Dysrhythmias part 4 blocks

Question 1

Which av node block is Wenkebach?

What occurs here?

Answer 1

Second degree type one!

The PR interval increases each time, and then drops a beat. (long, longer, longest, drop)

Question 2

Drugs that can cause a Wenkebach (second degree type one)?

Answer 2

Digoxin - bc it slows everything down

Beta blockers

Question 3

Conditions Wenkebch block can be associated with?

Answer 3

CAD (or any condition that can slow av node condition)

- usually an MI

Question 4

What is the significance of a Wenkebach for patients?

Answer 4

It’s usually tolerable BUT if it can be a warning for a more serious issue going on

Question 5

Wenkebach treatment for symptomatic? What increases the symptoms?

Wenkebach treatment for asymptomatic?

Answer 5

If symptomatic… Atropine and temporary pacemaker
Increased symptoms with hypotension, heart-failure, and shock

Monitor with the use transcutaneous pacer

Question 6

What is Mobitz type 2 block?

What will it look like? And how can you tell?

Answer 6

Second degree av block type 2?

Think of it as being a mirror image.
- a good way to remember is if you fold it in half, it would be the same. Think 2; mirror.

• you’ll notice it looks funny, so split in half

Question 7

Clinical associations of second degree av block type 2 (mobitz type2)?

Answer 7

Rheumatic heart disease
CAD
Anterior MI
Digoxin

Question 8

Why is Mobitz type 2 block a concern?

Why?

Answer 8

Mobitz type 2 progresses into the 3rd degree heart block (so the patient is on the block spectrum)

There will be a decrease in CO, leading to hypotension and MI

Question 9

What is the pathology behind Mobitz type 2 block?

And ask yourself why would we use a pacer?

Answer 9

Distal electrical conduction system of the ventricles is diseased causing the QRS to be dropped

We use the pacer so the impulse can get to the ventricles incase it is dropped

Question 10

Your patient is having a Mobitz 2. You see they are developing bradycardia due to the QRS being dropped. You as the nurse understand the patient has hx of MI. Would you give them atropine?

Answer 10

No - do not give them atropine.

They are not getting oxygen - so if you give a drug to increase HR, you are getting even less oxygen.

Question 11

What does this strip show?

Answer 11

Av node 2nd degree type 2 (mobitz type 2)

Question 12

What is 3rd degree av node heart block?

(Severity?

Answer 12

Atrial impulse is blocked but the av pacemaker & ventricles are still trying to do something; chaos. No relationship between p wave and qrs to see

Dangerous )

Question 13

Heart Diseases that can cause 3rd degree heart block?

Systemic disease that can cause 3rd degree heart block?

Answer 13

CAD & MI - most common
Myocarditis
Cardiomyopathy

Amyloidosis
Scleroderma

Question 14

Drugs that can cause 3rd degree heart block?

Answer 14

Beta Blockers
Calcium channel blockers
Digoxin

Question 15

Symptoms of 3rd degree heart block?

Answer 15

Bradycardia
Hypotension
Hemodynamcally unstable - sometimes

Question 16

Treatment for 3rd degree heart block?

Answer 16

Get them a transcutaneous pacer

Question 17

What else can be going on with a 3rd degree heart block?

Answer 17

Well due to the decrease in CO…
ischemia
heart failure
shock

Question 18

What can result from the bradycardia in 3rd degree heart block?

Answer 18

Bradycardia can lead to syncope and even asystole

Question 19

What happens if you don’t treat 3rd degree heart block seriously?

How will you as the nurse react?

Answer 19

The patient can go into asystole

You need to be getting the pacer on the patient and calling the doctor

Question 20

Treatments for each block

1st

2nd (2 types)

3rd

Answer 20

1 - no treatment. just monitor

2 - monitor with pacer (can also use atropine for wenkebach)

3 - get the transcutaneous pacer

Question 21

Amiodarone drip patient has to go home soon. What do you anticipate?

Answer 21

The patient will be switched to PO.

Question 22

Joules needed for monophasic defibrillators and meaning

Joules needed for biphasic defibrillators?

What do you do when the defibrillator is charging?

Answer 22

360 joules for initial shock (more voltage)
- one direction

150 to 200 for first and successive
- two directions

Continue CPR as it charges

Question 23

Things to consider as you defibrillate/cardiovert a patient?

Answer 23

First, know where you are placing the paddles and know the size.
Use enough gel.
Pick the right setting
Synchronize (R wave) by pushing the button
Make sure to clear
If the patient is receiving cardioversion, they should be sedated (used for non-emergency)