Accelerated Junctional Rhythm
Asystole
At what heart rate is it considered an 60-100 bpm
accelerated junctional rhythm?
At what heart rate is it considered junctional 100+ bpm
tachycardia?
Can patients have a pulse with v-tach? yes (carotid pulse)
Does defibrillation start or stop the heart? stops the heart
Failure To Capture
,Failure to Fire/Pace
Failure to Sense
First Degree Heart Block
Historically, why have families been Harmful physiological consequences, interferes with time nurses need to spend
restricted from the ICU? caring for patients, delays in care
How can central venous pressure (CVP) be through a central venous catheter
measured? (transducer/computer or visual)
How can decreased SVR be treated? dopamine, phenylephrine, norepinephrine, change dose of drugs, fluid resuscit
How can hemodynamics be measured at BP, HR, urine output
the most basic level?
diuretics, nitrates, nitro, ACE inhibitor, milrinone
How can increased SVR be treated?
reduce preload and afterload
,How can nurses act as an advocate in control the environment and ensure rest throughout the day/night
providing rest and sleep?
How can PVCs be treated? reduce caffeine and stress, correct electrolytes, BBs, CCBs
How can the family help the ICU patient they can comfort patients in ways not open to staff, as well as provide info to he
and nursing staff? nurse individualize care
Using PA catheter measurements
How can we measure afterload?
Right side = PVR, left side = SVR
via right arterial pressure (RAP) and pulmonary artery wedge pressure (PAWP)
How can we measure preload?
Right side = RAP, left side = PAWP
How do ectopic impulses of the ventricular there is decreased CO from the loss of atrial kick from backward depolarization
origin alter hemodynamics? from pushing ventricular blood against closed valves
How does hypoxia contribute to ventricular cardiac cells are extremely sensitive to the lack of oxygen
dysrhythmias?
How does the Uniform Determination of Total irreversible failure of the cardiorespiratory system, or irreversible loss of a
Death Act (UDDA) define death? brain functions (stem and neocortex)
How do we keep aneurysms small? oral antihypertensives, surveillance, treat hyperlipidemia, smoking cessation
typically asymptomatic
How is a first degree heart block treated?
withhold digitalis
, admit to ICU and administer IV antihypertensives, treat damaged organ, reduce
How is a hypertensive emergency by 20% in first half hour, achieve 160/100 within 2-6 hours
managed?
in aortic dissection, rapidly recude systolic BP to <100
oral antihypertensives, alleviate pain and anxiety, gradually decrease BP over 24
hours
How is a hypertensive urgency treated?
clonidine, captopril, nifedipine
How is a junctional rhythm treated if atropine, pacemaker insertion
symptomatic?
How is a second degree AV block (Mobitz 1 atropine, dopamine, epinephrine, temporary pacemaker, permanent pacemaker
or Wenckebach) treated? withhold digitalis
How is a second degree AV block (Mobitz atropine, dopamine, epinephrine, temporary pacemaker, permanent pacemaker
II) treated?
How is a third degree AV block (complete atropine, dopamine, epinephrine, temporary pacemaker, permanent pacemaker
block) treated?
How is a valvular disease diagnosed? Echo (TEE or TTE), cardiac catheterization
antibiotics (if sepsis related), vasoconstrictors, IV nitrates, oral replacement, IV
How is decreased RAP treated? hydration, blood products, crystalloid IV fluids, surgical intervention to stop ble
if necessary, strict I&Os, daily weights, frequent assessments
How is dilated cardiomyopathy managed? manage HF, place ICD as needed, heart transplant
Asystole
At what heart rate is it considered an 60-100 bpm
accelerated junctional rhythm?
At what heart rate is it considered junctional 100+ bpm
tachycardia?
Can patients have a pulse with v-tach? yes (carotid pulse)
Does defibrillation start or stop the heart? stops the heart
Failure To Capture
,Failure to Fire/Pace
Failure to Sense
First Degree Heart Block
Historically, why have families been Harmful physiological consequences, interferes with time nurses need to spend
restricted from the ICU? caring for patients, delays in care
How can central venous pressure (CVP) be through a central venous catheter
measured? (transducer/computer or visual)
How can decreased SVR be treated? dopamine, phenylephrine, norepinephrine, change dose of drugs, fluid resuscit
How can hemodynamics be measured at BP, HR, urine output
the most basic level?
diuretics, nitrates, nitro, ACE inhibitor, milrinone
How can increased SVR be treated?
reduce preload and afterload
,How can nurses act as an advocate in control the environment and ensure rest throughout the day/night
providing rest and sleep?
How can PVCs be treated? reduce caffeine and stress, correct electrolytes, BBs, CCBs
How can the family help the ICU patient they can comfort patients in ways not open to staff, as well as provide info to he
and nursing staff? nurse individualize care
Using PA catheter measurements
How can we measure afterload?
Right side = PVR, left side = SVR
via right arterial pressure (RAP) and pulmonary artery wedge pressure (PAWP)
How can we measure preload?
Right side = RAP, left side = PAWP
How do ectopic impulses of the ventricular there is decreased CO from the loss of atrial kick from backward depolarization
origin alter hemodynamics? from pushing ventricular blood against closed valves
How does hypoxia contribute to ventricular cardiac cells are extremely sensitive to the lack of oxygen
dysrhythmias?
How does the Uniform Determination of Total irreversible failure of the cardiorespiratory system, or irreversible loss of a
Death Act (UDDA) define death? brain functions (stem and neocortex)
How do we keep aneurysms small? oral antihypertensives, surveillance, treat hyperlipidemia, smoking cessation
typically asymptomatic
How is a first degree heart block treated?
withhold digitalis
, admit to ICU and administer IV antihypertensives, treat damaged organ, reduce
How is a hypertensive emergency by 20% in first half hour, achieve 160/100 within 2-6 hours
managed?
in aortic dissection, rapidly recude systolic BP to <100
oral antihypertensives, alleviate pain and anxiety, gradually decrease BP over 24
hours
How is a hypertensive urgency treated?
clonidine, captopril, nifedipine
How is a junctional rhythm treated if atropine, pacemaker insertion
symptomatic?
How is a second degree AV block (Mobitz 1 atropine, dopamine, epinephrine, temporary pacemaker, permanent pacemaker
or Wenckebach) treated? withhold digitalis
How is a second degree AV block (Mobitz atropine, dopamine, epinephrine, temporary pacemaker, permanent pacemaker
II) treated?
How is a third degree AV block (complete atropine, dopamine, epinephrine, temporary pacemaker, permanent pacemaker
block) treated?
How is a valvular disease diagnosed? Echo (TEE or TTE), cardiac catheterization
antibiotics (if sepsis related), vasoconstrictors, IV nitrates, oral replacement, IV
How is decreased RAP treated? hydration, blood products, crystalloid IV fluids, surgical intervention to stop ble
if necessary, strict I&Os, daily weights, frequent assessments
How is dilated cardiomyopathy managed? manage HF, place ICD as needed, heart transplant
