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NRSG 110: Med Surg 2 > [Exam 1] Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems (Page 713-720, 734-736) > Flashcards

[Exam 1] Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems (Page 713-720, 734-736) Flashcards

1
Q

Obtaining an Electrocardiogram: Biomonitoring electrodes come in various shapes in size, but have these two components

A

An adhesive substance that attaches to the skin to secure the electrode in place

  1. A substance that reducs the skin’s electrical impendance and enhancing conductivity
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2
Q

Obtaining an Electrocardiogram: How to improve conduction?

A

Gently abrading skin with a clean dry gauze

Don’t clean with alcohol

May need to clip hair

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3
Q

Obtaining an Electrocardiogram: Most continuous monitors use how many electrodes?

A

2-5, and they create a lead which serves as a reference point from which electrical activity is viewed

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4
Q

Obtaining an Electrocardiogram: To prevent interference from electrical activity of skeletal muscles, limb electrodes are placed on what type of areas?

A

Areas that are not bony and that do not have significant movement

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5
Q

Obtaining an Electrocardiogram: The limb electrodes provide the first

A

six leads.

Leads I, II, III, aVR, aVL, and aVF.

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6
Q

Obtaining an Electrocardiogram: Where is V1 placed?

A

Locate the fourth intercostal space is where this goes.

The sternal angle and then the sternal notch can help you locate it.

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7
Q

V1 Location spot

A

Fourth intercostal space, right sternal border

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8
Q

V2 location spot

A

Fourth intercostal space, left sternal border

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9
Q

V3 location spot

A

Diagnoally betwen V2 and V4

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10
Q

V4 Location spot

A

fifth intercostal space, left midclavicular line

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11
Q

V5 Location Spot

A

Same level as V4, anterior axillary line

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12
Q

V6 location spot

A

Same level as V4 and V5, mixaxillary line

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13
Q

A standard 12-lead ECG reflects the electrical activity primarily in the

A

left ventricle

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14
Q

An ECG waveform reflects the function of the

A

heart’s conduction system in relation to the specific lead. ECG ofers important information about the electrical activity of the heart and is useful in diagnosing dysrhythmias.

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15
Q

When an ECG waveform moves toward the top of the paper , it is called a

A

positive deflection

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16
Q

When it an ECG waveform moves towawrd the bottom of the paper, it is called a

A

negative deflection

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17
Q

What is measured on the horizontal axis of the graph?

A

Time and rate

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18
Q

What is measured on the vertical axis?

A

Amplitude or voltage

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19
Q

What does the P Wave represent?

A

The electrical impulse starting in the SA node and spreading through the atria.

This represent atrial depolarization

The atrial is contracting

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20
Q

Size and length of the P Wave?

A
  1. 5 mm or less

0. 11 seconds or less in duration

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21
Q

What does the QRS represent?

A

Ventricular depolarization

The ventricles are contracting and then relaxing

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22
Q

What is the first negative deflection after the P wave?

A

Q Wave

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23
Q

Size and length of Q Wave?

A

Less than 25% of R-Wave Amplitude

Less than 0.04 second

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24
Q

What is the first positive deflection after the P Wave?

A

R Wave

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25
Q

What is the first negative deflection after the R wave.

A

S Wave

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26
Q

When the wave is less than 5 mm in height, what is used?

A

Small letters for qrs

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27
Q

When the wave is 5 mm or higher, what is used?

A

QRS in capitals

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28
Q

QRS wave length?

A

0.12 seconds

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29
Q

What does the T wave represent?

A

Ventricular repolarization (when the cells regain a negative charge, also called the resting state).

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30
Q

The T wave follows what in the same direction?

A

QRS

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31
Q

Atrial repolarization is not visible on the ECG because it occurs at the same time as

A

ventricular depolarization (QRS)

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32
Q

What is the PR Interval

A

Measured from the beginning of the P wave to the beginning of the WRS complex

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33
Q

What does PR Interval represent?

A

The time needed for sinus node stimulation, atrial depolarization and conduction through the AV node before ventricular depolarization

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34
Q

PR interval normally ranges from what time?

A

0.12to 0.2 seconds

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35
Q

What does the ST segment represent?

A

Early ventricular repolarization.

Lasts from end of QRS to beginning of the T wave.

If ST segment above the line, it indicates MI

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36
Q

Beginning of the ST segment is usually identified by a

A

change in the thickness or angle of the terminal portion of the QRS complex

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37
Q

The end of the ST segment may be more difficult to identify because it merges into the

A

T Wave

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38
Q

Why is the ST Segment analyzed?

A

To idetnify whether it is above or below the isoelectric line, which may be among other signs and symptoms a sign of cardiac ischemia

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39
Q

What is the QT interval?

A

Represents the total time for ventricular depolarization and repolarization. FRom beginning from QRS complex to end of T wave.

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40
Q

The WT interval varies with heart rate, gender, and age there the measured intervals need to be

A

corrected (QTc) for these variables through specific calculations.

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41
Q

Length of QT interval?

A

0.32 to 0.40 seconds if the heart is at 65-95 bpm.

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42
Q

What is the TP intervl?

A

Measured form end of T wave to beginning of P, anisoelectric period. No electrical activity is detected.

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43
Q

What is the PP intervl?

A

Measured from the beginning of one P wave ot the beginning of the next P wave.

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44
Q

Why is PP Interval used?

A

To determine atrial rate and rhythm

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45
Q

How is PP Interval measured?

A

Measured form one QRS complex to the next QRS complex

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46
Q

What is the RR interval used for?

A

Determine ventricular rate and rhythm

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47
Q

Normal conduction goes from the

A

SA NODe -> AV Node -> Bundle of his via the right and left bundle branches to the purjinje fibers

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48
Q

The HR is determined by

A

myocardical cells with the fastest firing rate, which are usually located in the SA node

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49
Q

Depolarization = stimulation =

A

systole.

This is when the heart is contracting

50
Q

repolarization = relaxed =

A

diastole

When the chambers relax and allow blood to fill them.

51
Q

First step in understanding an EKG strip is to get a

A

six second strip. You have to count 30 big boxes.

Each small box represent 0.04 seconds.

Each big box represents 0.2 seconds.

52
Q

Second step in understanding an EKG strip is

A

Locating the Q wave in each box.

53
Q

Third step in understanding an EKG strip is

A

Locating the QRS interval

You do not want this to be bigger than 0.12 seconds (three small boxes)

54
Q

There are ticker marks located every how many boxes?

A

Every 10 big boxes.

55
Q

Every small box represents

A

0.04 seconds.

56
Q

Every big box represents

A

0.2 seconds

57
Q

Fourth step in understanding an EKG strip is

A

Measure the PR interval measurement by

Locating the P wave and beginning of the Q wave. Time can be from 0.12-0.2 seconds.

58
Q

If something stops in the middle of the small box, the time is

A

0.02 seconds

59
Q

Fifth step in understanding an EKG strip is

A

Determine if HR is regular or irregular

You measure the distance between two R’s. If they are equal distance aparts, they are regular.

60
Q

Sixth step in understanding an EKG strip is

A

Determining the HR. Within the six second strip, count the R waves and multiply by 10.

61
Q

What is ST Elevation?

A

There is cardiac tissue that has died.

62
Q

What is ST Depression?

A

Shows Cardiac Ischemia. Heart is lacking oxygen but hasnt died yet

63
Q

How to remember ST Depression?

A

Imagine you are drowning and lacking surface. Once you have died, you’ll float to the surface with tissue death

64
Q

The RR interval is used to determine

A

ventricular rhythm

65
Q

The PP interval is used to determine

A

atrial rhythm

66
Q

If the intervals are the same or if difference between intervals is less than 0.8 seconds throuhgout strip, rhythm is called

A

regular

67
Q

What are Dysrhythmias?

A

DIsorders of formation or conduction (or both) of electrical impulses within heart

68
Q

Dysrhythmias can cause disturbances of

A

Rate
Rhythm
Both Rate nd Rhythm

69
Q

Dysrhythmias can potentially alter

A

blood flow and cause hemodynamic changes

70
Q

Dysrhythmias diagnosed by

A

analysis of electrographic waveform

71
Q

Sinus Node Dysrhythmias originiate in the

A

SA Node

72
Q

Sinus Bradycardia occurs when

A

SA node creates an impulse at a slower-than-normal rate.

73
Q

Causes of Sinus Bradycardia include

A

lower metabolic needs, vagal simulation, medications, idiopathic sinus node dysfunction, increased intracarnial pressure, and coronary artery disease

74
Q

Unstable and Symptomatic bradycardia is frequently due to

A

hypoxemia, AMS, and acute decompensated heart failure

75
Q

Sinus Bradycardia: Ventricular and Atrial Rate

A

Less than 60 bpm in adults

76
Q

Sinus Bradycardia: Ventricular and Atrial Rhythm

A

Regular

77
Q

Sinus Bradycardia: QRS shape and duration

A

Usually normal, but may be regularly abnormal

78
Q

Sinus Bradycardia: P Wave

A

Normal and consistent shape

79
Q

Sinus Bradycardia: PR Interval

A

Consistent between 0.12 and 0.20 seconds

80
Q

Sinus Bradycardia: All haracteristics are the same as those of normal sinus rhythm, except for the

A

rate

81
Q

Sinus Bradycardia: If decrease in heart rate results from stimulation of the vagus nerve, attempts are made to prevent

A

further vagal stimulation

82
Q

Sinus Bradycardia: SLow heart rate may be due to

A

sinus node dysfunction, which has a number of risk factors including increased age, white race, obesity, hypertension

83
Q

Sinus Bradycardia: Medical Management for this?

A

0.5 mg of Atropine via IV bolus and repeated every 3-5 minutes until a maximum dosage of 3 mg is given

84
Q

Sinus Tachycardia: When does this occur?

A

When the sinus node creates an impulse at a faster than normal rate

85
Q

Sinus Tachycardia: What Physiologic or Psychological Stress may occur?

A

Acute blood loss, anemia, shock, hypervolemia, hypovolemia, heart failure)

86
Q

Sinus Tachycardia: Medications that can cause this?

A

Meds that stimulate sympathetic response, stimulants, and illicit drugs

87
Q

Sinus Tachycardia: Ventricular and Atrial Rate

A

Greater than 100 bpm in the adult, but less than 120 bpm

88
Q

Sinus Tachycardia: All aspects are same as those of normal sinus rhythm except for

A

the rate

89
Q

Sinus Tachycardia: Other things that can cause this is

A

Exercise, Stress, Pain, Infection, FEar, Bleeding

90
Q

Sinus Tachycardia: If this is a true conduction disorder, we would have them

A

Bear down , to cause vagal stimulation.

91
Q

Sinus Tachycardia: Synchronized Cardio Version

A

Low shock is given to reset the SA node to reset into a normal heart

92
Q

Sinus Tachycardia: Medical Management

A

6 mg Adenosine and then followed by 12 mg dose.

If it doesn’t work, you can do synchronized cardio version.

93
Q

QRS Complex and Hypokalemia

A

QRS will be widened if you have low potassium.

94
Q

Caring for Patient with a Dysrhythmia - Assessment: Causes of dysrhythmia and contributing factors

A

Health history and medications

95
Q

Caring for Patient with a Dysrhythmia - Assessment: Physical assessment include

A

Skin (pale and cool)

Signs of fluid retention (JVD, lung auscultation)

Signs of decreased CO

Rate, rhythm of apical, peripheral pulses (want to make sure theyre the same)

Heart sounds blood pressure ,pulse pressure

96
Q

Caring for Patient with a Dysrhythmia - Diagnoses: These include

A

Decrease CO

Activity Intolerance

Decreased tissue perfusion

Anxiety

DEficient Knowledge

97
Q

Caring for Patient with a Dysrhythmia - Complications and PRoblems

A

Cardiac Arrest

Heart Failure

Thromboemboli Event (especially with atrial Fibrillation)

98
Q

Caring for Patient with a Dysrhythmia - Goals: This includes

A

Eradicating or decreasing occurence of dysrhythmias to maintain cardiac output

Minimizing Anxiety

Acquiring knowledge about dysrhythmia and its treatment

99
Q

What does Cardiac Stress Testing Determine?

A

CAD

Cause of Chest Pain

Function of heart after MI or surgery

Effectiveness of antiaginal and antiarrythmic meds

Occurrence of dysrhythmias

100
Q

Contraindications of Cardiac Stress Testing

A

Severe Aortic Stenosis or Hypertension,

Acute myocarditis

Suspected left main CAD

HF

Unstable Angina

101
Q

Cardiac Stress Testing Patient Preparation

A

Fasts for four hours and avoid stimulants prior to test

102
Q

Cardiac Stress Testing can be done how many ways?

A

Through medicine or exercise

103
Q

Cardiac Stress Testing, ECG applied and pt is monitored for

A

HR

Rhythm

Perceived Exertion

VS

Skin Temp

104
Q

Cardiac Stress Testing stopped when

A

target HR reached or if pt shows signs of ischemia

105
Q

Pharmacologic Stress Testing uses what two medications

A

Adenosine and Dipyridamole

106
Q

Pharmacologic Stress tTesting; what medicine cannot be used

A

No Theophylline , Aminophylline or Dipyridamole 24/48 hours before test

107
Q

Pharmacologic Stress Testing : May feel sick due to

A

the adenosine the pt may feel flushing and nausea

108
Q

Pharmacologic Stress Testing: Monitored for 1-3 hours because

A

it takes time ot wear off

109
Q

Echocardiography: TRansthoracic goes through

A

ultrasound via chest well

110
Q

Echocardiography: TEE works how?

A

Ultrasound via esophagus

111
Q

Echocardiography: Prior to TEE, pt

A

is NPO for 6 hours, dentures removed

112
Q

Echocardiography: During TEE

A

Moderate sedation and topical anesthetic, monitor VS, LOC, ECG, O2 Sat

113
Q

Echocardiography: TEE recovery

A

Keep HOB 45 degrees, bedrest 2 hours, gag reflex assessed after2 hours and monitor vs.

Sore throat for 24 hours

114
Q

How does Radionluclide Imaging Work

A

Myocardiac perfusion imaging

Can be done with stress test to check perfusion

Pt is injected with radionuclear dye

115
Q

Cardiac Catherization: What is this?

A

Invasive procedure study used to measure cardiac chamber pressures, assess patency or coronary arteries

116
Q

Cardiac Catherization: What does this require?

A

Recquires ECG, hemodynamic monitoring; emergency equipment must be available

117
Q

Cardiac Catherization: Assessment prior to test

A

Test for allergies, blood work, pt to fast 8-12 hours prior, need someone to drive pt home

118
Q

Cardiac Catherization: Duration

A

Take up to 2 hours and pt will be lying on hard table

119
Q

Cardiac Catherization: Prior to procedure

A

Consent signed, Fast 8-12 hours, allergies to dye

120
Q

Cardiac Catherization: During Procedure

A

Will experience pounding sensation in chest due to extrea beat when catheter touches endocardium

Injected with contrast agent (will give a flushed sensation)

May have to cough and deep breathe during procedure

121
Q

Cardiac Catherization: Post Procedure

A

Assess pulses every 15 minutes, then every hr

Assess for bleeding

Assess for dysrhythmias by monitor

Assess temp, color, cap refill

Bedrest 2-6 hrs with effected leg straight

Increase fluid to flush dye to protect kidneys

Assess for orthostatic hypotension

NRSG 110: Med Surg 2 (29 decks)

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