Card Set Information
lccc nursing cardiac complexcare
For Gordons Exam 4
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
Describe a normal sinus rhythm
atrial and ventricular rates are regular
one, consistent p-wave prior to the constant QRS complex
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
Pale, cool skin
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
What is A-Fib? What are the S/S?
most common dysrhymia
: 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
Leads to thrombus formation
fatigue, syncope, SOB, SOBOE, dizziness, anxiety, CP, asymptomatic
What is the treatment for A-Fib?
No treatment for AF without symptoms
If uncontrolled or above >100bpm:
Heparin, Enoxaparin (Lovenox), Warfarin (Coumadin) for pts at risk of emoboli
Cardioversion when meds are unsuccessful
: amiodarone, adenosine,verapamil
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)
What are S/S of Diltiazem (Cardizem)
: HA, fatigue, dizziness, drowsiness, nervousness, insomnia, confusion, tremor
: edema, arrhythmias, angina, bradycardia, hypotension, CHF
: N/V/D, constipation
: rash, SJS
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
slows conduction through the AV node to slow down sinus rate
Treatment for AFIB
ACLS if CPR, meds and defib have failed
What are the side effects of Amiodarone (Cordarone)?
: peripheral neuropathy, fatigue, dizziness
: bradycardia, hypotension, sinus arrest, cardiogenic shock
: blurred vision, photosensitivity
: anorexia, N/V, constipation, hepatotoxicity
What is the nursing care for Amiodarone (Cordarone)?
Monitor BP, HR, rhythm
: 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
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
-Dizziness and syncope
What are the causes of atrial flutter? What is the treatment?
-Abn valves, congenital anomalies
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
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
What is the treatment for VTach?
Elective cardioversion for stable VT
Describe the difference between cardioversion and defibrillation
: direct, synchronized counter shock to heart during QRS complex for atrial dysrhythmias, superventricular tachycardia and vtach with pulse
: 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
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
What is ventricular asystole?
No ventricular rhythm and no QRS complex
No contraction or CO
Complete cardiac arrest
CPR and defib needed
How does a pacemaker work?
What are some post op complications for a pace maker?
Spike but no QRS complex
Thread migration leading to SOB or hiccups (risk for cardiac tamponade)
Decreases myocardial excitability
Prolongs repolarization of the QT interval
Excreted by liver
Given IM, IV
What are the side effects for procainamide? What is the nursing care?
Confusion, dizziness, n/v/d
-monitor EKG, HR, BP continuously
-cbc check q2wks
-monitor for toxicity
Describe left sided HF
Describe right sided HF
What are the interventions for HF?
Describe Enalapril (Vasotec) for CHF
: synthetic vasodilation
Metabolized in the kidneys
Given PO or IV
Lower dose in pt with diuretic
: dizziness, drowsiness, fatigue, HA, hypotension, cough, dyspnea, chest pain, tachycardia, angioedema
: monitor BP, assess for dyspnea, angioedema, daily wt, breath sounds, BUN, lytes
Describe Digoxin for right sided HF
: increases the myocardial contraction and decreases conduction. This slows the HR while increasing CO
: 0.5-2 ng/mL
: fatigue, HA, weakness, blurred vision, yellow/green halos around light (toxicity), N/V (toxicity) and d
: 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
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
What is the postop nursing care for CABG?
Ventilated for 3-6hrs
Pacemaker and chest tubes
Central lines an 2 large bore IVs
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
: hypokalemia, decreased electrolytes, dysrhythmias, aplastic anemia, metabolic alkalosis, dehydration, agranulocytosis