Nursing Care of Patients with Cardiac Dysrhythmias – Flashcards
Unlock all answers in this set
Unlock answersquestion
cardiac conduction system
answer
SA node to AV node to Bundle of His, to right and left Bundle Branches, to Purkinje Fibers.
question
Sinoatrial (SA) node
answer
60-100 bpm across both atria. Pacemaker.
question
AV node
answer
40-60 bpm. Can become the pacemaker if SA node fails.
question
One heartbeat
answer
From beginning of one heartbeat, to the beginning of the next heartbeat.
question
electrical representation of contraction, relaxation of atria/ventricles
answer
cardiac cycle.
question
PEA
answer
Pulseless Electrical Activity.
question
Electrocardiogram (ECG)
answer
shows cardiac electrical activity. 12 lead ECG = 12 different views. Waveforms change appearance in different leads. continuous monitoring often in lead 2. Waveforms upright in lead 2.
question
used to calculate HR
answer
ECG graph paper.
question
Occurs when there are no +/- electrical wave deflections
answer
Isoelectric Line.
question
components of a cardiac cycle
answer
P wave, P-R interval, QRS complex, QRS interval, T wave, QT interval, U wave, ST segment.
question
P wave
answer
one per cycle "in normal cycle". First wave, atrial depolarization. Round and symmetrical.
question
P-R interval
answer
beginning of P to beginning of QRS. 0.12 to 0.20 seconds.
question
venticles depolarization
answer
QRS complex
question
atrial depolarization
answer
P wave
question
first downward deflection
answer
Q wave.
question
first upward deflection
answer
R wave.
question
second negative deflection if Q wave or First negative deflection after R wave
answer
S wave.
question
ventricles contracting
answer
QRS interval
question
beginning of QRS to end of QRS
answer
QRS interval. less than or equal to 0.10 seconds.
question
Ventricular repolarization
answer
T wave. Follows QRS complex.
question
Resting state, ventricles are filled with blood, waiting for next contraction.
answer
T wave.
question
can show ischemia
answer
T wave.
question
Beginning of Q wave to end of T wave
answer
QT interval. normal ranges 0.34-0.43 seconds.
question
Prolonged or shortened can lead to ventricular dysrhythmias, can cause deadly arrhythmia.
answer
QT interval.
question
Rare, indicates Hypokalemia, and comes after T wave
answer
U wave.
question
ends of QRS to beginning of T wave
answer
ST segment
question
depressed with Ischemia
answer
ST segment
question
Elevated with Cardiac Injury, indicates Ischemia
answer
ST segment.
question
six steps process
answer
regularity of rhythm, HR, P wave, P-R interval, QRS omplex, QT interval.
question
Normal sinus rhythm rules
answer
rhythm: regular. HR: 60-100bpm. P wave: rounded, before each QRS. PR interval: 0.12-0.20 seconds. QRS interval: less than or 0.10 seconds.
question
rhythm disturbances
answer
dysrhythmias
question
impulse formation disturbed, disturbance in conduction
answer
Rhythm disturbances
question
Sinoatrial node dysrhythmias
answer
sinus bradycardia, sinus tachycardia.
question
sinus bradycardia rules
answer
rhythm: regular. HR: less than 60 bpm. P waves: rounded, before QRS. normal PR and QRS interval.
question
none, fatigue, fainting
answer
s/s sinus bradycardia
question
asymptomatic treatment for sinus bradycardia
answer
none
question
symptomatic treatment for sinus bradycardia
answer
O2, atropine, dopamine, epinephrine, pacemaker.
question
sinus tachycardia rules
answer
rhythm: regular. HR: 101-180bpm. P waves: rounded, before each QRS. Normal PR and QRS intervals.
question
often first sign of hemorrhage
answer
sinus tachycardia.
question
s/s sinus tachycardia
answer
none. angina or dyspnea. elderly more sensitive.
question
therapeutic interventions for sinus tachycardia
answer
treat cause. digoxin, CCB,BB.
question
Premature atrial contractions
answer
atrial dysrhythmias.
question
very rapid, saw tooh pattern, HTN, CHF, PE
answer
atrial flutter
question
atrial dysrhythmias
answer
Premature atrial contractions. atrial flutter. a fib.
question
a fib
answer
rapid, chaotic. AV node blocks most of the impulses, resulting in lower VR than AR.
question
PAC rules
answer
rhythm: PAC interrupts rhythm. HR: per underlying rhythm. P waves: early beat, abnormal shape. PR interval: usually normal. QRS interval: normal.
question
s/s PAC
answer
none.
question
PAC therapeutic interventions
answer
none. Treat cause. BB.
question
Atrial Flutter rules
answer
Rhythm: Atrial Rhythm regular. HR: varies. P waves: F waves, saw tooth pattern. PR interval: none measurable. QRS interval: normal.
question
Atrial Flutter s/s with normal VR
answer
none
question
Atrial Flutter s/s with rapid VR
answer
palpitations, angina, dyspnea.
question
Therapeutic interventions to slow HR in Atrial Flutter
answer
cardioversion, CCB, BB, Digoxin.
question
Cardioversion
answer
sedate patient. "electrical shock". Non emergent, controlled atmosphere.
question
high risk of thrombus and emboli
answer
a fib
question
a fib rules
answer
rhythm: irregularly irregular. HR: atrial rate not measurable, ventricular rate 100 rapid ventricular response. P waves: no identifiable P waves. PR interval: none measurable. QRS interval: normal.
question
a fib s/s
answer
palpitations. Faint radial pulse.
question
a fib treatment is based on patient's condition
answer
if stable: meds. if not stable: synchronized cardioversion.
question
a fib therapeutic interventions
answer
synchronized cardioversion. ablation. biatrial pacing. implantable atrial defibrillators. surgical maze procedure
question
a fib meds
answer
Digoxin, BB, CCB, amiodarone or dronedarone, warfarin (coumadin)
question
Digoxin
answer
Decrease VR
question
ventricular dysrhthmias
answer
Premature Ventricular Contraction. V tach. V fib.
question
common cause of PVC
answer
ischemia, caffeine, hypokalemia, anxiety, alcohol.
question
run of PVCs
answer
3 in a row.
question
rules PVC
answer
rhythm: PVC interrupts rhythm. HR: per underlying rhythm. P waves: absent in PVC. PR interval: none for PVC. QRS interval: pvc >0.10 seconds.
question
frequent PVC
answer
"R on T". need to be treated. v tach. >6 PVCs/min
question
PVC s/s
answer
palpitations. fatigue. dizziness. severe dysrhythmias.
question
PVC therapeutic interventions
answer
none. antidysrhythmics (amiodarone, cordarone, pacerone), BB
question
V tach rules
answer
Rhythm: usually regular. HR: 150-250 ventricular bpm. slow v tach: 0.10 seconds
question
v tach s/s
answer
dyspnea. palpitations. light headedness. angina. cardiac arrest.
question
v tach therapeutic interventions if pulseless
answer
CPR, defibrillation, vasopressors, anti dysrhythmics, precordial thump.
question
v tach therapeutic interventions if stable
answer
amiodarone, consider magnesium.
question
v fib rules
answer
rhythm: chaotic, extremely irregular. HR: not measurable. P waves: none. PR interval: none. QRS interval: none.
question
v fib s/s
answer
unconscious, no heart sounds, peripheral pulses, BP. resp arrest. cyanosis. pupil dilation.
question
ACLS protocols
answer
immediate defibrillation. CPR. epinephrine, vasopression, amiodarone, magnesium. endotracheal intubation.
question
asystole rules
answer
rhythm: none HR: none P waves: none PR interval: none QRS interval: none
question
asystole interventions
answer
CPR. ACLS protocols ( endotracheal intubation, epinephrine, vasopressin, atropine).
question
cardiac pacemakers
answer
external and temporary. internal and permanent. override dysrhythmias. generate an impulse. can be placed in atria, ventricle, or both.
question
cardiac pacemakers problems
answer
failure to sense. failure to pace. failure to capture.
question
nursing care for pacemakers
answer
monitor ECG. rest several hours. monitor apical pulse, symptoms.
question
patient education on pacemakers
answer
incision care. how to take radial pulse. symptoms to report. pacemaker ID card. things to avoid. trigger metal detectors. grounded appliances safe. periodic pacemaker checks. no contact sports/lifting for 6 weeks. infection r/t incision.
