Cardiovascular Therapeutic Management

Question 1

what is the equation for cardiac output

Answer 1

heart rate X stroke volume

Question 2

what is the defintion for heart rate

Answer 2

number of beats per minute

Question 3

what are the factors for stroke volume

Answer 3

preload
contractility
afterload

Question 4

preload defintion

Answer 4

how much fluid is in the ventricles
stretching in diastole

Question 5

what are some things that can influence preload

Answer 5

hypovolemia or hypervolemia
regurgitation of cardiac valves
heart failure

Question 6

contractility defintion

Answer 6

contraction of the heart

Question 7

afterload defintion

Answer 7

force the heart has to push against to exit the heart

Question 8

what are some things that can effect afterload

Answer 8

arterial contraction
hypertension

Question 9

average heart rate

Answer 9

70bpm

Question 10

average stroke volume

Answer 10

70mL

Question 11

average cardiac output

Answer 11

4-8L

Question 12

what are some things that can impact heart rate

Answer 12

stress
meds
caffeine

Question 13

what happens if we increase after load

Answer 13

increase cardiac workload

Question 14

what does frank starling law mean

Answer 14

increased preload leads to increase stroke volume which leads to increased cardiac output

Question 15

intrinsic rate

Answer 15

the patients own heart beat

Question 16

extrinsic rate

Answer 16

a rate that is set by an artificial source

Question 17

capture

Answer 17

heart responds to the pace maker stimulation

Question 18

sense

Answer 18

the ability of the pacer to see the intrinsic activity of the heart

Question 19

trigger

Answer 19

an intrinsic event causes a stimuli to be delivered

Question 20

inhibited

Answer 20

an intrinsic event causes the pacer to turn off because some activity is seen

Question 21

Asynchronous pacing (fixed)

Answer 21

set at a fixed rate, a non sensing mode
pacer paces regardless of the intrinsic activity

Question 22

synchronous pacing

Answer 22

pacer delivers a stimuli in response to what it senses

Question 23

what do we need for atrial pacing

Answer 23

intact AV node condition system

Question 24

why might we do ventricular pacing

Answer 24

loss of atrial kick

Question 25

ventricular pacing will sustain

Answer 25

cardiac output

Question 26

atrial and ventriclar pacing is more like

Answer 26

intrinsic pacing

Question 27

what is the most physiologic pacing mode

Answer 27

DDD

Question 28

what dose DDD do

Answer 28

pace both the atria and the ventricle both of the chambers are sensed dual response to sensing

Question 29

why might we do temporary pacemakers

Answer 29

ischemia electrolyte imbalance myocardial infarction cardiac surgery heart surgery low HR 3rd degree block

Question 30

three types of pacing routes

Answer 30

transcutaneous epicardial transvenous

Question 31

transcutaneous pacing route

Answer 31

outside of the body large skin electrodes non invasive

Question 32

epicardial pacing route

Answer 32

routine after many cardiac surgeries right into the heart

Question 33

what side of the body do the atrial wires come out

Answer 33

right side of the sternum

Question 34

what side of the body do the ventricular wires come out of

Answer 34

left side of sternum

Question 35

transvenous pacing route

Answer 35

into the endocardial tissue through a vein or artery

Question 36

what do pacing artifacts mean

Answer 36

this is good it means that the pacemaker is working

Question 37

how might atrial pacing look

Answer 37

spike and then P wave

Question 38

how might ventricular pacing look

Answer 38

spike and then QRS

Question 39

how might both atrial and ventricular pacing look

Answer 39

spike, P wave, spike, QRS

Question 40

what does rate control control

Answer 40

how quickly we want the heart to beat

Question 41

what is the output dial

Answer 41

how much electrical impulse is giving

Question 42

what is output dial measured in

Answer 42

miliamps

Question 43

sensitivity control

Answer 43

how much the pace maker is sensing intrinsic

Question 44

what is the sensitivity control measured in

Answer 44

millivolts

Question 45

if the pace maker is not sensing what will we do

Answer 45

turn down millivolt

Question 46

if we are pacing the patient externally what should we do

Answer 46

give pain meds and sedation

Question 47

what happens if we don't have our millivolts low enough

Answer 47

it is not going to see what the patients heart rate is doing

Question 48

what happens if we do not have our milliamps high enough

Answer 48

then it is not giving enough of an electrical impulse for the heart to respond

Question 49

how do the QRS look in ventricular pacing

Answer 49

wide and bizarre QRS

Question 50

what is the solution for failure to sense

Answer 50

increase pacemaker sensitivity DECREASE MILIVOLTS

Question 51

what is happening in under sensing

Answer 51

pacemaker is not seeing the intrinsic activity and sending out impulses when it is not needed

Question 52

what is happening during over sensing

Answer 52

the pacemaker is sensing there is a QRS when there isn't

Question 53

why is over sensing dangerous

Answer 53

potential for decreased cardiac output

Question 54

why might failure to sense be dangerous

Answer 54

if a spike lands on the T wave and then R on T phenomenon can occur leading to V tach or V fib

Question 55

how might failure to capture look

Answer 55

throwing a pacemaker spike but there is no wave that follows

Question 56

why might failure to capture occur

Answer 56

low pacemaker battery electrolyte abnormality

Question 57

how do we fix failure to capture

Answer 57

increase pacer output INCREASE MA OR VOLTS

Question 58

under sensing how to fix

Answer 58

increase pacemaker sensitivity or MILIVOLT

Question 59

how to fix over sensing

Answer 59

decrease pacemaker sensivitiy

Question 60

what are some education for pacemakers

Answer 60

avoid large generator or large magnetic fields

Question 61

the use of what can inhibit pacemaker function

Answer 61

electrocautery

Question 62

what is ICD

Answer 62

these can shock patients who go into a dangerous rhythm such as vfib and vtach

Question 63

why might someone get an ICD

Answer 63

sudden cardiac arrest spontaneous and sustained VT inherited conditions

Question 64

postoperative nursing management for cardiac surgery

Answer 64

normalize cardiac output rewarming but not too quickly control bleeding promote early extubation

Question 65

what happens to body temp during bypass

Answer 65

lowered to 28-32

Question 66

what is a complication of bypass

Answer 66

altered coagulation

Question 67

what could happen with a valve replacement

Answer 67

rejection infection clot formation

Question 68

what should we watch for with carotid endaretrectomy

Answer 68

cranial nerve intact difficulty swallowing or breathing

Question 69

what CN do we want to assess for with carotid endarterectomy

Answer 69

VII (7), X, XI, XII

Question 70

how does an intraaortic balloon pump work

Answer 70

in diastole the balloon inflates to promote blood flow to the coronary arteries in systole the balloon deflates and decreases afterload

Question 71

how do we treat 3rd degree heart block

Answer 71

pacemaker

Question 72

what meds decrease preload

Answer 72

nitro morphine diuretics