Cardiac Meds & Cardiac Arrhythmias PDF

3. Cardiac and Meds **Calcium Channel Blockers are like VALIUM for your 💓!!!...calms the heart down! Tachy = yes it needs to relax Shock = no it does not need to relax Digoxin is the only drug that mixes + and - effects; other 99% have either + or - effects CCB are negative inot...

3. Cardiac and Meds **Calcium Channel Blockers are like VALIUM for your 💓!!!...calms the heart down! Tachy = yes it needs to relax Shock = no it does not need to relax Digoxin is the only drug that mixes + and - effects; other 99% have either + or - effects CCB are negative inotropic, chronotropic, dromotropic Apical pulse: best assessed at the apex of the heart/mitral area. It is located at the fifth intercostal space on the midclavicular line. ACTION DEFINITION POSITIVE ↑ NEGATIVE ↓ Cardiac Stimulant Cardiac Depressant Inotropic Strength of heartbeat Strong Weak Chronotropic Rate of heartbeat Fast Slow Dromotropic Conductivity Excitable Blocks/Slows conduction What do Calcium Channel Blockers treat? (indications) Antihypertensives (BP way UP- relaxes heart and blood vessels) Antianginal (relaxes heart- reduces O2 demand) Anti A trial A rrhythmia (does not treat ventricular arrhythmias; treats Afib/Aflutter and SVT) Calcium Channel Blocker side effects: Headache (vasoconstriction in the brain) Hypotension (relaxes heart and blood vessels) Bradycardia Names of Calcium Channel Blockers: Verapamil Cardizem (can be given as a continuous IV) -dipine Nursing Actions: before administering CCBs→ Check BP, if systolic lower than 100 → Hold and call MD If on a drip, titrate drip to keep systolic over 100 Cardiac Arrhythmias Terminology  ○ P wave > atrial ○ QRS depolarization > always refers to ventricular Rhythms you must know for NCLEX > NSR, V-Fib, V-Tach, Asystole **Normal Sinus Rhythm P wave QRS complex evenly spaced T wave Regular rhythm Atrial Fibrillation Chaotic P-wave depolarization Lack of any discernible pattern Atrial Flutter Rapid P-wave depolarizations Saw-tooth pattern **Ventricular Fibrillation Chaotic QRS depolarization No pattern Lethal arrhythmia Treatment ○ Beat to treat electrically ○ Shock = 200 defibrillate **Ventricular Tachycardia Wide, bizarre QRS complexes Tachy is always discernible repeating pattern Potentially life-threatening arrhythmia ○ Pulseless V-tach is the same as asystole and V-fib and would depend on how long down ○ After 8 min > consider dead Treatment ○ Lidocaine **Asystole A lack of QRS depolarization Lethal arrhythmia Treatment ○ Epinephrine ○ Atropine ○ S/E anticholinergics Premature Ventricular Complex Periodic wide, bizarre QRS Generally low to moderate priority, unless everyone else has a normal rhythm Be concerned, if: ○ More that 6 per min ○ 6 in a row ○ PVC falls on the T-wave of previous beat Treatment ○ Lidocaine (Ventricular, last longer) ○ Amiodarone Supraventricular arrhythmias Treatment ○ Adenosine (push fast IV push; usually 8 seconds or faster) ○ Beta blockers ○ Calcium Channel Blockers ○ Digoxin (Digitalis) Lanoxin *LETHAL arrhythmias (High Priority) They will kill you in 8 minutes or less ○ Asystole ○ V-Fib They both have: NO cardiac output (pulse) → NO brain perfusion. Potentially life threatening arrhythmia →V-Tach (they have cardiac output → pulse) Pulseless V-Tach: treat the same as asystole and V-Fib It would depend on how long the person has been down →After 8 mins, they are considered dead Treatments PVC’s ○ Lidocaine (Ventricular, lasts longer) ○ Amiodarone V-Tach ○ Lidocaine ○ Amiodarone (using more coming April 2019) Supraventricular arrhythmias (SVT) ○ Adenosine (push fast, usually 8 sec or faster > watch for asystole but they will come out of it) Have crash cart near by ○ Beta Blockers ○ Calcium Channel Blockers ○ Digoxin (Digitalis)→ Lanoxin V-Fib ○ Best to treat with electricity ○ Shock > 200 Defibrillate Asystole ○ Epinephrine ○ Atropine ○ S/E anticholinergics Anticholinergic Effects Cholinergic Effects ↓ Mucus Bronchodilation Bronchorrhea (large amounts of mucus in airway) Dry mouth Dry eyes Bronchoconstriction Salivation Urinary retention Dry skin Lacrimating Urination Constipation Shuts down GI Diaphoresis/Diarrhea GI upset Prevents V when trying to intubate Emesis