Pacemaker

Question 1

Provide extrinsic electrical stimuli to–> contraction (depolarization)

Answer 1

Pacemaker

Question 2

Pacemaker that senses low HR & fires w/in predetermined pd

Answer 2

Demand (Synchronous) Pacer

Require 3 wire system

Question 3

2 Types of Demand Pacers

Answer 3

Single-chamber (most pop)

Dual-chamber

Question 4

Pacer in atrium or ventricle/ sense and pace

Answer 4

Demand Single Chamber

Question 5

Sense and pace atrium & ventricle

Answer 5

Demand Dual Chamber

Question 6

Before applying temporary pacers

Answer 6

sedate the pt, wash and trim (never use a razor)

Question 7

Pads of temporary pacers are placed

Answer 7

anterior-posteror or anterior-apex

Question 8

Sedation for permanent pacemaker placement

Answer 8

IV conscious sedation under local anesthesia

Question 9

3 functions of permanent pacemakers

Answer 9

1. sensing (pulse generator sees intrinsic beats)
2. Firing (pg delivers stimulis)
3. Capturing (heart responds)

Question 10

VVI

Answer 10

commonly used
Ventricle paced, sensed, inhibit
Pace maker fires if it doesn’t sense heart beat

Question 11

DDD

Answer 11

commonly used for heart block/ sick sinus syndrome

Triggered by sensing AV (PR) interval expiring

Question 12

DDD does not work for

Answer 12

A-fib

P waves unable to be paced

Question 13

ECG spike occurs on time, but not followed by a QRS

Answer 13

Failure to capture

Question 14

ECG shows spikes occurring after QRS but earlier than it should

Answer 14

Failure to sense

Turn off Temp Pacers

Question 15

under-sensing (generator does not sense intrinsic beats aka

Answer 15

Failure to sense
May/ may not capture
Hits on T wave–> R on T –>V Tach

Question 16

Causes of Failure to Sense

Answer 16

Problems with interface
Sensitivity Set too High
Pacer at fixed rate/ asynchronous

Question 17

Periods of brady w/ NO SPIKES on ECG

Answer 17

Failure to pace

Question 18

Keep Cell phones/ MP3 headphones, iPods, Ipads…etc

Answer 18

6 ft away

Question 19

Most common cause of pulmonary edema

Answer 19

Left side HF

Question 20

Abnormal accumulation of fluid in alveoli & interstitial spaces

Answer 20

Acute Pulmonary Edema

Question 21

Crackles, wheezing, dullness to percussion…

Answer 21

pleural effusions

Question 22

1st Line drug
decreases afterload & PAP
Increase CO
Limits Myocardial remodeling

Answer 22

ACE inhibitors

Question 23

SE ACE Inhibs

Answer 23

Low BP, Renal insufficiency, cough

Question 24

VAD can be used up to

Answer 24

2 years

Question 25

Diet for Acute HF

Answer 25

DASH | 2g Na+, avoid dairy and canned foods

Question 26

Teach Acute HF/PE

Answer 26

2g+ Na+, No dairy/ canned food Fluid restrictions <2000ml/d No more than 2lbs/d Rest

Question 27

20% of anterior MI's develop

Answer 27

Cardiogenic shock (LAD)

Question 28

Preferred drug tx of Cardio Shock w/ NO hypotension

Answer 28

Dobutamine

Question 29

Counterpulsation

Answer 29

inflation/deflation cycle of IABP

Question 30

Most common artery used for CABG

Answer 30

Internal Mammary Artery

Question 31

Most common vein used for CABG

Answer 31

Saphenous

Question 32

Pre-op stop smoking

Answer 32

1 wk to 1 mo prior

Question 33

Immediately prior to CABG

Answer 33

EKG, Type n X, CXR, Coag studies, CBC, UA, Lytes, BUN, Creat, Liver panel, Pulmonary Funx, ABG's

Question 34

Normal PaCO2

Answer 34

35-45 mmHG

Question 35

Normal HCO3

Answer 35

22-26 mEq/L

Question 36

PaO2

Answer 36

80-100mmHG

Question 37

SaO2

Answer 37

>/= 96%

Question 38

Increased PaCO2 > 45mmHg

Answer 38

(hypercapnea)

Question 39

No sign of compensation Bicarbonate WNL PaCO2 level increased pH decreased < 7.35

Answer 39

Acute respiratory acidosis

Question 40

pH decreased PaCO2 elevated HCO3 elevated

Answer 40

Partially compensated respiratory acidosis

Question 41

pH – low, normal level PaCO2 - elevated HCO3 – (Bicarbonate) - elevated to compensate

Answer 41

Fully compensated respiratory acidosis

Question 42

Post PTCA

Answer 42

``` Bedrest 3-4h HOB flat for 30 min, then 30 degrees Leg straight (restraint/sandbag) Log Roll EKG post-procedure ```

Question 43

D/C Teaching PTCA

Answer 43

``` No heavy lifting 1-2wks Norm activity in 1-2wks MD approval for work Medications Deit ```

Question 44

Primary indicator for a VAD

Answer 44

Failure to wean patients of the heart lung machine

Question 45

Contraindications for VAD

Answer 45

Aortic valve insufficiency Major CVA/prolonged cardiac arrest with brain damage Sepsis/make limiting comorbidities Body surface area