Term
| Tells us about electrical heart activity |
|
Definition
|
|
Term
| 3 or more electrodes on chest, can be ambulatory or stationary, not allowed to take a shower with monitor. |
|
Definition
|
|
Term
| This is used to determine ischemia or infarction to the cardiac muscle, establish pt's rhythm and identify any dysrhythmias |
|
Definition
|
|
Term
| EKG rhythm recorded over 48-72 hrs , portable c 5 electrodes. |
|
Definition
|
|
Term
| Pt's activity limitations for Holter monitoring. |
|
Definition
| None, perform normal activities, keep activity diary |
|
|
Term
| What can pts on Holter monitoring not do? |
|
Definition
| Shower or remove electrodes |
|
|
Term
| Sound wave test that depicts size of heart, functioning of valves and other structures of the heart. Record electrical activity concurrently c electrodes. |
|
Definition
|
|
Term
| A type of echocardiogram that emits sound waves across the esophagus. |
|
Definition
| Transesophageal echocardiogram (TEE) |
|
|
Term
| This test involves a hose down the throat, conscious sedation and numbing of throat c lidocaine. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Pts getting a TEE are NPO for __-__ hrs before and afterwards until what? |
|
Definition
| 4-6; until gag reflex returns |
|
|
Term
| What kind of pt do we use TEE with more frequently? |
|
Definition
|
|
Term
| Determines blood flow through the coronary arteries & pumping ability of <3 muscle |
|
Definition
|
|
Term
| How does cardiac nuclear scanning work? |
|
Definition
| Inject radioactive material into vein and scan to determine where it collects. |
|
|
Term
| Infarcted or ischemic areas do not take up substance, cold spots are revealed, used in determining the location & extent of MIs. |
|
Definition
|
|
Term
| Infarcted or ischemic areas do take up substance (hot spot revealed); used to determine if <3 muscle has been damaged by MI; material only appears in damaged <3 muscle; takes 2 hrs to complete. |
|
Definition
|
|
Term
| RBCs tagged; used to estimate EF and visualize <3 wall abnormalities |
|
Definition
| Multiple Gated Acquisition (MUGA) or Radionuclide ventriculopathy (Gated Blood Pool scan) |
|
|
Term
| Notes electrical activity or BP changes in your <3 during exercise; treadmill/bike |
|
Definition
|
|
Term
| What does an exercise stress test determine? |
|
Definition
|
|
Term
| NPO __ hrs before exercise stress test |
|
Definition
|
|
Term
| Like treadmill test + injection of dye to check blood flow through coronaries during exercise in a person suspected to have CAD. |
|
Definition
| Exercise stress test c thallium or sestamibi |
|
|
Term
| This test can help determine if the heart muscle is getting enough blood supply. Radio-isotopes are taken up (or not) and show regions of ischemia |
|
Definition
| Exercise stress test c thallium or sestamibi |
|
|
Term
| Medications used for pharmacological stress testing. |
|
Definition
dipyridamole (Persantine)
adenosine (Adenocard)
Vasodilators |
|
|
Term
| Pt undergoing pharmacological stress testing should be NPO after ______ and should not do what? |
|
Definition
| Midnight; no smoking/caffeine |
|
|
Term
| Medication to reverse the effects of adenosine/dipyridamole. |
|
Definition
|
|
Term
| Radiologic agent used for pharm stress testing |
|
Definition
|
|
Term
| Administer this medication in greater amounts over 3 minute intervals & do an echocardiogram to visualize cardiac wall motion abnormalities. |
|
Definition
| Dobutamine (stress echocardiogram) |
|
|
Term
| Test where patient holds mouth piece while exercising. Connects to machine that collects inhaled/exhaled air and determines amt of activity body can take before fatigue. |
|
Definition
| Cardiopulmary Exercise Test |
|
|
Term
| This test identifies ectopic activity, assesses conduction system and evaluates drug therapy and attempts to fix ectopic activity. |
|
Definition
| Electrophysiological study (EPS) |
|
|
Term
| Used to destroy ectopic areas of <3 muscle, worry about damaging SA node or SA/AV pathway. |
|
Definition
| Ablation (can freeze or burn) |
|
|
Term
| What should a patient not have for 3-4 d. maybe prior to an EPS? |
|
Definition
| Arrhythmia meds (we want them to go into the rhythm.) |
|
|
Term
| How long to you need bedrest for after EPS and why? |
|
Definition
|
|
Term
| Pt status/meds during EPS |
|
Definition
| Awake for procedure, give sedatives/anti-anxiety meds & IV heparin. |
|
|
Term
| Any rhythm with abnormality of 1 or more Dx features |
|
Definition
|
|
Term
| Own electrical capabilities (movement of Na+, K+ & Ca++) |
|
Definition
|
|
Term
| Free flow of electrical impulses through cardiac cells |
|
Definition
|
|
Term
| Special pathways to carry impulse |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| This is elevated in infarction & injury and depressed c ischemia |
|
Definition
|
|
Term
| Ventricular repolarization |
|
Definition
|
|
Term
| Represents total ventricular activity; the time it takes for vent. depol & repol to occur; if too long can precede life threatening arrhythmia. |
|
Definition
|
|
Term
| Prolongation of the QT interval is called the _______ phenomenon and can cause this arrhythmia _______. |
|
Definition
|
|
Term
| Which electrolyte may U wave be related to? |
|
Definition
|
|
Term
|
Definition
Cardiovascular problems
Drugs (perscriptions, OTCs & recreational)
Congenital Defects
Electrical shock
Acid/base & electrolyte imbalances
Trauma
Hypo/hyperthermia
Endocrine disorders (thyroid, adrenal)
Stress - physical & emotional
Hypoxia
Sleep apnea
Neurological disorders |
|
|
Term
| 1 P wave for every QRS, 60-100 bpm, normal P & QRS interval. |
|
Definition
|
|
Term
| Treatment for Sinus Bradycardia (3) |
|
Definition
Pacemaker
Atropine
Epinephrine |
|
|
Term
| This arrhythmia can be caused by exercise, caffeine, pain, dehydration & abnormal conduction. |
|
Definition
|
|
Term
|
Definition
| B-blockers, Ca++ blockers, determine cause & Tx |
|
|
Term
| Single atrial irritated area fired 250-400 bpm; cycle only completes through to the ventricle ________ times per minute. |
|
Definition
|
|
Term
| What kind of rhythm is a flutter? |
|
Definition
|
|
Term
| Atria has chaotic signals resulting in fibrillation waves instead of P waves; shaking, not contracting. |
|
Definition
|
|
Term
| In Afib may have ___-___ impulses in the atrium in a minute. |
|
Definition
|
|
Term
| A fib can decrease CO by ___% |
|
Definition
|
|
Term
| What may form as a result of a fib? |
|
Definition
|
|
Term
| What waves does A fib have? |
|
Definition
|
|
Term
| SA rate/AV Rate/Ventricular Rate |
|
Definition
|
|
Term
| If pt is in afib >48 hrs may give _______ and obtain this test prior to restoring rhythm in order to look for a clot. |
|
Definition
|
|
Term
|
Definition
Cardioversion
ibutilide bolus, B-blocker, Ca++ blocker, digoxin |
|
|
Term
| If you are unable to convert a pt in afib what is the Tx? (3) |
|
Definition
Ca++ blocker
Digoxin
coumadin |
|
|
Term
| Premature atrial impulse initiated by ectopic focus in atrium (not SA) so P wave may appear different; beat comes early and has a P wave c a QRS; may have noncompensatory pause afterwards to reestablish rate/rhythm. |
|
Definition
| Premature Atrial Contraction |
|
|
Term
|
Definition
|
|
Term
| This arrhythmia is predominantly seen in young, white women & children. Dramatically decreases CO. |
|
Definition
| Paroxysmal Supraventricular Tachycardia |
|
|
Term
|
Definition
|
|
Term
| QRS of normal interval, PR v. short due to fast rhythm. |
|
Definition
|
|
Term
|
Definition
Vagal manuevers
adenosine IV
calcium/beta blockers |
|
|
Term
| What is important to keep in mind when giving adenosine. |
|
Definition
| V. short half life; push fast & flush well/fast |
|
|
Term
| Beat begins in AV node; no P wave |
|
Definition
|
|
Term
|
Definition
| Same as bradycardia (epinephrine, atropine, pacemaker |
|
|
Term
| Rate junctional dysrhythmia |
|
Definition
|
|
Term
| No p wave, wide QRS, may or may not perfuse. |
|
Definition
|
|
Term
| How many PVCs in a row are considered vtach? |
|
Definition
|
|
Term
|
Definition
| May begin amiodarone if patient is symptomatic or if PVCs are frequent |
|
|
Term
| Regular, wide (>.12) QRS with no p waves; "pretty rhythm". Perfusion becomes an issue, check for pulse. |
|
Definition
|
|
Term
| Chaotic rhythm with multiple areas in ventricle firing at once; irregular; no p wave and no discernible QRS; rate too fast to count; no pulse. |
|
Definition
|
|
Term
|
Definition
Synchronized cardioversion then
Amiodarone |
|
|
Term
| V tach without a pulse/V fib Tx/Rx (4) |
|
Definition
Defibrillate (faster the better)
Begin CPR until defib arrives
Epinephrine
vasopressin
amiodarone
lidocaine |
|
|
Term
| PR >.20; usually benign so no treatment. |
|
Definition
|
|
Term
| Wenkebach; progressively longer PR interval until a QRS is dropped; usually asymptomatic if Sx may treat like bradycardia. (regularly Irregular) |
|
Definition
| 2nd Degree AV Block Type I |
|
|
Term
| Mobitz II; more ominous an dmay lead to complete heart block; reg P/QRS usually; PR prolonged but remains constant; QRS normal or slightly longer; More than 1 P for every QRS; Tx if symptomatic. |
|
Definition
| 2nd Degree AV block Type II |
|
|
Term
| Complete heart block; atria 60-100, ventricle 20-40; Very symptomatic. |
|
Definition
|
|
Term
|
Definition
| Pacemaker; may use atropine/epinephrine before then. |
|
|
Term
| Widened beat due to delay in conduction through the ventricle "bunny ears" No Sx=No Tx |
|
Definition
|
|
Term
| Flatline; very poor prognosis; requires aggressive Tx (consider DNRs) |
|
Definition
|
|
Term
| How do you confirm asystole? |
|
Definition
|
|
Term
|
Definition
Epinephrine
Vasopressin
Atropine |
|
|
Term
| Why do we defibrillate asystole? |
|
Definition
| We don't! No rhythm to reset. |
|
|
Term
| Nonfunctional rhythm; body using up all chemical or electrical energy; escaped beats; why we turn off monitor when pt is dying. |
|
Definition
|
|
Term
| Electical rhythm w/o perfusion (no pulse) Multiple causes. |
|
Definition
| Pulseless electrical activity |
|
|
Term
| What do you have to do until you discover and Tx cause of Pulseless Electrical Activity? |
|
Definition
|
|
Term
| What may you give with Pulseless Electrical Activity until you figure out cause? |
|
Definition
Epinephrine
Vasopressin
Atropine |
|
|
Term
Hypovolemia
hypoxia
acidosis
hyper/hypokalemia
hypothermia
OD
cardiac tamponade
pneumothorax
thrombosis
can all cause what? |
|
Definition
| Pulseless Electrical Activity |
|
|
Term
| catacholamine, acts on both alpha & beta receptors. ++chronotrope; +inotrope |
|
Definition
|
|
Term
| presor & antidiuretic properties med |
|
Definition
|
|
Term
| Antidysrhythmic; acts directly on cardiac tissue; prolongs duration of action potential & refractory period. Oral & IV. |
|
Definition
|
|
Term
| Blocks vagal responses to <3; +chronotrope |
|
Definition
|
|
Term
| Increases the force of myocardial contractions (+inotrope); delays conduction time through AV node (-chrnotrope) Give to afib |
|
Definition
|
|
Term
| Blocks beta receptors (-inotrope/chronotrope) |
|
Definition
|
|
Term
|
Definition
| low K+, halo, bradycardia, n/v |
|
|
Term
| blocks Ca++ influx (-chronotrope) meds that end in pine, small inotrope effect. |
|
Definition
| Calcium channel blockers (nifedipine, verapamil, diltiazem) |
|
|
Term
| Antiarrhythmic agent slows SA/AV conduction. Push in fast r/t short 1/2 life. |
|
Definition
|
|
Term
| antidysrhythmic used to terminate afib or flutter; prolongs AP. |
|
Definition
|
|
Term
| For cardiac used only for ventricular dysrhythmias; slows conduction. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| One shock at a higher amt of energy (old type of countershock) |
|
Definition
|
|
Term
| Shock sent one way and then returned immediately, uses a smaller amt of energy (newer type of countershock) |
|
Definition
|
|
Term
| Used to depolarize the <3 and hopefully reset the rhythm. Clear! Use conductive jelly if using paddles. |
|
Definition
|
|
Term
| Paddle placement asynchronized defib. |
|
Definition
| R of sternal border & at the lower portion of the rib cage midaxillary on L side |
|
|
Term
| Post-procedure asynchronized defib. |
|
Definition
Resume CPR
Check rhythm & pulse |
|
|
Term
| Releases energy during the R wave of QRS complex; uses lower amt of energy. |
|
Definition
| Synchronized cardioversion |
|
|
Term
| Pre-procedure synchronized cardioversion. |
|
Definition
Consider sedation if pt is stable
If elective make pt NPO and may hold some drugs. |
|
|
Term
| Paddle placement/post-procedure synchronized cardioversion. |
|
Definition
R of sternal border & lower portion of rib cage midaxillary;
Check pulse & rhythm; no CPR b/c have pulse |
|
|
Term
| Machine that does all thinking for the person; research has shown that faster defib occurs with Vtach/Vfib better prognosis |
|
Definition
|
|
Term
| Stimulate muscle & cause a contraction; pulse generator, battery, leads. |
|
Definition
|
|
Term
| What are pacemakers used to treat? |
|
Definition
| Bradycardia, tachycardia, PSVT, Vtach & asystole AV blocks. |
|
|
Term
| Pacemaker inserted with Swan Ganz; box at bedside, high infection rate. Central line going into ventricle. |
|
Definition
|
|
Term
| External through the skin, can use crash cart pads, feel shock, |
|
Definition
|
|
Term
| Rx transcutaneous pacemaker |
|
Definition
| Sedate/pain meds, dress with silvadene cream |
|
|
Term
| Pacer wires protruding through chest; used routinely after open <3 surgery in case swelling affects conduction system causing a need for pacing. Pull in 2-3 d. |
|
Definition
|
|
Term
| Placed in Same day surgery or cath lab, may go home hrs or day after. Pt sedated not intubated, usually takes 30 min to 2 hrs. |
|
Definition
|
|
Term
| #1 Nsg diagnosis c pacemaker |
|
Definition
|
|
Term
| First letter pacemaker coding. |
|
Definition
|
|
Term
| Second letter pacemaker coding |
|
Definition
| Chamber Sensed (A/V/D) Delivers shock to ventricle if senses that it does not contract) |
|
|
Term
|
Definition
Mode of response (T/I/D)
Inhibited/Triggered/Dual |
|
|
Term
| Does not fire if intrinsic beat noted. |
|
Definition
|
|
Term
| Fires in response to sensing an electrical impulse |
|
Definition
|
|
Term
| Most common pacemaker setting. |
|
Definition
| DDD both paced & sensed, inhibited & triggered. |
|
|
Term
|
Definition
Rate
sensitivity
energy output |
|
|
Term
| Common problem with pacemakers in young people. |
|
Definition
| Battery failure (lasts 10-15 yrs) |
|
|
Term
| This pacemaker problem may cause R on T phenomenon. How do you fix it? |
|
Definition
| Failure to sense; may fire inappropriately. Increase the sensitivity. |
|
|
Term
| What can failure to sense cause? |
|
Definition
|
|
Term
| Pacemaker problem where fires but <3 is not responding. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Sx of this pacemaker problem are not pacing correctly & hiccoughs |
|
Definition
| Displaced or fractured leads (esp if on diaphragm for hiccoughs) |
|
|
Term
| Motion in affected arm after pacemaker implantation for 48 hrs. |
|
Definition
| PROM, may immobilize, no chicken arms or will pull out |
|
|
Term
| Activity restrictions post pacemaker |
|
Definition
| No lifting >10 lbs for 2 months |
|
|
Term
| Things for pacemaker patients to avoid |
|
Definition
| Magnets, welding, MRIs & constrictive clothing. (can displace leads) |
|
|
Term
| What must a pacemaker patient have with them at all times? |
|
Definition
| Card with type of pacer & setting |
|
|
Term
| Your patient calls because his pacemaker is set for 68 bpm but his pulse is 65 right now. What should he do? |
|
Definition
| If the pulse is >5 below setting notify MD |
|
|
Term
| Used for patients with sudden cardiac death (recurrent Vtach or Vfib) |
|
Definition
| Automatic Implantable Cardioverter Defibrillators (AICD) |
|
|
Term
| Third generation AICDs are able to ___ and _______. |
|
Definition
|
|
Term
Can pace bradycardia, antitachycardia pacing
Memory and event retrieval |
|
Definition
|
|
Term
| Programmed electrical stimulus for AICD |
|
Definition
Pacing
Cardioversion
Defibrillation |
|
|
Term
| Lowest amt of energy needed to cause depolarization |
|
Definition
|
|
Term
|
Definition
Decreases
Need for psych preparation
Worry about going off & not going off |
|
|
Term
| What do you need to teach family of AICD pts |
|
Definition
|
|
Term
| Family contact restrictions with ICD pts |
|
Definition
| None, can have sex & hold a baby! |
|
|
Term
| Call MD if what happens with ICD. |
|
Definition
|
|
Term
| Others touching patient with ICD may feel what? |
|
Definition
|
|
Term
| What do you need to know about ICD? |
|
Definition
| Know if its on or off, if on let it do its job instead of defibrillating/cardioverting |
|
|
Term
| Main trunk of arterial system; vital to functioning of every organ 2-3 cm x 45 cm |
|
Definition
|
|
Term
| Localized dilation of blood vessel |
|
Definition
|
|
Term
| Risk factors for aneurysms |
|
Definition
| Hereditary, HTN, smoking,trauma, syphilis, infection, high cholesterol, gender (men 4x higher), age >50 for arterial, >70 abdominal |
|
|
Term
|
Definition
| Anything that weakens the vessel wall |
|
|
Term
| Weakening of all 3 layers and complete stretching of the vessel wall. |
|
Definition
|
|
Term
| Break through all layers and surroundig tissue forms a false wall with a clot. |
|
Definition
|
|
Term
| Aneurysm between adventitious & intima layers |
|
Definition
|
|
Term
| Grape like aneurysm off the side. |
|
Definition
|
|
Term
| Aneurysm that balloons out around entire circumference |
|
Definition
|
|
Term
| What are symptoms of aneurysm associated with? |
|
Definition
|
|
Term
US
CXR
CT
Aortogram
MRI
TEE (throcic)
These tests are used for what? |
|
Definition
|
|
Term
| Tracheal deviation, tracheal tug, deep & dull chest pain. |
|
Definition
|
|
Term
| Difficulty swallowing, speaking, chest pain, SOB, n/v |
|
Definition
| Ascending thoracic aneurysm |
|
|
Term
| Difference in brachial blood pressure >20 mm Hg; pulse deficit form side to side; mimics a stroke - hoarseness, cough, dysphagia |
|
Definition
| Transverse thoracic aneurysm |
|
|
Term
| Aneurysm with back pain and psinal stroke |
|
Definition
| Descending thoracic aneurysm |
|
|
Term
| Most common place for aortic aneurysm; usually forms below renal artery (good b/c does not decrease kidney perfusion/UO) |
|
Definition
| Abdominal Aortic Aneurysm (AAA) |
|
|
Term
| Femoral, iliac, Sx are 6 Ps |
|
Definition
|
|
Term
|
Definition
Pulselessness
Poikilothermia
Pain
Pallor
Paresthesias
Paralysis |
|
|
Term
| Compares BP measured at ankle c BP in arm. |
|
Definition
|
|
Term
| What does a low ankle-brachial index # indicate? |
|
Definition
| Narrowing/blocking of arteries in legs |
|
|
Term
| Beginning of aneurysm rupture; thoracic 80% mortality rate, classic sign: severe tearing pain, can be abrupt shut off blood to distal circulation |
|
Definition
|
|
Term
| Your patient has severe tearing pain in his chest and says "I would feel better if I could just burp." What do you suspect? |
|
Definition
|
|
Term
| Medical Tx of causes of aneurysm |
|
Definition
Stop smoking
Control HTN
Control Diabetes |
|
|
Term
| Follow up guidelines aneurysms |
|
Definition
| Once found assess every 6 months c ultrasound |
|
|
Term
| How fast do abdominal aneurysms tend to grow? |
|
Definition
|
|
Term
| When do you treat aneurysms? |
|
Definition
>5 cm
Grows >0.5 cm/yrs
Pt is symptomatic |
|
|
Term
| How is surgery done to treat abdominal aneurysms? |
|
Definition
| Pt not on bypass, aorta corss clamped, split open like butterfly, graft sewn in place and vesel sewn around graft |
|
|
Term
| How do they decrease a patients metabolic rate during procedure to fix aneurysm |
|
Definition
|
|
Term
| New possibilty for aortic aneurysms, go through groin; eat/walk much faster than traditional |
|
Definition
|
|
Term
|
Definition
|
|
Term
| #1 complication of graft side (aneurysm) |
|
Definition
|
|
Term
| Rupture from aneurysm can bleed out in _____; EMERGENT SITUATION |
|
Definition
|
|
Term
| May cause occlusion of blood flow to distal organs; renal, Gi, extremities & brain. |
|
Definition
|
|
Term
|
Definition
Mark peripheral pulses
Watch renal function
Perform neuro status checks
Monitor H&H |
|
|
Term
| What to watch out for post aneurysm surgery? |
|
Definition
Bleeding/leaking
Bruising on back
Decreased UO, Inc. HR |
|
|
Term
| How often do you get H&H after aneurysm repari? |
|
Definition
|
|
Term
| How is BP usually monitored post aneurysm surgery? |
|
Definition
|
|
Term
| Ultrasound frequency post aneurysm repair. |
|
Definition
|
|
Term
| Your post-aneurysm surgery pt has tiny black dots on his foot. What do you suspect? |
|
Definition
| Arterial emboli (trash foot) b/c sutures. Microscopin clots/necrosis |
|
|
Term
| Specialized methods used to evaluate cardiovascular function. |
|
Definition
|
|
Term
| Good assessment indicator of low CO. |
|
Definition
| Tissue perfusion (pale/sweaty/slow refill) |
|
|
Term
| stroke volume of the heart increases in response to an increase in the volume of blood filling the heart (the end diastolic volume). The increased volume of blood stretches the ventricular wall, causing cardiac muscle to contract more forcefully |
|
Definition
| Starling's law of the heart |
|
|
Term
| End-diastolic volume & pressure in both ventricles prior to contraction. |
|
Definition
|
|
Term
| Pressure created by blood volume & arterial tone which the <3 must overcome to open the aortic & pulmonic heart valves. |
|
Definition
|
|
Term
| Ability of <3 muscle to contract/pump effectively/recoil. |
|
Definition
|
|
Term
| Why does HR determine CO? |
|
Definition
| HR determines filling time |
|
|
Term
| 4 main hemodynamic assessment parameters |
|
Definition
Preload
Afterload
Contractility
HR |
|
|
Term
| Parameters evaluated for change |
|
Definition
|
|
Term
| Parameters manipulated by drugs, fluid & cardiac devices. |
|
Definition
Preload
Afterload
Contractility
HR |
|
|
Term
| Measures as ventricular end-diastolic pressure (VEDP) |
|
Definition
|
|
Term
| Measured as Right Atrial Pressure (RAP) or Central Venous Pressure (CVP) |
|
Definition
| RVEDP (right ventricular end-diastolic pressure) |
|
|
Term
|
Definition
Wedge presure
Pulmonary artery occlusive pressure (PAOP) |
|
|
Term
|
Definition
Right Atrial Pressure (RAP)
Central Venous Pressure (CVP) |
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Term
| What is Right ventricle afterload reflected by? |
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Definition
| Pulmonary Vascular Resistance (PVR) |
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Term
| What is Left Ventricle afterload reflected by? |
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Definition
| Systemic Vascular Resistance (SVR) |
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Term
| Causes of increased resistance/afterload. |
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Definition
| Inc. blood viscosity, diseased <3 valves, atherosclerosis |
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Term
| What does increased resistance put pt at risk of? |
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Definition
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Term
Functions independently in variations of preload & afterload.
Not measured directly.
Changes in this can be inferred whe CO is decreased and other variables that effect Co remain the same. |
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Definition
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Term
| Things that increase contractility |
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Definition
Sympathetic NS
Calcium
Digitalis
Dobutamine
Milrinone
Beta adrenergics |
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Term
Acidemia
Hypoxia
MI
Myocardial ischemia
Cardiomyopathies
B blockers &
Antidysrhythmics can all do what? |
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Definition
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Term
| Why does an MI decrease contractility? |
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Definition
| Lose <3 muscle & it turns into scar tissue |
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Term
| Slight increases in ___ with steady stroke volume increase CO. |
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Definition
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Term
| _____ decreases CO if SV is not increased. |
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Definition
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Term
| Coronaries fill during _____ on systemic side of aortic valve. |
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Definition
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Term
| Indirect BP method is _____; Direct BP method is _______. |
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Definition
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Term
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Definition
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Term
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Definition
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Term
| L preload is monitored by ____; R preload monitored by ____. |
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Definition
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Term
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Definition
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Term
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Definition
Diuretics
Venous vasodilators
Fluid restrict
Low-salt diet
PEEP |
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Term
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Definition
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Term
| Decrease afterload (Lots) |
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Definition
AceIs
A blockers
Amrinone
Arterial vasodilators
B & Ca++ blockers
Milrinone
Morphine
Nitrates
Nitroprusside
IABP |
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Term
| Increase contractility (lots) |
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Definition
Amrinone
Dobutamine
Calcium
Digoxin
Epinephrine
Isoproterenol
Milrinone
Norepi
Dopamine @ 3-10 mcg/kg/min |
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Term
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Definition
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Term
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Definition
Atropine
Epi
Isoproterenol
Pacer |
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Term
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Definition
B & Ca++ blockers
anti-arrhythmics
Digoxin
Pacing |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
| Blood circulation through <3 |
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Definition
| Inferior & Superior vena cava > R atrium > tricuspid valve > R ventricle > pulmonic valve > pulmonary arteries lungs > pulmonary veins > L atrium > mitral valves > L ventricle > aorta |
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Term
| Level transducter to ________ axis prior to use. Intersection of 4th ICS & midaxillary line. |
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Definition
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Term
| Readings c transducer are accurate with HOB elevated ___-___ degrees. |
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Definition
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Term
| What should be done c transducer at least once a shift, a patient position change or if questioning the reading. |
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Definition
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Term
| What does swan-gans catheter measure? |
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Definition
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Term
| Never wedge greater ___-__ s |
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Definition
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Term
| Tests complicance of monitoring system with swan gans |
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Definition
| Square wave test. Done once system set up, every shift, open to air or when waves distorted. Fast flush with pigtail |
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Term
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Definition
Continuous BP monitoring (+MAP)
Frequent ABGs |
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Term
| Insertion of rigid, hollow catheter |
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Definition
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Term
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Definition
| Radial, subclavian or femoral |
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Term
| Test to do before using radial site for art line |
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Definition
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Term
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Definition
| Internal Jugular; Subclavian, femoral or brachial |
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Term
Potential limb ischemia
Decreased perfusion distal to isnertion site
Thrombus formation r/t slower blood flow
Air entering system during line insertion
Exsanguinations are all complications of what? |
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Definition
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Term
| Pulmonary tissue ischemia/infarction Thrmobus formaiton Air embolus Perforation of cardiac chambers Exsanguinations are complicaitons of what? |
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Definition
| Swan Ganz (pulmonary artery pressure monitoring) |
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Term
| Suspected air embolism action |
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Definition
Place pt in L lateral trendelenburg
Can try to aspirate |
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Term
| How can you stop inspiration from sucking air into catheter if catheter is open to ai? |
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Definition
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Term
| ___ mLs air emoblism can be a problem for crticially ill; 200-300 mLs over seconds has ___% mortality rate |
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Definition
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Term
| How can you prevent pulmonary infarction swith swan gans? |
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Definition
| Do not leave catheter wedged |
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Term
| What should you check with art lines? |
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Definition
Leakage/infection;
Document distal pulse q 1-2 hrs
Compare R & L cuff BPs c arterial BPs |
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Term
| ARD, apnea, possible wheezing, sudden hypotension, syncope, hypoxia, elevated CVP, neuro deficits &/or cardiac arrest, V fib are signs of what? |
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Definition
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Term
| How long can art lines stay in? |
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Definition
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Term
| When level transducer to phlebostatic access it is level with what? |
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Definition
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Term
| What can swan gans hitting ventricle wall cause? |
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Definition
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Term
| What does dopamine do at low doeses (1-3 mcg) |
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Definition
| Vasodilates renal arteries only |
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Term
| provides graph of PAWP and CI and problems with each. |
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Definition
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Term
| Normal CI, Normal/low PAWP. (I) |
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Definition
No pulmonary or peripheral hypoperfusion.
Tx: rest & sedation |
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Term
| Normal CI, High PAWP (II) |
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Definition
Pulmonary congestion w/o hypoperfusion
Diuretics
Vasodilators |
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Term
| Low CI, Normal/low PAWP (III) |
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Definition
Peripheral hypoperfusion w/o pulmonary congestion.
60-70% survival |
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Term
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Definition
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Term
| Low CI/ High PAOP (Subset IV) |
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Definition
| Hypoperfusion & pulmonary congestion |
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Term
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Definition
Inotropes
Vasodilators
Surgery
IABP
Diuretics
Lasix, Nipride, Dobutamine |
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