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73 Cards in this Set
- Front
- Back
Characteristics of normal sinus rhythm?
1. P wave 2. PR interval length 3. Rhythm 4. QRS complex 5. Rate |
1. upright P; only 1 P for every QRS
2. < 0.20 sec 3. regular 4. no longer than 0.10 sec or 2.5-3 little boxes 5. 60-100 beats/min |
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1. length of little box?
2. big box? = 5 little boxes |
1. 0.04 sec
2. 0.20 sec |
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What is an SVT rhythm ie Super Ventricular Rhythm?
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catch-all phrase for any rhythm over 150 beats/min
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What is treatment of choice for SVT?
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Adenosine; its pushed fast via IV push; stops heartrate; allows heart to reboot
- used for "SVT conversion" |
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Drugs of choice to treat V-Tach? Also, drugs of choice for all ventricular dysrrhythmias
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Lidocaine & amiodarone - antidysrhythmics
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what are the only 2 rhythms that are shockable by defibrillator?
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V-Tach & V-Fib
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1. Digoxin is ____.
2. It's a ___ inotrope & a ____ chronotrope. |
1. Digitalis
2. positive; negative |
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How to treat A-Fib?
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Digoxin,
Cardizem (diltiazem) - Ca Channel Blocker Cardioversion may be nec |
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An EKG w a saw-tooth appearance is ____
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Atrial Flutter
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How to treat A-Flutter?
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digoxin (Lanoxin) & diltiazem (Cardizem)
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If EKG rhythm has more Ps than QRS complexes, it's (3rd degree) heartblock (as long as not sawtooth).
How to treat? |
drugs don't work; pt needs pacemaker
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How to treat V-Fib?
1st 2nd 3rd |
1. Defib
2. Epinephrine 3. Atropine |
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____ means that for every spike from a pacemaker, you see a QRS complex. If you see spike w/o QRS, you have a pacemaker with ___
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Capture; loss of capture
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You'll never see a P wave before a QRS in a PVC (Premature Ventricular Contractions), since the impulse comes from ventricle.
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T
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2 spikes on an EKG for pt with pacemaker means
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Dual chamber or atrio-ventricular pacemaker;
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Only 1 spike with pacemaker strip means it's a 1 -spike ventricular pacemaker. T or F
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T
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Most common lead utilized for continuous cardiac monitoring?
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lead II or Mcl= Modified Chest Lead
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A normal sinus rhythm has 1 Pwave, 1 QRS complex, & 1 T wave. T or F
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T
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How do you measure heart rate on EKG strip?
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- Quick way: 300/# of large squares between R-R intervals
- More accurate: 1500/# of small squares |
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1. Sinus tach is HR of ____
2. effect on cardiac output and heart? 3. Treatment? |
1. >100/min
2. initially increases cardiac output; however, sustained increase in HR lowers cardiac output & decreases coronary perfusion time 3. correct underlying cause |
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1. Sinus brady is HR of ___
2. You treat sinus brady only when? 3. Causes? 4. Treatment? |
1. , 60
2. treat only if pt is symptomatic ie SOB, etc 3. vagal stimulation ie, bowel straining, beta blockers, hypothyroidism 4. Atropine is first choice |
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A -Fib is most common dysrhythmia; causes dec in cardiac output; atria quiver 350-600x/min
- can lead to blood stagnation leading to thrombus formation increasing stroke risk 1. EKG has no ___ waves 2. Treatment? |
1. no P waves
2. anticoagulant to prevent clots, pacemaker, Cardizem, digoxin, cardioversion may be necessary |
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1. PVC?
2. What is priority treatment? 3. Key electrolyte imbalance that causes PVCs? |
1) Premature ventricular contraction, ie early ventricular complexes (QRS) followed by a pause; PVCs may occur in singles, doubles or triplets ventricle is irritable; freq of PVCs increase with age;
2. Oxygen, then Lidocaine; also need to eliminate underlying causes (such as caffeine, stress) 3. Hypokalemia- give potassium; if Hyperkalemia treat with insulin; can also be caused by hyperkalemia |
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1. V-tach has HR of _____
2. V-tach can cause ____ 3. Causes? 4. Assess? 5. Treatment? |
1. 100-220; V-Tach can quickly deteriorate into V-Fib
2. Cardiac arrest 3. anything that causes PVCs; hypo/hyperkalemia 4. Airway, Breathing, Circulation. LOC 5. O2 is priority for ischemia; lidocaine; if pulseless, use AED; if conscious, ask them to cough (intrathoracic pressure allows for cerebral perfusion) |
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1. V-Fib?
2. Causes? 3. Assessment? 4. Treatment? |
1. ventricles quiver, consuming large amts of 02; no cardiac output or pulse, and therefore no perfusion; rapidly fatal if not terminated in 3-5 min.
2. Most commonly caused by myocardial ischemia 3. Pt loses consciousness, becomes pulseless, and apneic (stops breathing) 4. 1st choice= defibrillate, then drugs: Immuteril, Lidocaine, Epineprine, Dopamine, Vasopressin (last choice since can only be used 1 time) 5. |
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1. Asystole?
2. Treatment? |
1. Pulseless, unconscious
2. CPR, External pacemaker, atropine, epinephrine |
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Preload is decreased when there is less blood return to the heart. this is caused by dilation of the ______
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veins
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Afterload is reduced because of dilation of the _____
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arteries
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Why should a Transderm Nitro patch be removed at night?
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removal of patch to allow for 8-12 hrs nitrate-free interval to prevent drug tolerance.
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what is the goal of Heparin therapy in a pt with angina or MI
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APTT of 1.5- 2x
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1. For Lovenox, don't need to monitor ___ or ____
2. For Coumadin, measure ___ & ___ |
1. PTT and INR
2. PTT and INR |
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What are 3 actions of morphine that make it useful in cardiac setting?
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- rapid onset of action
- dilates veins so preload is decreased & heart workload is decreased - relieves pain of MI |
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Before administering morphine, what do you check for?
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- check baseline resp rate
- check BP - monitor for respiratory depression |
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Antidote for morphine?
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- Naxolone aka Narcan
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Beta blockers aka Beta-Adrenergic blockers block the release of _____ and thus decrease HR & BP
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- catecholamines such as epinephrine, norepinephrine
- Beta Blockers are std protocol after MI and have been shown to increase survival rates of MI pts |
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There are 2 types of beta blockers
- Cardioselective - Noncardioselective Which type is preferred for cardiac pts? |
Cardioselective is preferred since Noncardioselective constrict your lungs (cause bronchoconstriction); so COPD pts shouldn't be put on these
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Why are ACE Inhibitors administered to pts who have had an MI?
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can prevent ventricular remodeling (scarring)
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Ca Channel Blockers?
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negative inotrope - decrease contractility; decrease workload of heart thus dec 02 need.
- Also dilate coronary & peripheral vessels - Diltiazem (Cardizen) |
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2 vitals to monitor for Ca Ch blockers?
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BP & HR (just like w Beta Blockers)
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Heparin measure is ___
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aPTT (activated partial thromboplastin)
- should be 1.5 to 2.5x normal |
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Coumadin aka ____ is measured by ____
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Warfarin;
PT (prothrombin time) 10 -12 sec INR (International normalized ratio) 1.3 to 2,0 |
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Name thrombolytic meds?
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- Activase, tPA
- Streptokinase |
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Name antiplatelet meds?
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-Aspirin (acetylsalicylic acid)
- clopidogrel (Plavix) |
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How do positive inotropes work?
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stimulate myocardial contractility which:
- improves blood flow to periphery and kidneys by increasing cardiac output - decreases preload - decreases fluid retention in lungs & extremeties - increases BP |
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Name positive inotrope meds?
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- Dobutamine (Adrenergic Agonists; also a catecholamine)
- Dopamine (Adrenergic Agonists) - Inamrinone (major side effect is thrombocytopenia) |
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Function of Cardiac glycosides like _____?
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Digoxin (Lanoxin)
- positive inotrope which increase myocardial contraction - negative chronotrope which slows heart rate |
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What do you monitor for pt taking digoxin?
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- digoxin toxicity- ( shown as prolonged PR interval on EKG)
- for hypokalemia (potassium level) which enhances digoxin toxicity - on EKG, hypokalemia would produce U waves - before giving digoxin, ck heart rate; if HR<60, don't give - controls rate of chronic A-Fib |
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Loop diuretics?
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- Furosemide (Lasix)
- are potassium wasting |
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SVR?
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Systemic Vascular Resistance
- vasoconstriction increases SVR - Vasodilation decrease SVR |
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- CVP (Central Venous Pressure) measures preload of RV
- PVR (Pulmonary Vascular Resistance) measures afterload of RV i e measures BP before blood is pumped through lungs - PAWP: Wedge pressure tells you LV afterload & preload |
T
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1. Elevated PAWP indicates_____
2. Decreased PAWP indicates____ While PAWP is inserted into R side of heart, it measures L side pressure |
1) LV failure, hypervolemia, mitral regurgitation
2) hypovolemia, afterload reduction |
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Signs of Digoxin toxicity?
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Anorexia, Dble vision, Blurred vision, halos
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A permanent pacemaker is inserted under general anesthesia & done under flouroscopy
- What is post-op care? |
- monitors heart rate & rhythm via EKG
- Chest xray to make sure leads are properly positioned -inspects insertion site |
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Nurse's pre-op resp for pt due for CABG surgery?
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-gets pt to sign consent
- prepares pt for post-op care; explains how to splint, deep breathe, cough - describe surgery: sternal incision, leg incision, chest tubes, foley - hold meds if diabetic - administer meds - antibiotics, anti HTN meds |
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Purpose of CPB (CardioPulmonary Bypass)
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- to provide O2, blood circ, hypothermia during induced cardiac arrest
- blood is heparinized, oxygenated & returned to body - pt core temp is cooled to 90 to slow metabolism & dec 02 need. - CPB machine can throw blood clots; won't know if pt had stroke until wakes up |
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Post-op care of CABG pt?
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- assess for dysrythmias
- monitor for complications of CABG: - fluid & electrolyte imbalance- may need to give potassium bolus due to hemodilution - hypothermia, hypertension - P: assess LOC - E: foley care, draining - R: assess for pain - S: assess for infection; use Bear Hugger to keep pt warm - O: pt on mech ventilator, monitor ABGs; Doc will keep pt hypotensive to prevent leaking of valves (if valve surg) |
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Risk factors for Infective Endocarditis?
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-Rheumatic Fever,
- valve repl: any infection entry site such as dental, skin rash, surgery - IV drug abuse |
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What is treatment of choice for prosthetic valve endocarditis?
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- first, antimicrobials, then valve repl
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Reasons for inserting a mechanical valve vs a biological valve?
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- young people get mechanical valve since they last longer; however, need to be on lifelong anticoagulants due to blood clots
- young people don't get biological valves since only last 7-10 yrs; younger pts also has higher calcium in blood and will calcify biological valves quicker. |
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Heart transplant list pts are at risk for sudden death & should report dec cardiac output causing dyspnea on exertion, dec exercise ability, fatique, palpitations, orthopnea, chest pain
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T
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What criteria are used for heart transplant candidate?
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-life expectancy < 1yr
- age <65 -absence of active infection - stable psychosocial - no evidence of drug/alcohol abuse - NY Heart Assoc class III or IV |
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Why will surgeon remove the diseased heart and leave the posterior atria in place?
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the atria serve as anchors for donor heart
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A heart transplant pt will show what on EKG?
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- will see 2 unrelated P waves-- 1 from donor heart and 1 from pt's atria
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How does post-op care for heart transplant pt differ from other cardiac surgery?
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- nurse must be especially vigilant to identify occult bleeding into pericardial sac w potential for cardiac tamponade
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Name the 4 pacemaker types in order of progression
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1) External pacemaker
2) Temporary external pacemaker 3) Permanent pacemaker 4) Pacemaker w AICD |
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Indications for PM?
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treat fainting spells, congestive heart failure, hypertrophic cardiomyopathy
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diff types of perm pacemakers?
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- Single chamber - 1 lead in atrium or ventricle
- Dual chamber - 1 lead in atrium and 1 lead in ventricle - Biventricular pacemaker- 3 leads: 1 in RA, 1 in RV, 1 in LV |
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1) Failure to Pace?
2) Failure to Sense? 3) Failure to Capture? |
1) if no spike occurs; Pacing is the delivery of impulse to heart causing spike; if single chamber PM, 1 spike before P wave; if dual chamber PM, then 2 spikes, 1 before P wave and 1 before QRS complex
2) PM isn't sensing pt's normal rhythm; so if PM is sensing properly, you only see spikes when HR falls below or above range 3) See spike but no QRS following; solution is to turn up output |
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Nursing role prepping pt for perm pm insertion?
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- consent witnessed
- NPO after midnight - |
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Post-op care of pt w perm pacemaker?
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- monitor HR & rhythm
- CXR to make sure leads are in proper pos - show pt how to care for wound - have pt carry pacemaker card & wear ID bracelet - inspect site for bleeding - assess for pain |
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Pt teaching for pacemaker?
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- don't lift heavy objects; more than 10 lbs
- no MRI; avoid strong electromagnetic fields: arc welding, - PM lasts 4-8 yrs - have FU appt in 5 wks to make adj to PM - take pulse on daily basis - notify PCP of dizzyiness, SOB, slow/fast HR |
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What is an ICD?
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Implantable Cardioverter Defibrilator. Used by pts:
- w 1 or more cardiac arrests - life-threatening Ventricular arrythmias - at risk for sudden death - recurrent V-tach |
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Pt/family teaching w ICD?
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- instruct family how to recognize, prevent & manage cardiac disorder that may set off ICD
- know how to perform CPR - When ICD fires, pt should lie down & call 911 - inform family members they may feel electric shock if touching pt when shock is delivered, but it's not harmful |