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NSG 4100- E3 Cardiac Exam Latest Update $10.99   Add to cart

Exam (elaborations)

NSG 4100- E3 Cardiac Exam Latest Update

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NSG 4100- E3 Cardiac Exam Latest Update...

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  • November 3, 2023
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  • 2023/2024
  • Exam (elaborations)
  • Questions & answers
  • NSG 4100- E3 Cardiac
  • NSG 4100- E3 Cardiac
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NSG 4100- E3 Cardiac Exam Latest Update


CVP (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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