Exam 1

Question 1

What things cause dysthymias?

Answer 1

• hypoxia (ie: respiratory arrest or depression decreases O2 which increases cardiac irritability and can cause PVCs)
• ischemia (decreased MVO2 increases irritatability and leads to PVCS)
• SNS stimulus (increased epinephrine from stimulants, amphetamies, caffeine, nicotine)
• meds (digoxin can cause many dysthymia or some meds prolong QT)
• drugs (stimulants or depressants)
• electrolyte disturbances (hypokalemia, hypo calcemia, hypomagnesemia)
• cardiac hypertrophic (torn muscles in heart cause irritability; atrial stretching can cause AFIB)
• cardiac disease (atherosclerosis )

Question 2

Manifestations of dysrthymias?

Answer 2

-possible to be asymptomatic
- palpitations, fluttering
- skipped heart beat feeling
- lightheaded, dizzy
- syncope
- fatigue
- angina

Question 3

What are measurements of P wave, PRI, QRS, QT interval?

Answer 3

P: 0.12
PRI: 0.12-0.20
QRS: less than 0.12 (or equal)
QT: 0.35-0.45

Question 4

What may cause QT interval prolongation?

Answer 4

Antipsychotics, antihistamines, albuterol, antiarrhythmics

Question 5

What is significant about the TP interval?

Answer 5

This is from the end of the T wave to next P wave, where Ventricle filling occurs. Coronary arteries are per fused here as well, so if pt is tachycardic, they will not have enough time to be perfused

Question 6

Way to calculate rates (regulate rhythm va irregular rhythm?

Answer 6

Regular rhythm: 1500/number small boxes between R-R
Irregular: 10 x R waves in 6 second strip

Question 7

What is the rate that determines NSR, Sinus bradycardia and sinus tachycardia?

Answer 7

NSR: 60-100
SB: less than 60
ST: greater than 100

Question 8

EKG interpret steps??

Answer 8

1. Determine regularity
2. Determine rate (even Rs)
3. P waves: present, upright, buddied up with each QRS
4. PRI: less than 5 small boxes (0.12-0.20)
5. QRS: less than 3 small boxes (<0.12) and upright

Question 9

What are the steps for EKG interpretation?

Answer 9

1. Rhythm (regular or irregular, march R-R)
2. Rate
3. P wave (present, upright, round, and buddies up with each QRS)
4. PRI: less than 5 small boxes (<0.20)
5. Less than 3 small boxes (<0.12)

Question 10

Answer 10

Normal sinus rhythm
60-100; regular R to R; atrial and ventricular rate are same; p waves present for each QRS

Question 11

Answer 11

Sinus Brady cardia
Less than 60; atrial ventricular rate same; P wave one for each QRS; PRI normal and QRS normal

Question 12

What are some symptoms of sinus bradycardia?

Answer 12

• SOB, dyspnea, hypotension, decreased CO

Question 13

Some causes of sinus bradycardia?

Answer 13

• increased PNS stim, SA node damage (Inferior wall MI), hypoxemia, athletes, beta blocks

Question 14

What are common sxs in all shock?

Answer 14

Tachycardia(except with neurogenic shock, instead bradycardia) , anxiety, agitation, tachypnea, hypotension

Question 15

What are some assessment findings in hipovolemic shock?

Answer 15

Flat neck veins, pulmonary congestión/crackles in lungs, cool/clammy skin

Question 16

What are hemodynamic values associated with hypovolemic shock?

Answer 16

HR: ^
CO/CI: v
CVP: v
PAP: v
PAOP: v
SVR: ^
O2: v

Question 17

What are ways to manage/treatments for hypovolemic shock?

Answer 17

-Treat cause (ie Emesis, diarrhea, hemorrhage, third spacing )
-Fluid redistribution
-draw blood for type and cross
-two LG bore Iv lines (>18G)
- 2 IVs
-fluids wide open
-LR or NS if hyperkalemic
- NO VASOPRESSORS, unless fluid tx not working

Question 18

Why is cardio genic shock like HF?

Answer 18

Cardio génica shock is like HF because the heart begins to fail which effects pumping action and blood backs up into the lungs

Question 19

What are some signs of cardiogenic shock?

Answer 19

S3 sounds, chest pain, crackles, dyspnea, cool/clammy, ascites, pitting edema (venous return stuck)

Question 20

What are hemodynamic values for cardiogenic shock?

Answer 20

HR: ^
CO/CI: v
CVP: ^
PAP: ^
PAOP: ^
SVR: ^
O2: v

Question 21

What are ways to treat cardiogenic shock?

Answer 21

• correct what is causing heart to pump ineffectively
• determine if coronary (MI) or non-coronary ( hypoxemia, tension pneumothorax, cardiac tamponade)
• O2 admin (non-reb, bipap)
• pain control (morphine, nitroglycerin, vasodilators)
• ## hemodynamic monitoring

Question 22

What are sxs of septic shock?

Answer 22

-fever or hypothermia
- warm/flushed to cool/clammy
- increased coagulation (DIC)
- increased lactate
- prolonged clotting times
-resp failure

Question 23

What are hemodynamic values with septic shock?

Answer 23

HR: ^
CO/CI: ^ hyper dynamic state / v hypodynamic statw
CVP: v
PAP: v
PAOP: v
SVR: v
O2: v

Question 24

What are ways to manage/treat septic shock?

Answer 24

-monitor lactate levels
-ABX, culture/sensitivity
- monitor coag labs (PT/INR, DIC panel, platelets, fibrinogen)
- fluids
- vasopressors (norepinephrine or dopamine)
-abscesses drained

Question 25

What are signs of neurogenic shock?

Answer 25

-hypothermia - central/peripheral cyanosis - warm/flushed -Neuro defecits -N/V -hypotension with bradycardia

Question 26

What are the hemodynamic values associated with neurogenic shock?

Answer 26

HR: v CO/CI: v CVP: v PAP: v PAOP: v SVR: v O2: v

Question 27

What medications/tx would be given to patient in neurogenic shock and why?

Answer 27

Don’t really need fluid bc not dry; administer atropine to encourage vasoconstriction and increase HR

Question 28

What are sxs of anaphylactic shock?

Answer 28

- swollen tongue - hives - warm/flushed - rash - wheezing or stridor -N/V

Question 29

What are the hemodynamic values associated with anaphylactic shock?

Answer 29

HR: ^ CO/CI: v CVP: v PAP: v PAOP: v SVR: v O2: v

Question 30

What is important in treatment of anaphylactic shock?

Answer 30

AIRWAY MANAGEMENT!!! - O2 therapy, intubation - epinephrine - Antihistamines and cortisone - beta agonist (albuterol) - IV fluids

Question 31

What are sxs of obstructive shock?

Answer 31

- respiratory failure - uneven breathing sounds - increased MV02 demand

Question 32

What hemodynamic values for obstructive shock?

Answer 32

HR: ^ CO/CI: v CVP: ^ PAP: ^ PAOP: ^ SVR: ^ O2:v