Problems of Oxygenation & Perfusion: Nrs Management of Dysrhythmias
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
|
|
||||
|---|---|---|---|---|---|
| perfusion | movement of oxygen - bringing O2 to the cells (delivering)
🗑
|
||||
| telemetry monitoring | remote monitoring of a patient. 3 electrodes & a little box (usually kept in the pocket).
🗑
|
||||
| EKG | tracing. road map of the heart. where does the message originate, which is it communicating with, where does it go to make the contraction happen.
🗑
|
||||
| dysrhythmias | electrical message in the heart "goes a different way." there is some problem that makes the impulse take a different route.
🗑
|
||||
| properties of cardiac tissue | automaticity; excitability; conductivity; contractility.
🗑
|
||||
| automaticity | the ability to initiate an impulse. SA node (where the impulse starts)
🗑
|
||||
| excitability | ability to be electrically stimulated.
🗑
|
||||
| conductivity | ability to transmit an impulse along the system. SA node communicates to the AV node.
🗑
|
||||
| Contractility | heart muscle responds to impulse and contracts
🗑
|
||||
| conduction system of the heart | originates in SA node -> (intraatrial pathways to LA) internodal pathways to AV node -> bundle of His -> R&L bundle branch -> purkinje fibers --> ventricular contraction
🗑
|
||||
| heart block | something is blocking the conduction pathway.
🗑
|
||||
| Autonomic NS | responsible for normal, regular control (rate of impulse formation, speed of conduction, strength of contraction).
🗑
|
||||
| parasympathetic NS | Vagus nerve is main nerve.
🗑
|
||||
| Vagal Nerve Stimulation | dec HR, slowed conduction, decreased force of contraction,
🗑
|
||||
| causes of Vagal Nerve Stimulation | valsalva maneuver (bearing down) -- this is a nursing action for high HR, panic attack
🗑
|
||||
| sympathetic NS | opposite of parasympathetic. increased HR, increased force of contraction
🗑
|
||||
| P wave | atrial depolarization
🗑
|
||||
| PR interval | beginning of P wave to beginning of QRS complex. time it takes for the atria to depolarize and repolarize
🗑
|
||||
| QRS complex | ventricular depolarization.
🗑
|
||||
| ST segment | flat line in normal heart. interval from the end of ventricular depolarization to the beginning of ventricular repolarization.
🗑
|
||||
| T wave | ventricular repolarization
🗑
|
||||
| QT interval | total time for ventricular depolarization and repolarization
🗑
|
||||
| ECG - vertical axis | electrical potential
🗑
|
||||
| ECG - horizontal axis | time - how long it takes
🗑
|
||||
| ECG - 5mm square | 0.2 seconds x 0.5 mV
🗑
|
||||
| ECG 1mm square | 0.04 seconds x 0.1 mV
🗑
|
||||
| Normal Sinus Rhythm | 60-100 bpm. follows normal conductive pathway. look for P wave - P wave present = NSR.
🗑
|
||||
| Sinus Bradycardia | sinus fires < 60 bpm. normal rhythm in aerobically trained athletes. can be problem w vagal nerve stim. some drugs do this (parasymphathomimetics). hypothermia can cause.
🗑
|
||||
| Sinus Bradycardia: Sx and Clinical Manifestations | hypotensive. hypoxia. weak. dizzy. nauseous (if due to vagal nerve stim). angina. confusion.
🗑
|
||||
| Parasymphathomimetic Drugs | mimic the parasympathetic NS. side effect = slows HR. ex: Pilocarpine (for dry mouth).
🗑
|
||||
| Sinus Bradycardia: Treatment | Atropine. Pacemaker
🗑
|
||||
| Atropine | anticholinergic drug. increases HR. may be given to reverse effects of muscarinic drugs (parasympathomimetics).
🗑
|
||||
| Sinus Tachycardia | discharge rate from the sinus node is increased as a result of vagal inhibition. > 100 bpm.
🗑
|
||||
| Sinus Tachycardia: Causes | anxiety. exercise. pain. fever. hypovolemia.
🗑
|
||||
| Sinus Tachycardia: Clinical Manifestations | hypotension. dizzy, lightheadedness, SOB, angina (not enough O2 to the heart)
🗑
|
||||
| Sinus Tachycardia: Treatment | beta-blocker (not for BP, to control/decrease HR). antipyretic (if caused by fever). analgesia (if caused by pain). IV fluids, increase oral intake (if caused by hypovolemia)
🗑
|
||||
| Treatment of Sinus Rhythms | treat the CAUSE to get the patient out of that rhythm
🗑
|
||||
| Normal Sinus Rhythms | NRS, sinus bradycardia, sinus tachycardia.
🗑
|
||||
| Premature Atrial Contraction | NOT NSR. irregular. ectopic beat occurs occasionally, originating not from SA node. no lethal.
🗑
|
||||
| Premature Atrial Contraction: causes | emotional stress, too much caffeine, too much alcohol, too much tobacco, electrolyte imbalances (some), COPD.
🗑
|
||||
| Premature Atrial Contraction: significance with heart disease | can be a warning. check labs (K & Na). have meds been taken?take apical pulse 1 min. inform provider.
🗑
|
||||
| Premature Atrial Contraction: Treatment | depends on the symptoms. find and eliminate the source. drugs secondary. beta-blocker (to control the rate). decrease caffeine/nicotine intake, halter monitor.
🗑
|
||||
| Paroxysmal Supraventrical Tachycardia (PSVT) | person is in NSR, run of tachy, then back to NSR. > 130 bpm in 6s strip (up to 200 bpm). sustained or non-sustained.
🗑
|
||||
| PSVT - sustained | emergency. BP can bottom out.
🗑
|
||||
| PSVT: Cauess | over exertion. stimulants. emotional stress. digitoxicity. known CAD.
🗑
|
||||
| Digitoxicity signs | nausea. lack of appetite. "yellow halos" in vision. blurry vision.
🗑
|
||||
| PSVT: causes in known CAD | could mean things are not going well. take vitals, symptoms, info from tele-clerk. Report to Dr.
🗑
|
||||
| PSVT: Clinical Manifestations | c/o palpitations. Hypotensive. dyspnea. angina
🗑
|
||||
| PSVT: Treatment | vagal maneuvers. if not effective, then drugs. Adenosine
🗑
|
||||
| Adenosine | potent anti-arhythmic. interrupts pathway to the AV node, slows AV node conduction, which slows HR. rapid response team will push this (not you - unless told to). want monitor by bedside.
🗑
|
||||
| Atrial Flutter | originates from a single ectopic focus w/in atria. very typical pattern (sawtooth mtns). tx depends on what pattern looks like.
🗑
|
||||
| Atrial Flutter - rapid ventricular response | TX directed at controlling vent rate (~160 bpm).BP drops, dizzy lightheaded, decreased CO.
🗑
|
||||
| Atrial Flutter: associated with... | CAD, HTN, valve disorders, lung disease
🗑
|
||||
| Atrial Flutter: risks | risk for stroke. risk for clots (blood not ejected from As, stasis --> clots --> stroke).
🗑
|
||||
| Atrial Flutter: clinical significance | has to do with how fast the ventricles are contracting.
🗑
|
||||
| Atrial Flutter: Treatment | goal: slow HR. beta-blockers, Ca Channel Blockers, anti-dysrhythmic. elective cardioversion.
🗑
|
||||
| Amdiodarone | anti-dysrhythmic. slows sinus rate, increases PR interval. many side effects. IV push under controlled circumstances. more potent than beta- or Ca- blockers.
🗑
|
||||
| elective cardioversion | controlled shock to get the heart out of a bad rhythm.
🗑
|
||||
| Atrial Fibrillation | irregular impulse coming from multiple ectopic focuses in atria. less organized than flutter, atria become very disorganized. most common dysrhythmia. prevalence increases w age.
🗑
|
||||
| Atrial Fibrillation: common with... | CAD. HF (sometimes first sign of HF). alcohol intoxication. too much caffeine. electrolyte imbalances (K & Na). post-cardiac surgery.
🗑
|
||||
| Atrial Fibrillation: Clinical Manifestations | exactly same as A flutter. decreased CO. some may have rapid ventricular response. high risk for embolus.
🗑
|
||||
| Atrial Fibrillation: Goals of Treatment | rapid ventricular response: slow HR, prevent thrombus formation. drugs: beta-blockers, Ca channel blockers, amiodarone. elective cardioversion.
🗑
|
||||
| Atrial Fibrillation: Elective Cardioversion | can only be done if we know when the AFib started. Don't want to cardiovert someone with thrombi. unknown: anticoagulant for 3-4 weeks.
🗑
|
||||
| Premature Ventricular Contractions (PVC): causes | stimulants (caffeine, alcohol, epinephrine, recreational drugs). electrolyte imbalances (K, usually too low). Known CAD.
🗑
|
||||
| PVC: known CAD or lasix usage | watch for these patients. lasix - pulls fluid off, K follows fluid, K imbalance.
🗑
|
||||
| PVC: Clinical Manifestations | CO can fall. hypoxia. angina.
🗑
|
||||
| PVC: Treatment | O2 (hypoxia, angina). electrolyte replacement (K and Na). drugs (beta-blockers, amiodarone, lidocaine).
🗑
|
||||
| Multifocal PVCs | QRSs are not the same. tells us that an impulse is coming from different places (weaker/stronger). not much of Q at first glance (distorted and wide = ineffective CO). patterns (couplets or triplets = both are bad).
🗑
|
||||
| PVC: Ventricular Bigeminy | one normal complex, then wide distorted one, repeate
🗑
|
||||
| Ventricular Tachycardia | EMERGENCY. can move from pulse VTach to pulseless VTach. activate rapid response team.
🗑
|
||||
| V Tach: Treatment | shock them. ACLS protocol.
🗑
|
||||
| Ventricular Fibrillation | can see this when they have an MI and progress to VFib.
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
malysab14
Popular Nursing sets