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NUR_1213 Exam 4
Oxygenation: Dysrhythmias/EKG
| Question | Answer |
|---|---|
| Sinus Rhythm- | Electrical activity of the heart initiated by the SA node. <center> occurs when the electrical impulse starts at a regular rate and rhythm in the sinus node and travels through the normal conduction pathway.</center> |
| Normal Sinus Rhythm (Characteristics) | V&A RATE: 60-100<center> V&A RHYTHM: regular</center><center>QRS: usually normal but maybe regularly abnormal</center><center>Pwave: normal & consistant; always in front of QRS</center><center>PR INTERVAL:0.12-0.20secs</center>P:QRS ratio: 1:1 |
| Sinus Bradycardia- | Occurs when sinus node creates an impulse at a slower-than-normal rate. |
| Causes of Sinus Bradycardia- | Lower metabolic needs (ie: sleep, athletic training, hypothyroidism), Vagal stimulation (from vomitting, suctioning, sever pain, extreme emotions), Medications (calcium channel blockers, amiodarone, beta blockers), Increased ICP, MI (esp of inferior wall) |
| H & T's of Sinus Bradycardia- | <center> hypovolemia </center><center> hypoxia </center><center> hydrogen ions (acidosis) </center><center> hypo- or hyper- kalemia </center><center> hypoglycemia </center><center> hypothermia </center><center> _______________________ </center><center> to |
| Characteristics of Sinus Bradycardia... | Ventricular & Atrial Rate: less than 60<center> Ventricular & Atrial Rhythm: Regular </center><center> QRS Shape & Duration: Usually normal, but may be regularly abnormal </center><center> P wave: Normal & Consistant shape; always in front of QRS </center |
| Only difference btwn Sinus Rhythm & Sinus Bradycardia? | Ventricular & Atrial Rate |
| Medication of Choice in Treating Symptomatic Sinus Bradycardia? | Atropine, 0.5 mg given rapidly as IV bolus q3-5mins to a max total dose of 3mg |
| Sinus Tachycardia- | Occurs when the sinus node created an impulse at a faster then normal rate. |
| Causes of Sinus Tachycardia- | *physiologic or pathological stress (acute bld loss, anemia, shock, hypervolemia, hypovolemia, heart failure, pain, hypermetabolic stated, fever, exercise, anxiety)<center> *Medications that stimulate the sympathetic respose (catecholamines, aminophylline |
| Characteristics of Sinus Tachycardia... | V&A rate: >100 (but usually <120)<center> V&A rhythm: Regular </center><center> QRS shape & duration: Usually normal, but may be regularly abnormal. </center><center> P wave: Normal and consistant, always in front of QRS, but may be burried in the precced |
| If rapid rate of Sinus Tachycardia persists and the heart cant compensate for the decreased ventricular filling, the patient may develop? | Acute pulmonary edema |
| Characteristics of Sinus Tachycardia... | V&A rate: >100 (but usually <120)<center> V&A rhythm: Regular </center><center> QRS shape & duration: Usually normal, but may be regularly abnormal. </center><center> P wave: Normal and consistant, always in front of QRS, but may be burried in the precced |
| If rapid rate of Sinus Tachycardia persists and the heart cant compensate for the decreased ventricular filling, the patient may develop? | Acute pulmonary edema |
| Sinus Tachycardia = Nonparoxysmal | does not start or end suddenly |
| Atrial Fibrillation- | causes a rapid, disorganized, and uncoordinated twitching or atrial musculature. |
| A Fib = Paroxysmal | may be transient, starting and stopping suddenly and occuring for a very short time. <center> may also be persistant, requiring trtmnt to terminate the rhythm or to control ventricular rate. </center> |
| Characteristics of Afib... | V&A rate: Atrial rate is 300-600, ventricular rate is usually 120-200 in untreated afib.<center> V&A rhythm: Highly irregular </center><center> QRS shape/duration: usually normal, but may be abnormal </center><center> P wave: No discrenible P waves, irreg |
| What treatment is indicated for afib that is hemodynamically unstable? | Electrical cardioversion<center> ***************** </center><center> d/t the high risk for emobolization or atrial thrombi, cardioversion or afib that has lasted longer that 48hrs should be avoided unless the pt has recieved anticoagulants. </center> |
| V Tach- | 3 or more PVCs in a row, occuring at a rate exceeding 100 BPM. Usually associated w/ CAD & may precede vfib. |
| V Tach = emergency b/c? | Pt is usually (not always) unresponsive & pulseless. |
| V Tach Characteristics... | V&A rate/rhythm: Ventricular rate = 100-200BPM. Atrial rate depends on underlying rhythm (ie-sinus rhythm);regular <center>QRS: 0.12sec or more; bizarre, abnormal shape</center><center>Pwave: difficult to detect, atrial R&R poss. indeterminable</center><c |
| center>PRwave: very irregular, if P waves are seen</center>P:QRS ratio: difficult to determine, but if P waves are apparent, there are usually more QRS complexs than P waves. | |
| A patient with stable Vtach would most be treated with what choice medication? | Amiodarone IV (antidysrhytmic medication of choice) |
| A symptomatic patient with monophasic Vtach would most likely recieve what type of treatment? | Cardioversion |
| Torsaded de pointes- | is a polymorphic Vtach preceded by a prolonged QT interval. |
| What should be the suspected cause of Vtach w/ an irregular rhythm? | Afib |
| What is the action of choice for a patient w/ any type of Vtach who is unconscious & pulseless? | Immediate Defibrillation!!!! (pt treated in same manner as vfib) |
| V Fib- | rapid, disorganized ventricular rhythm that causes ineffective QUIVERING of the ventricles. (no atrial activity seen on ECG.) |
| Causes of Vfib? | same as for Vtach; may result from untreated or unsuccessfully treated Vtach, electrical shock, Brugada syndrome. |
| Brugada Syndrome- | (freq. of asian decent) has structurally normal heart, few or no risk factors for CAD, and family HX of sudden cardiac death. |
| Vfib Characteristics... | Ventricular rate/rhythm: >300/min; extremely irregular, w/o specific pattern.<center>QRS: irregular, undulating waves w/o recongnizable QRS complexes</center>absence of audible heartbeat, palpable pulse and respirations. |
| In this arrythmia there is no coordinated cardiac activity, and cardiac arrest and death are imminent if not corrected? | Vfib |
| Treatment of choice for Vfib? | immediate bystander cardiopulmonary resuscitation (CPR), defibrillation asap, activation of emergency services. |
| A patient w/ Afib should be administered what medication asap after 2nd rhythm check? | Vasoactive medications- epinephrine, vasopressin, or both. |
| A patient w/ Afib should be administerd what medication asap after 3rd rhythm check? (immediatel before of after 3rd defibrillation) | Antidysthymis medications- amiodarone, lidocaine or possibly magnesium |
| a pt who is unconscious, who experiences cardiac arrest d/t vfib is recommended by the AHA guidelines to induce ___________? | mild hypothermia for 12-24 hrs. (core body temp of 89.6-93.2*F (32-34*C)) |
| Asystole characteristics.. | absent QRS complexes confirmed by 2 diff. leads, although P waves maybe apparent for a short duration. No heartbeat, no palpable pulse and no respiration. |
| Asytole treatment? | (same as PEA)rapid assessment to find poss. cause, 2 mins or 5 cycles of CPR, bolus of IV epinephrine is administered and repeated at 3 to 5 min intervals. 1 dose of vasopressin may be admin. for 1st or 2nd dose of epi. 1mg bolus IV atropine may be admin |
| Possible causes of asytole? | hypoxia, acidosis, severe electrolyte imbalance, drug OD, hypovalemia, cardiac tamponade, tension pneumothorax, coronary or pulmonary thrombosis, trauma, hypothermia. |
| What is the normal PR interval? | 0.12-0.20 seconds |
| PR interval- | measured from begining of P wave to the begining of QRS complex and represents time needed for SA node stimulation, atrial depolarization, conduction through AV node b4 ventricular depolarization. |
| What is the normal QRS duration? | >0.12 secs |
| QRS- | represents ventricular depolarization |
| What is the normal pace maker of the heart? | SA node |
| SA node rate? | 60-100 |
| AV node rate? | 40-60 |
| P to T represents? | 1 heart beat |
| U wave found in patients with? | hypokalemia, htn. heart disease |
| Horizontal = | time |
| Vertical = | voltage |
| How do you calculate the HR on a 6 sec. strip? | # of QRS intervals (in 6 sec. strip) X10 or # of R-R intervals (in 6 sec. strip) X10 |
| What do the small boxes represnt? (time) | 0.04 secs |
| What do the big boxes represent? | 0.20 secs (5 small boxes) |
| Cardiac Tamponade- | pericardium fill up w/ fluid |
| sinus rhythm starts? | narrow |
| v tach = | 3 or more Y beats on rate >100 BPM |
| Carsioversion- | electrical current administration in synchorony witht the patients own QRS complex to stop dysrhythmia |
| Defibrillation- | electrical current administered to stop a dysrhythmia, not synchronized with the pt's QRS complex. |
| What nursing DX would be most applicable to a pt dysrhythmias? | decreased cardiac output <center>anxiety related to fear of the unknown</center>Deficient knowledge about the dsyrhythmia and its treatment |
| Depolarization- | process by which cardiac muscle cells change from a more negatively charged to a more positively charged intracellular state. |
| Repolarization- | process by which cardiac smooth muscle cells return to a more negatively charged intracellular condition, their resting state. |
| difference btwn cardio version and defibrillation? | cardio version- involves delivery of a "timed" electrical current to terminate a TACHYDYSHYTHMIA. Done on conscious pt<center>defib- used in emergency situations at trtmnt of choice for vfib, pulselessness Vtach. not used on conscious pts who have a pulse |
| What is the nurse's 1st action when told that a pt's rhythm has changed on the monitor? | Check the patient |
Created by:
lprovoost
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