cardiac
Atrial Flutter BPM
250-400
Which nursing intervention must a nurse perform when administering prescribed vasopressors to a client with a cardiac dysrhythmia? Keep the client flat for one hour after administration Administer every five minutes during cardiac resuscitation Document heart rate before and after administration Monitor vital signs and cardiac rhythm
Monitor vital signs and cardiac rhythm
What map is needed to keep renal perfusion?
60
normal sinus rhythm
60 - 100 BPM P wave is normal PR interval is normal QRS complex normal
Which arrhythmia is classically irregular
atrial fibulation
Calcium channel blockers
help slow the heart rate by blocking the number of electrical impulses that pass though the AV node in to the lower heart chambers
A client asks the nurse what causes the heart to be an effective pump. The nurse informs the client that this is due to the: inherent rhythmicity of cardiac muscle tissue. inherent rhythmicity of all muscle tissue. sufficient blood pressure. inherent electrons in muscle tissue.
inherent rhythmicity of all muscle tissue.
SA block or arrest treatment
treat symptoms with atropine IV Temporary pacemaker or permanent pace maker if considered for repeated episodes cautious use of digoxin, calcium channel blockers, and beta blockers
QRS
ventricular depolarization
T wave
ventricular repolarization
5 lead electrode placement white, brown, green, black, red
white electrode- right side mid clavicular under clavicle Brown right of sternum 4th intercostal space Green- place between 6th and 7th intercostal space on right mid clavicular line black- place new left mid clavicular line directly below clavicle Red- place between 6th and 7th intercostal space on mid clavicular line
QT interval time?
0.36 to 0.44 (9 to 11 boxes)
Atrial repolarization occurs?
in the QRS complex hidden
Symptoms of A fib
palpations, fatigue, syncope, dyspnea, dizziness, and angine
What does a PR interval that is prolonged greater than 0.20 indicate? and interventions
1st degree AV block most are a symptomatic pay attention, esp if new symptom 1st look to see if they are symptomatic Then look at any drugs that might cause a AV block if new and discontinue and consult physician Possible atropine is PR interval exceeds 0.26 second or symptomatic bradycardia develops
The nurse is caring for a client who is being discharged after insertion of a permanent pacemaker. The client, an avid tennis player, is scheduled to play in a tournament in 1 week. What is the best advice the nurse can give related to this activity? "You will need to cancel this activity; you must restrict arm movement above your head for 2 weeks." "You may resume all normal activity in 1 week; if you are used to playing tennis, you may proceed with this activity." "You should avoid tennis; basketball or football would be a good substitute." "Cancel your tennis tournament and wait until fall, then try hockey; skating is much easier on pacemakers."
"You will need to cancel this activity; you must restrict arm movement above your head for 2 weeks."
MAP is and equation
(SBP + 2DBP)/3 perfusion that is getting to the organs
What does it mean if the PR interval is outside of 0.20 seconds
1st degree heart block
Steps to treating dysrhythmias?
1st think- are there any symptoms? If no symptoms- treat underlying cause If symptoms- treat the symptoms and underlying cause
SA block or arrest causes
-infection -coronory artery disease -acute inferior wall MI -vagal stimulation -valsalva's maneuver
Causes of 1st degree AV block
-inferior wall MI -ischemia -hypothyroidism -hypokalemia -hyperhalemia -Digoxin toxicity -use of quindine, procamide, beta blockers, and calcium channel blockers
PR interval duration
0.12-0.20 seconds measure from the beginning of the P wave to the Q represents the time from the onset of atrial depolarization to the onset of ventricular depolarization
The nurse knows that what PR interval presents a first-degree heart block? 0.24 seconds 0.14 seconds 0.16 seconds 0.18 seconds
0.24
Atrial tachycardia BPM
150-250 bpm
Patient is in the ER with an EKG that shows atrial fabulation. does the patient receive a cardio version?
1st assess to see if the patient is stable or unstable, showing symptoms, or abnormal vitals? Is the patient stable? If stable, the patient has time for an ultra sound for clots and then can be started on anticoagulant therapy. If patient is UNSTABLE-then cardio version is used. If patient has been in A fib longer than 48 hours, wait on cardio version because of risk of clot.
Sinus Bradycardia
<60 bpm P wave is normal PR interval is normal QRS complex normal
Sinus Tachycardia
>100 to 200 BPM P wave is normal PR interval is normal QRS complex normal
The nurse is assigned to care for several clients admitted to a telemetry unit. Which clients should the nurse assess first? A client whose implantable cardioverter defibrillator (ICD) fired twice on the prior shift, requiring amiodarone IV A client who received elective cardioversion 1 hour ago and whose heart rate (HR) is 115 bpm A client diagnosed with new onset of atrial fibrillation, requiring scheduled IV diltiazem A client returned from an electrophysiology procedure 2 hours ago, reporting constipation
A client whose implantable cardioverter defibrillator (ICD) fired twice on the prior shift, requiring amiodarone IV
Treatment for sinus tachycardia
treat underlying cause Beta blockers to decrease cardiac demand -Metoprolol -Atenolol -Bisoprolol
The nurse knows that electrocardiogram (ECG) characteristics of atrial fibrillation include what? Atrial rate of 300 to 400 Normal PR interval Regular rhythm P wave resent before each QRS
Atrial rate of 300 to 400
ABCDE of A Fib?
A: Anticoagulants B: Betablockers C: Calcium channel blockers D: Digoxin E: Electrocardioversion
Luistrope
Affects diastolic relaxation ex:Milrinon
Which dysrhythmia has an atrial rate between 250 and 400, with saw-toothed P waves? Atrial flutter Atrial fibrillation Ventricular fibrillation Ventricular tachycardia
Atrial flutter
A client's electrocardiogram (ECG) tracing reveals a ventricular rate between 250 and 400, with saw-toothed P waves. The nurse correctly identifies this dysrhythmia as Atrial flutter Atrial fibrillation Ventricular fibrillation Ventricular tachycardia
Atrial flutter he nurse correctly identifies the electrocardiogram (ECG) tracing as atrial flutter. Atrial flutter occurs in the atrium and creates impulses at a regular atrial rate between 250 and 400 times per minute. The P waves are saw-toothed in appearance. Atrial fibrillation causes a rapid, disorganized, and uncoordinated twitching of atrial musculature. The atrial rate is 300 to 600, and the ventricular rate is usually 120 to 200 in untreated atrial fibrillation. There are no discernible P waves. Ventricular fibrillation is a rapid, disorganized ventricular rhythm that causes ineffective quivering of the ventricles. The ventricular rate is greater than 300 per minute and extremely irregular, without a specific pattern. The QRS shape and duration is irregular, undulating waves without recognizable QRS complexes. Ventricular tachycardia is defined as three or more PVCs in a row, occurring at a rate exceeding 100 beats per minute.
Treatment of A flutter?
If patient is stable with ventricular rate greater than 150 BPM, prepare for immediate cardioversion If patient is stable, drug therapy my include Digoxin, Diltazem, Betablockers Antiarrhythmic drugs (Amiodaron, Procainamide) Ablation therapy
QT interval represents?
Beginning of Q to end of T, ventricular depolarization → ventricular repolarization
SA node BPM AV node BPM Ventricles BPM
SA node: 60-100 AV node: 40-60 ventricles: 15-40
The nurse is assessing a patient with a probable diagnosis of first-degree AV block. The nurse is aware that this dysrhythmia is evident on an ECG strip by what indication? Variable heart rate, usually fewer than 90 bpm Irregular rhythm Delayed conduction, producing a prolonged PR interval P waves hidden within the QRS complex
Delayed conduction, producing a prolonged PR interval
A nurse is caring for a client who has been admitted to have a cardioverter defibrillator implanted. The nurse knows that implanted cardioverter defibrillators are used in which clients? Clients with recurrent life-threatening bradycardias Clients with sinus tachycardia Clients with ventricular bradycardia Clients with recurrent life-threatening tachydysrhythmias
Clients with recurrent life-threatening tachydysrhythmia
The nurse knows that a pacemaker is the treatment of choice for what cardiac dysrhythmia? Supraventricular tachycardia Atrial flutter Ventricular fibrillation Complete heart block
Complete heart block
A patient converts from normal sinus rhythm at 80 beats/min to atrial fibrillation with a ventricular response at 166 beats/min. Blood pressure is 162/74. Respiratory rate is 20/min with normal chest expansion and clear lungs bilaterally. IV heparin and Cardizem are given. The nurse caring for the patient understands that the primary goal of treatment is what? Decrease SA node conduction Control ventricular rate Improve oxygenation Maintain anticoagulation
Control ventricular rate
The nurse recognizes which as being true of cardioversion? Amount of voltage used should exceed 400 watts/second. Electrical impulse can be discharged during the T wave. Defibrillator should be set to deliver a shock during the QRS complex. Defibrillator should be set in the non-synchronous mode so the nurse can hit the button at the right time.
Defibrillator should be set to deliver a shock during the QRS complex.
After evaluating a client for hypertension, a health care provider orders atenolol, 50 mg P.O. daily. Which therapeutic effect should atenolol have in treating hypertension? Decreased cardiac output and decreased systolic and diastolic blood pressure Decreased blood pressure with reflex tachycardia Increased cardiac output and increased systolic and diastolic blood pressure Decreased peripheral vascular resistance
Decreased cardiac output and decreased systolic and diastolic blood pressure
The nurse is observing the monitor of a patient with a first-degree atrioventricular (AV) block. What is the nurse aware characterizes this block? A variable heart rate, usually fewer than 60 bpm An irregular rhythm Delayed conduction, producing a prolonged PR interval P waves hidden with the QRS complex
Delayed conduction, producing a prolonged PR interval
Treatment for sinus bradycardia
Dependent on clients symptoms and follow ACLS protocol for administration of Atropine -Atropine for severe symptoms -pacemaker therapy
causes of A fib? and significance
Ectopic pacemaker site in the atria causing the atria to quiver and not contract significance: decreased cardiac output and formation of a thrombi (stroke) because the blood is not being pushed out efficiently.
causes of A flutter?
Heart failure tricuspid or mitral valve disease Pulmonary embolism cor pulonale inferior wall MI carditis Digoxin toxicity
Digoxin
Helps slow the heart rate by blocking the number of electrical impulses that pass through the AV node into the lower heart chamber (ventricles)
Treatment of A fib?
If patient is stable with ventricular rate above 150 BPM, prepare for immediate cardio version to If stable, drug therapy Digoxin IV Metoprolol calcium channel blockers Antiarrhythmic drugs Cardioversion: to reset the electrical impulses ANTICOAGULANTS therapy to prevent emboli Dual chamber atrial pacing, implantable pace maker, or surgical maze procedure
Which nursing intervention is required to prepare a client with cardiac dysrhythmia for an elective electrical cardioversion? Instruct the client to restrict food and oral intake Administer digitalis and diuretics 24 hours before cardioversion Facilitate CPR until the client is prepared for cardioversion Monitor blood pressure every 4 hours
Instruct the client to restrict food and oral intake
The nurse is caring for a client with a dysrhythmia. While assessing the data in the history of the chart, the nurse anticipates the cause of the dysrhythmia to be which of the following? Peripheral vascular disease Ischemic heart disease Aortic stenosis Atherosclerotic heart disease
Ischemic heart disease
The staff educator is teaching a class in dysrhythmias. What statement is correct for defibrillation? It is a scheduled procedure 1 to 10 days in advance. The client is sedated before the procedure. It is used to eliminate ventricular dysrhythmias. It uses less electrical energy than cardioversion.
It is used to eliminate ventricular dysrhythmias.
Where is the J point?
Junction between end QRS and begin of ST Segment marks the beginning of the ST segment
A patient is 2 days postoperative after having a permanent pacemaker inserted. The nurse observes that the patient is having continuous hiccups as the patient states, "I thought this was normal." What does the nurse understand is occurring with this patient? Fracture of the lead wire Lead wire dislodgement Faulty generator Sensitivity is too low
Lead wire dislodgement
A client admitted to the telemetry unit has a serum potassium level of 6.6 mEq/L. Which electrocardiographic (ECG) characteristic is commonly associated with this laboratory finding? Occasional U waves Peaked T waves Flattened P waves Prolonged QT interval
Peaked T waves
A healthy adult client is seeing a health care provider for an annual physical examination. While the nurse is taking the client's vital signs, the client states, "Occasionally, my heart skips a beat. Is this normal?" What is the nurse's best response? Premature atrial complex Atrial flutter Sinus tachycardia Ventricular fibrillation
Premature atrial complex
When the nurse observes an electrocardiogram (ECG) tracing on a cardiac monitor with a pattern in lead II and observes a bizarre, abnormal shape to the QRS complex, the nurse has likely observed which of the following ventricular dysrhythmias? Premature ventricular contraction (PVC) Ventricular bigeminy Ventricular tachycardia Ventricular fibrillation
Premature ventricular contraction (PVC)
The nurse analayzes the electrocardiogram (ECG) tracing of a client newly admitted to the cardiac step-down unit with a diagnosis of chest pain. Which finding indicates the need for follow-up? QT interval that is 0. 46 seconds long PR interval that is 0.18 seconds long QRS complex that is 0.10 seconds long ST segment that is isoelectric in appearance
QT interval that is 0. 46 seconds long
Atrial fibulation rhythm rate P waves PR interval QRS complex
Rhythm: irregular rate:varies P waves: fibrillary waves present PR interval: not measurable too many QRS complex: usually normal T wave: can't see
The nurse is placing electrodes for a 12-lead electrocardiogram (ECG). The nurse would be correct in placing an electrode on which area for V1? Right side of sternum, fourth intercostal space Left side of sternum, fourth intercostal space Midway between V2 and V4 Mid-clavicular line, fifth intercostal space
Right side of sternum, fourth intercostal space
anti arrhythmic drugs
Sotalol (Betapace, Sørine) Amiodarone (Cordarone, Pacerone) Propafenone (Rythmol) Flecainide
The licensed practical nurse is co-assigned with a registered nurse in the care of a client admitted to the cardiac unit with chest pain. The licensed practical nurse is assessing the accuracy of the cardiac monitor, which notes a heart rate of 34 beats/minute. The client appears anxious and states not feeling well. The licensed practical nurse confirms the monitor reading. When consulting with the registered nurse, which of the following is anticipated? The registered nurse stating to administer digoxin The registered nurse administering atropine sulfate intravenously The registered nurse stating to hold all medication until the pulse rate returns to 60 beats/minute The registered nurse stating to administer all medications except those which are cardiotonics
The registered nurse administering atropine sulfate intravenously
Which electrocardiogram (ECG) characteristic is usually seen when a client's serum potassium level is low? U wave T wave P wave QT interval
U wave
A patient who had a myocardial infarction is experiencing severe chest pain and alerts the nurse. The nurse begins the assessment but suddenly the patient becomes unresponsive, no pulse, with the monitor showing a rapid, disorganized ventricular rhythm. What does the nurse interpret this rhythm to be? Ventricular tachycardia Atrial fibrillation Third-degree heart block Ventricular fibrillation
Ventricular fibrillation
cardiac tamponade
acute compression of the heart caused by fluid accumulation in the pericardial cavity
Dromotrop
affects the AV node conduction Ex: Atropine
Chronotrop
affects the heart rate Ex: Digoxin or epinepherine
Inotrop
affects the strength of contraction EX: Digoxin
p wave
atrial depolarization
What is indicated if the QRS complex is over .12 or more
bundle branch block. The cells in the bundle branches is making it take longer to depolarize
Significance of A flutter?
decrease CO and thrombi formation (stroke)
Beta blockers
decrease heart rate and dilate arteries by blocking beta receptors blocks the effects of certain hormones on the heart to slow the rate
symptoms of sinus bradycardia?
low cardiac out put causing dizziness, weakness, altered LOC, or low blood pressure
causes of sinus bradycardia
normal response of the heart to relaxation or sleeping when parasympathetic effect dominates the sympathetic and a well conditioned heart -Acute MI -vagal stimulation -orthostatic hypotension -increase intercrainial pressure -tone due to straining -vomiting -intubation -mechanical ventilation -drugs such as beta blockers, calcium channel blockers, and digitalis
Causes for sinus tachycardia
normal response to increase oxygen demand excitement exercise exertion fever infection sepsis dehydration pain hypoxia hypotension heart failure smoking/nicotine, alcohol, and caffeine response to atropine left sided heart failure hyperthyroidism
The nurse analyzes a 6-second electrocardiogram (ECG) tracing. The P waves and QRS complexes are regular. The PR interval is 0.18 seconds long, and the QRS complexes are 0.08 seconds long. The heart rate is calculated at 70 bpm. The nurse correctly identifies this rhythm as normal sinus rhythm. sinus tachycardia. junctional tachycardia. first-degree atrioventricular block.
normal sinus rhythm
The nurse recognizes that Premature ventricular contractions (PVCs) are considered precursors of ventricular tachycardia (VT) when they: occur at a rate of more than six per minute occur during the QRS complex have the same shape are paired with a normal beat
occur at a rate of more than six per minute
Preparation for placement of leads and what to avoid?
prepare the skin: clip hair, wipe site, clear hair if electrodes will not adhere due to perspiration then apply a thin coat of tincture of benzoin and allow to dry use alcohol preps to cleanse skin before lead application if skin is oily make sure the pads have moist conductive gel avoid application to bony areas as the clavicles and ribs avoid any non intact skin avoid placing over a CVA Avoid placing over pacemakers, implantable devices
A Flutter
rapid but more regular contractions in the atria 250 to 400 BPM flutter waves saw tooth or picket fence QRS normal but PR interval is unmeasurable
ST segment?
represent the end of ventricular depolarization and the beginning of ventricular re polarization. Look at the end of the QRS complex to the beginning of the T wave
QT interval and duration
represents time between the onset of ventricular depolarization and the end of ventricular repolarization should be less than half the R-R but varies with gender and age
When the nurse observes that the client's heart rate increases during inspiration and decreases during expiration, the nurse reports that the client is demonstrating normal sinus rhythm. sinus bradycardia. sinus dysrhythmia. sinus tachycardia.
sinus dysrhythmia.
U wave?
small rounded wave seen after the T wave often seen in hypokalemia
A client has a heart rate greater than 155 beats/minute and the ECG shows a regular rhythm with a rate of 162 beats/minute. The client is intermittently alert and reports chest pain. P waves cannot be identified. What condition would the nurse expect the physician to diagnose? supraventricular tachycardia sinus tachycardia heart block atrial flutter
supraventricular tachycardia
QRS duration
time required for depolarization of both ventricles (0.04 TO 0.10)- 1-1 1/2 little blocks
