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Complex Exam 2

ARDS/TB/Cardiac

QuestionAnswer
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