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MedSurg Test 1 > Chapter 36 > Flashcards

Chapter 36 Flashcards

1
Q

What are the intervalves of conduction?

A

P-R interval
QRS interval
Q-T interval

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2
Q

P-R interval

A

Amount of time to fill the ventricles
.20 or less
If >.20 we have a 1 degree AV block

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3
Q

ORS Interval

A

Represents time taken for deplarization (contraction) of both ventricles (systole)
.12 or less
If

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4
Q

Q-T interval

A

Represents time take for entire electrical depolarization and repolarization of the ventricles.
0.44 or less
If > 0.44 we have to treat the underlying cause with drubgs, electrolyte imbalance, or changes in H.R.

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5
Q

If the T wave is spiked (think electrolyte)

A

Hyperkalemia

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6
Q

If the T wave is flat

A

Hypokalemia

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7
Q

What does the 12 lead ECG show?

A

Structural changes, conduction disturbances, ischemia, infarction, electrolyte imbalance, and drug toxicity

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8
Q

Where do you place the 5 lead ECG?

A

R and L 7th ICS
V Lead on the right side of the sternum 3rd ICS
R and L 2nd ICS.

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9
Q

How can you determine a persons HR from an ECG?

A

count the number of QRS complexes in 1 minute..

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10
Q

Six Sec. Strip Method

A

If the conduction has regular rate and rhythm then you can count the number of QRS complexes in 6 sec and mult. by 10.

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11
Q

What does the P wave represent?

A

Atrial contraction (depolarization).

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12
Q

What is the small block method?

A

Count # of small squares between one R-R interval, divide by 1500

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13
Q

What is the big block method?

A

Count # of large square between one R-R Interval, divide by 300

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14
Q

What is the First degree heart block?

A

When the PR interval is larger than .20. No sinus rhythm, the AV node has taken over

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15
Q

What is a Bundle Branch Block?

A

When the QRS Complex is larger than .12. The conduction is only traveling through the bundle branch.

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16
Q

U Wave

A

Often over looked and is associated with electrolyte imbalance, heart disease, and HTN. Seen in hypokalmeia

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17
Q

How many bpm does the SA node provide

A

60-100

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18
Q

How many bpm does the AV node provide

A

40-60

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19
Q

How many bpm does the purkinje fibers provide

A

20-40

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20
Q

What are the three speed for junctional?

A

1) Junctional bradycardia-bpm are less than 40-60
2) Accelerated Junctional- bpm are greater than 60
3) Junctional Tachycardia-bpm are greater than 100

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21
Q

What three morphologies are in place for Junctional

A

1) When SA node is sick, P the wave is inverted
2) When SA node is knocked out. P wave is gone
3) the P wave is after the T wave

22
Q

Stable vs. Unstable dysrhythmias?

A 
Stable=Asymptomcatic or mild symptoms
Unstable= Decreased perfusion/CO. (too fast, too slow)
-Pulseless
-Dizziness
-Syncope
-Hypotension
-Chest pain
-Shortness of breath
23
Q

Syncope

A

Fainting

24
Q

Head-up-tilt-test

A

Induce orthostatic hypotension (decrease BP, increase HR)

25
Q

What are the different diagnostic Tests we can use for dsrythmias?

A 
Cont. ECG monitoring
Transesophageal echocardiogram
Electrophysiologic Study
Holter monitoring
Event monitoring (loop)
Excercise treadmill testing
26
Q

What medications are used for dysrhythmias and why?

A

Atropine - bradycardia
Adenosine - tachycardia
Epinephrine- Cardiac arrest
Amiodarone- VFibb and VTach

27
Q

What do you flush medications with?

A

20 mLs of NS to circulate

28
Q

Explain how you would administer Adenosine?

A

First you would fast push 6 mg = 1st dose

Then you can push 12 mg = 2nd dose

29
Q

When would you encourage vagal stimulation?

A

To slow down the heart = tachycardia

30
Q

Where do you NEVER want conduction to spike?

A

On the T wave b/c it can cause ventricular tachycardia

31
Q

What are the two malfunction that can occur with Pacemaker monitoring?

A

Failure to sense-Pacemaker isnt meeting the conduction pattern. Not spiking at the right place.
Failure to capture- Pacemaker isnt carrying out conduction after it spikes.

32
Q

What are some main teaching points for a pacemarker>

A
  • Avoid large magnets and electromagnetic fields
  • Dont use a cell phone on the same side as the device or place over the device
  • May set off metal detectors
  • Monitor pulse daily
  • Wear med alert braclet
33
Q

What are some complication after CPR

A

-Sternum and rib fractures
-Liver and spleen lacerations
Pneumothorax
-Cardiac tamponade

34
Q

Defibrillation is used for

A

Is used only for pulseless VT and VF.

  • nonsynchronized
  • no QRS
35
Q

Cardioversion is used for

A

Used for Afib, Aflutter, SVT

  • synchronized
  • QRS
36
Q

How do you use a defibrillator?

A 
Pick appropriate energy level
-Monophasic 360
-biphasic 200
Turn of synch switch
Apply conductive mater
Charge fibrillator
yell clear
Deliver charge
37
Q

How do you used a cardioversion

A

Synchronzied circuit delievers a countershock to occur on the R wave of the QRS Complex.

  • Pick appropriate energy lever (50-100)
  • If non emergent sedate pt
  • Turn on synch switch
  • apply conductive matter
  • Charge cardioversion
  • yell clear
  • Deliever charge
38
Q

When would a pt recieved and ICD (Implanted Cardioverter Defibrillator)?

A

If they survive SCD (Sudden Cardiac Death)

39
Q

Important facts about ICD’s

A
  • Deliever 25J shock
  • Can have a combo (Pacemaker included)
  • If it fires more than once call EMS
40
Q

What is Radiofrequency Catheter Ablation Therapy

A
  • Electrical energy used to burn ectopic areas
  • SVT’s
  • used for atrial dysrhytmias
41
Q

What do you do after ROSC (Return of spontaneous ciruclation)

A

therapeutic hypothermia

42
Q

Sinus means…

A

Impulse came from the SA node.

43
Q

What is Normal Sinus Rhythm

A

-Reg. PQRST cycles
-Rate b/w 60-100
P wave before each QRS complex
-Narrow QRS complex (0.12)
-All complexes look the same

44
Q

Sinus Bradycardia

A
  • We have reg PQRST cycles
  • Rate is slowed to less than 60 bpm
  • P wave before QRS
  • Narrow QRS
  • All complexes look the same.

TX: 1) Oxygen 2) Atropine 3) Pacemaker

45
Q

Sinus Tachycardia

A

CB: Exercise, fever, pain, hypovolemia, meds

  • Reg PQRST cycles
  • Rate is too fast b/w 101-200 bpm
  • P wave before each QRS complex
  • Narrow QRS
  • All Complexes look the same

Tx: Treat the underlying cause

46
Q

Sinus Arrhythmia

A

Normal phenomenon of mile acceleration with inspiration and slowing of the heart rate with expiration

No Tx

  • Irregurlar PQRST cycles (Q waves dont match up)
  • Rate slightly abnormal
  • P wave before each QRS Complex
  • Narrow QRS
  • All complexs look the same
47
Q

Premature Atrial Complex (PAC)

A

Abnormal electrical shock that is picked up by the AV node cuaseing the rest of the heart to fire.

  • Regular PQRST
  • Rate is normal with one interval that dosent belong
  • P wave before each QRS complex
  • Narrow QRS
  • All complexs look the same

CB: Emotional stress, fatigue, caffeine, tobacco, alcohol, meds
tx: Decrease sources of stimulation

Isolated occurances are normal

48
Q

Tachydsyrhythmias

A

HR > 100 bpm

Decrease supply/ Increases Demand

49
Q

Dysrhythmias

A 
Atrial!!
-Aflutter
-Afib
-SVT 
(Cardioversion/ Synchronized)
50
Q

What do you treat dysrhythmias with?

A

Adensoin

51
Q

What are 4 types of Atrail Dysrhythmias?

A

1) PACs’
2) SVT
3) Atrial Flutter
4) Atrial fibrillation (most common)

MedSurg Test 1 (6 decks)

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