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Complex exam 1
| Question | Answer |
|---|---|
| Perfusion interpretation process | rate, rhythm, P waves, QRS, P:QRS |
| sinus tachycardia causes | hypothyroidism, hypovolemia, HF, anemia, exercise, stimulants, fever, fear, pain, anxiety |
| sinus bradycardia risk factors | cardiac surgery, MI, elderly, athletic, congential heart disease, myocarditis, drug toxicities |
| sinus bradycardia symptoms | pale, diaphoretic, hypoxia, SOB, hypotensive, decreased LOC |
| sinus bradycardia nursing care | pacemaker, fix underlying cause |
| sinus bradycardia meds | Atropine: first line of treatment for symptomatic Epinephrine: first line of treatment for cardiac arrest, asystole, PEA Dopamine: hypotensive, bradycardia, shock |
| Sinus arrhythmia definition | rate varies with respirations |
| Premature atrial complex rhythm | -early beats initiated by atrium -P wave may be found in T wave *pt may feel skipped beat |
| Atrial flutter rhythm | -saw tooth pattern, atrial rate is 250-350bpm -regular |
| Atrial flutter causes | lung disease, ischemic heart disease, hyperthyroidism, hypoxemia, HF, alcoholism |
| Atrial fibrillation rhythm | -erratic impulse with no discernible P wave -irregular ventricular rate *high risk for emboli |
| Afib treatment | manage symptoms, monitor BP, limit activity if rate is too fast, administer anticoagulant |
| Afib meds | Anticoagulants: apixaban, warfarin, coumadin Beta blockers, calcium channel blockers, amiodarone |
| Supraventricular tachycardia rhythm | -rate greater than 150bpm coming from atria -p waves undeterminable |
| Supraventricular tachycardia treatment | vagal maneuvers, adenosine, cardioversion |
| Adenosine | stops heart to reboot system, can be give twice 6mg then 12mg |
| Premature ventricular complex rhythm | -wide and bizarre beats, wide QRS -bigeminy, trigeminy, couplets, triplets -absent p wave prior PVC |
| Ventricular tachycardia priority nursing action | check pulse! |
| Ventricular tachycardia rhythm | -rapid, life threatening, 3 PVC's in a row or more -wide QRS, regular rhythm |
| Symptoms of VT | hypotension, loss of cardiac output, may or may not have a pulse |
| Treatment for VT with pulse | -treat like SVT 1. vagal maneuver 2. adenosine 3. cardioversion |
| Treatment for VT without pulse | CPR, defibrillate |
| Torsades de pointes | -type of vtach -treat with magnesium |
| Ventricular tachycardia rhythm | -chaotic pattern, no discernible P, QRS, T wave -no cardiac output, life threatening, DEFIB |
| Asystole | death, CPR, epinephrine, then maybe defib |
| Pulseless electrical activity | -must treat the cause -CPR, epinephrine |
| What causes a pt to go into a lethal arrhythmia | H's & T's |
| H's & T's | -hypoxia, hypovolemia, hypothermia, H+ acidosis, hypo/hyperkalemia -tablets (overdose) tamponade, tension pneumothorax, thrombosis (coronary or pulmonary) |
| Cardioversion and its rhythms | -electrical shock given to convert a rhythm thats too fast -vtach with pulse, afib rvr, svt |
| Defibrillation and its rhythms | -electrical shock to cease ineffective/sporadic impulses -vtach without pulse, vfib |
| Temporary pacemaker indications | MI, heart blocks, new med or wrong dose, post CABG |
| Permanent pacemaker indications | symptomatic bradycardia, complete heart block, sick sinus syndrome, cardiac arrest, atrial tacharrhythmias |
| Implantable cardiac cardioverters/defibrillator indications | Indicated for survivors of sudden cardiac death syndrome, risk for sudden cardiac death, and spontaneous or symptomatic ventricular dysrhythmias. |
| Firing, capture, sensing definitions | -initiation of current -successful stimulation of myocardium -pacemaker recognizing activity |
| Post op pacemaker patient education | wear sling, prevent arm raising for 1-2 weeks, avoid lifting, carry identification card, avoid strong magnets, notify airport security, report symptoms, no unsupervised swimming/activities, take pulse daily |
| ICD shock education | feels like blow to chest, report discharge to provider |
| Sodium channel: example, use, considerations | -lidocaine -tachyarrhythmias -hypotension, neutropenia, thrombocytopenia, lupus, CNS effects, dizziness |
| Beta blockers: example, use, considerations | -propanolol -tachyarrhythmias -hypotension, bradycardia, bronchospasms *don't give to pts with asthma |
| Potassium channel blockers: example, use, considerations | -amiodarone -conversion of afib to nsr, vtcha, vfib -pulmonary toxicity (monitor cough and dyspnea), visual disturbances, liver and thyroid dysfunction, phlebitis |
| Calcium channel blockers: example, use, considerations | -diltiazem -tachyarrhythmias -constipation, peripheral edema, hypotension |
| Digoxin use and consideration | -increases myocardial contraction, for afib, aflutter, hf, svt -watch for toxicity: nausea, visual disturbances |
| Adenosine use | for SVT or VT with pulse |
| Meds for sinus bradycardia | -atropine -epinephrine -dopamine |
| Types of shock | Hypovolemia: hemorrhage Cardiogenic: MI Distributive: systemic vasodilation sepsis, neurogenic, anaphylaxis Obstructive: tamponade |
| Initial stage of shock | -mild decrease in perfusion MAP drops 5-10 -difficult to detect, normal vitals, heart rate increases |
| Compensatory stage | -MAP drops 10-15 -urine output decreases, mild acidosis low pH, mild hyperkalemia -restlessness, irritability, increased HR RR, narrowing pulse pressure, decreased O2, cool extremity -thirst and anxiety |
| Progressive stage | -vital organs experience hypoxia, impending doom feeling -rapid weak pulse, decreased BP and O2, pallor cool moist skin, anuria, -increased lactic acid (causing acidosis) and potassium -must be corrected in 1 hour |
| Quick nursing action for progressive stage treatment | place in trendelenburg for a bolus |
| Refractory stage | -too little O2 leading to MODS -rapid loc, non palpable pulse, slow shallow respirations, unmeasurable oxygen -this stage is a code |
| Sepsis symptoms | -fever or hypothermia >38 <36 -tachycardia >90 -tachypnea >20 -increased or decreased leukocyte count |
| SIRS | bacteria spreads and systemic inflammatory response is triggered |
| Sepsis health promotion | use aseptic technique, remove foley and invasive lines, wean off ventilator |
| Risk factors for sepsis | malnutrition, immunocompromised, open wounds, recent injury, cancer, diabetes, CKD, alcoholism, hepatitis, HIV/AIDS, advanced age |
| Pharm for sepsis | -antibiotics, vasopressors, inotropic drugs, oxygen, fluid replacement |
| Vasopressors, vasopressin, inotropic Med examples, use, consideration | -dopamine, vasopressin, dobutamine (digoxin is oral) -shock -titratable drugs, vasopressin requires central line |
| Shock prioritization | IV fluids, cultures, lab values -oxygen first is its crazy low |
| DIC causes and treatment | -infection, trauma, shock, sepsis, -heparin |
| DIC assessment | -overt bleeding or oozing -occult bleeding -signs of platelet deficiency like petechia -decreased perfusion(change in mental status, infarction in digits or toes) |
| DIC nursing management | -correct underlying cause -assess and monitor perfusion status -administerblood and components -heparin |
| Angina types | Stable: most common, by physical exertion, exposure to col or stress, relieved by rest or nitrates Prizmetal (variant): often at night, could have coronary spasms Unstable: occurring at rest or with activity, risk for AMI |
| Physical assessment of AMI | -midsternal chest pain unrelieved with nitrates -pale, diaphoretic, dyspnea, tachypnea, hypotension, syncope, n/v -women less likely to have traditional symptoms |
| Rhythm identification for past MI | Inversion of T waves |
| Spiked T waves | hyperkalemia |
| Nursing care for AMI | MONA morphine, oxygen #1, Nitro 5mcg can cause headache, Aspirin prevents platelet aggregation |
| AMI pharm | analgesics, beta blockers, nitrates, thrombolytics, antiplatelets, anticoagulants |
| Treatment instructions for Nitrates | 1. stop activity and rest 2. put tab under tongue 3. if pain not relieved in 5 min, call 911 and take second tab 4. take third if not relieved after 5 min 5. don't take more than 3 don't swallow, record duration, frequency and characteristics of pain |
| What is a coronary artery bypass graft | restores perfusion to myocardium when theres more than a 50% blockage |
| Pre op CABG interventions | -consent, EKG, x-ray, labs, baseline vitals -identify health issues that can complicate -administer anxiolytics, prophylactic antibiotics, anticholinergics |
| Post op CABG interventions | -monitor hemodynamics, vitals, ventilator, airway -monitor rhythm, chest tubes, titrate meds, pacemaker -assess and treat pain, assist mobility, prevent infection -monitor electrolytes, I+O, nutrition |
| CABG complications | fluid/electrolytes imbalance, atelectasis, pulmonary edema, pneumonia, hypothermia, HTN, tamponade, infection |
| CABG education | -splint while deep breathing and coughs -monitor/report infection -treat angina, adhere to meds -heart healthy diet, quit smoking -remain home first week, sexual activity based on provider |
| Common aneurysm spots | thoracic, abdominal, aortic, iliac |
| Physical findings for aneurysm for AAA Thoracic Aortic disection | -low back pain, pulsating mass, bruit heard, elevated bp -severe back pain, hoarseness, cough, SOB, difficulty swallowing, decreased urine output -marfan syndrome, sudden ripping or tearing, pain, hypovolemic shock |
| Aneurysm risk factors | atherosclerosis, males, HTN, tabacco, hyperlipidemia, blunt force trauma, older adults, genetic |
| Aneurysm nursing care | maintain bp, administer antihypertensive, pain, hemodynamics, urinary output, rhythm, O2, IV access, prepare for surgery |
| Cardiac tamponade findings and nursing action | -hypotension, JVD< muffled heart sounds, narrowed pulse pressure, paradoxical pulse -notify provider, prepare for pericardiocentesis |
| Cushing's triad | loss of autonomic control -bradycardia, systolic HTN and low diastolic, bradypnea |
| ICP values | Normal: 5-15 above 20 is life threatening |
| Early signs of increased ICP | restlessness, changes in speech, irritability, confusion |
| Late signs of increased ICP | changes to vitals, cushing's triad |
| Lumbar puncture pre op nursing actions | assess anticoagulant use, have them void, assist in cannonball position |
| Causes of increased ICP | cough, hip flexion, trach suctioning, increased intraabdominal pressure, cerebral edema, increased blood volume, increase CSF |
| Head injury descriptions Concussion Contusion Diffuse axonal injury | -temporary loss of neruo function with recovery -bruising of brain results in confusion -widespread injury results in coma and fever |
| Primary vs secondary brain injury | direct injury to brain (hemorrhage, hematoma, skull fracture) something else happens first (hypotension, hypo/hypercapnia, anemia, acidosis) |
| Basilar skull fracture symptoms | rhinorrhea- torn vessels in nose, csf means torn meninges, salty tast Otorrhea- test for glucose, halo sign for csf |
| Hematomas | epidural is arteiral, pt loses consciousness subdural is venous, progresses slower |
| Symptoms of brain neoplasm | n/v, headache, seizures, change in vision or smells, personality changes, loss of balance, dizziness, difficulty speaking |
| Nursing care to lower ICP | -elevated HOB, maintain body neck alignment -maintain airway, limit o2 suctioning -stool softeners, low stim, space activities, treat fever -mannitol |
| Altered autonomic function | due to spinal cord injury bradycardia, hypotension, hypothermia- distributive shock |
| Pharm for spinal cord injury | -Steroids for pain and inflammation -monitor glucose |
| Nursing care of spinal cord injury | -respiratory statu, ventilate for c1-c3 injury, monitor for shock, neuro status, prevent pressure ulcers, stool softners, urinary devices, monitor for ileus |
| Autonomic dysreflexia and nursing actions | injury to T6 or above intense sympathetic response to stimuli like kinked catheter or fecal impaction -sit pt up, remove the cause, administer antihypertensives |
| Diagnostics for stroke | ct done in 25 min to identify hemorrhage mri for ischemia |
| Pharm for both strokes | ischemic- warfarin, tpa, aspirin hemorrhage- vitamin K if taking warfarin |
| Priority for burns in emergent phase | stop burning by removing clothes/jewelry, ABC's, fluid, pain, wound care, maintain temp |
| Nursing care for acute phase of burns | promotoe nutrition up to 2-3x more, pain control before wound care, treat like neutropenic |
| Complications of burns | ileus, compartment syndrome, fluid imbalance, sepsis, shock |
| atropine vs adenosine vs amiodarone | -increase rate, for symptomatic bradycardia -for SVT and VT with a pulse, stops heart for sec -for afib, vtach, vfib |
Created by:
yeaitsliv