CCRN Cardio 4 Arrhythmias Associated with AMI

Question Answer
What is the most common reason for atrial arrhythmias following an AMI? Left atrial distention
What causes left atrial distention? high pressure in the left ventricle
What atrial arrhythmias often result from atrial distention after an AMI? PAC's, Afib, Aflutter
What is the ECG finding of a 1st degree heart block? PR interval > .20

CCRN – Cardio Cardiac Trauma, Cardiomyopathies

Question Answer What is the most common cause of a traumatic pericardial tamponade? Penetrating injury What is the first sign of a traumatic pericardial tamponade? Tachycardia If a chest trauma patient presents with signs of shock that are unresponsive to fluid administration and distended jugular veins, what should the nurse suspect? Pericardial tamponade What is the Beck's triad and what condition does it indicate? Hypotension, JVD & muffled heart sounds; pericardial tamponade If a patient with a penetrating chest wound presents with agitation, confusion, and insists on sitting upright due to air hunger, what condition should the nurse suspect? Pericardial tamponade What is the most common type of cardiac arrest? PEA What is the most important tool for diagnosing a pericardial tamponade in the ER when a patient is unstable? Ultrasonography What is the classic pattern seen on an ultrasound of the chest with a pericardial tamponade? "Swinging heart" (heart oscillates from side to side in the pericardial sac) What changes would be seen on the ECG of a patient with a pericardial tamponade? Pulsus alterans What produces the pulsus alterans seen on ECG in a patient with a pericardial tamponade? Heart moving from side to side What immediate interventions should be implemented for a hypotensive patient with a pericardial tamponade who has been stabbed in the chest? Oxygen, fluids, inotropic agent (Dobutamine) Why is fluid administration important for a patient with a pericardial tamponade? Increases SV and perfusion What complication should the nurse be monitoring for when administering fluids to a patient with a pericardial tamponade? Volume overload How should a patient with a pericardial tamponade be positioned and why? Elevate legs to increase venous return and improve ventricular filling When ventilating a patient with a pericardial tamponade __________ pressure should be avoided or minimized. Positive (PEEP) What is the treatment for a pericardial tamponade? Emergent needle aspiration or pericardiocentesis How is a pericardiocentesis performed? Drain is placed using anatomical landmarks or guided by echocardiogram How is a pericardotomy performed for a patient with a pericardial tamponade? Balloon is used to create a pericardial window What is a VAT (video-assisted thorascopic) procedure? Minimally invasive technique used to treat a pericardial tamponade What is a life-threatening complication of a pericardiocentesis? Puncture and rupture of the myocardium or coronary arteries In addition to the risk of puncturing the heart, what other complications should the nurse monitor for during a pericardiocentesis? Arrhythmias or puncture to other organs (lungs, liver, stomach) Which ventricle is most susceptible to an injury such as a myocardial contusion following a blunt chest trauma and why? Right ventricle because it is located below the sternum Which valves are most likely to be affected by blunt chest trauma and why? Aortic and mitral because pressure is higher in the left ventricle What is the most common complaint of a myocardial contusion? Chest pain unrelieved by analgesics What is the most common arrhythmia following a myocardial contusion? Sinus tachycardia What are the most lethal arrhythmias associated with myocardial contusions? VT, VF Tachycardia beyond what is expected for the amount of blood loss is strongly indicative of ____________ ___________. Myocardial contusion Clinical presentation including chest wall bruising, S3 gallop, crackles, pericardial friction rub/murmurs and hypotension may all be signs of what? Myocardial contusion If a patient has a myocardial contusion, what would be and indication for continuous cardiac monitoring? Abnormal ECG or echo Which cardiac markers are most specific to injury caused by myocardial contusions? Troponins What is the purpose of using an echocardiogram in the assessment of a patient with a myocardial contusion (MC)? Identifies abnormal wall motion How abnormal wall motion following a MC affect hemodynamics? Decreases SV, CO and BP How long should cardiac monitoring be in place following a MC and why? 24-48 hours because that is the time period arrhythmias are most likely to occur Following a blunt chest trauma, a new-onset systolic murmur develops. Which valve abnormality is most likely the cause? Mitral valve regurgitation (caused by rupture of the mitral valve) If a new-onset diastolic murmur is detected following a blunt chest trauma, which valve has likely ruptured? Aortic valve Valve regurgitation causes a murmur to be heard when the valve should be (open or closed)? Closed The ________ valve in the left ventricle should be closed during systole. Mitral The ________ valve in the left ventricle should be closed during diastole. Aortic Complications of myocardial contusions include: Arrhythmias
LV dysfunction; Valve rupture
Ventricular aneurysm or thrombosis
Pericardial effusion
Cardiac damage/rupture
Chronic constrictive pericarditis
Coronary vasospasm, thrombosis, rupture
Atrial fistula By what mechanism of injury is a traumatic aortic aneurysm usually sustained? Sudden deceleration

**Question often involves a high speed MVC with sudden deceleration on impact** What is the most common site of a traumatic aortic aneurysm? Level of isthmus What is the classic sign of a traumatic aortic aneurysm? CXR = widened mediastinum How does a patient with a traumatic aortic aneurysm often present, hemodynamically? Hypotension, responds well to fluid bolus but then becomes hypotensive again (cyclic pattern) How does pseudocoarction syndrome present following a traumatic aortic aneurysm? Hypertension in upper extremities and hypotension in lower extremities

**Question may also ask nurse to check BP in both arms, assessing for a significant difference between the two** A left-sided chest tube placed in a trauma patient immediately returns large amounts of bright red blood. What does this usually indicate? Aortic rupture A rupture of the aorta usually causes bleeding into the (left or right) pleural space and results in a __________? Left, hemothorax Which radiology procedure has the most definitive diagnosis of a thoracic aortic aneurysm? (Gold Standard) Arteriogram What should SBP level be maintained at if a patient has a thoracic aortic aneurysm? 90-120 mmHg In a patient with a thoracic aortic aneurysm, even if hemodynamically unstable, avoid aggressive _______ administration due to risk of rupture. Fluid How is an aortic aneurysm treated? Surgical intervention – open thoracotomy-graft replacement of aorta How is perfusion often maintained during surgery for an aortic aneurysm? CPB or partial left heart bypass Which type of cardiomyopathy has the highest incidence of sudden cardiac death related to lethal arrhythmias? Hypertrophic Why are hypertrophic cardiomyopathies most lethal? The hypertrophied left ventricular wall places the patient at risk for increased myocardial O2 consumption = fatal arrhythmias Thickening the the ventricular wall is called ___________. Remodeling A patient with hypertrophic cardiomyopathy needs placement of an ______ to prevent fatal arrhythmias. AICD (automatic internal cardiac defibrillator) What are the 2 classifications of hypertrophic cardiomyopathy? Obstructive and non-obstructive Obstructive hypertrophic cardiomyopathy is due to the enlarged septal wall interfering with outflow of blood from the _____ ventricle through the ________ valve. Left, mitral A patient with a history of alcoholism or cocaine abuse would be most likely to have ____________ cardiomyopathy. Dilated ______________ cardiomyopathy is associated with stiffness of the ventricles and is the least common type of cardiomyopathy. Restrictive _____________ cardiomyopathy should be differentiated from constrictive cardiomyopathy because constrictive cardiomyopathy may be treated with surgical intervention. Restrictive What is the most common cause of restrictive cardiomyopathy? Amyloid deposits, protein deposits Which type of cardiomyopathy is the only type associated with a high EF and why? Hypertrophic, d/t increased contractility r/t increased muscle mass Why is hypertrophic cardiomyopathy considered a diastolic dysfunction? The ventricles have no problems ejecting blood because of the large muscle mass, but d/t the preload is decreased d/t the limited space for filling during diastole Dilated cardiomyopathy causes _____________ CO and ______________ pulmonary pressures r/t abnormal contractility, volume overload, and HF. decrease, increase __________ cardiomyopathy is characterized by an increase in end-diastolic and end-systolic volumes with a low EF and classified as a ___________ dysfunction in HF. Dilated, systolic Progressive dilation of the left ventricle can lead to abnormalities in which valves? Mitral, aortic regurgitation What is the most common symptom of hypertrophic cardiomyopathy? SOB What is the most common cause of sudden cardiac death in hypertrophic cardiomyopathy? VF Which cardiomyopathy frequently produces an S4 gallop? Hypertrophic When in the cardiac cycle is S4 heard and what does it correlate with? Occurs during atrial kick, associated with ventricular non-compliance A _________ cardiomyopathy is more likely to produce an S3 gallop due to __________ ___________. Dilated, volume overload Common 12-lead ECG finding in hypertrophic cardiomyopathy? Left-axis deviation cause by the thicker LV wall mass A LBBB with a right-axis deviation is suggestive of _________ cardiomyopathy. Dilated What is the most common arrhythmia associated with restrictive cardiomyopathy? Complete heart blocks and AFIB due to amyloid deposits within the SA and AV node Is restrictive cardiomyopathy more likely to have atrial or ventricular arrhythmias? Atrial Sudden cardiac death with restrictive cardiomyopathy is usually caused by ____. PEA What abnormal lab value is associated with poor outcomes in dilated cardiomyopathy? Hyponatremia How do low Na+ levels related to poor outcomes in dilated cardiomyopathy? Severity of hyponatremia = severity of HF due to release of ADH which causes water retention, increasing volume overload (dilutional hyponatremia) Which lab value is elevated in dilated cardiomyopathy? BNP What causes BNP to be elevated in dilated and restrictive cardiomyopathies? Overstretched ventricles How do BNP levels differ in restrictive and constrictive cardiomyopathy? Severely elevated in restrictive, normal in constrictive In restrictive cardiomyopathy, the atria would appear bilaterally __________ on the echocardiogram. Dilated Why does the atria appear dilated on echo with restrictive cardiomyopathy? The ventricles are noncompliant and restrictive to ventricular filling so blood backs up into atria How is restrictive cardiomyopathy due to amyloid deposits diagnosed? Cardiac biopsy; fine needle aspiration of abdominal fat may also be used and is safer for the diagnosis of amyloidosis; liver biopsy diagnoses hemochromatosis, another cause of restrictive cardiomyopathy Which anti-arrhythmic agent is the only medication proven to lower the incidence of sudden cardiac death in hypertrophic cardiomyopathy? Amiodarone The goal of managing hypertrophic cardiomyopathy is to __________ inotropic state of the left ventricle. First-line agents include ____ _________ to decrease HR to 60-65 bpm. decrease, beta-blockers Which type of calcium channel blocker would be contraindicated in hypertrophic cardiomyopathy? Dihydropyridine CCB's (Procardia) Cardiac glycosides (_________) and other positive _________ agents should be avoided in hypertrophic cardiomyopathy. digoxin ____________ (________) is an L-type CCB and is indicated if beta blockers not effective. Verapamil (Calan) What is the indication of anticoagulation in dilated cardiomyopathy? LV dysfunction causes low EF = ventricular pooling = increased risk for stroke; these patients are also at risk for developing AFIB Surgical management of restrictive cardiomyopathy is ____________ ____________. heart transplant Surgical option for an obstructive hypertrophic cardiomyopathy LV myomectomy – removal of septal muscle
dual-chamber pacemaker What is the primary complication of all cardiomyopathies? HF
Afib can also affect all types

PE 3 2nd MT

Question Answer
Basic body movements that you do every day so you can go from one place to another. locomotor movements.
Locomotor movements include: walking; running; jumping; hopping; skipping; galloping; and sliding
Motor skills that help you in handling objects with your hands, feet, and other parts of the body. manipulative skills
examples of manipulative skills used in basketball. Bouncing and dribbling a ball
A ball handling skill that involves tapping a ball onto the floor using your fingertips. bouncing
Bouncing the ball successively using one hand at a time. It is a basic skill in basketball, that requires a hand-eye coordination. dribbling
A long slender piece of wood that has various uses. stick
Rule in handling sticks: 1) ________________________________________ to avoid accidentally hitting those near you. Keep the sticks close to your body
Rule in handling sticks: 2) Use only_____________________________. your sticks
Rule in handling sticks: 3) ___________________________________________________________ to produce the needed sound or beat. Tap your sticks gently or with just enough force
Examples of Filipino games patintero; piko
A Filipino game played by two teams. The object of the game is for the players of one team to get past the lines and return to their starting position without getting tagged by the players from the other team. patintero
A Filipino game played by individual players. Each player moves through each box in the playing field on one leg without losing his or her balance. piko
An illness or any harmful condition in your body. disease
A kind of disease caused by he presence of germs or virus that easily transferred from one person to another. communicable disease
Examples of common communicable disease. cold, influenza, malaria, dengue, rabies
A disease that gives you a runny nose, sore throat, fever, headache, and pain. cold
a disease caused by virus that attacks the upper respiratory tract. influenza or flu
How influenza virus spread in the air? coughing or sneezing.
A disease caused by a bite of an infected Anopheles mosquito. Malaria
Mosquito that causes malaria. Anopheles mosquito
A disease caused by virus transferred to people by the bite of mosquito called Aedes Aegyti. Dengue
Mosquito that causes dengue Aedes Aegyti
A disease caused by virus that enters the body through the bite of an infected animal. Rabies
Commons sources of rabies. dogs, cats, foxes, skunks, raccoons, and bats

Portuguese rooms Rooms and parts of an apartment/house

Question Answer
entrance hall hall da entrada
passage corredor
kitchen cozinha
lounge / sitting room salao / sala de estar / sala de visitas
diningroom sala de jantar
bedroom quarto
bathroom casa de banho
terrace terraco
balcony balcao / varanda
staircase escadas
stair escada
fireplace lareira
ceiling teto
roof telhado
sink pia
basin bacia
bidet bidet
toilet sanita
tap / taps torneira
lavatory retrete
floor tiles azulejos do chao
wall tiles azulejos de parede
wall parede
built in oven construido no forno
door handle macaneta
skirting board rodape
socket for plugs a tomada / soquete para plugue
window janela
light fittings / light fixtures luminarias
circuit board placa de circuito / placa de circuito eletrico
light switch interruptor
chamine chamine
barbecue churrasco /
washing line linha de lavagem
swimming pool piscina
first floor primeiro andar /
ground floor res-do-chao
second floor segundo andar
third floor terceiro andar
fourth floor quarto andar
fifth floor quinto andar
sixth floor sexto andar
seventh floor septimo piso
eighth floor oitavo andar
basement cave
gas bottles garrafas de gas
water meter contador de agua

health 5 2nd GP review quiz

Question Answer
They start from the union of egg and sperm cell, which develops into fetus into a baby, a toddler, into early children, adolescents and adulthood. growth and development
The stage of growth and development wherein several changes in the body are experienced. puberty or adolescence
Characteristic of adolescent: 1) rapid growth in body size
Characteristic of adolescent: 2) love games and sports
Characteristic of adolescent: 3) enjoy talking and spending time with friends and peers
Characteristic of adolescent: 4) like to dance, sing, watch TV, and movies
Characteristic of adolescent: 5) spend time in malls and hang around with fiends and new acquaintances
Characteristic of adolescent: 6) love to listen to music
Characteristic of adolescent: 7) love to attend parties and gathering
Characteristic of adolescent: 8) always conscious with appearance and looks
Characteristic of adolescent: 9) want to explore new thing
Characteristic of adolescent: 10) try dating
Characteristic of adolescent: 11) assert rights and privileges

health 5 2nd GP Physical development of boys

Question Answer
Physical development of boys: 1) Puberty starts at _______________. the age of 13.
Physical development of boys: 2) __________________ increase and he becomes stronger. increase and he becomes stronger.
Physical development of boys: 3) Testes ___________________________. begin producing testosterone.
Physical development of boys: 4) Growth of __________________________________. hair in armpit and pubic areas.
Physical development of boys: 5) Enlargement of _________________________________. penis, testes and scrotum.
Physical development of boys: 6) ________________________ occurs at the end of puberty Sperm production
Physical development of boys: 7) _________________________ and there is uncontrollable in the voice while speaking. and there is uncontrollable in the voice while speaking.
Physical development of boys: 8) ___________________ and become bigger. and become bigger.


Question Answer
#1 Ichi
#2 Ni
#3 San
#4 yon/shi
#5 Go
#6 Roku
#7 Nana
#8 Hachi
#9 Kyung/ku
#10 Juu
#100 Hyaku
#1000 Sen
Count 1 Hito-tsu
Count 2 Futa-tsu
Count 3 Mit'-tsu
Count 4 Yot'-tsu
Count 5 Itsu-tsu
Count 6 Mut'tsu
Count 7 Nana-tsu
Count 8 Yat'-tsu
Count 9 Kokono-tsu
Count 10 Too

comment vas tu chapter 4 bt french

Question Answer
The pharmacy la pharmacie
chemist un phamacien(ne)
doctors office un cabinet d' un me*decin
prescription une ordonnance
make an appointment prendre un rendez-vous
hospital l'ho^pital
x ray une radio
a +e les urgences
a doctor un me*dicin
medicine le me*dicament
i'm not good ce ne va pas
i don't feel well je me sens mal
i have a fever j'ai de la fi*ere
i'm cold j'ai chaud
i am allegic je suis allergique au/ *a la/aux
i have a pain in my stomach j'ai mal au ventre
i cough je tousse
i have sunburn j'ai pris un coup de soleil

health 5 2nd GP Physical development of girls

Question Answer
Girl's puberty starts at what age? age of 10 or 14
Physical changes in girls: 1) Ovaries begin producing estrogen and progesterone
Physical changes in girls: 2) breast growth
Physical changes in girls: 3) growth of pubic hair
Physical changes in girls: 4) widening of hips
Physical changes in girls: 5) start of menstruation


Question Answer
Strategy Strategy is defined as a consistent pattern of resource allocation directed to those competitive methods that add significant value to the equity base of the firm’s owners. Strategy making must be future oriented, dynamic, and interactive.
FDCS These forces will have significant and long term impact and will change the way hospitality organizations are managed and the strategies they will select to compete with in the future.
Co-alignment The co-alignment model describes and explains how hospitality managers respond to the environment and male strategic choices to attain sustainable competitive advantage.
Co-alignemnt model steps Environment events, strategic choice, firm structure, firm performance
Environmental Events major forces driving change in the remote environment and immediate environments of the organization. These forces, often referred to as trends, create opportunities and pose threats to the firm
Strategic Choice the choice of competitive methods invested in by the firm to take advantage of the threats and opportunities in the business environment. These methods should provide the firm with sustainable competitive advantage.
Firm Structure the effective and efficient allocation of the firm’s resources to the successful execution of the firms competitive methods.
Firm performance CFs, ROA, ROI, aggregate value of competitive methods
Levels of strategy Corporate, business, functional
Corporate strategy In which business you compete (5 year strategy)
Business Strategy How are you competing in that market? (5 year strategy)
Functional Strategy operational activities, most narrow scope (1year strategy)
What are the different levels of external? Remote, task, industry, functional
Remote entails forces that are external to the company. These forces cannot be altered or controlled by the firm
Task has a more direct and immediate impact to a firm than remote environment. In task environment domain, customers, suppliers, competitors and regulators are analyzed
Industry In industry environment, one can identify the competitors and the competitor’s competitive methods (CM).
Functional The functional environment focus on the forces driving change in operations
Environmental DImensions Uncertainty, complexity, munificence
Uncertainty This is the degree of change occurring in the environment and the rate of change. The objective of any manager in this context is to try to identify and understand what forces contribute to this variability.
Complexity Complexity is defined as the number of different variables impacting the business. The larger the number of variables the more complexity.
Munificence Refers to the amount of potential capacity for growth that exists in an industry environment.
Domain The environment where the company competes in
Value Drivers An independent variable that has a causal impact on a dependent variable. Value drivers are multidimensional, interconnected and exist and can be found in each environmental layer
CSF Bundles of products and services that are absolutely necessary for a firm to invest in if they want to compete in the industry
CMs A cm is a portfolio of products and services bundled which has strong market appeal and can offer the firm competitive advantage which leads to a cf maximization.
CC Core competencies are resources and capabilities in which a firm excels
PC Those which support the development and maintenance of the core competencies
CA A condition or a circumstance that puts a firm in a better position that the rest of the industry
Value Creation Is a process for creating value in the marketplace, which would provide the firm with a competitive advantage over it competition
Pillars of investment in CMs 1.Estimating CF 2.Determining Cost of Capital 3.Determining Risk 4.The Investment
Three imperatives of an investment 1. Managers will provide on return on investment that meets investment goals 2.Managers will take into consideration inflation when making investments 3. Managers will reflect the investors’ need to be compensated for risk
1. Managers will provide on return on investment that meets investment goals The first imperative means that all investments will provide returns that exceeds the firm’s cost of capital (cost of capital is what the investor expects to win for each dollar invested).
2. Managers will take into consideration inflation when making investments The second imperative means that investors expect you to understand that a dollar today wont have the same value in the future (value-time of money). Therefore, investors are expecting that managers make investments that will compensate for inflation.
3. Managers will reflect the investors’ need to be compensated for risk The third imperative means that an investor expects a higher percentage on return required if the investment is risky. This is also called risk premium or hurdle rate. Risk can be avoided if there is an effective environmental scanning.
What is Capital? Refer to money. An entreprise need money might be be acquired either by equite (invsetments) or debt (loand and bonds)
Debt Capital Money from loands, lower risks as asets are guaratee of payment tax deductable.
Equity capital Must always provide return that is equal or exceeds the cost of capital of the firm.
Implementation Determine the strenghts and weakeness of the firm's CCs. Align the CCs and the Cms. To conclude, it is the link between the business plan and operating budgets.
CMs & CCs The aligment between CMs and CCs creates CAs. The more CMs are aligned with the CCs the more consistent will be the elvels of quality.