SINUS RHYTHMS

Question 1

Normal Sinus Rhythm

EKG Characteristics

Answer 1

P waves: Uniform in appearance, positive (upright) in lead II and only one precedes each QRS complex.

QRS: 0.10 second or less. The QRS may appear widened when a delay in conduction occurs within the ventricles.

PRI: .12-.20 seconds

RATE: 60-100 bpm

RHYTHM: Regular (atrial and ventricular)

Question 2

SINUS BRADYCARDIA

EKG CHARACTERISTICS

Answer 2

P wave: Uniform in appearance, positive (upright) in lead II and only one precedes each QRS complex

QRS: 0.10 seconds or less

PRI: .12 to .20 seconds and constant from cardiac cycle to cardiac cycle

RATE: < 60 bpm

RHYTHM: Regular (atrial and ventricular)

Question 3

SINUS BRADYCARDIA NURSING INTERVENTIONS

[interventions same as junctional escape beat, junctional escape/accelerated rhythms]

Answer 3

Nursing
   Vital Signs (including SpO2)
   Assess for shock (cool clammy skin, ALOC)
   Decrease HOB for hypotension
   Oxygen if hypoxic 
   Assess for angina
   IV access
   Identify and treat possible causes (hold 
   negative chronotropic medications)

*Digoxin, amiodarone, and beta blockers are the most common pharmacologic causes for sinus bradycardia

Question 4

SINUS BRADYCARDIA PHARMACOLOGIC AND ELECTRICAL NURSING INTERVENTIONS

Answer 4

Pharmacologic:
Atropine - initial dose is 0.5 mg IVP (given if symptomatic)

Electrical:
Pacing (if symptomatic)

Question 5

SINUS TACHYCARDIA

EKG CHARACTERISTICS

Answer 5

RATE: 101-180 bpm

RHYTHM: Regular (atrial and ventricular)

P waves: Uniform in appearance, positive (upright) in lead II and only one precedes each QRS complex; at very fast rates.

PRI: 0.12-0.20 seconds and constant from cardiac cycle to cardiac cycle

QRS: usually measures 0.10 second or less; At very fast rates, it may be difficult to distinguish between a P wave and T wave.

Question 6

SINUS TACHYCARDIA NURSING INTERVENTIONS

Answer 6

Nursing:
   Vital Signs (including SpO2)
   Assess for shock (cool clammy skin, ALOC)
   Decrease HOB for hypotension
   Oxygen if hypoxic 
   Assess for angina
   IV Access
   Identify and treat possible causes 
   (Pain? Fever? Anxiety? Meds?)

Question 7

SINUS TACHYCARDIA PHARMACOLOGIC AND ELECTRIAL NURSING INTERVENTIONS

Answer 7

Pharmacologic:
Beta Blockers; Calcium Channel Blockers

Electrical:
Usually NA for rates of 160 or less