Pacemakers

Question 1

conduction problems are blocks, like

Answer 1

1st or 2nd degree

Question 2

premature atrial complexes can be what part of the heart?

Answer 2

atria or ventricles. it just means that they come early.

Question 3

premature atrial complexes in atria are usually caused by (Art also gets irritated)

Answer 3

irritation

Question 4

premature atrial complexes - how is the rate and rhythm?

Answer 4

rate usually normal. rhtym usually normal just comes early.

Question 5

premature atrial complexes (PAC) - P waves

Answer 5

comes early, PR interval normal usually. QRS normal.

Question 6

if irregular rhtym, always

Answer 6

take apical for a full minute

Question 7

In most cases PACs are not a sign of

Answer 7

heart disease. Common in Cardio myopathy (a disease of the heart muscle that makes it harder for the heart to pump blood to the rest of the body)

Question 8

treatment for PAC - lifestyle modifications

Answer 8

No smoking, loose weight if overweight, heart healthy diet, exercise regularly, limit alcoholic drinks to a maximum of 1 drink/day for women and 2 drinks/day for men (varies with individual)

Question 9

PAC nursing implications - If patient is symptomatic, what is the treatment?

Answer 9

If patient is symptomatic (presyncope, syncope, angina, dyspnea) expect treatment with calcium channel blockers or beta blockers .

Question 10

if aFib lasts more than a couple of days, we have to put them on (not blockers)

Answer 10

anticoagulants for 2 weeks before we can cardiovert

Question 11

aFib atrial rate

Answer 11

400 - 600 bmp. ventricular is just irregular, depending on how well the AV node is blocking the extra beats.

Question 12

big caution with aFib

Answer 12

development of clots

Question 13

aFib treatment - calcium channel blockers

Answer 13

help slow the heart rate by blocking the number of electrical impulses that pass through the AV node into the ventricles

Question 14

aFib treatment - digoxin

Answer 14

Digoxin to help slow the heart rate by blocking the number of electrical impulses that pass through the AV node into the ventricles

Question 15

mitral and tricuspid diseases - what heart rhthym?

Answer 15

atrial flutter

Question 16

Ventricular Tachycardia

Answer 16

when 3 or more PVCs (premature ventricular contractions) occur in succession at a rate greater than 100 bpm

Question 17

coronary artery disease - what heart rhtyhm will you see? (CAD is tachy)

Answer 17

coronary artery disease is MOST common with ventricular tachycardia

Question 18

vfib - less than 3 mm is what type?

Answer 18

fine, the other is coarse

Question 19

vtach turns into vfib in about (not 5)

Answer 19

3 min

Question 20

vfib treatment

Answer 20

CPR, precordial thump, defibrillation, medications. Dfib - the faster the better

Question 21

pulseless electrical activity - PATCH FOR MD

Answer 21

P = Pulmonary embolus.
A = Acidosis
T = Tension pneumothorax. C = Cardiac tamponade
H = hypovolemia***(most common cause of pulseless), hypoxia, hypo or hyper thermia, hypo/hyperkalemia
M = MI
D = drug overdose (digoxin, calcium channel blockers)

Question 22

2nd degree heart block - 2 types

Answer 22

mobitz type 1, mobitz type 2

Question 23

2nd degree heart blocks - what happens?

Answer 23

some, but not all atrial impulses are blocked from the ventricles

Question 24

mobitz type 1

Answer 24

delay at AV node, longer and longer PR interval. eventually you have no QRS

Question 25

mobitz type 2 (no QRS w/ 2)

Answer 25

conduction delay at the AV node, PR interval long overall, constant for all beats. SUDDEN QRS drop d

Question 26

mobitz type 1 and 2 treatment and 3rd degree heart block (Mozart is serious)

Answer 26

pacemaker bc it can eventually turn into complete heart block

Question 27

3rd degree heart block

Answer 27

ALWAYS need a pacemaker. we don't know if we're going to have a cardiac output or not. P waves normal, QRS sometimes wide. other times, QRS not there at all. don't stree their heart.

Question 28

anyone with a HR under 40 gets

Answer 28

a pacemaker

Question 29

Hypokalemia (U lay down with T)

Answer 29

Flattened T waves, prominent U wave

Question 30

hyperkalemia

Answer 30

Tall, pointy T waves

Question 31

severe hyperkalemia (big kalema severely loves QVC)

Answer 31

Widened QRS complexes

Question 32

pacemakers can be placed in

Answer 32

atria and ventricle, or one or the other

Question 33

demand pacemakers

Answer 33

only work if you need them to

Question 34

failure to pace (spike my pace)

Answer 34

spike on pacemaker right before QRS, a line.

Question 35

pacemaker problems (failure)

Answer 35

Failure to Pace, failure to sense, failure to capture

Question 36

failure to capture (can't capture P, or QRS)

Answer 36

Pacer spike is noted on ECG but not followed by P waves or QRS complexes

Question 37

failure to sense

Answer 37

Is when the pacemaker doesn’t sense patient’s rhythm and starts an electrical impulse

Question 38

when to worry with pacemaker***

Answer 38

ALWAYS WORRY IF THE RATE DROPS BELOW THE SET RATE

Question 39

pacemaker post-operative care - and what to do with arm?

Answer 39

Postoperative care Monitor incision Most common complication is electrode displacement Immobilize arm to allow wires to imbed ROM to prevent frozen shoulder

Question 40

pacemaker pt teaching

Answer 40

Check pulse daily ID card Avoid microwaves (most are ok now)/MRI’s Avoid contact sports

Question 41

signs pacemaker is not working

Answer 41

Presyncope/syncope Weakness Arrhythmia, palpitations, tachycardia/bradycardia Dyspnea Constant twitching of muscles in chest or abdomen Frequent hiccups Angina, chest pain Confusion, extreme drowsiness

Question 42

common problems with pacemakers

Answer 42

Battery depletion Loose or broken wire between heart and pacer Lead dislodgment or gets pulled out Electronic circuit failure Electrolyte imbalance Electromagnetic interference (generators, medical equipment) Cyber attack Change in condition that requires pacemaker reprogramming

Question 43

ICD is for ppl with (Tachy needs the ICD)

Answer 43

vtach, vfib

Question 44

ICD can detect

Answer 44

life threatening arrhythmias and then cardioverts, defibrillates and/or paces and records ECG

Question 45

The newer subcutaneous ICD delivers the energy at the

Answer 45

left sternum from sites near the left axilla

Question 46

nursing intervention for ICD

Answer 46

ECG assessment CXR Nursing assessment CO and hemodynamic stability Incision site Signs of ineffective coping Level of knowledge and education needs of family and patient

Question 47

ICD discharge teaching

Answer 47

Postoperative complications Follow up appointments Battery life

Question 48

ICD - Electrical interference issues - cell phones?

Answer 48

Cell/mobile devices (keep at least 6 inches/15 cm away from implantation site Security systems and held metal detectors (airports) Medical equipment (MRI, MRA not recommended

Question 49

Cardiogenic shock - loss of how much volume?

Answer 49

Due to primary cardiac disorder Caused by inability of heart to contract effectively Generally occurs with loss of 40% or greater of left ventricular volume Stroke volume and cardiac output are reduced.

Question 50

Heart attack as a cause of

Answer 50

cardiogenic shock: Damaged heart muscle results in reduced force of contractions, reduced stroke volume, and reduced cardiac output.

Question 51

signs of heart attack - BP?

Answer 51

decreased BP, narrow pulse pressure

Question 52

ICD - lifting and exercising?

Answer 52

No lifting more than 5 pounds No contact sports, strenuous exercise or swimming, bicycling, bowling, vacuuming (above shoulder activities)

Question 53

ICD - driving?

Answer 53

No driving for at least one month and up to 6 months if implanted for previous VT, VF

Question 54

ICD - how far to keep away from Power generators?

Answer 54

Power generators (keep at least 2 feet/0.6 meters away)

Question 55

ICD - how far to keep headphone devices?

Answer 55

MP3 player headphones devices (keep at least 6 inches/15 cm away from implantation site)

Question 56

signs of a heart attack - HR?

Answer 56

tachy or bradycardia

Question 57

heart attack - breathing?

Answer 57

tachypnea

Question 58

heart attack - skin?

Answer 58

pale, cool, clammy skin, mottled, anxiety, cynatoic

Question 59

heart attack - pulse?

Answer 59

jugular vein distention, weak or absent peripheral pulse

Question 60

heart attack - urine?

Answer 60

decreased urine output