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Pn3 - RN > T2 Cardiac Dysrhythmias > Flashcards

T2 Cardiac Dysrhythmias Flashcards

1
Q

The ability of the body to deliver nutrients and oxygen via the blood through arteries and capillaries, organs

and in turn picking up cellular waste and carbon dioxide from the cells via the veins
Cardiac dysrhythmias decrease perfusion and can lead to organ failure

A

Perfusion

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2
Q

Gas exchange vs perfusion?

Cardiac arrythmias can decrease?

A

Perfusion- how the blood gets there or is able to carry to end point

Has exchange- exchanging of oxygen and carbon dioxide across capillary and aveolli

Perfusion

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3
Q

Perfusion assessment

A

Recognize indicators of adequate and inadequate perfusion*

Central perfusion: assess HR and BP

Cerebral tissue: patients mental status

Peripheral tissue: extremity temp, color, pulse, cap refill

Low bp and confusion, fever, bounding, threads pulse capillary refill more than 3seconds= perfusion issue

Central= organs , heart

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4
Q

How does heart rhythm affect perfusion ?

A

Body receives more blood oxygen demand with a faster/more beats

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5
Q

Pacemaker of heart

A

SA node (top left)

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6
Q

Cardiac conduction system

A 
SA node (right atrium) travels to AV node in middle - travels down bundle of His, bundle branch , fibers which causes ventricular contraction 
This shows QRS complex

SA node stimulates P wave -> QRS -> T wave

AV node stimulates PR segment

The length of time it takes for electricity to come back to normal, repoloarize and be able to receive electrical stimulation again.

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7
Q

Electrical impulses 60 to 100 beats/min
P wave on ECG

Alterations in HR occur here first*

If something wrong see what?

How it connects to EKG waveforms?

A

Sinoatrial node *

Elevated or decreased heart rate or dysrhythmias

Affected by sympathetic and parasympathetic nerves that increase or decrease the heart rate

Atrial depolarization(contraction) and P wave on ECG

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8
Q

beats 40-60 beats/min
Contraction known as “atrial kick”

If SA node stopped working - AV works as back up but only 40-60 bpm so may need assistance (pacemaker) or may have decreased perfusion

How it connects to EKG waveforms?

A

Atrioventricular Node -AV node

Below right atrium

PR segment and contraction through AV node and bundle of His which allows atrium to contract and ventricles to fill before ventricular contraction

Atrial kick contributes to additional blood volume for greater cardiac output

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9
Q

Right bundle branch system
Left bundle branch system
(beats 20-40 beats/min)

Causes ventricles to contract

Not enough on its own to give proper perfusion

How it connects to EKG waveforms?

A

Bundle of His

Stimulates ventricles

Ventricular depolarization = QRS on ECG

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10
Q

Conduction begins in SA node, located in right atrium
SA node is pacemaker of the heart, effected by sympathetic and parasympathetic nerves which increase or decrease heart rate
Impulses travel through SA node resulting in atrial depolarization (contraction) and p wave on ECG

AV node beneath right atrium, impulse slows through AV node before proceeding to ventricles
AV junction is PR segment and includes conduction through AV node and Bundle of His, allows atrium to contract and ventricles to fill before ventricular contraction
Atrial kick contributes additional blood volume for greater cardiac output

Bundle of His= right and left bundle to stimulate ventricles
End of bundle branches are purkinje fibers.
Ventricular depolarization = QRS on ECG

A

Yes

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11
Q

Within the cardiac condition system there are Specialized myocardial cells

Characteristics of the cells include:

A

Automaticity: able to spontaneously generate an electrical impulse

Excitability: capable of being activated and reacting to electrical stimuli

Conductivity: able to conduct electricity

Contractility: form a contraction and strength of the hearts contraction during systole

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12
Q

ECG waveforms are measured in what??

Isoelectric, positive deflection and negative deflection

One small block =_____? seconds.

Five small blocks equal one large block=____seconds

Five large blocks =1 second and 30 large blocks =6 seconds

Left to right- measure time

Top to bottom- measures voltage and amplitude (how much voltage is conducted)

Measure how long each waveform should be

A

amplitude (voltage) and duration (time).

One small block = 0.04 seconds.

Big-0.2 seconds

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13
Q

Each segment between the dark lines (above the monitor strip) represents 3 seconds (15 large boxes). To estimate the ventricular rate, count the QRS complexes in a 6-second strip and then multiply that number by 10 to estimate the rate for 1 minute. In this example, there are 9 QRS complexes in 6 seconds. Therefore the heart rate can be estimated to be 90 beats/min.

A

Look at rate - count qrs x by 10 (6 seconds is 15 boxes)

There are 9 QRS x 10= 90 bpm

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14
Q

_____wave is usually positive deflection that represents atrial depolarization. Every beat has a this wave hopefully. First thing will see.

A

P wave

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15
Q

____segment/interval is isoelectric line from end of P wave to QRS represents time traveled between SA and AV node .12-.20 or 3-5 little squares.

A

PR segment

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16
Q

____complex represents ventricular depolarization .04-.12 seconds

A

QRS complex

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17
Q

______ is first negative deflection after p wave and isn’t always present (can mean myocardial necrosis)

A

Q wave

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18
Q

______duration is time it takes impulse to travel through Bundles and cause contraction

A

QRS

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19
Q

_____ represents early ventricular repolarization (becoming ready to be stimulated again) isoelectric line

A

ST segment

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20
Q

______follows ST segment and represents full ventricular repolarization, usually positive and rounded but can be tall, peaked, inverted, or flat

A

T wave

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21
Q

_____ is not normally seen and may represent electrolyte abnormality (hypokalemia)

A

U wave

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22
Q

____interval varies with age, gender, and heart rate.

A

QT

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23
Q

How to analyze an ECG?

Should be what?

A 
Determine heart rate
Determine heart rhythm
Analyze P waves
Measure PR interval
Measure QRS duration
Examine ST segment
Assess T wave and QT interval
Interpret rhythm

**Should be systematic and consistent
Rate=speed
Rhythm=consistency
P wave= are p waves present, are p waves consistent (PR interval)

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24
Q

Simplified rhythm analysis ?

4 steps

A

Determine heart rate-bmp

Determine heart rhythm- is the hr even and rhythmic/regular

Assess P wave
Present and consistent- one for each QRS and they look the same

Interpret rhythm- use above info to interpret this

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25
Q

What type of heart rhythm?

. Both atrial and ventricular rhythms are essentially regular (a slight variation in rhythm is normal). Atrial and ventricular rates are both 80 beats/min. There is one P wave before each QRS complex, and all the P waves are of a consistent morphology, or shape. The PR interval measures 0.18 second and is constant; the QRS complex measures 0.06 second and is constant

A

Normal sinus rhythm

26
Q

Must be within these ranges for this rhythm

Rate: 60 to 100 beats/min
Rhythm: Regular
P waves: Present, consistent configuration, one P wave before each QRS complex
PR interval: 0.12 to 0.20 second and constant-normal
QRS duration: 0.04 to 0.10 second and constant- normal

A

Normal sinus rhythm

27
Q

Variant of NSR (normal sinus rhythm)

Results from changes in intrathoracic pressure during breathing inhalation

Exhale beat goes back up

A

Sinus arrhythmia

28
Q

Common dysrhythmias

A

Premature complexes

  • Bigeminy
  • Trigeminy
  • Quadrigeminy

Bradydysrhythmias - hr slower than normal

Tachydysrhythmias- hr faster than normal

29
Q

Premature complexes are early rhythm complexes. can be atrial or ventricular

______exists when normal complexes and premature complexes occur alternately

_______exists when normal and premature beats occur in a three beat pattern

_______is four beat pattern

PVCs- how frequent they are happening

A

Bigeminy

Trigeminy

Quadrigeminy

30
Q

Causes of dysrhythmias

A 
May occur for many reasons
Myocardial infarction
Electrolyte imbalances
Hypoxia
Drug toxicity
Hypovolemia
Drugs-illegal substances

Electrolytes: potassium and magnesium

Drugs: cocaine, nicotine, alcohol, caffeine
Also stress and fear

31
Q

Care for clients with dysrhythmias?

What to check with ABCs?

Teach patient to check what? How?

A

Ensure ABC’s are intact*
Check Perfusion, hr, Bp, cap refil, mentation

Assess vital signs

Determine if symptomatic*

Administer medications as prescribed and
monitor response

Monitor appropriate lab values

Teach patient to monitor their pulse regularly* rate and regular

32
Q

S/s of symptomatic dysrhythmias?

A

Low bp

Poor mentation

SOB

Chest pain/pressure/discomfort

Restlessness/anxiety

Dizziness

Syncope - loc r/t low bp

Weakness fatigue

Pale/diaphoresis

33
Q

Monitor which labs with dysrhythmias

A

Potassium and magnesium

34
Q

On 6 second strip determine what?

A

Rate - bpm

Rhythm - regular?

P wave - present and consistent?

Tx- monitor, treat underlying causes

35
Q

Major concern in patients with CAD, increases work load on the heart (sinus tachycardia)

Coronary Perfusion decreases due to decrease in diastolic time (coronary perfusion occurs during diastole)
May remain adequate

Symptoms include:?

Symptoms of heart failure:?

A

Symptoms include: palpitations, chest discomfort, restlessness, anxiety, pale cool skin, syncope (from possible hypotension), can lead to heart failure

Symptoms of heart failure: dyspnea, lung crackles, JVD, fatigue, and weakness

36
Q

What Can cause increased heart rate in sinus tachycardia ?

A

Fever , pain, anxiety, dehydration

Treat underlying cause first

The may need beta blockers?

37
Q

Rate: 100-180 beats per minute
Rhythm: regular
P Wave: present, consistent
Treatment*: monitor, treat underlying causes

A

Sinus tachycardia

38
Q

40 bpm

Regular rhythm

P wave for every QRS - present and consistent

What type of rhythm is this?

A

Sinus bradycardia rhythm

39
Q

Sinus Bradycardia musts

Rate?

Rhythm?

P wave?

Tx?

If symptomatic?

Common symptoms-?

A

Rate: < 60 beats per minute
Rhythm: regular
P wave: present and consistent
Treatment: first monitor, treat underlying causes
If symptomatic*: atropine, oxygen, increase IV fluids, temporary pacing

Hypoxia and dehydration are common symptoms - treat with oxygen and IV fluids

40
Q

Sinus Bradycardia Myocardial oxygen demand is less (can be beneficial) perfusion may remain adequate

Forms of bradycardia include________ degree blocks

Symptomatic= __________?????

Tx?

A

2nd and 3rd degree blocks

Symptomatic= syncope, dizziness, weakness, confusion, hypotension, shortness of breath, chest pain, dehydration, hypoxia

Atropine 0.5 mg IV

41
Q

Temporary pacing—two different types invasive and noninvasive

Invasive wires go into chest

Noninvasive- pads on chest and machine on outside of body to stimulate hr
—————
Permanent pacemakers

Safety considerations*:

Temporary:

A

Keep cell phones 6 inches away

Avoid electromagnetic fields (MRI)

Carry identification card or wear bracelet

Teach patient to monitor for pulse lower than pacemaker has it set at

Temporary-external pass or invasive wires to external pacemaker

42
Q

Pacemaker spikes

If see it before p wave- atrial paced

Before QRS- ventrical paced

Know what the spike means?

Know where it is?

Know which part of the heart it’s stimulating?

A

Know what the spike means? vertical signals that represent the electrical activity of the pacemaker.

43
Q

Rapid stimulation of atrial tissue occurs at rate of 180 to 280 beat/min (adults)

P waves may not be visible/ because heart is beating so fast

May occur in healthy people (women more prone)

Paroxysmal supraventricular tachycardia rhythm is intermittent, terminated suddenly with or without intervention (comes and goes)

200 bpm, regular- t wave covers up p wave - slow HR down first

A

Supraventricular tachycardia SVT

44
Q

SVT

May be asymptomatic

Symptoms (if symptomatic) include: *?

Treatment:?

If symptomatic:

A

Symptoms (if symptomatic) include: chest pain, palpitations, shortness of breath, fatigue, restlessness, hypotension, altered mental status*

Treatment: fix as soon as possible, perfusion is greatly reduced being this fast ,first line tx is vagal maneuvers (bear down or blow/push/blow through straw)- can kick hr back into normal Adenosine 6 or 12 mg ** (slow down heart and may stop for brief amt of time. May feel impending doom and anxiety. Wears off very quickly..goal is normal rhythm when starting back up..if doesn’t work- if that doesn’t work then sync cardioversion (deliver shock to patient and reset heart)

If symptomatic: synchronized cardioversion*

2nd line Mexican tx to control HR-
Beta and calcium channel blockers can also be given to treat SVT.

Long term may need ablation

45
Q

Most common dysrhythmia
Most common dysrhythmia- especially in elderly (May be normal beat for them)

High risk for morbidity (disability)and mortality (death)

Clotting can lead to stroke or PE** asses for signs

Many atria foci depolarize in a disorganized manner (not a clear atrial contraction) - so blood may pool and form a clot- can push into ventricles and release clot into other parts of body such as brain or lungs =stroke risk

No clear p waves, no atrial contraction, irregular ventricular response

Associated with underlying cardiac disease

A

Atrial fibrillation

46
Q

No clear P waves

HR 100

Irregular

Electricity Shivering causing fibrillation

What is this?

A

Atrial fibrillation

47
Q

Assessment of atrial fibrillation?

Signs of poor perfusion
Irregular palpated pulse
Anxiety
12 lead ECG

Complications* ?
Goals*?

Teach patient what??

A

Potential for embolus formation
Potential for heart failure
PE; VTE

Goals*
Preventing embolus formation
Preventing heart failure

Teach to check pulse - rate and rhythm

48
Q

Interventions for atrial fibrillation?

Goal?

A

Medications*
Antidysrhythmic drugs to slow rate or convert

Electrical cardioversion

Maze procedure

Radiofrequency catheter ablation

Bi-ventricular pacing

Goal: restore regular blood flow, correct rhythm, control heart rate

Medications: calcium channel blockers (diltiazem), or antiarrhythmics (amiodarone), beta blockers (metoprolol) for rate control add info about beta blockers…slow the HR

Medications also include anticoagulation- prevent clots

Risks of cardioversion (May not want to for someone that doesn’t know when rhythm started) May jolt clot

Maze procedure: open chest surgical technique, place “maze” of sutures in various locations to try to impede electrical impulses

Ablation: abolish irritable focus with scar tissue

49
Q

Ventricular dysrythmias :

Premature ventricular complexes
Ventricular tachycardia
Ventricular fibrillation
Ventricular asystole

Lethal rhythms - important to identify quickly

Are more what?

A

More life-threatening than atrial dysrhythmias

Because Left ventricle pumps oxygenated blood through the body to perfuse vital organs and other tissues

50
Q

Also called V tach—repetitive firing of irritable ventricular ectopic focus, usually at 140 to 180 beats/min

A

Ventricular tachycardia

51
Q

V tachycardia tx?

A

Treatment: assess patient*, fix ASAP if pulse -antiarrhythmics and monitor, if no pulse start CPR

Sustained ventricular tachycardia at a rate of 166 beats/min.

Antiarrhythmic: amiodarone

52
Q

V-tach strip - what it looks like?

A

A bunch of Wide QRS in a row

53
Q

Also called —

result of electrical chaos in ventricles

No clear contraction - quivering

Treatment ?*

Lethal rhythm - no counting

Coarse ventricular fibrillation

A

V fib-Ventricular fibrillation

Will never have a pulse, start CPR and defibrillate ASAP*

Tx Interupt electricity in heart, stop and reset heart

54
Q

Also called ventricular standstill—complete absence of any ventricular rhythm

Ventricular asystole with one idioventricular complex

Firing of random electricity but not enough for a pulse.

Treatment??

A

Ventricular asystole

Can not defibrillate, can do CPR and ACLS medications to get them back to a point where we can defibrillate

Check for artifacts if patient is sitting up and talking to you and appears normal

If unresponsive- start chest compressions stat!

55
Q

How to manage cardiac arrest

Most important thing ?

A

CPR, Cardiopulmonary resuscitation

Start high quality chest compressions (most important thing)*

Maintain patent airway

Ventilate with mouth-to-mask device

Defibrillate as needed

Advanced cardiac life support

56
Q

Asynchronous countershock that depolarizes critical mass of myocardium simultaneously to stop re-entry circuit and allow sinus node to regain control of heart

Goal is to reset electrical activity of the heart*

A

Defibrillation

57
Q

Automated external defibrillation

AEDs create an opportunity for laypersons to respond to cardiac arrest
AEDs analyze the rhythm and shocks are delivered for ventricular fibrillation or pulseless ventricular tachycardia only

Safe use of AED*:

A

Safe use of AED*:

Avoid puddles - pull out of water and dry off chest as best as possible- doesn’t need to be completely dry

Remove medication patches- avoid or remove , quick wipe and put AED on

Avoid pacemakers- never out on top of pacemaker

Hair removal- some come with shavers- avoid hair or shave spot. If no shaver- can try to rip hair off with AED pads and the. Use new ones after if available.

Anyone can use - turn it on and it walks you through the steps

It decides if patient needs to be defibrillated or continue CPR

58
Q

The nurse working in the outpatient setting identifies which dysrhythmia as the most commonly diagnosed?

A.Atrial fibrillation
Sinus tachycardia
Sinus bradycardia
Ventricular fibrillation

A

A. Atrial Fibrillation

Rationale: Atrial fibrillation (AF) is the most common dysrhythmia seen in clinical practicel- especially in elderly.

It is responsible for a third of hospitalizations for cardiac rhythm disturbances. Patients can live with this dysrhythmia, but most are treated with anticoagulation therapy to avoid possible blood clots.

59
Q

On a telemetry monitor, the nurse observes that a patient’s heart rhythm is sustained ventricular tachycardia (VT). Upon assessment, the patient is alert and oriented with no reports of chest pain, but expresses feeling slightly short of breath. His blood pressure is 108/70. What is the nurse’s first action?

A.Synchronized cardioversion
B.CPR and immediate defibrillation
C.Administration of IV amiodarone (Cordarone) and dextrose
D.Administration of oxygen and observation of the heart rhythm

A

D. Administration of oxygen and observation of the heart rhythm

Current advanced cardiac life support (ACLS) guidelines recommend administration of oxygen and observation of heart rhythm first, followed by administration of an IV antidysrhythmic agent such as amiodarone mixed with dextrose 5%. Synchronized cardioversion would be the next step. CPR and immediate defibrillation would be used only to treat unstable VT.

60
Q

A patient is admitted to a telemetry unit with a new diagnosis of atrial fibrillation (AF). The patient states, “I feel fine, this rhythm won’t hurt me.” Which nursing response is appropriate?

A.AF can cause clots to form from the irregular blood flow in the heart.”
“B.It’s important to monitor the AF for 24 hours.”
“C.AF leads the death of the heart muscle.”
“D.AF can cause cardiac output to increase.”

A

A. AF can cause clots to form from the irregular blood flow in the heart.”

Educate patient -
Many times patients are found to have atrial fibrillation and they may be asymptomatic. While some patients do live with long-term atrial fibrillation, they need to be anticoagulated to decrease the risk of embolus formation due to the irregular cardiac rhythm. AF does not cause death of the heart muscle, nor does it cause the cardiac output to increase. Cardiac output will decrease due to the shortened filling time in the atria, which contributes to the development of heart failure due to altered conduction. While monitoring the patient is appropriate, it is not the best response to help educate the patient on the process of atrial fibrillation.

61
Q

Jaimie will Post -

Practice websites

Worksheet with strips to print off and assess

Using calipers to identify rhythms

Slideshow - blocks -1st degree, 2nd degree, 3rd degree heart rhythms

Refer to book

YouTube videos -registered nurse RN

A

Utilize these resources for practice

Pn3 - RN (25 decks)

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