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CardiacStack Ex#1
infomation for exam #1
| Question | Answer |
|---|---|
| This Heart Rhythm has a P wave for every normal QRS complex, is consistent and HR of 60-100. | Normal Sinus Rhythm or NSR |
| This heart rhythm has a P wave for every normal QRS complex, is consistent and a HR <60. | Sinus Bradycardia or SB |
| What is the treatment for SB if patient was Symptomatic? | May give Atropine. May need a pacemaker. |
| This heart rhythm has a P wave for ever normal to narrow QRS complex, is consistent and a HR >100. | Sinus Tachycardia or ST |
| What is the treatment for ST? | Treat the cause of tachycardia Valsalva Maneuver May give Beta Blockers |
| What heart rhythm has 2-3 P waves for every normal QRS complex (saw tooth waves)? | Atrial Flutter |
| What is the treatment for Atrial Flutter | Cardioversion May give Diltiazem Digoxin Verapamil Quinidine |
| What heart rhythm has no normal P waves, no measurable PR interval, normal QRS complex, Atrial HR of 300-600, Ventricular HR of 50-180? | Atrial Fibbrillation |
| What is the Treatment for Atrial Fibrillation? | Cardioversion May give Diltiazem Digoxin Verapamil Quinidine |
| What heart rhythm has an irregular rate, P waves that are rarely seen or lost in the QRS comlex, no measurable PR interval, QRS complex that are wide and "bizarre" that measure more than 0.1 sec? | PVC or Premature ventricular contractions |
| What is the treatment for PVCs on a stable patient? | Give Amiodarone,Lidocaine,Magnesium Sulfate or Procainamide |
| What is the treatment for PVCs on an unstable patient? | Cardioversion |
| What is the treatment for PVCs on a pulseless patients? | Defib, ACLS |
| What heart rhythm has an irregular rate that is not measurable, no visible P waves, no measurable PR interval, no measurable QRS complex? | Ventricular Fibrillation or V. Fib. |
| What is the treatment for a patient who is in V. Fib? | Defibrillation STAT. ACLS protocols, Monitor ABGs for O2 levels |
| What heart rhythm has an impulse delay at the AV node, a regular rhythm, a PR interval that is >0.2 seconds and consistent, a normal QRS complex? | First Degree AV block |
| What heart rhythm has PR intervals that vary & gradually lengthens until a QRS is dropped, then repeats itself? | 2nd Degree AV Block Type 1 OR Mobitz I or Wenckeback |
| What is the treatment for a 2nd degree AV block Type I on a patient who is symptomatic? | Atropine and Temporary Pacemaker |
| What heart rhythm has some P waves that are nonconduction so there is usually 2-3 waves for every 1QRS complex BUT when P waves are conducting , the PR is normal? | 2nd degree AV block Type II or Mobitz II |
| What is the treatment for a 2nd degree Type II heart rhythm? | May give Isoproterenol, Atropine, Epinephrine or Dopamine as temporary measures while waiting for a pacemaker to be inserted. |
| What heart rhythm has an atrial HR of 60-100 and regular, ventricular HR that varies and is regular, normal but not conducting P waves, a PR interval that varies with no relationship between P and QRS, and a QRS Complex that is wither normal or abnormal? | 3rd Degree AV block Complete. |
| What is the treatment for a 3rd degree AV block --complete? | Give Isoproterenol, Atropine, Epinephrine or Dopamine. Put in a temporary pacemaker until permenant pacemaker can be implanted. |
| What heart rhythm has a lack of ventricular contractions? | Asystole |
| What is the treatment for a patient in Asystole? | CPR, ACLS protocols, intubation... |
| What is the name of the lining that surrounds the heart and it's functions? | Name: Pericadium or Pericardial Sac Function: anchors heart in place; prevents ventricles from over filling |
| What is the purpose of the fluid that is between the heart and the pericardium? | The fluid acts as a lubricant to reduce friction. |
| Name the layers of the heart wall and their thickness and location? | Endocardium/thin inner layer Myocardium/midde-thick layer Epicardium/ outer thin membrane |
| What is the function of the myocardium? | It is muscle layer of the heart that is responsible for contraction. |
| List the blood flow through the heart. | In from Vena Cava, Right Atrium, Tricuspid Valve, Right Ventricle,Pulmonic Valve, Pulmonic Artery, In from Lungs, Left Atrium, Mitral Valve, Left Ventricle,Aortic Valve, Aorta, out to body |
| What is the purpose of the chordae tendineae? | Prevent backflow into the ventricles. Make sure the valves stay shut. |
| In a cell at rest or repolarized call which charge is inside the cell and outside the cell? Name the Ions that would be inside or outside? | (+) charge inside/ (-) charge outside Na+ & Ca+ inside / K+ and Cl- outside |
| In a depolarized cell which charge is inside the cell and outside the cell? Name the Ions that would be inside or outside? | (-) charge outside/ (+) charge inside K+ & Cl- outside/ Na+ & Ca + outside (caused by Na+ moving across the membrane and into cell). |
| What is happening in the heart at the P wave on an EKG? | the firing of the SA node and the depolarization of the atria causing atrial contraction. |
| What is happening in the heart at the QRS complex on an EKG? | Depolarization of the ventricles resulting in contraction and Atria filling with blood. |
| What is happening in the heart at the T wave on an EKG? | Repolarization of the ventricles; the heart is at rest. |
| List the pathway for an electrical impulse that is traveling through the heart. | Starts at SA node, travels through atria to AV node, delays briefly, Atria contract, travels down through Bundle of His into R & L Bundle branches into purkinje fibers, venticles contrac,then repolarization. |
| Define Cardiac Output (CO) and the formula for calculating CO? | the amount of blood pumped by each ventricle in 1 min. CO = SV X HR |
| What factors effect CO? | HR affected by the Autonomic Nervous System. SVR is affected by Preload, contractility, and afterload. |
| What is SV and the formula to calculate SV? | Stroke volume: the mount of blood ejected by the ventricles with each beat. SV = (CO x 1000)/HR |
| Define Dromotropic effect? | the speed of conduction through the AV node. (+)= increased speed (-)= decreased speed. |
| Define Chronotropic effect? | when the pulse is affected. (+)= increased pulse (-) = decreased pulse |
| Define Inotropic effect? | changes in contractility that affects contractions. (+)= increased contractility (-)= decreased contractility |
| Define Preload? | the stretching of muscle fibers in the ventricles as the ventricles fill with blood. |
| Define Contractility? | the inherent ability of the myocardium to contract normally. It is influenced by preload. The more stretch, the more forceful contraction. |
| Define Afterload? | it is the amount of vascular resistance that must be overcome by the ventricles to pump the blood. SVR = a measure of L afterload (systemic vascular resistance) PVR = a measure of R afterload (Pulmonary vascular resistance) |
| What is automaticity? | the ability of a cell to initiate an impulse without outside stimuli (ex. SA node generating an impulse) |
| What is excitability? | the ability of a cell to respond to a stimulus and initiate an impulse (AV node) |
| What is Conductivity | the ability of cardiac cells to conduct an electrical charge. |
| What is Contractility? | the ability of the cardiac cells to contract when stimulated. |
| What is Refractoriness? | cells are not able to respond to the stimulus until that have recovered (repolarized) from the previous stimulus. |
| IN the SNS (sympathetic Nervous System) name the common Neurotransmitters (NT) and what CV changes occur when the SNS is stimulated? | NTs: Norepinephrine (nor-epi) and Epinephrine (epi). Stimulation causes: increased Pulse (+) chronotropic Increased conduction speed (+) dromotropic Increased force of contraction (+) inotropic. |
| IN the PNS (parasympathetic Nervous System) name the common Neurotransmitters (NT) and what CV changes occur when the SNS is stimulated? | NTs: ACh or Acetylcholine Stimulation causes: Decreased Pulse (-) chronotropic Decreased Conduction (-) dromotropic Decreased force of contraction (-) inotropic. |
| What subjective data do you need during your CV assessment? | history,current and past health problems, current medications, socioeconomic status, risk factors. |
| What objective data do you need during your Physical Exam for your CV assessment? | PE: skin color and temp, BP and VS, Jug. vein pressure, heart sounds. |
| What diagnostic and labs are looking for your CV assessment? | Labs: CBC, e-lytes, ABG, coag. levels, cardiac enzymes (CK-MB, troponin, CPK...), serum lipids, CXR, coronary angiography, Cardiac Cath, EKG, stress test, Echo,EPS (electrophysiography study), Transesophageal Echo (TEE), Nuclear Imaging (Thallium imaging) |
| What is hemodynamic monitoring? | Invasive lines that monitor CV pressures and blood flow. |
| Define Starling's Law? | the more a muscle is stretched, the stronger a contraction will be until after some point, additional stretching only cause a decrease in strength of contractions. |
| What does the arterial line measure in hemodynamic monitoring? | The arterial in measures the L ventricle afterload or SVR. |
| What does the pulmonary arterial line (i.e. Swan-Ganz line) measure in hemodynamic monitoring? | The pulmonary arterial line measures the R ventricular afterload or PVR. |
| how does decreased peripheral resistance affect afterload, CO, and O2 required by the heart? | Afterload: decreased CO: increased O2: decreased |
| What are some complications of that can occur with Arterial Lines? | Hemorrhage if cath is dislodged. Infections thrombus formation distal circulatory occlusion. |
| Why is it important by monitoring Pulmonary Arterial Pressure | Fluid maintenance can be maintained without overload; preload can be regulated; CO can be maintained without going into pulmonary edema. |
| What does the circulatory asssitive devices do? | stabilize & maintain pts with heart failure decrease L vent workload increased myocardial perfusion augments circulation by reducing L vent afterload. |
| Repolarized cell or cell at rest have ____ charge outside & ____ charge inside? List the charge and the ions. | repolarized cells or cells at rest have __+__ charge outside & __-__ charge inside. Na+ and Ca+ outside & K+ and Cl- inside. |
| Depolarized cells have ____ charge outside & ____ charge inside List the charge and Ions. | Depolarized cells have __-__ charge outside & __=__ charge inside. K+ & Cl- ions outside & Na+ & Ca+ ions inside. |
| What are the common symptoms of Angina? | CP: gradual or sudden onset Chest: tightness, squeezing, indigestion CP located mid-substernal & can radiate to neck, back, arms, jaw & fingers Pain lasts 15-30min Pain relieved w/ NTG other S/S: apprehension, dyspnea, sweating,N, need to pee or burp |
| What are common symptoms of myocardial Infarction or MI? | CP: sudden onset Chest: similiar to angina and more severe. CP: similiar to angina but difficult to pin-point Pain last 30m-2hrs Pain not relieved with NTG other s/s: similiar to angina with fatigue and vertigo. |
| Normal range values for ABGs | pH: 7.35-7.45 PaCO2: 35-45 HCO3: 21-28 PaO2: 80-100 |
| Electrolyte normal range values | Na+:135-145 K+ :3.5-5.0 Ca+:9.0-10.5 Cl-:98-106 Mg+:1.3-2.1 Phos: 3.0-4.5 |
| Normal Lab values for: Hgb Hct RBC WBC Platelet PT PTT INR | Hgb: female: 12-16/male:14-18 Hct: female: 37-47/male:42-52 RBC: female:4.2-5.4/male: 4.7-6.1 WBC: 5000-10000 Platelets: 150000-400000 PT: 11-12.5sec |
| Normal Lab values for Serum Lipids | Total Cholestrol: <200mg/dL Trigylceride: <150mg/dL HDL: >40mg/dL LDH: <100mg/dL for mod. risk; <70mg/dL for high risk HDL:LDL ratio: 3:1 |
| Normal lab value for Troponin + rise, peak, and return times. | Troponin T < 0.20 Troponin I <0.03 Rise: 3-6 hr Peak: 10-24 hr Return : 4-7 days. |
| Cardiac Enzyme normal values + rise, peak and return times | Creatine Kinase (CK): female: 30-135 male: 55-170 CK-MB: 0% of total CK Rise within 1-3 hr Peak: 12-24hr Return: 2-3 days. |
| Normal lab values for LDH1,LDH2,total LDH + rise, peak and return times | LDH1:17-27% LDH2:27-37% (both found in heart, RBCs and kidney) Total LDH: 100-190 Rise: 24-48 hr Peak: 48-72hr Return: 7-10days |
| Normal lab values for CRP (c-reactive protein)? | <10.mg/dL |
| Normal lab value for AST? | 0-35 units/L |
| Antiarrhythmics-Class I:type IA What they do? what they treat? examples NIs | Do: slows conduction (-)dromotropic Lowers HR (-)chronotropic Treats: Afib, PVC, Vtach EX: Quinidine, Procainamide, Disopyramide NI: monitor BP, widening QRS complex, prolong QT or PR interval or heart block, watch for S/S SOB, wt. gain. |
| Antiarrhythmics-Class I:type IB What they do? what they treat? examples NIs | Do: Shorten repolarization Depress ventricular automaticity Treat: PVC, VT, VF Ex: lidocaine, tocainide NI: monitor LOC,BP & HR, watch for tremors or seizures, watch for S/S of CHF. |
| Antiarrhythmics-Class I:type IC What they do? what they treat? examples NIs | Do: Slows conduction (-)dromotropic Treat: Afib, life threatening vent. arrhythmias EX: flecanide, Propafenone NI: Monitor BP, S/S of CHF, for increase in dysrhythmias. |
| Antiarrhythmics-Class II: Beta Blockers What they do? what they treat? examples NIs | Do: Slows HR (-)chronotropic Dec. AV conduction (-)dromotropic Dec. Contractility (-)Inotropic Dec. BP TREAT: AF, A-flutter, PVC EX: -olol atenolol, metoprolol, propranolol NI: Monitor HR & BP, Assess for SOB, insomnia,fatigue, dizzy & S/S of CHF |
| Antiarrhythmics-Class III:K+ channel blockers What they do? what they treat? examples NIs | Do: slows HR (-)chronotropic TREAT: AF, A-flutter, life threatening vent. dysrhythmias EX: amiodarone, Ibutilide NI: monitor HR & BP and ECG |
| Antiarrhythmics-Class IV:Ca+ channel Bockers What they do? what they treat? examples NIs | Do:delay conduction (-)dromotropic depress automaticity Dec HR (-)chronotropic Dec Contactility (-)Inotropic Prolong refractory TREAT: Afib, Aflutter EX:Verapramil, Diltiazem NI: Monitor HR & BP, Dig levels, SS of CHF, change positions slowly. |
| Digoxin (antiarrhythmic) What they do? what they treat? NIs | Decreases HR (-) chronotropic Increases conduction (+)dromotropic increase contraction (+)inotropic TREATS:AF, CHF,A-flutter NI: Apical HR x 1 min before admin. check dig levels : 0.8-2ng/dL monitor for CHF, ECG, HR, BP |
| Atropine What they do? what they treat? NIs | DO: increases HR (+)chronotropic TREATS: bradycardia NI: monitor HR, BP, ECG, |
| Adenosine What they do? what they treat? NIs | DO: decreases conduction (-)dromotropic TREATS: PSVT NI: monitor HR, BP, ECG |
| Magnesium Sulfate What they do? what they treat? NIs | DO: decreases myocardial cell activity TREAT: VT, VF, Atrial Paroxsymal tachycardia NI: monitor for seizure, resp, HR, BP, ECG |
| Defibrillation What does it do? What it treats NI | DO: an electrical shock that depolarizes all heart cells with the thought that it will then use SA node to pace. TREATS: V-fib without a pulse NI: apply pads to pt chest start w/ low dose & then increase as higher dose can cause damage to myocardium. |
| Describe the 4 Different AV Heart blocks? | PR interval:constant;1P:1QRS=1stDeg AV block PR interval:constant;P:QRS not 1:1=2nd Deg Type II PR interval:varied;RtoR,constant=3rd Deg AV block PR interval: varied;RtoR,varied=2nd Deg TypeII |
| Cardioversion What does it do? What does it treat NI | Used for unstable Vtach,Afib,Aflutter. Hold Dig for 48hr prior Hold Anticoag for 4-6wks prior Maintain Airway Assess VS, LOC, EKG, for burns Provide emotional support Doc results from procedure. |
| Cardiac Catheter What is it used for? | Used to assess heart dz, ID the best form of TX for heart Prob, measure intracardiac pressures, check O2 levels at various parts of the heart, to determine CO. |
| name some nursing interventions for Pre, intra, and post-procedure for Cardiac Catheter | Pre: need to d/c blood thinners or metformin before procedure. Intra: watch for complications (Cath looping, kinking, breaking, blood loss, CVA, dysrhythmias, embolism,MI death) Post keep minb straight with femStop for 4-6hr. monitor VS, CV circ, SS o |
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shelbycanino
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