Medsurge test 1

upper right

on a 5 lead ECG, where does the white lead go

lower left

on a 5 lead ECG, where does the red lead go

0.12-0.20 seconds

How long is a normal PR interval

0.35-0.45 seconds

How long is a normal QT interval

<0.12 seconds

How long is a normal P wave

skinny fast

type of less dangerous tachycardia where the QRS complex is narrow (less than 0.12 seconds, or 3 small boxes on the ECG).

Fat fast

more dangerous type of tachycardia where the  QRS complex is wide (greater than 0.12 seconds)

rhythm

if the R to R interval does not march out then what is irregular?

afib

an irregular irregular rhythm is

lidocaine

what is the intervention for someone with regular but >6 premature beats /minute (premature atrial contraction)

permanent pacemaker

what is the treatment for 2nd(missing QRS) and 3rd degree heart block (atria and ventricles independent of each other)

Atropin, isoproterenol

what is the treatment when PR interval is prolonged or > 5 small blocks (1st degree Heart block)

stop underlying cause, B-blockers, digitalis

whats the treatment for tachycardia

SOB, and hypotension

you would give atropine for sinus bradycardia if the patient also has

V fib, V tach, torsades de pointes

what are the three lethal rhythms

supraventricular tachycardia

what is it when rate is at 165 and it is very narrow and fast

adenosine

what is the treatment for supraventricular tachycardia

amiodarone, syndronized cardioversion

what is the treatment for v-tach with a pulse

CPR, Defibrillation and epi, or amiodarone

what is the treatment for v-tach WITHOUT a pulse.

CPR, Defibrillation and Epi OR antiarrhythmic (amiodarone or lidocaine)

what is the treatment for ventricular fibrillation

only CPR and EPI

what is the treatment for Asystole

only CPR and EPI

What is the treatment for Pulseless Electrical Activity

versed

what medication can be used for conscious sedation during synchronized cardioversion

supraventricular tachycardia

vagal maneuvers such as the Valsalva for 10-30 seconds can be used for

transvenous or transcutaneous

what are the two types of temporary pacemakes

stable Angina

angina pain when the vessel is unable to dilate enough to allow adequate blood flow to meet myocardial demand but theres a normal ECG

unstable angina

angina where the plaque ruptures and a thrombus forms. Pain occurs at rest and progresses

NSTEMI

plaque ruptures and thrombus forms causing injury and infarct. there are often inverted t waves or st depression

STEMI

when there is complete occlusion of blood vessel lumen resulting in injury and infarct to the myocardium. ECG sees ST elevation and rise in troponins

ischemia

depression on an ECG means there is

injury

Elevation on an ECG means there is

myocardial infarction

sustained ischemia resulting in Myocardial cell death, severe chest pain not relieved by rest or nitro. pain lasts >20 min, radiates to left arm, jaw, back,

CK, CK-MB, troponin

what are the serum cardiac markers released into blood from necrotic heart muscle after MI. anything > 0 is bad

MONA

what is the initial management for heart attack

2 large bore

how many IVs for heart attack patient initially

sublingually q5 min for 3 doses. may use IV after 3 SL tried

how is nitro given for a heart attack?

dysrhythmias

what is the most common complication of heart failure

cardiogenic shock

a life-threatening condition that occurs when the heart can't pump enough blood to the body

cardiac tamponade

a life-threatening condition that occurs when fluid builds up around the heart, compressing it and preventing it from pumping properly. 

dressler syndrome

Pericarditis with effusion and fever – develops 4-6 weeks after MI 

antiplatelet therapy, elective cardiac cath, potential hospital admission

chest pain + negative cardiac markers = what treatment?

reperfusion therapy, ICU hospital admission

chest pain + STEMI/NSTEMI on EKG + positive cardiac markers =

Percutaneous Coronary Intervention (PCI)

first line tx in reperfusion therapy where a catheter is used to place a stent in the blood vessel. The goal is to open the blockage within 90 min.

bedrest, restrict movement to site, frequent monitoring of VS, for CP, and dysrhythmias

what type of care is given after insertion of a percutaneous coronary intervention (PCI)

Thrombolytic (Fibrinolytic) Therapy

medication(-teplase) used to break down blood clots. goal is start within 30 min of arrival and start no later than 6 hours after onset of symptoms.

-need prior consent (will not be able to clot)

LOC change, bleeding in urine

in what emergency should thrombolytic therapy be stopped

low sat, low cholesterol, low trans fat

what is part of a cardiac diet

Coronary Artery Bypass Graft (CABG) surgery

done when PCI doesn’t work, if they have diabetes, or multiple blocked arteris.

sternal precaution, chest tube drainage, EKG, check for cardiac tamponade, hypothermia warning, intubated/ventilator, Foley, check circulation distal,

what nursing care is done post Coronary Artery Bypass Graft (CABG) surgery

low arterial BP, dilated neck veins, muffled heart sounds

what are the signs of the cardiac tamponade (becks triad)

100

in ACS home care, what is the BPM limit starting out

1

in ACS home care, 911 should be called after how many nitros