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med surg II Unit 6
cardio
77
Nursing
Undergraduate 1
11/05/2011

Additional Nursing Flashcards

 


 

Cards

Term
What are Cardiac dysrhythmias?
Definition
abnormal rhythms of the heart's electrical system that can affect its ability to effectively pump oxygenated blood throughout the body.
Term

All dysrhythmias are life threatening

 

T/F?

Definition

False.

 

Some dysrhythmias are life threatening, and others are not.

Term
What are common causes of dysrhythmias?
Definition
 coronary artery disease (CAD), electrolyte imbalances, changes in oxygenation, and drug toxicity
Term
What is is the ability of cardiac cells to generate an electrical impulse spontaneously and repetitively.
Definition
Automaticity (pacing function)
Term
What are the primary pacemaker cells of the heart?
Definition
sinoatrial [SA] node, atrioventricular [AV] junction
Term
Under what types of  conditions may other cells (not the pace maker) in the heart generate electrical impulses independently and create dysrhythmias.
Definition
myocardial ischemia , electrolyte imbalance, hypoxia, drug toxicity, and infarction
Term
What is Excitability?
Definition
the ability of non-pacemaker heart cells to respond to an electrical impulse generated from pacemaker cells and to depolarize.
Term
When does Depolarization occure?
Definition
occurs when the normally negatively charged cells within the heart muscle develop a positive charge.
Term
What is Conductivity?
Definition
the ability to transmit an electrical stimulus from cell membrane to cell membrane.
Term

What does Conductivity result in?

 

 

 

 

Definition

excitable cells depolarize in rapid succession from cell to cell until all cells have depolarized.

 

The wave of depolarization causes the deflections of the electrocardiogram (ECG) waveforms that are recognized as the P wave and the QRS complex.

Term
What is Contractility?
Definition
the ability of atrial and ventricular muscle cells to shorten their fiber length in response to electrical stimulation, generating sufficient pressure to propel blood forward.
Term
The conduction system consists of:
Definition
the sinoatrial node, atrioventricular junctional area, and bundle branch system.
Term
Impulses from the sinus node move directiy through atrial muscle and lead to atrial depolarization, which is reflected in a ____ _____ on the ECG.
Definition
 P wave
Term
What does the PR segment on the ECG represent
Definition
impulses slow down or are delayed in the AV node before proceeding to the ventricles. This slow conduction provides a short delay, allowing the atria to contract and the ventricles to fill.
Term
How is the PR interval measured?
Definition

from the beginning of the P wave to the end of the PR segment.

 

It normally measures from 0.12 to 0.20 second

(five small blocks).

Term
What does the Q wave represent?
Definition
initial ventricular septal depolarization
Term
What can it mean if the Q wave is abnormally present in a lead?
Definition
it represents myocardial necrosis (cell death)
Term
What does the QRS duration represent?
Definition

the time required for depolarization of both ventricles.

 

Term
How is the QRS complex measured
Definition

It is measured from the beginning of the QRS complex to the J point (the junction where the QRS complex ends and the ST segment begins).

 

It normally measures from 0.04 to 0.10 second

(up to three small blocks).

Term
What does the ST segment represent
Definition
early ventricular repolarization.
Term
How is the ST segment measured?
Definition

It occurs from the J point (the junction where the QRS complex ends and the ST segment begins) to the beginning of the T wave.

 

Its length varies

Term
What does the T wave represent
Definition
ventricular repolarization
Term
If an ectopic stimulus excites the ventricles during the T wave, it may cause:
Definition
ventricular irritability, lethal dysrhythmias, and possible cardiac arrest
Term
QT interval Represents:
Definition
the total time required for ventricular depolarization and repolarization 
Term
How is the QT measured 
Definition
from the beginning of the QRS complex to the end of the T wave.
Term
On a ECG each small block represents _____ second.
Definition
0.04 
Term
Five small blocks make up one large block. Five large blocks represent ________ 
Definition
1 second
Term
how would a nurse determin the heatr rate if given a 6 seconds strip?
Definition
by counting the number of QRS complexes in 6 seconds and multiplying that number by 10 to calculate the rate for a full minute.
Term

The six second method is the most accurate.

 

T/F?

Definition

False.

 

This method is the least accurate; however, it is the method of choice for irregular rhythms.

Term
How would the nurse determin the heart rate by using the big block method?
Definition
Count the number of big blocks between the same point in any two successive QRS complexes (usually R wave to R wave) and divide into 300.
Term
What are the six steps a nurse must do in order to correctly analyze a ECG? 
Definition

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. Interpret the rhythm.

 

Term

Determine the heart rate.

 

A nurse should now that a normal heart rate is:

Definition

 between 60 and 100 beats/min.

A rate less than 60 beats/min is called bradycardia.

A rate greater than 100 beats/min is called tachycardia.

Term

Determine the heart rhythm.

 

What should the nurse know when determining the heart rhythm?

Definition
Heart rhythms can be either regular or irregular. Irregular rhythms can be regularly irregular, occasionally irregular, or irregularly irregular.
Term

Determine the heart rhythm.

 
How should the nurse check the regularity of the atrial rhythm?
Definition

by assessing the PP intervals-

placing one caliper point on a P wave, and placing the other point on the precise spot on the next P wave. Then move the caliper from P wave to P wave along the entire strip ("walking out" the P waves) to determine the regularity of the rhythm.

Term
A slight irregularity in the PP intervals, varying no more than three small blocks, is considered:
Definition

essentially regular

if the P waves are all of the same shape.

Term
How should the nurse check the regularity of the ventricular rhythm?
Definition

by assessing the RR intervals-

placing one caliper point on a portion of the QRS complex (usually the most prominent portion of the deflection) and the other point on the precise spot of the next QRS complex. Move the caliper from QRS complex to QRS complex along the entire strip

Term
When the nurse is doing analysis of p waves what questions should the nusrse be asking her/his-self?
Definition

Are P waves present? 

Are the P waves occurring regularly? 

 Is there one P wave for each QRS complex? 

Are the P waves smooth, rounded, and upright in appearance, or are they inverted? 

Do all the P waves look similar?

Term
P waves that have the same shape throughout the strip indicats:
Definition
atrial depolarization is occurring from impulses originating from one focus, normally the SA node.
Term

One P wave occurring before each QRS complex

This relationship indicates:

Definition
that an impulse from one focus is responsible for both atrial and ventricular depolarization.
Term

Measure the PR interval.

 

How should it be measured?

What should the measurment be?

Definition

Place one caliper point at the beginning of the P wave and the other point at the end of the PR segment.

 

The PR interval normally measures between 0.12 and 0.20 second. about 3 small boxes no more then 5

Term

Measure the QRS duration.

 

 How should it be measured?

What should the measurment be?

Definition

Place one caliper point at the beginning of the QRS complex and the other at the J point, where the QRS complex ends and the ST segment begins.

 

The QRS duration normally measures between 0.04 and 0.10 second. about two small boxes

Term
When the QRS is narrow (0.10 second or less), this indicates:
Definition
that the impulse was not formed in the ventricles and is referred to as supraventricular or above the ventricles.
Term
When the QRS complex is wide (greater than 0.10 second), this indicates:
Definition
that the impulse is either of ventricular origin or of supraventricular origin with aberrant conduction, meaning deviating from the normal course or pattern.
Term

What are the types of Cardiomyopathy?

3

Definition

Hypertrophic cardiomyopathy

Dilated Cardiomyopathy

Restrictive Cardiomyopathy

 

Term
What is Cardiomyopathy?
Definition
either a chronic or acute enlargement of the cardia muscle.
Term
What is Hypertrophic cardiomyopathy?
Definition
an asymertic ventricular hypertrophy f the left ventricle and a disarray of the myocardial fibers causing a small chamber size. This cause an obstruction of the left ventricular outflow tract of about 70-80%.
Term
In 50% of the cases of Hypertrophic cardiomyopathy what is the cause?
Definition
In about 1/2 of the clients with HE there is a single gene autosomal dominant trait that resulted in defective sarcomere proteins.
Term
Pts with Hypertrophic cardiomyopathy, what may be there firts sing of disease?
Definition

SUDDEN DEATH may be the first sign of the disease.

 

also- exertional dyspnea, angina at rest, and syncope. there is a high incidence of ventricular dysrhythmias.

Term
What is Dilated Cardiomyopathy?
Definition

a structural abnormality in about 87% of cases there is extensive damage to the myofibrils and this interferes with myocardial metabolism.

 

There is normal ventricular wall thickness with dilation of both ventricles.

Term
What may be the cause of Dilated Cardiomyopathy?
Definition
may be caused by ETOH abuse or chemotherapy 
Term
What are the S/S of Dilated Cardiomyopathy?
Definition

Some clients have no symptoms for months or years.

 

sudden symptoms of L sided heart failure. A-fib occurs in about 25% of these clients.

If there is R sided heart failure, the the prognosis is poor.

Term
What is Restrictive Cardiomyopathy
Definition

the least common form of cardiomyopathy.

There is restrictive filling since the fibrosed walls cannot expand or contract.

The heart chambers are narrowed and this causes emboli. 

Term
What can Restrictive Cardiomyopathy mimic?
Definition
The presentation mimics that of constrictive pericarditis.
Term
What can cause Restrictive Cardiomyopathy?
Definition
amyloidosis or hemochromotosis.
Term

What are the S/S of Restrictive Cardiomyopathy?

Why?

Definition

exertional dyspnea as the CO cannot increase with the demands of exertion due to the fixed ventricular volume.

 

Other S/S include exercise intolerance, palpitations, and syncope.

Term
What types of Diagnostic studies are used for Cardiomyopathys?
Definition
Echocardiogram, radionuclide imaging, and angiocardiography can differentiate between the types of CM. Some providers may also order the MuGa or PET scan.
Term

Non-surgcial management:

 

For RCM and DCM

Definition
diuretics, vasodilators, cardiac glycosides, and beta blockers.
Term

Non-surgcial management:

 

HCM

Definition
inotropic drugs and Calcium channel blockers since they decrease the outflow obstruction.
Term

Surgical management of Cardiomyopathy

4

Definition

excision of the hypertrophied septum,

cardiomyoplasty,

batista,

heart transplant

Term

heart transplant (usu. reserved for DCM).

Transplant consideration has specific national and sate criteria which include:

Definition

an expected life expectancy of < 1 yr., age < 65, class iii, or iv of the New York heart association, normal to slightly increased pulmonary vascular resistance, stable psychsocial status, no current ETOH or drug abuse.

 

Additional UT requirements include: PRV < 3 WOOD, negative hep and HIV, well controlled DM with no end organ damage, family support, documented hx of compliance.

Term
Diagnosis that may be considered for transplant are:
Definition
Coronary artery dx., Idiopathic cardiomyopathy, myocarditis, idiopathic restrictive cardiomyopathy, congenital heart dx., adriamycin/periparum cardiomyopathy.
Term
What are 2 different goals that may be expected when using an LVAD.
Definition

1. is to maintain the pt. for cardiac transplant

 

2.  destination therapy, is used to prolong the pts. life who is not going to receive a transplant. Thus the destination therapy could be considered death.

Term
Heart Failure Definition:
Definition

Complex clinical syndrome Can result from cardiac or chronic metabolic disorder, ischemic heart dx., HTN, cardiomyopathy, or hyperthyroidism. 

Impairs the ability of the ventricle to eject blood. 

Heart Failure=Pump failure.

Term
Heart Failure Patho:
Definition

Inability of the heart to pump enough blood at a rate sufficient to meet the metabolic needs of the body or can do so only with an elevated filling pressure. 

Can be seen acutely (MI) usually chronic, progressive changes. = Insufficient perfusion of body tissues.

Term
Heart Failure demographics:
Definition

Only cardiac disorder that is still increasing Death rate up 135% from 1979-1998.

Afflicts 10% of the population over the age of 70.

Most common admitting dx. among clients over the age of 65.

Females account for over 50%

Term
What is Systolic Heart Failure?
Definition
Difficulty emptying of the L ventricle. Implies impairment of myocardial contractility.
Term
What is Diastolic Heart Failure?
Definition
Inability of the ventricle to fill and relax sufficiently to accomodate an adequate amount of oxygenated blood returning from the lungs.
Term
What is Left sided heart failure?
Definition

Left ventricle can no longer pump enough blood to the system CO decreases and increased pressure in LV, LA, and pulmonary vaculature. 

HP forces fluid into pulmonary tissues

Term

What are the Clinical manifestations

of L- sided Heart failure?

Definition

Exertional dyspnea presents as orthopnea and PND Pulmonary edema manifests as crackles Expiratory rhonchi and/or a non-productive cough 

S4 

Decreased CO leads to fatigue, confusion, nocturia

Term
What is Right sided heart failure?
Definition

Typically follows L-sided heart failure 

HP forces more blood into the venous circulation Increased JVD, peripheral edema, weight gain, engorgement of the hepatic and gastric vessels.

Term
What are the Clinical manifestations- right sided heart failure
Definition

peripheral edema hepatomegaly, ascities JVD, hepatojugular reflux increased 1 cm with moderate pressure Impaired GI blood flow, gut edema causes anorexia, N/V. 

Cyanosis (late sign), VS may be normal Cool extremities, diaphoresis

Term

Classification: New York Heart Association Functional Classification system: 

 

 

Heart failure grading system: Four stages: (1-4)

Definition

1- Symptomatic only with strenuous activity that exceeds usual level. 

2- Symptomatic with usual level of activity 

3- Symptomatic with minimal activity, but asymptomatic at rest 

4- Symptomatic at rest.

Term
What Diagnostic Tests are used to conferm heart failure?
Definition

Labs: CBC, urinalysis, T4, TSH, AST, PTT, hyperbilirubinemia

 

Test-EKG-non-specific T and ST wave changes Chest x-ray

 

PCAWP above 20-25 Echo- determines EF, wall motion abnormalities

 

Heart cath if refractory to standard therapy, MI possible, surgical procedure

Term

furosemide(Lasix)

How does the Aims help with heart failure?

Definition
Control of NA and fluid retention Vasodilator Inotropic support
Term

 

How do Vasodilators[clonidine (Catapres)]

 help with heart failure?

Definition

Decrease peripheral resistance, decrease afterload, improving SV and CO Isosorbide- venous dilator 

Hydralizine- arterial dilator NTG- venous and arterial dilator

 

ALSO INCLUDS  ACE inhibitors: decrease preload and afterload- (captopril and enalapril)

Term
What should the nurse know about Digitalis?
Definition

Increased myocardial contractility- it inhibits the Na/K pump causing a buildup of cellular Na. Na is exchanged for Ca which enhances the actinomycin cross-bridge formation

 

Efficacious in CHD caused by AF

Narrow therapeutic margin 0.9-2.0 ng/ml

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