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NUR 254-Test 1 > Dysrhythmias > Flashcards

Dysrhythmias Flashcards

1
Q

EKG placement

A

“clouds over grass, smoke over fire, brown in the middle”

R-arm: white L-arm: black
V1 (precordium): brown,
r-side of sternum 4th ICS
R-Leg: green L-leg: red

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2
Q

P wave

A

depolarization & contraction of ATRIA

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3
Q

QRS complex

A

depolarization & contraction of VENTRICLES

** 0.06 - 0.10 seconds ** (1.5 - 2.5 small boxes)

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4
Q

T wave

A

REPOLARIZATION of ventricles

  • -inverted w/ injury
  • -peaked w. HYPERKALEMIA
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5
Q

PR interval

A

time it takes SA impulse to reach Purkinje fibers

–beginning of P to beginning of QRS–

** 0.12 - 0.20 seconds ** (3 - 5 small boxes)

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6
Q

ST segment

A

ELEVATED = INFARCT

DEPRESSED = INJURY

–end of QRS to beginning of T wave–

**should be level w/ ISOELECTRIC LINE **

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7
Q

QT interval (time)

A

** 0.32 - 0.44 seconds **

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8
Q

5 steps to interpreting EKG

A

1) RATE
- -# of complexes on 6sec strip x 10
- -number of large boxes b/t 2 complexes / 300
- -number of small boxes b/t 2 complexes / 1500

2) REGULAR RHYTHM?
- -assess r-r (ventricular)
- -assess p-p (atrial)

3) P WAVES
- -present? upright? smooth?

4) P WAVES + QRS
- -is there a P wave for every QRS complex?

5) INTERVAL DURATION
- -PR interval (0.12 - 0.20)
- -QRS duration (0.06 - 0.10)
- -QT interval (0.32 - 0.44)

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9
Q

sinus arrhythmia

A

normal rate but has IRREGULAR RHYTHM

  • -no manifestations
  • -no treatment
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10
Q

sinus tachycardia

A

normal rhythm but has FAST RATE

s/s:

  • fast pulse / heart racing
  • SOB
  • dizzy

tx:
- treat underlying cause (not normal @ rest
- –some reasons include: hypovolemia, fever, pain, anxiety, anemia, hypoxia

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11
Q

sinus bradycardia

A

normal rhythm but has S L O W RATE

s/s:

  • may result from vagal response or ischemia
  • IICP
  • AMI
  • hypothermia
  • drugs
  • acidosis
  • *normal in athletes
***ONLY TX IF SYMPTOMATIC***
tx:
-- IV ATROPINE 0.5 - 1.0 mg
   -increases HR; relieves CP by ridding ischemia
--pacemaker if profound or chronic
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12
Q

premature atrial complexes (PACs)

“ectopic atrial beat”

A

variable rate and irregular rhythm

  • -often asymptomatic
  • -may precede a dysrhythmia
  • -no tx required
  • -advise to reduce caffeine, alcohol, stress; stop smoke
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13
Q

paroxysmal supraventricular tachycardia (PSVT)

A
  • regular rhythm
  • RATE: 150 - 280 bpm
    • not enough time to fill*
    • using all myocardial O2*
  • HIDDEN P waves (in prev. T wave)

causes:
- fever, sepsis, hyperthyroidism, heart disease, MI

s/s:
-c/o racing heart, anxiety, dyspnea, dizzy, angina, diaphoresis, fatigue, polyuria (incr. CO)

tx:

  • VAGAL MANEUVERS (valsalva, suction)
  • O2
  • IV ADENOSINE (w/ continuous monitor strip)
    • -1st 6 mg + 20mL NS bolus rapid! over 1-3 sec
    • –if pt. does not convert out of SVT w/i 1 - 2 mins
      • -2nd 12 mg + 20mL NS bolus *rapid!
      • -3rd 12 mg + 20mL NS bolus *rapid!
  • synchronized CARDIOVERSION (avoids VF)
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14
Q

atrial flutter

A

“SAWTOOTH pattern”

  • regular rhythm
  • RATE: 101 - 150 bpm
  • P : QRS ratios (2:1, 4:1, 6:1)

causes:
-SNS stimulation, heart disease, MI, PE

s/s:

  • c/o palpitations
  • decreased CO (hypoten, dizzy, cool/clammy, low UO)

tx:

  • BB or CCB to slow ventricular rate + AMIODERONE
    • -start amioderone drip once stabile
  • synchronized cardioversion
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15
Q

a-fib

A
  • irregular rhythm
  • fast rate: 100-180
  • undistinguishable P waves (atria are quivering)
    • –* DECR. CARDIAC FILLING *

causes:
-HF, heart disease, HTN, hyperthyroidism

s/s:
-high ventricular rate causes decr. CO s/s
(hypotension, dizzy, cool/clammy, low UO)
-irregular peripheral pulses
-RISK OF THROMBUS FORMATION

tx:

  • synchronized cardioverison (sync w/ R-wave)
  • meds to reduce ventricular rate:
    • -BB, CCB,
      • **DIGOXIN ** (0.5 - 2.0 mg/mL)
  • anticoagulant to PRVENT STROKE
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16
Q

Digoxin administration

A

positive ionotrope to INCREASE CONTRACTILITY&raquo_space; INCREASE STROKE VOLUME&raquo_space;
d e c r e a s e s ventricular rate

**ONLY USE FOR A-FIB if HF IS PRESENT! **

s/s of toxicity:
-vision color changes (yellow halo), bradycardia, heart block, bronchospasm,

tx toxicity:

  • Digibind
  • IV potassium chloride

**HOLD OF HR < 60 bpm

**hyPOkalemia makes toxicity likely

17
Q

premature ventricular contractions (PVCs)

A
  • -no P wave before PVC (b/c start at ventricle)
  • -QRS is wide b/c impulse starts in PURKINJE FIBERS
  • -have apical-radial deficit
  • -precursor to lethal arrhythmia
  • -precipitated by HYPOkalemia

causes:

  • stress, anxiety, stimulants, alcohol, acidosis, hypoxia, electrolytes, reperfusion (irritating to heart)
  • greatest occurrence after MI**

tx:

  • -TREAT ONLY IF SYMPTOMATIC or w/ heart disease
  • no stimulants
  • BB or antidysrhythmic
18
Q

V-tach

“3 or more consecutive PVCs”

A
  • no P-waves (unidentifiable)
  • QRS wide & bizarre ( > 0.12 sec)
  • rate: 100-250
  • regular rhythm

** can have v-tach w/ or w/o pulse

tx:
treat if SUSTAINED (> 30 sec), symptomatic, or w/ heart disease&raquo_space;> SLOW HR DOWN so SA can take over (amioderone)
–if amioderone doesn’t work&raquo_space; CARDIOVERT

if PULSELESS: check for carotid pulse b/t each!!!

1) CPR (keep blood circulating manually)
2) DEFIBRILLATE
3) EPINEPHRINE
4) AMIODERONE

19
Q

v-fib

fine or coarse

A
  • rate too rapid and rhythm very irregular;
  • no identifiable waves; vary is size and shape
  • **CARDIAC ARREST
  • **DEATH W/I 4 MINUTES

triggered by myocardial ischemia/ infarction

tx:
* *most effective tx = EARLY DEFIBRILLATION! **
1) CPR (keep blood circulating manually)
2) DEFIBRILLATE
3) EPINEPHRINE
4) AMIODERONE

20
Q

amioderone administration

A

300 mg IV push OVER 10 MINS

maintenance drip:
–360 mg IV over 6 hours ( 1mg/min )&raquo_space;> THEN
540 mg IV over 18 hours ( 0.5mg/min )

21
Q

asystole

A

* shock to make sure its not fine v-fib*

** verify in at least TWO LEADS **

** ARE ALL LEADS ON PT?! **

22
Q

heart blocks

A

1st:
- -PR > 0.20 SLOWED CONDUCTION

2nd type I:
–PR interval gets longer and longer until not followed by a QRS

2nd type II:

  • -slow ventricular rate; some P waves not followed by QRS
  • -**PACEMAKER or ATROPINE 0.5 - 1.0 mg

3rd (complete)
–P waves and QRS DO NOT CORRELATE
(each are contracting on their own; out of synch)
–PACEMAKER! immediately!*

23
Q

cardioversion vs. defibrillation

A

CARDIOVERSION

  • -current is SYNCHRONIZED with pt heart rhythm
  • -requires SEDATION
  • -100 J
  • -elective
  • -“all clear”

DEFIBRILLATION

  • -current is NOT synchronized w/ pt heart rhythm
  • -no sedation required
  • -360 J (b/c of chaotic rhythm)
  • -“all clear”
24
Q

automatic implantable cardioverter defibrillators (AICD)

A

PACES & DEFIBRILLATES

  • pacing for brady
  • defibrillates for VT or VF (looks for fast HR)

NUR 254-Test 1 (6 decks)

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