Adult Health 2 Stuff I need to memorize
What are the major signs and symptoms of cardiogenic shock
- Agitation - Low BP - Cool pale skin - Low urine output (less than 30 mL/HR
Parasympatholytic
- Anticholinergic drugs - Atropine
Parasympathomimetic
- Digoxin - Cholinergic drugs Drugs that increase the rest and digest reponse
Sympathomimetic drugs example
- Epinephrine - Adrenergic drugs
What are the four major signs of heart failure
- Rapid weight gain - New edema - Worsening dyspnea
What is the dosing of nitroglycerine?
3 doses MAX 5 min apart, no swallowing SL sublingual under the tongue
Interpret this image
Afib
Which possible dysrhthmia would a nurse anticipate testing for after noting that a client in the clinic can an irregularly irregular pulse rhythm at a rate of 88 beats a minute.
Afib
Which clinical finding enables the nurse to conclude that the heparin therapy is effective in a client who has atrial fibrillation with rapid ventricular response and is started on a continuous heparin infusion?
An activated partial thromboplastin time (aPTT) is twice the usual value.
Amiodarone is what
Antiarrhythmic
Which client response must the nurse monitor to determine the effectiveness of amiodarone?
Decrease in cardiac dysrhythmias
The patient has a blood pressure of 80/30 mmHg and they are diaphoretic and feeling dizzy. The O2 saturations are 88% on room air. The provider has just written orders. The patient has chronic atrial fibrillation and their INR is 3. The nurse would question orders for which of the following? Select all that apply. (FYI-all doses are correct) - Digoxin 0.25mg IVP stat - Start amiodarone drip at 1mg/min x 6 hours and then 0.5 mg/min x 18 hours. No loading dose. Tell me why
Dig: We question because dig works SLOW and we need to move FAST with this pt Amiodarone: This drip is for stable angina we need a STAT BIG LOADING DOSE
Which finding will the nurse expect when analyzing the Cardiac rhythm for a client with first degree atrioventricular (AV) block?
Every P wave is conducted to the ventricle. (It just takes longer- if the R is far from P then you've got first degree"
What happens in cardiac tamponade>
Heart is squished to death by its own heart sac causing the heart to stop beating (deadly condition)
What is the major treatment for heart failure
IV Diuretics (furosemide and bumetanide)
What does ST segment ELEVATION indicate on a 12 lead ECG?
Indicates that there is a true myocardial infarction where there is NO perfusion which leads to MI/Heart attack and death of muscle tissue
What medication must be held prior to taking a patient to the cath lab and what can happen if it is not held?
Metformin 48 before and after cath lab. We are trying to prevent lactic acidosis and nephropathy
ST segment elevation on ECG would indicate which of the following?
Myocardial infarction
What does an ST segment depression indicate on a 12 lead ECG??
Myocardial ischemia due to low perfusion Memory trick: ST segment beLOW the baseline LOW O2
What medication is absolutely contraindicated with nitroglycerine? Why?
NO viagra or afil ending drugs like sildenafil AFIL will KILL because both meds are potent vaso dialators using both can lead to vascular colase
Interpret the ECG image
No P waves. This is an SVT. This is what we use adenosine for (slows heart rhythm and decreases blood pressure)
Atropine is a
Parasympatholytic
What is pericarditis
Paricarditis is inflammation of the sac around the heart. Two major complications is pericardial effusion and cardiac tamponade
Interpret the following image
Regularly irregular this means Afib
Interpret this image
Sinus Tachycardia
Adenosine does what
Slows conduction throughthe AV node, Restores sinus rythum. slows heart rhythm and BP
Which action would the nurse take first after obtaining a radial pulse rate of 136 beats per minute in a client with chronic atrial fibrillation?
Take the client's apical pulse for a full minute
When a client suddenly develops a second degree heart block type 1 with a rate of 48 beats/min which action should the nurse take first?
Take the client's blood pressure Rational: Becuase second degree heart block, type 1 is usually transient and well tolerated, the nurses first action would be to assess the client for adequate perfusion by checking parameters such as blood pressure, skin temp, an alertness. A temporary pacemaker may be needed but only if the assessment indicates a need to increase Heart rate to adequately perfuse the client.
What rhythm is this?
Third degree AV block
Which term would the nurse use to document the rhythm when a client's rhythm strip shows more P waves than QRS complexes and there is no relationship between the atria and the ventricles?
Third degree AV block (Complete heart block)
Treatment for the following rhythm would include which of the following?
This is SVT. Its coming from the atrium because QRS is narrow Rhythm is regular so SVT, treat with adenosine 6 mg
What are the two condistions that lead to myocardial ischemia?
Unstable Angina Non ST sEgment evevation MI clled NSTEMI
With supply ischemia it is
Unstable angina
If a patient is having chest pain and their cardiac enzymes are negative what test may be done to diagnose the cause of the chest pain?
We do a stress test to pinpoint blockage
Which finding consult HCP before administering metoprolol to a client with stable angina? Sinus bradycardia rate 54 on monitor why
because beta blocks slow down the heart!!
What are fibrinolytics
clot busters. One time push drugs
If The pt is experiencing Unstable Angina will they have any ECG changes?
no
What is the memory trick for Third degree AV block?
"P's and Q's dont agree, then you have a third degree"
What three mediations are used to help the myocardium rest following an MI?
- Beta blockers - Calcium channel blockers - Dilators like nitro
What is Beck's triad?
- Big JVD - Extremally low BP - Cant hear heart sounds
What are the first interventions of treating Bradycardia in order?
- Check airway and breathing - Put on cardiac monitor and assess blood pressure - Determine if pt is stable or unstable - If pt is symptomatic with signs of poor persusion give atropine 1 mg every 3-5 minutes up to 3 mg - If pt does not respond to atropine then consider pacing dopamine or epinephrine
If a pt is in VF or VT and does not have a pulse wat is the treatment?
- Defibrillate (before CPR) NO PULSE = DONT SYNCHRONIZE
Sympatholytic drugs
- Metoprolol - Anti-adrenergic drugs
Which nursing intervention is important when caring for clients reciving intravenous (IV) digoxin?
- Monitor the heart rate closely - Check the blood levels of digoxin - Monitor the serum potassium level
What are the four enzymes that are released from dying heart muscle?
- Myoglobin - CK-MB - Troponin I - Troponin T
Initial treatment for a pt experiencing myocardial infarct includes what and in what order?
- Oxygen - Aspirin - Nitroglycerine - Morphone "Oh Anm"
In what order does normal cardiac conduction occur through the heart?
- Sinoatrial node - Atrioventricular (AV) node - Bundle of His - Bundle branches - Purkinje fibers
7. What is an acute coronary syndrome? Is it due to demand ischemia or supply ischemia?
Acute coronary syndrome is a spectrum of conditions caused by atherosclerosis. All these conditions are due to supply ischemia where there is lack of blood flow to coronary artery
What do they do? Atropine - Amiodarone - Adenosine -
Atropine - Increases heart rate Amiodarone - Antiarrhythmic Adenosine - slowing HR and blood pressure
Pt is lethargic, less alert, BP has dropped to 80/30 mmHg, she is placed on Oxygen because her sats are low and she has an altered rhythm. She is unstable. What is the next step? What would we give her?
Atropine because she is lethargic. Blood pressure is low. She is UNSTABLE.
How would you explain to Mrs. Jones the purpose of atropine?
Atropine is a medication that works to block your parasympathetic nervous system or you rest and digest system. When we give this to you, because it is going to block that system, it will speed up your heart.
Which medication is indicated to treat bradycardia for a client who's heart rate drops to 38 beats/minute during a procedure?
Atropine sulfate
During a chemical stress test what do patients need to be taught to stop taking 24-48 hours before the test? Prior to a chemical stress test how long must the patient usually be NPO?
Avoid stimulants such as cigarettes and caffeine (no tea, no soda, no coffee, no decar) and avoid meds such as nitro, beta blockers, ad theophylline and no eating or drinking 4 hours before and after
What causes mitral valve prolapse? What does the pt commonly develop with mitral valve prolapse?
Causes: One of the strings on the left side (Strings holding flap or valve down) snap loose from heart muscle Pt commonly develops a heart murmur from blood backing up
Which rhythm is the client experiencing when the cardiac monitor shows sudden bursts of a regular heart rhythm with a rate of 220 beats/minute, normal QRS duration and P waves that are difficult to see?
Paroxysmal supraventricular tachycardia (PSVT)
With demand ischemia it is
Stable Angina