Adult Health_Exam 2

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NLH_828
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66595
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Adult Health_Exam 2
Updated:
2011-02-15 23:04:25
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Dysrythmia Review
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ECG, dysrythmias, cardiac
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  1. Normal sinus rhythm (ECG pattern)
    • Rhythm: Regular
    • Rate: 60-100
    • P Waves: upright, identical, 1 per QRS
    • PR Interval: .12-.20 sec
    • QRS duration: .10 sec
  2. Sinus bradycardia (ECG pattern)
    • Rhythm: Regular
    • Rate: <60
    • P Waves: upright, identical, 1 per QRS
    • PR Interval: .12-.20 sec
    • QRS duration: .10 sec
  3. Sinus tachycardia (ECG pattern)
    • Rhythm: Regular
    • Rate: 101-180
    • P Waves: upright, identical, 1 per QRS (at high rate may blend with T-wave)
    • PR Interval: .12-.20 sec
    • QRS duration: .10 sec
  4. Sinus arrythmia (ECG pattern)
    • Rhythm: Irregular, phasic with respiration
    • Rate: Usually 60-100, but may vary
    • P Waves: upright, identical, 1 per QRS (at high rate may blend with T-wave)
    • PR Interval: .12-.20 sec
    • QRS duration: .10 sec
  5. Sinoatrial (sinus) block (ECG pattern)
    • Rhythm: Irregular, and the pause is an EXACT MULTIPLE of the distance between two other P-P intervals
    • Rate: Usually normal, but varies due to block
    • P Waves: upright, identical, 1 per QRS (at high rate may blend with T-wave)
    • PR Interval: .12-.20 sec
    • QRS duration: .10 sec
  6. Sinus arrest (ECG pattern)
    • Rhythm: Irregular, more than one P-QRST complex missing and NOT SAME DISTANCE as other P-P intervals
    • Rate: Usually normal, but varies due to block
    • P Waves: upright, identical, 1 per QRS (at high rate may blend with T-wave)
    • PR Interval: .12-.20 sec
    • QRS duration: .10 sec
  7. Wandering atrial pacemaker (ECG pattern)
    • Rhythm: Regular OR irregular
    • Rate: Usually normal, may be slower
    • P Waves: Vary in size, shape, direction across rhythm strip, with at least THREE variations
    • PR Interval: .12-.20 sec
    • QRS duration: .10 sec
  8. Premature atrial complexes (ECG pattern)
    • Rhythm: Irregularity caused by PAC
    • Rate: Underlying rhythm
    • P Waves: P-wave associated with PAC is abnormal or hidden
    • PR Interval: .12-.20 sec (may be prolonged)
    • QRS duration: .10 sec or less
  9. Supraventricular tachycardias (atrial tachycardia) (ECG pattern)
    • Rhythm: Regular
    • Rate: atrial 140-250, vent. 140-250
    • P Waves: abnormal, often pointed, may be hidden in preceeding T-wave or in the QRS complex
    • PR Interval: not measurable
    • QRS duration: .10 sec or less
  10. Atrial flutter (ECG pattern)
    • Rhythm: Atrial is regular, vent. is irregular depending on AV blockade
    • Rate: Atrial rate of 250-450, vent. rate is variable but usually does not exceed 180
    • P Waves: Saw toothed, flutter waves
    • PR Interval: Not measurable
    • QRS duration: .10 sec or less
  11. Atrial fibrillation (ECG pattern)
    • Rhythm: Irregular
    • Rate: Atrial rate is 400-600, vent. rate is variable
    • P Waves: Not identifieable, fibrillatory waves
    • PR Interval: Not measurable
    • QRS duration: .10 sec or less
  12. Premature ventricular complexes (ECG pattern)
    • Rhythm: Usually normal
    • Rate: Usually regular with premature beats
    • P Waves: Usually absent or after QRS of PVC
    • PR Interval: None with PVC, the beat originates in the ventricle
    • QRS duration: Greater than .12 sec, and is wide and bizarre
  13. Idioventricular rhythm (ECG pattern)
    • Rhythm: Essentially regular
    • Rate: 20-40
    • P Waves: Usually absent, can appear after QRS if retrograde conduction
    • PR Interval: None
    • QRS duration: Greater than .12 sec, T-wave frequently opposite QRS complex
  14. Ventricular tachyardia (ECG pattern)
    • Rhythm: Essentially regular
    • Rate: 101-300
    • P Waves: Not usually present, and if it is present it has no relationship to QRS
    • PR Interval: None
    • QRS duration: wide, greater than .12 sec
    • Monomorphic VT: QRS complexes are of same shape and amplitude
    • Polymorphic VT: QRS complexes are variable in size, shape, and amplitude; Normal QT verus long QT or Torsades de Pointes
    • Sustained VT= greater than 30 seconds
  15. Ventricular fibrillation (ECG pattern)
    • Rhythm: Rapid and chaotic, no pattern
    • Rate: Unable to determine
    • P Waves: None
    • PR Interval: None
    • QRS duration: None
  16. First degree AV block (ECG pattern)
    • Rhythm: Regular
    • Rate: Usually normal
    • P Waves: Normal, upright
    • PR Interval: Prolonged, >.20 sec, CONSTANT
    • QRS duration: .10 sec or less
  17. Second degree AV block Type I (ECG pattern)
    • Rhythm: atrial regular, vent. irregular
    • Rate: atrial rate > than vent. rate
    • P Waves: Normal in configuration, more P waves than QRS
    • PR Interval: Lengthens with each cycle until QRS is dropped
    • QRS duration: .10 sec or less, periodically dropped
  18. Second degree AV block Type II (ECG pattern)
    • Rhythm:atrial regular, vent. irregular, P's plot through time
    • Rate: atrial rate is > than vent. rate, vent. rate is often slow
    • P Waves: Normal in configuration, more P's than QRS's
    • PR Interval: WNL or slightly prolonged constantly
    • QRS duration: .10 sec or less, periodically dropped
  19. Third degree AV block
    • Rhythm: atrial regular, vent. regular, however there is NO ASSOCIATION between the two
    • Rate: atrial rate is > than vent. rate
    • P Waves: Normal inconfiguration
    • PR Interval: None; both atria and vent. beat independently of each other
    • QRS duration: Escape beats, depends on origin
  20. Give 5 causes of bradycardia?
    • Medications (beta blockers, digitalis, calcium channel blockers)
    • Hypoxia
    • MI
    • Hypo/Hyperkalemia
    • Hypothyroidism
  21. What medication is often used to treat bradycardia?
    Atropine
  22. Give 8 causes of tachycardia?
    • Exercise
    • Anxiety/Fear
    • Infection
    • Pain
    • Dehydration/hypovolemia
    • Medications/Illicit drugs (Epi, dopamine, cocaine)
    • Caffeine
    • Nicotine
  23. Could sinus arrythmia occur in the healthy adult?
    Yes
  24. Give three causes of sinus arrythmias?
    • Post MI/heart disease
    • Increased ICP
    • Effects of medications (Digitalis)
  25. Treatment for sinus arrythmia?
    Only necessary to treat if accompanied by slow heart rate with hemodynamic compromise; would treat with Atropine and transcutaneous pacing
  26. Give two treatments for bradycardia?
    • Atropine
    • Transcutaneous pacing
  27. When would you treat bradycardia?
    When patient is symptomatic (signs of shock, chest pain, sudden altered status, or high degree sinus block)
  28. Give 4 causes of SA block?
    • AMI
    • Medications
    • CAD
    • CHF
  29. Treatment for SA block?
    • Stable: remove causative meds if necessary and monitor patient
    • Unstable: IV atropine, TCP, and insertion of PPM if needed
  30. Give 4 causes of sinus arrest?
    • Hypoxia
    • Myocardial ischemia/infarction
    • Hyperkalemia
    • Medications (beta blockers, digitalis, calcium channel blockers)
  31. Treatment for sinus arrest?
    • Stable: monitor
    • Unstable: Atropine, TCP, insertion of PPM if needed
  32. Can wandering atrial pacemaker be seen in the healthy adult?
    Yes
  33. Give two commonly co-occurring conditions with wandering atrial pacemaker?
    Underlying heart disease and digitalis toxicity
  34. Premature atrial complexes are often common in the normal adult in response to _____, ______, _____, or ______ use?
    • Stress
    • Alcohol
    • Caffeine
    • Tobacco
  35. Give two causes of premature atrial complexes?
    • Heart disease
    • Electrolyte disturbances
  36. What do frequent PAC's sometimes warn of or initiate?
    A more serious atrial rhythm such as tachycardia and atrial fib
  37. What does paroxysmal mean?
    Sudden onset and sudden end, but occurs greater than 50% of the day
  38. Give 7 common causes of atrial tachycardia?
    • Stimulant use
    • Infection
    • Electrolyte imbalances
    • MI or other heart disease (often common after bypass surgery)
    • Hypoxia
    • Medications
    • WPW, abnormal accessory pathways
  39. Give 5 common symptoms of atrial tachycardia?
    • Palpitations/heart "flutter"
    • Chest pressure
    • Dizziness
    • Lightheadedness
    • Dyspnea
  40. Treatment of atrial tachycardia?
    • Stable:
    • IV access
    • O2
    • 12 lead
    • Vagal maneuvers
    • Antiarrythmics
    • *Seek expert consultation*

    • Unstable:
    • IV access
    • Synchronized cardioversion
    • Antiarrythmics (Adenosine - stops the heart; WARN THE PT!)
    • *Seek expert consultation*
  41. What voltage is used with synchronized cardioversion?
    30-100
  42. When is unsynchronized cardioversion used?
    With LETHAL rhythms withOUT a pulse (Vfib, pulseless VT)
  43. What should the nurse make absolutely sure of prior to administering either type of cardioversion?
    That the patient is SEDATED
  44. When is synchronized cardioversion used?
    In rhythms WITH a pulse (atrial fib, atrial flutter)
  45. True or False: Atrial flutter is usually paroxysmal and occasionally does not occur more than 24 hours - will convert to SR or atrial fib
    True
  46. Should symptomatic atrial flutter patients be cardioverted immediately, or after medication has first been administered?
    IMMEDIATELY
  47. What symptoms do you expect with high rate atrial flutter?
    • Weakness
    • Dizziness
    • Fainting
    • Chest pain
    • Heart flutters
    • Difficulty breathing
    • Nausea
  48. When would cardioversion be contraindicated?
    • Digitalis toxicity
    • Sinus tachycardia
  49. What should be performed prior to cardioversion?
    ???
  50. What is the most common arrythmia?
    Atrial fib
  51. Give 7 common causes of atrial fib?
    • Many heart conditions
    • CABG surgery
    • Systemic infection
    • WPW (Wolfe Parkinson Syndrome)
    • Pericarditis
    • Pulmonary embolism
    • Hypoxia
  52. Treatment of atrial fib?
    • Control heart rate
    • Anti-coagulation and prevention of clots
    • Cardioversion
    • Surgery
    • Antiarrythmics (Amiodarone, Cardizem, sotolol)
  53. What oral drug is used for anti-coagulation?
    Coumadin
  54. How often should INR be assessed in the pt undergoine anti-coagulation therapy, and what should the level be to be therapeutic?
    • Weekly
    • Between 2-3
  55. Give 2 most common complications of ablation of pathways?
    • Hematoma at the introduction site
    • AV block
  56. Give three tachyarrythmias that ablation of pathways may be used?
    • A fib
    • A flutter
    • SVT
  57. When are PVCs worrisome?
    • Frequent (>6 per minute)
    • Coupled or paired, trigeminy
    • Multiform (coming in from several different areas)
    • During an AMI
    • On the T-wave
  58. What do you do when your patient's rhythm begins to include worrisome PVCs?
    Give the patient LIDOCAINE
  59. What treatment does accelerated idioventricular rhythms require?
    Usually none, unless symptoms are associated
  60. How do you identify vent. tachycardia?
    Big, wide QRS complex with a heart rate > 100
  61. What are the symptoms of vent. tachy?
    • Heart fluttering
    • Pt doesn't feel well
  62. If a patient has sustained ventricular tachycardia, what will happen?
    If sustained, the pt will code
  63. What is ventricular tachycardia often associated with? Give 3.
    Underlying heart disease (valve disease, ACS, cardiomyopathy, CHF, trauma to the heart, Long QT syndrome)

    Drugs (cocaine, digitalis, TCAs)

    Electrolyte imbalances (hypo/hyperkalemia, hypomagnesemia**associated with Torsades)
  64. What is the FIRST thing you do when you see VT on the heart monitor?
    • Check the patient
    • Determine if stable or unstable
  65. What three types of meds would you give a pt with unstable vent. tachycardia?
    • Amiodarone
    • Lidocaine
    • ACLS drugs
  66. What are some drugs that can lengthen QT interval?
    • Amiodirone
    • Sotolol
    • Haldol
  67. Give 5 causes of vent. fibrillation?
    • Heart disease (ACS, CHF, arrythmias, Long QT syndrome)
    • Electrolyte disturbances (hypo/hyperkalemia, hypomagnesemia)
    • Electrocution (usually during the ST cycle)
    • Drugs (anti-arryrythmics, digitalis)
    • Vagal stimulation
  68. If you a pt who has vent. fibrillation and there is NO pulse, what should be done for the pt?
    CARDIOVERSION
  69. What is the difference between Monophasic and Biphasic defibrillators?
    • Biphasic is NEWER
    • Biphasic currents go BOTH ways
    • Biphasic currents use less energy (200 instead of 300)
  70. Give 4 main points in administering cardioversion?
    • Make sure there is no pulse
    • Attach pads correctly
    • Use gel
    • Call an "all clear"
  71. Is asystole shockable with cardioversion?
    NO
  72. What do you do if the pt goes into asystole after the first shock of cardioversion?
    • Perform CPR
    • Administer epinephrine or atropine
    • Try to get shockable rhythm
  73. What is the first thing you do if you find a pt with PVCs and underlying sinus rhythm?
    Check for a pulse
  74. Is a sinus rhythm with PVCs a shockable rhythm?
    NO
  75. Is pulseless electrical activity a possible cause of PVCs?
    Yes
  76. How do you treat PEA?
    Treat the underlying cause
  77. What are the 11 underlying causes of PEA? (Hs and Ts)
    • Hypovolemia
    • Hypoxia
    • Hydrogen ions (Acidosis)
    • Hypo-Hyperkalemia
    • Hypoglycemia
    • Hypothermia

    • Toxins-drugs
    • Tamponade (cardiac)
    • Tension pneumo
    • Thrombosis
    • Trauma
  78. How do you treat cardiac tamponade?
    Blood has pooled around the heart and the heart cannot pump anymore, so treat this by removing fluid from around the heart with a huge needle
  79. How do you treat a tension pneumo?
    Insert a chest tube
  80. How does heart disease lead to AV block?
    Heart disease causes damage to the AV node via the fibers/muscles that carries the impulse
  81. Give 2 common causes of AV block?
    Heart disease (AMI, particullary to the right coronary artery!)

    Medications (beta blockers, digitalis, amiodarone, calcium channel blockers): these patients usually end up with a pacemaker
  82. When dealing with any type of block, what is the first thing that you need to know?
    Whether or not the pt is symptomatic!
  83. Is first degree AV block usually symptomatic or asymptomatic?
    Asymptomatic
  84. What is the treatment for AV block?
    Asymptomatic/first degree and second degree Type I: usually just monitor

    Symptomatic or second degree Type II and third degree: usually associated with lower heart rate and should be treated with atropine, TCP, and possible insertion of PPM or transvenous PM
  85. Give 6 indications for the insertion of a pacemaker?
    • Symptomatic heart blocks
    • Post AV node ablation
    • Sick sinus syndrome
    • Frequent pauses
    • To control CHF
    • To control arrythmias
  86. What are the three temporary pacemakers?
    • Transcutaneous
    • Epicardial
    • Transvenous
  87. What is the permanent pacemaker called?
    Permanent implantable device or PPM
  88. How do you know what the PM is pacing at?
    The pt should have a card with them or you can call the rep for the company and they can tell you
  89. What is an AICD?
    Automated internal cardio defibrillator - it turns the pacemaker off; may only be needed to shock
  90. Demand vs. fixed rate PM?
    Demand: set to kick on when HR drops to set parameters

    Fixed rate: on all the time
  91. What do you anticipate doing for a HB patient?
    • Vital signs
    • O2
    • IV
    • Atropine
  92. What is a common neurological sign of tension pneumo?
    Anxiety
  93. Post-operative instructions for a pt who has recently undergone PM implantation?
    • Avoid lifting arm up (because leads take several weeks to adhere)
    • NO MRI! (magnet turns PM off!)
    • Can continue to take coumadin
    • Monitor HR
  94. What is a common sign of lead dislodgement?
    Frequent episodes of dizziness
  95. What do you do to assess the function of the PM?
    Hook the pt up to a heart monitor

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