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Med Surg 3 (theory class) > NURS 444 week 6 arrhythmias > Flashcards

NURS 444 week 6 arrhythmias Flashcards

1
Q

Properties Cardiac Cells

A

Automaticity- ability to initiate impulse

Excitability- ability to be electrically stimulated

Conductivity- ability to transmit an impulse in an orderly manner

Contractility- ability to respond mechanically

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2
Q

U wave

A

if present;
repolarization of purkinje fibers OR hypokalemia

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3
Q

Normal QRS interval in seconds

A
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4
Q

What rhythms can be defibrillated

A

v fib
pulseless v taach
v tach

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5
Q

1mm square

A

0.04 sec

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6
Q

5mm box

A

0.2 seconds

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7
Q

Sinus Bradycardiaa

A

SA nodes fires less than 60 seconds

Can be sleeping or from an athlete

Associated with some disease states

Can occur with response to parasympathetic nerve stimulation and certain drugs

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8
Q

Sinus Bradycardia:
Clinical associations

A

Occurs in response to;
-Carotid sinus massage
-hypothermia
-increased vagal tone
-meds.

Occurs in disease states;
>hypothyroidism
> ^ intracranial pressure
>obstructive jaundice
>inferior wall MI

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9
Q

Sinus Tachycardia

A
  • Discharge rate from SA node is increased (>100 bpm)
  • caused by vagal inhibition or sympathetic stimulation
  • physiologic or psychological stressors
  • drugs can increase rate
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10
Q

Sinus Tachycardia: Clinical associations

A

_ exercise
_ hypotension
_ hypovolemia
_ myocardial ischemia
_ CHF
_ anxiety

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11
Q

normal PR interval

A

0.12 (3 boxes) - 0.2 (5 boxes)

  • if it’s longer it may be a block
  • if it’s shorter it is called a junctional rhythm
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12
Q

Normal QRS interval

A

< 0.12

  • if greater, you can have a disturbance in the ventricles (block)
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13
Q

Elevated ST segment

A
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14
Q

What does a depressed ST segment mean?

A
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15
Q

unusual T wave?

A
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16
Q

Premature Atrial Contractions

A
  • contraction starts from ectopic focus in the atrium
  • travels across the atria by abnormal pathway –> distorted P wave
  • impulse may be stopped or delayed
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17
Q

PAC: clinical associations

A

> emotional stress
physical fatigue
caffeine
tobacco
alcohol
hypoxia **
electrolyte imbalances
disease states: infection, inflammation, COPD, valvular disease **

18
Q

Paroxysmal Supraventricular Tachycardia (PSVT)

A

Starts or stops abruptly
- originated in ectopic focus anywhere above bundle of HIS (QRS interval is normal, less than 3 boxes) **
-paroxysmal means an abrupt onset and termination
- usually a PAC triggers a run of repeated premature beats **

19
Q

PSVT: clinical associations

A
  • overexertion
  • stress
  • deep inspiration
  • stimulants, disease
  • digitalis toxicity
  • can occur in presence of Wolff- Parkinson- White Syndrome (onset during childhood)
20
Q

Atrial Flutter

A

^ atrial tachyarrhythmia
^ identified by recurring, regular, sawtoothed-shaped waves
^ from single ectopic focus
^ associated with slower ventricular response. (ex. atrial rate 200-350, vent. rate generally <100
^ vent. rate may be regular or irregular

21
Q

Atrial fibrillation

A

total disorganization of atrial activity w/out effective atrial activity

chronic or intermittent; Paroxysmal or Persistent

most common dysrhythmia

prevalence increases with age

usually occur with underlying heart diseases

atrial rate 350 -600, ventricular response variable/ irregular (CVR 60-100, rapid ventricular response RVR)

22
Q

A. flutter: clinical associations

A
  • CAD
  • htn
  • mitral valve disorders
  • cardiomyopathy
  • pulmonary embolus
  • chronic lung disease
  • Cor pulmonale
  • hyperthyroidism
  • Drugs: digoxin, quinidine, epinephrine
23
Q

A. fib: clinical association

A

> CAD or cardiac surgery
htn
valvular heart disease
cardiomyopathy and/or HF
pericarditis
thyrotoxicosis
alcohol intoxication and/or caffeine
electrolyte imbalances
stress

24
Q

First Degree AV block

A

PR interval prolonged (> .20)

Associated with increasing age, disease states, and certain drugs

usually not serious; patients asymptomatic

no treatment

monitor for changes in heart rhythm

25
Q

2nd Degree AV block, Type 1 (mobitz 1, Wenckebach)

“type 1- wencke- widen”

A
  • gradual lengthening of PR interval until QRS complex eventually dropped.
    — occurs because of prolonged conduction time

may result from drugs or CAD

typically associated with ischemia

usually transient and well tolerated

TREAT if symptomatic with; Atropine or pacemaker ***

observe closely if symptomatic- give atropine
can progress into more serious

have pacemaker, code cart on stand by

26
Q

MOST DANGEROUS TIME FOR A.FIB

A

when they go down to cardioversion AND they are NOT anticoagulated

27
Q

Second Degree AV block Type 2

A

Sudden dropped QRS complexes

-no widening of PR interval
- P wave not conducted
- almost always occurs when bundle branch block is present
- associated with heart disease and drug toxicity
- unlike type 1, we drop the beat without warning (PR intervals are the same)

28
Q

Third Degree AV Heart Block

A

“Complete Heart Block”
- P waves & QRS complexes have nothing to do with each other. “divorced”
- no impulses from atria conducted ventricles
- no/ minimal CO

Associated with;
- severe heart disease; CAD, MI, myocarditis, cardiomyopathy, scleroderma
- some systemic diseases
- certain drugs; digoxin, beta blockers, calcium channel blockers

DO NOT GIVE ATROPINE!!!***

29
Q

PVCs

A

contraction that originates somewhere in the ventricles
- premature QRS occurrence
- can be unifocal (look the same) or multifocal (look different)
- QRS complex is widened: wider than 0.12

30
Q

PVCs: clinical associations

A

stimulants, electrolyte imbalances, hypokalemia hypoxia, heart disease, exercise

may occur following acute MI and/or following coronary artery reperfusion, mitral valve prolapse

31
Q

R-on-T
if PVC happens during T…

A

ventricular tachycardia can occur

32
Q

Ventricular Tachycardia

A
  • Run of 3 or more PVCs
    occurs
  • ectopic foci in ventricles take over as pacemaker
  • monomorphic, polymorphic, sustained and nonsustained
33
Q

V-Tach: clinical associations

A
  • Heart disease
  • long QT syndrome
  • electrolyte imbalances
  • drug toxicity
  • CNS disorders
  • has been observed in individuals with no evidence of heart disease
34
Q

Ventricular Fibrillation

A

chaotic firing of multiple ectopic Vent. foci

35
Q

V. Fib: clinical associations

A
  • Acute MI
  • electrolyte imbalances, hypoxia, acidosis
  • chronic disease (CAD, HF, cardiomyopathy)
  • cardiac procedures
  • electrical shock
  • drug toxicity
36
Q

Pulseless Electrical Activity

A
  • activity can be observed on the ECG, but no mechanical activity of the heart is evident
  • patient has no pulse
  • prognosis is poor unless cause is identified and treated
37
Q

PEA: causes

A

> hypovolemia
hypoxia
hydrogen ion (acidosis)
hyper/ hypokalemia
hypoglycemia
hypothermia
toxins
tamponade (cardiac)
thrombosis (MI and pulmonary)
tension pneuomo.
trauma

38
Q

PEA: treatment

A
  • CPR, intubation, IV epinephrine
  • treatment directed to underlying cause
39
Q

Defibrillation

A

treatment of choice for V.FIB and pulseless VT

40
Q

Synchronized Cardioversion

A

treatment of choice for ventricular or supraventricular tachydysrhythmias (VT with pulse)

synchronized delivery of a shock on the R wave of QRS complex of ECG

intent is to allow SA node to resume role

41
Q

ICD: implantable cardioverter defibrillator

A
  • for patients who survived sudden cardiac death
  • have spontaneous sustained VT
  • have syncope w/ inducible ventricular tachycardia/ fibrillation during EPS
  • who are at high risk for threatening dysrhythmias

Med Surg 3 (theory class) (13 decks)

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