cardiac dysrhythmias

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Author:
Martia
ID:
258884
Filename:
cardiac dysrhythmias
Updated:
2014-01-30 16:09:13
Tags:
nursing
Folders:
N303Critical Care,Test 1
Description:
nursing school
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  1. automaticity
    ability to spontaneously depolarize without external stimulus
  2. excitability
    ease or difficulty to invoke depolarization
  3. conductivity
    ability to transmit impulse to other cells
  4. contractility
    ability of cardiac cells to shorten in response to electrical simulation; squeeze of the heart
  5. rhythm analysis
    • normal QRS = .12
    • normal PR = .12 - .20
  6. dysrhythmia risk factors
    • electrolytes
    • fluid volume
    • hypoxemia/myocardial ischemia
    • mechanical factors (cardiomegaly; myocardial scar)
    • body temperature
  7. sinus bradycardia
    • HR<60 bpm
    • causes:
    • 1. sinus node disease
    • 2. meds
    • 3. hypoxia
    • 4. well conditioned athletes
    • treatment (if pt. is symptomatic):
    • 1. O2
    • 2. IV access
    • 3. consider temporary pacing
    • 4. meds - atropine sulfate : anticholinergic; 0.5mg IV Q3-5min max3mg
  8. sinus tachycardia
    • HR>100bpm (usually 100-150)
    • always has a cause :anxiety, pain, fever, activity, dehydration, heart failure, anemia
    • fix the cause and the rhythm will be fixed
    • meds - beta blockers & CCB
    • O2
  9. atrial fibrillation
    • irregularly irregular (QRS comes irregularly) with no meaningful P waves
    • loss of atrial kick (20-30% decrease in CO)
    • blood pools and clots in the atria, so high risk for embolus
  10. atrial flutter
    • atrial rate>250bpm
    • sawtooth P wave
  11. treatment for a fib/ a flutter
    • cardioversion
    • CCB
    • beta blockers
    • digoxin
    • amiodarone
    • diltiazem
    • anticoagulate
  12. superventricular tachycardia (SVT)
    • HR 150-250
    • always regular
    • paroxysmal (abrupt start and stop)
    • may or may not see p waves
    • treatment for stable SVT:
    • 1. valsalva maneuver
    • 2. adenosine - drug of choice
    • 3. carotid massage
    • 4. O2
    • treatment for unstable SVT:
    • 1. adenosine
    • 2. CCB
    • 3. beta blocker
    • 4 cardioversion
  13. premature atrial contraction
    • caused by early atrial depolarization (P wave) before next scheduled sinus beat
    • causes: emotion, stress, anxiety, fatigue, infection, lack of sleep, meds, caffeine, heart failure, MI, electrolyte imbalance
    • treat the cause if become symptomatic
  14. premature ventricular contraction
    • irritable ectopic site in ventricle
    • QRS wide and bizarre
    • t wave deflected opposite to the QRS
    • cause: increased age, hypoxia, MI, CHF, stress, meds, electrolyte imbalance, caffeine, alcohol, tobacco
    • treatment: eliminate cause; consider antiarrhythmic (amiodarone, lidocaine)
  15. ventricular tachycardia
    • cause: significant cardiac disease, K or Mag imbalance, artifacts (loose leads, brushing teeth); be sure to check the patient
    • treatment for stable with a pulse:
    • 1. amiodarone
    • 2. lidocaine
    • 3. magnesium
    • 4. potassium
    • 5. cardioversion
    • treatment for unstable with no pulse:
    • 1. CPR
    • 2. defibrillate
    • 3. epinephrine
    • 4. vasopressin
    • 5. amiodarone
    • 6. lidocaine
    • 7. resuscitation
  16. ventricular fibrillation
    • electrical chaos; no perfusion
    • always fatal unless terminated
    • treatment : immediate electrical shock
    • causes:
    • 1. heart disease, CAD, cardiomyopathy
    • 2. hypovolemia, hypoxia
    • 3. acidosis
    • 4. hypokalemia, glycemia, thermia
    • 5. hyperkalemia
    • 6. toxins
    • 7. cardiac tamponade
    • 8. trauma, tension pneumothorax, thrombus
  17. asystole
    • flat line; no electrical impulses
    • treatment :
    • 1. CPR
    • 2. epinephrine and vasopressin
    • 3. treat the cause
  18. 1st degree AV block
    • PR interval > .20
    • usually asymptomatic
  19. 2nd degree AV Block Mobitz I (wenkebach)
    • PR lengthens progressively until QRS is dropped
    • treat symptoms
  20. 2nd degree AV block Mobitz II
    • PR interval is constant
    • some beats are conducted = p wave then QRS
    • some beats nonconducted = p wave then no QRS
    • unstable and usually requires  pacemaker
    • cause :
    • 1. MI; AV node disease
    • treatment :
    • 1. atropine, dopamine, epinephrine
    • 2. pacemaker
  21. 3r degree AV block
    • no communication between atria and ventricles
    • no relationship between P waves and QRS
    • CO is decreased
    • P waves are a constant distance no matter what
    • Treat as symptomatic bradycardia
    • cause :
    • 1. meds (dig toxicity)
    • 2. acute MI; myocarditis
    • 3. degenerative heart disease
    • treatment :
    • 1. treat symptoms
    • 2. temporary pacing
    • 3. atropine, epi, dopamine
  22. defibrillation
    • asynchronous
    • high energy level
    • for pulseless V tach and V fib
  23. cardioversion
    • low energy shock
    • for unstable SVT, a fib, a flutter, V tach with a pulse
    • premedicate with sedation and pain meds

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