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Blueprint Cardio 2

Cardiovascular Part 2 Blueprint

Elective Cardioversion Shock is synched with the R wave to avoid vulerable period of repolarization of Twave.
Cardioversion Chemical or Mechanical Methods of Converting abnormal rhythm back into normal sinus rhythm.
The best way to treat and prevent occurence of cardiac dysrhythmia is to monitor cardiac rhythm continuously.
Atrial Rate Count # of P waves on a 6 second strip and multiply by 10 (should match Ventricular rate)
Ventricular rate Count # of R waves on a 6 second strip and multiply by ten (should match atrial rate)
Regularity is measured by distance between P and R waves, if they are regular they would "march out"
Who gets AICD? used for selected clients with recurrent life-threatening tachydysrhythmias as clients with: Recurrent episodes of Vtach, Previous episodes of sinus arrest, risk for sudden cardiac death
What is AICD *Automatic implanted cardiac defibrillator*? Device made with a generator and one or two lead wires. 1st wire for defib. 2nd wire for pacemaker function. Wires inserted into subclav or cephalic vein to the apex or septum of RV. Sense rhythm of the heart for dysrhythmias will shock if needed.
AICD is checked every 3-4 months. Magnetic device placed into the generator to retrieve the stored info. Just like any other mechanical device it can malfunction, it can be too sensitive and shock the pt.
Post care AICD instructions avoid devices with magnetic fields: MRI, digi cell phones, metal detectors; carry ID about the ICD at all times, driving restrictions for 6months; when to notify md; ICD firing, symptoms, etc.
Ventricular Fibrillation is erratic twitching of ventricles with no cardiac output. Rhythm of a dying heart. Will need treatment to prevent death.
Ventricular Fibrillation Treatment Precordial thump, CPR, Defibrillation, Prevent reocurrence.
Ischemia is the number one cause of dysrhythmias
Characteristics of Normal Sinus Rhythm: Heart rate is between 60-100bpm
Characteristics of Normal Sinus Rhythm: The SA node initiates the impulse (upright P before QRS)
Characteristics of Normal Sinus Rhythm: Impulse travels to the AV node in 0.12 to 0.2 seconds (PR Interval)
Characteristics of Normal Sinus Rhythm: Each impulse occurs regularly (evenly spaced)
The usual cardiac rhythm is called normal sinus rhythm.
A dysrhythmia is a conduction disorder that results in an abnormally slow or rapid heart rate or one that does not proceed though the conduction system in the usual manner.
Cardiac output may be greatly compromised when a rhythm disturbance develops
Sinus bradycardia is a dysrhythmia that proceeds normally through the conduction pathway but at a slower than usual rate (less than or equal to 60 bpm)
The danger in sinus bradycardia is that the slow rate bay be insufficient to maintain cardiac output.
Atropine sulfate, a cholinergic blocking agent, is given IV to increase a dangerously slow heart rate.
Important pacemaker discharge instructions: Check pulse for 1 minute every day (report if less than set rate), Signs of infection, Pacemaker checks, avoidance of injury Carry ID, Battery WILL run down, Call MD for ss of decrease in CO.
Chemical Cardioversion Using medications to convert abnormal rhythm into SR; Digoxin, betapace, rhythmol, amiodarone, lidocaine, adenosine
The number one cause of cardiac dysrhythmias is myocardial ischemia which can occur from CAD, CHF, and Inadeuate ventilation.
The conduction system of the heart itself can be altered by Shock, anxiety, endocrine disorders, electrolyte impalances, medication effects, valvular heart diseases.
Regardless of WHY dysrhythmias are present, they affect cardiac output.
What to check when administering Metoprolol (Toprol XL)` Heart rate and Blood pressure
3rd degree heart block is caused by the atrial rate being faster than the ventricular rate which is usually <45bpm. There is no correlation between the atrea and ventricles
Impulses are originated in the SA node but during 3rd degree heart block they are blocked at the AV node.
3rd degree heart block is a MEDICAL EMERGENCY.
Treatment for 3rd degree heart block Atropine, pacemaker
LVNs responsibility with a cardiac drop Monitor pt. Monitor. Monitor. Then monitor some more.
Ventricular Tachycardia (V-tach) is caused by a single, irritable focus in the ventricle that initiates and then continues the same repetitive pattern. The ventricles beat very fast (150-250) and cardiac output is decreased.
V-Tach may progress into V-Fib
V-Tach Treatments Lidocaine, Procainamide, Bretylium, cardioversion, defrillation if pulseless.
Atrial Fibrillation (Afib) Multiple areas in rt atrium are sending out signal for heart to beat. Instead of contracting atria, it just quivers. Ventricles receiving multiple commands from rt. atria and try to follow. irregular rhythm and rate.
Regularly Irregular AFib
Most common arrhythmia AFib
Treatment for Afib Cardioversion, Methods used to convert rhythm back into normal sinus rhythm, Drug therapy (chemical cardioversion): lanoxin, ibutilide, flecainide, propafenone, sotolol, amiodarone, quinidine sulfate;
Afib Treatment: Maze procedure new conduction pathway is surgically created that eliminates the ectopic area in atria.
PVC is a ventricular contraction that occurs early and independently in the cardiac cycle before the SA node initiates an electrical impulse.
PVCs often cause what kind of sensation in the chest? Flip-flip or "fluttering"
S/S of PVC Pallor, nervousness, sweating, and faintness.
Many people experience occasional PVC's which usually are harmless. They may be related to anxiety, stress, fatigue, alcohol withdrawal or tobacco use.
When dangerous PVCs occur the client is given an IV bolus of lidocaine followed by an IV infusion of the drug.
Atrial Flutter Aflutter is a single area in atria initiates impulse at rapid rate of 200-400 contractions/min - only some impulse get through the AV node. Vents are beating slower than atrium.
Atrial Flutter Treatments cardiversion, digitalis, quinidine, propanolol, verapamil
P Waves in atrial flutter make a "saw tooth" pattern.
Sinus bradycardia treatment none unless symptomatic: atropine
2nd degree heart block is also known as mobitz 1 or Wenckebach
Atrial rate is greater than ventricular; atrial is regular but ventricular is NOT 2nd degree heart block
Treatment for 2nd Degree heart Block Atropine and pacemaker
Post care after CABG Watch I & O's, Turn cough deep breathe (pillow if painful), Leg exercises,
Client teaching after heart transplant increase fruit, liquids, and fiber to relieve constipation; depression is normal; There may be a "grating" sound in the chest until the seternum heals, s/s of infection, daily weight: If >2lbs in 24 hours call MD
Pronestyl is a sodium channel blocker that slows electrical conduction. Suppresses ventricular dysrhythmias
Pronestyl S/E have to do with what part of the body? GI
Cordarone is a Potassium Channel Blocker
(temporary pacemakers) An external transcutaneous pacemaker is an emergency measure for maintaining adequiate heart rate. The heart rate is paced from an external generator. Applied to the chest.
(temporary pacemakers) A transvenous pacemaker is a temporary pulse-generating device that sometimes is necessary to manage transient bradydysrhythmias such as those that occur during acute MIs or after CABG surgery.
(temporary pacemakers)The electrical lead of a transvenous pacemaker is introduced through the subclavian, external or internal jugular or cephalic vein and threaded first into the right atrium and then the right ventricle. AT THE BEDSIDE. Fluoroscopy and a cardiac monitor are used to determine the correct placement of the tip of the pacemaker.
(temporary pacemakers)Transthoracic pacemaker is inserted during open-heart surgery. They extend from the chest incision. if the client requires cardiac pacing during postop recovery the leads are connected to a temp pacing unit.
Aftercare for cardiac surgery Major goal is to prevent post-op infections Hemodynamic monitoring invasive lines DC'd ASAP to decrease the risk of infection, ventilation, cardiac assessment, chest tubes out asap to decrease risk of infection, accurate i and os, revers ioslation.
(cardiopulmonary bypass machine 1 of 3) cannulae are placed into the superior and inferior venae cavae to divert blood from the body and into the bypass system.
(cardiopulmonary bypass machine 2 of 3) The pump creates a vacuum and pulls blood into the venous reservoir. The filter clears the blood of air bubbles, clots and particulates.
(cardiopulmonary bypass machine 3 of 3) the blood hen passes thrugh the oxygenator to the pump and to the heat exchanger, which regulates the bloods temperature the blood is then returned to the body. (page406)
Heart transplant is not appropriate with a pt with a heart tumor because the tumor will just reoccur on a new heart
Emolectomy is removal of embolus regardless of procedure the vessel is opened and the thrombus is removed and teh vessel is sutured closed. May be done as emergency procedures depeneding on area and amount of occlusion.
Vascular Grafts Just as gfafts are used to bypass a disease section of a coronary blood vessel, vascular grafts are used to bypass or replace diseased sections of major systemic blood vessels.
The replacement vascular graft may be made of synthetic fiber, such as Dacron or Teflon, or may be human tissue harvested from cadavers.
A clamp is placed ambove and blow the affected area during a vascular graft and the diseased blood vessel is removed. The replacement graft is then sewn into place, and the clamps are removed. Depending on the area, cardiopulmonary bypass may be necessary.
-ectomy is removal of
P wave SA node fires and the atria contract
QRS Complex: Q wave 1st downward deflection. Contraction of the ventricles.
Deflection of Q Wave increased during MI
PR Interval From beginning of P to beginning of the QRS complex
ST Segent From the end of the S wave to the beginning of the T wave Usually a straight line.
If ST Segment is elevated... Myocardial damage has occured
T Wave Resting stage or rechariging of the ventricles
Depressed T Ischemia
Elevated T Hyperkalemia
The best way to treat and prevent occurence of cardiac dysrhythmias is to monitor your cardiac rhythm continously.
S/S of poor cardiac output hypotension, confusion, decreased urine output, thready pulse
Valsalva maneuver does what to the heart rate? Reduces it!#%@#%RWESDFUYUIK$#%$Q
asystole flatline
Most letha dysrhythmias Dysrhythmias originating in the ventricles
S/S of PVC's Fluttery feeling in chest, irregular pulse rate and rhythm
Complications related to heart surgery HTN, Hyperlipidemia, Obesity, Malignancies, CAD, Heart takes longer to respond to exercise
Disadvantages of cardiopulmonary bypass long operative period, necessity for anticoags, hypotension, need for postop blood replacement, overall decline in mental function, risk for stroke, dysrhyhms, and renal failure,
IV antiobiotic therapy for 1-2 months is considered standard treatment following a prosthetic heart valve replacement to prevent endocarditis from a staphylococcal, streptococcal, or enterococcal infection.
S/S of Heart transplant rejection Fever over 100.4, flu like symptoms, SOB, New chest tenderness, fatigue and mailase, elevated blood pressure.
narcotics must be given with caution in older adults because the respiratory system of the older adult is more sensitive to the depressent effect of narcotic analgesics
(Discharge instructions after cardiac surgery) It may take several weeks for a normal appetite to return. Increase fruits, fiber and liquids to relieve constipation or use an occasional mild laxative
(Discharge instructions after cardiac surgery) Depression is normal and temporary.
(Discharge instructions after cardiac surgery) You may have some slight problem with memory but it SHOULD not be severe.
(Discharge instructions after cardiac surgery) A painless lump, if felt at the top of the chest incision will disappear in given time
(Discharge instructions after cardiac surgery) There may be an occasional "grating" sound in the chest until the sternum heals.
(Discharge instructions after cardiac surgery) There may be some numbness in the chest if the internal mammary was used as a graft. After 1 week, the adhesive strips can be removed
(Discharge instructions after cardiac surgery) Wait to take a tub bath until all incisions are healed; take a shower until then
(Discharge instructions after cardiac surgery) Report an redness, drainage or tenderness from any incision. Loose, nonconstricting clothing promotes comfort and avoids interfering with circulation.
(Discharge instructions after cardiac surgery) Refrain from lifting, pushing, or pulling anything that weighs more than 10 lb until the physician relieves the restriction.
(Discharge instructions after cardiac surgery) Sexual relations usually can be resumed in 2-4 weeks depending on your comfort level and tolerance for activity. Climbing two flights of stairs without dyspnea or chest pain is a common guideline.
(Discharge instructions after cardiac surgery) Perform exercises as taught. Report to the doctor if swelling of the legs occurs.
(Discharge instructions after cardiac surgery) Contact your doctor if your pulse rate in your wrist or neck is more than 150 beats/min
Created by: christinego