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210 Ch. 27

Dysrhythmias/Conduction prob

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