Caring for Clients with Dysrhythmias Flashcards
how long is each segment of a monitor strip
6 second strip
P wave
represents atrial depolarization (atrial contraction)
present, consistent, configuration, one P wave before each QRS complex
PR interval
represents the time required for atrial depolarization as well as impulse travel through the conduction system
QRS complex
is measured from the beginning of the Q (or R) wave to the end if of the S wave (ventricular contraction)
ST segment
represents early ventricular repolarization- ventricular returning to resting state. indication of MI
QT interval
total time required for ventricular depolarization and repolarization
Steps to ECG Rhythm Analysis
determine HR, Heart rhythm, analyze P waves, measure PR interval, QRS duration, examine the ST segment.
normal PR interval duration
0.12- 0.20 and constant
normal QRS duration
0.06-0.12 and constant
Elevations in ST segment
may indicate myocardial infarction, pericarditis, hyperkalemia
depression in ST segment
is associated with hypokalemia, myocardial infarction, ventricular hypertrophy.
normal sinus rhythm
rate 60-100 bpm
rhythm: atrial and ventricular rhythms are regular
sinus arrhythmia (SA)
variant of normal sinus rhythm, results from changes in intrathoracic pressure during breathing, has all the characteristics if normal sinus rhythm except for its irregularity. The PP and RR intervals vary, with the difference between the shortest and the longest intervals being greater than 0.12 second
Dysrhythmias
Any disorder of the heartbeat
Tachydysrhythmias
Heart rate greater than 100 beats per minute
Bradydysrhythmias
Heart rate less than 60 bpm
Premature complexes
Early rhythm complexes; if they become more frequent, especially those that are ventricular, the patient may experience symptoms of decreased cardiac output.
Repetitive rhythm complexes
Bigeminy, trigeminy, quadrigeminy
Etiology for dsyrhythmias
May occur for many reasons. Can be classified by their site of origins in the heart (sinus, atrial, ventricular). Managed with antidysrhythmic drug therapy.
Care of patients with dysrhythmias
Asses VS every 4 hours
Monitor for cardiac dysrhythmias
Evaluate and document patients response
Encourage patient to notify nurse if chest pain occurs
Asses for chest pain and respiratory difficulty
Asses peripheral circulation
Administer medication and monitor response
Monitor lab values
Monitor activity tolerance and schedule exercise/rest periods, avoid fatigue
Promote stress reduction
Offer spiritual support
Atrial Dysrhythmia-Supra-ventricular Tachycardia
Rapid stimulation of atrial tissue occurs at rate of 100-280 bpm in adults. P waves may not be visible, because they are embedded in the preceding T wave.
Atrial Fibrillation
Most common dysrhythmia. Associated with atrial fibrosis and loss of muscle mass. Common in heart disease such as HTN, heart failure, CAD. Many other risk factors. Cardiac output can decrease by as much as 20-30%
Assessment for A Fib
Assess for fatigue, weakness, SOB, dizziness, anxiety, syncope, palpitations, chest discomfort or pain, hypotension. High risk for PE, VTE, stroke
Drug Therapy for A fib
Calcium channel blocker, aminodarone, beta blockers, digoxin, anticoagulants, antiplatelet
Other treatments for A fib
Cardio version, per cutaneous radio frequency catheter ablation, bi-ventricular pacing, surgical maze procedure
Ventricular dysrhythmias
More life threatening than atrial dysrhythmias. Left ventricle pumps oxygenated blood throughout the body to perfume vital organs and other tissues. Most common or life threatening: PVC, VT, VF, VA
Ventricular dysrhythmia- ventricular tachycardia
Also called v tach- repetitive firing of an irritable ventricular ectopic focus, usually 140-180 bpm or more.
Stable VT
Treatment: oxygen amiodarone, lidocaine, or magnesium sulfate, elective cardio version radio frequency catheter ablation, implantable cardioverter debrillation.
Oral antidysrhythmic agent: mexiletine or sotalol
To prevent further occurrences.
Unstable VT
Can cause cardiac arrest, unstable VT without a pulse is treated the same way as v fib. Assess patient’s airway, breathing, circulation, LOC, and oxygenation level
Treatment for V Fib
Life threatening… no cardiac output or pulse, blood is no longer being pumped out of the heart and brain not receiving blood. May be the first manifestation of CAD. First priority: patient immediately. Continue high quality CPR, provide airway management, follow ACLS protocol.
Ventricular dysrhythmia- ventricular fibrillation
Called v fib. Result of electrical chaos in ventricles
Ventricular dysrhythmia-ventricular asystole
Called ventricular standstill- complete absence of any ventricular rhythm.
Treatment for ventricular asystole
Full cardiac arrest- no cardiac output or perfusion to the rest of the body. Prognosis is poor. Manage airway. Administer CPR- compressions, airway, breathing. DO NOT DEFIBRILLATE… no electrical activity to shock. Follow ACLS protocols
Patient teachings with dysrhythmias
Prevention, early, recognition, and management. Lifestyle, modifications, (avoid caffeinated beverages, stop, drinking, drink, alcohol in moderation, follow prescribe diet). Drug therapy instructions. Teach the patient and family how to take pulse and or blood pressure and report any changes. Keep follow up appointments. Provide oral and written instruction for pacemaker, ICDS, cardiac exercise programs, support groups as applicable.
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.
C
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
D
