Exam (elaborations)
NSG 4100- E3 Cardiac Exam Latest Update
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NSG 4100- E3 Cardiac Exam Latest Update...
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NSG 4100- E3 Cardiac Exam Latest UpdateCVP (central venous pressure) - ANSWER 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) - ANSWER 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 - ANSWER 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 - ANSWER 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 - ANSWER 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 - ANSWER 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 - ANSWER 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 - ANSWER
SNS Effect on Hemodynamics - ANSWER Catecholamines released increase HR ->
increase conduction speed/strength/quicker relaxation.
Meds that cause: Bronchodilators like Albuterol, Vasopressors, Atropine
ANS Effect on Hemodynamics - ANSWER Decrease HR -> decreased action
potential speed/contraction
Causes:
- Vagal maneuver
-Drugs: Procainamide, A-Blockers, B-Blockers, Amiodarone, Sotalol
Sinus Tachycardia - ANSWER >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 - ANSWER
Sinus Tachycardia Nrsg Interventions - ANSWER Assess and tx cause
Vagal stim. = bearing down
Withhold drugs which cause tachycardia = Atropine
Monitor for hemodynamic instability
Sinus Tachycardia Med. Mgmt - ANSWER 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 - ANSWER <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 - ANSWER - 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
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