cardiac exam 2

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Author:
copperkid2
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156905
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cardiac exam 2
Updated:
2012-06-02 17:25:33
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cardiac exam
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chpt 25 and 26
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  1. what does the p wave on the ekg represent?
    • atrial depolarization
    • first positive wave in a normal cardiac cycle
    • a positive p wave before a QRS complex means the impulse came from teh sa node
  2. what does the q wave on the ekg represent?
    first negative wave after a p wave in a normal cardiac cycle
  3. what does the r wave on the ekg represent?
    second positive wave in a normal cardiac cycle
  4. what does the t wave on the ekg represent?
    ventricle depolarization
  5. f waves
    indicate atrial flutter
  6. cardiac preload
    • preload is stretch
    • volume of blood received by the heart
    • amount of volume being returned to the right side of the heart from systemic circulation
  7. cardiac afterload
    • pressure or resistance the heart has to overcome to eject blood
    • Afterload is squeeze
    • The amount of resistance the left side of the heart has to overcome in order to eject blood
  8. pt teaching with a pacemaker
    • notify MD if pulse is 5 beats over or under set rate
    • take the radial pulse
    • report dizzines, irregular heartbeats, palpitations
    • avoid magnetic fields, high voltage, antitheft devices and large running motors
    • may set off metal detectors
    • use grounded appliances
    • resume normal activity within 6 weeks
    • don't lift anything over 10 lb or play sports before 6 weeks
    • keep scheduled appointments
  9. What is ventricular fibrillation
    • when the ventricle quivers and is unable to initiate a contraction
    • causes: hyperkalemia, hypomagnesemia, electrocution, CAD, MI
    • signs and symptoms: immediate loss of conciousness, no heart sounds, no peripheral pulses, no blood pressure, respiratory arrest, cyanosis, pupil dilation
    • immediate defibrillation required
    • meds given: epinephrine, vasopressin, amiodarone, magnesium
  10. premature ventricular contraction (pvc)
    • ventricles fire prematurely
    • causes: caffeine, alcohol, anxiety, hypokalemia, cardiomyopathy, ischemia, MI
    • signs and symptoms: skipped beat/palpitations, fatigue, dizziness
    • can lead to more sever dysrhythmias
  11. eventricular tachycardia
    • 3 or more PVCs in a row
    • ventricles rather than the SA node become the pacemaker
    • causes: myocardial irritability, MI, and cardiomyopathy are most common; respiratory acidosis, hypokalemia, digoxin toxicity, cardiac catheters, pacing wires
    • signs and symptoms: sudden onset of rapid heart rate, dyspnea, palpitations, light-headedness, angina
    • can progress to ventral fibrillation
  12. Sinus tachycardia
    • heart rate greater than 100 bpm
    • causes: physical activity, hemorrhage, shock, medications (epinephrine, atropine, nitrates), dehydration, fever, MI, electrolyte imbalance, fear, hypoxia and anxiety
    • signs and symptoms: angina, dyspnea. may be asymptomatic
  13. where is the sinus (sa) node located
    right atrium
  14. premature atrial contraction
    • atria fire an impulse before the sa node
    • causes: hypoxia, cigarette smoking, myocardial ischemia, enlarged atria in valvular disorders, medications (digoxin), electrolyte imbalance, afib, heart failure
    • signs and symptoms: palpitations otherwise asymptomatic
    • therapeutic measures: beta blockers to slow heart rate
  15. ST segment
    • time from completion of a contraction to recovery of myocardial muscle for the next impulse
    • examined if a pt complains of chest pain
    • appears inverted or depressed if a pt has ischemia
  16. atrial fibrillation
    • rapid and chaotic atrial rate (350 - 600 bpm)
    • increased stroke risk; blood pools in atria and thrombus may form
    • causes: cigarette smoking, rheumatic or ischemic heart diseases, heart failure, hypertension, pericarditits, pulmonary embolism, postoperative coronary artery bypass surgery
    • signs and symptoms: faint radial pulse (decreased stroke volume), may lead to left heart failure
  17. digoxin side effects
    • fatigue
    • nausea
    • vomiting
    • anorexia
    • headache
    • bradycardia
    • cardiac arrhythmias
  18. Bumex
    • potassium wasting diuretic
    • side effects: hypokalemia, hypochloremia, hypomagnesmia, hyponatremia, dehydration, hypotension
  19. left sided heart failure
    • blood backs up and congests pulmonary circulation causing edema in the pulmonary system
    • left sided heart failure is all about the lungs
    • hypertension is the major cause; increases arterial pressure and makes the left ventricle work harder
    • valvular problems, cardiomyopathy, heart muscle infection are also causes
    • signs and symptoms: pulmonary edema, shortness of breath, cyanosis, alveolar edema
  20. right sided heart failure
    • blood builds up in the systems blood vessels
    • major cause is left sided heart failure
    • signs and symptoms: distended jugular veins, edema in peripheral tissues, abdominal organ hypertrophy, anorexia, nause, abdominal pain
  21. cor pulmonale
    the right ventricle hypertrophies or fails because of increased pulmonary pressures
  22. pulmonary edema (acute heart failure)
    • occurs when the left ventricle fails
    • signs and symptoms: pinky, frothy sputum; increased heart rate and blood pressure (may drop); decreased PaO2 and increasing PaCO2
    • therapeutic measures: goal is to reduce workload on left ventricle; fowlers position (easier lung expansion); oxygen given, morphine to decrease preload; IV meds
  23. care for patient with chronic heart failure
    • O2 therapy; 2 - 6 L/min via nasal cannula (max 2L/min for COPD pts)
    • balance rest and activity
    • place in fowlers position
    • monitor weight daily; report gains of 2 - 3 lb over 1 - 2 days
    • prevent constipation
    • teach to conserve energy when perfoming ADLs
    • low sodium diet; spices, herbs and lemon juice replace salt
  24. exertional dyspnea
    shortness of breath that increases with activity
  25. orthopnea
    • dyspnea that increases when lying down
    • 2 or more pillow usually used for sleeping
  26. paroxysmal nocturnal dyspnea (PND)
    • sudden shortness of breath that occurs after lying flat for a time
    • excess fluid accumulation in the lungs
    • relieved by sitting upright for a short time; reduces amount of fluid returning to the heart
  27. dyspnea
    • common symptom of left sided heart failure
    • pulmonary congestion impairs gas exchange between the alveoli and capillaries
  28. continuous ECG monitoring
    lead II usually provides a good view

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