NUR 375 EXAM ONE |158 QUESTIONS AND ANSWERS

p wave atrial depolarization (contraction) pr interval atrial depolarization and delay in AV junction; allows atria to contract (0.12-0.20; 0.20 = 1° AVB QRS complex ventricular depolarization and atrial repolarization; (0.04-0.12) ventricular or conduction delay wide QRS atrial issue narrow QRS T wave ventricular repolarization QT interval ventricular depolarization and repolarization (0.36-0.44) increased risk of arrhythmia risk of prolonged QT NSR rate: 60-100; p-waves: normal; regularity: normal; QRS: 0.04-0.12; PR: 0.12-0.20; QT interval: 0.36-0.44 sinus brady and sinus tachy SA node problems can cause sinus brady deviation from NSR; rate 60bpm; SA node is depolarizing slower than normal, impulse is conducted normally (norm PR and QRS) sinus tachy deviation from NSR; rate 100; SA node is depolarizing faster than normal, impulse is conducted normally; can be a response to stress- not a primary arrhythmia; tx: underlying cause SVT supraventricular tachycardia; heart rate suddenly speeds up, often triggered by PAC and p-waves are lost; narrow QRS a-fib no organized atrial depolarization; no normal p-waves (not originating in SA node); impulses unpredictably formed; AV node allows some to pass through at variable intervals; irregularly irregular a-flutter no p-waves; flutter waves (sawtooth pattern) at 250-350 bpm; only some impulses conducted through AV node (usually every other impulse); every 2nd, 3rd, or 4th impulse generating a QRS (others blocked as in AV node as it repolarizes) 3rd degree heart block p-waves completely blocked in AV junction; QRS complexes originate independently from below the junction; complete block of conduction in the AV junction, so atria and ventricles form independently; pt. pulse about 30 bpm b/c ventricles contracting PVCs ectopic beats originate in ventricles resulting in wide and bizarre QRS ; one or more ventricle cells are depolarizing and impulses are abnormally conducting through the ventricles v-tach impulse is originating in ventricles (no p-wave, wide rapid QRS); re-entrant pathway looping in a ventricle (most common cause) v-fib completely abnormal; ventricular cells are excitable and depolarizing randomly; not contracting but quivering asystole absence of contractions of the heart clinical manifestations of arrhythmias decreased CO sinus bradycardia tx atropine, pacemaker sinus tachy tx fix underlying cause (e.g., fluids if hypovolemia, fever, etc.) a-fib/a-flutter tx less than 24 hours: diltiazem/amiodarone/cardiovert more than 24 hours: worried about blood clots in heart- stroke/PE; need anticoagulants, TEE, meds to slow down to less than 100 (PRN; beta blocker, dig).When anticoagulants are therapeutic and TEE ok, diltiazem/amiodarone to convert, cardiovert PRN SVT tx modified valsalva, adenosine - push fast, follow w flush bc of low half life), cardiovert PRN v-tach with pulse tx assess pt; amiodrone 150 mg bolus and gtt, cardiovert asap/PRN v-tach w/o pulse + v-fib epi 1 mg IV q 3-5 min, amiodarone 300 mg push x1, then 150 mg IVP, defib asap asystole tx CPR, EPI 1 mg q 3-5 min, fix the problem 3rd degree heart block tx transcutaneous pacing, fix problem and/or perm pacemaker cardioversion any shockable rhythm with a pulse; holds shock until it will land on R defibrillation any shockable rhythm w/o a pulse Trancutaneous pacing temporary for emergent situation- 3rd degree heart block stridor upper airway (trachea) obstruction/inflammation - tracheal obstruction crackles fluid - heart failure, ARDS, pneumonia rhonchi mucus plug in airways- bronchitis, pneumonia, bronchitis (COPD) wheezes narrowed airways (increased mucus and inflammation) decreased/absent decreased/no air movement call rapid response/code, prepare for intubation and vent and supportive care what should you do if you suspect ARDS huge assault on body (illness or injury) causes reaction that includes an alteration in the permeability of capillary and alveolar membranes; fluid and cells start shifting from intravavascular spaces (blood vessels) into extravascular spaces (outside of blood vessles) and into alveoli (in lungs); alveoli full with fluid (haziness on CXR), greatly impairs gas exchange (hypoxemia), may have hypotension patho of ARDS resp and CV support, prep for intubation; complete support PRN - cardiopulmonary; prep for ecmo NI for ARDS set rate and volume; spontaneous breaths trigger vent to give full volume; considerations: barotrauma, hyperventilation; good for pts with no ventilatory effort AC- assist control vent provides mandatory rate; pressure and/or volume controlled; breaths are pt or time triggered; breaths taken between cycle are not assisted; identical to AC if pt have no vent effort; low set rates allow for increased spontaneous respirations SIMV - synchronized intermittent mechanical ventilation vent attempts to reach set tidal volume at lowest possible airway pressure; commonly used in ICUs- much lower risk barotrauma PRVC- pressure related volume control valve set two pressure levels- inspiratory and expiratory positive airway pressure during spontaneous inhalation and exhalation; requires intact respiratory drive and adequate TV; decreases shunting; non invasive; prevents alveolar collapse HF and COPD first line tx bipap - bi-level positive airway pressure continuous pressure throughout and spontaneous inhalation and exhalation; noninvasive; requires intact respiratory drive and adequate TV; decreases shunting and prevents alveolar collapse CPAP- continuous positive airway pressure volume of air inspired or programmed to be ventilate tidal volume number of respirations per minute rate percentage of oxygen delivered to pt fraction of inspired oxygen (FiO2) highest proximal airway pressure reached during inspiration; should be 35 cm H20 peak inspiratory pressure (PIP) the maintenance of positive pressure within the lungs at the end of expiration (prevent total deflation/collapse of alveoli) positive end-expiratory pressure (PEEP) stridor, somnolence, inability to protect airway, severe hypoxia (PaO2 50), severe hypercapnia (PaCO2 50), retractions, use of accessory muscles, RR of 8 or 30, unable to speak more than 2-3 words at a time, "I can't breathe" evidence of respiratory distress restlessness, confusion, poor judgement, coma, tachycardia, HTN/hypo, cyanosis, tachypnea/bradypnea sx of low O2 HA, lethargy, progressive somnolence, CV collapse, arrhythmias, hypotension, bradypnea high CO2 sx procedure in which the bronchi are seen through a fiberoptic tube; used for dx purposes and for tx (e.g., remove mucus plugs, foreign bodies etc) bronchoscopy used to evaluate lung function; involved use of spirometer to asses air movement as pt performs prescribed respiratory maneuvers; measures lung volumes and airflow pulmonary function test used to screen, dx, and evaluate changes in respiratory system; have pt undress and remove any metal between neck and waist CXR dx suspicious lesions difficult to asses by conventional xray; requires contrast medium; evaluate renal fx and allergy to shell fish/iodine; may need to be NPO 4 hours before; contrast may cause a feeling of being warm and flushed- pt must lie completely still during scan; encourage fluids to avoid renal problems with contrast CT scan used for in-depth dx of lesions difficult to asses by CT scan (e.g, lung apex) and for differentiating vascular from nonvascular structures; an IV contrast agent ,ay be given; check for pregnancy, allergies and a renal function test; remove metal objects; hx of surgical insertion of metal objects, claustrophobia and the need for antianxiety medication; must lie completely still during scan MRI assesses ventilation and perfusion of lungs; decreased or absent radioactivity suggests lack of perfusion or airflow; ventilation without perfusion suggests a pulmonary embolus; V/Q scan insertion of large-bore needle through chest wall into pleural space to obtain specimen fo dx evaluation, remove pleural fluid, or instill medication;used to obtain specimen of pleural fluid for dx, remove pleural fluid, or instill medication; obtain CXR after procedure to check for pneumothorax; don't cough or talk during procedure thoracentesis apprehension and restlessness early sx of inadequate oxygenation common cold; rhinovirus most common cause of mild sx, coxsackievirus and adenovirus cases more severe sx; airborne droplets, dx based on sx viral rhinitis runny nose/congestion, watery eyes, sneezing and coughing, sore throat, fever (low grade/none), HA, fatigue viral rhinitis sx rest and fluids; antipyretics, analgesics, antihistamines, decongestants (intranasal decongestants-no more than three days, can cause rebound congestion); warm salt water gargles, magic mouth wash, observe for sx of infection viral rhinitis sx