Podcast
Questions and Answers
Which of the following are NOT potential causes of Sinus Bradycardia?
Which of the following are NOT potential causes of Sinus Bradycardia?
- Valsalva maneuver
- Hypertension (correct)
- Increased Intracranial Pressure
- Hypothyroidism
In a patient with a rapid ventricular response and hemodynamic instability from Atrial Fibrillation, what is the initial intervention recommended in the provided text?
In a patient with a rapid ventricular response and hemodynamic instability from Atrial Fibrillation, what is the initial intervention recommended in the provided text?
- Perform a synchronized cardioversion (correct)
- Administer amiodarone
- Administer beta-blockers and calcium channel blockers
- Seek expert consultation
What is the typical atrial firing rate in Atrial Fibrillation?
What is the typical atrial firing rate in Atrial Fibrillation?
- 60-100 beats per minute
- 101-180 beats per minute
- 300-600 beats per minute (correct)
- 160-200 beats per minute
Which of the following medications is NOT mentioned as a treatment for Sinus Tachycardia?
Which of the following medications is NOT mentioned as a treatment for Sinus Tachycardia?
What is the most common cause of Sinus Tachycardia?
What is the most common cause of Sinus Tachycardia?
What is the primary goal of treatment for Atrial Fibrillation?
What is the primary goal of treatment for Atrial Fibrillation?
Which of the following treatments is MOST likely to be effective in treating symptomatic Sinus Bradycardia, if Atropine is ineffective?
Which of the following treatments is MOST likely to be effective in treating symptomatic Sinus Bradycardia, if Atropine is ineffective?
Which of the following is NOT specified as a potential trigger for Supraventricular Tachycardia (SVT)?
Which of the following is NOT specified as a potential trigger for Supraventricular Tachycardia (SVT)?
A patient is experiencing ventricular tachycardia with a heart rate of 180 bpm. They are awake and responsive. What is the priority nursing intervention?
A patient is experiencing ventricular tachycardia with a heart rate of 180 bpm. They are awake and responsive. What is the priority nursing intervention?
Which of the following is NOT a vagal maneuver used to terminate SVT?
Which of the following is NOT a vagal maneuver used to terminate SVT?
Which of the following conditions is characterized by a rate of 101-180 bpm, with P waves present but potentially difficult to identify at higher rates?
Which of the following conditions is characterized by a rate of 101-180 bpm, with P waves present but potentially difficult to identify at higher rates?
What is the initial expected finding in the suction control chamber of a chest tube drainage system?
What is the initial expected finding in the suction control chamber of a chest tube drainage system?
A patient with a chest tube has continuous vigerous bubbling in the water-seal chamber. What is the most likely cause?
A patient with a chest tube has continuous vigerous bubbling in the water-seal chamber. What is the most likely cause?
Which of the following conditions is considered a compensatory mechanism and does not typically require treatment?
Which of the following conditions is considered a compensatory mechanism and does not typically require treatment?
A patient is experiencing atrial fibrillation. What is the priority assessment?
A patient is experiencing atrial fibrillation. What is the priority assessment?
Which of the following are NOT typically used in the treatment of Atrial Fibrillation?
Which of the following are NOT typically used in the treatment of Atrial Fibrillation?
A patient is experiencing chest tube drainage that is excessive and continuous. What is the priority nursing action?
A patient is experiencing chest tube drainage that is excessive and continuous. What is the priority nursing action?
Which of the following is NOT a common symptom of Sinus Bradycardia?
Which of the following is NOT a common symptom of Sinus Bradycardia?
Which of the following breathing patterns is most likely to be seen in a patient at the end of life?
Which of the following breathing patterns is most likely to be seen in a patient at the end of life?
Which of the following medications is NOT typically used for long-term management of SVT?
Which of the following medications is NOT typically used for long-term management of SVT?
Which of the following conditions is most likely to be seen in athletes due to enhanced vagal tone?
Which of the following conditions is most likely to be seen in athletes due to enhanced vagal tone?
What is the most likely cause of a patient experiencing ventricular fibrillation?
What is the most likely cause of a patient experiencing ventricular fibrillation?
What is the priority nursing action for a patient experiencing pulseless ventricular tachycardia?
What is the priority nursing action for a patient experiencing pulseless ventricular tachycardia?
Which of the following interventions should be implemented first for a patient experiencing asystole?
Which of the following interventions should be implemented first for a patient experiencing asystole?
A patient with a chest tube has tidaling in the water-seal chamber. What does this indicate?
A patient with a chest tube has tidaling in the water-seal chamber. What does this indicate?
What is the priority intervention for a patient experiencing unstable ventricular tachycardia?
What is the priority intervention for a patient experiencing unstable ventricular tachycardia?
Which of the following medications is commonly used to treat polymorphic ventricular tachycardia?
Which of the following medications is commonly used to treat polymorphic ventricular tachycardia?
What is the priority nursing action if a chest tube becomes disconnected?
What is the priority nursing action if a chest tube becomes disconnected?
Which of the following breathing patterns is characterized by periods of apnea and irregular breaths with varying depths?
Which of the following breathing patterns is characterized by periods of apnea and irregular breaths with varying depths?
What is the priority nursing action when preparing a client for extubation?
What is the priority nursing action when preparing a client for extubation?
What is the primary goal of medications used to treat Supraventricular Tachycardia (SVT)?
What is the primary goal of medications used to treat Supraventricular Tachycardia (SVT)?
Which of the following is NOT a common lifestyle modification recommended for managing SVT?
Which of the following is NOT a common lifestyle modification recommended for managing SVT?
What is the most common dysrhythmia associated with high morbidity and mortality rates?
What is the most common dysrhythmia associated with high morbidity and mortality rates?
What is the primary concern with Atrial Fibrillation (Afib) related to blood clots?
What is the primary concern with Atrial Fibrillation (Afib) related to blood clots?
Which of the following is NOT a potential risk factor for developing Atrial Fibrillation (Afib)?
Which of the following is NOT a potential risk factor for developing Atrial Fibrillation (Afib)?
Which of the following medications is NOT typically used for rate control in Atrial Fibrillation (Afib)?
Which of the following medications is NOT typically used for rate control in Atrial Fibrillation (Afib)?
What is the purpose of electrical cardioversion in the treatment of Atrial Fibrillation (Afib)?
What is the purpose of electrical cardioversion in the treatment of Atrial Fibrillation (Afib)?
Which of the following is NOT a commonly prescribed direct oral anticoagulant (DOAC) for preventing stroke in Atrial Fibrillation (Afib)?
Which of the following is NOT a commonly prescribed direct oral anticoagulant (DOAC) for preventing stroke in Atrial Fibrillation (Afib)?
What is the primary goal of catheter ablation in the treatment of Atrial Fibrillation (Afib)?
What is the primary goal of catheter ablation in the treatment of Atrial Fibrillation (Afib)?
What is the characteristic electrical pattern seen on an EKG during Atrial Flutter?
What is the characteristic electrical pattern seen on an EKG during Atrial Flutter?
What is a common cause of both Atrial Flutter and Atrial Fibrillation?
What is a common cause of both Atrial Flutter and Atrial Fibrillation?
Which of the following is NOT a potential consequence of Atrial Flutter?
Which of the following is NOT a potential consequence of Atrial Flutter?
What is the characteristic feature of Ventricular Tachycardia (VTach) on an EKG?
What is the characteristic feature of Ventricular Tachycardia (VTach) on an EKG?
Which of the following is NOT a common treatment option for Ventricular Tachycardia (VTach)?
Which of the following is NOT a common treatment option for Ventricular Tachycardia (VTach)?
What is the mechanism of action of magnesium sulfate in the treatment of asthma?
What is the mechanism of action of magnesium sulfate in the treatment of asthma?
Which of the following medications is used as a first-line bronchodilator for an acute asthma attack?
Which of the following medications is used as a first-line bronchodilator for an acute asthma attack?
Which of the following is a potential complication of heparin therapy?
Which of the following is a potential complication of heparin therapy?
What is the most common clinical presentation of a pulmonary embolism (PE)?
What is the most common clinical presentation of a pulmonary embolism (PE)?
Which of the following diagnostic tests is used to confirm the diagnosis of a pulmonary embolism?
Which of the following diagnostic tests is used to confirm the diagnosis of a pulmonary embolism?
What is the priority nursing intervention for a patient with status asthmaticus?
What is the priority nursing intervention for a patient with status asthmaticus?
Which of these is NOT a possible intervention for a patient with a pulmonary embolism?
Which of these is NOT a possible intervention for a patient with a pulmonary embolism?
What is the expected partial thromboplastin time (PTT) range in a patient receiving heparin therapy?
What is the expected partial thromboplastin time (PTT) range in a patient receiving heparin therapy?
Which of the following conditions is characterized by chronic leg swelling, pain, and skin changes after a deep vein thrombosis (DVT)?
Which of the following conditions is characterized by chronic leg swelling, pain, and skin changes after a deep vein thrombosis (DVT)?
What type of medication is commonly prescribed for venous thromboembolism (VTE) prevention?
What type of medication is commonly prescribed for venous thromboembolism (VTE) prevention?
Which of the following is a risk factor for developing a pulmonary embolism (PE)?
Which of the following is a risk factor for developing a pulmonary embolism (PE)?
What does the P wave represent in an EKG?
What does the P wave represent in an EKG?
Which of the following is an example of a systemic corticosteroid used in the treatment of asthma?
Which of the following is an example of a systemic corticosteroid used in the treatment of asthma?
What is the normal duration of the PR interval in an EKG?
What is the normal duration of the PR interval in an EKG?
What is the mechanism of action of anticholinergics in the treatment of asthma?
What is the mechanism of action of anticholinergics in the treatment of asthma?
What is the main reason for inserting a chest tube into a patient?
What is the main reason for inserting a chest tube into a patient?
What condition is often indicated by the presence of U waves on an EKG?
What condition is often indicated by the presence of U waves on an EKG?
Which of the following is NOT a sign or symptom of hypoxia?
Which of the following is NOT a sign or symptom of hypoxia?
Which of the following indicates a normal QRS complex duration?
Which of the following indicates a normal QRS complex duration?
Atrial flutter is characterized by which pattern on an EKG?
Atrial flutter is characterized by which pattern on an EKG?
What is the most appropriate nursing intervention for a patient with a PE who develops respiratory distress?
What is the most appropriate nursing intervention for a patient with a PE who develops respiratory distress?
What does a prolonged PR interval potentially indicate?
What does a prolonged PR interval potentially indicate?
Which interval on the EKG represents the time it takes for the ventricles to depolarize and repolarize?
Which interval on the EKG represents the time it takes for the ventricles to depolarize and repolarize?
What is a potential characteristic feature of Brady dysrhythmias regarding the EKG reading?
What is a potential characteristic feature of Brady dysrhythmias regarding the EKG reading?
Which of the following conditions may cause respiratory acidosis?
Which of the following conditions may cause respiratory acidosis?
Which of the following is a common laboratory finding in respiratory acidosis?
Which of the following is a common laboratory finding in respiratory acidosis?
What is the primary goal of treatment for respiratory acidosis?
What is the primary goal of treatment for respiratory acidosis?
Which of the following is a sign or symptom of respiratory acidosis?
Which of the following is a sign or symptom of respiratory acidosis?
What is the typical respiratory rate in a patient with respiratory acidosis?
What is the typical respiratory rate in a patient with respiratory acidosis?
Which of the following is a potential cause of respiratory alkalosis?
Which of the following is a potential cause of respiratory alkalosis?
What EKG change is most likely to be seen in a patient experiencing metabolic alkalosis?
What EKG change is most likely to be seen in a patient experiencing metabolic alkalosis?
Which of the following laboratory findings is characteristic of respiratory alkalosis?
Which of the following laboratory findings is characteristic of respiratory alkalosis?
Which of the following conditions is characterized by a regular rhythm with a rate of 150-250 bpm and may have a P wave hidden or difficult to identify?
Which of the following conditions is characterized by a regular rhythm with a rate of 150-250 bpm and may have a P wave hidden or difficult to identify?
Which of the following EKG patterns is most likely to be seen in a patient with severe hyperkalemia?
Which of the following EKG patterns is most likely to be seen in a patient with severe hyperkalemia?
Which of the following is a common clinical manifestation of respiratory alkalosis?
Which of the following is a common clinical manifestation of respiratory alkalosis?
Which of the following EKG findings is typically seen in a patient with Atrial Flutter?
Which of the following EKG findings is typically seen in a patient with Atrial Flutter?
What is a potential complication of respiratory alkalosis?
What is a potential complication of respiratory alkalosis?
Which of the following conditions is the most common cause of a prolonged QT interval?
Which of the following conditions is the most common cause of a prolonged QT interval?
What is the most important nursing intervention for a patient with respiratory alkalosis?
What is the most important nursing intervention for a patient with respiratory alkalosis?
Which of the following is a characteristic of Ventricular Tachycardia (VT)?
Which of the following is a characteristic of Ventricular Tachycardia (VT)?
Which of the following medications might be used to treat respiratory alkalosis?
Which of the following medications might be used to treat respiratory alkalosis?
What is a potential risk factor for a patient with respiratory alkalosis?
What is a potential risk factor for a patient with respiratory alkalosis?
Which of the following conditions is known as a 'complete heart block'?
Which of the following conditions is known as a 'complete heart block'?
What EKG change is most commonly seen in a patient with respiratory alkalosis?
What EKG change is most commonly seen in a patient with respiratory alkalosis?
Which of the following is a key nursing intervention for managing DVT?
Which of the following is a key nursing intervention for managing DVT?
Which of the following is a sign of post-thrombotic syndrome (PTS)?
Which of the following is a sign of post-thrombotic syndrome (PTS)?
A patient with a history of heart disease presents with a rapid, irregular rhythm and absent P waves on their EKG. Which of the following conditions is most likely?
A patient with a history of heart disease presents with a rapid, irregular rhythm and absent P waves on their EKG. Which of the following conditions is most likely?
Which of the following conditions is often seen in athletes due to increased vagal tone?
Which of the following conditions is often seen in athletes due to increased vagal tone?
What is the primary role of a nurse in managing anticoagulant therapy for a patient with DVT?
What is the primary role of a nurse in managing anticoagulant therapy for a patient with DVT?
A patient presents with a prolonged PR interval on their EKG. Which of the following conditions is most likely?
A patient presents with a prolonged PR interval on their EKG. Which of the following conditions is most likely?
Which of the following conditions is characterized by a sawtooth pattern on the EKG?
Which of the following conditions is characterized by a sawtooth pattern on the EKG?
A patient with a regular rhythm and a heart rate of 120 bpm has a P wave for every QRS complex. Which of the following conditions is most likely?
A patient with a regular rhythm and a heart rate of 120 bpm has a P wave for every QRS complex. Which of the following conditions is most likely?
Which of the following conditions is characterized by a completely irregular rhythm with absent P waves?
Which of the following conditions is characterized by a completely irregular rhythm with absent P waves?
A patient with a regular rhythm and a heart rate of 200 bpm has wide, bizarre QRS complexes on their EKG. Which of the following conditions is most likely?
A patient with a regular rhythm and a heart rate of 200 bpm has wide, bizarre QRS complexes on their EKG. Which of the following conditions is most likely?
What is the primary mechanism of compensation in respiratory alkalosis?
What is the primary mechanism of compensation in respiratory alkalosis?
Which of the following is NOT a common cause of metabolic acidosis?
Which of the following is NOT a common cause of metabolic acidosis?
What is the typical presentation of Kussmaul respirations?
What is the typical presentation of Kussmaul respirations?
Which conditions can lead to metabolic alkalosis due to loss of hydrochloric acid through the kidneys?
Which conditions can lead to metabolic alkalosis due to loss of hydrochloric acid through the kidneys?
Which of the following is NOT typically associated with metabolic alkalosis?
Which of the following is NOT typically associated with metabolic alkalosis?
What is the typical blood pH in metabolic alkalosis?
What is the typical blood pH in metabolic alkalosis?
Which of the following conditions can cause lactic acidosis?
Which of the following conditions can cause lactic acidosis?
What is the primary goal of treatment for metabolic acidosis?
What is the primary goal of treatment for metabolic acidosis?
What is the most significant EKG finding associated with respiratory acidosis?
What is the most significant EKG finding associated with respiratory acidosis?
Which of the following is a potential treatment for metabolic alkalosis?
Which of the following is a potential treatment for metabolic alkalosis?
What is the typical bicarbonate level in metabolic acidosis?
What is the typical bicarbonate level in metabolic acidosis?
Which of the following statements is TRUE regarding potassium imbalances and acid-base disorders?
Which of the following statements is TRUE regarding potassium imbalances and acid-base disorders?
What is the characteristic EKG finding associated with hypokalemia?
What is the characteristic EKG finding associated with hypokalemia?
What is the typical breathing pattern seen in respiratory acidosis?
What is the typical breathing pattern seen in respiratory acidosis?
Which of the following medications can lead to metabolic alkalosis?
Which of the following medications can lead to metabolic alkalosis?
Flashcards
P wave
P wave
Represents depolarization of the atria, lasting 0.06-0.12 seconds.
PR interval
PR interval
Duration from the start of the P wave to the QRS complex, lasting 0.12-0.20 seconds.
QRS complex
QRS complex
Indicates depolarization of ventricles, lasting less than 0.12 seconds, with atrial repolarization hidden.
T wave
T wave
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QT interval
QT interval
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U wave
U wave
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Atrial flutter
Atrial flutter
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Assessing EKG
Assessing EKG
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Synchronized Cardioversion
Synchronized Cardioversion
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Atrial Fibrillation
Atrial Fibrillation
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Rapid Ventricular Response (RVR)
Rapid Ventricular Response (RVR)
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Sinus Bradycardia
Sinus Bradycardia
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Sinus Tachycardia
Sinus Tachycardia
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Supraventricular Tachycardia (SVT)
Supraventricular Tachycardia (SVT)
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Normal Sinus Rhythm
Normal Sinus Rhythm
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Atrial Rate in A-Fib
Atrial Rate in A-Fib
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PR Interval in A-Fib
PR Interval in A-Fib
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Risks of A-Fib
Risks of A-Fib
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Vagal Maneuvers
Vagal Maneuvers
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Medications for RVR
Medications for RVR
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Amiodarone Usage
Amiodarone Usage
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Causes of Sinus Bradycardia
Causes of Sinus Bradycardia
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Complications of Bradycardia
Complications of Bradycardia
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Asthma monitoring
Asthma monitoring
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SABA
SABA
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Systemic corticosteroids
Systemic corticosteroids
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Anticholinergics
Anticholinergics
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Magnesium sulfate
Magnesium sulfate
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Heliox
Heliox
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Epinephrine
Epinephrine
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Pulmonary embolism (PE)
Pulmonary embolism (PE)
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PE symptoms
PE symptoms
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Diagnosing PE
Diagnosing PE
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Heparin administration
Heparin administration
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Post-Thrombotic Syndrome (PTS)
Post-Thrombotic Syndrome (PTS)
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Chronic Venous Insufficiency (CVI)
Chronic Venous Insufficiency (CVI)
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Disseminated Intravascular Coagulation (DIC)
Disseminated Intravascular Coagulation (DIC)
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SVT
SVT
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Pulse Deficit
Pulse Deficit
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A-Fib RVR
A-Fib RVR
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Stroke Risk in A-Fib
Stroke Risk in A-Fib
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Rate Control
Rate Control
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Rhythm Control
Rhythm Control
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Anticoagulants
Anticoagulants
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Left Atrial Appendage Closure
Left Atrial Appendage Closure
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Catheter Ablation
Catheter Ablation
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Ventricular Tachycardia
Ventricular Tachycardia
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PVC
PVC
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Lifestyle Modifications
Lifestyle Modifications
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Triggers of SVT
Triggers of SVT
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Respiratory Alkalosis
Respiratory Alkalosis
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Compensatory Mechanism
Compensatory Mechanism
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Ketoacidosis
Ketoacidosis
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Uremia
Uremia
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Salicylate Poisoning
Salicylate Poisoning
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Lactic Acidosis
Lactic Acidosis
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Kussmaul Respirations
Kussmaul Respirations
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Metabolic Alkalosis
Metabolic Alkalosis
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Hypokalemia
Hypokalemia
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Hyperkalemia
Hyperkalemia
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T-Wave Changes
T-Wave Changes
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Diuretic Use
Diuretic Use
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Electrolyte Imbalance
Electrolyte Imbalance
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Intravenous Fluids
Intravenous Fluids
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Metabolic Acidosis
Metabolic Acidosis
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Diabetic Ketoacidosis (DKA)
Diabetic Ketoacidosis (DKA)
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EKG Changes in Acidosis
EKG Changes in Acidosis
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Hypokalemia in Alkalosis
Hypokalemia in Alkalosis
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Atrial Fibrillation (AFib)
Atrial Fibrillation (AFib)
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Ventricular Tachycardia (VT)
Ventricular Tachycardia (VT)
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Ventricular Fibrillation (VFib)
Ventricular Fibrillation (VFib)
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First Degree Heart Block
First Degree Heart Block
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Second Degree Heart Block (Wenckebach)
Second Degree Heart Block (Wenckebach)
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Third Degree Heart Block
Third Degree Heart Block
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Bigeminy
Bigeminy
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Trigeminy
Trigeminy
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Ventricular Tachycardia (VTach)
Ventricular Tachycardia (VTach)
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Asystole
Asystole
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Defibrillation
Defibrillation
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Cardioversion
Cardioversion
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Hypotension
Hypotension
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Pulmonary Edema
Pulmonary Edema
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Suctioning
Suctioning
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Tidaling
Tidaling
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Subcutaneous Emphysema
Subcutaneous Emphysema
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Respiratory Distress
Respiratory Distress
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Cheyne-Stokes Breathing
Cheyne-Stokes Breathing
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DVT Assessment
DVT Assessment
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DVT Risk Factors
DVT Risk Factors
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DVT Prevention
DVT Prevention
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Signs of PE
Signs of PE
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Respiratory Acidosis
Respiratory Acidosis
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Causes of Respiratory Acidosis
Causes of Respiratory Acidosis
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Symptoms of Respiratory Acidosis
Symptoms of Respiratory Acidosis
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Causes of Respiratory Alkalosis
Causes of Respiratory Alkalosis
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Symptoms of Respiratory Alkalosis
Symptoms of Respiratory Alkalosis
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Assessment for PE
Assessment for PE
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Laboratory Findings in Respiratory Acidosis
Laboratory Findings in Respiratory Acidosis
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Laboratory Findings in Respiratory Alkalosis
Laboratory Findings in Respiratory Alkalosis
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Psychosocial Support
Psychosocial Support
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Study Notes
EKG Interpretation
- P wave: Depolarization of atria (0.06-0.12 seconds).
- PR interval: Time from P wave onset to QRS onset (0.12-0.20 seconds), atria depolarization and conduction to ventricles.
- QRS complex: Ventricular depolarization (and atrial repolarization), less than 0.12 seconds.
- ST segment: Ventricular repolarization early phase, from QRS end to T wave start.
- T wave: Ventricular repolarization.
- QT interval: Time from QRS start to T wave end (0.34-0.43 seconds), ventricular depolarization and repolarization.
- U wave: Repolarization of Purkinje fibers; sometimes indicated by electrolyte imbalances (e.g., hypokalemia). Usually not a concern unless new, prominent, or associated with symptoms.
EKG Assessment
- P wave presence? Yes = sinus rhythm (SA node origin).
- P wave upright? Yes, then QRS for every P wave? Yes = normal conduction.
- Rhythm regularity? (P-P timing) Irregular may indicate A-fib or A-flutter.
- PR interval normal (0.12-0.20 seconds)? Prolonged may indicate a heart block or bradycardia.
- QRS timing (0.04-0.12 seconds)? Wide QRS suggests ventricular origin.
- Rate (R-R intervals): Gives ventricular rate.
Atrial Flutter
- Not from SA node; usually right atrium origin.
- No P waves; "sawtooth" flutter waves before QRS.
- Atrial rate is fast (>100 bpm); check ventricular rate.
- Associated with pulmonary disesases (COPD, hypertension), heart valve abnormalities, hyperthyroidism, and alcohol.
- Treatment: Expert consultation unless rapid ventricular response and hemodynamic instability; then synchronized cardioversion.
Atrial Fibrillation
-
Atria fire erratically from multiple ectopic sites.
-
No discernable P waves; irregularly irregular R-R intervals.
-
Ventricular rate varies; uncontrolled or rapid ventricular response (RVR) if >100 bpm.
-
Risk factors include cardiovascular disease, pulmonary disease, hypertension, hyperthyroidism, open heart surgery, alcohol, and sleep apnea.
-
Treatment:
- Stabilize if unstable (symptomatic or hypotensive); synchronized cardioversion or medications to slow ventricular response.
- Medications to slow ventricles: Beta-blockers, calcium channel blockers.
- Medication to convert rhythm: Amiodarone.
- Prevent clot formation (stroke, PE) with anticoagulation (Warfarin, DOACs).
- Long-term treatment: Medications and ablations.
Normal Sinus Rhythm (NSR)
-
Begins at the SA node (pacemaker).
-
Rate of 60-100 bpm.
-
Optimal cardiac output.
-
P wave for every QRS? Yes
-
PR interval < 0.20 seconds? Yes.
-
QRS < 0.12 seconds? Yes.
-
Causes for increased HR (>150 bpm): Anxiety, fever, hypovolemia, shock, requires treatment of the cause, not just the HR.
-
Symptoms: Dizziness, dyspnea, hypotension from reduced CO. Higher demand on heart.
Sinus Bradycardia
- Meets NSR criteria but with a rate < 60 bpm.
- Lower cardiac output and hypotension possible.
- Treatment:
- Treat underlying cause.
- Atropine (anticholinergic) every 3-5 minutes if symptomatic.
- Transcutaneous or endovascular pacing if atropine ineffective.
- Dopamine or epinephrine infusion.
- Permanent pacemaker.
Other Rhythms
- Ventricular Tachycardia (VT): Run of 3+ PVCs; monomorphic or polymorphic.
- Treatment: Treat underlying causes (electrolytes, MI); medications (lidocaine, procainamide, amiodarone); cardioversion. If unstable, defibrillate, CPR, epinephrine.
- Ventricular Fibrillation (VF): No discernable P or QRS waves; quivering ventricles.
- Treatment: Defibrillation, CPR, epinephrine, treat underlying cause.
- Asystole: No pulse; CPR, and treat underlying cause.
- First-degree Heart Block: Prolonged PR interval (>0.20 seconds).
- Second-degree Heart Block:
- Type I (Wenckebach): Gradual PR lengthening with dropped beat(s).
- Type II (Mobitz): No PR lengthening; dropped beat with ratio evaluation (p to QRS).
- Third-degree Heart Block ("Complete Heart Block"): Atrial and ventricular rhythms dissociated; paced with transcutaneous or permanent pacemaker.
Respiratory & Perfusion
- Ventilation and Intubation: Sedatives, analgesics, neuromuscular blockers.
- Extubation: Semi-Fowler's position; suction prior; pre-oxygenate patient.
- Suctioning: Pre-oxygenate patient.
- Breathing Patterns: Observe retractions, use of accessory muscles, tripod position, hyperventilation, tachypnea, bradypnea, Cheyne-Stokes.
- Chest Tube: Assess for continuous bubbling (suction), tidaling, excessive bubbling (air leak), subcutaneous emphysema.
- Interventions: Monitor drainage, vital signs, notify HCP, sterile technique during dressing changes, encourage coughing and deep breathing, spirometer, ROM exercises.
Asthma
- Monitoring: Vital signs, oxygen saturation, respiratory status.
- Medications:
- SABAs (Short-acting Beta-agonists): First-line; albuterol. Nebulizer or MDI.
- Systemic Corticosteroids: Reduce inflammation; prednisone, methylprednisolone, dexamethasone (IV preferred).
- Anticholinergics: Ipratropium bromide; nebulizer or MDI, often with SABAs.
- Magnesium Sulfate: Bronchodilator/anti-inflammatory; IV.
- Heliox: Reduces airway resistance. Mask or ventilator.
- Ketamine: Sedation and bronchodilation.
- Epinephrine: Life-threatening cases.
Pulmonary Embolism (PE)
- Presentation: Sudden chest pain, shortness of breath, cough, hemoptysis, rapid heart rate.
- Diagnosis: CTPA, V/Q scans, D-dimer.
- Treatment: Anticoagulants (blood thinners) to prevent further clot formation; thrombolytics (severe cases).
- Prevention: Early mobility, leg exercises, graduated compression stockings.
- Symptoms: Dyspnea, hypoxia, cough, tachypnea, chest pain, hemoptysis, crackles, wheezing, fever, tachycardia, syncope.
- Nursing care: Oxygen as needed; labs, diagnostic tests; clot-dissolving medications (monitor for heparin-induced thrombocytopenia).
Acid-Base Imbalance
- Respiratory Acidosis: Impaired ventilation, increased CO2. Causes (obstructions, depression).
- Respiratory Alkalosis: Hyperventilation, decreased CO2. Causes (anxiety, high altitudes).
- Metabolic Acidosis: Excess acid production or bicarbonate loss. Causes (DKA, lactic acidosis, renal failure, diarrhea).
- Metabolic Alkalosis: Loss of acid or excess bicarbonate. Causes (vomiting, diuretic use, antacid abuse).
- EKG changes with imbalances: Assess for hyperkalemia (acidosis) and hypokalemia (alkalosis); evaluate for widening QRS, inverted or peaked T waves (hyperkalemia), flattened T waves, ST depression, and U waves (hypokalemia).
Other Important Considerations
- Patient Prioritization: ABCs (Airway, Breathing, Circulation).
- NG Tube Suctioning: Monitor for dehydration, electrolyte imbalances, and aspiration.
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