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Nursing 231 - Exam 3 > Cardiac Dysrhythmias EXAM 3 > Flashcards

Cardiac Dysrhythmias EXAM 3 Flashcards

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1
Q

small body of specialized muscle fibers, located in the right atrium of the
heart, whose activity is responsible for initiating the heartbeat. Rate of automaticity?

A

SA node (sinoatrial) - 60 to 100 BPM

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2
Q

a part of the electrical conduction system of the heart that coordinates the top of the heart; it electrically connects the atria and ventricles. (Atrial contraction and filling of ventricles) Rate of automaticity?

A

AV node (atrioventricular) - 40 to 60 BPM

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3
Q

a specialized conduction system within the heart that ensures the proper activation of
the ventricles to produce effective contraction. Rate of automaticity?

A

Purkinjie Network - 20 to 40 BPM

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4
Q

What is the order of conduction through the heart?

A

SA ->intraatrial pathway ->AV -> Bundle of his-> left and right bundle branches -> purkinjie fibers

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5
Q

Represents the time for the electrical impulse to spread through the atria. What is the wave and the action?

A

*P wave
*Atrial depolarization/contraction

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6
Q

In a normal EKG, why cant you see a wave represented for atrial repolarization?

A

happens simultaneously with ventricular depolarization and is hidden in the QRS complex

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7
Q

Represents the time for the electrical impulse to spread through the ventricles.

A

QRS complex

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8
Q

The interval from the beginning of the QRS complex to the apex of the T wave is referred to as the?

A

Absolute refractory period

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9
Q

The last half of the T wave is referred to as the

A

relative refractory period

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10
Q

Ventricular repolarization is represented by?

A

T wave

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11
Q

Late ventricular repolarization (purkinjie fibers) rarely seen, but represented by? What could abnormal elevation of this wave signify?

A

*U wave
*K+ electrolyte imbalance

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12
Q

Represents the time from the onset of atrial depolarization to the onset of ventricular depolarization).

A

PR interval

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13
Q

How is the PR interval measured and what is the normal range?

A

*From the beginning of P wave to the beginning of the QRS complex
*Normally 0.12-0.20 seconds

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14
Q

How many seconds is a big box on an ECG strip?

A

0.20 seconds

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15
Q

How many seconds is a little box on an ECG strip?

A

0.04 seconds

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16
Q

How is the QRS duration measured and what is the normal range.

A

*Measured from the beginning of the QRS to the end of the S wave or J point (where the QRS ends and the ST segment begins).
*0.04-0.12 seconds

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17
Q

Represents the total time required for ventricular depolarization and repolarization. How is this measured and what is the normal range?

A

*QT interval
*From beginning of QRS complex to the end of the t wave
*Normal is .30 to .44 seconds

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18
Q

is any cardiac rhythm that is not normal sinus rhythm.
Can be due to abnormal impulse initiation, either at an abnormal rate or from a site other than the sinus node, or abnormal impulse conduction through any part of the heart.

A

dysrhythmia (arrhythmia)

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19
Q

Normal QTc is less than_____

A

0.44 seconds

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20
Q

what are the three parts you want to measure when analyzing an ekg?

A

PR interval, QRS duration, and QT interval

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21
Q

Rule of 300 to Calculate Heart Rate for Regular Rhythms

A

Heart Rate = 300 / divided by number of large boxes between two QRS complexes

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22
Q

Rule of 6 Seconds to Calculate Heart Rate for Irregular Rhythms

A

Heart Rate = Number of QRS Complexes in 6 Seconds Multiplied by 10

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23
Q

Drugs used for Ventricular Tachycardia & Ventricular Fibrillation?

A

Vasopressor - Epi
Antiarrhythmics- Amirodarone, Lidocaine, Mag sulf

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24
Q

Drugs used for Asystole & Pulseless Electrical Activity?

A

Vasopressor- Epi

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25
Drugs used for symptomatic bradycardia?
a. Atropine (GIVE FIRST) b. Dopamine (infusion) c. Epinephrine (infusion)
26
Drugs used for Symptomatic Tachycardia
a. Adenosine b. Beta-blockers c. Calcium Channel Blockers (Diltiazem) d. Amiodarone e. Procainamide f. Sotalol
27
\_\_\_\_\_\_\_is a ______ countershock delivered by a defibrillator at the \_\_wave of the QRS complex to prevent delivery during the relative refractory period (vulnerable period)
\*CARDIOVERSION \*Synchronized\* \*R
28
\_\_\_\_\_is an ______ countershock delivered by a defibrillator at ____ of the cardiac cycle
\*DEFIBRILLATION \*Asynchronous \*Any phase
29
Rhythm is analyzed and shock advised by the machine.
AED
30
External pulse generator that stimulates the cardiac cells to depolarize; pacing pads applied on thorax
Transcutatneous Pacing
31
the rhythm is generated by the sinus node and traveling in a normal fashion in the heart, but also that the heart rate, the rate at which the sinus node is generating impulses, is within normal limits
Normal sinus rhythm
32
What are some medications that can cause sinus bradycardia?
Digoxin, Ca+ channel blockers, or beta-adrenergic blockers
33
In sinus bradycardia you need to determine what?
Determine if patient is symptomatic or experiencing symptoms of syncope, chest pain, hypotension, SOB or diaphoresis
34
Treatments for sinus bradycardia? If hypotensive?
\*Atropine bolus \*Transcutatneous Pacemaker (maybe perm) \*If hypotensive, give dopamine or epi infusion
35
Signs and symptoms of Sinus brady/Tachy?
\*DASH FLS\* (add palpitations for tachy) \*Dizziness \*Anxiety \*SOB \*Hypotensive \*Fainting \*Lightheadedness \*Sweating
36
Treatments for sinus tachy?
\*Treat underlying cause \*Meds - Beta blockers, calcium channel blockers (slow hr)
37
Most commonly seen dysrhythmia, especially in aged population?
A-fib
38
Some signs and symptoms of A-Fib
1. Pulse irregularity 2. Fatigue 3. SOB 4. Decreased BP 5. Palpitations
39
Name the type of rhythm: \***Regular** \*Rate - **60-100** \*P wave - **upright** \*PRI - 0.12-0.20 sec \*QRS - 0.04-0.12 secs **1:1 P to QRS**
NORMAL SINUS RHYTHM
40
Name the type of rhythm: \*Regular \*Rate - **\<60** \*P wave - upright \*PRI - 0.12-0.20 sec \*QRS - 0.04-0.12 secs
SINUS BRADYCARDIA
41
Name the type of rhythm: \*Regular \*Rate - **100-160** \*P wave - upright \*PRI - 0.12-0.20 sec \*QRS - 0.04-0.12 secs
Sinus Tachycardia
42
Name the type of rhythm: \*Irregular/ **w/ sinus rhythm** \*Rate - 60-100 \*P wave - upright \*PRI - 0.12-0.20 sec \*QRS - 0.04-0.12 secs \***Early beat is seen with wide and bizarre QRS**, **Twave can inverted**
PVC/PVD
43
Name the type of rhythm: \***Irregular (R-R intervals)** \*Rate - A: **350-600** V: \<100=controlled/\>100=uncontrolled \*P wave - **None (multiple "F" waves)** \*PRI - **None** \*QRS - 0.04-0.12 secs
AFIB
44
Name the type of rhythm: \*Regularly irregular \*Rate - **A:250-400 V:70-150** \*P wave - **None/sawtooth pattern** \*PRI - **None** \*QRS - 0.04-0.12 secs
Atrial Flutter
45
Name the type of rhythm: \*Regular \*Rate - **160-250** \*P wave - upright \*PRI - 0.12-0.20 secs \*QRS - **0.04-0.12 secs** \*P wave/T wave can be meshed
SVT
46
Name the type of rhythm: \*Irregular \*Rate - Varies \*P wave - sometimes difficult to see \*PRI - May appear early \*QRS - Narrow \*compensatory pause
PAC
47
Name the type of rhythm: \*Regular \*Rate - **\>100** \*P wave - None \*PRI - None \*QRS - **\>0.12 WIDE AND BIZARRE** **(can be seen with or without pulse)**
V-Tach (MONO)
48
Name the type of rhythm: \*Irregular/Chaotic \*Rate -100-160 \*P wave - upright \*PRI - 0.12-0.20 secs \*QRS - morphology varies, but still generally wide complex
V-TACH (POLY) (Torsades)
49
Name the type of rhythm: \*Irregular/**Chaotic** \*Rate - \>None \*P wave - None \*PRI - None \*QRS -None, **No discernable waves**
V-Fib
50
What are the treatment options for AFIB/AFLUTTER?
\*RRS\* Rate control -BB,CCB, Cardioversion Rhtyhm control - Antiarrhythmic, Cardioversion, Ablation Stroke prevention - Anticoags
51
A condition in which the heart's upper chambers (atria) beat too quickly
A-flutter
52
Treatment for SVT?
1. Vagal maneuvers 2. O2 3. Adenosine IVP 4. Cardioversion/ablation
53
Pulseless electrical activity causes
\*PATCH MED\* Pulmonary embolus Acidosis Tension pneumothorax Cardiac tamponade Hypokalemia/ Hyperkalemia/ Hypoxia/ Hypothermia/ Hypovolemia Myocardial infarction Electrolyte derangements Drugs
54
Causes of AFIB?
\*Pirates\* Pulmonary: PE, COPD Iatrogenic Rheumatic heart: mirtral regurgitation Atherosclerotic: MI, CAD Thyroid: hyperthyroid Endocarditis Sick sinus syndrome
55
Treatment for VT with a pulse?
\*ACE\* Antiarrythmic- Amiodarone, lidocaine, mag sulf Cardioversion Electrolyte replacement - (K, mag)
56
Which two electrolyte imblanaces can cause V-tach
hypokalemia and hypomagnesmia
57
Treatment for VT without a pulse?
\*First line CPR and defibrillation \*Epinephrine and antiarrhythmics (amiodarone, lidocaine, mag sulfate) \*This follows the same treatment guidelines as ventricular fibrillation\*
58
A life-threatening heart rhythm that results in a rapid, inadequate heartbeat
V-FIb
59
Signs and symptoms of V-Fib
Loss of consciousness No pulse No respirations NoBP Absent heart sounds
60
when should medication be considered during pulseless V-fib
after patient is defibrillated and while CPR is being given
61
First line of meds for pulseless V-fib?
\*Epi 1mg q 3 to 5 minutes IVP, or Vassopressin 40 units IVP once
62
2nd Line of meds for pulseless V-Fib
Choice of an antiarrhythmic such as amiodarone (cordarone, Pacerone) 300 mg IVP followed by second dose of 150 mg IVP
63
List treatments in order for pulseless V-fib
1. Basic CPR/ACLS 2. Defibrillation 3. Epinephrine IVP 4. Consider antiarrhythmics, such as Amiodarone or Lidocaine IVP 5. Chest compressions 6. Defibrillation
64
Potentially Reversible Causes of Cardiac Arrest: H’s
Hydrogen Ion (acidosis) Hyper-/Hypokalemia Hypothermia Hypovolemia Hypoxia i. For refractory VF/Pulseless VT, consider acute coronary ischemia or myocardial infarction
65
Potentially Reversible Causes of Cardiac Arrest: Ts
Tamponade (cardiac) Tension Pneumothorax Thrombosis (coronary and pulmonary) Toxins (drug overdose)
66
Treatment for Asystole?
Basic CPR/ACLS (Compressions should be started immediately) Epinephrine IVP Patient should be assessed with a second monitor lead, pausing compressions only briefly to rule out a fine VF, and if VF is confirmed, then patient should be defibrillated
67
After the __________ there is a compensatory pause
PAC
68
PVCs can precipitate what?
V-TACH
69
In PVC there is no _____ preceding the PVC and the \_\_\_\_\_is wide
\*Pwave \*QRS
70
Treatment for PVC?
Correct the cause/Antiarrhythmic drugs if symptomatic or rhythm is dangerous
71
Chest compressions should be at a depth and rate of what?
\*Depth of 2 to 2.5 inches \*Rate of 100-120 per minute
72
refers to cardiac arrest in which the electrocardiogram shows a heart rhythm that should produce a pulse but does not. What does this exclude?
Pulseless electrical activity (PEA) excludes other cardiac arrest rhythms - V-Fib, V-Tach and Asystole
73
Treatments for PEA?
Most important is to search for, identify, and reverse any treatable cause, including H's and T's - Basic CPR/ACLS - Epinephrine IVP
74
What rhythym might be temporarily seen directly after admnistering Adenosine?
Asystole
75
With SVT what is the first thing you would ask the patient to do?
perform the Valsalva maneuver by bearing down.
76
Name this? Rate = Variable Rhythm = Regular P Wave = Precedes QRS complex PR interval = Longer than 0.20 seconds and constant QRS complex = WNL, 0.08 – 0.12 sec
1st degree AV block
77
Characteristic sign = PR interval with each complex becomes progressively longer until there is a dropped QRS complex Atrial rate is regular; ventricular rate is irregular What is this called?
Mobitz type 1 (2nd degree)
78
If symptomatic, how can mobitz type 1 be treated
Atropine IVP
79
P waves are not consistently followed by a QRS complex QRS complexes are wide The ventricular rate is irregular since impulses are blocked randomly or may be blocked in a pattern What is this called?
Mobitz type 11
80
In mobitz ll, if symptomatic treatment may be \_\_\_\_\_\_\_\_\_...if Hypotensive _____ or \_\_\_\_may be given
Transcutaneous Pacemaker Dopamine or Epi infusion
81
A medical emergency that can result in cardiac arrest and death in which none of the electrical signals from the AV node reach the ventricles
3rd degree AV block (complete heart block)
82
treatment for 3rd degree AV block?
Withdrawal of aggravating drugs IV fluids; transcutaneous pacemaker Dopamine or Epinephrine infusion if hypotensive Permanent pacemaker

Nursing 231 - Exam 3 (5 decks)

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