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NRSG 421 > Week 6 - CVS and Rhythm interpretation > Flashcards

Week 6 - CVS and Rhythm interpretation Flashcards

1
Q

how is cardiac output calculated?

A

SV (stroke volume) X heart rate

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2
Q

what is the normal CO in a healthy adult at rest?

A

4-8L/ min

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3
Q

increased venous return, ventricle filling and stretching, leads to greater contraction and stroke volume. What is this referring to?

A
  • preload
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4
Q

what can indicate decreased cardiac output?

A
  • narrowed pulse pressure (BP 90/65)
  • bradycardia (HR regular at 52/ min)
  • tachycardia (HR irregular at 180/min)
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5
Q

what does decreased CO mean for the body?

A

bodies demands not being met

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6
Q

what is the range for normal pulse pressure?

A

40-60 mmHg

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7
Q

what is the range for narrow pulse pressure? What does it indicate?

A

<40 mmHg
- HF

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8
Q

what is the range for wide pulse pressure? What does it indicate?

A
  • > 60 mmHg
  • A. Fib
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9
Q

what does low MAP indicate?

A
  • blood loss through sepsis, stroke or bleed
  • HF once ejection fraction is low
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10
Q

what does a high MAP indicate? why?

A

HF due to high pressure in the arteries

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11
Q

describe frank starlings law

A

increased stretch = increased contraction

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12
Q

what causes widening pulse pressure?

A
  • aortic regurgitaiton
  • aortic sclerosis
  • severe anemia
  • arteriosclerosis
  • hyperthyroidism
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13
Q

why does anemia cause widening pulse pressure?

A

reduced blood viscosity

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14
Q

why does arteriosclerosis cause widening pulse pressure?

A

less compliant arteries

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15
Q

why does hyperthyroidism cause widening pulse pressure?

A

increased systolic pressure

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16
Q

what are the different ways you can measure cardiac output (CO)?

A
  • doppler ultrasound
  • fick’ method
  • thermodilution method
  • arterial pulse contour analysis
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17
Q

what is preload?

A
  • volume of blood being returned to the heart
  • heart stretches
  • end diastolic
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18
Q

what is afterload?

A
  • pressure or resistance the heart has to overcome to eject blood
  • heart squeezes
  • systolic
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19
Q

describe cariogenic shock

A
  • life threatening
  • heart unable to pump enough blood to rest of body
  • filling issue
  • heart cannot contract properly
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20
Q

what happens as a result of cariogenic shock?

A

acute hypo perfusion and hypoxia of tissue and organs

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21
Q

if someone is in hypovolemic shock how does preload affect stroke volume?

A
  • increase with fluid
  • SNS activation
  • give vasopressors to increase blood return
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22
Q

if someone is fluid overloaded how does preload affect stroke volume?

A
  • to much pressure in tubes need to get rid of some of the water
  • do this with diuretics and vasodilation
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23
Q

how is after load affected in the right and left side of the heart in regards to vascular resistance? How do you treat it?

A

right
- pulmonary vascular resistance
affects right atrium

left
- systemic vascular resistance
- affects left atrium

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24
Q

how do you decrease after load?

A

vasodilators

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25
Q

how do you increase after load ?

A

give vasopressors

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26
Q

what are conditions that increase vascular resistance for after load?

A
  • pulmonary HTN
  • valve problems
  • aortic stenosis
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27
Q

heart failure that leads to decreased CO and bodies inability to perfuse tissues. This is referring to what?

A

shock

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28
Q

what are signs and symptoms of left sided HF?

A
  • dyspnea
  • crackles on auscultation
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29
Q

what med is best for a client with heart failure, crackles, pitting edema and needing O2 therapy?

A

furosemide

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30
Q

what medications are used to treat heart failure and fluid overload?

A
  • midodrine
  • furosemide
  • amiodarone
  • captopril
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31
Q

what is midodrine?

A
  • vasopressor
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32
Q

what does midodrine treat?

A
  • orthostatic hypotension
  • supine HTN
  • urinary pruritis
  • paresthesia
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33
Q

what is furosemide?

A

loop diuretic

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34
Q

how does furosemide work?

A
  • blocks Na and K reabsorption
  • increases fluid elimination
  • eliminates urine even if blood flow to kidney’s is diminished
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35
Q

what are things we need to watch for when giving someone furosemide?

A
  • serum K levels
  • S/S of hypokalemia
  • hypotension
  • syncope
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36
Q

What is amiodarone?

A

potassium channel blocker

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37
Q

what does amiodarone treat?

A
  • atrial fibrillation
  • bradycardia
  • hypotension
  • thyroid dysfunction
  • liver toxicity
  • hypokalemia
  • hypomagnesium
  • SOB
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38
Q

what is captopril?

A

ACE inhibitor “pril”

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39
Q

what does captopril treat?

A
  • reduce after load that was affected by RAAS
  • hypokalemia
  • renal function
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40
Q

if someone is taking digoxin and they have A. fib what medication do we need to be careful with? Why

A
  • lasix
  • potassium can increase the risk of digoxin toxicity
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41
Q

what could chest pain indicate in a patient with A. Fib?

A
  • MI
  • ischemia
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42
Q

what is the most accurate way to get a pulse?

A

auscultate heart

43
Q

what is atrial fibrillation?

A
  • irregular rhythm and pulse deficit
  • atria are fluttering
44
Q

how can you tell someone has A.Fib during your assessment?

A

listen to heart and feel pulse at the same time, there will be a difference

45
Q

what is the goal for a pt with A. fib?

A

assess rhythm and rate control

46
Q

if someone has A. Fib, what do you want to assess for?

A
  • FAST VAN
  • CHADS
47
Q

what does CHADs stand for?

A

C - congestive heart failure
H - hypertension
A - age > 75 yrs
D - diabetes
S - prior stoke/ TIA

48
Q

what are some risk factors for A. Fib?

A
  • HTN
  • CAD
  • valve disease
  • obesity
  • DM
  • alcohol
  • hyperthyroid
  • smoking
  • genetics
49
Q

How do you treat atrial Fibrillation from short to long term interventions in the order of priority

A
  • antiarrhythmics
  • cardio version
  • beta blockers
  • anticoagulants
  • ablation
  • pacemaker
50
Q

how do you know if someone has persistent or permanent Atrial fibrillation?

A
  • s/s come and go then Ca builds up and there’s scarring - leads to persistent Af
  • if lasts > 12 months is permanent A. Fib
51
Q

if a patient just had a pulmonary ablation, what do we want to assess after procedure?

A
  • bleeding
  • pedal pulses
  • reports chest pain 2/10
  • apply pressure prn
  • supine with HOB < 30
  • keep extremities straight
52
Q

if a pt just had a pulmonary ablation, and we are assessing them after the procedure why are we concerned if they have chest pain?

A

at high risk of cardiac damage or ischemia

53
Q

what are S/S of atrial fibrillation ?

A
  • proximal events
  • irregular HR <100/min
  • fluttering
  • weakness
  • light headed
54
Q

what can cause SOB in someone with A. Fib?

A

fluid build up in lungs due to increased irregular rate with exertion

55
Q

what are red flags to watch out for with A. Fib?

A
  • HR >110
  • chest pain
  • SOB
  • anxiety
56
Q

what is the number 1 thing we want to watch out for in pt’s with A. Fib?

A

chest pain

57
Q

what is the ejection fraction for someone with heart failure?

A

< 40% (55-65%)

58
Q

what is the ejection fraction for someone with preserved heart failure?

A

40-50%

59
Q

what medication groups do we want to give patients with heart failure?

A
  • ACE inhibitors
  • ARBS
  • beta blockers
60
Q

what does S3 indicate?

A
  • reduced left ventricular ejection
  • class sign of left ventricular failure
61
Q

when does S4 indicate? What can it result in?

A
  • with reduced compliance of left ventricle
  • impairs diastolic filling
62
Q

What are worsening signs and symptoms of heart failure?

A
  • crackles
  • decreased O2
  • elevated BNP
  • low Ejection fraction <50%
  • edema
63
Q

why is BNP elevated in heart failure?

A

response to increased intraventricular volume and stretch

64
Q

What do you use to diagnose someone with A. Fib?

A
  • ECG
  • halter monitor
65
Q

what do you use to diagnose someone with heart failure?

A
  • BNP
  • ECHO
  • risk factors
66
Q

what do you use to diagnose someone with fluid overload?

A
  • crackles in lungs
  • labs
  • Chest X-Ray
67
Q

when diagnosing someone with A. Fib what would their ECG look like?

A
  • no P wave
  • irregular R wave intervals
68
Q

when diagnosing someone with heart failure what would their ECHO look like?

A
  • low ejection fraction
  • enlarged ventricle
  • altered structure
69
Q

when diagnosing someone with fluid overload what would their labs look like?

A
  • low or normal Na
  • low Hct
  • low K
  • low bun
70
Q

what do inotropic agents do?

A

increases the force of contraction

71
Q

what do chronotropic agents do what?

A

increase or decrease heart rate

72
Q

what are some risk factors for hypertension?

A
  • black ethnics
  • frequent stress
  • smoking 1 pack of cigarettes/ day
  • type 2 diabetes
73
Q

what are the signs of hypertension crisis?

A
  • BP 210/ 110
  • tachycardia
  • RR 20
  • SpO2 normal
74
Q

what do we want to assess for HTN crisis?

A
  • LOC
  • Systolic > 180 and or diastolic > 120
  • N/V
  • confusion
  • seizures
75
Q

what can hypertension crisis cause?

A
  • end organ damage
  • hemorrhagic stroke
  • AKI
  • HF
  • papilledema
76
Q

how do you treat hypertension crisis?

A
  • IV nitrates
  • IV antihypertensives
  • monitor BP
  • telemetry
  • urine output
77
Q

describe automaticity

A

ability of cardiac pacemaker cells to spontaneously initiate an electrical impulse

78
Q

what is automaticity usually done by?

A
  • SA node/ pacemaker
79
Q

describe excitability

A

ability of cardiac cells to respond to an electrical impulse generate by pacemaker cells of other stimuli

80
Q

when does depolarization occur?

A

occurs when the cells become electrically excited

81
Q

when does repolarization occur?

A

occurs when cells return to the resting state

82
Q

what cations are we mostly worried about when it comes to the heart?

A
  • sodium
  • potassium
83
Q

what happens to cations during deloparization?

A

sodium rushed into the cells

84
Q

what happens to cations during reloparization?

A
  • potassium leaves cells slower than sodium came in
  • calcium enters at the beginning or repolarization when potassium is had way out
85
Q

describe conductivity

A

ability of the cardiac cells to transmit the electrical impulse to adjacent cardiac cells

86
Q

describe contractility

A

ability of the cardiac cells to shorten in response to electrical stimulation
- mechanical event

87
Q

what electrolyte is primarily responsible for contraction?

A

calcium

88
Q

is it possible to have contraction without depolarization?

A

no

89
Q

explain the normal cardiac conduction system beginning with the sinus node and ending with the purkinje fibers

A
  • starts in SA node
  • then sent to AV node
  • then goes through bundle branches/ purkinje fibers into ventricles
90
Q

what is the pacemaker of the heart?

A

SA node

91
Q

what is the gatekeeper of the heart? why is it called this?

A
  • AV node
  • only electrical pathways between the Atari and ventricles
92
Q

what does the P wave represent?

A

atrial depolarization

93
Q

what does the QRS complex represent?

A

ventricles depolarizing

94
Q

what does the T wave represent?

A

ventricles repolarizing

95
Q

what should the P wave look like ?

A
  • round
  • upright
  • before QRS
96
Q

what does the PR interval reflect?

A

depolarization of right and left atria
- impulse delay through the AV node/ AV junction

97
Q

what does the ST segment represent?

A

early repolarization of the ventricles

98
Q

What are the 7 steps of interpreting an ECG rhythm strip?

A
  • determine HR
  • determine heart rhythm
  • examine P waves
  • examine P to QRS ratio
  • measure the QRS complex
  • interpret the rhythm/ pt response
99
Q

what do you do if someone is in V. Fib?

A
  • check for pulse
  • no pulse
  • call code blue
  • start chest compressions
  • ACLS protocol
100
Q

what do you do if someone is in V. Tach?

A
  • check for pulse
  • if pulse present > electrical or chemical cardio version
  • no pulse present > begin CPR and follow ACLS protocol
101
Q

How do you know if someone is in controlled A. Fib?

A

< 100 HR

102
Q

how do you know if someone is in uncontrolled A. Fib?

A

> 100 HR

103
Q

practice interpreting rhythm strips prof made on word document. Know how to identify:

  • sinus rhythm
  • sinus bradycardia
  • sinus tachycardia
    -controlled/ uncontrolled A. Fib
  • ventricular tachycardia
  • ventricular fibrillation
  • Asystole
A
104
Q

what are the interventions for A. Fib/ A-flutter? what does each do?

A

anticoagulant
- prevents clots

beta blocker
- control rate

cardioversion
- stops impulses to help SA node take over again

digoxin
- slows down HR

NRSG 421 (6 decks)

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