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5 lead EKG nursing applications
- answer-V1 is the preferred lead with which to monitor wide QRS morphology,
BBB and ventricular 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.
Acute coronary syndrome
- answer-pathophysiology: progressive atherosclerosis with plaque rupture causing
blood clot formation leading to an imbalance of o2 supply and demand.
Adult causes of secondary HTN
- answer-obstructive sleep apnea: excessive daytime sleepiness. Aortic coarctation:
diminished femoral pulses compared to radial pulses. Primary aldosteronism
(Conn's syndrome): unexplained hypokalemia. Bilateral renal artery stenosis: flash
pulmonary edema with normal LVEF. Pheochromocytoma: HTN with palpitations,
headache, and sweating. other potential causes include Cushing's disease, cranial
tumors, hyperparathyroidism and various types of chronic kidney diseases
Adult pulmonary HTN, group 1
- answer-causes: genetics, HIV, portal HTN, congenital heart disease drug abuse,
connective tissue disease, schistosomiasis. treatment: no primary treatment.
Advanced Tx: prostanoids endothelin receptor antagonists. other: only type
considered pulmonary arterial HTN, consider 02, diuretics, anticoagulants digoxin,
and exercise therapies.
Adult pulmonary HTN, group 2
- answer-causes: LA/LV heart dx, chronic pulmonary venous HTN, valve dx.
Treatment: treat underlying heart dx. Advanced Tx: may be harmful. other:
consider 02, diuretics, anticoagulants digoxin, and exercise therapies.
Adult pulmonary HTN, group 3
- answer-causes: chronic lung dx, hypoxemia. Treatment: treat lung dx, O2.
advanced treatment: not FDA approved. other: consider 02, diuretics,
anticoagulants digoxin, and exercise therapies.
,Adult pulmonary HTN, group 4
- answer-causes: Thromboembolic disease. Treatment: anticoagulants. Advanced
tx: pulm thromboendarterectomy. other: consider 02, diuretics, anticoagulants
digoxin, and exercise therapies.
Adult pulmonary HTN, group 5
- answer-causes sarcoidosis, sickle cell, other hematologic, systemic or metabolic
dx. Treatment: treat cause. Advanced tx: benefit unclear. other: consider 02,
diuretics, anticoagulants digoxin, and exercise therapies.
Adult synchronized cardioversion
- answer-used for nonemergent/elective procedure.
adult synchronized cardioversion nursing duties prior
- answer-Ensure NPO status if possible, IV access, Right AC preferable, place ECG
monitor; pulse ox, BP cuff, oxygen, get a 12 lead prior to procedure if possible,
place defibrillation pads; ensure resuscitation meds and equipment are at bedside;
sedate pt. position pt supine, dry chest, remove transdermal med patches if present
adult synchronized cardioversion Other
- answer-synchronizes shock to the r wave. May be elective or emergent,
depending on stability of pt. Consider removal of dentures prior to procedure. do
not place pads over an implanted pacemaker device. reduce or with hold AM
digoxin dose prior to elective cardioversions.
adult synchronized cardioversion used for
- answer-most often used for unstale SVT in peds; also for Afib. a flutter, A tach,
and monomorphic VT with pulse.
adult syncronized cardioversion nursing duities after
- answer-monitor LOC, Oxygen, ECG and skin color; obtain a post conversion 12
lead, abbpy emollient cream to any burns, bedrest for elective procedures, pt may
be discharged home with family if stable. Watch for electrical burns, developent of
lethal rhythms such as VFib.
after load
- answer-force against which the ventricles push blood during systole.
RV: measured by pulmonary vascular resistance
,LV: measured by systemic vascular resistance.
inversely related to stroke volume
afterload nursing application
- answer-diastolic BP is the closes noninvasive measurement that correlates to
SVR, but a narrowing pulse pressure may indicate an increase in SVR as well. The
SVR and PVR readings do not give a complete clinical picture, as the readings do
not account for blood viscosity or valve malfunctions.
Increase: vasopressors, hypothermia, HTN, high blood viscosity
Decrease: vasodilatiors, hyperthermia, early sepsis, anaphylaxis, low blood
viscosity
Angioplasty (PTCA)
- answer-percutaneous transluminal coronary angioplasty. one PCI procedure that
uses a balloon to compress arterial plaque and dilate the designated portion of the
artery.
Angioplasty (PTCA) nursing application
- answer-PTCA causes plaque formations to rupture, triggering coagulation and
formation of a thrombus. Thus, anticoagulation is essential during the procedure to
avoid this complication. In addition, the pt should continue with antiplatelet
medications following the procedure. reocclusion of an artery following PTCA
alone is frequent, so this procedure is often paired with the insertion of stents or
other PCI procedures. If coronary arteries cannot undergo angioplasty or stenting,
consider recommending rotablation or CABG.
Anterior MI
- answer-Part of the LV that is closest to the sternum and to the left breast
Apical Impulse (PMI)
- answer-a visible and/or palpable pulsation at the apex of the heart that occurs
when the heart bumps against the chest wall; corresponds with S1 and carotid
pulsation. Normally found at the midclavicular line 5th intercostal space (ICS). An
absent PMI is considered a normal finding.
apical impulse nursing application
- answer-to better assess the PMI, instruct the pt to sit up and lean forward, exhale
completely and/or assume the left lateral decubitus position. it may be impossible to
assess PMI on a pt with copious breast tissue. if located, document the
amplitude, size intensity, location and duration. Size should be no larger than about
, a penny or nickel size. for suspected findings associated with abnormal apical
impulses, see the PMI abnormalities card.
asprin for treatment of STEMI
- answer-81 to 325 mg PO load (Chewed!) Onset of action 1 to 7.5 min. inhibits
cyclooxygenase 1 within platelets and prevents formation of thromboxane A2.
disables platelet aggregation. Monitor for intolerance and bleeding. used
indefinitely post MI. Maintenance dose for life at least 81 mg daily.
Baroreceptor reflex
- answer-vasomotor response to changes in blood pressure within systemic vessels.
baroreceptor, nerve tissues, in the aortic arch ad carotid sinus sense pressure
changes and communicate those to the medulla. stretch receptor in the right atrium
senses fluid excess.
baroreceptor reflexes aortic reflex
- answer-high arterial BP stimulates the medulla to decrease HR and Cardiac
output, and thus decrease BP, accounts for reflex bradycardia associated with acute
hypertensive crisis.
baroreceptor reflexes bainbridge reflex
- answer-high venous BP stimulate RA stretch receptors, which cause the medulla
to increase HR in order to deal with the excess venous return.
baroreceptor reflexes carotid massage
- answer-this maneuver manually triggers the baroreceptors to signal the edulla to
slow the SA node rate and conduction across the AV node; do not us if pt has hx of
TIA, stroke or MI within last 3 months or any hx of VF/VT or known carotid artery
disease.
baroreceptor reflexes nursing application
- answer-these reflexes respond sluggishly when the patient displays orthostatic
hypotension. three reflexes directly affect CV Function
Beta blockers: oLOL
- answer-Start within 24 hours if hemodynamically stable. Hold if hypotension or
signs of hypoperfusion/shock. Metoprolol tartrate and carvedilol mostly used.
(metoprolol tartrate is the only form of metoprolol that is cardio protective.) blocks
catecholamin and sympathetic nervous system. Cardio protective, decreases
arrhythmias, decreases HR and Contractility. Decreases myocardial O2