Codes and EKG

Causes of cardiac arrest:

Coronary artery disease (CAD) - History of a heart attack Cardiomyopathy Abnormal Cardiac arrhythmias Heart birth defects Respiratory arrest Medications Recreational drug usage

how many seconds is one tiny box on the ECG?

0.04

what do the following portions on the ECG represent? 1. P wave 2. PR segment 3. QRS complex 4. T wave

1. P wave: atrial contraction 2. PR segment: AV node slowing 3. QRS complex: ventricular contraction 4. T wave: ventricular repolarization (recovery)

The nursing instructor teaches a group of students about cardiopulmonary resuscitation. The instructor asks a student to identify the most appropriate location at which to assess the pulse of an infant younger than 1 year of age. Which response would indicate that the student understands the appropriate assessment procedure? 1.Radial artery 2.Carotid artery 3.Brachial artery 4.Popliteal artery

3.Brachial artery The infant's relatively short, fat neck makes palpation of the carotid artery difficult.

how many blocks equals 1 second on the ECG?

5 large blocks

what produces PR interval on EKG?

AV node

ventricular standstill/asystole

Absence of electrical activity in ventricles requires immediate medical treatment however is a poor prognosis

Bigeminy vs Trigeminy

Bigeminy is a premature contraction in every other complex Trigeminy is a premature contraction in every third complex.

what is the treatment for ventricular standstill/asystole?

CPR, ACLS, dugs (epi, atropine), intubation, transcutaneous pacer Do not shock! No pulse

how is ventricular tachycardia characterized by?

Characterized by 3 or more PVCs in a row and ventricular rate exceeding 100bpm

Advanced Directives:

Group of instructions (Written or Oral) stating a person's wishes regarding his/her healthcare if incapacitated or unable to make a decision. Either a living will or durable power of attorney.

Heart attack vs cardiac arrest

Heart attack - decreased or lack of oxygen to heart muscle Cardiac arrest - cessation of heart function

Depolarization vs Repolarization

Depolarization - impulse formation, contract of the heart, spreads electrical impulse prior to contraction Repolarization- relaxation and recovery, cardiac tissue prepares for another electrical impulse to be conducted

what is the treatment for ventricular fibrillation (V-fib)?

Immediate defibrillation w AED, CPR, ABCs, O2 admin, intubation, ACLS protocol, epinephrine, amiodarone, lidocaine

What is cardiac arrest?

It is cessation of heart function, the brain is damaged by lack of oxygen within 4-6 minutes

Atrial Flutter

Shark tooth/ Sawtooth pattern

where do you place the leads on the body for ECG?

Snow over Grass - Right chest (white over right arm/chest, green over flank area) Smoke over Fire - Left chest (black over left arm/chest, red over left flank) Chocolate over the heart - heart

Automated External Defibrillator (AED)

a device that delivers electrical shock through the chest to the heart. The shock can potentially stop an irregular heartbeat and allow a normal rhythm to resume following a cardiac arrest. The shock momentarily stuns the heart, stops its activity, and gives the heart a chance to resume effective beating.

living will

a document providing specific instructions about the kinds of healthcare the person would wish or not wish to have. i.e. meds, ventilator support

Ventricular tachycardia

a very rapid heartbeat that begins within the ventricles may have a pulse may not have a pulse Usually precedes v-fib and sudden cardiac death

Ventricular fibrillation (V-fib)

abnormal heart rhythm which results in quivering of ventricles. have no pulse

what is ventricular fibrillation (V-fib) caused by?

acute MI, chronic HF, cardiomyopathy, electrolyte abnormality, hypoxia, drug toxicity, electric shock

how would we treat supraventricular tachycardia?

adenosine

what causes ventricular standstill/asystole?

advanced cardiac disease

Bundle of His and Bundle Branches

beginning of ventricular system, depolarization occurs rapidly

The nurse is teaching adult cardiopulmonary resuscitation (CPR) guidelines to a group of laypeople. The nurse observes the group correctly demonstrate 2-rescuer CPR when which ratio of compressions to ventilations is performed on the mannequin? a.10:1 b.15:2 c.20:1 d.30:2

d.30:2

how do we treat atrial flutter?

digoxin and other drugs

what often causes atrial flutter?

disease heart, CAD

what are the three kinds of drugs used for treating ventricular tachycardia or ventricular fibrillation?

epinephrine lidocaine amiodarone

Normal Sinus Rhythm

heart rhythm originating in the sinoatrial node with a rate in patients at rest of 60 to 100 beats per minute regular rhythm with normal intervals

how would you treat ventricular tachycardia?

if they have a pulse, we just give them medications. if they have no pulse, we would start CPR and use the defibrillator.

Purkinje Fibers

receives impulses from bundles branch back up pacemaker if SA and AV nodes do not pace Depolarize the ventricles Produce QRS complex on the EKG

what is a major complication of atrial fibrillation?

there is a large potential for blood clots and thrombus formation due to stagnant blood flow

when do we use the defibrillator?

ventricular fibrillation or ventricular tachycardia without a pulse

how often must you update your competency with AED?

yearly

The nurse witnesses the collapse of a victim in her neighborhood and suspects cardiac arrest. Which action should the nurse take first? 1. Initiate rescue breathing 2. Begin giving chest compressions 3. Activate the emergency response system 4. Obtain an automated external defribillator

3. Activate the emergency response system

DNR

An order by the Healthcare provider to NOT attempt resuscitation of the patient in the event of cardiac or respiratory failure. The American Heart Association is considering changing the acronym to AND (Allow Natural Death). Carefully explain with patient and family what Cardiopulmonary Resuscitation (CPR) involves.

how would you treat sinus bradycardia or tachycardia?

medications to either treat symptoms of low blood pressure with bradycardia or medications to reduce heart rate with sinus tachycardia

Sinus Tachycardia

more than 100 bpm regular rate and rhythm

what should you do if your patients QT interval suddenly increases greater than 0.52?

notify HCP because there is a high risk of dangerous ventricular dysrhythmias

if your patient dies after a cardiac arrest, what nursing interventions should be completed?

notify attending physician communicate and support family debrief with team know institutional policy

Supraventricular tachycardia

rhythms that are greater than 150 bpm

Describe the complications of a sudden cardiac arrest

rib fractures, lung injuries (pneumothorax), abdominal injuries, brain injury (lack of oxygen), aspiration, airway complications

Atrial Fibrillation (A-Fib)

very common atrial arrhythmia IRREGULARLY IRREGULAR (p waves barely present, rhythm is irregular)

Sinus Arrhythmia

very common in children and young adults irregular QRS intervals

The nurse is performing cardiopulmonary resuscitation (CPR) on an adult client. When performing chest compressions, the nurse should depress the sternum by how many inch(es)? a. 3/4 inch b. 1 inch c. 2 inches d. 3 inches

c. 2 inches

if you walk into the room and your patient has NO pulse, what do you do?

check patient check responsiveness of patient call help and code check carotid pulse --> no pulse begin CPR/defibrillate

if you walk into the room and your patient has a pulse, what do you do?

check patient check responsiveness of patient (patient responds) place HOB in high fowlers check vitals and O2 sats

if your patient lives after a cardiac arrest, what nursing interventions should be completed?

communicate with patient and family, make patient comfortable, HOB 30 or higher

AV node

conduction system relay station backup pacemaker if SA node does not pace allows conduction from the atria to the ventricles

The nurse is teaching cardiopulmonary resuscitation (CPR) to a group of community members. The nurse tells the group that when chest compressions are performed on infants, the sternum should be depressed how far? 1.At least 2 inches (5 cm) 2.About 1½ inches (4 cm) 3.At least one half the depth of the chest 4.Deep enough to make a finger impression

2.About 1½ inches (4 cm)

5 small blocks form a large block on the ECG, which is equivalent to _______ seconds

0.20

what is ventricular tachycardia caused by?

MI, HF, heart valve disease, irritable focus

Describe the conduction system of the heart

SA node --> intermodal pathways --> AV node --> left and right bundle branches --> purkinje fibers

Sinus Arrest

SA node fails to initiate an impulse so there is an absence of PQRST

2.Initiate cardiopulmonary resuscitation (CPR).

The nurse is assigned the care of a client who experienced a myocardial infarction and is being monitored by cardiac telemetry. The nurse notes the sudden onset of this cardiac rhythm on the monitor. The nurse should immediately take which action? Refer to figure. 1.Take the client's blood pressure. 2.Initiate cardiopulmonary resuscitation (CPR). 3.Place a nitroglycerin tablet under the client's tongue. 4.Continue to monitor the client for 1 minute and then contact the primary health care provider (PHCP).

Normal sinus rhythm with multifocal PVCs - what does it look like and why is it a problem?

it can lead to ventricular tachycardia by having 3 PVCs in a row

what does ectopy mean?

its an impulse formation located somewhere other than the SA node. They are extra (premature) contractions that are identified by the location they come from

Sinus Bradycardia

less than 60 bpm, regular rate and intervals

SA node

pacemaker of the heart, atrial contraction, produces P waves

What does cardiac arrest look like?

pale , cool, gray skin Absence of carotid pulse Apnea Pupil dilation

what are the 3 types of premature contractions?

premature atrial contraction premature junctional contraction premature ventricular contraction

The nurse is performing cardiopulmonary resuscitation (CPR) on an infant. When performing chest compressions the nurse compressses at least how many times? 1. 60 times per minute 2. 80 times per minute 3. 100 times per minute 4. 160 times per minute

3. 100 times per minute 3. Rationale-In an infant, the rate of chest compressions is at least 100 times per minute.

Steps in CPR for an Adult

1. Check the scene. 2. Check the person. Scan for bleeding 3. If unconscious call 911. 4. Check for breathing for no longer then 10 seconds. 5. If not breathing begin compressions (approximately 100 compressions per minute). 6. Continue cycles of 30 compressions and 2 breaths until the person shows signs of life or more advanced help arrives. Child/Infant- 2 breaths before compressions

what are the normal intervals? 1. PR interval 2. QRS interval 3. QT interval

1. PR interval: 0.12-0.20 seconds 2. QRS interval:0.06-0.10 seconds 3. QT interval: 0.30-0.52 seconds

what are the intrinsic rates of the following portions of the conduction system? 1. SA node 2. AV node 3. Purkinje Fibers

1. SA node: 60-100 bpm 2. AV node: 40-60 bpm 3. Purkinje Fibers: 20-40 bpm

Describe how blood flows through the heart

1. right atrium 2. tricuspid valve 3. right ventricle 4. pulmonic valve 5. left atrium 6. bicuspid/mitral valve 7. left ventricle 8. aortic valve

The nurse is initiating 1-rescuer cardiopulmonary resuscitation on an adult client. The nurse should place the hands in which position to begin chest compressions? 1.On the lower half of the sternum 2.On the upper half of the sternum 3.On the lower third of the sternum 4.On the upper third of the sternum

1.On the lower half of the sternum

The nurse witnesses a neighbor's husband sustain a fall from the roof of his house. The nurse rushes to the victim and determines the need to open the airway. The nurse opens the airway in this victim by using which method? 1. Flexed position 2. Head tilt-chin lift 3. Jaw thrust maneuver 4. Modified head tilt-chin lift

3. Jaw thrust maneuver

which of the following would we administer anticoagulants for? 1. Atrial flutter 2. Atrial fibrillation 3. V tach 4. V fib

2. Atrial fibrillation because a fib causes high risk for clots

The nurse is performing cardiopulmonary resuscitation (CPR) on a client who has had a cardiac arrest. An automatic external defibrillator (AED) is available to treat the client. Which activity will allow the nurse to assess the client's cardiac rhythm? 1.Hold the defibrillator paddles firmly against the chest. 2.Apply adhesive patch electrodes to the chest and move away from the client. 3.Connect standard electrocardiographic electrodes to a transtelephonic monitoring device. 4.Apply standard electrocardiographic monitoring leads to the client, and observe the rhythm.

2.Apply adhesive patch electrodes to the chest and move away from the client.

The nurse has completed 5 cycles of compressions after beginning cardiopulmonary resuscitation (CPR) on a hospitalized adult client who experienced unmonitored cardiac arrest. What should the nurse plan to do next? 1.Prepare epinephrine. 2.Charge the defibrillator. 3.Check the client's heart rhythm. 4.Pause CPR for 20 seconds and reassess.

2.Charge the defibrillator.

The nurse notes that a 14-year-old child is choking but is awake and alert at this time. The nurse rushes to perform the abdominal thrust maneuver. The child becomes unconscious. What procedure should the nurse perform next? 1.Perform a finger sweep. 2.Start chest compressions. 3.Attempt rescue breathing. 4.Ask the parent what happened.

2.Start chest compressions.

An adult client has been unsuccessfully defibrillated for ventricular fibrillation, and cardiopulmonary resuscitation (CPR) is resumed. The nurse confirms that CPR is being administered effectively by noting which action? 1.The ratio of compressions to ventilations is 30:2. 2.The carotid pulse is palpable with each compression. 3.Respirations are given at a rate of 10 breaths per minute. 4.The chest compressions are given at a depth of 1.5 to 2 inches (2.5 to 5 cm).

2.The carotid pulse is palpable with each compression. he rate of compressions and respirations and the depth of the compressions are procedural and do not reflect an outcome. The strategic word guides you to look for an end result of the procedure, which is a palpable carotid pulse.

The nurse on the day shift walks into a client's room and finds the client unresponsive. The client is not breathing and does not have a pulse, and the nurse immediately calls out for help. Which is the next nursing action?1. Open the airway 2. Give the client oxygen 3. Start chest compressions 4. Ventilate with a mouth-to-mask device

3. Start chest compressions CAB - compressions, airway, breathing

The nurse is teaching chest compressions for cardiopulmonary resuscitation (CPR) to a group of lay clients. Which behavior by one of the participants indicates a need for further teaching? 1.Keeping the shoulders directly over the hands 2.Straightening the arms and locking the elbows 3.Letting the right and left fingers rest on the chest 4.Performing compressions on the lower half of the sternum

3.Letting the right and left fingers rest on the chest

Cardiopulmonary resuscitation (CPR) is immediately initiated on a client who is unconscious and has no pulse. A monitor is attached, it is determined that the rhythm is shockable, and defibrillation with 1 shock is delivered. Which action should the nurse plan to take next? 1.Defibrillate 1 more time, and then terminate the resuscitation effort. 2.Administer a bolus of fluid intravenously, and resume defibrillation attempts. 3.Perform CPR for 5 cycles, and then defibrillate again if the rhythm is shockable. 4.Perform CPR for 1 minute, assess, and then defibrillate up to 3 more times.

3.Perform CPR for 5 cycles, and then defibrillate again if the rhythm is shockable

The nurse is caring for a client who is pulseless and experiencing dysrhythmia. Which interventions should the nurse anticipate implementing in collaboration with the primary health care provider (PHCP)? Select all that apply. (patient is in ventricular fibrillation) 1.Prepare for cardioversion. 2.Prepare to administer digoxin. 3.Prepare to administer amiodarone. 4.Prepare to administer epinephrine. 5.Provide cardiopulmonary resuscitation (CPR).

3.Prepare to administer amiodarone. 4.Prepare to administer epinephrine. 5.Provide cardiopulmonary resuscitation (CPR). Pulseless ventricular tachycardia is treated the same way as ventricular fibrillation with measures that include defibrillation, CPR, and medication therapy, with agents such as epinephrine and amiodarone and others.

The nurse understands that which is a correct guideline for adult cardiopulmonary resuscitation (CPR) for a health care provider (HCP)? 1. One breath should be given for every five compressions 2. Two breaths should be given for every 15 compressions 3. Initially, two quick breaths should be given as rapidly as possible 4. Each rescue breath should be given over 1 second and should produce a visible chest rise

4. Each rescue breath should be given over 1 second and should produce a visible chest rise 4. Rationale-In adult CPR, each rescue breath should be given over 1 second and should produce a visible chest rise. Excessive ventilation (too many breaths per minute or breaths that are too large or forceful) may be harmful and should not be performed. HCP's should employ a 30:2 compression-to-ventilation ratio for the adult victim.

The nurse is documenting information in a client's chart when the electrocardiogram telemetry alarm sounds, and the nurse notes that the client is in ventricular tachycardia (VT). The nurse rushes to the client's bedside and should perform which assessment first? 1.Heart rate 2.Blood pressure 3.Respiratory rate 4.Check responsiveness

4.Check responsiveness

An external public access defibrillator (PAD) interprets that the rhythm of a pulseless victim is ventricular fibrillation and advises defibrillation. Which action should the rescuer take next? 1.Administer rescue breathing during the defibrillation. 2.Perform cardiopulmonary resuscitation (CPR) for 1 minute before defibrillating. 3.Charge the machine and immediately push the discharge buttons on the console. 4.Order people away from the client, charge the machine, and depress the discharge buttons.

4.Order people away from the client, charge the machine, and depress the discharge buttons. Eliminate rescue breathing during defibrillation first because it is contraindicated for the safety of any rescuer. Eliminate performing CPR for 1 minute next because there is no benefit to the myocardium by delaying the defibrillation attempt. From the remaining options the correct option has a first step that the other does not, which is the order to "clear." This order is given no matter what type of defibrillation method is used.

Durable power of Attorney

identifies another person to make decisions. Specific instructions should be identified i.e. feeding, tubes, hydration, resuscitation, mechanical ventilation, etc.