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144 Cards in this Set
- Front
- Back
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what is systole
3 |
ventricular contraction
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what is diastole
3 |
ventricular relaxation
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what is the purpose of
using electricity in the heart 3 |
to disrupt the dysrhythmia
so the natural pacemaker (SA node) can take over |
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what causes an unhealthy rhythm
3 |
unhealthy tissue in the
myocardium has taken over as the pacemaker |
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what are the two types of
electrical shock that can be delivered 3 |
cardioversion
defibrillation |
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when is cardioversion done
3 |
when the pt has a heartbeat/pulse
the shock is delivered in synchrony with the pts heartbeat so you are not put into a fatal rhythm |
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what do you need for cardioversion
3 |
consent
sedation if the pt is awake |
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when is defibrillation used
3 |
pt is clinically dead
no pulse no heart rate no CO no breathing not conscious |
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when is defibrillation done
3 |
not done in synchrony with rhythm
it interrupts the fatal rhythm so the SA node can take over as pacemaker |
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what is joules
3 |
the quantified amount of
electricity from the defibrillator or cardioversion the physician order the amount |
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what is the purpose of the Holter monitor
3 |
to detect dysrhythmias
to evaluate the effectiveness of drugs done for 24-48 hours and pt keeps diary |
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what is the disadvantage of the Holter monitor
3 |
pt may not have dysrhytmias while weaning
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why does a pt get a pacemaker
3 |
to help keep the rhythm of the SA node
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why are some other reasons
to use pacemakers 3 |
septic shock
MI over the SA node digoxin toxicity(SE bradycardia so will need temporary pacemaker) |
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what the types of pacemakers
3 |
percutaneous
temporary permanent |
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what is a percutaneous pacemaker
3 |
a pulse generator that provide electricity
via pads over outside chest walls the pacing is thru the chest wall it stings the chest so give sedation |
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what is a temporary pacemaker
3 |
a cordis or central line is
threaded into a jugular and embedded into the epicardium it is paced outside body ordered by physician controlled by a nurse |
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what is a permanent pacemaker
3 |
last 10-15 years
disc is implanted in abdomen or axilla wire implanted in ventricular or atrium OR or general anesthsia |
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what are the two functions of the pacemaker
3 |
sensing-senses heart rhythm and if it drops
pacer kicks on to keep pace capture-beats at a specific rhythm overrides person's rhythm that may not be adequate |
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what are the 2 things that can
cause pacemaker failure 3 |
battery failure
displaced wire |
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what is the purpose of the EPS lab
3 |
Electrophysiology studies
id tachydysrhythmias id heart block id bradydysrhythmias id accessory pathways see effectiveness of antidysrhythmic drugs |
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what is done with medications in EPS
lab 3 |
will try various drugs IV to see which drugs will convert you
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what is an AICD
automatic implantable cardioverter-defibrillator 3 |
detect lethal arrhythmais
delivers 25 joules of electrical shock to heart to interrupt lethal rhythm and allow SA node to resume as pacemaker |
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how does the AICD work
3 |
senses HR and rhythm from wires implanted in
epicardium |
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what does the P wave represent
3 |
that the SA node sent the signal out
the SA node is in charge |
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what is the QT interval
3 |
beginning of the Q to end of T wave
time it takes the heart to depolarize and repolarize |
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what is S1
3 |
mitral and tricuspid closing
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what is S2
3 |
pulmonic and aortic closing
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what can we diagnose from the 12 lead EKG
3 |
when and where injury and ischemia occuring
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what lead is used in
continuous telemetry monitoring 3 |
Lead II
check for dysrhythmias |
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what is conduction pathway of
electricity thru the heart 3 |
the SA node
to AV node to the Bundle of HIS to the Left and Right Bundle branches to the Perkinje Fibers to the Ventricles |
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what is the measurement of each box
3 |
.04
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what is the PR interval
3 |
atrial contraction
SA node send out electrical signal that travels thru atruim and atruim contracts normal .12-.20 (3-5 boxes) |
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what is the QRS interval
3 |
ventricular contraction
depolarization of ventricles normal .06-.12 |
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what is the T wave
3 |
repolarization of ventricles
rest/refractory period waiting for next action to happen |
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what is an EKG
3 |
graphic tracings of electrical impulse of the heart from charged ions moving across membranes of myocardial walls
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how are the leads placed
3 |
negative to a positive across the heart
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what is dysrhythmia
3 |
abnormal
disordered rhythm of the heart interruption of automaticity |
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what does dysrhythmias cause
3 |
decreased cardiac output
clots fatal rhythms |
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when can nurse do defribrillation
3 |
in critical care unit without physician if pt in
ventricular tachycardia |
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what are the 6 questions to analyze
an EKG strip 3 |
1-is it regular
2-do I see a P wave 3-what is the rate 4-what is the PR length 5-what is QRS lenght 6-what is the QT interval length |
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what does the P wave infer
3 |
if there is a P wave that means the
SA node is in charge and this rhythm is a sinus rhythm |
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how do you measure the rate
3 |
use a 6 second strip
count the complexes and multiple by 10 |
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what is the normal PR interval
3 |
.12-.20
this is a measure of the atrium |
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what is the normal QRS interval
3 |
.06-.12
this a measure of the ventricle |
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what is the first place to check for the causes of PVC
3 |
check labs for potassium levels
check for hypokalemia check for hyperkalemia |
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what could be another cause of PVCs
3 |
reperfusion dysrhythmias
when clot is broken up after an MI |
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what is the drug of choice for
reperfusion PVCs 3 |
amiodarone
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what types of PVCs need to be treated
3 |
multifocal-going in differenct directions
or greater than 6 in a minute |
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what is the drug of choice for
PVCs, reperfusion dysrhythmias or MIs |
amiodarone
if PVCs caused by hypokalemia give K can push K alittle faster not very fast 20 Meq in 100 mg over 1 hour or 40 Meq in 250 mg over 2-3 hours to stop PVCs fast |
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what does amidarone do
3 |
calms the irritable tissue to cause the cells to stop firing
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what is unsustained
ventricular tachycardia 3 |
a break in PVCs without
any intervention and heart beat goes back to normal sinus rhythm |
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what is sustained
ventricular tachycardia 3 |
PVCs greater than 30 secords
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what is the treatment for
ventricular tachycardia 3 |
best treatment is to
continuously monitor pt for prevention treatment will be based on whether have pulse or no pulse |
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what is treatment for ventricular
tachycardia if you have a pulse 3 |
first treat with drug-amiodarone
push amiodarone and then put on drip if amiodarone does not convert rhythm then do cardioversion |
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what is the treatment for ventricular
tachycardia if you do not have a pulse 3 |
drugs are not given first
no meds are given first do defibrillation because there is not pulse or rhythm to consider |
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Normal Sinus Rhythm
3 |
rate 60-100
rhythm regular P wave-yes PR interval-normal QRS normal |
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what is interpretation of
Normal Sinus Rhythm 3 |
normal sinus rhythm without ectopy
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what are the clinical S/S of
Normal Sinus Rhythm 3 |
none
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what is the collaborative management of
Normal Sinus Rhythm 3 |
keep monitoring
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Sinus Bradycardia
3 |
rate- 60 bpm or lower
rhythm-regular P wave-yes PR interval-normal QRS interval-normal |
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what is the interpretation of
Sinus Bradycardia 3 |
normal sinus bradycardia with
normal conduction pathway but discharging at less than 60 pbm |
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what are the clinical S/S
of Sinus Bradycardia 3 |
only treat if symptomatic
decrease CO that leads to SOB dizziness/lightheadness change of level of consciousness-LOC |
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in what people is
Sinus Bradycardia normal 3 |
athletes
people in excellent health |
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what are the causes of
Sinus Bradycardia 3 |
straining-valsalva maneuver
hypothermia MI over SA node medications head injury hypothyroidism vomiting (vagal stimulation) |
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what is collaborative management
for Sinus Bradycardia 3 |
atropine-only if symptomatic
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Sinus Tachycardia
3 |
rate more than 100 (100-149)
rhythm-regular P wave-yes PR interval-normal QRS interval-normal |
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what is the interpretation of
Sinus Tachycardia 3 |
sinus tachycardia with normal conduction pathway
but discharging at more than 100 bpm |
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what is the clinical S/S of
Sinus Tachycardia 3 |
hypoxia-using lots of O2-manifested as angina
change in LOC-level of consciousness low BP-hypotension SOB |
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what are the causes of
Sinus Tachycardia 3 |
caffiene (coffee, tea, soda)
pain exercise medications-OTC (epinephrine) (Primatene Mist) hypermetabolis state-cocaine mad/anger |
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what is the collaborative management of
Sinus Tachycardia 3 |
Drug of Choice
drug that will block beta stimulation Beta Blocker-olol slows down myocardial oxygen consumption |
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Supraventricular Tachycardia
3 |
rate- 150 bpm or faster
rhythm-regular P wave-no not in SA node PR interval-no P buried in T unmeasurable QRS interval-normal |
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what is interpretation of
Supraventricular Tachycardia 3 |
SA node not in charge
ventricle is fine but rate is 150 or greater rhythm originates above ventricle |
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what are clinical S\S
Supraventrical Tachycardia 3 |
angina-ischemia
dizzy anxiety SOB exhaustion/lack of rest caffeine stress |
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what is collaborative
management of Supraventricular Tachycardia 3 |
SVT is manageable
Drug of choice-adenosine or calcium channel blocker (verapamil,cardizem) physician can do carotid massage valsava maneuver will drop rate EPS lab for ablation |
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Premature Atrial Contraction
3 |
rate
rhythm-regular with 1 irregular beat P waves-yes PR interval-normal QRS interval-normal |
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what is interpretation
of Atrial Ventricular Contraction 3 |
regular rhythm with early atrial contraction
sinus rhythm with PAC |
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what are the clinical S/S of
Premature Atrial Contraction 3 |
asymptomatic
can be prelude to more dysrhythmias so monitor |
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what are causes
Premature Atrial Contraction 3 |
SOB
exercise COPD |
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what is the collaborative
management of Premature Atrial Contraction 3 |
monitor
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Atrial Fibrillation
3 |
rate-over 100 bpm
rhythm-irregular-fibrillation-waves quivering P waves-no PR interval-no QRS interval-normal ventricles fine QRS interval-normal |
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what is the interpretation of
Atrial Fibrillation 3 |
uncontrolled atrial fibrillation
disorganized atrial electrical activity can lead to blood clots losing 10% CO-atrial kick |
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what are the clinical S/S of
Atrial Fibrillation 3 |
dizziness
SOB thrombus-stroke-left side PE-right side |
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what are the causes of
Atrial Fibrillation 3 |
Heart Disease
CHF infection stress procedure on heart cardiac cath heart surgery cardiomyopathy |
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what is collaborative management
of Atrial Fibrillation 3 |
drug of choice
digoxin can also use calcuim channel blockers to bring rate down also heparin infusion to prevent clots coumadin at home also cardioversion to slow down rate |
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what is collaborative management of
Premature Ventricular Contractions 3 |
treat multifocal or greater than 6 PVCs in a minute
bigemy or trigemy Drugs amiodarone replace K Kayexalate |
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what should the nurse observe
for following ICD implantation 3 |
signs of infection
redness swelling drainage also look for fever pneumothorax hematoma bradycardia |
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what information should
be given to pt following ICD implantation 3 |
give specific information on
activity restrictions firing will feel like blow to chest if fires call physician ICD support group |
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what is included in discharge
teaching for ICD pt 3 |
no direct blows to ICD site
avoid large magnets and MRI scans may set off metal detectors if fires and do not feel good call 911 family needs to learn CPR medic alert bracelet and list of meds |
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Premature Ventricular Contraction
PVC 3 |
rate
rhythm regular with 1 irreg beat P waves-yes QRS complex-normal |
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what is interpretation of PVC
3 |
sinus rhythm with PVCs
ectopic focus in ventricle |
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what are the clinical S/S of
PVCs 3 |
could be nothing
if more than 6 in a minute could be serious |
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what are some causes of PVCs
3 |
hypokalemia
hyperkalemia MI-ischemia/hypoxiz CHF reperfusion dysrhythmias (amiodarone) |
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what is DOC for PVCs
3 |
amiodarone
supplemental K Kayexalate |
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Ventricular Tachycardia
VT 3 |
rate 150 bpm
rhythm life threatening P waves no PR interval no QRS complex wide and bizarre |
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what is the interpretation of VT
3 |
tachycardia with more than
3 PVCs in a row unsustained-break before given intervention sustained-need intervention |
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what are clinical S/S of VT
3 |
no pulse
no CO dead or almost dead occasionally can hold pulse for short time |
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what are the causes of VT
3 |
electrolyte imbalances
hypo or hyperkalemia acute MI reperfusion dysrhythmias CAD |
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what is an ectopic beat
3 |
originating outside SA node
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what does a normal conduction look
like 3 |
P wave before QRS complex
T wave after QRS complex |
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what is P wave
3 |
firing of SA node
atrial depolarization contraction if change in shape indicate pulse started outside SA node |
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what is QRS complex
3 |
ventricular depolarization
contraction |
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what is T wave
3 |
ventricular repolarization
changes in T wave ischemic process or electrolyte imbalance |
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what is the relative refractory period
in the T wave 3 |
resting state of the ventricles
second half of T wave any abnormal stimulus here leads to electrical chaos |
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where can you find P waves in
a fast rhythm 3 |
look on top of P waves
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what is the PR segment
3 |
isoelectric straight line from end
of P to QRS complex delay at AV node to allow for atrial contraction |
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positions of heart
3 |
inferior-bottom
anterior-front lateral-side posterior-back |
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what is NSR
3 |
PR 0.12-0.20
constant QT intervals regular rate of 60-100 bpm QRS complex of 0.04-.0.11 |
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what is sinus tachycardia
3 |
all the criteria of NSE
except rate is 101-150 |
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what is sinus tachycardia cause
3 |
decreased ventricular filling time
lower bp decreased cardiac output and inadequate tissue perfusion increases workload of heart |
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what are causes of sinus tachycardia
3 |
SNS stimulation-flight or flight
fear anxiety exercise excitement pain some drugs fever hypovolemic shock (bleeding or dehydration) heart failure |
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what is the treatment of sinus tachycardia
3 |
treat underlying cause
eliminate source of SNS stimulation antipyretics for fever id drug as source of SE for SNS stimulation sinus tachycardia is not usually treated with heart medication |
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what can sinus tachycardia be sign of
3 |
more serious problems like hemorrhage
or HF |
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what can sinus tachycardia
cause in people who already have heart disease 3 |
trigger CHF or MI
heart not able to sustain rapid rate |
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what is sinus bradycardia
3 |
same criteria as NSR
except rate below 60 bpm |
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what are causes of sinus
bradycardia 3 |
parasympathetic stimulation
PNS vagus nerve causes heart to slow down rest and digest |
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what can cause PNS
stimulation 3 |
valsalva maneuver
(stool softner) vomiting gagging carotid sinus massage injured SA node from ischemia or infarction SE cardiac meds |
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what does sinus bradycardia cause
3 |
decreased cardiac output
decreased cerebral blood flow (fainting) decreased coronary blood flow (angina) |
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when is sinus bradycardia not
treated 3 |
athletes
stable pts healthy pts |
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when is bradycardia treated
3 |
when pt is symptomatic with signs
of decreased perfusion hypotension SOB decreased LOC angina |
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what else can be used for the
treatment of sinus bradycardia besides drugs 3 |
temporary of permanent
pacemaker can be used alone or with drugs |
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what happens when atrial kick
is lost due to Afib 3 |
decreased cardiac output
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why are pts placed on anticoagulants
when dx with AFib 3 |
fibrillation in atria leads to blood
clots forming this can lead to pulmonary emboli, heart attack or stroke |
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what are the physical signs an emboli has
been released in the atria 3 |
sudden chest pain-heart attack
SOB-pulmonary emboli cool extremites-blood clot to legs change of LOC-stroke |
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what needs to be monitored for
pts with AFib 3 |
coagulation studies
heparin PTT Coumadin PT INR |
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what is stable VT
3 |
pt has adequate pulse and BP
is alert and talking and no chest pain give meds lidocaine |
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what is unstable VT
3 |
pt has chest pain, hypotension
decreased LOC, SOB or pulmonary edema from decreased perfusion due to decrease CO must be treated immediately with cardioversion |
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what is treatment for pulseless
VT or VF 3 |
unsynchronized defibrillation is used
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what does VT look like
3 |
ventricle greater than 100
no P wave wide and bizarre QRS QT interval normal |
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what is VFib
3 |
most frequent initial rhythm in sudden cardiac arrest
lethal but can be reversed with defibrillator no effective contraction, just quivering |
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what does VFib look like
3 |
no CO
unresponsive no pulse-no breathing no blood pressure no P wave, QRS, PR or QT pt is clinically dead and will be biologically dead unless rhythm terminated |
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what pts are at high risk for VFib
3 |
pts who have heart disease
MI HF will have AICD implanted |
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what are causes of VFib
3 |
VTachy
shock at wrong place in cardiac cycle hypoxia acidosis electrolyte imbalances electrical shock (lightening or electrical devices) |
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what is priority of VFib
3 |
pt must be defibrillated
immediately can do CPR until defibrillator avail do no wait for CPR, drugs, IV accesss or intubaton |
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what is done if first 3 shocks fail
to convert rhythm 3 |
CPR
intubation IV line med-first choice epinephrine then defibrillator repeated |
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what is asystole
3 |
absence of any cardiac rhythm
recovery is rare no CO pulse blood pressure goal is to prevent causes of asystole |
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what is done with confirmation
of asystole 3 |
CPR
then intubation, IV access the only hope of recovery is to reverse the causes |
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what are the causes of asystole
3 |
Hubert H Hoover HAD asystole
Hypoxia Hyperkalemia Hypokalemia Hypothermia Acidosis Drug Overdose |
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what are causes of PVC
3 |
SNS stimulation
caffeine drugs digitalis toxicity hypoxia hypokalemia MI |
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causes of PVC mneumonic
3 |
Hank And Harry Have Depressed Enlarged Hearts
Hypoxia Acidemia Hypokalemia Hypocalcemia Drugs-digoxin Epinephrine-stress, emotions, fever Hypomagnesuim |
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what is treatment of PVC
3 |
treat underlying cause
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why does chest pain occur as HR increases
3 |
not enough time to fill coronary arteries
during diastole |
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how does QRS dx where
dysrhythmias occur 3 |
QRS narrow and no P wave
atrial QRS wide and no P wave ventricle |
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what can happen in PVCS
3 |
can lead to life threatening
dysrhythmias have emergency drugs and defibrillator available |
