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ANATOMY AND PHYSIOLOGY > NURSING CARE FOR ARRYTHMIAS PTs > Flashcards

NURSING CARE FOR ARRYTHMIAS PTs Flashcards

1
Q

Electrocardiogram

A
  • shows 12 lead (views), standard view for practice
  • Waveforms Upright in Lead II…easier to read
  • PT must be supine
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2
Q

Isoelectric Line

A
  • no electrical current (i.e. PT not attached to monitor
  • baseline
  • straight line
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3
Q

P Wave

A
  • 1st wave, shows atrial depolarization
  • should always appear rounded and upright
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4
Q

P-R Interval

A
  • Time it takes an impulse to travel from SA to AV node
  • Beginning of P-wave to Beginning of QRS complex
  • 0.12 to 0.20 Seconds normal time interval (or 3-5 tiny boxes..which are 0.04 seconds/ea.)
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5
Q

QRS Complex

NOT the QRS Interval

A
  • After P Wave
  • Q Wave is First Downward Deflection after P-wave
  • R Wave is First Upward Deflection
  • S Wave Second Negative Deflection if Q Wave/ First Negative Deflection after R Wave
  • QRS shows Ventricular Depolarization
  • S wave ends when its back to isoelectric line
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6
Q

QRS Interval

A
  • Shows time it takes an impulse to travel from AV node to the ventricles (0.06-0.10 seconds or 1.5-2.5 tiny boxes)
  • Beginning of QRS to End of QRS
  • AV node through ventricles
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7
Q

T Wave

A
  • ventricular repolarization (resting)
  • Contraction must occur 1st
  • follows QRS Complex
  • QRS Ventricular depolarization must occur before ventricular depolarization
  • Inverted T wave (it’s upside down) can indicate ischemia
  • Normal T wave: rounded and facing upward
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8
Q

QT Interval

A
  • beginning of Q wave to end of T Wave
  • Ventricular depolarization & repolarization
  • Prolonged or Shortened>Ventricular Arrhythmias
  • (0.34-0.43)
  • varies from gender, age, H.R.
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9
Q

U wave

A
  • rare
  • hypokalemia
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10
Q

ST segment

A
  • checked for angina complaints
  • Time from depolarization to repolarization (from contracting to resting)
  • End of QRS to Beginning of T Wave
  • segment elevates with ischemia/cardiac injury
  • segment can also depress with ischemia
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11
Q

Reading Cardiac Rhythms

A
  1. Measure of mini boxes between R to R is =
  2. Regular:# of tiny boxes/1500=H.R…irregular: # of Rs on 6-second stripX10=H.R.
  3. If there’s P-waves, they round/regular? must find arrythmia type if no P wave(s)
  4. P-R interval vary?
  5. QRS Complex normal? (0.06-0.10) Identical?
  6. QT Interval normal? (0.34-0.43)
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12
Q

Normal Sinus Rules

A
  • Rhythm: Regular
  • Heart Rate: 60 to 100 bpm
  • P Wave: Rounded, one Before each QRS
  • PR Interval: 0.12 to 0.20 Seconds
  • QRS Interval: 0.06 to 0.10 sec
  • Begins in SA node
  • Sinus: Impulse originates from S(sino)A node
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13
Q

ARRHYTHMIAS

A
  • Impulse can begin from atria, AV node, or ventricles
  • Increased/decreased HR
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14
Q

Sinus Bradycardia

A
  • Impulse from SA node but slow
  • HR less than 60 BPM..can show S/S at 50
  • electrolyte imbalance, meds, M.I.
  • Tx: treat cause, atropine via IV, transcutaneous pacing
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15
Q

Sinus Bradycardia Rules

A
  • Rhythm: Regular
  • Heart Rate: < 60 bpm
  • P Waves: Rounded, Before Each QRS
  • Normal PR & QRS interval
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16
Q

Atrial Arrhythmias

A
  • PACs»R TO R will be shorter
  • Heart Rate: Per Underlying Rhythm
  • P Waves: Early Beat, Abnormal Shape
  • P–R Interval: Usually Normal
  • QRS interval: normal
  • Signs & symptoms: possible palpitations
  • Therapeutic Interventions: None (asym), Treat Cause, Beta Blockers
17
Q

Atrial Flutter

A

** Rhythm: Atrial Rhythm Regular
* Heart Rate: Varies
* P Waves: F Waves, Sawtooth Pattern
* P–R Interval: Non Measurable
* QRS Interval: normal
* Heart failure, ischemic heart disease, pericarditis
*S/S: Ventricular Rate Normal, None, Rapid Ventricular Rate(Palpitations, Angina, Dyspnea)
* control HR: ca channel blockers, betas, digoxin
* Cardioversion–for pts with stable rates…goal is to control ventricular rate and convert to NSR
* Amiodarone–antiarrhythmic
* Catheter ablation&raquo_space;right atrium, gets rid of flutter

18
Q

A Fib Rules

A
  • Rhythm: Irregularly Irregular (rapid, chaotic)
  • Heart Rate: Atrial Rate Not Measurable, Ventricular Rate: <100–controlled, >100–uncontrolled
  • P Waves: No Identifiable P Waves because of the fibrillation
  • P–R Interval: Non Measurable
  • QRS Interval: normal
  • A fib PTs at risk of increased stroke from dysrhythmias
19
Q

Premature Ventricular Contractions

A
  • have diff shapes: uni or multifocal
  • occur every other heartbeat
  • caused by caffeine, anxiety, cardio myopathy
  • PVC Interrupts Rhythm
  • PVCs originate in ventricles NOT SA Node
  • P Waves: Absent in PVC
  • 3 or more PVCs in a row= V Tach
  • bigeminy- every other beat
20
Q

V-Tach

ventricular tachy
##footnote
not an immediate emergency

A
  • Something wrongs QRS segment…Can occur from MI, cardiomyopathy, digoxin toxicity (side effect could be dysrhythmias)
  • Rhythm: Usually Regular
  • Heart Rate: 150 to 250 Ventricular bpm
  • seriousness should be determined by arrhythmia duration
    *sustained VT can become pulseless VT
  • S/S: Dyspnea, palps, dizzy, angina…MONITOR PT VT CAN CAUSE FAILURE
21
Q

Digoxin

A
  • Inotrope—slows HR, maintains sinus rhythm for sinus tachy, atrial flutter, and AF
  • AKA Lanoxin
  • listening to apical pulse for full min, if less than 60 hold med, contact HCP
  • be aware of this toxicity.. S/S bluish vision, GI upset
22
Q

Asystole

A
  • no electrical activity
  • occurs from hyperkalemia, V Fibromyalgia, MI
  • no pulse, pressure, or Resps START CPR
23
Q

Fluid Overload

A
  • cause by backwards fluid and elevated pressure
  • causes back up of interstitial fluid which causes swollen alevoli, leading too
  • pulmonary edema or L sided H.F.
  • diuretics are used to lower fluid amt via urination by lowering Na conc.
  • fluid usually overloads in the
    lungs
  • NANDA: fluid vol. excess r/t
24
Q

Pulmonary Edema

A
  • life threatening, sudden, complication of L sided HF (L think LUNG)
  • comes from alveolar fluid build up
  • can cause arrhythmias && cardiac arrest
  • impaired gas exchange
25
Pulmonary edema diagnostics, therapy
* dx: chest xray, ABG, ECG, hemodynamic monitoring… P.E. can cause *respiratory acidosis* * interventions: inoptropes **(digoxin/Lanoxin)**, diuretics, morphine, vasodilators; high fowler’s, O2, rest, V.S, monitor Output
26
Left sided Heart Failure
* after load is **increased** * **blood backs up from left vent into left atrium** * Left ventricle works harder, weakens and fails over time * causes: aortic stenosis (^ vol. to pump), cardiomyopathy (bad contracility), aortic coarctation (^ pressure), myocarditis, M. I., mitral regurgitation * generally caused by disorders that: **restrict blood outflow, impair contracility, allow backward blood flow**
27
Left Sided Heart Failure S/S
* paroxysmal nocturia * pulmonary congestion (cough, crackles, wheezes, bloody sputum, tachypnea * restlessness * confusion * orthopnea * fatigue * cyanosis
28
Right Sided Heart Failure
* **L sided H.F is a major cause** * **fluid backs up in lungs causing ^ pulmonary pressure** * R ventricle failure leads to build up of blood in systemic vessels * **caused by: cor pulmonale (right ventricle failure/hypertrophy), L sided HF, pulmonary hypertension, pulmonary stenosis, atrial septal defect**
29
Right sided Heart Failure S/S
* **JVD** * **peripheral edema** * **organ engorgement: splenomegly, hepatomegaly** * **GI tract congestion**: nausea, anorexia, abdominal pain * **progression>>hepatic venous stasis** * **pain in RUQ** * **elevated LFTs: ALT and ALP**
30
Compensatory Mechanisms
* designed to maintain C.O…. **but can lead to further heart failure for overworking** * **sympathetic NS releases epi and norepinephrine >>tachycardia** * **kidneys activate RAA>> ADH secreted to save H2O>>urine decreased so more fluid is held in addition to pre existing excess** * **heart remodeling: caused by chamber enlargement, dilation/hyoertrophy, increases heart’s O2 needs**
31
Diuretics
* loop: potassium **sparing** **(spironolactone)** & potassium **wasting** (thiazides) * always check potassium levels **before** giving pt a potassium **wasting** diuretic …**lasix, bumex, démodex**
32
Dyspnea Types
* **orthopnea**: Dyspnea when laying down..fluid moves from bottom to top (legs>heart) which adds to the congestion…PTs will usually use 2+ pillows when lying flat * **paroxysmal nocturnal dyspnea**: SOB after lying flat for some time, results from excessive lung fluid. PT may awaken feeling “suffocated”, have PT sit up to *reduce returning fluid to heart*
33
Cardiac pacemaker
* generates impulse if there’s a cardiac conduction issue, overrides arrhythmia * **external**: permanent; for bradycardia * temporary: for Brady/Tachy * internal/permanent too * can be placed in atria, ventricle, or both * done with fluoroscopy * **single lead: atria or ventricle; double lead: atria AND ventricle** * issues: can’t sense beat, pace failure, capture failure (lack of depolarization)
34
Pacemaker Nursing Care and PT eduction
* Nursing care: monitor ECG, rest, don’t raise arm * PT education: incision care (infection awareness like discharge or swelling), radial pulse self-assessment, pacemaker ID card, S/S reportable (angina, hiccups, palps), grounded appliances like microwaves are safe to be around, periodic pacemaker checks, lifting/workout restrictions, metal detector triggers
35
Cardiac Conduction System
* SA (60-100)>>AV(40-60)>>bundle of His>>R/L branches>>purkinje fibers * ventricles can kick in with an insufficient BPM of 20-40 * Impulse made by SA stimulates atria * depolarization aka **contraction**, repolarization **Relaxation** *
36
Ventricular Tachycardia Tx
* if pulseless: **CPR, AED, ACLS (life support), vasopressors (epinephrine)** * if stable: **amiodarone (anti-arrhythmic), possibly magnesium for electrolyte abnormality, lidocaine**
37
Ventricular Fibrillation S/S & Tx ##footnote Is an emergency
* rhythm: chaotic and irregular * **immediately unconscious** * V Fib is associated with sudden cardiac death * **no heart sounds, no peripheral pulses, or BP** * **resiprstory arrest, cyanosis, pupil dilation** * Tx: **ACLS: immediate defibrillation is the 1st choice, then CPR, epinephrine, amiodarone, magnesium, vasopressin, endo tube**
38
Atrial Fibrillation S/S and Treatment
* **S/S: palps, faint radial pulse, valve disorders (HTN, M.I.)** * **Tx: Medications to control HR, prevent thombus formation, and try to restore normal rhythm. Treatment based on condition. Meds started if PT is stable.** * Tx: **digoxin (inotrope), beta blockers, -PINES (ca channel blockers)** * Tx: **amiodarone, warfarin (both control ventricular rate), ablation, synchronized cardio version**
39
Premature Ventricular Contractions Tx & S/S
* **S/S: palps, Fatigue, Dizziness, Severe Dysrhythmias..occurs with frequent PVCs , Can occur from CO decrease** * **Tx: none, Antiarrhythmics (“-ONE” meds) ca channel blockers, betas**

ANATOMY AND PHYSIOLOGY (11 decks)

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