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Med Surge and Maternity > Med Surge chapters 24, 25, and 26 > Flashcards

Med Surge chapters 24, 25, and 26 Flashcards

1
Q

Sinoatrial (SA) node

A

75 to 100 beats per minute

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2
Q

Atrioventricular (AV) node

A

40 to 60 beats per minute

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3
Q

Bundle of His

A

a continuation of the AV node

carries electrical signals from the AV node to the bundle branches.

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4
Q

Purkinje fibers

A

a diffuse network of conducting strands .
spread the wave of depolarization through the ventricles
purkinje fibers can act as the pacemaker with a rate between 20 and 40 beats/min (when SA and AV nodes fail)

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5
Q

Cardiac Cycle

A

One heartbeat

Electrical representation of contraction and relaxation of atria/ventricles

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6
Q

Electrocardiogram (ECG)

A

Shows cardiac electrical activity.

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7
Q

Isoelectric Line

A

Baseline
Seen with no electrical activity
Straight line produced

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8
Q

P wave

A

First wave

Represents atrial depolarization

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9
Q

P R interval

A

Beginning of P wave to beginning of Q R S complex

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10
Q

QRS complex

A

Follows P wave
Q wave first negative (downward) deflection
R wave first positive (upward) deflection
S wave second negative deflection

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11
Q

Q,R,S waves are not…

A

present every time.

this represents ventricular depolarization

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12
Q

T wave

A

Ventricular repolarization

Follows Q R S complex

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13
Q

Q to T interval

A

Beginning of Q wave to end of T wave
Varies based on gender, heart rate, age
Prolonged or shortened Q T interval can lead to ventricular arrhythmias

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14
Q

U wave

A

Rare
Indicates hypokalemia
After T wave

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15
Q

what is an Arrhythmia?

A

disturbance in the rhythm and conduction

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16
Q

Sinus Bradycardia

s/s and treatment

A

fatigue or fainting
None if asymptomatic
treatment:
Oxygen, atropine, dopamine or epinephrine, pacing

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17
Q

sinus tachycardia

s/s and treatment

A

Angina or dyspnea (Older adults are more sensitive)
Therapeutic interventions
Medications
Adenosine, beta blocker, calcium channel blocker

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18
Q

Atrial Arrhythmia

A

Premature atrial contractions (P A C’s)
Atrial flutter
Atrial fibrillation

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19
Q

Premature Atrial Contractions therapeutic interventions

A

Treat cause

Beta blocker

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20
Q

Atrial Flutter Signs and symptoms

A

if the ventricular rate normal
None
if a rapid ventricular rate is present then
Palpitations, angina, dyspnea

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21
Q

therapeutic interventions for atrial flutter

A 
Cardioversion for rapid ventricular rate
Rapid atrial pacing
Calcium channel blocker
Beta blocker
Catheter ablation
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22
Q

Atrial Fibrillation

Signs and symptoms

A

Palpitations

Faint radial pulse

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23
Q

Atrial Fibrillation therapeutic interventions

A 
Synchronized cardioversion if unstable
Medications
Beta blocker
Calcium channel blocker
Digoxin
Anticoagulation
Ablation (after anticoagulation)
Surgical maze procedure
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24
Q

causes of Third-Degree Atrioventricular Block

A

Coronary heart disease
Myocardial infarction
Digoxin
Aging

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25
Q

symptoms of Third-Degree Atrioventricular Block

A 
Dizziness
Syncope
Fatigue
Shortness of breath
Chest pain
Hypotension
Diminished or absent peripheral pulses
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26
Q

Third-Degree Atrioventricular Block Therapeutic interventions

A 
Medical emergency
Supportive care to treat symptoms
Atropine considered
Temporary pacemaker
Permanent pacemaker possibly for lifetime
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27
Q

Ventricular Arrhythmias

A

abnormal heart rhythms that make the lower chambers of your heart twitch instead of pump.
ex. Premature ventricular contractions (P V C’s), Ventricular tachycardia , and Ventricular fibrillation

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28
Q

Premature Ventricular Contractions

s/s

A

Palpitations

Fatigue, dizziness, severe arrhythmias

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29
Q

Premature Ventricular Contractions Therapeutic interventions

A

Antiarrhythmics
Amiodarone I V
Beta blocker
Lidocaine

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30
Q

Ventricular Tachycardia

s/s

A 
Dyspnea
Palpitations
Lightheadedness
Angina 
Cardiac arrest
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31
Q

Ventricular Tachycardia

Therapeutic interventions

A

If pulseless V T
C P R, defibrillation, epinephrine, amiodarone, lidocaine
If stable
Antiarrhythmics

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32
Q

Ventricular Fibrillation

Signs and symptoms

A 
Unconscious
No heart sounds, peripheral pulses, blood pressure
Respiratory arrest
Cyanosis
Pupil dilation
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33
Q

Ventricular Fibrillation

Therapeutic interventions

A 
Advanced cardiac life support (A C L S) protocols 
Immediate defibrillation 
C P R 
Epinephrine, amiodarone, or lidocaine
Endotracheal intubation and oxygen
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34
Q

asystole signs and symptoms

A 
Unconscious
No heart sounds, peripheral pulses, blood pressure
Respiratory arrest
Cyanosis
Pupil dilation
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35
Q

asystole therapeutic regimen

A 
CPR 
ACLS protocols 
Endotracheal intubation with oxygen
Epinephrine
Treat cause
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36
Q

Cardiac Pacemakers

A

Generate an electrical impulse
Traditional types
External and temporary
Internal and permanent

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37
Q

Cardiac Pacemaker Problems

A

Failure to sense
Failure to pace
Failure to capture

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38
Q

Nursing Care for Pacemakers

A

Monitor ECG.
Monitor apical pulse.
Monitor for symptoms.

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39
Q

Patient Pacemaker Education

A 
Incision care
Activity restrictions
Symptoms or infection signs to report
Pacemaker I D card
Periodic pacemaker checks
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40
Q

Defibrillation

A

Electrical shock to reset lethal ventricular arrhythmias

Must announce “clear” for safety

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41
Q

Synchronized Cardioversion

A

Used in arrhythmias if R wave present
Sedation used
Low energy: 25 to 50 joules

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42
Q

Automatic External Defibrillator

A

Automatically analyzes rhythms

Automatically delivers or prompts operator to deliver electrical shock if shockable rhythm (V-Fib or V T) detected

43
Q

Nursing Diagnoses for Arrhythmias

A

Decreased Cardiac Output

Anxiety

44
Q

On the ECG paper, one small square is equal to how many seconds of time?

  1. 0.02 seconds
  2. 0.04 seconds
  3. 0.20 seconds
  4. 0.40 seconds
A

Correct Answer: 2

45
Q

causes of Angina Pectoris

A

atherosclerosis, blood clots, and poor blood flow

46
Q

place the Cardiac conduction system in order

  1. atrioventricular node
  2. bundle of his
  3. internodal tracts
  4. purkinje fibers
  5. sinoatrial node
A
  1. sinoatrial node
  2. internodal tracts
  3. atrioventricular node
  4. bundle of his
  5. purkinje fibers
47
Q

sinus bradycardia

A

low heart rate may be normal for people who are athletes
treatment will be necessary if client is symptomatic
-hold a medication
-oxygen
-atropine sulfate
-pacemaker
Notify The RN

48
Q

atrial fibrillation

A

multiple rapid impulses from many foci depolarize in the atria at a rate of 350 to 600 times per minute. The atria quiver which can lead to thrombi.

no definitive wave can be observed-only fibrillatory waves before each QRS

49
Q

sinus tachycardia

A

atrial and ventricular rates are 100 to 180 beats/min

Notify the RN

50
Q

atrial fibrillation treatment

A 
oxygen
anticoagulants 
cardiac medications
possible cardioversion
Notify the RN
51
Q

premature ventricular contractions

A

early ventricular complexes result from increased irritability of the ventricles.
PVC’s frequently occur in repetitive patterns such as bigeminy, trigemini, and quadrigeminy.
Notify the RN

52
Q

bigeminy

A

irregular heartbeat that is characterized by an extra heartbeat that comes too early

53
Q

trigeminy

A

three-beat tightening

the extra contractions happen sooner then the next usual heartbeat

54
Q

quadrigeminy

A

every fourth beat is a premature ventricular contraction

55
Q

Ventricular tachycardia

A

this occurs because of a repetitive firing of an irritable ventricular ectopic focus at a rate of 140 to 250 beats/min or more and can lead to cardiac arrest.
Notify the RN

56
Q

VT(ventricular dysrhythmia) and a stable client

A

no signs or symptoms of decreased cardiac output and a pulse.
treatment will be oxygen and antidysrhythmics .

57
Q

females who smoke and take birth control are at a higher risk for a…?

A

MI

58
Q

VT(ventricular dysrhythmia) in a unstable client

A

pulse and signs and symptoms of decreased cardiac output
oxygen
antidysrhythmic
possible synchronized cardioversion

59
Q

Raynaud’s

A

the vasospasm of the arterioles and arteries of the upper and lower extremities. such as…
blanching of the extremity
reddened tissue
numbness, tingling, and numbness

60
Q

peripheral arterial disease (PAD)

A

a chronic disorder in which partial or total arterial occlusion deprives the lower extremities of oxygen and nutrients

61
Q

Buerger’s disease

A

occlusive disease of the median and small arteries and veins.
(the distal upper and lower limbs are affected most commonly )

62
Q

atherosclerosis in layman terms

A

formation of plaque in the arteries

63
Q

how do you use sublingual nitro

A

Place the tablet under the tongue or between the cheek and gum, and let it dissolve. Do not eat, drink, smoke, or use chewing tobacco while a tablet is dissolving.

64
Q

controlling blood cholesterol with diet

A

two thirds of the body’s cholesterol is produced by the liver and intestines. Most, but not all, people produce less cholesterol or increase it secretion in response to high levels of dietary cholesterol.

65
Q

aneurism therapeutic measures

A

smoking cessation
gentle exercise
blood pressure (to prevent arterial wall rupture)
beta clockers (to slow AAA enlargement)

66
Q

a pt has had a vascular surgery. When a neuro vascular check is done the extremity is cool to the touch and dusty in color. What should you do?

A

notify the physician

67
Q

if the legs are brown PVD put them up

A
68
Q

myocardial infarction older adults

A

if pain is not present sudden SOB, restlessness, or fainting

reperfusion therapies such as angioplasty and bypass surgery is proven to be beneficial for older adults

69
Q

normal troponin level

A

<0.04

70
Q

nursing process of pt experiencing a MI

A 
thorough hx is obtained 
continuous cardiac monitoring
serial ECG's 
laboratory values 
controlling the pain reduces anxiety (which reduces the physiologic effects pain has)
screen for depression afterward
71
Q

patient education sexual activity during recovery to cardiac disorders

A

sexual counseling should be offered.
if the pt has angina NTG can be taken prophylactically before sexual activity. After a MI a pt can resume sex 1-2 months or when they can climb two flights of stairs with no symptoms( and approved by HCP).
referral to a sexuality counselor

72
Q

dissecting aneurism

A

created when blood separates the layers of the artery wall forming a cavity between them

73
Q

sudden back or flank pain are classic symptoms of a…?

A

abdominal aortic aneurism

needs to be reported immediately because it can rupture

74
Q

venous insufficiency and pathophysiology

A

damaged or aging valves within the veins interfere with blood return to the heart, causing pooling of blood in the lower extremities.
(chronic venous insufficiency can lead to venous stasis ulcers)

75
Q

main treatment of buergers disease

A

no smoking

76
Q

electrical impulse that originates from the SA node

A

the p wave

77
Q

pt has a pacemaker placed what should you do?

A

take radial pulse for 1 minute

78
Q

caffeine

A

D-fib

79
Q

common cause of a PVC is

A

caffeine

80
Q

smoking and digoxin puts a pt at risk for

A

PAC’s

premature atrial contractions

81
Q

what is the pattern of A flutter

A

saw tooth

82
Q

ST depression indicates cardiac ischemia

A

need to alert HCP

83
Q

calcium,
sodium,
potassium,
magnesium

A

potassium is 3.5 to 5

84
Q

increase in potassium can cause

A

ventricular fibrillation

85
Q

normal sinus rhythm

A

PQRST intervals

60 to 100 bpm

86
Q

acute heart failure s/s

A

anxiety/restlessness, clammy, cold skin, coughing, crackles, and wheezes

87
Q

left sided heart failure

A

aortic stenosis- increased volume to pump from restricted blood outflow
cardiomyopathy- increased workload from impaired contractility
hypertension- resistance increased from elevated pressure

88
Q

chronic heart failure summary

A

s/s- ascites, dependent peripheral edema, and fatigue
tests- arterial blood gas (ABG’s)
complications- cardiogenic shock

89
Q

symptoms of digoxin toxicity

A

abdominal pain, anorexia, nausea, vomiting, visual changes, and bradycardia

90
Q

digoxin

A

same time every day
take pulse before taking medication
if below 60 bpm hold and contact HCP

91
Q

bedside commode ensures

A

patient safety puts less strain on the heart and it maintains bedrest order

92
Q

bnp high level indicates

A

heart failure

93
Q

pink frothy sputum is an indicator of

A

pulmonary edema

Contact Healthcare Provider

94
Q

what should you instruct a patient taking captopril?

A

monitor BUN

Electrolytes

95
Q

medications used for HF

A

ACE inhibitors- first-line therapy to decrease afterload to prevent hypertension.
angiotensin 2- block angiotensin 2 receptor to reduce extracellular fluid and cause vasodilation.
angiotensin receptor nephrilysin inhibitors- reduce blood volume

96
Q

data collection with CHF

A 
respiratory- lung disease
cardiovascular-cardiac disease hx
fluid retention-daily sodium intake
GI- appetite present? nausea?
Urinary- decrease in daytime urine output?
97
Q

nursing care plans for post op cardiac transplant surgery

A 
turn every 2 hours
monitor electrolytes
monitor arterial blood gases(ABG's)
monitor i&o's
listen to lung sounds- note any characteristics of sputum
98
Q

foods high in potassium

A

banana’s, potatoes, citrus fruit, cooked spinach

99
Q

criteria for a heart donor

A 
no hypertension
diabetes 
absent of malignant diseases
no active infections 
no significant cardiac disease
100
Q

Raynaud’s and buergers nursing interventions

A

monitor pulses
administer vasodilators
reinforce instructions to the client to wear warm in cold weather
advise the client to avoid injuries to fingers and hands

101
Q

dissecting aortic aneurysm

A

created when blood separates the layers of the artery wall forming a cavity between them.

102
Q

right-sided heart failure

A

atrial septal defect- left atrial blood flow into right atrium increases right ventricular volume to pump.
pulmonary hypertension- resistance increased from elevated pressure
pulmonary valve stenosis- increased volume to pump from restricted right ventricular blood outflow

103
Q

Buerger’s data collection

A

intermittent claudication
ischemic pain occurring in the digits while at rest
aching pain that is more severe at night

Med Surge and Maternity (14 decks)

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