lots of cardiac, rhythms, how to read ekgs
Help!
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| Formula for Cardiac Output | Cardiac Output= SV X HR
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| Risk Factors for Cardiovascular Disease | Smoking, Obesity, Stress, Sedintary, Diabetes, Male, Age
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| S/S of CVD | angina, dyspnea, fatigue, palpitations, sudden weight gain, pain, cramps, syncope
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| Define: Syncope | Fainting
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| Nurse assessment for CVD | skin color, VS, edema, JVD, ausculatation of heart
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| How many directions does blood flow? | one direction
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| What % of blood is dumped when a valve is opened? | 70%
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| What is the 2 most important parts of the heart? | ventricles and the "left side"
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| What is the normal pulmonary pressure of the heart? | 20/10
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| What does the "lubb-dupp" sound indicate? | the valves opening and blood rushing through
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| S/S of pulmonary edema? | JVD, crackles, SOB, dyspnea
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| Pulmonary edema = ____ Pressure, ___ Volume | High, High
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| Rx to decrease pressure/volume | diuretics
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| Define: Vascular disease | disease of the valves when the valves won't open to allow blood to flow, causing high pressure to open the valves
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| What does the heart need in order to function? | oxygen and blood
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| What are the 2 arteries that branch off the aortic valve? | Left/Right Coronary Arteries
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| Define: Collateral Circulation | improves circulation by finding new pathways around a heart blockage by forming new branches of arteries
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| What occurs is the left main artery, "widow artery" is blocked? | DEATH
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| What does the posterior descending artery feed? | muscles of the body the posterior heart
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| What mineral is inside a cell? | Potassium, (K+)
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| What mineral is outside a cell? | Sodium, (Na+)
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| During depolarization what does the minerals of the cells do? | Na+ leaks into the cell, the cell and K+ tries to pump it back out and becomes depolarized
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| How does a cell repolarize? | when Na+ is back outside the cell after moving from depolarization and from inside the cell- causing an electrical stimulus
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| What is the SA node and its rate? | 60-100; "pacemaker" of the heart; sends stimulus most rapidly
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| What is the AV node rate? | 40-60
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| _____ always precedes ______ | electrical; mechanical
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| If ______ precedes _____ the rhythm becomes V-Fib | mechanical; electrical
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| Define: Cardiac Output | amount of blood ejected each minute
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| Normal Cardiac Output Amount | 4-8 mL/minute
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| Formula for Cardiac Output per Body Weight | Cardiac Output/Body Surface Area
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| Define: Stroke Volume | amount of volume pumped each minute
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| Stroke Volume Rate | 50-60mL
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| As you bleed, SV will ____ which causes HR to __ | decrease; increase
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| S/S of Decreased Cardiac Output | clammy, cold, poor cap. refill, pale, decreased BP/LOC/Urine Output
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| What medication helps to lower preload? | Nitroglycerin
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| Explain Preload | "rubberband"; as volume increases so does contractility
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| Explain Afterload | "bicycle pump"; left ventricle pressure must be greater than systemic pressure
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| What medications help to lower afterload? | antihypertensive meds
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| Questions for pt. about chest pain? | pressure?, pain?, radiating?, sharp?, SOB?, does it occur during activity/eating/night?
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| What is the number one sign of heart disease? | Fatigue
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| Define: Palpitations | fluttering, dysrhythmias
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| What does sudden weight gain indicate? | pulmonary edema, fluid retention,CHF
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| What does extreme chest pain indicate? | a possible clot or imbalanced electrolytes
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| When does a pt always have JVD? | when lying down
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| Which jugular vein do you want to look at when checking for JVD? | Internal Jugular
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| What does JVD indicate? | Heart Failure due to an Increase in volume
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| Define: PMI | Point of Maximal Impulse
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| Where do can PMI be located? | 5th intercoastal, Left midclavicular
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| What does PMI help in assessing? | if the heart is enlarged, the PMI will shift
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| Where is S1 loudest? | at the apex
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| Where is S2 loudest? | at the base
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| When S3 is heard, it indicates? | possibly too much blood flow
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| When s4 is heard, it indicates? | possibly a stiff ventricle
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| When is s3 usually heard and what does it sound like? | after s1 and s2; lub dupp dupp
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| When is s4 usually heard and what does it sound like? | before s1; lub lub dupp
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| What is a murmur? | "turbulence" thru a valve causing a swooshing noise
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| Explain an electrocardiography | helps see the chambers of the heart
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| What is the TEE and how does it work? | an ultrasound that enters thru the esphogaus and helps to see if clots are forming
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| What is can be both chemical and mechanical? | a stress test
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| Explain Myocardial Perfusion | a test using a dye to see if part of the heart has been damaged
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| Explain Coronary Angiography | a wire that enters the coronary artery and shoots dye into the heart to see how well it is processed thru the heart
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| Is coronary angiography diagnostic or treatment? | diagnostic
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| Nursing Actions for a coronary angiography | monitor below puncture site, push fluids to help get contrast out, look at perfusion of lower limbs
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| What is hemodynamic monitoring? | provides info. about cardiac effectivness, blood voume and tissue perfusion
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| What instruments are used in hemodynamic monitoring? | balloon tipped catheter
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| How does hemodynamic monitoring work? | the cath recieves pressure waves from heart chambers and coverts the mechanical energy to electrical which is displayed via monitor
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| What is the swan-ganz or pulmonary artery catheter? | cath inserted into right atrium through vena cava or jugular and wedges into the branch of the pulmonary artery
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| What does the swan-ganz cath do? | shows wedge pressure of heart will help show info. about left ventricle and left atrial pressures and volume
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| What does PCWP stand for? | Pulmonary Capillary Wedge Pressure
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| What diagnosis' would need a swan-ganz cath? | MI, CHF, etc.
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| What is normal wedge pressure? | 8-12 mm/Hg
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| If wedge pressure is higher than normal what does that indicate? | heart is working too hard to pump blood due to too much fluid or vasoconstriction
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| How long does a swan-ganz cath stay in? | 24 hours to 2 wks
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| For both right and left side of heart, what are normal wedge pressures? | right=lower; left=higher
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| If left wedge pressure is higher what does this indicate? | left ventricular failure, valvular disease, tamponade, fluid overload
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| If left wedge pressure is lower what does this indicate? | hypovolemia or vasodilation
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| A pt. is being assessed to r/o CV problems. The RN understands that some of common S/S of CVD are: | SOB, chest discomfort, palpitations
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| A pt. returns post coronary angiography to the floor. What is the priority intervention following this procedure? | puncture site observation b/c bleeding is priority
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| What client is at greatest risk for developing CVD? | look at most # of risk factors
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| List the electrical pathway of the heart. | Sa node triggers electrical impulse traveling to AV node then to Bundle of His and to Purkinje Fibers
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| What is a lead? | a camera that looks at the heart from different angles and takes pics of its electrical activity
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| What does a flat line on an EKG indicate? | no electrical activity in the heart
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| What is the 1st hump of an EKG? | P-wave
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| What does the P-wave indicate about the heart? | atrial depolarization
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| What is atrial depolarization? | where Na+ rushes into the cell and changes gradients to make the K+/Na+ pump push Na+ back out (Electrical)
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| What is directly after the P-wave and what does it indicate? | a flat line; waiting for atria to contract
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| What is the 2nd wave of an ekg? | QRS wave
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| What does the QRS wave indicate? | ventricular depolarization/atrial repolarization
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| Of the QRS wave, which is negative and which is positive? | q is negative; r is positive; t is negative
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| What is the 3rd wave of an ekg? | t-wave
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| What does the T-wave indicate? | ventricular repolarization
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| Define: Ventricular repolarization | recovering and getting ready for a new contraction
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| Out of atrial/ventricular and de/repolarization which is the most vulnerable? | ventricular repolarization is most vulnerable period where rhythm can be changed
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| High K+ in cells can cause spiked ___ waves? | T-waves
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| Waves or amplitudes are bigger if: | the heart is bigger
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| On an EKG, how do you find the HR? | looking at a 6 sec. strip, count # of QRS waves and multiply by ten
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| What do calipers help do? | help to measure regular/irregular rhythms over time
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| S/S of Normal Sinus Rhythm | HR:60-100; Regular Rhythm; p-wave is before QRS
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| What is a 12 lead EKG used for? | Used with MI; reflects wall of the heart
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| How is a dsyrhythmia classified? | location of atria/ventricle, brady/tachy, premature waves
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| Between atrial and ventricular which arrhythmia is more lethal? | ventricular; atrial is just when the AV node becomes the pacemaker instead of the SA node
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| What can cause a PAC arrythmia? | High levels of caffeine or stress
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| Explain a PAC? | Occurs right before P-wave and is a dip under the baseline
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| Explain Sinus Bradycardia | less than 60bpm, regular, looks like normal sinus just slower
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| Rx: Sinus Bradycardia | VS, may be normal if athletic; check for shock
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| Explain Sinus Tachycardia | between 100-160bpm, regular, looks like normal sinus just faster
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| What could cause sinus tachycardia? | anxiety, exercise
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| What could cause sinus bradycardia? | age, athletic
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| Rx: Sinus Tachycardia | VS, treat underlying condition
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| Are PAC benign or fatal? | benign
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| Rx: Atrial Flutter | give Coumadin
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| S/S of Atrial Flutter on EKG | HR: 220-430bpm, regular or irregular, sawtoothed, alot of P-waves
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| Explain Atrial Flutter | the impulse circulatees in the atria and instead of contracting the heart flutters
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| S/S of Atrial Flutter thru VS | decreased Cardiac Output, decreased BP/Perfusion,
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| Pts w/ Atrial Flutter are at increased risk for? | risk for pulmonary edema and cranial embolus
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| What is most common arrhythmia? | atrial fibrillation
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| S/S of Atrial Fibrillation on EKG? | HR:350-650bpm, irregular,no p-waves
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| Rx of A-Fib | give coumadin or put in pacemaker if ventricles aren't getting enough blood, cardioversion, radiofrequency ablation
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| A-fib thru stethoscope? | pulse and apical pulse will be irregular
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| What can A-Fib cause? | a stroke
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| What causes A-Fib? | ischemia
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| What is SVT? | Supraventricular Tachycardia
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| AKA SVT? | Paroxysmal Atrial Tachycardia, PSVT, PVT
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| S/S of SVT? | "sudden", starts out in Normal sinus rhythm then goes into SVT
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| Rx of SVT? | Adenosine
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| What does adenosine do to the heart? | stops heart for a long pause and then restarts heart into normal sinus node
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| How to give adenosine? | 6mg push very fast, if heart doesn't stop give 12mg
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| How to treat SVT at home w/o meds? | do valsalva maneuvers and carotid massages
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| Explain Cardioversion | planned, with anesthesia, with electricity, give Versed/Valium, put on 50jewels and deliver shock but not on t-wave
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| Why can't you deliver shock on a cardioversion on a t-wave? | b/c it will cause ventricular tachycardia
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| Explain Radiofrequency ablation | pinpointed in cath lab, invasive, finds and destroys area where extra impulses are
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| Explain Defibrillation | 360jewels of shock, shock pads
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| Explain PVC | t-wave is always inverted, wide QRS
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| If Pt. has PVC what is their risks? | increased risk for v-tachy
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| Rx of PVC | Lidocaine
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| S/S of V-Tach for patient | decreased BP, barely 0+ pulse, 3+ PVC beats in a row, awake, alert, racing heart
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| Rx of V-Tach | if stable can give Amiodarone if unstable use defibrillator
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| S/S of V-Tach on EKG | +100bpm, regular, wide QRS,
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| S/S V-Fib | 300-600, irregular, no p-wave, chaotic, no pulse/BP/waves,
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| Rx V-Fib | Amiodarone/defibrillator/implantable cardioverter/radiofrequency ablation
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| S/S of Ventricular Asystole | little or no electricity, no contraction,
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| RX of Ventricular Asystole | do CPR, give epinephrine before defibrillator
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| Risk of Ventricular Asystole | DEATH
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| Explain Implantable Cardioverter | aka AIEC, monitors heart and shocks when needed
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| Explain radiofrequency ablation | kills tissues that send bad impulses
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| Pt with CVA, monitors shows dysrhythmia and irregular rhythm with rate of 120-160bpm w/o P waves. Identify rhythm as? | atrial-fibrillation
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| Treatment for v-tach to v-fib | Defibrillation
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| Rn prepares pt. for cardioversion, what is priority intervention? | turn on sync button
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| On EKG what is vertical axis? | amplitude or size
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| On EKG what is horizontal axis? | time
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| Adenosine is given for? | Tachycardia and PSVT/SVT
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| SE of Adenosine | flushed, dizzy, headache, dyspnea
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| Adenosine classification | chemical cardioverter
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| Amiodarone classification | antiarrhythmic
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| Amiodoarone is given for? | v-tach/fib
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| Amiodarone is given via? | IV or PO
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| SE of Amiodarone | vasodilation, hypotension
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| Explain process of beta blockers | works on entire body to slow all processes down
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| Beta Blockers do what to pt. suffering? | lower BP, stops angina, prevents rhythm issues
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| SE of Beta Blockers | VERY fatigued, dizzy, hypotension, bradycardia
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| Suffix of Beta Blocker | OLOL
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| Diogoxin Classification | inotropic, antiarrhythmic
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| Define Inotropic | increases contractility of heart but slows HR
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| Nursing Implications of Digoxin | check apical pulse for 1 min and it must be greater than 60bpm in order to givecheck K+ to make sure not hyperkalemic b/c
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| TL of Digoxin | 0.5-2.0
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| Diltiazem classification | calcium blocker
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| What does a calcium do in the body? | Ca+ helps to contract muscles
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| Give Diltiazem for? | A-fib, A-flutter, PSVT
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| Digoxin is given for? | chronic A-fib
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| When to not give Digoxin? | Hypotension with systolic BP less than 90
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| SE of Digoxin | hypotension, bradycardia
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| How to give Digoxin? | give bolus then IV, then PO, taper
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| What does Diltiazem do to the heart? | decreased contractility to slow down the HR
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| Epinephrine is given for? | cardiac arrest, before defibrillation, allergy shock
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| How many times can Epinephrine be given? | every 3-5 minutes
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| SE of epinephrine | angina, tachycardia
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| Lidocaine classification | antiarrhythmic, numbing agent
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| Lidocaine is given for? | PVC
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| What does Lidocaine do to the heart? | numbs heart to where abnormalities don't fire
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| How to give Lidocaine? | given as bolus then drip
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| SE of Lidocaine? | confusion, agitation, anxiety
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| What is preload? | volume of blood in ventricles at end of diastole
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| What is afterload? | left ventricle must overcome resistance to circulate blood
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| When is preload increased? | during hypervolemia, regurgitation of cardiac valves
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| When is afterload increased? | hypertension and vasoconstriction
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| If afterload increases, what else increases? | Cardiac workload
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| What are the three levels of damage for MI? | ischemia, injury, infarction
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| Describe infarction | o2 deprived, irreversible, causes Q waves
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| Describe MI injury | tissue is almost necrotic but is reversible, causes S-T elevation
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| Describe ischemia | causes depressed s-t segment, is helpful if pt has collateral circulation
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| What are the 2 types of angina? | unstable and stable
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| What is CAD? | Coronary Artery Disease
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| What causes athrosclerosis? | high fat diets, aging, history, stress, obesity
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| Of stable/unstable angina which is better? | stable
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| S/S of stable angina? | pressure, pain, occurs with exertion
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| Rx of stable angina? | sit down, deep breaths, take nitro
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| how is stable angina relieved? | with rest and nitro
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| S/S of unstable angina? | chest pain with rest or minimal exertion
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| When does unstable angina usually occur? | after meals or during sleep
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| If unstable angina, at risk for? | MI
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| Precautions for Nitro pill | light sensitive, don't touch!, vasodilator everywhere
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| How to take nitro? | take every one minute up to 3 pills, assess BP each time and if pain still doesnt go away go to ER
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| The quicker perfusion is increased, the quicker ____ is turned back to _____ | infarction; ischemia
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| When heart becomes ____, EKG changes are noted | ischemic
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| EKG + Ischemia = | s-t segment elevation
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| EKG + Infarction = | very tall q wave
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| What happens to the heart with infarcted tissue? | no contractility and can cause HF
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| The extent of infarction depends on | collateral circulation, workload of myocardium
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| What is the suffix of drugs that lower cholesterol? | -"statin", ex. Lovostatin
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| What to monitor in meds that lower cholesterol? | LFTs, if LFTs are increased, must D/C and change drug
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| Nitro __ workload of the heart, ___ oxygen demand and__ pre/afterload | decrease;decrease;decrease
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| What does morphine do to the body? | decreased pain, pre/after load and BP; vasodilatees
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| WNL range of morphine? | 2-4mg IVP
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| When do you give Morphine for MI? | after giving all Nitro and aspirin
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| What is the worst and most common MI? | anterior MI
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| If pt. has LAD obstruction whattype of MI? | anterior MI
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| If pt. has Circumflex obstruction what type of MI? | posterior/lateral MI
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| If pt. has RCA obstruction what type of MI? | inferior MI
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| What are lab tests performed for MI? | Troponin, CK-enzyme, lipids, triglycerides
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| When are enzymes released from cells? | when the cells die
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| Normal levels of CK-enzyme? | 0, the more + the worse the MI damage
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| Normal level of Cholesterol | less than 200
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| In assessing MI pt. what do RN assess for? | description of pain, VS, HR/rhythm, pain radiation, abnormal heart sounds
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| What heart sounds are heard with MI? | S1, S2, S4
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| With MI pain radiation, where does pain radiate to? | jaw, chest, arm, back
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| Pt. with MI would appear to look like? | cold, clammy skin, decreased distal pulses, decreased perfusion,
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| Pt. with MI, lungs would sound like? | crackles if leading to progression of HF
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| Classification of ACE inhibitors | vasoconstrictor, usually ends with -"pril", helps prevent conversion of angiotension from 1 to 2
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| What are ACE inhibitors given for? | MI and hypertension but are mild
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| SE of ACE inhibitors | non-productive, dry cough
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| Classification of Ca+ Channel Blockers | ends in -"dipine" except for Cardiazem
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| What is the role of Ca+ Channel Blockers | to decrease BP and HR
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| What is the Pain management sequence for MI? | MONA
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| What is the order sequence for Pain management of MI? | 1. Oxygen, 2. Nitro/Aspirin, 3. Morphine (only if still in pain)
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| What do fibronolytics do? | dissolve blood clots
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| When to give fibronolytics? | if meet qualifications; absolute = Do not giverelative = risk v benefit
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| SE of fibronolytics | Bleeding
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| Nursing action with fibronolytics | check stool and urine and iv site for oozing or blood
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| Major to watch for with fibronolytics | pt. will go into V-tach, treat v-tach; its good b/c shows reestablished perfusion
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| Explain glycoprotein inhibitors | target platelets, Short term, stops platelets from being sticky to reduce risk of clots
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| Examples of fibronolytics | tpa, activase
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| Examples of Glycoprotein inhibitors | reopro, aggrastat
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| SE of Glycoprotein inhibitors | bleeding! possible allergic reaction that causes a rash so give Benadryl
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| Explain Plavix | antiplatelet effect; long term; 75mg daily
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| Explain Aspirin | antiplatelet effect; long term;
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| Explain Beta Blockers | decreased afterload, HR, BP, fatigue; long term; end with -"olol"
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| Monitor what with Beta Blocker | BP, HR, VS
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| ACE Inhibitors dont affect __ | HR
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| Examples of Ca+ Blockers | Nitedipine
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| Explain PTCA | put stents in artery; never occurs in left main!
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| Post PTCA monitoring | lay flat, watch pedal pulse, push fluids, pain m, give aspirin/plavix
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| Define: Cardiac Tamponade | heart begins to leak and blood fills sack of heart and stops heart from filling with blood
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| S/S of Cardiac Tamponade | decrease Cardiac output/stroke volume/BP/HR, increased PCWP, muffled heart tones, JVD, crackles
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| Cardiac Tamponade with decreased BP, think ___ ___ | Pulsus Paradoxus
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| Define: Pulsus Paradoxus | BP decreases 15mmHg when taking big deep breath
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| Rx of Cardiac Tamponade | surgery and repair area thats leaking and put in chest tube
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| What is CABG? | bypass surgery
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| Explain CABG | removes sapheneous vein from leg and attach it to aorta and blood vessel below where there is a blockage
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| During CABG, explain what to do with heart | give cold potassium (Cardioplegia) to stop heart and to decrease metabolic needs
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| Define: Cardioplegia | cold potassium given to stop heart with CABG surgery
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| 1st Post-Op stage of CABG- Nursing actions | slowly warm up pt, monitor pressure with Swan Ganz, iv fluids, give warm blankets, watch chest tubes,
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| What will pt. appear like during 1st Post-Op stage? | asleep, hypothermic, ventilator
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| Rx of CABG | give Heparin (may ooze) and give morphine
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| 2nd Post-Op stage of CABG- Nursing actions | watch for atelactasis, dysrhythmias, watch wound and dressing, watch hemodynamics and pericardial friction rub
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| Define: Atelactasis | alveoli collapses in lungs leading to pneumonia
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| Rx of Atelactasis | incentive spirometry, cough, deep breathe
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| What Dysrhythmias to look for with CABG | A-fib/PVC
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| What labs to watch for with CABG? | K+, Mag, O2
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| Precautinos with CABG | cant drive for 6wks, watch for infection
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| Define: Pericardial Friction Rub | hear "lubb" squeak "dupp, expected with CABG, no pain,
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| 3rd Post-Op of CABG-nursing actions | Usually 6-8wks, pt to cardiac rehab, med/diet, risk factors
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|
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