Week 2 Management Pt with Dysrhythmias Flashcards
1
Q
Disorders of formation or conduction or both of electrical impulses within heart
A
Dysrhythmias
Can cause
- Rate
- Rhythm
- Both rate and rhythm
2
Q
Potentially can alter blood flow, cause hemodynamic changes
Diagnosed by analysis of EKGs
A
Dysrhythmias
3
Q
Abnormal cardiac rhythms
A
Dysrhythmias
4
Q
Electrode Placement
A
5 Lead
Right
- White above
- Green Below
Left
Black above- Smoke
Red below - Fire
Middle is Brown
5
Q
V1-V6 placement
A
V1: Placed on the right side of the sternum in the fourth intercostal space
V2: Placed on the left side of the sternum in the fourth intercostal space
V3: Placed midway between V2 and V4
V4: Placed on the mid-clavicular line in the fifth intercostal space
V5: Placed on the anterior axillary line on the same horizontal level as V4
V6: Placed on the mid-axillary line on the same horizontal level as V4 and V5: Placed on the
6
Q
Lead 1
A
RA (-) to LA (+) (Right Left, or lateral)
7
Q
Lead II
A
RA (-) to LL (+) (Superior Inferior)
8
Q
Lead III
A
LA (-) to LL (+) (Superior Inferior)
1-3 - Bipolar Leads
9
Q
Lead aVR
A
RA (+) to [LA & LL] (-) (Rightward)
10
Q
Lead aVL
A
LA (+) to [RA & LL] (-) (Leftward)
11
Q
Lead aVF
A
LL (+) to [RA & LA] (-) (Inferior)
12
Q
P wave represents
A
Atrial Depolarization
13
Q
QRS represents
A
Ventricular depolarization
14
Q
T wave represents
A
Ventricular repolarization
15
Q
One small box on ECG is counted as
A
0.04s
16
Q
One large box represents
A
5 small boxes
0.20 s
Vertically- 5mm of half mV
17
Q
P waves represent?
A
Atrial rate
18
Q
Ventricular rate
A
Number of QRS complexes
19
Q
Normal PR interval is
A
max 5 small boxes
0.12-0.20
above 0.20
= Heart block
20
Q
QRS complex is how many seconds
A
0.04-0.12 sec
3 small boxes
above 0.12 = Bundle Branch block
21
Q
What is QT Interval?
A
Normal is 0.36-0.44 seconds
9-11 small boxes
22
Q
Name the steps for rhythm analysis
A
Step1 - Determine regularity
Step2- Calculate rate
Step 3- Determine P waves
Step 4- Determine PR interval
Step 5- Determine QRS complex
Step 6- QT Interval
23
Q
NSR
who is firing?
A
SA node fires 60-100 BPM
Follows normal conduction pattern
24
Q
SA node fires less than 60
Normal in well-trained athletes
A
Sinus Bradycardia
-40-59 BPM
- P wave
QRS- Normal
Conduction- Normal may be slightly prolonged
Rhythm- Regular or slightly irregular
25
Name the clinical associations for Sinus bradycardia
Occurs in response to
- Carotid Sinus massage
- Hypothermia
- Administration of parasympathetic drugs
26
Tx for Sinus Bradycardia
Atropine
Isoproterenol
Pacemaker may be required
27
Rate is 101-160
P wave sinus
QRS- Normal
Conduction- Normal
Rhythm- Regular or slightly irregular
Sinus Tachycardia
28
Name the clinical associations of Sinus Tachycardia
Associated with physiologic stressors
- Exercise
- Pain
- Hypovolemia
- MI
- HF
- Fever
29
Tx for Sinus Tachycardia includes
Treat the underlying cause
Use
- B- Adrenergic blockers to reduce HR and myocardial oxygen consumption
- Antipyretics to treat fever
- Analgesics to treat pain
30
This is an atrial tachydysrhythmia identified by recurring, regular, "sawtooth" shaped flutter waves
Originates from a single ectopic focus
Atrial Flutter
31
Heart rate is 220-430 BPM
V rate is less than 300 BPM
Rhythm is regular or variable
P wave is saw-toothed
PR- N/A
QRS is less than <.12 sec
Atrial Flutter
32
Tx of Atrial Flutter includes
Primary goal is to slow ventricular response by increasing AV block
33
Drugs to slow HR for atrial flutter
CCBs
Beta Blockers
Amiodarone
34
-------------------------- or -------------------- may be used to convert atrial flutter to sinus rhythm emergently and electively
Electrical cardioversion
Ablation
For a flutter
35
Total disorganization of atrial electrical activity due to multiple ectopic foci resulting in loss effective atrial contraction
Most common dysrhythmia
Prevalence increases with age
Atrial Fibrillation
36
HR atrial is 350-650 BPM
V rate is slow to rapid
Rhythm is irregular
P wave fibrillatory from fine to course
PR- N/A
QRS- <0.12 seconds
Atrial Fibrillation
37
A- Fib Tx goals include
Decrease ventricular response
- Prevent embolic stroke
38
Drug for rate control for A-Fib includes
Digoxin
Beta blockers
CCBs
39
Long term anticoagulation for Afib includes
Coumadin
40
For some patients, conversion to sinus may be considered
Antidysrhythmic used for conversion: Amiodarone, propafenone
Cardioversion may be used to convert atrial fibrillation to NSR
41
Tx of AFib includes what if pt has been in AFIB for more than 48 hours
Use anticoagulation with warfarin for 3-4 weeks before cardioversion and after 4-6 weeks after successful cardioversion
42
AFIB tx of radiofrequency catheter ablation incudes
Use of cold- cryoablation
Use of heat- High- intensity ultrasound
43
Contraction originating in ectopic focus of the ventricles
Premature occurrence of a wide and distorted QRS complex
PVCs
Multifocal, unifocal, ventricular bigeminy, ventricular trigeminy, couples, triplets, Ron T phenomena
44
P wave is usually obscured by the QRS, PST, or T wave of the PVC
QRS in wide more than 0.12 sec
Morphology is bizarre with the ST segment and the T wave opposite in polarity. May be multifocal and exhibit different morphologies.
Conduction- Impulse originates below the branching portion of the Bundle of His; full comp. pause is characteristic
Rhythm- Irregular. PVCs may occur in singles, couplets, or triplets or in bigeminy, trigemeny, or quadrigemeny.
PVCs
45
PVCs clinical associations include
Stimulants : alcohol, caffeine, nicotine, aminophylline, epinephrine, isoproterenol
- Digoxin
- Electrolyte imbalances
- Hypoxia
- Fever
- Disease states : MI, Mitral Valve prolapse, HF, CAD
46
Tx of PVCs include
Based on the cause
- O2 therapy for hypoxia
- Electrolyte replacement
Drugs
- Beta Blockers
Procainamide
Amiodarone
Lidocaine
47
Run of three or more PVCs
Considered life- threatening because of deceased CO and the possibility of deterioration and VFIB
VTACH
48
Rate: Usually between 100-220 BPM, but can be as rapid as 250 BPM
P-wave: Obscured if present and are unrelated to the QRS complexes
QRS: Wide and bizarre morphology
Conduction: as with PVCs
Rhythm: 3 or more ventricular beats in a row, may be regular or irregular.
VTACH
49
Tx for VTACH includes
Precipitating causes must be identified and treated hypoxia
50
VTACH with a pulse
Amiodarone
Adenosine
Verapamil
Pulse- Synchroniozed cardioversion
51
No pulse with VTACH
Defibrillation - CPR
52
Severe derangement of the heart rhythm characterized on ECG by irregular rhythm of varying contour and amplitude
No effective contraction or CO occurs
Emergency life threatening Rhythm
VFIB
53
HR is 300-600
Rhythm is extremely irregular
P wave - Absent
PR- N/A
QRS- Fib Baseline
VFIB
54
Clinical Associations for VFIB
Acute MI, CAD, Cardiomyopathy
- VF may occur during cardiac pacing or cardiac cath.
- VF may occur with coronary reperfusion after fibrinolytic therapy
- Accidental electrical shock
- Hyperkalemia
- Hypoxia
- Acidosis
- Drug toxicity
55
Tx of VFIB
Immediate defib AED or CPR and ACLS measures with use
56
Represents total absence of ventricular electrical activity
No ventricular contraction occurs because depolarization does not occur
Asystole
57
Clinical associations for Asystole include
Advanced cardiac disease
Severe cardiac conduction system disturbance
End Stage HF
58
Tx for Asystole
Tx
CPR with initiation of ACLS measures (intubation, transcutaneous pacing, and IV therapy with epi)
59
Goal with pt without pulse (pulseless) includes
ROSC and maintain it
60
Assess indicators of CO and oxygenation especially changes in
LOC
61
Physical assessment of pt with dysrhythmia includes
Rate
Rhythm of apical
peripheral pulse
Heart sounds
Blood pressure, pulse pressure
Signs of fluid retention
62
Health Hx of pt with dysrhythmia
Include presence of coexisting conditions, indications of previous occurrence
Medications
63
H's in dysrhythmias include
Ts include
Hypovolemia
Hypoxia
Acidosis
Hyper/Hypokalemia
Hypothermia
Toxins
Tamponade
Tension Pneumothorax
Thrombosis (coronary and pulmonary)
64
Drug Class I are
Sodium Channel blockers
65
How many classes of Sodium channel blockers are there?
3
Class IA
Class IB
Class IC Class
66
Class IA includes?
Quinidine, Procainamide, Disopyramide
67
Class IB includes?
Lidocaine
68
Class IC includes?
Flecainide, Propafenone
69
Class II for Dysrhythmias include?
Beta Blockers
-olols
70
Class III includes ?
Potassium Channel Blockers
Amiodarone, Dofetilide, Ibutilide, Sotalol
71
Class IV Calcium Channel Blockers include
Diltiazem
Verapamil
72
Unclassified drugs for arrhythmias
Adenosine
Mag sulfate
73
Treat tachydysrhythmias by doing what?
Delivering electrical current that depolarizes critical mass of myocardial cells
- When cells repolarize, sinus node usually able to recapture role as heart pacemaker
74
In cardioversion current delivery is
Synchronized with patient's ECG
75
In DeFIB current delivery is
Unsynchronized
76
Choice of therapy for hemodynamically unstable ventricular, supraventricular tachydysrhythmias, AFIB, A. FLUTTER
Synchronized Cardioversion
77
Synchronized circuit delivers a countershock on...
R wave of the QRS complex of ECG
78
Synchronizer switch must be ...
turned on
79
Most effective method of terminating VF and pulseless Vtach
Defibrillation
80
Passage of direct current -DC- lectrical shock through the heart to depolarize the cells of the myocardium to allow the SA node to resume pacemaker role
Defibrillation
81
This is an elective procedure where the client is wake
Synchronized with QRS
Sedation
50-200 Joules
Consent form
EKG monitor
Cardioversion
82
Used for emergency
VFIB and VTACH
No CO
Begin with 200J- up to 360 J
Client unconscious
EKG monitor
Defibrillation
83
Safety Measures for equipment include
Assure good contact between skin, pads, or paddles
- Use conductive medium, 20-25 pounds of pressure
-Place paddles so they do not touch bedding or clothing, are not near medication patches or oxygen flow
- If cardioverting- Turn synchronizer on
- If Defib- Turn synchronizer off
84
Electronic device that provides electrical stimuli to heart muscle
Pacemakers
Types include
- Temp
- Permanent
85
Used to pace the heart when the normal conduction pathway is damaged or diseased
Pacemakers
86
Pacing circuit consists of ...
Power source
One or more conducting leads
And the myocardium
87
How does the electrical signal travel in a pacemaker?
Through the leads
to the wall of the myocardium
Myocardium is captured and stimulated to contract
88
Power source outside the body
Temporary pacemaker
- Transvenous
- Epicardial
- Transcutaneous
89
Implanted totally within the body
Permanent pacemaker placement
90
Pacing technique that resynchronizes the cardiac cycle by pacing both ventricles
CRT
Combined CRT with an ICD for max therapy
91
Device that detects and terminates life-threatening episodes of tachycardia or fibrillation
Anti-tachycardia pacing
ICD
92
ICD are appropriate for what type of pts
- Have survived severe cardiac dysrhythmias
- Have spontaneous VT
- Have syncope with inducible ventricular tachycardia/ fibrillation
- High risk for future life-threatening dysrhythmias
93
ICD education is extremely important
True
Variety of emotions are possible
- Fear of body image change
- Fear of recurrent dysrhythmias
Expectation of pain with ICD discharge
Anxiety going home
Participation in ICD support group is important
- DEFIB LIFE VEST- External
94
Patient Teaching for Pacemakers and or ICDs
Don't drive until site healed
Wear sling
No lifting arm above head
Incision care, S &S of infection
Carry ID card
Do not put cell phone on pocket of side of ICD
Avoid strong electrical fields
Learn how to check pulse
No magnetic fields
Battery lasts 5-10 years
Analyzed for fx periodically
No commercial driving
Be aware of shock
95
