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210 Ch. 27
Dysrhythmias/Conduction prob
| Question | Answer |
|---|---|
| Define dysrhythmia | disorder with formation/conduction of electrical impulse in heart. |
| The electrical stimulation of depolarization results in what mechanical action repolarization = mechanical? | contraction...systole relaxation...diastole |
| Describe the electromechanical circuit | SA node-AV node(delayed)-atria contract-(atria kick)vent filling-bundle of His-Purkinje fibers-vent contract-vent relax |
| pos/neg chronotrophy pos/neg dromotrophy pos/neg inotrophy | chr: incr HR dro: conduction ino: force of contraction |
| autonomic nervous system incl | sympathetic(adrenergic)/parasympathetic nerve fibers |
| sympathetic stimulation does what in cardiac Parasympathetic stimulation fibers do what to cardiac? | Sym:constricts peripheral vessels, incr BP Para: decr HR, conduction, force of contraction, dilate aa, decr BP |
| Risk factors for dysrythmias | ischemia(not enuf O2) of heart muscle, hypoxia, electrolyte imbal, drug toxicity(Dig), conductions alter, reentry of pulses |
| ECG terms: Pwave? P-R Seg?, QRS complex? S-T seg? | Pwave: arterial depolarization, .06-.12s, SA node firing P-R: end Pwave to beg. of QRS. Rep time needed for SA fire QRS: Vent depolarization S-T: end of QRS to start of T(elevated in MI, depressed in ischemia) |
| Twave? Q-T interval? Uwave? P-P int? R-R int? | Twave: repolarization of vent, atrial repolarization not visible, resting, QT int: vent dep/rep, (prolonged =torsades de pointes, vent dys, twisting) Uwave: rep of Purkinje fibers, hypokalemia w/ depressed ST seg P-P: pwave to pwave R-R: QRS to QRS |
| ECG grid paper moves at? lg box (5sm box) horizontal? lb box(5 box) vertically? How calculate HR | move at: 25mm/sec hor: .20sec/5mm vert: 5mm/0.5mv Cal: cout # of QRS complexes in 6 sec strip and multiply by 10 |
| Normal Sinus Rhythm | reg rate/rhythm. Rate: 60-100bpm |
| Sinus bradycardia? Sinus tachycardia? Sinus arrythmia? | rate: <60 rate: >100 rate: 60-100 but irregular |
| Atrial Dysrythmias: | PAC premature atrial complex, atrial flutter, atrial fibrillation |
| Premature atrial complex | PP interval short/long/short Pwave hidden/buried in Twave "skipped beat" no tx needed if not more than 6 per min., stop caffeine |
| Atrial flutter | conduction defect in atrium, rate: 250-400, vent rate: 75-150 "saw tooth" pattern/reg more Pwave b4 QRS tx unstable: cardioversion(reset) tx stable: dilitiazem(CCB-reduce tetany), betablockers, dig(strength), verapamil, heparin/warfarin prevent clot |
| Atrial fibrillation | short dur(paroxysmal)/long, incr stroke/death rate:350-600, vent rate: 120-200 ir "quivering" throw clots tx: can recover on own med: amiodarone/ibutilide/procainamide, diltiazem, dig, warfarin, Prodaxa(no antedote), cardioversion/pacemaker |
| Junctional Dysrhythmias | Premature jx complex, jx rhythm, AV node reentry |
| Premature Junctional Complex | Impulse starts in AV node before next impulse reaches AV node No Pwave cause: dig tox, CHF, CAD tx: same for PAC, none needed |
| Junctional Rhythm | SA node gone, so AV node is pacemaker vent rate: 40-60 reg rhythm No Pwave/inverted QRS inverted(other cells firing it) |
| AV Node Reentry | AV node fire repeated impulse in same area cause: caffeine/nicotine tx: ablation(cauterize vessel) to break reentry of impulse, vagal manuevers, cardioversion |
| Conduction Disorders/AV blocks What is a block? | 1st Degree, 2nd degree type I, 2nd degree type II, 3rd Degree block: impeding firing of SA node to AV node |
| 1st Degree AV Block | atrial impulse r thru AV node into vent at slower rate. longer PR int, but constant cause: CAD, dig tx: if dig, then stop drug |
| 2nd Degree AV Block, Type I? Type II? | I: "Wenckebach",PR widens til QRS drops off, QRS norm tx: not needed if perfusion is good(vent rate is adequate), atropine to incr HR, look at ejection fraction II: reg, Wide/inverted QRS(vent fire on own), constant PR, more Pwaves, irr RR int |
| 3rd Degree AV Block | "complete", decr CO, irr. no atrial impulses, Atria/Vent beat ind., inverted QRS more Pwaves than QRSs tx: IV bolus Atropine, pacemaker |
| Ventricular Dysrthmias | Premature Vent Complex(PVC), Multifocal PVC, Ventricular Tachycardia(Vtach), ventricular fibrillation(VFib), asystole |
| Premature Ventricular Complex | most common, irr., wide QRS and diff cause diff cells firing vent from diff spots), bizarre QRS tx: lidocaine IV push w/ D5W |
| Multifocal PCVs | Quadrigeminy: q 4th beat is PVC trigeminy: q 3rd bigeminy: q 2nd |
| Vtach | 3 or more PVCs in row(mtn peaks), emergency reg rate: vent rate: 100-200 wide QRS, no Pwave(buried in QRS) tx: stable: procainamide IV/lidocaine bolus(numb tissue so not fire) unstable: cardioversion/ defibrill/amiodarone |
| Vfib | vent quivering, rate: >300 no Pwave, QRS, Twave tx: defibrillation, Na bicarb for lactic acidosis |
| asystole | flatline, code tx: IV bolus epi/atropine, Na bicarb |
| Diff bn cardioversion and defibrillation | defib: emergency if no pulse, lubricate paddles w/ specific jelly, CLEAR x 3, "not-sync" cardio: synchronized with pt electrical current(QRS) |
| Pacemakers have two essential components Nsg intv? | Electronic pulse generator pacemaker electrodes intv: prevent inf, check battery |
| atrial kick | last part of diastole and vent filling, accounting for 25%-30% of CO |
| Meds to control persistant Atrial fibrillation | IV beta blockers or nondihydropyridine calcium channel blocker(diltiazem/verapamil) |
| Why is a pt put on heparin and warfarin for anticoagulation therapy? | Until warfarin level is therapuetic, defined as INR(interna'l normalized ratio) b/n 2-3. |
| What is monomorphic? polymorphic? | mon: have consistent QRS shape/rate poly: varying QRS shape/rhythm |
| Assessment of rhythm strip in order | assess underlying rhythm, PR interval for block |
| Understanding what's happening with AV Block Type I Tx: | Ea atrial impulse takes longer time for conduction until one impulse is fully blocked. Tx: incr HR to maintain norm CO |
| Nsg assessments for dysrhythmias | skin: pale/cool, edema, neck vein distention lungs: crackles/wheeze heart: S3/S4, murmurs, decr PP |
| What is universal code for pacemakers fx? | 1. chamber(s) paced: A/V/D 2.chamber sensed: A/V/D/O(off) 3.pacemaker response: I(inhibited)/T(triggered) 4.vary HR 5. |
| What is diff in inhibited and triggered? | inhibited: pacemaker beats only when pt heart doeesn't triggered: pacemaker paces heart |
Created by:
palmerag
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