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NURS 370 - Final > Heart Rhytms > Flashcards

Heart Rhytms Flashcards

1
Q

How do Beta-blockers work at controlling heart rate?

A

-Metropol

-These slow down the conduction throughout the AV node

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2
Q

If there is an increase in afterload what is there an increase in?

A

an increase in afterload = an increase in cardiac workload

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3
Q

What do we do before the administration of digoxin? What does it do?

A

-Digoxin

-Do 60 sec apical pulse before admin
-Slows down the heart and improves strength of contractions

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4
Q

What is the QRS complex?

A

Ventricular depolarization

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5
Q

What do we do post-op after cardioversion if it was successful?

A

If the procedure was successful we:
-Repeat vitals
-Obtain ECG

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6
Q

What kind of patients recive an implantable cardioverter defibrillator (ICD)?

A

Have survived SCD

Have spontaneous sustained VT

Have syncope with inducible ventricular tachycardia/fibrillation during EPS

Are at high risk for future life-threatening dysrhythmias

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7
Q

What is the clinical significance/what can a-fib lead to?

A

Can result in decrease in CO due to ineffective atrial contractions (loss of atrial kick) and rapid ventricular response

Thrombi may form in the atria as a result of blood stasis

Embolus may develop and travel to the brain, causing a stroke

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8
Q

What are the 3 main goals of management with A-fib?

A

Three main goals:
1.) Control heart rhythm and heart rate
-.Want to get the heart back into a sinus rhythm – get the SA node back under control

2.) Prevent stroke
-We do this through medications (blood thinners) or cardiovert to avoid development of a stroke

3.) Optimize quality of life
-Sometimes, we can’t get individuals out of the rhythm so we want to try our best to improve the patients individuals quality of life as best as we can

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9
Q

What does a 12 lead ECG tell us?

A

They have to be placed in the specific order because it tells us 12 different electrical views of the heart – produces 12 different views

-Looking at 30 seconds in time

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10
Q

What is the pacemaker of the heart?

A

SA Node is our primary conductor – it is the Pacemaker of the heart – 60 – 100bpm

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11
Q

What is Cardiac telemetry? What does it give patients?

A

This is a portable device that monitors the patient’s pulse on the unit

Gives patients freedom

Given to patients who are stable

Allows patient to walk around only their unit

Limited in the number of leads we can get

Continuous monitoring

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12
Q

What are some Non-cardiovascular clinical associations/riskfacotrs with A-fib?

A

Age
Diabetes
Alcohol consumptions
Obesity
Smoking
Stress
Hyperthyroidism

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13
Q

What does the P-wave represent?

A

Atrial Depolarization (contraction of atria)

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14
Q

What are the 4 things I am looking for on an ECG? (What is the proper time frame/period for certain sections?)

A

1.) 1:1 conduction

2.) Right rate (beats per minute)

3.) Right time interval of P wave ( 0.12-0.20 seconds) and QRS (0.04-0.12 sec)

4.) Regularity (same distance from P wave to next p-wave or QRS to next QRS

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15
Q

What is the MAZE procedure?

A

-Surgical treatment for a-fib

-Scaring

-They take away the firing pathways

-A number of incisions are made in the left and right atrium to create scars to take away the number of pathways

-Not within the heart!!! On the outside of the atrium

-We can ablade It comletey and results in needed a pacemaker

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16
Q

What is the clinical significance of V-fib?

A

Unresponsive, pulseless, and apneic state

If not treated rapidly, death will result

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17
Q

Treatment of V-fib?

A

Immediate initiation of CPR and advanced cardiac life support (ACLS) measures with the use of defibrillation and definitive drug therapy

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18
Q

How do we place a 12-lead ECG? Where does each line get placed?

A

RA- White Right shoulder

LA-Black- left shoulder

RL-Green – over liver

LL-Red - lower left across from green lead

V1- Brown - over heart

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19
Q

IS blood pumping around the body with v-fib?

A

No blood is pumping around the body

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20
Q

What do we deal with more with a-fib, stroke or PE?

A

We deal with strokes more with A-fib but in some cases we can have a PE

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21
Q

Where do we have blood pooling with A-fib?why?

A

We have blood pooling in the tricuspid area due to the ineffective heart contractions

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22
Q

Characteristics of V-fib on an ECG?

A

Chaotic activity
-No QRS complexes
-No P waves
-No measurable heart rate

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23
Q

What can cause V-tach?

A

Caused by medications (stimulants), MI (myocardial infarction), Mitral valve prolapse, Digoxin toxicity, Electrolyte disorders (potassium)

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24
Q

What is the normal time range for the PR interval?

A

0.12 - 0.20 sec

25
Q

What class of medications control rhythm?

A

-Sodium channel blockers

-Potassium channel blockers

26
Q

What is failing to pace on a pacemaker?

A

Complication of pacemaker

Failing to pace – pulse rate drops below what we set the machine at and it won’t bring the rate back up

27
Q

What is the first thing we do if a patient has V-tach

A

1.) Check lead

2.) Check for pulse

3.) Call a code/initiate CPR

28
Q

Preload Vs Afterload?

A

Preload: Amount of blood that is sitting in the heart before it contracts - volume of blood in ventricles at end of diastole (end diastolic)

Afterload: The pressure the heart must overcome to pump that blood out to the rest of the body
-Resistence left ventricle must overcome to circulate blood

29
Q

What can we do as students to help treat a-fib?

A

As students, we can:
-Console family
-We can stay in the room if our patient
-Start lines
-Backboard
-Recession basket
-Crowd control is a big thing

30
Q

How do triggers affect the reacurance of a-fib coming back once its been treated?

A

Whatever triggered it the first time will most likely trigger it again

31
Q

How do we prevent strokes in patients that have a-fib

A

Preventing clots with medication
Anticoagulants
Antiplatelets

-Patients are put on asprin for the rest of their life

32
Q

What is happening with A-fib?

A

-There is rapid firing of the SA node

*The heart is quivering:
-If it is to fast it triggers the ventricles to contract before they are fully filled up

-If its to slow the ventricles are not firing out blood fast enough

33
Q

What does on demand mean on a pacemaker?

A

On-demand: means that it is monitoring the patients heart rate

34
Q

What can cause V-fib?

A

Electrolyte imbalances, severe acidosis response, patient that has been struck by lightning, hypoxia

35
Q

If we have a patient that is symptomatic, why don’t we anticoagulate them right away?

A
36
Q

What is the normal time range for the QRS Complex?

A

0.04 - 0.12 sec

37
Q

What is the treatment for V-tach?

A

Precipitating causes must be identified and treated

38
Q

Treatment for badycardia

A

Atropine
Pacemaker may be required

39
Q

Symptoms of a-fib?

A

Hypotension
Pale, cool skin
Weakness
Angina
Dizziness or syncope
Confusion or disorientation
Shortness of breath

40
Q

What does the T - wave represent?

A

-Ventricular repolarization

-Ventricular repolarization is the process by which the ventricular myocytes return to their negative resting potential so they can depolarize again.

41
Q

What is cardiac output?

A

Cardiac output:
-The amount of blood that the heart pumps to the rest of the body

42
Q

What side of the heart does a-fib most commonly occur in?

A

Most commonly occurs in the left side of the heart

43
Q

Symptoms of A-fib

A

Irregular heartbeat.
Heart palpitations (rapid, fluttering, or pounding)
Lightheadedness.
Extreme fatigue.
Shortness of breath.
Chest pain.

44
Q

What will V-tach look like on an ECG?

A

No P waves (no 1:1 conductions)
We have regularity
Rate 100bpm
Width (QRS greater than 0.12)

45
Q

What is the PR Interval?

A

The time between the onset of atrial depolarization and the onset of ventricular depolarization

46
Q

WHat is failing to sense on a pacemaker?

A

Complication of a pacemaker

Failing to sense Since – the patient had a rhythm and the pacemaker was not set sensitive enough, so it fired another shock - faired in the middle of the rhythm – didn’t sense the rhythm

47
Q

If patient has been in atrial fibrillation for >48 hours what is recomended?

A

If patient has been in atrial fibrillation for >48 hours, anticoagulation therapy is recommended

48
Q

How do we treat collapsable rhythms?

A

For patient’s with collapse (life-threatening rhythms), they often have a defibrillator implanted

49
Q

on a 12 lead ECG what is the main lead that we count/look at?

A

V2

50
Q

What nursing care do we do before a synchronized cardioversion?

A

Before we do this we want to do:
-ECG
-Start IV
-Vitals
-Consent
-History
-Procedural sedation

51
Q

What is radio frequency catheter ablation?What is it used to treat?

A

-Treatment for A-fib

Burning the areas the areas around the pulmonic vein to reduce the areas where they are firing

52
Q

What is failure to capture on a pacemaker?

A

-Pacemaker complication

Failure to capture – didn’t respond respond to the shock - it fired but didn’t capture it

53
Q

If we have a stable patient, are we going to cardiovert them or deferberlate them?

A

-If we have a stable patient (still have BP and pulse) we are going to cardiovert them – we set the machine to synchronize the machine so they get the voltage on the R wave and NOT the T-wave

54
Q

What does the ST segment represent?

A

ST segment represents the interval between depolarization and repolarization of the ventricles.

*Early ventricular repolarization

55
Q

What are some underlying heart disease clinical associations with A-fib?

A

-Valve problems
-Issues with myocardium tissue

56
Q

What is happening with a collapsed rhythm?

A

Collapse: Ventricle is no longer contracting – not normal

57
Q

Difference between stable and unstable v-tach

A

VT can be stable (patient has a pulse) or unstable (patient is pulseless)

58
Q

How much time should there be between the SA and AV node? What occurs if it is longer?

A

There should be .12-.20 seconds between the SA and AV node – if it is longer, this indication of a blockage (this is your QRS complex)

59
Q

What class of medications control heart rate?

A

-Beta-blockers

-Calcium channel blockers

-Digoxin

NURS 370 - Final (7 decks)

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