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2.0 Adult Nursing Exam 1 > Dysrhythmias > Flashcards

Dysrhythmias Flashcards

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1
Q

Rate that the sa node should be between for a normal heart

A

60-100

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2
Q

What does the sa node do?

A

It is the pacemaker of the heart and it creates the impulse which then travels to the atria

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3
Q

What is conduction?

what allows for the ATRIA to contract?

A

Conduction is when the the muscle cells of the atria contract.

The AV node allows for the atria to contract by slowing the impulse down. This allows time for the atria to contract and ventricles to fill

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4
Q

Where does the impulse travel in order for the ventricles to receive the impulse to contract?

A

The impulse goes from AV node&raquo_space; bundle of his&raquo_space; perkinje fibers in the ventricles

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5
Q

systole

A

muscle contraction

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6
Q

diastole

A

muscle relaxation

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7
Q

What does heart depolarization correlate with?

A

Depolarization corresponds with heart muscles contracting like a wave through the heart

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8
Q

When the heart repolarizes the heart is doing what?

A

relaxing

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9
Q

What is the impulse doing when the ekg shows a P-wave?

A

The atria is depolarizing meaning conduction (remember this happens int he atria) is occurring there so there will be corresponding muscle contraction.

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10
Q

What is the impulse doing when the ekg shows a QRS?

A

The ventricles are just depolarizing and experiencing conduction.

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11
Q

What is going on if there is a T-wave on the ekg?

A

Ventricles are repolarizing or relaxing

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12
Q

What is the QT interval on an ekg?

A

Time from ventricles depolarizing to ventricles repolarizing.

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13
Q

What is an ST segment?

When do we common see it?

A

Early repolarization

Commonly seen elevated with an acute MI

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14
Q

Time for a ONE small box on the ekg

A

0.04 seconds

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15
Q

Time for ONE large box on the ekg

How many small boxes are in a large box?

A

0.20 seconds

5 small boxes inside a large box

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16
Q

Time for FIVE large boxes on the ekg

A

5 large boxes will equal 1 second

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17
Q

How many boxes on an ekg gives you 6 seconds?

A

30 large boxes

so 150 small boxes

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18
Q

What is positive deflection

A

Waveforms that move up the paper

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19
Q

First question you ask yourself when you’re assessing the cardiac rhythm on ekg?

A

Does the rhythm look regular?

- meaning does it look spaced out evenly

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20
Q

Second question you ask yourself when you’re assessing the cardiac rhytm on an ekg?

A

Are all the pieces there?

- P wave, QRS, T wave?

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21
Q

Third question you can ask yourself when assessing the cardia rhythm on the ekg?

A

What is the rate?

- add up the amount of boxes in between R intervals (top). then take 1500/n.

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22
Q

Fourth question you can ask yourself when assessing cardiac rhythm on the ekg to double check?

A

Check and see is the patient presentation lines up with your findings.
Do they have symptoms? Is the issue new or has it always been chronic?

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23
Q

When someone says your st segment is “isoelectric” what do they mean?

A

At baseline or straight

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24
Q

How big is the Pwave not supposed to exceed?

A

Should not exceed 1 box in length and 1 box in height

1x1

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25
Q

What is the time length and box length of a normal QRS complex?

A

0.08-0.12 seconds

2-3 horizontal boxes

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26
Q

What is the time length and box length of a normal PR interval?

How is this measured?

A

0.12-.20 seconds

3-5 horizontal boxes

Beginning of the P wave to the onset of the QRs. (initial wave can sometimes be an R isnead of the Q)

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27
Q

T/F

Sa node stimulates the heart for a rate of 40-60 bpm and the impulse travels to the ventricles

A

False.
Sa node heart rate is the higher one of 60-100.
The impulse of the sa node travels to the atria.

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28
Q

T/F

It is common for normal sinus rhythms to change during non-strenuous movements

What is treatment for normal sinus?

A

False.

Normal sinus rhythms are supposed to be able to remain steady when you aren’t straining yourself

Treatment includes monitoring closely (bc it can all change in an instant)

29
Q

What is the definition of a normal sinus rhytm?

A

It is when all the correct components of an ekg are there and the HR is within the normal limits of 60-100 bpm (remember - the SA node is the pacemaker here so it should be between these numbers if the heart is NORMAL)

30
Q

What is sinus bradycardia?

A

Correct components of the ekg but the HR is below 60 (or bradycardic)

31
Q

T/F

Sinus bradycardia only occurs in a diseased heart

A

False

Sinus bradycardia can be present in normal and a diseased heart - you don’t have to be completely unhealthy to have it.
Ex: athletes

32
Q

What is the clinical presentation of sinus bradycardia (as in a clue where you don’t have to look at the ekg)?

A

You look for signs of decreased cardiac output.

Fatigue
Thready pulse
Diaphoretic and sweaty
DOB

Decreased UO
confusion

33
Q

T/F

You only ever need to treat sinus bradycardia if the client is having symptoms of distress

A

True.

34
Q

What is the first treatment for sinus bradycardia?

What are the other meds you can give?

Machine that can help?

A

Atropine

Dopamine drip, Epinephrine

Cardiac pacing
- gives jolt if the hr drops below 60

35
Q

When giving dopamine for sinus bradycardia what is the dosage?

low dose effect

high dose effect

A

2-10 mcg/kg/minute
helps increase contractions and hr

low dose = increase renal perfusion due to vasodilation

high dose = acts as presser for faster HR due to vasoconstriction

36
Q

Explain how low and high dose effects of dopamine can affect renal perfusion

A

If you need more perfusion to kidneys (bc the hr is too low to perfuse) you can give low dose to dilate the vessels

if you were to give a high dose you can cause too much restriction and cause renal failure

37
Q

If a pt is in sinus bradycardia and they are having angina why is this and how can we help them?

A

Pt is probably having angina due to not getting enough o2 from low HR. So, we can give them 02.

38
Q

Body states that begin with an “H” which can lead to sinus bradycardia?

A

Hypoxia
Hypo/Hyperkalemia
Hypothermia
Hypovolemia

39
Q

How can hypoxia cause sinus bradycardia?

A

Well there just low on 02 already

40
Q

How can Hypovolemia cause sinus bradycardia?/

A

Not having enough fluids in the body can cause HR to slow (but be careful the same goes for tachycardia too)

41
Q

What site stimulation can cause sinus bradycardia?

What procedure can cause the sinus bradycardia rt to it?

A

Vagal stimulation from barring down, coughing, vomiting

intubation can stimulate the vagal nerve and cause it

42
Q

Causes of sinus bradycardia that begin with “T”?

“PT”?

A

Toxins
Trauma
Tamponade
Thrombosis

Pneumothorax

H & T????

43
Q

Drugs that can cause sinus bradycardia

A

Digoxin
Beta Blockers
Verapamil
Diltiazem

(the drugs youd give for tachy essentially)

  • make sure you monitor patient or even make sure there are perimeters
44
Q

Atropine dosage for bradycardia?

Push speed?

A
  1. 5 mg IV push
    - can repeat up yo 3 mg

Push it fast!!! as well as the flush

45
Q

Second line bradycardia drug?

What is the caution here?

A

Dopamine 2-10 mg/kg/min

Caution with heart blocks and active MI
- if we increase hr, a heart that is already exhausted will become even more exhausted

also know some doctors will choose Epi (depends on doctor). same dosage too

46
Q

More invasive treatment for bradycardia that just won’t go away?

Two types and their meaning?

A

Pacemaker placement that can be temporary or permanent

transcutaneous - on skin . delivers shock set to 60 zou

transvenous - invasive at central venous access. gives shock

47
Q

Treatment of choice for patients with symptoms of bradycardia with signs of poor perfusion (if meds aren’t working)?

A

Transcutenous - on skin

48
Q

What is Sinus Tachycardia?

Why does it occur?

A

It is when all the components are there so its sinus but the HR is faster making it tachycardia. 100-150 rate

The sa node rapidly fires

49
Q

T/F

Sinus tachycardia is a rapid contraction in response to a condition of an abnormal heart

A

False. It is usually in a normal heart

50
Q

Eight main causes of sinus tachycardia

Which is a main indicator of sepsis?

A 
Drugs
Disease
Pain
FEVER
Excitement or caffeine 
Hypovolemia
MI 
HF

The fever. If they have tachy it can be from infection

51
Q

What is sinus tachycardia characterized by?

A
  • Normal RESTING heart rate but with an exaggerated postural sinus tachy with or without orthostatic (pt can get tachycardic but won’t have changes in BP)
  • decreased cardiac output
52
Q

What does clinical presentation of sinus tachycardia rely on?

A

The rate and how well the pt can handle it

53
Q

Why do patients with sinus tachycardia experience:

Dizziness

Hypotension

Angina and chest pain

A

Dizziness = due to the HR being too fast, the rest of the organs of the body may not be perfused enough and could be starving

Hypotension = with prolonged tachy

Angina = due to no oxygen to heart
- can put them on O2

54
Q

How can psychological stress cause sinus tachycardia?

What other obvious causes of tachycardia are there?

A

Stress can make your HR increase, duh.

Pain
Exercise
Fear

55
Q

Medical conditions that can make sinus tachy appear?

A

Fever
Myocardial Ischemia
Hypovolemia (being dry)

56
Q

Drugs that can cause sinus tachycardia?

A

Atropine
EPI
Dopamine
Caffeine

57
Q

Main symptoms of sinus tachycardia

A

Dizzy
Hypotension later on
Angina due to heart muscles not having enough o2

58
Q

What determine the sinus tachycardia treatment?

Should you treat symptoms of the underlying condition FIRST?

A

The underlying cause as with anything.

Treat condition first

59
Q

Med classifications you can use for sinus tachycardia treatment

A

Beta blockers
Calcium channel blockers
Antipyretic
Analgesics

60
Q

Examples of beta blockers for sinus tachy

Why do we use them for sinus tachy?

A

Metroprolol
Coreg
Labetolol

Reduce the HR and need for myocardial oxygenation

61
Q

Example of a calcium channel blockers used for sinus tachycardia?

Why do we use it?

A

Verpamil

Slows the sa pacemaker down

62
Q

Why use an antipyretic for sinus tachy and what is an example?

A

Use acetaminophen to reduce FEVER which is a big reason that HR can increase

63
Q

Why use analgesics for sinus tachy?

A

To treat the pain which is causing HR to increase

64
Q

You’re the nurse. You give beta blockers to one patient. You give calcium channel blockers to another patient. What do you need to monitor for both of these patients?

A

Monitor both BP and apical pulse

65
Q

What is sick sinus syndrome?

Is it common?

A

Heart rhythm can be too fast, too slow, or a combination of both.
- Will have marked sinus bradycardia while sometimes having a coexisting atrial flutter or a fib. Can even have long pause and look like asystole

Very uncommon

66
Q

Why is the patho behind sick sinus?

A

SA node doesn’t fire and the atria rapid fires not knowing what to do. Av node is no help either.

67
Q

When patients have sick sinus syndrome what are symptoms like?

A

Can often come and go.

- may not have them at all

68
Q

Your patient has fatigue, bradycardia, dizziness, SOB. Even co chest pains. They complain of palpitations. You check the rhythm and it shows a HR that is all over the place. Start, stop, etc. Then pt says they have a tickling feeling. What heart rhythm could this be?

A

Sick sinus syndrome

2.0 Adult Nursing Exam 1 (11 decks)

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