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G270 Exam #2 > Dysrhythmias > Flashcards

Dysrhythmias Flashcards

1
Q

What part of the cardiac cycle is atrial depolarization?

A

P-wave

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2
Q

What part of the cardiac cycle is ventricular depolarization?

A

QRS complex

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3
Q

What part of the cardiac cycle is ventricular repolarization?

A

T wave

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4
Q

Inherent rate of SA node

A

60-100 bpm

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5
Q

inherent rate of AV node

A

40-60 bpm

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6
Q

Inherent rate of Bundle of HIS and Purkinje fibers

A

20-40 bpm

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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’
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8
Q

PR interval timing

A

0.12-0.20 seconds

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9
Q

QRS timing

A

0.06-0.12 seconds

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10
Q

ST segment timing

A

0.08-0.12 seconds

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11
Q

Q timing

A

< 0.04 seconds

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12
Q

How to calculate HR on a 6 second strip

A

count QRS complexes and multiply by 10

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13
Q

Normal Sinus Rhythm rate

A

60-100 bpm

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14
Q

sinus tachycardia rate

A

100-150 bpm

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15
Q

causes of tachycardia (9)

A
  • hyperthyroidism
  • hypovolemia
  • heart failure
  • anemia
  • exercise
  • use of stimulants
  • fever
  • pain
  • anxiety
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16
Q

treatment for sinus tachycardia

A

treat cause

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17
Q

What question to ask patient with tachycardia?

A

do you have any symptoms?

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18
Q

rate for bradycardia

A

< 60 bpm

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19
Q

causes of bradycardia- 7

A
  • vagal response
  • drugs
  • ischemia
  • disease of the nodes
  • ICP
  • hypoxemia
  • athletes
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20
Q

question to ask about bradycardia patients

A

are they symptomatic?

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21
Q

emergency drug for bradycardia

A

atropine

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22
Q

atropine dose, frequency, and max dose

A

1mg q 3-5 minutes max 3 mg

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23
Q

3 treatments for bradycardia

A
  • atropine
  • transcutaneous pacing
  • epinephrine or dopamine infusion
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24
Q

Drug class for atropine

A

anticholinergic/antimuscarinic

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25
Q

What does atropine do?

A

increases HR

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26
Q

Other uses for atropine besides bradycardia (2)

A
  • surgery

- end of life care to decrease salivation/secretions

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27
Q

What is sinus arrhythmia?

A

a sinus rhythm where the rate varies with respirations

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28
Q

causes of Sinus Arrest-5

A
  • MI
  • hyperkalemia
  • digoxin
  • OD
  • physiologic response to increased vagal tone
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29
Q

On an EKG, where do you see atrial dysrhythmias?

A

P wave

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30
Q

In a PAC, the QRS is ___

A

narrow

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31
Q

in a PVC, the QRS is ___

A

wide

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32
Q

Atrial Tachycardia rate

A

150-250 bpm

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33
Q

outward s/s atrial tachycardia- 3

A
  • low BP
  • Low SaO2
  • Low CO
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34
Q

Atrial tachycardia AKA

A

supraventricular tachycardia (SVT)

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35
Q

main difference between SVT and Paroxysmal SVT

A

SVT is continuous while PSVT starts and stops

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36
Q

What does Adensine do?

A

conversion of PSVT to SR

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37
Q

Adenosine dose, route for 1st dose

A

6mg IVP FAST

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38
Q

Adenosine dose, route for 2nd dose

A

12mg IVP fast

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39
Q

What needs to happen after every dose of adenosine?

A

20ml rapid saline flush IVP

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40
Q

What needs to be at the bedside when adenosine is given?

A

crash cart

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41
Q

causes of atrial flutter-6

A
  • lung disease
  • ischemic heart disease
  • hyperthyroidism
  • hypoxemia
  • heart failure
  • alcoholism
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42
Q

What is the pattern of atrial flutter referred to as?

A

sawtooth pattern

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43
Q

someone with Afib has a high risk for ….

A

pulmonary or systemic emboli

44
Q

Afib treatment –> rate control CCB-2

A

cardizem, verapamil

45
Q

Afib treatment –> rate control beta blockers-4

A

-atenolol, carvedilol, metoprolol, propanolol

46
Q

Afib treatment –> rate control-AV Node blocker-1

A

digoxin

47
Q

Afib treatment –> rate control-antidysrhythmics-2

A

amiodarone, sotalol

48
Q

Afib treatment –> rhythm control-2

A

amiodarone or cardio version

49
Q

Afib treatment –> anticoagulants-4

A
  • warfarin (Coumadin)
  • apixaban (eliquis)
  • dabigratan (Pradaxa)
  • rivaroxaban (Xarelto)
50
Q

Non-pharmacological a fib tx-2

A

cardioversion, ablation

51
Q

Junctional escape rhythm rate

A

40-60

52
Q

accelerated junctional rate

A

60-100

53
Q

junctional Bradycardia rate

A

< 40

54
Q

Where do conductions begin from in a junctional rhythm?

A

AV node

55
Q

in the junctional escape rhythm what happens to the p wave

A

may be inverted, absent, or may follow the QRS

56
Q

patient response in accelerated junctional

A

decrease CO and hemodynamic instability

57
Q

Causes of accelerated junctional-7

A
  • SA node disease
  • ischemic heart disease
  • electrolyte imbalances
  • dig toxicity
  • acute MI
  • hypoxemia
58
Q

tx of accelerated junctional rhythm

A

tx tachycardia if hemodynamically unstable. alert provider for change of rhythm

59
Q

Main characteristics of ventricular dysrhythmias

A

wide and bizarre QRS

60
Q

Types of PVCs –> pair

A

2 sequential PVCs

61
Q

Types of PVCs –> runs or bursts

A

3 or more sequential PVCs

62
Q

Types of PVCs –> bigeminy

A

every other beat is a PVC

63
Q

Types of PVCs –> trigeminy

A

every third beat is a PVC

64
Q

Types of PVCs –> quadreminy

A

every fourth beat is a PVC

65
Q

When are PVCs dangerous? -4

A
  • 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
Q

Causes of Vtach-10

A 
hypoxemia
acid-base imbalance
exacerbation of heart failure
ischemic heart disease
cardiomyopathy
hypokalemia
hypomagnesemia
valvular heart disease
genetic abnormalities
QT prolongation
67
Q

rate of vtach

A

> 100 but may go up to 300

68
Q

cause of torsades de pointes

A

magnesium deficiency

69
Q

tx for v fib

A

CPR and Dfib

70
Q

rate for idioventricular rhythm

A

15-40 bpm

71
Q

How is vfib described

A

chaotic pattern

72
Q

Description of vtach

A

3 or more PVCs in a row with wide QRS complexes

73
Q

Question to ask for vtach

A

pulse or no pulse

74
Q

how do you treat pulseless vtach

A

CPR and Dfib

75
Q

epinephrine dose, frequency

A

1mg IVP q 3-5 min

76
Q

amiodarone dose, route, frequency

A

150mg IV (may repeat once)

77
Q

Magnesium dose, route

A

1-2 g diluted in 10ml of D5W IV

78
Q

Sodium Bicarb dose/route

A

1 mEq/kg IV

79
Q

For PEA what do you do first?

A

apical and carotid pulse check

80
Q

PEA causes: 5 H’s

A
  • hypoxemia
  • hypovolemia
  • hypothermia
  • H+ ions (acidosis)
  • Hypo and hyperkalemia
81
Q

PEA causes: 5 T’s

A
  • tablets (OD)
  • tamponade (cardiac)
  • Tension pneumothorax
  • thrombosis (coronary)
  • thrombosis (pulmonary)
82
Q

First-degree heart block…what is the defining characteristic

A

regular, prolonged PR interval > 0.20 seconds

83
Q

causes of First degree heart block (6)

A
  • AV node trauma
  • hypoxemia
  • MI
  • digitalis tooxicity
  • ischemic disease
  • hyperkalemia
84
Q

2nd degree heart block type 1 aka (2)

A
  • Mobitz 1

- Wenckebach

85
Q

2nd degree block type 1..what is the defining characteristics…

A

steadily increasing PR interval then skipped beat (p wave without QRS complex)

86
Q

2nd degree block type 2 aka ….

A

Mobitz 2

87
Q

2nd degree heart block defining characteristics (2)

A
  • regular PR interval

- more P’s than Q’s

88
Q

2nd degree block can lead to ____ and may cause patient to become ____

A

3rd degree, symptomatic

89
Q

3rd degree block defining characteristics (2)

A
  • regular PP and RR intervals

- P waves not associated with QRS complex

90
Q

defining characteristic of LBBB

A

“bunny ears”

91
Q

defining characteristic of RBBB

A

“2 R’s”

92
Q

3 types of pacemakers

A
  • Atrial paced
  • ventricular paced
  • A-V paced
93
Q

Pacemaker rate definition

A

number of impulses delivered per minute to atrium, ventricle, or both.

94
Q

Pacemaker mode definition

A

demand mode or fixed-rate (asynchronous) mode

95
Q

Pacemaker electrical output definition

A

milliamperes (mA): energy needed to stimulate depolarization

96
Q

pacemaker sensitivity defintiion

A

ability of the pacemaker to recognize the body’s intrinsic electrical activity, measured in millivolts (mV).

97
Q

pacemaker AV interval definition

A

time between atrial and ventricular stimulation (dual chamber pacemakers only)

98
Q

failure to pace

A

no pacer spikes

99
Q

failure to capture

A
  • electrical impulse is generated and no depolarization is noted.
  • There are pacer spikes but no P wave (atrial) or QRS complex (ventricular)
100
Q

Failure to sense

A

the pacemaker does not sense patient’s own heartbeat.

Pacer spikes that are too close to the patient’s own rhythm

101
Q

most common cause of pacemaker issues

A

displacement of pacemaker electrode wire

102
Q

2 nursing interventions to help with displacement of pacemaker electrode

A
  • turn to left side

- adjust sensitivity

103
Q

What is an implantable Cardioverter-Defibrillator (ICD/AICD)?

A
  • Does everything a pacemaker does plus
  • Treat life threatening dysrhythmias
  • Pace and shock
104
Q

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

A

synchronized electrical cardioversion

105
Q

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.

A

defibrillation

106
Q

also called chemical cardioversion, uses antiarrhythmia medication instead of an electrical shock.

A

pharmacologic cardioversion

G270 Exam #2 (5 decks)

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