[Exam 2/Final] Chapter 26 - Management of Patients with Dysrhythmias and Conduction Problems Flashcards
(143 cards)
1
Q
Conduction of Electricity: What is the SA NOde?
A
Primary pacemaker of heart.
2
Q
Conduction of Electricity: Rate of SA Node?
A
60 - 100 when firing properly
3
Q
Conduction of Electricity: What comes aftter SA node?
A
AV Node, sits next to tricuspid valve.
4
Q
Conduction of Electricity: What is the AV Node?
A
Secondary pacemaker of the heart.
5
Q
Conduction of Electricity: Rate of AV Node?
A
40-60 bpm.
6
Q
Conduction of Electricity: What happens if SA Node goes wrong?
A
You have a backup, the AV Node. Will be in 40-60 range.
7
Q
Conduction of Electricity: What comes after AV Node?
A
Bundle of His, which leads to purkinje fibers.
8
Q
Conduction of Electricity: What could be going on with Purkinje fiber?
A
Heart lost natural rhythm. Will see rates in 30s-40s. Can also lead to Heart Blcok
9
Q
Conduction of Electricity: What is Heart Block?
A
Something failed with nautral pacemakers with SA and AV Node. Relying of Purkinje Fibers to pump ventricles. Dangerous.
10
Q
Conduction of Electricity: What’s an arrhythmia?
A
When you start to have stagnant blood flow, and heart is not following the normal blood flow and conduction.
11
Q
Conduction of Electricity: What problem does stagnant blood lead to?
A
Clots
12
Q
Conduction of Electricity: If heart not beating properly, what problems are caused?
A
Increased workload which leads to hypertrophy. Also leads to decrease in CO
13
Q
Youtube ECG: What is the P Wave?
A
Atrial squeeze (contraction). Depolarizing and decompressing, sending out a charge.
14
Q
Youtube ECG: What is the QRS Wave?
A
Ventricles are squeezing, contracting and depolarizing and decompressing sending out charnge.
15
Q
Youtube ECG: What is the T Wave?
A
Ventricles relax and repolarize. RE-filling with blood
16
Q
Dysrhythmias: What are these?
A
Disorders of the formation or conduction (or both) of the electrical impulses in the heart
17
Q
Dysrhythmias: These disorders can cause disturbance of what
A
Rate , Rhythm, and Both
18
Q
Dysrhythmias: This can potentially alter what?
A
BLood flow and cause hemodynamic changes
19
Q
Dysrhythmias: What is the P Wave?
A
Atrial DEpolarizastion
20
Q
Dysrhythmias: What is the PR Segment?
A
Delay at AV node.
21
Q
Dysrhythmias: What is the QRS complex?
A
Ventricular Depolarization
22
Q
Dysrhythmias: What is the T wave?
A
Ventricular Repolarization
23
Q
Dysrhythmias: What are isoelectric lines?
A
There is no electric activity
24
Q
Dysrhythmias: When does Repolarization occur for Atria?
A
It is the little dip between the P and Q waves
25
ECG Graph: Each small box is worth how long
0.04 seconds
26
ECG Graph: Every bigger box is how long?
0.2 seconds (5 boxes)
27
ECG Graph: PR interval should be how long
< 0.20 seconds
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ECG Graph: What can a long PR interval lead to
Heart blocks
29
ECG Graph: QRS should be how long?
Less than <0.12 seconds.
30
ECG Graph: QT segment should be how long?
Less than 0.4 seconds
31
ECG Graph: What is the PR Segment?
Conduction of the SA node down to the AV node. Want it 0.12 - 0.20.
32
Cardio Electrophysiology: What happens at P Wave?
Produced as impulse from SA Node and causes atrial contraction. Think Atria are contracting
33
Cardio Electrophysiology: What happens during QRS Complex?
Conduction of impulse through bundle of HIS to Purkinje fibers causing contraction of ventricles. Thats when ventricles contact
34
Cardio Electrophysiology: What is the T Wave?
Ventricaular repolarization. Ventricles are resetting and relaxing in diastole.
35
Cardio Electrophysiology: What is the ST segmenet?
The hearts resting period
36
Cardio Electrophysiology: What is the P-R interval?
Time between atrial depolarization adn the start of ventricular conduction (depolarization)
37
Cardio Electrophysiology: How do you calculate heart rate?
Count number of R waves in 6 seconds, and multiple that by 10
38
Normal Sinus Rhythm: What is the first thing we should do when analyzing strip?
Look and see if there is a P wave
39
Normal Sinus Rhythm: What is the second thing you should look for when analyzing strip?
Do you have one P wave for every QRS?
40
Normal Sinus Rhythm: How much chart look for this to be normal sinus rhythm?
One P wave for every QRS and HR within 60-100.
41
Normal Sinus Rhythm: Once we determine whether theres a P and Q wave, what should we do next?
Count our QRS in a 6 second strip to determine HR.
42
Sinus Bradycardia: Why is this Brady?
The impulses from the SA node are a little slower rate than normal.
43
Sinus Bradycardia: This can be caused by what?
Runners have lower HR. Vagal nerve stimulation when sleeping
Beta Blockers
44
Sinus Bradycardia: Why is this Sinus?
Because you have one P wave for every QRS
45
Sinus Bradycardia: What makes this unique?
You are sinus, but have a HR below 60.
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Sinus Bradycardia: What problems may this person experience?
Dizziness, having a decrease a blood pressure
47
Sinus Bradycardia: What interventions may be done?
Atropine IV Push to stimulate HR to increase it.
Pacemaker to increase HR.
Maybe hold back on Beta-Blocker to let HR return.
48
Sinus Tachycardia: What is this?
When SA Node causes the HR to be above 100 or more than 120
49
Sinus Tachycardia: How will this look on EKG strip?
Will be normal rhythm with P in front of every QRS, but will have HR above 100
50
Sinus Tachycardia: What can cause this?
Exercise, Anxiety
Hyper/Hypovolemic.
Caffeine, Nicotine, Stimulants
Shock Patients, Fever
51
Sinus Tachycardia: How is this treated?
Find underlying cause and eliminate it.
52
Sinus Tachycardia: What medications can be given?
Beta blockers, CCB.
53
Sinus Tachycardia: How to treat if they are dehydrated or have a fever?
Give them fluids, or also give them tylenol to treat their fever
54
Sinus Arrhythmia: Is there a P wave before every QRS?
Yes
55
Sinus Arrhythmia: How does this appear on a strip?
The R waves are extremely elevated, and they are not equal distances from each other
56
Sinus Arrhythmia: Where is the impulse coming from?
SA Node, but impulse created is adding an abnormal rhythm.
57
Sinus Arrhythmia: How does thsi change with breathing?
Goes up with inspiration, and then decreases with expiration
58
Sinus Arrhythmia: What can this sometimes lead to?
Further Dysrhythmias
59
Sinus Arrhythmia: What is the treatment for this?
Maybe sometimes get a pacemaker, but we often dont do anything with it
60
Premature Atrial Complexes: What is this?
The atrium beats prematurely.
61
Premature Atrial Complexes: What is normal here?
YOu have normal P, QRS, PR Interval, ST segment.
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Premature Atrial Complexes: What makes this look different on a strip?
Sometimes the atria fires early, and P wave fires early, and kind of merges into T wave.
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Premature Atrial Complexes: What is shortened because of this?
RR Interval
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Premature Atrial Complexes: What can cause this?
Caffeine, Alcohol, Nicotine, or if the atrium is just too strethed out
65
Premature Atrial Complexes: What hppens if you frequently have this?
May start to lead to atrial dysrhythmias
66
Atrial Flutter: Where is the problem?
Conduction defect in atrium, impulses coming from spot other than SA Node in atrium
67
Atrial Flutter: How does this look on strip?
You have a lot of P waves before a QRS wave. They flutter. Can't tell where T wave is.
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Atrial Flutter: What CMs may they have
Chest pain, SOB, Decreased BP
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Atrial Flutter: What does EKG look like?
A saw blade.
70
Atrial Flutter: How quickly will it fire?
250-400, but not all of these will make it to ventricl
71
Atrial Flutter: What patient will have this?
Valve disease , Pulmonary Hypertension, COPD post open heart
72
Atrial Flutter: How is this treated?
1. Vagal Maneuvers
2. Adenosine, is a chemical cardioversion. Helps heart reset
3. Electrical Cardioversion
4. Catheter Ablation
73
Atrial Flutter: What is a Catheter Ablation
Go into the spot in the heart where impulse is firing and try to scar it to get rid of impulse.
74
Atrial Flutter: What medication will they need to be put on?
Anticoagulant, because they are more likely to develop blood clots.
75
Atrial Fibrillation: What is this?
Uncontrolled atrium beating. Disorganized. Can be rapid and uncoordinated.
76
Atrial Fibrillation: How does the chart look?
Doesn't looko like saw blade. All the P and T waves are all over the place before a QRS happens.
77
Atrial Fibrillation: How fast can rate go for atrium / ventricle?
Atrium: 300-600
Ventricle: Whatever QRS is.
78
Atrial Fibrillation: What can cause this
Valve disease, CAD, enlarged heart, hypertension, HF.
79
Atrial Fibrillation: What to know about HF?
AFib can cause HF, but HF can also cause AFib. Whatever comes first.
80
Atrial Fibrillation: What is lsot here?
Atrial kick, doesnt squeeze as well and doesnt empty fully. Becaus eof this, increased RF stroke and clots.
81
Atrial Fibrillation: Clinical signs?
SOB, Drop in BP, Fatigued,
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Atrial Fibrillation: How is this treated?
Electrial Cardioversion , but TEE first to make sure they don't have clot.
83
Atrial Fibrillation: What meds can be given?
Amiodarone (Antirhythmic to be Sinus) or Cardizine (Lowers HR
Ticosin / Digoxin for Contractility and lower HR
84
Atrial Fibrillation: What may be given for HR control?
Beta Blockers
85
Atrial Fibrillation: What therapy will be started?
Anticoagulation (Eliquis. Heparin, Lovanox), because of increased risk for strokes and clots.
86
Premature Ventricular Contraction: What is this?
Early firing of the ventricles.
87
Premature Ventricular Contraction: How does this look on EKG?
Random firings of QRS. After random fire, may see T wave go negative. This QRS just looks like it doesn't belong.
88
Premature Ventricular Contraction: What may cause this?
When your heart races or drink too much caffeine.
89
Ventricular Tachycardia: What is this?
Three or more PVCs in a row.
90
Ventricular Tachycardia: Which patient is more at risk for htis?
If they've had an MI, or have a lower ejection fraction.
91
Ventricular Tachycardia: Can these patients have a pulse?
Yes
92
Ventricular Tachycardia: How does this look on the chart?
Just very sharp up and down waves. Can't distinguish anything. A tall loopy wave.
93
Ventricular Tachycardia: Wht must we do when we see this on screen for patient?
Determine if they are alert and talking or if we need to code them
94
Ventricular Tachycardia: How is this treated if they have pulse?
Amiodarione and Lidocaine.
Cardioversion
Pre-Cordial Thump
Vagal Maneuvers
95
Ventricular Tachycardia: How is a cardioversion performed?
Electricty shocks the heart, and it has to be synced up with the QRS. Want to shock at right point.
96
Ventricular Tachycardia: What is a Pre-Cordial Thump?
A thump on the heart
97
Ventricular Tachycardia: What is done if they don't have pulse
Start chest compression and hook up to DFib pads.
Epinephrine is important to give.
98
Ventricular Fibrillation: How will this be treated?
Start chest compression and hok up DFib pads.
Give Epinephrine and Vasopressin.
99
Ventricular Fibrillation: Why may patients sometimes go into this?
Because they have low mag level.
100
Ventricular Fibrillation: How does this look on strip?
Tall loopy waves for a little bit then potential P waves and then more loopy waves.
101
Asystole: What is this?
Patient's flatline
102
Asystole: Treatment?
CPR, Epinephrine, Vasopressin
103
Asystole: How does this look
Flat line
104
Asystole: Do we shock these patients?
No, because there is nothing to shock.
105
Care of Patient with Dysrhythmia - Assess: What is done first?
What the rhythm is and what is causing it
106
Care of Patient with Dysrhythmia - Assess: Nursing Diagnosis?
Decreased CO
RF Clots (AFib)
Decrease Anxiety
Education
107
Care of Patient with Dysrhythmia - Interventions:
Administer Medications, or Vagal Maneuvers, Assess Labs (Potassium causes VT).
108
Potential Problems: What are some problems
```
Cardiac Arrest (VFib, VT)
HF (Can't Contract , VFib)
Thromboembolic Event (AFib)
```
109
Cardioversion: WHy is this used
To shock heart into normal rhythm and hit that AV Node
110
Cardioversion/Defibrillation: How does this treat tachydysrhythmias?
Delivers an electrical current that depolarizes a critical mass of myocardial ceclls. Whenrepolarized, SA Node can reapture pacemaker role
111
Cardioversion/Defibrillation: Patient status in cardioversion?
Awake and have pulse. Syncs shock with rhythm. Synced at top of R waves.
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Cardioversion/Defibrillation: When would cardioversion be formed?
AFub, AFlutter and VT with a Pulse
113
Cardioversion/Defibrillation: When is Defibrillation performed?
When patient doesn't have a pulse. VFib/VT
114
Cardioversion/Defibrillation: Cardioversion is synched to what?
R Wave
115
Pad Placement for Defib: Cross on pad shows what?
Where to do chest compression
116
Pad Placement for Defib: where are triangle and square positioned?
Square on back
| Triangle on front
117
Pacemakers: Who would get this?
Someone who has bradycarida, or has a heart block for electricity
118
Pacemakers: Example of temporary?
Epicardial, open heart that goes through vein or transcutaneous.
119
Pacemakers: Two main parts?
Generator and the lead that goes into heart to stimulate it.
120
Pacemakers: What do the codes tell you
What type of pacemaker it is .
A = Atrial B = Ventricle D= Dual
121
Pacemakers: When do these turn on?
May pace at a fixed interval, or may also always pace.
122
Pacemakers: Why does Transcutaneous pacing hurt?
They are sending shocks through the skin to the heart.
123
Pacemakers: For a planted pacemaker, where does it follow and go
Enters through Subclavian, down through heart and plant into ventricle.
124
Pacemakers: What different types of pacemakers are tehre?
Single chamber, Dual Chamber, and Biventricular
125
Implanted TRansvenous Pacemaker: How does this work?
Placed beneath skin. Enters through external jugular. Placed in right ventricle.
126
ECG On-Demand Pacing: How will ECG look with Pacemaker?
Want to make sure there are packer spike fires. Sharp spike before QRS showing its pacing it there.
127
Comp of Pacemaker Use: What is included
```
Infection
Bleeding/Hematoma
Dislocation of Lead
Skeletal Muscle/Phrenic Nerve Stimulation
Cardiac Tamponade
Pacemaker Malfunction
```
128
Comp of Pacemaker Use: What happens if lead dislocated?
You lose that heart rate
129
Comp of Pacemaker Use: Why does Cardiac Tamponade happen?
It could be due to lead placement. IT compresses heart
130
Comp of Pacemaker Use: What Electromagnetic interference can occur?
Like going through airport security, carry card. Don't put cell phone in chest pocket.
131
Implantable Cardioverter Defibrillator (ICD): What is this?
Device that detects and terminates life-threatening episodes of tachycardia and fibrillation.
132
Implantable Cardioverter Defibrillator (ICD): Can this be isnerted at same time of pacemaker?
Yes
133
Implantable Cardioverter Defibrillator (ICD): Who would get this?
Patient at risk for VT and VFib.
Those with <35% EF
134
Implantable Cardioverter Defibrillator (ICD): What is Anti-Tachycardia Pacing?
Pacemaker just tries to disrupt tachycardia, tried to override the firing of the heart.
135
Nurse Mx After Insertion: How will you assess their ECG?
Get their heart rate, and rhythm detection
136
Nurse Mx After Insertion: How to verify lead placement?
Chest X-Ray and to make sure no pneumothorax.
137
Nurse Mx After Insertion - Nursing Assess: What will the nurse monitor for?
CO and Hemodynamic Stability
Incision Site
Signs of Ineffective Coping
138
Nurse Mx After Insertion - Education : What arm will be immobilized
Whatever arm has been impacted. Don't want them reaching up because leads need to heal.
139
Nurse Mx After Insertion - Education : What to tell them abotu electromagnetic influence?
MRI
MEtal Dectors
Tell people they have pacemaker and have ID card present.
140
Invasive Methods to Diagnose and Tx Recurrent Dysrhythmias: What are electrophysiological studies?
AFib, VT. Go in and look at heart in lab and see if they can tell where the heart stimulation is rising from..
141
Invasive Methods to Diagnose and Tx Recurrent Dysrhythmias: Cardiac Conduction Therapy , Maze Production is done when
If patient is having open heart surgery
142
Invasive Methods to Diagnose and Tx Recurrent Dysrhythmias: What is the Maze Procedure?
They will fix blocked arteries and scar a portion of the heart to try to prevent arrhythmia from happening
143
Invasive Methods to Diagnose and Tx Recurrent Dysrhythmias: What is Catheter Ablation Therapy?
Go in with heart cath and ablate scarring area to prevent firing.
