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Adult Critical Care > Test 1 > Flashcards

Test 1 Flashcards

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1
Q

What is the difference between ECG and Continuous cardiac monitoring

A

Provides information about cardiac status

  • as it is happening
  • it does not diagnose pump problems(CHF, heart failure, cor pul)
  • Records electrical activity in the heart
  • records dysrhythmias
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2
Q

Dysrhythmias are caused by

A

Hypoxia, Ishemia, Sypathetic stimulation, drugs, Electrolyte imbalance, rate, stretch

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3
Q

1 reason adult cardiac arrest

A

Underlying heart problem

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4
Q

1 reason kids cardiac arrest

A

Resp failure/ Sepsis

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5
Q

Heart blood path

A

Superior Vena Cava, Inlet of the superior vena cava, right atrium, inlet of the inferior vena cava, Coronary sinus, Inferior vena cava, Coronary sinus, Inferior vena cava, Tricuspid valve, Right Ventricle, Interatrial septum, Interventricular Septum, Left atrium, Mitral valve, Left ventricle

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6
Q

During a fib. blood starts

A

elsewhere other than SA node

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7
Q

Heart conduction

A
  1. SA Node
  2. AV node
  3. Bundle of His
  4. Bundle branches
  5. Purkinje fibers
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8
Q

SA Node-

A

Automaticity

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9
Q

AV Node-

A
  • Conduction is delayed at the AV node to allow the ventricles to fill with blood
  • Also limits the rate of ventricular stimulation during excessive atrial firings
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10
Q

Purkinje fibers-

A

Finger like branches that penetrate the cardiac muscle

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11
Q

Properties of cardiac muscle

A
  1. Contractile muscle fibers

2. Auto-rhythmic cells

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12
Q

Contractile muscle fibers

A

Responsible for pumping activity of the heart, Make up bulk of musculature of myocardium

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13
Q

Auto-rhythmic cells

A

Make up 1% of cardiac cells, most found in SA node, cause myocardial fibers to contract, stimulate and create action potential

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14
Q

Four properties of cardiac muscle

A
  1. Automaticity
  2. Excitability
  3. Conductivity
  4. Contractility
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15
Q

Excitability

A

Response to stimulation or irritation, Ischemia and hypoxia cause myocardial cells to become more excitable (irritated)

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16
Q

Conductivity

A

Unique ability of the heart cells to transmit electrical current from cell to cell throughout the entire conductive system

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17
Q

Contractility

A

Is the ability of cardiac muscle fibers to shorten and contract in response to an electrical stimulus

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18
Q

Electrolytes responsible for electricity

A
  1. Potassium (K+)
  2. Sodium (Na+)
  3. Calcium (Ca2+)
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19
Q

Nervous System Role

A

plays important role in the rate of impulse formation, conduction, and contraction strength

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20
Q

Sympathetic stimulation role

A
  • Cause increase in HR
  • Increase in AV conduction
  • Increase in heart contractility
  • increase in excitability
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21
Q

Parasympathetic role

A
  • Decrease in HR
  • Decrease in AV conduction
  • Decrease in contractility
  • Decrease in excitability
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22
Q

Continuous Cardiac Monitor 5 leads

A

White in the clouds over grass (green), with crap in the middle, then smoke (black) over fire (red)

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23
Q

Ectopic beat

A

any heart beat originating outside the SA node

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24
Q

Foci/Focus

A

Where the ectopic beat originates

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25
Dysrhythmias
abnormal cardiac conduction, also termed arrhythmia
26
Escape beat
a heart beat that originates outside the sinus node after a period of SA node inactivity
27
Myocardial ischemia
partial or complete obstruction of blood flow, reducing oxygen supply to the heart
28
angina
chest pain associated with reduced coronary blood flow
29
Stable Angina
Persistent reoccurring chest pain that usually occurs with exertion
30
Unstable Angina
Unexpected chest pain, usually occurring during rest. Chest pain is usually more intense and lasts for a longer period of time
31
Myocardial infarction
death of muscle tissue
32
Atrial kick
Responsible for cardiac output (10-30% ventricular filling)
33
Heart block
Conduction stopped or insignificantly delayed
34
Automaticity
ability of heart to beat on own
35
PVCs
Premature ventricular contractions
36
Syncope
Fainting (lack of blood flow)
37
STEMI
ST elevated myocardial infarction (BAD)
38
Normal rates: SA Node, AV junction, Bundle Branches, Purkinje Network
SA- 50-100 AV- 40-60 Bundle-30-40 Purkinji- 30-40
39
Steps to reading ECG
1. HR 2. Heart rhythm (reg/ irreg) R-R interval 3. Presence of P wave 4. Is there a QRS following each P wave 5. PR interal (is it less than 0.20) 6. QRS complex (Is it less than 0.12 seconds) 7. ST segment (baseline)
40
PVC
Wide ectopic beat from ventricles
41
ECG systems use the same standard paper and run at the same speed of
25mm/sec
42
Each small ECG square=
0.04
43
Each large ECG square=
0.20, containing 5 small squares
44
1 second on a ECG strip=
5 large squares
45
Ventricle rhythm, comparing the R-R ratio with the longest/ shortest... how many seconds to make irregular
>0.12
46
P Wave
Represent atrial conduction originated in the SA node, Paces the heart. - Less than 2.5 mm in height - more than 0.10 seconds in length
47
PR Interval
Normal 0.12-0.20 seconds | -Longer= delay in conduction through the AV node (AV block)
48
Complete heart block=
third degree heart block
49
QRS Complex
-Normal is less than 0.12 seconds long, | Represents ventricular depolarization
50
Rules of QRS
- If the first deflection is downward than it is a Q wave - The initial upward deflection is an R wave - The first neg. deflection following R is an S wave - QS is a negative deflection with no positive deflection at all - regardless of missing waves it is still called QRS complex and represents ventricular depolarization
51
T wave
reflects ventricular repolarization, inverted T waves suggest ischemia
52
ST segment
Normally baseline, A depressed ST segment suggests myocardial ischemia -an elevated segment suggests myocardial infarction
53
Sinus Dysrhythmias
Sinus bradycardia- Regular rhythm, HR < 60bpm, | Sinus tachycardia- Regular rhythm, HR 100-160bpm
54
Supraventricular Tachycardia
Ventricular rate: 150-250bpm - Regular rhythm - P waves may be hard to see - Narrow QRS - Connect SVT to adenosine as first line drug - Cardioversion
55
Cardioversion
machine cardioverts on R wave (synchronize) | Resents heart
56
Defibrillation
shock whenever
57
Atrial flutter
-flutter or saw tooth wave is produced by same ectopic beat (outside SA node) -Flutter wave replaces P (sinus)wave -Atria Rate 250-350bpm Commonly seen in pts with atrial fibrillation
58
Complications of atrial flutter
-Diminishes atrial filling: results in minimal atrial assistance in filling the ventricles (10-30% CO) -Development of thrombi in atrial walls: need for blood thinners (blood in atrial for too long)
59
Atrial Fibrillation
- The AV node is bombarded with hundreds of ectopic atrial beats at various rates and amplitudes - atrial rate: >400 (chaotic and irregular) - RHYTHM is regular
60
Treatment options for A. Fib.
Reduce the heart rate with cardioversion, Medication to maintain normal rhythm:amiodarone, medication to control ventricular rate: calcium channel blockers, beta blockers, Medication to reduce atrial thrombus: coumadin, Pradaxa, Xarelto, Eliquis, Cardiac ablaton: burn places in heart
61
A. Fib Symptoms
``` Racing heartbeat, irregular Heart palpitations Dizziness Sweating Chest pain or pressure SOB Confusion Fatigue Reduced ability to exercise A. Fib may be occasional, persistent, or permantent FROM POOR CARDIAC OUTPUT ```
62
Associated causes of A flutter and A fib
COPD, CHF, Valvular heart disease, Chronic hypertension, Ischemic heart disease, MI
63
First Degree AV block
Normal rate, regular rhythm, one p wave before each QRS, - PR prolonged and constant (longer than 0.20) - usually no tx needed
64
Second Degree AV block- Wenkebach type 1
- Progressive prolongation of the PR interval until a Pwave is not conducted - Patterns repeats itself - it occurs when an abnormality in the AV junction delays or blocks conduction of some of the impulses through the AV node
65
Second Degree AV block- Mobitz type II
PR intervals: for conducted p waves, P-R intervals is consistent (normal or can have a 1st degree block), muliple p waves not followed by QRS wave
66
Mobitz type II result from
serious problem such as MI or ischemia, requires tx to improve cardiac output, pacemaker is indicated
67
3rd degree (complete) AV block
Normal everything, but no measurable PR intervals, heart must pace to maintain acceptable cardiac output
68
List one major complication/ risk of having Atrial fib.
Thrombi= must be on blood thinners, and emboli= stroke
69
Symptomatic Bradycardia
(Need IV access) - HR is slow - Pt has symptoms - Symptoms due to slow HR
70
Bradycardia symptoms
Chest discomfort or pain, SOB, decrease LOC, Weakness, fatigue, light headed, dizziness, and presyncope or syncope similar to tachycardia

Adult Critical Care (5 decks)

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