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375 Exam 2
Review
| Term | Definition |
|---|---|
| flail chest | free floating, does not contribute to lung expansion, paradoxical chest wall movement |
| 1st chamber | collection chamber, fluid collection |
| 2nd chamber | water seal chamber, allows air to exit the pleural space, intermittent bubbling; this is where you would see an air leak; tidaling is a normal finding |
| 3rd chamber | suction control chamber; wet - gentle bubbling, dry no bubbling |
| hypertensive urgency | days to weeks, no evidence of TOD; captopril, labetalol, clonidine |
| hypertensive emergency | 220/140 with TOD, hospitalization and IV drug therapy titrated to MAP 110 - 115; sodium nitroprusside |
| 6 lead placement | extra lead over 4th intercostal space for better ST observation |
| hyperkalemia | causes peaked T waves |
| hypokalemia | PVC, V tach and bradycardia |
| hypomagnesmia | V tach |
| hypercalcemia | depressed ST and decreased QT |
| hypocalcemia | elevated ST and prolonged QT |
| timing for cardioversion a fib | if longer than 48 hours need 3 - 4 weeks of anticoagulation therapy |
| radiofrequency ablation | destroys ectopic foci |
| atrial flutter | sawtooth shape |
| PVC | PR wave is not measurable; apical and radial pulses do not match |
| R on T phenomenon | PVC whose R wave falls on the T wave of the preceding beat, puts the patient at risk of V tach or V fib |
| V tach | tombstone, can have pulse or no pulse; no atrial rate or P wave, QRS wide and distorted |
| V tach pulse | lightheaded, SOB, chest pain, assess the patient and give oxygen; synchronized cardioversion and possibly amiodarone |
| V tach pulseless | start a code, high quality CPR and defibrillation |
| V fib | pulseless; start a code |
| indications for a pacemaker | symptomatic bradycardia, a fib or flutter, sustained SVT or V tach, heart failure, sick sinus syndrome |
| fixed pacemaker | always paces at a set rate |
| on demand pacemaker | senses electrical activity and fires when heart rate falls |
| temporary pacemaker | power source outside the body, used with MI or symptomatic bradycardia |
| cardiac resynchronization therapy | biventricular pacing sends electrical signals to both ventricles |
| benefits of CRT | improves hearts efficiency, increases blood flow, alleviates heart failure symptoms |
| ICD | implanted under the skin, lead wires convert life threatening arrhythmias; delivers shock after 25 seconds |
| transcutaneous | delivered through skin via electrodes, noninvasive |
| epicardial | pacing wires inserted to pericardial wall, connected to pulse generator, can pace both atria and ventricles |
| transvenous | catheter inserted to right ventricle through jugular vein, used as a bridge, only affects ventricle |
| failure to sense | pacemaker does not recognize atrial or ventricular activity and fires inappropriately; caused by setting too high, dislodged electrode |
| fail to sense | QRS with pacer spike right after, can cause R on T phenomenon |
| failure to capture | stimulus is generated but fails to trigger depolarization; assess hemodynamic status; electric charge may be too low |
| fail to capture | see pacer spike but not followed by a P wave or QRS |
| failure to pace | pacemaker does not generate electrical stimulus when it should fire; wire fracture, lead displacement, oversensing; check hemodynamic stability |
| fail to pace | absence of pacer spike on strip |
| chronic stable angina | similar pattern, duration and onset often provoked by physical exertion, stress or emotional upset; occurs when O2 demand is greater than O2 supply |
| prinzmetal's angina | occurs at rest in response to a spasm of a major coronary artery, ST segment elevation, occurs during REM sleep because of increased O2 demand |
| prinzmetal | raynaud's, migraines and smoking |
| long acting nitrates | reduce frequency of angina attack and prinzmetal's by dilating vessels to reduce preload and afterload; side effects headache and orthostatic hypotension can premedicate with tylenol |
| niacin | water soluble B vitamin lowers LDL by inhibiting triglyceride synthesis; causes flushing and pruritis |
| fibric acid derivatives | decrease triglycerides and increase HDL, GI side effects; fenofibrate |
| bile acid sequestrants | increase conversion of cholesterol to bile acids, can bind with other drugs; cholestyramine |
| ezetimibe (zetia) | used to decrease the absorption of dietary and biliary cholesterol |
| stress test | evaluates oxygen demand on coronary arteries, positive means ST changes were noted |
| coronary computed tomography angiography | injects iodine material into patient, CT examines coronary arteries to see if they are narrowed; need IV access, assess for allergies to iodine and shellfish and kidney function |
| troponin | sensitive to cardiac damage, usually stays inside the heart muscle; 0.0.4 normal |
| catheterization | identify and localize CAD; uses conscious sedation |
| PCI balloon angioplasty | catheter is threaded into blocked artery and balloon is inflated to compress the plaque against the arterial wall |
| PCI stent | expandable mesh like structure designed to keep the vessel open by providing support, need anti platelet therapy; aspirin indefinitely and clopidogrel for 12 months |
| beta blocker CAD | decrease myocardial contractility, HR, SVR and BP, decrease myocardial oxygen demand |
| ACE inhibitors | vasodilators and reduce blood volume, prevent or reverse ventricular modeling; pril, cause dry cough |
| hypertension manifestations | chest pain or palpitations, headache, vision changes, nosebleeds, reduced activity tolerance, dizziness |
| DASH diet | fruits and vegetables, low cholesterol and dat, low fat dairy - limit milk to 2 cups a day, increase calcium rich foods |
| ICD indications | survivors of sudden cardiac death, spontaneous sustained V tach, high risk for future arrhythmias |
| chronic stable angina pain | relieved with nitroglycerin, pressure and heaviness associated with dyspnea and fatigue; does not change with position or breathing |
| cardiac catheterization N/STEMI time | within 90 minutes STEMI, within 12 - 72 hours NSTEMI |
| elderly ACS symptoms | LOC change, shortness of breath, dizziness, pulmonary edema |
| ACS sympathetic response | diaphoresis, tachycardia, tachypnea, ashen and cool clammy skin, hypertension |
| ACS nursing intervention | semi fowler and nasal cannula, assess and obtain IV access |
| thrombolytic inclusion criteria | chest pain less than 12 hours with EKG findings consistent with acute STEMI |
| nitroglycerin | goal to reduce pain and improve coronary blood flow, immediate onset, reduce preload and afterload, monitor for hypotension |
| ACS drugs | cholesterol lowering, stool softeners, anti platelet and anticoagulant |
| papillary muscle dysfunction | massive mitral valve regurgitation that causes extreme dyspnea, pulmonary edema and decreased cardiac output; blood backup in the atria; different heart sounds and rapid clinical deterioration |
| ventricular aneurysm | myocardial wall thinning and bulges out leading to heart failure and angina, fatal if ruptures |
| pacemaker indications | symptomatic bradycardia, a fib, a flutter, sustained AVT, VT, heart failure, sick sinus syndrome |
| unstable angina | new in onset, occurs at rest, worsening pattern, increasing frequency |
| unstable angina women | anxiety, fatigue, indigestion |
| statin caution | liver function and myopathy, muscle weakness |
| shock following an MI | cool and diaphoretic skin, crackles, anxiety and restlessness |
Created by:
ahommel
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