Heart Tracing
Normal and Abnormal PR interval length
Normal: 0.12 to 0.20 seconds
Abnormal: >0.20 seconds
Assessment for Symptomatic Sinus Bradycardia and Interventions
Signs: Shock, Chest Pain, Ischemia, potential MI, mental status changes
Interventions: Atropine, Transcutaneous pacing, ensure IV access, fluids, don't get out of bed
PVC appearance and strip, including Bigeminy/Trigeminy/Quadrigeminy
Contraction from unknown part of ventricles, abnormal ventricular beat independent of atrial beat, no P wave before PVC, wide and distorted QRS complex
Bi: every other beat, frequently could mean V tach is coming
Tri: every third beat
Quad: every fourth beat
Pacemaker use, short term and permanent
short term: transcutaneous, after big cardiac surgeries or procedures, good if brady is secondary to another disease while treating it
permanent: implanted surgically
Holter monitor definition
A portable, wearable device that continuously records the heart's electrical activity (EKG/ECG) for usually 24-48 hours while a person goes about their daily routine)
Elevated ST segment meanings
Depressed below baseline meanings
Elevated: STEMI, pericarditis
Depressed: N-Stemi, myocardial ischemia
Asymptomatic Sinus Tachycardia Interventions
Check BP, determine source of tachy, potentially give BB or CCB and check H/H for anemia
Assessment and considerations for PVC
Assess: LOC, BP, potassium and magnesium, frequency (if more than 3-6 in a row, could turn into V tach), can be caused by low K or Mg or CAD or HF
Isolated: continue to monitor
Pacemaker single chamber and dual chamber EKG strips
Single:
only pacing aorta- pacer spike before the P wave
only pacing ventricles- pacer spike before the QRS
Dual: both atria and ventricles are paced, pacer spike before the P wave AND before QRS complex
Holter Monitor patient education
Keep device completely dry, log symptoms in a diary throughout the day with time stamps, avoid magnets and metal detectors
Drugs that can prolong the QT interval
Antipsychotics, Antidepressants, Antiemetics
Symptomatic Sinus Tachy Interventions
Take BP, Administer BB or CCB (do not administer if BP is low), Valsavla bearing down maneuver
Appearence and ventricular rate of V tach
Appearance: no p wave, wide QRS complex
Ventricular Rate: 150 to 250 bpm
Pacemaker failure to sense malfunctions- failure to sense and failure to capture
Failure to sense: pacemaker is not accurately detecting heart activity, will fire inapropriate and patient will be tachycardic
Failure to capture: sends signal but heart ignores it, pacer spike not following P wave or QRS complex
Exercise Treadmill Test patient education
NPO 3-4 hours prior, avoid smoking and caffeine 24 hours prior, hold BB 24 hours prior to the test, patient should report symptoms during the test (chest pain, dizziness, severe SOB, or leg pain)
What can a prolonged QT interval lead to
Torsades de Pointes
Interventions for A-Fib
Anticoagulation, rate control (BB and CCB, amiodarone), synchronized cardioversion
Nursing interventions for V tach (asymptomatic with a pulse, symptomatic with a pulse, pulseless)
Asymptomatic with a pulse: delegate crash cart and round of vitals, check electrolytes, check BP
Symptomatic with a pulse: call a rapid
Pulseless: call a code, CPR, defibrillator
ICD indication
Patients who have: suffered a cardiac event such as Vtach, Vfib, spontaneous sustained V tach, are at a high risk for future life threatening dysrhythmias
How many seconds is each little box and regular box on the ECG
little: 0.04 seconds
normal: 0.20 seconds
5 boxes: 1 minute
QRS complex normal length
0.12 seconds or less
Considerations for Synchronized Cardioversion and RN role
Considerations: Use for dysrhythmias with a pulse, synchronizer switch turned on, patient is awake (sedate them), chemical cardioversion is amiodarone
RN role: assess airway (have ambu bag and suction), check IV patency, continuous pulse ox and vital signs, esnure there is signed consent and education
Treatment for V fib
Call a code (patient is clinically dead), defib (before CPR if patient already has pads on), CPR, Epinephrine
ICD Patient Education
If fires contact HCP, do not lift arm on side where it was implanted unless cleared by provider, make sure partner knows CPR, no driving until cleared by HCP, monitor site for infection, patient is allwed to use microwave and get on planes, place phone on ear opposite to ICD, do not linger around auto-theft detectors, inform HCP before getting an MRI, can take baths after site heals
What to do before synchronized cardioversion
Get a transesophageal echocardiogram (TEE) before cardioversion if the duration of afib is unknown or greater than 48 hours (it takes 48 hours for a clot to form)