Key Features of Dysrhythmias

Question 1

if a beat is early what do we call it

Answer 1

a complex

Question 2

bradydysrhythmias significance (3)

Answer 2

-myocardial oxygenation demand is reduced (good, can do this on purpose w/ drugs like beta blockers)
-adequate coronary perfusion time d/t prolonged diastole (good)
-if rate is too slow, coronary perfusion may decrease (bad)

Question 3

perfusion of coronary arteries prevents what

Answer 3

MIs

Question 4

what happens when the coronary arteries are not perfused properly

Answer 4

patient will present w/ angina

Question 5

if a person’s heart rate is <60, what should be check to see if it is tolerated

Answer 5

blood pressure
athletes might have a HR of 54 but if there BP is good then it is fine

Question 6

if a patient is bradycardic & not tolerating, possible problems that can occur are

Answer 6

-myocardial ischemia/infarct
-dysrhythmias
-hypotension
-heart failure

Question 7

tachydysrhythmias significance (4)

Answer 7

-shortened diastolic time shortens coronary perfusion time (bad)
-initially, increases CO & BP (good)
-if sustained, ventricular filing decreases and CO & BP decrease (bad)
-increases workload on heart which increase oxygen demand (bad)

Question 8

decrease in ventricular filing causes a decrease in

Answer 8

stroke volume

Question 9

if someone is tachycardic and not tolerating, possible problems that can occur are

Answer 9

-myocardial ischemia/infarct
-dysrhythmias
-hypotension
-heart failure

Question 10

key features of tachy & brady dysrhythmias (16)

Answer 10

-angina
-restlessness, anxiety, confusion
-dizziness, syncope (get orthostatic BP)
-palpitations
-pulse deficit
-SOA, tachypnea
-pulmonary crackles
-orthopnea (cant breath unless sitting up)
-S3S4
-JVD
-weakness, fatigue
-pale/cool/calmy skin
-N/V
-decreased urine out
-delayed cap refill
-hypotension

Question 11

synchronized cardioversion is

Answer 11

the choice of therapy for hemodynamically unstable supra ventricular tachydysrhythmias
delivers a counter-shock on the R wave of the QRS

Question 12

what is needed to be able to cardiovert a patient

Answer 12

an R wave

Question 13

if a patient has a R wave, what can you not do

Answer 13

defibrillate the patient

Question 14

what happens if the the cardiovert fires on the wrong part of the QRS and how to prevent

Answer 14

life threatening dysrhythmias -> ensure that if pt has an R wave to turn on the synchronizer switch

Question 15

if a patient needs a cardioversion but it is non emergent

Answer 15

sedate the patient before the procedure

Question 16

cardioversion facts

Answer 16

-start w/ 50 to 100 joules, increase if needed after initial shock
-“all clear” before discharging the device

Question 17

what is the next best action if patient becomes pulseless after a cardiovert

Answer 17

turn the synchronizer switch off & perform defibrillation

Question 18

nursing care during a cardioversion

Answer 18

-maintain patent airway
-administer oxygen
-assess VS & LOC
-monitor for dysrhythmias
-provide emotional support
-document

Question 19

what order should you expect if an emergent caridoversion needs to be performed

Answer 19

heparin drip

Question 20

catheter ablation

Answer 20

invasive procedure that destroys an irritable focus causing the dysrhythmia
must undergo electrophysiology (EP) studies & mapping procedures to locate the focus

Question 21

maze procedure

Answer 21

surgical procedure consists of creating a number of incisions in atrium to disrupt the re entrant circuits -> looks schematically like a child’s maxe w/ only one patho from the SA node to the AV node

Question 22

proper valsalva maneuver

Answer 22

hold breath 10-15 secs (should see neck vein distention), then resume breathing

Question 23

cardioversion overview

Answer 23

-elective
-pt is awake, ideally we sedate them
-sync w/ QRS
-50 to 200 joules
-consent signed
-EKG monitoring

Question 24

defibrillation overview

Answer 24

-emergency
-v.fib/v.tach
-no CO
-begin w/ 200 joules, go up to 360
-pt is unconscious
-EKG monitoring