Cardiac 2 Rhythms

Question 1

PSVT Treatment

Answer 1

Vagal Stimulation (Valsava, coughing, etc.)
Adenosine
Synchronized Cardioversion

Question 2

PVC Treatment

Answer 2

Beta-blockers
Amiodarone
Lidocaine

Question 3

PSVT Causes

Answer 3

Overexertion
Emotional Stress (EMO STRESS)
Stimulants (caffeine)

Question 4

A-fib/ A-flutter Goals

Answer 4

Control ventricular rate
Rhythm Control
Prevent embolic stroke

Question 5

A-fib/A-flutter Meds Rate Control

Answer 5

Metoprolol
diltiazem
Verapamil

Question 6

Tele (White)

Answer 6

Below clavicle; mid-clavicular

Question 7

Tele (Brown)

Answer 7

Right sternal border 4th ICS

Question 8

Tele (Green)

Answer 8

Lower chest
Just above the right umbilicus

Question 9

Tele (Black)

Answer 9

Below Clavicle
Mid-clavicular

Question 10

Tele (Red)

Answer 10

Lower
Just above left to the umbilicus

Question 11

Key features of tachydysrhythmias and bradydysrhythmias

Answer 11

Angina
restlessness
anxiety
confusion
dizziness
syncope
Palpitations
pulse deficit
SOA, tachypnea
Pulmonary crackles (LHF)
Orthopnea (LHF)
Orthostatic hypotension
S3 or S4 heart sounds (gallops)
JVD (RHF)
Weakness, fatigue
Pale, cool, in, diaphoresis
N/V
Decreased Urine Output
Delayed cap refill

Question 12

Causes Sinus Bradycardia

Answer 12

Excessive vagal stimulation (carotid sinus massage, vomiting/gagging, Valsalva maneuvers, eyeball pressure, giving parasympathomimetic drugs)
Digitoxin Toxicity
Hyperkalemia (slow depolarization)
MI

Question 13

Sinus Brady Treatment

Answer 13

Symptomatic
Atropine - 1mg q3-5 minutes, 3 mg MAX) increases HR
IF NOT that, a pacemaker

Question 14

Pacemaker Malfunctions

Answer 14

Failure to sense: Does not sense depolarization
Failure to capture: Stimulation does not result in myocardial activation
Failure to pace: Doesn’t stimulate as expected

Question 15

Pacemaker complications

Answer 15

Infection
Hematoma
Pneumothorax
Atrial/ventricular septum perforation
Lead misplacement

Question 16

Post Op. Care of pacemaker

Answer 16

OOB
Limit arm and shoulder activity
Observe insertion site for bleeding and infection
Pt. teaching

Question 17

Education r/t pacemakers

Answer 17

Follow-up appointments
Incision care
Arm Restrictions
Avoid direct blows, high output generator
No MRI but microwaves ok
Avoid antitheft devices
No traveling restrictions
Monitor pulse
Pacemaker and Medic Alert ID

Question 18

Sinus Tachycardia Causes

Answer 18

Physical Activity
Anxiety
Pain
Stress
Fever
Anemia
Hypoxia
Dehydration/hypovolemia, MI, HF

Question 19

Sinus Tachycardia TX

Answer 19

Fluid replacement
Analgesic
Anti-pyretic
Anxiolytic
Beta Adrenergic Blockers (decrease HR and myocardial O2 consumption

Question 20

PAC causes

Answer 20

Stimulants
Electrolyte Imbalances
Stress

Question 21

A-Fib

Answer 21

Multiple sources of signal firing (atrial kick isn’t effective)
Atrial > 400 bpm Ventricular =100-175
R-R interval = irregularly irregular

Question 22

A-Fib Causes

Answer 22

Underlying heart disease
Electrolyte Imbalance
Hypoxia
Cardiac Surgery

Question 23

A-fib complication

Answer 23

Stroke r/t emboli forming with blood sitting in the atrium

Question 24

A-Flutter

Answer 24

Recurring, Regular r/t single source of impulse
R to R Interval = regular or irregular
Atrial >250 Ventricular Rate = slow
4 f waves:1 QRS complex

Question 25

A-Flutter Causes

Answer 25

Electrolyte Imbalances Heart Condition

Question 26

A-Fib/ A-Flutter Tx

Answer 26

Ventricular rate control (B-blockers, CCB) Rhythm Control (amiodarone, dofetilide) Prevent Embolic Stroke (warfarin) UNSTABLE = synchronized cardioversion Maze Procedure/ Catheter Ablation

Question 27

Synchronized Cardioversion Nursing Care

Answer 27

Maintain patent airway Administer oxygen VS and LOC Monitor for dysrhythmias Emotional support Document results of cardioversion

Question 28

Premature Ventricular Contractions

Answer 28

Contraction occur in the ventricle Early before QRS complex Widen QRS "Ugly Lil Beats"

Question 29

PVC causes

Answer 29

Electrolytes Hypoxia Exercises Stimulants/Caffeine CVD Fever

Question 30

Bigeminy

Answer 30

PVCs every other beat

Question 31

Trigeminy

Answer 31

Every 3rd beat

Question 32

Quadgeminy

Answer 32

Every 4th Beat

Question 33

V-Tach

Answer 33

3 or more PVCs Rate = 150-200 Regular rate No p wave (there cannot measure PR interval) CAD, MI, CAD, significant electrolyte imbalances, heart failure, drug toxicity

Question 34

V-tach Tx

Answer 34

CHECK FOR A PULSE Puleless? Defrib (ACLS) Pulse? Cardiovert TX THE CAUSE Anti-Dysrhythmic Meds Beta blocker/ CCB/Amiodarone

Question 35

V-Fib

Answer 35

Irregular Waveforms "quivering" No effective contractions = NO CO

Question 36

V-Fib Tx

Answer 36

CPR and ACLS (Defibrillation)

Question 37

Defribillating Care

Answer 37

Emergency NO CO 200-360 Joules Unconscious ECG monitor

Question 38

First-Degree AV Heart Block

Answer 38

PROLONGED PR interval Asymptomatic Associated with increasing age, disease states, and certain drugs

Question 39

1st Degree AV Heart Block TX

Answer 39

Monitor changes in heart rhythm No specific tx

Question 40

Second-Degree AV Block Type 1 (Mobitz I, Wenkebach)

Answer 40

Long Long Wekenbach Ischemia Well tolerated

Question 41

2nd-Degree Type 1 Tx

Answer 41

Asymptomatic - Monitor Symptomatic - Atropine and pacemaker

Question 42

2nd-Degree, Type 2 (Mobitz II)

Answer 42

PR interval is = QRS Complex dropped sometimes Heart Disease and drug toxicity Decreased CO

Question 43

2nd-Degree, Type 2 Tx

Answer 43

Pacemaker (no ventricular response)

Question 44

3rd-Degree Heart Block (Complete Heart Block)

Answer 44

The atrium and Ventricles are firing but no communication) aka PURE CHAOS Severe heart disease, some drugs, systemic diseases Decreased CO, ischemia, HF, and Shock Lead to syncope

Question 45

3rd Degree TX

Answer 45

Pacemaker Drugs that increase HR while waiting for pacing (positive chronotropes)