Chp. 29 EKG Flashcards
What is the normal second measurement for the QRS complex?
0.12 sec
The nurse is administrating atropine. Which rhythm would the client show on the EKG monitor?
Sinus Bradycardia
A client shows a HR of 130 bpm on the EKG monitor. What would be that cause of this rhythm? Hypovolemia Use of beta-blockers Well trained athlete Sleeping
Hypovolemia
A client is in new-onset A fib with a rapid ventricular rate. What Ca+ channel blocker would be administered to help control the rate?
Diltiazem
The telemetry tech calls the nursing station and tells the secretary that the client is in V tach. What would be the nurse’s priority when walking into the room?
Assess the client
Pulse or no Pulse V Tach? will determine Tx
The ambulance is bringing in a client in cardiac arrest. When they arrive tot he room a rhythm check is done and the client is in V fib. What is your priority?
Defibrilation
You are watching the monitor at the nursing station and notice a client’s rhythm turn from normal sinus rhythm to asystole. What should you do?
Check the leads and client
You are working in the ICU and you are assessing your client when all of a sudden they become unresponsive but they have an organized rhythm on the monitor. What is your priority?
Check for a pulse
What electrolyte imbalance can change T wave?
Hypo/hyperkalemia
When would you see a U wave on the EKG?
Digoxin toxicity or hypokalemia
What is the normal measurement fro PR interval?
< 0.20 sec.
A Pt. is having an EKG done. You notice they are bradycardic. You assess the pt. and they are not showing any symptoms. How do you treat the bradycardia?
You do not treat bradycardia unless they are symptomatic.
Symptoms: SOB, chest pain, syncope, diaphoresis, dizziness
You notice your Pt. has suddenly become bradycardic and they complain of dizziness, SOB, and chest pain. What is the treatment for this Pt.?
Atropine (Anticholinergic) 0.5-1 mg
What is the maximum dose of Atropine you the nurse can administer?
3 mg IVP
What are some causes of Bradycardia?
Hypoxia, Hypothermia, Sleeping, well trained athletes, drugs
Your Pt. is showing a HR: 150 with regular R waves and P waves are present. What is the treatment for this Pt.?
#1 Treat the underlying cause Also admin beta-block or Ca+ channel blocker (Diltiazem)
What are some causes of Sinus Tachycardia?
Fever, anemia, hypovolemia, hypotension, MI, Sepsis, PE, and anxiety
Your Pt. is showing a HR: 146 with regular R waves and P waves are present. On assessment: Temp: 99 BP: 96/60 What is the treatment for this Pt.?
Fluids ASAP
Beta-Blockers
“-olol”
Ca+ Channel Blockers
“Very Nice Drugs”
Verapamil
Nifedipine
Diltiazem
What is the nurse’s concern with a Pt. with new onset A Fib?
Clots!
On EKG assessment you find your admit has no P wave, the R waves are irregular, and BP: 157. What type of rhythm does the nurse expect?
A Fib
On EKG assessment you find your admit has no P wave, the R waves are irregular, and BP: 157. What does the nurses expect the orders for Tx to be?
Blood thinner
Beta-blocker
Ca+ Channel Blocker
Digoxin (control rate)
A Pt. with A Fib is expecting a Cardioversion tomorrow morning. What should the nurse educate the Pt. about?
Before the Cardioversion they must do a Transesophageal Echo to determine if there are clots inside the atria
What are some causes of A Fib?
Increased Age, Hypertension, hyperthyroidism, obesity, diabetes, chronic kidney disease, cardiac surgeries, and CAD
What is a concern with A Fib?
#1 clots #2 decreased CO
What can a Atrial Flutter rhythm look like on EKG?
Shark fins
When do you perform a Cardioversion?
When they have a pulse. Must be synchronized.
When do you perform a defibrilaiton?
When they have NO pulse. Considered unsynchronized
What are some causes of A Flutter?
CHF, CAD, valve disease, MI, PE, HTN, digoxin toxicity
A pt. has an EKG done. You determine there are no P waves, the rhythm is regular. Instead of P wave you see several shark fin like waves. What do you expect the orders to be?
Beta-blocker
Ca+ Channel Blocker
Digoxin
Cardioversion (not first line defense)
What is your goal with A Fib or A Flutter?
Control the heart rate (Controlled)
What are examples of Vagal Maneuvers?
Bearing down
Blowing paper off a straw
Placing an ice on pt.
A pt.’s EKG has came you assess it to find: HR: 200, regular rhythm, and no P waves. The pt. is showing symptoms of palpitations, chest pain, SOB, diaphoretic, and BP: 80/74. What do you determine the rhythm to be?
Supraventricular Tachycardia
A pt.’s EKG has came you assess it to find: HR: 200, regular rhythm, and no P waves. The pt. is showing symptoms of palpitations, chest pain, SOB, diaphoretic, and BP: 80/74. What do you expect the orders to be?
This is an unstable pt. w/ supraventricular tachycardia (SOB, diaphoretic, chest pain)
Tx: Adenosine 6 mg IVP (if does not work: push 12 mg), or Cardioversion
A pt. is stable if not showing symptoms
A pt.’s EKG has came you assess it to find: HR: 170, regular rhythm, and no P waves. The pt. is not showing symptoms of distress. How can your treat the pt.?
Vagal maneuvers
What is the goal to treating Supraventricular Tachycardia?
Get HR normal
What can cause Supraventricular Tachycardia?
Caffeine, drugs, lung disease, med toxicity, heart problems
Pt. EKG: P waves absent, rhythm irregular, QRS wide (greater than 0.12 sec), and has an underlying regular rhythm. What kind of rhythm is this?
Premature Ventricular Contractions
What are causes of Premature Ventricular Contractions?
CAD, MI, hypokalemia, hypoxia, stress, drug toxicity, HTN, caffeine
What is the nurse’s main concern with PVCs?
If they become more frequent PVCs can turn into V tach or V fib
A nurse finds the patient is unresponsive with no pulse or blood pressure. Which dysrhythmia does the nurse anticipate?
Asystole
Which are true regarding the QRS wave? Select all that apply.
a. ) The QRS wave is the first wave that is normally seen in pt.
b. ) The QRS wave represents ventricular depolarization
c. ) Normal QRS waves are usually rounded in width
d. ) Wide QRS waves may indicate that there is a block in the ventricles
e. ) QRS waves can take on many different forms
B, D, E
A nurse overhears another team member saying that atrial fibrillation begins in the atrioventricular (AV) node of the heart. What action should the nurse take?
Correct her. A Fib begins in the SA node
While assessing the electrocardiogram (ECG) report of a patient, the nurse observes that there is an absence of P waves and the QRS complex is narrow with irregular RR intervals. Which dysrhythmia is the patient experiencing?
A Fib
The nurse is caring for a patient taking multiple cardiac medications. The patient asks which medication should be taken during episodes of chest pain. Which medication is correct?
Nitro
Which dysrhythmias requires defibrillation?
V Fib
Pulseless V Tach
The nurse is performing an Allen test in preparation for the placement of an arterial line. What would be a positive finding?
Color returns in 7-10 sec.
If you determine a pt. heart is only working off of the purkinje fibers firing and no other electrical activity, what is the treatment?
Pt needs to be on pacemaker or will not last long. Need to increase HR ASAP
As the nurse, you know that the following can cause rhythm disorders: (Select all that apply.)
a. ) Exercise
b. ) Electrolyte imbalances
c. ) Myocardial hypertrophy
d. ) Myocardial damage
e. ) Eating Red Meat
B, C, D
All can lead to dysrhythmias
If the PR interval is longer than 0.20 sec what does the nurse suspect?
AV Heart Block
5 Questions to ask yourself when interpreting EKG Strip
Rate? Rhythm? P wave present? What is the PR interval? What is the QRS complex?
Premature Atrial Contraction
The atria is firing earlier than it should. Tx: stop the thing causing PAC (ex. stop drinking caffiene)
A Fib RVR (Rapid Ventricular Response)
Means: A fib with high heart rate (uncontrolled)
Safety Alert: Adenosine
Adenosine is given IVP and it stops the heart to reset, which results in asystole and then you are hoping the SA node kicks back in and starts working. Have a crash cart nearby
Key patient teaching points for A Fib include which of the following? (Select all that apply.)
a. ) Medications for HR control
b. ) Bleeding precautions
c. ) Signs and symptoms of A Fib with RVR
d. ) Cardioversion
e. ) Defibrilation
A, B, C, D
Rationale: Medications may be used for rate control. A Fib pt. are typically on anticoagulants. A rapid ventricular response may occur with A Fib, resulting in adverse symptoms and decrease CO. Cardioversion, not defibrillation, is sometime indicated for A Fib pt.
Which of the following is not an appropriate intervention for all atrial dysrhythmias?
a. ) An EKG
b. ) A pulse check
c. ) BP check
d. ) Cardioversion
D
Cardioversion is only used with symptomatic atrial dysrhythmias
Your pt. goes into V Tach. but has a pulse and is able to maintain BP. What is the Tx?
Amiodarone then synched cardioversion
Treat H’s and T’s (Stable but won’t be stable for long, treat cause early)
Your pt. goes into V Tach. and has no pulse. What is your priority?
Defibrillate ASAP
Your pt. goes into V Tach. and has no pulse. What do you do?
Assess, CPR, Epi (1 mg q 3 min), amiodarone, and Defibrillate ASAP
Your pt. goes into V Tach. you cannot get them back unless you treat ___ and ___
H’s and T’s
What are H’s and T’s?
Hypovolemic, Hypoxia, Hypothermia, Hydrogen imbalance (Acidotic - ABG’s), Hypo/Hyperkalemia, Hypoglycemic, Toxins, Thrombosis, pneumothorax
What kind of V Tach is Tordes de Pointes and what does it look like?
Polymorphic
A twisted ribbon
What king of people do you see with Tordes de Pointes? Tx?
Low Mg (Alcoholics) Tx - Mg Sulfate
V Fib never has a ___
Never has a pulse
Tx for V Fib:
Assess CPR Epi and amiodarone Defibrillate (#1 priority after CPR intiated) Treat H's and T's
When pt. is in Asystole you should ___ ___
NOT SHOCK!
DO NOT SHOCK ASYSTOLE!
Tx asystole:
CPR
Epi (1 mg q3min)
H’s and T’s
What must be done to confirm cardiac death?
Asystole must be checked in 2 leads
Tx for Pulseless Electrical Activity (PEA):
CPR
Epi (1 mg q3min)
H’s and T’s
Amiodarone is contraindicated in what kind of pt.’s?
Pt. that have complete heart block because can prolong QT interval
Why is your priority with pulselessness V Tach and V Fib Defibrilation?
You want to restore circulation ASAP
The nurse understands that rhythms originating in the ventricle have which of the following characteristics? (Select all that apply.)
a. ) Wide QRS complex
b. ) Narrow QRS complexes
c. ) Only QRS complexes
d. ) Only fast rates
e. ) Only slow rates
A, C
Rationale: Rhythms originating in the ventricles can be slow/fast, have wide QRS complexes and sometime only have QRS complexes (VT). Narrow QRS complexes indicate rhythm originating above the AV node
