Upgrade to remove ads

Only $35.99/year

Critical Care: Cardiac I

Terms in this set (288)

___ is the amount of resistance to ejection of blood from the left ventricle

___ is the degree of stretch of the cardiac muscle fibers at the end of diastole

What is the formula for Mean Arterial Pressure?

Coronary blood supply

___ is the supply of oxygen and nutrient rich blood to cardiac muscle tissue and the return of oxygen poor blood from this active tissue to the venous system

-Isovolumetric ventricular contraction
-Ventricular ejection
-Isovolumetric relaxation
-Ventricular filling
-Atrial systole

what are the 5 phases of the cardiac cycle?

Isovolumetric ventricular contraction

___ is a phase of the cardiac cycle where the mitral/tricuspid valves close due to increased pressure in the ventricles; Pulmonic aortic valve remain closed

ventricular ejection

___ is a phase of the cardiac cycle where ventricular pressure exceeds aortic & pulmonary artery pressures causing aortic/pulmonic valves to open - blood ejected from ventricles

Isovolumetric relaxation

___ is a phase of the cardiac cycle where

a. Ventricular pressure is < aorta & pulmonary artery pressure causing aortic/pulmonic valves to close
b. All valves are closed
c. Blood begins to fill atria

Ventricular Filling

___ is a phase of the cardiac cycle where pressure > in atria than ventricles causing mitral/tricuspid valves to open. Blood flows passively from atria to ventricles (~75%)

about how much blood is able to flow passively by gravity from the atria to the ventricles during ventricular filling?

___ is an atrial contraction that occurs during atrial systole and helps to move the remaining 25% of the blood that did not flow passively from the atria to the ventricle by gravity.

during ___ is when the ventricles contract leading to the body to be perfused

during ___ is when the ventricles are relaxed and the myocardium is oxygenated. there needs to be appropriate resting time for ventricular filling and myocardial perfusion to take place

ventricular systole

___ is when the entire body is perfused

autonomic nervous system (ANS)

___ is the part of the peripheral nervous system that controls the glands and the muscles of the internal organs (such as the heart). Its sympathetic division arouses; its parasympathetic division calms.

sympathetic nervous system

___ is the division of the autonomic nervous system that arouses the body, mobilizing its energy in stressful situations

the sympathetic nervous system stimulation results in the release of ___ which increases HR, AV conduction, and CO

the SNS innervates (supply an organ or other body part with nerves) ___ areas of the heart

parasympathetic nervous system

___ is the division of the autonomic nervous system that calms the body, conserving its energy

Stimulation of parasympathetic nervous system results in release of ___ leading to ↓ HR, ↓ AV conduction, ↓ CO. this is known as vagal stimulation

mechanical contraction

with the transmission of electrical impulses, electrical stimuli originating in the heart travels throughout the cardiac muscle resulting in ___

-Automaticity
-Excitability
-Conductivity
-Contractility

what are the 4 key factors of Transmission of Electrical Impulses

-Automaticity
-Excitability
-Conductivity

what 3 factors of the Transmission of Electrical Impulses are due to an electrical component?

___ is the ability of the heart to generate and initiate electrical impulses on its own.

what is the normal origin for automaticity to occur?

___ is the ability of cardiac cells to respond to an electrical stimuli

___ is the ability to transmit electrical impulses to other myocardial cells

___ is the mechanical response to the electricity

-phase 0: rapid depolarization
-phase 1: early repolarization
-phase 2: plateau phase
-phase 3: rapid repolarization
-phase 4: resting phase

what are the 5 phases of depolarization and repolarization for a myocardial contraction to occur

phase 0: rapid depolarization

a. Na+ moves rapidly into the cell
b. Ca++ moves slowly into the cell

this is known as which phase of a myocardial contraction?

phase 1: early repolarization

a. Na+ channels close

this is known as which phase of a myocardial contraction?

phase 2: plateau phase

a. Ca++ continues to flow in
b. K+ flows out of the cell

this is known as which phase of a myocardial contraction?

phase 3: rapid repolarization

a. Ca++ channels close
b. K+ flows out rapidly
c. Na+/K+ pump begins to restore intracellular K+ and extracellular Na+

this is known as which phase of a myocardial contraction?

phase 4: resting phase

a. Cell membrane now impermeable to Na+
b. K+ moves into the cell

this is known as which phase of a myocardial contraction?

During Phase 1-2 and the start of Phase 3 cardiac cells are in an absolute refractory period - they ___ be stimulated, no matter how strong the electrical stimulus

-K: potassium
-Na: sodium
-Ca: calcium

what are the 3 electrolytes that are involved with depolarization and repolarization during cardiac contractions?

-K: inside
-Na and Ca: outside

where are the 3 electrolytes located with normal positioning before myocardial contractions occur?

-K: moves outside of the cell
-Na and Ca: move inside of the cell

during depolarization of a myocardial contraction, how are the electrolytes shifted/moved?

mechanical contraction

with depolarization, the movement of the electrolytes (K, Na, and Ca) as they depart from their home position is what causes the ___ of the heart

___ is known as the "resting period" and is when the electrolytes return to their home positioning

Electrical cells

Electrical impulses travel through a predictable pathway called the conduction system. ___ = initiate and conduct impulses

Mechanical cells

Electrical impulses travel through a predictable pathway called the conduction system. ___ = contract in response to electrical stimulation

___ activity ALWAYS precedes mechanical contraction

Can you have electrical conduction without mechanical contraction?

Can you have mechanical contraction without electrical conduction?

electrical impulses travel ___ - cannot travel backwards because a cell cannot respond to an electrical stimulus immediately after depolarization

-Sinoatrial (SA) Node
-Atrioventricular (AV) Node
-Internodal tracts and Bachmann's bundle

what 3 things are apart of the Atrial conduction

the Sinoatrial (SA) Node is located in the in the ___ near superior vena cava

Sinoatrial (SA) Node

the ___ is the pacemaker of heart (remember "automaticity") fires at 60 - 100 beats/min

Takes about ___ seconds for impulse from the SA node to reach AV node

Internodal tracts

Researchers are unsure how impulses travel through the atria; there is a theory that:

a. ___ provides a pathway for travel through the right atria

Bachmann's bundle

Researchers are unsure how impulses travel through the atria; there is a theory that:

b. ___ provides a pathway for impulses to travel to left atria

the Atrioventricular (AV) Node is located near ___ valve in inferior right atrium

Conduction through the ___ node is slow (delay of ~ 0.04 sec) to allow time for the ventricle to fill

junctional tissue

Junctional tissue that surrounds the AV node contains pacemaker cells that can intrinsically fire at 40-60 beats/min; if the SA node is damaged, the ___ surrounding the AV node can take over and control rate/rhythm of the heart

-Bundle of His
-Purkinje fibers

what are the 3 components of ventricular conduction

___ is a bundle of modified heart muscle that transmits the cardiac impulse from the atrioventricular (AV) node to the ventricles causing them to contract

Bundle of His is the beginning of ___ conduction

the Bundle of His is able to intrinsically fire impulses at ___ beats/min; occurs when SA node failure to generate impulses at a normal rate or when impulse doesn't reach AV node

-right bundle branch
-left bundle branch

the Bundle of His divides into what 2 branches?

right bundle branch

___ is on the right side of interventricular septum and right ventricle. the impulse travels slower as the right ventricle is smaller/thinner

left bundle branch

___ is on the left side of interventricular septum and left ventricle. the impulse travels fast as the left ventricle is thicker/larger

the difference in speed of conduction through right/left bundle branch (of the Bundle of His) ensures that the ___/___ ventricle will contract at the same time

Purkinje fibers

___ are fibers in the ventricles that transmit impulses to the right and left ventricles, causing them to contract. the most rapid transmission of cardiac conduction system occurs here

The Purkinje system covers the endocardial surfaces of both ventricles; the impulse spreads from the endocardium to the myocardium then to the ___

The Purkinje system is able to intrinsically fire at a rate of ___ beats/min; occurs when SA/AV node fail to generate an impulse or when the normal impulse is blocked in both bundle branches

___ are recordings of heart activity from several angles around the heart

___ leads consist of one positive (+) and one negative (-) pole

with ___ leads, between the two poles there is an "imaginary line" that represents the leads axis or direction of electrical current

Unipolar leads consist of a ___ electrode. The direction of the current determines the appearance of the waveform

a lead with ___ Deflection will have the current flow towards the + pole

a lead with ___ Deflection the current flows away from the + pole

Hardwire Monitoring

with ___ electrodes are placed on patient and connected directly to cardiac monitor; electrical signals visible on patient's bedside cardiac monitor and cardiac monitors located at nurses' station

there is ___ mobility when a patient is connected to Hardwire Monitoring

Telemetry Monitoring

with ___ the electrodes are placed on patients and connected to a small, battery-powered transmitter that sends electrical signals to a monitor screen, usually located at nurses' station

-3-lead/5-lead ECG (Continuous)
-12 lead ECG

what are the 2 types of ECG recordings

a ___ lead ECG is the most common recording

cardiac condition

with Electrode Placement, it is different for each lead/view of the heart. Many cardiac monitor systems have the capability to monitor a patient in more than one lead. Choosing the most appropriate lead for your patient depends upon your patient's ___ and the monitoring capabilities in the facility

is it appropriate to delegate lead placement to the chest wall by unlicensed personnel?

with the ___ view of the heart, the chest wall is in a vertical cut

what type of lead is used for view of the frontal plane (vertical cut)

I, II, III, aVR, aVL, aVF

what are the 6 limb leads used to view the frontal plane in a vertical cut?

What are the 3 bipolar leads of the six limb leads?

what are the 3 unipolar limb leads of the six limb leads

with ___ leads (I, II, and III), one lead connects to another

with ___ leads (aVR, aVL, and aVF), these leads look directly at the heart and do not connect to another lead

___ of the six limb leads looks at the top part of the heart from the right shoulder to the left shoulder

___ of the six limb leads looks from the right shoulder to the left leg

___ of the six limb leads looks from the left shoulder to the left leg

aVR lead

(right shoulder)

___ of the six limb leads is placed on the right shoulder and looks directly at the heart

aVL lead

(left shoulder)

___ of the six limb leads is placed on the left arm/shoulder and looks directly at the heart

aVF lead

(foot lead)

___ of the six limb leads is placed at the bottom of the chest and views the heart from the underneath section

the aVF of the six limb leads is known as the "___" but is not actually placed on the foot

precordial leads (V1-V6)

the six ___ leads look from a horizontal plane (transverse cut)

are the six precordial leads (V1-V6) all bipolar or unipolar?

all of the six precordial leads (V1-V6) are looking directly at the ___

___ is a blockage of the coronary artery to the right side of the heart which leads to damage on the right side of the heart.

with an inferior MI, this is evident in leads that are able to view the ___ of the heart or the inferior portion of the heart

Lead II, Lead III, aVF

what are the 3 leads that are able to view the right side of the heart to show evidence of an inferior MI?

inferior MI's are located on the right side of the heart. this can cause problems with automaticity as the SA node is located on the right side of the heart. this can ultimately lead to problems with ___

the right side of the heart is responsible for the initiation from the ___.

the right coronary artery supplies blood to the SA node and the AV node. patients with an inferior MI need to be monitored for complications such as initiation issues of the SA and AV nodes. ___ may result from an inferior MI

coronary artery

inferior MI is caused by the blockage of the ___ to the right side of the heart which can lead to damage on the right side of the heart.

___ occurs due to a blockage to the left anterior descending artery.

left anterior descending artery

anterior MI occurs due to blockage of the ___

evidence of an anterior MI is shown in leads that monitor the anterior portion of the heart. the best view point for looking at the anterior portion of the heart is through which leads?

an anterior MI causes problems to the ___ which is responsible for ejecting blood throughout the body.

left ventricular HF

what may be the resulting problem from an anterior MI?

which leads look at the left side of the heart and are good for viewing an anterior MI?

▪ Educate patient regarding purpose of "wires" and potential for hearing alarms
▪ Maintain privacy
▪ Make sure skin is clean - enhances electrical contact
▪ If patient is excessively hairy may need to trim
▪ Ok to clean area of skin with soap/water or alcohol pad - be sure to let air dry
▪ Choose sites over soft tissue - do not place electrodes over bone, thick tissues (breast) or skin folds
▪ Remove backing of electrode (should be a moist gel)
▪ Place firmly against skin ensuring a tight seal
▪ Make sure all electrodes are same brand
▪ Monitor skin integrity daily - change pads every 24-48 hours
▪ Attach wire to the electrodes - most are snap-on type - more comfortable for patient to snap to electrodes prior to placing electrode on patient
▪ Make sure monitor is on - select lead(s) to monitor

these are things the nurse should do with the application of ___

cardiac rhythms

▪ Observe the waveform on the monitor - should be able to visualize all components of the waveform
▪ The size can be adjusted by increasing or decreasing the gain
▪ Compare patients heart rate with the displayed heart rate on the monitor
▪ Set the alarms - upper and lower limits - be sure to keep your patients' condition in mind when setting the alarms - NEVER TURN ALARMS OFF
▪ Enter patient's information into monitor (i.e. name, room #)
▪ Print a strip and interpret - place in patients record
▪ Most monitors sense dysrhythmias and will alarm when detected
▪ Strips can be printed, and key information noted on the strip as indicated (i.e. medications administered, patient activity, presence of chest pain)

these are things the nurse should do with the monitoring of ___

nurses judgement

NOT physicians orders

who or what set the upper and lower limits for cardiac monitors?

the nurse should set an alarms upper and lower limits that are appropriate to that ___ patient

ex. if the patients normal heart rate is between 55-70 bpm, we want to set the lower limit to 55. this is specific to the patient! this can also be done for BP, O2 saturation, and anything else that is monitored

-horizontal axis
-vertical axis

what are the 2 axis of an ECG strip?

the horizontal axis of an ECG strip represents ___

on the horizontal axis of an ECG strip, each small block represents ___

on the horizontal axis of an ECG strip, 5 small block (or 1 large block) represents ___

on the horizontal axis of an ECG strip, 5 large blocks represent ___

on the horizontal axis of an ECG strip, a ___ strip or 30 large blocks is commonly used to calculate heart rate. this is easier to analyze and equals about 1 minute

on the vertical axis of an ECG strip, this measures ___ in millimeters (mm) or millivolts (mV)

on the vertical axis of an ECG strip, each block represents ___ mm, ___ mV

-P wave
-PR interval
-QRS complex
-ST segment
-T wave
-QT interval
-U wave

what are the 7 components of an ECG wave form

-step 1: determine rhythm
-step 2: calculate rate
-step 3: evaluate P wave
-step 4: determine PR interval (PRI)
-step 5: determine QRS complex duration
-step 6: evaluate T wave
-step 7: determine QT interval
-step 8: evaluate other components

what are the 8 steps with an ECG rhythm interpretation?

___ is measuring tool with two usually adjustable jaws used especially to measure thickness or diameter in an ECG waveform. this is the most accurate way of determining the rhythm of a waveform

-step 1: determine rhythm

▪ Measure with Paper/pencil or caliper
▪ Atrial Rhythm:
➢ Measure intervals between P waves - P-P intervals
➢ Determine if regular or irregular
▪ Ventricular Rhythm
➢ Measure intervals between R waves - R-R intervals
➢ Determine if regular or irregular
▪ If rhythm is irregular evaluate if regularly irregular or irregularly irregular

these are apart of which step in interpreting an ECG rhythm

P waves (P-P intervals)

we are able to measure Atrial rhythm by measuring the intervals between ___. Determine if regular or irregular.

R waves (R-R intervals)

we are able to measure ventricular rhythm by measuring the intervals between ___. Determine if regular or irregular.

-step 2: calculate rate

▪ "Times Ten Method" - easiest
➢ Obtain 6-second strip
➢ Count the number of P waves - multiply by 10
➢ Count the number of R waves - multiply by 10
▪ "1,500 Method"
▪ "Sequence Method"

these are apart of which step in interpreting an ECG rhythm

Times Ten Method

___ is a way to calculate heart rate by:

-Obtain a 6-second strip
-count the number of P-waves; multiply by 10 (atrial)
-count the number of R-waves; multiply by 10 (ventricular)

step 3: evaluate P wave

▪ Are P waves present?
▪ One P wave for every QRS?
▪ Similar size & shape? Normal configuration?

these are apart of which step in interpreting an ECG rhythm

Count small squares - start of P wave to start of QRS complex; multiply by 0.04

how are we able to determine the PR interval (PRI)?

0.12 - 0.20 seconds

what is the normal length of a PR interval?

step 4: determine PR interval (PRI)

▪ Count small squares - start of P wave to start of QRS complex; multiply by 0.04
▪ Normal = 0.12 - 0.20 seconds
▪ Is PR interval constant?

these are apart of which step in interpreting an ECG rhythm

Count small squares from beginning to the end of QRS complex; multiply by 0.04

how are we able to determine the QRS complex duration?

0.06 - 0.10 seconds

what is the normal length of time for a QRS complex interval?

Step 5: Determine QRS Complex Duration

▪ Count small squares from beginning to the end of QRS complex; multiply by 0.04
▪ Normal = 0.06 - 0.10 seconds
▪ Do all QRS complexes have the same size/shape?
▪ Is there a QRS complex for every P wave?

these are apart of which step in interpreting an ECG rhythm

Step 6: Evaluate T waves

▪ Are T waves present?
▪ Do all the T waves have a normal shape?
▪ Could a P wave be hidden in a T wave?
▪ Do all T waves have normal amplitude?
▪ Do all T waves have the same deflection as the QRS complex?

these are apart of which step in interpreting an ECG rhythm

Count the small squares from beginning of QRS complex to end of the T wave; multiply by 0.04

how are we able to determine the QT interval?

Normal = 0.36 - 0.44

what is the normal length of time for the QT interval?

Step 7: Determine the QT Interval

▪ Count the small squares from beginning of QRS complex to end of the T wave; multiply by 0.04
▪ Normal = 0.36 - 0.44

these are apart of which step in interpreting an ECG rhythm

Step 8: Evaluate other components

▪ Any ectopy
▪ Presence of U wave

these are apart of which step in interpreting an ECG rhythm

A. blood pressure

An 86 year old female is admitted to the hospital with a fractured right femur. she is connected to a cardiac monitor and is found to have a heart rate of 36. what should the nurse assess initially?

A. blood pressure
B. respiratory rate
C. pulse oximetry
D. home medications

A. yes, her CO and perfusion are decreased

An 86 year old female is admitted to the hospital with a fractured right femur. BP = 76/48, HR = 36, RR = 26, O2 stat = 91%, home meds = metoprolol, ASA, and tolterodine. is this rhythm problematic?

A. yes, her CO and perfusion are decreased
B. No, she is stable because of her age

B. Atropine 0.5 mg IV

An 86 year old female is admitted to the hospital with a fractured right femur. BP = 76/48, HR = 36, RR = 26, O2 stat = 91%, home meds = metoprolol, ASA, and tolterodine. what needs to be done?

A. Adenosine 6 mg IV
B. Atropine 0.5 mg IV
C. Epinephrine 1:10,000 IV
D. Vasopressin 4 units IV

dizziness due to beta blocker, fall, etc

An 86 year old female is admitted to the hospital with a fractured right femur. BP = 76/48, HR = 36, RR = 26, O2 stat = 91%, home meds = metoprolol, ASA, and tolterodine. what do you think is the underlying cause of her fracture?

A. decreased ventricular filling and decreased CO

A 16 year old female is admitted to the ICU after taking an overdose of Adderall. her vital signs are: BP = 86/44, HR = 166, RR = 32. identify the best description of this patients hemodynamic status?

A. decreased ventricular filling and decreased CO
B. Tachycardia and bradypnea
C. normal CO and tachycardia

A. reduce the HR (will improve the BP)

A 16 year old female is admitted to the ICU after taking an overdose of Adderall. her vital signs are: BP = 86/44, HR = 166, RR = 32. what is the priority goal of care?

A. reduce the HR
B. increase the BP
C. reduce the RR

A 16 year old female is admitted to the ICU after taking an overdose of Adderall. her vital signs are: BP = 86/44, HR = 166, RR = 32. what medication is anticipated?

A. nitroglycerin
B. metoprolol
C. atropine sulfate
D. dobutamine

"HISDEBS"

1. Hypoxia
2. Ischemia & Irritability
3. Sympathetic Stimulation
4. Drugs
5. Electrolyte Disturbances
6. Bradycardia
7. Stretch

what are the 7 reasons cardiac dysrhythmias occur?

Cardiac dysrhythmias

1. Angina / Chest Pain
2. DEATH
3. HF if underlying cardiac disease
4. Light-headedness
5. Palpitations
6. Syncope

these are common manifestations of ___

are all cardiac dysrhythmias problematic?

1. CO is decreased
2. systemic perfusion is impaired

cardiac dysrhythmias become problematic when what 2 things occur?

-Sinus bradycardia
-Normal sinus rhythm
-Sinus tachycardia

Sinus Rhythms is an impulse that originates from the SA node and can causes what 3 things?

-Bradydysrhymias
-Tachydysrhythmias

Atrial Dysrhythmias is an impulse that originates from the Atria and can cause what 2 things?

-Ventricular Fibrillation
-Ventricular Tachycardia

Ventricular Dysrhythmias is an impulse that originates from the Ventricle and can cause what 2 things

Premature Ventricular Complexes (PVCs):

___ is an early rhythm complex / ectopic / may originate from atria, junctional, or ventricular tissue

-Bigeminy: 2 beat pattern (every other beat is PVC)
-Trigeminy: 3 beat pattern (every 3rd beat is PVC)
-Quadrigeminy: 4 beat pattern (every 4th beat is PVC)

what are the 3 types of Premature Ventricular Complexes (PVCs) that can occur?

Premature Ventricular Complexes (PVCs) is NOT a ___ beat, meaning blood would not be delivered to the body during a PVC

1. Transcutaneous
2. Epicardial
3. Transvenous
4. Permanent

what are the 4 types of pacemakers?

transcutaneous pacemaker

___ is a pacemaker that goes on the skin

Epicardial pacemaker

___ is a pacemaker where the lead or leads are passed through the chest wall from an external power source and attached to the epicardium overlying the atrium or ventricle

transvenous pacemaker

___ is a pacemaker that is temporary and the leads access the heart through the venous system

permanent pacemaker

___ is a pacemaker that is implanted totally within the body and is the most common

pulse generator

___ is the power source that houses the battery and controls for regulating a pacemaker

___ are implanted wires which carry electrical impulses (stimuli) between the pulse generator and the heart

___ of the pacemaker is a rate that is increased or decreased

___ of the pacemaker is the strength of electrical impulse delivered that needs to be strong enough to have effect

sensitivity control

___ of the pacemaker senses what is going on in the heart

-synchronous pacing
-asynchronous pacing

what are the 2 types of pacing impulses that pacemakers can cause

synchronous pacing

___ is when the pacemaker delivers an impulse when the hearts intrinsic pacemaker fails. this is the most common type

Asynchronous pacing

___ is when the pacemaker delivers a pacing stimulus at a set rate regardless of intrinsic cardiac activity. this is used less commonly and used in emergent situations

where leads are located

Ex.
A = lead in atria
V = lead in ventricle
D = dual (in both chambers)

what does the 1st letter of the pacing code indicate?

where the pacemaker is sensing within the heart

Ex.
A = atria
V = ventricle
D = dual (both chambers)

what does the 2nd letter of the pacing code indicate?

what the pacemaker is going to do

Ex.
I = inhibit

what does the 3rd letter of the pacing code indicate?

if the 3rd pacing code of a pacemaker is "I" then then pacemaker is going to be ___ unless the HR falls below a certain point

-failure to pace
-failure to capture

what are the 2 types of pacing malfunctions

failure to pace

___ occurs when the pace maker fails to initiate an electrical stimulus when the pacemaker is due to fire. This is noted by the absence of a pacer spike on the rhythm strip.

Failure to capture

___ is a pacemaker malfunction that occurs when the artificial pacemaker stimulus is unable to depolarize the myocardium. the pacemaker fires, but does not stimulate enough to cause a contraction. this is a more complex problem

electrolyte imbalance, acidosis, output dial needs to be increased so impulse is stronger

what are 3 things that can cause Failure to capture to occur with a pacemaker?

___ is an asynchronous delivery of an electrical impulse and occurs without regard to what is going on in the heart.

is defibrillation used when there is a pulse or when there is no pulse?

-V fib
-pulseless V tach

what 2 rhythms are we able to defibrillate?

___ is a synchronous electrical impulse and is used WITH the patients intrinsic pulse.

Cardioversion is synchronized to the pulse in the heart or the patients intrinsic HR. this is ONLY used ___ a heart rate

with cardioversion, the electrical impulse is synchronous and is only going to be delivered at the ___. if delivered at any other time besides this wave, it can worsen the dysrhythmia

Implantable Cardioverter Defibrillator (ICD)

___ is an implanted, battery-operated device with rate-sensing leads; the device monitors cardiac impulses and initiates an electrical stimulus as needed to stop ventricular fibrillation or tachycardia

ventricular tachycardia

Implantable Cardioverter Defibrillator (ICD) are indicated for patients who have had one or more incidences of ___ that was not associated with an MI

Implantable Cardioverter Defibrillator (ICD)

• Identifies and treats atrial/ventricular dysrhythmias
• Contains generator, electrodes, and leads
• Postop complications include dysrhythmias, bleeding, cardiac tamponade

these are characteristics of a ___

Lightweight vests may be worn as cardioverter/defibrillator. this need to be worn 24 hours a day and should only be taken off for ___

Adrenergic Agents

___ is a cardiovascular drug that stimulates the sympathetic nervous system and induce symptoms characteristic of the fight-or-flight response

ex. albuteral (Proventil, Ventolin), ephedrine, metaproternenol (Alupent), phenylephrine (Neo-Synephrine), terbutaline (Brethine, Bricanyl)

Antiadrenergic Agents

___ inhibit the activity of the sympathetic nervous system. They act by blocking adrenergic receptors in target organs or by inhibiting the synthesis, storage, or release of endogenous catecholamines (mainly norepinephrine)

ex. Catapres

Antianginal Drugs

___ improve blood delivery to the heart muscle by dilating blood vessels
Increasing the supply of oxygen
Improve blood delivery to the heart muscle by decreasing the work of the heart
Decreasing the demand for oxygen

Ex.
-Nitrates
-Beta-Adrenergic Blockers
-Calcium Channel Blockers

Antidysrhythmic Drugs

___ are drugs used to treat abnormal heart rhythms

-amiodarone (Cordarone, Pacerone)
-flecainide (Tambocor)
-ibutilide (Corvert)
-lidocaine (Xylocaine)
-procainamide (Procan, Procanbid)
-propafenone (Rythmol)

Antihypertensive drugs

___ are medications that are used to lower blood pressure

ex.
-Diuretics. - thiazide diuretics. - loop diuretics. ...
-Vasodilators. - alpha-adrenoceptor antagonists (alpha-blockers) - angiotensin converting enzyme inhibitors (ACE inhibitors) ...
-Cardioinhibitory drugs. - beta-blockers. - calcium-channel blockers.

___ is a drug that reduces amount of cholesterol and lipids in the bloodstream; treats hyperlipidemia

ex.
-"statin" drugs

Coagulation Modifiers

___ is a class of drugs that aid the body in achieving hemostasis; includes anticoagulants and antiplatelets

-Heparin
-Thrombin inhibitors

___ are substances such as large protein molecules that do not readily dissolve into true solutions

___ are salts that dissolve readily into true solutions

___ is a medication administered to increase urine secretion in order to rid the body of excess water and salt

ex.
-Chlorothiazide (Diuril)
-Chlorthalidone.
-Hydrochlorothiazide (Microzide)
-Indapamide.
-Metolazone

vasoactive agents (vasopressors)

___ are medicines that constrict (narrow) blood vessels, increasing blood pressure. They are used in the treatment of extremely low blood pressure, especially in critically ill patients.

ex.
-Norepinephrine.
-Epinephrine.
-Vasopressin (Vasostrict)
-Dopamine.
-Phenylephrine.
-Dobutamine.

___ is a medication that cause dilation of blood vessels

-angiotensin converting enzyme (ACEs)
-angiotensin receptor blockers (ARBs)
-calcium channel blockers

2.8-4.2 L/min/m2

what is the normal Cardiac Index (CI)

What is the normal cardiac output?

what is the normal Mean Arterial Pressure (MAP)

what is the normal Mixed Venous Saturation (SVo2)?

15-30 / 10-15 mmHg

what is the normal Pulmonary Artery Pressure?

what is the normal Pulmonary Occlusive Pressure (PAOP) or Pulmonary Artery Wedge Pressure (PCWP)?

what is the normal central venous pressure (CVP)/ preload (atria) / Right Atrial Pressure (RAP)

800-1200 dynes/sec/cm5

What is the range for normal systemic vascular resistance (SVR)/ Afterload?

intra-arterial blood pressure

___ monitoring is used for actual or potential compromised hemodynamics [CO, perfusion, volume]

CO, perfusion, volume

a person needing intra-arterial blood pressure monitoring will have a problem with what 3 things?

intra-arterial blood pressure monitoring is a continuous measurement of what 2 things?

arterial system

how does intra-arterial blood pressure monitoring gain access into the body?

intra-arterial blood pressure monitoring provides a route to obtain blood gases and draw labs. ___ is a better site due to the bending of the arm with the branchial

with intra-arterial blood pressure monitoring, the cute should not have any gauze that covers the cite and should be ___. we want to make sure we palpate around the cite and assess for tenderness, blood, etc.

distal extremity

with a intra-arterial blood pressure monitoring, it is important that the nurse is making sure to assess the ___ to make sure it is being perfused, there is no ischemia, color is pink, etc

-Air Emboli
-Hemorrhage
-Infection
-Distal ischemia / infarction

what are 4 complications of intra-arterial blood pressure monitoring?

is a student allowed to remove an arterial line?

we NEVER should administer medications via ___ such as with intra-arterial blood pressure monitoring

C. assess the insertion site

risk of hemorrhage

A 55 yr old arrives to the ICU following a stent placement. he has a right femoral arterial line in place. what is the 1st nursing action?

A. connect the client to the monitor
B. assess for a dorsalis pulse to the right foot
C. assess the insertion site
D. ask the patient if he has any chest pain

Central Venous Pressure monitoring

___ is measuring the pressure of venous blood in the central vein

with Central Venous Pressure (CVP) Monitoring, if thoracic placement ___ must be done to verify placement prior to administering meds and rule out pneumothorax and/or hemothorax

▪ Administration of select medications (e.g. TPN or highly acidic infusions)
▪ Rapid infusion of large volumes of fluids
▪ Actual or potential alterations in volume

what are the 3 purposes of Central Venous Pressure (CVP) Monitoring

jugular or subclavian vein

Central Venous Pressure (CVP) Monitoring gain access by either the ___ or ___ vein

Right arterial pressure

once Central Venous Pressure (CVP) Monitoring is inserted, the catheter lies right above the right atrium. we are able to measure the ___ (which is essentially central venous pressure). this reflects the central pressure of the body (CVP) and reflect the volume of blood being returned to the heart.

the right atrial (RA) of the CVP is known as the "___ pressure"

if Central Venous Pressure (CVP) is low, is volume low or high?

if Central Venous Pressure (CVP) is high, is volume low or high?

Normal central venous pressure or preload is?

volume of blood

central venous pressure reflect the ___ in the body!!

low BP, high HR, tachycardia

what are 3 manifestation of fluid volume deficit that can be seen if the CVP is low?

systemic circulation

-Pressure system: High pressure
-Measurement: Blood pressure B/P
-Normal value: 120/80
-Systole: Measurement of the pressure in the systemic arteries when the left ventricle contracts
-Diastole: Measurement of the pressure in the systemic arteries when the *left ventricle relaxes

these are characteristics of which circulation system?

what is the normal values of the systemic circulation?

Systole of the systemic circulation is the measurement of the pressure in the systemic arteries when the left ventricles ___

Diastole of the systemic circulation is the measurement of the pressure in the systemic arteries when the left ventricle ___

pulmonary circulation

-Pressure system: Low pressure
-Measurement: Pulmonary Artery Pressure (PAP)
-Normal value: 25/10-15
-Systole: Measurement of the pressure in the pulmonary artery when the right ventricle contracts
-Diastole: Measurement of the pressure in the pulmonary artery when the right ventricle relaxes

these are characteristics of which circulation system?

25/10-15 mmHg

"quater (25) over a dime (10)"

what is the normal value for the pulmonary circulation (Pulmonary Artery Pressure [PAP])?

Systole of the pulmonary circulation (Pulmonary Artery Pressure [PAP]) is the measurement of the pressure in the pulmonary artery when the right ventricle ___

Diastole of the pulmonary circulation (Pulmonary Artery Pressure [PAP]) is the measurement of the pressure in the pulmonary artery when the right ventricle ___

if pulmonary circulation (Pulmonary Artery Pressure [PAP]) is low, then the volume is ___

if pulmonary circulation (Pulmonary Artery Pressure [PAP]) is high, then the volume is ___

pulmonary artery pressure monitoring

___ is the most invasive type of catheter and is also known as Swan Ganz Catheter

Swan Ganz Catheter

pulmonary artery pressure monitoring is the most invasive type of catheter and is also known as ___

what is the normal value for pulmonary artery pressure?

with pulmonary artery pressure monitoring, if the pressure is less than 4 mmHg then the volume is ___

with pulmonary artery pressure monitoring, if the pressure is greater than 12 mmHg then the volume is ___

pulmonary artery pressure monitoring

with ___, the catheter enters the subclavian and into the right atrium, to the right ventricle, and into the pulmonary artery. the tip of the catheter inflates in the pulmonary artery to help it to stay in place

Jugular or Subclavian

how are we able to gain access with pulmonary artery pressure monitoring?

▪ Cardiac Surgery
▪ Hemodynamically unstable patients (e.g. shock states)

what are 2 reasons why pulmonary artery pressure monitoring would be needed?

a ___ is needed for confirmation once pulmonary artery pressure monitoring is inserted

▪ Measuring cardiac output (CO)
▪ Measuring cardiac index (CI)
▪ Evaluating hemodynamics

what 3 things are we able to monitor and evaluate with pulmonary artery pressure monitoring?

C. systemic vascular resistance (SVR)

afterload can also be described as

A. cardiac output
B. stroke volume
C. systemic vascular resistance (SVR)
D. cardiac index

A. start at the beginning of the P wave

to measure PRI

A. start at the beginning of the P wave
B. start at the end of the P wave
C. start at the beginning of the Q wave
D. start at the end of the Q wave

symptomatic bradycardia is treated with

A. Adenosine
B. Amiodarone
C. Atropine
D. Epinephrine

venous oxygenation saturation

the purpose of ___ is measurement of oxygen supply and demand

venous oxygenation saturation is the measurement of ___ blood from the subclavian venous catheter (SVC) near the right atria

venous oxygenation saturation

___ is the measurement of % of O2 that is attached to Hgb in the venous system or what is left over after the arterial system has already delivered O2 to the cells of the body

60-80%

Balanced O2 supply/demand

What is a normal venous oxygenation saturation (SVO2)?

with low venous oxygenation saturation (SVO2) there is a decreased O2 supply with less than ___. we want to assess the patient, verify supplemental O2, measure CO, assess Hgb

with high venous oxygenation saturation (SVO2) there is a decreased O2 supply with greater than ___. this may occur with anesthesia, hypothermia, septic shock

Intra-aortic balloon pump (IABP)

___ is a pump that is inserted into the body and resides in the descending thorastic aorta

the purpose of Intra-aortic balloon pump (IABP) is to support the ___

Intra-aortic balloon pump (IABP) inflates on ___

Intra-aortic balloon pump (IABP) deflates on ___

-decrease O2 demand
-decrease afterload
-improve myocardial supply/demand

what are the 3 main goals of Intra-aortic balloon pump (IABP)

with Intra-aortic balloon pump (IABP) we want to prevent perforation. ___ in the tubing may indicate perforation. if this is detected, we want to stop pumping and call the MD

with Intra-aortic balloon pump (IABP), we want to monitor for catheter displacement by monitoring the ___ pulse. this can indicate proximal migration

with Intra-aortic balloon pump (IABP), we want to monitor for catheter displacement by monitoring the left radial pulse. this can indicate ___ migration

with Intra-aortic balloon pump (IABP), we want to monitor for catheter displacement by monitoring the patients ___. this can impair renal blood flow and we would see a decrease in the urine output. this can indicate distal migration

with Intra-aortic balloon pump (IABP), we want to monitor for catheter displacement by monitoring the patients urine output. this can impair renal blood flow and we would see a decrease in the urine output. this can indicate ___ migration

what is the insertion site for a Intra-aortic balloon pump (IABP)?

with a Intra-aortic balloon pump (IABP), the insertion site is in the femoral artery. we want to make sure we are monitoring for ___ extremity perfusion

leg must remain straight (log roll if needed)

what position should a patients leg be in if they have a Intra-aortic balloon pump (IABP) inserted into the femoral artery

Left lateral trendelenburg

if air is suspected in a Intra-aortic balloon pump (IABP) catheter, what position should the patient be placed in?

-decrease O2 demand
-decrease afterload
-improve myocardial supply/demand

what are the 3 main goals of Intra-aortic balloon pump (IABP)

-decrease O2 demand
-decrease afterload
-improve myocardial supply/demand

what are the 3 main goals of Intra-aortic balloon pump (IABP)

-decrease O2 demand
-decrease afterload
-improve myocardial supply/demand

what are the 3 main goals of Intra-aortic balloon pump (IABP)

-decrease O2 demand
-decrease afterload
-improve myocardial supply/demand

what are the 3 main goals of Intra-aortic balloon pump (IABP)

-decrease O2 demand
-decrease afterload
-improve myocardial supply/demand

what are the 3 main goals of Intra-aortic balloon pump (IABP)

-decrease O2 demand
-decrease afterload
-improve myocardial supply/demand

what are the 3 main goals of Intra-aortic balloon pump (IABP)

-decrease O2 demand
-decrease afterload
-improve myocardial supply/demand

what are the 3 main goals of Intra-aortic balloon pump (IABP)

-decrease O2 demand
-decrease afterload
-improve myocardial supply/demand

what are the 3 main goals of Intra-aortic balloon pump (IABP)

-decrease O2 demand
-decrease afterload
-improve myocardial supply/demand

what are the 3 main goals of Intra-aortic balloon pump (IABP)

-decrease O2 demand
-decrease afterload
-improve myocardial supply/demand

what are the 3 main goals of Intra-aortic balloon pump (IABP)

-decrease O2 demand
-decrease afterload
-improve myocardial supply/demand

what are the 3 main goals of Intra-aortic balloon pump (IABP)

-decrease O2 demand
-decrease afterload
-improve myocardial supply/demand

what are the 3 main goals of Intra-aortic balloon pump (IABP)

-decrease O2 demand
-decrease afterload
-improve myocardial supply/demand

what are the 3 main goals of Intra-aortic balloon pump (IABP)

-decrease O2 demand
-decrease afterload
-improve myocardial supply/demand

what are the 3 main goals of Intra-aortic balloon pump (IABP)

Sets with similar terms

N244 Cardiac Questions

57 terms

Chapter 15 - Shock and Resuscitation: Online Tests

115 terms

Chapter 17

237 terms

Chapter 21 Quizes / Homework

70 terms

Sets found in the same folder

Critical Care: Cardiac Rhythms

61 terms

Critical Care: Alterations in Comfort

177 terms

Critical Care: Cardiac II

349 terms

CC Exam 1: Normal values

31 terms

Other sets by this creator

EXIT HESI Comprehensive B Evolve Practice Questions

100 terms

Integrations: Chapters 1 & 2

111 terms

L&M: Patient Education

68 terms

L&M: Healthcare Reform - ACA

80 terms

Other Quizlet sets

Psychology-Module 4

11 terms

Patient Care Final

84 terms

Classical Empires AP World Test #2

58 terms

Environmental Biology Final Exam

95 terms