more ekg

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more ekg
2015-08-30 20:22:27
test ekg

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  1. No P-Wave, No PRI, No QRS

    baseline is totally chaotic

    Pt has no heart beat, no cardiac output, is clinically dead
    Ventricular fibrillation
  2. Clinical picture of Ventricular fibrillation
    • NO BP, pulse or resp
    • unresponsive, cold, clammy, pale, and cyanotic
    • intervention defib 200, 300, 360 then CPR
  3. Bundle branch block
    • QRS 0.12 or greater
    • Can be left or right
    • watch for heart blocks
  4. what is a bundle branch block
    • impulse reaches the ventricles at different times
    • Wide QRS pathways with 2 peaks
    • QRS .12 or greater
  5. Asystole
    what is it, how to treat it?
    • no electrical activity, flat baseline
    • start with CPR, no electrical activity to shock
  6. ischemia is represented by...
    ST- depression and t-wave inversion
  7. Injury is represented by...
    ST-elevation, tombstone T-Waves
  8. MI is represented by ...
    significant Q-Wave
  9. what causes U-Wave?
  10. Hyperkalemia causes..
    tall peaked T-waves
  11. which is more concerning, Hypokalemia or Hyperkalemia
    Hyperkalemia = tall peaked T-Waves

    Hypokalemia = U-Wave and systole
  12. Defibrillation occurs when...
    • an electrical current is strong enough to depolarize a critical mass of cardiac fibers
    • The depolarization is followed by a spontaneous repolarization which will restore coordinated effective heart contraction by allowing the pacemaker in the atrium to resume dominence
  13. each cardiac cycle has a vulnerable period which is essentially the ...
    • T-wave
    • during this brief period, any electrical stimulus that occurs may induce Ventricular Fibrillation
  14. synchronized is _____
    • cardioversion
    • by synchronizing the defib unit with pts heart rhythm  it prevents the electrical shock from occurring during the T-Wave
  15. unsynchronized is ______
    • defibrillation
    • electrical energy is delivered through the chest wall all myocardial cell halt and the SA node starts controlling the rhythm again
  16. Defibrillation
    • unstable V-Tach (unconscious)
    • Ventricular Fibrillation
    • Defib rapidly up to 3 times as nec, 200, 300, 360 checking the pulse between each shock
  17. Defibrillator safety
    • operator makes sure all personal are away fro the bed, and defib
    • only touch pt with paddles
    • operator should not be preforming CPR
    • do not discharge in the air
    • apply gel to pads
    • operator should be standing in a dry surface
    • remove all NTG sources
    • no ETOH
    • Turn pacer off
  18. Synchronized Cardioversion
    • programs the machine to know the patients rhythm so that the shock is not given during the T-Wave (vulnerable period). usually shocks during the R-wave
    • 50,100,...
  19. when should cardioversion be used
    • Supraventricular tachycardia
    • uncontrolled atrial fibrillation
    • uncontrolled atrial flutter
    • ventricular arrhythmias (stable v tach)
  20. pacemakers
    • can be temp or permant used to pace the heart when normal conduction tissue is unable to generate a normal adequate rhythm
    • they deliver electrical stimulation to myocardial muscle when normal conduction tissue of the heart fails to generate adequate BPM
  21. what is the purpose of the pacemaker
    • to generate electrical stimulation when SA has failed and the AV and purkinjie fibers cannot provide adequate backup
    • To generate a HR that creates an adequate cardiac out put and stable blood pressure
    • can also be programmed to generate atrial contractility in lower generated pacer rhythms (improve ventricular rhythms)
    • To override (outpace) ectopic tachy rhythms
  22. transvenous pacing
    wire feed into the rt atrium but the end of the pacing catheter is on the outside and is attached t the external generator
  23. epicardial pacing
    used after open heart surgery, wires are placed on the epicardium rt atrium and rt ventricle and attached to external generator
  24. temporary and parment pacemaker wires are
    the wires are on the right side of the heart
  25. indications for temp pacemaker
    • crisis intervention (3rd degree heart block,   symptomatic bradycardia (until perment), cardiac arrest)
    • Short term support ( following cardiac surgery, insertion of a temp atrial pacing wire to override atrial tachycardia)
  26. permanent pacemakers, when are they indicated?
    long term rhythm disturbances such as sinus bradycardia, sinus arrest, heart blocks, tachyarrythmias, a fib with slow ventricular rate)
  27. how do we know pt has pacemaker?
    • pacer spikes
    • if atrial pacing spike with be before the p-wave
    • ventricular paced when pacing spike is before QRS
  28. pacemaker terminology
    pacer has discharged an adequate electrical impulse and depolarization QRS has occurred

    (non-capture is when pacer spike fails to produce desired effect)
  29. things that will cause pacer to non-capture
    • low Ma
    • lead misplaced
    • drifting lead
    • placed in scar tissue
    • (evaluated with x-ray)
  30. Demand Pacing
    • pacer is set to fire when the pts HR falls below set rate.
    • synchronous demand pacing means that generated impulse occurs as needed
    • triggered or asynchronous demand is when the pacemaker fires continuously at fixed rate-regardless of underlying rhythm
  31. pacer terminology
    pacemaker Is set to detect the patients own heart rhythm
  32. pacemakers are identified by ....
    • letter codes
    • 1st letter = chamber being paced (Atial, Ventricle, Dual, O is nothing)
    • 2nd letter = chamber which the pacemaker can sense pts electrical activity (A,V,D,O)
    • 3rd letter= tells what the pacer does in response to sensing the pts own electrical activity
    • 4th letter= tell sophistication of the pacer (Not always a 4th letter)
  33. complications with pacemaker
    • failure to fire, capture, or sense
    • oversensing
    • Ventricular irritability
    • may cause abdominal twitching or hiccups
    • infection or phlebitis
    • migration of generator
    • malfunction related to the defib
  34. Nursing Management
    for paccemaker
    • assess fro infection, check connctions, batteries, keep generator suspended
    • Safety-prevent microshocks! wear rubber gloves when handling pacer wires, no electrical equipment by the bed
    • NO MRIs or TENS unit
  35. Ablation
    • study to evaluate electrical activity with the insertion of multiple catheters
    • stimulate arrhythmias
    • burn tissue that initiates it
    • (localized destruction or excision of cardiac tissue that initiates the arrhythmia)
    • Indicated for SVT, AFib, Aflutter, VT
  36. Pre-Ablation
    • education
    • cardiac monitoring, hemodynamic monitoring, labs, no preg
    • Antiarrhythmics are held several days before
    • NPO 8 Hours prior to procedure
  37. During ablation
    • education
    • safety equipment
    • telemetry
    • monitor hemodynamic status, ACT, sedation status
  38. Post ablation
    • VS
    • Monitor rhythm
    • assess insertion sites and peripheral pulses, LOC, N/V, I&O, assess for bleeding
    • Leg immobilization for 4-6hours
  39. ICD
    • can cardiovert, pace and defib when needed
    • need to have psyc eval to make sure they can handle being shocked.
  40. indications for ICD
    • cardiac arrest
    • high risk for sudden death
    • ventricular arrhythmias that are under control with medications
    • Educate
    • Family must be trained in CPR
    • Must wear ID