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Med-Surg: Telemetry Study Guide
electrical systole Correct Answer-activation excitation depolarization electrical diastole Correct Answer-recovery repolarization mechanical systole Correct Answer-shortening contraction emptying mechanical diastole Correct Answer-lengthening relaxation filling automaticity Correct Answer-ability to initiate and maintain electrical rhythm excitability Correct Answer-ability to respond to electrical stimulus conductivity Correct Answer-ability to transfer that electrical stimulus to the neighboring cell
contractility Correct Answer-the ability of myocardial cells to shorten and contract in response to an electrical stimulus force generated by the contracting myocardium under any given condition cardiac output Correct Answer-stroke volume X heart rate amount of blood pumped by each ventricle in liters per minute stroke volume Correct Answer-the amount of blood ejected with each heart beat affects by preload, afterload, and contractility preload Correct Answer-volume of blood in ventricles at the end of diastole (ventricular filling) afterload Correct Answer-the amount of resistance the ventricle must overcome to eject the blood out of the heart SA node Correct Answer-primary pacemaker of the heart initiates electrical impulses at rate of 60-100 bpm AV node Correct Answer-synchronizes atrial and ventricular activity picks up slack of SA node at rate of 40-60 bpm
named according to site of origin of impulse and mechanism of conduction 12-lead EKG Correct Answer-uses 10 electrodes (one of each limb, 6 on chest) produces 12 difference waveforms gives us full picture of what is going on in heart continuous telemetry monitoing Correct Answer-uses 5 leads typically seen in hospital setting leads in continuous telemetry Correct Answer-LA, RA, LL, RL, anywhere V1-V smoke over fire, clouds over grass, poop in the middle continuous telemetry monitoring indications Correct Answer-any ICU patient post-cardiac intervention post-acute MI specific medications cardiac patients being actively treated EKG Correct Answer-graphic recording of the electrical activity of the heart L-R is time
vertical is voltage small box is 0.04 seconds isoelectric line Correct Answer-the flat line that occurs when no electrical activity is taking place used as baseline to identify changing electrical movement positive deflection Correct Answer-when a wave moves towards the top of the paper negative deflection Correct Answer-when a wave moves towards the bottom of the paper steps to analyze a heart rhythm Correct Answer-calculate HR analyze regularity analyze P wave and measure PR interval analyze QRS and measure QRS interval analyze QT and measure QT interval interpret the rhythm calculate the HR Correct Answer-count number of QRS complexes in sex second strip and multiple by 10 analyze the regularity Correct Answer-same number of boxes in between the QRS
beginning of QRS to the end of T wave 0.35-0.45 seconds normal ST segment Correct Answer-early ventricular repolarization ventricles have fully contracted elevation or depression may indicate injury or ischemia J point to beginning of T wave normal T wave Correct Answer-represents ventricular depolarization or relative refractory period rounded and usually upright U wave Correct Answer-represents old tissue necrosis ST elevation Correct Answer-J point is above isoelectric line will see when you are first have an MI ST depression Correct Answer-J point is below the isoelectric line will see if you have a prolonged MI indicates tissue ischemia and necrosis normal sinus rhythm Correct Answer-60-100 bpm R-R is equal
P waves are upright and similar PR interval is 0.12-0.20 seconds P to QRS ratio is 1: sinus bradycardia Correct Answer-all normal except rate is under 60 bpm causes of sinus bradycardia Correct Answer-SA node firing too slow normal for athletes, during sleep, or lower metabolic needs medication induced vagal stimulation increased ICP inferior wall MI hypothermia hypothyroidism sinus bradycardia management Correct Answer-CHECK PATIENT if asymptomatic, observe and monitor if symptomatic, treat via ACLS bradycardia algorithm common medications - Atropine, Dopamine, Epinephrine pacing may be required adult bradycardia algorithm Correct Answer-1. get 12 lead EKG
atrial flutter causes Correct Answer-PE hyperthyroidism mitral or tricuspid valve disease atrial flutter treatment Correct Answer-cardioversion (if unstable) beta-blockers anticoagulation (blood can clot in atria) atrial fibrillation (A-fib) Correct Answer-rapid, disorganized, and uncoordinated electrical activity in atria no defined P wave ventricle rate is variable muscles of atria quiver ineffective atrial "kick" causing blood to pool in atria causes of A-fib Correct Answer-most common dysrhythmia increased age CAD HTN CHF DM OSA
obesity cardiomyopathy rate-controlled A-fib Correct Answer-stable on meds non-rate controlled a-fib Correct Answer-HR is bounding all over the place aka A-fib RVR decreases cardiac output by 25% high risk for STROKE and EMBOLISM A-fib RVR Correct Answer-A-fib rapid ventricular response reduced ventricular filling causing smaller stroke volume a-fib management Correct Answer-CHECK PATIENT treat underling cause control the rate, slow conduction through AV node (goal) ANTICOAGULATION medically control rate - amiodarone, beta-blockers, calcium-channel blockers, digoxin synchronized cardioversion if unstable synchronized cardioversion Correct Answer-"controlled shocking" giving shock at a specific time in cardiac cycle
12 lead EKG vagal maneuvers (carotid massage, bear down, cough) SVT ACLS algorithm adenosine IV synchronized cardioversion surgical intervention adenosine Correct Answer-stops the heart to see underlying heart rhythm nurse can push, but have to have provider at bedside good working IV, closest to heart have to immediately flush give 6mg then 12mg then another 12mg SVT algorithm Correct Answer- premature complexes Correct Answer-early - before next expected complex pause - failure to generate an impulse for a period of time premature atrial complex Correct Answer-irregular rhythm P wave is upright in front of QRS premature junctional complex Correct Answer-P wave is inverted or absent
premature ventricular complex Correct Answer-wide and bizarre no P wave most common feels like heart "skips a beat" impulse that happened early pairs (couplet) premature complex Correct Answer-two sequential complexes runs (bursts) premature complexes Correct Answer-three or more sequential complexes bigeminal pattern of premature complex Correct Answer-every other complex is premature trigeminal pattern of premature complexes Correct Answer-every third complex is premature causes of PVCS Correct Answer-Normal Stimulants Medications Acid-Base Imbalances Electrolyte imbalances
asystole ventricular tachycardia Correct Answer-defined as 3 or more consecutive PVCs rate is 100-250 bpm rhythm is not regular QRS is wide and bizarre treatment for "stable" vtach (rare) Correct Answer-CHECK PATIENT - ensure they have pulse 12 lead EKG ABCs check electrolytes and review medication fix Hs and Ts synchronized cardioversion will progress quickly to v-fib Hs and Ts Correct Answer-Hypovolemia, Hypoxia, Hydrogen ion acidosis, Hypoglycemia, hypo/hyperkalemia, hypothermia Tension PTX, tamponade, toxins, thrombosis (PE), thrombosis (MI) ventricular fibrillation Correct Answer-MEDICAL EMERGENCY there is never a pulse ventricle is quivering
no discernable waves treatment for pulseless v-tach or v-fib Correct Answer-code blue CPR defibrillation epinephrine IVP establish airway difibrillation Correct Answer-attempts to restore the normal HR by sending an electrical shock to heart need to have an electrical current present in heart to shock initial shock is 200-360 joules defibrillation nursing considerations Correct Answer-don't stop CPR until shock is charged and ready oxygen is flammable ensure all clear asystole Correct Answer-MEDICAL EMERGENCY no pulse, no waveforms absence of cardiac electricity start CPR and epinephrine
Wenckebach 2nd degree type 2 AV block Correct Answer-PR interval is consistent until QRS is dropped P waves not followed by QRS conduction is blocked below the AV node, caused by ischemia 3rd degree AV block Correct Answer-PR interval varies more P waves than QRS complexes no atrial impulse is conducted through AV node into the ventricles two separate impulses are happening at same time pacemakers Correct Answer-electronic devices that delivers electrical stimulation to the heart to regulate HR may be temporary or permanent used primarily for brady and heart block different than AICD temporary pacemakers Correct Answer-transcutaneous transvenous does not go home with patient may require conscious sedation permanent pacemakers Correct Answer-surgical procedure
batteries can last 5+ years newer versions are MRI compatible pacemakers on EKG Correct Answer-if pacer spike happens immediately before p wave - atrial paced if pacer spike happens immediately before QRS - ventricular paced
