Test Bank - High-Acuity Nursing 7th Edition by Kathleen Wagner, All Chapters.pdf

HIGHsACUITYsEXAMsONE

EKGsSTRIPSs
⎯ SINUSsBRADYCARDIAs
▪ Sinussrhythmswithsrates<s60sbpm
▪ Treatment→sAtropines

⎯ SINUSsTACHYCARDIAs
▪ Sinussrhythmswithsrates>100sbpms
▪ Treatment
➢ Treatsthescauses
➢ Betasblockers—slowssdownsthesHR
➢ CCB—blockssthescalciumsenteringsthesheartsmuscles
➢ Worstscase→scardioversions

⎯ ATRIALsFIBRILLATION
▪ Multiplesimpulsesswithinsthesatria.s*Risksforsstrokes*
▪ Treatment
➢ Ratescontrol—Digoxin,sbetasblockers,scalciumschannelsblockers
➢ Antiarrhythmicsmeds—Amiodarones
➢ Cardiacsablations
➢ Cardioversions

⎯ ATRIALsFLUTTER
▪ AtrialsrhythmsproducedsoutsidesofsSAsnodes
▪ Treatments
➢ Ratescontrol—Betasblockers,sCCB,sDigoxins
➢ Antiarrhythmics
➢ Cardioversions

⎯ VENTRICULARsTACHYCARDIAs
▪ ThreesorsmoresPVCssinsasrow.sLife-




threateningsdysrhythmiasassasresultsofsthessignificantsreductionsinsCOsthatscansoccurs
▪ Treatments
➢ NOsPULSE→sCallscode,sstartsCPRsandsdefibrillate,sMedss(Amiodarone)
➢ PULSE→sNotifysHCP,schecksBPs(ifslowsstartscardioversion)
➢ Amiodarone,slidocaine,sprocainamides


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,⎯ VENTRICULARsFIBRILLATIONs
▪ Lethalsdysrhythmiasrequiringsimmediatestreatments
▪ Treatment→schestscompressions,sdefibrillations
⎯ ASYSTOLE
▪ Nosmeasurableselectricalsactivitysfromstheshearts
▪ Treatment


➢ CPR,sEpinephrines(stimulatesselectricalsactivity),sTreatsthescause!s*Nosdefibsifsnosactivitysinsthesheart*

⎯ PACEMAKER
▪ Thereswillsbesasspikesinsthesstrips

⎯ REVIEWsMEDS
▪ Procainamides(Pronestyl)-
sClasss1asAntidysrhythmicsdrug,shelpsstosregulatesthesheartsrhythmsaftersasdisordersoccurssinsthesventricles.ssUs


edstostreatslife-threateningsventricularsarrhythmias.s
▪ Amiodarones(Cordarone)-sClasss3sAntiarrhythmicsdrug,susedstostreatsventricularstachycardia/sfibrillations.
▪ Epinephrines(Auvi-Q)-
susedstostreatsverysserioussallergicsreactions;sforscardiacsitsincreasessheartsratesandsmyocardialscontractility.sUs


edswithsasystolesarrhythmias
▪ Adenosines(Adenocard):srelaxessandsdilatessthesbloodsvessel,susedsonsptswithsSVTsdysrhythmias
▪ Lidocaines(Lidamantle):slocalsanestheticsthatsnumbssthessensationssofstissuessresultingsinsasvasodilationseffect.s
usedsonsptsswithsventricularsarrhythmiass
▪ Atropines(Atropen)-sincreasessheartsrate.sUsedsforsbradycardia

⎯ MEDICATIONsFORsHEARTsFAILUREsPTS
▪ Diuretics
➢ Thiazide-sHCTZ
➢ Loop-Furosemides(laxis)
▪ Antihypertensivesmeds
➢ BetasBlockers-sAtenolol,sPropranolol,sMetoprolol
➢ ACEsinhibitors-sCaptopril,sLisinopril,sEnalapril
➢ CalciumsChannelsBlockers-sDiltiazem,sNifedipine,sVerapamil.sAmlodipine
➢ ARBs-sLosartansandsValsartan
▪ Dietaryssupplement
➢ Avoidssaltsandshighsfatsdiet,s1500mgsofssaltss(2,000-3,000mg)spersday
▪ Vasodilator




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, ➢ Hydralazinesrelaxessthesbloodsvesselsstosallowsbloodstosflowseasily.
▪ Antianginals
▪ Nitroglycerin,sAmiodarone,sDiltiazem,sVerapamil.
WARFARINsTHERAPEUTICsLEVELsANDsLABsVALUESs
▪ PT:s10-13ssec
▪ INR:s2-3ssec

⎯ VENTRICULARsHYPERTROPHYsHISTORYsANDsASSESSMENTS
▪ AsymmetricsLt.sventricularshypertrophyswithoutsdilationswithsenlargementsofsseptumsandsobstructionsofsblood
sflowsinsLt.sventricless


➢ Fillingsissimpaireds
➢ Ventriclesissstiff,snoncompliant,sunablestosrelax,sresultingsinsdecreasedsCOsespeciallysduringsexertions
▪ S/S
➢ Exertionalsdyspneas(mostscommon),sfatigue,sangina,ssyncope,sdysrhythmiasssuchsasssupraventricularstachy
cardias(SVT),satrialsfibrillation,sV-TachsandsV-Fibsleadingstosunconsciousnesssandsdeath
▪ Administersmedication
➢ BetasBlockerssfirst-line,sthensVerapamils(CCB,snegsinotrope)
➢ **Digoxinsisscontraindicated**

⎯ COMPLICATIONsOFsMI
▪ Dysrhythmiass
▪ HeartsFailures
▪ Thromboembolis
▪ Cardiogenicsshock
▪ Ventricularsaneurysms
▪ Papillarysmusclesdysfuntions
▪ Acutespericarditiss
▪ Dresslerssyndromes

⎯ LABSsANDsVALUESsFORsCONGESTIVEsHFsPTs(BNP)
▪ BrainsNatriureticsPeptides(<100spg/mL)slesssthans8
0*
▪ Releasedsfromsoverstretchsventricularstissues
▪ ElevationsindicatessHFs
⎯ LABsANDsDIAGNOSTICsPROCEDUREsTOsDETECTsMIs
▪ Laboratorystests—biomarkerss
➢ CK-MB
➢ TroponinsTsorsI—
TroponinsissthesmostsspecificscardiacsmarkersforsINJURY.sIfsMIsissbeingsruledsout,sCardiacsEnzymess(CK,sCK-
MB,sandsTroponin)swillsbesorderedsQ6shourssxs3,sthensdailysifsnecessary.s
➢ NormalsTroponinsTs<s0.1ng/ml
➢ NormalsTroponinsIs<s0.4ng/ml

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, ⎯ DIFFERENTsTYPESsOFsANGINASsSTABLEsVSsUNSTABLE
▪ Anginaspectoris—
characterizedsbysepisodessorsparoxysmalspainsorspressuresinsthesanteriorschestscausedsbysinsufficientscoronarys
bloodsflows
▪ Stable→schestspainsorsdiscomfortsthatsissassociatedswithsphysicalsactivity
▪ Unstable→sincreasedsfrequencysandsseveritysandsissnotsrelivedsbysrestsandsNTG.s**Requiressmedicalsinterventi
on**

⎯ INTERVENTIONSsFORsPTsWITHsRIGHTsCONGESTIVEsHF
▪ Right-
sidedsheartsfailurescansalsosresultsfromspulmonarysdiseases(corspulmonale)sandsprimaryspulmonarysarteryshype
rtension.s
▪ Pulmonarysembolussissascommonscausesofsacutesright-sidedsHF
▪ Management:
➢ Fluidsrestrictionsandsdiureticss
➢ Meds—Digoxin,sCCB,sACEsinhibitor,sBetasblockerss

⎯ BYPASSsSURGERYsNURSINGsINTERVENTIONs
▪ CoronarysArterysBypasssGrafts(CARG)—blockedscoronarysarterysbypassedsutilizingsveinsfromslegsorsnon-
essentialsarterys
▪ Post-opscare
➢ SpecializedscaresrequiredsinsCVICUs
➢ Usuallysintubatedsforsfirstsfewshours
➢ Willshavesbetweens1sands4scheststubes,satsleastsoneswillsbesmediastinals
➢ Epicardialspacingswiressinscasesofsdysrhythmiass
➢ Maysrequirescombinationsofsvasoactivesdripsstosstabilizesconditions(Dopamine,sPrimacor,sLevophed,sNTG)
➢ Specializedsmonitoringslines—PAscatheter,sarterialsline

⎯ EKGsREADINGsANDsTIMEsFRAMEsFROMsALLsSEGMENTSs
▪ Onessmallsbox=0.04ssec,sOnesbigsbox=s0.20ssecs
▪ PRsinterval:s0.12ssecs(threessmallsboxes)stos0.20ssecs(fivessmallsboxes)sinslength.
▪ QRSsinterval:s0.06stos0.10ssecsinslength
▪ QTsinterval:slesssthansorsequalstos0.52ssecsinslength.

⎯ PROTOCOLsFORsPTsWITHsCHESTsPAINsANDsNITRO
▪ Alwaysscarrysnitroglycerinswithsyousforsimmediate.sIfstheschestspainsoccursswithsactivity→sstopsthesactivitys
▪ Forsreliefschestspain→splacesNTGsundersthestongues&swaits5sminutes,sifspainsissnotsrelievedstakesthes2ndspills&sw
aitsanothers5sminutes.sSupposedsthespainsissstillsnotsreliefscalls911sbeforestakingsthes3rdspill
s

⎯ MIsSYMPTOMSsANDsNURSINGsINTERVENTIONS,stPAsTREATMENTs&sNITROsASSESSMENTsANDsINTERVENTIONS
▪ MI—
sAnsareasofsthesmyocardiumsisspermanentlysdestroyedsandsbecomessnecrotic.ssUsuallyscausedsbysreducedsblood




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