ATI EXAM 2 450 AND EXTRA REVIEW

Sinus Bradycardia causes

-hypoxia, hypothermia -sleep -well trained athletes

Allen Test Procedure

1. Rest hand palm up 2. Make a fist 3. Occlude radial/ulnar arteries with thumb 4. Fist released-pale at first 5. Release ulnar artery-Color should return; then release radial artery

cardiogenic shock NI

100% nonrebreather anticipate intubation restrict activity admin fluid replacement prep hemodynamic monitoring meds: vasopressors to support BP and inotropes to increase contractility

hypovolemic shock tx

100% nonrebreather mask fluid replacement: NS, LR, blood products maintain airway prep intubation

obstructive shock NI

100% nonrebreather mask prep intubation admin NE, DA, vasoconstriction pericardiocentesis if cardiac tamponade

pulmonary embolism s/s

1st indication: dyspnea pleuritic chest pain tachypnea high ventilation, low perfusion increased HR hotn

ventricular tachycardia

3 PVCs in a row vent rate over 150 life threatening because decreased CO wide QRS no PT waves

a fib with HR over 100

A fib with RVR

Abdominal Aortic Aneurysm

AAA below diaphragm in abd

for RBCs who is the universal donor and who is the universal recipient

AB O

cardiogenic shock dx

ABG ECG, cardiac enzymes, CXR lactate: increased

hypovolemic shock dx

ABGs: respiratory alkalosis to metabolic acidosis venous O2 sat decreased hbg/hct decreased BUN and Cr increased lactate increased, check every 4 hours

obstructive shock dx

ABGs: respiratory alkalosis to metabolic acidosis venous O2: decreased

cardiomyopathy tx

ACE and ARBS BB diuretics: prevent further scarring pace maker

myocardial infarction NI

ASSESS FIRST! O2 IV access "NAM" continuous ECG semi/high fowlers

A nurse in an urgent care center is assessing a client who reports a sudden onset of irregular palpitations, fatigue, and dizziness. The nurse finds a rapid and irregular heart rate with a significant pulse deficit. Which dysrhytmia?

Atrial Fibrillation rate is irregular with no visible P waves ventricular response is irregular which results in irregular pulse and a pulse deficit

A nurse is assessing a client who has right ventricular failure. Which of the following findings should the nurse expect? dry, hacking cough hepatomegaly dizziness crackles in the lungs

B

A nurse is caring for a client who is in the compensatory stage of shock. Which of the following findings should the nurse expect? mottle skin blood pressure 115/68 heart rate 160 hypokalemia

B

A nurse is giving a presentation about preventing DVT. Which of the following should the nurse include as a risk factor? BMI of 20 oral contraceptive use HTN high calcium intake immobility

B and E

heart failure dx

BNP increased echo: EF CXR hemodynamic with swanz ganz

myocardial infarction surgical

CABG -arterial cath -fowler's position

Thrombocytopenia dx

CBC with differential: confirm Thrombocytopenia bone marrow biopsy: confirm ITP

transmyocardial revascularization

CO2 ablation to increase CO

aortic artery disease (aneurysms) dx

CT with IV contrast: gold standard

preload measured by

CVP: right side preload (5-10 mmHg) PAWP/PAOP: left side preload (4-12 mmHg)

cardiomyopathy dx

CXR ECG MRI BNP increased

septic shock complications

DIC MODS

pulmonary embolism risk factors

DVT! fat: long bone fracture air: central venous catheter amniotic fluid tumor obesity smoking

gold standard dx for STEMI

ECG

coronary artery disease NI

ECG within 10 minutes coronary angiography- gold standard hold BB/CCB prior to exercise test statins to decrease cholesterol ONAM

myocardial infarction dx

ECG: gold standard for STEMI stress test: myocardial ischemia coronary angiography troponin: increased, cardiac injury up to 10 days CK, CK-MB: increased

myocardial infarction complications

HF arrythmias

cardiomyopathy complications

HF, dysrhythmias, thrombosis

coronary artery disease assessment

HTN headache: s/e of nitrates depressed ST or flat/inverted T waves= ischemia elevated ST= acute injury cocaine use can resemble s/s depression screening increased troponin, CK, CK-MB

heart failure risk factors

HTN! high Na intake African American Male Afib 65 plus CAD

high afterload causes and tx

HTN, hypovolemia, cardiogenic shock, pulmonary HTN fluid bolus, positive inotropes, vasodilators

heparin monitor

I and O aPTT: 1.5-2.5 therapeutic range

cardiogenic shock surgical

IABP mechanical circulatory support heart transplant

warfarin monitor

INR (2-3 sec)

What does the aPTT measure?

It measures deficiencies in all coagulation factors except VII and XIII. The aPTT is monitored in clients who are receiving heparin therapy. The expected range of aPTT is 30 to 40 seconds. The therapeutic range (on heparin therapy) is 1.2 to 2 times the expected range.

right sided heart failure s/s

JVD dependent edema ascites hepatomegaly splenomegaly

atrial flutter causes

MI COPD digoxin toxicity CABG pneumothorax

low contractility causes and tx

MI, HF, cardiogenic shock, metabolic acidosis, hypoxemia positive inotropes, IABP, LAVD

cardiomyopathy risk factors

Male african american DM HTN obesity

Sinus Bradycardia

NSR under 60 bpm

Sinus Tachycardia

NSR with HR over 100 bpm

asystole

No electrical activity; only a straight line

for FFP who is universal donor and who is universal recipient

O AB

cardiomyopathy NI

O2 semi/high fowlers supine promotes diuresis restrict Na and fl no vigorous exercise!

VO2

O2 utilization difference between O2 delivered and amount O2 used by tissues norm about 25% of O2 delivered via monitoring catheters: SVO2 (mixed venous) and SCVO2 (central venous)

coronary artery disease tx

ONAM PTCA CABG

ONAM

Oxygen Nitrates: under tongue, max 3 doses in 5 min, s/e: headache, hotn Aspirin: antiplatelet, bleeding precautions Morphine

DO2

Oxygen Delivery amount O2 admin to pt (supplemental)

deep vein thrombosis complications

PE post thrombotic syndrome

afterload measured by

PVR: right side (200-400) SVR: left side (800-1200)

U wave

Purkinje fiber repolarization med toxicities

neurogenic shock

SNS disruption: decrease vascular tone, venous return, and CO brain/spinal injury/anesthesia

left sided heart failure s/s

SOB orthopnea weak pulses pulmonary edema delayed capillary refill frothy sputum

NONSTEMI

ST depression coronary artery partial blockage increased cardiac markers reversible partial thickness muscle damage

STEMI

ST elevation coronary artery completely blocked increased cardiac markers irreversible full thickness muscle damage

contractility measured by

SV and SV index

atrial fibrillation symptomatic

TEE b4 cardioversion

warfarin antidote

Vitamin K

dissemintated intravascular coagulation (DIC)

abnorm coagulation involving fibrinogens systemically abnorm bleeding and clotting in bloodstream with massive consumption of clotting factors

descending thoracic aortic aneurysm

above diaphragm

cardiogenic shock risk factors

acute MI end stage congestive HF cardiomyopathy HTN

hypovolemic shock risk factors

acute blood loss: GI bleed, trauma rapid fluid loss: vomit, diarrhea, burns

heart blocks causes

acute coronary syndrome! electro imbalances med toxicities

elevated ST

acute injury

obstructive shock risk factors

acute pulmonary embolism cardiac tamponade tension pneumothorax

pulmonary embolism pt edu

aerobic exercise limit saturated fat and Na intake stop smoking limit foods high in Vitamin K

pulmonary embolism NI

airway: priority elevate HOB fluid to decrease viscosity bleeding precautions prep for intubation anticoagulants thrombolytic therapy

True Aortic Aneurysm

all 3 layers weakened

arterial catheter NI

allen test prior! if negative then use a different site set up system calibrate (zeroing) maintain transducer at phlebostatic axis monitor site

deep vein thrombosis prevention

ambulation early low molecular weight heparin leg ambulation: pillow under feet avoid prolonged standing, constrictive clothing, crossing legs, and smoking don't massage area

ventricular tachycardia with pulse

amiodarone electro replacement cardioversion

SV

amount of blood ejected in each beat 60-130 mL

Sinus Tachycardia symptomatic

anemic/volume depleted: admin RBC and IV fluids BB CCB: dilitazem

aortic artery disease (aneurysms) surgical

aneurysectomy under 5 cm NOT advised

cardiomyopathy s/s

angina rapid/irregular HR SOB edema in legs pulm congestion sleeplessness cough HTN!! decreased urine output: first s/s of decreased CO

myocardial infarction s/s

angina that leads to arm, back, jaw, shoulder diaphoresis Levine's sign nausea increased HR

deep vein thrombosis NI

anticoagulants alteplase: immediately remove clot risk for bleeding

atrial fibrillation tx

anticoagulants! digoxin BB/CCB Amiodarone cardiac ablation

hypovolemic shock late s/s

anuria cyanotic skin absent pulses dysrhythmias

Pulseless Electrical Activity (PEA)

any shape on ECG but no pulse

asystole causes

anything!

aortic artery disease (aneurysms) complications

aortic dissection aneurysm rupture

Ascending aortic aneurysm

arch of aorta

nurse finds that cap refill is 10 seconds. This is indicative of what?

arterial insufficiency

stable angina tx

aspirin nitrates meds that reduce RFs

asystole tx

assess 1st! -check leads -check for pulse -check if breathing code blue! chest compressions ACLS no defib

myocardial infarction risk factors

atherosclerosis smoking obesity HTN stress male 45 plus african american

coronary artery disease risk factors

atherosclerosis! smoking HTN sedentary lifestyle excess alcohol male african american 45 plus hx GERD or resp disorders post menopausal

p wave

atrial depolarization under 0.10 seconds

1st degree AV block

atrial depolarization delayed in AV node PR interval over 0.20 seconds P and R far apart no s/s

2nd degree AV block type 1 tx

atropine and temporary pacing

2nd degree AV block type 2 tx

atropine and temporary pacing

LVAD

attached to weakened ventricle

CI

based on body size better assessment CI= CO/BSA (body surface area) 2.5-4

arterial catheter complications

bleeding infection embolism (air) thrombosis user error damage to artery

dissemintated intravascular coagulation (DIC) NI

bleeding precautions assess perfusion minimal BP inflation

Thrombocytopenia NI

bleeding precautions safe environment

heart blocks

block at AV node from right coronary artery

deep vein thrombosis

blood clot in large vein, leg, pelvis virchows triad

left sided heart failure

blood goes from L ventricle to body's circulation leading to fluid accumulation in lungs

right sided heart failure

blood goes from R ventricle to pulmonary and leads to backup of blood in right atrium

fusiform aneurysm

both sides

septic shock early s/s

bounding pulses flush skin febrile decreased urine output

Which food has vitamin K and should be avoided when taking warfarin? cabbage cantaloupe green beans

cabbage

Sinus Bradycardia symptomatic

call rapid transcutaneous pacing Atropine 0.5 mg IVP dopamine/epi drip

aortic artery disease (aneurysms) NI

calm environment to decrease stress avoid crossing/elevated legs stop smoking exercise BP screenings gentle auscultation and palpitation

Premature Atrial Contraction (PAC)

can be seen in NSR pacemaker cell close to SA node fires earlier compensatory pause!

Which pulses should be palpated during CPR

carotid

hypertrophic cardiomyopathy

cause sudden cardiac death EF norm left ventricle enlarges and thickens

Febrile reaction to blood transfusion

caused by antibodies s/s: fever, chills, headache, chest pain

Hemolytic reaction to blood transfusion

caused by incompatibility s/s: fever, chills, hotn, flank pain

allergic reaction to blood transfusion

caused by sensitivity to donor's plasma proteins s/s: itching, hives, flushed, SOB

obstructive shock pt edu

causes of PE: inactivity bleeding precautions

A nurse enters a room and finds pt unresponsive. After notifying rapid response team, which action next? attach defib check for carotid pulse chest compressions deliver two breaths

check for carotid pulse

Sinus Tachycardia s/s

chest pain palpitations diaphoresis

indications for clotting factors admin

clotting factors deficiency bleeding

Pulseless Electrical Activity (PEA) tx

code blue immediately! check pulse and breathing compressions prep epi

ventricular tachycardia w/o pulse

code blue! CPR defib epi, amiodarone, airway management

ventricular fibrillation tx

code blue! chest compressions defib epi 1 mg every 3-5 min

Warfarin Patient Education

consistent intake vitamin K report blood in stool, urine, emesis, sputum bleeding precautions

arterial catheter indications

continuous BP ABG draws

central venous catheter indications

continuous CVP monitoring blood sampling SVO2 is PA not in place med and fluid admin

pulmonary artery catheter indications

continuous hemodynamic monitoring: CVP, CO, CI, PAWP, SVR, SVO2 med and fluid admin

septic shock late s/s

cool, pale skin weak pulses

gold standard for dx coronary artery disease

coronary angiography

CABG

coronary artery bypass graft

pulmonary embolism dx

d dimer positive ABGs BNP pulmonary angiography: most definitive chest CT: most common way to dx

deep vein thrombosis dx

d-dimer compression ultrasonography

Thrombocytopenia tx

d/c heparin 1st step in treating HIT -avoid warfarin -platelet transfusion discouraged glucocorticoids: increase platelet counts replace clotting factors for hemophilia

heart failure NI

daily weights elevate HOB fan for dyspnea increased BP, HR, RR decreased O2 restrict fluids and Na

ACE inhibitors and heart failure

decrease afterload, workload, and BP "-pril" increased risk for angioedema

aortic artery disease (aneurysms) meds

decrease growth and prevent comps BP aggressively managed statins: decrease AA growth rate tetracyclines and macrolides: inhibit progression and infection of AA

heart failure and diuretics

decrease preload d/t decrease fluids don't give if hotn morning med spironolactone: hyperkalemia and furosemide: hypokalemia

neurogenic shock hemodynamics

decreased CO, CVP, PAOP, SVR, SVO2, SCVO2 hotn bradycardia

anaphylactic shock hemodynamics

decreased CO, CVP, PAOP, SVR, SVO2, SCVO2 hotn tachycardia

obstructive shock hemodynamics

decreased CO, SVO2, SCVO2 increased SVR vary CVP and PAOP hotn tachycardia

septic shock late hemodynamics

decreased CO, SVO2, SCVO2 vary CVP, PAOP, SVR tachycardia hypothermia hotn

hypovolemic shock hemodynamics

decreased CVP, CO, SV, SVO2, PAOP increased SVR hotn tachycardia

septic shock early hemodynamics

decreased CVP, PAOP, SVR increased CO, SVO2, SCVO2 tachycardia hyperthermia

Sinus Bradycardia s/s

decreased LOC ortho hotn

obstructive shock s/s

decreased LOC and urine output poor pulses pale skin n and v chest pain

dissemintated intravascular coagulation (DIC) labs

decreased fibrinogen increased d dimer, PT, PTT, ACT, INR

virchows triad

decreased flow rate of blood (stasis) endothelial injury hypercoagubility

1st sign of decreased CO

decreased urine output

hypovolemic shock early s/s

decreased urine output hyperventilation leads to respiratory alkalosis restlessness and decreased LOC weak pulses hypoactive bowel sounds hyperglycemia

hemophilia

deficiency in factor 8 or 9

QRS interval

depolarization of the ventricles 0.06-0.10 seconds

PR interval

depolarize atria and travel to ventricles 0.12-0.20 seconds

myocardial infarction

destruction of heart muscle from lack of O2 blood supply CAD leads to MI

heart failure meds

diuretics digoxin ACE inhibitors beta blockers

2nd degree AV block type 2

drops QRS but PR intervals same length life threatening because can turn into 3rd degree

a nurse is caring for a client who is postop following vascular surgery. Which of the following signs should indicate to the nurse that the client has developed a thrombus? positive homans sign dull, aching calf pain soft calf muscle

dull, aching calf pain

myocardial infarction is most dangerous in

early mornings

a nurse is caring for a client who reports heart palpitations. ECG conforms ventricular tachycardia. Which action first? defib elective cardioversion CPR

elective cardioversion because pt is awake and responsive

ventricular fibrillation causes

electro imbalance hypoglycemia hypothermia cardiac tamponade MI PE

ventricular tachycardia causes

electro imbalances hypoxia hypoglycemia hypothermia cardiac tamponade MI PE

pulmonary embolism surgical

embolectomy: removes clots inferior vena cava filter

supraventricular tachycardia s/s

exhausted diaphoretic

aneurysm rupture

extreme loss of blood

Sinus Tachycardia causes

fever, anemia, hypovolemia, hypotension, pulmonary embolism, myocardial infarction

Which herbal supplement may interact adversely with aspirin

feverfew

neurogenic shock NI

fluid resuscitation atropine prep for pacing raise HOB slowly thromboembolism prophylaxis

Contractility

force of ventricular contraction how well the heart is pumping

Which findings expected with Left sided HF frothy sputum dependent edema nocturnal polyuria jugular distention

frothy sputum

atrial flutter tx

goal to control ventricular rate until SA node takes over BB and CCB digoxin: control vent rate antiarrhythmics if still in AFL after HR under 100 possible TEE and cardioversion

septic shock NI

hand washing O2 prep for intubation bundle of care within one hour

cardiomyopathy

heart muscle becomes weak, enlarged, thick, rigid, structural changes

Thrombocytopenia complications

hemorrhage

heparin complications

heparin induced thrombocytopenia, tx: argatroban bleeding thrombocytopenia

absolute contraindications for thrombolytic therapy

hx hemorrhagic stroke active intracranial neoplasm recent surgery recent trauma: under 2 mos active/recent internal bleeding: under 6 mos

high preload causes and tx

hypervolemia and HF, cardiogenic shock diuretics, vasodilators, positive inotropes

A nurse is evaluating the central venous pressure of a client who has sustained multiple traumas. Which interpretation of a low CVP should be made?

hypovolemia low CVP indicates reduced right ventricular preload

low preload causes and tx

hypovolemia, vasodilation, distributive shock fluid bolus and vasopressors

Premature Atrial Contraction (PAC) causes

hypoxia caffeine excess infections digoxin toxicity CAD

Heparin-induced thrombocytopenia (HIT)

immune response to heparin

cardiogenic shock

inadequate pumping of heart heart muscle can't contract state of hypoperfusion at tissue level from severe impairment of ventricle contraction, decreased EF

digoxin and heart failure

increase contractility hold if HR under 60 listen to apical pulse toxicity (2.0): yellow halos around lights, K over 3.5 increases toxicity

The client had episode of intraoperative bleeding. Which finding indicates that the client may be developing hypovolemic shock? decrease in resp rate to 16 decrease in urinary output to 30 ml increase in temp to 101.5 increase in hr to 110

increase in HR to 110

caring for a client with acute right sided heart failure. which finding is expected? decreased BNP increased CVP increased PAWP decreased specific gravity

increased CVP CVP is measurement of pressure in right atria or ventricle at the end of diastole elevated is indicative of heart failure

a nurse in the ER is assessing a client who has internal injuries from a car crash. Pt is disorientated to time and place, diaphoretic, and cyanotic lips. The nurse should anticipate which of the findings as indication of hypovolemic shock? increased HR widening pulse pressure increased deep tendon reflexes pulse ox 96%

increased HR

myocardial infarction assessment

increased HR decreased BP and O2 restless at early stage severe anxiety and sense of doom at late stage cold skin decreased pulses

cardiogenic shock hemodynamics

increased afterload increased SVR, CVP, PAOP hotn tachycardia decreased CO, SVO2, SCVO2

atrial fibrillation causes

increased age cardiomyopathy CAD hyperthyroidism HTN undergoing cardiac procedures/surgeries

earliest sign that shock is developing

increased resp rate

dobutamine drip does what

increases urine output admin to heart failure to improve hemodynamic status

septic shock progression

infection SIRS SEPSIS early stage late stage MODS

septic shock

inflammatory response not localized and uncontrolled excess release of proinflammatory cytokines leads to vasodilation, decreased vasomotor tone, and increase capillary permeability

warfarin

inhibit synthesis of vitamin K clotting factors

pulmonary artery catheter NI

inserted by provider only setup system calibrate (zeroing) maintain transducer at phlebostatic axis monitor site CXR auscultate breath sounds

heart failure surgical

internal cardiac defibrillator ventricular assist device valve repair/replacement

central venous catheter sites

internal jugular subclavian femoral

pulmonary artery catheter sites

internal jugular subclavian femoral

IABP

intra-aortic balloon pump; used to support patients in cardiogenic shock contraindication: leaky valve

pulse characteristics of atrial fibrillation

irregular

depressed ST of flat/inverted T waves

ischemia

restrictive cardiomyopathy

leads to HF and dysrhythmias EF norm muscle replaced by fibrosis and scarring

False Aortic Aneurysm

leak from artery leads to blood clot

atrial fibrillation complications

loss of CO: loss of atrial kick, only quivers clot formation: blood pools in atria

Thrombocytopenia risk factors

malignancy infection sulfa meds autoimmune conditions DIC

obstructive shock

mechanical barrier to ventricular filling/emptying leads to decreased CO

Which medication interacts with contrast material and places the client at risk for AKI?

metformin

supraventricular tachycardia asymptomatic

monitor vagal maneuvers Adenosine CCB BB

Premature Atrial Contraction (PAC) tx

monitor frequency and eliminate cause

3rd degree AV block

more P waves than QRS atrial rate (60-100) and ventricle rate (under 40) no impulses entering/exiting QRS march out regularly and independnet

2nd degree AV block type 1

more P waves then QRS complexes PR interval gets longer longer longer then QRS dropped not all impulses get to ventricle

dilated cardiomyopathy

most common and LV chamber enlarges chronic alc use viral infections EF decreased spreads to R ventricle and then atria

distributive shock

neurogenic, anaphylactic, septic

indications for granulocytes admin

neutropenia

what med causes the s/e of headache

nitrates

atrial fibrillation

no p waves independent impulses lead to chaos within atria

Pulseless Electrical Activity (PEA) s/s

no pulse not breathing dead with false ECG

aortic artery disease (aneurysms) s/s

none until rupture then palpable mass and extreme pain new chest, abd, flank pain could mean dissectionasce/rupture

HR

number of cardiac contractions/min 60-100 bpm

pulmonary embolism

obstruction of 1 or more branches of pulmonary artery due to thrombus

pulmonary embolism complications

obstructive shock respiratory failure

A nurse is caring for a client who has hypovolemic shock. Which of the following is an expected finding? HTN flushing of skin oliguria bradypnea

oliguria

saccular aneurysm

one side

Which blood product for a pt experiencing hypovolemic shock

packed RBCs

deep vein thrombosis s/s

pain swelling redness discoloration warmth

atrial fibrillation s/s

palpitations hotn weakness

atrial flutter s/s

palpitations hotn weakness

EF

percentage of blood ejected with each beat 60-70%

PCTA

percutaneous transluminal coronary angioplasty

a nurse is planning care for a client following a cardiac catheterization accessed through his femoral artery. Which action should the nurse plan? perform rom neurovascular checks ambulate restrict fluids

perform neurovascular checks with vital signs

aortic artery disease (aneurysms)

permanent dilation of artery that forms when middle layer (media) is weakened and stretches inner layer (intima)

3rd degree AV block tx

permanent pacemaker

Thrombocytopenia s/s

petechiae/purpura ecchymosis frank bleeding: nose, gums, GI black, tarry stools

The nurse suspects air embolism and clamps catheter immediately. What other action should be taken.

place the client on his left side in trendelenburg position helps trap air in apex of right atrium

A nurse is reviewing the lab findings for a client who has idiopathic thrombocytopenic purpura. Which of the following findings should the nurse expect to be decreased? WBC RBC granulocytes platelets

platelets destruction of platelets by antibodies

pulmonary artery catheter complications

pneumothorax air embolism

left sided heart failure causes

post MI ischemic heart disease

STEMI best outcome

prep for PCI and transport to cath lab within 90 min

diuretics and cardiomyopathy

prevent further scarring

heparin

prevents clot formation

atrial flutter

produced by pacemaker cell other than SA node no P waves F waves: flutter, resembles sawtooth pattern

heart failure

progressive disease leads to inability of heart to pump enough CO for entire body low EF compensatory mechanisms: ventricular remodeling, increased BP, Na and water retention, and release of BNP

heparin antidote

protamine sulfate

right sided heart failure causes

pulmonary HTN

heart failure complications

pulmonary edema, renal failure

arterial catheter sites

radial: most common brachial axillary femoral

supraventricular tachycardia

rapid HR 150-250 originates above ventricles can't differentiate between P and T waves narrow QRS waves

hypovolemic shock

rapid fluid loss leads to inadequate circulating volume most common is external/internal bleeding excess fluid loss: vomiting, diarrhea, pee, burns

supraventricular tachycardia symptomatic

rapid response cardioversion

deep vein thrombosis surgical

rare thrombectomy balloon angioplasty vena cava interruption

what does polystyrene sulfonate change on an ECG

reduce T wave amplitude

dabigatran purpose

reduce risk of stroke with atrial fibrillation anticoagulants

anaphylactic shock

release of histamine leads to widespread vasodilation, increased cap permeability, and smooth muscle contraction

anaphylactic shock NI

remove trigger IM epinephrine 100% nonrebreather antihistamines, corticosteroids, bronchodilators IV fluids

indications for fresh frozen plasma

replace coagulation factors

asystole s/s

resp arrest agonal breathing: gasping for air decreased LOC pulselessness

preload

right ventricle end diastolic volume degree of muscle fibers stretch before systole volume of blood in ventricle b4 contraction

cocaine use can resemble

s/s of coronary artery disease

monomorphic ventricular tachycardia

same shape

dissemintated intravascular coagulation (DIC) risk factors

sepsis OB comps infections snake bites

cardiomyopathy surgical

septal myectomy: when meds don't decrease s/s LVAD: attached to weakened vent surgical vent remodeling: decrease size of L vent transmyocardial revascularization: CO2 ablation to increase CO

central venous catheter NI

setup system assist with insertion calibrate (zeroing) maintain transducer at phlebostatic axis monitor site place pt on left side in Trendelenburg position

relative contraindications for thrombolytic therapy

severe HTN: over 200/110 nonhemorrhagic stroke within 2 mos surgery in past 10 days thrombocytopenia hx of bleeding tendencies

polymorphic ventricular tachycardia

shape varies torsades

cardiogenic shock s/s

similar to MI: chest pain, n and v poor pulses pale decreased LOC and urine output

aortic artery disease (aneurysms) risk factors

smoking! HTN! increased age fam hx atherosclerosis

A patient's platelet count is 9000/mm3. The nurse should monitor for which conditions? spontaneous bleeding oliguria hyperactive deep tendon reflexes infection

spontaneous bleeding

coronary artery disease s/s

stable angina unstable angina pain between shoulders and jaw SOB n and v diaphoresis pale

aortic dissection

sudden tear in intima

A nurse is caring for a client who has atrial fibrillation is receiving heparin. Which of the following findings is priority? ECG shows irregular heart rate without P waves aPTT of 80 seconds sudden weakness of one arm and leg

sudden weakness of one arm and leg indicate that the pt is at great risk for stroke

dissemintated intravascular coagulation (DIC) tx

supportive therapy blood component therapy

pulmonary artery catheter

swanz-ganz: flexible tip cath guided via right side of heart and thru pulm artery

indications for RBC admin

symptomatic anemia acute blood loss

afterload

systemic vascular resistance pressure/resistance against flow that left ventricle must overcome

anaphylactic shock s/s

tachypnea wheezing stridor cyanosis confusion urticaria

A nurse is assessing a client before admin of a unit of packed RBCs. The nurse should identify which of the following data as most important to obtain prior to infusion? skin color fluid intake temperature hemoglobin level

temperature

A nurse is preparing to administer warfarin to a client. Which of the following info should the nurse recognize prior to admin the med? warfarin is compatible with heparin the client's aPTT should be monitored the client should be observed for manifestations of hemorrhage

the client should be observed for manifestations of hemorrhage

indications for platelets admin

thrombocytopenia bleeding

what lab values increase in coronary artery disease

troponin CK CK-MB

Thrombocytopenia

under 150,000 platelets

heart failure pt edu

under 2 g salt/day daily weights: 2 lbs/day or 5 lbs/week is bad, morning after voiding TED hose no canned/packaged foods

ventricular fibrillation s/s

unresponsive pulseless

how long will troponin show up as increased after cardiac injury

up to 10 days

A nurse is teaching a client who has a dx of venous insufficiency. Which of the following instructions should the nurse include?

use elastic stockings

deep vein thrombosis risk factors

varicose veins polycythemia pregnancy/PP OCs or hormone therapy smoking cancer increased age

low afterload causes and tx

vasodilation, distributive shock fluid bolus and vasopressors

ventricular fibrillation

ventricles have multiple chaotic impulses rapid firing leads to no CO squiggles no pulse and life threatening!

mechanical circulatory support

ventricular assist device used to support patients in cardiogenic shock extracorporeal membrane oxygenation

qrs wave

ventricular depolarization if over 0.10 seconds then something in ventricle

QT interval

ventricular depolarization and repolarization under 0.52 seconds

heart failure compensatory mechanisms

ventricular remodeling, increased BP, Na and water retention, and release of BNP

T wave

ventricular repolarization electrolyte imbalances

coronary artery disease

vessels that deliver O2 rich blood heart muscle becomes obstructed/dysfunctional

Idiopathic Thrombocytopenic Purpura (ITP)

viral infection/immunization in children

indications for albumin admin

volume expansion

CO

volume of blood ejected from heart every min CO=HRxSV 4-8 L/min

neurogenic shock s/s

warm, dry, flushed

septal myectomy

when meds don't decrease s/s

septic shock bundle of care

within one hour monitor lactate blood culture b4 abx crystalloids vasopressors