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Nursing: 201 > exam2 > Flashcards

exam2 Flashcards

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1
Q

normal sinus rhythm

A

SA node at rate of 60 to 100 per minute and follows the normal conduction pattern of the cardiac cycle

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2
Q

sinus bradycardia

A

sinus rhythm at a rate less than 60 beats/min

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3
Q

clinical associations for sinus bradycardia

A

may be normal in trained atheletes and other individuals during sleep. Can occur as response to carotid sinus message, Valsalva maneuver, hypothermia, increased intracranial pressure, hypoglycemia, and inferior wall MI

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4
Q

ECG characteristics of sinus bradycardia

A

HR less than 60, rhythm regular, p wave before each QRS, and has a normal shape and duration. PR interval is normal, QRS complex is normal shape and duration

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5
Q

clinical significance of sinus bradycardia

A

depends on the patient. S/S can include pale, cool skin, HypoTN, weakness, angina, dizziness or syncope, confusion or disorientation, SOB

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6
Q

TX for sinus bradycardia

A

may require atropine for pt with symptoms. Pacemaker may be necessary, discontinue/hold drugs that cause bradycardia and dose may need to be adjusted

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7
Q

sinus tachycardia

A

normal sinus rhythm tthat is 101 to 200 beats/min

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8
Q

clinical associations for sinus tachycardia

A

stressors: exercise, fever, pain, hypoTN, hypovolemia, anemia, hypoxia, hypoglycemia, myocardial ischemia, HF, hyperthyroidism, anxiety and fear. DRUGS: epi, norepi, atropine, caffeine, theophylline, nifedipine, or hydralazine. OTC cold remedies (pseudoephedrine)

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9
Q

ECG characteristics of sinus tachycardia

A

HR: 101 to 200. P wave: normal, before every QRS and normal shape and duration. PR: normal, QRS: normal shape and duration

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10
Q

clinical significance of sinus tachycardia

A

depends on pt tolerance of increased HR. S/S dizziness, dyspnea, hypoTN due to decreased CO. increased myocardial oxygen consumption is associated with increased HR. anginia or increase in infarction size may accompany in pt with CAD or MI

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11
Q

Tx for sinus tachycardia

A

treat underlying cause (Pain management, hypovolemia), for clinically stable pt: vagal maneuvers,

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12
Q

drugs for sinus tachycardia

A

beta adrenergic blockers can be given to reduce HR and decrease myocardial oxygen consumption

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13
Q

Premature Atrial Contraction

A

contraction orgininating from an ectopic focus in the atrium.

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14
Q

clinical associations for PAC

A

emotional stress or physical fatigue, use of caffeine, tobacco, ETOH. Hypoxia, Elyte imbalances, hyperthyroidism, chronic obstructive pulmonary dz, heart dz (CAD, and valvular dz)

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15
Q

ECG characteristics of PAC

A

HR varies with underlying rate, frequency of PAC and rhythm is irregular. P: different shape from a P wave from the SA. May be notched or downward, may be hidden in a T wave. PRI: shorter or longer than PR orginating from SA node, however WNL. QRS: normal, if QRS is greater than or equal to 0.12 sec abnormal conduction through the ventricles is present

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16
Q

clinical significance of PAC

A

in healthy hearts not significant. “skipped a beat” . Persons with heart dz: frequent PACs may indicate enhanced automaticity of the atria, reentry mechanisms. May be a warning of initiate more serious dysrhythmias (supraventricular tachycardia)

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17
Q

Tx for PAC

A

depends on symptoms. Withdrawl stimulation sucha as caffiene or sympathomimetic drugs may be warrented. Beta adrenergic blockers used to decrease PACs

18
Q

Paroxysmal supraventricular tachycardia

A

dysrthythmia originating in an ectopic focus anywhere above the bifurcation of the bundle of His. (Id of ectopic focus is often difficult even with a 12 lead ECG, as it requires recording the dysrhythmia as it is initiated

19
Q

PSVT occurs because

A

reentrant phenonmenon (reexcitation of the atria when there is a one- way block) Usually a PAC triggers a run of repeated premature beats. Paroxysmal refers to an abrupt onset and termination

20
Q

clincal associations of PSVT

A

overexertion, emotional stress, deep inspiration and stimulates such as caffine and tobacco. Rheumatic heart dz, dig toxicity, CAD, and corpulmonale

21
Q

ECG characteristics of PSVT

A

HR: 150-220 beats/min. Rhythm: regular or slightly irregular. P: often hidden in preceding T wave, if its seen it may have an abnormal shape. PRI: shortened or normal. QRS: normal

22
Q

clinical significance of PSVT

A

depends on symptoms. Prolonged episode and HR greater than 180 beats/min may precipitate a decreased CO due to reduced stroke volume. HypoTN, dyspnea, angina

23
Q

Tx for PSVT

A

vagal stimulation (coughing and Valsalva) and drug therapy- 1st choice: IV adenosine (Adenocard), IV beta adrenergic blockers and calcium channel blockers and amiodarone can be used

24
Q

Tx for PSVT if drugs/vagal stimulation are ineffective and pt becomes hemodynamically unstable

A

direct current cardioversion

25
Q

why is IV adenosine the first choice?

A

short half life and is well tolerated by most patients

26
Q

Atrial flutter

A

atrial tachydysrhythmia. Identified by recurring, saw tooth shape flutter waves from a single eptopic focu in the right atrium or less commonly the left atrium

27
Q

clinical association of atrial flutter

A

rare in healthy heart. In dz states it is associated with CAD, HTN, mitral valve disorders, pulmonary embolus, chronic lung dz, cor pulmonale, cardiomyopathy, hyperthyroidism. Drugs: digoxine, quinidine, epi

28
Q

ECG characteristics of atrial flutter

A

atrial rate of 200-350 /min. ventricular rate will vary according to the conduction ratio. Artial rhythm is regular and ventricular rhythm is usually regular. PRI: variable and not measurable. QRS: normal

29
Q

atrial flutter waves represent

A

atrial depolarization followed by repolarization

30
Q

there is usually some AV block in a fixed ratio of flutter waves to QRS complexes because

A

AV nodes can delay signals from the atria

31
Q

clinical significance of A-flutter

A

high ventricular rates (greater than 100/min) and loss of the atrial “kick” decrease CO and cause serious consequences such as HF. High risk of stroke

32
Q

why does A-flutter have a high risk of stroke

A

thrombus formation in the atria from the stasis of blood

33
Q

what drug is given to prevent stroke with A-flutter

A

warfarin

34
Q

goal of tx of a-flutter

A

slow ventricular response by increasing AV block

35
Q

Drug used for tx of A-flutter to control ventricular rate

A

calcium channel blockers, beta adrenergic blockers

36
Q

emergency tx for a-flutter

A

electrical cardioversion (proceduce may also be elective)

37
Q

tx drugs to convert atrial flutter to sinus rhythm (or to maintain NSR)

A

amiodarone, propafenone, ibutilide and flecainide

38
Q

what is dronedarone (Multaq) used for

A

a flutter for patients whose hearts have returned to NSR or those who will be undergoing drug or electric shock tx to restore a normal heartbeat

39
Q

tx of choice for a-flutter

A

radiofrequency catheter ablation

40
Q

atrial fibrillation

A

total disorganization of atrial electrical activity due to multiple foci resulting in loss of effective atrial contraction. Maybe paroxysmal or persistent (more than 7 days)

Nursing: 201 (6 decks)

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