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Adult II Complex > ECGs > Flashcards

ECGs Flashcards

1
Q

Calculate HR for regular rhythm

A

count small squares between to R waves then divide that number by 1500

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2
Q

Calculate HR for irregular rhythms

A

Count number of R waves and multiply by 10

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3
Q

How to assess a client tolerance for bradycardia and tachycardia

A

Assess for low cardiac output:
-Change of LOC
- chest pain
- hypotension
- SOB
- Respiratory distress
- dizziness/syncope
- fatigue
- restlessness

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4
Q

Pt is having symptomatic bradycardia, blood pressure is 80/60, having changes of LOC, fatigue, and dizziness. What do you do first?

A

Give Atropine 1st since having symptoms

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5
Q

Pt having sympotmatic bradycardia and was already given atropine but still hypotensive, what do you do next?

A

Give fluids

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6
Q

Pt having sympotmatic bradycardia and was already given atropine and fluids but still hypotensive, what do you do next?

A

Give dopamine

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7
Q

Pt having sympotmatic bradycardia and was already given atropine, fluids, and dopamine but still hypotensive, what do you do next?

A

put pt on a pacemaker

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8
Q

Reasons for Sinus Tachycardia

A
  • Pain -> pain medication
  • Fever -> antipyretic
  • Anxiety -> benzo’s
  • Drugs/stimulants ex. cocaine
  • Caffeine
  • Dehydration= low bp/ high hr, urine output
  • Hemorrhaging

*JUST IDENTIFY AND TREAT CAUSE

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9
Q

What makes a strip show sinus arrhythmia

A

Irregular ventricular/atrial regularity, varies with respirations between shortest R-R and longest R-R intervals is greater than 0.12 sec.

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10
Q

Treatment for Sinus Arrhythmia

A

No treatment, just monitor and assess

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11
Q

Premature Atrial Contractions (PACs)

A

P wave changes (Abnormal - may be flatten, notched, or lost in the QRS

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12
Q

Two premature beats in a row

A

Coupled/Paired

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13
Q

Three or more premature beats in a row

A

“Runs” or “bursts”

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14
Q

Every other beat is a premature beat

A

Bigeminy

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15
Q

Every third beat is a premature beat

A

Trigeminy

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16
Q

Every fourth beat is a premature beat

A

Quadrigeminy

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17
Q

Management for PACs

A
  • Occasional PACs usually do not require treatment; just monitor and assess.
  • Frequent PACs are treated by correcting the underlying cause:
    – Correcting electrolyte imbalances
    – Reducing stress
    – Reducing or eliminating stimulants
    – Treating heart failure
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18
Q

In Atrial Fib or Atrial Flutter there is no __

A

p wave, its quivering not contracting

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19
Q

Pt with A fib or A flutter, has a heart rate of 120. What is priority?

A

Give Amiordone to bring heart rate down

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20
Q

Pt is admitted to step down unit and are connected to continous monitoring telemetry and all of the sudden it shows they are going into a mix of A fib and A flutter, with a HR of 190. Their having palpatations and chest pains. What is the priority thing to do?

A

Give Amiorodone to bring HR down

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21
Q

Risk of Amiorodone

A

-Toxic to thyroid gland: check TSH and TS4
-Toxic to lungs
-Toxic to Liver (check AST/ALT, may look jaundice)
-Can cause other dysrhthmias

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22
Q

A fib and A flutter can also cause

A

clots.
So anticoagulation is recommended if A fib has been present for 48 hours or longer. So give heparin, warfarin, lovanox, eliquis

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23
Q

Pt was given amiodorone and my pt goes in and out of A fib a flutter every now and then we do

A

Invasive procedures - ablation or MAZE procedure

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24
Q

Pt comes in the ED with HR of 120, blood pressures in the 70s. What do you do?

A

INVASIVE FIRST SINCE HEMODYNAMICALLY UNSTABLE
: So Cardioversion

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25
Q

If pt comes in and develops Afib or A flutter, and the rapid ventricular repsonse and blood pressure are okay greater than 90 systolically. What do you do first?

A

Give Amiodorone, metoprolol, cardizam, then start a heparin drip

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26
Q

Junctional Rhythm

A

Slow rhythm, No P waves or inverted P waves, with 40-60 bpm rate

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27
Q

Supraventricular Tachycardia SVT

A

Pts typically have fast HR

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28
Q

Pt has Supraventricular Tachycardia SVT with super fast HR, what do you give?

A

Adensoine (PUSH IT FAST) but pt must be connected to CRASH CART FIRST!!! bc adensoine will drop HR fast and make heart stop for a second.

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29
Q

When pushing Adenosine..

A

it must be in a good IV like central line or midline in AC, not in small ivs like finger or wrist.

30
Q

Atropine

A

Raises HR

31
Q

Adenosine

A

Slows HR for SVTs

32
Q

Amioradone

A

Brings HR down

33
Q

With PVCs and PACs you must identify what first?

A

identify the underlying rhythm first

Ex. Sinus Bradycardia with PVC, Sinus Rhythm with PVCs

34
Q

PVCs can be caused by

A

potassium, caffiene, heart attack, ect, and sometimes there asympotomatic

35
Q

If patient has PVCs but asympotmatic and pts are occasional

A

not a concern

36
Q

PVCS are dangerous when

A
  • Frequent- Call doctor is see frequent, multifocal pvc’s and are new.
  • Multifocal
  • Two in a row
  • Three or more in a row
37
Q

Management for PVCs

A
  • Assess client’s signs and symptoms
  • Assess for cause and treat cause
    – Drug induced (caffeine, alcohol, cocaine sympathomimetic drugs)
    – Hypoxia
    – Cardiac disease, ACS (Acute coronary syndrome/same thing as MI heart attack), cardiomyopathy, vent aneurysm
    – Metabolic imbalance, acidosis
    – Hypokalemia
    – Irritation of ventricle
  • Antidysrhythmic medication
38
Q

V Tach with pulse and or have a high HR you give

A

Amiorodone

39
Q

V Tach Ventricular Rate

A

101-250 beats per minute

40
Q

Torsade De Pointes Ventricular rate

A

150-300 bpm

41
Q

Treatment for Torsade

A

Correct cause –

hypomagnesemia(THINK LOW MAG FIRST WITH TORSADE) , hypokalemia, drugs that prolong QT interval (Quinidine, Amiodarone, Tricyclic antidepressants), congenital Long QT syndrome

42
Q

Treatment for Pulseless V tach

A

(first) Defibrillate “say clear first”, CPR (after defib),Then assess if have a pulse, Epinephrine, then flush with 20ml of saline.

43
Q

Treatment for V tach with pulse hemodynamically unstable

A

cardioversion

44
Q

Pt went into V tach with no pulse and getting ready to defibrillate, we already said everybody clear.. then what?

A

CPR, chest compression then —> check pulse after cpr

45
Q

Treatment for V tach with pulse, stable but symptomatic

A

Amiodarone

46
Q

Ventricular Fibrillation Treatment

A

PT HAS NO PULSE AND NO HR,

(first) Defibrillate “say clear first”, CPR (after defib),Then assess if have a pulse, Epinephrine, then flush with 20ml of saline.

47
Q

Pulseless Electrial Activity PEA

A

Organized electrical activity is observed on the cardiac monitor but the patient is unresponsive, is not breathing, and has no pulse

48
Q

Management for PEA Pulseless Electrial Activity

A

– CPR 1ST
– Epinephrine 2ND
– Treat underlying causes “H’s and T’s”

49
Q

Lethal Disrhythmmias

A
  1. Asystole
  2. PEA
  3. V tach with no pulse
  4. V fib
50
Q

5 H’s

A
  • Hypoxia
  • Hypovolemia
  • Hypothermia
  • H+ ions (acidosis)
  • Hypokalemia or hyperkalemia (if potassium is HIGH give DICK: D- D50 I- Insulin IV C- Calcium gluconate IV push K- Kayexalate) Give calcium 1st its Priority.
51
Q

If patients postassium is high give DICK
D- d50
I- insulin IV
C- Calcium gluconate
K- Kayexalate
What do you do first?

A

Giv calcium gluconate first

52
Q

5 T’s

A
  • Tablets/toxins (overdose)
  • Tamponade (cardiac)- fluid around heart
  • Tension pneumothorax- chest tube or needle compression to fix
  • Thrombosis (coronary)
  • Thrombosis (pulmonary)
53
Q

Asystole Treatment

A
  • Never shock Asystole
  • Confirm client unresponsive and has no pulse
  • Check second ECG lead to confirm not V Fib
  • CPR
  • Establish vascular access
  • Administer epinephrine every 3-5 minutes
54
Q

First Degree AV block

A

Regular rate, PR Interval prolonged; greater than 0.20 sec; constant

55
Q

First Degree AV block Treatment

A
  • Same treatment for Symptomatic sinus bradycardia
  • Assess for cause and treat
  • Assess for changes in PRI
  1. Atropine** - USED 1st IF HAVING SYMPTOMS.
  2. If hypotensive and already gave atropine = Give fluids (Normal Saline or LR)
  3. If fluids and atropine doesn’t work and blood pressure is still low give Dopamine.
  4. Pacemaker (give meds like versed, diazepam when placing pt on pacemaker)
56
Q

Artifact

A
  1. Distortion of ECG tracing by electrical activity that is noncardiac in origin
  2. Can mimic cardiac dysrhythmias, including ventricular fibrillation
  3. Client evaluation is essential before initiating any medical interventions
57
Q

Artifact troubleshooting

A

a. Assess client first: look at lead placement
b. Identify problem
c. Check electrodes
d. Ensure electrical equipment properly grounded

58
Q

After defibrillation, the advanced cardiac life support (ACLS) nurse says that the patient has pulseless electrical activity (PEA). What is most important for the nurse to understand about this rhythm?
a. The HR is 40 to 60 bpm.
b. Hypoxemia and hypervolemia are common with PEA.
c. There is dissociated activity of the ventricle and atrium.
d. There is electrical activity with no mechanical response.

A

d. There is electrical activity with no mechanical response.

59
Q

The nurse is evaluating the telemetry ECG rhythm strip. How should the nurse document the distorted P wave causing an irregular rhythm?
a. Atrial flutter
b. Sinus bradycardia
c. Premature atrial contraction (PAC)
d. Paroxysmal supraventricular tachycardia (PSVT)

A

c. Premature atrial contraction (PAC)

60
Q

Which rhythm abnormality has an increased risk of ventricular tachycardia and
ventricular fibrillation?
a. PAC
b. Premature ventricular contraction (PVC) on the T wave
c. Accelerated idioventricular rhythm
d. PVC couplet

A

b. Premature ventricular contraction (PVC) on the T wave

61
Q

A patient with an acute MI has sinus tachycardia of 126 bpm. The nurse recognizes that if this dysrhythmia is not treated, what is the worst thing the patient is likely to experience?
a. Hypertension
b. Escape rhythms
c. Ventricular tachycardia
d. An increase in infarct size

A

d. An increase in infarct size

62
Q

A patient with no history of heart disease has a rhythm strip that shows an occasional distorted P wave followed by normal AV and ventricular conduction. About what should the nurse question the patient?
a. The use of caffeine
b. The use of sedatives
c. Any aerobic training
d. Holding of breath during exertion

A

a. The use of caffeine

63
Q

Priority Decision: A patient’s rhythm strip indicates a normal HR and rhythm with normal P waves and QRS complexes, but the PR interval is 0.26 second. What is the most appropriate action by the nurse?
a. Continue to assess the patient.
b. Administer atropine per protocol.
c. Prepare the patient for synchronized cardioversion.
d. Prepare the patient for placement of a temporary pacemaker.

A

a. Continue to assess the patient.

64
Q

In the patient with a dysrhythmia, which assessment indicates decreased cardiac output (CO)?
a. Hypertension and bradycardia
b. Chest pain and decreased mentation
c. Abdominal distention and hepatomegaly
d. Bounding pulses and a ventricular heave

A

b. Chest pain and decreased mentation

65
Q

Priority Decision: A patient with an acute MI is having multifocal PVCs and couplets. He is alert and has a BP reading of 118/78 mm Hg with an irregular pulse of 86 bpm. What is the priority nursing action at this time?
a. Continue to assess the patient.
b. Ask the patient to perform Valsalva maneuver.
c. Prepare to administer antidysrhythmic drugs per protocol.
d. Be prepared to administer cardiopulmonary resuscitation (CPR).

A

c. Prepare to administer antidysrhythmic drugs per protocol.

66
Q

Which rhythm pattern finding is indicative of PVCs?
a. A QRS complex > 0.12 second followed by a P wave
b. Continuous wide QRS complexes with a ventricular rate of 160 bpm
c. P waves hidden in QRS complexes with a regular rhythm of 120 bpm
d. Saw-toothed P waves with no measurable PR interval and an irregular
rhythm

A

a. A QRS complex > 0.12 second followed by a P wave

67
Q

In the patient experiencing ventricular fibrillation (VF), what is the rationale for using
defibrillation?
a. Enhance repolarization and relaxation of ventricular myocardial cells b. Provide an electrical impulse that stimulates normal myocardial
contractions
c. Depolarize the cells of the myocardium to allow the SA node to resume
pacemaker function
d. Deliver an electrical impulse to the heart at the time of ventricular
contraction to convert the heart to a sinus rhythm

A

c. Depolarize the cells of the myocardium to allow the SA node to resume

68
Q

What action is included in the nurse’s responsibilities in preparing to administer
defibrillation?
a. Applying gel pads to the patient’s chest
b. Setting the defibrillator to deliver 50 joules
c. Setting the defibrillator to a synchronized mode
d. Sedating the patient with midazolam before defibrillation

A

a. Applying gel pads to the patient’s chest

69
Q

While providing discharge instructions to the patient who has had an implantable cardioverter-defibrillator (ICD) inserted, the nurse teaches the patient that if the ICD fires, it is important that he or she should do what?
a. Lie down.
b. Call the cardiologist.
c. Push the reset button on the pulse generator.
d. Immediately take his or her antidysrhythmic medication.

A

b. Call the cardiologist.

70
Q

A patient with a sinus node dysfunction has a permanent pacemaker inserted. Before discharge, what should the nurse include when teaching the patient?
a. Avoid cooking with microwave ovens.
b. Avoid standing near antitheft devices in doorways.
c. Use mild analgesics to control the chest spasms caused by the pacing
current.
d. Start lifting the arm above the shoulder right away to prevent a “frozen
shoulder.”

A

b. Avoid standing near antitheft devices in doorways.

71
Q

Priority Decision: A patient on the telemetry unit goes into VF and is unresponsive.
Following initiation of the emergency call system (Code Blue), what is the next priority for the nurse in caring for this patient?
a. Begin CPR.
b. Get the crash cart.
c. Administer amiodarone IV.
d. Defibrillate with 360 joules.

A

a. Begin CPR.

72
Q

A patient with chest pain that is unrelieved by nitroglycerin is admitted to the coronary care unit for observation and diagnosis. While the patient has continuous ECG monitoring, what finding would most concern the nurse?
a. Occasional PVCs
b. QRS complex change
c. ST segment elevation
d. A PR interval of 0.18 second

A

c. ST segment elevation

Adult II Complex (15 decks)

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