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Cardiac Chapters
lots of cardiac, rhythms, how to read ekgs
| Question | Answer |
|---|---|
| Formula for Cardiac Output | Cardiac Output= SV X HR |
| Risk Factors for Cardiovascular Disease | Smoking, Obesity, Stress, Sedintary, Diabetes, Male, Age |
| S/S of CVD | angina, dyspnea, fatigue, palpitations, sudden weight gain, pain, cramps, syncope |
| Define: Syncope | Fainting |
| Nurse assessment for CVD | skin color, VS, edema, JVD, ausculatation of heart |
| How many directions does blood flow? | one direction |
| What % of blood is dumped when a valve is opened? | 70% |
| What is the 2 most important parts of the heart? | ventricles and the "left side" |
| What is the normal pulmonary pressure of the heart? | 20/10 |
| What does the "lubb-dupp" sound indicate? | the valves opening and blood rushing through |
| S/S of pulmonary edema? | JVD, crackles, SOB, dyspnea |
| Pulmonary edema = ____ Pressure, ___ Volume | High, High |
| Rx to decrease pressure/volume | diuretics |
| Define: Vascular disease | disease of the valves when the valves won't open to allow blood to flow, causing high pressure to open the valves |
| What does the heart need in order to function? | oxygen and blood |
| What are the 2 arteries that branch off the aortic valve? | Left/Right Coronary Arteries |
| Define: Collateral Circulation | improves circulation by finding new pathways around a heart blockage by forming new branches of arteries |
| What occurs is the left main artery, "widow artery" is blocked? | DEATH |
| What does the posterior descending artery feed? | muscles of the body the posterior heart |
| What mineral is inside a cell? | Potassium, (K+) |
| What mineral is outside a cell? | Sodium, (Na+) |
| During depolarization what does the minerals of the cells do? | Na+ leaks into the cell, the cell and K+ tries to pump it back out and becomes depolarized |
| How does a cell repolarize? | when Na+ is back outside the cell after moving from depolarization and from inside the cell- causing an electrical stimulus |
| What is the SA node and its rate? | 60-100; "pacemaker" of the heart; sends stimulus most rapidly |
| What is the AV node rate? | 40-60 |
| _____ always precedes ______ | electrical; mechanical |
| If ______ precedes _____ the rhythm becomes V-Fib | mechanical; electrical |
| Define: Cardiac Output | amount of blood ejected each minute |
| Normal Cardiac Output Amount | 4-8 mL/minute |
| Formula for Cardiac Output per Body Weight | Cardiac Output/Body Surface Area |
| Define: Stroke Volume | amount of volume pumped each minute |
| Stroke Volume Rate | 50-60mL |
| As you bleed, SV will ____ which causes HR to __ | decrease; increase |
| S/S of Decreased Cardiac Output | clammy, cold, poor cap. refill, pale, decreased BP/LOC/Urine Output |
| What medication helps to lower preload? | Nitroglycerin |
| Explain Preload | "rubberband"; as volume increases so does contractility |
| Explain Afterload | "bicycle pump"; left ventricle pressure must be greater than systemic pressure |
| What medications help to lower afterload? | antihypertensive meds |
| Questions for pt. about chest pain? | pressure?, pain?, radiating?, sharp?, SOB?, does it occur during activity/eating/night? |
| What is the number one sign of heart disease? | Fatigue |
| Define: Palpitations | fluttering, dysrhythmias |
| What does sudden weight gain indicate? | pulmonary edema, fluid retention,CHF |
| What does extreme chest pain indicate? | a possible clot or imbalanced electrolytes |
| When does a pt always have JVD? | when lying down |
| Which jugular vein do you want to look at when checking for JVD? | Internal Jugular |
| What does JVD indicate? | Heart Failure due to an Increase in volume |
| Define: PMI | Point of Maximal Impulse |
| Where do can PMI be located? | 5th intercoastal, Left midclavicular |
| What does PMI help in assessing? | if the heart is enlarged, the PMI will shift |
| Where is S1 loudest? | at the apex |
| Where is S2 loudest? | at the base |
| When S3 is heard, it indicates? | possibly too much blood flow |
| When s4 is heard, it indicates? | possibly a stiff ventricle |
| When is s3 usually heard and what does it sound like? | after s1 and s2; lub dupp dupp |
| When is s4 usually heard and what does it sound like? | before s1; lub lub dupp |
| What is a murmur? | "turbulence" thru a valve causing a swooshing noise |
| Explain an electrocardiography | helps see the chambers of the heart |
| What is the TEE and how does it work? | an ultrasound that enters thru the esphogaus and helps to see if clots are forming |
| What is can be both chemical and mechanical? | a stress test |
| Explain Myocardial Perfusion | a test using a dye to see if part of the heart has been damaged |
| Explain Coronary Angiography | a wire that enters the coronary artery and shoots dye into the heart to see how well it is processed thru the heart |
| Is coronary angiography diagnostic or treatment? | diagnostic |
| Nursing Actions for a coronary angiography | monitor below puncture site, push fluids to help get contrast out, look at perfusion of lower limbs |
| What is hemodynamic monitoring? | provides info. about cardiac effectivness, blood voume and tissue perfusion |
| What instruments are used in hemodynamic monitoring? | balloon tipped catheter |
| How does hemodynamic monitoring work? | the cath recieves pressure waves from heart chambers and coverts the mechanical energy to electrical which is displayed via monitor |
| What is the swan-ganz or pulmonary artery catheter? | cath inserted into right atrium through vena cava or jugular and wedges into the branch of the pulmonary artery |
| What does the swan-ganz cath do? | shows wedge pressure of heart will help show info. about left ventricle and left atrial pressures and volume |
| What does PCWP stand for? | Pulmonary Capillary Wedge Pressure |
| What diagnosis' would need a swan-ganz cath? | MI, CHF, etc. |
| What is normal wedge pressure? | 8-12 mm/Hg |
| If wedge pressure is higher than normal what does that indicate? | heart is working too hard to pump blood due to too much fluid or vasoconstriction |
| How long does a swan-ganz cath stay in? | 24 hours to 2 wks |
| For both right and left side of heart, what are normal wedge pressures? | right=lower; left=higher |
| If left wedge pressure is higher what does this indicate? | left ventricular failure, valvular disease, tamponade, fluid overload |
| If left wedge pressure is lower what does this indicate? | hypovolemia or vasodilation |
| A pt. is being assessed to r/o CV problems. The RN understands that some of common S/S of CVD are: | SOB, chest discomfort, palpitations |
| A pt. returns post coronary angiography to the floor. What is the priority intervention following this procedure? | puncture site observation b/c bleeding is priority |
| What client is at greatest risk for developing CVD? | look at most # of risk factors |
| List the electrical pathway of the heart. | Sa node triggers electrical impulse traveling to AV node then to Bundle of His and to Purkinje Fibers |
| What is a lead? | a camera that looks at the heart from different angles and takes pics of its electrical activity |
| What does a flat line on an EKG indicate? | no electrical activity in the heart |
| What is the 1st hump of an EKG? | P-wave |
| What does the P-wave indicate about the heart? | atrial depolarization |
| What is atrial depolarization? | where Na+ rushes into the cell and changes gradients to make the K+/Na+ pump push Na+ back out (Electrical) |
| What is directly after the P-wave and what does it indicate? | a flat line; waiting for atria to contract |
| What is the 2nd wave of an ekg? | QRS wave |
| What does the QRS wave indicate? | ventricular depolarization/atrial repolarization |
| Of the QRS wave, which is negative and which is positive? | q is negative; r is positive; t is negative |
| What is the 3rd wave of an ekg? | t-wave |
| What does the T-wave indicate? | ventricular repolarization |
| Define: Ventricular repolarization | recovering and getting ready for a new contraction |
| Out of atrial/ventricular and de/repolarization which is the most vulnerable? | ventricular repolarization is most vulnerable period where rhythm can be changed |
| High K+ in cells can cause spiked ___ waves? | T-waves |
| Waves or amplitudes are bigger if: | the heart is bigger |
| On an EKG, how do you find the HR? | looking at a 6 sec. strip, count # of QRS waves and multiply by ten |
| What do calipers help do? | help to measure regular/irregular rhythms over time |
| S/S of Normal Sinus Rhythm | HR:60-100; Regular Rhythm; p-wave is before QRS |
| What is a 12 lead EKG used for? | Used with MI; reflects wall of the heart |
| How is a dsyrhythmia classified? | location of atria/ventricle, brady/tachy, premature waves |
| Between atrial and ventricular which arrhythmia is more lethal? | ventricular; atrial is just when the AV node becomes the pacemaker instead of the SA node |
| What can cause a PAC arrythmia? | High levels of caffeine or stress |
| Explain a PAC? | Occurs right before P-wave and is a dip under the baseline |
| Explain Sinus Bradycardia | less than 60bpm, regular, looks like normal sinus just slower |
| Rx: Sinus Bradycardia | VS, may be normal if athletic; check for shock |
| Explain Sinus Tachycardia | between 100-160bpm, regular, looks like normal sinus just faster |
| What could cause sinus tachycardia? | anxiety, exercise |
| What could cause sinus bradycardia? | age, athletic |
| Rx: Sinus Tachycardia | VS, treat underlying condition |
| Are PAC benign or fatal? | benign |
| Rx: Atrial Flutter | give Coumadin |
| S/S of Atrial Flutter on EKG | HR: 220-430bpm, regular or irregular, sawtoothed, alot of P-waves |
| Explain Atrial Flutter | the impulse circulatees in the atria and instead of contracting the heart flutters |
| S/S of Atrial Flutter thru VS | decreased Cardiac Output, decreased BP/Perfusion, |
| Pts w/ Atrial Flutter are at increased risk for? | risk for pulmonary edema and cranial embolus |
| What is most common arrhythmia? | atrial fibrillation |
| S/S of Atrial Fibrillation on EKG? | HR:350-650bpm, irregular,no p-waves |
| Rx of A-Fib | give coumadin or put in pacemaker if ventricles aren't getting enough blood, cardioversion, radiofrequency ablation |
| A-fib thru stethoscope? | pulse and apical pulse will be irregular |
| What can A-Fib cause? | a stroke |
| What causes A-Fib? | ischemia |
| What is SVT? | Supraventricular Tachycardia |
| AKA SVT? | Paroxysmal Atrial Tachycardia, PSVT, PVT |
| S/S of SVT? | "sudden", starts out in Normal sinus rhythm then goes into SVT |
| Rx of SVT? | Adenosine |
| What does adenosine do to the heart? | stops heart for a long pause and then restarts heart into normal sinus node |
| How to give adenosine? | 6mg push very fast, if heart doesn't stop give 12mg |
| How to treat SVT at home w/o meds? | do valsalva maneuvers and carotid massages |
| Explain Cardioversion | planned, with anesthesia, with electricity, give Versed/Valium, put on 50jewels and deliver shock but not on t-wave |
| Why can't you deliver shock on a cardioversion on a t-wave? | b/c it will cause ventricular tachycardia |
| Explain Radiofrequency ablation | pinpointed in cath lab, invasive, finds and destroys area where extra impulses are |
| Explain Defibrillation | 360jewels of shock, shock pads |
| Explain PVC | t-wave is always inverted, wide QRS |
| If Pt. has PVC what is their risks? | increased risk for v-tachy |
| Rx of PVC | Lidocaine |
| S/S of V-Tach for patient | decreased BP, barely 0+ pulse, 3+ PVC beats in a row, awake, alert, racing heart |
| Rx of V-Tach | if stable can give Amiodarone if unstable use defibrillator |
| S/S of V-Tach on EKG | +100bpm, regular, wide QRS, |
| S/S V-Fib | 300-600, irregular, no p-wave, chaotic, no pulse/BP/waves, |
| Rx V-Fib | Amiodarone/defibrillator/implantable cardioverter/radiofrequency ablation |
| S/S of Ventricular Asystole | little or no electricity, no contraction, |
| RX of Ventricular Asystole | do CPR, give epinephrine before defibrillator |
| Risk of Ventricular Asystole | DEATH |
| Explain Implantable Cardioverter | aka AIEC, monitors heart and shocks when needed |
| Explain radiofrequency ablation | kills tissues that send bad impulses |
| Pt with CVA, monitors shows dysrhythmia and irregular rhythm with rate of 120-160bpm w/o P waves. Identify rhythm as? | atrial-fibrillation |
| Treatment for v-tach to v-fib | Defibrillation |
| Rn prepares pt. for cardioversion, what is priority intervention? | turn on sync button |
| On EKG what is vertical axis? | amplitude or size |
| On EKG what is horizontal axis? | time |
| Adenosine is given for? | Tachycardia and PSVT/SVT |
| SE of Adenosine | flushed, dizzy, headache, dyspnea |
| Adenosine classification | chemical cardioverter |
| Amiodarone classification | antiarrhythmic |
| Amiodoarone is given for? | v-tach/fib |
| Amiodarone is given via? | IV or PO |
| SE of Amiodarone | vasodilation, hypotension |
| Explain process of beta blockers | works on entire body to slow all processes down |
| Beta Blockers do what to pt. suffering? | lower BP, stops angina, prevents rhythm issues |
| SE of Beta Blockers | VERY fatigued, dizzy, hypotension, bradycardia |
| Suffix of Beta Blocker | OLOL |
| Diogoxin Classification | inotropic, antiarrhythmic |
| Define Inotropic | increases contractility of heart but slows HR |
| Nursing Implications of Digoxin | check apical pulse for 1 min and it must be greater than 60bpm in order to givecheck K+ to make sure not hyperkalemic b/c |
| TL of Digoxin | 0.5-2.0 |
| Diltiazem classification | calcium blocker |
| What does a calcium do in the body? | Ca+ helps to contract muscles |
| Give Diltiazem for? | A-fib, A-flutter, PSVT |
| Digoxin is given for? | chronic A-fib |
| When to not give Digoxin? | Hypotension with systolic BP less than 90 |
| SE of Digoxin | hypotension, bradycardia |
| How to give Digoxin? | give bolus then IV, then PO, taper |
| What does Diltiazem do to the heart? | decreased contractility to slow down the HR |
| Epinephrine is given for? | cardiac arrest, before defibrillation, allergy shock |
| How many times can Epinephrine be given? | every 3-5 minutes |
| SE of epinephrine | angina, tachycardia |
| Lidocaine classification | antiarrhythmic, numbing agent |
| Lidocaine is given for? | PVC |
| What does Lidocaine do to the heart? | numbs heart to where abnormalities don't fire |
| How to give Lidocaine? | given as bolus then drip |
| SE of Lidocaine? | confusion, agitation, anxiety |
| What is preload? | volume of blood in ventricles at end of diastole |
| What is afterload? | left ventricle must overcome resistance to circulate blood |
| When is preload increased? | during hypervolemia, regurgitation of cardiac valves |
| When is afterload increased? | hypertension and vasoconstriction |
| If afterload increases, what else increases? | Cardiac workload |
| What are the three levels of damage for MI? | ischemia, injury, infarction |
| Describe infarction | o2 deprived, irreversible, causes Q waves |
| Describe MI injury | tissue is almost necrotic but is reversible, causes S-T elevation |
| Describe ischemia | causes depressed s-t segment, is helpful if pt has collateral circulation |
| What are the 2 types of angina? | unstable and stable |
| What is CAD? | Coronary Artery Disease |
| What causes athrosclerosis? | high fat diets, aging, history, stress, obesity |
| Of stable/unstable angina which is better? | stable |
| S/S of stable angina? | pressure, pain, occurs with exertion |
| Rx of stable angina? | sit down, deep breaths, take nitro |
| how is stable angina relieved? | with rest and nitro |
| S/S of unstable angina? | chest pain with rest or minimal exertion |
| When does unstable angina usually occur? | after meals or during sleep |
| If unstable angina, at risk for? | MI |
| Precautions for Nitro pill | light sensitive, don't touch!, vasodilator everywhere |
| How to take nitro? | take every one minute up to 3 pills, assess BP each time and if pain still doesnt go away go to ER |
| The quicker perfusion is increased, the quicker ____ is turned back to _____ | infarction; ischemia |
| When heart becomes ____, EKG changes are noted | ischemic |
| EKG + Ischemia = | s-t segment elevation |
| EKG + Infarction = | very tall q wave |
| What happens to the heart with infarcted tissue? | no contractility and can cause HF |
| The extent of infarction depends on | collateral circulation, workload of myocardium |
| What is the suffix of drugs that lower cholesterol? | -"statin", ex. Lovostatin |
| What to monitor in meds that lower cholesterol? | LFTs, if LFTs are increased, must D/C and change drug |
| Nitro __ workload of the heart, ___ oxygen demand and__ pre/afterload | decrease;decrease;decrease |
| What does morphine do to the body? | decreased pain, pre/after load and BP; vasodilatees |
| WNL range of morphine? | 2-4mg IVP |
| When do you give Morphine for MI? | after giving all Nitro and aspirin |
| What is the worst and most common MI? | anterior MI |
| If pt. has LAD obstruction whattype of MI? | anterior MI |
| If pt. has Circumflex obstruction what type of MI? | posterior/lateral MI |
| If pt. has RCA obstruction what type of MI? | inferior MI |
| What are lab tests performed for MI? | Troponin, CK-enzyme, lipids, triglycerides |
| When are enzymes released from cells? | when the cells die |
| Normal levels of CK-enzyme? | 0, the more + the worse the MI damage |
| Normal level of Cholesterol | less than 200 |
| In assessing MI pt. what do RN assess for? | description of pain, VS, HR/rhythm, pain radiation, abnormal heart sounds |
| What heart sounds are heard with MI? | S1, S2, S4 |
| With MI pain radiation, where does pain radiate to? | jaw, chest, arm, back |
| Pt. with MI would appear to look like? | cold, clammy skin, decreased distal pulses, decreased perfusion, |
| Pt. with MI, lungs would sound like? | crackles if leading to progression of HF |
| Classification of ACE inhibitors | vasoconstrictor, usually ends with -"pril", helps prevent conversion of angiotension from 1 to 2 |
| What are ACE inhibitors given for? | MI and hypertension but are mild |
| SE of ACE inhibitors | non-productive, dry cough |
| Classification of Ca+ Channel Blockers | ends in -"dipine" except for Cardiazem |
| What is the role of Ca+ Channel Blockers | to decrease BP and HR |
| What is the Pain management sequence for MI? | MONA |
| What is the order sequence for Pain management of MI? | 1. Oxygen, 2. Nitro/Aspirin, 3. Morphine (only if still in pain) |
| What do fibronolytics do? | dissolve blood clots |
| When to give fibronolytics? | if meet qualifications; absolute = Do not giverelative = risk v benefit |
| SE of fibronolytics | Bleeding |
| Nursing action with fibronolytics | check stool and urine and iv site for oozing or blood |
| Major to watch for with fibronolytics | pt. will go into V-tach, treat v-tach; its good b/c shows reestablished perfusion |
| Explain glycoprotein inhibitors | target platelets, Short term, stops platelets from being sticky to reduce risk of clots |
| Examples of fibronolytics | tpa, activase |
| Examples of Glycoprotein inhibitors | reopro, aggrastat |
| SE of Glycoprotein inhibitors | bleeding! possible allergic reaction that causes a rash so give Benadryl |
| Explain Plavix | antiplatelet effect; long term; 75mg daily |
| Explain Aspirin | antiplatelet effect; long term; |
| Explain Beta Blockers | decreased afterload, HR, BP, fatigue; long term; end with -"olol" |
| Monitor what with Beta Blocker | BP, HR, VS |
| ACE Inhibitors dont affect __ | HR |
| Examples of Ca+ Blockers | Nitedipine |
| Explain PTCA | put stents in artery; never occurs in left main! |
| Post PTCA monitoring | lay flat, watch pedal pulse, push fluids, pain m, give aspirin/plavix |
| Define: Cardiac Tamponade | heart begins to leak and blood fills sack of heart and stops heart from filling with blood |
| S/S of Cardiac Tamponade | decrease Cardiac output/stroke volume/BP/HR, increased PCWP, muffled heart tones, JVD, crackles |
| Cardiac Tamponade with decreased BP, think ___ ___ | Pulsus Paradoxus |
| Define: Pulsus Paradoxus | BP decreases 15mmHg when taking big deep breath |
| Rx of Cardiac Tamponade | surgery and repair area thats leaking and put in chest tube |
| What is CABG? | bypass surgery |
| Explain CABG | removes sapheneous vein from leg and attach it to aorta and blood vessel below where there is a blockage |
| During CABG, explain what to do with heart | give cold potassium (Cardioplegia) to stop heart and to decrease metabolic needs |
| Define: Cardioplegia | cold potassium given to stop heart with CABG surgery |
| 1st Post-Op stage of CABG- Nursing actions | slowly warm up pt, monitor pressure with Swan Ganz, iv fluids, give warm blankets, watch chest tubes, |
| What will pt. appear like during 1st Post-Op stage? | asleep, hypothermic, ventilator |
| Rx of CABG | give Heparin (may ooze) and give morphine |
| 2nd Post-Op stage of CABG- Nursing actions | watch for atelactasis, dysrhythmias, watch wound and dressing, watch hemodynamics and pericardial friction rub |
| Define: Atelactasis | alveoli collapses in lungs leading to pneumonia |
| Rx of Atelactasis | incentive spirometry, cough, deep breathe |
| What Dysrhythmias to look for with CABG | A-fib/PVC |
| What labs to watch for with CABG? | K+, Mag, O2 |
| Precautinos with CABG | cant drive for 6wks, watch for infection |
| Define: Pericardial Friction Rub | hear "lubb" squeak "dupp, expected with CABG, no pain, |
| 3rd Post-Op of CABG-nursing actions | Usually 6-8wks, pt to cardiac rehab, med/diet, risk factors |
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dukedreamr
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