CC Cardiac

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  1. Describe electric conduction through the heart
    • SA node in the right atrium is the pacemaker at 60-100bpm
    • Continues to the AV node where it is slowed down
    • Goes through the bundle of his, right and then bundle branches and into the perkinje fibers
  2. Describe a normal sinus rhythm
    • 60-100 bpm
    • atrial and ventricular rates are regular
    • one, consistent p-wave prior to the constant QRS complex
  3. What is Tachycardia? What are the s/s?
    • hr >100 bpm
    • Increases the workload of the heart
    • increase in oxygen demand
    • palpitations and chest pain
    • Restlessness/anxiety
    • Pale, cool skin
    • Syncopial episodes
  4. What is bradycardia?What are the complications?
    • HR <60 bpm
    • O2 demand is low
    • Can lead to MI and HF
    • If symptomatic, treat with atropine, isoproterenol and pace maker
  5. What is A-Fib? What are the S/S?
    • most common dysrhymia
    • Risk factors: HTN, TIA, CVA, CAD, DM, age, obesity, caucasian, alcohol intake, etc
    • Caused by multiple atrial foci
    • Characterized by NO PWAVE and a rapid irregular rate
    • Atrial and ventricals are no coordinated
    • Decreased CO
    • Leads to thrombus formation
    • S/S: fatigue, syncope, SOB, SOBOE, dizziness, anxiety, CP, asymptomatic
  6. What is the treatment for A-Fib?
    • No treatment for AF without symptoms
    • If uncontrolled or above >100bpm:
    • Diltiazem (Cardizem)
    • Amiodarone (Codarone)
    • Metoprolol (Lopressor)
    • Digoxin (Lanoxin)
    • Heparin, Enoxaparin (Lovenox), Warfarin (Coumadin) for pts at risk of emoboli
    • Cardioversion when meds are unsuccessful
    • Emergencies: amiodarone, adenosine,verapamil
  7. Describe Diltiazem
    • Calcium Channel Blocker that inhibits calcium influx into the myocardium
    • Improves myocardial perfusion by dilation
    • Decreases left ventricular workload
    • Slows the SA and AV node conduction
    • Used for AFib, AFlutter, Supraventricular Tachycardia and Angina (NOT recent MI)
  8. What are S/S of Diltiazem (Cardizem)
    • CNS: HA, fatigue, dizziness, drowsiness, nervousness, insomnia, confusion, tremor
    • CV: edema, arrhythmias, angina, bradycardia, hypotension, CHF
    • GI: N/V/D, constipation
    • Derm: rash, SJS
  9. What is the nursing care for Diltiazem (Cardizem)?
    • Check BP and ECG before therapy
    • Monitor and report S/S of CHF (I/O)
    • Supervise ambulation (risk of falls)
    • Metabolized in liver, monitor labs
    • Do not give if recent MI
  10. Describe Amiodarone
    • Antiarrhythmic
    • slows conduction through the AV node to slow down sinus rate
    • Treatment for AFIB
    • ACLS if CPR, meds and defib have failed
  11. What are the side effects of Amiodarone (Cordarone)?
    • CNS: peripheral neuropathy, fatigue, dizziness
    • CV: bradycardia, hypotension, sinus arrest, cardiogenic shock
    • Senses: blurred vision, photosensitivity
    • GI: anorexia, N/V, constipation, hepatotoxicity
  12. What is the nursing care for Amiodarone (Cordarone)?
    • Monitor BP, HR, rhythm
    • Labs: AST, ALT, thyroid, GI
    • Check pulse daily, DC if <60bpm
    • Monitor for diminished breath sounds, rales, pleuric friction rub
    • Avoid grapefruit juice
    • Avoid the sun, wear sunglasses and reg eye exams
    • Assess for possible cross allergy to iodine
  13. What is atrial flutter? What are the s/s?
    • Regular patter where the atria are not in sync with the ventricles
    • Creates a saw tooth pattern in the P wave upon ECG
    • May lead to AFib
    • Blood moves slower, risk of clots
    • May be asymptomatic
    • S/S:
    • -palpitations
    • -tachycardia
    • -SOB
    • -Activity intolerance
    • -Chest pain
    • -Dizziness and syncope
  14. What are the causes of atrial flutter? What is the treatment?
    • Causes:
    • -HF
    • -Abn valves, congenital anomalies
    • -HTN
    • -thyroid dysfunction
    • -binge drinking
    • -DM
    • Treatment:
    • -Diltiazem
    • -Digoxin
    • -Cardioversion
  15. Describe PVCs
    • Electric firing somewhere other than the SA node (fires in the ventricles) initiates the PQRS rhythm, followed by a pause
    • Can lead to decreased cardiac output and dizziness although pt may be asymptomatic
    • Eliminate contributing cause, such as stress or caffeine
    • Common dysrhythmia that increases with age
    • Often feels like/sounds like skipping a beat
    • Treatment is Amiodarone and O2
    • Image Upload
  16. What is VTach?
    • Repetitive firing of the ventricles with a rate of 140-180 bpm
    • Intermittent or Sustained
    • VT can lead to VFib and cardiac arrest, death
    • Associated with MI, cardiomyopathy, hypokalemia, hypomagnesia, valvular disease, HF, drug toxicity and hypotension
  17. What is the treatment for VTach?
    • Elective cardioversion for stable VT
    • PO Antidysrhythmics
    • Amiodarone (Codarone)
    • Lidocaine
    • Procainamide
    • Epinephrine
  18. Describe the difference between cardioversion and defibrillation
    • Cardioversion: direct, synchronized counter shock to heart during QRS complex for atrial dysrhythmias, superventricular tachycardia and vtach with pulse
    • Defibrillation: unsynchronized, direct countershock to stop all electric activity in the heart to allow SA node to take over. Used for vfib ad vtach without pulse
  19. What is VFib?
    • Uncoordinated multifocal firing in the ventricles so that no contraction occurs
    • No CO, no pulse, no perfusion, no LOC, no breathing, no BP
    • Lethal within 3-5 minutes
    • Defibrillate immeadiately
  20. What is ventricular asystole?
    • No ventricular rhythm and no QRS complex
    • No contraction or CO
    • Complete cardiac arrest
    • CPR and defib needed
  21. How does a pacemaker work?
  22. What are some post op complications for a pace maker?
    • Infection
    • Hematoma
    • PVCs
    • Spike but no QRS complex
    • Thread migration leading to SOB or hiccups (risk for cardiac tamponade)
  23. Describe procainamide
    • Decreases myocardial excitability
    • Slows conduction
    • Prolongs repolarization of the QT interval
    • Treats arrhythmias
    • Excreted by liver
    • Given IM, IV
  24. What are the side effects for procainamide? What is the nursing care?
    • Confusion, dizziness, n/v/d
    • Seizures
    • Asystole
    • Heart block
    • Arrhythmias
    • Agranulocytosis
    • Nursing Care:
    • -monitor EKG, HR, BP continuously
    • -cbc check q2wks
    • -monitor for toxicity
  25. Describe left sided HF
    Image Upload
  26. Describe right sided HF
    Image Upload
  27. What are the interventions for HF?
    Image Upload
  28. Describe Enalapril (Vasotec) for CHF
    • Action: synthetic vasodilation
    • Metabolized in the kidneys
    • Given PO or IV
    • Lower dose in pt with diuretic
    • SE: dizziness, drowsiness, fatigue, HA, hypotension, cough, dyspnea, chest pain, tachycardia, angioedema
    • Nursing care: monitor BP, assess for dyspnea, angioedema, daily wt, breath sounds, BUN, lytes
  29. Describe Digoxin for right sided HF
    • Action: increases the myocardial contraction and decreases conduction. ┬áThis slows the HR while increasing CO
    • Therapeutic range: 0.5-2 ng/mL
    • SE: fatigue, HA, weakness, blurred vision, yellow/green halos around light (toxicity), N/V (toxicity) and d
    • AE: fatigue, bradycardia <60bpm, NV, anorexia
    • Monitor apical pulse for 1 full min prior to admin
    • Monitor I/O, dig level, electrolyts, BUN, LFT
    • Monitor for signs of toxicity (digibind is antidote)
    • If on lasix, higher risk of toxicity
  30. What is a CABG?
    • Coronary artery bypass graft
    • Can be elective or emergency
    • is done under general anesthesia and is done open heart
    • A heparinized, oxygenated bypass machine circulates blood during the surgery
    • Potassium used to stop the heart during surgery and then it is defibrillated into NSR
  31. What is the postop nursing care for CABG?
    • Ventilated for 3-6hrs
    • Pacemaker and chest tubes
    • Central lines an 2 large bore IVs
    • Cardiac monitoring
    • Multple meds
  32. Describe Furosemide
    • Loop diuretic, works on loop of henle
    • Increases renal excretion of water and eletrolytes
    • Half life is 30-60 min, depending on how given (PO, IM, IV). IV is 5 min
    • SE/AE: hypokalemia, decreased electrolytes, dysrhythmias, aplastic anemia, metabolic alkalosis, dehydration, agranulocytosis
Card Set:
CC Cardiac
2015-05-04 02:29:36
lccc nursing cardiac complexcare

For Gordons Exam 4
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