders)
44
Output is equal to
milliamperes (mA) how much electrical current is needed to depolarize the heart and capture a rhythm start small
45
sensitivity is equal to
millivolts (mV) the degree to which the pm is response to electrical activity of heart
46
AV interval control
time interval b/w atrial and ventricle pacing stimuli
47
temporary pacemaker care (three types)
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
Permanent Pacemakers Post op care
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
Permanent Pacemakers Patient and Caregiver Teaching
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
Failure to pace
Absence of pacing spikes and return to the underlying rhythm
51
what should you do when there's a failure pace
check connections of pacing wire/extension cable attached to pulse generator check/change battery replace generator unit remove source of electromagnetic interference
52
failure to capture
pacemakers spikes not followed by what they should (p or qrs)
53
what to do when there's a failure to capture
increase mA settings until there's a capture
54
over-sensing
absence of pacing spikes lower sensitivity
55
undersensing
pacing spikes that occur after or are unrelated to the intrinsic rate higher sensitivity setting replace battery reposition leads
56
how will you know a pm is working
increased cardiac output increased BP palpable pulses improved color, temp, LOC
57
defibrillation
unsynchronized shock used to terminate ventricular fibrillation 2 MIN allows SA node to resume pacemaker role
58
output is in what for defibrillation
joules or watts per seconds
59
how many joules do you start with
biphasic: 120 - 200 monophasic: 360 (one)
60
steps to defibrillation
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
do you shock a pulse
no
62
do you shock asystole
no
63
synchronized cardioversion
low energy shock that goes with the R rhythm sync button is on sedate pt 70-75 joules (not 120)
64
rhythms that may be cardioverted
V tach with pulse unstable SVT unstable AFib unstable Aflutter
65
nursing responsibilities for synchronized cardioversion
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
implantable cardioverter-defibrilator (ICD)
lead placed via subclavian vein to endocardium and the generator is placed in the skin (subcutaneously) 25 joules
67
when pt get ICD do they need to take their meds
YES teach to still take meds, ICD is last resort

Complex Exam One (3 decks)

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