CC Cardiac

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julianne.elizabeth
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301774
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CC Cardiac
Updated:
2015-05-03 22:29:36
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lccc nursing cardiac complexcare
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For Gordons Exam 4
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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
  16. What is VTach?
    • LIFE THREATENING ARRHYTHMIA
    • 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?
    • LIFE THREATENING ARRHYTHMIA
    • 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
  26. Describe right sided HF
  27. What are the interventions for HF?
  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

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