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Advanced Med/Surg > Advanced Cardiac > Flashcards

Advanced Cardiac Flashcards

1
Q

For patients with symptomatic A Fib who are hemodynamically unstable, what interventions are performed?

A
  • Cardioversion
  • Transesohageal Echocardiogram (TEE)
    • Looking at tricuspid valve
    • Looking for plaque or clot
  • Radiofrequency catheter ablation
  • Permanent Pacemaker
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2
Q

Causes of V Fib

A
  • Myocardial infarction
  • Myocardial ischemia
  • Untreated V-Tach
  • Acid-base imbalance (metabolic or resp.)
  • Electric shock
  • Electrolyte imbalance
    • Hypokalemia
    • Hypomagnesaemia
  • Severe hypothermia
  • Underlying heart disease
  • Trauma
  • Surgery
  • Hemorrhage
  • Antidysrhythmic therapy
    • Cardioversion
  • Rapid supraventricular tachycardia (SVTs)
  • Shock
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3
Q

What should the nurse do after valsalva maneuvers?

A

Re-assess V/S & EKG rhythm

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4
Q

Normal Mg++ Level

A

1.3 - 2.1

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5
Q

Causes of V Tach

A
  • Electrolyte imbalances
    • Hypokalemia
    • Hypomagnesaemia
  • Myocardial irritability
  • Ischemic heart disease
  • Acute MI
  • CAD
  • Cardiac arrest
  • Drug toxicity
  • Digitalis
  • Heart Failure
  • Hypothermia
  • Hypovolemic Shock
    • caused by…Hemorrhage
    • which leades to…Hypotension
  • Electrical shock
  • Trauma
  • Surgery
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6
Q

With Noninvasive Temporary Pacing (NTP), the QRS is ____________.

A

wide & bizarre

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7
Q

What interventions beyond medication are performed for Junctional Dysrhythmias?

A

Transcutaneous Pacing

Pacemaker

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8
Q

therapy used for V Tach, V Fib and asystole in which cooling blankets or hypothermia pads are used to decrease a patient’s temperature to 89.6-93.2 ºF for 24 hours before slowly re-warming at a rate of 0.5-1 ºC/ hour

A

Therapeutic Hypothermia

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9
Q

Dysrythmias defined as repetitive firing of an irritable ventricular ectopic focus resulting in a HR of 140-180 bpm

…or 3 or more PVC’s in a row or runs

A

Ventricular Tachycardia (V Tach)

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10
Q

Medication given for symptomatic Junction Dysrhythmia is:

A

Atropine 0.5 -1.0 mg IV bolus FAST q 3-5 min

Dopamine (if hemodynamically compromised)

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11
Q

V Tach HR is _____ to ____ bpm.

A

140 -180 bpm

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12
Q

PSVT patient may be prescribed ________ or ________ for maintenance

A

Cardizem or amirodione

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13
Q

What is used to hear the pulse during V Tach?

A

dopper or echo

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14
Q

Supraventricular Tachycardia (SVT) HR = ___ to ___ bpm

A

150 - 280

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15
Q

Rhythm in which the entire heart is no longer contracting, only quivering without organized contraction with random depolarization of many cells

A

Ventricular Fibrillation

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16
Q

Complications of Transvenous Pacing

A
  • PVC
  • V Tach
  • V Fib
  • Cardiac tamponade
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17
Q

In Cardioversion, delivering a synchronized shock prevents ___________.

A

R on T Phenomenon

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18
Q

In Atrial Flutter, P waves are _______.

A

absent

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19
Q

In monophasic defibrillation, the monitor is set to a rate of _____ Joules.

A

360

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20
Q

In biphasic defibrillation, the monitor is set to a rate of _____ to _____ Joules.

A

120 - 200

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21
Q

Causes of Premature Atrial Complexes (PAC)

A
  • Myocardial ischemia
  • CHF
  • Valvular disease
  • Pulmonary HTN
  • Hypermetabolic states
  • Electrolyte imbalance
  • Atrial stretch
  • Hyperthyroidism
  • Stress
  • Fatigue
  • Anxiety
  • Inflammation
  • Infection
  • Caffeine, nicotine, or alcohol
  • Drugs
    • epinephrine
    • catecholamines
    • sympathomimetics
    • amphetamines
    • digitalis
    • anesthetic agents
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22
Q

For A Fib patient with normal heart function, what beta blocker can be given and at what dose?

A

Brevibloc

Initially, 500 mcg/kg/min for 1 min

Then, 50 mcg/kg/min for 4 min

Then, titrate up as necessary

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23
Q

occurs when the R wave of the PVC falls on the T wave of the previous complex which may lead to lethal dysrhythmia, such as V Tach because the PVC occurs during the vulnerable period of ventricular repolarization

A

R on T Phenomonon

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24
Q

For Biphasic Cardioversion, the monitor is set in __________ mode.

A

synchornized

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25
Q

What does the nurse do when the metal external ends of the lead wires in Transvenous Pacing are not attached to the pulse generator?

A

insulate the wires with gloves, loop and cover with non-conductive tape

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26
Q

If PVCs are caused by MI or ischemia, what medication is given?

A

Amiodarone PO or IV

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27
Q

Will Sustained V Tach have a pulse?

A

may or may not

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28
Q

Signs & Symptoms of Atrial Flutter

A
  • Angina
  • Palpitations
  • Weakness
  • SOB
  • Hypotension
  • Irregular HR
  • Syncope
  • Anxiety
  • Heart failure
  • Shock
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29
Q

What are the only two rhythms that can be shocked?

A

V Fib and V Tach

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30
Q

Bradydysrhythmia is defined as a HR less than ______ bpm.

A

60 bpm

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31
Q

antidysrhythmic drug that may cause asystole

A

Adenosine

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32
Q

Premature Complexes are generated by ________, _________, or __________ tissue.

A

atrial, junctional or ventricular

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33
Q

Dysrhythmia in which impulses are excessively delayed or totally blocked in the AV node while the SA node continues to function normally, and atrial depolarizations and P waves occur regularly but because of the conduction dysfunction, ventricular depolarizations and QRS complexes are either delayed or blocked

A

Atrioventricular Blocks

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34
Q

Where are the electrodes placed during Noninvasive Temporary Pacing (NTP)?

A

one to the right of the sternum and one placed over the heart apex

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35
Q

Symptoms of SVT

A
  • Palpitations
  • Light-headedness
  • Dizziness
  • Anxiety
  • Shortness of breath
  • Rapid breathing
  • Chest pain
  • Hypotension
  • Syncope
  • Loss of consciousness
  • Numbness of various body parts
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36
Q

Normal K+ Level

A

3.5 - 5.0

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37
Q

Symptoms of Sustained V Tach

A
  • Non-responsiveness
  • Loss of pulse
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38
Q

Symptoms of Junctional Dysrythmias

A
  • Fatigue
  • Fluttering in chest
  • Chest pain
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39
Q

In ______-degree heart block, none of the sinus impulses reach the ventricles. The ventricles are therefore depolarized by a second, independent pacemaker.

A

third (complete heart block)

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40
Q

Junctional Dysrhythmias are most commonly _________.

A

temporary

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41
Q

Treatment for Idioventricular Rhythm, PEA & Ventricular Asystole

A
  1. Oxygenate
  2. CPR
  3. Intubate

4. Epinephrine

1 mg IV bolus followed by 20 ml saline flush

Repeat q 3-5 min

  1. If rhythm becomes shockable,defibrillate

Or if you have a pulse, try to pace

  1. Treat reversible causes (H’s & T’s)
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42
Q

In __________-degree heart block, some sinus impulses reach the ventricles but others do not because they are blocked.

A

second

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43
Q

During Radiofrequency catheter ablation, check for _________ pulses.

A

peripheral

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44
Q

Tachydysrhythmias cause _______ and ______ to decrease.

A

cardiac output and BP

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45
Q

Causes of Sinus Tachycardia

A
  • Sympathetic nervous system impulse imbalance
  • Hypovolemic shock
  • MI
  • Infection
  • Heart failure
  • Pain
  • Anxiety
  • Fever
  • Hypoxemia
  • Stress
  • Fear
  • Anemia
  • Hyperthyroidism
  • PE
  • Alcohol
  • Nicotine
  • Caffeine
  • Drugs
    • Thyroid medications
    • Epinephrine
    • Atropine
    • Aminophylline
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46
Q

Tachydysrythmias are considered HR greater than _____ bpm.

A

100 bpm

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47
Q

Rhythm called the “rhythm of last resort” or “rhythm of the dying heart” acting as safety mechanism to prevent ventricular standstill when no impulses are conducted to the ventricles from above the bundle of His…rate usually less than 40 bpm

A

Idioventricular Rhythm

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48
Q

MD may perform these procedures before giving meds for A Fib?

A

vagal maneuvers or carotid massage

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49
Q

Symptoms of Sinus Bradycardia:

A
  • Syncope
  • Dizziness and weakness
  • Confusion
  • Hypotension
  • Diaphoresis
  • Shortness of breath
  • Angina pain
  • T-wave inversion
  • ST-segment elevation or depression
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50
Q

What does the valsalva maneuver and raising the hands above the head do in the heart?

A

slows SA to AV node conduction which slows the heart rate

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51
Q
A

Sinus Rhythm with Premature Atrial Complexes (PAC)

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52
Q

Dysrhythmias are treated based on what?

A

their effect on cardiac output and the risk to the patient

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53
Q

What does the nurse do if a patient is having non-sustained V Tach runs?

A

Give Amiodarone PO

Give O2

Call the physician

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54
Q

MD may perform these procedures before giving meds for SVT?

A

valsalva maneuver or carotid massage

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55
Q

cardioversion electrode placement in which the electrodes are on the right and left of the chest

A

Monophasic

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56
Q

Causes of Ventricular Asystole

A
  • MI
  • Severe electrolyte disturbances
    • Hyperkalemia
    • Severe uncorrected acidosis
  • Massive PE
  • Prolonged hypoxemia
  • Electric shock
  • Drug overdose
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57
Q

What should the nurse do during valsalva maneuvers?

A
  • Assess HR
  • Asess Rhythm
  • Assess BP
  • Record rhythm strip
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58
Q

Medications given for Unstable V Tach are:

A

Epinephrine

1 mg IV bolus followed by 20 ml saline flush

Repeat q 3-5 min

Amiodarone

1st dose: 150 mg IV rapid loading dose over 10 min (15 mg/min)

2nd dose: 360 mg IV slow loading dose over 6 hrs (1 mg/min)

Maintenance Infusion: 540 mg IV over 18 hrs

Then, 720 mg/24 hrs

Lidocaine (Xylocaine)

1 -1 .5 mg/kg IV bolus

0.5-0.75 mg/kg bolus q 5-10 min up to 3 mg/kg (loading dose)

Followed by infusion of 2-4 mg/min

(1 - 2 doses then start drip)

Magnesium Sulfate

1 - 2 gm in 100ml/D5W IV over 1-2 min

(normally give over 1 hr)

(Then start drip)

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59
Q

What does this EKG strip show?

A

It shows pacing attempted but not acheiving capture. The arrow shows the pacing stimulus indicator which is below threshold.

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60
Q

In Third-Degree (Complete) Heart Block, there about 2x as many P waves as ____________.

A

QRS complexes

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61
Q

Supraventricular Tachycardia (SVT) is defined as a heart rate higher than ______.

A

150 bpm

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62
Q

For Biphasic Cardioversion, the monitor is set at a rate of

_______ Joules.

A

120

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63
Q

Signs & Symptoms of V Fib

A
  • Loss of consciousness
  • Pulselessness
  • Syncope
  • Apneic
  • No BP
  • No heart sounds
  • Respiratory and metabolic acidosis
  • Seizures
  • Pupils become fixed and dilated
  • Cold and Mottled Skin
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64
Q

For A Fib patient with normal heart function, it is controlled by administering what type of drug?

A

Beta Blocker

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65
Q

MD may perform these procedures before giving meds for A Flutter?

A

vagal maneuvers and carotid massage

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66
Q

Before we treat the rhythm, we must ________ the rhythm.

A

identify

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67
Q
A

A Fib

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68
Q

Causes of AV Heart Blocks

A
  • Drug therapy
    • digoxin
    • beta-adrenergic blockers
    • calcium channel blockers
    • antiarrhythmic drugs such as amiodarone
  • MI
  • Chronic degenerative disease of the atrial conduction system (seen with aging)
  • CHF
  • Hypo- or Hyperkalemia
  • Increased vagal tone
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69
Q

Sinus Tachycardia QRS Width

A

< 0.12 seconds

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70
Q

What are the potential complications of valsalva maneuvers?

A
  • rebound tachycardia
  • severe bradycardia
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71
Q

Radiofrequency catheter ablation could lead to _________ requiring insertion of a ____________.

A

heart blocks; permanent pacemaker

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72
Q

Digoxin Level is toxic above _____.

A

2.4

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73
Q

PACs could lead to these dysrhythmias:

A

A Fib, A Flutter or PSVT

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74
Q

What electrolytes do you always check on a patient with a Run of V Tach?

A

K+ and Mg++

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75
Q

Causes of V Fib, V Tach, PEA & Asystole

(H’s & T’s!!!)

A
  • Hypovolemia
  • Hypoxia
  • Hydrogen ions (Acidosis)
  • Hyperkalemia or Hypokalemia
  • Hypoglycemia
  • Hypothermia
  • Tablets or Toxins (Drug overdose)
  • Tension pneumothorax
  • Chest Tube
  • Thrombosis
  • Anti-Thrombolytics
  • Cardiac Tamponade
  • Trauma
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76
Q

Dysrhythmias are classified according to __________.

A

site of origin

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77
Q

What does carotid massage do in the heart?

A

slows SA to AV node conduction which slows the heart rate

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78
Q

What should the nurse do during carotid sinus massage?

A

Observe rhythm strip

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79
Q

The degrees of block of the heart are differentiated by their ______________.

A

PR intervals

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80
Q

For an elective cardioversion, digoxin is held for _____ hours.

A

48

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81
Q

Treatment for V Fib

A
  1. CPR (if no code cart)
  2. Immediate Defibrillation
  3. ACLS Protocol
  4. Oxygen
  5. Intubation
  6. Epinephrine
  7. Amiodarone
  8. Lidocaine
  9. Magnesium sulfate
  10. Alternating CPR with Defibrillation
82
Q

Beta Blocker used as an antidysrhythmic drug

A

Propanolol

83
Q

If V Fib results after cardioversion, then switch to ___________.

A

asynchronized defibrillation

84
Q

intermittent Supraventricular Tachycardia (SVT)

A

Paroxysmal Supraventricular Tachycardia (PSVT)

85
Q

Most common dysrhythmia in which the atria fibrillate or quiver without organized contraction

A

Atril Fibrillation (A Fib)

86
Q

decrease in the rate of atrial depolarization due to slowing of the SA node

A

Sinus Bradycardia

87
Q

type of pacing usually done in temporary pacing situations in which the pacemaker’s sensitivity is set to sense the patient’s own heart beats and if patients heartbeat goes above the rate set on the pulse generator, the pacemaker does not fire and if it goes under, the pacemaker provides the electrical impulses

A

synchronous or demand pacing

88
Q

Causes/ Risk Factors for Atrial Flutter are:

A
  • Acute or chronic cardiac disorder
    • Rheumatic or ischemic heart disease
    • Heart failure
  • Mitral or tricuspid valve disorder
  • Septial defects
  • Pericarditis
  • Post MI complication
  • PE
  • Hyperthyroidism (speeds up HR)
  • Alcoholism
89
Q

For patients with PVCs, be on alert for _____________.

A

R on T phenomenon

90
Q

a synchronized countershock that may be performed in emergencies for hemodynamically unstable A Flutter, A Fib or SVT and electively for stable tachydysrythmias that are resistant to medical therapies. The shock depolarizes a critical mass of myocardium simultaneously during intrinsic depolarization and is intended to stop the re-entry circuit and allow the sinus node to regain control of the heart.

A

Cardioversion

91
Q

Atrial Flutter HR is _____ to _____ bpm

A

220 - 350 bpm

92
Q

Medication given for digoxin toxicity:

A

Digibind

93
Q

Normal PR Interval

A

0.12 - 0.20 seconds

94
Q

Calcium Channel Blockers used as antidysrhythmic drugs

A

Cardizem and verapamil

95
Q

Risk Factors/ Causes of A Fib

A
  • Hypertension
  • Diabetes mellitus
  • Male gender
  • Congestive heart failure
  • Valvular disease
  • Alcohol
  • Rheumatic heart disease
  • Coronary artery disease
  • Caffeine
  • Cardiac surgery
  • Electrocution
  • MI
  • Pericarditis
  • Myocarditis
  • Pulmonary embolism
  • Digoxin toxicity
  • COPD
96
Q

Normal Ca+ Level

A

9.0 - 10.5

97
Q

If Idioventricular Rhythm is accompanied by NO pulse its is called ________________.

A

Pulseless Electrical Activity (PEA)

98
Q

In V Fib, there is no cardiac output or pulse and therefore no cerebral, myocardial, or systemic perfusion. This rhythm is rapidly fatal if not successfully ended within ___ to _____ minutes.

A

3 - 5

99
Q

P waves in Junctional Dysrythmias may be _______ or may occur _________, _________, or _______ the QRS.

A

absent; before; during; after

100
Q

Causes of Sinus Bradycardia:

A
  • Increased vagal tone
  • Hyperkalemia
  • Increased intracranial pressures
  • Possible result of inferior MI
  • Drugs
    • Beta-adrenergic blockers
    • Calcium channel blockers
    • Digoxin
    • Morphine
101
Q

“R on T leads to __________”

A

asystole

102
Q

What medication is given for patients with more than 5000 PVCs in 24 hours?

A

Beta Blockers

103
Q

The components of ACLS are:

A

CPR

Manual Resuscitation Bag with O2 @ 10-15 L/min

Intubation

2 Large-Bore IV lines (NS)

Suction Equipment

External Pacing

Therapeutic Hypothermia

104
Q

Sustained V Tach is defined as lasting longer than ___ to ___ seconds.

A

15 - 30

105
Q

4 ºC = ____ ºF

A

39.2

106
Q

What is done for PVCs in a patient with no underlying heart condition?

A

no treatment except for eliminating contributing cause

107
Q

What are the 6 steps of analyzing an EKG?

A
  1. Heart Rate
  2. Determine the Rhythm
  3. Analyze the P Waves
  4. Measure the PR Interval
  5. Measure the QRS Duration
  6. Interpret the Rhythm
108
Q

cardiac treatment that is used to depolarize cells followed by a contraction and increase cardiac output and provides timed electrical stimulus to the heart (used in bradycardia)

A

temporary pacing

109
Q

Symptoms of PAC

A

usually asymptomatic except for heart palpitations

110
Q

In Supraventricular Tachycardia (PSVT), the ______ may not be visible on the EKG.

A

P waves

111
Q

What are the potential complications of carotid sinus massage?

A
  • Bradydysrhtyhmias
  • Asystole
  • V Fib
  • Cerebral damage
112
Q

Causes of PVC

A
  • Myocardial ischemia
  • Myocardial infarction
  • CHF
  • Chronic hypoxemia
  • Anemia
  • Hypokalemia
  • Hypomagnesaemia
  • Catecholamine
  • Digitalis
  • Acidosis
  • Anesthesia
  • Stress
  • Nicotine
  • Caffeine
  • Alcohol
  • Infection
  • Trauma
  • Surgery
113
Q

Medication Given for Stable V Tach (Run of V Tach)

A

Amiodarone

1st dose: 150 mg IV rapid loading dose over 10 min (15 mg/min)

2nd dose: 360 mg IV slow loading dose over 6 hrs (1 mg/min)

Maintenance Infusion: 540 mg IV over 18 hrs

Then, 720 mg/24 hrs

Lidocaine (Xylocaine)

1 -1 .5 mg/kg IV bolus

0.5-0.75 mg/kg bolus q 5-10 min up to 3 mg/kg (loading dose)

Followed by infusion of 2-4 mg/min

Magnesium Sulfate

1 - 2 gm in 100ml/D5W IV over 1-2 min

(normally give over 1 hr)

Mexitil

200 - 300 mg PO q 8 hrs

Betapace

80 mg PO BID

Increase q 2-3 days to 240 - 320 mg/day

114
Q

If strip shows R on T that leads to asystole, always __________ to see if V Fib can be picked up.

A

change the lead

115
Q

Never give _______ to a Second-Degree Mobitz II, because it can cause Third-Degree AV Block.

A

atropine

116
Q

Which 2 electrolyte imbalances contribute to PVCs?

A

Hypomagnesemia & Hypokalemia

117
Q

Causes/ Risk Factors of Junctional Dysrhythmias

A
  • Most common causes:
  • Hypokalemia
  • Drug induced
    • Beta blockers
    • Calcium channel blockers
    • Cardiac glycoside
    • Digoxin toxicity
  • Younger/athletic individuals during periods of increased vagal tone
  • Structural heart disease
  • Sick Sinus syndrome
  • Oxygen deficiency
  • Inferior wall MI
  • Ischemia of the AV node
  • Cardiac surgery
  • Sepsis
118
Q

Medications given for A. Flutter are:

A

Cardizem (hung as a drip)

1st dose: 0.25 mg/kg IV over 1-2 min

2nd dose 15 min later: 0.35 mg/kg IV over 2 min

Then, 5-15 mg/hr infusion

Amiodarone

1st dose: 150 mg IV rapid loading dose over 10 min (15 mg/min)

2nd dose: 360 mg IV slow loading dose over 6 hrs (1 mg/min)

Maintenance Infusion: 540 mg IV over 18 hrs

Then, 720 mg/24 hrs

Corvert

1 mg IV over 10 min for weight > 60 kg

0.01 mg IV over 10 min for weight < 60 kg

May repeat 10 min later, if necessary

119
Q

Symptoms of Sustained Tachydysrhythmias and Bradydysrhythmias

A
  • Chest discomfort, pressure, or pain, which may radiate to the jaw, the back, or arm
  • Restlessness, anxiety, nervousness, confusion
  • Dizziness, syncope
  • Palpitations (in tachydysrhythmias)
  • Change in pulse strength, rate, and rhythm
  • Pulse deficit
  • Orthopnea
  • S3 or S4 heart sounds
  • Jugular venous distention
  • Weakness, fatigue
  • Pale, cool, skin; diaphoresis
  • Nausea, vomiting
  • Decreased urine output
  • Delayed capillary refill
  • Hypotension
  • Shortness of breath
    • Dyspnea
  • Tachypnea
  • Pulmonary crackles
120
Q

An asynchronous countershock that depolarizes a critical mass of myocardium simultaneously to stop the re-entry circuit, allowing the sinus node to regain control of the heart used only for V Fib and V Tach

A

Defibrillation

121
Q

Treatment of Second-Degree Mobitz I (Wenkebach)

and Mobitz II AV Block

A

For concomitant acute myocardial ischemia or myocardial infarction (MI)…

  1. Telemetry monitoring
  2. Treat underlying cause (change or hold drugs)
  3. Oxygen
  4. Atropine (ONLY FOR MOBITZ TYPE I WENKEBACH!!)
  5. Transcutaneous pacing
  6. Permanent pacemaker if unresolved
122
Q

Sinus Tachycardia is defined as a heart rate of _______.

A

100-140 bpm

123
Q

The treatment for Unstable V Tach (the same as for V Fib) is:

A
  1. Check ABC’s
  2. Defibrillate if code cart is bedside or start CPR if no cart
  3. After 2 minutes of CPR, check rhythm
  4. Treat accordingly
    • V Tach= defibrillate
    • Asystole = CPR
124
Q

type of pacing pacing used in the patient with extreme bradycardia which may occur after heart surgery…it does not sense heart beats but fires at a fixed rate

A

asynchronous or fixed-rate pacing

125
Q

In Noninvasive Temporary Pacing (NTP), set the current milliamperes (mA) output ________ above the dose at which consistent capture is observed.

A

2 mA

126
Q

For more than 6 PVCs in a row, put the patient on a __________

A

Holter Monitor

127
Q

In Sinus Bradycardia, coronary perfusion time ________ while coronary perfusion pressure may ___________.

A

increase; decrease

128
Q

Dysrhytmia caused by irritability of ventricular cells that result in early ventricular complexes followed by a pause

A

Premature Ventricular Complexes (PVC)

129
Q

Treatment for Torsade is the same as _______.

A

V Tach

130
Q

occurs when three or more PVCs occur in a row

A

Run of Ventricular Tachycardia (Run of VT) or Nonsustained Ventricular Tachycardia

131
Q

type of pacing in which the pacemaker is inserted through a vein such as a subclavian or internal jugular vein at the bedside or in other nonsurgical environments

A

Transvenous Pacing or Invasive Temporary Pacing

132
Q

Sites of origin for dysrhythmias include:

A

SA node

AV node

Junctional Tissue

Ventricular Tissue

133
Q

How do you check to see if the heart beat is being perfused through the body?

A

Assess apical pulse while feeling radial pulse and looking at the monitor for ONE MINUTE

134
Q

a disturbance in the relationship between electrical conductivity and the mecDhanical response of the myocardium

A

Dysrhytmias

135
Q

Normal QRS Duration

A

0.04 - 0.10 second

136
Q

Cardiac dysrhythmia that is initiated in the AV node (AV junctional area) when the SA node and atrial sites fail to initiate an electrical impulse that causes loss of ventricular filling during the last part of diastole, loss of atria kick, and loss of cardiac output by 20-25 %

A

Junctional Dysrythmias

137
Q

For patients with symptomatic A Flutter who are hemodynamically unstable, what interventions are performed?

A
  • Cardioversion
  • Transesohageal Echocardiogram (TEE)
  • Radiofrequency catheter ablation
  • Permanent Pacemaker
138
Q

Sinus Tachycardia HR _____ to ____ bpm.

A

100 - 160

139
Q

During Noninvasive Temporary Pacing (NTP), the nurse should palpate the ________ or the ________ pulse.

A

right radial or carotid pulse

140
Q

equipment used for patients that have experienced one or more episodes of spontaneous sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) not caused by an MI

A

Implantable Cardioverter/Defibrillator (ICD)

141
Q
A
142
Q

A Fib patients are given _______ to prevent blood clots.

A

anticoagulants such as heparin, lovenox, or coumadin

143
Q

If the HR in a Junctional Rhythm is above 60 bpm, it is referred to as ___________ junctional rhythm.

A

accelerated

144
Q

Occurs when:

  • HR increases slightly during inspiration and decreases slightly during exhalation
  • Atrial and ventricular rates are 60 - 100 bpm
  • Atrial and ventricular rhythms irregular with the shortest PP or RR interval varying at least 0.12 second from the longest PP or RR interval
A

Sinus Arrythmia

145
Q

an invasive procedure that uses radiofrequency waves to abolish an irritable focus that is causing a supraventricular or ventricular tachydysrhythmia

A

Radiofrequency Catheter Ablation

146
Q

Full cardiac arrest with the absence of any ventricular rhythm or electrical impulses in the ventricles and therefore, no ventricular depolarization, no QRS complex, no contraction, no cardiac output, and no pulse

A

Ventricular Asystole

147
Q

The most dangerous PVCs

A

multifocal PVCs

148
Q

Signs & Symptoms of Mobitz I (Wenckebach)

and Mobitz II AV Block

A
  • Asymptomatic
  • Light-headedness, dizziness, or syncope
  • Chest pain (with myocarditis or ischemia)
  • Regularly irregular heartbeat
  • Bradycardia
  • Decreased cardiac output
  • Hypoperfusion
  • Hypotension
149
Q

Causes of SVT

A
  • Myocardial Infarction
  • Cardiomyopathy
  • Congenital anomalies
  • Hyperthyroidism
  • Systemic hypertension
  • Digoxin Toxicity
  • Excessive caffeine
  • Electrolyte Imbalances
  • Hypoxia
  • Physical or psychological stress
  • PE
  • Cocaine abuse
  • Alcohol
  • Smoking
150
Q

Antidysrhythmic drug that slows conduction and shortens repolarization

A

Sodium Channel Blockers 1B

151
Q

Prior to a cardioversion, the patient will be placed on ________ for 4-6 weeks.

A

anticoagulants

152
Q

Causes of Torsade

A
  • Electrolyte imbalances, particularly
    • Hypokalemia
    • Hypomagnesaemia
  • Drugs which lengthen the QT interval such as quinidine
    • Myocardial ischemia
153
Q

Normal Digoxin Level

A

0.8 - 2.0

154
Q

What medications are given for Torsades?

A

_*Magnesium IV*_

_*Potassium IV*_

Amiodarone

1st dose: 150 mg IV rapid loading dose over 10 min (15 mg/min)

2nd dose: 360 mg IV slow loading dose over 6 hrs (1 mg/min)

Maintenance Infusion: 540 mg IV over 18 hrs

Then, 720 mg/24 hrs

155
Q

What should the nurse do after carotid sinus massage?

A

Assess V/S & LOC

156
Q

On a biphasic monitor, one electrode is on the _______ and one is on the _________.

A

chest; back

157
Q

Frequent PACs are treated by correcting __________.

A

the underlying cause such as stress, stimulants, CHF, electrolyte imbalances.

158
Q

Medications given for A Fib with normal heart function:

A

Cardizem (hung as a drip)

1st dose: 0.25 mg/kg IV over 1-2 min

2nd dose 15 min later: 0.35 mg/kg IV over 2 min

Then, 5-15 mg/hr infusion

Verapamil

1st dose: 2.5 - 5 mg IV over 1-2 min

2nd dose 15-30 min later: 5 -1 0 mg IV over 1-2 min

Repeat up to a max of 20 mg

PO: 80 - 120 mg q6-8 hrs

159
Q

cardioversion electrode placement in which the they are on the patient’s back and chest

A

Biphasic

160
Q

In A Fib, there is a decrease in cardiac output by ____ to ____ %

A

25 -30%

161
Q

Rate of Idioventricular Rhythm

A

20 - 40 bpm

162
Q

In _______-degree AV block, all sinus impulses eventually reach the ventricles.

A

first

163
Q
A

Supraventricular Tachycardia (SVT)

164
Q

Antidysrhythmic drug that slows conduction and prolongs repolarization

A

Sodium Channel Blockers 1A

165
Q

Interventions for SVT

A

Cardioversion

Radiofrequency Catheter Ablation (if rhythm as decreased)

166
Q

If PAC is symptomatic, what is the treatment drug?

A

Beta Blockers

167
Q

Medications given for A Fib with impaired heart function:

A

Digoxin

0.5 - 1.0 mg PO or IV

O.125 - 0.5 mg PO or IV q 6h until total of 1 - 1.15 mg is reached

Cardizem (hung as a drip)

1st dose: 0.25 mg/kg IV over 1-2 min

2nd dose 15 min later: 0.35 mg/kg IV over 2 min

Then, 5-15 mg/hr infusion

Amiodarone

1st dose: 150 mg IV rapid loading dose over 10 min (15 mg/min)

2nd dose: 360 mg IV slow loading dose over 6 hrs (1 mg/min)

Maintenance Infusion: 540 mg IV over 18 hrs

Then, 720 mg/24 hrs

168
Q

Dysrhythmia in which the P waves are notched, peaked or buried in the preceding T wave

A

Premature Atrial Complexes (PAC)

169
Q

For Sinus Bradycardia, what drug is given IV?

A

Atropine 0.5 -1.0 mg IV bolus FAST

170
Q

Mobitz I and Mobitz II can cause ________.

A

Third-Degree (Complete) Heart Block

171
Q

Torsade HR is ____ to _____ bpm.

A

150 - 220 bpm

172
Q

In Third-Degree (Complete) Heart Block, the atrial HR is ___ to ____ bpm but the ventricular HR (electrical impulse) is ____ to ____.

A

60 - 100; 20 - 40

173
Q

Antidysrhythmic drug that prolongs conduction with little to no effect on repolarization

A

Sodium Channel Blockers 1C

174
Q

Tachydysrhythmias shorten _________.

A

diastolic time and therefore the coronary perfusion time (the amount of time available for blood to flow through the coronary arteries to the myocardium)

175
Q

In Sinus Bradycardia, myocardial oxygen demand is __________.

A

decreased

176
Q

Class III Antidysrhythmic drug that prolongs repolarization and decreases irritability in the heart

A

Lidocaine

177
Q

PSVT may be treated with _________ before it becomes SVT

A

radiofrequency catheter ablasion

178
Q

Symptoms of Run of V Tach

A
  • Slight weakness
  • Palpitations
179
Q

In PVCs, QRS complexes are _______ & ________.

A

wide & bizarre

180
Q

Complications of CPR

A

Rib fractures

Fracture of the sternum

Costochondral separation

Lacerations of the liver and spleen

Pneumothorax

Hemothorax

Cardiac tamponade

Lung contusions

Fat emboli

181
Q

What does CAB stand for?

A

Chest Compressions

Maintain Patent Airway

Ventilate (Breathing)

182
Q
A

First Degree AV Block

183
Q

A Fib HR = ______ bpm

A

350 - 600 bpm

184
Q

type of pacing that uses two large external electrodes to transcutaneously stimulate ventricular depolarization that should be followed by a contraction and cardiac output…used as an emergency measure to provide ventricular pacing until invasive pacing or the heart rate returns back to normal (profound bradycardia or PEA)

A

Noninvasive Temporary Pacing (NTP)

185
Q

Which arm does the nurse use for BP during Noninvasive Temporary Pacing (NTP)? And why?

A

right arm because in the left arm, the pacer might get the wrong reading

186
Q

Normal HR for Junction Dysrythmias

A

40 - 60 bpm

187
Q

type of pacing used for disorders that are not temporary, including complete heart block ,in which the pulse generator is surgically implanted in a subcutaneous pocket…introduced transvenously via the cephalic or the subclavian vein to the endocardium on the right side of the heart.

A

Permanent Pacemaker

188
Q

Type of Ventricular Tachycardia that demonstrates a polymorphic ventricular tachycardia with a characteristic illusion of a twisting of the QRS complex around the isoelectric baseline

A

Torsades

189
Q

Medications given for SVT:

A

Cardizem (hung as a drip)

  • 1st dose*: 0.25 mg/kg IV over 1-2 min
  • 2nd dose 15 min later*: 0.35 mg/kg IV over 2 min

Then, 5-15 mg/hr infusion

Adenosine (closest IV to the heart)

  • 1st dose*: 6 mg rapid bolus followed by NS
  • 2nd dose 1-2 min later*: 12 mg rapid bolus followed by NS
190
Q

P waves in Junctional Dysrhythmias are referred to as “_________” P waves.

A

inverted

191
Q

Patients with A Fib are at risk for:

A

Pulmonary Emboli (PE)

Septic Emboli (black fingers/toes)

Embolic Stroke

192
Q

Symptoms of A Fib

A
  • SOB
  • Dizziness, weakness, faintness
  • Hypotension
  • Dyspnea
  • Diaphoresis
  • Mild to severe chest pain
  • Confusion or disorientation
  • Cyanosis
    • Decreased urinary output
  • Unresponsiveness
193
Q

For Monophasic Cardioversion, the monitor is set at a rate of

_____ to ___ Joules.

A

150 - 200

194
Q

Reccomendation for CPR is _____ compressions/ minute.

A

120

195
Q

Dose for Atropine

(used for bradydysrhythmias & Mobitz I AV Block)

A

0.5 -1.0 mg IV bolus FAST q 3-5 min

196
Q

Epinephrine Dose

(used for asystole, PEA, idioventricular rhythms, V Tach, V Fib)

A

1 mg IV bolus followed by 20 ml saline flush

Repeat q 3-5 min

197
Q

Amiodarone Dose

(used for tachydysrhythmias)

A

1st dose: 150 mg IV rapid loading dose over 10 min (15 mg/min)

2nd dose: 360 mg IV slow loading dose over 6 hrs (1 mg/min)

Maintenance Infusion:

540 mg IV over 18 hrs

Then, 720 mg/24 hrs

198
Q

Lidocaine Dose

A

1 -1 .5 mg/kg IV bolus

0.5-0.75 mg/kg bolus q 5-10 min up to 3 mg/kg (loading dose)

Followed by infusion of 2-4 mg/min

(1 - 2 doses then start drip)

199
Q

Magnesium Sulfate Dose

A

1 - 2 gm in 100ml/D5W IV over 1-2 min (normally give over 1 hr)

Then start drip

200
Q
A
201
Q

Corvert Dose

(used for A Flutter)

A

1 mg IV over 10 min for weight > 60 kg

0.01 mg IV over 10 min for weight < 60 kg

May repeat 10 min later, if necessary

202
Q

Cardizem Dose

A

1st dose: 0.25 mg/kg IV over 1-2 min

2nd dose 15 min later: 0.35 mg/kg IV over 2 min

Then, 5-15 mg/hr infusion

Advanced Med/Surg (10 decks)

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