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Nursing 202 - Midterm > Dysrhythmias > Flashcards

Dysrhythmias Flashcards

1
Q

Sinus bradycardia

Causes

A
  • WNL in well-conditioned heart (athletes)

- Increased ICP, increased vagal tone due to straining during defecation, vomiting, intubation, mechanical ventilation

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2
Q

Sinus bradycardia

Treatment

A
  • ACLS protocol for atropine for S/S of low CO —> dizziness, weakness, altered LOC, low blood pressure
  • Pacemaker
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3
Q

Sinus tachycardia

Treatment

A

Correction of underlying cause

B-blockers, CCBs for symptomatic patients

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4
Q

Sinus tachycardia

Causes

A
  • Normal response to fever, exercise, anxiety, pain, dehydration
  • May accompany shock, L-sided HF, cardiac tamponade, hyperthyroidism, anemia
  • Atropine, Epi, quinidine, caffeine, nicotine, alcohol
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5
Q

Premature atrial contraction (PAC)

Description

A
  • Premature, abnormal looking P waves
  • QRS complexes after P waves except in very early or blocked PACs
  • P wave often buried in the preceding T wave or identified in the preceding T wave
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6
Q

PAC

Causes

A
  • May prelude SVT

- Stimulants, hyperthyroidism, COPD, infection and other heart diseases

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7
Q

PAC

Treatment

A
  • Usually no TX required
  • TX of underlying cause if pt symptomatic
  • Carotid sinus massage
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8
Q

Atrial flutter

Description

A
  • Atrial rhythm regular, rate 200-400 bpm
  • Ventricular rate variable, depending on degree of AV block
  • Saw-tooth shaped P wave!!
  • PR interval not measurable
  • QRS complexes uniform in shape but often irregular in rate
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9
Q

Atrial flutter

Causes

A
  • HF, AV valve disease, PE, cor pulmonale, inferior wall MI, carditis
  • Digoxin toxicity
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10
Q

Atrial flutter

Treatment

A
  • If pt unstable w/ventricular rate > 150 bpm, prepare for immediate cardioversion
  • If pt stable, drug therapy —> CCBs, b-blockers, antidysrhythmics
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11
Q

Atrial fibrillation

Description

A
  • Atrial rhythm irregular, rate > 350-600 bpm
  • Ventricular rhythm varies and is irregular
  • PR interval indiscernible
  • No P waves
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12
Q

Atrial fibrillation

Causes

A

-HF, COPD, thyrotoxicosis, constrictive pericarditis, MI, sepsis, PE, rheumatic heart disease, HTN, mitral stenosis, atrial irritation, complication of coronary bypass or valve replacement SX

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13
Q

Atrial fibrillation

Treatment

A
  • If pt unstable w/ventricular rate > 150 bpm, immediate cardioversion
  • If stable, drug therapy —> CCBs, B-blockers, digoxin, procainamide, quinidine, ibutilide, amiodarone, anticoagulants
  • Dual chamber pacing, implantable atrial pacemaker, SX maze procedure
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14
Q

1st degree AV block

Description

A

-Normal except for prolonged PR interval (> 0.2 sec)

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15
Q

1st degree AV block

Causes

A
  • Associated w/disease states or certain drugs, MI, CAD, rheumatic fever, hyperthyroidism, lyte imbalances (hypokalemia), vagal stimulation
  • Drugs —> b-blockers, digoxin, CCBs, flecainide
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16
Q

1st degree AV block

Treatment

A

No treatment, monitor patient for new changes in rhythm

17
Q

Premature ventricular contraction (PVC)

Description

A
  • Atrial rhythm regular, ventricular rhythm irregular
  • QRS premature, usually followed by pause; wide & distorted, usually > 0.14 sec
  • Ominous when clustered, multifocal, or w/R waves on T pattern
18
Q

PVC

Causes

A
  • HF, old/acute myocardial ischemia/infarction/contusion
  • Myocardial irritation by ventricular catheters (eg. pacemaker)
  • Hypercapnia, hypokalemia, hypocalcemia
  • Drug toxicity by cardiac glycosides, aminophylline, TCAs, b-adrenergic
  • Caffeine, tobacco, alcohol use,
  • Physiological stress, anxiety, pain
19
Q

PVC

Treatment

A
  • Procainaide, lidocaine, amiodarone IV
  • Treat underlying cause
  • D/C drug causing toxicity
  • Potassium chloride IV if hypokalemia
  • Magnesium sulfate IV if hypomagnesemia
20
Q

Ventricular tachycardia

Monomorphic

A

QRS complexes are same shape, size, direction

21
Q

Ventricular tachycardia

Polymorphic

A

QRS complexes gradually change back and fourth from one shape, size, and direction to another over a series of beats

22
Q

Ventricular tachycardia

Causes

A
  • Myocardial ischemia, infarction, or aneurysm
  • CAD, rheumatic heart disease, mitral valve prolapse, HF, cardiomyopathy
  • Ventricular catheters
  • Hypokalemia, hypocalcemia
  • PE
  • Digoxin, procainamide, epinephrine, quinidine toxicity
  • Anxiety
23
Q

Ventricular tachycardia

Treatment

A
  • If pulseless: CPR, follow ACLS protocol for defibrillation
  • If pulse: if hemodynamically stable, follow ACLS protocol for admin of amiodarone —> if ineffective initiate synchronized cardioversion
24
Q

What RX is given for polymorphic ventricular tachycardia (torsades de pointes)?

A

Magnesium sulfate IV

25
Q

Ventricular fibrillation

Causes

A
  • Myocardial ischemia/infarction, R-on-T phenomenon, untreated ventricular tach
  • Hypokalemia, hyperkalemia, hypercalcemia, alkalosis, electric shock, hypothermia
  • Digoxin, epi, or quinidine toxicity
26
Q

Ventricular fibrillation

Treatment

A
  • If pulseless: start CPR, follow ACLS protocol for defibrillation
  • ET intubation
  • Admin of epi or vasopressin, lidocaine, amiodarone —> if ineffective mag sulfate
27
Q

Asystole

Causes

A
  • MI, aortic valve disease, HF, hypoxemia, hypo/erkalemia, severe acidosis, electric shock, ventricular arrhythmia, AV block, PE, heart rupture, cardiac tamponade, electromechanical dissociation
  • Cocaine overdose
28
Q

Normal PR interval

A

0.12 - 0.2 seconds (3-5 small boxes)

29
Q

Normal QRS

A

0.06 - 0.12 sec

30
Q

Abnormal ST findings

A
  • > 1 mm segment elevation or depression from isoelectric line
  • T wave = opposite direction than R wave
31
Q

Hs and Ts for determining cause of asystole

A

Hs: hypovolemia, hypoxia, H+, hyper/hypokalemia, hyper/hypoglycemia, hypothermia

Ts: toxins, tamponade, thrombosis, tension pneumothorax, trauma

32
Q

Complications of pacemaker

A 
Infection
Bleeding, hematoma formation
Dislocation of lead
Skeletal muscle or phrenic nerve stimulation
Cardiac tamponade
Pacemaker malfunction

Nursing 202 - Midterm (12 decks)

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