lecture 3 – cardio + ECG readings Flashcards
definition
sinus
conduction began in SA node
HR for sinus rhythm
60-100 bpm
it is possible to have a waveform on the ECG while the patient does have a pulse
true
definition
arrhythmia
conduction cycle does not begin in the SA node
what is the regularity for sinus rhythm?
regular
what is the PRI for sinus rhythm?
0.12 - 0.20
how many seconds is each box on an EKG strip?
0.04
how long is the QRS wave on a sinus rhythm?
less than or equal to 0.12 seconds
what is the QTI of a sinus rhythm?
less than 0.40 seconds
sinus rhythm
what are the nursing actions for sinus rhythm?
none
what is the HR for sinus brady?
< 60 bpm
every other data besides HR for sinus rhythm is the same for sinus brady & sinus tachy
true
what causes sinus brady?
- B-blockers
- Ca+ channel blockers
- post-cath lab procedures
what are the nursing actions for sinus brady?
- assess BP, for syncope and SOB
- prevent falls
- administer Atropine
the patient has AMS & visible signs of hypoxia, their ECG shows sinus brady. what is the nursing action?
pt is SYMPTOMATIC
administer Atropine
what is the MOA of Atropine?
elevates heart rate
indicated for sinus brady
sinus brady
what is the HR for sinus tachy?
100 -150 bpm
nursing actions for sinus tachy
- check BP, for syncope and SOB
- prevent falls
- possibly administer B-blockers & Ca+ channel blockers
sinus tachy
what is the PRI of A-fib?
none
what is the rate & regularity of A-fib?
none; it has irregular rhythm
what is it called when an A-fib has more than 100bpm?
rapid ventricular response
what causes A-fib?
- MI
- rheumatic heart disease
- COPD
- CHF
- ischemia
- CAD
what does the nurse need to check for a patient with A-fib?
INR
how does a patient with A-fib present?
- CP
- hypoxia
- hypotension
- SOB
- decreased cardiac output
what is the QTI of A-fib?
less than 0.40 seconds
how long is the QRS wave of A-fib?
less than 0.12 seconds
what causes atria to quiver and lead to A-fib?
chaotic ectopic current activity
what are possible treatments for A-fib?
- cardioversion
- B-blockers
- Ca+ channel blockers
- Digoxin
- possibly anticoagulant (hemostasis)
A-fib
what is the HR of atrial flutter?
250 - 350 bpm
P waves are absent in atrial flutter
true
how long is the QRS complex in atrial flutter?
less than or equal to 0.12 seconds
what are the causes for atrial flutter?
- RHF
- pericarditis
- valve disorder
- hyperthyroidism
atrial flutter
what is the HR for V-tach?
100 - 250 bpm
what is the characteristic of the QRS complex in V-tach?
wide and bizarre
P waves are often buried in the QRS complex in V-tach due to rapid rhythm
true
what is the rhythm for V-tach?
regular
how is V-tach defined?
3 or more consecutive PVCs occur at a rate of 100 bpm
what causes V-tach?
- low Mg
- low K+
- CNS stimulants
- digoxicity
- AMI
what are the priority nursing actions for V-tach?
- check for pulse
- check BP
potential treatments for stable V-tach
pulse present
- oxygen
- 12-lead EKG
- Amiodarone
- check K+ & Mg
- prepare for cardioversion (may turn unstable)
potential treatments for unstable V-tach
pulse present
- cardioversion
- administer Amiodarone bolus + infusion
what are the nursing actions for pulseless V-tach?
- defib + CPR
- activate code (ACLS certified)
V-tach
what is V-fib?
irritable ventricles send out rapid electrical stimuli
how do ventricles act during V-fib?
they do not contract because they never depolarize
conduction bypasses SA & AV node in V-tach
true
how does the patient with V-fib present?
- pulseless
- no BP
- no cardiac output
- apneic
- unresponsive
what causes V-fib?
- CAD
- AMI
- hypoxia
- acidosis
- cardiac catheterization
- cardioversion
- accidental electrocution
- extreme hypothermia
nursing priorities for V-fib
- check ABC
- begin CPR
- defib
- epinephrine
V-fib
what is the HR for supraventricular tachycardia?
150-250 bpm
what does the QRS complex look on supraventricular tachycardia?
narrow; < 0.12 seconds
what is the rhythm of supraventricular tachycardia?
regular
what are the causes of supraventricular tachycardia?
- stimulants
- sepsis
- stress
- alcohol
SVT
what are the treatments for SVT?
- vasovagal maneuver
- baring down
- carotid massage
- Adenosine
- Verapamil
- ablation
- cardioversion
- anticoagulant for stroke prevention
what is an angioplasty?
a procedure in which a balloon is inserted & inflated within a narrow or blocked artery
what is CABG?
coronary artery bypass grafting
surgeon takes one piece of a blood vessel in other parts of the body & use it to reroute blood from a blocked artery
what is the sequence for cardiac conduction?
- SA node
- AV node
- Bundle of His
- Purkinje fibers
which node generates impulses?
SA node
what are the causes of ST elevation?
- low oxygen from CAD
- elevated Potassium
- blocked coronary arteries
what are the major treatments for STEMI?
- reperfusion
- angioplasty
- possible CABG
how does STEMI manifest in the heart?
constant contraction of ventricles
what are the s/s of STEMI?
- hyperkalemia
- diaphoresis
- CP
- elevated troponin
what are the minor treatments for STEMI?
- nitroglycerin
- O2
- Morphine
- Aspirin
what is another word for contraction?
depolarization
what is another word for relaxation (of myocardium)?
repolarization
what does the P wave represent?
atrial depolarization
atria squeeze blood into the ventricles
what is cardiac ablation?
cauterization of erratic cells
what does the QRS complex represent?
ventricle depolarization
ventricles squeeze blood into the aorta or pulmonary artery
what does the T wave represent?
ventricle repolarization
what is the most common lead to monitor?
Lead II
aligns w/ RA to apex of heart
why is the presence of a P wave pertinent?
indicate the conduction started in the SA node as it should
the width of the QRS complex is determined by the amount of time it takes for ventricles to repolarize
true
what does an elevated ST segment indicate?
myocardium infarction
what does the T wave represent?
- the end of the conduction cycle
- ventricle repolarization
what does a peaked T wave indicate?
electrolyte imbalances
particularly K+
5 lead ECG
- clouds over grass
- smoke over fire
- Vhite on right
what is the anatomical landmark for a V1 lead?
4th intercostal space
indications
defibrillation
- V-fib
- pulseless V-tach
- accompanied w/ CPR
- only for EMERGENCY
what is the priority nursing action for delivering shocks to a patient?
ensure absence of clots
indications
cardioversion
- V-tach w/ pulse
- SVT
- to reset SA NODE
- low-energy shock only
- do NOT deliver during T wave
what is the MOA of Adenosine?
suppresses automaticity of pacemakers
leading to FLATLINE
how is Adenosine administered?
- fast & hard
- followed by saline flush
what are the nursing actions for asystole?
- CPR
- ET tube insertion
- ACLS
- Epinephrine
- Vasopressin
asystole is a shockable rhythm
false
what does Amiodarone do for the heart?
slows cardiac conduction
waveform interpretation
what are the s/s of AV heart block?
- CP
- low SpO2
- hypotension
- lethargy
- anxiety
- palpitations
- SOB
- elevated HR
- syncope
in other words, COLLAPSED
what are first line of treatments for AV heart block?
- B-blockers
- Ca+ channel blockers
- Digoxin
what is the goal of treating an AV heart block?
restore AV node function
what type of drug is Digoxin?
inotropic antiarrythmic
what are second line of treatments for AV heart block?
- Atropine
- Dopamine
- Epinephrine
also classified as VASOPRESSORS
what is the third line of treatments for AV heart block?
pacemaker
post-op care for pacemakers
- immoblize arm
- prevent infection
- advise to avoid soaking, powders, & creams on the area
- check pulse daily
what are patients allowed to do when they have had pacemakers for about 2 weeks?
- swim
- drive
- report dyspnea & dizziness
why do patients with a pacemaker need an ID card?
it contains important information such as the make of their pacemaker, their doctor, or other precautions for events contraindicated with a pacemaker
what do patients need to avoid when they wear a pacemaker?
- MRI
- metal detectors
- stereos
- earphones
why do patients with pacemakers need to avoid contact sports and tight clothing?
avoid displacement of wires
