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Flashcards in Chapter 5 Deck (65):
1

What is evaluated and classified when determining dysrhythmias?

The ECG waveform has various components—such as waves, segments, and intervals—that are evaluated and classified based on their size, length of time, and location on the tracing.

2

Normal Heart rate:

15-25 lil boxes P-P or R-R intervals

3

Name the five components that must be evaluated on a rhythm strip.

Rhythm (regularity): taking measure of P to P or R to R or S to S intervlas for at least 6 consecutive seconds
Rate
P wave configuration
PR interval
QRS duration and configuration

4

A regular rhythm has 19 small boxes between the P-P interval. What is the heart rate?

79

5

After you measure the QRS duration and configuration, what other questions need to be answered?

Are all the QRS complexes of equal length?
What is the actual measurement, and is it within the normal limits?
Do all QRS complexes look alike, and are the unusual QRS complexes associated with an ectopic beat?

6

The most common monitoring lead

Lead II

7

P wave represents

atrial depolarization (contraction)

8

QRS complex represents

ventricular depolarization

9

The rhythm of atrial contraction is evaluated by assessing

the regularity or irregularity of the occurrence of the P waves

10

The QRS complexes are assessed to evaluate

ventricular contraction

11

Atrial is determined by the

P-P wave interval measurement.

12

The ventricular rate is determined by the

R-R wave interval measurement

13

If the atrial and ventricular rates are different, there is a problem with the

myocardium

14

Determining the atrial rate of a regular rhythm tracing

Count the number of small boxes between the P-P intervals, divide into 1500

15

Determining the ventricular rat of a regular rhythm tracing

Count the number of small boxes between the QRS complexes, divide into 1500

16

Determining heart rate in an irregular rhythm tracing

6-second rule: Identify 6 seconds on strip (2 vertical lines at the bottom or top of strip), count the number of complete complexes seen in one 6 second interval, multiply the number of complexes by 10.

17

How to identify the P wave configuration (shape)

Are the shapes and waveforms all the same?
Does each P wave have a QRS complex following it?

18

What does the PR interval measure?

The time it takes the electrical current to be initiated at the sinoatrial node and travel through the electrical current pathway to cause a ventricular contraction

19

How to measure the PR interval

Measure form the beginning of the P wave to the beginning of the QRS complex

20

Normal range of the PR interval

0.12 to 0.20 seconds

21

What does the QRS complex determine

Duration of time it takes for the ventricles to depolarize or contract

22

Normal QRS complex duration

0.06 to 0.10 seconds

23

Hoe to measure the QRS complex duration

Measure between the beginning of the QRS complex and the J point

24

What does the J point indicate

The ventricular depolarization (contraction) completion and beginning of re-polarization

25

Primary pacemaker of the heart

SA (sinoatrial) node

26

Normal conduction pathway

SA node, AV node, bundle of His, bundle branches of the ventricles (contraction!!!)

27

Why is called sinus rhythm?

Because the rhythm starts at the SA node

28

NSR Rhythm

The intervals between the two P and two R waves will occur in a consistent pattern

29

NSR Rate:

Both the atrial and ventricular rate twill be between 60 and 100 bpm

30

NSR P wave configuration

The P waves will have the same shape and are usually upright in deflection on the rhythm strip. A P wave will appear in front of every QRS complex

31

NSR PR interval

The PR interval measurement will be between 0.12 and 0.20 seconds, which is within normal limits. Each PR interval will be the same, without any variation

32

NSR QRS duration and configuration

The QRS duration and configuration measurement will be between 0.06 and 0.10 seconds, which is within normal limits, Each QRS duration and configuration will be without any variations from PQRST complex to complex

33

Cardiac output

Observation guidelines used to assess the blood supply to the vital organs of the body to maintain normal function

34

Sx's of neurological low cardiac output

Change in mental status, light headedness, dizziness, confusion, loss of consciousness

35

Sx's of cardia low cardiac output

Chest pain, palpitation, chest discomfort, enlarged cardiac size, congestive heart failure

36

Sx's of respiratory low cardiac output

difficulty breathing. SOB, frothy sputum, fluid present in lungs, lung congestion

37

Sx's of urinary low cardiac output

Decreased urinary output of less than 30ml in one hours

38

Sx's of peripheral low cardiac output

Hypotension, pale skin, skin cool and clammy to the touch

39

What to include in the ECG tracing

pt's name, date, time, performer's initials

40

Where does sinus bradycardia originate from

SA node

41

S.Brady criteria for classification

The heart rate is less than 60 bpm, and all other measurement are WNL

42

Sx's and signs of S.Brady

The pt may or may not experience signs ans sx's of low cardiac output.

43

Tx of S.Brady

May require drug administration or application of a pacemaker

44

S.Tachy criteria for classification

The heart rate is greater than 100 bpm, and all other measurement are WNL

45

Cardiac output in S.Tachy

Low

46

Sx's of S.Tachy

palpitations and other sx's of low cardiac output

47

Sinus Dysrhythmia

Condition in which the heart rate remains within normal limits but is influenced by the respiratory cycle and variations of vagal tone causing the rhythm to be irregular

48

Vagal tone

Condition in which impulses over the vagus nerve cause a decrease in heart rate

49

S.Dys criteria for classification

The P-P and R-R intervals will progressively widen then narrow, following the pt's breathing pattern and all other measurements are WNL

50

Sx's and signs of S.Dis

No clinical signs and sx's unless hr is less between 40-50 which will produce palpitation or dizziness

51

Sinus Arrest

Sometimes referred to as sinus pause, occurs when the A node stops firing, causing a pause in electrical activity. During the pause no electrical impulse is initiated or sent to the normal conduction system to cause either an atrial or a ventricular contraction

52

When is sinus alert considered a medical emergency?

When it reaches or exceeds 6 seconds. Code Blue procedures are initiated

53

Sinus arrest criteria for classification

Regularly occurring PQRSTs both before and after the arrest period. No electrical activity occurs during the arrest period

54

Signs and sx's of sinus arrest

Depend on the length of the pause, decreased cardiac output if pause if 2 seconds long, periods of ischemia, hypotension, dizziness, and syncope

55

Asystole

Caused by sinus arrest that lasts longer than 6 seconds. No electrical current is traveling through the cardiac conduction system

56

Explain the process of evaluating ECG tracings and determining the presence of dysrhythmias

Evaluating an ECG requires basic knowledge of waves, segments, and intervals of the tracing and the rate, rhythm, and regularity of the heartbeat

57

Describe the criteria used for classification of the dysrhythmias, including rhythm, rate, P wave configuration, PR interval measurement, and QRS duration measurement.

The process of evaluating an ECG tracing includes determining the ECG rhythm or regularity, determining the atrial and ventricular rate, identifying the P wave configuration, measuring the PR interval, measuring the QRS duration, and analyzing the configuration

58

What rhythm shows an irregularity during inspiration and expiration?

S.Dys

59

Tje normal PR interval is

0.12 and 0.20 seconds

60

If a QRS complex measures 0.12 seconds or wider, it most likely indicates

Delayed ventricular conduction

61

Sinus tachycardia may e a nl finding in persons as a result of

physical activity

62

When sinus arrest continues for 6 sec or more it is considered

A medical emergency (code bleue)

63

The rhythm originating in the sinoatrial node that is considered nl is

60-100

64

Two rhythms originating in the sinoatrial nodes that only affect the heart rate are

S. Brady and Tachy

65

The rhythm originating in the node that affects the breathing pattern is

S. Dys