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Critical Care Nursing > Patients w/ Conduction Probs > Flashcards

Patients w/ Conduction Probs Flashcards

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1
Q

How many seconds are the tiny boxes worth on a 6 second strip?

A

0.04 seconds

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2
Q

How much are the bigger boxes worth on a six second strip?

A

0.20 seconds

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3
Q

How many boxes are in a 6 seconds strip?

A

30

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4
Q 
1R
2R
3P
4PR
5QRS
A 
1 Rate 
2 Rhythm is regular or irregular?
3 P-wave 
4 PR interval 
5 QRS complex < .12 seconds?
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5
Q

How do you find the rate for step 1 on a 6 second strip?

A

Count how many QRS complexes appear on a 6 second strip and multiply by 10

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6
Q

What do you determine in step 2 about the rhythm?

A

If it is regular or irregular-look at QRS complexes

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7
Q

What do you determine about the P-wave in step 3?

A

do they all look alike and do they come before and after the QRS complexes

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8
Q

What is a normal PR Interval?

A

0.12-0.20 seconds

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9
Q

How do you measure the PR intervals?

A

Measure from the beginning of the P-wave to the beginning of the QRS complex
-count how many tiny boxes are between and multiply by 0.04 seconds

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10
Q

How do you measure the QRS duration in step 5?

A

measure from beginning of QRS complex to the end and multiply be 0.04 seconds

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11
Q

What does the P-wave represent?

A

the electrical impulse starting in the SA node and spreading throughout the atria
-atrial depolarization

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12
Q

What does the PR interval represent?

A

the time needed for SA node stimulation, atrial node depolarization, and conduction through AV node before ventricular depolarization

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13
Q

What does the QRS complex represent?

A

ventricular depolarization

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14
Q

How long is a normal QRS duration?

A

less than .12 seconds

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15
Q

What does the T-wave represent?

A

ventricular repolarization or electrical recovery

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16
Q

When does NORMAL Sinus Rhythm occur?

A

when the electrical impulse starts at the SA node and travels through the normal conduction pathway

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17
Q

Normal Sinus Rhythm serves as a what?

A

Baseline

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18
Q

Normal Sinus Rhythm Characteristics

A 
Rate: 60-100
Rhythm: regular 
P-wave: normal and consistent 
PR Interval: b/t .12-.20
QRS duration: less than .12 seconds
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19
Q

What is the ONLY difference b/t Normal Sinus Rhythm and Sinus Arrhythmia?

A

Irregular Rhythm

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20
Q

A Sinus Arrhythmia’s irregular rhythm may correlate w/ what?

A

Breathing

Rate increases w/ inspiration and decreases w/ expiration

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21
Q

When does Sinus Bradycardia occur?

A

when the SA node creates an impulse at a slower rate than normal

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22
Q

What is the ONLY difference b/w Sinus Brady and Normal Sinus Rhythm?

A

rate is less than 60 bpm

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23
Q

What are some causes of Sinus Brady?

A
  • sleep
  • pain
  • athleticism
  • vomiting/hypovolemia
  • suctioning
  • medications
  • increased intracranial pressure
  • MI
  • anemia
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24
Q

What medications may cause Sinus Brady?

A
  • calcium channel blockers
  • amiodarone
  • beta blockers
  • digoxin
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25
Q

Sinus Brady ECG Characteristics

A 
Rate: < 60 bpm
Rhythm: regular 
P-wave: present before and after QRS and looks same 
PR: normal 
QRS: normal
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26
Q

Treatment for symptomatic Sinus Brady may be what?

A
  • transcutaneous pacing
  • atropine
  • dopamine
  • epinephrine
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27
Q

When does Sinus Tachycardia occur?

A

When SA node creates an impulse at a faster rate than normal

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28
Q

What are some causes of Sinus Tachy?

A
  • stress
  • medications
  • stimulants
  • drugs
  • emotions/agitation
  • blood loss/hemorrhage/hypovolemia
  • sepsis
  • hyperthyroidism
  • anemia
  • infection/inflammation
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29
Q

ECG Characteristics of Sinus Tachycardia

A 
Rate: > 100 bpm
Rhythm: regular 
P-wave: before and after QRS and same 
PR: normal 
QRS: normal
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30
Q

What is a Premature Atrial Complex (PAC)?

A

single ECG complex that occurs when electrical impulse starts in the atrium before the next normal impulse from the SA node

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31
Q

What may cause a PAC?

A
  • caffeine
  • alcohol
  • nicotine
  • hypervolemia
  • anxiety
  • hypokalemia
  • injury/infarction
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32
Q

ECG Characteristics w/ PAC

A 
Rate: depends on underlying rhythm
Rhythm: irregular 
P-wave: all same except one 
PR interval: all normal except one 
QRS duration: normal
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33
Q

How many PAC’s occurring in one strip is considered to be a sign of worsening arrhythmia?

A

more than 6 per min

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34
Q

Where does Atrial Flutter occur?

A

in the Atrium

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35
Q

What is the ATRIAL rate for atrial flutter?

A

220-350 bpm

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36
Q

What happens w/ Atrial Flutter?

A

The atrial rate is faster than what the AV node can conduct so not all atrial impulses are conducted to the ventricle

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37
Q

Causes of Atrial Flutter

A
  • CAD
  • hypertension
  • mitral/tricuspid valve disease
  • hyperthyroidism
  • chronic lung disease
  • pulmonary emboli
  • cardiomyopathy
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38
Q

S/S of Atrial Flutter IF present

A
  • fatigue
  • light headed
  • chest pain
  • SOB
  • low BP
  • blood clots
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39
Q

ECG Characteristics for Atrial FLUTTER

A

Rate: Atrial 220-350 bpm; Ventricular 75-150 bpm
Rhythm: usually regular
P-wave: flutter waves-“saw tooth pattern”
PR: not measurable
QRS: normal

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40
Q

What is the initial treatment for Atrial Flutter?

A

Cardioversion or radiofrequency ablation

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41
Q

Atrial Fibrillation causes what?

A

Rapid, disorganized , and uncoordinated electrical activity w/in the atria

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42
Q

A-fib can appear as what?

A
  • transient, starting and stopping suddenly
  • occur for short period of time
  • may be persistent
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43
Q

Long-standing Persistent A-fib

A

continuous AF or lasting longer than 12 months

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44
Q

When is the term “Permanent A-fib” used?

A

when the physician and patient together decide to stop further attempts of NSR

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45
Q

Nonvalvular A-fib

A

AF exists in the absence of preexisting heart valve problems

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46
Q

Patients in A-fib are at an increased risk for what?

A
  • blood clots/DVT
  • Pulmonary embolism
  • MI
  • stroke
  • kidney infarction
  • myocardial ischemia
  • heart failure
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47
Q

S/S of A-fib

A
  • asymptomatic
  • decreased CO
  • fatigue
  • malaise
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48
Q

ECG Characteristics of A-fib

A 
Rate: Atrial Rate 300-400, w/ variable ventricle response
Rhythm: irregular 
P wave: no discernible p-wave
PR: not measurable 
QRS: normal
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49
Q

Treatment for A-fib depends on what?

A
  • cause
  • duration
  • symptoms
  • age
  • comorbidities
50
Q

Treatment for A-fib

A

-cardioversion by meds or electrical shock

51
Q

Cardioversion via Medications

A

Intravenous ibutilide
procainamide
amiodarone

52
Q

When will pharmacological cardioversions be more effective?

A

When A-fib is more recent

53
Q

When are electrical cardioversions indicated?

A

when a patient w/ new onset AF is hemodynamically unstable

54
Q

What will be performed before a cardioversion for a patient w/ new-onset AF for over 48 hours or when the onset is unknown?

A

trans-esophageal echocardiography (TEE)

55
Q

Why is a TEE performed before a cardioversion?

A

to rule out left atrial thrombus because when a patient converts back to NSR the risk for PE is increased

56
Q

How long does a patient need to be on anticoagulants after a cardioversion?

A

4 weeks to prevent thromboembolism

57
Q

For patients who are unresponsive to medications w/ A-fib what is considered?

A

Pacemaker implantation or catheter ablation

58
Q

Supra-ventricular Tachycardia is a broad term for what?

A

to describe tachycardias where the atrial or ventricular rate exceeds 100 bpm at rest

59
Q

SVT electrical impulses are usually stimulated from where?

A

HIS bundle or AV node

60
Q

SVT is the term that covers what?

A
  • Sinus tachy
  • Focal/multifocal atrial tachy
  • junctional tachy
61
Q

Symptoms of SVT vary depending on what?

A
  • frequency/duration of episodes
  • timing of SVT
  • rhythm
62
Q

S/S of SVT

A
  • palpitations
  • chest pain
  • SOB
  • dizziness
  • syncope
  • panic/anxiety
63
Q

ECG Characteristics for SVT

A 
Rate: > 100 bpm
Rhythm: regular 
P wave: if visible sometimes inverted seen after QRS
PR: not measurable 
QRS: in paroxysmal SVT its normal
64
Q

Treatment for Atrial SVT depends on what?

A
  • cause
  • duration
  • symptoms
  • age
  • comorbidities
65
Q

What is recommended as the first step for Atrial SVT’s to discontinue rhythm in patients who are hemodynamically stable?

A

Vagal maneuvers

66
Q

What medication is given short term for patients w/ Stable SVT’s?

A

Adenosine

67
Q

If SVT becomes unstable what is the recommended treatment?

A

synchronized cardioversion

68
Q

For ongoing management of SVT’s patients mat be placed on what?

A
  • beta blockers
  • diltiazem
  • verapamil
69
Q

When does a Junctional Rhythm occur?

A

when the AV node instead of the SA node becomes the pacemaker of the heart

70
Q

Why would the AV node take over?

A
  • SA node slows from increased vagal tone

- impulse cannot be conducted through AV node b/c of heart block

71
Q

Junctional Escape Rhythm may be caused by what?

A
  • acute coronary syndromes
  • valvular disease
  • hypoxia
  • increased parasympathetic tone
  • medications
72
Q

What medications may cause junctional escape rhythms?

A
  • digoxin
  • beta blockers
  • calcium channel blocker
73
Q

ECG Characteristics for Junctional Escape Rhythms

A

Rate: 40-60 bpm
Rhythm: regular
P wave: if visible may be before, during, or after
QRS: normal

74
Q

What is the treatment for Junctional escape rhythms if symptomatic?

A

Same as for bradycardia

  • temporary/permanent pace maker
  • IV atropine
  • IV epinephrine
75
Q

If there is a delay or defect in the conduction system w/in the ventricles what happens to the QRS complex?

A

It will be prolonged or widened

> .12 seconds

76
Q

What may cause Ventricular Arrhythmias?

A
  • ventricular hypertrophy
  • cardiomyopathy
  • myocardial ischemia/infarction
77
Q

When would Ventricular Arrhythmias require temporary pacing?

A

When there is an acute MI that progresses to complete heart block

78
Q

What is a premature ventricular complex (PVC)?

A

Impulse that starts in the ventricle and is conducted through the ventricles before the next normal sinus impulse

79
Q

PVC’s may occur in normal healthy people because of what?

A

Intake of caffeine, nicotine, or alcohol

80
Q

Causes of PVC’s

A
  • cardiac ischemia/infarction
  • exercise
  • fever
  • hypervolemia
  • heart failure
  • tachycardia
  • hypoxia
  • acidosis
  • hypokalemia
81
Q

PVC’s may be an early marker for what?

A

Heart failure

82
Q

Patients w/ PVC’s may be asymptomatic or complain of what?

A

their heart “skips a beat”

83
Q

Bigeminy PVC

A

a rhythm in which every other complex is a PVC

84
Q

Three or more successive PVC’s are termed as what?

A

Ventricular Tachycardia

85
Q

ECG Characteristics for PVC

A 
Rate: depends on underlying rhythm 
Rhythm: regular 
P wave: depends on timing of PVC
PR: if in front of QRS its <0.12 sec
QRS: wider/abnormal in PVC
86
Q

What is Ventricular Tachycardia defined as?

A

three or more consecutive ventricular beats occurring at a rate more than 100 bpm

87
Q

Ventricular Tachycardia may occur with what?

A
  • ACS
  • after MI
  • inherited arrhythmia syndromes
  • electrolyte imbalances
  • cardiomyopathies
  • structural heart disease
88
Q

Ventricular tachycardia can deteriorate into what?

A

Ventricular fibrillation

89
Q

S/S Ventricular Tachycardia

A
  • hypotension
  • syncope
  • pulselessness
  • unresponsiveness
90
Q

ECG Characteristics for Ventricular Tachy

A 
Rate: 100-250 bpm
Rhythm: regular 
P wave: not visible 
PR interval: none 
QRS: > 0.12 sec
91
Q

Monomorphic Ventricular Tachy

A

consistent QRS shape and rate

92
Q

Polymorphic V-tach

A

varying QRS shapes and rhythms

93
Q

If a patient is stable w/ V-tach the only treatment may be what?

A

Continued assessment w/ 12-lead ECG

94
Q

What is often the medication of choice for a stable patient w/ V-tach?

A

Amiodarone

95
Q

What is the treatment of choice for Monophasic V-tach in symptomatic patient?

A

Cardioversion

96
Q

When would the nurse begin to prepare the patient w/ V-tach for a cardioversion?

A

When the patient begins to demonstrate hypotension, shock, angina, symptoms of CHF, edema, or symptoms of cerebral hypoperfusion

97
Q

What is Ventricular Fibrillation?

A

Rapid, disorganized ventricular rhythm that causes ineffective quivering of the ventricles

98
Q

S/S of V-fib

A

Absence of audible heart beat, palpable pulse, and respirations

99
Q

What is imminent w/ V-fib?

A

Cardiac arrest and death

100
Q

ECG Characteristics for V-fib

A 
Rate: often cannot be determined but > 220 bpm
Rhythm: irregular 
P wave: not visible 
PR: none
QRS: none
101
Q

What is the treatment of choice for V-fib?

A
  • immediate defibrillation
  • immediate CPR
  • activation of emergency services
102
Q

What vasoactive medications should be delivered after the second rhythm check for someone in V-fib?

A

Epinephrine

103
Q

What does a Ventricular Escape Rhythm occur? (Idioventricular Rhythm)

A

When the impulse starts in the conduction system below the AV node

104
Q

Who is creating the impulse in a Ventricular Escape Rhythm?

A

Purkinje Fibers

105
Q

ECG Characteristics of Ventricular Escape Rhythm

A 
Rate: 20-40 bpm
Rhythm: regular 
P wave: not visible 
PR: none 
QRS: 0.12 secs or more
106
Q

If the rate is greater than 40 bpm w/ Ventricular Escape Rhythms it is known as what?

A

Accelerated ventricular escape rhythm

107
Q

Treatment for Ventricular Escape Rhythm

A
  • same as asystole if patient is in cardiac arrest
  • if not in cardiac arrest same as if bradycardia
  • administer IV atropine and vasopressors
  • emergency pacing
108
Q

What is Ventricular Asystole characterized as?

A

“flat line”

Absent of QRS complexes confirmed in two different leads

109
Q

How is Asystole treated?

A

Focusing on CPR and identifying underlying cause

110
Q

Possible causes of Asystole

A
  • hypoxia
  • acidosis
  • severe electrolyte imbalance
  • overdose
  • hypovolemia
  • cardiac tamponade
  • tension pneumothorax
  • trauma
  • hypothermia
111
Q

When does SR w/ First Degree Heart Block occur?

A

When atrial conduction is DELAYED through the AV node, resulting in prolonged PR interval

112
Q

Causes of First Degree Heart Block

A
  • beta blockers
  • calcium channel blockers
  • digoxin
  • vomiting
  • Valsalva maneuver
113
Q

ECG Characteristics of First Degree Heart Block

A 
Rate: depends on underlying rhythm 
Rhythm: regular
P wave: present before and after and consistent
PR: greater than 0.20 secs
QRS: normal
114
Q

When is a patient w/ First Degree Heart Block treated?

A

When symptoms related to bradycardia are presentre

115
Q

Second Degree Heart Block Type 1 is also known as what?

A

Wenckebach

116
Q

What causes Second Degree Heart Block type 1?

A

a gradual and progressive conduction delay through the AV node

117
Q

When does SDHB Type 1 occur?

A

When there is a repeating pattern in which all but 1 of a series of atrial impulses are conducted through the AV node

118
Q

What is seen w/ the PR interval on an ECG of SDHB Type 1?

A

Increasing PR interval is seen w/ each successive beat until a P wave is seen w/o a resulting QRS

119
Q

S/S of Wenckebach

A
  • symptoms of bradycardia
  • chest discomfort
  • dyspnea
  • hypotension
120
Q

Causes of Wenckebach

A
  • increased parasympathetic tone
  • ischemia
  • or meds that slow conduction
121
Q

ECG Characteristics of Wenckebach

A 
Rate: atrial faster than ventricular
Rhythm: Atrial regular/ventricular irregular
P wave: normal 
PR: increasingly longer 
QRS: normal
122
Q

If patient w/ Wenckebach is symptomatic how is it treated?

A

Atropine or transcutaneous pacing

Critical Care Nursing (14 decks)

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