EKG

• increased BP
• increased BUN/Creatinine
• decreased urine output

SV x HR

CO 4-8 L or 4,000-8,000L/min

SV and HR are 60-100

• 0.5ml/kg/hr
• 30mL/hr

right to left and top to bottom

• Altered LOC
• weak
• prolonged cap refill
• cool extremities
• weak pulse
• SOB....using accessory muscles
• restless
• agitated
• angina

P wave and QRS complex

time from the onset of atrial depolarization to the onset of ventricular depolarization

.12-.20 or 3-5 small boxes

atrial depolarization

ventricular depolarization

0.4-.12 seconds or 1-3 small boxes

• MI
• Hypertrophy
• Ischemia
• Bundle Branch Block

early ventricular repolarization....it is isoelectric and is located on the baseline

• elevated = MI
• depressed = ischemia or dig toxicity

ventricular repolarization.....should be larger than the P wave

• Inverted-ischemia
• Flattened/Inverted-hypokalemia
• Tall/Peaked-hyperkalemia
• Notched-periarditis

the time between the onset of depolarization and the and of repolarization of the venticles

Total duration of ventricular systole

.35-.40 seconds or 9-10 small boxes

time in seconds and distance in mm

voltage in mm

• can only be used if you have a regular rhythm
• lines away....
• 1=300
• 2=150
• 3=100
• 4=75
• 5=60
• 6=50

• R-R
• is it regular or irregular?
• If there is a difference either way by 3 small boxes, it is a problem

the same

1 systolic + 2 diastolic/3

• Atropine
• Dopamine
• Epinephrine

• dysrhythmias like-
• PAC
• PVC
• A Fib

• angina
• hypotension
• heart failure (elderly)
• cerebral perfusion (LOC)
• renal perfusion (UO)

• electrolyte imbalances
• hypoxia
• drug toxicity
• heart failure
• myocardia ischemia

• you know their level of education
• can they hear/see/read
• provide instruction in large easy to read print
• include the family in teaching
• inform of community resources of places to take pulse and bp

avoid stimulating the vagus nerve.....keep carotid pressure low, dont bear down or stimulate the gag reflex

• stop smoking
• avoid caffeine
• drink with moderation
• manage stress
• take meds and report AE

• treat angina promptly with nitro
• if no relief with nitro call 911
• if chest pain is accompanied by sweating, nausea, weakness or palpitations call 911

• teach generic and brand name
• teach what each drug does
• clear instructions about dosage, schedule and side effects
• consider physical limitations of older patients...can they see/read/open container
• teach all patients to report dizziness, n/v, sob or chest discomfort....report to Dr.

teach all clients to take their pulse and report a HR over 100 or below 60 or any increase in irregularity

• weakness
• lethargy
• cardiac irregularity (PVC)

• tomatoes
• beans
• prunes
• avocados
• bananas
• strawberries
• lettuce

• weakness
• ventricular irregularities

• green leafy vegetables
• nuts
• dried peas
• beans
• whole grains

• take pulse for 1 min every day at the same time.  Report a pulse lower than the set pacemaker rate
• report redness/swelling @ insertion site
• keep cell phones 6 in away
• avoid strong electromagnetic fields
• carry a pacemaker id card

• anti theft devices in stores may interfere with their function
• they can set off metal detectors
• if you are close to an electrical or magnetic device and you feel weird...move away and take pulse

• cont. with antidysrhythmia meds
• if shocked...site or lie down and call Dr.
• avoid electromagnetic fields
• cell phones kept 6 inch away
• carry ICD ID card
• report any fainting or black outs
• encourage family to learn cpr
• avoid strenuous exercise

• coordination of resources, such as time, people, supplies, to achieve outcomes.
•  
• Involves problem solving and decision making processes

the act of guiding or influencing people to achieve desired outcomes; occurs at any time a person attempts to influence the beliefs, opinions or behaviors of an individual or group

• planning-defining goals and objectives
• organizing-how to communicate, coordinate people, time and work
• staffing-recruit good qualified people
• directing-encourage employees to accomplish goals
• controlling-perform employee reviews and analyze finances and quality of care

technical skills-clinical expertise and nursing knowledge

human skills-ability ad judgment to work with people in effective leadership role

the ability to understand the complexities of the overall organization and to recognize how

makes all decisions with no staff input and uses the authority of the position to accomplish goals

encourages staff involvement in goal setting, problem solving, and decision making

provides little direction or guidance and forgoes decision making

depending on the situation, the nurse manager may need to use different types of management styles

attempt to influence beliefs, opinions or behaviors of persons, but may not have formal authority but can still influence others

a formal line of authority and accountability

• new grads can be intimidating to old nurses
• ....also if I go on a specialized floor go to seminars to learn the new stuff and wow them

transactional....just concerned with the day to day duties

transformation....has goals and visions for the floor, know charge nurse

when there is a code....somebody has to be the leader

people who are involved with decisions for the floor in goal setting and problem solving

teacher student relationship like us....we are self motivated and driven, teachers dont need to tell us what to do

democratic....but may need to adapt to other styles, depending on the situation

offers learning and training opportunities to enhance professional and personal growth for all employees

Accesses resources and plans staff development activities to meet the needs of individual staff members

mentors

he/she is a professional representative for the organization who is committed to the mission, goals and objectives of the employing organization

work environment and medical errors

• practice to the full extent of education and training
• achieve a higher level of education
• be full partners w/ physicians and other health care professionals in redesigning healthcare
• engage in effective work force planning and policy making with better data collection and information infrastructure