# Shared Flashcard Set

## Details

Cardiac
prep for Exam 2 (Med/Surg)
41
Nursing
03/28/2011

Term
 [image]     How many boxes long is the QRS interval? How long is the PR interval on the EKG strip? How long is the QT interval on the strip?
Definition
 QRS interval is no more than 2 small boxes. PR interval is 3-5 small boxes. QT interval is usually less that 1/2 of the RR interval (about 2 large boxes on the EKG strip)
Term
 A fib
Definition
 irregularly irregular with absence of P waves   [image]
Term
 Ventricular fibrillation
Definition
 Unattainable rate; undiscernable P waves; QRS not apparent; chaotic   [image]
Term
 Premature ventricular contractions (PVCs)
Definition
 QRS = wide; bigger than 3 small boxes (ST & T wave may be opposite) Rhythym = irregular P wave = usually obscured by QRS, PST, or T wave of PVC   [image] sinus rhythm with uniform PVCs
Term
 Atrial flutter
Definition
 [image]   P wave not present; usually a saw-tooth pattern present Symptoms: palpitations, rapid heart rate, chest pain, shortness of breath, lightheadedness, fatigue, and low blood pressure. Rhythm: usually regular, but can be irregular if the AV block varies.
Term
 Count # of complexes in 6 sec strip & multiply by 10 Count # of large boxes between 2 complexes & divide into 300 Count # of small squares between complexes & divide into 1500
Definition
 Ways to determine HR on ECG strip:
Term
Definition
 Degree of myocardial stretch at end of diastole. Indicates how hard heart will push blood out.
Term
Definition
 Resistance; This will increase when arteries are occluded (harder to push blood through).
Term
 Hypercalcemia
Definition
 Electrolyte imbalance that causes increased contractility, ventricular dysrhythmias.   S&S = decreased DTR's, arrhythmias, decreased HR, decreased RR, decreased LOC, N&V, muscle weakness   TX: phosphorous, steroids, fluids, MOVE!
Term
 Hypocalcemia   Normal Ca+ = 9.0 - 10.5 mg/dl
Definition
 Electrolyte imbalance that causes decreased contractility, decreased sensitivity to Digoxin, & cardiac insufficiency.   S&S: increased DTRs, tight/rigid muscles, stridor/laryngospasm, arrythmias, unpredictable mind changes   TX: Vitamin D, Renagel, Oscal, IV Ca+
Term
 Hyperkalemia   Normal potassium: 3.5 - 5 meq/L
Definition
 Electrolyte imbalance that causes slowed conduction of impulses   S&S: muscle twitching -> weakness -> flaccid paralysis ***life threatening arrythmias*** ECG: bradycardia, tall/peaked T waves, prolonged PR intervals, flat or absent P waves, widened QRS conduction, blocks ventricular fibrillation   TX: dialysis, calcium gluconate, glucose & insulin, kayexalate
Term
 Hypokalemia   Normal potassium levels: 3.5 - 5 meq/L
Definition
 Electrolyte imbalance that causes prolonged cardiac repolarization and decreased muscle strength; potentiates Digoxin toxicity   S&S: muscle cramps, weakness ***life threatening arrythmias*** ECG: u waves, PVCs, ventricular tachycardia   TX: Give k+, aldactone, eat k+ rich foods
Term
 Asystole
Definition
 ventricular standstill [image]
Term
 5th Intercostal space
Definition
 best place to hear/assess S1 (Lubb)
Term
 2nd Intercostal space
Definition
 Best place to hear/assess S2 (Dubb)
Term
 4th Intercostal space;  commonly heard with HF, close after S2 in early diastole   bigger deal if hearing this in someone over 40 years old
Definition
 Best place to hear S3   When would you hear this?   When would this be of most concern?
Term
 Heart at apex; late diastole (before S1)   (scarring after MI, htn)
Definition
 Best place to assess for S4:   What might cause you to hear S4?
Term
 Cardiac output is the amount of blood ejected from the L ventricle into the aorta per MINUTE   Equation:   CO = SV x HR
Definition
 What is Cardiac Output?   How is it determined?
Term
 Stroke volume is the amount of blood ejected into the aorta by L ventricle per BEAT   SV = End diastolic volume - End systolic volume   ***usually 70 mls/beat***
Definition
 what is stroke volume?   How is it determined? Average Stroke volume is?
Term
 Ejection fraction measures L ventricular function;   Decreased ejection fraction = L ventricular FAILURE   SV divided by End diastolic volume = Ejection Fraction   {{55-60% is a healthy Ejection Fraction}}
Definition
 What does ejection fraction measure?   How is it determined?
Term
 P Waves
Definition
 Contraction of the atrium (atrial depolarization) is represented by what wave on the ECG?
Term
 the QRS complex
Definition
 contraction of the ventricles are represented by what wave(s) on the ECG?
Term
 T wave
Definition
 ventricular repolarization is represented by what on the ECG?
Term
 Pt symptoms diet med hx w/abnormal EKG ask, "Is this new?" Remember: MONA greets you at the door: Monitor O2 Nitro Aspirin
Definition
 Priority assessment in pt with dysrhythmia(s)?
Term
 evaluate bp, LOC, CO (baseline?) show them how to check pulse (check frequently) evaluate for presence of hemodynamic deterioration assess for angina, hypotension, HF, decreased cerebral & renal perfusion consider causes of dysrhythmias education: avoid alcohol, smoking, caffeine Reg bp checks
Definition
 NSG care of elderly with dysrhythmias:
Term
 Eliminate underlying cause if possible Evaluate severity of problem Med: antiarrhythmic (i.e., Lidocaine); if also bradycardic, may give atropine to speed things up
Definition
 TX for PVC:
Term
 relieve hypoxia anticoag. tx cardioversion (pharmacologic & electrical)
Definition
 TX for A fib:
Term
 Observe ECG closely!! Look for prolonging of PR interval, QRS complex or QT, RR intervals. If QT interval prolongs more than one half the RR - HOLD the drug and report Monitor for Torsades De Pointes - be prepared to treat to slow down rate if it occurs Monitor for S&S of GI effects (N&V, Diarrhea)
Definition
 Nursing implications with Class I antidysrhythmics (effect the Na+ channel and cardiac action potentials...declining in use)
Term
Definition
 a variant type of ventricular tachycardia: P wave: obscured, if present QRS: wide & bizarre morphology Rhythm: irrregular   [image]
Term
 Class IA   s/e: diarrhea, N&V, abdominal cramping, anorexia
Definition
 Side effects of Class IA drugs:   Examples: procainamide (pronestyl, procan) disopyramide (Norpace)
Term
Definition
 Side effects of Class 1B drugs: Examples: Lidocaine (IV, short duration) phenytoin tocainide mexiletene (Mexitil)
Term
 Class 1C   s/e: palpitation, SOB, chest pain, HF, MI
Definition
 What class are Flecanide (Tambocor) and Propafenone (Rythmol) in?   Side effects?
Term
 Monitor HR, Bp, ECG: HOLD if low HR and Bp Assess QRS duration: HOLD if expands 25% Monitor electrolytes assess for respiratory effects usually not used in HF Do not abruptly stop: may cause lethal rhythms, angina symptoms or precipitate MI (in pts w/coronary artery disease) teach pts to watch for symptoms of fluid retention (wt gain, edema, SOB) teach pts to limit fluid & Na+ intake to minimize fluid retention
Definition
 Nursing Implications for Class II antidysthythmics:   Examples: propranolol (Inderal) metoprolol (Lopressor)
Term
 monitor ECG when starting tx do not administer sotolol unless pt is unresponsive to others (sotolol is used for atrial or ventricular tachyarrhthmias) see special instructions for specific meds: Ibutilide: acute conversion of A fib to sinus rhythm Bretylium: acute VF Amiodarone: refractory VT or VF, cardiomyopathy and A fib (to maintian NSR)
Definition
 Nursing implications for class III antidysrythmics:   Examples: bretylium (bretylol) amiodarone (Cordarone) ibutilide (Corvert) Sotolol (betapace)   Side effects: AV block, bradycardia, ventricular arrhythmias, bronchospasm, hypotension
Term
 monitor bp & HR: hold med if HR below 60 & systolic bp below 90 monitor bp & ECG continuously if pt is rec'g. IV verapamil teach pt to rise/change position slowly (minimize orthostatic hypotension) encourage to increase fiber intake to prevent constipation assess dizziness: may need dose changed   NOTE: grapefruit juice increases therapeutic effects & risk of toxicity! Other interactions: Digoxin (dig toxicity); beta blockers (risk of bradycardia & HF); antihypertensives: additive hypotension; verapimil decreases lithium levels
Definition
 Nursing implications with Class IV antidysrhythmics:   Examples: verapamil (Calan) diltiazem (Cardiazem) Nifedapine (procardia)   *slows HR in fast rhythms, decreases contractility (lowers bp) S/E: dizziness, hypotension, bradycardia, edema, constipation, HF, AV block, ventricular asystole, V Fib, Nausea
Term
 Class 5 antidysrhythmics
Definition
 What class are these drugs? Examples: adenosine (adenocard) used for: paroxysmal SVT (unresponsive to vagal man.) s/e: transient arrhythmias, dyspnea, facial flushing *do not use: AV block, A fib, A flutter, V tach   Atropine (anticholinergic) s/e: hallucinations, tachycardia, dry mouth, constipation Use for: sinus bradycardia (symptomatic) & bradyarryth. *do not use: glaucoma, urine retention or ileus
Term
 Monitor Dig levels Monitor for Dig toxicity abnormal heart rhythms, visual disturbances, N&V, diarrhea Monitor for conditions that increase toxicity w/HOLD if Dig toxicity is suspected W/HOLD if HR below 60
Definition
 Nursing implications with Digoxin:   (Class V: cardiac glycoside)   used for: HF (improves contractility and CO); can be used to slow fast cardiac rhythms; A fib; A flutter   S/E: Dig toxicity, bradycardia, hypotension
Term
 hypokalemia hypercalcemia renal impairment advanced age acute hypoxia hypothyroidism drug use of: amphotericin B, quinidine, amiodarone, diltiazem, captopril, furosemide, erythromycin, ibuprofen, nifedipine, and/or verapamil  Herbal use of: cascara sagrada bark, ginseng, pleurisy root, ephera, ephedrine, sarsaparilla
Definition
 Conditions that increase Dig toxicity are:
Term
 elevate lower extremities above heart level infuse a bolus of IV fluid IV atropine (TX for bradycardia) (vasovagal response caused by distended bladder, discomfort from manual pressure during removal of arterial or venous catheter)
Definition
 NSG interventions after cardiac cath...to prevent vasovagal response:   What causes vasovagal response?
Term
 increase activity gradually diet: No fat, low salt, no cholesterol no isometric exercisis (increases workload of heart) no valsalva no straining, no suppository (Docusate/Colace) Walking is best exercise S&S of HF are: wt gain, ankle edema, SOB, Confusion Sex can be resumed when they can walk up flight of stairs or around block w/out SOB (safest time: morning, when well rested)
Definition
 What are discharge activity guidelines for cardiac clients?
Term
 Avoid IM injections  monitor for dysrhythmias bleeding precautions/S&S blood typing (have blood "on hand") Monitoring pain w/angina
Definition
 List nsg assessments/interventions assoc. w/thrombolytic therapy:
Supporting users have an ad free experience!