Chapter 16 Cardiac Care Skills.

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Presentation transcript:

Chapter 16 Cardiac Care Skills

Electrical Conduction of the Heart Two phases of the cardiac cycle are contraction and relaxation Heart beats during contraction, pumping blood to the body Heart rests and recovers during relaxation Understanding normal heart conduction means understanding a cardiac rhythm Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.

Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED. The Pacemaker Electrical activity resulting in a heartbeat begins in the pacemaker Any heart tissue can function as the pacemaker Normal pacemaker is in the right atrium, called sinoatrial node (SA node) SA node fires 60 to 100 times each minute Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.

The Atrioventricular Node AV node is located on the bottom of the atrium, just above the ventricles AV node conducts the electrical impulse into the ventricles If AV node acts as pacemaker, it sends impulses at 40 to 60 beats per minute Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.

Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED. The Ventricles Ventricles: bottom chambers of heart Impulse travels through right and left bundle branches and Purkinje fibers Structures work together and cause ventricles to contract Contraction results in a heartbeat forcing blood throughout the body Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.

Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED. The Ventricles Ventricles can function as the pacemaker at a rate of 20 to 40 beats per minute Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.

Monitoring the Heartbeat P wave Pacemaker firing and sending impulse through the atria PR interval Length of time it takes impulse to travel through the atrium and AV node Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.

Monitoring the Heartbeat QRS complex Impulse traveling through the ventricles T wave Resting and recovery phase of the heart Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.

Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED. The Twelve Lead ECG Lead I Right arm negative; left arm positive Lead II Left leg positive; right leg negative Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.

Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED. The Twelve Lead ECG Lead III Left arm negative; left leg positive Central terminal At intersection of leads I, II, and III Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.

Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED. The Twelve Lead ECG Limb leads include leads I, II and III, and AVR, AVL, and AVF Einthoven’s triangle consists only of leads I, II, and III Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.

Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED. The Twelve Lead ECG Leads I, II, and III are called standard leads or bipolar leads These show the difference in electrical potential between two limb electrodes Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.

Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED. The Twelve Lead ECG Central terminal is negative; limb electrodes are positive Lead II and right chest leads identify cardiac problems They best show the P wave Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.

Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED. The Twelve Lead ECG P wave To identify a dysrhythmia, or abnormal heart rhythm (also referred to as “arrhythmia”) Remember to treat the patient, not the monitor! Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.

Apical Radial Pulse Rate Comparison of apical and radial pulse; usually they are the same Difference between apical and radial pulse is pulse deficit Pulse deficits are present in some forms of heart disease Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.

Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED. Pulses in Legs and Feet Femoral pulse Center of crease in leg near groin Posterior tibial pulse Posterior to inner ankle Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.

Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED. Pulses in Legs and Feet Dorsalis pedis artery Imaginary line drawn from the ankle to between the great toe and second toe Count the pulse for one full minute Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.

Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED. Other Measurements If peripheral pulse is weak or irregular, check the apical pulse Use Doppler to amplify pulse Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.

Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED. Other Measurements Hypotension Blood pressure below 100/60 Prehypertension 120/80 to 139/89 (likely to develop high blood pressure) Hypertension Blood pressure over 140/90 Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.

Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED. Infection Control Blood pressure cuffs Potential source of infection Some facilities issue a disposable cuff to each patient Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.

Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED. Infection Control Others require personnel to wipe the cuff with a disinfectant solution after each patient Follow your facility policies for prevention of infection Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.

Cardiac Catheterization Diagnostic procedure that requires threading a catheter into the heart Complications Nausea, vomiting Low blood pressure Bradycardia Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.

Cardiac Catheterization Complications Internal bleeding in which the patient may complain of thigh, back, or groin pain Hematoma formation at the puncture site Myocardial infarction Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.

Angiogram or Arteriogram X‑ray study of the blood vessels Specific vessels are studied by positioning a catheter into the artery Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.

Angiogram or Arteriogram Contrast medium Special dye injected through catheter during x-ray Enables physician to see blood vessels and identify potential problems Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.

Post-Arteriogram (Angiogram) Care Maintain bedrest for 4 to 6 hours Keep the head flat for 3 hours Keep operative extremity extended Evaluate vital signs and peripheral pulses Every 15 minutes x 4 Every 30 minutes x 4 Hourly until discharged Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.

Post-Arteriogram (Angiogram) Care Monitor puncture site for bleeding and hematoma Encourage fluids and monitor I&O Verify patient has voided prior to discharge Inform RN if patient develops complications Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.