Next Gen NCLEX Review Miami Dade College

Mark Klimek Lecture 3 Cardiac Medication, Calcium Channel Blockers, Cardiac Arrhythmias, Chest Tube, Congenital Heart Defects, Infectious Disease, PPE Next Gen NCLEX Review (Miami Dade College) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Mark Klimek Lecture 3 Cardiac Medication, Calcium Channel Blockers, Cardiac Arrhythmias, Chest Tube, Congenital Heart Defects, Infectious Disease, PPE Next Gen NCLEX Review (Miami Dade College) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by Morris Muthii ([email protected]) lOMoARcPSD|40307388

Lecture 3 Cardiac Medication, Calcium Channel Blockers, Cardiac Arrhythmias, Chest Tube, Congenital Heart Defects, Infectious Disease, PPE

Calcium Channel Blockers CCBs (Calcium channel blockers) are like Valium for the heart

• They relax and slows down the heart
• In other words, CCBs have negative inotropic, chronotropic, dromotropic effects on

the heart

(+) Inotropy, Chronotropy, Dromotropy Positive inotropy Increase cardiac contractile force → Ventricles empty more completely → Cardiac output improved Positive chronotropy Increase rate of impulse formation at SA node → Accelerate heart rate Positive dromotropy Increase speed that impulses from SA node travel to AV node (increase conduction velocity)

When do you want to relax and slows down the heart? … To treat “A, AA, AAA”

• Antihypertensive
• AntiAnginal drugs (decreasing oxygen demand)
• AntiAtrialArrhythmia

Side Effects Headache and hypotension

Name: ends in “dipine” … Not “pine”

• Also, verapamil, Cardizem (diltiazem)
• Cardizem (diltiazem) is given continuous IV drip

What are the parameters to assess before putting a pt on CCBs?

• Assess for BP - Hold if SBP <100

(–) Inotropy, Chronotropy, Dromotropy Negative inotropy Weaken/decrease the force of myocardial contraction

Negative chronotropy Decrease rate of impulse formation at the SA node → decelerate heart rate Negative dromotropy Decrease speed that impulses from SA node travel to AV node (decrease conduction velocity)

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Cardiac arrhythmias

• Knowing how to interpret rhythm.
• Must know the following 4 cardiac rhythms by sight

Normal Sinus Rhythm

• There is a P wave, followed by a QRS, followed be a T wave for every complex
• Peaks of the P wave is equally distant to the QRS, and fall within 5 small boxes

Ventricular Fibrillation

• No pattern

Ventricular Tachycardia

• Sharp peaks with a pattern

Asystole

• A flat line

Extras:

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If the question mentions

• QRS depolarization = Ventricular
• P wave = Atrial

The 6 rhythms most tested on the NCLEX

• A lack of QRS complexes is asystole—a flat line
• P waves (atrial) in the form of saw tooth wave = atrial flutter

3. Chaotic P wave patterns = atrial fibrillation (a-fib) (Chaotic: word used to

describe fibrillation)

• Chaotic QRS complexes = ventricular fibrillation (v-fib)
• Bizarre QRS complexes = ventricular tachycardia (v-tach) (Bizarre: word used to

describe tachycardia)

• Periodic wide bizarre QRS complexes = PVCs (Salvos of PVCs = A short runs of v-

tach)

PVCs (premature ventricular contractions) are usually low priority • However, elevate them to moderate priority if under the following 3 circumstances

• There are 6 or more PVCs in a minute
• More than 6 PVCs in a row
• R on T phenomenon (a PVC falls on a T wave)

• PVCs after an MI is common and is a low priority

Lethal arrhythmias are high priority and will kill a patient in 8 minutes or less. They

are:

• Asystole and V-fib (ventricular fibrillation) • Both rhythms produce low or no cardiac output (CO), without which there is inadequate or no brain perfusion. This may lead to confusion and death

Potentially Lethal Cardiac Arrhythmia V-tach (ventricular tachycardia) is a potentially lethal cardiac rhythm, but it has a CO

How would a patient with or without CO presents?

• CO is absent = there is no pulse
• CO is present = there is a pulse

There are 3 levels of nursing knowledge

• Stuff you need to know
• Stuff that is nice to know
• Stuff that is nuts to know

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