Chapter 7

Question 1

Junctional Dysrhythmias

Answer 1

Involves the AV junction/node/tissue. Abnormal. AV node rate of 40-60 bpm. Junctional rhythms are a result of electrical impulses coming fromt the AV node rather than form the SA node. As a result of the electrical activity coming formt he AV node or junction, the electrical impulses causing depolarization of the atria are flowing retrograde, or backward.

Question 2

What is unique in the ECG of junctional dysrhythmias

Answer 2

An inverted O wave morphology

Question 3

What is suggestive in junctional dysrhythmias

Answer 3

More serious conditions with electrical conduction system

Question 4

Premature Junctional Complex (PJC)

Answer 4

A single early electrical impulse that originates in the atrioventricular junction. It occurs before the next expected sinus impulse, causing an irregularity in the underlying rhythm

Question 5

PJC criteria for classification

Answer 5

PJC will cause the rhythm to be irregular, and the P wave may appear before, during, r after the QRS complex. Regardless of location, if the P wave is seen, it will be inverted.

Question 6

Signs and sx’s of PJCs

Answer 6

When a pt is healthy there are none, when it occurs more that four to six per minute, this warns of amore serious condition and the pt may experience hypotension due to low cardiac input

Question 7

Junctional Escape Rhythm

Answer 7

Also called junctional rhythm, originates at AV junctional tissue (not the SA node), producing retrograde depolarization of atrial tissue, and at the same time, stimulates the depolarization of ventricles.

Question 8

Junctional escape rhythm criteria for classification

Answer 8

The P wave may occur before, during (buried), or after the QRS. If the P wave is seen, it will be inverted. The hr is between 40-60 bpm

Question 9

Signs and sx’s of junctional escape rhythm

Answer 9

Slow hr than nl, loses the atrial kick due to the shortening of the interval between the atrial depolarization and ventricular depolarization. Hypotension, AMS, confusion, disorientation.

Question 10

Junctional Tachycardia

Answer 10

Share the same unique morphology as junctional escape rhythm and accelerated junctional rhythm, the only difference again being the hr is FASTER in junctional tachy

Question 11

Junctional Tachycardia criteria for classification

Answer 11

May have an inverted or absent P wave or P wave that follows the QRS complex. Hr is between 100 and 150 bpm

Question 12

Signs and sx’s of pt with junctional tachycardia

Answer 12

Depend on the rate. Sx’s of low cardiac output, palpitations, if pt has a hx of similar heart conditions, this is more serious.

Question 13

Tx for junctional tachycardia

Answer 13

Monitoring of ECT tracings, medication to treat dysrhythmias

Question 14

Supraventricular Tachycardia (SVT)

Answer 14

Classification of rapid heartbeats occurring at a rate greater than 150 bpm. Not specifically a junctional dysrhythmia, but the origin causing the rapid heart rhythm may come from any location “above the ventricles”. NON SPECIFIC, electrical impulse may come form the sinus node, atria or AV junction. Atria contract as soon as the ventricles are relaxing.

Question 15

P wave in SVT

Answer 15

Difficult to identify, (atrial contraction) they occur at the same time as the QRS or T waves (ventricle relaxation).

Question 16

Dysrhythmias associated with SVTs (re-entry dysrhythmias)

Answer 16

Sinus tachycardia: Sinus node
Atrial flutter and Atrial fibrillation: Atrium
Junctional tachycardia: Junctional

Question 17

What can we do to make it easier to identify the type of re-entry dysrhythmia

Answer 17

Sleep up the paper of the ECG, it will help determine the P wave and the origine of the dysrhythmia

Question 18

SVT criteria for classification

Answer 18

Normal-narrow-appearing QRS complex and a rate of greater than 150 bpm

Question 19

Signs and sx’s in SVT

Answer 19

The stable pt may only complain of palpitations.
The unstable pt may experience sx’s of low cardiac output which are reflective of the heart not pumping effectively to other body systems

Question 20

Tx for SVTs

Answer 20

SVT increases myocardial oxygen demand, pt should be given oxygen asap.

Question 21

Identify premature junctional complex using the criteria for classification, and explain how the rhythm may affect the pt, including basic pt care and tx

Answer 21

A premature junctional complex (PJC) is a single early electrical impulse that originates in the AV junction. It occurs before the next expected sinus impulse, causing an irregularity in the rhythm

Question 22

Identify junctional escape rhythm using the criteria for classification, and explain how the rhythm may affect the pt, including basic pt care and tx

Answer 22

Junctional rhythm, also known as junctional escape rhythm, originates at AV junctional tissue, producing retrograde depolarization of atrial tissue, and at the same time, stimulates the depolarization of ventricles

Question 23

Identify accelerated junctional rhythm using the criteria for classification, and explain how the rhythm may affect the pt, including basic pt care and tx

Answer 23

Accelerated junctional rhythm shares the same unique morphology as junctional escape rhythm, with the distinguishing difference being the hr, which is between 60-100 bpm for accelerated junctional rhythm

Question 24

Identify junctional tachycardia using the criteria for classification, and explain how the rhythm may affect the pt, including basic pt care and tx

Answer 24

Junctional tachycardia rhythm shares the same unique morphology as junctional escape rhythm and accelerated junctional rhythm, the only difference again being the hr exceeds 100 bpm

Question 25

Identify supraventricular tachycardia using the criteria for classification, and explain how the rhythm may affect the pt, including basic pt care and tx

Answer 25

Although supraventricular tachycardia is not specifically a junctional dysrhythmia, the origin causing this rapid heart rhythm may come from any location “above ventricles”. SVT presents with nl-narrow-appearing QRS complex and a arate of greater than 150 bpm