Reading EKG Strips–Nur 105

sinus rhythm: normal sinus rhythm, sinus bradycardia, or sinus tachycardia

ventricular

60-100 (NSR or AJR) <60 (SB or JR) >100 (ST or JT)

sinus rhythm, sinus brady, sinus tach

junctional rhythm, next look at rate

1st degree heart block--type of rhythm with 1st degree heart block

ventricular tachycardia, ideoventricular, atrial flutter, fixed conduction

0.06-0.10

<3 little boxes

when you have a pulse

when you have no pulse

epinephrine, atropine

adenosine

fear, deficient knowledge, ineffective cardiac tissue perfusion, decreased cardiac output, impaired gas exchange, risk for imbalanced fluid volume, disturbed sensory perception, acute pain, ineffective tissue perfusion, ineffective thermoregulation

CVP: 0-4 wedge pressure: 8-15 PAP 20-30/5-15

massive left sided heart failure, full of fluid, pink frothy secretionstreatment: diuretics (lasix first line); if pt has renal failure (nitroglycerin and morphine)

a-flutter, sinus arrhythmia, 2 degree or 3 degree heart block, a-fib

tamponade, also massive JVD

model of pacemaker, type of generator, date and time of insertion, location of pulse generator, stimulation threshold, pacer settings (eg, rate, energy output, sensitivity, duration of interval between atrial and ventricular impulses)

risk factors: heart valve prosthesis, hx of heart disease (mitral valve prolapse), chronic dibilitatin disease, IV drug abuse and immunosuppression

friction rub, notched T waveS/S: fever, positional chest discomfort, nonspecific ST segment elevation, elevated ESR erythrocyte sedimentation rate, retrosternal pain that worsens during supine positioning, pulsus paradoxus

U waves after the T

tall QRS complexes

torsades de pointes

lidocaine, beta blockers, amiodarone (drug of choice for v-tac)

JVD, dependent edema, right upper gastric pain (right heart handles systemic blood return)

bibasilar fine crackles, dyspnea, tachycardia, S3 and S4 heart sounds, fatigue, hemoptysis, non-productive cough, cool pale skin, PMI displaces toward the left anterior axillary line

t-wave inversion: inadequate blood supplyST segment elevation: injury, prolonged ischemiapathological Q waves: are all signs of tissue hypoxia

hold if apical pulse is less than 60bpmdigitalis toxicity=vision changes (halos), dysrhythmia, anorexia, nausea, vomiting, headache, and malaiseincreases force of myocardial contraction and decreases HR

warfarin to prevent clots and decrease risk of stroke, digoxin to control HR

ST elevation indicates immediate myocardial injuryST depressions indicate myocardial ischemiaQ wave forms several days after a myocardial infarctionU wave is a sign of hypokalemia

IV push: give at a rate of 20mg/min or lessrapid injection can cause hearing loss as a result of ototoxicitynormal daily dose: 40mg loop diuretic

reduces oxygen consumption to reverse ischemia and relieve pain.

vasodilator mainly in veins and reduces blood return to heart and preload is reduced. may cause a significant drop in cardiac output and BP if pt is hypovolemic at higher doses

slows heart rate and decreases strength of contraction which decreases workload of heart. relaxes blood vessels decreasing BP and increases coronary artery perfusion

caused by strep

osler's nodes (red, painful nodules on the fingers and toes), splinter hemorrhages, fever, diaphoresis, joint pain, weakness, abdominal pain, new murmur, Janeway's lesions (small, hemorrhagic areas on fingers, toes, ear, and nose)

flu-like symptoms, fatigue, dyspnea, palpitations, and occasional discomfort in the chest and upper abdomen. may develop dysrhythmias, or ST-T wave changes. systolic murmur, gallop rhythm

promote vasodilation and diuresis by decreasing afterload and preload

left ventricular dysfunction. increases cardiac contractility.

at high doses, it also increases HR and incidence of ectopic beats and tachydysrhythmias. take care in pt with a-fib

4-8hrs, peaks 12-24hrs, and retunrs to normal 1-3 weeks

3-4hrs, peaks in 4-24hrs and returns to normal 1-3weeks

BUN, TSH, CBC, BNP

dyspnea, progressive fatigue, hemoptysis, paroxysmal nocturnal dyspnea, cough, wheeze, repeated respiratory infectionsdysrhythmias like a-fibtests doppler echocardiography

caused by inflammatory lesions that deform the leaflets of the aortic valve. also infective or rheumatic endocarditis, congenital abnormalities, diseases such as syphilis, dissecting aneurysm, blunt chest trauma, or valve replacement

forceful heartbeats in head and neck, arterial pulsations that are visible or palpable at the carotid or temporal arteries. exertional dyspnea, fatigue, progressive s/s of left ventricular failure including breathing difficulties, orthopnea, PND

take long term anticoagulant therapy, frequent follow up appointments and blood lab studies.

may need to take aspirin, prescribed medication teaching

life threatening need stat interventions, fullness within the chest, substantial or ill defined pain, sob, massive JVD, falling systolic blood pressure, narrowing pulse pressure, rising venous pressure (increased JVD) and distant heart sounds

pericardiocentesis, pericardiotomy (pericardial window)

70% occlusion (60% if in the left main), artery must be patent beyond the occlusion. use greater saphenous vein, lesser saphenous, cephalic and basilic veins