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58 Cards in this Set
- Front
- Back
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Sinus Bradycardia
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Treatment includes:
treat the underlying cause, atropine, isuprel, or artificial pacing if patient is hemodynamically compromised. |
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Sinus Tachycardia
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Underlying causes include:
increased circulating catecholamines CHF hypoxia PE increased temperature stress response to pain Treatment includes identification of the underlying cause and correction |
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Atrial Flutter
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Atrial flutter almost always occurs in diseased hearts. It frequently precipitates CHF.
The treatment depends on the level of hemodynamic compromise. Cardioversion, vagal maneuvers and verapamil are used when prompt rate reduction is needed. Otherwise, digoxin and other antiarrhythmic drugs can be used |
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A-Fib
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Atrial fibrillation may occur paroxysmally, but it often becomes chronic. It is usually associated with COPD, CHF or other heart disease.
Treatment includes: CPR, epi O2 Digoxin, diltiazem, or other anti-dysrhythmic medications to control the AV conduction rate and assist with conversion back to normal sinus rhythm. Cardioversion may also be necessary to terminate this rhythm |
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1st degree block
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This is the most common conduction disturbance. It occurs in both healthy and diseased hearts.
First degree AV block can be due to: inferior MI, digitalis toxicity hyperkalemia increased vagal tone acute rheumatic fever myocarditis. Interventions include treating the underlying cause and observing for progression to a more advanced AV block |
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2nd degree block w/ type I
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Second degree AV block type I occurs in the AV node above the Bundle of His.
It is often transient and may be due to acute inferior MI or digitalis toxicity. Treatment is usually not indicated as this rhythm usually produces no symptoms |
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2nd degree block w/type II
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This block usually occurs below the Bundle of His and may progress into a higher degree block.
It can occur after an acute anterior MI due to damage in the bifurcation or the bundle branches. It is more serious than the type I block. Treatment is usually artificial pacing - atropine |
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3rd degree block
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May be caused by:
digitalis toxicity acute infection MI and degeneration of the conductive tissue. Treatment modalities include: external pacing and atropine for acute, symptomatic episodes and permanent pacing for chronic complete heart block |
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V-tac
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Ventricular tachycardia almost always occurs in diseased hearts.
Some common causes are: CAD acute MI digitalis toxicity CHF ventricular aneurysms. Patients are often symptomatic with this dysrhythmia. Ventricular tachycardia can quickly deteriorate into ventricular fibrillation. Electrical countershock is the intervention of choice if the patient is symptomatic and rapidly deteriorating. Some pharmacological interventions include amiodarone and lidocaine when deterioate and loose pulse then defib |
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Torsades de Pointes
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Consider it V-tach if it doesn’t respond to antiarrythmic therapy or treatments
Caused by: drugs which lengthen the QT interval such as quinidine electrolyte imbalances, particularly hypokalemia myocardial ischemia Treatment: Synchronized cardioversion is indicated when the patient is unstable. IV magnesium IV Potassium to correct an electrolyte imbalance Overdrive pacing |
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V-fib
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This dysrhythmia results in the absence of cardiac output.
Almost always occurs with serious heart disease, especially acute MI. The course of treatment for ventricular fibrillation includes: immediate defibrillation and ACLS protocols. if pulseless Identification and treatment of the underlying cause is also needed meds- epi - after go to amiodarone |
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In a normal heart, the pacemaker is the:
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1: AV node
2: sinoatrial node 3: purkinje fibers 4: left bundle branch 2 |
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Ectopy are caused by an irritable portion of the heart muscle
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true
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Parasympathetic stimulation of the heart can
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1: Increase the heart rate
2: Increase contractility of the heart 3: Decrease the heart rate |
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One way of calculating heart rate from a rhythm strip is to count the number of R waves in a 6 second strip and multiply by 10
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true
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The QRS complex indicates
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1: Ventricular depolarization
2: Ventricular repolarization 3: Atrial depolarization 4: an abnormal conduction pathway 1 |
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Normal QRS duration is .15 - .25 seconds
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false
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It is normal to see sinus bradycardia in athletes during sleep
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true
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Sinus Tachycardia may be seen as a response to
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1: Anxiety
2: Pain 3: Fever 4: All of the above 4 |
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The hallmark sign of atrial fibrillation is
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1: A sawtooth pattern
2: An irregularly irregular rhythm 3: A compensatory pause 4: None of the above 2 |
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In a third degree heart block the P waves are "married" to the QRS complexes.
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false
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A first degree heart block is characterized by
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1: A prolonged PR interval
2: A rapid rate 3: A PR interval that gets progressively longer until one P wave is dropped. 4: All of the above 1 |
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A second degree heart block type II is likely to degrade into a higher degree heart block.
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true
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Ventricular tachycardia is characterized by:
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1: 3 or more PVCs in a row
2: A rate of 100-220 bpm 3: Wide and bizarre QRS complexes 4: All of the above 4 |
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An appropriate nursing diagnosis for the patient with cardiac dysrhythmias is alteration in cardiac output
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true
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Providing a restful environment is an appropriate nursing intervention for the patient with cardiac dysrhythmias
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true
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Patient teaching activities include all of the following except
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1: Teaching the patient to report chest pain and/or dyspnea
2: Teaching the patient to "bear down" or hold breath during bowel movement 3: Instructing a patient how to self administer medications 4: Instructing a patient about a healthy diet 2 |
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Providing psychosocial support to the family members is an appropriate nursing intervention
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true
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Lead II is the best lead for viewing ventricular activity
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false
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The QT interval represents the time it takes the ventricles to depolarize and then repolarize
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true
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Skin preparation prior to EKG lead placement includes
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1: Shaving away hair
2: Cleansing with alcohol 3: Rubbing with a 2 x 2 gauze 4: All of the above 4 |
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A patient is experiencing a sinus arrhythmia. It is important that treatment begins immediately
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false
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Causes of Torsade de pointes includes all of the following except
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1: Hypokalemia
2: Myocardial ischemia 3: Suppression of ventricular rhythm 4: Drugs which lengthen the QT interval c |
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The Hallmark of Torsade de pointes is:
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1: Slow, regular rhythm
2: Upward and downward deflection of the QRS complexes around the baseline 3: Lengthening of the PR interval 4: Shortening of the ST segment 3 |
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What is the atrial kick and which rhythm is without it?
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near the end of the rapid filling phase the atria contract and an additional 30% is ejected into the ventricles. it is important for overall tissue perfusion
A-Fib is without an atrial kick |
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Cardiac Output
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normal 4-8 liters/min,
CO= HR X SV |
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SA node
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primary pacemaker
60-100 sinus rhythms originate |
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AV node
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delays relay of impulse to HIS, rate is 40-60 beats/min
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normal K+ and how it affects rhythms
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3.5-5.0
if low causes Vent-arrhythmia or small T wave if high-Peaked T wave, P wave begins to disappear, wide QRS, bradycardia so if high = SVT's, PVC, V-tac, |
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What is normal Magnesium and what happens if too low or high?
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1.8 to 3.0
if low - hypokalemia if high - prolonged PR int., prolonged QRS and prolonged QT so if high= blocks, PVT |
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What is normal Calcium and what happens if too low or high?
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2.2-2.6 mmols or 9-10.5 mg/dl
shortens QT intervaal to high Lengthens QT interval |
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Einthovan's Triangle
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Electricity flows from a negative electrode to a positive electrode.
R.arm negative, l. arm positive – left left always +, right arm always - |
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What does lead I read?
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from R arm to L arm
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What does lead II read?
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R. arm to L. leg
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What does Lead III read?
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L.arm to L. leg
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each small block is?
each 5 small blocks are? |
0.4
0.20 |
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for Vertical (used for ST segment) ea small block is?
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0.1mv
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What is the time period of the hatch marks?
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3 sec
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P wave
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<3mm in hgt and rounded
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PR interval
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0.12-0.2 sec
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QRS
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<0.1 sec
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Q wave
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<25% of R wave
and <0.04 sec |
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rule of 10
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count how many R's in 6 sec strip and multiply by 10
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Rule of 1500
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locate to R waves-count small blocks and divide 1500 by that amount
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Rule of 300
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look for two consecutive R waves on black lines, count the large blocks and divide 300 by that number
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Lead II
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– measures electrical impulses from the right arm to the left leg. Lead II is the most common monitoring lead because it produces the most upright R wave. leads in same direction as elec. Node – AV – so tallest-same direction as current in heart, gives tall R wave
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PEA
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pulseless electrical activity - give CPR - epi, perfect rhythm no pulse or BP, so figure out why
fluid bolus after epi |
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Hypokalemia
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causes ventricular arrythmias and U waves
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