Cardiac Tamponade

This has nothing to do with tampons in the heart ok! Just an FYI.

When blood or fluid accumulate in the sac which surrounds the heart it exerts pressure against the heart, making it harder for the heart to pump. As you can imagine, if the ventricles cannot fill fully or contract effectively then cardiac output decreases. Decrease cardiac output is not good news!

So how do you know if someone has this?

Well the symptoms are nothing unusual: chest pain, restlessness, quick shallow breathing, palpitations, pallor, tachycardia, weak peripheral pulses, pulsus paradoxical, distended neck veins, low BP… (do these all sound a little familiar? MI anyone?) Well causes of cardiac tamponade can be MI, Dissecting aortic aneurysm (thoracic), end-stage lung cancer, heart surgery, Pericarditis caused by bacterial or viral infections, or direct wounds to the heart.

How do we diagnose? Echocardiogram is the usual diagnostic tool, but MRI, CT, CXR or EKG can also highlight or confirm this.

Can you see the halo of fluid around the heart?

This is an emergency! The fluid must be drained to reduce damage to the myocardium and reestablish cardiac output.

Pericardiocentesis is a procedure that uses a needle to remove fluid from the pericardial sac, the tissue that surrounds the heart. The patient will be hyperoxygenated, given fluids to maintain blood pressure. It is important to note that a pericardiocentesis may have to be repeated because cardiac tamponade can return. With fast treatment the outcome is usual good, without treatment death is immanent.

A pericardial draining tube may be placed during surgery to keep in place postop. The drainage will be measured every shift and documentation on the color, amount and consistency is very important! The tube will usually be removed slowly over the postop recovery weeks at the discretion of the cardiologist.

NCLEX Success: Remember your A-B-Cs!

Say it with me: AIRWAY, BREATHING, CIRCULATION!

If you have renewed CPR with AHA recently you’ll know that they have changed that to CAB from ABC, but for NCLEX you need to stick with the ABC.

So here comes that irritating priority question. You try to apply Maslow but all options are physiological, so there is nothing to eliminate. What do you do? You apply the ABCs.

Airway will always be the most important factor to take priority: anaphylaxis? Choking? So look for it, if it isn’t there, look for breathing, it could be simple like raising HOB to decrease dyspnea in a CHF pt – keep focused on the “B” until you can rule it out. If no luck at that point, move to circulation. Hemmorhage? Potential for bleed? Change in vitals (↑HR, ↓BP)?

Look at the big picture and apply all the ABCs and use them to lead you to the right answer! Priorities will always contain ABC/Maslow or combination! Use your question answering skills! 🙂

NCLEX Success: Maslow’s Hierarchy of Needs

Maslow is a great tool to narrowing down or answering NCLEX questions. Those pesky priority questions are the ones in which Maslow can lend a helping hand. Here is how you use the Maslow Strategy:

1. Look at the answer choices. Determine if the answer choices are both physiological and psychosocial, if they are – apply the Maslow strategy.
2. Now, eliminate all psychosocial answer choices.
3.  If the answer choice is physiological, don’t eliminate it. Maslow states that physiological needs must be met first. Although pain certainly has a physiological component, it is considered a psychosocial need on Nclex.

NCLEX Success: Use Free Resources!!!

Being a student of any kind, well apart from some of those really rich Harvard prodigies, you probably know all about being on a budget, or to put it plainly – poor. Due to lack of funds due to all those lab fees, uniforms, strange looking nursing gadgets, your pocket is probably lacking the big bucks required to take one of those fancy NCLEX review courses. Hence, the advice I am about to crown you with – GOOGLE MAGIC BABY!

Yes, I passed the NCLEX-RN. And no, I did not pay for Kaplan or Hurst or any other claim-to-pass program. I knew that those courses were never an option because of the cost, so I gave myself a low budget and decided to use Google to help me. When Googling away, I found a plethora of material which was amazing! None of it cost $, and all of it so easy to access. The use of torrents is a controversial topic, but if you are guilt free about it then crack on! There are apps out there, as well as Saunders interactive test bank (very helpful resource), these can be purchased or with a little digging, found for free.

Kaplan Trainers. I see these are talked about a lot on the forums and people seem to freak out about the scores they get on them. I Googled them and found them posted on scribd.com. I printed a few and worked through them as a brain exercise. My best advise is not to focus on the scores! Scores don’t matter – learning matters. It really isn’t about the questions you get right, its about learning from the rationales on the ones you got wrong. Read ALL rationales, but make notes on the ones you get wrong – see if there is a trend, any topic that you are frequently getting wrong, which shows you where you need to put in some hard graft. Focus in on those weaknesses.

Practice, practice, practice! It’s all about banging out those questions.

So get those fingers Googling, and find out what’s free. There are some great Tumblr sites out there too. Below I will post some of the most helpful and intriguing sites I found!

http://rightatrium.tumblr.com/post/43568301576

http://www.scribd.com/doc/148347851/Nclex-Kaplan-Exam-1

http://www.scribd.com/doc/148349057/NCLEX-Kaplan-Exam-6

http://www.youtube.com/watch?v=HzqOkRnXBFw

http://mp3skull.com/mp3/hurst_review.html

The NCLEX-RN Cram Sheet – Welcome to…

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NCLEX Success

For all those who are embarking on their NCLEX – I feel for you!
I remember the relentless studying, the anxiety, and the need to use the bathroom every 2 minutes while in the waiting room before taking me test! Arghhhh! It was a momentous day in the life of a student. Overnight you become an RN, like a caterpillar to a butterfly…. Ok I’ll cut the crappy metaphors, we all know the torture! But do not despair, I hope to have helpful tip posts just for you NCLEXers.

This first tip is from my personal experience. Often times on the forum I saw people asking “what books did you use?”
So here is my list:

– Kaplan Strategies, Practice and Review
– Fluids & Electrolytes Made Incredibly Easy
– Prioritization, Delegation, and Assignment: Practice Exercisers for the NCLEX Exam – LaCharity

More Tips to Come! Good Luck!

EKG Time!

EKG TIME! (For basic understanding)

Ok so for many the EKG is a weird and wonderful map of squiggles, but actually each little squiggle is very important in translating the conduction of the heart. From your A&P course you should know that the normal conduction of the heart starts in the SA node in the Right Atrium, it travels to the AV node in the wall of the right atrium (middle of the heart), then through the Bundle of His/Left & Right Bundle Branches and down through the Purkinje fibers. The EKG is basically a map of that scenario. Imagine that you are in a car in San Antonio (SA node), you need to drive to Aventura (AV node), then you go through the spaghetti junction (Bundle of His) while heading to Pittsburg (Purkinje fibers) – if you were to use Google maps, you would have the route highlighted out on the roads you have to take, right? Well that is basically what an EKG is! It is the highlighted route the conduction took through the heart.

I hope that has given you a little clarity on those squiggly lines, haha!

Now what does the map tell us?

As you can see we use letters to signify different areas of the squiggle. You can see that P is a little bump at the beginning. This is showing us that the atria of the heart are depolarizing (another fancy word for compress or pump). The atria is pushing the blood into the ventricles. P shows that the car has left the SA node in the Right Atrium and is traveling to the AV node in the middle of the heart. From P to Q (called PR complex),  the car then leaves the AV node and travels down through the Bundle of His. One the car travels out from the Bundle of His down the Bundle Branches, through the Purkinje fibers and the rest of the heart so a QRS complex occurs. The QRS shows that the ventricles have received all the blood from the atria and pumps it back out to lungs (right V) and aorta (left V). And with that you have just witnessed a heartbeat.

Well what about the leftover squiggles…

So between the S and the T (called the ST segment), we see the heart recovering from the heartbeat, otherwise known as Ventricular REpolarization. Think about clenching your fist really hard and then relaxing, that is in essence what the heart is doing. The ST segment is very important to monitor on an EKG strip because if you are looking for something pathological, such as an MI, you might just find it here with ST segment elevation. This would mean the patient would be diagnosed as having a STEMI. We could continue this further, but we’ll save the pathological changes for another time.

So following the T wave, the heart is now ready to complete another beat! We have come full circle!

I hope you found this helpful, it is purely for basic understanding, EKG’s can be much more in depth! My best advice is so search YouTube for videos, as visualizing this is the best way to learn what it going on inside the heart!

Good Resources:

http://www.youtube.com/watch?v=7b98JcGIGyE

http://handwrittentutorials.com/

Rapid Interpretation of EKG’s 6th Ed. – Dale Durbin (really good book)