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NUR 230 > Cardiac Rhythms > Flashcards

Cardiac Rhythms Flashcards

1
Q

what is automaticity

A

ability of cardiac cells to initiate electrical impulses- av node

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2
Q

what is excitability

A

ability of non-pacemaker cells to respond to pacemaker cell

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3
Q

what is conductivity

A

transmission of impulses from one cell to the next

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4
Q

electrical conduction

A

SA
between 1 and 2….. intranodal pathway
AV
bundle of his
bundle branches
purkinje fibers

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5
Q

inherent rate of SA node

A

60-100 x per min

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6
Q

what is inherent rate of AV node

A

40-60 bpm

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7
Q

inherent rate of purkinje fibers

A

20-40 bpm

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8
Q

chronotropic properites

A

affect hr itself
slow/increase hr

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9
Q

dromotropic properties

A

speed of conduction through heart

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10
Q

inotropic properites

A

affects contractility
how much the heart is able to squeeze

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11
Q

what are arrhythmias

A

D i s o r d e r s o f f o r m a t i o n o r
c o n d u c t i o n ( o r b o t h ) o f
e l e c t r i c a l i m p u l s e s w i t h i n
h e a r t
* C a n c a u s e d i s t u r b a n c e s o f
* R a t e
* R h y t h m
* B o t h r a t e a n d r h y t h m
* P o t e n t i a l l y c a n a l t e r b l o o d
f l o w a n d c a u s e
h e m o d y n a m i c c h a n g e s
* D i a g n o s e d b y a n a l y s i s o f
e l e c t r o g r a p h i c ( E C G )
w a v e f o r m

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12
Q

causes of arrhythmias

A

Coronary artery disease (CAD)
* Cardiomyopathy
* Hypertension
* MI
* Valve disorders
* Electrolyte imbalances
* Cardiac medications

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13
Q

how to arrhythmias affect perfusion

A

sv
co
preload
contractility
afterload

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14
Q

what is afterload

A

resitance heart is pumping against

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15
Q

diagnostics for arrhythmias

A

12-lead EKG
* CXR
* Labs
* CBC
* Electrolytes
* Thyroid (tachycardias)

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16
Q

what causes action potential

A

electrolytes moving in and out of cell

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17
Q

what is p wave

A

atrial depolarization

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18
Q

hat is qrs

A

ventricular depolarization

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19
Q

t wave

A

ventricular repolarization

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20
Q

repolarization is

A

diastole

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21
Q

depolarization is

A

systole

22
Q

systemactic approach to rhythm interpretation

A

Measure Heart Rate (slow,
normal, fast?)
* Evaluate Rhythm (regular or
irregular?)
* Is there a P wave before every
QRS?
* Is the QRS narrow or wide?
* Evaluate the ST segment- flat,
depressed, elevated?
* Interpret Rhythm

23
Q

sinus bradycardia

A

the same as sinus rhythm but lower than 60 bpm

24
Q

causes of sinus bradycardia

A

l o w m e t a b o l i c n e e d s , v a g a l s t i m u l a t i o n ,
m e d i c a t i o n s , S A n o d e d y s f u n c t i o n , i n c r e a s e d
I C P , C A D , M I

25
Q

how to treat sinus bradycardia

A

atropine
transcutaneous pacemaker

26
Q

sinus tachycardia

A

regular rhythm
higher than 100 bpm

27
Q

causes of sinus tachy

A

ph y s i c a l / p s y c h o l o g i c a l s t r e s s ,
m e d i c a t i o n s , i l l i c i t d r u g s , a u t o n o m i c
d y s f u n c t i o n ( P O T S )
TREAT UNDERLYING CAUSE

28
Q

treatment for sinus tachy

A

iv fluids
blood transfusion
antipyretics
analgesics
vagal maneuvers
iv beta blockers
calcium channel blockers (verapamil)

29
Q

premature ventricular contraction (PVC)

A

could be sinus/tachy/brady
p waves sometimes absent
not conducted normally
Rate: 60-100 bpm (could vary depending on underlying)
* Rhythm/ Regularity: Irregular due to early beat
* P Waves: upright, round, 1:1- PVC’s P wave often absent
* QRS Complexes: normal beats narrow, PVCs wide
* ST Segment: without elevations

30
Q

causes pvc

A

stimulants
etoh
mi
heart failure
digitalis toxiicty
hypoxia
acidosis
electrolyte imbalances

31
Q

amiodarne side effects

A

sun sensitivity
dizziness/syncope
wt gain edema
blurry vision
thyroid toxicity and other toxicities

32
Q

determine is\f pvcs are….

A

PERFUSING
check pulse while auscultating heart or watch monitor and correlate findings

33
Q

afib

A

Characteristics:
* Rate: Atrial rate 300-600 bpm;
Ventricular rate varies
* Regularity: Irregular
* P Waves: fibrillatory waves
* QRS Complexes: narrow
* C o m m o n a r r h y t h m i a a s s o c i a t e d w i t h i n c r e a s e d
a g e a n d r i s k f a c t o r s d i s c u s s e d i n e a r l i e r s l i d e

34
Q

treatment for a fib

A
  • A n t i t h r o m b o t i c s - l o n g t e r m - w a r f a r i n , F a c t o r X a i n h i b i t o r s
    ( a p i x a b a n , e t c . ) ; s h o r t t e r m - h e p a r i n , e n o x a p a r i n
  • H e a r t r a t e c o n t r o l - ( m a i n t a i n H R < 8 0 ) - b e t a b l o c k e r , c a l c i u m
    c h a n n e l b l o c k e r
  • M e d i c a t i o n s t o C o n v e r t - s o d i u m c h a n n e l b l o c k e r ( f l e c a i n i d e ) ,
    p o t a s s i u m c h a n n e l b l o c k e r ( a m i o d a r o n e , d o f e t i l i d e )
  • C a t h e t e r a b l a t i o n - d e s t r o y s s p e c i f i c c e l l s t h a t a r e t h e c a u s e o f a
    t a c h y a r r h y t h m i a
  • E l e c t r i c a l c a r d i o v e r s i o n - i f h e m o d y n a m i c a l l y u n s t a b l e
  • T i m e d e l e c t r i c a l c u r r e n t
  • S y n c h r o n i z e d w i t h E C G o n c a r d i a c m o n i t o r t h a t p r e v e n t s s h o c k f r o m
    o c c u r r i n g d u r i n g r e p o l a r i z a t i o n
  • M e d i c a t e c l i e n t w i t h s e d a t i v e & a n a l g e s i c , o r d o n e u n d e r a n e s t h e s i a
35
Q

what is r on t phenomenon

A

Can cause ventricular tachycardia
or ventricular fibrillation

36
Q

v tach

A

Rate: 120-200 bpm
* Regularity: May be regular or irregular
* P Waves: Will not see
* QRS Complexes: Wide, abnormal shape

37
Q

increased risk in vtach

A

p r o l o n g e d Q T , M I , h e a r t f a i l u r e

38
Q

treatment for vtach

A

S t a b l e - A s s e s s m e n t a n d m o n i t o r 1 2 - l e a d E K G
* U n s t a b l e w i t h p u l s e - s o d i u m o r p o t a s s i u m
c h a n n e l b l o c k e r s ( a m i o d a r o n e , l i d o c a i n e ,
p r o c a i n a m i d e ) ; c a r d i o v e r s i o n
no pulse- CPR and defib (unsynchronized shock)

39
Q

vfib

A

Rate: Unable to determine, no pulse
* Regularity: Irregular
* P Waves: Will not see
* QRS Complexes: Unable to determine, irregular waves, changing amplitudes
CALL A CODE

40
Q

causes of vfib

A

M I c a u s e d b y C A D , u n t r e a t e d V T ,
v a l v u l a r h e a r t d i s e a s e , c a r d i o m y o p a t h y ,
m e d i c a t i o n s , a c i d - b a s e / e l e c t r o l y t e a b n o r m a l i t i e s ,
e l e c t r i c a l s h o c k

41
Q

treatment for vfib

A

defibrilation
cpr
amiodarone
epi

42
Q

asystole

A

Rate: Unable to determine, no pulse
* Regularity: Unable to determine
* P Waves: Unable to determine
* QRS Complexes: Unable to determine
CALL A CODE

43
Q

management asystole

A

cpr
epi
identify and treat possible underlying cause

44
Q

nsg interventions

A
  • Assess vital signs on an ongoing basis
  • Assess for lightheadedness, dizziness, fainting
  • If hospitalized
  • Obtain 12-lead ECG
  • Continuous monitoring
  • Monitor rhythm strips periodically
  • Antiarrhythmic medications
  • Minimize anxiety of client
45
Q

indications for pacemakers

A

lower than normal impulse formation, symptomatic AV or
ventricular conduction disturbance

46
Q

types of pacemakers

A

permanent
temp: ex is transcutaneous
* On-demand vs. Fixed/asynchronous
* Implantable Cardioverter Defibrillator (ICD)
* Provides additional ability to cardiovert or defibrillate VT or VFib

47
Q

pacemaker complications

A

Infection
Bleeding or
hematoma
formation
Dislocation of
lead
Skeletal muscle
or phrenic nerve
stimulation
Cardiac
tamponade
Pacemaker
malfunction

48
Q

restrict what with pacemaker insertion

A

arm movement
do not raise above head for 2 weeks

49
Q

pacemaker discharge education

A

carry id
avoid electromagnetic interference
mri precautions
pulse diary

50
Q

icd discharge ed

A

log of icd discharges
know rate cut off
avoid activities that raise hr near cut off
notify ems
no airport want security screenings, request hand search
no driving

51
Q
A

NUR 230 (16 decks)

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