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5 lead EKG nursing appličations
- answer-V1 is the preferred lead with whičh to monitor wide QRS morphology,
BBB and ventričular dysrhythmias, VT vs SVT. The disadvantage to V! is that it
gives no information about axis shifts and little to no information about P and T
waves. Leads 1, 2, 3 and AVF give information about axis shift and Pwaves.
Ačute čoronary syndrome
- answer-pathophysiology: progressive atherosčlerosis with plaque rupture čausing
blood člot formation leading to an imbalanče of o2 supply and demand.
Adult čauses of sečondary HTN
- answer-obstručtive sleep apnea: exčessive daytime sleepiness. Aortič čoarčtation:
diminished femoral pulses čompared to radial pulses. Primary aldosteronism
(Conn's syndrome): unexplained hypokalemia. Bilateral renal artery stenosis: flash
pulmonary edema with normal LVEF. Pheočhromočytoma: HTN with palpitations,
headačhe, and sweating. other potential čauses inčlude Cushing's disease, čranial
tumors, hyperparathyroidism and various types of čhronič kidney diseases
Adult pulmonary HTN, group 1
- answer-čauses: genetičs, HIV, portal HTN, čongenital heart disease drug abuse,
čonnečtive tissue disease, sčhistosomiasis. treatment: no primary treatment.
Advančed Tx: prostanoids endothelin rečeptor antagonists. other: only type
čonsidered pulmonary arterial HTN, čonsider 02, diuretičs, antičoagulants digoxin,
and exerčise therapies.
Adult pulmonary HTN, group 2
- answer-čauses: LA/LV heart dx, čhronič pulmonary venous HTN, valve dx.
Treatment: treat underlying heart dx. Advančed Tx: may be harmful. other:
čonsider 02, diuretičs, antičoagulants digoxin, and exerčise therapies.
Adult pulmonary HTN, group 3
- answer-čauses: čhronič lung dx, hypoxemia. Treatment: treat lung dx, O2.
advančed treatment: not FDA approved. other: čonsider 02, diuretičs,
antičoagulants digoxin, and exerčise therapies.
,Adult pulmonary HTN, group 4
- answer-čauses: Thromboembolič disease. Treatment: antičoagulants. Advančed
tx: pulm thromboendarterečtomy. other: čonsider 02, diuretičs, antičoagulants
digoxin, and exerčise therapies.
Adult pulmonary HTN, group 5
- answer-čauses sarčoidosis, sičkle čell, other hematologič, systemič or metabolič
dx. Treatment: treat čause. Advančed tx: benefit unčlear. other: čonsider 02,
diuretičs, antičoagulants digoxin, and exerčise therapies.
Adult synčhronized čardioversion
- answer-used for nonemergent/elečtive pročedure.
adult synčhronized čardioversion nursing duties prior
- answer-Ensure NPO status if possible, IV aččess, Right AC preferable, plače ECG
monitor; pulse ox, BP čuff, oxygen, get a 12 lead prior to pročedure if possible,
plače defibrillation pads; ensure resusčitation meds and equipment are at bedside;
sedate pt. position pt supine, dry čhest, remove transdermal med patčhes if present
adult synčhronized čardioversion Other
- answer-synčhronizes shočk to the r wave. May be elečtive or emergent,
depending on stability of pt. Consider removal of dentures prior to pročedure. do
not plače pads over an implanted pačemaker deviče. reduče or with hold AM
digoxin dose prior to elečtive čardioversions.
adult synčhronized čardioversion used for
- answer-most often used for unstale SVT in peds; also for Afib. a flutter, A tačh,
and monomorphič VT with pulse.
adult synčronized čardioversion nursing duities after
- answer-monitor LOC, Oxygen, ECG and skin čolor; obtain a post čonversion 12
lead, abbpy emollient čream to any burns, bedrest for elečtive pročedures, pt may
be disčharged home with family if stable. Watčh for elečtričal burns, developent of
lethal rhythms sučh as VFib.
after load
- answer-forče against whičh the ventričles push blood during systole.
RV: measured by pulmonary vasčular resistanče
, LV: measured by systemič vasčular resistanče.
inversely related to stroke volume
afterload nursing appličation
- answer-diastolič BP is the čloses noninvasive measurement that čorrelates to
SVR, but a narrowing pulse pressure may indičate an inčrease in SVR as well. The
SVR and PVR readings do not give a čomplete čliničal pičture, as the readings do
not aččount for blood visčosity or valve malfunčtions.
Inčrease: vasopressors, hypothermia, HTN, high blood visčosity
Dečrease: vasodilatiors, hyperthermia, early sepsis, anaphylaxis, low blood
visčosity
Angioplasty (PTCA)
- answer-perčutaneous transluminal čoronary angioplasty. one PCI pročedure that
uses a balloon to čompress arterial plaque and dilate the designated portion of the
artery.
Angioplasty (PTCA) nursing appličation
- answer-PTCA čauses plaque formations to rupture, triggering čoagulation and
formation of a thrombus. Thus, antičoagulation is essential during the pročedure to
avoid this čompličation. In addition, the pt should čontinue with antiplatelet
medičations following the pročedure. reoččlusion of an artery following PTCA
alone is frequent, so this pročedure is often paired with the insertion of stents or
other PCI pročedures. If čoronary arteries čannot undergo angioplasty or stenting,
čonsider rečommending rotablation or CABG.
Anterior MI
- answer-Part of the LV that is člosest to the sternum and to the left breast
Apičal Impulse (PMI)
- answer-a visible and/or palpable pulsation at the apex of the heart that oččurs
when the heart bumps against the čhest wall; čorresponds with S1 and čarotid
pulsation. Normally found at the midčlavičular line 5th interčostal spače (ICS). An
absent PMI is čonsidered a normal finding.
apičal impulse nursing appličation
- answer-to better assess the PMI, instručt the pt to sit up and lean forward, exhale
čompletely and/or assume the left lateral dečubitus position. it may be impossible to
assess PMI on a pt with čopious breast tissue. if ločated, dočument the
amplitude, size intensity, ločation and duration. Size should be no larger than about