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Cardiac Rhythms
| Question | Answer |
|---|---|
| Define Normal Sinus Rhythm | • Rate 60 to 100 beats/min • Regular rhythm • Normal P wave in lead II • Narrow QRS • P:QRS ratio normal • Normal PR, QRS, and QT intervals |
| Define Sinus Tachycardia | - rate: >100bpm - causes: hyperthyroidism, hypovolemia, HF, anemia, exercise, stimulants, fever, response to fear/pain/anxiety -ASSESS: for symptoms of low cardiac output |
| Treatment of sinus tachycardia? | TREAT THE CAUSE |
| Define Sinus Bradycardia | - rate <60bpm - risk factors: cardiac surgery, MI, elderly, athletes, congenital heart disease, myocarditis, drug toxicities - Nursing care: support C/O that meets body's demands, pacemaker, fix underlying cause, meds: atropine, epinephrine, dopamine |
| Medications that treat Sinus Bradycardia (1/2) | *Atropine: increases automaticity of the SA node and speed of conduction through the av node. * first line treatment for symptomatic bradycardia * Epinephrine: indicated for symptomatic bradycardia, first line treatment in cardiac arrest, asystole/PEA |
| Medications that treat Sinus Bradycardia (2/2) | *Dopamine: indicated for hypotension, bradycardia, and shock |
| Define sinus arrythmia | -rate varies with respirations with inspire it increases, and expire decreases - common in pediatrics - no need to treat |
| Define Premature Atrial Complex (Contraction) | - early beats initiated by atrium - P waves and PR interval may vary - P wave may be found in the T wave - pt may be unaware or feel like they skipped a beat |
| Define Atrial Flutter | -multiple origins of electricity in atria, heart disease -classic sawtooth pattern - varying rate -atrial rate fast and regular (250-350bpm) -rhythm: regular - QRS: narrow |
| Atrial Flutter causes | - lung disease -ischemic heart disease - hyperthyroidism -hypoxemia -heart failure -alcoholism |
| Define atrial fibrillation | - may be fast/slow/normal ventricular rate (afib rvr, rapid ventricular response) - erratic impulse formation in atria - no discernible P wave - narrow QRS - irregular ventricular rate -high risk for pulmonary systemic or pulmonary emboli |
| Atrial Fibrillation treatment | - manage/monitor symptoms&complications - continuous cardiac monitor - monitor BP -limit activity if rate is too fast - monitor for PE or embolic stroke - admin anticoags: apixaban, warfarin, rivaroxaban |
| Meds for AFIB | (aside from anticoags) -Beta blockers -calcium channels blockers -amiodarone |
| Define Supraventricular tachycardia | - non-ventricular tachycardia , - rate over 150bpm - regular rhythm - P waves : unable to determine - QRS: narrow -p/qrs ratio 1:1 but often too fast to tell |
| Treatment for Supraventricular tachycardia | - vagal maneuvers (bearing down, blowing through straw/syringe) -Adenosine (more info in another card) - cardioversion |
| Define adenosine and how it's used | - decreases electrical conduction through the AV node. - heart is "turned off and back on" -stopcock is used to administer, to quickly flush saline - used for SVT and VT with pulse |
| Define premature ventricular complexes (contractions) | -QRS is wide and bizarre - irregular rhythm -absent P wave prior to PVC - pt may feel they skipped beat - bigeminy, trigeminy, couplets/triplets - unifocal vs multifocal |
| When are PVCs dangerous ? | -frequent -multifocal -two or more in a row |
| Ventricular Tachycardia | -rapid, life-threatening -three or more pvcs in a row - fast rate >100bpm -wide QRS -usually regular - pulse vs no pulse - significant loss of C/O -Hypotension |
| How to treat Ventricular Tachycardia (pulse vs no pulse) | -Pulse: (treat like SVT), vagal maneuvers, Adenosine, cardioversion -No Pulse: (treat like VFib), CPR, defibrillate |
| Define Ventricular Fibrillation | - chaotic pattern - no discernible P, QRS, or T waves - coarse vs fine - no cardiac output, life threatening |
| Treatment for ventricular fibrillation | - EMERGENT DEFIBRILLATION |
| Define Asystole | - no electrical activity - no cardiac output - death -Treatment: Chest compressions, epinephrine (do not shock asystole) |
| Pulseless electrical activity | - electrical activity but no pulse - must treat the cause - treatment: chest compressions, epinephrine (do not shock) |
| Define Cardioversion | - electrical shock given to convert a rhythm that is too fast to restore the impulse back to origin in the SA node - Rhythm ex: VTach with pulse, AFib RVR, SVT |
| Define defibrillation | -electrical shock given to cease ineffective and sporadic electrical impulses in hopes that the SA node will regain function - Rhythm ex: VTach without a pulse, VFib |
| Types of temporary pacemakers | - external/transcutaneous - epicardial -transvenous/endocardial |
| Indications for a temporary pacemaker | - MI, Heart blocks - new meds or wrong dose - post cabg |
| Permanent pacemaker indications | *surgically implanted - symptomatic bradycardia - complete heart block - sick sinus syndrome -cardiac arrest - atrial tachyarrhythmias |
| Implantable cardiac cardioverters / defibrillators | indications : risk for sudden cardiac death |
| Post op teaching for pacemaker/ICD patient | - wear sling postop to prevent arm being raised above head - incision site care: dry dressing, monitor for infection, do not submerge in water - avoid heavy lifting and contact sports |
| Pacemaker Teaching | - carry identification card or bracelet - avoid strong magnets and notify airport security - report symptoms of fatigue and dizziness |
| Patient teaching for ICD discharges and shocks | - feels like blow to chest - no unsupervised swimming or other dangerous activities -report ICD discharge to provider and seek medical attention |
| Sodium channel blockers (class I antidysrhythmic) | - slows HR - use: AFIB, AFLUTTER, VTACH, SVT -EX: procainamide, Lidocaine, Flecainide -complications/consid: hypotension, bradycardia, cardiotoxicity, neutropenia, thrombocytopenia, lupus, CNS effects, dizziness |
| Beta Blockers (Class II Antidysrhythmic) | - decrease HR and contractility - USE: AFIB, AFLUTTER. HTN, ANGINA, SVT, PVCs - EX: propranolol - complications/considerations: hypotension, bradycardia, heart blocks, bronchospasms |
| Potassium Channel Blockers (Class III antidysrhythmic) | - reduces heart rate - conversion of afib to NSR, VTACh, VFIB -Ex: Amiodarone (IV, oral) -Complications/consid: hypotension, bradycardia, pulmonary toxicity, visual disturbances, liver/thyroid dysfunction, phlebitis (vesicant) |
| Calcium Channel Blockers (Class IV antidysrhythmic) | - reduce HR, decrease contraction force, decrease cardiac o2 demand, relaxation of vasc smooth muscle -use: AFIB, AFLUTTER, SVT, HTN, ANGINA -EX: verapamil, diltiazem -comp/consid: hypotension, bradycardia, heart blocks, constipation, periph edema |
| define digoxin and its use | - decreased electrical conduction through the AV node and increases myocardial contraction -use: AFIB, AFLUTTER, HF, SVT -complications: digoxin toxicity (green/yellow halos), nausea/vom, dizziness |
Created by:
Katelynsw27