Nursing 432 Exam 2 2023 with verified questions and answers

What is the equation for CO? CO = HR x SV What is preload? volume of blood in ventricles at end of diastole What is afterload? resistance left ventricle must overcome to circulate blood What are the conduction cells? automaticity, excitability, rhythmicity, and refraction What is automaticity? discharge electrical current without external stimulus What is excitability? able to depolarize and form action potential when stimulated What is refraction? temporary inability of depolarized cells to become excited and generate another action potential What are the myocardial cells? contractility and conductivity What is contractility? ability of atrial and ventricular muscle cells to shorten their fiber length in response to electrical stimulation, causing sufficient pressure to push blood forward through the heart (it is the mechanical activity of the heart) What is conductivity? ability to conduct impulse adjacent cardiac cells and spread throughout the heart. What is the SA node and what is the bpm? Sinoatrial 60-100 bpm What is the AV node and what is the bpm? atrioventricular 40-60 bpm What is the inherent rate for the ventricles? 20-40 bpm What regulates the HR? autonomic nervous system Characteristics of P wave -First positive deflection from isoelectric line -SA node excites -Atrial depolarization -rounded and consistent -Ca and Na are rushed in while K is rushed out Characteristics of QRS wave Q: first negative deflection R: positive deflection (tall spike) S: negative deflection -Represents ventricles depolarizing and contracting (Na and Ca rushing out and K rushing in) Characteristics of T wave -positive wave following QRS -repolarization of ventricles and testing state before next beat Characteristics of PR interval (measuring and interval) -measures time from SA signal through complete depolarization of atria and arrival at AV node -measure from beginning of P wave to beginning of QRS -interval = 0.12 to 0.20 seconds Measuring and interval of QRS -beginning to end of QRS -interval = 0.06 to 0.10 seconds Characteristics of QT intervals (measure and interval) -total time of depolarization and repolarization of ventricles -measure from beginning of Q eave to end of T wave -interval = 0.32 to 0.40 seconds How many seconds is a small block? 0.04 seconds How many seconds is a big block? 0.20 seconds What are the bpm for the first 6 blocks with the Big Block Method? 1st - 300 bpm 2nd - 150 bpm 3rd - 100 bpm 4th - 75 bpm 5th - 60 bpm 6th - 50 bpm How to use the Six Second Strip Method? -count the QRS complexes within 6 seconds and multiply by 10 -30 big blocks equal 6 seconds With the 12 Lead EKG, what are the leads on all four limbs? -R. leg: acts as a ground electrode -R. arm: always negative L. leg: always positive L. arm: positive or negative What is the Lead placement? Smoke over fire (L); sky over grass (R); dirt in the middle Normal Sinus Rhythm -Rate -Regularity -P wave -PR interval -QRS -Rate: 60-100 bpm -Regularity: regular -P wave: 1 P/QRS, upright, rounded, consistent -PR interval: 0.12 to 0.20 seconds and consistent -QRS: 0.10 seconds and consistent Atrial Fibrillation -Rate -Regularity -P wave -PR interval -QRS -Rate: any rate--if 100 bpm called Rapid Ventricular Response -Regularity: irregularly irregular -P wave: none visible--may see scratchy baseline -PR interval: cannot measure since no P wave -QRS: 0.10 seconds Premature Ventricular Contractions -QRS What is it followed by? -QRS: wide and bizarre -a pause What is a 1 PVC and 1 sinus beat? What is a 2 PVC and 2 sinus beat? What is a 3 PVC and 3 sinus beat? -bigeminy PVC -trigeminy PVC -quadrigeminy PVC Ventricular Tachycardia -Rate -Regularity -P wave -PR interval -QRS -Rate: 150-200 -Regularity: usually regular -P wave: none visible -PR interval: cannot measure -QRS: 0.12 seconds -pt may or may not have a pulse Ventricular Fibrillation -Rate -Regularity -P wave -PR interval -QRS -Rate: NONE -Regularity: NONE -P wave: NONE -PR interval: NONE -QRS: NONE What is a priority with Ventricular Fibrillation? defibrillate the patient immediately according to ACLS protocol Asystole -Rate -Regularity -P wave -PR interval -QRS -Rate: NONE -Regularity: NONE -P wave: NONE -PR interval: NONE -QRS: NONE What should you do if a pt is in VF or VT? defibrillate! What is sinus bradycardia and the standard treatment? -60 bpm -standard treatment: administer atropine 0.5 mg IV, increased intravascular volume via IV fluids, and apply O2 The pacemaker does two things: senses and captures. (definition) -sensing: recognizing heart is initiating a beat and will not "fire" -capture: artificial pacemaker fired and the heart responds What is sinus tachycardia and what will the EKG look like? -100 bpm -EKG pattern may show T-wave inversion or ST-segment elevation or depression in response to MI. What does coronary artery disease include? stable angina and acute coronary syndromes What is ischemia? insufficient oxygen supply to meet the requirements of myocardium What is infarction? necrosis or cell death that occurs when severe ischemia is prolonged and decreased perfusion cause irreversible damage to tissues What are the three main arteries? R. coronary, L. coronary, and L. anterior descending artery Where does the R. coronary artery supply blood to? R. atrium and ventricle, inferior part of the L. ventricle, and SA and AV nodes** Where does the L. coronary artery, L. anterior descending artery, and circumflex artery supply blood to? L. ventricle, septum, Chordnae tendonae, and papillary muscles. What is SV? amount of blood ejected per beat What are the three things that affect SV? preload, afterload, and contractility. What is the healthy and cardiac pt ejection fraction? -healthy = 70% -cardiac = 50% What is unstable angina pectoris? chest pain or discomfort that occurs at rest or with exertion and causes severe activity limitations. What is new-onset angina? pt who has first angina symptoms, usually after exertion or other increased demands on the heart. What is variant (Prinzmetal's) angina? chest pain or discomfort resulting from coronary artery spasm and typically occur after rest. What is preinfarction angina? chest pain that occurs in the days or weeks before a MI. What will you see on an EKG if someone has unstable angina pectoris? ST changes on 12-head ECG, but will not have changes in troponin or CK levels What is chronic stable angina pectoris? -"strangling of the chest" -temporary imbalance between coronary artery's ability to supply oxygen and cardiac muscle's demand for oxygen How to resolve chronic stable angina pectoris? rest and NTG What is MI? Acute blockage of the coronary arteries results in ischemia and infarct of the heart muscle What happens during MI? -necrosis of myocardium -hypoxia -subendocardial MI, transmural MI, and inferior wall MI -ventricular remodeling What is ventricular remodeling? Scar tissue permanently changes size and shape of the entire L ventricle. What are the complications of MI? Ventricular aneurysm, ventricular septal rupture, papillary muscle rupture, cardiac wall rupture, pericarditis, and HF What is the medical management for MI? -Recanalization of the coronary artery -Anticoagulation -Dysrhythmia prevention -Prevention of ventricular remodeling What are the nursing managements for MI? -Balance of myocardial oxygen supply and demand -Prevention of complications -Depression after MI What should we educate to the patient who had a MI? -Risk factors reduction -Manifestations of angina -When to call a physician or emergency services -Medications -Resumption of physical and sexual activities What is the most common cause of sudden cardiac arrest? VT or VF What is the standard of care for sudden cardiac arrest? Rapid defibrillation within 5 minutes of calling EMS How should you place the pads? -Anterior or anterior/posterior for an obese pt. -one pad at R. upper chest and one pad at L. lower chest. What are the indications for Intra-arterial blood pressure monitoring? monitoring conditions that compromise CO What test do you use for Intra-arterial blood pressure monitoring? In the Allen test, the radial and ulnar arteries are compressed simultaneously. The patient is asked to clench and unclench the hand until it blanches. One of the arteries is then released, and the hand should immediately flush from that side. The same procedure is repeated for the remaining artery. Nursing management for Intra-arterial blood pressure monitoring? watching out for infection and clots. Indications for central venous pressure monitoring? volume status of pt What is the Normal CVP level? -2-5 mm Hg (3-8 cm H20) -Low volume = low CVP -High volume = high CVP Three insertion sites for CVP? Internal jugular vein, subclavian vein, and femoral vein. Complications for CVP? Air embolism, thrombus formation, infection What increases and decreases contractility? -increased: sympathetic stimulation, Ca++ release, and positive inotropic drugs -decreased: hypoxia and acidemia. What are the post cardiac cath care? -Bedrest with leg/insertion site straight 2-6 hrs -VS monitoring -Assess for hematoma/bleeding at insertion -Assess peripheral circulation distal to insertion -Monitor I&O—make sure adequate excretion of contrast. cardiac signs and symptoms -Chest pain (standard sign) -palpitations -new murmur -increased JVD -BP elevation or depression -irregular pulse (count 1 minutes apically) -EKG changes -SOB -Tachypnea -Crackles -N/V -indigestion -decreased urine output -cool clammy pale skin -anxiety and restlessness (sign of inadequate oxygen perfusion) -fear of impending doom or denial Chest pain signs and symptoms -Heaviness, pressure, squeezing, burning like heartburn, tightness, achy, misery -May radiate to neck, jaws, throat, arms, back -May or may not be associated with stress or activity -May have N/V -First sign may be sudden death -Women may have atypical presentations—fatigue and SOB What are the two main things that are critical to maintaining health and preventing disease? inflammation and immunity What are stem cells? -Immature, undifferentiated cells produced by the bone marrow -Become anything they are programmed to be What are leukocytes? Protect body from effects of invasion by organisms What cells are the key for recognition and self-tolerance? Human Leukocyte antigens What are band cells? immature neutrophils What is a left shift? What is it also called and what is the pt at a higher risk for? -increase in immature cells in the CBC -Also called bandosis -Pt at a higher risk for septic shock What is the Innate Native Immunity? Provides immediate protection against effects of tissue injury and foreign proteins What are the 5 cardinal signs of inflammation? -Pain -Heat -Redness -Swelling -Loss of function What are the 3 stages of inflammatory response? -Stage 1 (vascular): Constriction of blood vessels, hyperemia, and edema -Stage 2: Cellular exudates that contain neutrophils (pus) -Stage 3 (tissue repair and replacement): WBC's trigger new blood vessel and growth (angiogenesis) and scar tissue formation What are the indications for a massive transfusion? -Penetrating trauma -Systolic BP 90 mmHg, HR 120 bpm -Positive ultrasound of internal bleeding What is the protocol for a massive blood transfusion? -Activation of blood bank protocols -Need blood warmers -Administer -RBC 1-2 units -Platelets 1 unit -FFP 1 unit -Check Pt -CBC, PTT/INR, Fibrinogen, ABG, creatine, electrolytes -Vital signs q 1 hour and PRN -Double check all blood products -Monitor for reactions What are the values for the CBC with differential? WBC 4-11 x 10^9 Neutrophils 2-7 x 10^9 Lymphocytes 1-3 x 10^9 Monocytes 0.2-1 x 10^9 Eosinophils 0.02-0.5 x 10^9 Basophils 0.02-0.1 x 10^9 What are the values for troponin? Cardiac troponin T 0.10 ng/mL Cardiac troponin I 0.03 ng/mL What are the values for total cholesterol? 200 desirable 200-239 borderline high = 240 high What are the values for LDL? 100 optimal 100-129 near optimal/above optimal 130-159 borderline high 160-189 high = 190 very high What are the values for HDL? 40 low = 60 high What are the values for triglycerides? 150 normal 150-199 borderline high 200-499 high = 500 very high What is the value for INR, PT, and aPTT? INR = 1 PT = 11-12.5 seconds aPTT = 20-30 seconds What are the two adrenergic agonist and what do they do? -Epinephrine and Norepinephrine -increase BP by vasoconstriction What is an adrenergic antagonist and what does it do? Regitine that blocks sympathetic receptors What are the two CCB and what do they do? Verapamil and Diltiazem -slow HR and decrease contractility of the heart Nursing considerations for ACE-I? -pt should report a dry, consistent cough -BP should be monitored (BP 100) -assess for hyperkalemia Nursing considerations for ARB? -avoid foods high in potassium -monitor BP (BP 100) What is digoxin used for and what is the antidote? -AF and Aflutter -Digibind is the antidote What are the two vasopressors and what do they do? -dopamine and dobutamine -improves MAP by increasing peripheral resistance, increasing venous return, and increasing myocardial contractility. What are the two vasodilators and what do they do? -nitroglycerin (NTG) and nitroprusside -reduce preload/afterload and O2 demand. How should the pt take nitroglycerine? -At first indication of chest discomfort, cease activity and sit -Place the tablet under down, wait 5 minutes for relief. -If not relief, call 911 and repeat the tablet waiting 5 more minutes. -If there is no relief, repeat and 5 more minutes (only 3 doses allowed) What are the three anticoagulants and what do they do? -warfarin, heparin, and lovenox -prevent clots What should you assess for in a pt taking warfarin? What is the antidote? What is the INR level for these pts? -Bleeding -Vitamin K -1.5-2.0 What is protamine sulfate? antidote for heparin What are the two antiplatelets and what do they? aspirin and clopidogrel -stop platelets from sticking together to form a clot What are the two antidysrhythmics and what do they do? -adenosine and amiodarone -treat irregular HR Adenosine: Half life, repeat with how many mg, and what are common side effects? -10 second half life -repeat to a total of 12 mg -facial flushing, SOB, and chest pain What can aminodarone cause? corneal pigmentation