Dysrhythmias
PAC risk factors/causes
Emotional disturbances Excessive alcohol Tobacco Stimulants- caffeine Common in older pts Can be normal in some individuals
A flutter risk factors/causes
SNS stimulation- anxiety, caffeine, alcohol MI PE
PVC risk factors/causes
SNS stimulation- anxiety, caffeine, alcohol MI PE Hypoxia
In addition to atrial fibrillation, which cardiac dysrhythmia exhibited by a client does the nurse determine may be converted to sinus rhythm by cardioversion?
SVT
Atrial flutter (A flutter)
Saw tooth P waves One or two areas in atrium sending impulse Constant rate of conduction= regular Variable rate of conduction= irregular
Synchronized Cardioversion
Shock on R wave- contraction
V tach treatment
Stable- has pulse, medicate Unstable- pulseless, CPR then shock/defibrillate Synchronized cardio version IV- procainamide, lidocaine, amiodarone Surgical ablation Pacing with ICD
A nurse is caring for a client with a myocardial infarction. What is most important for the nurse to assess that has a direct relationship to the action potential of the heart?
Strength of contractions
The nurse is caring for a client who has had frequent premature ventricular complexes (PVCs) and monitors the client closely for ventricular fibrillation. The nurse recalls that the risk for ventricular fibrillation is greatest during which phase of the cardiac cycle?
T wave The T wave is the period of repolarization of the ventricles; stimulation of the ventricles during this vulnerable period often causes ventricular fibrillation
Paroxysmal Supraventricular Tachycardia (PSVT)
Tachycardia of sudden onset and termination Usually indicated by a HR >150 *If you can't tell P or T have to call it SVT
A nurse is determining whether or not a client's atrial rhythm is regular when reviewing the ECG rhythm strip. Which consistency of spacing will the nurse use to determine regularity?
The P wave represents atrial contraction
PVC clinical manifestations
Usually insignificant in pts without heart disease Pts with preexisting heart disease may indicate drug toxicity, lethal dysrhythmias, cardiac arrest Risk is greatest following acute MI or R on T phenomenon
PAC treatment
Usually require no treatment
What are three life threatening dysrhythmias that require immediate attention?
V-fib- CPR with defibrillator, epinephrine V-tach- if stable with pulse, give meds, cardioversion... if not stable with no pulse CPR and defibrillator Asystole- check 2nd lead for beat and if nothing CPR and epinephrine
Ventricular tachycardia (V-tach)
Ventricles take over Can be lethal Sustained >30 seconds
SVT clinical manifestations
"Racing" heart Anxiety Dizziness Dyspnea Angina pain Diaphoresis Extreme fatigue
Premature Atrial Contraction (PAC)
A finding in a rhythm Shape of P wave is different from others Ectopic beat that can arise anywhere in the atrium
What two dysrhythmias are not as life threatening but can cause severe decreased CO?
A-fib- vital signs, O2, bolus drip SVT- vital signs, O2, adenosine
SVT treatment
Adenosine- BBW- can stop heart Amiodarone Vagal maneuvers- Valsalva, carotid sinus massage O2 BB CCB- diltiazem, verapamil Temporary pacing Synchronized cardio version
Asystole
Always confirm in more than one lead No electrical activity- flat line
A fib complications
At risk for CLOTS! When atrium quivers blood pools at the bottom= emboli risk/PE Will do a TEE first to see if there are any blood clots
A flutter treatment
BB CCB Synchronized cardio version
The nurse is providing teaching to a client with atrial flutter who has received a prescription for an oral anticoagulant. The client asks the nurse to provide a list of foods that are high in phytonadione and that should be avoided. What should the nurse include on the list? Select all that apply.
Broccoli Spinach Phytonadione is Vitamin K
Asystole treatment
CPR Epinephrine
V Fib Complications
Cardiac arrest
PAC prevention methods
Decrease stimulants Alcohol Caffeine Stress Smoking
SVT prevention methods
Decrease stimulants Treat underlying cause
A client with an inferior myocardial infarction has a heart rate of 120 beats per minute. Which goal achievements are priority?
Decrease the workload on the heart and promote maximum coronary artery filling
PVC treatment
Decrease use of stimulants BB if severe heart disease
A fib clinical manifestations
Depends on HR Controlled- HR <100 Uncontrolled- HR >100 Usually won't notice unless HR is fast
Potassium 3.5-5.0
Essential for transmission of electrical impulses in cardiac and skeletal muscle High or low can cause irregular HR and rhythm- PVCs/V tach Hyperkalemia- peaked T wave/wide QRS Hypokalemia- U wave
A client experiences crushing chest pain and is brought to the emergency department. When assessing the electrocardiogram (ECG) tracing, the nurse concludes that the client is experiencing premature ventricular complexes (PVCs). Which abnormalities of the ECG support this conclusion?
Irregular rhythm, absence of a P wave, and wide and distorted QRS
Atrial Fibrillation (A-Fib)
Irregularly irregular rhythm with no P waves Disorganized atrial activity without discrete atrial contractions Multiple ectopic sites/areas firing in atria sending lots of impulses bombarding AV node "Quivering" atria
Monomorphic V tach
QRS complexes are similar shape
SVT risk factors/causes
SNS stimulants Fever Sepsis Hyperthyroidism
The client is in atrial fibrillation. Which information should the nurse consider about atrial fibrillation when planning care for this client?
Loss of atrial kick
V fib risk factors/causes
MI Electrolyte imbalances- high/low K or Mg Digoxin toxicity V tach
V tach risk factors/causes
MI Valvular disease Cardiomyopathy Metabolic disorders Drug toxicity
V-fib treatment
CPR until you can Shock/defibrillate immediately because they have no pulse ICD- better long term survival rates than those who only receive meds
A nurse identifies premature ventricular complexes (PVCs) on a client's cardiac monitor. What does the nurse conclude that these complexes are a sign of?
Cardiac irritability
Calcium 8.2-10.6
Control of skeletal and cardiac muscle contractility Hypocalcemia- decreased CO, hypotension, dysrhythmias, seizures Hypercalcemia- HTN, dysrhythmias, N/V
A nurse is caring for a client with a diagnosis of right ventricular heart failure. The nurse expects what assessment findings associated with right-sided heart failure?
Dependent edema Swollen hands and fingers RUQ pain
R on T phenomenon
If a PVC lands on the downslope of the T wave during repolarization/resting, it can cause v-fib
Ventricular fibrillation (V-fib)
Lethal Firing of multiple ectopic beats in ventricles "Quivering" ventricles- heart doesn't pump
PVC complications
Lethal dysrhythmias Decreased CO
To which assessment findings should the nurse give the highest priority when caring for a client with symptomatic sinus tachycardia?
Lightheadedness Orthopnea Decreased blood pressure
PAC complications
May be associated with MI, HF hypoxemia, PE
SVT complications
May be associated with heart disease, MI, myocarditis
A fib treatment
Meds to slow ventricles/HR BB- metoprolol CCB- diltiazem Synchronized cardio version Anticoagulants- to reduce risk of clot formation
If comes from atria the QRS is
Narrow
A nurse is teaching a group of clients about risk factors for heart disease. Which factors will the nurse include that increase a client's risk for a myocardial infarction (MI)?
Obesity and HTN
The home health nurse is visiting a client with multiple health problems that include a history of chronic atrial fibrillation. The nurse obtains a radial rate of 136 beats per minute. What should the nurse do first?
Obtain the other vital signs The radial pulse of a client with chronic atrial fibrillation may range from 50 to 180 beats per minute. Other vital signs should be assessed before notifying the primary healthcare provider
A flutter clinical manifestations
Palpitations Decreased CO Pts may be unaware
Premature ventricular contraction (PVC)
Premature QRS beat Ectopic ventricular beats Couplet- 2 PVCs in a row Bigeminy- PVC every other beat Trigeminy- PVC every other third beat V tach- 3 or more PVCs
Atrial dysrhythmias
Premature atrial contractions- PACs Supraventricular tachycardia- SVT Atrial fibrillation- A fib Atrial flutter- A flutter A-systole
Ventricular dysrhythmias
Premature ventricular contractions- PVCs Ventricular tachycardia- V tach Ventricular fibrillation- V fib
Polymorphic V-Tach or Torsades de Pointes
QRS complexes are different shapes Often associated with electrolyte imbalances or toxicities Check Mg- probably deficient Common in alcoholics
Magnesium 1.6-2.6
Required for transmission of nerve impulses an muscle relaxation Hypomagnesemia- tachycardia, tremors, muscle weakness, HTN Hypermagnesemia- PVCs/V tach, bradycardia, muscle weakness, hypotension
A nurse is caring for a client who was diagnosed with a myocardial infarction. While caring for the client 2 days after the event, the nurse identifies that the client's temperature is elevated. The nurse concludes that this increase in temperature is most likely the result of what?
Tissue necrosis The body's inflammatory response to myocardial necrosis causes an elevation of temperature
PAC clinical manifestations
Usually benign May indicate PSVT in high risk pts
If comes from ventricles the QRS is
Wide because it puts out more energy and can cover up other beats
