Critical care HESI – 55 questions
• Cardiac
o SVT: supraventricular tachycardia
▪ No p waves seen
▪ Treatment:
• Adenosine – give 6mg, then 12mg, then another 12mg
• Cardioversion if pt not tolerating rhythm
• Don’t defibrillate!!!
▪ Have someone bring crash cart to room
o Atrial fibrillation:
▪ Chaotic atrial activity
▪ Irregularly irregular
▪ Controlled: vent rate < 100
• On digoxin at home and has controlled a fib look at digoxin
level
▪ Uncontrolled: vent rate > 100
▪ P waves are fibrillatory
▪ High risk for clots give anticoagulant
▪ Common in elderly
▪ Holiday heart syndrome: alcohol and emotional stress
o Atrial flutter:
▪ Ventricular rhythm stays regular
▪ Sawtooth waves
▪ Cardiovert!
o Asystole: flat line
▪ Patient is essentially dead
▪ Give CPR and epi
▪ Pulse is gone
▪ Patient in asystole for 20 minutes talk to family, patient is dead
o 3rd degree heart block
▪ Look at patient’s blood pressure, bradycardia
▪ Give atropine, epinephrine, pacemaker
o Alcoholic EKG
▪ Wide QRS and flat T = life threatening
▪ Flat T means hypokalemia
o Peaked t waves are usually from hyperkalemia
o STEMI: ST elevation myocardial infarction
▪ Give thrombolytics within 4 hours of onset
o MI vs. Indigestion
▪ Classic symptoms of MI: dull chest pain radiating down left arm
▪ Women, elderly, pt’s with hx of DM may not have classic symptoms,
instead:
• N/V
• Belching
• Indigestion
• Diaphoresis
, • Dizziness
• Fatigue
o New nurse on cardiac unit:
▪ Assign pt with sinus arrhythmia going for a stress test
▪ Don’t assign:
• Torsades
• V tach
• V fib
o Pulmonary artery catheter insertion, swan insertion
▪ Priority is monitoring the pressures
▪ When it gets into right ventricle watch for arrhythmias
▪ Sterile field
o Hand is cold and decreased capillary refill – call physician because clot may be
forming, don’t do an Allen test
o Radial artery line and pt has decreased cap refill call the physician
o Hemorrhagic stroke
▪ Do not give tPa!!!
o Ischemic stroke
▪ Look at BP before giving alteplase
o Cardiac tamponade
▪ Muffled heart sounds
▪ Jugular venous distention
▪ Hypertension
▪ Tx: pericardial centesis
o Vasodilation medications
▪ Morphine
▪ Lidocaine
o Dopamine
▪ Vasopressor and will increase BP
▪ Increases renal flow at low doses
▪ So if low dose renal dose
• Increases vasodilation of artery no higher than 5 mcg/kg/min
o DIC: first sign is often gums bleeding
▪ PT/INR
o Heart failure
▪ BNP should be less than 100, if it’s over 100 it’s indicative of heart failure,
lung dysfunction
o Pacemaker is firing and nothing is happening
▪ Look at sensitivity/sync mode of pacemaker, possibly increase rate
o IABP: intraaortic balloon pump
▪ Pt condition is improving with IABP when you see a decreased wedge
pressure, and an increased cardiac output
o CVP: for monitoring
▪ Need transducer hooked up and at phlebostatic axis
• Cardiac
o SVT: supraventricular tachycardia
▪ No p waves seen
▪ Treatment:
• Adenosine – give 6mg, then 12mg, then another 12mg
• Cardioversion if pt not tolerating rhythm
• Don’t defibrillate!!!
▪ Have someone bring crash cart to room
o Atrial fibrillation:
▪ Chaotic atrial activity
▪ Irregularly irregular
▪ Controlled: vent rate < 100
• On digoxin at home and has controlled a fib look at digoxin
level
▪ Uncontrolled: vent rate > 100
▪ P waves are fibrillatory
▪ High risk for clots give anticoagulant
▪ Common in elderly
▪ Holiday heart syndrome: alcohol and emotional stress
o Atrial flutter:
▪ Ventricular rhythm stays regular
▪ Sawtooth waves
▪ Cardiovert!
o Asystole: flat line
▪ Patient is essentially dead
▪ Give CPR and epi
▪ Pulse is gone
▪ Patient in asystole for 20 minutes talk to family, patient is dead
o 3rd degree heart block
▪ Look at patient’s blood pressure, bradycardia
▪ Give atropine, epinephrine, pacemaker
o Alcoholic EKG
▪ Wide QRS and flat T = life threatening
▪ Flat T means hypokalemia
o Peaked t waves are usually from hyperkalemia
o STEMI: ST elevation myocardial infarction
▪ Give thrombolytics within 4 hours of onset
o MI vs. Indigestion
▪ Classic symptoms of MI: dull chest pain radiating down left arm
▪ Women, elderly, pt’s with hx of DM may not have classic symptoms,
instead:
• N/V
• Belching
• Indigestion
• Diaphoresis
, • Dizziness
• Fatigue
o New nurse on cardiac unit:
▪ Assign pt with sinus arrhythmia going for a stress test
▪ Don’t assign:
• Torsades
• V tach
• V fib
o Pulmonary artery catheter insertion, swan insertion
▪ Priority is monitoring the pressures
▪ When it gets into right ventricle watch for arrhythmias
▪ Sterile field
o Hand is cold and decreased capillary refill – call physician because clot may be
forming, don’t do an Allen test
o Radial artery line and pt has decreased cap refill call the physician
o Hemorrhagic stroke
▪ Do not give tPa!!!
o Ischemic stroke
▪ Look at BP before giving alteplase
o Cardiac tamponade
▪ Muffled heart sounds
▪ Jugular venous distention
▪ Hypertension
▪ Tx: pericardial centesis
o Vasodilation medications
▪ Morphine
▪ Lidocaine
o Dopamine
▪ Vasopressor and will increase BP
▪ Increases renal flow at low doses
▪ So if low dose renal dose
• Increases vasodilation of artery no higher than 5 mcg/kg/min
o DIC: first sign is often gums bleeding
▪ PT/INR
o Heart failure
▪ BNP should be less than 100, if it’s over 100 it’s indicative of heart failure,
lung dysfunction
o Pacemaker is firing and nothing is happening
▪ Look at sensitivity/sync mode of pacemaker, possibly increase rate
o IABP: intraaortic balloon pump
▪ Pt condition is improving with IABP when you see a decreased wedge
pressure, and an increased cardiac output
o CVP: for monitoring
▪ Need transducer hooked up and at phlebostatic axis
