STUDY GUIDE REVIEW How do we treat A Fib? Amiodarone, Dig, beta blocker, blood thinners (if chronic), synchronized cardioversion A Flutter? Same thing V Fib and V tach – CPR and defib SVT? Adenosine, vagal maneuvers, synchronized cardioversion Asystole – CPR First degree heart block – monitor. If symptomatic – speed it up, atropine Second degree heart block – monitor. If symptomatic, give drugs is ar stu ed d vi y re aC s o ou urc rs e eH w er as o. co m Third degree heart block – pacer First degree – prolonged PR Second degree, type one – PR, longer, longer, longer, drop Third degree – Ps and QRS are disassociated – divorced Stages of shock: Compensated don’t look terrible, starting to show changes. LOC. BP dropping but compensating with increased HR. Blood flow is being shunted to the brain, heart, lungs --] decreased GI motility, decreased bowel sounds, decreased rental blood flow Progressive – decreased cerebral perfusion pressure, delirium, BP dropping more, HR increasing more, might see ARDS, liver enzymes increasing (jaundice), hypo or hyperthermia, cold and clammy Refractory – they just look bad Possible complications for CABG? MI, bleeding, infection, pneumonia, resp failure, anemia, electrolyte imbalances Th Teaching for CABG – lifestyle changes, sternum has been cut in half so no pushing or pulling or carrying heavy weight (puts too much stress), increase activity as tolerated, no driving 6 weeks, postpone sex until they can walk or climb stairs without symptoms Who needs to talk to a dentist before a procedure? Endocarditis, valve issues – prosthetic valve sh What do we do for cardiomyopathy? Goal? Increase CO, alleviate HF symptoms, improve contractility, decrease afterload, decrease preload. How do we do that? Medications – nitrates, positive inotrope for contractility Who develops and throws clots? A fib, infective endocarditis, aneurysm What do you find with infective endocarditis? Fever, chills, petechia, splinter hemorrhages in the nails What do we do for PT with AAA? Decrease BP This study source was downloaded by 100000768761063 from CourseHero.com on 08-28-2021 21:26:17 GMT -05:00 https://www.coursehero.com/file/83025315/STUDY-GUIDE-REVIEWdocx/ What are s/s of dissection vs aneurysm? Aneurysm? May not have any symptoms – may have chest and abdominal pain. AAA will have pulsatile mass in abdomen – do not palpate Dissection? Bruising (grey turner sign), profound hypotension, narrowing pulse pressure, decreased BP, tachycardia Risk factors for AAA? Age over 40, pregnancy, marphans, heart procedures, hypertension, smoking OTHER REVIEW QUESTIONS What nursing care would you include for a patient on a vent? Oral care, VAP prevention, no water in tubing, prevent reflux, hand hygiene, increase HOB Which PT do you see first? New onset V fib, rate 110 Hx of IV drug abuse with intercardiac mass complaining of SOB - correct PT who has stemi and transferring to cardiac rehab today PT who has sepsis three days ago and complains of pain when urinating is ar stu ed d vi y re aC s o ou urc rs e eH w er as o. co m Priority question PT who had coronary angioplasty yesterday and is reporting occasional chest pain PT with cardiomyopathy, SOB, and agitated – correct Be prepared to intervene on PT who has cardiac dysrhythmias that you don’t have a strip for. Example – regular fast rate 100-200, wide QRS, no P waves. Would you? place oxygen and give IV put on fibrillator pad and call code check BP and breath sounds check pulse and assess mental status – correct – check PT not monitor. What do we do for possible thoracic aneurysm, complaining of chest pain? Echo STAT chest x-ray Call code Get STAT CT – correct Th Which cardiac rhythms require pacemaker therapy? Third degree Junctional when symptomatic Any slow heart rate that is symptomatic sh How do we know if pericardialcentisis with tamponade has been successful? You can hear heart sounds – not muffled This study source was downloaded by 100000768761063 from CourseHero.com on 08-28-2021 21:26:17 GMT -05:00 https://www.coursehero.com/file/83025315/STUDY-GUIDE-REVIEWdocx/ BP is increased Pulse pressure widened No JVD CVP decreased – not as much pressure in the chest What does SIRS look like? Risk factors for DIC? Pregnancy/OB Surgery Bleeding What’s the purpose of the intraaortic balloon pump? Decrease afterload and decreases oxygen demand is ar stu ed d vi y re aC s o ou urc rs e eH w er as o. co m PT gets into a car wreck, has bruising over the sternum, muffled breath sounds. What do you prepare for? Pericarialcentesis Why do we give nitroglycerin in cardiogenic shock? Vasodilate and decrease afterload. The heart doesn’t have to work as hard and alleviates the shock symptoms PT is tachypnic, CPV is high, wedge is high, what would we do for them? Diuretic What meds do we give for A fib? Cardizem, dig, Coumadin What are goals for PT in shock? Increase oxygen, restore balance, fluid status, tissue perfusion You have a PT with dilated cardiomyopathy, another with mitral valve prolapse, and another with infective endocarditis of the mitral valve. What do they have in common? Risk for clots What lab values would you see in PT with DIC? Increase PT/PTT Increased FSP Decreased platelets Decreased fibrinogen Pt in septic shock, hypotensive, tachycardic, tacynpnic, temp increase, blood glucose increased. What do you do first? Fluids Th Complications of the intraaortic baloom pump? Infection, migration, bleeding, mental status changes, emboli, distal pulses decreased sh Before administering a cardiac glycoside, what lab value do we look for? Low potassium = risk for toxicity Know Sepsis 3-hour and 6-hour bundle. If PT’s art-line pressure does not match blood pressure cuff, what is intervention? Level and zero Before administering adenosine, what do you want to have in place? Monitor, crash cart, oxygen This study source was downloaded by 100000768761063 from CourseHero.com on 08-28-2021 21:26:18 GMT -05:00 https://www.coursehero.com/file/83025315/STUDY-GUIDE-REVIEWdocx/ What is a risk factor for mitral valve prolapse needing replacement? What might you find in their history? Rheumatic heart disease What do you see in hypertrophic cardiomyopathy? Dysrhythmias, pulses paradoxes, cardiac tamponade, JVD, tachycardia (increased pressure in chest) What do you see in a PT with ARDS? Contractions, tachypnea, dyspnea, hypoxemia, restlessness PT on the vent, dropping sats, alarms going off. What do you do? Bag them PT has rib fractures, tachypnic, O2 sats dropping, BP is fine. What’s the best intervention? Pain meds Can you ambulate a PT with a chest tube? Yes. What are the interventions while ambulating? Keep tube low is ar stu ed d vi y re aC s o ou urc rs e eH w er as o. co m PT has chest tube, bubbling in suction control chamber, and fluid level is tidaling with respirations. How do you interpret this? Normal. What do you do right after a PT is intubated? Chest x-ray, mark where it’s at. Immediately after intubation, listen for breath sounds sh Th On vented PT, why do we use PEEP? To keep the alveoli open – to prevent atelectasis This study source was downloaded by 100000768761063 from CourseHero.com on 08-28-2021 21:26:18 GMT -05:00 https://www.coursehero.com/file/83025315/STUDY-GUIDE-REVIEWdocx/ Powered by TCPDF (www.tcpdf.org)
