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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
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
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?
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
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 ## Footnote **(H's & T's!!!)**
* **H**ypovolemia * **H**ypoxia * **H**ydrogen ions (Acidosis) * **H**yperkalemia or **H**ypokalemia * **H**ypoglycemia * **H**ypothermia * **T**ablets or **T**oxins (Drug overdose) * **T**ension pneumothorax * Chest **T**ube * **T**hrombosis * Anti-**T**hrombolytics * Cardiac **T**amponade * **T**rauma
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: ## Footnote * 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
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
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 ***C**ompressions* Maintain Patent ***A**irway* Ventilate (***B**reathing*)
182
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

Advanced Med/Surg (10 decks)

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