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  • 1. Cardiac ArrestCardiac Arrest By Kristi Eilers and Hali Saucier, N441 Senior SeminarBy Kristi Eilers and Hali Saucier, N441 Senior Seminar
  • 2. What is V-fib? What does a patientWhat is V-fib? What does a patient with V-fib look like?with V-fib look like?
  • 3. Ventricular FibrillationVentricular Fibrillation  ventricle “quivers.”ventricle “quivers.”  No effectiveNo effective contractioncontraction  No cardiac output.No cardiac output.  Pt is unresponsive,Pt is unresponsive, pulseless, apneic.pulseless, apneic. Lewis S.L., Heitkemper M.M., Dirkesen S.R., O’Brien P.G., & Bucher L. (2007). Medical surgical nursing: Assessment and management of clinical problems (7th ed.). St. Louis: Mosby Elsevier.
  • 4. Fill in the blank:Fill in the blank: TThehe mitral valvemitral valve separates theseparates the __________and the __________.__________and the __________.
  • 5.  The mitral valveThe mitral valve separates theseparates the leftleft atriumatrium and theand the leftleft ventricleventricle..
  • 6. What is MVP?What is MVP? (and no, we’re not talking about sports!)(and no, we’re not talking about sports!)
  • 7. Mitral Valve ProlapseMitral Valve Prolapse  One or both cusps ofOne or both cusps of the mitral valve fallthe mitral valve fall back into LA duringback into LA during contractioncontraction  Congenital defectCongenital defect  May have a murmurMay have a murmur  Can lead to heartCan lead to heart failurefailure  SCD is a rareSCD is a rare complication of MVPcomplication of MVP Lewis S.L., Heitkemper M.M., Dirkesen S.R., O’Brien P.G., & Bucher L. (2007). Medical surgical nursing: Assessment and management of clinical problems (7th ed.). St. Louis: Mosby Elsevier.
  • 8. What is the difference between A-What is the difference between A- fib and A-flutter?fib and A-flutter?
  • 9. Atrial dysrhythmiasAtrial dysrhythmias  A-fibA-fib – Disorganized electricalDisorganized electrical activity due toactivity due to multiplemultiple ectopic foci.ectopic foci. – High atrial rate, not all theHigh atrial rate, not all the signals get through.signals get through. – Most common dysrhythmiaMost common dysrhythmia  A-flutterA-flutter – Atrial tachydysrhythmiaAtrial tachydysrhythmia – ““sawtooth” patternsawtooth” pattern – Regular, flutter wavesRegular, flutter waves – Originates from aOriginates from a singlesingle ectopic sourceectopic source Lewis S.L., Heitkemper M.M., Dirkesen S.R., O’Brien P.G., & Bucher L. (2007). Medical surgical nursing: Assessment and management of clinical problems (7th ed.). St. Louis: Mosby Elsevier.
  • 10. What type of drug is dopamine?What type of drug is dopamine? What does it do?What does it do?
  • 11. DopamineDopamine ββ-adrenergic agonist-adrenergic agonist – ↑↑HRHR – ↑↑COCO – ↑↑BPBP
  • 12. What type of drug is lidocaine?What type of drug is lidocaine? What does it do?What does it do?
  • 13. LidocaineLidocaine - Antidysrhythmic drugAntidysrhythmic drug - Sodium channel blocker (decreasesSodium channel blocker (decreases conduction velocity)conduction velocity) - Also used as a local anestheticAlso used as a local anesthetic
  • 14. What is the equation for cardiacWhat is the equation for cardiac output?output?
  • 15. CO = HR X SVCO = HR X SV
  • 16. What isWhat is sudden cardiac deathsudden cardiac death oror cardiac arrestcardiac arrest? What are the risk? What are the risk factors?factors?
  • 17. Sudden Cardiac DeathSudden Cardiac Death  Unexpected death from cardiacUnexpected death from cardiac causes within 1 hour of the onsetcauses within 1 hour of the onset of symptoms.of symptoms.  Abrupt disruption of cardiacAbrupt disruption of cardiac function, producing and abruptfunction, producing and abrupt loss of CO and cerebral bloodloss of CO and cerebral blood flow.flow.  300,000 deaths per year300,000 deaths per year  Caused by acute ventricularCaused by acute ventricular dysrhythmias, or primary leftdysrhythmias, or primary left ventricular outflow obstructionventricular outflow obstruction (aortic stenosis)(aortic stenosis)  AKA “cardiac arrest”AKA “cardiac arrest”  Still referred to as SCD even ifStill referred to as SCD even if victim survivesvictim survives (Copstead & Banasik, 2005) (Lewis, 2007)
  • 18. Risk factors for SCDRisk factors for SCD  CAD (especially hx of MI)CAD (especially hx of MI)  Family hxFamily hx  ArrhythmiasArrhythmias  Birth defects of heart or blood vessels, orBirth defects of heart or blood vessels, or an enlarged heart (an enlarged heart (MVPMVP))  Heart failureHeart failure  Recreational drug use (cocaine)Recreational drug use (cocaine)
  • 19. LabsLabs  Acute Coronary syndrome/MIAcute Coronary syndrome/MI – CK-MBCK-MB – TroponinTroponin – MyoglobinMyoglobin – Lipid panelLipid panel – CBCCBC – C-reactive proteinC-reactive protein – HomocysteineHomocysteine  BNP:BNP: evaluate HFevaluate HF  PT/INRPT/INR (coumadin)(coumadin)  Digoxin levelDigoxin level  K+:K+: hyperkalemiahyperkalemiaST-segment depression. HypokalemiaST-segment depression. Hypokalemiadigdig toxicity, dysrhythmiastoxicity, dysrhythmias  Mg+:Mg+: low Mg can aggravate arrhythmias. High retards conduction.low Mg can aggravate arrhythmias. High retards conduction.  ABGs:ABGs: to evaluate oxygenationto evaluate oxygenation  Blood glucose:Blood glucose: MI can increase glucose levels because of stressMI can increase glucose levels because of stress to bodyto body Pagana K.D., & Pagana T. J. (2006). Mosby’s manual of diagnostic and laboratory tests (3rd ed.). St. Louis: Mosby Elsevier.
  • 20. Lidocaine Toxicity?Lidocaine Toxicity?  S/s: HA, drowsiness, tremor,S/s: HA, drowsiness, tremor, paresthesia, tinnitus, nystagmus,paresthesia, tinnitus, nystagmus, blurred vision, slurred speech,blurred vision, slurred speech, dizziness,dizziness, confusionconfusion ,, disorientationdisorientation, hyperactivity, coma,, hyperactivity, coma, seizures.seizures.  Toxicity is 5mg/L, severe toxicity isToxicity is 5mg/L, severe toxicity is greater than 9mg/L. (K.K’s level wasgreater than 9mg/L. (K.K’s level was 16.8)16.8)  Toxicity symptoms persist for as longToxicity symptoms persist for as long as drug levels are toxic in the bloodas drug levels are toxic in the blood (Peralta, 2007).(Peralta, 2007).  Half-life:Half-life: The amount of time it takesThe amount of time it takes for the drug level to decrease by 50%for the drug level to decrease by 50% (Deglin & Vallerand, 2007).(Deglin & Vallerand, 2007).  Terminal half-life of lidocaine = 2 hrsTerminal half-life of lidocaine = 2 hrs HourHour ConcentrationConcentration 00 16.816.8 22 8.48.4 44 4.24.2 66 2.12.1 Wooten, J.M., Earnest, J., & Reyes, J. (2000). Review of common adverse effects of selected antiarrhythmic drugs. Critical Care Nusing Quarterly, 22(4), 23-38.
  • 21. An ICD monitors the heartbeat and delivers shock whenAn ICD monitors the heartbeat and delivers shock when it detects lethal dysrhythmia.it detects lethal dysrhythmia. Implantable Cardioverter Defibrillator
  • 22. Discharge Instructions for ICDDischarge Instructions for ICD Information from table 36-9 in Lewis medical/surgical textbookInformation from table 36-9 in Lewis medical/surgical textbook  Follow up with PCPFollow up with PCP  Report any s/s of infection at the incision siteReport any s/s of infection at the incision site  Keep incision dry for 4 daysKeep incision dry for 4 days  Avoid lifting arm on ICD side above shoulder until approved by PCPAvoid lifting arm on ICD side above shoulder until approved by PCP  Discuss resuming sexual activity with PCP. It’s safe once the incision isDiscuss resuming sexual activity with PCP. It’s safe once the incision is healed.healed.  Avoid driving until cleared with PCPAvoid driving until cleared with PCP  Avoid direct blows to ICD siteAvoid direct blows to ICD site  Avoid large magnets and strong electromagnetic fields because they mayAvoid large magnets and strong electromagnetic fields because they may interfere with the deviceinterfere with the device  Never have an MRINever have an MRI  Inform airport security when traveling because it may set off the metalInform airport security when traveling because it may set off the metal detector.detector.  IF your ICD fires, call health care provider immediatelyIF your ICD fires, call health care provider immediately  IF your ICD fires and you do not feel well, contact EMSIF your ICD fires and you do not feel well, contact EMS  Wear a medic alert ID or bracelet at all timesWear a medic alert ID or bracelet at all times  Always carry the ICD identification card and a current list of yourAlways carry the ICD identification card and a current list of your medicationsmedications  Family members should learn CPR.Family members should learn CPR.
  • 23. Sexual ConcernsSexual Concerns According to a 2003 study inAccording to a 2003 study in Critical CareCritical Care Nursing:Nursing: - Patients need writtenPatients need written education tools specific toeducation tools specific to sexual issues forsexual issues for patients/partnerspatients/partners - Health care professionals needHealth care professionals need educational resources to passeducational resources to pass on to patientson to patients - 42.5% of ICD patients in the42.5% of ICD patients in the study reported a concern thatstudy reported a concern that sexual activity would triggersexual activity would trigger the device.the device. - 82% of subjects reported that82% of subjects reported that their ICD had not fired duringtheir ICD had not fired during sexsex - ICD firing only happened in 3ICD firing only happened in 3 patients within a year (therepatients within a year (there were about 387 participants)were about 387 participants) TIPS:TIPS: - ICD patients can resumeICD patients can resume sexual activity after incision issexual activity after incision is healedhealed - Alter positions to decreaseAlter positions to decrease physical activity and strainphysical activity and strain - Slow down, make sex relaxingSlow down, make sex relaxing - Alternative ways of expressingAlternative ways of expressing sexuality (touching, holding,sexuality (touching, holding, etc.)etc.) - ““Is there a better way to go?”Is there a better way to go?” – Dr. Carr– Dr. Carr 
  • 24. Nursing DiagnosesNursing Diagnoses  Fluid Volume ExcessFluid Volume Excess  Knowledge deficitKnowledge deficit  Ineffective Health-MaintenanceIneffective Health-Maintenance  FearFear  Risk for infectionRisk for infection  Confusion (possibly chronic)Confusion (possibly chronic)
  • 25. Works CitedWorks Cited  Ackley B.J. & Ladwig G.B. (2006).Ackley B.J. & Ladwig G.B. (2006). Nursing diagnosis handbook: A guide to planning careNursing diagnosis handbook: A guide to planning care (7th ed.). St. Louis:(7th ed.). St. Louis: Mosby Elsevier.Mosby Elsevier.  Channer, K., & Morris, F. (2002). ABC of clinical electrocardiography: Myocardial ischaemia.Channer, K., & Morris, F. (2002). ABC of clinical electrocardiography: Myocardial ischaemia. British MedicalBritish Medical Journal, 324Journal, 324(7344): 1023–1026. Retrieved March 2, 2008 from(7344): 1023–1026. Retrieved March 2, 2008 from http://http:// www.pubmedcentral.nih.gov/articlerender.fcgi?toolwww.pubmedcentral.nih.gov/articlerender.fcgi?tool==pmcentrez&artidpmcentrez&artid=1122957%20=1122957%20..  Copstead L.C., & Banasik J.L. (2005).Copstead L.C., & Banasik J.L. (2005). PathophysiologyPathophysiology (3rd ed.). St. Louis: Elsevier Saunders.(3rd ed.). St. Louis: Elsevier Saunders.  Deglin J.H., & Vallerand A.H. (2007).Deglin J.H., & Vallerand A.H. (2007). Davis’s drug guide for nursesDavis’s drug guide for nurses (10th ed.). Philadelphia: F.A. Davis Company.(10th ed.). Philadelphia: F.A. Davis Company.  Dougherty, C.M., Lewis, F.M., Thompson, E.A., Baer, J.D., & Kim, W. (2004). Short-term efficacy of a telephoneDougherty, C.M., Lewis, F.M., Thompson, E.A., Baer, J.D., & Kim, W. (2004). Short-term efficacy of a telephone intervention by expert nurses after an implantable cardioverter defibrillator.intervention by expert nurses after an implantable cardioverter defibrillator. Pacing & Clinical Electrophysiology,Pacing & Clinical Electrophysiology, 27,27, 1594-1602.1594-1602.  Dougherty, C.M., Pyper, G.P., & Benoliel, J.Q. (2004). Domains of concern of intimate partners of sudden cardiacDougherty, C.M., Pyper, G.P., & Benoliel, J.Q. (2004). Domains of concern of intimate partners of sudden cardiac arrest survivors after ICD implantation.arrest survivors after ICD implantation. Journal of Cardiovascular Nursing, 19Journal of Cardiovascular Nursing, 19(1), 21-31.(1), 21-31.  Kamphius, H., Verhoeven, N., De Leeuw, R., Derksen, R., Hauer, R., & Winnubst, J. (2004). ICD: a qualitativeKamphius, H., Verhoeven, N., De Leeuw, R., Derksen, R., Hauer, R., & Winnubst, J. (2004). ICD: a qualitative study of patient experience the first year after implantation.study of patient experience the first year after implantation. Journal of Clinical Nusing, 13,Journal of Clinical Nusing, 13, 1008-1016.1008-1016.  Lewis S.L., Heitkemper M.M., Dirkesen S.R., O’Brien P.G., & Bucher L. (2007).Lewis S.L., Heitkemper M.M., Dirkesen S.R., O’Brien P.G., & Bucher L. (2007). Medical surgical nursing:Medical surgical nursing: Assessment and management of clinical problemsAssessment and management of clinical problems (7th ed.). St. Louis: Mosby Elsevier.(7th ed.). St. Louis: Mosby Elsevier.  Mayo Clinic Staff (2006) Implantable cardioverter-defibrillators: Controlling a chaotic heart. Retrieved March 2,Mayo Clinic Staff (2006) Implantable cardioverter-defibrillators: Controlling a chaotic heart. Retrieved March 2, 2008 from2008 from http://www.mayoclinic.com/print/implantable-cardioverter-defibrillator/HB00003/METHOD=printhttp://www.mayoclinic.com/print/implantable-cardioverter-defibrillator/HB00003/METHOD=print  Pagana K.D., & Pagana T. J. (2006).Pagana K.D., & Pagana T. J. (2006). Mosby’s manual of diagnostic and laboratory testsMosby’s manual of diagnostic and laboratory tests (3rd ed.). St. Louis:(3rd ed.). St. Louis: Mosby Elsevier.Mosby Elsevier.  Peralta, Ruben. (2007) Lidocaine toxicity. Retrieved March 4, 2008 fromPeralta, Ruben. (2007) Lidocaine toxicity. Retrieved March 4, 2008 from http://www.emedicine.com/MED/topic1297.htmhttp://www.emedicine.com/MED/topic1297.htm  Peskine, A., Picq, C., & Pradat-Diehl, P. (2004). Cerebral anoxia and disability.Peskine, A., Picq, C., & Pradat-Diehl, P. (2004). Cerebral anoxia and disability. Brain Injury, 18Brain Injury, 18(12), 1243-1254.(12), 1243-1254.  Steinke, E. (2003). Sexual concerns of patients and partners after an implantable cardioverter defibrillator.Steinke, E. (2003). Sexual concerns of patients and partners after an implantable cardioverter defibrillator. Dimensions of Critical Care Nursing, 22Dimensions of Critical Care Nursing, 22(2), 89-96.(2), 89-96.  Wooten, J.M., Earnest, J., & Reyes, J. (2000). Review of common adverse effects of selected antiarrhythmicWooten, J.M., Earnest, J., & Reyes, J. (2000). Review of common adverse effects of selected antiarrhythmic drugs.drugs. Critical Care Nusing Quarterly, 22Critical Care Nusing Quarterly, 22(4), 23-38.(4), 23-38.