Term
| Why are dysrhythmias a problem? |
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Definition
| Because they affect cardiac output |
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Term
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Definition
| Initiate their own impulse (intrinsic pacemakers, not dependent on neuro) |
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Term
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Definition
| Ions rapidly shift, depolarization. |
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Term
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Definition
| Transfer the electrical impulse from the muscle cell to muscle cell |
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Term
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Definition
| Cardiac muscle continually convert an electrical signmal into mechanical action without rest |
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Term
| If EKG measures electrical activity of the heart, how do we measure mechanical activity? |
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Definition
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Term
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Definition
| Usually refers to extra or abnormal beats |
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Term
| What is the order of pacemakers failure in the heart? |
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Definition
-SA Node (sinus)
-Atrial
-Junctional (AV node)
-Ventricular |
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Term
| Average Stroke Volum (SV) |
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Definition
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Term
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Definition
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Term
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Definition
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Term
| What are supportive care for symptomatic dysrhythmias? |
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Definition
-Assess cerebral & CV perfusion
-Give supplemental oxygen
-Check IV access, consider second line
-IVF-NS
-Stat EKG
-Stat labs: BMP, CBC, Coags, CK/Troponin
-RRT |
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Term
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Definition
-Low BP
-Altered or loss of LOC
-Chest pain
-Heart failure
-Cool and clammy (shock state) |
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Term
| Care for symptomatic bradydysrhythmias |
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Definition
-Airway, O2, IVF, and get EKG
-Call RRT/code and prepare to give Atropine rapid IV push and/or Pacing |
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Term
| Symptoms of symptomatic tachydysrhythmias |
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Definition
-Low BP
-Altered or loss of LOC
-Chest pain
-Heart failure
-Cool and clammy
-Anxious |
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Term
| Nursing care for symptomatic tachydysrhythmias |
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Definition
-Airway, O2, IVF, EKG
-Meds differ if SVT (Adenosine, Diltiazem) vs. VT (Amiodarone)
-Cardioversion if pulse and BP present
-Defib and CPR if no pulse or BP |
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Term
| What area do EKG leads reflect? |
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Definition
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Term
| Advantages pf "wireless" telemetry |
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Definition
-Real-time continuous monitoring of rhythm
-Allows immediate identification, assessment and treatment of dysrhythmia
-Does not restrict patient to bed
-Unusual events on telemetry are followed up with 12 lead EKG |
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Term
| Advantages of 12 lead EKG |
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Definition
-Can measure amplitude (height) as well as time -- dx Myocardial ischemia &/or infarction and what part of the heart is affected.
-Consistent method across all providers which allows good baseline across time
-12 leads reflect more areas of the heart |
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Term
| What is a pathophysiology r/t ST depression and ST elevation? |
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Definition
Depression: Ischemia
Elevation: Infarction |
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Term
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Definition
-Primary pacemaker-starts cardiac cycle
-Initiates atrial depolarization and synchronized atrial contraction
-EKG: P wave
-HR: 60-100
-Location in right atrium makes it vulnerable to atrial enlargement or distension |
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Term
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Definition
-HR > 100
-Start with the assumption that ST is compensatory if HR is 150 or less
-Look for the cause, DO NOT treat rate without knowing cause
-ST>150-pt may become hemodynamically unstable if prolonged or compromised heart |
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Term
| Atrial dsyrhythmias: A. Fib |
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Definition
-Most common dysrhythmias
-R/t aging, HTN, CAD, HR, damage to right atrium
-Multiple sites send out weak uncoordinated impulses-atria quiver, no coordinated contraction to push blood into ventricles (loos of atrial kick-10%-30%
-Can be chronic underlying lung problem |
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Term
| When someone is on Coumadin what lab do you monitor? |
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Definition
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Term
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Definition
-Decreased cardiac output
-Risk for impaired cerebral perfusion: loss of contraction leaves blood sitting in atria->production of multiple small clots-> increased risk of stroke |
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Term
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Definition
| Calcium channel blocker-see for rate control, slows AV node |
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Term
| A. Fib: Tachy protocol, brady protocol |
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Definition
Tachy: IV diltiazem, followed by infusion
Brady: Check meds, hold inotropes, BB & CBC; may need permanent pacemaker |
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Term
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Definition
-Caused by localized irritable spot that rapidly and persistently fires impulses, seen as flutter waves
-AV node does not pass on every one
-See how atria have different rae from ventricles, but al vent impluses originate from atria |
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Term
| Synchronized cardioversion |
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Definition
-Treatment for a fib and a flutter
-All myocardial cells depolarize at once, allowing a refractory period for SA node to start first
-Done at bedside on telemetry unit or outpatient
-If non-urgent (pt asymptomatic), usually try "chemical" cardioversion first with meds |
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Term
| Why must a patient be anticoagulated before a cardioversion? |
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Definition
| If not anticoagulated, first strong beats of newly coordinated atria will send shower of clots to the brain . . . pt will have transesophageal echo |
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Term
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Definition
Depolarizing every cell in your heart at once
-Use if no pulse on patient |
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Term
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Definition
-Secondary pacemaker
-Normal rate 40-60 bpm
-Only electrical connection between atria and ventricles
-PRI: measures time charge is held in the AV node so ventricles have time to fill
-Normal PRI: 0.12-0.20 sec |
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Term
| Problems with AV blocks and Junctional Rhythms |
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Definition
-Rate too low:
AV blocks: Impulses blocked to ventricles and vent initiated rate is low
JR: inherent rate is 40-60
-Is patient symptomatic?
Yes: Follow Brady protocol
No: Check cardiac meds |
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Term
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Definition
Extension of AV node that splits into right and left bundle branches
-QRS: AV node firing & ventricular depolarization, initiating what?
-Normal QRS: < 0.12 sec |
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Term
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Definition
-Not a dysrhythmia, but abnormal conduction pattern in the ventricles.
-One BB is damaged (usually due to MI) and does not conduct impulses
-Normal fast conduction in one ventricle but delayed cell-to-cell transmission in other |
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Term
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Definition
-Ventricular origin of rhythm
-Ectopic vent site takes over pacing
-R/t electrolyte imbalance (esp K+ and Mg++), hypoxia, ischemia, infarction, idiopathic
-"Downward displacement of pacemaker"-bad sign |
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Term
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Definition
-If slow, the vent rhythm is usually called an "escape" rhythm: no rhythm initiated by SA or AV node, so ventricular site starts its own rhythm (to escape death)
-<40 we do not treat with antiarrhythmics |
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Term
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Definition
-Vent rate >100
-Treatment based on symptoms: with pulse or pulseless
-Pulse: tachy protocol if symptomatic
-No pulse: CODE
-AMIODARONE IV bolus, and then infusion x 18 hours |
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Term
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Definition
-No synchronized electrical activity in ventricles
-NO CARDIAC OUTPUT
-Loss of consciousness within seconds
-Code! Requires immediate CPR and defib |
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Term
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Definition
-No cardiac electrical activity, no cardiac output
-Code!
-ACLS does not recommend defibrillation for asystole
-Defib Resets the electrical system-no electrical activity to reset in asystole |
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Term
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Definition
Call a code and start CPR
-V tach
-V fib
-Asystole |
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Term
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Definition
-Not necessarily a problem
-Check for new onset, increased frequency, oxygenation, labs (especially lytes).
-Watch for new onset or increased frequency-might indicate precipitating condition that could cause heart dysrhythmias
-PAC-A. Fib
-PVCs-V. Tach |
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Term
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Definition
-Indications: chronically or intermittenly low rate that does not meet metabolic demands (low cardiac output)
-3rd degree heart block, slow a. fib, post-ablation
-No sinus pacemaker for ventricles
-Danger re intermittent a. fib
Override pacing: for SVT |
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Term
| Implantable cardioverter-defibrillator (ICD) |
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Definition
Indications:
-Documented history of v. tach or v. fib, long QT syndrome
-Significant risk factor like familial history, severe heart failure
Usually combined with pacemaker, especially in HF patients who need biventricular pacing.
Able to convert with much less electricity (comfort, anxiety) |
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Term
| Nursing care specific to CABG |
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Definition
-Cardiac perfusion
-Fluid overload
-Dysrhythmias: A. fib, V. arrhythmias, Pacemakers (temp)
-Pericarditis, pericardial effusion, cardiac tamponade
-Perfusion of graft extremity
-Telemetry
-"Off pump" v. "On pump" |
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Term
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Definition
-If only one bypass needed (LIMA to LAD)
-Endoscopic
-Robotic assisted |
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Term
| How long does a CABG last based on donor grafts? |
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Definition
LIMA (left internal mammary artery): 90% patent after 10 years
SVG (Saphenous vein graft): 75% occluded after 10 years |
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Term
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Definition
-'On pump': heart-lung bypass machine (extracorporeal)
Heart stopped and blood circulates via machine
ECMO: extracorporeal membrane oxygenation, non-surgical support for oxygenation and perfusion
-"Off pump"-no CP bypass adn heart stabilized mechanically with tools for surgery |
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Term
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Definition
-Single incision
-Valve sounds
-Biomechanical (porcine, autograft, or cadaver allograft) vs mechanical valve |
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Term
| Pre-procedure for cardiac cath |
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Definition
-Look out for Heparin allergies (more common) HIT
-Left main CAD="widow maker", first artery off aorta |
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Term
| Post-procedure cardiac cath: femoral access |
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Definition
-Check groin access every 15 minutes for first hour-palpate
-When there is a bleed, HR will rise first, then BP is the second sign
-Hemodynamically stable: Outcome for Care Plan, AEB
-Interventions are mostly about limiting mobility adn using pressure devices |
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Term
| Cardiac cath: radial access |
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Definition
More the norm in Europe but becoming more popular in America
-It awesome because you have no activity restriction
-Just wear "button pressure device" for a few hours |
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Term
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Definition
-Purpose is to improve cardiac perfusion
-These patients have fluid overload
-A. Fib is most common complication
-Will give beta blockers and temp pacemakers to fix rhythm |
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Term
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Definition
| Difference between systolic and diastolic |
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Term
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Definition
-Should chest tube fall out, cover with Vaseline gauze
-Atelectasis: diminished at bases
-Pleural effusion: crackles
-Toradol is very common for surgical pain (non-opioid, NSAID) |
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Term
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Definition
| Initiation of treatment prior to firm diagnosis |
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Term
| Bypass considerations comparing donor sites |
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Definition
-Arteries are better than veins
-Patients with IMA bypass, pay attention to lungs
-Arteries do better than veins because they are made for the high flow
-SVG only last about 10 years, but LIMA last about 25 years
-Hypertension lowers life of grafts |
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Term
| Heart valves (comparisons) |
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Definition
Valves: before surgery there will be "murmur," after surgery (with a mech valve) it will be a "tick" sound
-Autograft: will take your own pulmonic valve and replace aortic valve and then give you a new pulmonic valve
-Porcine/autograft valve: don't require anti-coag, have les s blood damage, but don't last as long (only 10 yrs)
-Mech valve: can last rest of life |
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