complex study guide filled

Question 1

What does a V-tachycardia strip look like

Answer 1

-looks frantic, chaotic
-WIDE QRS
-NO PULSE

Question 2

What to do with a v-tach patient

Answer 2

*life threatening dysrhythmia

1. CALL CODE (PRIORITY)
2. start CPR
3. defibriliate
4. epinephrine
5. amiodarone

Question 3

A-fib looks like

Answer 3

*irregulary irregular rhythm

-NO DISTINCT P WAVES

Question 4

Big risk for a-fib

Answer 4

clotting

Question 5

a-fib priorities

Answer 5

1. warfarin (coumadin)–>anticoagulant because blood pools in atria–>clot
2. monitor rate
3. possible cardioversion

Question 6

what is a Complete heart block (3rd degree)

Answer 6

*atria/ventricles beat independelty–> poor cardiac output leading to:
-syncope
-hypotension
-shock

Question 7

how does complete heart block look

Answer 7

-atrial rate= 82
-ventricular rate= 46
-NO relation between P and QRS waves
-PR interval inconsistent

Question 8

PVCs

Answer 8

*irritated ventricles–>can lead to VT

-variable rate
-wide, abnormal QRS
-P wave only with normal cycles
-R-R irregular

*bigeminy, trigeminy, quadrigeminy

Question 9

what to check w/ Asystole

Answer 9

*No rate–>no CO (flatline?)

-MAKE SURE LEADS ARE ATTACHED

Question 10

When to suction

Answer 10

*ALWAYS HYPEROXYGENATE BEFORE
-visible secretions
-rhonchi
- - O2 sat
-restless
-increased peak pressure alarm

Question 11

furosemide is used for

Answer 11

-pulmonary edema
-fluid overload

*GIVE EARLY
*WATCH FOR HYPOKALEMIA

Question 12

warfarin is used for

Answer 12

*prevent clots in:
-afib
-dvt
-PE

Question 13

dobutamine used for

Answer 13

*increases contractility–> improve cardiac function

• -CO
  -Cardiogenic shock
  -Severe HF

Question 14

digoxin toxicity monitor for

Answer 14

-nausea
-vision changes
-bradycardia
-check potassium

Question 15

Dopamine use (low dose)

Answer 15

*mild diuretic effect–> 1-3mg/kg)
-improves kidney perfusion

Question 16

dopamine high dose used for

Answer 16

cardiac function

Question 17

bradycardia care

Answer 17

*<60 bpm

1. LOOK AT THEM (assess)
   *are they symptomatic?:
   -hypotension
   -dizziness
   -confusion

Question 18

symptomatic Bradycardia tx

Answer 18

O2 and ATROPINE

Question 19

Goal of HF tx

Answer 19

-improve CO
-improve O2
-improve perfusion
-reduce preload/afterload

Question 20

HF planning care

Answer 20

-monitor meds effectiveness
-monitor urine output
-watch potassium
*call provider if BP low or UO low

Question 21

Whats major concern for HF

Answer 21

-urine output less than 30 ml/hr
-low BP

*call provider

Question 22

MI biggest concerns

Answer 22

(Heart is failing)
*low BP+ low urine–> poor perfusion–>cardiogenic shock risk

Question 23

If pt has HR of 165 bpm, what do you do?

Answer 23

1. O2
2. IV
3. Continuous monitoring

*fast rate–> - filling time–> - CO

Question 24

What to know about pacemaker malfunctions

Answer 24

*low battery!
-leads dislodging
-high-output electrical devices

*Teach:
-how to check pulse
-report rate over 100 bpm
-report if HR is lower than set
-wear medical bracelet

Question 25

pacemaker education

Answer 25

*know brand, settings, when battery expires -send home w. discharge teachings -normal settings -how to check pulse -when to call for help (hr over 100bpm or HR lower than set) -know when battery will give out

Question 26

atrial pacemaker

Answer 26

pace spike before P wave

Question 27

ventricular pacemaker

Answer 27

*pacemaker working as AV node -looks like a line before QRS -P wave can be present *SPIKE IS NORMAL BEFORE QRS*

Question 28

ARDS

Answer 28

*ACUTE INFLAMMATORY LUNG INJURY-->can lead to resp failure -noncardiac pulmonary edema -CO2 normal initially -no hypercapnia -severe hypoxemia

Question 29

what causes ARDS

Answer 29

-inflammatory process--> fluid build up-->alveolar damage impacts gas exchange

Question 30

3 complications with intubated patients

Answer 30

1. communication (PRIORITY-->use paper/pen or whiteboard) 2. Preventing pneumonia 3. oxygenation

Question 31

Lung issues post op care (easy)

Answer 31

-help them with coughing, IS, chest compression

Question 32

lung issues post op care more in depth

Answer 32

*pain, splint, assist, assess 1. splint the area 2. pain meds 30 min before breath excercise 3. assist with coughing/deep breathing 4. Ausculate AFTER excerices

Question 33

assessing for pulmonary edema

Answer 33

*fluid buildup in lungs -dyspneic -frequent cough -crackles

Question 34

Pt getting PA catheter and now has SOB, what do you expect?

Answer 34

*pneumothorax -probably punctured lung

Question 35

Pt has chest surgery and complaining of pain. What do you do?

Answer 35

*ASK THEM-->is the patho unrelated to another MI or is it incisional pain? 1. Check Troponin levels to rule out MI before you give meds 2. check O2/nitro

Question 36

Patient post CABG only has 20 ml urine in last hr with high Specific urine gravity. Whats expected?

Answer 36

*inadequate fluid volume--> expect fluid replacement

Question 37

what to have during PA cath insertion?

Answer 37

*ALL OF THE ABOVE* -O2 -Continuous Ekg -amiodarone/lidocaine for dysrhythmias

Question 38

pt is an old lady in NY

Answer 38

increase in activity level bc of HF that prevents from normal activity

Question 39

Cardicac rehab concerning pt

Answer 39

*pt that is 4 weeks post cardiac surgery, walking 4/5 miles a day--> OVERACTIVITY NOT GOOD -relax 3x/day is good -reducing sodium is good

Question 40

Ventilators big complications

Answer 40

*GASTRIC HEMORRHAGE/STRESS ULCERS NOT: -increase CO, PE, immunosuppresion

Question 41

what do mech vents do

Answer 41

increase intrathoracic pressure-->usually lower systolic pressure bc cant pump blood back to heart.

Question 42

Best way to determine ET placement

Answer 42

listen to breath sounds B/L

Question 43

High pressure alarm went off, what do you do

Answer 43

1. look for obstruction 2. suction if needed *hyperoxygenate ebfore

Question 44

Low pressure alarm went off, what do you do?

Answer 44

1. assess for leaks/disconnections 2. if not able to fix, disconnect-->bag them *100% oxygenate them

Question 45

Pt on vent is restless, do what

Answer 45

1. CHECK O2, are they hypoxic 2. are they overstimulated or uncomfortable--> decreases stimulation, cluster care

Question 46

Pt biting on ET tube, what do you do?

Answer 46

1. find out why-->educate why they shouldnt 2. know they cant harm themselves doing so 3. if continues to bite-->use bite block

Question 47

If telemetry is weird do what first

Answer 47

-if hr too high or low-->check lead placement-->check if sleeping, resting, uncomfy

Question 48

what to asses for w/ cardiomyopathy

Answer 48

*s/s of low perfusion: -SOB -PALE *HEART working extra hard--> fatigued and hypoxic *LF is flappy--> decreased EF --> contributes to HF

Question 49

Chest tube assessment

Answer 49

*drainage should decrease -monitor drainage -check dressing -tidaling in close system, bubbles -want to see changes in waves but no air bubbles

Question 50

If there is quick increase in drainage from chest tube, whats expected

Answer 50

pneumothorax--> call provider

Question 51

Chest tube, tidaling changing to bubbling means what?

Answer 51

-air leak/pneumothorax *bubbling should go down over time because the air is decreasing in pleural space and tidaling is okay because it shows pressure changes

Question 52

complications of mechanical vent

Answer 52

-BAROTRAUMA -increased presusre in lun field--> pneumothorax; tx is chest tube -pneumoniae

Question 53

Most important intervention with central lines

Answer 53

maintain sterile technique and dressing changes

Question 54

A lines can be used for

Answer 54

*BLOOD DRAWS

Question 55

pt planning for HF

Answer 55

-effectiveness of meds -complications of disease -when to call for help

Question 56

priority for ineffective airway clearance

Answer 56

-keep secretions out -change positions -hydrate -bronchodilators