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NURSADN6 Med Surg > Week 5 ECG/ EKG Monitoring CH 22 > Flashcards

Week 5 ECG/ EKG Monitoring CH 22 Flashcards

1
Q

What is the conduction system of the heart?

A

Includes
SA Node
AV Node
Conduction
Bundle of HIS
Right and Left Bundle Branches
Purkinje Fibers
Depolarization- Stimulation- systole
Repolarization- Relaxation- diastole

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2
Q

What is the pace of the SA node?

A

60-100 BPM

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3
Q

Junction pace is ?

A

40-60 BPM

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4
Q

Purkinje System pace is?

A

30-40 BPM

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5
Q

Failure of one pacemaker allows what to fire?

A

Subsidiary pacemaker to fire

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6
Q

Name the normal electrical conduction system

A

SA - sinus node
AV node
Conduction
Bundle of HIS
Right and Left Bundle Branches Purkinje Fibers
Depolarization
Repolarization

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7
Q

SA Node Depolarization includes phase 4 what is happening in this phase?

A

K channels close, slow NA channels opening

Then Ca channels open

Ca channels close, K channels open

Decrease of Ca permeability
Increase K permeability

Then K channels close, slow open Na channels; slow depolarization - pacemaker potential

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8
Q

Myocardial Action Potential Includes

A

Na in fast
K out fast
Ca in slow
K out fast

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9
Q

Bipolar Lead placement includes

A

Lead 1- RA- —– LA+
Lead 2- RA- ——- LL+
Lead 3 LA- ——- LL+

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10
Q

Unipolar Lead placement includes

A

V1- 4th intercostal space RSB
V2- 4th intercostal space LSB
V3- halfway between V2-V4
V4-V5-intercostal space, midclavicular line
V5- anterior axillary line between V4 and V6
V6- midaxillary line, level with V4

Opposite with right sided ECG

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11
Q

EKG graph contains a background pattern of horizontal and vertical lines
that form 1mm small boxes and 5 mm larger boxes

A

True

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12
Q

The vertical axis on ECG measures?

A

Voltage/ Amplitude
Vertically measured - 1 small box equals 0.1 mV

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13
Q

What does horizontal y axis measure on EKG?

A

Measures time

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13
Q

1 small box on EKG equals?

A

0.04 seconds or 40 ms

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14
Q

5 small boxes =

A

1 Large box = 0.20 seconds or 200 ms

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15
Q

25 small boxes =

A

5 large boxes= 1 second or 1000 ms

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16
Q

Printing a rhythm strip that is 6-12 seconds long makes it easier to calculate what

A

HR whether it is regular or irregular using the 6 second method

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17
Q

Atrial depolarization is represented by?

A

The P wave

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18
Q

QRS is represented by?

A

Ventricular Depolarization

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19
Q

T on the EKG is represented by?

A

Ventricular repolarization

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20
Q

Different interval measurements include

A

P-R
Q-T
S-T

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21
Q

PR interval is

A

0.12-0.20 s
Starts beginning of P wave to beginning of flat line of Q

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22
Q

QRS interval is

A

0.06-0.12 s

Measured Flat line of Q beginning to of Flat line of S

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23
Q

QT interval is

A

0.36-0.44s

Measured Flat line beginning of Q to end of T wave

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24
Q

PR segment is measured from

A

End of p wave to flat line beginning q

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25
Q

ST segment is measured from

A

Flat line of S wave to beginning part of T

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26
Q

The first small wave upright seen on EKG

A

P wave

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27
Q

This wave represents discharge of the SA node and depolarization of both atria

A

P wave

Small, smooth, and rounded

Should be a P wave preceding each QRS complex 1:1

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28
Q

Reflects the period of time required for the cardiac conduction impulse to travel from the atria to the ventricles

A

PR Interval

Should be constant

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29
Q

_____ wave is first negative deflection below the isoelectric line

A

Q wave

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30
Q

______ wave is first upward or positive deflection

A

R wave

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31
Q

_____ wave next negative deflection immediately after the R wave

A

S wave

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32
Q

What represents ventricular depolarization?

A

QRRS complex

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33
Q

Rounded upward deflection immediately after the QRS complex

Signifies ventricular repolarization

A

T wave

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34
Q

Small rounded upright wave after the T wave

Represents the repolarization of the Purkinje fibers of the heart

Usually not present

Most frequently seen in slow rhythms

A

U wave

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35
Q

Begins with the end of the QRS complex and ends at the start of the T wave

A

ST Segment

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36
Q

This represents the time between the end of the ventricular depolarization and the beginning of ventricular repolarization

A

ST Segment

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37
Q

The normal _________ segment is flat isoelectric relative to the T-P

A

ST

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38
Q

This measurement represents the total activity of the ventricles

A

Q-T Interval

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39
Q

How is HR calculated?

A

R to R interval
60-100 Normal
Less than 60 Brady
More than 100 Tachy

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40
Q

QT Interval can be either short or long

A

True

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41
Q

How to interpret rhythm strip

A

P
- Is it same size, shape, and direction
- 1 per every QRS

R-R Interval
-Reg or ireg
- Rate
PR Interval
- 0.12-.20

QRS Complex
Less than 0.12 seconds
all same shape

Then QT Interval
- 0.36-0.44

Use EKG calipers

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42
Q

Initial approach analysis for EKG includes what?

A
  1. P waves?
  2. Rate?
  3. Rhythm?
  4. QRS normal or wide?
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43
Q

Name Atrial Rhythms

A

SR/SB/ST
Sinus Arrhythmia
Sinus pause/ arrest
PACs
SVTs

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44
Q

Rhythm: Regular
Rate: 60-100
P waves: One every QRS all same shape, size, and direction
QRS Complex: less than 0.12 sec and all the same shape

Pacemaker is SA Node

A

NSR

45
Q

Rhythm: Regular
Rate: Less than 60 BPM
P waves: One per every QRS all same
PR: WNL
QRS: less than 0.12 and all the same

A

BSR

Pacemaker is SA Node

46
Q

What causes Sinus Brady?

A

Adults and children asleep
Common in well conditioned athletes
Present in up to 35% people under 25 while at rest
MI
Vagal Stimulation
Medication
Diseases of SA Node

47
Q

Rhythm: Regular
Rate is 100- 160BPM
P wave one per every QRS
PR: WNL
QRS: Less than 0.12
Pacemaker is SA node

A

Sinus Tachy

48
Q

What causes Sinus Tachycardia?

A

Acute MI
Caffeine
Dehydration
Drugs
Exercise
Fear and anxiety
Fever
HF
Hyperthyroidism
Hypoxia
Infection
Meds
Nicotine
Pain
PE
Shock
Sympathetic Stimulation

49
Q

Rhythm Irregular
Rate usually normal
P waves : WNL
PR: WNL
QRS Complex less than 0.12 ad all same

Pace is SA Node

A

Sinus Dysrhythmia

50
Q

When the SA node fires irregularly it is called

A

Sinus Arrhythmia

51
Q

Associated with the phases of breathing and changes in intrathoracic pressure

A

Respiratory Sinus Arrythmia

52
Q

Not related to the ventilatory cycle

A

Non resp sinus arrhytmia

53
Q

Rhythm: Irregular but underlying is regular
Rate Normal but may be slow
P waves WNL
PR Interval: 0.12-0.20 second and constant
QRS Complex: Less than 0.12 second and all the same shape

A

Sinus Pause/ Arrest

54
Q

Disorder of impulse formation
Sinus impulses are not generated
Results in absent PQRST

A

Sinus Arrest

55
Q

What causes Sinus Arrest?

A

Damage to or a disease of the SA Node
-CAD
- MI
- Rheumatic Disease
Carotid Sinus Pressure
- Sudden increase in parasympathetic activity on SA Node
- Stimulation of the pharynx
- OBSA
- Hypothermia
- Reactions to medications

56
Q

What do I do about Sinus Arrest?

A

No tx if episodes are transient and there are no significant symptoms

57
Q

Sinus Arrest with hemodynamic compromise present

A

Possible Atropine

Possible Temporary Pacing

58
Q

If episodes of Sinus Arrest are prolonged and frequent as result of SA Node disease then?

A

Insertion of pacemaker may be warranted

59
Q

Rhythm: Regular
- PACs interrupt the rhythm making it appear irregular
Rate: 60-100 BPM
P Waves: Present and premature
- One every QRS
- May be flattened
PR: Normal or slightly abnormal
QRS: Less than 0.12 second and all the same shape

A

PAC

60
Q

Occur when an irritable site within the atria discharges before the next SA node impulse due to discharge

A

PACs

61
Q

P wave of PAC may be what?

A

Biphasic
Flattened
Notched
Pointed
Lost in preceding T wave

62
Q

Rhythm: Regular
Rate: 100-250 BPM
P Waves: Present but may be buried in T waves commonly pointed
QRS: WNL
SA NODE Pace

A

Atrial Tachycardia

63
Q

Rhythm: Generally regular but can be irregular
Rate: Varies, Controlled less than 100, Uncontrolled greater than 100
P waves: Multiple for every QRS
P wave never stops and overlaps other waves
PR Interval: Unmeasurable
QRS: less than 012

A

Atrial Flutter

64
Q

Rhythm: Irregular
Rate: Varies: Controlled less than 100, uncontrolled greater than 100
P waves: Wavy baseline. Looks like artifact
PR: Unmeasurable
QRS: less than 0.12

A

A Fib

65
Q

Name the most common type of SVT and is caused by reentry in the area of the AV Node

A

AVNRT

Fast pathway is Beta
Slow Pathway is Alpha

66
Q

How do you recognize AVNRT?

A

Ventricular rhythm is usually regular

150-250 BPM

P waves- Hidden in QRS complex, Ventricles stimulated then atria then it will show negative p wave after the QRS in lead II, III, and avF

When atria is depolarized after the ventricles, the p wave typically distorts the QRS

67
Q

AVNRT what causes it?

A

Common in individuals with no structural disease

Triggers
- Hypoxia
- Stress
- Anxiety
- Caffeine
- Smoking
- Sleep Dep
- Many meds

68
Q

AVNRT can also occur in individuals with

A

COPD
CAD
Valvular Heart Disease
Heart Failure
Digitalis Toxicity

69
Q

Stable pt with AVNRT, what do you do?

A

Apply pulse ox
Administer supplemental O2
Establish IV
Administer sedation

70
Q

Unstable pt with AVNRT?

A

Synchronized Cardioversion

71
Q

Someone has atrial tachycardia, what do you do?

A

If symptomatic with rapid rate then

Vagal maneuvers
Adenosine drug of choice
Calcium channel blockers
Beta Blockers
Synchronized cardioversion if hemodynamic compromise present

72
Q

Delivery of an electrical shock to the heart timed to occur during QRS

A

Synchronized Cardioversion

73
Q

Why would someone use cardioversion?

A

Some unstable narrow QRS Tachys
Unstable
- AFIB
AFLUTTER
Monomorphic VTACH

74
Q

Ventricular beat is the

A

Purkinje System 30-40 BPM

75
Q

Junction is

A

40-60 BPM

SA- 60-100 BPM

76
Q

Rhythm: Regular except for premature beat
Rate: Depends on underlying
P wave: may not be seen may be inverted in lead II,III, and aVF
may precede follow or be buried
PR: 0.12 or unmeasurable
QRS: less than 0.12

A

PJC

77
Q

Rhythm: Regular
Rate: 40-60 BPM originating in the AV junction
P waves: May not be present. in lead II,III, and aVF
may precede follow or be buried
PR Interval: 0.12 or not measured
QRS: Less than 0.12

A

Junctional Rhythm

78
Q

Rhythm: Regular
Rate: Greate than 100 BPM usually 130-180 Originating in AV
P waves:May not be present. in lead II,III, and aVF
PR Interval: Less than 0.12 or unmeasured
QRS: Less than 0.12 sec

A

Junctional Tachycardia

79
Q

Heart blocks originate where?

A

Junction or bundle

80
Q

All charcteristics of NSR except PR is more than 0.20 sec

Originates in SA node

A

1st Degree AV Block

81
Q

Rhythm: Irregular. P waves will map out. Ventricular rhythm is irregular.
Rate: Ventricular rate. Will be less than atrial rate.
P waves: Upright round. Lose 1:1 ratio. Will have dropped QRS
PR Interval: Gradually lengthens then QRS dropped
QRS Complex: Less than 0.12 sec.

A

2nd Degree AV Block Type 1
Mobitz 1 or Wenckeback

82
Q

Rhythm: Can be regular or irregular
Rate: Frequently slow.
P waves: Present, march out. Lose 1:1 ratio. More P’s than QRSs
PR Interval: Present on conducted beat and constant. May be normal or prolonged

QRS: Usually slightly wide greater than 0.12 sec

A

Second Degree AV Block Type 2
Mobitz II

83
Q

Rhythm: Atrial regular, P waves march out. Ventricular rhythm, QRS march out and not in sync
Rate: Slow. Dependent on secondary pacemaker (junctional or ventricular)
P Waves: No true PR since the atria and ventricles are independent
QRS: Normal or wide
Narrow- Junctional
Wide- Ventricular

A

3rd Degree

84
Q

Rhythm: PVC interrupt rhythm
Rate: Underlying rhythm
P waves: None or not related to QRS
PR Interval: None
QRS: Wide and bizarre. Greater than 0.12

A

PVCs

85
Q

PVCs how do you recognize them?

A

Multiform PVCs appear different from one another in the same lead

Often not always though arise from different anatomical sites

86
Q

What causes PVCs?

A

Acid Base imbalance
Acute coronary syndromes
Cardiomyopathy
Digitalis Toxicity
Electrolyte Imbalance
Exercise
Heart Failure
Hypoxia
Increase in catecholamines and sympathetic tone medications
Normal variant
Stimulants
Valvular heart disease
Ventricular Aneurisym

87
Q

Rhythm: Regular, can become irregular
Rate: 100-250
P waves: None
PR: None
QRS: Greater than 0.12 wide and bizarre

A

VTACH

Code Blue= No pulse
Rapid: With a pulse

88
Q

Rhythm: Regular or irregular
Rate: 150-300, typically 200-250 BPM
P waves: NONE
PR Interval: NONE
QRS Complex: Greater than 0.12 sec changes direction and twists

A

Torsades de Pointes

89
Q

Rhythm: Irregular
Rate: 0BPM
P waves: NONE
PR: NONE
QRS: Not clear

CODE BLUE

A

VFIB

90
Q

Rhythm: Usually regular, may become irregular
Rate: 20-40 BPM can be slower
P waves: None
PR: None
QRS: Greater than 0.12

T wave opposite direction as QRS

CODE BLUE

A

Idioventricular Rhythm
V Escape

91
Q

Rhythm: Regular
Rate: 40-100 BPM
P waves: Usually absent
PR Interval: NONE
QRS Complex: Greater than 0.12 sec

T wave opposite direction as QRS

A

Accelerated Idioventricular Rhythm

92
Q

Rhythm: NONE
Rate: 0 BPM
P waves: None
PR: None
QRS: None

A

Asystole

Code blue

93
Q

Transvenous Pacemakers are at

A

Internal jugular vein
Brachial vein

Also, there are implanted Pacemakers

94
Q

One spike producing an abnormal P wave followed by a normal QRS

A

Atrial Pacemaker single chamber

95
Q

One spike producing a wide QRS

A

Ventricular Pacemaker

96
Q

One spiked followed by an abnormal P followed by a second spike producing a wide QRS

A

AV Sequential Pacemaker Dual Chamber

97
Q

Name complications of Pacemaker Use

A

Infection
Bleeding
Dislocation of lead
Skeletal muscle or phrenic nerve stimulation
Cardiac tamponade
Pacemaker malfunction

98
Q

Monitoring ECG strips should be documented every

A

4hrs
in the CICU or CCU

8 hrs in tele

ED- Obtain initial ECG on pt with suspected cardiac event and document rhythm interpretation in record

99
Q

ECG Monitoring

A

ANY

Dysrhythmias
Change in conduction
New ST Segment elevation or depression
Document on the strip of any treatment
Follow strip after therapeutic intervention

100
Q

ECG monitoring

A

PR interval measurement
QRS duration
Rhythm interpretation
Nurse signature

101
Q

Clinical Symptoms/ Signs of pt deteriorating status

A

HR less than 40 or greater than 130 if it is change for pt
SBP less than 90
RR less than 8 RR or greater than 30
O2 less than 90% at 2L more than baseline oxygen use
Acute change in LOC
Acute change in oxygen and needs FiO2 50% or greater
New, repeated, or prolonged seizures

102
Q

Care of Patient with Dysrhythmia

A

Cause of it, factors, effect on the heart

health Hx, previous occurrences of decreased cardiac output, possible causes of dysrhythmias

Psychosocial assessment, pt perception of dysrhythmias

Assess indicators or cardiac output and oxygenation

All medications

103
Q

Physical Assessment includes

A

Skin pale and cool
Signs of fluid retention
Rate, rhythm of apical, peripheral pulses
Heart sounds
BP and pulse pressure

104
Q

Nursing Diagnoses include

A

Decreased cardiac output
Anxiety
Deficient knowledge of

105
Q

Collaborative problems and potential complications

A

Cardiac arrest
HF
Thrombotic event, especially a fib

106
Q

Nursing process care for pt with dysthymias Planning and goals

A

Eradicating or decreasing occurrence of dysrhythmias to maintain CO

Minimizing anxiety

Acquiring knowledge about dysrhythmias and its Tx

107
Q

Nursing Interventions include

A

Monitor ECG and manage
Reduce anxiety
Promote home and community care
Educate pt about self-care
Continuing care

108
Q

Nursing interventions

A

Assess VS ongoing
Lightheadedness, dizziness, fainting

If hospitalized
- Obtain 12 lead ECG
Continuous monitoring
Monitor strips

Antiarrhythmic Medications
- 6 min walk test

109
Q

Nursing Intervention Minimize Anxiety

A

Stay with pt

Maintain safety and security

Discuss emotional response

Help develop system to identify factors

Maximize the pt control

110
Q

Nursing Intervention Promote Home and Community Based Care

A

Educate pt on

Tx options
Med levels of therapeutic range
How to take pulse before med
How recognize symptoms of dysrhythmias
Measures to decrease recurrence
Plan of action in case of emergency
CPR

111
Q

Evaluation Nursing process for pt with dysrhythmias

A

Maintain CO
-stable vs, and no signs of dysrhythmia

Decrease of anxiety
- Positive attitude

Express understanding of tx of dysrhythmias

NURSADN6 Med Surg (9 decks)

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