EKG NHA Certification Exam
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| hollow muscular organ located in the thoracic cavity between the lungs just behind the sternum | heart
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| innermost layer of the heart that forms the lining and folds back onto it self to form the four valves where the conduction system is found | endocardium
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| middle and contractile layer of the heart made of striated muscle fibers interspersed with intercalated disks | myocardium
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| outermost layer of the heart that is actually the inner (visceral) layer of the pericardium | epicardium
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| sac in which the heart is contained | pericardium
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| right atrium, left atrium, right ventricle, left ventricle | the heart chambers
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| receives deoxygenated blood returning to the heart from the body via the superior vena cava which carries blood from the upper body and the inferior vena cava which carries blood from the lower body | right atrium
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| receives deoxygenated blood from the right atrium which it pumps to the lungs for oxygenation through the pulmonary artery (trunk) to the right and left pulmonary arteries | right ventricle
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| only arteries in the body that carry deoxygentated blood | pulmonary arteries
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| receives oxygenated blood returning from the lungs via the right and left pulmonary veins | left atrium
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| the only veins in the body that carry oxygenated blood | pulmonary veins
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| receives the oxygenated blood from the left atrium and pumps it to the body through the aorta | left ventricle
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| largest artery of the body | aorta
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| purpose is to prevent back flow of blood thereby assuring unidirectional flow though the heart | heart valves
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| tricuspid valve and mitral valve; located between the atria and ventricles | atrioventricular (AV) valves
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| pulmonic valve and aortic valve; shaped like half moon cusps | semilunar valves
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| located between the right atrium and the right ventricle and has three cusps | tricuspid valve
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| located between the left atrium in the left ventricle and has two cusps; also called the bicuspid valve | mitral valve
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| located between the right ventricle and the pulmonary trunk | pulmonic valve
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| located between the left ventricle and aorta | aortic valve
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| caused by diseases of the valves or other structural abnormalities | heart murmurs
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| produced by the closure of the valves | heart sounds
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| first heart sound is due to the closure of the mitral and tricuspid valves | S1 or lubb
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| second heart sound is due to the closure of the aortic and pulmonic valves | S2 or dupp
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| arteries are the right and left coronary from the aorta; veins accompany the arteries and terminate in the right atrium | vessels of the heart
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| heart is influenced by the autonomic nervous system (ANS) which is divided into the sympathetic and parasympathetic nervous systems | neural influences of the heart
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| affectys both the atria and ventricles by increasing heart rate, conduction, and irritability | sympathetic nervous system
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| affects the atria only by decreasing heart rate, conduction, and irritability | parasympathetic nervous system
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| primary characteristics of cardiac cells | automaticity, excitability, conductivity, and contractility
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| ability of the cardiac pacemaker cells to spontaneously initiate their own electrical impulse without being stimulated from another source | automaticity
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| sites that possess automaticity | SAn node, AV junction, Pukinje fibers
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| also referred to as irritability; shared by all cardiac cells; ability to respond to external stimuli; electrical, chemical, and mechanical | excitability
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| ability of all cardiac cells to receive an electrical stimulus and transmit the stimulus to other cardiac cells | conductivity
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| ability of cardiac cells to shorten and cause cardiac muscle contraction in response to an electrical stimulus; can be enhanced by medications such as digitalis, dopamine, and epinephrine | contractility
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| charge of resting cardiac cells inside as compared to outside | negative
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| when a cardiac cell is stimulated and sodium ions rush into the cell and potassium leaks out changing the charge within the cell to positive; results in contraction; flows from the endocardium to the myocardium to the epicardium | depolarization
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| ions shift back to their original places and the cell recovers the negative charge inside; results in myocardial relaxation; flows from the epicardium towards the endocardium | repolarization
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| SA node to AV node to Bundle of His to right and left bundle branches to Purkinje fibers | conduction system of the heart
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| found in the upper posterior portion of the right atrial wall just below the opening of the superior vena cava; primary pacemaker of the heart with a normal firing rate of 60-100 beats per minute | SA node
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| AV node and Bundle of His | AV junction
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| located at the posterior septal wall of the right atrium just above the tricuspid valve; one tenth of a second delay of electrical activity to allow blood to flow from the atria to the ventricles | AV node
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| found at the superior portion of the interventricular septum; pathway that leads out of the SA node; able to initiate electrical impulses with an intrinsic firing rate of 40-60 beats per minute | Bundle of His
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| located at the interventricular septum; divides in the the right and left bundle branches; functions to conduct the electrical impulse to the Purkinje fibers | Bundle branches
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| found within the ventricular endocardium; consists of a network of small conduction fibers that delivers the electrical impulse to the ventricular myocardium; able to initiate electrical impulses and act as a pacemaker at a rate of 20-40 beats per minute | Purkinje fibers
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| Consist of three bipolar leads and three augmented leads. These leads record electrical potentials in the frontal plane. | Limb Leads
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| Electrodes are applied to the left arm (LA), the right arm (RA) and the left leg (LL). Electrode and lead are also applied to the right leg which acts as a ground (or reference lead) and has no role in production of the electrocardiogram | Bipolar Standard Leads
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| the left arm is positive and the right arm is negative. (LA - RA) | Lead I
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| the left leg is positive and the right arm is negative.(LL-RA) | Lead II
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| the left leg is positive and the left arm is negative. (LL-LA) | Lead III
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| They are designated as aVR, aVL, and aVF. These leads are unipolar and they require only one electrode from one limb to make a lead. The EKG machine uses a midpoint between the two other limbs as a negative reference point | Augmented Unipolar Lead
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| the right arm is positive and the other limbs are negative | Lead aVR
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| the left arm is positive and the other limbs are negative | Lead aVL
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| the left leg (or foot) is positive and the other limbs are negative | Lead aVF
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| Six positive electrodes are placed on the chest to create Leads VI through V6 | Unipolar Precordial Leads
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| Fourth intercostal space, right sternal border | V1
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| Fourth intercostal space, left sternal border | V2
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| Equidistant between V2 and V4 | V3
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| Fifth intercostal space, left midclavicular line | V4
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| Fifth intercostal space, anterior axillary line | V5
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| Fifth intercostal space, midaxillary line | V6
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| consists of placing 10 electrodes on the patient producing 12 Leads: I, II, III, aVR, aVF, aVL; VI-V6 | routine EKG
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| graph paper with horizontal and vertical lines at 1-mm intervals. A heavy line appears every 5mm. Running speed is 25mm/sec. Machine must be calibrate so 1mV produces a deflection of 10mm. | EKG grid
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| represents time: 1mm = 0.04 seconds; 5mm = 0.2 seconds. | horizontal axis
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| represents amplitude measured in millivolts but expressed in millimeters: O.lmV = 1mm | vertical axis
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| refers to movement away from the isoelectric line either upward (positive) deflection or downward (negative) deflection | waveform
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| line between two waveforms | segment
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| waveform plus a segment | interval
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| several waveforms | complex
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| atrial activation, ventricular activation, and ventricular repolarization | normal electrocardiogram complexes
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| deflection produced by atrial depolarization; does not exceed 0.1 Is in duration or 2.5mm in height in standard, limb, and precordial leads | P wave
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| atrial activation | P wave
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| ventricular activation | QRS complex, Q wave, R wave, and S wave
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| ventricular repolarization | T wave and U wave
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| represents ventricular depolarization (activation). The ventricle is depolarized from the endocardium to the myocardium, to the epicardium. | QRS complex
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| the initial negative deflection produced by ventricular depolarization | Q wave
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| the first positive deflection produced by ventricular depolarization | R wave
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| the first negative deflection produced by the ventricular depolarization that follows the first positive deflection, (R) wave | S wave
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| the deflection produced by ventricular repolarization | T wave
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| the deflection seen following the T wave but preceding the next P wave. A prominent is due to hypokalemia (low potassium blood level) | U wave
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| interval between two R waves | RR interval
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| P wave plus the PR segment. The normal interval is 0.12 - 0.2 sec | PR interval
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| represents ventricular depolarization time. It should be no more than 0.1 sec. in the limb leads and 0.11 sec. in the precordial leads | QRS interval (or duration)
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| line from the end of the P wave to the onset of the QRS complex | PR segment
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| point at which QRS complex ends and ST segment begins | J (RST) junction
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| from J point to the onset of the T wave | ST segment
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| somatic tremors, wandering baseline, 60-cycle interference, broken recording | artifacts
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| patient's tremors or shaking the wires can produce jittery patterns on the EKG tracing. | Somatic tremors
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| sweat or lotion on the patient's skin or tension on the electrode wires can interfere with the signal going to the EKG apparatus causing the baseline of the tracing to move up and down on the EKG paper | Wandering baseline
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| can produce deflections occurring at a rapid rate that may mimic atrial flutter. This is caused by electrical appliances or apparatus being used nearby while the tracing is taken. | 60-cycle interference
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| the stylus goes up and down trying to find the signal. This can be caused by loose electrode or cables or by frayed or broken wires | Broken recording
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| How are artifacts prevented? | patient should be lying on a comfortable bed or table large enough to support the
entire body;good contact between the skin and the electrode; EKG machine must be properly standardized; proper grounding; no patient contact with electronic equipment
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| A noninvasive diagnostic procedure to determine the presence and severity of coronary artery disease | stress testing
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| What are some indications for stress testing? | • Evaluation of chest pain in patient with normal EKG.
• Evaluation of patient who has recently had a myocardial infarction.
• Diagnosis and treatment of arrhythmias.
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| What are some indications for terminating a stress test? | • Patient develops chest pain, shortness of breath, or dizziness.
• Blood pressure abnormalities
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| exercise stress test | performed until at least 85% of the target heart rate is reached or symptoms or EKG changes develop which requires the test to be terminated. Target heart rate is: 220 minus patient's age.
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| pharmocologic stress test | appropriate for patients with physical limitations; Medications (adenosine, dipyridamole, or dobutamine)are given IV to increase heart rate to the target level; concluded after 85% of the target heart rate is achieved.
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| Cardiac arrhythmias are due to what mechanisms? | Arrhythmias of sinus origin,Ectopic rhythms, Conduction blocks, Preexcitation syndromes
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| Arrhythmias of sinus origin | where electrical flow follows the usual conduction pathway
but is too fast, too slow, or irregular. Normal is 60-100 bpm; >100 per minute, it is called sinus tachycardia; <60
per minute, it is referred to as sinus bradycardia.
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| Ectopic rhythms | electrical impulses originate from somewhere else other than the sinus
node.
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| Conduction blocks | electrical impulses go down the usual pathway but encounter blocks
and delays.
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| Preexcitation syndromes | the electrical impulses bypass the normal pathway and,
instead, go down an accessory shortcut
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| What is myocardial ischemia? | occurs when there is a decrease in the amount of blood flow to a section of the heart. This is usually experienced as chest pain and discomfort and is called angina
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| What is myocardial infarction? | refers to the actual death of the myocardial cells
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| How does an MI present on an EKG? | abnormal Q waves (Q waves are >1 mm (0.04 second) wide and the height is greater than 25% of the height of the R wave in that lead) combined with changes in T waves and ST segments
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| What is the World Health Organization creiteria for the diagnosis of MI? | at least two of the following:
Clinical history of ischemic-type of chest discomfort
Changes on serial EKG tracings
Rise and fall in serum cardiac markers
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| Ambulatory EKG monitoring | enables the evaluation of the patient's heart rate, rhythm, and QRST morphology during the usual daily activities
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| Holter monitor | an ambulatory EKG done to rule out intermittent arrhythmias or ischemia that could be missed on a routine EKG
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| What is the typical electrode placement for Holter monitoring? | Two exploring electrodes are placed over bone near the VI
and V5; Two indifferent electrodes placed over the manubrium; One ground electrode placed over the 9th or 10th rib at the right midaxillary line
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| What indicates a positive Holter? | one that has recorded abnormalities that may explain the patient's symptoms which could include one or more of the following:
• Tachycardias or bradycardias
• ST segment elevation or depression
• Pauses
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| What indicates a negative Holter? | A negative Holter will have no significant arrhythmias or ST changes
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| What are some artifacts of ambulatory EKG recording? | Incomplete tape erasure; Tape drag within the apparatus; Battery depletion; Loose connection; Movement of electrodes
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| can result in EKG tracings belonging to two different patients confounding both the scanner and the interpreter | Incomplete tape erasure
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| will result in recording of spuriously rapid cardiac rhythms. A narrowing of all EKG complexes and intervals should give clue to this situation. | Tape drag within the apparatus
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| may result in varying QRS amplitude | Battery depletion
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| can result in the absence of all EKG signals which may mimic bradycardia-tachycardia syndrome | Loose connection
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| may occur during scratching the chest near the electrodes and can produce tracings that look like malignant ventricular arrhythmias | Movement of electrodes
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| What is event monitoring (event recorder)? | a hand held device carried in the patient's pocket or purse which is switched only when the patient is actually experiencing the symptom.
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| What are some common pharmacological cardiovascular agents? | oxygen, epinephrine, isoproterenol (Isuprel), dopamine (Intropin), beta blockers (Propranolol, Metoprolol, Atenolol, and Esmolol), licodaine, verapamil, digitalis, morphine sulfate, and nitroglycerin
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| How is oxygen used as a pharmacological cardiovascular agent? | Oxygen should be given to all patients with acute chest pain that may be due to cardiac ischemia, suspected hypoxemia of any cause, and cardiopulmonary arrest. Prompt treatment of the hypoxemia may prevent cardiac arrest
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| How is epinephrine used as a pharmacological cardiovascular agent? | Epinephrine is indicated in the management of cardiac arrest. The chance of successful defibrillation is enhanced by administration of epinephrine and proper oxygenation
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| How is isoproterenol used as a pharmacological cardiovascular agent? | Isoproterenol produces an overall increase in heart rate and myocardial contractility, but newer agents have replaced it in most clinical settings. It is contraindicated in the routine treatment of cardiac arrest
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| How is dopamine used as a pharmacological cardiovascular agent? | indicated for significant hypotension in the absence of hypovolemia; significant hypotension =systolic blood pressure <90 mmHg, poor tissue perfusion, oliguria, or changes in mental status.
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| How are beta blockers used as a pharmacological cardiovascular agent? | reduce heart rate, blood pressure, myocardial contractility and oxygen consumption; effective in the treatment of angina pectoris and hypertension; useful in preventing atrial fibrillation, atrial flutter, and paroxysmal supra-ventricular tachycardia.
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| What are the adverse effect of beta blockers? | hypotension, congestive heart failure and broncho-spasm.
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| How is lidocaine used as a pharmacological cardiovascular agent? | drug of choice for the suppression of ventricular ectopy, including ventricular tachycardia and ventricular flutter.
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| What are the adverse effect of lidocaine? | Excessive doses can produce neurological changes, myocardial depression, and circulatory depression. Neurological toxicity is manifested as drowsiness, disorientation, decreased hearing ability, paresthesia, and muscle twitching, and eventual seizures.
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| How is verapamil used as a pharmacological cardiovascular agent? | in the treatment of paroxysmal supraventricular tachycardia (PSVT), also useful in slowing ventricular response to atrial flutter and fibrillation
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| How is digitalis used as a pharmacological cardiovascular agent? | increases the force of cardiac contraction as well as cardiac output
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| What are the signs and symptoms of digitalis toxicity? | yellow vision, nausea, vomiting, and drowsiness
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| How is morphine sulfate used as a pharmacological cardiovascular agent? | traditional drug of choice for the pain and anxiety associated with acute myocardial infarction.
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| How is nitroglycerin used as a pharmacological cardiovascular agent? | powerful smooth muscle relaxant effective in relieving angina pectoris. It is effective for both exertional and rest angina
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| consent given by the patient who is made aware of any procedure to be performed, its risks, expected outcomes, and alternatives | Informed consent
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| key concept of HIPAA. All patients have a right to privacy and all information should remain privileged | Patient confidentiality
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| failure to exercise the standard of care that a reasonable person would give under similar circumstances and someone suffers injury because of another's failure to live up to a required duty of care. | Negligence
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| What are the four elements of negligence(4 Ds? | 1. Duty: duty of care
2. Derelict: breach of duty of care
3. Direct cause: legally recognizable injury occurs as a result of the breach of duty of care.
4. Damage: wrongful activity must have caused the injury or harm that occurred.
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| wrongful act that results in injury to one person by another | Tort
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| examples of common torts | battery, invasion of privacy, and defamation of character
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| the unprivileged touching of one person by another. When a procedure is to be performed on a patient, the patient must give consent in full knowledge of the procedure and the risk it entails (informed consent). | battery
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| the release of medical records without the patient's knowledge and permission. | invasion of privacy
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| consists of injury to another person's reputation, name, or character through spoken (slander) or written (libel) words | defamation of character
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| Good Samaritan Law | deals with the rendering of first aid by health care professionals at the scene of an accident or sudden injury. It encourages health care professionals to provide medical care within the scope of their training without fear of being sued for negligence.
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| Infection Control/Chain Of Infection | consists of links, each of which is necessary for the infectious disease to spread. Infection control is based on the fact that the transmission of infectious diseases will be prevented or stopped when any level in the chain is broken or interrupted
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| What are the links in the chain of infection? | Agent, Mode of transmission, Susceptible host, portal of exit, portal of entry
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| infectious microorganisms that can be classified into groups namely: viruses, bacteria, fungi, and parasites | Agents
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| method by which an infectious agent leaves its reservoir | Portal of exit
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| specific ways in which microorganisms travel from the reservoir to the susceptible host | Mode of transmission
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| What are the five modes of transmission? | Contact: direct and indirect
Droplet
Airborne
Common vehicle
Vectorborne
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| allows the infectious agent access to the susceptible host | Portal of entry
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| What are considered common portals of entry? | broken skin, mucous membranes, and body systems exposed to the external environment such as the respiratory, gastrointestinal, and reproductive
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| What methods can limit the transmission of the infectious agents? | sterile wound care, transmission-based precautions, and aseptic technique
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| The infectious agent enters a person who is not resistant or immune | Susceptible host
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| the destruction of pathogenic microorganisms after they leave the body; involves environmental hygiene measures such as equipment cleaning and disinfection procedures. Methods are Standard Precautions and Transmission-Based Precautions. | Medical Asepsis
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| the most important means of preventing the spread of infection | hand washing
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| Protective clothing | barrier protection
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| What are some examples of PPE? | •Masks
•Goggles
•Face Shields
•Respirator.
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| an infection control method designed to prevent direct contact with blood and other body fluids and tissues by using barrier protection and work control practices | standard precautions
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| When should Standard Precautions be used? | when there is a possibility of contact with blood, body fluids, nonintact skin, mucous membranes, and recognized and unrecognized sources of infections
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| What are the standard precautions? | Wear gloves when collecting and handling blood, body fluids, or tissue specimen.
• Wear face shields when there is a danger for splashing on mucous membranes.
• Dispose of all needles and sharp objects in puncture-proof containers without
recapping.
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| second tier of precautions and are to be used when the patient is known or suspected of being infected with contagious disease. They are to be used in addition to standard precautions | Transmission- Based Precautions
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| What are the categories of isolation? | contact precautions, airborne precautions, and droplet precautions
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| designed to reduce the risk of transmission of microorganisms by direct or indirect contact | contact precautions
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| designed to reduce the risk of airborne transmission of infectious agents. | airborne precautions
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| designed to reduce the risk of droplet transmission of infectious agents; involves contact with mucous membranes of the nose or mouth of a susceptible person with large-particle droplets generated during coughing, sneezing, or talking | droplet precautions
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