Untitled Quiz

Insulin Peaks

• For short-acting insulin, check blood glucose around 1000-1100.
• For long-acting insulin, check blood glucose at regular intervals, no specific peak time to monitor.
• Check blood glucose 15 minutes after administration

Types of Insulin

• Rapid-acting insulin starts working in 5-10 minutes and peaks in 30-90 minutes.
• Regular/short-acting insulin starts working in 30 minutes to 1 hour and peaks in 2-5 hours.
• Intermediate-acting insulin starts working in 1-2 hours and peaks in 4-12 hours.
• Long-acting insulin starts working in 1-2 hours and has no peak.

Dressing Considerations

• Note the date and time when applying a new dressing.

Chest Tube Drainage System

• Monitor the drainage system.
• A water seal chamber acts as a one-way valve to let air out but not back in.
• Tidaling, with bubbles and pauses, is normal with breathing.
• Continuous bubbling may indicate an air leak.
• The suction control chamber, if ordered, is filled with sterile water or uses wall suction to pull out air and fluid.

Drainage Assessment

• Color, amount, consistency should be assessed
• Report drainage of more than 100 mL/hr of blood (post-op), sudden bright red, or cloudy/purulent drainage.
• Mark and time output on the chamber regularly.

Chest Tube Positioning

• Keep the drainage system upright and below chest level to promote drainage by gravity.
• Do not lift or clamp tubing unless ordered.

Dressing and Insertion Site Maintenance

• Keep the dressing occlusive (airtight), dry, and intact.
• Monitor for signs of infection: redness, swelling, drainage, and fever.
• Check for subcutaneous emphysema (air under the skin, feels like Rice Krispies).

Emergency Situations with Chest Tubes

• If the tube gets pulled out, immediately cover the site with a sterile occlusive dressing, taped on 3 sides to allow air to escape but not enter.
• If the system breaks, place the chest tube end in sterile water to create a temporary water seal.

Patient Care with Chest Tubes

• Encourage deep breathing, coughing, and incentive spirometry to help lung expansion.
• Reposition as needed, but don't clamp the tube unless ordered.

Equation

• Glucose plus oxygen yields carbon dioxide and water.

EKG

• Assess the patient and leads.

Signs and Symptoms

• Hypotension, shortness of breath (SOB), chest pain, altered mental status (AMS), changes in pulses, and capillary refill.

Sinus Rhythm EKG

• Normal heart rate is 60-100 bpm.
• Monitor the patient.

Sinus Bradycardia

• Heart rate is less than 60 bpm.
• Reasons heart rate may be low includes vagal stimulation, beta-blockers (meds), digoxin toxicity and increased ICP
• Notify the doctor, administer oxygen, and consider atropine or a pacemaker.

Sinus Tachycardia

• Heart rate is greater than 100 bpm.
• Calcium channel blockers and beta-blockers are used to lower heart rate
• Pain, anxiety, fever, hypovolemia, pulmonary emboli, myocardial infarction (MI), and drugs can cause tachycardia.

PVC

• Premature ventricular complex can have a wide and bizarre QRS complex.
• Electrolyte imbalance, hypoxia, and ischemia can cause premature ventricular complex
• Notify the PCP, administer oxygen, administer medication
• Bigeminy/trigeminy is usually caused by low potassium or magnesium levels.
• Bigeminy is when every other beat is a PVC, and trigeminy is every two beats is a PVC

A-Fib (Atrial Fibrillation)

• Atrial rate is greater than 350 bpm.
• Rhythm is irregular
• Inconsistent R-R intervals
• There is an absence of P waves
• Bumpy, unorganized flutter waves
• HTN, ISCHEMIA, MI, CHF, COPD and EDEMA POST OP can cause afib
• Notify the PCP, administer oxygen,CCB, BB, DIGOXIN ANTICOAGULANTSX medication and consider cardioversion if the patient has been in afib for lesss than 48 hours

A-Flutter

• Atrial rate is 250-350 bpm.
• the rhythm is regular or irregular
• A unique f wave is saw tooth shaped

Ventricular Tachycardia

• Rate is 150-250 bpm
• The heartbeat's shape and rhythm is regular

Irregular Ventricular Tachycardia

• Cause for irregular rhythms
• Hypokalemia or hypomagnesemia, myocardial infarction or CHF can cause this
• Monitor vital signs, administer oxygen
• No pulse: defibrillation! then CPR.
• Amidarone, magnesium and lidocaine will help
• Either pulse administration or cardioversion

SVT

• Supraventricular tachycardia has a rate of 150-250 bpm.
• It also presents with a very regular pattern
• Anxiety/caffeine, atrial enlargement, hyperthyroidism, and toxicity from nicotine
• Administer oxygen and attempt vagal maneuver (coughing and valsava) and/or cardioversion If they are unstable, then give CCB or BB medication and administer adenosine

Torsade de Pointes

• Ventricular tachycardia with rate of 200-250 bpm.
• Arrhythmias, Irregular can lead to VFIB OR ASYSTOLE

V-Fib

• Arrhythmia, Ventricular fibrillation, with a chaotic rhythm and rate
• There is no pulse or output
• CAD, MI, Trauma, Hypoxia and OD can cause this so give DEFIB therapy
• Give ACLS medications like Epinephrine, vasopressin, and amiodarone

Asystole

• Lack of electrical activity
• give treatment CPR, IV, intubation, and transcutaneous pacing

H's and T's

• Hypovolemia:
• Hypoxia:
• Acidosis from hydrogen ions,
• Hypoglycemia:
• Hypothermia,
• Toxins, Tamponade, Tension pneumothorax, Thrombosis, and Trauma
• Check Pulse and a different second lead
• Do not shock! Start CPR, IV, and intubate
• Transcutaneous pacing is early

1. Heart Anatomy & Physiology

• The 4 chambers of the heart are:
  • Right atrium → Right ventricle → Lungs
  • Left atrium → Left ventricle → Body
• The heart valve mnemonic is: "Toilet Paper My Ass" = Tricuspid, Pulmonic, Mitral, Aortic

Electrical Conduction System

• SA node (pacemaker, 60–100 bpm) → AV node (slows down and allows ventricles to fill before contracting, 40–60 bpm) → Bundle of His → Purkinje fibers (stimulate ventricular contraction)

Perfusion Basics:

• CO = HR x SV
• Normal EF (Ejection Fraction) = 55–70%

Blood Flow

• Deoxygenated blood flows from the body into the right atrium, passes through the tricuspid valve to the right ventricle, and then to the lungs via the pulmonary artery for oxygenation.
• Oxygenated blood returns to the left atrium, passes through the mitral valve into the left ventricle, and is pumped through the aorta to supply the body.

Assessment for Disease

• Assess patient vitals signs as well as make note off heart sounds S3 - CFH, edema, JVD, lung sounds crackles, perfusion fatigue, chest pain, and dyspnea. It is important to obtain the patients histories and the modifiable risk factors

Diagnosis (D)

• Diagnosis can be Decreased cardiac output and Impaired gas exchange. Other factors include: Fluid volume excess and Activity intolerance

Planning (P)

• Goal planning can include Improve oxygenation & cardiac output Reduce fluid overload Support balance Provide complications balance and dysrhythmia

Intervention (I)

• Daily weights, I&Os Administer meds

Medications

• Antihypertensives (Lisinopril, Metoprolol) Lower blood pressure to maintain normal blood and vessels pressure
• Diuretics (Furosemide): reduce blood by increasing urine output Anticoagulants (Warfarin, Heparin): Prevents blood. Antiarrhythmics (Amiodarone): Used to manage heart rythmns. Statins (Atorvastatin): Lowers levels to prevent heart problems. Nitrates (Nitroglycerin): increases blood flow and to the heart muscle. Beta-Blockers (Metoprolol): Reduce labor and heart rate of hypertension

Monitor labs:

• monitor labs through BNP, Kt, Mgt Troponin elevate and oxygen PRN restrict fluids/sodium if need you can
• Educate on lifestyle changes low sodium smoking, cessation and meds is important

Evaluation

• Improved breath ,sounds stable vitals, decreases in edemas, better activity tolerance

Diagnostic Tests – Cardiac Focus Test

• ECG/EKG, Rhythm & rate Look for ST elevation, arrhythmias Troponin I/T Cardiac muscle damage up it MI; most specific BNP CHF marker (damage/failure) (up) fluids and heart is not at normal value.
• Echocardiogram Looks at EF, valves abnormalities, heart function, Noninvasive Cardiac Cath visuals of Coronary arteries and diagnosis such of bleeding .
• Chest X-ray Size of heart, fluid check for cardiomegaly
• Stress Test Assess heart activity test to determine patients chemical tread nil.

Cardiac Diseases – Compare & Contrast

• CAD Angina, fatigue reduction test, lifestyle change, risk Nitro CAD
• MI Chest, SOB, N/V prioritize Morphine, Oxygen, Nitrogen CHF (L crackles, SOB , Weight daily.

AFIB

• AFIB monitor through ECG Monitor may need anticoagulants Valvular Disease.
• HIN Valvular silent
• AFIB Monitor leads through HF Valvular Interprofessional & Nursing Management: Low sodium diet .

Dietary

• Monitor for Fluid restrictions, weights report O2 support, elevate HOB Meds , diuretics, blocks digoxin education Na+ restriction management Pharmacist-side effect support: follow -up resources,

Chronic Cardiac Disease

• C Issues: Angina, fatigue, Othopnea, edema and exercise

Management:

• Follow up medication, heart rates and sodium

Infective Endocarditis Definition :

• Inside of the heart, inner endocardium

Causes/Risk Factors:

• Risk of infectious bacteria

Signs and Symptoms:

• Fevers, chills, fatigue body.

Diagnosis:

• Blood identify Echocardiogram, to visualize valve

Treatment:

• Long term surgery of valve

Angina Pectoris:

Defition is Chest pain because of oxygen

Signs and Symptoms:

• Dizziness, pain, and sweating Diagnsis: ECG and stress. medication given: NTG, Antipaletes. CA channel

CHD (structural problems)

• Definition: problem structure

Symptoms:

• Cyanosis, fatigue, heart .

Medications:

• Antibiotics and diuretics

ACS (acute problems) reduced blood flow:

• Angina, STME Medications: (Morphone and o2)

Left-Sided Heart Failure

• Lungs are not able to pump fluids in to cause in fluid to back up of lungs

Signs and symptoms

• SOB , Dypena Diagnosis test and treatment

Right-Sided heart failure

• Right side blood is not able to pump the fluid in and cause for veins symptoms/signs includes edema, fatigue

Medications:

• Ace for better blood flow

Myocardial Infarction

• Definition: Blood is going to go through and cause in damage
• Sign and symptoms, chest pain and anxiety

Treatment :

Provide heart medications and Beta-blocks.

Post-op

• Patients, need help to teach basic care.

Q and A

• Risk overload due to elctrolyte imbalances
• Digon therapy due to toxicity for high potassium

Teaching the patients:

• Weigh themselves daily, limit sodium, report weight . The patient can not limit fluid to take potassium

Post - operation

• Educate stopping to Digoin Begin to ask a professional help if needed. DO NOT advise taking potassium

What treatment would you do for a patient with MI

• Chest radiating his left are
• ST elevation for help

How to give tenecteplase in 30 min

• Give medical treatment and watch for symptoms of o2.