MedSurge Exam 1

What is Sclerosis?

Hardening of tissue due to fibrous tissue overgrowth

What is Stenosis?

The narrowing or constricting of passage or orifice

What is Atrophy?

Wasting away or a decrease in the size of an organ

What is Calcification?

Calcium and calcium salts are deposited in abnormal locations
ex. Blood vessels

What is the difference between sclerosis and stenosis?

Sclerosis is the hardening and stenosis is the narrowing of vessels

What three things can an RN NOT delegate?

1. Anything with the nursing process

2. Client education

3. Tasks that require nursing judgement (Unstable pt)

Remember TAPE of what a nurse must do

T- initial Teaching
A- Assessment
P- Planning
E- Education

What is the order of conduction in the heart and what is each rate?

SA Node (60-100 bpm) —> AV Node (40-60 bpm) —> Bundle Branches ( <40 bpm)

What is repolarization?

The contraction of the heart

What is Repolarization?

The relaxation of the heart

What does Normal Sinus Rhythm (NSR) look like?

Normal waves 

What wave represents atrial depolarization?

The P wave

What wave represents ventricular depolarization?

QRS

What wave represents ventricular repolarization?

The T wave 

What causes an arrhythmia or dysrhythmia?

A disruption in cardiac conduction pathways

What is the number 1 risk factor for dysrhythmias?

AGE!

What are some signs and symptoms of dysrhythmias?

• Palpitations

• Hypotension 

• Diaphoresis

• SOB

• Syncope

How many leads are placed for a 12 lead ECG?

Only 10 are placed

Where are the leads placed for an ECG?

What about just the ones on the chest for an ECG?

Where do the leads go for a 5 lead ECG?

Snow WHITE is over GREEN grass
BLACK smoke over a RED fire
Always keep CHOCOLATE close to your heart

Which lead is the most accurate?

Lead 2

When reading an ECG what does the amplitude reflect?

The strength of the electrical signal generated by the heart

For ECG paper what does everything represent?

Each small box is 1 mm in height and 0.04 seconds
Each big box is 0.20 seconds long and is made up of 5 small boxes

What is sinus bradycardia?

HR <60 caused by hypoxia, hypothermia, medications, sleep, and athletes

What drug is given to treat sinus brady?

Atropine is given because Atropine Accelerates the heart as long as it is symptomatic 

What causes sinus tachycardia?

Fever, anemia, hypovolemia, hypotension, pulmonary embolism, and MI

What is a treatment for sinus tachy?

It varies so, if anemic = blood, if hypovolemic = fluids. Medications such as Beta Blockers and CCB

What are premature atrial contractions (PACs)?

This is when the pacemaker cells close to the SA node fires earlier than anticipated? These are non life threatening

What causes a PAC?

• Hypoxia

• Caffeine

• Infection

• Digoxin toxicity

• Coronary artery disease

What is Atrial Fibrilation?

The most commonly seen dysrhythmia worldwide. It is when the atria of your heart just shake a little

What are some cause of afib?

• Genetics

• Age

• Diet

What are the 4 classifications of afib?

1. Paroxysmal - spontaneously self limiting

2. Persistent - Longer than 7 days

3. Long-standing - Longer than 12 months

4. Permanent/Persistent - This is resistant to rhythm control therapies

How do you treat afib?

Meds: Digi, BB, CCB, Anticoags, Antiplatelet

What else can be used to treat Afib?

Can also be treated with cardioversion AFTER anticoagulants

What are some risks with Afib?

Loss of cardiac kick (last 20% of blood) and clots 

What does Afib look like?

No clear P wave but you do still get the QRS complexes

What is Afib RVR?

It is Afib with Rapid Ventricular Response. It is when the HR is >100

What is an echocardiogram

A noninvasive diagnostic test that uses ultrasound to look at the structure and function of the heart 

What is a Trans-Esophageal Echo (TEE)?

This requires sedation and topical anesthesia. A small transducer is put through the mouth and into the esophagus

When is a TEE done?

It is used before cardioversion for afib to ensure there are no blood clots in the atria?

What is aflutter?

It is from a pacemaker cell other than the SA node.

What does aflutter look like?

• There are no P waves

• Instead, you get Flutter waves (F waves)

• Sawtooth pattern

• Loss of atrial kick!

What are some causes of AFlutter?

• Acute MI

• Mitral Valve Disease

• Thyrotoxicosis

• COPD

• Cardiac/Pulmonary Surgery

How do you treat AFlutter?

Rate control drugs: BB, CCB, Digoxin 
Antiarrhythmic (Amiodarone)
Cardioversion

What is SVT?

It is Supraventricular Tachycardia and it has a super narroe QRS complex

What does SVT look like?

Narrow QRS complex with a continuous fast heart rate, often the P wave is absent

What is a PJC?

It is a premature junctional contraction that typically do not require treatment

What does a PJC look like?

They are often kinda upside down and weird looking

What is a PVC?

It is a premature ventricular contraction that comes from the ventricle firing earlier than expected

What can cause a PVC?

• Hypoxia

• MI

• Cardiomyopathy

• Electrolyte imbalance

• CAFFEINE

• HTN

• Recreational drug use

What are two PVCs in a row called?

A couplet 

What are three PVCs in a row called?

A triplet, this is the most deadly!

What is a PVC that happens every other beat?

It is called a Bigeminy

What is a PVC that happens every third beat?

A Trigeminy

What do you do to treat a PVC?

You correct the cause as they are typically non life threatening

What does a PVC look like?

They vary based on the type

What is Vtach?

It is a wide and fast impulse from the ventricles with a rate greater than 150bpm and it can definitely be life threatening.

What is a Non-Sustained VT?

A NSVT is a run of three or more PVCs that end in 30 seconds and it can act as a warning to ppl with heart problems

What is a sustained VT?

An SVT is an episode of vtach for more than 30 seconds that needs stabilization as it is considered life threatening 

How do you treat Vtach if they have a pulse?

Give antiarrhythmic meds (Amiodarone), electrolyte replacement, or cardioversion

How do you treat Vtach that does not have a pulse?

This is cardiac arrest and requires resuscitation and defibrillation as it is lethal

What does Vtach look like?

It looks like a bunch of tombstones bc that is where you are going

What is Vfib?

It requires IMMEDIATE treatment and happens when the ventricle has multiple impulses rapidly firing

How do you treat Vfib?

Chest compressions and defibrillation 

What does Vfib look like? 

It just looks like a bunch of squiggles

What is Asystole?

You’re dead, no measurable electrical activity from the heart

How do you treat asystole?

Push epi and start CPR

What is a first degree AV heart block?

It is a prolonged PR interval longer than .20 seconds

What is a second degree heart block type 1?

It is when the PR interval gets longer and longer until a QRS gets dropped

How do you treat a type 1 heart block?

You give atropine only if they are symptomatic

What is a second degree type 2 heart block

It is a dropped QRS without a prolonged PR interval, not lethal but can quickly change to a type 3 which is lethal

How do you treat a type 2?

If the pt is symptomatic then you treat with a transcutaneous patch which HURTS

What does a Wenckebach look like?

What is a third degree AV heart block?

This is a COMPLETE block of the AV node where the AV is completely independent

What does a third degree complete heart block look like?

Lines with a quick QRS. THE ONE WITH ARROWS!

How do you treat a third degree?

You will be getting a pacemaker

What is the poem for a first degree HB?

If the R is far from the P then it must be a FIRST DEGREE

What is the poem for a second degree type 1 HB?

Longer, longer, longer, drop! Then you have a TYPE 1 WENCKEBACH

What is the poem for a second degree type 2 HB?

If PR stays normal and QRS quits, then it must be a TYPE 2 MOBITZ

What is the poem for a third degree complete HB?

If Ps and Qs don’t agree, then you have a THIRD DEGREE

What leads show an Inferior MI STEMI? and what is occluded?

ST elevation in leads 2, 3, aVF, RCA and/or left circumflex

What leads show a Lateral MI STEMI? and what is occluded?

1, aVL, V5, and V6, Left circumflex or diagonal branch of LAD

What leads show an anterior/septal STEMI? and what is occluded?

Leads V1-V4, LAD

What leads show a Posterior STEMI? and what is occluded?

Leads V7, V8, and V9, the descending artery

What is an NSTEMI?

Caused by a partial blockage of a major coronary artery or a blockage in a minor artery that have inverted ST waves

What is a Q wave?

These are signs of a previous MI

What does a pacemaker do?

It gives the heart a “gentle boop” to remind it to keep going that is battery operated

What does a transcutaneous pacemaker do?

It tells the heart to “WAKE THE FUCK UP AND WORK” often used on a 3rd degree HB pt

What is the order of blood flow thru the heart?

What does dopamine do for the heart?

It is used to increase HR and contractility in cases of low BP low HR and HF

What does Atropine do for the heart?

It increases HR and improves electrical conduction by blocking the effects of the vagus nerve on the heart

What does Adenosine do for the heart?

It slows the HR and dilates blood vessels 

What does Amiodarone do for the heart?

It is an antiarrhythmic med that helps regulate a person’s HR by controlling the signals

What is Senescence?

The process of aging or deterioration that is characterized by a permanent stop in cell division and a decline in cell function