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