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Nu 236 > Cardiac Dysrhythmias > Flashcards

Cardiac Dysrhythmias Flashcards

1
Q

What is the normal rate of impulse generation by the SA Node?

A

60-100 bpm

The SA Node is the primary pacemaker of the heart.

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2
Q

What does the P wave on an ECG represent?

A

Atrial depolarization

The P wave indicates that the impulse originated at the SA Node.

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3
Q

What is the function of the AV Node?

A

Delays impulse to allow atrial contraction and ventricular filling

It generates impulses at a rate of 40-60 bpm.

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4
Q

What is the normal duration of a PR interval?

A

0.12 - 0.20 seconds

The PR interval measures the time for the impulse to travel from the SA node to the ventricles.

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5
Q

Which ECG component represents ventricular depolarization?

A

QRS Complex

The QRS complex duration should be less than 0.12 seconds.

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6
Q

What does the T Wave on an ECG signify?

A

Ventricular repolarization

The T wave should be upright and has a duration of about 0.16 seconds.

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7
Q

Fill in the blank: The total time for ventricular depolarization and repolarization is represented by the _______.

A

QT Interval

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8
Q

What is the heart rate range for Sinus Rhythm?

A

60-100 bpm

Sinus rhythm is characterized by a regular rhythm and P waves before each QRS complex.

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9
Q

What is the primary cause of Tachydysrhythmias?

A

Heart rates greater than 100 beats/min

This condition can lead to decreased cardiac output.

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10
Q

What is the normal response of the heart rate to metabolic needs?

A

Increased heart rate with exercise or stress

Sinus Tachycardia is a normal response to such needs.

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11
Q

True or False: Atrial Fibrillation results in effective atrial contraction.

A

False

Atrial fibrillation leads to the loss of effective atrial contraction.

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12
Q

What are common causes of Atrial Fibrillation?

A
  • Aging
  • CAD
  • MI
  • HF
  • HTN
  • Hyperthyroidism
  • Electrolyte disturbances
  • Drugs

Atrial fibrillation can be acute or chronic.

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13
Q

What is the characteristic rhythm of Atrial Flutter?

A

Regular, sawtooth-shaped flutter waves

Atrial flutter originates from a single ectopic focus.

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14
Q

What is the definition of a PVC?

A

An impulse that starts in the ventricle and is conducted through the ventricles before the next normal sinus impulse

PVCs result in a wide distorted QRS complex.

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15
Q

Fill in the blank: Unifocal PVCs arise from _______.

A

One focal point

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16
Q

What is the treatment for symptomatic Sinus Bradycardia?

A
  • Atropine
  • Catecholamines
  • Cardiac pacing

Treatment is only necessary if the patient is symptomatic.

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17
Q

What does a J point on an ECG indicate?

A

Marks the end of the QRS complex

It signifies the transition from depolarization to repolarization.

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18
Q

What is the heart rate range for Sinus Bradycardia?

A

< 60 bpm

Sinus Bradycardia can be normal in athletes and during sleep.

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19
Q

What are the primary nursing actions if a patient’s heart rate drops to 45 during suctioning?

A
  • Stop suctioning
  • Administer atropine
  • Call a rapid response

These actions prioritize the patient’s safety and address potential bradycardia.

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20
Q

What is the duration of the QRS complex in a normal ECG?

A

< 0.12 seconds

A wider QRS complex may indicate a conduction issue.

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21
Q

What is the typical heart rate for Supraventricular Tachycardia (SVT)?

A

> 100-280 bpm

P waves may not be visible during SVT.

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22
Q

What are potential complications associated with Atrial Fibrillation?

A
  • Embolus formation
  • Heart failure
  • Decreased cardiac output

The irregular rhythm leads to these complications.

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23
Q

What is a common treatment for Atrial Fibrillation?

A
  • Anticoagulation (warfarin, DOACs)
  • Rate control medications (beta-blockers, calcium channel blockers)
  • Electrical cardioversion

Treatment aims to control ventricular rate and prevent thromboembolism.

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24
Q

True or False: The U Wave is commonly seen on an ECG.

A

False

The U wave is usually not visible but may indicate certain conditions like hypokalemia.

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25
Q

What is the endocardium?

A

The endocardium is the inner lining of the heart, with catheters such as pacing leads and PA catheter passing through it.

The endocardium plays a crucial role in heart function and can be accessed for various medical procedures.

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26
Q

What are some causes of electrolyte imbalance related to cardiac issues?

A
  • Hypokalemia
  • Low magnesium

Electrolyte imbalances can significantly affect heart rhythm and function.

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27
Q

Which drugs can cause PVCs?

A
  • Digoxin toxicity
  • Aminophylline
  • Epinephrine

Certain medications can lead to the occurrence of premature ventricular contractions (PVCs).

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28
Q

What factors can contribute to the occurrence of PVCs?

A
  • Anxiety
  • Stress
  • Exercise
  • Excessive caffeine
  • Alcohol
  • Nicotine

Lifestyle factors can influence heart rhythm and contribute to PVCs.

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29
Q

What is the primary treatment approach for PVCs?

A
  • Treat the underlying cause
  • Medications: Amiodarone or Beta-blockers
  • Oxygen if cardiac patient

Treatment usually starts with addressing the cause and may include medications.

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30
Q

What is Ventricular Tachycardia (VT)?

A

A run of 3 or more PVCs in a row occurring at a rate exceeding 100 bpm, with an irritable ventricular ectopic focus firing repetitively.

VT can lead to more serious arrhythmias if not addressed.

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31
Q

What are the classifications of Ventricular Tachycardia?

A
  • Monomorphic
  • Polymorphic
  • Patient stability (stable or unstable)

Classifying VT helps determine the appropriate treatment.

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32
Q

What are the clinical features of VT?

A
  • Rate: 100-200 beats/min
  • Rhythm: Usually regular with wide, bizarre QRS complexes
  • P waves: Usually absent
  • PR interval: Not measurable
  • QRS complex: > 0.12 sec, distorted

Recognizing these features is crucial for diagnosis and treatment.

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33
Q

What is the treatment for stable Ventricular Tachycardia?

A
  • Oxygen
  • 12 Lead ECG
  • Amiodarone or Lidocaine
  • Cardiovert

Prompt treatment is essential to prevent deterioration.

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34
Q

What characterizes Ventricular Fibrillation (V Fib)?

A

Multiple impulses from many irritable foci within the ventricles firing in a disorganized manner, leading to ineffective contractions and no cardiac output.

V Fib is a critical condition requiring immediate intervention.

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35
Q

What are the clinical features of V Fib?

A
  • Rate: Not measurable
  • Rhythm: Irregular & chaotic
  • P waves: Not visible
  • PR interval: Not measurable
  • QRS complex: Not measurable

Identifying V Fib quickly is vital for survival.

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36
Q

What is Asystole?

A

Total absence of any ventricular activity, characterized by a flatline on the monitor and unresponsive, pulseless, apneic patients.

Asystole is a lethal condition with poor prognosis.

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37
Q

What are some causes of Asystole?

A
  • Hypoxia
  • Hypovolemia
  • Hydrogen ion imbalance
  • Hypo or hyperglycemia
  • Hypo or hyperkalemia
  • Hyperthermia
  • Trauma
  • Toxins
  • Tamponade
  • Tension pneumothorax
  • Thrombus

Understanding the causes is essential for effective treatment.

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38
Q

What is First Degree Heart Block?

A

Rate of conduction of atrial impulses through the AV node is slowed, characterized by a PR interval longer than 0.2 seconds.

This condition often requires monitoring but may not need immediate intervention.

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39
Q

What defines Second Degree AV Block Type 1 (Wenckebach)?

A

Each atrial impulse takes progressively longer to conduct through the AV node until one impulse is fully blocked, characterized by a dropping QRS complex.

This block is often temporary and may resolve on its own.

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40
Q

What is Second Degree AV Block Type II?

A

Only some atrial impulses are conducted through the AV node, resulting in more P waves than QRS complexes.

This type often requires a pacemaker.

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41
Q

What is Third Degree AV Block?

A

No atrial impulse is conducted through the AV node, leading to independent atrial and ventricular depolarization.

This complete heart block requires immediate intervention with a pacemaker.

42
Q

What is a pacemaker?

A

An electronic device that provides electrical stimuli to the heart muscle, consisting of a generator and electrodes.

Pacemakers are used for various cardiac conditions, including symptomatic bradycardias.

43
Q

What are the two components of a pacemaker?

A
  • Generator (power source)
  • Electrodes located in wires or leads

These components work together to regulate heart rhythm.

44
Q

What are the types of pacemakers?

A
  • Permanent
  • Temporary
  • Transvenous
  • Epicardial
  • Transcutaneous

Each type serves different clinical needs based on patient condition.

45
Q

What is Capture in pacing terms?

A

The ability of a pacing stimulus to result in depolarization of the chamber being paced.

Capture is critical for effective pacing.

46
Q

Fill in the blank: In Synchronous (Demand) pacing, the pacemaker senses the heart’s own beats and _______.

A

inhibits itself

This mode ensures that the pacemaker only activates when the heart rate falls below a certain threshold.

47
Q

What is the purpose of the pacemaker codes?

A

To provide a means of safe communication about pacemaker function.

Understanding these codes is essential for healthcare providers.

48
Q

What is the significance of the first letter in pacemaker codes?

A

Indicates the chamber being paced, which can be A (atrium), V (ventricle), or D (dual).

This classification helps identify the specific pacing action.

49
Q

What are common complications of pacemaker use?

A
  • Infection at entry site
  • Dislodgment of pacing electrode
  • Bleeding & hematoma
  • Hemothorax/Pneumothorax
  • Ventricular ectopy
  • Twiddler Syndrome
  • Erosion

Awareness of these complications is crucial for monitoring and management.

50
Q

What is Loss of Capture in pacemaker malfunction?

A

The pacemaker fires, but no QRS follows the spike, often due to electrical charge set too low or lead dislodgement.

Immediate intervention is needed to restore effective pacing.

51
Q

What does Failure to Sense mean in pacemaker malfunction?

A

The pacemaker keeps firing at preset intervals despite the patient’s own intrinsic rhythm.

This can lead to inappropriate pacing and requires adjustment of the device.

52
Q

What is a client education point for patients with a permanent pacemaker?

A

Monitor pulse for 1 full minute daily and record the rate in a pacemaker diary.

Regular monitoring helps detect any potential issues early.

53
Q

What is an Implantable Cardioverter Defibrillator (ICD)?

A

A device that detects and terminates life-threatening episodes of VT or V Fib, consisting of a lead and implanted pulse generator.

The ICD is crucial for patients at high risk for sudden cardiac arrest.

54
Q

What is the function of the Wearable Automatic Cardioverter Defibrillator Vest?

A

Works like an AED and shocks when needed, vibrating and alarming before delivering a shock.

This vest provides an additional layer of protection for patients at risk.

55
Q

What is the primary purpose of defibrillation?

A

To depolarize a critical mass of myocardial cells in V Fib and pulseless VT to restore normal rhythm.

Time-sensitive intervention is critical for patient survival.

56
Q

What is Synchronized Cardioversion?

A

Cardioversion for tachydysrhythmias with a pulse, using lower energy levels than defibrillation.

This procedure is typically performed in a controlled setting with patient consent.

57
Q

What are key nursing actions when caring for patients with dysrhythmias?

A
  • Assess patient with any rhythm change
  • Monitor vital signs
  • Administer anti-arrhythmic medications
  • Notify physician of changes
  • Maintain a calm attitude

Effective nursing care is essential to manage dysrhythmias and enhance patient outcomes.

58
Q

What will happen if SA node stop to work

A

Sinus bradycardia or sinus tachycardia

59
Q

Which node will take part in if SA node stop to work

A

AV node will take place over
40-60 bpm

60
Q

What will happen if AV node fails

A

Ventricular pacemakers (purkinje fibers )will work
20-40 bpm

61
Q

Name the medication that affect SA node

A

Beta blockers slows heart rate and atropine block parasympathetic activity and increase heart rate

62
Q

In which part of ECG the delay in AV node show

A

PR segment
Delay allow complete contraction of atria and filling of ventricles

63
Q

What does dysfunction of AV node indicate

A

Damage or dysfunction of AV node lead to heart block
In third degree heart block, the SA node signals are completely blocked and ventricles are relies on their own pacemakers

64
Q

What are the two name of 12-lead ECG

A

Limb leads
Precordial leads

65
Q

What are the 4 limb leads

A

Right Arm
Left Arm
Right leg
Left leg

66
Q

What are the location of precordial lead

A

V1-fourth intercoastal space-Right
V2-fourth intercoastal space-left
V3-diagonally between V2 and V4
V4=fifth intercoastal space, left midclavicular line
V5=fifth ICS,anterior axillary line
V6=Fifth ICS, midaxillary line

67
Q

What is the height and width of one small box on RKG strip

A

1 mm

68
Q

How many seconds each small box in EKG strip represent

A

0.04 seconds

69
Q

How many small box make 1 larger boxes

A

5

70
Q

What does PR segment represent

A

Isoelectric line from the end of the P wave to the beginning of the QRS complex, when the electric impulse is traveling through the AV node, where it is delayed

71
Q

What does QT interval represent

A

Time between ventricular depolarization and ventricular depolarization

72
Q

What does ST segment represent

A

Early ventricular repolarization

73
Q

Rule to calculate heart rate by rule of 300

A

Take the number of 5 boxes between r-r interval and divide this by 300
300/number of 5 boxes

74
Q

What is the 6 second rule

A

Calculate number of R in 6 second strip and multiply by 10

75
Q

What is the duration of QRS complex

A

0.06-0.12 second

76
Q

What are the causes of sinus bradycardia

A

Lower metabolic needs
Sleep
Athletic training
Hypothyroidism

Vagal stimulation
Carotid sinus massage
Bearing down for a bowel movement
Gaging

Certain medication
calcium channel blockers
Beta blockers
Amiodarone
Digoxin

Vomiting
Suctioning
Hypoxia
Inferior wall MI
Lyme diseases
Electrolyte imbalance

77
Q

Signs and symptoms of sinus bradycardia

A

Syncope
Fainting
Dizziness and weakness
Hypotension
Diaphoresis
SOB
Chest pain

78
Q

Intervention for sinus bradycardia

A

Only treat if symptomatic
Atropine IV
Increased intravascular volume by IV fluids
Apply oxygen if oxygen saturation is <94% or SOB
Cardiac transcutaneous pacing
Catecholamines-epinephrine or dopamine infusion

79
Q

What is the dose of atropine

A

0.5 mg IV bolts q 3-5 minutes to a max dose of 3 mg

80
Q

What can nurse do if beta blockers overdose is suspected

A

Administration of glucagon may help by increasing the HR and blood pressure

81
Q

What are the causes of sinus tachycardia

A

Physiological and psychological stress
Anxiety
Pain
Blood loss
Fever
Exercise
Infection
Sepsis
Anemia
Hypoxemia

Certain medication calcium channel
Caffeine
Nicotine
Epinephrine
Atropine
Cocaine
Aminophylline
thyroid medication

Compensatory response to decreased blood pressure or cardiac output
Dehydration
hypovolemic shock
Myocardial infarction
Infection
Heart failure

82
Q

Intervention for sinus tachycardia

A

Assess for signs and symptoms of hypovolemia and dehydration including increased pulse rate, decreased urine output, decreased blood pressure, dry skin and mucous membranes

The ECG pattern may show T wave inversion or ST segment elevation or depression in response to myocardial ischemia.

Treat the underlying causes.

Teach patient to remain on bed rest if tachycardia is causing hypotension and weakness.
Avoid the substance that increased cardiac rate including caffeine, alcohol and nicotine.

83
Q

What is Supra’s

A
84
Q

What is supraventricular tachycardia?

A

Rapid stimulation of atrial tissue at a rate of 100-280 beats/min

85
Q

What is the ECG pattern of SVT?

A

Rate: >100 bpm (100-280 bpm)
Rhythm: Regular
P-wave: None
PR-interval: Unable to identify (no-p wave)
QRS complex: Narrow (<0.12 sec)

86
Q

Causes of SVT

A

Accessory or extra electrical pathway
Reentering of electrical signal from ventricular to atria
High level of physical or mental stress
Electrolyte imbalance

87
Q

What are the signs and symptoms of SVT?

A

Hypotension
SOB
Dizziness
Chest discomfort

“All due to decreased perfusion”

88
Q

What are the treatment for SVT?

A

Valsalva maneuver
Teach the client to hold their breath and bear down as if having a bowel movement

Carotid massage
Vagal maneuvers (activate parasympathetic nervous system and relax the heart)

Cold water or ice on face

Pharmacological treatment
ABCDs of SVT
Adenosine
Beta-blockers
Cardiac ablation (ablate to burn away extra pathway)
Digoxin

If symptoms of poor perfusion are severe and persistent or if patient become unstable synchronized cardio version is immediately used to terminate SVT

89
Q

How you need to administer adenosine medication?

A

It is used to terminate acute episode and is given rapidly (over several seconds) followed by a normal saline bolus.

90
Q

What is atrial fibrillation

A

Multiple rapid impulses from many atrial foci depolarize the atria in a totally disorganized manner at a rate of 350-600 bpm

91
Q

What are the complications of atrial fibrillation?

A

Clotting factors like embolic stroke, DVT or PE

92
Q

Causes of atrial fibrillation

A

Open heart surgery
Heart failure
COPD
Hypertension
Ischemic heart diseases
Fibrotic changes associated with aging
Cardiomyopathy
Pericarditis
Rheumatic heart diseases
Valvular heart diseases
Hyperthyroidism
Electrolyte imbalance
Hypoxia
Alcohol

93
Q

What are the EKG presentation for atrial fibrillation

A

Rate: 350-600 bpm
Rhythm: Irregular
P-wave: None
PR interval: None
QRS complex: Irregular and Narrow

94
Q

What are the sign and symptoms of atrial fibrillation

A

Because of loss of atrial kick, the patient in uncontrolled AF is at greater risk for inadequate cardiac output.

Fatigue
Weakness
SOB
Dizziness
Anxiety
Syncope
Palpitations
Chest discomfort or pain
Hypotension

Most commonly asymptomatic

95
Q

Intervention for the stable client

A

Oxygen

Drug therapy to slow conduction
Betablockers
Calcium channel blockers
Digoxin
Amiodarone

Anticoagulant therapy to prevent clots
Warfarin
DOAC’s

96
Q

Intervention for unstable client with AF

A

Oxygen
Cardioversion

97
Q

What need to be done if onset of atrial fibrillation is greater than 48 hours

A

The patient must take anti-coagulant for at least 3 weeks (or until the INR 2-3) before the procedures to prevent clots from moving heart to brain or lungs

98
Q

What can we do if onset of atrial fibrillation is uncertain

A

A transesophageal echocardiogram may be performed to assess for clot formation in the left atrium

99
Q

What is atrial flutter

A

Tachydysrhythmias identified by recurring, regular, sawtooth-shaped flutter wave just originate from a single ectopic focus in the right atrium or less commonly left atrium

100
Q

What are the EKG interpretation

A

Rate: 75-150 bpm
Rhythm: Usually regular
P-wave: Sawtooth shaped flutter waves
PR interval: Unable to measure
QRS complex: Usually normal and upright

101
Q

Causes of atrial flutter

A

Coronary artery diseases
Hypertension
Heart failure
Valvular diseases
Hyperthyroidism
Chronic lung diseases
Pulmonary embolism
Cardiomyopathy

102
Q

Intervention for atrial flutter

A

Stable client
Drug therapy
Calcium channel blockers
Anti arrhythmias
Anticoagulants

Unstable client
Cardioversion

Nu 236 (9 decks)

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