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Nursing 250 > MED-SURG---Cardiac Rhythm & Dysrhythmias > Flashcards

MED-SURG---Cardiac Rhythm & Dysrhythmias Flashcards

Mark Lieb, MSN, RN, CEN

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1
Q

Multiple PVC’s in a row (3 or more) is known as ________________

A

Ventricular Tachycardia

VTACH

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2
Q

what are the “4” rhythms that can be cardioverted?

A

1) A-Fib
2) A-Flutter
3) SVT
4) V-Tach with pulse

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3
Q

Two main systems in the heart

A

1) Electrical (Conduction)

2) Mechanical (Contraction)

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4
Q

most common Dysrhythmia?

A

atrial fibrillation

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5
Q

Delivery of unsynchronized, direct countershock to the heart–Stopping all electrical activity of the heart –allowing the SA NODE to take over nd reestablish a perfusing rhythm.

A

Defibrillation

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6
Q

Calcium Channel Blocker

  • INDICATIONS
  • ACTIONS
A

*RATE \ RHYTHM control of rapid Atrial rhythms (A-fib with RVR) A-Flutter, SVT

  • SLOWS SA NODAL FIRING= decreased automaticity
  • SLOWS TRANSMISSION THROUGH AV NODE = reduced ventricular rate
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7
Q

TX for VTACH (w/o Pulse)

1) DRUGS (3)
2) Electrical Mangemet

A

Amiodarone
Lidocaine
Epinephrine

Defibrillation

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8
Q

What is “R on T phenomenon”?

A

PVC’s falling on the T WAVE

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9
Q

EQUATION FOR CARDIAC OUTPUT?

A

Heart Rate x Stroke Volume == CO

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10
Q

Vagal Maneuvers (4)

A

1) blowing through straw
2) Valsalva Maneuver (holding breath and bear down)
3) Ice to face (for babies)
4) Carotid sinus massage (cannot be done by nurse-clot could break off and occlude the carotid)

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11
Q

TX for VTACH (with pulse)

1) Drugs (3)
2) Electrical management

A

Amiodarone
Adenosine
Verapamil

Synchronized Cardioversion

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12
Q

indications for adenosine

A

SVT (regular, narrow QRS of 0.10 or less with rate >150)

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13
Q

Immediate intervention needed for V-FIB

A

CPR / Defibrillation

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14
Q

IF allowed to continue—VTACH can deteriorate into ________________

A

Ventricular Fibrillation

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15
Q

PVC that is noted to be EVERY THIRD BEAT

A

Ventricular Trigeminy

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16
Q

INDICATIONS FOR DEFIBRILLATION

A

1) V-Fibrillation (V-FIB)

2) VTACH (without a pulse)

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17
Q

Cardiac cells possess 4 similar properties

A

AUTOMATICITY ability to depolarize itself. can start an electrical impulse by themselves without any outside initiation

EXCITABILITY–ability to respond to a stimulus

CONDUCTIVITY–ability to transmit a stimulus to a neighboring cell

CONTRACTILITY–ability to respond to a an electrical impulse with a pump or contraction

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18
Q

Type of ventricular tachycardia associated with LON QT Syndrome

A

Torsades de Pointes

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19
Q

side effects of ADENOSINE

A 
chest discomfort
lightheadedness
syncope
bradycardia
asystole
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20
Q

ability to respond to a stimulus

A

EXCITABILITY

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21
Q

describe the “action” of adenosine

A

slows conduction through the AV node and interrupts reentry pathways

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22
Q

EKG complexes and what do they represent

A

P WAVE—represents atrial depolarization

QRS WAVE–represents ventricular depolarization

T WAVE –represents ventricular repolarization

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23
Q

The EKG reading states that your patient is in ASYSTOLE…what do you do first?

A

1) Check your patient
2) Check EKG lead (Disconnected lead?)

**IF REAL—BEGIN CPR IMMEDIATELY

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24
Q

INDICATIONS for Cardioversion (3)

A

1) Elective treatment of atrial dysrhythmias
2) SVT
3) VTACH (with a pulse)

**tx of Choice for Clients that are symptomatic

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25
Q

first line treatment for dsyrhtymias

A

adenosine, CCB, BB

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26
Q

PVC’s originating at more than one site appear different from one another on the ECG (polymorphic) and are called _____________

A

MULTIFOCAL

27
Q

(7) side effects of Beta blockers

A

Hypotension

Bradycardia

Bronchospasm

Flushing

CHF

Dizziness

Heart block

28
Q

ability to respond to a an electrical impulse with a pump or contraction

A

CONTRACTILITY

29
Q

ability to transmit a stimulus to a neighboring cell

A

CONDUCTIVITY

30
Q

ability to depolarize itself. can start an electrical impulse by themselves without any outside initiation

A

AUTOMATICITY

31
Q

Name “3” types of Ventricular Dysrhythmias

A
  • Premature Ventricular Contractions (PVC)
  • V-Tachycardia
  • V-Fibrillation
32
Q

Which dysrhythmia can be classified by ventricular rate?

A

ATRIAL FIBBRILATION

Controlled-ventricular rate–<100 bpm

Uncontrolled(RAPID)ventricular rate–> 100 bpm

33
Q

With PVC’s…when the ventricular impulse arises from one ectopic site all the PVC’s look the same (monomorphic) and are called ___________

A

UNIFOCAL

34
Q

Electrical “picture” of what is happening in the conduction system

A

ECG

Electrocardiogram

35
Q

Normal Magnesium Lab Values

A

1.5 - 2.5

36
Q

Delivery of a direct countershock to the heart synchronized to the QRS complex

A

Cardioversion

37
Q

Time when a cell cannot accept another impulse and be stimulated

A

ABSOLUTE REFRACTORY PERIOD

38
Q

how does a tachydysrhythmia affect the patient

A

Excessive Heart rate >100. (TOO FAST)
—–>short diastolic (relaxation / filling) time—–>decreased Cardiac Output

THIS MEANS THERE ISNT VERY GOOD VENTRICULAR FILLING—->resting/filling time is cut short and the ATRIA can not work properly to fill the ventricles which provides for good cardiac output

INCREASED WORKLOAD OF THE HEART & INCREASED MYOCARDIAL O2 DEMAND

39
Q

(3) Nursing administration for Calcium Channel Blockers

A

1) Check HR–if <50 call provider for order
2) change position slowly- (orthostatic hypotension)
3) avoid activities that require alertness until effects are known

40
Q

The life threatening effects of dysrhythmias are generally related to ______________ and ____________.

A

Decreased cardiac output

ineffective tissue perfusion

41
Q

Norma Potassium Lab Values

A

3.5 - 5

42
Q

implementation of Beta Blockers

A

Metoprolol \ Propranolol
GIVE IV DOSE OVER 2 MINUTES TO PATIENT WHILE ON CARDIAC MONITOR

Sotalol

     - GIVEN OVER 5 HOURS 
     - PT MUST BE HOSPITALIZED FOR UP TO 3 DAYS
43
Q

How does a Bradydysrhythmias affect the patient

A

SLOW HEART RATE <60–negatively affects perfusion because the HR is too slow to provide for adequate output for perfusion to entire body

44
Q

Dysrhythmias treatment is based on the cardiac rhythm, which can require any of the following (4) forms of treatment

A

Cardioversion
Defibrillation
Pacemaker insertion
Medication

45
Q

Dysrhythmias have a disturbance in impulse from _____________ or ______________

A

FORMATION—where the signal begins

PROPAGATION—how the impulse travels

46
Q

A PVC that follows every normal beat

A

Ventricular Bigeminy

47
Q

If a change is notated on EKG (from the baseline) you should_______

A

Consider a 12 lead EKG

48
Q

HOW TO BETA BLOCKERS WORK (ACTION?) WHICH ENDS UP RESULTING IN …(3) THINGS

A

ACTION: block beta 1 receptor in the heart

OUTCOME: < Heart Rate

49
Q

Time when a cell needs a “greater than normal” impulse to be stimulated

A

RELATIVE REFRACTORY PERIOD

50
Q

5 steps involved in administered adenosine

A

1) administer at IVP at a site closest to the heart (central line or AC)–only has half life of 10 seconds
2) rapid push with 20 ml of NSS Flush immediately after
3) Raise arm following push
4) Have code cart in room just in case
5) patient must be on monitor

51
Q

Some potential Causes for AV BLOCK / Heart Blocks

A 
Beta Blockers
Calcium channel blockers Digoxin
Ischemia
Necrosis 
Myocardial Infarction
52
Q

Name two Calcium Channel Blockers

A

Diltiazem (Cardizem)

Verapamil

53
Q

The “3” steps of “THE ACTION POTENTIAL”

A

1) RESTING POTENTIAL (unexcited)
* *cells are polarized and ready to accept impulse
* *Mainly (-) inside the cell and (+) outside cell

2) DEPOLARIZATION
* *cells receive and respond to electrical stimulus
* *Movement of charged particles making inside more (+)

3) REPOLARIZATION
* *Cells return to negative state by moving (+) ions out

54
Q

(TRUE / FALSE)

If HR is elevated it doesn’t permit for proper ventricular filling—which leads to a decrease in cardiac output

A

TRUE

55
Q

DEFINE PRELOAD

A

AMOUNT OF BLOOD LEFT IN VENTRICLES JUST PRIOR TO CONTRACTION

HOW FULL IS THE VENTRICLE BEFORE IT SQUEEZES?

56
Q

Name “3” Beta Blockers

A

Metoprolol
Propranolol
Sotalol

57
Q

uncontrolled (or RAPID) ventricular rate is AKA ___________

A

RVR

Rapid Ventricular Rate

58
Q

Side effects of Calcium Channel Blocker (5)

A

Bradycardia

Constipation

Hypotension

Heart Failure

Peripheral Edema

59
Q

an extremely rapid, chaotic ventricular depolarization that causes the ventricles to quiver and cease contracting; the heart DOES NOT Pump

A

Ventricular Fibrillation (AKA: Cardiac Arrest)

60
Q

“5” Characteristic features of Ventricular Dysrhythmias?

A
  • Wide / Bizarre QRS Complex—– >0.12
  • No relationship between the QRS complex and P Wave
  • Increased amplitude of QRS complex
  • Abnormal ST Segment
  • T-Wave deflected in the opposite direction from the QRS complex.
61
Q

What is a PREMATURE COMPLEX?

A

Occurs when a cell other than the SA NODE becomes irritable and fires off an impulse.

**Because of automaticity, these cells can depolarize by themselves

DECREASED VENTRICULAR FILLING = DECREASED CARDIAC OUTPUT

62
Q

Complications of A-Fib (2)

A

1) Blood pooling in atria can lead to thrombus / clot formation increasing risk of stroke , MI, PE
2) If HR is too rapid and irregular, ventricular filling time is decreased so cardiac output decreases

63
Q

Clinical Symptoms of Dysrhythmias / poor perfusion

A

“WASP HAD CPU”

W-eakness
A-ngina
S-OB
P-ale skin

H-ypotension
A-nxiety
D-izziness

C-onfusion
U-rine is decreased
P-alpitations

64
Q

AV BLOCKS

Where are the electrical impulses delayed?
Does the SA NODE function normally?

A
  • Electrical impulses are delayed or blocked in the AV NODE or INTRAVENTRICULAR conduction system
  • Yes, the SA NODE functions normally

Nursing 250 (9 decks)

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