Exam 1: dysrhythmias

Question 1

priority actions for chest pain (MI suspected)

Answer 1

1. pain assessment (OLDCART)
2. VS
3. 12 lead EKG
4. manage pain + keep comforted

Question 2

depolarization =

Answer 2

contraction (cells become more negative)

Question 3

P wave = (2 things)

Answer 3

atrial depolarization (contraction of atria)
+
filling of ventricle

Question 4

atrioventricular (AV) junction area is comprised of what 3 things?

Answer 4

1. AV node
2. transitional cell zone
3. bundle of His

Question 5

role of transitional cell zone

Answer 5

slow down the impulse… to allow atria to contract + ventricles to fill

Question 6

PR segment = (what is happening here)

Answer 6

delay of impulse at the AV junction area/ventricles filling

Question 7

PR segment duration

Answer 7

0.12-0.2 seconds

Question 8

movement of cardiac impulse

Answer 8

SA node –> atrial muscle –> AV junction –> R + L bundle branch –> purkinje fibers (ventricle muscle) –> rapid conduction of impulse through ventricles

Question 9

ventricular depolarization =

Answer 9

contraction of ventricles

Question 10

QRS complex =

Answer 10

ventricular depolarization (ventricles contract) = blood pushing out of heart

Question 11

T wave =

Answer 11

ventricular REpolarization (cells back to resting potential)

Question 12

ST segment = (what’s happening)

Answer 12

early repolarization

Question 13

ST segment changes can indicate what?

Answer 13

ischemia issues

Question 14

term:

the picture each electrode provides of the electrical conduction

Answer 14

lead

(EKG)

Question 15

how often should telemetry electrodes be changed?

Answer 15

daily!

skin prepped + cleaned

Question 16

EKG graph paper times:

-tiny block
-whole block

Answer 16

tiny block: 0.04 seconds

whole block: 0.2 seconds

Question 17

PR segment should be ________ (in regards to EKG strip, shape, line)

Answer 17

isoelectric

Question 18

PR segment (landmarks)

Answer 18

start of P wave to start of QRS complex

Question 19

QRS duration

Answer 19

0.04-0.12 seconds

Question 20

how should ST segment look?

Answer 20

isoelectric - within 1 of the tiny block

(early ventricular repolarization-returning to resting state)

Question 21

how should T wave look?

Answer 21

positive, round, symmetrical

Question 22

QT interval (landmarks)

Answer 22

start of QRS to end of T wave

Question 23

QT interval (what’s happening?) =

Answer 23

ventricular depolarization (QRS) + repolarization (ST)

Question 24

QT interval duration

(2 methods)

Answer 24

0.36-0.44 seconds

but should consider HR, so can measure R to R and should be less than half of that

Question 25

Exam Question

when you see changes in EKG, what do you do first??? before assuming the worst ◡̈

Answer 25

ASSESS YOUR PATIENT!

could be artifact from patient movement, old electrodes, poor contact, etc

Question 26

type of dysrhythmia:

irregular rate with no discernible P wave

Answer 26

atrial fibrilation

Question 27

PVC =

Answer 27

no P wave; wide QRS; impulse started in ventricles

Question 28

PAC =

Answer 28

P wave; narrow and maybe shorter QRS; impulse started in atria (hence the P wave)

Question 29

bradyarrhythmia can cause what changes to VS?

Answer 29

hypotension

Question 30

if someone is in a bradyarrhythmia and their BP is low, what other signs of perfusion should you look for?

Answer 30

changes in LOC
urinary output

Question 31

when you see a brady or tachy dysrhythmia, what should you check???

Answer 31

BP + pulse!

Question 32

supraventricular tachycardia: what’s happening?

Answer 32

rapid impulse firing through atria; cannot see P wave b/c too fast (hidden)

Question 33

if patient goes into SVT, what is priority?

Answer 33

assess patient: BP, pulse, are they perfusing?

Question 34

term:

irritable atria; no discernible P wave; irregular rhythm

Answer 34

atrial fibrillation

Question 35

re: CO, what happens with a fib?

Answer 35

decreased CO (no kick)

Question 36

interventions for a fib

Answer 36

1. O2
2. meds (dilt, amiodarone)
3. manage anxiety

Question 37

term:

rapidly firing impulses from ventricles

Answer 37

ventricular tachycardia

Question 38

intervention for unstable (low BP) ventricular tachycardia

Answer 38

synchronized cardioversion

Question 39

intervention for unstable pulseless ventricular tachycardia

Answer 39

defibrillation

Question 40

intervention for stable ventricular tachycardia

Answer 40

call provider (won’t stay stable for long)

Question 41

intervention for ventricular fibrillation

Answer 41

CPR + call code + defibrillate

“V FIB = D FIB”

Question 42

term:

no impulses being conducted (SA Node may fire, but doesn’t conduct); no electrical activity

Answer 42

ventricular asystole

(terminal rhythm)

Question 43

intervention for ventricular asystole

Answer 43

fix underlying cause (fluids, electrolytes, acid base, glucose)

(cannot shock a rhythm that doesn’t exist)