MSII_2_Dysrhythmias

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Author:
vanwin
ID:
273013
Filename:
MSII_2_Dysrhythmias
Updated:
2014-05-03 17:34:25
Tags:
medsurg nursing
Folders:
MSII,MSII_E1
Description:
UT Tyler Nursing
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  1. ECG reading steps
    • Rate
    • Rhythm (reg/irreg)
    • P
    • PR
    • QRS
    • ST
    • T wave
    • QT interval
    • identify
  2. How to calculate ECG rate
    • 6 second strip: count R waves then (x) by 10
    • if not; count number of small boxes between 2 R waves
    • > 300 > 150 >100> 75> 60>50> 43> 37
  3. T wave reading
    • .3-.4 secs
    • high = hyperkalemia
    • low = MI
  4. Normal PR interval
    • 3-5 smll boxes
    • .12-.2 secs
  5. Normal QRS complex
    narrow
  6. Normal QT interval
    .32 -.42 secs
  7. Raise/ Depressed ST segment
    • raise = MI
    • depressed = ischemia
  8. Sinus Bradycardia causes (4)
    • nothing; its their baseline
    • digoxin
    • hypothyroidism
    • ↑ICP
  9. Sinus Bradycardia treatment (2)
    IV atropine .5 - 1 mg; up to 2mg

    pacemaker
  10. Sinus Tachycardia treatment
    treat underlying causes- fluids? frm dehydration? B-blockers?
  11. Clinical significance of atrial flutter (3)
    • loss of atrial kick
    • risk of thrombus
    • ↓ Cardiac output
  12. Atrial flutter treatment goal
    • decrease ventricular response
    • control pacing
  13. Atrial flutter treatment (4)
    • Anticoagulant
    • beta blockers/calcium channel blockers
    • cardioversion if emergency
    • catheter ablation
  14. Atrial fibrillation treatment
    • *cntrl clotting & rate*
    • If in Afib longer than 48 hrs; anticoagulant before cardioversion
    • if emergency; TEE before cardioversion (check for clots)
  15. 1st degree AV block
    • prolonged PR intervals
    • benign
    • asymptomatic
    • may lead to something worse
  16. 2nd degree AV block type I
    • gradually prolonged PR interval until QRS complex is skipped
  17. Second degree AV block type II
    • random dropped QRS complex
  18. 3rd degree AV block
    Atria & ventricles functioning independently of each other
  19. 3rd degree heart block treatment
    • transcutaneous pacing until pacemake is put in
    • atropine/ dopamine in the mean time
  20. Possible causes of PVC's
    • stimulants
    • hypoxia
    • hypokalemia
    • acidosis
  21. PVC concerns
    • if after MI
    • acute onset
    • R on T phenomenon
    • more than 6 per min
  22. PVC treatment
    amiodarone/ lidocaine bolus drip
  23. R on T phenomenon
    PVC R wave happens at T segment, can lead into V fib
  24. V Tach treatment
    defib if no pulse

    • if awake: amiodarone, lidocaine, pronestyl
    • then cardiovert
  25. Defibrilation nursing consisderation (3)
    • 5 inches away from pace maker
    • remove nitro patches

    document
  26. Asystole treatment (5)
    • BLS
    • ALS
    • CPR
    • atropine
    • percutaneous pacing
  27. Uses of cardioversion
    Everything except for Vfib
  28. Cardioversion (6)
    • Consent needed
    • 50-100 joules
    • synch button
    • NPO before
    • IV sedation
    • monitor digoxin & K levels
  29. Implantable cardioverter Defibrillator (4)
    • defibs if pt after 25 secs of vfib
    • for patients with high risk of Ventricular dysrhythmias
    • sends straight to heart so less voltage needed
  30. ICD teaching
    • sit down after being shocked
    • go see doctor after being shocked
  31. Pacemaker patient teaching (5)
    • watch signs of infection
    • check pulse daily
    • avoid weight bearing on affected side
    • cary pace maker card
    • avoid MRI & trauma to site
  32. Pacemaker malfunctions
    • failure to sense
    • failure to capture

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