CV Questions

What does the P wave represent?

atrial depolarization

What does the QRS complex represent?

ventricular depolarization and atrial repolarization

What does the T wave represent?

ventricular repolarization

P-R interval is how many seconds

0.12 - 0.20 sec (3 - 5 small squares)

QRS width is how many seconds

0.08 - 0.12 sec (2 - 3 small squares)

Q-T interval is how many seconds

0.35 - 0.43 sec

5 lead EKG placement

White lead - right sternum / clavicle area Black lead - Left sternum / clavicle area Red lead - Left lower thoracic area Green lead - Right lower thoracic area Brown lead - just below and to the right of the bottom of the sternum

normal rhytms are considered ______

sinus (originating from the SA node

what conducts first in a "normal" heart

SA node

Sinus Rhythm (SR, NSR) characteristics

•P waves are present & appear at regular time intervals •P wave rate is constant •Each P wave is followed by a QRS complex •QRS complexes are of normal width (slim) •The intervals between QRS complexes are equal •The heart rate is between 60 and 100 beats per minute

Sinus Tachycardia characteristics of ECG and rate

same a normal siuns rhythm EXCEPT HR is 101-180 bpm

s/s of sinus tachycardia

SOB, dyspnea, diaphoresis decrease CO, decrease BP rapid, regular pulse, possible palpitation

cause of sinus tachycardia

exercise, fever, pain, stimulants. fluid overload, anxiety, and CVD, hypotension

treatment for sinus tachycardia

TREAT cause VALSALVA MANEUVER fever- antipyretic reduce stimulant reduce pain

drug therapy for sinus tachycardia

B-blocker CCB adenosine

sinus bradycardia characteristics if ECG and rate

same as normal sinus rhythm EXCEPT HR < 60 bpm

s/s of sinus bradycardia

fatigue, lightheadedness, syncope, symptomatic

cause of sinus bradycardia

vagal maneuver (bearing down) meds (CCB, B-blockers) vomiting, hypothermia common in trained athletes

treatment of sinus bradycardia

try to arouse the patient head of the bed FLAT fall preacutions atropine

drug therapy of sinus bradycardia

ATROPINE only if showing decreased perfusion (cool, pale, clammy()

atrial fibrillation

rapid, random, ineffective contractions of the atrium

Causes of atrial fibrillation

CAD, HTN, HF (any underlying heart disease) surgery

treatment/drug therapy for atrial fibrillation

CCB (Diltiazem!!!), B-Blockers, amiodarone, digoxin (all for rate control) anticoagulants

what is a big concern with A-fib

BLOOD STASIS!! can lead to clots

what drug is used for clots in A-fib

Warfarin

what is important to know about warfarin

monitor INR Vit K is the antidote moderate green leafy veggies

what needs to be checked before giving digoxin

apical pulse (60 or greater) toxicity: 0.5-2.0, visual changes, N/V, anorexia potassium below 3.5 increases the risk for toxixity

s/s of atrial fibrillation

usually asymptomatic if symptomatic: dizzy, faint, fatigue, SOB, chest pain, fluttering in chest, irregular pulse, change in LOC, dyspnea, asymptomatic or syncope

atrial fibrillation characteristics of ECG and rate

-absence or inconsistent (fibrillary) p wave -Appears irregular, often changes speed of the heart rate 350-600bpm

Transcutaneous Pacemaker

external pacemaker used as a temporary emergency measure for maintaining adequate heart rate

Cardioversion

restoration of a normal heart rhythm by electric shock

Transcutaneous Pacemaker & Cardioversion is used with what type of dysrhythmia

atrial fibrillation

normal digoxin range

0.5-2ng/mL

Premature Ventricular Contraction (PVC)

•Abnormal heart beats starting from the ventricles •Takes place in conjunction/addition to the underlying rhythm

Premature Ventricular Contraction (PVC) characteristics of ECG and rate

underlying rhythm can be any rate, regualr or irregular, PVCs can occur at variable rates -wide and distorted QRS complex, Pwave barely visible

what is Premature Ventricular Contraction (PVC) caused by

•Caused by the hearts demand for O2 -stimulants (caffiene, alcohol, nicotine, epi, etc), electrolyte imbalance, hypoxia, fever, exercise, emotional stress

s/s Premature Ventricular Contraction (PVC)

•Almost always

Premature Ventricular Contraction (PVC) treatment:

treat the cause O2 therapy for hypoxia elecrolyte replacement

3 or more PVC's occur consecutively

indicates Ventricular Tachycardia

Ventricular Tachycardia characteristics of ECG and rate

•Ventricular rate is 150-250bpm •Regular to slightly irregular rhythm p wave and Pr interval not visible, ORS wide and distorted

causes of ventricular tachycardia

post MI, CAC, hypoxemia, electrolyte imbalance (decrease K and Mg), drug toxicity

s/s ventricular tachycardia

•asymptomatic if it lasts a short amount of time due to anxiety •If it happens for an extended amount of time death can occur

a patient in V-tach is a patient that is trying to....

CODE!

a patient in V-tach may or may not have

a pulse

treatments for a patient in V-tach: IV antidyrhythmics

-Procainamide -Lidocaine -Adenosine

what is done if the pulse is present in v-tach

assess VS, call rapid response, prepare to call code, give IV dysrhythmias

what is done if no pulse is present in v-tach

CALL CODE, begin CPO, early D-fib

v-tach with no pulse

defibrillation

v-tach with pulse

cardioversion

Torsades de Points

-Lethal heart rhythm. Occurs if QT interval is prolonged greater than 0.50 seconds......this is why it is importnt to monitor for a prolonged QT interval. -Treated with IV

the quivering of te ventricles in v-tach means

NO CARDIAC OUTPUT, MEDICAL EMERGENCY IF THERE IS NO PULSE

cause of ventricular fibrillation

untreated v-tach, MI, hyperkalemia, electric shock, hypoxemia, acidosis, drug toxicity

s/s ventricular fibrillation

-Poor to no cardiac output -loss of consciousness -no pulse -BP and respirations leading to brain damage -death if not reversed

V FIB

D FIB

V tach treatment

•check pulse, Call a CODE, start CPR, & early defibrillation •Amiodarone, Epinephrine, Lidocaine •Best results if ACLS is started in the first 30 seconds

if a patient goes into cardiac arrest

-check pulse -Call a Code -Start CPR -Start ACLS when trained ACLS professional arrives (rapid response or code team)

defibrillator

a device that delivers an electric shock to the heart to restore its normal rhythm

Digoxin toxicity symptoms

nausea, vomiting, diarrhea, vision changes, arrythmias, electrolyte imbalance

asystole

flatline

rate of asystole

none

asystole is ___

FATAL- client is clinically DEAD (unresponsive, no respiration or heart beat)

causes of asytole

long cardiac Hx, HF, MI

treatment for asystole

NO DEFIBRILLATION (no pulse) -epi, atropone, CPR w/ ACLS

Cardiac Output (CO= HR x SV)

6-8 liters of blood ejected from the left ventricle per minute

stroke volume

•Amount of blood ejected from the left ventricle during each contraction

preload

•stretch of at the end of diastole and just before contraction

afterload

•Resistance that the ventricles must overcome to eject blood through the valves and into the peripheral blood vessels

heart failure

•Inability of the heart to maintain adequate cardiac output (CO) to meet the metabolic needs of itself & the body
•The pump is broken, the blood doesn't move as quickly to the body (impaired oxygenation & perfusion)

what cardiovascular diseases are associated with HF

•long-standing hypertension
•coronary artery disease (CAD)
•myocardial infarction (MI)
•Metabolic syndrome
•Advance age
•Smoking

Left sided heart failure

pulmonary congestion. Decreased tissue perfusion from poor cardiac output

right sidedheart failure

Right ventricle doesn't empty completely leading to increased volume and pressure in the venous system leading to peripheral edema

How does the nurse assess for pulmonary edema?

-Anxious, pale, cyanotic
-Cool and clammy skin
-Dyspnea
-Orthopnea
-Tachypnea
-Use of accessory muscles
-Cough with frothy, blood-tinged sputum
-Crackles and wheezes
-Tachycardia
-Hypotension or hypertension
-Abnormal S3 or S4

Chronic Heart FailureClinical Manifestations

•Fatigue
•Limitation of Activities
•Chest congestion/cough
•Edema
•Shortness of breath

Labs & Diagnostic Tests for HF

-Serum Electrolytes
-TROPONIN
- BNP
-ABG's
-Echocardiogram
Ejection Fraction
-Chest X-Ray
-12-lead ECG

how to improve gas exchange in HF

-Apply oxygen (which device is the most appropriate?)
-Raise the head of the bed
-Sit them up in a chair

how to reduce preload in HF

•Eliminate table salt, eliminate high Na foods
•Fluid Restrictions/ 2L a day
•Diuretics
•Loop (Lasix) and bumetanide (Bumex)
•Thiazide diuretic (hydrochlorothiazide) Relieve symptoms of HF

how to reduce after load in HF

•Vasodilators (hydralazine, Isosorbide dinitrate, nitrates, nitroprusside)
•ACE Inhibitors (ex. Lisinopril, Captopril, Enalapril)
•ARBs (valsartan, losartan)

What do you assess to know the medications are working correctly?

Daily weight and I&Os

which medications increase CO and enhance contractility

Digoxin
Beta-blockers (metoprolol)

DASH diet

what is the most effective medication to reduce fluid volume overload

Furosemide

what labs should be checked when taking furosemide

check for potassium loss & dehydration

HCTZ and HF

•more gradual diuresis, stops sodium reabsorption, self limiting.

ACE inhibitors and HF

↓ systemic vascular resistance, lower blood pressure

NItrates and HF

will relieve myocardial ischemia by coronary vasodilation

BBlocers and HF

stop the SNS effects on the failing heart

Positive inotropes and HF

•: increase force of heart contractions, slow the heart rate, to increase the stroke volume and cardiac output

Digoxin toxicity s/s

GI effects - anorexia, nausea, vomiting, abdominal pain; CNS effects - fatigue, weakness, diplopia, blurred vision, yellow-green or white halos around objects

what should be monitored whentaking digoxin

-Monitor for signs of hypokalemia and hyperkalemia, since these can increase or decrease the effects of digoxin, respectively.
-Monitor for early signs of toxicity: anorexia, nausea and vomiting, fatigue, headache, depression, visual changes.
-Monitor for late signs of toxicity, such as dysrhythmias (e.g., bradycardia, atrioventricular block).

what is done to help decrease fatigue in HF patients

do all activities at once then let patient rest for 2 hours in between

right sided HF S/S

· Peripheral edema
· Anasarca (massive generalized body edema)
· Ascites
· Hepatomegaly
· JVD
· Weight gain
· Increased HR
· Murmurs
· Right ventricular heaves
· Fatigue
· RUQ pain
· Anorexia and GI bloating
Nausea

left sided HF s/s

· Crackles (pulmonary edema)
· Dyspnea
· Paroxysmal nocturnal dyspnea
· Orthopnea
· Nocturia
· S3 and S4 heart sounds
· Pleural effusion
· Shallow respirations up to 34-40min
· Dry, hacking cough
· Frothy, pink-tinged sputum (advanced pulmonary edema)
· Restlessness, confusion
· Increased HR
· Left ventricular heaves
· Decreased PaO2 and slight increase in PaCO2
Weakness, fatigue

management of HF

· Treatment of underlying cause
· Drug therapy
· Circulatory assist devices
· Daily weights
· Sodium and possibly fluid restricted diet
· O2 by mask or nasal cannula if indicated
· High Fowlers position
Check VS

dietary therapy for HF

· Adhere to specific sodium restriction guidelines
· Examine labels to determine sodium content (food packages and OTC meds)
· Weight yourself in the morning at the same time each day preferably in the morning under the same conditions
· Eat small, frequent meals

what weight gain should be reported to the HCP

3 lb in 2 days, or 3-5 in a week

what should a patient report to the HCP w HF

· Weight gain of 3 lb in 2 days, or 3-5 in a week
· Difficulty breathing, especially when lying flat or with activity
· Waking up breathless at night
· Frequent dry, hacking cough, especially when lying down
· Fatigue, weakness
· Swelling of ankles, feet or abdomen
· Swelling of face or difficulty breathing (angioedema; may because of ACE inhibitor)

activity program for HF

· Increase walking and other activities gradually, as long as they do not cause fatigue or dyspnea
· Consider cardiac rehabilitation
· Avoid extreme heat and cold

reat and HF

· Plan a regular daily rest and activity program
· After exertion, such as exercise and ADLs, plan a rest period
· Consider shorter working hours or schedule periods of rest during working hours
· Avoid emotional upsets

heath promotion for HF

· Get flu and pneumococcal vaccine
· Develop plan to reduce risk factors (BP control, tobacco cessation, BG/HbA1C control, weight reduction)

before taking drugs for HF what VS should the client know before taking the drug

· Count pulse rate each day before taking drugs, know the parameters to take the drug
· Take BP and know parameters and target BP