Med/surg Exam 1

Preload

The precontraction pressure in the heart as the volume of blood builds up.

Contractility

ability to shorten forcibly when stimulated

Calcium Channel Blockers

agents that inhibit the entry of calcium ions into heart muscle cells, causing a slowing of the heart rate, a lessening of the demand for oxygen and nutrients, and a relaxing of the smooth muscle cells of the blood vessels to cause dilation; used to prevent or treat angina pectoris, some arrhythmias, and hypertension

ventricular tachycardia treatment

amiodarone

Supraventricular Tachycardia (SVT)

an abnormal heart rhythm arising from aberrant electrical activity in the heart; originates at or above the AV node

paroxysmal supraventricular tachycardia

an episode that begins and ends abruptly during which there are very rapid and regular heartbeats that originate in the atrium or in the AV node

Vasopressin

antidiuretic hormone

potential causes of sinus tachy

anxiety, caffeine, exercise, anemia

when a client in the coronary care unit develops vent tachy, which action will the nurse take first

assess client pulse and BP

which action would the nurse take first after noting a flat line on a clients cardiac monitor

assess the pulse

after noting that a client in the clinic has an irregularly irregular pulse rhythm at a rate of 88 bpm, the nurse will anticipate further testing for...

atrial fibrillation

which dysrhythmia is this client with weakness, dizziness, and dyspnea exhibiting?

atrial fibrillation

Tx of bradycardia

atropine, pacemaker

right ventricular failure

blood backs up in the vena cava causing systemic or generalized edema

left ventricular failure

blood backs up into the lungs causing pulmonary edema > shortness of breath or sense of suffocation

Verapamil

calcium channel blocker

Digoxin (Lanoxin)

cardiac stimulant and diuretic

a client collapses and is unresponsive what is the next step

check the carotid pulse

Stable angina

chest pain that occurs when a person is active or under severe stress

unstable angina

chest pain that occurs while a person is at rest and not exerting himself

heart failure (HF)

condition in which there is an inability of the heart to pump enough blood through the body to supply the tissues and organs with nutrients and oxygen

a client on a tele unit demos a sinus rhythm with an occasional PAC. which action would the nurse take

continue to monitor

Beta Blockers

decrease heart rate and dilate arteries by blocking beta receptors

which adverse hemodynamic effects typically occur when a client develops tachy

decreased vent filling time, lower cardiac output, weaker pulse quality

Vfib priority?

defibrillation

Hypokalemia

deficient level of potassium in the blood

Heart Failure Treatment

diuretics, diet low in sodium, DASH, fluid restriction as needed digitalis increase strength of heart condition

systolic heart failure

heart can't contract and eject

"skipped heartbeat" cause

high preload, next beat has strong force of contraction, increase CO for that one systole

which action would the nurse perform when a client is in VFib

initiating CPR, assessing EKG, using defib, obtaining electrolytes, administering epi

Atrial Flutter

irregular beating of the atria; often described as "a-flutter with 2 to 1 block or 3 to 1 block"

Premature Atrial Contraction (PAC)

irregular heart rhythm characterized by atrial contractions occurring before the expected time

Lidocaine

local anesthetic

Anticoagulant therapy

medications that increase the tendency to bleed

MAWDS

medications, activity, weight, diet, symptoms

actions the nurse can take to help specifically promote gas exchange in the patient heart failure include all of the following except

monitoring the pt hr, rhythm and quality every 1-4 hours and auscultating heart sounds q 4-8 hrs

digoxin and verapamil should be monitoring for

myocardial depression

regarding acute coronary syndromes, atypical and associated symptoms may present as

pain between shoulders, unusual fatigue, indigiestion

the cardiac monitor shows suddent bursts of a regular heart rhythm with a rate of 220 beats/ min, normal QRS, and P waves that are difficult to see. which rythym is the client experiencing

paroxysmal supraventricular tachy.

concominant use of nitroglycerin with these meds can cause profound hypotension

phosphodiesterase inhibitors

modifiable risk factors of CV disease are

physical inactivity, obesity, psychological variables, cigarette smoking

PVCs

premature ventricular contractions

atrial fibrillation

rapid, random, ineffective contractions of the atrium

normal sinus rhythm (NSR)

regular rhythm of the heart cycle stimulated by the SA node (average rate of 60-100 beats/minute)

U wave

repolarization of the purkinje fibers

any problem in these systems requires the CV system to work harder

respiratory and hematologic system

cardioversion (defibrillation)

restoration of a normal heart rhythm by electric shock

which finding for a client who has a diagnosis of paroxysmal atrial fibrillation is most important to report

right arm weakness

the nurse caring for a patient post-cardiac catheterization should assess

skin temp and color, peripheral pusles, hematoma, bloody drainage

new onset afib, most important s/sx to report

sudden vision change

a client with supraventricular tachy reports fluttering feeling in chest with a BP of 110/55 mmg hg. which potnetial tx would the nurse question

synchronized cardioversion

which action is essential for the nurse to include in the poc for atrial fibrillation

take pulse apically for a full minute

ventricular fibrillation

the rapid, irregular, and useless contractions of the ventricles

Atropine Sulfate

use as first line defense in sinus bradycardia 0.5mg every 3-5 minutes as needed MAX is 3mg ( think alive gets 0.5) do not use if hypothermia

diastolic heart failure

ventricles can't relax and fill

QRS complex

ventricular depolarization and atrial repolarization

T wave represents

ventricular repolarization

Nursing interventions for hypokalemia

- giving potassium chloride supplements (PO or IV) and increasing dietary intake of potassium - KCL is never given unless there is UOP of at least 0.5ml/kg of body wt per hour. -KCL supplements added to IV should never ecxeed 60meq/L . preferred level s 40meq/L -Rate should not exceed 10-20 meQ per hour to prevent hyperkalemia and cardiac arrest. - encourage foods high in potassium- avocados, brocolli, dairy products, dried fruit, cantaloupe, bananas - IV potassium- never IV push (risk of cardiac arrest); macimum recommended rate is (5-10mEq/hr) ; monitor for phlebitis, monitor and maintain UOP

Digoxin effects on heart

- suppresses dysrhythmias by decreasing conduction through AV node and by decreasing automaticity in the SA node - drug decreases AV conduction by 1. a direct depressant effect on the AV node 2. acting in the CNS to increase vagal impulses to AV node

Atrial Flutter Treatment

-Give anticoagulants (faster the HR, more risk for thrombus) -treat underlying cause -digoxin (slows rate by enhancing AV block) -Quinidine (supresses atrial ectopic block) -Amiodarone -Calcium Channel Blockers (Cardizem)/Beta Blockers (-olol) -consider cardioversion

Post cardiac cath care

-assess femoral/distal sites -assess BP and pulse -NPO until gag -BR for 2-6hrs post based on the size of the catheter used -angio seals may be used (provide mechanical compression at site) [cork at site where tubes are inserted so pt does not bleed]

SVT treatment

-vagal stimulation: Valsalva maneuver, carotid massage -IV adenosine is drug of choice -IV beta blockers, CCB, amiodarone also used -if none of that works, cardioversion

normal value for serum magnesium

1.5-2.5 mEq/L

Normal value for sodium

135-145 mEq/L

preload, contractility, afterload

3 Variables that Govern Stroke Volume

Normal value for potassium

3.5-5.0 mEq/L

normal value for calcium

9-10.5 mg/dL

Sinus Bradycardia

<60 normal sinus rhythm

Sinus Tachycardia

>100 (100-150) normal sinus rhythm

Ventricular tachycardia (V-tach)

A condition in which the heartbeat is quite rapid; if rapid enough, ventricular tachycardia will not allow the heart's chambers to fill with enough blood between beats to produce blood flow sufficient to meet the body's needs.

Adenosine

Antiarrhythmic

Amiodarone

Antiarrhythmic

ventricular tachycardia treatment

If unstable: Synchronized DC cardioversion If stable: -Amiodarone -Lidocaine If recurrent: -ICD -amiodarone with beta blocker -Ablation

Lidocaine for SVT with a pulse, dose

Lidocaine - 0.5-1.5 mg/kg, Repeat at half dose to 3mg/kg -NEED A DRIP

which illustrates atrial depolarization

P wave

when the nurse needs to determine atrial rate and rhythm, which component of the ecg will be used

P waves

Normal EKG intervals

PR 0.12-0.20 QRS <0.12 QT <0.40 (if prolonged= hypocalcemia)

Diltiszem

SVT tx

PVC's occurring in which phase would be most concerning

T wave

Afterload

The force or resistance against which the heart pumps.