Summary review Notes for NR 341 Complex Adult Health (Chamberlain University)

SUMMARY REVIEW NOTES FOR NR 341 COMPLEX ADULT HEALTH (CHAMBERLAIN UNIVERSITY) EXAM PREPARATIONS COMPLEX ADULT HEALTH ->With EKG, impulses starts from the SA node, and passes via internodal pathways to the AV node, where it is sent through the bundle of HIS to the purkinje fibers where it causes ventricular depolarization (contraction). ->The SA node is the pacemaker, it depolarizes the atrium (contracts), beats at 60-100bpm, forms the Pwave. ->The AV node is the gate keeper wc beats at 40-60bpm, it causes a lil delay that allows all blood from the atrium to empty in to the ventricles. ->The BofHIS is located in the intraventriular septum, it contracts the ventricles causing the QRS complex and beats at 20-40bpm. ->The T-wave occurs when the ventricles relax or repolarizes. ->PR interval measures AV conduction time, wc is 0.12 – 0.20 secs. If not normal, it may represent a heart block. That is 3 to 5 small squares since 1 small square is 0.04 secs.PR interval starts from the beginning of a P wave to where the Q wave starts. ->The QRS complex is ventricular depolarizn wc is 0.06-1.2 sec ie 1.5 to 3 small boxes. ->In EKG strip, 30 large squares = 6 Secs cos a mini box is 0.04 secs. The width of a large box contains 5 mini boxes, meaning a large box is 0.04 * 5 = 0.20secs for a large box. When we pile 30 large boxes together, we get 6 secs. So, our 6 Secs strip has 30 boxes. ->To measure the HR using the 6 secs strip, just count the P or R waves within the 6sec strip or otherwise the 30 boxes and multiply by 10. ->Interpreting EKG’s require steps to follow ie 1. Any P waves present? If yes, how many are they in a 6secs strip? 2. Are the P-waves regular? 3.Are there R waves regular? Use a calibre or piece of paper to measure to see if their pattern and length is same. Eg with paper marker, mark the first 2, and move the paper across to see if they fall at the same place. 4. How many R waves ina 6 sec strip?, 5.What is the length of your PR interval and what is the width of your QRS complex? For example in tachy, your qrs is narrow and in V-tach, it is wide. ->If we analyze the 5 stuff in the 6sec strip and the rhytms are normal, rate btn 60-100, PRinterval btn 0.12-0.20 secs, and the QRS complex btn 0.06 and 0.12 secs it 1.5-3 boxes, we are looking at normal sinus rhythm. Normal QT interval is between .04 and 0.44 secs. Longer, it means ineffective ventricular repolarization. ->With A-fib, you cant determine the p-waves cos there are multiple little bumps that look like p-waves but they are actually fibrillatory or f-waves. R-waves will be present but irregular. If you do multiple strips, the HR will fluctuate a lot in afib. We cant determine the PR interval since the P-wave is undetermined, but the QRS interval is normal or <0.12 secs. So catch is no p-wave but rather f-waves. ->With A-flutter, Patient is in Afib mode too since no p-waves, wc are rather replaced by f-waves wc looks like saw tooth this time around. In afib the f-waves look like regular waves. The R-waves are present and mostly regular, qrs interval will be normal. So, catch is that the p-waves are absent and present as fibrillatory or f-waves that are saw tooth in appearance. ->With right bundle branch block, the electrical system on the right side of the heart is blocked at the level of the septum and the rest of the impulses are sent to the left side. Its identifier is that you see a doubled R-wave with one shorter than the other, before a t-wave comes. Caused by several factors like a MI, PE, myocarditis, uncontrolled htn etc. We will need a 12 lead ekg, qrs will be >0.12 sec, there will be a double R with 1 bigger than the other. Also, the S-wave deeps down instead being a lil neutral . ->In 1st degree AV block = PR interval abnormally long ie >0.20 secs and delivers impulses slowly to the QRS. It is obvious in well conditioned athletes and young folks. The P waves are present and regular ie same rhythm. R waves are present too and regular. So everything looks normal except for a long PR interval >0.20secs. ->In second degree type 1, also called a Wenckebach or Mobitz I. The P waves are present but slightly irregular in rhythm, R wave is present but also irregular and someR waves can be absent or dropped, PR interval is very wide, and presents as cyclic lengthening ie 2nd PR longer than the 1st, and third longer than the 2nd, then a dropped qrs occurs, and the cycle continues. ->In Second degree type II or Mobitz II, the P-waves are regular, the R waves are irregular since there are sudden dropped qrs complexes. There is no cyclic pattern of the PR waves and the PR is normal. ->In the 3rd degree heart block or a complete heart block, the atria and ventricles are not synced. As a result, you just have random p-waves and suddenly, you have a QRS complex. Here, the P wave and R wave will be regular, but just not occurring in a normal pattern. ->ABG normal values are PH=7.35-7.45. If under 7.35, its acidic and if over 7.45, it is a base. The PCO2=35-45. If under 35, it is alkalosis and if over 45, it is acidic. For HCO3=22-26. If under 22, it is acidic and if over 26, it’s a base. ->While using thetic tac mtd, if the 3 values are posted in each column, further look at the ph tosee what side it falls on eg a ph of 7.42 is normal but is getting towards alkalotic. Which ever element is on the alkalotic side too eg cos will thus be the determinant of why it is getting alcolotic. Eg a ph of 7.37, Pco2 of 33 and hco3 of 17 fills each column, but the ph of 7.37 is closer to the acidic side, meaning the hco3 is the determinant of its drive to the acidic side. This gives s metabolic acidosis fully compensated/ ->Whenever PH is normal, know that we are fully compensating. -> Heparin is administered by pump. Check aPTT or PTT. 2 nurse verifier needed. Don’t remove air bubble. ->Stress ulcers can be reduced with H2 inhibitors like famotidine wc reduce HCL vol in few hrs in stomach, but can cause confusion in older folks. Proton pump inhibitors PPIs like pantoprazole are also good, they take 24hrs. ->Sinus rhythm is when we have 1 P and 1 qrs simultaneously. 2nd qtion is “is the rate fast or slow? If P wave is between 3-5 large boxes, it’s a normal rate. Is it regular? How does the P waves and the R-waves look like? Is the qrs wide?