CEN

  1. Initial triage assessment should be done within ___ minutes.
    5
  2. Three level acuity system for triage?
    • Emergent- go directly back
    • Urgent
    • nonurgent
    • Urgent and nonurgent can wait safely in waiting room
  3. How often should urgent and nonurgent patients waiting in the waiting room be reassessed?
    • urgent - every 30 minutes
    • nonurgent - every hour
  4. Five-level acuity system?
    • Critical - immediate Tx and constant monitoring
    • Ustable/emergent:  Tx and reassessment q15min
    • Urgent/potentially unstable:  reassess q30-60min
    • Stable/nonurgent:  reassess q1-2 hours
    • Minor:  reassessment q4h
  5. Telephone triage?
    assess patients and direct them to appropriate care
  6. What must be established in order for a nurse to do telephone triage?
    compentency assessment training and CE to demonstrate proficiency
  7. Reportable occurances?
    mandated by law to be reported to health department, social services, or law enforcement:  abuse/neglect, animal bites, communicable diseases, suicide attempt, etc
  8. Airway triage red flags?
    • apnea
    • choking
    • drooling
    • audible airway sounds
    • positioning
  9. Breathing triage red flags?
    • grunting
    • sternal retractions, increased WOB
    • irregular resp patterns
    • RR >60
    • RR <20 in children <6yrs
    • RR <15 in children <15yrs
    • absence of breath sounds
    • cyanosis
  10. Circulation triage red flags?
    • cool/clammy skin
    • tachycardia/bradycardia
    • HR>200  OR <60
    • hypotension
    • diminished or absent peripheral pulses
    • decreased tearing, sunken eyes
  11. Disability triage red flags
    • altered LOC
    • inconsolability
    • sunken or bulging fontanel
  12. Exposure triage red flags?
    • petechiae
    • pupura
    • S/S of maltreatment or abuse
  13. Vital signs triage red flags?
    • hypothermia
    • temp >100.4 in infant <3mo old
    • temp >104 any age
  14. Pain triage red flag?
    severity
  15. History triage red flags?
    • chronic illness
    • family crisis
    • return visit to ED within 24 hours
  16. What is the most common cause of airway obstruction?
    tongue
  17. Type of breathing with alternating period of hyperventilation and apnea?
    Cheyne-Stokes
  18. What do Cheyne-Stokes respirations indicate?
    cerebrum injury
  19. Type of respirations with 3-4 breaths of identical rate and depth followed by apnea?
    Biot
  20. What is indicated by biot respirations?
    injury of lower pons or upper medulla
  21. Type of respirations with no respiratory pattern, mostly apneic?
    ataxic
  22. What is indicated by ataxic respirations?
    injury of medulla
  23. Late sign of pneumothorax?
    tracheal deviation
  24. Maintain SpO2 of > ____% for patients with ineffective ventilation?
    90%
  25. Tx of open pneumothorax?
    petroleium guaze dressing secured on 3 sides.  Remove and reapply if tension pneumo develops

    chest tube
  26. Tx of flail chest?
    stabilization with a bulky dressing

    mechanical ventilation
  27. Tx of tension pneumothorax?
    needle decompression followed by chest tube
  28. Tx of hemothorax?
    chest tube

    surgical exploration and repair may be required
  29. Tx of impaled object?
    stabilization of object

    removal by surgeon
  30. Normal HR in infants?
     
    1yr old?

    8-12 yr old?
    infants 90-170

    year old 80-160

    8-12 children 70-110
  31. If you can feel a brachial or radial pulse, the systolic BP is at least ___.
    80
  32. If you can feel a femoral pulse the systolic BP is at least ____
    70
  33. If you can feel a carotid pulse the systolic BP is at least ____
    60
  34. Bleeding that requires immediate intervention?
    • uncontrolled, pulsating bleeding
    • pallor of lips, skin, or nail beds
    • lg amnts of blood or clots in emesis/urine/stool
    • distended/rigid abd
    • gross swelling of an injured extremity
  35. What is minimum urine output?
    1mL/kg/hr
  36. What position should pt with hypoperfusion be placed in?
    flat
  37. What is conjugate gaze?
    normal mvmt of both eyes together in same direction

    disconjugate is abnormal
  38. Glasgow coma scale
    Eye:  4 spontaneous, 3 voice, 2 pain, 1 no

    • Verbal Response:  5 oriented, 4 confused
    • 3 inappropriate words
    • 2 incomprehensible sounds 1 No

    • Moter Response:  6 obeys commands
    • 5 localizes pain, 4 withdraws from pain
    • 3 abnormal flexion to pain
    • 2 abnormal extension to pain 1 NO
  39. Contraindication for foley in trauma pt?
    blood at meatus, scrotal hematoma, or perineal ecchymosis
  40. What type of exam should be done on male trauma pt before inserting foley?
    rectal exam to rule out urethral injury or trauma
  41. What pain scale should be used for children and nonverbal adults?
    FACES
  42. Infant task and fear?
    develop trust

    separation and strangers
  43. Toddlers task and fear?
    autonomy and self-control

    searation and loss of control
  44. Preschool-aged children task and fears?
    creating a sense of initiative

    bodily injury and mutilation, loss of control, the unknown, the dark, and being left alone
  45. School-aged children task and fears?
    developing a sense of industry

    loss of control, bodily injury, and mutilation, failure to live up to expectations, death
  46. Adolescents task and fears?
    separation from parents, adaptation to rapidly changing body, development of sexual identity and sense of who they are, autonomous function, privacy is extremely important

    loss of control, altered body image, and separation from peer group
  47. Should packing be inserted into ear/nose if they are draining during an assessment?
    no
  48. Bruising behind the ear?

    What does this indicate?
    battle sign

    possible basal skull fracture but may not be evident immediately after injury
  49. Trismus?
    inability to open mouth completely
  50. What is indicated by flat jugular veins when a pt is flat?
    hypovolemia
  51. What is indicated by distended jugular veins when pt is elevated?
    hypervolemia, R ventricular failure, cardiac tamponade, or tension pneumo
  52. What is indicated by hyperresonance of chest?
    hyperinflated lung or air-filled thoracic cavity
  53. What is indicated by dullness of chest?
    fluid-filled or consolidated lung tissue
  54. Bruising in flank area is called?

    What does it indicate?
    Grey-Turner sign

    retroperitoneal bleeding
  55. Bruising of periumbilical area is called?

    Suggestive of?
    Cullen sign

    intraperitoneal bleeding
  56. How is pelvic instability tested?
    push the pelvis in and press down but do not rock it
  57. Equation to find normal BP for children?
    {70+(2 X age in years)}
  58. What age group are prone to hypothermia?
    seniors
  59. Infants are obligate ____ breathers
    nose
  60. What type of breathing occurs in pt until age 6-7?
    abd breathing
  61. Considerations for children airways and respiratory system?
    more susceptible to resp infections

    airway smaller and more easily occluded
  62. When is visual acuity of 20/20 attained?
    age 7
  63. When is ability to control urination gained?
    between 2-3 years old
  64. What happens to renal function after age 40?
    renal function decreases and incomplete bladder emptying occurs
  65. What endocrine issue may occur in children?
    growth hormone abnormalities
  66. What occurs in children due to increased flexibility of bones?
    greenstick fractures, subluxation is common
  67. What type of endocrine disorder is likely to occur in geriatric patients?
    thyroid disorders
  68. What must be done before a patient is transferred to another facility?
    pt must be stabilized
  69. Why do different cultures and illegals delay seeking medical attention?
    language, cost, and cultural barriers
  70. Does culture affect a patient's pain?
    patient's reactions to pain are culturally driven
  71. Does genetics affect a person's drug metabolism?
    drug metabolism is genetically determined
  72. Environmental factors that can affect drug metabolism?
    diet, alcohol, smoking, malnutrition, vitamin deficiencies, stress, fever, and physiologic rhythms
  73. What type of HTN med is ineffective in African Americans?
    ACE inhibitors
  74. What type of BP meds are used for African Americans?
    • calcium-channel blocker: diovan/valsartan
    • Beta-blocker

    r/t decreased response to ACE
  75. Cultural variation for Native Americans?
    eye contact is considered a sign of disrespect
  76. Cultural variation for Appalachians?
    eye contact is impolite or sign of hostility
  77. Cultural variation for American Eskimos?
    seldom disagrees publicly with others
  78. Cultural variation for Jewish Americans?
    excess touching is offensive
  79. Cultural variation for Chinese Americans?
    • Excessive eye contact is rude
    • Excessive touch is offensive
  80. What cultures consider eye contact to be rude/offensive?
    • Native Americans
    • Chinese Americans
    • Appalachians
    • Vietnamese Americans
  81. Cultural variation for Filipino Americans?
    offending people is to be avoided at all cost
  82. Cultural variation for Haitian Americans?
    • Touch is used in conversation
    • Direct eye contact is used to gain attention & respect
  83. Cultural variation for East Indian Hindu Americans?
    Women avoid eye contact as a sign of respect
  84. Cultural variation for Vietnamese Americans?
    • Avoidance of eye contact = respect
    • The head is considered sacred - not polite to pat the head
    • Upturned palm is offensive in communication
  85. Cultural variation for Christian Scientist?
    Disease and illness are delusions of the nonspiritual mind and can be overcome with prayer

    may refuse medical care
  86. Cultural variation for Hinduism?
    • Illness may be r/t misuse of the body or from the sins of a previous life
    • Females cannon be left in the presence of unfamiliar males
  87. Cultural variation for Islam (Muslim)?
    • Prayer and washing are required 5X/day
    • The L hand is considered unclean- will not handle food with L hand
  88. Cultural variation for Jehovah's Witnesses?
    Opposed to transfusions - source of soul is in the blood

    Do not celebrate national holidays or birthdays and do not salute flags
  89. Cultural variation in Judaism?
    Sabbath begins at sundown on Friday and ends at sundown on Saturday - no work: includes driving & using the phone

    Must stay with a critically ill or dying family member until death so the soul will not feel alone
  90. Cultural variation with Seventh-Day Adventist?
    Sabbath begins at dusk on Friday and ends at dusk on Saturday
  91. Omnibus Reconcilation Act of 1986?
    requires hospitals that receive Medicare and Medicaid reimbursement to make patients and families aware of organ and tissue donation options
  92. What will improve a patient with lung transplant prognosis?
    if they receive a heart too
  93. Exclusions for organ/tissue donation?
    suspected or Hx of IV drug use in past year, sepsis, transmissible disease, metastatic cancer (except for primary brain tumor)
  94. PaCO2 that indicates brain death?
    PaCO2 of >60 X3-5 minutes with absence of spontaneous ventilation
  95. EEG indication of brain death?
    no electrical activity X at least 30 minutes
  96. Cerebral angiography indication of brain death?
    no intracerebral filling in circle of Willis or at carotid bifurcation
  97. What is required for determination of brain death?
    signature of 2 physicians:  one not being involved in the care of the patient
  98. Who must be called for chemical terrorism if the chemical is a military agent?
    army
  99. Pharmacy consideration in chemical terrorism with organophosphate?
    may need large amounts of atropine and pralidoxime (2-PAM)
  100. What part of a debriefing is the only part that is required?
    Fact phase:  individuals discuss their role in the incident and what they experienced through their five senses
  101. What should be included when labeling photo that is collected for evidence?
    patient's name and photographer's name, date and time
  102. Chain of custody documentation that is included on evidence?
    • How evidence was collected
    • Who collected
    • How transferred to law enforcement
    • Date and time
    • Person who took evidence and affilation with date and time

    The fewer ppl who handle evidence the better
  103. 2 limitations to autonomy?
    Rights of 1 person interfere with another individual's rights

    High probability that a person may injure himself or others
  104. Positive euthanasia?
    • life support is withdrawn or med/Tx/procedure
    • is used to cause death
  105. Negative euthanasia?
    no extraordinary or heroic life-support measures are used to save a person's life

    DNR
  106. Law that spells out nursing responsibilities and scope of practice?
    Nurse Practice Act
  107. Civil?
    one individual sues another
  108. Tort?
    • legal wrong committed against a person or property - direct invasion of someone's legal rights
    • (assault, battery, false imprisonment, invasion of privacy, defamation, slander
  109. Administrative issues?
    charges filed by a state or federal government agency
  110. Malpractice?
    unintentional tort:  omission to do something that a reasonable and prudent professional would do or doing something reasonable person wouldn't do
  111. Common problems made in documentation?
    • omissions without explanation
    • vague and ambiguous language
    • unapproved abbreaviations
    • error correction
    • spelling and grammar errors
    • illegibility
  112. What treatment exceptions are made for minors?
    • 1. pregnancy
    • 2. Tx of STD
    • 3. drug/alcohol Tx
    • 4. birth control
  113. Can person in custody of law enforcement consent/refuse treatment? 

    How can they be treated if they refuse?
    may consent/refuse

    need court order to collect forensic evidence
  114. What law states patients must be given info regarding advance directives if the do no already have one?
    Patient Self-Determination Act of 1991
  115. Independent variable?
    the variable that is being observed, introduced or manipulated in research study
  116. Dependent variable?
    variable that is being observed for a change after the intervention
  117. Extraneous variables?
    not being studied but may or may not be relevant to the results of the study
  118. Quantitative research?
    tests hypotheses and examines cause and effect of relationships:  emphasizes facts and data
  119. Ex post facto (correlational)?
    describes relationships between variables
  120. Qualitative?
    emphasizes development of new insight, theory, and knowledge

    nursing strategies, interpersonal communication techniques, intuition, and collaboration
  121. Ethical responsibilities r/t nursing research studies?
    • 1. Protect rights of subjects
    • 2. Benefits outweigh potential risk
    • 3. submit proposed study for review by investigational review committee
    • 4. Obtain informed consent from each subject
  122. TJC regulations for risk assessments?
    TJC requires hospitals to perform risk assessments for at least one high-risk process each year
  123. What must be included in a physician's order for restraints?
    • date and time
    • type of restraint
    • purpose of restraint
    • time limit
  124. Observation required during first hour of restraint?
    continuous face-to-face observation
  125. How often must restrained pt be offered food, toileting, and hydration?
    q3h
  126. What must be documented about restrained patient's condition?
    • General condition and response to treatment
    • condition of restrained limb before restraint
  127. When should restraints be loosened?
    at regular intervals
  128. What not to do if a patient is in denial?
    confront with the truth
  129. What should be done if family is allowed to be present during CPR?
    designate staff person to be the facilitator for the family
  130. How do pediatric patients compensate for decreased cardiac output?  Why?
    tachycardia

    decreased vascular tone -> decreased venous return-> limits ability to increase stroke volume to raise CO
  131. What may be indicated in a child with a new murmur with a fever?
    Rheumatic fever
  132. What is the primary cause of bradycardia and cardiac arrest in peds?
    respiratory issues
  133. What complication may occur r/t rheumatic fever?
    valvular disease
  134. What may be cause of tachycardia in peds?
    underlying conduction system anomalies:  Wolff-Parkinson White syndrome, Lown-Ganong_Levine syndrome
  135. What may be cause of cardiac s/s in pediatric patient?
    congenital cardiac issue

    accidental drug ingestion
  136. Why are older adults less able to adapt to cardiac stressors?
    cardiac output at rest decreases and cardiac reserve is limited
  137. Vascular changes with aging result in?
    increase in diastolic BP
  138. Consideration for s/s of MI in older adult?
    more likely to have a silent MI than younger patients
  139. Consideration for aging of liver and kidneys?
    altered drug metabolism
  140. Why are older adults predisposed to adverse effects of drugs?
    polypharmacy
  141. Where is apex of heart located?
    normally at the fifth L intercostal space at the midclavicular line
  142. Where is the base of the heart located?
    second intercostal space
  143. 4 layers of the cardiac wall?
    • pericardium
    • epicardium
    • myocardium
    • endocardium
  144. How much serous fluid is in pericardial space?
    10-30 mL
  145. What is included in myocardium?
    conduction fibers and cardiac muscle
  146. Endocardium?
    smooth surface for blood contact and the deterrence of clot formation

    • continues with lining of great vessels
    • lines heart chambers and valves
  147. Inflow tracts to R atria?
    superior vena cava, inferior vena cava, coronary sinus, and Thebesian veins?
  148. Outflow tract for R atria?
    through tricuspid valve to R ventricle
  149. L atria inflow tracts?
    4 pulmonary veins - only veins that carry oxygenated blood
  150. L atria outflow tract?
    through the mitral valve to L ventricle
  151. R ventricle outflow tract?
    pulmonary artery - only case of artery carrying deoxygenated blood
  152. L ventricle outflow tract?
    aorta
  153. Stenosis?
    narrowing of the valvular orifice to prevent normal antegrade flow
  154. AV valves?
    mitral and tricuspid
  155. What is the cause of the first heart sound S1?
    closing of AV valves:  mitral and tricuspid
  156. Semilunar valves?
    aortic and pulmonic
  157. Where are aortic and pulmonic valves located?
    • aortic - b/t L ventricle and aorta
    • pulmonic - b/t R ventricle and pulmonary artery
  158. What is the cause of S2 second heart sound?
    closing of semilunar valves
  159. Pathway of blood through the heart and vascular system?
    vena cava->R atrium->tricuspid valve->R ventricle->pulmonic valve->PA->pulmonary capillary bed->pulmonary veins->L atrium->mitral valve->L ventricle->aortic valve->aorta->arteries->arterioles->capillaries->venules->veins->vena cavae
  160. Where are coronary arteries located?
    first branch off of the aorta immediately outside of the aortic valve
  161. When is the L ventricle primarily perfused?
    DIASTOLE
  162. When is R ventricle perfused?
    throughout cardiac cycle - greater during diastole
  163. Preload?
    stretch of heart muscle:  affected by ventricular volume
  164. Afterload?
    pressure against which the ventricle must pump to open the semilunar valve:  affected by vascular resistance, ventricular diameter, and the mass and viscosity of blood
  165. Contractility?
    the contractile force of the heart
  166. Determinants of myocardial oxygen supply?
    • 1. patent arteries
    • 2. diastolic pressure
    • 3. diastolic time
    • 4. oxygen extraction:  hemoglobin, O2 sat
  167. L coronary artery before bifurcation?

    Divides into what arteries?
    L main coronary artery

    L anterior descending artery and L circumflex artery
  168. What areas are supplied by the L anterior descending coronary artery?
    • 1. anterior L ventricle
    • 2. Anterior 2/3 of interventricular septum
    • 3. apex of L ventricle
    • 4. Bundle of His and bundle branches
  169. What areas are supplied by the L circumflex coronary artery?
    • 1. L atrium
    • 2. sinoatrial node in 45% of hearts
    • 3. AV node in 10% of hearts
    • 4. obtuse marginal branch ->lateral L ventricle, posterior L ventricle
  170. What areas are supplied by the marginal branch?
    lateral R ventricle and inferior R ventricle
  171. Factors that foster development of collateral flow?
    • 1. anemia
    • 2. hypoxemia
    • 3. gradual occlusion (arteriosclerosis)
  172. Most coronary veins empty into the __ which empties into the ___.
    • coronary sinus
    • R atrium
  173. Natural pacemaker?
    sinoatrial node
  174. Where is SA node located?
    R atrial wall near the opening of superior vena cava
  175. Bachmann bundle?
    takes impulse from the R atrium to the L atrium
  176. AV node?
    accounts for 0.08-0.12 second delay to allow atria to completely depolarize, contract, and finish filling ventricles before the ventricles are stimulated
  177. What is primary function of AV node?
    delay impulse - contains no pacemaker
  178. Secondary pacemaker?

    HR?
    AV junction

    40-60BPM
  179. Function of R bundle branch?
    takes impulse to R ventricle myocardium
  180. Hemiblock?
    blockage of either of 2 major branches of L bundle branch
  181. Final tertiary pacemaker?

    HR?
    Purkinje fiber system

    20-40
  182. What occurs during systole?
    • Contraction increases pressure in ventricles - no change in volume
    • AV valves are closed
    • Ventricular pressures must exceed the pressure in great vessels to open semilunar valves
    • Blood ejected->when pressure in vessels > pressure in ventricles ->semilunar valves close
  183. What happens during diastole?
    AV valves open -> blood rushes into ventricles->atrial anv ventricular pressures decrease and ventricular volumes increase
  184. What may cause atrial contraction to account for more ventricular filling than the normal 15to30%?
    L ventricular filling is impeded (mitral stenosis)
  185. What occurs at end of diastole?
    AV valves close
  186. 4 determinates of CO?
    • heart rate
    • preload
    • afterload
    • contractility
  187. What occurs with increased preload?
    greater force of contraction:  increased stretch -> increased contraction force
  188. Chronotropic?
    effect on heart rate
  189. Inotropic?
    effect on contractility
  190. Dromotropic?
    effect on conductivity
  191. SNS effects on heart?
    positive chronotropic, inotropic, and dromotropic effects
  192. What type of drugs counteract SNS effects?
    sympathomimetic/adrenergic drugs
  193. Parasympathetic nervous system effects on heart?
    negative chronotropic, inotropic, and dromotropic effects
  194. Is PNS stimulation generally desirable in critically ill patients? 
    How might it help?
    no

    decreases myocardial oxygen consumption by up to 50%
  195. What drugs block the effects of PNS?
    parasympatholytic/vagolytic agents: atropine
  196. Where are chemoreceptors located?
    carotid and aortic bodies
  197. Function of chemoreceptors?
    sensitive to changes in PaO2, PaCO2, and pH

    cause changes in HR and RR
  198. Baroreceptor reflex location and function?
    in carotid sinus and aortic arch

    sensitive to arterial pressure

    increased BP causes vagal stimulation ->decrease in HR and contractility
  199. Bainbridge reflex location and function?
    • R atrium
    • sensitive to R atrial pressure
    • increased R atrial pressure ->increase in HR
  200. Respiratory reflex?
    inspiration -> decreased intrathoracic pressure -> increases venous return to R side of heart ->Bainbridge reflex -> LV cardiac output increases -> increases arterial BP and decreases HR through stimulation of baroreceptors
  201. What dysrhythmia is respiratory reflex partly responsible for?

    What else contributes?
    sinus dysrhythmia

    interaction b/t respiratory and cardiac centers in the medulla
  202. Alpha receptor location and function?
    vessels

    vasoconstriction of most vessels, especially arterioles
  203. Beta 1 receptors location and function?
    heart

    chronotropic, inotropic, and dromotropic effects
  204. Beta 2 receptor location and function?
    Bronchial and vascular smooth muscle

    bronchodilation and vasodilation
  205. Dopaminergic receptor location and function?
    renal and mesenteric artery bed

    dilation of renal and mesenteric arteries
  206. Sympathomimetic agents?
    • phenylephrine/Neo-Synephrine
    • norepinephrine
    • epinephrine
    • dopamine
    • dobutamine
    • isoproterenol/Suprel
  207. Phenylephrine/Neo-Synephrine receptor stimulation?
    alpha ++++
  208. Norepinephrine/Levophed receptor stimulation?
    • alpha ++++
    • beta 1 ++
  209. Epinephrine/Adrenalin receptor stimulation?
    • alpha ++++
    • beta 1 ++++
    • beta 2 ++
  210. Dopamine/Intropin receptor stimulation?
    • alpha ++ >5mcg/kg/min
    • beta 1 ++++ >10 mcg/kg/min
    • beta 2 +
  211. Dobutamine/Dobutrex receptor stimulation?
    • alpha +
    • beta 1 ++++
    • beta 2 ++
  212. Isoproterenol/Isuprel receptor stimulation?
    • beta 1 ++++
    • beta 2 ++++
  213. 3 layers of arterial wall?
    intima, media, adventitia
  214. Intima layer of arterial wall?
    thin lining of endothelium & small amnt of elastic tissue

    decreases resistance to flow and minimizes chance of platelet aggregation
  215. Media layer of arterial wall?
    smooth muscle and elastic tissue

    changes lumen diameter as needed
  216. Adventitia layer of arterial wall?
    connective tissue

    strengthens and shapes the vessels
  217. What is the cause of edema?
    imbalance in pressures or increase in capillary permeability
  218. Cause of edema in HF?
    peripheral edema caused by venous congestion and excessive hydrostatic pressure a the venous end
  219. Cause of edema in liver disease?
    decrease in plasma proteins->decreases capillary colloidal oncotic pressure ->fluid leak out of capillary
  220. What is the purpose of the venous pump?
    sends blood back to R side of heart

    skeletal muscles contract->compress veins -> propel blood toward the heart
  221. What prevents retrograde blood flow in veins?
    valves
  222. 4 regulators of BP?
    • 1. autonomic nervous system
    • 2. Renin-angiotensin-aldosterone system
    • 3. capillary fluid shifts
    • 4. local control mechanisms
  223. Renin-angiotensin-aldosterone system?
    Renin secreted by kidney in response to decreased BP, SNS stimulation, hyponatremia ->stimulates conversion of angiotensinogen to angiotensin I->angiotensin I converted to angiotensin II by ACE -> angiotensin II stimulates vasoconstriction and release of aldosterone->vasoconstriction and Na+/water retention increase BP and decrease renin secretion
  224. Pulse pressure?
    difference between systolic and diastolic pressures
  225. Normal pulse pressure?
    40mmHG
  226. 2 factors that affect pulse pressure?
    stroke volume and arterial elasticity
  227. Mean arterial pressure?
    average pressure in the aorta and its major branches during the cardiac cycle
  228. Formulas for MAP?
    (systolic BP + [diastolic BP X2]) /3

    diastolic BP + 1/3 pulse pressure
  229. Normal MAP?
    70-105
  230. 2 factors that affect MAP?
    CO and systemic vascular resistance
  231. Oxygen delivery to tissues is a product of ___ ____ and ___ ____ ___.
    cardiac output and arterial oxygen content
  232. VO2?
    volume of oxygen consumed by tissues each minute

    determined by comparing O2 content in arterial blood with venous blood
  233. Therapeutic methods to decrease VO2?
    hypothermia, sedation, analgesia
  234. What is indicated by lactic acidosis?
    tissue oxygen deficit
  235. Characteristics of cardiac cough?
    • usually occurs at night
    • precipitated by supine position, exertion, or turning to one side
  236. Possible cardiac cause of hemoptysis?
    pulmonary edema
  237. Cardiac cause of ascites?
    RV failure
  238. Cardiac cause of abd pain?
    RV failure
  239. Cardiac cause of edema or weight gain?
    frequently r/t RV failure
  240. Cardiac cause of nocturia?
    HF
  241. Cardiac cause of unexplained joint pain?
    may be r/t rheumatic fever
  242. Angina pectoris provocation, palliation, and timing
    provocation:  exercise, exertion, exposure to cold, emotional stress, eating, smoking

    palliation:  rest, oxygen, nitro, Ca channel blockers

    gradual or sudden onset, duration usually 1-4 min
  243. When do most MI's occur?
    within 3 hours of awakening
  244. Is MI pain relieved with rest or nitroglycerin?
    no
  245. Dissecting aortic aneurysm provocation, palliation, and duration
    provocation:  peripheral vascular disease, Marfan syndrome, aortitis, htn, hypertensive crisis, chest trauma

    palliation:  no relief with rest or nitro

    sudden onset, worse at onset, hours to days
  246. Pericarditis predisposing factors?
    MI, cardiac surgery, trauma, infections, uremia, lupus erythematosus
  247. Palliation for pericarditis?
    NSAIDS, sitting up and leaning forward
  248. Quality of pain with pericarditis?
    sharp, stabbing, knifelike, worsened by inspiration, coughing movement, recumbent position
  249. S/S of pericarditis?
    • tachycardia/tachypnea
    • FEVER
    • dyspnea
    • pericardial friction rub
    • diffuse concave ST segment
  250. Pulmonary embolism provocation?
    • venous stasis (immobility, pelvic surgery)
    • hypercoagulability (contraceptives)
    • injury to vessel (IV, vascular surgery)
  251. Pulmonary embolism palliation?
    • narcotics
    • high fowler's position
    • splinting of chest
  252. S/S of PE?
    • PALLOR/CYANOSIS
    • COUGH
    • ATRIAL DYSRHYTHMIAS
    • ACCENTUATED P2
    • IF RVF -> JVD
    • IF PULMONARY INFARCTION: pleural friction rub, hemoptysis, fever
    • tachycardia/tachypnea
    • dyspnea
  253. Medications that may cause dysrhythmias?
    tricyclic antidepressants, Dilantin, pheothiazines, lithium, theophylline,
  254. Cardiac effects of phenothiazines?
    dysrhythmias or hypotension
  255. Cardiac effect of doxorubincin/Adriamycin?
    may cause cardiomyopathy
  256. Consideration with corticosteroids and HF?
    cause Na and fluid retention
  257. Cardiac effects of theophylline?
    dysrhythmias, tachycardia
  258. Cardiac effect of erectile dysfunction meds?
    hypotension
  259. Normal of BP that is normal when standing?
    up to 15 systolic and 5 diastolic
  260. How to assess for orthostatic changes?
    stand pt-> wait 2-3 min and recheck
  261. Variation of BP up to ___mmHg b/t arms is normal.
    15mmHg
  262. How does BP in lower extremities compare to upper extremities?
    expected to be 10mmHg higher than in upper
  263. What is indicated by narrowed pulse pressure?

    Causes?
    vasoconstriction

    innervation of SNS (hypovolemic shock), vasopressor use
  264. What is indicated by widened pulse pressure?

    Cause?
    vosodilation

    septic shock, vasodilators
  265. Central cyanosis is seen where?

    Indicates __g of deoxygenated HgB
    lips, tongue, and mucous membranes

    5
  266. What does cyanosis look like on dark-skinned ppl?
    ashen
  267. What cardiac issues can ruddiness indicate?
    polycythemia or hypercapnia
  268. What does edema indicate?
    increase in interstitial fluid of 30% above normal
  269. 3 causes of facial edema?
    • 1. allergies- anaphylaxis
    • 2. steroids - exogenous/endogenous
    • 3. renal disease
  270. Endogenous cause of facial edema?

    Exogenous?
    Cushing syndrome

    prednisone
  271. Degree of pitting assessment?
    • 1+ = 0-4inch
    • 2+ = 1/4=1/2 inch
    • 3+ = 1/2 to 1 inch
    • 4+ = > 1 inch
  272. What may be indicated by episodic facial flushing?
    pheochromocytoma - tumor of the adrenal medulla that produces large amnts of catecholamines
  273. What is head bobbing up and down with each heartbeat referred to as?

    What does it indicate?
    de Musset sign

    indicates aortic aneurysm or regurgitation
  274. Positioning of patient for JVD assessment?
    45 degree angle
  275. Normal height of neck vein distention?
    1-2 cm above sternal notch
  276. What may be indicated if neck vein distention is >2cm above the sternal angle?
    • 1. RVF
    • 2. hypervolemia
    • 3. tension pneumothorax
    • 4. cardiac tamponade
  277. Estimage central venous pressure CVP using height of neck vein?
    add 5 cm to the height of the neck vein distention
  278. What may happen to aortic pulsation with aneurysm?
    lateral expansion my be felt
  279. Pulsus alternans?
    alternating pulse waves with every other beat being weaker than the preceding one
  280. Pulsus alternans in characteristic of what condition?
    LVF
  281. Pulsus paradoxus?
    an exaggeration of the normal physiologic response to inspiration

    • normal BP decrease 10
    • pulsus paradoxus:  drop >10
  282. What happens to BP during inspiration?
    normal decrease in BP during inspiration is 10mmHg
  283. Pulsus paradoxus may be characteristic of what conditions?
    • pericardial effusion
    • constrictive pericarditis
    • cardiac tamponade
    • severe lung disease
    • advanced HF
    • hemorrhagic shock
  284. S3?
    low-pitched sound that occurs early during diastole after S2  ken-tuc-ky
  285. Cause of S3?
    rapid rush of blood into a dilated ventricle
  286. S3 abnormal in what patients?
    patients >30
  287. S3 primarily associated with what condition?

    What other conditions may cause it?
    HF

    fluid overload, cardiomyopathy, ventricular septal defect or patent ductus arteriosus, mitral and tricuspid regurgitation
  288. S4
    dull, low-pitched sound that occurs late during diastole before S1
  289. Cause of S4?
    atrial contraction of blood into a noncompliant ventricle
  290. When is S4 abnormal
    in adults
  291. S4 associated with what conditions?
    • myocardial ischemia or infarction
    • hypertension
    • ventricular hypertrophy
    • AV blocks
    • severe aortic or pulmonic stenosis
  292. Pericardial friction rub?

    Where is it best heard?
    scratchy sound

    at 4th and 5th intercostal space at lower L sternal blocker with patient leaning forward
  293. Differentiate between pericardial and pleural friction rub?
    have pt hold breath
  294. Cause of pericardial friction rub?

    When is is commonly heard?
    inflammation of pericardium

    after MI or cardiac surgery
  295. Bruit is associated with what 2 conditions?
    plaque or aneurysm
  296. normal Na+
    136-145
  297. K+ normal
    3.5-5
  298. Chloride normal?
    95-103
  299. Calcium normal
    9.0-10.5
  300. Ionized calcium normal?
    4.5-5.6
  301. phosphorus normal
    3.0-4.5
  302. Mg normal
    • adults 1.3-2.1
    • children 1.4-1.7
    • infants 1.4-2
  303. Glucose normal
    65-110
  304. BN normal
    8-23
  305. Creatinine
    • women 0.6-1.1
    • men 1.8-1.3
  306. Total creatine kinase normal
    • men 55-170
    • women 30-135
  307. Creatine kinase myocardial bound normal?
    0% of total creatine kinase
  308. Lactate dehydrogenase normal
    90-200
  309. Lactate dehydrogenase-1 normal?
    17 to 25% of total Lactate dehydrogenase
  310. Normal myoglobin?
    <110
  311. Troponin I normal?
    1.5 g/ml
  312. Tropnin T normal
    0.1g/ml
  313. Cholesterol normal
    150-200
  314. triglycerides normal
    40-150
  315. HDL normal
    29-77
  316. LDL normal
    62-130
  317. Homocyseine normal
    <15
  318. CRP normal
    <1
  319. BNP normal/
    <100
  320. BNP with HF
    • mild:  100-300
    • moderate:  300-700
    • severe:  >700
  321. ABG HCO3 normal?
    22-26
  322. SaO2 ABG normal?
    • >95%
    • >92% in elderly
  323. ESR normal?
    • men </= 15 mm/h
    • women </= 20mm/h
  324. Prothromibin normal?
    12-15 seconds
  325. Therapeutic prothrombin time?
    1.5-2.5X normal
  326. PTT normal?
    60-90 seconds
  327. PTT therapeutic?
    1.5-2.5 X normal
  328. INR normal
    <2.0
  329. Platelets normal
    150,000 to 400,000
  330. specific gravity serum normal?
    1.005-1.030
  331. Osmolality serum normal?
    50-1200
  332. Considerations with cardiac catheterization and coronary angiography?
    check for allergy to iodine, shellfish, or dye

    hydration (contrast used)

    cath extremity immobilized in straight position for 6-12 hours

    Note complaints of back pain & vital sigh changes:  may indicate retroperitoneal hemorrhage
  333. Contraindications for MRI?
    implanted metallic devices:  pacemakers, defibrillators, metallic heart valves, intracranial aneurysm clips
  334. Stress electrocardiography?
    for ppl know to have CAD or postsurgical pt for ischemia

    exercise or pharmacological agent (adenosine, dipyridamole, dobutamine)
  335. Positive stress electrocardiography for CAD?
    >/= 1 mm of transient ST segment depression
  336. Monitoring during stress electrocardiography?
    monitor for exercise-induced hypotension or ventricular dysrhythmias
  337. Thallium stress elctrocardiography?
    ischemic areas show a decreased uptake of radioactivity
  338. What can arterial catheter measure?
    systemic arterial BP and mean
  339. CVP catheter measurement?
    CVP measured as a mean
  340. PA catheter measurement?
    R atrial pressure measured as a mean
  341. PA catheter 2 types?
    • R atrial (proximal port)
    • PA (distal port) - cannot use for fluid and drug admin - heparinized flush only to ensure patency
  342. What can specialized PA catheters do?
    • perform intracardiac pacing
    • measure SvO2
    • measure continuous CO
  343. When would diastolic pressure be expected to be higher and pulse pressure to be narrowed?
    endogenous catecholamine release or if receiving sympathomimetic agents
  344. When is diastolic pressure expected to lower and pulse pressure widened?
    excessive vasodilatory mediators (septic shock, anaphylactic shock) or if patient is taking vasodilators
  345. What MAP is necessary to perfuse vital organs?
    60
  346. Normal adult systolic, diastolic and MAP?
    • systolic:  90-130
    • diastolic: 60-90
    • MAP: 70-105
  347. How is R atrial pressure measured?
    catheter in superior vena cava (CVP) or at the proximal port of the PA catheter (RAP)
  348. R atrial pressure normal values?
    • 2-6mmHg
    • 3-8 H2O
  349. Normal pulmonary artery pressure?
    • systolic:  15-30
    • diastolic:  5-15
    • Mean:  10-20
  350. Pulmonary artery occlusive pressure normal?
    8-12
  351. CO normal?
    4-8 L/min
  352. Cardiac index normal?
    2.5-4 L/min
  353. SvO2 normal?
    60-80%
  354. ScvO2 normal?
    70-80&
  355. Where is PA pressure measured?
    from distal tip of the PA catheter with the balloon deflated
  356. Pulmonary artery occlusive pressure (pulmonary capillary wedge pressure & PA wedge pressure)
    pressure in the PA with the balloon inflated - indicates pressure in L atrium in absence of pulmonary htn
  357. Where is pulmonary artery occlusive pressure/pulmonary wedge pressure measured?
    from dital tip of the PA catheter with balloon inflated
  358. Mixed venous oxygen saturation? (SvO2)
    oxygen saturation of the blood as it returns to the lung for reoxygenstion
  359. What does SvO2 represent?
    average of the venous oxygen saturation of all organs and tissues
  360. Normal SvO2
    60-80%
  361. Central venous oxygen saturation? (ScvO2)
    oxygen saturation of the blood in the superior vena cava
  362. When is ScvO2 used?
    serves as a surrogate for SvO2 before PA cath is performed or when PA cath placement is not possible
  363. What happens to SvcO2 readings with shock conditions?
    consistently overestimates SvO2 by around 5-15%
  364. Normal ScvO2
    70%
  365. When should art line transducer be leveled and balanced to 0?
    with each position change of HOB and at least q12h
  366. Phlebostatic axis?
    correlates with R atrium and is at 4th intercostal space midway b/t sternum anterior and spine posterior
  367. What happens if transducer is too high?
    readings too low
  368. Positioning of patient for hemodynamic monitoring?
    supine with HOB no more than 60 degrees and air-fluid interface is level with phlebostatic axis
  369. Confirming placement of CVP or PA catheter?
    CXR
  370. Pressure readings obtained at the end of expiration?
    minimize the effects of intrathoracic pressure changes
  371. Difference in hemodynamic pressure in spontaneously and mechanically ventilated pt?
    • spontaneous:  expiration is positive - high point of fluctuation
    • mechanically ventilated:  expiration is neutral- low point of fluctuation

    ventilator valley patient peak
  372. Usual heparin concentration ?
    0.5-1 unit/ 1mL of flush
  373. When is heparin contraindicated for art line?
    Hx of HITT
  374. Why should hemodynamic values by correlated with clinical presentation?
    hemodynamic parameter changes may precede clinical presentation changes
  375. What occurs during P wave?

    P wave is no more than ___mm tall and no more than ___ sec wide.
    atrial depolarization

    2.5mm        0.11 seconds
  376. What occurs during PR segment?

    What is PR segment?
    delay in the AV node

    line b/t P wave and QRS
  377. What occurs during PR interval?

    How is PR interval measured?
    atrial depolarization and delay in AV node

    beginning of the P wave to the beginning of the QRS
  378. Normal PR interval time?
    0.12-0.20
  379. What occurs during QRS complex?

    Measuring QRS?

    Normal QRS interval?
    ventricular depolarization

    from beginning of first wave of complex to the end of last wave of complex

    0.06-0.11
  380. Normal QRS amplitude?
    <30mm
  381. What occurs during ST segment?
    ventricles have completely depolarized and the beginning of repolarization

    normally isoelectric at baseline
  382. J point?

    When does J point deviate from isoelectric line?
    angle at which the QRS complex ends and ST segment begins

    ST segment is elevated or depressed
  383. What occurs during T wave?
    ventricular repolarization
  384. Cardiogenic shock s/s?
    • tachycardia, tachypnea, hypotension
    • S3
    • crackles, dyspnea
    • JVD
    • hepatomegaly
    • peripheral edema
    • oliguria
  385. Hemodynamic presentation of cardiogenic shock?
    • CVP, PAP, & PAOP elevated
    • CO & CI decreased
    • SaO2, SvO2 & ScvO2 decreased
  386. Hypovolemic shock s/s?
    • flat neck veins
    • tachycardia, hypotension, tachypnea
    • oliguria
  387. Hemodynamic presentation in hypovolemic shock?
    • CVP, PAP, PAOP decreased
    • CO & CI decreased
    • SvO2 and ScvO2 decreased
  388. Anaphylactic shock s/s?
    • hypotension, tachypnea, tachycardia
    • angioedema
    • warmth, erythema, pruritus, and hives
    • wheezing & stridor
  389. Anaphylactic shock hemodynamic presentation?
    • CVP, PAPA, & PAOP decreased
    • CO & CI decreased
    • SvO2 & ScvO2 decreased
  390. Neurogenic shock s/s?
    • hypotension, tachypnea
    • bradycardia
    • warm, dry, flushed skin
    • hypothermia
    • neurologic deficit
  391. Neurogenic shock hemodynamic monitoring?
    • CVP, PAP, PAOP decreased
    • CO & CI decreased
    • SvO2 & ScvO2 decreased
  392. Septic shock s/s?
    • hypotension, tachycardia, tachypnea
    • hyperthermia
    • irritability and confusion
    • warm, moist, flushed skin
  393. S/S of cardiogenic shock?
    • S/S of shock:  hypotension, tachycardia, tachypnea
    • S/S of fluid overload:  crackles, dyspnea, JVD,
    •            S3, peripheral edema
    • oliguria
    • hepatomegaly
  394. S/S of hypovolemic shock?
    • S/S of shock:  hypotension, tachycardia, tachypnea
    • S/S of decreased fluid volume:  flat neck veins, oliguria
  395. S/S of anaphylactic shock?
    • S/S of shock:  hypotension, tachycardia, tachypnea
    • S/S of allergic reaction:  warmth, erythema, pruritis, hives, wheezing, stridor, angioedema
  396. S/S of neurogenic shock?
    • S/S of shock:  hypotension, tachypnea, but with BRADYCARDIA in stead of tachycardia
    • warm/dry/flushed skin
    • hypothermia
    • neurologic deficit
  397. S/S of septic shock?
    • S/S of shock:  hypotension, tachycardia, and tachypnea
    • fever
    • irritability and confusion
    • warm/moist/flushed skin
  398. Pulmonary hypertension S/S?
    tachycardia, JVD, dyspnea
  399. Cardiac pulmonary edema S/S?
    tachycardia, dyspnea, crackles, S3
  400. Cardiac tamponade s/s?
    • S/S of shock:  hypotension, tachycardia, and tachypnea
    • feeling of fullness in the chest
    • muffled heart sounds
    • JVD
    • electrical alternans
  401. Hemodynamic presentation with cardiogenic shock?
    • CVP, PAP, PAOP elevated
    • CO, CI decreased
    • SaO2, SvO2, ScvO2 decreased
  402. Hemopdynamic presentation with hypovolemic shock?
    • CVP, PAP, PAOP decreased
    • CO & CI decreased
    • SvO2 & ScvO2 decreased
  403. Hemodynamic presentation with anaphylactic shock?
    • CVP, PAP, & PAOP decreased
    • CO & CI decreased
    • SvO2 & ScvO2 decreased
  404. Hemodynamic presentation with neurogenic shock?
    • CVP, PAP, & PAOP decreased
    • CO & CI decreased
    • SvO2 & ScvO2 decreased
  405. Hemodynamic presentation with septic shock?
    • CVP, PAP, & PAOP decreased
    • CO & CI increased
    • SvO2 & ScvO2 increased as a result of decreased O2 extraction at the tissues
  406. Hemodynamic presentation with pulmonary htn?
    • CVP may be elevated
    • PAP elevated
    • SaO2, SvO2, & ScvO2 decreased
  407. Hemodynamic presentation with cardiac tamponade?
    • CVP, PAP, & PAOP elevated
    • pulsus paradoxis:  drop in BP of 10 during inspiration
    • CO & CI  decreased
    • SvO2 & ScvO2 decreased
  408. S4 at apex may indicate what type of infarction?
    left ventricular infarction
  409. S4 at apex may indicate what type of infarction?
    R ventricular infarction
  410. New holosystolic murmur at lower L sternal border may indicate what condition?
    rupture of ventricular septum
  411. Positioning of patient for insertion of deep vein catheters?
    trendelendburg
  412. What should you have patient during deep vein catheter-tubind disconnections?
    hold their breath
  413. Intervention if suspect air embolus in deep vein catheter?
    Durant maneuver:  turn pt to L side with his or her head down
  414. How long should pressure be held on an arterial puncture?
    • 5-10 min
    • longer if on anticoagulants
  415. How long should catheter for hemodynamic monitoring be in place?
    ideally no longer than 72 hours
  416. When should you stop injecting air into balloon of hemodynamic monitoring catheter?
    when PAOP waveform is seen
  417. Indications that balloon has ruptured on hemodynamic monitoring catheter?
    inability to obtain the PAOP and absence of resistance during inflation
  418. What equipment should be available during insertion of hemodynamic monitoring device?
    emergency equipment and transcutaneous pacemaker
  419. What patient position may assist hemodynamic monitoring device to migrate back into the pulmonary artery?
    L side
  420. Intervention for art line clot?
    • aspirate rather than flush
    • use only luer-lock connections
    • alarms on
  421. How often should flush solution, tubing, and dressing be changed on art line?
    every 72-96 hours
  422. Indications of pulmonary artery rupture with art line?
    hemptysis, dyspnea, and hypotension
  423. Prevent pulmonary artery rupture with art line?
    • only enough air to cause the PAOP waveform
    • do not overinflate balloon
    • limit inflation time to a max of 15 seconds
  424. Indications of pulmonary infarction with art line?
    chest pain, dyspnea, and decreased SaO2
  425. Prevention of thrombosis with art line?
    maintain heparinized NS drip with intermittent flush device

    keep pressure bag at 300

    neurovascular checks every hour
  426. QT interval?
    ventricular depolarization and repolarization

    first wave of QRS to end of T wave

    slower the HR, the longer the normal QT interval
  427. ECG changes with hypokalemia?
    flat T with prominent U wave - U wave taller than T wave as K decreases

    T wave and U wave same amplitude or U wave taller

    ST segment flattening or depression

    prolongation of QT interval

    if <1 U wave fuses with T wave
  428. Hyperkalemia ECG changes?
    • tall, narrow, peaked T waves
    • QRS widens - can merge with T wave
    • Pwave widens/shallow
  429. ECG changes with hypocalcemia?
    • prolonged QT
    • prolonged ST segment
  430. Hypercalcemia ECG changes?
    • shortened QT
    • shortened ST segment
  431. Hypomagnesemia ECG changes?
    • prolonged QT
    • broad, flattened T wave
  432. Hypermagnesemia ECG changes?
    • prolonged PR and QT
    • prolonged QRS
  433. What is caused by a block of either bundle branches?
    delay in conduction through ventricles and a prolongation of QRS interval
  434. ECG indication of L BBB?
    • QRS >/= 0.12 seconds
    • QRS positive in V6 and negative in V1
  435. ECG indication of R BBB?
    • QRS >/= 0.12 seconds
    • QRS positive in V1 and negative in V6
  436. Junctional escape rhythm?
    • 40-60 BPM
    • P wave, if visible, will be inverted - may be in front of, in, or after the QRS complex
  437. Accelerated junctional rhythm?
    • 60-100 BPM
    • P wave, if visible, will be inverted - may be in front of, in, or after QRS complex
  438. Idioventricular and accelerated idioventricular rhythm?
    ventricular rhythm usually regular - no atrial activity

    20-40 BPM and 40-100BPM
  439. What ECG changes indicate ischemia?
    T wave changes
  440. What T wave changes indicate ischemia?
    symmetrically inverted T waves in the leads that face the ischemic area
  441. What is an ECG reciprocal change?
    tall T waves in the leads opposite the ischemic area
  442. What ECG changes indicate injury?
    • ST segment changes:
    • ST segment elvation in leads that face the injured area

    reciprocal change: ST segment depression in the leads opposite the injured area
  443. What leads indicate an anterior MI?

    What artery is affected?
    V2, V3, V4

    LAD
  444. What leads indicate a septal MI?

    What artery is affected?
    V1 and V2

    LAD
  445. What leads indicate an anteroseptal MI?

    What artery is affected?
    V1, V2, V3, and V4

    LAD
  446. What leads indicate a lateral MI?

    What artery is affected?
    • I and aVL indicate high lateral
    • V5 and V6 indicate low lateral

    LCA
  447. Lead I axis and view?
    R shoulder to L shoulder

    shows lateral surface of L ventricle

    good for looking at atrial rhythms
  448. Lead II axis and view?
    R arm to L leg axis

    views inferior surface of L ventricle

    position mirrors normal current flow of heart

    useful with atrial dysrhythmias and sinus node problems
  449. Lead III axis and view?
    L arm to L leg axis

    inferior surface of L ventricles
  450. Where is V1 placed?

    View?
    4th intercostal space to R of sternum

    views septum of heart

    monitors ectopic beats, ventricular arrhythmias, ST changes, and BBB's
  451. Where is V2 placed?

    View?
    4th intercostal space to L of sternum

    views septum

    shows ST segment elevation
  452. What does V3 show?
    anterior surface of heart

    detects ST elevation
  453. Where is V4 placed?

    View?
    5th intercostal space at midclavicular line

    anterior surface of heart

    shows changes in ST segment and T wave
  454. Where is V5 placed?

    View?
    fifth intercostal space at anterior axillary line

    lateral surface of heart

    shows changes in ST segment or T wave
  455. Where is V6 placed?

    view?
    5th intercostal space at midaxillary line

    lateral surface of heart
  456. aVR axis and view?
    R arm to heart

    view of atria and great vessels but no view of heart walls
  457. aVL axis and view?
    L arm to heart

    lateral wall of L ventricle
  458. aVF axis and view?
    L leg to heart

    inferior wall
  459. What leads indicate an anterolateral MI?

    What artery is affected?
    V3, V4, V5, V6 (may be I and aVL)

    LCA
  460. What leads indicate an inferior MI?
    II, III, and aVF

    RCA
  461. What leads indicate a RV MI?\

    What artery is affected?
    V4R, V5R, V6R may be transient

    RCA
  462. What leads indicate a posterior MI?

    What artery is affected?
    V7, V8, V9 or reciprocal in V1, V2, and V3

    RCA, LCA, or both
  463. Where are posterior chest leads placed?

    What do these show?
    • V7 on L side of back at midaxillary line
    • V8 on L side midclavicular
    • V9 on L side near spine

    posterior surface of heart
  464. What leads show reciprocal changes in posterior MI?
    V1, V2, V3
  465. Wellens syndrome?
    group of signs associated with the occlusion of the proximal L anterior descending artery and a high risk of sudden cardiac death in a patient with unstable angina
  466. ECG changes with Wellens syndrome?
    symmetric and deeply inverted T waves in V2 and V3 that persist even when patient is pain free

    little or no ST elevation

    little or no enzyme elevation
  467. Tx of Wellens syndrome?
    cardiac catheterization
  468. ST elevation in leads II, III, and aVF indicate what type of MI?

    What type of reciprocal changes might occur?
    inferior

    Leads I and aVL
  469. ST elevation in leads I and aVL indicate what type of MI?

    What type of reciprocal changes might occur?
    high lateral MI

    II, III, aVF
  470. ST elevation in leads VI, V2, V3, & V4 indicate what type of MI?

    What type of reciprocal changes occur?
    anterior

    none
  471. What indicates posterior MI?
    ST depression in V1, V2, and V3

    ST elevation in V7, V8, and V9 with posterior EKG
  472. ECG changes in pt with pericarditis?
    normal in V1 and aVR but all other leads show ST segment elevation

    depression of PR interval in limb leads and L chest leads V5 and V6

    Decrease in QRS voltage if pericardial effusion is present
  473. ECG changes in pt with trauma?
    high risk for dysrhythmias and AV nodal blocks
  474. What cardiac dysfunction may be caused by binge drinking?
    acute dysrhythmias especially SVT
  475. Wolff-Parkinson White syndrome?
    AV node is bypassed:  short PR, wide QRS with slurring of the first portion of the QRS (delta wave)

    tachydysrrhythmias
  476. Second degree type I heart block?
    Wencke-bach
  477. Junctional escape rhythm?
    protects pt from asystole, do not suppress

    treat by accelerating sinus node:  atropine, pacemaker

    discontinue digoxin if it is cause:  common cause of this rhythm
  478. What SpO2 should be maintained for all patients unless ordered otherwise?

    SpO2 for COPD patients?
    95%

    90%
  479. What type of fluid is contraindicated for liver patients?
    LR
  480. Contraindications for cardioversion?
    tachydysrhythmias that result from digoxin toxicity

    nonsustained tachydysrhythmias

    longstaniding Afib

    Afib with normal or slow ventricular rate in the absence of AV nodal blocking drugs

    Multifocal atrial tachycardia
  481. Elective procedures should be preceded by at least a ____ hour fast.
    6
  482. What electrode placement is preferable for the cardioversion of Afib?
    anteroposterior
  483. What type of shock is used for cardioversion?

    how much voltage is used?
    synchronized

    25 to 200 joules
  484. Indications for pacemakers?
    • 1. symptomatic bradydysrhythmias
    • 2. sinus block or sinus arrest with ventricular asystole
    • 3. alternating tachycardia and bradicardia
  485. Asynchronous and synchronous pacemakers?
    asynchronous:  fixed rate regardless of heart's intrinsic activity

    synchronous:  pacing stimulus only when the heart's intrinsic pacemaker fails to function at predetermined rate (demand)
  486. Atrial pacemaker requires what?
    intact AV node
  487. How are pacing leads placed?
    percutaneously via the internal jugular or subclavian vein and advanced into the R atria, the R ventricle or both

    Image Upload 1
  488. Presence of T wave confirms what?
    ventricular depolarization
  489. Complications that can occur with pacemaker placement?
    infection, pneumothorax, myocardial perforation, hematoma, frozen shoulder, dysrhythmias, electrical malfunction
  490. What setting is pacemaker initially set on?
    between 3 and 5 mA depending on pacing threshold
  491. Defibrillating with pacemaker?
    do not place defibrillator paddles within 5 to 10 cm of the generator

    anteroposterior may be more effective
  492. How is the automatic implantable cardioverter-defibrillator deactivated?
    with a magnet
  493. During ACLS if a patient is adequately breathing what is the preferred position?
    L side
  494. Ventilator rate for rescue breathing for adults and children?
    10-12 BPM for adults and 12-20 for infants and children
  495. Depth of compressions in adults and children?

    Compression rate?
    • 1.5 - 2 inches in adults
    • 1/3 to 1/2 depth of chest for children
    • \
    • 100 compressions/minute
  496. CPR that is expertly performed provides ___% of normal cardiac output.
    20
  497. Why is prompt defibrillation critical to survival?
    resistance of ventricular dysrhythmias to defibrillation occurs over time
  498. What rhythm is is especially important to ID and treat cause of cardiac arrest?
    PEA
Author
mbeklj
ID
341673
Card Set
CEN
Description
CEN
Updated