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Advanced MedSurg > Ch 35 Dysrhythmias (Exam 2) > Flashcards

Ch 35 Dysrhythmias (Exam 2) Flashcards

1
Q

BPM of normal sinus rhythm

A

60-100 bpm

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2
Q

Sinus bradycardia (4)

A
  • <60 bpm
  • normal in athletes
  • significant if symptomatic (decreased CO)
  • does not always adversely affect CO
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3
Q

Sinus tachycardia (4)

A
  • > 100 bpm
  • normal when associated with exercise
  • abnormal when associated with fever, pain, low BP, MI, HF, anxiety, fear, drugs
  • treatment depends on the cause
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4
Q

S/S of decreased CO (7)

A
  • sweating
  • clubbing of fingers/toes
  • palpitations
  • SOB
  • decreased peripheral pulses
  • altered mental status
  • LATE: cyanosis
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5
Q

Medication treatment for sinus bradycardia?

A

administer atropine (anticholinergic)

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6
Q

What is the best way to determine if the cardiac rhythm is regular?

A

By determining if the R-R interval is normal

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7
Q

2 types of cardioelectric therapy?

A

defibrillation and synchronized cardioversion

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8
Q

Defibrillation is indicated for which lethal arrhythmias? (2)

A
  • ventricular fibrillation

- ventricular tachycardia

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9
Q

Defibrillation works by?

A

sending an electrical shock through the heart to depolarize the cells of the myocardium

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10
Q

Defibrillation is placed where on the chest?

A

Apex and sternum (ribs are expected to get fractured)

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11
Q

In defib, the synch button should be ____

A

OFF

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12
Q

For safety during defibrillation, yell ____ and ____

A
  1. clear to make sure no one touches patient

2. make sure oxygen is off (could spark a fire)

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13
Q

Synchronized cardioversion is indicated for?

A

ventricular or SVTs (VT with a pulse)

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14
Q

Cardioversion works by?

A

delivering a shock that occurs on the R wave of the QRS complex

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15
Q

What is required to administer to the patient during cardioversion?

A

Sedation (usually painful for patients)

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16
Q

In cardioversion, the synch button should be turned ____

A

ON

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17
Q

If the patient becomes pulseless during synchronized cardioversion…

A

Turn the synch button OFF and defibrillate

18
Q

Name the 8 steps of defibrillation

A
  1. continue CPR until defibrillator is charged
  2. turn on and select proper energy level (joules)
  3. make sure synch button is OFF
  4. apply gel pads
  5. charge defibrillator
  6. position paddles firmly on the chest wall
  7. ensure “all clear!”
  8. deliver charge
19
Q

A patient in VFib was shocked and a normal sinus rhythm was established. What should the nurse do next?

A

Check the pulse

20
Q

Atrial fibrillation (4)

A
  • regularly irregular
  • occurs in coronary artery disease (CAD), rheumatic heart disease, cardiomyopathy
  • results in decreased CO and an increased risk for stroke d/t clot formation
  • requires anticoagulant therapy
21
Q

Atrial flutter (4)

A
  • high ventricular rates (over 100 per min) and a LOSS of the atrial “kick” leads to decreased CO and blood stagnation
  • manifests as chest pain and possible HF
  • increased risk for stroke
  • treatment: radiofrequency catheter ablation, beta-blockers, calcium channel blockers, anticoagulants
22
Q

Supraventricular tachycardia (3)

A
  • HR > 150
  • related to the alteration in the conduction of the heart
  • treated with vagal maneuvers, adenosine, beta blockers
23
Q

Premature ventricular contractions (“throwing PVCs) (3)

A
  • extended P wave
  • cause: stimulants (coffee, epi, digoxin), low potassium, hypoxia
  • treatment: amiodarone, lidocaine, procainamide (to decrease electrical activity)
24
Q

Ventricular tachycardia - lethal ! (3)

A
  • no P wave, wide QRS
  • decreased CO
  • associated with MI, CAD, electrolyte imbalance, cardiomyopathy, CNS disorders
25
Q

Treatment for ventricular tachycardia if patient has PULSE + stable

A

drug therapy (amiodarone, lidocaine, magnesium)

26
Q

Treatment for ventricular tachycardia if patient has PULSE + unstable

A

synchronized cardioversion

27
Q

Treatment for ventricular tachycardia if patient is PULSELESS

A

rapid defibrillation have crash cart ready

28
Q

Interventions from first to last in the event of ventricular tachycardia

A

1) assess: check leads, pulse, s/s of CO
2) administer oxygen and call MD
3) prepare crash cart + call rapid response (can progress to pulseless vtach or vfib)

29
Q

Ventricular fibrillation or “code blue” (4)

A
  • heart loses ability to generate impulse that sustains HR or CO
  • results in unresponsive, pulseless, and apneic state
  • if not treated rapidly, patient will die
  • treatment: immediate initiation of CPR and advanced cardiac life support (ACLS) with defibrillation and drug therapy
30
Q

What is the purpose of defibrillation?

A

To shock the patient to stop and recalibrate electrical impulses at the SA node

31
Q

Normal sinus rhythm starts where?

A

Sinoatrial node (SA node)

32
Q

P wave

A

Depolarization of the atria (atrial contraction)

33
Q

PR interval

A

time period for the impulse to spread through the atria, AV node, bundle of HIS, and Purkinje fibers

34
Q

QRS complex

A

depolarization of the ventricles (ventricular contraction)

35
Q

QRS interval

A

time it takes for ventricular depolarization

36
Q

ST segment

A

time BETWEEN ventricular depolarization and repolarization (should be flat or isoelectric)

37
Q

T wave

A

repolarization of the ventricles

38
Q

QT interval

A

duration of depolarization and repolarization of the ventricles

39
Q

What is a good method to determine heart rate for a quick estimate but is less accurate?

A

“6 second strip” count the number of QRS complexes in 6 seconds then multiply by 10

40
Q

What is a FAST method to determine heart rate but can only be used with regular rhythms

A

Large box method: count the number of large boxes between 2 consecutive QRS complexes and divide into 300

41
Q

What is the most accurate but time consuming method to determine heart rate on an ECG?

A

Small box method: count the number of small boxes between two consecutive QRS complexes and divide into 1500

Advanced MedSurg (11 decks)

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