Key Features of Dysrhythmias Flashcards
if a beat is early what do we call it
a complex
bradydysrhythmias significance (3)
-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)
perfusion of coronary arteries prevents what
MIs
what happens when the coronary arteries are not perfused properly
patient will present w/ angina
if a person’s heart rate is <60, what should be check to see if it is tolerated
blood pressure
athletes might have a HR of 54 but if there BP is good then it is fine
if a patient is bradycardic & not tolerating, possible problems that can occur are
-myocardial ischemia/infarct
-dysrhythmias
-hypotension
-heart failure
tachydysrhythmias significance (4)
-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)
decrease in ventricular filing causes a decrease in
stroke volume
if someone is tachycardic and not tolerating, possible problems that can occur are
-myocardial ischemia/infarct
-dysrhythmias
-hypotension
-heart failure
key features of tachy & brady dysrhythmias (16)
-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
synchronized cardioversion is
the choice of therapy for hemodynamically unstable supra ventricular tachydysrhythmias
delivers a counter-shock on the R wave of the QRS
what is needed to be able to cardiovert a patient
an R wave
if a patient has a R wave, what can you not do
defibrillate the patient
what happens if the the cardiovert fires on the wrong part of the QRS and how to prevent
life threatening dysrhythmias -> ensure that if pt has an R wave to turn on the synchronizer switch
if a patient needs a cardioversion but it is non emergent
sedate the patient before the procedure
cardioversion facts
-start w/ 50 to 100 joules, increase if needed after initial shock
-“all clear” before discharging the device
what is the next best action if patient becomes pulseless after a cardiovert
turn the synchronizer switch off & perform defibrillation
nursing care during a cardioversion
-maintain patent airway
-administer oxygen
-assess VS & LOC
-monitor for dysrhythmias
-provide emotional support
-document
what order should you expect if an emergent caridoversion needs to be performed
heparin drip
catheter ablation
invasive procedure that destroys an irritable focus causing the dysrhythmia
must undergo electrophysiology (EP) studies & mapping procedures to locate the focus
maze procedure
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
proper valsalva maneuver
hold breath 10-15 secs (should see neck vein distention), then resume breathing
cardioversion overview
-elective
-pt is awake, ideally we sedate them
-sync w/ QRS
-50 to 200 joules
-consent signed
-EKG monitoring
defibrillation overview
-emergency
-v.fib/v.tach
-no CO
-begin w/ 200 joules, go up to 360
-pt is unconscious
-EKG monitoring
