Module 3 cardiac

How long should someone stay in bed after catheterization?

2-6 hours

Synchronized cardioversion can be used to treat which dysrhythmias?

A fib, SVTs, v-tach with a pulse

ST elevation

Above isometric line Draw troponin labs

Meds for ventricular tachycardia without a pulse and V fib

Amiodarone, lidocaine, and Epinephrine

Who is at risk for MI?

Coronary artery Atherosclerosis Smoking Obesity Age Gender

Why is aspirin given

Decreases chance of clots

And a nurse on a telemetry unit is caring for a client who has premature ventricular contractions (PVCs). While sitting in a chair, the client reports feeling lightheaded. If the client is having PVCs, which of the following findings should the nurse expect when auscultating the clients apical pulse?

Irregular pulsations PVCs are early ventricular depolarizations with a pause immediately afterwards. That pause in the usual heart rhythm results in an irregular force and rate on palpation of a peripheral pulse and an irregular beat on auscultation of the apical pulse. PVCs have a wide variety of causes. Clients typically perceive them as "palpitations" and can feel lightheaded if they occur frequently.

Pulseless Electrical Activity (PEA)

Looks like normal sinus rhythm but there is no pulse Continue CPR and advanced cardiac life support measures

Is arteries are blocked, inflamed or stenosed this increases chances of

MI

Sodium bicarbonate is administered to correct

Metabolic acidosis that does not improve with cpr

Who is at risk for development of dysrhythmia?

Metabolic alkalosis COPD or lung disease Stent placement in a coronary artery Shock Hypovolemia Drug alcohol use Pericarditis Kidney failure Liver failure Electrolyte imbalance Acid base imbalance Hypoxia MI Cardiovascular disease

Who is nitro contraindicated for

Someone who has taken viagra

defibrillation

Stops all electrical activity of the heart, allowing the SA node to take over and reestablish a perfusing rhythm Treats: ventricular fibrillation(v-fib) or PULSELESS V-tach

A client with atrial fibrillation is at risk for developing heart failure because of decrease

Ventricular filling and decrease cardiac output

Vagal maneuvers

tx SVT, blowing on thumb (valsalva), ice to face, holding breath then bearing down, massaging carotid on one side of neck. if they do not work, give IV adenosine (antiarrythmic)

Interventions for SVT

• Vagal manuever • Adenosine 6 mg, then 12 mg • Cardiovert

Sinus Bradycardia

<60bpm Sinus bradycardia is a slow heart rate with a regular rhythm.

Sinus Tachycardia

>100 bpm Rapid heart rate with regular rhythm

If pacing stimulus is delivered for atrial pacing, what should follow the vertical line?

A P-wave

When is pacing stimulus is delivered what does it look like on a ECG strip?

A pacer spike- a vertical line

Medications for Atrial fibrillation, superventricular tachycardia (SVT), ventricular tachycardia with a pulse

Amiodarone, adenosine and verapamil

First degree AV block

Are you regular rhythm with a prolonged PR interval. A pulse deficit does not occur.

What do you see on monitor when adenosine is given?

Asystole -heart stopped and converted back to normal rhythm

A person who has hypertension is at risk for developing

Atrial fibrillation

A nurse in an urgent care center is assessing a client who reports a sudden onset of a irregular palpitations, fatigue, and dizziness. The nurse finds a rapid and a irregular heart rate with a significant pulse deficit which of the following dysrhythmias should the nurse expect to find on an ECG?

Atrial fibrillation Atrial fibrillation causes a disorganized twitching of the atrial muscles. The rate is irregular with no visible P waves. The ventricular response is irregular, which results in an irregular pulse and pulse deficit.

A nurse enters a client's room and find the client pulseless. The family has requested a do not resuscitate order from the provider, but he has not written the order yet. Which of the following action should the nurse take?

Call the emergency response team Unless the provider writes a DNR order, the nurse should make every effort to revive the client. The nurse should follow the facilities protocol for an acting the emergency response procedure.

What symptoms would you educate the client for after post catheterization

Chest pain and angina How to take nitroglycerin How many complete grown ADLs? How are they modifying risk factors? Provide them with resources

Epinephrine is administered during cpr when

Clients who have a systole or pulseless electrical activity

What are the biggest concerns after Cath Lab?

Clotting, bleeding, troponins

What type of stroke volume is associated with PVCs?

Decreased stroke volume; pulse can feel weak or absent

A nurse is caring for a client who develops in ventricular fibrillation with them. The client is unresponsive, pulseless, and apneic. Which of the following actions is the nurses priority?

Defibrillation The greatest risk to the client is death from lack of cardiac output. Ventricular fibrillation is a lethal rhythm in which the ventricles are in a quivering pattern and there is no atrial activity. Defibrillation is essential to resolve, ventricular fibrillation promptly, and convert the rhythm to restore, cardiac output . The nurse should follow, defibrillation with cardio, pulmonary resuscitation, and repeat defibrillation, if necessary to convert the ventricular fibrillation into a sustainable rhythm.

A nurse is caring for a client who reports heart palpitations. An ECG confirms. The client is experiencing ventricular tachycardia (VT) the nurse should anticipate the need for taking which of the following actions?

Elective cardioversion This is a priority in an intervention, when the client is awake, and responsive. Ventricular tachycardia might not be an immediate threat to the client, but it does require intervention to prevent long-term cardiac impairment.

Pacemakers consist of two parts

Energy source and control center Can be permanent or temporary

troponin

Enzyme released after MI

If a patient has a heart rate of 48 bpm, and is unresponsive to atropine. What does the nurse give?

Epinephrine infusion, or dopamine

Asystole

Flat line- No cardiac out put. Call a code. Epinephrine

A nurse is caring for a client 4 hrs following a cardiac catheterization. Which of the following action should the nurse take?

Have a client life flat in bed The nurse should have the client lie flat in bed. Clients who had manual or mechanical pressure after catheter removal require. 6 hr bedrest. Those who had a closure device or patch only need 2 hr of bedrest

What vital do you want to watch HR. Why?

Increased HR could indicate bleeding

ST elevation or Stemi

Indicates MI and necrosis

Do PVCs decrease the heart rate?

No

What do you do for an MI?

O-oxygen N-nitro M-morphine A- asprin

What can help with electrical management of bradycardia?

Pacemaker

A nurse is teaching a client who has a new diagnosis of atrial fibrillation. The nurse should instruct the client to monitor for which of the following complications?

Pulmonary embolism Altered atrial contractions can cause blood pooling and thrombus formation. The client is at risk for developing a pulmonary embolism or an embolic stroke. The client should monitor and report immediate manifestation such a shortness of breath or neurological changes.

what are the six "ps"that need to be assessed following cardiac catheterization?

Pulselessness Pallor Pain Paresthesias Pokilothermia Perfusion

If pacing stemless is delivered for ventricular pacing, what should follow the vertical line or pacers spike?

QRS complex

The nurse is evaluating a client who had a cardiac catheterization with a left antecubital insertion site, which of the following pulses should the nurse palpate?

Radial pulse in the left arm Palpating the clients pulse distal to the insertion site is essential for evaluating possible thrombophlebitis and vessel occlusion. The left radial pulse should be strong and essentially equal to the right radial pulse.

Interventions for SVT

Raise HOB Administer o2 Continuously monitor O2 sat Cardiac , BP monitor Ekg IV as close to heart as possible- double lumen Notify HCP, RT Crash cart at bedside Defibrillator pads on client

After a cardiac catheterization, the clients affected leg should remain

Straight

symptoms of MI

Substernal pain Nausea and vomiting Diaphoresis Dizziness Weakness Palpitations Shortness of breath

Atropine is administered during CPR if the client has

Symptomatic bradycardia, or is hemodynamically unstable

How many does of nitro can a patient have

Tab- 5 minutes- 2nd dose call 911

A nurse is caring for a client who has atrial fibrillation and is receiving heparin which of the following findings is the nurses priority?

The client experiences sudden weakness of one arm and leg. Sudden weakness or numbness of the face, and one arm or leg, can indicate that the client is at greatest risk for stroke; therefore, this is the nurses priority, finding. In addition to these findings, the client may appear confused, have slurred speech, loss of balance, dizziness, or sudden, severe headache.

Before a client with a fib receives cardioversion what must happen first

They receive anticoagulation for 4 to 6 weeks prior to cardioversion therapy to prevent dislodgment of thrombi into the bloodstream

Magnesium is administered during CPR for clients who have

Torsade de pointes; which is a specific type of ventricular tachycardia

Draw LABs after ONMA; which ones

Troponin

Which dysrhythmias can you defibrillate?

V-tach without pulse and V-fib

Bradycardia meds t (any rhythm less than 60 BPM)

atropine; dopamine or Epinephrine infusion, if unresponsive to atropine

What is an MI?

myocardial infarction (heart attack)

supra ventricular tachycardia

rapid, regular heartbeats origination at or above the AV node 151-250bpm Heart rate will stay the same until interventions are made

cardioversion

returning a heart to normal rhythm delivery of direct counter shock to the heart synchronized to the QRS complex Treats: atrial dysrhythmias, SVT's, and VTach WITH a pulse