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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
Q

PR interval greater than 0.20 seconds

A

First Degree AV Block

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26
Q

Failure to capture with a permanent pace maker is the result of

A

Insufficient charge to the myocardium

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27
Q

Failure to capture is bad because

A

It can lead to serious bradycardia or asystole

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28
Q

Sinus Tachycardia manifestation and s/s

A

HR = 101-200 BPM
Potential decrease in CO r/t inadequate vent. Filling time
(Dizziness, low BP, SOA, chest pain)

29
Q

Treatment for Sinus Tachy

A

Treat underlying cause - pain meds, acetaminophen for fever, beta blockers might be started

30
Q

Where does impulse originate in PACs

A

Ectopic source in atrium (other than SA node)

31
Q

What does PAC look like?

A

Distorted p-wave before PAC; Usually have normal conduction through the ventricles

32
Q

What can cause PACs

A

Caffeine, stress, exercise, tobacco, electrolyte imbalance, heart disease, hypoxia

33
Q

Symptoms of PACs

A

Usually palpitations

Healthy patients = asymptomatic

34
Q

PAC Treatment

A

Treat Underlying source (caffeine, smoking, stress. . .)

Can be warning of more serious dysrhythmia in pts w/ heart disease

35
Q

Supraventricular Tachycardia (SVT) impulse origination

A

Ectopic focus above the bundle of His

36
Q

SVT manifestations

A

HR > 150 BPM

Often triggered by PAC

37
Q

Treatment of SVT

A
  1. Vagal Stimulation
  2. Drug Therapy
  3. Cardioversion, if pt is unstable
  4. Ablation if recurrent
38
Q

Drug Therapy for SVT

A

IV Adenosine

IV Beta blockers and Calcium Channel blockers

39
Q

Biggest difference between atrial flutter and atrial fibrillation

A

Atrial flutter impulse = single ectopic focus in atria

Atrial fibrillation impulse = multiple ectopic foci

40
Q

Characteristic of atrial flutter on ECG

A

Saw-tooth shaped flutter waves

Seen in patents w/ heart and lung disease

41
Q

Atrial flutter manifestation

A

Atrial rate can be 200-350 BPM

42
Q

Atrial Fibrillation manifestation

A

Atrial rate = 350-600 BPM

Ventricular rate = 60-100 (controlled)/ >100 (rapid ventricular response or RVR)

43
Q

Goals for treatment of A-Flutter/A-fib

A

HR Control

Rhythm Control

44
Q

Rate control (A-flutter/fib)

A

Goal: achieve HR 60-100 BPM
Use: beta blockers, calcium channel blockers, digoxin

45
Q

Rhythm Control (A-flutter/fib)

A

Goal: Convert back to sinus rhythm
Use: Amiodarone or Sotalol

46
Q

Delivery of “timed” electrical current to stop a tachydysrhythmia

A

Cardioversion

47
Q

Cardioversion is used for

A

Unstable atrial dysrhythmias and unstable v-tach w/ pulse

48
Q

What is the main thing to remember with cardioversion

A

Sync button ( to sync to heart beat and avoid cardioversion on t-wave)

49
Q

Nursing Care: Pre-Cardioversion

A 
Warfarin therapy for planned (3-4 weeks before)
IV Sedation
Consent
NPO
Oxygen
50
Q

Nursing Care: Post-Cardioversion

A

Watch Airway
Check Gag reflex (if TEE was done and throat numbed)
ECG and V/S
Watch for decreased Cardiac output

51
Q

Premature ventricular contractions

Impulse origination

A

Originates in ventricles (ectopic focus)

52
Q

What does PVC look like on ECG

A

Premature QRS (will be wide and look different than other QRSs)

53
Q

What is the problem w/ PVCs?

A

Can lead to v-tach

54
Q

Things that can cause PVCs

A

Caffeine, low potassium, low magnesium, fever, exercise, coronary artery disease, MI

55
Q

Treatment for PVCs

A

IF frequent and pt is unstable: meds - amiodarone; beta blockers
Correct any problems: electrolyte replacement, decrease caffiene intake

56
Q

Ventricular tachycardia (v-tach) is

A

A run of 3 or more PVCs
Ventricle takes control as the pacemaker
Life threatening

57
Q

Ventricular rate of v-tach and consequences

A

> 100 BPM = decreased vent filling time = decreased CO

58
Q

V-Tach Treatment

A

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
Q

Ventricular Fibrillation (v-fib) Impulse origination

A

Multiple ectopic foci w/in ventricles

60
Q

What is v-fib

A

Quivering of ventricles; no real heart activity;

LETHAL CARDIAC ARREST- loss of consciousness w/in seconds and death w/in minutes

61
Q

Treatment for v-fib

A

Call a code
Immediate CPR and Defibrillation
Drug therapy and ACLS

62
Q

Defibrillation is the treatment of choice to stop

A

V-fib and pulseless v-tach

63
Q

Timeframe for defibrillation

A

Critical w/in 2 minutes max

Speed is essential: >12 minutes = < 5% survival; <1 min = 90% survival

64
Q

What should you charge defibrillator to?

A

360J for monophonic defibrillators

65
Q

Implantable Cardioverter-Defibrillator (ICD) is used for

A

Patients who have spontaneous sustained v-tach or are at risk for life threatening dysrhythmias

66
Q

How much of a shock does ICD deliver

A

25J after sensing a lethal rhythm (goes directly into heart)

67
Q

Nursing Care: Pacemaker and ICD: Pre-procedure

A

NPO night before
Consent
Possible antibiotics

68
Q

Nursing Care: PPM and ICD: Post-Procedure

A

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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