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Complex Exam 2
ARDS/TB/Cardiac
| Question | Answer |
|---|---|
| difference between hypoxia and hypercapnia | hypoxia = metabolic acidosis; causes restlessness. Hypercapnia= resp acidosis; causes lethargy |
| Early signs of ARF | restless, tachycardia, anxiety, HTN, dyspnea |
| Intermediate signs of ARF | lethargy, confusion, hypotension, tachypnea |
| Late signs of ARF | cyanosis, coma, resp arrest |
| Diagnosing pneumonia | chest x ray, sputum culture, and ABGs |
| Treatment of pneumonia | antibiotics, bronchodilators, expectorants, oxygen |
| Diagnosing COPD | ABGs, PFTs, Chest x rays |
| Treating COPD | corticosteroids, smoking cessation, oxygen, bronchodilators |
| CPAP and BiPap | CPAP (continuous positive pressure to keep airway from collapsing) BiPap (2 pressure settings for inhalation and exhalation) |
| Meds used with vents | neurocuscular blockers to cause sedation and prevent muscle contraction; eye drops; pain meds (morphine) |
| Weaning off the vent parameters | O2 setting less than 50% and underlying cause of ARF has been corrected |
| ARF | resulting secondary to another condition like COPD or pneumonia |
| ARDS | rapid onset inflammation of the resp tract in response to injury; usually occurs 2-3 days after hospitalization for injury/trauma |
| Signs of ARDS | tachypnea, retractions, cyanosis that does not improve with O2, mental changes, and lungs sounds of rhonchi and crackles |
| Treating ARDS | vent (always), surfactant, steroids, abx, heparin (prevent PE) |
| Nursing interventions for ARDS patients | VS q2h, continuous IV fluids, monitor arterial pressures, VS q 15-30min during weaning trials |
| layers of the heart | epicardium -> myocardium (muscle) -> endocardium with pericardial fluid within the pericardial sac |
| Circulation to the heart | coronary arteries |
| Blood flow through the heart | inferior vena cava -> R atrium -> tricuspid valve -> R ventricle -> pulmonary valve -> pulmonary arteries -> lungs -> pulmonary veins -> L atrium -> bicuspid valve -> L ventricle -> aortic valave -> aorta -> body |
| Electrical conduction of the heart | SA node (pace maker) -> AV node -> bundle of HIS -> perkinje fibers |
| cardiac output | amount of blood pumped in 1 minute |
| preload | the amount the heart expands to fill with blood |
| afterload | the resistance the heart overcome to pump blood out |
| contractility | the elasticity of the heart muscle |
| ACE inhibitors | "-prils" cause decreased vascular resistance by interrupting the angiotension converting process and preventing vasodilation |
| Cardonone | used with V-tach and V-fib |
| S1/S2 heart sounds | S1 (lub) = AV valves closing; S2 (dub) semilunar valves closing |
| increased fluid volume in the body affects preload and afterload how | increasing he preload and afterload; causing increased cardiac workload and decreasing contractility of the heart |
| MI panel | CK-MB (cardiac muscle specific), Troponin (cardiac specific) |
| Normal potassium, sodium, and calcium | 3.5-5.0; 135-145; 8.5-10.0 |
| causes of hypokalemia | GI loss, diuretics, steroid use, tx for DKA (insulin drip) |
| causes of hyperkalemia | medications, renal failure, burn patients |
| ECK changes with hypokalemia | tachycardia; prominent U wave and increased risk of V-tach and V-fib |
| ECG changes with hyperkalemia | bradycardia; peaked T wave; widened QRS complex; prolonged PR interval, and increased risk of cardiac standstill |
| CHD or CVD | impaired blood flow to the coronary arteries; usually caused by arthrosclerosis |
| presentation of women with MI | lower back pain and nausea |
| chronic CVD (ischemic heart disease) | stable angina, silent MI, most common in women |
| acute CVD (coronary syndrome) | unstable angina to MI, most common in men |
| Nitroglycerin | vasodilator; generally used for angina |
| Cardiac history | rheumatic fever (leads to rheumatic heart); use of Viagra/Cialis, use of birth control, use of herbs (gingko/st johns wart, |
| syncope | sinkable episodes |
| claudication | pain in extremities from decreased CO (tx by resting legs) |
| parathesis | blocked blood flow to the area causes tingling/numbness |
| what does the P-wave represent | atrium contracting |
| What does the QRS complex signal represent | ventricular contraction |
| what does the t wave represent | ventricular relaxation |
| steps to analyzing a ECG | 1. HR; 2. regularity; 3. P waves present; 4. P-QRS ratio; 5. interval durations; 6. does it look abnormal/normal |
| Normal sinus rhythm | 60-100; regular; present; 1:1; WDL; normal |
| Sinus arrhythmia | 60-100; irregular; present; 1:1; WDL; normal but irregular |
| causes of sinus arrhythmia | HR fluctuates with resp. (increases with inspiration; decreases with expiration) |
| Sinus tachycardia | 100-150; regular; present; 1:1; WDL; normal but fast |
| causes of sinus tachycardia | normal; anxiety, pain, shock, caffeine, medications, hypoxia |
| treatment of sinus tachycardia | no treatment needed or treat underlying cause |
| sinus bradycardia | <60; regular; present; 1:1; WDL; normal but slow |
| causes of sinus bradycardia | sleep, rest, athletes, MI, meds, acidosis |
| treatment for sinus bradycardia | treat cause; or no treatment needed |
| Sick sinus syndrome | intervals of tachy, brady, fib, and pause |
| causes of SSS | sinus node disease; sinus node injury |
| treatment for SSS | pacemaker placement and medications |
| PAC (premature atrial contraction) | fluctuates; irregular; present; 1:1; prolonged PR interval; heart "skips a beat" and then compensates |
| treatment for PAC | decrease stimuli; no treatment needed |
| causes of PAC | caffeine, strong emotions; drug/alcohol |
| PSVT (paroxysmal supraventricular tachycardia) | 100-280; regular; not visualized; PR not measured; normal but very fast |
| causes of PSVT | fever, sepsis, rheumatic heart, heart disease |
| treatment for PSVT | if symptomatic: vagal maneuver's; medications; pacing; cardioversion |
| A-flutter | 240-360; regular; present; 2-6:1; PR not measured; multiple P waves to 1 QRS complex |
| causes of A-flutter | caffeine, thyrotoxicosis; CHD; PE; anxiety |
| treatment for A-flutter | decrease stimulants; meds; cardiovert |
| A-fib | 300-600; irregular; not present; not measured; no atrial contraction (only shaking), can occur and reoccur suddenly or be chronic |
| causes of A-fib | heart failure, CHD, HTN, hyperthyroid |
| treating A-fib | *anticoagulants; cardiovert (maybe); meds; treat symptoms |
| PVC (premature ventricular contraction) | variable rate; irregular; absent P wave; no PR interval; QRS complex is wide and bizarre; some normal looking rates with irregular QRS mixed in |
| causes of PVC | anxiety, caffeine, drug use, stress; acid-base imbalance |
| treatment of PVC | decrease stimulation; treat symptoms |
| V-tach | 100-250; regular; not visualized, PR not measured; QRS wide and bizzare; no P/T waves visualized and QRS complex comes fast and strange looking **must treat |
| causes of V-tach | MI; valve diseases; anorexia; metabolic disorders; hyperkalemia; drug toxicity |
| treatment for V-tach | cardiovert; decrease HR; medications **must treat; it will progress to V-fib if not treated |
| V-fib | HR not measured; not identifiable rhythm; QRS is bizarre and variable; V-fib is CARDIAC ARREST and needs immediate treatment |
| causes of V-fib | severe MI; drug toxicity; acidosis; metabolic problems; hypo/hyperkalemia |
| treatment for V-fib | CPR and defibrillation |
| first degree block | 60-100; regular; 1:1; prolonged PR; result of injury to AV node/cardiac conduction |
| causes of first degree block | injury to AV node; medication effects |
| treatment for first degree block | no treatment needed |
| third degree heart block | bradycardia; regular P-P and R-R intervals; NO CORRELATION between P waves and QRS complexes; there is a heart conduction problem blocking the impulse to the ventricles |
| causes of third degree heart block | MI; congenital defects; damage to conduction pathway |
| treatment for third degree block | IMMEDIATE pacing; life threatening condition |
| Bundle branch block | result of bundle branch delay; usually asymptomatic; no treatment needed |
| cardioversion | shock delivery that is in rhythm with the patients ECG pattern |
| defibrillation | shock delivery that is emergent and not synchronized to the ECG |
| Pacemaker | pulse generator that provides regular electrical stimulus to the heart for conduction dysrhythmias |
| ICD | implanted defibrillator; delivers shock to the heart based on life-threatening changes in conduction pattern |
| cardiac mapping and ablation | detects cardiac conduction problems and destroy excess electrical impulses |
Created by:
jperrault9941
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