Unit 2: Cardiac Dysrhythmias Flashcards
1
Q
Dysrhythmias
A
disruptions in the cardiac conduction pathway
-disorders of the electrical impulse conduction within the heart
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
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)
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
5
Q
Usual Treatment Pathway
A
- Non-invasive/ non-pharmacological
- vasovagal maneuvers (cough, bear down) - Pharmacology
- Adenosine, Diltiazem, Atropine - Electricity
- cardioversion, defibrillation, pacing
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
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
8
Q
Defibrillation
A
- no pulse
- for VT, Vfib
- joules always 200 J
- emergency, no cardiac output
9
Q
Medications
A
> HR too fast
- Adenosine
- Diltiazem
- Digoxin
- Amiodarone
- Metoprolol
> HR to Slow
-Atropine
> Anticoagulant
- Heparin
- Warfarin
> No HR/CPR
-epinephrine
10
Q
Medications for a HR that is too fast
A
- Adenosine
- Diltiazem
- Digoxin
- Amiodarone
- Metoprolol
11
Q
Medications for a HR too Slow
A
Atropine
12
Q
Anticoagulants
A
- Heparin
- Warfarin
13
Q
Medications for no HR/CPR
A
Epinephrine
14
Q
Sinus Dysrhythmias
A
- Sinus Bradycardia (SB)
- Sinus Tachycardia (ST)
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
16
Q
Treatment for Symptomatic Sinus Bradycardia (SB)
A
atropine 0.5 mg IV push
17
Q
Atropine Sulfate
A
anticholinergic
- increases SA node stimulus and increases conduction through the AV node
- use cautiously with MI patients
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
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)
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)
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
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
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
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
25
Nursing Interventions for ALL Asymptomatic Sinus Dysrhythmias
- 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
26
Nursing Interventions for ALL Symptomatic Sinus Dysrhythmias
-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
27
Cardiac Dysrhythmias: Atrial Dysrhythmias
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)
28
Premature Atrial Contractions (PAC)
-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
29
Asymptomatic Vs Symptomatic PCAs
>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
Atrial Fibrillation (AF)
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
Complications of Atrial Fibrillation (AF)
- Loss of Cardiac Output (CO)
| - Clots
32
Complications of Atrial Fibrillation (AF): Loss of CO
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
Complications of Atrial Fibrillation (AF): Clots
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
Antiarrhythmic Medications used for AF
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
Anticoagulant Medications for Atrial Fibrillation (AF)
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
Calcium Channel Blockers for AF
Diltiazem (Cardizem)
- slows conduction through AV node
- use cautiously in pts with heart failure
37
Beta Blockers for AF with RVR
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
Cardiac Glycosides for AF
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
Asymptomatic Atrial Fibrillation (AF)
>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
Symptomatic Atrial Fibrillation (AF)
>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
Atrial Flutter (AFL)
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
Asymptomatic Atrial Flutter (AFL)
>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
Symptomatic Atrial Flutter (AFL)
>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
Supraventricular Tachycardia (SVT)
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
Asymptomatic Supraventricular Tachycardia (SVT) ALL
```
>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
Symptomatic Supraventricular Tachycardia (SVT) ALL
```
>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
Junctional Rhythms
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
Premature Junctional Contractions (PJCs)
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
Asymptomatic Premature Junctional Contractions (PJCs)
>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
Symptomatic Premature Junctional Contractions (PJCs)
>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
Ventricular Dysrhythmias
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
Premature Ventricular Contractions (PVCs)
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
Unifocal PVCs
premature ventricular contractions coming from one ventricular pacemaker cell
54
Multifocal PVCs
premature ventricular contractions coming from multiple ventricular pacemaker cells
55
Couplet PVC
2 premature ventricular contractions in a row
56
Triplet/ Three-beat run of VT (PVC)
3 premature ventricular contractions in a row
57
Bigeminy PVC
a premature ventricular contraction that occurs every other beat
58
Trigeminy PVC
a premature ventricular contraction falling every 3rd beat
59
Asymptomatic Vs Symptomatic PVCs ALL
>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
Ventricular Tachycardia (VT)
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
VT with a Pulse
```
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
Pulseless Ventricular Tachycardia
```
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
Ventricular Fibrillation (VF)
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
Things to Consider in the Treatment for VF
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
Idioventricular Rhythm (IVR)
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
Asymptomatic Idioventricular Rhythm (IVR)
>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
Symptomatic Idioventricular Rhythm (IVR)
>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
Asystole
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
Automatic Implantable Cardioverter Defibrillator (AICD)
may be required to prevent reoccurrence of V-fib or V-tach
| -automatically detects ventricular dysrhythmias and delivers a shock as needed
70
Internal Pacemakers
- Atrial: spike before P wave
- Ventricular: spike before QRS complex
- Biventricular: 2 spikes before QRS complex
- Dual: spike before P wave and QRS complex
