Arrhythmias: 220 Test II

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Arrhythmias: 220 Test II
2014-02-22 15:06:16
Arrhythmias cardiac nursing

Nursing 220 Test II: Arrhythmias (Vickers)
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  1. 2 things that must be done before any arrhythmia observed on an EKG is Tx?
    1. assess pt hemodynamic response to rhythm:  BP and symptoms

    2. find cause
  2. What will result from early beats on EKG if the pattern continues?
  3. EPS?
    stimulate various areas of the heart to stimulate arrhythmia & find area acting up
  4. What procedure may be done during EPS?
    may Tx Afib by ablation of SA node & putting in pacemaker
  5. AE of EPS?
    lethal arrhythmias can occur
  6. How long is Holter monitor worn?

    Pt teaching?
    24 - 48 h

    • 1. should not remove pads or shower
    • 2. keep a diary of s/s that occur to compare to EKG
  7. First action if see sinus brady on monitor?
    check on pt- may not be symptomatic - if not symptomatic will try to find cause & monitor
  8. 6 causes of  bradycardia?
    • 1. athletes
    • 2. sleeping
    • 3. hypothyroidism
    • 4. increased ICP
    • 5. hypoglycemia
    • 6. inferior wall MI
  9. Important consideration with bradycardia & DM?
    bradycardia & hypoglycemia have similar s/s - need to monitor pt BG & check BG if pt having s/s:  pale, cool skin; diaphoretic; weakness, dizziness, syncope; NV
  10. Action if pt is symptomatic with bradycardia?
    atropine 0.5mg & put pads for defib on to externally pace if atropine doesn't work

    pt may need PPM
  11. 5 s/s of bradycardia?
    • 1. low BP
    • 2. diaphoretic, pale, cool skin
    • 3. dizziness & syncope
    • 4. NV (decreased BF to GI)
    • 5. angina
  12. How will bradycardia be Tx if atropine is not an option?
    externally pacing with debifrillator
  13. If a pt has a HR of 56 & BP of 96/42 but is not symptomatic what will be the priority nursing action?
    look for cause & monitor closely
  14. Priority action with a pt who is tachycardic?
    Tx the underlying cause
  15. 4 causes of tachycardia?
    pain, anxiety, fever, shock
  16. 3 s/s of tachycardia?
    • 1. dizziness
    • 2. dyspnea
    • 3. hypotension r/t decreased CO
  17. What Tx may be used for tachycardia if pt is clinically stable?
    vagal maneuvers
  18. Tx for pt who is tachycardic & symptomatic?
    beta blockers to decrease HR & O2 use:  PO or IV (breviblock)
  19. Monitoring needed when giving beta blockers (for tachycardia)?
    Monitor closely to make sure don't drop HR or BP too much
  20. Tx for SVT?
    Tx anything that may be causing it first:  pain, anxiety, fever, shock

    Then will give adenosine to stop heart
  21. 6 causes of PACs?
    • 1. caffeine
    • 2. stress
    • 3. tobacco
    • 4. alcohol
    • 5. CAD
    • 6. COPD
  22. First action if new PAC develops?
    Assess pt (VS, chest pain, s/s) & eval for caffeine intake, stress, etc
  23. What is usually done if pt complains of PAC's?
    first priority is to ask about caffeine intake & monitor for more serious arrhythmias that can develop - will usually wear holter monitor
  24. Med that may be given for PACs?
    beta blocker
  25. IV beta blocker?
  26. Causes of BBB?
    anything that could overwork the heart & cause hypertrophy of heart muscle, MI
  27. First action if new BBB occurs on EKG?
    ask pt about chest pain - could be MI

    assess for other s/s
  28. Tx for BBB if it is ongoing?

    New development?

    assess pt for symptoms of MI & inform MD
  29. Atrial flutter?
    atrial tachydysrhythmia with regular or irregular R-R waves
  30. 3 causes of atrial flutter?
    • 1. CAD
    • 2. hypertension
    • 3. lung disease
  31. What med will be given to pt with ongoing atrial flutter?
    blood thinners r/t pooling in atria
  32. What may happen to the heart with atrial flutter?
    HF r/t fast HR & decreased CO
  33. 3 primary goals in Tx of atrial flutter?
    slow ventricular response with meds that increase AV block:  Ca channel blockers, beta blockers, digoxin
  34. Actions if pt is on a cardizem drip & HR is 56?
    Assess & get VS:  stop med & call MD
  35. 3 types of meds that may be given for atrial flutter?
    • 1. anticoagulants
    • 2. meds that increase AV block
    • 3. antiarrhythmia
  36. 3 anti-arrhythmic drugs that may be given for atrial flutter?

    2 reasons they may be used?
    cordarone, rhythmol, & betapace

    control rate or to convert to SR
  37. What Tx for atrial flutter may be used in emergencies?
    electrical  cardioversion
  38. Action to take before use of electrical cardioversion for any pt?
    sedate with versed or diprovan:  pt feels pain but won't remember it
  39. 7 causes of Afib?
    • 1. CAD
    • 2. CHF
    • 3. cardiomyopathy
    • 4. caffeine
    • 5. stress
    • 6. cardiac surgery
    • 7. thyrotoxicosis
  40. Afib with RVR?

    What will be the result?
    Afib with rapid ventricular response

    will cause decreased CO
  41. What must be done before treating any pt with an arrhythmia?
    assess if pt is symptomatic
  42. 3 goals of Tx with Afib?
    • 1. Keep vent. response to <100
    • 2. prevent cerebral embolism
    • 3. convert to SR if possible
  43. Meds that Afib pt may be taking?
    • all are on anticoagulants (warfarin or aspirin)
    • Ca channel blockers, beta blockers, or digoxin to decrease ventricular response to fast atrial contraction
  44. What may occur if a pt taking Ca channel blockers, beta blockers, or digoxin to control ventricular response with Afib stops taking these meds?
    can cause arrhythmia to develop
  45. How may Afib be converted to SR?

    What action must be taken before Tx is done?
    cardioversion/antiarrhythmic drugs

    must do TEE t check for clots in atria to prevent embolism during Tx
  46. What antiarrhythmic drugs may be given for Afib?
    Cordarone, batapace
  47. fdaWhen my Afib be an emergency?

    What Tx may be used?
    Afib with RVR

    may need cardioversion
  48. 3 types of arrhythmias commonly caused by caffeine use?
    PACs, Afib, & PVCs
  49. How will cardioversion be done for Afib?
    sedate with versed or diprovan & use low joules
  50. Ablation therapy for Afib?
    same as for flutter:  ablate SA node & put in PPM
  51. Maze procedure?
    surgical procedure that interrupts Afib ectopic signals

    incisions are made in both atria & cold therapy used to stop formation & conduction of signals & restore SR
  52. 7 causes of PVCs?
    • 1. stress
    • 2. caffeine
    • 3. hypoxia
    • 4. hypokalemia
    • 5. MI
    • 6. fever
    • 7. exercise
  53. Lab that will be important for all atrial flutter & Afib patients?
    PT INR

    platelets if on aspirin
  54. If a pt has PVCs what should be first action?
    check on pt:  check O2 status & if O2 is on & check electrolytes (esp. K & Mg)

    check electrolytes before calling MD!
  55. Meds that may cause PVC's?
    K+ wasting meds:  diuretics
  56. Can lasix be given to a pt having PVCs?
    yes, if K is normal
  57. What pt can go into lethal arrhythmia easily?
    pt with low EF:  CHF:  need perfect K level
  58. Priority actions with a pt having PVC's?
    • 1. check O2 & electrolytes
    • 2. monitor closely - can develop lethal arrhythmia
  59. Tx that may be used for PVC's?
    • 1. K & Mg replacement & O2
    • 2. lidocaine
    • 3. cordarone
    • 4. beta blockers
  60. What type of arrhythmias may be caused by hypokalemia?
    PVCs, Vtach, VFib, Torsades
  61. V tach?

    Priority action?
    run of 3 or more PVCs

    assess pt immediately & check leads:  may be artifact
  62. Sustained & nonsustained V tach?
    sustained > 30 seconds:  compromises CO & increases risk for development of V fib
  63. 4 things that may occur r/t sustained V tach?
    • 1. hypotension
    • 2. pulmonary edema
    • 3. decreased cerebral BF
    • 4. cardiopulmonary arrest
  64. Stable & nonstable V tach?
    stable = has a pulse
  65. Tx of V tach?
    must ID & Tx cause
  66. Tx for V tach with a pulse?
    lidocaine or cordarone
  67. Major AE of cordarone?
    prolonged QT interval
  68. Normal QT interval?
  69. Tx for pulseless V Tach?  (same as Tx for V Fib)
    difibrillate & CPR
  70. Clinical characteristics of pt with V Fib?
    ventricle is quivering with no pulse or CO

    will be unresponsive & apneic
  71. 3 causes of V Fib?
    • 1. MI
    • 2. hyper/hypokalemia
    • 3. hypoxia
  72. What arrhythmias may be Tx with lidocaine?
    PVCs, Vtach
  73. Consideration with renal failure & arrhythmias?

    What other condition can cause this?
    renal failure can cause fast increase in K

    DKA - K+ is attracted to acidic environment & goes into blood
  74. Tx for hyperkalemia in emergencies?

    If cause by DKA?
    will give 10u R insulin with D50 (to prevent hypoglycemia OR give bicarb
  75. 3 Tx/procedures that can cause V Fib?
    cardiac pacing, cath procedures, after coronary reperfusion with fibrinolytics
  76. Tx for V Fib?
    immediate initiation of CPR & defibrillation
  77. 4 causes of Torsades?
    • 1. hypokalemia
    • 2. hypomagnesemia
    • 3. OD on tricyclic antidepressants:  imipramine, amitryptyline, nortriptyline, etc
    • 4. antidysrhythmic drugs
  78. Tx for Torsades?
  79. Causes of first degree AV block?
    MI & ischemia of heart, some drugs
  80. Symptoms of first degree AV block?
    will be asymptomatic but may be precursor to more serious rhythms:  need to monitor
  81. Most important intervention with existing first degree AV block?

    With new development?
    existing:  monitor for more serious dysrhythmias

    new:  check pt for s/s of ischemia/MI
  82. Why can MI cause AV blocks?
    can cause infarction at AV node
  83. Tx of first degree AV block?
    monitor for more serious arrhythmias & stop any meds that may increase the block:  Ca channel blockers,  beta blockers, digoxin:  any med that slows HR can slow conduction
  84. Causes of Wenckebach?
    • dig or beta blockers
    • Usually r/t:  MI or ischemic heart
  85. Priority action if Wenckebach occurs?
    assess pt
  86. Tx for symptomatic & asymptomatic Wenckebach?
    symptomatic:  atropine 0.5mg &/or temporary pacemaker

    asymptomatic:  monitor & have TCP nearby
  87. If no cause for Wenckebach other than old age what will Tx probably be?
  88. What often occurs with 2nd degree AVB type II?
    progresses to 3rd degree
  89. Results of 2nd degree AVB type II?
    decreased HR, BP, CO leads to myocardial ischemia
  90. 3 causes of 2nd degree AVB type II?
    • 1. MI
    • 2. dig toxicity
    • 3. rheumatic heart disease
  91. Tx for 2nd degree AVB type II?
    will get temporary pacemaker until permanent one can be put in

    symptomatic:  atropine & temp pacemaker
  92. 6 causes of 3rd degree AVB?
    • 1. MI
    • 2. heart surgery
    • 3. dig, beta blockers, Ca channel blockers
    • 4. myocarditis
    • 5. cardiomyopathy
    • 6. CAD
  93. What are the results of 3rd degree heart block?
    decreased CO leads to myocardial ischemia, HF, & shock
  94. S/S of 3rd degree heart block?
    s/s of decreased CO:  decreased HR, BP, dizziness, dyspnea, chest pain, etc

    may be asymptomatic rarely
  95. Tx of 3rd degree AVB?
    same as for 2nd degree Type II:  atropine and temporary pacing until PPM
  96. Priority actions if asystole occurs?
    look at 2 lines to make sure & assess pt
  97. 2 causes of asystole?
    MI & cardiac trauma
  98. Tx of asystole?
    CPR, ACLS, intubation, TCP, & Tx cause
  99. Meds used for asystole?
  100. Defibrillation?
    pass electric shock that causes depolarization -purpose is so repolarization will occur & allow SA to resume pacemaker role
  101. When is defibrillation used?
    pulseless V tach & V fib
  102. Monophasic defib AE?
    causes more burns
  103. Advantage of biphasic?
    less post defib EKG abnormalities & less burns

    need less joules
  104. Biphasic initial & successive shocks?
    120-200 joules
  105. How is monophasic used?
    initial shock 350 joules then start CPR with chest compressions
  106. Steps for defibrillation?
    • 1. do CPR until defib avail
    • 2. turn on, & select energy
    • 3. make sure synchronizer switch is off
    • 4. deliver shock 
    • 5. place pads:  R of sternum just below clavicle & L of apex
    • 6. all clear & shock
  107. 3 arrhythmias that may require synchronized cardioversion?
    • 1. V tach with a pulse
    • 2. SVT
    • 3. A fib with RVR
  108. What is done before use of synchronized cardioversion?
    sedation with versed or diprovan b/c painful

    may also give demerol for pain
  109. Procedure for synchronized cardioversion?
    same procedure as for defib EXCEPT:  make sure synchronization switch is ON - if not can cause it to hit on QT interval & cause lethal arrhythmia
  110. 2 priorities when using synchronized cardioversion?
    • 1. maintain patent airway
    • 2. if pt becomes pulseless turn synchronization switch off & defibrillate
  111. Function of implantable cardioverter-defibrillator?
    monitors HR & rhythm:  shocks with 25 joules if VT or VF occurs

    can also Tx brady & tachy rhythms
  112. Pre & post procedure pt management with implantable cardioverter-defibrillator?
    similar to PPM placement
  113. Pt education post-cardiovert/defibrillator placment?
    • 1. Need follow-up to check device
    • 2. normal post surgery instructions
    • 3. keep incision dry for 4 days
    • 4. avoid lifting arm on ICD side above shoulder
    • 5. no driving until cleared
    • 6. No direct blows t ICD site
    • 7. Avoid lg magnets, MRI, security devices in stores (don't stand in them),
    • 8. if ICD fires call MD; if it fires more than once or if s/s are occurring with firing:  call EMS
    • 9. wear medic alert ID & carry ICD card & current list of meds
    • 10. CG should learn CPR
  114. PPM?
    power source placed over pec on nondominant side & pacing wires through R atrium & 1 or both ventricles
  115. Where will PPM be placed?
    surgery or cath lab
  116. Pre-op care for PPM?
    may do hibiclens etc
  117. Action if hiccups occur after placement of PPM?
    need to inform MD:  may be r/t pacing wire touching diaphragm
  118. PPM care?
    • 1. do not allow pt to sleep or turn on R side for about 1 month
    • 2. do not raise arm where PPM placed
    • 3. HOB elevated & bedrest X 24h
    • 4. no pullover shirts X 1 month
    • 5. keep immobilizer on until MD D/C's order
  119. Temporary pacemaker?
    power source outside body & sheath with wires in it placed in jugular or femoral vein
  120. When can pt ambulate after placement of temp pacemaker?
    30min to 1h after procedure
  121. Tx for dig toxicity?
    digibind & may put in temporary pacemaker until it works
  122. 3 types of temporary pacemakers?
    transvenous, epicardial, & transcutaneous
  123. Purposes of transvenous pacemaker?
    • 1. use until underlying cause is found
    • 2. bridge for PPM
    • 3. prophylactic in case of brady or tachy dysrhthmias post op
  124. When is TCP used?
    in emergencies
  125. Where are pads placed for TCP?
    one on anterior & one on posterior of chest
  126. Pt teaching with TCP?
    will be painful but is temporary
  127. Monitoring for pt with any type of pacemaker?
    will have EKG monitoring
  128. 2 types of pacemaker malfunctions & their effects?
    failure to sense:  doesn't sense underlying rhythm:  can cause firing during QT

    failure to capture:  pacemaker firing doesn't cause contraction:  can cause bradycardia or asystole
  129. 5 complications of pacemaker placement?
    • 1. infection
    • 2. hematoma
    • 3. pneumothorax
    • 4. failure to capture/sense
    • 5. perforation of atrial or ventricular septum
  130. 4 actions to prevent complications with pacemaker placment?
    • 1. prophylactic IV ABX before & after
    • 2. postinsertion CXR for lead placement & pneumothorax
    • 3. observation of insertion site
    • 4. continuous EKG
  131. S/S of pneumothorax?
    • 1. chest pain
    • 2. tachycardia & tachypnea
    • 3. dyspnea
    • 4. cough
  132. PPM discharge instructions?
    • 1. limit arm & shoulder mvmt & do not: Lift arm above shoulder on PPM side, lift anything heavier than newspaper/fork, do yard work, use rifle, hit,
    • 2. report s/s of infection/bleeding
    • 3. do not get wet until MD says
    • 4. avoid direct blows, close proximity to high-output electric getnerators, MRI, anti-theft devices, metal detectors (tell airport security), lean directly over open hood of running car, have cell phone in breast pocket
    • 5. monitor pulse regularly & inform PCP if below expected rate
    • 6. carry pacemaker info card & current list of meds & wear medic alert bracelet
    • 7. do not remove steri-strips:  they will fall off
    • 8. do not wear tight clothes
  133. Can person with PPM use a microwave?
  134. ICD?
    internal cardiac difibrillator - senses lethal arrhythmia and fires
  135. cardiac resynchronization therapy?
    resynchronizes cardiac cycleby pacing both ventricles
  136. What pt may have cardiac resynchronization therapy?
    pt with HF with intraventricular conduction delays

    pt with severe vent dysfunction will also have ICD