med surge test 2
rheumatic fever
Rheumatic Fever (RF) Inflammatory disease occurs after Group A ß-hemolytic streptococcal pharyngitis. Autoimmune reaction 3% of strep + population develops RF Infrequently seen in U.S.; big problem in Third World countries Self-limiting-usually runs its course, but will still take meds for it but hope you don't have long term effects from it Affects joints, skin, brain, serous surfaces, and heart "Rheumatic heart disease" - if patient has cardiac valve damage, strep is attracted to heart and particularly bicuspid/mitral valve, so many pts. with this have to have mitral valve replacement Most common complication of RF Damage to valves as result of RF
Which laboratory findings are consistent with acute coronary syndrome (ACS)? Select all that apply.
Troponin 3.2 ng/mL Myoglobin of 234 mcg/L
anatomy of unborn baby's heart
Umbilical vein-sends oxygenated blood from mom to baby Ductus venosus-allows blood to bypass liver filtration and go to the heart Formanen ovale-opening between atria that take deoxygenated blood in order to bypass blood being sent to the lungs, due to high right sided pressure Ductus arteriosus-takes deoxygenated blood instead of sending more to lungs another short cut
purkinje fibers
at the end of the left and right bundle branches, are in interweaving network located on the surface of the ventricles, make up bundle of HIS, bundle branches, and terminal purkinje fibers, are responsible for the rapid conduction of electrical impulses throughout the ventricles, leading to ventricular depolarization and the ventricular muscle contraction
A client with hypertension is started on verapamil (Calan). What teaching does the nurse provide for this client?
avoid grape juice
What is a common side effect of the antihypertensive drug amlodipine (Norvasc)?
dependent foot and ankle edema
The nurse is providing education to a client with heart failure (HF) about an appropriate diet. Which information is most important for the nurse to emphasize?
do not add any salt to you food
The nurse is teaching a group of teens about prevention of heart disease. Which point should the nurse emphasize?
do not smoke or chew tobacco
The nurse notes ventricular fibrillation on a client's cardiac monitor. What is the priority intervention at this time?
initiate high quality CPR
electrocardiogram (ECG)
provides a graphic representation or picture of cardiac electrical activity, uses electrodes on body connected to an ECG monitor, cardiac electrical current is transmitted via the electrodes and through the lead wires to the machine or monitor that displays the activity
lead
provides one view of the heart's electrical activity, or multiple leads with multiple views can be obtained, made up of positive and negative poles
Which kind of diet does the nurse recommend to a client with arterial occlusive disease/peripheral arterial disease (PAD)?
reduced sodium
during ECG
remind pt. to be still as possible in a semi reclined position, breathing normally, with no repetitive movement, breasts may need to be moved, do not place on hairy skin or irritated and scarry skin
quadrigeminy
repeated four beat pattern usually occurring as three sequential normal complexes followed by a premature complex and a pause, with the same pattern repeating itself in a four beat pattern
P wave
represents atrial depolarization, shape may be positive, negative or biphasic depending on the lead selected, should have a consistent shape
QRS duration
represents the time required for depolarization of both ventricles, normally measures from 0.04-0.12 secs (3 small blocks)
QRS complex
represents ventricular depolarization, shape depends on the lead selected, Q wave is negative and is usually very small, r wave is first positive deflection, may be small, large or absent depending on the lead, S wave is negative deflection following R wave and is not present in all leads
A client who has been admitted for the third time this year for heart failure says, "This isn't worth it anymore. I just want it all to end." What is the nurse's best response?
Considers further assessment for depression
The nurse is caring for a client with coronary artery disease (CAD) who has been prescribed metoprolol XR (Lopressor). What action does the nurse perform when caring for the client?
Hold the medication if the heart rate is less than 50-60 beats/min.
The nurse is teaching a client about self-management of hypertension. Which client statement indicates a correct understanding of the teaching?
I'll cut back on the salt when I cook
The nurse is teaching a client about the synchronous demand pacemaker that has just been implanted for an episode of complete heart block. Which statement indicates the client understands the teaching?
"When my pulse is less than the set rate, the pacemaker stimulates my heart to beat."
During discharge planning after admission for a myocardial infarction, the client says, "I won't be able to increase my activity level. I live in an apartment, and there is no place to walk." What is the nurse's best response?
"Where might you be able to walk?"
The nurse is teaching a young female client how to prevent venous thromboembolism specific to her hospital stay after intensive orthopedic surgery. Which statement made by the client indicates the need for further teaching?
"If I wear pantyhose, I won't have to wear the stockings the hospital gives me."
The nurse is teaching a client about the purpose of electrophysiology studies (EPS). Which statement by the nurse reflects the most correct teaching?
"This test evaluates you for potentially fatal cardiac rhythms."
2 major nodes of pacing
1) synchronous (demand) pacing-temporary is usually this way, pacemaker's sensitivity is set to the pt's own beat 2) asynchronous (fixed rate) pacing
2 types of temporary pacing
1) transcutaneous-Accomplished through application of two large external electrodes attached to an external pulse generator that emits pulses to stimulate ventricular depolarization when pt's heart rate is slower than the rate set on pacemaker in transcutaneous tissue, used in an emergency measure to provide demand ventricular pacing in a profoundly bradycardic or asystolic pt until invasive pacing can be used or pt's heart rate returns to normal, temporary measure to maintain HR and perfusion until a more permanent method can be done 2) transvenous-consists of an external battery operated pulse generator and pacing electrodes or lead wires that attach to the generator on one end and are threaded to the RA via subclavian or femoral vein
care of the pt with dysrythmias
-assess vital signs at least every 4 hours as needed -monitor pt, for cardiac dysrhythmias -evaluate and document the pt's response to dysrhythmias -encourage pt. to notify the nurse when chest pain occurs -assess chest pain and factors -assess peripheral circulation -provide antidysrhythmic therapy according to unit policy -monitor and document pt's response to antiarrhythmic meds or interventions -monitor appropriate lab values -monitor pt's activity tolerance and scheduled exercise/rest periods to avoid fatigue -observe for resp. difficulty -promote stress reduction -offer spiritual support to pt. and/or family as appropriate
most common atrial dysrythmias
-premature atrial complexes -supraventricular tachycardia -atrial fibrillation
complications of CPR include
-rib fractures -fracture of the sternum -costochondral separation -lacerations of the liver and spleen -pneumothorax -hemothorax -cardiac tamponade -lung contusions -fat emboli
dysrhythmias classifications
1) premature complexes 2) bradydysrhythmias 3) tachydysrhythmias
The nurse is assessing an older client for postural (orthostatic) hypotension. Arrange the actions in the order in which the nurse performs the assessment.
1. Measure the blood pressure in a supine position 2. Allow the client to be in a supine position for 3 minutes. 3. Assist the client to a sitting position 4. Wait for one minute before auscultating blood pressure and counting the radial pulse 5. Return the client to a position of comfort
ECG rhythm analysis
1. determine the heart rate 2. determine the heart rhythm 3. analyze the p waves 4. measure the PR interval 5. measure the QRS duration 6. examine the ST segment 7. asses the T wave 8. measure the QT interval
lead system
12 leads (views), six are called limb leads because they are placed on the four extremities in the frontal plane, the remaining six are called chest leads because they are placed on the chest in the horizontal plane
80 lead ECG
80 views instead of 12 and gives a 360 view of heart, increase in diagnosing MI especially in posterior wall and right ventricular region which was missed in 12 lead view, consists of a vest which contains 58 anterior leads, 12 lateral leads, 10 posterior leads, are only available in 4 sizes and may not fit some pts.
use of AED
AHA promotes use of AED for use of laypersons and health care professionals responding to cardiac emergencies, pt. must be on a firm, dry, surface, shocks are recommended for v-fib or pulseless v-tach only
Which statement about diagnostic cardiovascular testing is correct?
An alternative to injecting a medium into the coronary arteries is intravascular ultrasonography
An older adult client, 4 hours after coronary artery bypass graft (CABG), has a blood pressure of 80/50 mm Hg. What action does the nurse take?
Assess pulmonary artery wedge pressure (PAWP).
Which diagnostic test is considered most helpful in diagnosing heart failure?
B-type natriuretic peptide (BNP)
For a client with an 8-cm abdominal aortic aneurysm (AAA), which problem must be addressed immediately to prevent rupture?
BP-192/102
The nurse is caring for a client who has developed a bradycardia. Which possible causes does the nurse investigate? Select all that apply.
Bearing down for a bowel movement Possible inferior wall myocardial infarction (MI) Diltiazem (Cardizem) administered 1 hour ago
patent ductus arteriosus
Blood takes short cut from pulmonary artery to aorta so less goes to lungs, shunt goes from aorta to pulmonary vein, is common in premature babies, can treat with medicine called endomethicin-is an NSAID or prostaglandin inhibitor, or use ibuprofen in nursery to try to get it to close and become a ligament, close the "DO" of the ductus arteriosus PATENT=means open, Prostaglandin-act like hormone and do vasoconstriction or dilation, in heart when we inhibit prostaglandin we want vessel to constrict so inhibit duct from staying open, after pregnancy prostaglandin begins to decline and duct closes on own Surgery-will ligate or suture off duct with tiny sutures without doing open heart surgery
abnormal heart rhythms
CAD, electrolyte imbalances, impaired oxygenation, and drug toxicity can cause this, can occur in people of any age but especially older people
The nurse is caring for a client with unstable angina whose cardiac monitor shows ventricular tachycardia. Which action is appropriate to implement first?
Check the client for a pulse-drug of choice is amiodarone
tests done on peds pts.
Chest X-ray-easiest and most common test to look at size of heart (CXR) Echocardiogram-may need to sedate child to keep them still (Echo) Electrocardiogram (ECG EKG) Telemetry-occasionally (Tele) Holter Monitor-more common in adults, easy, non-invasive, looks similar to telemetry box but has leads that you wear for about 2 days and it records heart activity over time and you mark when you had chest pain to determine the cause of problem (HM) Magnetic Resonance Imaging-be careful when you explain this procedure to ease nerves of parents and let kids see equipment you are going to use so they won't be scared of it(watch words dye-die, and shoot), may need to sedate child to keep them still (MRI) Cardiac Catheterization-may be the only test that is NPO (Cardiac Cath)
A client has just returned from coronary artery bypass graft (CABG) surgery. For which finding does the nurse contact the surgeon?
Chest tube drainage 175 mL last hour
To validate that a client has had a myocardial infarction (MI), the nurse assesses for positive findings on which tests?
Creatine kinase-MB (CK-MB) and troponin
atrial septal defect
Foramen Ovale decides not to close=Atrial Septal Defect in babies that are no longer living in mother's womb This causes a left to right shunt-due to the left sided high pressure so the sound sounds like a choo choo train instead of lub dub like it should The smaller the hole the louder the sounds because there is greater pressure May hear a murmur or child is asymptomatic, a lot of times it goes away on its own by closing up could take up to a month or two but for most babies closes within a day after birth In order to fix it->requires a patch to close up the hole Many children that have cardiac defects also have other things going on, could be due to a special need like down syndrome, High risk categories-women who are diabetic, women who smoke, women who are obese, women who are on antidepressants-can
sinus tachycardia
HR>100, excessive sympathetic stimulation, initially increases CO and BP, however continued increase in HR decreases coronary perfusion time, diastolic filling time, and coronary perfusion pressure while increasing myocardial oxygen demand, may be caused by anxiety, stress, and pain, fever, anemia, hypoxemia, and hyperthyroidism, drugs such as epi, atropine, caffeine, alcohol, nicotine, cocaine, aminophylline, and thyroid meds can increase HR, in some cases is a compensatory response to decreased cardiac output or BP as occurs in dehydration, hypovolemic shock, MI, and HF, may have increased pulse rate, decreased urinary output, decreased BP, and dry skin mucous membranes, may be asymptomatic except for an increased pulse rate goal-decrease HR to normal by treating underlying cause, teach pt. to avoid substances that increase cardiac rate, including caffeine, alcohol, nicotine, and develop stress mgmt techniques
Which are risk factors that are known to contribute to atherosclerosis-related diseases? Select all that apply.
LDL of 160, smoking, and type 2 dm
atrial fibrillation
MOST COMMON DYSRHYTHMIA, can impair quality of life, cause considerable mortality and impose a large economic burden on HC systems, associated with atrial fibrosis and loss of muscle mass, mutation in the lamin AC gene has been linked to atrial fibrosis and dilation, common in diseases like hypertension, HF, and CAD, as the disease progresses CO decreases by 20-30 %, ~2.3 million ppl in US have it, incidence increases with age, causes serious problems in older ppl leading to stroke or HF, risk factors include hypertension, previous ischemic stroke, transient ischemic attack, or other thromboembolic event, CAD, diabetes mellitus, HF, and mitral valve disease, other risk factors are advanced age, obesity, caucasian race more than AA's, and excessive alcohol, AF that is temporary and reversible is associated with excessive alcohol consumption, ventricular response is usually 120-200 bpm, result is a chaotic rhythm with no clear P waves, no atrial contractions, loss of atrial kick, and an irregular ventricular response, atria are quivering, and ventricles beat with a rapid response due to the numerous atrial impulses firing, decreases ventricular filling and reduces CO impairing heart's perfusion ability, interventions depend on the severity of problem, drug therapy is often done, antidysrhythmic drugs to slow ventricular conduction like CCB's or diltiazem, amiodarone, BB's use CHADS scoring to determine if pt with afib needs anticoag therapy-C-congestive heart failure, H-ypertension, A-ge>75yo, D-iabetes mellitus S-troke, if scores 0-1 aspirin is used, if 2 or > considered high risk for clot development and are placed on anticoags such as heparin, warfarin, enoxaparin
In caring for a client following an acute myocardial infarction, what is the greatest priority when planning care?
Monitor for increased frequency of premature ventricular contractions
A client who has had a myocardial infarction is speaking angrily and finding fault with nurses, family members, and hospital employees. What is the best nursing intervention for this client?
Offer the client the ability to make decisions related to care
vital signs for peds pts-
Newborn (HR)120-160 (RR)30-60 (BP)75/50 1 yo 120 30 90/50 2-3 yo 110 25 90/55 4-5yo 100 25 90/55 6yo 100 22 95/55 10 yo 90 20 100/60
The nurse receives a report that a client with a pacemaker has experienced loss of capture. Which situation is consistent with this?
Pacemaker spikes are noted, but no P wave or QRS complex follows.
Which description is characteristic of peripheral cyanosis?
Presence of rubor (dusky redness) in a dependent foot
The nurse is caring for a client 36 hours after coronary artery bypass grafting (CABG), with a priority problem of intolerance for activity related to imbalance of myocardial oxygen supply and demand. Which finding causes the nurse to terminate an activity and return the client to bed?
RR 28
Which vascular assessment by the student nurse requires intervention by the supervising nurse?
Simultaneously palpating the bilateral carotids
After receiving change-of-shift report in the coronary care unit, which client does the nurse assess first?
The client with acute coronary syndrome who has a 3-pound weight gain and dyspnea
Which statement best explains why tachydysrhythmias such as supraventricular tachycardia lead to chest pain?
The diastole is shortened and coronary perfusion is decreased
The nurse anticipates finding a bounding or hyperkinetic pulse in the client with which disorder or condition?
Thyrotoxicosis
trigeminy
a repeated three beat pattern, usually occurring as two sequential normal complexes followed by a premature complex and a pause with the same pattern repeating itself in triplets
cardioversion
a synchronized countershock that may be performed in emergencies for unstable ventricular or supraventricular tachydsyrhythmias or electively for stable tachydysrhythmias that are resistant to medical therapies, the shock depolarizes a large amount of myocardium during the cardiac depolarization, intended to stop the re-entry circuit and allow the SA node to regain control of heart, emergency equipment must be available during procedure, physician, APN, or other qualified nurse explains the procedure to pt. and family, short acting anesthetic agent is administered for sedating, after the procedure: -maintain a patent airway -administer oxygen -assess vital signs and the LOC -administer antidysrhythmic drugs -monitor for dysrhythmias -assess for chest burns from electrodes -provide emotional support -document the results of the cardioversion
sinus arrythmia
a variant of NSR, results from changes in intrathoracic pressure during breathing, does not mean an absence of rhythm, but heart rate increases slightly during exhalation, is irregular but frequently observed in healthy adults rate-60-100 rhythm-atria and ventricular rhythms irregular, with the shortest PP or RR interval varying at least 0.12 secs form the longest PP or RR interval P waves-one P wave before each QRS complex, consistent configuration PR interval-normal, constant QRS duration-normal, constant this is occasionally due to morphine or digitalis, enhances vagal tone, decreases heart rate
18 lead ECG
adds six leads placed on the horizontal plane on the right side of the chest to view the right side of the heart, also sometimes placed on back, also known as right sided ECG
telemetry
allows a battery operated transmitter to record activity and to send to a monitor, allows freedom of movement within a certain area without losing transmission of the ECG,most technicians of ECG- -watch a bank of monitors on a unit -print ECG rhythm strips routinely and as needed -interpreting rhythms -reporting the pt's rhythm and significant changes to the nurse
bi-ventricular pacing
an alternative for patients with HF and conduction disorders to resolve A-fib
defibrillation
an asynchronous countershock depolarizes a critical mass of myocardium simultaneously to stop the reentry circuit allowing the SA node to regain control of the heart
radiofrequency catheter ambulation
an invasive procedure that may be used to destroy an irritable focus causing a supraventricular or ventricular tachydysrhythmias
TP segment
begins at the end of the T wave and ends at the beginning of the P wave, true isoelectric interval in the ECG
determining heart rate
can be estimated by counting the number of QRS complexes in 6 seconds and multiplying that number by 10 to calculate the rate for a minute, called 6 second strip method, least accurate but method of choice for irregular rhythms, big block method-used if QRS complexes are regular or evenly spaced, count the number of big blocks between the same point in any two successive QRS complexes and divide into 300, there are 300 big blocks in 1 minute, memory method-relies on memorizing sequence-300, 150, 100, 75, 60, 50, 43, 37, 33, 30,-find QRS that falls on dark line representing 0.2 seconds and count backwards to the next QRS complex, each dark line is a memorized number-most widely used in hospitals for calculating heart rate for regular rhythms
Which drug is a beta blocker used to treat coronary artery disease (CAD)?
carvedilol
A client has refractory end-stage heart failure. In which class of the New York Heart Association (NYHA) functional classification system is the client categorized?
class IV NYHA
vaughn williams classification
commonly used to categorize drugs according to their effects on the action potential of cardiac cells
SA node
conduction begins with this node "pacemaker", it spontaneously and rhythmically generates electrical impulses at a rate of 60-100 bpm and has greatest degree of automaticity, controlled by the sympathetic nervous system and results in changes in the heart rate
unipolar limb leads
consists of a positive electrode only, aVR, aVF, there are six of them, four placed on extremities as designated on each electrode, fifth is on the chest
AV junctional area
consists of a transitional cell zone, the AV node itself and the bundle of HIS, T cells cause impulses to slow down or to be delayed in the AV node before proceeding to the ventricles, this delay is reflected in the PR segment of EKG, this allows atria to contract and ventricles to fill also known as atrial kick and contributes additional blood volume for a greater cardiac output, controlled by sympathetic and parasympathetic nervous systems
standard bipolar limb leads
consists of three leads that each measures the electrical activity between two points and a fourth lead that acts as a ground electrode, right arm is always negative, the left leg is positive, and the left arm can be either positive or negative
When administering furosemide (Lasix) to a client who does not like bananas or orange juice, the nurse recommends that the client try which intervention to maintain potassium levels?
consume melons and baked potatoes
Which assessment finding is an indication of left-sided heart failure?
crackles in the lung fields
negative deflection
current towards the negative pole
positive deflection
current towards the positive pole
A client with heart failure reports a 7.6-lb weight gain in the past week. What intervention does the nurse anticipate from the health care provider?
daily weight monitoring
The nurse is caring for a client with advanced heart failure who develops asystole. The nurse corrects the graduate nurse when the graduate offers to perform which intervention?
defibrillation
catheter maze
done by inserting a catheter through a leg vein into the atria and dragging a heated ablating catheter along the atria to create lines (scars) of conduction block, pts that have this done have fewer complications, less pain, and a quicker recovery than those with the open, surgical maze procedure
ECG measuring
each small box measures 0.04 secs, five small blocks make up one large block defined by bolder lines and representing 0.02 secs, five large blocks represent 1 second and 30 large blocks represents 6 seconds, made up by P wave, QRS complex, and T wave
premature complexes
early rhythm complexes, occur when a cardiac cell group other than the SA node becomes irritable and fires an impulse before the next sinus impulse is produced, there is a pause before next normal complex, creating an irregularity in the rhythm, pt. may be unaware that they have it or may feel palpitations or experience symptoms of decreased CO if more severe, may occur repetitively in a rhythmic fashion
sinus bradycardia
excessive parasympathetic stimulation of heart causes a decreased rate of SA node discharge, HR <60,may result from carotid sinus massage, vomiting, suctioning, valsalva maneuvers, ocular pressure, or pain, may also result from hypoxia, inferior wall MI, and admin of drugs such as BB's, CCB's, and digitalis, may be caused by Lyme disease or hypothyroidism, slow heart rate and decrease speed of conduction through heart, increases coronary perfusion time but may decrease coronary perfusion pressure, myocardial oxygen demand is decreased, either in sick ppl or super in shape athletes, may be asymptomatic except for decreased pulse rate, many cases the cause is unknown, other symptoms include: -syncope -dizziness and weakness -confusion -hypotension -diaphoresis -SOB chest pain treatments include incease intravascular volume of IV fluids, atropine 0.5 mg IV, apply 02, may require pacemaker long term
bigeminy
exists when normal complexes and premature complexes occur alternately in a repetitive two beat pattern, with a pause occurring after each premature complex so that complexes occur in pairs
T wave
follows the ST segment and represents ventricular repolarization, usually positive, rounded, and slightly symmetric, may become tall and peaked, inverted or flat as a result of myocardial ischemia, potassium or calcium imbalances, meds, or autonomic nervous system effects
U wave
follows the T wave when present may result from slow repolarization of ventricular purkinje fibers, the same polarity as the T wave, but generally is smaller, an abnormal U wave may suggest an electrolyte imbalance or other disturbance
While performing a cardiovascular assessment of a client, the nurse detects a very loud heart murmur accompanied by a palpable thrill. This is audible even if the stethoscope is partially off the client's chest. What grade of heart murmur does this describe?
grade V
tachydysrhythmias
heart rates greater than 100 bpm, major concern for the adult pt. with CAD, serious because: -shorten the diastolic time and therefore the coronary perfusion time -initially increase CO and BP, however a continued rise in heart rate decreases the ventricular filling because of shortened diastole decreasing the stroke volume so CO and BP will begin to decrease, reducing aortic pressure and coronary perfusion pressure -increase the workload of the heart increasing myocardial oxygen demand, pt. may have palpitations, chest discomfort, restlessness and anxiety, pale cool skin, syncope from hypotension, may also lead to HF presenting symptoms of dyspnea, lung crackles, distended neck veins, fatigue, and weakness
Ventricular septal defect
hole between left and right ventricles, shunting of blood from left to right across ventricles, some need treatment and some don't depends on situation Risk factors-rubella or German measles in the mother are risk for this defect when born, can't give MMR to pregnant women but must see if they are immune to it and can give them after wards, tobacco, alcohol, cocaine use, obesity in mother, may be genetic also but is unknown, if have a child with a heart defect they are more likely to have another child born with a heart defect also, women who are also on seizure meds-need to taper off to one less teratogenicity for pregnancy
lead axis
imaginary line joining the two poles
artifact
interference seen on the monitor or rhythm strip which may look like a wandering or fuzzy baseline, can be caused by pt. movement, loose or defective electrodes, improper grounding, or faulty ECG equipment, such as broken wires or cables, some can mimic lethal dysrhythmias like v-tach (with tooth brushing) or v-fib (tapping on electrode)
supraventricular tachycardia
involves rapid stimulation of atrial tissue at a rate of 100-280 bpm in adults, P waves may not be visible especially if there is a 1:1 conduction with rapid rates because P waves are embedded in preceding T wave, may occur in healthy young ppl especially women, usually due to re-entry mechanism in which one impulse circulates repeatedly throughout the atrial pathway restimulating the atria tissue at a rapid rate-term paroxysmal supraventricular tachycardia is used when rhythm is intermittent, initiated suddenly by premature complex such as PAC and terminated suddenly with or without intervention, assess for palpitations, chest pain, weakness, fatigue, SOB, nervousness, anxiety, hypotension, and syncope, cardiovascular deterioration may occur if rate does not sustain BP adequately, can result in angina, heart failure, and cardiogenic shock, pt. may also be asymptomatic except for occasional palpitations if less severe, no intervention needed if stops on its own in healthy person, need to eliminate cause if continues should be studied with electrophysiology test, preferred treatment is radiofrequency cath ablation, need to decrease ventricular response convert dysrhythmias to a sinus rhythm, physicians can do vagal maneuvers like carotid massage, results are often temporary and can cause rebound tachycardia or severe bradycardia, AV blocking agents can be given such as beta and calcium channel blockers or synchronized cardioversion
implanted cardioverter/defibrillator
is indicated for pts who have experienced one or more episodes of spontaneous sustained v-tach or v-fib not caused by an MI, generator is implanted in left pectoral area, similar to a permanent pacemaker insertion procedure, requires close monitoring post-op for dysrhythmias, and complications such as bleeding and cardiac tamponade
PR segment
isoelectric line from the end of the P wave to the beginning of the QRS complex when the electrical impulse is traveling through the AV node and is delayed
In assessing a client at risk for peripheral arterial disease, which factor concerns the nurse most?
leg pain with walking
What does the nurse anticipate administering to a client with pulmonary edema to promote diuresis?
loop diuretic by infusion
PR interval
measured from the beginning of the P wave to the end of the PR segment, represents the time required for atrial depolarization as well as the impulse delay in the AV node and the travel time to the purkinje fibers usually is 0.12-0.20 secs (five blocks)
In which condition does reduced pulse pressure occur?
mitral stenosis
Which statement by a client scheduled for a percutaneous coronary intervention (PCI) indicates a need for further preoperative teaching?
my angina will be gone for good
A client is believed to have had a myocardial infarction (MI). Which laboratory study would be positive for MI first?
myoglobin
temporary pacing
nonsurgical intervention that provides a timed electrical stimulus to the heart when either the impulse initiation or the conduction system of the heart is defective, electrical stimulus may be delivered to the RA or RV or both, used for pts with symptomatic, atropine refractory bradyarrhythmias or asystole
ST segment
normally an isoelectric line and represents early ventricular repolarization, length varies with changes in the heart rate, admin of meds, and electrolyte disturbances
bradydysrhythmias
occur when heart rate is less than 60 beats per minute can be significant because: -myocardial oxygen demand is reduced from the slow heart rate which can be beneficial -coronary perfusion time may be adequate because of prolonged diastole which is desirable -coronary perfusion pressure may decrease if the heart rate is too slow to provide adequate cardiac output and BP, this is a serious consequence, can be symptomatic( causing MI, dysrhythmias, hypotension, or HF) or asymptomatic
premature atrial complex
occurs when atrial tissue becomes irritable, fires an impulse before the next sinus impulse is due, P wave may not be visible because can be hidden by preceding T wave, usually followed by a pause, causes of atrial irritability can include: -stress, fatigue, anxiety, inflammation, infection, caffeine, nicotine, or alcohol, drugs such as epi, sympathomimetics, amphetamines, digitalis, or anesthetic agents, may result from MI, hypermetabolic states, electrolyte imbalances, atrial stretch-resulting from congestive HF, valvular disease, and pulmonary hypertension with cor pulmonale, usually has no symptoms except heart palpitations, need to treat cause such as HF, if occur frequently may lead to more serious dysrhythmias and need treatment, teach pt. to manage stress and substances to avoid such as caffeine and alcohol
depolarization
occurs when the normally negatively charged cells within the heart muscle develop a positive charge
v-tach
occurs with repetitive firing of an irritable ventricular ectopic focus usually at a rate of 140-180 bpm or more, may result from an increased automaticity or a re-entry mechanism, may be intermittent or sustained, lasting longer than 15-30 secs, SA node may continue to charge independently, depolarizing the atria but not the Ventricles, although p waves are seldom seen in sustained v-tach, may occur in pts with ischemic heart disease, MI, cardiomyopathy, hypokalemia, hypomagnesemia, valvular heart disease, HF, drug toxicity, or hypotension, pts who use cocaine or illicit inhalants are at high risk for V-tach, usually occurs first in cardiac arrest before v-fib, elective cardioversion is highly recommended for stable V-tach, or antidysrhythmics, as well as radiofrequency catheter ablation, for unstable v-tach it is treated just like v-fib with defibrillator
Which complementary and alternative therapy is known to reduce lipid levels and stabilize atherosclerotic plaques in clients with coronary artery disease (CAD)?
omega 3 fatty acids
surgical maze procedure
open chest surgical technique often performed with coronary artery bypass grafting, places a maze of sutures in strategic places in the atrial myocardium, pulmonary artery, and possibly the superior vena cava to prevent electrical circuits from developing and continuing A-fib,
automaticity
pacing function, the ability of cardiac cells to generate an electrical impulse spontaneously and repetitively, usually this is done by the SA node, disturbances can cause an increase or decrease in pacing function
A client with peripheral arterial disease (PAD) has undergone percutaneous transluminal angioplasty (PTA) of the lower extremity. What is essential for the nurse to assess after the procedure?
pedal pulses
What is the greatest priority once a crash cart has been brought to a room when responding to a client in ventricular fibrillation?
perform defibrillation
Which intervention does the nurse perform to decrease dyspnea in a client with acute heart failure?
place the client in high fowler's position
The nurse is caring for a client with heart failure in the coronary care unit (CCU). The client is now exhibiting signs of air hunger and anxiety. Which nursing intervention does the nurse perform first for this client?
positions the client to alleviate dyspnea
ventricular dysrhythmias
potentially more life threatening than atria dysrhythmias because the left ventricle pumps oxygenated blood throughout the body to perfuse vital organs and other tissues
most common or life threatening ventricular dysrhythmias are
premature ventricular complexes ventricular tachycardia ventricular fibrillation ventricular asystole
premature ventricular complexes
result from increased irritability of ventricular cels and are seen as early ventricular complexes followed by a pause, when multiple PVC's are present the QRS complexes may be unifocal or uniform (Same shape) or multifocal multiform (different shape), PVC's frequently occur in repetitive rhythm, such as bigeminy, trigeminy, and quadrigeminy, two sustained PVC's are a pair or couplet, while three or more successive PVC's are called non-sustained ventricular tachycardia, PVC's are common and frequency increases with age, may occur with problems such as MI, chronic heart failure, COPD, and anemia, or pts with hypokalemia, hypomagnesemia, or with stress, alcohol, caffeine, nicotine, infection, or surgery especially in older adults, post menopausal women find that PVC's and palpitations can occur with caffeine, pt. may be asymptomatic or experience palpitations, or chest discomfort, caused by increased stroke volume, peripheral pulses may be diminished or absent because the decreased stroke volume of the premature beats may decrease peripheral perfusion, if there is no underlying cause of heart disease, it is not usually treated except eliminating the cause, potassium or magnesium may be given for replacement therapy if hypokalemia or hypomagnesemia is a cause, ppl with more than 500 in a 24 hr period are usually placed on a beta blocker
v-fib
result of electrical chaos in the ventricles and is life threatening, impulses from many irritable fire in a totally disorganized manner so that ventricular contraction cannot occur, there are no recognizable ECG deflections, ventricles merely quiver consuming a tremendous amount of oxygen, there is no CO or pulse and no cerebral, myocardial, or systemic perfusion, is rapidly fatal if not successfully ended within 3-5 minutes, may be the first manifestation of CAD, pts with MI are at great risk for v-fib, it may also occur in those with hypokalemia, hypomagnesemia, hemorrhage, drug therapy, rapid supraventricular tachycardia or shock, surgery or trauma may also cause it, when v-fib begins pt. becomes faint, immediately loses consciousness, and becomes pulseless, and apneic, there is no BP and heart sounds are absent, resp. and metabolic acidosis develop, seizures may occur, within minutes the pupils become fixed and dilated and skin becomes cold and mottled death results without prompt intervention, desire is to resolve v-fib and convert to organized rhythm, priority is to defibrillate pt. immediately according to ACLS protocol, or give high quality CPR if defibrillator is not available, , AED is typically used
Before administering furosemide (Lasix) to a client with heart failure, it is most important for the nurse to assess which diagnostic test result?
serum electrolytes
A client expectorates frothy, pink-tinged sputum. Which condition does the nurse suspect in the client?
severe pulmonary edema
A client's rhythm strip shows a heart rate of 116 beats/min, one P wave occurring before each QRS complex, a PR interval measuring 0.16 second, and a QRS complex measuring 0.08 second. How does the nurse interpret this rhythm strip?
sinus tachycardia
Which factors increase the risk of atherosclerosis? Select all that apply.
smoking, DM, genetic predisposition
ventricular asystole
sometimes called ventricular standstill, the complete absence of any ventricular rhythm there are no electrical impulses in the ventricles and therefore no ventricular depolarization, no QRS complexes, no contraction, no CO, and no perfusion to the rest of the body, pt. has no pulse, respirations, BP, is in full cardiac arrest, SA node in some cases may continue to fire and depolarize the atria with only p waves seen on ECG, sinus impulses do not conduct to the ventricles and QRS complexes remain absent, in most cases the entire conduction system is electrically silent with no P waves on ECG, usually results from myocardial hypoxia, which may be a consequence of advanced heart failure, or by severe hyperkalemia and acidosis, if p waves are seen asystole is likely because of severe ventricular conduction blocks, cardiopulmonary resuscitation is essential to prevent brain damage and death, BCLS must be initiated immediately when asystole occurs, confirm unresponsiveness before initiating CPR: -check for a carotid pulse for 5-10 secs - if carotid pulse is absent, start chest compressions of at least 100 compressions per minute and a compression depth of at least 2 inches, push hard and fast, -maintain a patent airway -ventilate with a mouth to mask device, give rescue breaths at a rate of 10-12 breaths/min, if an advanced airway is in place one breath should be given every 6-8 secs -ventilation to compression ratio should be maintained at 30 compressions to 2 breaths if advanced airway is not in place
capture
spike on ECG strip indicating a pacing stimulus has been delivered to the heart by a pacemaker causing depolarization
The AED indicates the client is in ventricular asystole. After checking for a carotid pulse and finding none, the nurse certified in basic life support knows the priority action is to
start compressions (CAB)-compressions, airway, rescue breathing
contractility
the ability of atrial and ventricular muscle cells to shorten their fiber length in response to electrical stimulation, causing sufficient pressure to push blood forward through the heart,the mechanical activity of the heart by specialized cells of the myocardium of the heart, consists of the SA node, AV node, and bundle branch system
excitability
the ability of non pacemaker heart cells to respond to an electrical impulse that begins in pacemaker cells and to depolarize
isoelectric line
the baseline that occurs when there is no current flow in the heart after complete depolarization and also after complete repolarization, positive deflections occur above line and negative below line, deflections=depolarization and repolarization of cells
cardiac axis
the direction of electrical current flow in the heart
conductivity
the heart's ability to send an electrical stimulus from cell membrane to cell membrane, as a result excitable cells depolarize in rapid succession from cell to cell until all cells have depolarized, disturbances occur when conduction is too rapid or too slow, when pathway is blocked or when electrical impulses travel an abnormal pathway
A client begins therapy with lisinopril (Prinivil, Zestril). What does the nurse consider at the start of therapy with this medication?
the risk for hypotension
QT interval
total time required for ventricular depolarization and repolarization, measured from beginning of the Q wave to the end of the T wave, varies with pt's age, gender, changes in heart rate, lengthening with slower heart rates and shortening with faster heart rates, may be prolonged by certain meds, electrolyte disturbances, or subarachnoid hemorrhage, a prolonged QT interval may lead to a type of v-tach called torsades de pointes
permanent pacemaker
treats conduction disorders that are not temporary including complete heart block, also combination defibrillator/pacemaker devices are available, biventricular pacemaker-coordinate interactions between right and left ventricles, usually implanted in subcutaneous pocket at the shoulder in the right or left subclavicular area, which may create a visible bulge, they should be assessed for signs of bleeding, redness, swelling, tenderness, and infection, dressing should remain clean and dry, pt. should be afebrile with stable vital signs, checks should be done regularly for programming and functionality
Which cardiac rhythm typically deteriorates into ventricular fibrillation?
ventricular tachycardia
biphasic complex
when current is moving neither toward or away from the positive pole
When following up in the clinic with a client with heart failure, how does the nurse recognize that the client has been compliant with fluid restrictions?
wt loss of 6 lbs since the last visit
Which points should be covered in the teaching plan for a client with essential hypertension? Select all that apply.
wt loss, smoking cessation, managing stress
