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RNSG 2539 (Healthcare Concepts) > Dysrhythmias > Flashcards

Dysrhythmias Flashcards

1
Q

what is PVC?

A

PVC - premature ventricular contractions -ectopic beat/impulse from inside ventricles BUT underlying rhythm is NORMAL

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2
Q

what does PVC look like on an EKG strip?

A

PVC = QRS complexes that appear WIDE & IRREGULAR -unifocal = uniform, QRS complex deformities look similar -multifocal = not uniform, QRS complex deformities differ throughout

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3
Q

is PCV dangerous?

A

PCV is generally harmless, most of the time!

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4
Q

what causes PCV?!

A

-ventricular/heart muscle irritability -ischemia -hypoxia -caffeine, stress, anxiety, smoking -reperfusion after stent placement -HYPOKALEMIA (electrolyte imbalances) -HYPOMAGNESEMIA -infection, trauma, surgery -increased risk for w/ increased age

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5
Q

what kind of effects does PVC have on the body?

A

-asymptomatic/unknown issues **increased levels of PVCs > increased risk of palpitations -dizziness **chest pain -decrease/absence of pulse -3+ PVCs = V-TACH ***PVCs may OR may not perfuse, check pulses to ensure perfusion

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6
Q

what are the treatment options for PVC?

A

**notify the physician -replace electrolytes (if HYPOkalemia or HYPOmagnesemia) -apply oxygen if needed ***USE MEDICATION LIKE: LIDOCAINE or AMIODARONE -reduce stress or caffeine

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7
Q

why AMIODARONE if PVC?

A

amiodarone delays rate at which hearts electrical system recharges after repolarization = slowing of speed of conduction in the heart > reduces hearts ability to produce electrical impulses

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8
Q

WHY LIDOCAINE if PVC?

A

lidocaine reduces irritability in the ventricles of the heart!

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9
Q

what is PAC?

A

PAC - premature atrial contraction -ectopic beat/impulse from inside the atrium **P WAVE comes sooner + appears distorted

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10
Q

is PAC dangerous?

A

NO, this is not as concerning as PVC may be

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11
Q

what happens with the AV node in PAC?

A

1) AV node might stop impulse, or not conduct at all 2) AV node might hold onto it a little longer, **LONGER PR INTERVAL 3) AV node might have completely normal impulse

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12
Q

what can cause PAC?

A

**EMOTIONAL/PHYSICAL STRESS -caffeine, tobacco, alcohol use -hypoxia -electrolyte imbalance -hyperthyroidism -COPD -CAD -heart disease

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13
Q

what does PAC look like on EKG strip?

A

P WAVE + T WAVE are combined; not concerning

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14
Q

what does PAC feel like; S/S?

A

**PALPITATIONS; can eventually lead to SVT

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15
Q

how do you treat PAC?

A

1) treat the SYMPTOMS 2) stop using alcohol, tobacco, caffeine products 3) utilize beta blockers = minimize PACs occurrences

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16
Q

what is SVT?

A

SVT - supraventricular tachycardia -ectopic beat ABOVE BOH; can be triggered by PAC **HR - 150-220 BPM

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17
Q

What does SVT look like on EKG strip?

A

**SHORT PR INTERVAL **NORMAL QRS

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18
Q

what does SVT do to your patient?

A

-decreased CO **CHEST PAIN **SOB -palpitations -HYPOtension

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19
Q

what is the treatment for SVT?

A

1)vagal maneuver (jump start getting back into normal rhythm) 2) adenosine > QUICK followed by QUICK NS FLUSH 3) IV medication: CCB, BB, amiodarone 4) synchron cardiovert

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20
Q

What is A-FIB?

A

A-FIB = atrial fibrillation; R > R intervals = IRREGULAR; NO P WAVE

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21
Q

A-FIB - atrial fibrillation

A

**COMMON -NO P WAVE > no contraction -NO ARTIAL KICK **irregular R>R intervals —blood pools and clots start to form **reduced cardiac output + HYPOtension

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22
Q

What is atrial flutter?

A

***NOT as common as A-FIB; contains regular R>R interval ratio -rapid atrial depolarization via SAW TOOTH P WAVES > 4 to 1 ratio; treated same as A-FIB

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23
Q

what are considered lethal arrhythmias?

A

-ventricular tachycardia -ventricular fibrillation -asystole (PEA - pulseless electrical activity; heart pumps but NO pulse present)

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24
Q

what is VENTRICULAR TACHYCARDIA?

A

***BPM = 150-220 BPM; patient CAN or CANNOT have pulse, depends on situation

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25
Q

what does VENTRICULAR TACHYCARDIA tend to occur before?

A

VENTRICULAR TACHYCARDIA often occurs before VENTRICULAR FIBRILLATION

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26
Q

what does V-TACH look like on EKG strips?

A

**very WIDE QRS complex **NO P WAVE -looks like a tombstone on EKG strip –monomorphic - one shape, looks same throughout

27
Q

what is the difference between V-TACH w/ PULSE vs PULSELESS

A

w/ pulse - -awake + talking > asymptomatic -does not last long -slower rates (closer to 150) = more tolerable -GIVE OXYGEN **NEED 12 LEAD EKG -give medications as needed PULSELESS = CODE STATUS = EMERGENT; —unstable w/ pulse = cardiovert

28
Q

what is CARDIOVERSION?

A

CARDIOVERSION is used to restore normal heart rhythm in patients experiencing dysrhythmias!

29
Q

can you use CARDIOVERSION on a patient that has a signed DNR?

A

you can; BUT only as treatment; not as a lifesaving measure!

30
Q

my patient is being administered oxygen, and needs cardioversion, what do I do?

A

TURN OFF, TAKE OFF ALL OXYGEN, you do not want any oxygen crossing the patients chest when cardioversion is performed!

31
Q

what is TORSADES DE POINTES?

A

TORSADES DE POINTES = pulseless + polymorphic on EKG; caused by LOW magnesium levels! –HR is usually 200-250 BPM

32
Q

what does TORSADES DE POINTES look like on EKG strip?

A

TORSADES DE POINTES looks a lot like ventric. tachycardia - VT **SMALL + LARGE QRS COMPLEXES

33
Q

what do I do for my TORSADES DE POINTES patient?

A

**treat like V-FIB **REPLACE mag levels (is low mag is cause)

34
Q

what is V-FIB or VENTRICULAR FIBRILLATION?

A

V-FIB = rapid, erratic beats by heart; ineffective heartbeats!; heart is QUIVERING

35
Q

what does V-FIB look like on EKG strip?

A

**NO P WAVE **NO QRS COMPLEXES –fine + course in appearance

36
Q

what is significant about V-FIB in regards to B/P & pulse?

A

with V-FIB there is NO B/P and there is NO pulse!

37
Q

what can you do first, to ensure your patient is actually in V-FIB?

A

**CHECK YOUR LEAD PLACEMENTS! maybe they have moved, been misplaced, etc!

38
Q

if my patient is truly in V-FIB and has no pulse/B/P, what can I do?

A

if your patient is truly in V-FIB and there is no pulse, START CPR!!!!!

39
Q

what are the serious effects of V-FIB?

A

**NO CARDIAC OUTPUT; NO PULSE; NO B/P –there is NO perfusion!!!

40
Q

how can we effectively treat V-FIB?!

A

**START CPR; patients heart is NOT achieving adequate perfusion, CPR will circulate the oxygenated blood to all the organs! + -defibrillation (offer electrical shock) to help jump start normal heart rhythm + -emergency medications: #1 choice = AMIODARONE, epi, vasopressin, lidocaine, mag sulfate

41
Q

what is DEFIBRILLATION?

A

electrical shock for heart!; measures in joules (watts) per second **TREATMENT CHOICE FOR: -V-TACH -pulseless V-TACH

42
Q

what are important things to remember about DEFIBRILLATION?

A

***make sure ALL CLEAR ***make sure NO O2 FLOW ***make sure PADS ARE CORRECTLY & SECURELY PLACED! ^^^^DO NOT place over pacemakers or ICDs; move over to side of these!

43
Q

what is ASYSTOLE?

A

ASYSTOLE is also known as ventricular standstill: no EKG activity; **NO ELECTRICAL ACTIVITY

44
Q

what does ASYSTOLE look like on EKG strip?

A

**NO P WAVES **NO QRS COMPLEXES ^^^are your EKG leads placed correctly & securely?

45
Q

my patient is asystole; do I need to shock?!

A

NO; you cannot shock asystole rhythm; this is lack of rhythm, there is technically no rhythm to correct

46
Q

since I can’t shock my asystole patient, what can I do?

A

you CAN give epi + start CPR Asystole = CPR + EPI!

47
Q

what is PULSELESS ELECTRICAL ACTIVITY?

A

PULSELESS ELECTRICAL ACTIVITY is electrical activity on EKG; however, the HEART IS NOT PUMPING!; there is no perfusion occurring; TREAT LIKE ASYSTOLE; NO SHOCKING!!!!

48
Q

what do I do for my patient experiencing PULSELESS ELECTRICAL ACTIVITY?

A

fix what is causing the PEA; there is no mechanically movement of heart, START CPR!

49
Q

what can cause my patients PULSELESS ELECTRICAL ACTIVITY? Hs & Ts: Hs

A

HYPOxia Acidosis (Hydrogen Ion ) HYPOthermia HYPER/HYPOkalemia HYPOvolemia HYPOglycemia

50
Q

how can I treat my causes of PEA: Hs

A

-HYPOxia: intubate; lack of oxygen -Acidotic: push bicarb; lower acidy in body -HYPOthermia: warm your patient! -HYPOvolemia: replace fluids/replace volume -HYPER/HYPOkalemia: replace/deplete potassium as appropriate -HYPOglycemia: IV dextrose 50: super thick; needs GOOD IV LINE

51
Q

what can cause my patients PULSELESS ELECTRICAL ACTIVITY? Hs & Ts: Ts

A

Tablets (overdose of drugs) Trauma Tension pneumothorax Tampanode (compression of heart due to fluid buildup) Thrombosis (heart and/or lungs)

52
Q

how can I treat my causes of PEA: Ts

A

-Tablets: give act. charcoal; blocks absorption of whats causing overdose! -trauma: address trauma -tamponade: cardiac window; relieve fluid buildup -thrombosis: thrombolytics (dissolve/resolve clots)

53
Q

my patient just had CPR; what can I do now to reduce risk of death?

A

you can induce HYPOthermia post cardiac arrest; CPR, to reduce chances of death + improve neuro outcomes!

54
Q

what is the protocol for HYPOthermia?

A

1: induction phase #2: maintenance #3: rewarming phase

55
Q

what is the protocol for HYPOthermia? #1 INDUCTION PHASE

A

1 INDUCTION PHASE: done in ER, brings down temperature to 89.6-93.2 degrees

56
Q

is my patient awake during induced HYPOthermia?

A

NO; patient will be sedated and on the vent; under admin of paralytic meds, on pain meds (can be painful)

57
Q

How do I know what my patients temperature truly is with induced hypothermia?

A

CORE TEMP MONITOR

58
Q

what is the protocol for HYPOthermia? #2: MAINTENANCE

A

**MONITOR VS; TEMPERATURE, URINE OUTPUT –continue to complete assessments and maintain drips/meds as ordered

59
Q

what is the protocol for HYPOthermia? #3 REWARMING PHASE

A

****SLOWLY; occurs over THREE HOURS

60
Q

what is important to watch for during the REWARMING PHASE?

A

**watch for ELECTROLYTE REBOUND EFFECT: (HYPERkalemia) -watch for dysrhythmias, HYPOtension, hypoxia

61
Q

how long does my patient need to stay on the paralytic medication?

A

wean off after patient has been warmed up!!

62
Q

what is an AICD - AUTOMATED IMPLANTABLE CARDIOVERTER DEFIBRILLATOR

A

an AICD is an implantable device that delivers defibrillation when needed

63
Q

what can I educate my patient on about AICDs?

A

-follow up with cardiologist to ensure working properly -avoid trauma/pressure on AICD -call HCP IF it fires more than once, if continues CALL EMS -wear medical alert bracelet -AVOID MRI -you can set off metal detector -be careful around antitheft alarms, can disable -have caregivers learn CPR; STILL AT RISK FOR DEVELOPING LETHAL DYSRHYTHMIAS

RNSG 2539 (Healthcare Concepts) (13 decks)

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