Electrocardiogram Findings and Treatment of Common Cardiac Dysrhythmias, Exams of Nursing

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Final Exam Dysrhythmia Study Guide

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First Degree Atrioventricular Heart Block - Answer: prolonged PR interval- measures the time required for an impulse to travel from the SA to the AV node. PRI longer than 0. Second degree AV block Type I - Answer: progressive prolongation of PRI, gradual shortening of R-to-R intervals P wave not followed by a QRS wave a pause with an R-to-R interval less than the sum of two P to P intervals first conducted atrial impulse after the pause shows a shorter or normal PRI Second Degree AV Block Type 2 - Answer: Rhythm: ventricular irregular; atrial regular Rate: atrial rate > ventricular rate P waves: P waves may not be followed by QRS PRI: WNL or prolonged; PRI before and after a blocked P waves are constant. QRS duration: WNL; greater than 0.11 sec block occurs below the bundle.

what causes second degree AV block type I - Answer: RCA, athletes, aortic valve disease, atrial septal defects, meds, mitral valve prolapse, rheumatic heart disease. what do i do about second-degree AV block type I - Answer: atropine for bradycardia. second degree AV block type II causes - Answer: MI is related to conduction effects, acute myocarditis, aortic valve disease, cardiomyopathy, fibrosis of the conduction system, rheumatic heart disease second degree AV block type II s/s - Answer: depends on the ventricular rate: if normal it is asymptomatic. could progress to third degree, pacemakers, ECG, pulse ox, obtain VS, administer oxygen, est IV access temporary or permanent pacing third degree heart block - Answer: Rhythm: ventricular regular; atrial regular, no relationship is present

Rate: the atrial rate is greater than the ventricular and the ventricular rate is determined by the escape P waves: normal in size and shape; not followed by a QRS complex PRI: no PRI bc they are not related QRS: narrow or wide depending on the location of the pacemaker hypokalemia T waves - Answer: depressed T waves hyperkalemia T waves - Answer: elevated T waves causes of third-degree heart block - Answer: acute MI acute myocarditis congenital heart disease drug effect fibrosis of the conduction system increased parasympathetic tone

transvenous: introduced into a central vein like the subclavian, femoral, brachial, internal or external jugular vein complications of pacemaker: - Answer: bleeding, infection, MI, PE, dysrhythmias, wires can come loose, battery changes, no MRI, cannot do electromagnetic for transcutaneous: hold pressure for 20 minutes and tell the patient not to bend their legs. 12 lead ECG - Answer: Limb leads: I, II, II, AVR, AVL, AVF Chest leads: V₁ , V₂ , V₃ , V₄ , V₅ , V₆ Where are the 12 lead ECG's placed - Answer: Lead I: receives information from R and L arms; dipolar views top of the heart Lead II: receives information from R arm and L foot lead III: receives information from Left leg and arm

avR: on the Right arm avF: on the right foot avL: on the Left arm Normal Sinus Rhythm - Answer: rhythm: R-R and P-P intervals are regular rate: 60-100 bpm P waves: positive (upright) in lead II; one precedes each QRS complex, P waves look alike PR Interval: 0.12-0.20 seconds and constant from beat to beat QRS duration: 0.11 seconds or less unless abnormally conducted Sinus Arrhythmia - Answer: Rhythm: irregular and often phasic with breathing; HR gradually increases during inspiration (shorter R-R interval) and decreases with expiration (longer R-R interval)

QRS duration: 0.11 seconds or less Sinus Bradycardia - Answer: rhythm: R-R and P-P intervals are regular rate: less than 60 bpm. P waves: positive (upright) in lead II; one precedes each QRS complex, P waves look alike PR Interval: 0.12-0.20 seconds and constant from beat to beat QRS duration: 0.11 seconds or less Atrial Flutter - Answer: rhythm: atrial regular; ventricular regular or irregular depending on AV conduction blockade rate: atrial ranges from 240-300 bpm; ventricular rates varies and determined by AV blockade; the ventricular rate will not exceed 180 bpm as a result of the intrinsic conduction of AV junction

P waves: no identifiable P waves; saw toothed "flutter" waves are present. PR Interval: not measurable QRS duration: 0.11 seconds or less but may be widened if flutter waves are buried in the QRS complex or if abnormally conducted Atrial Fibrillation (A-Fib) - Answer: rhythm: ventricular rhythm usually irregularly irregular rate: atrial rate usually 300-600 bpm; ventricular rate variable P waves: no identifiable P waves, fibrillatory waves present; erratic, wavy baseline PR Interval: not measurable QRS duration: 0.11 seconds or less unless abnormally conducted list the signs and symptoms of cardiac output - Answer: 1. acute changes in BP

2. acute changes in mental status

6. rheumatic heart disease
7. stimulants
8. valvular heart disease list the common causes of ventricular tachycardia - Answer: 1. acid/base imbalance
9. acute coronary syndrome
10. cardio myopathy
11. cocaine abuse
12. digitalis toxicity
13. electrolyte imbalance
14. mitral valve prolapse
15. trauma
16. tricyclic antidepressants OD
17. valvular heart displacement how do we treat ventricular tachycardia - Answer: in a pulseless patient: cardiopulmonary resuscitation and defibrillation

a stable patient with a pulse give antidysrhythmics (procainamide, amiodarone, sotalol), establish IV access, oxygen unstable patient - oxygen, IV access, sedation (if patient is awake and time permits) what is PEA - Answer: pulseless electrical activity: patient has no pulse despite the appearance of organized electrical activity on cardiac monitor how to treat PEA? - Answer: nonshockable rhythm CPR, oxygen, start IV, placement of airway, aggressive search for the cause, and intubation how many minutes do you have to reverse PEA, VT, or V Fib before the patient dies? - Answer: 4 minutes what are the 5 h's and 5 t's - Answer: hypovolemia hypoxia hydrogen ion (acidosis) hypo/hyperkalemia

P-wave: inverted, absent, or occur after the QRS-complex PR-interval: short or absent Ventricular Tachycardia - Answer: premature ventricular contraction (PVC) - Answer: Rhythm: irregular rate: WNL P wave: absent or inverted PRI: none QRS: greater than 0.12 s. with t waves in opposite direction asystole - Answer: nonshockable. no rhythms or cardiac output. there at be super tiny atrial beat. ventricular fibrillation - Answer: chaotic rhythm that begins in the ventricle and has no organized ventricular depolarization. the waves quiver and cannot contract so there is no pulse waves are not normal. Torsades de pointes - Answer: PMVT that occurs in the presence of prolonged QT interval (0.45 sec or more).

caused by hypomagnesium treatment: magnesium what are idioventricular rhythms - Answer: three or more ventricular escape beats that occur in a row at 20-40 bpm (because of the Purkinje fibers). agonal rhythm or a dying heart - Answer: ventricular rate less than 20 bpm. how to identify an idioventricular rhythm - Answer: no P wave, wide QRS complex, and inverted t waves Premature Junctional Complex - Answer: Rhythm: irregular with premature beats (the beat that is abnormal will cause irregularities) Rate: The underlying rate P Wave: Present before, during (hidden) or after QRS, if visible it is inverted PR Interval: Absent or short QRS: Normal (0.06-0.10 sec)

protective mechanism for when the SA node doesn't fire like it is supposed to. - Answer: junctional escape beat s/s of junctional escape beat - Answer: weakness, chest pain or pressure, syncope, altered LOC, hypotension, dizzy treatment for junctional escape beats - Answer: usually asymptomatic with no s/s if a slow HR: pulse ox, oxygen, IV access, 12 lead ECG, reassess, maybe a bradycardia accelerated junctional rhythm - Answer: 61-100 bpm regular rhythm with no P ave junctional tachycardia - Answer: ventricular rate of 101 bpm or higher P wave inverted Causes of Junctional Tachycardia - Answer: - Kids -Acute coronary syndrome -CHF

-Theophylline administration -Digitalis toxicity Treatment of Junctional Tachycardia - Answer: pulse ox, supplemental oxygen, IV, 12 lead, vagal maneuvers, IV adenosine, CCB or beta blockers, cadioversion what can junctional tachycardia cause - Answer: HF, hypotension, cardiogenic shock, MI, myocardial ischemia, chest pain, and ventricular dysrhythmia predisposition Why do Ventricular rhythms occur - Answer: failure of the higher pacemaker sites within the heart. rate of automaticity from this portion of the heart is faster. becomes the primary pacemaker within the heart. ventricular rhythms - Answer: 20-40 bpm QRS complex: abnormally shaped and longer than usual T waves in the opposite direct than QRS or even no T wave