Care II Exam II

Cardiac output

CO = stroke volume (SV) × heart rate (HR)

Preload

The pressure generated in the ventricles at the end of diastole and the resultant stretching of the muscle fibers

Afterload

The amount of resistance to ejection of blood from the ventricle

Contractility

The force generated by the contracting myocardium under any given condition

Creatine kinase

Enzyme found mainly in cardiac cells that is released upon cell death; Elevated levels is indicator of acute MI- peaks within 24 hrs

Troponin

Protein found in myocardium which regulates contractile process; Increase in troponin can be detected within hours and remains elevated for often as long as 3 weeks to detect recent MI damage

Echocardiogram

• Measure ejection fraction

• Examine size, shape, & motion of cardiac structures

• Determine chamber size

• Etiology of heart murmurs

• Evaluating function of heart valves & ventricular wall motion

Electrocardiogram

Records the electrical activity of the heart using skin sensors called electrodes; The # & placement of electrodes depends on type of ECG needed *Most use 3 to 5 placed on limbs and chest

P wave

Atrial depolarization; Firing of the SA node, indicating atrial contraction

QRS

Ventricular depolarization; Impulse has traveled through Bundle of His, right & left bundles & has reached Purkinje fibers, indicating ventricular contraction

T wave

Ventricular repolarization (resting state)

Isoelectric line

When no electrical activity is detected the line on the graph is flat

PR interval

0.12-.20 sec

A fib

Quivering— no P waves; Big risk for clots!!

PP interval

Used to determine atrial rhythm & rate

RR interval

Used to determine ventricular rhythm and rate

ST segment

Represents early ventricular repolarization; Usually isoelectric

U wave

Thought to be Purkinje fiber repolarization; Sometimes also seen with low potassium, HTN, heart disease

QT interval

<0.40 sec; If prolonged = risk for the lethal ventricular dysrhythmia of “Torsades de Pointes”

Arrhythmias

Disorders of the electrical impulses within the heart that cause disturbances of heart rate, heart rhythm, or both

Athersclerosis

Deposition of plaque on walls

Myoglobin

Heme protein that helps transport O2, also found in skeletal & cardiac muscle; Not cardiac specific so (-) results r/o MI

Heparin induced thrombocytopenia

Immune-mediated disorder in which antibodies form against the heparin-platelet factor complex; Dx heparin as soon as HIT is suspected

Cardiac arrest

Occurs when the heart ceases to produce an effective pulse and circulate blood; Consciousness, pulse, and blood pressure are lost immediately

Acid-base balance

Measured in the concentration of Hydrogen ions in bodily fluids

Lung compensation takes…

5-15 mins *Sensitive to acid-base changes

Kidney compensation takes…

Up to 24 hrs *Much more powerful and result in changes in ECF composition

Arterial blood pH

7.35-7.45

PaCO2

35-45

HCO3

22-26

PaO2

80-100 on RA

Arterial blood gas

Provides information about the ventilation and diffusion of gases in the lungs and the acid-base balance of the blood; Evaluates CO2, pH, O2 saturation, and HCO3- levels

Partial compensation

If that value is < or > normal & pH is abnormal

Complete compensation

If that value is < or > normal & pH is normal

Respiratory acidosis

Caused by retention of carbon dioxide or conditions which impair gas exchange *Hypoventilation→Hypoxia

Metabolic acidosis

Happens when there is an excess of hydrogen or decrease of bicarbonate *Kussmaul respirations

Respiratory alkalosis

Caused by excessive loss of carbon dioxide *Hyperventilation

Metabolic alkalosis

Happens when there is an excess of bicarbonate or decrease of hydrogen

K levels in acidosis

Hyperkalemia

K levels in alkalosis

Hypokalemia

Oxygen transport

Transported from the lungs to the tissues; Most O2 combines with hemoglobin in RBCs and carried to tissues as oxyhemoglobin, and remaining is dissolved and transported in plasma and cells

Carbon dioxide transport

Must be transported from the tissues to the lungs and is continually produced in cell metabolism; Carried inside RBCs, combines with hemoglobin as carbhemoglobin, and transported in plasma as carbonic acid

Pneumonia

Inflammation of lung; Bacterial or viral lung infection

Early signs of hypoxemia

Dyspnea, restlessness, anxiety, fatigue, inc BP, and tachycardia

Late signs of hypoxemia

Cyanosis and coma

Nasal cannula

2-6 L; Humidify

Simple face mask

6-10 L; Prevents rebreathing exhaled CO2

Nonrebreather mask

10-15 L; Don’t forget to inflate

Venturi mask

2-15 L (Different colors); Helpful for pts at risk for hypercapnic resp failure

Aerosol mask

6-10 L; Helps ease bronchospasms and humidified

Face tent

10-15 L; Helpful for facial trauma/burns

High flow oxygen therapy

30-60 L; Oxygen delivered at a rate higher than traditional oxygen therapy to reduce work of breathing, improve gas exchange, and reduce anatomical dead space

CPAP

Provides a single set of pressure throughout sleep

BIPAP

Two distinct pressure settings for inhale and exhale

Atelectasis

Closure or collapse of alveoli; Absorptive, compressive, or obstructive

Rhinitis

Nasal and/or sinus mucosa inflammation/ irritation

Sinusitus

Inflamed sinuses *Often occurs after rhinitis

Obstructive sleep apnea

Airway collapses; Air flow blocked to lungs

Pharyngitis

Inflammation of pharyngeal walls

Tonsillitis

Inflammation and infection of the tonsils and lymphatic tissues located on each side of the throat

Laryngitis

Inflammation of the mucous membranes lining the larynx, possibly including edema of the vocal cords

Pulmonary tuberculosis

Highly communicable disease caused by Mycobacterium tuberculosis; Transmitted via aerosolization

Acute respiratory failure

A sudden, life threatening, inadequate ventilation and/or oxygenation

Precontemplation

Denial

Contemplation

Ambivalence

Determination/Preparation

Motivated

Action

Doing it

Maintenance

Living it

Relapse

Start over

Chantix

Prescription nicotine receptor blocker; Take 1 week before quitting, stay on for 12 weeks (GI s/e)

Pleural effusion

Excess fluid in pleural space *#1 sx is SOB

Chest tube assessment ABCDE

Air leak

Bubbling

Crepitus

Dependent loops

Excellent seal

Partial laryngectomy

Pt can still speak

Total laryngectomy

Patient will not have a voice and will have a stoma; May need radical neck dissection

Tracheostomy

Elective or emergency procedure for airway that can be temporary or permanent; Uncuffed for children < 8-years old

Stoma

Surgically created during surgery for total laryngectomy- required in order to remove all tissue that may be cancerous; Always permanent

Exercise stress test

Walking on treadmill to see if there is a change in VS, EKG, or ↑ pain

Dobutamine/adenosine

Medication given to ↑ HR, if the patient cannot walk on treadmill

Arteriosclerosis

Degeneration of arteries

Coronary artery disease

Buildup of plaque that causes arteries to narrow, leading to limited blood flow to the heart

Angina

Chest pain from temporary ischemia

Stable angina

Lasts 3-5 minutes; Treated with rest and NTG

Unstable angina

Lasts longer than 20 minutes; Does not go away

with rest or NTG *Medial Emergency!

Myocardial infarction

Complete blockage in the hearts arteries from lack of oxygen; Assess VS, EKG, labs, history, and start an IV

Percutaneous intervention

Balloon inflate with a stent to open artery; If cath-lab is not available, may give thrombolytics (Alteplase) but it has a high risk for bleeding!

Coronary artery bypass grafting

Bypasses the artery and places a graft (up to 4x)

Heparin therapy

Prevents formation of NEW clots; Start with bolus, then continuous infusion *Monitor pTT and platelets

QRS complex

0.06-0.12 sec

QT interval

<0.40 sec

Prolonged P wave

First degree AV block *Give beta blockers

Prolonged QRS

PVC

ST elevation

MI

ST depression

Ischemia

V tach

Shaped like a tombstone; QRS is wide— no P or T waves

A flutter

Shaped like a sawtooth; Affects the P-wave

SVT

Narrow QRS; Vagal treatment (bear down)

V fib

No QRS or P waves; Medical emergency *Defib the V-fib

Asystole

Give epi and CPR; Medical emergency!

Cardioversion

A synchronized shock used ONLY during the R wave of the QRS complex; Indicated for A fib, A flutter, SVT & V tach

Defibrillation

Asynchronous shock used during emergencies, often combined with CPR; Indicated for V fib & pulseless V tach