unit 4

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tonders
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201342
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unit 4
Updated:
2013-02-21 21:49:41
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cardiac
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nursing 2212 cardiac unit 4
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  1. Conduction System
  2. P wave
    • Represents time for the passage of the electrical impulse through the atrium causing atrial depolarization (contraction)
    • should be upright
    • 0.06-0.12 seconds
    • Disturbance in conduction within atria
  3. PR interval
    • Measured from beginning of P wave to beginning of QRS complex
    • represents time taken for impulse to spread through the atria, AV node and bundle of His, the bundle branches, and Purkinje fibers, to a point immediately preceding ventricular contraction
    • 0.12-0.20 seconds
    • Disturbance in conduction usually in AV node, bundle of His, or bundle branches but can be in atria as well
  4. QRS complex
    • Measured from beginning to end of QRS complex
    • represents time taken for depolarization (contraction) of both ventricles (systole)
    • <0.12 seconds
    • Disturbance in conduction in bundle branches or in ventricles
  5. ST segment
    • Measured from the S wave of the QRS complex to the beginning of the T wave
    • represents the time between ventricular depolarization and repolarization (diastole)
    • should be isoelectric (flat)
    • 0.12 seconds
    • Disturbances usually caused by electrolyte imbalances, ischemia, or infarction
  6. T wave
    • Represents time for ventricular repolarization
    • should be upright
    • 0.16
    • Disturbances usually caused by electrolyte imbalances, ischemia, or infarction
  7. How to calculate heart rate
    • count the number of R waves in a 6-second strip and multiply by 10.
    • PVCs are not counted on rhythm strip
  8. Analyze Rhythms
    • Rate: 60-100 (WNL) <60 (brady) >100 (tachy) do atrial (P wave) and ventricle (QRS) rates match?
    • Rhythm: regular, irregularly irregular
    • P wave: present, one uniform infront of every QRS
    • PR interval: 0.12-0.20
    • QRS complex: <0.12
  9. ECG Paper
  10. Normal Sinus Rythm
    • Rate: 60-100 bpm
    • Rhythm: regular
    • P waves: present; one uniform infront of every QRS complex
    • PR interval: 0.12-0.20 second and constant from beat to beat
    • QRS duration: <0.12 second
  11. Normal Sinus Rythm
  12. Sinus Arrhythmia
    • Rate: Usually 60-100 bpm, but may be slower or faster
    • Rhythm: R-R vary.  Rate changes with respiration
    • P waves: present; one uniform infront of every QRS complex
    • PR interval: 0.12-0.20 second and constant from beat to beat
    • QRS duration: <0.12 seconds
  13. Sinus Arrhythmia
  14. Sinus Bradycardia
    • Rate: Less than 60 bpm
    • Rhythm: P-P interval regular, R-R interval regular
    • P waves: present; one uniform infront of every QRS complex
    • PR interval: 0.12-0.20 second and constant from beat to beat
    • QRS duration: <0.12 second
  15. Sinus Bradycardia
  16. Sinus Tachycardia
    • Rate: Greater than 60 bpm
    • Rhythm: P-P interval regular, R-R interval regular
    • P waves: present; one uniform infront of every QRS complex
    • PR interval: 0.12-0.20 second and constant from beat to beat
    • QRS duration: <0.12 second
  17. Sinus Tachycardia
  18. Atrial Fibrillation
    • Rate: atrial rate is unmeasurable.  Ventrical rate <100 "controlled"  >100 "rapid ventricular response" / "RVR"
    • Rhythm: atrial rhythm is unmeasurable; ventricular rhythm is grossly irregular
    • P waves: none; "fibrillatory" waves
    • PR interval: none
    • QRS duration: <0.12 second
  19. Atrial Fibrillation
  20. Ventricular Tachycardia
    • Rate: 150-250
    • Rhythm: usually regular
    • P wave: none
    • PRI: none
    • QRS: 0.12 or greater wide and bizarre
  21. Ventricular Tachycardia
  22. Ventricular Fibrillation
    • Rate: cannot be determined
    • Rhythm: baseline is totally chaotic
    • P wave: none
    • PRI: none
    • QRS: none discernible
  23. Ventricular Fibrillation
  24. Asystole
    No electrical activity; only straight line
  25. Asystole
  26. Premature Ventricular Contraction (PVC)
    • Rate: do not count PVCs
    • Rhythm: underlying can be regular or irregular
    • P waves: PVC not preceded by P wave
    • PRI: none w/ PVC
    • QRS: wide and bizarre; at least 0.12 second T wave is frequently opposite direction from QRS
    • Multi-focal or unifocal
    • **more than 6 PVCs / minute typically requires treatment**
  27. PVC (multifocal)
    • Couplet PVCs
    • Two PVCs in a row
  28. Bigeminy
  29. S&S / Tx
    Bradycardia
    • S&S: syncope & CHF
    • tx: Atropine; epinephrine/dopamine; pacemaker may be needed
  30. S&S / Tx
    Sinus Bradycardia
    • S&S: decreased CO (lightheadedness, chest pain, CHF)
    • Treat Cause (pain, hypovolemia)
    • Tx: betablockers, calcium channel blockers, digoxin, cardioversion
    • (rarely treated in emergency situation, always treat underlaying cause)
  31. S&S / Tx
    Atrial Fibrillation
    • S&S: decreased CO ( dizziness, fatigue, dyspnea)
    • tx: control rate (digoxin, beta blockers *lopressor*, calcium channel blockers *diltiazem/cardizem*) convert and maintain sinus rhythm (antidysrhythmics *amiodarone/cordarone*) Cardioversion if meds do not work.  (anticoagulants if pt has been in A-fib >48 hours; anticoagulation therapy recommended 3-4 weeks BEFORE cardioversion)
  32. ACE Inhibitors
  33. Beta Blockers
  34. Calcium Channel Blockers
  35. Nitros
  36. Antidysrhythmics
  37. Digitalis
  38. Heparin

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