Cardiac – Rhythm Strips – Flashcards

•Predisposing Factors: -NORMAL -Regular impulses at a normal rate. •ECG Appearance: -P wave, QRS wave, T wave -60-100 bpm -Equal distances bwt each beat -PRI: 0.12-0.20 sec. -QRS: < 0.12 sec •Hemodynamic Effects & Nursing Implications: -Normal •Treatment: -Normal

•Predisposing Factors: -Normal -Varies with breathing •ECG Appearance: -NSR but irregular •Hemodynamic Effects & Nursing Implications: -Normal •Treatment: -Normal

•**Sinus= arrhythmia originates in SA (sinus) node** •Predisposing Factors: -Meds: Beta blocker, Digoxin, Narcotics -Athletes that have low base HR -Sleep -Valsava Maneuver-straining with BM -Carotid Massage -Hypothyroid -Hypothermia •ECG Appearance: -Same as NSR except 40-60 bpm •Hemodynamic Effects & Nursing Implications: -Sinus Brady is ok it pt. is asymptomatic •Symptomatic Sinus Brady can cause: -Hypotension -Diaphoresis -Chest Pain -SOB -Change in mental status •Treatment: 1. Why brady? May be normal for pt. If not, assess pt. treat underlying cause first. - Ex. If cold=warm pt., constipated=stool softener, decr. thyroid=synthroid. 2. O2 3. Pacer 4. Epi or dopamine gtts 5. Atropine- help inc. HR

•**Sinus= arrhythmia originates in SA (sinus) node** •Predisposing Factors: -Running, exercise, hypovolemia (dehydration), pain, anxiety, fever, infection -CHF (heart thinks its not getting enough O2 out, ? HR), hyperthyroid •ECG Appearance: -Same as NSR except >100 bpm •Hemodynamic Effects & Nursing Implications: -Depends on pts. tolerance of Inc. HR. -May experience dizziness, hypotension, or increased need for O2 •Treatment: 1. Why Tachy? If normal for pt. then no treatment. What is underlying cause- assess and treat. -Ex. Limit Stimulants, Give O2, HF-Give Lasix, If r/t fever-treat fever, Dr. can do carotid massage. Vagal manuevers. 2. Meds to Dec. HR: Ca channel and Beta blockers

•**Disorganized uncoordinating twitching of atrial muscle** •Predisposing Factors: -CAD, MI, valve probs, rheumatic heart disease, HTN, HF, hyperthyroid -Possible Post-CABG -Lone Afib (happens without an underlying cause) -Holiday Heart (alcohol) •ECG Appearance: -No distinct 1 P wave; instead many fibrillatory waves. -Only QRS and T waves present. -QRS to QRS is irregular -Baseline present but wiggly •Hemodynamic Effects & Nursing Implications: -No atrial kick. -Ineffective atrial depolarization -Blood becomes stasis in heart -Risk of clots: PE, heart attack or stroke -? CO -Irregularly irregular pulse -Palpitations, SOB, CP, fatigue, syncope, HF, change in mental status •Goals: 1. HR control; 60-100 2. Convert to sinus rhythm and maintain 3. Prevent Clots •Treatment: 1. Heparin drip: prevent clots 2. Covert to NSR (meds): -Digoxin (dec. HR) -Ca Channel Blocker (cardizem) -Anti-arrythmic (Amiodarone) 3. Cardioversion: mild sedation, monitor rhythm, low joules. Do TEE first to check for clots (so you don't send the clots around the body when you shock!) 4. Coumadin: Long term, Monitor pt/inr. 5. Abalation: determine where arrrythmia is starting, burn pin points 6. Pacemaker

•**Single irritable focus area in heart that has rapid repetitive impulses.** •Predisposing Factors: -CAD, MI, valve probs, rheumatic heart disease, HTN, HF, hyperthyroid -Possible Post-CABG -Lone Afib (happens without an underlying cause) -Holiday Heart (alcohol) -Hyperthyroid -Mitral Valve Disease -Heart Diseases •ECG Appearance: -QRS is normal -P waves have a sawtooth pattern -Usually regular rhythm •Hemodynamic Effects ; Nursing Implications: •Hemodynamic Effects ; Nursing Implications: -No atrial kick. -Ineffective atrial depolarization -Blood becomes stasis in heart -Risk of clots: PE, heart attack or stroke -? CO -Irregularly irregular pulse -Palpitations, SOB, CP, fatigue, syncope, HF, change in mental status •Goals: 1. HR control; 60-100 2. Convert to sinus rhythm and maintain 3. Prevent Clots •Treatment: 1. Heparin drip: prevent clots 2. Covert to NSR (meds): -Digoxin (dec. HR) -Ca Channel Blocker (cardizem) -Anti-arrythmic (Amiodarone) 3. Cardioversion: mild sedation, monitor rhythm, low joules. Do TEE first to check for clots (so you don't send the clots around the body when you shock!) 4. Coumadin: Long term, Monitor pt/inr. 5. Abalation: determine where arrrythmia is starting, burn pin points 6. Pacemaker

•Predisposing Factors: -Uncommon -Heart damage •ECG Appearance: -Inverted p wave before, during, or after QRS -Always regular •Hemodynamic Effects & Nursing Implications: -Depends on rate •Treatment: -Depends on rate

•Predisposing Factors: -Side effect of beta blocker •ECG Appearance: -PRI greater than .20 •Hemodynamic Effects & Nursing Implications: -none •Treatment: -Watch/monitor: could progress to more serious blocks

•**Single abnormal beat that originates in the ventricle** •Predisposing Factors: -Fever, caffeine, stress, exercise, drugs (cocaine) -Hypokalemia, Hypovolemia metabolic acidosis, hypoxia, HF, MI -Digoxin Toxicity, Tricyclic Antideppressants, Amphetamines -? or ? K, Ca, Mg •ECG Appearance: -Early QRS beats -Big, Wide, QRS wave occurs without a P wave before it •Hemodynamic Effects & Nursing Implications: -Pt. may be asymptomatic -Possibly may have: `Palpitations `Irregular Pulse `? CO `Hypotension -HR will lead to V-tach ? V-fib ? Cardiac Arrest if not treated •Treatment: 1.Poss. Asymptomatic- just keep an eye on them -Anti-arrhythmic -Amiodarone 2. Treat the Cause! -Give O2 -Check Chem panel: replace necessary electrolytes -? Digoxin: check for Toxicity -Correct Acidosis -Treat Fever

•**3 or more PVC's in a row** •Predisposing Factors: -Fever, caffeine, stress, exercise, drugs (cocaine) -Hypokalemia, Hypovolemia metabolic acidosis, hypoxia, HF, MI -Digoxin Toxicity, Tricyclic Antideppressants, Amphetamines -? or ? K, Ca, Mg •ECG Appearance: -Pt may have FAST, LIGHT PULSE OR NO PULSE! -No P wave before QRS -QRS intervals are wide and bizarre -150-250 bpm •Hemodynamic Effects ; Nursing Implications: -may have a pulse -No pulse! -Pt pale, unconscious or non-responsive -Pt may not have BP-if yes, very low •Treatment: 1. Check Pt First, before calling a code- Pt. may be brushing their teeth! 2. If Real Rhythm -Call Code -ABC's; Start CPR -IV-O2-Monitor -Defibrillation -Epi/Vasopressin -Amiodarone, sotolol, procainamide (if patient has a pulse) -Mag Replacement **Be prepared for pt to go into V-fib

•**Ventricle continually firing; only electrical, no contractions** •Predisposing Factors: -Fever, caffeine, stress, exercise, drugs (cocaine) -Hypokalemia, Hypovolemia metabolic acidosis, hypoxia, HF, MI -Digoxin Toxicity, Tricyclic Antideppressants, Amphetamines -? or ? K, Ca, Mg -Electrolyte Imbal. -Drug Overdose -Electrocution -MI •ECG Appearance: -No QRS -No P waves -No CO -No Pulse -Only fluttering of the heart •Hemodynamic Effects & Nursing Implications: -No pulse ever -No BP •Treatment: Same as pulseless vtach 1.Check Pt First before calling a code!! 2. CALL CODE!!! -START CPR -Push hard and fast w. compressions; check pulse while doing compressions -IV-O2-Monitor -Defibrillation -Epi/Vasopressin -Amiodarone, sotolol, procainamide -Mag Replacement 3. Defibrillate **Pads go on left side directly below the heart, and on the right side of the heart past sternum**

•**Heart is dying, slowly stopping, periodic QRS wave** •ECG Appearance: -Slow wide QRS complexes •Hemodynamic Effects & Nursing Implications: -Faint pulse or none •Treatment: -Check DNR status -Check pt: Call code -CPR -Epi / vasopressin -Do not shock!

•**Nothing, No HR, No Pulse, No CO, No Electrical Activity** •Predisposing Factors: 1. 5 H's: -Hypovolemia -H ion (acidosis) -Hyper/Hypo K+ -Hypoxia -Hypothermia 2. 5 T's: -Toxins -Tamponade -Tension Pneumothorax -Thrombus -Trauma •ECG Appearance: -Straight lining -Periodic QRS; electrical activity slowing, no contractions occurring in the heart •Treatment: -Check Pt First! -Call Code -IV-O2-monitor -CPR -Epi / Vasopressin -CANNOT shock pt. in this rhythm-you will kill pt completely