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Exam II

Dysrhythmias, Cardiomyopathy, Acute and Chronic AKI

MVS Sign? dyspnea on exertion
MVS secondary to? Rheymatic fever
MVS common dysrhythmia Afib
MVR Sign cool extremities, pulmonary edema, S3 (lubb, dubb, whoosh)
MVP Sign Click murmur, chest pain without relief with nitroglycerin
AVS Sign SAD - Syncope, Angina, Dyspnea
AVS Treatment note NO NITRO! Chest pain worsens
AVR Sign Water hammer pulse, L HF Sympotms
What does stenosis mean? narrowing... not opening
what does regurgitation mean? no closing
failure to capture heart didn't hear pacemaker
failure to sense pacemaker didn't hear heart
asytole absence of hear rate
diastole atria open aortic and pulmonary valves are closed ventricles are filling dubb 120
systole ventricles open aortic and pulmonary valves are open atria are filling lubb 80
EKG lead placement white is right grass under clouds smoke above fire fire under smoke brown in middle, far from fire (right, 4th intercostal space)
tachycardia med adenosine - push hard and fast, flush immediately
bradycardia med atropine
PAC on EKG abnormal P wave short PR interval irregular rhythm
PAC leads to SVT
PSVT on EKG HR 100-300 hidden P wave regular rhythm
Atrial flutter on EKG Regular rhythm Atria >200 bpm Sawtooth P wave
Afib on EKG Disorganized rhythm atria >350 bpm
AFib with RVR Disorganized rhythm P >350 QRS >100
Afib without RVR Disorganized rhythm P >350 QRS 60-100
AV block - 1st degree Prolonged PR PR interval > 0.20
AV block - 2nd degree (in general) More P's than QRS's
AV Block - 2nd degree Type I Progressively longer PR intervals Then dropped QRS
AV Block - 2nd degree Type II P:QRS = 2:1, 3:1, 4:1 regular pattern QRS > 0.12
AV Block - 3rd degree independent... no communication
PVC on EKG No P waves QRS wide and bizarre T large
PVC sign Apical/radial pulse deficit
Vtach on EKG 3+ PVCs in a row QRS rate is 150-250 QRS is > 0.12 (wide)
Vfib on EKG extremely irregular
Antidysrhythmia Classes 1 - sodium blocker 2 - beta blocker 3 - potassium blocker 4 - calcium blocker
sodium blockers used for VT, SVT, PVC, prevent Vfib (the ventriculars)
Examples of sodium blockers lidocaine, procainamide
beta blockers used for SVT, Afib, Aflutter
what do beta blockers do? lower HR vasodilation lower contractilit
examples of beta blockers atenolol, the -olols
what do potassium blockers do? delay repolarization (increases PR and QT, widens QRS)
examples of potassium blockers amiodarone, sotalol
what do calcium blockers do? lower HR vasodilation decrease contractility
Calcum blockers used for? SVT, Afib, Aflutter
Example of calcum blocker amlodipine
What does digoxin do? decrease HR increase contratility
What does adenosine do? decrease conduction through AV node decrease HR
what does atropine do? anticholinergic increase HR
What does magnesium do? decrease conduction through AV node
what does hydralazine do? vasodilation
what does nitro do? vasodilation
Small box on EKG 0.04 seconds
Large box on EKG 0.20 seconds
5 large boxes on EKG 1 second
30 large boxes on EKG 6 seconds (1/10th of a minute)
normal P wave 0.06 - 0.12 seconds
normal PR interval 0.12 - 0.20 seconds
normal QRS 0.04 - 0.12 seconds
normal T wave 0.16 seconds
T wave inversion ischemia
ST depression ischemia
ST elevation injury
ST elevation + pathological Q infarction
when do you defibrillate? Vfib Vtach
when do you use cardioversion? afib aflutter PSVT sinus tachycardia
When do you use asynchronous pacemaker? AV block Afib w/ RVR BBB Vtach
Defib joules rate for biphasic? 120-200
Defib joules rate for monophasic? 360
ICD candidates syncope with Vtach/Vfib survived SCD spontaneous sustained Vtach life-threatening dysrhythmias
ICD teaching? No MRI if it fires, call PCP if it fires and you don't feel well, call 911
Pacemaker candidates AV block AFib with RVR BBB Vtach Cardiomyopathy HF SA node dysfunction
Pacemaker teaching? No MRI if it fires, call PCP if it fires and you don't feel well, call 911 take daily pulse
Aortic dissection signs weak or absent pulses different between bilateral upper extremities
Aortic dissection complication cardiac tamponade (JVD, pulsus paradoxus)
Kidney functions Eliminate toxins regulate acid/base balance erythropoietin release
No renal function characteristics CA down Phos up anemia metabolic acidosis
normal urine output 30 ml/hr
kidney function (AFEVER) A = acid base balance F = fluid/electrolyte balance E = elimination of wastes V = Vitamin D E = erythropoietin release R - renin releaase
kidney failure symptoms (AFEVER) A = acidic F = K up, CA down, Phos up E = retain fluids V = CA down, hypocalcemia E = H&H down, RBC down - anemia R = BP up
when is dialysis needed creatinine 15 or below
nitrogenous waste in blood azotemia
condition of nitrogenous waste in blooc uremia
normal creatinine 0.6 - 12 mg/dl
good indicator of AKI urine output
normal BUN 6-20 mg/dl
crush injury increased myoglobin
Does BUN or creatinine fluctuate more BUN
most accurate kidney function test creatinine clearance
what is creatinine end product of muscle and protein metabolism
what is BUN end product of protein metabolism
BUN would do what with fluid retention BUN would go down
What level is oliguria? < 400 ml/day
Hallmark signs of AKI increased potassium increased phosphorous decreassed calcium decreased Ph (acidic)
Mannitol is what? diuretic
symptoms of hyperkalemia nausea, fatigue, weakness, tingling, bradycardia, AV block
what to do with hyperkalemia insuin/glucose IV sodium bicarb induce diarrhea calcium supplements phosphorous with meals
normal GFR 100-125 ml/min
kidney diet low salt, low potassium, fluid restrictions, low protein, no dairy
osmosis moves what water
diffusion moves what solvent (potassium)
ultrafiltration does what pressure (like wringing out a mop)
dialysis complications hypertension, cramping, disequilibrium syndrome
what do you do with hypertension complciation during dialysis stop, supine, NS bolus, O2
what do you do with cramping complicatino during dialysis stop, NS bolus, weight
what are signs of disequilibrium syndrome during dialysis BP up, N/V, HA, convulsions
what do you do with disequilibrium syndrome? decrease time, decrease flow rate, call PCP
what are the three types of cardiomyopathy? dilated, hypertrophic restrictive
what cardiomyopathy is most common? dilated
what can be the first sign of hypertrophic cardiomyopathy? SCD
what is a sign of restrictive cardiomyopathy JVD, RHF
Created by: Sharonwhite513
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