Cardiac Flashcards
(66 cards)
1
Q
depressed ST segments mean..
A
ischemia, not dying
2
Q
elevated ST segments mean..
A
injury, hypoxic, dying
3
Q
a giant T wave indicates..
A
hyperkalemia
4
Q
How do PVCs look on an ECG?
A
- no P wave
- wide, bizarre QRS complex
- T wave in opposite direction of QRS
5
Q
How does A-fib look on an ECG?
A
- absence of definable P wave
- P wave appears small and quivering
6
Q
How does V-fib look on an ECG?
A
no distinct QRS complex seen
7
Q
How does V-tach look on an ECG?
A
- 3 or more PVCs in a row
- Wide, bizarre QRS complexes occuring in a fairly reg rhythm
- P waves usually not seen
8
Q
Normal Cardiac Index (CI)
A
2.5-4 L/min
9
Q
Normal CO
A
4-8 L/min
10
Q
Normal EF
A
55-65%
11
Q
Normal MAP
A
65 or 70-120
12
Q
Normal Dig dose
A
0.125-0.5 mg/day
13
Q
LA pressure
A
4-12 mmHg
14
Q
What is a widowmaker?
A
a clot in the L main artery
NO BP
15
Q
what is the average stroke volume?
A
70 mL
16
Q
What is the preload?
A
volume amount of fluid in LV just before it contracts
17
Q
what is afterload?
A
pressure in the aorta
18
Q
What drugs decrease pressure in the aorta?
A
beta blockers
19
Q
What drug decreases preload?
A
Lasix
20
Q
what drugs decrease afterload?
A
beta blockers, ACE inhibitors, & hydrochlorothiazide
21
Q
What does the P wave represent?
A
atrial depolarization
22
Q
what does the QRS complex represent?
A
depolarization of the ventricles
23
Q
what does the T wave represent?
A
ventricular repolarization
24
Q
What is the tx for sinus bradycardia?
A
atropine
25
what is the tx for sinus tachycardia?
Ca channel blockers, beta blockers, oxygen
26
*S/Es of amiodorone
Pulm edema, CHF, ARDS, V-tach
27
*tx for PVCs
Lidocaine or amiodarone
28
*tx for V-tach
lidocaine, amiodarone, if pulseless CPR & defibrillation
29
What can S3 in an older adult with heart disease signify?
ventricular failure
30
What is an S4 sound?
An atrial gallop, heard just before S1. The sound is produced by atrial contraction forcing blood into a noncompliant ventricle
31
what diseases can cause an S4 sound?
Systemic HTN, MI, angina, cardiomyopathy, and aortic stenosis
32
what is the therapeutic serum levels of Dig?
0.5-2 mg/mL
33
*mitral regurgitation and aortic & pulmonic stenosis are audible during..
systole
34
*mitral & tricuspid stenosis, aortic regurg, and aortic/pulmonic valvular insufficiency are heard during..
diastole
35
Potassium
major intracellular cation. It is released when cells are damaged and is vital to normal functioning of cardiac muscle. It is particularly important in regulation of cardiac rate and force of contraction
36
Calcium
Plays a significant role in the initiation and propagation of electrical impulses and in myocardial contractility. It is also important for intracellular energy production
37
Hypercalcemia can cause..
bradys, AV blocks, BB blocks. Potentiates dig.
potentiates- increases the power or effect of something
38
Hypocalcemia can cause..
decreased myocardial contractility with decreased CO and hypotension, decreased responsiveness to dig. ST segment lengthens. Sometimes brady, VT, asystole
39
What are the ECG changes associated with a MI?
For most patients, the first changes occur as a hyperacute T wave followed closely by changes in the ST segment. Changes in Q wave are also present and usually remain evident (called a pathological Q wave)
40
an inverted T wave indicates
ischemia
41
S3 and S4 in MI pt is indicative of..
left ventricular failure
42
Transient systolic murmurs may be heard because of..
papillary muscle dysfunction
43
What does morphine do for the MI pt?
relieves pain, provides euphoria for feeling of doom, and dilates bronchioles
44
What does nitroglycerin drip do for the MI pt?
decreases preload and afterload.
*monitor BP q 15mins
45
why is heparin used for the MI pt?
used in pts with elevated ST segments (myocardial injury) to prevent systemic MI due to possible development of a-fib, cardiogenic shock, or for those with a previous embolus
46
NSG dx for MI pt
- Acute Pain r/t MI, angina
- Decreased CO
- Deficient Knowledge r/t illness and impact on pts future
- Activity Intolerance r/t decreased CO or alterations in myocardial tissue perfusion
- Risk for Ineffective Cerebral Tissue Perfusion r/t thrombolytic therapy impact
47
PAWP of ___ is very bad and pt will have s/sx of ____ soon
18; pulmonary edema
| (normal PAWP is 4-12)
48
How is pain relieved for pericarditis?
by sitting up and leaning forward
49
List the possible causes of Heart Failure
- Impaired cardiac function: MI, myocarditis, cardiomyopathy, valve disease, pericarditis, tamponade
- Excess work demands- stress, dysrhythmias, infections
- Anemia
- Thyroid disorders
- Pregnancy
- Nutritional deficiency- Thiamine
- Pulmonary disease
- Hypervolemia
50
What are the 3 compensatory mechanisms the failing heart uses?
1. ventricular dilation
2. ventricular hypertrophy
3. increased sympathetic nervous system stimulation (tachycardia)
51
S/Sx of Left Ventricular Heart Failure
pulm congestion, cough, dyspnea, decreased BP, tachycardia, prerenal azotemia, dysrhythmias, orthopnea, PND, acute pulm edema, Cheyne-Stokes respirations
52
S/Sx of acute pulmonary edema
severe dyspnea, orthopnea, pallor, possible cyanosis, tachycardia, blood-tinged sputum, wheezing and bubbling resp, fear, sweating, nasal flaring, use of accessory muscles, tachypnea, vasoconstriction, hypoxia, gallop, pulsus alternans (pulse goes up and down), cerebral hypoxia, fatigue, muscle weakness, nocturia, oliguria=late sign
53
S/Sx of Right Ventricular Heart Failure
```
peripheral edema and venous congestion of all organs
Liver & GI engorgement
dependent edema
anasarca (edema everywhere)
cyanosis
anxiety, fright, depression
```
54
Best position for acute HF
high Fowler's with legs kept dependent
55
S/Sx of dig toxicity
abdominal pain, anorexia, N/V, visual disturbances (halos), bradycardia, and other arrhythmias
56
Action/Therapeutic Effects of Dig
- Increases ventricular contractility
- Increases ventricular emptying
- Slows conduction of impulses through the AV node and Purkinje fibers
- Slows HR
- Increases CO
57
How does dopamine work?
in LOW doses (lower than 4), causes vasodilation in the renal, cerebral and coronary vascular beds, primarily resulting in increased renal blood flow, glomerular filtration rate, and sodium excretion
58
What does dobutamine do?
increases HR, AV conduction, and myocardial contractility. The heart does not require as much additional oxygen when dobutamine vs. dopamine is used
59
Best position for dyspnea and resp distress?
High Fowler's
60
S/Sx of cardiac tamponade
tachycardia, JVD, cyanosis, dyspnea, muffled heart sounds, diaphoresis, paradoxical pulse, hypotension
61
Which type of heart valves require life long anticoagulant therapy?
Mechanical valves
62
What are the risks associated with the ECC (bypass) machine used during open heart surgery?
pump can crush blood cells, leading to thrombus formation; or create and air emboli. Other complications include shock, hemorrhage, fluid overload, hemolysis, and kidney or lung damage
63
You don't want more than ___mL/hr coming out of a chest tube
100mL/hr
64
What could sudden cessation of drainage from a chest tube indicate?
clot in tube or other obstruction
65
NSG care for arterial bypass pt
check pulses frequently and watch for compartment syndrome and bleeding. Intractable pain- call doc ASAP!
66
The 6 Ps
```
pain
paresthesia
poililothermia
paralysis
pallor
pulselessness
```
