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NRSG 200: Med Surg 3 > [Exam 2/Final] Chapter 26 - Management of Patients with Dysrhythmias and Conduction Problems > Flashcards

[Exam 2/Final] Chapter 26 - Management of Patients with Dysrhythmias and Conduction Problems Flashcards

1
Q

Conduction of Electricity: What is the SA NOde?

A

Primary pacemaker of heart.

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2
Q

Conduction of Electricity: Rate of SA Node?

A

60 - 100 when firing properly

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3
Q

Conduction of Electricity: What comes aftter SA node?

A

AV Node, sits next to tricuspid valve.

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4
Q

Conduction of Electricity: What is the AV Node?

A

Secondary pacemaker of the heart.

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5
Q

Conduction of Electricity: Rate of AV Node?

A

40-60 bpm.

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6
Q

Conduction of Electricity: What happens if SA Node goes wrong?

A

You have a backup, the AV Node. Will be in 40-60 range.

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7
Q

Conduction of Electricity: What comes after AV Node?

A

Bundle of His, which leads to purkinje fibers.

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8
Q

Conduction of Electricity: What could be going on with Purkinje fiber?

A

Heart lost natural rhythm. Will see rates in 30s-40s. Can also lead to Heart Blcok

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9
Q

Conduction of Electricity: What is Heart Block?

A

Something failed with nautral pacemakers with SA and AV Node. Relying of Purkinje Fibers to pump ventricles. Dangerous.

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10
Q

Conduction of Electricity: What’s an arrhythmia?

A

When you start to have stagnant blood flow, and heart is not following the normal blood flow and conduction.

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11
Q

Conduction of Electricity: What problem does stagnant blood lead to?

A

Clots

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12
Q

Conduction of Electricity: If heart not beating properly, what problems are caused?

A

Increased workload which leads to hypertrophy. Also leads to decrease in CO

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13
Q

Youtube ECG: What is the P Wave?

A

Atrial squeeze (contraction). Depolarizing and decompressing, sending out a charge.

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14
Q

Youtube ECG: What is the QRS Wave?

A

Ventricles are squeezing, contracting and depolarizing and decompressing sending out charnge.

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15
Q

Youtube ECG: What is the T Wave?

A

Ventricles relax and repolarize. RE-filling with blood

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16
Q

Dysrhythmias: What are these?

A

Disorders of the formation or conduction (or both) of the electrical impulses in the heart

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17
Q

Dysrhythmias: These disorders can cause disturbance of what

A

Rate , Rhythm, and Both

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18
Q

Dysrhythmias: This can potentially alter what?

A

BLood flow and cause hemodynamic changes

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19
Q

Dysrhythmias: What is the P Wave?

A

Atrial DEpolarizastion

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20
Q

Dysrhythmias: What is the PR Segment?

A

Delay at AV node.

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21
Q

Dysrhythmias: What is the QRS complex?

A

Ventricular Depolarization

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22
Q

Dysrhythmias: What is the T wave?

A

Ventricular Repolarization

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23
Q

Dysrhythmias: What are isoelectric lines?

A

There is no electric activity

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24
Q

Dysrhythmias: When does Repolarization occur for Atria?

A

It is the little dip between the P and Q waves

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25
Q

ECG Graph: Each small box is worth how long

A

0.04 seconds

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26
Q

ECG Graph: Every bigger box is how long?

A

0.2 seconds (5 boxes)

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27
Q

ECG Graph: PR interval should be how long

A

< 0.20 seconds

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28
Q

ECG Graph: What can a long PR interval lead to

A

Heart blocks

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29
Q

ECG Graph: QRS should be how long?

A

Less than <0.12 seconds.

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30
Q

ECG Graph: QT segment should be how long?

A

Less than 0.4 seconds

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31
Q

ECG Graph: What is the PR Segment?

A

Conduction of the SA node down to the AV node. Want it 0.12 - 0.20.

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32
Q

Cardio Electrophysiology: What happens at P Wave?

A

Produced as impulse from SA Node and causes atrial contraction. Think Atria are contracting

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33
Q

Cardio Electrophysiology: What happens during QRS Complex?

A

Conduction of impulse through bundle of HIS to Purkinje fibers causing contraction of ventricles. Thats when ventricles contact

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34
Q

Cardio Electrophysiology: What is the T Wave?

A

Ventricaular repolarization. Ventricles are resetting and relaxing in diastole.

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35
Q

Cardio Electrophysiology: What is the ST segmenet?

A

The hearts resting period

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36
Q

Cardio Electrophysiology: What is the P-R interval?

A

Time between atrial depolarization adn the start of ventricular conduction (depolarization)

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37
Q

Cardio Electrophysiology: How do you calculate heart rate?

A

Count number of R waves in 6 seconds, and multiple that by 10

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38
Q

Normal Sinus Rhythm: What is the first thing we should do when analyzing strip?

A

Look and see if there is a P wave

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39
Q

Normal Sinus Rhythm: What is the second thing you should look for when analyzing strip?

A

Do you have one P wave for every QRS?

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40
Q

Normal Sinus Rhythm: How much chart look for this to be normal sinus rhythm?

A

One P wave for every QRS and HR within 60-100.

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41
Q

Normal Sinus Rhythm: Once we determine whether theres a P and Q wave, what should we do next?

A

Count our QRS in a 6 second strip to determine HR.

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42
Q

Sinus Bradycardia: Why is this Brady?

A

The impulses from the SA node are a little slower rate than normal.

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43
Q

Sinus Bradycardia: This can be caused by what?

A

Runners have lower HR. Vagal nerve stimulation when sleeping

Beta Blockers

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44
Q

Sinus Bradycardia: Why is this Sinus?

A

Because you have one P wave for every QRS

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45
Q

Sinus Bradycardia: What makes this unique?

A

You are sinus, but have a HR below 60.

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46
Q

Sinus Bradycardia: What problems may this person experience?

A

Dizziness, having a decrease a blood pressure

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47
Q

Sinus Bradycardia: What interventions may be done?

A

Atropine IV Push to stimulate HR to increase it.

Pacemaker to increase HR.

Maybe hold back on Beta-Blocker to let HR return.

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48
Q

Sinus Tachycardia: What is this?

A

When SA Node causes the HR to be above 100 or more than 120

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49
Q

Sinus Tachycardia: How will this look on EKG strip?

A

Will be normal rhythm with P in front of every QRS, but will have HR above 100

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50
Q

Sinus Tachycardia: What can cause this?

A

Exercise, Anxiety

Hyper/Hypovolemic.

Caffeine, Nicotine, Stimulants

Shock Patients, Fever

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51
Q

Sinus Tachycardia: How is this treated?

A

Find underlying cause and eliminate it.

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52
Q

Sinus Tachycardia: What medications can be given?

A

Beta blockers, CCB.

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53
Q

Sinus Tachycardia: How to treat if they are dehydrated or have a fever?

A

Give them fluids, or also give them tylenol to treat their fever

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54
Q

Sinus Arrhythmia: Is there a P wave before every QRS?

A

Yes

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55
Q

Sinus Arrhythmia: How does this appear on a strip?

A

The R waves are extremely elevated, and they are not equal distances from each other

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56
Q

Sinus Arrhythmia: Where is the impulse coming from?

A

SA Node, but impulse created is adding an abnormal rhythm.

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57
Q

Sinus Arrhythmia: How does thsi change with breathing?

A

Goes up with inspiration, and then decreases with expiration

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58
Q

Sinus Arrhythmia: What can this sometimes lead to?

A

Further Dysrhythmias

59
Q

Sinus Arrhythmia: What is the treatment for this?

A

Maybe sometimes get a pacemaker, but we often dont do anything with it

60
Q

Premature Atrial Complexes: What is this?

A

The atrium beats prematurely.

61
Q

Premature Atrial Complexes: What is normal here?

A

YOu have normal P, QRS, PR Interval, ST segment.

62
Q

Premature Atrial Complexes: What makes this look different on a strip?

A

Sometimes the atria fires early, and P wave fires early, and kind of merges into T wave.

63
Q

Premature Atrial Complexes: What is shortened because of this?

A

RR Interval

64
Q

Premature Atrial Complexes: What can cause this?

A

Caffeine, Alcohol, Nicotine, or if the atrium is just too strethed out

65
Q

Premature Atrial Complexes: What hppens if you frequently have this?

A

May start to lead to atrial dysrhythmias

66
Q

Atrial Flutter: Where is the problem?

A

Conduction defect in atrium, impulses coming from spot other than SA Node in atrium

67
Q

Atrial Flutter: How does this look on strip?

A

You have a lot of P waves before a QRS wave. They flutter. Can’t tell where T wave is.

68
Q

Atrial Flutter: What CMs may they have

A

Chest pain, SOB, Decreased BP

69
Q

Atrial Flutter: What does EKG look like?

A

A saw blade.

70
Q

Atrial Flutter: How quickly will it fire?

A

250-400, but not all of these will make it to ventricl

71
Q

Atrial Flutter: What patient will have this?

A

Valve disease , Pulmonary Hypertension, COPD post open heart

72
Q

Atrial Flutter: How is this treated?

A
  1. Vagal Maneuvers
  2. Adenosine, is a chemical cardioversion. Helps heart reset
  3. Electrical Cardioversion
  4. Catheter Ablation
73
Q

Atrial Flutter: What is a Catheter Ablation

A

Go into the spot in the heart where impulse is firing and try to scar it to get rid of impulse.

74
Q

Atrial Flutter: What medication will they need to be put on?

A

Anticoagulant, because they are more likely to develop blood clots.

75
Q

Atrial Fibrillation: What is this?

A

Uncontrolled atrium beating. Disorganized. Can be rapid and uncoordinated.

76
Q

Atrial Fibrillation: How does the chart look?

A

Doesn’t looko like saw blade. All the P and T waves are all over the place before a QRS happens.

77
Q

Atrial Fibrillation: How fast can rate go for atrium / ventricle?

A

Atrium: 300-600
Ventricle: Whatever QRS is.

78
Q

Atrial Fibrillation: What can cause this

A

Valve disease, CAD, enlarged heart, hypertension, HF.

79
Q

Atrial Fibrillation: What to know about HF?

A

AFib can cause HF, but HF can also cause AFib. Whatever comes first.

80
Q

Atrial Fibrillation: What is lsot here?

A

Atrial kick, doesnt squeeze as well and doesnt empty fully. Becaus eof this, increased RF stroke and clots.

81
Q

Atrial Fibrillation: Clinical signs?

A

SOB, Drop in BP, Fatigued,

82
Q

Atrial Fibrillation: How is this treated?

A

Electrial Cardioversion , but TEE first to make sure they don’t have clot.

83
Q

Atrial Fibrillation: What meds can be given?

A

Amiodarone (Antirhythmic to be Sinus) or Cardizine (Lowers HR

Ticosin / Digoxin for Contractility and lower HR

84
Q

Atrial Fibrillation: What may be given for HR control?

A

Beta Blockers

85
Q

Atrial Fibrillation: What therapy will be started?

A

Anticoagulation (Eliquis. Heparin, Lovanox), because of increased risk for strokes and clots.

86
Q

Premature Ventricular Contraction: What is this?

A

Early firing of the ventricles.

87
Q

Premature Ventricular Contraction: How does this look on EKG?

A

Random firings of QRS. After random fire, may see T wave go negative. This QRS just looks like it doesn’t belong.

88
Q

Premature Ventricular Contraction: What may cause this?

A

When your heart races or drink too much caffeine.

89
Q

Ventricular Tachycardia: What is this?

A

Three or more PVCs in a row.

90
Q

Ventricular Tachycardia: Which patient is more at risk for htis?

A

If they’ve had an MI, or have a lower ejection fraction.

91
Q

Ventricular Tachycardia: Can these patients have a pulse?

A

Yes

92
Q

Ventricular Tachycardia: How does this look on the chart?

A

Just very sharp up and down waves. Can’t distinguish anything. A tall loopy wave.

93
Q

Ventricular Tachycardia: Wht must we do when we see this on screen for patient?

A

Determine if they are alert and talking or if we need to code them

94
Q

Ventricular Tachycardia: How is this treated if they have pulse?

A

Amiodarione and Lidocaine.

Cardioversion

Pre-Cordial Thump

Vagal Maneuvers

95
Q

Ventricular Tachycardia: How is a cardioversion performed?

A

Electricty shocks the heart, and it has to be synced up with the QRS. Want to shock at right point.

96
Q

Ventricular Tachycardia: What is a Pre-Cordial Thump?

A

A thump on the heart

97
Q

Ventricular Tachycardia: What is done if they don’t have pulse

A

Start chest compression and hook up to DFib pads.

Epinephrine is important to give.

98
Q

Ventricular Fibrillation: How will this be treated?

A

Start chest compression and hok up DFib pads.

Give Epinephrine and Vasopressin.

99
Q

Ventricular Fibrillation: Why may patients sometimes go into this?

A

Because they have low mag level.

100
Q

Ventricular Fibrillation: How does this look on strip?

A

Tall loopy waves for a little bit then potential P waves and then more loopy waves.

101
Q

Asystole: What is this?

A

Patient’s flatline

102
Q

Asystole: Treatment?

A

CPR, Epinephrine, Vasopressin

103
Q

Asystole: How does this look

A

Flat line

104
Q

Asystole: Do we shock these patients?

A

No, because there is nothing to shock.

105
Q

Care of Patient with Dysrhythmia - Assess: What is done first?

A

What the rhythm is and what is causing it

106
Q

Care of Patient with Dysrhythmia - Assess: Nursing Diagnosis?

A

Decreased CO
RF Clots (AFib)
Decrease Anxiety
Education

107
Q

Care of Patient with Dysrhythmia - Interventions:

A

Administer Medications, or Vagal Maneuvers, Assess Labs (Potassium causes VT).

108
Q

Potential Problems: What are some problems

A 
Cardiac Arrest (VFib, VT)
HF (Can't Contract , VFib)
Thromboembolic Event (AFib)
109
Q

Cardioversion: WHy is this used

A

To shock heart into normal rhythm and hit that AV Node

110
Q

Cardioversion/Defibrillation: How does this treat tachydysrhythmias?

A

Delivers an electrical current that depolarizes a critical mass of myocardial ceclls. Whenrepolarized, SA Node can reapture pacemaker role

111
Q

Cardioversion/Defibrillation: Patient status in cardioversion?

A

Awake and have pulse. Syncs shock with rhythm. Synced at top of R waves.

112
Q

Cardioversion/Defibrillation: When would cardioversion be formed?

A

AFub, AFlutter and VT with a Pulse

113
Q

Cardioversion/Defibrillation: When is Defibrillation performed?

A

When patient doesn’t have a pulse. VFib/VT

114
Q

Cardioversion/Defibrillation: Cardioversion is synched to what?

A

R Wave

115
Q

Pad Placement for Defib: Cross on pad shows what?

A

Where to do chest compression

116
Q

Pad Placement for Defib: where are triangle and square positioned?

A

Square on back

Triangle on front

117
Q

Pacemakers: Who would get this?

A

Someone who has bradycarida, or has a heart block for electricity

118
Q

Pacemakers: Example of temporary?

A

Epicardial, open heart that goes through vein or transcutaneous.

119
Q

Pacemakers: Two main parts?

A

Generator and the lead that goes into heart to stimulate it.

120
Q

Pacemakers: What do the codes tell you

A

What type of pacemaker it is .

A = Atrial B = Ventricle D= Dual

121
Q

Pacemakers: When do these turn on?

A

May pace at a fixed interval, or may also always pace.

122
Q

Pacemakers: Why does Transcutaneous pacing hurt?

A

They are sending shocks through the skin to the heart.

123
Q

Pacemakers: For a planted pacemaker, where does it follow and go

A

Enters through Subclavian, down through heart and plant into ventricle.

124
Q

Pacemakers: What different types of pacemakers are tehre?

A

Single chamber, Dual Chamber, and Biventricular

125
Q

Implanted TRansvenous Pacemaker: How does this work?

A

Placed beneath skin. Enters through external jugular. Placed in right ventricle.

126
Q

ECG On-Demand Pacing: How will ECG look with Pacemaker?

A

Want to make sure there are packer spike fires. Sharp spike before QRS showing its pacing it there.

127
Q

Comp of Pacemaker Use: What is included

A 
Infection
Bleeding/Hematoma
Dislocation of Lead
Skeletal Muscle/Phrenic Nerve Stimulation
Cardiac Tamponade
Pacemaker Malfunction
128
Q

Comp of Pacemaker Use: What happens if lead dislocated?

A

You lose that heart rate

129
Q

Comp of Pacemaker Use: Why does Cardiac Tamponade happen?

A

It could be due to lead placement. IT compresses heart

130
Q

Comp of Pacemaker Use: What Electromagnetic interference can occur?

A

Like going through airport security, carry card. Don’t put cell phone in chest pocket.

131
Q

Implantable Cardioverter Defibrillator (ICD): What is this?

A

Device that detects and terminates life-threatening episodes of tachycardia and fibrillation.

132
Q

Implantable Cardioverter Defibrillator (ICD): Can this be isnerted at same time of pacemaker?

A

Yes

133
Q

Implantable Cardioverter Defibrillator (ICD): Who would get this?

A

Patient at risk for VT and VFib.

Those with <35% EF

134
Q

Implantable Cardioverter Defibrillator (ICD): What is Anti-Tachycardia Pacing?

A

Pacemaker just tries to disrupt tachycardia, tried to override the firing of the heart.

135
Q

Nurse Mx After Insertion: How will you assess their ECG?

A

Get their heart rate, and rhythm detection

136
Q

Nurse Mx After Insertion: How to verify lead placement?

A

Chest X-Ray and to make sure no pneumothorax.

137
Q

Nurse Mx After Insertion - Nursing Assess: What will the nurse monitor for?

A

CO and Hemodynamic Stability
Incision Site
Signs of Ineffective Coping

138
Q

Nurse Mx After Insertion - Education : What arm will be immobilized

A

Whatever arm has been impacted. Don’t want them reaching up because leads need to heal.

139
Q

Nurse Mx After Insertion - Education : What to tell them abotu electromagnetic influence?

A

MRI
MEtal Dectors

Tell people they have pacemaker and have ID card present.

140
Q

Invasive Methods to Diagnose and Tx Recurrent Dysrhythmias: What are electrophysiological studies?

A

AFib, VT. Go in and look at heart in lab and see if they can tell where the heart stimulation is rising from..

141
Q

Invasive Methods to Diagnose and Tx Recurrent Dysrhythmias: Cardiac Conduction Therapy , Maze Production is done when

A

If patient is having open heart surgery

142
Q

Invasive Methods to Diagnose and Tx Recurrent Dysrhythmias: What is the Maze Procedure?

A

They will fix blocked arteries and scar a portion of the heart to try to prevent arrhythmia from happening

143
Q

Invasive Methods to Diagnose and Tx Recurrent Dysrhythmias: What is Catheter Ablation Therapy?

A

Go in with heart cath and ablate scarring area to prevent firing.

NRSG 200: Med Surg 3 (46 decks)

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