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Reading EKG Strips

How to read EKG strips

IF there is a P-wave, the rhythm will be one of theses Sinus Rhythms: Sinus Rhythm: Normal Sinus Rhythm, Sinus Bradycardia or Sinus Tachycardia
If you do not have a P-wave the rhythm is: Ventricular
Determine the Rate: 60-100 (NSR or AJR)<60 (SB, or JR)> 100 (ST or JT)
PR Interval = <.12 (less than 3 little boxes) = Junctional Rhythm, nextlook at rate
PR Interval = .12-.20 = (3 to 5 little boxes) = Sinus Rhythm, Sinus Brady, Sinus Tach
PR Interval = >.20 = 1st degree heart block. Type of rhythnm with 1st degree heart block
No P-wave= Ventricular Tachacardia, ideoventricular, Atrial flutter, Fixed conduction (...!...!...!)
Regular QRS = 0.06-0.10
Super Ventricular Tachycardia <3 little boxes
When do you cardiovert When you have a pulse
When do you Defibulate When you have no pulse
What drug(s) do you use for Asystole Epinephrine, and atropine
The drug used to Chemicaly Cardiovert SVT is Adenosine
Nursing Diagnosis related to CABG Fear, Deficient knowledgeIneffective cardiac tissue perfusion, Decreased cardiac output, Impaired gas exchange, Risk for imbalanced fluid volume, Disturbed sensory perception, Acute pain, Ineffective tissue perfusion, Ineffective thermoregulation
CVP normal value:Wedge pressure:PAP CVP:0-4 Wedge pressure:8-15 PAP 20-30/5-15
Pulmonary Edema Massive left sided heart failure, full of fluid, pink frothy secretions, Treatment: diuretics (lasix first line)If pt has renal failure then (nitroglycerin and morphine)
Irregular Rhythms A-flutter, Sinus Arrhythmia, 2 degree or 3 degree heart block, A-fib
Narrowing pulse pressure would be seen in which patient Tamponade, also massive JVD
Pacemaker Information required on Chart Model of pacemaker, type of generator, date and time of insertion, location of pulse generator, stimulation threshold, Pacer settings (eg, rate, energy output, sensitivity, and duration of interval between atrial and ventricular impulses)
Endocarditis Infective Risk factors Risk factors: heart valve prosthesis, hx of heart disease (mitral valve prolapse), chronic dibilitatin disease, IV drug abuse and immunosuppression
Pericarditis Friction rub. notched T wave, S/S: fever, positional chest discomfort, nonspecific ST-segment elevation, elevated ESR erythrocyte sedimentation rate, retrosternal pain that worsens during supine positioning, pulsus paradoxus
hypokalemia wave form changes U uaves after the T
hyperkalemia Tall QRS complexes
hypomagnesium Torsades de pointes
Medications to treat ventricular dysrhythmias Lidocaine, Beta blockers, amiodarone (drug of choice for v-tac)
Right Heart Failure (chronic condition) JVD, Dependent Edema, right upper gastric pain(Right heart handles systemic blood return)
Left Heart Failure Bibasilar fine crackles, dyspnea, tachycardia, S3 and S4 heartsounds,fatigue, hemoptysis, non-productive cough, cool pale skin, PMI displaces toward the left anterior axillary line
Inferior wall myocardial Infarction T-wave inversion:inadequate blood supplyST-segment elevation:injury prolonged ischemiaPathologic Q waves Are all signs of tissue hypoxia
Digoxin Hold if apical pulse is less than 60 bpm. Digitalis Toxicity = vision changes (halos), dysrhythmia, anorexia, nausea, vomiting, headache, and malaise. Increases force of myocardial contraction and decreases HR.
A-fib Warfarin to prevent clots and decrease risk of stroke, Digoxin to control HR
12 Lead EKG ST elevation indicates immediate myocardial injury. ST depressions indicate myocardial ischemia. Q wave forms several days after a myocardial infarction, U wave is a sign of hypokalemia.
Laxix Furosemide IV push: give at a rate of 20 mg/min or less. Rapid injection can cause hearing loss as a result of ototoxicity.Normal daily dose: 40 mg. loop diuretic
Nitroglycerin Reduces oxygen consumption to devrease ischemia and relieve pain. Vasodialator mainly in veins and reduces blood return to heart and preload is reduced. May cause a significant drop in cardiac output and B/P if pt is hypovolemic at higher doses.
Calcium Channel Blockers Slows heartrate and decreases strength of contraction which decreases workload of heart. Relaxes blood vessels decreasing BP and increases coronary artery perfusion
Rhumatic Fever Caused by strep
S/S of Infective Endocarditis Osler's nodes (red, painful nodules on the fingers and toes) splinter hemorrhages, fever, diaphoresis, hoint pain, weakness, abdominal pain, new murmur, Janeway's lesions (small, hemorrhagic areas on fingers, toes, ears, and nose)
Myocarditis S/S Flu-like symptoms.fatigue, dyspnea, palpitations, and occasional discofort in the chest and upper abdomen. My develop dysrhythmias, or ST-T wave changes. Systolic murmur, gallop rhtyhm,
ACE Inhibitors promote vasodilation and diuresis by decreasing afterload and preload.
Dobutamine left ventricular dysfunction. increases cardiac contractility. at high doses, it also increases HR and incidence of ectopic beats and tachydysrhythmias. take care in pt with a-fib.
CK-MB earliest increase, peak and return to normal 4-8 hours, peaks 12-24 hrs, and returns to normal 1-3 weeks
Troponin earliest increase, peak and return to normal 3-4 hours, peaks in 4-24 hrs and returns to normal 1-3 weeks
Labs for Heart failure BUN, TSH, CBC, BNP
Mitral stenosis: Rhythms, S/S S/S: dyspnea, progressive fatigue, hemoptysis, paroxysmal nocturnal dyspnea, chough, wheeze, repeated respiratory infections. Dysrhythmias like A-fib. Tests Doppler echocardiography.
Aortic Regurgitation: Cause Caused by inflammatory lesions that deformt he leaflets of the aortic valve. also infective or rheumatic endocarditis, congenital abnormalities, diseases such as syphilis, dissecting aneurysm, blunt chest trauma, or valve replacement.
Aortic Regurgitation: S/S Forceful heartbeats in head and neck, arterial pulsations that are visible or palpable at the carotid or temporal arteries. Exertional dyspnea, fatigure, progressive s/s of left ventricular failure includie breathing difficulties, orthopnea, PND.
Valve replacement teaching: pre and post take long term anticoagulant therapy, freequent follow up appointsments and blood lab studies. mak need to take aspirin, precribed medication teaching,
Cardiac Tamponade S/S Life threatening need stat interventions. S/S fullness within the chest, substantial or ill defined pain. sob, massive JVD, falling systolic blood pressure, narrowing pulse pressure, rising venous pressure (increased JVD) and distant heart sounds
Cardiac Tamponade treatment pericardiocentesis, pericardiotomy (pericardial window)
CABG: 70% occlusion (60% if in the Left main). artery must me patent beyond the occlusion. Use greater saphenous vein, lesser saphenous, chephalic and basilic veins.
Created by: mummsword
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