Dysrhythmias Flashcards
1
Q
What part of the cardiac cycle is atrial depolarization?
A
P-wave
2
Q
What part of the cardiac cycle is ventricular depolarization?
A
QRS complex
3
Q
What part of the cardiac cycle is ventricular repolarization?
A
T wave
4
Q
Inherent rate of SA node
A
60-100 bpm
5
Q
inherent rate of AV node
A
40-60 bpm
6
Q
Inherent rate of Bundle of HIS and Purkinje fibers
A
20-40 bpm
7
Q
Where ECG leads go on a 5 lead system
A
- white “White over right”
- Green “clouds over grass”
- Black “smoke over fire”
- Red “fire”
- Brown “Chocolate is close to the heart’
8
Q
PR interval timing
A
0.12-0.20 seconds
9
Q
QRS timing
A
0.06-0.12 seconds
10
Q
ST segment timing
A
0.08-0.12 seconds
11
Q
Q timing
A
< 0.04 seconds
12
Q
How to calculate HR on a 6 second strip
A
count QRS complexes and multiply by 10
13
Q
Normal Sinus Rhythm rate
A
60-100 bpm
14
Q
sinus tachycardia rate
A
100-150 bpm
15
Q
causes of tachycardia (9)
A
- hyperthyroidism
- hypovolemia
- heart failure
- anemia
- exercise
- use of stimulants
- fever
- pain
- anxiety
16
Q
treatment for sinus tachycardia
A
treat cause
17
Q
What question to ask patient with tachycardia?
A
do you have any symptoms?
18
Q
rate for bradycardia
A
< 60 bpm
19
Q
causes of bradycardia- 7
A
- vagal response
- drugs
- ischemia
- disease of the nodes
- ICP
- hypoxemia
- athletes
20
Q
question to ask about bradycardia patients
A
are they symptomatic?
21
Q
emergency drug for bradycardia
A
atropine
22
Q
atropine dose, frequency, and max dose
A
1mg q 3-5 minutes max 3 mg
23
Q
3 treatments for bradycardia
A
- atropine
- transcutaneous pacing
- epinephrine or dopamine infusion
24
Q
Drug class for atropine
A
anticholinergic/antimuscarinic
25
What does atropine do?
increases HR
26
Other uses for atropine besides bradycardia (2)
- surgery
| - end of life care to decrease salivation/secretions
27
What is sinus arrhythmia?
a sinus rhythm where the rate varies with respirations
28
causes of Sinus Arrest-5
- MI
- hyperkalemia
- digoxin
- OD
- physiologic response to increased vagal tone
29
On an EKG, where do you see atrial dysrhythmias?
P wave
30
In a PAC, the QRS is ___
narrow
31
in a PVC, the QRS is ___
wide
32
Atrial Tachycardia rate
150-250 bpm
33
outward s/s atrial tachycardia- 3
- low BP
- Low SaO2
- Low CO
34
Atrial tachycardia AKA
supraventricular tachycardia (SVT)
35
main difference between SVT and Paroxysmal SVT
SVT is continuous while PSVT starts and stops
36
What does Adensine do?
conversion of PSVT to SR
37
Adenosine dose, route for 1st dose
6mg IVP FAST
38
Adenosine dose, route for 2nd dose
12mg IVP fast
39
What needs to happen after every dose of adenosine?
20ml rapid saline flush IVP
40
What needs to be at the bedside when adenosine is given?
crash cart
41
causes of atrial flutter-6
- lung disease
- ischemic heart disease
- hyperthyroidism
- hypoxemia
- heart failure
- alcoholism
42
What is the pattern of atrial flutter referred to as?
sawtooth pattern
43
someone with Afib has a high risk for ....
pulmonary or systemic emboli
44
Afib treatment --> rate control CCB-2
cardizem, verapamil
45
Afib treatment --> rate control beta blockers-4
-atenolol, carvedilol, metoprolol, propanolol
46
Afib treatment --> rate control-AV Node blocker-1
digoxin
47
Afib treatment --> rate control-antidysrhythmics-2
amiodarone, sotalol
48
Afib treatment --> rhythm control-2
amiodarone or cardio version
49
Afib treatment --> anticoagulants-4
- warfarin (Coumadin)
- apixaban (eliquis)
- dabigratan (Pradaxa)
- rivaroxaban (Xarelto)
50
Non-pharmacological a fib tx-2
cardioversion, ablation
51
Junctional escape rhythm rate
40-60
52
accelerated junctional rate
60-100
53
junctional Bradycardia rate
< 40
54
Where do conductions begin from in a junctional rhythm?
AV node
55
in the junctional escape rhythm what happens to the p wave
may be inverted, absent, or may follow the QRS
56
patient response in accelerated junctional
decrease CO and hemodynamic instability
57
Causes of accelerated junctional-7
- SA node disease
- ischemic heart disease
- electrolyte imbalances
- dig toxicity
- acute MI
- hypoxemia
58
tx of accelerated junctional rhythm
tx tachycardia if hemodynamically unstable. alert provider for change of rhythm
59
Main characteristics of ventricular dysrhythmias
wide and bizarre QRS
60
Types of PVCs --> pair
2 sequential PVCs
61
Types of PVCs --> runs or bursts
3 or more sequential PVCs
62
Types of PVCs --> bigeminy
every other beat is a PVC
63
Types of PVCs --> trigeminy
every third beat is a PVC
64
Types of PVCs --> quadreminy
every fourth beat is a PVC
65
When are PVCs dangerous? -4
- Frequent, multifocal
- Two or more in a row, frequent repeat
- PVC falls into the vulnerable period of the T wave
- May lead to ventricular tachycardia (pulseless VT) or ventricular fibrillation (VF)
66
Causes of Vtach-10
```
hypoxemia
acid-base imbalance
exacerbation of heart failure
ischemic heart disease
cardiomyopathy
hypokalemia
hypomagnesemia
valvular heart disease
genetic abnormalities
QT prolongation
```
67
rate of vtach
> 100 but may go up to 300
68
cause of torsades de pointes
magnesium deficiency
69
tx for v fib
CPR and Dfib
70
rate for idioventricular rhythm
15-40 bpm
71
How is vfib described
chaotic pattern
72
Description of vtach
3 or more PVCs in a row with wide QRS complexes
73
Question to ask for vtach
pulse or no pulse
74
how do you treat pulseless vtach
CPR and Dfib
75
epinephrine dose, frequency
1mg IVP q 3-5 min
76
amiodarone dose, route, frequency
150mg IV (may repeat once)
77
Magnesium dose, route
1-2 g diluted in 10ml of D5W IV
78
Sodium Bicarb dose/route
1 mEq/kg IV
79
For PEA what do you do first?
apical and carotid pulse check
80
PEA causes: 5 H's
- hypoxemia
- hypovolemia
- hypothermia
- H+ ions (acidosis)
- Hypo and hyperkalemia
81
PEA causes: 5 T's
- tablets (OD)
- tamponade (cardiac)
- Tension pneumothorax
- thrombosis (coronary)
- thrombosis (pulmonary)
82
First-degree heart block...what is the defining characteristic
regular, prolonged PR interval > 0.20 seconds
83
causes of First degree heart block (6)
- AV node trauma
- hypoxemia
- MI
- digitalis tooxicity
- ischemic disease
- hyperkalemia
84
2nd degree heart block type 1 aka (2)
- Mobitz 1
| - Wenckebach
85
2nd degree block type 1..what is the defining characteristics...
steadily increasing PR interval then skipped beat (p wave without QRS complex)
86
2nd degree block type 2 aka ....
Mobitz 2
87
2nd degree heart block defining characteristics (2)
- regular PR interval
| - more P's than Q's
88
2nd degree block can lead to ____ and may cause patient to become ____
3rd degree, symptomatic
89
3rd degree block defining characteristics (2)
- regular PP and RR intervals
| - P waves not associated with QRS complex
90
defining characteristic of LBBB
"bunny ears"
91
defining characteristic of RBBB
"2 R's"
92
3 types of pacemakers
- Atrial paced
- ventricular paced
- A-V paced
93
Pacemaker rate definition
number of impulses delivered per minute to atrium, ventricle, or both.
94
Pacemaker mode definition
demand mode or fixed-rate (asynchronous) mode
95
Pacemaker electrical output definition
milliamperes (mA): energy needed to stimulate depolarization
96
pacemaker sensitivity defintiion
ability of the pacemaker to recognize the body’s intrinsic electrical activity, measured in millivolts (mV).
97
pacemaker AV interval definition
time between atrial and ventricular stimulation (dual chamber pacemakers only)
98
failure to pace
no pacer spikes
99
failure to capture
- electrical impulse is generated and no depolarization is noted.
- There are pacer spikes but no P wave (atrial) or QRS complex (ventricular)
100
Failure to sense
the pacemaker does not sense patient's own heartbeat.
Pacer spikes that are too close to the patient’s own rhythm
101
most common cause of pacemaker issues
displacement of pacemaker electrode wire
102
2 nursing interventions to help with displacement of pacemaker electrode
- turn to left side
| - adjust sensitivity
103
What is an implantable Cardioverter-Defibrillator (ICD/AICD)?
- Does everything a pacemaker does plus
- Treat life threatening dysrhythmias
- Pace and shock
104
therapeutic dose of electric current to the heart at a specific moment in the cardiac cycle, restoring the activity of the electrical conduction system of the heart
synchronized electrical cardioversion
105
therapeutic dose of electric current to the heart at a random moment in the cardiac cycle; most effective resuscitation measure for cardiac arrest associated with ventricular fibrillation and pulseless ventricular tachycardia.
defibrillation
106
also called chemical cardioversion, uses antiarrhythmia medication instead of an electrical shock.
pharmacologic cardioversion
