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MedSurge-DYSRHYTHMIA
MedSurge DYSRHYTHMIAS review
| Question | Answer |
|---|---|
| 4 Properties of cardiac cells | automaticity, excitability, conductivity, contractility |
| Automaticity is defined as? | ability to initiate an impulse spontaneously and continuously |
| Excitability is defined as? | ability to be electrically stimulated |
| Conductivity | Ability to transmit an impulse along a membrane in an orderly manner |
| Contractility | ability to respond mechanically to an impulse |
| Stimulation of the Vagus nerve (PNS) causes a _____ rate of firing of the SA node. | decreased |
| Stimulation of the sympathetic nerves (SNS) _____ SA node firing. | increases |
| Patient w/acute MI w/sinus tachycardia, if not treated, pt. likely to experience? | ↑ myocardial O2 needs, leading to ↑ angina / ↑ ischemia / ↑ necrosis |
| Rhythm strip shows occasion distorted P wave, followed by normal AV & ventricular conduction, indicates ____, nurse should question pt. about ____? | premature atrial contraction / use of: caffeine, smoking, tobacco, alcohol, stress |
| Normal rhythm, except prolonged PR interval, is characteristic of? | first-degree heart block |
| Treatment for first-degree heart block? | none; patient is observed for progression to higher degrees |
| Defibrillation is used ONLY for? | ventricular fibrillation |
| Atropine is administered for? | bradycardia |
| Pacemakers are used for? | high-degree heart blocks |
| Symptoms of decreased cardiac output related to dysrhythmias include? | ↓ BP, ↓ mentation, chest pain, dyspnea, weak peripheral pulses |
| PVC is? | Premature Ventricular Contractions |
| PVCs in pt. w/acute MI indicates? | ventricular irritability, may lead to ventricular tachycardia or fibrillation |
| Antidysrhythmics that can be used to control dysrhythmias include? | a-adrenergic blockers, procainamide, amiodarone, or lidocaine |
| Valsalva maneuver may be used to treat? | Paroxysmal supraventricular tachycardia |
| PRIORITY NURSING ACTION: Pt. w/acute MI, multifocal PVCs, ventricular couplets, alert, BP 118/78, irregular pulse 86 BPM? | prepare to administer antidysrhythmic drugs per protocol |
| PVCs is an ectopic beat that causes? | wide-distorted QRS complex > 0.12 sec (impulse not conducted normally) |
| an Ectopic beat is? | a disturbance of the cardiac rhythm |
| Continuous wide QRS complexes w/rate between 110 - 250 are seen in? | ventricular tachycardia |
| Saw-toothed P waves are characteristic of? | atrial flutter |
| What does cardiac defibrillation do? | depolarizes the cells of the myocardium to allow the SA node to resume pacemaker function |
| Initial treatment of asystole and pulseless electrical activity is? | CPR (to maintain minimal CO and oxygenation), followed by intubation and administration of epinephrine and atropine |
| Why is defibrillation not an effective treatment of asystole and pulseless electrical activity? | because the myocardial cells are in a state of depolarization |
| In preparation for defibrillation, the nurse should? | apply conductive materials (e.g. saline pads, electrode gel, defibrillator gel pads) |
| Why are conductive materials applied? | to ↓ impedance and prevent burns |
| Initial shock for defibrillation in joules? | 200 joules, if 3rd shock is required, up to 360 joules |
| If ICD (implantable cardioverter-defibrillator) fires, pt. should? | lie down, call health care provider |
| ICD (implantable cardioverter-defibrillator) fires when? | pt. has experienced a lethal dysrhythmia |
| Pt. with pacemakers should avoid? | high-voltage electrical generators, large magnets (as in MRI) - they reprogram the pacemaker |
| After the pacemaker is placed, arm should not be raised above shoulder for how long? | 1 week |
| Pt. with external pacemakers may experience? | uncomfortable chest muscle contractions |
| Following initiation of emergency call system (CODE BLUE), next nursing priority is to? | begin CPR |
| Joules for monophasic defibrillators? | 360 joules |
| Joules for biphasic defibrillators? | 120 - 200 joules |
| Catheter ablation therapy is indicated for treatment of? | tachydysrhythmias |
| Pt. w/chest pain, not responding to nitroglycerin, nurse should be most concerned with presence of? | ST segment elevation |
| ST segment elevation indicates? | injury / infarction of an area of the heart |
| Inverted T wave indicates? | ischemia and resolves when blood flow is restored |
| Occasional PVCs may be due to? | electrolyte imbalance or hypoxia, or may be normal |
| Pt. with neurocardiogenic (vasovagal) syncope experiences what symptoms? | marked bradycardia and hypotension |
| Atropine is not indicated for? | supraventricular tachycardia |
| Nurse should administer ___ for pt. experiencing supraventricular tachycardia | vagal stimulation |
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