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Ventricular Fibrillation 1
Ventricular Fibrillation 2
Atrial Fibrillation 1
Atrial Fibrillation 2
Misc
100
Define Ventricular Fibrillation
A severe derangement of the heart rhythm that represents the firing of multiple ectopic foci in the ventricle. The ventricles are simply quivering with no effective firing.
100
What is defibrillation?
Passive shocking through the heart to depolarize to myocardium. The goal is following repolarization of myocardial cells will allow the SA node to resume the role of the "pacemaker"
100
What are some characteristics of and A. fib strip?
Atrial rate as high as 350-600 beats/min. P waves are replaced by chaotic fibrillatory waves. Ventricular rates vary but are usually irregular. PR interval is not measureable and the QRS complex has a normal shape and duration
100
What procedure is done to convert A. Fib to Normal Sinus Rhythm?
Cardioversion
100
What is the most common type of dysrhythmia?
A. Fib
200
List some clinical manifestations
unresponsiveness, pulselessness, apnea
200
What are some causes of V. Fib?
Acute MI or ischemia, CHF, CMP, Cardiac pacing or catheterization, electric shock, hyperkalemia, hypoxemia, acidosis, and drug toxicity
200
What is the difference between controlled ventricular response and rapid ventricular response?
CVR is a ventricular rate between 60-100 beats/min RVR is a ventricular rate greater than 100 beats/min
200
What should be done before the patient is cardioverted?
Transesophageal Electrocardiogram to rule out clots in the atria. **If the patient is in A.fib for greater than 48 hours, warfarin is needed for 3-4 weeks before cardioversion
200
What is an artifact and what should you do as a nurse?
distortion of the baseline and waveforms seen on the ECG; check the connections of the equipment, you may need to replace the electrodes if the conductive gel has dried out
300
What are some treatments for v. fib?
Initiate CPR and ACLS, defibrillation, and administration of epinephrine or vasopressin
300
Does defibrillation require sedation?
No, but in a non-emergent cardioversion sedation is used
300
Define A. Fib
dysrhythmias characterized by a total disorganization of atrial electrical activity resulting in loss of effective atrial contraction
300
What is the drug of choice if cardioversion does not convert A. fib to Normal Sinus Rhythm?
Warfarin
300
How should you prepare the patients skin before placing electrode pads?
Clip excessive hair with scissors, gently rub skin with dry gauze until slightly pink, if the skin is oily, wipe with alcohol first
400
How soon should a client with V. Fib be defibrillated?
within 2 minutes
400
What are some safety precautions while using the defibrillation?
Check to see the synchronizer is switched off, be certain that personnel are "all clear" before discharging the device, also reference table 36-10 on page 803
400
What is a patient with A. Fib at risk of and why?
stroke; because clots can form in the atria due to blood stasis. An embolized clot can move to the brain and cause a stroke
400
What can cause A. Fib?
CAD, Valvular heart disease, CMP, hypertensive heart disease, HF, pericarditis, alcohol, caffeine, stress, electrolyte imbalances, cardiac surgery
400
What is telemetry monitoring?
the observation of a patient's HR and rhythm at a site distant from the patient
500
WHat are characteristics of a v. fib strip?
No measurable heart rate, The rhythm is irregular and chaotic. No visible P wave. PR interval and QRS complex are not measurable
500
Is V. Fib a medical emergency?
Yes
500
What are some drugs used to control the heart rate?
calcium channel blockers (Diltiazem) Beta Blockers (Metoprolol) Digoxin
500
What should you teach your patient who is on long-term warfarin therapy?
-Importance of lab monitoring -Call provider if any s/s of bleeding (dark, tarry stools, coffee-ground emesis, unusual bleeding from gums, nose, skin, stomach pains, avoid activities that may cause bleeding) -Avoid aspirin and NSAIDS -Limit alcohol to small amounts -Don't increase intake of Vit. K (dark, leafy greens) -Consult HCP before stopping therapy
500
What is the easiest way to calculate a patients HR from an ECG strip?
Count the number of QRS complexes in 6 seconds and multiply that number by 10