Exam 1: dysrhythmias, SC injuries, pacemakers, chest tubes

Question 1

normal sinus rhythm

Answer 1

indicates that the electrical impulse sent from the SA node is being adequately transmitted following the normal conduction pathway

Question 2

criteria for NSR (rate, rhythm, p wave, PR interval, QRS complex)

Answer 2

• rate 60-100
• rhythm: regular
• p wave: one consistently shaped p wave before QRS
• pr interval: 0.12-0.2 seconds
• QRS complex: <0.12 seconds

Question 3

causes of sinus arrhythmia

Answer 3

respiratory patterns, digitalis, morphine

Question 4

s/s of sinus arrhythmia

Answer 4

HR increases during inspiration and decreases during exhalation

Question 5

cardiac output formula

Answer 5

heart rate x stroke volume

Question 6

sinus dysrhythmia

Answer 6

originates in the SA node + conducted through normal pathway

Question 7

bradycardia strip presentation

Answer 7

• rate: <60
• rhythm: regular
• p wave: normal
• pr interval: 0.12-0.2 seconds
• QRS: <0.12 (wdl)

Question 8

causes of bradycardia (NOT MEDS)

Answer 8

• MI
• vagal stimulation (suctioning, Valsalva maneuvers)
• neuro disorders
• hypothyroidism
• prolonged hypoxia

Question 9

meds that cause bradycardia

Answer 9

• acetylcholine
• amiodarone
• beta blockers
• calcium channel blockers
• digitalis
• lithium

Question 10

bradycardia: impact on client

Answer 10

• assess CO
• symptomatic: unable to complete ADLs w/o fatigue or SOBm may have syncopal episodes

Question 11

interventions for bradycardia

Answer 11

• implement fall risk
• d/c meds causing bradycardia
• administer atropine
• apply O2
• temporary pacing

Question 12

tachycardia strip presentation

Answer 12

• rate: >100
• rhythm: regular
• p wave: normal
• pr interval: 0.12-0.2 seconds
• QRS: <0.12 (wdl)

Question 13

causes of tachycardia

Answer 13

• physical activity
• anxiety
• fever
• pain
• stress
• anemia
• hypoxemia
• hyperthyroidism
• compensatory response to decreased cardiac output/BP (shock)
• dehydration
• infection
• heart failure
• illicit drugs
• caffeine
• nicotine

Question 14

atrial dysrhythmias

Answer 14

abnormal electrical activity that results in stimulation outside the SA node

Question 15

premature atrial contractions (PACs)

Answer 15

benign cardiac rhythm occurrence that causes the heart’s electrical conduction system to activate an early heartbeat/impulse from one of the two atrial chambers

Question 16

causes of PACs

Answer 16

• stress
• cardiac irritability
• anxiety
• fatigue
• inflammation
• infection
• alcohol
• tobacco
• caffeine

Question 17

s/s of PACs

Answer 17

• usually asymptomatic
• sometimes palpitations

Question 18

supraventricular tachycardia (SVT)

Answer 18

impulses originating from above the AV node that cause excessive excitability of the atrial tissue

Question 19

SVT appearance phrase

Answer 19

if you can’t tell if it’s a p or a t, you have to call it an SVT

Question 20

paroxysmal supraventricular tachycardia (PSVT)

Answer 20

tachycardia of sudden onset and termination

Question 21

causes of PSVT

Answer 21

• stress
• smoking
• alcohol
• caffeine
• HF/heart disease
• HTN
• DM
• renal disease
• pregnancy
• chronic lung disease
• Wolff-Parkinson-White Syndrome

Question 22

s/s of PSVT

Answer 22

• rapid ventricular response
• chest pain
• palpitations
• weakness
• fatigue
• SOB
• anxiety
• hypotension
• syncope

Question 23

1st degree block

Answer 23

• conduction between atrium and ventricles is slower
• pr interval: <0.20
  -no threat, no symptoms, no treatment

Question 24

2nd degree block type 1

Answer 24

• more Ps than QRS
• PR interval gets longer and longer, drops QRS, then restarts
• irregular rhythm
• caused by MI, drugs

Question 25

2nd degree block type 2

Answer 25

• more Ps than QRS, AV node refuses to allow impulses through
• PR intervals are equal
• rhythm is regular or irregular
• caused by severe MI, CAD, drug toxicity
• treat with pacemaker

Question 26

3rd degree block

Answer 26

• more Ps than QRS with a pattern
• PR intervals have no pattern to them
• rhythm is regular (usually brady)
• narrow to wide QRS complex
• complete heart block at the AV node, so ventricles take over
• treatment is immediate pacemaker
• caused by MIs, drug levels, electrolyte imbalances

Question 27

how long should a pr interval, qrs, and qt interval be?

Answer 27

PR: 0.12-0.20 (3-5 squares)
QRS: 0.08-0.12 (2-3 squares)
QT interval: equal to or less than 1/2 the R-R interval

Question 28

5 steps to interpreting an ECG strip

Answer 28

1. determine heart rate
2. determine rhythm
3. analyze p waves (present, equal, regular, one for each QRS?)
4. measure PR interval
5. measure QRS duration

Question 29

indications for ICDs

Answer 29

• pts who have survived ventricular fibrillation (sudden cardiac death)
• pts who have recurrent v-tach
• pts who have risk factors for SCD (big hearts, low EF, cardiomyopathy, long QT intervals)

Question 30

complicatios for ICDs

Answer 30

• infection during implantation
• delivery of inappropriate shocks

Question 31

pacemaker education

Answer 31

• assess pulse everyday and keep log
• report s/s of decreased CO
• keep sling on and limit arm/shoulder activity after procedure 1-2 weeks
• keep appt with HCP
• keep incision dry for several days after implantation
• avoid close proximity to high output electric generators
• no MRIs
• avoid standing near anti-theft devices in store doorways, no wand over pacemaker at airport
• carry pacemaker information/medic alert ID at all times
• keep cellphone 6/ away
• do not manipulate generator