Cardiac NCLEX® Quick Points

Cardiac NCLEX® Quick Points

Okay, on this video, we re just kinda condense
and talk very briefly about some of the things that weren t covered in the disease specific
videos relating to the cardiac system and some of the things that you really need to
know. So, this is gonna bring about a lot of kind of electic is gonna seem a little
bit random but we re gonna talk about the things that you really need to know for NCLEX
just as quick points, okay? So, first of all, heart rate. What is a normal
heart rate? Well, we all know that normal heart rate is 60-100. Sinus tachycardia is
gonna be over 100 beats per minute and Sinus bradycardia is gonna be less than 60 beats
per minute. And the way that we re obviously gonna assess that is gonna be through our
EKG, we have our P, Q, R, S, and T. This is gonna be one complete cardiac cycle. This
is the mechanical representation of one complete cardiac cycle and we re looking, hoping that
our patients are between 60 – 100 beats per minute. That s gonna be normal. Sinus tachy
is gonna be greater than 100. Sinus brady is gonna be less than 60. Okay. So, now very quickly, let s talk about
the vascular system. Hopefully, this is not new information for you at all. But, our vascular
system consists of arteries and veins, then there s venules, arterioles, and there s capillaries,
okay? So, basically, we have our heart, and coming out of our heart is gonna be arteries
and then it gonna go to arterioles which are gonna be a little bit smaller, and then we
re gonna have this capillary network, okay, within different organs. And then, we re gonna
have our venules, and then we re gonna have our veins bringing it back to the heart. Easy
way to remember this is arteries take blood away and venules or veins bring blood back.
I remember that because I learned Spanish back in the day and viene means to come. So,
V, Viene , comes back to the heart. A for away, arteries and then again you have your
arterioles and this is gonna be our capillary bed. And the capillary network is really what
s gonna be within organs, so like for an example, here s a kidney, here s a kidney, or a pancreas,
there s kidney right there, then you re also gonna have your liver, and those are all gonna
be, have all these capillaries, or these arteries and veins within those. So, that s kinda your
capillaries are gonna branch out and perfuse all those different areas. And here s lungs,
of course. And, so, on this picture here, the red is going to indicate arteries and
your blue is gonna indicate a vein. Okay, here s your aorta, and then here s your vena
cava. Okay, so that s very simple overview of the vascular system. Now, when we have a patient who is suspected
of having a heart attack, one thing that we re gonna run is we re gonna run with our cardiac
markers. Another way to refer this is gonna be CIP s: Cardiac Injury Profile. Okay, Cardiac
Injury Profile is going to be a set of a few labs that we run to determine the extent or
the presence of cardiac damage. That s going to consist of Troponin, that s gonna be Troponin
I and Troponin T, CK-MB and Myoglobin. I know we talked about this in our Myocardial Infarction
lecture. But very briefly, Troponin is going to be your most sensitive to cardiac damage,
however, it takes 12 hours to peak. Your CK-MB is gonna be a little bit less sensitive and
it takes a little bit longer than your Troponins. Myoglobin, very low specificity to infarction
because this can indicate damage to muscles in general. It does peaks the fastest but
very low specificity. So the number that we re gonna be concerned about are the Troponins,
and most of all, I mean, in my hospital, the number that we re really looking at is our
Troponin I. Okay, if our Troponin I is elevated, then that s an indicative of infarction. Okay,
specially when we can match that up with an EKG, if we have an EKG that shows like an
ST Elevation, and we have Troponins that are elevated, the patient is having a heart attack.
If we have a Non-STEMI but we have our elevated Troponins, we can also determine that they
maybe having a heart attack. So, Cardiac Labs. These are gonna be some
of the labs you re going to be concerned about with cardiac damage. First of all is gonna
be potassium, a normal potassium is 3.5 – 5. We know that hypokalemia, so less than 3.5
can lead to ventricular dysrhythmias, increased digoxin toxicity if your patient is receiving
digoxin, it can develop a U wave. Now, what a U wave is, is it s, so here s our normal,
then there will be an additional wave here, this is gonna be our U wave and this is gonna
show up with hypokalemia. This could also lead to ST depression. Again, ST depression,
here s our, so ST depression is gonna look like that. So, Q, R, S, and T, so instead
of ever really coming up, it will just go below our isoelectric line and that s gonna
be ST depression. Hyperkalemia can lead to peaked T waves, so, what you ll see with your
patient is they will have a T wave that s very high and maybe almost as high as your
Q, R, S. And then, you ll also have the widened QRS and then it could lead to ventricular
dysrhythmias as well. And again, if this QRS continues to widen, that s gonna lead to severe
ventricular arrythmias and then you ll gonna have your peaked T waves. So, what I would
do, if you have a patient that s on 5-lead continuous cardiac monitoring or whatever,
if you start noticing that these T waves are elevating, you know, cause your normal T waves
is gonna be way down here, we notice that these T waves start to elevate, what I would
do, is I would just kinda call a physician and say Hey, you know, I noticed the EKG is
getting a little bit funky. We re getting these changes in the T wave. Do you mind if
I run, just get like a CBC or a BNP, you know. Another lab we re gonna look about at is Hematocrit.
Hematocrit is basically percent of RBC s in the blood. It s different for males and females.
But as that number goes up, as our percent of red blood cells goes up, that s gonna be
indicative of dehydration. Why is that? Well, you know, part of our blood, only a portion
of our blood is red blood cells, as you can see here, it s 30 – 50 % or so, and the rest
is gonna be different fluids and things. So, if that continues to go up, you know, and
we re at 60 for our hematocrit, that s gonna mean there s less of the other fluids which
shows that we are dehydrated. On the other hand, if our hematocrit goes down, hemoglobin
goes down, that can be indicative of anemia. Another lab that you re gonna look at for
your cardiac patients is gonna be lipids, it s gonna be total cholesterol, you want
to have under 200 mg/dL, LDL, that s our bad cholesterol, you want it under 130, HDL, happy,
high density lipoproteins, you want that between 30 and 70, and that s our good cholesterol.
Okay. A couple of the labs I did not write on here but I want you to remember are gonna
be BNP, I know we talked about this with heart failure, that s brain natriuretic peptide,
and what happens with that, as the ventricles stretch, as there s increase ventricular stretch,
that s gonna release BNP into the system. Normal value should be under a 100. You might
notice patients with heart failure have levels 4,000 and above. But anytime we get up over
a 100, that s gonna be indicative of ventricular stretch and heart failure. What was another
lab I want to talk about? BNP, that s really a big one, indicative of heart failure. Okay. Holter Monitoring. So, Holter Monitoring is
important for patients who maybe have angina, whether it s stable or unstable or prinzmetal
angina, because what this can do, as you can see here, this is a picture of a Holter monitoring.
It can be worn on a patient, it s supposed to be worn in 24 hours and it can be worn
under their clothes. And, it s kinda have this continuous EKG monitoring. What the patient
needs to do is, it s going to store this data, it s going to store their EKG, and as they
start to have chest pain, they need to write down the time they have chest pain and what
they were doing. And what can happen from that is the physician can take that EKG print
out and they can match it up with what the patient s activities were, and what was going
on, and they can kinda give them a better idea of the angina, better idea of what s
causing the abnormalities in their EKG. But that s basically Holter Monitoring. This patient
or this picture should help you remember. While we re on this one, let s talk about
too, about EKG placement. So, for our 5 Lead EKG, now, as you guys know, I don t like mnemonics,
okay? The reason why I don t like mnemonics is because I believe that if you understand
the process, if you understand what s going on, you re going to better understand and
remember forever the process and exactly what s going on. So, as you can separate learning
mnemonics from learning the systems and the processes, I think you can better understand.
However, for EKG placement, I think that there s an easy way to remember the mnemonic because
it is just color-based. So, we wanna have our white one, we have our green one, black,
red, and brown. So, best way to remember this is white on right, so, white on right is the
first thing to remember, we have white on right, and then you ll do SNOW over TREES
and SMOKE over FIRE. Okay, so, white is snow, right? Green is the color of trees. Black
is the color of smoke and smoke comes out over fire right? And so smoke rises over fire.
So, white on right, and snow over trees, white over green, and then smoke over fire, our
brown is our ground, and that s gonna go right in the middle. Alright. So, that s the best
way to remember 5 Lead EKG placement. Last thing we wanna talk about here is cardiogenic
shock. So, what happens with cardiogenic shock is the heart is unable to maintain effective
cardiac output. This can be due to various reasons, heart failure, disruptions in the
cardiac functions. And, so, what we re gonna see is, so, shock. What we need to understand
really quickly though is shock is a decreased delivery of oxygen to the body. And so, as
oxygen delivery is decreased and it s affected, our organs are not gonna be able to function
appropriately. So, it s not necessarily low blood volume, necessarily what it is, is decreased
delivery of oxygen to the tissues and then the tissues are not able to function without
that oxygen. So, what happens with our heart, is, for whatever reason, our heart is not
beating as it should, it s not maintaining effective cardiac output. Okay. Cardiac output
is volume of blood out in 1 minute, okay? So, some of these reminds us is gonna be low
urine output. Why is that? Well, we re not delivering enough oxygen to our kidneys, or
enough blood to our kidneys, so, the kidneys are not able to work appropriately. We re
gonna have low urine output. Low BP, obviously, low cardiac output. The thing we re gonna
want to assess most with this is our CVP. Okay. The reason we assess CVP, what that
tells us, is it tells us the right atrial preload and what right atrial preload basically
tells us is it tells us the overall volume in the system. Okay. The system is our body,
okay? Because what CVP is, is CVP tells us right atrial preload basically. It s really
gonna tell us the preload in the right side of our heart. Okay. And if we know the preload
of the right side of our heart, we basically know about how much volume is kinda in the
system. So, what is preload? Preload is gonna be the stretch as the ventricles fills up,
okay. So, as the volume comes in, the stretch, the pressure exerted on those as the volume
fills up. Normal CVP is gonna be 2 – 8 mmHg. Okay, so, if you have a very high CVP, that
means it s gonna be indicative of like hypervolemia etc., if you have a low CVP, that means we
have a decrease in volume. Okay, so, a CVP of less than 2 or hovering around there is
gonna be indicative of low volume. Okay. So, that might mean we need to supply more volume.
However, if we have a CVP of greater than like 8, 6 or 8 or so, that s gonna mean we
have high volume and volume is not our problem, okay? So, if the patient is ventilated, you
wanna take the end expiration and you re gonna zero the transducer at the fourth intercostal
space along the mid axillary line and that s the location of the right atrium. Okay,
where is that at? So, mid axillary line is here under the armpit and then you re gonna
wanna the fourth intercostal space. And you have a little transducer, so this will be
going like in your jugular and then we re gonna end up with these wave forms and we
want that to be 2-8 mmHg. Okay, so that s gonna tell us our CVP. Hopefully, that makes a little bit of sense
about cardiogenic shock, we ll go into shock in greater detail later. But, that s really
kinda what you need to know. You don t need a lot to know a lot about shock for NCLEX.
If you start working in an ICU, that s gonna be a topic you re wanna come back to and visit
quite often. If you have any questions, you guys, let us know. Those are some of the quick
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12 thoughts on “Cardiac NCLEX® Quick Points

  1. when mentioning HYPERkalemia at around 6:50, you state you'd run a BMP and if the K was 2.7 you'd understand why there were peaked T waves. I think you mean to say an elevated K, not a low K….

  2. I signed up for your "Free" course and watched the first two videos. When it was time to watch this cardiac video your "Free" program asked me for $20.00 to watch it. I came to Youtube and its "free" so is your course "Free" or not?

  3. I think the EKG example was overly complicated – think hamburger. Salt pepper ketchup lettuce and patty in center… or just remember white black – red green – brown.. lol good video regardless.

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