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NURS 2245 Cardiac > Week 1 Class 2 Rhythms > Flashcards

Week 1 Class 2 Rhythms Flashcards

1
Q

Which part of the heart beat makes the P wave.

A

Both Atrium depolarization (contracting)

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2
Q

P wave begins at this location in the electric conduction system

A

SA node firing

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3
Q

PR segment on ECG comes from this area of electrical conduction system.

A

AV junction

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4
Q
  1. Define the time length a Small box on an ECG is.
  2. How many of these boxes make up a larger box.
  3. With a time frame is represented with the larger box…
A
  1. 0.04
  2. 5 × 5
  3. 0.20
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5
Q

Normal time intervals

P - R Interval (PRI) Or P - Q (PQI) ….

QRS Interval…

S-T Segment…..

Q - T Interval…..

A

P - R Interval (PRI) Or P - Q (PQI) ….

0.12 - 0.20 seconds

QRS Interval…

0.08 - 0.11 seconds

S-T Segment…..

No standard time. But usually 0.36 - 0.44

Q - T Interval…..

0.33 - 0.42 Seconds

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6
Q

Normal interval times

PR & PQ…

QRS….

ST….

QT…

A

PR & PQ: 0.12 - 0.20 or 3 small boxes - 1 large box

QRS: 0.08 - 0.11 or 2 - 3 small boxes

ST: No normal Generally 0.36 - 0.44 or 1 big box 4 small - 2 big box and 1 small

QT: 0.33 - 0.42 or 1 big box & 3 small - 2 big boxes

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7
Q

5 lead EKG placement

A

Right:

White: Right 2nd intercoast space (Right Side)

Brown: 4th intercoastal space Right sternal boarder

Green: 8th intercoastal space Right side. Near bottom of rib cage.

Left

Black 2nd intercoastal space Far left side

Red: 8th IC left hand side

Brown:

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8
Q

Purpose of the 5 color EKG leads..

What does eaxh color do…

A

White & black Record activity of arms

Red & Green: legs & ground (Green)

Brown: Chest activity

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9
Q

Bedside monitoring

Single lead shows…

A

Rate & Regularness

Time to conduct impulses

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10
Q

Describe Normal Sinus Rhythm

P wave & QRS complex

Time for waves…

A

P wave present befire each QRS complex

P = 0.12 - 0.20 or 3 small boxes - 1 large box

QRS = 0.06. - 0.10 OR 1.5 SMALL Boxes - 2.5 small boxes

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11
Q

PR interval

Measures…. (location on strip)

What it represents….

A

Beginning of P wave (Atrial depolarization/ Contraction) -

Beginning of QRS complex (Ventriclar depolarization/ Contraction)

0.12 - 0.20

PR interval represents: Time it takes impulse to travle through AV node, bundle of His, Purkinje Fibers. BEFORE reaching the Ventricles

This delay allows for ventricular filling of blood before contracting.

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12
Q

Prolonged PRI >0.20

  1. Indicates this problem…
  2. Seen with these conditions…
  3. Variable PRI times is this problem…
A
  1. 1st degree heart block - Least Serious- delay conduction through AV node.
  2. Conditions:

Ischemia (Reduction in blood) / Infarction (Death of tissue caused by lack of blood)

Meds: Beta-Blocker, CCB

Electrolyte imbalance Hyperkalemia

  1. Variable PRI times suggest
    2nd or 3rd degree heart block

Mobitiz Type 1 (Wenckebach) Progressive lengthening of PRI until QRS is dropped.

Mobitz Type II: Fixed PRI with intermittent dropped QRS complex

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13
Q

Explain the difference between 2nd degree heart block :
Mobitz Type 1 (Wenckebach) & Mobitz II.

In relation to their appearance on an ECG…

Symptoms…

A

Mobitiz Type 1 (Wenckebach) Progressive lengthening of PRI until QRS is dropped.

Rhythm: Irregular

Usually asymptomatic possible dizziness

Cause: Vagal or meds

Mobitz Type II: Fixed PRI with intermittent dropped QRS complex

Symptoms: Fatigue, syncope, dizzy

More serious pathology & often requires a pacemaker.

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14
Q
  1. 3rd Degree aka…
  2. Cause….
  3. Describe appearance on EKG…
  4. Signs & Symptoms…
  5. Treatment….
A
  1. Complete heart block
  2. Electrical signals from atria isn’t making it to the ventricles

Congenital
Heart disease
MI
Meds Digoxin
Structure damage
Heart valve problem

  1. Fewer QRS complexes than P waves. “Missing P waves” Regular rate

(Ventriclar rate is lower than atrial rate)

  1. Low BP, Mental Status change, pale / clammy skin
  2. Activate Emergency Response
    Atropine
    Temporary Pace Maker / Permanent Pacemaker
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15
Q

Sinus Bradycardia

Rate…

Rhythm…

Pacemaker Site…

A

<60

Rhythm: Normal

Pacemaker Site: SA node

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16
Q

Sinus Tachycardia

Rate…

Rhythm…

Pacemaker site…

A

> 100

Rhythm: Regular

Pacemaker site: SA node

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17
Q

Sinus Dysrhthmias

Rate…

Rhythm…

Pacemaker site…

A

60 - 100 normal

Rhythm: Irregular

Pacemaker site: SA node

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18
Q

PR interval

How to measure…

What abnormalities suggest…

A

Start of P wave to Beginning of QRS complex.

Normal 0.12 - 0.20

Abnormalities

Prolonged:

1st degree heart block / conduction delays

2nd Degree Mobitz Type 1 Wenckebach
Progressive lengthening of PRI until QRS is dropped

2nd Degree Mobitz Type 2
PRI is normal QRS is dropped- More dangerous- Block at or below Bundle of His, Structural Abnormalities.

Can progress to Type 3 Total Heart block

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19
Q

Premature Atrial Contractions

Describe…

Causes…

Treatment…

A

Extra Heart beat originates from ectopic focus in the atria.

Typically benign

ECG

P wave Abnormal, maybe burried in the T wave / Close to QRS complex

PRI normal / Slightly prolonged

QRS Narrow

Causes:
Stress, fatigue, caffeine, alcohol, drug

Electrolyte imbalance
Hyperthyroidism
Hypertension
CAD
Atrial enlargement

Meds

Sympathomimetic
- bronchodilator
Digoxin toxicity

Treatment:

None normally- happens with stress & caffeine

Frequent >1 in 10 beats - further evaluation

Education: Avoid drugs & stress. If frequent notify HCP

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20
Q

Paroxysmal Supraventricular Tachycardia (PSVT)

Describe…

Rhythm….

P waves….

QRS complex…

Cuases…

Clinical Presentation….

Nursing interventions….

Stable / Unstable

Treatment….

Pacemaker site…

A

HR 150 - 250. Originates in atria / AV node due to abnormal electrical circuit.
BEGINS & ENDS SUDDEN (PAROXSYMAL)

Rhythm: Normal

P wave: Hidden in T wave or inverted if visible

QRS: Narrow <0.12, unless there is a bundle branch block.

Causes:

Stess, anxiety, fatigue
Caffeine, alcohol, drugs, smoking

Underlying conditions:

Congenital Heart conditions (Wolff-Parkinson-White Syndrome)

Hypokalemia

Structure disease/ ischemia

Digoxin

Presents:

Palpation
Dizzy
SOB
Chest discomfort (May resemble angina - Chest pain causes by lack of blood “Ischemia “
Fatigue

Nursing interventions

Stable:

Valsalva Maneuver
Notify HCP
Administer Adenosine if ordered

Unstable:

Prepare for synchronized Cardioversion

Oxygen if SpO² < 94%

Establish IV access

Treatment:

Adenosine IV push, may terminate rhythm

Beta Blockers/ CCB

Antiarrhythmic
For recurrent PSVT (amiodarone)

Longterm

Referred for Electrophysiologic Study
Ablation therapy for recurrent or severe cases

Pacemaker site: Atrial Outside the SA node

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21
Q

Which type of medication will you give for SVT & PSTV

This medication is given after less invasive interventions are tried ( Valsalva Maneuver)

Describe administration….
What scary side effect may happen…

A

Adenosine

Rapid IV push 1 - 2 seconds follow by saline flush.

6 mg, if no response 12 mg, follow by 12 mg if necessary

Scary SE
Asystole may is normal and expected before rhythm is restored.

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22
Q

Atrial Flutter

Rate (Atrial / Ventriclar)…

Rhythm….

Pacemaker….

P waves…

PRI…

QRS….

A

Rate (Atrial / Ventriclar)
Atrial 250 - 350
Ventricular Varies

Rhythm
Usually Regular

Pacemaker
Atrial Outside SA node

P waves
F (Flutter) Waves present

PRI Normal

QRS Normal

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23
Q

A Flutter has this appearance with the P waves…

A

Saw tooth

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24
Q

A Flutter

Associated Conditions…

Symptoms…

Treatment….

A

Associated Conditions:

Structure heart disease
Hyperthyroidism
Post-cardiac surgery

Symptoms:

Palpation
Dizzy
Fatigue
SOB
Chest discomfort
Maybe asymptomatic

Treatment:

Rate Control:
Beta Blockers / CCB

Rhythm Conversion:
Cardioversion or Antiarrhythmic drugs (Amiodarone)

Anticoagulantion:

To reduce stroke in persistent A Flutter

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25
A Fibrillation Rate... Rhythm... Pacemaker site... P waves.... PRI.... QRS....
Rate: Atrial 350 - 750 Ventricular Varies Rhythm: Irregularly Irregular Pacemaker site: Atrial Outisde SA node P waves None discernible F waves Present PRI None QRS Normal
26
A fib results in chaotic Atrial depolarization Result: Irregularly Irregular ventricular rhythm Decreased cardiac output due to loss of Atrial Kick. Sign & Symptoms..... Complications... Nursing Responsibilities... Assessment... Acute management... Chronic management...
Signs Palpation Irregular pulse Chest discomfort Dizzy SOB Hypotension STROKE Symptoms: Slurred Speech, Unilateral weakness, Confusion- due to embolism Tjromboembolic Events: Blood statis in atria can lead to clot Heart failure: Loss of Atrial Kick and rapid ventricle response can worsen heart function Cardiomyopathy: Chronic uncontrolled AF may lead to Atrial & Ventriclar remodeling Nurse Responsibility Assess: BP, HR, OX Sat Ask about palpation, fatigue, dizzy, chest discomfort Monitor ECT ACUTE MANAGEMENT Beta-blockers (metoprolol) CCB (Diltiazem) Digoxin MONITOR THESE MEDICATIONS FOR HYPOTENSION & BRADYCARDIA Rhythm Control: Adminster Antiarrhythmic (Amiodarone) Assist with Cardioversion if indicated Anticoagulantion Adminster Heparin, Warfarin, Apixaban
27
Most common Dysrhthmia.... Symptoms depende on....
A Fib Ventricular rate
28
Amlodipine Nifedipine Felodipine Nicardipine Diltiazem Verapamil This type of medication... What affect... Conditions to use it in...
Calcium Channel Blockers Slows down Cardiac Conduction, Contractility. Dilation of coronary arteries. Conditions it treats: A fib, A Flutter, SVT
29
What conditions are a Contradictions for CCB.
hypotension, bradycardia, heart failure,
30
CHADS2 Score Purpose.... Scoring: C: Congestive heart failure (1 point) H: Hypertension (1 point) A: Age ≥75 years (1 point) D: Diabetes mellitus (1 point) S: Prior stroke or transient ischemic attack (2 points)
Purpose: Estimates stroke risk in patients with AF.
31
CHADS2 is a scoring chart used to determine likely hood of stroke with A fib. Describe....
C: Congestive heart failure (1 point) H: Hypertension (1 point) A: Age ≥75 years (1 point) D: Diabetes mellitus (1 point) S: Prior stroke or transient ischemic attack (2 points)
32
What is CHADS2 VASC2 Used for.... Describe.....
A more refined scoring system to determine Use of Anticoagulants in a patient with Afib to prevent stroke. C: Congestive heart failure (1 point) H: Hypertension (1 point) A2: Age ≥75 years (2 points) D: Diabetes mellitus (1 point) S2: Prior stroke or TIA (2 points) V: Vascular disease (e.g., PAD, MI, aortic plaque) (1 point) A: Age 65–74 years (1 point) Sc: Sex category (female) (1 point) Total Range: 0–9
33
Vitamin K agonist This medication... Target IRN level for effective use... Target IRN level for age >75... Normal healthy IRN level... Antidote for Vitamin K agonist Warfarin (Coumadin) Normal IRN level
Warfarin (Coumadin) Target IRN 2.0 - 3.0 >75 1.6 - 2.5 Normal healthy: 0.8 - 1.2 Antidote: Vitamin K Phytonadione or Phylloquinone.
34
Difference in use between Vitamin K agonist Warfarin (Coumadin) & Heparin, Enoxaparin (Lovenox)
Heparin, Enoxaparin (Lovenox) Acute situations requiring rapid anticoagulation (e.g., pulmonary embolism, deep vein thrombosis, myocardial infarction). Bridging therapy before starting warfarin or before surgery. Warfarin When Used: Long-term anticoagulation for conditions like atrial fibrillation, mechanical heart valves, or chronic DVT/PE. Reason: Slower onset of action but ideal for chronic management.
35
PTT (Partial Thromboplastin Time): Target PTT for Therapeutic Use with these medications.... 60–80 seconds (1.5–2.5 times the normal value). Normal PTT: 25–35 seconds.
Target therapeutic use for: Heparin, Enoxaparin (Lovenox)
36
What is the target time at type of blood clotting value for Heparin & Enoxaparin (Lovenox)... Vitamin K agonist: Warfarin (Coumadin)
Heparin & Enoxaparin (Lovenox) PTT: 80 seconds (1.5–2.5 times the normal value). Normal PTT: 25–35 seconds. Vitamin K agonist Warfarin (Coumadin) INR 2 - 3 seconds unless >75 1.6 - 2.5 seconds
37
Antidote for Heparin or Enoxaparin (Lovenox)
Protamine Sulfate.
38
Direct Thrombin inhibitors Dabigatran - Pradaxa has a specific antidote ______ Rivaroxaban (Xarelto) Apixaban (Eliquis) Antidote _____
Dabigatran (idarucizumab) Rivaroxaban (Xarelto) Apixaban (Eliquis) Andexanet alfa (Andexxa)
39
Which area of the heart is the primary source of blood clots in A Fib.... Treatment...
Atrial appendage Atrial appendage closure
40
Ventricular Escape Complexes Rate... Rhythm.... Pacemaker site... P waves... PRI..... QRS.... General appearance...
Rate 15 - 40 Rhythm Escape Complex Irregular/ Escape Rhythm, Regular Pacemaker site Ventricle P waves None PRI None QRS: Wide QRS, Bizarre General appearance: Huge QRS with a peak on Left Side
41
Premature Ventriclar Contractions Rate Rhythm Pacemaker site P wave PRI QRS General appearance
Rate Underlying rhythm Rhythm Interupts regular underlying rhythm Pacemaker site Ventricle P wave None PRI None QRS >0.12, General appearance: Wide QRS complexes, Irregularly spaced
42
V Tach Rate Rhythm Pacemaker site P waves PRI QRS General appearance
Rate 100 - 250 Rhythm Usually regular Pacemaker site Ventricle P waves Usually absent, if present not associated with QRS PRI None QRS >0.12 Wide, Bizarre General appearance Tombstone
43
V Fib Rate Rhythm Pacemaker site P waves PRI QRS General appearance
Rate no organized Rhythm Rhythm no organized Rhythm Pacemaker site Numerous ventricular foci P waves Usually absent PRI NONE QRS NONE General appearance: Squiggly lines No P waves nor QRS
44
Asynchronous countershock depolarizes myocardium to allow ____ to regain control Defibrillation
SA node
45
Pacemakers can be Temporary Transcutaneous External Epicardial or Permanent Ventricular Atrial- Ventricular Biventricular S-ICD Precautions.... (4)
Incision care Restricted arm motion for 1 - 2 months (Lead Displacement- hematoma) Avoid electromagnetic fields Regular follow up
46
1st degree block Rate Rhythm Pacemaker site P waves PRI QRS General appearance
Rate Depends on underlying rhythm Rhythm Usually regular Pacemaker site SA node or Atrial P waves Normal PRI >0.20 sec QRS Normal General appearance. Regular rhythm but the PRI is consistently longer than 0.20
47
2nd degree type 1 AV block Winkebach Rate Rhythm Pacemaker site P waves PRI QRS General appearance
Rate: Atrial Normal, Ventriclar Normal to Slow Rhythm Atrial Regular Ventriclar Irregular Pacemaker site SA node or Atrial P waves Normal, sone P waves will not be followed by QRS complex PRI Increases in length until a QRS is dropped QRS Normal General appearance Increasing PRI until a QRS is dropped
48
Type 2 second degee AV block Rate Rhythm Pacemaker site P waves PRI QRS General appearance
Rate Atrial normal Ventriclar maybe slow Rhythm maybe regular or irregular Pacemaker site SA node or Atrial P waves Normal some P waves not followed by QRS PRI Constant >0.20 QRS Normal General appearance. Constant >0.20 PRI with dropped QRS complexes
49
3rd Degree AV block Rate Rhythm Pacemaker site P waves PRI QRS General appearance
Rate Atrial Normal Ventriclar 20-40-60 Rhythm Regular Pacemaker site SA & AV node or Ventricle P waves Normal with No Correlation to QRS PRI No relationship to QRS QRS >0.12 General appearance P & QRS are not dependent on eachother
50
________ life-threatening condition where fluid accumulates in the pericardial sac, exerting pressure on the heart and impairing its ability to fill and pump effectively.
Cardiac tamponade
51
How to treat Pulseless Electrical Activity...
Treat the cause. Hypovolemia Tension pneumothorax Cardiac Tamponade Hypoxia
52
SVT, 160 - 180 HR, 88/56 BP, SOB, Palpation, weakness INITIAL REACTIONS...
Notify HCP - Hemodynamically unstable Provide oxygen if <95% Establish IV Vagal maneuver Adenosine (if ordered) 6 mg IV push 1 - 2 seconds, 20 mL saline flush. 2nd dose if ineffective Prepare for synchronized Cardioversion - consent - Sedation- Versed - Monitor patient response Reassess
53
In which cases will the nurse give adenosine. Severe Bronchospastic Disease: Asthma or COPD exacerbation risk. Supraventricular Tachycardia (SVT): Narrow QRS tachycardia with a rate >150 bpm. Regular, Stable Tachycardia: Symptomatic (e.g., palpitations, chest discomfort, SOB) and unresponsive to vagal maneuvers. Second- or Third-Degree AV Block: Without a functioning pacemaker. Sinus Node Dysfunction: Without a pacemaker. Wide Complex Tachycardia (diagnostic): To distinguish SVT with aberrancy from ventricular tachycardia under physician direction. Atrial Fibrillation/Flutter with Accessory Pathway (e.g., WPW syndrome): Risk of triggering ventricular fibrillation.
Supraventricular Tachycardia (SVT): Narrow QRS tachycardia with a rate >150 bpm. Regular, Stable Tachycardia: Symptomatic (e.g., palpitations, chest discomfort, SOB) and unresponsive to vagal maneuvers. Wide Complex Tachycardia (diagnostic): To distinguish SVT with aberrancy from ventricular tachycardia under physician direction. When a Nurse Cannot Give Adenosine Atrial Fibrillation/Flutter with Accessory Pathway (e.g., WPW syndrome): Risk of triggering ventricular fibrillation. Second- or Third-Degree AV Block: Without a functioning pacemaker. Sinus Node Dysfunction: Without a pacemaker. Severe Bronchospastic Disease: Asthma or COPD exacerbation risk.
54
Which is the preferred treatment of reoccurring Symptomatic SVT
Diltiazem CCB
55
When a coronary vessel is mostly originates completely occuleded, the cells that depend on the oxygen become Ischemic, then necrotic, and die. This result is known as ....
MI
56
1. Nitrates cause blood vessels to.... 2. Results in drop in PVR & BP and decreased venous return to the heart. These actions (Decrease / Increase ) myocardial workload and restore balamce to the heart's Supply-and-demand ratio.
1. Relax and dilate 2. Decrease
57
Angina Pectoris occurs when... SS.... Stable vs Unstable...
Myocardial oxygen demand cannot be meet Pain, anxiety, SOB, Fatigue Stable: Oxygen demand is meet when at rest. Unstable: Oxygen demand may not be meet when at rest
58
Drug of choice for treating Acute Anginal Attack
Sublingual Nitroglycerin
59
Beta-Blockers work by...
Prevent activation of Sympathetic NS (which increases heart stuff)
60
Leading cause of death US & world wide
ASCVD
61
____ is the bais of our clot-dissolving system
Plasminogen
62
____ drugs are used to stop bleeding
Hemostatic

NURS 2245 Cardiac (11 decks)

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