NSG 4100- E3 CARDIAC QUESTIONS AND ANSWERS A+ GRADED. Buy Quality Materials!

NSG 4100- E3 CARDIAC QUESTIONS AND ANSWERS A+ GRADED. Buy Quality Materials! CVP (central venous pressure) Normal: 2-6 mmHg (or 8-12cm H2O) Measure of pressure in vena cava/R. Atrium. Estimation of preload and R. Atrial pressure 6 = Fluid overload = lasix tx 2 = Hypovolemia = Infuse volume/blood Pulmonary artery pressure(Swan-Ganz) Pressure sensor via catheter in the artery b/w heart and lungs Dx HF, shock etiology, response to medical interventions Red Flag: Ensure that balloon is deflated after measuring pulmonary artery wedge pressure to ensure the catheter has returned to its normal position. Verified by evaluating pulmonary artery pressure waveform on bedside monitor. Intra-Arterial Blood Pressure Obtain direct and continuous BP in critical pts with sever hypo or hypertension. Thin hollow tube placed in artery on wrist/groin/etc. ABG and blood samples only, no fluids/meds. Sterile procedure. Concerned with CLABSI 72-96hrs with line . Risks= pneumothorax. get CXR post insertion esp. with superior vena cava insertion Pressure bag priming must be accurate before spiking bag. Intra-Arterial Blood Pressure Nsg Interventions Wash hands with soap/water ir EtOH based hand rub before/after contact with the catheter Cleanse skin with CHG Cover with sterile gauze/sterile transparent semipermeable dressing. Change gauze Q2days, transparent Q7days, or PRN if soiled/damp/loose. No topical Abx/creams No dextrose in system Assess Cath. site during dressing change/palpation through intact dressing Remove dressing ifs tender, fever, or sx of local or blood infection Replace system Q96hrs or pre facility policy Do not submerge in water when bathing, shower shield when showering Edu pt to report any new discomforts to Cath. site. Phlebostatic Axis An external landmark that is the intersection of two imaginary lines drawn on the chest used to position the zero reference on the transducer level with the atria Measurements can be taken at 0, 30, 60 degrees and transducer must be repositioned after each position change. Complications in Hemodynamic monitoring Pneumothorax Infection = CLABSI- lab-confirmed bloodstream infection not related to an infection at another site that dev. w/in 48hrs of central line placement. Air embolism cardiac conduction system P wave: electrical impulse starting in SA node , spreading through atria (atrial depolarization) PR Interval: beginning of P wave to beginning of QRS complex; atrial depolarization, conduction through AV node before ventricular depolarization QRS Complex: ventricular depolarization (contracting) ST segment: end of QRS complex to beginning of T wave; ventricular repolarization T wave: ventricular repolarization (resting) QT interval: beginning of QRS complex to end of T wave; total time for ventricular depolarization and repolarization Sinus Rhythm strip SNS Effect on Hemodynamics Catecholamines released increase HR - increase conduction speed/strength/quicker relaxation. Meds that cause: Bronchodilators like Albuterol, Vasopressors, Atropine ANS Effect on Hemodynamics Decrease HR - decreased action potential speed/contraction Causes: - Vagal maneuver -Drugs: Procainamide, A-Blockers, B-Blockers, Amiodarone, Sotalol Sinus Tachycardia 100 bpm but 120 PR Interval = 0.12-0.20sec Sympathetic activation and decreased Parasymp. activity Compensatory response to increase demand for CO/SV Etiology: -Fever, Hyperthyroidism, Hypoxia, Anxiety, blood loss, increased metabolism, low BP, pain Dx: EKG Sinus Tachycardia Strip Sinus Tachycardia Nrsg Interventions Assess and tx cause Vagal stim. = bearing down Withhold drugs which cause tachycardia = Atropine Monitor for hemodynamic instability Sinus Tachycardia Med. Mgmt Determined by severity of sx and directed and ID-ing/removing the cause Synchronized Cardioversion = low energy (30-60joules) shock synchronized to the QRS complex [tx of choice] Ca Channel Blocker: Adenosine -decreased Ca in SA and AV nodes = decreased HR and AV conduction B-Adrenergic Blockers: Sotalol , Popranolol -decreased adrenaline, blocks SNS, decrease BP Sinus Bradycardia 60 bpm -Slowed impulse generated by the sinus node SA is the heart's pacemaker with normal rate at 60-100BPM, AV rate is 40-60BPM -Not tx-ed if pt is asymptomatic Interpretation Characteristics • Rate: Less than 60 bpm • Rhythm: Regular • QRS Shape: Normal • P Wave: Normal and Consistent Shape, always infront of QRS • PR Interval: 0.12-0.20 seconds Sinus Bradycardia Etiology - Increased parasympathetic activity - Lower metabolic needs: Sleep, Physically Trained Individuals (lowered O2 demands d/t peak body performance), hypothyroid - Vagal stimulation: vomiting, suctioning - Drugs: Ca Channel blockers (Amiodarone, Nifedipine) Beta blockers (-lol), Lithium, Histamine blockers, Anti-Depression Drugs, NM blockers, Amphetamines. -Atropine is 1st line tx for tachycardia but may cause bradycardia - Increased Stroke Volume (volume of blood ejected with contraction) - HTN Sinus Bradycardia Treatment -ID cause, stop vagal maneuver, Hold Rate Slowing Drugs (Digoxin, Beta Blockers), -Stop Valsalva Maneuver Medications: - Adrenergic Receptor (Epinephrine) - Anticholinergic (Atropine): IV bolus, repeated Q3-5 min until max dose of 3 mg given - Emergency Transcutaneous Pacing (if meds don't work): delivering pulses of electric current through the patient's chest, stimulating the heart to contract (Temporary till pacemaker placed) Atrial Fibrillation (A-Fib) • Atrial depolarization are blocked at the AV Node, with a few reaching the ventricles and initiating ventricular contractions. • Causes atria to quiver rather than contract forcefully. • Completely disorganized and irregular atrial rhythm accompanied by an irregular ventricular rhythm of variable rate.