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High Acuity Hesi > Dysrhythmia Management > Flashcards

Dysrhythmia Management Flashcards

1
Q

What are some medications used to treat SVT?

A

Adenosine - Causes cardiac vasodilation, which will lead to a decreased heart rate

Amiodarone - Relaxes vascular smooth muscle, reduces peripheral vascular resistance (afterload), and slightly increases cardiac index. (all of this helps make the heart beat normally)

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2
Q

What are some medications used to treat ventricular tachycardia’s?

A
  • Amiodarone
  • Procainamide
  • Sotolol
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3
Q

What are some medications used to treat bradycardia’s?

A
  • Atropine
    • Can be less effective for Mobitz II and Complete Heart Block
  • Dopamine IV Infusion
  • Epinephrine IVP or Infusion
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4
Q

What are the first things you do if you have a patient come in with bradycardia and has a detectable pulse, and in what order are interventions given for this patient?

A
  • First Identify and Treat Cause of Bradycardia
    • Get an Airway, Oxygen, IV, Cardiac Monitor, 12 Lead EKG started
  • If patient is symptomatic of bradycardia, he/she then requires an intervention to be done

Order of Interventions:

  • Atropine
  • Transcutaneous Pacing
    • or Dopamine Infusion
    • or Epinephrine Infusion
  • Expert Consult
  • Transvenous Pacing
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5
Q

What are the first things you do if you have a patient come in with tachycardia and has a detectable pulse, and in what order are interventions given for this patient?

A

When the patient walks in:

  • Assess HR > 150 to situation/context
  • Identify and Treat Cause of Tachycardia if possible
  • establish an Airway, Oxygen, IV, Cardiac Monitor, and 12 Lead EKG on the patient.

If the patient is symptomatic they will need an intervention!

Order of intervention for SVT’s (narrow QRS complex tachycardia):

  1. Synchronized cardioversion
  2. Consider IV Adenosine

Order of interventions for Vtach (wide QRS complex tachycardia)

  • If the rhythm is wide and regular = synchronized cardioversion
  • If the rhythm is wide and irregular, they have gone into ventricular fibrillation = defibrillate!
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6
Q

What are the first things you do if you have a patient come in with tachycardia, has a detectable pulse, and is not symptomatic; in what order are interventions given for this patient?

A

(SVT) Narrow QRS:

  • IV, 12 Lead EKG
  • Vagal maneuvers
  • Adenosine
  • Beta or Calcium Channel Blockersq

(Vtach) Wide QRS:

  • IV, 12 Lead EKG
  • Consider Anti-dysrhythmic IV Infusion
  • Procainamide
  • Amiodarone
  • Sotalol
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7
Q

What are the order of interventions for a patient with Pulseless V-Tachycardia or V-Fibrillation?

A
  1. Immediately Start CPR
  2. Give O2, Attach monitor
  3. Defibrillate
  4. Start CPR again for 2 minutes and get IV/Intraosseous access
  5. Defibrillate
  6. Push Epinephrine IV, then push it again every Q 3-5 minutes as needed, if it doesn’t work:
  7. Consider advanced airway and waveform capnography
  8. Defibrillate
  9. CPR 2 minutes and Amiodarone IV bolus
  10. Treat reversible causes
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8
Q

What are the Order of Interventions for a patient who is Asystole or has Pulseless Electrical Activity (PEA)?

A
  1. Immediately Start CPR
  2. Give O2, Attach Monitor
  3. Start CPR for 2 minutes
  4. Get IV/Intrasseous access
  5. Push Epinephrine IV, then every Q 3-5 minutes
  6. Consider advanced airway and waveform capnography
  7. If rhythm has changed, is it “Shockable”?-> go to (you have to wait to get the heart beating on its own before your can defibrillate)
  8. VFib / Pulseless VTachy arm of algorithm
  9. CPR for 2 minutes
  10. Treat possible causes
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9
Q

What are the 12 causes of PEA?

A

6 H’s:
•Hypovolemia (most common)
•Hypoxia (most common)
•Hydrogen Ion (Acidosis)
•Hypothermia
•Hypo- or Hyper-Kalemia

6 T’s:
•Tension Pneumothorax
•Tamponade (cardiac)
•Toxins
•Thrombosis (PE)
•Thrombosis (Cardiac-MI)

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10
Q

What are some electrical therapies used to treat tachycardias?

A
  • Cardioversion
  • Defibrillation
  • Internal Cardioverter Defibrillator
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11
Q

What are some electrical therapies used to treat bradycardias?

A

Temporary Pacing

  • Transcutaneous Pacing
  • Transvenous Ventricular Pacing
  • Epicardial Ventricular Pacing wires (after Cardiac Surgery)

Permanent Pacemaker

  • Transvenous Pacing
  • Pacing Leadwire placed into heart through large vein
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12
Q

How do temporary pacemakers function?

A
  • They Stimulate myocardial tissue to depolarize and sense patient’s spontaneous initiation of heart beat
  • They also Improve Atrial-Ventricular synchrony in Heart Failure after cardiac surgery
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13
Q

Describe the “failure to capture” malfunction in a pacemaker

A
  • Pacemaker sends an impulse, but myocardium does not receive it or depolarize
  • A correctly delivered pacing impulse fails to depolarize the heart
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14
Q

Describe the “failure to sense” malfunction in a pacemaker

A
  • Pacemaker does not sense the pts intrinsic depolarization and fires inappropriately
  • Pacemaker fires randomly at any point during the cardiac cycle instead of at the indicated or appropriate time
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15
Q

Describe the “failure to fire or pace” malfunction in a pacemaker

A
  • Occurs when pacemaker should deliver a pacing impulse but does not.
  • On ECG tracing, it is characterized by a prolonged interval between two beats that exceeds the timing interval for the low rate limit
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16
Q

What are some nursing considerations for patient’s w/ permanent pacemakers?

A

The patient will have activity restrictions:

  • On affected side, do not raise elbow above shoulder or do any stretching movements
  • Do not lift > 5 lbs of weight on pacer side
  • Do not reach above head or out to the side
  • No swimming, over head motions, or golfing
  • No driving for 2 weeks after the procedure
  • Flying is okay, but can’t go through METAL DETECTORS or have an MRI

When the patient gets a shock:

  • May feel like someone has hit you, or like a thump in chest (feels like a horse kicked you in the chest).
  • If someone is touching you during shock, they may feel a tingling sensation
  • The first time you feel a shock, it may scare you.
  • Sit or lie down and stay calm. Ask someone to stay with you if possible

Patient Education:

  • Keep an ICD Diary
  • Tell the Physician about any shocks received
17
Q

When should a patient who has an ICD call 911 or seek help?

A
  • When he/she has > than 3 shocks in a row from ICD
  • Feels Weakness, dizziness, or feeling faint
  • Has palpitations, fast or slow HR with simultaneous shock from ICD.
  • Chest pain that is not relieved w/ rest or med

High Acuity Hesi (7 decks)

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