NURS 5463: Exam 4 Study Guide
When to stop ACLS? 1. Unsafe conditions for the rescuer
2. DNR
3.Signs of death
4. Conditions not compatible for life
ACLS Considerations 1. Witnessed arrest?
2. Initial rhythm
3. Time elapsed (depends on the situation)
4. Duration of CPR (depends on the situation)
5.Patient's overall condition
5. Legal/ethical considerations
7. Debrief
Factors that improve ACLS 1. Witnessed cardiac arrest with immediate CPR
2. Utilization of defibrillation when indicated
What IV drip should be considered in patients with Nitroglycerin
persistant signs of heart failure?
What are three signs of heart failure? Orthopnea
JVD
Pulmonary Edema
What is diastolic heart failure? AKA heart failure with preserved ejection fraction (HFpEF)
When does diastolic heart failure occur? It occurs when the heart's left ventricle becomes stiff and does not relax properly,
leading to impaired filling of the heart with blood.
,Define ejection fraction A measure of how much blood is pumped out with each heartbeat) remains
normal, but symptoms of heart failure still develop.
Common signs of diastolic heart failure - Shortness of breath (dyspnea):
- Fatigue and Weakness:
- Swelling (edema):
- Weight Gain:
- Frequent Urination:
- Cough or Wheezing:
- Difficulty Exercising:
- Chest Pain or Discomfort:
- Palpitations
- Cool Extremities:
What is systolic heart failure? AKA heart failure with reduced ejection fraction (HFrEF).
When does systolic heart failure occur? It occurs when the heart's left ventricle loses its ability to contract effectively
which impairs the heart's ability to pump blood to meet the body's needs.
Ejection fraction in systolic heart failure The EF is reduced, typically below 40%, compared to a normal range of 50-70%.
What are the causes of systolic heart failure? - CAD
- HTN
- Dilated cardiomyopathy:
- Valve diseases: (AS, AR, MS, MR)
- Arrhythmias
- Myocarditis:
- Smoking
- Excessive alcohol use,
- Drug use (e.g., cocaine).
What are the symptoms of systolic heart failrue? - Shortness of breath (dyspnea)
- Fatigue and weakness
- Fluid retention
- Cough or wheezing
- Rapid or irregular heartbeat
- Chest pain or pressure
- Exercise intolerance
- Cool extremities or pale skin
Treatments for Atrial Fibrillation Rate control with:
- digoxin
- beta blockers (atenolol, metoprolol)
- calcium channel blockers (diltiazem, verapamil)
- amiodarone
Procedures
- Cardiac ablation
- TEE (recommended before cardioversion)
- Cardioversion
- MAZE procedure
, How do you risk stratify Afib? CHADs2-Vasc score
0 = low risk (anticoags are not recommended)
1 = low-moderate risk (consider anticoags and/or anti-platelet therapy)
> 2 = moderate-high risk (anticoags are recommended)
Also recommended, rate control with beta-blockers, calcium channel
blockers, amiodaronem, digoxin)
Mangement of Afib depends on: Risk stratification
Hemodynamic stability
Causes of Afib - Valvular disorders
- Structural disease
- Ischemic heart disease,
- OSA
- Obesity
- Hypoventilation syndrome
- Smoking, alcohol intake, illicit drug use
- History of rheumatic fever
- Heart disease
- History of pericarditis
- HLD
Symptoms of Afib - Palpitations
- Chest pain
- Shortness of breath
- Increased lower extremity swelling
- Dyspnea on exertion
- Dizziness
Define Hypertensive Urgency Hypertensive crisis with:
- BP > 180/120 with no end organ damage
- Requires a reduction in BP within a few hours-days
Hypertensive Urgency: Treatments - Long-term BP control
- Oral medication to reduce BP within 24-48 hours
- Compliance with medications
- Close primary care follow-up
*** Avoid rapid reduction of BP
Hypertensive Urgency: Complications The rapid correction of elevated BP is associated with an abrupted perfusion and
results in inadequate blood flow, ischemia, and potential infarction
When to stop ACLS? 1. Unsafe conditions for the rescuer
2. DNR
3.Signs of death
4. Conditions not compatible for life
ACLS Considerations 1. Witnessed arrest?
2. Initial rhythm
3. Time elapsed (depends on the situation)
4. Duration of CPR (depends on the situation)
5.Patient's overall condition
5. Legal/ethical considerations
7. Debrief
Factors that improve ACLS 1. Witnessed cardiac arrest with immediate CPR
2. Utilization of defibrillation when indicated
What IV drip should be considered in patients with Nitroglycerin
persistant signs of heart failure?
What are three signs of heart failure? Orthopnea
JVD
Pulmonary Edema
What is diastolic heart failure? AKA heart failure with preserved ejection fraction (HFpEF)
When does diastolic heart failure occur? It occurs when the heart's left ventricle becomes stiff and does not relax properly,
leading to impaired filling of the heart with blood.
,Define ejection fraction A measure of how much blood is pumped out with each heartbeat) remains
normal, but symptoms of heart failure still develop.
Common signs of diastolic heart failure - Shortness of breath (dyspnea):
- Fatigue and Weakness:
- Swelling (edema):
- Weight Gain:
- Frequent Urination:
- Cough or Wheezing:
- Difficulty Exercising:
- Chest Pain or Discomfort:
- Palpitations
- Cool Extremities:
What is systolic heart failure? AKA heart failure with reduced ejection fraction (HFrEF).
When does systolic heart failure occur? It occurs when the heart's left ventricle loses its ability to contract effectively
which impairs the heart's ability to pump blood to meet the body's needs.
Ejection fraction in systolic heart failure The EF is reduced, typically below 40%, compared to a normal range of 50-70%.
What are the causes of systolic heart failure? - CAD
- HTN
- Dilated cardiomyopathy:
- Valve diseases: (AS, AR, MS, MR)
- Arrhythmias
- Myocarditis:
- Smoking
- Excessive alcohol use,
- Drug use (e.g., cocaine).
What are the symptoms of systolic heart failrue? - Shortness of breath (dyspnea)
- Fatigue and weakness
- Fluid retention
- Cough or wheezing
- Rapid or irregular heartbeat
- Chest pain or pressure
- Exercise intolerance
- Cool extremities or pale skin
Treatments for Atrial Fibrillation Rate control with:
- digoxin
- beta blockers (atenolol, metoprolol)
- calcium channel blockers (diltiazem, verapamil)
- amiodarone
Procedures
- Cardiac ablation
- TEE (recommended before cardioversion)
- Cardioversion
- MAZE procedure
, How do you risk stratify Afib? CHADs2-Vasc score
0 = low risk (anticoags are not recommended)
1 = low-moderate risk (consider anticoags and/or anti-platelet therapy)
> 2 = moderate-high risk (anticoags are recommended)
Also recommended, rate control with beta-blockers, calcium channel
blockers, amiodaronem, digoxin)
Mangement of Afib depends on: Risk stratification
Hemodynamic stability
Causes of Afib - Valvular disorders
- Structural disease
- Ischemic heart disease,
- OSA
- Obesity
- Hypoventilation syndrome
- Smoking, alcohol intake, illicit drug use
- History of rheumatic fever
- Heart disease
- History of pericarditis
- HLD
Symptoms of Afib - Palpitations
- Chest pain
- Shortness of breath
- Increased lower extremity swelling
- Dyspnea on exertion
- Dizziness
Define Hypertensive Urgency Hypertensive crisis with:
- BP > 180/120 with no end organ damage
- Requires a reduction in BP within a few hours-days
Hypertensive Urgency: Treatments - Long-term BP control
- Oral medication to reduce BP within 24-48 hours
- Compliance with medications
- Close primary care follow-up
*** Avoid rapid reduction of BP
Hypertensive Urgency: Complications The rapid correction of elevated BP is associated with an abrupted perfusion and
results in inadequate blood flow, ischemia, and potential infarction
