Unit VI: Advanced understanding of the client with alterations in oxygenation and perfusion

The nurse is caring for a client who is being discharged after insertion of a permanent pacemaker. Which question by the client indicates a need for clarification? "I should ask for a handheld device search when I go through airport security." "I should avoid large magnetic fields, such as an MRI machine or large motors." "I should avoid contact sports." "I'll watch the incision for swelling or redness and will report if either occurs."

"I should ask for a handheld device search when I go through airport security."

A patient is undergoing preoperative teaching before cardiac surgery. The nurse explains that a temporary pacemaker will be placed later that day, and it will be removed after the surgery. The patient asks the nurse what will happen if the pacemaker quits functioning. What is the nurse's best response? "Monitoring for pacemaker malfunctioning and battery failure is something the nurse caring for you does." "Monitoring for pacemaker malfunctioning and battery failure is something the technician down the hall does." "Monitoring for pacemaker malfunctioning and battery failure is something the secretary at the nurse's station does." "Monitoring for pacemaker malfunctioning and battery failure is something the health care provider caring for you does when he makes rounds every day."

"Monitoring for pacemaker malfunctioning and battery failure is something the nurse caring for you does."

While teaching a CPR class, a student in the class asks what the difference is between cardioversion and defibrillation. What would be the nurse's best response? "Cardioversion is done on a beating heart; defibrillation is not." "The difference is the timing of the delivery of the electric current." "Defibrillation is synchronized with the electrical activity of the heart; cardioversion is not." "Cardioversion is always attempted before defibrillation because it is not as dangerous."

"The difference is the timing of the delivery of the electric current."

The nursing student asks the nurse to describe the difference between sinus rhythm and sinus bradycardia on the electrocardiogram strip. What is the nurse's best reply? "The only difference is the heart rate." "The P waves will be shaped differently." "The QRS complex will be smaller in sinus bradycardia." "The P-R interval will be prolonged in sinus bradycardia."

"The only difference is the heart rate."

Sublingual nitroglycerin is

-- placed under the tongue for acute relief of angina pectoris. -A transdermal nitroglycerin patch is for prevention of angina pectoris. Nitroglycerin transdermal patches are typically applied for 12 to 14 hours, and then removed for the same amount of time.

The client asks the nurse to explain what is meant by a ventricular bigeminy cardiac rhythm. What is the best response by the nurse? "It is when the heart conduction is primarily from the atrioventricular node." "The rhythm has a normal beat, then a premature beat pattern." "The rhythm is regular but fast." "The heart rate is between 150 to 250 bpm."

"The rhythm has a normal beat, then a premature beat pattern."

CF of GI s/s 3

- Children also experience malabsorption of fats and fat-soluble vitamins, secondary to impaired pancreatic function. They have difficulty gaining weight. Risk for bowel obstruction, cholecystitis, and cirrhosis is increased. · For the client with CF who has significant GI involvement, the nurse must review the client's diet. Collaboration with dietitians can ensure that the client has a diet high in calories, with appropriate amounts of carbohydrates, fats, and proteins. It is essential for the client to take his or her pancreatic enzymes (Creon, or Pancreaze), which aid in the digestion of carbohydrates, fats, and proteins.

A fib V tach

- No p wave-a fib; fast rhythm tachycardia - V tach if pt is unconscious can shock them

- Causes ARDS 5

- Sepsis, a life-threatening condition occurs when your immune system must work aggressively to fight off infection or trauma - Inhaling harmful substances - Pneumonia - Trauma to the head, chest or other areas of the body - Blood transfusions - Pancreatitis - Near drowning

An infarct is an

- area of tissue that dies (necrosis) from inadequate oxygenation. An MI, or heart attack, occurs when there is prolonged total occlusion of coronary arterial blood flow.

pacemaker provides an

- electrical stimulus to the heart muscle to treat an ineffective slow rhythm). Pacemakers function in either a demand (synchronous) or fixed-rate (asynchronous) mode.

cerebral infarction Hemiplegia: Hemianopia:

-- Localized necrosis of brain tissue caused by impaired blood flow. -Paralysis of one side of the body. -Loss of vision for one half of the visual field of one or both eyes.

Atrial fibrilation (A-fib) nursing interventions 4

-. The atria quiver, which can lead to the formation of thrombi. No definitive P wave can be identified. o Administer O2 o Ensure patent airway o Administer anticoagulants as prescribed o Administer cardiac medications to maintain cardiac output o Prepare the client for cardioversion as prescribed

What meds raise potassium

-Ace inhibitors: Lisinopril -ARB: Losartan -Diuretic:spirnolactone- potassium sparing

MI risk 6 dx confirmation 3

-Atherosclerosis, -CAD, -elevated cholesterol levels, -smoking, -hypertension, obesity, physical inactivity, -impaired glucose tolerance, stress -· Troponin level rise, CKMB level rise, Electrocardiogram shows ST elevation

Unstable angina s/s treatment 5

-Chest pain of increased frequency, severity, and duration poorly relieved by rest or oral nitrates Client at risk of MI within 18 months of angina's onset -Sedation, IV nitroglycerin, oxygen, antihypertensives, anticoagulant or antiplatelet therapy, revascularization procedures

Variant angina s/s treatment 2

-Chest pain that occurs at rest (usually between 12 and 8 AM), is sporadic over 3-6 months, and diminishes over time; ST elevation rather than depression on ECG -Nitrates or calcium channel blockers

Heart failure classification scale 4

-Class I: pt exhibits no manifestations with activity -Class II: client has manifestations with ordinary exertion -Class III: clients displays manifestations with minimal exertion -Class IV: client has manifestations at rest

Distributive shock (Neurogenic, Septic, Anaphylactic) 3

-Enlargement of the vascular compartment and redistribution of intravascular fluid from arterial circulation to venous or capillary areas -- the amount of fluid in the circulatory system is not reduced, yet the fluid circulation does not permit effective tissue perfusion. -Vasodilatation, a prominent characteristic of distributive shock, increases the space in the vascular bed.

FAST is

-Face Drooping Does one side of the face droop or is it numb? Ask the person to smile. • Arm Weakness Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward? • Speech Difficulty Is speech slurred, are they unable to speak or are they hard to understand? Ask the person to repeat a simple sentence, like "the sky is blue." Is the sentence repeated correctly? • Time to call 9-1-1 If the person shows any of these symptoms, even if the symptoms go away, call 9-1-1 and get them to the hospital immediately

Calcium channel blockers-verapamil and diltiazem purpose 3 adverse reaction complication

-HTN, angina pectoris, cardiac dysarthymias -constipation espicially in verpamil -dig toxicity increase the levels and grapefruit cause toxicity

Systemic inflammatory response syndrome (SIRS) is diagnosed when two or more of the following are present, and there is a strong suspicion of inflammation such as microbial infection, pancreatitis, multiple trauma, and others: 4

-Heart rate greater than 90 beats/minute -Body temperature less than 36 °C (96.8 °F) or greater than 38 °C (100.8 °F) -Respiratory rate over 20 breaths/minute or blood gas measurement of carbon dioxide (PaCO2) of less than 32 mm Hg (normal is 35-45 mm Hg) -White blood cell count less than 4000 cells/mm3 or greater than 12,000 cells/mm3 or the presence of more than 10% immature neutrophils

hypovolemic (hemorrhagic) shock EX 5

-Hemorrhage (frank and internal) -Extreme diuresis -Severe diarrhea or vomiting -Dehydration -Third-spacing

Angina causes dx confirmation

-Imbalance between O2 supply and demand due to obstruction of coronary blood flow. -·ECG, stress testing, rule out MI

NIH stroke scale 10

-LOC -Best gaze -visual -facial palsy -motor arm -motor leg -limb ataxia (lack of muscle control or coordination) -sensory -best language -dysarthria (slurred speech) 42 is the highest score possible. In the NIHSS, the higher the score, the more impaired a stroke patient is. -less than 6 indicates a strong probability of a good recovery.

Nursing care of heart failure 5

-Monitor SOB and dyspnea -administer oxygen -position high fowler -monitor medication digoxin toxicity -maintain dietary restrictions like fluid and sodium

R right sided HF Left sided HF

-Rocks the body: peripheral edema -lungs: pulmonary edema

Cystic Fibrosis causes 2 DX confirmation

-Stagnation of mucous in the airway leads to bacterial colonization and destruction of lung tissue. -Emphysema and atelectasis occur as the airways become increasingly obstructed. -· Quantitative sweat chloride test. Chloride concentrations of 40-60 mEq.

what is a stroke? 3

-Stroke is a disease that affects the arteries leading to and within the brain. -A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts (or ruptures). -When that happens, part of the brain cannot get the blood (and oxygen) it needs, so it and brain cells die.

How Is ARDS Treated? 4

-Ventilator support: Oxygen alone is usually not enough, and high levels of oxygen can also injure the lung. A ventilator is a machine used to open airspaces that have shut down and help with the work of breathing -Prone positioning: ARDS patients are sometimes turned over on their stomach to get more oxygen into the blood. -Sedation and medications to prevent movement:To relieve shortness of breath and prevent agitation, the ARDS patient usually needs sedation -Fluid management

Atrial flutter

-a disorder in which a single atrial impulse outside the SA node causes the atria to contract at an exceedingly rapid rate (200 to 400 contractions/minute). -The AV node conducts only some impulses to the ventricle, resulting in a ventricular rate that is slower than the atrial rate. The atrial waves in atrial flutter have a characteristic sawtooth pattern.

ventricular tachycardia nursing interventions 4

-a repetitive firing of an irritable ventricular ectopic focus at the rate of 140-240+. Can lead to cardiac arrest if not treated quickly o Ensure patent airway o Prepare for synchronized cardioversion if client is unstable o Prepare for defibrillation and initiate CPR o Administer O2 as prescribed o Administer antidysrhythmic therapy as prescribed

Ventricular tachycardia is caused by 3

-a single, irritable focus in the ventricle that initiates and then continues the same repetitive pattern. The ventricles beat very fast (150 to 250 beats/minute), and cardiac output is decreased. Depending on how long the arrhythmia is present, the client may lose consciousness and become pulseless. Ventricular tachycardia sometimes ends abruptly without intervention but often requires defibrillation. It may progress to ventricular fibrillation.

MIs are classified based on 3

-affected area of the heart: anterior, lateral, inferior or posterior -ECG changes produced: ST elevation myocardial infarction (STEMI) vs non ST elevation myocardial infarction (NSTEMI) -the time frame within the progression of infarction: acute, evolving, old

hypoxia can affect 2

-altered cognition -cyanosis

Supraventricular tachycardia (SVT) is an 3 causes 3

-an arrhythmia in which the heart rate has a consistent rhythm but beats at a dangerously high rate (≥150 beats/minute). -Cardiac output drops dangerously low and heart failure can occur, especially in clients with preexisting heart disease or damage. -Clients with coronary artery disease (CAD) and SVT can develop chest pain because coronary blood flow cannot meet the increased need of the myocardium for oxygen imposed by the fast rate. -Besides tachycardia and angina, hypotension, syncope, and reduced renal output are signs and symptoms of low cardiac

Manifestations acute coronary syndrome are due to 2

-an imbalance between myocardial oxygen supply and demand -when blood flow to the hearts comprised ischemia causes chest pain

expected findings MI 6

-anxiety: impending doom -chest pain: substernal or precordial- can radiate shoulder or arm present in arm -females can experience atypical angina characterized by pain between the shoulders -pallor -diaphoresis -tachypnea

Coronary artery disease (CAD) refers to 2

-arteriosclerotic and atherosclerotic changes in the coronary arteries supplying the myocardium. -diagnosed until clients are in late middle age or older, but the vascular changes most likely begin much earlier.

Factors associated with the development of ARDS include 5

-aspiration related to near drowning or vomiting; - drug or alcohol ingestion/overdose; - hematologic disorders such as disseminated intravascular coagulation or massive transfusions; -direct damage to the lungs through prolonged smoke inhalation or other corrosive substances; - pneumonia or localized lung infection

Assist with safe feeding stroke 2 what are the 4 liquid consistencies

-assist with obtaining a consult for speech -language pathologist (SLP) determine swallowing or gag reflex before feeding --keep them NPO -four liquid consistencies have been identified by a collaborative group of specialist for clients who have dysphagia: thin(water, juice), nectar (cream soups, nectar) honey (honey, yogurt) spoon thick (pudding, cooked cereal) -place food in the back of the mouth on the unaffected side

Stable angina/classic angina 3

-atherosclerosis -occurs with exertion or exercise -relieved by antianginals or rest

Unstable angina/Crescendo angina 3

-atherosclerosis with blood clot -severe pain often occurs at rest or minimal exertion -not relieved by medication or rest

Glascow coma scale

-best score : 15 -comatose: 8 -worst score: 3

Beta blockers-metoprolol expected theraputic3 comp 2

-blockade in the myocardium and in the electrical conduction system of the heart -decreased HR -primary HTN -angina -anxiety -bradycardia -decraesed cardiac output

occlusion

-blockage in the central IV catheter that impedes flow. A emboli can cause occlusion.

Risk cystic fibrosis

-both biologic parents carry the recessive trait -Caucasian ethnicity

Dysrhythmias treatment 3

-bradycardia: medication: atropine; electrical management: peacemaker -atrial fibrillation: medication: verapamil and adenosine; electrical management synchronized cardioversion -ventricular fibrillation and tachycardia: medication: lidocaine and epinephrine; electrical management: defibrillation

Ischemia stroke

-can be reversed with fibrinolytic therapy using altepase all known tissue plasminogen activator (tPA) if given 3 to 4.5 hour of the initial manifestation

V tach V fib

-can be typically no pulse; code blue/CPR/shock -unknown QRS

cardiac tamponade

-can result from fluid accumulation the pericardial sac -include hypotension, jugular venous distention, muffled heart sounds

Acute respiratory distress syndrome risks 7

-can result from localized lung damage or from the effects of other systematic problems -pulmonary emboli (fat, amniotic fluid) -sepsis -near drowning -damage to the central nervous system -smoke or toxic gas inhalation -drug ingestion/toxicity (heroin, opioids, salicylate)

angiography 5

-cardiac cauterization is an invasive diagnostic procedure used to evaluate the presence and degree of coronary artery blockage -can be done to determined blood flow and areas of possible blockage of a vessel -maintain NPO for at least 8 hours -determine iodine/shellfish allergy -client takes metformin as the provider about withholding prior to 48 hr procedure

Client presentation dysrhythmias 6

-cardiovascular disease -myocardial infarction -hypoxia -shock -drug or alcohol abuse -pericarditis

Embolic stroke

-caused by an embolus traveling from another part of the body to cerebral artery

Risk factors of stroke6

-cerebral aneurysm -DM -obesity -HTN -atrial fibrillation -atherosclerosis

client presentation heart failure subjective data 5 objective data 3

-chest pain -pain radiate to the jaw, left arm through the back -increase with excercise -dyspnea -diaphoresis -ECG changes might include ST elevation -vomiting -mental disorientation

S/S MI 5

-chest pain -sweating -unrelieved nausea -pain in the back between shoulder blades -left arm and left jaw pain

pulmonary management cystic fibrosis 4

-chest physiotherapy (CPT) with postural drainage as prescribed (manual or mechanical) -Positive expiratory therapy (PEP) used flutter mucus clearance device -administer aerosol therapy as prescribed (bronchodilator) -administer IV antibiotics

In mild CAD 3

-clients are asymptomatic or complain of fatigue -The classical symptom is chest pain (angina pectoris) or discomfort during activity or stress. -Such pain or discomfort typically is manifested as sudden pain or pressure that may be centered over the heart (precordial) or under the sternum (substernal). -The pain may radiate to the shoulders and arms, especially on the left side, or to the jaw, neck, or teeth

Human B-type natriuretic peptides (hBNP) 2

-clients who have dyspnea, elevated hBNP confirms a diagnosis of heart failure rather than a problem originating in the respiratory system -greater than 400

variant angina/ prinzmetal angina 3

-coronary spasm -typically at rest during the night or early morning hours -relieved by antianginals drugs (nitroglycerin)

The most common cause of MI is3

-coronary thrombosis, the consequence of a blood clot located within a coronary artery. -Thrombosis usually is secondary to arteriosclerotic and atherosclerotic changes. -Arterial spasms also may cause an MI.

Dornase alfa (aerosol) 3

-decreases the viscosity of mucus and improves lung function -monitor sputum thickness and ability of client to expectorate -administer once or twice a day

cardioversion 3

-delivery of a direct counter shock to the heart synchronized to the QRS complex -elective treatment of atrial dysrhythmias; supraventricular tachycardia and ventricular tachycardia -treatment of choice for clients who are symptomatic

Right sided heart failure left sided heart failure

-dependent edema in male can cause swelling scrotum will have to elevate and ice -left sided leads to right sided failure

Inotropic agents 3

-digoxin are used to increase in tactility and thereby improve cardiac output -hold med if apical pulse is less than 60 bpm -report toxicity manifestation fatigue, muscle weakness, confusion, loss of appetite

what is cardimyopathy what does dopamine do

-disease of the heart muscle -increases contractility

CHF interventions

-diuretic -digoxin -dietary (2L restrict, low sodium) -daily weights -ultrasound echocardiogram: below 55 diminished over 65 normal -BNP:beta nitrate peptide increase heart failure

ARDS s/s 4

-dyspnea -bilateral pulmonary edema (crackles upon auscultation) -dense patchy bilateral pulmonary infiltrates -severe hypoxemia

left sided failure 8

-dyspnea -cyanosis -restlessness -displaced apical pulse -s3 heart sounds (gallop) -pulmonary congestion:crackles, tacypnea -frothy sputum -change LOC

Myoglobin Creatine Kinase-MB Troponin I or T -trop I -trop T

-earliest marker of injury to cardiac or skeletal muscle. Levels no longer evident after 24 hours. -Peaks around 24 hours after onset of chest pain. Levels no longer evident after 3 days. -any positive value indicate damage to cardiac tissue and should be reported I: levels no longer evident after 7-10 days T: levels no longer evident after 10 to 14 days

Stable angina s/s treatment 4

-eating a large meal Chest pain that lasts 15 minutes or less and may radiate Similar pain severity, frequency, and duration with each episode -Rest, sublingual nitrates, antihypertensives, lifestyle changes

stroke s/s 4 stroke scale

-facial dropping, slurred speech, difficulty speaking, and unequal pupils -more points if unresponsive want score to be low

how do you treat shock

-figure out the cause: -fix arrthrymias -stop bleeding -introduce fluids for hypovolemia

Loop diuretics Thiazide diuretics Potassium sparing diuretics

-fureosmide -hydrochlorthiazide -spirnolactone

Septic shock (toxic shock), 3

-has the highest mortality rate of the various types of shock. Up to 60% of those who develop septic shock die despite aggressive treatment -Septic shock is preceded by a systemic inflammatory response syndrome (SIRS) -most commonly in clients with gram-negative bacteremia (bacteria in the blood) caused by such pathogens as Escherichia coli

heart failure hypertrophy

-heart damage can't pump effective -muscles larger working harder

Sepsis shock 3

-highest mortality rate -elderly is the most common (decrease mobility) -do not have to see the fever; elderly may be decrease than normal

Neurogenic shock 4

-hypotension -bradycardia -warm dry skin -decreased CO(cardiac output) venous and arterial vasodilation, loss sympathetic tone

Anaphylactic shock 8

-hypotension -tachycardia -cough -dyspnea -pruitis/urticus -restlessness -decreased LOC -Decreased CO(CARDIAC OUTPUT) decreased SVR(systematic vascular resistance)

Septic shock 6

-hypotension -tachycardia: full bounding pulse -tachypnea -decreaesd urine output -fever -Decreased CO(cardiac output) decreased SVR(systematic vascular resistance)

Cariogenic shock 5

-hypotension -tachycardia: weak thready pulse -cool pale moist skin -crackles, tacypnea -Decreased CO(cardiac output) Increased SVR(systematic vascular resistance)

Hypovolemic shock 4

-hypotension -tachycardia: weak thready pulse -cool pale moist skin -urine output decreased -Decreased CO(cardiac output) Increased SVR(systematic vascular resistance)

CT scan

-initial diagnostic test and should be performed within 25 min from the time of client arrival to the ER

Anginal pain2

-is often described as a tight squeezing, heavy pressure, or constricting feeling in the chest -pain unrelieved by rest or nitroglycerin and lasting for more than 15 min differentiates an MI from angina

defibrillation 3

-is the delivery of an unsynchorized, direct countercheck to the heart -stops all electrical activity of the heart allowing the SA node to take over -ventricular fibrillation or pulseless ventricular tachycardia

unilateral neglect

-is the loss of awareness of the side of affected by the stroke. The client cannot see, feel, or move the affected side of the body; therefore forget that it exists

Cardiac monitoring diagnose

-is used to diagnose dysrhythmias, chamber enlargement, myocardial ischemia and to monitor the effects of electrolyte imbalances or medication administration

Right sided failure 7

-jugular vein distension -edema -Nausea -polyuria at rest -liver and spleen enlargement -ascites -weight gain

GI findings cystic fibrosis 6

-large frothy foul smelling steatorrhea -voracious appetite (early) and loss of appetite (late) -distended abdomen (infant) -thin arms and legs (infant) -deficiency fat soluble vitamins -prolapse rectum (infant, child)

R HF path and cause 4

-left sided HF can cause R HF -pulmonary HTN -fibrotic lungs like stiff lungs -obstructive sleep apnea

Peripherally inserted central catheter (PICC)

-length of use up to 12 months --adm of blood, long term arm of chemotherapeutic agents, antibiotics, and TPN -check placement by X-ray

Digoxin 6

-levels:. 0.5-2 -increased force of myocardial contraction -decreased heart rate -dysrhymias (atrial fibrillation) -check pulse rate less than 60 bpm -toxicity s/s: fatigue, weakness, vision changes (white halos), GI effects

ARDS can cause

-lung damage or trauma -inhaling harmful substance (carbon monoxide, household cleaners ammonia and bleach)

MI health promotion and disease prevention 4

-main an exercise routine -have cholesterol and BP checked regularly -consume diet low in saturated fats and sodium -promote smoking cessation

heart failure diet 4

-maintain adequate blood flow throughout the circulatory system. Results in excess sodium and fluid retention, and edema -reduce sodium intake to less than 3000 mg mild to moderate heart failure and severe heart failure 2000 mg -monitor fluid intake restrict 2L -use small frequent meals that are soft easy to chew foods

Risk factors of MI 8

-male sex -ethnic background -sedentory lifestyle -obesity -HTN -hyperlipidemia -stress -DM

expected findings cystic fibrosis 6

-meconium illness at birth manifested as dissension of the abdomen, vomiting, and inability to pass stool; earliest indication -mucus increases risk for respiratory infections -dyspnea -cyanosis -barrel shaped chest -clubbing of fingers and toes

Beta blockers 3

-metoprolol has antidysrhythmic and antihypertensive properties that decrease the imbalance between myocardial oxygen supply and demand reducing after load and slowing heart rate -beta blockers can cause bradycardia and hypotension hold the medication if the apical pulse rate less than 50 bpm -avoid giving to pt with asthma

Percutaneous coronary intervention results

-might reduce ischemia during the occurrence of an acute myocardial infarction (MI) by opening artery -performed within 4 to 6 hours of the onset of manifestations if having a non-ST-elevation (NSTEMI) or myocardial infarction within 60 to 90 min for ST elevation

nursing care for stroke 3

-monitor VS every 1 to 2 hours. notify the immediately if BP exceeds a systolic greater than 180 or diastolic greater than 110 -monitor the pt temperature; fever can cause increase intracranial pressure -elevate 30 degrees of the bed

CF interventions 4

-need about 3000-4500 calories have hard time eating -babies test sweat chloride test -3 month less chloride 40 mEq/L -unlimited salt

Vasodilator 4

-nitroglycerin prevents coronary vasospasm and reduces preload and afterload, decreasing myocardial oxygen demand -use to treat angina and help control blood pressure -headache is a common adverse effect of this medication -if pain unrelieved in 5 min call 911 or be driven to ER up to two more doses nitroglycerin 5 min interval

left ventricle right ventricle

-not able to get blood out will be back up to the lungs filled with blood congestion -back up into the veins (venous congestion)

hemorrhagic stroke

-occur secondary to a ruptured artery or aneurysm. The prognosis for a client who has experienced a hemorrhagic stroke is poor due to the amount of ischemia and increased ICP caused by the expanding collection of blood

Thrombotic stroke

-occurs secondary to the development of a blood clot on an atherosclerotic plaque in a cerebral artery that gradually shuts off the artery and causes ischemia distal to the occlusion

myocardial infarction diet

-occurs when is an inadequate supply of oxygen to the myocardial -liquid diet best fir the first 24 hr after infarction -caffeine should be avoid because it stimulates the heart and increases heart rate

Heart failure

-occurs when the heart muscle is unable to pump effectively, resulting in inadequate cardiac output, myocardial hypertrophy , and pulmonary congestion

-Stable (exertional) angina -Unstable(pre infarction) angina -Variant (Prinzmetal's) angina

-occurs with excerpts or emotional stress and is relieved by rest or nitoglycerin -occurs with exercise or at rest, but increases in occurrence , severity, and duration over time -due to a coronary artery spasm, often occurring during periods of rest

What is the SA node What is the AV node

-pacemaker of the heart -atrioventricular node-rate

pancreatic enzymes 4

-pancrelipase treats pancreatic insufficiency associated with cystic fibrosis -monitor stools for adequate dosing 1 to 2 stools a day -monitor weight -adm with all meals and snacks

How to apply ECG

-position 12 lead ECG -wash clients skin to remove oils -attach one electrode of the clients extremities by applying to flat surface; chest hair can be shaved or clipped

stable angina vs4 Myocardial infarction4

-precipitated by exertion or stress -relieved by rest or nitroglycerin -manifestation last less than 15 mins -not associated with nausea, epigastric distress, dyspnea, or diaphoresis -can occur without cause, often in the morning after rest -relieved only by opiods -manifestation last more than 30 minutes -associated with nausea, epigastric distress, dyspnea, or diaphoresis

GI management cystic fibrosis4

-provide a well balanced diet high in protein and calories -administer pancreatic enzymes within 30 mins of eating a meal or snack -administer water soluble vitamins A,D,E and K -Encourage to add salt to food during hot weather (dehydration)

Chest x-rays ARDS 2

-pulmonary edema -diffuse infiltrate and white out or ground glass appearance

L HF s/s 3

-rales -frothy pink: blood tinged sputum -dyspnea/orthopnea

ECG

-record the electrical activity of the heart over time -connected by leads by electrodes to chest and limbs of a client -continuous cardiac monitoring

Supraventricular tachycardia rhythm atrial rate ventricular rate treatment Ventricular fibrillation rhythm atrial rate ventricular rate treatment

-regular -150-250 -150-250 -cardioversion -chaotic -60-100 -400-600 -defribillation

Sinus bradycardia rhythm atrial rate ventricular rate treatment Sinus tacycardia rhythm atrial rate ventricular rate treatment

-regular -<60 -<60 -none;atropine -regular -100-150 -100-150 -treat underlying disease

Cystic fibrosis

-respiratory disorder that results from inheriting a mutated gene. It is characterized by mucus glands that secrete an increase the quantity of thick, tenacious mucus, which leads to mechanical obstruction of organs (pancreas, lungs, liver, small intestine)

Left cerebral hemisphere 5 right cerebral hemisphere3

-responsible for language, math, and analytic thinking -expressive and receptive aphasia (inability to speak and understand language) -agnosia (unable to recognize familiar objects) -alexia (reading difficulty) -agraphia (writing difficulty) -responsible for visiual and spartial awareness -altered preception and deficits -unilateral neglect syndrome: ignore left side of the body -poor impulse control and judgement

CHF interventions7

-restriction fluid and salt (2L or 2g less a day) -risk for falls (change slowly) -BP and BNP (never be high) -elevate HOB -daily weights -sex (2 flights of stairs without SOB) -stocking

left side heart failure 3 Right side heart failure

-result in inadequate left ventricle output and consequently in inadequate tissue perfusion -systolic heart failure (ejection fraction below 40% pulmonary and systematic congestion) -diastolic heart failure relaxation or stiffening prevents ventricular filling -right side heart failure results in inadequate right ventricle output and systematic venous congestion (pulmonary edema)

Acute Respiratory Distress Syndrome (ARDS) causes 6 dx confirmation

-sepsis, -fluid overload, -shock, -trauma, -neuro injuries, -burns and aspiration -Chest X ray shows bilateral interstitial and alveolar infiltrates. ABG reveals respiratory acidosis.

Atrial fibrillation 3

-several areas in the right atrium initiate impulses resulting in disorganized, rapid activity. The atria quiver rather than contract). The ventricles respond to the atrial stimulus randomly, causing an irregular ventricular heart rate, which may be too infrequent to maintain adequate cardiac output. One of the chief complications of atrial fibrillation is the formation of blood clots within the atria that may become stroke-causing emboli if they enter the circulation.

Anaphylactic shock is 2

-severe allergic reaction that follows exposure to a substance to which a person is extremely sensitive -· Common allergic substances include bee venom, latex, fish, nuts, and penicillin.

Dopamine 3

-shock -heart failure -acute kidney injury

Non tunneled percutaneous central venous catheter 2

-short term use only -adm of blood, long term arm of chemotherapeutic agents, antibiotics, and TPN

Dysrhythmias 4

-sinus bradycardia or tachycardia -supraventricular tachycardia -ventricular tachycardia -ventricular fibrillation

ST elevated myocardial infarction (STEMI)

-st elevation -emergency type of heart attack

Cerebrovascular accident 3

-stroke; blood flow interrupted blood clot or aneurysm; -artery: do not stop by itself-brain surgery or clip it -vein: stop itself from bleeding

Acute respiratory distress syndrome

-systematic inflammatory response injuries the alveolar capillary membrane. It becomes preamble to large molecules and the lung space is filled with fluid -a reduction in surfactant weakens the alveoli, which causes collapse or filling of fluid leading to worsening edema

Acute Respiratory Distress Syndrome (ARDS) s/s 7 nursing interventions 5

-tachypnea, -dyspnea, -decreased breath sounds, -deteriorating ABG levels, -hypoxemia, -decreased pulmonary compliance, -pulmonary infiltrates o Identify and treat the cause o Administer O2 as prescribed o Place the client in a fowlers position o Restrict fluid intake as prescribed o Provide respiratory treatments as prescribed o Administer diuretics, anticoagulants or corticosteroids as prescribed o Prepare the client for intubation and mechanical ventilation

Tropin CKMB Myoglobin

-take 3 sets of the cardiac enzyme to see if elevated -cardiac enzyme release when heart is injured -earliest marker after 24h it does not show

sweat chloride test 3

-the child must be well hydrated to ensure accurate test results -a device that uses an electrical current stimulates sweat production -chloride greater than 40 mEq/L for infant less than 3 months of age and greater than 60 mEq/L for all others; sodium greater than 90 mEq/L

arterial fibriation

-the top is quivering not pumping adequately the blood stays up can cause blood clot and can cause a stroke --control medication, put on Warfarin

Stroke causes 3 dx confirmation

-thrombosis, -embolism, -hemorrhage from rupture of a vessel -CT, cerebral arteriography and MRI

Ischemia can lead to 3

-tissue necrosis (infarction) if blood supply and oxygen are not restored -ischemia is reversible -cardiac muscle suffers ischemic injury, cardiac enzymes are released into the bloodstream providing specific markers of MI

In shock,

-tissues receive less oxygen. In response, the body tries to obtain more oxygen by breathing faster. Rapid respirations help move blood in the large veins toward the heart -· added diaphoresis increases heat loss.

Prioritization of principles 7

-transient:130/90 to 150/80 expected to be pain comes and go -trends:GCS 15 to 9 to 8

expressive aphasia: receptive aphasia: global aphasia

-type of aphasia characterized by partial loss of the ability to produce language (spoken, manual, or written), although comprehension generally remains intact. Global aphasia - you can't speak, understand speech, read, or write. -Expressive aphasia - you know what you want to say, but you have trouble saying or writing what you mean. Receptive aphasia - you hear the voice or see the print, but you can't make sense of the words.

ECG rhythm 2

-upright and round P waves occurring at regular intervals at rate of 60 to 100 ppm (QRS) -PR interval duration (20seconds) and QRS complex (12 seconds)

atherectomy stent percutaneous transluminal coronary angioplasty

-used to break down and remove plaques within cardiac vessels -placement of a mesh wire device that contains no medication to hold an artery -inflating ballon to dilate arterial lumen this can include stent placement

Atrial flutter rhythm atrial rate ventricular rate treatment Atrial fibrillation rhythm atrial rate ventricular rate treatment

-usually regular -250-350 -75-175 -cardioversion, digitalis, propranolol, verapamil -grossly irregular -400-600 -100-160 -cardioversion, digitalis, verapamil

Expected findings stroke 6

-visual disturbances -dizziness -slurred speech -weakness extremity -transient ischemia attack (TIA) warning of impending stroke -manifestation of TIA last no more than an hour and resolve without permanent effcets

L HF path and causes3

-weak heart = weak pump -MI (heart attack) -iscchemic heart disease

R HF s/s 4

-weight gain up to 3lbs; 5lb in 7 days very bad -edema: pitting -jugular vein distension -abdominal girth: ascites, spleen enlargement, liver enlargement

ventricular fibrillation nursing interventions 3

-· A chaotic rapid rhythm in which the ventricles quiver and there is no cardiac output. Fatal if not successfully terminated within 3-5 minutes. o Defibrillate client immediately o Ensure patent airway o Initiate CPR o Administer O2 as prescribed o Administer antidysrhythmic therapy as prescribed

MI s/s 6 Nursing interventions4

-· Pain usually in the chest but may radiate to jaw, back and left arm, -N/V, -diaphoresis, - dyspnea, - dysrhythmias, -feelings of fear and anxiety, pallor, cyanosis and coolness of extremities o MONA- (morphine, O2, nitrates and aspirin) o Continuous cardiac monitoring o Monitor labs o Monitor VS especially BP

Shock (hypovolemic, cardiogenic, neurogenic, and septic) causes 4 s/s 6

-· Trauma, -heatstroke, - blood loss, an allergic reaction, -severe infection, poisoning, severe burns or other causes -Cool, clammy skin, pale or ashen skin, -rapid pulse, rapid breathing, -nausea or vomiting, -enlarged pupils, -weakness or fatigue, dizziness or fainting, -changes in mental status or behavior, such as anxiousness or agitation

Cystic Fibrosis S/S 6 nursing interventions 4

-· Wheezing and cough, -dyspnea, -cyanosis, -clubbing of the fingers and toes, -barrel chest, -repeated episodes of bronchitis and pneumonia o Prevent and treat pulmonary infection by improving aeration, removing secretions and administering antibiotic medications. o Monitor respiratory status o Chest physiotherapy o Administer O2 as prescribed o Flutter mucous clearance device o Bronchodilators as prescribed

Atropine sulfate,

-· a cholinergic blocking agent, is given intravenously to increase a dangerously slow heart rate.

The three major reasons to suspect CF in children are

-· are respiratory symptoms; failure to thrive; and foul-smelling, bulky, greasy stools. In newborns, the first clinical sign may be a meconium ileus (impacted meconium in the intestines). Another sign may be salty-tasting skin.

Sinus tachycardia is an causes 5

-· arrhythmia that proceeds normally through the conduction pathway but at a faster-than-usual rate (100 to 150 beats/minute). - It occurs in clients with healthy hearts as a physiologic response to strenuous exercise, or anxiety and fear, pain, fever, hyperthyroidism, hemorrhage, shock, or hypoxemia.

sinus bradycardia is an 2 causes 4

-· arrhythmia that proceeds normally through the conduction pathway but at a slower-than-usual rate. -Healthy athletes and others who are physically fit often have heart rates below 60 beats/minute; however, it reflects a well-toned heart conditioned through regular exercise. -A heart rate slower than 60 beats/minute is pathologic in clients with heart disorders, increased intracranial pressure, hypothyroidism, or digitalis toxicity.

Angina s/s 6 nursing intervention 4

-· chest pain may occur upon exertion or rest depending on the pattern (Stable, unstable & variant), -dyspnea, -pallor, -sweating, -palpitations and -tachycardia, syncope and hypertension · Nursing Interventions: o Assess pain and institute pain relief measures, o Administer O2 as prescribed o Continuous cardiac monitoring o Bed rest

A client whose arrhythmia causes 2

-· decreased cardiac output is likely to feel weak and tired, experience anginal pain, or faint. -Some clients with tachyarrhythmias (abnormally fast rhythms) describe palpitations or flutterings in their chest. BP usually is low. Pulse is irregular or difficult to palpate; the rate is unusually fast or slow. The apical and radial pulse rates may differ. The skin may be pale and cool

Stroke s/s 5 nursing interventions 4

-· hypertension, -headache, N/V, -visual changes, -ataxia: loss of full control of bodily movements. -decreased sensation, -speech changes, facial drooping, weakness in the contralateral side o Maintain patent airway and deliver O2 o Monitor vital signs, maintain BP o Monitor level of consciousness o Monitor deficits, maintain safety and NPO status

hypovolemic (hemorrhagic) shock causes 2

-· most common type of shock, the volume of extracellular fluid is significantly diminished, primarily because of lost or reduced blood or plasma -Decreased blood volume with decreased filling of the circulatory system

S/S in CAD4

-· obese person with an apple-shaped body (carries most weight in the abdomen) is at higher risk for CAD than one with a pear-shaped body (carries most weight below the hips). -The pulse may be high at rest and become irregular with exercise. -An opaque white ring about the periphery of the cornea, called arcus senilis ,, results from a deposit of fat granules but may be apparent only in older adults. -Xanthelasma, a raised yellow plaque on the skin of the upper and lower eyelids), suggests lipid accumulation

Ventricular fibrillation 3

-· rhythm of a dying heart. PVCs or ventricular tachycardia can precipitate it. The ventricles do not contract effectively, and there is no cardiac output. Ventricular fibrillation is an indication for cardiopulmonary resuscitation (CPR) and immediate defibrillation.

In all but the early stages of septic and neurogenic shock 2

-· the skin is cold and clammy. As peripheral blood vessels constrict to direct blood from the skin to more vital organs (heart, kidneys, brain), the skin becomes pale. -· skin may appear mottled (i.e., a mix of pale and cyanotic areas lacking any uniform color). Capillary filling longer than 3 seconds and cyanosis, especially of the nail beds, lips, and earlobes, indicate oxygen deficiency.

A monitor rhythm strip or

12-lead ECG can identify arrhythmias. Electrophysiology studies can locate their origin. An electrophysiology study is a procedure that enables the physician to examine the electrical activity of the heart; produce actual arrhythmias by stimulating structures in the conduction pathway;

A client is diagnosed with sinus bradycardia. The nurse knows that the client's atrial rate is at or below what number?

60

Stable angina cause

75% Coronary occlusion that accompanies exertion Elevated heart rate or BP

Stroke

: A sudden focal neurological deficit caused by cerebrovascular disease.

Heart failure staging 4

A. high risk for developing heart failure B. cardiac structural abnormalities or remodeling but no manifestation of heart failure C. current or prior manifestation of heart failure D. refractory end stage heart failure

The nurse is working on a telemetry unit, caring for a client who develops dizziness and a second-degree heart block, Mobitz Type 1. What will be the initial nursing intervention? Administer an IV bolus of atropine. Send the client to the cardiac catheterization laboratory. Prepare to client for cardioversion. Review the client's medication record.

Administer an IV bolus of atropine.

A client is brought to the ED and determined to be experiencing symptomatic sinus bradycardia. The nurse caring for this client is aware the medication of choice for treatment of this dysrhythmia is the administration of atropine. What guidelines will the nurse follow when administering atropine? Administer atropine 0.5 mg as an IV bolus every 3 to 5 minutes to a maximum of 3.0 mg. Administer atropine as a continuous infusion until symptoms resolve. Administer atropine as a continuous infusion to a maximum of 30 mg in 24 hours. Administer atropine 1.0 mg sublingually.

Administer atropine 0.5 mg as an IV bolus every 3 to 5 minutes to a maximum of 3.0 mg.

Variant angina cause

Arterial spasm in normal or diseased coronary arteries

Shock or not pt3

Asystole- CPR em!

The nurse cares for a client with a dysrhythmia and understands that the P wave on an electrocardiogram (ECG) represents which phase of the cardiac cycle? Atrial depolarization Early ventricular repolarization Ventricular depolarization Ventricular repolarization

Atrial depolarization

The nurse is monitoring a patient in the postanesthesia care unit (PACU) following a coronary artery bypass graft, observing a regular ventricular rate of 82 beats/min and "sawtooth" P waves with an atrial rate of approximately 300 beat/min. How does the nurse interpret this rhythm? Atrial fibrillation Atrial flutter Ventricular tachycardia Ventricular fibrillation

Atrial flutter

A nurse is caring for a client who's experiencing sinus bradycardia with a pulse rate of 40 beats/minute. The client's blood pressure is 80/50 mm Hg and the client reports dizziness. Which medication does the nurse anticipate administering to treat bradycardia? Atropine Dobutamine Amiodarone Lidocaine

Atropine

A patient has had an implantable cardioverter defibrillator inserted. What should the nurse be sure to include in the education of this patient prior to discharge? (Select all that apply.) Avoid magnetic fields such as metal detection booths. Call for emergency assistance if feeling dizzy. Record events that trigger a shock sensation. The patient may have a throbbing pain that is normal The patient will have to schedule monthly chest x-rays to make sure the device is patent.

Avoid magnetic fields such as metal detection booths. Call for emergency assistance if feeling dizzy. Record events that trigger a shock sensation.

A nurse provides morning care for a client in the intensive care unit (ICU). Suddenly, the bedside monitor shows ventricular fibrillation and the client becomes unresponsive. After calling for assistance, what action should the nurse take next? Begin cardiopulmonary resuscitation Prepare for endotracheal intubation Provide electrical cardioversion Administer intravenous epinephrine

Begin cardiopulmonary resuscitation

A client has returned to the cardiac care unit after having a permanent pacemaker implantation. For which potential complication should the nurse most closely assess this client? Chest pain Bleeding at the implantation site Malignant hyperthermia Bradycardia

Bleeding at the implantation site

The nurse recognizes which as being true of cardioversion? Amount of voltage used should exceed 400 watts/second. Electrical impulse can be discharged during the T wave. Defibrillator should be set to deliver a shock during the QRS complex. Defibrillator should be set in the non-synchronous mode so the nurse can hit the button at the right time.

Defibrillator should be set to deliver a shock during the QRS complex.

The nurse is caring for a client who has had a dysrhythmic event. The nurse is aware of the need to assess for signs of diminished cardiac output (CO). What change in status may signal to the nurse a decrease in cardiac output? Increased blood pressure Bounding peripheral pulses Changes in level of consciousness Skin flushing

Changes in level of consciousness

Angina

Chest pain resulting from myocardial ischemia caused by inadequate myocardial blood and O2 supply.

A client is scheduled for catheter ablation therapy. When describing this procedure to the client's family, the nurse should address which aspect of the treatment? Resetting of the heart's contractility Destruction of specific cardiac cells Correction of structural cardiac abnormalities Clearance of partially occluded coronary arteries

Destruction of specific cardiac cells

• A nurse is planning to administer hydrochlorothiazide to a client. The nurse understands that which of the following are concerns related to the administration of this medication? Hypouricemia, hyperkalemia Increased risk of osteoporosis Hypokalemia, hyperglycemia, sulfa allergy Hyperkalemia, hypoglycemia, penicillin allergy

Hypokalemia, hyperglycemia, sulfa allergy

• You are caring for a client diagnosed with left sided heart failure. You have administered his scheduled dose of Digoxin. Which of the following does the nurse know to be true about digoxin? Select all that apply. It reduces cardiac workload. It is important to monitor for S&S including visual disturbances and halo lights. It is important to monitor for bleeding. The normal level of dig is 1.2-3 ng/ml

It reduces cardiac workload. It is important to monitor for S&S including visual disturbances and halo lights.

Nursing care for MI

M: Morphine-decrease myocardial oxygen consumption so it won't work so hard O: Oxygen -keep perfusion and oxygen up N: Nitroglycerin- vasodilate heart works less not for pain A: Aspirin-platelet aggret: prevents vasoconstriction

Distributive shock (Neurogenic, Septic, Anaphylactic) 3 EX

Neurogenic: Spinal cord injury Septic: Toxic reaction to gram-negative bacterial infection Anaphylactic: Severe allergic reaction

Shock or not pt4

Normal Sinus

The nurse is assessing vital signs in a patient with a permanent pacemaker. What should the nurse document about the pacemaker? Date and time of insertion Location of the generator Model number Pacer rate

Pacer rate

Patient 1: 64 year old male. Dx: COPD exacerbation. Current vitals: BP 162/92, HR 102, Respirations 24, Temp 98.9 F oral, O2 89% on 2L nasal cannula. Alert and Oriented. Patient 2: 72 year old female. Dx: UTI, AMS (Altered Mental Status). Current Vitals: BP 142/84, Temp 101.6 F oral, HR 86, Respirations 18, O2 91% on room air. Disoriented and a high fall risk. Patient 3: 32 year old male. Post op day 1, Tonsillectomy. Low H&H, low platelet count. Current Vitals: BP 97/65, HR 115, Respirations 18, Temp 100.1 F orally, O2 92% on room air. Was alert upon nurse's last assessment, but now seems a bit disoriented. Patient 4: 27 year old female. Dx: DKA. Current blood glucose 201. Current vitals: BP 125/82, HR 64, Respirations 18, T 98.7 F orally, O2 96% on room air. Patient 5: 89 year old female. Dx: Terminal Cancer. Currently on Hospice care and comfort measures. DNR/DNI. Family at bedside. Current vitals BP 78/58, HR 122, Respirations 10, T 96.2 F orally, O2 89% on 4L nasal cannula.

Patient number 3 should be seen 1st. Vitals indicate hemorrhage as well as the potential for a blocked airway given the tonsillectomy if he is bleeding from there. Also concerned about the change in mental status. Patient number 2 should be seen second. High fall risk, and disorientation is a cause for concern. The argument could be made that patient number 1 could also be seen second or third, given his O2 status, however, he is a chronic COPD patient and currently A&O. Patient number 4 or 5 could then be seen last. Patient number 5's vitals are extremely concerning; however she is on comfort care (meaning we would not intervene). Therefore, she does not take priority over a patient who is still receiving treatment and care.

• The nurse is preparing to administer Furosemide to a patient. Which of the following lab values would the nurse be most concerned with for a patient receiving Furosemide? Hemoglobin of 11 Na+ of 130 Calcium level of 8 Potassium level of 3.3

Potassium level of 3.3

Unstable angina cause

Progressive worsening of stable angina, with more than 90% coronary occlusion

• Intravenous heparin therapy is prescribed for a client. While caring for this client, the nurse ensures that which of the following medications is available on the unit? Protamine sulfate Potassium Chloride Aminocaproic Acid Vitamin K

Protamine sulfate

The nursing educator is presenting a case study of an adult client who has abnormal ventricular depolarization. This pathologic change would be most evident in what component of the ECG? P wave T wave QRS complex U wave

QRS complex

The nurse is attempting to determine the ventricular rate and rhythm of a patient's telemetry strip. What should the nurse examine to determine this part of the analysis? PP interval QT interval RR interval TP interval

RR interval

During a client's care conference, the team is discussing whether the client is a candidate for surgery maze procedure. What would be the most important criterion for a client to have this surgery? Angina pectoris not responsive to other treatments Decreased activity tolerance related to decreased cardiac output Refractory atrial fibrillation Ventricular fibrillation not responsive to other treatments

Refractory atrial fibrillation

1. What are some other classic signs and symptoms of a cerebrovascular accident? 7 What scale would you use to assist you in assessing Mr. Edwards?

S&S: Possible unequal pupils, headache, facial drop, aphasia, fainting, numbness, weakness, confusion, trouble speaking, visual disturbances, and difficulty walking. NIHSS

Shock or not pt8

Sinus Bradycardia- possibly Pace em!

Shock or not pt6

Sinus Tachycardia

TIA

Sometimes a TIA or transient ischemic attack occurs, also known as a "warning stroke" or "mini-stroke" that produces stroke-like symptoms. If this occurs, call 9-1-1

stroke treatment

Stroke survivors have the best outcomes when they receive treatment in 4.5 hours or less. -A clot busting drug called tissue plasminogen activator(tPA) may improve the chances of getting better but only if they get help right away.

supra ventricular tachycardia

Supraventricular tachycardia (SVT) is an extremely fast atrial rhythm with narrow QRS complexes when the impulse originates above the bundle branches (above the ventricles).

The nurse is analyzing a rhythm strip. What component of the ECG corresponds to the resting state of the client's heart? P wave T wave U wave QRS complex

T wave

1. You are evaluating the swallowing pattern of Mr. Edwards who has a confirmed diagnosis of a CVA. What assessments will you use to evaluate the patient's ability to tolerate oral intake?

Test the pharyngeal reflexes (swallow test) and place food on the unaffected side. Keep NPO until patient has passed a bedside swallow exam and a barium swallow exam to prevent aspiration pneumonia

A patient has been admitted to the unit for an electrophysiology (EP) study. For what is an electrophysiology study primarily performed? To facilitate cardioversion To freeze hypersensitive cells To diagnose the dysrhythmia To determine the nursing plan of care

To diagnose the dysrhythmia

A nurse is providing health education to a client scheduled for cryoablation therapy. The nurse should describe what aspect of this treatment? Peeling away the area of endocardium responsible for the dysrhythmia Using electrical shocks directly to the endocardium to eliminate the source of dysrhythmia Using high-frequency sound waves to eliminate the source of dysrhythmia Using a cooled probe to eliminate the source of dysrhythmia

Using a cooled probe to eliminate the source of dysrhythmia

Shock or not pt5

V Fib- Shockem!

Shock or not pt 2

V Tach- Shockem

Shock or not

V fib- Shockem!

Shock or not pt7

V tach- Shockem!

Epinephrine 4

VASOCONSTRICTION -anaphylactic shock -slows absorption -manages superficial bleeding -decreased congestion of nasal mucosa

Ace Inhibitors- enalapril, lisinopril therapeutic uses

VASODILATION -HTN -heart failure -myocardial infarction -Look out for angioedema

A patient who had a myocardial infarction is experiencing severe chest pain and alerts the nurse. The nurse begins the assessment but suddenly the patient becomes unresponsive, no pulse, with the monitor showing a rapid, disorganized ventricular rhythm. What does the nurse interpret this rhythm to be? Ventricular tachycardia Atrial fibrillation Third-degree heart block Ventricular fibrillation

Ventricular fibrillation

The nurse is caring for a client who has just had an implantable cardioverter defibrillator (ICD) placed. What is the priority area for the nurse's assessment? Assessing the client's mobility Facilitating transthoracic echocardiography Vigilant monitoring of the client's ECG Close monitoring of the client's peripheral perfusion

Vigilant monitoring of the client's ECG

A patient with hypertension has a newly diagnosed atrial fibrillation. What medication does the nurse anticipate administering to prevent the complication of atrial thrombi? Adenosine Amiodarone Warfarin Atropine

Warfarin

Cardiac dysthrimias

are heartbeat disturbances (beat formation, beat conduction, or myocardial response to beat)

cerebral infarction dysarthria

blood clot cut off result tissue death slurred speech

Ischemic stroke

blood clot in the brain; TPA within 3 hours quicker you give it better outcome

Cardiac electrical activity

can be monitored by using an electrocardiogram(ECG). The hearts electrical activity can be monitored by a standard 12-lead ECG

When the appropriate electrocardiogram (ECG) complex follows the pacing spike, it is said to be triggered. captured. inhibited. nonsynchronous.

captured.

Cystic fibrosis originates in

epithelial cells produce thick sticky mucous and abdominal distension from malnourished

White lung

filled with fluid-happens with ARDS

The nurse assesses a client with a heart rate of 120 beats per minute. What are the known causes of sinus tachycardia? hypovolemia vagal stimulation hypothyroidism digoxin

hypovolemia

A client asks the nurse what causes the heart to be an effective pump. The nurse informs the client that this is due to the: inherent rhythmicity of cardiac muscle tissue. inherent rhythmicity of all muscle tissue. sufficient blood pressure. inherent electrons in muscle tissue.

inherent rhythmicity of cardiac muscle tissue.

Tissue Plasminogen Activator

is an intravenous medicine given for ischemic stroke - a stroke caused by a blood clot - that can dissolve the stroke-causing clot. Studies show that people who receive tPA within 3 hours - up to 4.5 hours in some patients

One of the most common causes of serious arrhythmias is

myocardial ischemia, lack of oxygenated blood to the heart muscle, which can occur secondary to coronary artery disease (CAD) congestive heart failure, inadequate ventilation, and shock

NSTEMI

non-ST elevation myocardial infarction

Elective electrical cardioversion is a

nonemergency procedure done by a physician to stop rapid, but not necessarily life-threatening, atrial arrhythmias. It is similar to defibrillation One difference is that the machine that delivers the electrical stimulation waits to discharge until it senses the appearance of an R wave.

The nurse analyzes a 6-second electrocardiogram (ECG) tracing. The P waves and QRS complexes are regular. The PR interval is 0.18 seconds long, and the QRS complexes are 0.08 seconds long. The heart rate is calculated at 70 bpm. The nurse correctly identifies this rhythm as normal sinus rhythm. sinus tachycardia. junctional tachycardia. first-degree atrioventricular block.

normal sinus rhythm.

Shock (hypovolemic, cardiogenic, neurogenic, and septic) nursing interventions 4

o Identify and treat the cause o Monitor VS and BP closely o Administer fluids and blood as prescribed o Administer O2 as prescribed

Sepsis can cause

sepsis shock (hypotension, tachycardia)

Neurogenic shock 2

the rarest type of shock, results from injury that affects the vasomotor center in the medulla of the brain or to the peripheral nerves that extend from the spinal cord -Injury to the spinal cord or head or overdoses of opioids, tranquilizers, or general anesthetics can cause neurogenic shock.

• Ca+ Channel Blockers • Very Nice Drugs and "Pine's"- Verapamil, Nifedipine, Diltiazem, Isradipine, Nicardipine, Amlodipine

• Ca+ blockers decrease the cardiac contractility and the workload of the heart thus decreasing the need for O2. • SE- Hypotension • Nursing Interventions- Check BP and HR before administering.

• Cardiac Glycosides • Digoxin (Lanoxin) 2

• Creates positive inotropic action, which increases cardiac output while decreasing cardiac workload. • Nursing Interventions: • Monitor for Dig toxicity (0.5-2 ng/mL).

• Adrenergic Agonists • Dobutamine, Dopamine, Epinephrine, Norepinephrine

• Increases myocardial force and cardiac output through stimulation of beta receptors VASOCONSTRICTOR

• Antianginal Medications 2 • Nitrates 3

• Nitroglycerin • Nitrates decrease preload and afterload and reduce myocardial O2 consumption. • Nursing Interventions • Check BP and HR (Hold Parameters) • Check Expiration (Most nitrates expire within 6 months of obtaining the medication and they will not relieve chest pain if it is expired.

when no identifiable R wave is present 3

ventricular tachycardia, ventricular fibrillation, and asystole (cardiac arrest)

Cystic fibrosis are at risk for

want to increase sodium can help with osteoporosis

Shock is a life-threatening condition that occurs when arterial blood flow and oxygen delivery to tissues and cells are inadequate. Shock develops as a consequence of one of three events: 3

· (1) blood volume decreases, (2) the heart fails as an effective pump, or (3) peripheral blood vessels massively dilate

Cystic Fibrosis

· : A chronic multi system disorder characterized by exocrine gland dysfunction. The mucous produced by the gland is abnormally thick and copious causing obstruction.

Acute Respiratory Distress Syndrome (ARDS) definition

· A form of acute respiratory failure that occurs as a complication of some other condition; it is caused by diffuse lung injury and leads to extravascular lung fluid.

While it is not clear who will develop ARDS, certain factors may increase the risk for ARDS including: 5

· Advanced age · A history of tobacco use · A history of alcoholism · Presence of chronic lung disease · High-risk surgery

Shock (hypovolemic, cardiogenic, neurogenic, and septic)

· Condition where the body is not getting enough blood or oxygen.

astoyle nursing interventions 2

· Definition: No cardiac output and no electrical activity in the heart. · Nursing interventions: o Initiate CPR and ACLS protocol. o Ensure patent airway

Cystic fibrosis (CF) Resulting major abnormalities include the following: 3

· Faulty transport of sodium and chloride in cells lining organs, such as the lungs and pancreas, to their outer surfaces · Production of abnormally thick, sticky mucus in many organs, especially the lungs and pancreas · Altered electrolyte balance in the sweat glands

Characteristics of Normal Sinus Rhythm 5

· Heart rate is between 60 and 100 beats/minute. · The SA node initiates the impulse (upright P wave before each QRS complex). · Impulse travels to the AV node in 0.12 to 0.2 second (the PR interval). · The ventricles depolarize in 0.12 second or less (the QRS complex). · Each impulse occurs regularly (evenly spaced).

· risk Factors for Coronary Artery Disease inherited 5 behavorial 5

· Male sex · Diabetes mellitus · Increased lipid levels · Genetic predisposition · Hypertension · Smoking · Sedentary lifestyle · Obesity · Competitive, aggressive personality · High-fat diet

MI

· Occurs when the myocardial tissue is abruptly and severely deprived of oxygen.

Pulse pressure is

· the numeric difference between systolic and diastolic BP. If a client has a BP of 120/80 mm Hg, the pulse pressure is 40 mm Hg. A pulse pressure between 30 and 50 mm Hg is considered normal, with 40 mm Hg being a healthy average

• Angiotensin-Converting Enzyme (ACE) Inhibitors (Pril's) • Benazepril, Captopril, Lisinopril, Enalapril 2

• ACE Inhibitors prevent peripheral vasoconstriction by blocking the conversion of Angiotensin I to angiotensin II. Used to treat hypertension and heart failure. Have a cardioprotective effect after MI. • SE- hyperkalemia, persistent cough (angioedema)

• Angiotensin II Receptor Blockers (Tan's) ARBS • Losartan, Valsartan, Eprosartan, Candesartan 2

• ARB'sprevent peripheral vasoconstriction and secretion of aldosterone and block the binding of AI to type AII. • Nursing Interventions • Check BP and HR before administering

• Antiplatelets

• Abciximab, Aspirin, Clopidogrel, Ticlopidine • Nursing interventions: Monitor for bleeding and labs (platelets, PT/INR- warfarin and aPTT for heparin)

• Antihypertensive Medications • Beta Blockers (Lol's) • Cartelol, Carvedilol, Labetolol, Pindolol, Propanolol, Sotolol 2

• Beta Blockers inhibit the response to beta adrenergic stimulation, thus decreasing cardiac output. Block the release of catecholamines, epi and norepi thus decreasing HR and BP. • SE- Orthostatic hypotension • Nursing Interventions- Check BP and HR before administering. Advise client to get up slowly.

• Antilipemic Medications (statin's) • Atorvastatin, Lovastatin, Simvastatin 2 SE nursing interventions

• SE-GI upset, elevated liver enzymes, muscle cramps and fatigue • Nursing interventions: • Monitor liver enzymes, instruct client to report any unexplained muscular pain

• Diuretics • Loop- Bumetanide, Furosemide • Thiazide- Hydrochlorothiazide (sulfa based medication) • K+ Sparing- Spironalactone

• SE: Hypotension, hypokalemia (unless K+ sparing), increased urination • Nursing interventions: • Monitor K+ level, daily weights and I&O

• Anticoagulants2

• Warfarin Sodium (Coumadin), Enoxaparin (Lovenox), Heparin sodium, Fondaparinux • Prevent the extension and formation of clots by inhibiting factors in the clotting cascade and decreasing blood coagulability.