Life-threatening Dysrhythmias

  • Two crucial interventions for cardiac arrest: CPR and early defibrillation.
    • Facilities require maintenance of CPR certification.
    • Familiarity with using an automated external defibrillator (AED) is essential.
    • Understanding your role in resuscitation efforts according to facility protocols is critical.

Ventricular Fibrillation (VF)

  • Causes of VF include:
    • Dizziness
    • A feeling of impending doom
    • Chest discomfort
    • Shortness of breath
    • Seizure activity
    • Death
  • Immediate action steps:
    • Call for help (e.g., call a code)
    • Initiate CPR
    • Have someone bring the AED
    • Assist with tasks and document once the rapid response team arrives.

Ventricular Tachycardia (VT)

  • VT can lead to:
    • Sudden drops in blood pressure
    • Drops in level of consciousness due to reduced cardiac output.
  • Symptoms include:
    • Dizziness
    • Feeling of impending doom
    • Chest discomfort
    • Shortness of breath
  • Response is the same as VF.

Asystole

  • Definition: Complete cessation of electrical activity in the heart.
  • Common causes include:
    • Large pulmonary embolism
    • Large myocardial infarction
    • Respiratory arrest
    • Hypoxia
    • Overdose
  • Other causes:
    • Hypothermia
    • Acidosis
    • Electrolyte abnormalities
    • Tension pneumothorax
    • Trauma
  • Actions when asystole appears on EKG:
    • Observe the patient.
    • If breathing and pulse are present, switch to another lead to check for rhythm.
    • Initiate CPR if no pulse or rhythm is present.
    • Use the AED if available.

Complete Heart Block

  • Third-degree AV block may progress to cardiac arrest.
  • Importance of careful monitoring of cardiac output.
  • CPR may be necessary.
Definitions
  • Defibrillation: Sending an electrical shock to the heart to restore an acceptable rhythm.
  • Acidosis: An increase in hydrogen ion concentration in the blood, lowering its pH and causing health complications.
  • Hypothermia: A body temperature below the expected reference range.
  • Tension Pneumothorax: Accumulation of air or gas in the pleural space, often complicating other pneumothorax types.

Bradycardia and Tachycardia

  • Bradycardia and tachycardia are only significant if accompanied by cardiovascular or respiratory compromise.
  • Actions include:
    • Alert the provider.
    • Ensure emergency equipment is available and functional.
    • Continuously monitor the patient.

Challenge Question

  • Identify which dysrhythmia on an EKG reflects atrial quivering with no organized contractions.
    • Correct answer: Atrial fibrillation (B)
    • In atrial fibrillation, the atria quiver leading to possible blood clot formation, increasing stroke or myocardial infarction risk.

Identification and Resolution of Artifacts

  • Common reasons for EKG artifacts:
    • Patient-related: Body movement, substances on skin.
    • Non-patient-related: Mechanical issues, electrical factors.
  • Filters on EKG machines typically set to 40 Hz help reduce muscle tremor artifacts.
  • Adjustment of the filter may be necessary for patients with pacemakers.

Wandering Baseline

  • Definition: Baseline appears as a flat line, indicating repolarization.
  • Causes of wandering baseline include:
    • Movement of cables or leads
    • Patient movement
    • Loose or dry electrodes
    • Labored breathing
    • Improper skin preparation
  • Prevention techniques:
    • Ensure skin is free of topical substances.
    • Clean attachment sites.
    • Educate patients about expectations during EKG.
Somatic Tremor
  • Definition: Muscle movement on EKG appears as uneven spikes.
  • Causes include:
    • Shivering (controllable)
    • Active seizure activity (non-controllable)
  • Mitigation suggestions:
    • Provide light blankets, maintain warm room temperature, reassure anxious patients, and deep breathing exercises.
Alternating Current (AC) Interference
  • Causes:
    • Electronic devices (cell phones, medical equipment)
    • Objects such as wall wires or electrical sources.
  • Appearance: Uniform small spikes on EKG.
  • Preventative measures:
    • Ensure cell phones are off and away.
    • Maintain distance from electrical sources during testing.
Interrupted Baseline
  • Definition: Indicates an interruption in electrical connection.
  • Appearance can be a flat line or erratic lines due to:
    • Patient movement
    • Dislodged electrodes
  • Regular observation and maintenance of lead wires can help prevent this.

Patient Care Responsibilities

  • Patient care technicians perform various tasks to ensure high-quality patient care.
  • Essential tasks include:
    • Dressing changes
    • Ambulation
    • Ostomy care
    • Skin care
    • Range-of-motion exercises
    • Monitoring critical values
    • Daily activities assistance
    • Postmortem care.
  • Techniques guiding patient care:
    • Safety awareness
    • Providing emotional support
    • Adhering to the Five Rights of Delegation
    • Monitoring changes in patient conditions.

Understanding Body Systems

  • Basic understanding of body systems necessary for effective patient care.
  • Anatomy vs. Physiology:
    • Anatomy: Structure of the body.
    • Physiology: How bodies function.
  • Homeostasis: The body's stable, balanced state.

Integumentary System

  • Components: Skin (including glands), hair, nails.
  • Primary functions:
    • Protection against foreign invaders.
    • Tone regulation and prevention of excessive water loss.

Skeletal System

  • Components: Bones and joints (cartilage and ligaments).
  • Functions:
    • Support and movement, mineral and fat storage, and blood cell production.

Muscular System

  • Components: Voluntary (striated) and involuntary (smooth) muscles.
  • Functions:
    • Movement, posture maintenance, heat production.

Nervous System

  • Components: Brain, spinal cord, nerves, sensory receptors.
  • Functions:
    • Regulating homeostasis, communication, thinking, and coordination of body movements.

Endocrine System

  • Components: Hormone-producing glands across the body.
  • Functions:
    • Regulates metabolism, growth, sleep cycles, stress response, blood glucose levels, and reproduction.

Cardiovascular System

  • Components: Heart, blood vessels, blood.
  • Functions:
    • Oxygen, nutrient, hormone, water, and waste transport; temperature regulation; immune response.

Lymphatic System

  • Components: Lymph nodes, lymphatic vessels, spleen, tonsils, thymus.
  • Functions:
    • Protects the body by filtering blood and lymph, removing toxins.

Respiratory System

  • Components: Airway (nose, pharynx, larynx, trachea, bronchi) and lungs.
  • Functions:
    • Gas exchange (oxygen intake and carbon dioxide elimination).

Digestive System

  • Components: Mouth, esophagus, stomach, intestines, rectum, anus (and accessory organs).
  • Functions:
    • Nutrient absorption and waste elimination, through mechanical and chemical processes.

Urinary System

  • Components: Kidneys, ureters, bladder, urethra.
  • Function:
    • Elimination of waste products and excess fluid.

Reproductive System

  • Components:
    • Female: Internal organs (ovaries, fallopian tubes, uterus, vagina) & external structures (labia, clitoris).
    • Male: Testes, epididymis, vas deferens, urethra, penis.

Disease Processes

  • Diseases arise when the body's systems cannot maintain homeostasis.
Types of Diseases
  • Infectious Diseases: Caused by bacteria; examples: urinary tract infections.
  • Acute Diseases: Sudden onset; typically short recovery; example: influenza.
  • Chronic Diseases: Last longer than six months, requiring ongoing treatment; examples: atherosclerosis, coronary artery disease.
  • Degenerative Diseases: Result from the aging process; example: arthritis.
Common Disease Processes
  • Osteoarthritis: Most common joint disorder; caused by obesity, joint injury, etc.; symptoms include stiffness and pain, decreased mobility.
  • Asthma: Chronic respiratory disorder leading to dyspnea due to inflammation.
  • Pneumonia: Lung inflammation due to infection; symptoms include fever, cough, fatigue.
  • Chronic Obstructive Pulmonary Disease (COPD): Includes emphysema and chronic bronchitis; causes progressive airflow obstruction.
  • Cancer: Abnormal cell growth that can spread to other body parts.
  • Hypertension: Diagnosed by consistent systolic pressure of 130 mm Hg or higher or diastolic pressure of 80 mm Hg or higher; known as the 'silent killer' due to lack of symptoms.
  • Blood pressure categories:
    • Expected range: Less than 120/80 mm Hg
    • Elevated: 120-129/<80 mm Hg
    • Hypertension stage 1: 130-139/80-89 mm Hg
    • Hypertension stage 2: ≥140/≥90 mm Hg
    • Hypertensive crisis: ≥180/≥120 mm Hg
  • Coronary Artery Disease (CAD): Caused by plaque buildup; leads to inadequate heart oxygen supply.
  • Heart Failure: Chronic disorder; heart cannot pump enough blood; causes include heart injury, congenital defects.
  • Myocardial Infarction: Occurs due to blood flow blockage in coronary arteries; symptoms include chest pain, shortness of breath.
  • Stroke: Occurs when blood flow is blocked in the brain; symptoms include slurred speech, cognitive changes.
  • Diabetes Mellitus: Categorized as type 1 and type 2; problems with insulin and glucose regulation can lead to serious complications.

Challenge Question

  • Which disorder results in the heart being unable to pump enough blood?
    • Correct answer: Heart failure (B)

Basic Patient Care

  • Patient care technicians assist in basic tasks assigned by nursing staff.
  • Examples include:
    • Activities of daily living (ADLs): bathing, dressing, toileting, etc.
    • Measuring vital signs, transferring patients, reporting changes in conditions.
    • Goal: Promote independence while ensuring safety.
Bathing Considerations
  • Common supplies include:
    • Bath towel, washcloth, skin cleanser, body lotion.
  • Water temperature guidelines:
    • Routine baths: 40.5° to 43.3° C (105° to 110° F).
  • Privacy considerations and safety practices essential during bathing.
  • Bathing techniques:
    • Clean to dirty area sequence; short, firm strokes to stimulate circulation; gentle drying to prevent skin injury.
Oral Care
  • Essential for overall health and should not be overlooked.
  • Timing: upon awakening, after meals, and before bed.
  • Check for swallowing difficulties or NPO status before assisting.
  • Cleaning techniques vary based on dental status (natural teeth vs. dentures).
Bed Making
  • Importance of clean beds for infection control and comfort.
  • Proper procedures for changing linens, especially when the patient is in bed, are necessary to uphold patient safety.
Dressing and Grooming
  • Assist patients based on their preferences; promote independence and self-esteem.
  • Be aware of IV lines and special considerations for patients with limited mobility.
Toileting Assistance
  • Be prudent and prepared for assisting patients; observe privacy and hygiene post-use.
  • Measure output if required and report unusual findings.
Nutrition Assistance
  • Assist with feeding, checking for restrictions; maintain clear communication and comfort during mealtime.

Equipment

Oxygen Equipment

  • Post-operative patients may require supplemental oxygen; know the equipment and prescribed flow rates.
  • Delivery methods: nasal cannula, face mask, and portable tanks.
  • Safety guidelines essential during oxygen usage to prevent fire hazards.

Suction Equipment

  • Essential for maintaining airway patency in patients requiring suctioning.
  • Know the procedure and safety protocols for suctioning to prevent airway compromise.

Monitors and Alarms

  • Various monitoring devices in a hospital setting include cardiac monitors, ventilators, capnography monitors, and infusion pumps.
  • Understand alarm mechanisms and protocols for patient safety.

Hospital Beds

  • Adjustable for patient comfort; side rails prevent falls and can be locked when moving patients.
  • Specialty beds may be required for certain patients to enhance care and comfort.

Ostomy Care

  • Proper care for ostomies involves maintaining cleanliness, managing discomfort, and providing emotional support.
  • Procedures include cleaning the stoma, monitoring for changes, and adjusting the pouching systems.

Equipment Sanitization, Disinfection, and Sterilization

Infection Control

  • Equipment must be sanitized to ensure it's disease-free.
  • Definitions:
    • Sanitization: Reducing microbes with soap and water.
    • Disinfection: Destroying pathogens with chemicals; does not eliminate all spores.
    • Sterilization: Destroys all pathogens and spores through methods like steam or gas.
  • Follow protocols for cleaning specific items effectively.
Disinfection Guidelines
  • Ideal disinfectants have an antimicrobial spectrum, fast-acting properties, and are nontoxic.
  • Common procedures for cleaning devices in an inpatient setting include the use of alcohol and bleach solutions.
Sterilization Methods
  • Understand various sterilization techniques and the importance of handling sterilized equipment carefully to maintain its sterile state.