GNP IV
QRS complex normal duration
.06 to .1 seconds 1.5 boxes to 2.5 boxes
PR interval normal duration
0.12-0.20 seconds
initial interventions for chest pain
12 lead ekg, semi fowlers position, oxygen sat >93, IV access, ASA chewable, SL nitro, morphine, baseline labs, vital signs, auscultate heart sounds
Normal platelet count
150,000-400,000
preload for the right ventricle
2-6
Normal WBC count
4,000-11,000
Normal RBC count
4-6 million
normal cardiac output
4-8 L/min
normal cardiac index
2.5-4 L/min/m2
Normal HCO3 (bicarb)
22-26
Which of the following is an appropriate tidal volume range (per textbook) for a patient weighing 60 kg and is mechanically ventilated for Acute Respiratory Failure?
400 ml
Preload for the left ventricle
6-12
if the sinus node works, what is normal HR?
60-100! you got this
normal anion gap
8-16 mEq/L
PaCO2 levels in alkalosis
<35 mm Hg
sinus tachycardia
>100 (100-150) normal sinus rhythm p wave is normal, precedes each qrs complex, and has normal shape and duration. everything looks normal, just FAST.
PaCO2 levels in acidosis
>45 mm Hg
The nurse can assess correct endotracheal tube (ETT) cuff pressure by:
A manometer reading of 22 mm Hg
what are the secondary pacemakers?
AV node (40-60 bpm) and His-Purkinje fibers (20-40 bpm)
What is Buerger's disease?
Buerger's disease (thromboangiitis obliterans) is a rare disease of the arteries and veins in the arms and legs. In Buerger's disease, your blood vessels become inflamed, swell and can become blocked with blood clots (thrombi). This eventually damages or destroys skin tissues and may lead to infection and gangrene.
What is cardiogenic shock?
Cardiogenic shock is a condition in which your heart suddenly can't pump enough blood to meet your body's needs. The condition is most often caused by a severe heart attack, but not everyone who has a heart attack has cardiogenic shock. Cardiogenic shock is rare, but it's often fatal if not treated immediately.
A client who underwent a lobectomy and has a chest tube drainage system ordered on water seal. The client's breathing requires more effort and with a rate faster than 1 hour ago. The client's pulse rate has also increased. The nurse should:
Check tubing for kinks
A nurse is caring for a client who required chest tube insertion for a pneumothorax. To assess for pneumothorax resolution, the nurse can anticipate that the client will require:
Chest x-ray
A client has a chest tube connected to a "wet" suction system at -20cm suction. The nurse notes gentle bubbling in the suction chamber. The nurse should:
Continue to monitor as gentle bubbling in the suction chamber is normal.
A nurse is caring for an adolescent involved in a motor vehicle crash. The client has a chest tube in place. If the chest tube is accidentally removed, the nurse should immediately:
Cover the opening with petroleum gauze
digoxin effect on heart rate
DECREASES. withhold and notify HCP if HR<60 prior to administration.
what does atenolol do exactly?
Decreased cardiac output and decreased systolic and diastolic blood pressure
Interventions to prevent aspiration in a mechanically ventilated patient with an endotracheal tube (ETT) include:
Elevate the head of the bed 30-45 degrees
normal troponin level
For troponin concentrations 0.40 ng/mL and higher, the underlying cardiac injury is usually a myocardial infarction. Troponin concentrations of 0.04-0.39 ng/mL require serial troponin measurements and clinical correlation to interpret, as further described in the guidelines.
manifestations of sinus bradycardia
Hypotension Pale, cool skin Weakness Angina Dizziness or syncope Confusion or disorientation Shortness of breath
atropine
IV push medication (anticholinergic) used to treat bradycardia. max dose is 3 mg. common side effect- pupil dilation. therapeutic response- we want heart rate to increase. if bradycardia continues to persist, patient might get a pacemaker.
The nurse caring for a client on the cardiac unit notices that the client's cardiac monitor shows ventricular fibrillation. What is the priority action by the nurse?
Immediate defibrillation
normal INR level
In healthy people an INR of 1.1 or below is considered normal. An INR range of 2.0 to 3.0 is generally an effective therapeutic range for people taking warfarin for disorders such as atrial fibrillation or a blood clot in the leg or lung
normal myoglobin levels
In most instances, the normal (or negative) range for the serum myoglobin test is 0 to 85 nanogram per milliliter (ng/mL). Normal results will allow your doctor to rule out a heart attack. Abnormal (above 85 ng/mL) results can also be seen in: muscular inflammation (myositis)
Measures to prevent ventilator acquired pneumonia (VAP) include:
Maintain head of bed at 30 - 45 degrees
A client with respiratory failure is intubated and placed on continuous mechanical ventilation. Which equipment is most important to keep at the bedside?
Manual resuscitation bag
The nurse is instructing the graduate nurse on how to care for a client with a chest tube that is connected to water seal drainage. Which instruction would be appropriate?
Mark the amount and time of drainage on the collection chamber
how to distinguish first degree heart blocks from sinus rhythm
PR interval is longer than .20. everything is getting conducted but it's slow
Vagus nerves part of which nervous system?
Parasympathetic. When stimulated, HR decreases
Which assessment finding indicates that the patient may not be tolerating ventilator weaning?
Pulse oximetry 88%
A registered nurse is making client care assignments. Which staff member should be assigned to a client who had a chest tube inserted yesterday?
RN
sinus bradycardia
SA node is still pacemaker, it's just slower. how do we know it's still sinus? the p wave is still there, all the parts are regular. doesn't have to be a regular rhythm
risk factors for buergers disease?
SMOKING is the biggest one. often first appears earlier than 45 years old. males>females
On a routine visit to the physician, a client with chronic arterial occlusive disease reports that he's stopped smoking after 34 years. To relieve symptoms of intermittent claudication, a condition associated with chronic arterial occlusive disease, which additional measure should the nurse recommend?
Taking daily walks! Taking daily walks relieves symptoms of intermittent claudication, although the exact mechanism is unclear. Anaerobic exercise may make these symptoms worse. Clients with chronic arterial occlusive disease must reduce daily fat intake to 30% or less of total calories. The client should limit dietary cholesterol because hyperlipidemia is associated with atherosclerosis, a known cause of arterial occlusive disease. However, HDLs have the lowest cholesterol concentration, so this client should eat, not abstain from, foods that raise HDL levels.
A client with rib fractures and a pneumothorax has a chest tube inserted that is connected to suction. The nurse notes that there is bubbling in the water seal chamber on expiration. What is the significance of the bubbling?
The chest tube system is draining air from the pleural space.
afterload
The force or resistance against which the heart pumps.
preload
The precontraction pressure in the heart as the volume of blood builds up.
A client with a history of myocardial infarction is admitted with shortness of breath, anxiety, and slight confusion. Assessment findings include a regular heart rate of 120 beats/minute, audible third and fourth heart sounds, blood pressure of 84/64 mm Hg, bibasilar crackles on lung auscultation, and a urine output of 5 ml over the past hour. The nurse anticipates preparing the client for transfer to the intensive care unit and pulmonary artery catheter insertion because:
This client's findings indicate cardiogenic shock, which occurs when the heart fails to pump properly, impeding blood supply and oxygen flow to vital organs. Cardiogenic shock also may cause cold, clammy skin and generalized weakness, fatigue, and muscle pain as poor blood flow causes lactic acid to accumulate and prevents waste removal. Left-sided and right-sided heart failure eventually cause venous congestion with jugular vein distention and edema as the heart fails to pump blood forward. A ruptured aneurysm causes severe hypotension and a quickly deteriorating clinical status from blood loss and circulatory collapse; this client has low but not severely decreased blood pressure. Also, in ruptured aneurysm, deterioration is more rapid and full cardiac arrest is common.
The nurse is involved in preoperative teaching with a client undergoing a lung resection. The client is told that two chest tubes will be placed during surgery. The nurse explains that the purpose of the lower chest tube is to:
To remove fluid
Synchronized intermittent mechanical ventilation (SIMV) provides:
a set respiratory rate and tidal volume; and senses the patient's spontaneous breath. In between mandatory set breaths, the patient can breathe at their own rate and tidal volume.
The most common site of aneurysm formation is in the:
abdominal aorta, just below the renal arteries. About 75% of aneurysms occur in the abdominal aorta, just below the renal arteries (Debakey type I aneurysms). Debakey type II aneurysms occur in the aortic arch around the ascending and descending aorta, whereas Debakey type III aneurysms occur in the descending aorta, beyond the subclavian arteries.
PCO2
acid
Bicarb <22
acidosis
bicarb >26
alkalosis
V3, V4
anterior wall
what's one of the first interventions for a fib or a flutter?
anticoagulants
what are some causes of increased afterload?
anything that causes vasoconstriction
two ways to draw abg
art line or a percutaneuos arterial puncture
atrial flutter increases risk of stroke why?
atria aren't fully emptying, clots can form, these can lead to PE or, more likely, stroke
Pr interval
atrial depolarization
bicarb
base
what is pentoxifylline
blood viscosity reducing agent? indicated for PVD and intermittent claudification. increases flexibility of RBCs. therapeutic effects include increased blood flow.
how often to assess an a line?
cada hora
palliative care time frame
can be much longer term than hospice, can be a few years. Having a palliative care consult day before death probably isnt the best decision
what impact does an elevated SVR have on CO?
cardiac output drops because of increased resistance.
what is pneumothorax
collapsed lung
qrs complex
depolarization (contraction) of the ventricles
sinus tachycardia
dizziness, dyspnea, hypotension, angina treated by fluids, beta blockers, GUIDED BY THE CAUSE OF THE TACHYCARDIA.
Complications of MI
dysrhymias, heart failure, cardiogenic shock, valvular insufficiency
what diagnostic studies and lab tests evaluate cardiac performance?
echocardiogram, ekg, BMP from blood test
top drugs that increase contractility of the heart
epi, milrinone, dobutamine
adenosine
has to be given very fast, half life of 6-12 seconds. basically resets heart rate. usual dose is 6 mg, but up to 12 mg can be given if pt is not responding to 6 mg
epinephrine increases blood sugar
im just telling you
bicarb is excreted where
kidneys
whats one cause of v tach (aka pvc)
low potassium level
goals of cardiogenic shock therapy
maximize oxygen delivery, control dysrhythmias, reduce oxygen demand, and prevent complications such as acute renal failure. support contractility of the heart, possible ABP therapy (intra-aortic balloon pump)
primary respiratory disorders
pH and PaCO2 change in opposite direction
metabolic disorders
pH and PaCO2 change in same direction
When performing cardiopulmonary resuscitation (CPR), which finding indicates that external chest compressions are effective?
palpable pulse
bearing down for a BM and vomiting will both cause what for CV?
parasympathetic system is triggered, HR decreases
The nurse is caring for a mechanically ventilated patient on the following setting: assist control rate 18, tidal volume 500 ml, and FIO2 35%. The patient's respiratory rate is 36. The nurse recognizes that this assessment finding can result in the following abnormal ABG:
ph 7.50, PaCO2 30, HCO3 24 mEq/l
A mechanically ventilated patient is receiving PEEP +8. The nurse should assess for this complication associated with PEEP:
pneumothorax
A nurse is assessing a client with heart failure. To assess hepatojugular reflux, the nurse should...
press the right upper abdomen. As the right upper abdomen (the area over the liver) is compressed for 30 to 40 seconds, the nurse observes the internal jugular vein. If the internal jugular vein becomes distended, a client has positive hepatojugular reflux. Hepatojugular reflux, a sign of right-sided heart failure, is assessed with the head of the bed at a 45-degree, not 90-degree, angle.
respiratory acidosis
probably most common acid-base disorder. pH is less than 7.35. elevation in PaCO2, hypercapnia. COPD, asthma, sleep apnea, CNS depression, neuromuscular impairment, ventilatory restriction, incorrect mechanical ventilator settings shivering, rigors, seizures,
Prior to administering an infusion of a neuromuscular blocking agent to a ventilator dependent patient, the nurse should administer which prescribed medication?
propofol (Diprivan)
Alteplase recombinant, or tissue plasminogen activator (t-PA), a thrombolytic enzyme, is administered during the first 6 hours after onset of myocardial infarction (MI) to
revascularize the blocked coronary artery.
II, III, avf leads
right coronary artery, inferior wall of the heart
An elderly male client has been taking doxazosin 2 mg daily for 4 weeks for treatment of benign prostatic hypertrophy. The client reports feeling dizzy. The nurse should first:
take his blood pressure lying, standing, and sitting.
Post intensive care syndrome
the effects of being in an ICU setting (both physical and mental/emotional). These effects grow more intense the longer the patient stays in the ICU and can impact patient and/or family.
whats the pacemaker of the heart?
the sinus node!
The physician inserted a chest tube in a client with a pneumothorax. The nurse should evaluate the effectiveness of the chest tube:
to remove air and fluid
v tach is especially ominous because it tends to transition into what?
v fib
common side effects of nitroglycerin
vasodilator, BP drops. really bad headache!!
t wave
ventricular repolarization
most common cause of metabolic alkalosis
vomiting
After a lobectomy for cancer, a client receives a chest tube connected to a disposable chest drainage system. Correct functioning of the chest tube would include tidaling with the respiratory cycle in which compartment of the system?
water seal chamber
metabolic acidosis
we see this a lot. DKA causes this. low pH and low bicarb. lactic acidosis can also cause this.
hospice is for patients that are expected to die when?
within 6 months
respiratory alkalosis
• characterized by a low Paco² due to hyperventilation. An excessive amount of CO₂ is exhaled, resulting in a decrease in H⁺ concentration and an increase in pH (above 7.45). pregnancy, fever, fear, anxiety, cerebral edema, brain trauma, brain tumor, sepsis, incorrect mechanical vent settings. not super common, most likely caused by hyperventilation.
