Exam 1: Chapter 28 - Electrocardiography and Dysrhythmia Monitoring

Question 1

What can cardiac monitoring be used to diagnose?

Answer 1

Dysrhythmias, chamber enlargement, myocardial ischemia/injury/infarction

Question 2

Besides diagnoses, what does cardiac monitoring monitor in the body?

Answer 2

Effects of electrolyte imbalances or medication administration

Question 3

What are preprocedure actions for preparing 12-lead ecg?

Answer 3

• position pt in supine
• wash pts skin to remove oils
• clip any hair (not shave)
• attach to flat surfaces

Question 4

What are intraprocedure actions for preparing 12-lead ecg?

Answer 4

• monitor for manifestations if dysrhythmias (chest pain, decreased level of consciousness, SOB) and hypoxia

Question 5

What do you educate pt during intraprocedure of ekg?

Answer 5

Remain still and breathe normally

Question 6

What are postprocedure actions for preparing 12-lead ecg?

Answer 6

• remove leads from the client
• print ecg report
• notify provider
• apply Holter monitor if client is on tele unit or/and needs continuous cardiac monitoring
• continue monitoring for dysthymias
• conduct rhythm analysis

Question 7

How do you conduct a rhythm analysis?

Answer 7

• determine HR
• determine regular/irregular
• analyze p waves for regularity and shape
• measure pr interval
• measure qrs duration
• examine ST segment
• assess t wave
• measure qt interval

Question 8

How are dysthymias classified?

Answer 8

• site of origin
• effect on rate and rhythm of the heart

Question 9

What are sites in which dysrhythmias take place?

Answer 9

• sinoatrial node (SA)
• atria
• atrioventricular node (AV)
• ventricle

Question 10

What are the different effects on rate or rhythm dysrhythmias have on the heart?

Answer 10

• bradycardia
• tachycardia
• heart block
• premature beat
• flutter
• fibrillation
• asystole

Question 11

What is the study performed to determine the area of the heart causing the dysrhythmia?

Answer 11

Electrophysiological study

Question 12

What are the life-threatening effects of dysrhythmias?

Answer 12

decreased cardiac output and ineffective tissue perfusion

Question 13

What is the primary cause of death in clients suffering acute MI and other sudden death disorders?

Answer 13

Cardiac dysrhythmias

Question 14

What is the delivery of a direct countershock to the heart synchronized to the QRS complex?

Answer 14

Cardioversion

Question 15

What is the delivery of an unsynchronized, direct countershock to the heart?

Answer 15

Defibrillation

Question 16

What treatment stops all electrical activity if the heart, allowing the SA node to take over and reestablish a perfusing rhythm?

Answer 16

Defibrillation

Question 17

What is the electrical treatment of choice for clients who are symptomatic?

Answer 17

Cardioversion

Question 18

What is the elective electrical treatment and medication for atrial dysrhythmias (AFib)

Answer 18

• Cardioversion
• Amiodarone, adenosine, verpamil

Question 19

What is the elective electrical treatment and medication for supraventricular tachycardia?

Answer 19

• Cardioversion
• Amiodarone, adenosine, verapamil

Question 20

What is the elective electrical treatment and medication for ventricular tachycardia WITH a pulse?

Answer 20

• cardioversion
• Amiodarone, adenosine, verapamil

Question 21

What is the elective electrical treatment and medication for ventricular fibrillation (VFib) and ventricular tachycardia WITHOUT a pulse?

Answer 21

• Defibrillation
• Amiodarone, lidocaine, epinephrine

Question 22

What are preprocedure precautions for pts with AFib prior to cardioversion therapy?

Answer 22

Pt must receive adequate anticoagulation (blood thinner) for 4-6 weeks to prevent dislodgement of thrombi into the bloodstream

Question 23

What are preprocedure actions prior to cardioversion?

Answer 23

• obtain consent
• administer O2
• document preprocedure rhythm
• have emergency equipment available
• hold Digoxin for 48 hr prior to procedure

Question 24

What does failure to synchronize with cardioversion lead to in the pt?

Answer 24

development of lethal dysrhythmia, such as VFib

Question 25

What should you monitor pt for during cardioversion?

Answer 25

pulmonary or systemic emboli

Question 26

What should you monitor pt for after cardioversion?

Answer 26

Minor vital signs, assess airway patency, and obtain an ECG

Question 27

What should the pt monitor for and report post cardioversion?

Answer 27

Palpitations or irregularities

Question 28

What should the nurse document post cardioversion and defibrillation?

Answer 28

• postprocedure rhythm
• # of defib or cardioversion attempts, energy settings, time, response
• pts condition and state of consciousness
• skin condition under electrodes

Question 29

What are two complications of cardioversion?

Answer 29

Embolism and decreased cardiac output

Question 30

What are manifestations of pulmonary embolism caused by the complication of embolism due to cardioversion?

Answer 30

• dyspnea
• chest pain
• air hunger
• decreased SaO2

Question 31

What are manifestations of CVA caused by the complication of embolism due to cardioversion?

Answer 31

• decreased level of consciousness
• slurred speech
• muscle weakness/paralysis

Question 32

What are manifestations of MI caused by the complication of embolism due to cardioversion?

Answer 32

• chest pain
• ST segment depression or elevation

Question 33

What are nursing actions for complication of decreased cardiac output and heart failure?

Answer 33

• monitor for manifestations of heart failure (dyspnea, productive cough, edema, venous distention)
• monitor for manifestations if decreased cardiac output (hypotension, syncope, increased HR)
• provide medications to increase output (inotropic agents) and to decrease cardiac workload