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NSC 386 > Dysrhythmias > Flashcards

Dysrhythmias Flashcards

1
Q

Disturbance in the electrical activity of the heart

A

dysrhythmia

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2
Q

ECG p-wave represents

A

Atrial depolarization (atrial kick)

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3
Q

Atrial kick represents what percent of cardiac output

A

20-30%

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4
Q

QRS Complex represents

A

Ventricular depolarization

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5
Q

T-Wave represents

A

Ventricular repolarization

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6
Q

Isoelectric line indicates

A

No muscular activity in the heart (flat line between waves and complexes)

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7
Q

Normal conduction of the heart originates in the

A

SA node

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8
Q

A 12-lead ECG shows ___ views of the heart

A

12

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9
Q

Why is a 12-lead ECG beneficial?

A

It gives a better idea of where the blockage may be

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10
Q

A 5-Lead ECG shows ___ views of the heart

A

7

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11
Q

Most typical ECG used

A

5-lead; 12-lead for MI

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12
Q

Spread of impulse from atria to Purkinje fibers (p-wave to beg QRS complex)

A

PR Interval

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13
Q

Normal PR Interval measurement

A

0.12-0.20 sec

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14
Q

Time it takes for depolarization of both ventricles

A

QRS interval

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15
Q

Normal QRS Interval Measurement

A

0.04-0.11 sec

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16
Q

Time it takes for complete depolarization and repolarization of the ventricles

A

QT Interval

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17
Q

Normal QT Interval measurement value

A

0.34 - 0.43 seconds

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18
Q

What is important to know about the T-Wave

A

Very fragile; messing w/ T-Wave can lead to fatal dysrhythmia

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19
Q

Steps to interpret ECG

A
  1. Evaluate HR - #QRS in 6 sec x 10 = HR
  2. Is rhythm regular? - distance between QRS same?
  3. P-wave before every QRS?
  4. T- Waves upright?
  5. PR and QRS intervals - measure them. Are they normal?
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20
Q

What happens if there is no P-Wave?

A

no atrial kick; loss of 20-30% cardiac output

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21
Q

Number 1 priority for treating dysrhythmias

A

TREAT THE PATIENT AND NOT THE MONITOR/DYSRHYTHMIA

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22
Q

Treatment of dysrhythmias are based on

A

Hemodynamic status of the patient ( color, BP, HR, Pain)

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23
Q

Symptomatic Sinus Bradycardia

A

Pale, cool, decreased BP, dizziness

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24
Q

Sinus Brady Treatment

A

Treat only if symptomatic
Atropine IV push (drug of choice)
Pacemaker for extreme cases

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25
PR interval greater than 0.20 seconds
First Degree AV Block
26
Failure to capture with a permanent pace maker is the result of
Insufficient charge to the myocardium
27
Failure to capture is bad because
It can lead to serious bradycardia or asystole
28
Sinus Tachycardia manifestation and s/s
HR = 101-200 BPM Potential decrease in CO r/t inadequate vent. Filling time (Dizziness, low BP, SOA, chest pain)
29
Treatment for Sinus Tachy
Treat underlying cause - pain meds, acetaminophen for fever, beta blockers might be started
30
Where does impulse originate in PACs
Ectopic source in atrium (other than SA node)
31
What does PAC look like?
Distorted p-wave before PAC; Usually have normal conduction through the ventricles
32
What can cause PACs
Caffeine, stress, exercise, tobacco, electrolyte imbalance, heart disease, hypoxia
33
Symptoms of PACs
Usually palpitations | Healthy patients = asymptomatic
34
PAC Treatment
Treat Underlying source (caffeine, smoking, stress. . .) | Can be warning of more serious dysrhythmia in pts w/ heart disease
35
Supraventricular Tachycardia (SVT) impulse origination
Ectopic focus above the bundle of His
36
SVT manifestations
HR > 150 BPM | Often triggered by PAC
37
Treatment of SVT
1. Vagal Stimulation 2. Drug Therapy 3. Cardioversion, if pt is unstable 4. Ablation if recurrent
38
Drug Therapy for SVT
IV Adenosine | IV Beta blockers and Calcium Channel blockers
39
Biggest difference between atrial flutter and atrial fibrillation
Atrial flutter impulse = single ectopic focus in atria | Atrial fibrillation impulse = multiple ectopic foci
40
Characteristic of atrial flutter on ECG
Saw-tooth shaped flutter waves | Seen in patents w/ heart and lung disease
41
Atrial flutter manifestation
Atrial rate can be 200-350 BPM
42
Atrial Fibrillation manifestation
Atrial rate = 350-600 BPM | Ventricular rate = 60-100 (controlled)/ >100 (rapid ventricular response or RVR)
43
Goals for treatment of A-Flutter/A-fib
HR Control | Rhythm Control
44
Rate control (A-flutter/fib)
Goal: achieve HR 60-100 BPM Use: beta blockers, calcium channel blockers, digoxin
45
Rhythm Control (A-flutter/fib)
Goal: Convert back to sinus rhythm Use: Amiodarone or Sotalol
46
Delivery of “timed” electrical current to stop a tachydysrhythmia
Cardioversion
47
Cardioversion is used for
Unstable atrial dysrhythmias and unstable v-tach w/ pulse
48
What is the main thing to remember with cardioversion
Sync button ( to sync to heart beat and avoid cardioversion on t-wave)
49
Nursing Care: Pre-Cardioversion
``` Warfarin therapy for planned (3-4 weeks before) IV Sedation Consent NPO Oxygen ```
50
Nursing Care: Post-Cardioversion
Watch Airway Check Gag reflex (if TEE was done and throat numbed) ECG and V/S Watch for decreased Cardiac output
51
Premature ventricular contractions | Impulse origination
Originates in ventricles (ectopic focus)
52
What does PVC look like on ECG
Premature QRS (will be wide and look different than other QRSs)
53
What is the problem w/ PVCs?
Can lead to v-tach
54
Things that can cause PVCs
Caffeine, low potassium, low magnesium, fever, exercise, coronary artery disease, MI
55
Treatment for PVCs
IF frequent and pt is unstable: meds - amiodarone; beta blockers Correct any problems: electrolyte replacement, decrease caffiene intake
56
Ventricular tachycardia (v-tach) is
A run of 3 or more PVCs Ventricle takes control as the pacemaker Life threatening
57
Ventricular rate of v-tach and consequences
>100 BPM = decreased vent filling time = decreased CO
58
V-Tach Treatment
W/ Pulse: Meds (amiodarone = antiarhythmetic; sotalol to maint sinus rhythm; cardioversion if unstable) W/O Pulse: Call Code and begin CPR and rapid defibrillation
59
Ventricular Fibrillation (v-fib) Impulse origination
Multiple ectopic foci w/in ventricles
60
What is v-fib
Quivering of ventricles; no real heart activity; | LETHAL CARDIAC ARREST- loss of consciousness w/in seconds and death w/in minutes
61
Treatment for v-fib
Call a code Immediate CPR and Defibrillation Drug therapy and ACLS
62
Defibrillation is the treatment of choice to stop
V-fib and pulseless v-tach
63
Timeframe for defibrillation
Critical w/in 2 minutes max | Speed is essential: >12 minutes = < 5% survival; <1 min = 90% survival
64
What should you charge defibrillator to?
360J for monophonic defibrillators
65
Implantable Cardioverter-Defibrillator (ICD) is used for
Patients who have spontaneous sustained v-tach or are at risk for life threatening dysrhythmias
66
How much of a shock does ICD deliver
25J after sensing a lethal rhythm (goes directly into heart)
67
Nursing Care: Pacemaker and ICD: Pre-procedure
NPO night before Consent Possible antibiotics
68
Nursing Care: PPM and ICD: Post-Procedure
ECG Monitor for stable rhythm; Chest x-ray to check lead placement; Immobilize arm first 24 hrs; Incision care - no drainage; activity restrictions; education (patient)

NSC 386 (11 decks)

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