Dysrhytmias Flashcards
(72 cards)
1
Q
What are dysrhythmias?
A
Irregularities in heart rate (HR) and heart rhythm.
2
Q
What is indicated by chest pain?
A
An echocardiogram is needed.
3
Q
What is a normal heart rhythm range?
A
60-100 bpm is a regular rhythm.
4
Q
What do EKGs reflect?
A
They reflect ischemia, infarction, and electrical disturbance.
5
Q
What is the normal P wave duration?
A
P wave duration is <0.11.
6
Q
What is the normal PR interval?
A
PR Interval is 0.12-0.20 (3-5 little boxes).
7
Q
What is the normal QRS complex duration?
A
QRS complex is <0.12.
8
Q
What does ST elevation indicate?
A
It indicates an acute myocardial infarction (MI) happening right now.
9
Q
What does ST depression indicate?
A
It indicates that the patient had a myocardial infarction (MI).
10
Q
What should be done if a patient is having a heart attack?
A
Get a cardiac catheterization (cath) or CABG.
11
Q
What does an elevated T wave indicate?
A
It indicates ventricular muscle repolarization and hyperkalemia.
12
Q
What can happen if hyperkalemia is left untreated?
A
The heart can flatline.
13
Q
Why is potassium important for dialysis patients?
A
Watch out for potassium levels if they missed dialysis.
14
Q
What should be checked with a peaked T wave?
A
Check potassium and BUN/Creatinine levels.
15
Q
What is the 1500 method used for?
A
Measuring sinus rhythms.
16
Q
What is a normal sinus rhythm?
A
It can see PQRST and is 60-100 bpm.
17
Q
What defines sinus bradycardia?
A
Less than 60 bpm.
18
Q
What are some causes of sinus bradycardia?
A
Sleep, athletes, thyroid issues, vagal stimulation, medications, TBI, hypoxemia, MI, CAD.
19
Q
What is the first treatment for symptomatic bradycardia?
A
Atropine increases HR; administer IV push.
20
Q
What should be done for asymptomatic bradycardia?
A
Continue to monitor.
21
Q
What is the second treatment for bradycardia?
A
Catecholamines (epinephrine IV).
22
Q
What is the third treatment for bradycardia?
A
A temporary pacemaker may be needed (emergency transcutaneous pacing).
23
Q
What is sinus tachycardia?
A
It is a heart rate of 100-120 bpm with a normal sinus rhythm.
24
Q
What are some treatments for sinus tachycardia?
A
Abolish cause, synchronized cardioversion, adenosine, increase fluids (POTS), carotid massage, bear down, try other drugs like Amiodarone.
25
What characterizes atrial flutter?
250-400 bpm with a ventricular rate of 75-150; P wave has a saw tooth appearance.
26
What are some causes of atrial flutter?
COPD, pulmonary HTN, bowel diseases; unstable cases require cardioversion.
27
What is the normal level for digoxin?
0.5-2; symptoms include halos, nausea/vomiting.
28
When should digoxin be held?
If potassium level is low.
29
What is atrial fibrillation?
It can occur postoperatively after CABG, during holiday heart, or due to subarachnoid hemorrhage.
30
What are the manifestations of atrial fibrillation?
Hemodynamic collapse.
31
What are some diagnostic methods for atrial fibrillation?
12-lead EKG, echocardiogram, stress test, CXR, Holter monitoring, thyroid labs.
32
What is the treatment goal for atrial fibrillation?
HR control with heparin and coumadin.
33
What is a PAC?
It interrupts the normal sinus rhythm; the PQRST comes earlier than it should, creating an irregular 'skipped beat'.
34
What are some causes of PACs?
Caffeine, nicotine, alcohol, anxiety, hypokalemia.
35
What should be done for infrequent PACs?
Treat the underlying cause; if infrequent, no treatment is needed.
36
What does more than 6 PACs indicate?
It may indicate another issue, and treatment may be necessary.
37
What is AV Nodal Re-Entry Tachycardia (SVT)?
Atrial rate 150-250/Ventricular rate 120–200. Causes include caffeine, nicotine, hypoxemia, stress, CAD, and cardiomyopathy.
## Footnote
Treatment options include CCB, adenosine, and breath holding.
38
What characterizes a PVC?
QRS is 0.12 or longer, abnormal, bizarre. Causes include cardiac ischemia/infarction, digitalis toxicity, imbalances, nicotine, caffeine, and alcohol.
## Footnote
Types include bigeminy, trigeminy, quadrigeminy, and couplets.
39
What is the management for frequent PVCs?
Just monitor unless frequent; may give amiodarone. Can give amiodarone, lidocaine, sotalol, give drip after bolus otherwise you can go back into the rhythm you just broke.
40
What defines Ventricular Tachycardia?
Three or more PVCs in a row with a rate exceeding 100 bpm. Low ejection fraction, QRS >0.12, abnormal, P wave difficult to detect, PR interval irregular.
41
What is the management for a stable patient with Ventricular Tachycardia?
Continue assessment, 12 lead EKG, procainamide, amiodarone, and supportive care.
42
What is the management for an unstable patient with a pulse in Ventricular Tachycardia?
Cardioversion.
43
What is the management for an unstable patient without a pulse in Ventricular Tachycardia?
Defibrillation, precordial thump, CPR FIRST, ICD for low ejection fraction less than 35, IV mag for torsades de point, amiodarone IV.
44
What is Ventricular Fibrillation?
A fatal dysrhythmia associated with CAD and AMI, untreated V tach, and cardiomyopathy.
45
What is the management for Ventricular Fibrillation?
CPR until defibrillator arrives, 5 cycles of CPR, epinephrine every 3-5 minutes, one dose of vasopressin, intubation, airway management, amiodarone/lidocaine drip.
## Footnote
Hypothermia protocol in comatose adults should be initiated as soon as circulation is restored and maintained for 12-24 hours.
46
What is Ventricular Asystole?
Flatline with absent QRS; cannot shock due to no electrical conduction. Management includes epinephrine and vasopressin to get something going.
## Footnote
Ensure IV is flushable and patent.
47
What are Conduction Abnormalities?
They occur when conduction through the AV nodal or His Bundle is decreased or stopped. Causes include medications, MI, cardiomyopathy, and increased vagal tone.
48
What is a First Degree AV Block?
Occurs when all atrial impulses are conducted through the AV node into the ventricles. Rate is slower than normal with a PR interval >0.20 that is constant.
49
What is a Second Degree AV Block Type 1?
Repeating pattern where all but one of a series of atrial impulses are conducted through the AV node. Each atrial impulse takes longer for conduction than the one before, leading to one blocked impulse.
## Footnote
The PR interval gets longer until no QRS is present.
50
What is a Second Degree AV Block Type 2?
Only some atrial impulses are conducted through the AV node into the ventricle. The P wave is constant and in front of the QRS, but the QRS is abnormal.
## Footnote
This type is worse because you don't know when it will drop.
51
What is Third Degree AV Block?
No atrial impulse is conducted through the AV node into the ventricle. Two impulses stimulate the heart: one stimulates the P wave (atrial), and one stimulates the ventricle (QRS). This is known as 'AV dissociation' and is considered a full heart block.
52
What are the characteristics of Third Degree AV Block?
The PR interval is very irregular, and it is the worst type to have due to the full block and slow rhythm.
53
How is Third Degree AV Block managed?
Management is based on the cause and degree of stability, directed towards increasing heart rate to maintain normal cardiac output.
54
What is the treatment for stable Third Degree AV Block?
No treatment is required; just look for the cause.
55
What is the treatment for unstable Third Degree AV Block?
Permanent pacemaker or translucent pacemaker. Atropine is not effective in second degree type 2 or third degree blocks. CPR may be required.
56
What is the key principle in treating patients with Third Degree AV Block?
Always treat the patient based on clinical presentation regardless of the rhythm being observed on the ECG monitor.
57
What are common nursing diagnoses for patients with Third Degree AV Block?
Decreased cardiac output, anxiety, and deficient knowledge.
58
What nursing interventions are important for Third Degree AV Block?
Evaluate vitals, respiratory rate, auscultate breath sounds, assess for syncope and dizziness, perform a 12-lead EKG, and minimize anxiety and stressors.
59
What are potential complications of Third Degree AV Block?
Cardiac arrest, heart failure, and thromboembolic events, especially with atrial fibrillation.
60
What is the difference between cardioversion and defibrillation?
Both give electrical current to depolarize a critical mass of myocardial cells, but cardioversion is timed with the ECG, while defibrillation is not.
61
What is cardioversion?
Delivery of timed electrical current synchronized with the ECG to discharge during ventricular depolarization. Sedation is required if elective.
62
What is defibrillation?
Treatment of choice for V-fib and pulseless V-tach. Not used for conscious patients or those with a pulse.
63
What medications may be used in conjunction with defibrillation?
Epinephrine, vasopressin, amiodarone, lidocaine, and magnesium.
64
What is a pacemaker?
An electronic device that provides electrical stimuli to the heart muscle, which can be permanent or temporary.
65
What are indications for a pacemaker?
Slower than normal pulse, symptomatic AV or ventricular conduction disturbance, control of tachydysrhythmia, heart failure, second degree heart block type 2, and symptomatic bradycardia.
66
What are complications of pacemakers?
**Infection,** pneumothorax/hemothorax, bleeding or hematoma formation, dislocation of the lead, skeletal muscle or phrenic nerve stimulation, cardiac tamponade, pacemaker malfunction, and ventricular ectopy/tachycardia.
67
What is an Implantable Cardioverter Defibrillator (ICD)?
A device that detects and terminates life-threatening episodes of tachycardia or fibrillation.
68
Who are at risk populations for ICDs?
Survivors of sudden cardiac death syndrome, those with EF less than 35%, dilated cardiomyopathy, and symptomatic refractory atrial fibrillation.
69
What nursing interventions are required for ICD patients?
Assess device function, ECG, cardiac output, hemodynamic stability, incision site, coping, and patient and family knowledge.
70
What nursing diagnoses are relevant for ICD patients?
Risk for infection, risk for ineffective coping, and knowledge deficit.
71
What should be included in the plan of care for ICD patients?
Absence of infection, adherence to self-care, effective coping, and maintenance of device function.
72
What should be checked in the chart for patients with ICD or pacemaker?
Check if the patient has an ICD or pacemaker, or if this information was passed off during report.
