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heart electrical conduction pathway -SA node (60-100 BPM; main pacemaker) -AV node (40-60 BPM; backup pacemaker) -Bundle of His -bundle branches -Purkinje fibers
ECG wave that represents atrial contraction (depolarizing); electrical impulse starting in the SA node and spreading through the atria P wave
part of ECG rhythm that represents ventricular contraction (depolarization) QRS
ECG wave that represents ventricular relaxation (repolarization) T wave
ECG graph paper...each small box represents how many seconds? five boxes represents how many seconds? 0.04; 0.2
electronic device that provides electrical stimuli to heart muscle to help control abnormal heart rhythms; device uses electrical pulses to prompt the heart to beat at a normal rate pacemaker
device that detects and terminates life-threatening episodes of tachycardia and fibrillation; especially those that are ventricular in origin implantable cardioverter defibrillator (ICD)
HR: 60-100 Rhythm: regular P waves: normal, in front of QRS PRI: consistent b/w 0.12 and 0.20 seconds QRS width: b/w 0.06 and 0.12 seconds normal sinus rhythm
HR: <60 Rhythm: regular P waves: normal, in front of QRS PRI: consistent and b/w 0.12 and 0.20 seconds QRS width: b/w 0.06 and 0.12 seconds sinus bradycardia
causes: lower metabolic needs (sleep, athletic training, hypothyroidism), vagal stimulation (vomiting, suctioning, severe pain), meds (calcium channel blockers, beta-blockers), idiopathic sinus node dysfunction, increased ICP, CAD (esp. MI) sinus bradycardia
Tx: atropine; if unresponsive to atropine, pacer or catecholamines (such as dopamine or epinephrine) are given sinus bradycardia
HR: >100 but usually <120 Rhythm: regular P waves: normal/consistent shape; always in front of the QRS (may be buried in the preceding T wave) PRI: consistent and b/w 0.12 and 0.20 seconds QRS width: b/w 0.06 and 0.12 seconds sinus tachycardia
some causes: anxiety; pain; electrolyte imbalances; meds that stimulate sympathetic response (catecholamines, atropine), stimulants (caffeine, nicotine), and illicit drugs (amphetamines, cocaine, Ecstasy) sinus tachycardia
Tx for sinus tachycardia correct the underlying cause
what med do you give for supraventricular tachycardia (SVT)? give med fast or slow? dosage? adenosine; fast; 6mg --> 12mg --> 12mg
HR: b/w 250 and 400 bpm Rhythm: regular P waves: F waves; SAW-TOOTH PRI: N/A QRS width: usually normal, but may be abnormal or may be absent atrial flutter
HR: 120-200 bpm Rhythm: highly irregular P waves: no discernible P waves PRI: N/A QRS width: usually normal, but may be abnormal atrial fibrillation
risk factors: cardiac disorders (HF, post-op cardiac surgery, HTN), increasing age, obesity, OSA atrial fibrillation
Tx: meds that control heart rate (beta blockers, calcium channel blockers), antithrombotics (Coumadin, Eliquis, Xarelto, Pradaxa), cardioversion atrial fibrillation
HR: depends on the underlying rhythm Rhythm: depends on the underlying rhythm P waves: normal, in front of QRS PRI: >0.20 seconds; consistent/prolonged QRS width: usually normal, but may be abnormal first degree block
PR gets further and further apart, QRS is dropped; "longer, longer, longer drop then you have a _____" Wenckebach (Mobitz I; second degree block, type 1)
PR interval is constant for those P waves just before QRS complexes; dropped QRS (more P waves than QRS complexes) second degree block, type 2 (Mobitz 2)
P and Qs don't agree, then you have a ____ ____; also, this rhythm usually bradycardic third degree (block)
third degree block treatment pacer
HR: 100-200 bpm Rhythm: usually regular P waves: very difficult to detect PRI: very irregular (if P waves are seen) QRS width: usually more QRS complexes than P waves V-tach
What do you do for V-tach and V-fib? 1-CPR 2-Defib 3-Epi
HR: >300 bpm Rhythm: extremely irregular, w/o a specific pattern P waves: none PRI: n/a QRS width: no recognizable QRS complexes V-fib
flatline on ECG asystole
Tx for asystole and PEA 1-CPR 2-Epi (no defib!)
condition in which electrical activity is present on an ECG, but there is not an adequate pulse or blood pressure pulseless electrical activity (PEA)
the expected ECG changes are T-wave inversion, ST-segment elevation, and development of an abnormal Q wave; "fireman's helmet" STEMI
the patient has elevated cardiac biomarkers (e.g., troponin) but no definite ECG evidence of acute MI; in this type of MI, there may be less damage to the myocardium; ST depression on ECG NSTEMI
main diagnostic tests for MI ECG, troponin (cardiac muscle biomarker; used as an indicator of heart muscle injury), CK-MB (cardiac-specific isoenzyme), myoglobin (heme protein that helps transport oxygen; found in cardiac and skeletal muscle), cardiac cath (w/in 90-mins)
spike where P wave should be; it's a consistent spike along ECG strip paced atrial
ECG strip: looks like bunny ears interventricular conduction delay (IVCD) aka BBB (bundle branch block)
occurs when electrical impulse starts in atrium before next normal impulse of sinus node; may be caused by caffeine, ETOH, nicotine, anxiety, hypokalemia, hypermetabolic states, or atrial ischemia/injury/infarction; often seen w/sinus tachycardia premature atrial complex (PAC)
electrical current given in synchrony with the patient’s own QRS complex to stop a dysrhythmia; used to treat atrial dysrhythmias cardioversion
electrical current given to stop a dysrhythmia, not synchronized with the pt’s QRS complex; stops all electrical activity of heart allowing SA node to take over and reestablish a perfusing rhythm; Tx of choice for V-fib and V-tach; ventricular arrhythmias defibrillation
A patient presents to the ER with SVT and has attempted to cough… What would be the next order by the physician? A. Administer 300mg Amiodarone B. Administer 1mg Epinephrine C. Administer 6mg Adenosine D. Administer 40mg Vasopressin C. Administer 6mg Adenosine (as prescribed then 12mg, and repeat again 12mg)
A patient is found in bed and unresponsive. A pulse check is complete… The patient has no pulse. What is the next nursing action by you the RN? A. Begin CPR B. Defibrillate patient C. Give the patient a sternal rub D. Call a rapid response A. Begin CPR (When no pulse we begin CPR, call a CODE BLUE if no pulse and then defibrillate if the rhythm is shockable. A sternal rub is not needed as patient has not pulse.)
The patient is given CPR, the team leader in the code is analyzing the rhythm. The rhythm is read as asystole… What do you the nurse do next? A. Defibrillate B. Resume CPR C. Give amiodarone D. Cardioversion B. Resume CPR (Asystole & PEA always immediately resumes CPR...No defib…Cannot defib when no electrical activity. 1mg epi may be given during CPR cycles but that is all. Cardioversion is for pts w/a pulse in v-tach and a-fib. It means lower joules)
nursing process: dysrhythmia: assessment (everything but the physical assessment---different slide for that one) -causes, contributing factors -indicators of decreased CO and oxygenation -health hx: coexisting conditions, previous occurrence -meds (prescribed and OTC) -psychosocial: pt’s perception of dysrhythmia
nursing process: dysrhythmia: physical assessment -skin (pale and cool) -Sx fluid retention (JVD, lung auscultation) -Sx decreased CO (altered LOC) -rate/rhythm of apical, peripheral pulses -heart sounds -B/P, pulse pressure
nursing process: dysrhythmia: nursing diagnoses -Decreased cardiac output -Anxiety -Deficient knowledge
Pt's electrical rhythm displays as progressively longer PR durations until there is a nonconducted P wave. Which type of heart block does the nurse expect that this pt has? -First degree -Second degree, type I -Second degree, type II -Third degree Second degree, type I
a localized sac or dilation of an artery formed at a weak point in the vessel wall aneurysm
after endovascular repair, pt must lie in ____ position for how long? HOB may be elevated up to __ degrees after 2-hours supine, 6-hours, 45
after endovascular repair, what should be performed initially every 15 minutes and then at progressively longer intervals if the patient’s status remains stable? VS and doppler assessment of peripheral pulses
PU: An OR nurse is preparing to assist with a coronary artery bypass graft (CABG). The OR nurse knows that the vessel most commonly used as source for a CABG is what? -Brachial artery -Brachial vein -Femoral artery -Greater saphenous vein Greater saphenous vein (is the most commonly used graft site for CABG; the femoral artery, brachial artery, and brachial vein are never harvested)
PU: What are the first symptoms of cardiac tamponade? Select all that apply. -Shortness of breath -Chest tightness -Dizziness -Tachycardia -Neck vein distention shortness of breath, chest tightness, dizziness (first Sx of cardiac tamponade are often SOB, chest tightness, dizziness, or restlessness--the client may have tachycardia; neck vein distention and other signs of rising central venous pressure develop)
PU: The nurse is removing a client's femoral sheath after cardiac catheterization. What medication will the nurse have available? -heparin -atropine sulfate -protamine sulfate -adenosine atropine sulfate (Removing the sheath after cardiac catheterization may cause a vasovagal response, including bradycardia. Nurse should have atropine sulfate on hand to increase the client's heart rate if this occurs.)
The client has been prescribed procainamide for a dysrhythmia. Which medication side effect will the nurse teach the client to watch for? -Hypertension -Tachycardia -Change in mental status -Feeling tired feeling tired (The side effects of procainamide hydrochloride can include hypotension, GI upset, and feelings of tiredness. Procainamide does not cause hypertension, tachycardia, or a change in mental status.)
PU: ICU client post-acute MI. During assessment, client reports SOB and CP. Client’s BP is 100/60 & HR of 53, and ECG tracing shows more P waves than QRS complexes. First nursing action? -transcutaneous pacing -defib -1 mg of IV atropine -12-lead ECG transcutaneous pacing (pt experiencing third-degree heart block; permanent pacemaker may be indicated if block continues; defib not indicated; third-degree heart block does not respond to atropine; a 12-lead ECG may be obtained, but is not first)
PU: A client is diagnosed with dilated cardiomyopathy. What is the most likely cause of the client's condition? -chronic alcohol abuse -heredity -scleroderma -previous myocardial infarction chronic alcohol abuse (one of the main causes of dilated cardiomyopathy; other causes include H/O viral myocarditis, an autoimmune response, and exposure to other chemicals in addition to alcohol)
PU: Pt admitted with Sx of an acute MI. Nurse should recognize what classic ECG changes that occur with an MI? Select all that apply. -Absent P-waves -Abnormal Q-waves -T-wave hyperactivity and inversions -ST-segment elevations -U-wave elevations abnormal Q-waves, T-wave hyperactivity and inversions, ST-segment elevations (These 3 signs are classic ECG changes suggestive of a MI. Changes can be diagnostic to the area of cellular damage. P wave and U wave changes are not characteristic of an MI.)
PU: The nurse knows that a pacemaker is the treatment of choice for what cardiac dysrhythmia? -Supraventricular tachycardia -Atrial flutter -Ventricular fibrillation -Complete heart block Complete heart block
PU: The nurse knows which heart rhythm occurs when the atrial and ventricular rhythms are both regular, but independent of each other? -Third-degree atrioventricular (AV) heart block -Second-degree heart block -First-degree AV block -Asystole Third-degree atrioventricular (AV) heart block (no relationship/synchrony b/w the atrial and ventricular contraction; each is beating at its own inherent rate and is independent of each other, thus the cardiac output is affected)
PU: A cardiac patient with a magnesium lab result of 2.5 mEq/L would most likely evidence which of the following? -Atrial tachycardia -Ventricular arrhythmias -Depressed myocardial contractility -Increased cardiac excitability Depressed myocardial contractility (The normal magnesium level is 1.3 to 2.2 mEq/L. An elevated magnesium level can depress myocardial contractility and excitability, which can lead to heart block or asystole.)
PU: What is the treatment of choice for ventricular fibrillation? -Immediate bystander CPR -Pacemaker -Implanted defibrillator -Atropine Immediate bystander CPR (The treatment of choice for ventricular fibrillation is immediate bystander CPR, defibrillation as soon as possible, and activation of emergency services.)
PU: What would be most important criterion for a client to have surgery maze procedure? -Angina pectoris not responsive to other Tx -Decreased activity tolerance r/t decreased CO -Refractory a-fib -V-fib not responsive to other treatments Refractory atrial fibrillation (The maze procedure is an open heart surgical procedure for refractory atrial fibrillation. Angina, reduced activity tolerance, and ventricular fibrillation are not criteria.)
PU: No cardiac rhythm on monitor. Nurse's rapid assessment suggests cardiac arrest. How should the nurse describe this initial absence of cardiac rhythm? -Pulseless electrical activity (PEA) -Ventricular fibrillation -Ventricular tachycardia -Asystole Asystole
PU: Client presents to the ER via ambulance w/HR 210 and a sawtooth waveform pattern per cardiac monitor. The nurse is most correct to alert the medical team of the presence of a client with which disorder? -Asystole -PVC -Atrial flutter -V-fib Atrial flutter
Clients with ____ must receive adequate anticoagulation for 4-6 weeks prior to cardioversion therapy to prevent dislodgement of thrombi into the bloodstream. A-fib
med that is held for 48 hr prior to elective cardioversion? digoxin
cardioversion requires activation of what in addition to charging the machine? synchronizer button (allows shock to be in sync with the client's underlying rhythm; failure to synchronize can lead to development of a lethal dysrhythmia, such as v-fib)
What does atropine do? increases heart rate (and improves the atrioventricular conduction by blocking the parasympathetic influences on the heart; the use of atropine in cardiovascular disorders is mainly in the management of patients with bradycardia)
Pt admitted w/AAA. POC...which goal should nurse keep in mind for interventions? -Decreasing B/P and increasing mobility -Increasing B/P and reducing mobility -Stabilizing HR and B/P and easing anxiety -Increasing B/P and monitoring fluid I&O Stabilizing HR and B/P and easing anxiety (focus on preventing aneurysm rupture by stabilizing HR and B/P; anxiety and increased stimulation may raise the HR and boost B/P, precipitating aneurysm rupture)
A _____ aneurysm projects from only one side of the vessel; appearance: a bulbous protrusion of one side of the arterial wall saccular (one of the most common forms of aneurysms)
If an entire arterial segment becomes dilated, a _____ aneurysm develops; appearance: symmetric, spindle-shaped expansion of entire circumference of involved vessel fusiform (one of the most common forms of aneurysms)
Aneurysms are potentially serious; if they are located in large vessels that rupture, this can lead to? hemorrhage and death
it is important to control ______ in patients with dissecting aneurysms blood pressure
most common cause is atherosclerosis; affects men more often (esp. caucasion men); most prevalent in pts 65+ y.o.; most occur below the renal arteries (infrarenal aneurysms); untreated, the eventual outcome may be rupture and death abdominal aortic aneurysm (AAA)
risk factors: genetic predisposition, tobacco use, and HTN; more than half of pts w/this have HTN aneurysms
major cause of aneurysms atherosclerosis
aneurysm that is actually a pulsating hematoma; the clot and connective tissue are outside the arterial wall false aneurysm
type of aneurysm: one, two, or all three layers of the artery may be involved true aneurysm
type of aneurysm: this usually is a hematoma that splits the layers of the arterial wall dissecting aneurysm
immediate Tx for midline AAA repair dehiscence? wet-to-dry dressing, notify doc
aneurysm classification? primary connective tissue disorders (Marfan syndrome, Ehlers-Danlos syndrome) and other diseases (focal medial agenesis, tuberous sclerosis, Turner syndrome, Menkes syndrome) congenital
aneurysm classification? poststenotic and arteriovenous fistula and amputation related mechanical (hemodynamic)
aneurysm classification? penetrating arterial injuries, blunt arterial injuries, pseudoaneurysms traumatic (pseudoaneurysms)
aneurysm classification? associated with arteritis (Takayasu disease, giant cell arteritis, systemic lupus erythematosus, Behçet syndrome, Kawasaki disease) and periarterial inflammation (i.e., pancreatitis) inflammatory (noninfectious)
aneurysm classification? bacterial, fungal, spirochetal infections infectious (mycotic)
aneurysm classification? infection, arterial wall failure, suture failure, graft failure anastomotic (postarteriotomy) and graft aneurysms
aneurysm at what size is just monitored? 4cm or less
aneurysm usually burst at what size? 6cm
the thoracic area is the most common site for what type of aneurysm? dissecting aneurysm
Sx: some asymptomatic; pain (most prominent symptom) that is usually constant and boring but may occur only when the person is supine, dyspnea, cough, dysphagia Thoracic Aortic Aneurysm
Sx: more than half of pts asymptomatic; severe back or abd pain, decreasing B/P, pulsatile mass in the middle and upper abd, systolic bruit may be heard over the mass Abdominal Aortic Aneurysm (AAA)
an abnormal accumulation of lipid, or fatty substances, and fibrous tissue in the lining of arterial blood vessel walls; these substances block and narrow the coronary vessels in a way that reduces blood flow to the myocardium atherosclerosis
risk factors: hyperlipidemia, cigarette smoking/tobacco use, HTN, DM, metabolic syndrome, obesity, physical inactivity; family history, increasing age, gender, race CAD
pts with CAD are at risk for? -angina pectoris -MI -heart failure -death -cardiac arrhythmias
Sx: angina pectoris (most common), epigastric distress and pain that radiates to jaw or lt arm, SOB, women--atypical Sx (indigestion, nausea, palpitations, numbness) CAD
Tx: anticoagulants, cholesterol meds, antiplatelet aggragation meds, low fat/cholesterol/sodium diet, smoking cessation, increase exercise, get regular check-ups CAD
labs to check for routine CAD check-up Lipid panel, BMP/CMP, Liver enzymes, CRP (inflammatory marker for CV risk; produced by liver in response to stimulus such as tissue injury; high levels of this protein may occur in people with DM and those who are likely to have an acute coronary event)
The nurse is caring for a patient with hypercholesterolemia who has been prescribed atorvastatin (Lipitor). What serum levels should be monitored in this patient? -CBC -Blood cultures -Na and K levels -Liver enzymes Liver enzymes (atorvastatin (Lipitor) is an HMG-CoA reductase inhibitor and is hepatotoxic; therefore, liver enzymes should be monitored in patients taking this med)
chest pain (anterior) brought about by myocardial ischemia; physical exertion or emotional stress increases myocardial oxygen demand, and the coronary vessels are unable to supply sufficient blood flow to meet the oxygen demand angina pectoris
type of angina: predictable and consistent pain that occurs on exertion and is relieved by rest and/or nitroglycerin stable angina
type of angina: symptoms increase in frequency and severity; may not be relieved with rest or nitroglycerin; requires medical intervention unstable angina
The nurse is caring for a pt who has severe CP after working outside on a hot day and is brought to the ER. Nurse administers nitro to help alleviate CP. Most concerning side effect? -Dry mucous membranes -HR 88 bpm -B/P 86/58 -C/o HA B/P 86/58 (Nitroglycerin dilates vessels in the body. Dilation of the veins causes venous pooling of blood throughout the body. As a result, less blood returns to the heart, and filling pressure (preload) is reduced.)
meds to treat angina? -nitrates -beta-blockers -calcium channel blockers -antiplatelets -anticoagulants
CABG post-op risks? -infection -decreased perfusion -electrolyte imbalances -dysrhythmias -pain -hypothermia
veins commonly used for bypass graft procedures? greater and lesser saphenous veins
valve replacement: which type lasts the longest? mechanical (30+ years)
type of valve replacement used for younger ages? downside--will be on coumadin for life mechanical
type of valve replacement that lasts ~10 years? synthetic
what can be heard with mitral valve regurgitation? murmur
what can lead to problems with the mitral valve? -rheumatic fever -IV drug use -genetic issues -infection
disease of the heart muscle that is associated with cardiac dysfunction; a series of progressive events that culminates in impaired cardiac output and can lead to heart failure, sudden death, or dysrhythmias cardiomyopathy
characterized by diastolic dysfunction caused by rigid ventricular walls that impair diastolic filling and ventricular stretch; systolic function is usually normal; problems: increased cardiac workload and HTN restrictive cardiomyopathy (RCM)
heart muscle asymmetrically increases in size/mass; increased thickness of heart muscle reduces size of ventricular cavities and causes ventricles to take a longer time to relax after systole; problems: decreased perfusion, HTN, increased cardiac workload hypertrophic cardiomyopathy (HCM)
What is the main electrolyte involved in cardiomyopathy? -Calcium -Phosphorus -Potassium -Sodium Sodium (Sodium is the major electrolyte involved with cardiomyopathy. Cardiomyopathy often leads to heart failure, which develops, in part, from fluid overload. Fluid overload is often associated with elevated sodium levels.)
causes of endocarditis? -dental work -IV drug use -CLABSI
Sx of endocarditis? -murmur -pericardial friction rub -fever -lethargy
pts with endocarditis are at risk for? -cardiac tamponade --> torsades (treat with IV Magnesium) -pericardial effusion
A pt w/restrictive cardiomyopathy taking digoxin has anorexia, N/V, HA, malaise. Include what in POC for this pt? -digoxin will be changed to nifedipine -digoxin dose will be decreased -nothing; these are expected signs -pt will be admitted to ICU digoxin dose will be decreased (Pts w/restrictive cardiomyopathy are sensitive to digitalis. Nurses must closely monitor these patients for digitalis toxicity, which is evidenced by dysrhythmia, anorexia, nausea, vomiting, headache, and malaise.)
the accumulation of fluid in the pericardial sac pericardial effusion
compression of the heart resulting from fluid or blood within the pericardial sac; it usually is caused by blunt or penetrating trauma to the chest; results in decreased venous return and decreased CO cardiac tamponade
Sx: ill-defined chest pain or fullness, pulsus paradoxus, engorged neck veins, labile or low BP, shortness of breath pericardial effusion and cardiac tamponade
systolic blood pressure that is more than 10 mm Hg lower during inhalation than during exhalation; difference is normally less than 10 mm Hg; patients with cardiac tamponade may develop this pulsus paradoxus
What is the most reliable sign of cardiac arrest in an adult and child? -Decrease in blood pressure -Absence of brachial pulse -Absence of breathing -Absence of carotid pulse Absence of carotid pulse (The most reliable sign of cardiac arrest is the absence of a pulse. In an adult or child, the carotid pulse is assessed. In an infant, the brachial pulse is assessed.)
Which is a diagnostic marker for inflammation of vascular endothelium? -C-reactive protein (CRP) -Low-density lipoprotein (LDL) -High-density lipoprotein (HDL) -Triglyceride C-reactive protein (CRP) (CRP is a marker for inflammation of the vascular endothelium. LDL, HDL, and triglycerides are not markers of vascular endothelial inflammation. They are elements of fat metabolism.)
The client has had biomarkers tested after reporting chest pain. Which diagnostic marker of myocardial infarction remains elevated for as long as 2 weeks? -Myoglobin -Troponin -Total creatine kinase -CK-MB Troponin (remains elevated for a long period, often as long as 2 weeks, and it therefore can be used to detect recent myocardial damage)
The nurse is reviewing the laboratory results for a patient having a suspected myocardial infarction (MI). What cardiac-specific isoenzyme does the nurse observe for myocardial cell damage? -Alkaline phosphatase -CK-MB -Myoglobin -Troponin CK-MB (cardiac-specific isoenzyme; found mainly in cardiac cells and therefore increases when damage to these cells. Elevated CK-MB is an indicator of acute MI; the level begins to increase w/in a few hrs and peaks w/in 24 hours of an infarct.)
Which medication is an antidote to heparin? -Protamine sulfate -Alteplase -Clopidogrel -Aspirin Protamine sulfate
Created by: nurse savage
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