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Exam 11 Med Surg > Ventricular Rhythms > Flashcards

Ventricular Rhythms Flashcards

1
Q

pairs -couplets
(PVC Patterns)

A

-2 sequential PVCS

-PVC is 0.14 or greater

-3 or more PVCs occurring in immediate succession at a rate of more than 100 bpm are called a run of V-tach

-need to have 3 in a row to be a rythm

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2
Q

bigeminal PVC - ventricular bigeminy
(PVC patterns)

A
  • every other beat is a PVC

-sinus beat and then a PVC

-need to have at least two repeating patterns

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3
Q

trigeminal PVC - ventricular trigeminy

A

-every 3rd beat is a PVC

-sinus, sinus, then PVC

-need to have at least 2 repeating patterns

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4
Q

quadrigeminal PVC - ventricular quadrigeminy

A

-every 4th beat is a PVC

-sinus, sinus, sinus, then PVC

  • repeating cycle of at least 2
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5
Q

Unifocal PVC

A

premature ventricular beats that look the same in the same lead and originate from the same anatomical site (focus)

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6
Q

Multifocal PVC

A

PVCs that appear different from one another in the same lead

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7
Q

R on T PVC

A

-occurs when the R wave of a PVC falls on the T wave of the preceding beat (during the relative refractory period)

-a PVC occurring during this period of the cardiac cycle may precipitate VT or VF

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8
Q

EKG Characteristics of PVCs

A

P Waves: NA
PRI: NA
QRS: greater than .12
Rate: varies
Rhythm: irregular

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9
Q

Nursing Interventions for PVCs
(Common causes, Nursing Interventions, Tx, Risks)

A

CC:
hypokalemia, hypomagnesemia, hypoxia, sympathomimetic medication, caffeine, ETOH

NI:
palpate pulse, chronic or new onset?, assess for cause, trend

Tx:
treat possible cause

Risks:
pts at higher risk for v-fib

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10
Q

Ventricular Escape Beats EKG Characteristics

A

P Waves: NA
PRI: NA
QRS: wide and bizarre
Rate: varies
Rhythm: irregular

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11
Q

Idioventricular Rhythm (IVR)

A

-3 or more sequential ventricular escape beats occurring at a rate of 20-40 bpm

  • hold amiodarone, lidocaine, procainamide, digoxin

-wide, no P waves

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12
Q

IVR EKG Characteristics

A

P Waves: NA
PRI: NA
QRS: wide and bizarre
Rate: 20-40 bpm
Rhythm: regular

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13
Q

Nursing Interventions for IVR

A

Nursing:
1. vital signs (incl SpO2)
2. assess for shock (cool clammy skin, ALOC)
3. lower HOB is there is hypotension
4. oxygen if hypoxic
5. assess for angina
6. IV access if symptomatic
7. 12 lead EKG
8. identify and tx possible causes (hold neg chonrontropic, dropmotropic medications)

Pharmacologic:
1. atropine (initial does is 0.5 mg IVP) if symptomatic
2. isoproterenol (Isuprel) if symptomatic

Electrical:
Pacing - if rate is slow and unresponsive to medication

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14
Q

AIVR EKG Characteristics

A

P Waves: NA
PRI: NA
QRS: wide and bizarre
Rate: 41-100 bpm
Rhythm: regular

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15
Q

Nursing Interventions for AVIR

A

Nursing:
1. vital signs (incl SpO2)
2. assess for shock (cool clammy skin, ALOC)
3. lower HOB if there is hypotension
4. Oxygen is hypoxic
5. assess for angina
6. IV access if symptomatic
7. 12 lead EKG
8. identify and treat possible causes (hold negative chronotropic, dromotropic medications)

Pharmacologic:
-tx unnecessary if pt is asymptomatic
-atropine (initial dose is 0.5 mg IVP) if symptomatic

Electrical:
-pacing – if rate is slow and unresponsive to medication

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16
Q

Monomorphic VT EKG Characteristics

A

P Waves: NA
PRI: NA
QRS: wide .12 or more
Rate: 101-250
Rhythm: regular

17
Q

Nursing Interventions for VT

A

Nursing:
1. check for a pulse first
2. if pulse then - vital signs incl SpO2
3. assess for shock (cool clammy skin, ALOC)
4. lower HOB if there is hypotension
5. oxygen if hypoxic
6. assess for angina
7. IV access
8. 12 leak EKG
9. identify and treat reversible causes

Nursing - If NO PULSE
1. no pulse, call Code Blue
2. start CPR
3. Ambu-bag the pt
4. IV access

Electrical:
-defibrillation: biphasic 120-200 J
monophasic 360 J

Pharm:
epinephrine 1 mg every 3-5 minutes

18
Q

Reversible Causes - H’s

A

H:
1. hypovolemia
2. hypoxia
3. hydrogen ions (acidosis)
4. hypo/hyperkalemia
5. hypothermia

19
Q

Reversible Causes - T’s

A

T:
1. tension pneumothorax
2. tamponade (cardiac)
3. toxins
4. thrombosis (pulmonary)
5. thrombosis (coronary)

20
Q

Torsade de Pointes EKG Characteristics

A

P Waves: NA
PRI: NA
QRS: wide
Rate: 150-300 bpm
Rhythm: varies

21
Q

Nursing Interventions for TdP

A

Nursing:
1. check for pulse first
2. if pulse, then vital signs incl SpO2
3. assess for shock (cool clammy skin, ALOC)
4. lower HOB if there is hypotension
5. give oxygen if hypoxic
6. assess for angina
7. IV access
8. 12 lead EKG
9. prepare to give 1-2 g Magnesium over 5-60 minutes, followed by an IV infusion of 0.5 - 1 g/hr

Nursing if NO PULSE:
1. no pulse, call Code Blue
2. start CPR
3. ambu-bag the pt
4. IV access

Electrical:
-defibrillation
biphasic 120-200 J
monophasic 360 J

Pharm:
-epinephrine 1 mg every 3-5 minutes
-prepare to give 1-2 g Magnesium IV over 5-20 minutes

22
Q

Fine VF

A

low amplitude waves (less than 3 mm)

23
Q

Coarse VF

A

waves more easily visible (greater than 3 mm)

24
Q

VF EKG Characteristics

A

P waves: NA
PRI: NA
QRS: NA
Rate: NA
Rhythm: NA

25
Q

Nursing Interventions for VF

A

Nursing:
1. check for pulse first
2. no pulse, call Code Blue
3. start CPR
4. ambu-bag the pt
5. IV access
6. identify and treat reversible causes

Electrical:
-defibrillation
biphasic 120-200 J
monophasic 360 J

Pharm:
epinephrine 1 mg IVP every 3-5 minutes

26
Q

Asystole (cardiac standstill)

A

-total absence of ventricular electrical activity, therefore is not a shockable rhythm

-always check in 2 leads to verify

-there is no ventricular rate, rhythm, or pulse

-some atrial electrical activity may be evident, but it still is not a shockable rhythm

27
Q

Pulseless Electrical Activity (PEA)

A

-electrical activity on a monitor that does not have a pulse

-treated like asystole, therefore it is not a shockable rhythm

-hypovolemia and hypoxia are two most common reversible causes

28
Q

Nursing Interventions for Asystole/ PEA

A

Nursing:
1. always check for pulse first
2. no pulse, call Code Blue
3. start CPR
4. confirm asystole in 2 different leads
5. ambu-bag the pt
6. IV access
7. identify and treat reversible causes

Pharm:
-epinephrine 1 mg every 3-5 minutes

Electrical:
-only if rhythm becomes shockable
-defibrillation (for VF or pulseless VT)
biphasic 120-200 J
monophasic 360 J

29
Q

Reversible Causes Are For What?

A

Asystole/ PEA
VF
VT

Exam 11 Med Surg (8 decks)

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