Nursing 202

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Nursing 202

• Module B
• Cardiovascular System Alterations

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CARDIAC DYRHYTHMIAS
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REVIEW OF CONDUCTION
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ELECTRICAL CONDUCTION

• SINOATRIAL NODE (SA)
• INTRAATRIAL FIBER (BACHMANS BUNDLE)
• INTRANODAL TRACTS
• ATRIOVENTRICULAR (AV) NODE
• BUNDLE OF HIS (COMMON BUNDLE)
• BUNDLE BRANCHES
• PURKINJE FIBERS

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TERMINOLOGY

• WAVE- POSITIVE OR NEGATIVE DEFLECTION GENERALLY
  BEGINS AND ENDS AT THE BASELINE, REPRESENTING
  DEPOLARIZATION OR REPOLARIZATION
• SEGMENT- LENGTH OF BASELINE BETWEEN 2 WAVES NAMED
  BY THE WAVE BEFORE AND AFTER
• INTERVAL-LENGTH OF A WAVE OR THE LENGTH OF A WAVE
  WITH THE SEGMENT THAT FOLLOWS
• COMPLEX-GROUP OF WAVES THAT FOLLOW ONE AFTER
  ANOTHER

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PR INTERVAL

• REPRESENTS TIME FROM THE BEGINNING OF ATRIAL
  DEPOLARIZATION TO THE BEGINNING OF VENTRICULAR
  DEPOLARIZATION, MEASURED FROM THE BEGINNING OF
  THE P WAVE TO THE BEGINNING OF THE QRS COMPLEX
  (O.12-O.20)

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QRS INTERVAL

• REPRESENTS THE LENGTH OF TIME FOR DEPOLARIZATION
  OF THE VENTRICULAR MUSCLE AND IS MEASURED FROM
  THE BEGINNING OF THE QRS COMPLEX TO THE END OF
  THE S WAVE, SHOULD MEASURE BETWEEN 0.06-0.10
  SECONDS IN DURATION

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ST INTERVAL

• REPRESENTS THE TOTAL LENGTH OF TIME FOR
  VENTRICULAR MUSCLE TO BE DEPOLARIZED AND
  REPOLARIZED, MEASURED FROM THE BEGINNING OF THE
  QRS COMPLEX TO THE END OF THE T WAVE, NORMAL
  RANGE IS 0.32-0.42

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INHERENT RATES

• SA 60-100
• AV JUNCTION 40-60
• VENTRICULAR 20-40

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SINUS DYSRHYTHMIA

• OCCURS IF THE P - P INTERVAL VARY BY MORE THAN
  0.16 . LESS THAN O.16 IS CONSIDERED NORMAL
  BECAUSE OF THE FLUCTUATION OF THE SYMPATHETIC/
  PARASYMPATHETIC STIMULATION
• ASSOCIATED WITH RESPIRATION IN CHILDREN AND
  ELDERLY

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SINUS BRADYCARDIA

• HR lt 60/MIN ARISING FROM THE SA NODE.
• IMPULSES FOLLOW THE NORMAL PATHWAY THROUGH THE
  CONDUCTION SYSTEM
• P AND QRS COMPLEXES NORMAL DURATION AND PATTERN

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ETIOLOGY

• INCREASED VAGAL STIMULATION
• MAY BE A NORMAL VARAITION IN ALTHLETES AND
  HEALTHY YOUG ADULTS
• MEDICAL CONDITIONS
• ANOREXIA NERVOSA
• ATHEROSCLEROTIC HEART DISEASE
• HYPOENDOCRINE STATES
• HYPOTHERMIA
• INCREASED INTRACRANIAL PRESSURE
• MYOCARDIAL INFARCTION
• MEDICATIONS
• ANTIHYPERTENSIVES
• BETA BLOCKERS
• CALCIUM CHANNEL BLOCKERS
• CNS DEPRESSANTS
• DIGOXIN

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SYMPTOMS

• SYMPTOMS RELATED TO DECREASE IN CARDIAC OUTPUT
• CHEST PRESSURE AND PAIN
• DYSPNEA
• HYPOTENSION
• DIZZINESS
• SEIZURES
• SYNCOPE

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TREATMENT

• MANAGEMENT -ONLY IF SYMPTOMATIC-
• AIMED AT INCREASING THE HEART RATE
• MEDICATIONS
• ATROPINE
• ISOPROTERENOL
• PACEMAKER
• SUPRESSION OF THE PARASYMPATHETIC NERVOUS SYSTEM
• STIMULATION OF THE SYMPATHETIC NERVOUS SYSTEM

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SINUS TACHYCARDIA

• HR OF 100-160/ MIN
• NORMAL RESPONSE TO SYMPATHETIC NERVOUS SYSTEM
  STIMULATION
• ANY CONDITION THAT PRODUCES AN INCREASE IN
  METABOLIC RATE

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ETIOLOGY

• DIET CAFFEINE
• LIFE-STYLE SMOKING / NICOTINE
• MEDICAL CONDITIONS ANEMIA, HEMORRHAGE, FEVER,
  HYPOTENSION, PAIN, SHOCK
• MEDICATIONS CENTRAL NERVOUS SYSTEM STIMULANTS
• MYOCARDIAL DAMAGE

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SYMPTOMS

• PRIMARY SYMPTOMS RELATED TO DECREASED CARDIAC
  OUTPUT
• CHEST PRESSURE AND PAIN
• DYSPNEA
• A CHARACTERISTIC FLUTTERING IN THE CHEST
• DIZZINESS
• SYNCOPE

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TREATMENT

• ELIMINATE THE CAUSE OF THE TACHYCARDIA
• MEDICATIONS
• CALCIUM CHANNEL BLOCKERS
• DIGOXIN
• BETA BLOCKERS
• ANTIANXIETY AGENTS
• ADENOSINE
• CAROTID MASSAGE

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ATRIAL DYSRHYTHMIAS

• IMPULSE ARISES OUTSIDE THE SINO ATRIAL NODE
• P WAVES DIFFER IN CONFIGURATION
• TYPES
• WANDERING ATRIAL PACEMAKER
• PREMATURE ATRIAL CONTRACTIONS
• PAROXYSMAL ATRIAL TACHYCARDIA
• ATRIAL FLUTTER
• ATRIAL FIBRILLATION

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ETIOLOGY

• CARDIAC DISEASE
• ISCHEMIA
• CORONARY ARTERY DISEASE
• CONGESTIVE HEART FAILURE
• MYOCARDIAL INFARCTION
• INCREASED VAGAL STIMULATION
• MEDICATIONS

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PREMATURE ATRIAL CONTRACTIONS

• MOST COMMON ECTOPIC BEAT
• OCCURS WHEN IMPULSE IS GENERATED BY AN IRRITABLE
  AREA OF TISSUE IN THE ATRIA
• ABNORMALLY SHAPED P WAVE
• QRS COMPLEX NOT AFFECTED

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ETIOLOGY

• CARDIAC DISEASE
• CHRONIC OBSTRUCTIVE PULMONARY DISEASE
• MEDICATIONS CENTRAL NERVOUS SYSTEM STIMULANTS
• DIET CAFFEINE
• ELECTROLYTE DISTURBANCES
• ANXIETY
• LIFE STYLE EXERCISE, ALCOHOL, NICOTINE

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SYMPTOMS

• FEELINGS OF PALPITATIONS OR SKIPPED BEAT

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TREATMENT

• TREATMENT DIRECTED TOWARD CAUSE
• TREATMENT NOT NECESSARY IF LESS THAN 6 PER MINUTE
• DECREASE CAFFEINE CONSUMPTION
• DECREASE STRESS
• MEDICATIONS
• ANTIANXIETY AGENTS
• BETA BLOCKERS
• CALCIUM CHANNEL BLOCKERS

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PAROXYSMAL ATRIAL TACHYCARDIA

• Caused by an irritable area of tissue in the
  atria that dominates the sinoatrial node and
  takes over as the pacemaker
• Usually preceded by premature atrial contractions
• Begin and end abruptly
• The raid rate prevents adequate ventricular
  filling

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ETIOLOGY

• SAME AS SEEN WITH PREMATURE ATRIAL CONTRACTIONS
• NOT USUALLY ASSOCIATED WITH ORGANIC HEART DISEASE

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SYMPTOMS

• CHEST PAIN
• DYSPNEA
• HYPOTENSION
• PALPITATIONS
• WEAK RAPID PULSE
• DIZZINESS
• SYNCOPE

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TREATMENT

• CAROTID SINUS PRESSURE
• VAGAL NERVE STIMULATION
• MEDICATIONS
• DILTIAZEM
• VERAPAMIL
• DIGOXIN
• PROPRANOLOL
• PROCAINAMIDE
• QUINIDINE
• VASOPRESSOR

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ATRIAL FLUTTER

• ATRIAL ECTOPIC PACER FIRES AT A RATE OF 250-400/
  MIN
• OCCURS IN A VARIETY OF HEART DISEASES- RHEUMATIC,
  CORONARY, HYPERTENSIVE, ALSO CARDIOMYOPATHY,
  HYPOXIA, HEART FAILURE,
• MAY BE ASYMPTOMATIC OR HAVE PALPITATIONS
• MANAGEMENT- DIGITALIS, BETA BLOCKERS, CALCIUM
  CHANNEL BLOCKERS, MAY USE CARDIOVERSION

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ATRIAL FIBRILLATION

• SEVERAL ECTOPIC FOCI CAUSING THE ATRIA TO QUIVER
  RATHER THAN CONTRACT.
• RATE gt400
• VENTRICULAR RATE DEPENDS ON THE NUMBER OF
  IMPULSES CONDUCTED THRU THE AV NODE
• MANAGEMENT- DIG., BETA BLOCKERS, CALCIUM CHANNEL
  BLOCKERS, COUNTERSHOCK

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AV HEART BLOCKS

• ABNORMAL DELAY IN CONDUCTION OF IMPULSE FROM THE
  ATRIUM TO THE VENTRICLES
• USUALLY ASYMPTOMATIC

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FIRST DEGREE

• DELAY OCCURS AT THE AV NODE PRODUCING A
  PROLONGED PR INTERVAL gt .20.

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ETIOLOGY

• COMMON OCCURANCE IN NORMAL HEARTS
• CARDIAC DISEASE INCLUDING
• ARTERIOSCLEROTIC HEART DISEASE, MYOCARDITIS,
  ORGANIC HEART DISEASE, MYOCARDIAL INFARCTION
• MEDICATIONS
• BETA BLOCKERS
• CALCIUM CHANNEL BLOCKERS
• DIGITALIS TOXICITY

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TREATMENT

• USUALLY NOT NECESSARY UNLESS THE BLOCK THAT IS
  CAUSED BY MEDICATION THAT CAN BE MODIFIED OR
  WITHHELD

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SECOND DEGREE HEART BLOCK

• TYPE I- MOBITZ I OR WENCKEBACH- PROGRESSIVE
  LENGTHENING OF THE PR INTERVAL UNTIL A QRS
  COMPLEX IS DROPPED OR NOT CONDUCTED
• USUALLY ASYMPTOMATIC
• TX- MAYBE NONE, ATROPINE, TEMP. PACER

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SECOND DEGREE- TYPE II

• EVERY SECOND THIRD OR FOURTH SINUS IMPULSE IS
  BLOCKED MAY HAVE 2,3,4 Ps TO EACH QRS
• MORE SERIOUS- AGGRESSIVE MANAGEMENT TO PREVENT
  PROGRESSION TO COMPLETE HEART BLOCK
• TREATMENT
• PACER
• ATROPINE
• DOPAMINE FOR SEVERE HYPOTENSION

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THIRD DEGREE HEART BLOCK

• TOTAL DISASSOCIATION OF ATRIA TO VENTRICLES.
  VENTRICLES ARE STIMULATED BY A SECONDARY OR
  ESCAPE BEAT. THE VENTRICULAR RATE WILL BE 40-60
  DEPENDING UPON THE LOCATION OF THE VENTRICULAR
  PACEMAKER
• BOTH THE SINUS P WAVE AND THE ESCAPE RHYTHM WILL
  BE OBVIOUS ON THE ELECTROCARDIOGRAM
• ETIOLOGY
• CARDIAC DISEASE
• MEDICATIONS BETA BLOCKERS, CALCIUM CHANNEL
  BLOCKERS, DIGITALIS TOXICITY
• MANIFESTATIONS- FATIGUE, HYPOTENSION, SYNCOPE,
  HEART FAILURE
• TX.- ATROPINE, ISOPROTERENOL, DOPAMINE, PACER

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JUNCTIONAL RHYTHMS

• RATE 40- 60
• THE DOMINANT PACER OF THE HEART FAILS ,
  RETROGRADE OR BACKWARD STIMULATION OF THE ATRIA-
  PRODUCING A CHARACTERISTIC P WAVE - MAY BE A
  NEGATIVE DEFLECTION BEFORE OR AFTER THE QRS
  COMPLEX OR NO P WAVE AT ALL

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ETIOLOGY

• CORONARY ARTERY DISEASE
• CONGESTIVE HEARAT FAILURE
• MYOCARDIAL INFARCTION
• CAFFEINE
• ANXIETY
• ALCOHOL, TOBACCO

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SYMPTOMS

• FEELINGS OF
• PALPITATIONS
• FLUTTERING
• SKIPPED BEATS

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MANAGEMENT

• TX UNDERLYING CAUSE
• MODIFY DIET / LIFESTYLE
• REDUCE STRESS
• MEDICATIONS
• QUINIDINE

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PREMATURE JUNCTIONAL CONTRACTIONS

• AN IRRITABLE JUNCTIONAL FOCUS DISCHARGES AN
  IMPULSE BEFORE THE SINOATRIAL NODE FIRES
• ABNORMAL P WAVES CAN PRECEDE, FOLLOW, OR OCCUR
  SIMULTANEOUSLY WITH THE QRS COMPLEX
• VENTRICULAR CONTRACTION IS USUALLY NORMAL
• MAY BE FOLLOWED BY AN INCOMPLETE OR COMPENSATORY
  PAUSE
• MAY OCCUR LATE IN THE CYCLE AND IS REFERRED TO AS
  JUNCTIONAL ESCAPE BEATS
• ETIOLOGY, SYMPTOMS, AND TREATMENT IS THE SAME AS
  LISTED UNDER JUNCTIONAL RHYTHMS

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PAROXYSMAL JUNCTIONAL TACHCARDIA

• A CLUSTER OF THREE OR MORE PREMATURE JUNCTIONAL
  CONTRACTIONS FIRING AT A RATE OF MORE THAN 150
  BEATS/ MINUTE
• ETIOLOGY IS THE SAME AS LISTED UNDER JUNCTIONAL
  RHYTHMS

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SYMPTOMS

• MAY BE ASYMPTOMATIC IS RATE IS LESS THAN 150
  BEATS/ MINUTE
• AT RATES GREATER THAN 150 BEATS/ MINUTE
• CHEST PAIN, PRESSURE, PALPITATIONS, DIZZINESS,
  SYNCOPE

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TREATMENT

• MEDICATIONS
• CALCIUM CHANNEL BLOCKER
• CENTRAL NERVOUS SYSTEM
• DEPRESSANTS
• DIGOXIN
• VAGAL STIMULATION
• CARDIOVERSION

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JUNCTIONAL ESCAPE BEATS

• BEATS THAT OCCUR WHEN THE AV JUNCTION TAKES OVER
  THE PACEMAKER ACTIVITY
• OCCUR LATE IN THE CYCLE

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ETIOLOGY

• RHEUMATIC HEART DISEASE
• MYOCARDIAL INFARCTION
• SINUS ARRHYTHMIAS
• BRADYCARDIA
• BLOCK
• ARREST
• MEDICATIONS
• BETA BLOCKERS
• CALCIUM CHANNEL BLOCKERS
• CENTRAL NERVOUS SYSTEM DEPRESSANTS
• DIGOXIN
• NARCOTICS
• SEDATIVES

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SYMPTOMS

• MOST ARE ASYMPTOMATIC
• FEELINGS OF
• PALITATIONS
• FLUTTERING
• SKIPPED BEATS

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TREATMENT

• MOST TREATMENT MEASURES ARE THOSE USED FOR SINUS
  BRADYCARDIA

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VENTRICULAR DYSRHYTHMIAS

• IMPULSE ORIGINATES IN THE VENTRICLES
• CAUSES- DRUG TOXICITY, HYPOXIA, HYPOTHERMIA,
  ELECTROLYE IMBALANCES

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PREMATURE VENTRICULAR CONTRACTIONS

• OCCUR EARLY- NOTED COMPENSATORY PAUSE, QRS
  COMPLEX WIDE
• MAY BE MULTIFOCAL OR UNIFOCAL
• BIGEMINY, TRIGEMINY OR COUPLETS
• THREE OR MORE VENTRICULAR TACH.
• R ON T PHENOMENON
• TX- 6 OR gt /MIN, COUPLETS , R ON T, OR MULTIFOCAL
  ARE NO LONGER CONSIDERED TO BE A WARNING OR
  PRECURSOR TO THE DEVELOPMENT OF VENTRICULAR
  TACHYCARDIA
• LIDOCAINE MOST COMMONLY USED FOR IMMEDIATE SHORT
  TERM THERAPY

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VENTRICULAR TACH

• DEFINED AS THREE OR MORE PREMATURE VENTRICULAR
  CONTRACTIONS IN A ROW
• RATE OF VENTRICULAR DISCHARGE IS 100-250/MIN
• ETIOLOGY- INCREASED MYOCARDIAL IRRITABILITY
  ASSOCIATED WITH CORONARY ARTERY DISEASE,
  MYOCARDIAL INFARCTION, ELECTROLYTE IMBALANCE,
  CARDIOMYOPATHY

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TREATMENT

• MANAGEMENT DEPENDS UPON SEVERITY
• IF STABLE CONTINUE MONITORING, OBATIN 12 LEAD
  ELECTROCARDIOGRAM
• FACTORS DETERMINING MEDICATIONS TO BE
  ADMINISTERED
• MONOMORPHIC OR POLYMORPHIC
• EXISTENCE OF PROLONGED QT INTERVAL PRIOR TO ONSET
• HEART FUNCTION (NORMAL OR DECREASED)
• UNSTABLE- UNCONSCIOUS / WITHOUT A PULSE TREAT
  AS VENTRICULAR FIBRILLATION IMMEDIATE
  DEFIBRILLATION

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VENTRICULAR FIBRILLATION

• RAPID, DISORGANIZED VENTRICULAR RHYTHM THAT
  RESULTS IN INEFFECTIVE QUIVERING OF THE
  VENTRICLES
• NO ATRIAL ACTIVITY SEEN ON ECG
• ABSENCE OF AUDIBLE HEARTBEAT, PALPABLE PULSE, AND
  RESPIRATION

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ETIOLOGY

• SAME AS VENTRICULAR TACHYCARDIA
• UNTREATED VENTRICULAR TACHYCARDIA
• ELECTRICAL SHOCK
• BRUGADA SYNDROME

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TREATMENT

• IMMEDIATE DEFIBRILLATION
• ACTIVATION OF EMS
• CPR
• ERADICATING THE CAUSE
• VASOACTIVE AND ANTIARRHYTHMIC MEDICATIONS

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VENTRICULAR ASYSTOLE

• ABSENCE OF
• QRS
• HEARTBEAT
• PALPABLE PULSE
• RESPIRATION

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ETIOLOGY

• HYPOXIA
• ACIDOSIS
• ELECTROLYTE IMBALANCE
• DRUG OVERDOSE
• HYPOTHERMIA

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TREATMENT

• CARDIOPULMONARY RESUSCITATION
• INTUBATION
• INTRAVENOUS ACCESS
• TRANSCUTANEOUS PACING
• EPINEPHRINE
• ATROPINE

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ADJUNCTIVE MODALITIES AND MANAGEMENT

• TREATMENT DEPENDS UPON
• WHETHER THE DYSRHYTHMIA IS ACUTE OR CHRONIC
• THE CAUSE OF THE DYSRHYTHMIA AND ITS POTENTIAL
  HEMODYNAMIC EFFECTS

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PACERS

• AN ELECTRICAL IMPULSE THAT STIMULATES THE
  MYOCARDIUM TO DEPOLARIZE, INITIATING A HEARTBEAT
• MAY BE DEMAND, FIXED, OR RATE RESPONSIVE
• MAY BE TEMPORARY OR PERMANENT
• PACER SPIKE NOTED ON EKG

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INDICATIONS

• A SLOWER THAN NORMAL IMPULSE FORMATION OR A
  ACONDUCTION DISTURBANCE THAT CAUSES SYMPTOMS
• MAY BE USED TO TREAT TACHYDYSRHYTHMIAS THAT DO
  NOT RESPOND TO MEDICATION THERAPY

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ASSESSMENT

• MONITOR HEART RATE AND RHYTHM BY
  ELECTROCARDIOGRAM
• ASSESS FOR PACEMAKER SPIKE AND ITS RELATIONSHIP
  TO THE SURROUNDING ELECTROCARDIOGRAM COMPLEXES
• ASSESS CARDIAC OUTPUT AND HEMODYNAMIC STABILITY
• INCISION SITE

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COMPLICATIONS

• LOCAL INFECTION AT THE ENTRY SITE
• BLEEDING AND HEMATOMA FORMATION
• HEMOTHORAX
• VENTRICULAR ECTOPY / TACHYCARDIA
• DISLOCATION OF THE LEAD
• STIMULATION OF THE PHRENIC NERVE
• CARDIAC TAMPONADE
• MY0CARDIAL WALL PERFORATION

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PACEMAKER MALFUNCTION

• LOSS OF CAPTURE
• UNDERSENSING
• OVERSENSING
• LOSS OF PACING

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CLIENT TEACHING

• MONITOR PACEMAKER FUNCTION
• PROMOTE SAFETY/ PREVENT INFECTION
• ELECTROMAGNETIC INTERFERENCE

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CARDIOVERSION AND DEFIBRILLATION

• PADS OR PADDLES ARE USED TO DELIVER A N
  ELECTRICAL CURRENT TO DEPOLARIZE A CRITICAL MASS
  OF CARDIAC CELLS IN AN ATTEMPT FOR THE SINUS NODE
  TO RECAPTURE THE ROLE OF THE PACEMAKER
• DIFFERENCE BETWEEN CARDIOVERSION AND
  DEFIBRILLATION HAS TO DO WITH THE TIMING OF THE
  DELIVERY AND THE CIRCUMSTANCE

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SAFETY

• MAINTAIN GOOD CONTACT BETWEEN THE PADS OR PADDLES
  AND THE SKIN
• ENSURE THAT NOONE IS IN CONTACT WITH THE CLIENT
  OR WITH ANYTHING TOUCHING THE CLIENT

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CARDIOVERSION

• DELIVERY OF A TIMED ELECTRICAL CURRENT TO
  TERMINATE A TACHYDYSRHYTHMIA
• THE DEFIBRILLATOR IS SET TO SYNCHRONIZE WITH THE
  ELECTROCARDIOGRAM ON A MONITOR SO THAT THE
  ELECTRICAL IMPULSE DISCHARGES DURING VENTRICULAR
  DEPOLARIZATION
• VOLTAGE VARIES FROM 25 TO 360 JOULES

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PREPARATION

• ANTICOAGULATION FOR A FEW WEEKS PRIOR TO
  PROCEDURE IF ELECTIVE
• DIGOXIN IS WITHHELD FOR 48 HOURS
• NPO FOR AT LEAST 8 HOURS
• INTRAVENOUS SEDATION
• SUPPLEMENTAL OXYGENATION

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POST PROCEDURE CARE

• MAINTAIN AIRWAY PATENCY
• MONITOR VITAL SIGNS AND OXYGEN SATURATION
• ELECTROCARDIOGRAM MONITORING

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DEFIBRILLATION

• USED IN EMERGENCY SITUATIONS AS THE TREATMENT OF
  CHOICE FOR VENTRICULAR FIBRILLATION AND PULSELESS
  VENTRICULAR TACHYCARDIA
• ELECTRICAL VOLTAGE IS USUALLY GREATER THAN WITH
  CARDIOVERSION
• THE USE OF EPINEPHRINE OR VASOPRESSIN MAY BE
  HELPFUL
• ANTIARRHYTHMIC MEDICATIONS SUCH AS AMIODARONE,
  LIDOCAINE, MAGNESIUM, PROCAINAMIDE ARE GIVEN IF
  VENTRICULAR DYSRHYTHMIA PERSISTS

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ELECTROPHYSIOLOGIC STUDIES

• IDENTIFY IMPULSE FORMATION THROUGH THE CARDIAC
  CONDUCTION SYSTEM
• ASSESS THE FUNCTION OF THE SA AND AV NODES
• MAP DYSRHYTHMOGENIC FOCI
• ASSESS THE EFFECTIVENESS OF ANTIARRHYTHMIC
  MEDICATIONS
• TREAT CERTAIN DYSRHYTHMIAS THROUGH THE
  DESTRUCTION OF CAUSATIVE CELLS (ABLATION)

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CARDIAC CONDUCTION SURGERY

• ENDOCARDIAL ISOLATION
• ENDOCARDIAL RESECTION
• CATHETER ABLATION THERAPY

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MEDICATIONS

• CLASS I SODIUM CHANNEL BLOCKERS
• IA SLOWS CONDUCTION AND PROLONGS
  REPOLARIZATION QUINIDINE, PROCAINAMIDE,
  DISOPYRAMIDE
• IB SLOWS CONDUCTION AND SHORTENS
  REPOLARIZATION LIDOCAINE, MEXILETINE HCL
• IC- PROLONGS CONDUCTION WITH LITTLE OR NO
  EFFECT ON REPOLARIZATION ENCAINIDE, FLECAINIDE

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CLASS II

• BETA BLOCKERS DECREASE CONDUCTION VELOCITY,
  AUTOMATICITY AND RECOVERY TIME ( REFRACTORY
  PERIOD) PROPRANOLOL, ACEBUTOLOL

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CLASS III

• PROLONG REPOLARIZATION- ARE USED IN THE EMERGENCY
  TREATMENT OF VENTRICULAR DYSRHYTHMIAS WHEN OTHER
  ANTIDYSRHYTHMICS ARE NOT EFFECTIVE BRETYLIUM,
  AMIODARONE

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CLASS IV

• CALCIUM CHANNEL BLOCKERS BLOCKS CALCIUM INFLUX,
  DECREASING THE EXCITABILITY AND CONTRACTILITY OF
  THE MYOCARDIUM VERAPAMIL, DILTIAZEM

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OTHERS

• DILANTIN- USED IN THE TX OF DIGITALIS INDUCED
  DYSRHYTHMIAS
• DIGOXIN- ATRIAL FLUTTER OR FIBRILLATION, PREVENT
  RECURRENCE OF PAT
• ATROPINE- BRADYCARDIA

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NURSING PROCESS - DYSRHYTHMIA

• ASSESSMENT
• HISTORY
• CAUSES OF DYSRHYTHMIA
• PHYSICAL EXAM
• EFFECT ON CARDIAC OUTPUT

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NURSING PROCESS

• DIAGNOSES
• DECREASED CARDIAC OUTPUT
• ANXIETY RELATED TO FEAR OF THE UNKNOWN
• DEFICIENT KNOWLEDGE ABOUT THE DYSRHYTHMIA AND
  TREATMENT

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NURSING PROCESS

• PLANNING AND GOALS
• ERADICATING OR DECREASING THE INCIDENCE OF THE
  DYSRHYTHMIA
• ACQUIRE KNOWLEDGE ABOUT THE DYSRHYTHMIA AND
  TREATMENT

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NURSING PROCESS

• INTERVENTIONS
• MONITOR
• BLOOD PRESSURE, PULSE RATE AND RHYTHM, RATE AND
  RHYTHM OF RESPIRATIONS, BREATH SOUNDS
• EPISODES OF LIGHTHEADEDNESS, DIZZINESS, FAINTNESS
• RHYTHM STRIPS
• MEDICATION ADMINISTRATION
• ASSIST IN DEVELOPING A PLAN TO MODIFY LIFESTYLE
• MINIMIZE ANXIETY
• TEACH SELF CARE

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NURSING PROCESS

• EVALUATION
• EXPECTED OUCOMES
• MAINTAINS CARDIAC OUTPUT
• EXPERIENCES REDUCED ANXIETY
• EXPRESSES UNDERSTANDING OF THE DYSRHYTHMIA AND
  ITS TREATMENT

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CORONARY ARTERY DISEASE

• TYPES
• ATHEROSCLEROSIS
• ARTERIOSCLEROSIS

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ATHEROSCLEROSIS

• AN ABNORMAL ACCULULATION OF LIPID, OR FATTY,
  SUBSTANCES AND FIBROUS TISSUE CREATING BLOCKAGES
  OR NARROWING OF THE VESSEL

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ARTERIOSCLEROSIS

• THICKENING OF THE WALLS OF THE ARTERIOLES, WITH
  LOSS OF ELASTICITY AND CONTRACTILITY

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PATHOPHYSIOLOGY

• FATTY STREAKS, LIPIDS THAT ARE DEPOSITED IN THE
  INTIMA OF THE ARTERIAL WALL THAT CONTINUE TO
  DEVELOP RELATED TO AN INFLAMMATORY RESPONSE
  FORMING PLAQUES OR ATHEROMAS WHICH NARROW THE
  VESSEL OBSTRUCTING BLOOD FLOW

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RISK FACTORS

• MODIFIABLE
• TOBACCO
• HYPERTENSION
• ELEVATED BLOOD LIPID LEVELS
• DIABETES
• OBESITY
• SEDETARY LIFE STYLE
• CHRONIC STRESS
• NONMODIFIABLE
• FAMILY HISTORY
• INCREASING AGE
• GENDER
• RACE

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CLINICAL MANIFESTATIONS

• MAY BE ASYMPTOMATIC
• ANGINA
• NAUSEA, VOMITING
• DIAPHORESIS
• COOL, CLAMMY SKIN
• EKG CHANGES

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MANAGEMENT

• LIFESTYLE CHANGES
• DIETARY MEASURES
• Therapeutic Lifestyle Changes diet
• LOW FAT
• LOW CHOLESTEROL
• Increased soluble fiber
• Increased physical activity
• Cessation of tobacco
• Managing hypertension
• Controlling diabetes
• Stress reduction
• MEDICATION
• Lipid lowering agents
• Nitrates
• Antiplatelets
• Beta blockers
• Calcium channel blockers
• Diuretics

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ANGINA

• EPISODES OF PAIN OR PRESSURE IN THE ANTERIOR
  CHEST
• ETIOLOGY INSUFFICIENT CORONARY BLOOD FLOW
  RESULTING IN A DECREASED OXYGEN SUPPLY TO MEET
  AN INCREASED MYOCARDIAL DEMAND IN RESPONSE TO
  PHYSICAL EXERTION OR EMOTIONAL STRESS

96
TYPES OF ANGINA

• STABLE
• UNSTABLE
• INTRACTABLE OR REFRACTORY
• VARIANT
• SILENT

97
FACTORS ASSOCIATED WITH ANGINA

• PHYSICAL EXERTION
• EXPOSURE TO COLD
• HEAVY MEALS
• STRESS

98
MANIFESTATIONS

• CHEST PAIN POORLY LOCALIZED AND MAY RADIATE TO
  THE NECK, JAW, SHOULDERS, LEFT ARM
• FEELING OF INDIGESTION
• CHOKING , TIGHTNESS, HEAVY SENSATIONTHAT HAS A
  VISELIKE, INSISTENT QUALITY
• FEELING OF WEAKNESS OR NUMBNESS
• SHORTNESS OF BREATH
• PALLOR
• DIAPHORESIS
• DIZZINESS
• LIGHTHEADEDNESS
• NAUSEA
• VOMITING
• ANXIETY

99
ASSESSMENT/ DIAGNOSTICS

• HISTORY
• 12 LEAD ECG
• ECHOCARDIOGRAM
• NUCLEAR SCAN
• CARDIAC CATHERIZATION
• BLOOD LAB VALUES
• C-REACTIVE PROTEIN
• TOTAL CHOLESTEROL LDL, VLDL, HDL
• TRIGLYCERIDES

100
MEDICAL MANAGEMENT

• AIMED AT DECREASING THE OXYGEN DEMAND OF THE
  MYOCARDIUM AND TO INCREASE THE OXYGEN SUPPLY
• REVASCULARIZATION PROCEDURES
• CABG
• PERCUTANEOUS TRANSLUMINAL MYOCARDIAL
  REVASCULARIZATION
• PERCUTANEOUS CORONARY INTERVENTIONAL PROCEDURES
  
• PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY
  (PTCA)
• INTRACORONARY STENTS
• ATHERECTOMY

101
MEDICATIONS

• NITROGLYCERIN
• BETA BLOCKERS
• CALCIUM CHANNEL BLOCKERS
• ANTIPLATELET / ANTICOAGULANTS

102
NURSING PROCESS

• ASSESSMENT
• FACTORS ABOUT PAIN THAT NEEDS TO BE ASSESSED
• POSITION/ LOCATION
• PROVOCATION
• WUALITY
• QUANTITY
• RADIATION
• RELIEF
• SEVERITY
• SYMPTOMS
• TIMING

103
NURSING PROCESS

• NURSING DIAGNOSES
• INEFFECTIVE MYOCARDIAL TISSUE PERFUSION SECONDARY
  TO CORONARY ARTERY DISEASE
• ANXIETY RELATED TO FEAR OF DEATH
• KNOWLEDGE DEFICIT ABOUT THE UNDERLYING DISEASE
• NONCOMPLIANCE, INEFFECTIVE MANAGEMENT OF
  THERAPEUTIC REGIMEN RELATED TO FAILURE TO ACCEPT
  NECESSARY LIFESTYLE CHANGES

104
NURSING PROCESS

• PLANNING AND GOALS
• TREATMENT OF ANGINA
• REDUCTION OF ANXIETY
• AWARENESS OPF DISEASE PROCESS
• UNDERSTANDING OF PRESCRIBED CARE
• ADHERENCE TO SELF-CARE PROGRAM
• ABSENCE OF COMPLICATIONS

105
NURSING PROCESS

• INTERVENTIONS
• TREAT ANGINA
• REDUCE ANXIETY
• PREVENT PAIN
• PROMOTE HOME AND COMMUNITY BASED CARE

106
NURSING PROCESS

• EVALUATION
• CLIENT OUTCOMES
• REPORT THAT PAIN IS RELIEVED PROMPTLY
• REPORTS DECRESED ANXIETY
• UNDERSTANDS WAYS TO AVOID COMPLICATIONS
• DEMONSTRATES FREEDOM FROM COMPLICATIONS
• ADHERES TO SELF CARE PROGRAM

107
MYOCARDIAL INFARCTION

• AREAS OF MYOCARDIAL CELLS IN THE HEART ARE
  PERMANENTLY DESTROYED
• AS CELLS ARE DEPRIVED OF OXYGEN, ISCHEMIA
  DEVELOPS, CELLULAR INJURY OCCURS
• OVER TIME, THE LACK OF OXYGEN RESULTS IN
  INFARCTION, OR DEATH OF THE CELLS

108
VARIOUS DESCRIPTIONS

• LOCATION
• LEFT VENTRICLE
• ANTERIOR, INFERIOR, POSTERIOR, LATERAL WALL
• RIGHT VENTRICLE
• POINT IN TIME
• ACUTE
• EVOLVING
• OLD

109
MANIFESTATIONS

• CHEST PAIN
• SHORTNESS OF BRETH
• COOL, PALE, MOIST SKIN
• ANXIOUS, RESTLESS INCREASED HEART AND RESPIRATORY
  RATE

110
ASSESSMENT AND DIAGNOSTIC FINDINGS

• HISTORY
• CHEST XRAY
• ECG
• ECHOCARDIOGRAM
• TRANSESOPHAGEAL ECHOCARDIOGRAM
• CARDIAC STRESS TESTING
• EXERCISE
• PHARMACOLOGIC
• RADIONUCLIDE IMAGING
• COMPUTED TOMOGRAPHY
• MAGNETIC RESONANCE IMAGING
• CARDIAC CATHERIZATION
• LABORATORY TESTS
• CREATINE KINASE AND ISOENZYMES
• MYOGLOBIN
• TROPONIN
• CHOLESTEROL LEVELS
• LIPID PROFILE
• ELECTROLYTES

111
MANAGEMENT

• GOAL MINIMIZE MYOCARDIAL DAMAGE, PRESERVE
  MYOCARDIAL FUNCTION, PREVENT COMPLICATIONS
• REPERFUSION
• RESOLUTION OF PAIN AND ECG CHANGES

112
PHARMACOLOGIC THERAPY

• THROMBOLYTICS
• ANALGESICS
• ANAGIOTENSIN-CONVERTING ENZYME INHIBITORS
• BETA BLOCKERS

113
INVASIVE CORONARY ARTERY PROCEDURES

• PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY
  (PTCA)
• CORONARY ARTERY STENT
• ATHERECTOMY
• BRACHYTHERAPY
• TRANSMYOCARDIAL REVASCULARIZATION

114
PERCUTANEOUS CORONARY INTERVENTION

• USED TO OPEN THE OCCLUDED CORONARY ARTERY AND
  PROMOTE REPERFUSION
• TREATS THE UNDERLYING ATHEROSCLEROTIC LESION

115
CARDIAC REHABILITATION

• TARGETS RISK REDUCTION
• GOALS
• EXTEND AND IMPROVE QUALITY OF LIFE
• LIMIT THE EFFECTS AND PROGRESSION OF
  ATHEROSCLEROSIS
• RETURN TO PRE-ILLNESS LIFESTYLE
• PREVENT ANOTHER CARDIAC EVENT

116
NURSING PROCESS

• ASSESSMENT
• HISTORY
• PHYSICAL ASSESSMENT

117
NURSING PROCESS

• NURSING DIAGNOSES
• INEFFECTIVE CARDIOPULMONARY TISSUE PERFUSION
• POTENTIAL IMPAIRED GAS EXCHANGE
• POTENTIAL ALTERED PERIPHERAL TISSUE PERFUSION
• ANXIETY
• DEFICIENT KNOWLEDGE ABOUT SELF-CARE

118
NURSING PROCESS

• PLANNING
• RELIEF OF PAIN OR ISCHEMIC SIGNS AND SYMPTOMS
• PREVENTION OF FURTHER MYOCARDIAL DAMAGE
• ABSENCE OF RESPIRATORY DYSFUNCTION
• MAINTENANCE OF ADEQUATE TISSUE PERFUSION
• REDUCE ANXIETY
• ADHERENCE TO SELF-CARE PROGRAM
• ABSENCE OR EARLY RECOGNITION OF COMPLICATIONS

119
NURSING PROCESS

• INTERVENTIONS
• RELIEVE PAIN/ ISCHEMIA
• IMPROVE RESPIRATOY FUNCTION
• PROMOTE TISSUE PERFUSION
• REDUCE ANXIETY
• MONITOR FOR COMPLICATIONS
• TEACH SELF-CARE

120
NURSING PROCESS

• EVALUATION
• OUTCOMES
• RELIEF OF ANGINA
• NO SIGNS OF REPIRATORY DIFFICULTIES
• ADEQUATE TISSUE PERFUSION
• DECREASED ANXIETY
• ADHERENCE TO SELF-CARE PROGRAM
• ABSENCE OF COMPLICATIONS

121
ETIOLOGY

• REDUCED BLOOD FLOW IN A CORONARY ARTERY DUE TO
  ATHEROSCLEROSIS AND OCCLUSION OF AN ARTERY BY AN
  EMBOLUS OR THROMBUS
• VASOSPASM OF A CORONARY ARTERY
• DECREASED OXYGEN SUPPLY
• INCREASED DEMAND FOR OXYGEN