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57 Cards in this Set

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Which part of stethoscope is used for high pitched sounds? Give examples of sounds in

Diaphragm


(S1 & S2)

Which part of stethoscope is used for low pitched sounds? Give examples of sounds in

Bell ( S3 & S4)

Which ❤️ sound indicates closure of the tricuspid & mitral (AV) valves? Signals beginning of systole (ventricular contraction)? Best heard w/ diaphragm? Soft lub sound

S1

Which ❤️ sound indicates closure of the aortic & pulmonic (semilunar) valve‘s? Signals the beginning of diastole? High-pitched best heard w/ diaphragm? Sharp dub or dup sound?

S2

What is an abnormal 💓 that has extra 💓 heard in early diastole? Heard close after S2 known as ventricular gallop? Maybe normal in young adults (🏋🏻‍♂️🏃🏻‍♂️), considered pathologic in pts w/ 💔 failure or mitral valve regurgitation?

S3

Explain the Kentucky gallop.

[S1(Ken) S2(tuc) S3(ky)]


The rhythm & stress of S1 followed by S2 & S3 together

What is an abnormal extra 💓 heard in late diastole? Precedes S1 Of next cardiac cycle (atrial gallop/presystolic gallop)? Low pitched/frequency vibration caused by atrial contraction, maybe normal inolder adults w/o CAD? Pathologic in pts w/ CAD, cardiomyopathy, aortic stenosis, L-ventricular hypertrophy

S4

When does the S4 💓 occur?

Just after atrial contraction at the end of diastole & immediately before S1 producing a rhythm sometimes referred to as the Tennessee gallop were S4 represents the “Tenn” syllable

What is generated by turbulent flow blood, can be physiologic (benign) or pathologic (abnormal), characterized by loudness, pitch, quality, timing, duration, grades?

Heart murmurs

High-pitched scratchy sound heard during S1/S2 at the apex of the heart? Transient or intermittent, may last several hours/days?

Pericardial friction rub

When is pericardial friction rub best heard?

When the patient is sitting and leaning forward at the end of expiration

How is pericardial friction rub caused?

By friction that occurs when inflamed surfaces of the pericardium move against each other (pericarditis)

6 Things to include in abnormal heart sound documentation when heard?

-if occurred during systole/diast


-anatomic location where heard loudest


-Heard with diaphragm or bell?


-position of pt (recumbent/leaning forward)


-characteristics of sound (soft/musical)


-other abnormal findings (irregular rhythms, palpable chest wall heaves)

How do you remember where heart valves & auscultation points are located?

Aortic valve


Pulmonic valve


Erb’s point


Tricuspid valve


Mitral valve

Where is the aortic valve auscultated?

2nd intercostal space, right sternal border

Where is the pulmonic valve auscultated?

2nd intercostal space, left sternal border

Where is Erb’s point auscultated?

Left intercostal space, close to sternum

Where is the tricuspid valve auscultated?

5th Intercostal space, close to the sternum

Where is the mistrial valve auscultated?

5th intercostal space, left midclavicular line

What are the symptoms of sinus bradycardia?

Pale cool skin


Hypotension


Weakness


Angina


Dizziness/syncope


Confusion/disorientation


SOB

What are the nursing interventions for a patient with symptoms of sinus bradycardia?

-give IV atropine


(If ineffective, transcutaneous pacing or a dopamine or epinephrine infusion)


-permanent pacemaker therapy maybe needed


(if bradycardia due to drugs, may be held/DC/reduced)

What are the symptoms of sinus tachycardia?

Dizziness


dyspnea


hypotension


⬆️myocardial O2 consumption


Angina

What are the nursing interventions for sinus tachycardia?

From pain=pain meds


Stable=vagal maneuvers


⤴️HR/O2= IV bblockers (metoprolol, lopressor), calcium channel block (cardizem)


Unstable= synch cardioversion

What are the symptoms of premature atrial contractions (PAC)?

-palpitations


-heart skipped a beat


-May indicate enhanced automaticity of the atria or a reentry mechanism (Supraventricular tachycardia)

How do you treat premature atrial contractions (PAC)?

Stop caffeine or sympathomimetic drugs


-use beta blockers

What are the symptoms of paroxysmal supraventricular tachycardia?

-prolonged episode & HR greater than 180 beats/minute


-⤵️ CO


-hypotension


-palpitations


-dyspnea


-angina

How is paroxysmal superventricular tachycardia treated?

Vagal stimulation/drug therapy


(Valsalva/carotid massage, coughing)


-IV adenosine (plus bblockers/ccb diltiazem/Calan)


-synchronized cardioversion (if others dnt work/unstable)

What is the ongoing treatment of recurring paroxysmal supraventricular tachycardia in pts w/ WPW syndrome?

Radio frequency catheter ablation of the accessory pathway

What are the symptoms of atrial flutter?

-tachydysrhythmias (200-350b)


-⤴️ ventricular rates


-loss of “atrial kick”


(HF/Stroke) give warfarin

How is atrial flutter treated?

Radiofrequency catheter ablation


Slowing ventricular response by increasing AV block


(calcium channel blocker/beta blocker’s)


-electrical cardioversion


-anti-dysrhythmia drugs (ibutilide)


-maintain rhythm (amiodarone, flecainide)

What are the symptoms of atrial fibrillation?

350-600bpm


-⤵️CO


-thrombi clots form in atria


(Stroke)

What are the nursing interventions for atrial fibrillation?

-ventricular rate control (diltiazem, metoprolol, digoxin)


-electrical conversion


-antidysrhymia drugs (amiodarone/ibutilide)


-anticoagulation therapy (warfarin if longer than 48hrs)


-if nonvalvular=dabigatran, apixaban, rivaroxaban


-if nothin works= radiofrequency catheter ablation, maze procedure, AV nodal ablation (pace maker)

What is a treatment strategy to prevent blood clot formation of patient who had atrial fibrillation?

Left atrial appendage inclusion (LAA)

What are the symptoms of junctional dysrhythmias?

*61-100bpm accelerated or 101-180bpm tachycardia


-Safety mechanism when SA node is not effective


Junctional tachycardia (hypertensive-hemodynamically unstable, ⤵️CO) emergency

How are junctional Dysrhythmias treated?

Escape rhythm= atropine


Accelerating rhythm/tachycardia= stop drug causing


(Use bblockers, ccb if no toxicity) no cardioversion

What are the nursing interventions for first degree AV block?

No treatment


Monitor patient for any new changes in heart rhythm

What are the nursing interventions for Second-Degree AV block type 1?

Symptomatic=atropine ⤴️HR


-temporary pacemaker (MI)


Asymptomatic= observe closely, pacemaker on standby

What are the symptoms of second-degree AV block type 2?

(Poor prognosis)


-⤵️HR/CO/BP


-myocardial ischemia


(need permanent pacemaker)

How is second degree AV block type 2 treated?

-transcutaneous pacing or temporary pacemaker

What are the symptoms of third degree AV block?

⤵️CO/Subsequent ischemia HF and shock


-syncope, periods of asystole

Kind of dysrhythmia?

None, regular

What kind of artifact is this?

Muscle tremor

What kind of artifact is this?

Loose electrodes

Name this ekg.

Sinus bradycardia

Name this ekg.

Sinus tachycardia

Name this ekg.

(PAC) Premature Atrial Contraction

What is this an example of?

Atrial flutter

What is this an example of?

Atrial fibrillation

Name this heart block.

1st degree atrioventricular block

Name this heart block.

Second degree AV block type I (w/ progressive lengthening of PR interval until a QRS complex is blocked)

Name this heart block.

2nd degree AV block II (w/ constant PR intervals & variable blocked QRS complexes)

Name this heart block.

3rd degree AV block

What are these various examples of?

Premature ventricular contractions

Which type of ventricular tachycardia is this?

Monomorphic

Which type of ventricular Tachycardia is this?

Torsades de pointes (polymorphic)

What is this an example of?

Ventricular fibrillation

How is 3rd degree AV block treated?

-Transcutaneous pacemaker until temporary transvenous pacemaker inserted


-dopamine & epinephrine


-(need permanent pacemaker)