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Flashcards in Advanced Cardiac Deck (202):
1

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

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

2

Causes of V Fib

  • 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

3

What should the nurse do after valsalva maneuvers?

Re-assess V/S & EKG rhythm

4

Normal Mg++ Level

1.3 - 2.1

5

Causes of V Tach

  • 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

6

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

wide & bizarre

7

What interventions beyond medication are performed for Junctional Dysrhythmias?

Transcutaneous Pacing

Pacemaker

8

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

Therapeutic Hypothermia

9

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 

Ventricular Tachycardia (V Tach)

10

Medication given for symptomatic Junction Dysrhythmia is:

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

Dopamine (if hemodynamically compromised)

11

V Tach HR is _____ to ____ bpm.

140 -180 bpm

12

PSVT patient may be prescribed ________ or ________ for maintenance

Cardizem or amirodione

13

What is used to hear the pulse during V Tach?

dopper or echo

14

Supraventricular Tachycardia (SVT) HR = ___ to ___ bpm

150 - 280

15

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

Ventricular Fibrillation

16

Complications of Transvenous Pacing

  • PVC
  • V Tach
  • V Fib
  • Cardiac tamponade

17

In Cardioversion, delivering a synchronized shock prevents ___________.

R on T Phenomenon

18

In Atrial Flutter, P waves are _______.

absent

19

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

360 

20

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

120 - 200

21



Causes of Premature Atrial Complexes (PAC)

  • 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

22

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

Brevibloc

Initially, 500 mcg/kg/min for 1 min

Then, 50 mcg/kg/min for 4 min

Then, titrate up as necessary

23

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

R on T Phenomonon

24

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

synchornized

25

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

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

26

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

Amiodarone PO or IV

27

Will Sustained V Tach have a pulse?

may or may not

28

Signs & Symptoms of Atrial Flutter

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

29

What are the only two rhythms that can be shocked?

V Fib and V Tach

30

Bradydysrhythmia is defined as a HR less than ______ bpm.

60 bpm

31

antidysrhythmic drug that may cause asystole

Adenosine

32

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

atrial, junctional or ventricular

33

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

Atrioventricular Blocks

34

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

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

35

Symptoms of SVT

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

36

Normal K+ Level

3.5 - 5.0

37

Symptoms of Sustained V Tach

  • Non-responsiveness
  • Loss of pulse

 

38

Symptoms of Junctional Dysrythmias

  • Fatigue
  • Fluttering in chest
  • Chest pain

39

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

third (complete heart block)

40

Junctional Dysrhythmias are most commonly _________.

temporary

41

Treatment for Idioventricular Rhythm, PEA & Ventricular Asystole

1. Oxygenate

2. CPR

3. Intubate

4. Epinephrine

1 mg IV bolus followed by 20 ml saline flush

Repeat q 3-5 min

5. If rhythm becomes shockable,defibrillate

Or if you have a pulse, try to pace

6. Treat reversible causes (H's & T's)

 

42

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

second

43

During Radiofrequency catheter ablation, check for _________ pulses.

peripheral

44

Tachydysrhythmias cause _______ and ______ to decrease.

cardiac output and BP

45

Causes of Sinus Tachycardia

  • 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

46

Tachydysrythmias are considered HR greater than _____ bpm.

100 bpm

47

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

Idioventricular Rhythm

48

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

vagal maneuvers or carotid massage

49

Symptoms of Sinus Bradycardia:

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

50

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

slows SA to AV node conduction which slows the heart rate

51

Q image thumb

 Sinus Rhythm with Premature Atrial Complexes (PAC)

52

Dysrhythmias are treated based on what?

their effect on cardiac output and the risk to the patient

53

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

Give Amiodarone PO

Give O2

Call the physician

54

MD may perform these procedures before giving meds for SVT?

valsalva maneuver or carotid massage

55

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

Monophasic

56

Causes of Ventricular Asystole

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

57

What should the nurse do during valsalva maneuvers?

  • Assess HR
  • Asess Rhythm
  • Assess BP
  • Record rhythm strip

58

Medications given for Unstable V Tach are:

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)

59

What does this EKG strip show?

Q image thumb

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

60

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

QRS complexes

61

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

150 bpm

62

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

_______ Joules.

120

63

Signs & Symptoms of V Fib

  • 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

64

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

Beta Blocker

65

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

vagal maneuvers and carotid massage

66

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

identify

67

Q image thumb

A Fib

68

Causes of AV Heart Blocks

  • 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

69

Sinus Tachycardia QRS Width

< 0.12 seconds

70

What are the potential complications of valsalva maneuvers?

  • rebound tachycardia
  • severe bradycardia

71

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

heart blocks; permanent pacemaker

72

Digoxin Level is toxic above _____.

2.4

73

PACs could lead to these dysrhythmias:

A Fib, A Flutter or PSVT

74

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

K+ and Mg++

75

Causes of V Fib, V Tach, PEA & Asystole

(H's & T's!!!)

  • 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

76

Dysrhythmias are classified according to __________.

site of origin

77

What does carotid massage do in the heart?

slows SA to AV node conduction which slows the heart rate

78

What should the nurse do during carotid sinus massage?

Observe rhythm strip

79

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

PR intervals

80

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

48

81

Treatment for V Fib

  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

Beta Blocker used as an antidysrhythmic drug

Propanolol

83

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

asynchronized defibrillation

84

intermittent Supraventricular Tachycardia (SVT)

Paroxysmal Supraventricular Tachycardia (PSVT)

85

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

Atril Fibrillation (A Fib)

86

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

Sinus Bradycardia

87

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

synchronous or demand pacing

88

Causes/ Risk Factors for Atrial Flutter are:

  • 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

For patients with PVCs, be on alert for _____________.

R on T phenomenon

90

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.

Cardioversion

91

Atrial Flutter HR is _____ to _____ bpm

220 - 350 bpm

92

Medication given for digoxin toxicity:

Digibind

93

Normal PR Interval

0.12 - 0.20 seconds

94

Calcium Channel Blockers used as antidysrhythmic drugs

Cardizem and verapamil

95

Risk Factors/ Causes of A Fib

  • 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

Normal Ca+ Level

9.0 - 10.5

97

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

Pulseless Electrical Activity (PEA)

98

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.

3 - 5

99

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

absent; before; during; after

100

Causes of Sinus Bradycardia:

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

101

"R on T leads to __________"

asystole

102

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

Beta Blockers

103

The components of ACLS are:

CPR

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

Intubation

2 Large-Bore IV lines (NS)

Suction Equipment

External Pacing

Therapeutic Hypothermia

104

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

15 - 30

105

4 ºC = ____ ºF

39.2

106

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

no treatment except for eliminating contributing cause

107

What are the 6 steps of analyzing an EKG?

  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

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)

temporary pacing

109

Symptoms of PAC

usually asymptomatic except for heart palpitations

110

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

P waves

111

What are the potential complications of carotid sinus massage?

  • Bradydysrhtyhmias
  • Asystole
  • V Fib
  • Cerebral damage

112

Causes of PVC

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

113

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

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

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

change the lead

115

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

atropine

116

Which 2 electrolyte imbalances contribute to PVCs?

Hypomagnesemia & Hypokalemia

117

Causes/ Risk Factors of Junctional Dysrhythmias 

  • 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

Medications given for A. Flutter are:

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

Symptoms of Sustained Tachydysrhythmias and Bradydysrhythmias  

  • 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

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

Defibrillation

121

Treatment of Second-Degree Mobitz I (Wenkebach)

and Mobitz II AV Block

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

Sinus Tachycardia is defined as a heart rate of _______.

100-140 bpm

123

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

  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

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

asynchronous or fixed-rate pacing

125

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

2 mA

126

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

Holter Monitor

127

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

increase; decrease

128

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

Premature Ventricular Complexes (PVC)

129

Treatment for Torsade is the same as _______.

V Tach

130

occurs when three or more PVCs occur in a row

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

131

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

Transvenous Pacing or Invasive Temporary Pacing

132

Sites of origin for dysrhythmias include:

SA node

AV node

Junctional Tissue

Ventricular Tissue

133

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

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

134

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

Dysrhytmias

135

Normal QRS Duration

0.04 - 0.10 second

136

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 %

Junctional Dysrythmias

137

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

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

138

Sinus Tachycardia HR _____ to ____ bpm.

100 - 160

139

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

right radial or carotid pulse

140

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

Implantable Cardioverter/Defibrillator (ICD)

141

142

A Fib patients are given _______ to prevent blood clots.

anticoagulants such as heparin, lovenox, or coumadin

143

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

accelerated

144

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

Sinus Arrythmia

145

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

Radiofrequency Catheter Ablation

146

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

Ventricular Asystole

147

The most dangerous PVCs

multifocal PVCs

148

Signs & Symptoms of Mobitz I (Wenckebach) 

and Mobitz II AV Block

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

149

Causes of SVT

  • 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

Antidysrhythmic drug that slows conduction and shortens repolarization

Sodium Channel Blockers 1B

151

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

anticoagulants

152

Causes of Torsade

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

153

Normal Digoxin Level

0.8 - 2.0

154

What medications are given for Torsades?

*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

What should the nurse do after carotid sinus massage?

Assess V/S & LOC

156

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

chest; back

157

Frequent PACs are treated by correcting __________.

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

158

Medications given for A Fib with normal heart function:

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

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

Biphasic

160

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

25 -30%

161

Rate of Idioventricular Rhythm

20 - 40 bpm

162

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

first

163

Q image thumb

Supraventricular Tachycardia (SVT)

164

Antidysrhythmic drug that slows conduction and prolongs repolarization

Sodium Channel Blockers 1A

165

Interventions for SVT

Cardioversion

Radiofrequency Catheter Ablation (if rhythm as decreased)

166

If PAC is symptomatic, what is the treatment drug?

Beta Blockers

167

Medications given for A Fib with impaired heart function:

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

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

Q image thumb

Premature Atrial Complexes (PAC)

169

For Sinus Bradycardia, what drug is given IV?

Atropine 0.5 -1.0 mg IV bolus FAST

170

Mobitz I and Mobitz II can cause ________.

Third-Degree (Complete) Heart Block

171

Torsade HR is ____ to _____ bpm.

150 - 220 bpm

172

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

60 - 100; 20 - 40

173

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

Sodium Channel Blockers 1C

174

Tachydysrhythmias shorten _________.

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

In Sinus Bradycardia, myocardial oxygen demand is __________.

decreased

176

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

Lidocaine

177

PSVT may be treated with _________ before it becomes SVT

radiofrequency catheter ablasion

178

Symptoms of Run of V Tach

  • Slight weakness
  • Palpitations

179

In PVCs, QRS complexes are _______ & ________.

wide & bizarre

180

Complications of CPR

Rib fractures

Fracture of the sternum

Costochondral separation

Lacerations of the liver and spleen

Pneumothorax

Hemothorax

Cardiac tamponade

Lung contusions

Fat emboli

181

What does CAB stand for?

Chest Compressions

Maintain Patent Airway

Ventilate (Breathing)

182

Q image thumb

First Degree AV Block

183

A Fib HR = ______ bpm

350 - 600 bpm

184

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)

Noninvasive Temporary Pacing (NTP)

185

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

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

186

Normal HR for Junction Dysrythmias

40 - 60 bpm

187

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.

Permanent Pacemaker

188

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

Torsades

189

Medications given for SVT:

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

P waves in Junctional Dysrhythmias are referred to as "_________" P waves.

inverted

191

Patients with A Fib are at risk for:

Pulmonary Emboli (PE)

Septic Emboli (black fingers/toes)

Embolic Stroke

192

Symptoms of A Fib

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

193

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

_____ to ___ Joules.

150 - 200

194

Reccomendation for CPR is _____ compressions/ minute.

120

195

Dose for Atropine

(used for bradydysrhythmias & Mobitz I AV Block)

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

196

Epinephrine Dose

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

1 mg IV bolus followed by 20 ml saline flush

Repeat q 3-5 min

197

Amiodarone Dose

(used for tachydysrhythmias)

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

Lidocaine Dose

  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

Magnesium Sulfate Dose

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

Then start drip

200

201

Corvert Dose
(used for A Flutter)

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

Cardizem Dose

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