Cardiac Rhythm Interpretation Practice

Question 1

Pacemaker of heart

Answer 1

SA Node

Question 2

SA node - AV node - Bundle of HIS - left and right bundle of branch - Purkinje fibers (that when see heart contract) - see all waves on rhythm strips

Answer 2

Order

Question 3

Atrial depolarization - atria contract - before every QRS wave

Answer 3

P wave

Question 4

Ventricular depolarization - ventricles contract

Answer 4

QRS

Question 5

Normal rate: 60-100 bpm
Number QRS complexes x10 in 6 sec strip - need know how fast going
Rhythm: regular
P waves: normal (upright and uniform); before QRS complex
PR interval: normal (0.12-0.20 sec)

Answer 5

NSR

Question 6

1.Rhythm regular or irregular – look at RR interval
2.P waves present? Before each QRS? Consistent? Look uniform?
3.Rate – fast or slow?
4.PR interval: 0.12 – 0.2 sec.
5. QRS complex: 0.06 – 0.12 sec.
First thing do - look at rate (fast/slow/normal); determine if rhythm regular/irregular (look at R-R interval): same interval/distance between QRS complexes - if same = reg; know if P wave present and before each QRS wave - should be present and see if upright and uniform and consistent and all look same

Answer 6

EKG interpretation

Question 7

Little box -

Answer 7

0.04 sec

Question 8

Big box -

Answer 8

0.2 sec

Question 9

5 big boxes -

Answer 9

1 sec

Question 10

PR interval/segment:

Answer 10

0.12-0.2 sec; start P to start QRS

Question 11

QRS complex:

Answer 11

0.06-0.12 sec; start Q to start T

Question 12

Regular rhythm, rate 130, P wave normal - present before each QRS, PR interval less than 0.2 sec, normal, QRS 0.1, normal - everything looks normal
Regular rhythm, rate 120 (tachy), P wave normal (before each QRS), PR interval 0.16 sec, normal, QRS 0.08, normal
Assess pat
Treat underlying cause - whatever causing HR to increase
Adenosine: blocks AV node conduction; use stopcock and put in really fast then give NS quickly after; do need have pat on monitor and have in room; when blocking conduction can see flat line for short period time so need monitor for short period of time

Answer 12

Sinus Tachycardia-What would you do?

Question 13

Drugs (prescribed and recreational), caffeine, nicotine, dehydration
Reason in it: exercise, stress, caffeine, scared, nervous, meds, drugs (recreational/meds prescribed), dehydration - HR going up see what going on with pat, history, meds take

Answer 13

What can cause tachycardia?

Question 14

A client who had open abdominal surgery 4 hours ago reports feeling weak and dizzy. The client’s current blood pressure has decreased to 98/50, and pulse rate is 120. What is the nurse’s best action at this time?
A. Document the vital signs, and continue to monitor the client.
B. Remind the client to stay in bed if feeling weak and dizzy.
C. Call the health care provider immediately.
D. Increase the client’s IV rate to restore fluid volume.

Answer 14

Answer: C
Rationale: might be in shock; open abd surgery and big wounds may lose blood; BP low and HR climbing so want call HCP; do doc VS and monitor pats but when know had surgery 4 hrs ago want let HCP know because want do something before get point where have call rapid response

Question 15

Irregular rhythm, rate not measurable, P wave absent, PR interval not measurable, no QRS
Irregular rhythm, rate not measurable, P wave absent, PR interval not measurable, no QRS
Odd looking
Complexes wide, bizarre, no regularity to them; looking all over place; is really fast
Looks all over place

Answer 15

vfib

Question 16

Assess the patient - first
No cardiac output - not getting any; ventricles quivering and not delivering blood to tissues/body: electrical choas occuring - firing rapidly; going so fast
No pulse
No brain perfusion
Not awake - not pushing blood out to body; no brain perufsion and everything shutting down
Defibrillate Immediately - if have vfib do need defibrillate; put pads on pat
Follow ACLS protocol - try to resuscitate them
High quality CPR

Answer 16

Ventricular fibrillation - what would you do?

Question 17

May have random complex in there but No rhythm, no rate, absent P wave, absent PR interval, absent QRS - flat line

Answer 17

Asystole -

Question 18

Assess the patient - actually in asystole
No electrical activity in the heart
No cardiac output
No pulse
No brain perfusion
Follow ACLS protocol
Start High quality CPR – compressions, airway, breathing
Do NOT defibrillate; cannot shock - no electrical activity/anything to shock

Answer 18

Asystole - what would you do?

Question 19

Regular rhythm, rate 50, P wave normal (before every QRS), PR interval less than 0.2, normal, QRS 0.08, normal

Answer 19

Sinus bradycardia

Question 20

Assess the patient
Can be norm for some people
s/s of low CO: Dizziness, confusion, hypotension, diaphoresis, SOA, chest pain, syncope; HR too low - want consider pat fall risk because could get up and pass out; if symptomatic then treat it; not good CO; not sustain low HR for long period time before something else happens
Assess for underlying cause
Medication - lot cardiac meds - one AE is bradycardia; may be too high dose as well
Give fluids
Atropine
If symptomatic and can’t eliminate underlying cause; give if super low
Transcutaneous or Transvenous pacing: pacemaker
If no response to above treatment - external pacemaking
Transvenous - through vein: into RA/RV/both and have temp pacemaker; have short period time until permanent

Answer 20

Sinus bradycardia - what do you do

Question 21

Irregular rhythm (time between QRS complexes not same), rate 70, absent P wave (see multiple P waves - atrial rate really fast), absent PR interval, QRS 0.1 (can measure), normal, flutter waves present; get out of this - sometimes may also have ventricles going really fast with it as well
Irregular rhythm, rate 90, absent P wave (lots P waves there), absent PR interval, QRS 0.09 (not same distance between QRS), normal, flutter waves present
Most common dysrhythmia
Associated with atrial fibrosis and loss of muscle mass
Common in heart disease such as hypertension, heart failure, coronary artery disease
High risk for PE, VTE, stroke (commonly seen) - need be on blood thinner
Cardiac output can decrease by as much as 20% to 30% - sig; in afib all time can take toll on them; not fully filling ventricles and sending blood to body; want try get back to norm rhythm if possible

Answer 21

Atrial fibrillation

Question 22

Assess the patient - first
some may feel it - esp with rapid ventricular rate; tolerating it
Some stay in afib but often try get back into sinus rhythm
Assess/look for fatigue, weakness, shortness of breath, dizziness, anxiety, syncope, palpitations, chest discomfort or pain, hypotension - s/s stem/come as a result of low CO
Atria firing multiple times before ventricles fire - causes blood pools; atria essentially quivering; not have good CO - ventricles not have adequate filling time and not have good atria kick to send blood through ventricles - so have low CO
Drug therapy
Calcium channel blockers
diltiazem (Cardizem) - drip/PO; often drip in hospital if BP can sustain in
Antiarrythmic agent
Aminodarone (Cordarone) - may go home PO on it
Beta blockers
metoprolol (Toprol) and esmolol (Brevibloc)
slows ventricular response
Ends in -lol
Digoxin (Lanoxin) - older drug; can have AE
Anticoagulants
Heparin, enoxaparin (lovenox), warfarin (coumadin), dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis - newer but still really expensive but preferred drug given compared to warfarin)
Given for afib
Atria quivering and blood pooling - cont in afib can send blood clots out to body; may end up having stroke if having for long time outpat and not realize it; if on afib start on anticoag - usually IV heparin in hospital but also home on anticoag
Antiplatelet
Aspirin, clopidogrel (Plavix)
Cardioversion - shock heart back into rhythm
Percutaneous radiofrequency catheter ablation - ablate irritable area that sending incorrect electrical signals
Bi-ventricular pacing - may need a pacemaker
Surgical Maze procedure - sychonrized shock

Answer 22

Atrial fibrillation - what do you do

Question 23

Regular rhythm, rate 210, absent P wave, PR interval not measurable, QRS greater than 0.12, complexes super wide, with bizarre appearance
Tombstone like appearance; rate very fast
Repetitive firing of irritable ventricle

Answer 23

Ventricular tachycardia

Question 24

Assess the patient - first one
Assess airway, breathing and circulation
O2 sat, BP, pulse - ABCs
Assess LOC - awake?
Cannot sustain vtach for long period of time
Defibrillate - determine if stable/not - imp assess pat
Stable and sustained VT
Oxygen - may need
Confirm with 12-lead ECG
Can give Amiodarone (drip and bolus), Lidocaine, Magnesium - if have vtach/any sort of abnorm rhythm check electrolytes
Cardioversion
Ablation
Do things to treat
Unstable and sustained VT
If become unstable might need to shock; unstable and not awake and no pulse do defribillate
Can lead to cardiac arrest
VT is often the initial rhythm leading to VF
Runs of VT and even if short not ignore - look for underlying causes - let HCP know; know why happening so not go into sustained VT and into VF and cardiac rest
If unstable then defibrillate
VT - no pulse - look at ABCs and defibrillate

Answer 24

Ventricular tachycardia - what do you do

Question 25

Regular rhythm, rate 70 (normal), P wave normal (present before each QRS), PR interval 0.13, normal, QRS 0.07, normal
Just Assess the patient as normally would but heart in NSR and want heart be in this rhythm and want them to always be in this rhythm

Answer 25

NSR - what would you do

Question 26

Without PVS is normal - P before QRS - P wave is upright and regular
PVC come in and Not come at correct time - ventricular contract that is premature/come before supposed to; before have another P wave have a premature contraction - lot wider than other ones and bizarre looking; NSR then have PVC then brief pause then back to norm
Increased irritability of ventricular cells and are seen as early ventricular complexes followed by a pause - can be norm; sometimes can feel/not
PVC’s with/and have acute myocardial infarction can lead to VT or VF, if not treated - if having closer together/post-MI biggest thing if having more can lead to VT/VF - chart NSR then ectopy then PVC and how often: see happening more often and trend; if happening more often can lead to VT/VF
Treatment depends on cause

Answer 26

PVC - premature ventricular contractions

Question 27

May occur as:
bigeminy (every other beat is PVC)
trigeminy (every third beat is PVC)
quadrigeminy (every fourth beat is PVC)
couplet (two consecutive PVCs - two in a row)
nonsustained ventricular tachycardia or NSVT (three or more consectutive PVCs)
Prob is if come closer together and happens more often

Answer 27

Increased irritability of ventricular cells and are seen as early ventricular complexes followed by a pause - can be norm; sometimes can feel/not

Question 28

A client in the telemetry unit is on a cardiac monitor. The monitor technician notices there are no ECG complexes and the alarm sounds. What is the first action by the nurse?
A. Begin CPR immediately.
B. Call the emergency response team.
C. Press the record button to get an ECG strip.
D. Assess the client and check lead placement

Answer 28

Answer: D
Always go in and check and having asystole that would be bad - check and see if asystole

Question 29

Report of chest discomfort or pain
Report of dizziness or syncope
Shortness of breath
Weakness and fatigue
Decreased urine output
Pale, cool skin
Diaphoresis
Level of Anxiety or restlessness
Confusion - LOC - can feel it may increase anxiety and know something going on
Using accessory muscles to breathe; not having CO and struggling to breathe and low pulse - not getting O2 circulated
Feel palpitations

Answer 29

What might you NOTICE if the patient is experiencing inadequate oxygenation and tissue perfusion as a result of dysrhythmias?

Question 30

Perform and interpret physical assessment, including: - good phys assessment
Taking vital signs (may have hypotension and weak pulse) - BP affected because can see heart rhythm but want to look at other things
Checking for pulse deficit
Asking if patient has palpitations - ask what feeling and experience
Checking capillary refill (decreased)
Listening to lung and heart sounds
Assessing/look at cognition
Taking an ECG - telemetry monitor have 5 stickers but with ECG have 12-lead so want look at diff angle and confirm it; if have time do this to confirm
Checking oxygen saturation

Answer 30

What should you INTERPRET and how should you RESPOND to a patient experiencing inadequate oxygenation and perfusion as a result of dysrhythmias? On monitor and went into abnormal rhythm how would you assess them?

Question 31

Applying oxygen
Keeping the head of the bed elevated unless patient is very hypotensive
Maintaining or starting an IV line - something changes and need IV not want be in emergency and get IV in pat; make sure have IV and is working; if infiltrated make sure new work
Notifying the health care provider or Rapid Response Team - call code blue/Rapid - having code call code blue - sustained vtach not under control then call Rapid
Giving drug therapy as prescribed - talking with HCP; meds as prescribed
Initiating CPR for asystole - good quality CPR
Defibrillating the patient in VF
Assisting with other procedures as needed, for example, defibrillation (quickly)
Know where code cart is and know how use AED and defibrillating quickly saves lives

Answer 31

Respond by doing what?

Question 32

Evaluate/look at patient’s response to drug therapy. - responding/not; need change what happening
Observe for evidence of increased oxygenation and perfusion. - O2 sat increasing; not have pale/cool skin
Think about what else you could have done to assist the patient with this problem. - before got to point where have code/rapid response; check telemetry monitors: look at alarms and keep on top condition to know what is going on with them

Answer 32

On what should you REFLECT?