Brainscape's Knowledge GenomeTM

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


See full index

Nursing 272: Final Semester > Unit 2: Cardiac Dysrhythmias > Flashcards

Unit 2: Cardiac Dysrhythmias Flashcards

You may prefer our related Brainscape-certified flashcards:
Nursing Pharmacology flashcards NCLEX-RN® flashcards Nursing Mental Health flashcards Nursing Fundamentals flashcards Nursing Safety & Infection flashcards Nursing Adult Health flashcards NCLEX-PN® flashcards Nursing Management of Care flashcards Nursing Pediatrics flashcards Nursing Maternity flashcards
1
Q

Dysrhythmias

A

disruptions in the cardiac conduction pathway

-disorders of the electrical impulse conduction within the heart

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

Symptoms of Cardiac Instability

A
  • Palpitations (fast fluttering or beating in the chest or skipping beats)
  • Hypotension
  • Diaphoresis
  • Shortness of breath (SOB)
  • Syncope (fainting)
  • Lightheadedness
  • Weakness & Fatigue
  • Dizziness
  • Anxiety
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Risk Factors for Developing a Dysrhythmia

A
  • Age
  • MI
  • HTN
  • Heart valve disease
  • Heart failure (HF)
  • Cardiomyopathy (CM)
  • Infections
  • Diabetes mellitus
  • Sleep apnea
  • Heart surgery (and procedures)
  • Electrolyte disturbances
  • Recreational drug use
  • Drug toxicities (digoxin toxicity)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Older Adults and Cardiac Instability

A

older adults have fewer pacemaker cells in the SA node

-there may be fat deposits around SA node causing a delay in the propagation of the action potential

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

Usual Treatment Pathway

A
  1. Non-invasive/ non-pharmacological
    - vasovagal maneuvers (cough, bear down)
  2. Pharmacology
    - Adenosine, Diltiazem, Atropine
  3. Electricity
    - cardioversion, defibrillation, pacing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Cardioversion

A

synchronized cardioversion
-controlled electrical discharge of energy at the peak of the R wave
-indicated for symptomatic tachy dysrythmias w/ a pulse (SVT, AF w/ RVR, AFL with RVR, VT w/ a pulse)
>Pulse
-SVT, A fib/flutter, VT
-start low and increase 50 to 200 Joules
-patient awake; consider sedation

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

Things to Consider with Cardioversion

A
  • considered for AF after anticoagulation is attained
  • the atrium is evaluated for presence of clots by esophageal echocardiogram (TEE) prior to cardioversion d/t risk of embolic events
  • if pt symptomatic (hypotensive, SOB, pain), urgent cardioversion may be required before anticoagulation is attained
  • IV heparin ASAP w/ loading dose before procedure
  • once stable, considerations include deciding on long-term rhythm or rate control w/ digoxin, beta blockers, calcium channel blockers, or antiarrhythmic meds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Defibrillation

A
  • no pulse
  • for VT, Vfib
  • joules always 200 J
  • emergency, no cardiac output
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Medications

A

> HR too fast

  • Adenosine
  • Diltiazem
  • Digoxin
  • Amiodarone
  • Metoprolol

> HR to Slow
-Atropine

> Anticoagulant

  • Heparin
  • Warfarin

> No HR/CPR
-epinephrine

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

Medications for a HR that is too fast

A
  • Adenosine
  • Diltiazem
  • Digoxin
  • Amiodarone
  • Metoprolol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Medications for a HR too Slow

A

Atropine

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

Anticoagulants

A
  • Heparin

- Warfarin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Medications for no HR/CPR

A

Epinephrine

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

Sinus Dysrhythmias

A
  • Sinus Bradycardia (SB)

- Sinus Tachycardia (ST)

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

Sinus Bradycardia

A

HR <60
-a regular rhythm that has the same characteristics of normal sinus rhythm (NSR) except the HR is less than 60 bpm
-Causes:
-hypoxia and/or hypothermia
-can occur during sleep or may be a normal rate in well trained athletes
-may be normal in a non-symptomatic pt; may just require observation
>important to determine if the patient is symptomatic (syncope, chest pain, hypotension, SOB, or diaphoresis) while bradycardic; require tx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Treatment for Symptomatic Sinus Bradycardia (SB)

A

atropine 0.5 mg IV push

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Atropine Sulfate

A

anticholinergic

  • increases SA node stimulus and increases conduction through the AV node
  • use cautiously with MI patients
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Asymptomatic Sinus Bradycardia (SB)

A 
>Symptoms: None
>Medical: 
-assess and treat the causes as necessary (hypoxia, ischemia, electrolyte imbalance, medication toxicities [digoxin, calcium 
channel blocker overdose])
>Nursing: notify provider
-assess for level of consciousness (LOC)
-assess palpable pulses
-assess BP
-obtain 12-lead ECG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Symptomatic Sinus Bradycardia (SB)

A

> Symptoms:
-hypotension, dizziness, lightheadedness, fainting, SOB, sweating

> Medical:

  • oxygen
  • atropine IVP
  • pacing
  • treat causes: hypoxia, ischemia, electrolyte imbalances, medication toxicities

> Nursing:

  • 02 per order
  • assess patient (initially + more frequently) for LOC, palpable pulses, BP, and HR
  • contact authorized prescriber or medical emergency team
  • obtain a 12-lead ECG
  • ensure IV access is available and patent
  • administer medications as ordered
  • prepare for transcutaneous pacing/cardioversion (if ordered)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Sinus Tachycardia (ST)

A

HR > 100 bpm
-regular rhythm that has the same characteristics a normal sinus rhythm (NSR) except the HR is greater than 100 bpm
>Causes: fever, anemia, hypovolemia, hypotension, pulmonary embolism (PE), myocardial infarction (MI)
>Treatment: based on symptoms and causes
-Medications: Atenolol (Tenormin), Metoprolol (Lopressor), Carvedilol (Coreg), Sotalol (Betapace), Digoxin (Lanoxin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Medications: Beta Blockers

A

> Atenolol (Tenormin)
Metoprolol (Lopressor)
Carvedilol (Coreg)
Sotalol (Betapace)
-slow down heart rate
-decreases cardiac workload and oxygen demand
-use cautiously in patient w/ heart failure and asthma

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

Medications: Digoxin (Lanoxin)

A

cardiac glycoside

  • slows conduction through the AV node
  • improves cardiac contractility
  • monitor digoxin levels and renal function
  • use cautiously in combo w/ amiodarone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Asymptomatic Sinus Tachycardia (ST)

A

> Symptoms: None

> Medical: depends on rate and cause of ST

  • HR less than 150 bpm–> observe for signs of decompensation
  • treat causes: infection, fever, hypovolemia, hypoxia, ischemia, electrolyte imbalance, stimulants
  • HR greater than 150 bpm (pt can decompensate quickly) consider beta blockers to slow down HR

> Nursing: notify provider

  • assess for LOC
  • assess for palpable pulses
  • assess BP
  • obtain a 12-lead ECG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Symptomatic Sinus Tachycardia

A

> Symptoms:
-hypotension, dizziness, lightheadedness, fainting, SOB, sweating/diaphoresis, anxiety, palpitations

Medical:

  • vagal maneuvers (carotid massage)
  • beta blockers
  • treat causes: hypoxia, ischemia, electrolyte imbalances, medication toxicities, stimulants

> Nursing:

  • give O2 per order
  • assess patient initially and more frequently for LOC, palpable pulses, BP, and HR
  • contact authorized prescriber or medical emergency team
  • obtain a 12-lead ECG
  • ensure IV access is available and patent
  • administer medications as ordered
  • prepare for transcutaneous pacing/cardioversion if ordered
  • stay w/ patient
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Nursing Interventions for ALL Asymptomatic Sinus Dysrhythmias

A
  • Notify Provider
  • Assess patient for level of consciousness (LOC)
  • Assess for palpable pulses
  • Assess blood pressure (BP)
  • Obtain a 12-lead ECG
  • Educate about S/S that can occur
  • Discuss S/S that warrant the patient to contact primary care provider or calling 911 for help
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Nursing Interventions for ALL Symptomatic Sinus Dysrhythmias

A

-Give O2 per order
-Assess patient (initially + more frequently) for LOC, palpable pulses, BP, and HR
-Contact authorized prescriber or medical team
-Obtain 12-lead ECG
-Ensure IV access available as ordered
-Administer medications as ordered
-Prepare for transcutaneous pacing/cardioversion (if ordered):
>place defibrillation/pacing pads in an anterior/posterior approach
>anticipate administration of sedative (midazolam (versed)) prior to procedure if stable BP
-Stay w/ patient until stable or care is transferred to another provider

> Education:

  • Medication: atropine
  • Intervention: 12-lead ECG, Pacing

-after stabilization, a basic debriefing should occur w/ pt/family to allow for questions that could not be asked during emergency

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

Cardiac Dysrhythmias: Atrial Dysrhythmias

A

caused by pacemaker cells firing not from the SA node but from somewhere else within the atria

  • Premature atrial contractions (PACs)
  • Atrial Fibrillation (AF)
  • Atrial Flutter (AFL)
  • Supraventricular Tachycardia (SVT)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Premature Atrial Contractions (PAC)

A

-non-life threatening
-can be seen in normal sinus rhythm (NSR)
-a pacemaker cell close to the SA node fires earlier than expected
-an irregular rhythm d/t early impulse or beat
-the PAC has a pause at the end of the complex (compensatory pause) allowing the conduction system to reset and resume the regular rhythm
-P wave present
>causes: hypoxia, excessive stimulant ingestion (caffeine), infections, digoxin toxicity, and coronary artery disease
>Treatment:
-monitor frequency and eliminate the cause

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

Asymptomatic Vs Symptomatic PCAs

A

> Symptomatic: palpitations (skipping beats), SOB, sweating, anxiety
For ALL PCAs:
Medical:
-treat cause if necessary; hypoxia, ischemia, electrolyte imbalance, medication toxicities, stimulants
Nursing:
-assess for LOC, palpable pulses, BP, HR, and symptoms
Educate:
-causes, S/S that need immediate attention, and appropriate actions if those symptoms occur

30
Q

Atrial Fibrillation (AF)

A

multiple pacemaker cells generating independent electrical impulses and causing chaos within the atria; irregularly irregular
-no P waves
-QRS complexes narrow w/ irregular R-R intervals
-atrial rate can range from 300 to 600 bpm
-HR or ventricular response is determined by the AV nodes ability to accept and transmit the impulses to the ventricles
>Controlled Vs Uncontrolled
-Controlled: when the AV node maintains the HR at less than 100 bpm
-AF w/ rapid ventricular response (RVR): HR is greater than 100 bpm
>Causes: risk increases w/ age
-cardiomyopathy, pericarditis, hyperthyroidism, HTN, valvular disease, obesity, diabetes, chronic kidney disease, coronary artery disease, pts undergoing cardiac procedures or surgery

31
Q

Complications of Atrial Fibrillation (AF)

A
  • Loss of Cardiac Output (CO)

- Clots

32
Q

Complications of Atrial Fibrillation (AF): Loss of CO

A

b/c the atrial pacemaker cells are firing and competing against one another at such a rapid rate, the atria can only quiver instead of beating or contracting/ squeezing normally

  • “loss of atrial kick” = loss of approx. 30% of CO
  • Decrease in CO can cause syncope, palpitations and SOB
33
Q

Complications of Atrial Fibrillation (AF): Clots

A

b/c the atria are not squeezing or contracting efficiently, blood pools in the atria, which predisposes pt to clot formation
-risk for embolic events (stroke)
>Treatment:
-anticoagulation to prevent clots
-rate control for new onset
-medications to control HR (digoxin, beta blockers, calcium channel blockers)
-Once HR managed, rhythm control is considered through antiarrhythmic medications, cardiac ablation (scarring/ destroying the tissue in the heart responsible for the irregular rhythm) or cardioversion

34
Q

Antiarrhythmic Medications used for AF

A

slows the cardiac action potential; slowing HR

  • Amiodarone (Cordarone, Pacerone)
  • Dronedarone (Mutlaq)
  • Dofetilide (Tikosyn)

> Special Considerations:

  • Amiodarone–> IV preparation for continuous infusion must be in a glass bottle
  • Monitor: pulmonary function tests, thyroid function, liver function
35
Q

Anticoagulant Medications for Atrial Fibrillation (AF)

A

inhibits clot formation

  • Warfarin (Coumadin)
  • Heparin
  • Dabigatran (Pradaxa)
  • Rivaroxaban (Xarelto)
  • Apixaban (Eliquis)
  • Edoxaban (Savaysa)

> Special considerations:

  • monitor for bleeding
  • Warfarin: monitor INR or PT
  • Heparin: monitor aPTT and Platelets
  • All the rest: monitor renal function
36
Q

Calcium Channel Blockers for AF

A

Diltiazem (Cardizem)

  • slows conduction through AV node
  • use cautiously in pts with heart failure
37
Q

Beta Blockers for AF with RVR

A

helps slow down HR; decreases cardiac workload and oxygen demand
-Atenolol (Tenormin)
-Metoprolol (Lopressor)
-Carvedilol (Coreg)
-Sotalol (Betapace)
>Special Considerations:
-use cautiously with HF and asthma
-Carvedilol used in pts w/ heart failure for rate and rhythm control
-Sotalol used in AF rate and rhythm control

38
Q

Cardiac Glycosides for AF

A

Digoxin (Lanoxin)
-slows conduction through the AV node; improves cardiac contractility
>Special Considerations:
-monitor digoxin levels and renal function
-use cautiously in combo w/ amiodarone

39
Q

Asymptomatic Atrial Fibrillation (AF)

A

> Symptoms: may feel palpitations
Medical: depends on rate and left ventricular function (LVF)
-medication to maintain rate control, anticoagulate
-treat underlying causes: acute MI, severe mitral valve disease, thyrotoxicosis, COPD, pericarditis, cardiomyopathy, HTN, coronary artery disease (CAD)
Nursing:
-assess pt for LOC, palpable pulses, BP, and HR
-Obtain a 12-lead ECG
-assess for underlying causes

40
Q

Symptomatic Atrial Fibrillation (AF)

A

> Symptoms:
-hypotension, dizziness, lightheadedness, fainting, SOB, sweating, anxiety, palpitations

> Medical: Oxygen

  • rate controlling medications (calcium channel blockers or beta blockers)
  • may consider using amiodarone (antiarrhythmic) to control HR
  • consider cardioversion
  • treat causes: infection, fever, hypovolemia, hypoxia

> Nursing: stay w/ patient

  • assess LOC, palpable pulses, BP, and HR
  • obtain a 12-lead ECG
  • ensure IV access is available and patent
  • administer meds as ordered
  • prepare for cardioversion; place defibrillator pads (front/back); anticipate order for anti-anxiety meds
  • real-time education regarding the event, treatment, and ways to avoid it in the future
41
Q

Atrial Flutter (AFL)

A

dysrhythmia produced by a pacemaker cell other than the SA node
-no P waves b/c the SA node is not the primary pacemaker in this rhythm
-F waves (flutter waves); sawtooth pattern between narrow QRS complexes
-atrial rate ranges from 250 to 350 bpm
-can be chronic or short term
>Causes: acute MI, severe mitral valve disease, thyrotoxicosis (high thyroid hormone levels), surgical procedures within chest, digoxin toxicity
>Treatment: goal is to control the ventricular rate until the SA node takes over again
-Beta Blockers, Calcium Channel Blockers, and Digoxin used to control ventricular rate
-if still in AFL after rate is controlled or less than 100 bpm, an antiarrhythmic may be ordered to chemically convert the rhythm back to NSR
-if severely symptomatic, cardioversion but is not first line tx (S/S for cardioversion: chest pain, hypotension, SOB)

42
Q

Asymptomatic Atrial Flutter (AFL)

A

> Symptoms: may feel palpitations

> Medical:

  • depends on rate and left ventricular function (LVF)
  • medication to maintain rate control, anticoagulate
  • treat underlying causes: acute MI, severe mitral valve disease, thyrotoxicosis, COPD, pericarditis, cardiomyopathy, HTN, CAD

> Nursing:

  • assess LOC, palpable pulses, BP, and HR
  • Obtain a 12-lead ECG
  • assess for underlying causes
  • discuss clinical manifestations that indicate a need to contact provider
43
Q

Symptomatic Atrial Flutter (AFL)

A

> S/S: hypotension, dizziness, lightheadedness, fainting, SOB, sweating, anxiety, palpitations

> Medical: oxygen

  • rate-controlling medications (calcium channel blockers or beta blockers)
  • may consider using an antiarrhythmic amiodarone to control HR
  • consider cardioversion
  • treat the causes: infection, fever, hypovolemia, hypoxia

> Nursing: stay w/ patient

  • assess LOC, palpable pulses, BP, and HR
  • obtain a 12-lead ECG
  • ensure IV access is available and patent
  • administer medications as ordered
  • prepare for cardioversion: place defibrillator pads (anterior/posterior); anticipate order for anti-anxiety meds
  • real-time education regarding event, tx, and ways to avoid it in the future
44
Q

Supraventricular Tachycardia (SVT)

A

a rapid heart rhythm that originates above the ventricles
-appears as regular, narrow QRS complex tachycardia
-any narrow complex rhythm greater than 100 bpm, but can have HRs from 150 to 250 bpm
-umbrella term for 5 rhythms:
-Sinus Tachycardia (ST), Atrial Tachycardia (AT), Atrial Fibrillation w/ RVR, Atrial Flutter w/ RVR, and Junctional Tachycardia (JT)
>Treatment:
-key is to figure out the underlying rhythm while slowing down the HR
-if symptomatic medications can be used; electrical cardioversion can be considered

45
Q

Asymptomatic Supraventricular Tachycardia (SVT) ALL

A 
>Sinus Tachycardia (ST)
>Atrial Tachycardia (AT)
>AF w/ RVR
>AFL w/ RVR
>Junctional Tachycardia (JT)

Medical:
-treat causes if necessary: hypoxia, ischemia, electrolyte imbalance, medication toxicities, stimulants

Nursing:

  • assess LOC, palpable pulses, BP, and HR, and evolving symptoms
  • educate about causes, S/S that need attention
46
Q

Symptomatic Supraventricular Tachycardia (SVT) ALL

A 
>Sinus Tachycardia (ST)
>Atrial Tachycardia (AT)
>AF w/ RVR
>AFL w/ RVR
>Junctional Tachycardia (JT)

S/S:
-hypotension, dizziness, lightheadedness, fainting, SOB, sweating, anxiety, palpitations

Medical:

  • Oxygen
  • Adenosine to assist w/ determination of underlying rhythm
  • Rate-controlling medications (calcium channel blockers, beta blockers)
  • May consider antiarrhythmic amiodarone to control HR
  • Consider cardioversion
  • Treat Causes

> Nursing:

  • Stay w/ patient
  • Assess LOC, palpable pulse, BP, and HR
  • Obtain a 12-lead ECG
  • Encourage IV access is available and Patent
  • Administer Medications as ordered
  • Prepare for Cardioversion; place defibrillator pads; anticipate order for antianxiety meds
47
Q

Junctional Rhythms

A

being with the AV node

  • Premature Junctional Contractions (PJCs)
  • Accelerated Junctional Rhythm: rate increases to 61 to 100 bpm
  • Junctional Tachycardia: HR is greater than 100 bpm
48
Q

Premature Junctional Contractions (PJCs)

A

junctional impulses generated early by the AV node
-not life-threatening
-inverted P wave prior to, buried in, or after QRS wave
-have a compensatory pause following the PJC
-rarely symptomatic
-does not require TX
>Causes: digoxin toxicity, acute MI, and heart surgery
>TX: based on symptoms and possible causes

49
Q

Asymptomatic Premature Junctional Contractions (PJCs)

A

> Medical:
-treat causes: ischemia, medication toxicities, hypoxia
Nursing:
-assess LOC, palpable pulses, BP, and HR
-obtain 12-lead ECG
-assess for other causes
-educate about S/S that warrant contacting provider

50
Q

Symptomatic Premature Junctional Contractions (PJCs)

A

> S/S:
-dizziness, lightheadedness, fainting, SOB, sweating, anxiety, hypotension

> Medical:

  • Oxygen
  • Atropine IV
  • Pacing
  • Treat the causes

> Nursing:

  • get help and stay w/ the patient
  • assess LOC, palpable pulses, BP and HR
  • obtain 12-lead ECG
  • give oxygen per order
  • ensure IV access is available and patent
  • administer medications as ordered
  • prepare for TCP
51
Q

Ventricular Dysrhythmias

A

rhythms that originate somewhere within the ventricles
-when an impulse starts in the ventricle, there is no P wave, and the QRS is usually wide (> 0.12 sec or 3 small boxes)
-normal rate for pacemaker cells in the ventricles is 40 bpm or less
>Premature Ventricular Contractions (PVCs)
>Ventricular Tachycardia (VT)
>Ventricular Fibrillation (VF)
>Idioventricular Rhythms (IVRs)

52
Q

Premature Ventricular Contractions (PVCs)

A

wide and atypical (bizarre-looking) QRS complexes that fire earlier than expected from within the ventricles
-compensatory pause at the end to allow the hearts conduction system to reset
-no P waves prior to the QRS b/c the impulse originated in the ventricle
>Unifocal PVCs
>Multifocal PVCs
>Couplet
>Triplet/Three-beat run of VT
>Bigeminy
>Trigeminy
>Causes: hypoxia, MI, CM, electrolyte imbalance, excessive stimulant ingestion (caffeine), hypertension, and recreational drug use
>Treatment: based on symptoms
-if symptomatic, correct the cause, and rarely antiarrhythmic therapy

53
Q

Unifocal PVCs

A

premature ventricular contractions coming from one ventricular pacemaker cell

54
Q

Multifocal PVCs

A

premature ventricular contractions coming from multiple ventricular pacemaker cells

55
Q

Couplet PVC

A

2 premature ventricular contractions in a row

56
Q

Triplet/ Three-beat run of VT (PVC)

A

3 premature ventricular contractions in a row

57
Q

Bigeminy PVC

A

a premature ventricular contraction that occurs every other beat

58
Q

Trigeminy PVC

A

a premature ventricular contraction falling every 3rd beat

59
Q

Asymptomatic Vs Symptomatic PVCs ALL

A

> Medical:
-treat causes if necessary
Nursing:
-assess LOC, palpable pulses, BP and HR, and symptoms
S/S if Symptomatic: dizziness, lightheadedness, fainting, SOB, sweating, anxiety, palpitations, hypotension

60
Q

Ventricular Tachycardia (VT)

A

3 or more PVCs (wide and fast impulses originating from the ventricles) in a row
-ventricular rate greater than 150 bpm
-can be life-threatening as a result of the reduction in CO that can occur
>Causes: hypovolemia, hypoxia, acidosis, hypokalemia, hyperkalemia, hypothermia, toxins, cardiac tamponade, MI, PE
>Treatment: based on presentation; VT w/ pulse, or Pulseless VT
-

61
Q

VT with a Pulse

A 
a patient in Ventricular Tachycardia who is maintaining a BP and pulse with or w/o symptoms
>TX: 
-antiarrhythmic medications (amiodarone)
-electrolyte replacement (potassium or magnesium)
-and/or cardioversion
(reserved for symptomatic: hypotensive, SOB, or chest pain)
-S/S: dizziness, lightheadedness, SOB, fainting, sweating, anxiety, palpitations, hypotension
>Medical: follow AHA/ACLS guidelines
-vagal maneuvers
-antiarrhythmic medications
-consider cardioversion
-treat causes
>Nursing:
-call for help
-stay w/ patient
-frequent assessment of symptoms
-frequent vital signs
-obtain 12-lead ECG
-ensure IV access available and patent
-administer medications as ordered
-prepare for cardioversion
62
Q

Pulseless Ventricular Tachycardia

A 
patient in cardiac arrest
>S/S: unresponsive, no pulse, no BP
>TX:
-First-line: cardiopulmonary resuscitation (CPR) and defibrillation
>Other tx: 
-epinephrine
-antiarrhythmics (amiodarone)

> Medical: follow AHA/ACLS guidelines

  • CPR
  • Defibrillation
  • medications (epinephrine, amiodarone)
  • treat possible causes

> Nursing:

  • activate emergency medical team
  • start and maintain compressions
  • defibrillate per ACLS guidelines
  • ensure IV access is available and patent
  • hang free-flowing IV fluids such as 0.9% NS
  • administer emergency medications (epinephrine, amiodarone)
63
Q

Ventricular Fibrillation (VF)

A

lethal dysrhythmia requiring immediate tx
-occurs when ventricle has multiple chaotic impulses rapidly firing
-the chaotic firing prevents the ventricles from pushing blood out of the heart, stopping CO and causing death
>S/S: unresponsive, no pulse, no BP
>Medical: follow AHA/ACLS guidelines
-CPR
-Defibrillate
-Medications: epinephrine, amiodarone
-Treat possible causes
>Nursing:
-activate emergency medical team
-start and maintain compressions
-defibrillate per ACLS guidelines
-ensure IV access is available and patent
-hang-free flowing IV fluids such as 0/9% NS
-administer emergency medications as ordered (epinephrine, amiodarone)
-no identifiable P waves or QRS waves
-rhythm displayed is a shaky or quivering line that can be very coarse or fine
TX:
-start with chest compressions and include defibrillation and medications

64
Q

Things to Consider in the Treatment for VF

A

Most important: chest compressions and defibrillation
-chest compressions initiated immediately and maintained as continuously as possible
-compressions should not be paused/stopped longer than 10 seconds
-only pause compressions when applying external defibrillation pads and when discharging the electrical impulse from defibrillation
-chest compressions need to be deep (2-2.4 inches in adult) and fast (rate of 100-120 bpm)
-compressors need to switch q 2 minutes
-defibrillation should be performed within 2 to 3 minutes of the onset of VF
-medication should be considered after the patient has bee defibrillated and while CPR is being performed
>First choice: vasopressor (epinephrine) 1 mg q 3 to 5 minutes IVP
>Second choice: antiarrhythmic (amiodarone) 300 mg IVP followed by second dose 150 mg IVP

65
Q

Idioventricular Rhythm (IVR)

A

occurs when the SA and AV nodes fail to function and the rhythm is generated from the ventricle
-rate usually less than 40 bpm; can be between 40 and 100 bpm
>Accelerated idioventricular rhythm: rate is between 40 and 100 bpm
>Agonal/dying heart: HR less than 20 bpm

> Causes: MI, postcardiac arrest, mediation and drug toxicities, electrolyte imbalances, myocarditis, CM, and congenital heart disease

Tx: based on symptoms
-if symptomatic, correcting the cause, pacing, and atropine

66
Q

Asymptomatic Idioventricular Rhythm (IVR)

A

> Medical:
-treat cause

  • Nursing:
  • assess LOC, palpable pulses, BP and HR
  • educate about causes, symptoms needing attention, and appropriate actions if these symptoms occur
67
Q

Symptomatic Idioventricular Rhythm (IVR)

A

> S/S: dizziness, lightheadedness, fainting, SOB, sweating, anxiety, palpitations, hypotension, decrease in LOC

> Medical:
-treat the cause

> Nursing:

  • call for help
  • stay w/ patient
  • frequent assessment for symptoms
  • frequent vital signs
  • obtain 12-lead ECG
  • ensure IV access is available and patent
  • administer medications as ordered
  • prepare for TCP
68
Q

Asystole

A

there is no measurable electrical activity originating from the heart
-straight or flat line is produced
-w/o an electrical stimulus, the cardiac muscles cannot squeeze or contract to force blood in or out of the hearts chambers
-will be pulseless
-always assess patient to see if it is a true asystolic event
>TX:
-compressions started immediately
-patient should be assessed w/ a second monitor lead, pausing compressions briefly (< 10 seconds) to r/o a fine VF
-If VF confirmed, pt defibrillated
-if second lead continues to show a flat line, asystole is confirmed and defibrillation not indicated
-TX = CPR, epinephrine, and treating cause

>S/S: unresponsive, no pulse, no BP
>Medical:
-CPR
-Epinephrine
-Treat possible causes
>Nursing:
-activate medical emergency team
-start CPR
-ensure IV access is available and patent
-hang free-flowing IV fluids (0.9% NS)
-administer emergency medications (epinephrine)
>Teaching:
-educate regarding disease management to avoid future occurrences if pt has retuned of circulation and survives event
69
Q

Automatic Implantable Cardioverter Defibrillator (AICD)

A

may be required to prevent reoccurrence of V-fib or V-tach

-automatically detects ventricular dysrhythmias and delivers a shock as needed

70
Q

Internal Pacemakers

A
  • Atrial: spike before P wave
  • Ventricular: spike before QRS complex
  • Biventricular: 2 spikes before QRS complex
  • Dual: spike before P wave and QRS complex

Nursing 272: Final Semester (79 decks)

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