Cardiac care

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Cardiac care
2015-04-29 18:33:18
lccc nursing CC

exam 4 cardiac
Show Answers:

  1. Explain the conduction of the heart
    • Begins with the SinoAtrial node in the right atrium, the hearts primary pacemaker at 60-100 bpm creates (creats depolarization.
    • Then continues to the atrioVentricular node, next the Bundle of His, then the right and left bundle branches, lastly the perkinje fibers.
  2. Describe Normal Sinus Rhythm?
    • begins in the SA; rate is 60-100bpm,
    • rhythm: atrial and ventricular rhythms are regular
    • P waves: consistent
    • PR interval: regular and constant
    • QRS duration: constant
  3. Describe tachycardia. What does it cause?
    • more than 100 bpm
    • increases workload of the heart
    • increases oxygen demand
    • palpitations
    • chest pain
    • restlessness/anxiety
    • pale, cool skin
    • syncopial episodes
  4. What is bradycardia and what does it cause?
    • HR less than 60 bpm
    • O2 demand is low
    • Can lead to MI and heart failure
  5. What is the most common dysrhythmia? What are the risk factors? What can it lead to? What are symptoms?
    • Atrial fibrillation
    • Risk factors: HTN, TIAs, Stroke, CAD, DM, age, obesity, being Caucasian, and increased alcohol intake
    • multiple atrial goci fire, no P wave, rapid irregular rate
    • Atria and ventricles are not coordinated. Reduced CO.
    • Can lead to thrombus formation
    • Symptoms: fatigue, weakness, SOB, SOBOE, dizziness, anxiety, syncope, CP,
    • Some patients may be symptomatic
  6. What is the treatment for atrial fibrillation?
    • Long term AF without S&S= no treatment
    • Uncontrolled ( greater than or = to 100bpm)= diltiazem(cardiazem), miodarone (cordarone), metoprolol (Toprol), digoxin (lanoxin), heperain, enoxaparin (lovenox), warfarin (Coumadin for pts at risk for emboli
    • Cardioversion used when drugs are ineffective
  7. Describe diltiazem (cardizem), what are the side effects? nursing care?
    • inhibits calcium influx into myocardium
    • improves myocardial perfusion (dilation)
    • Reduces left ventricular workload
    • slows SA and AV node conduction
    • Used for A fib, A flutter, Supraventricular trachycardia and angina
    • side effects: CNS (HA, fatigue, dizziness, drowsiness, nervousness, insomnia, confusion, tremor); CV (edema, arrhythmias, angina, bradycardia, hypotension, CHF); GI (N/V/D, constipation), Derm: rash
    • Nursing care: check BP and ECG before therapy, monitor and report S&S of chf, supervise ambulation, *metabolized in lever
  8. What is the class, action, indication Side effects and nursing implications of amiodarone (Cordarone)
    • Class: antiarrhythmic
    • action: slows conduction time through the AV node
    • Indication: tx for A fib 
    • Side effects: CNS (peripheral neuropathy, fatigue, dizziness) CV ( bradycardiaa, ypotension, sinus arrest, cardiogenic shock) Senses (blurred vision, photosensitivity), GI (anorexia, N/V, constipation, hepatotoxicity
    • Nursing implications: monitor BP, HR, Rhythm, monitor AST, ALT, thyroid and GI, diminished breath sounds, rales, pleuritic friction rub, check pulse daily, DC if <60
    • Avoid grapefruit juice, dark glasses, regular eyes exams
  9. What is atrial flutter? S&S? causes? treatment?
    • Not life-threatening but can be if continuos or left untreated, blood moves slowly, which causes a High risk of emboli, Atria are not in sync with the ventricles, but in a regular pattern 
    • S&S: may be asymptomatic, palpitations, increased HR, SOB, Activity intolerance, Chest pain, dizziness/fainting; Sawtooth pattern ECG
    • Causes: heart failure, Abnormal valves, congenital anomalies, HTN, thyroid dysfunction, binge drinking, DM
    • Treatment: diltiazem can be used to slow AV conduction, digoxin, cardioversion 
    • *can lead to a-fib
  10. What are premature ventricular contractions?
    • Something other tha the SA node fires initiating the rythm complex (PORST); followed by a pause, can lead to decreased CO and dizziness. 
    • Common dysrhythmia that increases with age
    • may be asymptomatic 
    • Eliminate contributing cause (stress, caffeine) 
    • Sometimes occur in repetition: Bigeminy(2 in a row) trigeminy (3 in a row) Quarigeminy (4 in row)
    • PVCs not palpable- noticed as skipped beat 
    • Tx is corderone, and oxygen
  11. What is ventricular tachycardia "V Tach"
    • Life threatening emergency
    • repetitve firing of ectopi foci
    • Rate is 140-180 BPM
    • intermittent or sustained
    • Associated with MI, cardiomyopathy, hypokalemia, hypomagnesemia, valvular disease, HF, drug Toxicity or hypotension
    • Elective cardioversion is the treatment for stable VT
    • VT can lead to ventricular fibrillation (lethal rhythm) then cardiac arrest
    • TX. VT with cardioversion and PO antidysrhyhmics, IV bolus amiodarone, Lidocaine, procainamide
  12. Ventricular Fibrillation
    • Life threatening: multifocal firing, disorganized, no contraction occurs, NO CO, no pulse, no perfusion, no LOC, no breathing, no BP lethal within 3-5 minutes
    • Defibrillate immediately
  13. Ventricular asystole
    • No ventricular rhythm so no QRS complex
    • No contraction or CO 
    • Full cardiac arrest
  14. What is a pace maker?
    • pulse generator and pacing electrodes
    • stimulate depolarization as a spike on EKG
  15. What should you assess for and notify the HCP when assessing a pacemaker site?
    • infection or hematoma at site
    • PVCs
    • Spike but no QRS complex
  16. What medications are used to treat arrythmias?
    • Procainamide hydrochloride
    • Action: decreases myocardial excitability
    • slows conduction
    • prolongs repolarization and the QT interval
    • treatment of arrythmias, excreted by liver,
    • given IV or IM  
    • SE: confusion, dizziness, NVD
    • AE: seizures, asystole, heart block, arrythmias
    • NI: monitor EKG, Pulse, BP continuously 
    • Patient teaching: SE, AE and when to notify the MD
  17. What is the cause of Left sided heart failure? S&S?
    • Causes: HTN, CAD, mitral or aoritc valve disease (stenosis or regurg)
    • S&S: impaired tissue perfusion, SOBDOE, DOE, Fatigue, orthopnea, chest discomfort, palpitations, skipped beats, tachycardia, pulmonary congestion, dry to wet cough 
    • DX: elevated NA and K+, elevated BUN, elevated H&H, CXR shows cardiomegaly, pulmonary congestion
  18. Angiotension converting enzyme inhibitors
    • Enalapril (vasotec) 
    • Action: systemic vasodilation
    • metabolized through kidneys
    • given PO and IV 
    • lower dose in pt with diuretic 
    • SE: dizziness, drowsiness, fatigue, HA, hypotension, cough, dyspnea, CP, tachy, angioedema (facial swelling) 
    • NI: monitor BP, assess for dyspnea, angioedema, daily wt, crackles, BUN, electrolytes,
    • *used for left sided heart failure
  19. What is the cause of right sided heart failure?
    • results when the right ventricle fails 
    • fluid retention in lower legs, nausea and anorexia, ascites in advance heart failure, frequent diuresis, awakening at night to urinate, excessive thirst due to sodium retention
  20. Digoxin (lanoxin)
    • Action: increases the force of myocardial contraction and decreases conduction (slows HR), increases cardiac output and decreases HR 
    • SE: fatigue, HA, weakness, blurred vision, halos around lights, diarrhea 
    • AE: fatigue, brady < 60, NV, anorexia 
    • Half life is 36-48 r
    • given PO, IM, IV, (Admin PO QOD)
    • NI: monitor apical pule for 1 minute, < 60 omit drug and notify HCP, monitor I&O and serum digoxin level (narrow tx range) monior K+, BUN, LFT
    • Monitor for Signs and symptoms of toxicity: abdominal pain, anorexia, NV, visual disturbances, bradycardia 
    • Administer Digibind: binds to digoxin and excreted by the kidneys
  21. What is the diet therapy for heart failure?
    • Low sodium diet: 2000 mg/day or less
    • low in fat 
    • No caffeine
  22. What is cardioversion?
    • synchronized countershock administered to patient with dysrhythmias resistant to medications
    • Dig is DC X2 days 
    • Anticoagulants given for 4-6 weeks after to prevent clots 
    • NI: pg 737
  23. What is Coronary artery bypass graft?
    • (CABG) 
    • Elective or emergent 
    • Under general anesthesia 
    • A heparinized, oxygenated bypass machine circulates blood during the surgery 
    • Potassium stops the heart during surgery 
    • Heart is defibrillated back into NSR
    • Saphenous veins or mammary artery grafts are used to bypass damaged coronary arteries
  24. What is the post op care for CABG?
    • Ventilated for 3-6 hours 
    • Pacemaker and chest tubes 
    • Central lines, 2 lg bore IVs
    • Cardiac monitor, FC 
    • Multiple meds
  25. Furosemide (Lasix)
    • Class: diuretic 
    • Action: increasess renal excretion of water and electrolytes 
    • Half life: 30-60minutes 
    • PO, Im, IV
    • PO Onset: 30-60 minutes, IV onset is 5 minutes 
    • SE: 
    • AE:
    • NI: