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N370-03: Cardiac II
Interventions, Medications & Treatment pt. 1
| Intervention | Problem |
|---|---|
| Rate (normal/brady/tachy) -> rhythm (reg/irreg) -> P-wave (one for each QRS) -> PR interval (even) -> QRS (all present and normal peaks) -> QRS duration (even) -> ST segment (baseline/depressed/elevated) -> T-wave (normal/inverted) -> QT interval length | How do you interpret EKG strips? |
| # of QRS complexes in a 6 sec strip x 10 = HR/min | How do you calculate HR/min on EKG strips? |
| R: clouds over grass + L: smoke over fire + mid: chocolate is near to my heart (4th intercostal); 6 on chest + 4 on limbs | The proper placement of a 5 lead EKG strip ______; for continuous cardiac monitoring; what about 12-lead? |
| Remove hair using electric clipper, NOT razor -> rub site briskly w/ alcohol pad -> rub site w/ 2x2 gauze -> place electrodes w/ adequate gel | What are the steps prior to placing electrodes? |
| Atropine IVP (SA node stimulant), Epinephrine IVP (SA node stimulant), or external temporary pacemaker | What is the tx for symptomatic bradycardia d/t unstable hemodynamic? |
| SA node stimulants don't work -> external temporary pacemaker right away | What is the tx for bradycardia d/t a heart block? |
| Temporary pacemaker | Brady refractory to atropine and epi (stubborn), 2nd degree type 2 heart block, and 3rd degree heart block are indications for ______. |
| Implanted; immobilize arm for 2 weeks and no heavy lifting, monitor incision for infection, no tub baths, swimming & driving for 2 weeks, inspect HR & BP daily, keep ID card at all times, report any sx of dizziness, fatigue, SOB, avoid sports, metals | For ______ pacemaker (permanent), instruct the pt to ____________. |
| Anticoagulants (Coumadin; dabigatran (contraindicated with P-glycoprotein inhibitors and reduces effects of H2 blockers/PPI), xa inhibitor - rivaroxaban & apixaban, enoxaparin); stroke | Those with Afib are more prone to blood clots which is why we have them on _______; prevents _____ especially. |
| Avoid sudden increase in high-fat diet; vitamin-K intake | For pts on coumadin (i.e. d/t A-fib), educate them about food-drug interactions such as: _______ and _______. |
| Anticoagulants, Beta blockers to slow HR, Calcium channel blockers to block impulses from passing through AV nodes and slow HR, Digoxin to slow HR by blocking impulses, and Electrocardioversion to reset heart's rhythm | What is A-fib management? (ABCDE) |
| Address and manage pain/anxiety ASAP to dec O2 demand -> dec cardiac workload | What do you do when pt is experiencing ACS? |
| PQRST: Precipitating factors, Quality, Region and Radiation, S/sx and Severity, Time and Tx response + body language (Levine's signs - clenched fist to center of chest) | When pt is experiencing chest pain, how do we evaluate? |
| OK | *Know the classic & alternate signs of MI using Ramon's SI notes* |
| Cardiac Troponin (I & T) | We look at elevated _______ levels as a major sign for heart attack; ↑24-48 hrs; ↓10 days; additional biomarkers are BNP (peaks in 24hrs if AMI), creatinine kinase, myoglobin, and copeptin |
| MONAH: Morphine, Oxygen, Nitrates, Anti-platelets (Aspirin - 1 chew & 1 swallow - low dose anticoag), Heparin (includes enoxaparin) | _______ greets all ACS patients (esp MI). |
| Nitroglycerine; 3 doses; 5 mins; HR (hold if below 60) & BP; go to the hospital + call 911 even before administering (?) | We administer ______ for chest pain; it vasodilates coronary arteries to inc blood flow to the heart to relieve ischemia; we can give up to _____ doses, SUBLINGUALLY at least ____ mins apart; check __ & __ between each dose; if CP's not resolved -> _____. |
| Cardiac enzymes (esp troponin), electrolytes (esp K and Ca), coagulation tests (D-dimer?), renal functions (BUN/Cr) | What laboratory tests do we check for a pt with cardiac ischemia? |
| YUP | *Know interventions for pt with chest pain from Ramon's SI notes* |
| Nitropaste; wear gloves | ______ is applied onto premarked paper; placed on skin (transcutaneous topical); absorbs gradually; Monitor BP/HR response; replaced @ prescribed frequency (Q6-8 hrs); be sure to ______ to avoid SELF ABSORPTION. |
| Amioderone | _______ is the initial treatment for hemodynamically stable wide-complex monomorphic tachycardia but is CONTRAINDICATED FOR POLYMORPHIC TACHY; better than Lidocaine |
| Tissue Plasminogen Activator (tPA) / clot busters; HTN, reduced sx, avoid invasive devices for 24hrs, screen all preexisting anticoag meds, labs - Hgb, Hct, plt, anti-xa, ptt, pt-inr, fibrinogen | We can give _____ (-ase) within 6 hrs of MI onset to breakdown clots (unless contraindicated - risk for bleeding + *check blue photos in our slides*); requires close monitoring of _______. |
| HR ≥ 20 points from resting, heart rhythm is irregular, RR and effort increases from resting, SOB, dizziness, unsteady on foot, chest pain, nausea | When should pt STOP AND REST? |
| Viagra | Nitrates are CONTRAINDICATED with _____ d/t severe vasodilation effects. |
Created by:
yortiz
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