Class 1 Flashcards
major pacemaker of the heart
sinoatrial node
intrinsic rate of SA node
60-100 bpm
second to take over if SA node fails as pacemaker
atrioventricular node
intrinsic rate of AV node
40-60 bpm
third to take over if SA node and AV node fail as pacemaker
purkinje fibers
intrinsic rate of purkinje fibers
30-40 bpm
in a 3rd degree AV block, what is the expected HR
30-40 bpm
what is the J point
where the S wave comes back to the isoelectric line
isoelectric line AKA
baseline
T or F: at the isoelectric line there is no electrical current flowing
true
should the Q wave be above or below the isoelectric line
below
should the R wave be above or below the isoelectric line
above
the S wave must do this
return to the isoelectric line
where is the normal ST segment
at the isoelectric line
should the T wave be above or below the isoelectric line
above
a low/flat T wave can indicate what
ischemia
a peaked T wave can indicate what
high potassium
a visible U wave can indicate what
low potassium
according to the AHA, how long do you have to intervene after an EKG shows an elevated or depressed ST segment
30 mins
a deep or wide Q wave can indicate what
necrosis/MI
what does a notch in the R wave indicate
bundle branch block
largest muscle in heart
left vent
pacing spike
pacemaker has discharged an electrical impulse
capture (pacemaker)
pacemaker has successfully depolarized the chamber
asynchronous/fixed (pacemaker)
pacemaker not programmed to sense intrinsic electrical activity
synchronous/demand (pacemaker)
pacemaker programmed to sense intrinsic electrical activity
this type of pacemaker is not programmed to fire unless electrical activity is not sensed
synchronous/demand
this type of pacemaker fire’s when it is programmed even if it does not need to fire based off of the intrinsic electrical activity
asynchronous/fixed
type of pacemaker that is across the skin and can cause painful electric shocks
transcutaneous
T or F: the nurse should wear gloves when caring for a patient with a transcutaneous pacemaker
TRUE
with this type of pacemaker BP should be taken only in the R arm or lower extremity and pulses may need to be taken with the carotid artery
transcutaneous
this type of pacemaker is used only in an emergency situation for someone who does not have an implanted pacemaker
transcutaneous
this type of pacemaker is threaded through an vein similar to a central line and goes into an artery in the heart
epicardial
pacemaker that has a probe attached to the heart during surgery
epicardial
important for positioning pt with endocardial pacemaker
HOB not too high
keep legs straight (if inserted in femoral)
you must assess for this after the placement of a permanent pacemaker
pneumothorax
type of pacemaker that is placed for recurrent/chronic dysrhythmias
permanent
holter monitor
can be worn at home and data can be looked at in office at any time
telemetry monitor
in hospital monitoring, no monitor in room, someone looks at screen outside of room
cardiac monitor
monitor is in the pts room
indicators of a pacemaker malfunction
pacing at inappropriate rate
s/s that were present prior to pacemaker placement
issue when pacemaker fires an impulse but the myocardium does not depolarize
failure to capture
issue when pacemaker fails to sense P wave or QRS complex
undersensing
which pacemaker issue can result in overpacing
undersensing
issue when pacemaker sense other electrical activity as a P wave or QRS complex
oversensing
which pacemaker issue can result in underpacing
oversensing
what can cause a pacemaker to oversense
increased potassium
normal appearance of QRS complex
peaked
normal appearance of P wave
rounded, upright
normal duration of PR interval
0.12-0.20
normal duration of QRS complex
0.12 or less
what can an elevated or depressed ST segment indicate
injury to myocardium
T or F: normal is no Q wave
TRUE
a synchronized cardioversion is done when there is an issue with which wave
R wave
what does a synchronized cardioversion do
depolarize myocardial cells
stop chaotic heart activity
pt gets this due to dysrhythmia that requires emergent attention
implantable cardio defibrillator
delivers a very strong shock that can cause pt to fall over, shake, etc
implantable cardio defibrillator
pt should not drive until they know the effect the shock of this device has on them
implantable cardio defibrilator
make sure there is a ___ for every QRS complex
P wave
common causes of sinus bradycardia
well conditioned athlete vagal stim decreased metabolic rate heart disease medications
dysrhythmia in which the sinus node creates an impulse at a below normal rate
sinus bradycardia
meds that can cause sinus bradycardia
amiodarone
beta blockers
CA channel blockers
digoxin
interventions/meds to correct sinus bradycardia
atropine
pacing
dopamine
epinepherine
dysrhythmia in which the PR interval is >0.20 seconds but all impulses are conducted to the ventricles
first degree AV block
the PR interval is greater than normal in these dysrhythmias
AV block
dysrhythmia in which the PR interval is progressively prolonged until the impulse is not conducted to the vents
second degree AV block type I
dysrhythmia in which the PR interval is constant but not all impulses are conducted to the ventricles
second degree AV block type II
dysrhythmia in which there is a complete block of all impulses to the ventricles
third degree AV block
junctional rhythm
the AV node is the pacemaker instead of the SA node
dysrhythmia in which the sinus node creates an impulse at a faster than normal rate
sinus tachycardia
common causes of sinus tachycardia
increased sympathetic tone
increased metabolic demands (fever, exercise)
interventions used to treat sinus tachycardia
indentify, correct, and eliminate underlying cause
dysrhythmia in which an electrical impulse starts in the atrium before the next normal impulse of the SA node occurs
premature atrial contraction (PAC)
dysrhythmia in which there is uncoordinated electrical activation that causes a rapid, disorganized twitching of the atrial muscles
a fib
common causes of PAC and SVT
increased catecholamine levels
heart disease
caffeine
interventions/meds used to treat PAC/SVT
vagal maneuvers synchronized cardioversion adenosine beta blockers CA channel blockers
T or F: in supraventricular tachycardia, there is an abnormal QRS complex
false, the QRS complex is normal
risk when giving adenosine
can cause absent HR for around 2 mins
can cause bronchospasm
pts with these issues should not be given adenosine
asthma
COPD
have this ready when giving adenosine
crash cart
common causes of a-fib/flutter
advanced age
heart disease
interventions/meds used to treat a fib/flutter
vagal maneuvers synchronized cardioversion beta blockers CA channel blockers if HF present: amiodarone and digoxin
these meds are used to treat a-fib/flutter only if HF is present
amiodarone
digoxin
more than 3 PVCs in a row
v tach
2 areas of the ventricle with abnormal activity
PVCs
common causes of PVCs
electrolyte disturbances
hypoxia
mechanical irritation of myocardium with catheters/wires
what can happen as a result of frequent PVCs
decreased cardiac output leading to v tach/v fib
interventions used to treat PVCs
search for possible reversible causes
common causes of v tach
electrolyte disturbances
hypoxia
mechanical irritation of myocardium with catheters/wires
interventions used to treat v tach w/ pulse
synchronized cardioversion (only for monomorphic) amiodarone lidocaine pronestyl sotalol
tx for polymorphic v tach
defibrillation
interventions used to treat v tach w/ no pulse
PT IS IN CARDIAC ARREST CPR defibrillation epinepherine amiodarone lidocaine
dysrhythmia in which there is a rapid disorganized ventricular rhythm that causes ineffective quivering of the ventricles and no atrial activity
v fib
common causes of v fib
electrolyte disturbances
hypoxia
mechanical irritation of myocardium with catheters/wires
interventions used to treat v fib
PT IS IN CARDIAC ARREST CPR defibrillation epinepherine amiodarone lidocaine
dysrhythmia in which there is an absent QRS complex confirmed by 2 leads
asystole
interventions used to treat asystole
PT IS IN CARDIAC ARREST
CPR
epinepherine
ID and treat reversible causes
dysrhythmias in which the pt is in cardiac arrest
asystole
v fib
v tach w/ no pulse
examples of pulses electrical activity
pericarditis
cardiac tamponade
s/s of cardiac tamponade
SOB
muffled heart sounds
JVD
pulsus paradoxus
T or F: you should shock a pt with asystole and a pulseless electrical activity
false