Topic 4: Heart Dysrhythmias & ECG/EKG

Question 1

What does the P wave represent?

Answer 1

atrial depolarization

Question 2

What does the QRS complex represent?

Answer 2

ventricular depolarization and atrial repolarization

Question 3

What does the T wave represent?

Answer 3

ventricular repolarization

Question 4

P-R interval is how many seconds

Answer 4

0.12 - 0.20 sec (3 - 5 small squares)

Question 5

QRS width is how many seconds

Answer 5

0.08 - 0.12 sec (2 - 3 small squares)

Question 6

Q-T interval is how many seconds

Answer 6

0.35 - 0.43 sec

Question 7

5 lead EKG placement

Answer 7

White lead - right sternum / clavicle area
Black lead - Left sternum / clavicle area
Red lead - Left lower thoracic area
Green lead - Right lower thoracic area
Brown lead - just below and to the right of the bottom of the sternum

Question 8

normal rhytms are considered ______

Answer 8

sinus (originating from the SA node)

Question 9

what conducts first in a “normal” heart

Answer 9

SA node

Question 10

Sinus Rhythm (SR, NSR) characteristics

Answer 10

*P waves are present & appear at regular time intervals
*P wave rate is constant
*Each P wave is followed by a QRS complex
*QRS complexes are of normal width (slim)
*The intervals between QRS complexes are equal
*The heart rate is between 60 and 100 beats per minute

Question 11

Sinus Tachycardia characteristics of ECG and rate

Answer 11

same a normal siuns rhythm EXCEPT HR is 101-180 bpm

Question 12

s/s of sinus tachycardia

Answer 12

SOB, dyspnea, diaphoresis
decrease CO, decrease BP
rapid, regular pulse, possible palpitation

Question 13

cause of sinus tachycardia

Answer 13

exercise, fever, pain, stimulants. hyper/hypovolemia, anxiety, and CVD (anemia, HF, or valvular heart diseases can increase the heart’s workload.), hypotension

Question 14

treatment for sinus tachycardia

Answer 14

TREAT cause
VALSALVA MANEUVER
fever- antipyretic
reduce stimulant
reduce pain

Question 15

drug therapy for sinus tachycardia

Answer 15

B-blocker
CCB
adenosine

Question 16

sinus bradycardia characteristics if ECG and rate

Answer 16

same as normal sinus rhythm EXCEPT HR < 60 bpm

Question 17

s/s of sinus bradycardia

Answer 17

fatigue, lightheadedness, syncope, symptomatic

Question 18

cause of sinus bradycardia

Answer 18

vagal maneuver (bearing down)
> responsible for the “rest and digest” activities in the body.
Vagal maneuvers, such as bearing down (as if having a bowel movement), can stimulate the vagus nerve = a reduction in HR
meds (CCB, B-blockers)
> These drugs are often used to treat hypertension and certain heart rhythm disorders. They work by relaxing the muscles of your heart and blood vessels.
vomiting, hypothermia
> Forceful or repeated vomiting can also stimulate the vagus nerve, leading to a reflex decrease in heart rate.
common in trained athletes

Question 19

treatment of sinus bradycardia

Answer 19

try to arouse the patient
head of the bed FLAT
fall preacutions
atropine

Question 20

drug therapy of sinus bradycardia

Answer 20

ATROPINE only if showing decreased perfusion (cool, pale, clammy)

Question 21

atrial fibrillation

Answer 21

rapid, random, ineffective contractions of the atrium

Question 22

Causes of atrial fibrillation

Answer 22

CAD, HTN, HF (any underlying heart disease)
surgery

Question 23

treatment/drug therapy for atrial fibrillation

Answer 23

CCB (Diltiazem!!!), B-Blockers, amiodarone, digoxin (all for rate control)
anticoagulants

Question 24

what is a big concern with A-fib

Answer 24

BLOOD STASIS!! can lead to clots

Question 25

what drug is used for clots in A-fib

Answer 25

Warfarin

Question 26

what is important to know about warfarin

Answer 26

monitor INR Vit K is the antidote moderate green leafy veggies

Question 27

what needs to be checked before giving digoxin

Answer 27

apical pulse (60 or greater) toxicity: 0.5-2.0, visual changes, N/V, anorexia potassium below 3.5 increases the risk for toxixity

Question 28

s/s of atrial fibrillation

Answer 28

usually asymptomatic if symptomatic: dizzy, faint, fatigue, SOB, chest pain, fluttering in chest, irregular pulse, change in LOC, dyspnea, asymptomatic or syncope

Question 29

atrial fibrillation characteristics of ECG and rate

Answer 29

-absence or inconsistent (fibrillary) p wave -Appears irregular, often changes speed of the heart rate 350-600bpm

Question 30

Transcutaneous Pacemaker

Answer 30

external pacemaker used as a temporary emergency measure for maintaining adequate heart rate

Question 31

Cardioversion

Answer 31

restoration of a normal heart rhythm by electric shock

Question 32

Transcutaneous Pacemaker & Cardioversion is used with what type of dysrhythmia

Answer 32

atrial fibrillation

Question 33

normal digoxin range

Answer 33

0.5-2ng/mL

Question 34

Premature Ventricular Contraction (PVC) characteristics of ECG and rate

Answer 34

underlying rhythm can be any rate, regualr or irregular, PVCs can occur at variable rates -wide and distorted QRS complex, Pwave barely visible

Question 35

what is Premature Ventricular Contraction (PVC) caused by

Answer 35

*Caused by the hearts demand for O2 -stimulants (caffiene, alcohol, nicotine, epi, etc), electrolyte imbalance, hypoxia, fever, exercise, emotional stress

Question 36

s/s Premature Ventricular Contraction (PVC)

Answer 36

*Almost always *asymptomatic, noticed on tele strip

Question 37

Premature Ventricular Contraction (PVC) treatment:

Answer 37

treat the cause O2 therapy for hypoxia elecrolyte replacement

Question 38

3 or more PVC's occur consecutively

Answer 38

indicates Ventricular Tachycardia

Question 39

Ventricular Tachycardia characteristics of ECG and rate

Answer 39

*Ventricular rate is 150-250bpm *Regular to slightly irregular rhythm p wave and Pr interval not visible, ORS wide and distorted

Question 40

causes of ventricular tachycardia

Answer 40

post MI, CAC, hypoxemia, electrolyte imbalance (decrease K and Mg), drug toxicity

Question 41

s/s ventricular tachycardia

Answer 41

*asymptomatic if it lasts a short amount of time due to anxiety *If it happens for an extended amount of time death can occur

Question 42

a patient in V-tach is a patient that is trying to....

Answer 42

CODE!

Question 43

a patient in V-tach may or may not have

Answer 43

a pulse

Question 44

treatments for a patient in V-tach: IV antidyrhythmics

Answer 44

-Procainamide -Lidocaine -Adenosine

Question 45

what is done if the pulse is present in v-tach

Answer 45

assess VS, call rapid response, prepare to call code, give IV dysrhythmias

Question 46

what is done if no pulse is present in v-tach

Answer 46

CALL CODE, begin CPR, early D-fib

Question 47

v-tach with no pulse

Answer 47

defibrillation

Question 48

v-tach with pulse

Answer 48

cardioversion

Question 49

Torsades de Points

Answer 49

-Lethal heart rhythm. Occurs if QT interval is prolonged greater than 0.50 seconds......this is why it is importnt to monitor for a prolonged QT interval. -Treated with IV *magnesium sulfate*, cardioversion, correct causative factors

Question 50

the quivering of te ventricles in v-tach means

Answer 50

NO CARDIAC OUTPUT, MEDICAL EMERGENCY IF THERE IS NO PULSE

Question 51

cause of ventricular fibrillation

Answer 51

untreated v-tach, MI, hyperkalemia, electric shock, hypoxemia, acidosis, drug toxicity

Question 52

s/s ventricular fibrillation

Answer 52

-Poor to no cardiac output -loss of consciousness -no pulse -BP and respirations leading to brain damage -death if not reversed

Question 53

V FIB

Answer 53

D FIB

Question 54

V tach treatment

Answer 54

*check pulse, Call a CODE, start CPR, & early defibrillation *Amiodarone, Epinephrine, Lidocaine *Best results if ACLS is started in the first 30 seconds

Question 55

if a patient goes into cardiac arrest

Answer 55

-check pulse -Call a Code -Start CPR -Start ACLS when trained ACLS professional arrives (rapid response or code team)

Question 56

defibrillator

Answer 56

a device that delivers an electric shock to the heart to restore its normal rhythm

Question 57

Digoxin toxicity symptoms

Answer 57

nausea, vomiting, diarrhea, vision changes, arrythmias, electrolyte imbalance

Question 58

asystole

Answer 58

flatline

Question 59

rate of asystole

Answer 59

none

Question 60

asystole is ___

Answer 60

FATAL- client is clinically DEAD (unresponsive, no respiration or heart beat)

Question 61

causes of asytole

Answer 61

long cardiac Hx, HF, MI

Question 62

treatment for asystole

Answer 62

NO DEFIBRILLATION (no pulse) -epi, atropone, CPR w/ ACLS