MS2 Exam2 CardiacDysrhyt Small00center10 1912821

8/11/2019 MS2 Exam2 CardiacDysrhyt Small00center10 1912821

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How many large squares in one minute? 300

How do you calculate BPM on ECG paper?Every 3 seconds, a mark appears. Count the number of upstrokes (

R waves) in 6 seconds, then multiply by 10.

How do you put an electrode on a client?

Clip excessive chest hair with scissors. Rub skin with dry gauze unti

l it is slightly pink. If skin is oily, wipe with alcohol first. If pt is diaph

oretic, apply skin protectant before placing the electrode.

What is an artifact?Due to loose ECG electrodes or dry conductive gel. Big distortion of

baseline and waveforms.

What are the nursing responsibilities for Holter monitoring?

Apply electrodes and leads. Teach pt to keep accurate diary of activ

ities and symptoms. No shower during monitoring. Pt wears ECG fo

r 24-48hrs and keeps a diary while doing regular activities.

What is electophysiologic study?

Invasive. Cathetar electrodes inserted through femoral or jugular v

ein induces and terminates dysrhythmias. Records electrical activity

of the heart.

What are the nursing responsibilities for an electrophysiologic study?

D/C antidysrhythmic meds several days before study. Pt NPO 6-8 hr

s before test. Premedicate to relax pt. Freq VS and continuous ECG

after the procedure.

What are the nursing responsibilities for cardiac cath?

Pt NPO 6-18hrs prior to test. Check for iodine sensitivity. After proc

edure, assess circulation for extremity used q 15 min for 1 hr, punc

ture site for bleeding. VS and ECG. Assess for hypo/hyper tension,

dysrhythmias, signs of pulmonary emboli.

MS2 - Exam 2 - Cardiac DysrhythmiasStudy this set online at: http://www.cram.com/flashcards/ms2-exam-2-cardiac-dysrhthmias-1912821
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How fast is sinus tachycardia? 101-200BPM

Signs and symptoms of sinus bradycardiaPale, cool skin; hypotension; weakness; angina; dizziness or syncop

e; confusion or disorientation; SOB

Tx for s inus bradycardia (Rx) Atropine or pacemaker

Symptoms of sinus tachycardia Dizziness, dyspnea, hypotension, angina, increase in infarction size

Tx of sinus tachycrdia beta blockers

What does the ECG look like for a premature atrial contraction? Abnormal P wave

Tx of premature ventricular contractions Beta blockers, withdrawal of the cause (caffeine/sympathomimeticdrugs)

ECG of paroxysmal supraventricular tachycardiaRate 150-220 BPM with abnormal P wave and a normal or shortene

d PR interval



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S/S of paroxysmal supraventricular tachycardia hypotension, dyspnea, angina

Tx for paroxysmal supraventricular tachycardia

Vagal stimulation like valsalva and coughing IV adenosine 1st line b

etal blocers, ca channel blockers, amidodarone Cardioversion last c

hoice

Adenosine

used for paroxysmal supraventricular tachycardia administer IV rap

idly over 1 or 2 seconds followed by rapid NS flush Monitor pt ECG

continuously. Brief asystole is common Observe pt for flushing, dizz

iness, chest pain, or palpitations

Wolff-Parkinson-White syndrome preexcitation paroxysmal supraventricular tachycardia

Atrial flutter ECG looks like... sawtooth pattern P waves and

Why would a person have atrial flutter?

It is associated with CAD, HTN, mitral valve disorders, pulmonary e

mbolus, chronic lung disease, cor pulmonale, cardiomyopathy, hyp

erthyroidism, and the use of drugs such as digoxin, quinidine, and

epinephrine.

Rate of atria and ventricles in atrial flutter Atria - 250-300BPM Ventricles - 150

Medication given to pts with atrial flutter

coumadin to prevent thrombus amiodarone propafenone (Rythmol)

ibutilide (Corvert) flecainide (Tambocor) Dronedarone (Multaq) is tx

of choice for a flutter whose hearts have returned to normal rhyth

m or for those who will undergo drug or electric shock tx to restore

a normal heartbeat.



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Tx of choice for atrial flutter Cardio ablation

Atrial fibrillation on an ECG looks like...Total disorganization of atrial electrical activity from multiple ectopic

foci.

What diseases are associated with atrial fibrillation?

CAD, rheumatic heart disease, cardiomyopathy, HTN, HF, pericarditi

s. Acutely with thyrotoxicosis, alcohol intoxication, caffeine use, ele

ctrolyte disturbances, stress, cardiac surgery.

The ECG with atrial fibrillation looks...P waves replaced by chaotic, fibrillatory waves. Atrial rate 350-600

Ventricular rate: irregular

How many large squares in a second? In a minute? 5 a sec 300 a min

Types of ventricular responses with atrial fibrillation?100 = rapid ventricular response

Drugs for atrial fibrillation Ca channel blockers, beta blockers, digoxin, dronedarone (Multaq)

Most common drugs given for conversion of dysrhythmias to norm

al sinus rhythm are......amiodarone and ibutilide



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What if a person is in a fib for more than 48 hours?Give coumadin for one week before cardioversion. MAKE SURE THE

RE ARE NO CLOTS BEFORE CARDIOVERSION!!!!!!!!!!

Moderate risk factors for a fib Age >75 Heart failure HTN LV ejection fraction


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Rx for junctional dysrhythmias

If a pt is symptomatic, atropine In accelerated, stop the drug (like di

goxin) In absence of digitalis toxicity, beta blockers, Ca channel blo

ckers, amiodarone

What does the ECG look like in first-degree AV block? Prolonged PR interval (greater than two small boxes) (0.4sec)

Significance of first-degree AV block It may be a precursor to more serious AV block

What is second degree AV block, type one? 2 P waves...1 QRS complex missing

Drug of choice for 2nd degree AV block, Type IAtropine to increase HR Or, stop the digoxin or beta blockers that a

re causing the rhythm

Other name for AV blocks Mobitz or Wenckebach

What does the ECG look like for 2nd degree AV block, Type II?

Multiple P waves for each QRS complex b/c some impulses from the

SA nodes are not conducted to the ventricles at all PR interval is RE

GULAR

How do you treat 2nd degree AV block, Type II? Pacemakers



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3rd degree heart block ECG Variable PR interval and missing QRS complexes POOR PROGNOSIS

What is 3rd degree heart block associated with?severe heart disease, amyloidosis, scleroderma, digoxin, beta bloc

kers, Ca channel blockers

What makes 3rd degree heart block so dangerous?The ventricles are not contracting, so there may be ischemia, HF, a

nd shock

Tx for 3rd degree heart blockfAtropine, epinephrine, isoproternol, and dopamine until a pacemake

r is inserted

What is a contraction of the ventricles resulting from an ectopic foc

us called?PVC

What is it called when every other beat is a PVC? ventr icular bigeminy ventr icular tr igeminy if it's every 3rd

What are 2 consecutive PVC's called? Couplet

Tx of PVC'sDepends on the cause... O2 for hypoxia Electrolyte replacement for

imbalances Beta blockers, procainamide, amiodarone, lidocaine



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What is a run of 3 or more PVC's in a row called?Ventricular tachycardia Monomorphic if QRS complexes are all the s

ame, polymorphic if they are different

What is Torsades de pointes?Polymorphic VT with prolonged QT interval (long line at the top of t

he ECG)

Does ventricular tachycardia have a good prognosis? NO. IT'S OMENOUS. Pt may be pulseless.

How is ventricular tachycardia treated?If there is no pulse, cardioversion, CPR and then epinephrine and a

miodarone

What dysrhythmia does hyperkalemia cause? Ventricular fibrillation

How do you treat asystole? Defibrillation, CPR, intubation, epinephrine, atropine

What causes asystole? End stage heart failure or prolonged cardiac arrest

What does sudden cardiac death usually result from? Ventricular dysrhythmias



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What is a prodysrhthmia? When a dysrhythmia drug causes what you are trying to fix.

Why do we monitor pts in the hospital when they start dysrhythmia

drugs?Possibility of prodysrhythmias

Which drugs slow the heart down? Propafone, beta blockers, Cardizem

Which drugs speed the heart up? lidocaine, phenytoin epinephrine

What are biphasic difibrillators?

Defibrillators that deliver energy in 2 directions so that they can us

e less electricity 120-200 joules as opposed to 360 with monophasic

, and they have less post shock consequences

Where do the defibrillator pads go?One to the rt of the sternum, under the clavicle...one to the left of

the apex

Nursing responsibility for synchronized cardioversion Medicate pt with Versed first

What do you make sure of if you are going to defibrillate? Synchronizer switch is OFF



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What do you make sure of if you are going to do cardioversion? Synchronizer switch is ON

Teaching for an implantable cardiover ter-defibrillator

Do not raise arm above shoulder level or drive until cleared by the

doctor. Avoid magnetic fields including MRI's. If you travel, tell the s

ecurity officer about the device and don't use wand over the area If

ICD fires, once call doc, more than once or you don't feel well call E

MS Carry card with make/model of ICD and a list of all meds with y

ou at all times.

Where are pacemakers implanted? Pectoral muscle on pt's nondominant side

What are the 3 types of temporary pacemakers?Transvenous (placed in ER or ICU) Epicardial (prophylactic during he

art surgery) Transcutaneous (one pad on pt back, one on chest)

Nursing interventions for transcutaneous pacemakerTell pt that muscles will contract and it will be uncomfor table until p

t gets transvenous pacemaker Provide analgesia or sedation

What are the two problems with pacemakers?Failure to sense - it fires when it's not supposed to Failure to captur

e - not sending enough jolt to affect the heart

Nursing interventions for all pacemakers post op

Prophylactic antibiotics to prevent infection Chest x-ray to ensure it'

s in the correct place - no pneumothorax Limit activity on side of p

acemaker to avoid dislodging.

Activity after pacemaker insertion Pt out of bed once stable



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Are microwave ovens safe for people with pacemakers? YES

Nursing interventions post cardioablationFast for 6-18 hrs beforehand Explain feeling of warmth when contra

st is given. Check CWMS in extremity used post-op

Troponin I Negative is 2.3 Suspicious is in between

What is the head up, tilt test?Strap pt to table and tilt table 60-80 degrees. If abnormal HR or BP

in 30 min, test is positive Do for syncope pt's

What is most suggestive of ACS with ischemia? Depressed ST segment

ECG changes with infarction ST segment elevation

How do you calculate HR on ECG strip? 1500/# of small boxes in R-R interval

What do you do for stable ventricular tachycardia? Amiodorone - don't shake the bottle (bubbles that won't go away)



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What is R on T phenomenon? PVC on T wave - can throw pt in to ventricular tachycardia

What is torsades de pointes?polymorphic ventricular tachycardia...PVC on R wave...THINK HYPO

MAGNESIUM WITH THIS. Certain antiarrhythmics can cause it too.

How do you treat v. fib? Make sure it's not artifact, and then defibrillate.

What is the 1st symptom of CAD? V fib, many times

How do you treat asystole? Drugs and CPR...hopefully return pt to v fib where we can shock.

What causes pulseless electrical activity?

Think of the 6 H's and the 5 T's. Hypovolemia, hypoxia, hypo/hyper

kalemia, H+ ions (acidotic), hypoglycemia, hypothermia. Toxins (dru

g overdose), temponade, tension pneumothorax, thrombosis, traum

a.

How do you treat pulseless electrical activity? CPR, ACLS, drugs

What is an EKG artifact?it's the pt moving/breathing, electrical interference (seizure, chills fr

om a fever, pt moving in bed),



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When do we use defibrillators ? V fib, pulseless Vtach.

When is a pacemaker indicated? b/c they have damaged hearts, electrical system is shot

What are the types of pacemakers?

Transcutaneous (patches on outside of body), Transvenous (go in to

jugular or femoral vein in emergent situation), permanent pacemak

er (placed in cath lab)

What is the nursing care for a pacemaker?

be careful about the arm on the side of the pacemaker. Post-op, pu

t arm in sling, keep immobile for 3-6 weeks. No heavy lifting or high

reaching. No MRI's!!

What does a pacemaker look like on the telemetry monitor? Wide QRS complex.


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MS2 Exam2 CardiacDysrhyt Small00center10 1912821