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Nursing 231 - Exam 3 > Cardiac Dysrhythmias EXAM 3 > Flashcards

Cardiac Dysrhythmias EXAM 3 Flashcards

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1
Q

small body of specialized muscle fibers, located in the right atrium of the
heart, whose activity is responsible for initiating the heartbeat. Rate of automaticity?

A

SA node (sinoatrial) - 60 to 100 BPM

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2
Q

a part of the electrical conduction system of the heart that coordinates the top of the heart; it electrically connects the atria and ventricles. (Atrial contraction and filling of ventricles) Rate of automaticity?

A

AV node (atrioventricular) - 40 to 60 BPM

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3
Q

a specialized conduction system within the heart that ensures the proper activation of
the ventricles to produce effective contraction. Rate of automaticity?

A

Purkinjie Network - 20 to 40 BPM

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4
Q

What is the order of conduction through the heart?

A

SA ->intraatrial pathway ->AV -> Bundle of his-> left and right bundle branches -> purkinjie fibers

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5
Q

Represents the time for the electrical impulse to spread through the atria. What is the wave and the action?

A

*P wave
*Atrial depolarization/contraction

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6
Q

In a normal EKG, why cant you see a wave represented for atrial repolarization?

A

happens simultaneously with ventricular depolarization and is hidden in the QRS complex

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7
Q

Represents the time for the electrical impulse to spread through the ventricles.

A

QRS complex

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8
Q

The interval from the beginning of the QRS complex to the apex of the T wave is referred to as the?

A

Absolute refractory period

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9
Q

The last half of the T wave is referred to as the

A

relative refractory period

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10
Q

Ventricular repolarization is represented by?

A

T wave

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11
Q

Late ventricular repolarization (purkinjie fibers) rarely seen, but represented by? What could abnormal elevation of this wave signify?

A

*U wave
*K+ electrolyte imbalance

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12
Q

Represents the time from the onset of atrial depolarization to the onset of ventricular depolarization).

A

PR interval

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13
Q

How is the PR interval measured and what is the normal range?

A

*From the beginning of P wave to the beginning of the QRS complex
*Normally 0.12-0.20 seconds

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14
Q

How many seconds is a big box on an ECG strip?

A

0.20 seconds

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15
Q

How many seconds is a little box on an ECG strip?

A

0.04 seconds

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16
Q

How is the QRS duration measured and what is the normal range.

A

*Measured from the beginning of the QRS to the end of the S wave or J point (where the QRS ends and the ST segment begins).
*0.04-0.12 seconds

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17
Q

Represents the total time required for ventricular depolarization and repolarization. How is this measured and what is the normal range?

A

*QT interval
*From beginning of QRS complex to the end of the t wave
*Normal is .30 to .44 seconds

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18
Q

is any cardiac rhythm that is not normal sinus rhythm.
Can be due to abnormal impulse initiation, either at an abnormal rate or from a site other than the sinus node, or abnormal impulse conduction through any part of the heart.

A

dysrhythmia (arrhythmia)

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19
Q

Normal QTc is less than_____

A

0.44 seconds

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20
Q

what are the three parts you want to measure when analyzing an ekg?

A

PR interval, QRS duration, and QT interval

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21
Q

Rule of 300 to Calculate Heart Rate for Regular Rhythms

A

Heart Rate = 300 / divided by number of large boxes between two QRS complexes

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22
Q

Rule of 6 Seconds to Calculate Heart Rate for Irregular Rhythms

A

Heart Rate = Number of QRS Complexes in 6 Seconds Multiplied by 10

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23
Q

Drugs used for Ventricular Tachycardia & Ventricular Fibrillation?

A

Vasopressor - Epi
Antiarrhythmics- Amirodarone, Lidocaine, Mag sulf

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24
Q

Drugs used for Asystole & Pulseless Electrical Activity?

A

Vasopressor- Epi

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25
Q

Drugs used for symptomatic bradycardia?

A

a. Atropine (GIVE FIRST)
b. Dopamine (infusion)
c. Epinephrine (infusion)

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26
Q

Drugs used for Symptomatic Tachycardia

A

a. Adenosine
b. Beta-blockers
c. Calcium Channel Blockers (Diltiazem)
d. Amiodarone
e. Procainamide
f. Sotalol

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27
Q

_______is a ______ countershock delivered by a defibrillator at the __wave of the QRS complex to prevent delivery during the relative refractory period (vulnerable period)

A

*CARDIOVERSION
*Synchronized*
*R

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28
Q

_____is an ______ countershock delivered by a defibrillator at ____ of the cardiac cycle

A

*DEFIBRILLATION
*Asynchronous
*Any phase

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29
Q

Rhythm is analyzed and shock advised by the machine.

A

AED

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30
Q

External pulse generator that stimulates the cardiac cells to depolarize; pacing pads applied on thorax

A

Transcutatneous Pacing

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31
Q

the rhythm is generated by the sinus node and traveling in a normal fashion in the heart, but also that the heart rate, the rate at which the sinus node is generating impulses, is within normal limits

A

Normal sinus rhythm

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32
Q

What are some medications that can cause sinus bradycardia?

A

Digoxin, Ca+ channel blockers, or beta-adrenergic blockers

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33
Q

In sinus bradycardia you need to determine what?

A

Determine if patient is symptomatic or experiencing symptoms of syncope, chest pain, hypotension, SOB or
diaphoresis

34
Q

Treatments for sinus bradycardia? If hypotensive?

A

*Atropine bolus
*Transcutatneous Pacemaker (maybe perm)
*If hypotensive, give dopamine or epi infusion

35
Q

Signs and symptoms of Sinus brady/Tachy?

A

*DASH FLS* (add palpitations for tachy)
*Dizziness
*Anxiety
*SOB
*Hypotensive

*Fainting
*Lightheadedness
*Sweating

36
Q

Treatments for sinus tachy?

A

*Treat underlying cause
*Meds - Beta blockers, calcium channel blockers (slow hr)

37
Q

Most commonly seen dysrhythmia, especially in aged population?

A

A-fib

38
Q

Some signs and symptoms of A-Fib

A
  1. Pulse irregularity
  2. Fatigue
  3. SOB
  4. Decreased BP
  5. Palpitations
39
Q

Name the type of rhythm:
*Regular
*Rate - 60-100
*P wave - upright
*PRI - 0.12-0.20 sec
*QRS - 0.04-0.12 secs
1:1 P to QRS

A

NORMAL SINUS RHYTHM

40
Q

Name the type of rhythm:
*Regular
*Rate - <60
*P wave - upright
*PRI - 0.12-0.20 sec
*QRS - 0.04-0.12 secs

A

SINUS BRADYCARDIA

41
Q

Name the type of rhythm:
*Regular
*Rate - 100-160
*P wave - upright
*PRI - 0.12-0.20 sec
*QRS - 0.04-0.12 secs

A

Sinus Tachycardia

42
Q

Name the type of rhythm:
*Irregular/ w/ sinus rhythm
*Rate - 60-100
*P wave - upright
*PRI - 0.12-0.20 sec
*QRS - 0.04-0.12 secs
*Early beat is seen with wide and bizarre QRS, Twave can inverted

A

PVC/PVD

43
Q

Name the type of rhythm:
*Irregular (R-R intervals)
*Rate - A: 350-600 V: <100=controlled/>100=uncontrolled
*P wave - None (multiple “F” waves)
*PRI - None
*QRS - 0.04-0.12 secs

A

AFIB

44
Q

Name the type of rhythm:
*Regularly irregular
*Rate - A:250-400 V:70-150
*P wave - None/sawtooth pattern
*PRI - None
*QRS - 0.04-0.12 secs

A

Atrial Flutter

45
Q

Name the type of rhythm:
*Regular
*Rate - 160-250
*P wave - upright
*PRI - 0.12-0.20 secs
*QRS - 0.04-0.12 secs
*P wave/T wave can be meshed

A

SVT

46
Q

Name the type of rhythm:
*Irregular
*Rate - Varies
*P wave - sometimes difficult to see
*PRI - May appear early
*QRS - Narrow

*compensatory pause

A

PAC

47
Q

Name the type of rhythm:
*Regular
*Rate - >100
*P wave - None
*PRI - None
*QRS - >0.12 WIDE AND BIZARRE

(can be seen with or without pulse)

A

V-Tach (MONO)

48
Q

Name the type of rhythm:
*Irregular/Chaotic
*Rate -100-160
*P wave - upright
*PRI - 0.12-0.20 secs
*QRS - morphology varies, but still generally wide complex

A

V-TACH (POLY) (Torsades)

49
Q

Name the type of rhythm:
*Irregular/Chaotic
*Rate - >None
*P wave - None
*PRI - None
*QRS -None, No discernable waves

A

V-Fib

50
Q

What are the treatment options for AFIB/AFLUTTER?

A

*RRS*

Rate control -BB,CCB, Cardioversion

Rhtyhm control - Antiarrhythmic, Cardioversion, Ablation

Stroke prevention - Anticoags

51
Q

A condition in which the heart’s upper chambers (atria) beat too quickly

A

A-flutter

52
Q

Treatment for SVT?

A
  1. Vagal maneuvers
  2. O2
  3. Adenosine IVP
  4. Cardioversion/ablation
53
Q

Pulseless electrical activity causes

A

*PATCH MED*

Pulmonary embolus
Acidosis
Tension pneumothorax
Cardiac tamponade
Hypokalemia/ Hyperkalemia/ Hypoxia/ Hypothermia/ Hypovolemia
Myocardial infarction
Electrolyte derangements
Drugs

54
Q

Causes of AFIB?

A

*Pirates*

Pulmonary: PE, COPD
Iatrogenic
Rheumatic heart: mirtral regurgitation
Atherosclerotic: MI, CAD
Thyroid: hyperthyroid
Endocarditis
Sick sinus syndrome

55
Q

Treatment for VT with a pulse?

A

*ACE*

Antiarrythmic- Amiodarone, lidocaine, mag sulf

Cardioversion

Electrolyte replacement - (K, mag)

56
Q

Which two electrolyte imblanaces can cause V-tach

A

hypokalemia and hypomagnesmia

57
Q

Treatment for VT without a pulse?

A

*First line CPR and defibrillation

*Epinephrine and antiarrhythmics (amiodarone, lidocaine, mag sulfate)

*This follows the same treatment guidelines as ventricular fibrillation*

58
Q

A life-threatening heart rhythm that results in a rapid, inadequate heartbeat

A

V-FIb

59
Q

Signs and symptoms of V-Fib

A

Loss of consciousness

No pulse

No respirations

NoBP

Absent heart sounds

60
Q

when should medication be considered during pulseless V-fib

A

after patient is defibrillated and while CPR is being given

61
Q

First line of meds for pulseless V-fib?

A

*Epi 1mg q 3 to 5 minutes IVP, or Vassopressin 40 units IVP once

62
Q

2nd Line of meds for pulseless V-Fib

A

Choice of an antiarrhythmic such as amiodarone (cordarone, Pacerone) 300 mg IVP followed by second dose of 150 mg IVP

63
Q

List treatments in order for pulseless V-fib

A
  1. Basic CPR/ACLS
  2. Defibrillation
  3. Epinephrine IVP
  4. Consider antiarrhythmics, such as Amiodarone or Lidocaine IVP
  5. Chest compressions
  6. Defibrillation
64
Q

Potentially Reversible Causes of Cardiac Arrest: H’s

A

Hydrogen Ion (acidosis)

Hyper-/Hypokalemia

Hypothermia

Hypovolemia

Hypoxia

i. For refractory VF/Pulseless VT, consider acute coronary ischemia or myocardial infarction

65
Q

Potentially Reversible Causes of Cardiac Arrest: Ts

A

Tamponade (cardiac)

Tension Pneumothorax

Thrombosis (coronary and pulmonary)

Toxins (drug overdose)

66
Q

Treatment for Asystole?

A

Basic CPR/ACLS (Compressions should be started immediately)

Epinephrine IVP

Patient should be assessed with a second monitor lead, pausing compressions only briefly to rule out a fine VF,

and if VF is confirmed, then patient should be defibrillated

67
Q

After the __________ there is a compensatory pause

A

PAC

68
Q

PVCs can precipitate what?

A

V-TACH

69
Q

In PVC there is no _____ preceding the PVC and the _____is wide

A

*Pwave

*QRS

70
Q

Treatment for PVC?

A

Correct the cause/Antiarrhythmic drugs if symptomatic or rhythm is dangerous

71
Q

Chest compressions should be at a depth and rate of what?

A

*Depth of 2 to 2.5 inches

*Rate of 100-120 per minute

72
Q

refers to cardiac arrest in which the electrocardiogram shows a heart rhythm that should produce a pulse but does not. What does this exclude?

A

Pulseless electrical activity (PEA)

excludes other cardiac arrest rhythms - V-Fib, V-Tach and Asystole

73
Q

Treatments for PEA?

A

Most important is to search for, identify, and reverse any treatable cause, including H’s and T’s

  • Basic CPR/ACLS
  • Epinephrine IVP
74
Q

What rhythym might be temporarily seen directly after admnistering Adenosine?

A

Asystole

75
Q

With SVT what is the first thing you would ask the patient to do?

A

perform the Valsalva maneuver by bearing down.

76
Q

Name this?

Rate = Variable

Rhythm = Regular

P Wave = Precedes QRS complex

PR interval = Longer than 0.20 seconds and constant

QRS complex = WNL, 0.08 – 0.12 sec

A

1st degree AV block

77
Q

Characteristic sign = PR interval with each complex becomes progressively longer until

there is a dropped QRS complex

Atrial rate is regular; ventricular rate is irregular

What is this called?

A

Mobitz type 1 (2nd degree)

78
Q

If symptomatic, how can mobitz type 1 be treated

A

Atropine IVP

79
Q

P waves are not consistently followed by a QRS complex

QRS complexes are wide

The ventricular rate is irregular since impulses are blocked randomly or may be blocked in a

pattern

What is this called?

A

Mobitz type 11

80
Q

In mobitz ll, if symptomatic treatment may be _________…if Hypotensive _____ or ____may be given

A

Transcutaneous Pacemaker

Dopamine or Epi infusion

81
Q

A medical emergency that can result in cardiac arrest and death in which none of the electrical signals from

the AV node reach the ventricles

A

3rd degree AV block (complete heart block)

82
Q

treatment for 3rd degree AV block?

A

Withdrawal of aggravating drugs

IV fluids; transcutaneous pacemaker

Dopamine or Epinephrine infusion if hypotensive

Permanent pacemaker

Nursing 231 - Exam 3 (5 decks)

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