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PEA
Pulseless electrical activity
CPR!
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P --> R interval
- 0.10-0.20 sec (ideal)
- Prolonged may mean a 1st degree heart block
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CVP line (central venous pressure cath)-
- Measure R atrial pressure, assesses preload
- *Listen to lung sounds for pneumothorax & lung puncture
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Pulmonary artery Line-
- Measures pt.s response to medications, cardiac index, measures afterload,
- * zero every shift (@ start) & PRN
- -If pt. fine and readings bad= check equipment
- -If pt doing bad but readings fine CHECK PT
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Intraortic Balloon pump-
Supports L ventricular function, used w/ pt.s with low cardiac index.
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MI intervention-
- O2,
- rest to decrease demand of O2,
- Beta blockers given long-term
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What can Pericarditis lead to?
Pericardial effussion (fluid) which can lead to Cardiac tamponade (increased pressure)
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Tx. for hytensive crisis (MAP)
MAP- mean artereal pressure
Decrease MAP 25% per hr.
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Inotropic medications (+/-)
- - Effects contractility
- - Pos= increase contractility
- -Neg= decrease contractility
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Chronotropic medications (+/-)
- Pos= increase HR
- Neg= decrease HR
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Dromotropic medications (+/-)
- Pos= increased rate of conduction
- Neg= decrease rate of conduction
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Atherosclerosis-
Accumilation of fatty deposits in the artery walls
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Arteriolosclerosis
Hardening, thickening, & loss of elasticity
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Captopril
- ACE inhibitor
- tx. for HTN & CHF
- Orthostatic hypotension SE
- Fail on ACE go to ARB
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ACE inhibitos
- If fail on ACE go to ARB
- tx. for CHF & HTN
- Used after MI to reduce remodeling of myocardium
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What drug is given if no response to D-fib?
Epinephrine
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Goal of tx. of arrhythmia
Increase CO
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What does elevated Troponin lvls tell use?
Extent of the cardiac damage
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Atropine
Used to stimulate HR to inrease
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Reasons for pacemaker
- 1) HR too slow
- 2) AV/SA nodes not fireing
- 3) disconnect of electrical signal within heart
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CVP line (central venous pressure cath)-
- Measure R atrial pressure, assessed preload
- * RN responsibility during cutdown CVP- listen to lung sounds for pneumothorax & lung puncture
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Pulmonary artery Line-
- pt.s response to medications, cardiac index, measures afterload,
- * RN responsibility- zero every shift (@ start) and if pt. fine and readings bad= check equipment & pt doing bad but readings fine CHECK PT
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Cardiac index-
- Ratio of CO to body mass,
- 2-4 normal range, it’s a number and below 2 is bad perfusion
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Intraortic Balloon pump-
Supports L ventricular function, used w/ pt.s with low cardiac index.
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Esmolol (Brevibloc)
- Used during surgery to prevent or treat tachycardia,
- Used as tx of acute supraventricular tachycardia
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Amiodarone
- -Tx and prevent certain types of serious ventricular arrhythmias
- -works by relaxing overactive heart muscles
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Diltiazem
- Tx. of high blood pressure & control angina. calcium-channel blockers.
- Relaxes blood vessels to reduce workload on heart.
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ECHO can tell us…
- CO, EF, size of atria & ventricles
- -tell us about hypertrophy,
- Can differentiate the different types of cardiomyopathy
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Cardiac catheterizationo
- -Dsg in groin area
- -Assess for bleeding immediate post op and after activity…such as ambulation to the bathroom,
- - avoid hematoma formation at the site.
- - Drink water to flush dye out of system (watch kidney function)
- o May give Mucomyst to help flush out the dye
- o Cardiac cath used to assess patency of coronary arteries
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How long to hold pressure in IV & Lines (on/off) anticoagulants?
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-A-fib can cause...
- A fib can lead to...
- Cause = intracardiac thrombi or systematic thrombi
- Lead to = lethal ventricular rhythm – THIS IS BIGGEST CONCERN!!!
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- Injury or ischemia –
ST segment
- ST segment will be elevated above baseline for injury,
- ST depressed below baseline for ischemia.
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S/S Left sided heart failure-
Crackles, rales- SOB, dyspnea- Pink Frothy sputum with pulmonary edema
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ASA & NSAID,
- decreases inflammation,
- can cause bleeding,
- don’t take with coumadin
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Captopril –
- treats HTN and HF –
- ACE inhibitor, watch for dry non productive cough. If this occurs, switch to ARB.
- Vasodilates so think safety regarding BP.
- May get metallic taste on mouth or loss of taste
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Atropine –
- increases firing of SA node so it increases HR,
- Useful in treating some heart blocks and bradycardia.
- Used to be used in asystole and PEA
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What kind of exercise should patients with angina avoid? what kind should they do?
- Avoid = isometric exercises (weight lifting)
- Do = Isotonic like walking
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Hiccups + pacemaker pt. may suggest...
may indicate that a pacemaker is stimulating the diaphragm
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