Ch 35 Dysrhythmias (Exam 2) Flashcards
BPM of normal sinus rhythm
60-100 bpm
Sinus bradycardia (4)
- <60 bpm
- normal in athletes
- significant if symptomatic (decreased CO)
- does not always adversely affect CO
Sinus tachycardia (4)
- > 100 bpm
- normal when associated with exercise
- abnormal when associated with fever, pain, low BP, MI, HF, anxiety, fear, drugs
- treatment depends on the cause
S/S of decreased CO (7)
- sweating
- clubbing of fingers/toes
- palpitations
- SOB
- decreased peripheral pulses
- altered mental status
- LATE: cyanosis
Medication treatment for sinus bradycardia?
administer atropine (anticholinergic)
What is the best way to determine if the cardiac rhythm is regular?
By determining if the R-R interval is normal
2 types of cardioelectric therapy?
defibrillation and synchronized cardioversion
Defibrillation is indicated for which lethal arrhythmias? (2)
- ventricular fibrillation
- ventricular tachycardia
Defibrillation works by?
sending an electrical shock through the heart to depolarize the cells of the myocardium
Defibrillation is placed where on the chest?
Apex and sternum (ribs are expected to get fractured)
In defib, the synch button should be ____
OFF
For safety during defibrillation, yell ____ and ____
- clear to make sure no one touches patient
2. make sure oxygen is off (could spark a fire)
Synchronized cardioversion is indicated for?
ventricular or SVTs (VT with a pulse)
Cardioversion works by?
delivering a shock that occurs on the R wave of the QRS complex
What is required to administer to the patient during cardioversion?
Sedation (usually painful for patients)
In cardioversion, the synch button should be turned ____
ON
If the patient becomes pulseless during synchronized cardioversion…
Turn the synch button OFF and defibrillate
Name the 8 steps of defibrillation
- continue CPR until defibrillator is charged
- turn on and select proper energy level (joules)
- make sure synch button is OFF
- apply gel pads
- charge defibrillator
- position paddles firmly on the chest wall
- ensure “all clear!”
- deliver charge
A patient in VFib was shocked and a normal sinus rhythm was established. What should the nurse do next?
Check the pulse
Atrial fibrillation (4)
- regularly irregular
- occurs in coronary artery disease (CAD), rheumatic heart disease, cardiomyopathy
- results in decreased CO and an increased risk for stroke d/t clot formation
- requires anticoagulant therapy
Atrial flutter (4)
- high ventricular rates (over 100 per min) and a LOSS of the atrial “kick” leads to decreased CO and blood stagnation
- manifests as chest pain and possible HF
- increased risk for stroke
- treatment: radiofrequency catheter ablation, beta-blockers, calcium channel blockers, anticoagulants
Supraventricular tachycardia (3)
- HR > 150
- related to the alteration in the conduction of the heart
- treated with vagal maneuvers, adenosine, beta blockers
Premature ventricular contractions (“throwing PVCs) (3)
- extended P wave
- cause: stimulants (coffee, epi, digoxin), low potassium, hypoxia
- treatment: amiodarone, lidocaine, procainamide (to decrease electrical activity)
Ventricular tachycardia - lethal ! (3)
- no P wave, wide QRS
- decreased CO
- associated with MI, CAD, electrolyte imbalance, cardiomyopathy, CNS disorders