Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Acute Care Exam 2 > Patients with Arrhythmias and Conduction Problems > Flashcards

Patients with Arrhythmias and Conduction Problems Flashcards

1
Q

process of cardiac conduction

A
  • electrical impulse generated at the SA node stimulates the atria to contract
  • the impulse travels to the AV node, where there is a brief delay
  • it then sweeps to the bundle of his and divides into the left and right bundle branches
  • conduction to the purkinjie fibers causes contraction of the ventricles
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

signs and symptoms of decreased cardiac output

A

tachypnea
SOB
orthopnea
DOE
hypoxemia
crackles
wheeze
dry or productive cough
edema
JVD
S3
murmurs
hypotension
decreased MAP
delayed cap refill
tachycardia
decreased urinary output
oliguria
abd distention
ascites
dizziness
syncope
fatigue
anxiety
restlessness

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

purpose fo electrocardiogram (ECG)

A

Provides a picture of cardiac electrical activity, including contraction and relaxation of the heart chambers

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

purpose of a lead on ECG

A

provides one view of heart; multiple can be used

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

Best lead to identify/interpret a rhythm for atria:
for ventricular:

A

Lead II for atria
Lead V1 for ventricles (mimics natural direction of a healthy heart)

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

Electrical impulses move b/w positive and negative pole

A

Moves toward from positive= waveforms upright on ECG
Moves away from positive = waveforms have negative deflection

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

positioning of electrodes

A

Crucial to obtaining an accurate ECG
Position the client supine with HOB 30-40⁰
Debride the skin with soap and water as necessary
Clip (DO NOT SHAVE) the hair if necessary
Avoid diaphoretic area
Connect electrodes to lead wires before placing them on the chest
Locate the landmarks for placement in the light
Change electrodes every 24-48 hours
Use hypoallergic electrodes if necessary
Who is responsible for obtaining an ECG?
Who is responsible for interpreting an ECG?

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

continuous ECG monitoring

A

Indications for use
– Risks of unnecessary monitoring
Electrodes placed on the trunk of the body in five locations
Ensure proper placement of leads
Always assess the patient first!!
Signals transmitted to bedside monitor or from a transmitter box to a central monitoring station (telemetry)
When should the monitoring be suspended? Who determines this?

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

ambulatory electrocardiography

A

Continuous form of monitoring used in the outpatient setting
Wears a portable recording device that is connected to the chest by electrodes
Monitoring period can be 24-48 hours (Holter) or weeks
Client records any symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

interpreting ECG strip paper

A

Rhythms are printed on special graph paper
Measures amplitude and time
–Time/rate is on horizontal axis (in sec); amplitude/voltage (in mm) is on the vertical axis
Each small box is 1 mm and 0.04 sec;
Each large box is 0.20 sec
–Small box X 5 = large box
–Five large blocks = 1 sec
–Thirty large blocks = 6 sec

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

interpretation of a P wave

A

SA Node sending out electrical impulse
**Atrial depolarization/contraction (generation of an impulse from SA node)
Should be upright and rounded
Should not be longer than 0.10 sec and no higher than 2.5 mm

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

interpretation of the PR interval

A
  • Measure of time it takes for sinus node stimulation,
    atrial depolarization, and conduction through AV node
  • Measured from beginning of P wave to the beginning
    of QRS
  • Electrical activity from atria to ventricles
  • Should be 0.12 – 0.20 seconds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

interpretation of QRS complex

A

Ventricle contraction
* Time required for depolarization of both ventricles
* Hides atrial repolarization
* Pointy, skinny
* A wide QRS indicates ventricular as pacemaker or block in ventricles delaying impulse going to ventricles
* Normally <0.10 seconds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

interpretation of T wave

A

Ventricles relax
* Represents ventricular repolarization; electrical recovery
* Positive, rounded, and upright; follows QRS
* Can become inverted, peaked, or flat from myocardial ischemia, potassium imbalances, meds, or ANS effects

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

interpretation of ST segment

A
  • Represents early ventricular repolarization (resting state)
  • Length can vary
  • ST-Depression = ischemia
  • ST Elevation = injury
  • Q wave = necrosis/infarction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

interpretation of U wave

A
  • Represents repolarization of Purkinje fibers
  • May or may not be present
  • Seen in hypokalemia, HTN, or heart disease
  • Follows T wave
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

QT interval

A
  • Time it takes ventricles to depolarize, contract and then repolarize
    **Start of Q to the end of T wave
  • Medications can prolong
  • < 0.50 sec.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

steps for interpreting arrhythmias

A
  1. determining the HR
  2. determine the rhythm regularity
  3. determine if the rhythm originated in the SA node
  4. evaluate conduction
  5. evaluate the appearance of the rhythm
  6. interpret the rhythm
  7. if a change is noted from pts baseline, evaluate the patient, consider obtaining a 12-lead ECG, and report the change to the provider as appropriate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

3 ways to determine the HR (step 1)

A

First
* Use a 6 second strip to determine rate
** Count number of QRS complexes and multiply by 10
** More commonly used to assess irregular rhythms
Second
* Count number of small boxes between 2 R waves
** Divide into 1500
** More commonly used for accuracy
Third
* Count number of large boxes between 2 R waves
** Divide into 300

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

how to determine regularity of rhythm (step 2)

A
  • Count boxes between waveforms being measured
  • From P wave to P wave (atrial)
  • From QRS complex to QRS complex (ventricular)
  • Regular rhythm has equal space b/w waveforms
  • Can be regularly irregular or irregularly irregular
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

how to analyze the P waves (step 3)

A

Check the P-wave shape is consistent and existent
Determine if there is one P wave for each QRS
Ask:
–Are P waves present?
–Are the P waves occurring regularly?
–Is there one P wave for each QRS complex?
–Are the P waves smooth, rounded, and upright in appearance?
–Do all the P waves look similar?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

how to measure the PR interval (step 4)

A
  1. measure from beginning of P wave to end of PR segment
  2. should be 0.12-0.20 sec
  3. should be consistent
  4. if there are no P waves, this cannot be calculated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

how to measure the QRS duration (step 5)

A

Measure at the beginning to the end of QRS complex
Normally measures 0.04 – 0.10 sec
–If QRS is narrow, indicates impulse was not formed in ventricles
–If QRS is wide, indicates impulse is ventricular (abnormal)
Should be consistent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

how to examine the ST segment and T wave

A

ST segment:
–Monitor for depression and elevation
–ST elevation: MI, pericarditis, hyperkalemia
–ST Depression: Hypokalemia, MI, ventricular hypertrophy
T wave:
–Note shape and height
–Abnormal T waves (peaking or inversion) indicate MI or ventricular hypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Originates from the SA Node
–Rate: 60-100
–Rhythm: Regular
–P Wave: Present, consistent, one P wave for each QRS
–PR interval: 0.12-0.20 sec and constant
–QRS duration: <0.10 sec and constant

A

normal sinus rhythm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Results from changing with breathing (increases with inspiration; decreases with expiration)
Same characteristics as NSR, but it is irregular
Not clinically significant

A

Sinus Arrythmia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what is a dysrhythmia

A

Disruptions in the cardiac conduction pathway
Can cause decreased cardiac output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

clinical manifestations that MAY be present with dysrhythmias

A

Palpitations,
hypotension,
anxiety,
diaphoresis,
SOB,
syncope,
lightheadedness,
weakness/fatigue,
dizziness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

possible causes of dysrhythmias

A

Cardiac disease: HTN, HF, Cardiomyopathy, MI
Electrolyte Imbalances
Hypoxia
Infections
Drug toxicity
Hypovolemia
Stress
Fear
Anxiety
Recreational drug use: Substance abuse, tobacco, alcohol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

components of sinus bradycardia

A

Regular rhythm same as NSR but HR
<60
Can be caused by a variety of things

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

s/s of sinus bradycardia

A

syncope,
dizziness,
weakness,
confusion,
hypotension,
diaphoresis,
SOB,
chest pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

interventions for sinus bradycardia

A
  • Treat underlying cause when symptomatic
  • Nursing: notify the MD; assess LOC, pulse, BP, ECG; educate about s/s
  • Atropine IV (if cause unknown), epi, IV Fluids, O2, discontinuance of causative agent
  • Pacing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Rate: Less than 60
* Rhythm: regular
* P wave: present and consistent in size and shape
* PR interval: WNL
* QRS: normal

A

Sinus Bradycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what is sinus tachycardia

A

Similar characteristics of NSR, but rate is >100
Over a long period of time, can cause inadequate perfusion
Different causes
Assess for reduced cardiac output; can be asymptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

symptomatic treatment of sinus tachycardia

A

treat underlying cause,
beta blockers,
vagal maneuvers (carotid massage ONLY MD),
IVF,
pain management,
anxiety reduction techniques,
treat infection,
control thyroid,
administer blood,
change medication regiment

Adenosine 6 mg (first dose) followed by 20 ml sale flush
repeat in 1-2 min with 12 mg (second dose)
o2, CCB, or BB, possible cardioversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

client teaching for sinus tachycardia

A

Avoid substances causing increase in heart rate,
stress management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Rate: Greater than 100
Rhythm: regular
P wave: present and consistent in size and shape
PR interval: WNL
QRS: normal

A

Sinus tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what is premature atrial contractions (PAC)

A

Electrical impulse starts in the atrium earlier than expected
Can be hidden in the T wave and is usually followed by a pause to reset and resume regular rhythm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

causes of premature atrial contractions (PAC)

A

hypoxia,
excessive stimulant ingestion like caffeine/alcohol/nicotine, hypervolemia,
anxiety,
hypokalemia,
atrial ischemia/injury/infarction

40
Q

s/s of premature atrial contractions (PAC)

A

asymptomatic
sometimes palpitations

41
Q

treatment of premature atrial contractions (PAC)

A

treat causes,
monitor frequency,
eliminate coffee,
manage stress,
avoid substances
If frequent, further work-up

42
Q

Rate: depends on underlying rhythm
Rhythm: irregular
P wave: premature beat different; others WNL
PR interval: premature beat >0.12
QRS: normal

A

premature atrial contraction (PAC)

43
Q

what is atrial flutter

A

Produced by a pacemaker cell other than the SA Node (so no P waves seen)
Flutter waves present, described as a saw-tooth pattern with F waves
Atria beat too fast, with rates of 250-300 but with a regular rhythm
- Atrial rate is faster than AV node can conduct  not all atrial impulses go to the ventricle

44
Q

causes of atrial flutter

A

CAD,
HTN,
pulmonary emboli,
cardiomyopathy,
MI,
severe mitral valve disease,
thyroid storm,
COPD

45
Q

complication of atrial flutter

A

emboli

46
Q

tx of atrial flutter

A

Like A-fib
Cardioversion, but not first line treatment unless symptomatic. Patient needs to have SOB, chest pain, and hypotension for use

47
Q

Rate: atrial rate 220-350; ventricular rate 75-150
Rhythm: usually regular
P wave: flutter waves in a characteristic sawtooth pattern
PR interval: not measurable
QRS: normal

A

atrial flutter

48
Q

what is atrial fibrillation

A

Most common dysrhythmia
Rapid, disorganized, and uncoordinated electrical activity within the atria; atria quiver
Can lead to pooling of blood in atria 
embolism
Can be chronic or short-term
Can be controlled (<100), uncontrolled (100-149), or with RVR (>150)

49
Q

risk factors of atrial fibrillation

A

age,
valvular heart disease,
CAD,
HTN,
HF,
cardiomyopathy,
DM,
OSA,
obesity,
hyperthyroid,
pulmonary disease,
chronic lung disease,
surgery;
hypoxia,
infection,
hypoglycemia,
caffeine,
alcohol,
smoking,
sympathomimetics

50
Q

assessment of afib

A

Chaotic rhythm with no clear P waves, irregular ventricular response/rhythm, narrow QRS, atrial rate 300-600 bpm
Characterized as irregularly irregular
Can cause impaired perfusion
Can be symptomatic or asymptomatic
Monitor for s/s of thromboembolism

51
Q

s/s of afib

A

fatigue,
malaise,
dizziness,
lightheadedness,
fainting,
SOB,
Sweating,
anxiety,
palpitations;
s/s of poor tissue perfusion

52
Q

goal of managing afib

A

control ventricular rate and achieve rhythm conversion to NSR

53
Q

medical management of afib

A

Can use CCBs (diltiazem) and amiodarone to convert rhythm to NSR, Beta blockers (metoprolol and esmolol) to slow ventricular response, Digoxin for HF and afib, anticoagulants (warfarin, apixaban/eliquis, dabigatran/pradaxa, rivaroxaban/xarelto)

Client teaching?
Teaching with anticoagulants?

Cardioversion with new-onset and unstable after TEE (but can’t have clots in atrium)
Catheter Ablation for no response to meds (electrical system is mapped out and problem area is burned with a laser to prevent conduction going to that area)

54
Q

what is supraventricular tachycardia

A

Tachycardias where the atrial and/or ventricular rate >100 at rest; electrical impulse originates above ventricles

55
Q

s/s of supraventricular tachycardia

A

Palpitations,
chest pain,
fatigue,
SOB,
nervousness,
anxiety,
hypotension,
syncope for SUSTAINED
Not sustained may be asymptomatic

56
Q

Rate: over 100
Rhythm: regular
P wave: if visible, may see it merged with QRS or T wave
PR interval: not measurable
QRS: normal generally depending on type

A

SVT

57
Q

SVT Treatment

A

Treatment (goal to decrease ventricular response, convert to NSR, and treat cause)
Remove cause
Vagal maneuvers are temporary and may cause rebound effects
–Carotid massage: MD massages carotid artery over a few seconds.
–Monitor ECG before, during, and after.
–Monitor for complications  bradydysrhythmias, asystole, Vfib, cerebral damage. Have emergency equipment ready!
–Valsalva: asking client to bear down
Adenosine 6 mg (first dose)  terminates acute episode and given rapidly followed by 20 mL NS.
–Repeat in 1-2 min with 12 mg (second dose) if needed
–Causes bradycardia with pause, nausea, and vomiting
–Have emergency equipment available because it can cause asystole for a brief period (expected response)
Cardioversion
CCBs (diltiazem and verapamil) and BBs for ongoing management

58
Q

what are premature ventricular contractions

A

Wide and atypical QRS complexes firing earlier than expected in ventricles
Can occur in bigeminy, trigeminy, or quadrigeminy, couplet; Can be unifocal or multifocal
Three or more successive PVCs are called ventricular tachycardia (VT)
Occur with MI (can trigger VT or VF), stress, nicotine, caffeine, alcohol, infection, exercise, dig toxicity, hypoxia, acidosis, hypokalemia
Modifiable risk factor for HF
Decrease cardiac output

59
Q

s/s of premature ventricular contractions

A

asymptomatic mostly; can have palpitations or chest discomfort; decreased stroke volume occurs which leads to decreased peripheral perfusion

60
Q

treatment of premature ventricular contractions

A

eliminating or managing cause
assess perfusion

61
Q

what is ventricular tachycardia

A

Repetitive firing of QRS complex >100
Can be monomorphic or polymorphic
LIFE THREATENING due to decreased CO!
Can be intermittent or sustained
Occurs with hypovolemia, hypoxia, acidosis, hypokalemia, hyperkalemia, hypoglycemia, hypothermia, toxins, cardiac tamponade, after MI, PE, trauma
Common rhythm seen before Vfib and can cause cardiac arrest
S/S depend on if pulse is present or not; generally decreased cardiac output

62
Q

Rate: 100-250
Rhythm: regular
P wave: usually not visible, if visible, not associated with QRS
PR interval: not measurable
QRS: Greater than 0.12

A

Ventricular tachycardia

63
Q

medical management of vtach with a pulse

A

Patient remains conscious
S/S dizziness, lightheadedness, fainting, SOB, sweating, anxiety, palpitations
Check ABCs
Cardioversion for symptomatic s/s
Administer Oral antidysrhythmic
Electrolyte replacements
ACLS protocol
Treat causes
Stay with the patient
Obtain 12 lead ECG
Frequent assessment

64
Q

medical management of vtach without a pulse

A

S/S: unresponsive, no pulse, no BP, apnea
Cardiac arrest
Follow ACLS protocol
-Initiate CPR/Defib/Code blue
–CAB approach (30:2)
–Maintain a patent airway
–Be aware of complications
–Do NOT stop while defibrillator is being set up
–Can do for about 5 cycles
Stay with client
Emergency meds: Epi and vasopressin

65
Q

what is torsade de pointes

A

Polymorphic VT
Congenital or acquired
-Acquired causes – drug therapy, hypokalemia, hypomagnesemia
Immediate treatment required

66
Q

treatment of torsade de pointes

A

Antiarrhythmics with temp pacing
IV mag initial treatment of choice for acquired

67
Q

what is ventricular fibrillation

A

Electrical chaos in the ventricles; ventricular contraction does not occur; quivering
Life threatening if not fixed in 3-5 minutes
No cardiac output or systemic perfusion

68
Q

when does ventricular fibrillation happen

A

hypovolemia,
hypoxia,
acidosis,
hypokalemia,
hyperkalemia,
hypoglycemia,
hypothermia,
toxins,
cardiac tamponade,
after MI, PE, trauma

69
Q

s/s of ventricular fibrillation

A

unresponsive, no pulse, no BP, apnea; cardiac arrest imminent

70
Q

treatment vfib

A

CODE BLUE,
Defib immediately,
CPR with chest compressions immediately,
epi

71
Q

Rate: often undetermined; >220
Rhythm: irregular
P wave: not measurable
PR interval: not measurable
QRS: not measurable

A

ventricular fibrillation

72
Q

what is asystole

A

No measurable electrical activity indicating no tissue perfusion

73
Q

asystole results from:

A

myocardial hypoxia,
hyperkalemia,
acidosis,
drug overdose,
hypovolemia,
cardiac tamponade,
tension pneumo,
coronary or pulmonary thrombosis, trauma,
hypothermia

74
Q

s/s of asystole

A

cardiac arrest (no pulse, BP, or resp), unconscious

75
Q

treatment of asystole

A

Call CODE BLUE, CPR, stay with patient, ensure IV access, administer epi as ordered
ASSESS PATIENT FIRST!!!!
NEVER SHOCK ASYSTOLE!!!!!!!!!
Be aware of complications from CPR
Be aware of when to “call it”

76
Q

Rate: not measurable
Rhythm: not measurable
P wave: not measurable
PR interval: not measurable
QRS: not measurable

A

Asystole

77
Q

what is pulseless electrical activity (PEA)

A

Electrical conduction system on the monitory is organized, but heart muscle doesn’t respond with a contraction; client is unresponsive, not breathing, pulseless

78
Q

causes of PEA

A

hypoxia, hypovolemia, hypo/hyperkalemia, acidosis, hypoglycemia, hypothermia, drug toxicities, cardiac tamponade, MI, PE

79
Q

treatment of PEA

A

CPR
Epi
Treat causes
Do not assume the patient has a pulse because you see a rhythm on a monitor! Palpate carotid pulse!!!

80
Q

assessment of patients with dysrhythmias

A

Vitals Q4 hours and PRN
Peripheral circulation
Change in LOC
Electrolytes and cardiac enzymes
respiratory difficulty

81
Q

general care of patients with dysrhythmias

A

Monitor for further development and complications and treat as appropriate
Evaluate and document response to dysrhythmias
Encourage client to notify of chest pain and document quality of chest pain
Provide antidysrhythmic therapy according to unity policy as appropriate and monitor response
Schedule exercise/rest periods appropriately
Monitor relevant labs
Promote stress reduction and decrease causative factors if possible
Offer spiritual support
Education
Prevention?
Care for older adult?

82
Q

purpose of cardioversion and defibrillation

A

Used to treat tachyarrhythmias by giving an electrical current that depolarizes, then repolarize, allowing SA node to take over again
Usually cardioversion has < amount of joules than defib
Electrically current done with paddles or electrode pads (used more frequently) OR internally or externally
Follow safety measures for both!!!

83
Q

what does cardioversion do

A

Delivery of electrical current is synced with client’s intrinsic rhythm
Used for tachy Afib, SVT, Vtach with pulse
Patient awake and sedated
with QRS
Consent form

84
Q

what does defib do

A

Emergency
Only corrects a rhythm, does not restart the heart
Not if the patient is conscious
Delivery of electrical current is not synced (delivered independent) of client’s intrinsic rhythm
Used for vfib or vtach without pulse
No cardiac output

85
Q

performing cardioversion

A

Delivery of timed electrical current for tachydysrhythmias
IV moderate sedation and analgesic/anesthesia
Defibrillator set in synchronous mode
Make sure area is clear; Turn 02 off and away from patient and bed (causes fire)
Never shock on T wave!! May cause VT or Vfib
Lower electricity
D/C dig 48 hours before elective cardioversion
May need anticoags few weeks before to prevent emboli during procedure
Don’t eat or drink 4 hours before

86
Q

performing defib

A

Used in emergencies for vtach w/o pulse and vfib
NOT used for clients that are conscious with pulse
After defib, immediately restart/start CPR
AED use
Stimulus stops the rhythm allowing the SA node to take over
Before, loudly and clearly command all personnel to CLEAR the area
Allow ACLS team to follow protocol
Never shock on T wave!! May cause Vfib
Maintain safety
D/C 02 near patient temporarily

87
Q

Implantable cardioverter/defibrillator (ICD)

A

Terminates life-threatening episodes of tachycardia or fibrillation
Used for those that have survived cardiac arrest, vfib, symptomatic vtach, right ventricular dysfunction
Programmed to automatically charge and deliver a shock when abnormality is present
Some have pacemaker function
Wearable cardioverter/defibrillator (LifeVest)
–Worn 24 hours a day except bathing
–Monitors for VF and VT; if patient conscious can press a button to deliver a shock

88
Q

teaching for Implantable cardioverter/defibrillator (ICD)

A

Shock can feel like a blow to the chest
Report to HCP swelling, fever, redness, soreness or drainage at incision site
Do not manipulate generator
Avoid rough contact and strenuous exercise
Do not wear tight clothing
Know function of device; emotional support
Avoid strong magnetic fields
Lie down or sit if dizzy or if they feel a shock
Wear medical alert bracelets and notify providers
Ensure family/friends know CPR

89
Q

pacemaker therapy

A

Electronic device that delivers electrical stimulation to the heart to regulate heart rate with slower than normal rate
Can be temporary or permanent
Consist of:
–Generator: contains energy source to determine the rate and strength of electrical stimulus to the heart
–Leads: deliver the settings from generator
Can be in fixed or demand mode
–Fixed (asynchronous) – fires at a constant rate regardless of heart’s electrical activity
–Demand (synchronous) – detects heart rate and fires only if rate is below a certain level

90
Q

what is temporary pacing

A

Nonsurgical technique providing a timed electrical impulse to the heart to regulate the heart

91
Q

transcutaneous pacing (temporary)

A

Electrodes are attached to the skin and a generator emits electrical impulses
Done for emergencies used for profound bradycardia and asystole when atropine has failed
Can cause discomfort; may need sedation and analgesia
Inspect skin for thermal burns
Obtain CXR for placement

92
Q

pacemaker leads attached directly to heart during open heart surgery

A

epicardial

93
Q

wires threaded through large vein and logged in chamber walls

A

endocardial

94
Q

permanent pacemaker

A

Treat conduction disorders that are chronic/recurrent AV node conduction disorders
Most last for 10 years
After procedure, monitor for: bleeding, swelling, redness, tenderness, and infection; teach ROM restrictions
Report failure to pace and capture

95
Q

Complication of Pacemakers

A

Local infection
Bleeding and Hematomas
Hemothorax or Pneumothorax
Ventricular ectopy and tachycardia
Movement or dislocation of electrode
Phrenic nerve stimulation (hiccups s/s)
Cardiac tamponade
Failure to sense/pace

96
Q

Client Teaching with Permanent pacemaker

A

With permanent pacemaker, restrict activity on side of implantation for 2-4 weeks
Wear sling when out of bed; avoid raising arm above shoulder for 1-2 weeks
Keep record of pacemaker settings
Monitor for s/s of bradycardia and decreased cardiac output
Objects that contain magnets should not be near the generator for longer than a few seconds
Keep cellphones 6 inches away from generator and do not keep in pocket
Keep identification card in wallet and wear medical alert bracelet
Don’t apply pressure to site
Take pulse for 1 minute every day at the same time; notify provider if there is a difference
Inform airport personnel
Follow up with pacemaker clinic

97
Q

treatment of PEA

A

CPR and epi

Acute Care Exam 2 (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions