Random Rhythms
What are the normal values for
PR QRS ST
PR- 0.12-0.20 sec
QRS- 0.04-0.10
ST 0.36-0.44
When is a synchronized cardioversion used?
with A-fib and stable v-tach
VENTRICULAR TACHYCARDIA- what is the rate, concerns, risk factors and treatments
rate- 140-180 bpm repetitive firing
concerns- develop into v-fib, lack of O2 perfusion
Risk factors- ischemic heart disease, MI, cardiomyopathy hypokalemia ( diuretics), hypomagnesmia, valvular heart disease, drug toxicity, hypotension, ventricular aneurysm.
Treatments- stable Vtach- oral antiarrhythmic (amiodarone) elective cardioversion, unstable VTACH- defibrillation
which dysrhythmia causes the ventricles to quiver resulting in absence of cardiac output?
a) v tach
b) v fib
c) asystole
d) a fib
b)v fib
A patient with AFIB is scheduled to have an elective cardioversion. tThe nurse ensures the patient has a prescription for a 4-6 week supply of which type of medication?
a) anticoagulants
b) digitalis
c) diuretics
d) potassium supplements
a) anticoagulants- prescribed up to 6 weeks prior to a cardioversion to prevent thrombolytic event
nurse should review K+ and Mg+ levels prior
typically wont work if a pt has been in afib >12 months
Sinus Bradycardia what is the rate, cause, patient considerations, treatment
rate is <60 bpm
myocardial o2 demand is lessened coronary perfusion time may be adequate because of prolonged diastole
causes- parasympathetic stimulation, valsalva maneuver, carotid sinus massage, vomiting, suctioning, hypoxia, inferior wall MI (betablockers, calcium channel blockers, digoxin)
considerations- pt may tolerate brady if BP is adequate if it is not pts can experience symptoms leading to MI or myocardial ischemia, dysrhythmias, hypotension, and heart failure
Assess for dizziness, synocope, hypotension, diaphoresis, SOB chest paint
treatment- Atropine, increase fluids, oxygen, pacemaker
If a patient has a pacemaker how long should that not raise their arm above the shoulder on the insertion side?
2-4 weeks
VENTRICULAR FIBRILLATION - what is it, what do you do
Electrical chaos in the ventricles, life threatening rhythm- IMMEDIATE defibrillation due to complete lack of cardiac output and quivering
which drug for symptomatic bradycardia does the nurse prepare to administer to a patient with a bradydysrhythmia?
a) epinephrine
b)atropine
c) calcium
d) lidocaine
b) atropine
list the 6 meds for cardiac arrest
Epinephrine ( first line), vasopressin ( used in VF and pulseless VT), dopamine (beta-adrenergic effects), dobutamine ( increases CO), norepinephrine( increases vasomotor tone and perfusion), sodium bicarbonate ( along with insulin calcium cl used in hypokalemia, DKA, metabolic acidosis).
Sinus Tachycardia- Rate, what is happening during this, causes, considerations, treatment
Rate >100
shorten diastolic time and coronary perfusion time, initially increase in BP & CO after extended time BP & CO decrease. increase work of heart and myocardial demand
causes- SNS stimulation ( anxiety, pain, stress, fever, anemia, hypoxia, hyperthyroidism, pulmonary embolism)
or parasympathetic inhibition increase rate of SA node
meds that can cause tachy- ( epinephrine, atropine, aminophylline, thyroid meds, caffeine nicotine, dehydration ( diuretics) or as a compensatory mechanism to decrease CO BP or shock, MI, infection, HF
considerations- may be asymptomatic, or experience hypotension, weakness, dizziness
Treatment ( calcium channel blockers Diltiazem, betablockers, antiarrthymics ( digoxin), vagal maneuver slows HR, ablation, fluids ( dehydration is a freq cause)
ATRIAL FLUTTER, what is it, patient considerations , risk factors, treatments
RHYTHMIC atrial impulses sending consistent impulses to the ventricles
Patient considerations- blood pooling can lead to clots, decreased CO due to faster atrial pumping, can lead to HF
Risk Factors- advanced age, obesity, caucasion, excessive alcohol intake, HTN, previous ischemic stroke, TIA, CAD, diabetes, HF, mitral valve disease
Treatment- monitor, meds( antiarrhythmics (amiodarone), calcium channel blockers ( diltiazem) beta blockers ( metoprolol, esmolol), anticoagulants ( enoxaparin, coumadin), cardioversion, ablation
1)which medication slows AV conduction and treats chronic AFIB?
2) Which medication treats symptomatic bradycardia?
3)Which medication slows AV conduction and treats SVT?
4) Which medication is given to treat refractory VT or VF, also used to treat torsades de pointes?
1) Digoxin 2) Atropine 3) adenosine 4) magnesium sulfate
AED is placed on a patient who is unconscious and has no pulse the nurse prepares to immediately defibrillate if the monitor analyzes which cardiac dysrhythmia?
a) third degree heart block
b) pulseless electrical activity
c) ventricular fibrillation
d) idioventricular rhythm
c) ventricular fibrillation
destroys areas of " hot spots" for conductions of electrical activity
Ablation
SUPRAVENTRICULAR TACHYCARDIA
what is the rate, what is happening, symptoms and treatment
rate 100-280 bpm
P wave may not be visible due to rapid rate and being emebedded in the preceding T wave
Symptoms- non-sustained = asymptomatic
sustained- palpations, chest pain, fatigue, weakness, short of breath, nervousness, anxiety, hypotension, syncope, severe could result in angina heart failure or cardiogenic shock
Treatment- radiofrequency catheter ablation med, ( Antiarrhythimics adenosine, beta blockers metoprolol, esmolol, calclium channel blockers, diltiazem)
Atrial Fibrillation- what is it, patient considerations, risk factors, treatments.
Sporadic impulses throughout the atrium with an occasional impulse getting through to the ventricles causing an irregular rhythm
PT considerations- blood clot formation due to stagnation in champers that can lead to thrombus formation WATCH FOR CVA or PE symptoms!!!
risk factors- age, obesity, Caucasian race, excessive alcohol.
Treatment- monitor, meds (antiarrhythmic (amiodarone), calcium channel blockers (diltiazem), beta blockers (metoprolol, esmolol) anticoagulants (enoxaparin, coumadin) antiplatelet (aspirin, Plavix) cardioversion, ablation, bi ventricular pacing
The class II drug that controls dysrhythmias associated with excessive beta adrenergic stimulation?
a. amiodarone hydrochloride
b. propranolol hydrochloride
c. diltiazem
d. verapamil hydrochloride
b. propranolol hydrochloride
Class II- control dysrhythmias associated with excessive beta adrenergic stimulation by competing for receptor sites, decreasing HR and conduction, prevent SVT, PVS, tachydysrhythmias (Beta blockers)
Class IV- slow the flow of calcium decrease HR and prolong AV nodal refractory period and treat SVT, atrial flutter, and AFIB (verapamil, diltiazem)
Class III- lengthen the absolute refractory period and prolong repolarization prevent PVS, VT, VF (amiodarone, ibutilide)
a patient reports chest pain and dizziness after exertion, and the family reports a concurrent new onset of mild confusion in the patient as well as difficulty concentrating. What is the priority problem for this patient?
a) activity intolerance
b) decreased cardiac output
c) acute confusion
d) inadequate oxygenation
B) decreased cardiac output
If a patient develops a new rhythm on the EKG what should the nurse do?
What is ask about chest pain, VS, then call MD
Which clinical manifestations are reflections of sustained tachydysrhythmias?
a) chest discomfort b) moist cyanotic skin c) palpitations, d) hypertension, e)syncope, f)restlessness
a) chest discomfort c) palpitations, e)syncope, f)restlessness
which dysrhythmia has no electrical activity in the heart, no defibrillation will help only CPR and meds ( epinephrine/ vasopressin)
ASYSTOLE
Name three different class I antidysrhythmic drugs
class 1A, class 1b, class 1c
class 1a- slow conduction treat/prevent PVCs, SVT, tachy (procainamide)
class 1b- shorten repolarization treat PVS VT VF ( lidocaine, mexiletine)
class 1c- slow conduction widen qrs complex- treat prevent recurrent life threatening PVCs, VT, VF ( tambocor, rythmol)
A patient diagnosed with recurrent supraventricular tachycardia. what does the nurse do in order to accomplish the preferred treatment?
a_ place the patient on the cardiac monitor and perform a carotid massage
b_ give oxygen and establish IV access for anydysrhythmic drugs
c_ assist the provider in attempting atrial overdrive pacing
d_ provide information about radiofrequency ablation therapy
d_ provide information about radiofrequency ablation therapy
A pt is diagnosed with torsades de pointes the nurse prepares to administer?
a) magnesium sulfate
b) epinephrine
c) adenosine
d) calcium chloride
a) magnesium sulfate