Electrical Therapy - Exam 6 Flashcards
What is defibrillation?
Refers to the delivery of an electrical shock to the heart through the chest wall without regard for the ECG waveform. The machine used is a defibrillator. The machine delivers the electrical shock as soon as the discharge mechanism is pushed, without regard to the ECG waveform. The electric shock completely depolarizes the cells of the myocardium in an effort to terminate the dysrhythmia. Defibrillation is the therapy of choice for:
- Ventricular fibrillation
- Pulseless ventricular tachycardia
What is a manual defibrillator?
For VT no pulse, VF. Recommended energy level dependent on whether defibrillator is monophasic or biphasic. Most = biphasic interpret cardiac rhythm, determine the need for shock and deliver.
What is an automated external defibrillator (AED)?
Defibrillator that has rhythm detection capability and ability to advise the operator to deliver a shock using hands-free defibrillator pads
What is an implantable cardioverter-defibrillator (ICD)?
For patients who have survived sudden cardiac death, have spotaneous sustained VT, syncope with ventricular tachydysrhythmias and high risk for future life threatening dysrhythmias. 25 seconds after sensing system detects lethal dysrhythmias, the defibrillating mech. delivers low dose (255) shock to the patients heart. If 1st is unsuccessful, generator recycles and can deliver additional shock.
What is cardioversion?
Refers to the delivery of an electrical shock to the heart through the chest wall, synchronized with the R wave of the ECG. The machine used is a defibrillator/cardioverter. When intended to use to cardiovert a patient’s cardiac rhythm, the machine is set to cardiovert (synch) mode. The machine will then wait to deliver the electrical shock during the QRS complex of the ECG.
It is the therapy of choice for:
- Hemodynamically unstable ventricular tachydysrhythmias
- Supraventricular tachydysrhythmias (EVT or atrial fibrillation)
- Ventricular tachycardia wiht pulse
- If non-emergency (elective), the patient undergoes moderate (conscious) sedation first
What are examples of cardiac rhythms that might be treated with cardioversion?
- SVT
- atrial fibrillation
- V tach with pulse
What is an implantable cardioverter-defibrillator (ICD)?
The implanted cardioverter-defibrillator (ICD) is utilized in patients who are at risk for sudden cardiac death (SCD) due to recurrent or sustained ventricular tachycardia, ventricular fibrillation, or significant heart damage from acute myocardial infarction (AMI)
The ICD is implanted in the chest wall. Leads are positioned within the heart. These leads are used to monitor the cardiac rhythm. If a lethal dysrhythmia is detected, will deliver an electrical shock in hopes of terminating a lethal dysrhythmia and restoring to the patient’s normal rhythm.
What are the nursing responsibilities for ICD?
- Reason for implantation
- Surgical site care and immobilization
- Traveling considerations
- Steps to follow if ICD device fires
- Educating family members in regard to sudden cardiac death (SCD)
- Explain range of emotions they will experience
- Methods to manage stress/anxiety
How do AEDs work?
- It is a portable defibrillator that automatically detects shockable dysrhythmias - ventricular fibrillation and ventricular tachycardia
- Once the two electrode pads are attached to the cardiac arrest victim, it automatically reads the cardiac rhythm. If shockable rhythm is detected, the AED will charge and signal that defibrillation is indicated
- The machine cues you when to check the pulse and when to perform CPR
- If rhythm is not a shockable rhythm (ex. asystole, NSR) you will be prompted to check pulse and perform CPR
What is a permanent cardiac pacemaker?
An electronic device implanted into the chest wall with electrodes that are placed the heart. It is able to monitor the cardiac rhythm and provide electrical stimulation to the heart if needed, casuing a depolarization of cardiac tissue and cardiac muscle contraction. A pacemaker may be indicated with bradydysrhythmias, some tachydysrhythmias, conduction defects, or in patients with atrial fibrillation and heart failure. Depending on the patient’s medical cardiac condition, a pacemaker may sense and pace either one chamber (commonly ventricle) or both chambers (atrial and ventricle).
Pacemakers may be permanent and implanted in the chest wall (see figure) or they may be temporary. Temporary pacing is achieved through a lead wire transvenously placed into the right ventricle. External pacing is achieved through placing pads onto the chest walls.
What are the nursing responsibilities for permanent cardiac pacemaker?
- Reason for implantation
- Surgical site care immobilzation
- Traveling considerations
- Teaching considerations
- Teaching regarding how to check their pulse rate
- Educating family members in regard to sudden cardiac death (SCD)
- Methods to manage stress/anxiety
