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adult health nursing > Lecture 6 Arrhythmias > Flashcards

Lecture 6 Arrhythmias Flashcards

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1
Q

SA node

A

heart’s natural pacemaker at the top of the right atrium
60-100 bpm

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2
Q

AV node

A

between the atria and ventricle at the interatrial septum
slows electrical impulses to give time for the atria to contract and ventricles to fill
40-60 bpm

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3
Q

Bundle of His

A

begins conduction to the ventricles
located in the ventricular septum

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4
Q

purkinje fibers

A

moves impulses through the outside of the ventricle to cause contraction

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5
Q

telemetry

A

continuous monitoring with 5 leads

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6
Q

Reading rate on EKG

A

count number of full complexes in 6 seconds and multiply by 10
atrial rate = # of P waves
ventricular rate = # of QRS complexes

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7
Q

Reading rhythm on EKG

A

regular = complexes are roughly same distance apart
irregular = complexes are not equal distance apart

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8
Q

Reading intervals on EKG - P wave

A

atrial depolarization (contraction)
should be round and upright

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9
Q

what does it mean if P wave is normal?

A

assume that electrical impulse originated in the SA node

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10
Q

PR interval

A

tracks impulse from atria to AV node
beginning of P wave to Q
should be 0.12-0.2 seconds, delay indicates AV block

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11
Q

QRS Complex

A

ventricular depolarization
creates pulse
should be 0.06-0.12 seconds

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12
Q

T wave

A

ventricular repolarization = relaxation
follows the ST segment

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13
Q

QT interval

A

represents ventricular depolarization and repolarization
measure from beginning of QRS complex to end of T wave
shorter QT = faster HR
longer QT = slower HR
should be 0.36-0.44 seconds

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14
Q

dysrhythmia

A

irregular or erratic heart rate
can cause disturbances of HR AND/OR rhythm

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15
Q

what to do if you see a dysrhythmia

A

always stop and check how patient is tolerating it

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16
Q

risk factors for dysrhythmias

A

age
caffeine, smoking, drugs, alcohol
heart valve disease (mitral valve near AV node)
MI, HTN, cardiomyopathy, heart surgery

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17
Q

sinus bradycardia

A

rate <60, regular rhythm
SA node is firing at slower rate
P waves are present and normal
QT interval may or may not be prolonged

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18
Q

causes of sinus bradycardia

A

lower metabolic needs - athletes
vagal stimulation - vomiting, severe pain
medications - beta blockers
acute decompensated heart failure
sinus node dysfunction
RCA lesion in MI

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19
Q

managine sinus bradycardia

A

assess hemodynamic effects
check reversible causes
if symptomatic and unstable, treat with atropine
0.5 mg atropine every 3-5 minutes, max dose of 3 mg

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20
Q

sinus tachycardia

A

> 100 bpm
regular rhythm
SA node firing at faster rate

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21
Q

s/sx of sinus tachycardia

A

low BP
change in LOC
N/V
doom and anxiety

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22
Q

causes of sinus tachycardia

A

compensating for acute blood loss, hypovolemia, anemia to try and meet oxygen needs of body
infection
cardiac ischemia
pain
exercise
stimulants

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23
Q

why is sinus tachycardia bad

A

it decreases ventricular filling time, which decreases cardiac output

24
Q

sinus tachycardia management

A

assess hemodynamic effects
reverse possible causes
vagal maneuvers - gagging, bearing down, sustained coughing, blowing through a straw, cold stimulus to face

25
Q

medical management of sinus tachycardia

A

adenosine IV - slam it and have flush ready
beta blockers IV
calcium channel blockers IV

26
Q

assessing patients with arrhythmias

A

history of cardiac disease
medications
blood pressure
s/sx of fluid retentions
auscultation

27
Q

atrial fibrillation

A

abnormally fast and chaotic HR
atria quiver instead of beating
abnormal electrical pathways in the atria
ventricular rate stays relatively consistent

28
Q

atrial fibrillation EKG

A

atrial rate 300-600
ventricular rate 100-120
irregular rhythm
no consistent P wave, no PR interval

29
Q

paroxysmal Afib

A

sudden onset and termination
lasts less than 7 days, may reoccur

30
Q

persistent Afib

A

lasts >7 days

31
Q

long standing persistent Afib

A

continuous for >12 months

32
Q

permanent Afib

A

long standing, but deciding to not restore or maintain normal sinus rhythm

33
Q

s/sx of atrial fibrillation

A

fatigue
palpitations
lightheadedness
SOB
decreased BP

34
Q

pharmacological management of Afib

A

beta blockers
potassium channel blockers - amiodarone
calcium channel blockers - verapamil, diltiazem

35
Q

where do 90% of afib clots form?

A

left atrial appendage

36
Q

anticoagulants for Afib

A

warfarin
- must for mechanical valves
- INR testing
- vitamin K for reversal

DOACs - Eliquis and Xarelto
- less monitoring and fewer drug interactions

37
Q

when must anticoagulants be initiated?

A

if Afib lasts for more than 48 hours

38
Q

watchman device

A

Left Arterial Appendage Occlusion Device

for patients who can’t tolerate anticoagulants

39
Q

atrial flutter

A

sawtooth waves
atrial rate - 250-400 bpm
ventricular rate - 75-100 bpm
p waves are called F waves
same cases, management, s/sx of afib
easier to treat than Afib because irregular electrical impulses are coming from one location, not all over the atria

40
Q

Ectopy

A

Extra or Early beats

Premature atrial contraction
premature ventricular contraction

41
Q

ventricular tachycardia

A

ventricular rate >100 bpm
irregular rhythm
p-wave difficult to detect

42
Q

QRS in ventricular tachycardia

A

wide: >0.12 seconds with abnormal shape

43
Q

monomorphic vs polymorphic vtach

A

one shape vs many shapes

44
Q

causes of vtach

A

cardiac ischemia
hypoxia
acidosis
electrolyte imbalances
heart failure
heart surgery - scarring
heart valve disorders

45
Q

signs and symptoms of vtach

A

chest pain
palpitations
dizziness
lightheadedness
shortness of breath
fainting

46
Q

sustained vtach

A

> 30 seconds

47
Q

non-sustained vtach

A

bursts with breaks

48
Q

first steps of vtach management

A

assess pulse, symptoms, and VS immediately
back to bed asap in case of cardiac arrest
notify MD
code cart and lifepak ready

49
Q

vtach management if sustained or patient unstable

A

cardioversion if patient is awake and has a pulse
defibrillate if patient is unconscious and does not have a pulse

50
Q

cardioversion vs defibrilation

A

both use lifepak
cardioversion synchronized
defibrillation unsynchronized

51
Q

ventricular fibrillation

A

no measurable rate, irregular, no pulse
defibrillate immediately

52
Q

asystole

A

CPR and intubation
IV epinephrine
no defibrillation because there’s no electrical activity to correct

53
Q

Hs and Ts

A

reversible causes of cardiac arrest
hypovolemia
hypoxemia
hyper and hypokalemia
H+ ion excess - acidosis
hypothermia

tension pneumothorax
tamponade
thrombosis - MI and PE
toxins

54
Q

ICD

A

Implantable Cardioverter Defibrillator
detects and terminates arrhythmias

55
Q

who is eligible for ICD?

A

Systolic heart failure
Vtach or Vfib

56
Q

Life vest

A

external defibrillator
must be worn at all times, including sleeping
can be removed for bathing but someone else should be home

57
Q

pacemaker indications

A

slow impulse formation
symptomatic AV or ventricular conduction issues

adult health nursing (10 decks)

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