Test # 2 Ekg's, Cardiac Meds

Front 1

Characteristics of normal sinus rhythm?
1. P wave
2. PR interval length
3. Rhythm
4. QRS complex
5. Rate

Back 1

1. upright P; only 1 P for every QRS
2. < 0.20 sec
3. regular
4. no longer than 0.10 sec or 2.5-3 little boxes
5. 60-100 beats/min

Front 2

1. length of little box?
2. big box? = 5 little boxes

Back 2

1. 0.04 sec
2. 0.20 sec

Front 3

What is an SVT rhythm ie Super Ventricular Rhythm?

Back 3

catch-all phrase for any rhythm over 150 beats/min

Front 4

What is treatment of choice for SVT?

Back 4

Adenosine; its pushed fast via IV push; stops heartrate; allows heart to reboot
- used for "SVT conversion"

Front 5

Drugs of choice to treat V-Tach? Also, drugs of choice for all ventricular dysrrhythmias

Back 5

Lidocaine & amiodarone - antidysrhythmics

Front 6

what are the only 2 rhythms that are shockable by defibrillator?

Back 6

V-Tach & V-Fib

Front 7

1. Digoxin is ____.
2. It's a ___ inotrope & a ____ chronotrope.

Back 7

1. Digitalis
2. positive; negative

Front 8

How to treat A-Fib?

Back 8

Digoxin,
Cardizem (diltiazem) - Ca Channel Blocker
Cardioversion may be nec

Front 9

An EKG w a saw-tooth appearance is ____

Back 9

Atrial Flutter

Front 10

How to treat A-Flutter?

Back 10

digoxin (Lanoxin) & diltiazem (Cardizem)

Front 11

If EKG rhythm has more Ps than QRS complexes, it's (3rd degree) heartblock (as long as not sawtooth).
How to treat?

Back 11

drugs don't work; pt needs pacemaker

Front 12

How to treat V-Fib?
1st
2nd
3rd

Back 12

1. Defib
2. Epinephrine
3. Atropine

Front 13

____ means that for every spike from a pacemaker, you see a QRS complex. If you see spike w/o QRS, you have a pacemaker with ___

Back 13

Capture; loss of capture

Front 14

You'll never see a P wave before a QRS in a PVC (Premature Ventricular Contractions), since the impulse comes from ventricle.

Back 14

T

Front 15

2 spikes on an EKG for pt with pacemaker means

Back 15

Dual chamber or atrio-ventricular pacemaker;

Front 16

Only 1 spike with pacemaker strip means it's a 1 -spike ventricular pacemaker. T or F

Back 16

T

Front 17

Most common lead utilized for continuous cardiac monitoring?

Back 17

lead II or Mcl= Modified Chest Lead

Front 18

A normal sinus rhythm has 1 Pwave, 1 QRS complex, & 1 T wave. T or F

Back 18

T

Front 19

How do you measure heart rate on EKG strip?

Back 19

- Quick way: 300/# of large squares between R-R intervals
- More accurate: 1500/# of small squares

Front 20

1. Sinus tach is HR of ____
2. effect on cardiac output and heart?
3. Treatment?

Back 20

1. >100/min
2. initially increases cardiac output; however, sustained increase in HR lowers cardiac output & decreases coronary perfusion time
3. correct underlying cause

Front 21

1. Sinus brady is HR of ___
2. You treat sinus brady only when?
3. Causes?
4. Treatment?

Back 21

1. , 60
2. treat only if pt is symptomatic ie SOB, etc
3. vagal stimulation ie, bowel straining, beta blockers, hypothyroidism
4. Atropine is first choice

Front 22

A -Fib is most common dysrhythmia; causes dec in cardiac output; atria quiver 350-600x/min
- can lead to blood stagnation leading to thrombus formation increasing stroke risk
1. EKG has no ___ waves
2. Treatment?

Back 22

1. no P waves
2. anticoagulant to prevent clots, pacemaker, Cardizem, digoxin, cardioversion may be necessary

Front 23

1. PVC?
2. What is priority treatment?
3. Key electrolyte imbalance that causes PVCs?

Back 23

1) Premature ventricular contraction, ie early ventricular complexes (QRS) followed by a pause; PVCs may occur in singles, doubles or triplets ventricle is irritable; freq of PVCs increase with age;
2. Oxygen, then Lidocaine; also need to eliminate underlying causes (such as caffeine, stress)
3. Hypokalemia- give potassium; if Hyperkalemia treat with insulin; can also be caused by hyperkalemia

Front 24

1. V-tach has HR of _____
2. V-tach can cause ____
3. Causes?
4. Assess?
5. Treatment?

Back 24

1. 100-220; V-Tach can quickly deteriorate into V-Fib
2. Cardiac arrest
3. anything that causes PVCs; hypo/hyperkalemia
4. Airway, Breathing, Circulation. LOC
5. O2 is priority for ischemia; lidocaine; if pulseless, use AED; if conscious, ask them to cough (intrathoracic pressure allows for cerebral perfusion)

Front 25

1. V-Fib?
2. Causes?
3. Assessment?
4. Treatment?

Back 25

1. ventricles quiver, consuming large amts of 02; no cardiac output or pulse, and therefore no perfusion; rapidly fatal if not terminated in 3-5 min.
2. Most commonly caused by myocardial ischemia
3. Pt loses consciousness, becomes pulseless, and apneic (stops breathing)
4. 1st choice= defibrillate, then drugs: Immuteril, Lidocaine, Epineprine, Dopamine, Vasopressin (last choice since can only be used 1 time)
5.

Front 26

1. Asystole?
2. Treatment?

Back 26

1. Pulseless, unconscious
2. CPR, External pacemaker, atropine, epinephrine

Front 27

Preload is decreased when there is less blood return to the heart. this is caused by dilation of the ______

Back 27

veins

Front 28

Afterload is reduced because of dilation of the _____

Back 28

arteries

Front 29

Why should a Transderm Nitro patch be removed at night?

Back 29

removal of patch to allow for 8-12 hrs nitrate-free interval to prevent drug tolerance.

Front 30

what is the goal of Heparin therapy in a pt with angina or MI

Back 30

APTT of 1.5- 2x

Front 31

1. For Lovenox, don't need to monitor ___ or ____
2. For Coumadin, measure ___ & ___

Back 31

1. PTT and INR
2. PTT and INR

Front 32

What are 3 actions of morphine that make it useful in cardiac setting?

Back 32

- rapid onset of action
- dilates veins so preload is decreased & heart workload is decreased
- relieves pain of MI

Front 33

Before administering morphine, what do you check for?

Back 33

- check baseline resp rate
- check BP
- monitor for respiratory depression

Front 34

Antidote for morphine?

Back 34

- Naxolone aka Narcan

Front 35

Beta blockers aka Beta-Adrenergic blockers block the release of _____ and thus decrease HR & BP

Back 35

- catecholamines such as epinephrine, norepinephrine
- Beta Blockers are std protocol after MI and have been shown to increase survival rates of MI pts

Front 36

There are 2 types of beta blockers
- Cardioselective
- Noncardioselective

Which type is preferred for cardiac pts?

Back 36

Cardioselective is preferred since Noncardioselective constrict your lungs (cause bronchoconstriction); so COPD pts shouldn't be put on these

Front 37

Why are ACE Inhibitors administered to pts who have had an MI?

Back 37

can prevent ventricular remodeling (scarring)

Front 38

Ca Channel Blockers?

Back 38

negative inotrope - decrease contractility; decrease workload of heart thus dec 02 need.
- Also dilate coronary & peripheral vessels
- Diltiazem (Cardizen)

Front 39

2 vitals to monitor for Ca Ch blockers?

Back 39

BP & HR (just like w Beta Blockers)

Front 40

Heparin measure is ___

Back 40

aPTT (activated partial thromboplastin)
- should be 1.5 to 2.5x normal

Front 41

Coumadin aka ____ is measured by ____

Back 41

Warfarin;
PT (prothrombin time) 10 -12 sec
INR (International normalized ratio) 1.3 to 2,0

Front 42

Name thrombolytic meds?

Back 42

- Activase, tPA
- Streptokinase

Front 43

Name antiplatelet meds?

Back 43

-Aspirin (acetylsalicylic acid)
- clopidogrel (Plavix)

Front 44

How do positive inotropes work?

Back 44

stimulate myocardial contractility which:
- improves blood flow to periphery and kidneys by increasing cardiac output
- decreases preload
- decreases fluid retention in lungs & extremeties
- increases BP

Front 45

Name positive inotrope meds?

Back 45

- Dobutamine (Adrenergic Agonists; also a catecholamine)
- Dopamine (Adrenergic Agonists)
- Inamrinone (major side effect is thrombocytopenia)

Front 46

Function of Cardiac glycosides like _____?

Back 46

Digoxin (Lanoxin)
- positive inotrope which increase myocardial contraction
- negative chronotrope which slows heart rate

Front 47

What do you monitor for pt taking digoxin?

Back 47

- digoxin toxicity- ( shown as prolonged PR interval on EKG)
- for hypokalemia (potassium level) which enhances digoxin toxicity
- on EKG, hypokalemia would produce U waves
- before giving digoxin, ck heart rate; if HR<60, don't give
- controls rate of chronic A-Fib

Front 48

Loop diuretics?

Back 48

- Furosemide (Lasix)
- are potassium wasting

Front 49

SVR?

Back 49

Systemic Vascular Resistance
- vasoconstriction increases SVR
- Vasodilation decrease SVR

Front 50

- CVP (Central Venous Pressure) measures preload of RV
- PVR (Pulmonary Vascular Resistance) measures afterload of RV i e measures BP before blood is pumped through lungs
- PAWP: Wedge pressure tells you LV afterload & preload

Back 50

T

Front 51

1. Elevated PAWP indicates_____
2. Decreased PAWP indicates____
While PAWP is inserted into R side of heart, it measures L side pressure

Back 51

1) LV failure, hypervolemia, mitral regurgitation
2) hypovolemia, afterload reduction

Front 52

Signs of Digoxin toxicity?

Back 52

Anorexia, Dble vision, Blurred vision, halos

Front 53

A permanent pacemaker is inserted under general anesthesia & done under flouroscopy
- What is post-op care?

Back 53

- monitors heart rate & rhythm via EKG
- Chest xray to make sure leads are properly positioned
-inspects insertion site

Front 54

Nurse's pre-op resp for pt due for CABG surgery?

Back 54

-gets pt to sign consent
- prepares pt for post-op care; explains how to splint, deep breathe, cough
- describe surgery: sternal incision, leg incision, chest tubes, foley
- hold meds if diabetic
- administer meds - antibiotics, anti HTN meds

Front 55

Purpose of CPB (CardioPulmonary Bypass)

Back 55

- to provide O2, blood circ, hypothermia during induced cardiac arrest
- blood is heparinized, oxygenated & returned to body
- pt core temp is cooled to 90 to slow metabolism & dec 02 need.
- CPB machine can throw blood clots; won't know if pt had stroke until wakes up

Front 56

Post-op care of CABG pt?

Back 56

- assess for dysrythmias
- monitor for complications of CABG:
- fluid & electrolyte imbalance- may need to give potassium bolus due to hemodilution
- hypothermia, hypertension
- P: assess LOC
- E: foley care, draining
- R: assess for pain
- S: assess for infection; use Bear Hugger to keep pt warm
- O: pt on mech ventilator, monitor ABGs; Doc will keep pt hypotensive to prevent leaking of valves (if valve surg)

Front 57

Risk factors for Infective Endocarditis?

Back 57

-Rheumatic Fever,
- valve repl: any infection entry site such as dental, skin rash, surgery
- IV drug abuse

Front 58

What is treatment of choice for prosthetic valve endocarditis?

Back 58

- first, antimicrobials, then valve repl

Front 59

Reasons for inserting a mechanical valve vs a biological valve?

Back 59

- young people get mechanical valve since they last longer; however, need to be on lifelong anticoagulants due to blood clots
- young people don't get biological valves since only last 7-10 yrs; younger pts also has higher calcium in blood and will calcify biological valves quicker.

Front 60

Heart transplant list pts are at risk for sudden death & should report dec cardiac output causing dyspnea on exertion, dec exercise ability, fatique, palpitations, orthopnea, chest pain

Back 60

T

Front 61

What criteria are used for heart transplant candidate?

Back 61

-life expectancy < 1yr
- age <65
-absence of active infection
- stable psychosocial
- no evidence of drug/alcohol abuse
- NY Heart Assoc class III or IV

Front 62

Why will surgeon remove the diseased heart and leave the posterior atria in place?

Back 62

the atria serve as anchors for donor heart

Front 63

A heart transplant pt will show what on EKG?

Back 63

- will see 2 unrelated P waves-- 1 from donor heart and 1 from pt's atria

Front 64

How does post-op care for heart transplant pt differ from other cardiac surgery?

Back 64

- nurse must be especially vigilant to identify occult bleeding into pericardial sac w potential for cardiac tamponade

Front 65

Name the 4 pacemaker types in order of progression

Back 65

1) External pacemaker
2) Temporary external pacemaker
3) Permanent pacemaker
4) Pacemaker w AICD

Front 66

Indications for PM?

Back 66

treat fainting spells, congestive heart failure, hypertrophic cardiomyopathy

Front 67

diff types of perm pacemakers?

Back 67

- Single chamber - 1 lead in atrium or ventricle
- Dual chamber - 1 lead in atrium and 1 lead in ventricle
- Biventricular pacemaker- 3 leads: 1 in RA, 1 in RV, 1 in LV

Front 68

1) Failure to Pace?
2) Failure to Sense?
3) Failure to Capture?

Back 68

1) if no spike occurs; Pacing is the delivery of impulse to heart causing spike; if single chamber PM, 1 spike before P wave; if dual chamber PM, then 2 spikes, 1 before P wave and 1 before QRS complex
2) PM isn't sensing pt's normal rhythm; so if PM is sensing properly, you only see spikes when HR falls below or above range
3) See spike but no QRS following; solution is to turn up output

Front 69

Nursing role prepping pt for perm pm insertion?

Back 69

- consent witnessed
- NPO after midnight
-

Front 70

Post-op care of pt w perm pacemaker?

Back 70

- monitor HR & rhythm
- CXR to make sure leads are in proper pos
- show pt how to care for wound
- have pt carry pacemaker card & wear ID bracelet
- inspect site for bleeding
- assess for pain

Front 71

Pt teaching for pacemaker?

Back 71

- don't lift heavy objects; more than 10 lbs
- no MRI; avoid strong electromagnetic fields: arc welding,
- PM lasts 4-8 yrs
- have FU appt in 5 wks to make adj to PM
- take pulse on daily basis
- notify PCP of dizzyiness, SOB, slow/fast HR

Front 72

What is an ICD?

Back 72

Implantable Cardioverter Defibrilator. Used by pts:
- w 1 or more cardiac arrests
- life-threatening Ventricular arrythmias
- at risk for sudden death
- recurrent V-tach

Front 73

Pt/family teaching w ICD?

Back 73

- instruct family how to recognize, prevent & manage cardiac disorder that may set off ICD
- know how to perform CPR
- When ICD fires, pt should lie down & call 911
- inform family members they may feel electric shock if touching pt when shock is delivered, but it's not harmful