Dysrhythmias (Exam 2) Flashcards
Bradycardia: What causes it?
-Excessive Vagal (parasympathomimetic) stimulation
-Vomiting / Gagging
-HYPERkalemia
-MI
Bradycardia: What will the patient look like if symptomatic?
-Angina
-Restless
-Dizziness
-SOA
-Orthopnea
-S3/S4 heart sounds
-JVD
-Weakness / fatigue
-Decrease Urine output
-Hypotension
Bradycardia: How do we treat it if symptomatic?
First:
-IV Atropine (1 mg over 3-5 min, 3 mg max)
Second:
-Transcutaneous Pacing
Last:
-Pacemaker
Tachycardia: What causes it?
-Physical activity
-Anxiety
-Stress
-Pain
-Fever
-Anemia
-Hypoxia
-Dehydration
-MI
-Heart Failure
Tachycardia: What will a patient look like?
-Palpitations
-Angina
-Restless
-Dizziness
-SOA
-Orthopnea
-S3/S4 heart sounds
-JVD
-Weakness / fatigue
-Decrease Urine output
-Hypotension
Tachycardia: How do we treat it?
TREAT THE CAUSE
-Fluid replacement
-Analgesic
-Anti-pyretic
-Anxiolytic
Beta Blocker to reduce HR and Myocardial O2 consumptions
Premature Atrial Contraction: What causes it?
-Benign
-Electrolyte Imbalance
-Stress
-Stimulants (caffeine)
Premature Atrial Contraction: What will a patient look like?
Asymptomatic
If increasing in frequency than signs of tachydysrhythmias
If increasing in frequency can indicated conversion into A-fib
Premature Atrial Contraction: How do we treat it?
Rate / Rhythm Control
Rate:
-Beta Blocker (olol)
-Calcium Channel Blocker
(diltiazem) (verapamil)
Rhythm: (antidysrhythmics)
-Amiodarone
-DoFETilide
Atrial Fib: What causes it?
-Underlying Heart Condition
-Electrolyte imbalance
-Cardiac Surgery
Atrial Fib: What will a patient look like?
Depends on:
-Ventricular rate
-How long it has been present
-CV status
Typically fast onset = Tachydysrhythmias
Stroke
Atrial Fib: How do we treat it if stable but symptomatic
Control Rate:
-Beta Blocker
-Calcium Channel Blocker
(Bolus / Drip)
Control Rhythm:
-Amiodarone
-DoFETilide
Prevent clots:
-Warfarin
Atrial Fib: How do we treat if unstable / hemodynamically compromised?
Synchronized cardioversion
Atrial Fib: Ways to treat if pharmacology does not work
Catheter ablation
Maze Procedure
Atrial Flutter: What causes it?
-Underlying hear condition (sick heart)
-Electrolytes
Atrial Flutter: What will a patient look like?
Depends on:
-Ventricular rate
-How long it has been present
-CV status
Typically fast onset = Tachydysrhythmias
Stroke
Atrial Flutter: How do we treat if stable but symptomatic?
Control Rate:
-Beta Blocker
-Calcium Channel Blocker
(Bolus / Drip)
Control Rhythm:
-Amiodarone
-DoFETilide
Prevent clots:
-Warfarin
Atrial Flutter: How do we treat if hemodynamically compromised?
Cardioversions
Atrial Flutter: Ways to treat if pharm does not work?
Catheter Ablation
Maze procedure
How do we slow ventricular rate in Afib or A-flutter?
IV CCB or BB
Bolus / Drip
Synchronized Cardioversion: What to know
-If non emergency sedate patient before procedure
-Start with initial energy 50-100 joules
-If patient becomes pusless, turn synchronized off and preform defibrillation
If patient has Afib > 48 hours what should be done before cadioversion?
-Patient should be on anticoagulation therapy 3 to 4 weeks before cardioversion and 3 to 4 weeks after cardioversion
-TEE should be preformed before to ensure no clots are present
If cardioversion is emergent, what will the patient be placed on?
Low-molecular weight heparin drip
Nursing Care for Synchronized Cardioversion
-Maintain patent airway
-Administer Oxygen
-Assess V.S and LOC
-Monitor for dysrhythmias
-Provide Emotional support
-Document results
Paroxysmal Supraventricular Tachycardia: What causes it?
-Overexertion
-Stress / Stimulants
-Digitalis toxicity
-Heart disease
Paroxysmal Supraventricular Tachycardia: What will a patient look like?
Depends on how long it last and how fast the rate is. (typically tachy)
-Palpitations
-Angina
-Restless
-Dizziness
-SOA
-Orthopnea
-S3/S4 heart sounds
-JVD
-Weakness / fatigue
-Decrease Urine output
-Hypotension
Paroxysmal Supraventricular Tachycardia: How do we treat it?
Vagal Maneuvers
-Valsalva (hold breath 10-15 seconds0 (should see neck distention)
-Coughing
-Carotid Sinus Massage
-Cold water immersion
Paroxysmal Supraventricular Tachycardia: How do we treat if vagal maneuvers fail?
Adenosine IV push
(follow with NS rapidly)
(Pause on rhythm strip)
(3 way stop cock)
Paroxysmal Supraventricular Tachycardia: How do we treat if Adenosine fails
Cardioversion
Premature Ventricular Contractions: What causes it?
-ELETROLYTES
-Hypoxia
-Stimulants
-CVD
Premature Ventricular Contractions: How do we treat it?
Treat the causes
-Electrolytes - Oxygen
Drugs:
-B-blockers
-Lidocaine
-Amiodarone
Ventricular Tachycardia: What causes it?
-MI
-CAD
-Electrolyte abnormalities
-Heart failure
-Drug toxicity
Ventricular Tachycardia: How do we treat it?
ACLS
Pulse:
-Cardioversion
-Electrolyte replacement
-Beta-blocker
-CCB
-Amiodarone
Pulseless:
-CPR / Defibrillation
Ventricular Fibrillation: How do we treat it?
CPR and ACLS/Defibrillation
