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Nursing III Test 3 > Dysrhythmias > Flashcards

Dysrhythmias Flashcards

1
Q

Length of time for PR interval

A

0.12-0.2s

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2
Q

Length of time for QRS

A

<0.12

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3
Q

What two conditions is sinus bradycardia normal?

A

Athletes

During sleep

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4
Q

Causes of Sinus Brady

A 
Meds: Beta blocker, digoxin
Valsava Maneuver
Carotid massage
Hypothyroid
Hypothermia
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5
Q

Symptomatic Sinus Brady

A 
Hypotension
Diaphoresis
Chest pain
SOB
Change in mental status, fatigue
Decrease C.O.
Decrease O2
Cool skin
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6
Q

Treatment for Sinus Brady

A

Do not treat if normal for pt

  1. Treat underlying cause
  2. Give O2
  3. Pacer
  4. Epinephrine or dopamine gtt
  5. Atropine helps increase HR (inhibits vagus nerve)
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7
Q

Sinus Tachycardia

A

100-149bpm

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8
Q

Causes of Sinus Tachy

A 
Running or exercise
Hypovolemia (dehydration)
Pain, Anxiety
Fever, Infection
CHF (heart thinks its not getting enough O2 out)
Hyperthyroid
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9
Q

Symptoms of Sinus Tachy

A

Depends on the patients tolerance to the increased HR

May experience dizziness, hypotension, or increase need for CO2

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10
Q

Treatment for Sinus Tachy

A

If normal, no treatment

  1. Treat underlying cause (hydrate pt, treat fever)
  2. Limit stimulants:
    - Give O2
    - Give lasix if HF
    - Carotid massage (physician only)
    - Valsalva maneuvers (bear down)
  3. Meds: CCB, Beta blocker
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11
Q

Premature Atrial Contraction (PAC)

A

Contraction originating from ectopic focus in atrium on location other than the sinus node
Travels across atria by abnormal pathway, creating distorted P wave
Is stopped, delayed, or conducted normally at the AV node

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12
Q

PAC causes

A 
Emotional stress
Caffeine, tobacco, or alcohol
Infection, inflammation
COPD
Valvular disease
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13
Q

PAC treatment

A
  • Depends on symptoms
  • Adrenergic blockers may be used to decrease PACs (caution in COPD & asthma pt’s)
  • Usually Mg replacement ordered
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14
Q

Atrial flutter

A
  • Recurring, regular, sawtooth-shaped flutter waves

- Associated with slower ventricular response

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15
Q

Atrial flutter causes

A 
CAD, MI, HTN
Valve problems
Rheumatic heart disease
HF
Hyperthyroid
Possible post-CABG
Lone Afib
Holiday heart
Hyperthyroid
Mitral valve disease
Heart diseases
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16
Q

Atrial flutter Symptoms

A 
Decreased C.O.
Palpitations
SOB, chest pain
Fatigue, syncope
HF
Change in mental status
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17
Q

Atrial flutter treatment

A
  1. Heparin drip: to prevent clots
  2. Meds: digoxin, CCB, Amiodarone (last line)
  3. Cardioversion
  4. Coumadin: long term, monitor PT/INR
  5. Ablation
  6. Pacemaker
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18
Q

Paroxysmal Supraventricular Tachycardia (PSVT)

A

HR greater than 150 bpm

Usually, no P wave identifiable

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19
Q

Causes of PSVT

A 
Overexertion
Emotional stress
Stimulants
Digitalis toxicity
CAD
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20
Q

PSVT treatment

A

Vagal stimulation & drug therapy
If hemodynamically unstable, cardioversion may be used
Chemical cardioversion: adenosine
Recurrent PSVT: ablation

21
Q

Atrial Fibrillation

A

Total disorganization of atrial activity without effective atrial contraction
Can’t identify a P wave, always irregular
QRS to QRS is irregular
350-450bpm

22
Q

Causes of A. fib

A 
CAD, MI, HTN
Valve problems
Rheumatic heart disease
HF
Hyperthyroid
Possible post-CABG
Lone Afib
Holiday heart
Hyperthyroid
Mitral valve disease
Heart diseases
23
Q

A. fib symptoms

A 
Decreased C.O.
Irregularly irregular pulse
Palpitations
SOB, chest pain
Fatigue, syncope
HF
Change in mental status
24
Q

A. fib treatment

A
  1. Heparin drip: to prevent clots
  2. Meds: digoxin, CCB, Amiodarone (last line)
  3. Cardioversion
  4. Coumadin: long term, monitor PT/INR
  5. Ablation
  6. Pacemaker
25
Q

Junctional rhythm

A

Arrythmia that originates in area of AV node
Impulse may move in retrograde fashion, producing abnormal P wave
Impulse usually moves through ventricles
Inverted P wave before, during, or after QRS
Always regular

26
Q

Causes of Junctional rhythm

A

Uncommon

Heart damage

27
Q

Junctional Rhythm Treatment

A

Atropine

Pacer

28
Q

Premature Ventricular Contractions

A 
Non perfusing or no pulse beat
Contraction originating in ectopic focus of the ventricles
Premature occurrence of QRS complex
Early QRS beats
Big, wide QRS wave
Occurs without P wave before it
29
Q

Unifocal vs. multifocal

A

Multifocal is if there is another PVC that looks different (more likely to go into V. tach)
More than 3 non perfusing beats in a row is considered V. tach

30
Q

Causes of PVC

A 
Fever
Caffeine, stress
Exercise
Drugs (cocaine)
Hypokalemia, hypovolemia
Metabolic acidosis
Hypoxia
HF, MI
Digoxin toxicity, TCA, amphetamines
Increase or decrease in K+, CA2+, or Mg
31
Q

PVC symptoms

A
  1. May be asymptomatic
  2. Palpitations
  3. Irregular pulse
  4. Decreased C.O.
  5. Hypotension
  6. HR can lead to V. tach –> V. fib –> cardiac arrest if not treated
32
Q

PVC treatment

A

If asymptomatic, continue to monitor

  1. Drugs: anti arrhythmic (amiodarone)
  2. Magnesium
  3. Treat cause
33
Q

Ventricular Tachycardia

A 
3 or more PVCs occur
Life threatening arrhythmia because it is non perfusing and it can lead to V. fib
No p wave before QRS
QRS are wide
150-250bpm
34
Q

Causes of V. tach

A 
Fever
Caffeine, stress
Exercise
Drugs (cocaine)
Hypokalemia, hypovolemia
Metabolic acidosis
Hypoxia
HF, MI
Digoxin toxicity, TCA, amphetamines
Increase or decrease in K+, CA2+, or Mg
35
Q

Symptoms of V. tach

A

No pulse or fast, light pulse
Pale, unconscious or non-responsive
Low or no BP

36
Q

Treatment of V. tach

A

Check lead placement first t confirm

  1. Call code
  2. ABC’s, start CPR
  3. IV-O2-Monitor
  4. Defibrillation
  5. Epi/vasopressin
  6. Amiodarone, sotolol, procainamide (if pt has pulse)
  7. Magnesium replacement
    * Be prepared for pt to go into V. fib
37
Q

Idioventricular Rhythm (Ventricular bradycardia)

A

Worst arrhythmia
Faint pulse or none
Slow, wide QRS complexes

38
Q

Idioventricular Rhythm Treatment

A
  1. Check DNR status
  2. Check pt: Call code
  3. CPR
  4. Epi/vasopressin
  5. Do not shock!
39
Q

Ventricular Fibrillation

A 
No QRS
No P waves
No C.O.
No pulse
Only fluttering of the heart
40
Q

V. fib causes

A 
Fever
Caffeine, stress
Exercise
Drugs (cocaine)
Hypokalemia, hypovolemia
Metabolic acidosis
Hypoxia
HF, MI
Digoxin toxicity, TCA, amphetamines
Increase or decrease in K+, CA2+, or Mg
41
Q

V. fib symptoms

A
  1. May be asymptomatic
  2. Palpitations
  3. Irregular pulse
  4. Decreased C.O.
  5. Hypotension
  6. HR can lead to V. tach –> V. fib –> cardiac arrest if not treated
42
Q

V. fib treatment

A

If asymptomatic, continue to monitor

  1. Drugs: anti arrhythmic (amiodarone)
  2. Treat cause:
    - give O2,
    - check chem panel for electrolyte replacement,
    - decrease digoxin if caused by toxicity,
    - correct acidosis
    - treat fever
43
Q

5 H’s of Asystole

A
  1. Hypovolemia
  2. H ion (acidosis)
  3. Hyper/hypo K+
  4. Hypoxia
  5. Hypothermia
44
Q

5 T’s of Asystole

A
  1. Toxins
  2. Tamponade
  3. Tension pneumothorax
  4. Thrombus
  5. Trauma
45
Q

Asystole treatment

A 
Check pt first
Call code
IV-O2-Monitor
CPR
Epi/Vasopressin
DO NOT SHOCK PT, you will kill pt completely
46
Q

Pulseless Electrical Activity

A

Can be ANY rhythm, but your pt will not have a pulse

Electrical activity can be observed on ECG, but there is no mechanical activity of ventricles and pt has no pulse

47
Q

Causes of Pulseless Electrical Activity

A 
Hypovolemia
Drug overdose
MI
Hyper or hypokalemia
Pulmonary embolus
48
Q

Pulseless Electrical Activity treatment

A

CPR –> intubation and IV therapy with dpi

Correct underlying cause

Nursing III Test 3 (3 decks)

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