What is the normal range for Pulmonary Artery Pressure:

Systolic

and

Diastolic

systolic= 15-25

diastolic= 8-15

1. catheter

2.  Heparinized flush system

3.  pressure bag

4.  transducer

5.  amplifier or monitor

How much pressure

 should the pressure bag

be maintained at?

The crossing of 2 reference points:

1) a line from the 4th intercostal space where it joins the sternum

2)a line midway between the ant. and post. surfaces of the chest near axilla area

1- make sure the system is set up and maintained properly- patent and free of air bubbles

2-  check to make sure stopcock of transducer is at phlebostatic level

3- to ensure that the pressure system is properly fx at atmospheric pressure (the nurse est. the zero reference point)

Can be raised up to 60 degrees-

nurse repositions the system to the phlebostatic level to ensure accurate reading

What is used to assess

right ventricular fx

 &

 venous blood return

to the right side of heart?

What causes decrease CVP

and

what should be done?

hypovolemia-

give pt a rapid IV infusion

infusing IV fluids

administering IV meds

drawing blood samples

What are common complications

to monitor for

in a pt with a CVP?

infection

pneumothorax

air embolism

1. SA node firing rate=__________

2.  AV node firing rate=_________

3.  Ventricle firing rate=__________

1. SA node= 60-100

2. AV=40-60

3. ventricles=30-40

What does T wave mean

and

what should it look like?

ventricular repolarization

it should be rounded and symmetrical

What does a inverted T wave indicate?

What does a high T wave indicate?

inverted- hypokalemia

high- hyperkalemia

1.  Lower metabolic needs

sleep

athletic training

hypothyroidism

2.  Vagal stimulation      

vomiting

suction

pain

3.  meds                     

4.  Increased ICP         

5.  M.I.                         

What is tx of sinus brady.

if pt is symptomatic?

Give O2( acute MI)

Atropine 0.5 mg up to 3 mg

increase fluids

trendelenburg position

stimulants-alcohol, nicotine, caffeine

hypovolemia/shock/blood loss

CHF

hyperthyroidism

anxiety/exercise

If pt is symptomatic

with sinus tach,

 what is tx?

TREAT THE CAUSE:

replace blood and fluids

give med for pain

fever > 101- Tylenol

give blockers if VERY symptomatic

What is the cause of

Premature atrial Contractions?

caffeine, etc.

anxiety

hypokalemia

pregnancy

MI

Will pt be hospitalized

 for premature atrial contractions?

What is the difference in

controlled A fib

and

uncontrolled A fib???

controlled the heart rate is < 100

uncontrolled the heart rate is > 100

adv. age, CAD, cardiomyopathy, hyperthyroidism, pulmonary disease, alcoholism, HTN, diabetes,

 and after CABG

What is tx for symptomatic

uncontrolled A fib?

cardioversion if occured less than 48 hours ago;

IV adenosine, amiodarone, cardizem, blockers

If pt has A fib and is at increase risk for stroke,

what med should the pt be on?

pulmonary embolism

and

systemic emboli

adenosine IV if stable (elevate arm to promote quick med absorption)

mag., cardizem, blockers

amiodarone, dig

cardioversion

What are some causes

of

PVC's?

stimulants

CAD, CHF, MI

fever, hypervolemia, dig. toxicity

hypoxia

acidosis

hypokalemia

If a pt has PVC's

and

is asymptomatic when should we tx it

and

with what med?

Tx PVC's if pt has hx of

CAD, CHF, or MI.....

Give pt amiodarone

What is the therapeutic level

for

Digoxin???

Normals:

1. PT=

2.  PTT=

3.  INR=

PTT= 20-39 sec

PT= 9.5-12 sec

INR= 1.0

Normals:

BUN=

Creatinine=

BUN-10-20

Creatinine- 0.7-1.4

(should be a 1:10 ratio)

normal

pH:

HCO3:

PaCO2:

     pH= acid<----7.35-7.45--->alk                             

HCO3 acid<----22-26--->alk  (metabolic origin)

PaCO2 alk<-----35-45----->acid (resp. origin)     

TREAT THE CAUSE

K+ IV diluted by pump

O2

decrease stimuli

tx MI

amiodorone, lidocaine, pronestyl

cardiovert

If stable, and pt has V tach, what should be done?

(V tach is a medical emergency)

amiodarone NO BLOCKERS

cardiovert

CPR until dr calls time of death.

do not shock.