Dysrhythmias part 4 blocks Flashcards
Which av node block is Wenkebach?
What occurs here?
Second degree type one!
The PR interval increases each time, and then drops a beat. (long, longer, longest, drop)
Drugs that can cause a Wenkebach (second degree type one)?
Digoxin - bc it slows everything down
Beta blockers
Conditions Wenkebch block can be associated with?
CAD (or any condition that can slow av node condition)
- usually an MI
What is the significance of a Wenkebach for patients?
It’s usually tolerable BUT if it can be a warning for a more serious issue going on
Wenkebach treatment for symptomatic? What increases the symptoms?
Wenkebach treatment for asymptomatic?
If symptomatic… Atropine and temporary pacemaker
Increased symptoms with hypotension, heart-failure, and shock
Monitor with the use transcutaneous pacer
What is Mobitz type 2 block?
What will it look like? And how can you tell?
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
Clinical associations of second degree av block type 2 (mobitz type2)?
Rheumatic heart disease
CAD
Anterior MI
Digoxin
Why is Mobitz type 2 block a concern?
Why?
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
What is the pathology behind Mobitz type 2 block?
And ask yourself why would we use a pacer?
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
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?
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.
What does this strip show?
Av node 2nd degree type 2 (mobitz type 2)
What is 3rd degree av node heart block?
(Severity?
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 )
Heart Diseases that can cause 3rd degree heart block?
Systemic disease that can cause 3rd degree heart block?
CAD & MI - most common
Myocarditis
Cardiomyopathy
Amyloidosis
Scleroderma
Drugs that can cause 3rd degree heart block?
Beta Blockers
Calcium channel blockers
Digoxin
Symptoms of 3rd degree heart block?
Bradycardia
Hypotension
Hemodynamcally unstable - sometimes
Treatment for 3rd degree heart block?
Get them a transcutaneous pacer
What else can be going on with a 3rd degree heart block?
Well due to the decrease in CO…
ischemia
heart failure
shock
What can result from the bradycardia in 3rd degree heart block?
Bradycardia can lead to syncope and even asystole
What happens if you don’t treat 3rd degree heart block seriously?
How will you as the nurse react?
The patient can go into asystole
You need to be getting the pacer on the patient and calling the doctor
Treatments for each block
1st
2nd (2 types)
3rd
1 - no treatment. just monitor
2 - monitor with pacer (can also use atropine for wenkebach)
3 - get the transcutaneous pacer
Amiodarone drip patient has to go home soon. What do you anticipate?
The patient will be switched to PO.
Joules needed for monophasic defibrillators and meaning
Joules needed for biphasic defibrillators?
What do you do when the defibrillator is charging?
360 joules for initial shock (more voltage)
- one direction
150 to 200 for first and successive
- two directions
Continue CPR as it charges
Things to consider as you defibrillate/cardiovert a patient?
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)
