infomation for exam #1
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| This Heart Rhythm has a P wave for every normal QRS complex, is consistent and HR of 60-100. | Normal Sinus Rhythm or NSR
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| This heart rhythm has a P wave for every normal QRS complex, is consistent and a HR <60. | Sinus Bradycardia or SB
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| What is the treatment for SB if patient was Symptomatic? | May give Atropine.
May need a pacemaker.
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| This heart rhythm has a P wave for ever normal to narrow QRS complex, is consistent and a HR >100. | Sinus Tachycardia or ST
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| What is the treatment for ST? | Treat the cause of tachycardia
Valsalva Maneuver
May give Beta Blockers
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| What heart rhythm has 2-3 P waves for every normal QRS complex (saw tooth waves)? | Atrial Flutter
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| What is the treatment for Atrial Flutter | Cardioversion
May give Diltiazem
Digoxin
Verapamil
Quinidine
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| What heart rhythm has no normal P waves, no measurable PR interval, normal QRS complex, Atrial HR of 300-600, Ventricular HR of 50-180? | Atrial Fibbrillation
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| What is the Treatment for Atrial Fibrillation? | Cardioversion
May give Diltiazem
Digoxin
Verapamil
Quinidine
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| What heart rhythm has an irregular rate, P waves that are rarely seen or lost in the QRS comlex, no measurable PR interval, QRS complex that are wide and "bizarre" that measure more than 0.1 sec? | PVC or Premature ventricular contractions
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| What is the treatment for PVCs on a stable patient? | Give Amiodarone,Lidocaine,Magnesium Sulfate or Procainamide
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| What is the treatment for PVCs on an unstable patient? | Cardioversion
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| What is the treatment for PVCs on a pulseless patients? | Defib, ACLS
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| What heart rhythm has an irregular rate that is not measurable, no visible P waves, no measurable PR interval, no measurable QRS complex? | Ventricular Fibrillation or V. Fib.
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| What is the treatment for a patient who is in V. Fib? | Defibrillation STAT. ACLS protocols, Monitor ABGs for O2 levels
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| What heart rhythm has an impulse delay at the AV node, a regular rhythm, a PR interval that is >0.2 seconds and consistent, a normal QRS complex? | First Degree AV block
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| What heart rhythm has PR intervals that vary & gradually lengthens until a QRS is dropped, then repeats itself? | 2nd Degree AV Block Type 1 OR Mobitz I or Wenckeback
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| What is the treatment for a 2nd degree AV block Type I on a patient who is symptomatic? | Atropine and Temporary Pacemaker
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| What heart rhythm has some P waves that are nonconduction so there is usually 2-3 waves for every 1QRS complex BUT when P waves are conducting , the PR is normal? | 2nd degree AV block Type II or Mobitz II
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| What is the treatment for a 2nd degree Type II heart rhythm? | May give Isoproterenol, Atropine, Epinephrine or Dopamine as temporary measures while waiting for a pacemaker to be inserted.
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| What heart rhythm has an atrial HR of 60-100 and regular, ventricular HR that varies and is regular, normal but not conducting P waves, a PR interval that varies with no relationship between P and QRS, and a QRS Complex that is wither normal or abnormal? | 3rd Degree AV block Complete.
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| What is the treatment for a 3rd degree AV block --complete? | Give Isoproterenol, Atropine, Epinephrine or Dopamine. Put in a temporary pacemaker until permenant pacemaker can be implanted.
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| What heart rhythm has a lack of ventricular contractions? | Asystole
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| What is the treatment for a patient in Asystole? | CPR, ACLS protocols, intubation...
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| What is the name of the lining that surrounds the heart and it's functions? | Name: Pericadium or Pericardial Sac
Function: anchors heart in place; prevents ventricles from over filling
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| What is the purpose of the fluid that is between the heart and the pericardium? | The fluid acts as a lubricant to reduce friction.
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| Name the layers of the heart wall and their thickness and location? | Endocardium/thin inner layer
Myocardium/midde-thick layer
Epicardium/ outer thin membrane
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| What is the function of the myocardium? | It is muscle layer of the heart that is responsible for contraction.
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| List the blood flow through the heart. | In from Vena Cava, Right Atrium, Tricuspid Valve, Right Ventricle,Pulmonic Valve, Pulmonic Artery, In from Lungs, Left Atrium, Mitral Valve, Left Ventricle,Aortic Valve, Aorta, out to body
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| What is the purpose of the chordae tendineae? | Prevent backflow into the ventricles. Make sure the valves stay shut.
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| In a cell at rest or repolarized call which charge is inside the cell and outside the cell? Name the Ions that would be inside or outside? | (+) charge inside/ (-) charge outside
Na+ & Ca+ inside / K+ and Cl- outside
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| In a depolarized cell which charge is inside the cell and outside the cell? Name the Ions that would be inside or outside? | (-) charge outside/ (+) charge inside
K+ & Cl- outside/ Na+ & Ca + outside
(caused by Na+ moving across the membrane and into cell).
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| What is happening in the heart at the P wave on an EKG? | the firing of the SA node and the depolarization of the atria causing atrial contraction.
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| What is happening in the heart at the QRS complex on an EKG? | Depolarization of the ventricles resulting in contraction and Atria filling with blood.
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| What is happening in the heart at the T wave on an EKG? | Repolarization of the ventricles; the heart is at rest.
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| List the pathway for an electrical impulse that is traveling through the heart. | Starts at SA node, travels through atria to AV node, delays briefly, Atria contract, travels down through Bundle of His into R & L Bundle branches into purkinje fibers, venticles contrac,then repolarization.
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| Define Cardiac Output (CO) and the formula for calculating CO? | the amount of blood pumped by each ventricle in 1 min.
CO = SV X HR
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| What factors effect CO? | HR affected by the Autonomic Nervous System.
SVR is affected by Preload, contractility, and afterload.
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| What is SV and the formula to calculate SV? | Stroke volume: the mount of blood ejected by the ventricles with each beat.
SV = (CO x 1000)/HR
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| Define Dromotropic effect? | the speed of conduction through the AV node.
(+)= increased speed
(-)= decreased speed.
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| Define Chronotropic effect? | when the pulse is affected.
(+)= increased pulse
(-) = decreased pulse
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| Define Inotropic effect? | changes in contractility that affects contractions.
(+)= increased contractility
(-)= decreased contractility
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| Define Preload? | the stretching of muscle fibers in the ventricles as the ventricles fill with blood.
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| Define Contractility? | the inherent ability of the myocardium to contract normally. It is influenced by preload. The more stretch, the more forceful contraction.
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| Define Afterload? | it is the amount of vascular resistance that must be overcome by the ventricles to pump the blood.
SVR = a measure of L afterload (systemic vascular resistance)
PVR = a measure of R afterload
(Pulmonary vascular resistance)
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| What is automaticity? | the ability of a cell to initiate an impulse without outside stimuli (ex. SA node generating an impulse)
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| What is excitability? | the ability of a cell to respond to a stimulus and initiate an impulse (AV node)
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| What is Conductivity | the ability of cardiac cells to conduct an electrical charge.
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| What is Contractility? | the ability of the cardiac cells to contract when stimulated.
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| What is Refractoriness? | cells are not able to respond to the stimulus until that have recovered (repolarized) from the previous stimulus.
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| IN the SNS (sympathetic Nervous System) name the common Neurotransmitters (NT) and what CV changes occur when the SNS is stimulated? | NTs: Norepinephrine (nor-epi) and Epinephrine (epi).
Stimulation causes:
increased Pulse (+) chronotropic
Increased conduction speed (+) dromotropic
Increased force of contraction (+) inotropic.
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| IN the PNS (parasympathetic Nervous System) name the common Neurotransmitters (NT) and what CV changes occur when the SNS is stimulated? | NTs: ACh or Acetylcholine
Stimulation causes:
Decreased Pulse (-) chronotropic
Decreased Conduction (-) dromotropic
Decreased force of contraction (-) inotropic.
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| What subjective data do you need during your CV assessment? | history,current and past health problems, current medications, socioeconomic status, risk factors.
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| What objective data do you need during your Physical Exam for your CV assessment? | PE: skin color and temp, BP and VS, Jug. vein pressure, heart sounds.
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| What diagnostic and labs are looking for your CV assessment? | Labs: CBC, e-lytes, ABG, coag. levels, cardiac enzymes (CK-MB, troponin, CPK...), serum lipids, CXR, coronary angiography, Cardiac Cath, EKG, stress test, Echo,EPS (electrophysiography study), Transesophageal Echo (TEE), Nuclear Imaging (Thallium imaging)
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| What is hemodynamic monitoring? | Invasive lines that monitor CV pressures and blood flow.
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| Define Starling's Law? | the more a muscle is stretched, the stronger a contraction will be until after some point, additional stretching only cause a decrease in strength of contractions.
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| What does the arterial line measure in hemodynamic monitoring? | The arterial in measures the L ventricle afterload or SVR.
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| What does the pulmonary arterial line (i.e. Swan-Ganz line) measure in hemodynamic monitoring? | The pulmonary arterial line measures the R ventricular afterload or PVR.
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| how does decreased peripheral resistance affect afterload, CO, and O2 required by the heart? | Afterload: decreased
CO: increased
O2: decreased
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| What are some complications of that can occur with Arterial Lines? | Hemorrhage if cath is dislodged.
Infections
thrombus formation
distal circulatory occlusion.
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| Why is it important by monitoring Pulmonary Arterial Pressure | Fluid maintenance can be maintained without overload; preload can be regulated; CO can be maintained without going into pulmonary edema.
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| What does the circulatory asssitive devices do? | stabilize & maintain pts with heart failure
decrease L vent workload
increased myocardial perfusion
augments circulation by reducing L vent afterload.
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| Repolarized cell or cell at rest have ____ charge outside & ____ charge inside? List the charge and the ions. | repolarized cells or cells at rest have __+__ charge outside & __-__ charge inside.
Na+ and Ca+ outside & K+ and Cl- inside.
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| Depolarized cells have ____ charge outside & ____ charge inside List the charge and Ions. | Depolarized cells have __-__ charge outside & __=__ charge inside.
K+ & Cl- ions outside & Na+ & Ca+ ions inside.
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| What are the common symptoms of Angina? | CP: gradual or sudden onset
Chest: tightness, squeezing, indigestion
CP located mid-substernal & can radiate to neck, back, arms, jaw & fingers
Pain lasts 15-30min
Pain relieved w/ NTG
other S/S: apprehension, dyspnea, sweating,N, need to pee or burp
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| What are common symptoms of myocardial Infarction or MI? | CP: sudden onset
Chest: similiar to angina and more severe.
CP: similiar to angina but difficult to pin-point
Pain last 30m-2hrs
Pain not relieved with NTG
other s/s: similiar to angina with fatigue and vertigo.
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| Normal range values for ABGs | pH: 7.35-7.45
PaCO2: 35-45
HCO3: 21-28
PaO2: 80-100
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| Electrolyte normal range values | Na+:135-145
K+ :3.5-5.0
Ca+:9.0-10.5
Cl-:98-106
Mg+:1.3-2.1
Phos: 3.0-4.5
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| Normal Lab values for: Hgb Hct RBC WBC Platelet PT PTT INR | Hgb: female: 12-16/male:14-18
Hct: female: 37-47/male:42-52
RBC: female:4.2-5.4/male: 4.7-6.1
WBC: 5000-10000
Platelets: 150000-400000
PT: 11-12.5sec
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| Normal Lab values for Serum Lipids | Total Cholestrol: <200mg/dL
Trigylceride: <150mg/dL
HDL: >40mg/dL
LDH: <100mg/dL for mod. risk; <70mg/dL for high risk
HDL:LDL ratio: 3:1
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| Normal lab value for Troponin + rise, peak, and return times. | Troponin T < 0.20
Troponin I <0.03
Rise: 3-6 hr
Peak: 10-24 hr
Return : 4-7 days.
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| Cardiac Enzyme normal values + rise, peak and return times | Creatine Kinase (CK):
female: 30-135
male: 55-170
CK-MB: 0% of total CK
Rise within 1-3 hr
Peak: 12-24hr
Return: 2-3 days.
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| Normal lab values for LDH1,LDH2,total LDH + rise, peak and return times | LDH1:17-27%
LDH2:27-37%
(both found in heart, RBCs and kidney)
Total LDH: 100-190
Rise: 24-48 hr
Peak: 48-72hr
Return: 7-10days
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| Normal lab values for CRP (c-reactive protein)? | <10.mg/dL
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| Normal lab value for AST? | 0-35 units/L
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| Antiarrhythmics-Class I:type IA What they do? what they treat? examples NIs | Do:
slows conduction (-)dromotropic
Lowers HR (-)chronotropic
Treats: Afib, PVC, Vtach
EX: Quinidine, Procainamide, Disopyramide
NI: monitor BP, widening QRS complex, prolong QT or PR interval or heart block, watch for S/S SOB, wt. gain.
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| Antiarrhythmics-Class I:type IB What they do? what they treat? examples NIs | Do:
Shorten repolarization
Depress ventricular automaticity
Treat: PVC, VT, VF
Ex: lidocaine, tocainide
NI: monitor LOC,BP & HR, watch for tremors or seizures, watch for S/S of CHF.
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| Antiarrhythmics-Class I:type IC What they do? what they treat? examples NIs | Do:
Slows conduction (-)dromotropic
Treat:
Afib, life threatening vent. arrhythmias
EX: flecanide, Propafenone
NI: Monitor BP, S/S of CHF, for increase in dysrhythmias.
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| Antiarrhythmics-Class II: Beta Blockers What they do? what they treat? examples NIs | Do:
Slows HR (-)chronotropic
Dec. AV conduction (-)dromotropic
Dec. Contractility (-)Inotropic
Dec. BP
TREAT: AF, A-flutter, PVC
EX: -olol atenolol, metoprolol, propranolol
NI: Monitor HR & BP, Assess for SOB, insomnia,fatigue, dizzy & S/S of CHF
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| Antiarrhythmics-Class III:K+ channel blockers What they do? what they treat? examples NIs | Do: slows HR (-)chronotropic
TREAT: AF, A-flutter, life threatening vent. dysrhythmias
EX: amiodarone, Ibutilide
NI: monitor HR & BP and ECG
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| Antiarrhythmics-Class IV:Ca+ channel Bockers What they do? what they treat? examples NIs | Do:delay conduction (-)dromotropic
depress automaticity
Dec HR (-)chronotropic
Dec Contactility (-)Inotropic
Prolong refractory
TREAT: Afib, Aflutter
EX:Verapramil, Diltiazem
NI: Monitor HR & BP, Dig levels, SS of CHF, change positions slowly.
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| Digoxin (antiarrhythmic) What they do? what they treat? NIs | Decreases HR (-) chronotropic
Increases conduction (+)dromotropic
increase contraction (+)inotropic
TREATS:AF, CHF,A-flutter
NI: Apical HR x 1 min before admin.
check dig levels : 0.8-2ng/dL
monitor for CHF, ECG, HR, BP
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| Atropine What they do? what they treat? NIs | DO: increases HR (+)chronotropic
TREATS: bradycardia
NI: monitor HR, BP, ECG,
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| Adenosine What they do? what they treat? NIs | DO: decreases conduction (-)dromotropic
TREATS: PSVT
NI: monitor HR, BP, ECG
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| Magnesium Sulfate What they do? what they treat? NIs | DO: decreases myocardial cell activity
TREAT: VT, VF, Atrial Paroxsymal tachycardia
NI: monitor for seizure, resp, HR, BP, ECG
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| Defibrillation What does it do? What it treats NI | DO: an electrical shock that depolarizes all heart cells with the thought that it will then use SA node to pace.
TREATS: V-fib without a pulse
NI: apply pads to pt chest
start w/ low dose & then increase as higher dose can cause damage to myocardium.
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| Describe the 4 Different AV Heart blocks? | PR interval:constant;1P:1QRS=1stDeg AV block
PR interval:constant;P:QRS not 1:1=2nd Deg Type II
PR interval:varied;RtoR,constant=3rd Deg AV block
PR interval: varied;RtoR,varied=2nd Deg TypeII
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| Cardioversion What does it do? What does it treat NI | Used for unstable Vtach,Afib,Aflutter.
Hold Dig for 48hr prior
Hold Anticoag for 4-6wks prior
Maintain Airway
Assess VS, LOC, EKG, for burns
Provide emotional support
Doc results from procedure.
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| Cardiac Catheter What is it used for? | Used to assess heart dz, ID the best form of TX for heart Prob, measure intracardiac pressures, check O2 levels at various parts of the heart, to determine CO.
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| name some nursing interventions for Pre, intra, and post-procedure for Cardiac Catheter | Pre: need to d/c blood thinners or metformin before procedure.
Intra: watch for complications (Cath looping, kinking, breaking, blood loss, CVA, dysrhythmias, embolism,MI death)
Post
keep minb straight with femStop for 4-6hr.
monitor VS, CV circ, SS o
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