CASAL II OA | well elaborated and 100% verified

CASAL II OA | well elaborated and 100% verified SA node - pacemaker, 60-100bpm,Depolarization R atria, p wave, AV node - Gatekeeper, intraseptal, Allows delay for blood so no back up, 40-60 bpm Bundle of His - Intraventricular, 40-60bpm, sends to purkinje fibers for ventricular depolarization L and R bundle branches - 20-40bpm, Purkinje fibers - 20-40bpm, ventricular depolarization (QRS) complex Preload - LVEDP determined by LVEDV Afterload - Vascular resistance Cardiac output = - heart rate x stroke volume Normal QRS complex - 0.06-0.12 sec. (1.5-3 small boxes) P wave - atrial depolarization QRS complex - ventricular depolarization T wave - ventricular repolarization U wave - hypokalemia, depolarization purkinje fibers A Fib on EKG - 1. P waves? No 2. P waves regular? U/A to determine 3. R waves regular? No irregular 4. How many R waves in 6 sec? 5. PR interval length? No, no p waves Saw tooth No p waves R waves irregular Stroke volume - the volume of blood pumped out by a ventricle with each heartbeat Cardiac output - Amount of blood pumped through body per min 3 things that affect stroke volume - preload, afterload, contractility What increases vascular resistance - pHTN (R️), vasoconstriction/HTN (L️), aortic stenosis (L ventricle) What can decrease afterload - Vasodilation Sympathomemetics/ adrenergic agonist - Dopamine ⬆️ BP & CO norepinephrine ⬆️ BP epinephrine ⬆️Bronchodilation beta 2 adrenergic agonist -inhaled for cold/asthma albuterol (short) solmedrol (long) Sympatholytic/ andrenergic antagonist - Beta blockers ⬇️ HR, ⬇️BP, constrict airway Parasympatholytic/anticholenergic - Airway: Ipratropium bronchodilator HR: Atropine ⬆️HR or dilate pupils nonselective beta blockers beta 1 ️ Kidneys beta 2 lungs, GI, vascular muscle, skeletal - propranolol, timolol, nadolol, pindolol, carvidolol Nursing implications non selective Beta blocker - Not for: COPD, asthma, PVD Selective Beta blockers - Atenolol, esmolol, metoprolol beta 1 found in ️ And kidneys-blocks RAAS Beta blockers treat - HTN, stable angina, dysthymia (SVT, tachy), compensated heart failure, glaucoma, migraines, tremors, anxiety Monitor with beta blockers - -Bradycardia-check physician desired -parameters -EKG-heart block 2nd and 3rd degree -watch for S&S ️ Failure don't want contraction to get too weak -monitor BG masks ⬆️HR of hypoglycemia/hyperglycemia -ortho htn - circulation impairment -OD S&S bradycardia, lethargic, ️ Block, hypotension Teach pt with beta blockers - Bradycardia ️ Failure exacerbation taper off-rebound htn/angina ortho htn know OD S&S blood glucose w/non selective Calcium Channel Blockers - blocks L type channels in: vascular smooth muscle cardiac myocytes cardiac nodal tissue (SA & AV nodual tissue) Calcium Channel Blockers (vascular selective) - Dihydropyridines: "Pines" amlodipine, felodipine, nifedipine Mainly for HTN and angina Calcium Channel Blockers-effects on vascular smooth muscle - coronary and peripheral arteries: Vasodilation: decrease BP, relax coronary arteries, decrease SVR = decrease afterload Calcium Channel Blockers-effects on myocytes - decrease heart contraction strength (- inrotropic effect) decrease O2 demand Treats angina-NOT for heart failure pt Calcium Channel Blockers- effects on cardiac nodal tissue - SA node- decrease heart rate (neg chronotropic effect) AV node- speed up conduction (positive dromotrophic) treats arrhythmia: SVTs, Afib Myocardial Selective Calcium Channel Blockers - Non-Dihydropyridines phenlalkylamines-Verapamil benzothiazepine- Diltiasem mainly for anti-arrhythmic htn/angina Misc. treatment with Calcium Channel Blockers - Rhanud's migraines cerebral spasms Nursing Implications - *monitor for bradycardia especially Verapamil & Diltiazem *monitor EKG for 1st degree especially for Verapamil & Diltiazem *Never give verapamil/Diltiazem with 2nd or 3rd degree HB *monitor S&S heart failure (dyspnea, weight gain, crackles, edema) *No grapefruit *High fiber diet -verapamil and diltiazem *Good oral hygiene with the "Pines" *monitor reflex tachycardia, ortho htn Teach pt on Calcium Channel Blocker - monitor HR and BP at home S&S of CHF exacerbation good oral hygiene for "pines" high fiber diet for varapamil and diltiazem orthostatic htn-change positions slowly Angiotensin Converting Enzyme Inhibitors - "Prils" Captorpil, lisinopril, enalapril, quinipril, ramipril Action of ACE inhibitor - Inhibits the enzyme that converts angiotension I to angiotension II No conversion = No vasoconstriction and no increase in BP In RAAS bradykinin is inhibited (it's a vasodilator) with inhibition of RAAS bradykinin is available to work and contribute to the decrease of BP ACE effects on the body system - decrease BP decrease SVR bradykinin available decrease Na+ & H2O increase K+ ACE inhibitor used to treat - HTN heart failure (systolic dysfunction) Post MI Nursing Implications ACE inhibitors - assess BP, and pulses regularly watch for hypotension -especially if on other BP meds or diuretic (SBP 90) monitor K (3.5-5) EKG tall peaked T waves = hyperK+ BUN (5-20)/creatinine (0.6-1.2)-anytime you mess with fluids I &O 30mL/h angioedema swelling in face, mouth especially in AA ortho htn side effect of ACE - dry cough caused by bradykinin Kussmaul respirations - (hyperpnea) seen in DKA large tidal volume increase in ventilatory rate with no expiratory pause Cheyne-Stokes - end of life rapid breathing followed by apnea for 15-60 sec ventilation that increases then decreases to apnea hypoventilation - inadequate alveolar CO2 removal can't keep up with intake hypercapneia tidal volume decrease increase H+ causes respirator acidosis hyperventilation - response to stimuli sick, panicking, anxiety, pain lungs remove CO2 @ higher rate than it's produced so decreased CO2 in lungs = hypocapnia=respiratory alkalosis Asthma - type I mediated allergic reaction early response is exposure to antigen late response happens 4-8 h later Forced Expiatory Volume (FEV) - measures volume of air that is exhaled during the 1st second in mouth piece **an increase of 12% of FEV after bronchodilater is how diagnosed** Theopylline/Methalzanthing - *vasodilator, a dirivative of caffiene *No caffiene while taking, coffee/chocolate *Take with full glass of water on empty stomach *1h before meal or 2h after *do not chew or crush *If pt can't swallow extended release can be sprinkled in apple sauce or pudding Side effects of Theopylline/Methalzanthine - upset stomach stomach pain diarrhea HA restlessness irritability vomit increased HR Sz if toxic When to draw labs for Theopylline/methalanthine - if given 1/day 8-12h after dose if bid 4h after dose normal lab value (5-15mg/ml) neuro alterations with frontal lobe damage - Broca's speech, reasoning, emotions, morals, judgement, attention, organization, expressive langue, awareness, problem solving, planning, abstraction, mental flexibility neuro alterations with parietal lobe damage - interpretation of : spacial perception, touch, pressure identification of size, and memory neuro alterations with temporal lobe damage - Wernicke's area, hearing, understanding, sensory speech, langue, sequencing, communication, memory neuro alteration occipital lobe damage - visual processes and interpretation of everything we see: shapes, color, movement neuro alterations limbic system - ALZ & Parkinsons memory detects fear perceives bowel & bladder HR sleep wake neuro alteration madulla oblongata - breathing vitals neuro alteration cerebellum - balance coordination decorticate - hand and feet in (flexion) classic sign of non functioning cortex Decerebrate - extension arms stiff and extended legs brain lesion on brain stem Babinski reflex - abnormal for adults dorsiflexion of big toe with extension of other toes up to shin causes: spinal cord injury or lesion on spine, ALS, possibly meningitis pernicious anemia, rabies corneal reflex (loss of) - loss of blink reflex damage of or loss of CN V gag reflex (loss of) - damage to CN 9&10 brain injury diffuse axonal - shaking or strong rotation of head shaken baby or car accident concussion - GSW, blunt hit, car accident traumatic brain injury contusion - bruising, bleeding on brain Coup-contercoup injury - whip lash, contusion slam into opposite side of skull from impact abusive head trauma - aka shaken baby syndrome. caused by vigorous shaking leading to subdural hemorrhage (tearing of briding veins) and retinal hemorrhages. Locked-in syndrome - Individual is aware and capable of thinking but is paralyzed and cannot communicate only eyes move open head injury - penetrating dura closed head injury - caused by outside force focal injury - specific location, precise epidural vs subdural diffuse - wide spread injury to many reasons sheering white matter example: meningitis encephalitis monitor for in diffuse injury to prevent seizure - Swelling = diabetes insipidus (polyuria 24-48h) complication of hypothalamus from increased ICP from swelling after TBI Epidural hemorrhage - collection of blood between the dura mater and the skull immediate medical treatment for injury to head with what S&S - confusion, dizziness, drowsiness, HA, N/V (MVA, sports accident, fall, abuse) Epsilateral pupil - uncal herniation with pressure to CN 3 enlarged pupil in one eye-same side as hemorrhage classic signs of this: LOC, alert, rapid deterioration back to loss of consciousness subdural hemorrhage - ou