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CASAL II OA Questions And Answers Graded A
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CASAL II OA Questions And Answers Graded A
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CASAL II OASA node ANSWER- pacemaker, 60-100bpm,Depolarization R atria, p wave,
AV node ANSWER- Gatekeeper, intraseptal, Allows delay for blood so no back up, 40-
60 bpm
Bundle of His ANSWER- Intraventricular, 40-60bpm, sends to purkinje fibers for
ventricular depolarization
L and R bundle branches ANSWER- 20-40bpm,
Purkinje fibers ANSWER- 20-40bpm, ventricular depolarization (QRS) complex
Preload ANSWER- LVEDP determined by LVEDV
Afterload ANSWER- Vascular resistance
Cardiac output = ANSWER- heart rate x stroke volume
Normal QRS complex ANSWER- 0.06-0.12 sec. (1.5-3 small boxes)
P wave ANSWER- atrial depolarization
QRS complex ANSWER- ventricular depolarization
T wave ANSWER- ventricular repolarization
U wave ANSWER- hypokalemia, depolarization purkinje fibers
A Fib on EKG ANSWER- 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 ANSWER- the volume of blood pumped out by a ventricle with each
heartbeat
Cardiac output ANSWER- Amount of blood pumped through body per min
3 things that affect stroke volume ANSWER- preload, afterload, contractility
,What increases vascular resistance ANSWER- pHTN (R❤️), vasoconstriction/HTN (L❤️),
aortic stenosis (L ventricle)
What can decrease afterload ANSWER- Vasodilation
Sympathomemetics/ adrenergic agonist ANSWER- Dopamine ⬆️ BP & CO
norepinephrine ⬆️ BP
epinephrine ⬆️Bronchodilation
beta 2 adrenergic agonist -inhaled for cold/asthma albuterol (short)
solmedrol (long)
Sympatholytic/ andrenergic antagonist ANSWER- Beta blockers ⬇️ HR, ⬇️BP, constrict
airway
Parasympatholytic/anticholenergic ANSWER- Airway: Ipratropium bronchodilator
HR: Atropine ⬆️HR or dilate pupils
nonselective beta blockers
beta 1 ❤️Kidneys
beta 2 lungs, GI, vascular muscle, skeletal ANSWER- propranolol, timolol, nadolol,
pindolol, carvidolol
Nursing implications non selective Beta blocker ANSWER- Not for: COPD, asthma,
PVD
Selective Beta blockers ANSWER- Atenolol, esmolol, metoprolol
beta 1 found in ❤️And kidneys-blocks RAAS
Beta blockers treat ANSWER- HTN, stable angina, dysthymia (SVT, tachy),
compensated heart failure, glaucoma, migraines, tremors, anxiety
Monitor with beta blockers ANSWER- -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 ANSWER- Bradycardia
❤️Failure exacerbation
taper off-rebound htn/angina
ortho htn
know OD S&S
,blood glucose w/non selective
Calcium Channel Blockers ANSWER- blocks L type channels in:
vascular smooth muscle
cardiac myocytes
cardiac nodal tissue (SA & AV nodual tissue)
Calcium Channel Blockers (vascular selective) ANSWER- Dihydropyridines: "Pines"
amlodipine, felodipine, nifedipine
Mainly for HTN and angina
Calcium Channel Blockers-effects on vascular smooth muscle ANSWER- coronary and
peripheral arteries:
Vasodilation: decrease BP, relax coronary arteries, decrease SVR = decrease afterload
Calcium Channel Blockers-effects on myocytes ANSWER- decrease heart contraction
strength (- inrotropic effect)
decrease O2 demand
Treats angina-NOT for heart failure pt
Calcium Channel Blockers- effects on cardiac nodal tissue ANSWER- SA node-
decrease heart rate (neg chronotropic effect)
AV node- speed up conduction (positive dromotrophic)
treats arrhythmia: SVTs, Afib
Myocardial Selective Calcium Channel Blockers ANSWER- Non-Dihydropyridines
phenlalkylamines-Verapamil
benzothiazepine- Diltiasem
mainly for anti-arrhythmic htn/angina
Misc. treatment with Calcium Channel Blockers ANSWER- Rhanud's
migraines
cerebral spasms
Nursing Implications ANSWER- *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 ANSWER- 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 ANSWER- "Prils"
Captorpil, lisinopril, enalapril, quinipril, ramipril
Action of ACE inhibitor ANSWER- 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 ANSWER- decrease BP
decrease SVR
bradykinin available
decrease Na+ & H2O
increase K+
ACE inhibitor used to treat ANSWER- HTN
heart failure (systolic dysfunction)
Post MI
Nursing Implications ACE inhibitors ANSWER- 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 ANSWER- dry cough caused by bradykinin
Kussmaul respirations ANSWER- (hyperpnea)
seen in DKA
large tidal volume
increase in ventilatory rate with no expiratory pause
Cheyne-Stokes ANSWER- end of life
rapid breathing followed by apnea for 15-60 sec
ventilation that increases then decreases to apnea
hypoventilation ANSWER- inadequate alveolar
CO2 removal can't keep up with intake
hypercapneia
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