Critical-Cardiac
Cardiac - E 1 BAPTIST HEALTH School of Nursing NSG 4017: Critical Care Nursing Nursing Management of Patients with Altered Cardiovascular Function Georgia Seward
I.
Anatomy and physiology review A. Layers B. Chambers C. Heart valves D. Flow of blood E. Blood supply of myocardium 1. RCA 2. L Main 3. LAD 4. Circumflex F. Cardiac cycle 1. Systole 2. Diastole G. Cardiac output and cardiac index - SV x HR. CI = CO /body surface area. 1. Preload 2. Afterload H. Cardiac pressures p. 1557 of Black and Hawks 1. R atrium 2. R ventricle 3. Pulmonary artery 4. L atrium 5. L ventricle I. Electrophysiology 1. Properties of heart a. Excitability - ability to respond - Na and K b. Automaticity (rhythmicity) - ability to initiate impulse spontaneously and repetitively without neurohormonal influence (1) SA node 60-100 bpm (2) atria 60-100 (3) AV node 40-60 (4) Ventricles 20-40 c. Contractility - extracellular calcium required! Then triggers more calcium from sarcoplasmic reticulum. Significance: Ca channel blockers alter cardiac rate but not skeletal muscle contraction. d. Refractoriness - inability to respond to new stimulus while still in state of depolarization - can shorten as HR increases
Cardiac - E 2 (1) ventricles - absolute refractoriness - .25 to .3 sec (2) ventricles - relative refractoriness - .05 sec e. Conductivity - move electrical impulses along and across cell membranes of muscle mass but not through fibrous bands. SA node AV node - delay is .07 Bundle of His and bundle branches a. R bundle b. L bundle - 2 fascicles (branches) Purkinje fibers
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Monitor waves - p. 120 in Urden. A. P B. QRS C. T D. PR Interval (PRI) E. ST segment 1. Depressed 2. Elevated Rate A. Using monitor paper B. Six second strip Rhythms - p. 123, Urden, Stacy, and Lough A. Normal sinus rhythm 1. Rate 2. Rhythm 3. P wave 4. PRI 5. QRS complex a. Shape b. Width (duration) 6. Etiology 7. Treatment B. Sinus bradycardia 1. Rate 2. Rhythm 3. P wave 4.
I.
Anatomy and physiology review A. Layers B. Chambers C. Heart valves D. Flow of blood E. Blood supply of myocardium 1. RCA 2. L Main 3. LAD 4. Circumflex F. Cardiac cycle 1. Systole 2. Diastole G. Cardiac output and cardiac index - SV x HR. CI = CO /body surface area. 1. Preload 2. Afterload H. Cardiac pressures p. 1557 of Black and Hawks 1. R atrium 2. R ventricle 3. Pulmonary artery 4. L atrium 5. L ventricle I. Electrophysiology 1. Properties of heart a. Excitability - ability to respond - Na and K b. Automaticity (rhythmicity) - ability to initiate impulse spontaneously and repetitively without neurohormonal influence (1) SA node 60-100 bpm (2) atria 60-100 (3) AV node 40-60 (4) Ventricles 20-40 c. Contractility - extracellular calcium required! Then triggers more calcium from sarcoplasmic reticulum. Significance: Ca channel blockers alter cardiac rate but not skeletal muscle contraction. d. Refractoriness - inability to respond to new stimulus while still in state of depolarization - can shorten as HR increases
Cardiac - E 2 (1) ventricles - absolute refractoriness - .25 to .3 sec (2) ventricles - relative refractoriness - .05 sec e. Conductivity - move electrical impulses along and across cell membranes of muscle mass but not through fibrous bands. SA node AV node - delay is .07 Bundle of His and bundle branches a. R bundle b. L bundle - 2 fascicles (branches) Purkinje fibers
2. 3. 4.
5. II.
III.
IV.
Monitor waves - p. 120 in Urden. A. P B. QRS C. T D. PR Interval (PRI) E. ST segment 1. Depressed 2. Elevated Rate A. Using monitor paper B. Six second strip Rhythms - p. 123, Urden, Stacy, and Lough A. Normal sinus rhythm 1. Rate 2. Rhythm 3. P wave 4. PRI 5. QRS complex a. Shape b. Width (duration) 6. Etiology 7. Treatment B. Sinus bradycardia 1. Rate 2. Rhythm 3. P wave 4.