ATRIAL DYSRHYTMIAS Flashcards
SUPRAVENTRICULAR TACHYCARDIA (SVT) (EKG CHARACTERISTICS)
P wave/PRI- Unable to distinguish p waves from t waves/UTD because there are no distinguishable p waves.
QRS: Narrow (.06-.10 seconds)
RATE: Ventricular rate is 150 to 250 beats per minute; Unable to determine atrial rate because there is no distinguishable P wave
RHYTHM: Ventricular rhythm is REGULAR; Unable to determine atrial rhythm because there is no distinguishable P wave
SVT NURSING INTERVENTIONS
Vital Signs (including SpO2) Assess for shock (cool clammy skin, ALOC) Decrease HOB for hypotension Oxygen if hypoxic Assess for chest pain IV access 12 Lead EKG VAGAL MANEUVERS
SVT PHARMACOLOGIC AND ELECTRIAL INTERVENTIONS
Pharmacologic:
Adenosine
6 mg rapid IVP, follow with NS flush
If SVT does not convert in 1-2 minutes, give 12 mg rapid IVP, follow with NS flush
Electrical:
Cardioversion
Narrow regular QRS (.06-.10 sec) 50-100 Joules
PREAMATURE ATRIAL COMPLEXES (PACs)
EKG Characteristics
Early (premature) P waves
Positive (upright) P waves (in lead II) that differ in shape from sinus P waves
The early P wave may or may not be followed by a QRS complex.
The PR interval of the PAC may be normal or prolonged, depending on the prematurity of the beat. The QRS complexes associated with a PAC are typically identical or similar in shape and duration to those of the underlying rhythm since the impulse is conducted normally through the AV junction, bundle branches, and ventricles.
PAC common causes (6)
Hypokalemia Hypomagnesemia Hypoxia Caffeine ETOH Medication (sympathomimetics)[epinephrine]
PAC NURSING INTERVENTIONS (4)
TREATMENT AND RISKS
Nursing interventions: Palpate pulse Chronic or new onset? Assess for cause Trend
Treatment:
Treat possible cause
Risks:
Patient at higher risk for atrial fibrillation
Atrial Fibrillation (A-FIB) (EKG Characteristics)
(fibrillatory waves)
P wave: No distinguishable P waves, only fibrillatory waves, which are not the same as P waves
PRI: No distinguishable P waves so no PRI.
QRS: Narrow (.06-.10)
RATE: Controlled A-fib has a ventricular rate <100; A-fib with a RVR (rapid ventricular rate) >100 (sometimes called “uncontrolled” A-fib.) There is no atrial rate because there are no distinguishable P waves
RHYTHM: Ventricular rhythm is irregularly irregular; There is no atrial rhythm because there are no distinguishable P waves
A-FIB NURSING INTERVENTIONS (7)
rate dependent
Nursing: *RATE DEPENDENT* Vital Signs (including SpO2) Assess for shock (cool clammy skin, ALOC) Decrease HOB for hypotension Oxygen if hypoxic Assess for chest pain IV access 12 Lead EKG (new onset)
A-FIB Pharmacologic and Medical Interventions
Pharmacologic:
Beta-blockers
CCBs
Medical Interventions:
Ablation
ATRIAL FLUTTER
(EKG CHARACTERISTICS)
(FLUTTER WAVES/SAWTOOTH WAVES/PICKET FENCE WAVES)
P waves/PRI: No distinguishable P waves, only flutter waves. Since there are no distinguishable P waves= No PRI
QRS: Narrow (.06-.10 seconds)
RATE: Atrial rate= NONE because there are no distinguishable P waves. Atrial flutter waves occur about 300 times per minute. Ventricular rate = Varies, depending on the conduction block (flutter wave) and is usually not over 100 bpm. (1 flutter wave= 1 big box)
RHYTHM: Atrial rhythm = NONE because there are no distinguishable P waves.
Ventricular Rhythm= Regular or Irregular
Conduction Blocks: Atrial flutter waves to QRS complexes can be 1:1, 2:1. 3:1, 4:1, 5:1, or can have a variable block. = irregular ventricular rhythm. (can hide behind the QRS)
ATRIAL FLUTTER NURSING INTERVENTIONS
Nursing: *Rate dependent* Vital Signs (including SpO2) Assess for shock (cool clammy skin, ALOC) Decrease HOB for hypotension Oxygen if hypoxic Assess for chest pain IV access 12 Lead EKG (new onset)
Atrial Flutter Pharmacologic and Medical Interventions
Pharmacologic:
Beta-blockers & CCBs
Medical Interventions:
Ablation
