Adult Health Unit 4

P wave meaning

Atrial depolarization

QRS complex

Ventricular depolarization

T wave

Ventricular depolarization

Inverted T waves

Indicates myocardial ischemia (decreased oxygen to heart)

Infarction

Sequence of depolarization

1. SA node fires

2. Atria depolarize (P wave)

3. AV node delay

4. Bundle of His

5. Bundle of branches

6. Purkinje fibers

7. Ventricles depolarize (QRS)

Ventricular depolarization problem

Seen in QRS complex abnormalities

Normal sinus rhythm

60-100 bpm

Regular rhythm

P wave before every QRS

Normal PR interval

Sinus bradycardia treatment

Temporary pacing

1. External electrodes

2. Internal transvenous pacing

Delivers electrical impuses to maintain HR

What rhythm do we normally do Dfib for?

Vfib

Avoid what during Sinus Tachycardia

Caffeine, nicotine, stimulants

Atrial fibrillation symptoms

Irregular pulse

Palpitations

Dizziness

Fatigue

Atrial fibrillation causes symptoms how?

Decreased cardiac output due to ineffective atrial contraction

Risk factors

Smoking, genetic, thyroid, electrolyte imbalances

Cabbage patients are at risk for

Developing Afib

Pharm treatment for Afib

Elequis

Aspirin

Warafarin

Lovenox

Cardezine

Cardioverter Defibrillator (ICD)

Detects lethal dysthymias

Delivers shock automatically

Plaque composition atherosclerosis

Lipids (cholesterol)

Calcium

Cellular debris

Atherosclerosis risk factors

High cholesterol

Hypertension

Diabetes

Obesity

Sedentary lifestyle

Total cholesterol goal

Less than 200 mg/dL

Bad cholesterol

LDL

Good cholesterol

HDL

What causes angina

Coronary atherosclerosis

Myocardial ischemia (decreased blood flow)

Angina nursing diagnosis

Acute pain

Angina key assessment

Pain characteristics (location, duration, triggers)

Myocardial infarction

Myocardial tissue death (necrosis)

Classic myocardial infarction signs

Chest pain (not relieved by rest)

Radiates to left arm/jaw

Pale, cool skin

Diaphoresis

Cardiac bypass machine

Sephaneous vein - graft

Myocardial infarction priority nursing action

Vital signs

Continous cardiac monitoring (telemetry)

EKG

Myocardial infarction emergency treatment

Aspirin

Oxygen

Nitroglycerin

Morphine (MONA concept)

Myocardial infarction goal

Minimize damage by rapid reperfusion therapy

Rapid reperfusion therapy

PCI (angioplasty) or thrombolytics

How do you prevent a thromboembolism after surgery

Walking

SCDs

Bloodless surgical field + perfusion use

Cardiopulmonary bypass machine

Pre-op anxiety best responses

Acknowledge fear

Provide emotional support

VTE prevention teaching example

“I will ambulate early and often”

Endocarditis antibiotics

Blood cultures (3 steps)

Endocarditis education priority

Oral hygiene and infection prevention

Endocarditis common symptom

Intense chest pain when deep breathing (inspiration) or coughing

Endocarditis mechanical valve requires what

Antibiotic prophylaxis before dental procedures

Mitral stenosis leads to

Pulmonary venous hypertension (narrowing)

Mitral stenosis procedure if pharmacology does not work?

Balloon valvularplasty

Aortic regurgitation

Blood flows back into left ventricle during diastole

Mitral valve prolapse (MVP) symptoms

Palpitations

Dizziness

Chest pain

Rheumatic heart disease risk

Untreated streptococcal infection

Pericarditis

Ventricles stiffening (rigid)

Pericarditis symptoms

Sharp chest pain

Worse with inspiration

Better sitting forward

Pericarditis teaching

Take anti-inflammatory meds

Rest

Left sided heart failure manifestations

Dyspnea

Crackles

Pulmonary edema!!!

Orthopnea

What signs suggest heart failure

Dyspnea, cough, cyanosis

Common cause of sudden cardiac death

Ventricular dysrhythmias (e.g. ventricular fibrillation)

Dilated cardiomyopathy (DCM)

Stretchcing of the ventricles

Heart becomes enlarged and weak

Decreased pumping ability

Restrictive cardiomyopathy (RCM)

Stiff ventricular walls > impaired filling

Peripheral arterial disease (PAD)

Narrowed arteries > decreased blood flow to extremities

Altered due to artherosclerosis in the ARTERIES

Peripheral venous disease (PVD)

In veins

???

Priority in chest pain

Assess

Monitor cardiac rhythm

Administer oxygen/meds

Chest pain key nursing points

Perfusion

Oxygenation

Pain

Early intervention