Exam 1: dysrhythmias Flashcards
priority actions for chest pain (MI suspected)
- pain assessment (OLDCART)
- VS
- 12 lead EKG
- manage pain + keep comforted
depolarization =
contraction (cells become more negative)
P wave = (2 things)
atrial depolarization (contraction of atria)
+
filling of ventricle
atrioventricular (AV) junction area is comprised of what 3 things?
- AV node
- transitional cell zone
- bundle of His
role of transitional cell zone
slow down the impulse… to allow atria to contract + ventricles to fill
PR segment = (what is happening here)
delay of impulse at the AV junction area/ventricles filling
PR segment duration
0.12-0.2 seconds
movement of cardiac impulse
SA node –> atrial muscle –> AV junction –> R + L bundle branch –> purkinje fibers (ventricle muscle) –> rapid conduction of impulse through ventricles
ventricular depolarization =
contraction of ventricles
QRS complex =
ventricular depolarization (ventricles contract) = blood pushing out of heart
T wave =
ventricular REpolarization (cells back to resting potential)
ST segment = (what’s happening)
early repolarization
ST segment changes can indicate what?
ischemia issues
term:
the picture each electrode provides of the electrical conduction
lead
(EKG)
how often should telemetry electrodes be changed?
daily!
skin prepped + cleaned
EKG graph paper times:
-tiny block
-whole block
tiny block: 0.04 seconds
whole block: 0.2 seconds
PR segment should be ________ (in regards to EKG strip, shape, line)
isoelectric
PR segment (landmarks)
start of P wave to start of QRS complex
QRS duration
0.04-0.12 seconds
how should ST segment look?
isoelectric - within 1 of the tiny block
(early ventricular repolarization-returning to resting state)
how should T wave look?
positive, round, symmetrical
QT interval (landmarks)
start of QRS to end of T wave
QT interval (what’s happening?) =
ventricular depolarization (QRS) + repolarization (ST)
QT interval duration
(2 methods)
0.36-0.44 seconds
but should consider HR, so can measure R to R and should be less than half of that
Exam Question
when you see changes in EKG, what do you do first??? before assuming the worst ◡̈
ASSESS YOUR PATIENT!
could be artifact from patient movement, old electrodes, poor contact, etc
type of dysrhythmia:
irregular rate with no discernible P wave
atrial fibrilation
PVC =
no P wave; wide QRS; impulse started in ventricles
PAC =
P wave; narrow and maybe shorter QRS; impulse started in atria (hence the P wave)
bradyarrhythmia can cause what changes to VS?
hypotension
if someone is in a bradyarrhythmia and their BP is low, what other signs of perfusion should you look for?
changes in LOC
urinary output
when you see a brady or tachy dysrhythmia, what should you check???
BP + pulse!
supraventricular tachycardia: what’s happening?
rapid impulse firing through atria; cannot see P wave b/c too fast (hidden)
if patient goes into SVT, what is priority?
assess patient: BP, pulse, are they perfusing?
term:
irritable atria; no discernible P wave; irregular rhythm
atrial fibrillation
re: CO, what happens with a fib?
decreased CO (no kick)
interventions for a fib
- O2
- meds (dilt, amiodarone)
- manage anxiety
term:
rapidly firing impulses from ventricles
ventricular tachycardia
intervention for unstable (low BP) ventricular tachycardia
synchronized cardioversion
intervention for unstable pulseless ventricular tachycardia
defibrillation
intervention for stable ventricular tachycardia
call provider (won’t stay stable for long)
intervention for ventricular fibrillation
CPR + call code + defibrillate
“V FIB = D FIB”
term:
no impulses being conducted (SA Node may fire, but doesn’t conduct); no electrical activity
ventricular asystole
(terminal rhythm)
intervention for ventricular asystole
fix underlying cause (fluids, electrolytes, acid base, glucose)
(cannot shock a rhythm that doesn’t exist)
