exam 1 - cardiac 1 Flashcards
(48 cards)
Identify 3 priority-nursing diagnoses for MI
acute pain (evidence of continuing cardiac damage),
ineffective cardiac tissue perfusion (the root cause of the problem), and
decreased cardiac output
important monitoring when giving amiodarone
QT interval assessment because it prolonges the refractory period
PTCI discharge 4 for femoral
continuing to monitor the EKG, I&O, kidney function labs and electrolytes
Keep the patient on bedrest,
HOB no higher than 30 degrees,
leg straight for 4-6 hours
PTCI discharge
- Patient should be on antiplatelet therapy with aspirin and clopidogrel for 1 year.
- Patient should report signs and symptoms of MI or angina to doctor
- Patient should notify HCP is infection or bleeding occrur (fever, swelling, oozing, bruising, pain, numbness, tingling)
- Patient will be discharged with antiplatlet medications like aspirin or clopidogrel, and a statin to lower LDL, and a beta blocker (antihypertensives**)to reduce cardiac workload.
- Patient should avoid pressure on puncture site and lifting items heavier than 8 pounds
- Do not drive for 3-4 days
- Patient can resume normal activities after 1 week
- smoking cessation*
- control BG*
4 aspects of a crisis
Caused by a stressful event or perceived threat/loss
Person’s usual way of coping becomes ineffective in dealing with the treat which causes anxiety
The treat/loss is usually identifiable
It may have occurred weeks or days before the crisis, but is a recent event
4 phases of crisis response
1st Phase – anxiety activates the person’s usual coping mechanisms; if these methods don’t bring relief and/or support is inadequate, the person progresses to the next phase
2nd Phase – more anxiety since usual coping mechanisms have failed
3rd Phase – new coping mechanisms are tried, or threat is redefined so old ones
can work – often resolution occurs here
4th Phase – if no resolution occurs, severe or panic levels of anxiety ensue which may lead to psychological disorganization
4 stages of crisis theory
equilibirum
stressful event
disequalibirum
need to restore equil
3 balancing factors and needs for crisis
Realistic Perception of the Event
Adequate Situational Support
Adequate Coping Mechanisms
goal of crisis intervention
get person to return to pre-crisis stage
5 steps for crisis intervention
Assess - Assess the person’s perception of the event, living situation, support available, and current coping mechanisms
Diagnose -
Plan -
Implement -
Evaluate -
general vs generic support for crisis intervention
General Support – using empathy, warmth, acceptance and other therapeutic techniques.
Generic Approach – used for high-risk individuals and large groups. It applies specific methods to all the people faced with a similar crisis. Grief counseling is an example of the generic approach.
4 needs of CCU families
info
proximity
support and assurance
comfort
4 key principles of pt and family care
Respect and Dignity
Information Sharing
Participation
Collaboration
5 characteristics of cardiac conduction
Automaticity - automatic
Rhythmicity
Conductivity – pass electrical impulse
Excitability
Contractility – muscle contracts
SA, AV and purkinjie fibers/ventricles HRs
SA Node – normal rate 60-100 bpm
AV Node – normal rate 40-60 bpm
Ventricles/Purkinje Fibers – normal rate 20-40 bpm
what is the problem when Hr is too high or low
perfusion
what is the normals for P and QRS and what does each represent
P wave reflects atrial depolarization, normal is .12-.20 seconds
QRS wave reflects ventricular depolarization, normal is .06-.12 seconds
ST wave reflects ventricular repolarization – VULNERABLE PERIOD*
Regular
HR: 70 ( count between peaks and multiple by 10)
Uniform and upright P waves
1:1 P to QRS complex
0.12 PR interval
Normal QRS
NORMAL SINUS RHYTHM
intervention = monitor pt
Sinus brady
1. Heart rhythm—regular
2. Heart rate—less than 60 beats per minute – 30
3. P waves—uniform and upright
4. P to QRS ratio—one to one
5. PR interval—0.12 to 0.20 second -
6. QRS complex—narrow, less than 0.12 second
intervention =
#1 go assess patient
#2 if symptomatic, give O2 if less than 93, establish IV access for atropine and if atropine doesnt work, use EPI then pacemaker later
atropine
MOA
SE
nursing
anticholinergic that blocks cholinergic and parasympathetic stimulation of the heart, increasing conduction through the AV node. - INCREASES HR
Side effects – dry mouth, urinary retention, blurred vision.
- Atropine administration should not delay the implementation
of temporary external pacing for patients with poor
perfusion. - Assessment of cardiac rhythm for increase in heart rate.
Epi
MOA
SE
catecholamine, causes vasoconstriction, cardiac stimulant, strengthens myocardial contraction and increases heart rate.
anxiety, dizziness, dyspnea, palpitations.
- Heart rhythm—regular
- Heart rate—greater than 100 beats per minute - 180
- P waves—uniform and upright
- P to QRS ratio—one to one
- PR interval—0.12 to 0.20 second
- QRS complex—narrow, less than 0.12 second
SINuS TACHY
interventions:
#1 assess
#2 correct cause
#3 IV access for adensoine, BB, Ca channel blockers
SVT
1. Heart rhythm—regular
2. Heart rate—150 to 250 beats per minute
3. P waves—may differ in shape from sinus P waves;
may be hidden in preceding T wave
4. P to QRS ratio—one to one
5. PR interval—may be difficult to measure
6. QRS complex—narrow, less than 0.12 second
interventions:
#1 assess
#3 O2 if <93
#4 vagal meneuver
IV access for adenosine , BB, Ca channel blockers if those dont work
adenosine
MOA
given
SE
nursing
causes a transitory block at the AV node. to lower HR
Must be given over 1-3 seconds followed by a 20 mL flush using an antecubital vein or through a central line.
Side effects – temporary asystole, facial flushing, diaphoresis, lightheadedness, chest pain, a sense of doom.
DOESNT affect BP, can give even if hypotensive
