Unit 2 Chapter 31 Dysrhythmias Flashcards
Where is the sinoatrial [SA] node located?
A. Right atrium
B. Mitral valve
C. Apex of the heart
D. Left ventricle
A. Right atrium
Conduction begins with the sinoatrial (SA) node (also called the sinus node), located close to the surface of the right atrium near its junction with the superior vena cava.
What is classified as the pacemaker of the heart?
A. Sinoatrial [SA] node
B. bundle of His
C. Purkinje cells
D. Automaticity
A. Sinoatrial [SA] node
What is the P wave indicative of?
ATRIAL DEPOLARIZATION
Impulses from the sinus node move directly through atrial muscle and lead to atrial depolarization, which is reflected in a P wave on the electrocardiogram (ECG).
What is the QRS wave indicative of?
Ventricular Deporiliazation
Stroke Volume
volume of blood that is ejected out of the left ventricle every heart beat
Preload
Volume of blood in the ventricles at the end of Diastole
Cardiac output
volume of liters ejected out of the left ventricle every minute
(normal range: 4-8L)
Afterload
resistence of pressure felt by the left ventricle when trying to push the blood out to the body
Systole
contraction of the heart chambers with blood ejecting out
Diastole
relaxing of the heart chambers with blood filling up
Ejection fraction
is a measurement of the percentage of blood leaving your heart each time it
contracts.
normal range; from a normal of 50% to 70%
How is the ejection fraction calculated?
through echocardiogram, if the ejection fraction is low in range, it indicates heart failure.
How many seconds is PR interval
0.12-0.20 seconds
How many second is the QRS duration
0.06-0.10 seconds
The nurse is assessing the client’s cardiac rhythm and notes the following: HR 64, regular rhythm, PR interval 0.20; QRS 0.10. How will the nurse document this rhythm interpretation in the electronic health record?
A. Sinus tachycardia
B. Sinus bradycardia
C. Normal sinus rhythm
D. Sinus arrhythmia
C. Normal sinus rhythm
The nurse is caring for client who is experiencing occasional premature ventricular contractions. What assessment data are most concerning to the nurse?
A. Potassium 4.8 mEq/L
B. Magnesium 2 mEq/L
C. Heart rate 90
D. History of smoking
D. History of smoking
While suctioning a client with a tracheostomy, the client becomes diaphoretic and nauseous and the heart rate decreases to 37 beats/min. What is the priority nursing action?
A. Continue to clear the airway.
B. Stop suctioning the patient.
C. Administer atropine.
D. Call the health care provider immediately.
C. Administer atropine.
The nurse sees the asystole rhythm on the ECG. The patient is unresponsive and has no pulse. The nurse calls a code blue and takes what step next?
A. Prepare for defibrillation
B. Administer Epinephrine
C. Start high-quality CPR
D. Notify the physician
The answer is C. The nurse would want to immediately start high-quality CPR and continue this until help arrives
You’re patient is in ventricular fibrillation (v-fib). You’ve started CPR and the airway is supported. A rhythm checked in performed and shows the patient is still in ventricular fibrillation. The NEXT action the code team will take in addition to performing high-quality CPR is to?
A. Administer Atropine
B. Defibrillate
C. Administer Epinephrine
D. Synchronized cardiovert
B. Defibrillate
The answer is B. Ventricular fibrillation is a shockable rhythm. The team will continue CPR until the machine is ready to deliver a shock (hence defibrillate). Once the machine is ready for defibrillation, the team will shout clear (all members will remove themselves from the patient) and a shock will be delivered. Then CPR will be resumed.
Your patient has reported his heart feeling like it skipped a beat after drinking coffee.
Which one of the dysrhythmias do you suspect your patient may be experiencing?
A. Sinus Tachycardia
B. Ventricular Tachycardia
C. Premature Ventricular Contraction
D. ventrricular fibrillation
C. Premature Ventricular Contraction
What are the 4 Ventricular Dysthmias?
Ventricular fibrillation
Ventricular tachycardia
Ventricular Asystole
Premature Ventricular Contraction
Ventricular fibrillation
Ventricular tachycardia
Ventricular Asystole
Premature Ventricular Contraction
Which of the following Ventricular Dysrthmias is the most fatal?
A.Ventricular fibrillation
B.Ventricular tachycardia
C.Ventricular Asystole
D.Premature Ventricular Contraction
A.Ventricular fibrillation
V FIB THERE IS NO PULSE
What is Premature ventricular complexes
Premature ventricular complexes (PVCs), also called premature ventricular contractions, result from increased irritability of ventricular cells and are seen as early ventricular complexes followed by a pause.
Originate in the ventricles resulting in wide and
bizarre QRS complexes
Is Premature ventricular complexes common?
A. yes
B.no
A. yes
Which of the following Dystrhmias are common to occur if your patient has a Potassium level of 2.3?
A.Ventricular fibrillation
B.Ventricular tachycardia
C.Ventricular Asystole
D.Premature Ventricular Contraction
D.Premature Ventricular Contraction
What are 3 causes of PVC?
PVCs may also be present in patients with hypokalemia or
hypomagnesemia.
** acute myocardial infarction
, chronic heart failure
chronic obstructive pulmonary disease (COPD),
and anemia
Sympathomimetic agents, anesthesia drugs, stress,
nicotine,
caffeine, alcohol, infection, or surgery can also cause PVCs, especially in older adults. P
What is the normal range for Potassium?
3.5-5
What is the normal range for Magnesium
1.5-2.5
Does PVC increase or decrease perfusion when it occurs?
premature beats may decreaseperipheral perfusion.
Treatment for PVC
PVCs are not usually treated other than by eliminating or managing any contributing cause (e.g., caffeine, stress).
If the PVC is caused by hypokalemia. What is the nurses next option?
A. Obtain an order for furosemide
B. Initiate Potassium IV push
C. Administer Kayexatlte
D. Administer potassium citrate mixed with water as ordered
D. Administer potassium citrate mixed with water as ordered
Potassium or magnesium is given for replacement therapy if hypokalemia or hypomagnesemia is the cause. If the number of PVCs in a 24-hour period is excessive, the patient may be placed on beta-adrenergic blocking agents (beta blockers)
What medication do youi suspoect to be ordered if PVC occurs excessively within a 24 hour period?
A. Atenolol
B. Lisinopril
C. Atorvastatin
D. Dobutamine
A. Atenolol
If the number of PVCs in a 24-hour period is excessive, the patient may be placed on beta-adrenergic blocking agents (beta blockers)
The nurse is caring for client who is experiencing occasional premature ventricular contractions. What assessment data are most concerning to the nurse?
A. Potassium 4.8 mEq/L
B. Magnesium 2 mEq/L
C. Heart rate 90
D. History of smoking
D. History of smoking
PVCs may also be present in patients with hypokalemia
anesthesia drugs, stress,
nicotine,
caffeine, alcohol,
Which of the following Dysthmias can occur is PVC is not treated?
A.Ventricular fibrillation
B.Ventricular tachycardia
C.Ventricular Asystole
D.Premature Ventricular Contraction
B.Ventricular tachycardia
What is Ventricular Tachcardia?
Ventricular tachycardia (VT), sometimes referred to as V tach, occurs with repetitive firing of an irritable ventricular ectopic focus, usually at a rate of 140 to 180 beats/min or more
LOOKS LIKE TOMB STONES ON ECG
What are the causes of Ventricular Tachycardia?
Ischemic heart disease,
Myocardial Infarction
, cardiomyopathy,
hypokalemia,
hypomagnesemia, valvular heart disease, heart failure,
drug toxicity (e.g., steroids), or hypotension.
Patients who use cocaine or illicit inhalants are at a high risk for VT.
Your patient has a past history of cocaine abuse. He reports that he didnt use cocaine in two days. What entricular dysryhtmia would you suspoect to show on the ECG?
‘A.Ventricular fibrillation
B.Ventricular tachycardia
C.Ventricular Asystole
D.Premature Ventricular Contraction
B.Ventricular tachycardia
Nursing Priority for a patient with VTACH
In some patients, VT causes cardiac arrest. Assess the patient’s circulation and airway, breathing, level of consciousness, and oxygenation level. For the stable patient with sustained VT, administer oxygen and confirm the rhythm via a 12-lead ECG. Amiodarone or lidocaine may be prescribed.
What is the drug of choice to treat Vtach?
A. Amiodarone
B. Nifedepine
C. Epinephrine
D. Diltiazem
A. Amiodarone
Which of the following medications must be discontinued 48hrs prior to synchronized cardioversion?
A. Amiodarone
B. Nifedepine
C. Epinephrine
D. Digoxin
. If the patient has been taking digoxin, the drug is withheld for up to 48 hours before an elective cardioversion. Digoxin increases ventricular irritability and puts the patient at risk for VF after the countershock.
What amount of joules would you perform synchronized cardioversion for a patient with V-tach?
A. 250 joules
B. 360 joules
C. 180 joules
D. 100 joules
C. 180 joules
What is Stable ventricular tachycardia?
. Stable ventricular tachycardia is managed with antiarrhythmic medications,
What is Unstable ventricular tachycardia?
unstable ventricular tachycardia requires immediate cardioversion.
What is the treatment for stable ventricular tachycardia
AMIODARONE
Patients who persist with episodes of stable VT may require radiofrequency catheter ablation.
What is the treatment for unstable stable ventricular tachycardia WITHOUT A PULSE
IMMEDIATE DEBRILLATION at 360joules
IF DEFIBRILLATOR IS NOT PRESENT , CPR FIRST
What is Ventricular Fibrillation?
Ventricular fibrillation (VF), sometimes called V fib, is the result of electrical chaos in the ventricles and is life threatening!
squiggly line
-there is no pulse present at all
What physical s/s would a patient present with V fib
-cardiac output
no pulse
no cerebral, myocardial, or systemic perfusion. **
**faintness,
** loss of consciousness,
apneic (no breathing).
no blood pressure
no heart sounds are absent.
Respiratory and metabolic acidosis develop.
Seizures may occur.
pupils become fixed and dilated,
cold skin
mottled skin
Death results without prompt intervention.
This rhythm is rapidly fatal if not successfully ended within 3 to 5 minutes.**
Is v fib life threatening?
A. No
B Yes
B Yes
What is the treatment for Ventricullar fibrillation?
The desired outcomes of collaborative care are to resolve VF promptly and convert it to an organized rhythm.
Therefore the priority is to defibrillate the patient immediately according to ACLS protocol.
** If a defibrillator is not readily available, high-quality CPR must be initiated and continued until the defibrillator arrives.**
DEBRIBILLATION AT 360 JOULES
An automated external defibrillator (AED) is frequently used because it is simple for both medical and lay personnel. Defibrillation is discussed with cardiopulmonary resuscitation later in this chapter.
Drugs of choice for v fib
Drugs—epinephrine: to increase heart rate
amiodarone: to fix the arrhytmia
Preventative Treatment—Radiofrequency ablation,
Automatic Implantable Cardiac Defibrillator (AICD)
You the nurse is documenting at the nursing station and notice that the ECG alarm goes off and indicates that your patient is in v-fib? What is your first action?
A. Notify the doctor
B. Call the rapid response team
C. Assess your patient
D. Go to the crash cart and bring the defibrillator in the room.
C. Assess your patient
What is Ventricular Asystole
Ventricular asystole, sometimes called ventricular standstill, is the complete absence of any ventricular rhythm (Fig. 31.14B). There are no electrical impulses in the ventricles and therefore no ventricular depolarization, no QRS complex, no contraction, no cardiac output, and no perfusion to the rest of the body.
CARDIAC ARREST
What would ventricular systole look like on a ECG
straight line
What are the clinical manifestations of Ventricular Asytole?
The patient in ventricular asystole has no pulse, respirations, or blood pressure. The patient is in full cardiac arrest.
What is the first action of the rapid response team to initiate for a patient with Ventricular Asystole?
1. CALL FOR HELP AND BEGIN CPR
2.ADMINISTER EPINEPHRINE AS QUICKLY AS POSSIBLE.
3.CIRCULATE THE EPINEPHRINE WITH CPR
4.IF AN ELECTRICAL IMPULSE RETURNS, YOU MAY DEFIBRILLATE OR “SHOCK”
THE PATIENT.
5.USE 360 JOULES
Shortly after cardiac arrest, respiratory arrest occurs. Therefore cardiopulmonary resuscitation is essential to prevent brain damage and death.
Which of the following is a cause of Ventricular Asystole(cardiac arrest)?
A. WBC 15,000
B. Potassium level 10
C. creatnine level 1.1
D. Bun level 20
B. Potassium level 10
It may also be caused by severe hyperkalemia and acidosis.
What should you do first before starting CPR for Ventricular Asystole?
A. check the level of consciousness
B. check carotid pulse for a full minute
C. Debrilate patient with 180 joules
D. assess the patient’s esophagus
A. check the level of consciousness
CPR GUIDELINE STEPS
Compression
Airway
Breathing
- Check for a carotid pulse for 5 to 10 seconds.
- If carotid pulse is absent, start chest compressions of 100 to 120
compressions per minute and a compression depth of at least 2 inches with no more than 2.4 inches. Push hard and fast! Avoid leaning into the chest after each compression to allow for full chest wall recoil. - Maintain a patent airway.
- Ventilate (breathing) with a mouth-to-mask device. Give rescue breaths
at a rate of 10 to 12 breaths/min. If an advanced airway is in place, one
breath should be given every 6 to 8 seconds (8 to 10 breaths/min). * Ventilation-to-compression ratio should be maintained at 30
compressions to 2 breaths if advanced airway is not in place. - Limit interruptions to compressions to less than 10 seconds.
- When possible, compressors should be changed every 2 minutes to
maintain effective compressions.
What is Atrial fibrillation
QUIVERING OF THE ATRIUM
- HEART IS NOT EFFECTIVELY PUMPING OR EJECTING BLOOD, SO THE BLOOD POOLS AND CLOTS
The result is a chaotic rhythm with no clear P waves, no atrial contractions, loss of atrial kick, and an irregular ventricular response (Fig. 31.11). The atria merely quiver in fibrillation (commonly called A fib).
What is the most severe complication of Atrail Fibrillation?
A. myocardial ischemia
B. lower flank pain
C. bilateral pain in lower legs
D. atherosclerosis
B. Cerebral vascular accident
It can impair quality of life and cause considerable morbidity and mortality, largely related to clo ing concerns such as embolic stroke, deep venous thrombosis (DVT), or pulmonary embolism (PE).
Risk factos of Atrial Fibrillation
Risk factors include hypertension (HTN), previous ischemic stroke, transient ischemic a ack (TIA) or other thromboembolic event, coronary heart disease, diabetes mellitus, heart failure, obesity, hyperthyroidism, chronic kidney disease, excessive alcohol use, and mitral valve disease.
Clinical manifestations of atrial fibrilation?
Signs of poor perfusion may be observed. Assess the patient for fatigue, weakness, shortness of breath, dizziness, anxiety, syncope, palpitations, chest discomfort or pain, and hypotension. Some patients may be asymptomatic.
Medication of choice for Atrail fibrillation?
Diltiazem , calcium channel blocker
