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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
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Describe a normal sinus rhythm
- 60-100 bpm
- atrial and ventricular rates are regular
- one, consistent p-wave prior to the constant QRS complex
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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
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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
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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
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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
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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)
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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
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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
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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
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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
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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
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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
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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
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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
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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
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What is the treatment for VTach?
- Elective cardioversion for stable VT
- PO Antidysrhythmics
- Amiodarone (Codarone)
- Lidocaine
- Procainamide
- Epinephrine
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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
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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
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What is ventricular asystole?
- No ventricular rhythm and no QRS complex
- No contraction or CO
- Complete cardiac arrest
- CPR and defib needed
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How does a pacemaker work?
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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)
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Describe procainamide
- Decreases myocardial excitability
- Slows conduction
- Prolongs repolarization of the QT interval
- Treats arrhythmias
- Excreted by liver
- Given IM, IV
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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
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What are the interventions for HF?
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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
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Describe Digoxin for right sided HF
- Action: increases the myocardial contraction and decreases conduction. This 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
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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
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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
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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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