Caring for Clients with Dysrhythmias

Question 1

how long is each segment of a monitor strip

Answer 1

6 second strip

Question 2

P wave

Answer 2

represents atrial depolarization (atrial contraction)
present, consistent, configuration, one P wave before each QRS complex

Question 3

PR interval

Answer 3

represents the time required for atrial depolarization as well as impulse travel through the conduction system

Question 4

QRS complex

Answer 4

is measured from the beginning of the Q (or R) wave to the end if of the S wave (ventricular contraction)

Question 5

ST segment

Answer 5

represents early ventricular repolarization- ventricular returning to resting state. indication of MI

Question 6

QT interval

Answer 6

total time required for ventricular depolarization and repolarization

Question 7

Steps to ECG Rhythm Analysis

Answer 7

determine HR, Heart rhythm, analyze P waves, measure PR interval, QRS duration, examine the ST segment.

Question 8

normal PR interval duration

Answer 8

0.12- 0.20 and constant

Question 9

normal QRS duration

Answer 9

0.06-0.12 and constant

Question 10

Elevations in ST segment

Answer 10

may indicate myocardial infarction, pericarditis, hyperkalemia

Question 11

depression in ST segment

Answer 11

is associated with hypokalemia, myocardial infarction, ventricular hypertrophy.

Question 12

normal sinus rhythm

Answer 12

rate 60-100 bpm
rhythm: atrial and ventricular rhythms are regular

Question 13

sinus arrhythmia (SA)

Answer 13

variant of normal sinus rhythm, results from changes in intrathoracic pressure during breathing, has all the characteristics if normal sinus rhythm except for its irregularity. The PP and RR intervals vary, with the difference between the shortest and the longest intervals being greater than 0.12 second

Question 14

Dysrhythmias

Answer 14

Any disorder of the heartbeat

Question 15

Tachydysrhythmias

Answer 15

Heart rate greater than 100 beats per minute

Question 16

Bradydysrhythmias

Answer 16

Heart rate less than 60 bpm

Question 17

Premature complexes

Answer 17

Early rhythm complexes; if they become more frequent, especially those that are ventricular, the patient may experience symptoms of decreased cardiac output.

Question 18

Repetitive rhythm complexes

Answer 18

Bigeminy, trigeminy, quadrigeminy

Question 19

Etiology for dsyrhythmias

Answer 19

May occur for many reasons. Can be classified by their site of origins in the heart (sinus, atrial, ventricular). Managed with antidysrhythmic drug therapy.

Question 20

Care of patients with dysrhythmias

Answer 20

Asses VS every 4 hours
Monitor for cardiac dysrhythmias
Evaluate and document patients response
Encourage patient to notify nurse if chest pain occurs
Asses for chest pain and respiratory difficulty
Asses peripheral circulation
Administer medication and monitor response
Monitor lab values
Monitor activity tolerance and schedule exercise/rest periods, avoid fatigue
Promote stress reduction
Offer spiritual support

Question 21

Atrial Dysrhythmia-Supra-ventricular Tachycardia

Answer 21

Rapid stimulation of atrial tissue occurs at rate of 100-280 bpm in adults. P waves may not be visible, because they are embedded in the preceding T wave.

Question 22

Atrial Fibrillation

Answer 22

Most common dysrhythmia. Associated with atrial fibrosis and loss of muscle mass. Common in heart disease such as HTN, heart failure, CAD. Many other risk factors. Cardiac output can decrease by as much as 20-30%

Question 23

Assessment for A Fib

Answer 23

Assess for fatigue, weakness, SOB, dizziness, anxiety, syncope, palpitations, chest discomfort or pain, hypotension. High risk for PE, VTE, stroke

Question 24

Drug Therapy for A fib

Answer 24

Calcium channel blocker, aminodarone, beta blockers, digoxin, anticoagulants, antiplatelet

Question 25

Other treatments for A fib

Answer 25

Cardio version, per cutaneous radio frequency catheter ablation, bi-ventricular pacing, surgical maze procedure

Question 26

Ventricular dysrhythmias

Answer 26

More life threatening than atrial dysrhythmias. Left ventricle pumps oxygenated blood throughout the body to perfume vital organs and other tissues. Most common or life threatening: PVC, VT, VF, VA

Question 27

Ventricular dysrhythmia- ventricular tachycardia

Answer 27

Also called v tach- repetitive firing of an irritable ventricular ectopic focus, usually 140-180 bpm or more.

Question 28

Stable VT

Answer 28

Treatment: oxygen amiodarone, lidocaine, or magnesium sulfate, elective cardio version radio frequency catheter ablation, implantable cardioverter debrillation.
Oral antidysrhythmic agent: mexiletine or sotalol
To prevent further occurrences.

Question 29

Unstable VT

Answer 29

Can cause cardiac arrest, unstable VT without a pulse is treated the same way as v fib. Assess patient’s airway, breathing, circulation, LOC, and oxygenation level

Question 30

Treatment for V Fib

Answer 30

Life threatening… no cardiac output or pulse, blood is no longer being pumped out of the heart and brain not receiving blood. May be the first manifestation of CAD. First priority: patient immediately. Continue high quality CPR, provide airway management, follow ACLS protocol.

Question 31

Ventricular dysrhythmia- ventricular fibrillation

Answer 31

Called v fib. Result of electrical chaos in ventricles

Question 32

Ventricular dysrhythmia-ventricular asystole

Answer 32

Called ventricular standstill- complete absence of any ventricular rhythm.

Question 33

Treatment for ventricular asystole

Answer 33

Full cardiac arrest- no cardiac output or perfusion to the rest of the body. Prognosis is poor. Manage airway. Administer CPR- compressions, airway, breathing. DO NOT DEFIBRILLATE… no electrical activity to shock. Follow ACLS protocols

Question 34

Patient teachings with dysrhythmias

Answer 34

Prevention, early, recognition, and management. Lifestyle, modifications, (avoid caffeinated beverages, stop, drinking, drink, alcohol in moderation, follow prescribe diet). Drug therapy instructions. Teach the patient and family how to take pulse and or blood pressure and report any changes. Keep follow up appointments. Provide oral and written instruction for pacemaker, ICDS, cardiac exercise programs, support groups as applicable.

Question 35

A client who had open abdominal surgery 4
hours ago reports feeling weak and dizzy.
The client’s current blood pressure has
decreased to 98/50, and pulse rate is 120.
What is the nurse’s best action at this time?
–A. Document the vital signs, and continue to
monitor the client.
–B. Remind the client to stay in bed if feeling
weak and dizzy.
–C. Call the health care provider immediately.
–D. Increase the client’s IV rate to restore fluid
volume.

Answer 35

C

Question 36

A client in the telemetry unit is on a
cardiac monitor. The monitor technician
notices there are no ECG complexes and
the alarm sounds. What is the first action
by the nurse?
–A. Begin CPR immediately.
–B. Call the emergency response team.
–C. Press the record button to get an ECG
strip.
–D. Assess the client and check lead
placement

Answer 36

D