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NUR 201 Week 7 > Pt 1 Care of Patients w/Dysrhythmias > Flashcards

Pt 1 Care of Patients w/Dysrhythmias Flashcards

1
Q

Properties of Cardiac Cells

  • Automaticity
  • Excitability
A
  • Conductivity
  • Contractility
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2
Q

?

Is the ability to respond mechanically to an impulse

A

Contractility

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3
Q

?

Is the ability to initiate an impulse spontaneously & continuously

A

Automaticity

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4
Q

?

Is the ability to be electrically stimulated

A

Excitability

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5
Q

?

Is the ability to transmit an impulse along a membrane in an orderly manner

A

Conductivity

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6
Q

Conduction System of the Heart

A
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7
Q

A normal cardiac impulse begins in the __ __ in the upper right atrium.

It spreads over the atrial myocardium via interatrial pathways & internodal pathways, causing atrial contraction.

A

sinoatrial node (SA)

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8
Q

The impulse then travels to the __ __, through the bundle of His, and down the left and right bundle branches.

It ends in the __ __, which transmit the impulse to the ventricles.

A

atrioventricular node (AV)

Purkinje fibers

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9
Q

Electrolytes & Dysrhythmias

  • Na, K, Ca, Mg
A
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10
Q

?

Imbalances of this electrolyte are the most common electrolyte-associated cardiac arrhythmias

A

Potassium

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11
Q

Potassium

  • Plays a role in both nerve conduction & the heart’s ability to send an electrical impulse
  • Low lvls can cause relatively stable arrhythmias, while high lvls can quickly lead to lethal arrhythmias
A
  • Na, Mg, & Ca imbalances also place heart @ risk for arrhythmias

AHA

→ Arrhythmias caused by these electrolytes only occur when electrolyte lvls are extremely high or low - lvls that are typically incompatible w/human functioning, leading to death

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12
Q

Cardiac Conduction System

A
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13
Q

Atrial activity is represented by the __ __

A

P wave

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14
Q

Ventricular activity is represented by the __ __

A

QRS complex

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15
Q

Sinoatrial node

> Electrical impulses __-__ beats/min
__ __ on ECG

A

60-100
P wave

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16
Q

Atrioventricular junction

> __ __ on ECG
Contraction known as “atrial kick”
__-__ bpm

A

PR interval

40-60

17
Q

Bundle of His

> Right & left bundle branch system
__-__ bpm

A

20-40

18
Q

ECG Monitoring

A
19
Q
  • P wave represents atrial activity
  • PR interval is measured from the beginning of the P wave to the beginning of the QRS complex
A
  • Represents the time taken for the impulse to spread through the atria, AV node, bundle of His, bundle branches, & Purkinje fibers to a point immediately preceding ventricular contraction
20
Q

QRS represents __ __?

A

ventricular activity

21
Q

QRS complex has 3 distinct waves

Q wave is the first negative (downward) deflection after P wave, short & narrow, & not present in several leads

A

R wave is first positive (upward) deflection in the QRS complex

S wave is the first negative (downward) deflection after the R wave

22
Q

QRS interval is measured from the beginning to end of QRS complex

  • Represents time taken for depolarization (contraction) of both ventricles (___)
A

systole

23
Q

ST segment is measured from the S wave of the QRS complex to the beginning of T wave

Represents time between ventricular depolarization & repolarization (___)

A

diastole

24
Q

**Should be isoelectric (flat)

ST segments should be flat, and when they begin to rise that’s how the EKG tracing represents an ST elevation MI (STEMI)**

A
25
Q

T wave represents time for ventricular ___

It can represent potassium levels & oxygenation problems

A

repolarization

26
Q

Q-T interval is measured from the beginning of the QRS complex to the end of the T wave

Represents the time taken for entire electrical depolarization & repolarization of ventricles

A

Can be important to assess as a side effect of rx’s (prolonged QT intervals) [i.e., Haldol]

27
Q

Normal time for PR interval: -

A

0.12 - 0.20

28
Q

Normal QRS: -

A

**0.04 - 0.10

! If these times exceed these measurements that means there’s a delay in conduction**

29
Q

Electrocardiographic Waveforms

A
30
Q

Assessment of Cardiac Rhythm

  • Interpret the rhythm AND evaluate the clinical status of the pt
  • Is the patient hemodynamically stable?
A
  • Determine the cause of dysrhythmia
  • Treat the patient, not the monitor!
31
Q

When Things Go Wrong = Dysrhythmias

  • Disorder of impulse formation, conduction of impulses, or both
  • SA node = normal pacemaker of heart (60-100 bpm)
A
  • Secondary pacemakers = AV node (40-60 bpm)
  • His-Purkinje fibers (20-40 bpm)
32
Q

If the SA node fires more slowly than a 2° PM, the electrical signals from 2° PM may “escape”

2° PM will then fire automatically @ its intrinsic rate

A

These 2° PM’s may start from the AV node @ a rate of 40-60x/min or the His-Purkinje system @ at a rate of 20-40x/min

33
Q

Another way that 2° PM’s can start is when they fire more rapidly than the normal PM of the SA node

Triggered beats (early or late) may come from an __ __ or accessory pathway (area outside the normal conduction pathway) in the atria, AV node, or ventricles

Results in a dysrhythmia, which replaces the normal sinus rhythm

A

ectopic focus

34
Q

Impulse started by SA node or an ectopic focus must be conducted to the entire heart

Property of myocardial tissue that allows it to be depolarized by a stimulus is ___

A

excitability

35
Q

This is an important part of the transmission of the impulse from one cell to another

A

Lvl of excitability is determined by the length of time after depolarization that the tissues can be re-stimulated

36
Q

Recovery period >stimulation is the __ __ or period

A

refractory phase

37
Q

When the normal impulse is changed, blocked, excited, or depressed, irregular heart rhythms (dysrhythmias) occur

A

When dysrhythmias occur, cardiac output and therefore perfusion may suffer

38
Q

Normal

  • Rate 60-100
  • Rhythm: regular
  • P waves present, consistent & have ratio of 1 P wave to 1 QRS
  • PR interval 0.12 - 0.20
  • QRS duration 0.04 - 0.10
A

Abnormal

  • Rate <60 or >100
  • Rhythm: irregular
  • P waves absent, inconsistent, or have ratio > 1:1 w/QRS
  • PR interval <0.12 or >0.20
  • QRS duration <0.04 or >0.10

NUR 201 Week 7 (7 decks)

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