• accurate anatomical placement/correct attachment
• skin prep
• place patient in semi-reclined position and remind them to breathe normally
• the nurse is ultimately responsible for accurate EKG rythm interpretation, patient assessment and management
• Nurse should obtain orders for shower, off floor testing, and leaving the unit

permitted out of bed once stable

arm and shoulder activity limited

nurse observes insertion site for signs of bleeding and ensure incision is intact

carry pacemaker information card at all times upon dismissal

wear medic alert ID/bracelet at all times

take pulse for 1 full minute each day at same time

in some patients, VTACH can cause cardiac arrest

assess the patient's airway, breathing, circulation, LOC, and oxygen level

for a stable patient with sustained VTACH, administer O2 and confirm the rhythm on an EKG.

Amiodarone, lidocaine, or magnesium sulfate may be given

cardioversion is highly recommended for stable VTACH

life threatening!!!

fatal if not successfully ended within 3-5min.

priority is to defibrillate the patient

if a defibrillator is not present, continue CPR until it arrives. An AED can be used

very concerning

Conduction Pathway:

occurs with repetitive firing of an irritable ventricular ectopic focus, usually at a rate of 140-180bpm or more

the sinus node may continue to discharge independently, depolarizing the atria but not the ventricles

VTach is commonly the initial rhythm before deterioration into VFIB as the terminal rhythm

Pathophysiology/Effects:

can cause cardiac arrest

Life threatening

Conduction Pathway:

impulses from many irritable foci fire in a totally disorganized manner so that ventricular contraction cannot occur

Pathophysiology/Effects:

ventricles quiver, consuming a tremendous amount of oxygen

no cardiac outpulse or pulse

no cerebral, myocardial, or systemic perfusion

may be the first manifestation of CAD

Causes:

hypokalemia

hypomagnesemia

hemorrhage

antidysrhythmic therapy

rapid SVTs

shock

Treatment:

resolve VFIB promptly

defibrillate the patient immediately

#1 dysrhythmia for hospitalization

Conduction Pathway

multiple rapid impulses from many atrial foci depolarize the atria in a totally disorganized manner at a rate of 350-600times a minute.

chaotic rhythm

no clear P waves, no atrial contractions, loss of atrial kick, and an irregular ventricular response

Pathophysiology/Effects:

decreases ventricular filling

reduces cardiac output (further imparing the heart's perfusion ability)

assess for fatigue, weakness, SOB, distended neck veins, dizziness, decreased exercise tolerance, anxieyt, syncope, palpitations, chest discomfort or pain, and hypotension

Causes/Risk Factors:

HTN

DM

male gender

congestive heart failure

valvular disease

alcohol intake

cardiac surgery

electrocution

MI

pericarditis

myocarditis

PE

Treatment:

Coumadin (more of prevention)

BB, CCB, digoxin

Cardioversion (ablation)

Conduction pathway:

sinus node fires <60bpm

Pathophysiology/Effects:

syncope

dizziness and weakness

confusion

hypotension

diaphoresis

shortness of breath

ventricular ectopy

anginal pain

Causes:

parasympathetic nervous system stimulation

vagal nerve stimulation

may result from hypoxia, inferior wall MI, or administration of beta-adrenergic blocking agents, calcium channel blockers, or digitalis.

Treatment:

Atropine

Pacing (external/internal)

oxygen

Conduction pathway:

sinus node fires <60bpm

Pathophysiology/Effects:

syncope

dizziness and weakness

confusion

hypotension

diaphoresis

shortness of breath

ventricular ectopy

anginal pain

Causes:

parasympathetic nervous system stimulation

vagal nerve stimulation

may result from hypoxia, inferior wall MI, or administration of beta-adrenergic blocking agents, calcium channel blockers, or digitalis.

Treatment:

Atropine

Pacing (external/internal)

oxygen

left ventricular infarction

HTN

aortic and mitral valve stenosis

Pulmonary Congestion

Dyspnea

Activity intolerance

Pulmonary Disease

left sided failure

pulmonic and tricuspid valve stenosis

Edema and weight gain

hepatic congestion

• no claudication present
• bruit or aneurysm may be present
• pedal pulses are decreased or absent

• muscle pain, cramping, or burning occurs with exercise and is relieved with rest
• symptoms are reproducible with exercise

• pain while resting commonly awakens the patient at night
• pain is described as numbness, burning, toothache-type pain
• pain usuallly occurs in the distal portion of the extremity, rarely in the calf or the ankle
• pain is relieved by placing the extremity in a dependent position

• ulcers and blackened tissue occur on the toes, the forefoot, and the heel.
• distinctive gangrenous odor is present

• intermittent claudication
• rest pain
• loss of hair on the lower calf, ankle and foot
• dry, scaly, dusky, pale, or mottled skin
• thickened tonails
• could be cyanotic or darkened
• pallor may occur when the extremity is elevated
• rubor may occur when the extremity is lowered

• occurs as a result of prolonged venous hypertension that stretches the veins and damages the valves.
• valvular damage can lead to a backup of blood and further venous htn, resulting in edema
• because the patient cannot eliminate waste products, they build up within the tissues.

assess for:

stasis dermatitis (reddish-brown discoloration along the ankes, extending up to the calf.)

stasis ulcers generally over the malleolus

decrease edema

promote venous return from the affected leg

stockings that fit from the middle of the foot to just below the knee or to the thigh

elevate legs for at least 20 minutes 4-5x/day

coordinate with the physician about the use of intermittent sequential pneumatic compression or foot plexus pumps

• elevate your legs for at least 20 minutes 4-5x/day
• when in bed, elevate your legs above the level of your heart
• avoid prolonged sitting or standing
• do not cross your legs. Crossing at the ankles is acceptable for short periods
• do not wear tight, restrictive pants. Avoid girdles and garters.

can function in many different ways

when the inner cannula is in place, the fenestration is covered and this tube works like a double-lumen tube.

when the inner cannula is removed and the plug or red stopper is locked in place, air can pass through the fenestration, around the tube, and up through the natural airway, the pt can then cough and speak.

abrupt onset

cough

fever

myalgia

headache

sore throat

age

comorbidity

immunocompromised

high risk exposure

streptococcus pneumoniae

H. Influenza

Risk factors:

smoking/alcohol use

age

vaccination status

co-morbidities

exposure?

Usually bacterial (Pseudomonas, Enterobacter, S. aureus, S. pneumoniae, E. coli, Klebsiella)

risk factors:

age

immunosuppression

ALOC/aspiration

co-morbidities

intubation

effective immune response: inactivates bacteria

positive skin test

cannot spread infection

active bacteria multiply and cause disease

Manisfestations:

fatigue, malaise

low-grade fevers

anorexia

unexplained weight loss

night sweats

decrease SNS effect on SA/AV nodes

neg Chronotropic

neg dromotropic

outcomes:

decrease SA rate of firing

decrease conduction velocity

• preoxygenate with 100% oxygen
• insert catheter without suction
• withdraw catheter with intermittent suction, rotating catheter
• oxygenate between passes
• repeat until clear