T2: Imaging & Devices Flashcards by Kalyn21Blessing .

Routinely obtained to determine the size, silhouette, and position of the heart

Chest X-Ray

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Chest X-rays:
In acutely ill patients, a simple _______ can be obtained at the bedside

anteroposterior (AP)

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What can be seen on a chest X-Ray (4)

-Cardiac enlargement
-Pulmonary congestion
-Cardiac Calcification
-Placement of central venous catheters (CVC), endotracheal tubes, and hemodynamic monitoring devices

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most definitive but most invasive test in the diagnosis of heart disease

Cardiac catheterization

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Uncommon, but serious complications that may follow coronary arteriography: (7)

Myocardial infarction (MI)
Stroke
Arterial bleeding
Thromboembolism
Lethal dysrhythmias
Arterial dissection
Death

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Indications for cardiac catheterization

-confirm suspected heart disorders
-determine the location and extend the disease process
-assess stage/severity of condition
-determine best therapeutic option
-evaluate effects of medical or invasive treatment

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Nursing actions pre-cardiac catheterization (7)

-Teach pt about procedure
-Obtain consent
-Pre-procedure exams
-Solids and non-clear liquids held 6 hours before procedure
-Clear liquids held 2 hours before procedure
-Prepare surgical site with antiseptic
-Obtain vitals

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Cardiac catheterization:
right side Cath through ___(1_____
left side Cath through ___(3)____

right side: femoral artery
left side: femoral, brachial, or radial artery

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Pre-Heart Cath tests (4)

-Chest X-Ray
-CBC
-Coagulation studies
-12 lead ECG

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Nursing Actions: Post Heart Cath

-HOB at 30 degrees
-Bedrest 2-6 hours with surgical limb remaining straight
-Monitor vital signs
-Assess site for blood drainage or hematoma

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Routine part of every cardiovascular evaluation and is one of the most valuable diagnostic tests

Electrocardiography

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Various forms of ECG: (5)

-Resting
-Continuous ambulatory (holter)
-Exercise (stress test)
-Signal-averaged
-30-day event monitoring

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Resting ECG provides information about: (6)

-Cardiac dysrhythmias
-Myocardial ischemia
-Site and extend of MI
-Cardiac hypertrophy
-Electrolyte imbalances
-Effectiveness of cardiac drugs

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assesses cardiovascular response to an increased workload

Stress test

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Nurse actions: stress test (8)

-inform pt
-attach 12 leads
-light meal 2 hours before
-comfortable outfit
-monitor vitals and note baseline BP
-check med history
-prep for resuscitation
-set treadmill to 1-10 mph w/ gradual incline

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On cardiac stress test, patient continues to exercise until one of the following occurs: (4)

-Predetermined HR is reached and maintained
-Signs and symptoms appear
-Significant ST-segment depression or T-wave inversion occurs
-20 minute protocol is completed

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Nursing actions: post stress test

-monitor VS
-No hot showers for 1-2 hours after
-telemetry observation

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noninvasive, risk free test that uses ultrasound waves to assess cardiac structure and mobility, particularly of the valves

echocardiography

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Echocardiography is used to help assess and diagnosis: (6)

-Cardiomyopathy
-valvular disorders
-pericardial effusion
-left ventricular function
-ventricular aneurysms
-cardiac tumors

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nursing action: echocardiography

-no special prep
-pt lies down on left side with HOB elevated 15-20 degrees
-takes 30-60 minutes to complete

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test used when patients cannot tolerate exercise; slightly more aggressive form due to the use of pharmacological induction of stress

pharmacologic stress echocardiogram

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Pharmacologic stress echocardiograms use what medications that do what (2)

-Dobutamine increases the heart’s contractibility
-Dipyridamole is a coronary artery dilator

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Nursing actions: pharmacologic stress echocardiogram

-NPO 3-6 hours before
-IV access is present before procedure
-Monitor BP and pulse continuously throughout procedure

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Nursing actions: post pharmacologic stress ECG

vital signs monitored until BP returns to baseline and pulse rate slows to less than 100 bpm

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examining cardiac structure and function with an ultrasound transducer placed immediately behind the heart in the esophagus or stomach

Transesophageal ECG

Transducer used in trasnesophagela ECG provides detailed views of ______ cardiac structures such as:

-posterior -left atrium, mitral valve, and aortic arch

generates & transmits electrical impulses which stimulates contractions of the atria and then the ventricels

cardiac conduction system

Steps in the heart's conduction system: (Send a big bounding pulse)

-SA node -AV node -Bundle of HIs -Bundle branches -Purkinje Fibers

Primary pacemaker of the heart; creates electrical impulses of 60-100 bpm

SinoAtrial (SA) node

Secondary pacemaker of the heart "backup pacemaker"; SA node malfunctions, the AV node takes over at a rate of 40-60 bpm

AtrioVentricular (AV) node

If the SA and AV nodes fail, the Purkinje fibers can fire at a rate of ________-

30-40 bpm

ECG: atrial contraction (depolarization)

P wave

movement of electrical activity from atria to ventricles

PR segment

Ventricle contraction (depolarization)

QRS complex

Time between ventricular depolarization & repolarization

ST segment

Ventricle relaxing (depolarization)

T wave

Ventricles relaxing and filling

TP interbal

ECG: 60-100 bpm

normal sinus

ECG: >100 bpm

sinus tachycardia

ECG: < 60 bpm

Sinus Bradycardia

Electronic apparatus used to initiate heartbeat when the SA node is seriously damaged and unable to act correctly

pacemaker

Types of pacemakers (4)

-Internal/implantable -External -Temporary -Permanent

Major methods of cardiac pacing (2)

Rate responsiveness pacemaker Demand pacemaker

pacemaker allows faster pacing rates to meet increased bodily demand

rate responsiveness pacemaker

electrode wire inserted percutaneously and threaded though to the ventricle; battery pack is implanted under skin

Demand pacemaker

Technical problems associated with cardiac pacing (5)

-Dislodgment and migration of endocardial leads -Wire breakage -Cracking of insulation surrounding wires -Infection of sites surrounding either pacing wires or pulse generator -Battery exhaustion

Pacemaker batteries can last ______. A computer monitors ____________ of the pacemaker. It could be a ___, _____, or ____chamber pacemaker

-5-10 years -electrical activity and tailor function -single, double, or triple chamber

Pacemaker functions when heart rate goes below set rate

Demand pacemaker

Pacemaker that stimulates ventricles at preset constant rate

fixed rate pacemaker

pacemaker used in emergency situations

Temporary pacemaker

Pacemaker is placed within right ventricle or right atrium and ventricle, and generator is implanted under skin below clavicle or in abdominal wall

permanent pacemaker

synchronized countercheck that may be performed to restore normal conduction in a hospitalized patient with -onset AF; can also be ordered for stable AF that is resistant to medical therapy

Cardioversion

Synchronized cardioversion is used to treat both:

-hemodynamically unstable ventricular -supraventricular rhythms

nursing care before cardioversion includes: (8)

-informed consent -Diazepam or Midazolam IV -Voltage 25-360 watts/s -digoxin withhold 48 hours prior to procedure -synchronizer turned on, check at the R wave -Oxygen discontinued -Assess airway latency -assess vital signs every 15 mins for first hour, then every 30 mins for 2 hours

Nursing care after cardioversion includes: (8)

-maintaining a patent airway -administer oxygen -assessing vital sings and the level of consciousness -administering antidysrhythmic drug therapy -monitoring for dysrhythmias -assessing for chest burns from electrodes -Providing emotional support -documenting the results of cardioversion

used in the treatment of v-fib; device sends an electrical pulse to the heart to restore a normal heartbeat (preventing/correcting uneven heartbeats

defibrillation

Defibrillation completely __________ the myocardial cells so SA node can be pacemaker

depolarizes

indicated for patients who have experienced one or more episodes of spontaneous sustained ventricular tachycardia (VT), or ventricular fibrillation (VF) not caused by a myocardial infarction (MI)

Implantable cardioverter defibrillator

continuously monitor the heart and apply a defibrillator shock to bring the pt back to NSR if it identifies that the pt has a shockable dysrhythmia

Implantable cardioverter defibrillator

ICDs are indicated for patients who have experienced one or more episodes of ____ or _____ not caused by myocardial infarction (MI)

-ventricular tachycardia -ventricular fibrillation