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Sophomore 2 Test 2 > EKG > Flashcards

EKG Flashcards

1
Q

Normal PR Interval

A

0.12 - 0.2 seconds (5 small squares)

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2
Q

Where is the electrical impulse generated from if the EKG is showing normal sinus rhythm?

A

SA node

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3
Q

PR interval for sinus bradycardia

A

Normal (0.12 - 0.2 seconds)

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4
Q

Where is the electrical impulse generated from in the EKG is showing normal sinus rhythm?

A

Could possibly be the AV node but could also be the SA node

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5
Q

Sinus Bradycardia Treatments

A

If patient is symptomatic:

  1. Atropine 0.5 mg IVP every 3-5 minutes with maximum total dose of 3 mg
  2. Transcutaneous pacing
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6
Q

Possible Symptoms a Bradycardic Patient might experience

A
  1. Hypotension
  2. Diaphoretic
  3. Drowsiness
  4. Cyanotic/Dusky
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7
Q

Causes of Sinus Bradycardia

A
  1. Lower metabolic needs
  2. Vagal stimulation
  3. Medications
  4. Increased ICP
  5. MI
  6. Hypovolemia
  7. Hypoxia
  8. Hypo/hyperkalemia
  9. Hypothermia
  10. Toxins
  11. Cardiac tamponade
  12. Tension pneumothorax
  13. Thrombosis
  14. Trauma
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8
Q

HR range for sinus tachycardia

A

More than 100 but less than 120

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9
Q

PR interval for sinus tachycardia

A

Normal (0.12 - 0.20 seconds)

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10
Q

Causes of Sinus Tachycardia

A
  1. Physiologic or psychological stress
  2. Medications
  3. Stimulants
  4. Illicit Drugs
  5. Autonomic dysfunction
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11
Q

Physiologic or Psychological Stress that can Cause Sinus Tachycardia

A
  1. Acute blood loss
  2. Shock
  3. Fever
  4. Exercise
  5. Anxiety
  6. Fluid overload
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12
Q

Medications that can cause Sinus Tachycardia

A
  1. Catecholamine’s
  2. Aminophylline
  3. Atropine
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13
Q

Stimulants that can cause Sinus Tachycardia

A
  1. Caffeine

2. Nicotine

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14
Q

Illicit drugs that can cause Sinus Tachycardia

A
  1. Cocaine

2. Ecstacy

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15
Q

Treatment for Sinus Tachycardia

A
  1. Correct the cause
  2. Beta-blockers
  3. Calcium-channel blockers
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16
Q

What does Atrial Flutter look like on an EKG?

A

Saw tooth or picket fence appearance

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17
Q

Is the rhythm regular or irregular for atrial flutter?

A

Regular

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18
Q

Atrial Flutter Rate

A
  1. Atrial rate ranges from 250 to 400

2. Ventricular rate ranges from 75 to 150

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19
Q

PR interval for Atrial Flutter

A

Not measurable

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20
Q

Causes of Atrial Flutter

A
  1. COPD
  2. Valvular disease
  3. Thyrotoxicosis (thyroid storm)
  4. S/P Cardiac Surgery
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21
Q

Treatment of Atrial Flutter

A
  1. Vagal maneuvers
  2. Adenosine
  3. Electrical cardioversion
  4. Catheter ablation
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22
Q

S/Sx of Atrial Flutter

A
  1. Patient may or may not be symptomatic
  2. Chest pain
  3. SOB
  4. Decreased BP
    * If a patient is asymptomatic, they might just put them on an anticoagulant but possibly no other therapy
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23
Q

Atrial Fibrillation Rhythm

A

Irregularly irregular

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24
Q

Atrial Fibrillation Rate

A
  1. Atrial rate from 300 to 600

2. Ventricular rate from 120 to 200

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25
Q

PR interval for atrial fibrillation

A

Not measurable

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26
Q

Causes of Atrial Fibrillation

A
  1. Valvular heart disease
  2. Inflammatory or infiltrative disease
  3. CAD
  4. HTN
  5. Heart failure
  6. Hyperthyroidism
  7. Pulmonary HTN
  8. Pulmonary embolism
  9. Obstructive sleep apnea
  10. S/P cardiac or pulmonary surgery
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27
Q

Treatment of Atrial Fibrillation

A
  1. Electrical cardioversion
  2. Amiodarone
  3. Flecainide
  4. Propafenone
  5. Ibutilide
  6. Catheter ablation
  7. Antithrombotic therapy
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28
Q

Special Consideration for a patient with Atrial Fibrillation

A

First obtain an H/P, how long has the patient been in this rhythm or is it new onset?

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29
Q

Supraventricular Tachycardia Rhythm

A

Regular

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30
Q

Supraventricular Tachycardia Rate

A

140 - 220

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31
Q

PR interval for Supraventricular Tachycardia

A

Depends on site of supraventricular pacemaker (where is the impulse coming from)

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32
Q

Where is the electrical impulse coming from in a patient with SVT

A

Impulses stimulating the heart are not being generated by the SA node, but instead are coming from a collection of tissue around and involving the AV node

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33
Q

Causes of SVT

A
  1. Caffeine
  2. Nicotine
  3. Hypoxemia
  4. Stress
  5. CAD
  6. Cardiomyopathy
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34
Q

Treatment of SVT

A
  1. Vagal maneuvers
  2. Adenosine (6 mg, then 12 mg)
  3. Calcium channel blockers
  4. Cardioversion
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35
Q

Premature Ventricular Complex Rhythm

A

Depends on the underlying rhythm

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36
Q

Premature Ventricular Complex Rate

A

Irregular due to early QRS

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37
Q

PR interval for Premature Ventricular Complex

A

Normal (0.12 - 0.20 seconds)

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38
Q

Causes of Premature Ventricular Complex (PVC)

A
  1. Caffeine
  2. Nicotine
  3. Alcohol
  4. Cardiac ischemia or infarction
  5. Heart failure
  6. Digitalis toxicity
  7. Hypoxia
  8. Acidosis
  9. Electrolyte imbalances
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39
Q

Treatment for PVC

A
  1. If the patient has no underlying disease or infrequent changes, no treatment is required
  2. Amiodarone
  3. Lidocaine
    * if not treated, they can progress to V-tach
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40
Q

PVC’s can cause problems if…

A
  1. More than 6 per minute
  2. Multifocal/polymorphic
  3. Occur 2 in a row
  4. Occur on the T wave
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41
Q

Ventricular Tachycardia Rhythm

A

Regular

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42
Q

Ventricular Tachycardia Rate

A

Range from 100 to 200

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43
Q

Causes of Ventricular Tachycardia

A
  1. CNS disease
  2. Hypokalemia
  3. Hypocalcemia
  4. Hypomagnesemia
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44
Q

Treatment of Ventricular Tachycardia

A
  1. Cardioversion if patient has a pulse
  2. Defibrillation if patient is pulseless
  3. Replace electrolytes
  4. Amiodarone
  5. Isuprel
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45
Q

Ventricular Fibrillation Rhythm

A

Extremely Irregular

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46
Q

Ventricular Fibrillation Rate

A

Greater than 300

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47
Q

Causes of Ventricular Fibrillation

A
  1. CAD
  2. MI
  3. Untreated V-tach
  4. Cardiomyopathy
  5. Vavlular heart disease
  6. Acid-base imbalance
  7. Electrolyte imbalance
  8. Electrical shock
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48
Q

Treatment of Ventricular Fibrillation

A

Defibrillation

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49
Q

Causes of Asystole

A
  1. Hypoxia
  2. Acidosis
  3. Severe electrolyte imbalance
  4. Drug overdose
  5. Hypovolemia
  6. Cardiac tamponade
  7. Tension pneumothorax
  8. Coronary/pulmonary thrombosis
  9. Trauma
  10. Hypothermia
50
Q

Treatment of Asystole

51
Q

Third Degree AV Block Rhythm

52
Q

Third Degree AV Block Rate

53
Q

PR interval for 3rd Degree AV Block

54
Q

3rd Degree AV Block is also called what?

A

Complete Heart Block

55
Q

Treatment of 3rd Degree Heart Block

A

Pacing

* This patient will have decreased cardiac output

56
Q

Potential Complications of Dysrhythmias

A
  1. Cardiac Arrest
  2. Heart Failure
  3. Thromboembolic Event
57
Q

Defibrillation

A

Shocking the patient is depolarizing the patient. It resets polarization so that the SA node picks up and starts

58
Q

Defibrillation is the treatment for what arrhythmias?

A
  1. Pulseless V-tach

2. V-fib

59
Q

Nursing Responsibilities for Defibrillation

A
  1. Start CPR before defibrillation
  2. Turn device on (apply gel if needed)
  3. Ensure device in defibrillation mode
  4. Select electric charge 300-360 joules (or follow MD order)
  5. If using paddles, apply 20 lbs of pressure
  6. Ensure all personnel are clear of patient/bed prior to shocking the patient
  7. After defibrillation, check the patient an monitor
60
Q

Cardioversion is the treatment for which arrhythmias?

A
  1. SVT
  2. A-Fib
  3. A-Flutter
  4. Stable V-tach (pulse is present)
61
Q

Cardioversion

A
  • The shock is synchronized with the rhythm
  • The MD can control the amount of joules
  • Synchronized hits in the QRS complex during ventricle depolarization
  • Even if the pads are pushed a little too early, it’s ok, it will wait until the QRS complex
62
Q

Nursing Responsibilities for Cardioversion

A
  1. Consent may be obtained if not emergent
  2. Patient may be given a sedative: diazepam or midazolam
  3. Usually try 3-4 times
63
Q

Pacemaker Therapy

A
  • Used to treat conduction defects or dysrhythmias
  • Uses a pulse generator to provide an electrical stimulus to the heart when the heart fails to conduct its own at a rate that maintains cardiac output
64
Q

Fixed (Asynchronus) Pacemaker

A

Pacemaker is set at a rate determined by the MD

65
Q

Demand (Synchronus) Pacemaker

A

Pacemaker fires when rate falls below set rate determined by MD

66
Q

Temporary Pacemaker

A

Uses an external pulse generator attached to a lead threaded intravenously into the right ventricle

67
Q

Types of Temporary Pacemakers

A
  1. Epicardial - directly in the heart

2. Endocardial - threaded through a central vein

68
Q

Permanent Pacemakers

A

Use an internal pulse generator placed in a subcutaneous pocket in the subclavian space or abdominal wall

69
Q

What kind of arrhythmias would require a pacemaker?

A
  1. 3rd degree AV Block
  2. Sick Sinus Syndrome
  3. Asystole
70
Q

S/Sx of Low Cardiac Output

A
  1. Dizziness
  2. Bradycardia
  3. Restlessness
  4. Hypotension
71
Q

Potential Complications after Pacemaker Placement

A
  1. Infection
  2. Pneumothorax
  3. Arrhythmias
72
Q

Patient Care of Pacemaker

A
  1. Monitor incision
  2. Avoid large magnetic fields
  3. Avoid heavy lifting for 2 weeks
  4. Medical identification
73
Q

Pacemaker on an EKG

A
  • Pacing is detected on ECG by sharp spike noted before the P wave with atrial pacing or before the QRS with ventricular pacing
  • If nurse caring for patient does not see pacer spikes, the voltage must be increased so that spikes are seen
74
Q

Implantable Cardioverter Defibrillator

A
  • Detects life threatening changes in the rhythm (tachycardia, fibrillation)
  • Automatically delivers an electrical shock to convert the dysrhythmia
  • Life vest are used until a patient can have an AICD placed
75
Q

Electrophysiological Studies

A
  • An electrophysiology study (EPS) is one of the most accurate and reliable methods of evaluating heart rhythms
  • The procedure is performed by an electrophysiologist who will attempt to reproduce dysrhythmias to determine the type and location
76
Q

Cardiac Conduction Surgery

A
  • Maze procedure is performed to treat atrial fibrillation (refractory)
  • Catheter ablation therapy is a curative procedure that involves the application of energy through a catheter tip to cauterize electrical tissue causing the dysrhythmias
77
Q

P Wave

A

Atrial Depolarization (atrial contraction)

78
Q

QRS Complex

A

Depolarization of ventricles (contraction of ventricles)

79
Q

What does the SA node do?

A
  • It is the primary pacemakers

- Highest degree of automaticity, causes depolarization

80
Q

What does the AV node do?

A
  • It is the backup pacemaker in the 40-60 bpm range

- Atrial junction, slower to allow the ventricle chamber to fill more completely

81
Q

Purkinje Fibers

A

Could take over as pacemaker if HR gets to 20-30 bpm range if needed

82
Q

Bundle of His

A

Ventricle sends blood to pulmonary artery and the aorta

83
Q

Stroke Volume

A

Injected blood into the system circulation in one beat

84
Q

Contractility

A

The ability of the cells to shorten when depolarized by an electrical impulse

85
Q

Automaticity

A

The ability of the cell to spontaneously generate and discharge an electrical impulse

86
Q

Excitability

A

The ability of the cell to respond by depolarization. The response can be influenced by: hormones, electrolytes, meds, O2, nutrition

87
Q

Refractory

A

The period which the cells resist stimulation

  • Relative refractory
  • Absolute refractory
88
Q

Relative Refractory

A

A greater than normal stimulus is required to generate another action potential

89
Q

Absolute Refractory

A

Depolarization will not occur no matter how strong the stimulus

90
Q

What is the PR interval?

A

Measures the amount of time it takes for impulse to travel from atrial depolarization to the beginning of ventricle depolarization (0.12-0.20 seconds); SA node to AV node

91
Q

Normal length of QRS interval

A

Complex is normally less than 0.12 seconds in duration

92
Q

ST segment

A

End of ventricle depolarization to the beginning of ventricle repolarization

  • Isoelectric or flat
  • Elevated or depressed may indicate disease or injury of ventricle muscle
93
Q

T Wave

A

Repolarization of ventricles (return to resting state) and are most vulnerable to dangerous stimuli

  • Should be up, if downward displacement = injury, ischemia, or infarction
94
Q

QT interval

A

The amount of time for ventricle to depolarize and repolarize (usually 0.32-0.40 seconds)

95
Q

Conditions that can change the shape and size of PR interval

A
  1. Digitalis
  2. Beta-blockers
  3. Age and conduction disease
  4. Atrial enlargement
  5. Valvular heart disease
96
Q

Conditions or medications that change the QRS

A
  1. Ventricle enlargement
  2. Dysrhythmic meds, Quinidine, Procainamide, Flocainidine
  3. Ventricle electrical conduction defects
  4. COPD
  5. Hyperkalemia
  6. Hypokalemia
97
Q

Conditions that cause the QT interval to prolong

A
  1. Low HR
  2. Hypocalcemia
  3. Hypokalemia
  4. Ischemia
  5. Infarction
98
Q

P Wave for Normal Sinus Rhythm

A

Visible before each QRS complex

99
Q

QRS Duration for Normal Sinus Rhythm

A

Normal (< 0.12 seconds)

100
Q

QRS Duration for Sinus Bradycardia

A

Normal (< 0.12 seconds)

101
Q

P Wave for Sinus Bradycardia

A

Visible before each QRS complex

102
Q

QRS Duration for Sinus Tachycardia

A

Normal (< 0.12 seconds)

103
Q

P Wave for Sinus Tachycardia

A

Visible before each QRS complex

104
Q

QRS Duration for Atrial Flutter

A

Usually normal (< 0.12 seconds)

105
Q

P Wave for Atrial Flutter

A

Saw-tooth shape (referred to as F waves)

106
Q

P Wave Rate for Atrial Flutter

A

300 beats per minute

107
Q

QRS Duration for Atrial Fibrillation

A

Usually normal (< 0.12 seconds)

108
Q

P Wave for Atrial Fibrillation

A

Not distinguishable as the atria are firing off all over

109
Q

QRS Duration for SVT

A

Usually normal (< 0.12 seconds)

110
Q

P Wave for SVT

A

Cannot be seen

111
Q

QRS Shape for PVC

A

Bizarre and abnormal

112
Q

P Wave for PVC

113
Q

P Wave Rate for PVC

A

Normal and same as QRS rate

114
Q

QRS Duration for V-tach

A

Prolonged with a bizarre abnormal shape

115
Q

P Wave for V-tach

116
Q

QRS Duration for V-fib

A

Not recognizable

117
Q

P Wave for V-fib

118
Q

QRS Duration for 3rd Degree Block

A

Usually abnormal

119
Q

P Wave for 3rd Degree AV Block

A

Unrelated to QRS complex

120
Q

P Wave Rate for 3rd Degree AV Block

A

Normal but faster than QRS rate

Sophomore 2 Test 2 (4 decks)

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