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NUR 146 Lecture > NUR 146 - Week 10 - EKG Interpretations > Flashcards

NUR 146 - Week 10 - EKG Interpretations Flashcards

(49 cards)

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1
Q

What determines heart rate?

A

Heart rate is determined by the myocardial cells with the fastest inherent firing rate

  • This is normally the SA node / pace maker
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2
Q

What is an electrocardiogram (EKG)?

A

Record of a test that measures the electrical activity of the heart

  • Each lead is a specific viewpoint of the electrical activity
  • Common EKG is 3-lead or 12-lead
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3
Q

Artifact:

What is it?
How to determine what happened?
Cause?
How to prevent/fix?

A

EKG alterations which are not related to cardiac electrical activity

  • Have to assess patient

Causes:
- Poor electrode adhesion to skin
- Patient motion
- Outside source of electricity

How to prevent?
- Shave excess hair
- Skin prep if necessary
- Use soap and water (NOT alcohol)
- Rub skin w/ dry gauze

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4
Q

Describe the structure/makeup of EKG graph paper and the significance of the components

A

1 small box = 0.04 sec
5 small boxes = 1 large box
1 large box = 0.20 sec
5 large boxes = 1 sec

Horizontal lines measure passage of time

Vertical lies measure voltage

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5
Q

EKG Waves:

A

PR Interval = 0.12-0.2 seconds:
- Start of P wave to start of Q wave
- Start of atrial depolarization to start of ventricular depolarization

P wave: Atrial depolarization
QRS Complex: Ventricular depolarization
T wave: Ventricular repolarization
U Wave: rare finding, seen in hypokalemia

ST Segment: Should be at isoelectric line
- No more electrical activity, but the ventricles contracting from previous electricity

QT Interval: Ventricular depolarization and repolarization; 0.32 - 0.4 seconds
- Start of QRS to end of T wave

PP Interval: Used to determine atrial rate and rhythm

RR Interval: Used to determine ventricular rate and rhythm

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6
Q

How long should a PR interval last?

A

0.12 - 0.20 seconds

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7
Q

What are the steps to interpret an EKG

A

1) Determine if the heart rhythm is regular or irregular “predictable”
2) Determine the heart rate
3) Identify the P waves
4) Measure the PR interval
5) Measure the QRS complex

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8
Q

Steps to interpret an EKG:

Step 1 - Determine if heart rhythm is regular or irregular

A
  • Examine R to R intervals on EKG strip
  • Use scrap paper to measure distance between R waves and determine if they’re equal in disstance
    If equal = regular rhythm
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9
Q

Steps to interpret an EKG:

Step 2 - Determine heart rate

A

If irregular rhythm: Count QRS complexes on a 6 sec strip then multiply by 10

If regular rhythm: Rule of 300, Rate = 300 / number of large squares in between R waves

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10
Q

How to interpret an EKG:

***Step 3 - Identify P waves

A

One P wave should precede each QRS complex
- Should be “one-to-one”

P waves should be identical to one another in size and shape

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11
Q

How to interpret an EKG:

Step 4: MEasure the PR interval

A

Measure from the beginning of the P wave to the beginning of the QRS

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12
Q

How to interpret an EKG:

Step 5: Measure the QRS complex

A

QRS is normally less than 0.12 seconds in duration

  • QRS should be tall and skinny
  • Wide QRS indicates something wrong in the ventricles
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13
Q

Normal Sinus Rhythm

A

Rhythm originates in: SA Node
Regular or irregular: Regular
Rate: 60-100bpm
PR Interval: 0.12-0.2 seconds
QRS: 0.06 - 0.12 seconds

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14
Q

Arrhythmia / Dysrhythmia

A

Disorder of the formation and/or conduction of electrical impulse within the heart; Anything outside of normal sinus rhythm

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15
Q

Sinus Node arrhythmias

Sinus bradycardia:

How to differentiate?
s/s?
Treatment?

A

Rate: <60bpm (slow)
- Only thing abnormal

s/s:
- Many won’t experience symptoms
- SOB
- Angina
- Hypotension
- Change in mentation

Treatment: If symptomatic –> administer atropine

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16
Q

What is the purpose of atropine?

A

Used to treat symptomatic bradycardia

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17
Q

Sinus Node arrhythmias

Sinus tachycardia:

How to differentiate?
s/s?
Treatment?

A

Differentiate:
- Rate = >100bpm (fast)

s/s:
- Palpitations
- Dizziness
- Syncope
- Hypotension

Treatment:
- Treat the cause

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18
Q

Sinus node arrhythmias

Sinus arrhythmia:

How to differentiate

A

Differentiate:

Rhythm: Irregular

“Normal variation of life, not considered ominous or of a bad heart.”

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19
Q

Describe Atrial Arrhytmias

A

SA node fails to generate an electrical impulse

Electrical impulse is generated by atrial nodes or internodal pathways

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20
Q

Atrial arrhythmias

Premature atrial contraction (PAC):

How to differentiate
s/s
Cause
Treatment

Study These Flashcards
A

Differentiate:
- P waves are a little more “peaked”
“Something is stimulating the atria, and the atria are contracting too early”

s/s:
- “my heart skipped a beat”

Cause:
- Caffeine, nicotine, stimulants
- Anxiety
- Alcohol

Treatment:
- Treat underlying cause, give oxygen as needed

21
Q

***Supraventricular Tachycardia (SVT) / Atrial Tachycardia

How to differentiate
Cause:
s/s
Treatment

Study These Flashcards
A

Differentiate:
Rate - 150-250bpm

Cause:
- Multiple causes
- May be d/t accessory electrical pathway

PR Interval:
Unable to measure – no visible P waves​

s/s:
- Palpitations
- SOB, hypotension, LOC
- Restlessness

Treatment:
- Adenosine
- Vagal maneuvers
- Cardioversion / Surgical ablation

22
Q

Atrial arrhythmias

Atrial flutter:

How to differentiate
Cause
s/s
Treatment

Study These Flashcards
A

Differentiate:
- rate: atrial rate = 250-400 bpm; ventricular rate = 75-150bpm

Cause:
- Conduction defect within the atria

s/s:
- Palpitations
- SOB
- Fatigue
- Dizziness

Treatment:
- Rate control
- Cardioversion
- Ablation

23
Q

Atrial arrhythmias

Atrial Fibrillation:

How to differentiate
Cause
s/s
Treatment
Increased risk of?

Study These Flashcards
A

Differentiate:
- Rhythm: irregular
- Rate: Rapid

Cause:
- Age
- HTN, CHF, MI
- Diabetes Mell.
- Obesity
- OSA

s/s:
- Palpitations
- Hypotension, lethargy

Treatment:
- Anticoagulation
- Cardioversion
- WATCHMAN device placement
“Increased risk of developing atrial thrombus and systemic embolism

24
Q

What is the WATCHMAN device placement?

Study These Flashcards
A

Blockage placed into atrial appendage to prevent blood pooling during atrial fibrillation

25
Cardioversion: What is it? How is it performed Nursing care
Delivers a "timed" electrical current to break a tachyarrhythmia; electricity is synchronized with the patient's own electrical impulses Implications: - Elective - Light sedation and analgesia - Anticoagulants for several weeks prior to procedure - Hold digoxin 48 hours prior Nursing care: - NPO - informed consent - Monitor EKG - Monitor vs, O2 sat
26
Ventricular Arrhythmias Premature Ventricular Contraction (PVC): What is it? Cause s/s Treatment
Extra, abnormal heartbeat originating in the ventricles Cause: - Typically d/t electrical irritability - Stimulants (caffeine, nicotine, alcohol) s/s: - Cardiac output may be compromised Treatment: - Treat the cause - Oxygen and anti-dysrhythmic drugs
27
When is a rhythm consider V Tach?
Three or more PVC's in a row
28
Ventricular Arrhythmias Ventricular tachycardia: What is it? How to differentiate Cause s/s
Definition: - Three or more PVC's in a row Differentiate: - Rate: 100 - 250 bpm - **QRS: Wide complexes measuring > 0.12 seconds*** Cause: - CAD, MI - Electrolyte imbalances s/s: - Chest pain, SOB - Dizziness, altered mental status - Cardiac arrest
29
Ventricular Tachycardia: Treatment
Stable: - Pulse - Minimal symptoms - Normotensive - AO x3 Treat with anti-arrhythmic drugs or synchronized cardioversion Unstable: - Pulseless - Hypotensive - Symptomatic Treat with defibrillation (similar to V-Fib)
30
Ventricular Arrhythmias Torsades de Pointes: How to differentiate
Differentiate: - Prolonged QT interval Cause: - Hypomagnesemia - Long QT syndrome Treatment: - 2g Magnesium sulfate
31
What causes Torsades de Pointes rhythm? How is it treated?
Cause: - Hypomagnesia - Medications known to prolong QT syndrome Treat: - 2g magnesium sulfate
32
Ventricular arrhythmia Ventricular fibrillation
Definition: **Rapid, disorganized electrical rhythm** Differentiate: - Extremely irregular - Rate: >300 bpm Cause: - CAD, MI, ischemia - Electrolyte imbalances, acid/base imbalances - Hypothermia - Untreated V-Tach Symptoms: - Pulselessness - Cardiac Arrest Treatment: - * "V-Fib = D-Fib"* - **High quality CPR** - anti-arrhythmic drugs
33
What is priority treatment for Ventricular fibrillation (V-Fib)?
Defibrillation High quality CPR
34
Cardioversion vs. Defirillation
Cardioversion - Planned and synced shock, weaker Used for: - A-Fib - SVT - Stable V-Tach "Weaker electricity" Defibrillation - Unsynchronized shock given in emergent situation, stronger shock Used for: - Pulselessness V-tach - V-Fib
35
Asystole: What is it? Treatment
What is it: - Flatline - Absent QRS complexes, cardiac standstill - No pulse Treatment: - High quality CPR - Epinephrine Usually fatal
36
Atrioventricular (AV) Blocks: What is it?
Electrical impulses are delayed or blocked from passing through the AV node Cause: - Medications - Ischemia - MI
37
1st degree AV block
Differentiate: - PR interval: Prolonged > .20 seconds s/s: - Usually asymptomatic Treatment: - Treat underlying cause if patients are symptomatic
38
2nd Degree - Type I Mobitz I (Wenkebach)
Differentiate: - R:R interval is irregular - PR interval: Progressive lengthening until a QRS complex is dropped - P to QRS interval is NOT 1:1; it may be 3:2, 4:3 Symptoms: - Often asymptomatic Treatment: - Treat underlying cause if pts are symptomatic
39
2nd degree Type II / Mobitz II
Differentiate: - PR interval: PRI remains constant until a block of the AV conduction, resulting in a P wave not being following by a QRS
40
3rd Degree (Complete Heart Block):
Differentiate: - Rate & rhythm: Atrial and ventricular rate and rhythm are independent of one another - Atrial rate: 60-100bpm - Ventricular rate often < 40 bpm s/s: - Fatigue, dizziness, SOB, LOC - Chest pain Treatment: - Temporary pacing followed by permanent pacemaker placement
41
Heart Block Poem
If the R is far from P, then you have a first degree Longer, longer, longer, drop! Then you have a WENKEBACH If some P's don't get through, then you have Mobitz II. If P's and Q's don't agree, then you have a third degree
42
Pacemaker: What is it?
Small, implantable device which helps regulate heart rhythm - Battery operated - Electrical spike is visible, followed by complexes - Requires intermittent surveillance
43
Pacemaker: Pacing function
Atrial pacing: - Stimulation of right atrium produce spike on ECG preceding the P wave Ventricular pacing: - Stimulation of right or left ventricle produce a spike on ECG preceding the QRS complex
44
Pacemaker: Indication
Slower than normal conduction disturbances: - Bradycardia - 2nd degree AV Block Type II - 3rd degree heart block Tachydysrhythmias: - Less common - Refractive to medication therapy
45
Pacemaker: Complications
- Local infection - Localized hematoma - Dislocated leads - Loss of pacing - Loss of capture
46
Pacemaker: Nursing Care Patient Education
Nursing Care: - Monitor HR and EKG strips - Assess hemodynamic stability - Incision care post-op Patient education: - Teach patient to check pulse frequently - Report slowing of pulse greater than the set rate - Report s/s of complications: palpitations, fatigue, dizziness, prolonged hiccups - Avoid MRI
47
Automatic implantable cardioverter defibrillator (AICD) What is it?
Purpose: - Monitors heart rate & rhythm and identifies V-Tach or V-Fib - Delivers a 25 joule shock to the heart muscle upon sensing a lethal arrhythmia Indicated: - Patients at high risk of spontaneous V-Tach / V - Fib "Like surveillance, fires only when necessary"
48
AICD: Patient teaching
Short term: - Monitor for s/s infection after placement - Avoid lifting arm above shoulder for 1 week Long term: - Avoid direct injury to AICD device - Airport security - Routine follow up for surveillance - Avoid MRI - Family trained in BLS
49
Which sinus rhythm causes an increased risk of developing an atrial thrombus and systemic embolism?
atrial fibrillation

NUR 146 Lecture (27 decks)

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