Exam 1: Chapter 28 - Electrocardiography and Dysrhythmia Monitoring Flashcards
What can cardiac monitoring be used to diagnose?
Dysrhythmias, chamber enlargement, myocardial ischemia/injury/infarction
Besides diagnoses, what does cardiac monitoring monitor in the body?
Effects of electrolyte imbalances or medication administration
What are preprocedure actions for preparing 12-lead ecg?
- position pt in supine
- wash pts skin to remove oils
- clip any hair (not shave)
- attach to flat surfaces
What are intraprocedure actions for preparing 12-lead ecg?
- monitor for manifestations if dysrhythmias (chest pain, decreased level of consciousness, SOB) and hypoxia
What do you educate pt during intraprocedure of ekg?
Remain still and breathe normally
What are postprocedure actions for preparing 12-lead ecg?
- 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
How do you conduct a rhythm analysis?
- 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
How are dysthymias classified?
- site of origin
- effect on rate and rhythm of the heart
What are sites in which dysrhythmias take place?
- sinoatrial node (SA)
- atria
- atrioventricular node (AV)
- ventricle
What are the different effects on rate or rhythm dysrhythmias have on the heart?
- bradycardia
- tachycardia
- heart block
- premature beat
- flutter
- fibrillation
- asystole
What is the study performed to determine the area of the heart causing the dysrhythmia?
Electrophysiological study
What are the life-threatening effects of dysrhythmias?
decreased cardiac output and ineffective tissue perfusion
What is the primary cause of death in clients suffering acute MI and other sudden death disorders?
Cardiac dysrhythmias
What is the delivery of a direct countershock to the heart synchronized to the QRS complex?
Cardioversion
What is the delivery of an unsynchronized, direct countershock to the heart?
Defibrillation
What treatment stops all electrical activity if the heart, allowing the SA node to take over and reestablish a perfusing rhythm?
Defibrillation
What is the electrical treatment of choice for clients who are symptomatic?
Cardioversion
What is the elective electrical treatment and medication for atrial dysrhythmias (AFib)
- Cardioversion
- Amiodarone, adenosine, verpamil
What is the elective electrical treatment and medication for supraventricular tachycardia?
- Cardioversion
- Amiodarone, adenosine, verapamil
What is the elective electrical treatment and medication for ventricular tachycardia WITH a pulse?
- cardioversion
- Amiodarone, adenosine, verapamil
What is the elective electrical treatment and medication for ventricular fibrillation (VFib) and ventricular tachycardia WITHOUT a pulse?
- Defibrillation
- Amiodarone, lidocaine, epinephrine
What are preprocedure precautions for pts with AFib prior to cardioversion therapy?
Pt must receive adequate anticoagulation (blood thinner) for 4-6 weeks to prevent dislodgement of thrombi into the bloodstream
What are preprocedure actions prior to cardioversion?
- obtain consent
- administer O2
- document preprocedure rhythm
- have emergency equipment available
- hold Digoxin for 48 hr prior to procedure
What does failure to synchronize with cardioversion lead to in the pt?
development of lethal dysrhythmia, such as VFib
What should you monitor pt for during cardioversion?
pulmonary or systemic emboli
What should you monitor pt for after cardioversion?
Minor vital signs, assess airway patency, and obtain an ECG
What should the pt monitor for and report post cardioversion?
Palpitations or irregularities
What should the nurse document post cardioversion and defibrillation?
- postprocedure rhythm
- # of defib or cardioversion attempts, energy settings, time, response
- pts condition and state of consciousness
- skin condition under electrodes
What are two complications of cardioversion?
Embolism and decreased cardiac output
What are manifestations of pulmonary embolism caused by the complication of embolism due to cardioversion?
- dyspnea
- chest pain
- air hunger
- decreased SaO2
What are manifestations of CVA caused by the complication of embolism due to cardioversion?
- decreased level of consciousness
- slurred speech
- muscle weakness/paralysis
What are manifestations of MI caused by the complication of embolism due to cardioversion?
- chest pain
- ST segment depression or elevation
What are nursing actions for complication of decreased cardiac output and heart failure?
- 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
