MS2 Exam2 CardiacDysrhyt Small00center10 1912821

What does stimulation of the vagus nerve do to the heart? It is parasympathetic, so it slows the heart rate.
What does stimulation of sympathetic nerve bers do to the heart? Increase the heart rate.
What charge does K have? Negative
What charge does Na have? Positive
What happens when the heart cell depolarizes?
Na from outside the cardiac cell quickly moves inside to make the in
side positively charged.
What happens when the heart cell repolarizes?
Slow movement of ions across the cell membrane restore the cell t
o being negatively charged (More K inside cell)
What do the small squares on ECG paper represent? 0.04 seconds horizontally 0.1 mV vertically
How many small squares in one large square on ECG paper? 5 horizontal and 5 vertical
MS2 - Exam 2 - Cardiac Dysrhythmias
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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 rst. 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.
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How fast is sinus tachycardia? 101-200BPM
Signs and symptoms of sinus bradycardia
Pale, cool skin; hypotension; weakness; angina; dizziness or syncop
e; confusion or disorientation; SOB
Tx for sinus 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 (caeine/sympathomimetic
drugs)
ECG of paroxysmal supraventricular tachycardia
Rate 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 ush Monitor pt ECG
continuously. Brief asystole is common Observe pt for ushing, dizz
iness, chest pain, or palpitations
Wol-Parkinson-White syndrome preexcitation paroxysmal supraventricular tachycardia
Atrial utter ECG looks like... sawtooth pattern P waves and
Why would a person have atrial utter?
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 utter Atria - 250-300BPM Ventricles - 150
Medication given to pts with atrial utter
coumadin to prevent thrombus amiodarone propafenone (Rythmol)
ibutilide (Corvert) ecainide (Tambocor) Dronedarone (Multaq) is tx
of choice for a utter 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 utter Cardio ablation
Atrial brillation on an ECG looks like...
Total disorganization of atrial electrical activity from multiple ectopic
foci.
What diseases are associated with atrial brillation?
CAD, rheumatic heart disease, cardiomyopathy, HTN, HF, pericarditi
s. Acutely with thyrotoxicosis, alcohol intoxication, caeine use, ele
ctrolyte disturbances, stress, cardiac surgery.
The ECG with atrial brillation looks...
P waves replaced by chaotic, brillatory 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 brillation?
<60 = slow ventricular response 60-100 = controlled ventricular res
ponse >100 = rapid ventricular response
Drugs for atrial brillation 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 b 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 b Age >75 Heart failure HTN LV ejection fraction <35% Diabetes
High risk factors for a b
Previous stroke, TIA, or embolism Mitral stenosis Prosthetic heart v
alve
What is the Maze procedure? Incisions in both atria and cryoablation to stop a b
What is a junctional dysrhythmia?
When the electrical impulse starts in the SA node and travels backw
ard to AV node
What causes junctional dysrhthmias?
CAD, HF, cardiomyopathy, electrolyte imbalances, inferior MI, rheu
matic heart disease, digoxin, amphetamines, caeine, nicotine
ECG characteristics of junctional dysrhythmias
Abnormal or inverted P wave that may be hidden in the QRS compl
ex HR 60 bpm Accelerated junctional is 60-100bpm Junctional tachy
cardia is 100-180 bpm
What is contraindicated with junctional dysrhymias?
CARDIOVERSION b/c junctional dysrhythmia is a safety mechanism
when SA node is not working
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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 rst-degree AV block? Prolonged PR interval (greater than two small boxes) (0.4sec)
Signicance of rst-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 I
Atropine 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 blockf
Atropine, 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? ventricular bigeminy ventricular trigeminy if it's every 3rd
What are 2 consecutive PVC's called? Couplet
Tx of PVC's
Depends 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 dierent
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 brillation
How do you treat asystole? Debrillation, 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 x.
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 dibrillators?
Debrillators 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 debrillator 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 rst
What do you make sure of if you are going to debrillate? 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 cardioverter-debrillator
Do not raise arm above shoulder level or drive until cleared by the
doctor. Avoid magnetic elds including MRI's. If you travel, tell the s
ecurity ocer about the device and don't use wand over the area If
ICD res, 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 pacemaker
Tell pt that muscles will contract and it will be uncomfortable until p
t gets transvenous pacemaker Provide analgesia or sedation
What are the two problems with pacemakers?
Failure to sense - it res when it's not supposed to Failure to captur
e - not sending enough jolt to aect 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 cardioablation
Fast 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 <0.5 Positive >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. b? Make sure it's not artifact, and then debrillate.
What is the 1st symptom of CAD? V b, many times
How do you treat asystole? Drugs and CPR...hopefully return pt to v b 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 debrillators ? V b, 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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What does stimulation of the vagus nerve do to the heart? It is parasympathetic, so it slows the heart rate.

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