Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

NUR 146 Lecture > NUR 146 - Week 10 - EKG Interpretations > Flashcards

NUR 146 - Week 10 - EKG Interpretations Flashcards

1
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What determines heart rate?

A

Heart rate is determined by the myocardial cells with the fastest inherent firing rate

  • This is normally the SA node / pace maker
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is an electrocardiogram (EKG)?

A

Record of a test that measures the electrical activity of the heart

  • Each lead is a specific viewpoint of the electrical activity
  • Common EKG is 3-lead or 12-lead
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Artifact:

What is it?
How to determine what happened?
Cause?
How to prevent/fix?

A

EKG alterations which are not related to cardiac electrical activity

  • Have to assess patient

Causes:
- Poor electrode adhesion to skin
- Patient motion
- Outside source of electricity

How to prevent?
- Shave excess hair
- Skin prep if necessary
- Use soap and water (NOT alcohol)
- Rub skin w/ dry gauze

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe the structure/makeup of EKG graph paper and the significance of the components

A

1 small box = 0.04 sec
5 small boxes = 1 large box
1 large box = 0.20 sec
5 large boxes = 1 sec

Horizontal lines measure passage of time

Vertical lies measure voltage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

EKG Waves:

A

PR Interval = 0.12-0.2 seconds:

P wave: Atrial depolarization
QRS Complex: Ventricular depolarization
T wave: Ventricular repolarization
U Wave: rare finding, seen in hypokalemia

ST Segment: Should be at isoelectric line

QT Interval: Ventricular depolarization and repolarization; 0.32 - 0.4 seconds

PP Interval: Used to determine atrial rate and rhythm

RR Interval: Used to determine ventricular rate and rhythm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How long should a PR interval last?

A

0.12 - 0.20 seconds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the steps to interpret an EKG

A

1) Determine if the heart rhythm is regular or irregular “predictable”
2) Determine the heart rate
3) Identify the P waves
4) Measure the PR interval
5) Measure the QRS complex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Steps to interpret an EKG:

Step 1 - Determine if heart rhythm is regular or irregular

A
  • Examine R to R intervals on EKG strip
  • Use scrap paper to measure distance between R waves and determine if they’re equal in disstance
    If equal = regular rhythm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Steps to interpret an EKG:

Step 2 - Determine heart rate

A

If irregular rhythm: Count QRS complexes on a 6 sec strip then multiply by 10

If regular rhythm: Rule of 300 - Rate = 300 / number of large squares in between R waves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How to interpret an EKG:

***Step 3 - Identify P waves

A

One P wave should precede each QRS complex
- Should be “one-to-one”

P waves should be identical to one another in size and shape

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How to interpret an EKG:

Step 4: MEasure the PR interval

A

Measure from the beginning of the P wave to the beginning of the QRS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How to interpret an EKG:

Step 5: Measure the QRS complex

A

QRS is normally less than 0.12 seconds in duration

  • QRS should be tall and skinny
  • Wide QRS indicates something wrong in the ventricles
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Normal Sinus Rhythm

A

Rhythm originates in: SA Node
Regular or irregular: Regular
Rate: 60-100bpm
PR Interval: 0.12-0.2 seconds
QRS: 0.06 - 0.12 seconds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Arrhythmia / Dysrhythmia

A

Disorder of the formation and/or conduction of electrical impulse within the heart; Anything outside of normal sinus rhythm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Sinus Node arrhythmias

Sinus bradycardia:

How to differentiate?
Treatment?

A

Rate: <60bpm (slow)
- Only thing abnormal

s/s:
- Many won’t experience symptoms
- SOB
- Angina
- Hypotension
- Change in mentation

Treatment: If symptomatic –> administer atropine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the purpose of atropine?

A

Used to treat symptomatic bradycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Sinus Node arrhythmias

Sinus tachycardia:

How to differentiate?
s/s?
Treatment?

A

Differentiate:
- Rate = >100bpm (fast)

s/s:
- Palpitations
- Dizziness
- Syncope
- Hypotension

Treatment:
- Treat the cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Sinus node arrhythmias

Sinus arrhythmia:

How to differentiate

A

Differentiate:

Rhythm: Irregular

“Normal variation of life, not considered ominous or of a bad heart.”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Describe Atrial Arrhytmias

A

SA node fails to generate an electrical impulse

Electrical impulse is generated by atrial nodes or internodal pathways

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Atrial arrhythmias

Premature atrial contraction (PAC):

How to differentiate
s/s
Cause
Treatment

A

Differentiate:
- P waves are a little more “peaked”
“Something is stimulating the atria, and the atria are contracting too early”

s/s:
- “my heart skipped a beat”

Cause:
- Caffeine, nicotine, stimulants
- Anxiety
- Alcohol

Treatment:
- Treat underlying oxygen, give oxygen as needed

22
Q

***Supraventricular Tachycardia (SVT) / Atrial Tachycardia

How to differentiate
Cause:
s/s
Treatment

A

Differentiate:
Rate - 150-250bpm

Cause:
- Multiple causes
- May be d/t accessory electrical pathway

s/s:
- Palpitations
- SOB, hypotension, LOC
- Restlessness

Treatment:
- Adenosine
- Vagal maneuvers
- Cardioversion / Surgical ablation

23
Q

Atrial arrhythmias

Atrial flutter:

How to differentiate
Cause
s/s
Treatment

A

Differentiate:
- rate: atrial rate = 250-400 bpm; ventricular rate = 75-150bpm

Cause:
- Conduction defect within the atria

s/s:
- Palpitations
- SOB
- Fatigue
- Dizziness

Treatment:
- Rate control
- Cardioversion
- Ablation

24
Q

Atrial arrhythmias

Atrial flutter:

How to differentiate
Cause
s/s
Treatment
Increased risk of?

A

Differentiate:
- Rhythm: irregular
- Rate: Rapid

Cause:
- Age
- HTN, CHF, MI
- Diabetes Mell.
- Obesity
- OSA

s/s:
- Palpitations
- Hypotension, lethargy

Treatment:
- Anticoagulation
- Cardioversion
- WATCHMAN device placement
“Increased risk of developing atrial thrombus and systemic embolism

25
What is the WATCHMAN device placement?
Blockage placed into atrial appendage to prevent blood pooling during atrial fibrillation
26
Cardioversion: What is it? How is it performed Nursing care
Delivers a "timed" electrical current to break a tachyarrhythmia; electricity is synchronized with the patient's own electrical impulses Implications: - Elective - Light sedation and analgesia - Anticoagulants for several weeks prior to procedure - Hold digoxin 48 hours prior Nursing care: - NPO - informed consent - Monitor EKG - Monitor vs, O2 sat
27
Ventricular Arrhythmias Premature Ventricular Contraction (PVC): What is it? Cause s/s Treatment
Extra, abnormal heartbeat originating in the ventricles Cause: - Typically d/t electrical irritability - Stimulants (caffeine, nicotine, alcohol) s/s: - Cardiac output may be compromised Treatment: - Treat the cause - Oxygen and anti-dysrhythmic drugs
28
When is a rhythm consider V Tach?
Three or more PVC's in a row
29
Ventricular Arrhythmias Ventricular tachycardia: What is it? How to differentiate Cause s/s
Definition: - Three or more PVC's in a row Differentiate: - Rate: 100 - 250 bpm - QRS: Wide complexes measuring > 0.12 seconds Cause: - CAD, MI - Electrolyte imbalances s/s: - Chest pain, SOB - Dizziness, altered mental status - Cardiac arrest
30
Ventricular Tachycardia: Treatment
Stable: - Pulse - Minimal symptoms - Normotensive - AO x3 Treat with anti-arrhythmic drugs or synchronized cardioversion Unstable: - Pulseless - Hypotensive - Symptomatic Treat with defibrillation (similar to V-Fib)
31
Ventricular Arrhythmias Torsades de Pointes: How to differentiate
Differentiate: - Prolonged QT interval Cause: - Hypomagnesemia - Long QT syndrome Treatment: - 2g Magnesium sulfate
32
What causes Torsades de Pointes rhythm? How is it treated?
Cause: - Prolonged QT syndrome Treat: - 2g magnesium sulfate
33
Ventricular arrhythmia Ventricular fibrillation
Definition: Rapid, disorganized electrical rhythm Differentiate: - Extremely irregular - Rate: >300 bpm Cause: - CAD, MI, ischemia - Electrolyte imbalances, acid/base imbalances - Hypothermia - Untreated V-Tach Symptoms: - Pulselessness - Cardiac Arrest Treatment: - "V-Fib = D-Fib" - High quality CPR - anti-arrhythmic drugs
34
What is priority treatment for Ventricular fibrillation (V-Fib)?
Defibrillation High quality CPR
35
Cardioversion vs. Defirillation
Cardioversion - Planned and synced shock, weaker Used for: - A-Fib - SVT - Stable V-Tach "Weaker electricity" Defibrillation - Unsynchronized shock given in emergent situation, stronger shock Used for: - Pulselessness V-tach - V-Fib
36
Asystole: What is it? Treatment
What is it: - Flatline - Absent QRS complexes, cardiac standstill - No pulse Treatment: - High quality CPR - Epinephrine Usually fatal
37
Atrioventricular (AV) Blocks: What is it?
Electrical impulses are delayed or blocked from passing through the AV node Cause: - Medications - Ischemia - MI
38
1st degree AV block
Differentiate: - PR interval: Prolonged > .20 seconds s/s: - Usually asymptomatic Treatment: - Treat underlying cause if patients are symptomatic
39
2nd Degree - Type I Mobitz I (Wenkebach)
Differentiate: - R:R interval is irregular - PR interval: Progressive lengthening until a QRS complex is dropped - P to QRS interval le Symptoms: - Often asymptomatic Treatment: - Treat underlying cause if pts are symptomatic
40
2nd degree Type II / Mobitz II
Differentiate: - PR interval: PRI remains constant until a block of the AV conduction, resulting in a P wave not being following by a QRS
41
3rd Degree (Complete Heart Block):
Differentiate: - Rate & rhythm: Atrial and ventricular rate and rhythm are independent of one another - Atrial rate: 60-100bpm - Ventricular rate often < 40 bpm s/s: - Fatigue, dizziness, SOB, LOC - Chest pain Treatment: - Temporary pacing followed by permanent pacemaker placement
42
Heart Block Poem
43
Pacemaker: What is it?
Small, implantable device which helps regulate heart rhythm - Battery operated - Electrical spike is visible, followed by complexes - Requires intermittent surveillance
44
Pacemaker: Pacing function
Atrial pacing: - Stimulation of right atrium produce spike on ECG preceding the P wave Ventricular pacing: - Stimulation of right or left ventricle produce a spike on ECG preceding the QRS complex
45
Pacemaker: Indication
Slower than normal conduction disturbances: - Bradycardia - 2nd degree AV Block Type II - 3rd degree heart block Tachydysrhythmias: - Less common - Refractive to medication therapy
46
Pacemaker: Complications
- Local infection - Localized hematoma - Dislocated leads - Loss of pacing - Loss of capture
47
Pacemaker: Nursing Care Patient Education
Nursing Care: - Monitor HR and EKG strips - Assess hemodynamic stability - Incision care post-op Patient education: - Teach patient to check pulse frequently - Report slowing of pulse greater than the set rate - Report s/s of complications: palpitations, fatigue, dizziness, prolonged hiccups - Avoid MRI
48
Automatic implantable cardioverter defibrillator (AICD) What is it?
Purpose: - Monitors heart rate & rhythm and identifies V-Tach or V-Fib - Delivers a 25 joule shock to the heart muscle upon sensing a lethal arrhythmia Indicated: - Patients at high risk of spontaneous V-Tach / V - Fib "Like surveillance, fires only when necessary"
49
AICD: Patient teaching
Short term: - Monitor for s/s infection after placement - Avoid lifting arm above shoulder for 1 week Long term: - Avoid direct injury to AICD device - Airport security - Routine follow up for surveillance - Avoid MRI - Family trained in BLS
50

NUR 146 Lecture (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions