Cyanosis of nail beds (left) Dependent, pitting edema (right) Diminished or absent peripheral pulses (left) Gradually increasing heart rate (both) Reduced urinary output (both) Crackles heard on auscultation of the lungs (left) Extra heart sound (S 3 or S 4 ) (both) (Also refer to Significant findings indicating heart failure pg 430.)
Complication of Heart Failure: Acute Pulmonary Edema Severe dyspnea; a cough productive of frothy, pink‑tinged sputum (pulmonary edema/causing it/increased fluid buildup); tachycardia; and moist, bubbling respirations with cyanosis They sleep in the recliner because if the they lay down they feel like they’re drowning High Fowler’s position Oxygen, diuretics, morphine, and other prescribed drugs Limit and monitor activity Assess cardiopulmonary status
Cardiac conduction disorders Review chapter 17 for SA node, AV node, Bundle of HIS, and Perkinje Fibers How often does a healthy heart beat? 60-80 bpm
Etiology of Cardiac Conduction Disorders Congenital abnormalities Electrolyte disturbances Caffeine, illegal drug use, stress, medication side effects Valvular disorders, infarct, thyroid problems
Impulse Generation SA node generates impulses @ 60-100 times/min AV node generates impulses @ 40-60 times/min Purkinje Fibers @ 20-40 times/min Any disruption of the SA node leads to abnormal heart rhythm or arrhythmia/dysrhythmia
BOX 19-2 Evaluating ECG KNOW Find the QRS Is the rhythm regular or irregular? Calculate the rate by counting the QRS for 6 sec and multiply by 10 QRS should be 0.04 – 0.12 seconds (1-3 little boxes) Does every QRS look the same? Find the P wave directly in front of QRS Is there 1 P wave for every QRS? Measure P wave from start of P to start of QRS Should be 0.12 – 0.2 second (3-5 little boxes) Is the P wave length the same for every beat?
Signs and Symptoms: Cardiac Conduction Disorders Severity of the symptoms depends on if it is atrial or ventricular in nature, amount of CO, and if dysrhythmia is persistent Sinus rhythm (“normal”) Electrical impulse originates in sinus node Atrial rhythm Impulse originates in atrium Ventricular rhythm Impulse originates in ventricles
Signs and Symptoms: Cardiac Conduction Disorders Tachycardia HR >100 bpm Ventricles do not have adequate filling time Heart unable to pump effectively S/S – dizziness, palpitations, fatigue, chest pain, unconsciousness >150 is considered too fast Calcium channel blockers-inhibit transmission of the impulse at AV node Atrial fibrillation/flutter Atria quiver (up to 300 times/min) rather than contract Healthy heart receives “atrial kick” – which accounts for 20% of ventricular stroke volume Drops CO d/t decreased blood in the ventricles Clot formation – need to be started on anticoagulants!
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- Fall '19
- right ventricle, Heart block, Heart failure