Exam 1

Cardiac & Critical Care Test Review Sheet

1. Heart Blocks & Dysrhythmias

Major Heart Blocks

Treatment Concepts

• Asymptomatic bradycardia: assess and monitor.

• Symptomatic/hemodynamically unstable bradycardia: may require atropine, pacing, or other interventions.

• Always assess the patient, not just the monitor.

4. Important ECG Intervals

QT Interval

The QT interval represents ventricular:

• Depolarization

• Repolarization

Important:

• A prolonged QT interval increases the risk for dangerous/life-threatening dysrhythmias.

5. Atrial Dysrhythmias

Atrial Flutter

• Characteristic “sawtooth” pattern

• Atrial rate is typically very fast.

• Ventricular rhythm may be regular or irregular.

Atrial Fibrillation

• Irregularly irregular rhythm

• No clearly identifiable normal P waves

• Increased risk of thrombus/stroke

Treatment Concepts for Atrial Fibrillation

Common treatment goals include:

• Rate control

• Anticoagulation when indicated to reduce thromboembolic risk

6. Catheter Ablation

What Is It?

A procedure used to treat certain abnormal heart rhythms.

Procedure

• A catheter is advanced through a blood vessel, commonly from the femoral area, toward the heart.

• The provider identifies abnormal areas of cardiac electrical activity and uses:

  • Heat (radiofrequency)

  • OR freezing (cryoablation)

• This destroys/isolates the abnormal tissue.

Remember

Ablation = eliminate abnormal electrical pathways.

7. Heart Failure

Common Manifestations

Heart failure can cause:

• Dyspnea

• Fatigue

• Fluid retention

• Peripheral edema

• Pulmonary edema

• Pulmonary crackles

• Cough

• Decreased appetite

Left-Sided Heart Failure

Think: LEFT = LUNGS (HEART NOT PUMPING PROPERLY)

Possible findings:

• Dyspnea

• Pulmonary edema

• Crackles

• Cough

• Orthopnea

Right-Sided Heart Failure

Think: RIGHT = REST OF BODY (backflow from left side can affect right side & systemic circulation)

Possible findings:

• Peripheral edema

• Increased abdominal girth

• Ascites

• Weight gain

• Jugular venous distention

8. Ejection Fraction (EF)

Ejection fraction measures the percentage of blood pumped out of the ventricle with each contraction.

• Low EF = reduced pumping function

9. Heart Failure Diagnostics

Echocardiogram

• Evaluates cardiac structure and function

• Helps determine EF

BNP

• Helps evaluate for heart failure

Chest X-ray

• Can show pulmonary congestion/edema

ECG

• Evaluates cardiac rhythm and electrical activity

10. Coronary Artery Disease (CAD)

Risk Factors

Modifiable

• Hypertension

• Diabetes

• Smoking

• Obesity

• Physical inactivity

• Unhealthy diet

• High cholesterol

Nonmodifiable

• Age

• Family history/heredity

11. Atherosclerosis & Thrombus Formation

Platelet Sequence

1. Adhesion

• Platelets attach/bind to the injured vessel wall.

2. Activation

• Platelets change shape and become activated.

3. Aggregation

• Platelets clump together.

Easy Memory Trick

A-A-A

Adhesion → Activation → Aggregation

12. Angiography & Angioplasty

During the Procedure

May include:

• Cardiac catheterization

• Contrast dye

• Visualization of coronary blood vessels

• Angioplasty

• Stent placement

Stent

• A small mesh tube used to help keep a coronary artery open.

Important Difference

Angioplasty/stent ≠ CABG

CABG (Coronary Artery Bypass Graft)

• Open-heart surgery

• Uses a blood vessel graft

• Creates a new route around a blocked coronary artery

13. Post-Angiography Nursing Care

Immediately Following the Procedure, Monitor For:

• Bleeding

• Hematoma

• Changes in cardiac rhythm

• Vital-sign changes

• Neurovascular status of the affected extremity

Activity

• The patient may need bed rest and restrictions on movement.

Patient Education

Reinforce:

• Medication adherence

• Statin therapy when prescribed

• Beta-blocker therapy when prescribed

• Heart-healthy diet

• Appropriate exercise/aerobic activity

• Smoking cessation

15. Patient With Chest Pain + Risk Factors

A patient with:

• Chest pain

• Leg pain

• Dizziness

• Smoking history

• Obesity

• Older age

• Lack of exercise

requires careful cardiovascular assessment.

Priority Nursing Actions

• PQRST Assessment of the Patient With Chest Pain

  • P = Provocation

  • Q = Quality

  • R = Region/Radiation

  • S = Severity

  • T = Timing (when began) and Treatment

• Assess chest pain

  • Assess the patient’s description of pain.

  • Identify exacerbating factors.

  • Identify measures that relieve the pain.

  • Determine whether the pain is chronic/stable angina or a new presentation.

• At the first sign of chest pain

  • Instruct the patient to relax and rest.

  • Instruct the patient to notify the nurse immediately when any type of chest pain begins.

  • Administer nitrates as indicated.

  • Provide oxygen via nasal cannula when oxygen saturation is ≤90%.

• Obtain an ECG when indicated

  • Assess for indications for obtaining an ECG to evaluate for ST-segment and T-wave changes.

• Provide emotional support

  • Offer assurance and emotional support.

  • Explain all treatments and procedures.

  • Encourage the patient to ask questions.

• Assess patient knowledge

  • Assess knowledge of:

    • Causes of angina

    • Diagnostic procedures

    • Treatment plan

    • Risk factors for CAD

• Address smoking

  • Assess readiness to quit smoking.

  • Encourage participation in a smoking cessation program.

  • Refer patients who want to stop smoking to organizations such as the American Heart Association, American Lung Association, or American Cancer Society for support groups and interventions.

Parameters to Monitor

16. Central Venous Catheters (CVC)

Preventing Catheter-Related Bloodstream Infection

One important nursing intervention is to review the continued need for the central line every day.

Key Principle

Remove unnecessary central lines as soon as they are no longer needed.

Also Remember Appropriate:

• Hand hygiene

• Aseptic technique

• Site care

• Dressing changes

• Line maintenance

17. Pain Assessment in Critical Care

If the Patient Can Communicate

• Use self-report whenever possible.

If the Patient Is Intubated and Cannot Communicate

• Use an appropriate behavioral pain assessment tool such as:

  • Critical-Care Pain Observation Tool (CPOT)

Know the Difference

Easy Memory

• CPOT = Pain

• RASS = Sedation/Agitation

• CAM-ICU = Delirium

18. Pain & Anxiety in Critical Care

Critically ill patients may experience pain and anxiety because of:

• anxiety/decreased ability to cope

• decreased mobility

• potential family dysfunction

• lack of control

• fear

• inability to get comfortable

• loneliness

• difficulty breathing

• pain

• age & developmental stage

• experiences with illness and hospitalization

• social support

• personal philosophies about life, death, and spirituality

• sleep disruption

• thirst

• medical procedures

• physical restraints

• difficulty swallowing