Exam 2 - Study Material Flashcards

Question

What is an embolus?

Answer 1

* A traveling intravascular mass * With IV's a piece of the catheter can breaking off causing a catheter shear

Answer 2

* Daily Weighing --the #1 indicator of an overload * Listen for crackles * Observe for edema

Answer 3

* Place one hand about the patient's knee and the hand belowthe greater trochanter of the femur. * Middle 1/3 ofthe muscle is the suggested site.

Answer 4

* Palpate the lower edge of the acromion process. * Injection site is 1-2 inches below the process.

Answer 5

**Guage:** * 22 (20-23 **Angle:** * 90° **Location:** * Deltoid * ventrogluteal site * lateral midthigh

Answer 6

**Guage:** * 25 **Angle:** * 45° or 90° **Location:** * lateral upper arm * thighs * abdomen * back * upper hip

Answer 7

Guage: * 26-27 Angle: * 15° Location: * medical aspects of the forearm

Answer 8

* Used for allergy testing * Testing for antibody formation (i.e., PPD)

Answer 9

* •To prepare skin, wash skin soiled with dirt, drainage, or feces with soap and water and dry. * Use friction and a circular motion while cleaning with an antiseptic swab. * Always swab from center of site and move outward in a 2 inch radius.

Answer 10

Avoid touching length of plunger or inner part of barrel. Keep tip of syringe covered with cap or needle.

Answer 11

Avoid letting needle touch contaminated surface (e.g., outer edges of ampules or vial, outer surface of needle cap, nurse’s hands, counter top, table surface).

Answer 12

Draw medication from ampule quickly. Do not allow it to stand open.

Answer 13

1. Volume of the medication 2. Medication’s characteristics & viscosity 3. Location of anatomical structures underlying injections sites

Answer 14

* Recommended to change IV sites every 72 to 96 hours * **Except blood, TPN, lipid emulsions, change every 24 hours (bacterial growth)** * Keep system sterile * Assist patient with self-care activities so not to disrupt system

Answer 15

* Date & time of the venipuncture * Number of the solution container * Type & amount of solution * Name & dosage of any additives * Type of venipuncture device including length and gauge * Flow rate * Any controller or pump * Name of person initiating the infusion

Answer 16

135-145mEq/L

Answer 17

98-107mEq/L

Answer 18

3.5-5.0mEq/L

Answer 19

8.6-10.2mEq/L

Answer 20

2.7-4.5mg/dL

Answer 21

1.5-2.5mEq/L

Answer 22

Elevated U wave

Answer 23

Depressed ST segment

Answer 24

Heart failure is a clinical syndrome characterized by systemic perfusion inadequate to meet the body's metabolic demands as a result of impaired cardiac pump function.

Answer 25

* Coronary artery disease * Past myocardial infarction * Hypertension * Heart valve disease * Cardiomyopathy * Congenital heart defects * Endocarditis and/or myocarditis

Answer 26

1. Contractility (inotropic state) of the muscle 2. Preload: amount of blood in the ventricle at the end of diastole 3. Afterload: the pressure against which the left ventricle ejects 4. Heart Rate

Answer 27

* Usually begins with left ventricular systolic dysfunction * Diminished pumping power of left ventricle results in EF below 40%; remaining blood increases pressure in pulmonary vasculature; Left ventricle stiffens * Right ventricular dysfunction often results from left ventricle because of high pulmonary pressures leading to high pressure in right side of heart and systemic circulation

Answer 28

The inability of the right ventricle to provide adequate blood flow into the pulmonary circulation at a normal ventral venous pressure

Answer 29

* LHF → back flow of blood into right side of heart → failure of right side * Pulmonary hypertension * COPD

Answer 30

**Blood backs up into the _venous system_, resulting in:** * Peripheral edema * Hepatomegaly * Abdominal pain * Ascites * Anorexia * Nausea * Weakness * Weight gain * Anasarca: late manifestation

Answer 31

occurs when the lower left chamber (left ventricle) is not able to fill properly with blood during the diastolic (filling) phase.

Answer 32

The major caues of diastolic dysfunction include: hypertension-induced myocardial hypertrophy and myocardial ischemia with resultant ventricular remodeling. Hypertrophy and ischemia cause a impaired relaxation of the heart, which leads to: * Pulmonary congestion * Normal SV, CO, & EF% * ↓ LV compliance * Abnormal diastolic relaxation from ischemia-caused ventricular remodeling

Answer 33

* Prevelance: Female \> Male * Left ventricular ejection fraction: normal * Left ventricular chamber size: ↓ * Chest radiography: pulmonary congestion without cardiomegaly * Gallop: S4

Answer 34

**Blood backs up into the _pulmonary vasculature_ resulting in:** * Dyspnea, Orthopnea, PND * Cough * Crackles, wheezing * Impaired oxygen exchange * S3, S4 heart sounds, tachycardia * Weakness, confusion, irritability, insomnia

Answer 35

1. Mitral stenosis → ↓ LA emptying → 2. ↑ LA preload: 1. Pulmonary edema → ↑PVR & ↓ O₂supply → RV failure 2. ↓ Force of LA contraction → ↓ blood to left ventricle → ↓ LV output 3. Which leads to → LV failure

Answer 36

An abnormal buildup of fluid in the air sacs of the lungs, which leads to shortness of breath.

Answer 37

1. **Valvular dysfunction / CAD / Left ventricular dysfunction →** ↑ left atrial pressure → ↑ pulmonary capillary hydrostatic pressure (pushing pressure) → Pulmonary edema 2. Injury to capillary endothelium → ↑ capillary permeability and disruption of surfactant production by alveoli → Movement of fluid and plasma proteins from capillary to interstitial space (alveolar space) and alveoli → pulmonary edema 3. Blockage of the lymphatic vessels → inability to remove ecess fluid from interstitial space → ↑ accumulation of fluid in intersitital space → pulmonary edema

Answer 38

* Severe dyspnea * Orthopnea * Pallor * Tachycardia * **Expectoration of large amounts of frothy, blood-tinged sputum Frothy pink sputum)¡Fear** * Wheezing * Sweating * **Bubbling respirations** * Cyanosis * Nasal flaring * Use of accessory breathing muscles * Tachypnea * Vasoconstriction * Hypoxia with ABG findings

Answer 39

* **Life threatening, medical emergency** * Provide supplemental oxygen * Begin with 100% non-rebreather mask. * Cardiac monitoring and pulse oximetry * IV * **Elevate head of bed to reduce venous return** * Medications: nitrates and diuretics. Morphine IV is an excellent adjunct in acute therapy. * **ACE inhibitors may rapidly reverse hemodynamic instability and symptoms.** * Beta-blockers: role is unclear in acute setting.

Answer 40

* **Signs and symptoms**; health history * **CXR:** shows pulmonary congestion as white, dense areas; may show enlarged heart or liver congestion. * **ECG:** may give clues to the cause of LVF. It my demonstrate prior MI, dysrhythmias, or left ventricular dysfunction. * **Echocardiogram**: provides information about the chamber size and ventricular function; ejection fraction. * **Cardiac cath:** for pts with CAD * MRI or CT

Answer 41

* **It is a protein secreted from the ventricles in response to overload.** * **This is the lab to check for heart failure** * **_BNP levels below 100 pg/mL indicate no heart failure_** * BNP levels of 100-300 suggest heart failure is present * BNP levels above 300 indicate mild heart failure * BNP levels above 600 indicate moderate heart failure * BNP levels above 900 indicate severe heart failure.

Answer 42

**Reduce preload** * High fowler’s position to reduce pulmonary congestion * Controlling sodium and water retention (restrict sodium intake, avoid NSAIDs) * Diuretics **Reduce afterload** * Vasodilators **Increase ventricular contractility** * Inotropes

Answer 43

* Goal is to improve cardiac performance without increasing cardiac workload; must manipulate preload, afterload, and contractility! * Medications are mainstay of management; make sure patients are complient with medications * Make sure patient is on a low Na+ diet, decrease the intake of fluids

Answer 44

No added salt or salt substitutes because they contain potassium salts. Fluid restriction based on weight, monitor I/O, lytes, need increased Kcal and protein.

Answer 45

Acute HF pts on bedrest to minimize O2 demands, but increase as soon as BP, HR, O2 sats stabilize.

Answer 46

**Effects:** * The decrease in afterload increases cardiac output by enhancing contractility. * The neurohormonal effects include inhibition of ACE and vasodilation and a decrease in systemic blood pressure. **Nursing implications:** * Monitor blood pressure. May increase BUN, Creatinine, Liver enzymes, and potassium levels. May increase digoxin levels. * Some patients cannot tolerate due to development of a cough.

Answer 47

**Effects:** * Decrease heart rate to promote left atrium emptying and improve left ventricular volume * Decrease myocardial O2 demand **Nursing implications:** * **Patients should not stop taking medication abruptly, may cause angina or rebound tachycardia.** * _Monitor blood sugar in a diabetic patient, may cause hypoglycemia._ * **The drug should not be given to a patient with history of asthma, however, benefits may outweigh risks.**

Answer 48

**Effects:** * Urine output should increase, therefore reducing circulating volume. The reduction in volume decreases central venous pressure, pulmonary congestion, and peripheral edema. * Used for symptom relief, does not change mortality. **Nursing implications:** * Monitor I/O and electrolytes, especially potassium. * Monitor for orthostatic hypotension.

Answer 49

* Two agents, Spironolactone and Eplerenone, have been approved for patients with heart failure as add-on therapy. * A 30% reduction in mortality and hospitalizations has been reported when spironolactone is added to standard therapy for patients with NYHA Class III or IV heart failure and a serum creatinine less than 2.5.

Answer 50

* Sodium forced out of the cell in exchange for calcium which increase force of contraction and increases CO (+ inotropic effect) * Slows conduction through AV node which slows HR (- chronotropic effect)

Answer 51

* Take HR x 1 min, hold dose if HR \< 60 bpm. Teach patient and family. * **Monitor for digoxin toxicity!** * **Narrow therapeutic index (0.8 - 2 ng/mL)** *

Answer 52

**Symptoms:** anorexia, **nausea, vomiting**, malaise, lethargy, **fatigue,** generalized weakness, dizziness, insomnia, palpitations, irregular heart beat, **confusion.** **Visual changes:** halos or rings of light around objects, seeing lights or bright spots, changes in color perception, blind spots in vision, **blurred vision.**

Answer 53

Occurs when heart valves that normally move blood progressively through the heart cannot fully open or fully close, perfusion of the heart and distal tissues is impaired.

Answer 54

* Myocardial ischemia * acute rheumatic fever * infectious endocarditis * connective tissue abnormalities

Answer 55

**Help the client maintain a normal cardiac output to prevent:** * Manifestations of heart failure * Venous congestion * Inadequate tissue perfusion

Answer 56

* **The aortic and mitral valves become dysfunctional more often then do the pulmonary and tricuspid valves.** * This change occurs because the left side of the heart is a system of higher pressures when compared to the lower pressures in the pulmonary circulation.

Answer 57

* backflow that occurs if a valve does not close tightly. Blood leaks back into the chambers rather than flowing forward through the heart or artery. * Backflow is commonly due to valve _prolapse_, the stretching of an atrioventricular valve leaflet into the atrium during diastole.

Answer 58

* Stenosis occurs when the valve opening is constricted and narrowed, impeding the forward flow of blood and **increases the workload of the cardiac champer proximal to the diseased valve causing hypertrophy.** * Occurs if the flaps of a valve thicken, stiffen, or fuse together.

Answer 59

* Mitral stenosis * Mitral regurgitation * Mitral valve prolapse * Aortic regurgitation * Aortic stenosis

Answer 60

* Mitral stenosis is a valve disorder that occurs when the valve becomes calcified and immobile, the vavlular orifice narrows, and this impairs the flow of blood from the **left atrium to the left ventricle.** * It is most commonly caused by **acute rheumatic fever** and is 2x-3x more common in women than men.

Answer 61

**Because the vavlular orifice narrows, and this impairs the flow of blood from the left atrium to the left ventricle, this causes:** * Incomplete emptying of the left ventricle * ↑ Artiral pressure * Left atrium hypertrophy * Pulmonary hypertension, pulmonary edema, RHF

Answer 62

* Gradual in onset * decreased exercise tolerance * dyspnea * orthopnea * paroxysmal nocturnal dyspnea.

Answer 63

* a low-pitched rumbling diastolic murmur heard best at the apex. * **Manifestations of right side heart failure may be present**

Answer 64

* Anticoagulation to decrease the risk of thrombus formation * surgical intervention.

Answer 65

* It is a backward flow of blood from the left ventricle into the left atrium during systole. * Can be caused by: * Mitral valve prolapse (abnormally thickened mitral valve) * Rheumatic heart disease * CAD * connective tissue diseases

Answer 66

**The backward flow of blood from the left ventricle into the left atrium → hypertrophy of left atrium, this can lead to:** * LV failure * Additionally it can lead to right-sided heart failure due to increasing pressure in the LA causing back up into the pulmonary vasculature

Answer 67

* **May be asymptomatic until cardiac output falls.** * **First signs are _fatigue and dyspnea_ then increasing to orthopnea, paroxsymal noctural dyspnea, and peripheral edema.** * Pulmonary hypertension * pulmonary edema * RHF * Atypical chest pain * pansystolic murmur

Answer 68

A blowing, high-pitched systolic murmur with radiation to the left axilla, heard best at the apex.

Answer 69

Nitrates, digitalis, and ACE inhibitors, possibly diuretics and low sodium diet to **_lessen workload of the heart._**

Answer 70

* It occurs when one or both of the valve leaflets bulge into the left atrium during ventricular systole **resulting in regurgitation into the atrium.** * Often accompanied by mitral regurgitation

Answer 71

* Not uncommon for patient with MVP to be completely **asymptomatic** * symptoms may be **vague** including: * tachycardia * lightheadedness * syncope * fatigue * weakness * dyspnea * anxiety * chest pain

Answer 72

regurgitant murmur or midsystolic click

Answer 73

**Depends on symptoms:** * **beta-blockers for:** relieving syncope, palpitations, and chest pain * **Aspirin:** to prevent TIAs * **prophylactic antibiotics:** before any invasive procedures.

Answer 74

* The inability of the aortic valve leaflets to close properly during diastole resulting from abnormalities of the leaflets or the aortic root, or both; **this results in blood back flowing from the aorta** * It is most often a result of infectious disorders such as **rheumatic fever, syphilis, and infective endocarditis.**

Answer 75

1. Blood back flows from aorta → LV during diastole. 2. This ↑ chamber volume → dilation, which in turn 3. ↑ workload → **hypertrophy of Left heart. **

Answer 76

* Prominent pulsations in the neck * Possible head-bobbing with each heart beat --\> Widened pulse pressure from ↑ SV and diastolic backflow * palpitations * dyspnea on exertion * fatigue * **Angina pectoris**

Answer 77

* soft, high-pitched, blowing diastolic murmur radiating to the left sternal border. * Turbulence across the aortic valvue druing diastole → **decrescendo murmur**

Answer 78

* relief of manifestations of heart failure and prevention of infection (prophylatic antibiotics) * prompt surgical treatment if s/s of LV failure.

Answer 79

* It is a narrowing of the orifice between left ventricle and aorta. * **Caused by:** 1. Congenital defects 2. Calcification related to aging 3. Retraction and stiffening of the valve from inflammatory damage caused by rheumatic fever

Answer 80

**The narrowing of the orifice between left ventricle and aorta leads to an increase in pressure within the LV, this leads to:** * ventricular hypertrophy * ↓ SV, ↓ Systolic BP, narrowed pulse pressure * Slowed HR & faint pulses * Decreased cardiac output and eventually **_heart failure._**

Answer 81

* dyspnea on exertion * exercise intolerance * chest pain * syncope * palpitations

Answer 82

Systolic murmur with diminished second heart sounds.

Answer 83

1. surgical intervention 2. prophylatic antibiotics 3. treatment of dysrhytmias.

Answer 84

Prevention of venous thrombosis & PE * & in pts with prosthetic heart valves * ** during atrial fibrillation**

Answer 85

* Antagonist of vitamin K (needed for factors VII, IX, X & prothrombin) * **Anti-clotting action delayed b/c it has no effect on clotting factors already in circulation**

Answer 86

* Initial response 8-12 h & several days for peak * **INR range should be kept between 2 - 4.5** * If using warfarin with heparin, monitor levels (blood draw) **no sooner than 5 h after IV or no sooner than 24 h after SQ inj**

Answer 87

* Patient needs routine lab work to monitor coagulation times * Instruct patient to avoid taking aspirin or other NSAIDS unless prescribed (due to enhanced action of warfarin) * Inform patient to avoid significantly increasing or decreasing consumption of foods high in Vitamin K (e.g. green leafy vegetables) * Patient should be informed to report excessive or prolonged bleeding from skin, nose, or mouth; red, rust-colored or smoky urine; bloody or tarry stools; blood in vomit or sputum; prolonged or excessive menses; excessive bruising; severe or persistent headache; or sudden abdominal or back pain; pregnancy is suspected or breast feeding! * Patient should inform provider if begins ANY new prescriptions or OTC * **Don't take if prego**

Answer 88

* Tx with **vitamin K1** (phytonadione) PO, IV (avoid SQ), infuse slowly * If vit K1 does not work, use whole blood or fresh-frozen plasma * food w/ Vit K can reduce efx: mayonnaise, canola oil, soybean oil, green leafy veggies – keep intake of these constant when testing

Answer 89

* Hemorrhage * **Category X (if need anticoag during pregnancy give heparin)** * Do not use during breast feeding

Answer 90

* Drugs that promote bleeding * Drugs that ↑ anticoag effects * Drugs that ↓ anticoag effects

Answer 91

* Use an electric razor rather than a straight-edge razor * Floss and brush teeth gently * Avoid putting sharp objects in mouth (e.g. toothpicks) * Do not walk barefoot * Cut nails carefully * Do not blow nose forcefully * Avoid straining to have a bowel movement * Instruct patient to control any bleeding by applying firm, prolonged pressure to the area if possible.

Answer 92

* Abnormality in the septum between the right and left side of the heart. * Atrial or ventricular * Congenital defects usually identified in infancy or childhood * Requires close monitoring, possible surgical repair.

Answer 93

* A heart muscle disorder causing impaired cardiac output and can lead to heart failure, sudden death, and/or dysrhythmias. * This is a result of an enlargig heart from the hypertrophy, it leads to decreased output,

Answer 94

* **Dilated** * Ventricular enlargement and contractile dysfunction * **Hypertrophic** * Disproportionate thickening of the interventricular septum * **Restrictive** * Excessively rigid/stiff ventricular walls

Answer 95

1. Rheumatic Endocarditis 2. Infective Endocarditis 3. Pericarditis

Answer 96

* Diffuse inflammatory disease characterized by a delayed response to an infection by the group A beta-hemolytic streptococcal pharyngitis. * Inflammatory process involves all layers of the heart producing permanent and severe heart damage.

Answer 97

* Complications include valvular disorders, cardiomegaly, and heart failure. * If appropriate antibiotic therapy for group A beta-hemolytic strep started within the first 9 days, rheumatic fever can be prevented…therefore, prompt recognition key.

Answer 98

* A microbial infection of the endocardium that begins from the microorganisms in the bloodstream. * Vegetative growths occur that may form clots that travel to other organs and/or severely damage heart valves. * Extensions of bacteria may invade the aorta or pericardium.

Answer 99

* prosthetic heart valves * structural cardiac defects * prolonged IV catheters * hemodialysis catheters * IV drug use.

Answer 100

* Fever, chills alternating with sweats * Malaise, weakness, anorexia, weight loss * Heart murmur * Clusters of petechia on body * Small, painful nodes on pads of fingers or toes (Osler nodes) * Irregular, red or purple, painless, flat macules on palms, fingers, hands, or soles (Janeway lesions) * Cardiomegaly and heart failure may occur * Central nervous system findings

Answer 101

* IV Antibiotics for 2-6 weeks * Antibiotic prophylaxis for future procedures * Good oral hygiene * No IUDs, body piercings * Surgical management if medical management unsuccessful

Answer 102

* Inflammation of the pericardium * Acute or chronic * **Many causes:** infection, myocardial injury, collagen diseases, drug reaction, radiation therapy

Answer 103

* **Manifestations:** chest pain worsened by deep inspiration, lying down, and turning. Sitting up and leaning forward typically relieves/minimized pain; pericardial friction rub; fever, tachycardia, chills, malaise, anxiety, anorexia, nausea * **Complications:** Pericardial effusion and **cardiac tamponade**

Answer 104

* Analgesics and NSAIDs to help with the pain during the acute phase * Corticosteroids may be prescribed if the patient does not response to NSAIDs * If related to bacterial, fungal infections, antibiotic therapy. * Bed rest or restricted activity

Answer 105

**S/S:** * Hypotension * Tachycardia * Dyspnea * JVD * Muffled heart sounds (distant) * Pulsus paradoxus: BP decreases by 10mmHg or more in SBP on inspiration. DBP stays the same, so pulse pressure narrows. * Restlessness, anxiety * Cyanosis of lips and nails **Treatment:** * Pericardiocentesis * Fluid or air is aspirated from the pericardial sac **_This is life threatening_**

Answer 106

* Fever, chills alternating with sweats * Malaise, weakness, anorexia, weight loss * Heart murmur * Clusters of petechia on body * Small, painful nodes on pads of fingers or toes (Osler nodes) * Irregular, red or purple, painless, flat macules on palms, fingers, hands, or soles (Janeway lesions) * Cardiomegaly and heart failure may occur * Central nervous system findings

Answer 107

* A form of arteriosclerosis caused by thickening & hardening of artiral walls by accumulation of lipid-laden macrophages because of ↑ LDL & ↓ HDL (transports cholesterol to liver for processing), and is the abnormal accumulation of lipid deposits and fibrous tissue within arterial walls and lumen. * This causes plaque to develop in the arteries * Blockages and narrowing of the coronary vessels reduce blood flow to the myocardium

Answer 108

1. Endothelium becomes damages → 2. inflammatory cytokines released & oxygen radicals formed → 3. Macrophages migrate & adhere to injured endothelium & release enzymes/oxidize LDL (fatty streak; lesion reversible) → 4. Smooth muscle cell proliferation → 5. collagen → 6. fibrous plaque (which obstructs blood flow) → 7. angina or intermittent claudication → 8. Unstable plaque prone to rupture

Answer 109

* Symptoms are due to myocardial ischemia, Inadequate tissue perfusion * Symptoms and complications are related to the location and degree of vessel obstruction * **Angina pectoris (usually caused by significant coronary atherosclerosis)** * Myocardial infarction * Heart failure * Sudden cardiac death

Answer 110

* Family hx of CAD * Increasing age * 45 for men * 55 for women * Gender * Men\>women * Race – AA\>Caucasians

Answer 111

* Hyperlipidemia * Tobacco use * Hypertension * Diabetes mellitus * Metabolic syndrome * Obesity * Physical inactivity --\> recommended Physical activity for 30 minutes per day of moderate exercise most days

Answer 112

* Controlling Cholesterol - statins * Stop Smoking * Manage Hypertension * Controlling Diabetes

Answer 113

Have the patient record: * Total calories * **Total fat (25%-35% of total calories)** * –Saturated fats (\< 7%) * –Polyunsaturated fats * –Monounsaturated fats * Carbohydrates **(50-60% of total calories**) * Dietary fiber **(20-30g a day)** * Protein **(15% of total calories)** * Cholesterol (**LESS THAN 200mg / day)**

Answer 114

* Optimal lvls = \< 200mg/dL * High lvls = 240mg/dL +

Answer 115

* Optimal lvls = \< 100mg/dL * Borderline = 130-156mg/dL * High lvls = 160-189 mg/dL

Answer 116

* Optimal lvls = 60mg/dL + * Low HDL lvls =

Answer 117

* Optimal lvls = \< 150 mg/dL * High lvls - 200-499mg/dL

Answer 118

* A syndrome characterized by episodes or paroxysmal pain or pressure in the anterior chest caused by insufficient coronary blood flow. * Physical exertion or emotional stress increases myocardial oxygen demand and the coronary vessels are unable to supply sufficient blood flow to meet the oxygen demand.

Answer 119

* Acute pulmonary edema * Heart failure * Cardiogenic shock * Dysrhythmias and cardiac arrest * Myocardial infarction

Answer 120

* Stable Angina * Unstable Angina * Refractory angina * Variant (Prinzmetal’s) - happens more likely at night * Silent ischemia (EKG changes with a stress test), patient reports no pain

Answer 121

* Stable angina (a.k.a. Angina pectrois) is substernal, transient chest pain that is usually relieved by rest and/or nitrates * It is caused by gradual luminal narrowing and hardening of the arterials so that the affected vessels cannot dilate in response to increased myocardial demand associated w/ PHYS exertion or emotional stress.

Answer 122

**Unstable angina is characterized by increased frequency and severity and is not relieved by rest and NTG. Requires medical intervention!**

Answer 123

* Transient, unpredictable chest pain from coronary vasospasm that occurs at rest

Answer 124

* Ischemia that has no symptoms (no chest pain) * Occurs more often in women * It can also occur in some people during mental stress

Answer 125

the patient has clinical manifestations of coronary ischemia, but ECG and cardiac biomarkers show no evidence of MI

Answer 126

* Pain described as tightness, choking, or a heavy sensation. * Frequently retrosternal and may radiate to neck, jaw, shoulders, back or arms (usually left). * Anxiety frequently accompanies the pain. * The pain of typical angina subsides with rest or NTG. * **Diabetes – may not feel pain (diabetic neuropathy)** * **Unstable angina is characterized by increased frequency and severity and is not relieved by rest and NTG. Requires medical intervention!**

Answer 127

* dyspnea/shortness of breath * dizziness * nausea and vomiting.

Answer 128

* **Treatment seeks to decrease myocardial oxygen demand and increase oxygen supply** * Medications - dialate the arteries -- Nitroglycerin * Start patient on oxygen * Reduce and control risk factors * Reperfusion therapy may also be done

Answer 129

* **Nitroglycerin** * **Beta-adrenergic blocking agents** * **Calcium channel blocking agents** * **Antiplatelet and anticoagulant medications** * **Aspirin** * Clopidogrel and ticlopidine * **Heparin** * Glycoprotein IIB/IIIa agents

Answer 130

* Cause vasodilation, reduce blood return to heart from veins, decrease preload & workload on heart, decrease O demand; * Dilate peripheral arteries to decrease afterload & decrease in O demand * Dilate coronary arteries to increase collateral flow to ischemic heart

Answer 131

* Decrease myocardial O2 demand by decreasing force of contraction, slowing heart rate, & slowing impulse conduction * Slowed HR increases filling time & increases CA perfusion * Decrease BP to decrease afterload & O2 demand

Answer 132

**The goal is to increase O2 supply & decrease O2 demand** * **M**orphine 1-5 mg IVP * **O**xygen 2L * **N**itro 0.4mg SL 5 min x 3 * **A**SA 160mg – 325mg * **B**eta Blockers 5mg IV q5-15 min x 3

Answer 133

**You would assess for:** * Symptoms and activities, especially those that precede and precipitate attacks * Ask about the pain, location, quality, etc, activities the patient was doing when the pain started * Risk factors, lifestyle, and health promotion activities * Patient and family knowledge * Adherence to the plan of care ( compliance is a big thing)

Answer 134

* Ineffective cardiac tissue perfusion * Death anxiety * Deficient knowledge * Noncompliance, ineffective management of therapeutic regimen

Answer 135

1. Lifestyle changes and reduction of risk factors 2. Explore, recognize, and adapt behaviors to avoid to reduce the incidence of episodes of ischemia 3. Teaching regarding disease process 4. Medications 5. Stress reduction 6. When to seek emergency care

Answer 136

An umbrella term covering ST elevation MI's and Non-ST elevation **MI's** ## Footnote **NSTEMI: = unstable angina** **STEMI: = MI heart attack, worst one to have, immediate concern, head to cath lab**

Answer 137

An area of the myocardium is permanently destroyed. Usually caused by reduced blood flow in a coronary artery due to rupture of an atherosclerotic plaque and subsequent occlusion of the artery by a thrombus.

Answer 138

* Prolonged ischemia → cellular death & irreversible damage to heart muscle caused by: * **Plaque progression, rupture, & clot formation (most common etiology)** * Coronary artery vasospasm * Coronary artery embolism

Answer 139

* Pallor * diaphoresis, * sense of unease, * palpitations, * nausea/vomiting (blood flow, reflex stimulation of vomiting center by pain fibers), * dyspnea * fatigue * **chest pain** * 12 lead ECG ( rule out an acute MI) Laboratory tests—biomarkers * **CK-MB - peaks at 24 hours** * **Myoglobin - peaks at 12 hours** * **Troponin T or I - levels are elevated for 3 weeks** * Patient history

Answer 140

* Obtain diagnostic tests including ECG within 10 minutes of admission to the ED * Start Oxygen * Aspirin, nitroglycerin, morphine, beta-blockers * Angiotensin-converting enzyme inhibitor within 24 hours * Evaluate for percutaneous coronary intervention or thrombolytic therapy * As indicated; IV heparin or LMWH, clopidogrel or ticlopidine, glycoprotein IIb/IIIa inhibitor * Bed rest - to prevent fatigue, DOE

Answer 141

* Frequent VS * Telemetry * I & O; daily weights * Careful assessment of restlessness, dyspnea, or chest pain - indicates that tissue damage is worsening * Assessment for S/S of CHF * Assessment of skin color

Answer 142

* **Rest is a priority – injured heart must have time to start repairing itself** * Bedside commode for bowel movement – preferred over bedpan if can. Stool softeners may be ordered * Assist with isometric exercises * Provide muscle exercise without causing exhaustion * **Sequental compression devices to prevent DVT** * Place all necessary items within patient’s reach. Call light available. Prevents stretching or straining * Perform physical care – provides rest & comfort * After assistance with ADLs – provide ample time for rest. Place in semi-Fowler’s position – position assists with breathing and relieves pain

Answer 143

* Assess all symptoms carefully and compare to previous and baseline data to detect any changes or complications. * Monitor ECG.

Answer 144

* Ineffective cardiac tissue perfusion * Risk for fluid imbalance * Risk for ineffective peripheral tissue perfusion * Death anxiety * Deficient knowledge

Answer 145

Goals include the relief of pain or ischemic signs and symptoms, prevention of further myocardial damage, absence of respiratory dysfunction, maintenance of or attainment of adequate tissues perfusion, reduced anxiety, adherence to the self-care program, and absence or early recognition of complications

Answer 146

**ST segment elevation is a classic sign of an AMI**: Resolves with restoration of blood flow or completion of MI

Answer 147

* Other blood tests * Chemistry & CBC to determine concurrent diseases * ESR rises 1st week after infarct * Stress test shows significance of blockage related to patient functioning * Cardiac cath--for patients with recurring symptoms to monitor heart structure & function

Answer 148

**Intraaortic balloon pump:** * pts with s/s of hemodynamic instability * balloon inserted into descending thoracic artery & inflated during diastole * changes early diastolic pressure & coronary artery perfusion * deflates at end diastole, decrease afterload, increases CO **Coronary angioplasty & intracoronary stents:** * sheath inserted into femoral artery & cath is guided through arteries to aorta & radiopaque dye is inserted into coronary arteries * lesion identified to see if PTCA possible * cath with balloon inserted & positioned central to blockage then inflated to reconfigure blockage * **WATCH OUT FOR INFECTION** * **MONITOR THE SITE for any changes** * Stent may be inserted to prevent restenosis

Answer 149

* NPO while evaluated for acute chest pain to prevent blood from being redirected to GI tract * Prevents vomiting from vagal effects * If not NPO then diet is low fat low cholesterol * Saturated fats should be less than 10% Kcals since large amounts saturated fats raises cholesterol; polyunsaturated fats help lower cholesterol

Answer 150

* Bedrest when initially experience chest pain to decrease O demand until AMI dx made * After pt stable activity gradually increased * Pts assessed for activity tolerance based on orthostatic changes in BP, dysrthymias, s/s; can indicate possible ischemia * Post infarct pts have stress test to determine safe exercise level * Cardiac rehab for activity progression

Answer 151

* In hospital, gradual increase in the patient’s activity level as prescribed * Exercise tolerance test and exercise progression * Graded exercise program with monitoring of tolerance based on BP and HR – cardiac rehab * Emotional support & counseling * Stress management * Sexual counseling * Lifestyle changes if needed (e.g. stop smoking) * Risk factor management * Dietary changes * Medication adherence

Answer 152

Internal mammary artery or saphenous vein grafted to coronary artery beyond the point of blockage to reestablish blood flow

Answer 153

* Internal mammary artery or saphenous vein grafted to coronary artery beyond the point of blockage to reestablish blood flow * Consider anatomy of occlusion & surgical risk/benefit * Not curative since grafts can occlude but it can improve quality of life * Cardiopulmonary bypass machine during procedure

Answer 154

* Goals include accurate H & P, preop teaching for pt & family regarding surgery, preparing pt & family physically & psychosocially * Dx testing to evaluate severity of disease * Assess risk factors which could hinder recovery & teach lifestyle changes * Obtain baseline data: apical & radial HR, bilat BP, peripheral pulses, neuro, nutrition * Withhold ASA 1 to 3 days before surgery * NPO at midnight

Answer 155

Postop care: promoting patent airway & effective gas exchange * intubation & MV until pt stable * **assess resp, breath sounds, cough, sputum, ABGs, pulse ox, CXR to check lung reexpansion, pulm care q1-2h** * pain meds to promote T, C, DB * splint incision, change position * **Preventing infection** * Monitoring neurological status * **Monitoring fluid balance: I/O (should have urine output 30 cc/hour), limit fluids to reduce chance of overload, daily weights, possible diuretics (watch K levels), H & H, PT, serum glucose (may be elevated from stress of surgery), plasma expanders** * **STOP METFORMIN**

Answer 156

* promote comfort, rest, sleep * support nutrition * promote activity * promote psychosocial adaptation * monitor anticoagulation * pt/family discharge teaching

Answer 157

* pulmonary most common; atelectasis, pleural effusion, pneumonia * cardiac instability & dysrhythmias * neuro changes * fluid imbalance & fever * immobility * sleep disturbance

Answer 158

* Drugs that prevent calcium ions from entering cells * Also known as calcium antagonists and slow channel blockers

Answer 159

Used to treat: 1. Hypertension 2. angina pectoris 3. cardiac dysrhythmias

Answer 160

To treat Pts w/ : * Angina * HTN * Cardiac dysrhythmias * MI * Heart failure * Hyperthyroidism * Migraine * Stage fright * Pheochromocytoma * Glaucoma All of these are due almost entirely to blocking β1 receptors

Answer 161

* 1st gen: nonselective – block β1 & β2 (ex. propran**olol**) * 2nd gen: selective – block β1 (ex. metopr**olol**) * 3rd gen: * nonselective - β1&2, α1 (carvedi**lol** & labeta**lol**) * selective (β1) - nebiv**olol** **All end in "LOL"**

Answer 162

* They block β1 & β2, resulting in: * Reduced HR (β1) * Decreases the force of ventricular contraction (β1) * Slows impulse conduction through AV node (β1) * Suppresses secretion of renin (β1) * Bronchoconstriction - β2 blockade in the lung * Casoconstriction - β2 arteriole blockade in heart, lung, skeletal muscle * Reduces glycogenolysis (β2 blockade in skeletal muscle & liver)

Answer 163

Rebound cardiac excitation

Answer 164

* Teach pts to carry enough medication on away trips! * Teach pts s & sx of HF: * SOB, night coughs, edema of extremities * Nurse should assess for ↑ resp, ↑ BP, ↑ HR & auscultate lungs for crackles

Answer 165

* Atorva**statin** * Lova**statin** * Rosuva**statin** * Simvastatin * Pravastin * Fluvastatin

Answer 166

* decrease LDL levels , triglycerides * Increase HDL levels ***Nonlipid CV Benefits*:** * ↑ plaque stability * ↓ inflammation @ site * Slow CAD calcification

Answer 167

* HA * Rashes * GI disturbances * Myopathy/rhabdomylolysis (RARE) * Hepatoxicity (RARE) **These are PREG X drugs**

Answer 168

Dilates the veins and leads to: * ↓cardiac preload * ↓blood return = ↓ventricular filling * ↓cardiac work = ↓CO/perfusion

Answer 169

* Primary HTN * Hypertensive crisis * Heart failure

Answer 170

Inhibit the activity of clotting factors

Answer 171

1^st line tx in DVTs

Answer 172

* Monitor for bleeding * Watch out for heparin induced thrombocytopenia, it will decrease platelet count * **Hypersensitivity (small test dose 1^st)**

Answer 173

* It is an abnormal widening or ballooning of a portion of an artery due to weakness, dilation, or outpouching in the wall of the blood vessel and are at least 1.5 times their normal size * Caused by atherosclerosis, trauma, syphilis, infection, connective tissue disorders, cigarette smoking, HTN **50% all aneurysms larger than 6cm in diameter will rupture within 1 year**

Answer 174

* chest trauma from MVA, and atherosclerosis * strongly linked to HTN & instability

Answer 175

* **Abdominal aorta most common site** * Growth unpredictable but larger the aneurysm the greater the risk of rupture * Commonly asymptomatic; but can be felt as palpable mass, bruit heard * May have thoracic, abdominal, or back pain; anterior chest wall, back, flank, pain; s/s shock if leakage, dyspnea, cough, & wheezing * If ruptures: severe pain, s/s shock, decreased RBC, increased WBC, death

Answer 176

Trans esophageal echocardiogram or X-ray, CT ## Footnote **Maintain BP is high priority**

Answer 177

info regarding surgery, care of wound, s/s infection, diet, activity, pain meds, avoid constipation /straining

Answer 178

* It is a progressive narrowing, degeneration, & obstruction of arteries of extremities; **usually lower involved** * **Arteriosclerosis obliterans most common:** atherosclerosis (plaque) combines with ateriosclerosis (calcification) to produce widespread slowly progressive narrowing of arteries

Answer 179

* Plaque formation causes thickening of intima & media causing partial or complete obstruction * Calcification of arteriosclerosis weakens arterial wall & increases chance of thrombus & aneurysm * Occurs segmentally; s/s appear with \>50% occlusion

Answer 180

* Age * Smoking * Hypertension * Atherosclerosis * Obesity * Diabetes * Stress * Family hx PVD * Sedentary lifestyle * Hyperlipidemia

Answer 181

* **Intermittent claudication--** aching pain or cramp distal to blockage occurring with exercise & relieved by rest * **Rest pain--** severe disease usually at night; has numbness, coldness, tingling * Hair loss on affected extremity * **Thick, brittle, slow growing nails** * **Shiny, thin, tight, fragile skin is dry & scaly** * **Cool to touch** * **Diminished or absent pulses** * Pale appearance with elevated extremity * Reddish color with extremity dependent * Decreased motor function * Ulcer formation with advanced disease

Answer 182

* ultrasound * segmental limb pressure & pulse volume record * exercise testing * arteriogram * Ankle-brachial index (ABI)-- measures degree of stenosis

Answer 183

* Pentoxifylline (Trental) and cilostazol (Pleta) are the only medications specifically indicated for the treatment of claudication. * Antiplatelet agents such as aspirin or clopidogrel (Plavix) help prevent the formation of thromboemboli, which can lead to myocardial infarction and stroke.

Answer 184

* Treatments: * pt assisted to improve management of other chronic conditions; smoking cessation * may use angioplasty & stents when condition is incapacitating * Surgical Management: Bypass grafts & endarterectomy, amputation * Activity * Referrals

Answer 185

**Subjective:** * presence, severity, location of intermittent claudication & rest pain * Hx HTN, diabetes, CAD (include tx adherence) * smoking hx & attempts to quit * diet patterns; exercise patterns * ADLs & social impact of disease * numbness or tingling **Objective:** * Peripheral pulses palpated or doppler * Appearance of skin, nails, hair on extremity * Skin breakdown * Postural color changes * Presence of muscle wasting * Ankle-Brachial index * Weight

Answer 186

* Ineffective peripheral tissue perfusion related to impaired arterial circulation. * Pain related to decreased oxygen supply to tissues. * Risk for impaired skin integrity related to compromised tissue perfusion. * Fear and anxiety related to actual or potential lifestyle changes.

Answer 187

* Place the client’s legs in a dependent position in relation to the heart to improve peripheral blood flow * Avoid raising the client’s feet above heart level unless specifically prescribed by the health care providers * Keep the client in a neutral, flat, supine position if in doubt about the nature of his peripheral vascular problems.

Answer 188

* Teach the client to avoid constricting clothes, such as garters, knee-high stockings and belts. * If overreplacement of glucocortiocoid is indicated, inform the client about the purpose of therapy and possible adverse effects such as cushingoid appearance, weight gain, acne, hirsutism, peptic ulcer, diabetes mellitus, osteoporosis, infection, muscular weakness, mood swings, cataracts and hypertension. * Provide insulating warmth with gloves, socks and other outerwear as appropriate. * Keep room temperatures comfortably warm. * Instruct the client to warm himself with warm drinks or baths. * Never apply a direct heat source to the extremities. Limited blood flow combined occur with normal circulation. * Teach the client about the vasoconstrictive effects of nicotine and caffeine, emotional stress, and chilling, discuss ways to avoid or minimize these risk factors.

Answer 189

For a client with decreased arterial function but without activity-limiting tissue damage, encourage a program of balanced exercise and rest to promote development of collateral circulation.

Answer 190

* lInjury * lInfection * lGangrene * lThrombus * lArterial ulcers * lAmputation

Answer 191

* A sudden process in which an artey is blocked * Can occur in healthy & diseased arteries resulting from thrombosis, embolism in healthy artery or trauma * Typically occurs at site of vessel bifurcation or narrowing

Answer 192

**Risk factors are conditions causing thrombus formation, which are:** * Rheumatic heart disease * artificial heart valves * MI * atrial fib * postop vascular surgery * trauma with lacerated or compressed arteries

Answer 193

* Severe constant **pain** not relieved by rest * **Pallor** or mottled appearance * **Pulselessness** or diminished over affected area * **Paresthesia** -- numbness, tingling, burning * **Poikilothermia** -- cool or cold to touch * **Paralysis** -- mobility is limited; indicates ischemic death of nerves

Answer 194

* physical exam, Doppler ultrasound, ABI, MRI

Answer 195

**Medications: to dissolve clot & prevent further clot formation** * heparin-- prevent further clots * urokinase-- dissolves clot over 24-48 hours * spasmolytic agents -- relieve arterial spasms * calcium channel blockers-- spasms * coumadin-- prevent future episodes

Answer 196

* physical, emotional, & psychosocial prep of pt & family * teach procedures, meds, postop care; provide as much info as possible for better decisions * **frequent VS & neurovascular checks**

Answer 197

* **Support circulation & perfusion:** monitor graft patency; check peripheral pulses, VS, neuro- vascular status, limb temp, ABGs, pulse ox, cardiac enzymes, cardiac monitor. Test pt output (drains & tubes) for blood. Measure abd girth & limb circumference * **Prevent respiratory complications:** atelectasis, resp. infection; TCDB, pain meds, ambulation * **Support fluid balance:** kidneys at risk from low CO (hypotension, hypovolemia, trauma); can lead to acute postop renal failure. I/O, daily weight, BUN, creatinine, lytes, UA * **Promote wound healing:** Infections common especially with diabetic & malnourished pt; perform & teach proper wound care; graft infection has high fever, ileus, high WBC * **Patient/family teaching:** have brief hospitalization so care for self at home * standard dc teaching: diet, activity, wound care, resuming normal activities * risk factor reduction * avoid constipation & straining * use pain meds for rest & activity

Answer 198

* Infection at graft site * Reoccclusion & restenosis * Multi-system injury * Ischemia leading to necrosis & gangrene * MI, dysrhythmias, stroke

Answer 199

* **More common in women & elderly** * 50% DVT pts will develop PE as result & @ 50,000 will die from PE/year * **Thrombi develop in areas of slow or turbulent blood flow** * Spasm & change in pressure dislodge thrombi & move them toward heart

Answer 200

* Age: elderly (have lots of risk factors) * Female * Pos. hx thrombosis * Immobility/ stasis * Increased viscosity * Intimal damage * Associated conditions * Trauma * Use of oral contraceptives (estrogen) * Chronic lung & heart disease

Answer 201

a blood clot that forms in a vein deep inside a part of the body. It mainly affects the large veins in the lower leg and thigh.

Answer 202

**Presentation: s/s vary according to size & location of thrombus** * 50% pts asymptomatic * local pain or tenderness * edema or swelling * local warmth, redness; mild fever *

Answer 203

venogram is criterion standard but is not always accurate; also use ultrasound & venous agglutination test

Answer 204

* §low dose heparin (sc) q12h * coumadin * other thrombolytic therapy to dissolve existing thrombi

Answer 205

**Treatments: mostly preventative; to increase venous return & prevent venous stasis** * antiembolism stockings * graduated compression stockings-- different degrees of compression to different parts of leg * external pneumatic compression sleeves-- uses air pump by inflating & deflating sleeves at regular intervals to stimulate venous return * Surgery: not major role in acute DVT, but used when other treatments ineffective * thrombectomy when circulation compromised * placement of transvenous filtration device in vena cava to trap thrombi before they reach heart & lungs; Greenfield filter, bird’s nest filter

Answer 206

* **Diet:** only major restriction for Coumadin pts-- consistent Vitamin K intake * **Activity:** ambulate as tolerated after therapeutic heparin level achieved; if edema or pain present, bed rest with leg elevated * **Referrals:** home health agency, APNs for monitoring anticoagulation

Answer 207

**Subjective Assessment:** * pain or tenderness in calf or thigh muscle with rest or exercise * tenderness with palpation * previous hx DVT * risk factors * sudden onset chest pain, dyspnea, tachypnea * pain starting in leg but moving to chest **Objective Assessment:** * unilateral or bilateral extremity edema * increase circumference in affected area * warmth/redness * abrupt pain with dorsiflexion * engorgement of collateral veins * positive dx results

Answer 208

**Support tissue perfusion**: * neurovascular assessment, distal pulses, pain, paresthesia, swelling, calf/thigh circumferences * initial bedrest with pain * avoid prolonged standing & sitting * avoid crossing the legs at knee or ankle * use compression devices if possible * **DO NOT MASSAGE LEGS!!!! ** * Watch labs, **use bleeding precautions** **Promote Comfort:** * pts have physical & psychosocial discomfort * use mild analgesics * elevate effected leg, warm soaks, * NSAIDs * encourage expression of fear & anxiety since risk of PE (potentially fatal) is very real

Answer 209

**Patient & Family Education:** * **Coumadin - action, dosage, side effects of meds; take at same time qd; no ASA monitor s/s bleeding** * keep follow-up appointments * life style modifications to decrease risk factors * diet, limit alcohol intake, Medic Alert tag

Answer 210

* DVT recurrence * Pulmonary Embolism

Answer 211

* Dyspnea * Chest pain * Apprehension * Cough * Hemoptysis * Sweating / diaphoresis * Syncope * Palpitations * Wheezing * Leg pain * Leg Swelling

Answer 212

* Usually have a brownish discoloration around the medial malleolus of the ankle * Skin is dry, cracked and itchy * Subcutaneous tissue is fibrotic and atrophied * **Complications: dermatitis and cellulitis**

Answer 213

* Elevate legs * Compression of superficial veins with elastic compression stockings * Walking encouraged * Avoid crossing legs when sitting * Avoid clothes that constrict * Keep skin clean and free of injury

Answer 214

* Disorders of formation or conduction (or both) of electrical impulses within heart * Can cause disturbances of: * **Rate (too fast, too slow)** * **Rhythm (regularity)** * Both * Potentially can alter blood flow, cause hemodynamic changes and instability * **Diagnosed by analysis of ECG**

Answer 215

* P wave - Atrial depolarization (atrial contraction) * QRS - Ventricular depolarization (ventricles are contrating) * T wave - Ventricular repolarization (ventricles relaxing)

Answer 216

Atrial depolarization + delay in AV junction (AV node/Bundle of His) (delay allows time for the atria to contract before the ventricles contract)

Answer 217

Sinoatrial node --\> AV node --\> Bundle of His --\> Bundle Branches --\> Purkinje fibers

Answer 218

* **SA Node -** Dominant pacemaker with an intrinsic rate of 60 - 100 beats/minute. * **AV Node -** Back-up pacemaker with an intrinsic rate of 40 - 60 beats/minute. * **Ventricular cells -** Back-up pacemaker with an intrinsic rate of 20 - 45 bpm.

Answer 219

* Represents depolarization of the atria * Present or Absent * _Shape_: gently rounded, does not exceed 2 to 3 mm in amplitude and is

Answer 220

* Measures the amount of time it takes for the impulse to travel from the SA node to the ventricles * Measured from beginning of the P wave to the beginning of the QRS complex * Normal range: 0.12-0.20 sec

Answer 221

* Represents depolarization of the ventricles * Often the most significant portion of the EKG * _Shape:_ 0.06-0.12 sec

Answer 222

* Represents the plateau (phase 2) of the action potential * Normally isoelectic because all cells are at zero potential and no current flows * **_Shape:_ baseline, elevation or depression by 1 mm above or below is abnormal** * **If above isoelectric line =**

Answer 223

* Represents the ventricles being rapidly repolarized * **_Shape:_ rounded, slightly asymmetric, same direction as QRS, height should not exceed 5 mm**

Answer 224

* Measures entire duration of ventricular depolarization and repolarization * Varies with age, gender and heart rate * Should be less than half the preceding R-R interval

Answer 225

* Represents a part of the latter phase of ventricular repolarization * Usually not seen * _Shape:_ \< 2 mm in height

Answer 226

1. What is the Rate (Too fast ,too slow) 2. Is the rhythm Regular ( How does it look) 3. Are the P waves present & in which direction (upright?) 4. Are the QRS complexes present ( wide or narrow) 5. P and QRS related 6. PR interval ( prolonged or short. Conduction problems)

Answer 227

* Sinus Rhythms * Premature beats * Ventricular Arrhythmias * AV Junctional Blocks

Answer 228

Count the PQRS complexes in a 6 sec strip and multiply by 10

Answer 229

* Sinus Rhythms are those that originate from the SA node. * P wave before every QRS * P wave in same direction as QRS * **Normal Sinus Rhythm** * **Sinus Bradycardia** * **Sinus Tachycardia**

Answer 230

SA node is depolarizing slower than normal, impulse is conducted normally (i.e. normal PR and QRS interval).

Answer 231

* SA node is depolarizing faster than normal, impulse is conducted normally. * Remember: sinus tachycardia is a response to physical or psychological stress, **IT IS NOT a primary arrhythmia.** * **100bpm+**

Answer 232

**Caused by:** Excitation of an atrial cell forms an impulse that is then conducted normally through the AV node and ventricles. **Characteristics:** * Deviation from NSR * These ectopic beats originate in the atria (but not in the SA node), therefore the contour of the P wave, the PR interval, and the timing are different than a normally generated pulse from the SA node. * When an impulse originates anywhere in the atria (SA node, atrial cells, AV node, Bundle of His) and then is conducted normally through the ventricles, the QRS will be narrow .

Answer 233

One or more ventricular cells are depolarizing and the impulses are abnormally conducting through the ventricles (wide QRS complex). ## Footnote **THEY ARE A RED FLAG, NO Cardiac Output!!**

Answer 234

* Ectopic beats originate in the ventricles resulting in wide and bizarre QRS complexes. * When there are more than 1 premature beats and look alike, they are called “uniform”. When they look different, they are called “multiform”. * They don't have a pulse, and don't increase cardiac output * You don't count them in your rate * **They can be inverted or can appear widened.**

Answer 235

* Atrial Fibrillation * Atrial Flutter * Paroxysmal Supraventricular Tachycardia

Answer 236

Recent theories suggest that it is due to multiple re-entrant wavelets conducted between the R & L atria. Either way, impulses are formed in a totally unpredictable fashion. The AV node allows some of the impulses to pass through at variable intervals (so rhythm is irregularly irregular).

Answer 237

* **No organized atrial depolarization**, so no normal P waves (impulses are not originating from the sinus node). * Atrial activity is chaotic (resulting in an irregularly irregular rate). * Decrease in CO

Answer 238

Reentrant pathway in the right atrium with every 2nd, 3rd or 4th impulse generating a QRS (others are blocked in the AV node as the node repolarizes).

Answer 239

* **No P waves.** Instead flutter waves (note “sawtooth” pattern) are formed at a rate of 250 - 350 bpm. * Only some impulses conduct through the AV node (usually every other impulse). * **In atrial flutter, the heart's atria beat very fast but at a regular rate. Atrial flutter is caused by irregular circuitry within the atria.** * **The fast rate results in weak contractions of the atria. The rapid signals entering the AV**

Answer 240

* **Regularity -** Atrial fib has no organization whereas flutter has a pattern * **Shape -** Atrial flutter doesn't have P waves

Answer 241

* Etiology: There are several types of PSVT **but all originate above the ventricles (therefore the QRS is narrow).** * Most common: abnormal conduction in the AV node (reentrant circuit looping in the AV node). * **Can be caused by PAC**

Answer 242

* **The heart rate suddenly speeds up, often triggered by a PAC (not seen here) and the P waves are lost.** * Super high BPM * **It is an emergency, intervene**

Answer 243

* Ventricular Tachycardia * Ventricular Fibrillation

Answer 244

* It is a rapid heart rate that originates with abnormal electrical signals in the ventricles. * The rapid heart rate doesn't allow the ventricles to fill and contract efficiently to pump enough blood to the body. * Ventricular tachycardia is often a life-threatening medical emergency.

Answer 245

* **There is a re-entrant pathway looping in a ventricle (most common cause).** * Ventricular tachycardia can sometimes generate enough cardiac output to produce a pulse; at other times no pulse can be felt.

Answer 246

* Impulse is originating in the ventricles (no P waves, wide QRS). * Lethal

Answer 247

* It is a rapid, chaotic electrical impulses cause your ventricles to quiver uselessly instead of pumping blood. * Without an effective heartbeat, your blood pressure plummets, instantly cutting off blood supply to your vital organs — including your brain. * Most people lose consciousness within seconds and require immediate medical assistance, including cardiopulmonary resuscitation (CPR).

Answer 248

* A problem in the electrical impulses traveling through your heart after a first heart attack, or problems resulting from a scar in your heart's muscle tissue from a previous heart attack. * Can be caused by a ventricular tachycardia (VT) *

Answer 249

* The ventricular cells are excitable and depolarizing randomly. * Rapid drop in cardiac output and death occurs if not quickly reversed * Completely abnormal.