Cardiac Disorders
A disorder that is brought on by a weakening of the arterial walls causing a local area of bulging or dilation, creating an out pouch that is susceptible to rupture
what is ANEURYSM
A heart rate of 101-150 with a normal pr/qrs interval.
Can be cause by hypovolemia, fever, anxiety, pain, hypoxia, electrolyte imbalances.
treatment: treat cause, may use an antiarrhythmic (beta blocker)
sinus tachycardia
dropped QRS, changing PR interval
Second degree type 1 block
wide and bizarre QRS periodically, QRS in opposite direction of P waves
can be present in couplets, triplets, or as a bigeminy
decrease in cardiac output
Premature ventricular contraction
An older pt hospitalized with chest trauma following an MVA who is not intubated has a R femoral arterial line. Because the pt has been thrashing about in bed, a physician writes an order for wrist restraints to be applied. Based on this, which action by a nurse is correct?
A) chemically restrain the patient, B) place a 4 point restraint on the patient, C) request and order for a right ankle restraint
C
A cardiac disorder that is often caused by atherosclerosis and results in the destruction of heart muscle from lack of oxygen
what is MYOCARDIAL INFARCTION
heart rate less than 60 with normal pr/qrs interval
causes: MI, electrolyte disturbances, med toxicity, respiratory, increased vagal tone
treatment: atropine, transcutaneous pacing, epi/dopamine infusion
sinus bradycardia
Prolonged PR interval, generally no treatment required
First degree AV block
many tall waves, 3 premature ventricular contractions in a row
pith a pulse: antiarrhythmic drugs
unstable with a pulse: cardioversion
without pulse: treat with CPR, defib, epi
ventricular tachycardia
The nurse is caring for a pt with a PA catheter. The nurse understands that the SVO2 will most likely be which of the following if the pt is in cardiogenic shock?
A) decreased, B)increased, C) the same as usual
A
A cardiac disorder that is caused by capillaries becoming highly permeable allowing proteins/ fibrinogens to leave the blood stream and enter pericardial cavity, resulting in inflammation. There are five categories: inflammatory, neoplastic, degenerative, vascular and idiopathic.
pacemaker cells fire earlier than expected. QRS is normal, interval between r waves change
causes: hypoxia, caffeine, medications, enlarged atria
no treatment needed
premature atrial contraction
present in someone that has had an MI in the past
QRS wide and has rabbit ears
bundle branch block
flat line
may have idioventricular beats: when SA and AV are failing and there is still some minimal activity
treat with CPR and epi, DO NOT defibrillate
asystole
A nurse is caring for a 12 kg child following cardiac surgery. The chest tube drainage total is 200ml for the past hour. What is the best action?
A) empty the drainage tube, B) Notify the provider, C) increase the suction to the chest tube
B
rationale: drainage should be 1ml/kg/hour. this could be indicative of bleeding
what is CARDIOGENIC SHOCK
SA node fails and the AV node takes over the pacing (40-60 bpm). p waves are not present or they are buries within the QRS
causes; ischemia, hypoxia, drug toxicity
treatment: transcutaneous pacemaker
junctional escape rhythm
atrial rate and ventricular rate but no connection. ventricular rate as low as 20-40
p waves fall in the middle of the qrs
EMERGENCY
causes: MI, ischemia, medication
treatment: pacing, epi/dop infusion
third degree heart block
many small waves, no atrial or ventricular contraction, no pulse, no BP
immediate CPR and defibrillation
ventricular fibrilation
A nurse is orienting a new nurse on care of a pt who is having a line placed for hemodynamic monitoring. Which of the following by the new nurse indicates understanding?
Air should be instilled into the monitoring system prior to the procedure
The pt should be positioned on the L side during the procedure
The transducer should be level with the 2nd intercostal space after the line is placed
A chest x-ray is needed to verify placement after the procedure
4
a cardiac disorder characterized by heart muscles becoming weak, enlarges, tick, or rigid and may develop structural changes. The ejection fraction decreases and symptoms are present when it becomes less than 30%
what is Cardiomyopathy
any dysrhythmia with a rate over 150 and originates above the ventricle. QRS in normal limits, one loopy wave between QRS complex
treatment: symptomatic=cardioversion, asymptomatic= vasovagal maneuvers, adenosine, then a beta blocker or calcium channel blocker
causes: hypoxia, cardiac disorders, electrolyte imbalances, drug toxicities, thyrotoxicosis
supraventricular tachycardia
causes: ischemia
treatment: atropine, transcutaneous pacing, IM epi
second degree type 2 heart block
type of v tach where depolarization is occuring in concentric manner around the ventricle
V tach waves with increasing and decreasing amplitude
stable: treat with magnesium push
unstable: use defibrilation
torsades de pointes
A nurse on a cardiac unit is caring for a group of pts. The nurse should recognize which of the following pts as being at risk for the dev. of dysrhythmia? (SELECT ALL THAT APPLY)
A pt who has metabolic alkalosis
A pt who has a blood K of 4.3
A pt who has an SaO2 of 96%
A pt who has COPD
A pt who underwent stent replacement in a coronary artery
1,4,5